https://doi.org/10.1177/0022034517740124
Advances in Dental Research
2018, Vol. 29(1) 55–59
© International & American Associations
for Dental Research 2018
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DOI: 10.1177/0022034517740124
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Advances
Introduction
Dental remineralization is the process of bringing minerals
from the surrounding environment (i.e., saliva, biofilm) into
partially demineralized tooth structures. Remineralization can
replace minerals in partially demineralized enamel and dentin
(Cochrane et al. 2010) or create amorphous mineral precipi-
tates in the intercrystal and interrod spaces. Remineralization
can occur naturally or be induced by therapies. Among the
available therapies, fluoride (F)–based treatments have the
highest level of supporting evidence (Amaechi and van
Loveren 2013; Fontana 2016), and the widespread use of fluo-
rides is generally considered the main reason for dental caries
reduction in most populations. However, currently available F
therapies have limited efficacy in some individuals, and at the
population level, the effect of F in reducing dental caries prev-
alence is reaching a plateau (Haugejorden and Magne Birkeland
2006). Consequently, investigators have been developing new
remineralization therapies to close this gap in efficacy. Most
new approaches have been designed to enhance the effect of
existing F therapies rather than to replace them, but those not
involving F might become an alternative for patients reluctant
to use F. In this article, we discuss and summarize some of the
latest advances in remineralization therapies.
Information Search
Advances in remineralizing therapies were identified after a
broad literature search by using the following terms: reminer-
alization, arrest, arrestment, repair, treatment and caries lesion,
dental caries, enamel or dentin. PubMed was used to identify
published data and other sources, while ClinicalTrials.gov and
google.com were used to obtain registered randomized con-
trolled trials (RCTs). We prioritized evidence published during
the last 5 y. Therapies that only targeted the modification of
dental biofilms (e.g., antimicrobials, probiotics, ozone) or created
diffusion barriers (e.g., sealants, infiltrants) were excluded, since
they do not promote remineralization directly. Antimicrobial
therapies combined with other remineralizing therapies (e.g.,
arginine plus F and calcium) were included in this review.
Therapies focused on preventing lesion formation only (not
remineralization) were also excluded. Therapies were classi-
fied regarding their general putative mechanism of action. For
each therapy, we summarized the most recent available evi-
dence derived from clinical trials. If recent RCTs were not
available, the latest available evidence is presented (in situ or
in vitro).
Compounds Increasing Mineral Saturation
Calcium and phosphate are essential minerals for remineraliza-
tion, while F plays a crucial role in enhancing the process.
Because remineralization can be hampered by limited bioavail-
ability of calcium and phosphate, new product formulations
740124ADR XX X 10.1177/0022034517740124Advances in Dental ResearchGonzález-Cabezas and Fernández
research-article 2017
1
Department of Cariology, Restorative Sciences, and Endodontics,
School of Dentistry, University of Michigan, Ann Arbor, MI, USA
2
College of Dental Medicine–Illinois, Midwestern University, Downers
Grove, IL, USA
Corresponding Author:
C. González-Cabezas, Department of Cariology, Restorative Sciences,
and Endodontics, School of Dentistry, University of Michigan, 1011 N.
University Room 2395, Ann Arbor, MI 48109-1078, USA.
Email: carlosgc@umich.edu
Recent Advances in Remineralization
Therapies for Caries Lesions
C. González-Cabezas
1
and C.E. Fernández
1,2
Abstract
Remineralization of caries lesions is naturally achieved by salivary ions, and it can be enhanced by external factors or elements such
as fluoride. Numerous studies have demonstrated the remineralizing efficacy of fluoride therapies as well as the limitations with some
groups of the population. Consequently, developing new remineralization therapies to close this gap in efficacy has been a priority for
the last 2 decades. In this review, we summarize and briefly discuss some of the latest advances in remineralization therapies. Most
new therapies try to enhance the effect of fluoride by adding other potentially active ingredients to the formulation, such as calcium,
phosphate, stannous, xylitol, and arginine. Other remineralization strategies have focused on creating remineralizing scaffolds within the
lesions (e.g., self-assembling peptides). While several of the new remineralization strategies have progressed significantly in recent years,
for most of them, the evidence is still insufficient to assess their true clinical potential.
Keywords: fluorides, calcium, phosphate, arginine, stannous, peptides