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MI Varnish and MI Paste Plus in a caries prevention and remineralization study: a randomized controlled trial

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Abstract

Objectives

White spot lesions (WSLs) are a complication of orthodontic therapy. This study investigated the effect of MI (minimally invasive) Paste Plus (MIPP) and MI Varnish (MIV) on WSLs in orthodontic patients during a 12-month, randomized, single-blind, prospective, standard-of-care controlled clinical trial.

Materials and methods

Forty subjects, recruited from the UCSF School of Dentistry Orthodontics Clinic, were randomly assigned to the experimental (twice-daily 1100 ppm fluoride toothpaste, daily MIPP, quarterly MIV application) or control group (twice-daily 1100 ppm fluoride toothpaste, fluoride rinse recommendation). Facial surfaces of incisors, canines, and first bicuspids were evaluated at baseline, 3, 6, and 12 months using the enamel decalcification index (EDI) and the international caries detection and assessment system (ICDAS).

Results

Findings from 37 subjects are reported. At 12 months, teeth receiving experimental treatment were at lower but not significantly different odds of increased EDI scores (odds ratio, OR 0.63; intra-patient cluster-adjusted 95% CI 0.43, 1.18) and not associated with increased ICDAS scores (OR 0.99; 95% CI 0.64, 1.54). There was no statistically significant difference in mean patient-level EDI sum (experimental group 40.2; control 41.3; t test p = 0.80), ICDAS score (experimental 22.3; control 22.6; Mann-Whitney U test p = 0.80), or percentage of scored surfaces with ICDAS > 0 (experimental 54.6%; control 55.2%; t test p = 0.88). Salivary fluoride levels were significantly higher at 12 months for the experimental than for the control group (0.20 ± 0.26 versus 0.04 ± 0.04 ppm, Mann-Whitney U test p < 0.01).

Conclusions

Applying daily MIPP and quarterly MIV resulted in no statistically significant differences in EDI sum and ICDAS scores. Higher salivary fluoride levels in the experimental group suggest that MIPP and MIV effectively deliver fluoride when used clinically.

Clinical relevance

Daily MIPP and quarterly MIV applications do not appear to reduce significantly WSLs incidence during fixed orthodontic treatment.

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References

  1. Gorelick L, Geiger AM, Gwinnett AJ (1982) Incidence of white spot formation after bonding and banding. Am J Orthod 81(2):93–98. https://doi.org/10.1016/0002-9416(82)90032-X

    Article  PubMed  Google Scholar 

  2. Geiger AM, Gorelick L, Gwinnett AJ, Griswold PG (1988) The effect of a fluoride program on white spot formation during orthodontic treatment. Am J Orthod Dentofac Orthop 93(1):29–37. https://doi.org/10.1016/0889-5406(88)90190-4

    Article  Google Scholar 

  3. Maxfield BJ, Hamdan AM, Tufekci E, Shroff B, Best AM, Lindauer SJ (2012) Development of white spot lesions during orthodontic treatment: perceptions of patients, parents, orthodontists, and general dentists. Am J Orthod Dentofac Orthop 141(3):337–344. https://doi.org/10.1016/j.ajodo.2011.08.024

    Article  Google Scholar 

  4. Shungin D, Olsson AI, Persson M (2010) Orthodontic treatment-related white spot lesions: a 14-year prospective quantitative follow-up, including bonding material assessment. Am J Orthod Dentofacial Orthop 138(2):136 e1-8; discussion -7. https://doi.org/10.1016/j.ajodo.2009.05.020

    Google Scholar 

  5. Akin M, Basciftci FA (2012) Can white spot lesions be treated effectively? Angle Orthod 82(5):770–775. https://doi.org/10.2319/090711.578.1

    Article  PubMed  Google Scholar 

  6. Hallgren K, Akyalcin S, English J, Tufekci E, Paravina RD (2016) Color properties of demineralized enamel surfaces treated with a resin infiltration system. J Esthet Restor Dent 28(5):339–346. https://doi.org/10.1111/jerd.12207

