Rechargeable microbial anti-adhesive polymethyl methacrylate incorporating silver sulfadiazine-loaded mesoporous silica nanocarriers

Managing massive palatial defect secondary to palatoplasty failures: an in-depth analysis

PURPOSE OF REVIEW

Massive palatal defects resulting from palatoplasty failures arising from cleft palate repair complications present ongoing challenges in clinical practice. The purpose of this review is to provide up-to-date insights into aetiology, risk factors, surgical techniques, and adjunctive therapies, aiming to enhance the understanding of such complex cases, and optimize patient outcomes.

RECENT FINDINGS

Primary palatoplasty has fistula recurrence rates ranging from 2.4% to 55%. Factors such as cleft width, surgical repair method, and patient characteristics, influence the likelihood of failure. Classifications such as the Pakistan Comprehensive Classification and Richardson's criteria aid in assessing defects. Surgical options range from local flaps and revision palatoplasty to regional flaps (e.g., buccinator myomucosal, facial artery-based flaps, tongue flaps, nasal septal flaps) to free microvascular flaps. Alternative approaches include obturator prostheses, and acellular dermal matrix has been used as an adjuvant to multiple repair techniques. Hyperbaric oxygen therapy has emerged as an adjunctive therapy to enhance tissue healing.

SUMMARY

This comprehensive review underscores the intricate challenges associated with massive palatal defects resulting from palatoplasty failures. The diverse range of surgical and nonsurgical options emphasizes the importance of patient-centric, individualized approaches. Practitioners, armed with evidence-based insights, can navigate these complexities, offering tailored interventions for improved patient outcomes.

Mapping the research landscape of nanoparticles and their use in denture base resins: a bibliometric analysis

BACKGROUND

Nanoparticles are increasingly used in dentistry for various applications, including enhancing the mechanical properties of denture base resins. This study aimed to comprehensively review and analyze the research landscape of nanoparticles and their effect on the flexural strength of denture base resins to identify key research areas and trends and to highlight the importance of collaboration between authors and institutions.

METHODS

A Bibliometric Analysis was conducted using the Keywords "Nanoparticle*" AND "Denture*" OR "CAD/CAM." The literature search from the WOS database was restricted to the publication years 2011 to 2022.

RESULTS

Key findings encompass an increase in research publications but a decline in citations. Saudi Arabia, China, and Iraq led this research, with specific institutions excelling. Notable journals with high impact factors were identified. Authorship patterns show variations in citation impact. Additionally, keyword analysis revealed that current research trends offer insights into influential authors and their networks.

CONCLUSIONS

The analysis of nanoparticles and denture base resins reveals a dynamic and evolving landscape that emphasizes the importance of collaboration, staying current with research trends, and conducting high-quality research in this ever-evolving domain.

Mechanophysical and Anti-Adhesive Properties of a Nanoclay-Containing PMMA Denture Resin

Poly(methyl methacrylate) (PMMA) is commonly used for dental dentures, but it has the drawback of promoting oral health risks due to oral bacterial adhesion. Recently, various nanoparticles have been incorporated into PMMA to tackle these issues. This study aims to investigate the mechanophysical and antimicrobial adhesive properties of a denture resin by incorporating of nanoclay into PMMA. Specimens were prepared by adding 0, 1, 2, and 4 wt % surface-modified nanoclay (Sigma) to self-polymerizing PMMA denture resin. These specimens were then evaluated using FTIR, TGA/DTG, and FE-SEM with EDS. Various mechanical and surface physical properties, including nanoindentation, were measured and compared with those of pure PMMA. Antiadhesion experiments were conducted by applying a Candida albicans (ATCC 11006) suspension to the surface of the specimens. The antiadhesion activity of C. albicans was confirmed through a yeast-wall component (mannan) and mRNA-seq analysis. The bulk mechanical properties of nanoclay-PMMA composites were decreased compared to those of pure PMMA, while the flexural strength and modulus met the ISO 20795-1 requirement. However, there were no significant differences in the nanoindentation hardness and elastic modulus. The surface energy revealed a significant decrease at 4 wt % nanoclay-PMMA. The antiadhesion effect of Candida albicans was evident along with nanoclay content in the nanocomposites and confirmed by the reduced attachment of mannan on nanoclay-PMMA composites. mRNA-seq analysis supported overall transcriptome changes in altering attachment and metabolism behaviors on the surface. The nanoclay-PMMA materials showed a lower surface energy as the content increased, leading to an antiadhesion effect against Candida albicans. These findings indicate that incorporating nanoclay into PMMA surfaces could be a valuable strategy for preventing the fungal biofilm formation of denture base materials.

Silica nanoparticles containing nano-silver and chlorhexidine respond to pH to suppress biofilm acids and modulate biofilms toward a non-cariogenic composition

OBJECTIVES

Dental caries is caused by acids from biofilms. pH-sensitive nanoparticle carriers could achieve improved targeted effectiveness. The objectives of this study were to develop novel mesoporous silica nanoparticles carrying nanosilver and chlorhexidine (nMS-nAg-Chx), and investigate the inhibition of biofilms as well as the modulation of biofilm to suppress acidogenic and promote benign species for the first time.

METHODS

nMS-nAg was synthesized via a modified sol-gel method. Carboxylate group functionalized nMS-nAg (COOH-nMS-nAg) was prepared and Chx was added via electrostatic interaction. Minimal inhibitory concentration (MIC), inhibition zone, and growth curves were evaluated. Streptococcus mutans (S. mutans), Streptococcus gordonii (S. gordonii), and Streptococcus sanguinis (S. sanguinis) formed multispecies biofilms. Metabolic activity, biofilm lactic acid, exopolysaccharides (EPS), and TaqMan real-time polymerase chain reaction (RT-PCR) were tested. Biofilm structures and biomass were observed by scanning electron microscopy (SEM) and live/dead bacteria staining.

