Caries preventive effect of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP): A meta-analysis

Division of Public Oral Health, University of the Witwatersrand, Parktown/Johannesburg, South Africa.
Acta odontologica Scandinavica (Impact Factor: 1.03). 09/2009; 67(6):321-32. DOI: 10.1080/00016350903160563
Source: PubMed


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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    • "In contrast to an erosive lesion, an incipient carious lesion in enamel possesses a typical micromorphology with a pseudo-intact surface layer on top of the subsurface body of the lesion as a result of re-precipitating minerals [5] . Despite efforts to remineralize enamel using agents containing fluoride or casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) [6] [7] , the prevention and treatment of incipient carious lesions and submicrometer erosion are still major clinical challenges. Currently, advanced lesions are treated by removing the compromised tissue and filling the resulting cavity with restorative materials, such as amalgam, composites, or ceramics. "
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    ABSTRACT: Amelogenin-chitosan (CS-AMEL) hydrogel has shown great potential for the prevention, restoration, and treatment of defective enamel. As a step prior to clinical trials, this study aimed to examine the efficacy of CS-AMEL hydrogel in biomimetic repair of human enamel with erosive or caries-like lesions in pH-cycling systems. Two models for enamel defects, erosion and early caries, were addressed in this study. Two pH-cycling systems were designed to simulate the daily cariogenic challenge as well as the nocturnal pH conditions in the oral cavity. After pH cycling and treatment with CS-AMEL hydrogel, a synthetic layer composed of oriented apatite crystals was formed on the eroded enamel surface. CS-AMEL repaired the artificial incipient caries by re-growing oriented crystals and reducing the depth of the lesions by up to 70% in the pH-cycling systems. The results clearly demonstrate that the CS-AMEL hydrogel is effective at the restoration of erosive and carious lesions under pH-cycling conditions.
    Full-text · Article · Jan 2016
    • "Andersson et al.[25] reported a significant reduction in WSLs after the application of CPP-ACP at 12-month follow-up as we expected. In a systematic review, Yengopal and Mickenautsch[26] reviewed the short-term remineralization effect of CPP-ACP in clinical in situ trials and long-term caries-preventing effect for CPP-ACP in vivo in a randomized control trial. According to our results, CPPs could be suggested as an alternative preventive system against demineralization of early enamel lesions as published before.[131427] "
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    ABSTRACT: To promote the remineralization by ionic exchange mechanism instead of invasive techniques many remineralizing agents can be used. To evaluate the remineralization effects of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) on white spot lesions (WSLs) and its inhibitory effect on Streptococcus mutans colonization. The study group consisted of 60 subjects exhibiting at least 1-WSL. Subjects were randomly divided into 2 groups: A test group using CPP-ACP cream (GC-Tooth Mousse, Leuven, Belgium) and a control group using only fluoride containing toothpaste for a period of 3-month. Baseline WSLs were scored using DIAGNOdent device (KaVo Germany) and the saliva samples were collected to measure S. mutans counts. After the 3-month period the WSLs were again recorded and the saliva collection was repeated. DIAGNOdent measurements were increased by time (P = 0.002) in the control group and no statistically significant difference (P = 0.217) was found in the test group by the 3-month period. In both groups, the mutans counts were decreased in the 3-month experimental period. These clinical and laboratory results suggested that CPP-ACP containing cream had a slight remineralization effect on the WSL in the 3-month evaluation period however, longer observation is recommended to confirm whether the greater change in WSLs is maintained.
    No preview · Article · Jul 2013 · Journal of Conservative Dentistry
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    • "The CPP-ACP literature has been reviewed by several authors (Reynolds, 1998; Llena et al., 2009; Azarpazhooh, et al 2008; Neuhaus, et al 2009, Yengopal & Mickenautsch, 2009). Yengopal and Mickenautsch (2009), in a systematic review, concludes that, within the limitations of the systematic review with meta-analysis, results of the clinical in situ trials indicate a short-term remineralization effect of CPP-ACP. Additionally, the promising in vivo randomized controlled trials results suggest a caries-preventing effect for long-term clinical CPP-ACP use. "

    Full-text · Chapter · Mar 2012
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