CC BY-NC-ND 4.0 · Eur J Dent 2018; 12(02): 210-216
DOI: 10.4103/ejd.ejd_265_17
Original Article
European Journal of Dentistry

Efficacy of erbium-doped yttrium aluminum garnet laser with casein phosphopeptide amorphous calcium phosphate with and without fluoride for remineralization of white spot lesions around orthodontic brackets

Sogra Yassaei
1   Department of Orthodontics, Faculty of Dentistry, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
,
Hossein Aghili
1   Department of Orthodontics, Faculty of Dentistry, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
,
Neda Shahraki
2   Department of Orthodontics, Faculty of Dentistry, Zahedan University of Medical Sciences, Zahedan, Iran
,
Isa Safari
1   Department of Orthodontics, Faculty of Dentistry, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
› Author Affiliations
Further Information

Publication History

Publication Date:
16 September 2019 (online)

ABSTRACT

Objective: This study aimed to assess the efficacy of erbium-doped yttrium aluminum garnet (Er:YAG) laser, pastes containing casein phosphopeptide amorphous calcium phosphate (CPP-ACP) with and without fluoride and their combination for prevention of white spot lesions in the enamel. Materials and Methods: This in vitro experimental study was conducted on 90 extracted sound premolars. The teeth were then randomly divided into six groups of 15: (1) Control, (2) laser, (3) CPP-ACP with fluoride (GC MI Paste, RecaldentTM 900 ppm as NaF), (4) CPP-ACP without fluoride (GC Tooth Mousse RecaldentTM), (5) laser + CPP-ACP with fluoride, and (6) laser + CPP-ACP without fluoride. In each group, enamel surface was exposed to the remineralizing agent. The teeth were then subjected to pH cycling for 14 days. The teeth were then sectioned, polished, and underwent cross-sectional microhardness testing at 20–160 μ depth quantitatively. Using the Simpson's rule, the amount of mineral loss was calculated in each group. Statistical Analysis Used: ANOVA was used for the comparisons, and Tukey's test was applied for pairwise comparisons. Results: The highest mean volume percentage of microhardness at 20–60 μ depth belonged to the group laser + CPP-ACP with fluoride and the lowest belonged to the control group (P = 0.001). The differences were not significant at 80-120 μ depth (P > 0.05). These finding are confirmed according to △Z (mineral loss). Conclusion: Based on these results, Er: YAG laser was able to decrease demineralization and was a potential alternative to preventive dentistry and was more effective when combined with CPP-ACP products.

