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Objective@#To explore effect on the remineralization of demineralized enamel surfaces with glycine-guided carboxymethyl chitosan (CMC)/amorphous calcium phosphate (ACP).@*Methods@# Remineralized solultion at different stages were prepared: ①reactive CMC/ACP (CMC/ACP nanoparticles treated with NaClO), ②reactive CMC/ACP+glycine; transmission electron microscopy was used to detect the morphology of the remineralized solution particles. Twenty teeth were randomly divided into two groups: group A and group B. Reactive CMC/ACP was applied to the enamel surface of group A and group B was treated with reactive CMC/ACP remineralization solution containing glycine. Scanning electron microscopy was used to detect the enamel surface morphology before and after remineralization, and nanoindentation was used to detect the mechanical strength (including nanoindentation depth, hardness and elastic modulus) of the enamel surface.@*Results@#Under a transmission electron microscope, the particles in the reactive CMC/ACP remineralization solution were smooth, and the increase in particle size was approximately 100-300 nm. After the addition of glycine, the particles in the reactive CMC/ACP remineralization solution particles showed a linear ordered arrangement, and microcrystals were formed in the solution 15 min later, with a crystal length of approximately 5-15 μm. Remineralization in group A was granular and heterogeneous. In group B, the crystal morphology of the demineralized enamel was homogeneous and ordered, similar to that of natural enamel. The nanoindentation depth of group B after remineralization was smaller than that of group A, and it was closest to that of natural enamel, there was no significant difference between group B and natural enamel in terms of the hardness and elastic modulus of the enamel surface after remineralization.@*Conclusion@# CMC/ACP nanoparticles treated with NaClO can rapidly and specifically form directional and ordered remineralization on the enamel surface of a model of glycine-guided rapid remineralization of enamel caries. The surface structure of remineralized enamel is similar to that of natural enamel in terms of nanoindentation depth, hardness and elastic modulus.
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@#Glass ionomer cement (GIC) is widely used as a common filling material in dentistry but still exhibits problems with secondary caries and fractures. Thus, the antibacterial and anti-caries performance of GIC needs to be further improved. In recent years, natural antimicrobial components have become more desirable due to their good biological properties and low drug resistance. In this review, the natural antimicrobial ingredients in GIC modification are classified, reviewed and summarized according to the different sources of antimicrobial ingredients. In terms of animal origin, chitosan and casein phosphopeptide-amorphous calcium phosphate exhibit antimicrobial properties without affecting the mechanical properties of materials; propolis and bioactive enzymes have good biocompatibility; in terms of plant origin, polyphenols help improve the antimicrobial and mechanical properties of the material; arginine has a good remineralization effect; and plant essential oils have a certain ion release effect. In terms of microbial origin, antibiotics greatly improve the antibacterial properties of materials; in addition, the combined application of natural antimicrobial ingredients also exhibited excellent performance. Despite these advantages, the optimal addition concentration and biocompatibility in vivo are questions that need to be further explored before clinical applications can be achieved.
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Background: Fragment re-attachment has been considered as one of the treatment modalities for the management of fractured anterior teeth. Hydration of fractured fragments aids in inhibiting the loss of ions and maintains vitality and esthetics. Aim: The study aimed to evaluate the effect of preconditioning the fractured fragments with remineralizing agents on fracture resistance of re-attached teeth. Settings and Design: This was an in vitro study. Materials and Methods: Sixty freshly extracted noncarious human permanent maxillary central and lateral incisors were randomly allocated into three Groups of 20 each: Group 1: 2% sodium fluoride (2%NaF), Group 2: casein phosphopeptide–amorphous calcium phosphate (CPP-ACP), and Group 3: self-assembling peptide P11-4 (SAP). These were further divided into two subgroups of 10 teeth each, based on contact time with remineralizing agents, i.e., 30 min and 2 h. Fractured fragments were treated with remineralizing agents for a specified contact time and then re-attached with flowable composite resin. Force required to fracture the re-attached tooth was recorded in Newtons using universal testing machine. Statistical Analysis: Unpaired t-test, one-way analysis of variance test, and post hoc Tukey test were used for the statistical analysis. Results: A higher fracture resistance was noticed in fragments treated with 2% NaF (30 min- 215.6 N, 2 h- 188.5 N) compared to CPP-ACP (30 min- 141.3 N, 2 h- 111.1 N) and SAP (30 min- 134.8 N, 2 h- 149.5 N). At 30 min interval, it was found to be more in 2% NaF and CPP-ACP groups compared to 2 h. However, it increased with time in the SAP group. A statistically significant difference was found between the groups at both time intervals (P = 0.007 and 0.017). Conclusion: Preconditioning of fractured coronal fragments with 2% NaF showed higher fracture resistance compared to CPP-ACP and self-assembling peptide P11-4. Samples treated with SAP P11-4 exhibited good fracture resistance at 2 h contact time.
