Principles of biocompatibility for dental practitioners

Digital manufacturing techniques and the in vitro biocompatibility of acrylic-based occlusal device materials

OBJECTIVES

Material chemistry and workflow variables associated with the fabrication of dental devices may affect the biocompatibility of the dental devices. The purpose of this study was to compare digital and conventional workflow procedures in the manufacturing of acrylic-based occlusal devices by assessing the cytotoxic potential of leakage products.

METHODS

Specimens were manufactured by 3D printing (stereolithography and digital light processing), milling, and autopolymerization. Print specimens were also subjected to different post-curing methods. To assess biocompatibility, a human tongue epithelial cell line was exposed to material-based extracts. Cell viability was measured by MTT assay while Western blot assessed the expression level of selected cytoprotective proteins.

RESULTS

Extracts from the Splint 2.0 material printed with DLP technology and post-cured with the Asiga Flash showed the clearest loss of cell viability. The milled and autopolymerized materials also showed a significant reduction in cell viability. However, by storing the autopolymerized material in dH2O for 12 h, no significant viability loss was observed. Increased levels of cytoprotective proteins were seen in cells exposed to extracts from the print materials and the autopolymerized material. Similarly to the effect on viability loss, storing the autopolymerized material in dH2O for 12 h reduced this effect.

CONCLUSIONS/CLINICAL RELEVANCE

Based on the biocompatibility assessments, clinical outcomes of acrylic-based occlusal device materials may be affected by the choice of manufacturing technique and workflow procedures.

Biocompatibility and Cytotoxicity of Pulp-Capping Materials on DPSCs, With Marker mRNA Expressions

OBJECTIVES

The present study aimed to (1) investigate biocompatibility and cytotoxicity of pulp-capping materials on viability of human dental pulp stem cells (hDPSCs); (2) determine angiogenic, odontogenic, and osteogenic marker mRNA expressions; and (3) observe changes in surface morphology of the hDPSCs using scanning electron microscopy (SEM).

METHODS

Impacted third molars were used to isolate the hDPSCs, which were treated with extract-release fluids of the pulp-capping materials (Harvard BioCal-Cap, NeoPUTTY MTA, TheraCal LC, and Dycal). Effects of the capping materials on cell viability were assessed using 3-(4,5-di-methyl-thiazol-2-yl)-5-(3-carboxy-methoxy-phenyl)-2-(4-sulfo-phenyl)-2H-tetrazolium (MTS) assay and the apoptotic/necrotic cell ratios and reactive oxygen species (ROS) levels from flow cytometry. Marker expressions (alkaline phosphatase [ALP], osteocalcin [OCN], collagen type I alpha 1 [Col1A], secreted protein acidic and rich in cysteine [SPARC], osteonectin [ON], and vascular endothelial growth factor [VEGF]) were determined by quantitative reverse-transcription polymerase chain reaction. Changes in surface morphology of the hDPSCs were visualised by SEM.

RESULTS

The MTS assay results at days 1, 3, 5, and 7 indicated that Harvard BioCal-Cap, NeoPUTTY MTA, and TheraCal LC did not adversely affect cell viability when compared with the control group. According to the MTS assay results at day 14, no significant difference was found amongst Dycal, Harvard BioCal-Cap, NeoPUTTY MTA, and TheraCal LC affecting cell viability. Dycal was the only capping material that increased ROS level. High levels of VEGF expression were observed with Harvard BioCal-Cap, TheraCal LC, and NeoPUTTY MTA. NeoPUTTY MTA, and Dycal upregulated OCN expression, whereas TheraCal LC upregulated Col1A and SPARC expression. Only Dycal increased ALP expression. HDSCs were visualized in characteristic spindle morphology on SEM when treated with TheraCal LC and Harvard BioCal-Cap.

CONCLUSIONS

NeoPUTTY MTA and Harvard BioCal-Cap showed suitable biocompatibility values; in particular, these pulp-capping materials were observed to support the angiogenic marker.

Biosafety and chemical solubility studies of multiscale crystal-reinforced lithium disilicate glass-ceramics

Lithium disilicate (Li2 Si2 O5 ) glass-ceramics are currently a more widely used all-ceramic restorative material due to their good mechanical properties and excellent aesthetic properties. However, they have a series of problems such as high brittleness and low fracture toughness, which has become the main bottleneck restricting its development. Therefore, in order to compensate for these shortcomings, we propose to prepare a reinforced glass-ceramics with better mechanical properties and to test the biosafety and chemical solubility of the material. Li2 Si2 O5 whiskers were synthesized by a one-step hydrothermal method, and multi-scale crystal-enhanced Li2 Si2 O5 glass-ceramics were prepared by reaction sintering. The biosafety of multi-scale crystal-reinforced Li2 Si2 O5 glass-ceramics was investigated by in vitro cytotoxicity test, rabbit pyrogen test, mice bone marrow micronucleus test, skin sensitization test, sub-chronic systemic toxicity test, and chronic systemic toxicity test. Additionally, the chemical solubility of multi-scale crystal-reinforced Li2 Si2 O5 glass-ceramics was investigated. The test results showed that the material was non-cytotoxic, non-thermogenic, non-mutagenic, non-sensitizing, and non-systemic. The chemical solubility, determined to be 377 ± 245 μg/cm2 , complied with the ISO 6872 standard for the maximum solubility of ceramic materials. Multi-scale crystal-reinforced Li2 Si2 O5 glass-ceramics' biosafety and chemical solubility met current normative criteria, and they can move on to mechanical property measurements (such as flexural strength test, fatigue life test, friction and wear property study, etc.) and bonding property optimization, which shows promise for future clinical applications.

Biocompatibility of three different root canal sealers, experimental study

OBJECTIVES

This study was assessed the biocompatibility of three different root canal sealers (Well-Root St, GuttaFlow Bioseal, and AH-Plus) following implantation in rat subcutaneous tissues, using histopathological immunohistochemical analysis.

METHODS

Four groups of eighty-four male rats each underwent subcutaneous dorsal implantation of a polyethylene tube, either empty or filled. Tissues were collected, fixed, and processed for histological analysis after 7, 15, and 30 d. Slides were photographed and digitally processed to identify lymphocytes and macrophages using Cluster of differentiation 3 (CD3) and cluster of differentiation 68 (CD68) markers, respectively. P was set at 0.05, when lymphocyte and macrophage infiltration was compared between groups and observation times using one-way analysis of variance (ANOVA).

