Novel rechargeable calcium phosphate dental nanocomposite

The demineralization resistance and mechanical assessments of different bioactive restorative materials for primary and permanent teeth: an in vitro study

OBJECTIVES

This article examines the efficacy of two bioactive dental composites in preventing demineralization while preserving their mechanical and physical properties.

MATERIALS AND METHODS

The study compares Beautifil Kids and Predicta® Bioactive Bulk-Fill (Predicta) composites with conventional dental composite. Flexural strength and elastic modulus were evaluated using a universal testing machine. A pH-cycling model assessed the composites' ability to prevent dentin demineralization. Color stability and surface roughness were measured using a spectrophotometer and non-contact profilometer, respectively, before and after pH-cycling, brushing simulation, and thermocycling aging.

RESULTS

Beautifil Kids exhibited the highest flexural strength and elastic modulus among the materials (p < 0.05). Predicta demonstrated the highest increase in dentin surface microhardness following the pH-cycling model (p < 0.05). All groups showed clinically significant color changes after pH-cycling, with no significant differences between them (p > 0.05). Predicta exhibited greater color change after brushing and increased surface roughness after thermocycling aging (p < 0.05). While Beautifil Kids had higher surface roughness after pH-cycling (p < 0.05).

DISCUSSION/CONCLUSION

Bioactive restorative materials with ion-releasing properties demonstrate excellent resistance to demineralization while maintaining mechanical and physical properties comparable to the control group.

Novel pit and fissure sealant with nano-CaF2 and antibacterial monomer: Fluoride recharge, microleakage, sealing ability and cytotoxicity

Conventional resin-based sealants release minimal fluoride ions (F) and lack antibacterial activity. The objectives of this study were to: (1) develop a novel bioactive sealant containing calcium fluoride nanoparticles (nCaF2) and antibacterial dimethylaminohexadecyl methacrylate (DMAHDM), and (2) investigate mechanical performance, F recharge and re-release, microleakage, sealing ability and cytotoxicity. Helioseal F served as commercial control. The initial F release from sealant containing 20% nCaF2 was 25-fold that of Helioseal F. After ion exhaustion and recharge, the F re-release from bioactive sealant did not decrease with increasing number of recharge and re-release cycles. Elastic modulus of new bioactive sealant was 44% higher than Helioseal F. The new sealant had excellent sealing, minimal microleakage, and good cytocompatibility. Hence, the nanostructured sealant had substantial and sustained F release and antibacterial activity, good sealing ability and biocompatibility. The novel bioactive nCaF2 sealant is promising to provide long-term F ions for caries prevention.

New generation of orthodontic devices and materials with bioactive capacities to improve enamel demineralization

OBJECTIVE

The article reviewed novel orthodontic devices and materials with bioactive capacities in recent years and elaborated on their properties, aiming to provide guidance and reference for future scientific research and clinical applications.

DATA, SOURCES AND STUDY SELECTION

Researches on remineralization, protein repellent, antimicrobial activity and multifunctional novel bioactive orthodontic devices and materials were included. The search of articles was carried out in Web of Science, PubMed, Medline and Scopus.

CONCLUSIONS

The new generation of orthodontic devices and materials with bioactive capacities has broad application prospects. However, most of the current studies are limited to in vitro studies and cannot explore the true effects of various bioactive devices and materials applied in oral environments. More research, especially in vivo researches, is needed to assist in clinical application.

CLINICAL SIGNIFICANCE

Enamel demineralization (ED) is a common complication in orthodontic treatments. Prolonged ED can lead to dental caries, impacting both the aesthetics and health of teeth. It is of great significance to develop antibacterial orthodontic devices and materials that can inhibit bacterial accumulation and prevent ED. However, materials with only preventive effect may fall short of addressing actual needs. Hence, the development of novel bioactive orthodontic materials with remineralizing abilities is imperative. The article reviewed the recent advancements in bioactive orthodontic devices and materials, offering guidance and serving as a reference for future scientific research and clinical applications.

Remineralizing effects of hydroxypropyl methylcellulose film-loaded amorphous calcium phosphate nanoprecursors on enamel artificial caries lesions

OBJECTIVES

This study was to investigate hydroxypropyl methylcellulose (HPMC) film as a carrier for amorphous fluorinated calcium phosphate (AFCP) nanoprecursors to continuously deliver biomimetic remineralization of enamel artificial caries lesions (ACL).

MATERIALS AND METHODS

The AFCP/HPMC films were comprised of 25 wt% AFCP nanoparticles and 75 wt% HPMC. They were characterized by transmission electron microscopy (TEM), Fourier transform infrared spectroscopy (FTIR), X-ray diffraction (XRD), X-ray photoelectron spectroscopy (XPS), and biocompatibility tests. Forty enamel ACL were prepared and randomly divided into four groups (n = 10): The enamel surfaces were covered with a pure HPMC film, Tooth Mousse Plus (contains 10% CPP-ACP and 0.2% NaF), and AFCP/HPMC film, or without any things (serving as negative control). Subsequently, all samples were alternatively kept in artificial saliva and a modified pH-cycling before they were characterized by Micro-CT, scanning electron microscopy (SEM), energy-dispersive X-ray spectroscopy (EDX), attenuated total reflectance (ATR)-FTIR, XRD, and nanoindentation.

