Effects of HEMA on type I collagen protein in human gingival fibroblasts

Influence of postwashing process on the elution of residual monomers, degree of conversion, and mechanical properties of a 3D printed crown and bridge materials

OBJECTIVES

This study aimed to determine the effects of the postwashing method and time on the mechanical properties and biocompatibility of three-dimensional (3D) printed crown and bridge resin.

METHODS

DLP (digital light processing)-printed specimens produced from Nextdent crown & bridge (C&B) resins were washed separately using an ultrasonic bath and rotary washer with TPM (tripropylene glycol monomethyl ether) for 3 min, 6 min, 10 min, 20 min, and 1 h. Postcuring was applied for 30 min to each specimen after the washing process. The flexural strength, Vickers hardness, water sorption and solubility, degree of conversion (DC), elution of residual monomers, and biocompatibility of the specimens were evaluated.

RESULTS

The ultrasonic bath showed greater washing efficacy by reducing the residual HEMA (2-hydroxyethyl methacrylate) from 2.0634 ppm to 0.1456 ppm and reducing the residual TEGDMA (triethylene glycol dimethacrylate) from 1.4862 ppm to 0.1484 ppm. With prolonged washing, the flexural strength significantly decreased from 129.67 ± 6.66 MPa (mean±standard deviation) to 103.17 ± 7.20 MPa, while the Vickers hardness increased slightly for the first 6 min and then decreased thereafter significantly. The DC was 87.78 ± 1.34% after 3 min and then gradually decreased with extended washing time. The cytotoxicity significantly decreases with the increment of the washing time.

SIGNIFICANCE

The washing effect on the elution of residual monomers was better for an ultrasonic bath than for a rotary washer. Extending the washing time reduces the mechanical properties and cytotoxicity of the Nextdent C&B resin.

How Water Content Can Influence the Chemomechanical Properties and Physical Degradation under Aging of Experimental Adhesives

Objective

To evaluate the physicochemical (sorption (SOR), solubility (SOL), and degree of conversion (DC)) and mechanical (flexural strength (FS), modulus of elasticity (ME), and compressive strength (CS)) properties of adhesives with different water contents (D₂O).

Materials and Methods

An adhesive was formulated: 55 wt% BisGMA, 45 wt% HEMA, 0.5 wt% camphorquinone, 0.5 wt% EDMAB, and 1.0 wt% DPIHP. D₂O was added into the adhesives (0 wt%, 10 wt%, and 16 wt%). DC was monitored through the FTIR. FS, ME, CS, SOR, and SOL were tested. The adhesive samples were aged in deionized water, ethanol, and acetone. Data were submitted to ANOVA and Tukey's tests (5%).

Results

For DC, the 0 wt% group showed a significant reduction (68.09 ± 0.14_A) compared with the 10 wt% (87.07 ± 0.81_B) and 16 wt% groups (89.87 ± 0.24_B); 10 wt% showed the highest FS (MPa) mean values (141.6 ± 6.71_B) compared with the 0 wt% (109.4 ± 20.5_A) and 16 wt% (107.8 ± 15.8_A). For the CS (MPa) and ME (GPa), the 16 wt% showed the lowest mean values (98.8 ± 18.0_B and 2.2 ± 0.3_B, respectively) compared with the 10 wt% and 0 wt%. For the SOR, 16 wt% of water showed the highest mean values and the ethanol showed the lowest mean values of SOL regardless of water content.

Conclusion

The amount of water content and the types of aging solvents significantly affect the adhesive properties.

An Oral-mucosa-on-a-chip sensitively evaluates cell responses to dental monomers

Knowledge of human gingival cell responses to dental monomers is critical for the development of new dental materials. Testing standards have been developed to provide guidelines to evaluate biological functionality of dental materials and devices. However, one shortcoming of the traditional testing platforms is that they do not recapitulate the multi-layered configuration of gingiva, and thus cannot evaluate the layer-specific cellular responses. An oral mucosa-chip with two cell layers was previously developed as an alternative platform to assess the oral mucosa responses to dental biomaterials. The mucosa-chip consists of an apical keratinocyte layer attached to a fibroblast-embedded collagen hydrogel through interconnecting pores in a three-microchannel network. Here, cell responses in the mucosa-chip were evaluated against 2-hydroxyethyl methacrylate (HEMA), a common monomer used in restorative and aesthetic dentistry. The response of mucosal cell viability was evaluated by exposing the chip to HEMA of concentrations ranging from 1.56 to 25 mM and compared to cells in conventional well-plate monoculture. The co-cultured cells were then stained and imaged with epifluorescence and confocal microscopy to determine the layer-specific responses to the treatment. Mucosa-chips were demonstrated to be more sensitive to assess HEMA-altered cell viability than well-plate cultures, especially at lower doses (1.56 and 6.25 mM). The findings suggest that the mucosa-chip is a promising alternative to traditional platforms or assays to test a variety of biomaterials by offering a multi-layered tissue geometry, accessible layer-specific information, and higher sensitivity in detecting cellular responses.

