Effect of fluoride-releasing restorative materials on bacteria-induced pH fall at the bacteria-material interface: an in vitro model study

Comparative measurement of short-term fluoride release and inhibition of caries around restoration by ion releasing restorative materials: an in vitro study

The main objective of the current study is to compare short-term fluoride release of three ion releasing restorative materials and assess their inhibitory effect on secondary caries. Materials used in this study included, Self-adhesive hybrid composite (group A), Ion releasing flowable composite liner (group B), and alkasite restorative material (group C). Twenty-two discs were fabricated from each material for short-term fluoride release test, conducted on days 1, 7, and 14. For assessing secondary caries inhibition, sixty-six sound molar teeth were used and standardized class V cavities were prepared. Teeth were divided into three groups according to each material, followed by 800 cycles of thermocycling. Subsequently, teeth were immersed in a solution containing cariogenic bacteria for 30 days. After that, teeth were sectioned bucco-lingually and analyzed using a polarized light microscope to measure inhibition area, outer lesion depth, and extension. Data was statistically analyzed using different tests. The study results revealed a statistically significant differences in fluoride release existed among materials. Self-adhesive hybrid composite exhibited the highest fluoride release. Lesion extension and depth were statistically significantly greater next to Ion-releasing flowable composite liner. The inhibition areas next to the Self-adhesive hybrid composite were statistically significantly larger than the other two materials. In conclusion, all tested ion-releasing restorative materials displayed fluoride release and the potential to inhibit secondary caries formation. Self-adhesive hybrid composite demonstrated the highest fluoride-releasing potential and the greatest ability to inhibit secondary caries. Conversely, Ion-releasing flowable composite liner exhibited the least fluoride release with minimal secondary caries inhibition. Increasing fluoride release correlated with larger inhibition areas and reduced outer lesion depth and extension.

Evaluation of mechanical, optical, and fluoride-releasing properties of a translucent bulk fill glass hybrid restorative dental material

OBJECTIVE

Measure and compare the mechanical properties, translucency, and fluoride-releasing capabilities of EQUIA Forte HT against Fuji IX GP and ChemFil Rock.

MATERIALS AND METHODS

Ten specimens of each material were fabricated for compressive strength (CS), flexural strength (FS), and surface hardness analysis at 24 h and 7 days. The L*a*b* values were measured against a black-and-white background using a spectrophotometer to analyze the translucency parameter (TP). Fluoride release was recorded after 2 months of immersion in distilled water. The mean data was analyzed by 1- and 2-way ANOVA (α = 0.5).

RESULTS

EQUIA Forte HT showed higher CS, surface hardness, and FS values (p < 0.05) compared with Fuji IX GIC, while no significant difference was found in FS values between EQUIA Forte HT and Chemfil Rock (p > 0.05). The EQUIA Forte HT exhibited significantly higher translucency in comparison to both ChemFil Rock (p < 0.001) and Fuji IX GICs (p < 0.05). An increase (p > 0.05) of fluoride release was observed for EQUIA Forte HT.

CONCLUSION

The EQUIA Forte HT Glass-ionomer cements (GIC) offers enhanced translucency, improved strength, and enhanced fluoride-releasing properties compared to the traditionally used Fuji IX GIC and ChemFil Rock GICs. This material might have a wide range of clinical applications due to its improved strength and optical properties.

CLINICAL SIGNIFICANCE

Glass-ionomer dental restorative materials possess unique advantageous characteristics. However, its poor mechanical and optical properties have typically limited its clinical applications. Efforts to improve these properties have resulted in enhanced GICs. EQUIA Forte HT GIC offers enhanced mechanical and optical properties with potential applications in posterior and anterior restorative procedures.

Lactic Acid Bacteria in the Human Oral Cavity: Assessing Metabolic Functions Relevant to Oral Health and Disease

Many perceive lactic acid bacteria as beneficial for health. They are recognized for preventing abnormal fermentation and spoilage of ingested foods by producing lactic acid, which aids in gut acidification. Moreover, lactic acid bacteria are extensively employed in food science. In contrast, lactic acid bacteria in the oral cavity are often perceived as pathogenic factors contributing to the development of dental caries. As a consequence, substantial research has been conducted in oral and dental sciences to explore lactic acid bacteria and the oral microbiome. This research primarily involves analyzing bacterial flora, investigating metabolic activities such as acid production, and investigating metabolic regulation within the oral environment. The oral cavity serves as the gateway to the digestive tract and respiratory system, characterized by a constantly fluctuating environment that significantly impacts the metabolic activity of lactic acid bacteria. Hence, when investigating oral lactic acid bacteria, it is crucial to adopt research plans and methodologies that account for these metabolic environment changes. In this section, we present some of the methods employed in our study.

