Enamel-like tissue regeneration by using biomimetic enamel matrix proteins

Self-assembled branched polypeptides as amelogenin mimics for enamel repair

The regeneration of demineralized enamel holds great significance in the treatment of dental caries. Amelogenin (Ame), an essential protein for mediating natural enamel growth, is no longer secreted after enamel has fully matured in childhood. Although biomimetic mineralization based on peptides or proteins has made significant progress, easily accessible, low-cost, biocompatible and highly effective Ame mimics are still lacking. Herein, we construct a series of amphiphilic branched polypeptides (CAMPs) by facile coupling of the Ame's C-terminal segment and poly(γ-benzyl-L-glutamate), which serves to simulate the Ame's hydrophobic N-terminal segment. Among them, CAMP15 is the best biomimetic mineralization template with great self-assembly performance to guide the oriented crystallization of hydroxyapatite and is capable of inhibiting the adhesion of Streptococcus mutans and Staphylococcus aureus on the enamel surfaces. This work highlights the potential application of amphiphilic branched polypeptide as Ame mimics in repairing defected enamel, providing a promising strategy for prevention and treatment of dental caries.

Remineralizing effects of hydroxypropyl methylcellulose film-loaded amorphous calcium phosphate nanoprecursors on enamel artificial caries lesions

OBJECTIVES

This study was to investigate hydroxypropyl methylcellulose (HPMC) film as a carrier for amorphous fluorinated calcium phosphate (AFCP) nanoprecursors to continuously deliver biomimetic remineralization of enamel artificial caries lesions (ACL).

MATERIALS AND METHODS

The AFCP/HPMC films were comprised of 25 wt% AFCP nanoparticles and 75 wt% HPMC. They were characterized by transmission electron microscopy (TEM), Fourier transform infrared spectroscopy (FTIR), X-ray diffraction (XRD), X-ray photoelectron spectroscopy (XPS), and biocompatibility tests. Forty enamel ACL were prepared and randomly divided into four groups (n = 10): The enamel surfaces were covered with a pure HPMC film, Tooth Mousse Plus (contains 10% CPP-ACP and 0.2% NaF), and AFCP/HPMC film, or without any things (serving as negative control). Subsequently, all samples were alternatively kept in artificial saliva and a modified pH-cycling before they were characterized by Micro-CT, scanning electron microscopy (SEM), energy-dispersive X-ray spectroscopy (EDX), attenuated total reflectance (ATR)-FTIR, XRD, and nanoindentation.

RESULTS

After the enamel ACL was challenged by pH cycling, Tooth Mousse Plus and AFCP/HPMC film groups exhibited less lesion depth and mineral loss than the negative control and pure HPMC film groups. Additionally, the AFCP/HPMC film group revealed a highest remineralization rate of 55.34 ± 3.10 % among the all groups (p < 0.001). The SEM findings showed that the enamel ACL were densely deposited with minerals in the AFCP/HPMC film group, and the EDX results suggested a higher content of fluorine in the remineralized tissues. In particular, the AFCP/HPMC film group exhibited the best nanomechanical performance after 2 weeks of pH cycling (p < 0.05), with the hardness (H) restored from 0.29 ± 0.19 to 2.69 ± 0.70 GPa, and elastic modulus (Er) restored from 10.77 ± 5.30 to 68.83 ± 12.72 GPa.

CONCLUSION

The AFCP/HPMC film might be used as a promising strategy for arresting or reversing incipient enamel caries lesions.

