Comparison of the remineralization potential of CPP-ACP and CPP-ACP with 900 ppm fluoride on eroded human enamel: An in situ study

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.     

GC护牙素在固定正畸中预防釉质脱矿的临床研究

目的观察固定正畸矫治中GC护牙素预防牙釉质脱矿的临床效果。方法选择固定矫治器治疗的患者64名,随机分为2组,护牙素组32例,657颗牙;对照组32例,678颗牙。矫治结束后对牙面脱矿情况进行临床观察,用SPSS13.0统计软件进行数据处理分析。结果矫治前二组患者被观察牙齿牙釉质脱矿率和脱矿程度均无明显差异(P>0.05)。矫治后护牙素组牙釉质脱矿率为5.78%,对照组为15.78%。护牙素处理组牙釉质脱矿率和脱矿程度明显低于对照组,有显著性差异(P<0.01)。结论在固定正畸治疗中配合使用GC护牙素处理牙面,可预防牙釉质脱矿的发生。     

The effect of CPP-ACP on enamel wear under severe erosive conditions

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.     

CPP-ACP对釉质抗酸蚀作用的显微放射定量研究

目的研究酪蛋白磷酸肽-非结晶型磷酸钙(CPP-ACP)对釉质抗酸蚀作用的效果。方法在模拟口腔条件下,5%CPP-ACP为实验组,去离子水为阴性对照,20g/L氟化钠为阳性对照,对30个正常离体牙釉质表面进行处理,然后采用细菌连续培养法制备人工脱钙模型。进行显微放射照相并测量各组的脱矿深度与脱矿量,进行配对t检验,观察CPP-ACP对釉质的抗酸蚀作用效果。结果5%CPP-ACP组较去离子水对照组脱矿量及脱矿深度均显著减少(P<0.05),与20g/L氟化钠对照组相比无显著差异(P>0.05)。结论5%CPP-ACP溶液可明显增强釉质抗酸蚀能力,其效果与20g/L氟化钠相当。     

CPP-ACP在正畸治疗中防治牙面脱矿的应用

目的:研究酪蛋白磷酸多肽-无定形磷酸钙(CPP-ACP)在固定矫治中防治牙釉质脱矿的价值。方法:选择75例接受固定矫治的正畸患者,随机分为3组:对照组交待矫治注意事项后强调牙周清洁,要求使用改良Bass法刷牙,每次刷牙时间必须超过3min,每天早晚刷牙。试验A组在对照组基础上,采用氟保护漆涂布在托糟和带环周围牙面,自然干燥。每3个月常规清洁牙面、隔湿吹干、再次均匀涂布1次。试验B组在对照组基础上,每天在托槽和带环等矫正器具的四周和牙面上涂布含有CPP-ACP的GC护牙素。临床检测指标为拆除矫治器后牙面是否有白垩色斑或齲洞,计算牙釉质脱矿指数(EDI)。采用SPSS11.0软件包对数据进行单因素方差分析。结果:对照组25例患者中,15例出现牙釉质脱矿,发生率为60%;试验A组25例患者中,9例出现牙釉质脱矿,发生率为36%;试验B组25例患者中,8例出现牙釉质脱矿,发生率为32%。观察的1632颗牙中,对照组占544颗,其中80颗出现牙釉质脱矿,发生率为14.7%;试验A组544颗,其中46颗出现牙釉质脱矿,发生率为8.46%;试验B组544颗,其中42颗出现牙釉质脱矿,发生率为7.72%。试验A组和B组的ED...     