RESULTS

nMS-nAg-Chx possessed pH-responsive properties, where Chx release increased at lower pH. nMS-nAg-Chx showed good biocompatibility. nMS-nAg-Chx exhibited a strong antibacterial function, reducing biofilm metabolic activity and lactic acid as compared to control (p < 0.05, n = 6). Moreso, biofilm biomass was dramatically suppressed in nMS-nAg-Chx groups. In control group, there was an increasing trend of S. mutans proportion in the multispecies biofilm, with S. mutans reaching 89.1% at 72 h. In sharp contrast, in nMS-nAg-Chx group of 25 μg/mL, the ratio of S. mutans dropped to 43.7% and the proportion of S. gordonii and S. sanguinis increased from 19.8% and 10.9 to 69.8% and 56.3%, correspondingly.

CONCLUSION

pH-sensitive nMS-nAg-Chx had potent antibacterial effects and modulated biofilm toward a non-cariogenic tendency, decreasing the cariogenic species nearly halved and increasing the benign species approximately twofold. nMS-nAg-Chx is promising for applications in mouth rinse and endodontic irrigants, and as fillers in resins to prevent caries.

Highlights on Drug and Ion Release and Recharge Capacity of Antimicrobial Removable Prostheses

This article aimed to review the ion and drug release, recharge abilities, and antimicrobial properties of drug/ion-releasing removable prostheses, and to assess their capability in preventing and inhibiting denture stomatitis as well preventing caries and reversing carious lesions. Data was collected from published scientific papers listed in PubMed database from January 1975 to December 2021. English full-text articles, involving clinical or in vitro studies, focusing on removable prostheses and are concerned with drug/ion release and rechargeability as a way to prevent or inhibit denture stomatitis or dental caries were included. The relevant articles reported that ion- or drug-modified polymethylmethacrylate acts as a reservoir for these ions and drugs and is capable of releasing significant amounts with sustained release effect. Recharging of modified resin resulted in greater sustainability of ion and drug release, thus improving the long-term effects of protection against demineralization and reducing the adhesion of Streptococcus mutans and Candida albicans. Modifications of removable prostheses with rechargeable ions and drugs enhance remineralization, hinder demineralization, and reduce microbial adhesion in difficult-to-access areas. Selection of denture base for clinical use will consider its ability to act as an ion/drug reservoir that is capable of release and recharge.

Overview of incorporation of inorganic antimicrobial materials in denture base resin: A scoping review

STATEMENT OF PROBLEM

Dental hygiene for institutionalized patients and recurring Candida-associated denture stomatitis remain problematic because of a patient's limited dexterity or inability to eliminate Candida from denture surfaces. Although there has been extensive research into antimicrobial modification of denture base resins with inorganic materials, scoping reviews of the literature to identify knowledge gaps or efficacy of inorganic antimicrobial materials in denture base resins are lacking.

PURPOSE

The purpose of this scoping review was to provide a synopsis of the efficacy of the major classes of inorganic antimicrobial materials currently incorporated into denture base resins.

MATERIAL AND METHODS

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews was applied. Four electronic databases, including Embase, PubMed, Web of Science, and Google Scholar, were accessed for articles in the English language, up to February 2019, without restrictions on the date of publication.

RESULTS

From the 53 articles selected, 25 distinguishable inorganic materials were found and divided into 3 subgroups. Forty-three articles evaluated nanomaterials, where mostly silver ion nanoparticles and/or titanium dioxide nanoparticles were incorporated into denture base resins. Fourteen articles examined antimicrobial drugs and medications, including azole group medications, amphotericin-B, Bactekiller, chlorhexidine, Novaron, and Zeomic. Two articles classified as others explored hydroxyapatite- and fiber-incorporated denture base resins.

CONCLUSIONS

Although nanotechnology and antimicrobial medications or drugs have been successfully used to reduce Candida-associated denture stomatitis, long-term solutions are still lacking, and their disadvantages continue to outweigh their advantages.

Cerium oxide nanozymes confer a cytoprotective and bio-friendly surface micro-environment to methacrylate based oro-facial prostheses

Poly-(methyl methacrylate) (PMMA) is the preferred biomaterial for orofacial prostheses used for the rehabilitation of naso-palatal defects. However, conventional PMMA has limitations determined by the complexity of the local microbiota and the friability of oral mucosa adjacent to these defects. Our purpose was to develop a new type of PMMA, i-PMMA, with good biocompatibility and better biological effects such as higher resistance to microbial adhesion of multiple species and enhanced antioxidant effect. The addition of cerium oxide nanoparticles to PMMA using a mesoporous nano-silica carrier and polybetaine conditioning, resulted in an increased release of cerium ions and enzyme mimetic activity, without tangible loss of mechanical properties. Ex vivo experiments confirmed these observations. In stressed human gingival fibroblasts, i-PMMA reduced the levels of reactive oxygen species and increased the expression of homeostasis-related proteins (PPARg, ATG5, LCI/III). Furthermore, i-PMMA increased the levels of expression of superoxide dismutase and mitogen-activated protein kinases (ERK and Akt), and cellular migration. Lastly, we demonstrated the biosafety of i-PMMA using two in vivo models: skin sensitization assay and oral mucosa irritation test, respectively. Therefore, i-PMMA offers a cytoprotective interface that prevents microbial adhesion and attenuates oxidative stress, thus supporting physiological recovery of the oral mucosa.

