Mechanical properties of visible light-cured resins reinforced with hydroxyapatite for dental restoration

Physicochemical characterization of experimental resin-based materials containing calcium orthophosphates or calcium silicate

OBJECTIVE

To evaluate experimental dimethacrylate-based materials containing calcium orthophosphates or calcium silicate particles in terms of their optical, mechanical and Ca2+ release behaviour.

METHODS

Dicalcium phosphate dihydrate (DCPD), hydroxyapatite (HAp), beta-tricalcium phosphate (β-TCP) or calcium silicate (CaSi) particles were added to a photocurable BisGMA/TEGDMA resin (1:1 in mols) at a 30 vol% fraction. Materials containing silanized or non-silanized barium glass particles were used as controls. Degree of conversion (DC) at the top and base of 2-mm thick specimens was determined by ATR-FTIR spectroscopy (n = 5). Translucency parameter (TP) and transmittance (%T) were determined using a spectrophotometer (n = 3). Biaxial flexural strength (BFS) and flexural modulus (FM) were determined by biaxial flexural testing after 24 h storage in water (n = 10). Ca2+ release in water was determined during 28 days by inductively coupled plasma optical emission spectrometry (n = 3). Statistical analysis was performed using ANOVA/Tukey test (DC: two-way; TP, %T; BFS and FM: one-way; Ca2+ release: repeated measures two-way, α = 5 %).

RESULTS

CaSi and β-TCP particles drastically reduced DC at 2 mm, TP and %T (p < 0.001). Compared to both controls, all Ca2+-releasing materials presented lower BFS (p < 0.001) and only the material with DCPD showed significantly lower FM (p < 0.05). The material containing CaSi presented the highest Ca2+ release, while among materials formulated with calcium orthophosphates the use of DCPD resulted in the highest release (p < 0.001).

SIGNIFICANCE

CaSi particles allowed the highest Ca2+ release. Notwithstanding, the use of DCPD resulted in a material with the best compromise between optical behaviour, DC, strength and Ca2+ release.

Mechanobiology of Dental Pulp Cells

The dental pulp is the inner part of the tooth responsible for properly functioning during its lifespan. Apart from the very big biological heterogeneity of dental cells, tooth microenvironments differ a lot in the context of mechanical properties-ranging from 5.5 kPa for dental pulp to around 100 GPa for dentin and enamel. This physical heterogeneity and complexity plays a key role in tooth physiology and in turn, is a great target for a variety of therapeutic approaches. First of all, physical mechanisms are crucial for the pain propagation process from the tooth surface to the nerves inside the dental pulp. On the other hand, the modulation of the physical environment affects the functioning of dental pulp cells and thus is important for regenerative medicine. In the present review, we describe the physiological significance of biomechanical processes in the physiology and pathology of dental pulp. Moreover, we couple those phenomena with recent advances in the fields of bioengineering and pharmacology aiming to control the functioning of dental pulp cells, reduce pain, and enhance the differentiation of dental cells into desired lineages. The reviewed literature shows great progress in the topic of bioengineering of dental pulp-although mainly in vitro. Apart from a few positions, it leaves a gap for necessary filling with studies providing the mechanisms of the mechanical control of dental pulp functioning in vivo.

New Physico-Chemical Analysis of Magnesium-Doped Hydroxyapatite in Dextran Matrix Nanocomposites

The new magnesium-doped hydroxyapatite in dextran matrix (10MgHApD) nanocomposites were synthesized using coprecipitation technique. A spherical morphology was observed by scanning electron microscopy (SEM). The X-ray diffraction (XRD) characterization results show hydroxyapatite hexagonal phase formation. The element map scanning during the EDS analysis revealed homogenous distribution of constituent elements of calcium, phosphor, oxygen and magnesium. The presence of dextran in the sample was revealed by Fourier transform infrared (FTIR) spectroscopy. The antimicrobial activity of the 10MgHAPD nanocomposites was assessed by in vitro assays using Staphylococcus aureus ATCC 25923, Pseudomonas aeruginosa ATCC 27853, Streptococcus mutans ATCC 25175, Porphyromonas gingivalis ATCC 33277 and Candida albicans ATCC 10231 microbial strains. The results of the antimicrobial assays highlighted that the 10MgHApD nanocomposites presented excellent antimicrobial activity against all the tested microorganisms and for all the tested time intervals. Furthermore, the biocompatibility assays determined that the 10MgHApD nanocomposites did not exhibit any toxicity towards Human gingival fibroblast (HGF-1) cells.

Effect of calcium orthophosphate particle size and CaP:glass ratio on optical, mechanical and physicochemical characteristics of experimental composites

OBJECTIVE

Evaluate light transmittance (%T), color change (ΔE), degree of conversion (DC), bottom-to-top Knoop microhardness (KHN), flexural strength (BFS) and modulus (FM), water sorption/solubility (WS/SL) and calcium release of resin composites containing different dicalcium phosphate dihydrate (DCPD)-to-barium glass ratios (DCPD:BG) and DCPD particle sizes.

METHODS

Ten resin-based composites (50 vol% inorganic fraction) were prepared using BG (0.4 µm) and DCPD particles (12 µm, 3 µm or mixture) with DCPD:BG of 1:3, 1:1 or 3:1. A composite without DCPD was used as a control. DC, KHN, %T and ΔE were determined in 2-mm thick specimens. BFS and FM were determined after 24 h. WS/SL was determined after 7 d. Calcium release was determined by coupled plasma optical emission spectroscopy. Data were analyzed by ANOVA/Tukey test (alpha: 0.05).

RESULTS

%T was significantly reduced in composites with milled, compared to pristine DCPD (p < 0.001). ΔE > 3.3 were observed with DCPD:BG of 1:1 and 3:1 formulated with milled DCPD (p < 0.001). DC increased at 1:1 and 3:1 DCPD:BG (p < 0.001). All composites presented bottom-to-top KHN of at least 0.8. BFS was not affected by DCPD size but was strongly dependent on DCPD:BG (p < 0.001). Reductions in FM were observed with milled DCPD (p < 0.001). WS/SL increased with DCPD:BG (p < 0.001). At 3DCPD: 1BG, using small DCPD particles led to a 35 % increase in calcium release (p < 0.001).

SIGNIFICANCE

A trade-off between strength and Ca2+ release was observed. In spite of its low strength, the formulation containing 3 DCPD: 1 glass and milled DCPD particles is preferred due to its superior Ca2+ release.

