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Title Efficacy of Casein Phosphopeptide-Amorphous Calcium Phosphate(CPP-ACP)in Remineralizing Demineralized Tooth Structure
Clinical Question In a patient with dental caries, is casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) effective in remineralizing demineralized tooth structure as compared to no treatment?
Clinical Bottom Line CPP-ACP demonstrates some remineralization of demineralized tooth structure, but more evidence is needed to make a strong recommendation of CPP-ACP for the reminerlization of demineralized teeth. (See Comments on the CAT below)
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 18594077Azarpazhooh/20086 studies of in situ caries models in adult patients.Systematic Review
Key resultsOf the studies identified by the systematic review, only 1 study compared a product (lozenges) with CPP-ACP to no treatment, and found it to be effective in promoting dose-dependent enamel remineralization. Four of the identified studies compared gum with CPP-ACP to gum without CPP-ACP, and three found greater remineralization in the group with CPP-ACP. One the identified studies compared milk with CPP-ACP to milk without CPP-ACP and found an improvement in subsurface remineralization in the group with CPP-ACP.
Evidence Search Meta-Analysis, "Dental Caries"[Mesh] "casein phosphopeptide-amorphous calcium phosphate nanocomplex "[Substance Name]
Comments on
The Evidence
A systematic review containing a comprehensive, detailed search for relevant trials (which were each assessed for validity) produced only one study comparing treatment with CPP-ACP to no treatment. This alone is not enough evidence to support the efficacy of CPP-ACP. However, three studies finding chewing gum with CPP-ACP to be more effective than gum without CPP-ACP and 1 study comparing milk with CPP-ACP against milk without CPP-ACP add to the evidence supporting the effectiveness of CPP-ACP in remineralizing tooth structure.
Applicability The current evidence does not warrant a recommendation of CPP-ACP to the average patient. However, a practitioner might consider recommending chewing gum with CPP-ACP to patients who are gum chewers and have a high caries risk.
Specialty/Discipline (Public Health) (General Dentistry) (Orthodontics) (Restorative Dentistry)
Keywords CPP-ACP; calcium phosphopeptide-amorphous calcium phosphate; dental caries; remineralization
ID# 573
Date of submission: 03/31/2010spacer
E-mail bonnerj@livemail.uthscsa.edu
Author Justin Bonner
Co-author(s) e-mail
Faculty mentor/Co-author James B. Summitt, DDS, MS
Faculty mentor/Co-author e-mail SUMMITT@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
post a rationale
None available
Comments and Evidence-Based Updates on the CAT
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by Matthew Nondorf (Valparaiso, IN) on 08/09/2011
Was the re-minerilization noted at the marcoscopic clinical level or the microscopic level? I think most practicing dentists are interested in results the patient and dentist can appreciate.

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