Inhibition of Caries around Restoration by Ion-Releasing Restorative Materials: An In Vitro Optical Coherence Tomography and Micro-Computed Tomography Evaluation

The objective of this study was firstly to assess the demineralization inhibitory effect of ion-releasing restorations in enamel adjacent to restoration using a biofilm caries model and secondly to compare the effect to that in a chemical caries model. Fifty-six bovine incisors were filled with either Surefil one (SuO), Cention N (CN) (both ion-releasing materials), Ketac-Molar (GIC) or Powerfill resin composite (RC). The restored teeth were then randomly divided into 2 groups according to the used caries model (biofilm or chemical caries model). The micro-computed tomography (MicroCt) and optical coherence tomography (OCT) outcome measures used to evaluate demineralization inhibition effects were lesion depth, LD and increase in OCT integrated reflectivity, ΔIR, at five different depths. It was observed that all outcome measures of CN were statistically the same as those of GIC and conversely with those of RC. This was also the case for SuO except for LD, which was statistically the same as RC. When comparing the two caries models, LD of the biofilm model was statistically deeper (p < 0.05) than the chemical model for all four materials. In conclusion, CN and SuO have similar demineralization inhibitory effects as GIC, and the biofilm caries model is more discriminatory in differentiating demineralization inhibitory effects of ion-releasing restorative material.

The reciprocal interaction between fluoride release of glass ionomers and acid production of Streptococcus mutans biofilm

Objectives

The aim of this study was to demonstrate the mode of action of glass ionomers (G-Is) against cariogenic biofilms in the slow fluoride release phase by analyzing the reciprocal interaction between fluoride release from G-Is and acid production of Streptococcus mutans biofilm.

Methods

G-Is discs in the slow fluoride release phase were prepared and 51 h-old S. mutans biofilms were formed on these discs. The interrelationship between the acid production of the biofilm and the fluoride release of the G-Is discs was investigated by analyzing both factors simultaneously during the biofilm formation period. The composition of the 51 h-old biofilms was then examined using microbiological, biochemical, and confocal laser scanning microscopic methods.

Results

Acid production by the cariogenic biofilm, particularly at < pH 5, promotes G-Is fluoride release. Conversely, G-Is fluoride release inhibits the acid production of the cariogenic biofilm. This reciprocal interaction results in the reduction of virulence such as extracellular polysaccharides formation and cariogenic biofilm bio-mass, which may reduce the potential of secondary caries development around G-Is.

Conclusions

These results suggest that G-Is may play a role in preventing the development of secondary caries during the slow fluoride release phase.

A water-soluble glass-based temporary restorative resin inhibited bacteria-induced pH reductions at the bacteria-material interface

This study aimed to evaluate the inhibitory effects of a water-soluble glass based temporary restorative resin (WSG-TRR) on bacteriainduced pH reductions at the bacteria-material interface. Each material (WSG-TRR, glass-ionomer cement, resin composite and conventional temporary restorative resin) was fixed to the bottom of the well of the experimental apparatus. The well was filled with pelleted cells of Streptococcus mutans, and the pH at the bacteria-material interface was monitored using a miniature pH electrode. The concentration of ions released from WSG-TRR and the effect of fluoride and zinc ions on bacteria-induced pH reduction was evaluated. The buffering capacities of WSG-TRR and WSG were also evaluated. At 90 min after the glucose addition, WSG-TRR exhibited the highest pH (5.29±0.12). Fluoride ion was detected at the interface between bacteria and WSG-TRR. Moreover, WSG were found to confer high buffering capacity. A WSG-TRR reduced bacteria-induced pH reductions at the bacteria-material interface.

The impact of glass ionomer cement and composite resin on microscale pH in cariogenic biofilms and demineralization of dental tissues

OBJECTIVE

Secondary caries is among the most frequent reasons for the failure of dental restorations. Glass ionomer cement (GIC) restorations have been proposed to protect the surrounding dental tissues from demineralization through the release of fluoride and by buffering the acid attack from dental biofilms. In contrast, the lack of buffering by composite resin (CR) restorations has been suggested as a promoting factor for the development of secondary caries.

METHODS

The present study employed transversal microradiography and confocal microscopy based pH ratiometry to quantify mineral loss and map microscale pH gradients inside Streptococcus mutans biofilms grown on compound specimens consisting of enamel, dentin and either GIC or CR.

RESULTS

Mineral loss in dentin was significantly lower next to GIC than next to CR, but no significant differences in local biofilm pH were observed between the two restorative materials.