体外应用氟化物对牙酸蚀症再矿化效果的评价-显微硬度测定

目的 用显微硬度测量法研究氟化物对碳酸饮料酸蚀后的乳牙釉质的再矿化作用.方法 收集临床拔除的滞留第二乳磨牙共16颗,制成牙釉质样本.经碳酸饮料浸泡,每天2次,每次10分钟,共5天后,分为对照组(A组)、2%氟化钠溶液组(B组)、含1.23%氟离子凝胶组(C组)和含低氟过饱和钙磷溶液矿化液组(含氟10ppm)(D组)四组,每组16个牙块.经不同的氟化物处理釉质表面,每天1次,每次2分钟,共5天.分别在酸蚀前、酸蚀后和再矿化后用显微硬度计测定釉质表面硬度.数据使用SPSS10.0统计软件包进行单因素方差分析(ANOVA).结果 饮料酸蚀后的牙釉质表面硬度值明显下降.与对照组相比,经2%氟化钠溶液和1.23%氟离子凝胶组处理后的牙釉质表面硬度值均比处理前显著上升(分别为P=0.031和P=0.017),这两组之间的差异无显著性;矿化液处理后的牙釉质表面硬度值无显著变化(P=0.894).结论 显微硬度测定实验显示高浓度的氟制剂2%氟化钠溶液和含1.23%氟离子凝胶能够显著地促进酸蚀釉质再矿化;低氟浓度矿化液在短时间内对酸蚀釉质再矿化作用不明显.     

釉质脱矿与再矿化的实验室及临床评估方法

釉质再矿化的研究是近年研究的热点,对釉质再矿化前后的评估方法多种多样,目前国际尚无统一的标准。作者就评估脱矿与再矿化的实验室及临床研究方法及其应用范围、优缺点进行综述。     

氟涂料用于固定矫治后釉质脱矿再矿化治疗的效果

目的评价氟浓度为2.26 mg/mL的氟涂料应用于正畸固定矫治后釉质脱矿再矿化治疗的临床效果。方法对正畸固定矫治结束并拆除托槽的患者进行牙釉质脱矿状况检查,选择符合纳入标准的110例受试者,随机分为2组,试验组在脱矿牙面上涂布氟涂料,对照组在脱矿牙面上涂布蒸馏水,每个月1次,持续6个月,在拆除托槽当天（基线）和拆除托槽3个月、6个月分别对唇颊面釉质脱矿区域进行临床视诊检查,使用临床视诊指数进行评分。结果基线、3个月、6个月时试验组的视诊指数分别为（2.22±0.42）分、（2.18±0.43）分、（2.15±0.41）分;对照组的视诊指数分别为（2.15±0.36）分、（2.14±0.38）分、（2.14±0.38）分。基线（t=2.470,P=0.228）、拆除托槽3个月（t=0.651,P=0.516）及6个月（t=0.149,P=0.882）试验组与对照组的差异均没有统计学意义。试验组的临床视诊指数在拆除托槽3个月、6个月与基线比较差异均有统计学意义（P＆lt;0.05）,但第3个月与第6个月的差异没有统计学意义（t=1.860,P=0.083）。结论应用2.26 mg/mL的氟涂料对固定矫治后出现的釉质脱矿进行再矿化治疗后,牙釉质脱矿程度有所降低,但再矿化效果不够显著。     

光学相干断层成像检测牙釉质表层脱矿与再矿化的实验研究

目的利用光学相干断层成像技术(OCT)观察不同制剂对年轻恒牙釉脱矿和再矿化效果的影响。方法 将正畸拔除的年轻恒前磨牙制成60个釉质块,随机均分为4组。每天进行如下处理:A组蒸馏水湿敷30min;B组含氟牙膏湿敷30min;C组护牙素湿敷30min;D组多乐氟湿敷30min,置于脱矿液1.5h,最后置于人工唾液中22h。每个步骤间用去离子水冲洗实验样品。实验周期重复30天。在处理前和第 7、15、30天,使用扫频光源OCT完成对样本的扫描和成像,同时使用显微硬度计测量各样本表面的显微硬度。结果 釉质脱矿深度:7天后,A组与其他各组相互比较,差异有统计学意义( P <0.05),B、C、D组组间比较差异无统计学意义( P >0.05)。30天后,C组和D组比较,差异无统计学意义( P >0.05),其余各组之间两两比较,差异均有统计学意义( P <0.05)。显微硬度测量:30天后,各处理组较处理前显微硬度值降低,A组显微硬度值最低,C组与D组显微硬度值高于B组,且差异有统计学意义( P <0.05)。C组和D组间釉质块显微硬度值差异无统计学意义( P >0.05)。结论 OCT可以较准确的显示釉质脱矿部位,在早期龋的诊断方面具有临床意义。护牙素和多乐氟均能有效的抑制牙釉质表面脱矿。     

The effect of xylitol and fluoride on remineralization for primary tooth enamel caries in vitro

