Emerging Contact-Killing Antibacterial Strategies for Developing Anti-Biofilm Dental Polymeric Restorative Materials

A novel zwitterion incorporated Nano-crystalline ceramic and polymer for bacterial resistant dental CAD-CAM block

OBJECTIVES

To create bacteria-resistant dental CAD-CAM blocks with a biofilm-resistant effect by incorporating Nano-crystalline ceramic and polymer (NCP) with 2-methacryloyloxyethyl phosphorylcholine (MPC) and sulfobetaine methacrylate (SBMA) and at an equimolar ratio, referred to as MS.

METHODS

Experimental groups comprised NCP blocks containing zwitterions at 0.15wt% (MS015) and 0.45wt% (MS045). NCP blocks without MS served as control (CTRL). Flexural strength, surface hardness, water sorption and solubility, photometric properties, and cytotoxicity were assessed for all samples. Additionally, the resistance to single and multi-species bacterial adhesion was investigated.

RESULTS

MS045 showed significant reduction in flexural strength (P < 0.01) compared to both CTRL and MS015. Both MS015 and MS045 showed significantly increased water sorption and significant reduction in water solubility compared to CTRL. Light transmission remained consistent across all MS content levels, but the irradiance value decreased by 12 % in the MS045 group compared to the MS015 group. Notably, compared to the CTRL group, the MS015 group exhibited enhanced resistance to adhesion by Porphyromonas gingivalis and a multi-species salivary biofilm, with biofilm thickness and biomass reduced by 45 % and 56 %, respectively.

CONCLUSIONS

NCP containing 0.15 % MS can effectively reduce adhesion of multiple species of bacteria while maintaining physical and mechanical properties.

CLINICAL SIGNIFICANCE

NCP integrating zwitterions is clinically advantageous in resisting bacterial adhesion at internal and external margins of milled indirect restoration.

Recent Advances in Antibacterial Coatings to Combat Orthopedic Implant-Associated Infections

Implant-associated infections (IAIs) represent a major health burden due to the complex structural features of biofilms and their inherent tolerance to antimicrobial agents and the immune system. Thus, the viable options to eradicate biofilms embedded on medical implants are surgical operations and long-term and repeated antibiotic courses. Recent years have witnessed a growing interest in the development of robust and reliable strategies for prevention and treatment of IAIs. In particular, it seems promising to develop materials with anti-biofouling and antibacterial properties for combating IAIs on implants. In this contribution, we exclusively focus on recent advances in the development of modified and functionalized implant surfaces for inhibiting bacterial attachment and eventually biofilm formation on orthopedic implants. Further, we highlight recent progress in the development of antibacterial coatings (including self-assembled nanocoatings) for preventing biofilm formation on orthopedic implants. Among the recently introduced approaches for development of efficient and durable antibacterial coatings, we focus on the use of safe and biocompatible materials with excellent antibacterial activities for local delivery of combinatorial antimicrobial agents for preventing and treating IAIs and overcoming antimicrobial resistance.

Testing mechanical properties and degree of conversion of resin-based composite material containing contact killing antibacterial agent in comparison with fluoride composite resin

Background

A major drawback of resin composites is their tendency to accumulate microbial biofilms that can lead to secondary caries. The objective of this study was to compare the mechanical properties and the degree of conversion of commercial resin-based composite materials containing a contact-killing antibacterial agent, dimethylaminohexadecyl methacrylate (DMAHDM), at different concentrations, with a fluoride-releasing composite material.

Materials and methods

Four groups were tested: Tetric N Ceram composite material (G1), Tetric Evo Ceram (G2), and Tetric N Ceram with the addition of contact-killing antibacterial agent DMAHDM at concentrations of 3% (G3) and 5% (G4). The mechanical properties, including flexural strength, elastic modulus, and Vickers microhardness and the degree of conversion were investigated.

Results

Adding 3 % and 5 % DMAHDM resulted in flexural strength values that were comparable to Tetric Evo Ceram. Tetric N Ceram was comparable to the group containing 3 % DMAHDM (p > 0.05). However, it was significantly greater when compared to Tetric Evo Ceram (93.3 ± 9.4) and 5 % DMAHDM (p < 0.05). Both the elastic modulus and Vickers microhardness values of Tetric N Ceram were significantly higher than those of the other groups (p < 0.05). Furthermore, the elastic modulus of Tetric Evo Ceram showed similar results to groups with 3 % and 5 % DMAHDM. Nevertheless, the Vickers microhardness value is significantly higher when compared to 5 % DMAHDM (0.394 ± 0.021) (p < 0.05) while it was comparable to that of 3 % DMAHDM (0.484 ± 0.016) (p > 0.05). There was no statistically significant difference in the degree of conversion between the groups (p > 0.05).

Conclusion

Adding 3% DMAHDM to Tetric N Ceram resulted in flexural strength values that were similar to those of Tetric N Ceram and Tetric Evo Ceram. DMAHDM did not affect the degree of conversion of Tetric N Ceram composite.

