Treatment of post-orthodontic white spot lesions with casein phosphopeptide-stabilised amorphous calcium phosphate

Abstract

This study aims to investigate the effect of topical applications of 10% casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) on white spot lesions (WSL) detected after treatment with fixed orthodontic appliances. Sixty healthy adolescents with ≥1 clinically visible WSL at debonding were recruited and randomly allocated to a randomised controlled trial with two parallel groups. The intervention group was instructed to topically apply a CPP-ACP -containing agent (Tooth Mousse, GC Europe) once daily and the subjects of the control group brushed their teeth with standard fluoride toothpaste. The intervention period was 4 weeks and the endpoints were quantitative light-induced fluorescence (QLF) on buccal surfaces of the upper incisors, cuspids and first premolars and visual scoring from digital photos. The attrition rate was 15%, mostly due to technical errors, and 327 lesions were included in the final evaluation. A statistically significant (p < 0.05) regression of the WSL was disclosed in both study groups compared to baseline, but there was no difference between the groups. The mean area of the lesions decreased by 58% in the CPP-ACP group and 26% in the fluoride group (p = 0.06). The QLF findings were largely reflected by the clinical scores. No side effects were reported. Topical treatment of white spot lesions after debonding of orthodontic appliances with a casein phosphopeptide-stabilised amorphous calcium phosphate agent resulted in significantly reduced fluorescence and a reduced area of the lesions after 4 weeks as assessed by QLF. The improvement was however not superior to the "natural" regression following daily use of fluoride toothpaste.

White Spot Lesions: Prevention and Management During the Orthodontic Treatment

“…After a 3-month treatment period, they found no advantage in the use of the fluoridated CPP-ACP paste over regular oral hygiene in WSLs regression as measured by Quantitative Lightinduced Fluorescence. Similarly, Bröchner et al [48], in a prospective clinical trial using nonfluoridated CPP-ACP paste, found WSL regression to be comparable with traditional toothpaste after a 4-week treatment period.…”

Enamel Surface Quality Improvement in White Spot Lesions After Orthodontic Treatment Using a Microabrasion Technique With Fluoride or Calcium Phosphopeptide-Amorphous Calcium Phosphate Application

“…Treatment of enamel white spot lesions with fluoride could decrease surface roughness of white spot lesions up to the surface roughness value of enamel, which is considered as a critical boundary for bacterial adhesion. Hence, the Ra value of 0.20 μm could indicate that the risk of bacterial adhesion after treatment of white spot lesions using a microabrasion technique was greater with fluoride application than with CPP-ACP application [3,18].…”

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

“…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.…”

“…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.…”