James SL, Abate D, Abate KH Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018; 392:1789-1858
Bernabé E, Marcenes W. Can minimal intervention dentistry help in tackling the global burden of untreated dental caries?. Br Dent J. 2020; 229:487-491
Kidd EAM, Fejerskov O. What constitutes dental caries? Histopathology of carious enamel and dentin related to the action of cariogenic biofilms. J Dent Res. 2004; 83:2002-2005
Banerjee A. Minimal intervention dentistry: Part 7. Minimally invasive operative caries management: Rationale and techniques. Br Dent J. 2013; 214:107-111
Banerjee A. ‘Minimum intervention’ – MI inspiring future oral healthcare?. Br Dent J. 2017; 223:133-135
Banerjee A. Minimum Intervention (Ml) Oral Healthcare Delivery Implementation – Overcoming the Hurdles. Prim Dent J. 2017; 6:28-33
Banerjee A. Minimum intervention oral healthcare delivery - is there consensus?. Br Dent J. 2020; 229:393-395
Cochrane NJ, Cai F, Huq NL, Burrow MF, Reynolds EC. New approaches to enhanced remineralization of tooth enamel. J Dent Res. 2010; 89:1187-1197
He T, Li X, Dong Y, Zhang N Comparative assessment of fluoride varnish and fluoride film for remineralization of postorthodontic white spot lesions in adolescents and adults over a 6-month period: A single-center, randomized controlled clinical trial. Am J Orthod Dentofac Orthop. 2016; 149:810-819
Ruan Q, Moradian-Oldak J. Amelogenin and enamel biomimetics. J Mater Chem B. 2015; 3:3112-3129
Philip N. State of the art enamel remineralization systems: The next frontier in caries management. Caries Res. 2019; 53:284-295
ten Cate JM, Buzalaf MAR. Fluoride mode of action: Once there was an observant dentist…. J Dent Res. 2019; 98:725-730
ten Cate JM, Featherstone JDB. Mechanistic aspects of the interactions between fluoride and dental enamel. Crit Rev Oral Biol Med. 1991; 2:283-296
Pajor K, Pajchel L, Kolmas J. Hydroxyapatite and fluorapatite in conservative dentistry and oral implantology—A review. Materials (Basel). 2019; 12
Featherstone JDB, Glena R, Shariati M, Shields CP. Dependence of in vitro demineralization of apatite and remineralization of dental enamel on fluoride concentration. J Dent Res. 1990; 69:620-625
Cate JM ten Current concepts on the theories of the mechanism of action of fluoride. Acta Odontol Scand. 1999; 57:325-329
Lippert F, Juthani K. Fluoride dose-response of human and bovine enamel artificial caries lesions under pH-cycling conditions. Clin Oral Investig. 2015; 19:1947-1954
Lippert F. Effect of enamel caries lesion baseline severity on fluoride dose-response. Int J Dent. 2017; 2017 https://doi.org/10.1155/2017/4321925
Watson PS, Pontefract HA, Devine DA, Shore RC, Nattress BR, Kirkham J Penetration of fluoride into natural plaque biofilms. J Dent Res. 2005; 84:451-455
Wong L, Cutress TW, Duncan JF. The influence of incorporated and adsorbed fluoride on the dissolution of powdered and pelletized hydroxyapatite in fluoridated and non-fluoridated acid buffers. J Dent Res. 1987; 66:1735-1741
Lynch RJM, Navada R, Walia R. Low-levels of fluoride in plaque and saliva and their effects on the demineralisation and remineralisation of enamel; role of fluoride toothpastes. Int Dent J. 2004; 54:304-309
Tokura T, Robinson C, Watson P Effect of pH on fluoride penetration into natural human plaque. Pediatr Dent J. 2012; 22:140-144
Rølla G. On the role of calcium fluoride in the cariostatic mechanism of fluoride. Acta Odontol Scand. 1988; 46:341-345
Øgaard B. Effects of fluoride on caries development and progression in vivo. J Dent Res. 1990; 69:813-819
González-Cabezas C, Fernández CE. Recent advances in remineralization therapies for caries lesions. Adv Dent Res. 2018; 29:55-59