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BACKGROUND: Based on excellent hydration ability, the materials for repairing bone defects could be fabricated by three-dimensional printing from amorphous calcium phosphate simply with pure water as adhesive solution; and more importantly, the printed products could be directly used in clinical medicine without high temperature sintering, so amorphous calcium phosphate fits well with technical features of three-dimensional printing. OBJECTIVE: To prepare bone repair materials of amorphous calcium phosphate with mechanical property and printing accuracy to meet practical application requirements by three-dimensional printing. METHODS: Amorphous calcium phosphate used as prototyping powder was prepared by coprecipitation method, and then the viscosity and surface tension of the deionized water as adhesive solution were adjusted by thickening agent and leveling agent, respectively. Afterwards, the three-dimensional printing productions for repairing bone defects were fabricated, and the effects of the viscosity and surface tension of adhesive solution on the forming of droplet, liquid-solid interaction and the mechanical property as well as printing accuracy of three-dimensional printing productions were investigated. RESULTS AND CONCLUSION: By investigating the forming of droplet and liquid-solid interaction, the optimal physicochemical parameters of the adhesive solution were obtained. The viscosity and surface tension of the optimal adhesive solution were 8.0 × 10-3 Pa•s and 40.0 × 10-3 N/m separately, and at this point, not only droplet could form stably and controllably (Z=5.06), but also it smoothly struck the powder layer during spraying (K=14.29), and then it infiltrated into the powder layer uniformly and spread in time (We=36.86). The corresponding three-dimensional printing production has good mechanical properties (compressive strength is 30.4 MPa), high printing accuracy (forming error is 0.9 mm), and a large number of pores indicating good bone conductivity, which partially meets clinical demands of repairing bone defects.
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@#Dental hard tissues lack the ability to self-heal. In dentin and cementum, hydroxyapatite (HA) can exist outside and/or inside collagen fibers. It is difficult to repair or regenerate HA with a highly ordered orientation in the presence of collagen fibers. At present, the biomimetic mineralization of dentin and cementum, mainly carried out by imitating its biological formation process and its physiological structure, can be divided into those originating from the fiber mineralization mechanism and those with HA as the main component. The materials used include natural materials such as demineralized dentin matrix (DDM) and calcined bovine hydroxyapatite (BHA), and synthetic materials such as polymer-induced liquid precursor (PILP) and synthetic HA. In the future, natural materials and synthetic materials should be combined for the restoration and regeneration of dentin and cementum by means of biomimetic mineralization of calcium phosphate released by remineralization solution-HA.
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@#In recent years, due to precise control of the amorphous mineral precursor in the demineralization of dentine collagen fibers in orderly deposition, forming apatite crystals similar to the natural mineralized dentin, the bottom-up remineralization approach which does not depend on the existence of seed crystallites, dentin biomimetic mineralization techniques gradually become a hotspot in the research field of restoration of demineralized dentin caused by dental caries. This paper reviews the changing concepts and practices of the remineralization of demineralized dentin, emphasizing biomimetic remineralization studies. The results of the literature review show that the traditional dentin remineralization method is usually a disordered mixture of demineralized dentin and minerals, so mineralized dentin is not comparable to natural mineralized dentin in terms of the morphological characteristics and mechanical properties. With its gradual increase in recent years, dentine biomimetic mineralization technology perfectly resembles the minerals in the dentin overlapping sequence arranged with the dentine collagen fiber structure characteristics, leading to greatly improved microstructural, physical and chemical properties. As a result, dentine biomimetic mineralization technology is expected to achieve new breakthroughs in the fields of resin-dentin bonding mixing layers and the decay of dentin. At present, the technical obstacles that need to be overcome in the clinical application of the biomimetic remineralization of dentin are how to continuously supplement all the active ingredients needed for mineralization in the process of remineralization and how to keep the mechanical properties of the parent material unchanged while slowly releasing all ingredients. Researchers have successively proposed three-step transportation of the biomimetic remineralization of raw materials, as well as the preparation of mineralization precursors stabilized by polymers in advance and the reuse of mesoporous silicon nanomaterials for the transportation of the mineralized ingredient system. The concept described above provides the preliminary in vitro experimental basis for the transformation of the biomimetic remineralization strategy of dentin in clinical applications.
