Biomechanical perspective on the remineralization of dentin

Nanoscopic dynamic mechanical analysis of resin-infiltrated dentine, under in vitro chewing and bruxism events

The aim of this study was to evaluate the induced changes in mechanical behavior and bonding capability of resin-infiltrated dentine interfaces, after application of mechanical stimuli. Dentine surfaces were subjected to partial demineralization through 37% phosphoric acid etching followed by the application of an etch-and-rinse dentine adhesive, Single Bond (3M/ESPE). Bonded interfaces were stored in simulated body fluid during 24h, and then tested or submitted to the mechanical loading challenge. Different loading waveforms were applied: No cycling (I), 24h cycled in sine (II) or square (III) waves, sustained loading held for 24h (IV) or sustained loading held for 72h (V). Microtensile bond strength (MTBS) was assessed for the different groups. Debonded dentine surfaces were studied by field emission scanning electron microscopy (FESEM). At the resin-dentine interface, both the hybrid layer (HL) and the bottom of the hybrid layer (BHL), and both peritubular and intertubular were evaluated using a nanoindenter in scanning mode. The load and displacement responses were used to perform the nano-Dynamic Mechanical analysis and to estimate the complex and storage modulus. Dye assisted Confocal Microscopy Evaluation was used to assess sealing ability. Load cycling increased the percentage of adhesive failures in all groups. Specimens load cycled in held 24h attained the highest complex and storage moduli at HL and BHL. The storage modulus was maximum in specimens load cycled in held 24h at peritubular dentine, and the lowest values were attained at intertubular dentine. The storage modulus increased in all mechanical tests, at peritubular dentine. An absence of micropermeability and nanoleakage after loading in sine and square waveforms were encountered. Porosity of the resin-dentine interface was observed when specimens were load cycled in held 72h. Areas of combined sealing and permeability were discovered at the interface of specimens load cycled in held 24h. Crack-bridging images appeared in samples load cycled with sine waveform, after FESEM examination.

Biomimetic mineralization of collagen fibrils induced by amine-terminated PAMAM dendrimers--PAMAM dendrimers for remineralization

OBJECTIVE

Achieving biomimetic mineralization of collagen fibrils by mimicking the role of non-collagenous proteins (NCPs) with biomimetic analogs is of great interest in the fields of material science and stomatology. Amine-terminated PAMAM dendrimer (PAMAM-NH2), which possesses a highly ordered architecture and many calcium coordination sites, may be a desirable template for simulating NCPs to induce mineralization of collagen fibrils. In this study, we focused on the ability of PAMAM-NH2 to mineralize collagen fibrils.

DESIGN

Type-I collagen fibrils were reconstituted over 400-mesh formvar-and-carbon-coated gold grids and treated with a third-generation PAMAM-NH2 (G3-PAMAM-NH2) solution. The treated collagen fibrils were immersed in artificial saliva for different lengths of time. The morphologies of the mineralized reconstituted type-I collagen fibrils were characterized by transmission electron microscopy.

RESULTS

No obvious mineralized collagen fibrils were detected in the control group. On the contrary, collagen fibrils were heavily mineralized in the experimental group. Most importantly, intrafibrillar mineralization was achieved within the reconstituted type-I collagen fibrils.

CONCLUSIONS

In this study, we successfully induced biomimetic mineralization within type-I collagen fibrils using G3-PAMAM-NH2. This strategy may serve as a potential therapeutic technique for restoring completely demineralized collagenous mineralized tissues.

Characterization of the elastic and viscoelastic properties of dentin by a nanoindentation creep test

Dentin is the main supporting structure of teeth, but its mechanical properties may be adversely affected by pathological demineralization. The purposes of this study were to develop a quantitative approach to characterize the viscoelastic properties of dentin after de- and re-mineralization, and to examine the elastic properties using a nanoindentation creep test. Dentin specimens were prepared to receive both micro- and nano-indentation tests at wet and dry states. These tests were repeatedly performed after demineralization (1% citric acid for 3 days) and remineralization (artificial saliva immersion for 28 days). The nanoindentation test was executed in a creep mode, and the resulting displacement-time responses were disintegrated into primary (transient) and secondary (viscous) creep. The structural changes and mineral densities of dentin were also examined under SEM and microCT, respectively. The results showed that demineralization removed superficial minerals of dentin to the depth of 400 μm, and affected its micro- and nano-hardness, especially in the hydrate state. Remineralization only repaired the minerals at the surface layer, and partially recovered the nanohardness. Both the primary the secondary creep increased in the demineralized dentin, while the hydration further enhanced creep deformation of untreated and remineralized dentin. Remineralization reduced the primary creep of dentin, but did not effectively increase the viscosity. In conclusion, water plasticization increases the transient and viscous creep strains of demineralized dentin and reduces load sustainability. The nanoindentation creep test is capable of analyzing the elastic and viscoelastic properties of dentin, and reveals crucial information about creep responses.

