Efficacy of Nano Crystallised Calcium Phosphate (NCCP) and Casein Phosphopeptide – Amorphous Calcium Phosphate (CPP-ACP) for Controlling Postoperative Sensitivity After Power Bleaching-A Comparative In-Vivo Study

Tooth bleaching is one of the most popular cosmetic dental procedures opted by the patients who desire pleasing smile. It is the simplest, least invasive means available to lighten discolored vital teeth. A number of desensitizing agents have been tried in an attempt to counteract bleaching-related sensitivity. This study was done to compare the effect of two different desensitizing agents for controlling post operative sensitivity after power bleach procedure. Sixty volunteers with mild to moderate dental fluorosis in maxillary anterior teeth, who fulfilled the inclusion and exclusion criteria, were randomly selected for this study. After the bleaching procedurea demo was given to the patient while application of desensitising gel and was instructed to use the gel for 14 days.All the patients were recalled at an interval of 1st day, 3rdday, 5th day, 7th day, and on 14th day to record the post operative sensitivity after power bleach procedure. The observations were analyzed using one way analysis of variance (ANOVA), Tukeys post hoc test. On the basis of VAS results, all the groups showed post operative sensitivity of varied intensity at different intervals. NCCP showed less sensitivity followed by CPP-ACP and Control group. Keywords: Power Bleaching, Post operative sensitivity, Nano Crystallized Calcium Phosphate, Casein Phosphopeptide-Amorphous Calcium Phosphate

Effects of desensitizing dentifrices on dentin tubule occlusion and resistance to erosive challenges

Background Many studies have demonstrated efficacy of casein phosphopeptide (CPP) containing products for dentin tubule occlusion for treatment of dentin sensitivity, but their effectiveness under dynamic erosive challenges remains to be elucidated. The purpose of the present study was to investigate the effectiveness of a desensitizing dentifrice containing CPP in occluding dentin tubules and resisting erosive challenges in comparison to that containing polyvinyl methyl ether/maleic acid (PVM/MA) copolymers. Methods A total of 33 dentin discs were prepared from coronal sections of human third molars and divided into 3 groups: a toothpaste containing CPP; a toothpaste containing PVM/MA and submicron silica; and a regular toothpaste (Controls). A soft-bristle toothbrush was used to brush the dentin discs with the dentifrices for 45 strokes in 30 s at a force of approximately 200 g. The brushing cycle was repeated after immersion of the dentin discs in artificial saliva overnight. The dentin discs were then challenged in orange juice for 10 min in an incubator rocking at 120 rpm. Three fields were randomly selected on each dentin disk surface to assess dentin tubule occlusions after each brushing cycle and after orange juice challenge with a 3D laser scanning microscope. Specimen cross sections were examined with a scanning electron microscope equipped with energy dispersive spectroscopy (SEM/EDS). Results After the first and second cycles of brushing, dentin tubules were occluded on average by 56.3% and 85.7% in CPP group, 66.2% and 88.1% in PVM/MA group, and 0.0 and 13.0% in the controls, respectively. There were no statistically significant differences in dentin tubule occlusions between the CPP and PVM/MA groups after two cycles of brushing (p>0.05). After dynamic erosive challenges with orange juice, 20.3% of the dentin tubules in the CPP group, 79.1% in the PVM/MA group and none in the control remained occluded (P<0.05). SEM/EDS imaging showed that dentin tubules were blocked with plugs containing dentifrice substances in CPP and PVM/MA groups after treatments, but none in the controls. Conclusions Desensitizing dentifrices containing CPP or PVM/MA could effectively occlude dentin tubules after two cycles of brushing. PVM/MA in combination with submicron silicon dioxide exhibited stronger resistance to dynamic erosive challenges by acidic beverages. Inorganic fillers that can enter dentin tubules and resist erosive challenges may be key for desensitizing dentifrices.

COMPARATIVE EVALUATION OF EFFECTIVENESS OF CASEIN PHOSPHOPEPTIDE AMORPHOROUS CALCIUM PHOSPHATE AND SODIUM FLOURIDE VARNISH IN DENTINE HYPERSENTIVITY

Objective: To determine efficacy of casein phosphopeptide amorphous calcium phosphate and sodium fluoride varnish in managing dentine hypersentivity. Study Design: Quasi-experimental study. Place and Duration of Study: Foundation University College of Dentistry, Islamabad, from Jun to Nov 2020. Methodology: Patients of both gender 20-60 years of age with ASA “American Society of Anesthesiologists physical status classification” status I (completely healthy fit patient) or status II (patient has mild systemic disease) diagnosed with dentine hypersensitivity of incisors, canines, premolars with clinical evidence of erosion, abrasion, gingival recession not requiring restorative treatment were enrolled in the study. At first visit baseline, dentine hypersentivity was recorded by means of tactile and evaporative stimuli, response was quantified using visual analogue scale. Patients were randomly divided in two groups 1-casein phosphopeptide amorphous calcium phosphate, 2-sodium fluoride varnish desensitizing agent was applied conferring to manufacturer instructions. Visual analogue scale readings were assessed at base line and post treatment valueswas recorded at 7th, 15th, 30th day. Results: Total 80 patients enrolled in the study with a mean age of 36.26 ± 8.91 years and age-range of 21-60 years. Visual analogue scale results of group-1 (n=40) were recorded at baseline as 5.9 ± 0 .94, 7th day 1.9 ± 0.92, 15th day 1.4 ± 0 .81 and 30th day 1.0 ± 0.71. In case of group-2 Visual Analogue Score recorded to be 6.2 ± 1.24,3.2 ± 0.81, 3.0 ± 0.52 and 2.7 ± 1.12 at baseline, 7th, 15th, and 30th day respectively. Conclusion: Casein phosphopeptide amorphous..................

