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Leveque M, Guittat M, Thivichon-Prince B, Reuzeau A, Eveillard M, Faure M, Farges JC, Richert R, Bekhouche M, Ducret M. Next generation antibacterial strategies for regenerative endodontic procedures: A scoping review. Int Endod J 2024; 57:804-814. [PMID: 37485747 DOI: 10.1111/iej.13958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 07/17/2023] [Accepted: 07/18/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND The clinical results following regenerative endodontic procedures (REPs) vary according to numerous parameters, including the presence of bacteria. This limitation reduces the indications for REPs and calls for the development of next generation antibacterial strategies (NGAS) providing alternatives to current antibacterial strategies (CAS) such as double or triple antibiotic paste (DAP/TAP) and (Ca(OH)2). OBJECTIVES The present scoping review aims to describe the current trends regarding the use of such strategies and highlight future perspectives. METHODS Four databases (PUBMed, Cochrane, ClinicalTrials and Science Direct) were searched until 1st May 2023. RESULTS A total of 918 records were identified, 133 were screened and assessed for eligibility, and 87 articles were included. The findings show that (1) clinical studies are only available for CAS, (2) although next generation strategies are the most studied approach since 2017, they are all at the pre-clinical stage, (3) most of the next generation strategies use galenic forms which offer cell support and colonization and which simultaneously contain antibacterial molecules as alternatives to CAS and to antibiotics in general, (4) standardization is required for future research, specifically regarding the bacterial strains studied, the use of biofilm studies and the cellular behaviour assessments. CONCLUSION Although NGAS are promising strategies to improve REPs in the context of infection, the current evidence is mostly limited to pre-clinical studies. Further methodological improvement is required to allow relevant comparisons between studies and to reduce the time from bench to bedside.
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Affiliation(s)
- Marianne Leveque
- Laboratoire de Biologie Tissulaire et Ingénierie Thérapeutique, UMR 5305 CNRS/Université Claude Bernard Lyon 1, Lyon, France
| | - Marie Guittat
- Faculté d'Odontologie, Université Claude Bernard Lyon 1, Lyon, France
- Service d'Odontologie, Hospices Civils de Lyon, Lyon, France
| | - Béatrice Thivichon-Prince
- Laboratoire de Biologie Tissulaire et Ingénierie Thérapeutique, UMR 5305 CNRS/Université Claude Bernard Lyon 1, Lyon, France
- Faculté d'Odontologie, Université Claude Bernard Lyon 1, Lyon, France
- Service d'Odontologie, Hospices Civils de Lyon, Lyon, France
| | - Alicia Reuzeau
- Laboratoire de Biologie Tissulaire et Ingénierie Thérapeutique, UMR 5305 CNRS/Université Claude Bernard Lyon 1, Lyon, France
| | - Matthieu Eveillard
- Département de Biologie des Agents Infectieux, CHU Angers, Angers, France
- Univ Angers, Nantes Université, CHU Angers, Inserm, CNRS, INCIT, Angers, France
| | - Marjorie Faure
- Laboratoire de Biologie Tissulaire et Ingénierie Thérapeutique, UMR 5305 CNRS/Université Claude Bernard Lyon 1, Lyon, France
- Faculté d'Odontologie, Université Claude Bernard Lyon 1, Lyon, France
- Service d'Odontologie, Hospices Civils de Lyon, Lyon, France
| | - Jean-Christophe Farges
- Laboratoire de Biologie Tissulaire et Ingénierie Thérapeutique, UMR 5305 CNRS/Université Claude Bernard Lyon 1, Lyon, France
- Faculté d'Odontologie, Université Claude Bernard Lyon 1, Lyon, France
- Service d'Odontologie, Hospices Civils de Lyon, Lyon, France
| | - Raphaël Richert
- Faculté d'Odontologie, Université Claude Bernard Lyon 1, Lyon, France
- Service d'Odontologie, Hospices Civils de Lyon, Lyon, France
- Laboratoire de Mécanique Des Contacts et Structures, CNRS/INSA, Villeurbanne, France
| | - Mourad Bekhouche
- Laboratoire de Biologie Tissulaire et Ingénierie Thérapeutique, UMR 5305 CNRS/Université Claude Bernard Lyon 1, Lyon, France
| | - Maxime Ducret
- Laboratoire de Biologie Tissulaire et Ingénierie Thérapeutique, UMR 5305 CNRS/Université Claude Bernard Lyon 1, Lyon, France
- Faculté d'Odontologie, Université Claude Bernard Lyon 1, Lyon, France
- Service d'Odontologie, Hospices Civils de Lyon, Lyon, France
