A 12-week assessment of the treatment of white spot lesions with CPP-ACP paste and/or fluoride varnish

This 12-week clinical study evaluated the impact of 10% CPP-ACP and 5% sodium fluoride varnish regimes on the regression of nonorthodontic white spot lesions (WSLs). The study included 21 children with 101 WSLs who were randomised into four treatment regimes: weekly clinical applications of fluoride varnish for the first month (FV); twice daily self-applications of CPP-ACP paste (CPP-ACP); weekly applications of fluoride varnish for the first month and twice daily self-applications of CPP-ACP paste (CPP-ACP-FV); and no intervention (control). All groups undertook a standard oral hygiene protocol and weekly consultation. Visual appraisals and laser fluorescence (LF) measurements were made in weeks one and twelve. The majority of WSLs in the control and FV groups exhibited no shift in appearance, whereas, in the CPP-ACP and CPP-ACP-FV groups, the lesions predominantly regressed. The visual and LF assessments indicated that the extent of remineralisation afforded by the treatments was of the following order: control ~ FV < CPP-ACP ~ CPP-ACP-FV. Self-applications of CPP-ACP paste as an adjunct to standard oral hygiene significantly improved the appearance and remineralisation of WSLs. No advantage was observed for the use of fluoride varnish as a supplement to either the standard or CPP-ACP-enhanced oral hygiene regimes

The in vitro remineralizing effect of CPP-ACP and CPP-ACPF after 6 and 12 weeks on initial caries lesion

Objective: The aim of this in vitro study was to determine the effects of remineralization promoting agents containing casein phosphopeptidestabilized amorphous calcium phosphate (CPP-ACP), or CPP-ACP in combination with fluoride (CPP-ACPF) on artificial white spot lesions (WSLs) after 6 and 12 weeks. Methodology: White spot lesions were created on 123 sectioned premolars (246 specimens) with a demineralization solution during a 96 hours pH-cycling regime. Two experimental groups were created: a CPP-ACP group (Tooth MousseTM), and a CPP-ACPF group (Mi Paste PlusTM). Additionally, two control groups were created, one using only a conventional toothpaste (1450 ppm fluoride) and another one without any working agents. All teeth were also daily brushed with the conventional toothpaste except the second control group. Tooth MousseTM and Mi Paste PlusTM were applied for 180 seconds every day. The volume of demineralization was measured with transverse microradiography. Six lesion characteristics regarding the lesion depth and mineral content of WSLs were also determined. Results: The application of CPP-ACP and CPP-ACPF had a significant regenerative effect on the WSLs. Compared to Control group 1 and 2 the volume of demineralization after 6 weeks decreased significantly for CPP-ACP (respectively p&lt;0.001 and p&lt;0.001) and CPP-ACPF (respectively p=0.001 and p=0.003). The same trend was observed after 12 weeks. For the CPP-ACPF group, WSL dimensions decreased significantly between 6 and 12 weeks follow-up (p=0.012). The lesion depth reduced significantly after application of CPP-ACP and CPP-ACPF but increased significantly in the Control groups. Mineral content increased for CPP-ACP and CPP-ACPF after an application period of 12 weeks, but this was only significant for CPP-ACP. Conclusions: Long-term use of CPP-ACP and CPP-ACPF in combination with a conventional tooth paste shows beneficial effects in the recovery of in vitro subsurface caries lesions

A COMPARATIVE EVALUATION OF THE NUMBER OF STREPTOCOCCUS MUTANS COLONIES IN THE ENAMEL SURFACE OF TEETH AFTER THE APPLICATION OF CPP-ACP CONTAINING PROPOLIS AND CPP-ACP WITHOUT PROPOLIS

Objective: This study was to determine the efficacy of CPP-ACP combined with propolis by evaluating the number of Streptococcus mutans colonies inthe enamel surfaces of children aged 7–9 years before and after the application of CPP-ACP containing propolis.Methods: A quasi-experimental pretest-posttest design with purposive sampling was used in this study, which was conducted on 32 students aged7–9 years who were divided into two groups that were intervention and control groups. Two young dentists examined the students, and their resultswere calibrated by a kappa value of 0.82. The number of S. mutans colonies was evaluated at baseline, and after a CPP-ACP propolis paste was appliedto white spot surfaces in the intervention group and CPP-ACP without propolis was applied to white spot surfaces of students in the control group inevery day for 4 weeks.Results: There was a significant decrease in the proportion of S. mutans colonies both of the intervention group (28%) and the control group (26%)(p&lt;0.05). However, there was no significant difference in the effect of CPP-ACP propolis combination compared to CPP-ACP without propolis indecreasing the number of S. mutans colonies (p&gt;0.05).Conclusion: This study confirmed that CPP-ACP containing propolis is not better than CPP-ACP without propolis in decreasing the number of S. mutanscolonies; however, the CPP-ACP propolis combination has the potential to be used as an alternative material to prevent demineralization and improveremineralization of white spots in enamel surfaces

