Effect of Casein Phosphopeptide-Amorphous Calcium Phosphate, Proanthocyanidin, Carbon Dioxide Laser Remineralization on the Bond Integrity of Composite Restoration Bonded to Caries Affected Dentin

Objective: Assessment of different remineralizing pretreatment casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), proanthocyanidin (PA), carbon dioxide laser (CO2), eggshell solution (ES) on the shear bond strength (SBS) of resin composite bonded to remineralized carious-affected dentin (CAD). Materials and methods: Eighty human molars were collected with occlusal caries that extended about halfway into the dentin. Using a water-cooled, low-speed cutting saw, a flat, mid-coronal dentin surface was exposed. CAD was differentiated from healthy dentin. Based on the remineralizing agent used on the CAD surface, the teeth were arbitrarily allocated into five groups (n = 10). Group 1: no remineralizing agent, Group 2: CPP-ACP, Group 3: 6.5% PA solution, Group 4: CO2 laser, and Group 5: ES solution. All samples were bonded to composite and light cured and thermocycled. SBS and failure mode analysis were performed using universal testing and stereomicroscope 40 × . Using SPSS, SBS, and failure mode data were analyzed using analysis of variance and Tukey's honesty significant difference (HSD) test Results: Group 3 (6.5% PA solution; 15.59 ± 1.44 MPa) samples established the maximum bond integrity. Nevertheless, Group 1 (No remineralizing agent; 11.19 ± 1.21 MPa) exhibited the minimum outcome of bond strength. Intergroup comparison analysis showed that Group 1 (No remineralizing agent), Group 2 (CPP-ACP), and Group 4 (CO2 laser) established comparable values of bond strength (p > 0.05). Likewise, Group 3 (6.5% PA solution) and Group 5 (EA solution) also revealed equivalent bond integrity (p > 0.05). Conclusions: PA and ES are considered potential remineralizing agents used for caries-affected dentin surfaces in improving bond integrity to composite resin. However, further studies are advocated to extrapolate the findings of this study.

Remineralisation of enamel and dentine with stabilised stannous fluoride dentifrices in a randomised cross-over in situ trial

OBJECTIVES

To compare the remineralisation efficacy and ion bioavailability of two novel SnF2-containing dentifrices in a blinded, cross-over, randomised in situ clinical study.

METHODS

Six participants wore removal palatal appliances holding human enamel and dentine blocks with subsurface lesions. Appliances were worn for two treatment periods of 14 consecutive days each, with a one-week washout period in-between. Participants were randomly allocated to rinse with a 1:5 diluted coded slurry of one of two dentifrices containing either 5 % casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) +1100 ppm F as SnF2 [MIPOP], or 1100 ppm F as SnF2 [CT], for 1 min, four times a day. Saliva was collected post-treatment and analysed for tin, calcium, inorganic phosphate and fluoride ions using atomic absorption spectrophotometry and ion chromatography. Enamel and dentine lesions were analysed for percent remineralisation (%R) using transverse microradiography and percent surface microhardness recovery (%SMHR).

RESULTS

MIPOP released significantly higher F (3.00 ± 0.27 mM), Ca (15.23 ± 3.23 mM) and Sn (1.18 ± 0.13 mM) into saliva whereas CT released 2.89 ± 0.32 mM F and only 0.84 ± 0.11 mM Ca and 0.28 ± 0.10 mM Sn. MIPOP produced significantly higher %R than CT: 25.6 ± 1.5 % compared to 15.2 ± 0.7 % in enamel, and 33.6 ± 3.1 % compared to 20.6 ± 1.1 % in dentine. Additionally, MIPOP produced significantly higher %SMHR (18.2 ± 7.9 %) compared to CT (4.1 ± 0.6 %).

CONCLUSIONS

Both dentifrices promoted remineralisation, but the MIPOP dentifrice with added CPP-ACP and the ion-stabilising effects of CPP released higher amounts of bioavailable tin and produced significantly higher remineralisation and surface microhardness recovery.

CLINICAL SIGNIFICANCE

Modern dentifrices contain SnF2 for a range of oral health benefits. Challenges associated with stability of these formulations can affect ion bioavailability, reducing efficacy. Two dentifrices with SnF2 promoted remineralisation in situ, however the dentifrice with the added saliva biomimetic CPP-ACP was superior and therefore may produce greater health benefits.

Long term remineralizing effect of casein phosphopeptide amorphous calcium phosphate in white spot lesions: A systematic review and meta-analysis

BACKGROUND

White spot lesions (WSLs) appear as white, opaque areas on the teeth and are caused by a demineralization of the enamel.

OBJECTIVE

The purpose of this systematic review and meta-analysis was to determine whether casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) has beneficial effects on WSLs and provides remineralizing benefits that are superior to those of placebo or no treatment.

METHODS

Following a thorough analysis of the literature across major online sources, 103 papers - 54 of which underwent in-depth evaluation - were found. We used inclusion and exclusion criteria to choose research articles that were appropriate for our review.

RESULTS

10 papers met this review's requirements and were subsequently included. As compared to the controls, CPP-ACP demonstrated increased efficacy in treatment of WSLs in terms of remineralisation and other parameters which included microhardness tests and enamel surface roughness. The forest plots present the results of meta-analyses comparing the effect of CPP-ACP versus control/other agents on white spot lesions (WSLs). In terms of odds ratios (OR), CPP-ACP showed a small increase in the odds of WSLs compared to control/other agents. In-vitro studies showed no significant difference in relative risk (RR) between CPP-ACP and control/other agents. Randomized control trials indicated a small increase in the risk of WSLs with CPP-ACP treatment, but the overall effect was not statistically significant.

CONCLUSION

There was evidence to support the use of CPP-ACP over other agents for WSL prevention or treatment, but further research is needed to confirm these findings.

Comparative evaluation of fluoride-free remineralization agents with and without Er,Cr:YSGG laser on artificial enamel remineralization

This study aimed to evaluate the efficacy of fluoride-free remineralizing agents in initial enamel caries, with and without combined Er,Cr:YSGG laser application. The remineralization effect of various agents and their combinations on artificial initial caries was investigated using 10 experimental groups (n = 7): NC, negative control; PC, positive control; TM, calcium-phosphate compounds (CPP-ACP); TD, theobromine-containing toothpaste; RG, ROCS® remineralizing gel; L, Er,Cr:YSGG laser (2780 nm; 0.25 W; repetition rate, 20 Hz; pulse duration, 140 μs; tip diameter, 600 μm; without air/water cooling); L + fluoride toothpaste; L + TM; L + TD; and L + RG. The demineralized bovine enamel specimens were subjected to an 8-day pH cycle by daily application of the remineralizing agents and laser therapy once prior to the pH cycle and paste application. The enamel samples underwent the Vickers surface microhardness test, and one sample per group was analyzed with scanning electron microscopy. The Kruskal Wallis test was used to compare the microhardness recovery percentage (SMHR%) for each group, and multiple comparisons were made with the Dunn test. Groups L (p = 0.003), RG (p = 0.019), L + TM (p < 0.001), L + fluoride toothpaste (p = 0.001),and L + RG (p = 0.036) exhibited significant increase in SMHR%. The tested remineralizing agents exhibited no statistically significant difference in effect when used alone and in combination with Er,Cr:YSGG laser. Combined application of Er,Cr:YSGG laser and ROCS® remineralization gel effectively promoted enamel remineralization, while use of CPP-ACP and fluoride toothpaste alone was ineffective. Theobromine-containing toothpaste exhibited the least SMHR%. Long-term evaluation of these agents is recommended.

Shear bond strength of metallic brackets bonded to enamel pretreated with CPP-ACP: a systematic review and meta-analysis of in vitro studies

BACKGROUND

Development of white spot lesions (WSLs) is common among orthodontic patients. Several measures have been introduced to prevent and remineralize the lesions. Casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) is used for both prevention and remineralization. The effect of its application before bonding is controversial. This systematic review was conducted to investigate the most up to date available literature regarding the effect of CPP-ACP enamel pre-treatment on shear bond strength (SBS) of metallic orthodontic brackets.

METHODS

A search was conducted in electronic databases (MEDLINE (via PubMed), Scopus, Cochrane Library, Web of Science and Google scholar (grey literature)) up to March 29th, 2023. The inclusion criteria included in vitro studies comparing the SBS of metal orthodontic brackets following pre-treatment of enamel using CPP-ACP versus control. The exclusion criteria included study types other than in vitro studies, studies conducted on non-human enamel, or studies using CPP-ACP in combination with another intervention. The included studies were analysed by two reviewers, independently. The risk of bias assessment was done using a modified risk of bias tool. A Meta-analysis was performed. I2 values and Q-test were used for assessment of heterogeneity. Results were displayed in forest plots with a random-effects model. Standardized mean difference, standard error (SE) and 95% confidence intervals were calculated for all studies.

RESULTS

The search resulted in 76 articles. After duplicate removal and assessment for eligibility, 15 studies were included in the review. High statistical heterogeneity was found among the included studies using I2 values and Q-Test (I2 = 95.147%; Q = 288.456; df = 14; P < 0.001). The overall effect of CPP-ACP pre-treatment on the SBS of metal orthodontic brackets was not significant (Mean difference = 1.163 MPa, SE = 0.757, 95% CI = -0.321, 2.648, p value = 0.125). The use of CPP-ACP for prevention of WSLs did not significantly affect the SBS of brackets (Standardized mean difference = 1.009, SE = 0.884, 95% CI = -0.723, 2.740, p value = 0.254). No significant change was found when CPP-ACP was used for remineralization of WSLs (Standardized mean difference = 1.501, SE = 1.087, 95% CI = -0.630, 3.632, p value = 0.167).

CONCLUSIONS

Within the limitations of the study, the evidence suggests that the use of CPP-ACP for either prevention or remineralization of WSLs before bonding does not affect the SBS of metal orthodontic brackets.

Comparison of therapies of white spot lesions: a systematic review and network meta-analysis

OBJECTIVE

White spot lesions (WSLs), the earliest evidence of enamel demineralization, are considered amenable to intervention to achieve a remineralized or arrested state of caries. The management of WSLs is quite challenging, and there is no definitive cure as yet. We performed a network meta-analysis to assess the efficacy of seven therapies for WSLs and gave a hierarchy of them.

