Casein Phosphopeptide-amorphous Calcium Fluoride Research Articles

Treatment Strategies for Incisors of Children Affected by Molar Incisor Hypomineralization: A Narrative Review

Today, molar incisor hypomineralization (MIH), which affects approximately one in seven children, is defined as a hypomineralized developmental enamel defect that often impacts at least one permanent first molar and frequently affects permanent incisors as well. Symptoms and signs include demarcated opacities of various colors, post-eruptive enamel deterioration, atypical caries and restorations, hypersensitivity, tooth loss due to MIH, and difficulty in achieving anesthesia. A detailed review of the scientific literature shows that there are many studies evaluating different treatment approaches for permanent first molars affected by MIH. On the other hand, there are very few scientific studies evaluating treatment approaches for affected incisors in patients with MIH. Most of these studies consist of case reports or series. White/creamy and/or yellow/brown demarcated opacities are commonly observed in affected incisors in patients with MIH. While these opacities increase the susceptibility of enamel to deterioration and dental caries, they also cause aesthetic problems and related psychosocial consequences. Treatment methods, such as resin infiltration, microabrasion, and/or dental bleaching, have been proposed for aesthetic and restorative purposes in affected incisors in patients with MIH. Additionally, various approaches to increase mineral content and relieve hypersensitivity have been recommended. The number of randomized controlled and prospective studies is quite low, but many case reports and case series have been encountered. The purpose of this review was to provide a comprehensive overview of the different treatment management modalities for permanent incisors affected by MIH. As a result, while resin infiltration, dental bleaching, microabrasion, and/or etch–bleach–seal techniques are preferred for aesthetic and restorative purposes in these teeth, it has been observed that agents containing casein phosphopeptide amorphous calcium phosphate, casein phosphopeptide amorphous calcium fluoride phosphate, fluoride, and calcium glycerophosphate increase the mineral content. Additionally, studies have reported that ozone and low-level laser therapy, in addition to these remineralizing agents, reduce hypersensitivity in these teeth. Although the findings of this review indicate that the level of evidence for current approaches is not high, clinicians may prefer one or more of the treatment approaches mentioned in this article based on experience and patient expectations.

Remineralization Strategies for Teeth with Molar Incisor Hypomineralization (MIH): A Literature Review.

Molar incisor hypomineralization (MIH) is a highly prevalent dental developmental disorder with a significant health burden for patients and high treatment needs, yet no comprehensive review article on all remineralization systems as a non-invasive treatment approach for MIH has been published. Typical characteristics of MIH-affected teeth are a lower mineral density and lower hardness compared to healthy teeth leading to sensitivity and loss of function. Thus, the use of formulations with calcium phosphates to remineralize MIH-affected teeth is reasonable. This review presents an up-to-date overview of remineralization studies focusing on active ingredients investigated for remineralization of MIH, i.e., casein phosphopeptide amorphous calcium phosphate (CPP-ACP), casein phosphopeptide amorphous calcium fluoride phosphate (CPP-ACFP), hydroxyapatite, calcium glycerophosphate, self-assembling peptide, and fluoride. Overall, 19 studies (in vitro, in situ, and in vivo) were found. Furthermore, an additional search for studies focusing on using toothpaste/dentifrices for MIH management resulted in six studies, where three studies were on remineralization and three on reduction of sensitivity. Overall, the studies analyzed in this review showed that MIH-affected teeth could be remineralized using calcium phosphate-based approaches. In conclusion, calcium phosphates like CPP-ACP, calcium glycerophosphate, and hydroxyapatite can be used to remineralize MIH-affected teeth. In addition to MIH-remineralization, CPP-ACP and hydroxyapatite also offer relief from MIH-associated tooth sensitivity.

Effect of casein phosphopeptide amorphous calcium fluoride phosphate and calcium glycerophosphate on incisors with molar-incisor hypomineralization: Across-over, randomized clinical trial.