RESULTS

Histopathological analysis of all groups revealed an inflammatory reaction followed by the emergence of a fibrous capsule after 7 days. After 30 days, the thickness of the fibrous capsule and the inflammatory response subsided. CD3 staining for immunohistochemical analysis revealed that the AH-Plus group had the highest mean percentage of lymphocyte infiltration at 7 and 15 days, followed by the Well-Root St, GuttaFlow Bioseal, and Control groups. After 30 days, no discernible difference was observed between the groups in terms of the mean percentage of lymphocyte infiltration. After 7, 15, and 30 days, there was a significant difference in the mean percentage of macrophage infiltration across the groups, as demonstrated by CD68 staining. After 7, 15, and 30 days, the AH-Plus group had the highest mean percentage of macrophage infiltration, followed by the Well-Root St. and GuttaFlow Bioseal groups, while the control group had the lowest mean percentage.

CONCLUSION

All observational periods showed minimal inflammatory reactions to GuttaFlow Bioseal. After subcutaneous tissue implantation in a rat model, the initial inflammatory reactions to Well-Root St and AH-Plus had abated by day 30, and all tested sealers had outstanding biocompatibility.

Improved Corrosion Resistance and Cytotoxicity of Nickel-based alloy using Novel Plasma processing technique.. [DOI: 10.21203/rs.3.rs-3200844/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

Nickel-based (NiCr) alloys are mostly utilized in the dental industry because of their good corrosion resistance, ease of casting, and adequate thermal coefficient of friction with ceramic porcelain. However, leakage of toxic metal ions (Ni and Cr) due to breakage or damage of protective metal oxide layers in aggressive body fluids affects corrosion resistance, tribological properties, and cytotoxicity. These drawbacks ultimately affect the biocompatibility of NiCr alloys for medical applications. This study employs magnetron sputtering in conjunction with cathodic cage plasma nitriding (CCPN) to perform a novel duplex plasma treatment on Ni-Cr alloy. Moreover, the cathodic cage plasma-treated TiN (CCPN-TiN) samples showed further enhanced corrosion resistance and low metal ion leakage. These findings made duplex plasma treatment an efficient method for the surface modification of metallic alloys against the leaching of toxic ions in chloride-aggressive electrolytes, thus proving an excellent strategy for various biomedical applications.

Human Histological Analysis of Early Bone Response to Immediately Loaded Narrow Dental Implants with Biphasic Calcium Phosphate® Grid-Blasted Surface Treatment: A Case Report

Implant surface topography using bioactive material provides faster bone-to-implant healing. This histological report described the analysis of human bone tissue around an immediately loaded implant, with BPC^® (Biphasic Calcium Phosphate) grit-blasted surface treatment, after two months of healing. Two temporary mini-implants (2.8 × 10 mm) with BPC^® grit-blasting surfaces were placed and immediately loaded to retain a complete interim denture. After a 60-day healing period, one mini-implant was removed for histologic analysis. The ground section showed the whole implant surrounded by healthy peri-implant tissues. Implant surface presented a close contact with newly formed bone, showing some areas of osteoblasts secreting mineral matrix. The ground section depicted a bone contact of 60.3 + 8.5%. The BPC^® grit-blasted surface was biocompatible and enabled the osseointegration process after a short-term period.

In Vitro Study of Composite Cements on Mesenchymal Stem Cells of Palatal Origin

Uniform filler distribution in composites is an important requirement. Therefore, BaO glass, nano hydroxyapatite and quartz filler distribution was realized through PCL microcapsules which progressively release filler during matrix polymerization. Two composites were realized based on a complex matrix containing BisGMA, UDMA, HEMA and PEG400 mixed with a previously described mineral filler: 33% for C1 and 31% for C2. The spreading efficiency was observed via SEM, revealing a complete disintegration of the microcapsules during C1 polymerization, while C2 preserved some microcapsule parts that were well embedded into the matrix beside BaO filler particles; this was confirmed by means of the EDS spectra. Mesenchymal stem cells of palatal origin were cultured on the composites for 1, 3, 5 and 7 days. The alkaline phosphatase (ALP) level was measured at each time interval and the cytotoxicity was tested after 3, 5 and 7 days of co-culture on the composite samples. The SEM investigation showed that both composites allowed for robust proliferation of the cells. The MSC cell pluripotency stage was observed from 1 to 3 days with an average level of ALP of 209.2 u/L for C1 and 193.0 u/L for C2 as well as a spindle cell morphology. Cell differentiation occurred after 5 and 7 days of culture, implied by morphological changes such as flattened, star and rounded shapes, observed via SEM, which were correlated with an increased ALP level (279.4 u/L for C1 and 284.3 u/L for C2). The EDX spectra after 7 days of co-culture revealed increasing amounts of P and Ca close to the hydroxyapatite stoichiometry, indicating the stimulation of the osteoinductive behavior of MSCs by C1 and C2. The MTT assay test showed a cell viability of 98.08% for C1 and 97.33% for C2 after 3 days, proving the increased biocompatibility of the composite samples. The cell viability slightly decreased at 5 and 7 days but the results were still excellent: 89.5% for C1 and 87.3% for C2. Thus, both C1 and C2 are suitable for further in vivo testing.

SIS membrane modification to improve antimicrobial and osteogenic properties for guide bone regeneration

The guided bone regeneration (GBR) technique is the most common and durable approach to repairing bone defects in periodontal surgery. However, membrane exposure causes bacterial infiltration, which lowers the functional integrity of the barrier membrane and destroys bone repair. Here, an antibacterial peptide-modified small intestinal submucosa (SIS) membrane is used as a new GBR membrane for effective bone regeneration. The peptide JH8194 was placed into chitosan microspheres to preserve its stability and allow for sustained release, which realizes rapid and efficient functional modification of the SIS membrane. Biocompatibility and certain antibacterial activities were found in the modified SIS membrane (SIS@CS-JH8194). Additionally, in vitro experiments showed that SIS@CS-JH8194 promoted the expression of osteogenic-related factors and decreased the secretion of inflammatory factors in rat bone mesenchymal stem cells. In vivo experiments showed that SIS@CS-JH8194 could effectively promote bone regeneration in rat skull defects. In this work, we created a new antibacterial GBR membrane to help avoid postoperative infection and improve bone tissue regeneration.