 
  • REFERENCES

  • 1 Sudjalim TR, Woods MG, Manton DJ. Prevention of white spot lesions in orthodontic practice: A contemporary review. Aust Dent J 2006; 51: 284-9
  • 2 Ogaard B. Prevalence of white spot lesions in 19-year-olds: A study on untreated and orthodontically treated persons 5 years after treatment. Am J Orthod Dentofacial Orthop 1989; 96: 423-7
  • 3 Gorelick L, Geiger AM, Gwinnett AJ. Incidence of white spot formation after bonding and banding. Am J Orthod 1982; 81: 93-8
  • 4 Lovrov S, Hertrich K, Hirschfelder U. Enamel demineralization during fixed orthodontic treatment – Incidence and correlation to various oral-hygiene parameters. J Orofac Orthop 2007; 68: 353-63
  • 5 Reynolds EC. Remineralization of enamel subsurface lesions by casein phosphopeptide-stabilized calcium phosphate solutions. J Dent Res 1997; 76: 1587-95
  • 6 Rose RK. Binding characteristics of Streptococcus mutans for calcium and casein phosphopeptide. Caries Res 2000; 34: 427-31
  • 7 Reynolds EC. The role of phosphopeptides in caries prevention. Dent Perspect 1999; 3: 6-7
  • 8 Reynolds EC. Calcium phosphate-based remineralization systems: Scientific evidence?. Aust Dent J 2008; 53: 268-73
  • 9 Reynolds EC, Cai F, Cochrane NJ, Shen P, Walker GD, Morgan MV. et al. Fluoride and casein phosphopeptide-amorphous calcium phosphate. J Dent Res 2008; 87: 344-8
  • 10 Uysal T, Amasyali M, Koyuturk AE, Sagdic D. Efficiency of amorphous calcium phosphate-containing orthodontic composite and resin modified glass ionomer on demineralization evaluated by a new laser fluorescence device. Eur J Dent 2009; 3: 127-34
  • 11 Iijima Y, Cai F, Shen P, Walker G, Reynolds C, Reynolds EC. et al. Acid resistance of enamel subsurface lesions remineralized by a sugar-free chewing gum containing casein phosphopeptide-amorphous calcium phosphate. Caries Res 2004; 38: 551-6
  • 12 Cochrane NJ, Saranathan S, Cai F, Cross KJ, Reynolds EC. Enamel subsurface lesion remineralisation with casein phosphopeptide stabilised solutions of calcium, phosphate and fluoride. Caries Res 2008; 42: 88-97
  • 13 Patil N, Choudhari S, Kulkarni S, Joshi SR. Comparative evaluation of remineralizing potential of three agents on artificially demineralized human enamel: An in vitro study. J Conserv Dent 2013; 16: 116-20
  • 14 Jayarajan J, Janardhanam P, Jayakumar P. Efficacy of CPP-ACP and CPP-ACPF on enamel remineralization – An in vitro study using scanning electron microscope and DIAGNOdent. Indian J Dent Res 2011; 22: 77-82
  • 15 Wu G, Liu X, Hou Y. Analysis of the effect of CPP-ACP tooth mousse on enamel remineralization by circularly polarized images. Angle Orthod 2010; 80: 933-8
  • 16 Hsu CY, Jordan TH, Dederich DN, Wefel JS. Effects of low-energy CO2 laser irradiation and the organic matrix on inhibition of enamel demineralization. J Dent Res 2000; 79: 1725-30
  • 17 Mohan AG, Ebenezar AV, Ghani MF, Martina L, Narayanan A, Mony B. et al. Surface and mineral changes of enamel with different remineralizing agents in conjunction with carbon-dioxide laser. Eur J Dent 2014; 8: 118-23
  • 18 Poosti M, Ahrari F, Moosavi H, Najjaran H. The effect of fractional CO2 laser irradiation on remineralization of enamel white spot lesions. Lasers Med Sci 2014; 29: 1349-55
  • 19 Bevilácqua FM, Zezell DM, Magnani R, da Ana PA, Eduardo Cde P. Fluoride uptake and acid resistance of enamel irradiated with Er: YAG laser. Lasers Med Sci 2008; 23: 141-7
  • 20 de Freitas PM, Rapozo-Hilo M, Eduardo Cde P, Featherstone JD. In vitro evaluation of erbium, chromium:yttrium-scandium-gallium-garnet laser-treated enamel demineralization. Lasers Med Sci 2010; 25: 165-70
  • 21 Geraldo-Martins VR, Lepri CP, Palma-Dibb RG. Influence of Er, Cr:YSGG laser irradiation on enamel caries prevention. Lasers Med Sci 2013; 28: 33-9
  • 22 Liu JF, Liu Y, Stephen HC. Optimal Er: YAG laser energy for preventing enamel demineralization. J Dent 2006; 34: 62-6
  • 23 Featherstone JD, ten Cate JM, Shariati M, Arends J. Comparison of artificial caries-like lesions by quantitative microradiography and microhardness profiles. Caries Res 1983; 17: 385-91
  • 24 O'Reilly MM, Featherstone JD. Demineralization and remineralization around orthodontic appliances: An in vivo study. Am J Orthod Dentofacial Orthop 1987; 92: 33-40
  • 25 Boersma JG, van der Veen MH, Lagerweij MD, Bokhout B, Prahl-Andersen B. Caries prevalence measured with QLF after treatment with fixed orthodontic appliances: Influencing factors. Caries Res 2005; 39: 41-7