The Effects of Three Remineralizing Agents on the Microhardness and Chemical Composition of Demineralized Enamel

This study aimed to determine the effects of three different varnish materials (containing casein phosphopeptide-amorphous calcium phosphate, nano-hydroxyapatite, and fluoride) on enamel. Thirty-three extracted human third molars were used for specimen preparation. These were demineralized using phosphoric acid. Three experimental groups (n = 11) were treated with 3M™ Clinpro™ White Varnish, MI Varnish®, and Megasonex® toothpaste, respectively, every twenty-four hours for fourteen days. Analysis of the microhardness of the specimens’ enamel surfaces was carried out via the Vickers method, and by scanning electron microscopy/energy dispersive X-ray spectroscopy (SEM/EDS). Analysis was performed at three stages: at baseline value, after demineralization, and after the period of remineralization. Data were subjected to Scheffe’s post hoc test. The mean microhardness values (HV0.1) obtained for the group of samples treated with MI Varnish® were higher compared with the other two groups (p = 0.001 for both comparisons), while the first and third groups did not differ significantly from each other (p = 0.97). SEM analysis showed uneven patterns and porosities on all samples tested. EDS results showed an increase in the mineral content of the examined samples, with the highest mineral content observed in the MI Varnish® group. It can be concluded that MI Varnish® use has a better remineralization effect on enamel than the other two materials.

Effectiveness of Casein Phosphopeptide-Amorphous Calcium Phosphate (CPP-ACP) Compared to Fluoride Products in an In-Vitro Demineralization Model

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.

Comparison of Casein Phosphopeptide with Potassium Nitrate and Sodium Monofluorophosphate Desensitizing Efficacy after In-Office Vital Bleaching—A Randomized Trial

Casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), potassium nitrate, and sodium monofluorophosphate are desensitizing agents that help in reducing teeth sensitivity. However, indecisive evidence exists regarding their efficacy. Therefore, this study was conducted to compare the desensitizing efficacy of casein phosphopeptide-amorphous calcium phosphate and potassium nitrate with sodium monofluorophosphate agents after in-office vital bleaching. A randomized controlled trial was conducted on 2011 patients. The patients were randomly and equally divided into the CPP-ACP group (group 1), potassium nitrate with sodium monofluorophosphate group (group 2), and placebo gel (group 3). The upper and lower anterior teeth including the first premolar were isolated with a rubber dam, then the bleaching agents were applied on the labial surface of all the teeth, followed by light activation for 15 min. The procedure was repeated 3 times with an interval of 5 min in-between. After carrying out the bleaching procedure, patients were given a desensitizing gel or placebo gel in unmarked syringes with an instruction to apply it every 12 h for up to 3 days. The intensity of pain was recorded using a discomfort interval scale (DIS). A decrease in pain was observed 24 h after the application of the desensitizing gel in groups 1 and 2. However, in group 3, the pain persisted, with 46 (69.69%) patients having moderate pain and 14 (21.21%) developing severe pain over time. A significant difference in discomfort level with time was noted in group 1 (p = 0.015) and group 2 (p = 0.036). However, no significant difference was found in group 3 (p = 0.085). It was concluded that both desensitizing agents performed exceptionally well in reducing teeth sensitivity.

Effect of Casein Phosphopeptide Amorphous Calcium Phosphate and Xylitol Chewing Gums, and Probiotic Yogurt on Periodontal Parameters: A Randomized Clinical Trial

Objectives: This study aimed to assess the effect of casein phosphopeptide amorphous calcium phosphate (CPP-ACP) and xylitol chewing gums, and probiotic yogurt, as chemical plaque control strategies, on periodontal parameters. Materials and Methods: This randomized clinical trial evaluated 120 eligible dental students that were randomly divided into four groups (n=30) for use of (I) CPP-ACP chewing gum, (II) xylitol chewing gum, (III) probiotic yogurt, and (IV) chlorhexidine (CHX) mouthwash. The oral hygiene index-simplified (OHI-S), Silness and Loe gingival index (GI), and Silness and Loe modified plaque index (PI) were measured before and on days 15 and 30 after using the products. Paired t-test or its non-parametric equivalent was used to analyze the parameters after the intervention compared with baseline. The study groups were compared using one-way ANOVA or its non-parametric equivalent. Results: The OHI-S did not change over time, and most participants had a good OHI-S. The CHX group had the most favorable, and the probiotic yogurt group had the least favorable GI. Pairwise comparisons of the groups did not reveal a significant difference in GI between the CPP-ACP gum and CHX groups (P>0.05). CHX caused the greatest improvement in PI, with significant differences with other groups. Conclusion: CHX was the most effective for improvement of periodontal parameters followed by CPP-ACP, which showed better results compared with other groups.

Enamel remineralisation-inducing materials for caries prevention

Background: Dental caries is a multifactorial disease indicated by the progressive demineralisation process of dental tissue. It is caused by an imbalance between the remineralisation and demineralisation processes. The focus of caries management is on prevention. Providing materials that can induce remineralisation is one management of caries prevention. Various materials have been or are being researched, such as casein phosphopeptide amorphous calcium phosphate (CPP–ACP), tricalcium phosphate (fTCP), bioactive glass (BAG), and nanotechnologies such as nano-hydroxyapatite (n-HAP) and silver nano fluorine (NSF). Purpose: This study aims to review the development of enamel remineralisation inducing materials as a newer approach in caries prevention. Review: Various ingredients have been shown to increase enamel remineralisation through different mechanisms in preventing the development of carious lesions. Conclusion: CPP–ACP, fTCP, BAG, n-HAP, and NSF can induce enamel remineralisation as caries prevention agents. n-HAP and NSF are the most effective agents to enhance enamel remineralisation to prevent caries.