Efficacy Of Nano Hydroxyapatite Derived From Marine Sources On Remineralization Of Enamel: A Systematic Review

Background and Aim: Nano Hydroxyapatite (nHA) is a biocompatible material similar to natural bone and is used in dentistry to prevent and remineralize dental caries, etc. Marine sources like seashells, mollusk shells, crab shells, shrimp shells, fish bones, etc can create Nano-hydroxyapatite (nHA), a biomimetic material potentially useful for remineralization. This study aimed to systematically review the literature on the efficacy of marine-derived nHA in enamel remineralization compared to other remineralizing agents (e.g., fluoride, CPP-ACP, amorphous calcium phosphate)Materials and Methods: This systematic review followed PRISMA guidelines, searching electronic databases from 1990 to July 2024 (Medline, Scopus, Cochrane). Only in vitro studies with Nano-hydroxyapatite from marine sources compared to other remineralizing agents were included. Two reviewers (VM, TGJ) screened articles, extracted data, and assessed study quality using the Quality Assessment Tool For In Vitro Studies (QUIN tool).Results: Out of 43 identified articles, eight in vitro studies published between 2019 and 2023 were included, evaluating nHA from blood cockle shells, fish bone/scale, and oyster shells. Most of the included articles compared with commercially available CPP-ACP remineralizing agents. The QUIN tool revealed a medium risk of bias in seven studies and a low risk of bias in one. Conclusion: While marine-derived nHA has shown promising results in remineralizing enamel lesions, the current evidence is limited by methodological shortcomings. Further well-designed research is needed to draw more definitive conclusions.