Evaluation methods of artificial demineralization protocols for coronal dentin: a systematic review of laboratory studies
Alaa Esmat Abdel Salam, Hoda Saleh Ismail, Hamdi H. Hamama
Abstract
BACKGROUND: Despite the widespread use of various laboratory models such as chemical, bacterial, or combination as demineralization protocols to induce artificial caries in dentin, there is lack in the literature regarding a comparison of their effectiveness and assessment of dentin mineral density through using several analytical techniques, including microscopic and spectroscopic ones. The purpose of this review was to determine the appropriate demineralization protocols for inducing artificial caries utilizing coronal dentin. Furthermore, this evidence-based study was conducted to identify the most reliable evaluation methods in assessing the efficiency of the reviewed protocols. MATERIALS AND METHODS: An electronic search was conducted on three databases: MEDLINE/PubMed, Scopus, and ScienceDirect, following PRISMA guidelines. Only the studies published between 2019 and 2024 were considered. All studies were assessed based on predefined eligibility criteria. English laboratory studies that employed chemical models for induction of artificial caries on human mid-coronal dentin were included. The selected studies were individually reviewed for potential bias according to predetermined criteria. RESULTS: A total of 23 studies met the inclusion and exclusion criteria of this systematic review. From the included studies, 11 studies utilized pH-cycling model, 10 studies reported using simple demineralization model, while only one study reported an undetailed protocol. Moreover, combined 'chemical and biological' protocol for dentin demineralization was reported in two studies. According to the outcome of included studies, dentin mineral density, depth of lesions, crystalline structure, surface morphology, and surface microhardness were evaluated using a variety of laboratory methods offering, either qualitative, quantitative, or semi-quantitative analysis. The conclusions of the studies revealed confirmatory results regarding the use of multiple devices. CONCLUSIONS: The pH-cycling model was found to be the most common type of chemical model used to induce dentin demineralization for 14 days immersion time, followed by a simple demineralization model through using an acetic acid solution. There was no single evaluation approach found to provide comprehensive information about the mineral content independently. Therefore, a combination of multiple techniques is recommended to yield sufficient and more accurate data.