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ABSTRACT Saliva and external agents containing different concentrations of sodium fluoride (NaF) promote the dental remineralization process. However, these resources may not be sufficient to counteract the multiple factors involved in the process of dental caries, especially in high-risk patients. There are alternatives that have been extensively researched, such as casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) which provides essential ions, like phosphate and calcium, acting as an adjuvant in the remineralization process. Manufacturers of CPP-ACP-based products also suggest that it can produce desensitizing effects. This nanocomplex has been used experimentally with some dental cements and adhesive systems, but it is important to clarify the effects of this procedure, and the remineralizing/desensitizing advantages it offers. The objective of this topic review was to present the state of the art on CPP-ACP nanocomplex. In terms of dental caries prevention, this remineralizing option is not better than NaF. CPP-ACP provides a dental desensitizing action, but it is temporary, similar or less effective than other alternatives such as potassium nitrate or NaF. The experimental incorporation of CPP-ACP into dental cements should be controlled for not to compromise the physico-chemical properties of the material. The use of dental products based on this nanocomplex as dental surface pretreatment may decrease the bond strength of adhesive materials, but this effect is material dependent.
RESUMEN La saliva y agentes externos que contienen diferentes concentraciones de fluoruro de sodio (NaF) favorecen el proceso de remineralización dental. No obstante, estos recursos podrían no ser suficientes para contrarrestar los múltiples factores involucrados en el proceso de caries dental, especialmente en pacientes con alto riesgo. Existen alternativas que han sido ampliamente investigadas, como el fosfopéptido de caseína-fosfato de calcio amorfo (CPP-ACP) que aporta iones esenciales como fosfato y calcio, actuando como coadyuvante en el proceso de remineralización. Los fabricantes de productos basados en CPP-ACP también sugieren que este es capaz de generar efectos desensibilizantes. Este nanocomplejo ha sido utilizado de forma experimental con algunos cementos dentales y sistemas adhesivos, pero es importante esclarecer los efectos de dicha incorporación y las ventajas remineralizantes/desensibilizantes que ofrece esta alternativa. El objetivo del presente artículo de revisión de tema consistió en presentar el estado del arte sobre el nanocomplejo CPP-ACP. En términos de prevención de caries dental, esta opción remineralizante no es superior al NaF. El nanocomplejo ejerce acción desensibilizante dental, pero esta es transitoria, similar o inferior a otras alternativas como nitrato de potasio o NaF. La incorporación experimental de CPP-ACP en cementos dentales debe ser controlada para no comprometer las propiedades fisicoquímicas del material. La utilización de productos dentales a base de este nanocomplejo como pretratamiento de la superficie dental puede disminuir la resistencia de unión de materiales adhesivos, pero este efecto es material-dependiente.
Subject(s)
Tooth Demineralization , Phosphopeptides , Dental CariesABSTRACT
Background: Although fluoride enables remineralization, presence of calcium and phosphate ions is necessary to promote the process. So, various nonfluoridated remineralizing agents have been emerging to treat the noncavitated carious lesions. Aim: The aim of this systematic review was to assess the clinical effectiveness of nonfluoridated remineralizing agents on initial enamel carious lesions. Methods: Seven electronic databases were searched using the key words. In total, 158 human clinical trials were retrieved in the search from January 1950 to October 2016. Seventy-one repeated articles were excluded. Among the 87 articles obtained, 53 articles were eliminated after reading the title and abstracts. After assessing the full text, 28 articles were excluded. Three more studies were included from the cross references of the articles chosen. Results: All the nine trials included assessed the clinical effectiveness of casein phosphopeptide amorphous calcium phosphate (CPP ACP). They showed a positive effect of CPP ACP on the remineralization of white spot lesions. Conclusion: The use of CPP ACP resulted in significant reduction of the white spot lesion size measured using visual examination methods. This systematic review indicated a lack of reliable evidence supporting the clinical effectiveness of other commercially available nonfluoridated remineralizing agents.
