Casein Phosphopeptide-amorphous Calcium Phosphate Group Research Articles

An experimental teeth bleaching agent containing casein phosphopeptide-amorphous calcium phosphate.

This study was aimed to obtain an experimental bleaching agent by adding casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) in order to eliminate the mineral loss on the tooth surface after bleaching and to evaluate the bleaching effectiveness. In this study, experimental bleaching agents containing 1%, 3% CPP-ACP and without CPP-ACP were obtained. Bleaching effectiveness (color change), the effect of bleaching agents on mineral content (energy dispersive x-ray spectroscopy), surface morphology (scanning electron microscope), and surface hardness of enamel (Vicker's microhardness) before and after bleaching were evaluated. The obtained data were statistically analyzed. When the bleaching levels of the groups were compared, no statistically significant difference was observed between the control and 1% CPP-ACP groups (p > 0.05) while the addition of 3% CPP-ACP decreased significantly the effectiveness of the bleaching agent (p < 0.05). When the effects of experimental bleaching agents on surface hardness were examined, while the enamel surface hardness decreased statistically significantly after application in the control group (p < 0.05), no statistically significant change was observed in surface hardness after the application of 1% CPP-ACP containing bleaching agent (p > 0.05). However, a statistically significant increase was observed in surface hardness after the application of 3% CPP-ACP containing bleaching agent (p < 0.05). When the Ca and P ratio of the groups were compared, no statistically significant difference was observed between the control and 1% CPP-ACP groups (p > 0.05), while they increased significantly in 3% CPP-ACP group (p < 0.05). The addition of 1% CPP-ACP to the bleaching agent had positive effects on the mineral content and surface hardness of the enamel, and did not negatively affect the whitening effectiveness. Adding CPP-ACP to the bleaching agent at appropriate concentrations can eliminate possible negative effects without compromising the effectiveness of the bleaching agent.

An in vitro evaluation of the effects of fluoride, CPP-ACP, or resin infiltration on discoloration caused by pediatric supplements.

White spot lesions are more susceptible to staining agents due to their porous structure. This study examines the impact of white spot lesion treatments on discoloration caused by pediatric supplements. Three treatments (fluoride, casein phosphopeptide-amorphous calcium phosphate [CPP-ACP], resin infiltration), a control, and their respective syrup-based subgroups (iron and black elderberry syrups) were established, each with eight teeth. Artificial white spot lesions were induced, and weekly applications of fluoride varnish, daily applications of CPP-ACP paste, or a single resin infiltration procedure were performed on the white spot lesions within the treatment groups over 4 weeks. Simultaneously, samples were exposed daily to iron or black elderberry syrups. Spectrophotometer measurements were taken at baseline, after demineralization (T0), and after 1 (T1), 2 (T2), and 4 weeks (T4). ΔE00 values were calculated. Statistical analysis was conducted using a three-way mixed-design ANOVA, with the significance level set at P = .05. At T4, ΔE00 values from all groups exceeded the clinical acceptability limit of 1.8. At T2 and T4, the ΔE00 values obtained from the black elderberry syrup subgroups were significantly higher (P < .001). At T4, the highest ΔE00 values were seen in the CPP-ACP groups (P < .001). The lowest ΔE00 values at T2 and T4 were observed in the resin infiltration groups (P < .05). Supplements containing ferrous sulfate and black elderberry extract caused color changes in white spot lesions that exceeded the clinical acceptability limit. Resin infiltration of white spot lesions provides advantages over remineralization treatments, particularly in minimizing discoloration induced by pediatric supplements.

Effect of Two Remineralizing Agents on Dentin Microhardness of Non-Caries Lesions.

