Synergistic effect of proanthocyanidin and CPP-ACFP on root caries remineralisation

Abstract

Objective: Root caries remains a major oral health problem among the elderly. Proanthocyanidin (PA) has shown positive effects on remineralization of artificial root caries. It is advantageous to find methods to enhance the remineralization effect of PA. This study evaluated the synergistic effect of PA and casein phosphopeptide amorphous calcium fluoride phosphate (CPP-ACFP) on remineralization of artificial root caries. Method: Demineralized root fragments (n=90) were randomly divided into six groups based on treatments: (i) 6.5% PA, (ii) CPP-ACP, (iii) CPP-ACFP, (iv) CPP-ACFP + 6.5% PA, (v) 1000ppm fluoride and (vi) deionized water (control). Each specimen was immersed in the demineralizing solution for 14 h, testing solutions/pastes for 2 h and remineralizing solution for 8 h. The pH cycling was performed at 37oC for 8 days. Specimens were evaluated using transverse microradiography (lesion depth and mineral loss), a microhardness tester (Knoop hardness) and confocal laser scanning microscopy (CLSM). The lesion depth and mineral loss were analyzed using one-way ANOVA; while microhardness were analyzed with two-way ANOVA and Tukey’s test.

Result: One-way ANOVA indicated that testing solutions had a significant effect on lesion depth (P<0.05) and mineral loss (P<0.05). Lesion depth was significantly lower in CPP-ACFP+PA and 1000ppm fluoride groups (P<0.05). Mineral loss was the lowest in CPP-ACFP+PA group (P<0.05). Two-way ANOVA indicated that the factors “testing solutions/pastes” and “lesion depth” had a significant effect on Knoop hardness (P<0.05), with interaction between the two factors (P<0.05). Artificial caries lesions treated with CPP-ACFP+PA showed significantly higher microhardness values at 130μm and 150 μm from the surface (P<0.05). Remineralizing bands with higher mineral density were observed in CPP-ACFP+PA group.

Conclusion: The combined use of proanthocyanidin and casein phosphopeptide amorphous calcium fluoride phosphate has a synergistic effect on root caries remineralization by enhancing mineral gain and increasing hardness of the artificial root caries.