Evaluation of the efficacy of casein phosphopeptide-amorphous calcium phosphate on remineralization of white spot lesions in vitro and clinical research: A systematic review and meta-analysis

Abstract

Background: This systematic review with meta-analyses sought to answer whether casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) provided a remineralizing benefit superior to that of nonintervention or placebo. Methods: The Cochrane databases, PubMed, EmBase, and Ovid up to May 20th, 2019, were scanned, only published in English. Study information extraction and methodological quality assessments were accomplished independently by two reviewers. The “Criteria for judging risk of bias in the ‘Risk of bias’ assessment tool” was used for methodological quality assessment. The continuous data was analyzed by mean difference (MD) or standardized mean difference (SMD) with a 95% confidence interval (CI). Review Manager 5.3 was used for statistical analysis. Outcome variables include quantitative light-induced fluorescence in clinical research, average surface roughness and surface microhardness in vitro. Results: There were significant differences in the quantitative light-induced fluorescence (SMD = −0.43, 95% CI: [−0.79, −0.07], P = 0.02), average surface roughness (SMD = −8.21, 95% CI: [−10.37, −6.04], P < 0.01), Vickers microhardness (SMD = 1.19, 95% CI: [0.72, 1.66], P < 0.01), and Knoop microhardness (SMD = 3.52, 95% CI: [2.68, 4.36], P < 0.01) between the CPP-ACP and control groups or baseline. Conclusion: Within the limitations of this meta-analysis, CPP-ACP exhibited excellent remineralization effects evaluated in clinical research and in vitro, indicating outstanding restoration of form, aesthetics, and function in treating white spot lesions.

Impact of Two Remineralizing Agents on White Spot Lesions

“…(8) Newly remineralization and anticariogenic mechanism of CPP-ACP includes the incorporation of nanocomplexes in the dental plaque and on the tooth surface and acts as a calcium and phosphate store, in addition to its high safety level. (22) The synergistic effect of CPP-ACP and uoride in reducing the white spot lesions is related to the formation of CPP-stabilized amorphous calcium uoride phosphate which increased the concentration of bioavailable calcium and phosphate particles. (23) Another studies proved that CPP reduce the adherence and functioning ofcariogenic streptococcus bacteria in the oral cavity.…”

Experiences of oral health: before, during and after becoming a regular user of GC Tooth Mousse Plus ®

“…Previous clinical and laboratory studies focused on the effectiveness of TMP in preventing and reversing of early dental caries lesions (10)(11)(12)(13)(14). Meta-analyses of clinical studies have also been published to support the use of the product (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22). However, no other study has addressed regular users' views about the product, how the product performs and addresses their individual needs (e.g.…”

“…There is a high-level of evidence supporting the ability of CPP-ACP to remineralise early caries lesions and prevent their progression (10)(11)(12)(13)(14). There are now twelve published systematic meta-analyses of these clinical studies to support the use of CPP-ACP to lower caries risk (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22). In addition, CPP-ACP effectiveness has also been demonstrated in relation to the reduction of cariogenic bacteria and increased colonization of commensal microorganisms, and the reduction of dentine hypersensitivity (23)(24)(25)(26).…”

Assessment of Mineral Gain in White Spot Lesions Using CPP-ACP and CPP-ACFP in Different Clinical Protocols: A Proof of Concept Study

“…In dental practice, the use of topical products containing nanoparticles of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) or casein phosphopeptide-amorphous calcium fluoride phosphate (CPP-ACFP), such as Tooth Mousse™/ MI Paste™ and Tooth Mousse Plus™/ MI Paste Plus™ (GC Corp, Tokyo, Japan) has been shown to provide a range of clinical benefits, including arrest and regression of enamel white spot carious lesions (WSL) [1][2][3][4]. This has been supported by numerous systematic reviews [5][6][7][8][9][10][11][12]. As a naturally derived remineralizing technology, CPP-ACP is a partner to fluoride, providing the bioavailable calcium and phosphate ions required for remineralization.…”