Articles Vol. 67 No. 5 25/05/2026

FACTORS ASSOCIATED WITH THE REMINERALIZATION EFFECTIVENESS OF CASEIN PHOSPHOPEPTIDE-AMORPHOUS CALCIUM PHOSPHATE ON MOLAR-INCISOR HYPOMINERALIZATION AFFECTED TEETH: A SYSTEMATIC REVIEW

Nguyen Thi Khanh Huyen1,2, Luong Minh Hang1,2, Tran Thi My Hanh1,2, Pham Nguyen Huong Ly1,2, Nguyen Duc Hoang1,2, Du Hoang Duong1,2, Dang Cong Son3,4
1 School of Dentistry, Ha Noi Medical University
2 Viện Đào tạo Răng Hàm Mặt, Trường Đại học Y Hà Nội
3 FPT Long Chau Pharmacy
4 Nhà Thuốc FPT Long Châu
DOI: 10.52163/yhc.v67i5.5174
45 Views
9 Downloads
Abstract

Objectives: This systematic review aimed to synthesize and analyse factors affecting the remineralizing effect of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) on molar-incisor hypomineralization (MIH) affected teeth.

Methods: The study followed the PRISMA guidelines and had the PICO criteria. A comprehensive search was conducted across four databases: PubMed, Google Scholar, Cochrane, and Embase and complemented by manual search.

Results: A total of 18 articles were selected, including 10 randomized controlled trial, 6 in vitro studies, and 2 non-randomized clinical trials. Among the in vitro studies, 3/6 studies indicated that CPP-ACP and CPP-ACFP had superior remineralization efficacy on white lesions compared to yellow lesions during short-term follow-up. 2/6 studies showed that CPP-ACFP resulted in greater remineralization of yellow lesions over long-term follow-up. 1 study highlighted that CPP-ACFP achieved faster remineralization than CPP-ACP on yellow lesions during the initial phase. Additionally, 3 studies found that the inclusion of fluoride in CPP-ACP did not result in a significant difference in remineralization efficacy during long-term follow-up.

Conclusion: CPP-ACFP is more effective at remineralizing white spot lesions than yellow lesions in the early stages. While fluoride accelerates the initial rate of remineralization, no significant difference in long-term efficacy is observed.

