Antibacterial and Remineralizing Fillers in Experimental Orthodontic Adhesives

The influence of filler load in 3D printing resin-based composites

OBJECTIVE

To evaluate the influence of the barium glass (BG) filler in 3D printing resin-based composites for restorative structures.

METHODS

Experimental 3D printing resin-based composites were formulated with UDMA 70%wt, Bis-EMA 20%wt, and TEGDMA 10%wt. Photoinitiators TPO and DFI (2%wt) were used. BG was incorporated at 40%wt and 50%wt. 0%wt BG was used as negative control and the VarseoSmile Crownplus (Bego) was used as a commercial control. Specimens were printed using a 3D printer. Subsequently, specimens were washed and submitted to post-curing with 405 nm at 60ºC for 2 × 20 min at FormCure (FormLabs). 3D printing resin-based composites were evaluated by flexural strength, degree of conversion, softening in solvent, radiopacity, and cytotoxicity against gingival fibroblasts. Data were statistically analyzed using one-way ANOVA (α = 0.05).

RESULTS

No significant differences in flexural strength were showed between BG40% (90.5 ± 5,4 MPa), BG50% (102.0 ± 11.7 MPa) and VA (105.2 ± 11.7 MPa). Addition of 40% and 50% of BG showed no influence in the degree of conversion compared to VA (p > 0.05). All groups showed softening in solvent after immersion in ethanol (p < 0.05). All groups showed more than 1mmAl of radiopacity. BG50% showed significantly higher radiopacity (2.8 ± 0.3 mmAl) than other groups (p < 0,05). Cytotoxicity evaluation showed gingival cell viability higher than 80% for all groups.

SIGNIFICANCE

Addition of up to 50%wt of barium glass in experimental 3D printing resin-based composites showed promising results for long-term restorative structures.

Graphene as a promising material in orthodontics: A review

Graphene is an extraordinary material with unique mechanical, chemical, and thermal properties. Additionally, it boasts high surface area and antimicrobial properties, making it an attractive option for researchers exploring innovative materials for biomedical applications. Although there have been various studies on graphene applications in different biomedical fields, limited reviews have been conducted on its use in dentistry, and no reviews have focused on its application in the orthodontic field. This review aims to present a comprehensive overview of graphene-based materials, with an emphasis on their antibacterial mechanisms and the factors that influence these properties. Additionally, the review summarizes the dental applications of graphene, spotlighting the studies of its orthodontic application as they can be used to enhance the antibacterial and mechanical properties of orthodontic materials such as adhesives, archwires, and splints. Also, they can be utilized to enhance bone remodeling during orthodontic tooth movement. An electronic search was carried out in Scopus, PubMed, Science Direct, and Wiley Online Library digital database platforms using graphene and orthodontics as keywords. The search was restricted to English language publications without a time limit. This review highlights the need for further laboratory and clinical research using graphene-based materials to improve the properties of orthodontic materials to make them available for clinical use.

New generation of orthodontic devices and materials with bioactive capacities to improve enamel demineralization

OBJECTIVE

The article reviewed novel orthodontic devices and materials with bioactive capacities in recent years and elaborated on their properties, aiming to provide guidance and reference for future scientific research and clinical applications.

DATA, SOURCES AND STUDY SELECTION

Researches on remineralization, protein repellent, antimicrobial activity and multifunctional novel bioactive orthodontic devices and materials were included. The search of articles was carried out in Web of Science, PubMed, Medline and Scopus.

CONCLUSIONS

The new generation of orthodontic devices and materials with bioactive capacities has broad application prospects. However, most of the current studies are limited to in vitro studies and cannot explore the true effects of various bioactive devices and materials applied in oral environments. More research, especially in vivo researches, is needed to assist in clinical application.

CLINICAL SIGNIFICANCE

Enamel demineralization (ED) is a common complication in orthodontic treatments. Prolonged ED can lead to dental caries, impacting both the aesthetics and health of teeth. It is of great significance to develop antibacterial orthodontic devices and materials that can inhibit bacterial accumulation and prevent ED. However, materials with only preventive effect may fall short of addressing actual needs. Hence, the development of novel bioactive orthodontic materials with remineralizing abilities is imperative. The article reviewed the recent advancements in bioactive orthodontic devices and materials, offering guidance and serving as a reference for future scientific research and clinical applications.