Changes in mechanical and bacterial properties of denture base resin following nanoceria incorporation with and without SBA-15 carriers

Poly (methyl methacrylate) (PMMA) is a commonly used material for the fabrication of biomedical appliances. Although PMMA has several advantages, it is susceptible to microbial insults with practical use. Therefore, different bioactive nanomaterials, such as nanoceria (CeN), have been proposed to enhance the properties of PMMA. In this study, we investigated the effect of the incorporation of CeN into PMMA with and without the use of mesoporous silica nanoparticle (SBA-15) carriers. The unmodified PMMA specimens (control, CTRL) were compared to groups containing SBA-15, CeN, and the synthesized SBA-15 impregnated with CeN (SBA-15@CeN) at different loading percentages. The mechanical and physical properties of the different SBA-15@CeN groups and their effects on cell viability were investigated, and the optimal CeN concentration was identified accordingly. Our results revealed that flexural strength was significantly (P < 0.01) reduced in the SBA-15@CeN_3× group (containing 3-fold the CeN wt. %). Although the surface microhardness increased with the increase in the wt. % of SBA-15@CeN, cell viability was significantly reduced (P < 0.001). The SBA-15@CeN_1× group had the optimal concentration and displayed significant resistance to single-and multispecies microbial colonization. Finally, the enzymatic activity of CeN was significantly high in the SBA-15@CeN_1× group. The proinflammatory markers (IL-6, IL-1β, TNF-α, CD80, and CD86) showed a significant (P < 0.001) multifold reduction in lipopolysaccharide-induced RAW cells treated with a 5-day eluate of the SBA-15@CeN_1× group. These results indicate that the addition of SBA-15@CeN at 1.5 wt % improves the biological response of PMMA without compromising its mechanical properties.

The application of mesoporous silica nanoparticles as a drug delivery vehicle in oral disease treatment

Mesoporous silica nanoparticles (MSNs) hold promise as safer and more effective medication delivery vehicles for treating oral disorders. As the drug's delivery system, MSNs adapt to effectively combine with a variety of medications to get over systemic toxicity and low solubility issues. MSNs, which operate as a common nanoplatform for the co-delivery of several compounds, increase therapy effectiveness and show promise in the fight against antibiotic resistance. MSNs offer a noninvasive and biocompatible platform for delivery that produces long-acting release by responding to minute stimuli in the cellular environmen. MSN-based drug delivery systems for the treatment of periodontitis, cancer, dentin hypersensitivity, and dental cavities have recently been developed as a result of recent unparalleled advancements. The applications of MSNs to be embellished by oral therapeutic agents in stomatology are discussed in this paper.

Obturator Manufacturing for Oronasal Fistula after Cleft Palate Repair: A Review from Handicraft to the Application of Digital Techniques

An oronasal fistula (ONF) is an abnormal structure between the oral and nasal cavities, which is a common complication of cleft palate repair due to the failure of wound healing. When some patients with ONF are unsuitable for secondary surgical repair, the obturator treatment becomes a potential method. The objectives of the obturator treatment should be summarized as filling the ONF comfortably and cosmetically restoring the dentition with partial function. The anatomy of patients with cleft palate is complex, which may lead to a more complex structure of the ONF. Thus, the manufacturing process of the obturator for these patients is more difficult. For performing the design and fabrication process rapidly and precisely, digital techniques can help, but limitations still exist. In this review, literature searches were conducted through Medline via PubMed, Wiley Online Library, Science Direct, and Web of Science, and 122 articles were selected. The purpose of this review was to introduce the development of the obturator for treating patients with ONF after cleft palate repair, from the initial achievement of the obstruction of the ONF to later problems such as fixation, velopharyngeal insufficiency, and infection, as well as the application of digital technologies in obturator manufacturing.

Effects of incorporation of nanoparticles into dental acrylic resins on antimicrobial and physico-mechanical properties: A meta-analysis of in vitro studies

Background

A meta-analysis study was conducted to determine whether the incorporation of nanoparticles into the dental acrylic resins influence the physico-mechanical properties and whether there are the appropriate nanoparticles exhibiting excellent antimicrobial activity against cariogenic bacteria along with acceptable physico-mechanical properties.

Methods

We systematically searched the various databases up to December 2021. The review was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and the Consolidated Standards of Reporting Trials (CONSORT) guidelines. A meta-analysis of physico-mechanical properties was performed by a random-effects model at a 95% confidence interval and the antimicrobial effects were analyzed descriptively.

Results

27 studies were included for the final analysis. There was no statistically significant difference in flexural strength (0.553, [95% confidence interval (CI) 0.501-0.604]), microhardness (0.509, [95% CI 0.278-0.736]), surface roughness (0.753, [95% CI 0.315-0.953]), impact strength (0.90, [95% CI 0.188-0.997]), and elastic modulus (0.848, [95% CI 0.514-0.967]), with nanoparticles addition compared with the control group. Forest plots were not generated for the thermal conductivity, tensile strength, and translucency because of the lack of comparison. Although the articles showed high heterogeneity without the high risk of bias, the finding showed the nanoparticles at low concentrations into dental acrylic resins could improve the antimicrobial activities without adverse effects on their physico-mechanical properties.

Conclusion

Adding the low concentration of nanoparticles such as 0.5% Ag, ≤0.25% TiO₂, and ≤0.25% SiO₂ as the most abundant antimicrobial nanoparticles do not influence their physico-mechanical properties and can be effective in the elimination of cariogenic pathogens.

Antimicrobial Efficacy of Silver Nanoparticles against Candida Albicans

Current treatment protocols for patients diagnosed with denture stomatitis are under scrutiny, and alternative options are being explored by researchers. The aim of this systematic review was to determine if silver nanoparticles inhibit the growth of Candida albicans, and the research question addressed was: In adults, do silver nanoparticles inhibit the growth of Candida albicans in acrylic dentures and denture liners compared to normal treatment options. A systematic review was the chosen methodology, and criteria were formulated to include all types of studies, including clinical and laboratory designs where the aim was tested. Of the 18 included studies, only one was a clinical trial, and 17 were in vitro research. The inhibition of candidal growth was based on the % concentration of AgNPs included within the denture acrylic and denture liner. As the % AgNPs increased, candida growth was reduced. This was reported as a reduction of candidal colony forming units in the studies. The quality of the included studies was mostly acceptable, as seen from the structured and validated assessments completed.

