A COMPARISON OF NOVAMIN AND CASEIN

PHOSPHOPEPTIDE – AMORPHOUS CALCIUM

PHOSPHATE FLUORIDE ON ENAMEL
REMINERALISATION – AN IN VITRO STUDY
USING SCANNING ELECTRON MICROSCOPE
AND DIAGNODENT
1
Dr Shailanathan R
1st Year PG
 AUTHORS

PRAKASH LATHA VINEETHA

K DHANYA
CHANDRA ANANTHAKRISHNA KARUVETTI

DEPARTMENT OF PEDODONTICS AND PREVENTIVE DENTISTRY,

FACULTY OF DENTAL SCIENCES,
M S RAMAIAH UNIVERSITY OF APPLIED SCIENCES
BENGALURU, KARNATAKA

2
INTRODUCTION
 Enamel remineralisation had been studied for about 100 years

 It has been suggested that “the non- invasive treatment of early caries lesions by
remineralisation has the potential to be the major advancement in the clinical
management of the disease.”

 Several remineralising agents and techniques have been tried out in dentistry which includes
use of the fluorides.

 Various studies and advancements have been emerged in the field of remineralisation .

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 Some of the latest
techniques involves

the use of casein – Bioactive glass

phosphopeptide stabilized Unstablized containing
– amorphous calcium ( ACP; calcium sodium
phosphate ( CPP- ACP;
RECALDENT ) ENAMELON ) phosphosilicate (
NOVAMIN)

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 CPP – ACP
 Milk and diary products have shown to exhibit anti- cariogenic properties

 They also exhibited remineralising potential both in vitro and in situ

 Since larger amount of micelles required to exhibit remineralising property, it is modified to form nano
complexes in CPP – ACP which is found to be more effective .

 It exhibits anti- caries effect by suppressing demineralisation and enhances remineralisation.

 Tooth mousse is the commercially available paste formula based on CPP – ACP .

Tooth mousse plus have been introduced which contains fluoride ions. It helps I formation of acid – resistant
fluorapatite .

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 NOVAMIN™
 A PARTICULATE BIOACTIVE GLASS COMPOSED OF

SILICA Na2O P2O5

SiO2 – CaO –
SODIUM
– – 6%
CALCIUM 45% 24.5%
PHOSPHOROUS
24.5%

 AVAILABLE IN THE CHEMICAL FORM OF SODIUM PHOSPHOSILICATE

 WHEN COMES IN CONTACT WITH SALIVA AND WATER , IT REACTS AND RELEASES
CALCIUM AND PHOSPHATE IONS , WHICH BINDS TO THE TOOTH STRUCTURE
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 With the advent of new remineralizing therapies and new conservative approach to restoring
carious lesions, interest in detecting and monitoring subclinical pre cavitated lesions has
increased.

 Some of the noninvasive methods available are Diagnodent and scanning electron
microscope (SEM) ,DIAGNOdent® (KaVo), a noninvasive method, uses laser fluorescence
(LF) to measure early demineralization.

 Although remineralization has been a major area of investigation, it is still difficult to exactly
define the efficacy of various remineralization methods.

 Hence, the aim of this study was to compare the efficacy of two newer dentifrices, namely
NovaMin™ and CPP‑ACPF on enamel surface that has been exposed to an artificial caries
challenge in a simulated oral environment using DIAGNOdent® and SEM .

 The null hypothesis is that there is no difference in remineralization potential between

NovaMin™ and CPP‑ACPF.

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ARMAMENTARIUM

8
 METHODOLOGY
STUDY GROUP -
ALL THE TEETH
86 NATURAL
WERE SLICED
PERMANENT
EXAMINED MESIODISTALLY
MAXILLARY THOROUGH CLEANED FREE
AND TOOTH INTO BUCCAL
FIRST WASHING AND OF DEBRIS,
WITH CARIES, AND LINGUAL
PREMOLARS CLEANING OF CALCULUS AND
WHITE SPOT HALVES USING
EXTRACTED DEBRIS DONE SOFT DEPOSITS
LESIONS , DIAMOND DISC
FOR
CRACKS WERE BURS.
THERAPEUTIC
DISCAREDED
PURPOSES ,

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• The buccal halves of the sliced teeth were used for the study, taking into consideration the technique
sensitivity of DIAGNOdent® (KaVo) the ease of mounting the sample on a SEM.

