In vivo assessment of DNA damage induced in oral mucosa cells by fixed and removable metal prosthodontic appliances

Minimization of Adverse Effects Associated with Dental Alloys

Metal alloys are one of the most popular materials used in current dental practice. In the oral cavity, metal structures are exposed to various mechanical and chemical factors. Consequently, metal ions are released into the oral fluid, which may negatively affect the surrounding tissues and even internal organs. Adverse effects associated with metallic oral appliances may have various local and systemic manifestations, such as mouth burning, potentially malignant oral lesions, and local or systemic hypersensitivity. However, clear diagnostic criteria and treatment guidelines for adverse effects associated with dental alloys have not been developed yet. The present comprehensive literature review aims (1) to summarize the current information related to possible side effects of metallic oral appliances; (2) to analyze the risk factors aggravating the negative effects of dental alloys; and (3) to develop recommendations for diagnosis, management, and prevention of pathological conditions associated with metallic oral appliances.

Toxicological Risks of the Cobalt-Chromium Alloys in Dentistry: A Systematic Review

Background: The toxicological risk of Co-Cr dental alloys is actually a sensitive subject with the European regulatory changes, namely regulation (EU) 2017/745 and annex VI to the CLP regulation (EC) 1972/2008. Objectives: The objective of this review is to conduct a rigorous analysis of the cytocompatibility of cobalt-chromium (Co-Cr) dental alloys. Considering various parameters such as cytotoxicity, type IV hypersensitivity reaction, sensitization, and irritation, we investigated evidence of toxicity of Co-Cr in human dental applications. Data sources: Specific search strategies were performed in three electronic databases, namely Medline, Embase, and Web of Science, using a main restriction in the search regarding the publication date (1995-2022). Study selection: Out of a total of 836 articles, only 21 studies were selected and analyzed according to PRISMA methodology. Results: Among them, 10 in vitro studies using human samples and 11 in vivo studies on human patients were distinguished. Most of the in vitro studies confirmed that Co-Cr alloys have a good cytocompatibility compared to Ni alloys. Regarding the in vivo studies, it appeared that Co-Cr could rarely cause sensitization, irritation, and allergic reactions. Reactions were mainly observed for people allergic to Co or Cr. Nevertheless, titanium-based materials showed better results. Conclusions: This study proposes a new state of the art on Co-Cr dental alloys and will thus be very useful for carrying out additional studies. Relevance: This review will help practitioners in their daily clinical choice.

Corrosive Studies of a Prosthetic Ni-Cr Alloy Coated with Ti(C,N) Type Layers

Background: Investigating the general corrosion resistance of Ti(C,N) type coatings on a prosthetic nickel alloy in the aspect of their use as protective coatings on prosthetic and orthodontic elements. Methods: Five groups of Ni-Cr alloy samples covered with Ti(C,N) type coatings differing in their carbon and nitrogen contents were used for the tests. The reference group included alloy samples without coatings. The samples were held for 105 days (2520 h) in salt spray chambers and examined by means of the NSS (neutral salt spray) and SWAAT (sea water acetic acid test) tests. After the periods of 14, 28, 81 and 105 days, the samples were removed and weighed, and their weight losses were determined. Results: In the case of each type of Ti(C,N) coating, the mass loss was lower than the mass loss of a sample without a coating, which makes it possible to state that coatings improve the corrosion resistance. No significant differences in the resistance were observed between the particular coatings. The corrosion rate of the examined coatings is close to parabolic. Conclusions: Ti(C,N) type coatings improve the resistance of a prosthetic Ni-Cr alloy and can be used as protective coatings for prosthetic and orthodontic elements.

