Comparison between ICON and CPP-ACP in the treatment of white spot lesion Introduction Initial caries lesion

Comparison between ICON and CPP-ACP in the treatment of white spot lesion

Introduction

Initial caries lesion (white spot lesion) considered the first sign of the progression of dental caries and being reversed, they are enamel demineralization without cavitation, these lesions characterized by white chalky appearance.(Paula et al., 2017)
casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) obtained from milk protein, it can promote remineralization process of the demineralized tooth structure.(Cai, Shen, Morgan, & Reynolds, 2003; Iijima et al., 2004; E. Reynolds, 1997, 2009; E. Reynolds, Cai, Shen, & Walker, 2003; E. Reynolds et al., 1995; E. C. Reynolds, 1998, 2008; Shen, Cai, Nowicki, Vincent, & Reynolds, 2001; Zero, 2009).
The localized anticariogenic property of CPP-ACP is a result of its reported to have topical anticariogenic effects due to its capability to maintain the amorphous state of calcium and phosphate.(Hegde, Shetty, & Pardal, 2007; E. Reynolds, 1997).
Resin infiltration (RI) is widely used for management of WSLs using a low viscosity resin which infiltrates etched enamel surface of the WSL.(S Paris, Schwendicke, Keltsch, Dörfer, & Meyer-Lueckel, 2013; Phark, Duarte, Meyer-Lueckel, & Paris, 2009),
filling the porosities by penetrating the enamel surface of the WSL, which arrest progression of the demineralized lesion(S Paris & Meyer-Lueckel, 2010),
it’s also enhances the mechanical integrity of the enamel surface.(S Paris, Schwendicke, Seddig, et al., 2013) it’s been used for management of smooth surface lesions interproximally and facially.(Ekstrand, Martignon, Bakhshandeh, & Ricketts, 2012)
scattered light of the WSL can be reduced by this procedure, thus enhancing the esthetics of the filled tooth.(Hallgren, Akyalcin, English, Tufekci, & Paravina, 2016; Sebastian Paris & Meyer-Lueckel, 2009; Torres, Borges, Torres, Gomes, & de Oliveira, 2011).

Literature review

– A study in vitro took place in Alexandria University Egypt, (2018) where treatment using RI done at various degrees of demineralized tooth surfaces divided into four groups: shallow enamel – deep enamel – shallow dentin – deep dentin, then each group subdivided into six groups with different methods of application. As the lesion goes deeper the color difference becomes more detectible. All deep lesions were dentin were partially masked remained clinically detectable and might require more invasive restorative procedures.(Abbas, Marzouk, & Zaher, 2018)
– A study in vitro took place in University of Kebangsaan Malaysia, (2018) where 60 extracted teeth were randomly divided into two groups control and test and artificial WSL were produced, they concluded that the material produced favorable esthetics on color and the surface roughness of teeth at distinct treatment times.(Mohamed et al., 2018)
– A study in took place National Dental College, India (2013) 60 patients shows at least 1-WSL. patients were divided into 2 groups: A test group using CPP-ACP and a control group using only fluoride containing toothpaste for a period of 3-month. results suggested that CPP-ACP containing cream had a slight remineralization effect on the WSL, but it needs longer duration to confirm if greater change in WSLs maintained.(Vashisht, Indira, Ramachandran, Kumar, & Srinivasan, 2013)
– A study took place in Brazil (2018) to assess the effectiveness of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) in the remineralization of WSLs in 80 anterior teeth of children aged 5-13 years. Baseline readings with a DIAGNOdent Pen before application. After the 90-day experiment, use of CPP-ACP and fluoride revealed comparable results in terms of remineralization. The best results were observed when CPP-ACP and fluoride were combined.(Mendes, Restrepo, Bussaneli, & Zuanon, 2018)

The aim of the study is to Compare Between ICON RI and CPP-ACP on Their Treatment of White Spot Lesions.