Casein Phosphopeptide-amorphous Calcium Phosphate Fluoride Research Articles

Synergistic effect of proanthocyanidin and CPP-ACFP on remineralization of artificial root caries.

This study evaluated the synergistic effect of proanthocyanidin (PA) and casein phosphopeptide amorphous calcium fluoride phosphate (CPP-ACFP) on remineralization of artificial root caries. Demineralized root fragments (n = 90) were randomly divided into six groups based on treatments: (1) 6.5% PA; (2) CPP-ACP; (3) CPP-ACFP; (4) CPP-ACFP + 6.5% PA; (5) 1000 ppm fluoride; and (6) deionized water (control). Each specimen was immersed in demineralizing solution for 14 h, testing solutions/pastes for 2 h, remineralizing solution for 8 h and pH cycling was performed at 37°C for 8 days. Specimens were evaluated using transverse microradiography (lesion depth and mineral loss), Knoop microhardness and confocal laser scanning microscopy. Lesion depth was significantly lower in CPP-ACFP+PA and 1000 ppm fluoride groups (p < 0.001) with no significant difference between the two groups (p > 0.05). Mineral loss was the lowest in CPP-ACFP+PA group (p < 0.05). Fluoride and CPP-ACFP groups showed similar mineral gain (p > 0.05). Artificial caries lesions treated with CPP-ACFP+PA showed significantly higher microhardness values at 130 μm and 150 μm from the surface (p < 0.05). Combined use of PA and CPP-ACFP has a synergistic effect on root caries remineralization by enhancing mineral gain and increasing hardness of artificial root caries.

Effects of Casein Phosphopeptide Amorphous Calcium Fluoride Paste on White Spots Lesions during Orthodontic Treatment: One Year Follow Up- Tooth Mousse GC in White Spot during Orthodontic Treatment

The effects of casein phosphopeptide amorphous calcium fluoride phosphate (CPP-ACFP) paste on the remineralization of white spot lesions, evaluated clinically (Nyvad Index) and by standard photography's. The aim of the study was analyses clinically, the effect of Tooth Mouse in orthodontic patients with active white scores. During orthodontic treatment, 12 patients with 134 white spot lesions, using Nyvad criteria and clinical photos were taken in order to confirm the diagnostic criteria. The patients were oriented to apply tooth mouse before going to sleep, after brushing the teeth, with a clean dry finger or cotton tip and leaved for 3 minutes and expectorate but not washed. The Patients were reexamined at three and six months after the mouse use of tooth mosse. Nyvad Scores 1:112 faces (83,6%); 2=14 faces (10,4%); 3=6 faces (4,5%); 5=2 faces (1,5%). The active white spots, were more frequent in score 1, when compared to scores 2, 3 and 5, significant at 1%. Score 2, had significative differences towards score 5. The active white spots, were more frequent in score 1, when compared to scores 2, 3 and 5, significant at 1%. Score 2, had significative differences towards score 5. After three month, from the 118 white spot lesions, the majority of them inactivated 114 (96, 61%), became inactive, while 4 remain active. The scores achieved after three month remain stable till one year evaluation. Tooth mouse, used topically in Brazilian patients, during orthodontic treatment, was effective in remineralizing white spots over one year period.

Efficacy of pastes containing CPP-ACP and CPP-ACFP in patients with Sjögren's syndrome.

The purpose of this study was to evaluate efficacy of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) and casein phosphopeptide-amorphous calcium fluoride phosphate (CPP-ACFP) containing pastes among individuals with Sjögren's syndrome (SS). Thirty patients were randomised into three groups: CPP-ACP, CPP-ACFP, and 0.05 % NaF to be used two times a day during a 28-day experimental period. Saliva was analysed for flow rate, pH, buffering capacity and mineral concentrations. Dental plaque was examined for pH. Following the formation of artificial carious lesion, participants wore enamel slabs for an in situ remineralisation study. Remineralisation potential was examined using scanning electron microscope (SEM) and energy dispersive spectroscopic (EDS) technique. SE microphotographs were subsequently analysed for area, diameter, perimeter, roundness and the number of enamel defects and percentage of tooth surface affected by defects. At the end of the experimental period, a slight increase of salivary pH could have been observed. No differences in mineral composition of saliva were noted. The use of CPP-ACP and CPP-ACFP contributed to a significant rise of plaque pH. Image analysis revealed excessive reduction of defects' dimensions in the three experimental groups, and a decrease of the number of enamel defects in the CPP-ACP and CPP-ACFP groups. The EDS analysis did not show differences in Ca/P, Ca/O and P/O ratios in any of the treatment groups. CPP-ACP and CPP-ACFP hold promise as remineralising agents for patients with SS. Pastes containing CPP-ACP/CPP-ACFP show enhanced remineralisation potential compared with NaF mouthrinse in patients with SS.