A Novel Role of Ascorbic Acid in Anti-Inflammatory Pathway and ROS Generation in HEMA Treated Dental Pulp Stem Cells

Resin (co)monomers issued from restorative dental materials are able to distribute in the dental pulp or the gingiva, to get to the saliva and to the flowing blood. Many authors have recently shown that methacrylate-based resins, in particular 2-hydroxyethylmethacrylate (HEMA), are responsible of inflammatory and autophagic processes in human dental pulp stem cells (hDPSCs) while ascorbic acid (AS), an antioxidant molecule, can assume a protective role in cell homeostasis. The purpose of the current work was to study if 50 µg/mL AS can affect the inflammatory status induced by 2 mM HEMA in hDPSCs, a tissue–specific cell population. Cell proliferation, cytokine release, morphological arrangement and reactive oxygen species (ROS) formation were determined respectively by MTT, ELISA, morphological analysis and dichlorofluorescein assay. The hDPSCs exposed to HEMA let to an increment of ROS formation and in the expression of high levels of inflammatory mediators such as nuclear factor-κB (NFkB), inflammatory cytokines such as interleukin IL6, IL8, interferon (IFN)ɣ and monocyte chemoattractant protein (MCP)1. Moreover, HEMA induced the up-regulation of pospho-extracellular signal–regulated kinases (pERK)/ERK signaling pathway associated to the nuclear translocation. AS treatment significantly down-regulated the levels of pro-inflammatory mediators. Then, the natural product AS reduced the detrimental result promoted by methacrylates in clinical dentistry, in fact restore cell proliferation, reduce the pro-inflammatory cytokine, downregulate ROS production and of NFkB/pERK/ERK signaling path. In synthesis, AS, could improve the quality of dental care and play a strategic role as innovative endodontic compound easy to use and with reasonable cost.

Streptococcus mutans Biofilm Formation and Cell Viability on Polymer-infiltrated Ceramic and Yttria-stabilized Polycrystalline Zirconium Dioxide Ceramic

OBJECTIVE

The aim of this study was to investigate the biofilm formation and cell viability of a polymer-infiltrated ceramic (PIC) and an yttria-stabilized polycrystalline zirconium dioxide ceramic (Y-TZP). The null hypothesis was that there would be no difference in biofilm formation and cell viability between the materials.

METHODS AND MATERIALS

Streptococcus mutans biofilm was analyzed with scanning electron microscopy (SEM), confocal laser scanning microscopy, and colony counting (colony-forming units/mL). The cell viability (fibroblasts) of both materials was measured with 3-(4,5-dimethylthiazol-2yl)-2,5-diphenyl tetrazolium) (MTT) test. Roughness measurements were also performed.

RESULTS

The PIC displayed higher roughness but showed similar colony-forming units and biovolume values to those of Y-TZP. SEM showed a higher amount of adhered fibroblasts on the PIC surface on the first day and similar amounts on both materials after seven days. Moreover, the materials were biocompatible with human fibroblasts.

CONCLUSION

PIC and Y-TZP are biocompatible and present the same characteristics for biofilm formation; therefore, they are indicated for indirect restorations and implant abutments.

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.

Genotoxicity and cytotoxicity induced by eluates from orthodontic glass ionomer cements in vitro

The aim of this study was to investigate genotoxicity and cytotoxicity of some orthodontic glass ionomer cements commercially available by means of the single cell gel (comet) assay. For this purpose, five commercial orthodontic glass ionomer cements (Vidrion C®, Meron®, Optiband®, Multicure® and Ultra Band Lok®) were tested in murine fibroblasts in vitro. For this purpose, eluates from each cement were prepared according manufactures instructions at 0, 2, 4, 8, 18, 32 and 64 days of immersion in artificial saliva at 37 °C. All orthodontic glass ionomer cements failed to induce cytotoxicity to murine fibroblasts for all periods evaluated in this study. However, Vidrion C® was able to induce genotoxicity after 64 days of exposure to eluates. Meron® also demonstrated genotoxicity as depicted by increasing DNA damage on 2nd day. Multicure® demonstrated genotoxicity on 32nd day and Ultra band Lok on 18th, 32nd days of exposure. Taken together, our results demonstrated that orthodontic cements derived from resin-modified glass ionomer composite (Multicure®) and compomer (Ultra Band Lok®) cause genetic damage in mammalian cells in vitro.

Cytotoxicity of Etch-and-Rinse, Self-Etch, and Universal Dental Adhesive Systems in Fibroblast Cell Line 3T3

The aim of this study was to evaluate in fibroblast cultures the direct cytotoxic effects of etch-and-rinse, self-etch, and universal adhesive systems. The sterile glass cover slips (n = 3) were then immersed in culture medium to obtain the eluates for the experimental groups: (1) Adper™ Single Bond 2; (2) Ambar; (3) Adper™ Scotchbond™ Multi-Purpose; (4) Scotchbond™ Universal; (5) Ambar Universal; and (6) OptiBond All-In-One. As a negative control, sterile glass cover slips were immersed in culture medium only. After 24 h, the eluate obtained was applied on fibroblast culture. Cell viability and cell morphology were evaluated by MTT assay and SEM, respectively. Data were analyzed by Kruskal-Wallis and Mann-Whitney tests (α = 0.05). All adhesive systems except universal reduced cell viability in 3T3 cells to between 26.04% and 56.57%, and Scotchbond Universal and Ambar Universal reduced cell viability to 2.13% and 3.57%, respectively, when compared to the negative control. Cytoplasmic membrane shrinkage and cell-free areas with residual membrane fragments from dead cells were observed. In conclusion, improvements in universal adhesive system formulations and their mechanisms of action are not accompanied by increased toxicity compared with those in other systems, warranting commitment to the use of these dentin-pulp complexes.

