Effect of CPP-ACP and Bioglass on Root Caries Using X-ray Microtomography

Objectives: To compare the efficacy of fluoride varnishes either with casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) or bioglass particles on root caries using visual-tactile assessment and X-ray Microtomography (XMT)
Methods: Visual-tactile assessments including hardness and severity index (SI) for 60 extracted teeth with root caries were carried out by two examiners (AS&AB). There were 13 leathery to soft lesions (SI: 3), 26 leathery type (SI: 2), and 21 leathery to hard (SI: 1) carious lesions. Each tooth was randomly divided into three varnish groups; CPP-ACP and fluoride (MI varnish GC, Japan), bioglass particles and fluoride (Experimental varnish, Dentsply Sirona, USA) with fluoride alone (NUPRO, Dentsply Sirona, USA). Standardised toothbrushing using a dentifrice containing 1,450 ppm fluoride was carried out twice a day for all groups. Each sample was stored in remineralising solution at 37C for 45 days. Visual-tactile assessments were carried out at baseline and after 45 days. XMT was performed at baseline and after 45 days for three samples from each group to quantify any potential changes in mineral contents within the lesion.
Results: The intra-class correlation coefficient (ICC) for (AS) was 0.92. The ICC between the two examiners at baseline and 45 days was 0.84 and 0.80 respectively. The visual-tactile assessment results showed a significant decrease in the SI of root caries, being 20% in CPP-ACP and fluoride (p=0.04), 100% in bioglass and fluoride (p<0.001), and 80% in fluoride alone group (p<0.001). XMT assessment showed a highly significant increase in the mineral deposition. The group containing CPP-ACP and fluoride had 31%, increase in mineral deposition whilst bioglass and fluoride had 60%, and finally for fluoride alone, the gain was 25% (p≤0.001)
Conclusions: The bioglass particles in addition to fluoride has potentially superior effect in comparison to either CPP-ACP with fluoride or fluoride alone to reverse and arrest root caries in a laboratory setting