Clinical evaluation of posterior restorations over wet and dry dentin using an etch-and-rinse adhesive: A 36-month randomized clinical trial

OBJECTIVES

To evaluate the clinical performance of posterior restorations over wet and dry dentin with an etch-and-rinse adhesive after 36 months of clinical service.

METHODS

Forty-five participants were recruited, each one had at least two posterior teeth that needed restoration. Ninety restorations were placed on Class I or Class II cavities. For the restoration protocol, a simplified etch-and-rinse adhesive (Adper Single Bond 2) was applied over wet (WD) or dry dentin (DD) and later restored with a bulk-fill composite (Filtek Bulk Fill) under rubber dam isolation. Each restoration was evaluated using the World Dental Federation (FDI) criteria after 6, 12, and 36 months of clinical service, regarding the following principal restoration characteristics: postoperative sensitivity, marginal discoloration, marginal adaptation, fracture of material and retention, and recurrence of caries. Kruskal Wallis analysis of variance rank (α = 0.05) and Kaplan-Meier survival analysis were used for statistical analysis.

RESULTS

After 36 months of clinical evaluation, no significant difference between groups was observed in each FDI criterion (p > 0.05). Twenty restorations (WD=10, DD=10) showed minor marginal staining, and twenty-two restorations (WD=11, DD=11) presented small marginal adaptation defects (p > 0.05). Four restorations were lost (WD = 2, DD = 2) and the fracture rates (95% confidence interval) were 94.9% for each one, without significant difference between wet and dry dentin (p > 0.05).

SIGNIFICANCE

The degree of dentin moisture does not seem to affect the clinical performance of a simplified etch-and-rinse adhesive in posterior restorations when the adhesive is applied vigorously over the dentine surface.

Evaluation of the antibacterial activity of dental adhesive containing biogenic silver nanoparticles decorated nanographene oxide nanocomposites (Ag@nGO NCs) and effect on bond strength to dentine

Our study aimed to evaluate the antibacterial activities and dentin bond strengths of silver nanoparticles (Ag NPs) and silver nano-graphene oxide nanocomposites (Ag@nGO NCs) produced by green and chemical synthesis methods added to the dental adhesive. Ag NPs were produced by green synthesis (biogenic) (B-Ag NPs) and chemical synthesis methods (C-Ag NPs) and deposited on nGO (nano-graphene oxide). Ag NPs and Ag@nGO NCs (0.05% w/w) were added to the primer and bond (Clearfil SE Bond). Group 1: control, Group 2: nGO, Group 3: B-Ag NPs, Group 4: B-Ag@nGO NCs, Group 5: C-Ag NPs, Group 6: C-Ag@nGO NCs. Streptococcus mutans (S. mutans) live/dead assay analysis, MTT metabolic activity test, agar disc diffusion test, lactic acid production, and colony forming units (CFUs) tests were performed. Bond strength values were determined by the microtensile bond strength test (μTBS). Failure types were determined by evaluating with SEM. Statistical analysis was performed using one-way ANOVA and two-way ANOVA (p < 0.05). There was a difference between the groups in the viable bacteria ratio and lactic acid production tests (p < 0.05). When the inhibition zone and S. mutans CFUs were evaluated, there was no difference between Group 3 and Group 4 (p > 0.05), but there was a difference between the other groups (p < 0.05). When the metabolic activity of S. mutans was evaluated, there was a difference between Group 1 and other groups, and between Group 2 and Group 5, and Group 6 (p < 0.05). There was no difference between the groups in the μTBS values (p > 0.05). As a result, although the antibacterial activity of B-Ag NPs and B-Ag@nGO Ag NPs obtained by green synthesis is lower than that of chemically synthesis obtained C-Ag NPs and C-Ag@nGO NCs, they provided higher antibacterial activity compared to the control group and did not reduce μTBS. The addition of biogenic Ag NPs to the adhesive system increased the antibacterial effect by maintaining the bond strength of the adhesive. Antibacterial adhesives can increase the restoration life by protecting the tooth-adhesive interface.

Tooth-composite bond failure with a universal and an etch-and-rinse adhesive depending on mode and frequency of application

OBJECTIVES

To evaluate the effect of an additional layer of universal adhesive on the interfacial enamel/dentin-composite gap formation in relation to application mode and aging, via spectral domain optical coherence tomography (SD-OCT) and scanning electron microscopy (SEM).

METHODS

In vitro class V cavities in 114 caries-free premolars were restored by applying one or two layers of a universal adhesive (Scotchbond Universal, SBU) in self-etch (se) and etch-and-rinse (er) mode or the reference adhesive OptiBond FL (OFL-er). The restorations were imaged by SD-OCT (six groups, n = 8) and SEM (n = 3) directly after filling (t1), water storage (t2, 24 h), embedding (t3), and thermo-mechanical loading (t4, TCML). The interfacial gaps were quantified using 26 parameters and analyzed using principal component analysis and linear mixed effect models.

RESULTS

Gap formation at enamel and dentin was significantly influenced by the adhesive, the application mode and number of layers (p < 0.001). This was due to the influence of the SBU-er mode (p < 1e-05), which showed significantly more gap formation and a greater range of variation with double application when compared to SBU-se and OFL. The fewest interfacial gaps occurred with one or two applications of OFL-er and one layer of SBU-er.

SIGNIFICANCE

Adhesive application mode and the number of adhesive layers are relevant factors in the tooth-composite bond failure. Double application worsened the adaptation of SBU to freshly prepared dentin conditioned with phosphoric acid.

Antibacterial effect, cytotoxicity, and bond strength of a modified dental adhesive containing silver nanoparticles

This study aimed to evaluate the antibacterial effect, cytotoxicity, and microtensile bond strength of an adhesive system containing silver nanoparticles (NAg). NAg was synthesized and incorporated (500 and 1000 ppm) into Scotchbond Multi-Purpose (SBMP) primer and bond. A microtensile bond test (μTBS) was performed after 24 h and 1 year. The adhesive interface was characterized using a confocal Raman microscope. The antibacterial activity was assessed using agar diffusion and biofilm inhibition assays (S. mutans). MTT assay was used to assess the cytotoxicity of NAg-conditioned culture media on human dental pulp stem cells (hDPSCs). The results were statistically analyzed using analysis of variance and Tukey's tests (α = .01). Incorporating 500 and 1000 ppm of NAg in the SBMP did not affect the μTBS after 24 h (p > 0.05). However, in the 1 year evaluation, 500 ppm presented the highest μTBS values (p < 0.05). The addition of NAg at 500 and 1000 ppm in the primer and bond led to larger inhibition halos and colony-forming units than the control (p < 0.05). For the unpolymerized and polymerized groups, the combination of primer and bond presented the highest cytotoxic effects on hDPSCs (p < 0.05). In conclusion, incorporating 500 or 1000 ppm of NAg into an etch-and-rinse adhesive system led to an antibacterial effect without altering the cytotoxicity. SBMP at 500 ppm presented a higher μTBS at 1 year.

Synthesis, characterization, photo-polymerization, hydrolytic stability, and etching behavior of new self-etch adhesive monomers

Considering the poor hydrolytic stability of the most methacrylate-based functional monomers of self-etch dental adhesives in acidic and aqueous conditions, in this study allyl-based photo-polymerizable self-etch monomers was synthesized in order to improve the hydrolytic stability. The new self-etch monomers based on phosphonic acid functional groups were synthesized through a two-step procedure. First, phosphoric anhydride, poly-phosphoric acid, and polyethylene glycol were reacted to produce phosphate ester precursor (P-PEG-P). Next, allyl 2, 3-epoxypropyl ether was reacted with P-PEG-P to synthesize allyl self-etch monomer. Glycidyl methacrylate was also reacted with P-PEG-P to synthesize a methacrylate self-etch analogue monomer. The monomers were characterized using FTIR and 1H-NMR spectroscopy. The viscosities of monomers were measured using a rheometer. The degree photopolymerization conversion of monomers was measured using FTIR spectroscopy. The pH assay was performed by a digital pH-meter. The etching behavior of the monomers on human teeth was studied using scanning electron microscopy (SEM). Thermo-gravimetric analysis (TGA) was performed to evaluate the possible interaction of the monomers with tricalcium phosphate (TCP). The solubility of synthesized monomers was examined in ethanol, acetone, and water. The hydrolytic stability of cured resins in artificial saliva during 4 months was also surveyed. The synthesis of new self-etching monomers was successfully confirmed by spectroscopy analyses. The results represented appropriate viscosity of self-etching monomers around 1 (Pa s). The resin containing methacrylate monomer exhibited its degree of conversion is more than that of allyl monomer (p < 0.05). The allyl and methacrylate self-etch monomers exhibited pH values of 1.2 and 1.3, respectively. SEM micrograph verified that the synthesized monomers were able to suitable etching of the enamel human premolar teeth. The data obtained from TGA tests revealed that thermal stability of (TCP) containing monomers is enhanced. Also, the monomers exhibited an excellent solubility in polar solvents, but when they are mixed with TCP, they are not, anymore, dissolved in these solvents. Furthermore, the allyl monomer showed higher hydrolytic stability than the methacrylate monomer. The new photo-polymerizable acidic monomer based on allyl functionality showed enhanced hydrolytic stability compared to methacrylate-based monomer. It may be considered as a promising monomer for self-etch dental adhesives.

L-arginine-containing mesoporous silica nanoparticles embedded in dental adhesive (Arg@MSN@DAdh) for targeting cariogenic bacteria

Dental caries is the major biofilm-mediated oral disease in the world. The main treatment to restore caries lesions consists of the use of adhesive resin composites due to their good properties. However, the progressive degradation of the adhesive in the medium term makes possible the proliferation of cariogenic bacteria allowing secondary caries to emerge. In this study, a dental adhesive incorporating a drug delivery system based on L-arginine-containing mesoporous silica nanoparticles (MSNs) was used to release this essential amino acid as a source of basicity to neutralize the harmful acidic conditions that mediate the development of dental secondary caries. The in vitro and bacterial culture experiments proved that L-arginine was released in a sustained way from MSNs and diffused out from the dental adhesive, effectively contributing to the reduction of the bacterial strains Streptococcus mutans and Lactobacillus casei. Furthermore, the mechanical and bonding properties of the dental adhesive did not change significantly after the incorporation of L-arginine-containing MSNs. These results are yielding glimmers of promise for the cost-effective prevention of secondary caries.

Novel bioactive adhesive containing dimethylaminohexadecyl methacrylate and calcium phosphate nanoparticles to inhibit metalloproteinases and nanoleakage with three months of aging in artificial saliva

OBJECTIVES

The objectives of this study were to: (1) develop a multifunctional adhesive via dimethylaminohexadecyl methacrylate (DMAHDM) and nanoparticles of amorphous calcium phosphate (NACP); and (2) investigate its ability to provide metalloproteinases (MMPs) deactivation and remineralization for long-term dentin bonding durability.