Characteristics and Key Features of Antimicrobial Materials and Associated Mechanisms for Diverse Applications

Since the Fourth Industrial Revolution, three-dimensional (3D) printing has become a game changer in manufacturing, particularly in bioengineering, integrating complex medical devices and tools with high precision, short operation times, and low cost. Antimicrobial materials are a promising alternative for combating the emergence of unforeseen illnesses and device-related infections. Natural antimicrobial materials, surface-treated biomaterials, and biomaterials incorporated with antimicrobial materials are extensively used to develop 3D-printed products. This review discusses the antimicrobial mechanisms of different materials by providing examples of the most commonly used antimicrobial materials in bioengineering and brief descriptions of their properties and biomedical applications. This review will help researchers to choose suitable antimicrobial agents for developing high-efficiency biomaterials for potential applications in medical devices, packaging materials, biomedical applications, and many more.

Norlobaridone Inhibits Quorum Sensing-Dependent Biofilm Formation and Some Virulence Factors in Pseudomonas aeruginosa by Disrupting Its Transcriptional Activator Protein LasR Dimerization

In the present study, norlobaridone (NBD) was isolated from Parmotrema and then evaluated as a new potent quorum sensing (QS) inhibitor against Pseudomonas aeruginosa biofilm development. This phenolic natural product was found to reduce P. aeruginosa biofilm formation (64.6% inhibition) and its related virulence factors, such as pyocyanin and rhamnolipids (% inhibition = 61.1% and 55%, respectively). In vitro assays inhibitory effects against a number of known LuxR-type receptors revealed that NBD was able to specifically block P. aeruginosa's LasR in a dose-dependent manner. Further molecular studies (e.g., sedimentation velocity and thermal shift assays) demonstrated that NBD destabilized LasR upon binding and damaged its functional quaternary structure (i.e., the functional dimeric form). The use of modelling and molecular dynamics (MD) simulations also allowed us to further understand its interaction with LasR, and how this can disrupt its dimeric form. Finally, our findings show that NBD is a powerful and specific LasR antagonist that should be widely employed as a chemical probe in QS of P. aeruginosa, providing new insights into LasR antagonism processes. The new discoveries shed light on the mysterious world of LuxR-type QS in this key opportunistic pathogen.

The germicidal effect, biosafety and mechanical properties of antibacterial resin composite in cavity filling

In recent years, dental resin materials have become increasingly popular for cavity filling. However, these materials can shrink during polymerization, leading to microleakages that enable bacteria to erode tooth tissue and cause secondary caries. As a result, there is great clinical demand for the development of antibacterial resins. The principle of antibacterial resin includes contact killing and filler-release killing of bacteria. For contact killing, quaternary ammonium salts (QACs) and antibacterial peptides (AMPs) can be added. For filler-release killing, chlorhexidine (CHX) and nanoparticles are used. These antibacterial agents are effective against gram-positive bacteria, gram-negative bacteria, fungi, and more. Among them, QACs has a lasting antibacterial effect, and silver nanoparticles even have a certain ability to kill viruses. Biocompatibility-wise, QACs, AMPs, and CHX have low cytotoxicity to cells when added into the resin. However, nanoparticles with smaller particle sizes have higher cytotoxicity. In terms of mechanical properties, QACs, AMPs, and CHX do not negatively affect the resin. However, the addition of magnesium oxide can have a negative impact. This paper reviews the types and antibacterial principles of commonly used antibacterial resins in recent years, evaluates their antibacterial effect, biological safety, and mechanical properties, and provides references for selecting clinical filling materials.

Current antibacterial agents in dental bonding systems: a comprehensive overview

Dental caries is mainly caused by oral biofilm acid, and the most common dental restoration treatment is composite dental restorations. The main cause of failure is secondary caries adjacent to the restoration. Long-term survival of dental materials is improved by the presence of antibacterial agents, which selectively inhibit bacterial growth or survival. Chemical, natural and biomaterials have been studied for their antimicrobial activities and antibacterial bonding agents have been improved. Their usage has been increased to inhibit the growth of invading and residual bacteria in the oral cavity, as biofilm accumulation increases the risk of treatment failure. In this article, the success and applications of antibacterial agents are discussed in dental bonding systems.

Smart dental materials for antimicrobial applications

Smart biomaterials can sense and react to physiological or external environmental stimuli (e.g., mechanical, chemical, electrical, or magnetic signals). The last decades have seen exponential growth in the use and development of smart dental biomaterials for antimicrobial applications in dentistry. These biomaterial systems offer improved efficacy and controllable bio-functionalities to prevent infections and extend the longevity of dental devices. This review article presents the current state-of-the-art of design, evaluation, advantages, and limitations of bioactive and stimuli-responsive and autonomous dental materials for antimicrobial applications. First, the importance and classification of smart biomaterials are discussed. Second, the categories of bioresponsive antibacterial dental materials are systematically itemized based on different stimuli, including pH, enzymes, light, magnetic field, and vibrations. For each category, their antimicrobial mechanism, applications, and examples are discussed. Finally, we examined the limitations and obstacles required to develop clinically relevant applications of these appealing technologies.

