Remineralization effectiveness of adhesive containing amorphous calcium phosphate nanoparticles on artificial initial enamel caries in a biofilm-challenged environment

Dopamer: A bioactive polydopamine-containing glass-ionomer cement with mineralizing and antibacterial properties

OBJECTIVE

To develop and characterize a novel bioactive polydopamine (PDA)-containing glass-ionomer cement (Dopamer) with enhanced mechanical, antibacterial, and mineralization properties for use as a restorative dental material.

METHODS

Dopamer was developed by coating fluoroaluminosilicate glass particles with polydopamine (PDA) via dopamine polymerization in alkaline solution. The PDA-coated glass particles were then mixed with a polyacrylic polymer. Mechanical properties were assessed through compressive strength, flexural strength, and Vickers microhardness testing using standardized specimens. Fuji XI and Herculite composite resin were used as the control groups. The adhesion to dentin was evaluated using shear bond strength test. Mineralization potential was investigated using Raman spectroscopy and scanning electron microscopy (SEM) to detect apatite formation on the surface and at the dentin-material interface. Cytocompatibility was evaluated using viability and proliferation assays on human dental pulp stem cells (DPSCs). Antibacterial activity against Streptococcus mutans was examined using both colony-forming unit (CFU) counts and live/dead bacterial staining assays on biofilms formed on the material surfaces. Additionally, odontogenic differentiation was examined using gene expression analysis. An in vivo mice molar pulp capping model was used to assess tertiary dentin formation and inflammatory response after placement of the material. All quantitative data were analyzed using one- or two-way ANOVA followed by Tukey's post hoc test, with significance set at p < 0.05. Kruskal-Wallis Test was utilized to evaluate pulp inflammation scores analysis.

RESULTS

Dopamer exhibited significantly enhanced (p < 0.001) mechanical properties, including improved compressive strength, flexural strength, and microhardness, compared to the conventional glass-ionomer cement (GIC). Shear bond strength to dentin also improved significantly (p < 0.05), demonstrating stronger adhesion. In vitro analyses confirmed in situ mineral formation and dentin mineralization capacity of Dopamer. Raman spectroscopy and SEM-EDS analyses revealed extensive mineral deposition at the interface between Dopamer and dentin, including calcium phosphate-rich layers suggestive of hydroxyapatite formation. Moreover, antibacterial testing demonstrated that Dopamer significantly (p < 0.001) inhibited Streptococcus mutans colonization compared to control (p < 0.001), reducing the risk of recurrent caries. Biocompatibility assays revealed high viability of DPSCs cultured on Dopamer, comparable to or better than the control groups. Dopamer also significantly upregulated odontogenic markers in vitro. In vivo studies showed formation of a continuous layer of tertiary dentin beneath the placed Dopamer, with minimal inflammatory response indicating excellent biocompatibility and regenerative potential.

SIGNIFICANCE

By combining enhanced mechanical strength, mineralization capacity, and antibacterial properties, Dopamer addresses critical limitations of existing glass-ionomer dental restorative materials, offering a bioactive, durable solution for restorative dentistry. This multifunctional material represents a promising advancement in dental restoration, supporting both clinical performance and long-term oral health.

Size-controllable synthesis of hydroxyapatite nanorods via fluorine modulation: applications in dental adhesives for enhanced enamel remineralization

BACKGROUND

There has been little application of fluorine-substituted hydroxyapatites (FHAs) in dental adhesives. Previous studies primarily focused on the effect of fluoride content on enamel remineralization, neglecting the role of FHA particle size. This study aimed to synthesize uniform FHA nanorods of varying sizes by adjusting the fluorine doping levels, and to investigate the synergistic effects of the fluorine content and nanorod size on enamel remineralization by incorporating the FHA nanorods into adhesives.