Mäkinen KK. Sugar alcohols, caries incidence, and remineralization of caries lesions: A literature review. Int J Dent. 2010; 2010:1-23
Cummins D. The superior anti-caries efficacy of fluoride toothpaste containing 1.5% arginine. J Clin Dent. 2016; 27:27-38
Ástvaldsdóttir Á, Naimi-Akbar A, Davidson T Arginine and caries prevention: A systematic review. Caries Res. 2016; 50:383-393
Fontana M. Enhancing fluoride: clinical human studies of alternatives or boosters for caries management. Caries Res. 2016; 50:22-37
Hench LL. Bioceramics: From Concept to Clinic. J Am Ceram Soc. 1991; 74:1487-1510
Cerruti M, Greenspan D, Powers K. An analytical model for the dissolution of different particle size samples of Bioglass in TRIS-buffered solution. Biomaterials. 2005; 26:4903-4911
Burwell A, Jennings D, Muscle D, Greenspan DC. NovaMin and dentin hypersensitivity-In vitro evidence of efficacy. J Clin Dent. 2010; 21:66-71
Vahid Golpayegani M, Sohrabi A, Biria M, Ansari G. Remineralization effect of topical NovaMin versus sodium fluoride (1.1%) on caries-like lesions in permanent teeth. J Dent (Tehran). 2012; 9:68-75
Liu X, Ding C, Chu PK. Mechanism of apatite formation on wollastonite coatings in simulated body fluids. Biomaterials. 2004; 25:1755-1761
Joiner A, Schäfer F, Naeeni MM Remineralisation effect of a dual-phase calcium silicate/phosphate gel combined with calcium silicate/phosphate toothpaste on acid-challenged enamel in situ. J Dent. 2014; 42:S53-S59
Tung MS, Eichmiller FC. Dental applications of amorphous calcium phosphates. J Clin Dent. 1999; 10:1-6
Li L, Pan H, Tao J, Xu X Repair of enamel by using hydroxyapatite nanoparticles as the building blocks. J Mater Chem. 2008; 18:4079-4084
Pepla E, Besharat LK, Palaia G Nano-hydroxyapatite and its applications in preventive, restorative and regenerative dentistry: a review of literature. Ann di Dtomatologia. 2014; 5:108-14
Huang S, Gao S, Cheng L, Yu H. Remineralization potential of nano-hydroxyapatite on initial enamel lesions: An in vitro study. Caries Res. 2011; 45:460-468
Karlinsey RL, Mackey AC, Walker ER, Frederick KE. Surfactant-modified β-TCP: structure, properties, and in vitro remineralization of subsurface enamel lesions. J Mater Sci Mater Med. 2010; 21:2009-2020
Kirkham J, Firth A, Vernals D Self-assembling peptide scaffolds promote enamel remineralization. J Dent Res. 2007; 86:426-430
Kind L, Stevanovic S, Wuttig S Biomimetic remineralization of carious lesions by self-assembling peptide. J Dent Res. 2017; 96:790-797
Silvertown JD, Wong BPY, Sivagurunathan KS, Abrams SH, Kirkham J, Amaechi BT. Remineralization of natural early caries lesions in vitro by P11-4 monitored with photothermal radiometry and luminescence. J Investig Clin Dent. 2017; 8
Wierichs RJ, Kogel J, Lausch J Effects of self-assembling peptide P11-4, fluorides, and caries infiltration on artificial enamel caries lesions in vitro. Caries Res. 2017; 51:451-459
Kobeissi R, Osman E, Badr SB. Effectiveness of self-assembling peptide P11-4 compared to tricalcium phosphate fluoride varnish in remineralization of white spot lesions: A clinical randomized trial. Int J Clin Pediatr Dent. 2021; 13:451-456
Kondelova PS, Mannaa A, Bommer C Efficacy of P11-4 for the treatment of initial buccal caries: a randomized clinical trial. Sci Rep. 2020; 10
Hicks J, Garcia-Godoy F, Flaitz C. Biological factors in dental caries enamel structure and the caries process in the dynamic process of demineralization and remineralization (part 2). J Clin Pediatr Dent. 2005; 28:119-124
