Antimicrobial Efficacy of Glass Ionomer Cement in Incorporation with Biogenic Zingiber officinale Capped Silver-Nanobiotic, Chlorhexidine Diacetate and Lyophilized Miswak

Incorporating nanosilver with glass ionomer cement-A literature review

OBJECTIVES

The objectives of this study were to retrieve and review studies that incorporated nanosilver with GIC and summarise the evidence regarding the properties of nanosilver-modified GIC.

MATERIALS AND METHODS

Two independent researchers performed a literature search using the keywords (nanosilver OR nano-silver OR (nano silver) OR (silver nanoparticles)) AND (GIC OR (glass ionomer cement) OR (glass ionomer cements)) in PubMed, Web of Science and ScienceDirect.

RESULTS

A total of 368 articles were identified. After removing duplicate results, titles and abstracts were screened for eligibility. Full texts of publications that investigated the manufacture and properties of nanosilver-modified GIC were retrieved and analysed. Finally, 21 studies were included.

CONCLUSIONS

All of the studies reviewed in this investigation included the incorporation of nanosilver in GIC. The proportions of nanosilver added into GIC varied from 0.05 % to 50 %. Thirteen studies investigated the antimicrobial properties of nanosilver-modified GIC; all studies supported that adding nanosilver enhanced antimicrobial effectiveness. Nineteen studies reported the mechanical properties including compressive strength, flexure strength, tensile strength, and microhardness of nanosilver-modified GIC; but the results were inconclusive. Four studies tested the bonding strength of nanosilver-modified GIC to dentine and found that adding nanosilver would not influence the bonding property of GIC. Some studies explored fluoride release level, colour stability, and cytotoxicity of nanosilver-modified GIC; but the results were all inconclusive.

CLINICAL SIGNIFICANCE

This literature review is the first study to retrieve and summarise the findings and evidence regarding nanosilver-modified GIC research. It can provide clinicians with clinically relevant information about novel GIC materials that can be used in their treatment decisions.

Compressive strength and fluoride release profile of a glass ionomer cement reinforced with silver-hydroxyapatite-silica hybrid nanoparticles: An in vitro study

OBJECTIVES

This study aimed to prepare a glass ionomer (GI) cement reinforced with silver-hydroxyapatite-silica (Ag/HA/Si) hybrid nanoparticles and assess its compressive strength and fluoride release profile.

MATERIAL AND METHODS

In this in vitro, experimental study, 60 cylindrical specimens were fabricated with 4mm diameter and 6mm height in 6 groups (n=10) using BracePaste composite, GC Fuji II LC pure RMGI, and RMGI reinforced with 0.1wt%, 0.5wt%, 1wt%, and 2wt% Ag/HA/Si hybrid nanoparticles. The specimens were subjected to compressive force in a universal testing machine to measure their compressive strength (MPa). To assess their fluoride release profile, discs with 3mm diameter and 2mm thickness were fabricated from Fuji II LC pure resin-modified glass ionomer (RMGI), and RMGI with 0.1wt%, 0.5wt%, 1wt%, and 2wt% hybrid nanoparticles, and the concentration of released fluoride was measured by a digital ion-selective electrode. Data were analysed by ANOVA and Scheffe test (alpha=0.05).

RESULTS

The compressive strength was 114.14MPa for BracePaste composite, and 97.14, 97.84, 100.65, 109.5, and 89.33MPa for GI groups with 0%, 0.1%, 0.5%, 1% and 2% hybrid nanoparticles, respectively, with no significant difference among them (P=0.665). Addition of 1% (0.21±0.07μg/mL, P=0.029) and 2% (0.45±0.22μg/mL, P=0.000) hybrid nanoparticles to RMGI significantly increased the amount of released fluoride, compared with the control group (0.09±0.03μg/mL).

CONCLUSIONS

Addition of Ag/HA/Si hybrid nanoparticles to RMGI in the tested concentrations had no significant effect on its compressive strength but addition of 1wt% and 2wt% concentrations of Ag/HA/Si hybrid nanoparticles increased its fluoride release potential.

