Enamel Subsurface Lesion Remineralisation with Casein Phosphopeptide Stabilised Solutions of Calcium, Phosphate and Fluoride

Abstract

Casein phosphopeptide stabilised amorphous calcium phosphate (CPP-ACP) and amorphous calcium fluoride phosphate (CPP-ACFP) solutions have been shown to remineralise enamel subsurface lesions. The aim of this study was to determine the effect of ion composition of CPP-ACP and CPP-ACFP solutions on enamel subsurface lesion remineralisation in vitro. CPP-bound and free calcium, phosphate and fluoride ion concentrations in the solutions were determined after ultrafiltration. The ion activities of the free ion species present were calculated using an iterative computational program. The mineral deposited in the subsurface lesions was analysed using transverse microradiography and electron microprobe. CPP was found to stabilise high concentrations of calcium, phosphate and fluoride ions at all pH values (7.0–4.5). Remineralisation of the subsurface lesions was observed at all pH values tested with a maximum at pH 5.5. The CPP-ACFP solutions produced greater remineralisation than the CPP-ACP solutions at pH 5.5 and below. The mineral formed in the subsurface lesions was consistent with hydroxyapatite and fluorapatite for remineralisation with CPP-ACP and CPP-ACFP, respectively. The activity gradient of the neutral ion pair CaHPO₄⁰ into the lesion was significantly correlated with remineralisation and together with HF⁰ were identified as important species for diffusion.

Calcium orthophosphates (CaPO 4 ): Occurrence and properties

“…Until recently, it was generally agreed that if there was sufficient time between the intake of foods (generally, 2-3 h) plus a damage was very limited, teeth could repair themselves by the ''passive mineralization '' process (LeGeros 1999). Data on increased remineralization of dental enamel by CaPO 4 -containing compounds (Cochrane et al 2008;Langhorst et al 2009;Weir et al 2012) are in support of this hypothesis.…”

Casein phosphopeptide-amorphous calcium phosphate and glass ionomer show distinct effects in the remineralization of proximal artificial caries lesion in situ

“…This indicated that CPP-ACP remineralized the deeper lesion region better than Fuji VII. CPP-ACP is electroneutral and can penetrate the subsurface lesion unaffected by the electric charge of enamel 26) . In addition, due to the small size of the CPP-ACP nanocomplex, it can enter the porosities of an enamel subsurface lesion and diffuse along its concentration gradient into the body of the lesion.…”

Remineralization Therapies for Initial Caries Lesions

“…When applied intraorally, these nanocomplexes bind onto the tooth surfaces and dental plaque to create a state of supersaturation of calcium and phosphate ions in the oral biofilm, providing high level of bioavailable calcium and phosphate ions to facilitate remineralization and modifying the dynamics of the demineralizationremineralization events when cariogenic challenge occurs, to prevent caries development [30]. The nanocomplexes has been reported to diffuse through the porosities in an early caries lesion into the body of lesion where they release the weakly bound calcium and phosphate ions, which would then deposit into crystal voids to form hydroxyapatite or in the presence of fluoride, the fluorapatite [31]. There is a lot of clinical evidence supporting the remineralizing efficacy of Recaldent™ [32].…”