RESULTS

After the enamel ACL was challenged by pH cycling, Tooth Mousse Plus and AFCP/HPMC film groups exhibited less lesion depth and mineral loss than the negative control and pure HPMC film groups. Additionally, the AFCP/HPMC film group revealed a highest remineralization rate of 55.34 ± 3.10 % among the all groups (p < 0.001). The SEM findings showed that the enamel ACL were densely deposited with minerals in the AFCP/HPMC film group, and the EDX results suggested a higher content of fluorine in the remineralized tissues. In particular, the AFCP/HPMC film group exhibited the best nanomechanical performance after 2 weeks of pH cycling (p < 0.05), with the hardness (H) restored from 0.29 ± 0.19 to 2.69 ± 0.70 GPa, and elastic modulus (Er) restored from 10.77 ± 5.30 to 68.83 ± 12.72 GPa.

CONCLUSION

The AFCP/HPMC film might be used as a promising strategy for arresting or reversing incipient enamel caries lesions.

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

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

In vitro evaluation of a novel fluoride-coated clear aligner with antibacterial and enamel remineralization abilities

OBJECTIVE

To investigate the antibacterial and enamel remineralization performances as well as physicochemical properties and biocompatibility of a fluoride-coated clear aligner plastic (FCAP).

MATERIALS AND METHODS

FCAP and normal clear aligner plastic (CAP) was bought from the manufacturer (Angelalign Technology Inc, China). The FCAP was observed under scanning electron microscopy. Its element composition, resistance to separation, contact angle, and protein adhesion performance were characterized. Colony-forming unit (CFU) count and 3-(4,5)-dimethylthiazol(-z-y1)-3,5-diphenyltetrazolium bromide (MTT) assay were used to evaluate the antibacterial ability of Streptococcus mutans. Fluoride release-recharge patterns were obtained. Apatite formation was evaluated after immersing FCAP in artificial saliva. Enamel remineralization capability was evaluated in the demineralization model (immersing samples in demineralization solution for 36 h) and pH cycling model (immersing samples in demineralization solution and remineralization solution in turns for 14 days). Cell Counting Kit-8 (CCK-8) and live/dead cell staining kits were used for cytotoxicity assay.

RESULTS

The FCAP showed uniformly distributed fluoride and did not compromise protein adhesion performance. CFU count (5.47 ± 0.55 for CAP, 3.63 ± 0.38 for FCAP) and MTT assay (0.41 ± 0.025 for CAP, 0.28 ± 0.038) indicated that the FCAP had stronger antibacterial activity compared with normal CAP (P < 0.05 for both evaluations). The FCAP could release fluoride continuously for 14 days and could be recharged after immersing in NaF solution. The FCAP could induce the formation of hydroxyapatite in artificial saliva and could reduce the microhardness decrease, color change, and mineral loss of enamels in both two models (P < 0.05 for all evaluations). CCK-8 and live/dead cell staining analyses showed that the coating did not compromise the biocompatibility of the clear aligner (P > 0.05 for CCK-8 evaluation).

CONCLUSIONS

The FCAP had antibacterial, fluoride recharge, and enamel remineralization abilities while it did not compromise physicochemical properties and biocompatibility.

CLINICAL RELEVANCE

The FCAP has the potential to prevent enamel demineralization during clear aligner treatment.

Influence of the Type of Nanofillers on the Properties of Composites Used in Dentistry and 3D Printing

Photopolymerization is a growing field with an extensive range of applications and is environmentally friendly owing to its energy-efficient nature. Such light-assisted curing methods were initially used to cure the coatings. However, it has become common to use photopolymerization to produce 3D objects, such as bridges or dental crowns, as well as to cure dental fillings. In this study, polymer nanocomposites containing inorganic nanofillers (such as zinc nano-oxide and zinc nano-oxide doped with two wt.% aluminum, titanium nano-oxide, kaolin nanoclay, zirconium nano-oxide, aluminum nano-oxide, and silicon nano-oxide) were fabricated and studied using Real Time FT-IR to investigate the effects of these nanoadditives on the final conversion rates of the obtained nanocomposites. The effects of the fillers on the viscosity of the produced nanocomposites were also investigated, and 3D prints of the selected nanocomposites were presented.

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

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

Effect of Zinc Oxide Incorporation on the Antibacterial, Physicochemical, and Mechanical Properties of Pit and Fissure Sealants

This study aimed to evaluate the antibacterial, physicochemical, and mechanical properties of pit and fissure sealants containing different weight percentages of zinc oxide nanoparticles (ZnO NPs). The following amounts of ZnO NPs were added to a commercially available pit and fissure sealant (BeautiSealant, Shofu, Japan) to prepare the experimental materials: 0 wt.% (commercial control (CC)), 0.5 wt.% (ZnO 0.5), 1 wt.% (ZnO 1.0), 2 wt.% (ZnO 2.0), and 4 wt.% (ZnO 4.0). The antibacterial effect against S. mutans was confirmed by counting the colony-forming units (CFUs) and observing live/dead bacteria. In addition, ion release, depth of cure, water sorption and solubility, and flexural strength tests were conducted. When compared with the CC, the experimental groups containing ZnO NPs showed zinc ion emission and significantly different CFUs (p < 0.05) with fewer live bacteria. ZnO NP addition reduced the depth of cure and water solubility and increased water sorption in comparison with the CC (p < 0.05). However, all groups showed similar flexural strength (p > 0.05). The pit and fissure sealants containing ZnO NPs exhibited antibacterial activity against S. mutans with no negative effects on physicochemical and mechanical properties, and thus, these sealants can be ideal secondary caries prevention material.