Mechanical Characterization of Dental Prostheses Manufactured with PMMA-Graphene Composites

The use of a PMMA composite with graphene is being commercialized for application as dental prostheses. The different proportions of fibers provide a wide range of colors that favors dental esthetics in prostheses. However, there are no studies that have explained the influence that graphene has on the mechanical properties. In this contribution, we studied the PMMA and PMMA material with graphene fibers (PMMA-G) in the form of discs as supplied for machining. The presence of graphene fibers has been studied by Raman spectroscopy and the Shore hardness and Vickers micro hardness were determined. Mechanical compression tests were carried out to obtain the values of maximum strength and Young’s modulus (E) and by means of pin-on-disc wear tests, the specific wear rate and the friction coefficients were determined following the established international standards. Finally, the samples were characterized by field emission scanning electron microscopy (FESEM) to characterize the graphene’s morphology inside the PMMA. The results showed the presence of graphene in PMMA and was estimated in an amount of 0.1027% by weight in G-PMMA. The Shore hardness and Vickers microhardness values did not show statistically significant differences. Differences were observed in the compression maximum strength (129.43 MPa for PMMA and 140.23 for PMMA-G) and E values (2.01 for PMMA and 2.89 GPa for PMMA-G) as well as in the lower wear rate for the G-PMMA samples (1.93 × 10−7 for PMMA and 1.33 × 10−7 mm3/N·m) with a p < 0.005. The coefficients of friction for PMMA-G decreased from 0.4032 for PMMA to 0.4001 for PMMA-G. From the results obtained, a slight content in graphene produced a significant improvement in the mechanical properties that could be observed in the prosthesis material. Therefore, we can state that the main attraction of this material for dental prosthesis is its esthetics.

Photocatalytic effect-assisted antimicrobial activities of acrylic resin incorporating zinc oxide nanoflakes

To overcome the deficiency of the antimicrobial effect of polymer, zinc oxide nanoparticles have been widely utilized as advanced nanofillers due to their antimicrobial and photocatalytic activity. However, the underlying antimicrobial mechanism has not been fully understood apart from topological and physical characteristics. In this study, we prepared zinc oxide nanoparticles-based acrylic resin to explore its antimicrobial mechanism under controlled mechanophysical conditions by using silane-treated zinc oxide nanoflakes (S-ZnNFs). S-ZnNFs incorporated acrylic resin (poly(methyl methacrylate), PMMA) composites up to 2 wt% were selected based on comparable mechanophysical properties (e.g., roughness, wettability, strength and hardness), possibly affecting antimicrobial properties beyond the zinc oxide nanoparticle effect, to bare PMMA. Antimicrobial adhesion results were still observed in 2 wt% S-ZnNFs incorporated PMMA using Candida albicans (C. albicans), one of the fungal infection species. In order to confirm the antimicrobial effects by photocatalysis, we pre-exposed the UV light on 2 wt% S-ZnNF composites before cell seeding, revealing synergetic antimicrobial effect via additional reactive oxygen species (ROS) generation to C. albicans over zinc oxide nanoparticle-induced one. RNA-seq analysis revealed distinguished cellular responses between zinc oxide nanoparticles and UV-mediated photocatalytic effect, but both linked to generation of intracellular ROS. Thus, the above data suggest that induction of high intracellular ROS of C. albicans was the main antimicrobial mechanism under controlled mechanophysical parameters and synergetic ROS accumulation can be induced by photocatalysis, recapitulating a promising use of a S-ZnNFs or possibly zinc oxide nanoparticles as intracellular-ROS-generating antimicrobial nanofillers in acrylic composite for biomedical applications.

Autopolymerizing acrylic repair resin containing low concentration of dimethylaminohexadecyl methacrylate to combat saliva-derived bacteria

Biofilm accumulation on the polymethyl methacrylate (PMMA) restorations negatively affect the prognosis of the provisional restorations or the following treatment. This study developed a novel antibacterial PMMA resin containing low concentration of dimethylaminohexadecyl methacrylate (DMAHDM). Four resins were tested: (1) PMMA resin (Control), (2) 1.25% DMAHDM, (3) 2.5% DMAHDM, (4) 5% DMAHDM. Adding 1.25% DMAHDM into the PMMA resin did not influence the mechanical properties, degree of conversion, monomer releasing, and color stability of the specimens (p > 0.05). The incorporation of DMAHDM into PMMA resin could greatly prevent saliva-derived biofilms adhesion compared with the control group (p < 0.05). The metabolism level of saliva-derived biofilms on the 1.25%, 2.5%, and 5% DMAHDM resins were reduced by 20%, 54%, and 62%, respectively. And the mechanism of DMAHDM disturbing the integrity of bacterial cell walls was confirmed by flow cytometric analysis. Adding 1.25% and 2.5% DMAHDM did not compromise cytocompatibility of the modified resin (p > 0.05). Therefore, novel PMMA resin containing low concentration DMAHDM is promising as a future antimicrobial provisional restoration material for preventing microbial-induced complications in clinical settings. Graphical abstract.

Characterization of polymethylmethacrylate microspheres loaded with silver and doxycycline for dental materials applications

OBJECTIVES

The manufacturing of polymethylmethacrylate(PMMA) microspheres loaded with doxycycline(DOX) and/or silver sulfate(Ag₂SO₄) to be incorporated into glass ionomer cement(GIC).

METHODS

PMMA microspheres were manufactured with Ag₂SO₄(1-5%) and/or DOX(5-15%). Particle size, encapsulation efficiency and drug release were measured by light microscope, ICP, and HPLC. Microspheres were added to a dental GIC(20%w/w). Drug release and DTS were investigated. Minimum inhibitory concentration and antibacterial effects of PMMA microspheres into GIC materials were tested.

RESULTS

The median diameter of 50 µm was obtained for microspheres. DOX was encapsulated at an efficiency of 8.3% using a theoretical loading of 15%DOX + 5%Ag₂SO₄. The Ag₂SO₄ encapsulation efficiency was 0.63% using a theoretical loading of 5%AgSO₄. All groups showed burst release within the first day and continued released up to 15 days, with 60-83% of DOX and approximately 30% of silver. For GIC, approximately 15% of DOX and 0.18% of silver were released in a 7-day period. Microbiological results showed an antimicrobial effect against S. mutans when the lead formulation of microspheres was added. The DTS was reduced by the inclusion of microspheres.

