Fluorinated Bioactive Glass Nanoparticles: Enamel Demineralization Prevention and Antibacterial Effect of Orthodontic Bonding Resin

Novel antibacterial orthodontic elastomeric ligature with oral biofilm-regulatory ability to prevent enamel demineralization

OBJECTIVES

To synthesize a novel antibacterial orthodontic elastomeric ligature incorporating dimethylaminohexadecyl methacrylate (DMAHDM) for the first time to prevent enamel demineralization during orthodontic therapy.

METHODS

Various mass fractions of DMAHDM (ranging from 0 % to 20 %) were grafted onto commercial elastomeric ligatures using an ultraviolet photochemical grafting method and were characterized. The optimal DMAHDM concentration was determined based on biocompatibility and mechanical properties, and the antibacterial efficacy was evaluated in a whole-plaque biofilm model. TaqMan real-time polymerase chain reaction and fluorescence in situ hybridization were used to assess the microbial regulatory ability of the multispecies biofilms. Furthermore, an in vitro tooth demineralization model was established to explore its preventive effects on enamel demineralization. Statistical analysis involved a one-way analysis of variance and LSD post hoc tests at a significance level of 0.05.

RESULTS

The elastomeric ligature containing 2 % mass fraction of DMAHDM exhibited excellent mechanical properties, favorable biocompatibility, and the most effective antibacterial ability against microorganisms, which decreased by almost two logarithms (P < 0.05). It significantly reduced the proportion of Streptococcus mutans in the multispecies plaque biofilm by 25 % at 72 h, leading to an enhanced biofilm microenvironment. Moreover, the novel elastomeric ligature demonstrated an obvious preventive effect on enamel demineralization, with an elastic modulus 30 % higher and hardness 62 % higher than those of the control group within 3 months (P < 0.05).

SIGNIFICANCE

The integration of DMAHDM with an elastomeric ligature holds significant promise for regulating biofilms and preventing enamel demineralization in orthodontic applications.

Multifunctional bioactive glass nanoparticles: surface-interface decoration and biomedical applications

Developing bioactive materials with multifunctional properties is crucial for enhancing their biomedical applications in regenerative medicine. Bioactive glass nanoparticle (BGN) is a new generation of biomaterials that demonstrate high biocompatibility and tissue-inducing capacity. However, the hard nanoparticle surface and single surface property limited their wide biomedical applications. In recent years, the surface functional strategy has been employed to decorate the BGN and improve its biomedical applications in bone tissue repair, bioimaging, tumor therapy and wound repair. This review summarizes the progress of surface-interface design strategy, customized multifunctional properties and biomedical applications in detail. We also discussed the current challenges and further development of multifunctional BGN to meet the requirements of various biomedical applications.

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.

POSS hybrid bioactive glass dental composite resin materials: Synthesis and analysis

INTRODUCTION

This study create a dental composite by hybirding polyhedral oligo-sesquioxide nano monomers and bioactive glass BG 45S5.

METHODS

Make an experimental composite resin material with a 60 % filler content overall by substituting 20 % of the filler with BG 45S5. The experimental resins are grouped and named P0, P2, P4, P6 and P8 based on the reactive nanomonomer methacrylic acid-based multifaceted oligomeric sesquisiloxane (POSS) added by 2 %-8 % in the resin matrix portion of each group. Utilize a universal testing machine to analyze and compare the mechanical properties of these, then perform Fourier infrared spectrum analysis, double bond conversion analysis, and scanning electron microscope analysis. Based on this, after soaking the experimental materials artificial saliva solution or lactic acid solution for a while, the pH changes of the solution, the release of Ca2+ and PO43- ions, and the precipitation of apatite on the resin material's surface were tested and analyzed. Cell viability tests were used to assess sample cell viability and quantify the cytotoxicity of biological cells. The independent sample t-test was used to examine the group comparisons, and a difference was considered statistically significant at P<0.05.

RESULTS

Outstanding mechanical and the double bond conversion are demonstrated by the nanocomposites when the POSS concentration hits 4 wt%. Agglomeration will cause the performance to deteriorate if the concentration beyond this threshold. In the P4 group, the double bond conversion, CS, and FS rose by a large margin, respectively, in comparison to the blank control group P0. Thankfully, the data demonstrate that adding POSS increases adhesive ability when compared to the blank group P0, however, there is no discernible difference between the other experimental groups. The acid neutralization capacity of the P4 group is essentially the same as that of the control group (P0). Ca2+ and PO43- ions are released in significant amounts following treatment with lactic acid solution, although this tendency is clearly less pronounced in artificial saliva. SEM and EDX data indicate that when the experimental resin is soaked in lactic acid solution and artificial saliva, apatite precipitation will happen on its surface. The results of the cell viability test indicated that there was no statistically significant difference between the experimental groups, and the viability of the cells increased after 24hours and 48 hours.

CONCLUSIONS

POSS was included into the composite resin along with 20% bioactive glass as a filler. When the proportion of POSS is less than 4%, the indices of composite resin materials rise in a dose-dependent way. When this value is surpassed, performance begins to deteriorate. The inclusion of POSS has no influence on the biological activity of the composites, which means that the hybrid composite resin is capable of acid neutralization, ion release, and apatite precipitation.

CLINICAL SIGNIFICANCE

The experimental composite resin can be used as an intelligent material in clinical treatment. It has the clinical application potential of preventing demineralization of tooth hard tissue, promoting remineralization, and improving edge sealing through apatite precipitation.