Pulmonary toxicity, genotoxicity, and carcinogenicity evaluation of molybdenum, lithium, and tungsten: A review

Molybdenum, lithium, and tungsten are constituents of many products, and exposure to these elements potentially occurs at work. Therefore it is important to determine at what levels they are toxic, and thus we set out to review their pulmonary toxicity, genotoxicity, and carcinogenicity. After pulmonary exposure, molybdenum and tungsten are increased in multiple tissues; data on the distribution of lithium are limited. Excretion of all three elements is both via faeces and urine. Molybdenum trioxide exerted pulmonary toxicity in a 2-year inhalation study in rats and mice with a lowest-observed-adverse-effect concentration (LOAEC) of 6.6 mg Mo/m³. Lithium chloride had a LOAEC of 1.9 mg Li/m³ after subacute inhalation in rabbits. Tungsten oxide nanoparticles resulted in a no-observed-adverse-effect concentration (NOAEC) of 5 mg/m³ after inhalation in hamsters. In another study, tungsten blue oxide had a LOAEC of 63 mg W/m³ in rats. Concerning genotoxicity, for molybdenum, the in vivo genotoxicity after inhalation remains unknown; however, there was some evidence of carcinogenicity of molybdenum trioxide. The data on the genotoxicity of lithium are equivocal, and one carcinogenicity study was negative. Tungsten seems to have a genotoxic potential, but the data on carcinogenicity are equivocal. In conclusion, for all three elements, dose descriptors for inhalation toxicity were identified, and the potential for genotoxicity and carcinogenicity was assessed.

In Vitro Ion Release of Wires in Removable Orthodontic Appliances

Various orthodontic wire compositions and configurations are present on the market for removable appliances; however, there have still been only few studies focusing on the effect of resin color and additives such as glitter on corrosion of metallic wires under different conditions. Thus, the aim of the study was to compare concentrations of released ions (aluminium, chromium, nickel) in a corrosive medium under three different conditions: non-loaded wires, loaded wires, and non-loaded wires treated with Kukis^® cleaning tablets. Six different wires made of three types of steel alloy were embedded in PMMA resin leaving one centimetre of each wire emerging from the resin to come into contact with the corrosive medium. Glitter particles were added to half of the produced test specimens. For the unloaded test series, five specimens of each group were covered in a petri dish with 50 mL of corrosive medium (pH 2.3) following EN-ISO 10271 for seven days at 37 °C. The wires for the mechanically loaded test specimens overlapped the resin by 5 cm and were clamped into a time-switched electric drive for a defined period of time before the samples were taken after a testing time of 7 days. In the third group, unloaded test specimens were transferred from their petri dishes into the prepared Kukis^® solution every 24 h before being stored in the corrosive medium. Inductively coupled plasma mass spectrometry (ICP-MS) was used to quantify the specific ions in the corrosive solution. Statistical analysis showed that the mechanical loading of all wires could significantly raise the diffusion of ions into the corrosive medium. The colour of the resin did not affect the concentration of the released ions. The Kukis^® cleaning tabs could not lower the corrosion of the tested metals, as some of the wires were corroded even more using the brace cleanser. Glitter-containing test specimens showed significantly higher amounts of aluminium. Mechanical loading as well as the presence of glitter particles in the resin significantly affected ion concentrations.

The apoptotic and autophagic effects of cast Au-Pt, and differently manufactured Co-Cr and cp-Ti on three-dimensional oral mucosal model

The application of digitally manufactured dental metals has aroused the attention on their biocompatibilities. Three-dimensional oral mucosal model (3D OMM) would provide excellent assessments to the biocompatibility. In the current study, we set to measure metal ion release levels in the extracts of cast gold-platinum alloy (Au-Pt), differently manufactured cobalt-chromium alloy (Co-Cr) and commercially pure titanium (cp-Ti). We further tested two scaffold materials of 3D OMM to determine the better one for the succedent work. Lastly, we evaluated the apoptotic and autophagic effects of cast Au-Pt, and differently manufactured Co-Cr and cp-Ti on mucosal cells based on 3D OMM. We found that, in the construction of 3D OMM, Matrigel showed better performance than bovine acellular dermal matrix. Thus, Matrigel was chosen to construct the 3D OMM in the succedent studies. The results of ion release and biological assessments showed that, firstly, cast Au-Pt and cp-Ti triggered less early apoptotic cells and ion release than cast Co-Cr, implying better chemical stability and biocompatibility of them; secondly, digitally manufactured (including CAD/CAM milling and SLM) Co-Cr showed significantly lower ion release levels and lesser early apoptotic effects on 3D OMM as compared to the cast one. Although cast cp-Ti released much more ions than CAD/CAM milling one, manufacturing methods had no impact on apoptotic effect of cp-Ti. Therefore, we believe that digital methods possess same or even better chemical stability and biocompatibility than conventional casting one. Thirdly, although increased autophagic levels are observed in all test groups, so far there is no evidence that the test metals trigger different levels of autophagy as compared to each other. In addition, correlation analysis indicates that Co, W, and Mn appear to be the potential inducements for the apoptotic and autophagic effects of Co-Cr.