Bioceramic micro-fillers reinforce antibiofilm and remineralization properties of clear aligner attachment materials

Introduction: Clear aligners, while offering a more hygienic alternative to fixed appliances, are still associated with challenges including plaque accumulation and enamel demineralization. The aim of the present study was to investigate the antibiofilm and remineralization effectiveness of innovative flowable composite attachments containing bioceramic micro-fillers. Methods: Four experimental attachments were formulated and bonded to human enamel specimens: 3M Filtek Supreme flowable composite (Filtek SF) + 10% bioactive glass 45S5 (BAG), Filtek SF + 30% BAG, Filtek SF + 10% Bredigite (BRT), Filtek SF + 30% BRT. Plaque biofilms were grown on the bonded enamel using a standardized protocol and the biofilm-killing effect was assessed by confocal laser scanning microscopy and scanning electron microscopy. Vickers microhardness was measured to evaluate the remineralization effect of the attachments containing bioceramic fillers after acid challenge. Shear bond test was performed to assess the bonding strength. Results: Attachments with bioceramic fillers significantly inhibited plaque biofilm growth in 3 weeks on enamel, contributing over 20% bacterial cell killing in 10% filler groups and over 30% killing in 30% filler groups. All four experimental groups demonstrated significantly higher microhardness values than the control group without fillers on the attachment side. The shear bonding strength was not compromised in the attachments with micro-fillers. Discussion: Proper incorporation of bioceramic micro-fillers in attachments provides an innovative approach for clear aligner therapy with reinforced antibiofilm and remineralization effects without weakening shear bonding strength.

Evaluation of shear bond strength and enamel remineralizing effect of experimental orthodontic composite containing nano-hydroxyapatite: An in vitro study

OBJECTIVE

The purpose of this study was to prepare an orthodontic composite containing hydroxyapatite nanoparticles to prevent demineralization and create a suitable environment for mineral deposition around orthodontic brackets, and to investigate the mechanical and remineralizing properties of the experimental adhesive composite.

METHODS

Experimental orthodontic composite were formulated using varying percentages of nano-hydroxyapatite particles. Assessments were based on four groups: a control group (3M™ Transbond™ XT) and experimental composites containing 2% (HA2), 5% (HA5) and 10% (HA10) hydroxyapatite. Vickers Microhardness test was performed to investigate the remineralizing effect in 3 stages: initial stage, after demineralization and after 4 weeks of exposure to artificial saliva. Scanning electron microscopy with energy dispersive X-ray spectroscopy analyser (SEM/EDAX) was used to evaluate hydroxyapatite precipitation and elemental composition of enamel surface. Shear Bond Strength tests were carried out using a universal testing machine and the debonding pattern was assessed using Adhesive Remnant Index (ARI).

RESULTS

All groups showed clinically acceptable SBS values. The highest SBS was achieved in the HA2 group, followed by Transbond™ XT, HA5 and HA10. There was no significant difference in the ARI scores. In terms of microhardness properties, HA5 and HA10 demonstrated a significant increase after 4 weeks. The results of SEM analysis showed the precipitation of hydroxyapatite crystals and EDAX analysis indicated the increase of calcium and phosphate ion peaks compared to the demineralized sample. The data were analysed using one-way ANOVA and Tukey's Post-hoc test.

CONCLUSIONS

Addition of hydroxyapatite nanoparticles to orthodontic composite can increase the mineral content and microhardness of the adjacent enamel. However, increasing the amount of nanoparticles reduces shear bond strength in a decreasing trend. The above-mentioned findings showed that incremental increase of nanoparticles of HA can be incorporated in composite to a certain extent and limitations are determined by mechanical properties (SBS) required for bracket bonding.

New Materials and Techniques for Orthodontics

Orthodontics is a specialty of dentistry dealing with the prevention, diagnosis, and treatment of mispositioned jaws and teeth [...].

