La remineralización del esmalte bajo el entendimiento actual de la caries dental / Enamel Remineralization under the Current Caries Understanding
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El entendimiento actual de la caries dental y el surgimiento de nuevos sistemas para su diagnóstico y manejo integral han obligado a los profesionales a reconocer lesiones iniciales o subclínicas y a realizar tratamientos no operatorios que detengan la pérdida o induzcan la ganancia de minerales. En respuesta a esta necesidad, se han propuesto agentes remineralizantes como alternativa de tratamiento. Además de la saliva —el agente natural por excelencia— y el fluoruro, que cuentan con evidencia suficiente, se han reportado agentes novedosos como aquellos a base de fosfopéptidos de caseína-fosfato de calcio amorfo (CPP-ACP, Recaldent®), los compuestos de minerales sintéticos (Novamin®) y otros de aparición más reciente, que requieren mayor evidencia para ser recomendados en la práctica clínica. Esta revisión hace un recorrido por aspectos básicos del esmalte, los procesos de desmineralización/remineralización y la aplicabilidad y evidencia científica de los nuevos agentes remineralizantes, y menciona de manera general el mecanismo de remineralización por fluoruro.
The current understanding of dental caries and the development of new integral diagnostic and management systems of caries force the professional to recognize initial or subclinical lesions of caries, in order to perform non-operative treatments that arrest caries progression and favor mineral regaining. As an alternative treatment option for the less severe lesions, remineralizing agents have been proposed. Apart from saliva —the natural remineralizing agent— and fluoride, both with sufficient evidence of their remineralizing potential, other novel remineralizing agents have been developed. Some of them include those based on casein phosphopeptides plus amorphous calcium phosphate (CPP-ACP, Recaldent®) and synthetic mineral compounds (Novamin®), which appeared recently and still require more evidence to be recommended for the clinical practice. This review aims at walking the reader through some basic aspects of the dental enamel, the processes of enamel demineralization and remineralization, and the applicability and scientific evidence of the new enamel remineralizing agents.
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