METHODS

FHA nanorods with varying fluorine doping levels and sizes were synthesized based on a hydrothermal method. The characterization analyses of FHA nanorods were demonstrated by X-ray diffraction (XRD), Fourier-transform infrared spectroscopy (FTIR), and transmission electron microscopy (TEM). The composite adhesives containing 10 wt% different FHA nanorods were characterized via scanning electron microscopy (SEM). The colloidal stability, light-curing poperties, and degree of conversion (DC %) were assessed. The shear bond strength (SBS) was determined and the failure mode analysis was reported. The release of Ca2+ and F- within 30 days was detected. The remineralization was evaluated via SEM, energy dispersive X-ray spectroscopy (EDS), XRD, and micro-hardness through in vitro and in vivo experiments. Statistical analyses were performed using the Shapiro-Wilk test, Levene test, one-way ANOVA, Tukey HSD method, Welch test, Tamhane test, Fisher's exact test and Kruskal-Wallis test (α = 0.05).

RESULTS

Uniform FHA nanorods of varying sizes were synthesized by adjusting the fluorine doping level (2 wt%, 6 wt%, and 10 wt%). The lengths of these FHA nanorods were 505.31 ± 104.43 nm, 111.27 ± 22.89 nm, and 66.21 ± 12.68 nm, respectively. The composite adhesives containing FHA nanorods showed good colloidal stability and appropriate light-curing properties. The SBS of composite adhesives decreased due to the incorporation of FHA nanorods, but the values still remained within the clinically required range. Three groups of the composite adhesives could release Ca2+ and F- continuously. The group of 10 wt% F-doped HA nanorods with shorter lengths exhibited more mineral deposition and absorption of Ca²⁺ onto the adhesive and enamel surfaces.

CONCLUSIONS

The strategy of adding the synthesized FHA nanorods into dental adhesives can be an effective approach to promote enamel remineralization, while maintaining adequate bond strength. The 10 wt% F-doped HA nanorods with shorter lengths exhibited superior remineralization.

Resin infiltrant with antibacterial activity: effects of incorporation of DMAHDM monomer and NACP on physical and antimicrobial properties

OBJECTIVES

Considering the fact that resin infiltrants lack antibacterial activity, this study assessed the influence of the quaternary ammonium monomer dimethylaminohexadecyl methacrylate (DMAHDM) and amorphous calcium phosphate nanoparticles (NACP) on the physical and antibacterial properties of an experimental resin infiltrant (ERI).

METHODOLOGY

The following groups were established: ERI (75/25 wt.% TEGDMA/BISEMA), ERI + 2.5% DMAHDM (2.5DM), ERI + 5% DMAHDM (5DM), ERI + 2% NACP (NACP), ERI + 2.5% DMAHDM + 2% NACP (2.5DM_NACP), ERI + 5% DMAHDM + 2% NACP (5DM_NACP), and Icon® (IC), a commercial resin infiltrant. Degree of conversion (DC; n=4), sorption and solubility (SO/SOL; n=8), and contact angle (CA; n=10) tests were conducted. Biofilm biomass (BB; n=6) and bacterial metabolism (BM; n=8) were evaluated after Streptococcus mutans (UA159) cultivation for 48 h on material samples. Data were evaluated by one-way ANOVA and Tukey or Games-Howell post hoc tests (α=0.05).

RESULTS

IC exhibited the highest DC, with no difference from 2.5DM and 5DM. IC showed the lowest CA. IC had the lowest SO, followed by ERI, which had the lowest SOL, with no difference from IC. 5DM_NACP showed the lowest biofilm biomass, similar to 2.5DM and 5DM. Resin infiltrants containing DMAHDM showed reduced bacterial metabolism.

CONCLUSIONS

DMAHDM, with or without NACP, demonstrated significant antibacterial activity, while NACP impaired DC. Both DMAHDM and NACP increased the contact angle, sorption, and solubility of the resin infiltrant, which may affect the material's clinical performance.

