CPP-ACP and CPP-ACFP versus fluoride varnish in remineralisation of early caries lesions. A prospective study

To evaluate the effects of novel casein phosphopeptide (CPP) formulations CPP-amorphous calcium phosphate (CCP- ACP) and CPP-amorphous calcium fluoride phosphate (CPP-ACFP) versus fluoride varnish on the remineralisation of enamel white spot lesions (WSLs) over a 12-week follow-up period.

Double-blind prospective study. Eligibility criteria were patients between 6 and 14 years old and have WSLs on their permanent teeth. We evaluated 786 WSLs. Participants were divided randomly into three groups. Groups A and B were instructed to daily topical application of GC Tooth Mouse (CPP-ACP) or Mi Paste Plus (CPP-ACFP), Group C received a monthly professional application of Duraphat fluoride varnish. WSLs were categorised according to the International Caries Detection and Assessment System (ICDAS II; grades 0-3) and assessed by laser fluorescence (DIAGNOdent) at baseline and at 4, 8 and 12 weeks. Changes in mineralisation before and after treatment were analysed using two-way analysis of variance, with post hoc Bonferroni's non-parametric tests for multiple comparisons.

DIAGNOdent values were significantly reduced in Group B at 4 weeks, and in Groups A and C at 8 weeks. Mean values in Group B were lower than in Groups A and C at 4 weeks, and lower than Group C at 8 weeks. CPP-ACFP appeared to have a specific effect on smooth-surface caries, but no significant effect on caries in pits and fissures.

At 4 weeks, CPP-ACFP is superior to fluoride varnish at remineralising smooth-surface WSLs. CPP-ACP is not superior to fluoride varnish by any of the measures studied.