The role of hydroxyapatite-based, fluoride-free toothpastes on the prevention and the remineralization of initial caries lesions: A systematic review and meta-analysis.

OBJECTIVES: Tauhe aim of the present systematic review and meta-analysis was to critically appraise all evidence available on the effectiveness of biomimetic hydroxyapatite (HAP) toothpastes in promoting remineralization and inhibiting demineralization. DATA: A literature search was conducted in electronic databases to identify in situ randomized controlled trials in children, adolescents, and young adults aged <25 years evaluating the effectiveness of fluoride-free HAP compared to conventional fluoride toothpastes. SOURCES: Medline (via Pubmed), Embase, Scopus, Cochrane Central Register of Controlled Trials, Dentistry & Oral Sciences Source, LILACS database were searched. Additional search of the grey literature, abstracts of conferences and meetings as well as manual search of the reference lists of retrieved studies, was also performed. STUDY SELECTION: The search retrieved 68 studies of which 4 were considered eligible. CONCLUSIONS: Development of new and progression of existing lesions, recorded using DMFS/ICDAS indices, showed no significant differences between HAP and fluoride toothpastes. Significant differences were recorded in lesion size (p < 0.0001) and fluorescence value (p = 0.01) after 6 months. Meta-analysis showed non-significant Risk Ratio (0.98, p = 0.61; 95 % CIs 0.85, 1.12) and Odds Ratio (0.90, p = 0.68; 95 % CIs 0.57, 1.42) for HAP and fluoride toothpastes. CLINICAL SIGNIFICANCE: HAP toothpaste could be an effective alternative to fluoride-containing toothpaste in preventing caries progression and promoting enamel remineralization. The comparable performance of HAP to fluoride, coupled with its superior biocompatibility and lack of toxicity, positions it as a promising option for individuals seeking fluoride-free oral care solutions.