Ceramic Nanomaterials in Caries Prevention: A Narrative Review

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

Bioactive Inorganic Materials for Dental Applications: A Narrative Review

Over time, much attention has been given to the use of bioceramics for biomedical applications; however, the recent trend has been gaining traction to apply these materials for dental restorations. The bioceramics (mainly bioactive) are exceptionally biocompatible and possess excellent bioactive and biological properties due to their similar chemical composition to human hard tissues. However, concern has been noticed related to their mechanical properties. All dental materials based on bioactive materials must be biocompatible, long-lasting, mechanically strong enough to bear the masticatory and functional load, wear-resistant, easily manipulated, and implanted. This review article presents the basic structure, properties, and dental applications of different bioactive materials i.e., amorphous calcium phosphate, hydroxyapatite, tri-calcium phosphate, mono-calcium phosphate, calcium silicate, and bioactive glass. The advantageous properties and limitations of these materials are also discussed. In the end, future directions and proposals are given to improve the physical and mechanical properties of bioactive materials-based dental materials.

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

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

Synthesis and characterization of arabinoxylan-bis[2-(methacryloyloxy)ethyl] phosphate crosslinked copolymer network by high energy gamma radiation for use in controlled drug delivery applications

Keeping in view the therapeutic important dietary fiber psyllium, herein this research report its potential has been explored for the formation of sterile hydrogel by high energy radiation induced copolymerization of arabinoxylan-poly bis[2-(methacryloyloxy)ethyl] phosphate (BMEP) for use as drug delivery carrier. The polymeric network structure was characterized by ¹³C NMR, FTIR, TGA/DTG and DSC, XRD and AFM techniques. Release profile of a drug cefuroxime and best fit kinetic model were determined. The blood -polymer interaction, mucosal-polymer adhesion, antioxidant and mechanical properties were also evaluated. The radiation dose influenced the crosslink density and the mesh size of the hydrogel network. Release profile of a drug cefuroxime followed non-Fickian diffusion and best fitted to first order kinetic model. The grafted product was sterile, porous, antioxidant and mucoadhesive in nature and could be explored for controlled and sustained GIT drug delivery applications.

Novel rechargeable calcium fluoride dental nanocomposites

OBJECTIVES

Composite restorations with calcium fluoride nanoparticles (nCaF₂) can remineralize tooth structure through F and Ca ion release. However, the persistence of ion release is limited. The objectives for this study were to achieve long-term remineralization by developing a rechargeable nCaF₂ nanocomposite and investigating the F and Ca recharge and re-release capabilities.

METHODS

Three nCaF₂ nanocomposites were formulated: (1) BT-nCaF₂:Bisphenol A glycidyl dimethacrylate (BisGMA) and triethylene glycol dimethacrylate (TEGDMA); (2) PE-nCaF₂:Pyromellitic glycerol dimethacrylate (PMGDM) and ethoxylated bisphenol A dimethacrylate (EBPADMA); (3) BTM-nCaF₂:BisGMA, TEGDMA, and Bis[2-(methacryloyloxy)ethyl] phosphate (Bis-MEP). All formulations contained 15% nCaF₂ and 55% glass particles. Initial flexural strength and elastic modulus, F and Ca ion release, recharge and re-release were tested and compared to three commercial fluoride-containing materials.

RESULTS

BT and BTM nCaF₂ composites were 3-4 times stronger and had elastic modulus 2 times that of resin-modified glass ionomer controls. PE-nCaF₂ had comparable strength to RMGIs. All nCaF₂ composites had significant F and Ca ion release and ion rechargeability. In F and Ca recharging cycles, PE-nCaF₂ had the highest ion recharging capability among nCaF₂ groups, followed by BT-nCaF₂ and BTM-nCaF₂ (p < 0.05). For all recharge cycles, ion release maintained similar levels, demonstrating long-term ion release was possible. Furthermore, after the final recharge cycle, nCaF₂ nanocomposites provided continuous ion release for 42 days without further recharge.

SIGNIFICANCE

Novel nCaF₂ rechargeable nanocomposites exhibited significant F and Ca ion release over multiple recharge cycles, demonstrating continuous long-term ion release. These nanocomposites are promising restorations with lasting remineralization potential.

Size Dependence of Particulate Calcium Phosphate Fillers in Dental Resin Composites

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

Metal and Metal Oxide Nanoparticles in Caries Prevention: A Review

Nanoparticles based on metal and metallic oxide have become a novel trend for dental use as they interfere with bacterial metabolism and prevent biofilm formation. Metal and metal oxide nanoparticles demonstrate significant antimicrobial activity by metal ion release, oxidative stress induction and non-oxidative mechanisms. Silver, zinc, titanium, copper, and magnesium ions have been used to develop metal and metal oxide nanoparticles. In addition, fluoride has been used to functionalise the metal and metal oxide nanoparticles. The fluoride-functionalised nanoparticles show fluoride-releasing properties that enhance apatite formation, promote remineralisation, and inhibit demineralisation of enamel and dentine. The particles' nanoscopic size increases their surface-to-volume ratio and bioavailability. The increased surface area facilitates their mechanical bond with tooth tissue. Therefore, metal and metal oxide nanoparticles have been incorporated in dental materials to strengthen the mechanical properties of the materials and to prevent caries development. Another advantage of metal and metal oxide nanoparticles is their easily scalable production. The aim of this study is to provide an overview of the use of metal and metal oxide nanoparticles in caries prevention. The study reviews their effects on dental materials regarding antibacterial, remineralising, aesthetic, and mechanical properties.