Methods for biomimetic remineralization of human dentine: a systematic review

This study aimed to review the laboratory methods on biomimetic remineralization of demineralized human dentine. A systematic search of the publications in the PubMed, TRIP, and Web of Science databases was performed. Titles and abstracts of initially identified publications were screened. Clinical trials, reviews, non-English articles, resin-dentine interface studies, hybrid layer studies, hybrid scaffolds studies, and irrelevant studies were excluded. The remaining papers were retrieved with full texts. Manual screening was conducted on the bibliographies of remaining papers to identify relevant articles. A total of 716 studies were found, and 690 were excluded after initial screening. Two articles were identified from the bibliographies of the remaining papers. After retrieving the full text, 23 were included in this systematic review. Sixteen studies used analogues to mimic the functions of non-collagenous proteins in biomineralization of dentine, and four studies used bioactive materials to induce apatite formation on demineralized dentine surface. One study used zinc as a bioactive element, one study used polydopamine, and another study constructed an agarose hydrogel system for biomimetic mineralization of dentine. Many studies reported success in biomimetic mineralization of dentine, including the use of non-collagenous protein analogues, bioactive materials, or elements and agarose hydrogel system.

Matrix metalloproteinases and other matrix proteinases in relation to cariology: the era of 'dentin degradomics'

Dentin organic matrix, with type I collagen as the main component, is exposed after demineralization in dentinal caries, erosion or acidic conditioning during adhesive composite restorative treatment. This exposed matrix is prone to slow hydrolytic degradation by host collagenolytic enzymes, matrix metalloproteinases (MMPs) and cysteine cathepsins. Here we review the recent findings demonstrating that inhibition of salivary or dentin endogenous collagenolytic enzymes may provide preventive means against progression of caries or erosion, just as they have been shown to retain the integrity and improve the longevity of resin composite filling bonding to dentin. This paper also presents the case that the organic matrix in caries-affected dentin may not be preserved as intact as previously considered. In partially demineralized dentin, MMPs and cysteine cathepsins with the ability to cleave off the terminal non-helical ends of collagen molecules (telopeptides) may lead to the gradual loss of intramolecular gap areas. This would seriously compromise the matrix ability for intrafibrillar remineralization, which is considered essential in restoring the dentin's mechanical properties. More detailed data of the enzymes responsible and their detailed function in dentin-destructive conditions may not only help to find new and better preventive means, but better preservation of demineralized dentin collagenous matrix may also facilitate true biological remineralization for the better restoration of tooth structural and mechanical integrity and mechanical properties.

Biomimetic remineralization of demineralized dentine using scaffold of CMC/ACP nanocomplexes in an in vitro tooth model of deep caries

Currently, it is still a tough task for dentists to remineralize dentine in deep caries. The aim of this study was to remineralize demineralized dentine in a tooth model of deep caries using nanocomplexes of carboxymethyl chitosan/amorphous calcium phosphate (CMC/ACP) based on mimicking the stabilizing effect of dentine matrix protein 1 (DMP1) on ACP in the biomineralization of dentine. The experimental results indicate that CMC can stabilize ACP to form nanocomplexes of CMC/ACP, which is able to be processed into scaffolds by lyophilization. In the single-layer collagen model, ACP nanoparticles are released from scaffolds of CMC/ACP nanocomplexes dissolved and then infiltrate into collagen fibrils via the gap zones (40 nm) to accomplish intrafibrillar mineralization of collagen. With this method, the completely demineralized dentine was partially remineralized in the tooth mode. This is a bottom-up remineralizing strategy based on non-classical crystallization theory. Since nanocomplexes of CMC/ACP show a promising effect of remineralization on demineralized dentine via biomimetic strategy, thereby preserving dentinal tissue to the maximum extent possible, it would be a potential indirect pulp capping (IPC) material for the management of deep caries during vital pulp therapy based on the concept of minimally invasive dentistry (MID).

Role of dentin MMPs in caries progression and bond stability

Dentin can be described as a biological composite with collagen matrix embedded with nanosized hydroxyapatite mineral crystallites. Matrix metalloproteinases (MMPs) and cysteine cathepsins are families of endopeptidases. Enzymes of both families are present in dentin and collectively capable of degrading virtually all extracellular matrix components. This review describes these enzymes and their presence in dentin, mainly focusing on their role in dentin caries pathogenesis and loss of collagen in the adhesive hybrid layer under composite restorations. MMPs and cysteine cathepsins present in saliva, mineralized dentin, and/or dentinal fluid may affect the dentin caries process at the early phases of demineralization. Changes in collagen and noncollagenous protein structure may participate in observed decreases in mechanical properties of caries-affected dentin and reduce the ability of caries-affected dentin to remineralize. These endogenous enzymes also remain entrapped within the hybrid layer during the resin infiltration process, and the acidic bonding agents themselves (irrespective of whether they are etch-and-rinse or self-etch) can activate these endogenous protease proforms. Since resin impregnation is frequently incomplete, denuded collagen matrices associated with free water (which serves as a collagen cleavage reagent for these endogenous hydrolase enzymes) can be enzymatically disrupted, finally contributing to the degradation of the hybrid layer. There are multiple in vitro and in vivo reports showing that the longevity of the adhesive interface is increased when nonspecific enzyme-inhibiting strategies are used. Different chemicals (i.e., chlorhexidine, galardin, and benzalkonium chloride) or collagen cross-linker agents have been successfully employed as therapeutic primers in the bonding procedure. In addition, the incorporation of enzyme inhibitors (i.e., quaternary ammonium methacrylates) into the resin blends has been recently promoted. This review will describe MMP functions in caries and hybrid layer degradation and explore the potential therapeutic role of MMP inhibitors for the development of improved intervention strategies for MMP-related oral diseases.

Preparation and properties of calcium-silicate filled resins for dental restoration. Part II: Micro-mechanical behaviour to primed mineral-depleted dentine

OBJECTIVE

Evaluating microtensile bond strength (μTBS) and Knoop micro-hardness (KHN) of resin bonded-dentine interfaces created with two methacrylate-based systems either incorporating Bioglass 45S5 (3-E&RA/BG) or MTA (3-E&RA/WMTA).

