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1.

Objective

To assess the long-term (>3 months) remineralizing effect of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) on early caries lesions in vivo.

Data sources

PubMed, Web of Science, Embase, Cochrane-Central, Science Direct, CBM, and CNKI were searched up to April 2013. Only articles in English and Chinese were included. Grey literature was also searched. Randomized or quasi-randomized clinical trials in which CPP-ACP was delivered by any method were considered. All relevant studies underwent two independent reviews.

Study selection

Of the 738 studies screened, 83 studies were reviewed and eight selected for inclusion in the final sample. The follow-up period of the studies included varied from 3 to 24 months. The long-term remineralizing effect of CPP-ACP in vivo was demonstrated in comparison with placebo in randomized controlled trial. However, there is conflicting evidence regarding the clinical efficacy of CPP-ACP when used in conjunction with fluoride toothpastes. No specific side effect related to CPP-ACP usage was found.

Conclusions

CPP-ACP has a long-term remineralizing effect on early caries lesions in comparison with placebo, although this does not appear to be significantly different from that of fluorides. The advantage of using CPP-ACP as a supplement to fluoride-containing products is still unclear. High-quality, well-designed clinical studies in this area are still required before definitive recommendations can be made.

Clinical significance

CPP-ACP is a promising remineralizing agent with a significant remineralizing effect that has been demonstrated in both in vivo and in vitro studies. The evidence to support its synergistic effect with fluoride is insufficient based on the current existing long-term human randomized controlled trials.  相似文献   

2.
目的 比较3种氟制剂对邻面去釉后牙釉质再矿化效果的影响,为临床选择预防邻面去釉后牙釉质脱矿的最佳氟制剂提供参考.方法 收集正畸减数拔除的前磨牙60颗,行近远中邻面去釉,牙冠颊舌向劈开后共120个标本,随机分为4组.对照组单纯用人工唾液进行再矿化,A组加用0.1 mol/L氟化钠溶液处理,B组加用6 000 mg/L(6 000 ppm)氟化泡沫处理,C组加用氟含量0.1%(质量分数)的氟保护漆处理.每4周处理1次,共处理3次.应用显微硬度仪测量每个标本再矿化前及再矿化后4周去釉面的显微硬度值,并进行统计学分析.结果 再矿化前、后牙釉质显微硬度差值在对照组为(3.42 ±2.27) kg/mm2,A组为(13.06 ±4.22) kg/mm2,B组为(20.21±4.96)kg/mm2,C组为(16.05 ±5.51) kg/mm2.各组再矿化前、后的显微硬度变化均有统计学意义(P<0.01).再矿化前、后显微硬度差值在4组间的差异有统计学意义(F =26.168,P=0.000);两两比较,A、B、C3组与对照组的差异均有统计学意义(P<0.01),B组和A、C组间的差异有统计学意义(P<0.01),A组和C组间的差异无统计学意义(q=2.142,P=0.139).结论 氟化钠溶液、氟化泡沫、氟保护漆对去釉后的牙釉质再矿化均具有良好的促进作用,其中氟化泡沫的效果优于其他2种制剂.  相似文献   

3.
BACKGROUND: The aims of this study were to investigate the efficacy of CPP-ACP containing Tooth Mousse on the remineralization of enamel lesions and to compare its efficacy to that of a fluoride-containing toothpaste. METHODS: Permanent teeth were placed in demineralizing solution for 96 hours to produce artificial caries-like lesions 120-200 microm in depth. They were sectioned into 100-150 microm thick samples and randomly assigned to five groups: for Group A, a fluoridated toothpaste (1100 ppm) was used as a positive control and in Group B, a non-fluoridated toothpaste was used as a negative control. Tooth Mousse containing CPP-ACP was tested by three different means: as a toothpaste (Group C); as a topical coating (Group D); and (Group E) as a topical coating after treating the sections with the same fluoridated toothpaste as in Group A. RESULTS: The lesion depth decreased significantly by 7 per cent in Group A, 10.1 per cent in Groups C and D, and 13.1 per cent in Group E (Paired t- test, p < 0.05), while in Group B the lesion depth increased significantly by 23 per cent. CONCLUSIONS: Based on the data obtained, CPP-ACP containing Tooth Mousse remineralized initial enamel lesions and it showed a higher remineralizing potential when applied as a topical coating after the use of a fluoridated toothpaste.  相似文献   

4.