Multifunctional Dental Composite with Piezoelectric Nanofillers for Combined Antibacterial and Mineralization Effects

After nearly seven decades of development, dental composite restorations continue to show limited clinical service. The triggering point for restoration failure is the degradation of the bond at the tooth-biomaterial interface from chemical, biological, and mechanical sources. Oral biofilms form at the bonded interfaces, producing enzymes and acids that demineralize hard tissues and damage the composite. Removing bacteria from bonded interfaces and remineralizing marginal gaps will increase restorations' clinical service. To address this need, we propose for the first time the use of piezoelectric nanoparticles of barium titanate (BaTiO₃) as a multifunctional bioactive filler in dental resin composites, offering combined antibacterial and (re)mineralization effects. In this work, we developed and characterized the properties of dental piezoelectric resin composites, including the degree of conversion and mechanical and physical properties, for restorative applications. Moreover, we evaluated the antibacterial and mineralization responses of piezoelectric composites in vitro. We observed a significant reduction in biofilm growth (up to 90%) and the formation of thick and dense layers of calcium phosphate minerals in piezoelectric composites compared to control groups. The antibacterial mechanism was also revealed. Additionally, we developed a unique approach evaluating the bond strength of dentin-adhesive-composite interfaces subjected to simultaneous attacks from bacteria and cyclic mechanical loading operating in synergy. Our innovative bioactive multifunctional composite provides an ideal technology for restorative applications using a single filler with combined long-lasting nonrechargeable antibacterial/remineralization effects.

Dentin remineralization in acidic solution without initial calcium phosphate ions via poly(amido amine) and calcium phosphate nanocomposites after fluid challenges

OBJECTIVES

A previous study showed that the combination of poly(amido amine) (PAMAM) and rechargeable composites with nanoparticles of amorphous calcium phosphate (NACP) induced dentin remineralization in an acidic solution with no initial calcium (Ca) and phosphate (P) ions, mimicking the oral condition of individuals with dry mouths. However, the frequent fluid challenge in the oral cavity may decrease the remineralization capacity. Therefore, the objective of the present study was to investigate the remineralization efficacy on dentin in an acid solution via PAMAM + NACP after fluid challenges for the first time.

METHODS

The NACP nanocomposite was stored in a pH 4 solution for 77 days to exhaust its Ca and P ions and then recharged. Demineralized dentin samples were divided into four groups: (1) control dentin, (2) dentin coated with PAMAM, (3) dentin with recharged NACP composite, and (4) dentin with PAMAM + recharged NACP. PAMAM-coated dentin was shaken in phosphate-buffered saline for 77 days to desorb PAMAM from dentin. Samples were treated in pH 4 lactic acid with no initial Ca and P ions for 42 days.

RESULTS

After 77 days of fluid challenge, PAMAM failed to prevent dentin demineralization in lactic acid. The recharged NACP nanocomposite raised the pH to above 6.5 and re-released more than 6.0 and 4.0 mmol/L Ca and P ions daily, respectively, which inhibited further demineralization. In contrast, the PAMAM + NACP combined method induced great dentin remineralization and restored the dentin microhardness to 0.54 ± 0.04 GPa, which approached that of sound dentin (P = 0.426, P > 0.05).

CONCLUSIONS

The PAMAM + NACP combination achieved dentin remineralization in an acid solution with no initial Ca and P ions, even after severe fluid challenges.

CLINICAL RELEVANCE

The novel PAMAM + NACP has a strong and sustained remineralization capability to inhibit secondary caries, even for individuals with dry mouths.

Recent Advances in the Development of Antimicrobial and Antifouling Biocompatible Materials for Dental Applications

The risk of secondary bacterial infections resulting from dental procedures has driven the design of antimicrobial and antifouling dental materials to curb pathogenic microbial growth, biofilm formation and subsequent oral and dental diseases. Studies have investigated approaches based primarily on contact-killing or release-killing materials. These materials are designed for addition into dental resins, adhesives and fillings or as immobilized coatings on tooth surfaces, titanium implants and dental prosthetics. This review discusses the recent developments in the different classes of biomaterials for antimicrobial and antifouling dental applications: polymeric drug-releasing materials, polymeric and metallic nanoparticles, polymeric biocides and antimicrobial peptides. With modifications to improve cytotoxicity and mechanical properties, contact-killing and anti-adhesion materials show potential for incorporation into dental materials for long-term clinical use as opposed to short-lived antimicrobial release-based coatings. However, extended durations of biocompatibility testing, and adjustment of essential biomaterial features to enhance material longevity in the oral cavity require further investigations to confirm suitability and safety of these materials in the clinical setting. The continuous exposure of dental restorative and regenerative materials to pathogenic microbes necessitates the implementation of antimicrobial and antifouling materials to either replace antibiotics or improve its rational use, especially in the day and age of the ever-increasing problem of antimicrobial resistance.

Recent Progress in Antimicrobial Strategies for Resin-Based Restoratives

Repairing tooth defects with dental resin composites is currently the most commonly used method due to their tooth-colored esthetics and photocuring properties. However, the higher than desirable failure rate and moderate service life are the biggest challenges the composites currently face. Secondary caries is one of the most common reasons leading to repair failure. Therefore, many attempts have been carried out on the development of a new generation of antimicrobial and therapeutic dental polymer composite materials to inhibit dental caries and prolong the lifespan of restorations. These new antimicrobial materials can inhibit the formation of biofilms, reduce acid production from bacteria and the occurrence of secondary caries. These results are encouraging and open the doors to future clinical studies on the therapeutic value of antimicrobial dental resin-based restoratives. However, antimicrobial resins still face challenges such as biocompatibility, drug resistance and uncontrolled release of antimicrobial agents. In the future, we should focus on the development of more efficient, durable and smart antimicrobial dental resins. This article focuses on the most recent 5 years of research, reviews the current antimicrobial strategies of composite resins, and introduces representative antimicrobial agents and their antimicrobial mechanisms.

Phosphate Ion Release and Alkalizing Potential of Three Bioactive Dental Materials in Comparison with Composite Resin

Aim

Several new bioactive compounds were recently introduced to the market with favorable ion release, tooth remineralization, and alkalizing potential. This study sought to compare the phosphate ion release and alkalizing potential of three bioactive materials in comparison with composite resin.