Bioactive Inorganic Materials for Dental Applications: A Narrative Review

Over time, much attention has been given to the use of bioceramics for biomedical applications; however, the recent trend has been gaining traction to apply these materials for dental restorations. The bioceramics (mainly bioactive) are exceptionally biocompatible and possess excellent bioactive and biological properties due to their similar chemical composition to human hard tissues. However, concern has been noticed related to their mechanical properties. All dental materials based on bioactive materials must be biocompatible, long-lasting, mechanically strong enough to bear the masticatory and functional load, wear-resistant, easily manipulated, and implanted. This review article presents the basic structure, properties, and dental applications of different bioactive materials i.e., amorphous calcium phosphate, hydroxyapatite, tri-calcium phosphate, mono-calcium phosphate, calcium silicate, and bioactive glass. The advantageous properties and limitations of these materials are also discussed. In the end, future directions and proposals are given to improve the physical and mechanical properties of bioactive materials-based dental materials.

The Influence of Low-Molecular-Weight Monomers (TEGDMA, HDDMA, HEMA) on the Properties of Selected Matrices and Composites Based on Bis-GMA and UDMA

Bisphenol A-glycidyl methacrylate (bis-GMA) and urethane dimethacrylate (UDMA) are usually combined with low-viscosity monomers to obtain more desirable viscosity, handling characteristics and general properties. The present study determined the flexural strength (FS), flexural modulus (FM), diametral tensile strength (DTS), and hardness (HV) of five matrices and composites based on these resins. The polymerization shrinkage stress (PSS) was also studied for the composites. The polymer matrices were formed using bis-GMA and UDMA. TEGDMA, HEMA and HDDMA acted as co-monomers. The composites had 45 wt.% of filler content. The highest FS and FM were obtained from the UDMA/bis-GMA/TEGDMA/HEMA matrix and the composite (matrix + filler). The best DTS values were obtained from the UDMA/bis-GMA/HEMA matrix and the composite. One of the lowest values of FS, FM, and DTS was obtained from the UDMA/bis-GMA/HDDMA matrix and the composite. All the composites demonstrated similar hardness values. The lowest polymerization shrinkage stress was observed for the UDMA/bis-GMA/TEGDMA/HEMA composite, and the highest PSS was observed for the UDMA/bis-GMA/TEGDMA/HDDMA composite. The addition of HEMA had a positive effect on the properties of the tested materials, which may be related to the improved mobility of the bis-GMA and UDMA monomers.

Effect of Nanostructures on the Properties of Glass Ionomer Dental Restoratives/Cements: A Comprehensive Narrative Review

Overall perspective of nanotechnology and reinforcement of dental biomaterials by nanoparticles has been reported in the literature. However, the literature regarding the reinforcement of dental biomaterials after incorporating various nanostructures is sparse. The present review addresses current developments of glass ionomer cements (GICs) after incorporating various metallic, polymeric, inorganic and carbon-based nanostructures. In addition, types, applications, and implications of various nanostructures incorporated in GICs are discussed. Most of the attempts by researchers are based on the laboratory-based studies; hence, it warrants long-term clinical trials to aid the development of suitable materials for the load bearing posterior dentition. Nevertheless, a few meaningful conclusions are drawn from this substantial piece of work; they are as follows: (1) most of the nanostructures are likely to enhance the mechanical strength of GICs; (2) certain nanostructures improve the antibacterial activity of GICs against the cariogenic bacteria; (3) clinical translation of these promising outcomes are completely missing, and (4) the nanostructured modified GICs could perform better than their conventional counterparts in the load bearing posterior dentition.

Calcium hydroxyapatite nanoparticles as a reinforcement filler in dental resin nanocomposite

The current study focuses on the fabrication of calcium hydroxyapatite (Ca₁₀(PO₄)₆(OH)₂) (HA) in a nanorange having whiskers- and cubic-shaped uniform particle morphology. The synthesized HA particles hold a promising feature as reinforcement fillers in dental acrylic resin composite. They increase the efficacy of reinforcement by length and aspect ratio, uniformity, and monodispersity. Therefore, the acrylic resin was reinforced with the as-synthesized monodispersed HA filler particles (0.2-1 Wt%). The presence of filler particles in the composite had a noticeable effect on the tribological and mechanical properties of the dental material. The morphological effect of HA particles on these properties was also investigated, revealing that cubic-shaped particles showed better results than whiskers. The as-fabricated composite (0.4 Wt%) of the cubic-shaped filler particles showed maximum hardness and improved antiwear/antifriction properties. Particle loading played its part in determining the optimum condition, whereas particle size also influenced the reinforcement efficiency. The current study revealed that particle morphology, particle size, uniformity, etc., of HA fillers, greatly influenced the tribological and mechanical properties of the acrylic resin-based nanocomposite. Improvement in the tribological properties of HA particle-reinforced acrylic resin composites (HA-acrylic resin) followed the trend as AR < C_mC < WC < CC.

The Development of Filler Morphology in Dental Resin Composites: A Review

Dental resin composites (DRCs) with diverse fillers added are widely-used restorative materials to repair tooth defects. The addition of fillers brings an improvement in the mechanical properties of DRCs. In the past decade, diverse fillers have emerged. However, the change of emerging fillers mainly focuses on the chemical composition, while the morphologic characteristics changes are often ignored. The fillers with new morphologies not only have the advantages of traditional fillers (particles, fibrous filler, etc.), but also endow some additional functional characteristics (stronger bonding ability to resin matrix, polymerization resistance, and wear resistance, drug release control ability, etc.). Moreover, some new morphologies are closely related to the improvement of traditional fillers, porous filler vs. glass particles, core-sheath fibrous vs. fibrous, etc. Some other new morphology fillers are combinations of traditional fillers, UHA vs. HA particles and fibrous, tetrapod-like whisker vs. whisker and fibrous filler, mesoporous silica vs. porous and silica particles. In this review, we give an overall description and a preliminary summary of the fillers, as well as our perspectives on the future direction of the development of novel fillers for next-generation DRCs.