Research progress of biomimetic materials in oral medicine

Biomimetic materials are able to mimic the structure and functional properties of native tissues especially natural oral tissues. They have attracted growing attention for their potential to achieve configurable and functional reconstruction in oral medicine. Though tremendous progress has been made regarding biomimetic materials, significant challenges still remain in terms of controversy on the mechanism of tooth tissue regeneration, lack of options for manufacturing such materials and insufficiency of in vivo experimental tests in related fields. In this review, the biomimetic materials used in oral medicine are summarized systematically, including tooth defect, tooth loss, periodontal diseases and maxillofacial bone defect. Various theoretical foundations of biomimetic materials research are reviewed, introducing the current and pertinent results. The benefits and limitations of these materials are summed up at the same time. Finally, challenges and potential of this field are discussed. This review provides the framework and support for further research in addition to giving a generally novel and fundamental basis for the utilization of biomimetic materials in the future.

Treatment Approaches to Molar Incisor Hypomineralization: A Systematic Review

AIM

This systematic review aimed to comprehensively evaluate the available literature on treating molar incisor hypomineralization (MIH) or enamel hypomineralization published between 2013 and 2023, focusing on identifying relevant studies and their characteristics.

MATERIALS AND METHODS

The search process encompassed reputable academic databases, including PubMed, Scopus, Cochrane Library, and Web of Science, using a precise keyword strategy ("((molar incisor hypomineralization) OR (enamel hypomineralization)) AND (treatment)"). A total of 637 articles were initially retrieved, followed by a strict selection process adhering to PRISMA guidelines. The inclusion criteria encompassed Randomized Control Trials (RCTs), case series with more than five clinical cases (CSs), studies involving human participants, availability as free full-text or accessible with university credentials, and English-language publications. Exclusion criteria included systematic or literature reviews, editorials, single-case reports, studies conducted in vitro, those involving animals, paid articles, and non-English-language publications.

RESULTS

The search yielded 864 articles, of which 23 met the stringent inclusion criteria after a meticulous selection process. These studies will serve as the basis for a comprehensive analysis of MIH treatment approaches. The systematic review ensures the quality and relevance of the chosen studies for a detailed assessment of MIH treatment strategies.

CONCLUSIONS

This systematic review will provide valuable insights into the characteristics of selected studies, patient profiles, and available treatment options for molar incisor hypomineralization, contributing to a better understanding of this dental condition's management.

Functional Covalent Organic Framework (COF) Nanoparticles for Biomimic Mineralization and Bacteria Inhabitation

Biomimic mineralization of hard tissues with hierarchical structures is a challenging task, while designing multifunctional materials possessing both the ability of biomimic mineralization and drug delivery is even more difficult. Herein, inspired by the multilevel structure and mineralization ability of amelogenin, a novel carboxyl-functionalized covalent organic framework (COF) nanosphere material was designed and synthesized, which exhibited a significant biomimetic remineralization ability as demonstrated on SiO2 glass, Ti6Al4V, and an acid-etched enamel surface. Furthermore, the nanoporous structure also enables the COF nanospheres to serve as a drug delivery system for the controlled release of antibacterial drugs. This work provides a promising strategy for the design of multifunctional biomimic materials.

Biomineralization of calcium phosphates functionalized with hydroxyapatite-binding peptide

Functionalization of calcium phosphates with biomimetic peptides is a promising strategy to increase cellular response for bone tissue repair. In this work, biphasic calcium phosphate pellets were functionalized with the hydroxyapatite-binding peptide pVTK by dropping a suspension of the peptide on the pellet surface. The bioactivity tests were performed in vitro by using McCoy culture medium. Cytotoxicity tests were also performed to assess cell viability. The material was characterized by X-ray diffraction (XRD), Fourier transform infrared spectroscopy (FTIR) and scanning electron microscopy with field emission gun (FEG-SEM). The results showed that functionalization with the biomimetic peptide was most effective in inducing precipitation of bone-like apatite on the pellets surface, when compared to the control groups (two positive control groups and one negative control group). Cytotoxicity tests showed that all samples are biocompatible but the pellets with peptide showed the highest values of cell viability.