The prevalence of non-carious dentin lesions is on the rise mainly due to improved life expectancy. Successful management of these lesions is often challenging, and given that dentin can be remineralized, adverse consequences due to progression of these lesions can be prevented or minimized as such. This study aimed to assess the effect of casein phosphopeptide amorphous calcium phosphate (CPP-ACP) and Remin-Pro remineralizing agents on dentin microhardness of non-carious dentin lesions. This in vitro, experimental study evaluated 36 extracted sound human premolars. The teeth were decoronated at the cementoenamel junction. Enamel was removed, and dentin was exposed at the cervical third of the buccal surface. The primary microhardness of dentin was then measured. The teeth, standardized in terms of dentin microhardness, then underwent demineralization by acid etching and were subjected to microhardness test again. They were then randomized into three groups for treatment with CPP-ACP, Remin-Pro, and artificial saliva (control), and dentin microhardness was measured for the third time after treatment. Data were analyzed using ANOVA. Within group comparisons showed a significant difference in microhardness at the three time points in all three groups (p< 0.005). Between-group comparisons revealed that the microhardness of the three groups was not significantly different at baseline or after demineralization. However, the microhardness of the three groups was significantly different after the intervention (p= 0.000). Pairwise comparisons revealed significantly higher microhardness in the CPP-ACP group than the other two groups (p= 0.003). Remin-Pro and the control groups were not significantly different in this respect (p= 0.340). CPP-ACP can be used for remineralization of non-caries dentin lesions; however, Remin-Pro does not appear to be effective for this purpose.

Comparative Evaluation on the Effect of Different Remineralizing Agents on Enamel-Bracket Shear Bond Strength: An In Vitro Study.

This study aimed to compare the effects of applying various remineralizing agents before and after acid etching on the enamel-bracket shear bond strength (SBS) in vitro. These agents included silver diamine fluoride (SDF), casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), and 5% sodium fluoride (5% NaF). All the selected teeth were divided equally into six subgroups depending on before and after acid etching and one separate control group for the in vitro study design. Eighty-four extracted premolar teeth (12 teeth in each group x seven groups, including the control group). Before acid etching, teeth in groups A1, B1, and C1 were given SDF, CPP-ACP paste, and 5% NaF, respectively. Following acid etching, all of the teeth in Groups A2, B2, and C2 received the same preventative treatments. After that, the SBSof the bonded brackets to the enamel was evaluated. The CPP-ACP group, control group, and SDF group had the highest values for SBS prior to acid etching.The 5% NaF group had the weakest bonds, and the difference between the groups was statistically significant. The CPP-ACP group had the highest SBS following acid etching, followed by the 5% NaF group. The least bond strength was seen in the SDF group, and the difference between the three groups was significant. When it comes to bonding orthodontic brackets, the CPP-ACP pretreatment is superior to fluoride pretreatment in terms of effectiveness. The use of these remineralizing agents resulted in favorable values that did not have any effect on the SBS and were therefore safe to use with orthodontic brackets.

Comparative evaluation of four treatments for postorthodontic white spot lesions: a randomized controlled trial.

To evaluate the treatment efficacy of fluoride toothpaste alone and those of adjunctive use of resin infiltration, sodium fluoride varnish, and casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) on white spot lesions (WSLs). Seventy-nine patients (356 teeth) with WSLs after orthodontic treatment were randomly allocated into four groups. The WSLs of the participants received resin infiltration only at baseline, and the other groups received fluoride varnish, CPP-ACP mousse, and placebo treatment every 6months, respectively. A toothpaste containing 1400ppm fluoride and toothbrushes were distributed to all participants, and oral hygiene instructions were provided. Photos of the teeth with WSL were taken to compare the change between groups which was measured by ImageJ software. Twelve months later, different degrees of reduction in the area of WSLs were observed in all groups. The percentage of lesion area reduction in WSLs in the resin infiltration group was 46.6%, which was significantly higher than that in fluoride varnish group (26.6%), CPP-ACP group (28.6%), and control group (29.8%), and the differences were statistically significant (p < 0.001). This study shows that after 1-year follow-up, the use of fluoride toothpaste, with or without the use of fluoride varnish or CPP-ACP, can reduce the area of WSLs. While resin infiltration can immediately improve dental aesthetics and continuously improved in 12months, resin infiltration groupshowed much better results than other groups. Clinical Trials Registration Number: ChiCTR2000032516. The use of fluoride toothpaste, with or without adjunctive use of fluoride varnish and CPP-ACP, can reduce the area of WSLs, while resin infiltration treatment has additional effect and can immediately improve dental aesthetics.