Inorganic Compounds as Remineralizing Fillers in Dental Restorative Materials: Narrative Review

Secondary caries is one of the leading causes of resin-based dental restoration failure. It is initiated at the interface of an existing restoration and the restored tooth surface. It is mainly caused by an imbalance between two processes of mineral loss (demineralization) and mineral gain (remineralization). A plethora of evidence has explored incorporating several bioactive compounds into resin-based materials to prevent bacterial biofilm attachment and the onset of the disease. In this review, the most recent advances in the design of remineralizing compounds and their functionalization to different resin-based materials' formulations were overviewed. Inorganic compounds, such as nano-sized amorphous calcium phosphate (NACP), calcium fluoride (CaF₂), bioactive glass (BAG), hydroxyapatite (HA), fluorapatite (FA), and boron nitride (BN), displayed promising results concerning remineralization, and direct and indirect impact on biofilm growth. The effects of these compounds varied based on these compounds' structure, the incorporated amount or percentage, and the intended clinical application. The remineralizing effects were presented as direct effects, such as an increase in the mineral content of the dental tissue, or indirect effects, such as an increase in the pH around the material. In some of the reported investigations, inorganic remineralizing compounds were combined with other bioactive agents, such as quaternary ammonium compounds (QACs), to maximize the remineralization outcomes and the antibacterial action against the cariogenic biofilms. The reviewed literature was mainly based on laboratory studies, highlighting the need to shift more toward testing the performance of these remineralizing compounds in clinical settings.

Multifunctional antibacterial chitosan-based hydrogel coatings on Ti6Al4V biomaterial for biomedical implant applications

Among biomedical community, great efforts have been realized to develop antibacterial coatings that avoid implant-associated infections. To date, conventional mono-functional antibacterial strategies have not been effective enough for successful long-term implantations. Consequently, researchers have recently focused their attention on novel bifunctional or multifunctional antibacterial coatings, in which two or more antibacterial mechanisms interact synergistically. Thus, in this work different chitosan-based (CHI) hydrogel coatings were created on Ti6Al4V surface using genipin (Ti-CHIGP) and polyethylene glycol (Ti-CHIPEG) crosslinking agents. Hydrogel coatings demonstrated an exceptional in vivo biocompatibility plus a remarkable ability to promote cell proliferation and differentiation. Lastly, hydrogel coatings demonstrated an outstanding bacteria-repelling (17-28 % of S. aureus and 33-43 % of E. coli repelled) and contact killing (186-222 % of S. aureus and 72-83 % of E. coli damaged) ability. Such bifunctional antibacterial activity could be further improved by the controlled release of drugs resulting in powerful multifunctional antibacterial coatings.

Promising Antimicrobial Action of Sustained Released Curcumin-Loaded Silica Nanoparticles against Clinically Isolated Porphyromonas gingivalis

BACKGROUND

Porphyromonas gingivalis (P. gingivalis) has always been one of the leading causes of periodontal disease, and antibiotics are commonly used to control it. Numerous side effects of synthetic drugs, as well as the spread of drug resistance, have led to a tendency toward using natural antimicrobials, such as curcumin. The present study aimed to prepare and physicochemically characterize curcumin-loaded silica nanoparticles and to detect their antimicrobial effects on P. gingivalis.

METHODS

Curcumin-loaded silica nanoparticles were prepared using the chemical precipitation method and then were characterized using conventional methods (properties such as the particle size, drug loading percentage, and release pattern). P. gingivalis was isolated from one patient with chronic periodontal diseases. The patient's gingival crevice fluid was sampled using sterile filter paper and was transferred to the microbiology laboratory in less than 30 min. The disk diffusion method was used to determine the sensitivity of clinically isolated P. gingivalis to curcumin-loaded silica nanoparticles. SPSS software, version 20, was used to compare the data between groups with a p value of <0.05 as the level of significance. Then, one-way ANOVA testing was utilized to compare the groups.

RESULTS

The curcumin-loaded silica nanoparticles showed a nanometric size and a drug loading percentage of 68% for curcumin. The nanoparticles had a mesoporous structure and rod-shaped morphology. They showed a relatively rapid release pattern in the first 5 days. The release of the drug from the nanoparticles continued slowly until the 45th day. The results of in vitro antimicrobial tests showed that P. gingivalis was sensitive to the curcumin-loaded silica nanoparticles at concentrations of 50, 25, 12.5, and 6.25 µg/mL. One-way ANOVA showed that there was a significant difference between the mean growth inhibition zone, and the concentration of 50 µg/mL showed the highest inhibition zone (p ≤ 0.05).

CONCLUSION

Based on the obtained results, it can be concluded that the local nanocurcumin application for periodontal disease and implant-related infections can be considered a promising method for the near future in dentistry.

