4种防龋方法在固定矫治中预防牙釉质脱矿的研究

目的:比较4种防龋方法在正畸固定矫治中预防牙釉质脱矿的效果.方法:采用固定矫治器矫治的200名患者随机分为4组(n=50),分别用普通牙膏、含氟牙膏、氟保护漆和护牙素对牙釉质进行处理,定期随访,比较矫治完成后4组患者的牙釉质脱矿情况.结果:按牙齿数计算含氟牙膏、普通牙膏、氟保护漆和护牙素4组牙釉质的脱矿率分别为16.3％、21.9％、9.3％和8.5％ (x2=99.7,P=0.000001)氟保护漆和护牙素组脱矿率低于其他2组,该2组脱矿率之间的差异无统计学意义(x2=0.39,P=0.529851).结论:应用含氟制剂可以有效预防固定矫治中牙釉质脱矿的发生,护牙素和氟保护漆的效果更明显.     

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。     

Potential Remineralization of Postorthodontic Demineralized Enamel and the Use of Enamel Microabrasion and Bleaching for Esthetics

Prevention of enamel demineralization during orthodontic treatment is of utmost importance. Should enamel demineralization occur (white spot lesions), early diagnosis and intervention is appropriate. Improved brushing with fluoridated dentifrice and over-the-counter fluoride rinses would be the first recommended intervention. If more aggressive intervention is considered to be necessary due to the extent of demineralized enamel or expected noncompliance with oral hygiene by the patient, professionally applied and/or prescribed fluorides are recommended. Likewise, casein phosphopeptide-amorphous calcium phosphate systems have demonstrated remineralization effects.     

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。     

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。     

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.     

CPP-ACP与含氟制剂抑制牙釉质脱矿效果比较的Meta分析

目的：系统评价局部应用CPP-ACP与含氟制剂比较抑制牙釉质脱矿的临床效果。方法：计算机检索Pubmed、CNKI、CBM、VIP和WanFang Data数据库,查找CPP-ACP与含氟制剂比较抑制牙釉质脱矿的随机对照试验（RCT）,并追溯纳入文献的参考文献,检索时间均为建库至2013年10月18日。由2名评价员按纳入和排除标准独立进行文献筛选、资料提取和评价纳入研究的方法学质量后,采用RevMan5.2软件进行Meta分析。结果：最终纳入7篇文献,11个RCT,共563例受试者。Meta分析结果显示：局部应用CPP-ACP后,其Diagnodent值[MD=2.30,95%CI（0.69,3.91）,P=0.005]及脱矿率[OR=1.40,95%CI（1.09,1.81）,P=0.009]明显低于局部应用含氟制剂,其差异有统计学意义。结论：在早期釉质龋、正畸治疗后出现的釉质白斑病损等牙釉质脱矿的预防和治疗方面,CPP-ACP具有优于含氟制剂的临床疗效,且不存在像含氟制剂的安全问题,因此,CPP-ACP作为一种新型再矿化剂有望替代含氟制剂发挥较优效果。     

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.     

氟化物在预防正畸釉质脱矿中的应用

釉质脱矿是正畸临床中经常伴有的牙体损害,一旦发生,大部分不可逆转,常会影响到牙齿的健康和美观,因此预防釉质脱矿非常重要.氟化物的应用可以抑制釉质脱矿的发生并促进釉质再矿化.氟化物防龋机制主要是降低釉质溶解度、生成氟化钙和氟磷灰石来促进釉质再矿化.本文就氟化物预防正畸釉质脱矿的可能机制和预防方法进行综述.     

含氟牙膏对固定矫治中牙釉质脱矿预防效果的研究

目的：探讨含氟牙膏在正畸固定矫治中对预防牙釉质脱矿的作用。方法本实验通过常规口腔卫生宣教指导接受固定矫治器治疗的患者分别使用不同种牙膏刷牙,将患者随机分为氟化物组和对照组,氟化物组采用含氟牙膏刷牙,对照组采用不含氟牙膏刷牙,应用时间平均18个月。分别比较矫治前后两组患者及被观察牙齿牙釉质脱矿发病率和脱矿程度,判断含氟牙膏在固定矫治中对牙釉质脱矿的预防效果。结果在正畸固定矫治中,应用氟浓度为0．15%的含氟牙膏刷牙,可明显降低牙釉质脱矿的发病率,明显减少牙釉质3度脱矿的发生。结论0．15%含氟牙膏应用于固定矫治能够降低牙釉质脱矿的程度。     

