The incorporation of casein phosphopeptide-amorphous calcium phosphate into a glass ionomer cement

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.     

Ion release and physical properties of CPP–ACP modified GIC in acid solutions

A new glass-ionomer cement (GIC) (Fuji VII? EP) includes 3% (w/w) casein phosphopeptide–amorphous calcium phosphate (CPP–ACP) to enhance ion release.ObjectivesTo assess this new GIC compared with a GIC without CPP–ACP (Fuji VII?) with respect to ion release, changes in surface hardness and in mass under a variety of acidic and neutral conditions.MethodsEighty blocks of Fuji VII? (F7) and Fuji VII? EP (F7EP) were subjected to three acidic solutions (lactic and citric acids pH 5.0, hydrochloric acid pH 2.0) and water (pH 6.9) over a three-day period. Ion release, surface hardness and weight measurements were carried out every 24 h.ResultsHigher calcium ion release from F7EP was observed under all acidic conditions. Increased inorganic phosphate ion release was observed for F7EP in hydrochloric and citric acids. Fluoride ion release was similar between F7 and F7EP under all conditions but was significantly higher in acids compared with water. After three days there was no significant difference in surface hardness (p > 0.05) between the two materials under all conditions except hydrochloric acid. Minimal change in mass was observed for F7 and F7EP in water, lactic and hydrochloric acids, however citric acid caused significantly more mass loss compared with water (p < 0.001).ConclusionIncorporation of 3% (w/w) CPP–ACP into F7 enhanced calcium and phosphate ion release, with no significant change in fluoride ion release and no adverse effects on surface hardness or change in mass.Clinical significance statementGICs have the potential to release fluoride ions particularly under acidic conditions associated with dental caries and erosion. A new GIC containing CPP–ACP and fluoride releases not only fluoride ions but also calcium and phosphate ions under acidic conditions which should help to inhibit demineralisation associated with caries and erosion.     

Calcium phosphopeptides -- mechanisms of action and evidence for clinical efficacy

Phosphoproteins/phosphopeptides with clusters of acidic residues are found throughout nature, where they aid in the prevention of unwanted precipitation of solid calcium phosphates. The acidic residues, particularly phosphoserine, interact with calcium and stabilize clusters of calcium and phosphate. Saliva and milk are two examples of biological fluids that contain such phosphoprotein/phosphopeptide-stabilized calcium phosphates, and both share a similar evolutionary pathway. Saliva has been shown to have remineralization potential and is of critical importance in maintaining the mineral content of teeth in the oral environment. Milk can be enzymatically modified to release casein phosphopeptides that contain the clusters of residues that allow milk to stabilize high concentrations of calcium and phosphate. These casein phosphopeptide-stabilized amorphous calcium phosphate nanocomplexes (CPP-ACP) can stabilize even higher concentrations of calcium and phosphate than milk and can be considered a salivary biomimetic, since they share many similarities to statherin. The mechanisms of action and the growing body of scientific evidence that supports the use of CPP-ACP to augment fluoride in inhibiting demineralization and enhancing the remineralization of white-spot lesions are reviewed.     

