Genetic and cellular toxicology of dental resin monomers

Alternative Direct Restorative Materials for Dental Amalgam: A Concise Review Based on an FDI Policy Statement

Dental restorative procedures remain a cornerstone of dental practice, and for many decades, dental amalgam was the most frequently employed material. However, its use is declining, mainly driven by its poor aesthetics and by the development of tooth-coloured adhesive materials. Furthermore, the Minamata Convention agreed on a phase-down on the use of dental amalgam. This concise review is based on a FDI Policy Statement which provides guidance on the selection of direct restorative materials as alternatives to amalgam. The Policy Statement was informed by current literature, identified mainly from PubMed and the internet. Ultimately, dental, oral, and patient factors should be considered when choosing the best material for each individual case. Dental factors include the dentition, tooth type, and cavity class and extension; oral aspects comprise caries risk profiles and related risk factors; and patient-related aspects include systemic risks/medical conditions such as allergies towards certain materials as well as compliance. Special protective measures (eg, a no-touch technique, blue light protection) are required when handling resin-based materials, and copious water spray is recommended when adjusting or removing restorative materials. Cost and reimbursement policies may need to be considered when amalgam alternatives are used, and the material recommendation requires the informed consent of the patient. There is no single material which can replace amalgam in all applications; different materials are needed for different situations. The policy statement recommends using a patient-centred rather than purely a material-centred approach. Further research is needed to improve overall material properties, the clinical performance, the impact on the environment, and cost-effectiveness of all alternative materials.

Surface alterations and compound release from aligner attachments in vitro

AIM

The aim of the present study was to assess the alterations in morphology, roughness, and composition of the surfaces of a conventional and a flowable composite attachment engaged with aligners, and to evaluate the release of resin monomers and their derivatives in an aqueous environment.

METHODS

Zirconia tooth-arch frames (n = 20) and corresponding thermoformed PET-G aligners with bonded attachments comprising two composite materials (universal-C and flowable-F) were fabricated. The morphological features (stereomicroscopy), roughness (optical profilometry), and surface composition (ATR-FTIR) of the attachments were examined before and after immersion in water. To simulate intraoral use, the aligners were removed and re-seated to the frames four times per day for a 7-day immersion period. After testing, the eluents were analyzed by LC-MS/MS targeting the compounds Bis-GMA, UDMA, 2-HEMA, TEGDMA and BPA and by LC-HRMS for suspect screening of the leached dental material compounds and their degradation products.

RESULTS

After testing, abrasion-induced defects were found on attachment surfaces such as scratches, marginal cracks, loss of surface texturing, and fractures. The morphological changes and debonding rate were greater in F. Comparisons (before-after testing) revealed a significantly lower Sc roughness parameter in F. The surface composition of the aligners after testing showed minor changes from the control, with insignificant differences in the degree of C = C conversion, except for few cases with strong evidence of hydrolytic degradation. Targeted analysis results revealed a significant difference in the compounds released between Days 1 and 7 in both materials. Insignificant differences were found when C was compared with F in both timeframes. Several degradation products were detected on Day 7, with a strong reduction in the concentration of the targeted compounds.

CONCLUSIONS

The use of aligners affects the surface characteristics and degradation rate of composite attachments in an aqueous environment, releasing monomers, and monomer hydrolysates within 1-week simulated use.

The influence of copper-doped mesoporous bioactive nanospheres on the temperature rise during polymerization, polymer cross-linking density, monomer release and embryotoxicity of dental composites

OBJECTIVES

Composites with copper-doped mesoporous bioactive nanospheres (Cu-MBGN) were developed to prevent secondary caries by imparting antimicrobial and ion-releasing/remineralizing properties.

METHODS

Seven experimental composites containing 1, 5 or 10 wt% Cu-MBGN, the corresponding inert controls (silica) and bioactive controls (bioactive glass 45S5) were prepared. The temperature rise during light curing, cross-linking density by ethanol softening test, monomer elution and their potential adverse effects on the early development of zebrafish Danio rerio was investigated.

RESULTS

Materials combining Cu-MBGN and silica showed the highest resistance to ethanol softening, as did the bioactive controls. Cu-MBGN composites showed significant temperature rise and reached maximum temperature in the shortest time. Bisphenol A was not detected, while bis-GMA was found only in the control materials and TEGDMA in the eluates of all materials. There was no increase in zebrafish mortality and abnormality rates during exposure to the eluates of any of the materials.

CONCLUSIONS

The composite with 5 wt% Cu-MBGN combined with nanosilica fillers showed the lowest ethanol softening, indicating the polymer's highest durability and cross-linking density. Despite the TEGDMA released from all tested materials, no embryotoxic effect was observed.

Salivary levels of eluents during Invisalign™ treatment with attachments: an in vivo investigation

BACKGROUND

The aim of the present study was to investigate qualitatively and quantitatively the elution of substances from polyester-urethane (Invisalign™) aligners and resin composite attachments (Tetric EvoFlow) in vivo.

METHODS

Patients (n = 11) treated with the aligners and attachments (16 per patient, without other composite restorations) for an average of 20 months, who were planned for attachment removed were enrolled in the study. Patients were instructed to rinse with 50 mL of distilled water upon entry and the rinsing solution was collected (before removal). Then, the attachments were removed with low-speed tungsten carbide burs for adhesive residue removal, a thorough water rinsing was performed immediately after the grinding process to discard grinding particle residues, and subsequently, after a second water-rinsing the solution was collected for analysis (after removal). The rinsing solutions were analyzed for targeted (LC-MS/MS: Bis-GMA, DCDMA, UDMA, BPA) and untargeted (LC-HRMS: screening of leached species and their degradation products) compounds.

RESULTS

Targeted analysis revealed a significant reduction in BPA after attachment removal (4 times lower). Bis-GMA, DCDMA, UDMA were below the detection limit before removal but were all detectable after removal with Bis-GMA and UDMA at quantifiable levels. Untargeted analysis reviled the presence of mono-methacrylate transformation products of Bis-GMA (Bis-GMA-M1) and UDMA (UDMA-M1), UDMA without methacrylate moieties (UDMA-M2), and 4-(dimethylamino) benzoic acid (DMAB), the degradation product of the photo-initiator ethyl-4-(dimethylamino) benzoate (EDMAB), all after attachment removal. Several amino acids and endogenous metabolites were also found both before and after removal.

CONCLUSIONS

Elevated levels of BPA were traced instantaneously in patients treated with Invisalign™ and flowable resin composite attachments for the testing period. BPA was reduced after attachment removal, but residual monomers and resin degradation products were found after removal. Alternative resin formulations and attachment materials may be utilized to reduce eluents.

Analysis of Gingival Fibroblasts Behaviour in the Presence of 3D-Printed versus Milled Methacrylate-Based Dental Resins-Do We Have a Winner?

Computer-aided design and computer-aided manufacturing (CAD/CAM) techniques are based on either subtractive (milling prefabricated blocks) or additive (3D printing) methods, and both are used for obtaining dentistry materials. Our in vitro study aimed to investigate the behavior of human gingival fibroblasts exposed to methacrylate (MA)-based CAD/CAM milled samples in comparison with that of MA-based 3D-printed samples to better elucidate the mechanisms of cell adaptability and survival. The proliferation of human gingival fibroblasts was measured after 2 and 24 h of incubation in the presence of these samples using a 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay, and the membrane integrity was assessed through the lactate dehydrogenase release. The level of reactive oxygen species, expression of autophagy-related protein LC3B-I, and detection of GSH and caspase 3/7 were evaluated by fluorescence staining. The MMP-2 levels were measured using a Milliplex MAP kit. The incubation with MA-based 3D-printed samples significantly reduced the viability, by 16% and 28% from control after 2 and 24 h, respectively. There was a 25% and 55% decrease in the GSH level from control after 24 h of incubation with the CAD/CAM milled and 3D-printed samples, respectively. In addition, higher levels of LC3B-I and MMP-2 were obtained after 24 h of incubation with the MA-based 3D samples compared to the CAD/CAM milled ones. Therefore, our results outline that the MA-CAD/CAM milled samples displayed good biocompatibility during 24-h exposure, while MA-3D resins are proper for short-term utilization (less than 24 h).

