Search Results (80)

Dental caries remains the most prevalent chronic disease worldwide, yet early enamel lesions are reversible if managed with appropriate remineralizing agents. This narrative review synthesizes current evidence on remineralizing agents, their mechanisms of action, and clinical applications, with a focus on dental materials used in preventive and minimally invasive dentistry. Traditional fluoride-based approaches enhance remineralization through fluorapatite formation; however, their effectiveness is limited when calcium and phosphate bioavailability is insufficient. Biomimetic agents, including casein phosphopeptide–amorphous calcium phosphate (CPP-ACP), bioactive glasses, tricalcium phosphate, and nano-hydroxyapatite, provide these bioavailable ions and demonstrate superior performance under challenging clinical conditions. Emerging therapies such as probiotics, photodynamic therapy, and laser-assisted mineralization show promise but require further clinical validation. Based on the primary mechanism of action, an original classification of remineralizing agents is proposed, grouping them into fluoride-based agents, calcium-phosphate systems, nanotechnology-based systems, biofilm modifiers, biomimetic and emerging systems, and adjunctive antimicrobial therapies. The review concludes that bioavailable calcium represents a critical limiting factor in remineralization under certain conditions, and that combination protocols incorporating multiple remineralizing agents, tailored to individual patient risk profiles, achieve superior outcomes compared to single-agent approaches. Clinicians are encouraged to adopt minimally invasive, patient-tailored remineralization strategies that arrest lesions before cavitation, preserving natural tooth structure and reducing the lifelong restorative burden. Full article

Although amorphous calcium phosphate (ACP) has been extensively employed as a biomaterial in dental and orthopedic fields, its exploration for environmental applications—particularly in potentially toxic element remediation—remains notably limited in the scientific literature. This study reports the rational design of a multifunctional adsorbent by integrating sodium citrate-stabilized ACP (Cit-ACP) nanoparticles into calcium-crosslinked sodium alginate (SA) hydrogel beads for selective Cu²⁺ sequestration from aqueous systems. Comprehensive sorption assessments revealed that equilibrium uptake aligned with the Freundlich isotherm (indicating heterogeneous surface interactions), while kinetic profiles adhered to pseudo-second-order behavior, characteristic of chemisorption-driven processes. Under optimized operational parameters (pH 5.0, 45 °C), the Cit-ACP/SA composite attained an exceptional maximum adsorption amount of 307.76 mg/g. Thermodynamic analysis further confirmed the spontaneity (ΔG° < 0) and endothermic nature (ΔH° > 0) of the process. Multi-technique characterization (XPS, FTIR, XRD, pH trajectory) elucidated a dual-mode adsorption mechanism: (i) ion exchange between aqueous Cu²⁺ and structural Ca²⁺ within both the alginate matrix and ACP framework; and (ii) in situ surface precipitation yielding copper-substituted hydroxyapatite. Owing to its facile aqueous-phase synthesis, superior adsorption performance, biodegradability, macroscopic bead morphology enabling rapid separation, and robust selectivity in complex matrices, the Cit-ACP/SA composite presents a sustainable, scalable, and eco-compatible platform for practical remediation of copper-contaminated wastewater. Full article

