Casein Phosphopeptide-amorphous Calcium Phosphate Research Articles

The damage and remineralization strategies of dental hard tissues following radiotherapy

ObjectivesThis study pursued two main purposes. The first aim was to expound on the microscopic factors of radiation-related caries (RRC). Further, it aimed to compare the remineralization effect of different remineralizing agents on demineralized teeth after radiotherapy.MethodsThe enamel and dentin samples of bovine teeth were irradiated with different doses of radiation. After analysis of scanning electron microscope (SEM), X-Ray diffraction (XRD), and energy dispersive spectrometer (EDS), the samples irradiated with 50 Gy radiation were selected and divided into the demineralization group, the double distilled water (DDW) group, the Sodium fluoride (NaF) group, the Casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) group, the NaF + CPP-ACP group, and the Titanium tetrafluoride (TiF4) group. After demineralization, remineralizing agents treatment, and remineralization, the samples were evaluated using SEM, atomic force microscope (AFM), EDS, and transverse microradiography (TMR).ResultsA radiation dose of 30 Gy was sufficient to cause damage to the dentinal tubules, but 70 Gy radiation had little effect on the microstructure of enamel. Additionally, the NaF + CPP-ACP group and the TiF4 group significantly promoted deposit formation, decreased surface roughness, and reduced mineral loss and lesion depth of demineralized enamel and dentin samples after radiation.ConclusionsRadiation causes more significant damage to dentin compared to enamel. NaF + CPP-ACP and TiF4 had a promising ability to promote remineralization of irradiated dental hard tissues.Advances in knowledgeThis in vitro study contributes to determining a safer radiation dose range for teeth and identifying the most effective remineralization approach for RRC.

Assessing the impact of the effect of ozone, casein phosphopeptide–amorphous calcium phosphate, silver diamine fluoride, and hydroxyapatite on remineralization of early carious lesions: An investigation using polarized light microscopic study

Abstract Introduction: A popular trend in dental offices, minimal intervention dentistry emphasizes using the least invasive treatments possible to minimize tissue loss and patient discomfort. The earliest indications of dental caries are white spot lesions that can remineralize. Thus, the effects of four different remineralizing agents on early carious lesions were assessed using polarized light microscopy. Materials and Methods: Teeth specimens were immersed in demineralizing agents to create subsurface demineralization. Subsequently, they were randomly assigned to various remineralization regimens, including ozonated water, casein phosphopeptide–amorphous calcium phosphate (CPP-ACP), silver diamine fluoride (SDF), and hydroxyapatite. Each specimen underwent treatment twice daily for 3 min and was then placed in artificial saliva. Mineral content was evaluated at baseline, after demineralization, and during remineralization (on the 7th and 14th day) using a polarized microscopic examination. Results: Group 1 demonstrated the most effective remineralization, consistently displaying the lowest lesion depths at both the 7th and 14th days. Post hoc comparisons indicate significant differences between group 1 and other groups, emphasizing the potential superiority of the remineralization process in group 1 compared to the other treatment groups. Conclusion: Tooth samples treated with ozonated water, followed by CPP-ACP, SDF, and hydroxyapatite demonstrated a more profound level of remineralization. These agents, namely ozonated water, CPP-ACP, SDF, and hydroxyapatite, prove to be effective in reversing the early stages of enamel caries. The following core competencies are addressed in this article: Practice-based learning and improvement, Patient care and procedural skills, Systems-based practice, Medical knowledge.

Evaluation of Prevention of Initial Enamel Lesions around Orthodontic Brackets by Using Different Remineralizing Agents: An Original Research

ABSTRACT Objective: The purpose of this study was to compare the efficacy of various remineralizing agents in stopping the early enamel lesions surrounding orthodontic brackets from progressing. Techniques: Four groups were randomly allocated to a total of 100 participants: the control group (no treatment), calcium phosphate, casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), and fluoride varnish. Remineralizing chemicals were administered in accordance with manufacturer recommendations, and enamel lesions were created around orthodontic brackets. At baseline and follow-up visits, enamel lesion development was evaluated by visual inspection, quantitative light-induced fluorescence, and microhardness tests. Results: All treatment groups showed significant improvements in microhardness and decreases in lesion size compared to the control group (P < 0.05). Of all the treatment groups, CPP-ACP showed the most notable improvement in microhardness. Regarding the reduction of lesion size, there were no notable variations between the therapy groups (P > 0.05). Conclusion: Initial enamel lesions surrounding orthodontic brackets can be effectively prevented from progressing with the use of fluoride varnish, calcium phosphate, and CPP-ACP. Promising improvements in microhardness indicate that CPP-ACP may be a better treatment choice. Larger sample sizes and longer follow-up times are needed for future studies to validate these results and clarify the best strategy for maintaining the health of enamel throughout orthodontic treatment.

