Efficacy of CPP-ACP and CPP-ACPF for Prevention and Remineralization of White Spot Lesions in Orthodontic Patients: a Systematic Review of Randomized Controlled Clinical Trials (original) (raw)
Related papers
Clinical Oral Investigations, 2010
Introduction: White spot lesions (WSLs) are the most common side effects found in orthodontically treated patients. Icon treatment has been reported to revert colorimetric alterations of WSLs and halt carious progression. Material and methods: Four young patients with post-orthodontic WSLs, who were treated with resin infiltration. Results: In all patients, existing WSLs were successfully treated by Icon resin application. Given the minimal substance loss due to the erosion infiltration procedure, all patients were extremely satisfied with the results, although some WSLs could still be seen. Conclusions: Our case series shows the capability of treating WSLs due to orthodontic treatment with Icon resin infiltration. Longer observation periods in studies with larger patient populations are needed to validate the clinical significance found in these case series.
Journal of clinical and diagnostic research : JCDR, 2016
As hindrance of remineralisation process occurs during orthodontic therapy resulting in decalcification of enamel because number of plaque retention sites increases due to banding and bonding of appliances to teeth. The present analytic study was undertaken to assess the occurrence of white spot lesions in permanent molars of children with and without orthodontic therapy and to evaluate the effect of Casein PhosphoPeptide-Amorphous Calcium Phosphate (CPP-ACP) on white spot lesions in post-orthodontic patients in a given period of time. The study comprised of examination of 679 first permanent molars which were examined to assess the occurrence of smooth surface white spot lesions in children of 8 to 16 years age group. Group I comprised subjects without any orthodontic treatment and Group II comprised of subjects who had undergone orthodontic therapy. The sample size was calculated using the epi-info6 computer package. Treatment group included 20 post-orthodontic patients examined w...
Progress in orthodontics, 2016
One of the most undesirable side effects of comprehensive orthodontic treatment is white spot lesions (WSLs). Despite many attempts at prevention of WSLs, its prevalence remains very high on debonding. There are many agents like fluoride toothpastes, fluoride varnishes, and fluoride mouth rinses, and casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) is frequently used for the remineralization of WSLs. However, there is no consensus in the literature with respect to the success rates of these agents. Thus, the present study was designed to evaluate the efficacy of fluoride toothpaste alone and in combination with fluoride varnish and CPP-ACP plus crème in the remineralization of post-orthodontic WSLs. Forty-five subjects in the age range of 16-25 years having at least one post-orthodontic WSL were included in the study. All the subjects were randomly divided into three groups (toothpaste group, varnish group, and CPP-ACP group). The efficacy of various remineralizing agents...
Interventions for orthodontically induced white spot lesions: a systematic review and meta-analysis
Background: Although orthodontic white spot lesions (WSLs) are one of the most often and most evident adverse effects of comprehensive fixed appliance treatment, the efficacy of interventions for WSLs has not yet been adequately assessed in an evidence-based manner. Objective: Aim of this systematic review was to assess the therapeutic and adverse effects of interventions to treat post-orthodontic WSLs from randomized trials in human patients. Search methods: An unrestricted electronic search of eight databases from inception to May 2016. Selection criteria: Randomized controlled trials assessing any interventions for post-orthodontic WSLs on human patients. Data collection and analysis: After duplicate study selection, data extraction, and risk of bias assessment according to the Cochrane guidelines, random-effects meta-analyses of mean differences (MDs), standardized mean differences (SMDs), and odds ratios (ORs), including their 95% confidence intervals (CIs) were performed, followed by subgroup and sensitivity analyses. Results: A total of 20 unique studies and a total of 942 (42 per cent male and 58% per cent female) patients were included, with an average age of 16.2 years and a mean number of 8.2 WSLs (range 2.2 to 45.4) per patient. These were allocated to adjunct treatment with casein phosphopeptide-stabilized amorphous calcium phosphate creams, external tooth bleaching, low-or high-concentration fluoride films, gels, mouthrinses or varnishes, resin infiltration, miswak chewing sticks, bioactive glass toothpastse, or to no adjunct treatment (i.e. conventional oral hygiene). The monthly use of fluoride varnish was the best supplement to improve WSLs in terms of lesion area (1 trial; MD = −0.80 mm 2 ; 95% CI = −1.10, −0.50 mm 2 ; P < 0.05; high quality) and enamel fluorescence (3 trials; SMD = −0.92; 95% CI = −1.32, −0.52; P < 0.05; high quality), followed by the use of fluoride film. WSL treatment did not provide a considerable improvement in their clinical evaluation (3 trials; OR = 0.97; 95% CI = 0.60, 1.56; P > 0.05; moderate quality), with imprecision due to small sample size being the main limitation of existing evidence. Conclusions: Based on the existing trials, interventions for post-orthodontic WSLs, mainly fluoride varnish, seem to be effective, but further research is needed to elucidate their clinical relevance. Registration: PROSPERO (CRD42016037538)
Treatment of post-orthodontic white spot lesions with CPP-ACP paste: A three year follow up study
Dental Materials Journal, 2017
To determine the efficacy of topical applications of 10% casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) paste in reverting white spot lesions (WSLs) after fixed orthodontic treatment. Forty one participants were randomly assigned to either the test group (CPP-ACP) or the control group (only fluoride toothpaste). All patients used regular fluoride-containing toothpaste. CPP-ACP paste or fluoridated toothpaste was applied on to tooth surfaces with WSLs twice a day during 36-month after de-bonding. The labial/buccal surfaces of teeth were assessed by use of DIAGNOdent pen (DD), Gorelick Index and ICDAS II criteria at baseline (T1) and 36-month (T2) follow-up visits. The total counts of Streptococcus mutans and Lactobacillus were obtained at T1 and T2. DMFT, DMFS, stimulated flow rate and buffer capacity were calculated in two appointments. Daily usage of CPP-ACP paste was not better than normal care for improving the appearance of WSLs after 36 months.
