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

Novel bioactive nanospheres show effective antibacterial effect against multiple endodontic pathogens

Aim

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

Methods

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

Results

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

Conclusions

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

Enamel changes of bleached teeth following application of an experimental combination of chitosan-bioactive glass

BACKGROUND

Considering the extensive use of bleaching agents and the occurrence of side effects such as enamel demineralization, this study aimed to assess the enamel changes of bleached teeth following the experimental application of chitosan-bioactive glass (CH-BG).

METHODS

In this in vitro study, CH-BG (containing 66% BG) was synthesized and characterized by Fourier-transform infrared spectroscopy (FTIR) and X-ray diffraction (XRD). Thirty sound human premolars were bleached with 40% hydrogen peroxide, and the weight% of calcium and phosphorus elements of the buccal enamel surface was quantified before and after bleaching by scanning electron microscopy/ energy-dispersive X-ray spectroscopy (SEM, EDX). Depending on the surface treatment of the enamel surface, the specimens were divided into three groups (n = 10): control (no treatment), MI Paste (MI), and CH-BG. Then the specimens were stored in artificial saliva for 14 days. The SEM/EDX analyses were performed again on the enamel surface. Data were analyzed by one-way ANOVA and Tukey's test and a p-value of < 0.05 was considered statistically significant.

RESULTS

In all groups, the weight% of calcium and phosphorus elements of enamel decreased after bleaching; this reduction was significant for phosphorus (p < 0.05) and insignificant for calcium (p > 0.05). After 14 days of remineralization, the weight% of both calcium and phosphorus elements was significantly higher compared to their bleached counterparts in both MI and CH-BG groups (p < 0.05). Following the remineralization process, the difference between MI and CH-BG groups was not significant (p > 0.05) but both had a significant difference with the control group in this regard (p < 0.05).

CONCLUSIONS

The synthesized CH-BG compound showed an efficacy comparable to that of MI Paste for enamel remineralization of bleached teeth.

The effect of combined use of resin infiltration with different bioactive calcium phosphate-based approaches on enamel white spot lesions: An in vitro study

OBJECTIVES

This in vitro study aimed to evaluate the effect of resin infiltration combined with casein phosphopeptide-amorphous calcium phosphate with fluoride (CPP-ACPF) or bioactive glass (BAG) on the stability of enamel white spot lesions (WSLs) treatment.

MATERIALS AND METHODS

Eighty-four enamel blocks were prepared from the buccal surfaces of sound human premolars. All enamel blocks were placed in a demineralisation solution for 3 days to establish the artificial enamel WSLs. Enamel blocks with WSLs were randomly divided into three groups (n = 28 each group): RI/B: one-off resin infiltration followed by twice daily BAG treatment; RI/C: one-off resin infiltration followed by twice daily CPP-ACPF treatment; RI: one-off resin infiltration treatment only (as control) and subjected to pH cycling for 7 days. Surface morphology, elemental analysis, crystal characteristics, surface roughness and microhardness of enamel surfaces were investigated by scanning electron microscopy and energy-dispersive spectrometry observation, X-ray diffraction (XRD), atomic force microscope and Vickers' hardness testing, respectively.

RESULTS

Mean values of the surface roughness (mean±standard deviation (nm)) were 24.52±5.07, 27.39±5.87 and 34.36±4.55 for groups RI/B, RI/C and RI respectively (p = 0.003). The calcium to phosphate ratios were 1.32±0.16, 1.22±0.26 and 0.69±0.24 for groups RI/B, RI/C and RI respectively (p < 0.001). XRD revealed apatite formation in all three groups. The mean enamel surface microhardness (kg/mm2) of the groups were 353.93±28.49, 339.00±27.32 and 330.38±22.55 for groups RI/B, RI/C and RI respectively (p = 0.216).

CONCLUSIONS

Resin infiltration combined with CPP-ACPF or BAG remineralisation appears to improve the surface properties of WSLs.

CLINICAL SIGNIFICANCE

The combination of resin infiltration and CPP-ACPF/BAG remineralisation may be a potential treatment for the management of the WSLs.

