10 - Comparing CPP-ACP and Fluoride Agents for Remineralizing Primary Teeth

Abstract:

Purpose:
This in vitro study evaluated the remineralization efficacy of casein phosphopeptide–amorphous calcium phosphate (CPP-ACP), CPP-ACP with fluoride (CPP-ACPF), fluoridated toothpaste, and stannous fluoride (SnF₂) gel on artificially induced enamel caries in primary teeth using surface microhardness analysis.

Methods:
Fifty enamel specimens prepared from 25 sound extracted or exfoliated primary teeth were subjected to artificial demineralization and randomly assigned to 5 groups: distilled water (control), CPP-ACP, CPP-ACPF (900 ppm fluoride), fluoridated toothpaste (1450 ppm fluoride), and 0.4% SnF₂ gel. Remineralizing agents were applied according to manufacturers’ instructions during a 20-day pH-cycling regimen simulating oral conditions. Enamel microhardness was measured at baseline, after demineralization, and after treatment using a Vickers hardness tester. Data were analyzed using paired t tests, one-way ANOVA, and Tukey’s post hoc tests (P < .05).

Results:
All groups showed a significant reduction in microhardness following demineralization (P < .001), with no significant differences among groups at baseline (P=.310). After treatment, microhardness significantly increased in all experimental groups except the control (P < .05). The greatest increase was observed in the CPP-ACP group, followed by CPP-ACPF, fluoridated toothpaste, and SnF₂ gel. CPP-ACP and CPP-ACPF demonstrated significantly higher microhardness values than SnF₂ gel and control (P≤.013). No significant difference was found between CPP-ACP, CPP-ACPF, and fluoridated toothpaste (P>.05).

Conclusions:
CPP-ACP, with or without fluoride, effectively remineralized incipient enamel lesions in primary teeth with efficacy comparable to highly fluoridated products, suggesting it may be a suitable alternative for young children at risk of fluoride ingestion.

Identify Supporting Agency and Grant Number: Research supported by internal funding