Impact of bisphenol A and analogues eluted from resin-based dental materials on cellular and molecular processes: An insight on underlying toxicity mechanisms

Dental resin systems, used for artificial replacement of teeth and their surrounding structures, have gained popularity due to the Food and Drug Administration's (FDA) recommendation to reduce dental amalgam use in high-risk populations and medical circumstances. Bisphenol A (BPA), an endocrine-disrupting chemical, is an essential monomer within dental resin in the form of various analogues and derivatives. Leaching of monomers from resins results in toxicity, affecting hormone metabolism and causing long-term health risks. Understanding cellular-level toxicity profiles of bisphenol derivatives is crucial for conducting toxicity studies in in vivo models. This review provides insights into the unique expression patterns of BPA and its analogues among different cell types and their underlying toxicity mechanisms. Lack of a consistent cell line for toxic effects necessitates exploring various cell lines. Among the individual monomers, BisGMA was found to be the most toxic; however, BisDMA and BADGE generates BPA endogenously and found to elicit severe adverse reactions. In correlating in vitro data with in vivo findings, further research is necessary to classify the elutes as human carcinogens or xenoestrogens. Though the basic mechanisms underlying toxicity were believed to be the production of intracellular reactive oxygen species and a corresponding decline in glutathione levels, several underlying mechanisms were identified to stimulate cellular responses at low concentrations. The review calls for further research to assess the synergistic interactions of co-monomers and other components in dental resins. The review emphasizes the clinical relevance of these findings, highlighting the necessity for safer dental materials and underscoring the potential health risks associated with current dental resin systems.

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.

Effects of washing agents on the mechanical and biocompatibility properties of water-washable 3D printing crown and bridge resin

Three-dimensional (3D) printing, otherwise known as additive manufacturing in a non-technical context, is becoming increasingly popular in the field of dentistry. As an essential step in the 3D printing process, postwashing with organic solvents can damage the printed resin polymer and possibly pose a risk to human health. The development of water-washable dental resins means that water can be used as a washing agent. However, the effects of washing agents and washing times on the mechanical and biocompatibility properties of water-washable resins remain unclear. This study investigated the impact of different washing agents (water, detergent, and alcohol) and washing time points (5, 10, 20, and 30 min) on the flexural strength, Vickers hardness, surface characterization, degree of conversion, biocompatibility, and monomer elution of 3D printed samples. Using water for long-term washing better preserved the mechanical properties, caused a smooth surface, and improved the degree of conversion, with 20 min of washing with water achieving the same biological performance as organic solvents. Water is an applicable agent option for washing the 3D printing water-washable temporary crown and bridge resin in the postwashing process. This advancement facilitates the development of other water-washable intraoral resins and the optimization of clinical standard washing guidelines.

Elution from direct composites for provisional restorations

Purpose To assess elution from direct composite materials for provisional restorations and compare them with elution from direct restorative composites for permanent restorations.Methods Two dual-cure (Integrity Multi-Cure and Tempsmart DC) and two self-curing composites (Protemp 4 and Structur 3) were used, with Essentia serving as a reference. Cylindrical specimens (n=20) were cured according to the manufacturer's instructions; the dual-cure materials were prepared in both self- and dual-curing modes. Elution experiments were performed using water and absolute ethanol. The samples were incubated at 37 °C for either 24 h or four weeks; the extraction solvents were refreshed weekly. The eluted BisEMA (-3 / -6 / -10), BisGMA, CQ, UDMA, and TEGDMA were quantified using UHPLC-MS/MS.Results Monomer elution was detected in all provisional composites at 24 h and four weeks, but the amounts released did not exceed those released by the reference composite. When prepared in self-curing mode, Integrity Multi-Cure exhibited significantly higher elution of BisEMA-3, -6, and -10 in ethanol both after 24 h and cumulatively after four weeks. Self-cured Tempsmart DC released significantly more CQ, TEGDMA, and UDMA in both water and ethanol after immersion for 24 h and four weeks, along with significantly more BisGMA in ethanol both after 24 h and four weeks comparison to dual-cured Tempsmart DC (two-way ANOVA, post-hoc Tukey, P < 0.05).Conclusions Provisional composite materials did not elute higher amounts of monomers than a restorative composite. Dual-cured materials, prepared in the self-curing mode, show a trend towards higher monomer elution.

In-vitro-cytotoxicity of self-adhesive dental restorative materials

OBJECTIVES

Although the introduction of self-adhesive composites in restorative dentistry is very promising, the innovation of new materials also presents challenges and unknowns. Therefore, the aim of this study was to investigate the cytotoxicity of four different self-adhesive composites (SAC) in vitro and to compare them with resin-modified glass ionomer cements (RM-GIC), a more established group of materials.

METHODS

Samples of the following materials were prepared according to ISO 7405/10993-12 and eluted in cell culture medium for 24 h at 37 °C: Vertise Flow, Fusio Liquid Dentin, Constic, Surefil One, Photac Fil and Fuji II LC. Primary human pulp cells were obtained from extracted wisdom teeth and cultured for 24 h with the extracts in serial dilutions. Cell viability was evaluated by MTT assay, membrane disruption was quantified by LDH assay and apoptosis was assessed by flow cytometry after annexin/PI staining.

RESULTS

Two SAC (Constic and Vertise Flow) and one RM-GIC (Photac Fil) significantly reduced cell viability by more than 30% compared to the untreated control (p < 0.001). Disruptive cell morphological changes were observed and the cells showed signs of late apoptosis and necrosis in flow cytometry. Membrane disruption was not observed with any of the investigated materials.

CONCLUSION

Toxic effects occurred independently of the substance group and need to be considered in the development of materials with regard to clinical implications.

CLINICAL SIGNIFICANCE

SAC have many beneficial qualities, however, the cytotoxic effects of certain products should be considered when applied in close proximity to the dental pulp, as is often required.

Melatonin protects TEGDMA-induced preodontoblast mitochondrial apoptosis via the JNK/MAPK signaling pathway

Resin monomer-induced dental pulp injury presents a pathology related to mitochondrial dysfunction. Melatonin has been regarded as a strong mitochondrial protective bioactive compound from the pineal gland. However, it remains unknown whether melatonin can prevent dental pulp from resin monomer-induced injury. The aim of this study is to investigate the effects of melatonin on apoptosis of mouse preodontoblast cells (mDPC6T) induced by triethylene glycol dimethacrylate (TEGDMA), a major component in dental resin, and to determine whether the JNK/MAPK signaling pathway mediates the protective effect of melatonin. A well-established TEGDMA-induced mDPC6T apoptosis model is adopted to investigate the preventive function of melatonin by detecting cell viability, apoptosis rate, expressions of apoptosis-related proteins, mitochondrial ROS (mtROS) production, mitochondrial membrane potential (MMP) and adenosine triphosphate (ATP) level. Inhibitors of MAPKs are used to explore which pathway is involved in TEGDMA-induced apoptosis. Finally, the role of the JNK/MAPK pathway is verified using JNK agonists and antagonists. Our results show that melatonin attenuates TEGDMA-induced mDPC6T apoptosis by reducing mtROS production and rescuing MMP and ATP levels. Furthermore, mitochondrial dysfunction and apoptosis are alleviated only by the JNK/MAPK inhibitor SP600125 but not by other MAPK inhibitors. Additionally, melatonin downregulates the expression of phosphorylated JNK and counteractes the activating effects of anisomycin on the JNK/MAPK pathway, mimicking the effects of SP600125. Our findings demonstrate that melatonin protects mDPC6T cells against TEGDMA-induced apoptosis partly through JNK/MAPK and the maintenance of mitochondrial function, offering a novel therapeutic strategy for the prevention of resin monomer-induced dental pulp injury.

Effect of post-curing conditions on surface characteristics, physico-mechanical properties, and cytotoxicity of a 3D-printed denture base polymer

OBJECTIVE

This study aims to investigate the influence of post-polymerization (post-curing) conditions on surface characteristics, flexural properties, water sorption and solubility, and cytotoxicity of additively manufactured denture base materials.

METHODS

The tested specimens were additively manufactured using digital light processing and classified into different post-curing condition groups: submerged in water (WAT), submerged in glycerin (GLY), and air exposure (AIR). An uncured specimen (UNC) was used as a control. The surface topography and roughness were observed. The flexural strength and modulus were determined via a three-point bending test. The water sorption and solubility were subsequently tested. Finally, an extract test was performed to assess cytotoxicity.

RESULTS

Different post-curing conditions had no significant effects on the surface topography and roughness (Sa value). Various post-curing conditions also had no significant effects on the flexural strength. Notably, the flexural modulus of the WAT group (2671.80 ± 139.42 MPa) was significantly higher than the AIR group (2197.47 ± 197.93 MPa, p = 0.0103). After different post-curing conditions, the water sorption and solubility of the specimens met the ISO standards. Finally, all post-curing conditions effectively reduced cytotoxic effects.

SIGNIFICANCES

Post-curing with different oxygen levels improved flexural properties, and flexural modulus significantly increased after the specimens were submerged in water. In addition, water sorption and solubility, and cytocompatibility were optimized by post-curing, irrespective of the post-curing conditions. Therefore, the water-submerged conditions optimized the flexural modulus of the 3D-printed denture base materials.