Developing a Novel Enamel Adhesive with Amorphous Calcium Phosphate and Silver Nanoparticles to Prevent Demineralization during Orthodontic Treatment

During fixed orthodontic treatment, white spot lesions are prevalent issues associated with cariogenic bacteria. This study aims to construct an orthodontic adhesive containing nanoparticles of amorphous calcium phosphate-polydopamine-Ag (NPA) fillers to combat white spot lesions. The NPA fillers were prepared and characterized by scanning electron microscopy (SEM), transmission electron microscopy (TEM), Fourier transform infrared spectroscopy (FTIR), and X-ray photoelectron spectroscopy (XPS). The biocompatibility of the fillers was evaluated. A colony counting test evaluated the antibacterial property of the fillers against Streptococcus mutans (S. mutans). NPA fillers were mixed with orthodontic adhesive (Transbond XT) at different weight ratios (0, 0.1, 0.2, 0.3, and 0.5 wt.%). The shear bond strength and antibacterial properties were then further investigated. The results showed that NPA was prepared successfully, with good antibacterial properties. The cell survival rate of all groups of fillers was higher than 70%, showing good biocompatibility. Moreover, the shear bond strength of the orthodontic adhesive with 0.2 wt.% NPA fillers was 11.89 ± 1.27 MPa, meeting the minimal clinical bond strength requirements of 7.8 MPa. Furthermore, the orthodontic adhesive resin blocks and the extract displayed good antibacterial properties, with the number of colonies decreasing significantly (p < 0.001). Taken together, we think that an orthodontic adhesive with NPA may have a good application potential for the prevention and treatment of white spot lesions.

Orthodontic resins loaded with niobium silicate particles: Impact of filler concentration on the physicochemical and biological properties

OBJECTIVES

White spot lesions (WSL) are prevalent in patients using orthodontic appliances. The presence of ion-releasing compounds in the tooth-appliance interface may limit enamel demineralization to control WSL incidence. Thus, this study aims to evaluate the mineral formation on SiNb-containing experimental orthodontic resins and the influence of these fillers on the physicochemical and biological properties of developed materials.

MATERIALS AND METHODS

The SiNb particles were synthesized via the sol-gel route and characterized by their molecular structure and morphology. Photopolymerizable orthodontic resins were produced with a 75 wt% Bis-GMA/25 wt% TEGDMA and 10 wt%, 20 wt%, or 30 wt% addition of SiNb. A control group was formulated without SiNb. These resins were tested for their degree of conversion, softening in solvent, cytotoxicity in fibroblasts, flexural strength, shear bond strength (SBS), and mineral deposition.

RESULTS

The addition of 10 wt% of SiNb did not impair the conversion of monomers, cytotoxicity, and flexural strength. All groups with SiNb addition presented similar softening in solvent. The presence of these particles did not affect the bond strength between metallic brackets and enamel, with SBS values ranging from 16.41 to 18.66 MPa. The mineral deposition was observed for all groups.

CONCLUSION

The use of niobium silicate as filler particles in resins may be a strategy for the adhesion of orthodontic appliances. The 10 wt% SiNb concentration resulted in a material with suitable physicochemical and biological properties while maintaining the bond strength to tooth enamel and promoting mineral deposition.

Formulation and characterization of experimental orthodontic adhesive containing antibacterial dimethacrylate DABCO monomers: An in vitro study

OBJECTIVE

The purpose of the study was to investigate the antibacterial efficacy and mechanical properties of experimental orthodontic adhesives containing newly synthesized antibacterial dimethacrylate monomers with doubly charged 1,4-diazabicyclo[2.2.2]octane (DABCO) group (dication).

METHODS

Experimental orthodontic adhesives were formulated using varying compositions of synthesized antibacterial dimethacrylate monomers containing DABCO dication, C16DC2DMA and BisC11DCDMA, replacing part of the control group, Transbond™XT. The concentrations of monomers tested were 5% C16DC2DMA, 10% C16DC2DMA, 5% BisC11DCDMA, and 10% BisC11DCDMA. The biofilm-inhibition effects of the experimental adhesives against Streptococcus mutans were tested. Brackets were then bonded to extracted human teeth utilizing the experimental adhesives in the bonding protocol. The shear bond strength and modulus of elasticity of the control and experimental groups were tested. The adhesive remnant index scores were recorded.

