Effect of CPP-ACP on remineralization of artificial caries-like lesion: an in situ study

Abstract

The purpose of this double-blind, randomized, crossover in situ study is to compare remineralization of preformed enamel lesions by casein phosphopeptide-stabilized amorphous calcium phosphate (CPP-ACP) and fluoride dentifrice products. During each of four 10-day experimental legs, 10 participants wore intraoral removable palatal acrylic appliances with four human enamel slabs with preformed lesions. A 0.03-mL treatment paste was dripped extraorally onto the enamel blocks once a day for 3 min. The four randomly allocated treatments were as follows: CO-Control: silica dentifrice without fluoride; MP: MI Paste; MPP: MI Paste Plus and FD: Fluoride dentifrice-1100 ppm F as NaF). Knoop surface hardness (SH) test was performed in three stages (T0-sound enamel, T1-after preformed lesion, and T2-after treatment) and the cross-sectional hardness (CSH) test was performed after treatment using a 50-gram Knoop load for 15 s. Knoop hardness number (KHN) was similar between treatments. %SHr was significantly higher in the MP, FD, and MPP when compared to CO group (Kruskal-Wallis and Mann-Whitney tests, p < 0.05). Harder enamel was found in MP (75 μm) and FD groups at 75 to 175 μm. Treatment with DF, MP, and MPP promoted an increase of 20.27%, 19.24%, and 14.71%, respectively, in Integral Hardness Change (ΔIHC) when compared to CO (p<0.05). Remineralizing agents (MP, MPP, and DF) were able to inhibit demineralization of human enamel subjected to high cariogenic challenge in situ. DF had the greatest preventive potential against the progression of carious lesions.

Remineralization effects of self‐assembling peptide P11‐4 associated with three materials on early enamel carious lesions: An in vitro study

“…Like others, we found that fluoride toothpaste enhances EMH (Dai et al, 2019;Oliveira et al, 2020;Zhang et al, 2011). This might be related to the formation of fluorapatite on the enamel surface.…”

“…This might be related to the composition of the CPP–ACP, which functioned as a reservoir of Ca and PO 4 3− ions, and its ability to penetrate the subsurface lesions to form hydroxyapatite (Mehta et al, 2013). However, some researchers believe that there is a greater influence of fluoride than CPP–ACP on early caries lesions (Oliveira et al, 2020; Vyavhare et al, 2015).…”

“…A greater efficacy of CPP-ACP than fluoride was suggested by reports of in vitro studies that did not follow pH-cycling conditions in permanent (Shen et al, 2020) or primary teeth (Zhang, Zou, Yang, & Zhou, 2011), as well as in a clinical study in permanent teeth (Dai et al, 2019). However, the others did not report the effect (Oliveira et al, 2020;Vyavhare, Sharma, & Kulkarni, 2015).…”

“…Hydroxyapatite crystals are composed mainly of calcium (Ca) and phosphate (PO 4 3− ) ions; thus, materials that contain these ions, such as casein phosphopeptide–amorphous calcium phosphate (CPP–ACP), have been developed. The material “stabilizes amorphous calcium phosphate (ACP) and forms CPP–ACP complexes,” leading to enhanced Ca and PO 4 3− in dental plaque and increased remineralization (Dai et al, 2019; Oliveira, Barboza, Barreto, & Tostes, 2020; Shen et al, 2020). There is still controversy about the superiority of CPP–ACP compared to fluoride products to treat caries lesions.…”

Remineralization of early enamel lesions with a novel prepared tricalcium silicate paste

“…At low pH, ACP separates from CPP, which usually increases the salivary saturation with Ca 2+ and PO 4 3− ions. After this separation, CPP can stabilize ACP in the oral biofilm, providing an amorphous state of supersaturation to maintain alkaline pH and enhance the remineralization process 13 , 14 .…”