Within the scope of minimally invasive dentistry, the use of different biocompatible remineralization agents on incisors affected by molar-incisor hypomineralization (MIH) gains importance. To evaluate the effect of casein phosphopeptide amorphous calcium fluoride phosphate (CPP-ACFP) and calcium glycerophosphate (CaGP) in mineral density (MD) of white/creamy and yellow/brown demarcated opacities on incisors affected by MIH by means laser fluorescence (LF). As a cross-over, randomized trial, twenty-two children with 167 incisors affected by MIH were recruited and randomly assigned to one of the two different agents and crossed over to other agents with two weeks washout in between. Incisors were examined by using LF at all before and after three months periods. The results of the paired t-tests for determining the period effect between the baseline findings showed significant difference in white/creamy and yellow/brown demarcated opacities of LF values for both groups (p <0.05). The difference between both groups according to after categorization of 20% increasing in MD in the percent of change before and after application on LF values; was not found statistically significant in white/creamy (p =0.970) and yellow/brown (p =0.948) opacities. The primary outcome was CPP-ACFP and CaGP had a positive effect in decreasing hypomineralization on MIH-affected enamel for three months period.

Assessment of White Spot Lesion and Enamel Demineralization in Orthodontic Patients With Fixed Brackets—A Clinical Appraisal Using Fluoride Mouth Rinse, Fluoride Varnish Containing CPP-ACP, and CPP-ACFP

Purpose: Efficacy evaluation of casein phosphopeptide amorphous calcium phosphate complex (CPP-ACP), casein phosphopeptide amorphous calcium fluoride phosphate complex (CPP-ACFP), fluoride mouthrinse, and fluoride containing toothpaste as compared to control group for the remineralization of white spot lesions (WSLs) in orthodontic patients with fixed brackets in an in vivo study. Methods: Seventy-five subjects with WSL determined by DIAGNOdent were randomly divided into 5 groups. The WSLs DIAGNOdent values for 0, 3, 6, 9, and 12 months were tabulated and subjected to statistical analysis. Results: Among the groups, the remineralizing potential of fluoride mouth rinse, fluoride containing toothpaste, and CPP-ACP were similar; however, CPP-ACFP value was superior in comparison to all other groups. Conclusion: The CPP-ACFP technique is highly beneficial for the remineralization of WSL in an orthodontic patient when compared to fluoride mouth rinse, fluoride-containing toothpaste, and CPP-ACP paste.

Effect of Remineralization Agents on Molar-Incisor Hypomineralization-Affected Incisors: A Randomized Controlled Clinical Trial.

The objective of this study was to evaluate the remineralization effect of two different mineral containing agents on white/creamy and yellow/brown demarcated opacities in incisors in children with molar-incisor hypomineralization (MIH) by using laser fluoresence (LF). Fifty-three children (n=401 lesions) with MIH were randomly divided into three groups: (1)calcium glycerophosphate (CaGP), (2)casein phosphopeptide amorphous calcium fluoride phosphate (CPP-ACFP) and, (3)control (1450 ppm fluoride toothpaste). Remineralization was evaluated by means of LF, at baseline, after one and threemonths. Anova Test for Repeated Measurements in intra-group comparisons in evaluating the effectiveness of remineralization agents. One-way Variance Analysis (ANOVA) and Tukey-Kramer Multiple Comparison test were used in the comparisons between groups and, Student Newman Keuls Multpile Comparison Test was used to determine the differences between the measurement averages in case of p<0.05. There was a significant improvement in MIH-lesions over time in all groups (p<0.001), with no differences between groups. The highest percentage of change was observed in CPP-ACFP in lesions LF≤20 scores and the mean percentage of change LF>20 scores, the highest percentage changes in CaGP. There was no significant difference between the groups over the time for all the used outcome measures (p>0.05). The additional use of both mineral containing agents in MIH-affected teeth improved these hypomineralized lesions with mineral deposition. Even if both agents could be used in the hypomineralized teeth with demarcated opacities, future studies are recommended the long-term effect of these mineral containing agents with longer observation and a larger sample size.

Comparative evaluation of the spectral-domain optical coherence tomography and microhardness for remineralization of enamel caries lesions

This study aimed to evaluate the Cirrus high-definition (HD) spectral-domain optical coherence tomography (SD-OCT) for the remineralization of artificial enamel caries and to compare it with the comparison surface microhardness (SMH) analysis. Artificial caries lesions were produced on forty human enamel samples. Then, three different remineralization agents containing casein phosphopeptide amorphous calcium phosphate; casein phosphopeptide amorphous calcium fluoride phosphate; calcium glycerophosphate, magnesium chloride, and xylitol; and remineralization solution (control) were applied with pH cycling for six days. The optical depth of backscattered light and microhardness of enamel were measured using SD-OCT and SMH. All remineralization agents were significantly efficient in reducing optical lesion depth on enamels (p1=0.001, p2=0.002, p3=0.006, p4=0.025), and in increasing the SMH of enamels (p1-3=0.005, p4=0.017). However, the optical lesion depths of the enamel showed no correlation with the SMH in the groups. In conclusion, demineralization and remineralization of artificial lesions can be assessed with both SD-OCT and SMH.

