Phosphopeptide-amorphous Calcium Phosphate Fluoride Research Articles

Biomimetic remineralization of eroded dentin by synergistic effect of calcium phosphate and plant-based biomodifying agents: An in vitro study

Context: Dentin, due to its organic content, exhibits a high susceptibility to dental erosion owing to its high permeability to intrinsic acids. A crucial challenge for successful remineralization of demineralized dentin is reestablishing a complete spatial relationship between the mineral and collagen. Aims: This study aimed to evaluate the synergistic effect of casein phosphopeptide amorphous calcium phosphate fluoride (CPP-ACPF) with plant-based dentin biomodifying agents: Grape seed extract (GSE), green tea extract (GTE), and cranberry extract (CE) on biomimetic remineralization of eroded dentin. Settings and Design: Dentin samples were prepared and subjected to surface microhardness (SMH) analysis at baseline followed by erosive challenge with hydrochloric acid (0.01M) and pH cycling with citric acid (0.05M) and artificial saliva. The samples in all the groups except the control were subjected to surface treatments: CPP-ACPF, GSE + CPP-ACPF, GTE + CPP-ACPF, and CE + CPP-ACPF. Subjects and Methods: Samples from all the groups were subjected to Vickers Hardness Tester for Post Treatment SMH analysis. Samples were qualitatively evaluated for changes in ultramorphological characteristics of dentin surface using scanning electron microscopy (SEM) and were quantitatively analyzed for changes in the calcium (Ca)/phosphorous (P) ratio using energy dispersive X-ray analysis (EDAX). Statistical Analysis Used: Data obtained were statistically analyzed using ANOVA, paired samples test, and Tukey HSD test. P value < 0.05 was considered statistically significant. Results: The samples pretreated with GSE showed the highest mean SMH followed by GTE and CE. The difference in % change was significant when GSE was compared to GTE and CE (P = 0.001 and P = 0.000, respectively). SEM pictomicrographs of demineralized dentin samples revealed enlarged and exposed dentinal tubules, and most of these tubules were unobstructed with no obvious sediments. Samples treated with test agents demonstrated amorphous crystal-like deposits occluding the dentinal tubules with higher incidence observed in the groups treated with the combination of the agents. EDAX analysis revealed the highest mean wt% of Ca and P in groups pretreated with GSE followed by GTE and CE. GSE showed the highest mean Ca/P ratio followed by CE and GTE. Conclusions: The findings of this study demonstrated a synergistic effect when CPP-ACPF was used after pretreatment with plant-based dentin biomodifying agents in causing biomimetic remineralization of eroded dentin.

In Vitro Efficacy of Tricalcium Phosphate and Casein Phosphopeptide Amorphous Calcium Phosphate Fluoride for Remineralization of Enamel White Spot Lesions.

Objectives: The main purpose of this study was to compare the remineralizing effects of casein phosphopeptide amorphous calcium phosphate fluoride (CPP-ACPF) and tricalcium phosphate (TCP) on artificially induced enamel white spot lesions (WSLs). Materials and Methods: In this in vitro study, 45 sound extracted premolars were immersed in a demineralizing solution (pH=4.5) for 96 hours, and were randomly divided into 3 groups of TCP, MI Paste Plus, and control. They were exposed to the remineralizing agents for 5 minutes once a day for 30 days. After mounting the teeth in resin blocks and polishing, they underwent a microhardness test at 3 different depths from the enamel surface. Data were analyzed by Prism software, two-way ANOVA, and Tukey's test (α=0.05). Results: The volume percentage of mineral content (VPM) was significantly different among the three groups at 30-, 60- and 90µm depths (P<0.0001). At 30µm depth, CPP-ACPF was significantly more effective than TCP (P<0.0001). At 60- and 90µm depths, there was no significant difference between CPP-ACPF and TCP (P>0.05). Conclusion: Both CPP-ACPF and TCP had significant efficacy for remineralization of artificially induced enamel WSLs under in vitro conditions.

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.

Effects of Two Remineralizing Agents in Combination with Er:YAG and CO2 Laser Irradiation on Microhardness of Demineralized Enamel: A Preliminary In Vitro Study.