Prospects on Tuning Bioactive and Antimicrobial Denture Base Resin Materials: A Narrative Review

Denture base resin (DBR) materials are used in dentistry in constructing removable dentures and implant-supported prostheses. A plethora of evidence has demonstrated that DBR materials are associated with a high risk of denture stomatitis, a clinical complication where the soft oral tissues underneath the resin-based material are inflamed. The prevalence of denture stomatitis among denture wearers is high worldwide. Plaque accumulation and the infiltration of oral microbes into DBRs are among the main risk factors for denture stomatitis. The attachment of fungal species, mainly Candida albicans, to DBRs can irritate the underneath soft tissues, leading to the onset of the disease. As a result, several attempts were achieved to functionalize antimicrobial compounds and particles into DBRs to prevent microbial attachment. This review article explored the advanced approaches in designing bioactive and antimicrobial DBR materials. It was reported that using monomer mixtures, quaternary ammonium compounds (QACs), and organic and inorganic particles can suppress the growth of denture stomatitis-related pathogens. This paper also highlighted the importance of characterizing bioactive DBRs to be mechanically and physically sustainable. Future directions may implement a clinical translational model to attempt these materials inside the oral cavity.

Bioactive Materials for Next-Generation Dentistry

Teeth were some of the first organs whose function was effectively restored by inert refilling materials that have become widely known to the general public; amalgams, polymeric resin composites, and gutta-percha are some such examples [...].

Novel Dental Restorative Solutions for Natural Teeth and Implants

The long-term survival of restorations in the oral cavity has always been one of the most significant challenges in modern dental practice [...].

Current Strategies to Control Recurrent and Residual Caries with Resin Composite Restorations: Operator- and Material-Related Factors

This review addresses the rationale of recurrent and/or residual caries associated with resin composite restorations alongside current strategies and evidence-based recommendations to arrest residual caries and restrain recurrent caries. The PubMed and MEDLINE databases were searched for composite-associated recurrent/residual caries focusing on predisposing factors related to materials and operator’s skills; patient-related factors were out of scope. Recurrent caries and fractures are the main reasons for the failure of resin composites. Recurrent and residual caries are evaluated differently with no exact distinguishment, especially for wall lesions. Recurrent caries correlates to patient factors, the operator’s skills of cavity preparation, and material selection and insertion. Material-related factors are significant. Strong evidence validates the minimally invasive management of deep caries, with concerns regarding residual infected dentin. Promising technologies promote resin composites with antibacterial and remineralizing potentials. Insertion techniques influence adaptation, marginal seal, and proximal contact tightness. A reliable diagnostic method for recurrent or residual caries is urgently required. Ongoing endeavors cannot eliminate recurrent caries or precisely validate residual caries. The operator’s responsibility to precisely diagnose original caries and remaining tooth structure, consider oral environmental conditions, accurately prepare cavities, and select and apply restorative materials are integral aspects. Recurrent caries around composites requires a triad of attention where the operator’s skills are cornerstones.

Chitosan and its application in dental implantology

OBJECTIVE

The aim of this review was to evaluate the properties of chitosan for an application in dental implantology.

METHODS

Electronic Databases: PubMed, Google Scholar, Scopus, were used to recherche the articles published from 2010 to 2021. The keywords used were: chitosan, biocompatible, antibacterial, osseointegration, implant, bioactive. After a carefully selection according to the above keywords 46 articles met the condition to be studied RESULTS: Chitosan is a biopolymer, that can be easy produced. Its antibacterial, anti-inflammatory, anti-fugal, hemostatic, analgesic, mucoadhesive, osseointegrative properties and its excellent film-forming ability make chitosan a material with a future in dental implantology and in other areas of dental applications. Titan implants coated with chitosan showed better bioactive properties than uncoated implants. The treatment of the implant surface played an important role on the stability of implants. The activity of osteoblasts increased when the surface was laser-treated followed by coating with chitosan. The subsequent coating with apatite improved the bioactivity of chitosan.

CONCLUSION

Chitosan is a promising biocompatible and bioactive material in dental implantology. Its antibacterial properties can be enhanced by modification of its structure. Its bioactive properties can be improved when mixing with hydroxy apatite.

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.

Effects of thermal cycling on mechanical and antibacterial durability of bioactive low-shrinkage-stress nanocomposite

OBJECTIVES

Recent studies developed low-shrinkage-stress composite with remineralizing and antibacterial properties to combat secondary caries and increase restoration longevity. However, their long-term durability in thermal cycling is unclear. The objectives of this study were to develop an antibacterial, remineralizing and low-shrinkage-stress composite, and to investigate its durability in thermal cycling for 20,000 cycles, equivalent to two years of clinical life.