RESULTS

The experimental adhesives containing 5% or 10% BisC11DCDMA and 10% C16DC2DMA showed significantly lower S. mutans colony forming units (CFU) than the control. Both BisC11DCDMA experimental groups displayed similar mechanical properties as compared to the control, although 10% C16DC2DMA showed a reduction in shear bond strength as compared to the control. For all experimental adhesives, the adhesive remnant index scores were not significantly different compared to the control.

CONCLUSION

BisC11DCDMA is a novel antibacterial dimethacrylate monomer that exhibits the significant ability to inhibit bacterial growth while maintaining acceptable mechanical properties. When incorporated into orthodontic adhesives, this monomer may reduce the occurrence of white spot lesions around brackets in orthodontic patients.

Alkyl trimethyl ammonium bromide for the formulation of antibacterial orthodontic resins

OBJECTIVES

This study aimed at formulating antibacterial orthodontic resins containing alkyl trimethyl ammonium bromide (ATAB) and evaluating their physicochemical and biological properties.

MATERIALS AND METHODS

The chemical composition and microstructure of ATAB was characterized through FTIR and SEM, respectively. Experimental orthodontic BisGMA/TEGDMA-based resins were formulated, and the ATAB filler was incorporated at 1wt%, 5wt%, and 10wt%, along with colloidal silica (5wt%). The degree of conversion, softening in solvent, and flexural strength of the experimental resins were analyzed. Biological properties were also assessed through cytotoxicity and antibacterial analyses.

RESULTS

The incorporation of ATAB, due to the presence of ⎯N⁺(CH₃)₃ alkyl groups, had no adverse effect on the degree of conversion of the resins (p > 0.05). The %ΔKHN values at 5wt% and 10wt% were comparable to those of the control group, while the flexural strength was reduced at all concentrations of ATAB. The viability of the gingival fibroblast was reduced with the addition of ATAB (p < 0.05). The viability of biofilm and planktonic bacteria was reduced when ATAB was incorporated at 5wt% and 10wt%.

CONCLUSIONS

The addition of ATAB at 5wt% resulted suitable for the formulation of orthodontic resins with the ability to control the biofilm formation and planktonic activity of S.mutans, without jeopardizing some specific physicochemical properties.

CLINICAL RELEVANCE

White spot lesions in orthodontic patients may be controlled by preventive treatments. Non-patient-dependent strategies, such as the use of orthodontic resins containing ATAB, may avoid accumulation of bacteria, especially in those areas surrounding orthodontic appliances.

In Vitro and In Vivo Cytotoxicity of Boron Nitride Nanotubes: A Systematic Review

Boron nitride nanotubes (BNNTs) are an exciting class of nanomaterials due to their unique chemical and physical characteristics. In recent decades, BNNTs have gained huge attention in research and development for various applications, including as nano-fillers for composites, semiconductor devices, hydrogen storage, and as an emerging material in biomedical and tissue engineering applications. However, the toxicity of BNNTs is not clear, and the biocompatibility is not proven yet. In this review, the role of BNNTs in biocompatibility studies is assessed in terms of their characteristics: cell viability, proliferation, therapeutic outcomes, and genotoxicity, which are vital elements for their prospective use in biomedical applications. A systematic review was conducted utilising the databases Scopus and Web of Science (WOS) (2008-2022). Additional findings were discovered manually by snowballing the reference lists of appropriate reviews. Only English-language articles were included. Finally, the significant analysis and discussion of the chosen articles are presented.

Physical/Mechanical and Antibacterial Properties of Orthodontic Adhesives Containing Calcium Phosphate and Nisin

Enamel demineralization around orthodontic adhesive is a common esthetic concern during orthodontic treatment. The aim of this study was to prepare orthodontic adhesives containing monocalcium phosphate monohydrate (MCPM) and nisin to enable mineralizing and antibacterial actions. The physicomechanical properties and the inhibition of S. mutans growth of the adhesives with added MCPM (5, 10 wt %) and nisin (5, 10 wt %) were examined. Transbond XT (Trans) was used as the commercial comparison. The adhesive containing a low level of MCPM showed significantly higher monomer conversion (42–62%) than Trans (38%) (p < 0.05). Materials with additives showed lower monomer conversion (p < 0.05), biaxial flexural strength (p < 0.05), and shear bond strength to enamel than those of a control. Additives increased water sorption and solubility of the experimental materials. The addition of MCPM encouraged Ca and P ion release, and the precipitation of calcium phosphate at the bonding interface. The growth of S. mutans in all the groups was comparable (p > 0.05). In conclusion, experimental orthodontic adhesives with additives showed comparable conversion but lesser mechanical properties than the commercial material. The materials showed no antibacterial action, but exhibited ion release and calcium phosphate precipitation. These properties may promote remineralization of the demineralized enamel.