Laser – fluorescence based evaluation of remineralization in artificial enamel lesions using three commercially available re-mineralizing agents – An invitro study

The objective of this in-vitro study is evaluation of remineralization potential of three remineralization agents- Tricalcium phosphate flouride(TCP-F), Calcium sucrose phosphate(CaSP), Casein phosphopeptide- amorphous calcium phosphate(CPP-ACP) in artificial enamel lesion using laser fluorescence based DIAGNOdent(KaVo). 30 single rooted premolars were selected. Samples were randomly divided into 3 groups with 10 samples each. Baseline values were recorded before any intervention. A 4mmx4mm window was prepared on the buccal surface which was then subjected to demineralization for 96 hr at 37°C. DIAGNOdent values were recorded after demineralization. Remineralization was done using Group I TCP-F, Group II CaSP, Group III CPP-ACP remineralizing agents. The samples were subjected to DIAGNOdent analysis after 72hrs, 7days, 14 days. The data was analyzed with analysis of variance (ANOVA) and Post Hoc test. All three groups showed significant difference in DIAGNOdent values at baseline, post demineralization and post remineralization. TCP-F group showed maximum remineralization followed by CaSP and CPP-ACP groups. DIAGNOdent is a reliable non-invasive caries detecting device to measure early demineralization. TCP-F, CaSP, CPP-ACP are proven to possess remineralization properties.

Synergistic remineralization of enamel white spot lesions using mesoporous bioactive glasses loaded with amorphous calcium phosphate.

Objectives: The purpose of this study was to create a new delivery system that can synergistically remineralize enamel white spot lesions (WSLs). Materials and methods: The delivery system (PAA-ACP@aMBG) was prepared by using aminated mesoporous bioactive glasses (aMBG) as the carrier loaded with polyacrylic-stabilized amorphous calcium phosphate (PAA-ACP). The materials were characterized by transmission electron microscopy (TEM), X-ray powder diffraction (XRD), inductively coupled plasma-optical emission spectrometry (ICP-OES), and so on. Forty-eight artificial WSLs enamel samples were randomized to four groups: artificial saliva (negative control, NC), casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), PAA-ACP@aMBG, and MBG. The effects of demineralization and remineralization of the enamel surface were compared by means of surface microhardness (SMH) measurements, surface color change measurements, fluorescence microscopy (FM), X-ray diffraction (XRD) analysis and scanning electron microscopy (SEM). Results: There was no significant difference in the surface microhardness recovery rate (SMHRR) or color recovery rate (CRR) among the CPP-ACP group, PAA-ACP@aMBG group and MBG group (P>0.05), but these values were significantly higher than those in the NC group (p < 0.01). FM demonstrated that the remineralization depth in the PAA-ACP@aMBG group was significantly greater than that of the remaining three groups (p < 0.01). SEM analysis indicated that the enamel demineralization marks in the PAA-ACP@aMBG group, CPP-ACP group, and MBG group were obscured by mineral deposition. Conclusions: PAA-ACP@aMBG showed good mineralization properties, implying its great potential for clinical application.

In vitro evaluation of remineralizing agents on dentinal tubule occlusion: A scanning electron microscopic study.

Over the years, numerous treatment modalities have been researched for the management of dentinal hypersensitivity. A recent remineralizing agent containing a phase of amorphous calcium phosphate combined with fluoride has shown the ability to rapidly convert into biomimetic hydroxyapatite. This potential can be utilized in occluding the dentinal tubules for the treatment of hypersensitivity. The present study aims to compare the effectiveness of biomimetic hydroxyapatite-based tooth mousse and casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) tooth mousse as desensitizing agents on dentinal tubule occlusion. The in vitro study design involved 30 prepared dentin specimens that were divided into three groups: Group A: negative control, Group B: CPP-ACP tooth mousse (GC tooth mousse™), and Group C: fluoride-doped amorphous calcium phosphate (F-ACP) tooth mousse (Curasept Biosmalto Denti Sensibili Tooth Mousse). The specimens were observed under a scanning electron microscope (SEM) and an attached energy-dispersive X-ray (EDX) spectroscopy apparatus after 1 week. The data were analyzed using Kruskal-Wallis test and post hoc Mann-Whitney test for intragroup and intergroup analysis, respectively. The SEM analysis of the F-ACP group showed statistically greater percentage of tubule occlusion (40.21%) compared to the CPP-ACP group (38.15%). EDX analysis of both F-ACP and CPP-ACP groups revealed calcium, phosphorus, carbon, oxygen, and silica with an additional fluoride element in the F-ACP group. In the present study, both remineralizing agents were able to occlude the dentinal tubules. Among the two, the F-ACP tooth mousse showed greater tubule occlusion, and therefore, appears promising as an upcoming remineralizing agent in the management of dentinal hypersensitivity.