MATERIALS AND METHODS

We systematically searched the PubMed, EMBASE, Cochrane, and Web of Science databases (last search: July 2022) to identify all relevant studies. We limited our search to studies published in English. Randomized controlled designed in vitro/clinical trials related to the efficacy of the seven therapies for WSLs were included. Data extraction was performed independently by two reviewers. The risk of bias (ROB) 2.0 tool from Cochrane and a previous in vitro methodological tool will be used for the quality assessment. Variations in quantitative light-induced fluorescence (QLF), laser fluorescence (LF), and lesions area were the primary outcome measures. Standard mean difference (SMD) was used as the effect size for the Network meta-analysis (NMA). Consistency and inconsistency tests were conducted. The hierarchy of 7 treatment effects was evaluated using surface probabilities under cumulative ranking (SUCRA). Publication bias was evaluated using a bias plot.

RESULTS

Forty-two articles were included in the systematic review. Thirty-one of them, with a total of 1906 participants, were included in the network meta-analysis. The studies owned a low and moderate risk of bias. This analysis does not suffer from significant inconsistency. The difference between 4 groups 'self-assembled peptide (SAP) P11-4', 'P11-4 + Fluoride Varnish (FV)', 'Resin Infiltration (RI)', 'casein phosphor peptides-amorphous calcium fluoride phosphate (CPP-ACFP)' and the 'Control' group was found to be statistically significant. Compared to the 'FV' and 'casein phosphor peptides-amorphous calcium phosphate (CPP-ACP)' groups, the 'P11-4 + FV" group and 'RI" group made a significant difference. The hierarchy was evident in the SUCRA values of 7 therapies. P11-4 + FV and RI were considered effective therapies compared to the control group or the FV group (gold standard group).

CONCLUSIONS

The available evidence suggests that resin infiltration and P11-4 in combination with fluoride varnish had advantages over gold standard (FV). The effect of tricalcium phosphate-based drugs and fluoride is not very noticeable. Overall, drugs based on P11-4 and resin infiltration will be better therapies. Using more than two drugs in combination also would increase efficacy.

Estimation of the Efficacy of Remineralizing Agents on the Microhardness of Deciduous Teeth Demineralized Using Pediatric Formulations

AIM

This study aimed to evaluate the demineralizing effect of commonly used pediatric syrup formulations on primary teeth and the efficacy of two readily available remineralizing agents in treating this effect.

MATERIALS AND METHODS

Ninety primary teeth were used for sample preparation and divided into three groups: antibiotic syrup (group A), cough syrup (group B), and control (group C) groups. These groups were further categorized into intragroups according to the treatment with remineralizing agents: groups A1, B1, and C1 received GC Tooth Mousse (casein phosphopeptide-amorphous calcium phosphate, CPP-ACP paste) and groups A2, B2, and C2 received Clinpro Tooth Crème. The samples were subjected to a series of demineralization cycles for 14 days, and remineralization cycles until 30 days were performed using two remineralizing agents, that is, GC Tooth Mousse (CPP-ACP paste) and Clinpro Tooth Crème and were evaluated using Vicker's microhardness test.

RESULTS

Antibiotic syrup (group A) and cough syrup (group B) showed a significant decrease in surface microhardness compared with control (group C). All intragroups showed an increase in surface microhardness after treatment with remineralizing agents, which was significantly higher in intragroups A1, B1, and C1 treated with GC Tooth Mousse (CPP-ACP paste).

CONCLUSIONS

Oral liquid medications showed definite demineralization potential. CPP-ACP paste was found to be better than Clinpro Tooth Crème for demineralized teeth.

CLINICAL SIGNIFICANCE

The use of over-the-counter drugs has increased among the average Indian population, especially for the treatment of fever, cold, and cough. Unwise use of medications by the present population without proper medical guidance will lead to irreparable changes in future generations.

Assessment of the Remineralizing Potential of Biomimetic Materials on Early Artificial Caries Lesions after 28 Days: An In Vitro Study

This study aimed to evaluate the loss of mineral content in the enamel surface in early artificial lesions and to assess the remineralizing potential of different agents by means of SEM coupled with energy-dispersive X-ray analysis (EDX). The analysis was performed on the enamel of 36 molars divided into six equal groups, in which the experimental ones (3-6) were treated using remineralizing agents for a 28-day pH cycling protocol as follows: Group 1, sound enamel; Group 2, artificially demineralized enamel; Group 3, CPP-ACP treatment; Group 4, Zn-hydroxyapatite treatment; Group 5, NaF 5% treatment; and Group 6, F-ACP treatment. Surface morphologies and alterations in Ca/P ratio were evaluated using SEM-EDX and data underwent statistical analysis (p < 0.05). Compared with the sound enamel of Group 1, the SEM images of Group 2 clearly showed loss of integrity, minerals, and interprismatic substances. Groups 3-6 showed a structural reorganization of enamel prisms, interestingly comprising almost the entire enamel surface. Group 2 revealed highly significant differences of Ca/P ratios compared with other groups, while Groups 3-6 showed no differences with Group 1. In conclusion, all tested materials demonstrated a biomimetic ability in remineralizing lesions after 28 days of treatment.

Comparative evaluation of prevention of demineralization of artificial enamel caries treated with two fluoride varnishes and 38% SDF in primary teeth: an in vitro study

BACKGROUND

This study aimed to compare the effect of Clinpro™ White varnish containing 5% sodium fluoride (NaF) and functionalized tricalcium phosphate, MI varnish containing 5% NaF and casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), and 38% Silver diamine fluoride (SDF) in preventing demineralization of treated white spot lesions (WSLs) in enamel of primary teeth.

METHODS

Forty-eight primary molars with artificial WSLs were allocated into four groups as follows: Group 1: Clinpro white varnish, Group 2: MI varnish, Group 3: SDF, and Group 4: control (no treatment). The three surface treatments were applied for 24 h and then enamel specimens were subjected to pH cycling. Thereafter, the mineral content of specimens was evaluated by Energy Dispersive X-ray Spectrometer and the lesion depth was assessed via Polarized Light Microscope. One-way ANOVA followed by Tukey's post hoc test were used at p ≤ 0.05 to identify significant differences.

RESULTS

Insignificant difference in mineral content was observed among treatment groups. Treatment groups exhibited significantly higher mineral content compared to control except for Fluoride (F). MI varnish showed the highest mean calcium (Ca) ion content (66.57 ± 0.63), and Ca/P (2.19 ± 0.11), followed by Clinpro white varnish, and SDF. MI varnish also displayed the highest phosphate (P) ion content (31.46 ± 0.56), followed by SDF (30.93 ± 1.02), and Clinpro white varnish (30.53 ± 2.19). Fluoride content was highest in SDF (0.93 ± 1.18), followed by MI (0.89 ± 0.34) and Clinpro (0.66 ± 0.68) varnishes. Significant difference in lesion depth was observed among all groups (p < 0.001). The lowest mean lesion depth (µm) was found in MI varnish (226.23 ± 44.25) which was significantly lower than Clinpro white varnish (285.43 ± 44.70), SDF (293.32 ± 46.82), and control (576.69 ± 42.66). Insignificant difference in lesion depth was found between SDF and Clinpro varnish.

CONCLUSIONS

In primary teeth, WSLs treated with MI varnish displayed better resistance to demineralization compared to WSLs treated with Clinpro white varnish and SDF.

Remineralization effect of three different agents on initial caries and erosive lesions: a micro-computed tomography and scanning electron microscopy analysis

BACKGROUND

This study aimed to investigate the remineralization efficiency of Sensodyne Promine containing Sodium flouride (NaF), GC Tooth Mousse containing CPP-ACP, and Agarta herbal toothpaste on initial caries and erosion using micro-computed tomography (CT) and scanning electron microscopy (SEM).

METHODS

Forty-five third-molar teeth for micro-CT were divided into three main groups after initial scans (T₁) were completed. Artificial caries lesions were created with the demineralization cycle (group 1, n = 15) and artificial erosion lesions were created with orange juice (group 2, n = 15) and Cola (group 3, n = 15), and second scans (T₂) were performed. The groups were divided into three subgroups within themselves. Sensodyne Promine toothpaste (subgroup 1a, 2a, 3a), GC Tooth Mousse topical cream (subgroup 1b, 2b, 3b), and Agarta herbal toothpaste (subgroup 1c, 2c, 3c) were applied using soft-tipped brushes for 2 min, twice per day for 15 days, and then a third scan (T₃) was performed. Mineral density, surface area, and lesion volume and depth were calculated using micro-CT. Changes in the surface morphology of the teeth were examined using SEM in 13 samples representing each group, subgroup, and healthy enamel. In the analysis of the data obtained from the scans performed at three different times (T₁, T₂, T₃), one-way analysis of variance (ANOVA) with the post-hoc Tukey test, repeated measures ANOVA with the post-hoc Bonferroni test, and paired sample t-test analyses were used.

RESULTS

All three agents caused a statistically significant increase in mineral density, and a decrease in surface area and lesion volume and depth (p < 0.05). There was no statistically significant difference between the groups in remineralization efficiency (p > 0.05). A statistically significant difference was found between the groups regarding the mineral density of the tissue that increased after remineralization (NaF > CPP-ACP > He; p < 0.05).

CONCLUSION

The remineralization efficacy of herbal toothpaste as an alternative to NaF and CPP-ACP was found to be successful.

Remineralization Efficacy of Four Remineralizing Agents on Artificial Enamel Lesions: SEM-EDS Investigation

Dental remineralization represents the process of depositing calcium and phosphate ions into crystal voids in demineralized enamel, producing net mineral gain and preventing early enamel lesions progression. The aim of the present study was to qualitatively and quantitatively compare the remineralizing effectiveness of four commercially available agents on enamel artificial lesions using Scanning Electron Microscopy (SEM) combined with Energy Dispersive Spectroscopy (EDS) techniques. Thirty-six extracted third molars were collected and randomly assigned to six groups (n = 6), five of which were suspended in demineralizing solution for 72 h to create enamel artificial lesions, and one serving as control: G1, treated with a mousse of casein phosphopeptide and amorphous calcium−phosphate (CPP-ACP); G2, treated with a gel containing nano-hydroxyapatite; G3, treated with a 5% SF varnish; G4, treated with a toothpaste containing ACP functionalized with fluoride and carbonate-coated with citrate; G5, not-treated artificial enamel lesions; G6, not demineralized and not treated sound enamel. G1−G4 were subjected to pH cycling over a period of seven days. Analyses of the specimens’ enamel surfaces morphology were performed by SEM and EDS. Data were statistically analyzed for multiple group comparison by one-way ANOVA/Tukey’s test (p < 0.05). The results show that the Ca/P ratio of the G5 (2.00 ± 0.07) was statistically different (p < 0.05) from G1 (1.73 ± 0.05), G2 (1.76 ± 0.01), G3 (1.88 ± 0.06) and G6 (1.74 ± 0.04), while there were no differences (p > 0.05) between G1, G2 and G6 and between G4 (2.01 ± 0.06) and G5. We concluded that G1 and G2 showed better surface remineralization than G3 and G4, after 7 days of treatment.

