18887
REMINERALISING POTENTIAL OF DENTIFRICE REINFORCED WITH NANOHYDROXYAPATITE: A SYSTEMATIC REVIEW
Parvathy Harshan1, S. Shreelakshmi 2, Sindhu 3, Bharathwaj 4, Dinesh5, Rajmohan 6 and Prabu. D 7
1Bachelor of dental surgery ( undergraduate), 2 Senior lecturer ( MDS), 3,4Senior lecturer (MDS). 5,6 Reader (MDS), 7 HOD and Professor ( MDS), Department of Public Health Dentistry, SRM Dental
College and Hospital, SRM Institute of Science and Technology, Ramapuram, Chennai, India.
Address: Bharathi Salai, Ramapuram, Chennai, Tamil Nadu- 600089 Telephone number: +918144542777
e-mail: [email protected]
ABSTRACT:
Background: Nano-dentistry is an extravagantly advancing field towards the diagnosis and treatment of diseases like dental caries, oral infections, gingival, and periodontal problems. Dental caries being the most frequently encountered dental problem, needs a minimally invasive method of treatment.
Hydroxyapatite is the major component of the tooth structure. Hence replenishing it can help tackle dental caries. For this purpose, various studies on nanohydroxyapatite are being conducted to assess its remineralising capacity to prevent or remineralise carious lesions.
Aim: To scrutinise the remineralising potential of dentifrice reinforced with nanohydroxyapatite in enamel lesions.
Study Design: A systematic review on in-vitro studies done using dentifrice incorporated with nanohydroxyapatite to gauge its remineralising capability in early enamel lesions was carried out. Various scientific electronic databases were searched, and 583 articles were obtained, among which 7 were included in this study based on specific selection criteria for further analysis.
Results: 7 in-vitro studies were included in this systematic review. Among these, 5 studies showed that nanohydroxyapatite dentifrices had a superior remineralising capability on artificially made enamel lesions compared to other available agents, hence, bringing us closer to a minimally invasive world of treatment.
Conclusion: Minimally invasive dentistry is taking over the conventional modalities in this modern world. Nano-hydroxyapatite incorporated into dentifrices showed superior strength and better
18888 remineralisation potential than other commercially available agents and can be used to manage enamel lesions early.
Keywords: Nanotechnology, Nanobots, Dental caries, Remineralisation, Nanohydroxyapatite, Dentifrice, Caries Prevention.
INTRODUCTION:
Dental caries is a chronic, biofilm-induced, multifactorial, dynamic disease resulting in the demineralisation of dental hard tissues. Caries can manifest throughout life, causing damage to the tooth[1]. It forms a convoluted interaction over time between acid-producing bacteria, fermentable carbohydrates, and host factors. As it stands, it is the most prevalent non-communicable chronic disease in humans, causing pain and discomfort to individuals affecting their daily activities and emotional stability[2]. As it is a preventable disease, early detection and treatment are important if intervened priorly. Approaches towards the condition are tailored based on the status of the tooth and the prevailing risk factors[2,3]. The age-old method of extension for prevention has shifted to minimally invasive techniques.
Newer techniques for treatment include - laser, ozone therapy, chemo-mechanical methods, resin infiltration techniques, CPP-APP, fluoridated agents, ART, remineralising agents, nanotechnology., etc.[4]
Nanotechnology is a multifaceted scientific field undergoing extravagant developments opening doors toward a new era of upgrade and imprinting its role in various fields like dentistry, medicine, genomics, etc.,5. It deals with the direct manipulation of materials at the nanoscale level[6]. Nano-dentistry is the dawn of technologically advanced clinical tools and devices that bestowed diagnostics, therapeutics, preventive and cosmetic dentistry developments, facilitating enhanced patient care[7]. It touched various aspects in dentistry, from local anaesthetics to bone replacement materials[8].
Enamel is a highly mineralised tissue predominantly formed by a component known as hydroxyapatite.