    Article  PubMed  Google Scholar 

  7. Reynolds EC (1997) Remineralization of enamel subsurface lesions by casein phosphopeptide-stabilized calcium phosphate solutions. J Dent Res 76(9):1587–1595. https://doi.org/10.1177/00220345970760091101

    Article  PubMed  Google Scholar 

  8. Reynolds EC, Cai F, Shen P, Walker GD (2003) Retention in plaque and remineralization of enamel lesions by various forms of calcium in a mouthrinse or sugar-free chewing gum. J Dent Res 82(3):206–211. https://doi.org/10.1177/154405910308200311

    Article  PubMed  Google Scholar 

  9. Iijima Y, Cai F, Shen P, Walker G, Reynolds C, Reynolds EC (2004) Acid resistance of enamel subsurface lesions remineralized by a sugar-free chewing gum containing casein phosphopeptide-amorphous calcium phosphate. Caries Res 38(6):551–556. https://doi.org/10.1159/000080585

    Article  PubMed  Google Scholar 

  10. Cross KJ, Huq NL, Palamara JE, Perich JW, Reynolds EC (2005) Physicochemical characterization of casein phosphopeptide-amorphous calcium phosphate nanocomplexes. J Biol Chem 280(15):15362–15369. https://doi.org/10.1074/jbc.M413504200

    Article  PubMed  Google Scholar 

  11. Cochrane NJ, Saranathan S, Cai F, Cross KJ, Reynolds EC (2008) Enamel subsurface lesion remineralisation with casein phosphopeptide stabilised solutions of calcium, phosphate and fluoride. Caries Res 42(2):88–97. https://doi.org/10.1159/000113161

    Article  PubMed  Google Scholar 

  12. Oshiro M, Yamaguchi K, Takamizawa T, Inage H, Watanabe T, Irokawa A, Ando S, Miyazaki M (2007) Effect of CPP-ACP paste on tooth mineralization: an FE-SEM study. J Oral Sci 49(2):115–120. https://doi.org/10.2334/josnusd.49.115

    Article  PubMed  Google Scholar 

  13. Kumar VL, Itthagarun A, King NM (2008) The effect of casein phosphopeptide-amorphous calcium phosphate on remineralization of artificial caries-like lesions: an in vitro study. Aust Dent J 53(1):34–40. https://doi.org/10.1111/j.1834-7819.2007.00006.x

    Article  PubMed  Google Scholar 

  14. Reynolds EC, Cai F, Cochrane NJ, Shen P, Walker GD, Morgan MV, Reynolds C (2008) Fluoride and casein phosphopeptide-amorphous calcium phosphate. J Dent Res 87(4):344–348. https://doi.org/10.1177/154405910808700420

    Article  PubMed  Google Scholar 

  15. Shen P, Cai F, Nowicki A, Vincent J, Reynolds EC (2001) Remineralization of enamel subsurface lesions by sugar-free chewing gum containing casein phosphopeptide-amorphous calcium phosphate. J Dent Res 80(12):2066–2070. https://doi.org/10.1177/00220345010800120801

    Article  PubMed  Google Scholar 

  16. Manton DJ, Walker GD, Cai F, Cochrane NJ, Shen P, Reynolds EC (2008) Remineralization of enamel subsurface lesions in situ by the use of three commercially available sugar-free gums. Int J Paediatr Dent 18(4):284–290. https://doi.org/10.1111/j.1365-263X.2008.00920.x

    Article  PubMed  Google Scholar 

  17. Cai F, Manton DJ, Shen P, Walker GD, Cross KJ, Yuan Y, Reynolds C, Reynolds EC (2007) Effect of addition of citric acid and casein phosphopeptide-amorphous calcium phosphate to a sugar-free chewing gum on enamel remineralization in situ. Caries Res 41(5):377–383. https://doi.org/10.1159/000104796

