Light curable dental composites designed with colloidal crystal reinforcement

Evaluation of chromatic changes of a nanocomposite resin using the new whitness index

Background and aims

To evaluate the staining effects of two brands of coffee and the bleaching efficiency of two in-office bleaching methods, upon different opacities of a commercial nanocomposite.

Methods

Twenty four specimens of each opacity, A3 Dentin, A3 Body and A3 Enamel, were fabricated from Filtek Supreme (3MEspe). The specimens were further divided into two groups (n=12) and were immersed in two coffee solutions (Bio Organic Coffee Bellarom, 100% Arabica, and Iulius Meinl Coffee), for 24 hours. Between the staining sessions, the specimens were stored in sterile water, at 37°C. Each group was further divided into three (n=4), in order to be bleached, as follows: Group 1 - Beyond 35% in office, for 4 applications of 15 minutes each, Group 2 – Zoom Day White 6% in office, for 4 applications of 15 minutes each, Group 3 – Control Group, stored in sterile water. Color values were measured with a dental spectrophotometer Vita EasyShade 4.0 and five measurements were recorded for each sample at a time. Lightness L*, color coordinates a* and b* were recorded, at baseline, after staining in coffee and after bleaching. Whiteness index (WID) of the three composite resins (A3D, A3B, A3E) in the three moments were calculated, as well as the color difference Delta E* correspondent to the staining and bleaching process. Data were analyzed using one-way repeated measures ANOVA and the WID index was calculated WID (p<0.05). Univariate analysis of variance was performed for assessing the influence of staining solution upon composite resins, as well as for testing the effect of bleaching agents. The significance level was set at α=0.05 and pairwise comparisons were adjusted by the Least Significant Difference method.

Results

The pairwise comparisons showed no significant difference between the effects of the two bleaching agents upon the WID, meaning that they induce almost similar color changes. The results of the univariate ANOVA test indicated a significant effect of the composite resin and the staining solution upon the WID (p<0.05). However, no significant interaction effect was found between the composite resin and the staining solution (p=0.095). There was a significant difference in the staining effect of the two coffee solutions only for A3B and A3E composite resins (p<0.05).

Conclusions

The chromatic changes of the nanocomposite resin could be evaluated by the variation of the whiteness index. The staining effect induced by the two types of coffee was similar. The most effective protocol was the in-office bleaching method based on Beyond 35%.

A novel protein-repellent dental composite containing 2-methacryloyloxyethyl phosphorylcholine

Secondary caries due to biofilm acids is a primary cause of dental composite restoration failure. To date, there have been no reports of dental composites that can repel protein adsorption and inhibit bacteria attachment. The objectives of this study were to develop a protein-repellent dental composite by incorporating 2-methacryloyloxyethyl phosphorylcholine (MPC) and to investigate for the first time the effects of MPC mass fraction on protein adsorption, bacteria attachment, biofilm growth, and mechanical properties. Composites were synthesized with 0 (control), 0.75%, 1.5%, 2.25%, 3%, 4.5% and 6% of MPC by mass. A commercial composite was also tested as a control. Mechanical properties were measured in three-point flexure. Protein adsorption onto the composite was determined by the microbicinchoninic acid method. A human saliva microcosm biofilm model was used. Early attachment at 4 h, biofilm at 2 days, live/dead staining and colony-forming units (CFUs) of biofilms grown on the composites were investigated. Composites with MPC of up to 3% had mechanical properties similar to those without MPC and those of the commercial control, whereas 4.5% and 6% MPC decreased the mechanical properties (P<0.05). Increasing MPC from 0 to 3% reduced the protein adsorption on composites (P<0.05). The composite with 3% MPC had protein adsorption that was 1/12 that of the control (P<0.05). Oral bacteria early attachment and biofilm growth were also greatly reduced on the composite with 3% MPC, compared to the control (P<0.05). In conclusion, incorporation of MPC into composites at 3% greatly reduced protein adsorption, bacteria attachment and biofilm CFUs, without compromising mechanical properties. Protein-repellent composites could help to repel bacteria attachment and plaque build-up to reduce secondary caries. The protein-repellent method might be applicable to other dental materials.