Cytotoxicity and genotoxicity of bioceramic root canal sealers compared to conventional resin-based sealer

The aim of this study was to evaluate cytotoxicity and genotoxicity of calcium-silicate based sealers and comparing them with a gold standard-an epoxy-based sealant. Two experimental cell lines were used, gingival fibroblasts (hGF) and monocyte/macrophage peripheral blood cell line (SC). The cytotoxicity (XTT assay) and genotoxicity (comet assay) were evaluated both after 24-h and 48-h incubation. Additionally, after 48-h incubation, the cell apoptosis and cell cycle progression was detected. BioRoot Flow induced a significant decrease in hGF cells viability compared to the negative control groups both after 24-h (p < 0.001) and 48-h incubation (p < 0.01). In group with SC cells, after 24-h incubation significant increase in cells viability was detected for AH Plus Bioceramic Sealer in comparison to negative control (p < 0.05). BioRoot Flow and BioRoot RCS can be considered potentially genotoxic for the hGF cells after 48-h incubation (> 20% DNA damage). BioRoot Flow and BioRoot RCS, may have potential genotoxic effects and induce apoptosis in hGF cells which may irritate periapical tissues, resulting in a delayed healing. The findings of the study would be useful in selection of an appropriate sealant for root canal filling without causing cytotoxicity and genotoxicity.

Effects of three disinfection solutions on residual monomers released from resin nanoceramic CAD/CAM blocks

The aim of this study was to evaluate the effects of three disinfection solutions on the amount of monomers released from resin nanoceramic CAD/CAM blocks using high performance liquid chromatography (HPLC). Forty resin nanoceramic CAD/CAM (Cerasmart, GC, Japan) samples (12x14 × 2 mm) were divided into four groups; each group was disinfected using one of four solutions (Group 1: no disinfectant; Group 2: 70 % ethanol; Group 3: 2 % glutaraldehyde; and Group 4: 1 % sodium hypochlorite) for 5 min. Analysis of residual monomers (UDMA and Bis-EMA) amounts was performed using an HPLC instrument (Dionex Ultimate 3000, Thermo Fisher Scientific). After 30 days, the amounts of monomers found were as follows: 14.54 ppm for Group 1; 9.28 ppm for Group 2; 10.60 ppm for Group 3; and 2.76 ppm for Group 4 (the smallest monomer amount) (p < 0.001). Disinfection of indirect restorations prior to cementation can reduce the amount of residual monomers remaining from resin nanoceramic CAD/CAM blocks.

Biocompatibility and Bioactivity of a Dual-Cured Resin-Based Calcium Silicate Cement: In Vitro and in vivo Evaluation

INTRODUCTION

This study aimed to assess the biocompatibility and bioactivity of a dual-cured resin-based calcium silicate cement in vitro and in vivo.

METHODS

For in vitro analyses, standardized samples were prepared using TheraCal LC, TheraCal PT, and ProRoot MTA. The amount of residual monomer released from TheraCal LC and TheraCal PT was assessed using liquid chromatography/mass spectrometry. Calcium ion release from the materials was evaluated using inductively coupled plasma-optical emission spectroscopy. Scanning electron microscopy and energy-dispersive X-ray spectroscopy were used to determine the calcium weight volume in the materials. For in vivo analysis, a rat direct pulp capping model with TheraCal LC, TheraCal PT, and ProRoot MTA groups (n = 16 per group) was used. The rats were euthanized after 7 or 28 days, and histological and immunohistochemical analyses (CD68 and DSPP) were performed.

RESULTS

Bisphenol A-glycidyl methacrylate and polyethylene glycol dimethacrylate release from TheraCal PT was lower than that from TheraCal LC (P < .05). Similar results were obtained for calcium-ion release and calcium weight volume, with ProRoot MTA showing the highest values. In the in vivo evaluation, TheraCal PT showed significantly greater hard tissue formation than TheraCal LC (P < .017). TheraCal PT showed lower CD68 expression and greater DSPP expression than TheraCal LC (P < .017). There were no significant differences in the expression of CD68 or DSPP between the TheraCal PT and ProRoot MTA groups.

CONCLUSIONS

Within the limitations of this study, the biocompatibility and bioactivity of TheraCal PT could be comparable to those of ProRoot MTA.

Disparity in the Influence of Implant Provisional Materials on Human Gingival Fibroblasts with Different Phases of Cell Settlement: An In Vitro Study

The development of healthy peri-implant soft tissues is critical to achieving the esthetic and biological success of implant restorations throughout all stages of healing and tissue maturation, starting with provisionalization. The purpose of this study was to investigate the effects of eight different implant provisional materials on human gingival fibroblasts at various stages of cell settlement by examining initial cell attachment, growth, and function. Eight different specimens-bis-acrylic 1 and 2, flowable and bulk-fill composites, self-curing acrylic 1 and 2, milled acrylic, and titanium (Ti) alloy as a control-were fabricated in rectangular plates (n = 3). The condition of human gingival fibroblasts was divided into two groups: those in direct contact with test materials (contact experiment) and those in close proximity to test materials (proximity experiment). The proximity experiment was further divided into three phases: pre-settlement, early settlement, and late settlement. A cell culture insert containing each test plate was placed into a well where the cells were pre-cultured. The number of attached cells, cell proliferation, resistance to detachment, and collagen production were evaluated. In the contact experiment, bis-acrylics and composites showed detrimental effects on cells. The number of cells attached to milled acrylic and self-curing acrylic was relatively high, being approximately 70% and 20-30%, respectively, of that on Ti alloy. There was a significant difference between self-curing acrylic 1 and 2, even with the same curing modality. The cell retention ability also varied considerably among the materials. Although the detrimental effects were mitigated in the proximity experiment compared to the contact experiment, adverse effects on cell growth and collagen production remained significant during all phases of cell settlement for bis-acrylics and flowable composite. Specifically, the early settlement phase was not sufficient to significantly mitigate the material cytotoxicity. The flowable composite was consistently more cytotoxic than the bulk-fill composite. The harmful effects of the provisional materials on gingival fibroblasts vary considerably depending on the curing modality and compositions. Pre-settlement of cells mitigated the harmful effects, implying the susceptibility to material toxicity varies depending on the progress of wound healing and tissue condition. However, cell pre-settlement was not sufficient to fully restore the fibroblastic function to the normal level. Particularly, the adverse effects of bis-acrylics and flowable composite remained significant. Milled and self-curing acrylic exhibited excellent and acceptable biocompatibility, respectively, compared to other materials.

Biocompatibility of bulk-fill resins in vitro

OBJECTIVES

This study aims to evaluate the cytotoxicity and genotoxicity of three different extracts obtained from Filtek™ One Bulk Fill, Tetric Evoceram® Bulk Fill and Coltene Fill-Up! resins.

MATERIALS AND METHODS

The cytotoxicity was determined on 3T3 fibroblast cells using the MTT and crystal violet assays. The genotoxicity was determined using a cytokinesis-block micronucleus assay.

RESULTS

The cytotoxicity of the resin extracts on 3T3 mouse fibroblasts was found to be dose-dependent with both the MTT and crystal violet assays. Extracts concentrated above 1% were cytotoxic according to the MTT assay. The Filtek™ One Bulk Fill, Tetric Evoceram® Bulk Fill, and Coltene Fill-Up! resins reached the LD50 at concentrations of 60%, 50%, and 20%, respectively, and showed genotoxicity rates that were 2-5 times, 3-8 times, and 4-15 times higher than the negative control, respectively.

CONCLUSIONS

Coltene Fill-Up! resin extracts were the most cytotoxic and genotoxic, followed by Tetric Evoceram® Bulk Fill and Filtek™ One Bulk Fill.

CLINICAL RELEVANCE

The analyzed bulk-fill resins showed differences in in vitro biocompatibility, and the Filtek™ One Bulk Fill was found to be the safest for clinical use.