It forms the structural foundation of the tooth and plays a major role in the remineralisation and demineralisation of enamel[9]. The recent developments in nanotechnology lead to the formulation of nanohydroxyapatite particles which have a strong affinity to bind with proteins, plaque and bacteria by increasing the surface area. Toothpaste containing nanohydroxyapatite was introduced in 1978. As the hydroxyapatite particles create a new layer on tooth structure rather than harden, the current layer makes it a superior choice for remineralisation of the tooth with an early lesion or as a preventive aid[10].
18889 Due to the lack of adequate literature on nanohydroxyapatite-based dentifrices, this study aimed to systematically review the related articles to gain a shred of scientific-based evidence.
MATERIALS AND METHODS:
Study Design: A systematic review of in-vitro studies done using dentifrice incorporated with nanohydroxyapatite.
Search Strategy: The following databases were used to find published articles on in-vitro studies based on the remineralising property of nanohydroxyapatite reinforced dentifrice on enamel lesions: PubMed, Ovid Medline, Elsevier science direct, Wiley online library, Cochrane Library, Lilacs and Google scholar.
Each database was searched to obtain the articles using specific Mesh representations. The mesh term used was "nanomaterials" AND "dental caries" AND "remineralisation/remineralising agent".
Table/Fig 1: Search Database and Characteristics Of Excluded Articles
Search Database and Keywords
Database Keyword Results After duplicate
removal Pubmed
central
nanomaterials AND dental caries AND remineralisation
265 265
Science direct nanomaterials AND dental caries AND remineralisation
152 120
Ovid Medline nanomaterials AND dental caries AND remineralisation
5 2
Cochrane nanomaterials AND dental caries AND remineralisation
0 0
Wiley online library
nanomaterials AND dental caries AND remineralisation
51 46
Google Scholar
"nanotechnology" AND "dental caries" AND
"remineralising agents"
115 75
Lilacs nanomaterials AND dental caries AND remineralisation
0 0
Total - 583
Characteristics Of Excluded Articles
SL.no Reason for exclusion No: of articles excluded
1 Articles not related to the topic 296
18890
2 Articles in other languages 4
3 Articles focusing on other remineralising agents
68
4 Review and literature-based articles
42
5 Articles on other properties of nanohydroxyapatite
53
6 Remineralisation of dentinal and cemental caries
7
7 Studies other than in-vitro 28
8 Relevant article without full text 1
Table 1: Keywords used for each electronic database and reasons for excluding articles from the obtained results.
ELIGIBILITY CRITERIA:
Inclusion Criteria:
1) Studies published in English
2) Articles on dentifrice containing nanohydroxyapatite 3) Articles on remineralisation of early enamel caries 4) In-vitro studies
5) Full-text articles
6) Publications over the years Exclusion Criteria:
1) Articles published in other languages 2) Only abstracts available
3) Studies with other formulations of nanohydroxyapatite 4) Studies with other nano components
18891 5) Studies based on remineralisation of dentinal and cemental caries
6) Unrelated articles 7) Review articles
RESULT:
After the search using the appropriate MeSH terms, 583 articles were found from various online databases. After duplicates removal, 506 articles were screened, further narrowed down by reading the title and abstract. Seven full-text articles were finalised based on the inclusion-exclusion criteria. The final seven articles were assessed in-depth about the remineralising potential of nanohydroxyapatite dentifrice.
18892
18893 Table/Fig 3: Characteristics Of Intervention And Outcome Data As Reported In Included Studies Sl
No:
Author Journal Name Volume,
Issue, Page No:
Year
Aim Sample size and Preparation
Used
Duration and Intervention
Tool of assessment and Statistical
test
Result Outcome
1 Meghna Bajaj et al.
The Journal of Clinical Pediatric Dentistr y, 40 (5), 404-409, 2016
To compare CPP-ACP, Tri-
calcium phosphate and hydroxyap atite on reminerali sation of artificial caries like lesions on primary enamel
Sample: 10 extracted sound primary molars were sectioned into 40 samples.
Demineralizi ng Agent: 2.2 mM CaCl2,
2.2 mM
KH2PO4, 0.05M acetic acid pH 4.4 with 1 M KOH.