White Spot Lesions in Fixed Orthodontics: A Literature Review on Etiology, Prevention, and Treatment.

White spot lesions (WSLs) are a common complication after treatment using fixed orthodontic appliances. Decalcification of enamel surrounding fixed orthodontic appliances, known as WSLs, poses a significant aesthetic difficulty during and after treatment, as the purpose of fixed orthodontic therapy is to improve facial and dental appearance. Modern dentistry utilizes remineralization therapiesto non-invasively treat WSLsto prevent the progression of disease and enhance the strength, appearance, and functionality of the affected tooth. This review aims to identify and assess the etiology, formation, and risk factors, as well as current treatment approaches used in achieving WSLs remineralization, induced by fixed orthodontic appliances.An electronic search on the PubMed and ScienceDirect databases was performed using a selected keyword.A total of 172 studies (from 2013 to 2023) were retrieved. Their references were also checked to find other relevant studies. Duplicate copies were excluded. After the abstract and full-text screening, only 39 studies were included. Even though numerous studies address the different treatment modalities for managing post-orthodontic WSLs, such as antiseptics; fluoridessuch as dentifrices, mouthwash, and varnish, and remineralizing agents such as casein phosphopeptides amorphous calcium phosphate, biomimetic self-assembling peptides, lasers, bleaching, microabrasion, and resin infiltration. There is a lack of evidence-based studies that examine the long-term effects of WSLtreatment. Further well-performed controlled clinical trials with long-term follow-up are needed to establish best clinical practice.

The effect of nano-hydroxyapatite and casein phosphopeptide-amorphous calcium phosphate with and without laser irradiation on the microhardness and surface morphology of demineralized primary enamel: An in vitro experimental study

The effect of nano-hydroxyapatite and casein phosphopeptide-amorphous calcium phosphate with and without laser irradiation on the microhardness and surface morphology of demineralized primary enamel: An in vitro experimental study

Randomized clinical trial to compare three fluoride varnishes in preventing early childhood caries

ObjectivesTo compare the effectiveness of two 5% sodium fluoride (NaF) varnishes containing casein phosphopeptide amorphous calcium phosphate (CPP-ACP) (MI VarnishTM) or tricalcium phosphate (TCP) (ClinproTM White) to the conventional 5% NaF varnish (Duraphat®) in preventing early childhood caries (ECC) in high-risk preschool children. MethodsA double-blinded, randomized controlled trial recruited healthy 3–4-year-old children (N = 582) having at least one carious lesion (pre-cavitated or cavitated) after obtaining written informed consent from parents. Using a computer-generated random-number table, children were assigned to one of the 3 groups: Control group (n = 196): 5% NaF varnish (Duraphat®) or two test groups: 5% NaF with TCP (Clinpro™ White) (n = 193) and 5% NaF varnish with CPP-ACP (MI Varnish™) (n = 193) to receive quarterly (every 3 months) application over 24 months. ResultsIncidence of new caries over 2 years was 59.2% in MI Varnish™ group (n = 125), 65.1% in the Clinpro™ White group (n = 129) and 66.1% in the Duraphat® group (n = 127) (p = 0.466). The mean cavitated lesions increment was not significant among the 3 groups (p = 0.714), as was the mean increment in non-cavitated carious lesions (p = 0.223). There was no significant difference (p = 0.630) in the distribution of total fluoride varnish applications among the three groups. Also, no significant difference was found in comparison of outcomes among the different number of fluoride varnish applications received by children in each group. ConclusionsBoth calcium- and phosphate-containing NaF varnishes showed similar efficacy against cavitated and non-cavitated carious lesions as compared to conventional NaF varnish in high-risk preschool children. Clinical significanceRandomized trial provided a crucial opportunity to advance the understanding of the clinical effectiveness of different fluoride varnishes in preventing early childhood caries. Varnishes containing tricalcium phosphate or casein phosphopeptide amorphous calcium phosphate when compared to sodium fluoride varnish, demonstrated a similar efficacy against early childhood caries in high caries-risk preschool children.