Recharge and increase in hardness of GIC with CPP-ACP/F

ObjectiveTo assess the effect of CPP-ACP/F recharging on ion release and hardness of GIC Fuji-Triage (VII) and Fuji-Triage-EP (VII-EP) containing CPP-ACP/F.MethodsCPP-ACP distribution in Fuji-Triage-EP was determined using immunofluorescence. Thirty blocks of Fuji-Triage and Fuji-Triage-EP with the same surface area were placed individually in 5 mL of 50 mM lactic acid (pH 5) for three days. Every 12 h ten Fuji-Triage and ten Fuji-Triage-EP blocks were treated with 2 mL of either MI Paste Plus (CPP-ACP/F) solution (1 g paste + 4 mL water), Placebo MI paste solution (no CPP-ACP/F), or distilled water for 2 min. After each 2 min treatment the blocks were rinsed with distilled water and placed back into the acid. Calcium, inorganic phosphate and fluoride levels in the acid solution were measured using atomic absorption spectrophotometry, colorimetry and ion specific electrode respectively. Vickers surface hardness of the GIC was also determined. Data were analysed using a two-sample t-test and one-way ANOVA with a Bonferroni-Holm correction for multiple comparisons.ResultsCPP-ACP was distributed throughout Fuji-Triage-EP. Significantly (p < 0.001) higher calcium, inorganic phosphate and fluoride ion release and greater surface hardness (acid resistance) was observed in both GIC’s treated with the CPP-ACP/F paste. Fuji-Triage-EP released higher ion levels and exhibited greater surface hardness (acid resistance) than Fuji-Triage.SignificanceTopical application of CPP-ACP/F paste to GIC Fuji-Triage-EP recharged ion release and increased surface hardness (acid resistance) which may help improve properties and resistance to degradation as well as improve ion release for caries control.     

Remineralization of enamel subsurface lesions in situ by sugar-free lozenges containing casein phosphopeptide-amorphous calcium phosphate

BACKGROUND: The anticariogenic potential of casein phosphopeptide-amorphous calcium phosphate nanocomplexes (CPP-ACP) has been demonstrated using laboratory, animal and human in situ caries models. The aim of this study was to determine the effect of CPP-ACP incorporation into a sugar-free lozenge (pressed mint tablet) on enamel remineralization in a human in situ model. METHODS: The study utilized a double-blind, randomized, cross-over design with four treatments: (i) a lozenge containing 56.4mg (3 per cent w/w) CPP-ACP; (ii) a lozenge containing 18.8mg (1 per cent w/w) CPP-ACP; (iii) a lozenge not containing CPP-ACP; and (iv) a no lozenge nil-treatment control. Ten subjects wore removable palatal appliances with four, human-enamel, half-slab insets containing subsurface lesions. Lozenges were consumed, without chewing, four times per day for 14 days duration. After each treatment period the enamel slabs were removed, paired with their respective demineralized control, embedded, sectioned and subjected to microradiography and computer-assisted densitometric image analysis to determine the level of remineralization. RESULTS: The incorporation of CPP-ACP into the lozenge significantly increased enamel subsurface lesion remineralization with 18.8 and 56.4mg of CPP-ACP increasing remineralization by 78 and 176 per cent respectively, relative to the control sugarfree lozenge. CONCLUSION: This study demonstrates that lozenges are a suitable vehicle for the delivery of CPP-ACP to promote enamel remineralization.     

Retention in plaque and remineralization of enamel lesions by various forms of calcium in a mouthrinse or sugar-free chewing gum

Casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) nanocomplexes incorporated into sugar-free chewing gum have been shown to remineralize enamel subsurface lesions in situ. The aim of this study was to compare the ability of CPP-ACP, with that of other forms of calcium, to be retained in supragingival plaque and remineralize enamel subsurface lesions in situ when delivered in a mouthrinse or sugar-free gum in randomized, double-blind trials. In the mouthrinse study, only the CPP-ACP-containing mouthrinse significantly increased plaque calcium and inorganic phosphate levels, and the CPP were immunolocalized to the surfaces of bacterial cells as well as the intercellular matrix. In the chewing gum studies, the gum containing the CPP-ACP, although not containing the most calcium per piece of gum, produced the highest level of enamel remineralization independent of gum-chewing frequency and duration. The CPP could be detected in plaque extracts 3 hrs after subjects chewed the CPP-ACP-containing gum. The results showed that CPP-ACP were superior to other forms of calcium in remineralizing enamel subsurface lesions.     

