An enamel-inspired bioactive material with multiscale structure and antibacterial adhesion property

Antimicrobial, remineralization, and infiltration: advanced strategies for interrupting dental caries

Dental caries, driven by plaque biofilm, poses a major oral health challenge due to imbalance in mineralization and demineralization. The primary objective in caries management is to maintain biofilm homeostasis while facilitating the repair and regeneration of dental hard tissues, thus restoring both structural integrity and functionality of affected teeth. Though antimicrobial and remineralization approaches haven shown promise, their standalone utilization without concurrent bacterial control or rebalancing lacks an integrated strategy to effectively arrest caries progression. Furthermore, according to the principles of minimally invasive dentistry, treatment materials should exhibit high permeability to ensure optimal sealing of demineralized tooth surfaces. The concept of interrupting dental caries (IDC) has emerged as a holistic approach, drawing upon extensive research encompassing three pivotal techniques: antibacterial strategies, remineralization therapies, and infiltration mechanisms, all of which are indispensable components in combating the progression of dental caries. In this review, we provide a comprehensive overview of the mechanisms and applications of antibacterial, remineralization, and infiltration technologies within the context of caries management. Additionally, we summarize advanced materials that align with the IDC concept, aiming to offer valuable insights for designing next-generation materials adept at preventing or halting caries progression efficiently.

Targeted antimicrobial self-assembly peptide hydrogel with in situ bio-mimic remineralization for caries management

The single-function agents with wide-spectrum activity which tend to disturb the ecological balance of oral cavity cannot satisfy dental treatment need. A multi-functional agent with specifically targeted killing property and in situ remineralization is warranted for caries management. A novel multi-functional agent (8DSS-C8-P-113) consisting of three domains, i.e., a non-specific antimicrobial peptide (AMP) (P-113), a competence stimulating peptide (C8), and an enhancing remineralization domain (8DSS), is fabricated and evaluated in this study. The findings demonstrates that 2 μM mL-1 of 8DSS-C8-P-113 eliminates planktonic Streptococcus mutans (S. mutans) without disrupting the oral normal flora. At a concentration of 8 μM mL-1, it exhibits the ability to prevent S. mutans' adhesion. Furthermore, 8DSS-C8-P-113 self-assembles a hydrogel state at the higher concentration of 16 μM mL-1. This hydrogel self-adheres on the tooth surface, resisting acid attack, eradicating S. mutans' biofilm, and inducing mineralization in order to facilitate the repair of demineralized dental hard tissue. Its significant effectiveness in reducing the severity of dental caries is also demonstrated in vivo in a rat model. This study suggests that the multi-functional bioactive AMP 8DSS-C8-P-113 is a promising agent to specifically target pathogen, prevent tooth demineralization, and effectively induce in situ bio-mimic remineralization for the management of dental caries.

Baiting bacteria with amino acidic and peptidic corona coated defect-engineered antimicrobial nanoclusters for optimized wound healing

Keeping steps ahead of the bacteria in the race for more efficacious antibacterial strategies is increasingly difficult with the advent of bacterial resistance genes. Herein, we engineered copper sulfide nanoclusters (CuSx NCs) with variable sulfur defects for enhanced dual-treatment of bacterial infections by manipulating photothermal effects and Fenton-like activity. Next, by encasing CuSx NCs with a complex mixture of amino acids and short peptides derived from Luria-Bertani bacterial culture media as a protein corona, we managed to coax E. Coli to take up these CuSx NCs. As a whole, Amino-Pep-CuSx NCs was perceived as a food source and actively consumed by bacteria, enhancing their effective uptake by at least 1.5-fold greater than full length BSA protein BSA-corona CuSx NCs. Through strategically using defect-engineering, we successfully fine-tune photothermal effect and Fenton-like capacity of CuSx NCs. Increased sulfur defects lead to reduced but sufficient heat generation under solar-light irradiation and increased production of toxic hydroxyl radicals. By fine-tuning sulfur defects during synthesis, we achieve CuSx NCs with an optimal synergistic effect, significantly enhancing their bactericidal properties. These ultra-small and biodegradable CuSx NCs can rapidly break down after treatment for clearance. Thus, Amino-Pep-CuSx NCs demonstrate effective eradication of bacteria both in vitro and in vivo because of their relatively high uptake, optimal balanced photothermal and chemodynamic outcomes. Our study offers a straightforward and efficient method to enhance bacterial uptake of next generation of antibacterial agents.

