Casein Phosphopeptide-amorphous Calcium Phosphate Nanocomplexes Research Articles

The Penetration Depth of Resin Infiltration Into Enamel: A Systematic Review.

Studies on resin infiltration and its penetration capability are becoming the focus of emerging dentistry. The depth of resin penetration could be a key determining factor in creating a diffusion barrier and in the success of infiltration. The aim of this review article was to evaluate the penetration depth of commercially available resin infiltration in early caries lesions and to identify factors that influence the penetration capability of resin infiltration. A literature search was performed in four databases (PubMed, Science Direct, Scopus, and Web of Science) and manual searching from 2009 to December 2022. Eligibility criteria included in vitro studies pertaining to factors affecting the penetration depth of resin infiltration into the enamel. The risk of bias assessment was done by using checklist for reporting in vitro studies (CRIS). The initial search resulted in a total of 297 studies. Twenty-nine were assessed for eligibility, and 23 were selected in the qualitative synthesis. According to the CRIS guidelines, all of the studies were classified as moderate risk of bias. The penetration of resin infiltration is influenced by the enamel surface treatment with hydrochloric acid, formulations containing triethylene glycol dimethacrylate (TEGDMA), the addition of ethanol, penetration time, duration of penetration time, saliva contamination, caries activity, and type of tooth. The hypermineralized surface layer needs to be removed for better resin perfusion. The key to optimal resin infiltration depends on the enamel surface treatment with hydrochloric acid and application technique, infiltration duration, formulation of TEGDMA and ethanol in the resin composition, as well as the type and caries activity of involved teeth. Resin infiltration has superior penetrability compared to fissure sealant, casein phosphopeptide-amorphous calcium phosphate nanocomplexes, flowable composite, adhesive and fluoride varnish. Resin penetration depth may be a critical factor in forming a diffusion barrier and the effectiveness of infiltration in halting the progression of caries.

NANOCOMPLEJO DE FOSFOPÉPTIDO DE CASEÍNA-FOSFATO DE CALCIO AMORFO (CPP-ACP) EN ODONTOLOGÍA: ESTADO DEL ARTE

Saliva and external agents containing different concentrations of sodium fluoride (NaF) promote the dental remineralization process. However, these resources may not be sufficient to counteract the multiple factors involved in the process of dental caries, especially in high-risk patients. There are alternatives that have been extensively researched, such as casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) which provides essential ions, like phosphate and calcium, acting as an adjuvant in the remineralization process. Manufacturers of CPP-ACP-based products also suggest that it can produce desensitizing effects. This nanocomplex has been used experimentally with some dental cements and adhesive systems, but it is important to clarify the effects of this procedure, and the remineralizing/desensitizing advantages it offers. The objective of this topic review was to present the state of the art on CPP-ACP nanocomplex. In terms of dental caries prevention, this remineralizing option is not better than NaF. CPP-ACP provides a dental desensitizing action, but it is temporary and less effective than other alternatives such as potassium nitrate or NaF. The experimental incorporation of CPP-ACP into dental cements should be controlled for not to compromise the physico-chemical properties of the material. The use of dental products based on this nanocomplex as dental surface pretreatment may decrease the bond strength of adhesive materials, but this effect is material dependent.

Comparative evaluation of Nano-hydroxyapatite and casein Phosphopeptide-amorphous calcium phosphate on the remineralization potential of early enamel lesions: An in vitro study

Background: Benefits of remineralizing agents in a wide variety of formulations have been proved beneficial in caries management. Casein phosphopeptide-amorphous calcium phosphate (CPP–ACP) nanocomplex has been recommended and used as remineralizing agent. Nano-hydroxyapatite (n-HAp) is one of the most biocompatible and bioactive material having wide range of application in dentistry, but does it excel better compared to CPP-ACP. Aims: To evaluate and compare the remineralizing efficiency of the paste containing hydroxyapatite and casein phosphopeptide-amorphous calcium phosphate. Settings and Design: The study was an in vitro single blinded study with lottery method of randomization approved by the Institutional Ethics Committee. Materials and methods: 30 non carious premolar teeth. The teeth were demineralized and divided into 2 groups and subjected to remineralization. The samples were analysed for surface hardness and mineral content. Statistical Analysis: Student t’ test and repeated measures of ANOVA was applied. Results: Average hardness in Nano-hydroxyapatite group increased to 340 ± 31.70 SD and 426 ± 50.62 SD for 15 and 30 days respectively and that of (CPP–ACP), 355.83 ± 38.55 SD and 372.67 ± 53.63 SD. The change in the hardness values was not statistically significant with P value of 0.39 (P > 0.05). Calcium and Phosphorous levels increased in both the groups but was not significant. Conclusion: Both the agents used are effective in causing remineralization of enamel. Nano-hydroxyapatite is more effective as compared to Casein phosphopeptide-amorphous calcium phosphate, in increasing the Calcium and Phosphorus content of enamel, and this effect is more evident over a longer treatment period. Key Message: Remineralizing agents are a boon for caries management. With the advent of many formulations it is difficult to clinically select the agent. This study compares the remineralizing potential of Casein phosphopeptide-amorphous calcium phosphate nanocomplex and Nano-hydroxyapatite and found that both are effective as remineralizing agents.

