Efficacy of casein derivate CPP-ACP1

PEREIRA, Renata Faria; LEAL, Soraya Coelho

doi:10.1590/1981-8637201400030000032595

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Sumário

Original • Rev Gaúch. Odontol. 62 (3) • Jul-Sep 2014 • https://doi.org/10.1590/1981-8637201400030000032595 copy

Efficacy of casein derivate CPP-ACP1

Eficácia clínica do complexo de caseína CPP-ACP1

Authorship SCIMAGO INSTITUTIONS RANKINGS

OBJECTIVE:

A literature review of systematic reviews and in situ and in vivo randomized controlled trials was conducted in order to assess the role of casein phosphopeptide - amorphous calcium phosphate in providing caries-preventive effect superior to any intervention or placebo.

METHODS:

Initially, Pubmed database was searched for systematic reviews. Two systematic reviews were identified, which concluded that the quantity and quality of randomized controlled trials were insufficient to recommend the clinical use of the product. After this, Pubmed database was searched for in situ and in vivo randomized controlled trials that were not included in the reviews identified. In vivo and in situ studies yielded mixed results.

RESULTS:

In situ studies indicated greater efficacy of casein phosphopeptide - amorphous calcium phosphate in comparison with placebo. Whereas, in vivo studies demonstrated different findings

CONCLUSION:

Casein phosphopeptide - amorphous calcium phosphate had a performance equivalent to or greater efficacy than placebo; fluoride was more effective than the casein complex; casein phosphopeptide - amorphous calcium phosphate associated with fluoride showed better or equivalent performance to that of placebo. In view of available evidence, it was not possible to generalize the indication of casein phosphopeptide - amorphous calcium phosphate for preventing dental caries. Further studies on the preventive effect and longer treatment applications are recommended.

Phosphopeptides; Sodium fluoride; Tooth remineralization

Bases	Terms	Results	Studies selected
Medline (via Pubmed)	“casein phosphopeptide-amorphous calcium phosphate nanocomplex” [substance] OR “CPP ACP”[All Fields] AND ((meta analysis[ptyp] OR meta-analysis[tiab] OR meta-analysis[mh] OR (systematic[tiab] AND review[tiab]) NOT ((case[ti] AND report[ti]) OR editorial[ptyp] OR comment[ptyp] OR letter[ptyp] OR newspaper article [ptyp])))	5	2
Cochrane Library (via Bireme)	CPP ACP	1 systematic review protocol	-
Centre for Reviews and Dissemination	CPP ACP	0	0

Bases	Terms	Results	Studies selected
Medline (via Pubmed)	“casein phosphopeptide-amorphous calcium phosphate nanocomplex”[Substance] OR “CPP ACP”[All Fields] AND (randomized controlled trial[Publication Type] OR (randomized[Title/Abstract] AND controlled[Title/Abstract] AND trial[Title/Abstract]))	39	13

Author/Year	Population	Intervention	Study period*	Outcomes	Type of study
Andersson et al.⁹	26 adolescents (60 teeth, 152 visible white spot lesions)	Test Group Brushing twice a day with CPP-ACP-based cream for 3 months, followed by use of fluoridated dentifrice for a further 3 months. Control Group Fluoridated mouth wash once a day in addition to the daily use of fluoridated dentifrice for six months.	12 months	Visual inspection and evaluation by means of fluorescent laser of white spot lesions in time intervals of 1, 3, 6 and 12 months after beginning of intervention.	RCS in vivo mono-blind
Hay & Thomson¹⁰	124 patients with salivary gland dysfunction	Test Group CD-CP-based mouth wash (casein derivative associated with calcium phosphate) 3 times a day. Control Group Fluoridated mouth wash 3 times a day.	12 months	Reduction of root caries lesion (Bite-wing radiograph) after 12 months	RCS in vivo double-blind (blinding not clear)
Cai et al.³	10 adults	Chewing gum without sugar + 20 mg citric acid + 18.8 mg of CPP-ACP Chewing gum + 20 mg of citric acid Chewing gum without addition of citric acid and CPP-ACP	14 days	Degree of subsuperficial remineralization	RCS In situ double-blind
Schirrmeister et al.¹¹	15 adults	CPP-ACP-based chewing gum	21 days	Reduction in depth of lesion	RCS In situ mono-blind
Walker et al.¹²	10 adults	Milk With addition of 2g CPP/ACP/l With addition of 5g CPP/ACP/l Without addition of CPP/ACP/l	15 days	Degree of subsuperficial remineralization	RCS In situ double-blind
Itthagarun et al.¹³	12 adults	Sugar-free chewing gum with: 30 mg of urea 30 mg of urea + 25mg of calcium phosphate 30 mg of urea + 47 mg of CPP-ACP	21 days	Reduction in lesion depth (remineralization of lesions in situ)	RCS In situ double-blind
Iijima et al.¹⁴	10 adults	Chewing gum: With addition of CPP-ACP (18.8MG) Without addition of CPP-ACP	14 days	Degree of subsuperficial remineralization	RCS In situ double-blind
Cai et al.¹⁵	30 adults	Study 1 Mouth wash 2% CPP-ACP 6% CPP-ACP Calcium + phosphate Placebo Study 2 CPP-ACP-based chewing gum or other calcium-based compound	Study 1 5 days Study 2 14 days	Mouth wash Level of phosphate and calcium present in dental plaque Chewing gum: Degree of subsuperficial remineralization	RCS In situ double-blind
Cai et al.¹⁶	10 adults	Chewing gum: With addition of 18.8mg CPP-ACP With addition of 56.4mg CPP-ACP Without addition of CPP-ACP	14 days	Degree of subsuperficial remineralization	RCS In situ double-blind
Shen et al.¹⁷	30 adults	Chewing gum: Sorbitol (‘pellet gum’) + 4 different doses of CPP-ACP Sorbitol (‘slab gum’) + 4 different doses of CPP-ACP Xylitol + 4 different doses of CPP-ACP 4 different doses: 0; 0,19; 18,8 and 56,4 mg CPP-ACP	14 days	Degree of subsuperficial remineralization	RCS In situ double-blind