The Use of Acrylate Polymers in Dentistry

The manuscript aimed to review the types of acrylate polymers used in dentistry, as well as their chemical, physical, mechanical, and biological properties. Regarding their consistency and purpose, dental acrylate polymers are divided into hard (brittle), which includes acrylates for the production of plate denture bases, obturator prostheses, epitheses and maxillofacial prostheses, their repairs and lining, and soft (flexible), which are used for lining denture bases in special indications. Concerning the composition and method of polymerization initiation, polymers for the production of denture bases are divided into four types: heat-, cold-, light-, and microwave-polymerized. CAD/CAM acrylate dentures are made from factory blocks of dental acrylates and show optimal mechanical and physical properties, undoubtedly better monomer polymerization and thus biocompatibility, and stability of the shape and colour of the base and dentures. Regardless of the number of advantages that these polymers have to offer, they also exhibit certain disadvantages. Technological development enables the enhancement of all acrylate properties to respond better to the demands of the profession. Special attention should be paid to improving the biological characteristics of acrylate polymers, due to reported adverse reactions of patients and dental staff to potentially toxic substances released during their preparation and use.

Cytotoxic assessment of 3D printed photoinitiated prosthodontic resins versus heat polymerized acrylic resin (In-Vitro Study).. [DOI: 10.21203/rs.3.rs-1948364/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

Background: Although 3D printed photoinitiated resins are among the many materials utilized in prosthetic appliances today, biocompatibility for photocuring 3D printing materials for direct and long-term contacting with living body remain scarce. The purpose of this in vitro study was to evaluate the cell viability of human gingival fibroblasts after the exposure to two different 3D printed photoinitiated resins and compare it to the traditionally used heat polymerized acrylic resin for up to 7 days.Methods: This comparative in vitro study of sample size (n= 96), where the 3D printed resin disc samples (n= 64), were divided into two test groups, test group 1 (TG1) for NextDent Base resin (n= 32) and test group 2 (TG2) for Dental LT clear resin (n= 32), to be compared to Heat polymerized acrylic resin samples (Reference group (RG)) (n= 32). Human gingival fibroblasts were extracted from attached keratinized gingival tissues collected from healthy patient undergoing clinical crown lengthening procedure, cellular viability using MTT assay in response to TG1, TG2 and RG samples was assessed throughout four-time intervals (24, 48, 72 and 168 hours). The One-Way ANOVA test followed by Tukey’s post hoc test and Repeated Measures ANOVA test were used for statistical analyses, statistically significant different at P value ≤ 0.05Results: Throughout time intervals, there was a decrease in cell viability of all groups but with favorable cell viability which was more that 90% denoting non cytotoxicity. It was found to be significant among RG (P< 0.0001). The highest cell viability was found after 24 hours among all groups; however, the least viability was found after 48 hours among TG1 and RG, and among TG2 after 72 hours. After 168 hours, there was a non-statistical significant change in cell viability between groups (P= 0.526). there was significant increase in optical density for all groups throughout time intervals (P< 0.0001).Conclusion: Photoinitiated resins are comparable to traditionally used heat polymerized acrylic resin with equivalent cytotoxic effect for long term use. 3D printed photoinitiated resins are biocompatible and suggested for long term intraoral use.

A critical analysis of research methods and experimental models to study biocompatibility of endodontic materials

Materials used for endodontics and with direct contact to tissues have a wide range of indications, from vital pulpal treatments to root filling materials and those used in endodontic surgery. In principle, interaction with dental materials may result in damage to tissues locally or systemically. Thus, a great variety of test methods are applied to evaluate a materials' potential risk of adverse biological effects to ensure their biocompatibility before commercialization. However, the results of biocompatibility evaluations are dependent on not only the tested materials but also the test methods due to the diversity of these effects and numerous variables involved. In addition, diverse biological effects require equally diverse assessments on a structured and planned approach. Such a structured assessment of the materials consists of four phases: general toxicity, local tissue irritation, pre‐clinical tests and clinical evaluations. Various types of screening assays are available; it is imperative to understand their advantages and limitations to recognize their appropriateness and for an accurate interpretation of their results. Recent scientific advances are rapidly introducing new materials to endodontics including nanomaterials, gene therapy and tissue engineering biomaterials. These new modalities open a new era to restore and regenerate dental tissues; however, all these new technologies can also present new hazards to patients. Before any clinical usage, new materials must be proven to be safe and not hazardous to health. Certain international standards exist for safety evaluation of dental materials (ISO 10993 series, ISO 7405 and ISO 14155‐1), but researchers often fail to follow these standards due to lack of access to standards, limitation of the guidelines and complexity of new experimental methods, which may cause technical errors. Moreover, many laboratories have developed their testing strategy for biocompatibility, which makes any comparison between findings more difficult. The purpose of this review was to discuss the concept of biocompatibility, structured test programmes and international standards for testing the biocompatibility of endodontic material biocompatibility. The text will further detail current test methods for evaluating the biocompatibility of endodontic materials, and their advantages and limitations.

Biosafety evaluation of Li2Si2O5 whisker-reinforced glass-ceramics

Lithium disilicate (Li2Si2O5) glass-ceramic is a commonly used dental ceramic material. In this study, Li2Si2O5 whiskers were prepared by the hydrothermal method, mixed with Li2Si2O5 glass powders, and Li2Si2O5 whisker-reinforced glass-ceramics were prepared by reaction sintering. The biosafety of the new Li2Si2O5 glass-ceramics were evaluated by in vitro cytotoxicity, hemolysis, oral mucosal irritation, acute systemic toxicity, and subacute systemic toxicity (oral route) tests according to ISO 7405/ISO 10993 standards. The cytotoxicity test results showed that the cell growth of the experimental group was good, and the cell number and morphology were not significantly different from those of the blank group (P > 0.05). The toxicity grading for both experimental and blank control groups were 0. The hemolysis rate of the material was 1.25%, which indicated that it did not cause hemolytic reaction. The material was non-irritating to the oral mucosa. In acute systemic toxicity test, animals in the experimental group showed increased body weight, moved freely, with no signs of poisoning. The food utilization rate and relative growth rate (change of the weight) of rats in the subacute systemic toxicity test were not statistically different from those of the control group (P > 0.05). Preliminary evaluation of the biosafety of the Li2Si2O5 whisker-reinforced glass-ceramics showed that it met the existing regulatory standards, and further biosafety experiments can be conducted, following which the material may be expected to be applied in clinical practice.