A systematic review and meta-analysis of the role of nutrition and its impact on orthodontic treatment/management

The nutritional needs already increased by adolescent growth, activity, and stress are further exacerbated by the physical, physiological, and psychological stress that orthodontic treatment causes. Hence, the main objective of this systematic review was to analyze the relationship between adequate nutrition and its impact on orthodontic treatment success rates. Using relevant keywords, reference searches, and citation searches, the databases such as PubMed-Medical Literature Analysis and Retrieval System Online, Web of Science, Cochrane, and Scopus were all searched. "Diet," "Minerals," "Nutrition," "Orthodontics," and "Vitamins" were the search terms used to scour the database. The 10 studies selected for the systematic review and subsequent meta-analysis could not conclusively establish the correlation between proper nutrition and its impact on orthodontic treatment of the patient. There was virtually little connection between patients' dietary intake and the effectiveness of their orthodontic treatment. Additionally, a direct causal link between the two could not be established legitimately because the majority of the studies reviewed only noted an impact during the early stages of the treatment. PROSPERO Registration Number: CRD42022380828.

Effect of incorporating silica-hydroxyapatite-silver hybrid nanoparticles into the resin-modified glass ionomer on the adhesive remnant index score and shear bond strength of orthodontic metal brackets: An in vitro study

OBJECTIVES

This study aimed to assess the effect of addition of silica-hydroxyapatite-silver (Si-HA-Ag) hybrid nanoparticles to light-cure glass ionomer (GI) on shear bond strength (SBS) of metal brackets bonded with this adhesive and the adhesive remnant index (ARI) score.

MATERIAL AND METHODS

In this in vitro experimental study, 50 sound extracted premolars were assigned to 5 groups (n=10) for orthodontic metal bracket bonding with BracePaste® composite, Fuji ORTHO™ pure resin modified GI (RMGI), and RMGI reinforced with 2wt%, 5wt% and 10wt% Si-HA-Ag nanoparticles. The SBS of brackets was measured by a universal testing machine. Debonded specimens were inspected under a stereomicroscope at×10 magnification to determine the ARI score. Data were analyzed by one-way ANOVA, Scheffe test, Chi-square test, and Fisher's exact test (alpha=0.05).

RESULTS

The maximum mean SBS was recorded in BracePaste® composite followed by 2% RMGI, 0% RMGI, 5% RMGI and 10% RMGI. Only the difference between the BracePaste® composite and 10% RMGI was significant in this regard (P=0.006). The groups were not significantly different regarding the ARI scores (P=0.665). All the SBS values were within the clinically acceptable range.

CONCLUSION

Addition of 2wt% and 5wt% Si-HA-Ag hybrid nanoparticles to RMGI as orthodontic adhesive caused no significant change in SBS of orthodontic metal brackets while addition of 10wt% hybrid nanoparticles significantly decreased the SBS. Nonetheless, all the SBS values were within the clinically acceptable range. Addition of hybrid nanoparticles had no significant effect on the ARI score.

Application of laser on enamel surface with three types of bioactive glasses-based resin infiltrants: An in vitro study

OBJECTIVE

The study aimed to evaluate and compare the surface micro-hardness, roughness, color, and morphology of enamel after Er,Cr:YSGG laser irradiation, followed by application of three types of bioactive glasses-based resin infiltrants, and the samples groups were challenged with the pH cycle.

METHODOLOGY

Experimental photoactivated resin infiltrants were synthesized using dimethacrylate resins, whereby three different types of bioactive glasses (BGs), i.e., 45S5, fluoridated-BG (F-BG), and borosilicate-BG (B-BG), were incorporated into the resin system. Initially, white spot lesions were created artificially on the toosth enamel surface, then irradiated with Er,Cr:YSGG laser. Then, the resin-only and BG-based resins were infiltrated on the enamel surface. All samples were pH challenged for 14 days, and the micro-hardness, surface roughness, surface morphology, and color stability (ΔE) analyses were conducted before and after the 14 days pH challenge.

RESULTS

After laser irradiation, the micro-hardness was significantly high with 45S5 group compared to resin-only (p = 0.021), F-BG (p = 0.042), and B-BG (p = 0.001) groups. After the pH challenge, the micro-hardness values for all groups were reduced significantly (p ≤ 0.05). The surface roughness was least with the resin-only group and showed a non-significant difference with F-BG (p = 0.34) and significant differences with both B-BG (p = 0.005), and 45S5 (p = 0.010) groups. After the pH cycle, the roughness of all groups was increased significantly (p ≤ 0.05), except B-BG group showed a non-significant difference (p = 0.528). The B-BG group showed significantly high ΔE between day 0 and baseline compared to resin-only (p = 0.0008), F-BG (p = 0.017), and 45S5 (p = 0.029), whereas between day 14 and baseline, the lowest ΔE value was observed for B-BG (14.2 ± 2.10) and maximum for the resin-only (20.57 ± 2.47) group. The SEM images showed pitting on the surface of all resin infiltrant groups after 14 days of pH challenge.

CONCLUSION

The morphological difference was observed after the laser irradiation on the enamel surface. The differences in micro-hardness, surface roughness, and color were observed after the application of experimental resin infiltrants and significant differences were observed after the pH challenge.

