ASSESSMENT OF REMINERALIZING POTENTIAL OF BIOACTIVE RESTORATIVE MATERIALS ON DEMINERALIZED DENTIN: A SYSTEMATIC REVIEW

Abstract

Background: Demineralization of dentin beneath restorations remains a major clinical challenge, compromising structural integrity, adhesion, and long-term restoration success. Bioactive restorative materials—such as calcium-silicate cements, bioactive glass composites, giomers, and ion-releasing resin-based systems—have emerged as promising alternatives due to their ability to release therapeutic ions and promote remineralization. Understanding the comparative remineralizing potential of these materials is essential for informed material selection in restorative dentistry.

Methods: A systematic review was conducted following PRISMA 2020 guidelines to evaluate the remineralizing performance of bioactive restorative materials on artificially demineralized dentin. Electronic searches of PubMed, Scopus, Web of Science, Cochrane Library, and Google Scholar (2000–2025) were performed. Inclusion criteria focused on laboratory studies that assessed remineralization through microhardness testing, Ca/P ratio analysis (EDX/EDS), Raman spectroscopy, FTIR, and SEM/FE-SEM evaluation of mineral deposition, tubule occlusion, or interface bridging. A total of 12 in-vitro studies met the eligibility criteria. Due to methodological heterogeneity, a qualitative synthesis was undertaken.

Results: Across the included studies, bioactive and ion-releasing materials consistently demonstrated measurable remineralization of demineralized dentin. ACTIVA BioACTIVE showed the highest microhardness recovery, with reported increases of up to ~82%, and significantly improved Ca/P ratios. Calcium-silicate–based materials such as Biodentine exhibited superior structural remineralization, characterized by progressive mineral deposition and distinct interface bridging, surpassing conventional GICs and most resin-based systems. Bioactive glass–containing materials produced rapid tubule occlusion and surface apatite formation, while NACP-modified composites achieved elevated Ca/P ratios and enhanced mineral deposition. Raman spectroscopy findings supported strong phosphate peak recovery, particularly in ion-releasing resin-based materials. Overall, the depth and quality of remineralization varied by material chemistry, with hydraulic calcium-silicate cements demonstrating the most cohesive integration.

Conclusion: Bioactive restorative materials significantly enhance remineralization of demineralized dentin, with improvements demonstrated across mechanical, chemical, and structural metrics. Calcium-silicate cements provide the most robust and integrated mineral recovery, while resin-based bioactive systems such as ACTIVA offer substantial surface-level remineralization. Bioactive glass and NACP-enhanced composites further contribute to tubule occlusion and mineral deposition. Despite promising outcomes, most available data derive from in-vitro studies, underscoring the need for standardized protocols and long-term in-vivo investigations to confirm clinical effectiveness.