METHODS

DMAHDM and NACP were incorporated into Adper™ Single Bond 2 Adhesive (SB2) at mass fractions of 5% and 20%, respectively. Degree of conversion and contact angle were measured. Endogenous MMP activity of the demineralized dentin beams, Masson's trichrome staining, nano-indentation, microtensile bond strength and interfacial nanoleakage analyses were investigated after 24 h and 3 months of storage aging in artificial saliva.

RESULTS

Adding DMAHDM and NACP did not compromise the degree of conversion and contact angle of SB2 (p > 0.05). DMAHDM and NACP incorporation reduced the endogenous MMP activity by 53 %, facilitated remineralization, and increased the Young's modulus of hybrid layer by 49 % after 3 months of aging in artificial saliva, compared to control. For SB2 Control, the dentin bond strength decreased by 38 %, with greater nanoleakage expression, after 3 months of aging (p < 0.05). However, DMAHDM+NACP group showed no loss in bond strength, with much less nanoleakage, after 3 months of aging (p > 0.05).

SIGNIFICANCE

DMAHDM+NACP adhesive greatly reduced MMP-degradation activity in demineralized dentin, induced remineralization at adhesive-dentin interface, and maintained the dentin bond strength after aging, without adversely affecting polymerization and dentin wettability. This new adhesive has great potential to help eliminate secondary caries, prevent hybrid layer degradation, and increase the resin-dentin bond longevity.

Novel calcium phosphate ion-rechargeable and antibacterial adhesive to inhibit dental caries

OBJECTIVES

This study aimed to develop an antibacterial and calcium (Ca) and phosphate (P) rechargeable adhesive and investigate the effects of dimethylaminododecyl methacrylate (DMAHDM) and nanoparticles of amorphous calcium phosphate (NACP) on dentin bonding, biofilm response, and repeated Ca and P ion recharge and re-release capability for the first time.

MATERIALS AND METHODS

Pyromellitic glycerol dimethacrylate (PMGDM), ethoxylated bisphenol A dimethacrylate (EBPADMA), 2-hydroxyethyl methacrylate (HEMA), and bisphenol A glycidyl dimethacrylate (BisGMA) formed the adhesive (PEHB). Three groups were tested: (1) Scotchbond (SBMP, 3 M) control, (2) PEHB + 30% NACP, and (3) PEHB + 30% NACP + 5% DMAHDM. Specimens were tested for dentin shear bond strength, and Ca and P ion release, recharge, and re-release. Biofilm lactic acid production and colony-forming units (CFU) on resins were analyzed.

RESULTS

The four groups had similar dentin shear bond strengths (p > 0.1). Adhesive with DMAHDM showed significant decrease in metabolic activity, lactic acid production, and biofilm CFU (p < 0.05). The adhesives containing NACP released high levels of Ca and P ions initially and after being recharged.

CONCLUSION

This study developed the first Ca and P ion-rechargeable and antibacterial adhesive, achieving strong antibacterial activity and Ca and P ion recharge and re-release for long-term remineralization.

CLINICAL RELEVANCE

Considering the restoration-tooth bonded interface being the weak link and recurrent caries at the margins being the primary reason for restoration failures, this novel calcium phosphate-rechargeable and antibacterial adhesive is promising for a wide range of tooth-restoration applications to inhibit caries.

Nitrogen doped titanium dioxide as an aesthetic antimicrobial filler in dental polymers

OBJECTIVE

To develop an aesthetic resin composite using a nitrogen-doped titanium dioxide (NTiO₂) filler that possesses antimicrobial properties against cariogenic bacteria.

METHODS

N-TiO₂ powder was manufactured by calcining commercial TiO₂ with urea. Free radical release from the N-TiO₂ powder under visible light irradiation was analysed using UV-Vis spectrophotometry. The N-TiO₂ powder was incorporated into a dental resin and the photocatalytic activity assessed using a dye under both visible light and dark conditions. Using XTT assay to measure the cellular metabolic activity, the antibacterial properties of the N-TiO₂ /resin composite discs were tested using Streptococcus mutans.

RESULTS

Doping nitrogen of TiO₂ resulted in a band gap shift towards the visible light spectrum, which enabled the powder to release reactive oxygen species when exposed to visible light. When incorporated into a dental resin, the N-TiO₂/resin composite still demonstrated sustained release of reactive oxygen species, maintaining its photocatalytic activity and showing an antibacterial effect towards Streptococcus mutans under visible light conditions.

SIGNIFICANCE

N-TiO₂ filled resin composite shows great promise as a potential aesthetic resin based adhesive for orthodontic bonding.

Evaluation of resveratrol-doped adhesive with advanced dentin bond durability

OBJECTIVES

This paper aimed to evaluate the influence of resveratrol-doped adhesive on the durability and antibiofilm capability of dentin bonding.

METHODS

Experimental adhesives were prepared by incorporating resveratrol into a universal adhesive at concentrations of 0 (control), 0.1, 1, and 10 mg/mL. The microtensile bond strength, fracture modes, and adhesive-dentin interface nanoleakage were assessed after 24 h of water storage, 10,000 times of thermocycling or 1-month of collagenase ageing. Relevant antibiofilm capability on Streptococcus mutans (S. mutans), in situ zymography, degree of conversion, and cytotoxicity of resveratrol-doped adhesives were also determined.

RESULTS

Irrespective of thermocycled or collagenase ageing, the resveratrol-doped adhesive (1 mg/mL) maintained the bond strength and reduced the nanoleakage expression. Meanwhile, the inhibitory ability on endogenous protease activity and S. mutans biofilm formation with acceptable biocompatibility were obtained.

CONCLUSIONS

This study suggested that the resveratrol-doped adhesive achieved effective improvement on dentin bond durability and secondary caries management.

CLINICAL SIGNIFICANCE

The application of the resveratrol-doped adhesive indicates promising benefits to increase the lifetime of composite restorations.

A novel dental adhesive containing Ag/polydopamine-modified HA fillers with both antibacterial and mineralization properties

OBJECTIVES

To evaluate the antibacterial and mineralization properties of a dental adhesive containing Ag/polydopamine-modified HA (HA, hydroxyapatite) fillers.

METHODS

First, an HA-polydopamine-Ag-polydopamine (HA-PDA-Ag-PDA) filler was prepared and characterized using SEM, TEM, XPS, XRD and FTIR. Then, the HA-PDA-Ag-PDA filler was mixed into an adhesive at different mass fractions (0 wt%, 0.5 wt%, 1 wt%, 2 wt%) to prepare a functional adhesive. Antibacterial and mineralization tests were carried out, and the cytotoxicity of the functional adhesive against L929 fibroblasts was also examined.

RESULTS

The SEM, TEM, XPS, XRD and FTIR characterizations confirmed the successful preparation of the HA-PDA-Ag filler. The 1 wt% and 2 wt% functional adhesives showed the strongest bacterial inhibition effect among all the samples (p < 0.05). Obvious apatite crystals were observed in the SEM micrograph of the surface of the functional adhesive sample after immersion in artificial saliva for predetermined times (1 d, 7 d, 14 d and 28 d). There was no significant difference between the experimental group and the control group in terms of cell proliferation activity (p > 0.05).

CONCLUSIONS

The 1 wt% and 2 wt% functional adhesives demonstrated good antibacterial and mineralization properties, as well as good biocompatibility.

CLINICAL SIGNIFICANCE

Functional adhesives containing Ag/polydopamine-modified HA fillers with antibacterial and mineralization capabilities might have excellent potential to enhance the stability and durability of hybrid layers and prolong the service life of dental restorations. Our study on bifunctional adhesives has paved the way for future clinical applications to increase restoration longevity.

Methacrylate-functionalized proanthocyanidins as novel polymerizable collagen cross-linkers - Part 2: Effects on polymerization, microhardness and leaching of adhesives

OBJECTIVE

The aim of the study was to investigate the effects of a novel polymerizable collagen cross-linker methacrylate-functionalized proanthocyanidins (MAPA) on the polymerization, microhardness and leaching of a HEMA-based experimental dental adhesive system.

METHODS

Three MAPAs were synthesized using different methacrylate (MA) to proanthocyanidins (PA) feeding ratios of 1:2, 1:1, and 2:1 to obtain MAPA-1, MAPA-2, and MAPA-3, respectively. The resulting three MAPAs and PA were added to an experimental adhesive formulated with HEMA and a tri-component photoinitiator system (0.5 wt% CQ/EDMAB/DPIHP) at 1%, 5% and 10% MAPA or PA concentrations (wt%). The adhesive polymerization kinetics was measured continuously in real-time for 10 min using a Fourier-transform infrared spectroscopy (FTIR) with an attenuated total reflectance (ATR) accessory. Degree of conversion (DC) and Vickers microhardness (MH) of cured adhesives were measured at 72 h post-cure. The leaching of cured adhesives in DI water was monitored using UV-vis spectrophotometer. Statistical analysis was performed using one-way and two-way ANOVA, Tukey's (p < 0.05).

RESULTS

The adhesive formulations with 1%, 5% and 10% MAPAs-1, -2, -3 all generated higher rate of polymerization and 10-min DC than the formulations with PA at the same concentrations. At 72 h post-cure, the adhesive formulation with 5% MAPA-2 exhibited significantly higher DC (99.40%) and more than doubled MH (18.93) values than the formulation with 5% PA (DC = 89.47%, MH = 8.41) and the control (DC = 95.46%, MH = 9.33). Moreover, the cured adhesive with 5% MAPA-2 demonstrated significantly reduced PA leaching in comparison with cured adhesive with 5% PA.

SIGNIFICANCE

Synthesized MAPA is a novel class of polymerizable collagen cross-linker that not only stabilizes dentin collagen via its PA component, but also improves polymerization, mechanical properties and stability of HEMA-based adhesives via its MA component. By inheriting the benefit while overcoming the drawback of PA, MAPA offers a revolutionary solution for improved bond-strength and longevity of dental restorations.

Scoping review of trials evaluating adhesive strategies in pediatric dentistry: where do simplified strategies lie?

BACKGROUND

Adhesive restorations allow a conservative approach to caries management and are increasingly used as a restorative option in pediatric dentistry. Placement can be difficult in children because of the cooperation required for multiple bonding steps. Due to this, it is vital to assess if novel, simpler strategies have been featured in clinical trials and if clinical trials are researching the different existing adhesive strategies.

METHODS

This review followed Preferred Reporting Items for Systematic Reviews and Meta-analysis adapted for Scoping Reviews (PRISMA-ScR) guidelines. PubMed/Medline, Cochrane Central, Scopus and EMBASE were used for systematic search, using free keywords and controlled search terms. Clinical trials of children requiring a restorative intervention which featured adhesive strategies were included. Only peer-reviewed trials of primary teeth restored with resin composites, published in the last 10-year period were eligible. Data charting was accomplished independently by two reviewers, and studies were summarized according to their date, type, intervention, sample size, observation period, outcomes and conclusions. Quality assessment was performed using Cochrane's Risk of Bias 2.0 tool.

RESULTS

700 potentially relevant references were found, which after a rigorous inclusion scheme, resulted in a total of 8 eligible clinical trials. Out of these, 7 were randomized clinical trials. Most trials featured a split-mouth design and the observation period ranged from 12 to 36 months. The trials evaluated interventions of two self-adhesive composites, two bulk-fill composites, two novel composites, one compomer and eight adhesives from different strategies. Most studies (4/8) included were judged to raise some concerns regarding risk of bias, while two were classified as high risk and two as low.