Zinc and Strontium-Substituted Bioactive Glass Nanoparticle/Alginate Composites Scaffold for Bone Regeneration

The global population is growing older and entering an aging society. Aging results in severe tissue disorder and organ dysfunction. Bone-related injuries are particularly significant. The need for alternative bone replacement materials for human implants has grown over the past few decades. Alginate has the potential for use as a cell scaffold for bone tissue engineering due to its high bio-compatibility. To improve the bioactivity of alginate scaffolds, zinc- and strontium-containing sol-gel-derived bioactive glass nanoparticles (Zn-Sr-BGNPs) with sizes ranging from 100 to l40 nm were incorporated. Zn-Sr-BGNPs synthesized through the sol-gel process have a high sur-face-to-volume ratio, homogeneity, and purity, resulting in faster degradation. The therapeutic bivalent ions released from Zn-Sr-BGNPs strengthen the cell scaffold and improve the stimulation of the production and development of bone cells. Zn-Sr-BGNPs with different Zn to Si nominal ratios of 0, 1, and 1.5 were mixed with alginate in this research. The ratio of Zn in Zn-Sr-BGNPs and the ratio of Zn-Sr-BGNPs in scaffolds impact the pore size, swelling, and biological properties of synthesized composite scaffolds. The surface area and pore volume of a 1:1 1Zn-Sr-BGNP:Alg composite scaffold were 22.58 m²/g and 0.055 cm³/g, respectively. The incorporation of Zn-Sr-BGNPs improved the mechanical performance of the scaffolds up to 4.73 ± 0.48 MPa. The swelling rate decreased slightly from 2.12 (pure Alg) to 1.50 (1Zn-Sr-BGNP:Alg (1:1)). The 1Zn-Sr-BGNP:Alg (1:1) composite scaffold promoted bioactivity through apatite layer formation, increased bone cell proliferation via the dissolution products released from the scaffold, enhanced calcium deposition, and facilitated cell attachment. Thus, 1Zn-Sr-BGNP:Alg (1:1) composite scaffold is proposed as a possible artificial bone scaffold in bone tissue regeneration.

Effects of Acidic Environments on Dental Structures after Bracket Debonding

Brackets are metallic dental devices that are very often associated with acidic soft drinks such as cola and energy drinks. Acid erosion may affect the bonding between brackets and the enamel surface. The purpose of this study was to investigate the characteristics of brackets' adhesion, in the presence of two different commercially available drinks. Sixty human teeth were divided into six groups and bonded with either resin-modified glass ionomer (RMGIC) or resin composite (CR). A shared bond test (SBS) was evaluated by comparing two control groups with four other categories, in which teeth were immersed in either Coca-Cola^TM or Red Bull^TM energy drink. The debonding between the bracket and enamel was evaluated by SEM. The morphological aspect correlated with SBS results showed the best results for the samples exposed to artificial saliva. The best adhesion resistance to the acid erosion environment was observed in the group of teeth immersed in Red Bull^TM and with brackets bonded with RMGIC. The debonded structures were also exposed to Coca-Cola^TM and Red Bull^TM to assess, by atomic force microscopy investigation (AFM), the erosive effect on the enamel surface after debonding and after polishing restoration. The results showed a significant increase in surface roughness due to acid erosion. Polishing restoration of the enamel surface significantly reduced the surface roughness that resulted after debonding, and inhibited acid erosion. The roughness values obtained from polished samples after exposure to Coca-Cola^TM and Red Bull^TM were significantly lower in that case than for the debonded structures. Statistical results evaluating roughness showed that Red Bull^TM has a more erosive effect than Coca-Cola™. This result is supported by the large contact surface that resulted after debonding. In conclusion, the prolonged exposure of the brackets to acidic drinks affected the bonding strength due to erosion propagation into both the enamel-adhesive interface and the bonding layer. The best resistance to acid erosion was obtained by RMGIC.

Development of a remineralizing calcium phosphate nanoparticle-containing self-etching system for orthodontic bonding

Objectives

This study aimed to incorporate hydroxyapatite nanoparticles (nHA) or amorphous calcium phosphate nanoparticles (nACP) into a self-etch primer (SEP) to develop a simplified orthodontic bonding system with remineralizing and enamel preserving properties.

Materials and Methods

nHA and nACP were incorporated into a commercial SEP (Transbond™ plus) in 7% weight ratio and compared with the plain SEP as a control. Shear bond strengths (SBS), enamel damage, and adhesive remnant index (ARI) scores were evaluated at 24 h and post 5000 thermocycling. Field-emission scanning electron microscope (FESEM) was used to inspect the distribution of the nanoparticles in the experimental SEPs and evaluate the enamel surface integrity both before bracket bonding and post bracket debonding. Phase determination and remineralizing capability of the modified SEP were characterized by X-ray diffraction and Raman spectroscopy, respectively.

Results

The addition of nHA or nACP to the SEP significantly reduced the SBS, ARI, and enamel damage (p < 0.05) as compared to the control SEP; however, only nHA-SEP survived the thermocycling protocol and yielded acceptable SBS (13.38 MPa). Enamel remineralizing ability of the developed nHA-SEP was confirmed by both FESEM images and Raman phosphate map.

Conclusions

Incorporating nHA into SEP resulted in clinically acceptable bond strengths with remineralizing ability.

Clinical relevance

The newly developed nHA-SEP has unprecedented ability to simultaneously etch, prime, and remineralize the enamel in a single step leaving immaculate enamel surface with the potential of saving cost and time at the post-debonding step.

Bioinspired Anti-demineralization Enamel Coating for Orthodontics

White spot lesions and enamel cracks are the 2 most prominent diseases that occur after orthodontic treatment and are caused by enamel demineralization from accumulated bacterial biofilms and/or enamel damage caused by the removal of residual adhesive after bracket debonding. Inspired by the self-assembled amelogenin nanoribbons in enamel, we developed an enamel coating with a self-assembling antimicrobial peptide, D-GL13K, to simultaneously reduce demineralization and residual adhesive. The self-assembled amphiphilic nanoribbons significantly increased the hydrophobicity of the etched enamel, which reduced the permeability of the coated enamel surfaces as desired. The antimicrobial activity of this coating was evaluated against Streptococcus mutans by colony-forming unit counting and live/dead assays. The anti-demineralization effect was demonstrated by the reduced demineralization depth analyzed by optical coherence tomography and the increased Vickers hardness. The coatings did not reduce the shear bond strength but significantly reduced the adhesive remnant index score. This bioinspired enamel coating may provide a new strategy for preventing white spot lesions and enamel cracks after orthodontic treatment.