Long-term evaluation of early-enamel lesions treated with novel experimental tricalcium silicate paste: A 2-year randomized clinical trial.

The aim of the current study is to evaluate the remineralization potential of experimental tricalcium silicate (TCS) paste in comparison with more popular remineralizing agents like silver diamine fluoride potassium iodide (SDF-KI) and casein phosphopeptide amorphous calcium phosphate (CPP-ACP) on early enamel lesions. Forty-five patients in the age range of 15-50 years had early enamel lesions on the buccal surface of molar teeth. The patients were randomly divided into three treatment groups (SDF-KI, CPP-ACP, and TCS group) with 15 patients per group. Lesions were evaluated clinically by DIAGNOdent pen immediately and after 3,6,12, and 24 months of treatment. The study was completed with 45 patients and 92 teeth. Twice-daily application of CPP-ACP and TCS paste showed a significant remineralization effect on early enamel lesions after 24 months (p< 0.001). Also, annual application of SDF-KI showed a significant remineralization effect after 24 months (p< 0.001). There was a significant difference between (SDF-KI and CPP-ACP) and (SDF-KI and TCS) at the different follow-up periods 3,6,12, and 24 months (p< 0.001). Meanwhile, there was no significant difference between CPP-ACP and TCS at the mentioned follow-up periods (p> 0.05). TCS showed potential remineralization for early enamel lesions. Experimental TCS is a promising remineralizing agent for management of early enamel lesions.

Efficacy of a Novel Bioactive Glass-Polymer Composite for Enamel Remineralization following Erosive Challenge.

Introduction Dental caries is the most common cause of tooth loss. However, it can be stopped by enhancing remineralization. Fluoride and casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) are among the most important remineralizing agents. Recent studies have used bioactive glass as a remineralizing agent in different forms. This study aimed to assess the efficacy of a composite paste (prepared by mixing urethane polypropylene glycol oligomer with bioactive glass powder for easier application). Materials and Methods Enamel disks were cut out of the buccal surface of extracted sound third molars. The samples were randomly divided into 3 groups of 15 and underwent Vickers microhardness test. X-ray diffraction (XRD) and field emission scanning electron microscopy/energy dispersive X-ray spectroscopy (FESEM/EDS) were performed. All samples were immersed in a demineralizing solution for 14 days. The tests were then repeated. Next, bioactive glass paste, fluoride, and CPP-ACP were applied on the surface of the samples and they were then stored in an artificial saliva for 14 days. The tests were repeated again. The microhardness values were analyzed using repeated measures ANOVA followed by one-way ANOVA and Tukey's post hoc test (P < 0.05). Results The microhardness of the bioactive glass group was significantly higher than that of other groups (P < 0.05). XRD revealed an enamel structure more similar to sound enamel in the bioactive glass and CPP-ACP groups compared with the fluoride group. FESEM/EDS revealed higher hydroxyapatite deposition in the bioactive glass group than in the other two groups. Conclusions All three remineralizing agents caused remineralization, but bioactive glass paste had a greater efficacy.

Efficacy of Nano Crystallised Calcium Phosphate (NCCP) and Casein Phosphopeptide – Amorphous Calcium Phosphate (CPP-ACP) for Controlling Postoperative Sensitivity After Power Bleaching-A Comparative In-Vivo Study

Tooth bleaching is one of the most popular cosmetic dental procedures opted by the patients who desire pleasing smile. It is the simplest, least invasive means available to lighten discolored vital teeth. A number of desensitizing agents have been tried in an attempt to counteract bleaching-related sensitivity. This study was done to compare the effect of two different desensitizing agents for controlling post operative sensitivity after power bleach procedure. Sixty volunteers with mild to moderate dental fluorosis in maxillary anterior teeth, who fulfilled the inclusion and exclusion criteria, were randomly selected for this study. After the bleaching procedurea demo was given to the patient while application of desensitising gel and was instructed to use the gel for 14 days.All the patients were recalled at an interval of 1st day, 3rdday, 5th day, 7th day, and on 14th day to record the post operative sensitivity after power bleach procedure. The observations were analyzed using one way analysis of variance (ANOVA), Tukeys post hoc test. On the basis of VAS results, all the groups showed post operative sensitivity of varied intensity at different intervals. NCCP showed less sensitivity followed by CPP-ACP and Control group.&#x0D; Keywords: Power Bleaching, Post operative sensitivity, Nano Crystallized Calcium Phosphate, Casein Phosphopeptide-Amorphous Calcium Phosphate