Self-Strengthening Hybrid Dental Adhesive via Visible-light Irradiation Triple Polymerization

A self-strengthening methacrylate-based dental adhesive system was developed by introducing an epoxy cyclohexyl trimethoxysilane (TS) which contains both epoxy and methoxysilyl functional groups. The experimental formulation, HEMA/BisGMA/TS (22.5/27.5/50, wt%), was polymerized by visible-light. Real-time Fourier transform infrared spectroscopy (FTIR) was used to investigate in situ the free radical polymerization of methacrylate, ring-opening cationic polymerization of epoxy, and photoacid-induced sol-gel reactions. Among the three simultaneous reactions, the reaction rate of the free radical polymerization was the highest and the hydrolysis/condensation rate was the lowest. With 40s-irradiation, the degrees of conversion of the double bond and epoxy groups at 600 s were 73.2±1.2%, 87.9±2.4%, respectively. Hydrolysis of the methoxysilyl group was initially <5%, and increased gradually to about 50% after 48 h dark storage. Photoacids generated through the visible-light-induced reaction were effective in catalyzing both epoxy ring-opening polymerization and methoxysilyl sol-gel reaction. The mechanical properties of copolymers made with TS concentrations from 5 to 35 wt% were obtained using dynamic mechanical analysis (DMA). In wet conditions, the storage moduli at 70 °C and glass transition temperature were significantly higher than that of the control (p<0.05); these properties increased with TS concentration and storage time. The post reaction of hydrolysis/condensation of alkoxysilane could provide persistent strengthening whether in a neutral or acidic environment and these characteristics could lead to enhanced mechanical properties in the oral environment. The cumulative amount of leached species decreased significantly in the TS-containing copolymers. These results provide valuable information for the development of dental adhesives with reduced leaching of methacrylate monomers and enhanced mechanical properties under the wet, oral environment.

HEMA but not TEGDMA induces autophagy in human gingival fibroblasts

Polymerized resin-based materials are successfully used in restorative dentistry. Despite their growing popularity, one drawback is the release of monomers from the polymerized matrix due to an incomplete polymerization or degradation processes. Released monomers are responsible for several adverse effects in the surrounding biological tissues, inducing high levels of oxidative stress. Reactive oxygen species are important signaling molecules that regulate many signal-trasduction pathways and play critical roles in cell survival, death, and immune defenses. Reactive oxygen species were recently shown to activate autophagy as a mechanism of cell survival and cell death. Although the toxicity induced by dental resin monomers is widely studied, the cellular mechanisms underlying these phenomena are still unknown. The aim of the study was to investigate the behavior of human gingival cells exposed to 2-hydroxy-ethyl methacrylate (HEMA) and triethylene glycol dimethacrylate (TEGDMA) to better elucidate the mechanisms of cell survival and cell death induced by resin monomers. Primary culture of human gingival cells were exposed to 3 mmol/L of HEMA or 3 mmol/L of TEGDMA for 24, 48, and 72 h. Morphological investigations were performed by transmission electron microscopy to analyze the ultrastructure of cells exposed to the monomers. The expression of protein markers for apoptosis (caspase – 3 and PARP) and autophagy (beclin – 1 and LC3B I/II) were analyzed by western blot to investigate the influence of dental resin monomers on mechanisms underlying cell death. Results showed that HEMA treatment clearly induced autophagy followed by apoptosis while the lack of any sign of autophagy activation is observed in HGFs exposed to TEGDMA. These data indicate that cells respond to monomer-induced stress by the differential induction of adaptive mechanisms to maintain cellular homeostasis.

Gene expression analysis of conventional and interactive human gingival cell systems exposed to dental composites

OBJECTIVES

The aim of this study was the detection of putative gene expression-related effects of dental composites in conventional and interactive gingival cell systems.

METHODS

Conventional monoculture (MC) and interactive cell systems (ICS) comprising human gingival fibroblast (HGF) and immortalized human gingival keratinocytes (IHGK) were exposed for 24h and 7 days according to ISO10993-12:2012 manufactured eluates of different composites (Ceram X(®), Filtek™ Supreme XT, Filtek™ Silorane, Fusio™ Liquid Dentin, and Vertise™ Flow). qRT-PCR-based mRNA analysis for biomarkers indicating cell proliferation, differentiation, apoptosis, inflammation, and adhesion was performed. Apoptotic cells were quantified by annexin-V labeling.