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.

Application of antibacterial nanoparticles in orthodontic materials

During the orthodontic process, increased microbial colonization and dental plaque formation on the orthodontic appliances and auxiliaries are major complications, causing oral infectious diseases, such as dental caries and periodontal diseases. To reduce plaque accumulation, antimicrobial materials are increasingly being investigated and applied to orthodontic appliances and auxiliaries by various methods. Through the development of nanotechnology, nanoparticles (NPs) have been reported to exhibit excellent antibacterial properties and have been applied in orthodontic materials to decrease dental plaque accumulation. In this review, we present the current development, antibacterial mechanisms, biocompatibility, and application of antibacterial NPs in orthodontic materials.

Enhanced antimicrobial and remineralizing properties of self-adhesive orthodontic resin containing mesoporous bioactive glass and zwitterionic material

Abstract Background/purpose

Self-adhesive resins (SARs) do not require additional restorative adhesives and provide adequate adhesion to mineralized dental structures by shortening the bonding time in clinics where moisture control and isolation are difficult. The aim of this study was to evaluate the mechanical and biological properties of SARs containing mesoporous bioactive glass nanoparticles (MBNs) and 2-methacryloyloxyethyl phosphorylcholine (MPC) and to determine their antibacterial and remineralization effects.

Materials and methods

MBNs and MPC were added to SARs to improve their physical properties and remineralization ability. The experimental resins assessed in this study were SARs mixed with 3%MPC, 5%MPC, 1%MBN+3%MPC, or 3%MBN+3%MPC. The shear bond strength, microhardness, adhesive remnant index, ion dissolution, degree of conversion, and antibacterial properties of the SARs were evaluated. To assess the remineralization properties, micro-computed tomography analysis was performed after pH cycling.

Results

Increasing the MBN content in SAR resulted in higher microhardness compared to the control SAR. The shear bond strength decreased in the SAR+5%MPC group and increased in the SAR+1%MBN+3%MPC and SAR+3%MBN+5%MPC groups.

Conclusion

Our findings suggest that SARs containing MBNs and MPC have antibacterial and remineralization effects on the enamel.

Sol-gel bioactive glass containing biomaterials for restorative dentistry: A review

OBJECTIVE

Bioactive glasses (BAGs) have been researched extensively for dentistry due to their favourable biocompatibility and hard tissue bonding ability. However, the specific application of BAGs produced through sol-gel synthesis in restorative dentistry has not been reviewed previously. This review provides a comprehensive account of the principles behind sol-gel derived BAGs and their investigation for dental tissue restoration materials.

METHODS

A search for in vitro and in vivo studies was performed using the databases Web of Science®, Medline®, Scopus® and Google Scholar®. Articles published over the past 20 years were selected and data on the BAG composition and morphology was extracted. Analysis of the effect of specific BAG additives on the properties of experimental dental materials was also performed.

RESULTS

A majority of BAG particles investigated were spheres ranging in size from 5 nm to ~650 µm. Sol-gel BAGs are mainly applied in the treatment of hypersensitive dentine and for pulp-dentine tissue engineering, while a handful have been used in target drug delivery. BAG fillers are promising additives that result in improved biological properties, antibacterial effects, hardness, acid buffering and remineralization. Unfortunately, some detrimental effects on optical properties have been observed with BAG addition. Additionally, in vivo data, investigations into radiopacity and standardization of test protocols are identified as areas for improvement and further studies.

SIGNIFICANCE

Future work should consider the pertinent issues raised in order to improve the quality of available data and expand knowledge in this area of dental biomaterials research and development.

In vitroandin vivostudy of magnesium containing bioactive glass nanoparticles modified gelatin scaffolds for bone repair

Magnesium containing bioactive glass nanoparticles modified gelatin scaffolds (MBGNs/Gel scaffolds) have shown recently the potential for bone regeneration due to its good biocompatibility, bioresorbability and bioactivity. Nevertheless, its use is limited by its complicated manufacturing process and a relatively expensive price. In this study, MBGNs were prepared by sol-gel process. The MBGNs/Gel was synthesized by a simple immersion method. SEM, transmission electron microscopy and dynamic light scattering analysis showed that the particles had spherical morphology with mean particle size of 100 nm. The MBGNs/Gel scaffolds were observed by SEM. The scaffolds showed connected pore structure with pore size ranging from 100 to 300 μm. SEM images with high magnification showed the existence of MBGNs on the surface of micro-pores. The ion release results revealed the release of Mg, Ca and Si elements from the MBGNs. MTT assay and cytotoxicity studies indicated that, the scaffolds provide a suitable ion related micro-environment for cell attachment and spreading. The Reverse Transcription-Polymerase Chain Reaction (RT-PCR) results showed the scaffolds could promote the osteogenesis of MC3T3-E1. Thein vivostudy also showed higher amount of new bone and trabecular bone which indicated excellent bone induction and conduction property of modified scaffolds. So, the developed MBGNs/Gel scaffolds are a potential candidate for bone regeneration applications.