Objectives: This study assessed the effects of two remineralizing agents namely MI Paste Plus containing casein phosphopeptide amorphous calcium phosphate fluoride (CPP-ACFP) and Remin Pro containing hydroxyapatite, fluoride and xylitol (HFX) with/without erbium-doped yttrium aluminium garnet (Er:YAG) and CO2 laser irradiation on demineralized enamel microhardness. Materials and Methods: In this in vitro study, 70 sound human premolars were mesiodistally sectioned, demineralized at a pH of 4.6 for 8 hours, and randomly divided into 7 remineralization groups (n=10): of (I) MI Paste Plus (CPP-ACFP), (II) Remin Pro (HFX), (III) MI Paste Plus+CO2 laser (0.7 W power, 50 Hz), (IV) Remin Pro+CO2 laser, (V) MI Paste Plus+Er:YAG laser (1 W power, 10 Hz), (VI) Remin Pro+Er:YAG laser, and (VII) negative control. The Vickers hardness number of specimens was then measured. The groups were compared by one-way ANOVA and Tukey's test (α=0.05). Results: The mean microhardness was 319.8±49.9, 325.3±44.6, 359.4±35.7, 296.4±33.7, 319.9±58.1, 358.9±28.4, and 240.0±41.6 kg/mm2 in groups 1 to 7, respectively. The difference in microhardness was significant among the groups (P<0.0001). Pairwise comparisons revealed significant differences in microhardness between all groups (P≤0.03) except between groups 1 and 2, 1 and 5, 2 and 5, and 3 and 6 (P>0.05). Conclusion: Both Remin Pro (containing HFX) and MI Paste Plus (containing CPP-ACFP) can cause enamel remineralization. MI Paste Plus+CO2 laser irradiation and Remin Pro+Er:YAG laser irradiation were significantly more effective than the application of each remineralizing agent alone.

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

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

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

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

Comparative Evaluation of the Increase in Enamel Hardness Post-External Bleaching after Using Casein Phosphopeptide Amorphous Calcium Phosphate Fluoride (CPP-ACPF) and 5% Sodium Fluoride (NaF) Remineralizing Agents.

The purpose of this study was to analyze the increase in enamel hardness post-external bleaching after remineralized with casein phosphopeptide amorphous calcium phosphate fluoride (CPP-ACPF) and 5% sodium fluoride (NaF) and the difference in increased enamel hardness between CPP-ACPF and NaF materials. The study was true experimental in vitro using 30 samples of mandibular premolars. All samples were bleached using 40% hydrogen peroxide. The samples were divided into three groups of 10 samples each; group I as a control without application of remineralization material, group II was given an application of CPP-ACPF (GC Tooth Mousse Plus: GC Europe, Lot #201130B), and group III was given an application of 5% NaF (Clinpro White Varnish: 3M ESPE, Lot #NA62322) Then the entire samples were stored in artificial saliva. The hardness of the samples was measured using a Vickers hardness tester before bleaching, after bleaching, and after remineralization for 7, 14, and 21 days. Analysis of the data used was an analysis of variance test to assess differences in the increase in enamel hardness between groups and paired t-tests and to determine differences in enamel hardness in each group. This study showed that there was an increase in the enamel hardness after bleaching which was remineralized with CPP-ACPF and 5% NaF. There was a difference in the increased enamel hardness between teeth remineralized with CPP-ACPF and 5% NaF. The enamel hardness of CPP-ACPF was higher compared with 5% NaF after remineralization of 7, 14, and 21 days. There was an increase in the enamel hardness after external bleaching that was remineralized with CPP-ACPF and 5% sodium fluoride (NaF). There was a difference in the increased enamel hardness between teeth remineralized with CPP-ACPF and 5% sodium fluoride (NaF). CPP-ACPF showed a higher enamel hardness value than 5% NaF.

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

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

Comparative Evaluation of Hydroxyapatite Fluoride and Casein Phosphopeptide Amorphous Calcium Phosphate Fluoride as Remineralizing Agents in Primary Teeth Using pH Cycling and Single-Sectioning Technique

Background: Hydroxyapatite and casein phosphopeptide-amorphous calcium phosphate are known to remineralize subsurface carious lesions. Aim: The aim of this study was to evaluate the effect of topical application of hydroxyapatite fluoride (HF) and caseinphosphopeptide-amorphous calcium phosphate fluoride paste (CPP-ACPF) in bringing about remineralization changes in artificially induced carious lesions of primary teeth using pH cycling and single-sectioning technique. Materials and Methods: Seventy extracted deciduous teeth were divided into two groups: Group A: HF (Remin Pro) n = 35 and Group B: CPP-ACPF (Tooth Mousse Plus®) n = 35. The samples were immersed in demineralizing solution for 96 h followed by pH cycling for 10 days which included cycles of demineralization and remineralization of their respective groups. Results: Intergroup comparison of the change in the mean value after demineralization and remineralization showed statistically highly significant difference as the change in Group A HF was 213.52 ± 113.17 (standard deviation [SD]) as compared to that in Group B (CPP-ACPF) 76 ± 57.22 (SD). Conclusion: HF was found to be better when compared to CPP-ACPF for tooth remineralization.

