Effectiveness of remineralizing dentifrices against caries lesions: A systematic approach

Dental caries remains a prevalent global oral health problem. Fluoride promotes enamel remineralization but is less effective on deeper lesions. Non-invasive agents, including bioactive glass and casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), aim to enhance remineralization and prevent caries.

A systematic review of in vitro studies was conducted following PRISMA 2020 guidelines. PubMed, Ovid, Cochrane Library, ScienceDirect, and Scopus were searched for studies published before 31 December 31, 2024. Titles, abstracts, and full texts were screened independently by two reviewers. Risk of bias was assessed using a modified CONSORT checklist.

Among 142 records identified, 38 were screened, 21 full texts retrieved, and 11 studies met the inclusion criteria. Bioactive glass-based dentifrices generally outperformed fluoride-only formulations, with greater mineral deposition, improved surface microhardness, and reduced lesion depth. The assessment methods included surface microhardness (Vickers or Knoop hardness testing), transverse microradiography, and scanning electron microscopy.

Bioactive glass and CPP-ACP exhibited promise for in vitro remineralization, and bioactive glass was consistently superior to fluoride alone. Methodological variability and limited randomization, blinding, and sample size justification reduced the reproducibility of studies. Well-designed in situ and clinical studies are needed to confirm clinical applicability.