The role of collagen cross-linker in dentin mineralization: a scoping review

OBJECTIVES: Dentin remineralization is a complex process that involves the crystallization of exposed collagen to restore the mechanical properties of demineralized dentin. It plays an essential role in managing dental caries and erosive tooth wear. Collagen cross-linkers have emerged as a promising strategy to enhance the stability of exposed collagen while facilitating mineral deposition. This scoping review evaluated the role of collagen cross-linkers in dentin remineralization. DATA: This scoping review was conducted following the PRISMA-ScR guidelines. SOURCES: The databases Medline, Scopus, and Web of Science were used. STUDY SELECTION: The databases were systematically searched up to December 2024 to identify publications that pre-treated dentin collagen with cross-linkers and assessed subsequent mineralization. Of the initially 251 identified publications, 16 publications were included in this review. The identified cross-linkers compromised glutaraldehyde, polyphenols, catechols, riboflavin, and genipin. These cross-linkers improved the mechanical properties of dentin collagen, increased its resistance to enzymatic degradation, and thus provided a stable scaffold for remineralization. Additionally, they enhanced the wettability of demineralized dentin and introduced functional groups that attracted calcium ions, serving as nucleation sites and reducing the interfacial energy required for mineralization. However, these findings are based on laboratory studies, and clinical studies are essential to verify the effects of collagen cross-linkers in dentin remineralization. CONCLUSIONS: Collagen cross-linkers support dentin remineralization both passively, by preserving exposed collagen in demineralized dentin, and actively, by enhancing the interaction between the collagen matrix and the remineralization solution. These properties make them promising adjuncts in remineralizing strategies. CLINICAL SIGNIFICANCE: Collagen cross-linkers could enhance remineralization therapies by improving dentin stability and resistance to degradation while also promoting mineral uptake, potentially leading to more effective treatments for dental caries and erosive tooth wear.