Management of Post Orthodontic White Spot Lesions Using Resin Infiltration and CPP-ACP Materials- A Clinical Study

The purpose of this present study was to assess and compare the effectiveness and durability of topical application of remineralizing agent Casein Phospho Peptide (CPP-ACP, Toothmousse, GC corporation, Germany, Europe) and Resin infiltration (ICON, DMG, Hamburg, Germany) in the management of post orthodontic white spot lesions. A Randomized Control clinical trial was conducted among 60 children who had undergone fixed orthodontic therapy presented with white spot lesions (WSLs) on maxillary or mandibular anteriors after debonding. Identification of WSLs was done with International Caries Detection and Assessment System (ICDAS II) criteria. The clinical photographs recorded were used to measure the size of lesion. The color assessment of the lesion and sound adjacent enamel was recorded by using spectrophotometer (Vita-Easy shade 4.0, VITA Zahnfabrik, Germany). Area of the lesion was calculated using Digimizer software (Digimizer, MedCalc Software, Belgium). The selected samples were randomly allocated into two groups: Group I- Resin infiltration- Icon, DMG, Germany, (n=30) and Group II- Casein Phosphopeptide-Amorphous Calcium Phosphate (CPP-ACP)-GC Toothmousse, GC Corporation, Germany, (n=30). The WSLs were evaluated immediately following resin infiltration, and in CPP-ACP group after 1 month. In both the groups lesions were evaluated at 1, 3, 6 and 12 months. There was significant reduction in lesion area, and improvement in color of white spot lesions with both of the treatment modalities. Both the resin infiltration and CPP-ACP have desired and durable esthetic improvement in terms of reduction in the area as well as color of post orthodontic white spot lesions.

Comparison of Casein Phosphopeptide with Potassium Nitrate and Sodium Monofluorophosphate Desensitizing Efficacy after In-Office Vital Bleaching—A Randomized Trial

Casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), potassium nitrate, and sodium monofluorophosphate are desensitizing agents that help in reducing teeth sensitivity. However, indecisive evidence exists regarding their efficacy. Therefore, this study was conducted to compare the desensitizing efficacy of casein phosphopeptide-amorphous calcium phosphate and potassium nitrate with sodium monofluorophosphate agents after in-office vital bleaching. A randomized controlled trial was conducted on 2011 patients. The patients were randomly and equally divided into the CPP-ACP group (group 1), potassium nitrate with sodium monofluorophosphate group (group 2), and placebo gel (group 3). The upper and lower anterior teeth including the first premolar were isolated with a rubber dam, then the bleaching agents were applied on the labial surface of all the teeth, followed by light activation for 15 min. The procedure was repeated 3 times with an interval of 5 min in-between. After carrying out the bleaching procedure, patients were given a desensitizing gel or placebo gel in unmarked syringes with an instruction to apply it every 12 h for up to 3 days. The intensity of pain was recorded using a discomfort interval scale (DIS). A decrease in pain was observed 24 h after the application of the desensitizing gel in groups 1 and 2. However, in group 3, the pain persisted, with 46 (69.69%) patients having moderate pain and 14 (21.21%) developing severe pain over time. A significant difference in discomfort level with time was noted in group 1 (p = 0.015) and group 2 (p = 0.036). However, no significant difference was found in group 3 (p = 0.085). It was concluded that both desensitizing agents performed exceptionally well in reducing teeth sensitivity.

An evaluation of remineralised MIH using CPP-ACP and fluoride varnish: An in-situ and in-vitro study.