• A white stick on paper of 3 mm × 3 mm dimension was stuck on each tooth surface to limit the area
of the study.

• Water‑resistant clear nail varnish was applied to the tooth surface to limit the area of study.

• Samples are examined using DIAGNOdent to assess for any surface changes

• Type B probe of DIAGNOdent used for measuring the smooth surface lesions

• Values between 3 to 7 on the digital display which indicates intact enamel surface were taken for the
study

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 86 samples divided
into 2 groups

43 samples Group 43 samples Group

A – ALLOTED TO B – ALLOTED TO
NOVAMINE CPP- ACPF ( GC
( SHY-NM) tooth mousse plus )

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• Baseline values are recorded using DIAGNOdent using type B probe by holding the tip in close contact with
the tooth surface and tilting the tip around the measuring site

• The teeth were immersed individually into separate plastic containers which were color coded based on
remineralizing agents and numbered 1-86

• It consists of 4ml of demineralising solution which was prepared by dissolving each buffer capsule in 100 ml
of deionised water and stirred until completely dissolved

• Tooth were kept in the solution for period of 10h until the enamel surface gets completely demineralised , thus
producing subsurface lesion

• After 10h in the demineralizing solution the tooth were taken out,, washed with deionized water, dried and
placed back in their respective clean containers

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 All the teeth were evaluated using DIAGNOdent and samples showing the moment value of 9 and above were
taken for study

 The values were indicative of demineralization

 All the readings suggestive of demineralization > 9 were recorded.

 After demineralization and drying, teeth were kept back into their respective containers , which were filled with 6
ml of artificial saliva

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Group A were rubbed with Novamin paste
twice a day for 4 minutes using a gloved
finger over demineralized surface
Group B were rubbed
with tooth mousse plus
( CPP-ACPF) paste
twice a day for 4 minutes
using a gloved finger
over demineralized
surface
The samples were dried and placed back
The remineralizing paste is then removed
into their respective containers containing
from the tooth surface by thoroughly
artificial saliva at room temperature
washing with deionising water
(37∙C) .
The samples were dried
The remineralizing paste
and placed back into
is then removed from the
their respective
tooth surface by
containers containing
thoroughly washing with
artificial saliva at room
deionising water
temperature (37∙C) .
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• The process is repeated for 1 week inorder to induce remineralisation of the enamel surface .

• All the teeth were assessed using DIAGNOdent to record the values after remineralization procedure

• Post remineralization surface changes on enamel were assessed with SEM

• To compare enamel surface remineralization of the 2 samples collected from each which was selected randomly
and compared with SEM and pictures were taken at x1000 and x2000.

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STATISTICAL ANALYSIS

• Performed using SPSS software v10.5

• Descriptive studies were expressed as mean and standard

deviation

• Student t- test

• A value of P < 0.05 was considered as stastically

significant
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RESULTS
 The results showed that before demineralisation values were 3 to 7

 After demineralization were > 9

 After use of remineralization agents , the values were <9.

 A significant change was seen after application of remineralizing agents was given in the
table .

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• The mean value at demineralization was highest for Group B CPP- ACPF ( 13.09 and then Group A Novamin
( 12.93 ± 2.08)

• There was no statistical difference between the groups which indicates that the study produced uniform artificial
carious lesions

• The mean value at remineralization was highest for Group B, CPP-ACPF (6.02± 0.93) following by Group A
Novamin (6.56 ± 1.09).

• The maximum remineralization was seen in Group B, CPP-ACPF was higher than in Group A , Novamin

• However, there was no statistically significant result in the mean value between the groups given in the table.

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20
 SEM EVALUATION -
NOVAMIN
AT 1000 X AT 2000 X

 The interprismatic substance is evident with  Thick and more frequent lines of
porosities, and areas of remineralization are remineralization are seen along the prismatic
also evident borders. Areas of calcification can also be seen
along the porosities

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 SEM EVALUATION – CPP-
ACPF
1000X 2000X

 The enamel rods and prismatic substances are  Areas of calcified deposits are evident and seen
not discernible , but the areas of calcified scattered along the porous defects. The enamel
deposits are more evident and are concentrated surface in this group had a maximum
along the porous defects remineralization.