Red fluorescence intensity as a criterion for assessing remineralization efficacy in early carious lesions

OBJECTIVES

Evaluating early carious lesion activity with an objective and clinically valid approach is crucial for developing effective treatment plans. Therefore, we here assessed the activity of non-cavitated carious lesions using a quantitative light-induced fluorescence-digital (QLF-D) camera and compared the remineralization efficiency after fluoride treatment according to the lesion's activity level.

METHODS

Red fluorescence emission rate (ΔR) and fluorescence loss (ΔF) were evaluated in 44 non-cavitated carious lesions by using a QLF-D camera. Based on the ΔR level, the lesions were classified into 22 active (ΔR ≥37.55) and 22 inactive carious lesions (ΔR <37.55). Each lesion was treated with 1.23 % fluoride gel for 60 s and then immersed into artificial saliva for 7 days. Subsequently, ΔR and ΔF changes in the lesions were measured.

RESULTS

Significant interactions between lesion activity and time were found for both ΔR and ΔF (p < 0.001). ΔR of active lesions declined faster and ΔF increased more steeply than did inactive lesions. Specifically, on day 7 post-fluoride treatment, the ΔR reduction rate was 1.40-times higher in active lesions, and the ΔF recovery rate was 2.50-times higher, indicating that active lesions respond more markedly to fluoride application.

CONCLUSIONS

This study highlighted the significance of ΔR in predicting remineralization efficiency in non-cavitated carious lesions after fluoride application. It underscored the importance of accurately assessing caries activity when formulating effective treatment plans. Lesion activity, as determined by ΔR, not only influences the outcome of remineralization treatments but also provides a more objective measure for tailoring caries management strategies.

Analysis of Spatial and Biochemical Characteristics of In Vitro Cariogenic Biofilms

Background Dental caries is the most common bacterial disease of calcified tissues of teeth. Cariogenic biofilms formed on the tooth surface secrete organic acids and thus result in demineralization. Delving into the depth of biofilms is crucial to understand the pathogenic mechanisms and design improved therapeutic approaches. The aim of the study is to analyze the spatial and biochemical characteristics of cariogenic biofilms. Materials and methods Pulp tissue samples sourced from freshly extracted third molars were incubated with oral cariogenic bacteria namely Streptococcus mutans, Staphylococcus aureus, Escherichia coli, Entamoeba faecalis, and Candida albicans to form the biofilm. Spatial assessment of biofilms was done under FESEM (field emission scanning electron microscope, JSM-IT800, JEOL, Tokyo, Japan). FTIR (Fourier transform infrared spectroscopy, Alpha II, Bruker, Germany) spectra were assessed for chemical molecular interactions in 24- and 48-hour time periods.  Results Morphological assessment with FESEM revealed rapid growth and aggregation within a short time period. FTIR spectra to analyze chemical constituents of biofilm presented with varied peaks of water, amide A, amide I, water, lipids, and phospholipids. Conclusion Further validation with more advanced imaging for an extended time period is vital to derive better conclusive evidence.

Incorporation of bioactive glass-ceramic into coconut oil for remineralization of incipient carious lesions

This study evaluated the efficacy of incorporating different concentrations of bioactive glass-ceramic (Biosilicate) into coconut oil on the remineralizing potential and surface roughness of white spot lesions. Fragments (6 x 6 x 2mm) of bovine teeth were sectioned and initial microhardness (KHN) and surface roughness (Ra) readings were obtained. The samples were submitted to cariogenic challenge to form white spot lesions and were separated into six groups (n=13): 1) Artificial Saliva (AS); 2) Coconut Oil (CO); 3) CO+2% Biosilicate (CO+2%Bio); 4) CO+5% Biosilicate (CO+5%Bio); 5) 2% Biosilicate Suspension (2% Bio) and 6) 5% Biosilicate Suspension (5% Bio). The treatments for 1 cycle/day were: immersion into the treatments for 5 minutes, rinsing in distilled water, and storage in artificial saliva at 37ºC. After 14 days, KHN and Ra readings were taken. The surface roughness alteration ((Ra) was analyzed (Kruskal-Wallis, Dunn's post-test, p<0.05). CO+2%Bio had higher (p = 0.0013) (Ra followed by CO+5%Bio (p = 0.0244) than AS. The relative KHN and remineralization potential were analyzed (ANOVA, Tukey, p<0.05), and 5% Bio treatment presented a higher relative microhardness than all other groups (p>0.05). The remineralizing potential of all the treatments was similar (p > .05). When Biosilicate was added, the pH of the suspensions increased and the alkaline pH remained during the analysis. Biosilicate suspension is more efficient than the incorporation of particles into coconut oil at white spot lesion treatment. In addition to the benefits that coconut oil and Biosilicate present separately, their association can enhance the remineralizing potential of Biosilicate.