In situ effect of CPP-ACP chewing gum upon erosive enamel loss

Casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) is able to increase salivary calcium and phosphate levels at an acidic pH. Previous studies demonstrated that a CPP-ACP chewing gum was able to enhance the re-hardening of erosion lesions, but could not diminish enamel hardness loss. Therefore, there is no consensus regarding the effectiveness of CPP-ACP on dental erosion. Objective This in situ study investigated the ability of a CPP-ACP chewing gum in preventing erosive enamel loss. Material and Methods: During three experimental crossover phases (one phase per group) of seven days each, eight volunteers wore palatal devices with human enamel blocks. The groups were: GI – Sugar free chewing gum with CPP-ACP; GII – Conventional sugar free chewing gum; and GIII – No chewing gum (control). Erosive challenge was extraorally performed by immersion of the enamel blocks in cola drink (5 min, 4x/day). After each challenge, in groups CPP and No CPP, volunteers chewed one unit of the corresponding chewing gum for 30 minutes. Quantitative analysis of enamel loss was performed by profilometry (µm). Data were analyzed by Repeated-Measures ANOVA and Tukey’s test (

THE EFFECT OF BILIMBI (BELIMBING WULUH) EXTRACT (Averrhoa bilimbi L) AGAINST DENTAL REMINERALIZATION AND ENAMEL MICROSTRUCTURE (IN VITRO RESEARCH): PENGARUH EKSTRAK BUAH BELIMBING WULUH (Averrhoa bilimbi L) TERHADAP REMINERALISASI GIGI DAN MIKROSTRUKTUR EMAIL (PENELITIAN IN VITRO)

Teeth physiologically undergo demineralization and remineralisation processes. One way to reduce demineralization can be done with the use of CPP-ACP (Casein Phosphopeptide-Amorphous Calcium Phosphate), which has high calcium bioavailability. The use of natural materials products in the field of dentistry is currently growing, one of which is bilimbi/ starfruit (belimbingwuluh) that is rich in minerals and has many benefits. This study aims to analyze the effect of extract of bilimbi in tooth enamel remineralisation which is tested by using SEM and EDX equipments so that the difference of enamel surface microstructure and the amount of calcium and phosphorus content of tooth enamel surface can be identified. A total of eight hidden molar teeth were extracted, cut into four parts and divided into four groups, namely group I: the teeth applied with the wuluh bilimbi gel, group II: the teeth applied with CPP-ACP gel, group III: the teeth applied with the combination gel of starfruit extract and CPP-ACP gel, group IV: without any application. The result of this study was assessed qualitatively and it was noticeable that the treatment group combination of CPP-ACP gel and starfruit gel had the smoothest enamel surface microstructure. Quantitatively, there were significant difference is the three treatment groups (p≤ 0.05). The conclusion of this research is the effect of the application of wuluh bilimbi extract gel, CPP-ACP gel and gel combination of starfruit with CPP-ACP gel towards the remineralisation and microstructure of tooth enamel surface

Antibacterial Efficacy of Silver Diamine Fluoride Compared to Casein Phosphopeptide-Amorphous Calcium Phosphate Against Streptococcus mutans in a Biofilm Caries Model

Objective: To compare the antibacterial efficacy of silver diamine fluoride (SDF) with a product containing casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) against Streptococcus mutans using a biofilm caries model. Material and Methods: Twenty-seven saliva-coated dentine blocks obtained from extracted human teeth were inoculated with Streptococcus mutans monospecies biofilm in this in vitro study. The biofilms were then exposed to 10% sucrose in brain heart infusion broth eight times daily for seven days. After the biofilm growth period, the dentine blocks (n=9 per group) were treated with one of the following substances: 1) sterile saline (control), 2) 38% SDF, and 3) a product containing CPP-ACP. Then, the samples were incubated at 37ºC for 48 hours, and the numbers of viable microorganisms in the biofilms were counted and compared. ANOVA and Tukey\u27s HSD tests were used to analyze the data (p&lt;0.05). Results: The number of viable bacteria, as determined by the number of colony-forming units (CFU mL-1) of Streptococcus mutans, was significantly reduced following treatment with SDF and the CPP-ACP product (p&lt;0.05). However, SDF showed superior antibacterial activity compared to the CPP-ACP product (mean CFU mL-1=zero compared to 96 x106) (p&lt;0.05). Conclusion: SDF has higher antibacterial activity against cariogenic Streptococcus mutans biofilm than the CPP-ACP product. The CPP-ACP product showed antibacterial activity, but it was limited

COMPARISON OF SHRIMP (LITOPENAEUS VANNAMEI) SHELL PASTE AND CASEIN PHOSPHOPEPTIDE-AMORPHOUS CALCIUM PHOSPHATE (CPP-ACP) PASTE AS TEETH REMINERALIZATION MATERIAL

Objective: To determine the comparison of shrimp shell and casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) as tooth remineralization material. Methods: This study was an experimental laboratory with a cross-sectional design. Study sample was 10 maxillary central incisors that were applied with 35% hydrogen peroxide for 2 h, then assessed with energy dispersive spectroscopy (EDS). Samples were divided into 2 groups: 5 samples were applied using CPP-ACP paste and 5 samples using shrimp shell paste every 8 h for 14 consecutive days then checked with EDS. Data analysis using SPSS test independent t-test to compare shrimp shell paste and CPP-ACP paste as tooth remineralization material. Results: The result of this study showed p&gt;0.05, meaning there was no significant difference between CPP-ACP and shrimp shell paste mineral composition. Conclusion: Shrimp shell paste has an effective value to be used as a tooth remineralization material

