Proteolytic Enzymes in Dentin Erosion: Roles of Matrix Metalloproteinases and Cathepsins and the Effectiveness of Synthetic and Natural Inhibitors—A Systematic Review
Description
This systematic review synthesizes and critically appraises the current evidence on the role of proteolytic enzymes in dentin erosion, with a specific focus on matrix metalloproteinases (MMPs) and cathepsins, and evaluates the effectiveness of synthetic and natural inhibitors in modulating their activity. Dentin erosion is a multifactorial process in which acid-mediated demineralization is exacerbated by endogenous enzymatic degradation of the exposed organic matrix, compromising structural integrity and accelerating tissue loss. Evidence indicates that MMPs and cysteine cathepsins act synergistically under erosive conditions, amplifying collagen breakdown and hindering remineralization. Following PRISMA guidelines, electronic searches were conducted across major databases to identify in vitro, ex vivo, and clinical studies assessing proteolytic activity in eroded dentin and the impact of inhibitory strategies. The review summarizes the mechanisms of enzyme activation, spatial distribution, and interaction, and compares the efficacy of commonly investigated inhibitors, including chlorhexidine, metal ions, polyphenols, and other naturally derived compounds. Overall, the findings highlight that targeted inhibition of proteolytic enzymes—particularly combined or dual-inhibition approaches—represents a promising adjunctive strategy for controlling dentin erosion. The review also identifies methodological limitations and research gaps, providing directions for future translational and clinical studies.