MATERIALS AND METHODS

Solvated resins (50% ethanol/50% co-monomers) were used as primers while their neat counterparts were filled with the two calcium-silicate compounds. Application of neat resin adhesive with no filler served as control (3-E&RA). μTBS, KHN analysis and confocal tandem scanning microscopy (TSM) micropermeability were carried out after 24 h and 10 months of storage in phosphate buffer solution (DPBS). Scanning electron microscopy (SEM) was also performed after debonding.

RESULTS

High μTBS values were achieved in all groups after 24 h of DPBS storage. On the contrary, solely the specimens created using 3-E&RA/BG and 3-E&RA/WMTA agents showed no significant reduction in terms of μTBS even after 10 months in DPBS; similarly, they did not restore the average superficial micro-hardness to the level of sound dentine, but maintained unchanged KHN values, and no statistical decrease was found following 10 months of DPBS storage. The only statistically significant changes occurred in the resin-dentine interfaces bonded with 3-E&RA that were subjected to a reduction of both μTBS and KHN values with ageing. In terms of micropermeability, adverse results were obtained with 3-E&RA while 3-E&RA/BG and 3-E&RA/WMTA demonstrated a beneficial effect after prolonged DPBS storage.

CONCLUSION

Calcium-silicate filled composite resins performed better than a current etch-and-rinse adhesive and had a therapeutic/protective effect on the micro-mechanical properties of mineral-depleted resin-dentine interfaces.

CLINICAL SIGNIFICANCE

The incorporation of calcium-silicates into dental restorative and bonding agents can create more biomimetic (life-like) restorations. This will not only enable these materials to mimic the physical characteristics of the tooth structure, but will also stabilize and protect the remaining dental hard tissues.

A novel self-assembled oligopeptide amphiphile for biomimetic mineralization of enamel

BACKGROUND

Researchers are looking for biomimetic mineralization of ena/mel to manage dental erosion. This study evaluated biomimetic mineralization of demineralized enamel induced by a synthetic and self-assembled oligopeptide amphiphile (OPA).

RESULTS

The results showed that the OPA self-assembled into nano-fibres in the presence of calcium ions and in neutral acidity. The OPA was alternately immersed in calcium chloride and sodium hypophosphate solutions to evaluate its property of mineralization. Transmission electron microscopy (TEM) and scanning electron microscopy (SEM) showed nucleation and growth of amorphous calcium phosphate along the self-assembled OPA nano-fibres when it was repetitively exposed to solutions with calcium and phosphate ions. Energy dispersive spectrometry (EDS) confirmed that these nano-particles contained calcium and phosphate. Furthermore, electron diffraction pattern suggested that the nano-particles precipitated on OPA nano-fibres were comparable to amorphous calcium phosphate. Acid-etched human enamel slices were incubated at 37°C in metastable calcium phosphate solution with the OPA for biomimetic mineralization. SEM and X-ray diffraction indicated that the OPA induced the formation of hydroxyapatite crystals in organized bundles on etched enamel. TEM micrographs revealed there were 20-30 nm nano-amorphous calcium phosphate precipitates in the biomimetic mineralizing solution. The particles were found separately bound to the oligopeptide fibres. Biomimetic mineralization with or without the oligopeptide increased demineralized enamel microhardness.

CONCLUSIONS

A novel OPA was successfully fabricated, which fostered the biomimetic mineralization of demineralized enamel. It is one of the primary steps towards the design and construction of novel biomaterial for future clinical therapy of dental erosion.

Outside-the-(cavity-prep)-box thinking

Direct placement restorative materials must interface with tooth structures that are often compromised by caries or trauma. The material must seal the interface while providing sufficient strength and wear resistance to assure function of the tooth for, ideally, the lifetime of the patient. Needed are direct restorative materials that are less technique-sensitive than current resin-based composite systems while having improved properties. The ideal material could be successfully used in areas of the world with limited infrastructure. Advances in our understanding of the interface between the restoration adhesive system and the stages of carious dentin can be used to promote remineralization. Application of fracture mechanics to adhesion at the tooth-restoration interface can provide insights for improvement. Research in polymer systems suggests alternatives to current composite resin matrix systems to overcome technique sensitivity, while advances in nano- and mesoparticle reinforcement and alignment in composite systems can increase material strength, toughness, and wear resistance, foreshadowing dental application.

Biomimetic remineralization of dentin

OBJECTIVES

Remineralization of demineralized dentin is important for improving dentin bonding stability and controlling primary and secondary caries. Nevertheless, conventional dentin remineralization strategy is not suitable for remineralizing completely demineralized dentin within hybrid layers created by etch-and-rinse and moderately aggressive self-etch adhesive systems, or the superficial part of a caries-affected dentin lesion left behind after minimally invasive caries removal. Biomimetic remineralization represents a different approach to this problem by attempting to backfill the demineralized dentin collagen with liquid-like amorphous calcium phosphate nanoprecursor particles that are stabilized by biomimetic analogs of noncollagenous proteins.

METHODS

This paper reviewed the changing concepts in calcium phosphate mineralization of fibrillar collagen, including the recently discovered, non-classical particle-based crystallization concept, formation of polymer-induced liquid-precursors (PILP), experimental collagen models for mineralization, and the need for using phosphate-containing biomimetic analogs for biomimetic mineralization of collagen. Published work on the remineralization of resin-dentin bonds and artificial caries-like lesions by various research groups was then reviewed. Finally, the problems and progress associated with the translation of a scientifically sound concept into a clinically applicable approach are discussed.