Objective

The aim of this in situ study was to compare the remineralization potential of pastes containing CPP-ACP and CPP-ACP with 900 ppm fluoride on human enamel softened by a cola drink.

Design

Forty-five enamel specimens obtained from human third molar teeth were eroded in a cola drink for 8 min and then attached to intra-oral devices worn by five volunteers. The specimens were subjected to three different in situ remineralization protocols using: (1) CPP-ACP (Group I), (2) CPP-ACP with 900 ppm fluoride (Group II), and (3) saliva (Group III, control). Vickers microhardness measurements were obtained at baseline followed by demineralization and remineralization stages.

Results

The CPP-ACP, CPP-ACP with 900 ppm fluoride and saliva controls resulted in 46.24%, 64.25% and 2.98% increase in post-erosion microhardness values, respectively. One-way ANOVA revealed statistically significant differences in the mean microhardness values between pastes containing CPP-ACP and CPP-ACP with 900 ppm fluoride.

Conclusions

Both CPP-ACP and CPP-ACP with 900 ppm fluoride substantially remineralized the softened enamel, with the CPP-ACP and fluoride combination showing higher remineralization potential than CPP-ACP. This study confirmed the synergistic effect of fluoride with CPP-ACP on remineralization of eroded enamel.  相似文献   

5.

Objectives

The aim of this study was to measure the effect of incorporating CPP-ACP into an autocure GIC on physical and mechanical properties, ion release and enamel demineralization inhibition.

Methods

Physical and mechanical properties were evaluated using tests specified by the International Organization for Standardization (ISO). Concentrations of fluoride, calcium and inorganic phosphate in deionized water (pH 6.9) and lactic acid (pH 4.8) were measured up to five months. Cavities on human extracted molars were prepared, restored with GIC (control), CPP-ACP modified GIC or resin composite, then stored in 50 mM lactic acid solution at pH 4.8 for 4 days. Sections of demineralized enamel were examined using polarized light microscopy followed by lesion area measurement.

Results

The incorporation of up to 5% CPP-ACP into Fuji VII decreased the cements’ strength and prolonged setting time. However, values remained within ISO limits. The incorporation of 3 or 5% CPP-ACP significantly decreased fluoride release, while higher calcium and inorganic phosphate release occurred. The demineralized enamel area adjacent to GIC with 3 or 5% CPP-ACP was significantly smaller compared to GIC control.

Significance

The incorporation of 3% CPP-ACP into GIC has the potential to improve its anticariogenic ability without adversely affecting its mechanical properties.  相似文献   

6.
7.
目的 探讨邻面去釉后牙釉质再矿化的方法.方法 以正畸减数的双尖牙为实验样本,共60个,随机平分为A,B组.A组采用去釉砂条去釉+35%磷酸抛光;B组采用片切盘去釉+35%磷酸抛光.每组再根据不同的氟保护剂随机平分为三个亚组.Ⅰ组去釉后应用氟保护漆,Ⅱ组应用氟化泡沫,Ⅲ组未处理,为对照组.经体外PH循环15 d后采用定量的显微硬度检测,进行统计学处理.结果 每组内的三个亚组间的显微硬度值差异均有统计学意义(P值分别为0.0015和0.0016),其中,Ⅰ组最高,ⅠA为(282.64±25.20) kg/mm2,ⅠB为(264.90±24.32)kg/mm2;Ⅲ组最低,ⅢA为(187.92±45.53) kg/mm2,ⅢB为(170.90±30.73)kg/mm2.每组内,Ⅰ、Ⅱ组间均无统计学差别,而Ⅰ组比Ⅲ组均高,差异有统计学意义;Ⅱ组比Ⅲ组均高,差异有统计学意义.结论 体外实验提示,经去釉砂条或片切盘去釉+35%磷酸抛光后,氟保护漆和氟化泡沫对去釉后的牙釉质均有良好的再矿化作用.  相似文献   