Polymerization shrinkage remains a primary cause of marginal failure in posterior composite restorations, contributing to interfacial gap formation and secondary caries development. Bioactive filler technologies represent a paradigm shift, offering simultaneous stress reduction and therapeutic ion release through engineered matrix–filler interactions. This narrative review synthesizes current evidence on how bioactive glass (including 45S5), amorphous calcium phosphate, and surface pre-reacted glass-ionomer fillers modulate polymerization shrinkage dynamics and mechanical performance in bulk-fill systems. These systems exhibit distinct mechanisms of bioactivity, with bioactive glass (45S5) promoting ion release and apatite formation, amorphous calcium phosphate (ACP) enabling rapid calcium phosphate ion delivery for remineralization, and surface pre-reacted glass-ionomer (S-PRG) fillers providing sustained multi-ion release with buffering and antibacterial potential. A comprehensive literature search was conducted in PubMed/MEDLINE, Scopus, and Web of Science for studies published up to June 2025, including experimental investigations and reviews assessing bioactive filler integration, with studies selected based on predefined inclusion and exclusion criteria focusing on relevance and reported outcomes. The available evidence indicates that optimized bioactive formulations reduce shrinkage stress by approximately 25–40%, decreasing from 35–40 MPa in conventional systems to 22–32 MPa in bioactive bulk-fill composites while maintaining flexural strength above 100 MPa and elastic modulus within clinically acceptable ranges (11–13 GPa). However, substantial heterogeneity in filler chemistry, loading protocols, and testing methodologies limits cross-study comparisons. This variability also reflects differences in testing conditions, material compositions, and evaluation protocols across studies. Full article

Energy gels are widely used by athletes to maintain performance during endurance activities; however, their acidic composition may pose a risk to dental health. This study aimed to evaluate the pH of four commercial energy gels at different dilutions with artificial saliva and to assess the potential neutralizing effect of casein phosphopeptide–amorphous calcium phosphate (CPP–ACP). An in vitro experimental design was conducted using four commercial gels (FullGas Hydrogel, ENA Energy Gel, UltraTech Gel, and Maverick Race Gel). Serial dilutions with artificial saliva (1:2, 1:5, 1:7, and 1:10) were prepared, and pH was measured using indicator strips at 0, 15, and 30 min at 37 °C. The effect of CPP-ACP was evaluated in the 1:2 dilution. Undiluted gels showed highly acidic pH values ranging from 2.0 to 3.0. Dilutions of 1:2 and 1:5 remained significantly more acidic than artificial saliva (p < 0.001). From 1:7 dilution onward, pH values increased and approached salivary levels (approximately 7.0), with no significant differences compared with artificial saliva. The addition of CPP-ACP significantly increased pH in the 1:2 dilution (p < 0.05), although the effect was limited in more diluted conditions. These findings suggest that commercial energy gels may represent a source of acidic exposure under in vitro conditions, which could be relevant for dental health. Adequate dilution, particularly ≥1:7, was associated with a reduction in acidity under the experimental conditions tested, although its clinical relevance cannot be directly inferred, while CPP-ACP may provide a limited buffering effect under concentrated exposure conditions. Full article

Amorphous calcium phosphate (ACP), a key calcium-phosphorus compound, has been widely applied in fields such as dentistry, orthopedics, and biomedicine. However, its potential for removing copper ions from aqueous solutions remains largely unexplored. In this study, sodium citrate-stabilized amorphous calcium phosphate (Cit-ACP) and its calcined derivatives at various temperatures were successfully synthesized as adsorbents for copper ions. The adsorption behavior of Cit-ACP was best described by the Langmuir isotherm, with kinetics following a pseudo-second-order model. Under conditions of pH 5.5 and an initial copper ion concentration of 200 mg/L, Cit-ACP exhibited a maximum adsorption capacity of 323.96 mg/g. Thermodynamic analysis confirmed that the adsorption process was spontaneous and endothermic. Comprehensive characterization via XRD, XPS, and zeta potential measurements before and after adsorption revealed a two-stage adsorption mechanism. At low initial copper concentrations, adsorption occurred predominantly through surface complexation between copper ions and sodium citrate molecules on Cit-ACP nanoparticles. At higher concentrations, the mechanism extended to include co-precipitation of copper ions with hydroxyl groups, which promoted the transformation of Cit-ACP into copper-substituted calcium phosphate phases, such as copper-containing hydroxyapatite. Owing to its straightforward synthesis, high adsorption capacity, and inherent biocompatibility, Cit-ACP presents a promising, cost-effective, and efficient adsorbent for the removal of copper ions from aqueous environments. Full article