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

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

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

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

Influence of two remineralizing agents on bleached enamel surface morphology and mineral composition - An In Vitro study.

To investigate the effects of bleaching with 35% hydrogen peroxide on the structure of tooth enamel and the role of two remineralizing agents for their potential to remineralize any damaged regions of enamel. Freshly extracted 32 mature permanent central incisors were selected and sectioned at the level of the cemento-enamel junction. The teeth were divided into four groups consisting of eight teeth each: No bleaching (control) [Group 1], bleaching with 35% hydrogen peroxide [Group 2], bleaching with 35% hydrogen peroxide followed by application of casein phosphopeptide amorphous calcium phosphate fluoride paste [Group 3], and bleaching with 35% hydrogen peroxide followed by application of xylitol-coated calcium phosphate fluoride varnish [Group 4]. The enamel surfaces were analyzed under the scanning electron microscope and quantitative energy dispersive X-ray analysis. Results were statistically analyzed by one-way analysis of variance and Tukey's posthoc test. Group 2 revealed changes in enamel surface morphology and a statistically significant decrease in mineral content. Groups 3 and 4 showed statistically significant remineralization potential. Intergroup comparison showed that samples in Group 4 had a higher mineral content compared to Group 3. The application of the tested remineralizing agents following bleaching was effective in repairing the enamel surface morphology with higher efficacy for the fluoride varnish product. Since bleaching regimes with high concentrations of hydrogen peroxide adversely affect the enamel surface, these findings can translate to clinical practice to reduce the long-term damaging effects of tooth bleaching.

Remineralization potential of gum arabic versus casein phosphopeptide–amorphous calcium phosphate–fluoride for demineralized enamel in acidic challenges: In vitro study

Remineralization potential of gum arabic versus casein phosphopeptide–amorphous calcium phosphate–fluoride for demineralized enamel in acidic challenges: In vitro study

Orthodontic brackets’ shear bond strengths after applying remineralizing agents

Aim: The aim of this in vitro study was to measure the effects of white spot lesions treatment agents on the shear bond strengths (SBSs) and adhesive residual indexes (ARIs) of orthodontic brackets.&#x0D; Methodology: This study used 100 human premolar teeth randomly divided into five groups. Group 1 comprised those with intact enamel, Group 2 comprised those with demineralized enamel and Groups 3–5 comprised those demineralized enamel that was treated with casein phosphopeptide amorphous calcium phosphate fluoride (CPP-ACPF), fluoride varnish and a resin infiltrant, respectively. Brackets were bonded to the teeth using the conventional method, then the samples were thermocycled and tested for SBS using a universal testing machine. The adhesive remnant indexes (ARI) of the brackets were also evaluated. One-way ANOVA and post-hoc Tukey tests were used to compare the groups’ SBSs and the Kruskal–Wallis test was used to evaluate the groups’ ARI scores. Results were considered statistically significant if p was less than 0.05.&#x0D; Results: Statistically significant differences were found between the groups (F was 6.895 and p was less than 0.001). The SBSs of the brackets in Group 4 were significantly lower than those of the other groups (the mean was 13.44 ± 6.37 MPa). Group 5 had the highest mean SBS value (22.11 ± 6.56 MPa). Additionally, the ARI scores of the four groups were significantly different (p was less than 0.001).&#x0D; Conclusion: Resin infiltration and CPP-ACPF applications can improve bonds to demineralized enamel, while fluoride varnish applications are not recommended for such enamel.&#x0D; &#x0D; How to cite this article: Özant Y, Ay Ünüvar Y. Orthodontic brackets’ shear bond strengths after applying remineralizing agents. Int Dent Res 2021;11(2):67-74. https://doi.org/10.5577/intdentres.2021.vol11.no2.3&#x0D; &#x0D; Linguistic Revision: The English in this manuscript has been checked by at least two professional editors, both native speakers of English.