In Vitro Determination of Genotoxicity Induced by Brackets Alloys in Cultures of Human Gingival Fibroblasts

Orthodontic brackets release ions that can be reabsorbed in the oral mucosa, potentially causing complications, including cytotoxic effects and mutagenic alterations. The aim was to evaluate the genotoxicity induced by orthodontic appliance alloys in cultures of human gingival fibroblasts by comet assay. Eluates were obtained from the following brackets alloys: EconoLine (SS: stainless steel), MiniMirage (Ni-Ti: nickel-titanium), Nu-Edge (Co-Cr: cobalt-chromium), In-Vu (PC-polycrystals (PC) aluminum oxide), and Monocrystal IZE (monocrystalline (MC) aluminum oxide). Each bracket was sterilized and exposed to a corrosive process for 35 days. The obtained eluates were tested for genotoxicity of human gingival fibroblasts (HGFA) by the alkaline comet assay. All study groups showed genotoxic effects; there was a significant difference (p < 0.0001) among groups. The eluates obtained from Ni-Ti showed a 16-times greater genotoxic effect. There were differences in genotoxicity after comparing the Ni-Ti with SS (p < 0.01) and Co-Cr brackets (p < 0.001). The ceramic was more genotoxic than metallic brackets (SS and Co-Cr), but less than the Ni-Ti. This in vitro model will be useful for further study of early DNA damage caused by brackets and other biomaterials used in the oral cavity before their introduction into the clinical setting.

Effect of Fixed Metallic Oral Appliances on Oral Health

There is a substantial proportion of the population using fixed metallic oral appliances, such as crowns and bridges, which are composed of various dental alloys. These restorations may be associated with a number of effects on oral health with variable degrees of severity, to review potential effects of using fixed metallic oral appliances, fabricated from various alloys. The MEDLINE/PubMed database was searched using certain combinations of keywords related to the topic. The search revealed that burning mouth syndrome, oral pigmentation, hypersensitivity and lichenoid reactions, and genotoxic and cytotoxic effects are the major potential oral health changes associated with fixed prosthodontic appliances. Certain oral disorders are associated with the use of fixed metallic oral appliances. Patch test is the most reliable method that can be applied for identifying metal allergy, and the simultaneous use of different alloys in the mouth is discouraged.

Co-Cr dental alloys induces cytotoxicity and inflammatory responses via activation of Nrf2/antioxidant signaling pathways in human gingival fibroblasts and osteoblasts

OBJECTIVE

Although cobalt-chromium (Co-Cr) dental alloys are routinely used in prosthodontics, the biocompatibility of Co-Cr alloys is controversial. The aims of the present study were to investigate the effects of Co-Cr alloys on human gingival fibroblasts (HGF) and osteoblasts in an in vitro model as well as their potential molecular mechanisms, focusing on NF-E2-related factor 2 (Nrf2) pathways.

METHODS

Cells were directly seeded on prepared Co-Cr alloy discs (15.0mm diameter, 1.0mm thickness) or indirectly treated with Co-Cr alloy located at the bottom of an insert well and incubated for 3 days. Cytotoxicity and reactive oxygen species (ROS) production was evaluated by MTS assay and flow cytometry, respectively. Protein and mRNA levels were determined by Western blotting and RT-PCR analysis, respectively.