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 DISCUSSION
 Caries is a chronic, slowly progressing disease, with symptoms not detected at the onset of the disease but
much later.
 Its initiation is associated with the demineralization of calcium and phosphate loss from the subsurface tooth
enamel, resulting in the formation of a subsurface lesion
 Demineralization results from a complex chemistry between the bacteria, diet and salivary components.

 A drop in the pH in the oral cavity results in demineralization.

 In the demineralization process, the bacteria produce organic acids that diffuse into the tooth through the
water among the hydroxyapatite crystals, which are the major composition of tooth enamel and dentin.
 When the acid reaches a susceptible site on a crystal surface, where impurities and inclusions of other ions
(especially carbonate ion) incorporated in the crystal lattice producing defects and calcium deficient regions,
calcium and phosphate are dissolved and transferred into the surrounding aqueous phase between the crystals.
 If the diffusion of calcium, phosphate, and carbonate out of the tooth can continue without proper
remineralization, cavitation will eventually take place

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• Remineralization is the body’s natural repair process for subsurface noncavitated lesions.

• This occurs when the pH rises and there is the deposition of calcium, phosphate, and fluoride ions in the form
of fluorapatite, which is more resistant to crystal dissolution by organic acids.

• During remineralization, the growth of newly formed crystals (fluorapatite) takes place, and with advancing
growth, the crystals fuse with each other to form large crystals with hexagonal outlines.

• Different preventive therapies have been studied to enhance the remineralization, decrease, and arrest carious
lesions.

• Much of the recent studies have focused on the concentration of calcium and phosphate present in the tooth.

• Since both ions are major components of the tooth and ultimately related to the demineralization of tooth
structure, most of the efforts have been directed toward their deposition in the dental structure.

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• Demineralization can be detected by two methods: (1) invasive and (2) noninvasive. The noninvasive
diagnostic methods available are quantitative light fluorescence, electrical resistance monitoring device,
fiberoptic transillumination, optical coherence tomography, LF (DIAGNOdent®) and SEM.

• LF is a method introduced for early diagnosis of dental caries. It is useful for the early detection of hidden
caries in non-cavitated teeth through a noninvasive method.

• The organic and inorganic materials present on the tooth surface absorb the laser light and emit fluorescence
in the infrared region (655 nm) of the spectrum.

• The presence of a demineralized area increases the fluorescence, with an audible sound indicating the
fluorescence increase showing various scales between 0 and 99.

• The higher number of sound and higher‑pitched sounds indicate more demineralization. It can reliably detect
even the tiniest of the lesions without requiring X‑rays.

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• The exact mechanism of DIAGNOdent® is still not clear, but two theories exists
 First, when the red light meets a change in tooth tissue, such as porosity due to
demineralization or hypomineralization, it stimulates fluorescent light of a different wavelength.

 Second, some bacterial metabolites such as porphyrins (proto‑porphyrin, meso ‑porphyrin, or co-
porphyrin), result in the red fluorescence of carious teeth.

• SHY‑NM is a “fluoride‑free” toothpaste containing nanometric bioactive glass NovaMin™.

• Fluoride has been shown to have substantial positive effects on preventing tooth decay.

• There are also negative effects to excessive ingestion of fluoride.

• Evidence mount that everyday ingestion of fluoride through normal food, beverage, and water intake
supplies most or all of the fluoride necessary for good oral health.

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 COMPARATIVE EVALUATION OF REMINERALIZATION POTENTIAL OF CASEIN
PHOSPHOPEPTIDE-AMORPHOUS CALCIUM PHOSPHATE AND CASEIN
PHOSPHOPEPTIDE-AMORPHOUS CALCIUM PHOSPHATE FLUORIDE ON ARTIFICIAL
ENAMEL WHITE SPOT LESION: AN IN VITRO LIGHT FLUORESCENCE STUDY
MEHTA R, NANDLAL B, PRASHANTH S

