Remineralization effect of CPP-ACP and fluoride for white spot lesions in vitro

Abstract

Background/Aims This in vitro study compared the remineralization effect on white spot lesions of casein phosphopeptide-amorphous calcium phosphate crème, or CPP-ACP (MI Paste™), 1.1% NaF dentifrice containing 5000 ppm of fluoride (ControlRX™), or CPP-ACP crème with 900 ppm of fluoride (MI Paste Plus™) with that of a control. Methods Artificial white spot lesions were created on smooth enamel surfaces of sound molars using a previously reported demineralization model. Specimens were randomly assigned to four treatments (n=35) with a pH-cycling model over 30 days: Control (no treatment); MI Paste (10% CPP-ACP crème); F5000 (1.1% NaF dentifrice); or MI Paste Plus (10% CPP-ACP plus 900 ppm fluoride crème). Products were applied following manufacturers’ directions. Changes in mean lesion depth expressed by percent fluorescence loss (∆F%), and lesion area (mm2) from baseline to after treatment were measured with light-induced fluorescence (QLF). Mean values of each parameter were compared between groups (p<0.05). Results The remineralization pattern for the F5000 group was unique with marked initial remineralization during the first 10 days and little subsequent change. Based on mean lesion area, the F5000 demonstrated greater remineralization than Control, MI Paste and MI Paste Plus groups. Based on mean fluorescence loss, the F5000 group showed improved remineralization relative to MI Paste Plus, but did not differ statistically from the Control at the end of 30 days. Conclusions The 1.1% NaF dentifrice demonstrated overall greater remineralization ability than 10% CPP-ACP crème. However, the 1.1% NaF dentifrice was only as effective as the Control to reduce fluorescence loss.

Remineralizing potential of CPP‐ACP creams with and without fluoride in artificial enamel lesions

“…However, similar to our results, the MI Paste did not show any differences in relation to the control (saliva) and MI Paste Plus . In other studies the MI Paste also did not show any effect on the inhibition of lesion progression . According to Pulido et al ., it might be necessary to have a longer application time to be able to detect any deposition of calcium and phosphate in a remineralized lesion.…”

“…According to Pulido et al ., it might be necessary to have a longer application time to be able to detect any deposition of calcium and phosphate in a remineralized lesion. Additionally, the lack of biofilm and, consequently, the optimal environment for the CPP‐ACP to create a state of supersaturation of calcium and phosphate ions could have prevented this system from properly exerting a remineralizing action of these products . Instead, the application of CPP‐ACP dentifrice on erosive lesions with continuous replenishment of saliva‐like solution significantly hardened enamel softened by a cola drink .…”

Protective effect of casein phosphopeptide‐amorphous calcium phosphate on enamel erosion: Atomic force microscopy studies

“…The application of a CPP-ACP paste either before or before and after inoffice bleaching protocols proved to be able to prevent negative changes of roughness and hardness to enamel (Cunha et al, 2012). Therefore recently casein phosphopeptide-amorphous calcium phosphate and fluoride (CPP-ACPF) due to its added fluoride content has shown improved ability to remineralize initial caries (Oliveira et al, 2014;Shetty et al, 2014).…”

Influence of biofilm formation on the mechanical properties of enamel after treatment with CPP-ACP crème

“…17,19 In addition, the efficacy of CPP-ACP may be influenced by saturation of saliva, 13,23 time of application, 17,22,24 or by biofilm formation. However, in the presence of CPP, which prevents rapid transformation of the calcium phosphate phases, the ions would be stabilized and maintained such that molecules would spontaneously move from a region of higher concentration to one of lower concentration in the subsurface lesion.…”