RESULTS

Cell viability and flow cytometric assay demonstrated that the Co-Cr alloy was cytotoxic to HGFs and osteoblasts, and significantly increased ROS production. In addition, the Co-Cr alloys upregulated pro-inflamamtory cytokines (TNF-α, IL-1β, IL-6, and IL-8) and increased levels of various inflammatory mediators (iNOS derived nitrite oxide, and COX-2-derived PGE2) in both cells. A mechanistic study showed that Co-Cr alloys activates the NRF2 pathway and up-regulate antioxidant enzymes including heme oxygenase-1 (HO-1). Co-Cr alloys activated JAK2/STAT3, p38/ERK/JNK MAPKs and NF-κB signaling pathways. Furthermore, antioxidants (resveratrol and NAC) and HO-1 inhibitor (SnPP) significantly inhibited the production of ROS and inflammatory mediators, as well as the activation of NF-κB signaling in Co-Cr alloy stimulated HGFs and osteoblasts.

SIGNIFICANCE

This study is the first to show that Co-Cr alloys exert cytotoxic and inflammatory effects via activation of Nrf2/ARE signaling and up-regulation of downstream HO-1, which could represent candidate targets for the regulation of inflammatory responses to Co-Cr alloys.

Epithelial cells as alternative human biomatrices for comet assay

The comet assay is a valuable experimental tool aimed at mapping DNA damage in human cells in vivo for environmental and occupational monitoring, as well as for therapeutic purposes, such as storage prior to transplant, during tissue engineering, and in experimental ex vivo assays. Furthermore, due to its great versatility, the comet assay allows to explore the use of alternative cell types to assess DNA damage, such as epithelial cells. Epithelial cells, as specialized components of many organs, have the potential to serve as biomatrices that can be used to evaluate genotoxicity and may also serve as early effect biomarkers. Furthermore, 80% of solid cancers are of epithelial origin, which points to the importance of studying DNA damage in these tissues. Indeed, studies including comet assay in epithelial cells have either clear clinical applications (lens and corneal epithelial cells) or examine genotoxicity within human biomonitoring and in vitro studies. We here review improvements in determining DNA damage using the comet assay by employing lens, corneal, tear duct, buccal, and nasal epithelial cells. For some of these tissues invasive sampling procedures are needed. Desquamated epithelial cells must be obtained and dissociated prior to examination using the comet assay, and such procedures may induce varying amounts of DNA damage. Buccal epithelial cells require lysis enriched with proteinase K to obtain free nucleosomes. Over a 30 year period, the comet assay in epithelial cells has been little employed, however its use indicates that it could be an extraordinary tool not only for risk assessment, but also for diagnosis, prognosis of treatments and diseases.

Metallic ion content and damage to the DNA in oral mucosa cells patients treated dental implants

The aim of this study was to assess the potential genotoxicity of dental implants, evaluating biomarkers of DNA damage (micronuclei and/or nuclear buds), cytokinetic defects (binucleated cells) and the presence of trace metals in gingival cells of patients with implants, comparing these with a control group. A total of 60 healthy adults (30 patients with dental implants and 30 control patients without) were included in the study. Medical and dental histories were made for each including life-style factors. Genotoxicity effects were assessed by micronucleus assays in the gingival epithelial cells of each patient; 1,000 epithelial cells were analyzed, evaluating the frequency of micronucleated cells and other nuclear anomalies. The concentration of metals (Al(27), Ag(107), Co (59), Cr (52), Cu(63), Fe(56), Sn(118), Mn(55), Mo(92), Ni(60), Pb(208), Ti(47)) were assayed by means of coupled plasma-mass spectrophotometry (ICP-MS). The frequency of micronuclei in the patient group with implants was higher than in the control group but without statistically significant differences (P > 0.05). Similar results were found for binucleated cells and nuclear buds (P > 0.05). For metals assayed by ICP-MS, significant differences were found for Ti(47) (P ≤ 0.045). Univariate analysis identified a significant association between the presence of micronuclei and age. Dental implants do not induce DNA damage in gingival cells, the slight effects observed cannot be indicated as biologically relevant.