RESULTS

Due to low RNA amounts, qPCR could not be performed for Vertise™ Flow and Fusio™ Liquid Dentin at day 7. At 24h, flowables yielded increased transcription for biomarkers of inflammation and apoptosis in IHGK, irrespective of the cell system. HGF cultures displayed lower transcription for cell adhesion markers in both cell systems. Filtek™ Supreme XT showed increased differentiation by elevated filaggrin gene expression in both cell systems for IHGK at day 7, while Filtek™ Silorane and Ceram X(®) yielded elevation of inflammation biomarkers in both cell types. Annexin-V labeling revealed high apoptosis rates for both flowables and Filtek™ Supreme XT for IHGK, while low rates were detected for Filtek™ Silorane and Ceram X(®).

SIGNIFICANCE

Among the composites evaluated, exposition of IHGK and HGF in conventional and interactive cell systems demonstrated most pronounced gene expression alterations in response to flowables, coinciding with elevated levels of apoptosis.

NF-kB mediated down-regulation of collagen synthesis upon HEMA (2-hydroxyethyl methacrylate) treatment of primary human gingival fibroblast/Streptococcus mutans co-cultured cells

PURPOSE

In vitro studies have evidenced the cytotoxic effect of HEMA (2-hydroxyethyl methacrylate), the most common component of dental resin-based restorative material, which is released within the oral cavity, on eukaryotic cells such as gingival fibroblast and epithelial cells. However, since the presence of microorganisms within the oral cavity cannot be excluded and little is known about the interactions occurring between eukaryotic cells and the human oral microbiota, our attention has been addressed to investigate the effect of 3 mM HEMA on the molecular mechanisms driving the response of human gingival fibroblasts (HGFs) co-cultured with Streptococcus mutans.

METHODOLOGY

HGF/S. mutans co-culture has been set up in our lab, and upon HEMA treatment, S.mutans and HGF cells' viability and adhesion along with type I collagen gene and pro-collagen I, Bax, Bcl2, nuclear factor kB (NF-kB), IkBα, pIkBα protein expression by PCR, Western blotting and ELISA assays have been investigated.

RESULTS

HEMA treatment determines a significant decrease of type I collagen protein production, even in the presence of S. mutans, in parallel to a decrease of cell viability and adhesion, which seem to be regulated by NF-kB activation. In fact, when SN50, NF-kB-specific pharmacological inhibitor, is added to the culture, cell proliferation along with collagen synthesis is restored.

CONCLUSION

The modulation exerted by S. mutans on the cytotoxic effect of HEMA suggests that within the oral cavity, the eukaryotic/prokaryotic cell interactions, maintaining the balance of the environment, allow HEMA to perform its adhesive and bonding function and that the use of a co-culture system, which simulates the oral cavity organization, improves the knowledge concerning the biocompatibility of this dental material.

Polymerization behavior of hydrophilic-rich phase of dentin adhesive

The 2-fold objectives of this study were 1) to understand whether model hydrophobic- and hydrophilic-rich phase mimics of dentin adhesive polymerize similarly and 2) to determine which factor, the dimethacrylate component, bisphenol A glycerolate dimethacrylate (BisGMA) or photoinitiator concentration, has greater influence on the polymerization of the hydrophilic-rich phase mimic. Current dentin adhesives are sensitive to moisture, as evidenced by nanoleakage in the hybrid layer and phase separation into hydrophobic- and hydrophilic-rich phases. Phase separation leads to limited availability of the cross-linkable dimethacrylate monomer and hydrophobic photoinitiators within the hydrophilic-rich phase. Model hydrophobic-rich phase was prepared as a single-phase solution by adding maximum wt% deuterium oxide (D2O) to HEMA/BisGMA neat resins containing 45 wt% 2-hydroxyethyl methacrylate (HEMA). Mimics of the hydrophilic-rich phase were prepared similarly but using HEMA/BisGMA neat resins containing 95, 99, 99.5, and 100 wt% HEMA. The hydrophilic-rich mimics were prepared with standard or reduced photoinitiator content. The photoinitiator systems were camphorquinone (CQ)/ethyl 4-(dimethylamino)benzoate (EDMAB) with or without [3-(3, 4-dimethyl-9-oxo-9H-thioxanthen-2-yloxy)-2-hydroxypropyl]trimethylammonium chloride (QTX). The polymerization kinetics was monitored using a Fourier transform infrared spectrophotometer with a time-resolved collection mode. The hydrophobic-rich phase exhibited a significantly higher polymerization rate compared with the hydrophilic-rich phase. Postpolymerization resulting in the secondary rate maxima was observed for the hydrophilic-rich mimic. The hydrophilic-rich mimics with standard photoinitiator concentration but varying cross-linker (BisGMA) content showed postpolymerization and a substantial degree of conversion. In contrast, the corresponding formulations with reduced photoinitiator concentrations exhibited lower polymerization and inhibition/delay of postpolymerization within 2 h. Under conditions relevant to the wet, oral environment, photoinitiator content plays an important role in the polymerization of the hydrophilic-rich phase mimic. Since the hydrophilic-rich phase is primarily water and monomethacrylate monomer (e.g., HEMA as determined previously), substantial polymerization is important to limit the potential toxic response from HEMA leaching into the surrounding tissues.

