Effectiveness of casein phosphopeptide‐amorphous calcium phosphate‐containing products in the prevention and treatment of white spot lesions in orthodontic patients: A systematic review

Abstract

The purpose of the present systematic review was to evaluate the effectiveness of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP)-containing products in the prevention and treatment of active white spot lesions (WSL) in orthodontic patients.Searched the Scopus, PubMed, Web of Science, Cochrane, Virtual Health Language, ClinicalTrials, and Open Gray databases without limitations on the year or language of publication. We included controlled clinical trials with patients with fixed orthodontic appliances under the use of CPP-ACP-containing products compared to control, placebo, or other interventions in the prevention and treatment of WSL around orthodontic braces.Case reports, editorials, in vitro studies, annals of congress, and reviews were excluded.To assess the risk of bias, the revised version of the Cochrane tool for randomized trials (RoB 2.0) and Risk Of Bias In Non-randomized Studies for non-randomized trials were used. The biases were graded low, moderate, and high according to the tools used. Of the 599 articles found, 11 met the inclusion criteria. Of these, nine were randomized, controlled clinical trials and two were non-randomized. Two studies were considered to have moderate bias risk, and the most-used CPP-ACP presented form was a cream for topical applications. Although CPP-ACP-containing products did not differ from other fluoride products, they were able to reduce WSL and neutralize the pH around the orthodontic braces. Products containing CPP-ACP are effective in preventing and treating WSL around the braces. However, further studies with the same measurement method and periods of use, and other forms of presentation of CPP-ACP are needed. K E Y W O R D Scasein phosphopeptide-amorphous calcium phosphate, orthodontic appliances, orthodontic brackets, tooth remineralization, white spot lesions | INTRODUC TI ONOrthodontic appliances make hygiene difficult and potentiate the accumulation of bacterial biofilms on dental surfaces, 1-3 whose bacteria produce acids from the fermentation of food debris leading to the carious process by means of demineralization of hydroxyapatite crystals of dental enamel. [4][5][6] This generates an imbalance between the processes of demineralization and remineralization performed by the saliva.

Combined effect of Er,Cr:YSGG laser and casein phosphopeptide amorphous calcium phosphate on the prevention of enamel demineralization:

“…21 The use of CPP-ACP in the current study was based upon the positive results demonstrated in previous studies that investigated the effect of different CPP-ACP formulations on the prevention of WSLs, 23,24 with no significant difference compared to fluoride compounds. 7,8 . Use of CPP-ACP resulted in signifi- cantly less lesion depth (48.7%) compared with the control group.…”

“…7 A systematic review in 2019 that reviewed effectiveness of CPP-ACP products in prevention of WSLs in orthodontic patients, showed that, although CPP-ACP-containing products did not differ from other fluoride products, they were able to reduce WSLs and neutralize the pH around orthodontic brackets. 8 Recently, it was shown that treatment with lasers reduced subsurface demineralization. A variety of explanations have been given including enamel surface melting, recrystallization and changing the enamel organic matrix.…”

Experiences of oral health: before, during and after becoming a regular user of GC Tooth Mousse Plus ®

“…Previous clinical and laboratory studies focused on the effectiveness of TMP in preventing and reversing of early dental caries lesions (10)(11)(12)(13)(14). Meta-analyses of clinical studies have also been published to support the use of the product (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22). However, no other study has addressed regular users' views about the product, how the product performs and addresses their individual needs (e.g.…”

“…There is a high-level of evidence supporting the ability of CPP-ACP to remineralise early caries lesions and prevent their progression (10)(11)(12)(13)(14). There are now twelve published systematic metaanalyses of these clinical studies to support the use of CPP-ACP to lower caries risk (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22). In addition, CPP-ACP effectiveness has also been demonstrated in relation to the reduction of cariogenic bacteria and increased colonization of commensal microorganisms, and the reduction of dentine hypersensitivity (23)(24)(25)(26).…”

Experiences of oral health: before, during and after becoming a regular user of GC Tooth Mousse Plus ®

“…There is a high-level of evidence supporting the remineralization potential of CPP-ACP, that is, prevention and reversal of early caries lesions (10)(11)(12)(13)(14). In fact, there are now twelve published systematic meta analyses of the clinical studies to support the use of CPP-ACP (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22). In addition, CPP-ACP effectiveness has also been demonstrated in relation to the reduction of cariogenic bacteria and increased colonization of commensal microorganisms, and the reduction of dentine hypersensitivity (23)(24)(25)(26).…”