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Table of Contents
REVIEW ARTICLE
Year : 2021  |  Volume : 9  |  Issue : 2  |  Page : 63-65

Recent advances in enamel and dentin remineralization


1 Department of Conservative Dentistry and Endodontics, Noorul Islam College of Dental Sciences, Neyyatinkara, Thiruvananthapuram, Kerala, India
2 Department of Pedodontics, Noorul Islam College of Dental Sciences, Neyyatinkara, Thiruvananthapuram, Kerala, India
3 Department of Oral Pathology and Microbiology, Noorul Islam College of Dental Sciences, Neyyatinkara, Thiruvananthapuram, Kerala, India

Date of Submission20-Apr-2021
Date of Acceptance28-Apr-2021
Date of Web Publication28-Jun-2021

Correspondence Address:
Dr. Mohammed Shaheen
Department of Conservative and Dentistry and Endodontics, Noorul Islam of Dental Sciences, Thiruvananthapuram, Kerala.
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/INJO.INJO_15_21

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  Abstract 

Dental caries is a complex, multifactorial, and transmittable infectious disease that is caused during the demineralization–remineralization process in the presence of fermentable dietary carbohydrates, saliva, and cariogenic oral flora. The chemical basis of the demineralization–remineralization process is similar for enamel, dentin. In this review, we have enlisted numerous types of remineralizing agents; remineralizing techniques have been researched, and many of them are being used clinically, with significantly predictable positive results.

Keywords: Demineralization, demineralization–remineralization, dental caries, fluoride, remineralization


How to cite this article:
Shaheen M, Aswin S, Thomas AJ. Recent advances in enamel and dentin remineralization. Int J Oral Care Res 2021;9:63-5

How to cite this URL:
Shaheen M, Aswin S, Thomas AJ. Recent advances in enamel and dentin remineralization. Int J Oral Care Res [serial online] 2021 [cited 2021 Oct 18];9:63-5. Available from: https://www.ijocr.org/text.asp?2021/9/2/63/319593




  Introduction Top


The pathophysiology of dental caries is not simply a continual cumulative loss of tooth minerals, but rather a dynamic process that is characterized by alternating periods of demineralization and remineralization. Lesion progression or reversal depends on the equilibrium between demineralization-favoring pathological factors (cariogenic bacteria, fermentable carbohydrates, salivary dysfunction) and the protective factors (antibacterial agents, sufficient saliva, remineralizing ions) that tip the balance toward remineralization. The chemical basis of the demineralization–remineralization process is similar for enamel, dentin. In this review, we have enlisted numerous types of remineralizing agents; remineralizing techniques have been researched and many of them are being used clinically, with significantly predictable positive results.[1],[2],[3],[4],[5]

Fluoride

Fluoride inhibits demineralization as the fluorapatite crystals, formed by a reaction with enamel apatite crystals, are more resistant to acid attack compared with hydroxyapatite (HAP) crystals. Second, fluoride enhances remineralization as it speeds up the growth of the new fluorapatite crystals by bringing calcium and phosphate ions together. Third, it inhibits the activity of acid-producing carious bacteria, by interfering with the production of phosphoenol pyruvate (PEP), which is a key intermediate of the glycolytic pathway in bacteria. Also, the F is retained on dental hard tissue, on the oral mucosa, and in the dental plaque to decrease demineralization and enhance remineralization.

Fluoride-containing dentifrices

Sodium fluoride directly provides free fluoride. Sodium monofluorophosphate is the fluoride of choice when calcium-containing abrasives are used. Stannous fluoride provides fluoride and stannous ions, where the latter act as an antimicrobial agent.

Calcium phosphate compounds

Calcium phosphate is the principal form of calcium found in bovine milk and blood. As the major components of HAP crystals, concentrations of calcium and phosphate in saliva and plaque play a key role in influencing the tooth demineralization–remineralization processes.

β-Tricalcium phosphate

During toothbrushing, tricalcium phosphate (TCP) comes into contact with saliva, causing the barrier to dissolve and releasing calcium, phosphate, and fluoride.[6]

Functionalized TCP

It provides a barrier that prevents premature TCP–fluoride interactions and also facilitates targeted delivery of TCP when applied to the teeth.

Dicalcium phosphate dihydrate

Dicalcium phosphate dihydrate is a precursor for apatite that readily turns into fluorapatite in the presence of fluoride.

Amorphous calcium phosphate

Amorphous calcium phosphate (ACP) is the initial solid phase that precipitates from a highly supersaturated calcium phosphate solution and can convert readily to stable crystalline phases such as octacalcium phosphate or apatitic products.

ACP-filled composites

ACP releases calcium and phosphate ions into the saliva and is deposited into tooth structures as an apatitic mineral, which is similar to the HAP found naturally in teeth and bone.

Bioactive materials

A bioactive material is defined as a material that stimulates a beneficial response from the body, particularly bonding to the host bone tissue and to the formation of a calcium phosphate layer on a material surface.

45S5 BG

45S5 BG consists of 45% SiO2, 24.5% Na2O, 24.5% CaO, and 6% P2O5 in weight. It is a highly biocompatible material possessing remarkable osteoconductivity, osteoinductivity, and controllable biodegradability.

Nanomaterials

Nanoparticles are often added to restorative materials as inorganic fillers, such as resin composites to release calcium, phosphate, and fluoride ions for remineralization of dental hard tissues.[7]

Calcium fluoride nanoparticles

The addition of nanoCaF2 increases the cumulative fluoride release compared with the fluoride release in traditional glass ionomer cements, because the CaF2 nanoparticle (nano-CaF2) has a 20-fold higher surface area compared with traditional glass ionomer cements.