Molar incisor hypomineralization (MIH) affected teeth have enamel with altered mineral content like decreased calcium and phosphorus and increased carbon content leading to porous enamel and subsequent post-eruptive breakdown. An in situ study was conducted to evaluate and compare the effects of a Casein Phosphopeptide-Amorphous Calcium Phosphate (CPP-ACP)-based cream and fluoride varnish on the remineralization of MIH affected teeth. Enamel slabs were prepared from MIH affected teeth that had been extracted for various reasons and inserted in appliances of 30 participants who were undergoing interceptive orthodontic therapy. They were randomly divided into two groups using block randomization technique: Group A-daily single application of CPP-ACP cream (n = 15); Group B-professional application of fluoride varnishes every 3months (n = 15). After 6months of regular wear of the appliance, the enamel slabs were placed under Field Emission Scanning Microscope (FESEM) and Energy-Dispersive Spectroscopy (EDS) for evaluation of ultra structure and mineral content, respectively. A significant increase in calcium and phosphorus content, and a decrease in carbon content was observed within the 6months period, suggesting remineralization in both the groups. On comparing the Ca:P and Ca:C ratios, a significant increase in the Ca:C ratio was evident in the two groups. No significant difference was seen in the Ca:P ratio in the CPP-ACP group at six months. The inter-group comparison did not reveal any significant difference between the two groups either at baseline or at 6months post-intervention. Remineralization can be achieved in MIH affected teeth with the use of remineralizing agents.

Effect of preconditioning the fractured coronal fragments with remineralizing agents on fracture resistance of re-attached teeth.

Fragment re-attachment has been considered as one of the treatment modalities for the management of fractured anterior teeth. Hydration of fractured fragments aids in inhibiting the loss of ions and maintains vitality and esthetics. The study aimed to evaluate the effect of preconditioning the fractured fragments with remineralizing agents on fracture resistance of re-attached teeth. This was an in vitro study. Sixty freshly extracted noncarious human permanent maxillary central and lateral incisors were randomly allocated into three Groups of 20 each: Group 1: 2% sodium fluoride (2%NaF), Group 2: casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), and Group 3: self-assembling peptide P11-4 (SAP). These were further divided into two subgroups of 10 teeth each, based on contact time with remineralizing agents, i.e., 30 min and 2 h. Fractured fragments were treated with remineralizing agents for a specified contact time and then re-attached with flowable composite resin. Force required to fracture the re-attached tooth was recorded in Newtons using universal testing machine. Unpaired t-test, one-way analysis of variance test, and post hoc Tukey test were used for the statistical analysis. A higher fracture resistance was noticed in fragments treated with 2% NaF (30 min- 215.6 N, 2 h- 188.5 N) compared to CPP-ACP (30 min- 141.3 N, 2 h- 111.1 N) and SAP (30 min- 134.8 N, 2 h- 149.5 N). At 30 min interval, it was found to be more in 2% NaF and CPP-ACP groups compared to 2 h. However, it increased with time in the SAP group. A statistically significant difference was found between the groups at both time intervals (P = 0.007 and 0.017). Preconditioning of fractured coronal fragments with 2% NaF showed higher fracture resistance compared to CPP-ACP and self-assembling peptide P11-4. Samples treated with SAP P11-4 exhibited good fracture resistance at 2 h contact time.

Effect of nano-hydroxyapatite versus caesin-phosphopeptide amorphous calcium phosphate on remineralization of early enamel lesions - In vitro study

Objective: To evaluate and compare the effect of zinc carbonate - nano hydroxyapatite (n-HA) (Biorepair toothpaste) and casein phosphopeptide - amorphous calcium phosphate (CPP-ACP) (GC Tooth Mousse creme) on the depth of white spot lesions (WSLs). Materials and Methods: Thirty six human premolar teeth with artificially induced WSLs were randomly assigned to three groups (n=12). Group I: n-HA toothpaste, Group II: CPP-ACP topical creme, and Group III: negative control. The teeth were longitudinally sectioned and photographed using polarized light microscopy (PLM) and the depth of enamel subsurface demineralization was measured. Statistical analysis was performed. Results: The n-HA group showed the least mean lesion depth, followed by the CPP-ACP group (76.8 ± 10.2 μm and 79.8 ± 9.7 μm respectively), while, the control group showed the largest mean lesion depth (107.8 ± 8.5 μm). The difference between the control group and each of the test groups was significant (p < 0.001), while there was no significant difference between the two test groups. Conclusion: Both n-HA and CPP-ACP showed significant remineralization of the early enamel lesions compared to the control group.

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.