CONCLUSION

Few studies comparing adhesive strategies were found, especially adhesives in sound substrates. The existing studies do not reflect all current approaches that could be used in pediatric dentistry. Further studies addressing bioactive composites and contemporary adhesives are necessary.

Morpho-functional effects of different universal dental adhesives on human gingival fibroblasts: an in vitro study

To analyze the effects of four universal adhesives (Optibond Solo Plus—OB, Universal Bond—UB, Prime&Bond Active—PBA, FuturaBond M + —FB) on human gingival fibroblasts in terms of cytotoxicity, morphology and function. After in vitro exposure for up to 48 h, fibroblast viability was determined by the MTT assay determined, morphology by phase-contrast microscopy and migration by the scratch wound assay. Expression levels of IL1β, IL6, IL8, IL10, TNFα and VEGF genes were assessed by RT-PCR and their protein production by Western blot analysis. Apoptosis and cell cycle were analyzed by flow cytometry. OB and UB induced early morphological changes on fibroblasts (3 h) with extended cell death at 24 h/48 h. Gene expression of collagen type I and fibronectin increased fivefold compared with controls, elastin disappeared and elastase increased threefold, indicating gingival tissue tended to become fibrotic. Only UB and OB increased gene expression of inflammatory markers: IL1β at 3 and 48 h (up to about three times), IL6 and IL8 at 3 h (up to almost four times) which corresponded to the increase of the activated form NF-kB. All adhesives showed an effect on the functionality of fibroblasts with cytotoxic effect time and concentration dependent. Among all the OB and UB adhesives, they showed the greatest cell damage. The in-depth analysis of the effects of universal adhesives and possible functional effects represents an important information for the clinician towards choosing the most suitable adhesive system.

Rechargeable adhesive with calcium phosphate nanoparticles inhibited long-term dentin demineralization in a biofilm-challenged environment

OBJECTIVES

This study aims to investigate the long-term demineralization-inhibition capability of a rechargeable adhesive with nanoparticles of amorphous calcium phosphate (NACP) on dentin in a biofilm-challenged environment.

METHODS

The NACP adhesive was immersed in a pH 4 solution to exhaust calcium (Ca) and phosphate (P) ions and then recharged with Ca and P ions. Dentin samples were demineralized underStreptococcus mutans biofilms for 24 h and randomly divided into two groups: (1) dentin control, (2) dentin with recharged NACP adhesives. Each day, all the samples were immersed in brain heart infusion broth with 1% sucrose (BHIS) for 4 h, and then in artificial saliva (AS) for 20 h. This cycle was repeated for 10 days. The pH of BHIS, the Ca and P ions content of the BHIS and AS were measured daily. After 10 days, the lactic acid production and colony-forming units of the biofilms were tested. The changes of remineralization/demineralization were also analyzed.

RESULTS

Dentin in the control group showed further demineralization. The recharged NACP adhesive neutralized acids, increasing the pH to above 5, and released large amounts of Ca and P ions each day. The recharged NACP adhesive decreased the production of lactic acid (P < 0.05), inhibited dentin demineralization and sustained the dentin hardness in the biofilm-challenged environment, showing an excellent long-term demineralization-inhibition capability.

CONCLUSIONS

The NACP adhesive could continuously inhibit dentin demineralization in a biofilm-challenged environment by recharging with Ca and P ions.

SIGNIFICANCE

The rechargeable NACP adhesive could provide long-term dentin bond protection.

Hydrophilic dyes as photosensitizers for photopolymerization of dental adhesives

OBJECTIVES

This study explored hydrophilic dyes as photosensitizers for application in dental adhesives. The goal was to identify dyes that enhance the degree of conversion (DC) of the hydrophilic-rich phase without impairing polymerization of the hydrophobic-rich phase.

METHODS

Properties that were investigated included the molar extinction coefficient at 480 nm, relative normalized photon absorption efficiency (PAE), rate of polymerization and degree of conversion (DC). The following hydrophilic dyes: Bromophenol blue sodium salt, Rosebengal sodium salt, Erythrosin B, New Fuchsin and Victoria blue B were identified as suitable photosensitizers.

RESULTS

In this study it was observed that dyes such as Bromophenol blue sodium salt, New Fuchsin, Victoria blue B and Rosebengal sodium salt were suitable candidates for dental adhesive photopolymerization, leading to substantial degree of conversion to both the hydrophilic-rich phase and the hydrophobic-rich phase.

CONCLUSIONS

In addition to the ability of the photosensitizer to absorb light in the visible range and transition to an excited state as a result of the absorbed energy, other factors such as the efficiency of the photosensitizer/light curing unit (LCU) combination, stability/efficiency of the excited state of the photosensitizer and/or initiating reactive species play an important role in the photopolymerization of the dental adhesive.

Catechol-thiol-based dental adhesive inspired by underwater mussel adhesion

The critical problem associated with the underwater mussel adhesive catechol-based 3,4-dihydroxy-L-phenylalanine (DOPA) is its sensitivity to oxidation. To overcome this problem, mussels underwent etching in the presence of acidic pH conditions (<3.0), and thiol chemistry was used to control the propensity of DOPA for oxidation. Similar strategies deployed by mussels are also actively utilized in dental adhesives which undergo etching in the presence of phosphoric acid derivatives to maximize the bonding strength and adapt thiol chemistries to minimize shrinkage stress. In view of the similarities between dental and underwater mussel adhesives, we employ in this study the strategy of mussel adhesion-the combination of DOPA and thiol chemistry with acid etching-to one of the most critical issues in dental adhesives, namely, the dentin bonding with zirconia. As a result, the adhesion bonding between zirconia and dentin, one of the most elusive problems in dentistry, has improved compared to the commercially available adhesive resin formulation. In addition, in view of the similar human oral and mussel adhesive environments, our findings will considerably contribute to the translation of the adhesive system inspired by mussels. STATEMENT OF SIGNIFICANCE: Mussels are effectively operated by creating an acidic environment when adhering with 3,4-dihydroxy-l-phenylalanine (DOPA)-thiol redox chemistry for underwater bonding. Similarly, in dental adhesives, phosphoric acid-based etching is used for dentin-bonding materials. In view of the similarity between dental adhesives and underwater mussel adhesives, the combination of DOPA and thiol chemistry with acid etching can be used to overcome one of the most critical issues in dentin medical adhesives. The proposed adhesion method produces high adhesion strengths compared to those currently used in dentin and zirconia adhesives. Here, we extend and evaluate dentin and zirconia dental adhesives by mixing with mussel (DOPA)-thiol redox chemistry and acid etching.

Resinous adhesive systems differentially affect the expression of cytokines by human monocytes stimulated or not with Streptococcus mutans in vitro

OBJECTIVES

The polymerization of adhesive systems is incomplete and the residual monomers that have been released have a cytotoxic capacity. Some teeth develop into pulp necrosis after composite resin restorations. Considering frequent pulpal inflammation in response to cariogenic bacteria, substances released from the patches could affect the cells of the inflammatory infiltrate and interfere with the mechanisms of defense against microorganisms and protection of pulpal tissue. The aim of this study was to evaluate the effect of substances released by different resinous adhesive systems on cell viability and cytokine expression by human monocytes stimulated in vitro with Streptococcus mutans.

DESIGN

Peripheral blood mononuclear cells from 10 healthy subjects were stimulated with S. mutans and then incubated with supernatants obtained from the Single Bond Universal (SBU) or Clearfil SE Bond (CSEB) adhesive systems for eight hours. Staining with Annexin V and 7AAD for analysis of apoptosis were performed and detection of monocytes expressing cytokines IL-1α, IL-6, IL-8, IL-10, IL-12 and TNF-α were performed by flow cytometry.

RESULTS

No treatment significantly affected apoptosis in monocytes. SBU supernatant increased the frequency of monocytes expressing IL-8 and decreased the monocytes expressing IL-10. Considering S. mutans-stimulated cells, while SBU increased the frequency of IL-8⁺ monocytes, CSEB reduced the frequency of IL-6 and TNF-α positive monocytes.

CONCLUSIONS

Products released from SBU seem to induce proinflammatory effects on monocytes while those from CSEB show an anti-inflammatory outcome. These effects may interfere in the control of cytokine-mediated immunoinflammatory pulp reactions, both in the presence and absence of stimulation by cariogenic bacteria.

Multifunctional monomer acts as co-initiator and crosslinker to provide autonomous strengthening with enhanced hydrolytic stability in dental adhesives

OBJECTIVE

The purpose of this study was to evaluate a new synthesized multifunctional monomer, aminosilane functionalized methacrylate (ASMA), containing polymerizable methacrylate, tertiary amine, and methoxysilane functionalities in dental adhesive formulations, and to investigate the polymerization kinetics, leachates, thermal and mechanical properties of copolymers.

METHODS

Adhesive contained HEMA/BisGMA (45/55, w/w) was used as a control, and mixtures based on HEMA/BisGMA/ASMA at the mass ratio of 45/(55-x)/x were used as experimental adhesive. Adhesives were characterized with regard to water miscibility, photo-polymerization behavior (Fourier transform infrared spectroscopy, FTIR), leached co-monomers (high performance liquid chromatography, HPLC), thermal properties (modulated differential scanning calorimeter, MDSC), and mechanical properties (dynamic mechanical analyzer, DMA). Stress relaxation times and the corresponding moduli, obtained from stress relaxation tests, are used in a simulated linear loading case.

RESULTS

As compared to the control, ASMA-containing adhesives showed higher water miscibility, lower viscosity, improved monomer-to-polymer conversion, significantly greater T_g and rubbery modulus. HPLC results indicated a substantial reduction of leached HEMA (up to 85wt%) and BisGMA (up to 55wt%) in ethanol. The simulation reveals that the ASMA-containing adhesive becomes substantially stiffer than the control.

SIGNIFICANCE

ASMA monomer plays multiple roles, i.e. it serves as both a co-initiator and crosslinker while also providing autonomous strengthening and enhanced hydrolytic stability in the adhesive formulations. This multifunctional monomer offers significant promise for improving the durability of the adhesive at the composite/tooth interface.