Advances in hybridized nanoarchitectures for improved oro-dental health

On a global note, oral health plays a critical role in improving the overall human health. In this vein, dental-related issues with dentin exposure often facilitate the risk of developing various oral-related diseases in gums and teeth. Several oral-based ailments include gums-associated (gingivitis or periodontitis), tooth-based (dental caries, root infection, enamel erosion, and edentulous or total tooth loss), as well as miscellaneous diseases in the buccal or oral cavity (bad breath, mouth sores, and oral cancer). Although established conventional treatment modalities have been available to improve oral health, these therapeutic options suffer from several limitations, such as fail to eradicate bacterial biofilms, deprived regeneration of dental pulp cells, and poor remineralization of teeth, resulting in dental emergencies. To this end, the advent of nanotechnology has resulted in the development of various innovative nanoarchitectured composites from diverse sources. This review presents a comprehensive overview of different nanoarchitectured composites for improving overall oral health. Initially, we emphasize various oral-related diseases, providing detailed pathological circumstances and their effects on human health along with deficiencies of the conventional therapeutic modalities. Further, the importance of various nanostructured components is emphasized, highlighting their predominant actions in solving crucial dental issues, such as anti-bacterial, remineralization, and tissue regeneration abilities. In addition to an emphasis on the synthesis of different nanostructures, various nano-therapeutic solutions from diverse sources are discussed, including natural (plant, animal, and marine)-based components and other synthetic (organic- and inorganic-) architectures, as well as their composites for improving oral health. Finally, we summarize the article with an interesting outlook on overcoming the challenges of translating these innovative platforms to clinics.

Synergistic effect of ion-releasing fillers on the remineralization and mechanical properties of resin-dentin bonding interfaces

In modern restorative dentistry, adhesive resin materials are vital for achieving minimally invasive, esthetic, and tooth-preserving restorations. However, exposed collagen fibers are found in the hybrid layer of the resin-dentin bonding interface due to incomplete resin penetration. As a result, the hybrid layer is susceptible to attack by internal and external factors such as hydrolysis and enzymatic degradation, and the durability of dentin bonding remains limited. Therefore, efforts have been made to improve the stability of the resin-dentin interface and achieve long-term clinical success. New ion-releasing adhesive resin materials are synthesized by introducing remineralizing ions such as calcium and phosphorus, which continuously release mineral ions into the bonding interface in resin-bonded restorations to achieve dentin biomimetic remineralization and improve bond durability. As an adhesive resin material capable of biomimetic mineralization, maintaining excellent bond strength and restoring the mechanical properties of demineralized dentin is the key to its function. This paper reviews whether ion-releasing dental adhesive materials can maintain the mechanical properties of the resin-dentin bonding interface by supplementing the various active ingredients required for dentin remineralization from three aspects: phosphate, silicate, and bioactive glass.

The preventive/therapeutic effect of CO2 laser and MI Paste Plus® on intact and demineralized enamel against Streptococcus mutans (In Vitro Study)

Background

To evaluate the preventive and therapeutic effects of CO2 laser and MI paste plus on intact and demineralized enamel surfaces and their impact on bacterial adhesion. Methods: 160 enamel slabs were prepared and randomly allocated into two main groups; sound and demineralized enamel (n = 80 per group), in which specimens were immersed in a demineralizing solution (50 mM acetic acid, pH 4.5) for 72 h at 37 °C. Each group was further divided into four subgroups (n = 20); the control (un treated surfaces), surfaces treated by CO2 laser, MI paste plus (Recaldent™, GC corporation/Germany), and those received a combination of CO2 and MI paste plus. Streptococcus Mutans biofilm was isolated, quantified, and then applied on treated enamel surfaces and incubated anaerobically for 24 h and then quantified by colony-forming unit (CFU). Meanwhile, surface changes were assessed by Vickers microhardness and Scanning Electron Microscope combined with Energy-Dispersive X-Ray Spectroscopy (SEM-EDX). Results: The combined use of CO2 laser followed by MI paste plus significantly (p < 0.000) enhanced surface microhardness of sound and demineralized enamel with a significant reduction in bacterial counts. However, each technique alone was beneficial as they exhibited higher microhardness with lower bacterial viability in comparison to the control. The treatment of demineralized enamel surfaces with MI paste significantly reduced the number of bacterial colonies with the presence of dispersed mineral deposits over the surface.

Conclusions

The combined use of CO2 laser and MI paste plus was effective as a preventive and/or therapeutic measures in enhancing surface properties of enamel and reducing the bacterial viability.

