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Introduction: Enamel subsurface lesions or white spot lesions (WSLs) are commonly found in orthodontic patients with a prevalence of 5% to 97%. Aim: This systematic review aimed to evaluate the efficacy of casein phosphopeptide amorphous calcium phosphate (CPP-ACP) and casein phosphopeptide amorphous calcium phosphate fluoride (CPP-ACPF) for prevention and remineralization of WSLs in orthodontic patients in human randomized controlled clinical trials (RCTs). Methods: Relevant articles were retrieved by searching the Web of Science, Scopus, PubMed, and Cochrane Library databases up to November 2018 with no language or date restriction. The collected data included examination method, groups included in each study with number of patients in each group, study design, follow-up period and summary of important findings of each study. The risk of bias of each study was assessed according to the guidelines of the Cochrane Collaboration’s tool. Results: Of 213 articles retrieved, 13 RCTs were included in this systematic review (none of them were included in the meta-analysis). Three articles showed superior efficacy of CPP-ACP for remineralization of WSLs while four studies reported the superior clinical efficacy of CPP-ACPF for this purpose. Conclusion: Both CPP-ACP and CPP-ACPF can decrease the prevalence and increase the remineralization of WSLs during/after orthodontic treatment.

Amorphous calcium phosphate (ACP) is a well-established bioceramic material known to promote the remineralization of dental hard tissues. White spot lesions (WSLs) represent the initial stage of enamel demineralization and are frequently observed in patients with fixed orthodontic appliances or inadequate oral hygiene. Although recommendations for remineralizing agents include both the prevention of lesion progression and the stimulation of tissue remineralization, the clinical efficacy of ACP-based materials remains under debate. This systematic review, registered in the PROSPERO database (CRD42024540595), aims to evaluate the clinical efficacy of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP)-based products in the remineralization of WSLs and to compare these outcomes with those achieved using non-bioceramic approaches. Inclusion criteria comprised randomized clinical trials, prospective cohort studies, and pilot studies conducted on human subjects with WSLs affecting permanent teeth. Studies involving artificial WSLs or non-cariogenic enamel lesions were excluded. The quality of the included studies was assessed using the Cochrane Risk of Bias 2 (RoB 2) tool. Fourteen articles met the inclusion criteria and were analyzed. The main findings indicate that CPP-ACP is clinically effective in promoting the remineralization of WSLs, although the results were inconsistent across studies. Comparisons with placebo and resin infiltration treatments revealed greater efficacy for CPP-ACP. The combination of CPP-ACP with fluoride appeared to further enhance the remineralizing effect on WSLs. Additional standardized clinical studies with longer follow-up periods are warranted to confirm these outcomes.

Phosphorus retention in small- and medium-sized wastewater treatment plants is crucial to preventing the eutrophication of downstream catchments. One popular solution in combination with treatment wetlands is the use of reactive filters for phosphorus retention; however, identifying a suitable substrate is not an easy task in this process. Apatites have already proven to be an effective alternative for phosphorus retention, yet more in-depth research is needed. This article uses two natural apatite materials, NA1 and NA2, introduced in four fixed-bed laboratory columns to assess their phosphorus retention capacity. Various inflow conditions are set for the NA1 substrate to evaluate the impact of calcium and biomass development on performance. The substrates show high phosphorus retention (>16.8 g PO 4 -P/kg for NA1 and >17.5 g PO 4 -P/kg for NA2) as well as high kinetic rate coefficients (1.45 and 1.70 h −1 for NA1 and NA2, respectively), with performances above 80% for both substrates. The maximum phosphorus retention capacity is not attained at the end of the experiments, despite their long duration (230 days) and the short hydraulic residence times applied (∼2 h), thus suggesting a long-term removal capacity. The NA1 column fed with a calcium-deficient synthetic solution displays just slightly reduced kinetic rates, most likely due to calcite and dolomite dissolution from the media. The column fed with treated wastewater does not reveal any significant reduction in hydraulic conductivity due to biomass development. No loss of permeability due to chemical clogging was observed in the other columns. Scanning electron microscopy indicates that phosphorus retention occurs by the precipitation of amorphous calcium phosphate for both natural apatites, thereby clearly demonstrating the implementation of seeding mechanisms. Such a retention process is sustainable, which suggests it may proceed over even higher retention capacities.