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The aim of the study is to compare the anticariogenic effectiveness of Casein phosphopeptide- Amorphous Calcium phosphate (CPP-ACP) and xylitol chewing gums based on salivary pH, buffer capacity, and Streptococcus mutans levels. Materials and Methods: A group of twenty individuals in the age group of 18–25 years were randomly divided into two Groups A and B. Test arm A received xylitol gums and test arm B received CPP-ACP gums and they were instructed to use the gums thrice daily for 2 weeks. Unstimulated salivary samples were collected before they began the use of the gums for baseline values, 24 h after beginning the usage of chewing gums and at the end of 14 days. The samples were analyzed for pH, buffer capacity, and S. mutans levels. Results: A statistically significant reduction of salivary S. mutans levels, improvement in salivary pH, and buffer capacity were displayed in both groups 24 h and 14 days after the intervention when compared with baseline. Group B showed more statistically significant improvement in pH than group A after 24 h (P = 0.028) and at the end of 2 weeks (P = 0.041). Conclusion: CPP-ACP has better ability than xylitol in improving the pH of saliva. Both CPP-ACP and xylitol gums individually have remarkable ability in bringing down S. mutans levels while simultaneously improving the pH and buffer of saliva.
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The aim of this systematic review was to assess the long term remineralizing potential of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) only in paste form compared with fluoride varnish, and or placebo in both naturally occurring and post-orthodontic white spot lesions in vivo. Data Sources: The literature search covered the electronic databases: PubMed and Google scholar from 2005-2016. Only articles published in English were included. Randomized control trials in which CPP-ACP delivered by paste form were included. All studies which met inclusion criteria underwent two independent reviews. Study Selection: Two ninety five articles were identified from the search after excluding duplications. Abstracts of forty one articles were reviewed independently. Twenty nine articles were excluded after reading abstract. Full text articles were retrieved for fifteen relevant studies. After reviewing articles independently, three articles were excluded after full text reading. Finally twelve studies were selected based on the eligibility criteria. The remineralizing effect of CPP-ACP were compared with placebo and fluoridated toothpaste and fluoride varnish in randomized control trial. Conclusion: A high level evidence of remineralizing potential of CPP-ACP on naturally occurring white spot lesion and WSL post orthodontic treatment was found in comparison with placebo/fluoridated toothpaste and fluoride varnish without any statistically significant difference. Well-designed RCTs are, therefore, required to improve the level of evidence in this area.
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@#Bone is a hierarchically structured and highly mineralized hard tissue composed of an organic phase (type I collagen and noncollagenous proteins) and an inorganic phase (nanohydroxyapatite). Intrafibrillar mineralized collagen is the basic structural unit of bone tissue and is of high significance due to its superior mechanical and biological properties. Thus, to truly understand the unique properties of bone, it is necessary to review the most basic structural level of bone. In this article, we review the recent advances in understanding the development of intrafibrillar mineralization and the prevailing theories in the formation of such intrafibrillar minerals. Understanding the mechanisms of intrafibrillar mineralization may facilitate the development of engineered bone for clinical applications and provide deeper insight into the nature of biomineralization.
