A Critical Review of Modern Approaches to Enamel Remineralization: Efficacy and Clinical Integration

Abstract

Enamel demineralization is a global health challenge, requiring advanced remineralization strategies beyond traditional fluoride, whose efficacy and clinical integration require critical evaluation. The aim of this study is to critically review and synthesize modern enamel remineralization approaches. This PRISMA-guided review synthesized 12 English studies (2020-2023) from PubMed, Scopus, and Web of Science. Modern strategies integrate biomimetic regeneration and material science. Chitosan-amelogenin composites reduce caries depth, and specific chitosan systems restored enamel hardness to 3.8 ± 0.3 GPa. Nano-hydroxyapatite excels for white spot lesions, and 38% Silver Diamine Fluoride is prioritized for arresting coronal lesions. These approaches offer promising advancements, but require more evidence for full fluoride substitution.