Casein phosphopeptide-amorphous calcium phosphate and shear bond strength of adhesives to primary teeth enamel

The effect of remineralization pretreatments on the enamel bond strength of demineralized and sound enamel: An in vitro study

Background

During tooth preparation, the clinician may face a hard remineralized enamel surrounding the cavity with unknown effects on the enamel bond strength. This study aims to assess the effect of remineralizing pretreatments with casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) or CPP-amorphous calcium fluoride phosphate (CPP-ACFP) on the bond strength of composite resin and sound or demineralized enamel.

Materials and Methods

This study employed an in vitro experimental factorial design. A total of 144 enamel surfaces were prepared and randomly divided into 12 groups (G1-G12). The surfaces of G7-12 were demineralized to create a lesion (L), while G1-6 were assigned to the sound (S) enamel group. The three pretreatment protocols were CPP-ACFP, CPP-ACP, or no pretreatment for a 10-day pH-cycling period. A composite rod was bonded to the surfaces using a self-etch or total-etch bonding system. Shear force was applied, and the bond strengths of the specimens were measured. The data were analyzed using the Kruskal-Wallis test, followed by pairwise comparisons using Dunn's test. The significance level for all tests was set at 0.05.

Results

The sound (S) groups (33.81 ± 8.48) showed a significantly higher bond strength than the lesion (L) groups (25.77 ± 6.69). Among the pretreatments, CPP-ACFP-pretreated groups had the highest bond strength (33.86 ± 8.87). Pairwise comparisons showed significant differences between CPP-ACFP-treated demineralized enamel and control demineralized enamel in both bonding systems (P = 0.019 and P = 0.025 for Clearfil SE and Optibond FL, respectively).

Conclusion

Pretreatment of demineralized enamel with CPP-ACFP before using total-etch and self-etch systems results in a bond strength comparable to that of sound enamel, making it clinically acceptable.

Effectiveness of casein phosphopeptide-amorphous calcium phosphate-containing products in the prevention and treatment of white spot lesions in orthodontic patients: A systematic review

The purpose of the present systematic review was to evaluate the effectiveness of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP)-containing products in the prevention and treatment of active white spot lesions (WSL) in orthodontic patients. Searched the Scopus, PubMed, Web of Science, Cochrane, Virtual Health Language, ClinicalTrials, and Open Gray databases without limitations on the year or language of publication. We included controlled clinical trials with patients with fixed orthodontic appliances under the use of CPP-ACP-containing products compared to control, placebo, or other interventions in the prevention and treatment of WSL around orthodontic braces. Case reports, editorials, in vitro studies, annals of congress, and reviews were excluded. To assess the risk of bias, the revised version of the Cochrane tool for randomized trials (RoB 2.0) and Risk Of Bias In Non-randomized Studies for non-randomized trials were used. The biases were graded low, moderate, and high according to the tools used. Of the 599 articles found, 11 met the inclusion criteria. Of these, nine were randomized, controlled clinical trials and two were non-randomized. Two studies were considered to have moderate bias risk, and the most-used CPP-ACP presented form was a cream for topical applications. Although CPP-ACP-containing products did not differ from other fluoride products, they were able to reduce WSL and neutralize the pH around the orthodontic braces. Products containing CPP-ACP are effective in preventing and treating WSL around the braces. However, further studies with the same measurement method and periods of use, and other forms of presentation of CPP-ACP are needed.

Adhesive systems for restoring primary teeth: a systematic review and meta-analysis of in vitro studies

AIM

To systematically review the literature for in vitro studies that evaluated the immediate or after ageing bond strength of etch-and-rinse and self-etch adhesive systems to enamel and dentin of primary teeth.

DESIGN

The search was conducted in PubMed/MEDLINE, Cochrane, SciELO, Lilacs, and Scopus databases with no publication year or language limits, following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement. From 459 potentially eligible studies, 39 were selected for full-text analysis, and 5 were identified in reference lists, with 36 considered in the meta-analysis. Two reviewers independently selected the studies, extracted the data, and assessed the risk of bias. Pooling bond strength data was calculated using random effects analysis method, comparing two categories of adhesives (etch-and-rinse versus self-etch systems) when applied in different types and conditions of substrate (α  =  0.05).

RESULTS

No statistical significant difference in bond strength between both categories was observed in caries-affected dentin at immediate evaluation and in sound dentin after ageing. Etch-and-rinse adhesives, however, performed better in sound enamel and dentin substrates considering immediate bond strength. None study assessed the long-term adhesive effectiveness to sound or demineralized enamel.

CONCLUSION

Although the articles included in this meta-analysis showed high heterogeneity and high risk of bias, the in vitro literature suggests superior performance of etch-and-rinse adhesives in primary teeth in comparison with self-etch systems.