Effect of CPP-ACP Modified-GIC on Prevention of Demineralization in Comparison to Other Fluoride-Containing Restorative Materials

BACKGROUND

This study evaluated the ability of a CPP-ACP-modified GIC to inhibit demineralization around the margin of cervical cavities in natural teeth in comparison with a Giomer and conventional GIC with and without coating.

METHODS

Thirty-two sound human molars were used. Box-shaped cavities were prepared along the CEJ. Teeth were randomly divided into 4 groups and restored with Equia Forte Fil, Coated Equia Forte Fil, Fuji VII EP, or Beautifil II. Teeth were subjected to pH cycling. Micromorphological and elemental analyses were done using SEM and EDX. Polarized light microscope analysis and microhardness tests were also performed.

RESULTS

Microhardness tests on enamel showed a significant difference between the coated Equia group, Equia, and Beautifil II groups (p<0.05). Dentin results showed significant differences between the coated Equia group and all other groups (p<0.05). Elemental analysis showed significant differences in calcium weight percentage among the first and second observation levels in all groups (p<0.05). A significant difference was found between the coated Equia group and the other three groups (p<0.05).

CONCLUSIONS

All tested materials showed some ability to resist demineralization at the restoration margins. The coated GIC restoration showed better outcomes compared with the other tested materials. © 2022 Australian Dental Association.

Remineralization effects of self-assembling peptide P11 -4 associated with three materials on early enamel carious lesions: An in vitro study

The aim of this study was to assess the remineralization of enamel caries lesions using the self-assembling peptide P11 -4 associated with different materials. Artificial early enamel lesions were prepared on 154 primary teeth. The samples were randomly divided into eight groups: (1) control, (2) P11 -4, (3) fluoridate toothpaste (FT), (4) P11 -4 + FT, (5) casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), (6) P11 -4 + CPP-ACP, (7) fluoridate bioactive glass toothpaste (BT), and (8) P11 -4 + BT. The surface enamel microhardness (EMH) and energy-dispersive X-ray spectroscopy (EDS) of the teeth were then measured at the baseline, after demineralization, and after 28 days of remineralization. The enamel surfaces were assessed by field emission scanning electron microscopy (FESEM) and atomic force microscopy (AFM). The data were analyzed with one-way analysis of variance (ANOVA) (p < .05). EMH after demineralization was significantly lower than the baseline value (p < .001). The interventions led to an enhanced percentage of EMH recovery (%REMH), which was higher in Groups 6 and 7. There was no significant difference between Groups 3 and 4. Groups 1 and 2 had the lowest %REMH. The mean calcium/phosphate weight percentage ratio of P11 -4 was significantly lower than the others (p < .001). The FESEM and AFM images revealed mineral deposition on the eroded enamel and reductions in surface roughness in Groups 5 and 7.

Effects of different remineralization agents on MIH defects: a randomized clinical study

OBJECTIVES

The aim of this study was to present a comparative evaluation of the long-term efficacy of fluoride varnish and pastes containing CPP-ACP and CPP-ACP with fluoride (CPP-ACFP) in the remineralization of creamy-white and yellow-brown defects in permanent first molars with MIH.

MATERIALS AND METHODS

The study included 120 teeth with yellow-brown or creamy-white defects in 67 children (37 girls, 30 boys) aged 6-9 years (mean, 7.2) who were newly diagnosed with MIH with no substance loss or caries or prior restorative treatment. The patients were randomly divided into the experiment groups; control (oral hygiene motivation only), fluoride varnish, and pastes containing CPP-ACP and CPP-ACPF, and followed up for 24 months. The evaluations were made based on the ICDAS criteria and the measurements which were performed using the laser fluorescence method (DIAGNOdent, KaVo, Biberach, Germany) in the follow-ups.

RESULTS

The research was completed with 49 patients (23 females, 26 males; mean age, 7.7) and 90 teeth. All remineralization agents increased remineralization rates in both creamy-white and yellow-brown colored defects without presenting any statistically significant difference at the end of the follow-up period (p > 0.05). However, the effects of fluoride varnishes were late to observe when compared to pastes containing CPP-ACP and CPP-ACPF.

CONCLUSIONS

Pastes containing calcium and phosphate may be recommended for the longer-term preservation of teeth with yellow-brown defects which showed a post-eruptive breakdown in a shorter time.

CLINICAL RELEVANCE

There is a lack of studies investigating MIH treatments in which lesion appearance was recorded. This study evaluated creamy-white and yellow-brown MIH defects separately and reported long-term results of different remineralization agents.

Effects of the association of high fluoride- and calcium-containing caries-preventive agents with regular or high fluoride toothpaste on enamel: an in vitro study

OBJECTIVES

The aim of this in vitro study was to compare the caries-preventive effect of various high fluoride- and calcium-containing caries-preventive agents (> 22.000 ppm F^- [ppm]) in adjunct to use of regular (1450 ppm) or high (5000 ppm) fluoride toothpaste on sound as well as demineralized enamel.

MATERIALS AND METHODS

Bovine enamel specimens (n = 276; 5 mm × 3.5 mm × 3 mm) having one sound surface [ST] and one artificial caries lesion [DT] were randomly allocated to 12 groups. Interventions before pH-cycling were no intervention ([SC₁/SC₅]), application of varnishes/solutions containing NaF (22,600 ppm; Duraphat [NaF₁/NaF₅]); NaF + tricalcium phosphate (22,600 ppm; Clinpro White Varnish [TCP₁/TCP₅]); NaF + CPP-ACP (22,600 ppm; MI Varnish [CPP₁/CPP₅]); silver diammine fluoride (35,400 ppm; Cariestop 30%[SDF₁/SDF₅]); and NaF + calcium fluoride (45,200 ppm; Biophat[CaF₁/CaF₅]). During pH-cycling (28 days, 6 × 120 min demineralization/day) half of the specimens in each group were brushed (10 s; 2 × /day) with either 1,450 (NaF; named, e.g., TCP₁) or 5,000 ppm (NaF; e.g., TCP₅) dentifrice slurry. Differences in integrated mineral loss (∆∆Z) and lesion depth (∆LD) were calculated between values after initial demineralization and after pH-cycling using transversal microradiography.

RESULTS

After pH-cycling, SC₁/SC₅ showed significantly increased ∆Z_DT/LD_DT values, indicating further demineralization (p < 0.05; paired t-test). Decreased ∆Z_DT values, indicating non-significant remineralization, could only be observed in CaF₁/CaF₅ (p > 0.05; paired t-test). Additional use of all varnishes/solutions significantly decreased ∆∆Z_DT/∆∆Z_ST and ∆LD_DT/∆LD_ST compared to SC₁/SC₅ (p < 0.05;ANCOVA). Between 1450 and 5000 ppm dentifrices, a significant difference in ∆∆Z_DT/∆∆Z_ST and ∆LD_DT/∆LD_ST could only be observed for SC₁/SC₅ (p < 0.05; ANCOVA).

CONCLUSION

Under the conditions chosen, all fluoride varnishes/solutions significantly reduced demineralization. Furthermore, a significant dose-response characteristic for fluoride varnishes could be revealed. However, no additional benefit could be observed, when varnishes were combined with high fluoride instead of regular fluoride dentifrices.

CLINICAL RELEVANCE

For children and adolescents with high caries risks varnishes containing more than 22,600 ppm should be further investigated, as they offered higher caries-preventive effects in vitro. Furthermore, there seems to be no difference in the demineralization-inhibitory capacity of fluoride varnishes when used in combination with either standard or highly fluoridated dentifrices.

Development of strontium-doped nano hydroxyapatite dentifrice and compare its remineralising potential with a topical cream containing casein phosphopeptide- amorphous calcium phosphate - An In Vitro study

Aim

To develop and evaluate the efficacy of synthesised strontium-doped nano hydroxyapatite dentifrice and compare its remineralizing potential with a topical cream containing Casein Phospho Peptide - Amorphous Calcium Phosphate, in remineralizing artificial carious lesion on enamel.

Materials and Methods

Enamel specimens of 4 x 4 x 1 mm were prepared from 90 freshly extracted teeth. Specimens were divided into 3 groups of 30 samples each, based on the type of dentifrice applied that is a control group (Group I) and two experimental groups (Groups II, III). Surface topography and the calcium/phosphorous ratio of all sound specimen were evaluated using Scanning electron microscope and Energy Dispersive X-ray Analysis (SEM-EDAX). The samples in group I and each of the experimental groups were subjected to demineralisation and the calcium/phosphorous ratio of the demineralized specimen were analysed. The samples were then subjected to remineralisation using different agents in each group. Samples in the control group (Group I) were brushed with a conventional dentifrice. In the experimental groups, Group II topical cream with Casein Phosphopeptide and Amorphous Calcium phosphate (CPP-ACP) was used and in Group III laboratory synthesized Strontium-doped nanohydroxyapatite paste (Sr-nHAP), respectively for 28 consecutive days. The samples in the both the control and the two experimental groups were again subjected to SEM-EDAX analysis to analyse the calcium phosphorus ratio following remineralisation cycle. Groupwise comparison of the data was done with one way ANOVA followed by Tukeys Post hoc Test.

Results

Both experimental groups (II, III) showed statistically significant remineralisation potential after demineralisation, compared to the control group I. Intergroup comparison showed that the samples in Group III showed the higher remineralisation potential than Group II and was statistically significant.

Conclusion

Both CPP- ACP containing tooth cream as well as Sr doped nHAp showed remineralisation potential. Sr doped nanohydroxyapatite showed better remineralisation than CPP ACP and can be considered for enamel repair in incipient carious lesions.

How different time intervals between repeated applications of CPP-ACP fluoride varnish effect smooth surface enamel demineralization?

OBJECTIVES

To evaluate the preventive effects of different time intervals between repeated applications of the CPP-ACP fluoride varnish on enamel demineralization.

METHODS

Human teeth were sectioned and randomly allocated to three groups: 4-week, 6-week, and 12-week (N = 22/group). Baseline images of the enamel surfaces were obtained using the FluoreCam recording the area, intensity, and impact of baseline enamel demineralization. All groups received fluoride varnish applications at the beginning of the experiment. The varnish was reapplied every 4 or 6 weeks in the 4-week and 6-week groups, respectively. Following each application, the groups underwent thermo-cycling, tooth brushing and pH cycling to simulate the time effect. After 12 weeks, the enamel surfaces were reimaged using the FluoreCam. Within and between-group differences in the area, intensity and impact of demineralization were evaluated.