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PURPOSE: The purpose of the current study was to evaluate the effect of incorporating nanoparticles of silver (NAg) and amorphous calcium phosphate (NACP) into a self-etching primer of a resin cement on the microtensile bond strength of dentin, regarding the proven antibacterial feature of NAg and remineralizing effect of NACP. MATERIALS AND METHODS: Flat, mid-coronal dentin from 20 intact extracted human third molars were prepared for cementation using Panavia F2.0 cement. The teeth were randomly divided into the four test groups (n=5) according to the experimental cement primer composition: cement primer without change (control group), primer with 1% (wt) of NACP, primer with 1% (wt) of physical mixture of NACP+Nag, and primer with 1% (wt) of chemical mixture of NACP+Nag. The resin cement was used according to the manufacturer's instructions. After storage in distilled water at 37℃ for 24 h, the bonded samples were sectioned longitudinally to produce 1.0 × 1.0 mm beams for micro-tensile bond strength testing in a universal testing machine. Failure modes at the dentin-resin interface were observed using a stereomicroscope. The data were analyzed by one-way ANOVA and Tukey's post-hoc tests and the level of significance was set at 0.05. RESULTS: The lowest mean microtensile bond strength was obtained for the NACP group. Tukey's test showed that the bond strength of the control group was significantly higher than those of the other experimental groups, except for group 4 (chemical mixture of NACP and NAg; P=.67). CONCLUSION: Novel chemical incorporation of NAg-NACP into the self-etching primer of resin cement does not compromise the dentin bond strength.
Subject(s)
Humans , Calcium , Cementation , Dentin , Molar, Third , Nanoparticles , Resin Cements , Silver , Tooth , WaterABSTRACT
The use of various biomimetic methods to achieve remineralization of demineralized dentin and the formation of an organic matrix-inorganic mineral complex with a certain mechanical strength has been a research hotspot in recent years in the field of stomatology, and it also provides a new idea for the restoration of dentin defect. Dentin biomineralization is a process that simulates the mineralization of biological tissue in nature in which the remineralization of dentin collagen is induced and regulated by organic macromolecules. This review summarizes the process of remineralization of decalcified dentin regulated by non-collagenous protein analogues in vitro.
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Objective@#To evaluate the remineralization effect and mechanism of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) with different concentrations of fluorine on demineralized enamel using electronic probe.@*Methods@#Extracted premolar teeth for orthodontic purpose were immersed into lactic acid gel to prepare artificial white spot lesions (10 teeth in each group). Then the specimens were randomly assigned to three groups: Control group, with 5% of the CPP-ACP+deionized water; Group A with 5% CPP-ACP+500 mg/L F- and Group B with 5% CPP-ACP+900 mg/L F-. The teeth in each group were soaked in different solutions for 4 days and then were measured using electron probe tester. The changes of contents among the three groups were compared.@*Results@#No statistically significant difference in the percentage of fluorine was found in the control group before and after treatment (P=0.06), and the difference in the percentage of fluorine quality in the other two groups was statistically significant (P<0.05). Statistically significant difference was found between calcium oxide and phosphorus peroxide in the three groups before and after mineralization (P<0.05). The percentage change of fluorine mass in group B [(0.107±0.035)%] was significantly greater than that in group A [(0.057±0.038)%] (P<0.05), while fluorine mass in group A was significantly greater than that in control group [(0.013±0.019)%] (P<0.05). In group A and group B, the change in quality of calcium oxide and phosphorus peroxide was significantly greater than that in control group (P<0.05), while no significant difference was found between group A and group B (P>0.05).@*Conclusions@#The addition of fluorine in CPP-ACP increased the transport and penetration of calcium, phosphorus and fluorine on enamel surface.
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ABSTRACT Introduction: Many patients seeking orthodontic treatment already have incipient enamel lesions and should be placed under preventive treatments. The aim of this in vitro study was to evaluate the effect of CPP-ACP paste and CO2 laser irradiation on demineralized enamel microhardness and shear bond strength of orthodontic brackets. Methods: Eighty caries-free human premolars were subjected to a demineralization challenge using Streptococcus mutans. After demineralization, the samples were randomly divided into five equal experimental groups: Group 1 (control), the brackets were bonded without any surface treatment; Group 2, the enamel surfaces were treated with CPP-ACP paste for 4 minutes before bonding; Group 3, the teeth were irradiated with CO2 laser beams at a wavelength of 10.6 µm for 20 seconds. The samples in Groups 4 and 5 were treated with CO2 laser either before or through CPP-ACP application. SEM photomicrographs of a tooth from each group were taken to observe the enamel surface. The brackets were bonded to the buccal enamel using a conventional method. Shear bond strength of brackets and ARI scores were measured. Vickers microhardness was measured on the non-bonded enamel surface. Data were analyzed with ANOVA and Tukey test at the p< 0.05 level. Results: The mean shear bond strength and microhardness of the laser group were higher than those in the control group and this difference was statistically significant (p< 0.05). All groups showed a higher percentage of ARI score 4. Conclusion: CO2 laser at a wavelength of 10.6 µm significantly increased demineralized enamel microhardness and enhanced bonding to demineralized enamel.