Ion release and surface roughness of silver soldered bands with two different polishing methods: An in-vitro study

OBJECTIVE:

To evaluate the surface roughness and ion release of silver-soldered joints by using two polishing methods.

METHODS:

174 orthodontic bands with and without silver-soldered joints were evaluated and divided into three groups: two experimental, with different polishing methods (SP1 and SP2), and one control (SS) composed of bands without silver solder. For ionic release, 50 bands of each group were immersed in saline solution and submitted to atomic absorption spectrophotometry to quantify the amount of Fe, Ni, Cr (in all the three groups), Ag, Cu, Cd, and Zn (in the two experimental groups). A rugosimeter was employed to verify the surface roughness.

RESULTS:

Ni and Cr were released in higher amounts after soldering. Cd, Ag, Zn, and Cu may be released from silver-soldered bands independently of the polishing method employed. Ag was released in higher amounts from the soldered bands that presented higher surface roughness.

CONCLUSIONS:

Differences exist in relation to the surface roughness of silver-soldered bands when distinct polishing methods are used. Toxic ions may be released from silver soldered joints and higher surface roughness may cause higher ionic release.

Application of Texture and Fractal Dimension Analysis to Evaluate Subgingival Cement Surfaces in Terms of Biocompatibility

Biocompatibility is defined as “the ability of a biomaterial, prosthesis, or medical device to perform with an appropriate host response in a specific application”. Biocompatibility is especially important for restorative dentists as they use materials that remain in close contact with living tissues for a long time. The research material involves six types of cement used frequently in the subgingival region: Ketac Fil Plus (3M ESPE, Germany), Riva Self Cure (SDI, Australia) (Glass Ionomer Cements), Breeze (Pentron Clinical, USA) (Resin-based Cement), Adhesor Carbofine (Pentron, Czech Republic), Harvard Polycarboxylat Cement (Harvard Dental, Great Britain) (Zinc polycarboxylate types of cement) and Agatos S (Chema-Elektromet, Poland) (Zinc Phosphate Cement). Texture and fractal dimension analysis was applied. An evaluation of cytotoxicity and cell adhesion was carried out. The fractal dimension of Breeze (Pentron Clinical, USA) differed in each of the tested types of cement. Adhesor Carbofine (Pentron, Czech Republic) cytotoxicity was rated 4 on a 0–4 scale. The Ketac Fil Plus (3M ESPE, Germany) and Riva Self Cure (SDI, Australia) cements showed the most favorable conditions for the adhesion of fibroblasts, despite statistically significant differences in the fractal dimension of their surfaces.

Recent update on potential cytotoxicity, biocompatibility and preventive measures of biomaterials used in dentistry

Dental treatment is provided for a wide variety of oral health problems like dental caries, periodontal diseases, periapical infections, replacement of missing teeth and orthodontic problems. Various biomaterials, like composite resins, amalgam, glass ionomer cement, acrylic resins, metal alloys, impression materials, bone grafts, membranes, local anaesthetics, etc., are used for dental applications. The physical and chemical characteristics of these materials influence the outcome of dental treatment. It also impacts on the biological, allergic and toxic potential of biomaterials. With innovations in science and their positive results, there is also a need for awareness about the biological risks of these biomaterials. The aim of dental treatment is to have effective, yet safe, and long-lasting results for the benefit of patients. For this, it is important to have a thorough understanding of biomaterials and their effects on local and systemic health. Materials used in dentistry undergo a series of analyses before their oral applications. To the best of our knowledge, this is the first and original review that discusses the reasons for and studies on the toxicity of commonly used biomaterials for applications in dentistry. It will help clinicians to formulate a methodical approach for the selection of dental biomaterials, thus providing an awareness for forecasting their risk of toxic reactions.

Microneedle Arrays for Sampling and Sensing Skin Interstitial Fluid

Dermal interstitial fluid (ISF) is a novel source of biomarkers that can be considered as an alternative to blood sampling for disease diagnosis and treatment. Nevertheless, in vivo extraction and analysis of ISF are challenging. On the other hand, microneedle (MN) technology can address most of the challenges associated with dermal ISF extraction and is well suited for long-term, continuous ISF monitoring as well as in situ detection. In this review, we first briefly summarise the different dermal ISF collection methods and compare them with MN methods. Next, we elaborate on the design considerations and biocompatibility of MNs. Subsequently, the fabrication technologies of various MNs used for dermal ISF extraction, including solid MNs, hollow MNs, porous MNs, and hydrogel MNs, are thoroughly explained. In addition, different sensing mechanisms of ISF detection are discussed in detail. Subsequently, we identify the challenges and propose the possible solutions associated with ISF extraction. A detailed investigation is provided for the transport and sampling mechanism of ISF in vivo. Also, the current in vitro skin model integrated with the MN arrays is discussed. Finally, future directions to develop a point-of-care (POC) device to sample ISF are proposed.

Periodontal clinico-morphological changes in patients wearing old nickel-chromium and copper alloys bridges

Elderly population frequently presents more than one prosthetic restoration realized from different types of dental alloys which, in time, suffer various alterations in the oral environment. Metallic ions are released in saliva due to its electrolytic qualities, interacting with the contact tissues. Studies regarding cytotoxicity of dental alloys are providing contradictory results. Besides biocompatibility, the microbial factor is also greatly influencing the long-term success of the prosthetic rehabilitation. This study's aim was to assess the response of the gingival tissue to nickel-chromium (Ni-Cr) and copper (Cu)-based dental casting alloys from fixed dentures present in many patients from Romania. Gingival samples were taken from 124 patients wearing fixed dental restorations made from these two types of alloys from injured areas surrounding the abutment teeth; histological specimens were prepared, fixed in 10% neutral buffered formalin, paraffin-embedded and stained with Hematoxylin-Eosin (HE). Histological analysis showed the existence of a chronic inflammatory infiltrate in the gingival chorion, necrosis areas, and vascular congestion. Various morphological alterations appeared, depending on the intensity of the inflammation and the immune response. The surface epithelium suffered a hyperplasic reaction, either limited to acanthosis or involving the whole epithelium, the release of the Cu(2+) and Ni(2+) ions from the dental alloys used in bridges and crowns being responsible for inducing gingival hyperplasia and a chronic inflammation in the areas situated around the abutment teeth. The immunohistochemical study allowed us to observe an increased number of positive cluster of differentiation 3 (CD3) T-lymphocytes in periodontium, proving that the cellular immune response is rapid and intense.