SIGNIFICANCE

The cariostatic effect of GIC relies predominantly on the provision of fluoride and not on a direct buffering action. The lack of buffering by CR did not affect local biofilm pH and may therefore be of minor importance for secondary caries development.

Low-shrinkage-stress nanocomposite: An insight into shrinkage stress, antibacterial, and ion release properties

The aims are: (a) To develop the first low-shrinkage-stress nanocomposite with antibacterial and remineralization capabilities through the incorporation of dimethylaminododecyl methacrylate (DMAHDM) and nanoparticles of amorphous calcium phosphate (NACP); (b) to investigate the effects of the new composite on biofilm inhibition, mechanical properties, shrinkage stress, and calcium (Ca) and phosphate (P) ion releases. The low-shrinkage-stress resin consisted of urethane dimethacrylate and triethylene glycol divinylbenzyl ether. Composite was formulated with 3% DMAHDM and 20% NACP. Mechanical properties, shrinkage stress, and degree of conversion were evaluated. Streptococcus mutans biofilm growth on composites was assessed. Ca and P ion releases were measured. The shrinkage stress of the low-shrinkage-stress composite containing 3% DMAHDM and 20% NACP was 36% lower than that of traditional composite control (p < 0.05), with similar degrees of conversion of 73.9%. The new composite decreased the biofilm colony-forming unit by 4 log orders and substantially reduced biofilm lactic acid production compared to control composite (p < 0.05). Incorporating DMAHDM to the low-shrinkage-stress composite did not adversely affect the Ca and P ion release. A novel bioactive nanocomposite was developed with low shrinkage stress, strong antibiofilm activity, and high levels of ion release for remineralization, without undermining the mechanical properties and degree of conversion.

Bioadhesion in the oral cavity and approaches for biofilm management by surface modifications

BACKGROUND

All soft and solid surface structures in the oral cavity are covered by the acquired pellicle followed by bacterial colonization. This applies for natural structures as well as for restorative or prosthetic materials; the adherent bacterial biofilm is associated among others with the development of caries, periodontal diseases, peri-implantitis, or denture-associated stomatitis. Accordingly, there is a considerable demand for novel materials and coatings that limit and modulate bacterial attachment and/or propagation of microorganisms.

OBJECTIVES AND FINDINGS

The present paper depicts the current knowledge on the impact of different physicochemical surface characteristics on bioadsorption in the oral cavity. Furthermore, it was carved out which strategies were developed in dental research and general surface science to inhibit bacterial colonization and to delay biofilm formation by low-fouling or "easy-to-clean" surfaces. These include the modulation of physicochemical properties such as periodic topographies, roughness, surface free energy, or hardness. In recent years, a large emphasis was laid on micro- and nanostructured surfaces and on liquid repellent superhydrophic as well as superhydrophilic interfaces. Materials incorporating mobile or bound nanoparticles promoting bacteriostatic or bacteriotoxic properties were also used. Recently, chemically textured interfaces gained increasing interest and could represent promising solutions for innovative antibioadhesion interfaces. Due to the unique conditions in the oral cavity, mainly in vivo or in situ studies were considered in the review.

CONCLUSION

Despite many promising approaches for modulation of biofilm formation in the oral cavity, the ubiquitous phenomenon of bioadsorption and adhesion pellicle formation in the challenging oral milieu masks surface properties and therewith hampers low-fouling strategies.

CLINICAL RELEVANCE

Improved dental materials and surface coatings with easy-to-clean properties have the potential to improve oral health, but extensive and systematic research is required in this field to develop biocompatible and effective substances.

Bioactive low-shrinkage-stress nanocomposite suppresses S. mutans biofilm and preserves tooth dentin hardness