White spots are common side effects of orthodontic treatment, and their presence after debonding appears unesthetic. This study aimed to quantify and compare the visual improvement in postdebonding white spot lesions following fluoride and casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) application. The sample included 42 upper premolars extracted for orthodontic reasons. Universal premolar brackets were bonded to the facial surfaces of the teeth that were exposed to a demineralization solution to create artificial white spot lesions, after which the brackets were debonded. The specimens were randomly allocated to three treatment groups (n = 14, each): acidulated phosphate fluoride (APF) gel application group; CPP-ACP paste application group; and control group. pH cycling was conducted to all groups for 14 days. Quantitative measurements were carried out using a spectrophotometer at the following times: before and after the white spot lesions artificially formed and after treating them. All groups showed significant differences in color change before and after treatment. However, there was no significant difference in the color improvement between the APF gel and CPP-ACP paste application groups. Although CPP-ACP application improved the color of the white spot lesions, it did not differ significantly from that of fluoride application.

The goal of this study was to evaluate the effectiveness of the toothpaste Tooth Mousse compared to conventional fluoride-based versions in the prevention of enamel and dentin demineralization. Human enamel and dentin samples (n = 120 each) were exposed to artificial demineralization at pH 4.92. During the demineralization process, the samples in the test groups were periodically treated with Tooth Mousse (TM) containing casein-phosphopeptide -amorphous-calcium-phosphate (CPP-ACP) and Tooth Mousse Plus (TMP) containing amorphous-calcium-fluoride-phosphate (CPP-ACPF) to evaluate their protective properties. Fluoride toothpastes containing 1400 ppm amine fluoride (AmF) and 1450 ppm sodium fluoride (NaF) were applied in the positive control groups. Treatment with distilled water (group C-W) or demineralization without treatment (group C-D) served as negative controls. After the demineralization and treatment process, all samples were cut longitudinally and lesion depths were determined at six locations using polarized light microscopy. In TM/TMP groups (enamel: 80/86 µm, dentin: 153/156 µm) lesion depths were significantly smaller compared to the negative control groups C-W/C-D (enamel: 99/111 µm, dentin: 163/166 µm). However, TM and TMP compared to the positive controls AmF/NaF (enamel: 58/63 µm, dentin: 87/109 µm) showed higher lesion depths. The application of TM/TMP (89%/78%) during demineralization led to a reduced number of severe lesions compared to the negative controls C-W/C-D (100%/95%). In this study we demonstrate that Tooth Mousse is less effective regarding prevention of enamel and dentin demineralization compared to fluoride containing toothpastes.

Nanocomposite hydrogels are suitable in bone tissue engineering due to their resemblance with the extracellular matrix, ability to match complex geometries, and ability to provide a framework for cell attachment and proliferation. The nanocomposite hydrogel comprises organic and inorganic counterparts. Gelatin methacrylate (GELMA) is an extensively used organic biomaterial in tissue engineering due to its excellent biocompatibility, biodegradability, and bioactivity. The photo-crosslinking of GELMA presents a challenge when aiming to create thicker nanocomposite hydrogels due to opacity induced by fillers, which obstructs the penetration of ultraviolet (UV) light. Therefore, using a chemical crosslinking approach, we have developed nanocomposite GELMA hydrogel in this study by incorporating citrate-containing amorphous calcium phosphate (ACP_CIT). Ammonium persulfate (APS) and Tetramethylethylenediamine (TEMED) were deployed to crosslink the methacrylate group of GELMA. The oscillatory shear tests have confirmed that crosslinking enhances both storage (G′) and loss modulus (G″) of GELMA. Subsequently, incorporation of ACP_CIT in GELMA hydrogel shows further enhancement in G′ and G″ values. In vitro analysis of the developed hydrogels revealed that chemical crosslinking and incorporation of ACP_CIT do not compromise the cytocompatibility of the GELMA. Hence, for developing nanocomposite GELMA hydrogels employing APS/TEMED crosslinking emerges as a promising alternative to photo-crosslinking.

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.