Experimental self-etching HEMA-free adhesive systems: cytotoxicity and degree of conversion

The aim of this study was to evaluate the effect of replacing 2-hydroxyethyl methacrylate (HEMA) by methacrylate surfactant monomers on the cytotoxicity and degree of conversion of two-step self-etching dentin adhesive systems. Five HEMA-free adhesive systems were tested: Bis-EMA 10, Bis-EMA 30, PEG400, PEG400UDMA, PEG1000, and a HEMA group was used as positive control. The cytotoxicity of the experimental primers, with different monomer concentrations (2 or 20 wt%), and bond resins, containing 25 wt% surfactant, was assessed using murine fibroblast cell line 3T3 and the tetrazolium assay (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT)). The degree of conversion of the bond resins was analyzed using Fourier transform infrared spectroscopy. The data were submitted to statistical analysis using level of significance set at P < 0.05. The PEG 1000 group obtained higher cell viability in comparison with HEMA in the 2 % primer. The cell survival rate using 20 % primer showed that PEG1000 and BIS-EMA 10 were less cytotoxic than HEMA. With regard to the eluate from bond resin, the data showed that the groups BIS-EMA 10, BIS-EMA 30 and PEG400UDMA were less cytotoxic than HEMA. No statistically significant difference was found among degrees of conversion of the experimental groups and HEMA. PEG 1000, BIS-EMA 10 and 30 monomers showed the biological potential for use in new adhesive system formulations since they showed lower cytotoxicity and similar degree of conversion when compared with the HEMA-containing group.

Non-thermal atmospheric plasma brush induces HEMA grafting onto dentin collagen

OBJECTIVE

Non-thermal atmospheric plasma (NTAP) brush has been regarded as a promising technique to enhance dental interfacial bonding. However, the principal enhancement mechanisms have not been well identified. In this study, the effect of non-thermal plasmas on grafting of HEMA, a typical dental monomer, onto dentin collagen thin films was investigated.

METHODS

Human dentin was sectioned into 10-μm-thick films. After total demineralization in 0.5M EDTA solution for 30min, the dentin collagen films were water-rinsed, air-dried, treated with 35wt% HEMA aqueous solution. The films were then subject to plasma-exposure under a NTAP brush with different time (1-8min)/input power (5-15W). For comparison, the dentin collagen films were also treated with the above HEMA solution containing photo-initiators, then subject to light-curing. After plasma-exposure or light-curing, the HEMA-collagen films were rinsed in deionized water, and then examined by FTIR spectroscopy and TEM.

RESULTS

The FITR results indicated that plasma-exposure could induce significant HEMA grafting onto dentin collagen thin films. In contrast, light-curing led to no detectable interaction of HEMA with dentin collagen. Quantitative IR spectral analysis (i.e., 1720/3075 or 749/3075, HEMA/collagen ratios) further suggested that the grafting efficacy of HEMA onto the plasma-exposed collagen thin films strongly depended on the treatment time and input power of plasmas. TEM results indicated that plasma treatment did not alter collagen's banding structure.

SIGNIFICANCE

The current study provides deeper insight into the mechanism of dental adhesion enhancement induced by non-thermal plasmas treatment. The NTAP brush could be a promising method to create chemical bond between resin monomers and dentin collagen.

Confocal time lapse imaging as an efficient method for the cytocompatibility evaluation of dental composites

It is generally accepted that in vitro cell material interaction is a useful criterion in the evaluation of dental material biocompatibility. The objective of this study was to use 3D CLSM time lapse confocal imaging to assess the in vitro biocompatibility of dental composites. This method provides an accurate and sensitive indication of viable cell rate in contact with dental composite extracts. The ELS extra low shrinkage, a dental composite used for direct restoration, has been taken as example. In vitro assessment was performed on cultured primary human gingival fibroblast cells using Live/Dead staining. Images were obtained with the FV10i confocal biological inverted system and analyzed with the FV10-ASW 3.1 Software. Image analysis showed a very slight cytotoxicity in the presence of the tested composite after 5 hours of time lapse. A slight decrease of cell viability was shown in contact with the tested composite extracts compared to control cells. The findings highlighted the use of 3D CLSM time lapse imaging as a sensitive method to qualitatively and quantitatively evaluate the biocompatibility behavior of dental composites.

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.

Saliva improves Streptococcus mitis protective effect on human gingival fibroblasts in presence of 2-hydroxyethyl-methacrylate

This study aimed to investigate the effect of saliva on Streptococcus mitis free cells and on S. mitis/human gingival fibroblasts (HGFs) co-culture model, in presence of 2-hydroxyethyl-methacrylate (HEMA). The bacterial aggregation both in the planktonic phase and on HGFs, as well as the apoptotic and necrotic eukaryotic cells amount were analyzed, in presence of saliva and/or HEMA. The aggregation test revealed a significant saliva aggregation effect on S. mitis strains compared to the untreated sample. No significant differences were recorded in the amount of culturable bacteria in all studied conditions; however, from microscopy images, the saliva/HEMA combining effect induced a significant bacterial aggregation and adhesion on HGFs. HEMA treatment decreased viable eukaryotic cell number with a parallel increment of necrotic cells, but when saliva was added to the co-culture, the viable cells percentage increased to a value comparable to the control sample.