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Cardoso LM, de Carvalho ABG, Anselmi C, Mahmoud AH, Dal-Fabbro R, Basso FG, Bottino MC. Bifunctional naringenin-laden gelatin methacryloyl scaffolds with osteogenic and anti-inflammatory properties. Dent Mater 2024:S0109-5641(24)00172-6. [PMID: 38876826 DOI: 10.1016/j.dental.2024.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 06/10/2024] [Accepted: 06/11/2024] [Indexed: 06/16/2024]
Abstract
OBJECTIVE To fabricate and characterize an innovative gelatin methacryloyl/GelMA electrospun scaffold containing the citrus flavonoid naringenin/NA with osteogenic and anti-inflammatory properties. METHODS GelMA scaffolds (15 % w/v) containing 0/Control, 5, 10, or 20 % of NA w/w were obtained via electrospinning. The chemical composition, fiber morphology/diameter, swelling/degradation profile, and NA release were investigated. Cytotoxicity, cell proliferation, adhesion and spreading, total protein/TP production, alkaline phosphatase/ALP activity, osteogenic genes expression (OCN, OPN, RUNX2), and mineralized nodules deposition/MND with human alveolar bone-derived mesenchymal stem cells (aBMSCs) seeded on the scaffolds were assessed. Moreover, aBMSCs seeded on the scaffolds and stimulated with tumor necrosis factor-alpha/TNF-α were submitted to collagen, nitric oxide/NO, interleukin/IL-1α, and IL-6 production assessment. Data were analyzed using ANOVA and t-student/post-hoc tests (α = 5 %). RESULTS NA-laden scaffolds presented increased fiber diameter, lower swelling capacity, and faster degradation profile over 28 days (p < 0.05). NA release was detected over time. Cell adhesion and spreading, and TP production were similar between GelMA and GelMA+NA5 % scaffolds, while cell proliferation, ALP activity, OCN/OPN/RUNX2 gene expression, and MND were higher for GelMA+NA5 % scaffolds (p < 0.05). Cells seeded on control scaffolds and TNF-α-stimulated presented higher levels of NO, IL-1α/IL-6, and lower levels of collagen (p < 0.05). In contrast, cells seeded on GelMA+NA5 % scaffolds showed downregulation of inflammatory markers and higher collagen synthesis (p < 0.05). SIGNIFICANCE GelMA+NA5 % scaffold was cytocompatible, stimulated aBMSCs proliferation and differentiation, and downregulated inflammatory mediators' synthesis, suggesting its therapeutic effect as a multi-target bifunctional scaffold with osteogenic and anti-inflammatory properties for bone tissue engineering.
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Affiliation(s)
- Lais M Cardoso
- Department of Cariology, Restorative Sciences and Endodontics, University of Michigan-School of Dentistry, 1011 N. University Avenue, Ann Arbor, MI 48109, USA; Department of Dental Materials and Prosthodontics, São Paulo State University (UNESP)-Araraquara School of Dentistry, Humaitá 1680, Araraquara, SP 14801-903, Brazil
| | - Ana Beatriz G de Carvalho
- Department of Cariology, Restorative Sciences and Endodontics, University of Michigan-School of Dentistry, 1011 N. University Avenue, Ann Arbor, MI 48109, USA; Department of Dental Materials and Prosthodontics, São Paulo State University (UNESP)-São Jose dos Campos School of Dentistry, Eng. Francisco Jose Longo 777, São Jose Dos Campos, SP 12245-000, Brazil
| | - Caroline Anselmi
- Department of Cariology, Restorative Sciences and Endodontics, University of Michigan-School of Dentistry, 1011 N. University Avenue, Ann Arbor, MI 48109, USA; Department of Morphology and Pediatric Dentistry, São Paulo State University (UNESP)-Araraquara School of Dentistry, Humaitá 1680, Araraquara, SP 14801-903, Brazil
| | - Abdel H Mahmoud
- Department of Oral Biology and Pathology, Stony Brook University-School of Dental Medicine, 100 Nicolls Road, Stony Brook, NY 11794, USA
| | - Renan Dal-Fabbro
- Department of Cariology, Restorative Sciences and Endodontics, University of Michigan-School of Dentistry, 1011 N. University Avenue, Ann Arbor, MI 48109, USA
| | - Fernanda G Basso
- Department of Phisiology and Pathology, São Paulo State University (UNESP), Araraquara School of Dentistry, Araraquara, SP, Brazil
| | - Marco C Bottino
- Department of Cariology, Restorative Sciences and Endodontics, University of Michigan-School of Dentistry, 1011 N. University Avenue, Ann Arbor, MI 48109, USA; Department of Biomedical Engineering, College of Engineering, University of Michigan, Ann Arbor, MI, USA.