Remineralizin g Agent:
1.CPP-ACP - GC tooth mousse 2.Tri-calcium Phosphate - Clinpro tooth crème, 0.21%
sodium fluoride with fTCP,
3.Hydroxyap atite-Remin- Pro
4.Artificial saliva
Duration: 10
days pH
cycling.
The specimens were randomly divided into 4 groups (n=40, 10 each) Group A:
negative control group Group B: GC tooth mousse ( positive control) Group C:
Clinpro tooth crème
Group D:
Remin-Pro Each cycle was 8 hrs /day- 3 hours of
demineralisati on twice a day and 2 hours of remineralisati
on in
between.
Specimens in Group B, C and D, were
1. Polarised Light
Microscopy 2.Paired t-test 3.ANOVA test
4.Post HOC TURKEY’s Test
1. Group D showed the highest amount of
remineralisation 2. There was a statistically significant
difference found between Group A and B and a highly significant difference
between Group A and D
1.All three groups - showed significant remineralisa tion under the in-vitro pH cycling model.
2.HA group showed superior remineralisa tion
compared to CPP-ACP and TCP.
3.
Remineralis ation was observed from the surface towards the lesion.
18894 Solution: 1.5
mM CaCl2,
0.9 mM
NaH2PO4, 0.15 M KCL had a pH of 7.0.
treated for 60 seconds with toothpaste supernatant (5 ml /section) before and after the first and second demineralisin g cycles.
2 Nithin Mancher y et al.
Dental Research Journal, 16 (5), 310-317, 2019
Evaluate and compare the reminerali sation ability of dentifrices containing nanohydro xyapatite, NovaMin, and amine fluoride on artificial enamel caries.
Sample: 48 extracted sound maxillary premolars were used.
Demineralizi ng Agent: 2.2 mM calcium chloride, 2.2 mM sodium phosphate, and 0.05 M acetic acid, 1 M potassium at pH of 4.4 Remineralizin g Agent:
1.APAGARD ROYAL containing 10%
nanohydroxy apatite
2. SHY-NM containing 5% calcium sodium phosphosilica
te 3.
AMFLOR containing 1450 ppm
Duration: 7
days pH-
cycling The specimens were randomly divided into 3 groups. (n=
48, 16 each) Group 1:
APAGARD ROYAL Group 2:
SHY-NM Group 3:
AMFLOR Each cycle- 3
hrs of
demineralisati on twice daily and 2 h of remineralisati
on in
between.
Following groups- A, B, and C were treated for 60 seconds with toothpaste supernatant (5 ml/section) before the first
1.Polarising Light Microscopy 2.Paired t-test 3.ANOVA
1. Comparisons between pre-and post-test lesion depths in all groups were highly
significant.
2. The reduction in mean lesion depth after pH cycling was maximum for
Group C,
followed by A and B.
3. No significant differential change in mean lesion depth across various groups pre- and post-pH cycling.
4. A considerable decrease in lesion
depth was
observed across all the groups indicating
effective
remineralisation.
5. The maximum decrease in lesion depth was seen in
Group A,
followed by Group C and B.
1. All three dentifrices could
reduce the progress of demineralis ation and enhance the remineralisa tion process on artificial carious lesions.
2.Nanohydr oxyapatite dentifrice produced better effects compared to other
agents.
18895 amine
fluoride Solution: 1.5 mM calcium chloride, 0.9 mM sodium hydrogen phosphate, and 0.15 potassium chloride, 1M potassium hydroxide at a pH 7.0.
demineralisin g cycling and before and after the second
demineralisin g cycles.
3 Joshi C et al.
Contemp orary Clinical Dentistr y, 10 (4), 605-613, 2019
To assess the
reminerali sing potential of four commerci ally available agents to restore the enamel closest to its
previous microhard ness levels
Sample: 60 extracted sound permanent premolar.
Demineralizi ng Agent:
CaCl2 2.2 mmol/l, KH2PO4 2.2 mmol/l, lactic acid 0.05 mmol/l, pH was adjusted to 4.5 with 50% NaOH.