Enamel subsurface lesion remineralisation with casein phosphopeptide stabilised solutions of calcium, phosphate and fluoride

Casein phosphopeptide stabilised amorphous calcium phosphate (CPP-ACP) and amorphous calcium fluoride phosphate (CPP-ACFP) solutions have been shown to remineralise enamel subsurface lesions. The aim of this study was to determine the effect of ion composition of CPP-ACP and CPP-ACFP solutions on enamel subsurface lesion remineralisation in vitro. CPP-bound and free calcium, phosphate and fluoride ion concentrations in the solutions were determined after ultrafiltration. The ion activities of the free ion species present were calculated using an iterative computational program. The mineral deposited in the subsurface lesions was analysed using transverse microradiography and electron microprobe. CPP was found to stabilise high concentrations of calcium, phosphate and fluoride ions at all pH values (7.0-4.5). Remineralisation of the subsurface lesions was observed at all pH values tested with a maximum at pH 5.5. The CPP-ACFP solutions produced greater remineralisation than the CPP-ACP solutions at pH 5.5 and below. The mineral formed in the subsurface lesions was consistent with hydroxyapatite and fluorapatite for remineralisation with CPP-ACP and CPP-ACFP, respectively. The activity gradient of the neutral ion pair CaHPO(4)(0) into the lesion was significantly correlated with remineralisation and together with HF(0) were identified as important species for diffusion.     

Fluoride and casein phosphopeptide-amorphous calcium phosphate

Casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) slows the progression of caries and remineralizes enamel subsurface lesions. The aim of this study was to determine the ability of CPP-ACP to increase the incorporation of fluoride into plaque and to promote enamel remineralization in situ. Randomized, double-blind, cross-over studies involved mouthrinses and dentifrices containing CPP-ACP and fluoride. The mouthrinses were used for 60 sec, three times/day for 5 days, and supragingival plaque was collected and analyzed for F. The dentifrices were rinsed as a water slurry for 60 sec four times/day for 14 days in an in situ model. The addition of 2% CPP-ACP to the 450-ppm-F mouthrinse significantly increased the incorporation of fluoride into plaque. The dentifrice containing 2% CPP-ACP produced a level of remineralization similar to that achieved with a dentifrice containing 2800 ppm F. The dentifrice containing 2% CPP-ACP plus 1100 ppm F was superior to all other formulations.     

Effect of CPP-ACP addition on physical properties of zinc oxide non-eugenol temporary cements

Objectives

Casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) is a milk derivative which holds nanoclusters of calcium and phosphate ions. The presence of CPP-ACP has been found to reduce demineralization and enhance remineralization in subsurface enamel and in dentin. Incorporation of CPP-ACP into luting cements has not been investigated. The aim of this study was to determine the effect on the physical properties of two commercially available zinc oxide non-eugenol temporary luting cements with incorporation of up to 8% (w/w) CPP-ACP.

Methods

Setting time, compressive strength, diametral tensile strength, film thickness and solubility tests were investigated for 0, 0.5, 1.0, 2.0, 3.0, 4.0 and 8.0% (w/w) CPP-ACP incorporated into Freegenol™ and Temp-Bond^® NE. Tests were carried out based on ISO 3107 requirements.

Results

Compressive and diametral tensile strengths progressively decreased with increasing concentrations of up to 8.0% (w/w) CPP-ACP incorporated into both Freegenol™ and Temp-Bond^® NE. Setting time was delayed beyond ISO requirements. Film thickness was not adversely affected. Increased solubility of Temp-Bond^® NE with 8.0% (w/w) CPP-ACP incorporation suggested an effect of the CPP-ACP on this property for this cement.

Significance

The incorporation of up to 8.0% (w/w) CPP-ACP into two zinc oxide non-eugenol luting cements has no adverse effects on the film thickness, compressive strength and diametral tensile strength of the cements investigated. Solubility investigations suggest that CPP-ACP leaches out of the zinc oxide non-eugenol luting cements into an aqueous environment.     

