Cutting-edge filler technologies to release bio-active components for restorative and preventive dentistry

Filler Mixed Into Adhesives Does Not Necessarily Improve Their Mechanical Properties

OBJECTIVES

To investigate the influence of filler type/loading on the micro-tensile fracture strength (μTFS) of adhesive resins, as measured 'immediately' upon preparation and after 1-week water storage ('water-stored').

METHODS

The morphology and particle-size distribution of three filler particles, referred to as 'Glass-S' (Esschem Europe), 'BioUnion' (GC), and 'CPC_Mont', were correlatively characterized by SEM, TEM, and particle-size analysis. These filler particles were incorporated into an unfilled adhesive resin ('BZF-29unfilled', GC) in different concentrations to measure the 'immediate' μTFS. After 1-week water storage, the 'water-stored' μTFS of the experimental particle-filled adhesive resins with the most optimum filler loading, specific for each filler type, was measured. In addition, the immediate and water-stored μTFS of the adhesive resins of three experimental two-step universal adhesives based on the same resin matrix but varying for filler type/loading, coded as 'BZF-21' (containing silica and bioglass), 'BZF-29' (containing solely silica), and 'BZF-29_hv' (highly viscous with a higher silica loading than BZF-29), and of the adhesive resins of the gold-standard adhesives OptiBond FL ('Opti-FL', Kerr) and Clearfil SE Bond 2 ('C-SE2', Kuraray Noritake) was measured along with that of BZF-29unfilled (GC) serving as control/reference. Statistics involved one-way and two-way ANOVA followed by post-hoc multiple comparisons (α<0.05).

RESULTS

Glass-S, BioUnion, and CPC_Mont represent irregular fillers with an average particle size of 8.5-9.9 μm. Adding filler to BZF-29unfilled decreased μTFS regardless of filler type/loading. One-week water storage reduced μTFS of all adhesive resins except BZF-21, with the largest reduction in μTFS recorded for BZF-29unfilled. Among the three filler types, the μTFS of the 30 wt% Glass-S and 20 wt% BioUnion filled adhesive resin was not significantly different from the μTFS of BZF-29unfilled upon water storage.

CONCLUSIONS

Adding filler particles into adhesive resin did not enhance its micro-tensile fracture strength but appeared to render it less sensitive to water storage as compared to the unfilled adhesive resin investigated.

Novel bioactive nanospheres show effective antibacterial effect against multiple endodontic pathogens

Aim

The current study evaluated the antibacterial activity of a newly developed quaternary ammonium polymethacrylate (QAPM)-containing bioactive glasses (BGs) via a two-step method by our group, namely BGs-HAEMB, and explored its cytotoxicity and biocompatibility.

Methods

The antibacterial effects of the BGs-HAEMB against planktonic bacteria, bacterial biofilm formation, and experimental root canal biofilms of persistent pathogens (Enterococcus faecalis, Streptococcus sanguis and Porphyromonas endodontalis) associated with endodontic infection were evaluated in vitro by agar diffusion tests, direct contact tests and live/dead staining. The cytotoxicity and biocompatibility of BGs-HAEMB were evaluated by CCK-8 assays in vitro and a skin implantation model in vivo.

Results

Compared to three clinically used endodontic sealers (Endofill, AH Plus, and iRoot SP), BGs-HAEMB exhibited the relatively strongest antibacterial effect against E. faecalis, S. sanguis and P. endodontalis after sitting for 14 and 28 days (P < 0.01). SEM images and CLSM images also showed that for each tested bacteria, BGs-HAEMB killed the most microorganism among all the experimental groups, regardless of treatment for 7 days or 28 days (P < 0.05). Besides, the BGs-HAEMB-treated groups showed a relatively low cytotoxicity (RGRs ranging from 88.6% to 102.9%) after 1, 3, and 7 days of exposure. Meanwhile, after 28 days of implantation, the inflammatory grade in BGs-HAEMB treated group was assessed as Grade I, in which the average numbers of inflammatory cells (6.7 ± 2.1) were less than 25.

Conclusions

BGs-HAEMB exerted a long-term and stable antibacterial effect. The remarkable biocompatibility of BGs-HAEMB in vitro and in vivo confirmed its possible clinical application as a potential alternative in the development of the next generation of endodontic sealers.

Changes in enamel hardness, wear resistance, surface texture, and surface crystal structure with glass ionomer cement containing BioUnion fillers

This study investigated the potential of BioUnion filler containing glass ionomer cement (GIC) to enhance the properties of enamel surrounding restorations, with a specific focus on the effect on hardness. The hardness of the bovine enamel immersed in the cement was measured using Vickers hardness numbers. Following sliding and impact wear simulations, the enamel facets were examined using confocal-laser-scanning microscopy and scanning-electron microscopy. Surface properties were further analyzed using energy-dispersive X-ray spectroscopy and X-ray diffraction (XRD). A significant increase in Vickers hardness numbers was observed in the BioUnion filler GIC after 2 days. Furthermore, the mean depth of enamel facets treated with BioUnion filler GIC was significantly less than that of untreated facets. Characteristic XRD peaks indicating the presence of hydroxyapatite were also observed. Our findings imply that GIC with BioUnion fillers enhances the mechanical properties of the tooth surface adjacent to the cement.