Remineralizin g Agent:
1.BAG NovaMin - SHY-NM 2. nHAp - Acclaim 3.f-TCP - Clinpro Tooth Crème
4. GSE 5. Fluoride - 1000 ppm
Duration: 21
days pH
cycling The specimens were randomly divided into 6 groups. (n = 60)
Group 1: n = 12, SHY-NM Group 2: n = 12, Acclaim, Group 3: n = 12, Clinpro Tooth Crème Group 4: n = 12, GSE Group 5: n = 12, Colgate Calci-Lock ( positive control) Group 6: n = 12 , Distilled
water (
negative control) Each cycle – 3h
1.Vickers microhardnes s tester 2.ANOVA 3.Post hoc Tukey
analysis
1. Percentage SMHR of the samples of Group 1 was the highest, followed by 3, 2, 4, 5, and 6.
2. There was no statistical
difference
between various
groups at
baseline SMH and SMH after demineralisation.
3. All the groups
showed a
significant
difference in
SMH after
remineralisation.
4. Statistically significant
difference was seen in values of SMH between Group 1 with 4, 5, and 6; Group 2 with 5 and 6;
Group 3 with 5 and 6
5. First three groups showed
1.All the four agents used in the study had the potential to
remineralise the
artificially carious lesion.
BAG Novamin (SHY-NM) showed the maximum potential for remineralisa tion
followed by f-TCP (Clinpro Tooth Creme), nHAp (Acclaim), and lastly, GSE.
2.
Statistically significant difference
18896 Colgate
Calci-Lock 6. Distilled water
7. Artificial saliva
Slurry:
prepared by manually mixing peanut-sized toothpaste into the distilled water.
demineralisati on twice a day and received
2 min
treatment with the respective remineralisin g agent slurry twice daily with a soft toothbrush.
statistically significant difference from control groups, but there was no statistically significant difference among them.
was not observed among the first three groups.
4 Charism a
Thimmai ah et al.
Journal of Clinical and Experim ental Dentistr y, 11 (12), 1120- 1126, 2019
To
quantitativ ely
evaluate the reminerali sation potential of Casein Phosphop eptide- Amorphou s Calcium phosphate -Fluoride, Tri- calcium phosphate
& Nano- hydroxyap atite using Scanning Electron Microscop
e and
Energy- dispersive X-ray Analysis.
Sample: 40 extracted sound premolars.
Demineralizi ng agent:
2.2mM CaCl2, 2.2mM KH2PO4, 0.075mmol/L acetate at pH 4.3.
Remineralisin g agent:
1.GC Tooth Mousse Plus- CPP-ACP 2.ClinproTM Tooth crème- Tri- Calcium Phosphate 3. Aclaim toothpaste- nanohydroxy apatite
4. Artificial saliva
Duration: 30 days
The specimens were randomly divided into 4 groups. (n=
40, 10 each) Group 1- GC Tooth Mousse Plus
Group 2- Clinpro tm Tooth Crème Group 3- Aclaim Toothpaste
Group 4-
Artificial Saliva
Each group were treated daily with their
respective remineralisin g agents using
1.SEM- EDX Analysis 2.ANOVA test
3.Post Hoc Analysis 4.Paired T- test
Comparison of Ca/P mass % values after remineralisation was done:
1.ANOVA test - the mean value of CPP-ACPF highest. This difference is statistically significant 2. The digital outputs of the EDX values: a decrease in the
Ca/P mass
percentage after demineralisation was observed compared to baseline.
3. SEM images of remineralised surface- Greater deposits were observed in the CPP-ACPF group.
1.CPP- ACPF and Tricalcium Phosphate showed enhanced remineralisa tion
potential compared to nanohydrox yapatite.
2.Topical application of CPP- ACPF, tricalcium phosphate or
nanohydrox yapatite containing toothpaste significant role in remineralisa tion of carious lesions.
18897 a cotton
applicator tip.
After which, the specimens were washed using
deionised water and placed in artificial saliva at a temperature of 37°C, in an incubator mimicking the oral temperature.