Polymeric Dental Nanomaterials: Antimicrobial Action

This review aims to describe and critically analyze studies published over the past four years on the application of polymeric dental nanomaterials as antimicrobial materials in various fields of dentistry. Nanoparticles are promising antimicrobial additives to restoration materials. According to published data, composites based on silver nanoparticles, zinc(II), titanium(IV), magnesium(II), and copper(II) oxide nanoparticles, chitosan nanoparticles, calcium phosphate or fluoride nanoparticles, and nanodiamonds can be used in dental therapy and endodontics. Composites with nanoparticles of hydroxyapatite and bioactive glass proved to be of low efficiency for application in these fields. The materials applicable in orthodontics include nanodiamonds, silver nanoparticles, titanium(IV) and zinc(II) oxide nanoparticles, bioactive glass, and yttrium(III) fluoride nanoparticles. Composites of silver nanoparticles and zinc(II) oxide nanoparticles are used in periodontics, and nanodiamonds and silver, chitosan, and titanium(IV) oxide nanoparticles are employed in dental implantology and dental prosthetics. Composites based on titanium(IV) oxide can also be utilized in maxillofacial surgery to manufacture prostheses. Composites with copper(II) oxide nanoparticles and halloysite nanotubes are promising materials in the field of denture prosthetics. Composites with calcium(II) fluoride or phosphate nanoparticles can be used in therapeutic dentistry for tooth restoration.

Effects of hybrid inorganic-organic nanofibers on the properties of enamel resin infiltrants - An in vitro study

This in vitro study aimed to evaluate the overall mechanical properties of resin infiltrants doped with bioactive nanofibers and their ability in inhibiting enamel demineralization or achieving remineralization of the adjacent enamel to white spots. A commercial resin infiltrant (ICON, DMG) was doped with hybrid inorganic-organic nanofibers and analyzed for degree of conversion (DC, n = 3) and surface hardness (SH, n = 6). Subsequently, enamel specimens (6 × 4 × 2 mm³) were prepared and submitted to a demineralizing/remineralizing process to produce a subsurface caries-like lesion. The specimens were treated with one of the following materials: ICON infiltrant, DMG (control); ICON + nanofibers of poly-lactic acid (PLA)-filled with silica (PLA-SiO₂); ICON + nanofibers of (PLA)-filled with calcium incorporated into a silica network (SiO₂-CaP). Then, the specimens were subjected to a pH-cycling demineralizing/remineralizing model for 7 days at 37 °C. The %ΔSH change (after treatment), %SH loss and %SH recovery (after pH-cycling regimen) were calculated after SH evaluation (n = 9/group). The Ca/P weight ratio before and after pH-cycling regimen was evaluated through SEM/EDX. The results of DC were analyzed through the T-test (p < 0.05). ANOVA followed by Tukey's test (p < 0.05) was performed for hardness and EDX. A significant SH increase was observed in the ICON/SiO₂CaP group (p < 0.05). The ICON/PLA-SiO₂ presented higher DC values than the control group (p = 0.043). All groups presented significant difference in %ΔSH (p < 0.05), although the specimens treated with ICON/SiO₂CaP presented greater values. Regarding the %SHL and %SHR, the ICON/SiO₂CaP and ICON/PLA-SiO₂ were significantly different compared to the control group (p < 0.001). However, no difference was observed between the ICON/SiO₂CaP and ICON/PLA-SiO_2. The Ca/P ratio showed that the ICON/SiO₂CaP and ICON/PLA-SiO₂ after the pH-cycling regimen differed from sound enamel and modified infiltrants before pH-cycling. In conclusion, tailored hybrid nanofibers may be incorporated into enamel resin infiltrants without compromise the mechanical properties of such experimental materials. These latter can inhibit the demineralization of enamel and increase its hardness during pH-clycling challange.

Experimental Bioactive Glass-Containing Composites and Commercial Restorative Materials: Anti-Demineralizing Protection of Dentin

The purpose of this in vitro study was to investigate whether different types of experimental and commercial restorative dental materials can protect dentin against acid-induced softening. Experimental composites were prepared with a photocurable mixture of methacrylates and two types of bioactive glass (45S5 and a customized low-Na F-containing formulation). Human dentin samples were prepared from mid-coronal tooth slices and immersed in lactic acid solution (pH = 4.0) at 5 mm from set specimens of restorative material. After 4, 8, 12, 16, 20, 24, 28, and 32 days, surface microhardness of dentin samples and pH of the immersion solution were measured, followed by replenishing of the immersion medium. Microstructural analysis was performed using scanning electron microscopy. The protective effect of restorative materials was determined as dentin microhardness remaining statistically similar to initial values for a certain number of acid additions. Scanning electron microscopy showed a gradual widening of dentinal tubules and proved less discriminatory than microhardness measurements. To produce a protective effect on dentin, 20 wt% of low-Na F-containing bioactive glass was needed, whereas 10 wt% of bioactive glass 45S5 was sufficient to protect dentin against acid-induced demineralization. The anti-demineralizing protective effect of experimental and commercial restoratives on dentin was of shorter duration than measured for enamel in a previous study using the same experimental approach.

Effect of Strontium-Doped Bioactive Glass on Preventing Formation of Demineralized Lesion

This study investigated the effect of strontium-doped bioactive glass (SBAG) on the formation of dental demineralized lesions. Materials and methods: The study materials were 48 sound human tooth specimens with both dentine and enamel, divided equally into four groups: Group 1 (SBAG), Group 2 (SBAG+Fluoride), Group 3 (Fluoride), and Group 4 (Water as control). After 14 days of pH cycling, the surface morphology of the specimens was observed by scanning electron microscopy. Crystal characteristics of the precipitates were assessed by X-ray diffraction (XRD). Micro-CT was used to measure the mineral loss and the depths of the demineralized lesions formed. Results: Exposure of collagen in inter-tubular areas in dentine was seen in the control group (Group 4) but not in Groups 1 to 3. In Group 2, there were obvious granular particles on the surface of the dentine. XRD revealed precipitation of apatites on the surface of the tooth specimens in Groups 1 to 3. The mean lesion depths in dentine were 81.80 μm, 30.68 μm, 39.04 μm, and 146.36 μm in Groups 1 to 4, respectively (p < 0.001). Lesions in enamel were only found in the control group. The mean mineral loss values in the dentine lesions were 1.25 g/cm³, 0.88 g/cm³, 0.87 g/cm³, and 1.65 g/cm³, in Groups 1 to 4, respectively (p < 0.001). Conclusion: Strontium-doped bioactive glass has a preventive effect on the formation of demineralized lesions in enamel and dentine.