Seriation of Enzyme-Functionalized Multilayers for the Design of Scalable Biomimetic Mineralized Structures

Biomimetic hydroxyapatites are widely explored for their potential applications in the repair of mineralized tissues, particularly dental enamel, which is acellular and, thus, not naturally reformed after damage. Enamel is formed with a highly-controlled hierarchical structure, which is difficult to replicate up to the macroscale. A biomimetic approach is thus warranted, based on the same principles that drive biomineralization in vivo. Herein, a strategy for the design of enamel-like architectures is described, utilizing enzymes embedded in polyelectrolyte multilayers to generate inorganic phosphate locally, and provide a favorable chemical environment for the nucleation and growth of minerals. Moreover, a method is proposed to build up seriated mineral layers with scalable thicknesses, continuous mineral growth, and tunable morphology. Results show the outstanding growth of cohesive mineral layers, yielding macroscopic standalone fluoride and/or carbonate-substituted hydroxyapatite materials with comparable crystal structure and composition to native human mineralized tissues. This strategy presents a promising path forward for the biomimetic design of biomineral materials, particularly relevant for restorative applications, with an exquisite level of synthetic control over multiple orders of magnitude.

Biofilm formation of Streptococcus mutans, Streptococcus sanguinis, Staphylococcus epidermidis, Staphylococcus aureus, Lactobacillus casei, and Candida Albicans on 5 thermoform and 3D printed orthodontic clear aligner and retainer materials at 3 time points: an in vitro study

INTRODUCTION

Orthodontic clear aligners and retainers have numerous advantages that is making them ever increasingly popular. However, they might, similar to any other oral appliance, contribute to biofilm formation and finally dental caries or white spot lesions or gingival inflammations. The literature on biofilm formation on orthodontic clear appliances is very scarce and limited to a few microorganisms and materials. Therefore, this experimental study evaluated the biofilm formation on 5 thermoformed and 3D printed CAD/CAM orthodontic retainers in 3 intervals.

METHODS

In this in vitro study, 345 specimens (270 test discs and 45 negative controls) were created from fabricated retainers. Retainers included a 3D printed CAD/CAM material (Detax) and four thermoformed retainers [Erkodent (polyethylene terephthalate glycol [PETG]); EasyVac (polyethylene); DB (polyester based on terephthalic acid); and Clear Tech]. They were all 1 mm thick, and all completely fabricated, i.e., heated or printed. The discs were placed in 96-well plates. Microorganisms were cultured on 270 discs for 24 h (90 discs), 72 h (90 other discs), and 5 days or 120 h (90 other discs). Biofilm formation of the strains and negative controls was measured using the microtiter plate assay by ELISA reading. The microbes' ability to produce biofilm was categorized based on the comparison of average optical density (OD) of tests versus a cut-off point OD (ODc) calculated as the average of the OD of corresponding negative controls plus 3× its standard deviation: non-biofilm former [OD ≤ ODc], weak biofilm former [ODc < OD ≤ (2 × ODc)], moderate biofilm former [(2 × ODc) < OD ≤ (4 × ODc)], and strong biofilm former [(4 × ODc) < OD]. These were also converted to ranked scores between zero (no biofilm) and 3. The difference between ODs with control ODs were calculated. These were analyzed using 3-way ANOVA, 2-way ANOVA, and Tukey tests (α = 0.05, α = 0.008).