RESULTS AND SIGNIFICANCE

The particle-based biomimetic remineralization strategy based on the PILP process demonstrates great potential in remineralizing faulty hybrid layers or caries-like dentin. Based on this concept, research in the development of more clinically feasible dentin remineralization strategy, such as incorporating poly(anionic) acid-stabilized amorphous calcium phosphate nanoprecursor-containing mesoporous silica nanofillers in dentin adhesives, may provide a promising strategy for increasing of the durability of resin-dentin bonding and remineralizing caries-affected dentin.

A characterization of the mechanical behavior of resin-infiltrated dentin using nanoscopic Dynamic Mechanical Analysis

This study explored the spatial variations in mechanical behavior of resin-infiltrated dentin using nanoscopic Dynamic Mechanical Analysis (DMA).

OBJECTIVE

The objectives were to: (1) evaluate the mechanical behavior of resin-infiltrated dentin using a scanning-based approach to nanoindentation, (2) identify contributions of the collagen matrix to time-dependent deformation of the hybrid layer, and (3) assess the importance of specimen hydration on the nanoDMA response.

METHODS

Specimens of completely demineralized dentin infiltrated with commercial resin adhesive and control samples of resin adhesive were evaluated using a nanoindenter in scanning mode. The load and displacement responses were used to perform DMA and to estimate the complex (E*), storage (E') and loss (E″) moduli over selected regions of evaluation. The importance of hydration on the mechanical behavior was also examined from a comparison of responses in the hydrated and dehydrated conditions.

RESULTS

In the hydrated state the apparent complex, storage and loss moduli for the resin-infiltrated dentin samples were 3.5±0.3GPa, 3.4±0.2GPa and 0.9±0.3GPa, respectively. Those values for the resin adhesive control were 2.7±0.3GPa, 2.7±0.3GPa and 0.2±0.02GPa, respectively. Viscoelastic deformation of the resin-infiltrated collagen exceeded that occurring in regions of uniform resin adhesive. Though dehydration resulted in a significant increase in both the complex and storage moduli of the macro hybrid layer, the largest changes occurred to the resin adhesive.

SIGNIFICANCE

The microstructure and hydration play critical roles on the mechanical behavior of the hybrid layer and nanoDMA provides a potent measurement tool for identifying the spatial variations.

Functional remineralization of dentin lesions using polymer-induced liquid-precursor process

It was hypothesized that applying the polymer-induced liquid-precursor (PILP) system to artificial lesions would result in time-dependent functional remineralization of carious dentin lesions that restores the mechanical properties of demineralized dentin matrix. 140 µm deep artificial caries lesions were remineralized via the PILP process for 7–28 days at 37°C to determine temporal remineralization characteristics. Poly-L-aspartic acid (27 KDa) was used as the polymeric process-directing agent and was added to the remineralization solution at a calcium-to-phosphate ratio of 2.14 (mol/mol). Nanomechanical properties of hydrated artificial lesions had a low reduced elastic modulus (E_R = 0.2 GPa) region extending about 70 μm into the lesion, with a sloped region to about 140 μm where values reached normal dentin (18–20 GPa). After 7 days specimens recovered mechanical properties in the sloped region by 51% compared to the artificial lesion. Between 7–14 days, recovery of the outer portion of the lesion continued to a level of about 10 GPa with 74% improvement. 28 days of PILP mineralization resulted in 91% improvement of E_R compared to the artificial lesion. These differences were statistically significant as determined from change-point diagrams. Mineral profiles determined by micro x-ray computed tomography were shallower than those determined by nanoindentation, and showed similar changes over time, but full mineral recovery occurred after 14 days in both the outer and sloped portions of the lesion. Scanning electron microscopy and energy dispersive x-ray analysis showed similar morphologies that were distinct from normal dentin with a clear line of demarcation between the outer and sloped portions of the lesion. Transmission electron microscopy and selected area electron diffraction showed that the starting lesions contained some residual mineral in the outer portions, which exhibited poor crystallinity. During remineralization, intrafibrillar mineral increased and crystallinity improved with intrafibrillar mineral exhibiting the orientation found in normal dentin or bone.

Therapeutic effects of novel resin bonding systems containing bioactive glasses on mineral-depleted areas within the bonded-dentine interface

This study aimed in evaluating the effects of two experimental resin bonding systems containing conventional Bioglass 45S5 (BAG) or Zinc-polycarboxylated bioactive glass (BAG-Zn) micro-fillers on the resin-bonded dentine interface after storage in a simulated body fluid solution (SBFS). Three resin bonding systems were formulated: Resin-A: (BAG containing); Resin-B; (BAG-Zn containing); Resin-C (no filler). The ability of the experimental resins to evoke apatite formation was evaluated using confocal Raman spectroscopy. Acid-etched dentine specimens were bonded, and prepared for AFM/nano-indentation analysis in a fully-hydrated status to evaluate the modulus of elasticity (Ei) and hardness (Hi) across the interface at different SBFS storage periods. Further resin-dentine specimens were tested for microtensile bond strength after 24 h or 3 months of SBFS storage. SEM examination was performed after de-bonding and confocal laser microscopy was used to evaluate the ultramorphology of the interfaces and micropermeability. The resin A and B showed a consistent presence of apatite (967 cm(-1)), reduced micropermeability within the resin-dentine interface and a significant increase of the Ei and Hi along the bonded-dentine interface after prolonged SBFS storage. Bond strength values were affected by the resin system (P < 0.0001) and by storage time (P < 0.0001) both after 24 h and 3 months of SBFS storage. In conclusion, resin bonding systems containing bioactive fillers may a have therapeutic effect on the nano-mechanical properties and sealing ability of mineral-depleted resin-dentine interface.