Development of novel dental adhesive with double benefits of protein-repellent and antibacterial capabilities

OBJECTIVES

Secondary caries at the tooth-restoration margins remains a main reason for restoration failure. The objectives of this study were to: (1) combine protein-repellent 2-methacryloyloxyethyl phosphorylcholine (MPC) with quaternary ammonium dimethylaminohexadecyl methacrylate (DMAHDM) to develop a new dental adhesive with double benefits of protein-repellent and antibacterial capabilities for the first time; and (2) investigate the effects on protein adsorption, anti-biofilm activity, and dentin bond strength.

METHODS

MPC and DMAHDM were incorporated into Scotchbond Multi-Purpose (SBMP) primer and adhesive. Dentin shear bond strengths were measured using extracted human molars. Protein adsorption onto the adhesive resin surfaces was determined by the micro bicinchoninic acid (BCA) method. A dental plaque microcosm biofilm model with human saliva as inoculum was used to investigate biofilm metabolic activity, colony-forming unit (CFU) counts, lactic acid production and live/dead staining of biofilms on resins.

RESULTS

Incorporation of 7.5% MPC and 5% DMAHDM into primer and adhesive did not adversely affect the dentin shear bond strength (p>0.1). The resin with 7.5% MPC+5% DMAHDM had protein adsorption that was nearly 20-fold less than SBMP control (p<0.05). The resin with 7.5% MPC+5% DMAHDM had much stronger antibacterial effects than using MPC or DMAHDM alone (p<0.05). Biofilm CFU counts on the resin with 7.5% MPC+5% DMAHDM were reduced by more than 4 orders of magnitude, compared to SBMP control.

SIGNIFICANCE

The use of double agents (protein-repellent MPC+antibacterial DMAHDM) in dental adhesive achieved much stronger inhibition of biofilms than using each agent alone. The novel protein-repellent and antibacterial bonding agent is promising to reduce biofilm/plaque buildup and reduce recurrent caries at the tooth-restoration margins.

Protein-repellent and antibacterial dental composite to inhibit biofilms and caries

OBJECTIVES

Biofilm acids contribute to secondary caries, which is a main reason for dental restoration failures. The objectives of this study were to: (1) develop a protein-repellent and antibacterial composite, and (2) investigate the effects of combining 2-methacryloyloxyethyl phosphorylcholine (MPC) with quaternary ammonium dimethylaminohexadecyl methacrylate (DMAHDM) on composite mechanical properties and biofilm response for the first time.

METHODS

MPC, DMAHDM and glass particles were mixed into a dental resin composite. Mechanical properties were measured in three-point flexure. Protein adsorption onto the composites was measured by a micro bicinchoninic acid method. A human saliva microcosm model was used to grow biofilms on composites. Colony-forming unit (CFU) counts, live/dead assay, metabolic activity, and lactic acid production of biofilms were determined.

RESULTS

Incorporation of 3% MPC and 1.5% DMAHDM into composite achieved protein-repellent and antibacterial capabilities without compromising the mechanical properties. Composite with 3% MPC+1.5% DMAHDM had protein adsorption that was 1/10 that of a commercial composite (p<0.05). The composite with 3% MPC+1.5% DMAHDM had much greater reduction in biofilm growth than using MPC or DMAHDM alone (p<0.05). Biofilm CFU counts on composite with 3% MPC+1.5% DMAHDM were more than three orders of magnitude lower than that of commercial control.

CONCLUSIONS

Dental composite with a combination of strong protein-repellent and antibacterial capabilities was developed for the first time. Composite containing MPC and DMAHDM greatly reduced biofilm growth and lactic acid production, without compromising mechanical properties of the composite.

CLINICAL SIGNIFICANCE

Novel composite with MPC and DMAHDM greatly reduced biofilm activity and is promising to inhibit secondary caries. The dual agents of MPC plus DMAHDM may have wide applicability to other dental materials.

Effect of water-ageing on dentine bond strength and anti-biofilm activity of bonding agent containing new monomer dimethylaminododecyl methacrylate

OBJECTIVES

The objectives of this study were to develop bonding agent containing a new antibacterial monomer dimethylaminododecyl methacrylate (DMADDM) as well as nanoparticles of silver (NAg) and nanoparticles of amorphous calcium phosphate (NACP), and to investigate the effects of water-ageing for 6 months on dentine bond strength and anti-biofilm properties for the first time.