Role of bioglass in enamel remineralization: Existing strategies and future prospects-A narrative review

Enamel, once formed, loses the ability to regenerate due to the loss of the formative ameloblasts. It is subjected to constant damaging events due to exposure to external agents and oral microbiomes. An enamel remineralization process targets to replenish the lost ionic component of the enamel through a multitude of methods. Enamel remineralization is highly challenging as it has a complex organized hierarchical microstructure. Hydroxyapatite nanocrystals of the enamel vary in size and orientation along alignment planes inside the enamel rod. The inability of the enamel to remodel unlike other mineralized tissues is another substantial deterrent. One of the well-known biomaterials, bioglass (BG) induces apatite formation on the external surface of the enamel in the presence of saliva or other physiological fluids. Calcium, sodium, phosphate, and silicate ions in BG become responsive in the presence of body fluids, leading to the precipitation of calcium phosphate. Studies have also demonstrated the bactericidal potential of BG against Streptococcus mutans biofilms. The anticariogenicity and antibacterial activity were found to be enhanced when BG was doped with inorganic ions such as F, Ag, Mg, Sr, and Zn. Due to the versatility of BG, it has been combined with a variety of agents such as chitosan, triclosan, and amelogenin to biomimic remineralization process. Key strategies that can aid in the development of contemporary enamel remineralization agents are also included in this review.

Anti-Microbial and Remineralizing Properties of Self-Adhesive Orthodontic Resin Containing Mesoporous Bioactive Glass

Self-adhesive resins (SARs) contain adhesives, which simplify the procedures of resin application, and primers, which provide sufficient bonding ability. In this study, mesoporous bioactive glass nanoparticles (MBN) were added to a SAR to easily improve the physical properties and remineralization ability. The experimental resins comprised 1%, 3%, and 5% MBN mixed in Ortho Connect Flow (GC Corp, Tokyo, Japan). As the MBN content in the SAR increased, the microhardness increased, and a statistically significant difference was observed between the cases of 1% and 5% MBN addition. Shear bond strength increased for 1% and 3% MBN samples and decreased for 5% MBN. The addition of MBN indicated a statistically significant antibacterial effect on both gram-negative and gram-positive bacteria. The anti-demineralization experiment showed that the remineralization length increased with the MBN content of the sample. Through the above results, we found that SAR containing MBN has antibacterial and remineralization effects. Thus, by adding MBN to the SAR, we investigated the possibility of orthodontic resin development, wherein the strength is enhanced and the drawbacks of the conventional SAR addressed.

Effect of the addition of Chitosan and TiO2nanoparticles on antibacterial properties of an orthodontic composite in fixed orthodontic treatment: a randomized clinical trial study

Due to the existing demands for methods independent of patient co-operation in preventing and overcoming the incidence of white spot lesions (WSLs) and caries in fixed orthodontic treatments, several studies have considered the modification of orthodontic composites using antimicrobial nanomaterials. In this regard, the aim of this study is to investigate the effect of the addition of chitosan nanoparticles (NPs) and TiO₂NPs onStreptococcus mutans(S. mutans) counts and the enamel mineral content in fixed orthodontic patients. A double-blind randomized clinical trial study was carried out in 24 patients (i.e., 48 upper second premolars and 48 maxillary lateral incisors) who were candidates for fixed orthodontic treatment. In the case of the control group, the bracket was bonded to the tooth with an orthodontic adhesive (Transbond XT, 3M Unitek, USA) while, in the experimental group, the bracket was bonded to the tooth with Transbond XT containing 1% chitosan NPs and 1% TiO₂NPs. For the maxillary lateral incisor and upper second premolar teeth, theS. mutanscounts around the brackets were measured, through the usage of real-time PCR, at the time points of 1 day, 2 months, and 6 months after bonding the brackets to the tooth. Furthermore, the enamel mineral content measurement was also performed around the brackets at 1 day, 2 months, and 6 months after bonding the brackets to the tooth. TheS. mutanscounts were analyzed using Friedman and Mann-Whitney U tests. The Repeated measures ANOVA test and Independent samples T-test were also applied, in order to evaluate the mineral content. According to the results, there was a significant reduction in theS. mutanscounts of experimental group at the time points of 1 day, 2 months, and 6 months in both maxillary lateral incisor and upper second premolar teeth. However, we did not observe any significant differences in the control group between the reports at 1 day, 2 months, and 6 months in both maxillary lateral incisor and upper second premolar teeth. The outcomes of this study indicate that, with regard to maxillary lateral incisor teeth, there were no significant differences between the results of the experimental group and control group at the time points of 1 day, 2 months, and 6 months. Furthermore, with respect to the upper second premolar teeth, no significant differences were observed between the two groups at 1 day and 2 months; however,S. mutanscounts were significantly lower in the experimental group than in the control group at the time point of 6 months. Moreover, our gathered data confirmed the absence of any significant differences between the experimental group and control group, in terms of enamel mineral content, at the time intervals of 1 day, 2 months, and 6 months. In conclusion, the incorporation of chitosan NPs and TiO₂NPs in orthodontic composites induces an antibacterial property in the resultant adhesive to be used for fixed orthodontic treatment.