Assessment of the Additive Effect of Remineralizing Agents in Combination With Fluoride Releasing Adhesives in the Prevention of Enamel Decalcification in Orthodontic Patients: An In Vitro Study.

Introduction Incorporation of remineralizing agents with fluoride-releasing bracket adhesives may prevent the development of white spot lesions (WSL) or reverse the established WSL in patients undergoing fixed orthodontic treatment. We aimed to find out how effectively casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) and fluoride varnish (FV) can remineralize teeth when mixed with fluoride-releasing orthodontic adhesive. Materials and methods We randomly assigned a total of 60 premolar teeth, therapeutically extracted for orthodontic purposes, into two equal groups. Group I (n = 30) utilized fluoride-releasing adhesive (FR), and Group II (n = 30) bonded with non-fluoride adhesive (NFR). Based on the applied remineralizing agent, we further divided each of the two groups into three equal subgroups of 10: Group IA (FR+FV), Group IB (FR+CPP-ACP), Group IC (control-only FR), Group IIA (NFR+FV), Group IIB (NFR+CPP-ACP), and Group IIC (control-only NFR). Following bonding procedures, all the samples underwent pH cycling for 28 days, where the enamel samples were immersed in 20 ml of demineralizing solution for three hours, followed by immersion in 30 ml of remineralizing solution for 17 hours. The samples were analyzed for shear bond strength (SBS) on a universal testing machine and hardness values (HV) by the Vickers microhardness test (VMT) using the indentation method. We also evaluated the adhesive remnant index (ARI) scores to determine the site of bracket failure. Statistical analysis The shear bond strength (SBS) and hardness value (HV) were expressed as the mean, standard deviation (SD), and median for each subgroup. We used the non-parametric Kruskal-Wallis test to analyze the SBS and HV, followed by the Dunn-Bonferroni test for intra-pair differences. The ARI score was expressed as the frequency of the percentage distribution, and the difference in the distribution of ARI scores between the groups was assessed by the Cochran chi-square test. The probability (p) value equal to or less than 0.05 was considered statistically significant. Results The results show that Group IB, bonded with a fluoride-releasing adhesive and a CPP-ACP remineralizing agent surface treatment, has the highest HV of300.23 units. Group IIC (only NFR) has the lowest hardness of153.3 units, which is statistically significant (p < 0.001). However, the ARI scores are not statistically significant between the groups tested. Conclusion The bond strength of the adhesive and the surface hardness of the enamel increased with the addition of fluoride varnish and CPP-ACP to both the fluoride-releasing and non-fluoride-releasing adhesives.

Layer-by-layer self-assembly of PLL/CPP-ACP multilayer on SLA titanium surface: Enhancing osseointegration and antibacterial activity in vitro and in vivo

Dental Implants are expected to possess both excellent osteointegration and antibacterial activity because poor osseointegration and infection are two major causes of titanium implant failure. In this study, we constructed layer-by-layer self-assembly films consisting of anionic casein phosphopeptides-amorphous calcium phosphate (CPP-ACP) and cationic poly (L-lysine) (PLL) on sandblasted and acid etched (SLA) titanium surfaces and evaluated their osseointegration and antibacterial performance in vitro and in vivo. The surface properties were examined, including microstructure, elemental composition, wettability, and Ca2+ ion release. The impact the surfaces had on the adhesion, proliferation and differentiation abilities of MC3T3-E1 cells were investigated, as well as the material’s antibacterial performance after exposure to the oral microorganisms such as Porphyromonas gingivalis (P. g) and Actinobacillus actinomycetemcomitans (A. a). For the in vivo studies, SLA and Ti (PLL/CA-3.0)10 implants were inserted into the extraction socket immediately after extracting the rabbit mandibular anterior teeth with or without exposure to mixed bacteria solution (P. g & A. a). Three rabbits in each group were sacrificed to collect samples at 2, 4, and 6 weeks of post-implantation, respectively. Radiographic and histomorphometry examinations were performed to evaluate the implant osseointegration. The modified titanium surfaces were successfully prepared and appeared as a compact nano-structure with high hydrophilicity. In particular, the Ti (PLL/CA-3.0)10 surface was able to continuously release Ca2+ ions. From the in vitro and in vivo studies, the modified titanium surfaces expressed enhanced osteogenic and antibacterial properties. Hence, the PLL/CPP-ACP multilayer coating on titanium surfaces was constructed via a layer-by-layer self-assembly technology, possibly improving the biofunctionalization of Ti-based dental implants.