SIGNIFICANCE

PMMA microspheres containing DOX and Ag₂SO₄ offer a sustained antimicrobial activity for dental applications and promising potential for the biomedical field.

Mechanical Biocompatibility, Osteogenic Activity, and Antibacterial Efficacy of Calcium Silicate-Zirconia Biocomposites

Zirconia ceramics with high mechanical properties have been used as a load-bearing implant in the dental and orthopedic surgery. However, poor bone bonding properties and high elastic modulus remain a challenge. Calcium silicate (CaSi)-based ceramic can foster osteoblast adhesion, growth, and differentiation and facilitate bone ingrowth. This study was to prepare CaSi-ZrO₂ composites and evaluate their mechanical properties, long-term stability, in vitro osteogenic activity, and antibacterial ability. The Escherichia coli (E. coli) and Staphylococcus aureus (S. aureus) bacteria and human mesenchymal stem cells (hMSCs) were used to evaluate the antibacterial and osteogenic activities of implants in vitro, respectively. Results indicated that the three-point bending strength of ZrO₂ was 486 MPa and Young's modulus was 128 GPa, which were much higher than those of the cortical bone. In contrast, the bending strength and modulus of 20% (201 MPa and 48 GPa, respectively) and 30% CaSi (126 MPa and 20 GPa, respectively) composites were close to the reported strength and modulus of the cortical bone. As expected, higher CaSi content implants significantly enhanced cell growth, differentiation, and mineralization of hMSCs. It is interesting to note the induction ability of CaSi in osteogenic differentiation of hMSCs even when cultured in the absence of an osteogenic differentiation medium. The composite with the higher CaSi contents exhibited the greater bacteriostatic effect against E. coli and S. aureus. In conclusion, the addition of 20 wt % CaSi can effectively improve the mechanical biocompatibility, osteogenesis, and antibacterial activity of ZrO₂ ceramics, which may be a potential choice for load-bearing applications.

Ceria-Incorporated Biopolymer for Preventing Fungal Adhesion

Although biopolymers are widely used in biomedical fields, the issue of poor antimicrobial properties remains unsolved, leading to a potential increase in infections. Here, ceria nanoparticles (CNPs) were incorporated into a representative biopolymer, poly(methyl methacrylate) (PMMA), for drug-free antimicrobial properties. After characterizing the CNPs and surface/mechanical properties of the CNP-PMMA nanocomposite, antiadhesive effects against Candida albicans, the most common fungal species responsible for fungal infections, were determined using metabolic activity assays, and the underlying microbial antiadhesive mechanism was revealed. Hydrothermally fabricated CNPs showed a size of ∼20 nm with a zeta potential of 12 ± 2.3 mV and showed catalytic properties as a ROS modulator. Successful incorporation of CNPs into PMMA up to 2 wt % was confirmed by EDS analysis. The surface roughness and mechanical properties such as flexural strength and modulus were relatively unchanged up to 2 wt %. In contrast, the surface energy increased, and the Vickers hardness decreased in the 2 wt % PMMA compared with the control. A drop of up to 90% of adherent Candida albicans was observed in CNP-incorporated PMMA, which was confirmed and quantified via fungus staining images. The antiadhesive mechanism was revealed from the direct antimicrobial effects of CNP via the upregulation of the intracellular ROS level. Taken together, the antimicrobial-adhesive properties of the CNP-PMMA nanocomposite suggest the potential usefulness of CNP as a promising drug-free antimicrobial ingredient for biopolymers, which could lead to the prevention of microbial-induced complications in clinical settings.

Bibliometric Analysis of Literature Published on Antibacterial Dental Adhesive from 1996-2020

This study aimed to investigate the current state of research on antibacterial dental adhesives. The interest in this field can be drawn from an increasing number of scholarly works in this area. However, there is still a lack of quantitative measurement of this topic. The main aim of this study was to consolidate the research published on the antibacterial adhesive from 1996 to 2020 in Web of Science indexed journals. The bibliometric method, a quantitative study of investigating publishing trends and patterns, was used for this study. The result has shown that a gradual increase in research was found, whereby a substantial increase was observed from 2013. A total of 248 documents were published in 84 journals with total citations of 5107. The highly cited articles were published mainly in Q1 category journals. Most of the published articles were from the USA, China, and other developed countries; however, some developing countries contributed as well. The authorship pattern showed an interdisciplinary and collaborative approach among researchers. The thematic evaluation of keywords along with a three-factor analysis showed that 'antibacterial adhesives' and 'quaternary ammonium' have been used commonly. This bibliometric analysis can provide direction not only to researchers but also to funding organizations and policymakers.

Co-effects of C/Ag dual ion implantation on enhancing antibacterial ability and biocompatibility of silicone rubber

Although silicone implants are the most popular choice around the world for breast augmentation, reconstruction, and revision, due to the poor antibacterial properties and limited biocompatibility of silicone rubber (SR), one of the major complications, capsule contracture, is a lingering problem. To overcome the two main shortcomings, a dual ion implantation technique was applied to modify the surface of SR with the basic skeleton element of organic matter, carbon (C) and the broad-spectrum bactericide, silver (Ag). We present surface characterization, toxicological effects, and evaluation of the mechanical, antibacterial and biocompatible properties of C and Ag co-implanted SR (C/Ag-SRs). After ion implantation, surface roughness and tensile strength of these new materials increased. Biotoxicity was fully assessed by in vitro experiments on human fibroblasts and in vivo experiments on rats, showing that the low-Ag groups met safety standards. Both the anti-bacterial adhesion and bactericidal abilities of C/Ag-SRs were superior to those of SR, which had few antibacterial activities, especially against Staphylococcus epidermidis. With respect to biocompatibility, the adhesion of fibroblasts was promoted, while their proliferation was moderately inhibited on ion-implanted surfaces. After subcutaneous implantation in rats for 7, 30, 90 and 180 d, the capsular thickness around C/Ag-SRs was significantly lower than that around the SR. Additionally, there was no difference in the inflammatory reaction after 7 d of retention in vivo between C/Ag-SRs and SR. The results demonstrate that C/Ag-SRs are desirable shell materials for breast implants.

