Comparative Evaluation of Remineralization Potential of Two Varnishes Containing CPP–ACP and Tricalcium Phosphate: An In Vitro Study

Varma, Rajiv K.; Ks, Hegde; Ss, Bhat; Ss, Sargod; Ha, Rao

doi:10.5005/jp-journals-10005-1629

Cited by 14 publications

(1 citation statement)

References 11 publications

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“…As expected, at lower pH, the binding is decreased; while higher pH prevents spontaneous precipitation of calcium phosphate [Reynolds, 1987;Ekambaram et al, 2017]. Therefore, this material has been suggested to be particularly effective in the remineralization of early enamel lesions and in the treatment of other types of enamel opacities [Reynolds, 1987;Imani et al, 2019;Varma et al, 2019;Sbaraini et al, 2021].…”

Section: Introductionmentioning

confidence: 81%

Combined Casein Phosphopeptide-Amorphous Calcium Phosphate and Fluoride Is Not Superior to Fluoride Alone in Early Carious Lesions: A Meta-Analysis

Golzio Navarro Cavalcante,

Schulze Wenning,

Szabó

et al. 2023

Caries Res

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There is a growing need for effective methods in the management of early-stage carious lesions. Therefore, the aim of this study was to evaluate the effect of combined casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) and fluoride on white spot lesions (WSLs) compared to fluoride-only interventions. This meta-analysis was performed according to PRISMA guidelines and registered in PROSPERO (CRD42021286245). The Medline, EMBASE and Cochrane Central databases were searched until October 17, 2022. Eligible studies were randomized controlled trials (RCTs). Outcome variables included Laser Fluorescence (LF), Quantitative Light-Induced Fluorescence (QLF), and lesion area scores. The random-effects model was used for analysis, and results were given as standardized mean difference (SMD) and mean difference (MD) with a 95% Confidence Interval. Risk of Bias was assessed using the RoB 2 tool, and the level of evidence with GRADE. Our systematic search yielded 973 records after duplicate removal, 21 studies were included for qualitative synthesis, and 15 studies were eligible for quantitative analysis. No significant difference was found between CPP-ACP and fluoride versus fluoride alone in LF at 1, 3 and 6 months of use: SMD -0.30 (-0.64; 0.04); SMD -0.47 (-1.02; 0.07); SMD -0.49 (-1.13; 0.15), respectively. For QLF, the analysis did not demonstrate significant differences between these two kinds of treatment at one and six months of use: MD 0.21 (-0.30;0.71); MD 0.60 (-1.70;2.90), but at three months higher QLF values were found in the fluoride-only group compared to the CPP-ACP and fluoride combination was shown regarding the WSLs: MD 0.58 (0.25;0.91). On the contrary, data showed a small but statistically significant decrease in the lesion area in favor of the CPP-ACP plus fluoride vs fluoride alone at six months MD -0.38 (-0.72; -0.04). None of these observed changes indicated substantial clinical relevance. The combination of CPP-ACP and fluoride did not overcome the effect of fluoride given alone. Our data suggest that fluoride itself is effective in improving WSLs. However, the certainty of evidence was very low. These results indicate that further studies and future development of more effective than CPP-ACP are needed in addition to fluoride to achieve robust amelioration of WSLs.

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Section: Introductionmentioning

confidence: 81%

Combined Casein Phosphopeptide-Amorphous Calcium Phosphate and Fluoride Is Not Superior to Fluoride Alone in Early Carious Lesions: A Meta-Analysis

Golzio Navarro Cavalcante,

Schulze Wenning,

Szabó

et al. 2023

Caries Res

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Effect of fluoride varnishes on oral bacteria of preschool children with cavitated and non-cavitated carious lesions: randomized clinical trial