Kim Y, Son H-H, Yi K The color change in artificial white spot lesions measured using a spectroradiometer. Clin Oral Investig. 2013; 17:139-146
Hua F, Yan J, Zhao S In vitro remineralization of enamel white spot lesions with a carrier-based amorphous calcium phosphate delivery system. Clin Oral Investig. 2020; 24:2079-2089
Ballard RW, Hagan JL, Phaup AN Evaluation of 3 commercially available materials for resolution of white spot lesions. Am J Orthod Dentofac Orthop. 2013; 143:S78-S84
Robinson C, Shore RC, Brookes SJ The chemistry of enamel caries. Crit Rev Oral Biol Med. 2000; 11:481-495
Milly H, Festy F, Watson TF Enamel white spot lesions can remineralise using bio-active glass and polyacrylic acid-modified bio-active glass powders. J Dent. 2014; 42:158-166
Flaitz CM, Hicks MJ. Remineralization of caries-like lesions of enamel with acidulated calcifying fluids: a polarized light microscopic study. Pediatr Dent. 18:205-9
Gjorgievska ES, Nicholson JW, Slipper IJ, Stevanovic MM. Remineralization of demineralized enamel by toothpastes: A scanning electron microscopy, energy dispersive X-ray analysis, and three-dimensional stereo-micrographic study. Microsc Microanal. 2013; 19:587-595
Elkassas D, Arafa A. Remineralizing efficacy of different calcium-phosphate and fluoride based delivery vehicles on artificial caries like enamel lesions. J Dent. 2014; 42:466-474
Tomaz PLS, Sousa LA de, de Aguiar KF Effects of 1450-ppm fluoride-containing toothpastes associated with boosters on the enamel remineralization and surface roughness after cariogenic challenge. Eur J Dent. 2020; 14:161-170
Wang Y, Mei L, Gong L Remineralization of early enamel caries lesions using different bioactive elements containing toothpastes: An in vitro study. Technol Heal Care. 2016; 24:701-711
Gängler P, Kremniczky T, Arnold WH. In vitro effect of fluoride oral hygiene tablets on artificial caries lesion formation and remineralization in human enamel. BMC Oral Health. 2009; 9
Amaechi BT, AbdulAzees PA, Alshareif DO Comparative efficacy of a hydroxyapatite and a fluoride toothpaste for prevention and remineralization of dental caries in children. BDJ Open. 2019; 5 https://doi.org/10.1038/s41405-019-0026-8
Damato FA, Strang R, Stephen KW. Effect of fluoride concentration on remineralization of carious enamel an in vitro pH-cycling study. Caries Res. 1990; 24:174-180
Cochrane NJ, Reynolds EC. Calcium phosphopeptides — mechanisms of action and evidence for clinical efficacy. Adv Dent Res. 2012; 24:41-47
Vieira AE de M, Danelon M, da Camara DM In vitro effect of amorphous calcium phosphate paste applied for extended periods of time on enamel remineralization. J Appl Oral Sci. 2017; 25:596-603
Bajaj M, Poornima P, Praveen S Comparison of CPP-ACP, tri-calcium phosphate and hydroxyapatite on remineralization of artificial caries like lesions on primary enamel. An in vitro study. J Clin Pediatr Dent. 2016; 40:404-409
Lendenmann U, Grogan J, Oppenheim FG. Saliva and dental pellicle-A review. Adv Dent Res. 2000; 14:22-28
Zhang J, Lynch RJM, Watson TF, Banerjee A. Remineralisation of enamel white spot lesions pre-treated with chitosan in the presence of salivary pellicle. J Dent. 2018; 72:21-28
Amaechi BT. Remineralisation. The buzzword for early MI caries management. Br Dent J. 2017; 223:173-182
Milly H, Festy F, Andiappan M Surface pre-conditioning with bioactive glass air-abrasion can enhance enamel white spot lesion remineralization. Dent Mater. 2015; 31:522-533
Zhang J, Boyes V, Festy F In vitro subsurface remineralisation of artificial enamel white spot lesions pre-treated with chitosan. Dent Mater. 2018; 34:1154-1167
Lippert F. An introduction to toothpaste - Its purpose, history and ingredients. 2013; 1-14