Author/Year	Population	Intervention	Study period*	Outcomes	Type of study
Reynolds et al.⁵	14	Study 1 Mouth wash based on CPP-ACP(2%) + 450 ppm Fluoride Mouth wash based on 450 ppm Fluoride Placebo Mouth wash Study 2 Dentifrice 1000 ppm F, as NaF 2800 ppm F, as NaF 2%CPP-ACP 2%CPP-ACP + 1100ppm F as NaF	Study 1 4 days Study 2, 14 days	Study 1 Level of fluoride present in dental plaque Study 2 Degree of subsuperficial remineralization	RCS in situ with in vivo stage double-blind
Manton et al.¹⁸	10	3 types of chewing gum Two chewing gums based on Sorbitol/Xylitol without addition of CPP-ACP CPP-ACP-based chewing gum	14 days	Degree of subsuperficial remineralization	RCS In situ double-blind
Morgan et al.¹⁹	2720	Sorbitol-based chewing gum without addition of CPP-ACP, 3 times a day (894 patients completed the treatment); CPP-ACP-based chewing gum, 3 times a day (926 patients completed the treatment);	24 months	Progression or regression of caries lesions observed by means of interproximal radiographs	RCS In vivo double-blind

Author/Year	Population	Intervention	Study period*	Outcomes	Type of study
Cochrane et al.²⁰	9	Chewing gum with addition of CPP-ACP Chewing gum without addition of CPP-ACP Control Group without use of chewing gum	14 days	Degree of remineralization	RCS In situ double-blind
Shen et al.²¹	5	Cream/mousse based on CPP-ACP Fluoride 900 ppm associated with CPP-ACP Fluoride 1000 ppm Fluoride 5000 ppm Climpro 950 ppm Placebo	10 days	Degree of subsuperficial remineralization	RCS In situ double-blind
Walker et al.²²	Study 1 10 participants Study 2 14 participants	In both studies, CPP-ACP-based “candies” were used: Study 1 Control (65% sucrose + 33% glucose); Sugar + 0.5% (w/w) CPP-ACP; Sugar + 1.0% (w/w) CPP-ACP; -ACP Control free of sugar Study 2 Control (65% sucrose + 33% glucose syrup); Sugar free + 0.5% (w/w) CPP Sugar + 1.0% (w/w) CPP-ACP; Control free of sugar	10 days	Degree of subsuperficial remineralization	RCS In situ double-blind
Srinivasan et al.²³	5	Cream/mousse based on CPP-ACP Cream/mousse based on CPP-ACP and fluoride 900 ppm Cream/mousse placebo *Treatment occurred 1 time per day for 3 minutes	2 days	Degree of subsurface remineralization in teeth that suffered erosion	RCS In situ mono-blind
Walker et al.²⁴	10	100 mL cows milk based on CPP-ACP (0.2%) 100 mL cows milk based on CPP-ACP (0.3%) 100 mL cows milk without addition of CPP-ACP	15 days	Degree of subsuperficial remineralization	RCS In situ double-blind
Cai et al.²⁵	10	Chewing gum with or without addition of CPP-ACP	14 days	Degree of subsuperficial remineralization	RCS In situ double-blind
Robertson et al.²⁶	60	CPP-ACP-based cream with addition of fluoride Cream placebo In both groups the product was applied 1 time per day, after night time brushing.	3 months	Prevention and reduction of white spots.	RCS In vivo double-blind
Altenburge et al.²⁷	32	Tooth brushing with fluoridated dentifrice and use of CPP-ACP-based cream, for 3 minutes, 1 time per day. Tooth brushing with fluoridated dentifrice	3 weeks	Evaluation of initial lesion of fissures in molars and premolars before and after treatment	RCS in vivo mono-blind
Beerens et al.²⁸	54	CPP-ACP-based cream, associated with fluoride, applied before going to sleep. Placebo creamed based on calcium, applied before going to sleep	3 months	Degree of remineralization of white spot lesions and composition of bacterial plaque	RCS In vivo double-blind
Uysal et al.²⁹	14	The brackets were bonded to premolars with 2 types of cement: Aegis Ortho® (composition based on ACP) Concise® resin cement	30 days	Reduction of dental demineralization around orthodontic brackets	RCS in vivo mono-blind
Uysal et al.³⁰	21 patients 60 teeth	Cream based on CPP-ACP Fluoride in gel form No product was applied in the control group	60 days (in vivo phase) 14 days (in vitro phase )	Reduction of dental demineralization around orthodontic brackets	RCS in vivo and in vitro mono-blind
Bröchner et al.³¹	60 patients	Tooth brushing with fluoridated dentifrice in the morning, and application of CPP-ACP-based cream at night. Tooth brushing with fluoridated dentifrice in the morning, and at night.	4 weeks	Degrees of remineralization of white spot lesions	RCS in vivo mono-blind
Bailey et al.³²	45 patients	Cream based on CPP-ACP Cream placebo *Application was made twice a day, after tooth brushing with fluoridated dentifrice	12 weeks	Regression of white spot lesions	RCS In vivo double-blind

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[1] Correspondência para / Correspondence to: SC LEAL. E-mail: < sorayaodt@yahoo.com>.