Comparison of Cytomorphometry and Early Cell Response of Human Gingival Fibroblast (HGFs) between Zirconium and New Zirconia-Reinforced Lithium Silicate Ceramics (ZLS)

Morpho-Functional Effect of a New Collagen-Based Medical Device on Human Gingival Fibroblasts: An In Vitro Study

Maintaining periodontal and peri-implant soft tissues health is crucial for the long-term health of teeth and dental implants. New biomedical strategies aimed at avoiding connective tissue alterations and related diseases (e.g., periodontitis and peri-implantitis) are constantly evolving. Among these, collagen-based medical products have proven to be safe and effective. Accordingly, the aim of the present study was to evaluate the effects of Dental SKIN BioRegulation (Guna S.p.a., Milan, Italy), a new injectable medical device composed of type I collagen of porcine origin, on primary cultures of human gingival fibroblasts (hGF). To this end, hGF were cultured on collagen-coated (COL, 100 µg/2 mL) or uncoated plates (CTRL) before evaluating cell viability (24 h, 48 h, 72 h, and 7 d), wound healing properties (3 h, 6 h, 12 h, 24 h, and 48 h), and the activation of mechanotransduction markers, such as FAK, YAP, and TAZ (48 h). The results proved a significant increase in cell viability at 48 h (p < 0.05) and wound closure at 24 h (p < 0.001) of hGF grown on COL, with an increasing trend at all time-points. Furthermore, COL significantly induced the expression of FAK and YAP/TAZ (p < 0.05), thereby promoting the activation of mechanotransduction signaling pathways. Overall, these data suggest that COL, acting as a mechanical bio-scaffold, could represent a useful treatment for gingival rejuvenation and may possibly help in the resolution of oral pathologies.

A Review on CAD/CAM Yttria-Stabilized Tetragonal Zirconia Polycrystal (Y-TZP) and Polymethyl Methacrylate (PMMA) and Their Biological Behavior

Yttria-stabilized tetragonal zirconia polycrystal (Y-TZP) and polymethyl methacrylate (PMMA) are used very often in dentistry. Y-TZP is the most widely used zirconia dental ceramic, and PMMA has classically been used in removable prosthesis manufacturing. Both types of materials are commercialized in CAD/CAM system blocks and represent alternatives for long-lasting temporary (PMMA) or definitive (Y-TZP) implantological abutments. The aim of the present work is to reveal that human gingival fibroblasts (HGFs) have a favorable response when they are in contact with Y-TZP or PMMA as a dental implant abutment or implant-supported fixed prosthesis, and also to review their principal characteristics. We conducted an electronic search in the PubMed database. From an initial search of more than 32,000 articles, the application of filters reduced this number to 5104. After reading the abstracts and titles, we reduced the eligible articles to 23. Ultimately, we have included eight articles in this review.

Fixed Prosthetic Restorations and Periodontal Health: A Narrative Review

Periodontal health plays an important role in the longevity of prosthodontic restorations. The issues of comparative assessment of prosthetic constructions are complicated and not fully understood. The aim of this article is to review and present the current knowledge regarding the various technical, clinical, and molecular aspects of different prosthetic biomaterials and highlight the interactions between periodontal health and prosthetic restorations. Articles on periodontal health and fixed dental prostheses were searched using the keywords “zirconium”, “CAD/CAM”, “dental ceramics”, “metal–ceramics”, “margin fit”, “crown”, “fixed dental prostheses”, “periodontium”, and “margin gap” in PubMed/Medline, Scopus, Google Scholar, and Science Direct. Further search criteria included being published in English, and between January 1981 and September 2021. Then, relevant articles were selected, included, and critically analyzed in this review. The margin of discrepancy results in the enhanced accumulation of dental biofilm, microleakage, hypersensitivity, margin discoloration, increased gingival crevicular fluid flow (GCF), recurrent caries, pulp infection and, lastly, periodontal lesion and bone loss, which can lead to the failure of prosthetic treatment. Before starting prosthetic treatment, the condition of the periodontal tissues should be assessed for their oral hygiene status, and gingival and periodontal conditions. Zirconium-based restorations made from computer-aided design and computer-aided manufacturing (CAD/CAM) technology provide better results, in terms of marginal fit, inflammation reduction, maintenance, and the restoration of periodontal health and oral hygiene, compared to constructions made by conventional methods, and from other alloys. Compared to subgingival margins, supragingival margins offer better oral hygiene, which can be maintained and does not lead to secondary caries or periodontal disease.

Zirconia-reinforced lithium silicate (ZLS) mechanical and biological properties: A literature review

OBJECTIVES

This paper aimed to provide a literature review of the mechanical and biological properties of zirconia-reinforced lithium silicate glass-ceramics (ZLS) in Computer-aided design / Computer-aided manufacturing (CAD/CAM) systems.