Effect of the incorporation of hydroxyapatite on the diametral tensile strength of conventional and hybrid glass ionomer cements

The objective was to evaluate the effect of the incorporation of calcium hydroxyapatite particles (HAp) in the diametral tensile strength of a conventional type II glass ionomer (GC Gold Label 2) and a resin-modified glass ionomer cement (GC Gold Label 2 LC R). Two experimental HAp (E1HAp or E2HAp) were synthesized and characterized using X-ray diffraction and Confocal Raman spectroscopy. Both HAp were added into the powder of a conventional or resin-modified glass ionomer cement at 5 or 10 wt.%. A commercial HAp (CHAp) was used as reference material. For each glass ionomer cement, a group without the incorporation of HAp was used as a control. A universal testing machine was used for the mechanical test. The results were analyzed through a two-way ANOVA test followed by a complementary Tukey test. For all analyzes, the level of significance was set at α = 0.05. The average particle size for E1Hap was 15 µm, E2HAp was 35 μm and for CHAp was 1 µm. For conventional GIC, the addition of 10% E1HAp and 5% CHAp significantly increased the diametral tensile strength values (p ≤ 0.005). On the other hand, for the resin-modified GIC, except for the 5% E2HAp group, all experimental groups significantly reduced the values of diametral tensile strength (p ≤ 0.007). The addition of HAp improved the mechanical properties only for the conventional glass ionomer cement.

Material behavior of resin composites with and without fibers after extended water storage

The objective of this study was to determine the long-term water sorption, solubility and hygroscopic expansion of resin composites with and without incorporated short fibers. Three resin composites incorporating fibers were examined: everX Posterior (EVX), NovoPro Universal (NPU) and NovoPro Flow (NPF). Four Particulate filled composites were used as controls: Filtek bulk Fill (FBF), Filtek one bulkfill (FBO), Filtek Supreme XTE (XTE), and Filtek Supreme Flow (XTEF). For sorption and solubility measurements, specimens were immersed in water for140 days, weighed at intervals, then dried for a further 42 days at 37±1°C. Laser micrometer measured diametral expansion. XTEF exhibited the highest sorption. The solubility range was between -1.4 to 4.1 μg/mm; XTEF had the highest solubility, with EVX demonstrating negative solubility. Hygroscopic expansion ranged between 1.4% for hydroxyapatite fiber reinforced composite (NPU) and 2.2% for E-glass fiber reinforced composite (EVX). A nano-fiber containing composite (NPU) had the most favorable outcomes compared to a range of composites.

Nano-structured hydroxyapatite and titanium dioxide enriching PENTA /UDMA adhesive as aesthetic coating for tooth enamel

OBJECTIVES

The aim of this study was to investigate the effect of the nanostructured hydroxyapatite (NHAp) and titanium dioxide nanoparticles (NTiO₂) on dispersion in an adhesive containing monomers of Dipenta erythritol penta-acrylate monophosphate (PENTA) and Urethane dimethacrylate (UDMA), as well as evaluating the structural, optical and mechanical behavior of the composite material for dental aesthetic application.

METHODS

The NHAp powders were synthesized through the wet chemical methods of hydrothermal and ultrasound-assisted precipitation. The microstructure, morphology and composition analysis of the powder of NHAp and NTiO₂ were performed by scanning and transmission electron microscopy. The optical microscopic identification of the different colors was obtained due to varying the amounts of NHAp and NTiO₂ in the adhesive. On the other hand, the diffuse reflectance spectra of the coatings were evaluated every 2nm with the wavelength from 400 to 800nm for combined specular and diffuse reflectance. The nanomechanical properties of the aesthetic coating such as (H), elastic modulus (E) and nanoscratching were evaluated by nanoindentation. The roughness of the composite coatings were evaluated by AFM.

RESULTS

From different powders combinations, NHAP 75%Wt-NTiO₂ %25Wt, at (10Wt %) into a dental adhesive, the resulting mixture manifested the optimum aesthetic white appearance. The scanning and transmission electron microscopy images confirmed that the HAp nanorods and TiO₂ nanoparticles sized were 55nm and 20nm respectively prepared by the high-energy ball mixed process. The values of nanomechanical properties of the optimum aesthetic coating were hardness, H=3.2±0.3GPa, elastic modulus, E=78±3GPa, Yield point, Y=107MPa±2 and scratching, maximum wear track deformation 3.7±0.12 μm². The percentage of reflectance to optimum aesthetic white appearance was of 46.83% at 423nm of wavelength.

CONCLUSIONS

The nanocomposite PENTA/UDMA with mixtures of Nanohydroxyapatite and titanium dioxide may be considerate as a mechanical toughened, also an option to modify shade qualities for dental aesthetic applications.

Microwave assisted urethane grafted nano-apatites for dental adhesives

The objectives were to synthesize urethane grafted nano-apatite in shortest possible time duration using the microwave irradiation method and to utilize them for synthesis of experimental dental adhesives. The structural, morphological, thermal, and mechanical behavior of synthesized grafted nano-apatite were investigated. Then, these grafted nano-apatite particles were incorporated in various concentrations that is, 5wt.%, 10wt.%, and 15wt.% into dimethacrylate resins to develop bioactive adhesives. The weight measurement analysis in deionized water and phosphate buffer saline, Knoop micro-hardness, and degree of conversion were evaluated. The bacterial adhesion was investigated with Streptococcus mutans at 6h, 24h, and 48h. Statistical analysis was conducted using one-way ANOVA. The urethane dimethacrylate was successfully grafted on the nano-apatite surface and spectroscopic analysis confirmed the presence of urethane and phosphate peaks. An inverse relationship was found in both media between the concentration of grafted fillers and weight loss. No significant difference was observed in the micro-hardness and degree of conversion among the groups, whereby the degree of conversion for all groups was in the range of 83% to 86%. The mean number of bacterial colonies was significantly lower in the 15wt.% group compared to 5wt.% and 10wt.%. The grafted nano-apatite presented favorable results for adhesive resin incorporation, where 15wt.% group comparatively showed superior results than other groups.

Use of Protein Repellents to Enhance the Antimicrobial Functionality of Quaternary Ammonium Containing Dental Materials

An advancement in preventing secondary caries has been the incorporation of quaternary ammonium containing (QAC) compounds into a composite resin mixture. The permanent positive charge on the monomers allows for electrostatic-based killing of bacteria. Spontaneous adsorption of salivary proteins onto restorations dampens the antimicrobial capabilities of QAC compounds. Protein-repellent monomers can work with QAC restorations to achieve the technology's full potential. We discuss the theory behind macromolecular adsorption, direct and indirect characterization methods, and advances of protein repellent dental materials. The translation of protein adsorption to microbial colonization is covered, and the concerns and fallbacks of the state-of-the-art protein-resistant monomers are addressed. Last, we present new and exciting avenues for protein repellent monomer design that have yet to be explored in dental materials.

