Medical Journal of Mashhad university of Medical Sciences

Medical Journal of Mashhad university of Medical Sciences

Effect of Incorporation of CPP-ACP into an Iranian Toothpaste on Remineralization of Enamel Lesion

Document Type : Research Paper

Authors
Shaghayegh Rafiei 1
Hossein Bagheri 2
Mohsen Gholizadeh 3
Ali Faramarzi Garmroodi 4
Aliakbar Hodjatpanah Montazeri 4
Abdolrasoul Rangrazi 5
1 School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran
2 Dental Materials Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
3 3Graduate student, School of Dentistry, University of Alberta, Edmonton, Alberta, Canada
4 Private Office, Mashhad, Iran
5 Dental Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
10.22038/mjms.2024.76904.4486
Abstract
Introduction
The aim of this study is to examine the impact of incorporating Casein Phosphopeptide-Amorphous Calcium Phosphate (CPP-ACP), produced at the Dental Materials Research Center of Mashhad University of Medical Sciences, into an Iranian toothpaste on the remineralization of enamel lesions.
Material and Method
Twenty enamel blocks were obtained by cutting sections from the crowns of cow incisor teeth. Each enamel block was divided into thirds; one-third was varnished to serve as the healthy control, while the remaining two-thirds underwent a demineralization process.
Following demineralization, the remaining half of the enamel block surface was varnished, leaving only the third area exposed to the remineralization process. The 20 enamel blocks were then divided into two groups: the first group received Meridant Complete7 toothpaste, and the second group received Meridant Complete7 toothpaste containing 1% CPP-ACP by weight.
In each group, the designated toothpaste was applied to the exposed third area for 3 minutes, followed by washing with distilled water and placement in an artificial saliva solution. This procedure was repeated daily for seven days. Remineralization was assessed using the Vickers microhardness method, measuring at depths of 20, 50, 100, and 150 micrometers in the three designated areas, from the surface to the depth.
Results
The results indicated that the incorporation of CPP-ACP into Merident toothpaste significantly enhanced remineralization at depths of 20 micrometers (p=0.028) and 50 micrometers (p=0.033). However, at other depths, the addition of CPP-ACP did not yield a statistically significant difference in the toothpaste's impact on remineralization.
Conclusion
In conclusion, the findings of this study demonstrate that the incorporation of CPP-ACP into Merident Iranian toothpaste enhances its efficacy in remineralizing enamel lesions, particularly in the surface layer of tooth enamel
Keywords
Toothpaste
Remineralization
CPP-ACP
Enamel Lesion
  1. Enax J, Meyer F, Schulze zur Wiesche E, Fuhrmann IC, Fabritius H-O. Toothpaste Abrasion and Abrasive Particle Content: Correlating High-Resolution Profilometric Analysis with Relative Dentin Abrasivity (RDA). Dentistry Journal. 2023;11(3):79.
  2. Kanouté A, Dieng SN, Diop M, Dieng A, Sene AK, Diouf M, et al. Chemical vs. natural toothpaste: which formulas for which properties? A scoping review. Journal of Public Health in Africa. 2022;13(3).
  3. Soi S, Vinayak V, Singhal A, Roy S. Fluorides and their role in demineralization and remineralization. J Dent Sci Oral Rehabil. 2013;14:19-21.
  4. Arifa MK, Ephraim R, Rajamani T. Recent advances in dental hard tissue remineralization: a review of literature. International journal of clinical pediatric dentistry. 2019;12(2):139.
  5. Walsh T, Worthington HV, Glenny AM, Marinho VC, Jeroncic A. Fluoride toothpastes of different concentrations for preventing dental caries. Cochrane database of systematic reviews. 2019(3).
  6. Schüpbach P, Neeser J-R, Golliard M, Rouvet M, Guggenheim B. Incorporation of caseinoglycomacropeptide and caseinophosphopeptide into the salivary pellicle inhibits adherence of mutans streptococci. Journal of Dental Research. 1996;75(10):1779-88.
  7. Aimutis WR. Bioactive properties of milk proteins with particular focus on anticariogenesis. The Journal of nutrition. 2004;134(4):989S-95S.
