Effect of CPP-ACP Paste on Enamel Carious Lesion of Primary Upper Anterior Teeth Assessed by Quantitative Light-Induced Fluorescence: A One-Year Clinical Trial

Abstract

The purpose of this clinical trial was to evaluate the effect of 1 year of daily application of 10% w/v CPP-ACP (casein phosphopeptide-amorphous calcium phosphate) paste in addition to regular toothbrushing with fluoridated toothpaste on the remineralization of enamel carious lesions in preschool children using quantitative light-induced fluorescence (QLF). A total of 103 Thai children (aged 2¹/₂-3¹/₂ years) with high caries risk who had at least 1 enamel carious lesion (ICDAS 1-3) on the labial surface of the upper anterior teeth were assigned to receive either CPP-ACP paste (n = 53) or placebo control (n = 50) following toothbrushing with fluoridated toothpaste after lunch at school. QLF measurement was performed at baseline, 6 months and 1 year. At 1 year, a significant reduction in fluorescence loss (ΔF), lesion area and lesion volume (ΔQ; p ≤ 0.001) of the lesions were found over time in both groups. However, no significant difference was observed between the groups (p = 0.79, 0.98 and 0.88, respectively). There was no statistically significant difference between the odds of ΔQ transition to a stage of regression or arrest compared with progression from baseline to 1 year between the two groups (OR = 1.03, 95% CI 0.31-3.39). The daily application of 10% w/v CPP-ACP paste on a school day for 1 year resulted in no improvement of enamel carious lesion remineralization in the primary upper anterior teeth as assessed by QLF. The lesion improvement was not superior to remineralization from regular toothbrushing with fluoridated toothpaste alone in these children.

Treatment of post-orthodontic white spot lesions with CPP-ACP paste: A three year follow up study

“…Both in-vitro and in-situ studies have demonstrated that CPP-ACP can promote the remineralization of subsurface enamel lesions 10,12) Thirty six weeks after debonding in our study, the lesions showed significant improvement with respect to fluorescence loss, as monitored by DD. However, both test and control methods resulted in significant improvements of WSLs severity and activity scores compared to baseline, but no significant differences were detected between the groups after three years.…”

“…Our bacterial results should be interpreted with caution because of dropout rate. The study period of 36 weeks might be regarded as long compared with other studies [11][12][13][14][15][16] , so the dropout rate in this study is relatively high (17%). So we failed to detect any positive or negative effects of CPP-ACP on saliva bacterial levels 30) .…”

“…The greater decrease in DD readings for lesions in test group compared to control may be taken to indicate a larger reversal of the early caries process due to the repeated CPP-ACP application. Several methods had been used for screening WSLs after orthodontic treatment such as QLF, DIAGNOdent or clinical scores [11][12][13][14][15][16] . On the other hand the DIAGNOdent readings should be interpreted with caution because statistically significant differences might not necessarily have clinical significance.…”

“…CPP is believed to have an antibacterial and buffering effect on plaque, and interfere in the growth and adherence of Streptococcus mutans and Streptococcus sobrinus. Moreover, CPP can stabilize the level of ACP in saliva by preventing precipitation of calcium and phosphate, and stabilize the level of calcium 12) . Tooth Mousse/MI Paste (GC, Tokyo, Japan) is a topical remineralizing cream containing CPP-ACP (10% w/v).…”

“…Tooth Mousse/MI Paste (GC, Tokyo, Japan) is a topical remineralizing cream containing CPP-ACP (10% w/v). While in vitro studies of the cream have shown demineralization prevention and remineralization promotion, its efficacy has to be substantiated in different short term clinical trials [11][12][13][14][15][16] . Therefore, the aim of this project was to evaluate the efficacy of topical applications of 10% CPP-ACP paste in reverting white spot lesions (WSLs) in a post-orthodontic population in a 36-month.…”