Enamel Hardness Differences After Topical Application Of Theobromine Gel And Casein Phosphopeptide-Amorphous Calcium Phosphate

Background: Most soft drinks contain citric acid / phosphoric acid with pH &lt;3.5. Strong acids in the oral cavity cause tooth erosion. Tooth erosion leads to demineralization enamel. Remineralization can prevent demineralization process. One of the commercial remineralization agents is Casein Phosphopeptide-amorphous Calcium Phosphate(CPP-ACP) but it has low solubility and less affordable price. Therefore, a natural ingredients such as theobromine from cocoa extract need to be developed as remineralization agent. Objective: To determine enamel hardness differences due to topical application of theobromine gel and CPP-ACP. Method: incisive crowns were cut off (1x1) cm then planted in cylindrical acrylic resin. All samples were immersed with citric acid for 90 minutes then divided into 3 groups. Group I (control) was immersed with aquades (96 min), group II was applied with theobromin gel 200 mg/l (96 min), group III was applied with CPP-ACP (96 min). By using vickers hardness tester, enamel hardness be measured (15 sec) at 3 points. Results: There were significant differences between the control group, CPP-ACP group, and theobromine gel group. Conclusion: Enamel hardnesse with theobromine gel application is higher than CPP-ACP application..

The effect difference of chitosan nanoparticles, chitosan microparticles, and casein phosphopeptide–amorphous calcium phosphate in reducing enamel demineralization

Background: Chitosan has been shown to inhibit free radicals that cause tooth enamel demineralization. Nano-sized chitosan can penetrate cell membranes that larger particles cannot penetrate. Objective: This study aimed to determine the difference between chitosan nanoparticles, chitosan microparticles, and casein phosphopeptide–amorphous calcium phosphate (CPP-ACP) in preventing tooth enamel demineralization. Methods: We used 0.2% chitosan nanoparticles. A total of 50 mL of chitosan solution was stirred and added in tripolyphosphate to prepare a nanoparticle suspension. It was then stirred for 1 h to generate crosslinking. The nanoparticles' size was 57.6 nm. The demineralization solution consisted of 2.2 mM/L CaCl2, 2.2 mM/L KH2PO4, and 50 mM of acetate buffer. Its acidity was regulated to a pH of 4.06. The sample consisted of 27 maxillary first premolar teeth post extraction due to orthodontic treatment needs divided into three groups: a chitosan microparticle treatment group, a chitosan nanoparticle treatment group, and a CPP-ACP treatment group used as a positive control. A scanning electron microscope with ×5000 magnification was used to observe the enamel surface morphology and mineral release. Results: The mean value of enamel surface microhardness in the chitosan nanoparticle group (233.39 HV) was significantly greater than those in the chitosan microparticle (153.192 HV) and CPP-ACP groups (152.626 HV) (P < 0.05). Moreover, the chitosan nanoparticle treatment resulted in the lowest enamel porosity. Conclusions: Chitosan nanoparticles are more effective than chitosan microparticles and CPP-APP in preventing enamel demineralization.

Efficacy of diode and CO2 lasers along with calcium and fluoride-containing compounds for the remineralization of primary teeth

BackgroundThis study aimed to assess the efficacy of a 980-nm diode and 10.6-μm CO2 laser accompanied by tricalcium phosphate-5% sodium fluoride (fTCP) and casein phosphopeptide amorphous calcium phosphate (CPP-ACP) for the remineralization of primary teeth.MethodsIn total, 117 extracted primary anterior teeth were randomly divided into eight experimental and one control group: (I) control (polished enamel), (II) fTCP varnish, (III) fTCP + diode laser, (IV) fTCP + CO2 laser, (V) CPP-ACP, (VI) CPP-ACP + diode laser, (VII) CPP-ACP + CO2 laser, (VIII) diode laser, and (IX) CO2 laser. The microhardness of 12 samples in each group and the enamel porosity of one sample in each group were assessed before and after demineralization and 28 days after remineralization. Data were analysed using two-way ANOVA.ResultsSignificant differences existed in microhardness (P = 0.004) and percentage of remineralization (P < 0.001) after remineralization among the material groups such that the highest mean was noted in the CPP-ACP group. No significant difference was noted in microhardness (P = 0.052) or percentage of remineralization (P = 0.981) after remineralization among the laser groups. In all groups, porosities increased after demineralization and slightly decreased after remineralization; the greatest reduction in porosity of the material groups was noted in the fTCP group, and the CO2 group among the laser groups. The interaction effect of materials and lasers was not significant (P > 0.05).ConclusionThe highest microhardness was achieved after remineralization with CPP-ACP. The efficacy of the diode and CO2 lasers was the same. No synergistic effect was found between materials and lasers.Trial registrationThis is not a human subject research.