Methods

Thirty-six discs (2 × 6 mm) were fabricated from Fuji II LC resin modified glass ionomer (RMGI), Activa BioActive, Cention N, and Z250 composite in plastic molds. The specimens were stored in distilled water for 24 and 48 h and 6 months. Half of the specimens were used to assess the phosphate ion release while the other half were used to assess the alkalizing potential 1 h after pH drop from 6.8 to 4. Phosphate ion release was quantified by a spectrophotometer while the pH value was measured by a pH meter. Data were analyzed using two-way ANOVA, one-way ANOVA, and Tukey's HSD test (for pairwise comparisons) at 0.05 level of significance.

Results

At 24 h, the maximum phosphate ion release in distilled water occurred in the Fuji II LC group followed by Cention N, Activa BioActive, and Z250. At 6 months, Cention N followed by Activa BioActive showed higher phosphate ion release than Fuji II LC and Z250. No significant difference was noted between Activa BioActive and Cention N at any time point. All materials, except for Z250, increased the pH of the environment. Fuji II LC had maximum alkalizing effect at all time points followed by Cention N and Activa BioActive.

Conclusion

Use of bioactive compounds is a promising method to ensure phosphate ion release, and can have a positive effect on tooth remineralization over time. Also, bioactive compounds can alkalize an acidic environment.

Dental Restorative Materials for Elderly Populations

The incidence of dental caries, especially root caries, has risen in elderly populations in recent years. Specialized restorative materials are needed due to the specific site of root caries and the age-related changes in general and oral health in the elderly. Unfortunately, the restorative materials commonly used clinically cannot fully meet the requirements in this population. Specifically, the antibacterial, adhesive, remineralization, mechanical, and anti-aging properties of the materials need to be significantly improved for dental caries in the elderly. This review mainly discusses the strengths and weaknesses of currently available materials, including amalgam, glass ionomer cement, and light-cured composite resin, for root caries. It also reviews the studies on novel anti-caries materials divided into three groups, antimicrobial, remineralization, and self-healing materials, and explores their potential in the clinical use for caries in the elderly. Therefore, specific restorative materials for caries in the elderly, especially for root caries, need to be further developed and applied in clinical practice.

Functional fillers for dental resin composites

Dental resin composites (DRCs) are popular materials to repair caries. Although various types of DRCs with different characteristics have been developed, restoration failures still exist. Bulk fracture and secondary caries have been considered as main causes for the failure of composites restoration. To address these problems, various fillers with specific functions have been introduced and studied. Some fillers with specific morphologies such as whisker, fiber, and nanotube, have been used to increase the mechanical properties of DRCs, and other fillers releasing ions such as Ag⁺, Ca²⁺, and F^-, have been used to inhibit the secondary caries. These functional fillers are helpful to improve the performances and lifespan of DRCs. In this article, we firstly introduce the composition and development of DRCs, then review and discuss the functional fillers classified according to their roles in the DRCs, finally give a summary on the current research and predict the trend of future development.

Review of nano-technology applications in resin-based restorative materials

OBJECTIVE

Nanotechnology has progressed significantly and particles as small as 3 nm are being employed in resin-based restorative materials to improve clinical performance. The goal of this review is to report the progress of nanotechnology in Restorative Dentistry by reviewing the advantages, limitations, and applications of resin-based restorative materials with nanoparticles.

MATERIALS AND METHODS

A literature review was conducted using PubMed/Medline, Scopus and Embase databases. In vitro, in vivo and in situ research studies published in English between 1999 and 2020, and which focused on the analysis of resin-based restorative materials containing nanoparticles were included.

RESULTS

A total of 140 studies were included in this review. Studies reported the effect of incorporating different types of nanoparticles on adhesive systems or resin composites. Mechanical, physical, and anti-bacterial properties were described. The clinical performance of resin-based restorative materials with nanoparticles was also reported.

CONCLUSIONS

The high surface area of nanoparticles exponentially increases the bioactivity of materials using bioactive nanofillers. However, the tendency of nanoparticles to agglomerate, the chemical instability of the developed materials and the decline of rheological properties when high ratios of nanoparticles are employed are some of the obstacles to overcome in the near future.

CLINICAL SIGNIFICANCE

In spite of the recent advancements of nanotechnology in resin-based restorative materials, some challenges need to be overcome before new nano-based restorative materials are considered permanent solutions to clinical problems.

Monomer conversion, biaxial flexural strength, apatite forming ability of experimental dual-cured and self-adhesive dental composites containing calcium phosphate and nisin

The aim was to develop dual-cured, self-adhesive composites containing monocalcium phosphate monohydrate (MCPM, 8 or 4 wt%) and nisin (6 or 3 wt%) with added adhesive monomer. The effect of additives on monomer conversion (MC), biaxial flexural strength (BFS), dentin shear bond strength (SBS), and surface apatite formation were examined. All experimental composites showed light-activated MC (70-75%) higher than the commercial self-adhesive composite (Vertise Flow; VF, 65%). The additives reduced BFS of the composites from 217 to 133 MPa. SBS of the experimental composites (2-6 MPa) was lower than that of VF (12 MPa). Rising MCPM level enabled apatite-like crystals precipitated on the surface of composites after immersion in simulated body fluid for 4 weeks. The additives showed negligible effect on MC and SBS. Rising level of additives reduced strength of the composites but the values were still higher than that required by the standard.