METHODS

The resin consisted of urethane dimethacrylate (UDMA) and triethylene glycol divinylbenzyl ether (TEG-DVBE). Composites were made with 5% dimethylaminohexadecyl methacrylate (DMAHDM) and 20% of nanoparticles of amorphous calcium phosphate (NACP). Composites were thermal cycled at 5°C and 55°C for 20,000 cycles. A human salivary biofilm model was used to evaluate antibiofilm activity before and after thermal cycling.

RESULTS

After 20,000 cycles, the flexural strength of bioactive low-shrinkage-stress composite matched commercial control with no antibacterial activity (p > 0.05). Surface roughness was clinically acceptable at less than 0.2 μm. UV+NACP+DMAHDM composite reduced the total microorganisms, total streptococci, and mutans streptococci by 2-5 logs, compared to commercial composite. Biofilm lactic acid production was reduced by 11 folds. The antibacterial performance was maintained after thermal cycling, with no decrease after 20,000 cycles.

CONCLUSIONS

Bioactive low-shrinkage-stress composite possessed good mechanical properties that matched commercial composite both before and after thermal cycling. The new composite had potent antibacterial activity, which was maintained and did not decrease after thermal cycling.

CLINICAL SIGNIFICANCE

The new bioactive low-shrinkage-stress composite could reduce polymerization shrinkage stress and release calcium and phosphate ions, with good mechanical properties and strong antibacterial function that were durable after thermal cycling. These properties indicate great potential for inhibiting recurrent caries and increasing the restoration longevity.

Cold Spray: Over 30 Years of Development Toward a Hot Future

Cold Spray (CS) is a deposition process, part of the thermal spray family. In this method, powder particles are accelerated at supersonic speed within a nozzle; impacts against a substrate material triggers a complex process, ultimately leading to consolidation and bonding. CS, in its modern form, has been around for approximately 30 years and has undergone through exciting and unprecedented developmental steps. In this article, we have summarized the key inventions and sub-inventions which pioneered the innovation aspect to the process that is known today, and the key breakthroughs related to the processing of materials CS is currently mastering. CS has not followed a liner path since its invention, but an evolution more similar to a hype cycle: high initial growth of expectations, followed by a decrease in interest and a renewed thrust pushed by a number of demonstrated industrial applications. The process interest is expected to continue (gently) to grow, alongside with further development of equipment and feedstock materials specific for CS processing. A number of current applications have been identified the areas that the process is likely to be the most disruptive in the medium-long term future have been laid down.

Ceragenin CSA-44 as a Means to Control the Formation of the Biofilm on the Surface of Tooth and Composite Fillings

Recurrent oral infections, as manifested by endodontic and periodontal disease, are often caused by Enterococcus faecalis (E. faecalis) and Candida albicans (C. albicans). Here, we assessed the anti-biofilm activity of ceragenin CSA-44 against these microbes growing as a biofilm in the presence of saliva on the surface of human teeth and dental composite (composite filling) subjected to mechanical stresses. Methods: Biofilm mass analysis was performed using crystal violet (CV) staining. The morphology, viscoelastic properties of the biofilm after CSA-44 treatment, and changes in the surface of the composite in response to biofilm presence were determined by AFM microscopy. Results: CSA-44 prevented biofilm formation and reduced the mass of biofilm formed by tested microorganisms on teeth and dental composite. Conclusion: The ability of CSA-44 to prevent the formation and to reduce the presence of established biofilm on tooth and composite filling suggests that it can serve as an agent in the development of new methods of combating oral pathogens and reduce the severity of oral infections.

Magnetic-Responsive Photosensitizer Nanoplatform for Optimized Inactivation of Dental Caries-Related Biofilms: Technology Development and Proof of Principle

Conventional antibiotic therapies for biofilm-trigged oral diseases are becoming less efficient due to the emergence of antibiotic-resistant bacterial strains. Antimicrobial photodynamic therapy (aPDT) is hampered by restricted access to bacterial communities embedded within the dense extracellular matrix of mature biofilms. Herein, a versatile photosensitizer nanoplatform (named MagTBO) was designed to overcome this obstacle by integrating toluidine-blue ortho (TBO) photosensitizer and superparamagnetic iron oxide nanoparticles (SPIONs) via a microemulsion method. In this study, we reported the preparation, characterization, and application of MagTBO for aPDT. In the presence of an external magnetic field, the MagTBO microemulsion can be driven and penetrate deep sites inside the biofilms, resulting in an improved photodynamic disinfection effect compared to using TBO alone. Besides, the obtained MagTBO microemulsions revealed excellent water solubility and stability over time, enhanced the aPDT performance against S. mutans and saliva-derived multispecies biofilms, and improved the TBO's biocompatibility. Such results demonstrate a proof-of-principle for using microemulsion as a delivery vehicle and magnetic field as a navigation approach to intensify the antibacterial action of currently available photosensitizers, leading to efficient modulation of pathogenic oral biofilms.

Errors in light-emitting diodes positioning when curing bulk fill and incremental composites: impact on properties after aging

Objectives

This study aimed to evaluate the effect of improper positioning single-peak and multi-peak lights on color change, microhardness of bottom and top, and surface topography of bulk fill and incremental composites after artificial aging for 1 year.