산부식 시간과 도포 횟수에 따른 불화 카제인포스포펩타이드-아모르포우스칼슘포스페이트의 치아 법랑질 재광화 효과

본 연구는 카제인포스포펩타이드-아모르포우스칼슘포스포페이트(CPP-ACP)에 불소이온을 결합시킨 불화 카제인포스포펩타이드-아모르포우스칼슘포스페이트(CPP-ACFP)제제의 법랑질 재광화 정도를 알아보기 위한 실험으로 법랑질 표면에 산부식 시간을 달리한 후 CPP-ACFP제제를 같은 횟수로 도포했을 때의 재광화 정도와 CPP-ACFP제제의 도포 횟수가 법랑질의 재광화에 미치는 영향을 알아보고자 건전한 치아 64개를 대상으로 미세경도측정, 주사전자현미경 관찰 실험을 하였다. 그 결과 산부식 시간이 길어질수록, CPP-ACFP제제의 도포 횟수를 증가시킬수록 법랑질의 재광화가 더 잘 일어나는 것을 관찰할 수 있었다. 그러므로 CPP-ACP에 불소이온을 결합시켜 치아에 무기질 공급과 불소도포를 한 번에 할 수 있는 CPP-ACFP제제는 법랑질 재광화 물질로 권장할 만하다고 하겠다. 【This study examined the remineralization effect of CPP-ACFP according to the etching time and the frequency of application. A CPP-ACFP paste was formed from a combination of CPP-ACP paste and fluorine. The remineralization effect of CPP-ACFP was measured according to the etching time and the frequency of applications of CPP-ACFP. The microhardness of 64 teeth was measured as the sound sample and observed by scanning electron microscopy. As a result, the effect on remineralization of the enamel increased with increasing etching time and frequency of application. Therefore, a CPP-ACP paste combination to fluorine in the tooth mineral CPP-ACFP paste fluoride application can be supplied with the material-advisable enamel remineralization.】

Influence of Pastes Containing Casein Phosphopeptide-amorphous Calcium Phosphate on Surface of Demineralized Enamel

The purpose of the study was to evaluate the surface characteristics of demineralized enamel after treatment with pastes containing casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) or casein phosphopeptide-amorphous calcium fluoride phosphate (CPP-ACFP) and to compare their efficacy with that of 0.05% NaF. Following formation of the artificial carious lesion, enamel slabs were divided into 4 groups (CPP-ACP, CPP-ACFP, 0.05% NaF and control) and submitted to a chemical caries model. Remineralization potential was examined using scanning electron microscope, energy-dispersive spectroscopy (EDS) and microhardness test. Scanning electron microphotographs were analyzed for area, minimal, maximal and mean diameter, perimeter, roundness and number of enamel defects and percentage of tooth surface affected by defects. Treatment with 0.05% NaF partly reduced the appearance of enamel defects when compared with irregular demineralized enamel. Treatment with CPP-ACP or CPP-ACFP resulted in occlusion of defects which produced more flattened enamel surface. Image analysis revealed reduction of the dimensions of the defects in the 3 experimental groups. Treatment with CPP-ACFP decreased the number of enamel defects when compared with demineralized enamel. The EDS analysis did not show differences in Ca/O, P/O and Ca/P ratios between the groups (P>0.05). Microhardness test revealed significant effects of CPP-ACP and CPP-ACFP (P<0.05). Pastes containing CPP-ACP or CPP-ACFP showed potential to remineralize enamel surface lesions.