New silyl-functionalized BisGMA provides autonomous strengthening without leaching for dental adhesives

Resin-based composite has overtaken dental amalgam as the most popular material for direct restorative dentistry. In spite of this popularity the clinical lifetime of composite restorations is threatened by recurrent decay. Degradation of the adhesive leads to gaps at the composite/tooth interface-bacteria, bacterial by-products and fluids infiltrate the gaps leading to recurrent decay and composite restoration failure. The durability of resin-dentin bonds is a major problem. We address this problem by synthesizing silyl-functionalized BisGMA (e.g., silyl-BisGMA), formulating dental adhesives with the new monomer and determining the physicochemical properties and leaching characteristics of the silyl-BisGMA adhesives. Silyl-BisGMA was synthesized by stoichiometric amounts of BisGMA and 3-isocyanatopropyl trimethoxysilane (IPTMS). The control adhesive was a mixture based on HEMA/BisGMA (45/55, w/w). In the experimental formulations, BisGMA was partially or completely replaced by silyl-BisGMA. Water miscibility, polymerization behavior (Fourier transform infrared spectroscopy, FTIR), thermal property (modulated differential scanning calorimetry, MDSC), mechanical properties in dry and wet conditions (dynamic mechanical analysis, DMA), and leached species (HPLC) were investigated. Data from all tests were submitted to appropriate statistical analysis (α = 0.05). Silyl-BisGMA-containing adhesives exhibited comparable water miscibility, lower viscosities, and significantly improved degree of conversion of CC bond as compared to the control. After 4 weeks aqueous aging, the glass transition temperature and rubbery moduli of the experimental copolymers were significantly greater than the control (p < 0.05). HPLC results indicated a substantial reduction of leached HEMA (up to 99 wt%) and BisGMA (up to 90 wt%). By introducing silyl-functional group, the new BisGMA derivative exhibited potential as a monomer that can lead to dental adhesives with improved mechanical properties and reduced leaching under conditions relevant to the oral environment. STATEMENT OF SIGNIFICANCE: The low-viscosity adhesive that bonds the composite to the tooth (enamel and dentin) is intended to seal and stabilize the composite/tooth interface, but it degrades leading to a breach at the composite/tooth margin. As the most popular crosslinking monomer in adhesives, Bisphenol A-glycerolate dimethacrylate (BisGMA) has limitations, e.g. susceptible to hydrolysis and concomitant property degradation. A methoxysilyl-functionalized BisGMA derivative (silyl-BisGMA) was introduced in this work to respond to these limitations. Our results indicated that by introducing silyl-BisGMA, higher crosslinked networks were obtained without sacrificing the homogeneity, and the leached amount of HEMA was reduced up to 99%. This novel resin offers potential benefits including prolonging the functional lifetime of dental resin materials.

Biostable, antidegradative and antimicrobial restorative systems based on host-biomaterials and microbial interactions

OBJECTIVES

Despite decades of development and their status as the restorative material of choice for dentists, resin composite restoratives and adhesives exhibit a number of shortcomings that limit their long-term survival in the oral cavity. Herein we review past and current work to understand these challenges and approaches to improve dental materials and extend restoration service life.

METHODS

Peer-reviewed work from a number of researchers as well as our own are summarized and analyzed. We also include yet-unpublished work of our own. Challenges to dental materials, methods to assess new materials, and recent material improvements and research directions are presented.

RESULTS

Mechanical stress, host- and bacterial-biodegradation, and secondary caries formation all contribute to restoration failure. In particular, several host- and bacterial-derived enzymes degrade the resin and collagen components of the hybrid layer, expanding the marginal gap and increasing access to bacteria and saliva. Furthermore, the virulence of cariogenic bacteria is up-regulated by resin biodegradation by-products, creating a positive feedback loop that increases biodegradation. These factors work synergistically to degrade the restoration margin, leading to secondary caries and restoration failure. Significant progress has been made to produce hydrolytically stable resins to resist biodegradation, as well as antimicrobial materials to reduce bacterial load around the restoration. Ideally, these two approaches should be combined in a holistic approach to restoration preservation.

SIGNIFICANCE

The oral cavity is a complex environment that poses an array of challenges to long-term material success; materials testing conditions should be comprehensive and closely mimic pathogenic oral conditions.

Piperonyl methacrylate: Copolymerizable coinitiator for adhesive compositions

OBJECTIVES

This study describes the synthesis of piperonyl methacrylate (PipM) and evaluates its effect when used as coinitiator in the photoinitiated radical polymerization of experimental adhesive resins.

METHODS

PipM was synthetized through an esterification reaction and characterized by FTIR and ¹H NMR spectroscopy. Adhesive resins containing camphorquinone as photoinitiator and PipM or ethyl-4-dimethyl amine benzoate (EDAB) as coinitiators were formulated. Scotchbond Multipurpose (SBMP) adhesive was used as commercial reference. All materials were analyzed for polymerization kinetics, flexural strength, elastic modulus, water sorption/solubility, shear bond strength to bovine enamel and dentin, characterization of hybrid layer by scanning electron microscopy (SEM), microbiological direct contact test, and cytotoxicity.

RESULTS

The adhesive with PipM presented higher degree of conversion and lower sorption/solubility when compared with other groups. Shear bond strength to enamel and dentin were similar for PipM and EDAB materials. The percentage of cellular viability was close to 100% and similar in the experimental groups and the commercial reference.

CONCLUSIONS

PipM presented similar or superior performance to the tertiary amine used as control, representing a potential alternative coinitiator for photopolymerizable dental materials.

CLINICAL SIGNIFICANCE

PipM could be potentially useful in the formulations of adhesive systems with enhanced chemical properties, which could mean improvement in the longevity of composite resin restorations.

Modulating pH through lysine integrated dental adhesives

OBJECTIVES

The objective of this study was to explore the effect of lysine integration to dental adhesives with respect to the polymerization kinetics, neutralization capacities in the acidic microenvironment, dynamic mechanical properties, and thermal properties.

MATERIALS AND METHOD

Lysine was incorporated into liquid resin formulations at 2.5 and 5.0wt % with additional water/ethanol co-solvents. The co-monomer system contained 2-hydroxyethyl-methacrylate (HEMA) and Bisphenol A glycerolate dimethacrylate (BisGMA) with a mass ratio of 45/55. The kinetics of photopolymerization, neutralization capacities, lysine-leaching, dynamic mechanical properties and thermal properties of the control and experimental adhesives were analyzed.

RESULTS

The degree of conversion of the experimental adhesive was increased substantially at 2.5wt% lysine as compared to the control. The experimental polymers provided acute neutralization of the acidic microenvironment. Approximately half of the lysine was released from the polymer network within one month. Under dry conditions and physiologic temperatures, the incorporation of lysine did not compromise the storage modulus. Comparison of the thermal properties suggests that the more compact structure of the control adhesive inhibits movement of the polymer chains resulting in increased T_g.

SIGNIFICANCE

Incorporating lysine in the adhesive formulations led to promising results regarding modulating pH, which may serve as one aspect of a multi-spectrum approach for enhancing the durability of composite restorations. The results provide insight and lay a foundation for incorporating amino acids or peptides into adhesive formulations for pH modulation or desired bioactivity at the interfacial margin between the composite and tooth.

Novel magnetic nanoparticle-containing adhesive with greater dentin bond strength and antibacterial and remineralizing capabilities

OBJECTIVES

A nanoparticle-doped adhesive that can be controlled with magnetic forces was recently developed to deliver drugs to the pulp and improve adhesive penetration into dentin. However, it did not have bactericidal and remineralization abilities. The objectives of this study were to: (1) develop a magnetic nanoparticle-containing adhesive with dimethylaminohexadecyl methacrylate (DMAHDM), amorphous calcium phosphate nanoparticles (NACP) and magnetic nanoparticles (MNP); and (2) investigate the effects on dentin bond strength, calcium (Ca) and phosphate (P) ion release and anti-biofilm properties.

METHODS

MNP, DMAHDM and NACP were mixed into Scotchbond SBMP at 2%, 5% and 20% by mass, respectively. Two types of magnetic nanoparticles were used: acrylate-functionalized iron nanoparticles (AINPs); and iron oxide nanoparticles (IONPs). Each type was added into the resin at 1% by mass. Dentin bonding was performed with a magnetic force application for 3min, provided by a commercial cube-shaped magnet. Dentin shear bond strengths were measured. Streptococcus mutans biofilms were grown on resins, and metabolic activity, lactic acid and colony-forming units (CFU) were determined. Ca and P ion concentrations in, and pH of biofilm culture medium were measured.

RESULTS

Magnetic nanoparticle-containing adhesive using magnetic force increased the dentin shear bond strength by 59% over SBMP Control (p<0.05). Adding DMAHDM and NACP did not adversely affect the dentin bond strength (p>0.05). The adhesive with MNP+DMAHDM+NACP reduced the S. mutans biofilm CFU by 4 logs. For the adhesive with NACP, the biofilm medium became a Ca and P ion reservoir. The biofilm culture medium of the magnetic nanoparticle-containing adhesive with NACP had a safe pH of 6.9, while the biofilm medium of commercial adhesive had a cariogenic pH of 4.5.

SIGNIFICANCE

Magnetic nanoparticle-containing adhesive with DMAHDM and NACP under a magnetic force yielded much greater dentin bond strength than commercial control. The novel adhesive reduced biofilm CFU by 4 logs and increased the biofilm pH from a cariogenic pH 4.5-6.9, and therefore is promising to enhance the resin-tooth bond, strengthen tooth structures, and suppress secondary caries at the restoration margins.

Biofabricated silver nanoparticles incorporated polymethyl methacrylate as a dental adhesive material with antibacterial and antibiofilm activity against Streptococcus mutans

In this study, polymethyl methacrylate (PMMA) thin films incorporated with biofabricated silver nanoparticles were used to evaluate the in vitro antimicrobial and antibiofilm activity against the cariogenic bacterium Streptococcus mutans. For this, silver nanoparticles (AgNPs) were generated using Bacillus amyloliquefaciens SJ14 culture (MAgNPs) and extract from Curcuma aromatica rhizome (CAgNPs). The AgNPs were further characterized by UV-Vis spectroscopy and high-resolution transmission electron microscopy. The minimum inhibitory concentration, minimum bactericidal concentration and antibiofilm activity of AgNPs against S. mutans were also assessed. Here, MAgNPs were found to have superior antimicrobial activity when compared to CAgNPs. The MAgNPs and CAgNPs also demonstrated 99% and 94% inhibition of biofilm formation of S. mutans at concentrations of 3 µg/mL and 50 µg/mL, respectively. The AgNPs were further incorporated into PMMA thin films using solvent casting method. The thin films were also characterized by scanning electron microscopy and UV-Vis spectroscopy. Subsequently, both PMMA/MAgNPs and PMMA/CAgNPs nanocomposite thin films were subjected to antimicrobial and antibiofilm analysis. The microbicidal activity was found to be higher for the PMMA/MAgNPs thin film, which highlights the potency of microbially synthesized AgNPs as excellent agents to inhibit cariogenic bacteria from colonising dental restorative material.

Protein-repelling adhesive resin containing calcium phosphate nanoparticles with repeated ion-recharge and re-releases

OBJECTIVES

The objectives were to develop a calcium (Ca) and phosphate (P) ion-rechargeable and protein-repellent adhesive containing nanoparticles of amorphous calcium phosphate (NACP) and 2-methacryloyloxyethyl phosphorylcholine (MPC), and investigate the MPC effects on ion recharge and re-releases for the first time.

METHODS

Pyromellitic glycerol dimethacrylate and ethoxylated bisphenol-A dimethacrylate were used to fabricate adhesive PEHB. Six adhesives were tested: (1) Scotchbond (SBMP); (2) PEHB, (3) PEHB + 20%NACP; (4) PEHB + 30%NACP; (5) PEHB + 20%NACP+3%MPC; (6) PEHB + 30%NACP+3%MPC. Dentin shear bond strength, Ca/P ion release, recharge and re-release, and protein adsorption were measured. A microcosm biofilm model was tested for lactic-acid production and colony-forming units (CFU).

