Remineralization of enamel subsurface lesions by sugar-free chewing gum containing casein phosphopeptide-amorphous calcium phosphate.

Casein phosphopeptide-amorphous calcium phosphate nanocomplexes (CPP-ACP) exhibit anticariogenic potential in laboratory, animal, and human in situ experiments. The aim of this study was to determine the ability of CPP-ACP in sugar-free chewing gum to remineralize enamel subsurface lesions in a human in situ model. Thirty subjects in randomized, cross-over, double-blind studies wore removable palatal appliances with six human-enamel half-slabs inset containing sub-surface demineralized lesions. The appliances were inserted immediately before gum-chewing for 20 min and then retained for another 20 min. This was performed four times per day for 14 days. At the completion of each treatment, the enamel half-slabs were paired with their respective demineralized control half-slabs, embedded, sectioned, and subjected to microradiography and densitometric image analysis, for measurement of the level of remineralization. The addition of CPP-ACP to either sorbitol- or xylitol-based gum resulted in a dose-related increase in enamel remineralization, with 0.19, 10.0, 18.8, and 56.4 mg of CPP-ACP producing an increase in enamel remineralization of 9, 63, 102, and 152%, respectively, relative to the control gum, independent of gum weight or type.     

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.     

Effect of addition of citric acid and casein phosphopeptide-amorphous calcium phosphate to a sugar-free chewing gum on enamel remineralization in situ

Casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) has been shown to remineralize enamel subsurface lesions in situ. The aim of this study was to investigate the effects of CPP-ACP in a fruit-flavoured sugar-free chewing gum containing citric acid on enamel remineralization, and acid resistance of the remineralized enamel, using an in situ remineralization model. The study utilized a double-blind, randomized, crossover design with three treatments: (i) sugar-free gum (2 pellets) containing 20 mg citric acid and 18.8 mg CPP-ACP, (ii) sugar-free gum containing 20 mg citric acid alone, (iii) sugar-free gum not containing CPP-ACP or citric acid. Ten subjects were instructed to wear removable palatal appliances, with 4 half-slab insets of human enamel containing demineralized subsurface lesions and to chew gum (2 pellets) for 20 min 4 times per day for 14 days. At the completion of each treatment the enamel half-slabs were removed and half of the remineralized lesion treated with demineralization buffer for 16 h in vitro. The enamel slabs (remineralized, acid-challenged and control) were then embedded, sectioned and subjected to microradiography to determine the level of remineralization. Chewing with gum containing citric acid and CPP-ACP resulted in significantly higher remineralization (13.0 +/- 2.2%) than chewing with either gum containing no CPP-ACP or citric acid (9.4 +/- 1.2%) or gum containing citric acid alone (2.6 +/- 1.3%). The acid challenge of the remineralized lesions showed that the level of mineral after acid challenge was significantly greater for the lesions exposed to the gum containing CPP-ACP.     

Consumption of milk with added casein phosphopeptide-amorphous calcium phosphate remineralizes enamel subsurface lesions in situ

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.     

Remineralization of enamel subsurface lesions by chewing gum with added calcium

Objectives

Chewing sugar-free gum has been shown to promote enamel remineralization. Manufacturers are now adding calcium to the gum in an approach to further promote enamel remineralization. The aim of this study was to compare the remineralization efficacy of four sugar-free chewing gums, two containing added calcium, utilizing a double-blind, randomized, crossover in situ model.

Methods

The sugar-free gums were: Trident Xtra Care, Orbit Professional, Orbit and Extra. Ten subjects wore removable palatal appliances with four human-enamel half-slab insets containing subsurface demineralized lesions. For four times a day for 14 consecutive days subjects chewed one of the chewing gums for 20 min. After each treatment the enamel slabs were removed, paired with their respective demineralized control slabs, embedded, sectioned and mineral level determined by microradiography. After 1-week rest the subjects chewed another of the four gums and this was repeated until each subject had used the four gum products.

Results

Chewing with Trident Xtra Care resulted in significantly higher remineralization (20.67 ± 1.05%) than chewing with Orbit Professional (12.43 ± 0.64%), Orbit (9.27 ± 0.59%) or Extra (9.32 ± 0.35%). The form of added calcium in Trident Xtra Care was CPP–ACP and that in Orbit Professional calcium carbonate with added citric acid/citrate for increased calcium solubility.

Conclusions

Although saliva analysis confirmed release of the citrate and calcium from the Orbit Professional gum the released calcium did not result in increased enamel remineralization over the normal sugar-free gums. These results highlight the importance of calcium ion bioavailability in the remineralization of enamel subsurface lesions in situ.     

酪蛋白磷酸多肽钙氟磷复合体对牙釉质缺损再矿化的实验研究

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     

酪蛋白磷酸肽钙磷复合体促进牙釉质再矿化的研究进展

酪蛋白磷酸肽钙磷复合体(CPP-ACP)是由酪蛋白磷酸肽与无定形磷酸钙结合形成的一种新型有效抗龋生物制剂,具有促进牙釉质龋再矿化的作用。本文就其结构、促进釉质再矿化的科学证据及其对牙釉质再矿化的作用机制进行综述。     

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.     