4.Post Hoc Analysis at three different
intervals showed that comparing the difference between mean values of Ca/P mass % after demineralisation and
remineralisation were highest in
TCP with
Fluoride. This difference was statistically significant.
6. Paired t-test:
On comparison, the mean values of Ca/P mass % after
remineralisation was higher, and the value was statistically significant for all individual
groups.
5 V.
Vijayasa nkari et al.
Europea n
Archives of Pediatric Dentistr y, 20 (6), 529-536 2019
To analyse the
reminerali sation potential of
experimen tal
nanohydro xyapatite paste on artificial caries lesions using a scanning
Sample: 35 extracted sound primary molars
sectioned to obtain 65 specimens.
Demineralisin g Agent:
CaCl2 2.2 mmol/l, NaH2PO4 2.2 mmol/l, lactic acid 0.05
Duration: 14 days
The specimens were randomly assigned into 4 test groups and 1 control group. (n = 65, 15 each) Group I:
Aclaim
1.SEM-EDX Analysis 2.Kolmogoro v- Smirnov test
3.Shapiro- Wilks test 4.Friedman test
5.Wilcoxon signed-rank test
6.Kruska- Wallis
1. Changes in weight percent of Calcium and Phosphorus:
After
demineralisation, all the groups
showed a
significant
reduction from baseline except the control
group. A
significant
increase was noticed after
1.Commerci ally
available and
experimenta
l nHAP
pastes can remineralise artificial carious lesions.
2.10%
EnHAP was most
effective in increasing
18898 electron
microscop e with energy dispersive X-ray analysis.
mmol/l, pH was adjusted to 4.5 with 50% NaOH.
Remineralizin g Agent:
1.Two experimental nHAP toothpaste with
concentration s of 1% nHAP
and 10%
nHAP were prepared by mixing with the
ingredients of standard toothpaste.
2. Acclaim- nanohydroxy apatite paste 3.GC tooth mousse- CPP- ACP
4.Artificial Saliva
Group II: 1%
experimental nHAP paste Group III:
10%
experimental nHAP paste Group IV: GC tooth mousse Group V:
control group The
specimens in groups I–IV were treated with their respective remineralisin g paste for 3 min twice daily for 14 days, washed with
deionised water, and then placed in artificial saliva and was
maintained at ambient temperature.
In the control group,
specimens were only washed with deionised water and placed in artificial saliva.
7.Mann- Whitney U test
remineralisation in all the groups except the control group.
2. 10% EnHAP showed
significant change in wt%
after
demineralisation and
remineralisation.
3. Intragroup comparison: All the groups except the control group showed
statistically significant differences.
4. Intergroup comparison:
statistically significant
difference in wt%, compared to the change in demineralisation to
remineralisation value.
5. Statistically significant
difference of phosphorus wt%
on comparing the
change in
baseline to remineralisation values.
6. The post hoc analysis-
statistically significant difference after remineralisation
calcium and phosphorus wt%,
followed by 1% CnHAP.
CPP–ACP
and 1%
EnHAP.
18899 between 1%
CnHAP and
CPP–ACP in change calcium wt%.
7. Among 1%
EnHAP paste-
10% EnHAP
paste and 10%
EnHAP paste- CPP–ACP, a statistically significant
difference was observed in calcium wt%.
8. Changes in demineralisation to
remineralisation
values of
phosphorus wt%
compared to 1%
EnHAP paste and
10% EnHAP
paste, 10%
EnHAP and
CPP–ACP, statistically significant
difference was observed.
6 Raneem Saudi et al.
BAU Journal- Creative Sustaina ble Develop ment, 2 (1), Article- 7, 2020
To evaluate the effect of
nanohydro xyapatite and casein phosphope ptide- amorphou s calcium phosphate fluoride on early
Sample: 30 extracted sound premolar teeth
sectioned- 60.
Demineralizi ng agent:
2.2mM CaCl2, 2.2mM K3PO4, 0.05M Acetic
Duration: 15 days cycle The
specimens were randomly divided into 4 groups.
