Department of Restorative Dental Science, College of Dentistry, University of Ha'il, Ha'il, Kingdom of Saudi Arabia; Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.
Cariology in Relation to Minimally Invasive Dentistry/Oral Bioengineering, Institute of Dentistry, Queen Mary University of London, Barts and the Royal London Dental Hospital, Turner Street, London, E1 2AD, UK.
J Dent. 2024 Dec;151:105402. doi: 10.1016/j.jdent.2024.105402. Epub 2024 Oct 10.
To assess the effect of nano-hydroxyapatite (nano-HAP) either with or without fluoride on white spot lesions (WSLs) in terms of remineralisation and colour change.
An electronic search was carried out in MEDLINE via PubMed, Scopus, Web of Science, LILACS, Embase, Cochrane Library, Google Scholar, Grey literature, and hand search. There were no limitations in terms of language and date (till August 2024) and all studies meeting the inclusion criteria were included. The outcome variables were enamel surface microhardness, enamel remineralisation rate, mineral content, and colour change. Different risk of bias tools were employed according to the study design. The level of evidence was graded using the GRADE profiler.
A total of 14 out of 422 studies met the inclusion criteria. Three out of 14 studies were in vivo, one was in situ, while ten of them were in vitro. All 14 studies investigated the nano-HAP effects on WSLs. Following the full-text reviews and statistical analysis, 12 out of 14 studies were only included in the meta-analysis, since the remaining two studies lacked comparable data (mean±SD).
Different forms of delivery for nano-HAP were reported in the included studies. Pure nano-HAP showed promising effects on enamel surface microhardness (MD = 9.29, 95 % CI [7.74, 10.84], p < 0.00001), and mineral gain (MD = 0.09, 95 % CI [0.05, 0.13], P < 0.0001) when compared to fluoride alone. In addition, nano-HAP and fluoride demonstrated similar remineralisation abilities based on the DIAGNOdent™ readings (MD=0.09, 95 % CI [0.05, 0.13], p < 0.0001) There were no colour improvements within the WSLs following the application of nano-HAP (MD = -2.76, 95 % CI [-6.79, 1.27], p = 0.18).
The intervention containing pure nano-HAP showed a promising remineralisation effect on WSLs in comparison to fluoride alone. However, there were no colour changes within WSLs following the use of nano-HAP. Limited number of clinical studies, high risk of bias, quality of the available studies, and relatively short follow-up periods failed to result in concrete evidence.
The intervention containing pure nano-HAP showed a promising remineralisation effect in comparison to fluoride alone. Therefore, it might be an effective alternative to fluoride-containing agents.
评估纳米羟基磷灰石（nano-HAP）单独或与氟化物联合用于治疗白斑（WSLs）时在再矿化和颜色变化方面的效果。
通过 MEDLINE 下的 PubMed、Scopus、Web of Science、LILACS、Embase、Cochrane 图书馆、Google Scholar、灰色文献和手工搜索进行电子检索。语言和日期（截至 2024 年 8 月）均无限制，所有符合纳入标准的研究均被纳入。结局变量为釉质表面显微硬度、釉质再矿化率、矿物质含量和颜色变化。根据研究设计使用了不同的偏倚风险工具。使用 GRADE 分析员评估证据水平。
在 422 项研究中，共有 14 项符合纳入标准。14 项研究中有 3 项为体内研究，1 项为原位研究，10 项为体外研究。所有 14 项研究均探讨了纳米 HAP 对 WSLs 的影响。经过全文审查和统计分析，由于另外两项研究缺乏可比数据（均值±标准差），只有 12 项研究被纳入荟萃分析。
纳入研究报告了纳米 HAP 的不同传递形式。与单独使用氟化物相比，纯纳米 HAP 对釉质表面显微硬度（MD=9.29，95%CI[7.74，10.84]，p<0.00001）和矿物质获得（MD=0.09，95%CI[0.05，0.13]，P<0.0001）均显示出有前景的效果。此外，基于 DIAGNOdent™读数，纳米 HAP 和氟化物表现出相似的再矿化能力（MD=0.09，95%CI[0.05，0.13]，p<0.0001）。在应用纳米 HAP 后，WSLs 内没有颜色改善（MD=-2.76，95%CI[-6.79，1.27]，p=0.18）。
与单独使用氟化物相比，含有纯纳米 HAP 的干预措施对 WSLs 具有有前景的再矿化效果。然而，在使用纳米 HAP 后，WSLs 内没有颜色变化。临床研究数量有限、偏倚风险高、现有研究质量以及相对较短的随访时间都未能得出确凿的证据。
与单独使用氟化物相比，含有纯纳米 HAP 的干预措施显示出有前景的再矿化效果。因此，它可能是一种有效的含氟制剂替代物。
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