Remineralization / reduction in lesion severity (change in QLF, laser fluorescence, or lesion area) · Patients with white spot lesions / early caries lesions (WSLs/ECLs), including orthodontic and non-orthodontic lesions, active caries…
CPP-ACP did not differ significantly from CPP-ACFP (SMD 0.25, 95% CI -0.24 to 0.73); certainty of evidence not assessed (no GRADE).
1 finding from 1 review
Remineralization / reduction in lesion severity (change in QLF, laser fluorescence, or lesion area) · Patients with white spot lesions / early caries lesions (WSLs/ECLs), including orthodontic and non-orthodontic lesions, active caries…
CPP-ACP did not differ significantly from control (SMD -0.18, 95% CI -0.49 to 0.14); certainty of evidence not assessed (no GRADE).
1 finding from 1 review
Quantitative light-induced fluorescence (QLF), fluorescence loss · Patients (mainly children) with white spot lesions (WSL)
CPP-ACP toothpaste did not differ significantly from placebo paste (fluoride control) for white spot lesion remineralization on QLF (MD 0.08, 95% CI -0.91 to 1.08; ungraded).
1 finding from 1 review
Quantitative light-induced fluorescence (QLF) change · Patients with early caries lesions in permanent teeth (non-fluoridated water area)
Adding CPP-ACP to fluorides did not significantly change QLF outcomes for smooth-surface early caries lesions versus fluorides alone; not GRADE-rated.
1 finding from 1 review
Visual inspection scores · Patients with early caries lesions in permanent teeth (non-fluoridated water area)
Two trials reported visual inspection scores but could not be pooled (different criteria, missing standard deviations) and gave inconsistent findings, so no quantitative conclusion could be drawn.
1 finding from 1 review
Laser fluorescence (LF) change · Patients with early caries lesions in permanent teeth (non-fluoridated water area)
For occlusal early caries lesions, adding CPP-ACP to fluorides produced significantly greater laser-fluorescence improvement than fluorides alone (favors the combination); not GRADE-rated.
2 findings from 1 review
Total lesion area divided by total surface area (visual) · Patients with early caries lesions in permanent teeth (non-fluoridated water area)
Adding CPP-ACP to fluorides did not significantly change the lesion-area outcome for smooth-surface early caries lesions versus fluorides alone; not GRADE-rated.
1 finding from 1 review
Average enamel surface roughness · Extracted human teeth with early/artificial enamel lesions (in vitro)
In vitro, CPP-ACP markedly reduced enamel surface roughness versus control (SMD -8.21, 95% CI -10.37 to -6.04; ungraded).
1 finding from 1 review
Arrest or reversal of noncavitated carious lesions on any coronal surface · Children and adults with noncavitated carious lesions on any coronal surface (primary and permanent teeth)
10% CPP-ACP paste may not differ from no treatment for arrest or reversal of any-coronal carious lesions (RR 1.03, 95% CI 0.9 to 1.18; low certainty).
1 finding from 1 review
Arrest or reversal of noncavitated carious lesions on any coronal surface · Children and adults with noncavitated carious lesions on any coronal surface (primary and permanent teeth)
10% CPP-ACP paste was probably less effective than 5% NaF varnish for arrest or reversal of any-coronal carious lesions (RR 0.48, 95% CI 0.38 to 0.6; moderate certainty).
1 finding from 1 review
Enamel surface microhardness · Extracted human teeth with early/artificial enamel lesions (in vitro)
In vitro, CPP-ACP increased Vickers microhardness versus control (SMD 1.19, 95% CI 0.72 to 1.66; ungraded).
3 findings from 1 review
SMD 1.19 [0.72, 1.66]
5 studies · 106 participants
GRADE not reported
SMD 2.07 [1.24, 2.89]
8 studies · 170 participants
GRADE not reported
SMD 3.52 [2.68, 4.36]
3 studies · 64 participants
GRADE not reported
Quantitative light-induced fluorescence (QLF), fluorescence loss · Patients (mainly children) with white spot lesions (WSL)
Compared with baseline, CPP-ACP significantly improved white spot lesions on QLF (SMD -0.43, 95% CI -0.79 to -0.07; ungraded).
1 finding from 1 review
Shear bond strength (SBS) of metallic orthodontic brackets · Extracted permanent human teeth (enamel); sound or demineralized
CPP-ACP enamel pre-treatment before bonding did not significantly affect the shear bond strength of metallic orthodontic brackets (MD 1.163 MPa, 95% CI -0.321 to 2.648; ungraded).
1 finding from 1 review
Shear bond strength (SBS) of metallic orthodontic brackets · Sound enamel of extracted permanent human teeth
When used to prevent white spot lesions on sound enamel, CPP-ACP pre-treatment did not significantly affect shear bond strength (MD 1.009, 95% CI -0.723 to 2.740; ungraded).
1 finding from 1 review
MD 1.009 [-0.723, 2.740]
7 studies
GRADE not reported
Shear bond strength (SBS) of metallic orthodontic brackets · Demineralized enamel of extracted permanent human teeth
When used to remineralize white spot lesions on demineralized enamel, CPP-ACP pre-treatment did not significantly affect shear bond strength (MD 1.501, 95% CI -0.630 to 3.632; ungraded).
1 finding from 1 review
MD 1.501 [-0.630, 3.632]
9 studies
GRADE not reported
Enamel resistance to demineralization (microhardness / lesion depth) · Extracted human teeth with early/artificial enamel lesions (in vitro)
Low-quality in vitro evidence suggests remineralising additives may reduce mineral loss, but no firm conclusion can be drawn.
1 finding from 1 review
no estimate extracted
4 studies
GRADE not reported
Immediate (24 h) resin-dentin bond strength (MPa) · Artificial caries-affected dentin (ACAD) in extracted permanent human teeth (in vitro)
In the Self-Etch adhesive + chemical ACAD protocol network, Calcium Phosphate vs Fluorine showed no significant difference in 24 h bond strength (MD 2.140, 95% CI -1.506 to 5.787; Moderate certainty).
2 findings from 1 review
Immediate (24 h) resin-dentin bond strength (MPa) · Artificial caries-affected dentin (ACAD) in extracted permanent human teeth (in vitro)
In the Etch-and-Rinse adhesive + chemical ACAD protocol network, Calcium Phosphate vs Calcium showed no significant difference in 24 h bond strength (MD 0.596, 95% CI -7.289 to 8.482; Low certainty).
2 findings from 1 review
Immediate (24 h) resin-dentin bond strength (MPa) · Artificial caries-affected dentin (ACAD) in extracted permanent human teeth (in vitro)
In the Self-Etch adhesive + chemical ACAD protocol network, Calcium Phosphate vs Control showed no significant difference in 24 h bond strength (MD 1.539, 95% CI -1.738 to 4.817; Moderate certainty).
1 finding from 1 review
Arrest or reversal of noncavitated facial/lingual carious lesions · Children and adults with noncavitated carious lesions on facial/lingual surfaces (primary and permanent teeth)
10% CPP-ACP cream (+ 900-ppm NaF mouthrinse + 1,000-ppm NaF dentifrice) may not differ from Placebo cream (+ 900-ppm NaF mouthrinse + 1,000-ppm NaF dentifrice) for arrest or reversal of facial/lingual carious lesions (RR 1.28, 95% CI 0.97 to 1.68; low certainty).
3 findings from 1 review