Recurrent dental caries is one of the main reasons for resin composite restoration failures. This study aimed to: (1) develop a bioactive, low-shrinkage-stress, antibacterial and remineralizing composite and evaluate the sustainability of its antibacterial effect against Streptococcus mutans (S. mutans) biofilms; and (2) evaluate the remineralization and cariostatic potential of the composite containing nanoparticles of amorphous calcium phosphate (NACP) and dimethylaminohexadecyl methacrylate (DMAHDM), using dentin hardness measurement and a biofilm-induced recurrent caries model. The antibacterial and remineralizing low-shrinkage-stress composite consisted of urethane dimethacrylate (UDMA) and triethylene glycol divinylbenzyl ether (TEG-DVBE), 3% DMAHDM and 20% NACP. S. mutans biofilm was used to evaluate antibiofilm activity, before and after 3 months of composite aging in acidic solution. Human dentin was used to develop a recurrent caries biofilm-model. Adding DMAHDM and NACP into low shrinkage-stress composite did not compromise the flexural strength. The low-shrinkage-stress composite with DMAHDM achieved substantial reductions in biofilm colony-forming units (CFU), lactic acid production, and biofilm biomass (p < 0.05). The low-shrinkage-stress DMAHDM+NACP composite exhibited no significant difference in antibacterial performance before and after 3 months of aging, demonstrating long-term antibacterial activity. Under S. mutans biofilm acidic attack, dentin hardness (GPa) was 0.24 ± 0.04 for commercial control, and 0.23 ± 0.03 for experimental control, but significantly higher at 0.34 ± 0.03 for DMAHDM+NACP group (p < 0.05). At an instrumental compliance of 0.33 μm/N, the polymerization shrinkage stress of the new composite was 36% lower than that of a traditional composite (p < 0.05). The triple strategy of antibacterial, remineralization and lower shrinkage-stress has great potential to inhibit recurrent caries and increase restoration longevity. Statement of Significance Polymerization shrinkage stress, masticatory load over time as well as biochemical degradation can lead to marginal failure and secondary caries. The present study developed a new low-shrinkage-stress, antibacterial and remineralizing dental nanocomposite. Polymerization shrinkage stress was greatly reduced, biofilm acid production was inhibited, and tooth dentin mineral and hardness were preserved. The antibacterial composite possessed a long-lasting antibiofilm effect against cariogenic bacteria S. mutans. The new bioactive nanocomposite has the potential to suppress recurrent caries at the restoration margins, protects tooth structures, and increases restoration longevity.

Evaluation of F, Ca, and P release and microhardness of eleven ion-leaching restorative materials and the recharge efficacy using a new Ca/P containing fluoride varnish

OBJECTIVES

The objectives of this study were to evaluate fluoride (F), calcium (Ca), and phosphate (P) release of ion-leaching restorative materials (ILMs), their recharge efficacy with a Ca/P-containing F varnish, and relative microhardness.

METHODS

Thirteen groups of materials were investigated. Cylindrical-shaped specimens were fabricated. Deionised water or lactic-acid solution were used as the storage media. Solutions were changed after 1d, 4d, 7d, and 14d of ion release and at the same periods after recharge with MI Varnish (7 -h storage). F, Ca, and P measurements were accomplished using a fluoride-ion selective electrode, atomic absorption spectrometry, and colourimetric method by spectrophotometer, respectively. Relative Vickers hardness was proceeded with similar specimens used in the F assay (4 periods). SEM/EDS was additionally performed. Statistical analyses were calculated in each parameter (p < 0.05).

RESULT

Hardness of several ILMs immediately increased after recharge. After 28d, Ketac Universal [a high-viscosity glass-ionomer cement (HVGIC)] showed the highest hardness similar to the resin composite control. Although 2 HVGICs (Zirconomer and Equia Forte Fil) ranked as first and second for F release/re-release, some HVGICs had inferior or comparable F capacity to RMGICs (Fuji VIII and Fuji II LC) and a resin-based (RB) ILM (Cention N). Cention N, Activa-Restorative (RB-ILM), and Zirconomer were the top-3 ranking for Ca release/re-release. Activa-Restorative showed the highest P release, whereas Cention N displayed the greatest recharge ability for P.

CONCLUSIONS

Zirconomer showed a versatile performance for ion-release/re-release, especially for F. Cention N had excellent capacity in relation to Ca release and recharge ability of Ca/P.

CLINICAL SIGNIFICANCE

With the F varnish recharge protocol, Zirconomer, Equia Forte, and Fuji VIII seems to have an ability to inhibit initial caries initiation. Cention N is a promising resin-based material that could be an alternative for high caries risk patients due to the high Ca release/recharge with acceptable F release.

In vitro evaluation of composite containing DMAHDM and calcium phosphate nanoparticles on recurrent caries inhibition at bovine enamel-restoration margins

OBJECTIVE

Recurrent caries is a primary reason for restoration failure caused by biofilm acids. The objectives of this study were to: (1) develop a novel multifunctional composite with antibacterial function and calcium (Ca) and phosphate (P) ion release, and (2) investigate the effects on enamel demineralization and hardness at the margins under biofilms.

METHODS

Dimethylaminohexadecyl methacrylate (DMAHDM) and nanoparticles of amorphous calcium phosphate (NACP) were incorporated into composite. Four groups were tested: (1) Commercial control (Heliomolar), (2) Experimental control (0% DMAHDM + 0% NACP), (3) antibacterial group (3% DMAHDM + 0% NACP), (D) antibacterial and remineralizing group (3% DMAHDM + 30% NACP). Mechanical properties and Ca and P ion release were measured. Colony-forming units (CFU), lactic acid and polysaccharide of Streptococcus mutans (S. mutans) biofilms were evaluated. Demineralization of bovine enamel with restorations was induced via S. mutans, and enamel hardness was measured. Data were analyzed via one-way and two-way analyses of variance and Tukey's multiple comparison tests.

