Combined effect of casein phosphopeptide-amorphous calcium phosphate and sodium trimetaphosphate on the prevention of enamel demineralization and dental caries: an in vitro study

Objective To evaluate the effect of treatment with fluoridated toothpaste supplemented with a combination of sodium trimetaphosphate (TMP) and casein phosphopeptide-amorphous calcium phosphate (MI Paste Plus(R)) on the demineralization of dental enamel. Methods Bovine enamel blocks selected by initial surface hardness (SHi) were randomly allocated into six groups (n= 12), according to the test toothpastes: (1) without F-TMP-MI Paste Plus(R)(Placebo); (2) 1100 ppm F (1100F); (3) MI Paste Plus(R); (4) 1100F + MI Paste Plus(R)(1100F-MI Paste Plus), (5) 1100F + 3 % TMP (1100F-TMP); and (6) 1100F-TMP + MI Paste Plus(R)(1100F-TMP-MI Paste Plus). Blocks were treated two times per day with slurries of toothpaste (1 min), and groups 4 and 6 received an application of MI Paste Plus (3 min). Next, the samples were subjected to five pH cycles (demineralizing/remineralizing solutions) at 37 degrees C, to produce subsurface enamel lesions.Thereafter, the blocks were maintained for 2 days in fresh remineralizing solution. After pH cycling, the following were obtained: percentage of surface hardness loss (%SH); integrated loss of subsurface hardness (Delta KHN); profile analysis and lesion depth subsurface through polarized light microscopy (PLM); scanning electron microscopy (SEM); and fluoride (F), calcium (Ca), and phosphorus (P) in the enamel. The data were subjected to ANOVA (1-criterion), followed by the Student-Newman-Keuls test (p< 0.001). Results The 1100F-TMP-MI Paste Plus group showed better results for SHR, Delta KHN, and PLM (p< 0.001). The F concentration was similar among all groups (p> 0.001). The 1100F-TMP-MI Paste Plus group showed the highest concentration of Ca and P in the enamel (p< 0.001). Conclusion The application of 1100F-TMP-MI Paste Plus promoted a higher inhibitory effect against enamel demineralization. Clinical significance The combination of treatments with F, TMP, and MI Paste Plus(R)can be an effective alternative to improve the oral health of individuals, especially those with high activity of dental caries and at high risk for its development.