Addressing Antimicrobial Properties in Guided Tissue/Bone Regeneration Membrane: Enhancing Effectiveness in Periodontitis Treatment

Guided tissue regeneration (GTR) and guided bone regeneration (GBR) are the two surgical techniques generally used for periodontitis disease treatment. These techniques are based on a barrier membrane to direct the growth of new bone and gingival tissue at sites with insufficient volumes or dimensions of bone or gingiva for proper function, esthetics, or prosthetic restoration. Numerous studies have highlighted biocompatibility, space-creation, cell-blocking, bioactivity, and proper handling as essential characteristics of a membrane's performance. Given that bacterial infection is the primary cause of periodontitis, we strongly believe that addressing the antimicrobial properties of these membranes is of utmost importance. Indeed, the absence of effective inhibition of periodontal pathogens has been recognized as a primary factor contributing to the failure of GTR/GBR membranes. Therefore, we suggest considering antimicrobial properties as one of the key factors in the design of GTR/GBR membranes. Antibiotics are potent medications frequently administered systemically to combat microbes and mitigate bacterial infections. Nevertheless, the excessive use of antibiotics has resulted in a surge in bacterial resistance. To overcome this challenge, alternative antibacterial substances have been developed. In this review, we explore the utilization of alternative substances with antimicrobial properties for topical application in membranes. The use of antibacterial nanoparticles, phytochemical compounds, and antimicrobial peptides in this context was investigated. By carefully selecting and integrating antimicrobial agents into GTR/GBR membranes, we can significantly enhance their effectiveness in combating periodontitis. These antibacterial substances not only act as barriers against pathogenic bacteria but also promote the process of periodontal healing.

A Comparative In Vitro Analysis of Antimicrobial Effectiveness and Compressive Strength of Ginger and Clove-Modified Glass Ionomer Cement

Background Glass ionomer cement (GIC) is widely recognized for its self-adhesive characteristics and biocompatibility, making it commonly used as a restorative material. However, challenges related to limited antibacterial effectiveness and relatively low mechanical properties have hindered its widespread clinical use. Clove and ginger are recognized for their potent antimicrobial activity against numerous pathogenic microorganisms. The present study aims to enhance the clinical applicability of GIC by modifying it with clove and ginger extract. Aim The objective of the study is to assess the antimicrobial effectiveness and compressive strength of GIC modified with ginger and clove extract. Materials and methods Ginger and clove extracts were prepared and incorporated into conventional GIC at three concentrations for each, creating ginger-modified GIC groups (Group A, Group B, and Group C) and clove-modified GIC groups (Group D, Group E, and Group F), with Group G as the control (conventional GIC without modification). The antimicrobial assessment was conducted on disc-shaped GIC specimens (3.0 mm height x 6.0 mm diameter) prepared using molds. Bacterial strains were used to evaluate antimicrobial properties, with minimum inhibitory concentration (MIC) assays conducted at intervals of one to four hours for both modified and unmodified groups. Compressive strength specimens were prepared using cylindrical molds (6.0 mm height × 4.0 mm diameter), according to the ISO (International Organization for Standardization) guidelines. The evaluation was conducted using a Zwick universal testing machine (ElectroPuls® E3000, Instron, Bangalore, India), with the highest force at the point of specimen fracture recorded to determine compressive strength. Statistical analysis was conducted utilizing a one-way analysis of variance (ANOVA) alongside Tukey's post hoc test, with a significance threshold set at p < 0.01. Results The antimicrobial effectiveness of clove and ginger-modified GIC was assessed through a MIC assay, revealing a statistically significant improvement in antimicrobial potency against Streptococcus mutans and Lactobacillus within the modified groups compared to the control group (p < 0.01). Increased extract concentration correlated with enhanced antimicrobial activity. Clove-modified GIC exhibited superior antimicrobial efficacy compared to ginger extract. Compressive strength was higher in clove-modified GIC groups (p < 0.01), with Group F showing a maximum value of 175.88 MPa, while other modified groups demonstrated similar results to the control, with a value of 166.81 MPa (p > 0.01). Conclusion The study concludes that both clove-modified GIC and ginger-modified GIC exhibited antimicrobial activity against Streptococcus mutans and Lactobacillus species. The antimicrobial activity was notably higher in clove-modified GIC compared to ginger-modified GIC. Additionally, the compressive strength of clove-modified GIC surpassed all other groups. Thus, clove-modified GIC emerges as a promising restorative material for addressing recurrent caries. Future investigation is necessary to assess the long-term durability of the material.

Miswak-Infused Glass Ionomer Cement: A Comparative In Vitro Analysis of Antibacterial Efficacy and Compressive Strength

BACKGROUND

Glass ionomer cement (GIC) restorations are commonly used in primary dentition, due to their aesthetic appeal, self-adhesive nature, and biocompatibility. However, the material's limited antibacterial activity and inadequate mechanical strength highlight the necessity for modifying the material.

