Remineralising fluorine containing bioactive glass composites

A review of new generation of dental restorative resin composites with antibacterial, remineralizing and self-healing capabilities

Dental restorative resin composites are widely used to repair tooth decay owing to attractive esthetics, adequate mechanical properties and minimally invasive tooth structure preparations. Nevertheless, dental restorative resin composites still face challenges because of their relatively high failure rate and short lifespan caused by secondary caries and bulk fracture. Thus, attempts have been carried out to explore a new generation of dental restorative resin composites with antibacterial, remineralizing, and self-healing capabilities to inhibit bacteria and lengthen the lifetime of the restorations. Such novel restorative composites can inhibit bacterial activity, reduce acid production, promote mineral regeneration and present a renewable advantage to achieve a higher performance, which are inspiring and provide support for further basic and clinical research. In this review, antibacterial dental restorative resin composites are first introduced, followed by remineralizing, self-healing, and multifunctional dental resin composites with two or more of the functions mentioned above. Meanwhile, we explain the mechanism of the corresponding dental restorative resin composites and describe their characteristics. Finally, we conclude and put forward prospects. This review will attract both researchers and clinicians in this field and help to provide innovative ideas to design new restorative resin composites for biomedical applications.

Applications of smart materials in minimally invasive dentistry - some research and clinical perspectives

OBJECTIVES

Dental caries is one of the most prevalent bacteria-induced non-communicable diseases globally. It is known to be the top oral health burden in both developing and developed nations. There is substantial literature on the disease process and there is still debate on the extent of caries removal needed and the adequacy of the materials available to restore the lost tooth structure. The current review discusses the disease process together with the contemporary management of the carious lesion and also presents substantial evidence on novel materials and techniques that make minimally invasive dentistry predictable.

METHODS

The written work presented shows the most relevant literature for the management of dental caries focusing on novel materials used in minimally invasive dentistry.

RESULTS

There is still much to learn about specific antimicrobial and caries prevention mechanisms of novel materials. Materials that respond to a single or a few stimuli remain "weakly intelligent" in the face of the complex microenvironment in the oral cavity. Engineered systems that combine artificial intelligence and chemical engineering, are expected to possess higher intelligence, self-healing capabilities as well as environmental adaptability, and may be future promising research directions.

SIGNIFICANCE

The targeted approach in managing dental caries will hopefully have a better clinical outcome. The strategies discussed are alternatives to the contemporary approach and will improve the clinical management.

Water-Induced Changes in Experimental Resin Composites Functionalized with Conventional (45S5) and Customized Bioactive Glass

The aim of the study was to evaluate microhardness, mass changes during 1-year water immersion, water sorption/solubility, and calcium phosphate precipitation of experimental composites functionalized with 5-40 wt% of two types of bioactive glass (BG): 45S5 or a customized low-sodium fluoride-containing formulation. Vickers microhardness was evaluated after simulated aging (water storage and thermocycling), water sorption and solubility were tested according to ISO 4049, and calcium phosphate precipitation was studied by scanning electron microscopy, energy dispersive X-ray spectroscopy, and Fourier-transform infrared spectroscopy. For the composites containing BG 45S5, a significant reduction in microhardness was observed with increasing BG amount. In contrast, 5 wt% of the customized BG resulted in statistically similar microhardness to the control material, while higher BG amounts (20 and 40 wt%) resulted in a significant improvement in microhardness. Water sorption was more pronounced for composites containing BG 45S5, increasing 7-fold compared to the control material, while the corresponding increase for the customized BG was only 2-fold. Solubility increased with higher amounts of BG, with an abrupt increase at 20 and 40 wt% of BG 45S5. Calcium phosphate was precipitated by all composites with BG amounts of 10 wt% or more. The improved properties of the composites functionalized with the customized BG indicate better mechanical, chemical, and dimensional stability without compromising the potential for calcium phosphate precipitation.