RESULTS

Adding NACP + MPC did not negatively affect dentin bond strength (p > 0.1). With increasing the number of recharge/re-release cycles, the Ca/P ion re-release reached similarly higher levels (p > 0.1), indicating long-term remineralization capability. One recharge enabled the adhesives to have continued re-releases for 21 days. Incorporation of 3% MPC yielded 10-fold decrease in protein adsorption, and 1-2 log decrease in biofilm CFU.

CONCLUSIONS

The new rechargeable adhesive with MPC + 30%NACP greatly reduced protein adsorption, biofilm growth and lactic acid. Incorporation of MPC did not compromise the excellent Ca/P ion release, rechargeability, and dentin bond strength.

CLINICAL SIGNIFICANCE

Novel bioactive adhesive containing MPC + NACP is promising to repel proteins and bacteria, and inhibit secondary caries at the restoration margins. The method of NACP + MPC to combine CaP-recharge and protein-repellency is applicable to the development of a new generation of materials including composites and cements to suppress oral biofilms and plaque formation and protect tooth structures.

Antibacterial effects and cytotoxicity of an adhesive containing low concentration of silver nanoparticles

OBJECTIVES

To evaluate the antibacterial effects, cytotoxicity and microtensile bond strength of an adhesive containing low concentrations of silver nanoparticles (NAg).

METHODS

Various concentrations of NAg (50, 100, 150, 200 and 250 ppm) were incorporated into the primer of the Scotchbond Multi-Purpose adhesive system (SBMP). Antibacterial activity was examined using a broth microdilution assay to determine minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC), agar diffusion assay and the MTT assay was used to examine the biofilm metabolic activity (S. mutans). The Microtensile Bond Test (μTBS) was performed after 24 h, followed by 6-months storage in distilled water. Cytotoxicity was assessed with an MTT reduction assay in human dental pulp stem cells viability after exposure to Nag-conditioned culture media during 0, 24, 48, and 72 h. The results were statistically analyzed (α ≤ 0.05).

RESULTS

MIC was found between NAg 25 and 50 ppm MBC was determined at 50 ppm of NAg. Bacterial activity inhibition was higher than control in all NAg groups compared to control in agar diffusion assay. Biofilm inhibition was statistically higher in 250 ppm NAg than control. All NAg groups and SBMP presented similar cytotoxicity in each period. Adhesives with NAg 200 and 250 ppm and SBMP (control) presented the highest μTBS values, similar to that of SBMP control, in both instances (24 h and 6 months) (p > 0.05).

CONCLUSIONS

The commercial primer containing NAg 250 ppm showed both antibacterial effect and reliable bond strength with no cytotoxicity increase. The addition of NAg to primers seems promising for the improvement of conventional dental adhesives efficacy.

CLINICAL SIGNIFICANCE

The addition of low concentrations of NAg (250 ppm) to primers were effective to improve antibacterial effect preserving the bond strength and the biocompatibility of the commercial product. NAg/primer association could protect the tooth-adhesive interface increasing dental restoration longevity.

[Correspondence between advances of dental composites and adhesives and clinical guidelines for direct restorations]

The longevity of direct adhesive restoration is related to the restorative materials, the patient and the professional. On one hand, dental composites/adhesives have been modified and developed to fulfill the criteria for clinical application. On the other hand, the clinical guidelines for adhesive restorations have been released and updated accordingly, which would prolong the longevity of restorations. In this commentary, the removal of carious tissues, interface preparation for bonding and application of adhesives are emphasized. The administrative measures for registration and clinical evaluation criteria for adhesive restorative material are also introduced.

Antibacterial quaternary ammonium compounds in dental materials: A systematic review

OBJECTIVE

Quaternary ammonium compounds (QACs) represent one of the most effective classes of disinfectant agents in dental materials and resin nanocomposites. This reviews aims to give a wide overview on the research in the field of antibacterial QACs in dental materials and nanocomposites.

METHOD

An introduction to dental materials components as well as the microorganisms and methods of evaluation for the antimicrobial assays are presented. Then, the properties and synthesis route of QACs, as monomer and filler, are shown. Finally, antimicrobial monomers and fillers, specifically those contain quaternary ammonium salts (QASs), in dental materials are reviewed.

RESULTS

QACs have been used as monomer and micro/nanofiller in restorative dentistry. They possess one or more methacrylate functional groups to participate in polymerization reactions. QACs with multiple methacrylate groups can also be used as crosslinking agents. Furthermore, QACs with chain length from ∼12 to 16 have higher antimicrobial activity in cured dental resins. In general, increasing the chain length leads to a threshold value (critical point) and then it causes decrease in the antimicrobial activity.

SIGNIFICANCE

The current state of the art of dental materials and resin nanocomposites includes a wide variety of antimicrobial materials. Among them, QACs presents low cytotoxicity and excellent long-term antimicrobial activity without leaching out over time.

Doxycycline-loaded nanotube-modified adhesives inhibit MMP in a dose-dependent fashion

OBJECTIVES

This article evaluated the drug loading, release kinetics, and matrix metalloproteinase (MMP) inhibition of doxycycline (DOX) released from DOX-loaded nanotube-modified adhesives. DOX was chosen as the model drug, since it is the only MMP inhibitor approved by the U.S. Food and Drug Administration.

MATERIALS AND METHODS

Drug loading into the nanotubes was accomplished using DOX solution at distinct concentrations. Increased concentrations of DOX significantly improved the amount of loaded DOX. The modified adhesives were fabricated by incorporating DOX-loaded nanotubes into the adhesive resin of a commercial product. The degree of conversion (DC), Knoop microhardness, DOX release kinetics, antimicrobial, cytocompatibility, and anti-MMP activity of the modified adhesives were investigated.

RESULTS

Incorporation of DOX-loaded nanotubes did not compromise DC, Knoop microhardness, or cell compatibility. Higher concentrations of DOX led to an increase in DOX release in a concentration-dependent manner from the modified adhesives. DOX released from the modified adhesives did not inhibit the growth of caries-related bacteria, but more importantly, it did inhibit MMP-1 activity.

CONCLUSIONS

The loading of DOX into the nanotube-modified adhesives did not compromise the physicochemical properties of the adhesives and the released levels of DOX were able to inhibit MMP activity without cytotoxicity.

CLINICAL SIGNIFICANCE

Doxycycline released from the nanotube-modified adhesives inhibited MMP activity in a concentration-dependent fashion. Therefore, the proposed nanotube-modified adhesive may hold clinical potential as a strategy to preserve resin/dentin bond stability.

Effects of ethanol concentrations of acrylate-based dental adhesives on microtensile composite-dentin bond strength and hybrid layer structure of a 10 wt% polyhedral oligomeric silsesquioxane (POSS)-incorporated bonding agent

Background

The aim of this study was to assess for the first time the effects of different amounts of ethanol solvent on the microtensile bond strength of composite bonded to dentin using a polyhedral oligomeric silsesquioxane (POSS)-incorporated adhesive.

Materials and Methods

This experimental study was performed on 120 specimens divided into six groups (in accordance with the ISO TR11405 standard requiring at least 15 specimens per group). Occlusal dentin of thirty human molar teeth was exposed by removing its enamel. Five teeth were assigned to each of six groups and were converted to 20 microtensile rods (with square cross-sections of 1 mm × 1 mm) per group. The "Prime and Bond NT" (as a common commercial adhesive) was used as the control group. Experimental acrylate-based bonding agents containing 10 wt% POSS were produced with five concentrations of ethanol as solvent (0, 20, 31, 39, and 46 wt%). After application of adhesives on dentin surface, composite cylinders (height = 6 mm) were bonded to dentin surface. The microtensile bond strength of composite to dentin was measured. The fractured surfaces of specimens were evaluated under a scanning electron microscope to assess the morphology of hybrid layer. Data were analyzed using one-sample t-test, one-way analysis of variance (ANOVA), and Tukey tests (α = 0.05).

Results

the mean bond strength in the groups: "control, ethanol-free, and 20%, 31%, 39%, and 46% ethanol" was, respectively, 46.5 ± 5.6, 29.4 ± 5.7, 33.6 ± 4.1, 59.0 ± 5.5, 41.9 ± 6.2, and 18.7 ± 4.6 MPa. Overall difference was significant (ANOVA, P < 0.0001). Pairwise differences were all significant (Tukey P < 0.05) except those of "ethanol 0% versus 20%" and "20% versus 31%." All groups except "0% and 46% ethanol" had bond strengths above 30 MPa (t-test P < 0.05).

Conclusion

Incorporation of 31% ethanol as solvent into a 10 wt% POSS-incorporated experimental dental adhesive might increase the bond strength of composite to dentin and improve the quality and morphology of the hybrid layer. However, higher concentrations of the solvent might not improve the bond strength or quality of the hybrid layer.

Fabrication of hybrid crosslinked network with buffering capabilities and autonomous strengthening characteristics for dental adhesives

Ingress of bacteria and fluids at the interfacial gaps between the restorative composite biomaterial and the tooth structure contribute to recurrent decay and failure of the composite restoration. The inability of the material to increase the pH at the composite/tooth interface facilitates the outgrowth of bacteria. Neutralizing the microenvironment at the tooth/composite interface offers promise for reducing the damage provoked by cariogenic and aciduric bacteria. We address this problem by designing a dental adhesive composed of hybrid network to provide buffering and autonomous strengthening simultaneously. Two amino functional silanes, 2-hydroxy-3-morpholinopropyl (3-(triethoxysilyl)propyl) carbamate and 2-hydroxy-3-morpholinopropyl (3-(trimethoxysilyl)propyl) carbamate were synthesized and used as co-monomers. Combining free radical initiated polymerization (polymethacrylate-based network) and photoacid-induced sol-gel reaction (polysiloxane) results in the hybrid network formation. Resulting formulations were characterized with regard to real-time photo-polymerization, water sorption, leached species, neutralization, and mechanical properties. Results from real-time FTIR spectroscopic studies indicated that ethoxy was less reactive than methoxy substituent. The neutralization results demonstrated that the methoxy-containing adhesives have acute and delayed buffering capabilities. The mechanical properties of synthetic copolymers tested in dry conditions were improved via condensation reaction of the hydrolyzed organosilanes. The leaching from methoxy containing copolymers was significantly reduced. The sol-gel reaction provided a chronic and persistent reaction in wet condition-performance that offers potential for reducing secondary decay and increasing the functional lifetime of dental adhesives.

STATEMENT OF SIGNIFICANCE

The interfacial gaps between the restorative composite biomaterial and the tooth structure contributes to recurrent decay and failure of the composite restoration. The inability of the material to increase the pH at the composite/tooth interface facilitates the outgrowth of more cariogenic and aciduric bacteria. This paper reports a novel, synthetic resin that provides buffering capability and autonomous strengthening characteristics. In this work, two amino functional silanes were synthesized and the effect of alkoxy substitutions on the photoacid-induced sol-gel reaction was investigated. We evaluated the neutralization capability (monitoring the pH of lactic acid solution) and the autonomous strengthening property (monitoring the mechanical properties of the hybrid copolymers under wet conditions and quantitatively analyzing the leachable species by HPLC). The novel resin investigated in this study offers the potential benefits of reducing the risk of recurrent decay and prolonging the functional lifetime of dental adhesives.

