In Vitro Assessment of Remineralizing Efficacy of CPP-ACP and Sodium Fluoride on Demineralized Enamel
DOI:
https://doi.org/10.48165/ajm.2026.9.01.33Keywords:
CPP-ACP, Sodium fluoride, Remineralization, Primary teethAbstract
Background: Early enamel demineralization is a reversible process, and various remineralizing agents have been introduced to restore mineral loss. Among these, casein phosphopeptide amorphous calcium phosphate (CPP-ACP) and fluoride-based formulations are widely used; however, their comparative efficacy in primary teeth remains an area of interest. Aim: To evaluate and compare the remineralization potential of CPP-ACP paste and sodium fluoride on artificially induced enamel lesions in primary molars. Materials and Methods: This in vitro experimental study was conducted on 30 extracted, caries-free primary molars, randomly allocated into three groups (n = 10 each): Group I received CPP-ACP paste (GC Tooth Mousse®), Group II received sodium fluoride toothpaste (0.165% w/w NaF; ~750 ppm fluoride) serving as a positive control, and Group III received normal saline as a negative control. Artificial enamel lesions were created by immersing samples in a demineralizing solution (pH 4.5) for 72 hours. The respective agents were applied for four minutes daily for seven days, with specimens stored in artificial saliva between applications. Surface microhardness (SMH) was assessed using a Vickers microhardness tester at baseline (T0), after demineralization (T1), and after remineralization (T2). Data were analyzed using one-way ANOVA, paired t-tests, and Tukey’s post-hoc tests, with significance set at p < 0.05. Results: A significant reduction in SMH was observed following demineralization in all groups (p < 0.05). Post-remineralization, both CPP-ACP and sodium fluoride groups demonstrated a statistically significant increase in SMH compared to the control group (p < 0.05). CPP-ACP showed a greater improvement in microhardness values compared to sodium fluoride; however, the difference between the two groups was not statistically significant. Conclusion: Both CPP-ACP and sodium fluoride exhibited effective remineralization potential on artificial enamel lesions in primary teeth. CPP-ACP demonstrated a comparatively higher, though not statistically significant, remineralization effect. These findings suggest that CPP-ACP can be considered a promising alternative or adjunct to fluoride therapy in pediatric dental care.
References
Kazeminia, M., Abdi, A., Shohaimi, S., Jalali, R., Vaisi-Raygani, A., Salari, N., & Mohammadi, M. (2020). Dental caries in primary and permanent teeth in children worldwide, 1995 to 2019: A systematic review and meta-analysis. Head & Face Medicine, 16(1), 22. https://doi.org/10.1186/s13005-020-00237-2
Nematollahi, H., Mehrabkhani, M., & Sheykhani, M. (2007). Assessing the relationship between diet and prevalence of early childhood caries in Birjand preschool children. Journal of Dentistry (Tehran), 8(1), 70–85.
Flemming, J., Hannig, C., & Hannig, M. (2022). Caries management—The role of surface interactions in de- and remineralization processes. Journal of Clinical Medicine, 11(23), 7044. https://doi.org/10.3390/jcm11237044
Seredin, P., Goloshchapov, D., Prutskij, T., & Ippolitov, Y. (2015). Phase transformations in human tooth tissue at the initial stage of caries. PLoS ONE, 10(4), e0124008. https://doi.org/10.1371/journal.pone.0124008
Walsh, T., Worthington, H. V., Glenny, A. M., Marinho, V. C. C., & Jeroncic, A. (2019). Fluoride toothpastes of different concentrations for preventing dental caries. Cochrane Database of Systematic Reviews, 2019(3), CD007868. https://doi.org/10.1002/14651858.CD007868.pub3
Philip, N. (2019). State of the art enamel remineralization systems: The next frontier in caries management. Caries Research, 53(3), 284–295. https://doi.org/10.1159/000493031
Baccolini, V., da Silva, L. P., Teixeira, L., de Sousa, R. T., & Manarte-Monteiro, P. (2025). The role of casein phosphopeptide–amorphous calcium phosphate (CPP-ACP) in white spot lesion remineralization—A systematic review. Journal of Functional Biomaterials, 16(8), 272. https://doi.org/10.3390/jfb16080272
Imani, M., Safaei, M., Afnaniesfandabad, A., Moradpoor, H., Sadeghi, M., Golshah, A., Sharifi, R., & Mozaffari, H. (2019). Efficacy of CPP-ACP and CPP-ACPF for prevention and remineralization of white spot lesions in orthodontic patients: A systematic review of randomized controlled clinical trials. Acta Informatica Medica, 27(3), 199–204. https://doi.org/10.5455/aim.2019.27.199-204
Patel, M., Bhatt, R., Patel, C., Joshi, K., Patel, F., & Makwani, D. (2023). Non-invasive management of initial occlusal enamel caries using silver modified atraumatic restorative technique and resin-based sealants: A randomized comparative split-mouth clinical trial. Advances in Human Biology, 13(Suppl 1), S69–S74. https://doi.org/10.4103/AIHB.AIHB_176_22
Behl, M., Taneja, S., & Bhalla, V. K. (2024). Comparative evaluation of remineralization potential of novel bioactive agents on eroded enamel lesions: A single-blinded in vitro study. Journal of Conservative Dentistry and Endodontics, 27(5), 545–551.
Arifa, M. K., Ephraim, R., & Rajamani, T. (2019). Recent advances in dental hard tissue remineralization: A review of literature. International Journal of Clinical Pediatric Dentistry, 12(2), 139–144. https://doi.org/10.5005/jp-journals-10005-1603
Farooq, I., & Bugshan, A. (2020). The role of salivary contents and modern technologies in the remineralization of dental enamel: A narrative review. F1000Research, 9, 171. https://doi.org/10.12688/f1000research.22499.1
Indrapriyadharshini, K., Madan Kumar, P. D., Sharma, K., & Iyer, K. (2018). Remineralizing potential of CPP-ACP in white spot lesions—A systematic review. Indian Journal of Dental Research, 29(4), 487–496. https://doi.org/10.4103/ijdr.IJDR_150_17
Salehzadeh Esfahani, K., Mazaheri, R., & Pishevar, L. (2015). Effects of treatment with various remineralizing agents on the microhardness of demineralized enamel surface. Journal of Dental Research, Dental Clinics, Dental Prospects, 9(4), 239–245. https://doi.org/10.15171/joddd.2015.042
Reynolds, E. C. (1997). Remineralization of enamel subsurface lesion by casein phosphopeptide-stabilized calcium phosphate solutions. Journal of Dental Research, 76(9), 1587–1595. https://doi.org/10.1177/00220345970760091101