RESULTS

At baseline, there were no significant between-group differences for area, intensity, or impact. Statistically significant (p<0.001) enamel demineralization occurred over time within each group. There were significant between-group differences in the changes that occurred in area (P = 0.004), impact (P = 0.022), but not intensity. The 12-week had significantly larger areas of demineralization than the 6-week (P = 0.041) and 4-week (P = 0.001) groups. Changes in impact was significantly (P = 0.007) greater in the 12-week group than 4-week group, but not greater than the 6-week group. There were no statistically significant differences between 4- and 6-week groups in the changes of area, intensity, or impact.

CONCLUSION

Reapplication of the CPP-ACP fluoride varnish every 4-6 weeks, is more effective in reducing enamel demineralization compared to every 12 weeks.

Shear bond strength of metallic brackets bonded to enamel pretreated with Er,Cr:YSGG LASER and CPP-ACP

Background

Increased risk of enamel demineralization during and after orthodontic treatment raises the demand for better preventive measures including combinations of laser, CPP-ACP, and fluoride. The combination of Er,Cr:YSGG laser with CPP-ACP was proved to have a synergetic effect compared to each of them alone. Shear bond strength (SBS) of orthodontic brackets bonded to the enamel surface after being treated with preventive measures is critical. The aim of this study was to compare the SBS and failure mode of metallic brackets bonded to teeth with no pretreatment and pretreated enamel surface, either with Er,Cr:YSGG laser alone or combined with CPP-ACP.

Methods

Sixty sound extracted human premolar teeth were allocated randomly to 3 groups: In Group 1 (control), teeth were etched and bonded directly; in Group 2, laser pretreatment of the enamel surface was done followed by etching and bonding as in the control group; in Group 3, the enamel surface was lased then CPP-ACP was applied according to the manufacturer instructions, etched and bonded. SBS and Adhesive remnant index (ARI) were evaluated.

Results

No significant differences were found between the 3 groups neither in the SBS nor in the ARI scores.

Conclusions

The use of combined Er,Cr:YSGG laser with CPP-ACP as a preventive measure before bonding orthodontic brackets does not endanger the bracket’s bonding strength.

Evaluation of Remineralizing Capacity of P11-4, CPP-ACP, Silver Diamine Fluoride, and NovaMin: An In Vitro Study

AIM AND OBJECTIVE

To determine and compare remineralizing efficacy of NovaMin, CPP-ACP, silver diamine fluoride (SDF), and P11-4.

MATERIALS AND METHODS

Sixty permanent premolars were divided into four groups with 15 samples in each group; group I: self-assembling peptide (P11-4), group II: SDF, group III: Casein phosphopeptide-stabilized amorphous calcium phosphate (CPP-ACP), and group IV: NovaMin. Mineral content was assessed using a scanning electron microscope at 7, 14, and 21 days after remineralization with each agent.

RESULTS

The mean remineralization in group I at 7 days was 1.73 ± 0.02, at 14 days was 1.79 ± 0.01, and at 21 days was 1.90±0.03. Mean remineralization in group II was 1.61 ± 0.01, 1.64 ± 0.02, and 1.73 ± 0.03 at 7, 14, and 21 days, respectively. Mean remineralization in group III was 1.62 ± 0.01, 1.65 ± 0.02, and 1.74 ± 0.05 at 7, 14, and 21 days, respectively. Mean remineralization in group IV was 1.59 ± 0.02, 1.62 ± 0.07, and 1.70 ± 0.09 at 7, 14, and 21 days, respectively. The maximum value was obtained on day 21. There was a significant difference in mean remineralization values between group I vs group II, group I vs group III, and group I vs group IV (p < 0.05).

CONCLUSION

Self-assembling peptides showed maximum remineralization in tested specimens followed by CPP-ACP, SDF, and NovaMin-containing toothpaste.

CLINICAL SIGNIFICANCE

CPP-ACP, SDF, and NovaMin-containing toothpaste can be indicated for remineralization of initial caries in clinical use.

Shear bond strength of orthodontic brackets on intact and demineralized enamel after application of resin infiltrant, fluoride varnish and casein phosphopeptide-amorphous calcium phosphate remineralizing agents: in-vitro study

OBJECTIVE

To evaluate the effects of remineralizing agents on the shear bond strength (SBS) of orthodontic brackets bonded to intact and demineralized enamel.

MATERIAL AND METHODS

In this in-vitro study, 160 human premolars were divided into 8 groups, including group 1 with intact enamel as the positive control, group 2 with demineralized enamel as the negative control, groups 3-5 treated with fluoride varnish, Casein Phosphopeptide-Amorphous Calcium Phosphate (CPP-ACP) and resin infiltrant on intact enamel, and groups 6-8 treated with the same agents on demineralized enamel. Brackets were bonded using the conventional method, and the samples were thermocycled. SBS of the brackets was measured using a universal testing machine, and the adhesive remnant index (ARI) was assessed. Data were analysed with one-way ANOVA and post hoc statistical test at the significance level of 0.05.

RESULTS

SBS of the brackets in all groups with intact enamel was higher than that of their counterparts on demineralized enamel, which was only significantly different between groups 1 and 2 (P-value<0.001). SBS values of groups 7 and 8 were not significantly different from group 1 (P-value=1), yet the application of fluoride varnish on both intact (P-value=0.091) and demineralized enamel (P-value<0.001) created less SBS than in group 1.

CONCLUSIONS

All pre-treatment methods increased SBS of the brackets bonded to demineralized enamel, yet only the resin infiltrant and CPP-ACP produced SBS similar to that of intact enamel. Also, the use of fluoride varnish on intact enamel significantly reduced SBS.

Comparative evaluation of compressive and flexural strength, fluoride release and bacterial adhesion of GIC modified with CPP-ACP, bioactive glass, chitosan and MDPB

Background. This study evaluated the incorporation of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), calcium sodium phosphosilicate bioactive glass (BAG), chitosan (CH), and methacryloyloxydodecylpyridinium bromide (MDPB) on the compressive and flexural strength, fluoride (F^‒ ) release, and bacterial adhesion of conventional glass-ionomer cement (C-GIC).

Methods. Modifications were implemented by adding CPP-ACP, BAG, and CH to the glass powder, while MDPB-GIC was prepared by incorporating MDPB to the liquid of C-GIC. Custom-made molds were used for specimen preparation. Compressive and flexural strengths were evaluated using a universal testing machine. F^‒ release was calculated with Erichrome cyanide reagent, using UV-spectrophotometry, at two time intervals of 24 hours and seven days. For bacterial adhesion, the test specimens were exposed to the bacterial suspension of Streptococcus mutans and Lactobacillus acidophilus for 4 hours, and the adherent bacteria were quantified using colorimetry as the optical density (OD).

Results. The incorporation of MDPB increased the flexural strength of C-GIC, with no effect on its compressive strength. CH significantly improved the compressive and flexural strength; modifications with CPP-ACP, BAG, and MDPB significantly improved the flexural strength of C-GIC. While MDPB-GIC released significantly higher F^‒ at 24 hours, CPP-ACP- and BAG-modified GICs were comparable to C-GIC on day 7. C-GIC exhibited the highest bacterial adhesion, and MDPB-GIC showed the least. The data were analyzed with one-way (ANOVA), and pairwise comparisons were made with Tukey HSD tests.

Conclusion. Hence, it can be concluded that the incorporation of CPP-ACP, BAG, and CH improved the mechanical properties of C-GIC, whereas MDPB improved the resistance of C-GIC to bacterial adhesion.

Casein phosphopeptide-amorphous calcium phosphate fluoride treatment enriches the symbiotic dental plaque microbiome in children

OBJECTIVES

The dysbiotic oral microbiome plays a key role in the pathogenesis of caries in children. Topical application of casein phosphopeptide-amorphous calcium phosphate containing fluoride (CPP-ACP/F) is an effective treatment modality for children with caries (CC). Hitherto the mechanism by which CPP-ACP/F modules the oral microbiome in CC has not been investigated. The study aimed to examine the CPP-ACP/F effect on the dental plaque microbiome of children group with caries.

METHODS

This preliminary prospective clinical cohort included 10 children with caries. The children received topical fluoride CPP-ACP/F once-a-week for one month. Plaque samples were collected before and after treatment and subjected to 16S rDNA-based next-generation-sequencing. Microbial composition, diversity and functional roles were analyzed in comparison to the clinical characteristics of cohort using standard bioinformatics tools.

RESULTS

CPP-ACP/F treatment modulated dysbiotic oral microbiome towards healthier community as the higher proportion of Proteobacteria and certain microbial protective species were enriched following CPP-ACP/F treatment. Despite overall uniformity of community structure in children with caries between the groups, some bacterial species were differentially represented in a statistically significant manner between pre- and post- treatments. Three bacterial species were found to be predictive of strongly sensitive to the CPP-ACP/F treatment, marked by decreased abundance of Lautropia mirabalis and increased abundance of Gemella haemolysans and Schwartzia succinivorans.

CONCLUSION

Within the limits of the current study, it could be concluded that the CPP-ACP/F varnish treatment modulated the microbial composition of the dental plaque microbiome towards symbiosis. These symbiotic changes may demonstrate the potential clinical significance of CPP-ACP/F varnish treatment.

Remineralising effects of fluoride varnishes containing calcium phosphate on artificial root caries lesions with adjunctive application of proanthocyanidin

OBJECTIVES

To evaluate the remineralising effects of fluoride (F) varnishes containing bioavailable calcium-phosphate compound (Ca-P) based remineralisation systems and 5000 ppm F toothpaste (FTP) on root caries lesions (RCLs) and the potential effects of proanthocyanidin (PA) for the treatments of RCLs when used as an adjunct to F regimens.

METHODS

Demineralised root dentine and a pH-cycling model were used to mimic RCLs and the oral environment. Remineralising effects of MI Varnish^TM (MIV) containing casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) and Clinpro™ White Varnish (CPWV) containing tri-calcium phosphate (TCP) along with FTP and PA were evaluated regarding the birefringence, elemental composition, mechanical properties and mineral density of remineralised dentine with Duraphat^TM as a comparison.

RESULTS

MIV, CPWV and Duraphat^TM promoted the incorporation of F into RCLs and increased mineral density but did not change microhardness of root dentine significantly. Surface microhardness increased significantly when MIV or CPWV was used with 5000 ppm FTP. Application of PA with F regimens significantly increased subsurface mineral density. When PA was applied with MIV or CPWV along with FTP, the highest ion uptake and relative mineral gain (%ΔZ) was achieved, and significant increase of microhardness was up to 30 μm depth. Generally, MIV was associated with a higher mineral content gain than CPWV.