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.

Antipathogenic properties and applications of low-dimensional materials

A major health concern of the 21st century is the rise of multi-drug resistant pathogenic microbial species. Recent technological advancements have led to considerable opportunities for low-dimensional materials (LDMs) as potential next-generation antimicrobials. LDMs have demonstrated antimicrobial behaviour towards a variety of pathogenic bacterial and fungal cells, due to their unique physicochemical properties. This review provides a critical assessment of current LDMs that have exhibited antimicrobial behaviour and their mechanism of action. Future design considerations and constraints in deploying LDMs for antimicrobial applications are discussed. It is envisioned that this review will guide future design parameters for LDM-based antimicrobial applications.

The Effect of Finishing and Polishing Sequences on The Surface Roughness of Three Different Nanocomposites and Composite/Enamel and Composite/Cementum Interfaces

The purpose of this study was to investigate the effect of final surface treatment and dental composite type on the roughness of the composite surface, composite/enamel interface, and composite/cementum interface, as well as on the polishing time. Class V cavities prepared in extracted teeth (n = 126) were restored using one of the three nanohybrid composites with different filler sizes. The specimens were randomly assigned to three different finishing and polishing sequences. The roughness (Ra) of the investigated surfaces was measured using the contact profilometer. The time required to achieve visible gloss was documented. The data were analyzed using ANOVA with Tukey's post hoc test (p < 0.05). There was no significant influence of the composite type on the restoration surface roughness (p = 0.088), while the polishing method had a significant impact (p < 0.001). The Ra of the composites ranged between 0.08 µm and 0.29 µm, with the lowest values (0.09 µm ± 0.05 µm) found in the aluminum oxide disc group (p < 0.001). The time to achieve a visible composite gloss was influenced by the polishing method, composite type, and interactions between these factors (p < 0.001). The interface roughness was significantly greater than that of the composite surface (p < 0.001), and depended on the composite type and polishing system employed.

Ionic liquid as antibacterial agent for an experimental orthodontic adhesive

OBJECTIVE

The aim of this study was to formulate and evaluate experimental orthodontic adhesives with different concentrations of 1-n-butyl-3-methylimidazoilium bis(trifluoromethanesulfonyl)imide (BMIM.NTf₂).

METHODS

The experimental orthodontic adhesives were formulated with methacrylate monomers, photoinitiators and silica colloidal. The ionic liquid BMIM.NTf₂ was synthesized and characterized. BMIM.NTf₂ was added at 5 (G_5%), 10 (G_10%) and 15 (G_15%) wt.%. One group contained no BMIM.NTf₂ to function as control (G_Ctrl). The adhesives were evaluated for polymerization kinetics, degree of conversion (DC), Knoop hardness and softening in solvent, ultimate tensile strength (UTS), shear bond strength (SBS), thermogravimetric analysis (TGA), antibacterial activity and cytotoxicity.

RESULTS

BMI.NTf₂ showed the characteristic chemical peaks. The polymerization kinetics were different among the groups. G_10% and G_15% showed higher DC (p < 0.05). G_5% and G_Ctrl had no differences for softening in solvent (p > 0.05). There were no differences for UTS (p > 0.05) and SBS (p > 0.05). TGA showed one different peak for G_15%. All groups with BMIM.NTf₂ showed antibacterial activity compared to G_Ctrl (p < 0.05) without cytotoxicity (p > 0.05).

SIGNIFICANCE

To reduce biofilm formation around brackets and to prevent demineralization at susceptible sites, materials have been developed with antibacterial properties. In this study, a new experimental orthodontic adhesive was formulated with an imidazolium ionic liquid (BMIM.NTf₂) as antibacterial agent. The incorporation of 5 wt.% of ionic liquid decreased biofilm formation without affecting the physico-chemical properties and cytotoxicity of an experimental orthodontic resin.