Bioactivity and remineralization potential of modified glass ionomer cement: A systematic review of the impact of calcium and phosphate ion release

This systematic review investigates the effectiveness of calcium and phosphate ions release on the bioactivity and remineralization potential of glass ionomer cement (GIC). Electronic databases, including PubMed-MEDLINE, Scopus, and Web of Science, were systematically searched according to PRISMA guidelines. This review was registered in the PROSPERO database. Five eligible studies on modifying GIC with calcium and phosphate ions were included. The risk of bias was assessed using the RoBDEMAT tool. The incorporation of these ions into GIC enhanced its bioactivity and remineralization properties. It promoted hydroxyapatite formation, which is crucial for remineralization, increased pH and inhibited cariogenic bacteria growth. This finding has implications for the development of more effective dental materials. This can contribute to improved oral health outcomes and the management of dental caries, addressing a prevalent and costly oral health issue. Nevertheless, comprehensive longitudinal investigations are needed to evaluate the clinical efficacy of this GIC's modification.

Clinical Investigation of the Inhibitory Effects of Tooth-Coating Materials on Initial Active Root Caries: A Pilot Randomized Controlled Trial

Background and Objectives: Caredyne ZIF-C is a novel, capsule-mixed zinc-containing prototype glass ionomer cement (GIC). Zinc ions are reported to inhibit root dentin demineralization, dentin collagen degradation, bacterial growth, acid production, and in vitro bacterial biofilm formation. However, the effectiveness of GICs against initial root caries lesions is unclear. Therefore, this study aimed to evaluate the efficacy of GICs, especially the new zinc-containing Caredyne ZIF-C GIC, as tooth-coating materials in patients with initial active root caries. Materials and Methods: A total of 58 lesions in 47 older adults (age > 65 years) were randomly allocated to one of the following three groups: Caredyne ZIF-C, Fuji VII (a conventional GIC), and sodium fluoride (NaF). All the lesions were treated with the assigned materials without removing the infected dentin, and the rates of dental plaque attachment and coating material fall-out were evaluated after 3, 6, and 12 months. The failure rate was defined as the number of teeth that needed restoration due to caries progression. Results: The plaque attachment rates tended to be lower in the material-coated root surfaces than in the healthy exposed root surfaces after 3, 6, and 12 months, although the differences among the three groups were not significant. Moreover, the coating material fall-out rate tended to be lower in the Caredyne ZIF-C group than in the Fuji VII group. There was no significant difference in the failure rate among the three groups at the 12 months mark. Conclusions: Though this pilot study offers a new direction for suppressing the progression of initial active root caries by controlling plaque attachment using GICs including Caredyne ZIF-C, clinical studies with a larger sample size are needed.

Metal-doped silicate and phosphate glasses for antibacterial dental biomaterials

Owing to the development of glass 45S5 (Bioglass®) comprising 45 mol% SiO2, 24.5 mol% Na2O, 24.5 mol% CaO, and 6 mol% P2O5, different compositions of silicate glasses have been developed. When these silicate glasses contact an aqueous environment, such as body fluids, they induce apatite layer formation on their surfaces owing to ion exchange. In addition to promoting hard tissue formation, researchers have sought to enhance the antibacterial properties of these glasses, thereby resulting in the development of metal-doped silicate glasses. The addition of antibacterial metals (silver, copper, zinc, and gallium) to silicate glass offers a promising avenue for combating oral pathogens. In recent years, there has been growing interest in metal-doped phosphate glasses. The release of metal ions can be regulated by modifying the dissolution rate of the phosphate glasses. This review summarizes the metal-doped silicate and phosphate glasses that confer antibacterial activity. Future strategies for the development of dental biomaterials that incorporate metal-doped glass and exhibit antibacterial effects are discussed.

In vitro analysis of durability of S-PRG filler-containing composite crowns for primary molar restoration

OBJECTIVE

To evaluate the reliability, maximum principal stress, shear stress, and crack initiation of a computer-aided design/computer-aided manufacturing (CAD/CAM) resin composite (RC) incorporating surface pre-reacted glass (S-PRG) filler for primary molar teeth.

METHODS

Mandibular primary molar crowns fabricated by experimental (EB) or commercially available CAD/CAM RCs (HC) were prepared and cemented to a resinous abutment tooth using an adhesive resin cement (Cem) or a conventional glass-ionomer cement (CX). These specimens were subjected to a single compressive test (n = 5/each) and the step-stress accelerated life testing (SSALT) (n = 12/each). Data was evaluated using Weibull analyses and reliability was calculated. Afterwards, the maximum principal stress and crack initiation point of each crown was analyzed by finite element analysis. To evaluate bonding of EB and HC to dentin, microtensile bond strength (μTBS) testing was conducted using primary molar teeth (n = 10/each).

RESULTS

There was no significant difference between the fracture loads of EB and HC for either cement (p > 0.05). The fracture loads of EB-CX and HC-CX were significantly lower than EB-Cem and HC-Cem (p < 0.05). The reliability at 600 N for EB-Cem was greater than that for EB-CX, HC-Cem, and HC-CX. The maximum principal stress concentrated on EB was lower than that on HC. The shear stress concentrated in the cement layer for EB-CX was higher than that for HC-CX. There was no significant difference among the μTBSs of EB-Cem, EB-CX, HC-Cem, and HC-CX (p > 0.05).