    Article  PubMed  Google Scholar 

  18. Cai F, Shen P, Morgan M, Reynolds E (2003) Remineralization of enamel subsurface lesions in situ by sugar-free lozenges containing casein phosphopeptide-amorphous calcium phosphate. Aust Dent J 48(4):240–243. https://doi.org/10.1111/j.1834-7819.2003.tb00037.x

    Article  PubMed  Google Scholar 

  19. Cochrane NJ, Shen P, Byrne SJ, Walker GD, Adams GG, Yuan Y, Reynolds C, Hoffmann B, Dashper SG, Reynolds EC (2012) Remineralisation by chewing sugar-free gums in a randomised, controlled in situ trial including dietary intake and gauze to promote plaque formation. Caries Res 46(2):147–155. https://doi.org/10.1159/000337240

    Article  PubMed  Google Scholar 

  20. Andersson A, Skold-Larsson K, Hallgren A, Petersson LG, Twetman S (2007) Effect of a dental cream containing amorphous cream phosphate complexes on white spot lesion regression assessed by laser fluorescence. Oral Health Prev Dent 5(3):229–233

    PubMed  Google Scholar 

  21. Bailey DL, Adams GG, Tsao CE, Hyslop A, Escobar K, Manton DJ, Reynolds EC, Morgan MV (2009) Regression of post-orthodontic lesions by a remineralizing cream. J Dent Res 88(12):1148–1153. https://doi.org/10.1177/0022034509347168

    Article  PubMed  Google Scholar 

  22. Wang JX, Yan Y, Wang XJ (2012) Clinical evaluation of remineralization potential of casein phosphopeptide amorphous calcium phosphate nanocomplexes for enamel decalcification in orthodontics. Chin Med J 125(22):4018–4021

    PubMed  Google Scholar 

  23. Singh S, Singh SP, Goyal A, Utreja AK, Jena AK (2016) Effects of various remineralizing agents on the outcome of post-orthodontic white spot lesions (WSLs): a clinical trial. Prog Orthod 17(1):25. https://doi.org/10.1186/s40510-016-0138-9

    Article  PubMed  PubMed Central  Google Scholar 

  24. Brochner A, Christensen C, Kristensen B, Tranaeus S, Karlsson L, Sonnesen L et al (2011) Treatment of post-orthodontic white spot lesions with casein phosphopeptide-stabilised amorphous calcium phosphate. Clin Oral Investig 15(3):369–373. https://doi.org/10.1007/s00784-010-0401-2

    Article  PubMed  Google Scholar 

  25. Huang GJ, Roloff-Chiang B, Mills BE, Shalchi S, Spiekerman C, Korpak AM, Starrett JL, Greenlee GM, Drangsholt RJ, Matunas JC (2013) Effectiveness of MI Paste Plus and PreviDent fluoride varnish for treatment of white spot lesions: a randomized controlled trial. Am J Orthod Dentofac Orthop 143(1):31–41. https://doi.org/10.1016/j.ajodo.2012.09.007

    Article  Google Scholar 

  26. Beerens MW, van der Veen MH, van Beek H, ten Cate JM (2010) Effects of casein phosphopeptide amorphous calcium fluoride phosphate paste on white spot lesions and dental plaque after orthodontic treatment: a 3-month follow-up. Eur J Oral Sci 118(6):610–617. https://doi.org/10.1111/j.1600-0722.2010.00780.x

    Article  PubMed  Google Scholar 

  27. He WD, Liu YZ, Xu YY, Chen D (2010) Study on application of CPP-ACP on tooth mineralization during orthodontic treatment with fixed appliance. Shanghai Kou Qiang Yi Xue 19(2):140–143

    PubMed  Google Scholar 

  28. Robertson MA, Kau CH, English JD, Lee RP, Powers J, Nguyen JT (2011) MI Paste Plus to prevent demineralization in orthodontic patients: a prospective randomized controlled trial. Am J Orthod Dentofac Orthop 140(5):660–668. https://doi.org/10.1016/j.ajodo.2010.10.025