(n=60, 15 each)
Group A:
Experimental - specimens
1.DIAGNOde nt pen
2. Energy Dispersive X- ray Analysis EDX
1. Statistically significant
difference was
seen in
DIAGNOdent pen readings at different periods in all groups EDX analysis:
2. Mineral content of calcium and phosphate at different periods:
1.Nano-HA and CPP- ACPF had similar potential in remineralisi ng artificial carious lesion.
2.Nano-HA and CPP- ACPF can reverse a demineralis
18900 deminerali
sed enamel utilising DIAGNO dent pen and energy dispersive X-ray analysis.
acid, 1M
KOH to
adjust pH to 4.4.
Remineralisin g agent:
1.Desensin repair- toothpaste, nano-HA.
2. Clinpro White
Varnish, (fTCP).
3. MI Paste Plus, CPP- ACPF.
4. Artificial saliva
Solution
- 20mM
NaH2CO3, 3 mM
NaH2PO4, 1mM CaCl2, 0.15M KCl used to adjust pH of 7.
were brushed using a soft toothbrush with Desensin repair
toothpaste for 30 cycles (15 seconds each, twice daily).
The specimens were dried and stored in artificial saliva throughout the whole procedure.
Group B: self- control
Group C:
Experimental - specimens were treated with MI Paste Plus
according to the
manufacturer instructions
using a
microtip applicator for 3 minutes, twice daily for 15 days.
Any remaining paste on the surface was left, and the specimen was stored in artificial saliva.
a statistically significant
difference at all periods was seen in all groups.
3. Statistically significant
difference was seen between baseline and remineralisation in all groups.
ed lesion into a sound tooth
structure.
3.DIAGNO dent pen is not a highly specific tool for
quantitative assessment of enamel mineralisati on; rather, it
is a
bacterial- mode dependant tool.
18901 Group D:
self-control 7 P.
Hemalat ha et al.
Journal of Conserv ative Dentistr y, 23 (6), 604-608, 2020
Evaluate the reminerali sation potential of four different reminerali sation agents used quantitativ ely by surface microhard ness and qualitative
ly by
energy dispersive X-ray analysis.
Sample: 60 extracted sound lower second
premolars.
Demineralizi ng Agent: 2.2 mM calcium chloride, 2.2 mM sodium dihydrogen orthophospha te dehydrate, and 0.05M acetic acid, 1M potassium hydroxide at pH 4.4
Remineralizin g Agent:
1.Remin Pro- Nano‐
hydroxyapatit e
2.Fluor Protector Gel -Fluoride 3.GC Tooth
Mousse -
CPP‐ACP 4.Chitosan 5 mg
5. Artificial saliva
Duration: 7 days
The specimens were randomly divided into 4 groups (n=60, 15 each)
Group 1:
Remin Pro Group 2:
Fluor
Protector Gel Group 3: GC Tooth Mousse Group 4:
Chitosan 5 mg
Samples were dried, and agents were applied and kept
undisturbed for 5 minutes every 24 h for 7 days. After that, the specimens were stored in artificial saliva.
1. Rockwell Hardness Test
2. SEM-
EDAX Analysis.
3.ANOVA 4. Tukey’s post hoc test -
1. On comparing the deposition of minerals between four groups, nanohydroxyapat ite had achieved the highest deposition rate.
2. The deposition of calcium and phosphate is more in Group A, followed by C, D and B.
3. Nano‐
hydroxyapatite had superior microhardness.
1. All
remineralisi ng agents produced improved surface remineralisa tion.
2. Nano‐
hydroxyapat ite has the potential to remineralise artificially induced lesion effectively.
Table 2: Shows the characteristics of the intervention, outcome and result in the included studies.
The remineralising property of nanohydroxyapatite dentifrice over other available remineralising dentifrices was compared. The outcome and results were positive in 4 of the studies, negative in 2 and neutral in 1.