Effect of varying functional monomers in experimental self-adhesive composites: polymerization kinetics, cell metabolism influence and sealing ability

The aim was to evaluate the effects of adding different functional monomers to experimental self-adhesive composites (SACs) on polymerization kinetics, cell metabolic activity, and sealing ability. SACs were formulated using urethane dimethacrylate as the base monomer and triethylene glycol dimethacrylate. Additionally, 10 wt.% of distinct functional monomers were added - 10-methacryloyloxydecyl dihydrogen phosphate, glycerol phosphate dimethacrylate (GPDM), 2-hydroxyethyl methacrylate (HEMA) or hydroxyethyl acrylamide (HEAA). ATR-FTIR was used to determine real-time polymerization kinetics (20 min,n= 3). The final extrapolated conversion and polymerization rates were determined (DC,max;Rp,max). TheDC,maxvalues were employed to calculate volumetric shrinkage. The MTT assay was performed on MDPC-23 cells using disc extracts at different concentrations (n= 8). Class V cavities were prepared in 60 sound human molars, assigned to six groups (n= 10), depending on the composite used and aging type (T0 or TC, if thermocycled for 10 000 cycles). One-way ANOVA, two-way, andKruskal-Wallistests were employed to treat the data (ɑ= 0.05). Varying the functional monomers had a large impact on DC,max, as confirmed by one-way ANOVA (p<0.001). The highest was obtained for HEMA (64 ± 3%). The HEMA and HEAA formulations were found to be significantly more toxic at concentrations below 100%. For microleakage, having a functional monomer or not did not show any improvement, irrespective of margin or aging period (Mann-Whitney U,p> 0.05). Larger functional monomers MDP and GPDM affected polymerization properties. Conversely, their acidity did not seem to be detrimental to cell metabolic activity. Regarding sealing ability, it seems that the functional monomers did not bring an advantage to the composites. Varying the functional monomer in SACs had a clear impact on the polymerization kinetics as well as on their cytotoxic potential. However, it did not confer better microleakage and sealing. Claiming self-adhesiveness based only on functional monomers seems dubious.

A Look Into the Cytotoxicity of Composite Fillings: Friend or Foe?

Dental resin composites are widely used restorative materials in dentistry for the treatment of carious and non-carious lesions as well as pit and fissure sealants, cavity liners, and endodontic sealers. They consist of two parts: an organic resin matrix and an inorganic/organic filler. The organic resin matrix phase is made up of multifunctional monomers and light-sensitive initiators, while the inorganic/organic filler phase is made up of micro/nano-sized fillers that primarily serve as reinforcement. Despite being a very promising dental material, its monomeric component has some drawbacks. It is well known for leaching out during incomplete polymerization, which can result in cytotoxicity. Bis-GMA (bisphenol A-glycidyl methacrylate) is the most cytotoxic of all monomeric components that exhibit synthetic estrogenic effects. The purpose of this article is to assess the cytotoxic effects of dental composite, understand the possible mechanism behind them, and explore ways to screen for and reduce this harmful effect, as well as shed light on its future prospects.

Bisphenol-A release from thermoplastic clear aligner materials: A systematic review

AIM

The aim of the present study was to undertake a systematic review of the available evidence on the release of bisphenol-A (BPA) from thermoplastic materials used in the fabrication of clear aligners (CA).

METHODS

Electronic databases, such as MEDLINE (via PubMed), Google Scholar, Scopus, Cochrane Library, Web of Science, OpenGrey, and the U.S. National Institute of Heath-Clinical Trials, were searched up to 27 October 2022. In vivo/in vitro studies that assessed the release of BPA from different thermoplastic CA materials, with or without a control group, were selected. The risk of bias (RoB) in the randomised controlled trials (RCT) and in vitro studies was assessed using the Cochrane RoB tool and the guidelines for the reporting of pre-clinical studies, respectively. The quality of evidence was determined using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) Pro tool.

RESULTS

Six studies were considered for review from a total of 1926 records. This included one RCT and five in vitro studies. Only two studies found leaching of BPA, while four did not report any traces. The RoB was found to be moderate to high. The GRADE evidence level ranged from low to very low. Five of the included studies were conducted in vitro. Significant heterogeneity among the included studies prevented a quantitative synthesis.

CONCLUSION

In light of the available conflicting evidence, BPA release from CAs can neither be confirmed nor denied. Safety remains questionable until high-quality in vivo trials prove otherwise.

REGISTRATION

PROSPERO CRD42022310434.

In vitro cytotoxicity of resin cement and its influence on the expression of antioxidant genes

AIM

This study evaluated cytotoxicity and antioxidant gene expression of resin cements on human gingival fibroblasts (hGF).

MATERIALS AND METHOD

RelyX Ultimate™(RXU), Variolink™II(VLII), and RelyXU200™(RXU200) resin cements were incubated with culture medium for 24 h to obtain eluates. Then, the eluates were applied over hGF to assess cell viability at 24 h, 48 h, and 72 h and antioxidant gene expression at 24 h. hGF cultures non-exposed to the eluates were used as Control. Data were submitted to ANOVA and Bonferroni tests (α≤0.05).

RESULTS

RXU and RXU200 reduced the number of viable cells in 24 h. Longer exposure to cement extracts caused cell death. Gene expression showed peroxiredoxin 1 (PRDX1) induction by all resin cement types, and superoxide dismutase 1 (SOD1) induction by RXU200 and VLII. Moreover, RXU200 induced not only PRDX1 and SOD1, but also glutathione peroxidase 1 (GPX1), catalase (CAT), and glutathione synthetase (GSS).

CONCLUSIONS

All resin cements showed toxicity, and induced antioxidant genes in hGF. Antioxidant gene induction is at least partly associated with cytotoxicity of tested cements to oxidative stress experience.

Polymeric Denture Base Materials: A Review

An ideal denture base must have good physical and mechanical properties, biocompatibility, and esthetic properties. Various polymeric materials have been used to construct denture bases. Polymethyl methacrylate (PMMA) is the most used biomaterial for dentures fabrication due to its favorable properties, which include ease of processing and pigmenting, sufficient mechanical properties, economy, and low toxicity. This article aimed to comprehensively review the current knowledge about denture base materials (DBMs) types, properties, modifications, applications, and construction methods. We searched for articles about denture base materials in PubMed, Scopus, and Embase. Journals covering topics including dental materials, prosthodontics, and restorative dentistry were also combed through. Denture base material variations, types, qualities, applications, and fabrication research published in English were considered. Although PMMA has several benefits and gained popularity as a denture base material, it has certain limitations and cannot be classified as an ideal biomaterial for fabricating dental prostheses. Accordingly, several studies have been performed to enhance the physical and mechanical properties of PMMA by chemical modifications and mechanical reinforcement using fibers, nanofillers, and hybrid materials. This review aimed to update the current knowledge about DBMs' types, properties, applications, and recent developments. There is a need for specific research to improve their biological properties due to patient and dental staff adverse reactions to possibly harmful substances produced during their manufacturing and use.

Conditional Mitigation of Dental-Composite Material-Induced Cytotoxicity by Increasing the Cure Time

Light-cured composite resins are widely used in dental restorations to fill cavities and fabricate temporary crowns. After curing, the residual monomer is a known to be cytotoxic, but increasing the curing time should improve biocompatibility. However, a biologically optimized cure time has not been determined through systematic experimentation. The objective of this study was to examine the behavior and function of human gingival fibroblasts cultured with flowable and bulk-fill composites cured for different periods of time, while considering the physical location of the cells with regard to the materials. Biological effects were separately evaluated for cells in direct contact with, and in close proximity to, the two composite materials. Curing time varied from the recommended 20 s to 40, 60, and 80 s. Pre-cured, milled-acrylic resin was used as a control. No cell survived and attached to or around the flowable composite, regardless of curing time. Some cells survived and attached close to (but not on) the bulk-fill composite, with survival increasing with a longer curing time, albeit to <20% of the numbers growing on milled acrylic even after 80 s of curing. A few cells (<5% of milled acrylic) survived and attached around the flowable composite after removal of the surface layer, but attachment was not cure-time dependent. Removing the surface layer increased cell survival and attachment around the bulk-fill composite after a 20-s cure, but survival was reduced after an 80-s cure. Dental-composite materials are lethal to contacting fibroblasts, regardless of curing time. However, longer curing times mitigated material cytotoxicity exclusively for bulk-fill composites when the cells were not in direct contact. Removing the surface layer slightly improved biocompatibility for cells in proximity to the materials, but not in proportion to cure time. In conclusion, mitigating the cytotoxicity of composite materials by increasing cure time is conditional on the physical location of cells, the type of material, and the finish of the surface layer. This study provides valuable information for clinical decision making and novel insights into the polymerization behavior of composite materials.

Cytotoxicity and reactive oxygen species production induced by different co-monomer eluted from nanohybrid dental composites

BACKGROUND

Safety issues for dental restorative composites are critical to material selection, but, limited information is available to dental practitioners. This study aimed to compare the chemical and biological characteristics of three nanohybrid dental composites by assessing filler particle analysis, monomer degree of conversion (DC), the composition of eluates, and cytotoxicity and reactive oxygen species (ROS) production in fibroblasts.

METHODS

Three nanohybrid composites (TN, Tetric N-Ceram; CX, Ceram X Sphere Tec One; and DN, DenFil NX) were used. The size distribution and morphology of the filler particles were analysed using scanning electron microscopy (n = 5). The DC was measured via micro-Raman spectroscopy (n = 5). For the component analysis, methanol eluates from the light-polymerised composites were evaluated by gas chromatography/mass spectrometry (n = 3). The eluates were prepared from the polymerised composites after 24 h in a cell culture medium. A live/dead assay (n = 9) and Water-Soluble Tetrazolium-1 assay (n = 9) were performed and compared with negative and positive controls. The ROS in composites were compared with NC. Statistical significance in differences was assessed using a t-test and ANOVA (α = 0.05).

