Casein Phosphopeptide-Amorphous Calcium Phosphate

Casein Phosphopeptide-Amorphous Calcium Phosphate
in Pediatric Dentistry.
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1. The Applications and Modifications of Casein Phosphopeptide -Amorphous Calcium Phosphate: An Update

2. content INTRODUCTION MECHANISM OF ACTION PROPERTIES OF CPP-ACP APPLICATIONS OF CPP-ACP MODIFICATIONS OF CPP-ACP CONCLUSION REFERANCES

3. INTRODUCTION/history

4. 4 ACP ( Amorphous calcium phosphate )was first described by Aaron S Posner in the mid 1960 In 1999, ACP was incorporated into toothpaste called Enamelon and 2004 reintroduced as Enamel care toothpaste

5. 5 Casein Phosphopeptides (CPPs) were first introduced by Reynolds in 1993 as an anti-cariogenic and anti-calculus agent , and later in 1998 as a Remineralizing Agent at the University of Melbourne in Australia Casein Phosphopeptides are produced from a tryptic d igest of the milk protein casein

6. Tooth demineralization is a chemical reaction that entails an acidic attack on the enamel, which can be caused by dental erosion or dental caries, leading to calcium and phosphate ions dissolution. Demineralization begins first as a reversible process and thus, the partially demineralized hydroxyapatite crystals could return to their normal form if they are exposed to oral environments with the potential of remineralization .

7. CPP-ACP stands for Casein Phosphopeptide - Amorphous Calcium Phosphate . It is a combination widely used in dental care to remineralize teeth and prevent cavities. These two components work together to strengthen teeth and repair enamel

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9. 9 CPP CPP CPP MIXING SUPERSATURATION NUCLEATION STABILIZATION

10. MECHANISM OF ACTION

11. 11 CPP-ACP Application on Tooth Surface ↓ CPP-ACP Binds to Tooth Surface and Plaque ↓ Calcium and Phosphate Ions Are Released ↓ Under Acidic Conditions, CPP-ACP Buffers Free Calcium and Phosphate Ions** ↓ Supersaturated Calcium Phosphate Environment is Created Around Tooth** ↓ Enamel Demineralization is Inhibited** ↓ Enhanced Remineralization Occurs, Repairing the Enamel

12. Ca Ca Ca P P P 12

13. PROPERTIES OF CPP-ACP

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15. 15 Ca Ca Ca Ca P P P P P

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17. 17 Ca Ca Ca P P P CPP ACP

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19. 19 Anti-Calculus Action

20. Applications of CPP-ACP

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22. 22 DESENSITIZING GEL 880/- BLEECHING GEL 1875/- GIC 5200/- VARNISH 5400/-

23. 23 Early childhood caries (ECC) is a major public health problem world wide. It corresponds at any form of caries in infants and preschool children. It begins with white-spot lesions, and caries can progress rapidly, leading to complete destruction of the crown. Calcium and phosphate ions are more readily lost for children because they eat mainly soft and sweet foods, and due to lower mineralization of deciduous enamel Casein phosphopeptide is capable of reversing early enamel lesions by stabilizing calcium, fluoride, and phosphate ions on the tooth surface, leading to sub-surface remineralization of WSLs

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25. 25 Increased consumption of carbonated beverages and conditions like anorexia/bulimia can cause dental erosion in children. Prolonged intra-oral exposure increases acidity (pH, pKa , titratable acidity), leading to enamel demineralization. Role of Citric Acid Citrate anions in carbonated drinks bind to calcium ions, forming chelates that reduce free calcium in enamel and saliva. This leads to weakening of the enamel and increased risk of erosion. Preventive Measures: Studies suggest adding calcium, phosphate, and fluoride to reduce erosive effects of carbonated drinks. Iron supplements and CPP-ACP (Casein Phosphopeptide -Amorphous Calcium Phosphate) can help protect enamel by maintaining its microhardness and reducing dissolution.

26. 26 pH Ca +Ca Ca Ca Ca Ca Ca Ca CPP-ACP

27. 27 Dentin Hypersensitivity (DH) is a short, sharp pain caused by exposed dentin in response to stimuli. CPP-ACP Complexes: Adhere to dentin and release calcium, phosphate, and fluoride ions in aqueous solutions. These ions help occlude (block )exposed dentinal tubules and reduce permeability. The released ions form fluorapatite crystals, which create a nanofilament coating on the dentin surface. This coating helps overcome dentin hypersensitivity by protecting the dentinal tubules. CPP-ACP helps in reducing dentin hypersensitivity by blocking tubules and forming a protective crystal layer on dentin.

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29. 29 Prolonged exposure to bleaching agents causes demineralization due to low pH and protein denaturation by-products. Peroxide solutions contact dentinal surfaces, retract odontoblastic processes, and induce fluid movement in dentinal tubules, causing sensitivity. CPP-ACP combined with bleaching agents provides calcium and phosphate ions, improving enamel remineralization without reducing the bleaching effect. Tooth Mousse Before Bleaching Improves enamel consistency, prevents microhardness reduction, and doesn’t affect the colour change from bleaching.

