The Remineralization Effect of Theobromine and CPP-ACP on Enamel of Primary Molars

Abstract

Background: Studies have investigated remineralization process utilizing non-fluoridated agents, however the efficacy of theobromine and casein phosphopeptide-amorphous calcium phosphate (CPP ACP) remain relatively scarce, especially in primary teeth. Objective: This study aimed to investigate the remineralization effects of theobromine and CPP-ACP on enamel of primary molars under carious simulation condition. Methods: Extracted forty-five primary molars were collected. The crown was divided into 4 pieces. Three samples from each crown were randomly assigned to one of three treatment groups: deionized water (control), theobromine, and CPP-ACP for microhardness test and another sample was randomly used for ultrastructure and Energy-Dispersive X-ray Spectroscopy (EDS) evaluation. Microhardness testing was applied before and after pH cycling for all three groups (n = 15 each). Ultrastructure and EDS analyzed were performed on samples from four groups: untreated, deionized water, theobromine, and CPP-ACP (n = 10 each). The 7 days pH cycling process was employed to simulate a caries model. Data were described and compared statistically. Result: After pH cycling, the microhardness of enamel decreased in all 3 groups. The theobromine group did not exhibit significant changes after pH cycling (220.72 ± 24.75 VHN from 275.84 ± 25.34) compared to deionized water (163.21 ± 28.08 from 275.18 ± 27.71 VHN) and CPP-ACP (184.74 ± 44.55 from 277.29 ± 28.48 VHN) groups. Theobromine and CPP-ACP groups showed mineral precipitation covered demineralized enamel surface, as well as deionized water group. The Wt.% of Ca and P elements in theobromine group (Ca 39.54 ± 4.11 and P 18.38 ± 1.61) were not significantly different from untreated enamel (43.33 ± 5.48 and 19.66 ± 1.70) while CPP-ACP (Ca 36.37 ± 3.77 and P 17.13 ± 1.71) and deionized water groups (Ca 36.88 ± 4.67 and P 17.24 ± 2.10) showed a significant reduction (p < 0.05). Conclusion: Under the carious simulation conditions, theobromine might induce remineralization on demineralized enamel by increased Ca and P elements concentration and improved the microhardness while CPP-ACP did not show significant change from the deionized water group.