8.
目的:通过体外pH循环实验,找到一种临床效果较好的邻面去釉方法。方法:收集因正畸减数治疗的前磨牙50颗,沿牙体长轴纵向剖开,得到100个样本,随机分为5组。Ⅰ组为片切砂条,Ⅱ组为片切盘,Ⅲ组为片切砂条+抛光+35%磷酸,Ⅳ组为片切盘+抛光+35%磷酸,Ⅴ组为未去釉组。每组样本经过体外pH循环30 d后,采用扫描电镜及显微硬度仪检测,采用SPSS13.0软件包对数据进行统计学分析。结果:①各组的显微硬度值两两比较,Ⅰ组与Ⅱ组、Ⅲ组与Ⅳ组间无显著差异(P>0.05);Ⅰ组与Ⅲ组、Ⅰ组与Ⅳ组、Ⅱ组与Ⅲ组、Ⅱ组与Ⅳ组有高度显著差异(P<0.01);Ⅰ组与Ⅴ组、Ⅱ组与Ⅴ组、Ⅲ组与Ⅴ组、Ⅳ组与Ⅴ组间差异显著(P<0.05)。②肉眼及扫描电镜观察,Ⅲ组及Ⅳ组无明显不同,但均优于其余几组。结论:①去釉盘和去釉砂条的去釉效果无显著不同。②化学抛光组的再矿化效果优于未抛光组及对照组。③邻面去釉后釉质表面的划痕,即使经再矿化也难以恢复。  相似文献   

9.
ObjectivesTo investigate the correspondence between programmed interproximal reduction (p-IPR) and implemented interproximal reduction (i-IPR) in an everyday-practice scenario. The secondary objective was to estimate factors that might influence i-IPR to make the process more efficient.Materials and MethodsFifty patients treated with aligner therapy by six orthodontists were included in this prospective observational study. Impressions were taken at the beginning of treatment and after the first set of aligners. Data on p-IPR, i-IPR and technical aspects of IPR were gathered for 464 teeth. Statistical analyses included the Wilcoxon signed-rank test, Kruskal-Wallis, and multilevel mixed regression.ResultsMean difference between p-IPR and i-IPR was 0.15 mm (SD: 0.14 mm; P = .0001), with lower canines showing the highest discrepancy. Use of burs and measuring gauges resulted in a smaller difference (respectively: coeff.: 0.09, P = .029; coeff.: −0.06, P = .013). IPR was performed more accurately on the mesial surface of teeth than on the distal surface. Round tripping before IPR resulted in a slightly more precise i-IPR compared to the previous alignment (coeff.: −0.021, P = .041).ConclusionsImplemented IPR tends to be less than p-IPR, especially for lower canines and distal surfaces of teeth. Burs tend to provide more precise i-IPR, especially compared to manual strips; however, there is variation between the techniques. Using a measuring gauge tends to increase the precision of i-iPR. As several factors influence the implementation of IPR, particular attention must be paid during the procedure to maximize its precision.  相似文献   

10.
目的研究含氟酪蛋白磷酸肽-磷酸钙复合物(CPP-ACP)在体外对酸蚀牛牙釉质显微硬度的影响。方法选择新鲜拔除的牛下切牙60个,制成60个5mm×5mm正方形釉质开窗区,其余部分由抗酸指甲油涂抹封闭,将釉质块样本完全随机分为4组,每组15个,分别进行4种不同处理(A组为阴性对照组;B组为阳性对照组,使用碳酸饮料酸蚀处理;C组为碳酸饮料酸蚀后使用CPP-ACP进行再矿化;D组为酸蚀后使用含氟CPP-ACP(氟浓度为900ppm)再矿化。使用显微硬度仪测定样本显微硬度,比较各组显微硬度的差别。结果 D组显微硬度较C组高,C组及D组显微硬度均高于B组但低于A组,各组间的差异具有统计学意义(P0.01)。结论含氟酪蛋白磷酸肽-磷酸钙复合物可以提高酸蚀牙釉质的显微硬度。  相似文献   

