Remineralisation and Enhanced
Fluoride Delivery with ACP:
emineralisation technologies are now playing an important role in preventative care. Creating excitement is
amorphous calcium phosphate (ACP). ACP is more than
a cosmetic benefit for patients- it’s the first non-fluoride therapy to remineralize enamel and dentin.1 The most reactive and
soluble calcium phosphate compound, ACP forms on the tooth
enamel within the dentinal tubules and provides a reservoir in
the saliva. ACP rapidly releases calcium and phosphate ions
to convert to apatite and remineralise. The potential of ACP
was discovered by ADA Foundation Paffenbarger Research
Center chemist and researcher, Ming S. Tung, Ph. D. in 1991.
Research shows that available ACP on the enamel can prevent damaging erosion by stimulating remineralisation of tooth
structure.2,3,4 Introducing calcium and phosphate back into the
surface of the tooth with products containing ACP technology
is an ideal strategy to reverse the demineralisation process.
R
The ACP-forming ingredients also strengthen teeth by acting
as an enhanced fluoride delivery system to deliver more fluoride than products without ACP. As a part of the prophylaxis
procedure, prophy paste is intended to polish the enamel.
While polishing, the fluoride-enriched layer of enamel also is
removed. Premier’s Enamel Pro® prophy paste delivers 31%
more fluoride uptake into the enamel than prophy paste without ACP.5 In addition to the increased fluoride uptake, Enamel
Pro prophy paste improves enamel lustre as the ACP fills in the
enamel crevices for an intense polish and shine.6
In other procedures involving ACP formulated products, ACP
also works together with fluoride to desensitise dentin.
Fluoride along with the ACP occludes tubules by depositing
tooth-like minerals to create a semi-permanent reduction in
hydraulic conductance, thereby minimising sensitivity.
Whether it arrests early stages of caries for patients, produces
a delivery system for fluoride, providing a more lustrous enamel surface, or desensitising teeth, the potential of ACP technology will continue to provide to professionals new tools to remineralise and great strides in eradicating the caries process.
1. Garvin, Jennifer, “ACP: the next big thing” ADA News. August 2007: 1 & 10 2. Tung,M.S.,
Eichmiller, F.C. “ACP for Tooth Mineralization”, Compendium Cont. Educ Dent, Vol 25, No 9, Suppl.
1, Sept. 2004, p 9-13. Journal Code 9600713, Journal Subset MEDJSD, ISSN 1548-8578. Corp.
Author: American Dental Association Foundation. 3. Tung,M., Eichmiller, F., Gibson, H., Ly, A.,
Skrtic, D., Schumacher, G.,(ADAHF Paffenbarger Research Center, NIST, Gaithersburg, MD),
“Dentin Desensitization by in situ Formation of Calcium Phosphate”, J. Dent Res 76 (IADR
Abstracts): 2985, 1997 4. Schemehorn, B.R., Orban, J.C.,Wood, G.D., et al. “Remineralization by
Fluoride Enhanced with Calcium and Phosphate Ingredients”, Journal of Clinical Dentistry, 1999;
10(1 spec. no.),:13-16. 5. Source: “Final Report: Enamel Fluoride Uptake Study #05-106,
Modified FDA Method #40, “Dental Products Testing, Indiana University Emerging Technologies
Center, December 2005 6. Winston, A.E., Charig, A., Patel,V., McHale, W.A. and Malerman,R.
“Effect of Prophy Pastes on Surface of Tooth Enamel,” Journal of Dental Research, Vol 84, Special
Issue A, IADR Abstracts, 2005
Enamel Pro®
The Clear Choice for You
and Your Patients
Independent studies show Enamel Pro® Varnish delivers
more enamel fluoride uptake and greater fluoride
release than 3M Varnish with TCP1,2
In a 2012 study evaluating incubation conditions on
fluoride release in vitro, Enamel Pro Varnish displayed
greater fluoride release than both 3M Varnish
and Colgate Duraphat †,2
Distinguished:
• First advanced fluoride varnish optimised to provide valuable toothbuilding ions of calcium and phosphate
• Designed to create substantive forms of CaF2 and ACP
Indications for use:
• Enamel Pro Varnish is a fluoride containing preparation for the
treatment of dentinal hypersensitivity, and for the reduction of post
operative sensitivity.
• Enamel Pro Varnish offers a nice esthetic appearance, is patient
pleasing and has studies which support fluoride uptake, fluoride
release and diminished hydraulic conductance.1,2,3
1. Schemehorn, B.R., Wood, G.D., McHale, W., Winston, A.E., “Comparison of Fluoride Uptake into Tooth
Enamel from Two Fluoride Varnishes Containing Different Calcium Phosphate Sources”, J Clin Dent,
2011;22:51-54 / 2. Fluoride Release from Fluoride Varnishes is Affected by Incubation Conditions C.