Objectives This study aimed to assess the impact of casein phosphopeptide‐amorphous calcium phosphate (CPP‐ACP) and proanthocyanidin (PA) on the microshear bond strength (μSBS) of universal adhesives to caries‐affected dentin (CAD) in primary teeth. Materials and Methods 160 human primary second molars with occlusal caries were utilized, with CAD‐exposed dentin surfaces. The teeth were categorized into four groups based on CAD pretreatment: no pretreatment, CPP‐ACP for 3 min, PA for 1 min, and PA for 1 min followed by CPP‐ACP for 3 min. Each group subdivided into four based on adhesive system (Gluma Bond Universal or All‐Bond Universal) and application mode (etch and rinse; E&R or self‐etch; SE). Following composite resin restoration, μSBS measurements were taken after 24 h of water storage. Results PA pretreatment showed the highest μSBS compared to controls and other methods (p < 0.001). Conversely, CAD pretreatment with CPP‐ACP + PA led to lower μSBS than the control (p = 0.009). Universal adhesive choice significantly influenced μSBS (p < 0.001), with Gluma Bond Universal outperforming All‐Bond Universal (p < 0.001). The E&R method demonstrated superior bond strength over SE (p < 0.001). Conclusion CAD pretreatment, particularly with PA, significantly impacted bond strength, with Gluma Bond Universal and the E&R method proving optimal for enhancing μSBS to CAD. These findings offer valuable insights for refining adhesive protocols in pediatric dentistry, potentially improving clinical outcomes in restorative procedures.

Objectives The aim of this study was to evaluate the effect of proanthocyanidin (PA) and casein phosphopeptide‐amorphous calcium phosphate (CPP‐ACP) paste on the micro‐shear bond strength (μSBS) durability of an etch‐and‐rinse adhesive to caries‐affected dentin (CAD). Materials and methods The occlusal surfaces of 80 human molars with occlusal caries were ground to expose flat dentin surfaces with CAD. Then, they were randomly divided into four groups (n = 20) according to the CAD pretreatment. The study groups included no pretreatment, pretreatment with CPP‐ACP for 3 min, pretreatment with PA for 1 min, and pretreatment with PA for 1 min followed by CPP‐ACP for 3 min before adhesive application. After restoring the specimens with composite resin, μSBS testing was performed for half of the bonded surfaces in each group after 24 h and the other half was tested after 6 months of water storage and failure mode analysis was performed. Results The PA group was associated with a higher μSBS than the control and CPP‐ACP groups after 24 hours (p < 0.05). No significant difference was observed regarding the μSBS of the control and the other groups after 24 h (p > 0.05). No significant difference was observed regarding the μSBS of the PA and PA + CPP‐ACP groups (p > 0.05). The μSBS of the 6‐month specimens was significantly lower than those of the 24‐h specimens for all the groups (p < 0.05) except for the PA group which did not exhibit a significant difference between the two times (p > 0.05). The most common type of failure was mixed failure. Conclusion PA pretreatment could stabilize the CAD‐resin interface and protect degradation over time. The same effect was not observed for CPP‐ACP or PA + CPP‐ACP.

Casein phosphopeptide stabilised amorphous calcium phosphate (CPP-ACP) and amorphous calcium fluoride phosphate (CPP-ACFP) solutions have been shown to remineralise enamel subsurface lesions. The aim of this study was to determine the effect of ion composition of CPP-ACP and CPP-ACFP solutions on enamel subsurface lesion remineralisation in vitro. CPP-bound and free calcium, phosphate and fluoride ion concentrations in the solutions were determined after ultrafiltration. The ion activities of the free ion species present were calculated using an iterative computational program. The mineral deposited in the subsurface lesions was analysed using transverse microradiography and electron microprobe. CPP was found to stabilise high concentrations of calcium, phosphate and fluoride ions at all pH values (7.0–4.5). Remineralisation of the subsurface lesions was observed at all pH values tested with a maximum at pH 5.5. The CPP-ACFP solutions produced greater remineralisation than the CPP-ACP solutions at pH 5.5 and below. The mineral formed in the subsurface lesions was consistent with hydroxyapatite and fluorapatite for remineralisation with CPP-ACP and CPP-ACFP, respectively. The activity gradient of the neutral ion pair CaHPO 4 ⁰ into the lesion was significantly correlated with remineralisation and together with HF⁰ were identified as important species for diffusion.