RESULTS

The 3-way ANOVA showed that the overall difference among the ΔODs of 5 retainers (all microorganisms and all intervals combined, n = 270) was not significant (F = 1.860, P = 0.119). Nevertheless, the difference among 3 intervals (F = 31.607, P = 0.0000) and the difference among the 6 microorganisms (F = 24.044, P = 0.0000) were significant. According to the Tukey test, the differences between the 1st interval with either of the other two intervals was significant (both P values = 0.000). There were significant differences between Candida albicans with all other organisms (all 5 P values = 0.0000). All other pairwise comparisons were insignificant (all 10 P values ≥ 0.1). After taking the averages of the 3 intervals, the order of the biofilm generation for different materials were as follows: Detax (average score: 1.56), Easyvac (1.67), Erkodent (1.78), Clear Tech (1.83), BD (2.28).

CONCLUSIONS

As far as these 6 microorganisms are of concern, there might not be a significant overall difference among the clear retainer materials tested in this study. A significant overall increase was observed between the first and third days, which later did not significantly increase more until day 5. The Candida albicans biofilm was more intense than the tested 5 bacteria, which themselves showed rather similar growth patterns to each other.

Rapid Deposition of the Biomimetic Hydroxyapatite-Polydopamine-Amino Acid Composite Layers onto the Natural Enamel

In this work, we developed a technology that enables rapid deposition of biomimetic composite films onto natural enamel slices (known as biotemplates). These films are composed of polydopamine (PDA) and nanocrystalline carbonate-substituted hydroxyapatite (nano-cHAp) that have been functionalized with amino acid l-Arginine. We utilized atomic force microscopy (AFM) and scattering scanning near-field optical microscopy (s-SNOM) combined with infrared (IR) synchrotron to achieve nanoscale spatial resolution for both IR absorption and topography analyses. This combined analytical modality allowed us to understand how morphology connects to local changes in the chemical environment on the biotemplate surface during the deposition of the bioinspired coating. Our findings revealed that when using the proposed technology and after the deposition of the first PDA layer, the film formed on the enamel surface nearly covers the entire surface of the specimen whose thickness is larger on the surface of the emerging enamel prisms. Calculation of the crystallinity index for the biomimetic layer showed a multiple increase compared with natural enamel. This indicates regular and dense aggregation of nano-cHAp into larger crystals, imitating the morphology of natural enamel rods. The microhardness of the formed PDA-based biomimetic layer mineralized with nano-cHAp functionalized with amino acid l-Arginine deposited on natural enamel was practically the same as that of natural enamel. The characterization of nano-cHAp-amino acid-PDA layers using IR and Raman microspectroscopy showed that l-arginine acts as a conjunction agent in the formation of mineralized biomimetic composite coatings. The uniformity of the mechanisms of PDA layer formation under different deposition conditions and substrate types allows for the formation of coatings regardless of the macro- and micromorphology of the template. Therefore, the results obtained in this work have a high potential for future clinical applications in dental practice.

Epigallocatechin-3-gallate/mineralization precursors co-delivery hollow mesoporous nanosystem for synergistic manipulation of dentin exposure

As a global public health focus, oral health plays a vital role in facilitating overall health. Defected teeth characterized by exposure of dentin generally increase the risk of aggravating oral diseases. The exposed dentinal tubules provide channels for irritants and bacterial invasion, leading to dentin hypersensitivity and even pulp inflammation. Cariogenic bacterial adhesion and biofilm formation on dentin are responsible for tooth demineralization and caries. It remains a clinical challenge to achieve the integration of tubule occlusion, collagen mineralization, and antibiofilm functions for managing exposed dentin. To address this issue, an epigallocatechin-3-gallate (EGCG) and poly(allylamine)-stabilized amorphous calcium phosphate (PAH-ACP) co-delivery hollow mesoporous silica (HMS) nanosystem (E/PA@HMS) was herein developed. The application of E/PA@HMS effectively occluded the dentinal tubules with acid- and abrasion-resistant stability and inhibited the biofilm formation of Streptococcus mutans. Intrafibrillar mineralization of collagen fibrils and remineralization of demineralized dentin were induced by E/PA@HMS. The odontogenic differentiation and mineralization of dental pulp cells with high biocompatibility were also promoted. Animal experiments showed that E/PA@HMS durably sealed the tubules and inhibited biofilm growth up to 14 days. Thus, the development of the E/PA@HMS nanosystem provides promising benefits for protecting exposed dentin through the coordinated manipulation of dentin caries and hypersensitivity.