Aims and objectives: The aim of this in vitro study was to evaluate and to compare the remineralization potential
of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) and casein phosphopeptide-amorphous
calcium fluoride phosphate (CPP-ACFP) on artificial white spot enamel lesions using the quantitative light
fluorescence (QLF).
Materials and methods: A total of 45 caries-free extracted maxillary first premolars were embedded in acrylic
resin. The samples were randomly divided into three groups namely control group, CPP-ACP group and CPP-
ACFP group with 15 samples in each group. The samples of each group were subjected to demineralization process
for a period of 96 h. The samples were then mounted in the artificial mouth model and subjected to
remineralization and pH cycling for a period of 21 days. QLF readings were recorded at the end of
demineralization (1st, 7th, 14th and 21st day) and were statistically analyzed.
Results: As compared with artificial saliva both CPP-ACP and CPP-ACFP produced significant amount of
remineralization of the artificial enamel white spot lesion (P < 0.001), however when the remineralizing effect of
CPP-ACP was compared with the remineralizing effect of CPP-ACFP there was no significant difference.
Significant amount of remineralization was produced by CPP-ACP and CPP-ACFP only after the 7th day.
After the 14th day, the remineralization produced by both CPP-ACP and CPP-ACFP as compared to artificial
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saliva was non-significant.
 COMPARATIVE EVALUATION OF COMBINED REMINERALIZATION AGENTS ON
DEMINERALIZED TOOTH SURFACE
A ARAS, S CELENK1 , MS DOGAN, E BARDAKCI
Objectives: The aim of this in vitro study was to evaluate the effects of casein phosphopeptides (CPP) ‑ACPF,
NovaMin+ fluoride‑containing toothpaste and Xylitol+ fluoride containing cream on demineralized areas on the
enamel surface. Materials and Methods: A total of 100 enamel slab samples was prepared to investigate in the
laboratory experiments. For this purpose, a total of 50 freshly extracted third molar teeth which completed root
formation split into two portions in the mesiodistal direction. Enamel surfaces were immersed in a pH cycling
protocol as described in the literature to simulate oral conditions for 9 days in order to evaluate the effect of test
materials on the artificial enamel lesions. Then the remineralization agents were applied on the enamel surfaces,
and we analyzed their effects. Results: We used Vickers Microhardness with the purpose of calculating the amount
of lost or acquisition of minerals on the enamel surface qualitatively; inductively coupled plasma atomic emission
spectroscopy (ICP‑AES) to define the calcium and phosphorus ions that dissolved in acid. One ‑way ANOVA and
Tukey’s T Post‑Hoc tests were performed to distinguish significant differences among groups (P < 0.05).
Conclusions: Remineralization was provided in all treated groups, according to the data obtained from all tests.
NovaMin was more effective in increasing acid resistance. It was also found that all three experimental groups were
effective in increasing the surface hardness, but CPP‑ACPF and NovaMin are more effective than Xylitol.
However, there was no statistically significant difference between the experimental groups.

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COMPARATIVE EVALUATION OF REMINERALIZATION POTENTIAL OF CASEIN PHOSPHOPEPTIDE- AMORPHOUS CALCIUM FLUORIDE PHOSPHATE
AND NOVAMIN ON ARTIFICIALLY DEMINERALIZED HUMAN ENAMEL - AN IN VITRO STUDY
MANOHARAN VIDYA; KUMAR R. KRISHNA ; SIVANRAJ ARUN KUMAR2; ARUMUGAM SELVA BALAJI

Aim: 
This study aimed to quantitatively compare the remineralization potential of casein phosphopeptide-amorphous calcium
fluoride phosphate (CPP-ACFP) and Novamin on artificially induced enamel subsurface lesions using scanning electron
microscope-energy dispersive X-ray (SEM-EDX).
Materials and Methods: 
Enamel specimens were prepared from seventy caries-free premolars and were kept for demineralization for 4 days.
Following demineralization, enamel specimens were assigned to three groups: (1) Control group, (2) Group with CPP-
ACFP-containing toothpaste, and (3) Group with Novamin-containing toothpaste. Further, both the experimental groups
(CPP-ACFP group and Novamin) were then divided into three subgroups based on the duration of re-mineralization as
follows: (a) 7 days, (b) 14 days, and (c) 21 days. Enamel specimens of experimental groups were then subjected to SEM-
EDX to evaluate mineral content after treating with CPP-ACFP and Novamin.
Results: 
Both the experimental groups showed very high significant differences between Ca/P ratios of remineralized samples.
Conclusion: 
Even though both CPP-ACFP and Novamin showed remineralization potential, remineralization was found to be
higher in the samples treated with CPP-ACFP