酪蛋白磷酸多肽-无定形磷酸钙制剂在固定矫治中抑制牙釉质脱矿的临床研究

目的探讨酪蛋白磷酸多肽-无定形磷酸钙(casein phosphopetide-amorphous calcium phosphate,CPPACP)制剂在固定矫治中抑制牙釉质脱矿的临床效果。方法选择固定矫治患者98例共2 142颗牙齿,按随机编号将纳入患者的左侧牙齿或右侧牙齿分为试验组,对侧牙齿为对照组,试验组牙面涂布含CPP-ACP成分的GC护牙素,对照组牙面涂布牙膏,每月复诊处理1次,观测记录矫治前、中、后的牙釉质脱矿情况。结果治疗前、治疗中和治疗后试验组牙釉质脱矿均明显低于对照组,差异有统计学意义(P<0.05)。试验组釉质脱矿增加指数为0.054,对照组釉质脱矿增加指数为0.091,差异有统计学意义(t=3.42,P<0.001)。结论 CPP-ACP制剂对抑制固定矫治中牙釉质脱矿操作简便,疗效可靠。     

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。     

Prevention of enamel demineralization: an in-vitro study using light-cured filled sealant.

INTRODUCTION: Enamel demineralization is an undesirable side effect of orthodontic treatment with fixed appliances. The purpose of this in-vitro study was to evaluate the efficacy of applying a light-cured filled sealant onto the buccal tooth surfaces to prevent demineralization. METHODS: Fifty extracted human third molars were allocated to 1 of 5 groups: (1) enamel surface untreated (control); (2) surface etched; (3) fluoride varnish applied; (4) enamel etched and coated with a light-cured, unfilled sealant (control sealant); and (5) enamel etched and coated with a light-cured, filled sealant (Pro Seal, Reliance Orthodontic Products, Itasca, Ill). The enamel surface of each specimen was brushed for 15,000 strokes with nonfluoride toothpaste slurry with a piston-action brushing machine under a standardized load. All samples were then cycled for 14 days through a daily procedure of demineralization for 6 hours and remineralization for 17 hours. Then the teeth were sectioned and evaluated quantitatively by cross-sectional microhardness testing. RESULTS: Demineralization in the Pro Seal group was significantly less (P < .05) than in the other groups. Teeth treated with fluoride varnish exhibited 30% less demineralization than the control teeth, the enamel-etched teeth, and the teeth treated with a light-cured, unfilled sealant (P < .05). CONCLUSIONS: Pro Seal can be considered for use as a preventive method to reduce enamel demineralization adjacent to orthodontic attachments, particularly in patients who exhibit poor compliance with oral hygiene and home fluoride use.     

酪蛋白磷酸肽钙磷复合体预防正畸治疗中釉质脱矿的临床研究

目的 评价酪蛋白磷酸肽钙磷复合体（Casein Phosphopeptide-Amorphic Calcium Phosphate）预防正畸患者牙釉质脱矿的临床效果.方法 选择固定正畸患者60例,随机分为试验组和对照组,所有患者在戴入前拍摄口内照片评价其牙釉质脱矿情况.试验组在戴入固定矫治器后常规口腔卫生宣教,并且每天均用主要成分为酪蛋白磷酸肽钙磷复合体的护牙素,对照组仅常规口腔卫生宣教.一年后拍摄口内照片观察并比较两组间的牙釉质脱矿增加的情况.结果 一年后牙釉质脱矿增加指数试验组为0.019±0.033,对照组为0.067±0.039,试验组明显低于对照组（F=9.1,P＜0.01）.结论 酪蛋白磷酸肽钙磷复合体对正畸治疗中的釉质脱矿有一定的预防作用.     

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.     

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.     

