Efficacy of CPP-ACP and CPP-ACPF for Prevention and Remineralization of White Spot Lesions in Orthodontic Patients: a Systematic Review of Randomized Controlled Clinical Trials

Enamel subsurface lesions or white spot lesions (WSLs) are commonly found in orthodontic patients with a prevalence of 5% to 97%. This systematic review aimed to evaluate the efficacy of casein phosphopeptide amorphous calcium phosphate (CPP-ACP) and casein phosphopeptide amorphous calcium phosphate fluoride (CPP-ACPF) for prevention and remineralization of WSLs in orthodontic patients in human randomized controlled clinical trials (RCTs). Relevant articles were retrieved by searching the Web of Science, Scopus, PubMed, and Cochrane Library databases up to November 2018 with no language or date restriction. The collected data included examination method, groups included in each study with number of patients in each group, study design, follow-up period and summary of important findings of each study. The risk of bias of each study was assessed according to the guidelines of the Cochrane Collaboration's tool. Of 213 articles retrieved, 13 RCTs were included in this systematic review (none of them were included in the meta-analysis). Three articles showed superior efficacy of CPP-ACP for remineralization of WSLs while four studies reported the superior clinical efficacy of CPP-ACPF for this purpose. Both CPP-ACP and CPP-ACPF can decrease the prevalence and increase the remineralization of WSLs during/after orthodontic treatment.