Casein phosphopeptide amorphous calcium phosphate and universal adhesive resin as a complementary approach for management of white spot lesions: an in-vitro study

Abstract

Background White spot lesion (WSL) is the most common consequence during and after orthodontic treatment. This study was conducted to investigate the ability of casein phosphopeptide amorphous calcium phosphate (CPP-ACP) coupled with universal adhesive resin to treat white spot lesions. Material and methods Forty-five extracted premolars were sectioned to create 90 specimens. Seventy-five specimens were demineralized to generate artificially created WSLs. Different strategies have been applied for the management of the artificially created WSLs. Six experimental groups were employed: Group I: sound enamel (control), Group II: demineralized enamel (artificially-created WSLs), Group III: ICON resin-treated WSLs, Group IV: CPP-ACP-treated WSLs, Group V: universal adhesive resin-treated WSLs, and Group VI: CPP-ACP followed by universal adhesive resin-treated WSLs. Assessment of color stability using a spectrophotometer, surface microhardness using a Vickers tester, and surface roughness using a profilometer was done. The surface topography of representative specimens from each experimental group was inspected using a scanning electron microscope. Collected data were analyzed using one-way ANOVA followed by Tukey’s post hoc test at p ≤ 0.05. Results White spot lesions treated with CPP-ACP and subsequently coated with universal adhesive resin (Group VI) exhibited a significantly lower ΔE than both CPP-ACP (Group IV) and universal adhesive resin-treated (Group V) groups (p ≤ 0.05), but it was not significantly different from the ICON resin-treated group (Group III). For surface microhardness, WSLs treated with CPP-ACP and consequently coated with universal adhesive resin (Group VI) recorded the highest mean that was significantly different from both ICON resin (Group III) and universal adhesive resin-treated (Group V) groups (p ≤ 0.05). All the tested strategies (ICON resin, CPP-ACP, universal adhesive resin, and CPP-ACP followed by universal adhesive resin) significantly lowered the surface roughness of the WSLs (p ≤ 0.05), while no significant difference was detected among them. Conclusions Combining a considerable caries remineralizing program using CPP-ACP with subsequent universal adhesive resin infiltration could be a promising approach to manage WSLs efficiently through increasing surface microhardness and restoring esthetic while developing a smoother surface.

Influence of casein phosphopeptide-amorphous calcium phosphate on the surface topography and composition of nickel-titanium archwires during orthodontic treatment with fixed appliances

“…It has been reported that CPP binds to the bacteria in oral biofilm found on teeth and surrounding areas, such as orthodontic wires [15,33]. One can argue that intraoral exposure to CPP-ACP in the present study facilitated accumulation of Ca and P on the wire surfaces.…”

Surface topography and spectrophotometric assessment of white spot lesions restored with nano-hydroxyapatite-containing universal adhesive resin: an in-vitro study

“…All weight ratios of nHA involvement in the universal adhesive resin had the same capacity for enhancing the surface texture, as confirmed by the insignificant difference among them. A preceding investigation confirmed that a smoother texture of the WSLs was successfully developed using a variety of protocols, including ICON resin, CPP-ACP remineralizing agent, universal adhesive resin, and CPP-ACP combined with universal adhesive resin [40].…”

“…The resin's infiltrating nature in combination with the nano-hydroxyaptite remineralizing potentiality, and deposition into the nanogaps explains the higher VHNs observed with increasing the nHA loading in the universal adhesive resin [28,[36][37][38][39]. A supportive study [40] tried combining the remineralizing approach with a subsequent resin infiltration and reported significant enhancement of surface microhardness of WSLs. Other supplementary study [41] tried nano-hydroxyapatitecontaining toothpaste, and concluded that nHA encourages more minerals to deposit on the outer layer as opposed to the lesion's body, and this new, highly mineralized surface layer can subsequently inhibit both the diffusion of more mineral ions into the lesion's deeper sections and the acid diffusion into deeper areas of enamel, besides slowing down demineralization, which would limit enamel recrystallization to the subsurface region.…”

Surface roughness and microhardness of enamel white spot lesions treated with different treatment methods

“…In the microhardness study, the initiation of WSLs led to a significant decrease in microhardness in all the groups that underwent demineralization [ 48 ].…”