METHODS

Four bonding agents were tested: Scotchbond Multi-Purpose (SBMP) Primer and Adhesive control; SBMP+5% DMADDM; SBMP+5% DMADDM+0.1% NAg; and SBMP+5% DMADDM+0.1% NAg with 20% NACP in adhesive. Specimens were water-aged for 1d and 6 months at 37°C. Then the dentine shear bond strengths were measured. A dental plaque microcosm biofilm model was used to inoculate bacteria on water-aged specimens and to measure metabolic activity, colony-forming units (CFUs), and lactic acid production.

RESULTS

Dentine bond strength showed a 35% loss in 6 months of water-ageing for SBMP control (mean±sd; n=10); in contrast, the new antibacterial bonding agents showed no strength loss. The DMADDM-NAg-NACP containing bonding agent imparted a strong antibacterial effect by greatly reducing biofilm viability, metabolic activity and acid production. The biofilm CFU was reduced by more than two orders of magnitude, compared to SBMP control. Furthermore, the DMADDM-NAg-NACP bonding agent exhibited a long-term antibacterial performance, with no significant difference between 1d and 6 months (p>0.1).

CONCLUSIONS

Incorporating DMADDM-NAg-NACP in bonding agent yielded potent and long-lasting antibacterial properties, and much stronger bond strength after 6 months of water-ageing than a commercial control. The new antibacterial bonding agent is promising to inhibit biofilms and caries at the margins. The method of DMADDM-NAg-NACP incorporation may have a wide applicability to other adhesives, cements and composites.

Novel calcium phosphate nanocomposite with caries-inhibition in a human in situ model

OBJECTIVES

Secondary caries at the restoration margins remains the main reason for failure. Although calcium phosphate (CaP) composites are promising for caries inhibition, there has been no report of CaP composite to inhibit caries in situ. The objectives of this study were to investigate the caries-inhibition effect of nanocomposite containing nanoparticles of amorphous calcium phosphate (NACP) in a human in situ model for the first time, and to determine colony-forming units (CFU) and Ca and P ion concentrations of biofilms on the composite restorations.

METHODS

NACP with a mean particle size of 116 nm were synthesized via a spray-drying technique. Two composites were fabricated: NACP nanocomposite, and control composite filled with glass particles. Twenty-five volunteers wore palatal devices containing bovine enamel slabs with cavities restored with NACP or control composite. After 14 days, the adherent biofilms were collected for analyses. Transverse microradiography determined the enamel mineral profiles at the margins, and the enamel mineral loss ΔZ was measured.

RESULTS

NACP nanocomposite released Ca and P ions and the release significantly increased at cariogenic low pH (p<0.05). Biofilms on NACP nanocomposite contained higher Ca (p=0.007) and P ions (p=0.005) than those of control (n=25). There was no significant difference in biofilm CFU between the two composites (p>0.1). Microradiographs showed typical subsurface lesions in enamel next to control composite, but much less lesion around NACP nanocomposite. Enamel mineral loss ΔZ (mean±sd; n=25) around NACP nanocomposite was 13.8±9.3 μm, much less than 33.5±19.0 μm of the control (p=0.001).

SIGNIFICANCE

Novel NACP nanocomposite substantially reduced caries formation in a human in situ model for the first time. Enamel mineral loss at the margins around NACP nanocomposite was less than half of the mineral loss around control composite. Therefore, the Ca and P ion-releasing NACP nanocomposite is promising for caries-inhibiting restorations.

Effect of quaternary ammonium and silver nanoparticle-containing adhesives on dentin bond strength and dental plaque microcosm biofilms

OBJECTIVE

Antibacterial bonding agents are promising to hinder the residual and invading bacteria at the tooth-restoration interfaces. The objectives of this study were to develop an antibacterial bonding agent by incorporation of quaternary ammonium dimethacrylate (QADM) and nanoparticles of silver (NAg), and to investigate the effect of QADM-NAg adhesive and primer on dentin bond strength and plaque microcosm biofilm response for the first time.

METHODS

Scotchbond Multi-Purpose adhesive and primer were used as control. Experimental adhesive and primer were made by adding QADM and NAg into control adhesive and primer. Human dentin shear bond strengths were measured (n = 10). A dental plaque microcosm biofilm model with human saliva as inoculum was used to investigate biofilm metabolic activity, colony-forming unit (CFU) counts, lactic acid production, and live/dead staining assay (n = 6).