Synthesis of Titanium Oxide Nanotubes Loaded with Hydroxyapatite

A simple method of synthesis of TiO2 nanotubes (TiNT) loaded with hydroxyapatite (HAP) is described. Such nanotubes find wide applications in various fields, including biomedicine, solar cells, and drug delivery, due to their bioactivity and potential for osseointegration. The Cp-Ti substrate was anodized at a constant voltage of 40 V, with the subsequent heat treatment at 450 °C. The resulting TiNT had a diameter of 100.3 ± 2.8 nm and a length of 3.5 ± 0.04 μm. The best result of the growth rate of HAP in Hanks' balanced salt solution (Hanks' BSS) was obtained in calcium glycerophosphate (CG = 0.1 g/L) when precipitates formed on the bottom and walls of the nanotubes. Structural properties, surface wettability, corrosion resistance, and growth rate of HAP as an indicator of the bioactivity of the coating have been studied. X-ray diffraction (XRD), scanning electron microscope (SEM), energy dispersive spectroscopy (EDS), potentiodynamic polarization test (PPC), electrochemical impedance spectroscopy (EIS), and contact angle (CA) measurements were used to characterize HAP-loaded nanotubes (HAP-TiNT). The CA, also serving as an indirect indicator of bioactivity, was 30.4 ± 1.1° for the TiNT not containing HAP. The contact angle value for HAP-TiNT produced in 0.1 g/L CG was 18.2 ± 1.2°, and for HAP-TiNT exposed to Hanks' BSS for 7 days, the CA was 7.2 ± 0.5°. The corrosion studies and measurement of HAP growth rates after a 7-day exposure to Hanks' BSS confirmed the result that TiNT processed in 0.1 g/L of CG exhibited the most significant capacity for HAP formation compared to the other tested samples.

In vitro evaluation of a novel fluoride-coated clear aligner with antibacterial and enamel remineralization abilities

OBJECTIVE

To investigate the antibacterial and enamel remineralization performances as well as physicochemical properties and biocompatibility of a fluoride-coated clear aligner plastic (FCAP).

MATERIALS AND METHODS

FCAP and normal clear aligner plastic (CAP) was bought from the manufacturer (Angelalign Technology Inc, China). The FCAP was observed under scanning electron microscopy. Its element composition, resistance to separation, contact angle, and protein adhesion performance were characterized. Colony-forming unit (CFU) count and 3-(4,5)-dimethylthiazol(-z-y1)-3,5-diphenyltetrazolium bromide (MTT) assay were used to evaluate the antibacterial ability of Streptococcus mutans. Fluoride release-recharge patterns were obtained. Apatite formation was evaluated after immersing FCAP in artificial saliva. Enamel remineralization capability was evaluated in the demineralization model (immersing samples in demineralization solution for 36 h) and pH cycling model (immersing samples in demineralization solution and remineralization solution in turns for 14 days). Cell Counting Kit-8 (CCK-8) and live/dead cell staining kits were used for cytotoxicity assay.

