An in situ study to determine the effects of casein phosphopeptide-amorphous calcium phosphate toothpaste in orthodontic patients

Objectives: To investigate the remineralisation of enamel subsurface lesions with CPP-ACP toothpaste compared with regular fluoride toothpaste in orthodontic patients. Design: Randomised controlled clinical trial with a cross-over design. Setting: Orthodontic department at the Liverpool University Dental Hospital. Participants: 12 orthodontic patients receiving fixed orthodontic treatment. Methods: Demineralised sub-surface enamel lesions were placed in situ onto a fixed appliance in the lower premolar region. Participants were randomly allocated to receive either standard fluoride toothpaste or a CPP-ACP paste (GC Tooth Mousse™) in addition to the fluoride toothpaste. Transverse Microradiography (TMR) was used to analyse and compare the mineral content profiles of the lesions. Results: Mineral loss ΔZ reduced by 15.4% and 24.6% for the fluoride and CPP-ACP groups respectively, with a statistical significant difference between these groups (p = 0.023). Lesion depth reduced by 1.6% and 11.1% for fluoride and CPP-ACP groups respectively, with a statistically significant difference between these groups (p = 0.037). Lesion width reduced by 4.5% and 15.3% for fluoride and CPP-ACP groups respectively, with a statistically significant difference between these groups (p=0.015). Conclusion/Implications: Remineralisation occurred during the in situ phase regardless of treatment group allocation, however the CPP-ACP combined with fluoride group demonstrated a statistically significant increased remineralising effect. CPP-ACP paste may be beneficial for patients undergoing orthodontic treatment who are at high risk of demineralisation or who have demonstrated early signs of white spot lesion formation. Trial Registration: Registered on Current Control Trials http://www.controlled-trials.com/ISRCTN0489952