<![CDATA[Introduction: White spot lesion (WSL) represents the earliest sign of enamel demineralization, with a prevalence up to 68.4% among patients after fixed orthodontic treatment. WSL may progress into caries or cause aesthetic concerns. Fluoride remains the gold standard for remineralization in WSL, but recently nanohydroxyapatite (n-HA) has emerged as a biomimetic alternative, claimed to occlude enamel micropores and release Ca²⁺/PO₄³⁻ ions for remineralization. This review aims to evaluate clinical evidence regarding the effectiveness of n-HA compared to fluoride in remineralizing WSL in post-orthodontic patients. Review: This review analyzed evidence from randomized controlled trials, in vivo, and in-vitro studies comparing n-HA with fluoride in managing post-orthodontic WSL. The review was conducted following the PRISMA flow method, with 345 articles initially identified from PubMed, Scopus, and Google Scholar. Following duplicate removal, screening, and eligibility assessment, 7 articles were included, comprising 3 randomized controlled trials (RCTs) and 4 in vivo/in-vitro studies. Findings suggest that n-HA has remineralization potential comparable and in some trials superior to, certain fluoride formulations with additional advantages in improving enamel gloss and decrease sensitivity. Several studies reported significant lesion regression with the use of n-HA toothpaste or mouthrinse. However, most studies were limited by small sample sizes, methodological heterogeneity, and short follow-up durations. Conclusion: Cumulative findings indicate that n-HA demonstrates promising remineralization effects and, in some small-scale clinical trials, performs comparably or even better than certain fluoride formulations. Given the current limitations of the evidence, well-designed, long-term multicenter studies are still needed to establish the effectiveness, safety, and cost-effectiveness of n-HA for post-orthodontic WSL management.]]>
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