Biomimetic mineralization: Long-term observations in patients with dentin sensitivity

A Drop-By-Drop Self-Assembled All-Natural Hydrogel as a Desensitizer for Rapid and Enduring Management of Dentin Hypersensitivity

Dentin hypersensitivity (DH) is a prevalent dental condition arising from the exposure of dentin tubules (DTs), leading to discomfort upon external stimuli. However, achieving swift and profound occlusion of these exposed DTs for immediate and enduring relief remains challenging due to the intricate dentin structure and oral environment. Herein, a pioneering and facile drop-by-drop strategy involving an in situ generated natural supramolecular hydrogel formed by self-assembling silk fibroin (SF) and tannic acid (TA) within the narrow DT space is proposed. When SF and TA aqueous solutions are applied successively to exposed dentin, they penetrate deeply within DTs and coassemble into compact gels, robustly adhering to DT walls. This yields a rapid and compact occlusion effect with an unprecedented depth exceeding 250 µm, maintaining stable occlusion efficacy even under rigorous in vitro and in vivo erosion and friction conditions for no less than 21 days. Furthermore, the biocompatibility and effective occlusion properties are verified through cell studies in simulated oral settings and an in vivo rabbit model. This study, for the first time, demonstrates the translational potential of hydrogel-based desensitizers in treating DH with prompt action, superior occlusion depth and enduring treatment benefits, holding promise as clinical-friendly restorative solutions for delicate-structured biosystems.

Biomimetic approaches and materials in restorative and regenerative dentistry: review article

Biomimetics is a branch of science that explores the technical beauty of nature. The concept of biomimetics has been brilliantly applied in famous applications such as the design of the Eiffel Tower that has been inspired from the trabecular structure of bone. In dentistry, the purpose of using biomimetic concepts and protocols is to conserve tooth structure and vitality, increase the longevity of restorative dental treatments, and eliminate future retreatment cycles. Biomimetic dental materials are inherently biocompatible with excellent physico-chemical properties. They have been successfully applied in different dental fields with the advantages of enhanced strength, sealing, regenerative and antibacterial abilities. Moreover, many biomimetic materials were proven to overcome significant limitations of earlier available generation counterpart. Therefore, this review aims to spot the light on some recent developments in the emerging field of biomimetics especially in restorative and regenerative dentistry. Different approaches of restoration, remineralisation and regeneration of teeth are also discussed in this review. In addition, various biomimetic dental restorative materials and tissue engineering materials are discussed.

Deep and compact dentinal tubule occlusion via biomimetic mineralization and mineral overgrowth

Dentinal tubule (DT) occlusion by desensitizing agents has been widely applied to inhibit the transmission of external stimuli that cause dentin hypersensitivity (DH). However, most desensitizing agents merely accomplish porous blocking or the formation of a superficial tubular occlusion layer, resulting in a lack of mechanical and acid resistance and long-term stability. Herein, combining biomimetic mineralization and mineral overgrowth of the dentinal matrix was shown to effectively occlude DTs, resulting in the formation of a compact and deep occluding mineral layer that is strongly bound to the organic matrix on tubule walls. This DT occlusion method could achieve both mechanical resistance and acid resistance, demonstrating the potential of an inexpensive, long-term, and efficient therapy for treating DH.

Comparative evaluation of the efficacy of the desensitizing and remineralizing agent in the reduction of dentin hypersensitivity after orthodontic debonding - a randomized clinical trial

Introduction

Enamel loss is a common problem during various orthodontic procedures. The study aims to compare the efficacy of a desensitizer and remineralizer in the reduction of the dentin hypersensitivity (DH) associated with enamel microcracks after orthodontic debonding.

Methods

A unicentric two arm parallel study with 30 subjects randomly assigned to each groups following debonding. Group-1 subjects were treated with Gluma® desensitizer (5% glutaraldehyde and 35% hydroxyethyl methacrylate (HEMA)) and the Group-2 intervention included a remineralizing agent GC Tooth Mousse Plus® (casein phospho peptide and amorphous calcium Fluro phosphate (CPP:ACFP)). The Visual Analogue Scale (VAS) was utilized to evaluate DH as subjective perception of pain following the Air blast test and Cold test. The VAS scale was indexed from 0–10 markings based on the intensity of perception. Five different time points T0 and T1 - immediately after debonding and intervention on day 1, T2 – 48 hours, and T3 after 72 hours were taken for the assessment of VAS scores.