30. Modifications of CPP-ACP

31. 31 CPP-ACPF Composition: Contains CPP-ACP plus 0.2% sodium fluoride Synergistic Effect: CPP-ACP and fluoride together enhance remineralization by localizing calcium, phosphate, and fluoride ions on the tooth surface. Forms fluoro -apatite crystals, which are more resistant to acid than hydroxyapatite.

32. 32 Study Results: Poureslami et al .: Higher salivary fluoride concentration with CPP-ACPF, making it more effective for preventing caries in primary teeth. Imani et al .: CPP-ACP and fluoride together show a synergistic effect, leading to improved enamel remineralization through stabilized ACPF.

33. 33 CPP-ACP containing Propolis Propolis is  a resin-like material made by bees from the buds of poplar and cone-bearing trees . Bees use it to build hives Propolis seems to help fight against bacteria, viruses, and fungi. It might also have anti-inflammatory effects and help skin heal Propolis is  used to maintain oral health and prevent caries due to its antibiotic and anti-plaque properties . ₹541 ₹249 .

34. 34 The use of CPP-ACP containing propolis for remineralization and as an antibacterial agent has good potential Darwita et al found neither significant difference in the reduction of Streptococcus mutans count and plaque index nor in preventing demineralisation while using CPP-ACP paste with or without propolis

35. 35 . Chitosan Properties: - Chitosan reacts with cariogenic acids, reducing acid dissolution of hydroxyapatite. - Forms a multilayer on enamel, making it more acid-resistant and preventing mineral loss. Pchi (Chitosan Derivative): - Chelates with calcium ions and stabilizes ACP, forming Pchi -ACP nano- complexes that help remineralize enamel lesions. Study Results**: Batubara et al: CPP-ACP with or without chitosan nanoparticles shows similar effectiveness in increasing enamel remineralization, with minimal morphological changes to enamel.

36. 36 Sodium Tripolyphosphate (TPP): - Biomimetic copy of dentin matrix protein - Helps in mineral accumulation on dentin and entry into collagen fibrils for complete mineralization. Research Findings: Zhou et al.**: Showed improved remineralization and even dentinal tubule occlusion when CPP- ACP was combined with TPP. Benefits: - Treating demineralized dentin with TPP and CPP- ACP enhances remineralization and restores mechanical properties of dentin .

37. 37 CPP-ACP in Glass Ionomer Cement (GIC): - Promotes remineralization and increases fluoride release under both neutral and acidic conditions.Maintains mechanical properties of GIC. Strength Improvements: - Significant increase in micro tensile bond strength and compressive strength. - Enhanced release of calcium, phosphate, and fluoride ions.

38. 38 Research Findings: Zraikat et al : Suggested adding 3% CPP-ACP to GIC. Zhao et al : Found no difference in shear bond strength with CPP-ACP. Performance Comparison: - CPP-ACP modified GIC outperforms traditional GIC and resin-modified GIC in terms of remineralization. Recommendations: Dawood et al .: Suggested adding no more than 1% CPP- ACP to BioDentine and 0.5% to MTA.

39. 39 This pit and fissure sealant facilitates the development of hydroxyapatite crystals. It helps to release calcium and phosphate ions and improving the tooth's natural repair mechanism. When compared to other forms of fissure sealants, the ACP-containing pit and fissure sealant showed the greatest inhibition in enamel demineralization. 11700/-

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41. 41 ₹242.00  ₹237

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43. Conclusion The significant role of CPP-ACP in the non-invasive treatment of early caries lesions, dental erosion, and various other conditions, along with its various modifications, can be recognized as an effective preventive strategy in pediatric dental care.

44. REFERANCES vinod d, gopalakrishnan a, subramani sm , balachandran m, manoharan v, joy a. a comparative evaluation of remineralizing potential of three commercially available remineralizing agents: an in vitro study. int j clin pediatr dent 2020;13(1):61-65 doi:10.5005/jp-journals-10005-1715 Reynolds EC. Casein phosphopeptide -amorphous calcium phosphate: the scientific evidence. Adv Dent Res 2009;21(1):25-29 doi:10.1177/0895937409335619 Hr P, Ra H, Re H, H S, P P . Concentration of calcium, phosphate and fluoride ions in microbial plaque and saliva after using CPP-ACP paste in 6-9 year-old children. J Dent Biomater 2016;3(2):214-219 Munjal D, Garg S, Dhindsa A, Sidhu GK, Sethi HS. Assessment of white spot lesions and in-vivo evaluation of the effect of CPP-ACP on white spot lesions in permanent molars of children. J Clin Diagn Res 2016;10(5):ZC149-ZC154 doi:10.7860/ JCDR/2016/19458.7896

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