Development of brushite particles synthesized in the presence of acidic monomers for dental applications

OBJECTIVES

To synthesize and characterize brushite particles in the presence of acidic monomers (acrylic acid/AA, citric acid/CA, and methacryloyloxyethyl phosphate/MOEP) and evaluate the effect of these particles on degree of conversion (DC), flexural strength/modulus (FS/FM) and ion release of experimental composites.

METHODS

Particles were synthesized by co-precipitation with monomers added to the phosphate precursor solution and characterized for monomer content, size and morphology. Composites containing 20 vol% brushite and 40 vol% reinforcing glass were tested for DC, FS and FM (after 24 h and 60 d in water), and 60-day ion release. Data were subjected to ANOVA/Tukey tests (DC) or Kruskal-Wallis/Dunn tests (FS and FM, alpha: 5%).

RESULTS

The presence of acidic monomers affected particle morphology. Monomer content on the particles was low (0.1-1.4% by mass). Composites presented similar DC. For FS/24 h, only the composite containing DCPD_AA was statistically similar to the composite containing 60 vol% of reinforcing glass (without brushite, "control"). After 60 days, all brushite-containing materials showed similar FS, statistically lower than the control composite (p<0.01). Composites containing DCPD_AA, DCPD_MOEP or DCPD_U ("unmodified") showed statistically similar FM/24 h, higher than the control composite. After prolonged immersion, all composites were similar to the control composite, except DCPD_AA. Cumulative ion release ranged from 21 ppm to 28 ppm (calcium) and 9 ppm to 17 ppm (phosphate). Statistically significant reductions in ion release between 15 and 60 days were detected only for the composite containing DCPD_MOEP.

SIGNIFICANCE

Acidic monomers added to the synthesis affected brushite particle morphology. After 60-day storage in water, composite strength was similar among all brushite-containing composites. Ion release was sustained for 60 days and it was not affected by particle morphology.

Synthesis and characterization of cellulose/hydroxyapatite based dental restorative composites

The aim of this study was an in-situ synthesis of hydroxyapatite (HA) on cellulose fibers to be used as a new reinforcing agent for dental restorations. The microwave irradiation method was used for synthesis and the materials were characterized with analytical techniques. The prepared dental resin composites were mechanically tested by a universal testing machine and electrodynamic fatigue testing system. FTIR, XRD, SEM/EDS analysis confirmed the successful synthesis of HA on cellulose fibers. The Alamar blue biocompatibility assay showed more than 90% cell viability for the prepared cellulose/HA. The mechanical properties of resin composites improved with cellulose content from 30 wt.% to 50 wt.% in the polymer matrix. Substantially, increasing the cellulose/HA content from 40% to 50% improved the mechanical properties. The results suggested that HA could be successfully synthesized on cellulose fibers using microwave irradiation and contributed to improving the mechanical properties of dental resin composites.

Fabrication and characterization of remineralizing dental composites containing hydroxyapatite nanoparticles

The aim of this study was to fabricate and characterize dental composites containing hydroxyapatite nanoparticles (HApNPs). Four dental composites were produced from the same organic matrix (70 wt% Bis-GMA and 30 wt% TEGDMA), with partial replacement of BaBSi particles (65 wt%) by HApNPs in the following concentrations (wt%): E0 (0) - control, E10 (10), E20 (20) and E30 (30). Ca²⁺ and PO₄^3- release was evaluated in solutions with different pHs (4, 5.5, and 7) using atomic emission spectroscopy with microwave-induced nitrogen plasma while the enamel remineralization potential was evaluated in caries-like enamel lesions induced by S. mutans biofilm using micro-CT. The following properties were characterized: degree of conversion (DC%), microhardness (KHN), flexural strength (FS), elastic modulus (EM) and translucency (TP). The higher the HApNPs content, the higher the Ca²⁺ and PO₄^3- release. The ions release was influenced by pH (4 > 5.5 > 7) (p < 0.05). All composites loaded with HApNPs were able to remineralize the enamel (E30 = E20 > E10) (p < 0.05). Contrarily, E0 was not able of recovering the enamel mineral loss. E0 and E10 presented highest DC%, while E20 and E30 showed similar and lowest DC%. KHN and FS were decreased with the addition of HApNPs, while EM was not influenced by the incorporation of HApNPs. E10 presented statistically similar TP to E0, while this property decreased for E20 and E30 (p < 0.05). Incorporation of HApNPs into dental composites promoted enamel remineralization, mainly at potentially cariogenic pH (= 4), while maintained their overall performance in terms of physicomechanical properties.

Triethyleneglycol dimethacrylate addition improves the 3D-printability and construct properties of a GelMA-nHA composite system towards tissue engineering applications

In tissue engineering, there is a growing interest in the development of 3D printable bone tissue-inspired nanocomposites. However, most such nanocomposites have poor mechanical properties, owing to poor dispersion of the mineral phase (e.g. nano-hydroxyapatite, nHA) within the organic phase (e.g. methacrylated gelatin, GelMA) and low volume fractions of each phase. Triethyleneglycol dimethacrylate (TEGDMA) is commonly added to dental resin-based composites to improve the properties of the dental resin. Here, the effects of substituting a portion of the water phase in a GelMA-nHA composite with TEGDMA were evaluated. TEGDMA improved the dispersion of nHA within the highly-concentrated GelMA-based composite ink, as well as increased the ink's shear yield strength and reduced the critical energy for ink cure. As a result, the printability of the composite ink was greatly improved upon TEGDMA inclusion. Lastly, while the swelling of the cast composite in 37 °C water increased slightly, the mechanical properties (tensile strength, toughness, and stiffness) of the cast composite increased by at least an order of magnitude upon TEGDMA addition, and all composites demonstrated MSC cytocompatibility after 24 h. Overall, TEGDMA shows promise as an additive to tune properties of the GelMA-nHA system towards use in tissue engineering applications.