The effect of fluoride and xylitol on remineralization at the early stage of the enamel caries in primary tooth was studied. The samples were divided into four groups (control, 10% xylitol, 950 ppm NaF and 10% xylitol+950 ppm NaF) and analyzed by the using single thin section method and pHcycling model in vitro. The remineralizing ratio were control –8.9%, xylitol –0.4%, NaF 8.3% and xylitol + NaF 32.4%, respectively. Xylitol+NaF group particularly showed significantly smaller ΔZ value compared with 0 days (P<0.05). Therefore we assume that the effect of xylitol and fluoride are additive. We concluded that xylitol and fluoride treatment to the tooth enamel may be an effective caries-preventive measure in both primary and permanent tooth enamel.     

Effects of different amine fluoride concentrations on enamel remineralization

Objectives

The aim of this study was to investigate the effects of decreasing fluoride concentrations on repeated demineralizing challenges on human enamel.

Materials and methods

In 24 teeth, 3 mm × 3 mm windows were prepared on the buccal and lingual sides and treated in a cycling demineralization–remineralization model. Remineralization was achieved with 100, 10 and 0.1 ppm fluoride from anime fluoride. Coronal sections were cut through the artificial lesions, and three sections per tooth were investigated using polarized light microscopy and scanning electron microscopy with quantitative element analysis.

Results

The morphology of the lesions was studied, and the extensions of the superficial layer and the body of the lesion were measured. Using element analysis, the Ca, P and F content were determined. The body of the lesion appeared remineralized after application of 100 ppm fluoride, while remineralization of the lesion was less successful after application of 10 and 0.1 ppm fluoride. The thickness of the superficial layer increased with decreasing fluoride concentrations, and also the extension of the body of the lesion increased. Ca and P content increased with increasing fluoride concentrations.

Conclusions

The effectiveness of fluoride in enamel remineralization increased with increasing fluoride concentration.

Clinical relevance

A consistently higher level of fluoride in saliva should be a goal in caries prevention.     

Effect of compounds of Galla chinensis on remineralization of enamel surface in vitro

Objective

The aim of the study was to investigate the effect of chemical compounds of Galla chinensis on in vitro the remineralization of enamel surface.

Method

Bovine enamel blocks with in vitro produced initial lesions were used. The lesions were subjected to a pH-cycling regime for 12 days. Each daily cycle included 4×1 min applications with one of four treatments: Group A: 1000 ppm F aq. (as NaF, positive control); Group B: deionized water (DDW, negative control); Group C: 4000 ppm crude aqueous extract of G. chinensis (GCE); Group D: 4000 ppm gallic acid. The enamel specimens were analysed by scanning electron microscopy (SEM), energy-dispersive X-ray spectrometry (EDS) and X-ray microdiffraction (XRD).

Results

The morphology of surface enamel was different in each group. The mineral composition was identified as similar to hydroxylapatite, but the crystallite sizes of enamel in different groups were significantly different. In addition, the Ca/P ratios were significantly lower in GCE group.

Conclusion

GCE could affect the mineral ions deposit on the surface layer and then modified the remineralization of initial dental caries. The mechanism seems to be different between GCE and gallic acid.     

氯化镧对脱矿釉质再矿化的影响

为了了解镧对脱矿釉质矿化的影响，以基础矿化液及含１０ｐｐｍｌａ＾３＋或氟的矿化液分别处理脱矿后人牙釉质，再作实验开窗区剖面表及里的显微硬度测定，结果显示各试验组表层硬度明显低于内层硬度，但１００μｍ以内各点之硬度值比较差异均无显著性，以各实验组相比较，表层硬度值之间差异有显著性，其他层次相应点之间硬度值无无显著性。     

Effects of remineralization procedures on shear bond strengths of brackets bonded to demineralized enamel surfaces with self-etch systems