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Huang L, Chen X, Yang X, Zhang Y, Qiu X. GelMA-based hydrogel biomaterial scaffold: A versatile platform for regenerative endodontics. J Biomed Mater Res B Appl Biomater 2024; 112:e35412. [PMID: 38701383 DOI: 10.1002/jbm.b.35412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 02/26/2024] [Accepted: 04/13/2024] [Indexed: 05/05/2024]
Abstract
Endodontic therapy, while generally successful, is primarily limited to mature teeth, hence the pressing need to explore regenerative approaches. Gelatin methacryloyl (GelMA) hydrogels have emerged as pivotal biomaterials, promising a bright future for dental pulp regeneration. Despite advancements in tissue engineering and biomaterials, achieving true pulp tissue regeneration remains a formidable task. GelMA stands out for its injectability, rapid gelation, and excellent biocompatibility, serving as the cornerstone of scaffold materials. In the pursuit of dental pulp regeneration, GelMA holds significant potential, facilitating the delivery of stem cells, growth factors, and other vital substances crucial for tissue repair. Presently, in the field of dental pulp regeneration, researchers have been diligently utilizing GelMA hydrogels as engineering scaffolds to transport various effective substances to promote pulp regeneration. However, existing research is relatively scattered and lacks comprehensive reviews and summaries. Therefore, the primary objective of this article is to elucidate the application of GelMA hydrogels as regenerative scaffolds in this field, thereby providing clear direction for future researchers. Additionally, this article provides a comprehensive discussion on the synthesis, characterization, and application of GelMA hydrogels in root canal therapy regeneration. Furthermore, it offers new application strategies and profound insights into future challenges, such as optimizing GelMA formulations to mimic the complex microenvironment of pulp tissue and enhancing its integration with host tissues.
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Affiliation(s)
| | - Xuan Chen
- Department of Endodontics, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, China
| | - XiaoXia Yang
- Department of Endodontics, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, China
| | - Yinchun Zhang
- Department of Endodontics, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, China
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Chen X, Liu Z, Ma R, Lu J, Zhang L. Electrospun nanofibers applications in caries lesions: prevention, treatment and regeneration. J Mater Chem B 2024; 12:1429-1445. [PMID: 38251708 DOI: 10.1039/d3tb02616g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
Dental caries is a multifactorial disease primarily mediated by biofilm formation, resulting in a net loss of mineral content and degradation of organic matrix in dental hard tissues. Caries lesions of varying depths can result in demineralization of the superficial enamel, the formation of deep cavities extending into the dentin, and even pulp infection. Electrospun nanofibers (ESNs) exhibit an expansive specific surface area and a porous structure, closely mimicking the unique architecture of the natural extracellular matrix (ECM). This unique topography caters to the transport of small molecules and facilitates localized therapeutic drug delivery, offering great potential in regulating cell behavior, and thereby attracting interest in ESNs' applications in the treatment of caries lesions and the reconditioning of the affected dental tissues. Thus, this review aims to consolidate the recent developments in ESNs' applications for caries lesions. This review begins with an introduction to the electrospinning technique and provides a comprehensive overview of the biological properties and modification methods of ESNs, followed by an introduction outlining the basic pathological processes, classification and treatment requirements of caries lesions. Finally, the review offers a detailed examination of the research progress on the ESNs' application in caries lesions and concludes by addressing the limitations.
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Affiliation(s)
- Xiangshu Chen
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, Sichuan, China.
- Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, No.14, Section 3, Renmin Road South, Chengdu, 610041, China
| | - Zhenqi Liu
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, Sichuan, China.
- Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, No.14, Section 3, Renmin Road South, Chengdu, 610041, China
| | - Rui Ma
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, Sichuan, China.
| | - Junzhuo Lu
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, Sichuan, China.
- Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, No.14, Section 3, Renmin Road South, Chengdu, 610041, China
| | - Linglin Zhang
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, Sichuan, China.
- Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, No.14, Section 3, Renmin Road South, Chengdu, 610041, China
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Han Y, Dal-Fabbro R, Mahmoud AH, Rahimnejad M, Xu J, Castilho M, Dissanayaka WL, Bottino MC. GelMA/TCP nanocomposite scaffold for vital pulp therapy. Acta Biomater 2024; 173:495-508. [PMID: 37939819 PMCID: PMC10964899 DOI: 10.1016/j.actbio.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 10/11/2023] [Accepted: 11/02/2023] [Indexed: 11/10/2023]
Abstract
Pulp capping is a necessary procedure for preserving the vitality and health of the dental pulp, playing a crucial role in preventing the need for root canal treatment or tooth extraction. Here, we developed an electrospun gelatin methacryloyl (GelMA) fibrous scaffold incorporating beta-tricalcium phosphate (TCP) particles for pulp capping. A comprehensive morphological, physical-chemical, and mechanical characterization of the engineered fibrous scaffolds was performed. In vitro bioactivity, cell compatibility, and odontogenic differentiation potential of the scaffolds in dental pulp stem cells (DPSCs) were also evaluated. A pre-clinical in vivo model was used to determine the therapeutic role of the GelMA/TCP scaffolds in promoting hard tissue formation. Morphological, chemical, and thermal analyses confirmed effective TCP incorporation in the GelMA nanofibers. The GelMA+20%TCP nanofibrous scaffold exhibited bead-free morphology and suitable mechanical and degradation properties. In vitro, GelMA+20%TCP scaffolds supported apatite-like formation, improved cell spreading, and increased deposition of mineralization nodules. Gene expression analysis revealed upregulation of ALPL, RUNX2, COL1A1, and DMP1 in the presence of TCP-laden scaffolds. In vivo, analyses showed mild inflammatory reaction upon scaffolds' contact while supporting mineralized tissue formation. Although the levels of Nestin and DMP1 proteins did not exceed those associated with the clinical reference treatment (i.e., mineral trioxide aggregate), the GelMA+20%TCP scaffold exhibited comparable levels, thus suggesting the emergence of differentiated odontoblast-like cells capable of dentin matrix secretion. Our innovative GelMA/TCP scaffold represents a simplified and efficient alternative to conventional pulp-capping biomaterials. STATEMENT OF SIGNIFICANCE: Vital pulp therapy (VPT) aims to preserve dental pulp vitality and avoid root canal treatment. Biomaterials that bolster mineralized tissue regeneration with ease of use are still lacking. We successfully engineered gelatin methacryloyl (GelMA) electrospun scaffolds incorporated with beta-tricalcium phosphate (TCP) for VPT. Notably, electrospun GelMA-based scaffolds containing 20% (w/v) of TCP exhibited favorable mechanical properties and degradation, cytocompatibility, and mineralization potential indicated by apatite-like structures in vitro and mineralized tissue deposition in vivo, although not surpassing those associated with the standard of care. Collectively, our innovative GelMA/TCP scaffold represents a simplified alternative to conventional pulp capping materials such as MTA and Biodentine™ since it is a ready-to-use biomaterial, requires no setting time, and is therapeutically effective.
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Affiliation(s)
- Yuanyuan Han
- Department of Cariology, Restorative Sciences, and Endodontics, School of Dentistry, University of Michigan, Ann Arbor, MI, United States; Applied Oral Sciences and Community Dental Care, Faculty of Dentistry, The University of Hong Kong, Hong Kong, China
| | - Renan Dal-Fabbro
- Department of Cariology, Restorative Sciences, and Endodontics, School of Dentistry, University of Michigan, Ann Arbor, MI, United States
| | - Abdel H Mahmoud
- Department of Cariology, Restorative Sciences, and Endodontics, School of Dentistry, University of Michigan, Ann Arbor, MI, United States
| | - Maedeh Rahimnejad
- Department of Cariology, Restorative Sciences, and Endodontics, School of Dentistry, University of Michigan, Ann Arbor, MI, United States
| | - Jinping Xu
- Department of Cariology, Restorative Sciences, and Endodontics, School of Dentistry, University of Michigan, Ann Arbor, MI, United States
| | - Miguel Castilho
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands; Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Waruna L Dissanayaka
- Applied Oral Sciences and Community Dental Care, Faculty of Dentistry, The University of Hong Kong, Hong Kong, China
| | - Marco C Bottino
- Department of Cariology, Restorative Sciences, and Endodontics, School of Dentistry, University of Michigan, Ann Arbor, MI, United States; Department of Biomedical Engineering, College of Engineering, University of Michigan, Ann Arbor, MI, United States.