New Pre-reacted Glass Containing Dental Composites (giomers) with Improved Fluoride Release and Biocompatibility

The aim of the present work was to prepare a series of novel restorative giomers and investigate the morphology, the physico-chemical properties (residual monomer, fluoride release), and the cytotoxicity of the new materials. The experimental giomers were prepared as light-cured pastes by blending different resin matrices comprising aromatic/aliphatic/urethane (di) methacrylates, with hybrid fillers containing pre-reacted glasses (PRGs), a radiopaque glass, and nano fluorhydroxyapatite. Polyalkenoic acids based on acrylic acid/itaconic acid/N-acryloyl -L-leucine modified or not with methacrylic groups, together with a superficially active glass, were used to prepare the PRGs. The fluoride ion release of the experimental giomers was investigated within a period of 60 days of storage in bidistilled water while using a fluoride ion selective electrode. Beautifil II commercial product was used as a reference. Cell cytotoxicity tests were done in vitro, in accordance with ISO 10993-122012 proceedings. Human dermal fibroblasts and umbilical endothelial vein cultures were used. The values that were obtained for cumulative fluoride release for all experimental giomers were higher than for the Beautifil II product, being more than twice the ones that were obtained for the commercial product after 60 days of storage in bidistilled water. The experimental biomaterials showed similar and/or better results when compared to the commercial one; this effect was maintained in all tested conditions.

The Biological Evaluation of Conventional and Nano-Hydroxyapatite-Silica Glass Ionomer Cement on Dental Pulp Stem Cells: A Comparative Study

BACKGROUND

Despite their lower strength, glass ionomer cements (GICs) are widely used as restorative materials because of their anti-cariogenic properties, direct adhesion to tooth structure and good biocompatibility. Recently, the addition of nano-hydroxyapatite (nano-HA)-silica to conventional GIC (cGIC) has been shown to improve the strength of cGIC. However, the biocompatibility and cell attachment properties of this material are unknown.

AIMS

This study aims to evaluate and compare the cytotoxicity and cell attachment properties of cGIC and nano-HA-silica-GIC on dental pulp stem cells (DPSCs).

METHODS AND MATERIALS

Material extracts of nano-HA-silica-GIC and cGIC were prepared into seven serial dilutions and applied to 96 well plates seeded with DPSCs. After 72 h, the cell viability was determined using MTT assay. The DPSCs cell attachment properties were examined under scanning electron microscope (SEM) after 24 and 72 h. Kruskal-Wallis test was used to analyse the data for MTT assay (P < 0.05). SEM images of cell attachment properties were also described.

RESULTS

Nano-HA-silica-GIC and cGIC was shown to be slight to non-cytotoxic at all concentrations, except 200 mg/ml. Moderate cytotoxicity has been observed at 200 mg/ml concentration where nano-HA-silica-GIC and cGIC revealed cell viability values of 44.38 and 42.15%, respectively. Nano-HA-silica-GIC demonstrated better cell viability values than cGIC at all concentrations except for 6.25 and 12.5 mg/ml. Nevertheless, the results were not statistically significant (P > 0.05). SEM examination revealed the increasing numbers of DPSCs attached to both groups with prominent filopodia, especially after 72 h.

CONCLUSIONS

Nano-HA-silica-GIC exhibited good biocompatibility which is comparable to cGIC and favoured the attachment of DPSCs.

Selective Atomic-Level Etching on Short S-Glass Fibres to Control Interfacial Properties for Restorative Dental Composites

Interfacial bonding between fibre and matrix is most critical to obtain enhanced mechanical properties of the resulting composites. Here we present a new surface tailoring method of selective wet etching and organosilicon monomers (3-(Trimethoxysilyl) propyl methacrylate, TMSPMA) deposition process on the short S-Glass fibre as a reinforcing material, resulting in increased mechanical retention and strong chemical bonding between glass fibres and polymer resin (a mixture of triethylene glycol dimethacrylate (TEGDMA) and urethane dimethacrylate (UDMA) monomers). The effect of surface modification on fibre matrix interfacial strength was investigated through microdroplet tests. An S-Glass fibre treated with piranha solution (a mixture of H₂O₂ and H₂SO₄) for 24 hours followed by TMSPMA surface silanization shows highest increase up to 39.6% in interfacial shear strength (IFSS), and critical fibre length could be reduced from 916.0 µm to 432.5 µm. We find the optimal surface treatment condition in that the flexural strength of dental composites reinforced by the S-Glass fibres enhanced up to 22.3% compared to the composites without fibre surface treatments. The significant elevation in strength is attributed to changes in the surface roughness of glass fibres at atomic scale, specifically by providing the multiplied spots of the chemical bridge and nano-mechanical interlocking. The findings offer a new strategy for advanced tailoring of short S-Glass fibres to maximise the mechanical properties of biomedical and dental composites.

Modification of glass ionomer cements on their physical-mechanical and antimicrobial properties

OBJECTIVE

The aim of this review was to provide an insight about the factors affecting the properties of glass ionomer cements and provides a review regarding studies that are related to modification of glass ionomer cements to improve their properties, particularly on physical-mechanical and antimicrobial activity.

METHODS

PubMed and Science Direct were searched for papers published between the years 1974 and 2018. The search was restricted to articles written in English related to modification of glass ionomer cements. Only articles published in peer-reviewed journals were included. The search included literature reviews, in vitro, and in vivo studies. Articles written in other languages, without available abstracts and those related to other field were excluded. About 198 peer-review articles in the English language were reviewed.

CONCLUSION

Based on the finding, most of the modification has improved physical-mechanical properties of glass ionomer cements. Recently, researchers have attempted to improve their antimicrobial properties. However, the attempts were reported to compromise the physical-mechanical properties of modified glass ionomer cements.

CLINICAL SIGNIFICANCE

As the modification of glass ionomer cement with different material improved the physical-mechanical and antimicrobial properties, it could be used as restorative material for wider application in dentistry.

A review of bioceramics-based dental restorative materials

Currently, much has been published related to conventional resin-based composites and adhesives; however, little information is available about bioceramics-based restorative materials. The aim was to structure this topic into its component parts and to highlight the translational research that has been conducted up to the present time. A literature search was done from indexed journals up to September 2017. The main search terms used were based on dental resin-based composites, dental adhesives along with bioactive glass and the calcium phosphate family. The results showed that in 123 articles, amorphous calcium phosphate (39.83%), hydroxyapatite (23.5%), bioactive glass (16.2%), dicalcium phosphate (5.69%), monocalcium phosphate monohydrate (3.25%), and tricalcium phosphate (2.43%) have been used in restorative materials. Moreover, seven studies were found related to a newly developed commercial bioactive composite. The utilization of bioactive materials for tooth restorations can promote remineralization and a durable seal of the tooth-material interface.