SIGNIFICANCE

Treatment of carious root surfaces remains challenging due to the complex pathological processes and difficulty in restoring the highly organised structure of root dentine. Treatment strategies targeting both remineralisation and preservation of the dentinal organic matrix have the potential to improve the fluoride-mediated remineralisation approaches.

Effect of fluoride, casein phosphopeptide-amorphous calcium phosphate and sodium trimetaphosphate combination treatment on the remineralization of caries lesions: An in vitro study

OBJECTIVE

To evaluate the effects of combination of treatments with fluoridated toothpastes supplemented with sodium trimetaphosphate (TMP) and casein phosphopeptide-amorphous calcium phosphate (MI Paste Plus®), on the remineralization of dental enamel.

DESIGN

Enamel blocks with artificial caries were randomly allocated into six groups (n = 12), according to the toothpastes: 1) without F-TMP-MI Paste Plus® (Placebo); 2) 1100 ppm F (1100 F), 3) MI Paste Plus®, 4) 1100 F + MI Paste Plus® (1100 F-MI Paste Plus®), 5) 1100 F + 3% TMP (1100 F-TMP) and 6) 1100 F-TMP + MI Paste Plus® (1100 F-TMP-MI Paste Plus®). Blocks were treated 2×/day with slurries of toothpastes (1 min). Furthermore, groups 4 and 6 received the application of MI Paste Plus® for 3 min. After pH cycling, the percentage of surface hardness recovery (%SHR); integrated loss of subsurface hardness (ΔKHN); profile analysis and lesion depth subsurface through polarized light microscopy (PLM), confocal laser scanning microscopy (LSCM), scanning electron microscopy (SEM), fluoride (F), calcium (Ca), phosphorus (P) concentrations in the enamel were determined. The data were analyzed by ANOVA (1-criterion) and Student-Newman-Keuls test (p < 0.001).

RESULTS

1100 F-TMP-MI Paste Plus® group showed the best results of %SHR, ΔKHN and PLM (p < 0.001). F concentration was similar between the 1100 F, 1100 F-MI Paste Plus®, and 1100 F-TMP-MI Paste Plus® groups (p > 0.001). 1100 F-TMP-MI Paste Plus® group showed the highest concentration of Ca and P in the enamel (p < 0.001).

CONCLUSION

The association of 1100 F-TMP and MI Paste Plus® led to a significant increase in the remineralization of initial carious lesions.

Addition of CPP-ACP to yogurt inhibits enamel subsurface demineralization

OBJECTIVES

The aim of this study was to investigate the capacity of an approved food additive with anticariogenic properties, casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), when added to a processed, sugar-containing yogurt with added lactic-acid bacteria (probiotics), to prevent demineralization of enamel subsurface lesions in vitro.

METHODS

Enamel subsurface demineralised lesions were created in thirty extracted human third molars. These were then exposed to artificial saliva (AS) with: 1) Danone yogurt alone; 2) Danone yogurt with 0.2 % w/w CPP-ACP; or 3) Danone yogurt with 0.5 % w/w CPP-ACP at 37 °C for two weeks. The yogurt/AS was replaced with fresh preparations each day. At the completion of each treatment the enamel slabs were embedded, sectioned and analyzed using transverse microradiography to measure changes in enamel lesion depths and subsurface mineral content. Yogurt samples were analysed for soluble calcium (Ca) and inorganic phosphate (Pi) levels and pH.

RESULTS

Yogurt alone demineralized enamel subsurface lesions to produce significantly larger lesions. However, the addition of 0.2 % CPP-ACP to the yogurt resulted in significant reduction in demineralization compared with yogurt alone (p < 0.0001). The addition of 0.5 % CPP-ACP to the yogurt produced a net remineralization effect with a significant increase in lesion mineral content (p < 0.0001). The addition of CPP-ACP resulted in a significant (p < 0.0001) dose-related increase in Ca, Pi and pH.

CONCLUSIONS

The addition of CPP-ACP to a commercial yogurt exhibited a dose related protective effect with 0.5 % CPP-ACP producing remineralization of existing enamel subsurface lesions under the in vitro experimental conditions. CLINICAL SIGNIfiCANCE: The results of this study suggest that some processed yogurts with added sugar could result in enamel demineralization when frequently consumed by individuals with poor oral hygiene. The addition of CPP-ACP to these yogurts may help prevent demineralization and promote enamel subsurface lesion remineralization, and therefore, make them safer for teeth.

Casein phosphopeptide-amorphous calcium phosphate modified glass ionomer cement attenuates demineralization and modulates biofilm composition in dental caries

The study investigated the effects of the modified conventional glass ionomer cement (GIC) incorporated with casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) on biofilm composition of dental caries. Shear bond strength, durability tests, adhesive remnant index (ARI) and scanning electron microscope were used to measure the physical properties. Microhardness and ions release were determined to evaluate anti-demineralization effects; growth of the biofilm and its composition were assessed using MTT assay and Q-PCR assay. All experimental groups exhibited a significant stimulation of ions release, and reduced attenuation of microhardness. Nearly 39% reduction in the bacterial biofilm was observed with 5% CPP-ACP group. The regulation ability is mainly manifested in the inhibition of S. mutans and promotion of S. gordonii. The modified GICs by exhibiting anti-demineralization effects potentially lead to a reduction in the cariogenicity of plaque and can serve as a putative promising remineralization system with both enhanced antimicrobial and remineralization properties.

Effects of casein phosphopeptide-amorphous calcium phosphate crème on nicotine-induced Streptococcus mutans biofilm in vitro

OBJECTIVES

The aim of this study was to test the effects of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) crème, or MI Paste™ (MIP), on nicotine-induced Streptococcus mutans biofilm. The experiment utilized S. mutans biofilm assays with varying concentrations of nicotine and MIP aqueous concentrate levels. First hand exposure to nicotine has been demonstrated to significantly increase S. mutans biofilm formation, while the active component, CPP-ACP, in MIP has been shown to reduce S. mutans biofilm formation.

MATERIALS AND METHODS

A 24-h culture of S. mutans UA159 in microtiter plates were treated with varying nicotine concentrations (0-32 mg/ml) in Tryptic Soy Broth supplemented with 1% sucrose (TSBS) with or without MIP aqueous concentrate. A spectrophotometer was used to determine total growth absorbance and planktonic growth. The microtiter plate wells were washed, fixed, and stained with crystal violet dye and the absorbance measured to determine biofilm formation.

RESULTS

The presence of MIP aqueous concentrate inhibits nicotine-induced S. mutans biofilm formation at different concentrations of nicotine (0-32 mg/ml).

CONCLUSION

The results demonstrated nicotine-induced S. mutans biofilm formation is decreased in the presence of MIP. This provides further evidence about the cariostatic properties of CPP-ACP, the active soluble ingredient in the MIP, and reconfirms the harmful effects of nicotine.

CLINICAL SIGNIFICANCE

Smokers may gain dual benefits from the use of MIP, as a remineralization agent and as a cariostatic agent, by inhibiting nicotine-induced S. mutans biofilm formation.

Remineralization and fluoride uptake of white spot lesions under dental varnishes

INTRODUCTION

The aim of this study was to evaluate white spot lesion (WSL) remineralization and fluoride uptake by the application of fluoride varnishes directly onto artificial WSLs in vitro.

METHODS

MI varnish containing casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) and 2.26% fluoride and Duraphat varnish containing 2.26% fluoride (no added calcium) were compared with a placebo varnish (no added calcium or fluoride). Two WSLs were prepared in enamel slabs and varnish applied to cover one of the two lesions. Each slab was immersed in artificial saliva for 14 days at 37°C. Mineral content was determined using transverse microradiography and fluoride uptake using electron probe microanalysis. The data were statistically analysed using a linear mixed model.

RESULTS

Both MI and Duraphat varnishes significantly remineralized the covered and uncovered WSLs when compared with the placebo varnish (P < 0.001). The WSLs covered with varnish showed greater remineralization than those uncovered. MI varnish produced the highest level of remineralization and significantly greater fluoride uptake (0.44 ± 0.08 wt%) compared with Duraphat (0.24 ± 0.03 wt%) and the placebo varnish (0.06 ± 0.05 wt%).

CONCLUSION

Varnish containing fluoride and CPP-ACP was superior to varnish containing fluoride alone in promoting WSL remineralization and fluoride uptake.

Combined effect of Er,Cr:YSGG laser and casein phosphopeptide amorphous calcium phosphate on the prevention of enamel demineralization

OBJECTIVES

To compare the effect of use of laser, casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), and their combination on prevention of enamel demineralization using polarized light microscopy to assess lesion depth.

MATERIALS AND METHODS

Eighty premolars were randomly allocated to four equal groups (n = 20): Group I: Control group, no preventive measures. Group II: CPP-ACP. Group III: Er,Cr:YSGG laser. Group IV: Er,Cr:YSGG laser followed by CPP-ACP. Specimens were subjected to thermocycling and brushing protocols equivalent to 1 year intraorally. Then, all teeth were subjected to acid challenge. Teeth were then sectioned longitudinally and examined under a polarized light microscope and lesion depth was measured.

RESULTS

Group IV resulted in the least lesion depth with a significant difference between it and all other groups. CPP-ACP alone and laser alone also showed a significant difference in white spot lesion (WSL) depth compared to the control group; however, no significant difference was found between them.

CONCLUSIONS

The combined use of laser and CPP-ACP showed the best prevention against WSL development. The use of CPP-ACP or laser alone also resulted in a significant reduction in lesion depth but was significantly less than their combined use, with no significant difference between them.

Antibacterial efficacy and remineralization capacity of glycyrrhizic acid added casein phosphopeptide-amorphous calcium phosphate

The aim was to evaluate remineralization capacity and antibacterial efficiency of Tooth Mousse and various amounts of glycyrrhizic acid added Tooth Mousse on primary tooth enamel. Three groups were formed; Group 1 (CPP-ACP), Group 2 (CPP-ACP + 5% glycyrrhizic acid), and Group 3 (CPP-ACP + 10% glycyrrhizic acid) in order to evaluate remineralization capacity. Enamel samples were immersed in demineralization solution and then remineralization agents were applied. Surface microhardness and SEM analyses were performed at the beginning, after demineralization and remineralization. For antibacterial tests, four groups were formed; Group 1, Group 2 and Group 3 and Group 4 (control). Biofilms were then exposed to 10% sucrose eight times per day for 7 days. After biofilm growth period, samples were treated with materials to evaluate antibacterial efficiency except control group. After application of materials, samples were incubated 2 more days at 37°C and at the end of this period, absorbance values of biofilms were determined and data were analyzed. An increase in microhardness values was Group 2 > Group 3 > Group 1, respectively, but there were no significant differences. After remineralization, microhardness values showed significant increases when compared to demineralized groups, but there was no significant difference. All groups showed decreased absorbance value of biofilm when compared with control group but they were insignificant. It was observed that both in Group 2 and Group 3, glycyrrhizic acid did not have a negative effect on remineralization and although they have an increase, it was insignificant. Although glycyrrhizic acid added CPP-ACP groups showed increased antibacterial activity, they were not statistically significant.