RESUMO Introdução: muitos pacientes, ao buscar o tratamento ortodôntico, já apresentam lesões incipientes no esmalte e precisam ser submetidos a tratamentos preventivos. O objetivo do presente estudo in vitro foi avaliar o efeito da pasta CPP-ACP e da irradiação com laser de CO2 na microdureza do esmalte desmineralizado e na resistência ao cisalhamento de braquetes ortodônticos. Métodos: oitenta pré-molares humanos hígidos foram submetidos a desmineralização usando Streptococcus mutans. Após a desmineralização, as amostras foram divididas aleatoriamente em cinco grupos experimentais: Grupo 1 (controle), os braquetes foram colados sem qualquer tratamento de superfície; Grupo 2, a superfície do esmalte foi tratada com pasta CPP-ACP por 4 minutos antes da colagem; Grupo 3, os dentes foram irradiados com laser de CO2 no comprimento de onda de 10,6 µm, por 20 segundos; Grupos 4 e 5, as amostras foram tratadas com laser de CO2 antes ou durante a aplicação de CPP-ACP. Foram feitas fotomicrografias por Microscopia Eletrônica de Varredura (MEV) de um dente de cada grupo, para avaliação da superfície do esmalte. Os braquetes foram colados ao esmalte na face vestibular, usando-se o método convencional. Foram medidos a resistência ao cisalhamento dos braquetes e o escore do Índice de Adesivo Remanescente (ARI). A microdureza Vickers foi medida nas superfícies do esmalte onde não foi realizada colagem. Os dados foram analisados com ANOVA e teste Tukey ao nível de p< 0,05. Resultados: a média da força de resistência ao cisalhamento e da microdureza do grupo laser foi superior à do grupo controle, com diferença estatisticamente significativa (p < 0,05). Todos os grupos apresentaram maior porcentagem do escore ARI=4. Conclusões: o laser de CO2 no comprimento de onda de 10,6 µm aumentou significativamente a microdureza do esmalte desmineralizado e melhorou a adesão dos braquetes nele.
Subject(s)
Humans , Caseins/pharmacology , Orthodontic Brackets , Dental Enamel/drug effects , Dental Enamel/radiation effects , Lasers, Gas , In Vitro Techniques , Random Allocation , Dental Bonding , Dental Enamel/pathology , Shear Strength , Hardness TestsABSTRACT
Abstract Casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) is able to increase salivary calcium and phosphate levels at an acidic pH. Previous studies demonstrated that a CPP-ACP chewing gum was able to enhance the re-hardening of erosion lesions, but could not diminish enamel hardness loss. Therefore, there is no consensus regarding the effectiveness of CPP-ACP on dental erosion. Objective This in situ study investigated the ability of a CPP-ACP chewing gum in preventing erosive enamel loss. Material and Methods: During three experimental crossover phases (one phase per group) of seven days each, eight volunteers wore palatal devices with human enamel blocks. The groups were: GI - Sugar free chewing gum with CPP-ACP; GII - Conventional sugar free chewing gum; and GIII - No chewing gum (control). Erosive challenge was extraorally performed by immersion of the enamel blocks in cola drink (5 min, 4x/day). After each challenge, in groups CPP and No CPP, volunteers chewed one unit of the corresponding chewing gum for 30 minutes. Quantitative analysis of enamel loss was performed by profilometry (µm). Data were analyzed by Repeated-Measures ANOVA and Tukey's test (p<0.05). Results The use of chewing gum (CPP and No CPP) resulted in lower erosive enamel loss compared with the control group (p<0.05). CPP-ACP chewing gum (CPP) did not improve the protection against erosive enamel loss compared with conventional chewing gum (No CPP) (p>0.05). Conclusion The CPP-ACP chewing gum was not able to enhance the anti-erosive effect of conventional chewing gum against enamel loss.