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Evaluation of the remineralisation potential of bioactive glass, nanohydroxyapatite and casein
phosphopeptide-amorphous calcium phosphate fluoride-based toothpastes on enamel erosion lesion –
An Ex Vivo study

Hafsa Suryani, Paras Mull Gehlot, Mysore Krishnaswamy Manjunath

Background: Erosion, a dynamic process with periods of demineralisation and remineralisation, has become a common problem
in modern societies, owing to changes in life style and dietary habits. Although fluorides have been included in toothpastes that
claim to prevent demineralisation and aid remineralisation, their ability to remineralise is limited by low concentration of calcium
and phosphate ions available in saliva. Hence, a new paste based on casein phosphopeptide-amorphous calcium phosphate fluoride
(CPP-ACPF), nanohydroxyapatite and bioactive glass (BAG) were introduced. Aim: To evaluate and compare the effects of BAG,
nanohydroxyapatite and CPP-ACPF pastes on surface microhardness of demineralised enamel. Materials and Methods: 48
enamel specimens were randomly divided into five groups: Group I positive control - intact specimens and Group II -
demineralised specimens. The test groups, Group III, IV and V, comprised CPP-ACPF, nanohydroxyapatite and BAG, respectively.
The test specimens were demineralised with 0.1% citric acid followed by remineralisation using either of the three prepared
slurries. The specimens were subjected to pH cycling regime for 15 times. The remineralisation potential of the specimens was
studied by evaluating the surface microhardness. One specimen from each group was analysed under SEM. Data was tabulated and
analysis performed by one way ANOVA and post hoc Scheffe test. Results: Statistically significant difference was found between
the negative control and three test groups based on microhardness evaluation. Nanohydroxyapatite had the least remineralising
potential as compared to CPP-ACPF and BAG. Conclusion: Comparatively, BAG and CCP-ACPF paste showed better
remineralising potential.

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 COMPARISON OF CASEIN PHOSPHOPEPTIDE AMORPHOUS CALCIUM PHOSPHATE
FLUORIDE AND FLUORIDE VARNISH ON REMINERALIZATION OF EARLY CARIES LESIONS
AROUND ORTHODONTIC BRACKETS
VAHID MOLLABASHI, SOUSSAN IRANI , AZADEH KAZEMISALEH, SHEIDA GHARAGOZLOU,
MARYAM SEYEDTABIB

Objectives: Orthodontic treatment increases the risk of caries and enamel white spot lesions incidence on
the buccal surface of teeth. This study aims to compare the effect of Casein PhosphoPeptide Amorphous
Calcium Phosphate Fluoride and fluoride varnish on remineralization of white spot lesions around orthodontic
brackets.
Materials and Methods: In this in-vitro study, 60 premolars teeth were etched for 15 seconds. Then brackets
were bonded with Relicane bond. All teeth were immersed in a demineralization solution for 4 days.
The lower part of the bracket was painted with nail polish to prevent the effect of a remineralizing agent
to serve as a control group. The teeth were divided into 4 groups, Group 1: treated with fluoride varnish for
3 weeks (one-time application), Group2: treated with fluoride varnish for 6 weeks (two-time application),
Group 3: treated with casein phosphopeptide and amorphous calcium phosphate with fluoride (CPP-ACPF)
for 3 weeks (twice a day), Group 4: treated with CPP-ACPF for 6 weeks (twice a day). Remineralizing agent
was applied on the occlusal of bracket for every tooth Area.
then the depth of specimens in treatment and control groups was measured by AutoCAD 2007. Pair-T test
and repeated measured ANOVA were used for data analysis by SPSS 23.
Result: There was no statistically significant difference between each group of treatment. However, mean
remineralization depth in group fourth and mean remineralization area in group three were higher than other
groups.
Conclusion: Fluoride varnish and CPP-ACPF have the potential to treat the white spot lesion which is
created during orthodontic treatment. According to less fluoride varnish use, it seems this substance is a
better option in case of patient’s cooperation is not good. 31
 PREVENTIVE AND REMINERALIZATION EFFECT OVER INCIPIENT LESIONS OF CARIES
DECAY BY PHOSPHOR PEPTIC PHOSPHATE OF CALCIUM AMORPHOUS 
JUÁREZ-LÓPEZ MLA, HERNÁNDEZ-PALACIOS RD, HERNÁNDEZ-GUERRERO JC, JIMÉNEZ-FARFÁN
D, MOLINA-FRECHERO N

