الفهرس 
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Abstract
Introduction: This study was conducted to evaluate the effect of casein phosphopeptide amorphous calcium phosphate paste (CPP-ACP) (GC Tooth Mousse) application in prevention of white spot lesions development during orthodontic treatment. Materials and Methods: Forty-five orthodontic patients who required at least two first premolars extraction as part of their orthodontic treatment plan were recruited from the outpatient’s clinic of the Orthodontic Department. The maxillary arch of each patient was divided into right and left quadrant. The total number was ninety quadrants which were divided randomly into two groups; intervention group and control group. The intervention group received CPP-ACP paste once every two weeks for three successive months, while the control group received no treatment. Intraoral pretreatment (initial) photographs of each patient were taken as part of standard orthodontic record keeping procedures. After 3 months upper first premolar’s brackets were then debonded, teeth were air dried for more than five seconds and lateral intra-oral photographs were taken, subsequently, the teeth were extracted, cleaned with 10% formalin and kept in distilled water. Pre-treatment and post-treatment photographs were evaluated by 10 dentists according to the International Caries Assessment and Detection System (ICDAS II) and Visual Analogue Scale (VAS) using PowerPoint presentation. Extracted teeth were sent to be tested for surface texture under scanning electron microscope with energy dispersive x-rays (SEM/EDX). For surface microhardness testing, each tooth was divided buccolingually. Each buccal half was mounted in a custom-made cylindrical mold that was prepared using self-cured acrylic resin. Results: The ICDAS II and VAS scale results showed a statistically significant difference (p < 0.001) for the control group which indicates increased opacity of the buccal surface between the beginning and end of treatment and there was no statistically significant difference (p = 0.320) and (p = 0.176) respectively in the intervention group before and after application of GC Tooth Mousse for 3 months, while SEM photographs showed increased enamel demineralization as revealed by the enamel porosity in the control (A) group than the intervention (B) group. Vickers’s Hardness test showed a statistically significant difference (p < 0.001) in the mean microhardness between the intervention and control groups. Conclusion: Application of GC Tooth Mousse has maintained the surface opacity as indicated by the non-significant difference in ICDAS-II and VAS scale between pre and post GC application compared to control group, Showed better surface topography and less porosity as revealed by the SEM photographs indicating less degree of demineralization compared to control group and higher microhardness value than the control value indicating low amount of mineral loss.