Comparison of Effect of Fluoride Varnish, Fluoride-releasing Composite, and Casein Phosphopeptide-amorphous Calcium Phosphate Fluoride on Demineralization around Brackets: An in vivo Study

Comparison of Effect of Fluoride Varnish, Fluoride-releasing Composite, and Casein Phosphopeptide-amorphous Calcium Phosphate Fluoride on Demineralization around Brackets: An in vivo Study

Comparison of Effect of Fluoride Varnish, Fluoride-releasing Composite, and Casein Phosphopeptide-amorphous Calcium Phosphate Fluoride on Demineralization around Brackets: An in vivo Study

Introduction: White spot lesions are a major problem in orthodontic patients as they compromise esthetics. They are the result of decalcification of enamel that occurs around brackets. This in vivo study was conducted to evaluate the effect of three different forms of topical fluoride on enamel demineralization adjacent to bonded brackets. Materials and methods: A total of 24 patients who needed extraction of at least two premolars for orthodontic reasons were selected. In each patient, one premolar was the test tooth and the other was the control. Brackets were bonded but only the test teeth received topical fluoride, that is, Transbond PLUS Color Change Adhesive, bifluoride12, GC Tooth Mousse Plus. The premolars were extracted after 80 to 90 days, and buccolingual sections 50 to 70 μm in thickness were evaluated with polarized light microscopy. The mean depth of demineralization in each lesion was measured using the software Image Pro Plus. Results: The difference between the values of the depth of demineralization in the experimental and control samples of all groups was found to be statistically significant (p < 0.05). There was a 43.3% reduction in the lesion depth in the transbond plus group. There was a 67.4% reduction in the lesion depth in the GC tooth mousse group. There was a 70% reduction in the lesion depth in the bifluoride varnish group. Conclusion: Enamel demineralization around brackets is signi­ ficantly reduced by all the three materials used in this study. The highest amount of lesion depth reduction was seen in the Bifluoride varnish group. Transbond plus, was the least effective among the three materials used.

Comparative evaluation of remineralization potential of casein phosphopeptide-amorphous calcium phosphate and casein phosphopeptide-amorphous calcium phosphate fluoride on artificial enamel white spot lesion: An in vitro light fluorescence study

World-wide, the contribution of dental caries to the burden of oral diseases is about 10 times higher than that of periodontal disease, the other common oral condition. Owing to its globally high prevalence, dental caries is a "pandemic" disease characterized by a high percentage of untreated carious cavities causing pain, discomfort and functional limitations. Untreated carious cavities; furthermore, have a significant impact on the general health of children and on the social and economic well-being of communities. A surgical approach to the elimination of carious lesion was developed a century ago; this approach was necessary at that time, because there was no valid alternative. The focus in caries has recently shifted to the development of methodologies for the detection of the early stages of caries lesions and the non-invasive treatment of these lesions. The non-invasive treatment of early lesions by remineralization has the potential to be a major advance in the clinical management of the disease. Remineralization of white-spot lesions may be possible with a variety of currently available agents containing fluoride, bioavailable calcium and phosphate and phosphate. This concept bridges the traditional gap between prevention and surgical procedures, which is just what dentistry needs today. The aim of this in vitro study was to evaluate and to compare the remineralization potential of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) and casein phosphopeptide-amorphous calcium fluoride phosphate (CPP-ACFP) on artificial white spot enamel lesions using the quantitative light fluorescence (QLF). A total of 45 caries-free extracted maxillary first premolars were embedded in acrylic resin. The samples were randomly divided into three groups namely control group, CPP-ACP group and CPP-ACFP group with 15 samples in each group. The samples of each group were subjected to demineralization process for a period of 96 h. The samples were then mounted in the artificial mouth model and subjected to remineralization and pH cycling for a period of 21 days. QLF readings were recorded at the end of demineralization (1st, 7th, 14th and 21st day) and were statistically analyzed. As compared with artificial saliva both CPP-ACP and CPP-ACFP produced significant amount of remineralization of the artificial enamel white spot lesion (P < 0.001), however when the remineralizing effect of CPP-ACP was compared with the remineralizing effect of CPP-ACFP there was no significant difference. Significant amount of remineralization was produced by CPP-ACP and CPP-ACFP only after the 7th day. After the 14th day, the remineralization produced by both CPP-ACP and CPP-ACFP as compared to artificial saliva was non-significant.