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

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

COMPARISON BETWEEN GREEN TEA EXTRACT AND CASEIN PHOSPHOPEPTIDE AMORPHOUS CALCIUM PHOSPHATE IN TREATMENT OF INCIPIENT CARIES IN PRIMARY TEETH: AN IN VITRO STUDY

ABSTRACT One of the major factors to prevent caries is to retrieve the mineral loss as early as possible through an internal source, which is natural saliva, or an external sources as artificial saliva, available remineralising agents and natural agents. The aim of the present study was to compare the effect of a natural agent called Green Tea Extract (GTE) and a synthetic remineralising agent called Casein Phosphopeptide Amorphous Calcium Phosphate fluoride (CPP-ACPF) in treatment of incipient caries in primary teeth through scanning electron microscope and Energy Dispersive X-Ray Analysis (SEM_EDX). Materials and methods: Fifteen extracted primary teeth were selected and randomly allocated into 2 groups: Group I: CPP-ACPF, Group II: green tea solution of green tea extract. All specimens were scanned with (SEM-EDX), analysis was carried out at baseline, after demineralization and later after remineralisation. Results: SEM-EDX evaluation showed that the surface minerals content mean value for groups I and II were decreased after demineralization and re-increased after remineralization. SEM also showed improvement in the enamel appearance and the surface became smooth after remineralisation. The surface minerals content mean value in the group treated by CPP-ACPF was higher than the recorded mean value for green tea group. Conclusions: both CPP-ACPF and green tea extract have comparable remineralisation potential. KEYWORDS: Casein phosphopeptide-amorphous calcium phosphate fluoride, SEM-EDX, primary teeth, green tea extract, white spot lesions.

Comparison of Casein Phosphopeptide Amorphous Calcium Phosphate Fluoride and Fluoride Varnish on Remineralization of Early Caries Lesions Around Orthodontic Brackets

Objectives: Orthodontic treatment increases the risk of caries and enamel white spot lesions incidence onthe buccal surface of teeth. This study aims to compare the effect of Casein PhosphoPeptide AmorphousCalcium Phosphate Fluoride and fluoride varnish on remineralization of white spot lesions around orthodonticbrackets.Materials and Methods: In this in-vitro study, 60 premolars teeth were etched for 15 seconds. Then bracketswere bonded with Relicane bond. All teeth were immersed in a demineralization solution for 4 days.The lower part of the bracket was painted with nail polish to prevent the effect of a remineralizing agentto serve as a control group. The teeth were divided into 4 groups, Group 1: treated with fluoride varnish for3 weeks (one-time application), Group2: treated with fluoride varnish for 6 weeks (two-time application),Group 3: treated with casein phosphopeptide and amorphous calcium phosphate with fluoride (CPP-ACPF)for 3 weeks (twice a day), Group 4: treated with CPP-ACPF for 6 weeks (twice a day). Remineralizing agentwas applied on the occlusal of bracket for every tooth Area.then the depth of specimens in treatment and control groups was measured by AutoCAD 2007. Pair-T testand repeated measured ANOVA were used for data analysis by SPSS 23.Result: There was no statistically significant difference between each group of treatment. However, meanremineralization depth in group fourth and mean remineralization area in group three were higher than othergroups.Conclusion: Fluoride varnish and CPP-ACPF have the potential to treat the white spot lesion which iscreated during orthodontic treatment. According to less fluoride varnish use, it seems this substance is abetter option in case of patient’s cooperation is not good.

THERAPEUTIC EFFECT OF TWO FLUORIDE VARNISHES INTENSIVE MODE ON WHITE SPOT LESIONS (RANDOMIZED CLINICAL TRIAL)

Background: Fluoride varnish has been used as therapeutic agent for white spot lesions. Bio-active calcium and phosphate was included in the varnish in order to provide better subsurface remineralization. One of the most promising modifications is the addition of casein phosphopeptide amorphous calcium phosphate to fluoride varnish (MI varnish). Objectives: Evaluate the therapeutic effect of intensive application of casein phosphopeptide amorphous calcium phosphate fluoride (CCP-ACPF) varnish and fluoride varnish on the activity of enamel white spot lesions (WSLs) in primary teeth over a 6 weeks follow-up period. Materials and Methods: Forty-four participants with at least 4 active WSLs each were divided randomly into two groups. Test group (22 participants) received three times intensive professional application of MI varnish with two weeks apart. Control group (22 participants) received three times intensive professional application of Duraphat with two weeks apart. Lesions’ activity in both groups was assessed using DIAGNOdent and visio-tactile lesion activity index at baseline and at 6 weeks. Results: Both groups had a significant decrease in mean DIAGNOdent scores and number of active WSLS when compared to their baseline mean score. However when comparing the results of both groups, the control group (Duraphat varnish) had a significant decrease in DIAGNOdent mean score and number of active WSLs when compared to the test group (MI varnish). Conclusions: Intensive application of fluoride varnish decreases caries lesion activity which may lead to the arrest of the early caries lesions. Duraphat varnish is superior to MI varnish in remineralization of early caries lesions.