Tooth Diversity Underpins Future Biomimetic Replications

Although the evolution of tooth structure seems highly conserved, remarkable diversity exists among species due to different living environments and survival requirements. Along with the conservation, this diversity of evolution allows for the optimized structures and functions of teeth under various service conditions, providing valuable resources for the rational design of biomimetic materials. In this review, we survey the current knowledge about teeth from representative mammals and aquatic animals, including human teeth, herbivore and carnivore teeth, shark teeth, calcite teeth in sea urchins, magnetite teeth in chitons, and transparent teeth in dragonfish, to name a few. The highlight of tooth diversity in terms of compositions, structures, properties, and functions may stimulate further efforts in the synthesis of tooth-inspired materials with enhanced mechanical performance and broader property sets. The state-of-the-art syntheses of enamel mimetics and their properties are briefly covered. We envision that future development in this field will need to take the advantage of both conservation and diversity of teeth. Our own view on the opportunities and key challenges in this pathway is presented with a focus on the hierarchical and gradient structures, multifunctional design, and precise and scalable synthesis.

Bone microenvironment regulative hydrogels with ROS scavenging and prolonged oxygen-generating for enhancing bone repair

Large bone defects resulting from fractures and disease are a major clinical challenge, being often unable to heal spontaneously by the body's repair mechanisms. Lines of evidence have shown that hypoxia-induced overproduction of ROS in bone defect region has a major impact on delaying bone regeneration. However, replenishing excess oxygen in a short time cause high oxygen tension that affect the activity of osteoblast precursor cells. Therefore, reasonably restoring the hypoxic condition of bone microenvironment is essential for facilitating bone repair. Herein, we designed ROS scavenging and responsive prolonged oxygen-generating hydrogels (CPP-L/GelMA) as a "bone microenvironment regulative hydrogel" to reverse the hypoxic microenvironment in bone defects region. CPP-L/GelMA hydrogels comprises an antioxidant enzyme catalase (CAT) and ROS-responsive oxygen-releasing nanoparticles (PFC@PLGA/PPS) co-loaded liposome (CCP-L) and GelMA hydrogels. Under hypoxic condition, CPP-L/GelMA can release CAT for degrading hydrogen peroxide to generate oxygen and be triggered by superfluous ROS to continuously release the oxygen for more than 2 weeks. The prolonged oxygen enriched microenvironment generated by CPP-L/GelMA hydrogel significantly enhanced angiogenesis and osteogenesis while inhibited osteoclastogenesis. Finally, CPP-L/GelMA showed excellent bone regeneration effect in a mice skull defect model through the Nrf2-BMAL1-autophagy pathway. Hence, CPP-L/GelMA, as a bone microenvironment regulative hydrogel for bone tissue respiration, can effectively scavenge ROS and provide prolonged oxygen supply according to the demand in bone defect region, possessing of great clinical therapeutic potential.

Advanced materials for enamel remineralization

Dental caries, a chronic and irreversible disease caused by caries-causing bacteria, has been listed as one of the three major human diseases to be prevented and treated. Therefore, it is critical to effectively stop the development of enamel caries. Remineralization treatment can control the progression of caries by inhibiting and reversing enamel demineralization at an early stage. In this process, functional materials guide the deposition of minerals on the damaged enamel, and the structure and hardness of the enamel are then restored. These remineralization materials have great potential for clinical application. In this review, advanced materials for enamel remineralization were briefly summarized, furthermore, an outlook on the perspective of remineralization materials were addressed.

Childhood Caries Management

Dental caries, also known as tooth decay or cavities, result from the breakdown of teeth due to bacterial acids [...]

