Remineralization effect of casein phosphopeptide-amorphous calcium phosphate for enamel demineralization: a system review

doi:10.7518/hxkq.2017.06.013

Abstract

Abstract:

Objective 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. Methods 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. Results Twelve RCTs were included. Because of the difference of experimental design and evaluation standards, the quantitative analysis can not be carried out. Conclusion There is no strong evidence that CPP-ACP is superior to con-ventional 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.

Key words: casein phosphopeptide-amorphous calcium phosphate, randomized controlled trial, system review, white spot lesion

CLC Number:

R781.1

Xiaotong Wang, Nanquan Rao, Jing Xie, Yuming Zhao, Lihong Ge. Remineralization effect of casein phosphopeptide-amorphous calcium phosphate for enamel demineralization: a system review[J]. West China Journal of Stomatology, 2017, 35(6): 629-635.

Figures/Tables 3

Tab 1

The basic characteristics of included studies

文献		氟暴露	研究设计	研究人群		评价方法	结果	不良反应及安全性
文献		氟暴露	研究设计	样本量	年龄/岁	评价方法	结果	不良反应及安全性
正畸后WSL	Bailey等^[4]	理想的水氟浓度,	随机双盲	45	12~19	ICDAS Ⅱ	Tooth Mousse^®组有更	与治疗相关或无关的
		每次就诊时用含氟	临床试验			临床计分	明显的病损减少趋势	非严重不良事件（39
		牙膏（1 000 mg·L^-1）					（无统计学差异）。	例）;可能与实验糊
		和含氟漱口水					12周时,基线2或3分	剂相关的轻微消化道
		（900 mg·L^-1）					的病损,Tooth Mousse^®	不适症状（1例）;
							组改善显著高于对照	相关联的或者严重不
							组	良反应（0）
	Beerens等^[10]	非氟化水;含氟	随机双盲	65	12~19	QLF图像	12周后,试验组与对	未提及
		牙膏	临床试验				照组均改善,无显著
							性差异
	Bröchner等^[5]	低水氟浓度（<	随机单盲	60	13~18	QLF测量法	4周后,QLF测量△F	无副作用或不良反应
		0.2 mg·L^-1）	临床试验				值以及病损都显著降	的报告
							低,试验组和对照组
							间无显著性差异
	Huang等^[6]	水氟浓度未	随机单盲	115	12~20	牙医、非专	8周时,试验组与对	未提及
		知,含氟牙膏	平行分组			业人士、患	照组无显著性差异
		（1 100 mg·L^-1）	试验			者根据照片
						记录进行目
						测评估
	Singh等^[7]	水氟浓度未	随机双盲	36	16~25	视诊;DIA-	6个月时,使用含氟	未提及
		知,含氟牙膏	临床试验			GNOdent	牙膏可以显著促进正
		（1 000 mg·L^-1）				scores	畸后WSL再矿化;额
							外使用 5%NaF或CPP-
							ACP没有叠加效果
	聂琳等^[8]	水氟浓度未知,含	随机临床	63	12~18	EDI	正畸治疗前和正畸结	未提及
		氟牙膏（0.14%）	对照试验				束后1个月两组EDI的
							差异无统计学意义,
							结束后3个月有试验
							组EDI显著低于对照
							组
	唐璐等^[9]	未知	随机双盲	20	10~17	根据照片进	2个月后,治疗前后	未提及
			临床试验			行EDI评价	B组EDI差值（CPP-
							ACP）大于A组
乳牙釉质脱矿	Memarpour等^[11]	水氟浓度相似	随机双盲	140	12~36	WSL尺寸;	12个月后,TM糊剂	组3、组4中没有出
		（<0.7 mg·L^-1）	平行临床			dmft指数	组WSL面积减小效果	现不良反应报告
			对照试验				最显著（63%）。但
							各组之间没有显著性
							差异
	Sitthisettapong等^[12]	水氟浓度<	随机双盲	296	2½~3½	QLF分析	1年时,两组的釉质	实验中无副作用或
		0.1 mg·L^-1,	安慰剂对				及牙本质龋坏数目、	不良反应报道
		含氟牙膏	照试验				dmfs均显著升高。组
		（1 000 mg·L^-1）					间无显著性差异
恒牙釉质脱矿	Aykut-Yetkiner等^[13]	水氟浓度未知,	随机单盲	60	13±0.68	拍照;	3个月后对照组的DI-	未提及
		含氟牙膏	临床对照			DIAGNOdent	AGNOdent读数显著
		（1 450 mg·L^-1）	试验			device	上升,实验有所降
							低,但无统计学意义
	Krithikadatta等^[14]	水氟浓度未知,膳	随机单盲	45	17~20	DIAGNOdent	30 d后, Tooth Mou-	未提及
		食和口腔卫生指导	对照试验			读数	sse^®和Tooth Mousse
							Plus^®再矿化效能相似,
							且显著优于漱口水
	Yazicioğlu等^[15]	水氟浓度未知,	随机单盲	42		视诊;影像	18个月后,CPP-ACP	未提及
		含氟牙膏	临床对照			学检查;	可以抑制釉质损伤脱
			试验			DIAGNOdent	矿,促进再矿化
						device