SIGNIFICANCE

The crowns fabricated with the experimental CAD/CAM RC incorporating S-PRG filler yielded greater fracture loads and reliability than the crowns manufactured with commercially available CAD/CAM RC regardless of the luting materials. These findings suggest that the experimental CAD/CAM RC crown may be clinically useful for the restoration of primary molars.

Effect of polymerization mode on shrinkage kinetics and degree of conversion of dual-curing bulk-fill resin composites

OBJECTIVES

To assess the behavior of dual-cure and conventional bulk-fill composite materials on real-time linear shrinkage, shrinkage stress, and degree of conversion.

MATERIALS AND METHODS

Two dual-cure bulk-fill materials (Cention, Ivoclar Vivadent (with ion-releasing properties) and Fill-Up!, Coltene) and two conventional bulk-fill composites (Tetric PowerFill, Ivoclar Vivadent; SDR flow + , Dentsply Sirona) were compared to conventional reference materials (Ceram.x Spectra ST (HV), Dentsply Sirona; X-flow; Dentsply Sirona). Light curing was performed for 20 s, or specimens were left to self-cure only. Linear shrinkage, shrinkage stress, and degree of conversion were measured in real time for 4 h (n = 8 per group), and kinetic parameters were determined for shrinkage stress and degree of conversion. Data were statistically analyzed by ANOVA followed by post hoc tests (α = 0.05). Pearson's analysis was used for correlating linear shrinkage and shrinkage force.

RESULTS

Significantly higher linear shrinkage and shrinkage stress were found for the low-viscosity materials compared to the high-viscosity materials. No significant difference in degree of conversion was revealed between the polymerization modes of the dual-cure bulk-fill composite Fill-Up!, but the time to achieve maximum polymerization rate was significantly longer for the self-cure mode. Significant differences in degree of conversion were however found between the polymerization modes of the ion-releasing bulk-fill material Cention, which also exhibited the significantly slowest polymerization rate of all materials when chemically cured.

CONCLUSIONS

While some of the parameters tested were found to be consistent across all materials studied, heterogeneity increased for others.

CLINICAL RELEVANCE

With the introduction of new classes of composite materials, predicting the effects of individual parameters on final clinically relevant properties becomes more difficult.

Multiple-Ion Releasing Bioactive Surface Pre-Reacted Glass-Ionomer (S-PRG) Filler: Innovative Technology for Dental Treatment and Care

Surface Pre-Reacted Glass-ionomer (S-PRG) filler, which releases strontium (Sr²⁺), borate (BO₃^3-), fluoride (F^-), sodium (Na⁺), silicate (SiO₃^2-), and aluminum (Al³⁺) ions at high concentrations, is a unique glass filler that are utilized in dentistry. Because of its multiple-ion releasing characteristics, S-PRG filler exhibits several bioactivities such as tooth strengthening, acid neutralization, promotion of mineralization, inhibition of bacteria and fungi, inhibition of matrix metalloproteinases, and enhancement of cell activity. Therefore, S-PRG filler per se and S-PRG filler-containing materials have the potential to be beneficial for various dental treatments and care. Those include restorative treatment, caries prevention/management, vital pulp therapy, endodontic treatment, prevention/treatment of periodontal disease, prevention of denture stomatitis, and perforation repair/root end filling. This review summarizes bioactive functions exhibited by S-PRG filler and its possible contribution to oral health.

Evaluation of the clinical impact and In Vitro antibacterial activities of two bioactive restoratives against S. mutans ATCC 25175 in class II carious restorations

Background

Streptococcus mutans is a Gram-positive opportunistic bacterial pathogen and that causes dental caries and then restorative treatment remains the best clinical practice approach to repair and prevent dental caries.

Aims

This study compared the antimicrobial performance of resin modified glass ionomer cement (RM-GIC) and ACTIVA restoratives by evaluating the S. mutans count, pH levels, and plaque index (PI) scores before and on the 7^th day of restoration, and then determined the antimicrobial activities against S. mutans ATCC 25175 in both restoratives in vitro.

Materials and Methods

Seventy-eight eligible Saudi female participants, with class II carious lesions, were randomly distributed into RM-GIC and ACTIVA restorative groups. We evaluated the S. mutans count by the serial dilution technique and salivary pH by using a portable pH meter. The PI scores were determined by Silness-Löe method and the antibacterial activity by the agar well diffusion method. Statistical analysis of normality distribution was performed with the Kolmogorov-Smirnov and the difference between groups was an analysis by paired t-test. In addition, the independent sample was compared with the independent samples t-test.

Results

Both groups reduced the S. mutans count, pH acidity, and PI scores, and this reduction was statistically significant on the 7^th day of restoration (P < 0.05), preference for ACTIVA. The in vitro antibacterial activity against S. mutans ATCC 25175 showed a non-significant difference between both bioactive restorative materials (P < 0.05).

Conclusion

The novel application of ACTIVA restorative material is a promising option for patients at risk of caries.