Materials and Methods

Bulk fill and incremental composites were cured using multi-peak and single-peak light-emitting diode (LED) following 4 clinical conditions: (1) optimal condition (no angulation or tip displacement), (2) tip-displacement (2 mm), (3) slight tip angulation (α = 20°) and (4) moderate tip angulation (α = 35°). After 1-year of water aging, the specimens were analyzed for color changes (ΔE), Vickers hardness, surface topography (Ra, Rt, and Rv), and scanning electron microscopy.

Results

For samples cured by single-peak LED, the improper positioning significantly increases the color change compared to the optimal position regardless of the type of composite (p < 0.001). For multi-peak LED, the type of resin composite and the curing condition displayed a significant effect on ΔE (p < 0.001). For both LEDs, the Vickers hardness and bottom/top ratio of Vickers hardness were affected by the type of composite and the curing condition (p < 0.01).

Conclusions

The bulk fill composite presented greater resistance to wear, higher color stability, and better microhardness than the incremental composite when subjected to improper curing. The multi-peak LED improves curing under improper conditions compared to single-peak LED. Prevention of errors when curing composites requires the attention of all personnel involved in the patient's care once the clinical relevance of the appropriate polymerization reflects on reliable long-term outcomes.

Surface Modification to Modulate Microbial Biofilms-Applications in Dental Medicine

Recent progress in materials science and nanotechnology has led to the development of advanced materials with multifunctional properties. Dental medicine has benefited from the design of such materials and coatings in providing patients with tailored implants and improved materials for restorative and functional use. Such materials and coatings allow for better acceptance by the host body, promote successful implantation and determine a reduced inflammatory response after contact with the materials. Since numerous dental pathologies are influenced by the presence and activity of some pathogenic microorganisms, novel materials are needed to overcome this challenge as well. This paper aimed to reveal and discuss the most recent and innovative progress made in the field of materials surface modification in terms of microbial attachment inhibition and biofilm formation, with a direct impact on dental medicine.

Metal Oxide Nanoparticles and Nanotubes: Ultrasmall Nanostructures to Engineer Antibacterial and Improved Dental Adhesives and Composites

Advances in nanotechnology have unlocked exclusive and relevant capabilities that are being applied to develop new dental restorative materials. Metal oxide nanoparticles and nanotubes perform functions relevant to a range of dental purposes beyond the traditional role of filler reinforcement-they can release ions from their inorganic compounds damaging oral pathogens, deliver calcium phosphate compounds, provide contrast during imaging, protect dental tissues during a bacterial acid attack, and improve the mineral content of the bonding interface. These capabilities make metal oxide nanoparticles and nanotubes useful for dental adhesives and composites, as these materials are the most used restorative materials in daily dental practice for tooth restorations. Secondary caries and material fractures have been recognized as the most common routes for the failure of composite restorations and bonding interface in the clinical setting. This review covers the significant capabilities of metal oxide nanoparticles and nanotubes incorporated into dental adhesives and composites, focusing on the novel benefits of antibacterial properties and how they relate to their translational applications in restorative dentistry. We pay close attention to how the development of contemporary antibacterial dental materials requires extensive interdisciplinary collaboration to accomplish particular and complex biological tasks to tackle secondary caries. We complement our discussion of dental adhesives and composites containing metal oxide nanoparticles and nanotubes with considerations needed for clinical application. We anticipate that readers will gain a complete picture of the expansive possibilities of using metal oxide nanoparticles and nanotubes to develop new dental materials and inspire further interdisciplinary development in this area.

Ionotronic Tough Adhesives with Intrinsic Multifunctionality

Ionotronic hydrogels find wide applications in flexible electronics, wearable/implantable devices, soft robotics, and human-machine interfaces. Their performance and practical translation have been bottlenecked by poor adhesiveness, limited mechanical properties, and the lack of biological functions. The remedies are often associated with complex formulations and sophisticated processing. Here, we report a rational design and facile synthesis of ionotronic tough adhesives (i-TAs), which have excellent mechanical, physical, electrical, and biological properties and promise high scalability and translational potential. They consist of an interpenetrating network with high-density amine groups and highly mobile chains, which enable intrinsic adhesiveness, self-healing, ionic stability, cytocompatibility, and antimicrobial functions. The i-TAs in both pristine and swollen states possess high toughness, stretchability, and strong adhesion to diverse substrates such as tissues and elastomers. The superior mechanical performance is achieved simultaneously with high ionic conductivity and stability in electrolyte solutions. We further demonstrate the use of i-TAs as wearable devices, strain sensors, and sensory sealants. This work is expected to open avenues for new ionotronics with novel functions and stimulate the development and translation of ionotronics.

