Combined Casein Phosphopeptide-Amorphous Calcium Phosphate and Fluoride Is Not Superior to Fluoride Alone in Early Carious Lesions: A Meta-Analysis.

There is a growing need for effective methods in the management of early stage carious lesions. Therefore, the aim of this study was to evaluate the effect of combined casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) and fluoride on white spot lesions (WSLs) compared to fluoride-only interventions. This meta-analysis was performed according to PRISMA guidelines and registered in PROSPERO (CRD42021286245). The Medline, Embase, and Cochrane Central databases were searched until October 17, 2022. Eligible studies were randomized controlled trials. Outcome variables included laser fluorescence (LF), quantitative light-induced fluorescence (QLF), and lesion area scores. The random-effects model was used for analysis, and results were given as standardized mean difference (SMD) and mean difference (MD) with a 95% confidence interval. Risk of bias was assessed using the RoB 2 tool, and the level of evidence with GRADE. Our systematic search yielded 973 records after duplicate removal, 21 studies were included for qualitative synthesis, and 15 studies were eligible for quantitative analysis. No significant difference was found between CPP-ACP and fluoride versus fluoride alone in LF at 1, 3, and 6 months of use: SMD -0.30 (-0.64; 0.04); SMD -0.47 (-1.02; 0.07); SMD -0.49 (-1.13; 0.15), respectively. For QLF, the analysis did not demonstrate significant differences between these two kinds of treatment at 1 and 6 months of use: MD 0.21 (-0.30;0.71); MD 0.60 (-1.70;2.90), but at 3 months, higher QLF values were found in the fluoride-only group compared to the CPP-ACP and fluoride combination was shown regarding the WSLs: MD 0.58 (0.25;0.91). On the contrary, data showed a small but statistically significant decrease in the lesion area in favor of the CPP-ACP plus fluoride versus fluoride alone at 6 months MD -0.38 (-0.72; -0.04). None of these observed changes indicated substantial clinical relevance. The combination of CPP-ACP and fluoride did not overcome the effect of fluoride given alone. Our data suggest that fluoride itself is effective in improving WSLs. However, the certainty of evidence was very low. These results indicate that further studies and future development of more effective products than CPP-ACP are needed in addition to fluoride to achieve robust amelioration of WSLs.

[In vitro investigation of three NiTi rotary instruments]. / Geépi NiTi-tágítók in vitro vizsgálata.

The purpose of our study was to compare the shaping ability of three nickel-titanium rotary instruments (RaCe/FKG Dentaire/, ProTaper /Dentsply-Maillefer/ and M(two)/VDW/) by measuring the asymmetry that occurs in curved canals during instrumentation. Eight simulated canals in resin blocks (Morita Europe) were prepared in each group by the same operator according to the instructions of the manufacturers. We used M(two) direct (VDW-Sirona) contra-angle with torque control function. Copious irrigation of the canals was performed with the use of Chloramine B solution and File-Eze (Ultradent) was used for lubrication. We accomplished our measurements on the pre- and postoperatively scanned images of the resin blocks with the aid of Image Tool for Windows 3.0 (UTHSCSA). Measuring points were assigned along the curvature of the canal axis line to represent 1 millimeter distance from the apex and from each other. The centre of the curvature was edited and radius lines were drawn from the centre through the measuring points. We determined the value of the preparation asymmetry at the levels of these measuring points along the radius lines. RaCe prepared with the greatest asymmetry at the first, second, fourth and fifth measuring points, at the third level ProTaper produced the highest value of asymmetry. In general M(two) prepared with the lowest asymmetry while it proved as a safe instrument system. The main disadvantage about ProTaper was the high risk of fracture. The RaCe sequence used in this study showed great asymmetry values at the apical area.