In vitro effect of hesperidin on root dentin collagen and de/re-mineralization

The aims of this study were to investigate the effects of hesperidin, a citrus flavonoid, on human root dentin demineralization and collagen preservation, and compare it with chlorhexidine and grape seed extract. Specimens were assigned to different treatment groups: hesperidin, chlorhexidine and grape seed extract. Specimens were subjected to pH cycling by demineralization for 14 h, incubation in testing solutions for 2 h and remineralization in presence of bacterial-derived collagenase for 8 h, for 8 days. Calcium release was measured by means of an atomic absorption spectrophotometer, and degraded collagen matrix was investigated by hydroxyproline assay. Specimens were assessed longitudinally with transverse micro-radiography to investigate lesion depth and mineral loss. In hesperidin and grape seed extract groups, demineralization was reduced when the collagen matrix was preserved. The hesperidin group showed the lowest value in lesion depth and mineral loss, indicating that hesperidin inhibited demineralization and probably enhanced remineralization even under fluoride-free conditions.

Mechanical and micromorphological evaluation of chlorhexidine-mediated dentin remineralization

Chlorhexidine (CHX) has been reported to reduce self-degradation of collagen fibrils by inhibiting host-derived protease activity in demineralized dentin. Theoretically, if the collagen fibril scaffold of demineralized dentin maintains its original crosslinkage pattern on treatment with CHX and appropriate supplementation with necessary mineral sources, dentin remineralization may occur in demineralized lesions. In this study, we provide direct mechanical and micromorphological evidence for the ability of CHX to promote remineralization of demineralized dentin. Specifically, with respect to demineralized dentin blocks treated with different concentrations of CHX (0.02-2%) and stored in simulated body fluid, we have observed a significant increase in the elastic modulus of dentin treated with relatively high concentrations of CHX (0.2 and 2%) as storage time increased, whereas the elastic modulus of the non-CHX treated control group decreased. We have also observed a dense mineral deposition along collagen fibrils in the dentin group treated with 0.2 and 2% CHX via field emission scanning electron microscopy.

Influence of hydration on nanoindentation induced energy expenditure of dentin

Improved understanding of the effects of hydration and drying in mineralized tissues is highly desirable, particularly for physiologically hydrated biological materials such as dentin. We investigated the influence of hydration on the nanomechanical properties of healthy dentin and hypothesized that drying leads to an increase in indentation induced energy expenditure and hardness. Hydrated and dry dentin were tested with a UMIS set up with a Berkovich indenter at a maximum load of 50 mN. Values representative of the energy expenditure behavior were presented as dissipated energy, U(d), recovered energy, U(e), normalized energy expenditure index, ψ, and hardness, H. Energy expenditure index results, which normalize the energy expenditure for each test and describe the relative energy dissipation-recovery behavior of a material, suggested that, for the relatively severe contact strains about a sharp Berkovich indenter, dissipation dominates the mechanical response of both the hydrated and dry dentin. In support of our initial hypothesis, dry dentin presented a significantly higher energy expenditure index than hydrated dentin (p<0.0001). These results were primarily associated with a lower U(e) that was found upon drying. Hydration also decreased H significantly (p<0.0001). In summary, this study presents the first direct measurements of the energy expenditure behavior of hydrated and dry dentin using instrumented nanoindentation.

Nanoscopic dynamic mechanical properties of intertubular and peritubular dentin

An experimental evaluation of intertubular and peritubular dentin was performed using nanoindentation and Dynamic Mechanical Analysis (DMA). The objective of the investigation was to evaluate the differences in dynamic mechanical behavior of these two constituents and to assess whether their response is frequency dependent. Specimens of hydrated coronal dentin were evaluated by DMA using single indents over a range of parametric conditions and using scanning probe microscopy. The complex (E∗), storage (E') and loss moduli (E″) of the intertubular and peritubular dentin were evaluated as a function of the dynamic loading frequency and static load in the fully hydrated condition. The mean complex E∗ (19.6 GPa) and storage E' (19.2 GPa) moduli of the intertubular dentin were significantly lower than those for peritubular dentin (E∗ = 31.1 GPa, p < 0.05; E' = 30.3 GPa, p < 0.05). There was no significant influence of dynamic loading frequency on these measures. Although there was no significant difference in the loss modulus (E″) between the two materials (p > 0.05), both constituents exhibited a significant increase in E″ with dynamic load frequency and reduction in the quasi-static component of indentation load. The largest difference in dynamic behavior of the two tissues was noted at small quasi-static indentation loads and the highest frequency.