Calcium phosphates as ion-releasing fillers in restorative resin-based materials

Calcium phosphates (CaP) are the main constituents of the mineral phase in bones and teeth and, along with calcium silicates and bioactive glasses, have been extensively investigated in remineralization of enamel and dentin. When used as ion-releasing fillers in resin-based materials, they could contribute to extend the service life of adhesive restorations, remineralize caries-affected dentin or prevent caries lesions under sealants and orthodontic brackets. However, the development of resin-based bioactive materials is not straightforward because of the several compositional variables involved in ion release. Also, CaP particles do not reinforce the material; therefore, if high mechanical properties are required, the ratio between CaP particles and reinforcing fillers must be observed. Several research groups have investigated how CaP phase, particle size and content, as well as resin matrix formulation affect remineralization, ion release kinetics and mechanical properties of these materials. This review presents an overview of the main findings reported in the literature.

Development of calcium phosphate/ethylene glycol dimethacrylate particles for dental applications

This study describes the synthesis of dicalcium phosphate dihydrate (DCPD) particles in the presence of different ethylene glycol dimethacrylates (EGDMA, ethylene glycol/EG units: 1, 2, 3 or 4) at two monomer-to-ammonium phosphate molar ratios (1:1 and 2:1), as a strategy to develop CaP-monomer particles with improved interaction with resin matrices. Particles displaying high surface areas and organic contents were added to a photocurable BisGMA-TEGDMA resin and the resulting materials were tested for degree of conversion (DC), biaxial flexural strength (BFS), flexural modulus, and ion release. Data were subjected to one-way ANOVA or Kruskal-Wallis/Dunn test (alpha: 0.05). Functionalization with EGDMA derivatives was dependent upon the length of the spacer group and monomer concentration in the synthesis. No differences in DC were observed among materials (p > 0.05). A 39% increase in BFS was obtained with the use of particles with the highest functionalization level compared to non-functionalized particles (p < 0.001). The use of functionalized DCPD reduced flexural modulus in comparison to non-functionalized particles (p < 0.001). Calcium release was similar among materials and remained constant during the experiment, while phosphate release was higher at 7 days in comparison to the remaining weeks (p < 0.001). In conclusion, diethylene glycol dimethacrylate resulted in the highest functionalization levels and the highest BFS among DCPD-containing materials. Ion release was not affected by functionalization. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 2018. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B: 708-715, 2019.

Evaluation of remineralization potential and mechanical properties of pit and fissure sealants fortified with nano-hydroxyapatite and nano-amorphous calcium phosphate fillers: An in vitro study

Objectives:

The aim of this study was: (i) to formulate pit and fissure sealants (PFS) containing nano-hydroxyapatite (nHAP) filler; nHAP filler and silica co-filler; nHAP and nano-Amorphous Calcium Phosphate (nACP) co-filler, (ii) to evaluate physical properties; degree of conversion (DOC), curing depth (CD) and mechanical properties; microshear bond strength (MBS) of fortified PFS, and (iii) to assess remineralization potential and release of Ca²⁼ and PO₄ ions from newly synthesized sealants.

Materials and Methods:

Four PFS were prepared using monomers with mixture of 35.5 wt % BisGMA, 35.5 wt % triethylene glycol dimethacrylate and 28 wt % hydroxyethyl methacrylate. Bioactive nanofillers (nHAP and n-ACP) were added in various concentrations (0%–30%). Three commercial sealants were used as follows: unfilled (Clinpro; 3M ESPE), Fluoride releasing (Delton FS plus, Dentsply), ACP filled (Aegis, Bosworth). The samples (n = 35.5/gp) were tested for MBS, DOC, and CD. Remineralization potential was assessed by scanning electron microscopy (SEM). The concentrations of Ca²⁼ and PO₄ released from the sealant specimens were analyzed with Ultraviolet-visible Spectrophotometer. Data obtained was statistically analyzed (one-way analysis of variance, Tukey's test, P < 0.05).

Results:

10% hydroxyapatite (HAP) =20% ACP sealant showed significantly higher DOC. A remineralized region on the surface between fissure sealant and tooth enamel was observed by SEM in all three HAP filled bioactive sealants. Decreasing the solution pH significantly increased ion release from sealant filled with 10% nHAP = 20% nACP (P ≤ 0.001).

Conclusion:

Results suggested that admixture of nHAP and nACP to PFS showed remineralizing capability, without declining their mechanical and physical properties.

Load-bearing capacity of various CAD/CAM monolithic molar crowns under recommended occlusal thickness and reduced occlusal thickness conditions

PURPOSE

The goal of this study was to evaluate the fracture resistances of various monolithic crowns fabricated by computer-aided design and computer-aided manufacturing (CAD/CAM) with different thickness.

MATERIALS AND METHODS

Test dies were fabricated as mandibular molar forms with occlusal reductions using CAD/CAM. With different occlusal thickness (1.0 or 1.5 mm), a polymer-infiltrated ceramic network (Enamic, EN), and zirconia-reinforced lithium silicate (Suprinity, SU and Celtra-Duo, CD) were used to fabricate molar crowns. Lithium disilicate (e.max CAD, EM) crowns (occlusal: 1.5 mm) were fabricated as control. Seventy crowns (n=10 per group) were bonded to abutments and stored in water for 24 hours. A universal testing machine was used to apply load to crown until fracture. The fractured specimens were examined with a scanning electron microscopy.

RESULTS

The type of ceramics and the occlusal thickness showed a significant interaction. With a recommended thickness (1.5 mm), the SU revealed the mean load similar to the EM, higher compared with those of the EN and CD. The fracture loads in a reduced thickness (1.0 mm) were similar among the SU, CD, and EN. The mean fracture load of the SU and CD enhanced significantly when the occlusal thickness increased, whereas that of the EN did not.

CONCLUSION

The fracture loads of monolithic crowns were differently influenced by the changes in occlusal thickness, depending on the type of ceramics. Within the limitations of this study, all the tested crowns withstood the physiological masticatory loads both at the recommended and reduced occlusal thickness.