Medical principles and practice : international journal of the Kuwait University, Health Science Centre, 2015
We aimed to evaluate the efficacy of oral hygiene instruction, fluoride varnish and casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) for remineralizing white spot lesions (WSL), and the effect of these on the dmft index in primary teeth. In this 1-year, randomized clinical trial, 140 children aged 12-36 months with WSL in the anterior maxillary teeth were selected and randomly divided into 4 groups of 35 children each. Group 1 (control) received no preventive intervention. In group 2, there was oral hygiene and dietary counseling. In group 3, there was oral hygiene and the application of fluoride varnish at 4, 8 and 12 months after baseline. In group 4, there was oral hygiene and tooth mousse was applied by the parents twice a day over a 12-month period. At baseline and 4, 8 and 12 months after the intervention, the size of WSL in millimeters and the dmft index were recorded. One hundred and twenty-two children completed the study. Data were analyzed using the repeated-me...
Acta Stomatologica Naissi , 2019
Background: The objective of this study was to determine the concentration of Ca and Mg in artificial saliva after preventive treatment. Methods: The laboratory examination (in vitro) was performed in 90 healthy teeth extracted for orthodontic reasons. Three groups of thirty teeth were formed. The teeth from each group were separated in half in bucco-lingual direction. Thus, the control and test specimens were obtained from the same teeth. The brackets were bonded with GC Fuji OrthoTM LC (GC America Chicago, III), a resin-modified glass ionomer cement and the teeth then were stored in artificial saliva. Once per day, the teeth were coated with topical gel - CG Tooth Mousse in duration of 5 minutes and then returned to artificial saliva. Preventive treatment was at certain intervals of 1, 3 and 6 months. After each study period, the artificial saliva where the samples were stored was used for determination of Ca and Mg concentration by flame atomic absorption spectrophotometry. Results: The results of this study (in vitro) showed that the concentrations of Ca and Mg in artificial saliva were significantly increased even after the first month of application of this means which released Ca and other minerals (including fluoride free cement used to bond the brackets) with maximum value after a three-month application. These values were significantly lower after six months, probably as a result of its absorption into the enamel. The results for Mg are the same as for Ca, and the value is increased as well as its stability in saliva after the first month. Conclusions: The results of this in vitro study clearly indicate that preventive materials used in fixed orthodontic treatment inhibit the demineralization of enamel around brackets and orthodontic rings. Evidently, their use as additional preventive methods/tools, besides primary oral hygiene, is recommended. Key words: dental caries, preventive treatment, Ca and Mg concentration
Stomatologija, Baltic Dental and Maxillofacial Journal, 2016
The aim of the study is to evaluate the effectiveness of fluoride and casein topical preparations in the prevention of white spot lesions during and after fixed orthodontic treatment. Information search for controlled studies on humans published in the English language between 2008 and 2013 was conducted in Medline via PubMed, ScienceDirect, and Oxford University Press: Oxford journals and The Cochrane Library, as well as the Web search Google Scholar. 177 articles were reviewed; eleven clinical studies fulfilled all inclusion criteria. In the clinical studies it was concluded that high-concentration fluoride supplements are effective in reducing white spot lesions. Results of the studies showed the same usefulness of fluoride varnish, MI Paste, and usual oral hygiene using 1100 ppm of fluoride toothpaste. Effect on the prevention and treatment of white spot lesions of oral hygiene with toothpaste containing 1450 ppm of fluoride in orthodontic patients was evaluated. The positive ef...
Dental and Medical Problems, 2020
The purposes of this review were to appraise the current evidence on the management of orthodontically induced white spot lesions (OIWSLs) and to choose the best evidence from among conflicting systematic reviews. The published literature was searched from inception through November 2019 in 5 databases. Only systematic reviews and/or meta-analyses were eligible for inclusion. Methodological quality was assessed using A Measurement Tool to Assess Systematic Reviews-2 (AMSTAR-2). The Jadad decision algorithm was applied to choose the best available evidence from among discordant reviews. Thirteen publications were included. The interventions reported in the management of OIWSLs were topical fluorides, casein phosphopeptide-amorphous calcium phosphate (CPP-APC)-containing products, fluoride-containing bonding materials, laser therapy, resin infiltration, and micro-abrasion. The methodological quality of the reviews ranged between moderate and critically low according to the AMSTAR-2 tool. Based on the Jadad decision algorithm criteria, topical fluorides yielded a 25-30% prevention of OIWSLs; however, their effect on reversing OIWSLs was unclear. The CPP-APC products were effective in both preventing and reversing OIWSLs. No differences were noted between fluoride-releasing adhesives and conventional adhesives. Laser irradiation was effective in preventing OIWSLs, with some concerns about the argon laser at a certain setting. Finally, there is a lack of reliable evidence supporting the efficacy of resin infiltration or micro-abrasion due to the limited number of available studies. Based on the currently available information, topical fluorides and laser irradiation are effective in preventing OIWSLs. The CPP-ACP products are effective in preventing and reversing OIWSLs. Fluoride-releasing adhesives have no effect on OIWSL prevention.