Calcium phosphate-based nanomaterials

It includes nanoparticles of HAP, TCP, and ACP as sources to release calcium/phosphate ions and increase the supersaturation of HAP in carious lesions.[8]

β-tricalcium phosphate (Ca3(PO4)2)

β-TCP can be functionalized with organic and/or inorganic materials to form the so-called functionalized β-TCP (fβ-TCP).

NanoHAP particles

Nano-sized HAP (n-HAP) is similar to the apatite crystal of tooth enamel in morphology and crystal structure. So it can be substituted for the natural mineral constituent of enamel for repair biomimetically.[9]

ACP nanoparticles

They are small spheroidal particles with a dimension in the nanoscale (40–100nm). The ACP nanoparticles, as a source of calcium and phosphate ions, have been added to composite resins, ionomer cements, and adhesives.

Nanobioactive glass materials

Sheng et al. have found that nanoBG particles could promote mineral formation on dentin surfaces and they were shown to make dentin more acid resistant.

Xylitol

Xylitol, when consumed as mints or gum, will stimulate an increased flow of alkaline and mineral-rich saliva from small salivary glands in the palate. Increased salivary flow results in increased buffering capacity against acids, and high mineral content will provide the minerals to remineralize the damaged areas of the enamel.[10]

Biomimetic remineralization of the dentin and enamel

Most of these studies on remineralization were based on the epitaxial deposition of calcium and phosphate ions over existing apatite seed crystallites. According to this concept, remineralization does not occur in locations where seed crystallites are absent, particularly in completely demineralized dentin due to the unavailability of seed crystallites in those regions.

Polydopamines

The oxidative polymerization of dopamine in aqueous solutions spontaneously forms polydopamine, mimicking DOPA, which exhibits a strong adhesive property to various substrates under wet conditions.

Proanthocyanidin

Proanthocyanidin (PA) is a bioflavonoid, containing benzene–pyran–phenolic acid molecular nucleus. Grape seed extract (GSE) contains PA, which can form visually insoluble HAP complexes when mixed with a remineralizing solution at pH 7.4.

Self-assembling peptide

Recent developments in research have revealed the role of treatment with peptide, where it proved the combined effect of increased mineral gain and inhibition of mineral loss from the tooth.

Electric field-induced remineralization

This technique is used to remineralize the completely demineralized dentin collagen matrix and also to shorten the mineralization time, which it achieved in the absence of both calcium phosphates and their analogs with the help of electrophoresis.[11]

Polyamide

Poly(amidoamine) (PAMAM) dendrimers are known as artificial proteins that mimic the self-assembly behavior of amelogenins to form a similar structure in vitro, and these are used as an organic template to control the synthesis of HAP crystals.[12]

Theobromine

Theobromine is a member of the xanthine family, seen in cocoa (240mg/cup) and chocolate (1.89%), and it has been shown to enhance crystalline growth of the enamel.[13]

Arginine bicarbonate

Arginine bicarbonate is an amino acid with particles of calcium carbonate, and it is capable of adhering to the mineral surface. When the calcium carbonate dissolves, the released calcium is available to remineralize the mineral whereas the release of carbonate may give a slight local pH rise.[14]


  Conclusion Top


In the present review, an attempt has been made to review the various remineralization materials and technologies currently being employed to remineralize enamel and dentin. It is expected that further experiments in this field would definitely bring out better products and technologies for clinical application, with optimal responses and results.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Carounanidy U, Sathyanarayanan R. Dental caries: A complete changeover (part I). J Conserv Dent 2009;12:46-54. doi: 10.4103/0972-0707.55617  Back to cited text no. 4
    
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Hemagaran G. Remineralisation of the tooth structure—The future of dentistry. Int J PharmTech Res 2014;6:487-93.  Back to cited text no. 6
    
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Naveena Preethi P, Nagarathana C, Sakunthala BK. Remineralising agent—Then and now—An update. Dentistry2014;4:1-5.  Back to cited text no. 7
    
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Zhang X, Deng X, Wu Y. Nanotechnology in endodontics: Current and potential clinical applications. In: Kishen A, editor. Remineralising Nanomaterials for Minimally Invasive Dentistry. Cham: Springer International Publishing; 2015. p. 173-93.  Back to cited text no. 8
    
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Amaechi BT, van Loveren C. Fluorides and non-fluoride remineralization systems. Monogr Oral Sci 2013;23:15-26.  Back to cited text no. 9
    
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Peter S. Essentials of Public Health Dentistry. 5th ed. New Delhi: Arya Medi Publishing House Pvt. Ltd. 2013.  Back to cited text no. 10
    
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Zhao J, Liu Y, et al. Amorphous calcium phosphate and its application in dentistry chemistry. Cent J2011;5:2-7.  Back to cited text no. 11
    
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Brown JP, Amaechi BT, Bader JD, Gilbert GH, Makhija SK, Lozano-Pineda J, et al; X-ACT Trial Collaborative Group. Visual scoring of non cavitated caries lesions and clinical trial efficiency, testing xylitol in caries-active adults. Community Dent Oral Epidemiol 2014;42:271-8.  Back to cited text no. 12
    
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Benjamin S, Sharma R, Thomas SS, Nainan MT. Grape seed extract as a potential remineralizing agent: A comparative in vitro study. J Contemp Dent Pract 2012;13:425-30.  Back to cited text no. 13
    
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Wu XT, Mei ML, Li QL, Cao CY, Chen JL, Xia R, et al. A direct electric field aided bio mineralisation system for inducing the remineralisation. Materials 2015;8:7889-99.  Back to cited text no. 14
    




 

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