Enhanced Osteogenic Differentiation of Human Mesenchymal Stem Cells on Amine-Functionalized Titanium Using Humidified Ammonia Supplied Nonthermal Atmospheric Pressure Plasma

The surface molecular chemistry, such as amine functionality, of biomaterials plays a crucial role in the osteogenic activity of relevant cells and tissues during hard tissue regeneration. Here, we examined the possibilities of creating amine functionalities on the surface of titanium by using the nonthermal atmospheric pressure plasma jet (NTAPPJ) method with humidified ammonia, and the effects on human mesenchymal stem cell (hMSC) were investigated. Titanium samples were subjected to NTAPPJ treatments using nitrogen (N-P), air (A-P), or humidified ammonia (NA-P) as the plasma gas, while control (C-P) samples were not subjected to plasma treatment. After plasma exposure, all treatment groups showed increased hydrophilicity and had more attached cells than the C-P. Among the plasma-treated samples, the A-P and NA-P showed surface oxygen functionalities and exhibited greater cell proliferation than the C-P and N-P. The NA-P additionally showed surface amine-related functionalities and exhibited a higher level of alkaline phosphatase activity and osteocalcin expression than the other samples. The results can be explained by increases in fibronectin absorption and focal adhesion kinase gene expression on the NA-P samples. These findings suggest that NTAPPJ technology with humidified ammonia as a gas source has clinical potential for hard tissue generation.

Molecular Response of Pulp Fibroblasts after Stimulation with Pulp Capping Materials

This in vitro study evaluated cell viability and metabolism, nitric oxide release and production of two chemokines and one cytokine by cultured human dental pulp fibroblasts (HDPF) in contact with two glass ionomer cements (Ketac Molar-KM and Vitrebond-VB), Single Bond (SB) and calcium hydroxide (Dycal-DY). Cultures of HDPF were established by means of an explant technique. The specimens were prepared under sterile conditions and in disks measuring 5 mm x 2 mm obtained from a prefabricated mold and placed on a permeable membrane to avoid direct contact with the cells. Cytotoxicity was assessed by Trypan Blue exclusion method and 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. Nitric oxide release in cell supernatant was detected by the Griess Method whereas stromal derived factor-1 alpha (SDF-1α or CXCL12), chemokine (C-X-C motif) ligand 8 [Interleukin 8 (IL-8 or CXCL8)] and interleukin-6 (IL-6) were detected by ELISA. RT-qPCR was employed for gene expression analysis. Statistical analyses were performed by One-way ANOVA followed by Tukey's post hoc test for materials independent of the time, and Two-way ANOVA followed by Bonferroni correction test for the comparisons between materials and experimental time (p<0.05). Cytotoxic tests showed significant differences only for DY. Protein levels and mRNA expression were significantly increased for IL-8 for both periods of time. IL-6 production increased when fibroblasts were stimulated by KM. SDF-1α protein production and mRNA expression were not affected by any of the materials. There was a decrease in nitrate/nitrite levels only for KM. Although DY caused intense cell death and did not stimulate the production of the inflammatory mediators evaluated in this work, it is known that this event seems to be fundamental for the process of repair of the pulp tissue and formation of mineralized barrier. KM and VB increased production of proteins related to the inflammatory process, thus favoring tissue repair. Therefore, although these glass ionomer cements did not lead to large cell death, they should be used with caution.

Cytotoxicity of acrylic resin-based materials used to fabricate interim crowns

STATEMENT OF PROBLEM

If the components in the acrylic resins used to fabricate interim crows are cytotoxic, they can interfere with the integrity of the adjacent periodontal tissue and the dentin-pulp complex.

PURPOSE

The purpose of this in vitro study was to assess the cytotoxicity of resin-based materials used to prepare interim crowns.

MATERIAL AND METHODS

The following materials were used in this study: CAR, conventional acrylic resin powder and liquid; BR, bis-acrylic resin; and PAR, pressed acrylic resin of the CAD-CAM type. Glass disks were used as the control (Co). Oral epithelial cells (NOK) were seeded on glass disks and standardized disks prepared with the resins under study. After incubation for 24 hours, the cells were analyzed for viability (Alamar Blue and Live or Dead), adhesion, and morphology (SEM and fluorescence), as well as epidermal growth factor synthesis (EGF-ELISA). The surface roughness (Ra) of test specimens was evaluated under a confocal microscope. The data were submitted to ANOVA and the Tukey HSD statistical tests (α=.05).

RESULTS

The highest Ra value was observed in BR in comparison with CAR, PAR, and Co (P<.05). The highest viability, adhesion, and EGF synthesis values were determined for the cells in contact with PAR (P<.001).

CONCLUSIONS

The computer-aided design and computer-aided manufacturing (CAD-CAM)-type resin favored adhesion, metabolism, and epithelial cell proliferation, and it was therefore considered cytocompatible.

Zirconia toughened mica glass ceramics for dental restorations: Wear, thermal, optical and cytocompatibility properties

BACKGROUND

In an effort to design novel zirconia reinforced mica glass ceramics for dental restorations, clinically relevant properties such as wear, coefficient of thermal expansion, optical transmittance, and cytocompatibility with human gingival fibroblast cell lines were investigated in the present study.

MATERIALS & METHODS

Microstructure analysis of two body wear of heat treated mica glass ceramic ceramics (47.2 SiO2-16.7 Al2O3-9.5 K2O-14.5 MgO-8.5 B2O3-6.3F wt.%) reinforced with 20wt.% YSZ, were evaluated against a steatite antagonist in a chewing simulator following Willytec Munich method. In addition, Coefficient of thermal expansion (CTE), total transmittance, scattering coefficient and cytocompatibility on human gingival fibroblast cell lines were performed and compared to the commercially available dental ceramic systems.

