Evaluation of the efficacy of casein phosphopeptide-amorphous calcium phosphate on remineralization of white spot lesions in vitro and clinical research: a systematic review and meta-analysis

Abstract

BackgroundThis systematic review with meta-analyses sought to answer whether casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) provided a remineralizing benefit superior to that of nonintervention or placebo.MethodsFollowing Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines, Cochrane databases, PubMed, EmBase, and Ovid up to May 20th, 2019, were scanned, only published in English. Study information extraction and methodological quality assessments were accomplished independently by two reviewers. The “Criteria for judging risk of bias in the ‘Risk of bias’ assessment tool” was used for methodological quality assessment. The continuous data was analyzed by mean difference (MD) or standardized mean difference (SMD) with a 95% confidence interval (CI). Review Manager 5.3 was used for statistical analysis. Outcome variables include quantitative light-induced fluorescence in clinical research, average surface roughness and surface microhardness in vitro.ResultsThere were significant differences in the quantitative light-induced fluorescence (SMD = − 0.43, 95% CI: [− 0.79, − 0.07], P = 0.02), average surface roughness (SMD = − 8.21, 95% CI: [− 10.37, − 6.04], P < 0.01), Vickers microhardness (SMD = 1.19, 95% CI: [0.72, 1.66], P < 0.01), and Knoop microhardness (SMD = 3.52, 95% CI: [2.68, 4.36], P < 0.01) between the CPP-ACP and control groups or baseline.ConclusionWithin the limitations of this meta-analysis, CPP-ACP exhibited excellent remineralization effects evaluated in clinical research and in vitro, indicating outstanding restoration of form, aesthetics, and function in treating white spot lesions.

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 – 14 ]. Meta-analyses of clinical studies have also been published to support the use of the product [ 11 – 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 – 14 ]. There are now twelve published systematic meta-analyses of these clinical studies to support the use of CPP-ACP to lower caries risk [ 11 – 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 – 26 ].…”

Biomimetic Aspects of Oral and Dentofacial Regeneration

“…The evaluation showed significant heterogenicity in the surface hardness values, due to which a random model of analysis was performed which included 5 of the 8 studies selected and which showed values (SMD = 1.19, 95% CI: [0.72, 1.66], p < 0.00001) indicating that the use of CPP-ACP resulted in superior remineralisation. The atomic force microscopy (AFM) analysis of three of their studies also showed that CPP-ACP's use resulted in reduced roughness of the enamel surface and showed their ability to repair and form a smooth surface [14,15]. In another study by Fernando et al which described the use of SnF2 along with ACP-CCP to induce tooth repair, their in-vitro studies showed the ability of SnF2 to interact with CPP-ACP complexes to form a nanofilament coating on the tooth surface, with superior remineralisation activity in comparison to either of these materials individually.…”

“…Most of them include the use of fluoridated toothpastes and other fluoride-containing products like varnishes and mouthwashes. Casein phosphopeptide (CPP)-amorphous calcium phosphate (ACP) combinations are used for improving enamel surface remineralisation owing to their ability to stabilise calcium, phosphate, and fluoride ions, which are already available in saliva, leading to faster and better surface remineralisation of the enamel layer [14]. Ma et al (2019) conducted a systematic review with metanalyses describing the efficiency of CCP-ACP in enamel remineralisation.…”

“…Casein phosphopeptide (CPP)-amorphous calcium phosphate (ACP) combinations are used for improving enamel surface remineralisation owing to their ability to stabilise calcium, phosphate, and fluoride ions, which are already available in saliva, leading to faster and better surface remineralisation of the enamel layer [14]. Ma et al (2019) conducted a systematic review with metanalyses describing the efficiency of CCP-ACP in enamel remineralisation. They summarised 12 studies based on the inclusion and exclusion criteria, which were evaluated either by surface roughness or their microhardness values.…”