Comparative evaluation of remineralizing potential of three agents on artificially demineralized human enamel: An in vitro study

Introduction:Remineralization as a treatment procedure has received much attention from clinicians. The objective of this in vitro study was to find out the efficacy of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), casein phosphopeptide-amorphous calcium phosphate fluoride (CPP-ACPF), and tricalcium phosphate fluoride (TCP-F) in remineralizing enamel surface on which artificial caries lesion had been created. The changes were analyzed using DIAGNOdent® (KaVo) and scanning electron microscope (SEM).Materials and Methods:A total of 52 premolars and 24 molars were selected and classified into four groups of 13 premolars and 6 molars in each: I (CPP-ACP), II (CPP-ACPF), III (TCP-F), and IV (artificial saliva). All the samples were assessed using DIAGNOdent at the baseline and after demineralization and remineralization. Ten samples were randomly selected from each group baseline after demineralization and after remineralization for surface evaluation using SEM.Results:Statistical analysis showed that all the experimental groups had a significantly higher amount of remineralization except for group IV.Conclusion:All the three experimental groups showed a statistically significant amount of remineralization. However, because of the added benefit of fluoride (NaF 0.2%), CPP-ACPF (Tooth Mousse-Plus®) and TCP-F showed marginally more amount of remineralization than did CPP-ACP (Tooth Mousse®). Remineralization efficacy was TCP-F > CPP-ACPF > CPP-ACP.

In-vitro study of the effect of casein phosphopeptide amorphous calcium fluoride phosphate on iatrogenic damage to enamel during orthodontic adhesive removal

White-spot lesions (WSL) might be susceptible to mechanical damage during orthodontic bracket and adhesive removal. The aims of this in-vitro study were to investigate enamel loss on bracket and adhesive removal when the brackets were surrounded by WSL and to determine the effect of remineralizing these lesions with a 1% (w/v) casein phosphopeptide amorphous calcium fluoride phosphate (CPP-ACFP) solution before bracket and adhesive removal. Precoated metal mandibular incisor brackets were centrally bonded onto polished third molars and WSL produced by exposure to a demineralization buffer for 4, 12, and 30 days (n= 20 per group). Half of the demineralized window was covered with acid-resistant nail varnish, and the specimens were then subjected to remineralization with 1% CPP-ACFP. Brackets and residual adhesive were removed, and enamel damage was assessed by digital photography, profilometry, and scanning electron microscopy. Lesion depth, mineral loss, and remineralization were measured by transverse microradiography. WSL enamel around the bracket was more susceptible to iatrogenic damage at adhesive removal compared with sound enamel. Remineralization of lesions with 1% CPP-ACFP before adhesive removal significantly (P<0.002) reduced the area and depth of damage. Remineralizing WSLs with CPP-ACFP before adhesive removal reduced iatrogenic enamel damage.

Efficacy of CPP-ACP and CPP-ACPF on enamel remineralization - An in vitro study using scanning electron microscope and DIAGNOdent®

Remineralization as a treatment procedure has received a lot of attention both from clinicians as well researchers. The objective of this in vitro study was to find out the efficacy of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) and casein phosphopeptide-amorphous calcium phosphate fluoride (CPP-ACPF) in remineralizing enamel surface on which artificial caries lesion had been created. The changes were analyzed using DIAGNOdent (KaVo) and scanning electron microscope (SEM). Ninety maxillary premolars were selected and divided into three groups of 30 teeth each: A (artificial saliva), B (CPP-ACP), and C (CPP-ACPF). All the samples were assessed using DIAGNOdent at the baseline and after demineralization and remineralization. Three samples were randomly selected from each group after remineralization for surface evaluation using SEM. Statistical analysis showed that group B {CPP-ACP (4.1 ± 1.8)} and group C {CPP-ACPF (4.8 ± 1.2)} had a significantly higher amount of remineralization than group A (1.7 ± 0.7). All the three groups showed a statistically significant amount of remineralization. However, because of the added benefit of fluoride (NaF 0.2%), CPP-ACPF (Tooth Mousse-Plus) showed marginally more amount of remineralization than CPP-ACP (Tooth Mousse).