Improper Light Curing of Bulkfill Composite Drives Surface Changes and Increases S. mutans Biofilm Growth as a Pathway for Higher Risk of Recurrent Caries around Restorations

How dentists cure a resin-based material has deleterious effects on the material's properties and its interaction with surrounding dental tissues. Biofilm accumulation has been implicated in the pathogenesis of carious lesions around dental restorations, with its composition manifesting expressed dysbiosis in patients suffering from dental caries. To evaluate the influence of varying radiant exposure on the degree of conversion (DC%), Streptococcus mutans biofilm growth, and surface roughness of bulk-fill composites under different light-curing conditions. Two light-curing units (LCU) at 600 and 1000 mW/cm² were used to simulate curing conditions with different angulations (∢20° and ∢35°) or 2 mm-distance displacements of the LCU tip. The radiant exposure (RE) was assessed, and the composites were analyzed for DC%. Biofilm formation was induced over the bulk-fill composites and analyzed via colony-forming units counting and scanning electron microscopy (SEM). The surface roughness was analyzed via a profilometer and SEM after biofilm formation. Curing conditions with different angulation or displacement decreased RE compared to the "optimal condition". The moderately (∢35°) angulated LCU tip and low (600 mW/cm²) radiant emittance significantly reduced the DC% (p < 0.05). The difference in DC% between the top and bottom of the composites ranged from 8 to 11% for 600 mW/cm² and 10 to 20% for 1000 mW/cm². Greater S. mutans biofilm and surface changes were found in composites with non-optimal RE delivery (e.g., tip displacement and angulation) (p < 0.05). Inadequate polymerization of bulk-fill composites was associated with more biofilm accumulation and surface topography changes. Overall, non-optimally performed curing procedures reduced the amount of delivered RE, which led to low DC%, more biofilm formation, and higher surface roughness. The improper light-curing of bulk-fill composites compromises their physicochemical and biological properties, which could lead to inferior clinical performance and reduced restorative treatments' longevity.

A Review on Current Trends of Polymers in Orthodontics: BPA-Free and Smart Materials

Polymeric materials have always established an edge over other classes of materials due to their potential applications in various fields of biomedical engineering. Orthodontics is an emerging field in which polymers have attracted the enormous attention of researchers. In particular, thermoplastic materials have a great future utility in orthodontics, both as aligners and as retainer appliances. In recent years, the use of polycarbonate brackets and base monomers bisphenol A glycerolate dimethacrylate (bis-GMA) has been associated with the potential release of bisphenol A (BPA) in the oral environment. BPA is a toxic compound that acts as an endocrine disruptor that can affect human health. Therefore, there is a continuous search for non-BPA materials with satisfactory mechanical properties and an esthetic appearance as an alternative to polycarbonate brackets and conventional bis-GMA compounds. This study aims to review the recent developments of BPA-free monomers in the application of resin dental composites and adhesives. The most promising polymeric smart materials are also discussed for their relevance to future orthodontic applications.

Sustained Antibacterial Effect and Wear Behavior of Quaternary Ammonium Contact-Killing Dental Polymers after One-Year of Hydrolytic Degradation

This study intended to investigate the long-term antibacterial effect, mechanical performance, and surface topography of new anticaries dental composites. While most artificial aging studies of dental resins lasted for 30–90 days, this study prolonged the water-aging to one year to be more clinically relevant. The base resin was loaded with dimethylaminohexadecyl methacrylate (DMAHDM) at 3 or 5 wt.% and nano-sized amorphous calcium phosphate (NACP) at 20 wt.%. Composites were subjected to one-year water storage and wear. Following water aging, samples were evaluated for flexural strength, elastic modulus, and microbiological assays. Biofilm plate counting method, metabolic assay, colorimetric quantification of lactic acid, and Baclight bacterial viability assay were measured after one year. Topography changes (ΔRa, ΔRq, ΔRv, ΔRt) were examined after wear and observed by scanning electron microscopy. Biofilm assays and topography changes data were analyzed via one-way ANOVA and Tukey’s tests. Mechanical properties and normalized data were verified using a t-test. The flexural strength values for the formulations that contained 5% DMAHDM-20% NACP, 3% DMAHDM, and 5% DMAHDM were reduced significantly (p < 0.05) in relation to the baseline but the values were still above the ISO standards. No significant differences were observed between the groups concerning the topography changes, except for the ΔRt, where there was a significant increase in the 5% DMAHDM-20% NACP group. All the groups demonstrated robust biofilm-inhibition, with slightly reduced antibacterial properties following water aging. The aged samples reduced the total microorganisms, total streptococci, and mutans streptococci by 1.5 to 3-log, compared to the experimental control. The new formulations containing DMAHDM and NACP were able to sustain the antibacterial performance after one-year of aging. Mechanical properties and surface topography were slightly affected over time.