Incorporation of antimicrobial agents in denture base resin: A systematic review

STATEMENT OF PROBLEM

Denture base resins (DBRs), such as polymethyl methacrylate, are commonly used in the fabrication of removable dentures because of their physical, mechanical, and esthetic properties. However, the denture base acts as a substrate for microorganism adherence and biofilm formation, which may lead to denture stomatitis and be further complicated by fungal infections, of especial importance with geriatric and immunosuppressed patients. Therefore, methods to enhance the antimicrobial property of DBRs will be beneficial.

PURPOSE

The purpose of this systematic review was to evaluate the literature on the antimicrobial activity of DBRs incorporating antimicrobial agents or materials.

MATERIAL AND METHODS

A search of English peer-reviewed literature up to February 2019 reporting on antimicrobial activity of DBRs with respect to antimicrobial agents or materials, antimicrobial test effects and methods, and conclusion or knowledge gaps was conducted by using Embase, Google Scholar, PubMed, and Web of Science databases. Search terms included denture base resin and antibacterial, denture base resin and antifungal, and denture base resin and antimicrobial. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were applied for subsequent data analysis.

RESULTS

Of 2536 identified articles, 28 met the inclusion criteria for the systematic review. Antimicrobial materials were divided into 3 groups: antimicrobial monomer or copolymer, phytochemical or phytomedical components, and other compounds. Strategies on how to incorporate these substances into DBRs and their impact on the reduction and prevention of the growth of microorganisms were identified.

CONCLUSIONS

Although many efforts have been made to improve the antimicrobial ability of DBRs, this systematic review found that the effectiveness of incorporating of antimicrobial agents into DBRs has not been demonstrated conclusively.

Silica Nanoparticles-A Versatile Tool for the Treatment of Bacterial Infections

The rapid emergence of drug resistance continues to outpace the development of new antibiotics in the treatment of infectious diseases. Conventional therapy is currently limited by drug access issues such as low intracellular drug accumulations, drug efflux by efflux pumps and/or enzymatic degradation. To improve access, targeted delivery using nanocarriers could provide the quantum leap in intracellular drug transport and retention. Silica nanoparticles (SiNPs) with crucial advantages such as large surface area, ease-of-functionalization, and biocompatibility, are one of the most commonly used nanoparticles in drug delivery applications. A porous variant, called the mesoporous silica nanoparticles (MSN), also confers additional amenities such as tunable pore size and volume, leading to high drug loading capacity. In the context of bacterial infections, SiNPs and its variants can act as a powerful tool for the targeted delivery of antimicrobials, potentially reducing the impact of high drug dosage and its side effects. In this review, we will provide an overview of SiNPs synthesis, its structural proficiency which is critical in loading and conjugation of antimicrobials and its role in different antimicrobial applications with emphasis on intracellular drug targeting in anti-tuberculosis therapy, nitric oxide delivery, and metal nanocomposites. The role of SiNPs in antibiofilm coatings will also be covered in the context of nosocomial infections and surgical implants.

Preparation of Zn doped mesoporous silica nanoparticles (Zn-MSNs) for the improvement of mechanical and antibacterial properties of dental resin composites

OBJECTIVE

The purpose of this work was to explore the enhancement effect of zinc doped mesoporous silica nanoparticles (Zn-MSNs), which could form micromechanical interlocking with resin matrix and sustainably release Zn²⁺, on the mechanical and antibacterial properties of the dental resin composites.

METHODS

Zn-MSNs were prepared by a sol-gel method, and characterized by scanning electron microscopy (SEM), transmission electron microscopy (TEM) and N₂ adsorption/desorption. The mechanical properties of the dental composites reinforced by Zn-MSNs were measured by a universal mechanical testing machine. Antibacterial activities of dental composites were evaluated by both qualitative and quantitative analysis using Streptococcus mutans (S. mutans). The cytotoxicity of the Zn-MSNs filled dental composites was investigated by osteoblasts (OBs).

RESULTS

The synthesized Zn-MSNs possessed good monodispersity with an average particle size of about 138nm. The mechanical properties of the composites gradually increased with the increase of the content of Zn-MSNs. The flexural strength, flexural modulus, compressive strength and micro-hardness of the composites containing 15wt% Zn-MSNs were 31.21%, 50.47%, 53.83% and 26.79% higher than the samples with no Zn-MSNs, respectively. The antibacterial performance was significantly improved by the addition of Zn-MSNs and the antibacterial rate of the composite with 15wt% of Zn-MSNs reached 100%. Cytotoxicity tests revealed that all the composites were biocompatible during OBs incubation.

SIGNIFICANCE

The prepared Zn-MSNs can effectively improve the mechanical and antibacterial properties of the dental resin composites.

Evaluation of nanomaterials to prevent oral Candidiasis in PMMA based denture wearing patients. A systematic analysis

Purpose

The purpose of this study is the prevention of Candida colonies on PMMA Denture Base by altering the surface and incorporations of Nanoparticles.

Materials and methods

The Pub Med/Medline was searched to identify 100 relevant studies published from 2011 to 2020. The search strategy employed the following keywords related to "use of Nanoparticles in dentistry", "Antimicrobial agents and PMMA", "Candidiasis and nanomaterials", "Prevention of oral Candidiasis", "Incorporation of antimicrobial agents in acrylic dentures," "nanoparticles as therapeutic agents for denture stomatitis", "Nanodentistry" or "Nanotechnology" or "Nanocomposite" or "Nanodrugs" or "Nanomaterials".