Polyvinylpyrrolidone Nanofibers Incorporating Mesoporous Bioactive Glass for Bone Tissue Engineering

Composite biomaterials that combine osteoconductive and osteoinductive properties are a promising approach for bone tissue engineering (BTE) since they stimulate osteogenesis while mimicking extracellular matrix (ECM) morphology. In this context, the aim of the present research was to produce polyvinylpyrrolidone (PVP) nanofibers containing mesoporous bioactive glass (MBG) 80S15 nanoparticles. These composite materials were produced by the electrospinning technique. Design of experiments (DOE) was used to estimate the optimal electrospinning parameters to reduce average fiber diameter. The polymeric matrices were thermally crosslinked under different conditions, and the fibers' morphology was studied using scanning electron microscopy (SEM). Evaluation of the mechanical properties of nanofibrous mats revealed a dependence on thermal crosslinking parameters and on the presence of MBG 80S15 particles inside the polymeric fibers. Degradation tests indicated that the presence of MBG led to a faster degradation of nanofibrous mats and to a higher swelling capacity. The assessment of in vitro bioactivity in simulated body fluid (SBF) was performed using MBG pellets and PVP/MBG (1:1) composites to assess if the bioactive properties of MBG 80S15 were kept when it was incorporated into PVP nanofibers. FTIR and XRD analysis along with SEM-EDS results indicated that a hydroxy-carbonate apatite (HCA) layer formed on the surface of MBG pellets and nanofibrous webs after soaking in SBF over different time periods. In general, the materials revealed no cytotoxic effects on the Saos-2 cell line. The overall results for the materials produced show the potential of the composites to be used in BTE.

Multifunctional dental resin composite with antibacterial and remineralization properties containing nMgO-BAG

The inherent characteristics of resin composite can lead to micro-leakage after polymerization shrinkage. The bacteria invasion through edge micro-leakage and attachment onto the material surface can cause secondary caries, reducing the service life of resin composites. In this study, magnesium oxide nanoparticles (nMgO) as an inorganic antimicrobial agent and bioactive glass (BAG) as a remineralization agent were simultaneously incorporated into the resin composite. With the addition of both nMgO and BAG, the resin composite showed an excellent antimicrobial effect compared to the resin composite with nMgO or BAG only. The remineralization capacity of demineralized dentin increased with the increasing content of BAG. Vickers hardness, compressive strength, and flexural strength of the resin composite with nMgO-BAG were not significantly affected compared to the ones with the same total filler amount but with BAG only. The depth of cure and water sorption values of the resin composite showed an increasing trend with the increasing total amount of nMgO and BAG fillers. This developed multifunctional resin composite is expected to reduce bacterial invasion and promote remineralization of early caries damage.

Mechanical Properties and Biocompatibility of 3D Printing Acrylic Material with Bioactive Components

The aim of this study was to create a 3D printing material with bioactive properties that potentially could be used for a transparent removable orthodontic appliance.

MATERIALS AND METHODS

To acrylic monomers, four bioactive glasses at 10% concentration were added, which release Ca, P, Si and F ions. The materials were printed on a 3D printer and tested for flexural strength (24 h and 30 days), sorption and solubility (7 days), ion release to artificial saliva pH = 4 and 7 (42 days) and cytotoxicity in the human fibroblast model. The released ions were determined by plasma spectrometry (Ca, P and Si ions) and ion-selective electrode (F measurement)s.

RESULTS

The material obtained released Ca2+ and PO43- ions for a period of 42 days when using glass Biomin C at pH 4. The flexural strength depended on the direction in which the sample was printed relative to the 3D printer platform. Vertically printed samples had a resistance greater than 20%. The 10% Biomin C samples post-cured for 30 min with light had a survival rate of the cells after 72 h of 85%.

CONCLUSIONS

Material for 3D printing with bioactive glass in its composition, which releases ions, can be used in the production of orthodontic aligners.

A Narrative Review of Bioactive Glass-Loaded Dental Resin Composites

This review aims to provide a comprehensive analysis of the characterizations of bioactive glass (BAG)-loaded dental resin-based composite materials. Online databases (Web of Science, PubMed, and Science Direct) were used to collect data published from January 2011 to January 2022. Only BAG-containing resin adhesive and resin restorative composites are discussed in this narrative review. BAG-loaded resin composites exhibit excellent mineralization ability reflecting enhanced ion release, pH elevation, and apatite formation, especially regarding high BAG loading. This aids the anti-demineralization and remineralization of teeth. Furthermore, BAG-loaded resin composites demonstrated in vitro biocompatibility and antibacterial performance. It has been suggested that BAG fillers with small particle sizes and no more than 20 wt% in terms of loading amount should be used to guarantee the appropriate mechanical properties of resin composites. However, most of these studies focused on one or some aspects using different resin systems, BAG types, and BAG amounts. As such, this makes the comparison difficult, and it is essential to find an optimal balance between different properties. BAG-loaded resin composites can be regarded as bioactive materials, which present major benefits in dentistry, especially their capability in the bacterial inhibition, cell biocompatibility, anti-demineralization, and remineralization of teeth.