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.

Remineralizing pretreatment using casein phosphopeptide-amorphous calcium phosphate fluoride, self-assembling peptide, and nanohydroxyapatite gel activation via invisible infrared light on the dentin microhardness and micro shear bond strength to the composite restoration

AimDifferent remineralizing pretreatments Casein phosphopeptide-amorphous calcium phosphate fluoride (CPP-ACPF), tricalcium phosphate fluoride (TCP-F), self-assembling peptide (SAP) P11-4 and 10 % Nanohydroxyapatite (nHA) gel activation via invisible infrared light on the dentin microhardness (MH) and micro shear bond strength (µSBS) of composite restoration. MethodsSeventy-five human molar teeth were collected and the dentinal surface of all the samples was exposed to different demineralizing solutions. (n = 15) Group 1 (demineralized dentin), Group 2 (CPP ACP), Group 3 (TCP-F), Group 4 (SAP P11-4), Group 5 (nHA gel activation via invisible infrared light). MH assessment was performed using Vickers hardness. Each group of 10 samples was subjected to composite restoration buildup and µSBS were tested. The debonded samples were then observed under a stereo-microscope for failure analysis. ANOVA was conducted, along with Tukey's post hoc analysis, to examine the µSBS of composite and MH of the remineralized surface. ResultsnHA gel activation via invisible infrared light pretreated specimens showed the maximum outcomes of surface hardness (331.2 ± 77.3) and bond strength (10.38 ± 2.77). However, Group 4 (SAP P11-4) (148.3 ± 29.2) remineralized dentin displayed minimum scores of MH and µSBS (5.88 ± 1.01). ConclusionRemineralizing pretreatment nHA gel activation via invisible infrared light and casein phosphopeptide-amorphous calcium phosphate fluoride seem to improve the dentin MH and µSBS of the composite restoration.

Preventive efficacy of 38% silver diamine fluoride and CPP-ACP fluoride varnish on molars affected by molar incisor hypomineralization in children: A randomized controlled trial

Background This randomized controlled trial aimed to compare the efficacy of silver diamine fluoride (SDF) and casein phosphopeptide-amorphous calcium phosphate fluoride varnish (CPP-ACPFV) in preventing caries development, enamel breakdown, and sensitivity on molars affected by molar incisor hypomineralization (MIH) in children. Methods A total of 100 children aged 6 to 9 years were enrolled in the study with two contralateral permanent molars mildly affected by MIH. Affected molars were randomly and equally assigned to receive either SDF or CPP-ACPFV treatment. The interventions were applied at four different time points (baseline, 3, 6, 9 months), and the incidence of caries, caries progression, enamel breakdown, and sensitivity were assessed. Results The findings of this study revealed significant differences in the incidence of caries between the groups treated with SDF and CPP-ACPFV (P-value &lt; 0.05). Similarly, there was a significant difference in caries progression between the two groups (P-value &lt; 0.05). However, no significant differences were observed in enamel breakdown scores between the treatment groups, as the majority of teeth in both groups exhibited a score of 0. Furthermore, there were no significant differences in sensitivity between the treatment groups throughout the study period. Conclusions In conclusion, the results of this study provide evidence that molars treated with SDF demonstrated a lower incidence of caries and a higher rate of caries arrest compared to those treated with CPP-ACPFV. Both interventions showed promise in preventing enamel breakdown and improving sensitivity. These findings highlight the potential of SDF and CPP-ACPFV as effective treatments for caries prevention and management, emphasizing the importance of early intervention and appropriate dental care strategies in maintaining oral health. Trial registration ISRCTN54243749 (13/01/2022).