AIM

The study aims to evaluate and compare the antimicrobial potency and compressive strength of GIC-incorporated Miswak extract with that of conventional GIC.

MATERIALS AND METHODS

After obtaining the Miswak extract, a modified GIC was formulated by combining the extract with the conventional GIC powder and liquid components, in three different ratios (Powder: Extract and Liquid), Group I (2:1:1), Group II (3:1:2), Group III (3:2:1), and the Group IV as control, which consist of unmodified/conventional GIC. To evaluate and compare the antibacterial efficacy of the modified and unmodified GIC, standard strains of Streptococcus mutans and Lactobacillus were utilized. For each group, the minimal inhibitory concentration (MIC) assay was tested. For the evaluation of compressive strength, cylindrical moulds were utilized in compliance with ISO 9917-1:2007 standards and tested using the universal testing machine (Instron, ElectroPuls®, Bangalore, IND). The highest force exerted at the point of specimen fracture was recorded to calculate the compressive strength values in MPa. The data obtained were analyzed using the Statistical Package for the Social Sciences (IBM SPSS Statistics for Windows, IBM Corp., Version 24.0, Armonk, NY) software. The statistical analysis was conducted utilizing repeated measures of analysis of variance (ANOVA) to calculate the mean MIC values and compressive strength, with pairwise comparisons assessed using Tukey's post hoc test.

RESULTS

The results proved that the antimicrobial properties of Miswak containing GIC performed better against S. mutans and Lactobacillus with a statistically significant difference when compared with group IV (p<0.05), it has been found that an increase in the concentration of extract increased the antimicrobial potency. Significant results were obtained in compressive strength where Group II (41.49±3.6) and Group III (15.23±4.96) proved to be weaker than the control (62.69±2.58), while Group I showed no differences from the control group (p>0.05).

CONCLUSION

It can be concluded that Group I was found to be better in terms of both antimicrobial properties and compressive strength, where no significant difference in compressive strength was identified when comparing Group I with Group IV. Thus, the overall study depicts that a lesser concentration of extract can be the best option in terms of good antimicrobial properties without altering its strength. Hence, the Miswak containing GIC could be a promising restorative material; further studies should include considering intraoral variables such as masticatory stress, moisture levels and in-vivo tests of this combination.

Herbalism and glass-based materials in dentistry: review of the current state of the art

Half a million different plant species are occurring worldwide, of which only 1% has been phytochemically considered. Thus, there is great potential for discovering novel bioactive compounds. In dentistry, herbal extracts have been used as antimicrobial agents, analgesics, and intracanal medicaments. Glass-ionomer cement (GIC) and bioactive glass (BAG) are attractive materials in dentistry due to their bioactivity, adhesion, and remineralisation capabilities. Thus, this review summarizes the evidence around the use of phytotherapeutics in dental glass-based materials. This review article covers the structure, properties, and clinical uses of GIC and BAG materials within dentistry, with an emphasis on all the attempts that have been made in the last 20 years to enhance their properties naturally using the wisdom of traditional medicines. An extensive electronic search was performed across four databases to include published articles in the last 20 years and the search was concerned only with the English language publications. Publications that involved the use of plant extracts, and their active compounds for the green synthesis of nanoparticles and the modification of GIC and BAG were included up to May 2023. Plant extracts are a potential and effective candidate for modification of different properties of GIC and BAG, particularly their antimicrobial activities. Moreover, natural plant extracts have shown to be very effective in the green synthesis of metal ion nanoparticles in an ecological, and easy way with the additional advantage of a synergistic effect between metal ions and the phytotherapeutic agents. Medicinal plants are considered an abundant, cheap source of biologically active compounds and many of these phytotherapeutics have been the base for the development of new lead pharmaceuticals. Further research is required to assess the safety and the importance of regulation of phytotherapeutics to expand their use in medicine.