Evaluation of the effect of home bleaching agents on surface microhardness of different glass-ionomer cements containing hydroxyapatite

Background

Home bleaching agents may exert some negative effects on surface hardness of restorative materials such as glass-ionomer cements (GICs). Since some studies have shown that some components such as hydroxyapatite (HA), as a bioactive glass, can improve the mechanical properties of dental materials, the effect of bleaching agents on surface hardness of GICs containing hydroxyapatite is questionable. This study was designed to evaluate the effect of home bleaching agents on the surface hardness of two different commercially available GICs containing hydroxyapatite.

Material and Methods

80 disk-shaped specimens were made from two different GICs, including resin modified glass-ionomer and Zirconomer. Each material was divided into four groups (n=10): 1. control, 2. 20 %wt. hydroxyapatite-containing, 3. bleached and 4. bleached 20 %wt. hydroxyapatite-containing. Group 1 and 2 specimens were stored in distilled water for 2 weeks while group 3 and 4 specimens were treated with 15% carbamide peroxide in that period. Surface hardness was tested with Vickers surface hardness tester. Data were analyzed with 3-way ANOVA and mean comparison done by post hoc Tukey tests (p<0.05).

Results

In general RMGI had a significantly highest Vickers surface hardness value among all groups. 15% carbamide peroxide reduced surface hardness compared to control groups (RMGI and Zr) significantly. In the HA-containing GICs groups, bleaching agent did not significantly changed the surface hardness value.

Conclusions

In this study we concluded that applied treatments (bleaching and adding HA) in implicit percentages reduced surface hardness of GICs. Also we suggest more studies in clinical conditions be done to verify these results.

Key words:Home bleaching, Resin Modified Glass-ionomer cement, surface hardness, Zirconia-reinforced glass ionomer, hydroxyapatite.

Trends in restorative composites research: what is in the future?

Clinical trials have identified secondary caries and bulk fracture as the main causes for composite restoration failure. As a measure to avoid frequent reinterventions for restoration replacement, composites with some sort of defense mechanism against biofilm formation and demineralization, as well as materials with lower susceptibility to crack propagation are necessary. Also, the restorative procedure with composites are very time-consuming and technically demanding, particularly concerning the application of the adhesive system. Therefore, together with bulk-fill composites, self-adhesive restorative composites could reduce operator error and chairside time. This literature review describes the current stage of development of remineralizing, antibacterial and self-healing composites. Also, an overview of the research on fiber-reinforced composites and self-adhesive composites, both introduced for clinical use in recent years, is presented.

Streptococcus mutans adherence and biofilm formation on experimental composites containing dicalcium phosphate dihydrate nanoparticles

This study aimed at evaluating bacterial adhesion and biofilm formation on resin-based composites (RBC) including dicalcium phosphate dihydrate nanoparticles (nDCPD).

METHODS

Specimens were prepared from experimental RBCs with BisGMA/TEGDMA resin matrix including 20 vol% of either nDCPD (nDCPD-RBC), TEGDMA-functionalized nDPCD (F-nDCPD-RBC) or silanized silica (SiO₂-RBC). Neat resin blend (control-Resin), conventional nanohybrid RBC (control-RBC) and human enamel were used for reference. Characterization of the specimens included surface roughness (SR), surface free energy (SFE), chemical surface composition (EDS, XPS), and buffering ability of a pH = 4.00 solution. Streptococcus mutans adherence was assessed after 2 h; biofilm formation was simulated for 48 h using a bioreactor. Adherent, viable biomass was determined using tetrazolium salt assay (MTT).

RESULTS

nDCPD-RBC yielded highest roughness and showed higher polar and lower disperse component to total SFE. EDS and XPS indicated higher amounts of calcium and phosphate on the surface of nDCPD-RBC than on F-nDCPD-RBC. nDCPD buffered the acidic solution to 5.74, while functionalization almost prevented buffering (pH = 4.26). F-nDCPD-RBC reduced adherence and biofilm formation in comparison to nDCPD-RBC. Regardless of functionalization, biofilm formation on nDCPD-containing RBCs was not significantly different from SiO₂-RBC. Control-Resin, control-RBC, and enamel surfaces showed similar adherence values as F-nDCPD-RBC, but lower biofilm formation compared to both nDCPD-containing RBCs. In conclusion, the incorporation of nDCPD did not minimize S. mutans adherence and biofilm formation as a function of the materials´ surface properties. However, results observed for the buffering capacity indicated that optimized formulations of biomimetic RBCs may be useful for modulating their interaction with microorganisms.

Effects of Different Percentages of Microhydroxyapatite on Microhardness of Resin-modified Glass-ionomer and Zirconomer

Background

Hydroxyapatite (HA) is the main mineral component of the tooth structure, which exhibits considerable biological behavior and its incorporation might improve microhardness of dental materials. Microhardness of restorative materials, like glass-ionomer, is critical for the clinical longevity of restorations. The aim of this study was to evaluate the microhardness of two glass-ionomers types by incorporating different percentages of microhydroxyapatite.

Material and Methods

In this study, 80 disc-shaped experimental specimens (6 mm in diameter, 2 mm in height) were prepared in 8 groups, including resin-modified glass-ionomer (RMGI, GC, Gold Label, Japan), zirconia-reinforced glass-ionomer (Zirconomer, Shofu, Kyoto, Japan), and their mixture with 0, 5, 15 and 25 wt% of microhydroxyapatite (Sigma-Aldrich, Germany). All the specimens were stored in deionized water at 37ºC for 24 hours. Then Vickers microhardness test was carried out on the both sides of specimens and data were analyzed using two-way ANOVA and paired t-test (P<0.05).

Results

Microhardness of Zirconomer and RMGI increased significantly due to adding 5 and 15 wt% of micrhydrox-yapatite (P<0.001). The highest Vickers hardness number (VHN) was recorded in the RMGI group with 5 wt% of microhydroxyapatite. In addition, in all the study groups RMGI exhibited higher microhardness values than Zirconomer (P<0.001). However, microhardness values decreased significantly after adding 25 wt% of microhydroxyapatite to Zirconomer (P<0.001). Similarly, VHN decreased in RMGI groups containing 25 wt% of HA compared to control groups (without HA) (P<0.001).

Conclusions

Incorporation of 5 and 15 wt% of microhydroxyapatite to RMGI and Zirconomer improved microhardness, while adding 25 wt% of HA decreased hardness with both experimental materials compared to the control groups (without HA).

Key words:Microhardness, Resin-modified glass-ionomer, Zirconia-reinforced glass ionomer, Microhydroxyapatite.