Engineered Biomaterials Trigger Remineralization and Antimicrobial Effects for Dental Caries Restoration

Dental caries is the most prevalent chronic disease globally, significantly impacting individuals' quality of life. A key reason behind the failure of implanted restorations is their biological inactivity, meaning they are unable to form crosslinks with the surrounding tooth structures, thus making patients susceptible to implant loss and recurrent tooth decay. For the treatment of caries, antibacterial medicine and remineralization are effective means of treating the recurrence of caries. Owing to the rapid progression in the biomaterials field, several biomaterials have been reported to display antimicrobial properties and aid in dentin remineralization. Bioactive materials hold considerable potential in diminishing biofilm accumulation, inhibiting the process of demineralization, enabling dentin remineralization, and combating bacteria related to caries. Bioactive materials, such as fluoride, amorphous calcium phosphate, bioactive glass, collagen, and resin-based materials, have demonstrated their effectiveness in promoting dentin remineralization and exerting antibacterial effects on dental caries. However, the concentration of fluoride needs to be strictly controlled. Although amorphous calcium phosphate can provide the necessary calcium and phosphorus ions for remineralization, it falls short in delivering the mechanical strength required for oral mastication. Resin-based materials also offer different advantages due to the complexity of their design. In this review, we delve into the application of advanced bioactive materials for enhancing dentin remineralization and antibacterial properties. We eagerly anticipate future developments in bioactive materials for the treatment of dental caries.

Inorganic Compounds as Remineralizing Fillers in Dental Restorative Materials: Narrative Review

Secondary caries is one of the leading causes of resin-based dental restoration failure. It is initiated at the interface of an existing restoration and the restored tooth surface. It is mainly caused by an imbalance between two processes of mineral loss (demineralization) and mineral gain (remineralization). A plethora of evidence has explored incorporating several bioactive compounds into resin-based materials to prevent bacterial biofilm attachment and the onset of the disease. In this review, the most recent advances in the design of remineralizing compounds and their functionalization to different resin-based materials' formulations were overviewed. Inorganic compounds, such as nano-sized amorphous calcium phosphate (NACP), calcium fluoride (CaF₂), bioactive glass (BAG), hydroxyapatite (HA), fluorapatite (FA), and boron nitride (BN), displayed promising results concerning remineralization, and direct and indirect impact on biofilm growth. The effects of these compounds varied based on these compounds' structure, the incorporated amount or percentage, and the intended clinical application. The remineralizing effects were presented as direct effects, such as an increase in the mineral content of the dental tissue, or indirect effects, such as an increase in the pH around the material. In some of the reported investigations, inorganic remineralizing compounds were combined with other bioactive agents, such as quaternary ammonium compounds (QACs), to maximize the remineralization outcomes and the antibacterial action against the cariogenic biofilms. The reviewed literature was mainly based on laboratory studies, highlighting the need to shift more toward testing the performance of these remineralizing compounds in clinical settings.

Ceramic Nanomaterials in Caries Prevention: A Narrative Review

Ceramic nanomaterials are nanoscale inorganic metalloid solids that can be synthesised by heating at high temperatures followed by rapid cooling. Since the first nanoceramics were developed in the 1980s, ceramic nanomaterials have rapidly become one of the core nanomaterials for research because of their versatility in application and use in technology. Researchers are developing ceramic nanomaterials for dental use because ceramic nanoparticles are more stable and cheaper in production than metallic nanoparticles. Ceramic nanomaterials can be used to prevent dental caries because some of them have mineralising properties to promote the remineralisation of tooth tissue. Ceramic minerals facilitate the remineralisation process and maintain an equilibrium in pH levels to maintain tooth integrity. In addition, ceramic nanomaterials have antibacterial properties to inhibit the growth of cariogenic biofilm. Researchers have developed antimicrobial nanoparticles, conjugated ceramic minerals with antibacterial and mineralising properties, to prevent the formation and progression of caries. Common ceramic nanomaterials developed for caries prevention include calcium-based (including hydroxyapatite-based), bioactive glass-based, and silica-based nanoparticles. Calcium-based ceramic nanomaterials can substitute for the lost hydroxyapatite by depositing calcium ions. Bioactive glass-based nanoparticles contain surface-reactive glass that can form apatite crystals resembling bone and tooth tissue and exhibit chemical bonding to the bone and tooth tissue. Silica-based nanoparticles contain silica for collagen infiltration and enhancing heterogeneous mineralisation of the dentin collagen matrix. In summary, ceramic nanomaterials can be used for caries prevention because of their antibacterial and mineralising properties. This study gives an overview of ceramic nanomaterials for the prevention of dental caries.