The management of dental caries has evolved from the traditional mechanical approach of “extension for prevention” to a biologically oriented philosophy centered on preserving natural tooth structures. Minimally invasive dentistry (MID) emphasizes early detection, risk assessment, prevention, and conservative intervention based on the lesion’s activity and depth. This review outlines current evidence on non-operative, micro-invasive, and minimally invasive strategies, including fluoride therapy, remineralizing agents such as casein phosphopeptide–amorphous calcium phosphate (CPP-ACP), self-assembling peptides that promote biomimetic enamel repair, sealants, and resin infiltration. Minimally invasive operative methods employ advanced technologies for selective tissue removal—chemomechanical systems (Carisolv, Papacarie, Brix3000), sono-and airabrasion, and new-generation polymeric and ceramic burs (SmartBur, Cerabur) designed to preserve sound dentin. Laser photoablation, particularly with erbium lasers (Er:YAG, Er,Cr:YSGG), enables precise cavity preparation with minimal thermal and mechanical stress. These approaches enhance patient comfort, reduce anesthesia requirements, and maintain tooth vitality. Despite limitations related to cost, equipment, and operator sensitivity, MID represents not only a set of refined clinical techniques but also a comprehensive, evidence-based treatment philosophy founded on biological principles, structural preservation, and the promotion of long-term oral health. Full article

Dental erosion has emerged as a significant modern oral health problem, characterized by the chemical dissolution of tooth structure resulting from frequent exposure to intrinsic or extrinsic acids. With a high global prevalence ranging from 30% to 50% in children and 20% to 40% in adults, its management is a clinical priority to prevent long-term complications like dentine hypersensitivity and functional impairment. This review outlines the multifactorial etiology of erosion, encompassing dietary acids, gastroesophageal reflux, and reduced salivary flow. The historical context of oral care is explored, leading to a discussion on contemporary management strategies centered on remineralization. Fluoride ions play a crucial role by inhibiting demineralization, facilitating the formation of acid-resistant fluorapatite, and exerting antibacterial effects. A major focus is placed on advanced biomimetic, calcium phosphate-based topical agents such as Casein Phosphopeptide–Amorphous Calcium Phosphate (CPP-ACP), functionalized Tricalcium Phosphate (fTCP), and Hydroxyapatite (HAP), which effectively replenish lost minerals. The review further explores innovative methods, such as laser-assisted and electrically enhanced remineralization. Finally, it outlines next-generation regenerative strategies, including self-assembling peptides (P11-4), stem cell therapies, 3D bioprinting, and gene-editing (CRISPR) technologies, which aim to biologically regenerate lost enamel and dentine. The field is rapidly evolving from a preventive to a restorative paradigm, with future directions focusing on biologically based, minimally invasive therapies to fully restore tooth structure and function. Full article

Background and Objectives: Sjögren’s syndrome (SS) causes destructive salivary gland dysfunction with substantial oral morbidity. To synthesize practical, evidence-based approaches for early recognition, initial oral management, and timely referral to dental care. Materials and Methods: Narrative review of English-language literature from the Web of Science Core Collection and PubMed, prioritizing systematic reviews, randomized trials, and consensus guidelines. Results: Early oral signs include rapid multifocal root and cervical caries, burning sensations, and rising dental treatment needs. Unstimulated whole saliva ≤ 0.1 mL/min supports significant hypofunction and complements the 2016 ACR/EULAR criteria. Preventive care should combine dietary counseling, salivary stimulation, and topical remineralization. Adjuncts include high-fluoride toothpaste, biomimetic hydroxyapatite dentifrices, and casein phosphopeptide–amorphous calcium phosphate (CPP-ACP). However, evidence for fluoride varnish in SS remains mixed. Pharmacologic sialogogues require screening for contraindications. Conclusions: Embedding oral screening, simple salivary metrics, and a structured referral pathway into rheumatology visits can reduce preventable tooth loss and improve comfort, function, and treatment adherence. Full article

