The Journal of Contemporary Dental Practice

Register      Login



Volume / Issue

Online First

Related articles

VOLUME 19 , ISSUE 10 ( 2018 ) > List of Articles


Effect of Two Remineralizing Agents on Initial Caries-like Lesions in Young Permanent Teeth: An in Vitro Study

Dalia AM Talaat, Ahmed AM Abdelrahman, Reham H Abdelaziz, Dina Nagy

Keywords : Casein phosphopeptide-amorphous calcium phosphate fluoride, Initial caries lesion, Nano-hydroxyapatite, Young permanent teeth.

Citation Information : Talaat DA, Abdelrahman AA, Abdelaziz RH, Nagy D. Effect of Two Remineralizing Agents on Initial Caries-like Lesions in Young Permanent Teeth: An in Vitro Study. J Contemp Dent Pract 2018; 19 (10):1181-1188.

DOI: 10.5005/jp-journals-10024-2403

License: CC BY-NC 3.0

Published Online: 01-08-2018

Copyright Statement:  Copyright © 2018; The Author(s).


Aim: To compare the effect of nano-hydroxyapatite (9000 ppm F) and casein phosphopeptide-amorphous calcium phosphate fluoride (900 ppm F) pastes on initial enamel carious lesions of young permanent teeth. Materials and methods: Sixty extracted young premolars with a standardized window on enamel were immersed in a demineralizing solution for 48 hours to produce subsurface enamel lesions. They were divided into three groups according to remineralizing agents (n = 20) group I: nano-hydroxyapatite paste; group II: casein phosphopeptide-amorphous calcium phosphate fluoride paste; and group III: control (without an agent). The enamel surface microhardness (SMH) was measured at baseline, after the incipient enamel lesion, and after treatment. Additional twenty young premolars were selected and prepared as mentioned above for surface morphology evaluation by scanning electron microscope (SEM). Results: No significant difference was found in mean surface microhardness in teeth treated with nano-hydroxyapatite paste and those treated with casein phosphopeptide-amorphous calcium phosphate fluoride p = 0.26. SEM showed improvement in surface defects of demineralized enamel in the two test groups. Conclusion: Nano-hydroxyapatite and casein phosphopeptide- amorphous calcium phosphate fluoride pastes were effective in rehardening the initial enamel caries lesions in young permanent teeth. Clinical significance: The best strategy for caries management is to focus on the methods of improving the remineralization process with the aid of the remineralizing agents. The current study compared the remineralizing effect of two remineralizing agents. Within the limitations of the study, both remineralizing agents were effective for remineralization of early caries-like lesions.