Subject(s)
Humans , Male , Female , Adult , Young Adult , Tooth Erosion/prevention & control , Caseins/therapeutic use , Chewing Gum , Protective Agents/therapeutic use , Dental Enamel/drug effects , Saliva , Tooth Remineralization , Cariostatic Agents/therapeutic use , Cariostatic Agents/pharmacology , Caseins/pharmacology , Reproducibility of Results , Analysis of Variance , Treatment Outcome , Statistics, Nonparametric , Cross-Over Studies , Protective Agents/pharmacology , Hardness TestsABSTRACT
<p><b>OBJECTIVE</b>This study aims to assess the remineralization effect of casein phosphopeptide (CPP)-amorphous calcium phosphate (ACP) on enamel demineralization by performing system review of randomized controlled trials (RCT) involving the treatment of enamel demineralization with CPP-ACP.</p><p><b>METHODS</b>The study was developed based on the Cochrane handbook for systematic reviews of interventions (Version 5.1.0) and included the following: search strategy, selection criteria, data extraction, and risk of bias assessment. We searched electronic databases such as PubMed, Embase, Cochrane Library, CNKI, Wanfang and VIP up to September 2016. RCT of treating enamel demineralization with CPP-ACP were included. Data extraction and domain-based risk of bias assessment were independently performed by two reviewers.</p><p><b>RESULTS</b>Twelve RCTs were included. Because of the difference of experimental design and evaluation standards, the quantitative analysis can not be carried out.</p><p><b>CONCLUSIONS</b>There is no strong evidence that CPP-ACP is superior to conventional fluoride formulations in enamel remineralization. However, due to the limitations of sample size, follow-up time and study design, more high quality and large-sample RCT are needed to further verify the evidence.</p>
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OBJECTIVES: The purpose of the present study was to evaluate the whitening effect, morphological and structural changes, and remineralization of the enamel induced by 3 combined agents: amorphous calcium phosphate (ACP), hydroxyapatite (HA), and tetrasodium pyrophosphate (TSP). METHODS: The study was performed on 90 bovine enamel slabs, which were divided into the 6 groups: negative control-distilled water (Group 1); positive control-opalescence F (Group 2); 10% mixed agent (Group 3); 25% mixed agent (Group 4); 50% mixed agent (Group 5); and 100% mixed agent (Group 6). Changes in the shade of the enamel slabs were evaluated using Shade Eye-NCC. Morphological changes were assessed by scanning electron microscopy (SEM) and confocal laser scanning microscopy (CLSM) was used to determine the remineralizing effect of the three agents on enamel slabs. RESULTS: The change in shade of the enamel (ad*) was noted to increase significantly with increase in whitening frequency in all groups. The value of Δn* was significantly greater in all groups except for the negative control group (P<0.001). SEM revealed that the control group, Group 5, and Group 6 had similar morphologies. The fluorescence lesion areas in the 4 mixture-treated group were significantly smaller than those in the positive control group (P<0.001). CONCLUSIONS: These results showed that the mixture of ACP, HA, and TSP was highly effective for bovine enamel whitening and acted by inducing the remineralization of enamel. CLINICAL SIGNIFICANCE: We evaluated the applicability of a new mixture containing ACP, HA, and TSP. This mixture would be highly useful in aesthetic dentistry because of its whitening efficiency, which does not compromise the enamel's integrity.
Subject(s)
Calcium , Dental Enamel , Dentistry , Durapatite , Fluorescence , Microscopy, Confocal , Microscopy, Electron, Scanning , WaterABSTRACT
OBJECTIVES: The aim of this in vitro study was to evaluate the effect of incorporating three different nanobiomaterials into bleaching material on microhardness of bleached enamel. MATERIALS AND METHODS: The crowns of 24 extracted sound human molars were sectioned. Sixty enamel specimens (2 × 3 × 4 mm) were selected and divided into five groups (n = 12): Group 1 received no bleaching procedure (control); Group 2 underwent bleaching with a 40% hydrogen peroxide (HP) gel; Groups 3, 4, and 5 were bleached with a 40% HP gel modified by incorporation of bioactive glass (BAG), amorphous calcium phosphate (ACP) and hydroxyapatite (HA), respectively. The enamel microhardness was evaluated. The differences in Knoop microhardness data of each group were analyzed by one-way ANOVA, followed by post hoc Tukey tests. RESULTS: Significant differences were observed between the study groups. The enamel microhardness changes in Groups 1, 3, 4, and 5 were significantly lower than that of Group 2 (p < 0.001). CONCLUSIONS: Within the limitations of this study, it can be concluded that incorporation of each one of the three tested biomaterials as remineralizing agents might be effective in decreasing enamel microhardness changes subsequent to in-office bleaching.