Remineralising effect of 45S5 bioactive glass on artificial caries in dentine

BACKGROUND

This study investigated the remineralisation effect of bioactive glass on artificial dentine caries.

METHODS

Dentine disks with artificial caries were treated with bioactive glass (group BAG), casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) (group CPP-ACP), sodium fluoride glycerol (group F) or deionized water (group W). All disks were subjected to pH cycling for 28 days subsequently. The topography, microhardness and remineralisation depth of the dentine carious lesion were assessed by atomic force microscopy (AFM), microhardness testing and confocal laser scanning microscope (CLSM), respectively.

RESULTS

AFM images indicated mineral depositions on the surface of the carious lesion in group BAG. The changes of Vickers hardness number (ΔVHN, mean ± SD) after pH cycling were 9.67 ± 3.60, 6.06 ± 3.83, 5.00 ± 2.19 and - 1.90 ± 2.09 (p < 0.001) in group BAG, group CPP-ACP, group F and group W, respectively. The remineralisation depth (mean ± SD) of the carious lesion in group BAG, group CPP-ACP, group F and group W were 165 ± 11 μm, 111 ± 11 μm, 75 ± 6 μm and 0 μm (p < 0.001), respectively.

CONCLUSION

Bioactive glass possessed a promising remineralisation effect on artificial dentine caries and could be a therapeutic choice for caries management.

Efficacy of remineralizing agents to occlude dentinal tubules in primary teeth subjected to dentin hypersensitivity in vitro: SEM study

Aim:

Comparison of casein phosphopeptides (CPPs) and amorphous calcium phosphate (ACP), tricalcium phosphate, and hydroxyapatite on assessment of dentine tubule occlusion on primary enamel using scanning electron microscope (SEM).

Materials and Methods:

A total of 20 freshly extracted noncarious primary molars were randomly divided into four groups (A to D) with five sections in each group; group A: negative control, group B: CPP-ACP, group C: tricalcium phosphate, and group D: Hydroxyapatite (HA). To assess tubule occlusion, 20 dentin sections of 2 mm thickness were obtained from cervical third of sound primary molars. Each section were processed to simulate the hypersensitive dentin and the test agents were brushed over the sections with an electric toothbrush and observed under SEM for calculation of the percentage of occluded tubules.

Results:

Group B and D showed greater percentage of tubule occlusion than group C. Intergroup comparison of tubule occlusion potential of Group B and D was not significant.

Conclusion:

HA showed significantly higher dentinal tubule occlusion when compared to CPP-ACP and tricalcium phosphate.

Effect of CPP-ACP on Streptococcus mutans in saliva of high caries-risk preschool children: a randomized clinical trial

PURPOSE

The aim of this study was to assess the efficacy of CPP-ACP in reducing salivary S. mutans levels and compare its effect as a dentifrice to use of a fluoride dentifrice alone, or with the sequential use of a combination of both agents (fluoride, then CPP-ACP) in three groups of preschool children over a 6-month period.

METHODS

This was a double-blinded clinical trial, the sample (n = 127, age 4.6 ± 0.47 years), with high caries risk, was randomized into three groups which applied different agents twice daily; fluoride toothpaste (500 ppm, n = 50), CPP-ACP (10% w/v, n = 38), and combination group (n = 39) applied fluoride, then CPP-ACP. S. mutans salivary levels were measured by GC Saliva-Check Mutans^™.

RESULTS

Within groups, a significant decrease in S. mutans-positive children (SMPC) occurred in fluoride and combination groups at 3-months, (P < 0.05), and in all groups at 6-months, (P < 0.05). The highest reduction in SMPC occurred in the CPP-ACP group, however, there were no significant differences in SMPC between groups at all study intervals, (P > 0.05).

CONCLUSION

Although all agents were effective, CPP-ACP showed the highest reduction in SMPC over 6-months.

A comparative evaluation of ion release characteristics of three different dental varnishes containing fluoride either with CPP-ACP or bioactive glass

OBJECTIVE

To compare ion release characteristics of three different dental varnishes either containing CPP-ACP and fluoride (CPP-ACPF, MI Varnish GC, Japan), bioactive glass and fluoride (BGAF, Dentsply Sirona USA) or fluoride alone (NUPRO White, Dentsply Sirona USA) using fluoride-Ion Selective Electrode (F-ISE), Inductively Coupled Plasma-Optical Emission Spectroscopy (ICP-OES), X-ray diffraction (XRD), Fourier Transform Infrared Spectroscopy (FTIR), ¹⁹F and ³¹P Magic Angle Spinning-Nuclear Magnetic Resonance (MAS-NMR).

METHODS

A thin layer (0.0674±0.0005g) of each varnish (20×25mm in area) was spread on a roughened glass slide (n=7). They were separately immersed in 10ml Tris buffer (0.06M, pH=7.30), and changed after 1, 2, 4, 6, 24 and 48h. Fluoride-ion concentration at each time using the F-ISE, whilst calcium and phosphate release were investigated using ICP-OES. XRD, FTIR. MAS-NMR analyses were also performed before and after immersion.

RESULTS

The cumulative F-ion release was significantly higher in CPP-ACPF (1.113mmol/g)>BGAF(0.638)>F(0.112) (p<0.001). The cumulative calcium and phosphorus were higher in the CPP-ACPF (0.137mmol/g, 0.119) than BGAF (0.067, 0.015) (p<0.001) respectively. The XRD and ¹⁹F MAS-NMR confirmed the presence of NaF peaks in all cases before immersion. There were less prominent signal and appearance of fluorapatite crystals after immersion. ¹⁹F MAS-NMR revealed CaF₂ formation after immersion in both CPP-ACPF and BGAF. ³¹P MAS-NMR showed phosphate signals in both CPP-ACPF and BGAF before immersion. FTIR failed to show any signs of apatite formation.

SIGNIFICANCE

Both CPP-ACP and bioactive glass enhanced ion release without compromising the bioavailability of fluoride. The CPP-ACPF varnish had the most promising ion release.

Effect of casein phosphopeptide-amorphous calcium phosphate on fluoride release and micro-shear bond strength of resin-modified glass ionomer cement in caries-affected dentin

Objectives

This study was conducted to evaluate fluoride release and the micro-shear bond strength of resin-modified glass ionomer cement (RMGIC) in casein phosphopeptide-amorphous calcium phosphate (CPP-ACP)-remineralized caries-affected dentin (CAD).

Materials and Methods

Exposed dentin surfaces of 30 human third molar teeth were divided into 2 equal groups for evaluating fluoride release and the micro-shear bond strength of RMGIC to CAD. Each group was subdivided into 3 equal subgroups: 1) control (sound dentin); 2) artificially demineralized dentin (CAD); 3) CPP-ACP remineralized dentin (remineralized CAD). To measure fluoride release, 15 disc-shaped specimens of RMGIC (4 mm in diameter and 2 mm in thickness) were bonded on one flat surface of the dentin discs of each group. Fluoride release was tested using ion chromatography at different intervals; 24 hours, 3, 5, 7 days. RMGIC micro-cylinders were built on the flat dentin surface of the 15 discs, which were prepared according to the assigned group. Micro-shear bond strength was measured after 24 hours water storage. Data were analyzed using 1- and 2-way analysis of variance and the post hoc least significant difference test (α = 0.05).

Results

Fluoride detected in solutions (at all intervals) and the micro-shear bond strength of RMGIC bonded to CPP-ACP-remineralized dentin were significantly higher than those bonded to artificial CAD (p < 0.05).

Conclusions

Demineralized CAD consumes more fluoride released from RMGIC into the solution for remineralization than CPP-ACP mineralized dentin does. CPP-ACP increases the micro-shear bond strength of RMGIC to CAD.

The effect of Er,Cr:YSGG laser, fluoride, and CPP-ACP on caries resistance of primary enamel

The aim of this in vitro study was to determine the effect of different remineralization agents and laser on caries resistance of primary enamel. In the study, 150 sound primary molars were used. The initial microhardness values were measured and the teeth were randomly assigned to ten treatment groups (n = 15): no treatment/negative control (C), NaF, APF, fluoride varnish (FV), CPP-ACP, laser (L), L + NaF, L + APF, L + FV, L + CPP-ACP. The microhardness values were measured after the treatments and the pH cycle. The obtained data were analyzed statistically. One sample from each group was examined before treatment, after treatment, and after the pH cycle with a scanning electron microscope. While microhardness values after treatment compared to baseline increased, microhardness after the pH cycle decreased compared to after treatment values in all experimental groups (p < 0.05). In regard to the difference in microhardness after the pH cycle and baseline, there were no statistically significant differences between groups C and NaF and between C and CPP-ACP (p > 0.05). There was a significant difference between groups L and L + FV (p < 0.05), while no significant difference was noted between groups L and L + NaF, L + APF, L + CPP-ACP (p > 0.05). As a conclusion, FV is more effective when used in combination with laser than laser alone. NaF, CPP-ACP, and laser may be insufficient in protecting the primary teeth against acid attacks compared to FV used with laser.

Effect of CPP-ACP on efficacy and postoperative sensitivity associated with at-home vital tooth bleaching using 20% carbamide peroxide

OBJECTIVES

To evaluate CPP-ACP effect on colour change and tooth sensitivity (TS) associated with at-home vital tooth bleaching using 20% carbamide peroxide (CP).

METHODS

A randomised double-blind placebo-controlled clinical trial was conducted to measure the TS and tooth colour change of 24 patients at 3-day, 7-day, 14-day and 30-day periods. The participants were instructed to apply 20% CP (7 days-04 h each) followed by the application of either CPP-ACP or non-active placebo paste, delivered by the bleaching custom tray (7 days-30 min each). Lightness (L*), redness (a*) and yellowness (b*) were measured using a digital spectrophotometer and the overall colour changes ∆E were calculated. ∆E and TS values were statistically analysed. The level of statistical significance was established at p = 0.05.

