BIOACTIVE MATERIALS IN THE REMINERALIZATION OF CARIES LESIONS: MECHANISMS OF ACTION, CURRENT EVIDENCE, AND CLINICAL APPLICATIONS

Abstract

Introduction: Dental caries remains a highly prevalent chronic condition characterized by a dynamic imbalance in the demineralization-remineralization process of hard dental tissues. With the advent of Minimally Invasive Dentistry, bioactive materials have gained prominence due to their active interaction with the oral environment, releasing therapeutic ions capable of arresting and reversing non-cavitated lesions. Objective: To analyze, through an integrative review of recent literature (2021–2025), the efficacy and role of bioactive materials in the remineralization of caries lesions, highlighting their mechanisms of action, clinical advantages, and limitations. Methodology: An integrative literature review was conducted across PubMed/MEDLINE, ScienceDirect, and Google Scholar databases using descriptor combinations via Boolean operators. In vitro studies, clinical trials, and reviews (systematic and narrative) published between 2021 and 2025 in Portuguese and English addressing bioactivity in caries management were included. Results and Discussion: Ten representative articles were selected. Findings indicate that nanohydroxyapatite and bioactive glasses promote rapid surface microhardness recovery through apatite precipitation, while CPP-ACP acts synergistically with fluorides by maintaining bioavailable ions. Self-assembling peptides (P₁₁-4) stand out for 3D biomimetic regeneration within the deep body of the lesion. In restorative materials, bioactive incorporation provides antimicrobial activity against Streptococcus mutans and prevents secondary caries, although long-term ion release sustainability (rechargeability) still requires further stability in resin composites. Conclusion: Bioactive materials are effective in reversing and arresting caries lesions, offering a conservative and biologically active approach. Technology selection should consider lesion depth and site to optimize clinical outcomes.