Assessment of Mineral Gain in White Spot Lesions Using CPP-ACP and CPP-ACFP in Different Clinical Protocols: A Proof of Concept Study (original) (raw)
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Current Technology and Techniques in Re-mineralization of White Spot Lesions: A Systematic Review
2020
White Spot lesions are a common iatrogenic occurrence on patients who are treated with fixed orthodontic appliances. There is a dynamic chemical interaction between enamel and saliva at the tooth surface that allow a lesion to have phase changes involving demineralization of enamel and remineralization. This is due to calcium and phosphate dissolved in saliva that is deposited onto the tooth surface or removed depending on the surrounding pH. Caseinphosphopeptide-amorphous calcium phosphate (CPP-ACP) is gaining popularity in dentistry as a way to increase the available level of calcium and phosphate in plaque and saliva to improve the chemical gradient so that if favors remineralization. The aim of our investigation is to search the available current literature and formulate a recommendation for use of CPP-ACP in orthodontics. Publications from the following electronic databases were searched: PubMed, Web of Science, Cochrane Library and Science Direct. Searches from August 2010 to ...
Background: The objective of this study was to evaluate, by means of elemental analysis the mineral density, calcium, and phosphorus weight percent of sound enamel, demineralized and CPP-ACP treated enamel. Elemental analysis allows elemental and isotopic composition of a biologic sample. It can be qualitative (determining what elements are present), and quantitative (determining how much of each are present). INCA Energy 250, Oxford Analytical Instruments Ltd. (UK), energy-dispersive X-ray spectroscopy system for elemental analysis was performed on random assigned samples. Methods: 12 sound premolars were extracted for orthodontic reason. Each tooth was sectioned by using a double-faced diamond microtome under water cooling into three section for a total of 36 samples and randomly assigned to three groups: Group 1 (control), Group 2 (WS: white spot) , Group 3 (WST white spot treated) of 12 samples each. Samples (Group 2 and Group 3) underwent equally to 24 h and 48 h of acid bath duration. Then all the treated samples (Group 3) were coated with CPP-ACP for 5 min before immersion into water twice a day. Group 2 served as control for enamel damage evaluation. Inca Point & ID, an analytic platform software for SEM was used for elemental analysis on samples from Group 1 (C), 2 (WS) and Group 3 (WST) in order to determine the weight % and atomic % presence of Ca and P. Results: The results of the samples analysis from the three Groups show different weight % and atomic% of Ca and P, and clearly reflect the different mineralization rates. Conclusions: 10% Casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) complex, promotes remineralization in vitro. The results of this in vitro study completely agree with this statement. Clinical studies to investigate the intraoral effectiveness of topical applications of CPP-ACP on white spot lesions are required to confirm these results.
Acta Informatica Medica
Introduction: Enamel subsurface lesions or white spot lesions (WSLs) are commonly found in orthodontic patients with a prevalence of 5% to 97%. Aim: This systematic review aimed to evaluate the efficacy of casein phosphopeptide amorphous calcium phosphate (CPP-ACP) and casein phosphopeptide amorphous calcium phosphate fluoride (CPP-ACPF) for prevention and remineralization of WSLs in orthodontic patients in human randomized controlled clinical trials (RCTs). Methods: Relevant articles were retrieved by searching the Web of Science, Scopus, PubMed, and Cochrane Library databases up to November 2018 with no language or date restriction. The collected data included examination method, groups included in each study with number of patients in each group, study design, follow-up period and summary of important findings of each study. The risk of bias of each study was assessed according to the guidelines of the Cochrane Collaboration's tool. Results: Of 213 articles retrieved, 13 RCTs were included in this systematic review (none of them were included in the meta-analysis). Three articles showed superior efficacy of CPP-ACP for remineralization of WSLs while four studies reported the superior clinical efficacy of CPP-ACPF for this purpose. Conclusion: Both CPP-ACP and CPP-ACPF can decrease the prevalence and increase the remineralization of WSLs during/after orthodontic treatment.
Dental Research Journal, 2020
Background: Studies show that fluoride (F) and nano-hydroxyapatite (nano-HA) would result in remineralization of white spot lesions (WSLs), which are among the most prevalent consequences of fixed orthodontic treatment. The present study evaluates and compares the clinical effects of an Iranian toothpaste containing nano-HA with F-containing one on early enamel lesions. Materials and Methods: In this randomized clinical trial study, 50 patients who had received fixed orthodontic treatment were recruited immediately after debonding. Three photographs, including frontal, lateral right and left views of occlusion, were obtained. Moreover, surfaces with WSLs were recorded using DIAGNOdent. Plaque index of each patient determined using disclosing agents. At first visit, each patient was asked to select one type of toothpaste (nano-HA containing vs. F containing named A or B), randomly and were instructed how to brush their teeth (25 patients in each group). Examination was done at 1, 3, and 6 months' intervals. Finally, photographs were analyzed by Digimizer (V5) software, and the lesion extent was recorded in pixels. SAS 9.4 was used to analyze data and was set at 0.05. Results: According to data, lesion extent showed a significant decrease (P < 0.001). At baseline, the difference between the two groups regarding the lesion extent was 268 pixels while it dropped to 89 pixels after 6 months. DIAGNOdent results showed that at baseline, fluorescence difference was 0.3 while it reached the number of 0.8 after 6 months, indicating the outperformance of nano-HA containing toothpaste. Conclusion: The Iranian nano-HA containing toothpaste performed better than F-containing one in terms of the amount of remineralization and diminishing the lesion extent.