DISCUSSION:
18902 Dental Caries is a multifactorial disease, is difficult to manage with a single technique, and it is important to devise a plan to prevent or treat it at the earliest. As this era of minimally invasive techniques comes into play, Nano-dentistry opened the doors that enable us to view dental structures from a nanoscale perspective leading to a better understanding of dental components[1-6]. For example, hydroxyapatite forms the core of the tooth structure and is affected during the demineralisation process. Hence, replenishing the same in the tooth will help in re-establishing the enamel structure. Furthermore, Nanohydroxyapatite incorporated into dentifrices can be used daily, can help provide a caries-resistant tooth structure. Therefore, a systematic review was conducted focusing on the remineralising capability of nanohydroxyapatite compared to other remineralising agents that are available in the market7-11. Meghna Bajaj et al., in their in-vitro study, did a comparison of remineralisation potential of CPP- ACP, TCP, and Hydroxyapatite (Remin- Pro), where hydroxyapatite showed the highest amount of remineralisation compared to CPP-ACP[12]. Similarly, P. Hemalatha et al., in their in-vitro study, evaluated the remineralisation potential of nanohydroxyapatite (Remin- Pro), fluoride, CPP-ACP, and chitosan 5 mg. The nanohydroxyapatite group has achieved the highest rate of remineralisation and had superior microhardness among other materials[18].
In the in-vitro study done by Nithin Manchery et al., a comparison of the remineralisation ability of dentifrices containing nanohydroxyapatite, NovaMin, and amine fluoride was done. Maximum remineralisation was seen in the nanohydroxyapatite group[13]. On the other hand, an in-vitro study done by Joshi C et al. was opposed to this. The remineralising potential of BAG NovaMin, nanohydroxyapatite, f-TCP, grape seed extract, and fluoride was assessed, and BAG NovaMin showed the superior remineralising potential followed by f-TCP, nHAp, and GSE[14].
V. Vijayasankari et al., in their in-vitro study, analysed the remineralisation potential of experimental nanohydroxyapatite paste of varying concentrations, commercially available nanohydroxyapatite, and CPP-ACP. 10% EnHAP was most effective in increasing calcium and phosphorus wt% followed by commercially available agents, hence better remineralising potential. Furthermore, they found that the higher the concentration of nHAP better the remineralising potential[16].
While Raneem Saudi et al. did an in-vitro study to evaluate the remineralising potential of nanohydroxyapatite, CPP-ACPF, and fTPC, it was found that Nano-HA and CPP-ACPF had similar potential in remineralising initial enamel lesions as fluoride varnish [17]. In contrast to this study, the in- vitro study done by Charisma Thimmaiah et al. quantitatively evaluated the remineralisation potential of
18903 CPP-ACPF, TCP, and nanohydroxyapatite, CPP-ACPF showed better remineralisation potential compared to nanohydroxyapatite[15].
Common limitations stated by the authors were that: no clinical trials were done, hence results under oral environment was not established. Secondly, some of the selected teeth may have more susceptibility to demineralisation due to various inherent factors. Thirdly, more aggressive acid attacks are seen in pH cycling, unlike in the oral environment. Lastly, the duration of the study and comparative factors differed in each study. In the article by Rameem Saudi, the DIAGNOdent pen was not a highly specific tool of assessment.
Numerous other studies have been done to assess and establish the remineralising potential of nanohydroxyapatite in various forms. As these articles do not fall under the inclusion-exclusion criteria established in this study, it is not discussed in-depth. Further clinical trials are needed to analyse the results in detail as the in-vitro studies do not provide the exact oral environment to obtain the results accurately.
CONCLUSION:
Minimally invasive dentistry is taking over the conventional modalities in this modern world.
However, Nanohydroxyapatite, even though artificially made, can rebuild the core structure of the tooth.
Moreover, when incorporated into dentifrices which can be used daily, it showed superior strength and enhanced remineralisation potential compared to other commercially available agents. Thus, proving that dentifrice reinforced with nanohydroxyapatite can successfully manage enamel lesions at an early stage.
REFERENCE:
1. Pitts NB, Zero DT, Marsh PD, Ekstrand K, Weintraub JA, Ramos-Gomez F, Tagami J, Twetman S, Tsakos G, Ismail A (2017). Dental caries. Natural Reviews Disease Primers Journal, 3:17030.