Results

Most of the studies shows that modified PMMA denture base resin containing different antimicrobial coatings and incorporation of metal oxides Nanoparticles and other nanomaterials showed antifungal activity in vitro; however some materials in higher concentration showing altered physical and mechanical properties possibly due to aggregation of Nanoparticles in the lattice of PMMA molecules.

Conclusion

Metal oxides nanomaterials revealed cytotoxicity to Candida and other microbes present in oral biofilm including PMMA denture surface. Nano toxicity may attribute to direct interaction of nanoparticles with cell membrane, hindrance in protein synthesis and early adhesion & interfere with physiology of pathogens.

Preparation of Cross-Linkable Waterborne Polyurethane-Acrylate Coating Films with Multifunctional Properties

Self-migration or unstable phase inversion occurs when the application conditions are varied, which limits the application of polyurethane-acrylate (PUA) composite films. In this paper, cross-linked polyurethane/poly(methyl methacrylate-co-borneol acrylate) shell microspheres were prepared by using the seeded emulsion polymerization method. The core-shell structure of these samples was identified by dynamic light scattering (DLS) and high-resolution transmission electron microscope (HR-TEM). Moreover, HR-TEM images indicated that the core-shell structure of the microsphere does not undergo complete phase inversion. In addition, with increasing content of borneol acrylate in the shell, the water resistance and antibacterial adhesion of films were improved. The X-ray photoelectron spectroscopy (XPS), Energy Dispersive Spectrometer (EDS), water contact angle (CA) measurements, antibacterial and anti-adhesion tests demonstrate that the C/N ratios of films from the inside to the upper surface had an obvious gradient in growth, indicating the shell component (polyborneol acrylate) was predominantly present at the surface of films after coalescence in cross-linked core-shell PUA. It was found that a suitable degree of cross-linking contributes to the segregation of the hydrophobic component (borneol groups) on the film surface. As a consequence, the excellent water resistance, cytocompatibility, and antibacterial properties endowed this series of polymer materials with promising application potential in the biomedical field.

Polymeric and inorganic nanoscopical antimicrobial fillers in dentistry

Failure of dental treatments is mainly due to the biofilm accumulated on the dental materials. Many investigations have been conducted on the advancements of antimicrobial dental materials. Polymeric and inorganic nanoscopical agents are capable of inhibiting microorganism proliferation. Applying them as fillers in dental materials can achieve enhanced microbicidal ability. The present review provides a broad overview on the state-of-the-art research in the field of antimicrobial fillers which have been adopted for incorporation into dental materials over the last 5 years. The antibacterial agents and applications are described, with the aim of providing information for future investigations. STATEMENT OF SIGNIFICANCE: Microbial infection is the primary cause of dental treatment failure. The present review provides an overview on the state-of-art in the field of antimicrobial nanoscopical or polymeric fillers that have been applied in dental materials. Trends in the biotechnological development of these antimicrobial fillers over the last 5 years are reviewed to provide a backdrop for further advancement in this field of research.

A New Antibacterial Agent-Releasing Polydimethylsiloxane Coating for Polymethyl Methacrylate Dental Restorations

Chlorhexidine (CHX) has been incorporated into the composition of polymethyl methacrylate (PMMA) dental restorations to enhance their antimicrobial performance. However, the controlled delivery of CHX remains a challenge. Although previous findings with pure silica or polymer coatings demonstrated the resistance to bacterial adhesion, they did not provide antibacterial activity beyond the coated surface. Polydimethylsiloxane (PDMS) and mesoporous silica nanoparticles (MSNs) are widely used in biomedical science as a transfer medium in drug delivery systems. Here, the MSNs are used to encapsulate CHX, and the combination is added to PDMS. A thin coating film is formed on the PMMA, using oxygen plasma and thermal treatment. The liquid chromatography analysis shows that the coating film has high encapsulation efficiency and loading capacity, with a slow and stable release rate of CHX. The cytotoxicity tests also show that the coating does not affect the proinflammatory cytokines, cellular mitotic activity, or apoptotic cell death. The ability of the coating to release CHX indicates that the coating may even be effective against bacteria that are not directly in contact with the surface. This antibacterial protective film is expected to be a novel method to inhibit bacterial activity distal to the coated surfaces of PMMA restorations.

Carbon nanotube incorporation in PMMA to prevent microbial adhesion

Although PMMA-based biomaterials are widely used in clinics, a major hurdle, namely, their poor antimicrobial (i.e., adhesion) properties, remains and can accelerate infections. In this study, carboxylated multiwalled carbon nanotubes (CNTs) were incorporated into poly(methyl methacrylate) (PMMA) to achieve drug-free antimicrobial adhesion properties. After characterizing the mechanical/surface properties, the anti-adhesive effects against 3 different oral microbial species (Staphylococcus aureus, Streptococcus mutans, and Candida albicans) were determined for roughened and highly polished surfaces using metabolic activity assays and staining for recognizing adherent cells. Carboxylated multiwalled CNTs were fabricated and incorporated into PMMA. Total fracture work was enhanced for composites containing 1 and 2% CNTs, while other mechanical properties were gradually compromised with the increase in the amount of CNTs incorporated. However, the surface roughness and water contact angle increased with increasing CNT incorporation. Significant anti-adhesive effects (35~95%) against 3 different oral microbial species without cytotoxicity to oral keratinocytes were observed for the 1% CNT group compared to the PMMA control group, which was confirmed by microorganism staining. The anti-adhesive mechanism was revealed as a disconnection of sequential microbe chains. The drug-free antimicrobial adhesion properties observed in the CNT-PMMA composite suggest the potential utility of CNT composites as future antimicrobial biomaterials for preventing microbial-induced complications in clinical settings (i.e., Candidiasis).