Background/Objectives: Dental caries, one of the most common oral diseases worldwide, represents a major public health concern. Contemporary dentistry has established several non-invasive approaches and resin infiltration, as a micro-invasive path, in the treatment of white spot lesions (WSLs). This study aimed to evaluate the effect of different WSL treatments on enamel surface microhardness. Materials and Methods: Seventy-five intact human premolars extracted upon orthodontic indication and the demineralizing solution composed of acetic acid, monopotassium phosphate and calcium chloride with pH = 4.4 and exposure time 96 h were used. The samples were randomly divided into five groups (n = 15): I—intact enamel (control group); II—artificial white spot lesion; III—artificial WSL treated with fluoride varnish; IV—artificial WSL treated with casein phosphopeptide—amorphous calcium phosphate (CPP-ACP) paste; V—resin-infiltrated artificial WSL. The surface microhardness was determined using the Oliver–Pharr method and a spherical indenter (Shimadzu Indenter, Kyoto, Japan). One-way analysis of variance (ANOVA) followed by a Post Hoc test (Bonferroni) was used with a level of significance set at p < 0.05. Results: Resin-infiltrated white spot lesions showed comparable microhardness mean value as the control group: 68.23 (±21.45) and 63.57 (±18.89), respectively (p > 0.05). Also, resin infiltration increased enamel microhardness compared to WSL values, with a statistically significant difference (p < 0.05). Fluoride varnish and CPP-ACP treatment resulted in equivalent values (50.84 ± 14.35 and 50.99 ± 15.31, respectively). Conclusions: Different WSL treatments (fluoride varnish, CPP-ACP and resin infiltration) produced comparable enamel microhardness values. Among the tested agents, resin infiltration resulted in higher microhardness values, while fluoride varnish and CPP-ACP demonstrated equivalent outcomes. Full article

Objective: This in vitro study quantitatively compared the time-dependent remineralization potential of three professional agents on artificially induced enamel lesions using Scanning Electron Microscopy (SEM) and energy-dispersive X-ray analysis (EDX). Methods: Sixty extracted sound molars were randomly assigned to three groups (number = 20): G_CPP-ACP, treated with casein phosphopeptide–amorphous calcium phosphate; G_Zn-HA, treated with zinc-hydroxyapatite; and G_F-ACP, treated with fluoridated amorphous calcium phosphate. The crown of each tooth was divided into three areas: one represented the control (CTRL, sound enamel), one underwent demineralization (DEMIN, demineralized enamel), and the third one was at first demineralized and then treated with a remineralizing agent, allowing intra-sample comparison. Artificial lesions were produced by immersion in 0.1 M lactic acid (72 h). Groups were subdivided according to remineralization time (7, 14, 21, and 28 days). Samples underwent daily treatment under a pH-cycling regimen. Surface morphology and Ca/P ratios were evaluated by SEM-EDX, and data were statistically analyzed (p < 0.05). Results: All agents promoted a progressive increase in Ca/P ratio over time, confirming a time-dependent remineralization effect. At day 7, G_Zn-HA showed higher Ca/P values, but from day 14 onward, G_F-ACP produced significantly greater mineral gain than the other groups (p < 0.05). By day 21, G_F-ACP reached Ca/P values approaching CTRL, while G_CPP-ACP and G_Zn-HA remained at lower levels, reaching a plateau respectively at 21 and 14 days. SEM observations supported these findings: G_CPP-ACP and G_Zn-HA showed partial surface recovery, whereas G_F-ACP exhibited a compact, homogeneous enamel-like structure at 28 days. Conclusions: All tested agents demonstrated time-dependent remineralization, enhanced with prolonged exposure, suggesting that the time of application represents a key factor for clinical success. Full article