RESULTS

Morphological variations in different-sized fillers were observed in the composites. The DC values were not significantly different among the composites. The amounts of 2-hydroxyethyl methacrylate (HEMA) were higher in TN than DN (p = 0.0022) and triethylene glycol dimethacrylate (TEGDMA) in CX was higher than in others (p < 0.0001). The lowest cell viability was shown in CX (p < 0.0001) and the highest ROS formation was detected in TN (p < 0.0001).

CONCLUSIONS

Three nanohybrid dental composites exhibited various compositions of filler sizes and resin components, resulting in different levels of cytotoxicity and ROS production. Chemical compositions of dental composites can be considered with their biological impact on safety issues in the intraoral use of dental restorative composites. CX with the highest TEGDMA showed the highest cytotoxicity induced by ROS accumulation. DN with lower TEGDMA and HEMA presented the highest cell viability.

Detection of Leachable Components from Conventional and Dental Bulk-Fill Resin Composites (High and Low Viscosity) Using Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS) Method

The aim of this study was to investigate leachable components (monomers) in high and low viscosity dental bulk-fill resin composites and conventional resin composite materials after polymerization. Six bulk-fill and six conventional dental resin composite materials were used in this study. The samples of each material (three sets of triplicates) were cured for 20 s with irradiance of 1200 mW/cm² with a LED curing unit and immersed in a 75% ethanol solution at 37 °C. The eluates from each triplicate set were analyzed after 24 h, 7 days or 28 days using liquid chromatography coupled with triple quadrupole tandem mass spectrometry (LC-MS/MS). Detectable amounts of 2-Hydroxyethyl methacrylate (HEMA) were found in both Gradia materials and the amount observed across different time points was statistically different (p ˂ 0.05), with the amount in solution increasing for Gradia and decreasing for Gradia Direct flo. Bisphenol A diglycidildimethacrylate (BIS GMA) was found in Filtek and Tetric materials. Triethylene glycol dimethacrylate (TEGDMA) was detected in all materials. On the other hand, there were no statistically significant differences in the amounts of TEGDMA detected across different time points in either of the tested materials. Monomers HEMA, TEGDMA, 4-dimethylaminobenzoic acid ethyl ester (DMA BEE) and BIS GMA in bulk-fill and conventional composites (high and low viscosity) can be eluted after polymerization. The good selection of composite material and proper handling, the following of the manufacturer's instructions for polymerization and the use of finishing and polishing procedures may reduce the elution of the unpolymerized monomers> responsible for the possible allergic and genotoxic potential of dental resin composites.

Applications of Antioxidants in Dental Procedures

As people are paying more and more attention to dental health, various dental treatment procedures have emerged, such as tooth bleaching, dental implants, and dental restorations. However, a large number of free radicals are typically produced during the dental procedures. When the imbalance in distribution of reactive oxygen species (ROS) is induced, oxidative stress coupled with oxidative damage occurs. Oral inflammations such as those in periodontitis and pulpitis are also unavoidable. Therefore, the applications of exogenous antioxidants in oral environment have been proposed. In this article, the origin of ROS during dental procedures, the types of antioxidants, and their working mechanisms are reviewed. Additionally, antioxidants delivery in the complicated dental procedures and their feasibility for clinical applications are also covered. Finally, the importance of safety assessment of these materials and future work to take the challenge in antioxidants development are proposed for perspective.

Cell Type-Specific Effects of Implant Provisional Restoration Materials on the Growth and Function of Human Fibroblasts and Osteoblasts

Implant provisional restorations should ideally be nontoxic to the contacting and adjacent tissues, create anatomical and biophysiological stability, and establish a soft tissue seal through interactions between prosthesis, soft tissue, and alveolar bone. However, there is a lack of robust, systematic, and fundamental data to inform clinical decision making. Here we systematically explored the biocompatibility of fibroblasts and osteoblasts in direct contact with, or close proximity to, provisional restoration materials. Human gingival fibroblasts and osteoblasts were cultured on the "contact" effect and around the "proximity" effect with various provisional materials: bis-acrylic, composite, self-curing acrylic, and milled acrylic, with titanium alloy as a bioinert control. The number of fibroblasts and osteoblasts surviving and attaching to and around the materials varied considerably depending on the material, with milled acrylic the most biocompatible and similar to titanium alloy, followed by self-curing acrylic and little to no attachment on or around bis-acrylic and composite materials. Milled and self-curing acrylics similarly favored subsequent cellular proliferation and physiological functions such as collagen production in fibroblasts and alkaline phosphatase activity in osteoblasts. Neither fibroblasts nor osteoblasts showed a functional phenotype when cultured with bis-acrylic or composite. By calculating a biocompatibility index for each material, we established that fibroblasts were more resistant to the cytotoxicity induced by most materials in direct contact, however, the osteoblasts were more resistant when the materials were in close proximity. In conclusion, there was a wide variation in the cytotoxicity of implant provisional restoration materials ranging from lethal and tolerant to near inert, and this cytotoxicity may be received differently between the different cell types and depending on their physical interrelationships.

N-Acetyl Cysteine-Mediated Improvements in Dental Restorative Material Biocompatibility

The fibroblast-rich gingival tissue is usually in contact with or adjacent to cytotoxic polymer-based dental restoration materials. The objective of this study was to determine whether the antioxidant amino acid, N-acetyl cysteine (NAC), reduces the toxicity of dental restorative materials. Human oral fibroblasts were cultured with bis-acrylic, flowable composite, bulk-fill composite, self-curing acrylic, and titanium alloy test specimens. Cellular behavior and function were analyzed on and around the materials. Impregnation of the bulk-fill composite and self-curing acrylic with NAC reduced their toxicity, improving the attachment, growth, and function of human oral fibroblasts on and around the materials. These mitigating effects were NAC dose dependent. However, NAC impregnation of the bis-acrylic and flowable composite was ineffective, with no cells attaching to nor around the materials. Although supplementing the culture medium with NAC also effectively improved fibroblast behaviors, direct impregnation of materials with NAC was more effective than supplementing the cultures. NAC-mediated improvements in fibroblast behavior were associated with reduced production of reactive oxygen species and oxidized glutathione together with increased glutathione reserves, indicating that NAC effectively directly scavenged ROS from materials and reinforced the cellular antioxidant defense system. These results establish a proof of concept of NAC-mediated improvements in biocompatibility in the selected dental restorative materials.

Biodegradation of Dental Resin-Based Composite—A Potential Factor Affecting the Bonding Effect: A Narrative Review

In recent years, although resin composite has played an important role in the restoration of tooth defects, it still has several disadvantages, including being biodegraded by saliva, bacteria and other enzymes in the oral cavity, which may result in repair failure. This factor is not conducive to the long-term survival of the prosthesis in the mouth. In this article, we review the causes, influencing factors and prevention methods of resin biodegradation. Biodegradation is mainly caused by esterase in saliva and bacteria, which breaks the ester bond in resin and causes the release of monomers. The mechanical properties of the prosthesis can then be affected. Meanwhile, cathepsin and MMPs are activated on the bonding surface, which may decompose the dentin collagen. In addition, neutrophils and residual water on the bonding surface can also aggravate biodegradation. Currently, the primary methods to prevent biodegradation involve adding antibacterial agents to resin, inhibiting the activity of MMPs and enhancing the crosslinking of collagen fibers. All of the above indicates that in the preparation and adhesion of resin materials, attention should be paid to the influence of biodegradation to improve the prosthesis’s service life in the complex environment of the oral cavity.