Cytotoxicity of adhesive systems of different hydrophilicities on cultured odontoblast-like cells

This study evaluated the cytotoxicity of experimental adhesive systems (EASs) on odontoblast-like cells. Paper discs (n = 132) were impregnated with 10 µL of each EAS-R1, R2, R3, R4, and R5 (in an ascending order of hydrophilicity), followed by photoactivation. R1 and R2 are nonsolvated hydrophobic blends, R3 represents a simplified etch-and-rinse adhesive system, and R4 and R5 represent simplified self-etch adhesive systems. Discs were immersed in Dulbecco's modified Eagle's medium for 24 h to obtain eluates applied on MDPC-23 cell cultures. No material was applied on discs used as control (R0). Cell viability [3-(4,5-dimethythiazol-2-yl)-2,5-diphenyl tetrazolium bromide assay], total protein (TP) production, alkaline phosphatase (ALP) activity, type of cell death, and degree of monomer conversion Fourier transform infrared (%DC-FTIR) were evaluated. Data were analyzed by Kruskal-Wallis and Mann-Whitney tests (α = 0.05). Considering R0 (control) as having 100% of cell viability, R1, R2, R3, R4, and R5 reduced the metabolic activity of cells by 36.4, 3.1, 0.2, 21.5, and 65.7%, respectively, but only R1 and R5 differed from R0. Comparing with R0, lower TP production was observed for R1, R4, and R5, while ALP activity decreased for R1 and R5. Necrotic cell death was predominant for all EASs, but only R1, R4, and R5 differed from R0. Only R5 presented a different apoptotic cell death ratio from R0. R1 presented the lowest %DC (ca. 37%), whereas R4 and R5 presented the highest (ca. 56%). In conclusion, R2 and R3 were not toxic to the MDPC-23 cells, suggesting that the degree of hydrophilicity or %DC of the EASs alone were not responsible for their cytopathic effects.

Toxicity evaluation of two dental composites: three-dimensional confocal laser scanning microscopy time-lapse imaging of cell behavior

The purpose of this study was to investigate the in vitro biocompatibility of two dental composites (namely A and B) with similar chemical composition used for direct restoration using three-dimensional confocal laser scanning microscopy (CLSM) time-lapse imaging. Time-lapse imaging was performed on cultured human HGF-1 fibroblast-like cells after staining using Live/Dead®. Image analysis showed a higher mortality rate in the presence of composite A than composite B. The viability rate decreased in a time-dependent manner during the 5 h of exposure. Morphological alterations were associated with toxic effects; cells were enlarged and more rounded in the presence of composite A as shown by F-actin and cell nuclei staining. Resazurin assay was used to confirm the active potential of composites in cell metabolism; results showed severe cytotoxic effects in the presence of both no light-curing composites after 24 h of direct contact. However, extracts of polymerized composites induced a moderate decrease in cell metabolism after the same incubation period. Composite B was significantly better tolerated than composite A at all investigated end points and all time points. The finding confirmed that the used CLSM method was sufficiently sensitive to differentiate the biocompatibility behavior of two composites based on similar methacrylate monomers.

2-Hydroxyethyl methacrylate inflammatory effects in human gingival fibroblasts

AIM

To investigate the inflammatory response in human gingival fibroblasts (HGFs) treated with a relatively low 2-hydroxyethyl methacrylate (HEMA) concentration by studying reactive oxygen species (ROS) production, cyclooxygenase-2 (COX-2) and tumour necrosis factor-alpha (TNF-α) gene expression, and prostaglandin E2 (PGE₂) release.

METHODOLOGY

Cultured HGFs were exposed to 3 mmol L⁻¹ HEMA for 0, 24 or 96 h. ROS production was investigated by flow cytometry; TNF-α and COX-2 gene expression was determined by RT-PCR, and prostaglandin E2 production was detected by an enzyme immunoassay.

RESULTS

After 24- or 96-h HEMA incubation, ROS levels were approximately eightfold and elevenfold higher than controls, whilst COX-2 gene expression was approximately twofold or fourfold higher than controls, respectively. Twenty-four-hour exposure enhanced TNF-α mRNA levels by approximately 66%, whilst after 96-h incubation, TNF-α gene expression was fivefold higher than controls. Ninety-six-hour HEMA treatment increased PGE₂ concentration in the culture medium by around 17% compared with controls.

CONCLUSIONS

2-Hydroxyethyl methacrylate treatment (3 mmol L⁻¹) induced an inflammatory response in HGFs modulated by ROS production, as well as by the increase in TNF-α and COX-2 gene expression and by PGE₂ release.