Effect of Particle Sizes and Contents of Surface Pre-Reacted Glass Ionomer Filler on Mechanical Properties of Auto-Polymerizing Resin

Herein, the mechanical properties of an auto-polymerizing resin incorporated with a surface pre-reacted glass ionomer (S-PRG) filler were evaluated. For this, S-PRG fillers with particle sizes of 1 μm (S-PRG-1) and 3 μm (S-PRG-3) were mixed at 10, 20, 30, and 40 wt% to prepare experimental resin powders. The powders and a liquid (powder/liquid ratio = 1.0 g/0.5 mL) were kneaded and filled into a silicone mold to obtain rectangular specimens. The flexural strength and modulus (n = 12) were recorded via a three-point bending test. The flexural strengths of S-PRG-1 at 10 wt% (62.14 MPa) and S-PRG-3 at 10 and 20 wt% (68.68 and 62.70 MPa, respectively) were adequate (>60 MPa). The flexural modulus of the S-PRG-3-containing specimen was significantly higher than that of the S-PRG-1-containing specimen. Scanning electron microscopy observations of the specimen fracture surfaces after bending revealed that the S-PRG fillers were tightly embedded and scattered in the resin matrix. The Vickers hardness increased with an increasing filler content and size. The Vickers hardness of S-PRG-3 (14.86–15.48 HV) was higher than that of S-PRG-1 (13.48–14.97 HV). Thus, the particle size and content of the S-PRG filler affect the mechanical properties of the experimental auto-polymerizing resin.

A Flexible Anti-Biofilm Hygiene Coating for Water Devices

Biofilm is a microbiome complex comprising different bacterial colonies that typically adhere to device surfaces in water, which causes serious medical issues such as indwelling infections and outbreaks. Here, we developed a non-nanoparticle, flexible anti-biofilm hygiene coating consisting of lithocholic acid (LCA), zinc pyrithione (Zn), and cinnamaldehyde (Cn) (named as LCA-Zn-Cn) that largely prevents the bacteria adhesion to various water device surfaces such as stainless steel and glass through a synergistic mechanism. The existing chelated groups on LCA and Cn attract plenty of bacteria via hydrophobic interaction. Both the bactericidal reaction by grafting biocidal groups from both LCA and Cn and the bacteriostatic reaction by inhibiting cell division via zinc ions (Zn) lead to a largely improved bacteria/biofilm prevention. The antibacterial performance was assessed by using the JIS Z 2801/ISO 22196 method. The designed LCA-Zn-Cn coating displayed log₁₀ reduction of 4.23 (99.9% reduction) of E. coli and log₁₀ reduction of 3.51 (99.8% reduction) of E. faecalis on stainless steel, which are much higher than the control samples, demonstrating a promising colonization inhibition. In parallel, the polysulfone encapsulated beads also showed >99% reduction efficiency in batch and >97-98% reduction efficiency in continuous column tests using the Lake Michigan water. Due to the strong cross-linked configuration, the coating still showed >90.9% bacterial reduction after 3000 abrasion cycles and over 99.9% bacteria reduction after a high flow velocity of 1.99 m/s test, which confirmed the enhanced mechanical durability. By applying either spray or dip-coating, the designed polymer composite can be coated on a variety of irregular water devices with mass production using an auto-controlled robot arm.

The denture microbiome in health and disease: an exploration of a unique community

The United Nations suggests the global population of denture wearers (an artificial device that acts as a replacement for teeth) is likely to rise significantly by the year 2050. Dentures become colonized by microbial biofilms, the composition of which is influenced by complex factors such as patient’s age and health, and the nature of the denture material. Since colonization (and subsequent biofilm formation) by some micro‐organisms can significantly impact the health of the denture wearer, the study of denture microbiology has long been of interest to researchers. The specific local and systemic health risks of denture plaque are different from those of dental plaque, particularly with respect to the presence of the opportunist pathogen Candida albicans and various other nonoral opportunists. Here, we reflect on advancements in our understanding of the relationship between micro‐organisms, dentures, and the host, and highlight how our growing knowledge of the microbiome, biofilms, and novel antimicrobial technologies may better inform diagnosis, treatment, and prevention of denture‐associated infections, thereby enhancing the quality and longevity of denture wearers.

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.

The power of weak ion-exchange resins assisted by amelogenin for natural remineralization of dental enamel: an in vitro study

This study aims to develop an innovative dental product to remineralize dental enamel by a proper combination of ion-exchange resins as controlled release of mineral ions that form dental enamel, in the presence of amelogenin to guide the appropriate crystal growth. The novel product proposed consists of a combination of ion-exchange resins (weak acid and weak base) individually loaded with the remineralizing ions: Ca²⁺, PO₄^3- and F^-, also including Zn²⁺ in a minor amount as antibacterial, together with the protein amelogenin. Such cocktail provides onsite controlled release of the ions necessary for enamel remineralization due to the weak character of the resins and at the same time, a guiding tool for related crystal growth by the indicated protein. Amelogenin protein is involved in the structural development of natural enamel and takes a key role in controlling the crystal growth morphology and alignment at the enamel surface. Bovine teeth were treated by applying the resins and protein together with artificial saliva. Treated teeth were evaluated with nanoindentation, scanning electron microscopy and energy-dispersive X-ray spectroscopy. The innovative material induces the dental remineralization creating a fluorapatite layer with a hardness equivalent to sound enamel, with the appropriate alignment of corresponding nanocrystals, being the fluorapatite more acid resistant than the original mineral. Our results suggest that the new product shows potential for promoting long-term remineralization leading to the inhibition of caries and protection of dental structures.

Investigating the mechanophysical and biological characteristics of therapeutic dental cement incorporating copper doped bioglass nanoparticles

OBJECTIVE

This study was investigated the mechanophysical properties of zinc phosphate cement (ZPC) with or without the copper doped bioglass nanoparticles (Cu-BGn) and their biological effect on dental pulp human cells and bacteria.