钙磷再矿化及其系统

龋病是一种釉质脱矿与再矿化作用失衡,牙体硬组织向脱矿方向持续发展的疾病。当口腔内钙和磷酸根离子饱和度下降时,釉质脱矿;反之,釉质再矿化;因此,钙和磷酸根离子是再矿化的物质基础,钙磷离子浓度越高,越有利于釉质再矿化的发生。无定形钙磷（ACP）能与氟离子结合生成无定形钙磷氟（ACPF）,ACP和ACPF能向口腔环境提供可利用的钙磷和氟离子,促进釉质的再矿化;但亦降低可利用的钙、磷酸根和氟离子浓度,降低其促再矿化能力。酪蛋白磷酸肽（CPP）与钙和磷酸根以一种微弱的化学力结合,使得CPP-ACP复合体中的钙、磷酸根离子与口腔环境中的游离钙、磷酸根离子间保持一种动态平衡。当pH值较高时,大量钙、磷离子以CPP-ACP形式存在;随着pH值降低,CPP-ACP释放出钙、磷酸根离子促进釉质再矿化。CPP-ACP有效定位于龋损表层及表层下并释放钙和磷酸根离子,具有良好的促再矿化效果。氟具有良好的再矿化防龋效果,可通过与CPP-ACP中的氢氧根离子置换生成CPP-ACPF。CPP-ACPF通过附着于牙体表面或顺CPP-ACPF浓度梯度渗透进入釉质龋坏表层下,持续释放钙、磷酸根和氟离子,促进釉质表层和表层下再矿化。     

含氟酪蛋白磷酸肽—磷酸钙复合物对酸蚀牙釉质显微硬度的影响

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。     

CPP-ACP与不同浓度氟促进釉质再矿化的研究

目的：探讨酪蛋白磷酸多肽-无定形磷酸钙(casein phosphopeptide-amorphous calcium phosphate,CPP-ACP) 与不同浓度氟离子联合应用对脱矿釉质再矿化的作用。方法：取正畸拔除的健康前磨牙30颗,乳酸凝胶法制备人工早期釉质脱矿后, 随机分为对照组(5% CPP-ACP组)、实验组1(5% CPP-ACP+500 mg/L F-组)和实验组2(5% CPP-ACP+900 mg/L F-组),采用MH-5型显微硬度仪测量处理前、后釉质标本的显微硬度,采用SPSS 18.0软件包对数据进行统计学分析。结果：显微硬度测量显示,实验组2牙釉质的表面显微硬度变化显著高于实验组1(P<0.05)及对照组(P<0.01)。结论：CPP-ACP能够促进脱矿釉质再矿化,氟对其有加强协同作用。在一定范围内,氟浓度越高,协同作用越好。     

Effect of casein phosphopeptide - amorphous calcium phosphate containing chewing gum on salivary concentration of calcium and phosphorus: An in-vivo study

Aim: Caries clinical trials of sugar-free chewing gum have shown that the gum is noncariogenic and in fact has anticariogenic effect through the stimulation of saliva. Sugar-free gums, therefore, may be an excellent delivery vehicle for safe and effective additive, capable of promoting enamel remineralization. Casein phosphopeptide - amorphous calcium phosphate (CPP-ACP) nanocomplexes incorporated into sugar-free chewing gum have shown to remineralize enamel subsurface lesions in situ. So this study was conducted to evaluate the effect of CPP-ACP containing sugar-free chewing gum on salivary concentration of calcium and phosphorous. Materials and Methods : Unstimulated saliva from each 24 selected subjects was collected. Then each subject was given two pellets of chewing gum containing CPP-ACP and asked to chew for a period of 20 min, after which saliva samples were collected from each individual. Once all the samples were collected they were assessed for calcium and phosphorous concentration using affiliated reagent kits and photometer. Statistical Analysis Used: Data obtained were analyzed using student's paired t test. Results: Significant difference was found in the calcium and phosphorus concentration of saliva before and after chewing CPP-ACP containing chewing gum. Conclusions: Chewing of CPP-ACP containing chewing gum showed a significant increase in the salivary concentration of calcium for a prolonged period of time hence it may help in the remineralization of tooth surfaces.     