Results

The VAS scores for the airblast test for group 1 were (2.73, 0, 0.06, 0.03) and group 2 (2.46, 0, 0.16, 0.13) at different periods. The sensitivity scores for the cold blast test for group 1 were (2.73, 0, 0.13, 0.03) and for group 2 (2.46, 0, 0.16, 0.13). There was 98 percent reduction in DH between T0 and T3 and was statistically significant (p<0.05) for both the groups.

Conclusion

Gluma® desensitizer and GC Tooth Mousse Plus® are equally effective in the reduction of DH in the orthodontic patient following debonding.

Notoginsenoside R1 functionalized gelatin hydrogels to promote reparative dentinogenesis

Pulp-capping materials are commonly adopted in the clinic to form reparative dentin and thus protect dental pulp tissues from cases of deep caries, accidentally exposed pulps or partial pulpotomy. Some traditional pulp capping materials used in the clinic include calcium hydroxide and mineral trioxide aggregates. However, there are limitations to thin restorative dentin, and a long period of time is needed to cause degenerative changes in dental pulp. In this paper, injectable colloidal gels were developed to induce the formation of reparative dentin through a simple UV method from methacrylic acid functionalized gelatin loaded with notoginsenoside R1 (Gel-MA/NGR1). The results of the physicochemical property examinations showed that the prepared Gel-MA/NGR1 hydrogel possessed an appropriate interconnected porous microarchitecture with a pore size of 10.5 micrometres and suitable mechanical properties with a modulus of 50-60 kPa, enabling cell adhesion and proliferation. The hydrogel remained hydrophilic with sustained drug release performance. In addition, Gel-MA/NGR1 significantly enhanced the odontogenetic differentiation of mouse dental papilla cells by elevating the expression levels of the dentinogenic markers ALP and OCN and extracellular matrix mineralization. In vivo stimulation was carried out by injecting the precursors into the predrilled alveolar cavity of Sprague-Dawley rats followed by immediate in situ UV crosslinking. The results showed that Gel-MA/NGR1 has a strong capacity to promote reparative dentin formation. Haematoxylin& eosin, Masson, and immunohistochemical staining (DMP-1, DSPP, OCN and RUNX2) and micro-CT were employed to illustrate the effectiveness of dentinogenesis, and the relative volumes of calcification were found to have increased ~175-fold. All of the results showed that the Gel-MA/NGR1 hydrogel promoted reparative dentin formation, which suggests that this hydrogel provides great potential as a pulp-capping material to induce dentin formation.

Acidic Monetite Complex Paste with Bleaching Property for In-depth Occlusion of Dentinal Tubules

Background

Dentin hypersensitivity (DH) is a common dental clinical condition presented with a short and sharp pain in response to physical and chemical stimuli. Currently no treatment regimen demonstrates long-lasting efficacy in treating DH, and unesthetic yellow tooth color is a concern to many patients with DH.

Aim

To develop a bi-functional material which can occlude dentinal tubules in-depth and remineralize dentin for long-lasting protection of the dentin–pulp complex from stimuli and bleach the tooth at the same time.

Methods

A mixture containing CaO, H₃PO₄, polyethylene glycol and H₂O₂ at a specific ratio was mechanically ground using a planetary ball. The mineralizing complex paste was characterized by X-ray diffraction (XRD) and scanning electron microscopy (SEM). Dentin was exposed to the synthesized paste for 8 h and 24 h in vitro. The mineralizing property was evaluated using SEM and microhardness tests. Red tea-stained tooth slices were exposed to the synthesized paste for 8 h and 24 h in vitro. The bleaching effect was characterized by a spectrophotometer.

Results

The complex paste had very a fine texture, was injectable, and had a gel-like property with 2.6 (mass/volume) % H₂O₂ concentration. The X-ray diffraction pattern showed that the inorganic phase was mainly monetite (CaHPO₄). The mineralizing complex paste induced the growth of inorganic crystals on the dentin surface and in-depth occlusion of dentin tubules by up to 80 μm. The regenerated crystals were integrated into the dentin tissue on the dentin surface and the wall of dentinal tubules with a microhardness of up to 126 MPa (versus 137 Mpa for dentin). The paste also bleached the stained dental slices.