Subject(s)
Humans , Biocompatible Materials , Calcium , Crowns , Dental Enamel , Durapatite , Glass , Hardness , Hydrogen Peroxide , In Vitro Techniques , MolarABSTRACT
O efeito protetor da caseína fosfopeptídea fosfato de cálcio amorfo (CPP-ACP) contra a erosão dentária é controverso. Este estudo in situ teve como objetivo investigar a capacidade de uma goma de mascar com CPP-ACP em prevenir uma única desmineralização erosiva. Blocos de esmalte bovino (120) selecionados pela dureza superficial inicial foram divididos aleatoriamente entre os grupos: GI - goma de mascar com CPP-ACP, GII - goma de mascar sem CPP-ACP e GIII - controle negativo para avaliação do efeito protetor sem estimulação salivar (sem goma de mascar). Dezenove voluntários participaram do estudo durante três fases cruzadas de 2 h cada. Nas fases de GI e GII os voluntários usaram dispositivos intrabucais palatinos contendo 2 blocos de esmalte, durante 120 minutos e mascaram uma unidade da goma de mascar correspondente ao grupo nos últimos 30 minutos. No grupo controle os voluntários usaram o dispositivo intrabucal por 2h, sem uso de goma de mascar. Em cada fase, imediatamente após a utilização, os dispositivos intrabucais foram imersos em refrigerante tipo cola durante 5 minutos para promover a desmineralização erosiva. A dureza superficial final foi mensurada e os valores foram utilizados para o cálculo do percentual de perda de dureza. Os dados foram analisados por ANOVA de medidas repetidas e teste Tukey (α = 5%). Menor perda de dureza do esmalte foi encontrada após a utilização de goma de mascar com (GI - 32,7%) e sem (GII - 33,5%) CPP-ACP relação ao efeito salivar sem estimulação (GIII - 39,8%) (p <0,05). Não houve diferença entre GI e GII (p> 0,05). Os resultados sugerem que a utilização de goma de mascar imediatamente antes de uma desmineralização erosiva é capaz de diminuir a perda de dureza do esmalte. No entanto, a presença de CPP-ACP na goma de mascar não foi capaz de melhorar este efeito...
The erosion-protective effect of CPP-ACP is controversial. This in situ study aimed to investigate the ability of CPP-ACP chewing gum to prevent a single event of erosive demineralization. Bovine enamel blocks (120), after selection (initial surface hardness) were randomly assigned to groups: GI-chewing gum with CPP-ACP, GIIchewing gum without CPP-ACP and Control group-salivary effect without stimulation (no gum). Nineteen volunteers participated on this study during 3 crossover phases of 2 h. On GI and GII, the volunteers wore intraoral palatal devices for 120 min and chewed a unit of the corresponding chewing gum on the last 30 min. On Control group the volunteer wore the appliance for 2 h, without chewing gum. On each phase immediately after the intraoral use, devices were extra orally immersed in cola drink for 5 minutes to promote erosive demineralization. The percentage of surface hardness loss was calculated. The data were analyzed by Repeated Measures ANOVA and Turkeys test. Less enamel hardness loss was found after the use of chewing gum with (GI-32.7 %) and without (GII-33.5%) CPP-ACP when compared to salivary effect without stimulation (control- 39.8%) (p<0.05). There was no difference between GI and GII (p>0.05). The results suggest that the use of chewing gum immediately before an erosive demineralization is able to diminish the enamel hardness loss. However, the presence of CPP-ACP in the chewing gum cannot enhance this protective effect...