Acid resistance of enamel subsurface lesions remineralized by a sugar-free chewing gum containing casein phosphopeptide-amorphous calcium phosphate

The aim of this clinical study was to investigate the acid resistance of enamel lesions remineralized in situ by a sugar-free chewing gum containing casein phosphopeptide-amorphous calcium phosphate nanocomplexes (CPP-ACP: Recaldent). The study utilized a double-blind, randomized, crossover design with two treatments: (i) sugar-free gum containing 18.8 mg of CPP-ACP, and (ii) sugar-free gum not containing CPP-ACP as control. Subjects wore removable palatal appliances with insets of human enamel containing demineralized subsurface lesions and chewed the gum for 20 min 4 times per day for 14 days. After each treatment the enamel slabs were removed and half of each lesion challenged with acid in vitro for 8 or 16 h. The level of remineralization was determined using microradiography. The gum containing CPP-ACP produced approximately twice the level of remineralization as the control sugar-free gum. The 8- and 16-hour acid challenge of the lesions remineralized with the control gum resulted in 65.4 and 88.0% reductions, respectively, of deposited mineral, while for the CPP-ACP-remineralized lesions the corresponding reductions were 30.5 and 41.8%. The acid challenge after in situ remineralization for both control and CPP-ACP-treated lesions resulted in demineralization underneath the remineralized zone, indicating that the remineralized mineral was more resistant to subsequent acid challenge. The results show that sugar-free gum containing CPP-ACP is superior to an equivalent gum not containing CPP-ACP in remineralization of enamel subsurface lesions in situ with mineral that is more resistant to subsequent acid challenge.     

Effect of fluoride on artificial caries lesion progression and repair in human enamel: regulation of mineral deposition and dissolution under in vivo-like conditions

OBJECTIVE: This study was carried out to determine in vitro the effect of fluoride on (1) the demineralization of sound human enamel and (2) the progression of artificial caries-like lesions, under relevant oral conditions. METHODS: Thin sections of sound human enamel were exposed to solutions undersaturated with respect to tooth enamel to a degree similar to that found in dental plaque fluid following sucrose exposure in vivo, containing fluoride concentrations (0-0.38ppm) found in plaque fluid. Mineral changes were monitored for 98 days, using quantitative microradiography. The effect of fluoride (1.0-25.0ppm) on the progression of artificial caries-like lesions was similarly studied. RESULTS: Fluoride concentrations of 0.19ppm and greater were found to prevent the demineralization of sound enamel in vitro. However, significantly higher concentrations of fluoride (25.0ppm) were required to prevent further demineralization of artificial caries-like lesions. Demineralizing solutions with intermediate fluoride concentrations (2.1-10.1ppm) induced simultaneously remineralization in the outer portion of the lesion and demineralization in the inner portion. Simultaneous remineralization and demineralization were also observed in hydroxyapatite pellets. CONCLUSIONS: Our results show that the observed effect of fluoride on enamel demineralization is not solely a function of bulk solution properties, but also depends on the caries-status of the enamel surface. A mechanistic model presented indicates that, in comparison to sound enamel surfaces, higher concentrations of fluoride are required to prevent the progression of artificial caries-like lesions under in vivo-like conditions since the diffusion of mineral ions that promote remineralization is rate-limiting.     

Effect of CPP-ACP paste on tooth mineralization: an FE-SEM study

Milk and milk products, such as cheese, have been shown to exhibit anticariogenic properties in human and animal models. CPP-ACP shows an anti-caries effect by suppressing demineralization, enhancing remineralization, or possibly a combination of both. The purpose of this study was to evaluate the effect of CPP-ACP paste on demineralization by observing the treated tooth surface using an FE-SEM. The specimens were prepared by cutting enamel and dentin of bovine teeth into blocks. A few specimens were stored in 0.1 M lactic acid buffer solution for 10 min and then in artificial saliva (negative control). The remaining specimens were stored in a 10 times-diluted solution of CPP-ACP paste or a placebo paste containing no CPP-ACP for 10 min, followed by 10 min immersion in a demineralizing solution (pH = 4.75, Ca) twice a day before storage in artificial saliva. After treatment of the specimens for 3, 7, 21 and 28 days, they were fixed in 2.5% glutaraldehyde in cacodylate buffer solution, dehydrated in ascending grades of tert-butyl alcohol, and then transferred to a critical-point dryer. The surfaces were coated with a thin film of Au in a vacuum evaporator, and were observed under field emission-scanning electron microscopy (FE-SEM). The SEM observations revealed different morphological features brought about by the various storage conditions. Demineralization of the enamel and dentin surfaces was more pronounced with the longer test period in the control and negative control specimens. On the other hand, enamel and dentin specimens treated with CPP-ACP paste revealed slight changes in their morphological features. From the morphological observations of the enamel and dentin surfaces, it could be considered that the CPP-ACP paste might prevent demineralization of the tooth structure.