RESULTS

No significant differences were detected between CPP-ACP and placebo groups regarding the ∆E. The ∆E measurements presented significant differences within CPP-ACP groups between 3-day vs. 14-day and 30-day measurements. The CPP-ACP application reduced significantly the TS reported by the participants at 3-day when compared with the placebo group.

CONCLUSION

The application of CPP-ACP paste during at-home tooth bleaching with 20% CP was beneficial since its use reduced the TS and presented no deteriorating effect on the colour change.

CLINICAL RELEVANCE

The current findings are of importance for clinicians to manage TS reported by patients when a high CP bleaching agent is used.

Coupling xylitol with remineralizing agents improves tooth protection against demineralization but reduces antibiofilm effect

To explore the efficiency of xylitol chewing gum enriched or not with remineralizing agents to protect tooth against cariogenic biofilm formation and demineralization. Six groups of chewing gums were prepared; Group 1: isomalt (1.8%), Group 2: casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) (3%) + isomalt (1.8%), Group 3: hydroxyapatite (HAP) (2.5%) + isomalt (1.8%), Group 4: xylitol (1.8%), Group 5: CPP-ACP (3%) + xylitol (1.8%) and Group 6: HAP (2.5%) + xylitol (1.8%). The antibiofilm properties of different chewing gum extracts using seven oral bacterial species including Streptococcus mutans, Streptococcus constellatus, Streptococcus Salivarius and Streptococcus oralis were explored via the crystal violet staining assay. The remineralizing effects of those products were assessed on thirty human permanent teeth, half-protected with varnish before chemical erosion and thermocycling process with chewing gum. Remineralization was evaluated using scanning electron microscopy and microscopic measurements on polarized light microscopy. The ratio R comparing the thickness between unvarnished and varnished sides was evaluated. While the minimum biofilm inhibitory concentration (MBIC₅₀) was low for xylitol alone compared to isomalt, it was inconsistent when enriched with remineralizing agents. The minimum biofilm eradication concentration (MBEC₅₀) was low for xylitol groups compared to isomalt, for all the studied strains. R was significantly lower in Group 1 and Group 2, while Group 6 showed the highest ratio. Xylitol chewing gums confirmed good antibiofilm properties and showed remineralized potential on eroded teeth. When xylitol is associated to CPP-ACP or HAP, antibiofilm activity decreased while remineralization of eroded teeth increased.

Increasing the efficiency of CPP-ACP to remineralize enamel white spot lesions

OBJECTIVES

To compare the remineralization efficacy of using the MI paste plus according to manufacturer's instructions to MI varnish and to using a modified method of MI-paste plus application.

MATERIALS AND METHODS

100 enamel specimens were obtained from the buccal and lingual surfaces of 50 extracted human non-caries third molars. All specimens were challenged by a buffered demineralization solution for 4 days, and were divided in 4 groups with 25 specimens in each group. 25 demineralized specimens had MI paste plus applied for 4 min and then wiped out (MI), 25 specimens had MI paste applied followed by application of SE-bonding agent (MI + Bond), 25 specimens had MI Varnish applied according to manufacturer instructions (MI Varnish) the rest of specimens served as controls (C). All specimens were stored for 7 days in artificial saliva. All specimens had their surface hardness (SH) measured by micro-hardness tester before/after the acidic challenge and after the treatment procedures. After the SH test all specimens were crosssectioned to obtain 100-150 micron thickness specimens to observe the lesion depth before/after treatment by the TMR (Transverse Micro Radiography) technique.

RESULTS

TMR experiment showed that (MI + Bond) and (MI varnish) groups recorded significant decrease in lesion depth and mineral loss of the tested subsurface lesion p < 0.05. (MI + Bond) group scored the highest significant regain of surface micro hardness results p < 0.05.

CONCLUSION

(MI varnish) and the modified application of MI paste are methods that can increase the efficacy of CPP-ACP in remineralizing the enamel surface lesions.

Efficacy of different strategies to treat root dentin eroded by liquid or gaseous hydrochloric acid associated with brushing abrasion

OBJECTIVE

This study aims to evaluate how casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) associated with Nd:YAG or Diode laser affects dentin exposed to hydrochloric acid (HCl) with or without tooth brushing.

DESIGN

One hundred and sixty human root dentin blocks were selected after they were initially eroded with liquid HCl (pH 1.2) 3x for one day. The blocks were divided into the following groups: G1- liquid HCl (HCl-l), G2- HCl-l + brushing, G3- gaseous HCl (HCl-g), and G4- HCl-g + brushing. Each group was randomly assigned to the following treatments (n = 10): A) Control (no treatment), B) CPP-ACP, C) CPP-ACP associated with Nd:YAG laser (λ = 1064 nm) (40 mJ, 10 Hz, 0.4 W, 15 s), and D) CPP-ACP associated with Diode laser (λ = 980 nm) (0.5 W, 200 μs, 15 s). The treatment with CPP-ACP (G2, G3 and G4) was applied on the dentine surface for 5 min. Erosion (6x/day/20 s) and erosion (6x/day/20 s) with abrasion (2x/10 s) were performed for five days. Dentin volume loss was determined by 3D confocal laser microscopy. Data were analyzed with two-way ANOVA and Tukey's tests.

RESULTS

G1 - CPP-ACP (10.77 ± 1.66) and CPP-ACP associated with Diode laser (9.98 ± 0.89) showed lower volume loss in relation Control group (12.86 ± 0.63) (p < 0.05). G2 - CPP-ACP associated with Diode laser (12.41 ± 1.08) elicited lower volume loss as compared to the Control (14.42 ± 1.24) (p < 0.05). As for G3 and G4, all treatments showed similar volume loss.

CONCLUSION

CPP-ACP and CPP-ACP associated with Diode laser could control dental tissue loss in dentin eroded by liquid HCl. Moreover, CPP-ACP associated with Diode laser could effectively decrease dental tissue loss in dentin exposed to liquid HCl and brushing.

The physical properties and ion release of CPP-ACP-modified calcium silicate-based cements

BACKGROUND

This study investigated the physical properties and ion release of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP)-modified calcium silicate-based cements (CSCs) and compared the properties of a trial mineral trioxide aggregate (MTA) with two commercially available CSCs, Biodentine(™) and Angelus(®) MTA.

METHODS

The setting time, solubility, compressive strength and Vickers surface microhardness of the three CSCs incorporated with 0%, 0.5%, 1.0%, 2.0% and 3.0% (w/w) CPP-ACP were investigated. Release of calcium (Ca(2+) ), phosphate ions (Pi ) and pH of the test cements were measured after 24, 72, 168 and 336 h of storage.

RESULTS

The addition of up to 1.0% CPP-ACP into Biodentine(™) and 0.5% into the other cements did not adversely affect their physical properties except for the setting time. The addition of 0.5% CPP-ACP increased Ca(2+) released from Biodentine(™) (after 168 and 336 h), Angelus(®) MTA (after 168 h) and the trial MTA (after 72 h). The addition of 1.0-3.0% CPP-ACP increased Ca(2+) and Pi released from all the cements. Biodentine(™) released more Ca(2+) particularly in the early stages and showed shorter setting time and higher mechanical properties than the other cements. The mechanical properties of Angelus(®) MTA and the trial MTA were similar. All the cements produced highly alkaline storage solutions.

CONCLUSIONS

Up to 1.0% CPP-ACP in Biodentine(™) improves Ca(2+) and Pi release and 0.5% CPP-ACP in Angelus(®) MTA and the trial MTA improves Ca(2+) release without altering the mechanical properties and solubility. The addition of CPP-ACP into CSCs prolonged the setting time.

Biocompatibility and Osteogenic/Calcification Potential of Casein Phosphopeptide-amorphous Calcium Phosphate Fluoride

INTRODUCTION

Casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) and CPP-ACP with fluoride (CPP-ACFP) have been shown to provide bioavailable ions to promote mineralization. Hence, the aim of this study was to evaluate the materials' biocompatibility and osteogenic/calcification potential for endodontic applications.

METHODS

Human and mouse osteoblast-like and fibroblast-like cell lines were incubated with 0.05%-3.0% w/v CPP-ACP and CPP-ACFP, and toxicity, proliferation, alkaline phosphatase, interleukin (IL)-1α, and IL-6 production, collagen type I, osteocalcin, and osteopontin production, and mineralization/calcification were determined.

RESULTS

CPP-ACP and CPP-ACFP were non-toxic and had no significant effect on proliferation or production of the inflammatory cytokine IL-1α. Alkaline phosphatase activity of the osteoblast-like cells was significantly increased (P < .05) by CPP-ACP and CPP-ACFP, as was the production of the osteotropic cytokine IL-6, the formation of calcium mineral deposits, and the secretion of mineralization-related proteins (collagen type I and osteocalcin).

CONCLUSIONS

CPP-ACP and CPP-ACFP are biocompatible and have the potential to induce osteoblastic differentiation and mineralization. Potential applications include apexification, perforation repair, vital pulp therapy, and regenerative endodontic procedures.

Micro-CT and FE-SEM enamel analyses of calcium-based agent application after bleaching

OBJECTIVES

The objective of the present study is to evaluate the effects of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) on bleached enamel.

MATERIALS AND METHODS

A bleaching agent (35% hydrogen peroxide) was applied, 4 × 8 min on premolar teeth (n = 8). A CPP-ACP paste was applied for 7 days. Prior and post-treatment, microtomography images were obtained and 3D regions of interest (ROIs) were selected, from outer enamel, extending to 110.2-μm depth. CT parameters of structure: thickness (St.Th), separation (St.Sp), and fragmentation index (Fr.I.) were calculated for each (ROI). Data was submitted to paired t tests at a 95% confidence level. The samples were evaluated at 3000 to 100,000 magnification. Quantitative analysis of enamel mineral content was also determined by SEM EDX.

RESULTS

There was a significant increase in structure thickness and calcium content. The phosphorus content increased after bleaching. There was also a decreased separation and fragmentation index on the outer enamel to a depth of 56.2 μm (p < 0.05). There were no changes at 110.2-μm depth for the bleaching CPP-ACP association. A covering layer and decreased spaces between the hydroxyapatite crystals appeared around the enamel prisms, 7 days after the CPP-ACP application.

CONCLUSIONS

The application of a CPP-ACP provides a compact structure on the enamel's outer surface, for 7 days, due to calcium deposition. CT parameters seem to be a useful tool for mineralizing and remineralizing future studies.

CLINICAL RELEVANCE

CPP-ACP neutralizes any adverse effects on enamel surface when applied during a week after bleaching and minimizes any side effects of the bleaching treatment due to a more compact structure.

