Effect of adhesive coating on calcium, phosphate, and fluoride release from experimental and commercial remineralizing dental restorative materials

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

OBJECTIVES

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

METHODS

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

RESULTS

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

SIGNIFICANCE

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

Evaluation of Mechanical and Elemental Properties of Bioceramic-Coated Orthodontic Brackets and Enamel Surface

OBJECTIVE

 The aim is to coat orthodontic brackets with two different bioactive materials and to compare the mechanical and morphological properties of coated brackets and tooth surfaces.

MATERIALS AND METHODS

 A total of 120 stainless steel brackets were divided equally into three groups, that is, the uncoated brackets and nanohydroxyapatite (nHA)-coated, and nanobioactive glass (nBG)-coated brackets using a spin coater machine. The brackets were bonded on the enamel surface and underwent remineralization/demineralization cycles for days 1, 7, 14, and 30. At each time interval, the bond strength of the brackets was assessed using mechanical loading. An optical and scanning electron microscope (SEM) were used for surface evaluation, and the adhesive remanent index (ARI) values were obtained and quantified.

STATISTICAL ANALYSIS

 One-way analysis of variance using Tukey's test was used to compare the differences among the groups.

RESULTS

 A uniform distribution of nanoparticles occurred on the surfaces of brackets. The shear bond strength (SBS) showed no significant differences in any tested groups on days 1, 7, and 14. However, control and nBG showed a significant difference from nHA at day 30. On days 7, 14, and 30, the nHA group showed the highest SBS values among the groups. For ARI, most samples showed an adhesive nature of failure at the enamel-brackets interface. The images confirmed the presence of coated particles on brackets and remnants of adhesives after SBS.

CONCLUSION

 This study confirmed that the nHA- and nBG-coated brackets have a high potential for application in orthodontics regarding structural and mechanical properties.

Is Cention-N comparable to other direct dental restorative materials? A systematic review with network meta-analysis of in vitro studies

OBJECTIVES

To compare the performance of Cention-N® with direct restorative materials used at the daily practice (e.g., resin-based composites/RBC, glass ionomer cements/GIC, bioactive resins, silver amalgam) via a systematic review study.

METHODS

The review followed the PRISMA-NMA recommendations, and the protocol of the review was published at osf.io/ybde8. The search was conducted in PubMed/MEDLINE, Scopus, Web of Science, Embase, Lilacs, and SciELO databases, as well as in the grey literature (Open Grey, Proquest, and Periódicos CAPES). Studies with an in vitro experimental design evaluating the characteristics and properties of Cention-N in comparison to other restorative materials were included. The risk of bias of included studies was assessed using the RoBDEMAT tool, and meta-analyses were conducted using Review Manager 5.4 and MetaInsight V3 tools.

RESULTS

A total of 85 studies were included in the review, from which 79 were meta-analyzed. Several characteristics of direct restorative materials were analyzed, including physical (color change, degree of conversion, hardness, microleakage, polymerization rate, roughness, water solubility, water sorption), mechanical (bond strength to dentin, compressive strength, diametral tensile strength, flexural modulus, flexural strength, load-to-fracture, wear), and biological (alkalinizing effect, antibacterial activity, calcium and fluoride release) properties.

SIGNIFICANCE

Cention-N presented similar physico-mechanical properties compared to RBCs, but a stronger behavior than GICs. Despite the Alkasite nature of Cention-N, GICs may still demonstrate the greatest fluoride releasing ability from all direct restorative materials. This review confirmed the adequate behavior of Cention-N when compared to several other more traditionally used materials, confirming its applicability for the permanent restoration of decayed or fractured teeth.

The development of resin-coating materials for enhancing elemental release of coated glass ionomer cements

This study aimed to develop resin coatings containing monocalcium phosphate monohydrate (MCPM), Sr/F-doped bioactive glass (Sr/F-BAGs), and pre-reacted glass ionomer fillers (SPG) that enhance ion release without detrimentally affecting the mechanical properties of GIC. The objective of this study was to evaluate the degree of monomer conversion (DC), biaxial flexural strength, surface microhardness, and ion release of the GICs coated with experimental coating materials compared to a commercial product (EQUIA Coat, EC). Four experimental resin coating materials containing 10-20 wt% of MCPM with Sr/F-BAGs and 5-10 wt% SPG were prepared. The DC of the coating material was determined using ATR-FTIR. The flexural strength and surface microhardness of the coated GICs were assessed. Fluoride and elemental (Ca,P,Sr,Si,Al) release were measured using fluoride-specific electrodes and ICP-OES. The DC of the experimental coating material (60-69 %) was higher than that of EC (55 %). The strength of GICs coated with experimental materials (35-40 MPa) was comparable to EC (37 MPa). However, their surface microhardness (13-24 VHN) was lower than EC (44 VHN). The experimental coating materials reduced fluoride release by ∼43 %, similar to EC (∼40 %). However, experimental coating materials promoted higher P and Sr release than EC. In conclusion, GICs coated with the experimental resin coating containing ion-releasing additives exhibited mechanical properties similar to those of the commercial product. The new coating materials promoted a higher level of ion release for GICs. These properties could potentially enhance remineralizing actions for the coated GICs.