Green Synthesized Iron-Coated Silver Nanoparticles: Economic Bimetallic Nanoparticles Potential Against Methicillin-Resistance Staphylococcus aureus

Iron coating was introduced as one of the novel techniques to improve physicochemical and biological properties of silver nanoparticles (AgNPs). In the current experiment, impact of iron coating on the antimicrobial potency of AgNPs was investigated against methicillin-resistance Staphylococcus aureus (MRSA). To obtain more accurate data about the antimicrobial potency of examined nanostructures, the experiment was done on the 10 isolates of MRSA which were isolated from skin lesions. AgNPs and iron-coated AgNPs (Fe@AgNPs) were fabricated based on a green one-pot reaction procedure. Minimal inhibitory concentration (MIC) of Fe@AgNPs was not significantly different with MIC of AgNPs against eight out of 10 examined MRSA isolates. Also, by iron coating a reduction in the minimal inhibitory concentration (MIC) of AgNPs was observed against two MRSA isolates. The average MIC of AgNPs against 10 MRSA isolates was calculated to be 2.16 ± 0.382 mg/mL and this value was reduced to 1.70 ± 0.638 mg/mL for Fe@AgNPs. However, this difference was not considered significant statistically (P-value > 0.05). From productivity point of view, it was found that iron coating would improve the productivity of the synthesis reaction more than fivefold. Productivity of AgNPs was calculated to be 1.02 ± 0.07 g/L, meanwhile this value was 5.25 ± 0.05 g/L for Fe@AgNPs. Iron coating may provide another economic benefit to reduce final price of AgNPs. It is obvious that the price of a particular nanostructure made of silver and iron is significantly lower than that of pure silver. These findings can be considered for the fabrication of economic and potent antimicrobial nanoparticles.

Incorporation of Nanomaterials in Glass Ionomer Cements-Recent Developments and Future Perspectives: A Narrative Review

Glass ionomer cements (GICs), restorative materials with commercial availability spanning over five decades, are widely applied due to their advantages (including bio-compatibility, fluoride release, or excellent bonding properties). However, GICs have shortcomings. Among the disadvantages limiting the application of GICs, the poor mechanical properties are the most significant. In order to enhance the mechanical or antimicrobial properties of these materials, the addition of nanomaterials represents a viable approach. The present paper aims to review the literature on the application of different types of nanomaterials for the enhancement of GICs' mechanical and antimicrobial properties, which could lead to several clinical benefits, including better physical properties and the prevention of tooth decay. After applying the described methodology, representative articles published in the time period 2011-present were selected and included in the final review, covering the modification of GICs with metallic nanoparticles (Cu, Ag), metallic and metalloid oxide nanoparticles (TiO₂, ZnO, MgO, Al₂O₃, ZrO₂, SiO₂), apatitic nanomaterials, and other nanomaterials or multi-component nanocomposites.

Comparison and Advanced Antimicrobial Strategies of Silver and Copper Nanodrug-Loaded Glass Ionomer Cement against Dental Caries Microbes

Caries lesions during cement repairs are a severe issue, and developing a unique antimicrobial restorative biomaterial can help to reduce necrotic lesion recurrence. As a result, Thymus vulgaris extract was used to biosynthesize copper nanoparticles (TVE-CuNPs) exhibiting different characteristics (TVE). Along with TVE-CuNPs, commercial silver nanoparticles (AgNPs) and metronidazole were combined with glass ionomer cement (GIC) to test its antibacterial efficacy and compressive strength. FTIR, XRD, UV-Vis spectrophotometry, and TEM were applied to characterize the TVE-CuNPs. Additionally, AgNPs and TVE-CuNPs were also combined with metronidazole and GIC. The modified GIC samples were divided into six groups, where groups 1 and 2 included conventional GIC and GIC with 1.5% metromidazole, respectively; group 3 had GIC with 0.5% TVE-CuNPs, while group 4 had 0.5% TVE-CuNPs with metronidazole in 1.5%; group 5 had GIC with 0.5% AgNPs, and group 6 had 0.5% AgNPs with metronidazole at 1.5%. An antimicrobial test was performed against Staphylococcus aureus (S. aureus) and Streptococcus mutans (S. mutans) by the disc diffusion method and the modified direct contact test (MDCT). GIC groups 4 and 6 demonstrated a greater antimicrobial efficiency against the two tested strains than the other groups. In GIC groups 4 and 6, the combination of GIC with two antimicrobial agents, 1.5% metronidazole and 0.5% TVE-CuNPs or AgNPs, enhanced the antimicrobial efficiency when compared to that of the other groups with or without a single agent. GIC group specimens combined with nanosilver and nanocopper had similar mean compressive strengths when compared to the other GIC groups. Finally, the better antimicrobial efficacy of GIC boosted by metronidazole and the tested nanoparticles against the tested strains may be relevant for the future creation of more efficient and modified restorations to reduce dental caries lesions.