RESULTS

The experimental mica glass ceramic demonstrate micro-ploughing, pull out and debris formation along the cutting surface, indicating abrasive wear mechanism. Thermal expansion of mica glass ceramic composite was recorded as 5×10-6/°C, which is lower than the thermal expansion of commercially available core and veneering ceramics. Further, significant differences of transmittance and scattering coefficient of mica glass ceramics with 20wt.% YSZ with commercial dental ceramics was found and extensive fibroblast cell spreading with filopodial extension, cell-to-cell bridges and proliferation with human gingival fibroblast cell lines.

CONCLUSION

With acceptable cytocompatibility with human gingival fibroblast cells and better wear properties with respect to commercial IPS emax Press, the mica glass ceramic composites (47.2 SiO2-16.7Al2O3-9.5 K2O-14.5 MgO-8.5 B2O3-6.3F wt.%) with 20wt.% YSZ have the potential for dental restorative applications as machinable veneering ceramics.

The cytotoxic and oxidative effects of restorative materials in cultured human gingival fibroblasts

The aim of this study was to evaluate the cytotoxic and oxidative effects of the most commonly used dental restorative materials on human gingival fibroblast cells (HGFCs). HGFCs were obtained from healthy individuals. The tested restorative materials were a microhybrid resin based composite, a compomer resin, a glass ionomer cement, and an amalgam alloy. One hundred eight cylindirical samples, 10 mm in diameter and 2 mm in height, were prepared according to ISO 10993-12:2002 specifications (n = 9 in the tested subgroups). Freshly prepared and aged samples in artificial saliva at 37 °C (7 and 21 d) were placed into well plates and incubated. Wells without dental materials were constituted as the control group. After 72 h incubation period, cytotoxicity was determined using the neutral red (NR) assay. Oxidative alterations were assessed using total antioxidant capacity (TAC) and total oxidant status (TOS) assay kits. Data were analyzed using the ANOVA and LSD post hoc tests. All tested materials led to significant decreases in the cell viability rates (33-73%) compared to the control group. Glass ionomer and resin composite were found to be more cytotoxic than amalgam alloy and compomer. The highest TAC level was observed in glass ionomer after seven-day aging and these changes prevented an increase in TOS levels. Increases in TAC levels after seven-day aging in all groups exhibited significant differences with freshly prepared samples (p < 0.05). In all material groups, TOS levels of freshly prepared samples differed statistically and significantly from samples aged for 7 and 21 d (p < 0.05). The data obtained suggested that all the tested materials exhibited cytotoxic and pro-oxidant features. Freshly prepared samples caused higher TOS levels. However, oxidant status induced by materials decreased over time.

The Effects of Non-Thermal Atmospheric Pressure Plasma treated Titanium Surface on Behaviors of Oral Soft Tissue Cells

Here, we investigated the possible use of the technology known as non-thermal atmospheric pressure plasma on integration and control of cytokine release of soft tissue on titanium surface. After NTAPP was applied to titanium samples, changes of surface characteristics were measured as topographical features, contact angle, surface tension, and with X-ray photoelectron spectroscopy (XPS). Protein absorption was evaluated using a bovine serum albumin absorption assay. The attachment, viability, morphology, proliferation, and cytokine release of soft tissue on titanium were assessed. No change in topographical features was observed between control and NTAPP-treated groups. However, NTAPP treatment resulted in significant lowering of the contact angle for polar and non-polar liquids and increase of surface tension. Protein absorption was significantly enhanced on the NTAPP-treated samples. Normal soft tissue attachment was improved on the NTAPP-treated groups with good viability. Cellular morphology was improved in NTAPP-treated groups whereas cellular proliferation was not enhanced. There was a significant reduction in the amounts of cytokine release for inflamed IHOK and hTERT-hNOF on the NTAPP-treated groups; except for IL-8 for IHOKs. This study demonstrates that surface functional consequences by NTAPP exposure enhanced behavior of oral soft tissue cells without topographical change.

Applications of Laser Welding in Dentistry: A State-of-the-Art Review

The dental industry without lasers is inconceivable right now. This captivating technology has outlasted other possible alternative technologies applied in dentistry in the past due to its precision, accuracy, minimal invasive effect as well as faster operating time. Other alternatives such as soldering, resistance (spot) welding, plasma (torch) welding, and single pulse tungsten inert gas welding have their pros and cons; nevertheless, laser welding remains the most suitable option so far for dental application. This paper attempts to give an insight into the laser principle and types of lasers used for dental purposes, types of dental alloys used by the dentist, and effect of laser parameters on prosthesis/implants. It is apparent from the literature review that laser assisted dental welding will continue to grow and will become an unparalleled technology for dental arena.

Interdisciplinary interface between fixed prosthodontics and periodontics

Although periodontal factors do not usually have a direct effect on the survival of a fixed prosthesis, harmony between the prosthesis and the periodontium is critical otherwise esthetics, the longevity of the prosthesis and the periodontium will be compromised. A close interdisciplinary relationship between periodontics and prosthodontics is therefore necessary to avoid an unsatisfactory treatment outcome, requiring extensive and expensive retreatment. The design of the prosthesis, the number and quality of the abutment teeth, the preparation and the pontic, the occlusion and the material need to be considered when planning prosthodontic treatment. The location of the preparation margin and the contour and emergence profile of the prosthesis will influence the response of the gingival tissues to the prosthesis. Pontic design and cleansibility also contribute to the response of the gingival tissues as well as to the clinical and esthetic outcome. Even an optimal pontic design will not prevent inflammation of the mucosa adjacent to the pontic if pontic hygiene is not maintained by removal of plaque. Case selection and the patients' ability to carry out adequate oral hygiene are therefore essential for longevity of the prosthesis, and regular reviews provide an opportunity for early detection and treatment of failures.

Oxidative Stress Evaluation in Patients Treated with Orthodontic Self-ligating Multibracket Appliances: An in Vivo Case-Control Study

OBJECTIVE

Oxidative stress is a pathologic event induced by a prevalence of oxidant agents on the antioxidant ones, with a consequent alteration of oxide-reducing balance.