MATERIALS AND METHODS

Cu-BGn were synthesized and characterized firstly and then, the experimental (Cu-ZPC) and control (ZPC) samples were fabricated with similar sizes and/or dimensions (diameter: 4 mm and height: 6 mm) based on the International Organization of Standards (ISO). Specifically, various concentrations of Cu-BGn were tested, and Cu-BGn concentration was optimized at 2.5 wt% based on the film thickness and overall setting time. Next, we evaluated the mechanophysical properties such as compressive strength, elastic modulus, hardness, and surface roughness. Furthermore, the biological behaviors including cell viability and odontoblastic differentiation by using dental pulp human cells as well as antibacterial properties were investigated on the Cu-ZPC. All data were analyzed statistically using SPSS® Statistics 20 (IBM®, USA). p < 0.05 (*) was considered significant, and 'NS' represents nonsignificant.

RESULTS

Cu-BGn was obtained via a sol-gel method and added onto the ZPC for fabricating a Cu-ZPC composite and for comparison, the Cu-free-ZPC was used as a control. The film thickness (≤ 25 µm) and overall setting time (2.5-8 min) were investigated and the mechanophysical properties showed no significance ('NS') between Cu-ZPC and bare ZPC. However, cell viability and odontoblastic differentiation, alkaline phosphate (ALP) activity and alizarin red S (ARS) staining were highly stimulated in the extracts from the Cu-ZPC group compared to the ZPC group. Additionally, the antibacterial test showed that the Cu-ZPC extracts were more effective than the ZPC extracts (p < 0.05).

SIGNIFICANCE

Cu-ZPC showed adequate mechanophysical properties (compressive strength, hardness, and surface roughness) and enhanced odontoblastic differentiation as well as antibacterial properties compared to the ZPC-only group. Based on the findings, the fabricated Cu-ZPC might have the potential for use in the field of dental medicine and clinical applications.

Physical properties and wear behavior of CAD/CAM resin composite blocks containing S-PRG filler for restoring primary molar teeth

OBJECTIVES

This study aimed to develop computer-aided design/computer-aided manufacturing (CAD/CAM) resin composite blocks (RCBs) containing surface pre-reacted glass-ionomer (S-PRG) filler for primary molar teeth and evaluate their physical properties and wear resistance.

METHODS

Experimental CAD/CAM RCBs containing S-PRG filler for primary molar teeth (EB), a commercial CAD/CAM RCB (HC), two resin composites for primary teeth (BKP and BKZ) and one for permanent teeth (BⅡ) were used. Hardness tests, three-point bending tests, fracture toughness tests, and water absorption tests were conducted. Wear tests were conducted for these materials and stainless steel crowns (SSCs).

RESULTS

The Vickers hardness of EB was lower than that of HC (p < 0.05), and there was no significant difference among BKZ, BKP, and BⅡ (p > 0.05). After 1 week of water immersion, EB and HC showed greater flexural strength than the other materials (p < 0.05). EB showed greater fracture toughness than the other materials (p < 0.05). The water absorption of EB was lower than that of HC, BKZ, and BKP (p < 0.05), and greater than that of BⅡ (p < 0.05). Antagonist wear was significantly smaller in EB than in HC and BⅡ (p < 0.05), and significantly greater than in BKZ (p < 0.05). Antagonist wear could not be measured in SSC because of excessive wear that was out of range of the surface roughness tester.

SIGNIFICANCE

The CAD/CAM RCBs containing S-PRG filler for primary molar teeth developed in this study demonstrated adequate physical properties and wear performance, suggesting that they are suitable for restoration of primary molar teeth and could function in place of SSCs.

Novel nanostructured resin infiltrant containing calcium phosphate nanoparticles to prevent enamel white spot lesions

OBJECTIVES

The objective of this study was to develop a novel nanostructured resin infiltrant containing nanoparticles of amorphous calcium phosphate (NACP) to treat enamel white spot lesions (WSLs). Physical properties and the therapeutic effect of the new resin infiltrant were investigated for the first time.

METHODS

NACP was incorporated into ICON (Icon caries infiltrant, DMG, Germany) with different mass fractions. Cytotoxicity, degree of conversion, surface hardness, calcium (Ca) and phosphorus (P) ions release concentrations were tested. After application to the demineralized enamel samples, the color changes were determined. Surface and cross-sectional hardness were measured, scanning electron microscopy (SEM) images were taken on the cross-section of samples to observe microstructure changes after 14-day pH cycling.

RESULTS

Incorporating 10%-30% of NACP did not compromise the biocompatibility and physical properties of the resin infiltrant. ICON + 30% NACP group had long-lasting and high level of Ca and P ion release. After 14-day pH cycling, enamel surface hardness of ICON + 30% NACP group was 1.83 ± 0.21 GPa, significantly higher than the control group (1.32 ± 0.18 GPa) (p < 0.05). ICON + 30NACP group had the highest cross-sectional enamel hardness among all groups (p < 0.05), especially at 50 μm and 100 μm depth. SEM images showed that apparent enamel prism and inter-prism gaps in negative control were masked by mineral deposition in ICON + 30% NACP group.

SIGNIFICANCE

The novel ICON+30% NACP infiltrant is promising to inhibit enamel WSLs, protect the enamel and increase its hardness.

