A 12-Week Assessment of the Treatment of White Spot Lesions with CPP-ACP Paste and/or Fluoride Varnish

Abstract

This 12-week clinical study evaluated the impact of 10% CPP-ACP and 5% sodium fluoride varnish regimes on the regression of nonorthodontic white spot lesions (WSLs). The study included 21 children with 101 WSLs who were randomised into four treatment regimes: weekly clinical applications of fluoride varnish for the first month (FV); twice daily self-applications of CPP-ACP paste (CPP-ACP); weekly applications of fluoride varnish for the first month and twice daily self-applications of CPP-ACP paste (CPP-ACP-FV); and no intervention (control). All groups undertook a standard oral hygiene protocol and weekly consultation. Visual appraisals and laser fluorescence (LF) measurements were made in weeks one and twelve. The majority of WSLs in the control and FV groups exhibited no shift in appearance, whereas, in the CPP-ACP and CPP-ACP-FV groups, the lesions predominantly regressed. The visual and LF assessments indicated that the extent of remineralisation afforded by the treatments was of the following order: control ~ FV < CPP-ACP ~ CPP-ACP-FV. Self-applications of CPP-ACP paste as an adjunct to standard oral hygiene significantly improved the appearance and remineralisation of WSLs. No advantage was observed for the use of fluoride varnish as a supplement to either the standard or CPP-ACP-enhanced oral hygiene regimes.

Efficacy of fluorides and CPP-ACP vs fluorides monotherapy on early caries lesions: A systematic review and meta-analysis

“…Heterogeneity was not observed between the studies(P = 0.74, I 2 = 0%). In the four studies [ 23 , 31 , 32 , 36 ] including lesions on smooth surfaces, the subgroup analysis showed no significant difference between using fluorides together with CPP-ACP and using fluorides alone (MD = -13.90, 95% CI: [-39.25, 11.46], P = 0.28) ( Fig 2 ).…”

“…The main characteristics of the included ten studies were summarised in Table 1 , and the risk of bias was shown in Table 2 . One [ 23 ] of the ten included had high risk of bias, three [ 24 , 26 , 31 ] had low risk of bias, while the other six [ 25 , 32 – 36 ] studies had unclear risk of bias.…”

“…Six [ 23 , 31 , 32 , 33 , 35 , 36 ] of the ten studies assessed efficacy using the values of LF. Llena et a l [ 23 ] included early caries lesions on both occlusal surfaces and smooth surfaces, and reported results for occlusal caries and smooth surface lesions respectively.…”

“…We conducted sensitivity analysis for trials with large sample size and low risk of bias. Eight [ 23 , 24 , 25 , 26 , 32 , 33 , 34 , 35 ] of the ten included studies were with large sample size, and three [ 24 , 26 , 31 ] of the ten included studies were with low risk of bias. When eliminating studies with small sample size or high risk of bias, all results were consistent to the meta-analysis results using all ten studies.…”

“…A number of in vitro , in situ and in vivo experiments have indicated the possible anticariogenic ability of CPP-ACP by its remineralising effects [ 18 , 32 – 35 , 42 – 45 ]. However, studies [ 31 , 36 ] demonstrating that fluorides combined with CPP-ACP achieved no clinical advantage over fluorides alone, which might question the anticariogenic ability of CPP-ACP. Our study concluded that fluorides combined with CPP-ACP treatment produces significantly better efficacy for occlusal early caries lesions.…”