2. Frazão P (2012). Epidemiology of dental caries: when structure and context matter. Brazilian Oral Research Journal, 26(1), 108-114.
3. Selwitz RH, Ismail AI, Pitts NB (2007). Dental caries. The Lancet Journal, 369(9555), 51-59.
18904 4. Frencken JE, Peters MC, Manton DJ, Leal SC, Gordan VV, Eden E (2012). Minimal intervention dentistry for managing dental caries - a review: report of an FDI task group. International Dental Journal, 62(5), 223-243.
5. Emerich DF, Thanos CG (2003). Nanotechnology and medicine. Expert Opinion on Biological Therapy, 3(4), 655-663.
6. Ozak ST, Ozkan P (2013). Nanotechnology and dentistry. European Journal of Dentistry, 7(1), 145-151.
7. Bhardwaj A, Bhardwaj A, Misuriya A, Maroli S, Manjula S, Singh AK (2014). Nanotechnology in dentistry: Present and future. Journal of International Oral Health, 6(1), 121-126.
8. Saravana KR, Vijayalakshmi R (2006). Nanotechnology in dentistry. Indian Journal of Dental Research. 2006;17(2):62-5.
9. J. Arends, J.M. Ten Cate (1981). Tooth enamel remineralisation, Journal of Crystal Growth, 53(1), 135-147.
10. Pepla E, Besharat LK, Palaia G, Tenore G, Migliau G (2014). Nano-hydroxyapatite and its applications in preventive, restorative and regenerative dentistry: a review of the literature. Ann Stomatol (Roma), 5(3), 108-114.
11. Melo MA, Guedes SF, Xu HH, Rodrigues LK (2013). Nanotechnology-based restorative materials for dental caries management. Trends in Biotechnology, 31(8), 459-467.
12. Bajaj M, Poornima P, Praveen S, Nagaveni NB, Roopa KB, Neena IE, Bharath KP (2016).
Comparison of CPP-ACP, Tri-Calcium Phosphate and Hydroxyapatite on Remineralization of Artificial Caries Like Lesions on Primary Enamel -An in vitro Study. Journal of Clinical Pediatric Dentistry, 40(5), 404-409.
13. Manchery N, John J, Nagappan N, Subbiah GK, Premnath P (2019). Remineralisation potential of dentifrice containing nanohydroxyapatite on artificial carious lesions of enamel: A comparative in vitro study. Dental Research Journal (Isfahan), 16(5), 310-317.
14. Joshi C, Gohil U, Parekh V, Joshi S (2019). Comparative Evaluation of the Remineralising Potential of Commercially Available Agents on Artificially Demineralized Human Enamel: An In Vitro Study. Contemporary Clinical Dentistry, 10(4), 605-613.
15. Thimmaiah C, Shetty P, Shetty SB, Natarajan S, Thomas NA (2019). Comparative analysis of the remineralisation potential of CPP-ACP with Fluoride, Tri-Calcium Phosphate and Nano
18905 Hydroxyapatite using SEM/EDX - An invitro study. Journal of Clinical and Experimental Dentistry, 11(12), 1120-1126.
16. Vijayasankari V, Asokan S, GeethaPriya PR (2019). Evaluation of remineralisation potential of experimental nano-hydroxyapatite pastes using a scanning electron microscope with energy dispersive X-ray analysis: an in-vitro trial. European Archive of Paediatric Dentistry, 20(6), 529- 536.
17. Saudi, Raneem and Ibrahim, Mohamed A (2020). Comparison Between Nano-Hydroxyapatite And CPP-ACPF In Remineralizing Early Carious Lesions (In Vitro Study)," BAU Journal - Creative Sustainable Development,2 (1), 7.
18. Hemalatha P, Padmanabhan P, Muthalagu M, Hameed MS, Rajkumar DI, Saranya M (2020).
Comparative evaluation of qualitative and quantitative remineralisation potential of four different remineralising agents in enamel using energy. Dispersive X-ray: An in vitro study. Journal of Conservative Dentistry, 23, 604-608.
