Remineralization Potential of Casein Phosphopeptide-Amorphous Calcium Phosphate, Nanohydroxyapatite Crystals, and Bioactive Glass on Initial Enamel Lesions: A Systematic Review and Meta-analysis.
Varkey Nadakkavukaran Santhosh, Anil V Ankola, Roopali M Sankeshwari, Anu Sara Varghese, Kavitha Ragu, Yuvarani Kandasamy Parimala, Prajakta J Chavan, Siva Shankkari
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Abstract
Background: Dental caries is a prevalent chronic disease among both adult and pediatric patients characterized by enamel demineralization, leading to significant oral health issues. While fluoride has been the cornerstone of caries prevention, alternative remineralizing agents such as casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), nanohydroxyapatite (nHAp) crystals, and bioactive glass (BAG) are gaining attention for their potential in biomimetic enamel restoration. This systematic review and meta-analysis aim to compare the efficacy of these novel agents with conventional fluoride treatments in remineralizing initial enamel lesions (IELs).
Materials and methods: This review was conducted across databases including MEDLINE, ProQuest, and Cochrane Library, covering studies from 2004 to 2024. The focus was on in vitro studies comparing fluoride with CPP-ACP, nHAp, or BAG in remineralizing IELs using surface hardness tests, scanning electron microscopy (SEM), and energy dispersive X-ray (EDX) spectroscopy. The methodological quality of the studies was assessed with the QUIN tool, and meta-analysis was performed using STATA® SE 16.1.
Results: Among the 292 identified articles, 19 met the inclusion criteria. Meta-analysis showed an overall pooled estimate of -1.31 (95% CI: -3.90 to 1.28) in favor of fluoride, though not statistically significant (p = 0.12). nHAp demonstrated significant remineralization potential with a pooled estimate of 1.40 (95% CI: 0.65-2.15) when the surface hardness test was considered.
Conclusion: nHAp show promise as alternatives to fluoride for IEL remineralization in both pediatric and adult patients. However, the evidence quality is weak due to high heterogeneity and methodological limitations. Further in vivo studies are needed to validate these findings and explore clinical applications.
How to cite this article: Santhosh VN, Ankola AV, Sankeshwari RM, et al. Remineralization Potential of Casein Phosphopeptide-Amorphous Calcium Phosphate, Nanohydroxyapatite Crystals, and Bioactive Glass on Initial Enamel Lesions: A Systematic Review and Meta-analysis. Int J Clin Pediatr Dent 2025;18(5):560-572.
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