不同再矿化处理对漂白后釉质表面形貌及钙磷比的影响

目的 探究不同再矿化处理对漂白后釉质表面形貌及钙磷比的影响。方法 制备牛牙釉质样本,漂白处理后,随机分为5组：去离子水(DW)组;2%氟化钠(NaF)组;10%原花青素(PC)组;酪蛋白磷酸肽-无定形磷酸钙(CPP-ACP)组;PC+CPP-ACP组。用色差仪、扫描电镜、能谱仪和原子力显微镜分别检测样本漂白前、漂白后即刻及再矿化1周的颜色、表面形貌、元素和粗糙度变化。结果 各组间色差值无统计学意义(P>0.05)。扫描电镜显示,再矿化后各组均可见程度不一的矿物质沉积,PC+CPP-ACP组沉积物更明显。能谱仪显示,漂白后釉质表面钙磷比降低,再矿化后均有升高,NaF及PC+CPP-ACP组更高(P<0.05)。原子力显微镜显示,再矿化后各组均可见沉积物且粗糙度降低(P<0.05),PC+CPP-ACP组沉积物更明显、粗糙度更小(P<0.05)。结论 PC和CPP-ACP均能促进漂白后釉质再矿化,联合作用效果更佳。PC和CPP-ACP没有影响漂白效果。     

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...     

牙釉质再矿化材料的研究进展

牙体釉质再矿化材料研究主要通过制备体外早期龋病模型作为研究样本,检测各种材料的再矿化性能。其中氟化物作为公认的再矿化物质已大量应用于临床,同时也作为再矿化研究的一个重要参考标准。羟基磷灰石、磷酸钙、碳酸氢钠等被证明有着明确的类似功能,并能配合氟离子的再矿化作用。酪蛋白磷酸肽-无定形磷酸钙作为一种新型安全材料也已被证明有再矿化作用。本文结合国内外相关的最新研究进展,总结了目前再矿化技术的研究现状,对龋病再矿化研究中各类再矿化材料作用机制及特点做一阐述。     

以磷酸钙系统为基础的再矿化材料的研究进展

目前,关于龋病的治疗理念,正逐步向早期诊断及微创治疗方面转变,其核心过程是早期龋的再矿化。氟化物作为一种传统的再矿化物质,需在有足量钙、磷酸根离子的口腔环境中,才能更好地形成氟磷灰石,完成再矿化过程。近年来一类能够改善钙、磷酸根等矿物质离子生物利用度的新型再矿化材料——以磷酸钙系统为基础的再矿化材料,已成为再矿化研究的热点。本文针对四种相关的新型再矿化材料进行综述,阐明其作用机制、促进牙体再矿化的科学证据及良好的发展前景。     

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。     

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。     

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。     

酪蛋白磷酸肽-非结晶型磷酸钙对正畸后釉白斑再矿化的临床评价

目的:量化研究酪蛋白磷酸肽-非结晶型磷酸钙(casein phosphopeptide-amorphous calcium phosphate,CPP-ACP)对正畸治疗所致釉白斑的再矿化作用.方法:选取止畸治疗结束并患有多数釉向斑的患者共10例,均年龄17.7岁.要求患者每天早晚刷牙后,将含有10%CPP-ACP复合体的糊剂均匀涂抹于牙的唇面,每天2次.治疗前和治疗中均拍摄口内彩色照片.通过肉眼观察和应用Image-Pro Plus图像分析软件,对釉白斑进行测量并计算釉白斑面积比,使用SPSS13.0软件包对治疗前及治疗后1个月、2个月的釉白斑面积比进行配对t检验.量化分析1个月后重新进行图像测量与统计学分析,并使用SPSS13.0软件包计算组内相关系数.结果:使用CPP-ACP 1个月后,釉白斑面积平均减少(4.89±2.05)%,2个月平均减少(8.359±3.472)%;与治疗前相比,釉白斑面积均显著减少(P<0.01).2次测量所得数据的组内相关系数为0.968.结论:CPP-ACP能显著减少正畸所致的釉白斑病损,提高牙的美学效果;利用口内照片量化釉白斑面积具有较好的可靠性与可重复性.     