INTRODUCTION

Freeradicals produce damages both in cellular and extra-cellular components; phospholipid membranes, proteins, mitochondrial and nuclear DNA, are the target of the oxidative stress, that can finally cause cellular death due to apoptosis.

MATERIALS & METHODS

Orthodontic appliances such as brackets, wires, resins and soldering have some components that can be considered as potential allergen, carcinogenic, cytotoxic and gene mutation factors. The primary aim of this research is to evaluate oxidative stress in the saliva of patients treated with multibracket self-ligating vestibular orthodontic appliances; the secondary purpose is to investigate the influence of orthodontic multibracket therapy on oral hygiene and the consequent effect on oxidative stress. Salivary specimens has been collected in a sample of 23 patients were enrolled (12 Female, 11 Male) between 12 and 16 years of age (mean age 14.2). For each patient has been collected a salivary specimen at the following time points; before orthodontic bonding (T1), five weeks (T2) and ten weeks (T3) after orthodontic appliance bonding.

RESULTS

Samples has been analysed with a photometer due to SAT Test (Salivary Antioxidant Test). Data obtained show a mean of 2971 mEq/l of anti-oxidant agents before orthodontic treatment, and after five weeks from the bonding the mean was decreased to 2909 mEq/l, instead at ten weeks was increased to 3332 mEq/l. Repeated measures ANOVA did not reveal statistically significant differences between the time points (P = 0.1697). The study did not reveal any correlation between the level of dental hygiene and that of oxidative stress (Pearson Correlation Coefficient R = 0).

CONCLUSION

Orthodontic treatment with multibrackets vestibular metallic appliance seems to be not able to affect oxidative stress during the first ten weeks of therapy.

Hard tissue reaction to mineral trioxide aggregate and experimental root-end filling material in guinea pig mandibles

Background/purpose

Root-end filling materials are used to fill and seal the root apex during periradicular surgery. Mineral trioxide aggregate (MTA) is a widely-used material because of its particular characteristics. Cold ceramic (CC) is an experimental material that has been recently introduced. The purpose of this study was to compare bone tissue response to CC and MTA in an animal model.

Materials and methods

Forty-five male guinea pigs (weighing 750–850 g) were anesthetized with 10 mg/kg ketamine HCL and 12 mg/kg xylazine. A triangular incision of around 15 mm was prepared in the posterior site along the symphysis in both right and left sides of the mandible. A 3 mm × 3 mm diameter cylindrical hole was prepared in each side using a trephine. Two Teflon cylindrical tube applicators were filled with white MTA and CC and inserted into the defects separately. Histopathological evaluation of the specimens was completed after 2 weeks and 12 weeks. The extent of inflammation was recorded and analyzed using the Mann–Whitney U test and SPSS software version 12 at a significance level of 0.05.

Results

MTA and CC produced moderate and mild hard tissue responses respectively after 2 weeks and 12 weeks. No significant differences were found in the distribution of the responses between the two groups at either time point.

Conclusion

Both CC and MTA demonstrated biocompatibility with minor adverse impact on hard tissue and healing recovery after 12 weeks.

Cytotoxicity Evaluation of Two Bis-Acryl Composite Resins Using Human Gingival Fibroblasts

Bis-acryl resins are used for temporary dental restorations and have shown advantages over other materials. The aim of this work was to evaluate the in vitro cytotoxicity of two bis-acryl composite resins (Protemp 4 and Luxatemp Star), obtained at 1, 7 and 40 days after mixing the resin components, using a standardized assay employing human primary cells closely related to oral tissues. Human gingival fibroblast cell cultures were exposed for 24 h to either bis-acryl composite resins, polystyrene beads (negative control) and latex (positive control) extracts obtained after incubation by the different periods, at 37 °C under 5% CO2. Cell viability was evaluated using a multiparametric procedure involving sequential assessment (using the same cells) of mitochondrial activity (XTT assay), membrane integrity (neutral red test) and total cell density (crystal violet dye exclusion test). The cells exposed to the resin extracts showed cell viability indexes exceeding 75% after 24 h. Even when cells were exposed to extracts prepared with longer conditioning times, the bis-acryl composite resins showed no significant cytotoxic effects (p>0.05), compared to the control group or in relation to the first 24 h of contact with the products. There were no differences among the results obtained for the bis-acryl composite resins evaluated 24 h, 7 days and 40 days after mixing. It may be concluded that the bis-acryl resins Protemp 4 and Luxatemp Star were cytocompatible with human gingival fibroblasts, suggesting that both materials are suitable for use in contact with human tissues.

Biocompatibility of a new epoxy resin-based root canal sealer in subcutaneous tissue of rat

Objective:

The objective was to evaluate the subcutaneous biocompatibility of two root canal sealers.

Materials and Methods:

Thirty female rats were distributed into two groups of 15 animals. Each received subcutaneous dorsal implants: Silicone tubes filled with AH Plus or Obtuseal. After the 11^th, 14^th, and 45^th days, tissues were collected for biopsy and fixed and processed for histologic evaluation. Observations of the cellular inflammatory components, such as lymphocytes and macrophages, were made. The data were analyzed using Kruskal–Wallis and Connover tests (P < 0.05).

Results:

By the 7^th day, lymphocyte infiltration increased in both groups (P = 0.0104). However, macrophage infiltration increased only in the AH Plus group (P = 0.0011). By the 14^th and 45^th days, lymphocyte and macrophage infiltrations were reduced. At the end of the experimental period, no statistically significant differences were found between the AH Plus group and the Obtuseal group (P > 0.05).

Conclusion:

After 45 days, Obtuseal yielded a satisfactory tissue reaction; it was biocompatible when tested in subcutaneous rat tissue. On the basis of the obtained results, it was concluded that Obtuseal root canal sealer caused a satisfactory tissue reaction as AH plus, because it was biocompatible when tested in the subcutaneous tissue of rats.

Enhanced properties of fiberglass-reinforced photocurable resin pile by introducing different fiberglass surface treatments and their biological evolution

The properties of fiberglass-reinforced photocurable resin piles are enhanced by introducing different fiberglass surface treatments, which shows good cell compatibility.