PDF Share
  1. Zero DT. Dental caries process Dent. Clin North Am.1999; 43:635-664.
  2. Tenuta LMA, Cury JA. Fluoride: its role in dentistry. Braz Oral Res. 2010;24:9-17.
  3. Ten Cate JM. Current concepts on the theories of the mechanism of action of uoride. Acta Odontol Scand. 1999;57: 325-329.
  4. Minah G, Lin C, Coors S, Rambob I, Tinanoff N, Grossman LK. Evaluation of an early childhood caries prevention program at an urban pediatric clinic. Pediatr Dent. 2008;30:499-504.
  5. O'Keefe E. Fluoride varnish may be effective in pre- schoolers. Evid Based Dent. 2011;12:41-42.
  6. Azarpazhooh A, Main PA. Fluoride varnish in the pre- vention of dental caries in children and adolescents: a systematic review. J Can Dent Assoc. 2008;74:73-79.
  7. Almeida MQ, Costa OX, Ferreira JM, Menezes VA, Leal RB, Sampaio FC. Therapeutic potential of Brazilian fluoride varnishes: an in vivo study. Braz Dent J. 2011;22: 193- 197.
  8. deAmorim RG, Leal SC, Bezerra AC, de Amorim FP, de Toledo OA. Association of chlorhexidine and fluoride for plaque control and white spot lesion remineralization in primary dentition. Int J Paediatr Dent. 2008;18:446-451.
  9. Yengopal V, Mickenautsch S. Caries preventive effect of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP): a meta-analysis. Acta OdontolScand. 2009;67:321-332.
  10. Huang SB, Gao SS, Cheng L, Yu HY. Combined effects of nano-hydroxyapatite and Gallachinensis on remineralization of initial enamel lesion in vitro. J Dent. 2010;38:811-819.
  11. Huang S, Gao S, Cheng L, Yu H. Remineralization potential of nano-hydroxyapatite on initial enamel lesions: an in vitro study. Caries Res. 2011;45:460-468.
  12. Aimuts WR. Bioactive properties of milk proteins with particular focus on anticariogenesis. J Nutr. 2004; 134: 989-995.
  13. Reynolds EC. Remineralization of enamel subsurface lesions by casein phosphopeptide-stabilized calcium phosphate solutions. J Dent Res. 1997; 76: 1587-1595.
  14. Yengopal V, Mickenautsch S. Caries preventive effect of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP): a meta-analysis. Acta OdontolScand. 2009;67:321-332.
  15. Lata S, Varghese NO, Varughese JM. Remineralization potential of fluoride and amorphous calcium phosphate-casein phosphopeptide on enamel lesions: an in vitro comparative evaluation. J Conserv Dent. 2010;13:42-46.
  16. Rehder Neto FC, Maeda FA, Turssi CP, Serra MC. Potential agents to control enamel caries-like lesions. J Dent. 2009;37:786-790.
  17. Zhang Q, Zou J, Yang R, Zhou X. Remineralization effects of casein phosphopeptide-amorphous calcium phosphate creme on artificial early enamel lesions of primary teeth. Int J Paediatr Dent. 2011;21:374-381.
  18. Rollings S, Greene L, Borrie F, Lamont T. Small trial finds beneficial effect for MI Paste in preventing white spot lesions during orthodontic treatment. Evid Based Dent. 2012;13:117- 118.
  19. Baroni C, Marchionni S, Bazzocchi MG, Cadenaro M, Nucci C, Manton DJ. A SEM and non-contact surface white light profilometry in vivo study of the effect of a crème containing CPP-ACP and fluoride on young etched enamel. Scanning. 2014;36:270-277.
  20. Li J, Xie X, Wang Y, Yin W, Antoun JS, Farella M, Mei L. Longterm remineralizing effect of casein phosphopeptide- amorphous calcium phosphate (CPP-ACP) on early caries lesions in vivo: asystematic review. J Dent. 2014; 42: 769-777.
  21. Reema SD, Lahiri PK, Roy SS. Review of casein phosphopeptides- amorphous calcium phosphate. Chin J Dent Res.2014; 17: 7-14.
  22. De Carvalho FG, Vieira BR, Santos RL, Carlo HL, Lopes PQ, De Lima B. In Vitro Effects of Nano-Hydroxyapatite Paste on Initial Enamel Carious Lesions. Pediatr Dent. 2014; 36:85-89.
  23. Kazuo Onumaa KY, Ayako O. Nucleation and growth of hydroxyapatite nanocrystals for nondestructive repair of early caries lesions. J Cryst Growth 2005; 282:199-207.
  24. Yamagishi K, Onuma K, Suzuki T, Okada F, Tagami J, Otsuki M, et al. A synthetic enamel for rapid tooth repair. Nature. 2005; 24: 433-819.
  25. Kim MY, Kwon HK, Choi CH, Kim BI. Combined effects of nano-hydroxyapatite and NaF on remineralization of early caries lesion. Key Eng Mater. 2007; 330-2, 1347-1350.
  26. Lu KL, Zhang JX, Meng XC, Li XY. Remineralization effect of the nano-HA toothpaste on artificial caries. Key Eng Mater.2007; 330-2, 267-270.
  27. IBM. SPSS Statistics for Windows. Version 21.0. Armonk, NY: IBM; 2012.
  28. Cem G, Ebru C, Seval Ö. Remineralizing effect of different topical agents on occlusal surfaces with or without caries: an in vitro evaluation study using electrical resistance measurements. Clin Dent and Res. 2012; 36: 4-9.
  29. Kumar VL, Itthagarun A, King NM. The effect of casein phosphopeptide-amorphous calcium phosphate on remin eralization of artificial caries-like lesions: an in vitro study. Aust Dent J. 2008; 53: 34-40.
  30. Kawai K, Heaven TJ, Retief DH. In vitro dentine fluoride uptake from three fluoride-containing composites and their acid resistance. J Dent. 1997; 25: 291-296.
  31. Vieira AEM, Delbem ACB, Sassaki KT, Rodrigues E, Cury JA, Cunha RF. Fluoride dose response in pH-cycling models using bovine enamel. Caries Res. 2005;39:514-520.
  32. Kruskal WH, Wallis WA. Use of Ranks in One-Criterion Variance Analysis. J Am Stat Assoc. 1952; 47: 583-621.
  33. Friedman M. The use of ranks to avoid the assumption of normality implicit in the analysis of variance. J Am Stat Assoc. 1937; 32: 675-701.
  34. Anwar AS, Kumar RK, Rao VAP, Reddy NV, Reshma VJ. Evaluation of microhardness of residual dentin in primary molars following caries removal with conventional and chemomechanical techniques: An in vitro study. J Pharm Bioallied Sci. 2017; 9 (Suppl 1): S166-S172.
  35. Shetty S, Hegde MN, Bopanna TP. Enamel remineralization assessment after treatment with three different remineralizing agents using surface microhardness: An in vitro study. J Conserv Dent. 2014; 17: 49-52.
  36. Talaat DM, Mahmoud A. Acid resistance of enamel subsurface lesions treated with casein phosphopeptide amorphous calcium phosphate fluoride. J Dent Child. 2015; 82:70-75.
  37. Huang SB, Gao SS, Yu HY. Effect of nano-hydroxyapatite concentration on remineralization of initial enamel lesion in vitro. Biomed Mater. 2009;4:034104.
  38. Haghgoo R, Rezvani MB, Zeinabadi MS. Comparison of nanohydroxyapatite and sodium fluoride mouthrinse for remineralization of incipient carious lesions. J Dent. 2014;11:406-410.
  39. De Carvalho GF, Brasil V, Filho T, Carlo H, Santos R, de Lima B. Protective effect of calcium nanophosphate and ACP-CPP agents on enamel erosin. Braz Oral Res. 2013;27:463-470.
  40. Jayarajan J, Janardhanam P, Jayakumar P, Deepika. Efficacy of CPP-ACP and CPP-ACPF on enamel remineralization - An in vitro study using scanning electron microscope and DIAGNOdent®. Indian J Dent Res 2011; 22: 77-82
  41. Srinivasan N, Kavitha M, Loganathan SC. Comparison of the remineralization potential of CPP–ACP and CPP–ACP with 900 ppm fluoride on eroded human enamel: An in situ study. Arch Oral Biol. 2010; 55: 541-544.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.