The efficacy of resin infiltrant and casein phosphopeptide–amorphous calcium fluoride phosphate in treatment of white spot lesions (comparative study)

ABSTRACTBackground:White spot lesions (WSLs) are considered as the first sign of the progression of dental caries that can be reversed. Casein phosphopeptide–amorphous calcium fluoride phosphate (CPP-ACFP) varnish can promote remineralization process of the demineralized tooth structure. Also, WSLs can be managed by using caries infiltrant (ICON), which infiltrates etched enamel surface of the WSLs.Objectives:The main aim was to evaluate and compare the efficacy of ICON versus CPP-ACFP varnish to treat WSLs in the same oral environments.Materials and Methods:A total of 30 participants aged 20–40 years with at least two WSLs have participated in this trial. Split-mouth technique has been used in this trial where WSLs on the left side have been treated with ICON, whereas WSLs on the right side have been treated with CPP-ACFP varnish. Clinical evaluation using DIAGNOdent was carried out at baseline, 1 week, 1, 3, 6, and 12 months after application to determine the effectiveness of these materials in treating WSLs.Results:Significant differences were observed between all follow-up DIAGNOdent scores compared to baseline readings of both ICON and CPP-ACFP (P = 0.000 for all comparisons). Statistically significant differences were observed between DIAGNOdent scores of ICON compared to CPP-ACFP at all follow-up intervals (P = 0.006, 0.008, 0.045, 0.036, and 0.000).Conclusion:Both ICON and CPP-ACFP were effective in the treatment of WSLs of smooth surfaces but the efficacy of CPP-ACFP was better than ICON.

Evaluation of the effectiveness of remineralization preparations used in paediatric dentistry practices

Aim: The goal of preventive dentistry is to intervene prior to the formation of dental caries. This study evaluated the remineralization effects of fluoride varnish, casein phosphopeptide amorphous calcium phosphates (CPP-ACP) and casein phosphopeptide amorphous calcium fluoride phosphates (CPP-ACFP) cream, and tricalcium phosphate (TCP) varnish.&#x0D; Materials and Methodology: Samples with early artificial caries lesions were randomly divided into the following 5 groups with 20 samples in each group: (I) control, (II) fluoride varnish, (III) CPP-ACP cream, (IV) CPP-ACFP cream and (V) TCP varnish. The effectiveness of these remineralization agents was evaluated using a laser fluorescence device (DIAGNOdent), a scanning electron microscope (SEM) and energy dispersive X-ray analysis (EDX).&#x0D; Results: In the pre- and post-treatment evaluations, the DIAGNOdent remineralization measurements were statistically significant in all the groups, except the control group (p &lt; 0.05). In comparison with the DIAGNOdent measurements, the CPP-ACFP group was found to have significantly higher remineralization than the fluoride group (p &lt; 0.05), while no significant differences were found between the other groups (p &gt; 0.05). The EDX analysis evaluated the Ca/P ratio between the groups. These results indicated that the CPP-ACFP group was significantly higher than the control group, the CPP-ACP group and the TCP group (p &lt; 0.05); no significant differences were found between the CPP-ACFP group and the fluoride group (p &gt; 0.05). In SEM imaging, the most extensive mineral accumulation was observed in the CPP-ACFP group.&#x0D; Conclusion: Three analytical methods demonstrated that CPP-ACFP was the most effective remineralization material tested in this study.&#x0D; &#x0D; How to cite this article: Tatar E, Toptancı İR. Evaluation of the effectiveness of remineralization preparations used in paediatric dentistry practices. Int Dent Res 2019;9(3):138-44.&#x0D; &#x0D; Linguistic Revision: The English in this manuscript has been checked by at least two professional editors, both native speakers of English.

In vivo Comparative Evaluation of Esthetics after Microabrasion and Microabrasion followed by Casein Phosphopeptide-Amorphous Calcium Fluoride Phosphate on Molar Incisor Hypomineralization-Affected Incisors.