RESULTS

The FCAP showed uniformly distributed fluoride and did not compromise protein adhesion performance. CFU count (5.47 ± 0.55 for CAP, 3.63 ± 0.38 for FCAP) and MTT assay (0.41 ± 0.025 for CAP, 0.28 ± 0.038) indicated that the FCAP had stronger antibacterial activity compared with normal CAP (P < 0.05 for both evaluations). The FCAP could release fluoride continuously for 14 days and could be recharged after immersing in NaF solution. The FCAP could induce the formation of hydroxyapatite in artificial saliva and could reduce the microhardness decrease, color change, and mineral loss of enamels in both two models (P < 0.05 for all evaluations). CCK-8 and live/dead cell staining analyses showed that the coating did not compromise the biocompatibility of the clear aligner (P > 0.05 for CCK-8 evaluation).

CONCLUSIONS

The FCAP had antibacterial, fluoride recharge, and enamel remineralization abilities while it did not compromise physicochemical properties and biocompatibility.

CLINICAL RELEVANCE

The FCAP has the potential to prevent enamel demineralization during clear aligner treatment.

Assessment of Nanoscale Configuration of Dentin in Non-carious Cervical Lesions

Introduction Non-carious cervical lesions (NCCLs) are structural deformities or tissue loss in the cervical region of teeth, which are closer to the gum line that do not result from caries (tooth decay). On the tooth enamel at the gingival margin, these lesions are frequently seen as V- or U-shaped notches. The causes of NCCLs are multifaceted and involve intricate relationships between chemical, mechanical, and biological elements. The slow loss of enamel and dentin in the cervical area occurs due to mechanical causes like abrasive toothbrushing and occlusal tension, as well as chemical variables such as erosive acidic food components. As NCCLs advance, dental discomfort, aesthetic issues, and impaired tooth function may result. The aim of this study was to assess the nanoscale configuration of dentin in non-carious cervical lesions using scanning electron microscopy (SEM) and energy-dispersive spectroscopy (EDS). Methodology Sterilized teeth samples were selected from the extracted tooth repository of Saveetha Dental College and Hospitals, Chennai. Tooth samples were thinly sliced using a diamond bur. The sliced teeth were examined using a scanning electron microscope. Ionic configuration was assessed using EDS and elemental analysis. Results The findings showed the nanoscale morphology and elemental configurations present. Elemental mapping showed specific elemental localization in the affected area. Conclusion NCCLs can be attributed as a predominant factor leading to gingival recession causing dentin exposure and hypersensitivity. NCCLs can also threaten the integrity of dentin; therefore, early diagnosis of non-carious cervical lesions is crucial to ensure proper treatment plan and therapeutic regimens.

Biodegradation and Cell Behavior of a Mg-Based Composite with Mesoporous Bioglass

Biodegradable magnesium (Mg) and its alloys show tremendous potential as orthopedic materials. Nevertheless, the fast degradation and insufficient osteogenic properties hinder their applications. In this study, mesoporous bioglass (MBG) with an ordered branch-like structure was synthesized via a modified sol-gel method and showed a high specific surface area of 656.45 m2/g. A Mg-based composite was prepared by introducing the MBG into a Mg matrix via powder metallurgy. Degradation tests showed that the introduction of MBG increased the adsorption sites for Ca and P ions, thus promoting the formation of a Ca-P protective layer on the Mg matrix. The Ca-P protective layer became thick and dense with an increase in the immersion time, improving the protection ability of the Mg matrix, as proven by electrochemical impedance spectroscopy measurements. Meanwhile, the Mg-based composite also exhibited excellent biocompatibility and osteogenic properties. This study demonstrated the advantages of MBG in the preparation of Mg-based bone implants and validated the feasibility of improving Mg matrix corrosion resistance and enhancing osteogenesis by introducing MBG.

Special Issue: Bioceramics, Bioglasses, and Gels for Tissue Engineering

Undoubtedly, biomaterials such as bioceramics, bioactive glasses, and gels have attracted a wide range of research interest in the field of tissue engineering (TE), as they facilitate the essential support and environment for cells to grow, differentiate, and, specifically, regenerate new tissues [...].

