The aim of this clinical study was to investigate the acid resistance of enamel lesions remineralized in situ by a sugar-free chewing gum containing casein phosphopeptide-amorphous calcium phosphate nanocomplexes (CPP-ACP: Recaldent™). The study utilized a double-blind, randomized, crossover design with two treatments: (i) sugar-free gum containing 18.8 mg of CPP-ACP, and (ii) sugar-free gum not containing CPP-ACP as control. Subjects wore removable palatal appliances with insets of human enamel containing demineralized subsurface lesions and chewed the gum for 20 min 4 times per day for 14 days. After each treatment the enamel slabs were removed and half of each lesion challenged with acid in vitro for 8 or 16 h. The level of remineralization was determined using microradiography. The gum containing CPP-ACP produced approximately twice the level of remineralization as the control sugar-free gum. The 8- and 16-hour acid challenge of the lesions remineralized with the control gum resulted in 65.4 and 88.0% reductions, respectively, of deposited mineral, while for the CPP-ACP-remineralized lesions the corresponding reductions were 30.5 and 41.8%. The acid challenge after in situ remineralization for both control and CPP-ACP-treated lesions resulted in demineralization underneath the remineralized zone, indicating that the remineralized mineral was more resistant to subsequent acid challenge. The results show that sugar-free gum containing CPP-ACP is superior to an equivalent gum not containing CPP-ACP in remineralization of enamel subsurface lesions in situ with mineral that is more resistant to subsequent acid challenge.
Thin sections of natural white spot enamel lesions (WS) and of artificial in vitro lesions (VL) were remineralized simultaneously in vitro. The sections, clamped in a PMMA holder, were microradiographed at baseline and after remineralization in a calcium– and phosphate–containing solution (pH = 7.0; 1 ppm F) after 2 and 4 weeks. All data were analyzed with respect to baseline. The results show that the lesion depth values did not change significantly during 2 and 4 weeks of remineralization. The mineral accumulation (change in ΔZ), however, was substantial and significant in WS and VL. In WS the change in mineral accumulation was roughly proportional to the amount of mineral at baseline. The WS accumulated more than two times the amount of mineral than VL in the same periods of remineralization. After 4 weeks of remineralization the maximum mineral value Vmax in the surface layer of the WS was nearly up to the sound enamel level ≈87 vol%. This study shows that the technique and calculation procedure described make this single section method attractive for longitudinal demineralization–remineralization studies in vitro or in situ. Both WS and VL samples obviously remineralized in vitro similarly with respect to the baseline. Furthermore, this in vitro work indicates that remineralization inhibitors present in saliva, and previously penetrated into the enamel tissue, do not influence remineralization later on.
Background: The aim of this study was to evaluate enamel remineralization and the acquisition of acid resistance by using sugar-free chewing gum containing fluoride extracted from green tea. Methods: Forty-five volunteers participated in a crossover, double-blind study and wore intraoral appliances with human demineralized enamel. Subjects chewed fluoride chewing gum (FCG: 50 lg fluoride) or placebo gum. Remineralization and acid resistance were evaluated using the mineral change value (DZ, in vol%AElm). Fluoride concentrations in saliva and remineralized enamel were analysed. Results: The peak salivary fluoride concentration was 3.93 ± 1.28 ppm (mean ± SD). The elevated salivary fluoride concentration resulted in a higher fluoride concentration of 656 ± 95 ppm in the remineralized region versus 159 ± 26 ppm for placebo gum (p < 0.001). After remineralization, the DZ of the FCG group was higher than that of the placebo gum group. After an acid challenge, DZ of the FCG group was lower than the placebo gum group. Both DZ were statistically significant. Conclusions: FCG produced a superior level of remineralization and acid resistance, as compared to the placebo gum. The in situ results suggest that regular use of FCG is useful for preventing dental caries.
Thin sections of natural enamel lesions, so–called white spots (WS), and areas of sound enamel (SEn) adjacent to the WS were exposed to an intraoral environment for 2 weeks. Thin sections of WS samples, clamped in a PMMA holder, were microradiographed before and after exposure to intraoral conditions. Acid resistance was evaluated by lesion depth and mineral changes during the cariogenic challenge. The results show that there were statistically significant differences in lesion depth, mineral loss and mineral volume percent at the surface before and after the intraoral cariogenic challenge at least at p<0.05, except for a change in mineral volume percent at the surface of WS samples. This exception indicates that no mineral change occurred in the surface layer of WS. The fact of 2.8 and 1.8 times higher ratios of SEn over WS of mean changes in lesion depth and mineral loss data, respectively, seems to indicate a quantitative difference in acid resistance level of WS lesions compared with the areas of SEn. Regarding the site of mineral changes, a distinctive feature of WS samples is that mineral loss occurs at the bottom of lesions. In contrast, areas of SEn produce a typical subsurface type of lesions. From this in situ study, it can be concluded that the surface of WS samples was apparently much more acid–resistant (at least approximately 2 times) than the areas of SEn that received a similar intraoral acid challenge.
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