Remineralization effect of case in phosphopeptide-amorphous calcium phosphate on enamel white spot lesions. A quantitative energy dispersive X ray elemental analysis: An in vitro study

  • Fabrizio Guerra
  • Marta Mazur
  • Gianna Maria Nardi
  • Cristina Chelariu
  • Maurizio Bossù
  • Umberto Romeo
  • Livia Ottolenghi
Keywords: Demineralization, Remineralization;, CPP-ACP;, White spot;


Background: The objective of this study was to evaluate, by means of elemental analysis the mineral density, calcium, and
phosphorus weight percent of sound enamel, demineralized and CPP-ACP treated enamel. Elemental analysis allows elemental and
isotopic composition of a biologic sample. It can be qualitative (determining what elements are present), and quantitative
(determining how much of each are present). INCA Energy 250, Oxford Analytical Instruments Ltd. (UK), energy-dispersive X-ray
spectroscopy system for elemental analysis was performed on random assigned samples.
Methods: 12 sound premolars were extracted for orthodontic reason. Each tooth was sectioned by using a double-faced diamond
microtome under water cooling into three section for a total of 36 samples and randomly assigned to three groups: Group 1 (control),
Group 2 (WS: white spot) , Group 3 (WST white spot treated) of 12 samples each. Samples (Group 2 and Group 3) underwent
equally to 24 h and 48 h of acid bath duration. Then all the treated samples (Group 3) were coated with CPP-ACP for 5 min
before immersion into water twice a day. Group 2 served as control for enamel damage evaluation. Inca Point & ID, an analytic
platform software for SEM was used for elemental analysis on samples from Group 1 (C), 2 (WS) and Group 3 (WST) in order to
determine the weight % and atomic % presence of Ca and P.
Results: The results of the samples analysis from the three Groups show different weight % and atomic% of Ca and P, and clearly
reflect the different mineralization rates.
Conclusions: 10% Casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) complex, promotes remineralization in vitro.
The results of this in vitro study completely agree with this statement. Clinical studies to investigate the intraoral effectiveness of
topical applications of CPP-ACP on white spot lesions are required to confirm these results.