RESULTS

Adding DMAHDM and NACP into composite did not compromise the mechanical properties (P > 0.05). Ca and P ion release of 3% DMAHDM + 30% NACP was increased at cariogenic low pH. Biofilm lactic acid and polysaccharides were greatly decreased via DMAHDM, and CFU was reduced by 4 logs (P < 0.05). Under biofilm acids, enamel hardness at the margins was decreased to about 0.5 GPa for control; it was about 1 GPa for antibacterial group, and 1.3 GPa for antibacterial and remineralizing group (P < 0.05).

CONCLUSIONS

The novel 3% DMAHDM + 30% NACP composite had strong antibacterial effects. It substantially reduced enamel demineralization adjacent to restorations under biofilm acid attacks, yielding enamel hardness that was 2-fold greater than that of control composites. The novel multifunctional composite is promising to inhibit recurrent caries.

Novel fluoride rechargeable dental composites containing MgAl and CaAl layered double hydroxide (LDH)

OBJECTIVE

This study aims to incorporate 2:1 MgAl and 2:1 CaAl layered double hydroxides (LDHs) in experimental dental-composites to render them fluoride rechargeable. The effect of LDH on fluoride absorption and release, and their physico-mechanical properties are investigated.

METHODS

2:1 CaAl and 2:1 MgAl LDH-composite discs prepared with 0, 10 and 30wt% LDH were charged with fluoride (48h) and transferred to deionized water (DW)/artificial saliva (AS). Fluoride release/re-release was measured every 24h (ion-selective electrodes) with DW/AS replaced daily, and samples re-charged (5min) with fluoride every 2 days. Five absorption-release cycles were conducted over 10 days. CaAl and MgAl LDH rod-shaped specimens (dry and hydrated; 0, 10 and 30wt%) were studied for flexural strength and modulus. CaAl and MgAl LDH-composite discs (0, 10, 30 and 45wt% LDH) were prepared to study water uptake (over 7 weeks), water desorption (3 weeks), diffusion coefficients, solubility and cation release (ICP-OES).

RESULTS

CaAl LDH and MgAl LDH-composites significantly increased the amount of fluoride released in both media (P<0.05). In AS, the mean release after every recharge was greater for MgAl LDH-composites compared to CaAl LDH-composites (P<0.05). After every recharge, the fluoride release was greater than the previous release cycle (P<0.05) for all LDH-composites. Physico-mechanical properties of the LDH-composites demonstrated similar values to those reported in literature. The solubility and cation release showed a linear increase with LDH loading.

SIGNIFICANCE

LDH-composites repeatedly absorbed/released fluoride and maintained desired physico-mechanical properties. A sustained low-level fluoride release with LDH-composites could lead to a potential breakthrough in preventing early stage carious-lesions.

Novel antibacterial calcium phosphate nanocomposite with long-term ion recharge and re-release to inhibit caries

Short-term studies on calcium-phosphate (CaP) ion-rechargeable composites were reported. The long-term rechargeability is important but unknown. The objectives of this study were to investigate nanocomposite with strong antibacterial and ion-recharge capabilities containing dimethylaminododecyl methacrylate (DMAHDM) and nanoparticles of amorphous calcium phosphate (NACP), and evaluate long-term ion-recharge by testing for 12 cycles (taking 6 months to complete) for the first time. Three groups were tested: (1) Heliomolar control; (2) Resin+20%NACP+50%glass; (3) Resin+3%DMAHDM+20%NACP+50%glass. Biofilm acid and colony-forming units (CFU) were measured. Ion-recharge was tested for 12 cycles. NACP-DMAHDM composite reduced biofilm acid, and reduced CFU by 4 logs. High levels of ion releases were maintained throughout 12 cycles of recharge, maintaining steady-state releases without reduction in 6 months (p>0.1), representing long-term remineralization potential. Bioactive nanocomposite demonstrated long-term ion-rechargeability for the first time, showed remineralization and potent anti-biofilm functions, with promise for tooth restorations to combat caries.