References
[1]
Bekes K. Molar incisor hypomineralization: a clinical guide to diagnosis and treatment. Springer, 2020. doi: 10.1007/978-3-030-31601-3. Google Scholar
[2]
Nguyễn Quốc Hoàn. Hiệu quả điều trị các răng phía trước mắc MIH có sử dụng nhựa xâm nhập: tổng quan hệ thống. Thư viện đại học Y Hà Nội, 2024. https://thuvien.hmu.edu.vn/pages/cms/FullBookReader.aspx?Url=/pages/cms/TempDir/books/202407261444-d534e70b-5826-4735-a7a3 86a777205c0f//FullPreview&TotalPage=93&ext=jpg#page/1/mode/2up Google Scholar
[3]
Inchingolo A.M et al. Treatment approaches to molar incisor hypomineralization: a systematic review. J Clin Med, 2023, 12 (22): 7194. doi: 10.3390/jcm12227194. Google Scholar
[4]
Võ Trương Như Ngọc. Kém khoáng hóa men răng hàm lớn răng cửa MIH. Nhà xuất bản Giáo dục Việt Nam, 2023. Google Scholar
[5]
Cavalcante B.G.N et al. Non-invasive strategies for remineralization and hypersensitivity management in molar-incisor hypomineralization - a systematic review and meta-analysis. J Clin Med, 2024, 13 (23): 7154. doi: 10.3390/jcm13237154. Google Scholar
[6]
Baroni C et al. MIH supplementation strategies: prospective clinical and laboratory trial. J Dent Res, 2011, 90 (3): 371-376. doi: 10.1177/0022034510388036. Google Scholar
[7]
Crombie F.A et al. Mineralisation of developmentally hypomineralised human enamel in vitro. Caries Res, 2013, 47 (3): 259-263. doi: 10.1159/000346134. Google Scholar
[8]
Kumar A et al. An evaluation of remineralised MIH using CPP-ACP and fluoride varnish: an in-situ and in vitro study. Eur Arch Paediatr Dent, 2022, 23 (1): 79-87, Feb. doi: 10.1007/s40368-021-00630-5. Google Scholar
[9]
Franco S et al. In vitro polarized Raman analysis for the evaluation of the efficacy of CPP-ACP remineralizing mousse in tooth hypomineralization. Results Chem, 2021, 3: 100232. doi: 10.1016/j.rechem.2021.100232. Google Scholar
[10]
Cardoso-Martins I, Pessanha S et al. Evaluation of the efficacy of CPP-ACP remineralizing mousse in molar-incisor hypomineralized teeth using polarized Raman and scanning electron microscopy-an in vitro study. Biomedicines, 2022, 10 (12): 3086. doi: 10.3390/biomedicines10123086. Google Scholar
[11]
Cardoso-Martins I, Arantes-Oliveira S et al. Evaluation of the efficacy of CPP-ACP remineralizing mousse in MIH white and yellow opacities-in vitro vickers microhardness analysis. Dent J, 2022, 10 (10): 186. doi: 10.3390/dj10100186. Google Scholar
[12]
Ozgül B.M et al. Clinical evaluation of desensitizing treatment for incisor teeth affected by molar-incisor hypomineralization. J Clin Pediatr Dent, 2013, 38 (2): 101-105. Google Scholar
[13]
Bakkal M et al. The effect of casein phosphopeptide-amorphous calcium phosphate on molar-incisor hypomineralisation: a pilot study. Oral Health Prev Dent, 2017, 15 (2): 163-167. doi: 10.3290/j.ohpd.a37928. Google Scholar
[14]
Biondi A.M et al. Comparison of mineral density in molar incisor hypomineralization applying fluoride varnishes and casein phosphopeptide-amorphous calcium phosphate. Acta Odontol Latinoam, 2017, 30 (3): 118-123. Google Scholar
[15]
Pasini M et al. Molar incisor hypomineralization treatment with casein phosphopeptide and amorphous calcium phosphate in children. Minerva Stomatol, 2018, 67 (1): 20-25. doi: 10.23736/S0026-4970.17.04086-9. Google Scholar
[16]
Bhandari R et al. In vivo comparative evaluation of esthetics after microabrasion and microabrasion followed by casein phosphopeptide-amorphous calcium fluoride phosphate on molar incisor hypomineralization-affected incisors. Contemp Clin Dent, 2019, 10 (1): 9-15, doi: 10.4103/ccd.ccd_852_17. Google Scholar
[17]
Olgen I.C et al. Effects of different remineralization agents on MIH defects: a randomized clinical study. Clin Oral Investig, 2022, 26 (3): 3227-3238. doi: 10.1007/s00784-021-04305-9. Google Scholar
[18]
Singh S.K. A comparative evaluation of CPP-ACP cream and fluoride varnish in remineralization of MIH-affected teeth using laser fluorescence. J South Asian Assoc Pediatr Dent, 2021, 4 (2): 117-121. doi: 10.5005/jp-journals-10077-3081. Google Scholar
[19]
Prathima G.S et al. Effects of Xylitol and CPP-ACP chewing gum on salivary properties of children with molar incisor hypomineralization. Int J Clin Pediatr Dent, 2021, 14 (3): 412-415. doi: 10.5005/jp-journals-10005-1779. Google Scholar
[20]
Sezer B, Tuğcu N et al. Effect of casein phosphopeptide amorphous calcium fluoride phosphate and calcium glycerophosphate on incisors with molar-incisor hypomineralization: a cross-over, randomized clinical trial. Biomed Mater Eng, 2022, 33, (4): 325-335. doi: 10.3233/BME-211371. Google Scholar
[21]
Sezer B, Kargul B. Effect of remineralization agents on molar-incisor hypomineralization-affected incisors: a randomized controlled clinical trial. J Clin Pediatr Dent, 2022, 46 (3): 192-198, doi: 10.17796/1053-4625-46.3.4. Google Scholar
[22]
Bardellini E et al. Molar incisor hypomineralization: optimizing treatment protocols for hypersensitivity: a randomized clinical trial. Dent J (Basel), 2024, 12, (6): 186. doi: 10.3390/dj12060186. Google Scholar
[23]
Al-Nerabieah Z et al. Preventive efficacy of 38% silver diamine fluoride and CPP-ACP fluoride varnish on molars affected by molar incisor hypomineralization in children: a randomized controlled trial. F1000 Research, 2024, 12: 1052. doi: 10.12688/f1000research.136653.2. Google Scholar