Quality of Cure in Depth of Commercially Available Bulk-fill Composites: A Layer-by-layer Mechanical and Biological Evaluation

Despite their popularity, the use of bulk-fill composites remains controversial, both in terms of their properties and their in-depth development. The objectives of the present work were (1) to provide a more comprehensive evaluation of the quality of cure in depth of commercially available bulk-fill composites by combining various key mechanical and biological characterization methods, (2) to evaluate the inter-material differences when optimally cured, and (3) to evaluate the efficiency of an antioxidant-N-acetyl-cysteine (NAC)-to restrain the adverse effects of the leached components on cell viability. Nine bulk-fill composites (including flowable and high-viscosity materials) were investigated and compared to two conventional resin-based composites, one flowable and one high-viscosity restorative material. The materials were injected or packed into Teflon molds of various configurations, up to 6 mm material thickness. They were then light-cured from the top for 20 seconds with Bluephase G2 (Ivoclar Vivadent, irradiance = 1050 mW/cm2). The following physicomechanical properties were measured for the upper (0-2 mm), intermediate (2-4 mm), and lower (4-6 mm) layers: degree of conversion using Raman Spectrometry (DC, in %), microhardness using a Vickers micro-indenter before (VHN dry) and after 24 hours of storage in ethanol (VHN EtOH), and flexural strength (in MPa) and flexural modulus (in GPa) using a three-point bend test. Each composite layer and an uncured layer were also stored for one week in a standard cell growth medium to generate conditioned media. Human dental pulp cells were then cultured for 24 hours with the latter and cell viability was measured using an MTS assay. A similar experiment was repeated with conditioned media produced in contact with uncured composites, with and without the addition of 4 mM NAC. The data were subjected to a Shapiro-Wilk test, then one-way ANOVA or Kruskal-Wallis test, followed either by Tukey's test (inter-material comparison) or by Dunnett's or Dunn's test (comparison between layers relative to the upper one). The level of statistical significance was set at 0.05. Some materials (EverX, X-traF, VenusBF, X-traB) did not show any significant differences (p>0.05) for any of the properties considered between the intermediate layers compared to the upper one (considered as reference). Others displayed significant differences, at least for some properties, highlighting the value of combining various key mechanical and biological characterization methods when investigating the quality of cure in depth. Significant inter-material differences (p<0.05) were observed when comparing the properties of their upper layer, considered as "optimally" polymerized. Hence, one needs to consider the absolute property values, not only their relative evolution concerning layer thickness. Finally, the use of NAC appeared as beneficial to reduce the risk of harmful effects to dental pulp cells, especially in case of excessive thickness use, and may therefore be of potential interest as an additive to composites in the future.

Effects of resin materials dedicated for additive manufacturing of temporary dental restorations on human gingival keratinocytes

OBJECTIVE

This study investigated the effect of eluates of conventional and 3D-printed resin materials for manufacturing temporary dental restorations on gingival keratinocytes.

METHODS

Three-dimensional (3D)-printed resin materials: 3Delta temp (Deltamed), NextDent MFH (Nextdent), Freeprint temp (Detax), GC temp (GC), were compared to Grandio disc (Voco) and Luxatemp (DMG). Human gingival keratinocytes (IHGKs) were exposed to eluates of the materials and XTT assays were performed at 24 h, 48 h, 72 h, or 144 h. For quantification of the proinflammatory response, the protein amount of IL-6 and 8 was determined in the supernatants using ELISA. One-way ANOVA with post hoc analysis was used to compare differences in cell viability and IL-6 and IL-8 levels between groups.

RESULTS

At 24 h, and more remarkably at 48 h, a significant decrease in cell viability occurred for the 3D-printed materials compared to the untreated IHGKs, but also compared to Grandio disc and Luxatemp. Except for the expression of IL-8 in presence of the eluate of Grandio disc at 24 and 48 h, all tested materials caused attenuation of IL-6 and 8 from IHGKs for any observation period.

CONCLUSIONS

The materials for additive manufacturing affect cell proliferation differently than the subtractive manufactured material Grandio disc and the conventional material Luxatemp.

CLINICAL SIGNIFICANCE

In comparison to conventional and subtractive manufactured restorations, 3D printed temporary restorations might induce more negative effects on the gingival and probably also on pulpal health since viability and the proinflammatory response of oral keratinocytes are more intensively affected by these materials.

Influence of Test Specimen Geometry and Water Soaking on the In Vitro Cytotoxicity of Orthocryl®, Orthocryl® LC, Loctite® EA 9483 and Polypropylene

Depending on their composition, plastics have a cytotoxic potential that needs to be evaluated before they are used in dentistry, e.g., as orthodontic removable appliances. Relevant guidelines set out requirements that a potential new resin in the medical field must meet, with a wide scope for experimental design. In the present study, test specimens of different geometries consisting of varying polymers (Orthocryl^®, Orthocryl^® LC, Loctite^® EA 9483, Polypropylene) were soaked for different periods of time, then transferred to cell culture medium for 24 h, which was subsequently used for 24-h cultivation of A549 cells, followed by cytotoxicity assays (WST-1, Annexin V-FITC-propidium iodide (PI) flow cytometry). In this context, a reduction in the cytotoxic effect of the eluates of test specimens prepared from Orthocryl^® LC and Loctite^® EA 9483 was particularly evident in the Annexin V-FITC-PI assay when the soaking time was extended to 48 h and 168 h, respectively. Consistent with this, a reduced release of potentially toxic monomers into the cell culture medium, as measured by gas chromatography-mass spectrometry, was observed when the prior soaking time of test specimens of all geometries was extended. Remarkably, a significant increase in cytotoxic effect was observed in the WST-1 assay, which was accompanied by a higher release of monomers when the thickness of the test sample was increased from 0.5 to 1.0 mm, although an elution volume adapted to the surface area was used. However, further increasing the thickness to 3.0 mm did not lead to an increase in the observed cytotoxicity or monomer release. Test specimens made of polypropylene showed no toxicity under all test specimen sizes and soaking time conditions. Overall, it is recommended to perform toxicity studies of test specimens using different geometries and soaking times. Thereby, the influence of the different specimen thicknesses should also be considered. Finally, an extension of the test protocols proposed in ISO 10993-5:2009 should be considered, e.g., by flow cytometry or monomer analysis as well as fixed soaking times.

Polymethyl methacrylate resin for provisional restoration affects rat macrophage function in in vitro conditions

PURPOSE

This study evaluated the cytotoxic effects of polymethyl methacrylate resin extracts on rat macrophage viability in in vitro conditions.

METHODS

Prepared test specimens were immersed in 5 mL of artificial saliva and incubated for 24, 48, and 72 h at 37°C. The cytotoxicity of the obtained solutions of extracted resins, used as a stock solution (100%) and diluted with Roswell Park Memorial Institute (RPMI) medium to obtain the working solutions (50, 40, 30, 20, 10, and 5%), was evaluated using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay.

RESULTS

No dose-dependent toxic activity in macrophage culture was detected for the three types of extracts obtained after 24, 48, and 72 h of material extraction. The shortest extraction of material was found to be completely non-toxic, and the 20% concentration of this extract obtained caused a significant increase in cell ability to metabolize MTT. Extracts obtained after 72 h of extraction showed the highest cytotoxic potential of 50%, 40% and 30%, and extracts obtained after 48 and 72 h of extraction at concentrations of 5% and 10% had a proliferative effect on the macrophage cell line.

CONCLUSION

This study demonstrated that the highest cytotoxic effect was observed in cells exposed to the highest concentrations (50, 40, and 30%) of the extracts that were extracted for 72 h.

Modeling Liquids and Resin-Based Dental Composite Materials—A Scoping Review

Several lubricant materials can be used to model resin-based composites (RBCs) during restorative procedures. Clinically, instruments or brushes are wet with bonding agents (BAs) or modeling liquids (MLs) for sculpturing purposes. However, a knowledge gap exists on their effects on the mechanical properties of RBCs, requiring greater insight. Five databases were searched, including 295 in vitro studies on the use of lubricant materials for modeling RBCs during restorative procedures. Only articles in the English language were included, with no limits on the publication date. The last piece of research was dated 24 March 2022. In total, 16 studies were included in the review process, together with a paper retrieved after screening references. A total of 17 BAs and 7 MLs were investigated. Tensile (n = 5), flexural strength (n = 2), water sorption (n = 2), color stability (n = 8) and translucency (n = 3), micro-hardness (n = 4), roughness (n = 3), degree of conversion (n = 3), and monomer elution (n = 2) tests were carried out. In general, a maximum of 24 h of artificial storage was performed (n = 13), while four papers tested the specimens immediately. The present review identifies the possibilities and limitations of modeling lubricants used during restorative procedures on the mechanical, surface, and optical properties of RBCs. Clinicians should be aware that sculpturing RBCs with modeling resins might influence the composite surface properties in a way that is material-dependent.

Cytotoxicity of 3D‐printed, milled, and conventional oral splint resins to L929 cells and human gingival fibroblasts

Objectives

Evidence on the biocompatibility of three‐dimensional (3D)‐printed and milled resins for oral splints is limited. This in vitro study assessed the influence of the manufacturing method on the cytotoxicity of oral splint resins on L929 cells and human gingival fibroblasts (GF1).

Materials and Methods

Standardized specimens of four 3D‐printed, two‐milled, one‐thermoformed, and one‐pressed splint resin were incubated with L929 and GF1 cells for 24 h. Immunofluorescence and WST‐8 assay were performed to evaluate cytotoxic effects. One‐way analysis of variance and Tukey's multiple comparison test were applied with the variables “splint resin” and “manufacturing method” (p < .05).