Conclusion

The mineralizing complex paste is a promising innovative material for efficient DH management by remineralizing dentin and in-depth occlusion of dentin tubules, as well as tooth bleaching.

[Research progress on the biomimetic remineralization of hard tooth tissues based on polyamide-amine dendrimer]

Polyamide-amine (PAMAM) dendrimer, a new hyperbranched macromolecular polymer, is considered an "artificial protein" by many scholars on account of its excellent chemical and biological characteristics. PAMAM has internal cavities and a large number of reactive terminal groups. These structures allow the polymer to be used as a bionic macromoleculethat could simulate the biomimetic mineralization of the natural organic matrix on the surface of tooth tissue. Specifically, PAMAM can beused as an organic template to regulate mineral nucleation and crystal growth; thus, the polymerisa more ideal dental restoration material than traditional allogenic materials. This article reviews research progress on thePAMAM-induced biomimetic mineralization of hard tooth tissues.

Influence of Bioactive, Resin and Glass Ionomer luting cements on the fracture loads of dentin bonded ceramic crowns

Objective:

To investigate the failure loads of dentin bonded all-ceramic crowns when luted with Bioactive, resin and glass ionomer cements (GIC) in an in-vitro setting.

Methods:

This study was conducted at King Saud University, Saudi Arabia, from Nov.2018 to March 2019. In this study, 60 premolar teeth were prepared for dentin-bonded ceramic crowns. Lithium disilicate ceramic crowns fabricated using CAD-CAM technique were cemented to teeth using Bioactive (ACITVA), Resin (Nexus 3 Gen) and GIC (Ketac Cem- Maxicap). Half of the bonded specimens in each group were thermocycled (50000 cycles), however the remaining half were not aged (n=10). Fracture loads of bonded crowns were assessed by exposing them to static axial occlusal loads (1mm/min) using a round ended metal probe in a Universal testing machine. Means and standard deviations among the study groups were compared with ANOVA and Tukey-Kramer multiple comparisons test.

Results:

Highest failure loads were observed in resin group without ageing (thermocycling) (689.13±89.41 N), however, the lowest loads were observed in GIC specimens with ageing (243.16±49.03 N). Among non-aged samples, failure loads for Bioactive (480.30±47.26 N) group were less than Resin (689.13±89.41 N) samples but higher than GIC (307.51±45.29 N) specimens respectively. Among the aged specimens, Bioactive (404.42±60.43 N) showed significantly higher failure loads than GIC (243.16±49.03 N), however lower failure loads than Resin (582.33±95.95 N) samples.

Conclusions:

Dentin boned crowns with resin cementation showed higher failure loads than Bioactive and GIC luted crowns. Crowns luted with Bioactive cement showed acceptable failure loads for use as restoration on anterior teeth.

Antimicrobial Activity of Protamine-Loaded Calcium Phosphates against Oral Bacteria

Protamine is an antimicrobial peptide extracted from fish. In this study, we loaded protamine onto dicalcium phosphate anhydride (DCPA), a dental material. Protamine was loaded by stirring DCPA into a protamine solution. To explore the antimicrobial activity of the materials, we cultivated Streptococcus mutans on fabricated discs for 24 h. When S. mutans was cultivated on the discs under no sucrose conditions, the loaded protamine was not released, and the ratio of dead bacteria increased on the surface of P (125) DCPA (half of the saturated level of protamine (125 ppm protamine) was loaded). Aside from P (500) DCPA (saturated level of protamine was loaded), some protamine was released, and the number of planktonic bacteria in the supernatant decreased. Using medium containing 1% sucrose, the release of protamine was promoted from P (125) DCPA due to lowered pH. However, lowering of the pH decreased the antimicrobial activity of protamine. On the other hand, P (500) DCPA released protamine before the pH was lowered, and biofilm formation was inhibited. The loaded protamine expressed antimicrobial activity, both on the surface of the materials and in the surrounding environment. The interaction of loaded protamine with calcium phosphates could promote the application of protamine in the dental field.

