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태아, 임신부, 6세이하의 어린이, 신장질환환자, 치아불소증 고위험군 환자 등..

Caries Res 2019;53:284–295

 

State of the Art Enamel Remineralization

Systems: The Next Frontier in Caries

Management

Nebu Philip

School of Dentistry, University of Queensland, Brisbane, QLD, Australia

Keywords

Enamel caries · Remineralization · Non-fluoride

remineralization · Fluoride booster

Abstract

The principles of minimally invasive dentistry clearly dictate the need for clinically effective measures to remineralize early enamel caries lesions. While fluoride-mediated remineralization is the cornerstone of current caries management philosophies, a number of new remineralization strategies have been commercialized or are under development that claim to promote deeper remineralization of lesions, reduce the potential risks associated with high-fluoride oral care products, and facilitate caries control over a lifetime. These non-fluoride remineralizing systems can be broadly categorized into biomimetic enamel regenerative technologies and the approaches that repair caries lesions by enhancing fluoride efficacy. This paper discusses the rationale for nonfluoride remineralization and the mechanism of action, challenges, and evidence behind some of the most promising advances in enamel remineralization therapies. Dental caries pathophysiology is not simply a continual cumulative loss of tooth minerals, but rather a dynamic process characterized by alternating periods of demineralization and remineralization. Lesion progression or reversal depends on the equilibrium between demineralization-favouring pathological factors (cariogenic bacteria, fermentable carbohydrates, salivary dysfunction) and the protective factors (antibacterial agents, sufficient saliva, remineralizing ions) that tip the balance towards remineralization [Featherstone and Chaffee, 2018]. Remineralization can occur as a natural repair process where plaque/salivary calcium (Ca2+) and phosphate (PO4 3–) ions are deposited into crystal voids of the demineralized tooth structure, resulting in net mineral gain. The presence of free fluoride (F–) ions in the oral environment can drive the incorporation of Ca2+ and PO4 3– ions into the crystal lattice, with the ensuing fluorapatite mineral significantly more resistant to a subsequent acid challenge [ten Cate, 1999]. A better understanding of regenerative and physiochemical mechanisms has influenced the development of a number of innovative remineralization technologies that go beyond fluoride-mediated remineralization. While traditional fluoride-based remineralization re-mains the cornerstone for caries management with the highest level of supporting evidence, additional remineralizing agents to enhance fluoride effects are often needed in high caries risk individuals and population groups [Amaechi and van Loveren, 2013; Fontana, 2016]. The

first International Conference on Novel Anticaries and Remineralizing Agents had suggested that the broad aim of new remineralization therapies should be to “facilitate caries control over a lifetime using evidence-based, clinically effective, multifactorial prevention to keep the caries process in balance” [Pitts and Wefel, 2009]. This paper

discusses the rationale for using non-fluoride remineralization systems and the mechanisms, challenges, and evidence underpinning some of the technological advances in enamel remineralization therapies.