Casein Phosphopeptide-amorphous Calcium Phosphate Treatment Research Articles

Long term remineralizing effect of casein phosphopeptide amorphous calcium phosphate in white spot lesions: A systematic review and meta-analysis.

White spot lesions (WSLs) appear as white, opaque areas on the teeth and are caused by a demineralization of the enamel. The purpose of this systematic review and meta-analysis was to determine whether casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) has beneficial effects on WSLs and provides remineralizing benefits that are superior to those of placebo or no treatment. Following a thorough analysis of the literature across major online sources, 103 papers - 54 of which underwent in-depth evaluation- were found. We used inclusion and exclusion criteria to choose research articles that were appropriate for our review. 10 papers met this review's requirements and were subsequently included. As compared to the controls, CPP-ACP demonstrated increased efficacy in treatment of WSLs in terms of remineralisation and other parameters which included microhardness tests and enamel surface roughness. The forest plots present the results of meta-analyses comparing the effect of CPP-ACP versus control/other agents on white spot lesions (WSLs). In terms of odds ratios (OR), CPP-ACP showed a small increase in the odds of WSLs compared to control/other agents. In-vitro studies showed no significant difference in relative risk (RR) between CPP-ACP and control/other agents. Randomized control trials indicated a small increase in the risk of WSLs with CPP-ACP treatment, but the overall effect was not statistically significant. There was evidence to support the use of CPP-ACP over other agents for WSL prevention or treatment, but further research is needed to confirm these findings.

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.

CPP-ACP Promotes SnF2 Efficacy in a Polymicrobial Caries Model

Dental caries is associated with plaque dysbiosis, leading to an increase in the proportions of acidogenic and aciduric bacteria at the expense of alkali-generating commensal species. Stannous fluoride (SnF2) slows the progression of caries by remineralization of early lesions but has also been suggested to inhibit glycolysis of aciduric bacteria. Casein phosphopeptide–amorphous calcium phosphate (CPP-ACP) promotes fluoride remineralization by acting as a salivary biomimetic that releases bioavailable calcium and phosphate ions, and the peptide complex has also been suggested to modify plaque composition. We developed a polymicrobial biofilm model of caries using 6 bacterial species representative of supragingival plaque that were cultured on sound human enamel and pulsed with sucrose 4 times a day to produce a high cariogenic challenge. We used this model to explore the mechanisms of action of SnF2 and CPP-ACP. Bacterial species in the biofilms were enumerated with 16S rRNA gene sequence analyses, and mineral loss and lesion formation were determined in the enamel directly under the polymicrobial biofilms via transverse microradiography. The model tested the twice-daily addition of SnF2, CPP-ACP, or both. SnF2 treatment reduced demineralization by 50% and had a slight effect on the composition of the polymicrobial biofilm. CPP-ACP treatment caused a similar inhibition of enamel demineralization (50%), a decrease in Actinomyces naeslundii and Lactobacillus casei abundance, and an increase in Streptococcus sanguinis and Fusobacterium nucleatum abundance in the polymicrobial biofilm. A combination of SnF2 and CPP-ACP resulted in a greater suppression of the acidogenic and aciduric bacteria and a significant 72% inhibition of enamel demineralization.

In vitro efficacy of CCP-ACP, Nano- hydroxyapatite, and Phosphorylated chitosan-ACP as anti-erosive agents on enamel

Purpose: This study assessed the anti-erosive effect of Casein Phosphopeptide-Amorphous Calcium Phosphate (CPP-ACP), nano-hydroxyapatite (nano-HAP) and phosphorylated chitosan Amorphous Calcium Phosphate (Pchi-ACP) on enamel. Materials and methods: A total of twenty five human incisors were ground and divided into five groups (n=5). Group1: intact enamel (negative control group) - Group 2: enamel + soft drink (positive control group). - Group3: enamel + soft drink+ CPP-ACP. Group4: enamel + soft drink+ 10% nano-HAP. Group5: enamel + soft drink+ Pchi-ACP. Four consecutive intervals of the immersion procedure were performed at 0, 8, 24 and 32 h for a total of 8 min. After each of the demineralizing immersion interval, the anti-erosive agent for groups 3, 4 & 5 was applied for 3 min. The total time for remineralization was 12 min. The root mean-square roughness (Rrms) was obtained from Atomic force Microscope images and the differences in the averaged values among the groups were analyzed by ANOVA, followed by Tukey’s post hoc test. The level of significance was set at P < 0.05. Results: Rrms of different groups at baseline was not statistically significant. However, after erosive demineralization, Rrms of group 2 increased and was significantly higher than all other groups. Rrms also significantly increased in group 3 subjected to CPP-ACP treatment after erosive demineralization. On the other hand, groups 4 and 5 did not show any significant change in Rrms. Conclusions: This study had revealed that nano-HAP and Pchi-ACP are promising remineralizing nano-biomaterials

