CPP-ACP - RECALDENT- REMINERALIZING MECHANISM

CPP-ACP IS CALLED AS RECALDENT

MOST COMMONLY USED REMINERALIZING AGENT IN DENTAL PRACTICE

Recaldent was developed by Professor Eric Reynolds in the School of Dental Science at the University of Melbourne.

The CPP-ACP (casein phosphopeptide-amorphous calcium phosphate) nanocomplex is found in the casein protein of cows milk. These peptides are responsible for carrying the calcium phosphate in milk and are what give milk its white colour.

The casein phosphopeptides can be easily prepared from a tryptic digest of caseinate by selective precipitation with Ca2+ in the presence of ethanol (Reynolds, 1991). This produces a casein phosphopeptide (CPP) fraction rich in the phosphopeptides aLS-CN(59-79) and PCN(l /2-25)

CPP containing the cluster sequence –Ser(P)-Ser(P)-Ser(P)-Glu-Glu- stabilize ACP in metastable solution. Through the cluster sequence the CPP bind to forming nanoclusters of ACP preventing their growth to the critical size required for nucleation and phase transformation.

Casein phosphopeptides (CPP) stabilize high concentrations of calcium and phosphate ions, together with fluoride ions, at the tooth surface by binding to pellicle and plaque, significantly increase the levels of calcium and phosphate ions in supragingival plaque.

Although the calcium, phosphate and fluoride ions are stabilized by the CPP from promoting dental calculus, during acidogenic challenges, nano-complexes release calcium and phosphate ions via a pH or concentration gradient mechanism to maintain a supersaturated environment with respect to hydroxyapatite

CPP-ACP was incorporated into supragingival dental plaque by binding onto the surfaces of bacterial cells, as well as to components of the intercellular plaque matrix, and significantly increased the plaque levels of calcium (Ca) and inorganic phosphate (Pi).

CPP are responsible for not only the stabilization and water solubility of ACP but also the incorporation of ACP into plaque by binding to bacterial cell surfaces and onto adsorbed macromolecules on the tooth surface.

The bacterial cell contains both hydrophilic and hydrophobic molecules on its surface (Rose et al., 1997). The CPP molecules also contain hydrophilic and hydrophobic regions, and it is possible that binding to the bacterial cell surface is mediated by Ca2+ cross-linking of the negative charges on the peptide and the cell surface molecules (e.g,phosphoryl and carboxylate groups) as well as by hydrophobic and hydrogen-bond-mediated interactions.

CPP-ACP would compete with calcium for plaque Ca binding sites. This will reduce the amount of calcium bridging between the pellicle and adhering cells and between cells themselves

As the pH decreases CPP-ACP residues become protonated thereby releasing calcium together with its associated anions. Hence, CPP can act as a reservoir for calcium, phosphate and fluoride ions.

remineralized enamel indicated that the mineral deposited was hydroxyapatite with a higher Ca:P ratio than normal apatite. remineralized apatite was more resistant to acid challenge than the normal calciumdeficient carbonated tooth enamel.

CPP act as a delivery vehicle to co-localize bioavailable calcium,fluoride and phosphate ions at the tooth surface.

casein proteins are capable of decreasing the rate of precipitation of calcium phosphate from a moderately supersaturated solution at concentrations, suggesting that the very rapid interaction of the phosphoprotein with calcium phosphate nuclei in such solutions is aided by the open and generally flexible conformation of casein produce nanometre-sized particles of calcium phosphate stabilized by a casein phosphopeptide.

IT IS COMMERCIALLY AVAILABLE AS TOOTH MOUSE

Tooth Mousse is NOT a toothpaste and should not be applied like toothpaste i.e. do not brush your teeth with it. MI paste is applied to the tooth with either a finger or can be applied in either a custom whitening tray if you have one .Mi paste can also be professionally applied by the hygienist with a polishing cup during your prophylaxis (tooth cleaning). Recommended to leave on the tooth for 3-5 minutes and then expectorate (spit out). For maximum benefit, do NOT rinse with water after application

Tooth Mousse plus is a water-based cream containing Recaldent with incorporated fluoride (CPP-ACPF - casein phosphopeptide – amorphous calcium phosphate fluoride). The level of fluoride is 0.2% (900ppm), similar to the level in adult-strength toothpastes

The sugar-free gums (control and CPP-ACP containing gums) were chewed for either 20- minute periods, four times a day or for 5-minute periods, seven times a day.

Supplies calcium and phosphate needed for patients with poor saliva flow.

GIC CONTAINGING CPP-ACP

The CPP-ACP nanoparticles may have been physically encapsulated into the set GIC, as has been found with
unreacted glass particles (Matsuya et al., 1984), and therefore released as the acid eroded the cement in the acidic buffer.

The acid-catalyzed release of the CPP-ACP nanoparticles from the GIC is consistent with the protection of the adjacent dentin observed during acid challenge

The CPP-ACP in the GIC may have also directly increased microtensile bond strength by the incorporation of the CPP-ACP nanoparticles into the crosslinked matrix of the GIC.

reference

Australian Dental Journal 2008; 53: 268–273

J. Biol. Chem., Vol. 280, Issue 15, 15362-15369, April 15, 2005

Biochem. J. (1996) 314 (1035–1039)

Arch Oral Biol 45:569-575 (2000).

J Am Dent Assoc 2008;139;25S-34S

J Dent Res 82(3):206-211, 2003

J Dent Res 82(11):914-918, 2003

The journal of nutrition 2004 989s-95s

Caries Res 2004;38:551–556