A Study of the Peculiarities of the Formation of a Hybrid Interface Based on Polydopamine between Dental Tissues and Dental Composites, Using IR and Raman Microspectroscopy, at the Submicron Level

The creation of buffer (hybrid) layers that provide improved adhesion to two heterogeneous materials is a promising and high-priority research area in the field of dental materials science. In our work, using FTIR and Raman microspectroscopy at the submicron level in a system of dental composites/intact dental enamel, we assessed the molecular features of formation and chemically visualized the hybrid interface formed on the basis of a nature-like adhesive, polydopamine (PDA). It is shown that a homogeneous bioinspired PDA-hybrid interface with an increased content of O-Ca-O bonds can be created using traditional methods of dental tissue pretreatment (diamond micro drilling, acid etching), as well as the subsequent alkalinization procedure and the developed synthesis technology. The development of the proposed technology for accelerated deposition of PDA-hybrid layers, as well as the creation of self-assembled biomimetic nanocomposites with antibacterial properties, may in the future find clinical application for minimally invasive dental restoration procedures.

Cementum is key to periodontal tissue regeneration: A review on apatite microstructures for creation of novel cementum-based dental implants

The cementum is the outermost layer of hard tissue covering the dentin within the root portion of the teeth. It is the only hard tissue with a specialized structure and function that forms a part of both the teeth and periodontal tissue. As such, cementum is believed to be critical for periodontal tissue regeneration. In this review, we discuss the function and histological structure of the cementum to promote crystal engineering with a biochemical approach in cementum regenerative medicine. We review the microstructure of enamel and bone while discussing the mechanism underlying apatite crystal formation to infer the morphology of cementum apatite crystals and their complex structure with collagen fibers. Finally, the limitations of the current dental implant treatments in clinical practice are explored from the perspective of periodontal tissue regeneration. We anticipate the possibility of advancing periodontal tissue regenerative medicine via cementum regeneration using a combination of material science and biochemical methods.

Smart dental materials for antimicrobial applications

Smart biomaterials can sense and react to physiological or external environmental stimuli (e.g., mechanical, chemical, electrical, or magnetic signals). The last decades have seen exponential growth in the use and development of smart dental biomaterials for antimicrobial applications in dentistry. These biomaterial systems offer improved efficacy and controllable bio-functionalities to prevent infections and extend the longevity of dental devices. This review article presents the current state-of-the-art of design, evaluation, advantages, and limitations of bioactive and stimuli-responsive and autonomous dental materials for antimicrobial applications. First, the importance and classification of smart biomaterials are discussed. Second, the categories of bioresponsive antibacterial dental materials are systematically itemized based on different stimuli, including pH, enzymes, light, magnetic field, and vibrations. For each category, their antimicrobial mechanism, applications, and examples are discussed. Finally, we examined the limitations and obstacles required to develop clinically relevant applications of these appealing technologies.

Recombinant amelogenin peptide TRAP promoting remineralization of early enamel caries: An in vitro study

Objective: To explore the regulatory effect of recombinant amelogenin peptide TRAP on the remineralization of early enamel carious lesions. Methods: Forty-eight bovine enamel blocks that prepared initial lesions in vitro were split at random into four groups for immersion treatment for 12 days: 1) remineralizing medium; 2) studied peptide 1 (consisting of the N- and C-termini of porcine amelogenin) + remineralizing medium; 3) studied peptide 2 (TRAP) + remineralizing medium; 4) fluoride + remineralizing medium. After demineralization and remineralization immersion, each specimen's mean mineral loss and lesion depth were measured using micro-computed tomography (micro-CT). The changes in lesion depth (∆LD) and mineral gain (∆Z) were computed following remineralization. The enamel samples were then cut into sections and examined with polarized light microscopy (PLM). The cross-section morphology was observed by scanning electron microscopy (SEM). The crystal phase was analyzed by an X-ray micro-diffractometer (XRD). The calcium-binding properties were determined using isothermal titration calorimetry (ITC). Results: Micro-CT analysis revealed a significant reduction in mineral loss in the four groups following the remineralization treatment (p < 0.05). The treatment with fluoride resulted in the greatest ∆Z and ∆LD, whereas the treatment with a remineralizing medium showed the least ∆Z and ∆LD among all groups. The ∆Z and ∆LD of the studied peptide 1 and studied peptide 2 groups were greater than those of the remineralizing medium group. However, there was no significant difference between the studied peptide 1 and studied peptide 2 groups (p > 0.05). All of the samples that the PLM analyzed had a thickening of the surface layer. A negative birefringent band changed in the lesion's body. The SEM displayed that minerals were formed in all four groups of samples. The XRD results indicated that the products of remineralization of the studied peptide were hydroxyapatite crystals (HA). ITC showed that there were two binding modes between the calcium and peptide TRAP. Conclusion: This study confirmed the potential of the recombinant amelogenin peptide TRAP as a key functional motif of amelogenin protein for enamel remineralization and provided a promising biomaterial for remineralization in initial enamel carious lesion treatment.