DATA/SOURCES

An extensive search of the literature for papers related to ZLS was made on the databases of PubMed/Medline, Scopus, Embase, Google Scholar, Dynamed, and Open Grey. The papers were selected by 3 independent calibrated reviewers.

STUDY SELECTION

The search strategy produced 937 records. After the removal of duplicates and the exclusion of papers that did not meet the inclusion criteria, 71 papers were included.

CONCLUSIONS

After reviewing the included records, it was found that two types of ZLS (Vita Suprinity PC; Vita Zahnfabrik and Celtra Duo; Dentsply Sirona) are nowadays available on the market for CAD/CAM systems, similar in their chemical composition, microstructure, and biological-mechanical properties. ZLS is reported to be a biocompatible material, whose fracture resistance can withstand physiological chewing loads. The firing process influences the improvements of strength and fatigue failure load, with a volumetric shrinkage. To date, ZLS can be considered a viable alternative to other glass-ceramics for fixed single restorations.

CLINICAL SIGNIFICANCE

. As to biocompatibility and mechanical properties of ZLS, data are still scarce, often controversial and limited to short-term observational periods. These promising ceramics require further in vitro/in vivo studies to accurately define mechanical and biological properties, mainly in the long-term performance of restorations produced with such materials.

Effects of surface roughness of ceria-stabilized zirconia/alumina nanocomposite on the morphology and function of human gingival fibroblasts

We evaluated the biological effects of implant abutments made from ceria-stabilized zirconia/alumina nanocomposite (Ce-TZP/Al₂O₃) with surface roughness variations using human gingival fibroblasts (HGF-1) in the transmucosal region. Two types of titanium (Ti) and Ce-TZP/Al₂O₃ disks with different surface roughness profiles were prepared (Ra0.9 and Ra0.02). Surface properties were evaluated using SEM, EDX, and wettability analysis. Biological parameters including cell adhesion, proliferation and morphology, collagen deposition, and inflammatory cytokine expression were evaluated for each disk. Surface morphology analysis of Ce-TZP/Al₂O₃ and Ti elucidated the uniform linear structures of Ra0.9 and the smooth and flat structures of Ra0.02. Cell morphology showed spindle-shaped and large, circular forms, respectively. Cell adhesion and proliferation and collagen deposition were significantly increased on Ce-TZP/Al₂O₃ Ra0.02 disk compared with the others, with no significant differences in cytokine expression among all the disks. The reduced surface roughness of Ce-TZP/Al₂O₃ was advantageous for promoting biological effects in the transmucosal region.

The phenotype of gingival fibroblasts and their potential use in advanced therapies

Advanced therapies in medicine use stem cells, gene editing, and tissues to treat a wide range of conditions. One of their goals is to stimulate endogenous repair of tissues and organs by manipulating stem cells and their niche, as well as to optimize the intrinsic characteristics and plasticity of differentiated cells in adult tissues. In this context, fibroblasts emerge as an alternative source to stem cells because they share phenotypic and regenerative characteristics. Specifically, fibroblasts of the oral mucosae have been shown to have improved regenerative capacity compared to other fibroblast populations. Additionally, their easy access by means of minimally invasive procedures without generating aesthetic problems, with easy and rapid in vitro expansion and with great capacity to respond to extrinsic factors, make oral fibroblasts an attractive and interesting resource for regenerative medicine. This review summarizes current concepts regarding the phenotypic and functional aspects of human Gingival Fibroblasts and their niche, differentiating them from other fibroblast populations of oral-lining mucosa and skin fibroblasts. Furthermore, some applications are presented in regenerative medicine, emphasizing on the biological potential of human Gingival Fibroblasts.

Cytomorphometric Analysis of Inflammation Dynamics in the Periodontium Following the Use of Fixed Dental Prostheses

Cytomorphometry is used in the sampling of biological materials and diagnostic procedures. The use of cytological studies in periodontal diseases is not well described in the literature. Our study aimed to quantitatively assess the inflammation dynamics using cytomorphometric analysis of the periodontium before and after the use of fixed dental prostheses. Following ethics approval, a total of 105 subjects were divided in 3 groups as gingivitis (n = 23), periodontitis (n = 58), and healthy periodontium (control) (n = 24). The fixed dental prostheses (crowns and fixed partial dentures) were fabricated from cobalt-chrome metal-ceramic prostheses using the conventional method (C/M-CoCr), cobalt-chrome metal-ceramic prostheses by the computer-aided design and computer-aided manufacturing (CAD/CAM) technique (C/C-CoCr), and zirconia-based ceramic prostheses by the CAD/CAM technique (C/C-Zr) among subjects with gingivitis and periodontitis. The gingival crevicular fluid (GCF) was obtained from subjects before and after the use of the prostheses. The total count of epithelial cells and the connective tissue cells or polymorphonuclear neutrophils (PMNs) in GCF were studied using cytomorphometric analysis. The Statistical Package Tor the Social Sciences (SPSS), Version 20 (IBM Company, Chicago, IL, USA) was used to analyze the results and the significance level was set at p = 0.05. The data for before and after the use of the prostheses were compared using independent t-Tests. Similarly, the results after the use of prostheses in gingivitis, periodontitis, and control in each type of prostheses were compared using One-way ANOVA with post hoc using Scheffe. The total epithelial cells and the PMNs were determined along with the epithelium/leukocyte index. Regardless of the prostheses type used, no significant change in the parameters was identified among patients with a healthy periodontium, before and after prosthetic treatment. In all study groups, a statistically increase (p value < 0.05) was observed in the oral epithelial cell counts and a statistically decrease (p < 0.05) in the PMNs count following the use of the fixed prostheses. Data on cytomorphometric analysis could enable the selection of the most appropriate prostheses for use in patients with periodontal pathologies. When choosing prostheses, changes in the composition of GCF could be considered as a useful criterion for their use.