Improved Flexural Properties of Experimental Resin Composites Functionalized with a Customized Low-Sodium Bioactive Glass

This study evaluated the flexural properties of an experimental composite series functionalized with 5-40 wt% of a low-Na F-containing bioactive glass (F-series) and compared it to another experimental composite series containing the same amounts of the conventional bioactive glass 45S5 (C-series). Flexural strength and modulus were evaluated using a three-point bending test. Degree of conversion was measured using Fourier-transform infrared spectroscopy. Weibull analysis was performed to evaluate material reliability. The control material with 0 wt% of bioactive glass demonstrated flexural strength values of 105.1-126.8 MPa). In the C-series, flexural strength ranged between 17.1 and 121.5 MPa and was considerably more diminished by the increasing amounts of bioactive glass than flexural strength in the F-series (83.8-130.2 MPa). Analogously, flexural modulus in the C-series (0.56-6.66 GPa) was more reduced by the increase in bioactive glass amount than in the F-series (5.24-7.56 GPa). The ISO-recommended "minimum acceptable" flexural strength for restorative resin composites of 80 MPa was achieved for all materials in the F-series, while in the C-series, the materials with higher bioactive glass amounts (20 and 40 wt%) failed to meet the requirement of 80 MPa. The degree of conversion in the F-series was statistically similar or higher compared to that of the control composite with no bioactive glass, while the C-series showed a declining degree of conversion with increasing bioactive glass amounts. In summary, the negative effect of the addition of bioactive glass on mechanical properties was notably less pronounced for the customized bioactive glass than for the bioactive glass 45S5; additionally, mechanical properties of the composites functionalized with the customized bioactive glass were significantly less diminished by artificial aging. Hence, the customized bioactive glass investigated in the present study represents a promising candidate for functionalizing ion-releasing resin composites.

Preparation and characterization of acrylic resins with bioactive glasses

This study aimed to prepare a bioactive acrylic material by adding different types of glasses. Commercially available polymerized acrylic resin was mixed with 10% of four different types of glasses in the powder form and cured. Flexural strength, sorption, and solubility of the samples were tested according to ISO 20795-1:2013. The total number of samples used in the tests were 60. The materials were placed in artificial saliva of pH 4 and 7, and elution was performed for 0, 1, 28, and 42 days. The collected samples were analyzed using inductively coupled plasma atomic emission spectrometry to detect Ca, P, and Si ions and using ion chromatography to detect F ions. The materials obtained after modification with glasses showed lower compressive strength compared with pure polymethyl methacrylate but met the standard requirements. Two glass types showed higher solubility values compared with the value defined by the ISO standard. Biomin C and S53P4 released Ca, P, and Si ions, respectively, after 42 days in artificial saliva. Acrylic resins modified with 10% Biomin C and S53P4 glasses can be a valuable source of Ca and P ions under acid conditions for 28 and 42 days.

Are inert glasses really inert?

OBJECTIVES

The aim of this study was to investigate the degradation of inert glass fillers which are commonly used in conventional resin-based composites to provide radiopacity, reduce the polymerization shrinkage and improve the mechanical properties.

METHODS

75 mg of five different glass powders (1 µm) was immersed separately into 50 mL of acetic acid (pH 4) and tris buffer (pH 7.4) for up to 4 weeks. At each time point the glass powder was filtered and dried for characterization using ATR-FTIR and XRD to assess the degradation behavior and crystallization. ICP-OES, ISE and pH measurements were performed on the supernatant solutions to monitor the pH and ion release.

RESULTS

Although FTIR and XRD analysis showed no significant glass degradation or crystallization upon immersion, there was a substantial release of ions from the inert fillers, especially from BABFG and CDL. Barium release for these fillers were 270 and 165 ppm respectively. G018-373 glass presented the lowest ion release followed by GM27884 and BABG. The ion release was more pronounced in acidic conditions compared to neutral conditions apart from the fluoride release.