Strategies and Challenges in the Treatment of Dental Enamel

Enamel tissue, the hardest body tissue, which covers the outside of the tooth shields the living tissue, but it erodes and disintegrates in the acidic environment of the oral cavity. On the one hand, mature enamel is cell-free and, if damaged, does not regenerate. Tooth sensitivity and decay are caused by enamel loss. On the other hand, the tissue engineering approach is challenging because of the unique structure of tooth enamel. To develop an exemplary method for dental enamel rebuilding, accurate knowledge of the structure of tooth enamel, knowing how it is created and how proteins interact in its structure, is critical. Furthermore, novel techniques in tissue engineering for using stem cells to develop enamel must be established. This article aims to discuss current attempts to regenerate enamel using synthetic materials methods, recent advances in enamel tissue engineering, and the prospects of enamel biomimetics to find unique insights into future possibilities for repairing enamel tissue, perhaps the most fascinating of all tooth tissues.

Self-Crosslinkable Oxidized Alginate-Carboxymethyl Chitosan Hydrogels as an Injectable Cell Carrier for In Vitro Dental Enamel Regeneration

Injectable hydrogels, as carriers, offer great potential to incorporate cells or growth factors for dental tissue regeneration. Notably, the development of injectable hydrogels with appropriate structures and properties has been a challenging task, leaving much to be desired in terms of cytocompatibility, antibacterial and self-healing properties, as well as the ability to support dental stem cell functions. This paper presents our study on the development of a novel self-cross-linkable hydrogel composed of oxidized alginate and carboxymethyl chitosan and its characterization as a cell carrier for dental enamel regeneration in vitro. Oxidized alginate was synthesized with 60% theoretical oxidation degree using periodate oxidation and characterized by Fourier Transform Infrared spectroscopy, proton nuclear magnetic resonance spectroscopy, and Ultraviolet-visible absorption spectroscopy. Then, hydrogels were prepared at three varying weight ratios of oxidized alginate to carboxymethyl chitosan (4:1, 3:1, and 2:1) through Schiff base reactions, which was confirmed by Fourier Transform Infrared spectroscopy. The hydrogels were characterized in terms of gelation time, swelling ratio, structure, injectability, self-healing, antibacterial properties, and in vitro characterization for enamel regeneration. The results demonstrated that, among the three hydrogels examined, the one with the highest ratio of oxidized alginate (i.e., 4:1) had the fastest gelation time and the lowest swelling ability, and that all hydrogels were formed with highly porous structures and were able to be injected through a 20-gauge needle without clogging. The injected hydrogels could be rapidly reformed with the self-healing property. The hydrogels also showed antibacterial properties against two cariogenic bacteria: Streptococcus mutans and Streptococcus sobrinus. For in vitro enamel regeneration, a dental epithelial cell line, HAT-7, was examined, demonstrating a high cell viability in the hydrogels during injection. Furthermore, HAT-7 cells encapsulated in the hydrogels showed alkaline phosphatase production and mineral deposition, as well as maintaining their round morphology, after 14 days of in vitro culture. Taken together, this study has provided evidence that the oxidized alginate-carboxymethyl chitosan hydrogels could be used as an injectable cell carrier for dental enamel tissue engineering applications.