Sjögren K. How to improve oral fluoride retention?. Caries Res. 2001; 35:14-17
Bakry AS, Abbassy MA. Increasing the efficiency of CPP-ACP to remineralize enamel white spot lesions. J Dent. 2018; 76:52-57
Cui F-Z, Ge J. New observations of the hierarchical structure of human enamel, from nanoscale to microscale. J Tissue Eng Regen Med. 2007; 1:185-191
Fincham AG, Moradian-Oldak J, Simmer JP. The structural biology of the developing dental enamel matrix. J Struct Biol. 1999; 126:270-299
Ruan Q, Zhang Y, Yang X An amelogenin–chitosan matrix promotes assembly of an enamel-like layer with a dense interface. Acta Biomater. 2013; 9:7289-7297
Ruan Q, Liberman D, Bapat R Efficacy of amelogenin-chitosan hydrogel in biomimetic repair of human enamel in pH-cycling systems. J Biomed Eng Informatics. 2015; 2
Hossein BG, Sadr A, Espigares J Study on the influence of leucine-rich amelogenin peptide (LRAP) on the remineralization of enamel defects via micro-focus x-ray computed tomography and nanoindentation. Biomed Mater. 2015; 10
Professor of Cariology & Operative Dentistry, Hon Consultant in Restorative Dentistry, King's College London Dental Institute at Guy's Hospital, KCL, King's Health Partners, London, UK
Dental caries remains a major global health challenge affecting millions of people worldwide, with both major health and financial implications. The minimum intervention oral healthcare (MIOC) delivery framework aims to improve caries management through early diagnosis and the use of remineralization strategies in primary and secondary preventive approaches. The landmark discovery of fluoride in caries remineralization resulted in an increase in research on such non-operative approaches. With an improved understanding of the biochemistry of caries and the demineralization-remineralization balance within dental hard tissues, researchers and clinicians currently seek new therapies to improve the non-operative management of early carious lesions. New remineralization technologies have been introduced in recent years, with varying chemistries, modes of action and degrees of success. This article, the first of a two-part series, explores the chemistry and mode of action of currently available remineralization technologies, outlining their clinical effectiveness and use in dental caries management.
CPD/Clinical Relevance: A scientific understanding of ever-evolving remineralization technologies is necessary for clinicians.
Article
Dental caries is one of the world's most prevalent non-communicable diseases, affecting adversely approximately 3.5 billion people, resulting in both a great health and financial burden.1,2 Carious lesions start from dissolution of hydroxyapatite crystals at the tooth surface, at an atomic level, which occurs following the formation and stagnation of the dental plaque biofilm, if left undisturbed.3 If no intervention occurs, the caries process will remain active and the lesion will progress which increases the complexity of its management.3 The minimum intervention oral care (MIOC) philosophy applied to caries management has moved from invasive conventional operative management to more micro-/minimally invasive early interventions, with an increasing emphasis placed on early diagnosis and non-operative preventive strategies, among which, remineralization plays a major part.4–7 The early disruption of the caries process negates the requirement for extensive operative intervention later, leading to the preservation of more tooth structure, and reducing the burden and complexity of future dental treatment.4
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