Comparative evaluation of remineralization potential of novel bioactive agents on eroded enamel lesions: A single-blinded in vitro study

Objective: The escalating prevalence of noncarious tooth wear stands as a critical concern in the backdrop of evolving lifestyles and dietary patterns. Dental erosion, a progressive condition induced by both endogenous and exogenous acidic influences, directly impacts enamel integrity, resulting in surface loss. The contemporary surge in carbonated beverage consumption further exacerbates this erosive milieu, underscoring the urgency for dental practitioners to adopt meticulous treatment strategies. Existing literature underscores a noteworthy 94% reduction in tooth erosion risk for individuals abstaining from sweetened soft beverages, emphasizing the imperative for a well-devised remineralization protocol to counter demineralized surfaces. Methodology: Seventy-three enamel specimens were taken. Forty samples were subjected to pre-operative hardness testing, and five samples were subjected to baseline EDX evaluation followed by grouping of samples (Group 1 = control Group; Group 2 = casein phosphopeptide–amorphous calcium phosphate fluoride [CPP-ACPF] Group; Group 3 = Biomin F Group; and Group 4 = self-assembling peptide [SAP] P-114 Group). A demineralization–remineralization cycle was carried out for 5 days followed by testing through Vickers Microhardness Tester, EDX Evaluation, and Scanning Electron Microscopy (SEM) Imaging. Statistical analysis was performed using one-way analysis of variance followed by intergroup analysis using Tukey’s post hoc test with SPSS software 25.0 version. Results: The mean percentage change in microhardness values was 30.05% in Group 1, 24.21% in Group 2, 18.85% in Group 3, and 12.08% in Group 4. The mean Ca/P ratio of samples tested through EDAX was 2.20 at baseline, 1.40 in Group 1 (Control Group), 1.62 in Group 2 (CPP-ACPF), 1.82 in Group 3 (Biomin F), and 2.01 in Group 4 (SAP-P114). Postintervention values were statistically significant from baseline values in both parameters. Conclusion: Curodont Protect exhibits superior efficacy, offering valuable insights for future in vivo studies and clinical applications. The multifaceted evaluation, encompassing microhardness testing, SEM analysis, and EDXS assessment, contributes to a nuanced interpretation of the agents’ impact, paving the way for informed decisions in clinical practice and future research endeavors.

Evaluation of Casein Phosphopeptide–Amorphous Calcium Phosphate Effect on the Bond Strength of Self-etch Adhesives to Dentin: A Systematic Review

Evaluation of Casein Phosphopeptide–Amorphous Calcium Phosphate Effect on the Bond Strength of Self-etch Adhesives to Dentin: A Systematic Review

Management of orthodontically induced white spot lesions: A survey of the orthodontic practitioners of Pakistan.

To assess the level of awareness among orthodontic practitioners about the diagnosis and management of orthodontically induced white spot lesions. The cross-sectional study was conducted from August 28, 2022, to March 3, 2023, at Bakhtawar Amin Medical and Dental College, Multan, and comprised orthodontic specialists and postgraduate residents. Data was collected using a 14-item questionnaire regarding diagnosis and management of orthodontically induced white spot lesions. The questionnaire was disseminated online, and the responses were compared between the groups. Data was analysed using SPSS 24. Of the 278 subjects, 205(73.7%) were residents; 156(75%) females and 49(24%) males with mean professional experience of 4.24±4.08 years. There were 73(26.3%) specialists; 44(60.3%) females and 29(39.7%) males with mean professional experience 9.07±4.85 years. There were 48(66%) specialists and 131(64%) residents who thought the most commonly affected teeth with WSL were maxillary central incisors, while 30(41%) specialists and 38(33%) residents said the least commonly affected tooth was maxillary canine. Among the specialists, 29(38%) considered halting treatment and regular follow-up as the best approach for managing white spot lesions detected during orthodontic treatment, while 76(37%) residents preferred to use fluorides and casein phosphopeptide-amorphous calcium phosphate. There were significant differences between the specialists and residents for the items related to the incidence of white spot lesions, timing for additional precautions and measures for detection, management during active treatment and modalities of prevention (p<0.05). Despite being fairly common in orthodontic patients, the awareness regarding white spot lesions and related management protocols was found to be dubious in orthodontic practitioners, depicting lack of a standardised protocol.

Comparative Evaluation of Mechanical Properties of Conventional Glass Ionomer Cement Incorporated with Nonfluoridated Remineralizing Agents.