Insights into the structure and composition of the peritubular dentin organic matrix and the lamina limitans

Dentin is a mineralized dental tissue underlying the outer enamel that has a peculiar micro morphology. It is composed of micrometer sized tubules that are surrounded by a highly mineralized structure, called peritubular dentin (PTD), and embedded in a collagen-rich matrix, named intertubular dentin. The PTD has been thought to be composed of a highly mineralized collagen-free organic matrix with unknown composition. Here we tested the hypothesis that proteoglycans and glycosaminoglycans, two important organic structural features found in dentin, are key participants in the microstructure and composition of the PTD. To test this hypothesis dentin blocks were demineralized with 10 vol% citric acid for 2 min and either digested with 1mg/ml TPCK-treated trypsin with 0.2 ammonium bicarbonate at pH 7.9 (TRY) or 0.1 U/mL C-ABC with 50mM Tris, 60mM sodium acetate and 0.02% bovine serum albumin at pH 8.0 (C-ABC). TRY is known to cleave the protein core of dentin proteoglycans, whereas C-ABC is expected to selectively remove glycosaminoglycans. All specimens were digested for 48 h in 37°C, dehydrated in ascending grades of acetone, immersed in HMDS, platinum coated and imaged using an FE-SEM. Images of demineralized dentin revealed a meshwork of noncollagenous fibrils protruding towards the tubule lumen following removal of the peritubular mineral and confirmed the lack of collagen in the peritubular matrix. Further, images revealed that the peritubular organic network originates from a sheet-like membrane covering the entire visible length of tubule, called lamina limitans. Confirming our initial hypothesis, after the digestion with C-ABC the organic network appeared to vanish, while the lamina limitans was preserved. This suggests that glycosaminoglycans are the main component of the PTD organic network. Following digestion with TRY, both the organic network and the lamina limitans disappeared, thus suggesting that the lamina limitans may be primarily composed of proteoglycan protein cores. In summary, our results provide novel evidence that (1) PTD lacks collagen fibrils, (2) PTD contains an organic scaffold embedded with mineral and (3) the PTD organic matrix is manly composed of glycosaminoglycans, whereas the lamina limitans is primarily made of proteoglycans protein cores.

Mechanical recovery of dentin following remineralization in vitro--an indentation study

This study sought to gain insights into the steps leading to remineralization and mechanical recovery of hydrated dentin. Mechanical recovery in water was hypothesized to result from effective mineral matrix binding and to occur from the innermost regions outwards due to an increase in the number of nucleation sites. Partially demineralized (0.05 M acetate, pH=5.0, 8h) dentin was remineralized using calcium and phosphate solutions of 10.1 or 9.8 degree of saturation (DS) for hydroxyapatite (pH=7.4) for 4, 8 or 24h. Remineralization used a constant solution composition approach, which allowed for a continuous mineral growth with relatively constant thermodynamic driving forces. Crystal growth rates (R) were calculated using concentrations of calcium and phosphate. Before and after de- and re-mineralization, specimens had their surface and cross-section elastic moduli measured using AFM-nanoindentation in water. DS=10.1 provided higher R and higher mechanical recovery at the surface (p<0.0001). Cross-sectional measurements showed that subsurface mechanical recovery occurred from the innermost demineralized areas gradually outwards for both groups with no statistical differences at different DS, thus suggesting that remineralization is driven by mineral growth within nucleation sites with preserved collagen fibrils. Further, mechanical recovery appeared to initially obey a heterogeneous pattern, which vanished with time. This study provides evidence of mechanical recovery of hydrated dentin after remineralization and novel insights into the steps leading to mechanical recovery of carious dentin.

Differences between top-down and bottom-up approaches in mineralizing thick, partially demineralized collagen scaffolds

Biominerals exhibit complex hierarchical structures derived from bottom-up self-assembly mechanisms. Type I collagen serves as the building block for mineralized tissues such as bone and dentin. In the present study, 250-300 μm thick, partially demineralized collagen scaffolds exhibiting a gradient of demineralization from the base to surface were mineralized using a classical top-down approach and a non-classical bottom-up approach. The top-down approach involved epitaxial growth over seed crystallites. The bottom-up approach utilized biomimetic analogs of matrix proteins to stabilize amorphous calcium phosphate nanoprecursors and template apatite nucleation and growth within the collagen matrix. Micro-computed tomography and transmission electron microscopy were employed to examine mineral uptake and apatite arrangement within the mineralized collagen matrix. The top-down approach could mineralize only the base of the partially demineralized scaffold, where remnant seed crystallites were abundant. Minimal mineralization was observed along the surface of the scaffold; extrafibrillar mineralization was predominantly observed. Conversely, the entire partially demineralized scaffold, including apatite-depleted collagen fibrils, was mineralized by the bottom-up approach, with evidence of both intrafibrillar and extrafibrillar mineralization. Understanding the different mechanisms involved in these two mineralization approaches is pivotal in adopting the optimum strategy for fabricating novel nanostructured materials in bioengineering research.

Effect of hesperidin in vitro on root dentine collagen and demineralization

OBJECTIVES

Caries progress might be controlled when collagen matrix could be preserved after demineralization. The aim of this pH cycling study was to investigate the effect of hesperidin, a citrus flavonoid antioxidant, on dentine collagen and remineralization in dentine lesion, and compared with that of chlorhexidine.

METHODS

The pH cycling was employed on bovine root dentine by demineralization for 14 h, incubation in testing solutions (hesperidin or chlorhexidine) for 2 h and remineralization with bacteria-derived collagenase for 8 h, for 8 days. Calcium release was measured by means of an atomic absorption spectrophotometer, and degraded collagen matrix by collagenase was investigated by assaying hydroxyproline. The lesion depth and mineral loss was evaluated by means of transverse microradiography.

