Effect of application sequence of fluoride and CPP-ACP on remineralization of white spot lesions in primary teeth: An in-vitro study

ObjectiveTo explore how application sequence of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) and fluoride influences remineralization of enamel white spot lesions (WSL) in primary teeth.DesignIn this in-vitro study, artificial WSLs were created in 130 primary teeth. Teeth were divided into 4 groups (n = 27) and a control group (n = 22) and exposed to one of the following remineralization regimens for 10 weeks: Group-1; 500 ppm fluoride dentifrice; Group-2; 10% w/v CPP-ACP; Group-3; fluoride applied first, then CPP-ACP; Group-4; CPP-ACP applied first, then fluoride, and Group-5 was control. All groups were kept in a remineralizing solution. Mineral changes (ΔF) were quantified weekly using quantitative light-induced fluorescence. Statistical analysis was done using Statistical Package for the Social Sciences (SPSS version 20.0).ResultsRemineralization occurred in all groups to different degrees; changes from baseline were significant in groups 1–4 (P ≤ 0.05). Group-4 showed the earliest significant remineralization (after 2 weeks) among groups, (P < 0.001). Group-4 showed maximum changes in ΔF among groups; however, only differences with Groups 1 and 5 were significant (P < 0.05 and P < 0.01, respectively). Group-3 showed better remineralization than Groups 1, 2 and 5; however, the difference was only significant with Group-5 (P < 0.001). There were no significant differences between Group 1and 2, however, only Group 2 showed better remineralization than Group 5, (P < 0.01).ConclusionCombined treatment with CPP-ACP followed by fluoride exhibited the best remineralization of white spot lesions in primary teeth in this study. Combined treatment with fluoride followed by CPP-ACP showed a tendency towards better remineralization than fluoride or CPP-ACP alone.     

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...     

The effect of casein phosphopeptide-amorphous calcium phosphate on remineralization of artificial caries-like lesions: an in vitro study

BACKGROUND: The aims of this study were to investigate the efficacy of CPP-ACP containing Tooth Mousse on the remineralization of enamel lesions and to compare its efficacy to that of a fluoride-containing toothpaste. METHODS: Permanent teeth were placed in demineralizing solution for 96 hours to produce artificial caries-like lesions 120-200 microm in depth. They were sectioned into 100-150 microm thick samples and randomly assigned to five groups: for Group A, a fluoridated toothpaste (1100 ppm) was used as a positive control and in Group B, a non-fluoridated toothpaste was used as a negative control. Tooth Mousse containing CPP-ACP was tested by three different means: as a toothpaste (Group C); as a topical coating (Group D); and (Group E) as a topical coating after treating the sections with the same fluoridated toothpaste as in Group A. RESULTS: The lesion depth decreased significantly by 7 per cent in Group A, 10.1 per cent in Groups C and D, and 13.1 per cent in Group E (Paired t- test, p < 0.05), while in Group B the lesion depth increased significantly by 23 per cent. CONCLUSIONS: Based on the data obtained, CPP-ACP containing Tooth Mousse remineralized initial enamel lesions and it showed a higher remineralizing potential when applied as a topical coating after the use of a fluoridated toothpaste.     

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.     

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。     

Biomimetic mineralisation of phosphorylated dentine by CPP-ACP

Objectives

Casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) has the potential to induce the biomimetic mineralisation of dentine collagen fibrils. This study aimed to demonstrate in vitro the ability of CPP-ACP to form apatite crystals on phosphorylated dentine collagen fibrils.

Methods

Dentine slices with a 2-mm thickness were prepared from sound human third molars. The slices were etched with phosphoric acid to expose the collagen fibres. Sodium trimetaphosphate was then used to phosphorylate the exposed collagen fibres. CPP-ACP paste was topically applied to the surface of the phosphorylated slices, which were then immersed in a metastable calcium phosphate remineralising solution and incubated at 37 °C for 10 days. The CPP-ACP paste and the remineralising solution were replaced every two days. Phosphorylated dentine slices without a CPP-ACP application and non-phosphorylated dentine slices with a CPP-ACP application were prepared and used for comparison. The slices were examined using scanning electron microscope (SEM), diffuse reflectance-Fourier transform infrared spectroscopy (DR-FTIR) and X-ray diffraction (XRD).