Ion release and recharge from a fissure sealant containing amorphous calcium phosphate

To assess- the release of calcium and phosphate ions from a fissure sealant containing amorphous calcium phosphate (ACP), and to determine the re-release capacity of these ions when charged with a solution containing casein phosphopeptide-amorphous calcium phosphate (CPP-ACP). Nine blocks of ACP resin-based sealant were prepared and immersed in three solutions at different pH (4.0, 5.5, 7.0), and calcium and phosphate ion release was measured with ion chromatography at 1, 3, 5, 7, 14, 21 and 28 days after immersion. Sixty days after immersion, each block was charged with CPP-ACP solution in three 7-day cycles to investigate the re-release of these ions, which was measured on days 1, 3, and 7. No difference was observed in initial calcium ion release at pH 4.0 and pH 5.5. At both values, ion release was significantly higher than at pH 7.0 (p<0.001). Initial phosphate release was significantly different among the three pH values (p<0.001). After re-charging the specimens, calcium ion re-release was greater than phosphate ion release. Initial ion release from ACP resin-based sealant was greatest at the lowest pH. Ion release decreased with time. As the number of recharge cycles increased, ion re-release also improved. Phosphate ion re-release required more recharge cycles than calcium ion re-release.

Nanotechnology in dentistry: Present and future perspectives on dental nanomaterials

OBJECTIVES

The number of dental nanomaterials has increased significantly over the past years. A variety of commercial dental nanomaterials are available and researched. Nevertheless, how these nanomaterials work, what makes them special and whether they are superior to traditional dental materials is not always clear to dentists and researchers. The objective of this review paper is, therefore, to give an overview of the principles of nanomaterials and basic research and applications of dental nanomaterials.

METHODS

The fundamentals of materials science of nanomaterials as well as their advantages and disadvantages are elaborated. The most important dental nanomaterials are discussed. This is mainly based on a survey of the literature and a review of the most frequently cited scientific papers in the international peer reviewed journal Dental Materials over the past five years. The developments of commercial dental nanomaterials as well as aspects of their clinical use are considered in this review.

RESULTS

Nanomaterials have unique structures and properties that distinguish them from other materials. The journal Dental Materials is the journal with the highest numbers of articles and citations on the subject of dental nanomaterials. The most frequently reported dental nanomaterials are nanocomposites, nanoparticles, antimicrobial nanomaterials and bio-mineralization systems. Hallmarks of dental nanomaterials include a set of unique properties and challenges in the preparation of these materials.

SIGNIFICANCE

By understanding the physical principles of dental nanomaterials, their strengths, limitations and their specific benefits will be better appreciated. Dental nanomaterials have potential for the future but currently do not always exhibit superior properties, for example in clinical situations.

Advances of Anti-Caries Nanomaterials

Caries is the most common and extensive oral chronic disease. Due to the lack of anti-caries properties, traditional caries filling materials can easily cause secondary caries and lead to treatment failure. Nanomaterials can interfere with the bacteria metabolism, inhibit the formation of biofilm, reduce demineralization, and promote remineralization, which is expected to be an effective strategy for caries management. The nanotechnology in anti-caries materials, especially nano-adhesive and nano-composite resin, has developed fast in recent years. In this review, the antibacterial nanomaterials, remineralization nanomaterials, and nano-drug delivery systems are reviewed. We are aimed to provide a theoretical basis for the future development of anti-caries nanomaterials.

Bioactive low-shrinkage-stress nanocomposite suppresses S. mutans biofilm and preserves tooth dentin hardness

Recurrent dental caries is one of the main reasons for resin composite restoration failures. This study aimed to: (1) develop a bioactive, low-shrinkage-stress, antibacterial and remineralizing composite and evaluate the sustainability of its antibacterial effect against Streptococcus mutans (S. mutans) biofilms; and (2) evaluate the remineralization and cariostatic potential of the composite containing nanoparticles of amorphous calcium phosphate (NACP) and dimethylaminohexadecyl methacrylate (DMAHDM), using dentin hardness measurement and a biofilm-induced recurrent caries model. The antibacterial and remineralizing low-shrinkage-stress composite consisted of urethane dimethacrylate (UDMA) and triethylene glycol divinylbenzyl ether (TEG-DVBE), 3% DMAHDM and 20% NACP. S. mutans biofilm was used to evaluate antibiofilm activity, before and after 3 months of composite aging in acidic solution. Human dentin was used to develop a recurrent caries biofilm-model. Adding DMAHDM and NACP into low shrinkage-stress composite did not compromise the flexural strength. The low-shrinkage-stress composite with DMAHDM achieved substantial reductions in biofilm colony-forming units (CFU), lactic acid production, and biofilm biomass (p < 0.05). The low-shrinkage-stress DMAHDM+NACP composite exhibited no significant difference in antibacterial performance before and after 3 months of aging, demonstrating long-term antibacterial activity. Under S. mutans biofilm acidic attack, dentin hardness (GPa) was 0.24 ± 0.04 for commercial control, and 0.23 ± 0.03 for experimental control, but significantly higher at 0.34 ± 0.03 for DMAHDM+NACP group (p < 0.05). At an instrumental compliance of 0.33 μm/N, the polymerization shrinkage stress of the new composite was 36% lower than that of a traditional composite (p < 0.05). The triple strategy of antibacterial, remineralization and lower shrinkage-stress has great potential to inhibit recurrent caries and increase restoration longevity. Statement of Significance Polymerization shrinkage stress, masticatory load over time as well as biochemical degradation can lead to marginal failure and secondary caries. The present study developed a new low-shrinkage-stress, antibacterial and remineralizing dental nanocomposite. Polymerization shrinkage stress was greatly reduced, biofilm acid production was inhibited, and tooth dentin mineral and hardness were preserved. The antibacterial composite possessed a long-lasting antibiofilm effect against cariogenic bacteria S. mutans. The new bioactive nanocomposite has the potential to suppress recurrent caries at the restoration margins, protects tooth structures, and increases restoration longevity.