RESULTS

The effect of testing solutions had a significant difference on the results of chemical analyses (p<0.0115 for calcium release; p<0.0008 for degradated collagen). The lesion depth and mineral loss were reduced in the lesions where were incubated with hesperidin and chlorhexidine. The remineralization in deep lesions was found when the matrix was incubated in hesperidin, whilst no mineral uptake in deep lesion when incubated in chlorhexidine.

CONCLUSION

Hesperidin preserved collagen and inhibited demineralization, and enhanced remineralization even under the fluoride-free condition.

Limitations in bonding to dentin and experimental strategies to prevent bond degradation

The limited durability of resin-dentin bonds severely compromises the lifetime of tooth-colored restorations. Bond degradation occurs via hydrolysis of suboptimally polymerized hydrophilic resin components and degradation of water-rich, resin-sparse collagen matrices by matrix metalloproteinases (MMPs) and cysteine cathepsins. This review examined data generated over the past three years on five experimental strategies developed by different research groups for extending the longevity of resin-dentin bonds. They include: (1) increasing the degree of conversion and esterase resistance of hydrophilic adhesives; (2) the use of broad-spectrum inhibitors of collagenolytic enzymes, including novel inhibitor functional groups grafted to methacrylate resins monomers to produce anti-MMP adhesives; (3) the use of cross-linking agents for silencing the activities of MMP and cathepsins that irreversibly alter the 3-D structures of their catalytic/allosteric domains; (4) ethanol wet-bonding with hydrophobic resins to completely replace water from the extrafibrillar and intrafibrillar collagen compartments and immobilize the collagenolytic enzymes; and (5) biomimetic remineralization of the water-filled collagen matrix using analogs of matrix proteins to progressively replace water with intrafibrillar and extrafibrillar apatites to exclude exogenous collagenolytic enzymes and fossilize endogenous collagenolytic enzymes. A combination of several of these strategies should result in overcoming the critical barriers to progress currently encountered in dentin bonding.

Biomimetic analogs for collagen biomineralization

Inability of chemical phosphorylation of sodium trimetaphosphate to induce intrafibrillar mineralization of type I collagen may be due to the failure to incorporate a biomimetic analog to stabilize amorphous calcium phosphates (ACP) as nanoprecursors. This study investigated adsorption/desorption characteristics of hydrolyzed and pH-adjusted sodium trimetaphosphate (HPA-Na(3)P(3)O(9)) to collagen. Based on those results, a 5-minute treatment time with 2.8 wt% HPA-Na(3)P(3)O(9) was used in a single-layer reconstituted collagen model to confirm that both the ACP-stabilization analog and matrix phosphoprotein analog must be present for intrafibrillar mineralization. The results of that model were further validated by complete remineralization of phosphoric-acid-etched dentin treated with the matrix phosphoprotein analog and lined with a remineralizing lining composite, and with the ACP-stabilization analog supplied in simulated body fluid. An understanding of the basic processes involved in intrafibrillar mineralization of reconstituted collagen fibrils facilitates the design of novel tissue engineering materials for hard tissue repair and regeneration.

Imperfect hybrid layers created by an aggressive one-step self-etch adhesive in primary dentin are amendable to biomimetic remineralization in vitro

Degradation of hybrid layers created in primary dentin occurs as early as 6 months in vivo. Biomimetic remineralization utilizes "bottom-up" nanotechnology principles for interfibrillar and intrafibrillar remineralization of collagen matrices. This study examined whether imperfect hybrid layers created in primary dentin can be remineralized. Coronal dentin surfaces were prepared from extracted primary molars and bonded using Adper Prompt L-Pop and a composite. One-millimeter-thick specimen slabs of the resin-dentin interface were immersed in a Portland cement-based remineralization medium that contained two biomimetic analogs to mimic the sequestration and templating functions of dentin noncollagenous proteins. Specimens were retrieved after 1-6 months. Confocal laser scanning microscopy was used for evaluating the permeability of hybrid layers to Rhodamine B. Transmission electron microscopy was used to examine the status of remineralization within hybrid layers. Remineralization at different locations of the hybrid layers corresponded with quenching of fluorescence within similar locations of those hybrid layers. Remineralization was predominantly intrafibrillar in nature as interfibrillar spaces were filled with adhesive resin. Biomimetic remineralization of imperfect hybrid layers in primary human dentin is a potential means for preserving bond integrity. The success of the current proof-of-concept, laterally diffusing remineralization protocol warrants development of a clinically applicable biomimetic remineralization delivery system.

Evaluation of surface structural and mechanical changes following remineralization of dentin

This study sought to gain insights into the surface structural and mechanical changes leading to remineralization of dentin. Remineralization was compared between a continuous remineralization approach and a nonbuffered static approach using solutions of the same initial composition. Artificial carious lesions were treated for 5 days and analyzed every 24 h using nanoindentation in water, SEM, and AFM. The continuous approach yielded a recovery of mechanical properties of up to 60% of normal dentin, whereas the static approach led to recovery of only 10%. Image analysis revealed that the static approach yielded the formation of areas suggestive of an apatite precipitate on the surface of the dentin matrix. In contrast, surface precipitate was absent using the continuous approach, suggesting that mineral formed within the lesion and re-associated with the collagenous matrix. This study provided evidence that mechanical recovery of dentin in near physiological conditions is attainable through the continuous delivery of calcium and phosphate ions.