Antibacterial effect and bond strength of a modified dental adhesive containing the peptide nisin

This study attempted to incorporate the antibacterial peptide nisin into an etch-and-rinse dental adhesive to evaluate the antibacterial activity of the modified adhesive against Streptococcus mutans and the bond strength. Single Bond 2 was used as a negative control, and nisin was incorporated at 1%, 3%, and 5% (w/v). The antibacterial activity against S. mutans was evaluated using the film contact test, the agar diffusion test, XTT assays and confocal laser scanning microscopy (CLSM). The microtensile bond strength (μTBS) of the modified dental adhesive was also evaluated. The cured nisin-incorporated dental adhesive exhibited a significant inhibitory effect on the growth of S. mutans (P<0.05), and the inhibitory effect was strengthened as the nisin concentration increased (P<0.05). However, no significant differences in the agar diffusion test were found for the cured nisin-incorporated adhesives compared with the control group. Based on XTT results and CLSM images, the cured nisin-incorporated adhesive interfered with the adherence of S. mutans and the integrity of its biofilms (P<0.05). Compared with the control group, the 1% nisin group did not exhibit a significant difference in μTBS (P>0.05), whereas the 3% and 5% nisin groups displayed decreased bond strength (P<0.05).

Probing the neutralization behavior of zwitterionic monomer-containing dental adhesive

OBJECTIVE

To investigate the polymerization kinetics, neutralization behavior, and mechanical properties of amine-functionalized dental adhesive cured in the presence of zwitterionic monomer, methacryloyloxyethyl phosphorylcholine (MPC).

METHODS

The control adhesive was a mixture based on HEMA/BisGMA/2-N-morpholinoethyl methacrylate (MEMA) (40/30/30, w/w/w). The control and experimental formulations containing MPC were characterized with regard to water miscibility of liquid resins, photopolymerization kinetics, water sorption and solubility, dynamic mechanical properties and leachables from the polymers (aged in ethanol). The neutralization behavior of the adhesives was determined by monitoring the pH of lactic acid (LA) solution.

RESULTS

The water miscibility decreased with increasing MPC amount. The water sorption of experimental copolymer specimen was greater than the control. The addition of 8wt% water led to improved photo-polymerization efficiency for experimental formulations at MPC of 2.5 and 5wt%, and significant reduction in the cumulative amounts of leached HEMA, BisGMA, and MEMA, i.e. 90, 60 and 50% reduction, respectively. The neutralization rate of MPC-containing adhesive was faster than control. The optimal MPC concentration in the formulations was 5wt%.

SIGNIFICANCE

Incompatibility between MEMA and MPC led to a decrease in water miscibility of the liquid resins. Water (at 8wt%) in the MPC-containing formulations (2.5-5wt% MPC) led to higher DC, faster RPmax and significant reduction in leached HEMA, BisGMA, and MEMA. The neutralization rate was enhanced with the addition of MPC in the amine-containing formulation. Promoting the neutralization capability of dentin adhesives could play an important role in reducing recurrent decay at the composite/tooth interface.

Novel dental adhesive with triple benefits of calcium phosphate recharge, protein-repellent and antibacterial functions

OBJECTIVE

A new adhesive containing nanoparticles of amorphous calcium phosphate (NACP) with calcium (Ca) and phosphate (P) ion rechargeability was recently developed; however, it was not antibacterial. The objectives of this study were to: (1) develop a novel adhesive with triple benefits of Ca and P ion recharge, protein-repellent and antibacterial functions via dimethylaminohexadecyl methacrylate (DMAHDM) and 2-methacryloyloxyethyl phosphorylcholine (MPC); and (2) investigate dentin bond strength, protein adsorption, Ca and P ion concentration, microcosm biofilm response and pH properties.

METHODS

MPC, DMAHDM and NACP were mixed into a resin consisting of ethoxylated bisphenol A dimethacrylate (EBPADMA), pyromellitic glycerol dimethacrylate (PMGDM), 2-hydroxyethyl methacrylate (HEMA) and bisphenol A glycidyl dimethacrylate (BisGMA). Protein adsorption was measured using a micro bicinchoninic acid method. A human saliva microcosm biofilm model was tested on resins. Colony-forming units (CFU), live/dead assay, metabolic activity, Ca and P ion concentration and biofilm culture medium pH were determined.

RESULTS

The adhesive with 5% MPC+5% DMAHDM+30% NACP inhibited biofilm growth, reducing biofilm CFU by 4 log, compared to control (p<0.05). Dentin shear bond strengths were similar (p>0.1). Biofilm medium became a Ca and P ion reservoir having ion concentration increasing with NACP filler level. The adhesive with 5% MPC+5% DMAHDM+30% NACP maintained a safe pH>6, while commercial adhesive had a cariogenic pH of 4.

SIGNIFICANCE

The new adhesive with triple benefits of Ca and P ion recharge, protein-repellent and antibacterial functions substantially reduced biofilm growth, reducing biofilm CFU by 4 orders of magnitude, and yielding a much higher pH than commercial adhesive. This novel adhesive is promising to protect tooth structures from biofilm acids. The method of using NACP, MPC and DMAHDM is promising for application to other dental materials to combat caries.

Effects of silver nanoparticles on the bonding of three adhesive systems to fluorotic enamel

The objective was to evaluate the effect of adding silver nanoparticles into three commercial adhesive systems (Excite™, Adper Prompt L-Pop™ and AdheSE™). Nanoparticles were prepared by a chemical method then mixed with the commercial adhesive systems. This was later applied to the fluorotic enamel, and then micro-tensile bond strength, contact angle measurements and scanning electron microscopy observations were conducted. The commercial adhesive systems achieved the lowest micro-tensile bond strength (Excite™: 11.0±2.1, Adper Prompt L-Pop™: 14.0±5.4 and AdheSE™: 16.0±3.0 MPa) with the highest adhesive failure mode related with the highest contact angle (46.0±0.6º, 30.0±0.5º and 28.0±0.4º respectively). The bond strength achieved in all the experimental adhesive systems (19.0±5.4, 20.0±4.0 and 19.0±3.5 MPa respectively) was statistically higher (p<0.05) than the control and showed the highest cohesive failures related to the lowest contact angle. Adding silver nanoparticles in order to decrease the contact angle improve the adhesive system wetting and its bond strength.

In vitro dentin barrier cytotoxicity testing of some dental restorative materials

OBJECTIVES

To investigate the cytotoxicity of four dental restorative materials in three-dimensional (3D) L929 cell cultures using a dentin barrier test.

METHODS

The cytotoxicities of light-cured glass ionomer cement (Vitrebond), total-etching adhesive (GLUMA Bond5), and two self-etching adhesives (GLUMA Self Etch and Single Bond Universal) were evaluated. The permeabilities of human dentin disks with thicknesses of 300, 500, and 1000μm were standardized using a hydraulic device. Test materials and controls were applied to the occlusal side of human dentin disks. The 3D-cell scaffolds were placed beneath the dentin disks. After a 24-h contact with the dentin barrier test device, cell viabilities were measured by performing MTT assays. Statistical analysis was performed using the Mann-Whitney U test.

RESULTS

The mean (SD) permeabilities of the 300-μm, 500-μm, and 1000-μm dentin disks were 0.626 (0.214), 0.219 (0.0387) and 0.089 (0.028) μlmin^-1cm^-2cm H₂O^-1. Vitrebond was severely cytotoxic, reducing the cell viability to 10% (300-μm disk), 17% (500μm), and 18% (1000μm). GLUMA Bond5 reduced the cell viability to 40% (300μm), 83% (500μm), and 86% (1000μm), showing moderate cytotoxicity (300-μm) and non-cytotoxicity (500-μm and 1000-μm). Single Bond Universal and GLUMA Self Etch did not significantly reduce cell viability, regardless of the dentin thicknesses, which characterized them as non-cytotoxic.

CONCLUSIONS

Cytotoxicity varied with the materials tested and the thicknesses of the dentin disks.

CLINICAL SIGNIFICANCE

The tested cytotoxicity of materials applied on 300-, 500-, and 1000-μm dentin disks indicates that the clinical use of the test materials (excepting self-etching adhesives) in deep cavities poses a potential risk of damage to the pulp tissues to an extent, depending on the thickness of the remaining dentin.

Mechanistic, genomic and proteomic study on the effects of BisGMA-derived biodegradation product on cariogenic bacteria

OBJECTIVES

Investigate the effects of a Bis-phenyl-glycidyl-dimethacrylate (BisGMA) biodegradation product, bishydroxypropoxyphenyl-propane (BisHPPP), on gene expression and protein synthesis of cariogenic bacteria.

METHODS

Quantitative real-time polymerase chain reaction was used to investigate the effects of BisHPPP on the expression of specific virulence-associated genes, i.e. gtfB, gtfC, gbpB, comC, comD, comE and atpH in Streptococcus mutans UA159. Possible mechanisms for bacterial response to BisHPPP were explored using gene knock-out and associated complemented strains of the signal peptide encoding gene, comC. The effects of BisHPPP on global gene and protein expression was analyzed using microarray and quantitative proteomics. The role of BisHPPP in glucosyltransferase (GTF) enzyme activity of S. mutans biofilms was also measured.

RESULTS

BisHPPP (0.01, 0.1mM) up-regulated gtfB/C, gbpB, comCDE, and atpH most pronounced in biofilms at cariogenic pH (5.5). The effects of BisHPPP on the constructed knock-out and complemented strains of comC from quorum-sensing system, implicated this signaling pathway in up-regulation of the virulence-associated genes. Microarray and proteomics identified BisHPPP-regulated genes and proteins involved in biofilm formation, carbohydrate transport, acid tolerance and stress-response. GTF activity was higher in BisHPPP-exposed biofilms when compared to no-BisHPPP conditions.

SIGNIFICANCE

These findings provide insight into the genetic and physiological pathways and mechanisms that help explain S. mutans adaptation to restorative conditions that are conducive to increased secondary caries around resin composite restorations and may provide guidance to clinicians' decision on the selection of dental materials when considering the long term oral health of patients and the interactions of composite resins with oral bacteria.

New acid BisGMA analogs for dental adhesive applications with antimicrobial activity

OBJECTIVE

To achieve bisphenol A glycerolate dimethacrylate (BisGMA) analogs with reduced viscosity to be used in the formulation of dental adhesives containing biocidal components.

