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      Comparative evaluation of remineralizing potential of three agents on artificially demineralized human enamel: An in vitro study

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          Abstract

          Introduction:

          Remineralization as a treatment procedure has received much attention from clinicians. The objective of this in vitro study was to find out the efficacy of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), casein phosphopeptide-amorphous calcium phosphate fluoride (CPP-ACPF), and tricalcium phosphate fluoride (TCP-F) in remineralizing enamel surface on which artificial caries lesion had been created. The changes were analyzed using DIAGNOdent ® (KaVo) and scanning electron microscope (SEM).

          Materials and Methods:

          A total of 52 premolars and 24 molars were selected and classified into four groups of 13 premolars and 6 molars in each: I (CPP-ACP), II (CPP-ACPF), III (TCP-F), and IV (artificial saliva). All the samples were assessed using DIAGNOdent at the baseline and after demineralization and remineralization. Ten samples were randomly selected from each group baseline after demineralization and after remineralization for surface evaluation using SEM.

          Results:

          Statistical analysis showed that all the experimental groups had a significantly higher amount of remineralization except for group IV.

          Conclusion:

          All the three experimental groups showed a statistically significant amount of remineralization. However, because of the added benefit of fluoride (NaF 0.2%), CPP-ACPF (Tooth Mousse-Plus ®) and TCP-F showed marginally more amount of remineralization than did CPP-ACP (Tooth Mousse ®). Remineralization efficacy was TCP-F > CPP-ACPF > CPP-ACP.

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          Most cited references25

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          Calcium phosphate-based remineralization systems: scientific evidence?

          Dental caries remains a major public health problem in most communities even though the prevalence of disease has decreased since the introduction of fluorides. The focus in caries research has recently shifted to the development of methodologies for the detection of the early stages of caries lesions and the non-invasive treatment of these lesions. Topical fluoride ions, in the presence of calcium and phosphate ions, promote the formation of fluorapatite in tooth enamel by a process referred to as remineralization. The non-invasive treatment of early caries lesions by remineralization has the potential to be a major advance in the clinical management of the disease. However, for net remineralization to occur adequate levels of calcium and phosphate ions must be available and this process is normally calcium phosphate limited. In recent times three calcium phosphate-based remineralization systems have been developed and are now commercially available: a casein phosphopeptide stabilized amorphous calcium phosphate (Recaldent (CPP-ACP), CASRN691364-49-5), an unstabilized amorphous calcium phosphate (ACP or Enamelon) and a bioactive glass containing calcium sodium phosphosilicate (NovaMin). The purpose of this review was to determine the scientific evidence to support a role for these remineralization systems in the non-invasive treatment of early caries lesions. The review has revealed that there is evidence for an anticariogenic efficacy of the Enamelon technology for root caries and for the Recaldent technology in significantly slowing the progression of coronal caries and promoting the regression of lesions in randomized, controlled clinical trials. Hence the calcium phosphate-based remineralization technologies show promise as adjunctive treatments to fluoride therapy in the non-invasive management of early caries lesions.
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            Remineralization potential of fluoride and amorphous calcium phosphate-casein phospho peptide on enamel lesions: An in vitro comparative evaluation

            Aim: This in vitro study was conducted on enamel blocks of human premolars with the aim of evaluating the remineralization potential of fluoride and ACP-CPP and the combination of ACP-CPP and fluoride on early enamel lesions. Materials and Methods: Fifteen intact carious free human premolars were selected. The coronal part of each tooth was sectioned into four parts to make 4 enamel blocks. The baseline SMH (surface microhardness) was measured for all the enamel specimens using Vickers microhardness (VHN) testing machine. Artificial enamel carious lesions were created by inserting the specimens in demineralization solution for 3 consecutive days. The SMH of the demineralised specimens was evaluated. Then the four enamel sections of each tooth were subjected to various surface treatments, i.e. Group 1- Fluoride varnish, Group 2- ACP-CPP cream, Group 3- Fluoride + ACP-CPP & Group 4- Control (No surface treatment). A caries progression test (pH cycling) was carried out, which consisted of alternative demineralization (3hours) and remineralization with artificial saliva (21 hours) for five consecutive days. After pH cycling again SMH of each specimen was assessed to evaluate the remineralization potential of each surface treatment agent. Then, to asses the remineralization potential of various surface treatments at the subsurface level, each enamel specimen was longitudinally sectioned through the centre to expose the subsurface enamel area. Cross-sectional microhardness (CSMH) was evaluated to assess any subsurface remineralization Results: Statistical analysis using one-way ANOVA followed by multiple comparisons test was applied to detect significant differences at P ≤ 0.05 levels between various surface treatments at different phases. Conclusions: With in the limits, the present study concludes that; ACP-CPP cream is effective, but to a lesser extent than fluoride in remineralizing early enamel caries at surface level. Combination of fluoride and ACP-CPP does not provide any additive remineralization potential compared to fluoride alone. Fluoride, ACP-CPP and their combination are not effective in remineralizing the early enamel caries at the subsurface level.
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              Review on fluoride, with special emphasis on calcium fluoride mechanisms in caries prevention.

              Low concentrations of fluoride have a beneficial effect on enamel and dentin de- and remineralization. After fluoride treatments, such as topical applications, rinses or dentifrices, salivary fluoride concentrations decrease exponentially in a biphasic manner to very low concentrations within a few hours. For treatments to be effective over periods longer than the brushing and the following salivary clearance, fluoride needs to be deposited and slowly released. Calcium fluoride (or like) deposits act in such a way, owing to a surface covering of phosphate and/or proteins, which makes the CaF2 less soluble under in vivo conditions than in a pure form in inorganic solutions. Moreover, due to the phosphate groups on the surface of the calcium fluoride globules, fluoride is assumed to be released with decreasing pH when the phosphate groups are protonated in the dental plaque.
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                Author and article information

                Journal
                J Conserv Dent
                J Conserv Dent
                JCD
                Journal of Conservative Dentistry : JCD
                Medknow Publications & Media Pvt Ltd (India )
                0972-0707
                0974-5203
                Mar-Apr 2013
                : 16
                : 2
                : 116-120
                Affiliations
                [1]Department of Pedodontics, Rural Dental College, Loni, India
                [1 ]Department of Pedodontics, Aurobindo Institute of Dental Sciences, Indore, India
                Author notes
                Address for correspondence: Dr. Saurabh R Joshi, Department of Pedodontics, Rural Dental College, Loni, Rahata, Ahmednagar, India. E-mail: saurabhjoshi2006@ 123456yahoo.co.in
                Article
                JCD-16-116
                10.4103/0972-0707.108185
                3659854
                23716961
                42f93c92-70cf-48bb-8494-784cf1f7703b
                Copyright: © Journal of Conservative Dentistry

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 09 June 2012
                : 08 October 2012
                : 19 November 2012
                Categories
                Original Article

                Dentistry
                casein phosphopeptide-amorphous calcium phosphate,casein phosphopeptide-amorphous calcium phosphate + fluoride,diagnodent®,remineralization,scanning electron microscope,tricalcium phosphate + fluoride

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