Morphological Analysis and Interleukin Release in Human Gingival Fibroblasts Seeded on Different Denture Base Acrylic Resins

The development of different types of materials with application in practice dentistry is an area of intense growth and research due to its importance in oral health. Among the diverse materials currently used in restoration or in dentures, the acrylic based resins have been widely employed. The release of toxic components and the changes on their physical and mechanical properties actually represent a goal of intensive research. In vivo analysis showed that the surface roughness of the acrylic resin represents a factor that could stimulate bacteria colonization and soft tissue inflammation. For this purpose, in this work, we have analyzed the cell response to acrylic based resins Ivoclar, Tokuso and Coldpack in basal conditions, unpolished, and after the polished procedure performed to reduce the surface roughness. Our in vitro results using human gingival fibroblasts (HGFs) showed a decrease of cell growth, evaluated by MTT assay starting at 24 h of incubation, in samples seeded on resins in basal conditions and after the polished procedure. This cell growth reduction was associated to evident morphological changes in unpolished materials. After 24 h of culture in presence of polished and unpolished resins a spontaneous release was present of pro-inflammatory cytokines such as Interleukin-6 (IL-6) and −8 (IL-8), which was higher in unpolished resins, indicating that the polished procedure, minimizing the cytotoxicity process, could contribute to reduce the gingival inflammation processes.

Anti-adhesive and pro-apoptotic effects of 2-hydroxyethyl methacrylate on human gingival fibroblasts co-cultured with Streptococcus mitis strains

AIM

To evaluate and observe the cellular reactions that occur during the interaction/integration between 2-hydroxyethyl methacrylate/host tissue/microbial environment, in a co-culture of human gingival fibroblasts (HGF) and Streptococcus mitis strains.

METHODOLOGY

Streptococcus mitis were cultured with strains in the presence of 3 mmol L(-1) HEMA for 48 h and 72 h. Cytotoxicity was evaluated by the trypan blue dye exclusion test. Apoptosis was evaluated by TUNEL analysis. Adhesion was evaluated by immunofluorescence and western blot analyses. Quantitative analyses of the results were acquired by Qwin Plus 3.5 and QuantityOne I-D analysis software, respectively. The statistical significance of the results was evaluated using t-tests and linear regression tests.

RESULTS

The trypan blue dye test revealed 47.3% and 46.5% of dead fibroblasts after 48 and 72 h HEMA treatment, respectively, while bacterial viability was not influenced by the presence of HEMA and fibroblasts. The expression of pro-collagen I, involved in fibroblast adhesion, in untreated samples ranged from 12.49% to 6.91% of the positive area after 48 and 72 h, respectively, dropping to below 2% of the positive area in the other experimental conditions. Unlike the trypan blue test, co-cultured samples treated with HEMA showed 20% and 25% versus 17% and 21% (after 48 and 72 h, respectively) of apoptotic cells.

CONCLUSIONS

The evidence for HEMA toxicity and anti-adhesive effects against eukaryotic cells was reduced in the presence of bacteria, suggesting that dental resins should be well polymerized to avoid the spread of toxic monomers within the mouth.

Streptococcus mitis/human gingival fibroblasts co-culture: the best natural association in answer to the 2-hydroxyethyl methacrylate release

One of the major components of dental polymerized resin-based restorative materials is 2-hydroxyethyl methacrylate (HEMA) and its release in monomeric form interferes with the oral cavity environment. This study aimed to evaluate HEMA monomeric effects on the co-culture of Streptococcus mitis and human gingival fibroblasts (HGFs). Streptococcus mitis DS12 and S. mitis ATCC 6249 were co-cultivated with HGF in the presence of HEMA (3 mM), for 48 and 72 h; the amount of sessile and planktonic cells, as well as the prokaryotic and eukaryotic cell viability were analyzed in treated and untreated samples. The treatment of S. mitis/HGFs with HEMA did not produce significant effects on the bacterial adhesion and induced an increase in planktonic S. mitis ATCC 6249 population after 48 and 72 h. HEMA increased significantly the planktonic S. mitis ATCC 6249 viability when co-cultured with HGFs, while a cytotoxic effect on HGFs, without bacteria, was recorded. An increase of bacterial aggregation on HGFs was also detected with HEMA. Data obtained in this study suggest that HEMA exhibits a toxic effect mainly on eukaryotic cells and this effect can be modulated by co-cultivation with the S. mitis cells which, in the presence of the monomer, enhance their aggregation rate on HGFs.

Suppression of procollagen {alpha}1 type 1 by long-term low-dose exposure to 2-hydroxyethylmethacrylate in human gingival fibroblasts in vitro

The purpose of this study was to evaluate the cytotoxicity of low doses and long-term exposure to 2-hydroxyethylmethacrylate (HEMA) on the protein expression of human gingival fibroblasts (HGFs). Human gingival fibroblasts were exposed to different concentrations of HEMA ranging from 0.5 mmol/L to 3 mmol/L for periods of time from 72 hours to 2 weeks. A significant decrease in the expression of procollagen α1 type I protein was observed 72 hours after treatment of cells with 3 mmol/L HEMA. Although low concentrations of the monomer after 2 weeks of exposure to HEMA did not appear to induce any marked changes in the morphology or viability of cells, the expression of procollagen α1 type I protein and its messenger RNA (mRNA) markedly decreased. In conclusion, our data demonstrated that cell viability and morphology assays could be deficient parameters in evaluating the biocompatibility of dental resin materials.