11.
目的 探讨 2 %酪蛋白磷酸多肽钙氟磷复合体 (caseinphosphopeptide amorphouscalciumfluoridephosphatecomplexes,CPP ACFP)溶液对人工牙釉质表层下缺损的再矿化作用。方法 从人第三磨牙切取 2 8块釉质片 (每片制备两条表层下釉质缺损 ) ,随机平分为 4组 ,每组分别于再矿化液中浸泡1、3、5、10d。将再矿化后的标本切片 ,显微放射照相 ,测定矿物质含量。结果 经 1、3、5和 10d再矿化后 ,矿化液分别取代人工牙釉质缺损丢失矿物质的 9 19%、14 2 7%、2 9 0 7%和 38 45 % (y =8 9316x0 63 47,R2 =0 932 2 ;y :再矿化率 ,x :时间 )。经One wayScheffe差异多因素分析比较发现 :每两组间再矿化率差异具有显著性。结论 实验室中CPP ACFP对人工牙釉质缺损有明显的再矿化作用  相似文献   

12.
Background: To investigate, in vitro, the effect on enamel erosion of the addition of 0.2% w/v casein phosphopeptide‐amorphous calcium phosphate (CPP‐ACP) to four commercially‐available soft drinks, two of which were carbonated. Methods: Enamel specimens (n = 27) were sectioned from sound extracted human third molar teeth and polished to a mirror finish. Exposed enamel windows of 1 mm2 were created by painting the surface with acid‐resistant nail varnish. Four citric flavoured soft drinks (pH range 2.2 to 2.4) and distilled deionized water (DDW) were tested. Each drink was tested with and without 0.2% CPP‐ACP w/v. The specimens were placed into 50 mL of solution at 37 °C for 30 minutes, rinsed and varnish removed. The samples were profiled with a white light profilometer and erosive depths recorded. Results: All soft drinks tested caused enamel erosion but adding 0.2% w/v CPP‐ACP significantly reduced (p <0.05) erosive depth in all test solutions in comparison with the solutions without CPP‐ACP. The erosive depths for all solutions with 0.2% CPP‐ACP did not differ significantly from those of DDW. Conclusions: Adding CPP‐ACP at 0.2% w/v significantly decreased the erosivity of all four soft drinks. The erosivity of the soft drinks with 0.2% CPP‐ACP added did not differ significantly from that of distilled water.  相似文献   

13.

Objective

In addition to its role as a remineralizing agent in preventing dental caries, recent evidence has shown that casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) can protect teeth against erosion. The aim of this study was to determine whether CPP-ACP could reduce enamel wear rates under severe erosive conditions simulating heavy attrition and gastric regurgitation.

Design

Enamel specimens were subjected to 10,000 wear cycles at a load of 100 N and pH 1.2 in a tooth wear machine. The machine was stopped every 2 min (160 cycles), and CPP-ACP in the form of a paste was applied for 5 min in experimental group 1. A paste with the same formulation but without CPP-ACP was applied in experimental group 2. No paste was applied in the control group.

Results

A linear mixed model analysis indicated that the mean wear rates in experimental group 1 (0.44 ± 0.05 mm3 per 1000 cycles) and in experimental group 2 (0.63 ± 0.06 mm3 per 1000 cycles) were significantly lower than that in the control group (0.92 ± 0.11 mm3 per 1000 cycles) (p < 0.05). The mean wear rate in experimental group 1 was also lower than that in experimental group 2 (p < 0.05). Wear facets in experimental groups 1 and 2 were noted to be smoother and more polished than those in the control group.

Conclusions

Both remineralizing and lubricating properties of the paste containing CPP-ACP appear to contribute to wear reduction in enamel. These findings may lead to new strategies for the clinical management of tooth wear.  相似文献   

14.

Objectives

The aim of this work was to evaluate the in vitro effect of chitosan (concentration and time of action) treatment on enamel de-remineralization behavior upon a pH cycling assay.

Methods

Different group of human tooth samples were exposed to de-remineralizing solutions of controlled pH using a random experimental design. Microhardness and phosphorus chemical analysis were employed to evaluate the loss of phosphorus from the samples. Optical coherence tomography (OCT) images were obtained for selected specimens in order to evaluate the degree of penetration of chitosan into enamel.