The researchers have been searching for ideal restorative material for many decades. The incorporation of a remineralizing agent into a restorative material to improve its property of preventing dental caries and the occurrence of secondary caries has been investigated by various researchers.Hence, in the present study, we have incorporated two nonfluoridated remineralizing agents [theobromine and casein phosphopeptide-amorphous calcium phosphate (ACP-CPP)] into the conventional glass ionomer cement (GIC) and evaluated their mechanical properties. The flexural strength, compressive strength, and microhardness values of the two test groups were more significant than the control group type IX GIC. With this study, we could conclude that the incorporation of theobromine and ACP-CPP into GIC increases the mechanical properties of conventional GIC. Mahalakshmi S, Chowdhary N, Shivanna V, et al. Comparative Evaluation of Mechanical Properties of Conventional Glass Ionomer Cement Incorporated with Nonfluoridated Remineralizing Agents. Int J Clin Pediatr Dent 2024;17(2):125-129.

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.

Effect of Casein Phosphopeptide-Amorphous Calcium Phosphate, Proanthocyanidin, Carbon Dioxide Laser Remineralization on the Bond Integrity of Composite Restoration Bonded to Caries-Affected Dentin.

Objective: Assessment of different remineralizing pretreatment casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), proanthocyanidin (PA), carbon dioxide laser (CO2), eggshell solution (ES) on the shear bond strength (SBS) of resin composite bonded to remineralized carious-affected dentin (CAD). Materials and methods: Eighty human molars were collected with occlusal caries that extended about halfway into the dentin. Using a water-cooled, low-speed cutting saw, a flat, mid-coronal dentin surface was exposed. CAD was differentiated from healthy dentin. Based on the remineralizing agent used on the CAD surface, the teeth were arbitrarily allocated into five groups (n = 10). Group 1: no remineralizing agent, Group 2: CPP-ACP, Group 3: 6.5% PA solution, Group 4: CO2 laser, and Group 5: ES solution. All samples were bonded to composite and light cured and thermocycled. SBS and failure mode analysis were performed using universal testing and stereomicroscope 40 × . Using SPSS, SBS, and failure mode data were analyzed using analysis of variance and Tukey's honesty significant difference (HSD) test Results: Group 3 (6.5% PA solution; 15.59 ± 1.44 MPa) samples established the maximum bond integrity. Nevertheless, Group 1 (No remineralizing agent; 11.19 ± 1.21 MPa) exhibited the minimum outcome of bond strength. Intergroup comparison analysis showed that Group 1 (No remineralizing agent), Group 2 (CPP-ACP), and Group 4 (CO2 laser) established comparable values of bond strength (p > 0.05). Likewise, Group 3 (6.5% PA solution) and Group 5 (EA solution) also revealed equivalent bond integrity (p > 0.05). Conclusions: PA and ES are considered potential remineralizing agents used for caries-affected dentin surfaces in improving bond integrity to composite resin. However, further studies are advocated to extrapolate the findings of this study.

Tegillarca granosa shell combination with Vitis vinifera and fluoride in decreasing enamel microporosity

Background: White spot lesion is a demineralization process indicated by the increased of enamel microporosity. A tegillarca granosa shell contains 98.7% calcium and Vitis vinifera contains phytochemical compounds with fluoride, which has a potential to stimulate remineralization. Purpose: To analyze the Tegillarca granosa shell combination with Vitis vinifera and fluoride in decreasing enamel microporosity. Methods: The cream was prepared by combining 10% and 20% Tegillarca granosa shell with 10 grams of Vitis vinifera extract and 100 mg of fluoride. The cream was tested beforehand for viscocity and pH. Furthermore, 16 premolars were etched and divided into four groups. Group 1 was smeared with placebo (negative control) and Group 2 was smeared with casein phosphopeptide-amorphous calcium phosphate (positive control). The other groups were smeared with cream 10% (Group 3) and 20% (Group 4) Tegillarca granosa shell combination with Vitis vinifera and fluoride. Teeth were treated three times a day for 30 minutes and soaked in artificial saliva. After 14 days, the enamel microporosity was carried out using a scanning electron microscope. The data was analyzed with one-way analysis of variance (ANOVA) test followed by post-hoc least significant difference (LSD). Results: The enamel microporosity showed significant difference between Group 1 and the other groups. There was no significant difference between Groups 2, 3, and 4 (p&lt;0.05). Although there was no significant difference between Group 3 and 4, the lowest one was in Group 4 (p&gt;0.05). Conclusion: The cream, prepared by combining Tegillarca granosa shell with Vitis vinifera and fluoride, is effective in decreasing the enamel microporosity.