酪蛋白磷酸肽-磷酸钙溶液体外再矿化作用的化学分析及显微硬度测试

目的研究酪蛋白磷酸肽-磷酸钙溶液在体外对牛牙釉质早期人工龋的再矿化作用。方法用不同浓度的酪蛋白磷酸肽-磷酸钙（CPP—CP）溶液对牛牙釉质早期人工龋进行再矿化处理后，首先采用化学分析法测量处理液中的残余矿物质，得出沉积在龋损区内的矿物质含量；然后采用显微硬度法测量处理前后牙釉质剖面硬度变化。结果CPP—CP溶液可以在体外使龋损牙釉质发生再矿化，再矿化作用与CPP—CP浓度呈剂量-效应关系。再矿化后龋损区矿物沉积量与再矿化液的CPP—CP浓度成正比。结论酪蛋白磷酸肽-磷酸钙溶液能凭借高钙磷浓度梯度促进牛牙釉质早期人工龋的再矿化。     

护牙素在正畸治疗中对减少牙齿脱矿及促进再矿化的功效研究

目的评价Tooth Mousse护牙素对减少离体牛牙粘接托槽周围的釉质脱矿及促进再矿化的功效。方法将60颗粘接托槽的离体牛牙随机分成实验组、阳性对照组和阴性对照组,分别在牙面上涂擦Tooth Mousse护牙素、Duraphat氟保护漆和蒸馏水。将3组样本轮流放置入人工致龋液和人工唾液中浸泡,然后使用偏光显微镜、扫描电镜、电子探针检测。结果偏光显微镜下观察,实验组釉质表面完整,主要表现为以脱矿为主的正性双折射区明显减少;扫描电镜观察实验组釉质表面有大量的矿物质沉积,填补釉质表面局限性的小凹陷;电子探针检测结果显示,实验组釉质表面钙、磷含量明显高于阴性对照组（P<0.05）,与阳性对照组之间无统计学差异（P>0.05）。结论Tooth Mousse护牙素在体外实验模型中能使牛釉质在人工致龋环境中减少脱矿和促进再矿化。     

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     

Effects of different topical agents on enamel demineralization around orthodontic brackets: an in vivo and in vitro study

Background: The aim of this study was to evaluate the in vivo and in vitro effects of a casein phosphopeptide‐amorphous calcium phosphate (CPP‐ACP) and fluoride containing topical agents in reducing enamel demineralization around orthodontic brackets, and to compare this with a control group. Methods: Twenty‐one patients and 60 extracted premolars were divided into three groups: two experimental and one control. Tooth Mousse^® (CPP‐ACP gel; GC‐Corp, Tokyo, Japan) and Fluoridin N5^® (Fluoride gel; Voco‐GmbH, Cuxhaven, Germany) were applied to tooth surfaces around orthodontic brackets in the experimental groups. Teeth were extracted after 60 days to evaluate the in vivo effects of the testing materials. For the in vitro experiment, samples were cycled for 14 days through a daily procedure of demineralization. All teeth were sectioned and evaluated by superficial microhardness analysis. An indentation was made from two positions (occlusal‐cervical) and one depth (10 μm). Results: Comparisons of occlusal and cervical microhardness scores for all specimens showed no statistically significant side differences. A multiple comparison test showed that the use of CPP‐ACP and fluoride containing topical gels were more significantly efficient than the control group (p <0.001). No significant differences were detected between CPP‐ACP and the fluoride groups against demineralization. Conclusions: In vivo and in vitro evaluations indicated that CPP‐ACP and fluoride containing agents successfully inhibited caries around orthodontic brackets.     

酪蛋白磷酸多肽-无定形磷酸钙在口腔治疗中的研究应用

随着人们对口腔健康重视程度的提高,人们逐渐意识到对于口腔健康而言,预防保健的作用及意义远远甚于后期的治疗。酪蛋白磷酸多肽-无定形磷酸钙作为一种新型口腔用品,因其较好的再矿化作用,良好的安全性和方便的操作性,得到越来越广泛的应用。该文就酪蛋白磷酸多肽-无定形磷酸钙的基本结构、作用原理、研究现状作一综述。     

The investigation of non‐invasive techniques for treating early approximal carious lesions: an in vivo study