Synthesis and antibacterial activity of polymer-antibiotic conjugates incorporated into a resin-based dental adhesive

This work reports on polymer-antibiotic conjugates (PACs) as additives to resin-based restorative dental materials as a new strategy to convey sustained antibacterial character to these materials. Such antibacterial performance is expected to improve their longevity in the oral cavity. Using the previously reported ciprofloxacin (Cip)-based PAC as a control, a penicillin V (PV)-based PAC was investigated. The monomer-antibiotic conjugate (MAC) containing a methacrylate monomer group and a PV moiety was prepared via nucleophilic substitution between 2-chloroethyl methacrylate (CEMA) and penicillin V potassium (PVK). The PV-based PAC was synthesized by reversible addition-fragmentation chain transfer (RAFT) polymerization of the MAC with hydroxyethyl methacrylate (HEMA), and further characterized by 1H NMR and gel permeation chromatography (GPC) analysis. Antibiotic resistance was investigated by passaging bacteria in low concentrations of the antibiotic for 19 days, followed by a 48 h challenge at higher concentrations. Our results suggest that the development of antibiotic resistance is unlikely. Zone of inhibition (ZOI) assays revealed no clearing zones around PV-containing resins indicating minimal antibiotic leakage from the material. Similarly, MTT assay demonstrated that the antibiotic-containing specimens did not release cytotoxic byproducts that may inhibit human gingival fibroblast growth. Counting of colony-forming units in an S. mutans biofilm model was used to assess bacterial survival at baseline and after subjecting the antibiotic-containing resin specimens to an enzymatic challenge for 30 days. Significantly reduced bacterial counts were observed as the biofilm aged from 24 to 72 h, and salivary enzymatic exposure did not reduce the antibacterial efficacy of the discs, suggesting that PV-resin will be effective in reducing the re-incidence of dental caries.

The burden of root caries: Updated perspectives and advances on management strategies

BACKGROUND

Root caries has gained much attention in the last few years. As the world's population is ageing and people currently tend to retain more teeth compared with older generations, there is an increased prevalence of periodontal disease and gingival recession, which may accelerate the onset of root caries.

OBJECTIVE

This review aims to summarise recent findings related to the diagnosis, prevention and treatment of root caries.

MATERIALS AND METHODS

MEDLINE (OVID) and Scopus (Elsevier) searches were performed to identify and discuss articles that address the pathogenicity and clinical management of root caries.

RESULTS

Root caries is a multifactorial disease. Cariogenic species involved in root caries are less dependent on carbohydrates since collagen degradation inside the dentinal tubules can provide nutrients and microcavities for the invading microorganisms. Furthermore, the root surface has fewer minerals in comparison with enamel, which may accelerate the onset of demineralisation. Root caries could be prevented by patient education, modification of risk factors, and the use of in-office and home remineralisation tools. The use of non-invasive approaches to control root caries is recommended, as the survival rate of root caries restorations is poor. When plaque control is impossible and a deep/large cavity is present, glass ionomer or resin-based restorations can be placed.

CONCLUSION

The assessment of root carious lesions is critical to determine the lesion activity and the required intervention. Dental practitioners should also be aware of different prevention and treatment approaches to design optimum oral health care for root caries-affected patients.

Light Energy Dose and Photosensitizer Concentration Are Determinants of Effective Photo-Killing against Caries-Related Biofilms

Caries-related biofilms and associated complications are significant threats in dentistry, especially when biofilms grow over dental restorations. The inhibition of cariogenic biofilm associated with the onset of carious lesions is crucial for preventing disease recurrence after treatment. This in vitro study defined optimized parameters for using a photosensitizer, toluidine blue O (TBO), activated via a red light-emitting diode (LED)-based wireless device to control the growth of cariogenic biofilms. The effect of TBO concentrations (50, 100, 150, and 200 μg/mL) exposed to light or incubated in the dark was investigated in successive cytotoxicity assays. Then, a mature Streptococcus mutans biofilm model under sucrose challenge was treated with different TBO concentrations (50, 100, and 150 μg/mL), different light energy doses (36, 108, and 180 J/cm²), and different incubation times before irradiation (1, 3, and 5 min). The untreated biofilm, irradiation with no TBO, and TBO incubation with no activation represented the controls. After treatments, biofilms were analyzed via S. mutans colony-forming units (CFUs) and live/dead assay. The percentage of cell viability was within the normal range compared to the control when 50 and 100 μg/mL of TBO were used. Increasing the TBO concentration and energy dose was associated with biofilm inhibition (p < 0.001), while increasing incubation time did not contribute to bacterial elimination (p > 0.05). Irradiating the S. mutans biofilm via 100 μg/mL of TBO and ≈180 J/cm² energy dose resulted in ≈3-log reduction and a higher amount of dead/compromised S. mutans colonies in live/dead assay compared to the control (p < 0.001). The light energy dose and TBO concentration optimized the bacterial elimination of S. mutans biofilms. These results provide a perspective on the determining parameters for highly effective photo-killing of caries-related biofilms and display the limitations imposed by the toxicity of the antibacterial photodynamic therapy’s chemical components. Future studies should support investigations on new approaches to improve or overcome the constraints of opportunities offered by photodynamic inactivation of caries-related biofilms.