Anti-demineralizing protective effects on enamel identified in experimental and commercial restorative materials with functional fillers

The aim of this study was to investigate whether experimental and commercial dental restorative materials with functional fillers can exert a protective anti-demineralizing effect on enamel that is not immediately adjacent to the restoration. Four experimental resin composites with bioactive glass and three commercial restorative materials were investigated. Enamel blocks were incubated in a lactic acid solution (pH = 4.0) at a standardized distance (5 mm) from cured specimens of restorative materials. The lactic acid solution was replenished every 4 days up to a total of 32 days. Surfaces of enamel blocks were periodically evaluated by Knoop microhardness measurements and scanning electron microscopy. The protective effect of restorative materials against acid was identified as enamel microhardness remaining unchanged for a certain number of 4-day acid addition cycles. Additionally, the pH of the immersion medium was measured. While enamel microhardness in the control group was maintained for 1 acid addition cycle (4 days), restorative materials postponed enamel softening for 2–5 cycles (8–20 days). The materials capable of exerting a stronger alkalizing effect provided longer-lasting enamel protection. The protective and alkalizing effects of experimental composites improved with higher amounts of bioactive glass and were better for conventional bioactive glass 45S5 compared to a fluoride-containing bioactive glass. Scanning electron micrographs evidenced the protective effect of restorative materials by showing a delayed appearance of an etching pattern on the enamel surface. A remotely-acting anti-demineralizing protective effect on enamel was identified in experimental composites functionalized with two types of bioactive glass, as well as in three commercial ion-releasing restorative materials.

Drug Delivery (Nano)Platforms for Oral and Dental Applications: Tissue Regeneration, Infection Control, and Cancer Management

The oral cavity and oropharynx are complex environments that are susceptible to physical, chemical, and microbiological insults. They are also common sites for pathological and cancerous changes. The effectiveness of conventional locally-administered medications against diseases affecting these oral milieus may be compromised by constant salivary flow. For systemically-administered medications, drug resistance and adverse side-effects are issues that need to be resolved. New strategies for drug delivery have been investigated over the last decade to overcome these obstacles. Synthesis of nanoparticle-containing agents that promote healing represents a quantum leap in ensuring safe, efficient drug delivery to the affected tissues. Micro/nanoencapsulants with unique structures and properties function as more favorable drug-release platforms than conventional treatment approaches. The present review provides an overview of newly-developed nanocarriers and discusses their potential applications and limitations in various fields of dentistry and oral medicine.

The Efficiency of Fluoride Bioactive Glasses in Protecting Enamel Surrounding Orthodontic Bracket

Objectives

The aim of this study was to evaluate the protective effect of using four different fluoride bioactive enamel sealers against an acidic erosion challenge.

Materials and Methods

A sample of 50 freshly extracted sound upper premolars had their buccal surface bonded to 50 orthodontic brackets using Transbond PLUS color change adhesive; the first four groups had four compositions of fluoride bioactive glasses based on 37 mol% SiO₂, 43.9-53.9 mol% CaO, 6.1 mol% P₂O₅ and CaF₂, and 0-10 mol% of Na₂O applied to their surfaces and the fifth group served as control (which was not treated by any bioactive sealer). All specimens were challenged by 1% citric acid for 18 minutes which was stirred by a magnetic stirrer. The enamel surfaces next to the orthodontic brackets were examined by SEM. The Wilcoxon signed-rank test was used to compare the area covered by the fluoride bioactive pastes before/after erosion (p < 0.05). Samples from the layer formed on top of the examined teeth were tested before/after erosion to be examined by the attenuated total reflectance Fourier-transform infrared spectroscopy (FTIR/ATR).

Results

The FTIR/ATR test showed that fluoride bioactive pastes' applications resulted in the formation of a hydroxyapatite-rich layer; the SEM analysis showed that the aforementioned layer significantly resisted erosion challenge when compared to the control group (p < 0.05).

Conclusions

Fluoride bioactive pastes can efficiently protect the enamel surfaces next to orthodontic brackets from acidic erosion challenges.

Hypersensitivity of teeth after orthodontic treatment in adolescence

Relevance. In adolescence, focal demineralization after orthodontic treatment is highly prevalent. This, in turn, leads to symptomatic hypersensitivity in the absence of other predisposing factors (recessions, exposure of cervical dentin, increased abrasion, etc.). Reviewed the mechanism for reducing hypersensitivity and remineralizing of calcium-sodium phosphosilicate, also the effectiveness of using a prophylactic toothpaste with this component in adolescents.

Materials and methods. A single-center, non-comparative open study was conducted to evaluate the  effectiveness of the Sensodyne Restoration and Protection toothpaste at the Department of Pediatric Dentistry and Orthodontics, USMU for 4 weeks. 22 adolescents aged 14-16 years with focal demineralization of enamel in the stain stage after completion of orthodontic treatment participated in the study.

Results. The use of toothpaste with calcium-sodium phosphosilicate after a month of use leads to a decrease in the hygiene index by 23.38%, a decrease in hypersensitivity according to the results of the Schiff air index by  56.94% (p ≤ 0.05), and a tendency to an increase in the level of mineralization and a decrease in areas of white  spot lesions.

Conclusions. Toothpaste with calcium-sodium phosphosilicate has a cleansing effect and reduces sensitivity and can be recommended for adolescents with focal demineralization against the background of orthodontic  treatment.