Novel Nanocomposite Inhibiting Caries at the Enamel Restoration Margins in an In Vitro Saliva-Derived Biofilm Secondary Caries Model

Secondary caries often occurs at the tooth-composite margins. This study developed a novel bioactive composite containing DMAHDM (dimethylaminohexadecyl methacrylate) and NACP (nanoparticles of amorphous calcium phosphate), inhibiting caries at the enamel restoration margins in an in vitro saliva-derived biofilm secondary caries model for the first time. Four composites were tested: (1) Heliomolar nanocomposite, (2) 0% DMAHDM + 0% NACP, (3) 3% DMAHDM + 0% NACP, (D) 3% DMAHDM + 30% NACP. Saliva-derived biofilms were tested for antibacterial effects of the composites. Bovine enamel restorations were cultured with biofilms, Ca and P ion release of nanocomposite and enamel hardness at the enamel restoration margins was measured. Incorporation of DMAHDM and NACP into composite did not affect the mechanical properties (p > 0.05). The biofilms’ CFU (colony-forming units) were reduced by 2 logs via DMAHDM (p < 0.05). Ca and P ion release of the nanocomposite was increased at cariogenic low pH. Enamel hardness at the margins for DMAHDM group was 25% higher than control (p < 0.05). With DMAHDM + NACP, the enamel hardness was the greatest and about 50% higher than control (p < 0.05). Therefore, the novel composite containing DMAHDM and NACP was strongly antibacterial and inhibited enamel demineralization, resulting in enamel hardness at the margins under biofilms that approached the hardness of healthy enamel.

In vitro evaluation of composite containing DMAHDM and calcium phosphate nanoparticles on recurrent caries inhibition at bovine enamel-restoration margins

OBJECTIVE

Recurrent caries is a primary reason for restoration failure caused by biofilm acids. The objectives of this study were to: (1) develop a novel multifunctional composite with antibacterial function and calcium (Ca) and phosphate (P) ion release, and (2) investigate the effects on enamel demineralization and hardness at the margins under biofilms.

METHODS

Dimethylaminohexadecyl methacrylate (DMAHDM) and nanoparticles of amorphous calcium phosphate (NACP) were incorporated into composite. Four groups were tested: (1) Commercial control (Heliomolar), (2) Experimental control (0% DMAHDM + 0% NACP), (3) antibacterial group (3% DMAHDM + 0% NACP), (D) antibacterial and remineralizing group (3% DMAHDM + 30% NACP). Mechanical properties and Ca and P ion release were measured. Colony-forming units (CFU), lactic acid and polysaccharide of Streptococcus mutans (S. mutans) biofilms were evaluated. Demineralization of bovine enamel with restorations was induced via S. mutans, and enamel hardness was measured. Data were analyzed via one-way and two-way analyses of variance and Tukey's multiple comparison tests.

RESULTS

Adding DMAHDM and NACP into composite did not compromise the mechanical properties (P > 0.05). Ca and P ion release of 3% DMAHDM + 30% NACP was increased at cariogenic low pH. Biofilm lactic acid and polysaccharides were greatly decreased via DMAHDM, and CFU was reduced by 4 logs (P < 0.05). Under biofilm acids, enamel hardness at the margins was decreased to about 0.5 GPa for control; it was about 1 GPa for antibacterial group, and 1.3 GPa for antibacterial and remineralizing group (P < 0.05).

CONCLUSIONS

The novel 3% DMAHDM + 30% NACP composite had strong antibacterial effects. It substantially reduced enamel demineralization adjacent to restorations under biofilm acid attacks, yielding enamel hardness that was 2-fold greater than that of control composites. The novel multifunctional composite is promising to inhibit recurrent caries.

Use of Protein Repellents to Enhance the Antimicrobial Functionality of Quaternary Ammonium Containing Dental Materials

An advancement in preventing secondary caries has been the incorporation of quaternary ammonium containing (QAC) compounds into a composite resin mixture. The permanent positive charge on the monomers allows for electrostatic-based killing of bacteria. Spontaneous adsorption of salivary proteins onto restorations dampens the antimicrobial capabilities of QAC compounds. Protein-repellent monomers can work with QAC restorations to achieve the technology's full potential. We discuss the theory behind macromolecular adsorption, direct and indirect characterization methods, and advances of protein repellent dental materials. The translation of protein adsorption to microbial colonization is covered, and the concerns and fallbacks of the state-of-the-art protein-resistant monomers are addressed. Last, we present new and exciting avenues for protein repellent monomer design that have yet to be explored in dental materials.

Novel low-shrinkage-stress nanocomposite with remineralization and antibacterial abilities to protect marginal enamel under biofilm

OBJECTIVES

Polymerization shrinkage stress may lead to marginal damage, microleakage and failure of composite restorations. The objectives of this study were to : (1) develop a novel nanocomposite with low-shrinkage-stress, antibacterial and remineralization properties to reduce marginal enamel demineralization under biofilms; (2) evaluate the mechanical properties of the composite and calcium (Ca) and phosphate (P) ion release; and (3) investigate the cytotoxicity of the new low-shrinkage-stress monomer in vitro.

METHODS

The low-shrinkage-stress resin consisted of urethane dimethacrylate (UDMA) and triethylene glycol divinylbenzyl ether (TEG-DVBE), and 3 % dimethylaminohexadecyl methacrylate (DMAHDM) and 20 % calcium phosphate nanoparticles (NACP) were added. Mechanical properties, polymerization shrinkage stress, and degree of conversion were evaluated. The growth of Streptococcus mutans (S. mutans) on enamel slabs with different composites was assessed. Ca and P ion releases and monomer cytotoxicity were measured.

