Cavalcante Bianca Golzio Navarro, Mlinkó Éva, Szabó Bence, Teutsch Brigitta, Hegyi Péter, Vág János, Németh Orsolya, Gerber Gábor, Varga Gábor
Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary.
Department of Oral Biology, Semmelweis University, 1089 Budapest, Hungary.
J Clin Med. 2024 Nov 26;13(23):7154. doi: 10.3390/jcm13237154.
Molar-incisor hypomineralization (MIH) is an enamel defect affecting molars and incisors, often leading to hypersensitivity, enamel breakdown, and increased caries risk. Non-invasive treatments, such as casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) and fluoride varnish, show potential in remineralizing affected enamel and reducing sensitivity, but their efficacy is still debated. This study systematically reviews and analyzes the effectiveness of CPP-ACP and other non-invasive agents in improving remineralization and reducing hypersensitivity in MIH-affected teeth. A systematic search was conducted on PubMed, Embase, and Central in July 2024, including interventional and observational studies on remineralization and hypersensitivity in pediatric MIH patients (<18 years). A total of 1566 studies were found, with 15 included in the meta-analysis. A random-effects model was applied, including subgroup analysis by lesion severity. CPP-ACP showed no statistically significant advantage over fluoride in remineralization (MD -3.80, 95% CI: -8.57; 0.98), but it significantly reduced hypersensitivity compared to fluoride varnish (MD -2.36, 95% CI: -3.83; -0.89). Although this reduction in hypersensitivity may be clinically relevant, the high heterogeneity (I² = 83%) and wide confidence intervals limit the reliability of these findings. CPP-ACP has a moderate effect in reducing hypersensitivity but does not outperform fluoride in remineralization. Other agents, such as calcium glycerophosphate and silver diamine fluoride, showed mild benefits. The current evidence base is limited and heterogeneous, highlighting the need for high-quality, long-term studies to confirm these findings and guide MIH management.
磨牙-切牙矿化不全（MIH）是一种影响磨牙和切牙的釉质缺陷，常导致牙齿敏感、釉质破损以及龋齿风险增加。非侵入性治疗方法，如酪蛋白磷酸肽-无定形磷酸钙（CPP-ACP）和氟化物 varnish，在使受影响的釉质再矿化和降低牙齿敏感方面显示出潜力，但其疗效仍存在争议。本研究系统回顾并分析了 CPP-ACP 和其他非侵入性药物在改善 MIH 患牙再矿化和降低牙齿敏感方面的有效性。2024 年 7 月在 PubMed、Embase 和 Central 上进行了系统检索，纳入了关于儿科 MIH 患者（<18 岁）再矿化和牙齿敏感的干预性和观察性研究。共检索到 1566 项研究，其中 15 项纳入荟萃分析。应用随机效应模型，包括按病变严重程度进行亚组分析。CPP-ACP 在再矿化方面与氟化物相比无统计学显著优势（MD -3.80，95%CI：-8.57；0.98），但与氟化物 varnish 相比，它能显著降低牙齿敏感（MD -2.36，95%CI：-3.83；-0.89）。尽管这种牙齿敏感的降低在临床上可能具有相关性，但高异质性（I² = 83%）和较宽的置信区间限制了这些结果的可靠性。CPP-ACP 在降低牙齿敏感方面有中等效果，但在再矿化方面并不优于氟化物。其他药物，如甘油磷酸钙和氟化银氨溶液，显示出轻微益处。目前的证据基础有限且存在异质性，凸显了需要高质量的长期研究来证实这些结果并指导 MIH 的管理。