Gonzalez-Cabezas, S.E.Flannagan, R. Krell, M. Uekihara, and C.C. Niquette, Dent Res 91(Spec Iss
A):1094, 2012 (www.dentalresearch.org). / 3.”Effect of Calcium Phosphate Containing Fluoride Varnish
of Dentin Permeability”, Tung, M.S., Torres, J., (ADAHF Paffenbarger Research Center, NIST,
Gaithersburg, MD and U.S. Navy Dental Corps, Bethesda MD), J Dent Red (Spec Iss A): 0985, 2008
(www.dentalresearch.org). / † 3M Vanish and Colgate Duraphat are not trademarks of Premier Dental.
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The Leading 10:
10 questions regarding
Enamel Pro® Varnish by Premier®
1. What are the latest technologies in strengthening enamel?
Products containing calcium and phosphate, which are naturally found in healthy saliva.
2. How do the additions of such salts contribute to a successful treatment plan?
Calcium and phosphate technologies are not all alike, the intention of these formulas is to reinstate lost minerals as a result of acidic or
erosive challenges that occur daily and affect both enamel and dentinal structures.
3. What are the differences that health professionals need to look at in these technologies?
The differences exist in the mechanism of action of each technology and how it sets up the delivery of calcium and phosphate ions.
For instance, products which create amorphous calcium phosphate (ACP) are derived from a combination of specialised salts of
calcium and phosphate.
4. Once the mechanism of action is determined, what sets them apart in providing the best
solution?
Solubility/bioavailability addresses how quickly these formulas break down to make calcium and phosphate ions readily available in the
oral environment. ACP provides for rapid delivery, in fact, its high solubility is its best attribute. It is immediately bio-available and
improves fluoride uptake.
5. How does the addition of ACP formula in products contribute to greater fluoride uptake?
As the specialised salts become soluble in the oral environment, calcium and phosphate ions are free to attach to the fluoride ions.
Fluoride reacts with tooth mineral, forming either fluoridated apatite (firmly-bound) or calcium fluoride (loosely-bound). ACP forms on
the tooth enamel within the dentinal tubules and when met with fluoride, provides a beneficial calcium fluoride ion reservoir on teeth
in plaque and in the saliva.
6. Explain loosely-bound fluoride.
Calcium fluoride, or loosely-bound fluoride provides a relatively slow-release form of ionic fluoride to plaque, saliva or soft tissue. A
potential reservoir source of solution fluoride enhances remineralisation and slows down the demineralisation processes.
7. Firmly-bound?
Firmly-bound fluoride, or fluorapatite, incorporated onto the surface of the crystals of apatite can reduce the solubility of tooth mineral
and, hence, inhibit demineralisation due to acids generated by plaque bacteria.
8. Is there a comparison of calcium/phosphate technologies on fluoride uptake?
In fact, a recent study with NaF varnish indicates Premier Enamel Pro Varnish with ACP formulation
delivers statistically significantly more fluoride both to intact and demineralised enamel than varnish
with tri-calcium phosphate (TCP). It is likely that this outcome results from the greater availability of
the calcium and phosphate ions in the ACP formulation.
9. NaF Varnishes are indicated as a desensitiser. Can you elaborate on how ACP technology contributes?
Enamel Pro Varnish with ACP formula is proven to diminish hydraulic conductance by 73%. ACP
works together with fluoride to desensitise dentin; ACP crystallizes with fluoride and forms fluorapatite - tooth-like mineral. ACP and fluoride provide semi-permanent occlusion with fluorapatite.
10. So, fluoride varnishes are not all alike?
No; while all varnishes provide fluoride, Enamel Pro Varnish has studies supporting fluoride uptake,
fluoride release and diminished hydraulic conductance. Enamel Pro Varnish is the perfect solution
for patients of all ages who need a fluoride treatment; takes seconds to apply, sets on contact with
saliva and provides relief from hypersensitivity.
Helpful article: http://www.premusa.com/Downloadablefiles/JCD_22_2_Schemehorn_et_al.pdf
Random Facts
# Enamel is comprised of approximately
96% inorganic material and 4% organic
material and water.
# Normal flow of saliva, whether it is resting or stimulated, is essential to keeping
the oral cavity maintained in a healthier
state.
# Minerals will start to leach out of
Hydroxyapatite when the pH is below 5.5.
# Minerals will start to to leach out of
Fluorapatite when the pH is below 4.5.
# ACP (Amorphous Calcium Phosphate)
technology was discovered through funding by the American Dental Association
(ADA) Foundation and developed in collaboration with the Paffenbarger Research
Center, ADAHF and NIST, Maryland, USA.
Remineralisation Instrumentation Prevention Oral Care - In Surgery & Take Home
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phone: 1800 025 300
fax: 1800 025 202
www.gunz.com.au