    Article  Google Scholar 

  29. Esenlik E, Uzer Celik E, Bolat E (2016) Efficacy of a casein phosphopeptide amorphous calcium phosphate (CPP-ACP) paste in preventing white spot lesions in patients with fixed orthodontic appliances: a prospective clinical trial. Eur J Paediatr Dent 17(4):274–280

    PubMed  Google Scholar 

  30. Banks PA, Richmond S (1994) Enamel sealants: a clinical evaluation of their value during fixed appliance therapy. Eur J Orthod 16(1):19–25. https://doi.org/10.1093/ejo/16.1.19

    Article  PubMed  Google Scholar 

  31. Pitts N (2004) “ICDAS”—an international system for caries detection and assessment being developed to facilitate caries epidemiology, research and appropriate clinical management. Commun Dent Health 21(3):193

    Google Scholar 

  32. Nyvad B, Machiulskiene V, Baelum V (1999) Reliability of a new caries diagnostic system differentiating between active and inactive caries lesions. Caries Res 33(4):252–260. https://doi.org/10.1159/000016526

    Article  PubMed  Google Scholar 

  33. Turesky S, Gilmore ND, Glickman I (1970) Reduced plaque formation by the chloromethyl analogue of victamine C. J Periodontol 41(1):41–43. https://doi.org/10.1902/jop.1970.41.1.41

    Article  PubMed  Google Scholar 

  34. Taves DR (1968) Evidence that there are two forms of fluoride in human serum. Nature 217(5133):1050–1051. https://doi.org/10.1038/2171050b0

    Article  PubMed  Google Scholar 

  35. Cohen J (1968) Weighted kappa: nominal scale agreement with provision for scaled disagreement or partial credit. Psychol Bull 70(4):213–220. https://doi.org/10.1037/h0026256

    Article  PubMed  Google Scholar 

  36. Richter AE, Arruda AO, Peters MC, Sohn W (2011) Incidence of caries lesions among patients treated with comprehensive orthodontics. Am J Orthod Dentofac Orthop 139(5):657–664. https://doi.org/10.1016/j.ajodo.2009.06.037

    Article  Google Scholar 

  37. Sitthisettapong T, Phantumvanit P, Huebner C, DeRouen T (2012) Effect of CPP-ACP paste on dental caries in primary teeth: a randomized trial. J Dent Res 91(9):847–852. https://doi.org/10.1177/0022034512454296

    Article  PubMed  PubMed Central  Google Scholar 

  38. Allen IE, Seaman CA (2007) Likert scales and data analyses. Qual Prog 40(7):64–65

    Google Scholar 

  39. Basdra EK, Huber H, Komposch G (1996) Fluoride released from orthodontic bonding agents alters the enamel surface and inhibits enamel demineralization in vitro. Am J Orthod Dentofac Orthop 109(5):466–472. https://doi.org/10.1016/S0889-5406(96)70130-0

    Article  Google Scholar 

  40. Linton JL (1996) Quantitative measurements of remineralization of incipient caries. Am J Orthod Dentofac Orthop 110(6):590–597. https://doi.org/10.1016/S0889-5406(96)80034-5

    Article  Google Scholar 

  41. Nascimento PL, Fernandes MT, Figueiredo FE, Faria ESAL (2016) Fluoride-releasing materials to prevent white spot lesions around orthodontic brackets: a systematic review. Braz Dent J 27(1):101–107. https://doi.org/10.1590/0103-6440201600482

    Article  PubMed  Google Scholar 

  42. Chandak S, Bhondey A, Bhardwaj A, Pimpale J, Chandwani M (2016) Comparative evaluation of the efficacy of fluoride varnish and casein phosphopeptide–amorphous calcium phosphate in reducing Streptococcus mutans counts in dental plaque of children: an in vivo study. J Int Soc Prev Commun Dent 6(5):423–429. https://doi.org/10.4103/2231-0762.192936

