Remineralizing Enamel : A Literature Review

Background: Tooth enamel is a non-living tissue, once matured it can no longer remineralization itself. Unfortunately, there are only a few studies that analyze the risks and benefits in applications towards remineralization. The objective was to examine the effectiveness and risks of synthetic applications towards remineralizing tooth enamel.

Methods: Experimental trials focusing on the effect of synthetic applications on tooth enamel such as, surface hardness, surface thickness and overall effectiveness were included in this review. Published articles from 1978 to 2018 were identified using specific keywords terms in the ScienceDirect and PubMed database. Each study was independently screened to meet eligibility and asses risk of bias, if any.

Results: Seven experimental reports applying three synthetic methods: Ca/PI ratios of stimulated saliva, Nano-hydroxyapatite and Calcarea Fluorica tablets were evaluated. Application process and outcomes varied throughout each study. Ca/PI ratios of stimulated saliva did not affect the remineralization process significantly (P > 0.5) and was associated with no harms on the molars used. Studies evaluating the use of synthetic nano-hydroxyapatite displayed statistically significant (P < 0.5) outcomes towards remineralization increasing surface hardness and thickness. One study analyzed the effects of Calcarea Fluorica tablets reporting the most overall increase in remineralization but mostly towards surface hardness, as well as being statistically significant (P < 0.5).

Conclusion: Studies were limited and short term, leaving room for error and miscalculation. However, there is data that expresses overall positive effects towards remineralization. The results show a need for future experimental trials on synthetics to get a better understanding in this area.

Key Words: Tooth Enamel, Remineralization, Demineralization, Erosion and Lesion Caries.

背景：牙釉质是一种无生命组织，一旦成熟便无法自行进行再矿化。遗憾的是，目前仅有少数研究针对牙釉质再矿化相关应用的风险与获益展开分析。本研究旨在评估人工合成干预手段用于牙釉质再矿化的有效性与安全性风险。
方法：本综述纳入了聚焦人工合成干预手段对牙釉质影响的实验研究，评估指标涵盖表面硬度、表面厚度及整体有效性。本研究通过特定关键词在ScienceDirect及PubMed数据库中检索了1978年至2018年发表的相关文献。每一项研究均由研究者独立筛选，以确认其是否符合纳入标准，并对存在的偏倚风险进行评估。
结果：本研究评估了7项采用3种人工合成干预手段的实验报告：刺激唾液的钙/磷酸肌醇（Ca/PI）比值、纳米羟基磷灰石（Nano-hydroxyapatite）及氟化钙片剂（Calcarea Fluorica tablets）。各项研究的干预操作流程与研究结局均存在差异。刺激唾液的钙/磷酸肌醇比值未对再矿化过程产生显著影响（P>0.5），且未对受试磨牙造成任何损害。针对人工合成纳米羟基磷灰石的研究显示，其对牙釉质再矿化的效果具有统计学显著性（P<0.5），可提升牙釉质表面硬度与厚度。有1项研究分析了氟化钙片剂的干预效果，结果显示其可使再矿化程度得到最大幅度的整体提升，且主要体现在表面硬度的增加，该结果同样具有统计学显著性（P<0.5）。
结论：现有研究样本量有限且均为短期研究，易出现误差与计算失误。不过已有数据表明，人工合成干预手段对牙釉质再矿化整体呈现积极效果。本研究结果显示，未来需开展更多针对人工合成干预手段的实验研究，以进一步深化该领域的研究认知。
关键词：牙釉质、再矿化、脱矿、牙釉质侵蚀与龋损。