Bond Strength of Self-Adhering Materials: Effect of Dentin-Desensitizing Treatment with a CPP-ACP Paste.

This study investigated the effect of dentin-desensitizing treatment with a casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) paste on shear bond strength (SBS) of two types of self-adhering (SA) restorative materials: resin-modified glass-ionomer (Fuji II LC, GC) and self-adhering flowable composite resin (Vertise Flow, Kerr). Flat and smear layer-free dentin surfaces from 48 extracted molars were prepared and divided into four groups (n = 12 per group) according to Fuji II LC or Vertise Flow and CPP-ACP pretreatment or not. After SBS testing, data were statistically analyzed. The adhesive interfaces were examined by scanning electron microscopy. SBS was significantly affected by CPP-ACP treatment (P < .001) and SA material (P < .05). The interaction of the two factors was not significant. The results suggested that the CPP-ACP pretreatment of the exposed dentin could have a beneficial effect on bonding ability and interfacial integrity of both SA materials so that intimately adapted interfaces were observed in CPP-ACP groups.

Effect of Fluoride Varnish Containing CPP-ACP on Preventing Enamel Erosion.

This study aimed to investigate the effect of a fluoride varnish with added casein phosphopeptide-amorphous calcium phosphate treatment on the prevention of enamel erosion, and it compared the results with those of other fluoride varnishes. Fifty enamel specimens obtained from bovine incisors were randomly divided into five groups (n = 10) based on the type of surface pretreatment used: intact enamel (Group 1); intact enamel+erosive cycles (Group 2); intact enamel+MI varnish+erosive cycles (Group 3); intact enamel+Clinpro White varnish+erosive cycles (Group 4); and intact enamel+Duraphat varnish+erosive cycles (Group 5). The specimens were subjected to erosive cycles for five days. The surface roughness was evaluated using atomic force microscopy. The results were statistically analyzed using one-way ANOVA and Tukey's tests. Group 1 had the smoothest surfaces. After the erosive cycles, the greatest surface roughness values were observed in Group 2, followed by Groups 5, 4, and 3, respectively. Statistically significant differences were observed among all groups (p < 0.05). The application of fluoride varnishes had some positive effects on preventing enamel erosion; however, the most effective agent was fluoride varnish with added casein phosphopeptide-amorphous calcium phosphate.

Casein Phosphopeptide-Amorphous Calcium Phosphate Reduces Streptococcus mutans Biofilm Development on Glass Ionomer Cement and Disrupts Established Biofilms.

Glass ionomer cements (GIC) are dental restorative materials that are suitable for modification to help prevent dental plaque (biofilm) formation. The aim of this study was to determine the effects of incorporating casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) into a GIC on the colonisation and establishment of Streptococcus mutans biofilms and the effects of aqueous CPP-ACP on established S mutans biofilms. S. mutans biofilms were either established in flow cells before a single ten min exposure to 1% w/v CPP-ACP treatment or cultured in static wells or flow cells with either GIC or GIC containing 3% w/w CPP-ACP as the substratum. The biofilms were then visualised using confocal laser scanning microscopy after BacLight LIVE/DEAD staining. A significant decrease in biovolume and average thickness of S. mutans biofilms was observed in both static and flow cell assays when 3% CPP-ACP was incorporated into the GIC substratum. A single ten min treatment with aqueous 1% CPP-ACP resulted in a 58% decrease in biofilm biomass and thickness of established S. mutans biofilms grown in a flow cell. The treatment also significantly altered the structure of these biofilms compared with controls. The incorporation of 3% CPP-ACP into GIC significantly reduced S. mutans biofilm development indicating another potential anticariogenic mechanism of this material. Additionally aqueous CPP-ACP disrupted established S. mutans biofilms. The use of CPP-ACP containing GIC combined with regular CPP-ACP treatment may lower S. mutans challenge.