  • 26 Knoop F, Peters CG, Emersoon WB. A sensitive pyramidal diamond tool for indentation measurements. J Res Natl Bur Stand 1939; 23: 39
  • 27 urdell-Lewis DJ, Groeneveld A, Arends J. Microhardness and densitometric measurements of the effect of 4% SnF2 solution on artificial white spot lesions. Caries Res 1976; 10: 216-26
  • 28 Paes Leme AF, Tabchoury CP, Zero DT, Cury JA. Effect of fluoridated dentifrice and acidulated phosphate fluoride application on early artificial carious lesions. Am J Dent 2003; 16: 91-5
  • 29 Delbem AC, Cury JA. Effect of application time of APF and NaF gels on microhardness and fluoride uptake of in vitro enamel caries. Am J Dent 2002; 15: 169-72
  • 30 Chedid SJ, Cury JA. Effect of 0. 02% NaF solution on enamel demineralization and fluoride uptake by deciduous teeth in vitro. Pesqui Odontol Bras 2004; 18: 18-22
  • 31 Brochner A, Christensen C, Kristensen B, Traneus S, Karlsson L, Sonnesen L. et al. Treatment of post orthodontic white spot lesions with casein phosphopeptide-stablished amorphous calcium phosphate. Clin Oral Investig 2010; 10: 20-8
  • 32 Reynolds EC. Anticariogenic complexes of amorphous calcium phosphate stabilized by casein phosphopeptides: A review. Spec Care Dentist 1998; 18: 8-16
  • 33 Rao SK, Bhat GS, Aradhya S, Devi A, Bhat M. Study of the efficacy of toothpaste containing casein phosphopeptide in the prevention of dental caries: A randomized controlled trial in 12- to 15-year-old high caries risk children in Bangalore, India. Caries Res 2009; 43: 430-5
  • 34 Sitthisettapong T, Phantumvanit P, Huebner C, Derouen T. Effect of CPP-ACP paste on dental caries in primary teeth: A randomized trial. J Dent Res 2012; 91: 847-52
  • 35 Andersson A, Sköld-Larsson K, Hallgren A, Petersson LG, Twetman S. Effect of a dental cream containing amorphous cream phosphate complexes on white spot lesion regression assessed by laser fluorescence. Oral Health Prev Dent 2007; 5: 229-33
  • 36 Bailey DL, Adams GG, Tsao CE, Hyslop A, Escobar K, Manton DJ. et al. Regression of post-orthodontic lesions by a remineralizing cream. J Dent Res 2009; 88: 1148-53
  • 37 Beerens MW, van der Veen MH, van Beek H, ten Cate JM. Effects of casein phosphopeptide amorphous calcium fluoride phosphate paste on white spot lesions and dental plaque after orthodontic treatment: A 3-month follow-up. Eur J Oral Sci 2010; 118: 610-7
  • 38 Bröchner A, Christensen C, Kristensen B, Tranæus S, Karlsson L, Sonnesen L. et al. Treatment of post-orthodontic white spot lesions with casein phosphopeptide-stabilised amorphous calcium phosphate. Clin Oral Investig 2011; 15: 369-73
  • 39 Huang GJ, Roloff-Chiang B, Mills BE, Shalchi S, Spiekerman C, Korpak AM. et al. Effectiveness of MI paste plus and PreviDent fluoride varnish for treatment of white spot lesions: A randomized controlled trial. Am J Orthod Dentofacial Orthop 2013; 143: 31-41
  • 40 Elsayad I, Sakr A, Badr Y. Combining casein phosphopeptide-amorphous calcium phosphate with fluoride: Synergistic remineralization potential of artificially demineralized enamel or not?. J Biomed Opt 2009; 14: 044039
  • 41 Kumar VL, Itthagarun A, King NM. The effect of casein phosphopeptide-amorphous calcium phosphate on remineralization of artificial caries-like lesions: An in vitro study. Aust Dent J 2008; 53: 34-40
  • 42 Tung MS, Eichmiller FC. Dental applications of amorphous calcium phosphates. J Clin Dent 1999; 10: 1-6
  • 43 Nammour S, Renneboog-Squilbin C, Nyssen-Behets C. Increased resistance to artificial caries-like lesions in dentin treated with CO2 laser. Caries Res 1992; 26: 170-5
  • 44 de Andrade LE, Pelino JE, Lizarelli RF, Bagnato VS, de Oliveira OB. Caries resistance of lased human enamel with Er:YAG laser_morphological and ratio Ca/P analysis. Laser Phys 2007; 4: 157-62
  • 45 Apel C, Birker L, Meister J, Weiss C, Gutknecht N. The caries-preventive potential of subablative Er:YAG and Er:YSGG laser radiation in an intraoral model: A pilot study. Photomed Laser Surg 2004; 22: 312-7
  • 46 Nair AS, Kumar RK, Philip ST, Ahameed SS, Punnathara S, Peter J. et al. Acomparative analysis of caries inhibitory effect of remineralizing agents on human enamel treated with Er:YAG laser: An in vitro atomic emission spectrometry analysis. J Clin Diagn Res 2016; 10: ZC10-3
  • 47 Yassaei S, Shahraki N, Aghili H, Davari A. Combined effects of Er: YAG laser and casein phosphopeptide-amorphous calcium phosphate on the inhibition of enamel demineralization: An in vitro study. Dent Res J (Isfahan) 2014; 11: 193-8