Early carious lesions, such as white spot lesions (WSL), and enamel erosion are forms of enamel demineralization that may progress into more severe caries if left untreated. Remineralization is one of the key strategies for preventing and managing these early lesions. One material widely studied for this purpose is Bioactive Glass 45S5 (BAG 45S5), which is believed to have bioactive properties that support the regeneration of enamel mineral structure.
Bioactive Glass 45S5: Characteristics and Mechanism
Bioactive Glass 45S5 is a material that, when in contact with physiological fluids such as saliva, can form a mineral layer resembling hydroxyapatite, specifically hydroxycarbonated apatite (HCA). This layer adheres to the enamel surface, serving as a protective foundation that supports further remineralization.
Literature Findings: Remineralization Effects of BAG 45S5
A literature review conducted by FKG UGM student Michael Abhiseka W., under the supervision of Dr. drg. Raphael Tri Endra Untara, M.Kes., Sp.KG(K) and Dr. drg. Yulita Kristanti, M.Kes., Sp.KG(K), presents several key findings:
- Increased microhardness of enamel treated with BAG 45S5.
- Higher levels of calcium and phosphate observed in treated enamel.
- Microscopic analysis shows the formation of a surface layer identified as hydroxycarbonated apatite (HCA), which binds strongly to the enamel and supports the remineralization process.
These findings highlight that enamel undergoing demineralization—whether from early carious lesions or erosion—can benefit from remineralization therapies that restore mineral integrity. BAG 45S5 interacts with bodily fluids to form a mineral-rich HCA layer, strengthening enamel and promoting recovery of mineral content.
Discussion
- The increase in enamel microhardness indicates that remineralization occurs both chemically and structurally.
- Elevated calcium and phosphate concentrations confirm the formation of a mineral layer consistent with natural enamel composition.
- The HCA layer provides protection against further demineralization, whether from acid erosion or bacterial activity.
- BAG 45S5 can be incorporated into toothpaste, varnishes, gels, or other dental care products for treating white spot lesions, acid erosion, and preventive care.
Clinical Considerations
- Application frequency and duration should be optimized to achieve maximal remineralization benefits.
- Product formulation (paste, varnish, gel, sealant) may influence material adhesion and enamel penetration.
- Patient factors, including salivary flow, oral hygiene, diet, and lesion severity, affect treatment outcomes.
- Accessibility and cost remain considerations for broader clinical use.
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Based on the narrative review conducted at UGM, Bioactive Glass 45S5 has been shown to effectively remineralize white spot lesions and enamel erosion by increasing enamel microhardness, enhancing calcium and phosphate ion levels, and forming a stable HCA layer on the enamel surface. Its use represents a promising minimally invasive and preventive approach in early caries management.
References
Michael Abhiseka W, Dr. drg. Raphael Tri Endra Untara, M.Kes., Sp.KG(K), Dr. drg. Yulita Kristanti, M.Kes., Sp.KG(K), Effect of Bioactive Glass 45S5 on the Remineralization of White Spot Lesions and Enamel Erosion (Narrative Review), https://etd.repository.ugm.ac.id/penelitian/detail/211887
Author: Rizky B. Hendrawan | Photo: Freepik