Effect of addition of nano-hydroxyapatite on physico-chemical and antibiofilm properties of calcium silicate cements

Objective

Mineral Trioxide Aggregate (MTA) is a calcium silicate cement composed of Portland cement (PC) and bismuth oxide. Hydroxyapatite has been incorporated to enhance mechanical and biological properties of dental materials. This study evaluated physicochemical and mechanical properties and antibiofilm activity of MTA and PC associated with zirconium oxide (ZrO₂) and hydroxyapatite nanoparticles (HAn).

Material and Methods

White MTA (Angelus, Brazil); PC (70%)+ZrO₂ (30%); PC (60%)+ZrO₂ (30%)+HAn (10%); PC (50%)+ZrO₂ (30%)+HAn (20%) were evaluated. The pH was assessed by a digital pH-meter and solubility by mass loss. Setting time was evaluated by using Gilmore needles. Compressive strength was analyzed by mechanical test. Samples were radiographed alongside an aluminum step wedge to evaluate radiopacity. For the antibiofilm evaluation, materials were placed in direct contact with E. faecalis biofilm induced on dentine blocks. The number of colony-forming units (CFU mL-1) in the remaining biolfilm was evaluated. The results were submitted to ANOVA and the Tukey test, with 5% significance.

Results

There was no difference in pH levels of PC+ZrO₂, PC+ZrO₂+HAn (10%) and PC+ZrO₂+HAn (20%) (p>0.05) and these cements presented higher pH levels than MTA (p<0.05). The highest solubility was observed in PC+ZrO₂+HAn (10%) and PC+ZrO₂+HAn (20%) (p<0.05). MTA had the shortest initial setting time (p<0.05). All the materials showed radiopacity higher than 3 mmAl. PC+ZrO₂ and MTA had the highest compressive strength (p<0.05). Materials did not completely neutralize the bacterial biofilm, but the association with HAn provided greater bacterial reduction than MTA and PC+ZrO₂ (p<0.05) after the post-manipulation period of 2 days.

Conclusions

The addition of HAn to PC associated with ZrO₂ harmed the compressive strength and solubility. On the other hand, HAn did not change the pH and the initial setting time, but improved the radiopacity (HAn 10%), the final setting time and the E. faecalis antibiofilm activity of the cement.

Polymer-based material containing calcium phosphate particles functionalized with a dimethacrylate monomer for use in restorative dentistry

Dicalcium phosphate dihydrate particles functionalized with triethyleneglycol dimethacrylate were synthesized and added to a photocurable mixture of bisphenol-A glycidyl dimethacrylate and triethyleneglycol dimethacrylate with the purpose of developing a resin composite capable of releasing calcium and phosphate ions to foster dental remineralization. Particle functionalization would minimize the deleterious effect of adding low cohesive strength nano-structured particles with no chemical interaction with the organic matrix on the material’s mechanical properties. The results showed that calcium release over 28 days was not impaired by particle functionalization. A statistically significant 32% increase in strength was recorded with the use of functionalized dicalcium phosphate dihydrate in comparison to the material containing non-functionalized particles. However, the strength of the unfilled resin was not matched by the composite with functionalized particles. Elastic modulus increased with particle incorporation, regardless of functionalization. Degree of conversion and optical properties (total transmittance and color change/ΔE) of the resin-based materials were not affected by the addition of dicalcium phosphate dihydrate particles (functionalized or not).

Bioactive composites containing TEGDMA-functionalized calcium phosphate particles: Degree of conversion, fracture strength and ion release evaluation

OBJECTIVE

To evaluate the strength and ion release of experimental composites containing TEGDMA-functionalized calcium phosphate particles.

METHODS

Seven composites containing equal parts (in mols) of BisGMA and TEGDMA and 60vol% of fillers were manipulated. Filler phase was constituted by silanized barium glass and 0% (control), 10% or 20% (volume) of dicalcium phosphate dihydrate (DPCD) particles, either non-functionalized or functionalized with two different TEDGMA contents. DCPD particles were synthesized and characterized by X-ray diffraction (XRD), elemental analysis, surface area and dynamic light scattering. Composites were tested for degree of conversion (DC) by near-FTIR. Biaxial flexural strength (BFS) was determined after 24h and 28days in water. Calcium and phosphate release after 7days was assessed using inductively coupled plasma optical emission spectrometry (ICP-OES). Data were analyzed by ANOVA/Tukey test (alpha:5%).

RESULTS

XRD confirmed the crystalline structure corresponding to DCPD. Elemental analysis revealed particles with zero, 14% or 22% TEGDMA, with similar D₅₀ (around 19μm) and surface areas from 3.5 to 11.4m²/g. The presence of DCPD did not reduce DC. After 24h, functionalization (both 14% and 22% TEGDMA) improved composite strength in comparison to non-functionalized DCPD, both at 10% and 20% levels. After 28days, BFS of materials containing 10% functionalized DCPD were statistically similar to the control containing only barium glass. Among composites containing 10% DCPD, particle functionalization with 14% TEGDMA did not jeopardize ion release.

SIGNIFICANCE

At 10vol%, the use of TEGDMA-functionalized CaP particles improved composite strength in relation to non-functionalized particles, while maintaining similar ion release levels.

Demineralization-remineralization dynamics in teeth and bone

Biomineralization is a dynamic, complex, lifelong process by which living organisms control precipitations of inorganic nanocrystals within organic matrices to form unique hybrid biological tissues, for example, enamel, dentin, cementum, and bone. Understanding the process of mineral deposition is important for the development of treatments for mineralization-related diseases and also for the innovation and development of scaffolds. This review provides a thorough overview of the up-to-date information on the theories describing the possible mechanisms and the factors implicated as agonists and antagonists of mineralization. Then, the role of calcium and phosphate ions in the maintenance of teeth and bone health is described. Throughout the life, teeth and bone are at risk of demineralization, with particular emphasis on teeth, due to their anatomical arrangement and location. Teeth are exposed to food, drink, and the microbiota of the mouth; therefore, they have developed a high resistance to localized demineralization that is unmatched by bone. The mechanisms by which demineralization-remineralization process occurs in both teeth and bone and the new therapies/technologies that reverse demineralization or boost remineralization are also scrupulously discussed. Technologies discussed include composites with nano- and micron-sized inorganic minerals that can mimic mechanical properties of the tooth and bone in addition to promoting more natural repair of surrounding tissues. Turning these new technologies to products and practices would improve health care worldwide.