Comparative Evaluation of Remineralizing Potential of Topical Cream Containing Casein Phosphopeptide-Amorphous Calcium Phosphate and Casein Phosphopeptide-Amorphous Calcium Phosphate with Fluoride: An In Vitro Study

ABSTRACT The requirement for clinically effective treatments to remineralize early enamel caries lesions is dictated by the principles of minimally invasive dentistry. Numerous studies outlined the significance of treating early carious lesions with different remineralizing agents. This study aimed to evaluate and compare the remineralization potential of topical cream containing casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) and CPP-ACP with fluoride in remineralizing artificial carious lesions on enamel. Forty-five freshly extracted human premolar teeth were selected as samples. These samples were divided into three groups: Group I-regular toothpaste without specific remineralizing agent; Group II-topical cream containing CPP-ACP and Group III topical cream containing CPP-ACP with fluoride. All the samples were viewed under scanning electron microscope (SEM) to assess the topographical pictures of the enamel surface and also subjected to energy dispersing X-ray analysis (EDX) for quantitative estimation of minerals, calcium (Ca), and phosphorous (P). In the result of the study, Group I does not show any increase in the Ca and P after applying toothpaste without any remineralizing agent but Group II and Group III showed a net increase in Ca and P- values after applying concerned remineralizing agents. Intergroup comparison showed Group III yielded higher net Ca and P- values than Group II. Two remineralizing agents showed remineralization potential on samples. Descriptive statistics were used to calculate the mean and standard deviation. Mann–Whitney test was used. The level of significance was set at 0.05. CPP-ACP containing fluoride showed better remineralizing potential than CPP-ACP. Hence, CPP-ACP containing fluoride can be considered the material of choice in remineralizing early enamel carious lesions.

Pengaruh Pemberian Ekstrak Cangkang Telur Bebek (Anas Plaptyrhynchos Domesticus) Konsentrasi 20% Dalam Sediaan Gel Dan Pasta Terhadap Kekerasan Permukaan Email Gigi Tikus Wistar (Rattus Norvegicus) : Studi (In Vivo)

Dental caries is a disease of the hard tissues of the teeth which is characterized by damage to the email and dentin caused by bacterial activity in fermented carbohydrates. One way to overcome and prevent caries is by giving anticariogenic substances that can inhibit caries development and trigger remineralization. As for other alternative materials used for remineralization, one of them is duck egg shell (Anas platyrhynchos domesticus) because it contains calcium carbonate which is in the eggshell can be converted into hydroxyapatite or calcium compounds, so that it can be used as the formation of damaged bones and teeth. In this study, duck egg shell hydroxyapatite extract was made in gel and paste preparations. In gel preparations, it has a high adhesive power so that the absorption on an email surface will be maximized. While in the preparation of pasta also has a great absorption power. This study aimed to determine the effect of hydroxyapatite gel and paste from duck eggshell extract (Anas platyrhynchos domesticus) and Casein Phosphopeptide-Amorphous Calcium Phosphate (CPP-ACP) on the tooth email hardness of wistar rats (Rattus norvegicus). In this study there were 3 treatment groups. Prior to treatment, the tooth sample was etched in the labial section for 20 seconds and rinsed using a brush and water. After etching was applied, in group 1, duck egg shell hydroxyapatite extract gel was applied, in group 2, duck egg shell hydroxyapatite extract paste was applied, and in group 3 as a control group, CPP-ACP was applied to the lower anterior teeth of wistar rats for 30 minutes 2 times a day. for 14 days. On the 15th day, the lower anterior teeth were decapitated by wistar rats and hardness testing was carried out using microvikers hardness in the labial part of the teeth. This research is a true experimental with Post Test Control Group Design. The result of the average hardness of email that has been treated with the highest hardness is CPP-ACP of 332 VHN. The results of the normality test using Shapiro Wilk showed that the duck egg shell extract gel could increase the surface hardness of tooth email. The results of the comparison test using Kruskal Wallis showed that there was a change in hardness between the hydroxyapatite gel of duck eggshell extract, hydroxyapatite paste of duck eggshell extract and CPP-ACP and there were significant differences. From the results of this study, there was an increase in the surface hardness of tooth email after the application of duck egg shell hydroxyapatite gel (Anas platyrhynchos domesticus) compared to paste preparations and as a positive control with CPP-ACP also increased the hardness of tooth email.