Results

Vickers microhardness results were higher for samples treated with chitosan for concentration between 2.5 mg/mL and 5.0 mg/mL and time of action between 60 s and 90 s. A maximum inhibition of mineral loss of 81% was obtained. Chemical analysis indicated lower net pohosphorus loss (net P loss) for samples treated with chitosan. Best results were obtained in the same conditions found out with microhardness measurements. Chitosan had little effect on the remineralization process. OCT results indicated a correlation of chitosan penetration with chitosan concentration. For chitosan concentrations of 2.5 g/mL and 5.0 g/mL the penetration was up to the dentin–enamel junction.

Conclusions

Chitosan interferes with the process of demineralization of the tooth enamel inhibiting the release of phosphorus in this laboratory study. Demineralization is influenced by the concentration and exposure time of the biopolymer to the enamel. Microhardness measurements may be used as an indication of mineral loss from tooth enamel. Additionally, OCT images support the idea that chitosan may act as a barrier against acid penetration, contributing to its demineralization inhibition.  相似文献   

15.
Objective:To evaluate the effect of casein phosphopeptide–amorphous calcium phosphate tooth mousse on the remineralization of bovine incisor by circularly polarized images.Methods:Eighty bovine incisors, each with a 4 × 4 mm artificially demineralized area, were used. The samples were divided into four groups: Group A, casein phosphopeptide–amorphous calcium phosphate tooth mousse; Group B, fluoride toothpaste; Group C, casein phosphopeptide–amorphous calcium phosphate tooth mousse and fluoride toothpaste; and Group D, no treatment. Circularly polarized images were taken after the specimens were treated for 3, 6, 9, or 12 weeks, and the size of the demineralized area and the mean grey level were measured. Data analysis was done using repeated measures variance analysis. Pearson correlation coefficients were computed to evaluate the correlation between the size of the demineralized area and the mean grey level.Results:In all four groups, the size of the demineralized area and the mean grey level declined with time. The size of the demineralized area of Group C was significantly smaller than that of Group A at the end of the third and sixth weeks (P  =  .039, P  =  .000, respectively), and the mean grey level of Group C was lower than that of Group A at the end of the 6th and 12th weeks (P  =  .037, P  =  .004, respectively). At the end of the 6th, 9th, and 12th weeks, the size of the demineralized area of Group C was smaller (P  =  .000, P  =  .005, P  =  .005, respectively) and the mean grey level was lower (P  =  .000) than those of Group B. No statistically significant correlations were detected between the size of the demineralized area and the mean grey level.Conclusion:Casein phosphopeptide–amorphous calcium phosphate tooth mousse can reduce the size and mean grey level of demineralized areas and promote the remineralization of bovine enamel. Combined application with fluoride toothpaste strengthens the effect.  相似文献   

16.
目的 评价酪蛋白磷酸肽-非结晶型磷酸钙(casein phosphopeptide-amorphous calcium phosphate,CPP-ACP)与几种临床常用的含氟制剂抑制牙釉质脱矿的作用,为正畸临床预防牙釉质脱矿提供依据.方法 将70颗离体牙分为7组,每组10颗,即A组:CPP-ACP组;B组:CPP-ACP+含氟漱口水组;C组:含氟漱口水组;D组:含氟玻璃离子牙体保护剂组;E组:含氟树脂粘接剂组;F组:氟保护漆组;G组:空白对照组.将7组样本按三餐进食时间放人人工致龋液中,每次10 min,前6组分别于样本颊面釉质表面涂布CPP-ACP、CPP-ACP和含氟漱口水、含氟漱口水、含氟玻璃离子牙体保护剂、含氟树脂粘接剂、氟保护漆,空白对照组不处理,7组样本其余时间均浸泡于人工唾液中.于实验1、2、3个月用原子力显微镜检测.结果 实验1个月D组釉质表面粗糙度[(114±1) nm]显著低于G组[(172±9) nm] (P <0.05);实验2和3个月各组釉质表面粗糙度与G组差异均有统计学意义(P<0.05);B组粗糙度2和3个月为(87±9)和(27±6) nm,显著低于其他各组(P<0.05);C组2和3个月粗糙度分别为(145±8)和(126±7)nm,显著高于D、E、F组(P<0.05).结论 CPP-ACP与含氟制剂在人工致龋环境中均有抑制牙釉质脱矿的作用,CPP-ACP与含氟制剂联合应用效果更佳;含氟固体(D、E、F组)比含氟液体(C组)抑制牙釉质脱矿作用效果更好.  相似文献   

