Biomimetic Enamel Remineralization in Pediatric Dentistry: From Biological Principles to Clinical Evidence

Remineralization of early enamel lesions is a crucial component of contemporary caries management in pediatric dentistry. Biomimetic approaches aim to support enamel repair by reproducing some features of natural mineralization. This narrative review presents the biological basis, mechanisms of action, and current literature on calcium-phosphate systems, nano-hydroxyapatite (nHAp), self-assembling peptide P11-4, and bioactive glasses (BG), with particular emphasis on pediatric dentistry. Although these approaches share the goal of restoring mineral to demineralized enamel, their mechanisms differ and sometimes overlap. Calcium-phosphate systems provide a reservoir of bioavailable calcium and phosphate ions at the tooth surface, mimicking the mineral-supplying function of oral fluids. nHAp resembles enamel apatite crystals in composition and nanoscale dimensions and acts as a mineral template for nucleation and further crystal growth. P11-4 self-assembles within the enamel lesion into a fibrillar scaffold that mimics the mineralization-guiding function of enamel matrix proteins and provides sites for mineral nucleation. Ion exchange, occurring when BG contacts oral fluids, creates a physicochemical environment at the enamel surface that promotes calcium-phosphate precipitation and subsequent apatite formation. Experimental and clinical studies support the remineralizing potential of these approaches. However, pediatric clinical evidence is more limited for some materials than for others, and differences in formulations, study designs, outcome measures, and follow-up periods complicate interpretation of the available literature. Comparisons with conventional fluoride therapy have not consistently demonstrated superior outcomes. Further well-designed pediatric studies are needed to establish clinical effectiveness and determine whether these approaches offer additional benefits in practice. Other emerging biomimetic approaches remain largely experimental. Biomimetic remineralization may therefore offer additional options for the management of early enamel caries in children, while complementing rather than replacing established fluoride-based preventive measures.