Evaluation of the long-term antibiofilm effect of a surface coating with dual functionality of antibacterial and protein-repellent effects

The provision of antibacterial properties to resinous restorative/reconstructive materials by incorporating polymerizable bactericides such as 12-methacryloyloxydodecylpyridinium bromide (MDPB) has been attempted. Previously, MDPB was combined with 2-methacryloyloxyethyl phosphorylcholine (MPC) to fabricate a copolymer coating to increase antibacterial effectiveness by protein repelling. In this study, we assessed the longevity of the protein-repelling, antibacterial, and antibiofilm effects of the MDPB-MPC copolymer. After 28 days of water immersion, MPC-containing copolymers exhibited lower adsorption of bovine serum albumin and salivary proteins; after 24 h of incubation, MDPB-containing copolymers demonstrated antibacterial effects against Streptococcus mutans. The copolymer containing both MDPB and MPC showed thinner biofilm formation with a higher percentage of membrane-compromised bacteria than control. The results were consistent with those before aging, indicating the long-lasting antibacterial, protein-repellent, and antibiofilm effects of this copolymer. The durable copolymer developed in this study can be applied to dental resins to control bacteria in the oral environment.

Establishment of novel in vitro culture system with the ability to reproduce oral biofilm formation on dental materials

Intensive research has been conducted with the aim of developing dental restorative/prosthetic materials with antibacterial and anti-biofilm effects that contribute to controlling bacterial infection in the oral cavity. In situ evaluations were performed to assess the clinical efficacy of these materials by exposing them to oral environments. However, it is difficult to recruit many participants to collect sufficient amount of data for scientific analysis. This study aimed to assemble an original flow-cell type bioreactor equipped with two flow routes and assess its usefulness by evaluating the ability to reproduce in situ oral biofilms formed on restorative materials. A drop of bacterial suspension collected from human saliva and 0.2% sucrose solution was introduced into the assembled bioreactor while maintaining the incubation conditions. The bioreactor was able to mimic the number of bacterial cells, live/dead bacterial volume, and volume fraction of live bacteria in the in situ oral biofilm formed on the surface of restorative materials. The usefulness of the established culture system was further validated by a clear demonstration of the anti-biofilm effects of a glass-ionomer cement incorporating zinc-releasing glasses when evaluated by this system.

Antibacterial effects and physical properties of a glass ionomer cement containing BioUnion filler with acidity-induced ability to release zinc ion

BioUnion filler is a bioactive glass particle that releases Zn²⁺ in an acidic environment. In this study, the ion release, antibacterial, and physical properties of a glass ionomer cement (GIC) incorporating BioUnion filler (CA) were assessed in vitro. The concentration of Zn²⁺ released from CA into acetic acid was higher than that released into water and its minimum inhibitory concentrations against six oral bacterial species. Moreover, the concentration of Zn²⁺-release was maintained during all the seven times it was exposed to acetic acid. Compared to a conventional cement and resin composite, CA significantly inhibited the growth of oral bacteria and hindered their adhesion on the material surface. Thus, our study outcomes show that the release of Zn²⁺ from CA in the acidic environment does not affect its compressive strength.

Immobilizing Bactericides on Dental Resins via Electron Beam Irradiation

Polymerizable bactericides, such as quaternary ammonium compound-based monomers, have been intensively studied as candidates for immobilizing antibacterial components on dental resin. However, they predominantly exhibit a bacteriostatic behavior, rather than bactericidal, as the immobilized components are left with insufficient molecular movement to disrupt the bacterial surface structure through contact-mediated action. In this study, we developed a novel strategy to increase the density of the immobilized bactericide and enhance its antibacterial/antibiofilm properties by combining a surface-grafting technique with electron beam irradiation. A solution of the quaternary ammonium compound-based monomer, 12-methacryloyloxydodecylpyridinium bromide (MDPB), was coated on polymethyl methacrylate (PMMA) resin specimens at the concentrations of 30, 50, and 80 wt%. The coated resins were subsequently exposed to 10 MeV of electron beam irradiation at 50 and 100 kGy, followed by thermal stabilization at 60 °C. The antibacterial effect was evaluated by inoculating a Streptococcus mutans suspension on the coated PMMA resin samples, which exhibited bactericidal effects even after 28 d of aging (P < 0.05, Tukey's honestly significant difference test). Transmission electron microscopy and bacteriolytic activity evaluation revealed that the S. mutans cells had sustained membrane depolarization. Furthermore, the antibiofilm effects against S. mutans and bacteria collected from human saliva were assessed. The thickness and the percentage of membrane-intact cells of the S. mutans and multispecies biofilms formed on the MDPB-immobilized surfaces were significantly lower than the uncoated PMMA specimens, even after 28-d aging (P < 0.05, Tukey's honestly significant difference test). Thus, the immobilization of antibacterial MDPB via electron beam irradiation induced rapid membrane depolarization, increasing membrane permeability and eventually causing cell death. Our strategy substantially enhances the antibacterial properties of the resinous materials and inhibits biofilm formation, therefore demonstrating significant potential for preventing infectious diseases in the oral environment.

