Is it Possible to Regain Lost Minerals to Initial Enamel Lesions Using Enamel Matrix Derivatives Combined with Casein Phosphopeptide Amorphous Calcium Phosphate: An in Vitro Study
![](/public/ojsicons/gor.png)
![](/public/ojsicons/pdf.png)
DOI:
https://doi.org/10.5152/eurjther.2020.19110Keywords:
Casein phosphopeptide amorphous calcium phosphate, enamel matrix derivatives, enamel remineralization, fluoride, SEM-EDXAbstract
Objective: This study aimed to assess the efficacy of enamel matrix derivatives (EMD) used in combination with casein phosphopeptide amorphous calcium phosphate (CPP-ACP) to recover minerals to the enamel after artificial caries formation. Methods: Fifty enamel samples were prepared from the buccal surfaces of extracted human third molars. The samples were divided into five groups: (G1) Untreated enamel samples (control), (G2) Application of 500 ppm sodium fluoride (NaF), (G3) CPP-ACP, (G4) EMD, and (G5) CPP-ACP + EMD. All of the samples were placed in an acidic buffer solution for 96 hours to simulate a carious lesion. Ca/P ratios were calculated using energy dispersive X-ray spectroscopy (EDX). After seven days of the remineralization procedure, the mineral contents of the samples were re-measured. All the data were analyzed statistically. Results: There were no statistically significant differences in the mineral contents of the samples between the groups after demineralization (p>0.05). The Ca/P ratios of G2, G3, G4, and G5 increased significantly (p<0.05) after remineralization. The highest levels of the Ca/P ratio were obtained in G5. Conclusion: Despite the limitations of this in vitro study, the combined use of CPP-ACP and EMD may increase the remineralization potential. Furthermore, this procedures may be an alternative for providing enamel remineralization in future clinical trials.
Metrics
References
Somasundaram P, Vimala N, Mandke LG. Protective potential of casein phosphopeptide amorphous calcium phosphate containing paste on enamel surfaces. J Conserv Dent 2013; 16: 152-6.
Gocmen GB, Yanikoglu F, Tagtekin D, Stookey GK, Schemehorn BR, Hayran O. Effectiveness of some herbals on initial enamel caries lesion. Asian Pac J Trop Biomed 2016; 6: 846-50.
Wang X, Wang Y, Wang K, Ren Q, Li H, Zheng S, et al. Bifunctional anticaries peptides with antibacterial and remineralizing effects. Oral Dis 2019; 25: 488-96.
Nakata T, Kitasako Y, Sadr A, Nakashima S, Tagami J. Effect of a calcium phosphate and fluoride paste on prevention of enamel demineralization. Dent Mater J 2018; 30; 37: 65-70.
Alkilzy M, Tarabaih A, Santamaria RM, Splieth CH. Self-assembling Peptide P11-4 and Fluoride for Regenerating Enamel. J Dent Res 2018; 97: 148-54.
Pinto de Souza SCT, Araújo KC, Barbosa JR, Cancio V, Rocha AA, Tostes MA. Effect of dentifrice containing fTCP, CPP-ACP and fluoride in the prevention of enamel demineralization. Acta Odontol Scand 2018; 76: 188-94.
Buckshey S, Anthonappa RP, King NM, Itthagarun A. Remineralizing Potential of Clinpro® and Tooth Mousse Plus® on Artificial Carious Lesions. J Clin Pediatr Dent 2019; 43: 103-8.
Attiguppe P, Malik N, Ballal S, Naik SV. CPP-ACP and Fluoride: A Synergism to Combat Caries. Int J Clin Pediatr Dent 2019; 12: 120-5.
Fatemeh M, Marjan S, Homa N, Mahsa S. CPP-ACP: Effect on Dental Plaque Acidity after Water Rinsing Following Topical Fluoride Therapy. J Clin Pediatr Dent 2017; 41: 22-6.
Lv X, Yang Y, Han S, Li D, Tu H, Li W, et al. Potential of an amelogenin based peptide in promoting reminerlization of initial enamel caries. Arch Oral Biol 2015; 60: 1482-7.
Fan Y, Wen ZT, Liao S, Lallier T, Hagan JL, Twomley JT, et al. Novel amelogenin-releasing hydrogel for remineralization of enamel artificial caries. J Bioact Compat Polym 2012; 27: 585-603.
Tian K, Peng M, Ren X, Liao C, Fei W. Regeneration of tooth-like hydroxyapatite depended on amelogenin functional section monolayer: a new approach for tooth repair. Med Hypotheses 2012; 79: 143-6.
Kubasad G, Ghivari S, Garg K. Replantation of an avulsed tooth with an extended extra oral period. Indian J Dent Res 2012; 23: 822-5.