The cytotoxic effects of resin-based sealers on dental pulp stem cells

AIM

To evaluate the effect of four current resin-based adhesives on expanded ex vivo human dental pulp mesenchymal stem cells (DP-MSCs).

METHODOLOGY

Dental pulp mesenchymal stem cells were derived from dental pulps of ten donors. After in vitro isolation, dental pulp stem cells were analysed using flow cytometry. The immunophenotype of DP-MSCs disclosed the homogeneous expression of the mesenchymal-related antigens CD29, CD44, CD73, CD90, CD105, CD166. DP-MSCs were exposed to four different commercially available bonding systems (CMF Bond, Prime&Bond NT, Clearfil S(3) Bond, XP Bond), and after 24, 48 and 72 h of incubation the morphological features and the cell growth were analysed. Moreover, the cell viability was evaluated at the same times by MTT assay. Data were statistically analysed using a two-way anova and Holm-Sidak method (alpha set at 0.05).

RESULTS

Significant differences were observed between the four groups when comparing DP-MSCs appearance. DP-MSCs survived and proliferated without inhibition in the presence of CMF Bond adhesive. On the contrary, microscopic evaluation of the other three groups revealed extensive cytotoxic effects from the dentine bonding agents. The MTT assay revealed no statistically significant differences in cell viability after 72 h between the control group and CMF Bond group. All the other experimental groups had statistically lower optical density values.

CONCLUSIONS

CMF Bond adhesive allowed human dental pulp stem cells to survive and proliferate. All of the other dentine bonding agents had extensive cytotoxic effects.

Molecular toxicology of substances released from resin-based dental restorative materials

Resin-based dental restorative materials are extensively used today in dentistry. However, significant concerns still remain regarding their biocompatibility. For this reason, significant scientific effort has been focused on the determination of the molecular toxicology of substances released by these biomaterials, using several tools for risk assessment, including exposure assessment, hazard identification and dose-response analysis. These studies have shown that substances released by these materials can cause significant cytotoxic and genotoxic effects, leading to irreversible disturbance of basic cellular functions. The aim of this article is to review current knowledge related to dental composites' molecular toxicology and to give implications for possible improvements concerning their biocompatibility.

HEMA down-regulates procollagen alpha1 type I in human gingival fibroblasts

2-Hydroxyethyl methacrylate (HEMA) can be released from restorative materials and diffused into the tooth pulp over long periods of time. Although cytotoxicity due to high concentrations of monomers has been well studied, little is known about the risk of chronic toxicity resulting from low concentrations. The purpose of the study was to evaluate the effects of a minor toxic concentration of HEMA in the synthesis and expression of procollagen alpha1 type I produced by human gingival fibroblasts (HGF). HGF were exposed to 3 mM HEMA from 24 to 96 h. An MTT assay was performed to evaluate cell viability while reverse-transcriptase polymerase chain reaction (RT-PCR), real-time polymerase chain reaction (real-time PCR), and Western-blot analysis were carried out to evaluate the variability in the expression and synthesis of procollagen alpha1. Immunofluorescence was performed to detect the protein inside the cells. The results showed that there was a strong reduction of procollagen alpha 1 type I expression at 72 and 96 h. These findings demonstrate that, even if it does not reduce cell viability, 3 mM HEMA interferes both with the synthesis of the procollagen alpha 1 type I protein and its mRNA expression, suggesting that normal cell production and activity are modified by HEMA at concentrations below those which cause acute cytotoxicity.

In vitro potential cytotoxicity of an adhesive system to alveolar macrophages

The purpose of this study was to evaluate the potential cytotoxicity of Adper Single Bond 2 (SB) simplified etch-and-rinse adhesive system in alveolar macrophage cultures, as a function of the post-polymerization time and duration of immersion in the culture medium for preparation of extracts, by observing the levels of nitric oxide (NO) release and cell survival rate (MTT assay). Wistar rat alveolar macrophages were exposed to 200 μL of extracts obtained from 24- or 72-h immersion of adhesive samples in culture medium (RPMI), immediately or 24 h after polymerization. Fresh RPMI and E. coli lipopolysaccharides were used as negative and positive controls, respectively. The cells were placed in a humidified incubator for 24 h. The results were analyzed by the Student's-t test (α=5%). The amount of NO produced and viable cells were significantly different (p<0.05) between the experimental and the control groups, showing that, irrespective of the post-polymerization time and duration of immersion in the culture medium, the adhesive system caused intense cytotoxicity to the macrophages. The cytotoxic effects were not statistically different (p<0.05) among the experimental groups. In conclusion, chemical components released from SB in aqueous environment were highly toxic to cell culture and thus an inflammatory pulpal response should be considered during the clinical application of dental adhesives.