This study evaluated a biomimetic filler strategy for two-step universal dental adhesives by integrating amine-functionalized mesoporous silica nanoparticles (MSNs) loaded with polyacrylic acid-stabilized amorphous calcium phosphate (PA–ACP) into the primer phase. MSNs were synthesized and characterized by FTIR, N₂ sorption (BET), and HRTEM to confirm structural integrity and effective PA–ACP loading. Two commercial adhesives (G2 Bond and OptiBond eXTRa) were modified by incorporating different volumes fractions (10, 15, 20 vol%) of PA–ACP/MSN. Wettability (contact angle), microtensile bond strength (μTBS), and cytotoxicity (indirect MTT assay using human periodontal ligament fibroblasts, HPLFs) were assessed. The results demonstrated that incorporating up to 15 vol% PA–ACP/MSN maintained favorable wettability and bond strength, comparable to those of the unmodified controls. At 20 vol%, significant increases in contact angles and reductions in bond strength indicated impaired primer infiltration. Cytotoxicity testing confirmed high fibroblast viability (>70%) across all tested concentrations, verifying the biocompatibility of PA–ACP/MSN-filled primers. This work confirms the feasibility of a biomimetic adhesive design using PA–ACP/MSN in the primer phase without compromising immediate wettability and immediate μTBS up to 15 vol%. Remineralization is a potential capability that requires verification in future studies. Full article

Background: A trilayered collagen/collagen–magnesium–hydroxyapatite (Col/Col-Mg-HA) scaffold is used in clinical practice to treat osteochondral lesions, but the regeneration of the subchondral bone is still not satisfactory. Objective: The aim of this study was to test, in vitro, the osteoinductivity induced by the addition of bone morphogenetic protein-2 (BMP-2) or amorphous calcium phosphate granules with strontium ions (Sr-ACP), in order to improve the clinical regeneration of subchondral bone, still incomplete. Methodology: Normal human osteoblasts (NHOsts) were seeded on the scaffolds and grown for 14 days in the presence of human osteoclasts and conditioned medium of human endothelial cells. NHOst adhesion and morphology were observed with transmission electron microscopy, and metabolic activity was tested by Alamar blue assay. The expression of osteoblast- and osteoclast-typical markers was evaluated by RT-PCR on scaffolds modified by enrichment with BPM-2 or Sr-ACP, as well as on unmodified material used as a control. Results: NHOsts adhered well to all types of scaffolds, maintained their typical morphology, and secreted abundant extracellular matrix. On the modified materials, COL1A1, SPARC, SPP1, and BGLAP were more expressed than on the unmodified ones, showing the highest expression in the presence of BMP-2. On Sr-ACP-enriched scaffolds, NHOsts had a lower proliferation rate and a lower expression of RUNX2, SP7, and ALPL compared to the other materials. The modified scaffolds, particularly the one containing Sr-ACP, increased the expression of the osteoclasts’ typical markers and decreased the OPG/RANKL ratio. Both types of scaffold modification were able to increase the osteoinductivity with respect to the original scaffold used in clinical practice. BMP-2 modification seemed to be more slightly oriented to sustain NHOst activity, and Sr-ACP seemed to be more slightly oriented to sustain the osteoclast activity. These could provide a concerted action toward better regeneration of the entire osteochondral unit. Full article

Amorphous calcium phosphate (ACP) is a well-established bioceramic material known to promote the remineralization of dental hard tissues. White spot lesions (WSLs) represent the initial stage of enamel demineralization and are frequently observed in patients with fixed orthodontic appliances or inadequate oral hygiene. Although recommendations for remineralizing agents include both the prevention of lesion progression and the stimulation of tissue remineralization, the clinical efficacy of ACP-based materials remains under debate. This systematic review, registered in the PROSPERO database (CRD42024540595), aims to evaluate the clinical efficacy of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP)-based products in the remineralization of WSLs and to compare these outcomes with those achieved using non-bioceramic approaches. Inclusion criteria comprised randomized clinical trials, prospective cohort studies, and pilot studies conducted on human subjects with WSLs affecting permanent teeth. Studies involving artificial WSLs or non-cariogenic enamel lesions were excluded. The quality of the included studies was assessed using the Cochrane Risk of Bias 2 (RoB 2) tool. Fourteen articles met the inclusion criteria and were analyzed. The main findings indicate that CPP-ACP is clinically effective in promoting the remineralization of WSLs, although the results were inconsistent across studies. Comparisons with placebo and resin infiltration treatments revealed greater efficacy for CPP-ACP. The combination of CPP-ACP with fluoride appeared to further enhance the remineralizing effect on WSLs. Additional standardized clinical studies with longer follow-up periods are warranted to confirm these outcomes. Full article