Recent Advances in Direct Adhesive Restoration Resin-Based Dental Materials With Remineralizing Agents

Resin-based dental materials are popular restorative materials especially in direct adhesive restoration because of the excellent mechanical and esthetic properties. Toward the realization of minimally invasive dental procedures, direct composite resin adhesive restoration has become the main treatment for dental defects. In addition, for caries-affected dentin close to the pulp, conservation remineralization has been advocated to save the living pulp. However, the resin–dentin interface can be destabilized by various factors, especially the enzymatic degradation of collagen fibrils within the hybrid layer and polymer hydrolysis. Furthermore, for resin-based restorative materials, the marginal gap remains a major problem that can lead to the occurrence of secondary caries. To address these issues, research efforts have focused on the remineralization of mineral-depleted dental hard tissues using remineralizing bioactive substances. In this review, we first described various bioactive agents with remineralizing properties. Furthermore, we discussed recent advances in resin-based dental materials for enamel or dentin remineralization. Finally, we examined the current challenges and prospects of these emerging materials. This work aims to provide a theoretical foundation for the future development of resin-based dental materials in direct adhesive restoration with remineralizing agents.

Effect of casein phosphopeptide amorphous calcium fluoride phosphate and calcium glycerophosphate on incisors with molar-incisor hypomineralization: A cross-over, randomized clinical trial

BACKGROUND: Within the scope of minimally invasive dentistry, the use of different biocompatible remineralization agents on incisors affected by molar-incisor hypomineralization (MIH) gains importance. OBJECTIVE: To evaluate the effect of casein phosphopeptide amorphous calcium fluoride phosphate (CPP-ACFP) and calcium glycerophosphate (CaGP) in mineral density (MD) of white/creamy and yellow/brown demarcated opacities on incisors affected by MIH by means laser fluorescence (LF). METHODS: As a cross-over, randomized trial, twenty-two children with 167 incisors affected by MIH were recruited and randomly assigned to one of the two different agents and crossed over to other agents with two weeks washout in between. Incisors were examined by using LF at all before and after three months periods. RESULTS: The results of the paired t-tests for determining the period effect between the baseline findings showed significant difference in white/creamy and yellow/brown demarcated opacities of LF values for both groups (p < 0.05). The difference between both groups according to after categorization of 20% increasing in MD in the percent of change before and after application on LF values; was not found statistically significant in white/creamy (p = 0.970) and yellow/brown (p = 0.948) opacities. CONCLUSIONS: The primary outcome was CPP-ACFP and CaGP had a positive effect in decreasing hypomineralization on MIH-affected enamel for three months period.

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

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

Size Dependence of Particulate Calcium Phosphate Fillers in Dental Resin Composites

Resin composites that consist of polymeric resins and functional fillers are commonly used as restorative materials for dental caries. Various types of calcium phosphates (CaPs) are studied as remineralizing fillers in the formulation of dental resin composites, which are generally inhibitory to demineralization of teeth, but the performance of resin composites has not yet been investigated comprehensively with respect to the size of CaP particles. In this study, the same tricalcium phosphate (TCP) particles within two different size ranges, the as-received TCP particles (TCP) and those resulted from grinding (TCP-G), were tested to determine the size dependence of CaP fillers in dental resin composites. The buffering capability, mechanical properties, ion release, antibacterial performance, and remineralization effect of TCP/TCP-G-containing composites were experimentally characterized and compared against two other commercial dental materials. The integration of micrometer-sized TCP particles resulted in a similar buffering effect and Ca²⁺/PO₄ ^3- release behaviors compared to the resin composite containing much smaller TCP-G particles. The flexural strength of the TCP-G resin composite was lower than that of the TCP composite after immersion in water for 30 days. However, the TCP-G composite facilitated crystal deposition toward better gap-closing performance at the dentin-composite interface. This study explored detailed insights about the size effect of CaP fillers, which is useful for the development of functional dental resin composites and their clinical translation.

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

OBJECTIVES

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

METHODS

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

RESULTS

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

SIGNIFICANCE

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