PENGARUH PENAMBAHAN KITOSAN NANOPARTIKEL PADA CASEIN PHOSPHOPEPTID AMORPHOUS CALCIUM PHOSPHATE (CPP-ACP) TERHADAP REMINERALISASI GIGI: EFFECT OF ADDING NANOPARTICLE CHITOSAN TO CASEIN PHOSPHOPEPTID AMORPHOUS CALCIUM PHOSPHATE (CPP-ACP) ON TOOTH REMINERALIZATION

Perawatan karies saat ini dikembangkan dengan pendekatan kontemporer. Intervensi non-invasif lesi karies yangbelum membentuk kavitas diperoleh dengan menggunakan bahan terapi untuk penyembuhan lesi. Penelitian inibertujuan untuk membandingkan efek CPP-ACP dan kombinasi gel CPP-ACP dan kitosan nanopartikel dalamremineralisasi email dengan menggunakan alat EDX. Sebanyak dua puluh empat buah sampel email gigi molarterpendam yang sudah diekstraksi dibagi menjadi empat kelompok. Kelompok I hanya diinkubasi dalam salivabuatan. Kelompok II direndam dalam larutan demineralisasi. Kelompok III direndam dalam larutandemineralisasi kemudian diaplikasi dengan gel CPP-ACP. Kelompok IV direndam dalam larutan demineralisasikemudian diaplikasi dengan kombinasi gel CPP-ACP dan kitosan nanopartikel. Seluruh sampel diuji dengan alatEDX. Uji statistik menunjukkan tidak ada perbedaan jumlah unsur kalsium dan fosfor yang bermakna antaraemail yang diaplikasikan gel CPP-ACP dan kombinasi gel CPP-ACP dan kitosan (p&gt;0,05). Sebagai kesimpulan,gel CPP-ACP dan kombinasi gel CPP-ACP dan kitosan nanopartikel memiliki kemampuan meningkatkanremineralisasi email gigi yang sama baiknya

Laser-Casein phosphopeptide effect on remineralization of early enamel lesions in primary teeth

Background: The aim of this study was to assess the effect of Nd:YAG laser irradiation following casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) application on calcium and phosphate concentration and surface microhardness (SMH) of enamel surface in artificial white spot lesions of primary teeth. Material and Methods: Eighty teeth with artificial white spot lesions were randomly divided into four groups: (A) distilled and deionized water, (B) Nd:YAG laser, (C) CPP-ACP crème, & (D) CPP-ACP plus laser. SMH was measured using Vickers diamond indenter in Vickers Hardness Number (VHN). Two samples of each group were analyzed using scanning electron microscope (SEM). The results were analyzed with the SPSS 17/win. Results: The subjects of group D demonstrated a significant increase in the calcium and phosphate contents of enamel surface compared to those of groups A ( P < 0.001, P < 0.001), B ( P < 0.001, P < 0.001) and C ( P = 0.024, P = 0.04), respectively. A statistically significant difference was seen for mean VHN between groups A and B ( P = 0.002). SEM evaluations confirmed the results. Conclusions: The combination of Nd:YAG laser and CPP-ACP crème could be recommended as an effective preventive modality for remineralizing of white spot lesions in primary teeth

Effect of Different Topical Agents on Remineralization of Early Enamel Lesion– an in vitro Study

Objective: This study aimed to compare the effect of using Casein phosphopeptide – amorphous calcium phosphate (CPP-ACP) paste, Remin-Pro and Fluoride Varnish on remineralization of  enamel lesions.Methods: In this experimental-in vitro study, 60 intact premolars and molars were used and flat enamel surfaces were prepared. The specimens were divided into 6 groups (N=10). After primary DIAGNOdent value measurement and a four-day immersion in demineralizing solution, the DIAGNOdent value were measured. Groups 1, 2 and 3 were treated by Fluoride varnish, CPP-ACP and Remin-Pro respectively, according to the manufacturer instruction and their DIAGNOdent value was read. Groups 4, 5, and 6 were treated by Fluoride varnish, CPP-ACP and Remin-Pro for 1  month (8 hours a day), respectively, and their DIAGNOdent value was measured. Then the specimens of these three groups were demineralized and pH cycled and their DIAGNOdent values were recorded. The data were analyzed by One-way analysis of variance (ANOVA) and repeated measures ANOVA.Results: After a one-month treatment, the DIAGNOdent value significantly decreased in groups 4, 5, and 6 in comparison to the manufacturer instruction (p&lt;0.001). ANOVA test indicated that decrease mean value of DIAGNOdent value was significantly higher for Remin-Pro and CPP-ACP groups than Fluoride varnish group, from entrance time to the study to re-demineralization stage (p&lt;0.001). Conclusion: All the three materials showed a statistically significant amount of remineralization after repeated application but the CPP-ACP and Remin pro were more resistant to  redemineralization and pH cycling