Dental Applications of Carbon Nanotubes

Glass ionomer cements and resin-based composites are promising materials in restorative dentistry. However, their limited mechanical properties and the risk of bulk/marginal fracture compromise their lifespan. Intensive research has been conducted to understand and develop new materials that can mimic the functional behavior of the oral cavity. Nanotechnological approaches have emerged to treat oral infections and become a part of scaffolds for tissue regeneration. Carbon nanotubes are promising materials to create multifunctional platforms for dental applications. This review provides a comprehensive survey of and information on the status of this state-of-the-art technology and describes the development of glass ionomers reinforced with carbon nanotubes possessing improved mechanical properties. The applications of carbon nanotubes in drug delivery and tissue engineering for healing infections and lesions of the oral cavity are also described. The review concludes with a summary of the current status and presents a vision of future applications of carbon nanotubes in the practice of dentistry.

Development of endodontic sealers containing antimicrobial-loaded polymer particles with long-term antibacterial effects

OBJECTIVE

The objective of this study is to prepare new dental resins with a long-lasting antimicrobial activity. Specifically, this study evaluates an approach for controlling infection in root canals using sealers containing polyhydroxyethyl methacrylate trimethylolpropane trimethacrylate (polyHEMA/TMPT) particles loaded with cetylpyridinium chloride (CPC). In addition, the physical properties of sealers containing CPC-loaded polyHEMA/TMPT particles (CLP) are determined.

METHODS

PolyHEMA/TMPT particles with 10 (10%-CLP) and 25wt.% CPC (25%-CLP) with different particle sizes were fabricated and incorporated in HEMA-based sealers. CPC-release profiles were evaluated over 14 days of immersion in water, followed by 14 days of storage and 14 days of water immersion. The antibacterial activity of these sealers against Enterococcus faecalis in dentinal tubules was assessed using a root-canal-infection model. Their sealing abilities were evaluated by fluid filtration and physical properties were tested according to the ISO 6876 standard. The long-term antibacterial activity of the cured sealer containing 25%-CLP (∼21μm particle diameter) was re-assessed after 1 year of storage.

RESULTS

After 28 days of immersion, 25%-CLP exhibited a higher and sustained CPC release unlike 10%-CLP. Residual bacteria in root dentinal tubules were eradicated by obturation with 25%-CLP-containing sealers. The incorporation of 25%-CLP (∼21μm) had no adverse effects on the sealing ability and physical properties of the sealer and resulted in long-term antibacterial activity.

SIGNIFICANCE

The incorporation of CPC-loaded particles in HEMA resins yielded endodontic sealers with long-term bactericidal activity against E. faecalis in root canals. These sealers can potentially be used to prevent recurrent apical periodontitis.

Phosphate Ion Release and Alkalizing Potential of Three Bioactive Dental Materials in Comparison with Composite Resin

Aim

Several new bioactive compounds were recently introduced to the market with favorable ion release, tooth remineralization, and alkalizing potential. This study sought to compare the phosphate ion release and alkalizing potential of three bioactive materials in comparison with composite resin.

Methods

Thirty-six discs (2 × 6 mm) were fabricated from Fuji II LC resin modified glass ionomer (RMGI), Activa BioActive, Cention N, and Z250 composite in plastic molds. The specimens were stored in distilled water for 24 and 48 h and 6 months. Half of the specimens were used to assess the phosphate ion release while the other half were used to assess the alkalizing potential 1 h after pH drop from 6.8 to 4. Phosphate ion release was quantified by a spectrophotometer while the pH value was measured by a pH meter. Data were analyzed using two-way ANOVA, one-way ANOVA, and Tukey's HSD test (for pairwise comparisons) at 0.05 level of significance.

Results

At 24 h, the maximum phosphate ion release in distilled water occurred in the Fuji II LC group followed by Cention N, Activa BioActive, and Z250. At 6 months, Cention N followed by Activa BioActive showed higher phosphate ion release than Fuji II LC and Z250. No significant difference was noted between Activa BioActive and Cention N at any time point. All materials, except for Z250, increased the pH of the environment. Fuji II LC had maximum alkalizing effect at all time points followed by Cention N and Activa BioActive.

Conclusion

Use of bioactive compounds is a promising method to ensure phosphate ion release, and can have a positive effect on tooth remineralization over time. Also, bioactive compounds can alkalize an acidic environment.

Evaluation of ion release and the recharge ability of glass-ionomer cement containing BioUnion filler using an in vitro saliva-drop setting assembly

OBJECTIVE

A glass-ionomer cement (GIC) containing BioUnion filler has been reported to release Zn²⁺ under acidic conditions and to inhibit oral bacteria on its surface. However, previous results are based on in vitro experiments under static conditions. This study aimed to assemble an in vitro saliva-drop setting to simulate in vivo conditions of the oral cavity and to investigate the ion releasing and recharging properties of the GIC containing BioUnion filler.

METHODS

The effective concentrations of Zn²⁺ and F^- against Streptococcus mutans and saliva-derived multi-species biofilms were determined. Artificial saliva was dropped on the GIC containing BioUnion filler using the in vitro saliva-drop setting assembly and was periodically replaced with acetic acid. Ion release/recharge properties were investigated by measuring the release concentrations of Zn²⁺ and F^-.

