Effects of Different Topical Agents on Enamel Demineralization around Orthodontic Brackets: An in Vivo and in Vitro Study

Abstract

Background: The aim of this study was to evaluate the in vivo and in vitro effects of a casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) and fluoride containing topical agents in reducing enamel demineralization around orthodontic brackets, and to compare this with a control group. Methods: Twenty-one patients and 60 extracted premolars were divided into three groups: two experimental and one control. Tooth Mousse (R) (CPP-ACP gel; GC-Corp, Tokyo, Japan) and Fluoridin N5 (R) (Fluoride gel; Voco-GmbH, Cuxhaven, Germany) were applied to tooth surfaces around orthodontic brackets in the experimental groups. Teeth were extracted after 60 days to evaluate the in vivo effects of the testing materials. For the in vitro experiment, samples were cycled for 14 days through a daily procedure of demineralization. All teeth were sectioned and evaluated by superficial microhardness analysis. An indentation was made from two positions (occlusal-cervical) and one depth (10 mu m). Results: Comparisons of occlusal and cervical microhardness scores for all specimens showed no statistically significant side differences. A multiple comparison test showed that the use of CPP-ACP and fluoride containing topical gels were more significantly efficient than the control group (p < 0.001). No significant differences were detected between CPP-ACP and the fluoride groups against demineralization. Conclusions: In vivo and in vitro evaluations indicated that CPP-ACP and fluoride containing agents successfully inhibited caries around orthodontic brackets.