  8. Cardoso-Martins I, Pessanha S, Coelho A, Arantes-Oliveira S, Marques PF. Evaluation of the Efficacy of CPP-ACP Remineralizing Mousse in Molar-Incisor Hypomineralized Teeth Using Polarized Raman and Scanning Electron Microscopy—An In Vitro Study. Biomedicines. 2022;10(12):3086.
  9. Bhat DV, Awchat KL, Singh P, Jha M, Arora K, Mitra M. Evaluation of remineralizing potential of CPP-ACP, CPP-ACP+ F and β TCP+ F and their effect on microhardness of enamel using vickers microhardness test: An in vitro study. International Journal of Clinical Pediatric Dentistry. 2022;15(Suppl 2):S221.
  10. Rose R. Effects of an anticariogenic casein phosphopeptide on calcium diffusion in streptococcal model dental plaques. Archives of oral biology. 2000;45(7):569-75.
  11. Giacamana RA, Molinaa CAMJ, Fernándeza CMVCE. Effect of Casein Phosphopeptide-Amorphous Calcium Phosphate Added to Milk, Chewing Gum, and Candy on Dental Caries: A Systematic Review. 2023.
  12. Itthagarun A, Verma S, Lalloo R, King N, Wefel J, Nair R. Effects of fluoridated milk on artificial enamel carious lesions: a pH cycling study. Journal of dentistry. 2011;39(12):817-24.
  13. Wu G, Liu X, Hou Y. Analysis of the effect of CPP-ACP tooth mousse on enamel remineralization by circularly polarized images. The Angle Orthodontist. 2010;80(5):933-8.
  14. Somasundaram P, Vimala N, Mandke LG. Protective potential of casein phosphopeptide amorphous calcium phosphate containing paste on enamel surfaces. Journal of conservative dentistry: JCD. 2013;16(2):152.
  15. Tao S, Zhu Y, Yuan H, Tao S, Cheng Y, Li J, et al. Efficacy of fluorides and CPP-ACP vs fluorides monotherapy on early caries lesions: A systematic review and meta-analysis. PloS one. 2018;13(4):e0196660.
  16. Ogata K, Warita S, Shimazu K, Kawakami T, Aoyagi K, Karibe H. Combined effect of paste containing casein phosphopeptide-amorphous calcium phosphate and fluoride on enamel lesions: an in vitro pH-cycling study. Pediatric dentistry. 2010;32(5):433-8.
  17. Zhou C, Zhang D, Bai Y, Li S. Casein phosphopeptide–amorphous calcium phosphate remineralization of primary teeth early enamel lesions. Journal of dentistry. 2014;42(1):21-9.
  18. Wegehaupt FJ, Attin T. The role of fluoride and casein phosphopeptide/amorphous calcium phosphate in the prevention of erosive/abrasive wear in an in vitro model using hydrochloric acid. Caries research. 2010;44(4):358-63.
  19. Caruana PC, Al Mulaify S, Moazzez R, Bartlett D. The effect of casein and calcium containing paste on plaque pH following a subsequent carbohydrate challenge. Journal of dentistry. 2009;37(7):522-6.
  20. Tantbirojn D, Huang A, Ericson M, Poolthong S. Change in surface hardness of enamel by a cola drink and a CPP–ACP paste. Journal of dentistry. 2008;36(1):74-9.
  21. Thierens LA, Moerman S, Elst Cv, Vercruysse C, Maes P, Temmerman L, et al. The in vitro remineralizing effect of CPP-ACP and CPP-ACPF after 6 and 12 weeks on initial caries lesion. Journal of Applied Oral Science. 2019;27.
  22. Holt C. Casein micelle substructure and calcium phosphate interactions studied by sephacryl column chromatography. Journal of Dairy Science. 1998;81(11):2994-3003.
  23. Kumar V, Itthagarun A, King N. The effect of casein phosphopeptide‐amorphous calcium phosphate on remineralization of artificial caries‐like lesions: an in vitro study. Australian dental journal. 2008;53(1):34-40.
  24. Rahiotis C, Vougiouklakis G. Effect of a CPP-ACP agent on the demineralization and remineralization of dentine in vitro. Journal of dentistry. 2007;35(8):695-8.
  25. Hay KD, Thomson WM. A clinical trial of the anticaries efficacy of casein derivatives complexed with calcium phosphate in patients with salivary gland dysfunction. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology. 2002;93(3):271-5.
  26. Hay K, Morton R. The efficacy of casein phosphoprotein-calcium phosphate complex (DC-CP)[Dentacal] as a mouth moistener in patients with severe xerostomia. The New Zealand Dental Journal. 2003;99(2):46-8.
Medical Journal of Mashhad university of Medical Sciences
Volume 66, Issue 6
January and February 2024