A novel modified oyster shell (MOS-800) was developed to enhance phosphorus sequestration and recovery from wastewater. Approximately 33.3% of phosphate was eliminated by the MOS-800, which also exhibited excellent pH regulation capabilities. In semicontinuous tests, a synergistic phosphorus separation was achieved through the coupling process of CaCl₂/MOS-800 and a circulating fluidized bed (CFB), resulting in an 86.5% phosphate separation. In continuous flow experiments, phosphorus elimination reached 98.2%. Material characterization revealed that hydroxyapatite (HAP) was the primary component of the crystallized products. Additionally, MOS-800 released 506.5–572.2 mg/g Ca²⁺ and 98.1 mg/g OH⁻. A four-stage heterogeneous crystallization mechanism was proposed for the coupling process. In the first stage, Ca²⁺ quickly reacted with phosphate to form Ca-P ion clusters, etc. In the second stage, these clusters packed randomly to form spherical amorphous calcium phosphate (ACP). In the third stage, the ACP spheres were transformed and rearranged into sheet-like HAP crystallites, Finally, in the fourth stage, the HAP crystallites aggregated on the surface of crystal seeds, also with the addition of crystal seeds and undissolved MOS-800, potentially catalyzing the heterogeneous crystallization. These findings suggest that the CaCl₂/MOS-800/CFB system is a promising technique for phosphate recovery from wastewater. Full article

Background: Due to limitations of fluoride (F) treatment as a main caries preventive measure, it is important to consider the use of other dental caries preventive measures to reduce caries prevalence, especially in its early stages. Recently, new remineralizing agents appeared on the market, with their commercial availability in a variety of oral care products. Objectives: The purposes include providing a scoping review that represents caries remineralizing efficacies of only commercially available products and their existing adverse effects (if it is presented) and ensuring that only evidence-based approved products are included. Methods: The following databases were used in searching scientific literature on 28 October 2024: PubMed, PubMed Advanced Search, MeSH database, and PubMed Clinical Queries. The study selection criteria were as follows: for laboratory, in vitro, and/or in situ—remineralization of enamel-scanning electron microscopy, spectroscopy, microhardness test, light microscopy, profilometry, transverse microhardness microradiography, integrated mineral loss, light microscopy, photothermal radiometry; if it was a randomized controlled trial—CONSORT protocol, ICDAS system (to detect dental caries), diagnostic additional devices; antibacterial ability-colony forming units, DNA-based sequencing, scanning electron microscopy, crystal violet staining, and confocal laser scanning microscopy. Results: This review includes 98 papers: 14 of them describing the current status of caries patterns in the world, 60 studies (45 laboratory studies and 15 RCTs), and 24 systematic reviews were analyzed in order to detect whether new remineralizing agents can replace fluoride in further caries prevention. Conclusions: All reviewed new remineralization agents could be used without additives to treat early caries lesions, but the combination with F promotes better remineralization. Only HAP demonstrated its potential to serve as an alternative to fluoride in oral care products. However, further clinical studies are needed to prove its role in the remineralizing process of initial caries lesions. One also needs to ensure that both the clinical trials and in vitro lab studies use the best gold standards to validate any changes in the tooth structure, both remineralization and demineralization. Full article