Results

The SEM results revealed the presence of intrafibrillar and interfibrillar crystal nucleation and growth along the phosphorylated dentine collagen fibres. The DR-FTIR and XRD confirmed that the crystals were hydroxyapatite. No apatite crystal nucleation and growth were observed in either the slices that had no non-phosphorylation or those without CPP-ACP application.

Conclusions

CPP-ACP can induce the biomimetic mineralisation of dentine through apatite formation along and between the phosphorylated dentine collagen fibres.

Clinical significance

The in vitro study imitated the application of CPP-ACP to exposed dentine tooth surfaces in the mouth. This could lead to the development of a new therapeutic technique for the treatment of tooth hypersensitivity.     

GC护牙素联合Beyond冷光美白治疗氟斑牙术后敏感性的评价

目的观察氟斑牙患者经Beyond冷光美白技术治疗后使用GC护牙素的效果,评价GC护牙素对氟斑牙美白术后敏感问题的有效性。方法选择门诊氟斑牙患者20例共157颗患牙,随机分为实验组和对照组,实验组患者在进行Be-yond冷光美白术后使用GC护牙素,对照组患者只进行Beyond冷光美白术治疗。术后13、7、1、4 d观察患者患牙的温度敏感性及化学敏感性。结果实验组术后敏感性显著低于对照组（P〈0.05）。结论 GC护牙素能有效预防氟斑牙冷光美白术后的敏感。     

Remineralizzazione dello smalto esposto all’azione erosiva delle bevande acide

Objectives

Aim of this in vitro study was to evaluate the effect of a calcium-phosphate based (CPP-ACP) paste in remineralisation of enamel surfaces eroded by acid soft drinks by atomic force microscopy (AFM).

Materials and methods

Twenty-four human caries-free central incisors were randomly and equally divided into four groups; teeth were exposed to the erosive action of two different acid soft drinks (Coca Cola and Gatorade) for 10 minutes twice a day for two weeks. After the second exposure, the teeth of two groups were covered with CPP-ACP paste for 10 minutes every day. Then, the samples were observed under AFM.

Results

All samples revealed increased values of surface roughness after exposure to acid soft drinks. Samples treated with CPP-ACP paste showed a significative reduction of roughness values (p < 0,01).

Conclusions

This study showed that acid soft drinks could erode tooth enamel surface; the use of CPP-ACP paste can enhance enamel remineralization.     

酪蛋白磷酸肽-磷酸钙溶液对牙釉质再矿化的影响**

背景：酪蛋白磷酸肽-磷酸钙的作用时间和效力均强于普通只含钙磷的再矿化液,实验室及人体研究证明其能使牙釉质缺损再矿化,但研究多集中于釉质表面的微脱矿。 目的：拟通过酸蚀剂处理形成不同深度的釉质表面脱矿形态,观察酪蛋白磷酸肽-磷酸钙溶液对牙釉质再矿化的影响。 设计、时间及地点：对照观察实验,于2008-05/07在兰州大学口腔医院完成。 材料：离体牙釉质块收集于兰州大学口腔医院外科门诊需拔除的正畸上颌第一前磨牙20个。 方法：选取需拔除的正畸上颌第一前磨牙20个,随机分为2组,每组10个,分别用35%磷酸凝胶、20%磷酸凝胶对牙冠颊、腭面酸蚀处理60 s,每颗牙牙冠沿近远中向纵剖,一半置于酪蛋白磷酸肽-磷酸钙再矿化液中矿化10 d,另一半作为对照置于去离子水中。比较两种材料酸蚀及再矿化后的形态改变。 主要观察指标：扫描电镜观察牙釉质表面在酸蚀后和酪蛋白磷酸肽-磷酸钙液再矿化后的表面形态改变。 结果：采用35%磷酸凝胶、20%磷酸凝胶酸蚀后形成深、浅两种不同釉质酸蚀表面结构,呈鱼鳞状,经酪蛋白磷酸肽-磷酸钙再矿化液处理后酸蚀釉质表面都有大量的矿化物沉积,颗粒细小,沉积不均匀,逐渐变平,两种结构间无明显区别。 结论：实验表明酪蛋白磷酸肽-磷酸钙可促进脱矿釉质再矿化,再矿化程度与釉质表面形态无关。