Esthetic comparison of white-spot lesion treatment modalities using spectrometry and fluorescence

To compare the esthetic improvements of white-spot lesions (WSLs) treated by fluoride, casein phosphopeptide amorphous calcium phosphate (CPP-ACP), or resin infiltration. WSLs were created on human enamel and randomly assigned to four groups: NaF (500 ppm), CPP-ACP, resin infiltration (Icon), or distilled deionized water (DDW; control group). The color change (ΔE) of each specimen was measured with a Crystaleye spectrophotometer, and fluorescence loss (ΔQ) was measured by quantitative light-induced fluorescence (QLF), at different time points after treatment: baseline (0 weeks), 2 weeks, 4 weeks, and 6 weeks. The ΔE and ΔQ baseline values for the four groups before the treatments did not differ significantly. Icon treatment improved the WSL color significantly and gave the lowest ΔE (2.9 ± 1.2 on average) compared with other treatments (P < .01). The Icon treatment also resulted in a significant change in the ΔQ of WSLs compared with baseline (P < .01). In the NaF and CPP-ACP treatment groups, ΔQ showed significant recovery compared with the baseline values only after 4 weeks after treatment (P < .05). Resin infiltration is more effective than NaF or CPP-ACP in providing esthetic improvement of WSLs.

Treatment of white spot lesions with ACP paste and microabrasion

To examine the effects of application of casein phosphopeptide amorphous calcium phosphate (CPP-ACP) paste and microabrasion treatment on the regression of white spot lesions (WSLs). Artificially-induced WSLs in bovine enamel were randomly assigned to one of four treatment groups: CPP-ACP paste only, microabrasion only, microabrasion and CPP-ACP, and a control. Samples were treated with each regimen twice daily for 2 weeks and stored in remineralizing solution between the treatments. Quantitative light-induced fluorescence was used to measure changes in fluorescence, which indicate changes in mineral content of WSLs immediately before (T1) and 2 weeks after treatment (T2). A two-within-subject factor analysis of variance was used to analyze the significance of any changes in mineral content of the lesions from T1 to T2. There was a statistically significant (P < .05) gain in fluorescence associated with the microabrasion only, as well as the microabrasion and CPP-ACP treatments. The changes in fluorescence for the CPP-ACP treatment alone were not statistically significant (P = .40). CPP-ACP paste alone does not significantly improve the fluorescence value (ie, the mineral content) of WSLs. Within the limitations of this in vitro study, microabrasion treatment with or without CPP-ACP improved the fluorescence and thus reduced WSLs.

An SEM evaluation of conditioned and bonded enamel following carbamide peroxide bleaching and casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) treatment

The study aimed to evaluate, (a) the surface morphology of acid etched/conditioned enamel following carbamide peroxide bleaching with/without casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) (Tooth Mousse (MI Paste); GC Corp., Tokyo, Japan) treatment; and b) the nature of the bonded resin-enamel interfaces formed with a self-etching primer adhesive. Twenty-four human adult molars were each sectioned into four, the specimens divided and treated according to four experimental groups: 1, no treatment; 2, 16% carbamide peroxide bleaching; 3, CPP-ACP paste; 4, bleaching and CPP-ACP paste. A self-etching primer adhesive (Clearfil SE Bond, CSE) was used. The specimens were further divided into four subgroups for etching/conditioning: A, CSE Primer only; B, 30-40% phosphoric acid and CSE primer; C, 15% EDTA and CSE primer; D, 20% polyacrylic acid and CSE primer. Bonded specimens were also prepared. The morphology of the etched/conditioned enamel surfaces and polished resin-enamel interfaces of the bonded specimens were observed by field-emission scanning electron microscopy (FE-SEM). Treatment with CPP-ACP did not inhibit phosphoric acid etching of enamel. Poorly defined enamel etch patterns were observed with the other conditioners in all the groups. The morphology of the bonded resin-enamel interfaces observed on FE-SEM for each acid etching/conditioning subgroup was similar in all the experimental groups, except after bleaching. Resin infiltration into enamel was observed with prior phosphoric acid etching and polyacrylic acid conditioning and was unaffected by experimental group treatments. The use of a CPP-ACP paste with or without prior bleaching did not inhibit enamel etching. Enamel etching/conditioning may help improve bonding efficiency of the self-etching primer adhesive after CPP-ACP treatment.