A randomised controlled trial to investigate the remineralising potential of Tooth Mousse™ in orthodontic patients

OBJECTIVE

To investigate the remineralisation of enamel subsurface lesions treated with fluoride toothpaste (1450 ppm) or a combination of fluoride toothpaste in addition to Tooth Mousse™.

DESIGN

An in situ, cross-over, randomised controlled trial.

SETTING

Orthodontic department at Liverpool University Dental Hospital, UK.

PARTICIPANTS

Twelve patients receiving fixed orthodontic treatment.

METHODS

Demineralised subsurface enamel lesions were placed in a carrier and attached onto a fixed orthodontic appliance. Interventions were either standard fluoride toothpaste or CPP-ACP paste (Tooth Mousse™) in addition to the fluoride toothpaste. Participants received both interventions in a randomised order. Transverse microradiography analysis was used to compare lesion mineral content profiles.

RESULTS

Mineral loss was reduced by 15.4 and 24.6% between the fluoride and CPP-ACP groups, respectively (p = 0.023). Lesion depth was reduced by 1.6 and 11.1% between the fluoride and CPP-ACP groups, respectively (p = 0.037). Lesion width was reduced by 4.5 and 15.3% between the fluoride and CPP-ACP groups, respectively (p = 0.015).

CONCLUSIONS

Remineralisation occurred regardless of treatment group allocation. However, the addition of Tooth Mousse™ resulted in a significantly increased remineralisation effect, compared to fluoride alone. Tooth Mousse™ may be beneficial for patients undergoing orthodontic treatment who are at high risk of demineralisation.

TRIAL REGISTRATION

Registered on Current Control Trials http://www.controlled-trials.com/ISRCTN04899524.

CPP-ACP: Effect on Dental Plaque Acidity after Water Rinsing Following Topical Fluoride Therapy

OBJECTIVES

There is some evidence that water rinsing immediately after topical fluoride therapy has the potential to reduce the effectiveness of fluoride. The aim was to determine if covering fluoridated teeth with a layer of mousse containing CPP-ACP could prevent the adverse effect of rinsing on fluoride and consequently its buffering effect on dental plaque pH during cariogenic challenge.

STUDY DESIGN

This randomized, controlled, crossover, in situ study was conducted on 25 participants. The participants were subjected to acidulated phosphate fluoride (APF) application followed by five treatment protocols: (1) water rinsing after 30 minutes (APF-30) or (2) immediate water rinsing (APF-0); (3) using CPP-ACP immediately before water rinsing (F-CPP-ACP); and two control groups: (4) no fluoride therapy (No-F) and (5) using CPP-ACP and immediate water rinsing (CPP-ACP-0). After 48 hours, teeth were rinsed with 10% sucrose solution and plaque pH was measured before and after 5, 10, 15, 20 and 30 minutes.

RESULTS

The least pH changes, the lowest pH drop, and the quickest pH recovery were found in the APF-30 and F-CPP-ACP groups. APF-0 ranked in the middle and the highest values were in the control groups.

CONCLUSIONS

The results show that in the case using CPP-ACP on fluoridated teeth, water rinsing immediately after topical fluoride therapy did not seem to influence the inhibitory effect of fluoride on plaque acidity.

Comparison of CPP-ACP, Tri-Calcium Phosphate and Hydroxyapatite on Remineralization of Artificial Caries Like Lesions on Primary Enamel -An in vitro Study

OBJECTIVES

To compare CPP-ACP, Tri-calcium phosphate and Hydroxyapatite on remineralization of artificial caries like lesions on primary enamel.

STUDY DESIGN

Ten extracted Primary molars coated with nail varnish, leaving a window of 2×4 mm on buccal and lingual surface were immersed in demineralizing solution for 96 hours and sectioned longitudinally to obtain 40 sections (4 sections per tooth) and were randomly divided into 4 groups (A to D) n=10; Group A: negative control, Group B: CPP-ACP, Group C: Tri-calcium phosphate, Group D: Hydroxyapatite. Sections were subjected to pH cycling for 10 days and were evaluated by polarized light microscope before and after treatment.

RESULTS

Intra group comparison of demineralization and remineralization was done by paired t-test. One way ANOVA was used for multiple group comparisons followed by post HOC TUKEY'S Test for group wise comparisons. Remineralization was found more with Group D followed by Group B, C and A.

CONCLUSION

Hydroxyapatite showed better remineralization when compared to CPP-ACP and Tri-calcium phosphate.

Incorporation of CPP-ACP into Luting and Lining GIC: Influence on Wear Rate (in the Presence of Artificial Saliva) and Compressive Strength

The improvement of mechanical and antibacterial properties of glass ionomer cements (GICs) is an important goal in dental research. In this way, modification of GIC with caries preventive and remineralizing materials such as casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) is a new strategy to enhance its anticariogenic properties and the remineralization of teeth. However, one main concern is that adding CPP-ACP may have negative effects on the mechanical properties of GIC. This study investigated the influence of adding CPP-ACP on the wear rate (in the presence of artificial saliva) and compressive strength of luting and lining glass ionomer cement. CPP-ACP was incorporated into a luting and lining glass ionomer cement at different percentages (1, 1.56, and 2%). Wear rate and compressive strength were measured for each group using Pin-on-Disk tribometer device (in artificial saliva condition) and universal testing machine, respectively. The wear test was carried out in the presence of artificial saliva for better simulation of the oral environment. Our results demonstrated that increasing the percentage of CPP-ACP from 0 up to 1.56% (w/w), caused a decrease of 19% in the wear rate. However, at 2% (w/w) CPP-ACP, the wear rate increased. Compressive strength was improved by 31% when the CPP-ACP concentration was increased to 1.56% (w/w), but decreased when the concentration was raised to 2% (w/w). In conclusion, adding 1.56% CPP-ACP into luting and lining glass ionomer cement appears to provide an acceptable combination of two important mechanical properties, compressive strength and wear rate.

Effect of fluoride varnish with added casein phosphopeptide-amorphous calcium phosphate on the acid resistance of the primary enamel

Background

This study aimed to investigate the effects of a fluoride varnish with added Casein Phosphopeptide-Amorphous Calcium Phosphate (CPP-ACP) treatments on acid resistance of primary teeth enamel.

Methods

Enamel specimens obtained from 40 primary incisors (for surface microhardness testing) and 40 primary molars (for demineralization depth measurement) were randomly divided into four groups (n = 10 incisors and 10 molars) each according to surface treatment: no treatment (control), MI varnish (1–8 % sodium fluoride and 1–5 % CPP-ACP), Clinpro White (1–5 % sodium fluoride and <5 % modified tricalcium phosphate), Duraphat (<5 % sodium fluoride). Specimens were stored for 24 h in a moist environment. After varnish residues were removed, specimens were subjected to pH cycling. The effects of fluoride varnishes were evaluated according to surface microhardness, lesion depth and structural changes. Results were analyzed by ANOVA and Tukey’s tests.

Results

The lowest changes in surface microhardness and lesion depth occurred in MI varnish group, followed by the Clinpro White, Duraphat and no treatment (control) group (for percentage of loss surface microhardness −20.80, −34.60, −57.80 and −73.40; for lesion depth values 23.60 μm ± 3.36, 29.85 μm ± 3.27, 40.37 μm ± 3.41 and 54.56 μm ± 4.16, respectively). Statistically significant differences in both surface microhardness and lesion depth were observed among all groups (P < 0.05).

Conclusions

Within the limitations of this in vitro study, fluoride varnish containing CPP-ACP was more effective in increasing the acid resistance of primary enamel than other fluoride varnishes. However, further clinical research is needed to confirm these in vitro results.

Enamel alteration following tooth bleaching and remineralization

The purpose of this study was to compare the effects of professional tooth whitening agents containing highly concentrated hydrogen peroxide (with and without laser activation), on the enamel surface; and the potential of four different toothpastes to remineralize any alterations. The study was performed on 50 human molars, divided in two groups: treated with Opalescence(®) Boost and Mirawhite(®) Laser Bleaching. Furthermore, each group was divided into five subgroups, a control one and 4 subgroups remineralized with: Mirasensitive(®) hap+, Mirawhite(®) Gelleѐ, GC Tooth Mousse™ and Mirafluor(®) C. The samples were analysed by SEM/3D-SEM-micrographs, SEM/EDX-qualitative analysis and SEM/EDX-semiquantitative analysis. The microphotographs show that both types of bleaching cause alterations: emphasized perikymata, erosions, loss of interprizmatic substance; the laser treatment is more aggressive and loss of integrity of the enamel is determined by shearing off the enamel rods. In all samples undergoing remineralization deposits were observed, those of toothpastes based on calcium phosphate technologies seem to merge with each other and cover almost the entire surface of the enamel. Loss of integrity and minerals were detected only in the line-scans of the sample remineralized with GC Tooth Mousse™. The semiquantitative EDX analysis of individual elements in the surface layer of the enamel indicates that during tooth-bleaching with HP statistically significant loss of Na and Mg occurs, whereas the bleaching in combination with a laser leads to statistically significant loss of Ca and P. The results undoubtedly confirm that teeth whitening procedures lead to enamel alterations. In this context, it must be noted that laser bleaching is more aggressive for dental substances. However, these changes are reversible and can be repaired by application of remineralization toothpastes.

Remineralizing potential of CPP-ACP applied for 1 min in vitro

AIM

To evaluate (1) the remineralizing potential of Tooth Mousse(®) (TM) on artificial carious lesions, when applied for 1 min, and (2) the benefit of a fluoridated dentifrice prior to TM application.

METHODS

Demineralisation caries-like lesions 120-200 μm deep were produced by placing molars in demineralizing solution for 96 h, sections 100-150 μm thick were then randomly assigned to four groups. Specimens were treated thrice daily with a non-fluoridated (Group A), or fluoridated dentifrice (1000 ppm) (Group B), or TM (Group C), or a fluoridated dentifrice followed by TM (Group D) then subjected to a 10-day pH cycling model. Lesion evaluation involved polarizing light microscopy and microradiography.

RESULTS

Application of TM in isolation (Group C) for 1 min resulted in significant increase in lesion depth (LD), however, an increase in mineral content deposition (V max) was not significant. Post treatment LD increases were greatest in Group A, then Group C and Group B respectively. A decrease in LD (by 19.9 %) was noted only after fluoridated dentifrice and TM (Group D) were applied consecutively for 1 min each (p < 0.05). Mineral content deposition was also greatest in this group (Group D) and both V max and LD changes were statistically significant when compared to other groups.

CONCLUSIONS

TM alone failed to remineralize carious lesions when applied for 1 min. However, remineralization occurred after a prior application of a fluoridated dentifrice.