Effect of Different Glucose Concentrations on Small RNA Levels and Adherence of Streptococcus mutans

Streptococcus mutans (S. mutans) adheres to the tooth surface, metabolizes carbohydrates, and produces acid products, leading to enamel demineralization-the onset of dental caries. Rapid acidification by S. mutans has been observed in the presence of glucose. However, little is known about the role of small RNAs (sRNAs) in S. mutans in the presence of glucose and their relationship to tooth adherence. The objective of this study was to evaluate the role of sRNAs in S. mutans (18-50 nucleotides) regarding adherence capacity under 1% and 5% glucose concentrations. The pH drop and adherence capacity in the 1% glucose condition were similar to these parameters under conditions of 5% sucrose that were published in our previous study. A total of 2149 candidate sRNA with at least 100 average reads in the 5% and 1% glucose libraries were obtained. Between the two libraries, 581 sRNAs were differentially expressed and 43 sRNAs were verified. However, the expression levels of the predicted target genes gtfC and spaP were similar between the 1% and 5% glucose conditions. The bioinformatic analysis suggested that differentially expressed sRNAs may be involved in several pathways. These findings indicate that sRNAs were induced under these glucose concentrations and a series of sRNAs were specifically induced, respectively. sRNAs that are induced under glucose stress may be involved in regulating adherence of S. mutans.

Sodium fluoride and silver diamine fluoride-coated tooth surfaces inhibit bacterial acid production at the bacteria/tooth interface

OBJECTIVES

This study aimed to evaluate whether coating tooth surfaces with sodium fluoride (NaF) or silver diamine fluoride (SDF) inhibits bacteria-induced pH reductions at the bacteria/tooth interface.

METHODS

Specimens of coronal enamel (CE) or root dentin (RD) were prepared. The surfaces of the specimens were treated with 2% NaF or 38% SDF solution. Some specimens were aged for 1 week after being treated. A tooth specimen was fixed to the bottom of the well of the experimental apparatus. A miniature pH electrode was placed on the specimen and the well was filled with Streptococcus mutans (SM) cells. The pH was monitored after the addition of 0.5% glucose. SM cells were recovered from the wells, and the amounts of lactate, calcium, fluoride, and silver were measured.

RESULTS

The fluoride-treated tooth specimens exhibited significantly higher pH values than the untreated controls, irrespective of the tooth substrate at 120 min (CE: NaF 4.62 ± 0.06 vs 4.34 ± 0.10 and SDF 5.23 ± 0.29 vs 4.44 ± 0.16, RD: NaF 5.10 ± 0.11 vs 4.54 ± 0.33 and SDF 6.65 ± 0.47 vs 4.64 ± 0.39). The SDF-coated RD specimens released the greatest amounts of fluoride (103.3 ± 48.1 nmol/well) and silver (70.4 ± 36.9 nmol/well), while they exhibited significantly lower lactate production and decalcification (calcium release) than the control samples (lactate: 4.0 ± 0.7 vs 7.4 ± 0.3 mmol/l, calcium: 2.2 ± 0.4 vs 3.7 ± 0.5 μg/ml). This antimicrobial effect was weakened by 1 week's aging, while the acid resistance of the fluoride-treated surfaces seemed to increase with aging.

CONCLUSIONS

Fluoride-treated tooth surfaces inhibit bacterial acid production at the bacteria/tooth interface. The SDF-coated RD had the strongest inhibitory effect.

CLINICAL SIGNIFICANCE

Coating RD with SDF could help to prevent root caries.

Influence of Dental Prosthesis and Restorative Materials Interface on Oral Biofilms

Oral biofilms attach onto both teeth surfaces and dental material surfaces in oral cavities. In the meantime, oral biofilms are not only the pathogenesis of dental caries and periodontitis, but also secondary caries and peri-implantitis, which would lead to the failure of clinical treatments. The material surfaces exposed to oral conditions can influence pellicle coating, initial bacterial adhesion, and biofilm formation, due to their specific physical and chemical characteristics. To define the effect of physical and chemical characteristics of dental prosthesis and restorative material on oral biofilms, we discuss resin-based composites, glass ionomer cements, amalgams, dental alloys, ceramic, and dental implant material surface properties. In conclusion, each particular chemical composition (organic matrix, inorganic filler, fluoride, and various metallic ions) can enhance or inhibit biofilm formation. Irregular topography and rough surfaces provide favorable interface for bacterial colonization, protecting bacteria against shear forces during their initial reversible binding and biofilm formation. Moreover, the surface free energy, hydrophobicity, and surface-coating techniques, also have a significant influence on oral biofilms. However, controversies still exist in the current research for the different methods and models applied. In addition, more in situ studies are needed to clarify the role and mechanism of each surface parameter on oral biofilm development.

