Real Time In Vivo Confocal Microscopic Analysis of the Enamel Remineralization by Casein Phosphopeptide-Amorphous Calcium Phosphate (CPP-ACP): A Clinical Proof-of-Concept Study

Maria Contaldo,Rossella Santoro,Fedora Della Vella,Dario Di Stasio,Dorina Lauritano,Alberta Lucchese,Rosario Serpico

doi:10.3390/app10124155

Abstract

Enamel defects (EDs) are qualitative and/or quantitative disturbances of the dental surface. To date, the responsiveness to remineralizing treatments has been studied ex vivo, on dental sections from extracted teeth. The present research aims to establish if in vivo reflectance confocal laser scanning microscopy is able to visualize the changes in the enamel architecture on living teeth, before, during and after remineralizing treatments by casein phosphopeptide-amorphous calcium phosphate (CPP-ACP). As proof-of-concept study, 17 consecutive children affected by EDs were enrolled and 38 EDs were considered. A CPP-ACP mousse was applied twice a week for 6 weeks and clinical and microscopic images were collected before, during and after the treatment for evaluating the changes occurred. For in vivo microscopic imaging, a reflectance confocal laser scanning microscope (RCM) for in vivo use was adopted. In this study RCM was proven to be able to visualize in vivo and at microscopic resolution the changes occurred during the remineralizing processes without needing for dental extractions and histopathological procedures. This in vivo RCM capability could encourage its clinical application in monitoring responsiveness to enamel therapies.

Highlights

Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, 70121 Bari, Italy; Department of Medicine and Surgery, Centre of Neuroscience of Milan, University of Milano-Bicocca, These authors should be considered joint last author
The present study aims to establish if in vivo reflectance confocal microscopy (RCM) is able to detect any changes occurred after remineralizing processes, performed in vivo on a series of permanent teeth in children affected by Enamel defects (EDs) of various degree
The present study aimed to establish the feasibility of in vivo RCM to image the changes in enamel microscopic appearance after casein phosphopeptide-amorphous calcium phosphate (CPP-amorphous calcium phosphate complexes (ACP)) treatments in vivo, on permanent teeth of children affected by

Summary

Introduction

“Enamel defects” (EDs) are a series of developmental disturbances, frequently encountered in clinical practice [1] and involving dental enamel during its formation processes and whose clinical aspect. The so-called amorphous calcium phosphate complexes (ACP), added with fluoride (ACFP) [11] and/or with milk-derived proteins (casein phosphopeptide, CPP) [12], are able to inhibit enamel demineralization and promote its remineralization by binding to the calcium and phosphate ions and stabilizing them as ACP [13,14,15] To date, all these processes and the dental microscopic architecture before, during and after the use of these biomimetic compounds, have been studied in vitro, mainly by transverse microradiography, scanning electron microscopy and confocal microscopy on dental sections of specimens from extracted teeth [16,17,18,19,20,21]. The present study aims to establish if in vivo RCM is able to detect any changes occurred after remineralizing processes, performed in vivo on a series of permanent teeth in children affected by EDs of various degree

Patients

CPP-ACP Topical Application

In Vivo Reflectance Confocal Laser Scanning Microscopy

Results

Discussion