Effect of erosive and abrasive stress on sealing ability of different desensitizers: In-vitro study

This in vitro study examined the sealing ability of different desensitizing agents under a chemo-mechanical stress condition. For the study, a total of 144 extracted, caries-free human third molars were used to produce 1 mm-thick dentin discs. The specimens were divided randomly into four groups: Superseal (SS), Gluma (GL), Gluma Self-etch (GS), and Tooth Coat (TC). For each group, the permeability was measured before and after applying the desensitizer, after being exposed to Coca Cola for 5 minutes, and after 3150 strokes of a brushing abrasion. The decrease in permeability after the erosive and abrasive stress was analyzed by ANOVA and Tukey post hoc test. As a result, the dentin permeability decreased significantly for all desensitizers immediately after application (p < 0.05). SS and GS showed a significant difference in permeability reduction observed immediately after application and after acid action with Coca Cola (p < 0.05). After brushing abrasion, the permeability reduction decreased significantly for all desensitizers tested in this study (p < 0.05). TC showed the largest decrease in dentinal permeability compared to that of the other desensitizers and the differences were significant after brushing abrasion (p < 0.05). All tested desensitizers were effective in reducing dentin permeability. The behavioral characteristics under erosive and abrasive stress varied according to the products used. TC exhibited excellent sealing ability among the other desensitizers.

Effect of Preetching on Microleakage with All-In-One Adhesives Using Calcium-Based Desensitizers: An In vitro Study

Objectives

The aim of this study was to evaluate the effect of calcium-based desensitizers on the microleakage with and without preetching enamel in Class V cavities restored with all-in-one adhesives.

Materials and Methods

Class V cavities were prepared on the buccal surfaces of 100 extracted human premolars. A total of 100 box-shaped cavities were divided into five groups (n = 20). Group 1 - no desensitizer was applied and Groups 2 and 4 - desensitizer (CCP-ACP and Novamin) was applied, respectively, followed by the application of G-Bond and restored with composite restoration. Groups 3 and 5 are same as Group 2 and 4, but preetching of enamel was done for 3 s after desensitizers application. The teeth were thermocycled and the specimens were examined for microleakage using methylene blue as a marker. The teeth were sectioned buccolingually and evaluated for microleakage under stereomicroscope and the scores obtained were analyzed with Kruskal-Wallis and Mann-Whitney tests.

Results

Statistically significant difference existed between Groups 2 and 3 (P < 0.05). There was also statistically significant difference between Groups 4 and 5 (P < 0.05). Groups 3 and 5 showed significantly less microleakage (P < 0.05). No statistically significant difference in microleakage values was observed between the two desensitizers CCP-ACP and Novamin.

Conclusion

The application of calcium-containing desensitizers with selective etch enamel technique in all-in-one adhesives could be considered an advisable procedure to minimize microleakage.

In vivo remineralization of dentin using an agarose hydrogel biomimetic mineralization system

A novel agarose hydrogel biomimetic mineralization system loaded with calcium and phosphate was used to remineralize dentin and induce the oriented densely parallel packed HA layer on defective dentin surface in vivo in a rabbit model. Firstly, the enamel of the labial surface of rabbits' incisor was removed and the dentin was exposed to oral environment. Secondly, the hydrogel biomimetic mineralization system was applied to the exposed dentin surface by using a custom tray. Finally, the teeth were extracted and evaluated by scanning electron microscopy, X-ray diffraction, and nanoindentation test after a certain time of mineralization intervals. The regenerated tissue on the dentin surface was composed of highly organised HA crystals. Densely packed along the c axis, these newly precipitated HA crystals were perpendicular to the underlying dental surface with a tight bond. The demineralized dentin was remineralized and dentinal tubules were occluded by the grown HA crystals. The nanohardness and elastic modulus of the regenerated tissue were similar to natural dentin. The results indicated a potential clinical use for repairing dentin-exposed related diseases, such as erosion, wear, and dentin hypersensitivity.

Biomimetic approaches with smart interfaces for bone regeneration

A 'smart tissue interface' is a host tissue-biomaterial interface capable of triggering favourable biochemical events inspired by stimuli responsive mechanisms. In other words, biomaterial surface is instrumental in dictating the interface functionality. This review aims to investigate the fundamental and favourable requirements of a 'smart tissue interface' that can positively influence the degree of healing and promote bone tissue regeneration. A biomaterial surface when interacts synergistically with the dynamic extracellular matrix, the healing process become accelerated through development of a smart interface. The interface functionality relies equally on bound functional groups and conjugated molecules belonging to the biomaterial and the biological milieu it interacts with. The essential conditions for such a special biomimetic environment are discussed. We highlight the impending prospects of smart interfaces and trying to relate the design approaches as well as critical factors that determine species-specific functionality with special reference to bone tissue regeneration.