Objectives: The aim of this study was to examine non‐cavitated approximal caries using non‐invasive treatment methods. Materials and methods : Molar and premolar teeth with approximal caries were used in this in vivo study. Approximal caries lesions were evaluated with visual and radiographic inspection and with the DIAGNOdent device. Five groups were formed to study non‐invasive treatment, and each had at least 25 early approximal carious lesions. Patients in the control group were not treated. After the separation, either ozone application, acidulated phosphate fluoride gel, CPP‐ACP‐containing material (Tooth Mousse), or an antibacterial bonding agent (Clearfil Protect Bond) was used. For 18 months after the non‐invasive treatment, radiological controls were used to observe the progress of the initial and approximal caries in the 1st, 3rd, 6th and 12th months of follow‐up. A Mann–Whitney U‐test was used to perform the statistical analysis; in‐group comparisons were made with the Wilcoxon signed‐rank test, and a quantitative assessment was performed using a chi‐squared test. Results: At the end of 18 months, the caries lesions in the control group were observed to progress (P < 0.01). The lesions that were scored as 1a during a visual inspection recovered by using non‐invasive treatments. Conclusion: Approximal caries lesions that were detected at the early stages remained stationary when using antibacterial agents and materials that promoted remineralisation. Clinical relevance: Antibacterial agents and remineralisation materials can be used in treatment of early approximal caries lesions.     

Effectiveness of casein phosphopeptide‐amorphous calcium phosphate‐containing products in the prevention and treatment of white spot lesions in orthodontic patients: A systematic review

The purpose of the present systematic review was to evaluate the effectiveness of casein phosphopeptide‐amorphous calcium phosphate (CPP‐ACP)‐containing products in the prevention and treatment of active white spot lesions (WSL) in orthodontic patients. Searched the Scopus, PubMed, Web of Science, Cochrane, Virtual Health Language, ClinicalTrials, and Open Gray databases without limitations on the year or language of publication. We included controlled clinical trials with patients with fixed orthodontic appliances under the use of CPP‐ACP‐containing products compared to control, placebo, or other interventions in the prevention and treatment of WSL around orthodontic braces. Case reports, editorials, in vitro studies, annals of congress, and reviews were excluded. To assess the risk of bias, the revised version of the Cochrane tool for randomized trials (RoB 2.0) and Risk Of Bias In Non‐randomized Studies for non‐randomized trials were used. The biases were graded low, moderate, and high according to the tools used. Of the 599 articles found, 11 met the inclusion criteria. Of these, nine were randomized, controlled clinical trials and two were non‐randomized. Two studies were considered to have moderate bias risk, and the most‐used CPP‐ACP presented form was a cream for topical applications. Although CPP‐ACP‐containing products did not differ from other fluoride products, they were able to reduce WSL and neutralize the pH around the orthodontic braces. Products containing CPP‐ACP are effective in preventing and treating WSL around the braces. However, further studies with the same measurement method and periods of use, and other forms of presentation of CPP‐ACP are needed.     

Effects of casein phosphopeptide amorphous calcium fluoride phosphate paste on white spot lesions and dental plaque after orthodontic treatment: a 3-month follow-up

The effects of casein phosphopeptide amorphous calcium fluoride phosphate (CPP-ACFP) paste vs. control paste on the remineralization of white spot caries lesions and on plaque composition were tested in a double-blind prospective randomized clinical trial. Fifty-four orthodontic patients, with multiple white spot lesions observed upon the removal of fixed appliances, were followed up for 3 months. Subjects were included and randomly assigned to either CPP-ACFP paste or control paste, for use supplementary to their normal oral hygiene. Caries regression was assessed on quantitative light-induced fluorescence (QLF) images captured directly after debonding and 6 and 12 wk thereafter. The total counts and proportions of aciduric bacteria, Streptococcus mutans, and Lactobacillus spp. were measured in plaque samples obtained just before debonding, and 6 and 12 wk afterwards. A significant decrease in fluorescence loss was found with respect to baseline for both groups and no difference was found between groups. The size of the lesion area did not change significantly over time or between the groups. The percentages of aciduric bacteria and of S. mutans decreased from 47.4 to 38.1% and from 9.6 to 6.6%, respectively. No differences were found between groups. We observed no clinical advantage for use of the CPP-ACFP paste supplementary to normal oral hygiene over the time span of 12 wk.     

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.