SIGNIFICANCE

Inert glasses are not as inert as previously thought. This may result in leaching of ions, potentially causing toxicity, reduction in mechanical properties, increased wear and subsequent failure of the composite material. The ions released from the inert glass may interfere with other glass fillers such as bioactive glass fillers, inhibiting degradation of the bioactive glass, beneficial ion release from the bioactive glass, pH neutralization and apatite formation.

Glass ionomer polyalkenoate cements and related materials: past, present and future

The aim of this article is to review the development of glass ionomer cements (GICs) over the last 40 years and look critically at both their clinical advantages and disadvantages. Primarily, it will explore the future development of both GICs and related ion-releasing materials in relation to improved mechanical properties, capability to prevent secondary caries and promoting remineralisation of hard carious dentine left after minimal cavity preparation procedures, including atraumatic restorative treatment. This article will also introduce new materials with a focus on degradable fluorine-containing glass fillers, including alkasite glasses and fluorine-containing bioactive glasses, that have the capability to raise the pH and promote remineralisation with the potential for fluorapatite formation.

Sol-gel bioactive glass containing biomaterials for restorative dentistry: A review

OBJECTIVE

Bioactive glasses (BAGs) have been researched extensively for dentistry due to their favourable biocompatibility and hard tissue bonding ability. However, the specific application of BAGs produced through sol-gel synthesis in restorative dentistry has not been reviewed previously. This review provides a comprehensive account of the principles behind sol-gel derived BAGs and their investigation for dental tissue restoration materials.

METHODS

A search for in vitro and in vivo studies was performed using the databases Web of Science®, Medline®, Scopus® and Google Scholar®. Articles published over the past 20 years were selected and data on the BAG composition and morphology was extracted. Analysis of the effect of specific BAG additives on the properties of experimental dental materials was also performed.

RESULTS

A majority of BAG particles investigated were spheres ranging in size from 5 nm to ~650 µm. Sol-gel BAGs are mainly applied in the treatment of hypersensitive dentine and for pulp-dentine tissue engineering, while a handful have been used in target drug delivery. BAG fillers are promising additives that result in improved biological properties, antibacterial effects, hardness, acid buffering and remineralization. Unfortunately, some detrimental effects on optical properties have been observed with BAG addition. Additionally, in vivo data, investigations into radiopacity and standardization of test protocols are identified as areas for improvement and further studies.

SIGNIFICANCE

Future work should consider the pertinent issues raised in order to improve the quality of available data and expand knowledge in this area of dental biomaterials research and development.

Enamel Remineralization Competence of a Novel Fluoride-Incorporated Bioactive Glass Toothpaste-A Surface Micro-Hardness, Profilometric, and Micro-Computed Tomographic Analysis

This study aimed to analyze the enamel remineralization efficacy of a novel fluoridated bioactive glass (F-BG) toothpaste compared to a standard fluoride toothpaste. Seventy-two enamel blocks (N = 72) were divided into groups of twenty-four blocks according to the toothpaste exposure—group 1: brushed with distilled water, group 2: brushed with fluoride toothpaste (Colgate^TM), and group 3: brushed with F-BG toothpaste (BioMinF^TM). Pre-brushing, enamel blocks were demineralized using 6 wt.% citric acid (pH = 2.4). Tooth brushing was performed using a mixture of respective toothpaste and artificial saliva (AS), and each enamel block received 5000 linear strokes. The samples were assessed for surface micro-hardness (to estimate Vickers hardness number, VHN), surface roughness (Ra), and volume loss/gain using micro-computed tomography (micro-CT). The highest increase in the VHN was noticed for group 3 (117.81) followed by group 2 (61.13), and all the intragroup comparisons were statistically significant (p < 0.05). Demineralization increased the Ra values, and a decrease was observed post-remineralization for all the groups. The maximum Ra decrease was observed for group 3 (−223.2 nm) followed by group 2 (−55.6 nm), and all the intragroup comparisons were again statistically significant (p < 0.05). Micro-CT investigation revealed that the enamel volume decreased after demineralization and increased after remineralization among all groups. The F-BG toothpaste showed greater enamel surface micro-hardness (increased VHN), smoother surface (low roughness), and better volume restoration (remineralization) in comparison to the fluoride toothpaste.