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, 27, e20180589

The in Vitro Remineralizing Effect of CPP-ACP and CPP-ACPF After 6 and 12 Weeks on Initial Caries Lesion


The in Vitro Remineralizing Effect of CPP-ACP and CPP-ACPF After 6 and 12 Weeks on Initial Caries Lesion

Laurent A M Thierens et al. J Appl Oral Sci.


Objective: The aim of this in vitro study was to determine the effects of remineralization promoting agents containing casein phosphopeptide-stabilized amorphous calcium phosphate (CPP-ACP), or CPP-ACP in combination with fluoride (CPP-ACPF) on artificial white spot lesions (WSLs) after 6 and 12 weeks.

Methodology: White spot lesions were created on 123 sectioned premolars (246 specimens) with a demineralization solution during a 96 hours pH-cycling regime. Two experimental groups were created: a CPP-ACP group (Tooth Mousse™), and a CPP-ACPF group (Mi Paste Plus™). Additionally, two control groups were created, one using only a conventional toothpaste (1450 ppm fluoride) and another one without any working agents. All teeth were also daily brushed with the conventional toothpaste except the second control group. Tooth Mousse™ and Mi Paste Plus™ were applied for 180 seconds every day. The volume of demineralization was measured with transverse microradiography. Six lesion characteristics regarding the lesion depth and mineral content of WSLs were also determined.

Results: The application of CPP-ACP and CPP-ACPF had a significant regenerative effect on the WSLs. Compared to Control group 1 and 2 the volume of demineralization after 6 weeks decreased significantly for CPP-ACP (respectively p<0.001 and p<0.001) and CPP-ACPF (respectively p=0.001 and p=0.003). The same trend was observed after 12 weeks. For the CPP-ACPF group, WSL dimensions decreased significantly between 6 and 12 weeks follow-up (p=0.012). The lesion depth reduced significantly after application of CPP-ACP and CPP-ACPF but increased significantly in the Control groups. Mineral content increased for CPP-ACP and CPP-ACPF after an application period of 12 weeks, but this was only significant for CPP-ACP.

Conclusions: Long-term use of CPP-ACP and CPP-ACPF in combination with a conventional tooth paste shows beneficial effects in the recovery of in vitro subsurface caries lesions.


Figure 1
Figure 1. Schematic drawing of white spot lesion using transverse microradiography (based on Theuns, et al. 20 ). A) Lesion characteristics: BMC, basic mineral content; MSL, Maximum mineral content of the surface layer; DSL, depth at the point where maximum mineral content is reached; MBL, minimum mineral content of the body lesion; DBL, depth at the point where minimum mineral content is reached; and DL, the depth of the lesion; B) Dissolved minerals are presented as the shaded area
Figure 2
Figure 2. The effect of time and treatment on the logarithmic volume of demineralization of the two experimental and two control groups. The significant reduction of the logarithmic demineralization volume of the CPP-ACPF group from 6 to 12 weeks (p=0.012) is indicated with an asterisk (*)

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