Efficacy of ClinproTMXT Varnish surrounding brackets on the enamel surface of white spot lesion

Orthodontics patients usual develop demineralization and present cavity caries lesions after six months. Minimally invasive procedures have been the goal in modern dental practice. The aim of this study was to evaluate the effect of ClinproTMXT Varnish, on the enamel surface roughness and severity of white spot lesions. Twenty premolars were submitted to bond brackets and experimental induction of demineralization and randomly divided into 2 groups: GI - fluoride varnish (Colgate Duraphat®); GII - Ionomeric Sealant (ClinproTMXT Varnish). The treatment was applied around the brackets. The surface roughness of specimens was analyzed, before treatment and 12 weeks after treatment by laser confocal microscopy, and the severity of the white spot lesion was by laser fluorescence device. The data were analyzed by non-parametric Wilcoxon and Mann-Whitney Test, at 5% significance, roughness percentage reduction was performed. The severity of demineralization decreased in both, GI (p = 0.005) and GII (p = 0.019). Enamel superficial roughness levels decreased in GI and GII. As well as the roughness percentage, being more expressive in the ClinproTMXT Varnish group (85,09%). Colgate Duraphat® or Clinpro™ XT Varnish reduced the severity of the demineralization and decreased the superficial roughness on the enamel. The Clinpro™ XT Varnish was superior to superficial roughness on enamel.

Synchrotron X-ray Studies of the Structural and Functional Hierarchies in Mineralised Human Dental Enamel: A State-of-the-Art Review

Hard dental tissues possess a complex hierarchical structure that is particularly evident in enamel, the most mineralised substance in the human body. Its complex and interlinked organisation at the Ångstrom (crystal lattice), nano-, micro-, and macro-scales is the result of evolutionary optimisation for mechanical and functional performance: hardness and stiffness, fracture toughness, thermal, and chemical resistance. Understanding the physical-chemical-structural relationships at each scale requires the application of appropriately sensitive and resolving probes. Synchrotron X-ray techniques offer the possibility to progress significantly beyond the capabilities of conventional laboratory instruments, i.e., X-ray diffractometers, and electron and atomic force microscopes. The last few decades have witnessed the accumulation of results obtained from X-ray scattering (diffraction), spectroscopy (including polarisation analysis), and imaging (including ptychography and tomography). The current article presents a multi-disciplinary review of nearly 40 years of discoveries and advancements, primarily pertaining to the study of enamel and its demineralisation (caries), but also linked to the investigations of other mineralised tissues such as dentine, bone, etc. The modelling approaches informed by these observations are also overviewed. The strategic aim of the present review was to identify and evaluate prospective avenues for analysing dental tissues and developing treatments and prophylaxis for improved dental health.

Chemical, structural and cytotoxicity characterisation of experimental fluoride-doped calcium phosphates as promising remineralising materials for dental applications

OBJECTIVES

This study aimed at evaluating the cytotoxicity, chemical and structural properties of experimental fluoride-doped calcium-phosphates as potential remineralising materials for dental applications.

METHODS

Experimental calcium phosphates were formulated using β-tricalcium phosphate, monocalcium phosphate monohydrate, calcium hydroxide, and different concentrations of calcium/sodium fluoride salts [(5 wt%: VSG5F), (10 wt%: VSG10F), (20 wt%: VSG20F)]. A fluoride-free calcium phosphate (VSG) was used as control. Each tested material was immersed in simulated body fluid (SBF), (24 h, 15 and 30 days) to assess their ability to crystallise into apatite-like. Cumulative fluoride release was assayed up to 45 days. Moreover, each powder was placed into a medium containing human dental pulp stem cells (200 mg/mL) and their cytotoxicity was analysed using the 3-(4,5-dimethylthiazol-2-yl)- 2,5-diphenyltetrazolium bromide (MTT) assay (24 h, 48 h and 72 h incubation). These latter results were statistically analysed by ANOVA and Tukey's test (α = 0.05).