Effect of brief periodic fluoride treatments on the virulence and composition of a cariogenic biofilm

The present study investigated the effect of periodic 1-min fluoride treatments on Streptococcus mutans biofilms and then determined the relationship between anti-biofilm activity, treatment frequency, and fluoride concentration using a linear-fitting procedure. S. mutans biofilms were periodically treated (1-min/treatment) with fluoride during biofilm formation and analyzed using microbiological methods, confocal microscopy, and real-time PCR. The results indicated that reductions in the dry weight and acidogenicity of biofilms due to periodic fluoride treatment occurred in a concentration dependent manner. The reduction in dry weight without affecting bacterial cell viability was observed mainly due to the inhibitory effect of fluoride on gtfB and gtfC gene expression, which suppresses EPS production and avoids reduction of the pH below the critical point on the tooth surface. This study suggests that brief periodic exposure to appropriate fluoride concentrations through mouthwashes and toothpastes may affect the virulence and composition of cariogenic biofilms and subsequently prevent dental caries.

pH Response and Tooth Surface Solubility at the Tooth/Bacteria Interface

Evaluating the physiochemical processes at the tooth surface/bacteria interface is important for elucidating the etiology of dental caries. This study aimed to compare the mineral solubility and protein degradation of coronal enamel (CE) and root dentin (RD), and investigate the involvement of dissolved components in bacteria-induced pH changes using a model of tooth/bacteria interface. An experimental apparatus forming a well was made of polymethyl methacrylate, and a bovine tooth (CE or RD) specimen was fixed at the bottom of the well. A miniature pH electrode was placed on the tooth, and Streptococcus mutans NCTC 10449 cells, grown in 0.5% glucose-containing complex medium, were packed into the well. The pH at the tooth/S. mutans interface was monitored continuously for 120 min after the addition of 0.5% glucose at 37°C. S. mutans cells were recovered from the wells, and the amounts of lactate and calcium were measured using a portable lactate meter and a fluorescent dye, respectively. Proteolytic activity was also evaluated fluorometrically. The pH of the RD/S. mutans interface was significantly higher than that of the CE/S. mutans interface (30 min: 6.37 ± 0.12 vs. 6.18 ± 0.11, 60 min: 6.08 ± 0.14 vs. 5.66 ± 0.27, 90 min: 5.49 ± 0.24 vs. 5.14 ± 0.22, p < 0.05). Greater amounts of calcium were dissolved from RD (3.19 ± 0.74 µg/mL) than from CE (1.84 ± 0.68 µg/mL; p < 0.05), while similar amounts of lactate were produced. Proteolytic activity was not detected at any of the interfaces. These results indicate that RD is more soluble to bacteria-induced acidification than CE. This method can contribute to the evaluation and development of caries-preventive materials.

Models of Caries Formation around Dental Composite Restorations

The main reason cited for the replacement of dental composite restorations is the recurrence of caries. Numerous models-both in vitro, with acid gels or bacterial biofilms, and in situ, with dental appliances-have been used to study caries formation around dental composites. The literature shows that many factors may affect caries formation, including marginal gap formation, gap size, the local chemical environment, the durability of the bonded interface, the extent of bacterial penetration, and the presence of mechanical loading. Studies have also shown that what have been called wall lesions may form independent of surface lesions, though not likely due to microleakage through very small gap spaces in the clinical situation. Gap size and mechanical loading have been shown to be related to lesion severity within in vitro models, but these results do not correspond exactly with those obtained from in situ studies using restorations in dental appliances. Though not conclusive, some in vitro models have shown that certain materials possessing antimicrobial characteristics may reduce the severity of lesion formation, suggesting possible pathways for developing new composite and adhesive materials for restorations with potentially enhanced longevity.

Lack of Buffering by Composites Promotes Shift to More Cariogenic Bacteria

Secondary caries (SC) remains a very important problem with composite restorations. The objectives of this study were to test the acid-buffering ability of several restorative materials and to evaluate whether buffering of the restorative material has an impact on the microbial composition of the biofilm. Disk-shaped specimens of conventional composite, composite with surface prereacted glass-ionomer filler particles (so-called giomer), glass-ionomer cement (GIC), amalgam, and hydroxyapatite (HAp) (control) were exposed to aqueous solutions with pH 4, 5, 6, and 7 and to the medium containing bacteria-produced acids, and pH changes were recorded over several days. Next, material specimens were immersed in bacterial growth medium with pH adjusted to 5. After a 24-h incubation, the extracts were collected and inoculated with a cariogenic ( Streptococcus mutans) and a noncariogenic ( Streptococcus sanguinis) species. The bacterial growth was monitored both in a single-species model by spectrophotometry and in a dual-species model by viability quantitative polymerase chain reaction. Amalgam and HAp showed the strongest acid-buffering ability, followed by the GIC and the giomer, while the conventional composite did not exhibit any buffering capacity. Furthermore, due to the lack of acid-buffering abilities, composite was not able to increase the pH of the medium (pH 5), which, in the absence of antibacterial properties, allowed the growth of S. mutans, while the growth of S. sanguinis, a less aciduric species, was completely inhibited. A similar effect was observed when bacteria were cultured together: there was a higher percentage of S. mutans and lower percentage of S. sanguinis with the conventional composite than with other materials and HAp. In conclusion, conventional composites lack the ability to increase the local pH, which leads to the outgrowth of more acidogenic/aciduric bacteria and higher cariogenicity of the biofilm. Together with lack of antibacterial properties, lack of buffering may account for the higher susceptibility of composites to SC.