Middle East Journal of Rehabilitation and Health Studies, 2019
Background: Dental caries is a preventable infectious disease. White spot lesions (WSLs) are incipient caries with high prevalence during orthodontic treatment. They develop on the enamel surface around the orthodontic brackets due to food impaction and difficult oral hygiene maintenance. Fluoride is renowned for its cariostatic properties. Objectives: This study aimed to assess the mineral content of white spot lesions around orthodontic brackets following the use of different concentrations of nano-hydroxyapatite mouthwash and fluoride gel. Methods: Fifty sound-extracted premolars with artificially induced WSLs were randomly divided into 5 groups (n = 10) for the application of 1.23% fluoride gel, 1%, 5%, and 10% nHA mouthwash, and artificial saliva (control group). All groups, except for the control group, were subjected to the application of gel or mouthwashes twice with a one-week interval, each time for 24 hours. The mineral content of all teeth was assessed using scanning electron microscopy (SEM)/energy-dispersive X-ray spectrometer (EDX). Results: Maximum calcium uptake was noted in fluoride gel (P < 0.001) and 10% nHA (P < 0.001) groups. Maximum phosphorus uptake was noted in 10% nHA (P < 0.001) followed by fluoride gel (P < 0.001) and 5% nHA (P < 0.001) groups but the difference among the afore-mentioned three groups was not significant (P = 0.437). Maximum fluoride uptake was observed in the fluoride gel group with significant differences compared with other groups (P < 0.001). Conclusions: Fluoride gel and 10% nHA mouthwash can be effectively used for remineralization of WSLs.
Contemporary …, 2010
Objective:This study aimed at qualitatively evaluating the remineralization potential of casein phosphopeptide amorphous calcium phosphate on artificial early enamel lesions in an ex-vivo scenario by observing the treated tooth surface using a scanning electron microscope (SEM).Materials and Methods:This randomized study was conducted on 10 subjects undergoing orthodontic treatment with premolar extraction as part of their treatment. Artificial white lesions were created with the application of 37% phosphoric acid for 20 mins. Teeth were then divided into two groups: one experimental and the other control. Customised orthodontic band with a window was luted with intermediate restorative material in the experimental group whereas in the control group, band without a window was luted. The casein phosphopeptide amorphous calcium phosphate (GC TOOTH MOUSSE) paste was then applied on the window region of the experimental group for 3 mins thrice daily after meals for 14 days, whereas no paste was applied in the control group. After 14 days, teeth were extracted and viewed under an SEM.Results:The study groups showed remineralization of the lesions as compared with the control group in most of the samples.Conclusion:Casein phophopeptide could significantly remineralize the artificial enamel lesions in vivo.
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...
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 Baghdad College of Dentistry, 2023
Background: This study aimed to compare the surface microhardness (MH) and mineral content of white spot lesions(WSLs) after using bioactive glass (BAG)casein phosphopeptides-amorphous calcium phosphate(CPP-ACP),and nanohydroxyapatite(Nano-HAP) under pHcycling. Material and method:18 sound maxillary first premolar were used for the study.10 were selected for the vickers microhardness test, For Energy-dispersive X-ray spectroscopy analysis (EDX), the remaining 8 premolar teeth were used, 40 sections of enamel blocks (Four from each tooth) were produced from the middle part of the buccal and palatal surfaces of teeth for MH test while 48 sections of enamel blocks (Six from each tooth) were produced for EDX analysis. Enamel slabs were divided into four groups: control group that preserved in DDW, Nano-HAP, CPP-ACP and BAG group, then were demineralised using 0.1 M lactic acid and 8 wt.% carboxymethylcellulose gel to create artificial WSL. The specimens were subjected to a pH cycling regime for 20 days. The remineralisation potential of the specimens was studied by evaluating the surface MH, calcium (Ca), and phosphrous (P) at different stages: baseline, after production of WSLs, and after treatment with different materials. The gathered data were statistically analyzed using repeated measures one-way ANOVA test and the Bonferroni test. Results: The results showed that Nano-HAP had the highest mean values of MH (157.699 kg/ mm 2), Ca (50.108), and P (24.840) followed by BAG (MH=147.769 kg/ mm 2 , Ca=47.408, P=22.285), and the lowest mean value was found in the control group (MH=52.299 kg/ mm 2 , Ca=35.291, P=17.228). Bonferroni's and Tukey's HSD test showed higher significant difference (p<0.05) from demineralization to remineralization phase in all groups, except when compared control group with WSL (Demineralization) showed non-significant difference (P>0.05). Conclusion:all tested agents have highly significant remineralizing potential. Nano-HAP has the highest potential for remineralizing initial enamel caries lesions.
2018
Objective: To evaluate and compare clinically the effectiveness of a nano-hydroxyapatite (n-HAP) paste (Sesensibilize™ Nano-P, FGM) and a tri-calcium phosphate fluoride (TCP-F) varnish (Clinpro™ White Varnish, 3M ESPE) in remineralization of white spot lesions (WSLs) on young permanent teeth. Methods: 20 patients having at least one pair of teeth with WSL were randomly selected to this study according to specific criteria. Each patient received two treatments of WSL; one treatment using n-HAP paste on one side of the arch (n-HAP group) and a second one using TCP-F varnish on the contralateral or opposing side of the arch (TCP-F group). A total of 80-teeth with WSLs were included in this randomized clinical trial. The reminaralizing agents were applied over the tooth surface with a WSL as per manufacturer recommendations. Four application sessions were completed during the first month on a weekly basis. DIAGNODENT PEN (DD) (Kavo Dental –Germany) was used to assess the degree of remin...