Chemical and biological properties of new sealant-use cement materials

Objectives

The aim of this study was to investigate the chemical and biological properties of newly developed bioactive cements, modified such that they are largely composed of calcium, phosphate and fluoride. We investigated whether newly developed bioactive cements have the potential to further protect surrounding hard tissue and enhance remineralization of demineralized tissue by additional ion release.

Effect of fluoride-releasing filling materials on underlying dentinal lesions in vitro

Fluoride-releasing materials placed over carious tissue are assumed to enhance remineralisation of the underlying lesion. This remineralisation, however, also depends on the availability of calcium and phosphate, which may be supplied by the pulpal fluid. The aim of this study was to measure the fluoride release of glass ionomer cements (GICs) into underlying dentin and to measure the effect of the released fluoride on the remineralisation of the underlying dentinal lesions using transversal microradiography. Discs of fluoride-releasing GIC were placed on top of dentinal lesions in an in vitro model. The discs and the dentin slabs were covered completely by a protective layer of nail varnish, leaving only the pulpal side of the dentin slab open, and hence the dentinal tubules as the pathway for the incubation fluid to the GIC disc. Specimens were incubated in a remineralisation buffer. The materials tested were a conventional GIC, an experimental GIC that was designed to have a high fluoride release, and an inert material. Fluoride was found to penetrate through the dentin slab into the surrounding fluid. Fluoride uptake from the experimental GIC was higher than from the conventional GIC. Mineral content-depth profiles after 10 weeks' remineralisation revealed that in the outer 30 microm of the lesion a higher mineral deposition occurred for the experimental GIC than in both other groups. No differences in the overall change of integrated mineral loss were found for the tested materials. We conclude that high fluoride release from filling materials only results in superficially increased remineralisation of underlying demineralised dentin.     

酪蛋白磷酸肽钙磷复合体在牙菌斑中的作用

酪蛋白磷酸肽钙磷复合体是由一种含成簇磷酸丝氨酸的生物活性肽———酪蛋白磷酸肽与无定形磷酸钙经生物结合而形成,具有重要的生物活性,是一种新型的生物防龋制剂。本文就其结构特征、在牙菌斑中对主要致龋菌的影响、抑制脱矿及促进早期龋再矿化作用,以及研究展望等方面作一综述。     

Effect of acidulated phosphate fluoride and casein phosphopeptide-amorphous calcium phosphate application on shear bond strength of orthodontic brackets

OBJECTIVE: To evaluate the effect of a recently introduced prophylactic agent, casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), on shear bond strength of brackets and compare it with the effect of acidulated phosphate fluoride (APF). MATERIALS AND METHODS: Forty-eight freshly extracted mandibular bovine incisors were used. Teeth were randomly divided into four groups (n = 12) as follows: group 1 served as control, and no pretreatment was performed on the enamel; group 2, enamel was treated with 1.23% APF and CPP-ACP, respectively; group 3, enamel was treated with CPP-ACP; and group 4, enamel was treated with 1.23% APF for 4 minutes. In all groups, brackets were bonded using a conventional acid-etch and bond system (Transbond XT, 3M Unitek, Monrovia, Calif). Bonded specimens were first stored in deionized water at 37 degrees C for 24 hours, subjected to thermal cycling for 1000 cycles, and further stored in distilled water for 6 weeks before debonding procedures. After debonding, teeth and brackets were examined under a stereomicroscope at 10x magnification for any adhesive remaining, in accordance with the modified adhesive remnant index. RESULTS: The shear bond strengths of all experimental groups were significantly higher than that of the control group (P < .01). There was no significant difference between the shear bond strengths of the experimental groups (P > .05). CONCLUSION: The use of CPP-ACP either alone or combined with APF could be considered as an alternative prophylactic application in orthodontic practice since it did not compromise bracket bond strength.     

