In Situ Effect of Intra-Oral Application of Pastes Containing CPP-ACP or CPP-ACPF Against Initial Enamel Erosion

Abstract

Objective: To evaluate in situ the effect of toothpastes containing casein phosphopeptideamorphous calcium phosphate (CPP-ACP) and casein phosphopeptide-amorphous calcium phosphate associated to fluoride (CPP-ACPF) on initial erosion prevention. Material and Methods: Bovine enamel blocks (n = 192) were randomly assigned into 4 phases according to the baseline surface hardness: GI: CPP-ACP Paste (MI Paste ™), GII: CPP-ACPF Paste (MI Paste Plus ™), GIII: Fluoridated paste and GIV: Placebo Paste. In each of the 4 crossover phases, twelve volunteers wore intraoral palatal appliances containing 4 enamel blocks for 2 hours, then the tested treatments were applied intraorally (3 min) and the appliance was maintained in the mouth for another 3 hours. After, the appliances were removed and immersed in hydrochloric acid (0.01 M, pH 2.3) for 30 seconds to promote erosive demineralization. The final surface hardness was evaluated and percentage of surface hardness loss was calculated. The data were analyzed by ANOVA and Tukey's test (α = 5%). Results: The application of CPP-ACP paste, independent of fluoride content, resulted in significant lower enamel hardness loss (GI: 9.26% ±3.48 and GII: 9.14% ±1.73) compared to NaF (GIII: 15.5% ± 3.94) and placebo (GIV: 16.7% ± 4.07) pastes, which did not show difference between them. Conclusion: The CPP-ACP pastes were able to reduce initial erosive demineralization in relation to fluoride and placebo pastes. Nevertheless the formulation of CPP-ACP with fluoride did not provide an additional benefit.

Topical Agents for Nonrestorative Management of Dental Erosion: A Narrative Review

“…In situ studies revealed that CPP-ACP reduced the surface loss, microhardness change and calcium ions release in human enamel specimens [ 73 , 77 , 78 , 79 ]. Similarly, in situ studies of CPP-ACFP reported that CPP-ACFP reduced bovine enamel loss [ 80 ] and decreased microhardness change in human enamel after erosive cycles [ 81 ]. The effectiveness of CPP-ACP depends on the concentration, the vehicles and time of application [ 73 , 74 , 75 ].…”