17.
18.
目的 通过体外实验研究酪蛋白磷酸多肽-无定形磷酸钙(cvv-ACP,商品名护牙素)对固定矫治中托槽周围牙釉质脱矿的预防作用.方法 将60颗因正畸治疗而拔除的前磨牙随机分成四组:①护牙素组;②0.2%NaF组;③0.2%NaF 护牙素组;④空白对照组.在牙齿颊面粘结正畸托槽.体外pH循环35天后.每组取10个样本经切片、磨片至厚度100/μm-110μm,采用软X线投照技术及高清晰度数码显微图像分析系统测量釉质脱矿深度和灰度.另外,每组取5个样本用扫描电镜观察釉质表面超微结构的改变.用SPSSl3.0统计软件进行数据处理分析.结果 形态学表现:软X线照片显示护牙素组、0.2%NaF组、0.2%NaF 护牙素组都没有出现明显脱矿,对照组出现了19.34±6.8pJn深的脱矿.扫描电镜显示前三组的牙釉质表面有矿物质沉积,孔隙变小,对照组的牙釉质表面有程度不等蜂窝状孔隙.灰度值比较结果显示:①护牙素组、0.2%NaF组之间脱矿量没有统计学差异(P>O.05);②护牙素组、0.2%NaF组、0.2%NaF 护牙素组的脱矿量与空白对照组之间有显著的统计学差异(P相似文献   

19.
Background:  Casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) is an anticariogenic agent that is suitable to be added to foods. The aim of this double-blind, three-way crossover randomized study was to investigate the capacity of CPP-ACP, when added to bovine milk, to remineralize enamel subsurface lesions in situ .
Methods:  Ten subjects drank 100 mL of bovine milk containing no added CPP-ACP (control milk), 0.2% (w/v) CPP-ACP or 0.3% (w/v) CPP-ACP, for 30 seconds once daily for 15 days, whilst wearing removable appliances with attached slabs of enamel containing subsurface enamel lesions. After each treatment and a one-week washout period, subjects crossed over to another treatment and this was repeated until they had consumed each of the three milk products. At the completion of each treatment the enamel slabs were removed and remineralization was determined using microradiography.
Results:  The results demonstrated that all three milk samples remineralized enamel subsurface lesions in situ . However, the two milk samples containing added CPP-ACP each produced significantly greater remineralization than the control milk.
Conclusions:  The remineralizing effect of CPP-ACP in milk was dose-dependent with milk containing 0.2% CPP-ACP and 0.3% CPP-ACP producing an increase in mineral content of 81% and 164%, respectively, relative to the control milk.  相似文献   

20.
Objective:To test in vitro and in vivo the wear performance of diamond-coated strips by means of tribological testing and scanning electronic microscope (SEM).Materials and Methods:To evaluate the in vitro wear performance, a tribological test was performed by a standard tribometer. The abrasive strips slid against stationary, freshly extracted premolars fixed in resin blocks, at a 2-newton load. At the end of the tribological test, the residual surface of the strip was observed by means of SEM analysis, which was performed every 50 meters until reaching 300 meters. For the in vivo analysis, the strip was used for 300 seconds, corresponding to 250 meters.Results:The strips presented a fenestrated structure characterized by diamond granules alternating with voids. After the first 50 meters, it was possible to observe tooth material deposited on the surface of the strips and a certain number of abrasive grains detached. The surface of the strip after 250 meters appeared smoother and therefore less effective in its abrasive power. After 300 seconds of in vivo utilization of the strip, it was possible to observe the detachment of diamond abrasive grains, the near absence of the grains and, therefore, loss of abrasive power.Conclusions:Under ideal conditions, after 5 minutes (300 meters) of use, the strip loses its abrasive capacity by about 60%. In vivo, a more rapid loss of abrasive power was observed due to the greater load applied by the clinician in forcing the strip into the contact point.  相似文献   

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