The effect of bioactive glasses on enamel remineralization: A systematic review

Introduction/Objectives: To evaluate the effectiveness of bioactive glasses in promoting enamel remineralization. Data: An electronic search with a complementary gray literature search for in vivo and in vitro research. No language restrictions were applied. Sources: MEDLINE and EMBASE via OVID, the Cochrane Oral Health Group's Trials Register, CENTRAL and LILACS Study selection: One hundred and sixteen studies were identified, of which, eleven met the inclusion criteria and formed the basis of this systematic review. Methodological quality was assessed independently by two reviewers. Factors investigated in the selected articles included the objective and subjective measures of enamel remineralisation; harms, including evidence of damage to the enamel surface; patient satisfaction; and in vitro evidence of enamel remineralisation, using recognized laboratory techniques. Results: A total of 11 laboratory-based studies were included in this review. The methodological quality was deemed to be high in four, and medium in the remaining studies. Based on the in vitro studies, enamel remineralization improved with bioactive glasses, irrespective of the method of application. Ex vivo signs of remineralization such as increase in enamel hardness, the formation of an enamel-protective layer and reduced intensity of light backscattering were less evident with alternatives including fluoride, and casein phosphopeptide-amorphous calcium phosphate (CPP-ACP). Conclusions: Based on in vitro findings only, bioactive glasses may be capable of enhancing enamel remineralization in various formulations, compared with other topical remineralizing materials including fluoride, and CPP-ACP. However, clinical research to confirm their effectiveness is now overdue.