    Article  Google Scholar 

  43. Reynolds EC, Cain CJ, Webber FL, Black CL, Riley PF, Johnson IH et al (1995) Anticariogenicity of calcium phosphate complexes of tryptic casein phosphopeptides in the rat. J Dent Res 74(6):1272–1279. https://doi.org/10.1177/00220345950740060601

    Article  PubMed  Google Scholar 

  44. Boyd RL (1993) Comparison of three self-applied topical fluoride preparations for control of decalcification. Angle Orthod 63(1):25–30. https://doi.org/10.1043/0003-3219(1993)063<0025:COTSTF>2.0.CO;2

    PubMed  Google Scholar 

  45. Featherstone JD, Glena R, Shariati M, Shields CP (1990) Dependence of in vitro demineralization of apatite and remineralization of dental enamel on fluoride concentration. J Dent Res 69:620–625 discussion 34-6

    Article  PubMed  Google Scholar 

  46. ten Cate JM, Featherstone JD (1991) Mechanistic aspects of the interactions between fluoride and dental enamel. Crit Rev Oral Biol Med 2(3):283–296. https://doi.org/10.1177/10454411910020030101

    Article  PubMed  Google Scholar 

  47. Zero D (1995) In situ caries models. Adv Dent Res 9(3):214–230. https://doi.org/10.1177/08959374950090030501

    Article  PubMed  Google Scholar 

  48. Leverett DH, Proskin HM, Featherstone JD, Adair SM, Eisenberg AD, Mundorff-Shrestha SA et al (1993) Caries risk assessment in a longitudinal discrimination study. J Dent Res 72(2):538–543. https://doi.org/10.1177/00220345930720021101

    Article  PubMed  Google Scholar 

  49. Shields CP, Moss M, Billings RJ, Featherstone JDB (1997) A longitudinal chemical analysis of saliva. J Dent Res 76(Abstract)

  50. Billings RJ, Gansky SA, Mundorff-Shrestha SA, Leverett DH, Featherstone JDB (2003) Pathological and protective caries risk factors in children's longitudinal study. Caries Res 37(4):277 (Abstract #31)

    Google Scholar 

  51. Featherstone JD (2006) Delivery challenges for fluoride, chlorhexidine and xylitol. BMC Oral Health 6(Suppl 1):S8

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

Thanks to Karina Lee and Anupama Sharma, UCSF School of Dentistry Class of 2016 for verifying data transfers into digital spreadsheets. Gerald Nelson, UCSF Division of Orthodontics, is gratefully acknowledged for consulting with clinical questions. The authors thank Marcia Rapozo-Hilo for performing the salivary fluoride assays.

Consent to submit the manuscript and contribution

Consent to submit has been received explicitly from all coauthors. All authors have contributed sufficiently to the scientific work and therefore share collective responsibility and accountability for the results.

Funding

This work is a Principal Investigator Initiated Study and was funded by GC America, Inc. (Alsip, IL) through the University of California, San Francisco’s Contracts & Grants Division.

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Authors and Affiliations

  1. Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California at San Francisco, 707 Parnassus, San Francisco, CA, 94143, USA

    Peter Rechmann, Beate M. T. Rechmann, Benjamin W. Chaffee & John D. B. Featherstone

  2. Division of Orthodontics, Department of Orofacial Sciences, School of Dentistry, University of California at San Francisco, 707 Parnassus, San Francisco, CA, 94143, USA

    Sona Bekmezian

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  1. Peter Rechmann
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  2. Sona Bekmezian
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Corresponding author

Correspondence to Peter Rechmann.

Ethics declarations

UCSF Institutional Review Board (IRB) approval was obtained (IRB #13-10710) and the study was registered with the US National Institute of Health as a Phase 4 clinical trial (ClinicalTrials.gov Identifier: NCT02424097).

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Rechmann, P., Bekmezian, S., Rechmann, B.M.T. et al. MI Varnish and MI Paste Plus in a caries prevention and remineralization study: a randomized controlled trial. Clin Oral Invest 22, 2229–2239 (2018). https://doi.org/10.1007/s00784-017-2314-9

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