Application of Antimicrobial Nanoparticles in Dentistry

Oral cavity incessantly encounters a plethora of microorganisms. Plaque biofilm-a major cause of caries, periodontitis and other dental diseases-is a complex community of bacteria or fungi that causes infection by protecting pathogenic microorganisms from external drug agents and escaping the host defense mechanisms. Antimicrobial nanoparticles are promising because of several advantages such as ultra-small sizes, large surface-area-to-mass ratio and special physical and chemical properties. To better summarize explorations of antimicrobial nanoparticles and provide directions for future studies, we present the following critical review. The keywords "nanoparticle," "anti-infective or antibacterial or antimicrobial" and "dentistry" were retrieved from Pubmed, Scopus, Embase and Web of Science databases in the last five years. A total of 172 articles met the requirements were included and discussed in this review. The results show that superior antibacterial properties of nanoparticle biomaterials bring broad prospects in the oral field. This review presents the development, applications and underneath mechanisms of antibacterial nanoparticles in dentistry including restorative dentistry, endodontics, implantology, orthodontics, dental prostheses and periodontal field.

Antibacterial and Remineralizing Fillers in Experimental Orthodontic Adhesives

Orthodontic adhesives with antimicrobial and remineralizing properties may be an alternative to control white spot lesions around brackets. The aim of this study is to develop an experimental orthodontic adhesive containing boron nitride nanotubes (BNNT) and alkyl trimethyl ammonium bromide (ATAB). Methacrylate (BisGMA and TEGDMA) monomers were used to formulate the adhesives. Four experimental groups were produced with the addition of 0.1 wt.% BNNT (G_BNNT); 0.1 wt.% ATAB (G_ATAB); and 0.2 wt.% BNNT with ATAB (G_BNNT/ATAB); in the control group, no fillers were added (G_Ctrl). The degree of conversion, cytotoxicity, softening in solvent, contact angle and free surface energy, antibacterial activity, shear bond strength, and mineral deposition were evaluated. Adhesives achieved degree of conversion higher than 50% and cell viability higher than 90%. G_BNNT and G_ATAB adhesives exhibited reduced softening in solvent. Mean free surface energy was decreased in the G_BNNT adhesive. Significant reduction in bacterial growth was observed in the G_BNNT/ATAB. No statistical difference was found for shear bond strength. Mineral deposition was found in G_BNNT, G_ATAB, and G_BNNT/ATAB groups after 14 and 28 days. The addition of 0.2% BNNT/ATAB to an experimental orthodontic adhesive inhibited bacterial growth and induced mineral deposition without affecting the properties of the material.

Dual-ion delivery for synergistic angiogenesis and bactericidal capacity with silica-based microsphere

Inhibition of bacterial growth with the simultaneous promotion of angiogenesis has been challenging in the repair and regeneration of infected tissues. Here, we aim to tackle this issue through the use of cobalt-doped silicate microspheres that can sustainably release dual ions (silicate and cobalt) at therapeutically-relevant doses. The cobalt was doped up to 2.5 wt% within a sol-gel silicate glass network, and microspheres with the size of ∼300 μm were generated by an emulsification method. The cobalt and silicate ions released were shown to synergistically upregulate key angiogenic genes, such as HIF1-α, VEGF and the receptor KDR. Moreover, the incorporation of ions promoted the polarization, migration, homing and sprouting angiogenesis of endothelial cells. Neo-vascular formation was significantly higher in the dual-ion delivered microspheres, as evidenced in a chicken chorioallantoic membrane model. When cultured with bacterial species, the cobalt-doped microspheres effectively inhibited bacteria growth in both indirect or direct contacts. Of note, the bacteria/endothelial cell coculture model proved the efficacy of dual-ion releasing microcarriers for maintaining the endothelial survivability against bacterial contamination and their cell-cell junction. The current study demonstrates the multiple actions (proangiogenic and antibacterial) of silicate and cobalt ions released from microspheres, and the concept provided here can be extensively applied to repair and regenerate infected tissues as a growth factor- or drug-free delivery system. STATEMENT OF SIGNIFICANCE: While several ions have been introduced to biomaterials for therapeutic purposes, relaying the effects of antibacterial into tissue regenerative (e.g., angiogenesis) has been a significant challenge. In this study, we aim to develop a biomaterial platform that has the capacity of both 'antibacterial' and 'proangiogenic' from a microsphere sustainably releasing multiple ions (herein cobalt and silicate). Here, dual-actions of the microspheres revealed the stimulated endothelial functions as well as the inhibited growth of different bacterial species. In particular, protecting endothelial survivability against bacterial contamination was reported using the bacterial/endothelial co-culture model. The current concept of drug-free yet multiple-ion delivery biomaterials can be applicable for the repair and regeneration of infected tissues with dual actions of angiogenesis and suppressing bacterial activity.

Multi-functional nano-adhesive releasing therapeutic ions for MMP-deactivation and remineralization

Restoration of hard tissue in conjunction with adhesive is a globally challenging issue in medicine and dentistry. Common clinical therapies involving application of adhesive and substitute material for functional or anatomical recovery are still suboptimal. Biomaterials with bioactivity and inhibitory effects of enzyme-mediated adhesive degradation can render a solution to this. Here, we designed a novel copper-doped bioactive glass nanoparticles (CuBGn) to offer multifunction: metalloproteinases (MMP) deactivation and remineralization and incorporated the CuBGn in resin-dentin adhesive systems, which showed most common failure of MMP mediated adhesive degradation among hard tissue adhesives, to evaluate proposed therapeutic effects. A sol-gel derived bioactive glass nanoparticles doping 10 wt% of Cu (Cu-BGn) for releasing Cu ions, which were well-known MMP deactivator, were successfully created and included in light-curing dental adhesive (DA), a filler-free co-monomer resin blend, at different concentrations (up to 2 wt%). These therapeutic adhesives (CuBGn-DA) showed enhanced (a)cellular bioactivity, cytocompatibility, microtensile bond strength and MMP deactivation-ability. In conclusion, the incorporation of Cu ions releasing nano-bioactive glass demonstrated multifunctional properties at the resin-dentin interface; MMP deactivation and remineralization, representing a suitable strategy to extend the longevity of adhesive-hard tissue (i.e. resin-dentin) interfaces.