Results

Immunofluorescence showed attachment of L929 and GF1 cells to the splint resins. Irrespective of the manufacturing method, the WST‐8 assay revealed significant differences between splint resins for the viability of L929 and GF1 cells. L929 cells generally showed lower viability rates than GF1 cells. The evaluation of cell viability by the manufacturing method showed no significant differences between 3D printing, milling, and conventional methods.

Conclusions

The cytotoxic effects of 3D‐printed, milled, and conventional oral splint resins were similar, indicating minor influence of the manufacturing method on biocompatibility. Cytotoxicity of the resins was below a critical threshold in GF1 cells. The chemical composition might be more crucial than the manufacturing method for the biocompatibility of splint resins.

Mass Spectrometry, Structural Analysis, and Anti-Inflammatory Properties of Photo-Cross-Linked Human Albumin Hydrogels

Albumin-based hydrogels offer unique benefits such as biodegradability and high binding affinity to various biomolecules, which make them suitable candidates for biomedical applications. Here, we report a non-immunogenic photocurable human serum-based (HSA) hydrogel synthesized by methacryloylation of human serum albumin by methacrylic anhydride (MAA). We used matrix-assisted laser desorption ionization-time-of-flight mass spectrometry, liquid chromatography-tandem mass spectrometry, as well as size exclusion chromatography to evaluate the extent of modification, hydrolytic and enzymatic degradation of methacrylated albumin macromer and its cross-linked hydrogels. The impacts of methacryloylation and cross-linking on alteration of inflammatory response and toxicity were evaluated in vitro using brain-derived HMC3 macrophages and Ex-Ovo chick chorioallantoic membrane assay. Results revealed that the lysines in HSA were the primary targets reacting with MAA, though modification of cysteine, threonine, serine, and tyrosine, with MAA was also confirmed. Both methacrylated HSA and its derived hydrogels were nontoxic and did not induce inflammatory pathways, while significantly reducing macrophage adhesion to the hydrogels; one of the key steps in the process of foreign body reaction to biomaterials. Cytokine and growth factor analysis showed that albumin-based hydrogels demonstrated anti-inflammatory response modulating cellular events in HMC3 macrophages. Ex-Ovo results also confirmed the biocompatibility of HSA macromer and hydrogels along with slight angiogenesis-modulating effects. Photocurable albumin hydrogels may be used as a non-immunogenic platform for various biomedical applications including passivation coatings.

Cytotoxicity of polymers intended for the extrusion-based additive manufacturing of surgical guides

Extrusion-based printing enables simplified and economic manufacturing of surgical guides for oral implant placement. Therefore, the cytotoxicity of a biocopolyester (BE) and a polypropylene (PP), intended for the fused filament fabrication of surgical guides was evaluated. For comparison, a medically certified resin based on methacrylic esters (ME) was printed by stereolithography (n = 18 each group). Human gingival keratinocytes (HGK) were exposed to eluates of the tested materials and an impedance measurement and a tetrazolium assay (MTT) were performed. Modulations in gene expression were analyzed by quantitative PCR. One-way ANOVA with post-hoc Tukey tests were applied. None of the materials exceeded the threshold for cytotoxicity (< 70% viability in MTT) according to ISO 10993-5:2009. The impedance-based cell indices for PP and BE, reflecting cell proliferation, showed little deviations from the control, while ME caused a reduction of up to 45% after 72 h. PCR analysis after 72 h revealed only marginal modulations caused by BE while PP induced a down-regulation of genes encoding for inflammation and apoptosis (p < 0.05). In contrast, the 72 h ME eluate caused an up-regulation of these genes (p < 0.01). All evaluated materials can be considered biocompatible in vitro for short-term application. However, long-term contact to ME might induce (pro-)apoptotic/(pro-)inflammatory responses in HGK.

Influence of curing modes on monomer elution, sorption and solubility of dual-cure resin-cements

OBJECTIVE

To explore the effect of two curing modes, for dual-cure resin cements, on their monomer elution, water sorption and solubility after 30 d water storage and 30 d dry reconditioning.

METHODS

Eight dual-cure resin-cements were investigated (Bifix SE, Nexus Third Generation, PANAVIA SA, PANAVIA V5, RelyX Ultimate Universal, RelyX Unicem 2, RelyX Universal and SpeedCEM Plus). Six disk-shaped specimens were made per curing mode: light-cure (LC) versus self-cure (SC) to measure amounts of eluted monomers after 30 d of water storage at 37 °C. Ultra-high performance liquid chromatography tandem mass spectrometry (UHPLC MS/MS) was performed to identify and quantify three eluted monomers (Bis-GMA, UDMA and TEGDMA). Water sorption/ solubility specimens were prepared according to ISO 4049. Specimens from each curing mode (LC/SC) were immersed separately in distilled water for 30 d and then reconditioned for 30 d; all at 37 °C. Mass change was measured at different time intervals. Data were analyzed via one-way ANOVA, Tukey post-hoc tests and independent sample t-tests (α = 0.05).

RESULTS

After 30 d of water storage, the three monomers Bis-GMA, UDMA and TEGDMA were detected in water. All monomers showed a variable extent of elution into water and were significantly higher (p < 0.0001) with SC compared to LC curing modes. BSE had the highest quantity of eluted monomers. After 30 d of water sorption (μg/mm³), all rein-cements showed significantly higher sorption (p < 0.05) of SC compared to LC curing modes except for PV5, RXU and CEM (p > 0.05). After 30 d of water solubility (μg/mm³), all resin-cements showed significantly higher solubility (p < 0.0001) of SC compared to LC curing mode. BSE had the highest water sorption and solubility. The total amounts of eluted monomers correlated positively with solubility: r² = 0.95 for LC and r² = 0.93 for SC.

SIGNIFICANCE

Whenever light access is possible, light curing remains beneficial to reduce the extent of resin degradation and related properties of dual-cure resin cements. BSE showed statistically the highest extent of eluted monomers, sorption and solubility.

The Cytotoxicity of OptiBond Solo Plus and Its Effect on Sulfur Enzymes Expression in Human Fibroblast Cell Line Hs27

The aim of the study was to determine the cytotoxic concentrations and incubation times of the commonly used dental adhesive system OptiBond Solo Plus in its non-polymerized form, and to test how it relates to oxidative stress by determining the reduced and oxidized glutathione (GSH and GSSG) levels as well as to study its influence on cell number and the expression of selected sulfur enzymes, with particular emphasis on cystathionine γ-lyase (CTH) and 3-mercaptopyruvate (MPST), sulfurtransferase. All investigations were conducted on an in vitro model of human fibroblast cell line Hs27. Changes in cellular plasma membrane integrity were measured by the LDH test. The expression levels were determined by RT-PCR and Western blot protocols. Changes in cell number were visualized using crystal violet staining. The RP-HPLC method was used to determine the GSH and GSSG levels. Reduced cell number was shown for all tested concentrations and times. Changes in the expression on the mRNA and protein level were demonstrated for CTH and MPST enzymes upon exposure to the tested range of OptiBond concentrations. Levels of low-molecular sulfur compounds of reduced and oxidized glutathione were also established. Cytotoxic effect of OptiBond Solo Plus may be connected with the changes of MPST and CTH sulfur enzymes in the human fibroblast Hs27 cell line. The elevated levels of these enzymes could possibly show the antioxidant response to this dental adhesive system. OptiBond Solo Plus in vitro results should be taken into consideration for further in vivo tests.

Cytotoxicity of Acrylic Resins, Particulate Filler Composite Resin and Thermoplastic Material in Artificial Saliva with and without Melatonin

There is limited information on the effect of melatonin on the cytotoxicity of dental materials. The study evaluated the cytotoxic effects of heat- and auto-polymerized acrylic resin, particulate filler composite resin and a thermoplastic material on L-929 fibroblast cell viability at different incubation periods in artificial saliva without and with melatonin. Disk-shaped specimens were prepared according to each manufacturer’s instructions and divided into two groups to be stored either in artificial saliva (AS) and AS with melatonin (ASM). The measurements were performed using an MTT (3-(4,5)-dimethylthiazol-2-yl)-2,5-diphenyl tetrazoliumbromide) assay, in which the L-929 mouse fibroblasts cell culture was used. For the MTT test, extracts were examined at 1, 24, 72 h and 1 and 2 weeks. Data were analyzed using 3-way ANOVA and Tukey’s tests. No significant difference was found between groups AS and ASM (F = 0.796; p = 0.373). Incubation period significantly affected all materials tested (p < 0.001). Storing resin-based materials in artificial saliva with melatonin solution for 24 h may reduce cytotoxic effects on the fibroblast cells for which the highest effect was observed. Soaking resin prosthesis or orthodontic appliances in artificial saliva with melatonin at least 24 h before intraoral use or rinsing medium containing melatonin may be recommended for decreasing the cytotoxicity of dental resin materials.