Recent Progress on Bioinspired Antibacterial Surfaces for Biomedical Application

Surface bacterial fouling has become an urgent global challenge that calls for resilient solutions. Despite the effectiveness in combating bacterial invasion, antibiotics are susceptible to causing microbial antibiotic resistance that threatens human health and compromises the medication efficacy. In nature, many organisms have evolved a myriad of surfaces with specific physicochemical properties to combat bacteria in diverse environments, providing important inspirations for implementing bioinspired approaches. This review highlights representative natural antibacterial surfaces and discusses their corresponding mechanisms, including repelling adherent bacteria through tailoring surface wettability and mechanically killing bacteria via engineering surface textures. Following this, we present the recent progress in bioinspired active and passive antibacterial strategies. Finally, the biomedical applications and the prospects of these antibacterial surfaces are discussed.

Research on Graphene and Its Derivatives in Oral Disease Treatment

Oral diseases present a global public health problem that imposes heavy financial burdens on individuals and health-care systems. Most oral health conditions can be treated in their early stage. Even if the early symptoms of oral diseases do not seem to cause significant discomfort, prompt treatment is essential for preventing their progression. Biomaterials with superior properties enable dental therapies with applications in restoration, therapeutic drug/protein delivery, and tissue regeneration. Graphene nanomaterials have many unique mechanical and physiochemical properties and can respond to the complex oral microenvironment, which includes oral microbiota colonization and high masticatory force. Research on graphene nanomaterials in dentistry, especially in caries, periodontitis therapy, and implant coatings, is progressing rapidly. Here, we review the development of graphene and its derivatives for dental disease therapy.

Synthesis of a graphene oxide/agarose/hydroxyapatite biomaterial with the evaluation of antibacterial activity and initial cell attachment

Various materials are used in bone tissue engineering (BTE). Graphene oxide (GO) is a good candidate for BTE due to its antibacterial activity and biocompatibility. In this study, an innovative biomaterial consists of GO, agarose and hydroxyapatite (HA) was synthesized using electrophoresis system. The characterization of the synthesized biomaterial showed that needle-like crystals with high purity were formed after 10 mA/10 h of electrophoresis treatment. Furthermore, the calcium-phosphate ratio was similar to thermodynamically stable HA. In the synthesized biomaterial with addition of 1.0 wt% of GO, the colony forming units test showed significantly less Staphylococcus aureus. Initial attachment of MC3T3-E1 cells on the synthesized biomaterial was observed which showed the safety of the synthesized biomaterial for cell viability. This study showed that the synthesized biomaterial is a promising material that can be used in BTE.

Electrophoresis-Aided Biomimetic Mineralization System Using Graphene Oxide for Regeneration of Hydroxyapatite on Dentin

Graphene oxide (GO) is an emerging luminescent carbon nanomaterial with the ability to foster hydroxyapatite (HA). A specially designed electrophoresis system can be used to accelerate the mineralization process. The aim of this study was to promote HA crystal growth on demineralized dentin using a GO incorporated electrophoresis system. GO was successfully synthesized by carbonization of citric acid and its presence was confirmed by Fourier transform infrared and UV-visible spectrophotometry evaluation. Dentin slices were placed in demineralized solution and divided into control (without the electrophoresis system) and experimental group. Demineralized dentin slices in the experimental group were remineralized using the electrophoresis system for 8 h/1.0 mA, with one subgroup treated without GO and the other with GO. Energy dispersive spectroscopy evaluation showed that the calcium/phosphate ratio of the crystal formed in control and experimental group with addition of GO was close to natural hydroxyapatite. However, scanning electron microscopy evaluation showed that the exposed dentinal tubules were occluded with rod-like crystals, which is similar to native enamel morphology, in the experimental group with addition of GO compared to the flake-like crystal in the control group. Mechanical evaluation revealed that the nanohardness and modulus of remineralized dentin were significantly higher in the experimental group. In conclusion, GO is a promising material to remineralize dentin and the introduction of an electrophoresis system can accelerate its process.