Nanostructured Zirconia-Based Ceramics and Composites in Dentistry: A State-of-the-Art Review

The objective of this paper is to review the current knowledge on the development of nanostructured zirconia-based ceramics and composites suitable for application in dentistry. Isi Web of Science, Science Direct, Scientific.net databases, and Google were searched electronically for the period of 1980 to the present, matching the keywords “nano” with the keywords: “Zirconia, ZrO₂, Y-TZP, and dental, dentistry”. A total of 74 papers were found, with the majority coming from Asia, indicating a more active scientific interest on the topic in this geographic area, followed by Europe, South America, and North America. The research shows, even though the scientific activity on nanostructured ceramics was intense in the last fifteen years, the development of fully dense zirconia-based nanoceramics is yet at an initial stage, most of all from the point of view of the clinical applications. It has been demonstrated that nanostructured ceramics can show improved properties because of the reduction of the grain size to the nanoscale. This is also true for zirconia-based nanoceramics, where some improvements in mechanical, optical, as well as resistance in low-temperature degradation have been observed. Potential applications of this class of material in the dental field are discussed, summarizing the results of the latest scientific research.

Biocompatibility of Polymer and Ceramic CAD/CAM Materials with Human Gingival Fibroblasts (HGFs)

Four polymer and ceramic computer-aided design/computer-aided manufacturing (CAD/CAM) materials from different manufacturers (VITA CAD-Temp (polymethyl methacrylate, PMMA), Celtra Duo (zirconia-reinforced lithium silicate ceramic, ZLS), IPS e.max CAD (lithium disilicate (LS₂)), and VITA YZ (yttrium-tetragonal zirconia polycrystal, Y-TZP)) were tested to evaluate the cytotoxic effects and collagen type I secretions on human gingival fibroblasts (HGFs). A total of 160 disc-shaped samples (Ø: 10 ± 2 mm; h: 2 mm) were milled from commercial blanks and blocks. Direct-contact cytotoxicity assays were evaluated at 24, 48, and 72 h, and collagen type I (COL1) secretions were analysed by cell-based ELISA at 24 and 72 h. Both experiments revealed statistically significant differences (p < 0.05). At 24 and 48 h of contact, cytotoxic potential was observed for all materials. Later, at 72 h, all groups reached biologically acceptable levels. LS₂ showed the best results regarding cell viability and collagen secretion in all of the time evaluations, while Y-TZP and ZLS revealed intermediate results, and PMMA exhibited the lowest values in both experiments. At 72 h, all groups showed sharp decreases in COL1 secretion regarding the 24-h values. According to the results obtained and the limitations of the present in vitro study, it may be concluded that the ceramic materials revealed a better cell response than the polymers. Nevertheless, further studies are needed to consolidate these findings and thus extrapolate the results into clinical practice.

In vitro Comparative Study of Fibroblastic Behaviour on Polymethacrylate (PMMA) and Lithium Disilicate Polymer Surfaces

Polymethyl methacrylate (PMMA) and lithium disilicate are widely used materials in the dental field. PMMA is mainly used for the manufacture of removable prostheses; however, with the incorporation of CAD-CAM technology, new applications have been introduced for this material, including as a provisional implant attachment. Lithium disilicate is considered the gold standard for definitive attachment material. On the other hand, PMMA has begun to be used in clinics as a provisional attachment until the placement of a definitive one occurs. Although there are clinical studies regarding its use, there are few studies on cell reorganization around this type of material. This is why we carried out an in vitro comparative study using discs of both materials in which human gingival fibroblasts (HGFs) were cultured. After processing them, we analyzed various cellular parameters (cell count, cytoskeleton length, core size and coverage area). We analyzed the surface of the discs together with their composition. The results obtained were mostly not statistically significant, which shows that the qualities of PMMA make it a suitable material as an implant attachment.