Caries preventive effect of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP): a meta-analysis
ABSTRACT This systematic review with meta-analyses sought to answer the following question: "Does CPP-ACP [casein phosphopeptide-amorphous calcium phosphate], when introduced into the oral environment, provide any caries-preventive benefit superior to that of any other intervention or placebo?"
Seven electronic databases were searched for trials relevant to the review question. Twelve articles were accepted after application of inclusion and exclusion criteria.
Of the accepted articles, five in situ randomized control trials (RCT) could be pooled for meta-analyses. During the short-term (7-21 days) in situ trials, participants wore appliances containing enamel slabs that were analyzed in the laboratory after exposure to CPP-ACP. The pooled in situ results showed a weighted mean difference (WMD) of the percentage remineralization scores in favor of chewing gum with 18.8 mg CPP-ACP as compared to chewing gum without CPP-ACP (WMD -8.01; 95% CI: -10.54 to -5.48; p = 0.00001), as well as compared to no intervention (WMD -13.56; 95% CI: -16.49 to -10.62; p = 0.00001). A significant higher remineralization effect was also observed after exposure to 10.0 mg CPP-ACP (-7.75; 95% CI: -9.84 to -5.66; p = 0.00001). One long-term in vivo RCT (24 months) with a large sample size (n = 2720) found that the odds of a tooth surface's progressing to caries was 18% less in subjects who chewed sugar-free gum containing 54 mg CPP-ACP than in control subjects who chewed gum without CPP-ACP (p = 0.03).
Within the limitations of this systematic review with meta-analysis, the results of the clinical in situ trials indicate a short-term remineralization effect of CPP-ACP. Additionally, the promising in vivo RCT results suggest a caries-preventing effect for long-term clinical CPP-ACP use. Further randomized control trials are needed in order to confirm these initial results in vivo.
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ABSTRACT: To compare the effects of different treatment methods used for the enamel damage, on the shear bond strength (SBS) and fracture mode of orthodontic brackets. Freshly-extracted 140 premolars were randomly allocated to seven groups: Group I was considered as the control of other groups. The remaining groups were exposed to demineralization. In group II, brackets were directly bonded to the demineralized enamel surface. CPP-ACP paste (GC Tooth Mousse), fluoride varnish (Bifluorid 12), microabrasion with a mixture prepared with 18% hydrochloric acid and fine pumice powder, microabrasion with an agent (Opalustre) and resin infiltrant (Icon®) were applied in Groups III, IV, V, VI and VII, respectively. The specimens were tested for SBS and bond failures were scored according to the Adhesive Remnant Index (ARI). Analysis of variance and Tukey tests were used to compare the SBS of the groups. ARI scores were compared with G-test. The statistical significance was set at p < 0.05 level. Statistically significant differences were found among seven groups (F = 191.697; p < 0.001). The SBSs of groups I (mean = 18.8 ± 2.0 MPa) and VII (mean = 19.1 ± 1.4 MPa) were significantly higher than the other groups. No statistically significant difference was found between groups IV (mean = 11.5 ± 1.2 MPa) and V (mean = 12.6 ± 1.5 MPa). The differences in ARI scores of the groups were statistically significant (p < 0.01). All demineralization treatment methods improve bonding to demineralized enamel. Resin infiltrant application after demineralization showed similar bond strength values as intact enamel.Acta odontologica Scandinavica 04/2015; DOI:10.3109/00016357.2014.982703 · 1.31 Impact Factor
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ABSTRACT: Most surrogate measures of caries were developed to test products containing fluoride, typically at relatively high and closely controlled oral concentrations. However, since the primary mechanism for the remineralization of early enamel caries lesions by chewing gum is through stimulation of saliva, delivering Ca and Pi to the demineralized enamel lesion, established methods may lack the sensitivity to detect the additional benefit of an active agent without the strong remineralizing potential of fluoride. Issues related to the release of active agents from the gum matrix, dilution in the saliva, and limited oral retention time, along with taste, safety, regulatory, and cost concerns, impose further limitations. This paper reviews the efficacy of some active agents used in chewing gum for improved remineralization and includes results from in situ testing of calcium-containing gums, including calcium lactate, tetracalcium phosphate/dicalcium phosphate anhydrous, calcium citrate/encapsulated phosphate, and a calcium lactate/sodium phosphate blend. Despite promising in vitro data from these agents, they did not provide consistently superior results from in situ testing. There is a need to develop better predictive in vitro models for chewing gum, as well as improved sensitivity of in situ models to discriminate relatively small amounts of remineralization against a background of high biological variability.Advances in dental research 09/2012; 24(2):58-62. DOI:10.1177/0022034512452886
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ABSTRACT: Untreated dentin caries in primary teeth is commonly found in preschool children worldwide. Recently, the use of simple non-surgical approaches to manage the situation has been advocated. The aim of the study was to systematically review and evaluate the literature on effectiveness of non-surgical methods in arresting or slowing down the progression of active dentin caries in primary teeth in preschool children. A systematic search of the main electronic databases (Pubmed, Cochrane Collaboration, EMBASE) was conducted to identify peer reviewed papers published in English in the years 1947-2014. Keywords and MeSH terms used in the search were "dental caries", "primary dentition" and various non-surgical treatments (fluoride, sealant, resin infiltration, xylitol, chlorhexidine, CPP-ACP, ozone, etc.). The inclusion criteria were clinical studies conducted in children under 6 years old, and reported findings on caries arrest or caries progression in primary teeth. Retrieved papers were read by two reviewers independently to assess suitability for inclusion, and the final decision was made by consensus. Quality of the included studies was assessed and data were extracted for analysis. The search identified 323 papers for screening. Among these, 290 papers did not satisfy the study inclusion criteria. Consequently, 33 full papers were retrieved and reviewed. Finally, 4 studies were included. Three studies reported that topical applications of silver diammine fluoride (SDF) solution could arrest dentin caries in preschool children. One study supported that having a daily toothbrushing exercise in kindergarten using toothpaste with 1000 ppm fluoride could stabilize the caries situation in young children. There is limited evidence to support the effectiveness of SDF applications or daily toothbrushing with fluoride toothpaste in arresting or slowing down the progression of active dentin caries in primary teeth in preschool children. More well-designed randomized controlled trials are required to confirm these findings.BMC Oral Health 04/2015; 15(1):44. DOI:10.1186/s12903-015-0033-7 · 1.15 Impact Factor