Introduction. Dental caries continues to affect a large percentage of Mexican children and currently
advises that if diagnosed at an early stage can be reversed with minimally invasive treatments. The
casein phosphopeptide amorphous calcium phosphate known as CPP-ACP is a phosphoprotein
capable of releasing calcium and phosphate ions in the oral environment promoting
remineralization. Objective. To evaluate the effect of CPP-ACP with fluoride added in a scholar
preventive program. Material and methods. A cuasi- experimental study was conducted in 104 schools
of six years old. The children were classified into three groups and received six months biweekly
applications of different treatments: casein phosphopeptide amorphous calcium phosphate added
fluoride (CPP-ACPF), sodium fluoride (NaF) and a control group. Clinical evaluation was performed with
the laser fluorescence technique (Diagnodent model 2095). 1340 teeth were included: 294 teeth with
incipient lesions and 1,046 healthy teeth. Statistical tests of χ2 y Mc Nemar were used. Results. In the
group that received the application of CPP-ACPF, 38% of incipient carious lesions were remineralizing
compared with 21% in the group receiving the NaF (p ‹ 0.001) and 15% in the control group (p ‹ 0.0001)
The percentage of teeth free of caries were preserved in the therapy group phosphoprotein was the
biggest. This group also showed the lower proportion of deep carious lesion development (p ‹ 0.0001).

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 Conclusion. The application biweekly for six months of CPP-ACPF showed a protective and
remineralizing effect on incipient carious lesions. His action was better than the application of
NaF. However, to reduce the impact from dental caries in schoolchildren is important to have a
comprehensive preventive approach that includes promoting self-care, as well as the
application of sealants.

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 COMPARATIVE IN VITRO EVALUATION OF THE NOVEL REMINERALIZING
AGENTS’ EFFECTS ON ENAMEL SURFACE HARDNESS
POOJA M RAI , DARSHANA DEVADIGA , JITHESH JAIN , ROHIT.A.NAIR

Abstract Remineralizing agents have been recommended as preventive and therapeutic agents in the management
of demineralization, but their efficacy to increase the surface hardness of enamel surface has not been evaluated.
The current study was designed to evaluate the effect of three new age remineralizing agents such as fluoride
enriched Casein Phosphopeptide – Amorphous Calcium Phosphate (GC Tooth mouse Plus) and beta-tri calcium
phosphate (ClinPro) and fluoride rich hydroxyapatite (ReminPro) based remineralizing agents on enamel surface
hardness. Sixty Tooth sections measuring 4x4x2 mm to harvest enamel were prepared on Intact caries free human
premolars extracted for orthodontic purposes from 17 patients in the age group of 15-30 years. Except the sections
in control group, all the other sections were subjected to demineralization followed by remineralisation by CPP-
ACPF, beta-tri calcium phosphate and fluoride rich hydroxyapatite based remineralizing agents. Enamel surface
hardness was calculated using Vickers micro hardness testing. Among three subgroups, CPP-ACP (331.5 VHN)
has increased enamel remineralization potential when compared to both ClinPro (281.5 VHN) and ReminPro
(313.6 VHN). In multiple comparison between subgroups p value was highly significant.