METHODS

A series of low-viscosity BisGMA derivatives (η: 39-12Pas) modified with 30, 60 and, respectively 80mol% carboxylic acid units were synthesized and characterized. Hydrogen bonding interactions in our monomers, the photopolymerization behavior and implicitly the conversion degree (DC) for some experimental adhesive formulations containing acid-modified BisGMA, commercial BisGMA (only in F1-F3), triethyleneglycol dimethacrylate and 2-hydroxyethyl methacrylate were examined by FTIR spectroscopy. The water effects on the photocrosslinked networks together with the flexural strength/modulus were also investigated. The adhesive penetration into the dentin surface was surveyed by SEM analysis, and the antimicrobial activity triggered by the incorporation of 0.5wt% AgNO₃, 10wt% zinc methacrylate or 1wt% triclosan methacrylate in selected adhesive formulations on the growth of Streptococcus mutans and Candida albicans strains was evidenced.

RESULTS

The contribution of the hydrogen bonding interactions was found to be lower in BisGMA derivatives than in non-modified BisGMA, and the DC varied between 56.5 (F6) and 83.7% (F1) compared with a control formulation based on BisGMA:TEGDMA (DC=58.2%). The flexural strength and flexural modulus varied in the range 33.7MPa (F6)-54.4MPa (F8)MPa and 0.64 (F6)-1.43 (F8)GPa, respectively. SEM observation of adhesive-dentin interface revealed the formation of resin tags for the carboxyl-containing adhesive, while for the control adhesive they are hardly formed. Also, the microorganism development was inhibited, the proposed materials displaying antimicrobial activity.

SIGNIFICANCE

The experimental formulations based on carboxyl-functionalized BisGMA exhibit a similar or even improved behavior over control sample, suggesting their potential applicability as antimicrobial dental adhesives.

Novel protein-repellent dental adhesive containing 2-methacryloyloxyethyl phosphorylcholine

OBJECTIVES

Biofilms at tooth-restoration margins can produce acids and cause secondary caries. A protein-repellent adhesive resin can potentially inhibit bacteria attachment and biofilm growth. However, there has been no report on protein-repellent dental resins. The objectives of this study were to develop a protein-repellent bonding agent incorporating 2-methacryloyloxyethyl phosphorylcholine (MPC), and to investigate its resistance to protein adsorption and biofilm growth for the first time.

METHODS

MPC was incorporated into Scotchbond Multi-Purpose (SBMP) at 0%, 3.75%, 7.5%, 11.25%, and 15% by mass. Extracted human teeth were used to measure dentine shear bond strengths. Protein adsorption onto resins was determined by a micro bicinchoninic acid (BCA) method. A dental plaque microcosm biofilm model with human saliva as inoculum was used to measure biofilm metabolic activity and colony-forming unit (CFU) counts.

RESULTS

Adding 7.5% MPC into primer and adhesive did not decrease the dentine bond strength, compared to control (p>0.1). Incorporation of 7.5% of MPC achieved the lowest protein adsorption, which was 20-fold less than that of control. Incorporation of 7.5% of MPC greatly reduced bacterial adhesion, yielding biofilm total microorganism, total streptococci, and mutans streptococci CFU that were an order of magnitude less than control.

CONCLUSIONS

A protein-repellent dental adhesive resin was developed for the first time. Incorporation of MPC into primer and adhesive at 7.5% by mass greatly reduced the protein adsorption and bacterial adhesion, without compromising the dentine bond strength.

CLINICAL SIGNIFICANCE

The novel protein-repellent primer and adhesive are promising to inhibit biofilm formation and acid production, to protect the tooth-restoration margins and prevent secondary caries.

Mimicking nature: Self-strengthening properties in a dental adhesive

Chemical and enzymatic hydrolysis provoke a cascade of events that undermine methacrylate-based adhesives and the bond formed at the tooth/composite interface. Infiltration of noxious agents, e.g. enzymes, bacteria, and so forth, into the spaces created by the defective bond will ultimately lead to failure of the composite restoration. This paper reports a novel, synthetic resin that provides enhanced hydrolytic stability as a result of intrinsic reinforcement of the polymer network. The behavior of this novel resin, which contains γ-methacryloxyproyl trimethoxysilane (MPS) as its Si-based compound, is reminiscent of self-strengthening properties found in nature. The efforts in this paper are focused on two essential aspects: the visible-light irradiation induced (photoacid-induced) sol-gel reaction and the mechanism leading to intrinsic self-strengthening. The FTIR band at 2840cm(-1) corresponding to CH3 symmetric stretch in -Si-O-CH3 was used to evaluate the sol-gel reaction. Results from the real-time FTIR indicated that the newly developed resin showed a limited sol-gel reaction (<5%) during visible-light irradiation, but after 48h dark storage, the reaction was over 65%. The condensation of methoxysilane mainly occurred under wet conditions. The storage moduli and glass transition temperature of the copolymers increased in wet conditions with the increasing MPS content. The cumulative amounts of leached species decreased significantly when the MPS-containing adhesive was used. The results suggest that the polymethacrylate-based network, which formed first as a result of free radical initiated polymerization, retarded the photoacid-induced sol-gel reaction. The sol-gel reaction provided a persistent, intrinsic reinforcement of the polymer network in both neutral and acidic conditions. This behavior led to enhanced mechanical properties of the dental adhesives under conditions that simulate the wet, oral environment.

STATEMENT OF SIGNIFICANCE

A self-strengthening dental adhesive system was developed through a dual curing process, which involves the free radical photopolymerization followed by slow hydrolysis and condensation (photoacid-induced sol-gel reaction) of alkoxylsilane groups. The concept of "living" photoacid-induced sol-gel reaction with visible-light irradiation was confirmed in the polymer. The sol-gel reaction was retarded by the polymethacrylate network, which was generated first; the network extended the life and retained the activity of silanol groups. The self-strengthening behavior was evaluated by monitoring the mechanical properties of the hybrid copolymers under wet conditions. The present research demonstrates the sol-gel reaction in highly crosslinked network as a potentially powerful strategy to prolong the functional lifetime of engineered biomaterials in wet environments.

Dental adhesives and strategies for displacement of water/solvents from collagen fibrils

OBJECTIVES

To evaluate the influence of temperature of evaporation in adhesive systems with different solvents on the apparent modulus of elasticity and mass change of macro-hybrid layers modified by proanthocyanidins (PACs).

METHODS

Adhesive resin beams (A) from Single Bond Plus (SB), Excite (EX) and One Step Plus (OS) were prepared after solvent evaporation at 23°C or 40°C (n=12). Macro-hybrid layers (M) (n=12) were prepared using demineralized dentin beams sectioned from extracted human third molars. The demineralized dentin specimens were infiltrated with each one of the three adhesive systems at 23°C or 40°C; with or without prior dentin treatment with PACs for 10min. The apparent modulus of elasticity (E) and mass change (Wmc, %) of adhesives beams and resin-infiltrated specimens were assessed in dry and wet conditions after immersion in water (24h, 1, 3 and 6 months). The E was statistically analyzed by Tukey-Kramer test and the Wmc, % by Kruskal Wallis, and Dunn (α=0.05).

RESULTS

Solvent evaporation at 40°C resulted in higher E values for adhesive resin beams at all storage conditions, regardless of the adhesive system (p<0.05). Increased mass loss (3 months: -0.01%; 6 months: -0.05%) was observed in One Step resin beams (p≤0.05). In the macro-hybrid layer models the pretreatment with PACs along with solvent evaporation at 40°C increased E and decreased the Wmc, % (3 months: -2.5; 6 months: 2.75%) for adhesives evaluated over time (p<0.05). No significant differences in ratio (resin/dentin) were found for the macro-hybrid layers (p>0.05).

SIGNIFICANCE

Improved solvent evaporation at higher temperature, and increased collagen cross-linking induced by PACs, enhanced the mechanical properties resulting in highly stable macro-hybrid layers over 6 months storage.

Tris(trimethylsilyl)silane as a co-initiator for dental adhesive: Photo-polymerization kinetics and dynamic mechanical property

OBJECTIVES

The purpose of this study was to evaluate the polymerization behavior of a model dentin adhesive with tris(trimethylsilyl)silane (TTMSS) as a co-initiator, and to investigate the polymerization kinetics and mechanical properties of copolymers in dry and wet conditions.

METHODS

A co-monomer mixture based on HEMA/BisGMA (45/55, w/w) was used as a model dentin adhesive. The photoinitiator system included camphorquinone (CQ) as the photosensitizer and the co-initiator was ethyl-4-(dimethylamino) benzoate (EDMAB) or TTMSS. Iodonium salt, diphenyliodonium hexafluorophosphate (DPIHP) serving as a catalyst, was selectively added into the adhesive formulations. The control and the experimental formulations were characterized with regard to the degree of conversion (DC) and dynamic mechanical properties under dry and wet conditions.

RESULTS

In two-component photoinitiator system (CQ/TTMSS), with an increase of TTMSS concentration, the polymerization rate and DC of CC double bond increased, and showed a dependence on the irradiation time and curing light intensity. The copolymers that contained the three-component photoinitiator system (CQ/TTMSS/DPIHP) showed similar dynamic mechanical properties, under both dry and wet conditions, to the EDMAB-containing system.

SIGNIFICANCE

The DC of formulations using TTMSS as co-initiator showed a strong dependence on irradiation time. With the addition of TTMSS, the maximum polymerization rate can be adjusted and the network structure became more homogenous. The results indicated that the TTMSS could be used as a substitute for amine-type co-initiator in visible-light induced free radical polymerization of methacrylate-based dentin adhesives.

Development of a multifunctional adhesive system for prevention of root caries and secondary caries

OBJECTIVES

The objectives of this study were to: (1) develop a novel adhesive for prevention of tooth root caries and secondary caries by possessing a combination of protein-repellent, antibacterial, and remineralization capabilities for the first time; and (2) investigate the effects of 2-methacryloyloxyethyl phosphorylcholine (MPC), dimethylaminohexadecyl methacrylate (DMAHDM), and nanoparticles of amorphous calcium phosphate (NACP) on dentin bond strength, protein-repellent properties, and dental plaque microcosm biofilm response.

METHODS

MPC, DMAHDM and NACP were added into Scotchbond Multi-Purpose primer and adhesive. Dentin shear bond strengths were measured. Adhesive coating thickness, surface texture and dentin-adhesive interfacial structure were examined. Protein adsorption onto adhesive resin surface was determined by the micro bicinchoninic acid method. A human saliva microcosm biofilm model was used to investigate biofilm metabolic activity, colony-forming unit (CFU) counts, and lactic acid production.

RESULTS

The resin with 7.5% MPC+5% DMAHDM+30% NACP did not adversely affect dentin shear bond strength (p>0.1). The resin with 7.5% MPC+5% DMAHDM+30% NACP produced a coating on root dentin with a thickness of approximately 70μm and completely sealed all the dentinal tubules. The resin with 7.5% MPC+5% DMAHDM+30% NACP had 95% reduction in protein adsorption, compared to SBMP control (p<0.05). The resin with 7.5% MPC+5% DMAHDM+30% NACP was strongly antibacterial, with biofilm CFU being four orders of magnitude lower than that of SBMP control. Significance The novel multifunctional adhesive with strong protein-repellent, antibacterial and remineralization properties is promising to coat tooth roots to prevent root caries and secondary caries. The combined use of MPC, DMAHDM and NACP may have wide applicability to bonding agents, cements, sealants and composites to inhibit caries.

