Casein phosphopeptide−amorphous calcium phosphate

Remineralization Casein phosphopeptide amorphous calcium phosphate Background.—The prevalence, incidence, and severity of dental caries have declined but it remains a major health problem in most countries. Caries research is currently focusing on developing ways to detect early caries lesions and to manage caries lesions noninvasively through remineralization and the preservation of tooth structure. Fluoride promotes remineralization but relies on calcium and phosphate ions in saliva. New remineralization agents supplement and enhance the ability of fluoride to restore tooth minerals. Casein phosphopeptide and amorphous calcium phosphate (CPP-ACP) offers the ability to stabilize free calcium and phosphate ions and binds well to dental plaque. It is also considered a calcium phosphate reservoir and interacts with fluoride ions to produce amorphous calcium fluoride phosphate (ACFP), which provides all the elements needed to promote remineralization with fluorapatite, creating a substance more resistant to acid challenges. CPP-ACP also offers an anticariogenic effect, promoting the remineralization of enamel subsurface lesions. The long-term (over 3 months) remineralizing effect of CPP-ACP on early caries lesions in vivo was compared to that of placebo and/or fluorides. Methods.—Data were gathered through a review of the databases of PubMed, the Web of Science, EMBASE, the Cochrane Library CENTRAL, Science Direct, Chinese Biological Medical (CBM), and the Chinese National Knowledge Infrastructure (CNKI) covering up to April 2013. Eight studies were evaluated, including six randomized controlled trials (RCTs) and two controlled clinical trials (CCTs) that covered 2367 subjects. Most were between age 11.5 and 18 years, with one trial including preschool children age 3.5 to 4.5 years. Follow-up lasted 3 to 24 months, with those using clinical examination as a diagnostic method usually having periods more than 1 year long and those using digital instruments for diagnosis having periods less than 6 months. CPP-ACP was delivered by water-based mousse, topical cream, paste, and chewing gum. Results.—The three studies evaluating the effect of CPP-ACP on naturally occurring caries noted a significant reduction in caries increment when CPP was used compared to the use of placebo. Chewing CPP-ACP gum significantly enhanced the regression of approximal caries compared to the results with placebo gum. The use of extra

CPP-ACP after brushing with fluoridated toothpaste offered no clear clinical advantage, however. Five trials evaluated CPP-ACP’s effects on white spot lesions (WSLs) associated with orthodontic treatment. Three found no clinical advantage to using these supplements to fluoride toothpaste, but two identified CPP-ACP as a way to help prevent WSLs. It was not clear if the toothpaste used in the latter two contained fluoride. None of the studies assessing the clinical safety of CPPACP found any serious side effects. The incidence of side effects in the treatment groups was similar to that in the control groups. No extra calculus formation occurred on primary teeth. Only one study had a low risk of bias, with the other seven having a high or unclear risk of bias. Substantial differences were found in intervention measures, times for outcome assessments, and measurement methods. Discussion.—CPP-ACP offered long-term remineralization effects on early caries lesions compared to placebo. The effect did not differ significantly from the effect achieved with fluoride, so the clinical benefit of CPP-ACP supplementation compared to fluoride’s benefits remains undetermined.

Clinical Significance.—CPP-ACP offers a significant remineralizing effect both in vivo and in vitro. However, its synergistic effect with fluoride is not yet sufficiently supported by the available evidence.

Li J, Xie W, Want Y, et al: Long-term remineralizing effect of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) on early caries lesions in vivo: A systematic review. J Dent 42:769777, 2014 Reprints available from L Mei, Discipline of Orthodontics, Dept of Oral Science, Faculty of Dentistry, Univ of Otago, Dunedin 9016, New Zealand; e-mail: [email protected], doctormeili@hot mail.com

Volume 60



Issue 4



2015

e133