酪蛋白磷酸肽-无定型磷酸钙凝胶治疗釉质脱矿效果的系统评价

目的 对有关酪蛋白磷酸肽（CPP）-无定形磷酸钙（ACP）凝胶对于釉质脱矿治疗的随机对照试验（RCT）进行系统评价,评价其治疗的效果。方法 依照Cochrane系统评价员手册（5.1.0版本）指导进行分析,包含检索策略、纳入排除标准、数据提取及质量评价。通过计算机检索PubMed、Embase、Cochrane Library、中国知网（CNKI）、万方、维普（VIP）数据库,查找有关CPP-ACP的RCT,检索时间截至2016年9月。由2位研究者独立根据纳入与排除标准进行文献筛选、资料提取和质量评价后,对纳入研究进行系统评价。结果 共纳入12个RCT,各文献中的实验设计、评价标准差异较大无法进行定量分析。结论 尚无有力证据表明,CPP-ACP比常规含氟制剂存在优越性;但纳入研究数量、随访时间、设计存在局限性,且样本量较小,仍需更多高质量、长时间随访、大样本的RCT以进一步验证。     

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。     

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。     

酪蛋白磷酸肽-非结晶型磷酸钙与含氟制剂抑制牙釉质脱矿的比较研究

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.     

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

Casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) nanocomplexes have been shown to prevent demineralization and promote remineralization of enamel subsurface lesions in animal and in situ caries models. The aim of this study was to determine the effect of incorporating CPP-ACP into a self-cured glass-ionomer cement (GIC). Incorporation of 1.56% w/w CPP-ACP into the GIC significantly increased microtensile bond strength (33%) and compressive strength (23%) and significantly enhanced the release of calcium, phosphate, and fluoride ions at neutral and acidic pH. MALDI mass spectrometry also showed casein phosphopeptides from the CPP-ACP nanocomplexes to be released. The release of CPP-ACP and fluoride from the CPP-ACP-containing GIC was associated with enhanced protection of the adjacent dentin during acid challenge in vitro.     

Effects of a chewing gum containing phosphoryl oligosaccharides of calcium (POs-Ca) and fluoride on remineralization and crystallization of enamel subsurface lesions in situ

Objectives

Manufacturers are adding fluoride (F) to calcium-containing chewing gums to further promote enamel remineralization. The aim of this study was to assess the effect of a chewing gum containing phosphoryl oligosaccharides of calcium (POs-Ca) and fluoride on remineralization of enamel subsurface lesions, in a double-blind, randomized controlled in situ trial.

Methods

Thirty-six volunteer subjects wore removable buccal appliances with three different insets of bovine enamel with subsurface demineralized lesions. For 14 days the subjects chewed one of the three chewing gums (placebo, POs-Ca, POs-Ca + F), three times a day. After each treatment period, the insets were removed from the appliance, embedded, sectioned, polished and then subjected to laboratory tests; mineral level was determined by transverse microradiography (TMR; n = 36), and hydroxyapatite (HAp) crystallites were assessed by synchrotron radiation wide-angle X-ray diffraction (WAXRD; n = 13). Data were analysed by t-test or Wilcoxon rank-sum test with Bonferroni corrections at 0.05 significance level.

Results

Chewing POs-Ca and POs-Ca + F gums resulted in 21.9 ± 10.6 and 26.3 ± 9.4 (mean ± SD) percentage mineral recovery, which was significantly higher than that of placebo gum (15.0 ± 11.4) (p < 0.05). Chewing POs-Ca + F gum resulted in 24.9 ± 5.4 (mean ± SD) percentage HAp crystallites recovery, which was significantly higher compared to POs-Ca (16.0 ± 4.1%) or placebo (11.1 ± 4.8%) gums (p < 0.05).

Conclusions

Addition of POs-Ca to the chewing gum resulted in significant remineralization of enamel subsurface lesions. Although POs-Ca + F gum was not superior in TMR recovery rate when compared with POs-Ca gum, WAXRD results highlighted the importance of fluoride ion bioavailability in the formation of HAp crystallites in enamel subsurface lesions in situ (NCT01377493).     

Remineralization and acid resistance of enamel lesions after chewing gum containing fluoride extracted from green tea

Background: The aim of this study was to evaluate enamel remineralization and the acquisition of acid resistance by using sugar‐free chewing gum containing fluoride extracted from green tea. Methods: Forty‐five volunteers participated in a crossover, double‐blind study and wore intraoral appliances with human demineralized enamel. Subjects chewed fluoride chewing gum (FCG: 50 μg fluoride) or placebo gum. Remineralization and acid resistance were evaluated using the mineral change value (ΔZ, in vol%·μm). Fluoride concentrations in saliva and remineralized enamel were analysed. Results: The peak salivary fluoride concentration was 3.93 ± 1.28 ppm (mean ± SD). The elevated salivary fluoride concentration resulted in a higher fluoride concentration of 656 ± 95 ppm in the remineralized region versus 159 ± 26 ppm for placebo gum (p < 0.001). After remineralization, the ΔZ of the FCG group was higher than that of the placebo gum group. After an acid challenge, ΔZ of the FCG group was lower than the placebo gum group. Both ΔZ were statistically significant. Conclusions: FCG produced a superior level of remineralization and acid resistance, as compared to the placebo gum. The in situ results suggest that regular use of FCG is useful for preventing dental caries.     

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 casein phosphopeptide-amorphous calcium phosphate added to acidic beverages on enamel erosion in vitro

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.     

酪蛋白磷酸肽-无定形磷酸钙促进牙再矿化的机制

牙体在正常生理状态下处于脱矿和再矿化的动力平衡之中,当环境改变后,平衡被打破,脱矿和再矿化会向某一方向持续进行.脱矿不仅导致牙体形态学发生改变,也是龋病的开端,所以应该采取有力措施阻断这一过程,使其平衡向再矿化方向发展.以往以氟化物防龋并取得了较好的效果,却因不良反应使其应用受到了一定的限制.研究显示,牛奶和奶酪等奶制...