The Effect of Bioactive Glass-Enhanced Orthodontic Bonding Resins on Prevention of Demineralization: A Systematic Review

At present, bioactive glasses (BAGs) are demonstrating promising results in the remineralization of hard tissues. Their bioactive properties can potentially overcome the demineralization effect accompanying orthodontic treatment. This review aimed to evaluate the effectiveness of bioactive glass enhanced orthodontic bonding resins on enamel remineralization, in addition to their antibacterial, ion release and acid neutralization effect. Four databases (PubMed, MEDLINE, Web of Science and Scopus) were searched. Two hundred and fifty-one full-text articles were screened independently, out of which seven studies satisfied the inclusion criteria. Quality appraisal was performed by two independent reviewers. Methodologies used to assess the anti-demineralization effect included Micro-Computed Tomography, Polarized Light Microscopy and Hardness Testing (Knoop and Berkovich). All seven articles confirmed the superior remineralization effect of BAG orthodontic bonding resins compared to their non-BAG counterparts. A proportional relationship was proved between BAG concentrations and increased anti-demineralization effect. The addition of antibacterial agents to BAG does not necessarily improve its anti-demineralization effect. Although studies have confirmed the effectiveness of BAG orthodontic bonding resins on enamel remineralization, there was a degree of heterogeneity across studies due to the lack of an in vitro studies standardized protocol.

Biomimetic Effect of Nano-Hydroxyapatite in Demineralized Enamel before Orthodontic Bonding of Brackets and Attachments: Visual, Adhesion Strength, and Hardness in In Vitro Tests

Dietary habits with high consumption of acidic food can induce in orthodontic patients an increased risk of demineralization lesions around orthodontic brackets and bands. The purpose of the present laboratory study is to assess the in vitro visual efficacy of a biomimetic nano-hydroxyapatite remineralizing solution in a hypomineralized enamel surface and its effect on adhesion of fixed orthodontic appliances and on enamel microhardness. Intact teeth were demineralized, and subsequently the areas of demineralization were visually recorded using a 0-100 scale. Subsequently, a remineralizing solution (Biorepair® Repair Shock Treatment) was applied for ten minutes once a day/for one week per month for a total remineralizing treatment of 3 months. Visual effects were recorded. Moreover, bond strength was recorded and adhesive remnant index scores were measured for both orthodontic brackets and composite attachments both before demineralization and after demineralization and application of remineralizing solution. Also, Vickers microhardness was measured. All data were submitted to statistical analysis. The application of remineralizing solution induced a significant in vitro reduction of demineralized areas after the first week of application. No significant differences between untreated enamel surfaces and remineralized surfaces were detected after 2 months of remineralizing treatment. Bond strength values were significantly reduced for both brackets and attachments after remineralizing treatment. However, attachments showed higher adhesion values than brackets in both conditions tested. Remineralized enamel showed significantly higher microhardness values than demineralized enamel and lower values than intact enamel.

In Vitro Effect of Gallium-Doped Bioactive Glass on Enamel Anti-Demineralization and Bond Strength of Orthodontic Resins

White spot lesions (WSL) that occur on teeth after orthodontic appliances have been attached are caused by bacterial demineralization of the enamel surface. This study investigated the anti-demineralization effect of orthodontic resins containing mesoporous bioactive glass nanoparticles (MBN) doped with gallium, which has antibacterial activity, as well as MBN with increased calcium and phosphate contents as these ions can remineralize enamel. Resins (CF, CharmFill Flow, Dentkist, Seoul, South Korea) containing 1%, 3%, and 5% Ga-doped MBN (GaMBN) were characterized using scanning electron microscopy with energy dispersive X-ray spectroscopy (SEM-EDX), X-ray diffraction (XRD), Fourier transform infrared (FTIR) spectroscopy, and isothermal tests, and their physical properties were measured in terms of Vickers microhardness, bracket retention force, and adhesive remnant index (ARI). Cell viability in the resins was confirmed by testing human dental pulp stem cells (hDPSCs), and ion release tests were performed after 1, 7, and 14 days to determine whether the resins released Ga3+, Ca2+, and PO43–. After 14 days, antibacterial activity was determined using Streptococcus mutans (S. mutans)—the bacteria that causes tooth decay—and the chemical remineralization effect was investigated using a cycle of acid–base solutions. The microhardness of the resins increased with GaMBN concentration whereas their bracket retention force, ARI, and cell viability remained unchanged. The bacterial activity of the 5%-GaMBN resin decreased after 24 and 48 h; however, the change in activity was not statistically significant. Anti-demineralization testing demonstrated that the degree of enamel demineralization decreased as the GaMBN concentration increased, which indicates that resins containing 5%-GaMBN may be viable orthodontic adhesives for preventing WSLs.

Shear Bonding Strength and Thermal Cycling Effect of Fluoride Releasable/Rechargeable Orthodontic Adhesive Resins Containing LiAl-F Layered Double Hydroxide (LDH) Filler

This study aims to investigate the shear bonding strength (SBS) and thermal cycling effect of orthodontic brackets bonded with fluoride release/rechargeable LiAl-F layered double hydroxide (LDH-F) contained dental orthodontic resin. 3% and 5% of LDH-F nanopowder were gently mixed to commercial resin-based adhesives Orthomite LC (LC, LC3, LC5) and Transbond XT (XT, XT3). A fluoroaluminosilicate modified resin adhesive Transbond color change (TC) was selected as a positive control. Fifteen brackets each group were bonded to bovine enamel and the SBS was tested with/without thermal cycling. The adhesive remnant index (ARI) was evaluated at 20× magnification. The fluoride-releasing/rechargeability and cytocompatibility were also evaluated. The SBS of LC, LC3, and LC5 were significantly higher than XT and TC. After thermal cycling, the SBS of LC, LC3, and LC5 did not decrease and was significantly higher than TC. The changes of ARI scores indicate that failure occurred not only cohesive but also semi-cohesive fracture. The 30 days accumulated daily fluoride release of LC3, LC5, and TC without recharge are higher than 300 μg/cm². The LDH-F contained resin adhesive possesses higher SBS compared to positive control TC. Fluoride release and the rechargeable feature can be achieved for preventing enamel demineralization without cytotoxicity.