Novel trends, challenges and new perspectives for enamel repair and regeneration to treat dental defects

Dental enamel is the hardest tissue in the human body, providing external protection for the tooth against masticatory forces, temperature changes and chemical stimuli. Once enamel is damaged/altered by genetic defects, dental caries, trauma, and/or dental wear, it cannot repair itself due to the loss of enamel producing cells following the tooth eruption. The current restorative dental materials are unable to replicate physico-mechanical, esthetic features and crystal structures of the native enamel. Thus, development of alternative approaches to repair and regenerate enamel defects is much needed but remains challenging due to the structural and functional complexities involved. This review paper summarizes the clinical aspects to be taken into consideration for the development of optimal therapeutic approaches to tackle dental enamel defects. It also provides a comprehensive overview of the emerging acellular and cellular approaches proposed for enamel remineralization and regeneration. Acellular approaches aim to artificially synthesize or re-mineralize enamel, whereas cell-based strategies aim to mimic the natural process of enamel development given that epithelial cells can be stimulated to produce enamel postnatally during the adult life. The key issues and current challenges are also discussed here, along with new perspectives for future research to advance the field of regenerative dentistry.

Hypes and Hopes of Stem Cell Therapies in Dentistry: a Review

One of the most exciting advances in life science research is the development of 3D cell culture systems to obtain complex structures called organoids and spheroids. These 3D cultures closely mimic in vivo conditions, where cells can grow and interact with their surroundings. This allows us to better study the spatio-temporal dynamics of organogenesis and organ function. Furthermore, physiologically relevant organoids cultures can be used for basic research, medical research, and drug discovery. Although most of the research thus far focuses on the development of heart, liver, kidney, and brain organoids, to name a few, most recently, these structures were obtained using dental stem cells to study in vitro tooth regeneration. This review aims to present the most up-to-date research showing how dental stem cells can be grown on specific biomaterials to induce their differentiation in 3D. The possibility of combining engineering and biology principles to replicate and/or increase tissue function has been an emerging and exciting field in medicine. The use of this methodology in dentistry has already yielded many interesting results paving the way for the improvement of dental care and successful therapies.

A Chitosan-Agarose Polysaccharide-Based Hydrogel for Biomimetic Remineralization of Dental Enamel

Developing multifunctional systems for the biomimetic remineralization of human enamel is a challenging task, since hydroxyapatite (HAP) rod structures of tooth enamel are difficult to replicate artificially. The paper presents the first report on the simultaneous use of chitosan (CS) and agarose (A) in a biopolymer-based hydrogel for the biomimetic remineralization of an acid-etched native enamel surface during 4–10-day immersion in artificial saliva with or without (control group) fluoride. Scanning electron microscopy coupled with energy-dispersive X-ray spectrometry, Fourier transform infrared and Raman spectroscopies, X-ray diffraction, and microhardness tests were applied to investigate the properties of the acid-etched and remineralized dental enamel layers under A and CS-A hydrogels. The results show that all biomimetic epitaxial reconstructed layers consist mostly of a similar hierarchical HAP structure to the native enamel from nano- to microscale. An analogous Ca/P ratio (1.64) to natural tooth enamel and microhardness recovery of 77.4% of the enamel-like layer are obtained by a 7-day remineralization process in artificial saliva under CS-A hydrogels. The CS component reduced carbonation and moderated the formation of HAP nanorods in addition to providing an extracellular matrix to support growing enamel-like structures. Such activity lacked in samples exposed to A-hydrogel only. These data suggest the potential of the CS-A hydrogel in guiding the formation of hard tissues as dental enamel.