In vivo remineralising effect of GC Tooth Mousse on early dental enamel lesions: SEM analysis

Casein phosphopeptide-amorphous calcium phosphate nanocomplexes (CPP-ACP) exhibit anticariogenic potential in laboratory, animal and human experiments. The remineralising potential of synthetic CPPs on early enamel caries was investigated. In vivo study. University of Naples 'Federico II', School of Dentistry, Department of Paediatric Dentistry, 2010, Italy. 40 volunteers (age range 10-16 years) were recruited and divided in two groups of 20 (Group A and B). In Group A subjects two demineralised enamel specimens were placed on the buccal surfaces of the first molars and subjects were instructed to apply a commercial product containing CPPs (GC Tooth Mousse) only on the right-sided specimen and a placebo mousse on the left, for 1 month. In Group B subjects two enamel specimens were similarly placed into the mouth and used as controls. SEM analysis revealed a diffuse and homogeneous mineral coating, reducing the surface alterations only in the demineralised specimens treated with synthetic CPPs into the mouth. Results demonstrate that CPPs are able to promote remineralisation of early enamel lesions.

Remineralization of enamel subsurface lesions in situ by the use of three commercially available sugar‐free gums

Commercially available sugar-free chewing gums have been claimed to provide oral health benefits. The aim of this randomized, double-blind crossover in situ study was to compare the efficacy of three commercially available sugar-free chewing gums: Trident White, Orbit, and Orbit Professional, in remineralizing enamel subsurface lesions in situ. Specimens containing enamel subsurface lesions were sectioned into test and control half-slabs with the test half-slabs inserted into removable palatal appliances. For each test chewing period, subjects were randomly allocated one of three test gums. Subjects (n = 10) chewed the randomly allocated gum for a 20-min period four times per day for 14 days. Each subject chewed all three test gums, with a 7-day washout period between crossovers. After each 14-day cycle, test and control half-slabs were paired, embedded in resin, sectioned, and subjected to microradiography to determine remineralization. The gum TW produced significantly greater remineralization (18.4 +/- 0.9%) than Orbit (8.9 +/- 0.5%) and Orbit Professional (10.5 +/- 0.9%). The superior remineralization activity of the TW gum in situ was attributed to the presence of casein phosphopeptide-amorphous calcium phosphate nanocomplexes.

Effects of Various Forms of Calcium Added to Chewing Gum on Initial Enamel Carious Lesions in situ

The purpose of this randomized, cross-over in situ study was to determine the effects of 4 chewing gums on artificial caries-like subsurface lesions. Two chewing gums (1 with zinc citrate and 1 without) contained dicalcium phosphate (3.9%), calcium gluconate (1.8%) and calcium lactate (0.45%), 1 chewing gum contained casein phosphopeptide-amorphous calcium phosphate nanocomplexes (0.7%), and another one contained no calcium. Fifteen subjects without current caries activity (7 male, 8 female; mean age: 27.5 ± 2.5 years) wore removable buccal appliances in the lower jaw with 4 bovine enamel slabs with subsurface lesions. The appliances were inserted immediately before gum chewing for 20 min and then retained for an additional 20 min. This was performed 4 times per day. Every subject chewed 4 different chewing gums over 4 periods of 14 days each. During a fifth period (control) the subjects only wore the appliances without chewing gum. At completion of each period the enamel slabs were embedded, sectioned and subjected to transversal microradiography. With regard to change of mineral loss and of lesion depth no significant differences could be found between chewing gums containing calcium and calcium-free chewing gums. Moreover, the chewing gum groups and the control group did not differ significantly if adjustments were made for baseline values (p > 0.05; ANCOVA). Under the conditions of the present study it may be concluded that the use of chewing gum offers no additional remineralizing benefit to buccal tooth surfaces, even if the chewing gum contains calcium compounds.

Acid Resistance of Enamel Subsurface Lesions Remineralized by a Sugar-Free Chewing Gum Containing Casein Phosphopeptide-Amorphous Calcium Phosphate

The aim of this clinical study was to investigate the acid resistance of enamel lesions remineralized in situ by a sugar-free chewing gum containing casein phosphopeptide-amorphous calcium phosphate nanocomplexes (CPP-ACP: Recaldent™). The study utilized a double-blind, randomized, crossover design with two treatments: (i) sugar-free gum containing 18.8 mg of CPP-ACP, and (ii) sugar-free gum not containing CPP-ACP as control. Subjects wore removable palatal appliances with insets of human enamel containing demineralized subsurface lesions and chewed the gum for 20 min 4 times per day for 14 days. After each treatment the enamel slabs were removed and half of each lesion challenged with acid in vitro for 8 or 16 h. The level of remineralization was determined using microradiography. The gum containing CPP-ACP produced approximately twice the level of remineralization as the control sugar-free gum. The 8- and 16-hour acid challenge of the lesions remineralized with the control gum resulted in 65.4 and 88.0% reductions, respectively, of deposited mineral, while for the CPP-ACP-remineralized lesions the corresponding reductions were 30.5 and 41.8%. The acid challenge after in situ remineralization for both control and CPP-ACP-treated lesions resulted in demineralization underneath the remineralized zone, indicating that the remineralized mineral was more resistant to subsequent acid challenge. The results show that sugar-free gum containing CPP-ACP is superior to an equivalent gum not containing CPP-ACP in remineralization of enamel subsurface lesions in situ with mineral that is more resistant to subsequent acid challenge.

Incorporation of casein phosphopeptide-amorphous calcium phosphate into a glass-ionomer cement.

Casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) nanocomplexes have been shown to prevent demineralization and promote remineralization of enamel subsurface lesions in animal and in situ caries models. The aim of this study was to determine the effect of incorporating CPP-ACP into a self-cured glass-ionomer cement (GIC). Incorporation of 1.56% w/w CPP-ACP into the GIC significantly increased microtensile bond strength (33%) and compressive strength (23%) and significantly enhanced the release of calcium, phosphate, and fluoride ions at neutral and acidic pH. MALDI mass spectrometry also showed casein phosphopeptides from the CPP-ACP nanocomplexes to be released. The release of CPP-ACP and fluoride from the CPP-ACP-containing GIC was associated with enhanced protection of the adjacent dentin during acid challenge in vitro.