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 EFFECTS OF CASEIN PHOSPHOPEPTIDE-AMORPHOUS CALCIUM PHOSPHATE
(CPP-ACP) APPLICATION ON ENAMEL MICROHARDNESS AFTER BLEACHING
SULE BAYRAK, DDS, PHD, EMINE SEN TUNC, DDS, PHD, ISIL SAROGLU
SONMEZ, DDS, PHD, TURKAN EGILMEZ, DDS & BILAL OZMEN, DDS

ABSTRACT: Purpose: To evaluate the effect of casein phosphopeptide-amorphous calcium phosphate (CCP-
ACP) application on the microhardness of bleached enamel and compare it to that of fluoride application.
Methods: 10 extracted bovine incisors were cut into four sections (4 x 4 x 3 mm) that were randomly distributed
among five groups (n=8). All groups were bleached three times using 38% hydrogen peroxide (HP), with 5-day
intervals between bleaching, according to the following treatment protocols: Group A: bleaching only; Group B:
bleaching + daily CCPACP paste; Group C: bleaching + daily casein phosphopeptide-amorphous calcium
fluoride phosphate (CPP-ACPF) paste; Group D: bleaching + daily 250ppm NaF solution; Group E: bleaching +
APF gel (once after final bleaching). Specimens were maintained in artificial saliva throughout the experiment.
Baseline and post-treatment Vickers microhardness values were obtained for all specimens. Statistical analysis
was performed using one-way ANOVA and post-hoc Tukey tests. Results: Groups B and C showed significant
increases in enamel microhardness following treatment (P< 0.001), whereas no statistically significant
changes were observed in Groups A, D, or E (P> 0.05). Oneway ANOVA of Vickers microhardness numbers
(VHN) revealed significant differences among groups (P< 0.001), with Group B showing the highest VHN and
Group A the lowest.

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EFFICACY OF CPP-ACP AND CPP-ACPF ON ENAMEL REMINERALIZATION - AN IN
VITRO STUDY USING SCANNING ELECTRON MICROSCOPE AND DIAGNODENT ®
JAYANTH JAYARAJAN, P JANARDHANAM, P JAYAKUMAR, DEEPIKA

Introduction: Remineralization as a treatment procedure has received a lot of attention both from

clinicians as well researchers. The objective of this in vitro study was to find out the efficacy of casein
phosphopeptide-amorphous calcium phosphate (CPP-ACP) and casein phosphopeptide-amorphous
calcium phosphate fluoride (CPP-ACPF) in remineralizing enamel surface on which artificial caries
lesion had been created. The changes were analyzed using DIAGNOdent® (KaVo) and scanning
electron microscope (SEM).
Materials and Methods: Ninety maxillary premolars were selected and divided into three groups of 30
teeth each: A (artificial saliva), B (CPP-ACP), and C (CPP-ACPF). All the samples were assessed using
DIAGNOdent® at the baseline and after demineralization and remineralization. Three samples were
randomly selected from each group after remineralization for surface evaluation using SEM.
Results: Statistical analysis showed that group B {CPP-ACP (4.1±1.8)} and group C {CPP-ACPF
(4.8±1.2)} had a significantly higher amount of remineralization than group A (1.7±0.7).
Conclusion: All the three groups showed a statistically significant amount of remineralization. However,
because of the added benefit of fluoride (NaF 0.2%), CPP-ACPF (Tooth Mousse-Plus®) showed
marginally more amount of remineralization than CPP-ACP (Tooth Mousse®).

36
CONCLUSION
The results obtained from the present study demonstrated that:

• Both Group B CPP‑ACPF and Group A NovaMin™ when compared with the demineralization values has
shown significant remineralization potential

• On comparing Group B CPP‑ACPF and Group A NovaMin™, the Group A CPP‑ACPF (6.02 ± 0.93)
showed a higher amount of remineralization than Group A Novamin™ (6.56 ± 1.09).This is mostly due to the
synergistic anticariogenic effects of CPP‑ACP and fluoride

• Remineralization is facilitated by nanometric bioactive glass NovaMin™ and can be comparable with
CPP‑ACPF

• From the results obtained, it can be inferred that both the experimental groups have the potential for
remineralization, and further studies with long follow‑up is evident to support this finding

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CRITICAL APPRAISAL
TITLE – COMPLETED AND MEANINGFUL

AIM – EXPLAINED PROPERLY

STUDY SETTING – EXPLAINED

ABSTRACT – STRUCTURED

METHODOLODY – GIVEN

INCLUSION AND EXCLUSION CRITERIAS – GIVEN

STATISTICAL ANALYSIS – DONE

RESULTS – GIVEN

GIST OF WHOLE TEXT – WELL EXPLAINED

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