Prosthetic Materials Used for Implant-Supported Restorations and Their Biochemical Oral Interactions: A Narrative Review

The purpose of this study is to outline relevant elements regarding the biochemical interactions between prosthetic materials used for obtaining implant-supported restorations and the oral environment. Implant-supported prostheses have seen unprecedented development in recent years, benefiting from the emergence of both new prosthetic materials (with increased biocompatibility and very good mechanical behavior), and computerized manufacturing technologies, which offer predictability, accuracy, and reproducibility. On the other hand, the quality of conventional materials for obtaining implant-supported prostheses is acknowledged, as they have already proven their clinical performance. The properties of PMMA (poly (methyl methacrylate))-which is a representative interim material frequently used in prosthodontics-and of PEEK (polyether ether ketone)-a biomaterial which is placed on the border between interim and final prosthetic use-are highlighted in order to illustrate the complex way these materials interact with the oral environment. In regard to definitive prosthetic materials used for obtaining implant-supported prostheses, emphasis is placed on zirconia-based ceramics. Zirconia exhibits several distinctive advantages (excellent aesthetics, good mechanical behavior, biocompatibility), through which its clinical applicability has become increasingly wide. Zirconia's interaction with the oral environment (fibroblasts, osteoblasts, dental pulp cells, macrophages) is presented in a relevant synthesis, thus revealing its good biocompatibility.

Effect of Adhesive Resin as a Modeling Liquid on Elution of Resin Composite Restorations

Background

Adhesive resin is increasingly used as a modeling liquid for composite. Based on previous studies, elution of some components from the composite mass negatively affects the oral tissues. Since few studies have focused on the effect of adhesive resin on composite mass, this study aimed to investigate the effect of dental adhesion factors as modeling liquid on the elution of substances from composite restorations.

Materials and Methods

Sixty-four composite specimens (6 × 2 mm diameter × height) were prepared in four groups (n = 16) by using a Teflon ring. Composite mass was incrementally applied in four layers (0.5 mm). The control group contained no material between the layers, but other groups had one of the single bond, SE bond, and wetting resin adhesives between the layers. Specimens were immersed in distilled water and methanol. The amount of released triethylene glycol dimethacrylate (TEGDMA), urethane dimethacrylate (UDMA), and camphorquinone (CQ) was monitored by gas chromatography after 24 hours and 7 days. Data were analyzed with SPSS software through Kruskal–Wallis and Mann–Whitney U tests (α = 0.05).

Results

The highest rate of released TEGDMA comonomer was seen in the wetting resin group in the water medium. The highest rate of released UDMA monomer was seen in SE bond and wetting resin groups in the methanol medium after 24 hours. The highest amount of released CQ in the methanol medium was observed in the SE bond group after 7 days.

Conclusion

Single bond adhesive can be used as modeling liquid since it has no significant effect on the elution of components from composite mass. Whereas, wetting resin and SE bond adhesives are not suitable to be used as modeling liquid due to the high amounts of released TEGDMA and UDMA.

The Biological Effects of 3D Resins Used in Orthodontics: A Systematic Review

Three-dimensional (3D) resin medical-dental devices have been increasingly used in recent years after the emergence of digital technologies. In Orthodontics, therapies with aligners have gained popularity, mainly due to the aggressive promotion policies developed by the industry. However, their systemic effects are largely unknown, with few studies evaluating the systemic toxicity of these materials. The release of bisphenol A and other residual monomers have cytotoxic, genotoxic, and estrogenic effects. This systematic review aims to analyze the release of toxic substances from 3D resins used in Orthodontics and their toxic systemic effects systematically. The PICO question asked was, "Does the use of 3D resins in orthodontic devices induce cytotoxic effects or changes in estrogen levels?". The search was carried out in several databases and according to PRISMA guidelines. In vitro, in vivo, and clinical studies were included. The in vitro studies' risk of bias was assessed using the guidelines for the reporting of pre-clinical studies on dental materials by Faggion Jr. For the in vivo studies, the SYRCLE risk of bias tool was used, and for the clinical studies, the Cochrane tool. A total of 400 articles retrieved from the databases were initially scrutinized. Fourteen articles were included for qualitative analysis. The risk of bias was considered medium to high. Cytotoxic effects or estrogen levels cannot be confirmed based on the limited preliminary evidence given by in vitro studies. Evidence of the release of bisphenol A and other monomers from 3D resin devices, either in vitro or clinical studies, remains ambiguous. The few robust results in the current literature demonstrate the absolute need for further studies, especially given the possible implications for the young patient's fertility, which constitutes one of the largest groups of patients using these orthodontic devices.

Genotoxicity evaluation of medical devices: A regulatory perspective

This review critically evaluates our current regulatory understanding of genotoxicity testing and risk assessment of medical devices. Genotoxicity risk assessment of these devices begins with the evaluation of materials of construction, manufacturing additives and all residual materials for potential to induce DNA damage. This is followed by extractable and/or leachable (E&L) studies to understand the worst case and/or clinical exposures, coupled with risk assessment of extractables or leachables. The TTC (Threshold of Toxicological Concern) approach is used to define acceptable levels of genotoxic chemicals, when identified. Where appropriate, in silico predictions may be used to evaluate the genotoxic potentials of identifiable chemicals with limited toxicological data and above the levels defined by TTC. Devices that could not be supported by E&L studies are evaluated by in vitro genotoxicity studies conducted in accordance with ISO10993-3 and 33. Certain endpoints such as 'site of contact genotoxicity' that are specific for certain classes of medical devices are currently not addressed in the current standards. The review also illustrates the potential uses of recent advances to achieve the goal of robust genotoxicity assessment of medical devices which are being increasingly used for health benefits. The review also highlights the gaps for genotoxicity risk assessment of medical devices and suggests possible approaches to address them taking into consideration the recent advances in genotoxicity testing including their potential uses in biocompatibility assessment.

Characteristics of a novel photoinitiator aceanthrenequinone-initiated polymerization and cytocompatibility of its triggered polymer

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AATQ is a novel photosensitizer with high-photoinitiating conversion efficiency at a relatively low concentration under 455 nm-blue light.

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Cytotoxicity of AATQ to different tissue types of cells is much lower than widely used-BAPO.

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Cytocompatibility of AATQ-initiated polymer is significantly superior to PANQ, but inferior to CQ.

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AATQ offers an alternative in industrial or biomedical areas, especially in the required low concentration of photoinitiators.

A number of photoinitiators are available in chemical industry, but less of them in biomedicine or clinical therapy due to the limitation of their cytotoxicity and biocompatibility. Thus, it is urgently necessary to find non-toxic or low-toxic photoinitiators to meet clinical demands. Aceanthrenequinone (AATQ) is a novel photosensitizer with high-photoinitiating ability, but no reports contribute, to date, to its cytotoxicity and biocompatibility. Here, primary cells and various cell lines were exposed to different concentrations of AATQ with or without irradiation. AATQ had the similar photoinitiating conversion efficiency to the extensively used bis(2,4,6-trimethylbenzoyl)-phenylphosphine oxide (BAPO) and higher one than 9,10-phenanthrenequinone (PANQ) with the similar extent of polymerization in depth within a certain range, but displayed much lower cytotoxicity than BAPO under non-irradiation or irradiation. The biocompatibility of BisGMA/TEGDMA polymer prepared by AATQ was superior to that of PANQ, but inferior to that of camphorquinone (CQ) although the far lower dose of AATQ is enough to initiate polymerization of monomer than that of CQ. Hence, AATQ offers a valuable alternative in applications of industrial or biomedical areas.

Cytotoxicity of two self-adhesive resin cements and their interference in the phagocytic activity of murine macrophages

Objectives

This study aimed to evaluate in vitro the effects of the self-adhesive resin cements RelyX U200 (3M ESPE) and seT PP (SDI Limited) on murine macrophages and the interference of the photoactivation.

Materials and Methods

Cell viability assays, cell adherence, yeast phagocytosis of Saccharomyces boulardii and production of reactive oxygen species (ROS) were performed in the presence of capillaries containing the respective self-adhesive cement when photoactivated or not.

Results

After long periods of contact, both types of cements, when not photoactivated, are more cytotoxic for macrophages. The seT PP cement when only chemically activated seems to interfere more negatively in the process of phagocytosis of yeasts S. boulardii. Both types of cements interfere in the cell adhesion process, independent of photoactivation. None of the types of cements tested was able to induce the production of ROS.

Conclusions

Our results highlight the great importance of the photoactivation of self-adhesive resin cements in the dental clinic, since RelyX U200, when photoactivated, presented the best results within the evaluated parameters.