Objective:To compare the effects of different remineralization procedures on the surface roughness of teeth, shear bond strengths (SBSs), and Adhesive Remnant Index scores of self-etching primer (SEP) used to bond orthodontic brackets to previously treated demineralized enamel surfaces.Materials and Methods:A total of 140 extracted human premolar teeth were randomly divided into seven equal groups. Group I was the control group. A demineralization procedure was performed in the other six groups. A remineralization procedure was performed before bonding by using casein phosphopeptide-amorphous calcium phosphate, fluoride, a microabrasion mixture (18% hydrochloric acid-fine pumice), a microabrasion agent, and resin infiltration in groups III to VII. Brackets were bonded using a self-etching primer/adhesive system. The specimens were tested for SBS. The roughness and morphology of the enamel surfaces were analyzed using profilometer and scanning electron microscopy. Data were analyzed with analysis of variance, Tukey, and G-tests at the α  =  .05 level.Results:Significant differences were found in the SBS values among the seven groups (F  =  32.69, P  =  .003). The lowest SBS value was found in group II (2.62 ± 1.46 MPa). No significant differences were found between groups I, III, and VII, between groups III and IV, or between groups V and VI. The differences in the roughness values were statistically significant among the groups (P  =  .002).Conclusions:Remineralization procedures restore the decreased SBS of orthodontic brackets and decrease surface roughness caused by enamel demineralization. SEPs provide clinically acceptable SBS values for bonding orthodontic brackets to previously treated demineralized enamel surfaces.     

Effect of CPP-ACP paste on mechanical properties of bovine enamel as determined by an ultrasonic device

OBJECTIVE: The purpose of this study was to determine the effect of Casein Phosphopeptide-Amorphous Calcium Phosphate (CPP-ACP) paste on demineralization of bovine enamel by measuring changes in the ultrasound transmission velocity. METHODS: The enamel specimens were prepared by cutting bovine teeth into blocks. The specimens were stored in 0.1 M lactic acid buffer solution (pH 4.75, Ca 0.75 mM, P 0.45 mM) for 10 min twice a day, and then stored in the artificial saliva (pH 7.0). Other specimens were stored in a 10-times diluted solution of CPP-ACP paste and a placebo paste without CPP-ACP for 10 min, followed by 10 min immersion into a demineralization solution twice a day before storage in the artificial saliva. The propagation time of longitudinal ultrasonic waves was measured by a Pulser-Receiver (Model 5900, Panametrics) with a transducer (V112, Panametrics). Six specimens were used for each condition, and one-way ANOVAs followed by the Tukey HSD tests (alpha = 0.05) were done. RESULTS: The sonic velocity was found to decrease with time for specimens stored in the demineralization solution. On the other hand, a significant increase in sonic velocity was found for specimens stored in the CPP-ACP solution. CONCLUSIONS: From the result of this study, it was suggested that the conditions of de- and remineralization of the enamel structure could be measured non-destructively by using an ultrasonic pulse method. It could be concluded that the inorganic components contained in high concentrations in CPP-ACP acted to enhance remineralization of the enamel structure.     

五倍子化学组分对脱矿牙釉质再矿化的影响

目的研究五倍子多酚性化合物(Galla chinensis extract,GCE)及其4个化学组分(GCE-A,GCE-B,GCE-C和GCE-D)对早期牙釉质龋的再矿化作用,初步追踪五倍子促牙釉质再矿化的有效成分。方法选择脱矿后显微硬度值为160～180努氏硬度的70个牛切牙釉质样本,随机分为7组,每天进行4次药物处理(1 min/次);药物包括4 g/L的GCE溶液(GCE组)、GCE-A溶液(GCE-A组),GCE-B溶液(GCE-B组),GCE-C溶液(GCE-C组)和GCE-D溶液(GCE-D组)、去离子水(DDW组,阴性对照)和1 g/L的氟化钠溶液(NaF组,阳性对照)。样本pH循环12 d后用显微放射照相定量分析循环前后病损的总矿物丢失量。结果 GCE组的矿物丢失量和病损深度明显低于阴性对照组,但仍高于阳性对照组(P<0.05);GCE的4个组分,即GCE-A、GCE-B、GCE-C、GCE-D都有一定的促进脱矿釉质再矿化作用(P<0.05),但效果明显差于相同浓度的GCE(P<0.05)。结论 GCE及其4个组分都有一定的促进脱矿釉质再矿化作用,GCE效果最佳。     

Effect of added calcium phosphate on enamel remineralization by fluoride in a randomized controlled in situ trial

Dental products containing calcium phosphate and fluoride are claimed to enhance enamel remineralization over fluoride products.