The release of metal ions from orthodontic appliances animal tests

OBJECTIVE

To investigate the release of metal ions from an orthodontic appliance in tests on animals (pigs).

MATERIALS AND METHODS

An animal test was conducted on 24 pigs divided equally into an experimental and a control group. In total, 12 sets of experimental orthodontic plates were surgically inserted into pig snouts in the experimental group for 6 months. Noninvasive matrices (hair [0, 3, and 6 months]) and invasive matrices (kidneys, liver, lungs, aorta, and oral mucosa) were collected for multi-elemental analysis (inductively coupled plasma optical emission spectrometry) from the experimental and control groups.

RESULTS

The greatest differences in the content of toxic metals were found in the aorta (Ni level was 4.8 times higher in experimental than in the control group), in the cheek (Ni 3.5 times higher), and in the hair sampled after 3 months (Cr 3.4 times higher).

CONCLUSIONS

The obtained data indicate that the products of corrosion have passed into selected tissues of pigs; however, the doses of toxic metal ions released from the appliance did not reach toxic levels.

XPS and electrochemical impedance spectroscopy studies on effects of the porcelain firing process on surface and corrosion properties of two nickel-chromium dental alloys

The aim of this study was to evaluate the effects of a simulated porcelain firing process on the surface, corrosion behavior and cell culture response of two nickel-chromium (Ni-Cr) dental alloys. A Be-free alloy and a Be-containing alloy were tested. Before porcelain firing, as-cast specimens were examined for surface composition using X-ray photoelectron spectroscopy and metallurgical phases using X-ray diffraction. Corrosion behaviors were evaluated using electrochemical impedance spectroscopy. 3T3 fibroblasts were cultured and exposed indirectly to specimens. MTT assays were counted after 3 and 6 days. The cell culture mediums exposed to specimens were analyzed for metal ion release. After porcelain firing, similar specimens were examined for the same properties. In both as-cast and fired conditions, the Be-free Ni-Cr alloy showed significantly more resistance to corrosion than the Be-containing Ni-Cr alloy, which exhibited BeNi phase. After porcelain firing, the corrosion resistance of the Be-free Ni-Cr alloy decreased statistically, corresponding with evident decreases of Cr and Ni oxides on the alloy surface. Also, the alloy's MTT assay decreased significantly corresponding with an obvious increase of Ni-ion release after the firing. For the Be-containing Ni-Cr alloy, the firing process led to increases of surface oxides and metallic Be, while its corrosion resistance and cell culture response were not significantly changed after porcelain firing. The results suggested that the corrosion resistance and biocompatibility of the Be-free Ni-Cr alloy decreased after porcelain firing, whereas the firing process had little effect on the same properties of the Be-containing Ni-Cr alloy.

Genotoxicity in gingival cells of patients undergoing tooth restoration with two different dental composite materials

OBJECTIVES

Dental composite materials come into direct contact with oral tissue, especially gingival cells. This study was performed to evaluate possible DNA damage to gingival cells exposed to resin composite dental materials.

MATERIALS AND METHODS

Class V restorations were placed in 30 adult patients using two different composite resins. The epithelial cells of the gingival area along the composite restoration were sampled prior to and after 7, 30, and 180 days following the restoration of the tooth. DNA damage was analysed by comet and micronucleus assays in gingival exfoliated epithelial cells.

RESULTS

The results showed significantly higher comet assay parameters (tail length and % DNA in the tail) within periods of 30 and 180 days. The micronucleus test for the same exposure time demonstrated a higher number of cells with micronuclei, karyolysis, and nuclear buds. Results did not reveal any difference between the two composite materials for the same duration of exposure.

CONCLUSION

Based on the results, we can conclude that the use of composite resins causes cellular damage. As dental composite resins remain in intimate contact with oral tissue over a long period of time, further research on their possible genotoxicity is advisable.

CLINICAL RELEVANCE

Long-term exposure of gingival cells to two different composite materials demonstrated certain DNA damage. However, considering the significant decline in micronuclei frequency after 180 days and efficiency in the repair of primary DNA damage, the observed effects could not be indicated as biologically relevant.