RESULTS

Adding QADM and NAg into adhesive and primer did not compromise the dentin shear bond strength which ranged from 30 to 35MPa (p>0.1). Scanning electron microscopy (SEM) examinations revealed numerous resin tags, which were similar for the control and the QADM and NAg groups. Adding QADM or NAg markedly reduced the biofilm viability, compared to adhesive control. QADM and NAg together in the adhesive had a much stronger antibacterial effect than using each agent alone (p<0.05). Adding QADM and NAg in both adhesive and primer had the strongest antibacterial activity, reducing metabolic activity, CFU, and lactic acid by an order of magnitude, compared to control.

SIGNIFICANCE

Without compromising dentin bond strength and resin tag formation, the QADM and NAg containing adhesive and primer achieved strong antibacterial effects against microcosm biofilms for the first time. QADM-NAg adhesive and primer are promising to combat residual bacteria in tooth cavity and invading bacteria at the margins, thereby to inhibit secondary caries. QADM and NAg incorporation may have a wide applicability to other dental bonding systems.

Long-term mechanical durability of dental nanocomposites containing amorphous calcium phosphate nanoparticles

Half of all dental restorations fail within 10 years, with secondary caries and restoration fracture being the main reasons. Calcium phosphate (CaP) composites can release Ca and PO(4) ions and remineralize tooth lesions. However, there has been no report on their long-term mechanical durability. The objective of this study was to investigate the wear, thermal-cycling, and water-aging of composites containing amorphous calcium phosphate nanoparticles (NACP). NACP of 112-nm and glass particles were used to fabricate four composites: (1) 0% NACP+75% glass; (2) 10% NACP+65% glass; (3) 15% NACP+60% glass; and (4) 20% NACP+50% glass. Flexural strength and elastic modulus of NACP nanocomposites were not degraded by thermal-cycling. Wear depth increased with increasing NACP filler level. Wear depths of NACP nanocomposites after 4 × 10(5) cycles were within the range for commercial controls. Mechanical properties of all the tested materials decreased with water-aging time. After 2 years, the strengths of NACP nanocomposites were moderately higher than the control composite, and much higher than the resin-modified glass ionomers. The mechanism of strength loss for resin-modified glass ionomer was identified as microcracking and air-bubbles. NACP nanocomposites and control composite were generally free of microcracks and air-bubbles. In conclusion, combining NACP nanoparticles with reinforcement glass particles resulted in novel nanocomposites with long-term mechanical properties higher than those of commercial controls, and wear within the range of commercial controls. These strong long-term properties, plus the Ca-PO(4) ion release and acid-neutralization capability reported earlier, suggest that the new NACP nanocomposites may be promising for stress-bearing and caries-inhibiting restorations.

Antibacterial and physical properties of calcium-phosphate and calcium-fluoride nanocomposites with chlorhexidine

OBJECTIVES

Previous studies have developed calcium phosphate and fluoride releasing composites. Other studies have incorporated chlorhexidine (CHX) particles into dental composites. However, CHX has not been incorporated in calcium phosphate and fluoride composites. The objectives of this study were to develop nanocomposites containing amorphous calcium phosphate (ACP) or calcium fluoride (CaF(2)) nanoparticles and CHX particles, and investigate Streptococcus mutans biofilm formation and lactic acid production for the first time.

METHODS

Chlorhexidine was frozen via liquid nitrogen and ground to obtain a particle size of 0.62 μm. Four nanocomposites were fabricated with fillers of: nano ACP; nano ACP+10% CHX; nano CaF(2); nano CaF(2)+10% CHX. Three commercial materials were tested as controls: a resin-modified glass ionomer, and two composites. S. mutans live/dead assay, colony-forming unit (CFU) counts, biofilm metabolic activity, and lactic acid were measured.

RESULTS

Adding CHX fillers to ACP and CaF(2) nanocomposites greatly increased their antimicrobial capability. ACP and CaF(2) nanocomposites with CHX that were inoculated with S. mutans had a growth medium pH>6.5 after 3 d, while the control commercial composites had a cariogenic pH of 4.2. Nanocomposites with CHX reduced the biofilm metabolic activity by 10-20 folds and reduced the acid production, compared to the controls. CFU on nanocomposites with CHX were three orders of magnitude less than that on commercial composite. Mechanical properties of nanocomposites with CHX matched a commercial composite without fluoride.