Conventional glass-ionomer materials: A review of the developments in glass powder, polyacid liquid and the strategies of reinforcement

OBJECTIVES

The development of glass-ionomers (GIs) from the earliest experimental GI formulations to the modern day commercially available GIs was reviewed. The aim of the review was to identify the developments in the glass powder and polyacid liquid constituents of GIs since their inception in the late 1960s.

DATA

The glass powder has undergone major changes from the earliest GI powder formulation (G200) in an effort to enhance the reactivity with the polyacid liquid. The GI liquids have also been optimised by the manufacturers in terms of polyacid composition, molecular weight and concentration to improve the handling characteristics. Despite these developments in the glass powder and polyacid liquid constituents, GIs cannot 'truly' be advocated for the restoration of posterior dentition due to the poor mechanical properties when compared with dental amalgam and resin-based composites (RBCs).

SOURCES

Various attempts to improve the mechanical properties of GIs through substitution of reinforcing fillers to the GI powder or modification of the GI liquid were identified in the dental literature. Despite the claimed improvements in mechanical properties of the modified GIs, a wide variation in mixing and testing conditions was identified which prevented a valid assessment of the reported reinforcement strategies. When investigating a GI reinforcement strategy it is crucial that the mixing and testing conditions are standardised to allow a valid comparison between studies.

STUDY SELECTION

The dental literature reporting the earliest experimental GIs to modern day commercially available GIs (1969-2015) was reviewed. In addition, full-text publications and abstracts published in English reporting various GI reinforcement strategies were included.

CONCLUSION

Nevertheless, major improvements in GI formulations through a reinforcement strategy have yet to be made to enable clinical usage of GIs for the restoration of posterior dentition.

CLINICAL SIGNIFICANCE

GIs chemically are inherently weak but bond to sound tooth structure without the need for preconditioning or removal of sound tooth structure such that improvements in the mechanical properties of GIs would be desirable. Although advances have been made through different GI glass powder and polyacid liquid formulations over the past 40 years, further improvements in the mechanical properties of the current GIs are required to be indicated for the restoration of posterior dentition. The literature is replete with reports on GI reinforcement, however, improved reporting and control of mixing and testing conditions are required for a valid assessment of the reinforcement strategies.

Effect of microparticulate silver addition in dental adhesives on secondary caries in vitro

OBJECTIVES

The aim of the present study was evaluate the effect of microparticulate silver additions in adhesives on secondary caries formation using an artificial mouth model.

MATERIALS AND METHODS

One hundred eight intact human third molars received standardized Class-V resin composite restorations (Filtek Supreme XTE bonded with Syntac, Scotchbond 1 XT, Futurabond M). Adhesives were charged with different amounts of microparticulate silver (0 %/0.1 %/0.5 %). After storage for 4 weeks at 37 °C, teeth were subjected to 10,000 thermocycles (+5 °C and +55 °C), and impressions were taken. Streptococcus mutans 10449 was used in a nutrition medium for secondary caries simulation in a fully automated artificial mouth. After completion of thermocycling and biological load cycling, impressions were taken and replicas were investigated under a light microscope for gap widths at enamel and dentin margins. Evaluation of fluorescence was carried out using a special FITC filter. The demineralization depths at the cavity margin were evaluated using Xpert for Windows working at a pixel distance of 5 μm.

RESULTS

After thermocycling, no difference in gap widths and demineralization depths was found (p > 0.05). After incubation, gap widths and demineralization depths were significantly reduced with higher amounts of silver loading in most of the adhesives (p < 0.05). The 0.5 % silver addition resulted in a slight decrease of secondary caries at resin-dentin margins (p < 0.05).

CONCLUSIONS

Addition of microparticulate silver in commercially available dental adhesives has the potential of reducing secondary caries.

CLINICAL RELEVANCE

The chosen setup was able to produce secondary caries with a distinct in vivo appearance. Microparticulate silver additions in dental adhesives may have an impact on inhibition of secondary caries.