Tab 1

Fig 1

Fig 2

References 26

[1]	Reynolds EC.Calcium phosphate-based remineralization systems: scientific evidence[J]. Aust Dent J, 2008, 53(3):
	268-273.
[2]	Ferrazzano GF, Amato I, Cantile T, et al.In vivo reminera-lising effect of GC tooth mousse on early dental enamel lesions: SEM analysis[J]. Int Dent J, 2011, 61(4):210-216.
[3]	Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions. Version 5.1.0[M/OL]. The Cochrane Collaboration, 2011. .
[4]	Bailey DL, Adams GG, Tsao CE, et al.Regression of post-orthodontic lesions by a remineralizing cream[J]. J Dent Res, 2009, 88(12):1148-1153.
[5]	Bröchner A, Christensen C, Kristensen B, et al.Treatment of post-orthodontic white spot lesions with casein phospho-peptide-stabilised amorphous calcium phosphate[J]. Clin Oral Investig, 2011, 15(3):369-373.
[6]	Huang GJ, Roloff-Chiang B, Mills BE, et al.Effectiveness of MI Paste Plus and PreviDent fluoride varnish for treat-ment of white spot lesions: a randomized controlled trial[J]. Am J Orthod Dentofacial Orthop, 2013, 143(1):31-41.
[7]	Singh S, Singh SP, Goyal A, et al.Effects of various remi-neralizing agents on the outcome of post-orthodontic white spot lesions (WSLs): a clinical trial[J]. Prog Orthod, 2016, 17(1):25.
[8]	聂琳, 李佳岭, 马巧玲, 等. 酪蛋白磷酸肽钙磷复合体治疗正畸后釉质脱矿的临床研究[J]. 口腔医学, 2015, 35(11):948-950.
	Nie L, Li JL, Ma QL, et al.Clinical study on remineralizing effect of CPP-ACP on enamel demineralization after ortho-dontic treatment[J]. Stomatology, 2015, 35(11):948-950.
[9]	唐璐, 李宇. CPP-ACP治疗正畸后釉质白斑的临床疗效评价[J]. 成都医学院学报, 2015, 10(4):442-444.
	Tang L, Li Y.The clinical efficacy evaluation of CPP-ACP on white enamel after orthodontic treatment[J]. J Chengdu Med College, 2015, 10(4):442-444.
[10]	Beerens MW, van der Veen MH, van Beek H, et al. Effects of casein phosphopeptide amorphous calcium fluoride phos-phate paste on white spot lesions and dental plaque after orthodontic treatment: a 3-month follow-up[J]. Eur J Oral Sci, 2010, 118(6):610-617.
[11]	Memarpour M, Fakhraei E, Dadaein S, et al.Efficacy of fluoride varnish and casein phosphopeptide-amorphous calcium phosphate for remineralization of primary teeth: a randomized clinical trial[J]. Med Princ Pract, 2015, 24(3):231-237.
[12]	Sitthisettapong T, Doi T, Nishida Y, et al. Effect of CPP-ACP paste on enamel carious lesion of primary upper ante-rior teeth assessed by quantitative light-induced fluorescence: a one-year clinical trial[J]. Caries Res, 2015, 49(4):434-441.
[13]	Aykut-Yetkiner A, Kara N, Ateş M, et al.Does casein phos-phopeptid amorphous calcium phosphate provide reminera-lization on white spot lesions and inhibition of Streptococcus mutans[J]. J Clin Pediatr Dent, 2014, 38(4):302-306.
[14]	Krithikadatta J, Fredrick C, Abarajithan M, et al.Reminera-lisation of occlusal white spot lesion with a combination of 10% CPP-ACP and 0.2% sodium fluoride evaluated using Diagnodent: a pilot study[J]. Oral Health Prev Dent, 2013, 11(2):191-196.
[15]	Yazicioğlu O, Ulukapi H.The investigation of non-invasive techniques for treating early approximal carious lesions: an in vivo study[J]. Int Dent J, 2014, 64(1):1-11.
[16]	Shungin D, Olsson AI, Persson M.Orthodontic treatment-related white spot lesions: a 14-year prospective quantitative follow-up, including bonding material assessment[J]. Am J Orthod Dentofacial Orthop, 2010, 138(2):136-131.
[17]	Boersma JG, van der Veen MH, Lagerweij MD, et al. Caries prevalence measured with QLF after treatment with fixed orthodontic appliances: influencing factors[J]. Caries Res, 2005, 39(1):41-47.
[18]	Heymann GC, Grauer D.A contemporary review of white spot lesions in orthodontics[J]. J Esthet Restor Dent, 2013, 25(2):85-95.
[19]	Honkala E.Primary oral health care[J]. Med Princ Pract, 2014, 23(Suppl 1):17-23.
[20]	Zhou C, Zhang D, Bai Y, et al.Casein phosphopeptide-amorphous calcium phosphate remineralization of primary teeth early enamel lesions[J]. J Dent, 2014, 42(1):21-29.
[21]	Wong MC, Glenny AM, Tsang BW, et al. Topical fluoride as a cause of dental fluorosis in children[J]. Cochrane Data-base System Rev, 2010, 6(1):CD007693.
[22]	Franco AM, Martignon S, Saldarriaga A, et al.Total fluoride intake in children aged 22-35 months in four Colombian cities[J]. Community Dent Oral Epidemiol, 2005, 33(1): 1-8.
[23]	Moraes SM, Pessan JP, Ramires I, et al.Fluoride intake from regular and low fluoride dentifrices by 2-3-year-old children: influence of the dentifrice flavor[J]. Braz Oral Res, 2007, 21(3):234-240.
[24]	Santos AP, Oliveira BH, Nadanovsky P.Effects of low and standard fluoride toothpastes on caries and fluorosis: syste-matic review and meta-analysis[J]. Caries Res, 2013, 47(5):382-390.
[25]	Mejàre I, Källestål C, Stenlund H.Incidence and progression of approximal caries from 11 to 22 years of age in Sweden: A prospective radiographic study[J]. Caries Res, 1999, 33(2):93-100.
[26]	Lussi A, Megert B, Longbottom C, et al.Clinical perfor-mance of a laser fluorescence device for detection of occlusal caries lesions[J]. Eur J Oral Sci, 2001, 109(1):14-19.