Antimicrobial and Antibiofilm Properties of Hydroxyapatite/Nano-Hydroxyapatite in Preventing Dental Caries: A Systematic Review

Controlling biofilm is a crucial strategy and an essential component of preventing dental caries. Considerable research has been conducted in recent years on the clinical application of hydroxyapatite (HAp) and hydroxyapatite nanoparticles (nHAp) in preventing dental caries. However, these studies have yet to investigate the effective- ness or mechanism of these substances as antibacterial and antibiofilm agents. This study aimed to provide a thorough analysis of the current evidence on the antibacterial and antibiofilm characteristics of HAp/nHAp in the prevention of dental caries. Searches were conducted across five databases: Cochrane Library, PubMed, Scopus, EBSCOhost, and ScienceDirect. Google Scholar was also searched. Titles, abstracts, and full text were evaluated following the guidelines set by the Preferred Reporting Item for Systematic Review and Meta-Analyses (PRISMA). A methodological quality assessment of the studies was conducted using the QUIN tool. The initial retrieval totaled 15,047 studies, from which 3,487 were excluded. A total of 11,560 studies were screened based on the title and abstract, resulting in 24 full-text studies considered potentially eligible for inclusion (κ = 0.9599). Finally, 19 studies met all the defined inclusion criteria and were included in this comprehensive systematic review (κ = 0.8837). HAp/nHAp demonstrates antimicrobial activities against gram-negative and gram- positive bacteria and fungi. However, nHAp’s antibiofilm efficacy remains limited. Further investigation is required to improve the efficacy of antibacterial and antibiofilm agents.