酪蛋白磷酸肽-无定形磷酸钙对正畸术后釉质再矿化的效果评价

目的: 比较含氟漱口水、护牙素即酪蛋白磷酸肽-无定形磷酸钙（casein phosphopeptide calcium phosphate complex,CPP-ACP）对正畸治疗后发生釉质脱矿的再矿化效果。方法: 应用Image J图像分析技术观察正畸治疗后釉质的再矿化。将固定矫治器正畸治疗后发生牙釉质脱矿的21例患者（女13例,男8例,84颗患牙）分为3组,每组28颗患牙。对照组仅用含氟牙膏每天刷牙2次,每次3 min。氟化物组用含氟牙膏每天刷牙2次,每次3 min,同时使用20 mL 0.01%氟化物冲洗牙2次。CPP-ACP组用含氟牙膏每天刷牙2次,每次3 min。同时按要求使用CPP-ACP 2次,3组均持续使用6个月。采用SPSS17.0软件包对数据进行统计学分析。结果: 正畸治疗后6个月,3组牙釉质脱矿白斑区域面积均有不同程度减少,3组治疗前、后均有显著差异（P<0.05）。CPP-ACP组效果尤为明显（51.68%）,显著高于氟化物组（44.42%）和对照组（42.71%）。结论: 正畸治疗后6个月内,正确刷牙、氟化物漱口、配合护牙素的使用,对正畸治疗中脱矿牙的再矿化均有一定效果, 而且CPP-ACP可以更有效地减小牙釉质脱矿白斑区域面积。     

含氟酪蛋白磷酸肽-磷酸钙复合物对牙齿耐磨性的影响

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耐磨性的影响。方法选择新鲜拔除的牛下切牙40个,每个牙冠唇面形成5mm×5mm的釉质窗,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10个,A组为阴性对照组;B组使用20%磷酸溶液酸蚀;C组经酸蚀后使用CPP-ACP再矿化处理;D组则经酸蚀后使用含氟CPP-ACP再矿化。每组分别采取以上不同处理方式后进入磨损循环,每个循环磨损3600次,共4个循环,总计磨损次数14400次。使用三维白光干涉表面形貌仪,测定每个样本磨损深度,比较各组磨损量的差别。结果 D组磨损量小于C组,C组及D组磨损量均低于A组和B组,各组间的差异具有统计学意义(P<0.01)。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耐磨性。     

Can white spot lesions be treated effectively?

Abstract Objective: To compare the effects of sodium fluoride mouth rinse, casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), and the microabrasion technique in treating white spot lesions. Materials and Methods: The study population consisted of 80 patients (46 females, 34 males; 966 affected teeth) who had developed multiple decalcified enamel lesions after fixed orthodontic therapy. The study population was divided into four groups of 20 patients each. The control group (group I) participants were to just brush their teeth, the fluoride group (group II) participants were instructed to use 20?ml of neutral 0.025% sodium fluoride rinse, the participants in the CPP-ACP group (group III) were instructed to use tooth mousse twice a day in addition to fluoride toothpaste for 6?months, and the participants in the microabrasion group (group IV) were to undergo treatment by the microabrasion technique, which is a commonly used mixture of 18% hydrochloric acid. Data were analyzed with the generalized linear mixed model and Tukey HSD at the P < .05 level. Results: The area of the white spot lesions decreased significantly in all groups. Inter group differences in the treatment success rates were significant. The highest success rate was observed for group IV (97%). The success rate of group III (58%) was significantly higher than that of groups II (48%) and I (45%). Conclusions: The use of CPP-ACP can be more beneficial than fluoride rinse for postorthodontic remineralization. Microabrasion is an effective treatment for cosmetic improvement of long-standing white spot lesions.