Rechargeable dental adhesive with calcium phosphate nanoparticles for long-term ion release

OBJECTIVES

The tooth-resin bond is the weak link of restoration, with secondary caries as a main reason for failure. Calcium phosphate-containing resins are promising for remineralization; however, calcium (Ca) and phosphate (P) ion releases last only a couple of months. The objectives of this study were to develop the first rechargeable CaP bonding agent and investigate the key factors that determine CaP ion recharge and re-release.

METHODS

Nanoparticles of amorphous calcium phosphate (NACP) were synthesized. Pyromellitic glycerol dimethacrylate (PMGDM), ethoxylated bisphenol-A dimethacrylate (EBPADMA), 2-hydroxyethyl methacrylate (HEMA), and bisphenol-A glycidyl dimethacrylate (BisGMA) were used to synthesize three adhesives (denoted PE, PEH and PEHB). NACP were mixed into adhesive at 0-30% by mass. Dentin shear bond strengths were measured. Adhesive specimens were tested for Ca and P initial ion release. Then the ion-exhausted specimens were immersed in Ca and P solution to recharge the specimens, and the recharged specimens were then used to measure ion re-release for 7 days as one cycle. Then these specimens were again recharged and the re-release was measured for 7 days as the second cycle. Three recharge/re-release cycles were tested.

RESULTS

PEHB had the highest dentin bond strength (p<0.05). Increasing NACP content from 0 to 30% did not affect dentin bond strength (p>0.1), but increased CaP release and re-release (p<0.05). PEHB-NACP had the greatest recharge/re-release, and PE-NACP had the least (p<0.05). Ion release remained high and did not decrease with increasing the number of recharge/re-release cycles (p>0.1). After the third cycle, specimens without further recharge had continuous CaP ion release for 2-3 weeks.

SIGNIFICANCE

Rechargeable CaP bonding agents were developed for the first time to provide long-term Ca and P ions to promote remineralization and reduce caries. Incorporation of NACP into adhesive had no negative effect on dentin bond strength. Increasing NACP filler level increased the ion recharge and re-release capability. The new CaP recharge method and PMGDM-EBPADMA-NACP composition may have wide application in adhesives, composites and cements, to combat caries and remineralize lesions.

Evaluation of cell responses toward adhesives with different photoinitiating systems

OBJECTIVES

The photoinitiator diphenyl-(2,4,6-trimethylbenzoyl)phosphine oxide (TPO) is more reactive than a camphorquinone/amine (CQ) system, and TPO-based adhesives obtained a higher degree of conversion (DC) with fewer leached monomers. The hypothesis tested here is that a TPO-based adhesive is less toxic than a CQ-based adhesive.

METHODS

A CQ-based adhesive (SBU-CQ) (Scotchbond Universal, 3M ESPE) and its experimental counterpart with TPO (SBU-TPO) were tested for cytotoxicity in human pulp-derived cells (tHPC). Oxidative stress was analyzed by the generation of reactive oxygen species (ROS) and by the expression of antioxidant enzymes. A dentin barrier test (DBT) was used to evaluate cell viability in simulated clinical circumstances.

RESULTS

Unpolymerized SBU-TPO was significantly more toxic than SBU-CQ after a 24h exposure, and TPO alone (EC50=0.06mM) was more cytotoxic than CQ (EC50=0.88mM), EDMAB (EC50=0.68mM) or CQ/EDMAB (EC50=0.50mM). Cultures preincubated with BSO (l-buthionine sulfoximine), an inhibitor of glutathione synthesis, indicated a minor role of glutathione in cytotoxic responses toward the adhesives. Although the generation of ROS was not detected, a differential expression of enzymatic antioxidants revealed that cells exposed to unpolymerized SBU-TPO or SBU-CQ are subject to oxidative stress. Polymerized SBU-TPO was more cytotoxic than SBU-CQ under specific experimental conditions only, but no cytotoxicity was detected in a DBT with a 200μm dentin barrier.

SIGNIFICANCE

Not only DC and monomer-release determine the biocompatibility of adhesives, but also the cytotoxicity of the (photo-)initiator should be taken into account. Addition of TPO rendered a universal adhesive more toxic compared to CQ; however, this effect could be annulled by a thin dentin barrier.

Development of novel dental adhesive with double benefits of protein-repellent and antibacterial capabilities

OBJECTIVES

Secondary caries at the tooth-restoration margins remains a main reason for restoration failure. The objectives of this study were to: (1) combine protein-repellent 2-methacryloyloxyethyl phosphorylcholine (MPC) with quaternary ammonium dimethylaminohexadecyl methacrylate (DMAHDM) to develop a new dental adhesive with double benefits of protein-repellent and antibacterial capabilities for the first time; and (2) investigate the effects on protein adsorption, anti-biofilm activity, and dentin bond strength.

METHODS

MPC and DMAHDM were incorporated into Scotchbond Multi-Purpose (SBMP) primer and adhesive. Dentin shear bond strengths were measured using extracted human molars. Protein adsorption onto the adhesive resin surfaces was determined by the micro bicinchoninic acid (BCA) method. A dental plaque microcosm biofilm model with human saliva as inoculum was used to investigate biofilm metabolic activity, colony-forming unit (CFU) counts, lactic acid production and live/dead staining of biofilms on resins.

RESULTS

Incorporation of 7.5% MPC and 5% DMAHDM into primer and adhesive did not adversely affect the dentin shear bond strength (p>0.1). The resin with 7.5% MPC+5% DMAHDM had protein adsorption that was nearly 20-fold less than SBMP control (p<0.05). The resin with 7.5% MPC+5% DMAHDM had much stronger antibacterial effects than using MPC or DMAHDM alone (p<0.05). Biofilm CFU counts on the resin with 7.5% MPC+5% DMAHDM were reduced by more than 4 orders of magnitude, compared to SBMP control.

SIGNIFICANCE

The use of double agents (protein-repellent MPC+antibacterial DMAHDM) in dental adhesive achieved much stronger inhibition of biofilms than using each agent alone. The novel protein-repellent and antibacterial bonding agent is promising to reduce biofilm/plaque buildup and reduce recurrent caries at the tooth-restoration margins.

In situ characterization of resin-dentin interfaces using conventional vs. cryofocused ion-beam milling

OBJECTIVE

The introduction of focused ion beam (FIB) milling has facilitated preparation of hard tissue samples for transmission electron microscope (TEM). However, this technique generates high temperature that may alter or damage morphological features in biological tissue. Therefore, the aim of this study was to determine the effects of cryogenic cooling on the morphological features of dentin interfaces with dental restorative materials in samples prepared by FIB for TEM examination.

METHODS

After preparation of a cylindrical-shaped cavities in extracted, non-carious premolar teeth, the specimens were restored with dental adhesive/composite and categorized into two restorative materials groups; (PB) a combination of Clearfil Protect Bond (Kuraray Noritake Dental, Japan)/Estelite Sigma Quick composite (Tokuyama Dental, Japan), and (SB) Filtek Silorane restorative system (3M ESPE, USA). The specimens were subjected to interfacial cross-sectioning, followed by observation and area selection using confocal laser microscopy. Later, ultrathin sections were prepared using FIB with cryogenic cooling (PB-C) and (SB-C), or without cooling (PB-NC) and (SB-NC) that all were examined under TEM.

RESULTS

Resulting TEM images of the ultra-morphological features at the resin-dentin nano-interaction zone were improved when FIB preparation was conducted in the cryogenic condition and no sign of artifacts were detected.

SIGNIFICANCE

Conducting ion beam milling with cryogenic cooling was advantageous in minimizing the elevation in specimen temperature. This led to preservation of dentin microstructures that revealed additional information about substrates that are necessary for advanced characterization of tooth-biomaterial interactions.

Incorporation of bactericidal poly-acrylic acid modified copper iodide particles into adhesive resins

OBJECTIVES

This study aimed to investigate incorporation of polyacrylic acid (PAA) coated copper iodide (CuI) nanoparticles into dental adhesives, and to evaluate for the first time, their antibacterial properties, bond strength and cytotoxicity.

METHODS

PAA-CuI nanoparticles were synthesized and incorporated into commercially available adhesives Optibond XTR (1.0mg/ml) and XP Bond (0.5 and 1.0mg/ml). The antibacterial properties of experimental and control specimens were evaluated (n=8), after ageing for 18h or 1 year, against Streptococcus mutans (1×10(8)cells/ml). Bond strength to human dentine of the control and experimental adhesives was evaluated by shear bond strength (n=10). For cytotoxicity evaluation, HGF cells were cultured with gingival fibroblast media and exposed to control and experimental adhesive blends (n=3). An MTT cell viability assay was used to assess cell metabolic function. A one-way analysis of variance followed by Tukey's test was used for data analysis.

RESULTS

Significantly greater antibacterial properties were demonstrated for PAA-CuI containing adhesives after ageing for 18h or 1 year relative to all control groups. A reduction in Streptococcus mutans viable cell count of 99.99%, 99.99% and 79.65% was shown for XP Bond - 0.5mg/ml, XP Bond - 1.0mg/ml and Optibond XTR - 1.0mg/ml PAA-CuI after ageing for 18h, and 99.99% for both XP Bond - 0.5mg/ml and XP Bond - 1.0mg/ml PAA-CuI after ageing for 1 year. No significant variations in shear bond strength or cytotoxicity were detected between the experimental resins and their corresponding controls.

CONCLUSIONS

PAA-CuI nanoparticles are an effective additive to adhesive blends as it renders them antibacterial without adversely affecting their bond strength or cytotoxicity.

CLINICAL SIGNIFICANCE

The incorporation of PAA-coated copper iodide particles into adhesive resins renders the adhesive antibacterial to S. mutans for at least 1 year in vitro. This may prevent or delay bacterial invasion and the consequent development of caries lesions if the adhesive interface becomes defective.

Polymerization- and solvent-induced phase separation in hydrophilic-rich dentin adhesive mimic

Current dental resin undergoes phase separation into hydrophobic-rich and hydrophilic-rich phases during infiltration of the over-wet demineralized collagen matrix. Such phase separation undermines the integrity and durability of the bond at the composite/tooth interface. This study marks the first time that the polymerization kinetics of model hydrophilic-rich phase of dental adhesive has been determined. Samples were prepared by adding varying water content to neat resins made from 95 and 99 wt.% hydroxyethylmethacrylate and 5 and 1 wt.% (2,2-bis[4-(2-hydroxy-3-methacryloxypropoxy)phenyl1]-propane prior to light curing. Viscosity of the formulations decreased with increased water content. The photopolymerization kinetics study was carried out with a time-resolved Fourier transform infrared spectrometer. All of the samples exhibited two-stage polymerization behavior which has not been reported previously for dental resin formulation. The lowest secondary rate maxima were observed for water contents of 10-30 wt.%. Differential scanning calorimetry (DSC) showed two glass transition temperatures for the hydrophilic-rich phase of dental adhesive. The DSC results indicate that the heterogeneity within the final polymer structure decreased with increasing water content. The results suggest a reaction mechanism involving both polymerization-induced phase separation and solvent-induced phase separation for the model hydrophilic-rich phase of dental resin.