Casein phosphopeptide–amorphous calcium phosphate fluoride treatment enriches the symbiotic dental plaque microbiome in children

ObjectivesThe dysbiotic oral microbiome plays a key role in the pathogenesis of caries in children. Topical application of casein phosphopeptide–amorphous calcium phosphate containing fluoride (CPP-ACP/F) is an effective treatment modality for children with caries (CC). Hitherto the mechanism by which CPP-ACP/F modules the oral microbiome in CC has not been investigated. The study aimed to examine the CPP–ACP/F effect on the dental plaque microbiome of children group with caries. MethodsThis preliminary prospective clinical cohort included 10 children with caries. The children received topical fluoride CPP–ACP/F once-a-week for one month. Plaque samples were collected before and after treatment and subjected to 16S rDNA-based next-generation-sequencing. Microbial composition, diversity and functional roles were analyzed in comparison to the clinical characteristics of cohort using standard bioinformatics tools. ResultsCPP-ACP/F treatment modulated dysbiotic oral microbiome towards healthier community as the higher proportion of Proteobacteria and certain microbial protective species were enriched following CPP-ACP/F treatment. Despite overall uniformity of community structure in children with caries between the groups, some bacterial species were differentially represented in a statistically significant manner between pre- and post- treatments. Three bacterial species were found to be predictive of strongly sensitive to the CPP-ACP/F treatment, marked by decreased abundance of Lautropia mirabalis and increased abundance of Gemella haemolysans and Schwartzia succinivorans. ConclusionWithin the limits of the current study, it could be concluded that the CPP-ACP/F varnish treatment modulated the microbial composition of the dental plaque microbiome towards symbiosis. These symbiotic changes may demonstrate the potential clinical significance of CPP-ACP/F varnish treatment.

Evaluation and Comparison of Self-applied Remineralizing Agents Using Confocal Microscopy: An In Vitro Study.

Aim and objectiveThe study was conducted to assess and compare the remineralization ability of fluoride varnish, casein phosphopeptide amorphous calcium phosphate fluoride (CPP-ACPF), bioactive glass-ceramic, and nanohydroxyapatite crystals using a confocal microscope.Materials and methodsEighty premolars and 80 deciduous central incisors were included in this study. Two windows of approximately 3 × 3 mm were created on the labial surface of the premolars and 2 × 2 mm on deciduous maxillary incisors. Artificial caries like lesions was created by demineralizing the sample windows. The teeth sections were then randomly assigned into four groups (n = 20). Specimens of the first group were once painted with fluoride varnish, while those in CPP-ACPF, bioactive glass-ceramic, and nanohydroxyapatite were brushed twice daily for 2 minutes each for 40 days, respectively. 150–200 μm longitudinal sections were obtained and were photographed under a confocal laser scanning microscope. They were quantified using a computerized imaging system for demineralization and later for remineralization. The recorded values were tabulated and analyzed using Fisher's test, analysis of variance (ANOVA), and post hoc Bonferroni's test.ResultsAll the materials used in the study showed remineralization potential at the end of 40 days in both permanent and deciduous teeth. The highest remineralization potential was observed in the fluoride varnish group followed by bioactive glass, CPP-ACFP, and nanohydroxyapatite in both permanent and deciduous teeth. In permanent teeth, the difference in the remineralization potential of fluoride varnish and bioactive glass was not statistically significant.ConclusionThe present study showed that self-applied bioactive glass has similar remineralization potential to fluoride varnish in permanent teeth. Therefore, bioactive glass can be used for the management of incipient caries lesions daily.How to cite this articleGoel T, Singhal A, Singh I, et al. Evaluation and Comparison of Self-applied Remineralizing Agents Using Confocal Microscopy: An In Vitro Study. Int J Clin Pediatr Dent 2020;13(S-1):S34–S39.