Manchanda,

Sardana,

Peng

et al. 2023

Sci Rep

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We compare the effect of calcium and phosphate-containing sodium fluoride (NaF) varnishes to conventional NaF varnish on S. mutans and L. fermentum counts. 3–4 years old children were grouped according to their caries status (n = 45 each): caries-free, with non-cavitated and with cavitated lesions. Each group was randomly subdivided (n = 15 each) into: Group 1- 5% NaF, Group 2- 5% NaF with tricalcium phosphate, Group 3- 5% NaF with casein phosphopeptide- amorphous calcium phosphate. Biofilm and saliva were collected to quantify microorganisms at baseline (T1) and 24-months (T2). Differences between groups were compared using Kruskal–Wallis test, followed by Dunn-Bonferroni post-test, at 0.0167 α-level. Significant difference was found for percentage of children with detectable biofilm L. fermentum (p = 0.013) at T1 and salivary S. mutans (p = 0.011) at T2. Percentage of children increased from T1 to T2 in Group 2 with salivary S. mutans (p = 0.007), salivary L. fermentum (p = 0.035), and biofilm L. fermentum (p = 0.019) and in Group 3 with salivary L. fermentum (p = 0.035). Bacterial change was not significant in both samples of intervention groups, except increase in salivary S. mutans (p = 0.038) in Group 3. Both calcium- and phosphate-containing NaF varnishes demonstrated similar antibacterial effect on S. mutans and L. fermentum compared to conventional NaF varnish.

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Comparative evaluation of prevention of demineralization of artificial enamel caries treated with two fluoride varnishes and 38% SDF in primary teeth: an in vitro study

2023

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Background This study aimed to compare the effect of Clinpro™ White varnish containing 5% sodium fluoride (NaF) and functionalized tricalcium phosphate, MI varnish containing 5% NaF and casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), and 38% Silver diamine fluoride (SDF) in preventing demineralization of treated white spot lesions (WSLs) in enamel of primary teeth. Methods Forty-eight primary molars with artificial WSLs were allocated into four groups as follows: Group 1: Clinpro white varnish, Group 2: MI varnish, Group 3: SDF, and Group 4: control (no treatment). The three surface treatments were applied for 24 h and then enamel specimens were subjected to pH cycling. Thereafter, the mineral content of specimens was evaluated by Energy Dispersive X-ray Spectrometer and the lesion depth was assessed via Polarized Light Microscope. One-way ANOVA followed by Tukey’s post hoc test were used at p ≤ 0.05 to identify significant differences. Results Insignificant difference in mineral content was observed among treatment groups. Treatment groups exhibited significantly higher mineral content compared to control except for Fluoride (F). MI varnish showed the highest mean calcium (Ca) ion content (66.57 ± 0.63), and Ca/P (2.19 ± 0.11), followed by Clinpro white varnish, and SDF. MI varnish also displayed the highest phosphate (P) ion content (31.46 ± 0.56), followed by SDF (30.93 ± 1.02), and Clinpro white varnish (30.53 ± 2.19). Fluoride content was highest in SDF (0.93 ± 1.18), followed by MI (0.89 ± 0.34) and Clinpro (0.66 ± 0.68) varnishes. Significant difference in lesion depth was observed among all groups (p < 0.001). The lowest mean lesion depth (µm) was found in MI varnish (226.23 ± 44.25) which was significantly lower than Clinpro white varnish (285.43 ± 44.70), SDF (293.32 ± 46.82), and control (576.69 ± 42.66). Insignificant difference in lesion depth was found between SDF and Clinpro varnish. Conclusions In primary teeth, WSLs treated with MI varnish displayed better resistance to demineralization compared to WSLs treated with Clinpro white varnish and SDF.

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Comparative Evaluation of Remineralization Potential of Two Varnishes Containing CPP–ACP and Tricalcium Phosphate: An In Vitro Study

Cited by 14 publications

References 11 publications

Combined Casein Phosphopeptide-Amorphous Calcium Phosphate and Fluoride Is Not Superior to Fluoride Alone in Early Carious Lesions: A Meta-Analysis

Combined Casein Phosphopeptide-Amorphous Calcium Phosphate and Fluoride Is Not Superior to Fluoride Alone in Early Carious Lesions: A Meta-Analysis

Effect of fluoride varnishes on oral bacteria of preschool children with cavitated and non-cavitated carious lesions: randomized clinical trial

Comparative evaluation of prevention of demineralization of artificial enamel caries treated with two fluoride varnishes and 38% SDF in primary teeth: an in vitro study

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