Background:Molar incisor hypomineralization (MIH) is an esthetic setback for the patient as well as for the dentist, treatment options for MIH includes minimally invasive techniques like microabrasion which has a limited literature of its effect. Furthermore, the effect of remineralizing such as casein phosphopeptide–amorphous calcium phosphate (CPP-ACP) agent on MIH-affected teeth is minimally studied.Aim:Comparative evaluation of the esthetic after microabrasion and microabrasion followed by Tooth Mousse Plus on hypomineralized incisors of MIH-affected patients.Settings and Design:The study was a randomized clinical trial.Materials and Methods:The study comprised Grade I MIH patients in the age strata of 7–16 years having lesions on incisors. As per inclusion criteria, 46 lesions were divided into two groups of microabrasion and microabrasion followed by CPP-amorphous calcium fluoride phosphate (ACFP). Photographs were obtained before treatment, just after treatment, and 6 months after treatment. The photographic evaluation was done using the CIE L*a*b* scoring method.Statistical Analysis Used:ANOVA and posthoc Tukey's test were applied to compare the difference in lightness ΔL and total color change ΔE of these two groups.Results:In microabrasion group, the overall change in ΔL of white tooth discoloration came −0.9 standard deviation (SD) 7.3. In microabrasion followed by CPP-ACFP group, statistically significant difference was found between both these groups with P value of P ≤ 0.001.Conclusions:Microabrasion followed by the remineralizing agent can improve the esthetics of white tooth discoloration with time.

A Comparative Analysis of Caries Inhibitory Effect of Remineralizing Agents on Human Enamel Treated With Er:YAG Laser: An In-vitro Atomic Emission Spectrometry Analysis.

The tug of war to maintain tooth integrity is dependent on a ratio between demineralization and remineralization. Hence, demineralization should be retarded and remineralization should be enhanced to maintain a natural equilibrium in the oral cavity. To compare in-vitro acid resistance of human enamel when using Casein Phosphopeptides Amorphous Calcium Phosphate (CPP-ACP) [GC Tooth mousse] cream, Casein Phosphopeptide Amorphous Calcium Fluoride Phosphate (CPP-ACFP) [GC Tooth mousse plus] cream, Er:YAG laser alone, combination of CPP-ACP with Er:YAG laser, CPP-ACFP with Er:YAG laser. An in-vitro study was done on 100 specimens which were prepared from 50 human premolars to investigate the caries inhibitory effect of remineralizing agents and laser on enamel using an atomic emission spectrometry analysis. The enamel specimens were randomly allocated into 6 groups: Untreated (control); CPP-ACP (GC Tooth mousse); CPP-ACFP (GC Tooth mousse plus); Er:YAG laser treatment alone; CPP-ACP with Er:YAG laser; CPP-ACFP with Er: YAG laser. Then specimens were immersed individually in 5ml of acetate buffer solution (0.1mol/L, pH 4.5) and incubated at 37°C for 24 hours, to determine the acid resistance by analyzing the calcium release using atomic emission spectrometry. An ANOVA model was constructed (p-value 0.05), followed by post-hoc Tukey's test for multiple pair wise comparisons of mean values. There was a significant difference among the various groups with respect to amount of calcium released (p<0.001). The lowest mean score of calcium release was observed for CPP-ACFP with Er:YAG laser followed by CPP-ACFP but the differences between these groups were statistically not significant (p>0.05). Similarly the differences between CPP-ACP with Er:YAG laser and CPP-ACP also were not significant (p>0.05). The highest mean score of calcium release was for Er:YAG laser and no significant statistical difference was noticed in comparison with control group (p>0.05). Combination of CPP-ACFP with Er:YAG laser is more effective in decreasing enamel demineralization when compared with other groups.

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.

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.

Lack of reliable evidence of the effectiveness of remineralising agents for the treatment of post orthodontic white spot lesions

PubMed, Medline, Web of Science and the Cochrane Library databases were searched. Selection was conducted independently by two reviewers, only randomised controlled trials were included. Study quality was assessed using the Cochrane risk of bias approach. Data abstraction was carried out independently by two reviewers and qualitative summary presented, because of the heterogeneity of the interventions and outcome measures. Seven studies were included, all except one (of medium risk) were considered to be at high risk of bias. Three studies evaluated fluoride preparations (50-ppm sodium fluoride mouth rinse, 5% sodium fluoride varnish and 0.5% sodium fluoride chewing sticks). Four compared remineralising agents containing casein phosphopeptide amorphous calcium phosphate or casein phosphopeptide amorphous calcium fluoride phosphate. Based on the literature, there is a lack of reliable evidence to support the effectiveness of remineralising agents for the treatment of post orthodontic white spot lesions.

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.

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.

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.