SIGNIFICANCE

The novel calcium phosphate and fluoride nanocomposites could be rendered antibacterial with CHX to greatly reduce biofilm formation, acid production, CFU and metabolic activity. The antimicrobial and remineralizing nanocomposites with good mechanical properties may be promising for a wide range of tooth restorations with anti-caries capabilities.

Recent advances and developments in composite dental restorative materials

Composite dental restorations represent a unique class of biomaterials with severe restrictions on biocompatibility, curing behavior, esthetics, and ultimate material properties. These materials are presently limited by shrinkage and polymerization-induced shrinkage stress, limited toughness, the presence of unreacted monomer that remains following the polymerization, and several other factors. Fortunately, these materials have been the focus of a great deal of research in recent years with the goal of improving restoration performance by changing the initiation system, monomers, and fillers and their coupling agents, and by developing novel polymerization strategies. Here, we review the general characteristics of the polymerization reaction and recent approaches that have been taken to improve composite restorative performance.

Dental glass-reinforced composite for caries inhibition: calcium phosphate ion release and mechanical properties

The two main challenges facing dental composite restorations are secondary caries and bulk fracture. Previous studies developed whisker-reinforced Ca-PO(4) composites that were relatively opaque. The objective of this study was to develop an esthetic glass particle-reinforced, photo-cured calcium phosphate composite. Tetracalcium phosphate (TTCP) particles were incorporated into a resin for Ca and PO(4) release, while glass particles provided reinforcement. Ion release and mechanical properties were measured after immersion in solutions with pH of 7, 5.5, and 4. For the composite containing 40% mass fraction of TTCP, incorporating glass fillers increased the strength (p < 0.05). Flexural strength (Mean +/- SD; n = 6) at 30% glass was 99 +/- 18 MPa, higher than 54 +/- 20 MPa at 0% glass (p < 0.05). Elastic modulus was 11 GPa at 30% glass, compared to 2 GPa without glass. At 28 days, the released Ca ion concentration was 4.61 +/- 0.18 mmol/L at pH of 4, much higher than 1.14 +/- 0.07 at pH of 5.5, and 0.27 +/- 0.01 at pH of 7 (p < 0.05). PO(4) release was also dramatically increased at cariogenic, acidic pH. The TTCP-glass composite had strength 2-3 fold that of a resin-modified glass ionomer control. In conclusion, the photo-cured TTCP-glass composite was "smart" and substantially increased the Ca and PO(4) release when the pH was reduced from neutral to a cariogenic pH of 4, when these ions are most needed to inhibit tooth caries. Its mechanical properties were significantly higher than previous Ca, PO(4), and fluoride releasing restoratives. Hence, the photo-cured TTCP-glass composite may have potential to provide the necessary combination of load-bearing and caries-inhibiting capabilities.

Strong nanocomposites with Ca, PO(4), and F release for caries inhibition

This article reviews recent studies on: (1) the synthesis of novel calcium phosphate and calcium fluoride nanoparticles and their incorporation into dental resins to develop nanocomposites; (2) the effects of key microstructural parameters on Ca, PO(4), and F ion release from nanocomposites, including the effects of nanofiller volume fraction, particle size, and silanization; and (3) mechanical properties of nanocomposites, including water-aging effects, flexural strength, fracture toughness, and three-body wear. This article demonstrates that a major advantage of using the new nanoparticles is that high levels of Ca, PO(4), and F release can be achieved at low filler levels in the resin, because of the high surface areas of the nanoparticles. This leaves room in the resin for substantial reinforcement fillers. The combination of releasing nanofillers with stable and strong reinforcing fillers is promising to yield a nanocomposite with both stress-bearing and caries-inhibiting capabilities, a combination not yet available in current materials.

Thermal pretreatment of silica composite filler materials

Three different silica filler materials were thermally treated in order to effect dehydration, dehydroxylation, and rehydroxylation. Samples were characterized by thermogravimetry (TG), pycnometry, elemental analysis, and scanning electron microscopy (SEM). For all fillers, our results indicate incremental removal of silanol groups at higher heating temperatures and irreversible dehydroxylation at over 673 K. To remove the organic content and maintain adequate silanol density for subsequent silanization on Stöber-type silica, we suggest heating at 673 K followed by overnight boiling in water.