In vitro remineralization by various ion-releasing materials of artificially demineralized dentin: A micro-CT study

OBJECTIVE

The aim of this study was to evaluate the remineralizing properties of ion-releasing restorative materials on pH cycling-induced carious dentin.

METHODS

Fifty sound molars were freshly extracted. The occlusal surfaces were abraded using water-cooled sandpaper (800 grit). The residual crowns were embedded in self-cured acrylic resin with the flat dentin surface exposed. A mesio-distal trench was created using a calibrated 0.5 mm deep occlusal reduction burr, and artificial dentin caries were generated by pH cycling. Then, teeth were randomly assigned to five groups according to the ion-releasing material used. For each sample, micro-CT acquisitions were performed at various intervals. Remineralization was assessed by mean gray value (MGV) measurements after registration and segmentation of the region of interest with 3D Slicer software. One-way repeated-measures ANOVA followed by Tukey's post hoc test was used to investigate the difference in MGVs among the various groups.

RESULTS

Only Cention Forte showed significantly increased MGVs after 4 weeks compared to demineralized dentin. MGVs were higher, but not significantly, after placement of the restorative materials, including in the resin composite control group. These results can be explained by the radiopacity of the materials.

SIGNIFICANCE

Cention Forte, the material with the highest radiopacity, showed a significant increase in the MGVs of artificially carious dentin after 4 weeks. However, the study of dentin remineralization by micro-CT could be impacted by the radiopacity of the restorative materials used. The relevance of this examination for the study of dentinal remineralization should be investigated.

Bioactivity and remineralization potential of modified glass ionomer cement: A systematic review of the impact of calcium and phosphate ion release

This systematic review investigates the effectiveness of calcium and phosphate ions release on the bioactivity and remineralization potential of glass ionomer cement (GIC). Electronic databases, including PubMed-MEDLINE, Scopus, and Web of Science, were systematically searched according to PRISMA guidelines. This review was registered in the PROSPERO database. Five eligible studies on modifying GIC with calcium and phosphate ions were included. The risk of bias was assessed using the RoBDEMAT tool. The incorporation of these ions into GIC enhanced its bioactivity and remineralization properties. It promoted hydroxyapatite formation, which is crucial for remineralization, increased pH and inhibited cariogenic bacteria growth. This finding has implications for the development of more effective dental materials. This can contribute to improved oral health outcomes and the management of dental caries, addressing a prevalent and costly oral health issue. Nevertheless, comprehensive longitudinal investigations are needed to evaluate the clinical efficacy of this GIC's modification.

Synergistic effect of ion-releasing fillers on the remineralization and mechanical properties of resin-dentin bonding interfaces

In modern restorative dentistry, adhesive resin materials are vital for achieving minimally invasive, esthetic, and tooth-preserving restorations. However, exposed collagen fibers are found in the hybrid layer of the resin-dentin bonding interface due to incomplete resin penetration. As a result, the hybrid layer is susceptible to attack by internal and external factors such as hydrolysis and enzymatic degradation, and the durability of dentin bonding remains limited. Therefore, efforts have been made to improve the stability of the resin-dentin interface and achieve long-term clinical success. New ion-releasing adhesive resin materials are synthesized by introducing remineralizing ions such as calcium and phosphorus, which continuously release mineral ions into the bonding interface in resin-bonded restorations to achieve dentin biomimetic remineralization and improve bond durability. As an adhesive resin material capable of biomimetic mineralization, maintaining excellent bond strength and restoring the mechanical properties of demineralized dentin is the key to its function. This paper reviews whether ion-releasing dental adhesive materials can maintain the mechanical properties of the resin-dentin bonding interface by supplementing the various active ingredients required for dentin remineralization from three aspects: phosphate, silicate, and bioactive glass.

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

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

The Fluoride Ion Release from Ion-Releasing Dental Materials after Surface Loading by Topical Treatment with Sodium Fluoride Gel

The study aimed to investigate the rechargeability of ion-releasing dental material specimens immersed in distilled water for 25 months, which depleted their ion-releasing ability. Four restorative dental materials (alkasite composite, giomer, glass-ionomer, and composite material) presented with 24 specimens were studied after topical treatment with a concentrated fluoride gel. The effect of resin coating on the ion uptake and release was investigated on additional 42 specimens of restorative dental materials with coatings. The composite materials were coated with two adhesive systems, whereas the glass-ionomer was coated with the special coating resin. After topical fluoride exposure, ion release and specimen mass were measured at 1, 2, 3, 4, 5, 6, 7, and 14-day intervals using an ion-selective electrode and an analytical balance, respectively. The cumulative fluoride levels for the uncoated specimens of alkasite composite were significantly higher than those of giomer and glass-ionomer cement, with no statistically significant difference between the latter two materials. The conventional composite had the lowest cumulative concentration of fluoride ions (p < 0.05). The adhesive systems affected the fluoride recharge and reduced the ion concentrations absorbed by the specimens. Specimens coated with universal adhesive showed significantly higher ion release compared to universal fluoride-releasing adhesive or special coating resin for glass-ionomers (p < 0.05). No statistically significant change in specimen mass was observed during the 14-day period. Surface coating with adhesive systems as well as special coating resin for glass-ionomers affects the fluoride recharge process.

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

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