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Dal-Fabbro R, Huang YC, Toledo PTA, Capalbo LC, Coleman RM, Sasaki H, Fenno JC, Bottino MC. Injectable Methacrylated Gelatin Hydrogel for Safe Sodium Hypochlorite Delivery in Endodontics. Gels 2023; 9:897. [PMID: 37998987 PMCID: PMC10670887 DOI: 10.3390/gels9110897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 11/11/2023] [Accepted: 11/12/2023] [Indexed: 11/25/2023] Open
Abstract
Keeping sodium hypochlorite (NaOCl) within the root canal is challenging in regenerative endodontics. In this study, we developed a drug delivery system using a gelatin methacryloyl (GelMA) hydrogel incorporated with aluminosilicate clay nanotubes (HNTs) loaded with NaOCl. Pure GelMA, pure HNTs, and NaOCl-loaded HNTs carrying varying concentrations were assessed for chemo-mechanical properties, degradability, swelling capacity, cytocompatibility, antimicrobial and antibiofilm activities, and in vivo for inflammatory response and degradation. SEM images revealed consistent pore sizes of 70-80 µm for all samples, irrespective of the HNT and NaOCl concentration, while HNT-loaded hydrogels exhibited rougher surfaces. The hydrogel's compressive modulus remained between 100 and 200 kPa, with no significant variations. All hydrogels demonstrated a 6-7-fold mass increase and complete degradation by the seventh day. Despite an initial decrease in cell viability, all groups recovered to 65-80% compared to the control. Regarding antibacterial and antibiofilm properties, 12.5 HNT(Double) showed the highest inhibition zone on agar plates and the most significant reduction in biofilm compared to other groups. In vivo, the 12.5 HNT(Double) group displayed partial degradation after 21 days, with mild localized inflammatory responses but no tissue necrosis. In conclusion, the HNT-NaOCl-loaded GelMA hydrogel retains the disinfectant properties, providing a safer option for endodontic procedures without harmful potential.
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Affiliation(s)
- Renan Dal-Fabbro
- Department of Cariology, Restorative Sciences and Endodontics, School of Dentistry, University of Michigan, Ann Arbor, MI 48109, USA; (R.D.-F.); (Y.-C.H.); (P.T.A.T.); (L.C.C.); (H.S.)
| | - Yu-Chi Huang
- Department of Cariology, Restorative Sciences and Endodontics, School of Dentistry, University of Michigan, Ann Arbor, MI 48109, USA; (R.D.-F.); (Y.-C.H.); (P.T.A.T.); (L.C.C.); (H.S.)
| | - Priscila T. A. Toledo
- Department of Cariology, Restorative Sciences and Endodontics, School of Dentistry, University of Michigan, Ann Arbor, MI 48109, USA; (R.D.-F.); (Y.-C.H.); (P.T.A.T.); (L.C.C.); (H.S.)
- Department of Preventive and Restorative Dentistry, School of Dentistry, São Paulo State University (UNESP), Aracatuba 16015-050, SP, Brazil
| | - Leticia C. Capalbo
- Department of Cariology, Restorative Sciences and Endodontics, School of Dentistry, University of Michigan, Ann Arbor, MI 48109, USA; (R.D.-F.); (Y.-C.H.); (P.T.A.T.); (L.C.C.); (H.S.)
| | - Rhima M. Coleman
- Department of Biomedical Engineering, College of Engineering, University of Michigan, Ann Arbor, MI 48109, USA;
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI 48109, USA
| | - Hajime Sasaki
- Department of Cariology, Restorative Sciences and Endodontics, School of Dentistry, University of Michigan, Ann Arbor, MI 48109, USA; (R.D.-F.); (Y.-C.H.); (P.T.A.T.); (L.C.C.); (H.S.)
| | - J. Christopher Fenno
- Department of Biologic and Materials Sciences & Prosthodontics, School of Dentistry, University of Michigan, Ann Arbor, MI 48109, USA;
| | - Marco C. Bottino
- Department of Cariology, Restorative Sciences and Endodontics, School of Dentistry, University of Michigan, Ann Arbor, MI 48109, USA; (R.D.-F.); (Y.-C.H.); (P.T.A.T.); (L.C.C.); (H.S.)
- Department of Biomedical Engineering, College of Engineering, University of Michigan, Ann Arbor, MI 48109, USA;
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