Effect of a calcium-phosphate based desensitizer on dentin surface characteristics

This study aimed to evaluate the ability of a newly developed calcium-phosphate desensitizer in dentin permeability reduction and its integration with dentin surface before and after immersion in artificial saliva (AS) under two different dentin surface characteristics; with or without the collagen exposure.Humandentin discs treated by EDTA to expose collagen fibrils or EDTA/NaOCl to expose plain dentin surface were subjected to a calcium-phosphate desensitizer (Teethmate Desensitizer; TMD), while non-desensitizer treatment served as control. TMD application showed the occlusion in dentinal tubules and reduction in dentin permeability up to 92%, regardless of dentin surface characteristics. After AS immersion, permeability reduction percent (PR%) significantly increased in EDTA/NaOCl pretreatment (p<0.05). Newly-formed crystallites were observed on desensitizer treated dentin and EDTA/NaOCl pretreatment control group, whereas the crystallites did not exist on EDTA pretreatment control group. Ultrasonication revealed the integration of the calcium-phosphate rich layer of desensitizer on dentin surface after AS immersion.

Exploring some aspects associated with dentine hypersensitivity in children

BACKGROUND

The etiology of dentine hypersensitivity (DH) is still inconclusive and there are few studies concerning it in children.

AIM

To evaluate clinical, dietary, and salivary variables in children with DH complaints.

DESIGN

Forty-eight children were asked about DH. Data regarding dietary habits were collected from the children's parents and an examination was performed to determine dental erosion. Dental biofilm was estimated by oral hygiene status, according to Greene and Vermillion's Simplified Oral Hygiene Index (OHI-S). Whole saliva was collected under mechanical stimulation and evaluated salivary flow rate, initial pH, buffer capacity, and calcium and phosphate concentrations. The temperature of soft drinks, drinking method, sense of bitter taste, and other variables were also determined. Possible factors associated with DH were analyzed by univariate and multiple Poisson regression analyses. The prevalence ratio (PR) values and 95% confidence intervals (95% CI) were calculated.

RESULTS

DH was associated with the presence of dental erosion (PR; 95% CI = 2.23; 1.05 to 4.71) and salivary flow rate (2.49; 1.05 to 5.91). When the presence of erosion was not included, other variables were retained as follows: bitter taste (2.36; 1.38 to 4.03), OHI-S (0.47; 0.23 to 0.97).

CONCLUSION

DH in children is associated with factors related to dental erosion.

Effect of different desensitizers on inhibition of bovine dentin demineralization: micro-computed tomography assessment

This study evaluated the effect of two desensitizers on inhibition of dentin demineralization, after immersion in artificial saliva using micro-computed tomography (μCT). Dentin blocks cut from bovine incisors were treated with deionized water (DW, a negative control) or one of three desensitizers: a fluoride varnish (Duraphat, a positive control), a calcium phosphate desensitizer (Teethmate Desensitizer), and a fluoro-alumino-calcium silicate-based desensitizer (Nanoseal). After each treatment, the specimens in Duraphat, Nanoseal, and Teethmate Desensitizer groups were pre-immersed in artificial saliva (pH 6.5) for either 1 d or 1 wk. The mineral loss of the specimens after demineralization (pH 5.0, 3 h) was evaluated by μCT. The treated surface was investigated with scanning electron microscopy. Mineral loss in all treatment groups was significantly lower than that in DW. Duraphat was the most effective treatment against demineralization, followed by Nanoseal. Nanoseal showed significantly better reduction in mineral loss following immersion for 1 wk in artificial saliva than for 1 d. However, Teethmate Desensitizer and Duraphat did not exhibit enhanced inhibition of demineralization over a longer period of immersion in artificial saliva. Scanning electron microscopy images showed deposition of particles on the dentin in both Teethmate Desensitizer. The application of Teethmate Desensitizer and Nanoseal to the exposed dentin surface resulted in inhibition of demineralization, with Nanoseal resulting in improved inhibition after prolonged immersion in artificial saliva.