Effects of casein phosphopeptide amorphous calcium fluoride phosphate paste on white spot lesions and dental plaque after orthodontic treatment: a 3‐month follow‐up

The effects of casein phosphopeptide amorphous calcium fluoride phosphate (CPP-ACFP) paste vs. control paste on the remineralization of white spot caries lesions and on plaque composition were tested in a double-blind prospective randomized clinical trial. Fifty-four orthodontic patients, with multiple white spot lesions observed upon the removal of fixed appliances, were followed up for 3 months. Subjects were included and randomly assigned to either CPP-ACFP paste or control paste, for use supplementary to their normal oral hygiene. Caries regression was assessed on quantitative light-induced fluorescence (QLF) images captured directly after debonding and 6 and 12 wk thereafter. The total counts and proportions of aciduric bacteria, Streptococcus mutans, and Lactobacillus spp. were measured in plaque samples obtained just before debonding, and 6 and 12 wk afterwards. A significant decrease in fluorescence loss was found with respect to baseline for both groups and no difference was found between groups. The size of the lesion area did not change significantly over time or between the groups. The percentages of aciduric bacteria and of S. mutans decreased from 47.4 to 38.1% and from 9.6 to 6.6%, respectively. No differences were found between groups. We observed no clinical advantage for use of the CPP-ACFP paste supplementary to normal oral hygiene over the time span of 12 wk.

Casein Phosphopeptides in Oral Health - Chemistry and Clinical Applications

The casein phosphopeptides (CPP) are derived from the milk protein casein by tryptic digestion. The CPP, containing the sequence -Pse-Pse-Pse-Glu-Glu- where Pse is a phosphoseryl residue, stabilize calcium and phosphate ions in aqueous solution and make these essential nutrients bioavailable. Under alkaline conditions the calcium phosphate is present as an alkaline amorphous phase complexed by the CPP, referred to as casein phosphopeptide-amorphous calcium phosphate (CPP-ACP). The CPP-ACP complexes readily incorporate fluoride ions forming casein phosphopeptide-amorphous calcium fluoride phosphate (CPP-ACFP). A mechanism is discussed which provides a rationale for the ability of the CPP-ACP to remineralize carious lesions in dental enamel. Clinical applications of the CPP-ACP as agents in the treatment of dental caries and other hypomineralized conditions are reviewed. It is concluded that the CPP are a safe and novel carrier for calcium, phosphate and hydroxide (fluoride) ions to promote enamel remineralization with application in oral care products, dental professional products and foodstuffs.

NMR studies of a novel calcium, phosphate and fluoride delivery vehicle- αS1-casein(59–79) by stabilized amorphous calcium fluoride phosphate nanocomplexes

The repair of early tooth enamel lesions has been recently demonstrated by tryptic phosphopeptides derived from milk caseins that associate with amorphous calcium phosphate (ACP) forming stable complexes. These casein phosphopeptides (CPP), containing the cluster sequence–Ser( P)–Ser( P)–Ser( P)–Glu–Glu–, form calcium phosphate delivery vehicles that retard enamel demineralization and promote remineralization. Recently, we have shown that these peptides also stabilize calcium fluoride phosphate as soluble complexes. These complexes designated CPP–ACFP, have the potential to provide superior clinical efficacy in preventing dental caries and treating and repairing early stages of disease. In an approach to determine the ultrastructure of the casein phosphopeptide–amorphous calcium fluoride phosphate complexes, we have studied the structure of the predominant peptide α S1-CN(59–79) bound to ACFP using nuclear magnetic resonance (NMR) spectroscopy and X-ray diffraction. The α S1-CN(59–79) peptide stabilized calcium fluoride phosphate as amorphous nanocomplexes with a hydrodynamic radius of 2.12±0.26 nm. The nanocomplexes exhibited stoichiometry of one peptide to 15 calcium, nine phosphate and three fluoride ions. Sequence-specific resonance assignments were determined for the peptide α S1-CN(59–79) complexed to the ACFP. The secondary structure of the peptide α S1-CN(59–79) was characterized by sequential ( i, i+1), medium-range ( i, i+2) nOes and H α chemical shifts. The spectral data were compared with that of the peptide α S1-CN(59–79) bound to calcium ions, revealing that the structurally significant secondary NH and α-chemical shifts were similar.