A chemical phosphorylation-inspired design for Type I collagen biomimetic remineralization

OBJECTIVES

Type I collagen alone cannot initiate tissue mineralization. Sodium trimetaphosphate (STMP) is frequently employed as a chemical phosphorylating reagent in the food industry. This study examined the feasibility of using STMP as a functional analog of matrix phosphoproteins for biomimetic remineralization of resin-bonded dentin.

METHODS

Equilibrium adsorption and desorption studies of STMP were performed using demineralized dentin powder (DDP). Interaction between STMP and DDP was examined using Fourier transform-infrared spectroscopy. Based on those results, a bio-inspired mineralization scheme was developed for chemical phosphorylation of acid-etched dentin with STMP, followed by infiltration of the STMP-treated collagen matrix with two etch-and-rinse adhesives. Resin-dentin interfaces were remineralized in a Portland cement-simulated body fluid system, with or without the use of polyacrylic acid (PAA) as a dual biomimetic analog. Remineralized resin-dentin interfaces were examined unstained using transmission electron microscopy.

RESULTS

Analysis of saturation binding curves revealed the presence of irreversible phosphate group binding sites on the surface of the DDP. FT-IR provided additional evidence of chemical interaction between STMP and DDP, with increased in the peak intensities of the PO and P-O-C stretching modes. Those peaks returned to their original intensities after alkaline phosphatase treatment. Evidence of intrafibrillar apatite formation could be seen in incompletely resin-infiltrated, STMP-phosphorylated collagen matrices only when PAA was present in the SBF.

SIGNIFICANCE

These results reinforce the importance of PAA for sequestration of amorphous calcium phosphate nanoprecursors in the biomimetic remineralization scheme. They also highlight the role of STMP as a templating analog of dentin matrix phosphoproteins for inducing intrafibrillar remineralization of apatite nanocrystals within the collagen matrix of incompletely resin-infiltrated dentin.

Nanomaterials in preventive dentistry

The prevention of tooth decay and the treatment of lesions and cavities are ongoing challenges in dentistry. In recent years, biomimetic approaches have been used to develop nanomaterials for inclusion in a variety of oral health-care products. Examples include liquids and pastes that contain nano-apatites for biofilm management at the tooth surface, and products that contain nanomaterials for the remineralization of early submicrometre-sized enamel lesions. However, the treatment of larger visible cavities with nanomaterials is still at the research stage. Here, we review progress in the development of nanomaterials for different applications in preventive dentistry and research, including clinical trials.

Functional biomimetic analogs help remineralize apatite-depleted demineralized resin-infiltrated dentin via a bottom-up approach

Natural biominerals are formed through metastable amorphous precursor phases via a bottom-up, nanoparticle-mediated mineralization mechanism. Using an acid-etched human dentin model to create a layer of completely demineralized collagen matrix, a bio-inspired mineralization scheme has been developed based on the use of dual biomimetic analogs. These analogs help to sequester fluidic amorphous calcium phosphate nanoprecursors and function as templates for guiding homogeneous apatite nucleation within the collagen fibrils. By adopting this scheme for remineralizing adhesive resin-bonded, completely demineralized dentin, we have been able to redeposit intrafibrillar and extrafibrillar apatites in completely demineralized collagen matrices that are imperfectly infiltrated by resins. This study utilizes a spectrum of completely and partially demineralized dentin collagen matrices to further validate the necessity for using a biomimetic analog-containing medium for remineralizing resin-infiltrated partially demineralized collagen matrices in which remnant seed crystallites are present. In control specimens in which biomimetic analogs are absent from the remineralization medium, remineralization could only be seen in partially demineralized collagen matrices, probably by epitaxial growth via a top-down crystallization approach. Conversely, in the presence of biomimetic analogs in the remineralization medium, intrafibrillar remineralization of completely demineralized collagen matrices via a bottom-up crystallization mechanism can additionally be identified. The latter is characterized by the transition of intrafibrillar minerals from an inchoate state of continuously braided microfibrillar electron-dense amorphous strands to discrete nanocrystals, and ultimately into larger crystalline platelets within the collagen fibrils. Biomimetic remineralization via dual biomimetic analogs has the potential to be translated into a functional delivery system for salvaging failing resin-dentin bonds.

Changes in stiffness of resin-infiltrated demineralized dentin after remineralization by a bottom-up biomimetic approach

This study examined changes in elastic modulus, mineral density and ultrastructure of resin-infiltrated dentin after biomimetic remineralization. Sixty demineralized dentin beams were infiltrated with Clearfil Tri-S Bond, One-Step or Prime&Bond NT. They were immersed in simulated body fluid (SBF) for 1 week to maximize water sorption before determining the baseline elastic moduli. For each adhesive (N = 20) half of the beams remained immersed in SBF (control). The rest were immersed in a biomimetic remineralization medium. The elastic moduli were measured weekly for 15 additional weeks. Representative remineralized specimens were evaluated by X-ray microtomography and transmission electron microscopy (TEM). The elastic moduli of control resin-infiltrated dentin remained consistently low, while those immersed in the biomimetic remineralization medium increased by 55-118% after 4 months. X-ray microtomography of the remineralized specimens revealed decreases in mineral density from the beam surface to the beam core that were indicative of external mineral aggregation and internal mineral deposition. Interfibrillar and intrafibrillar remineralization of resin-sparse intertubular dentin were seen under TEM, together with remineralized peritubular dentin. Biomimetic remineralization occurs by diffusion of nanoprecursors and biomimetic analogs in completely demineralized resin-infiltrated dentin and proceeds without the contribution of materials released from a mineralized dentin base.