Emerging methods used in the prevention and repair of carious tissues

A systematic review was undertaken to investigate four emerging methodologies that might be used in the prevention of caries and/or repair of carious tissues. These included a partitioned dentifrice, laser technology, fluoride-releasing dental materials, and for deep carious lesions, bone morphogenic protein (BMP) therapy. The search strategy was to review articles written in English, indexed in MEDLINE and EMBASE databases and published since 1976. Over two hundred articles were read but because of the inclusion and exclusion criteria, only thirty-three were included in the evidence tables. The review of partitioned toothpaste showed either a greater remineralizing effect or a greater increase in the resistance to demineralization of both enamel and dentin, with the exception of its lack of effectiveness on coronal caries in the only clinical trial. Five of the six in vitro studies on enamel and the one study on dentin reported that lased tissue was less soluble than nonlased. Six clinical and four in situ studies were reviewed in answering the question as to whether fluoride-releasing restorative materials increase the remineralization or resistance to demineralization of human enamel and dentin. Eight of these reported positive findings. Six animal studies investigating BMP were reviewed, and all showed the ability of BMP to induce tubular dentin formation. Although the laboratory, animal, and limited clinical trials report encouraging results, independent, randomized, controlled clinical trials need to be carried out before these emerging technologies can be recommended for use in general practice.