RESULTS

The concentration of Zn²⁺ released from the BioUnion filler-containing GIC during seven days with repeated exposure to acid could be maintained at the level to inhibit S. mutans and saliva-derived multi-species biofilm formation. Moreover, the BioUnion filler-containing GIC could be recharged with Zn²⁺ and F^- by the application of a tooth gel containing Zn²⁺ and F^-. The release concentration of Zn²⁺ after recharging was significantly higher than the effective concentration of Zn²⁺ to hinder S. mutans and saliva-derived multi-species biofilm formation on material surfaces.

SIGNIFICANCE

The GIC containing BioUnion filler was shown to have the potential to inhibit biofilm formation in the oral cavity. In addition, recharging Zn²⁺ and F^- would further enhance the effect of the GIC containing BioUnion filler.

Anti-demineralization characteristics of surface pre-reacted glass-ionomer (S-PRG) filler-containing varnishes

This study investigated the anti-demineralization effects of surface pre-reacted glass-ionomer (S-PRG) filler-containing varnishes. Thirty-five bovine root specimens were divided into five treatment groups, with seven specimens each coated with 1) MI varnish (MIV), 2) F varnish (FV), 3) PRG varnish I (PV), 4) PRG varnish II (with sodium fluoride added, PVF), and 5) acid-resistant nail varnish (Control). A 3×1 mm area of the dentin surface adjacent to each varnish was demineralized for one week at 37°C. Integrated mineral loss (IML) of these lesions was determined by transverse microradiography, as was the amount of fluoride released by each material. IML was significantly lower in the PV and PVF groups than in the Control group, and was significantly lower in the PVF than in the MIV and FV groups. These findings indicated that S-PRG filler-containing varnishes, especially varnish containing sodium fluoride, had superior anti-demineralization effects on root dentin.

Monomer conversion, biaxial flexural strength, apatite forming ability of experimental dual-cured and self-adhesive dental composites containing calcium phosphate and nisin

The aim was to develop dual-cured, self-adhesive composites containing monocalcium phosphate monohydrate (MCPM, 8 or 4 wt%) and nisin (6 or 3 wt%) with added adhesive monomer. The effect of additives on monomer conversion (MC), biaxial flexural strength (BFS), dentin shear bond strength (SBS), and surface apatite formation were examined. All experimental composites showed light-activated MC (70-75%) higher than the commercial self-adhesive composite (Vertise Flow; VF, 65%). The additives reduced BFS of the composites from 217 to 133 MPa. SBS of the experimental composites (2-6 MPa) was lower than that of VF (12 MPa). Rising MCPM level enabled apatite-like crystals precipitated on the surface of composites after immersion in simulated body fluid for 4 weeks. The additives showed negligible effect on MC and SBS. Rising level of additives reduced strength of the composites but the values were still higher than that required by the standard.

Development of novel surface coating composed of MDPB and MPC with dual functionality of antibacterial activity and protein repellency

Resin-based reconstructive/restorative materials with antibacterial effects are potentially useful for preventing dental and oral diseases. To this end, the immobilization of an antibacterial component on the surface of a resin by incorporating polymerizable bactericide such as a quaternary ammonium compound-monomer 12-methacryloyloxydodecylpyridinium bromide (MDPB) is an effective technique. However, the effectiveness of immobilized bactericide is reduced by salivary protein coverage. We address this issue by utilizing 2-methacryloyloxyethyl phosphorylcholine (MPC) polymer, which exhibits protein repellency, with MDPB to fabricate a novel copolymer, which served as a surface coating on a methacrylate-based resin. This coating provided a more hydrophilic surface than that provided by MDPB coating and reduced the adsorption of bovine serum albumin and salivary protein. To evaluate bacterial growth on the contact surface, Streptococcus mutans suspension was placed on the coated specimen. After 24-h incubation, MDPB/MPC copolymer exhibited killing effects against S. mutans. Moreover, confocal laser scanning microscopy and scanning electron microscopy were used to evaluate biofilm formation after 48-h incubation in S. mutans suspension, which revealed sparse biofilm and dead bacteria in biofilm on the surface coated with MDPB/MPC. Overall, the proposed surface coating on dental resins exhibited protein-repellent ability and inhibitory effects against bacteria and oral biofilms.

Technique for simple apatite coating on a dental resin composite with light-curing through a micro-rough apatite layer

Tooth root surfaces restored with dental resin composites exhibit inferior biocompatibility. The objective of this study was to develop a simple technique for coating apatite onto a resin composite to improve its surface biocompatibility. First, we fabricated a polymer film coated with a micro-rough apatite layer and pressed it (coating-side down) onto a viscous resin composite precursor. As a result of light-induced curing of the precursor through the overlaid film, the micro-rough apatite layer was integrated with the resin composite and, thus, transferred from the polymer film surface to the cured resin composite surface as a result of the difference in interfacial adhesion strength. The transferred apatite layer attached directly to the cured resin composite without any gaps at the microscopic level. The adhesion between the apatite layer and the cured resin composite was so strong that the layer was not peeled off even by a tape-detaching test. The flexural strength of the resulting apatite-coated resin composite was comparable to that of the clinically used resin composite while satisfying the ISO requirement for dental polymer-based restorative materials. Furthermore, the apatite-coated resin composite showed better cell compatibility than the uncoated resin composite. The present apatite coating technique is well suited for dental treatment because the coating is applied during a conventional light curing procedure through simple utilization of the apatite-coated polymer film in place of an uncoated film. The proposed technique represents a practical evolution in dental treatment using light-curing resin composites, although further in vitro and in vivo studies are needed.