Objectives

To compare remineralization of enamel subsurface lesions by dental products with added calcium phosphate in a double-blind, randomized, cross-over in situ study.

Methods

Human enamel specimens with subsurface lesions were prepared and inserted into intra-oral appliances worn by volunteers. A slurry (1 g product plus 4 ml H₂O) of each product was rinsed for 60 s, 4 times per day for 10 days. Six products were tested (i) placebo, (ii) 1000 ppm F, (iii) 5000 ppm F, (iv) Tooth Mousse (TM), (v) TM plus 900 ppm F (TMP) and (vi) Clinpro with 950 ppm F. Calcium, inorganic phosphate and fluoride levels were measured in post-rinse/saliva samples using ion chromatography. Mineral content was measured using transverse microradiography.

Results

Only TM and TMP significantly increased salivary calcium and phosphate levels. The products produced remineralization in the following order from lowest to highest: placebo < 1000 ppm F = Clinpro < 5000 ppm F < TM < TMP.

Conclusion

Clinpro was not significantly different to 1000 ppm F whereas TM and TMP were superior to 5000 ppm F with TMP producing the highest level of enamel lesion remineralization.     

磷硅酸钠钙对乳牙釉质再矿化作用的研究

目的：研究生物活性材料磷硅酸钠钙（CSP）对人工脱矿的乳牙釉质表面再矿化的作用。方法：收集30颗健康离体乳磨牙,将每颗牙冠沿近远中径和颊舌径分成4个釉质块,每个釉质块随机分为4组（n ＝30）。样本经35％磷酸酸蚀2 min后分别进行如下处理：空白对照（A 组）、0．14％氟化物处理（B 组）、CSP 处理（C 组）、氟化物＋CSP 处理（D 组）,每天循环处理2次。在10、30 d 时扫描电镜观察釉质表面形态并测定釉质表面显微硬度值（SMH）。结果：扫描电镜观察显示,10 d 时A 组表面呈脱矿的蜂窝状表现,B、C 组脱矿不明显,D 组可见明显的矿化物沉积。30 d 时 A 组可见明显釉质脱矿和釉柱溶解表现,B、C 和 D 组可见程度不等的再矿化。10 d 时 D 组的 SMH 值高于 A 组（P ＜0．05）,30 d 时 B、C、D 组 SMH 值均高于 A组（P ＜0．05）,D 组 SMH 值显著高于 B 和 C 组（P ＜0．05）。结论：CSP 和氟化物具有促进乳牙釉质再矿化的作用,CSP 和氟化物联合应用优于二者的单独应用。     

Effects of CPP-ACP with sodium fluoride on inhibition of bovine enamel demineralization: a quantitative assessment using micro-computed tomography

Objectives

The present study evaluated the effects of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) and CPP-ACP with 900 ppm fluoride (CPP-ACPF) pastes on inhibition of enamel demineralization over time, using polychromatic micro-computed tomography (micro-CT).

Methods

Enamel blocks were prepared from bovine teeth. The specimens were each treated by one of the following agents, 30 min daily for 7 days: deionized water (negative control); CPP-ACP paste; CPP-ACPF paste; and NaF solutions (positive controls) (90, 900, and 9000 ppm F). After treatment, the specimens were immersed in a demineralizing solution (pH 4.5) for 24, 72, and 120 h. Mean mineral loss (ML) and lesion depth (LD) after each period were determined from mineral density profiles obtained using micro-CT.

Results

ML values in all the treatment groups were significantly smaller than those in the control group after 72 and 120 h of demineralization (p < 0.05, two-way ANOVA and t-test with Bonferroni correction). ML values in CPP-ACPF and NaF solution groups were significantly smaller compared to CPP-ACP group after 72 h (p < 0.05). LD values in the CPP-ACPF and all the NaF solutions groups were significantly smaller compared to the control group after 120 h (p < 0.05). The 9000 ppm F group showed the lowest nominal ML and LD values.

Conclusions

The application of CPP-ACP or CPP-ACPF pastes to sound enamel surfaces resulted in inhibition of enamel demineralization, and a better effect was noted for the latter paste. Quantitative assessment using polychromatic micro-CT demonstrated to be useful for detecting mineral density changes.