RESULTS

All the experimental VSG-F materials produced fluoride-containing apatite-like crystals after SBF immersion. VSG20F presented prolonged release of fluoride ions into the storage media (45d). VSG, VSG10F and VSG20F showed a significant cytotoxicity at dilution of 1:1, while at 1:5, only VSG and VSG20F demonstrated a reduction in cell viability. At lower dilutions (1:10, 1:50 and 1:100) all specimens showed no significant toxicity to hDPSCs, but an increase in cell proliferation.

SIGNIFICANCE

The experimental fluoride-doped calcium-phosphates are biocompatible and possess a clear ability to evoke fluoride-containing apatite-like crystallisation. Hence, they may be promising remineralising materials for dental applications.

Remineralization effects of Er,Cr:YSGG and/or bioactive glass on human enamel after radiotherapy-an in vitro study

The aim was to evaluate the effects of Er,Cr:YSGG and/or bioactive glass 45S5 (BG) on the chemical and physical properties of enamel after radiotherapy. Third molar crowns were cut in half (buccal-lingually), and the mid part of the labial/oral surface was subjected to different protocols. All samples were treated with standard 70 Gy. After radiotherapy, enamel was treated with either Er,Cr:YSGG (2780 nm; pulse 60 μs) and BG or only BG, and control samples were kept in deionized water. Vickers microhardness, scanning electron microscopy (SEM), and characteristic X-ray spectroscopy (EDS) were performed before, after radiotherapy, and after treatment. Analysis of variance (ANOVA) was used. A significant drop in enamel microhardness was observed after radiotherapy (p < 0.001). After Er,Cr:YSGG and BG or BG alone, there was a significant increase in microhardness (p < 0.001), which was on average significantly higher compared to the initial measurements for Er,Cr:YSGG with BG (p < 0.001), but not observed in BG alone (p = 0.331). After radiotherapy, SEM showed increased surface roughness with eroded prisms. Er,Cr:YSGG and BG or BG alone both showed disorderly packed glass particles on the enamel surface. Radiotherapy noticeably reduced the concentrations of calcium and phosphorus. Er,Cr:YSGG and BG treatment increased the concentrations of calcium, sodium, phosphorus, and silicate. BG treatment alone increased the concetration of calcium and phosphorus. Directly induced radiotherapy led to potential damage of enamel, but afterwards treatment with Er,Cr:YSGG laser and BG resulted in a higher increase of enamel microhardness compared to BG alone, reflecting in a possible better remineralization effect.

Bioactive Restorative Dental Materials-The New Frontier

Bioactive materials for dental resin restorations are a rising field of investigation exploring treatment strategies for reducing the recurrence of carious lesions. The current effort has been directed toward developing dental materials that can inhibit biofilms and prevent tooth mineral loss. Bioactive resin materials have shown the potential to interfere with polymicrobial consortia in vivo and help maintain the lifespan of restorations.

Enamel Demineralization Resistance and Remineralization by Various Fluoride-Releasing Dental Restorative Materials

The aim of this study is to investigate the resistance of various fluoride-releasing restorative materials against the demineralization and remineralization of enamel surfaces, including those that have been recently introduced to the market. Three different fluoride-releasing restorative materials were considered: glass ionomer (FI), resin-modified glass ionomer (RL), and an alkasite restorative material (CN). The acid neutralization ability was investigated using pH measurement, and the concentrations of released fluoride and calcium ions were measured. Finally, the demineralization resistance and remineralization effects of enamel were observed using a microhardness tester and SEM. CN showed an initial substantial increase in pH followed by a steady increase, with values higher than those of the other groups (p < 0.05). All three groups released fluoride ions, and the CN group released more calcium ions than the other groups (p < 0.05). In the acid resistance test, from the microhardness and SEM images, the CN group showed effective resistance to demineralization. In the remineralization test, the microhardness results showed that the FI and CN groups recovered the microhardness from the values of the demineralized enamel surface (p < 0.05). This was confirmed by the SEM images from remineralization tests; the CN group showed a recovered demineralized surface when immersed in artificial saliva for 7 days. In conclusion, alkasite restorative material can be an effective material when used in cariogenic environments.