Cytotoxicity evaluation of zinc oxide-eugenol and non-eugenol cements using different fibroblast cell lines

OBJECTIVES

Despite being commonly used as temporary cements in dentistry, there is a lack of studies regarding the cytotoxicity of zinc oxide-eugenol (ZOE) and zinc oxide non-eugenol (ZONE) cements. In addition, cytotoxicity evaluation of the materials often involves animal-based cells. Therefore, in this study, a cytotoxicity evaluation of commercially available ZOE and ZONE cements was carried out using both animal and human-based cells.

MATERIALS AND METHODS

The extraction or dilution of the extraction from four commercially available cements (two zinc oxide-eugenol and two zinc oxide non-eugenol) was tested for cytotoxicity, using three different cells and a water-soluble treatzolium salt assay. The results were confirmed using a confocal laser microscope following calcein AM and ethidium homodimer-1 staining.

RESULTS

The results showed that there was a significant difference in cell viability depending on which cell was used, even when the same material was tested. Generally, L929 showed relatively low cell viability with a low EC50 (effective concentration of extracts that caused 50% of cell viability compared to the control) value compared to both HGF-1 and hTERT-hNOF. Such results were also confirmed by a confocal laser microscope.

CONCLUSIONS

Careful consideration on interpreting the results for cytotoxicity evaluation of ZOE and ZONE cements is needed when different cells are used.

Nickel alloys in the oral environment

The use of nickel casting alloys for long-term restorations in dentistry has long been controversial. A 'tug-of-war' between economic, engineering and biological considerations is central to this controversy; nickel-casting alloys have low costs and favorable physical properties, but are corrosion-prone in the oral environment. Clinicians and researchers have questioned the safety of nickel-containing dental alloys because several nickel compounds are known to cause adverse biological effects in vivo and in vitro in contexts outside of dentistry. The debate revolves around the extent to which corrosion products from oral restorations cause intraoral or systemic biological problems. Current evidence suggests that nickel alloys may be used successfully and safely in dentistry if clinical risks are taken into account. However, these alloys may cause significant clinical problems, primarily allergenic and inflammatory, if the risks are ignored.

Cytotoxicity of root canal sealers on endothelial cell cultures

This study evaluated, in vitro, the cytotoxicity of six root canal sealers after 12, 24 and 72 h of contact time, using an endothelial ECV-304 cell line. The MTT assay was used for analysis of cell viability. Twelve specimens of each sealer were prepared and randomly assigned to 6 groups according to the commercial brands (n=4/time). A control group was also formed, which was not subjected to the contact with sealers. To assess the effects of sealers on endothelial cells, the specimens were placed in culture plate wells and incubated at 37°C with 5% CO2 and 100% humidity. MTT assays were performed in quadruplicate after 12, 24 and 72 h of contact of the sealer specimens with monolayers. Statistical analysis was performed by two-way ANOVA with Bonferroni post-hoc test at a significance level of 5%. Analysis of absorbance in the experimental groups showed that GuttaFlow presented the lowest cytotoxicity, with a mean absorbance of 0.048, followed by Pulp Canal Sealer (0.038), Sealer 26 (0.038), Endo Densell (0.036) and Pulp Fill (0.035). The control group had a mean absorbance of 0.098. Based on the results, Endofill and GuttaFlow were the most and the least cytotoxic sealers, respectively.

Modified cytotoxicity evaluation of elastomeric impression materials while polymerizing with reduced exposure time

OBJECTIVE

Cytotoxicity evaluation is an important step in biocompatibility assessment of dental impression materials. Previously, cytotoxicity evaluations were carried out on already set ('set') impression materials for contact time or extraction time of 24 h or longer in duration. However, clinically, dental impression materials are in contact with oral tissue while they are being set ('polymerizing'), for no longer than 10 min. Hence, the aim of this study was to investigate the difference in results between 'polymerizing' and 'set' forms of impression materials as well as the difference in results between longer duration of contact or extraction time (12 or 24 h) and shorter duration of time (15 or 30 min).

MATERIALS AND METHODS

Seven dental impression materials of different chemical compositions were tested. Two commonly used in vitro tests were used-test on extraction and test by direct contact. Both 'polymerizing' and 'set' forms of impression materials were used with different durations of extraction and contact (15 min, 30 min, 12 h and 24 h).

RESULTS

There were significant (p < 0.05) differences of cell viability and cell proliferation between the 'polymerizing' and 'set' impression materials. Also, significant (p < 0.05) differences were noted with variance in duration of time.

CONCLUSION

In light of the results, it is recommended to use a 'polymerizing' state of dental impression material for cytotoxicity evaluation, with 15 or 30 min of contact between cell and dental impression materials and an extraction time of 15 or 30 min that is more reflective of clinical situations.

Predicting clinical biological responses to dental materials

OBJECTIVES

Methods used to measure and predict clinical biological responses to dental materials remain controversial, confusing, and to some extent, unsuccessful. The current paper reviews significant issues surrounding how we assess the biological safety of materials, with a historical summary and critical look at the biocompatibility literature. The review frames these issues from a U.S. perspective to some degree, but emphasizes their global nature and universal importance.

METHODS

The PubMed database and information from the U.S. Food and Drug Administration, International Standards Organization, and American National Standards Institute were searched for prominent literature addressing the definition of biocompatibility, types of biological tests employed, regulatory and standardization issues, and how biological tests are used together to establish the biological safety of materials. The search encompassed articles published in English from approximately 1965-2011. The review does not comprehensively review the literature, but highlights significant issues that confront the field.

RESULTS

Years ago, tests for biological safety sought to establish material inertness as the measure of safety, a criterion that is now deemed naive; the definition of biocompatibility has broadened along with the roles for materials in patient oral health care. Controversies persist about how in vitro or animal tests should be used to evaluate the biological safety of materials for clinical use. Controlled clinical trials remain the single best measure of the clinical response to materials, but even these tests have significant limitations and are less useful to identify mechanisms that shape material performance. Practice-based research networks and practitioner databases are emerging as important supplements to controlled clinical trials, but their final utility remains to be determined.

SIGNIFICANCE

Today we ask materials to play increasingly sophisticated structural and therapeutic roles in patient treatment. To accommodate these roles, strategies to assess, predict, and monitor material safety need to evolve. This evolution will be driven not only by researchers and manufacturers, but also by patients and practitioners, who want to use novel materials in new ways to treat oral disease.