Mohd Said SN, Ekambaram M, Yiu CK. Effect of different fluoride varnishes on remineralization of artificial enamel carious lesions. Int J Paediatr Dent 2017; 27: 163-73.
Oliveira GM, Ritter AV, Heymann HO, Swift E Jr, Donovan T, Brock G, et al. Remineralization effect of CPP-ACP and fluoride for white spot lesions in vitro. J Dent 2014; 42: 1592-602.
Peric TO, Markovic DL, Radojevic VJ, Heinemann RM, Petrovic BB, Lamovec JS. Influence of pastes containing casein phosphopeptide-amorphous calcium phosphate on surface of demineralized enamel. J Appl Biomater Funct Mater 2014; 12: 234-9.
Featherstone JD, Domejean S. The role of remineralizing and anticaries agents in caries management. Adv Dent Res 2012; 24: 28-31.
Rugg-Gunn A, Banoczy J. Fluoride toothpastes and fluoride mouthrinses for home use. Acta Med Acad 2013; 42: 168-78.
Altenburger MJ, Bernhard J, Schicha TD, Wrbas KT, Hellwig E. Comparison of in vitro fluoride uptake from whitening toothpastes and a conventional toothpaste in demineralised enamel. Schweiz Monatsschr Zahnmed 2010; 120: 104-13.
Hammarstrom L. Enamel matrix, cementum development and regeneration. J Clin Periodontol1997; 24: 658-68.
Kobayashi E, Fujioka-Kobayashi M, Saulacic N, Schaller B, Sculean A, Miron RJ. Effect of enamel matrix derivative liquid in combination with a natural bone mineral on new bone formation in a rabbit GBR model. Clin Oral Implants Res 2019; 30: 542-9.
Youssef AR, Emara R, Taher MM, Al-Allaf FA, Almalki M, Almasri MA, Siddiqui SS. Effects of mineral trioxide aggregate, calcium hydroxide, biodentine and Emdogain on osteogenesis, Odontogenesis, angiogenesis and cell viability of dental pulp stem cells. BMC Oral Health 2019; 19: 133.
Ieong CC, Zhou XD, Li JY, Li W, Zhang LL. Possibilities and potential roles of the functional peptides based on enamel matrix proteins in promoting the remineralization of initial enamel caries. Med Hypotheses 2011; 76: 391-4.
Wang ZW, Zhao YP, Zhou CR, Li H. The study on the enamel remineralization by enamel matrix proteins' inducing. Sichuan Da Xue Xue Bao Yi Xue Ban 2008; 39: 579-82.
Chen H, Clarkson BH, Sun K, Mansfield JF. Self-assembly of synthetic hydroxyapatite nanorods into an enamel prism-like structure. J Colloid Interface Sci 2005; 288: 97-103.
Xiang C, Ran J, Yang Q, Li W, Zhou X, Zhang L. Effects of enamel matrix derivative on remineralisation of initial enamel carious lesions in vitro. Arch Oral Biol 2013; 58: 362-9.
Ellingham STD, Thompson TJU, Islam M. Scanning Electron Microscopy-Energy-Dispersive X-Ray (SEM/EDX): A Rapid Diagnostic Tool to Aid the Identification of Burnt Bone and Contested Cremains. J Forensic Sci 2018;63: 504-10.
Zhou C, Zhang D, Bai Y, Li S. Casein phosphopeptide-amorphous calcium phosphate remineralization of primary teeth early enamel lesions. J Dent 2014; 42: 21-9.
Hegde MN, Moany A. Remineralization of enamel subsurface lesions with casein phosphopeptide-amorphous calcium phosphate: A quantitative energy dispersive X-ray analysis using scanning electron microscopy: An in vitro study. J Conserv Dent 2012; 15: 61-7.
Alkilzy M, Santamaria RM, Schmoeckel J, Splieth CH. Treatment of Carious Lesions Using Self-Assembling Peptides. Adv Dent Res 2018; 29: 42-7.
Ruan Q, Zhang Y, Yang X, Nutt S, Moradian-Oldak J. An amelogenin-chitosan matrix promotes assembly of an enamel-like layer with a dense interface. Acta Biomater 2013; 9: 7289-97.
Schmidlin P, Zobrist K, Attin T, Wegehaupt F. In vitro re-hardening of artificial enamel caries lesions using enamel matrix proteins or self-assembling peptides. J Appl Oral Sci 2016; 24: 31-6.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 European Journal of Therapeutics
![Creative Commons License](http://i.creativecommons.org/l/by-nc/4.0/88x31.png)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
The content of this journal is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.