The limitations of traditional composite materials have highlighted the need for new classes of biologically active restorative materials. Among these are alkasites, which belong to the group of pH-responsive materials. The aim of this review is to summarize the body of evidence regarding alkasite performance, based on nearly a decade of use, since their introduction into practice. This review article includes in vitro and in vivo studies that explore the properties and performance of alkasites. Two reviewers conducted a search of literature published up to March 2025 in databases including PubMed, Web of Science and Scopus. The articles summarized and critically analyzed are primarily from journals with Q1 and Q2 quartiles. Various studies demonstrated that alkasites exhibit comparable or even superior physical and mechanical properties to the most commonly used restorative materials in dentistry. The materials' ability to withstand masticatory forces, combined with its favorable esthetic properties and bulk-fill method of application, make them a suitable option for restoring I, II and V class cavities in primary and permanent teeth. A significant advantage of the alkasites is that they can release hydroxide, calcium, and fluoride ions which may contribute to enamel and dentin remineralization. The release of hydroxyl ions might increase the pH in the surrounding environment, thus neutralizing the acidic medium created by cariogenic bacteria. This process helps inhibit demineralization and creates favorable conditions for remineralization. The application of alkasites, particularly in caries-active patients, provides another alternative for restorative treatment of carious lesions. Analyzing their properties raises once again the question of improving the biological activity of restorative materials and the development of smart materials to meet the needs of conservative dental approach.

Dental caries remains one of the most prevalent bacterium-caused chronic diseases affecting both adults and children worldwide. The development of new materials for enhancing its remineralization is one of the most promising approaches in the field of advanced dental materials as well as one of the main challenges in non-invasive dentistry. The aim of the present study is to develop novel hybrid materials based on (PDMAEMA)/Carbomer 940 microgels with in situ deposited calcium phosphates (CaP) and to reveal their potential as a remineralization system for artificial caries lesions. To this purpose, novel PDMAEMA/Carbomer 940 microgels were obtained and their core–shell structure was revealed by transmission electron microscopy (TEM). They were successfully used as a matrix for in situ calcium phosphate deposition, thus giving rise to novel hybrid microgels. The calcium phosphate phases formed during the deposition process were studied by X-ray diffraction and infrared spectroscopy, however, due to their highly amorphous nature, the nuclear magnetic resonance (NMR) was the method that was able to provide reliable information about the formed inorganic phases. The novel hybrid microgels were used for remineralization of artificial caries lesions in order to prove their ability to initiate their remineralization. The remineralization process was followed by scanning electron microscopy (SEM), X-ray diffraction, infrared and Raman spectroscopies and all these methods confirmed the successful enamel rod remineralization upon the novel hybrid microgel application. Thus, the study confirmed that novel hybrid microgels, which could ensure a constant supply of calcium and phosphate ions, are a viable solution for early caries treatment.

Biomacromolecules control mineral formation during the biomineralization process, but the effects of the organic components’ functionality on the type of mineral phase is still unclear. The biomimetic precipitation of calcium phosphates in a physiological medium containing either polycarboxybetaine (PCB) or polysulfobetaine (PSB) was investigated in this study. Amorphous calcium phosphate (ACP) or a mixture of octacalcium phosphate (OCP) and dicalcium phosphate dihydrate (DCPD) in different ratios were identified depending on the sequence of initial solution mixing and on the type of the negative functional group of the polymer used. The more acidic character of the sulfo group in PSB than the carboxy one in PCB determines the dominance of the acidic solid phases, namely, an acidic amorphous phase or DCPD. In the presence of PCB, the formation of ACP with acicular particles arranged in bundles with the same orientation was observed. A preliminary study on the remineralization potential of the hybrid material with the participation of PSB and a mixture of OCP and DCPD did not show an increase in enamel density, contrary to the materials based on PCB and ACP. Moreover, the latter showed the creation of a newly formed crystal layer similar to that of the underlying enamel. This defines PCB/ACP as a promising material for enamel remineralization.

Biomimetic mineralization is a methodology that imitates the natural process of mineralization. The biomimetic synthesis of enamel-like apatite structures under a physiological condition is an attractive, bioavailable alternative of repairing defective enamel. During the last several years different biomimetic systems for enamel remineralization were developed. They are based on amelogenin, other peptides, dendrimers, amino acids, calcium phosphate nanoparticles and others. Despite all the promising studies, described in this systematic review, the biomimetic strategies still face ongoing challenges in the fields of dentistry and material sciences.