RESULTS

Composite with DMAHDM and NACP had flexural strength of 84.9 ± 10.3 MPa (n = 6), matching that of a commercial control composite. Adding 3 % DMAHDM did not negatively affect the composite ion release. Under S. mutans biofilm, the marginal enamel hardness was 1.2 ± 0.1 GPa for the remineralizing and antibacterial group, more than 2-fold the 0.5 ± 0.07 GPa for control (p < 0.05). The polymerization shrinkage stress of the new composite was 40 % lower than that of traditional composite control (p < 0.05). The new monomers had fibroblast viability similar to that of traditional monomer control (p > 0.1).

CONCLUSION

A novel low-shrinkage-stress nanocomposite was developed with remineralizing and antibacterial properties. This new composite is promising to inhibit recurrent caries at the restoration margins by reducing polymerization stress and protecting enamel hardness.

Prevention of Secondary Caries Using Resin-Based Pit and Fissure Sealants Containing Hydrated Calcium Silicate

The objective of this study was to investigate the effects of hydrated calcium silicate filler (hCS) on resin-based pit and fissure sealants' acid neutralization, calcium ion release, and mechanical and physical properties. To produce the hCS filler, Portland cement (CS) was mixed with distilled water and ground into fine particles. The particles were then mixed with silanized glass filler and added to a photo-activated resin matrix. To evaluate the acid neutralization and calcium ion release properties, the specimens were immersed in a pH 4.0 lactic acid solution and distilled water for 28 days. Also, the flexural strength, depth of cure, water sorption, and solubility were tested. All of the groups containing hCS and CS required less than one minute to increase the pH from 4.0 to 5.5. With 50% hCS, the calcium ion release was higher than 50% CS in the distilled water at the initial time. The flexural strength and depth of cure decreased according to the increasing proportion of hCS added. The water sorption and solubility had an increasing trend as increasing proportions of hCS were added. These findings showed that pit and fissure sealant containing hCS exhibit superior acid neutralization and calcium release properties, and may be promising for caries-inhibiting dental material.

Fabrication and characterization of remineralizing dental composites containing hydroxyapatite nanoparticles

The aim of this study was to fabricate and characterize dental composites containing hydroxyapatite nanoparticles (HApNPs). Four dental composites were produced from the same organic matrix (70 wt% Bis-GMA and 30 wt% TEGDMA), with partial replacement of BaBSi particles (65 wt%) by HApNPs in the following concentrations (wt%): E0 (0) - control, E10 (10), E20 (20) and E30 (30). Ca²⁺ and PO₄^3- release was evaluated in solutions with different pHs (4, 5.5, and 7) using atomic emission spectroscopy with microwave-induced nitrogen plasma while the enamel remineralization potential was evaluated in caries-like enamel lesions induced by S. mutans biofilm using micro-CT. The following properties were characterized: degree of conversion (DC%), microhardness (KHN), flexural strength (FS), elastic modulus (EM) and translucency (TP). The higher the HApNPs content, the higher the Ca²⁺ and PO₄^3- release. The ions release was influenced by pH (4 > 5.5 > 7) (p < 0.05). All composites loaded with HApNPs were able to remineralize the enamel (E30 = E20 > E10) (p < 0.05). Contrarily, E0 was not able of recovering the enamel mineral loss. E0 and E10 presented highest DC%, while E20 and E30 showed similar and lowest DC%. KHN and FS were decreased with the addition of HApNPs, while EM was not influenced by the incorporation of HApNPs. E10 presented statistically similar TP to E0, while this property decreased for E20 and E30 (p < 0.05). Incorporation of HApNPs into dental composites promoted enamel remineralization, mainly at potentially cariogenic pH (= 4), while maintained their overall performance in terms of physicomechanical properties.

Novel antibacterial calcium phosphate nanocomposite with long-term ion recharge and re-release to inhibit caries

Short-term studies on calcium-phosphate (CaP) ion-rechargeable composites were reported. The long-term rechargeability is important but unknown. The objectives of this study were to investigate nanocomposite with strong antibacterial and ion-recharge capabilities containing dimethylaminododecyl methacrylate (DMAHDM) and nanoparticles of amorphous calcium phosphate (NACP), and evaluate long-term ion-recharge by testing for 12 cycles (taking 6 months to complete) for the first time. Three groups were tested: (1) Heliomolar control; (2) Resin+20%NACP+50%glass; (3) Resin+3%DMAHDM+20%NACP+50%glass. Biofilm acid and colony-forming units (CFU) were measured. Ion-recharge was tested for 12 cycles. NACP-DMAHDM composite reduced biofilm acid, and reduced CFU by 4 logs. High levels of ion releases were maintained throughout 12 cycles of recharge, maintaining steady-state releases without reduction in 6 months (p>0.1), representing long-term remineralization potential. Bioactive nanocomposite demonstrated long-term ion-rechargeability for the first time, showed remineralization and potent anti-biofilm functions, with promise for tooth restorations to combat caries.

High-Performance Dental Adhesives Containing an Ether-Based Monomer

Dental adhesives are vital for the success of dental restorations. The objective of this study is to make strong and durable dental adhesives that are free from 2 symbolic methacrylate-based dental resins-2-bis[4-(2-hydroxy-3-methacryl-oxypropoxy)-phenyl]-propane (Bis-GMA) and 2-hydroxyethyl-methacrylate (HEMA)-and have equivalent/improved bonding strength and durability. We formulated, prepared, and evaluated 2 dental adhesives using mixtures of a hydrolytically stable ether-based monomer, triethylene glycol divinylbenzyl ether (TEG-DVBE), with urethane dimethacrylate (UDMA) or pyromellitic glycerol dimethacrylate. These adhesives were composed of equimolar ester-/ether-based vinyl functional groups. They were compared with Bis-GMA/HEMA-based commercial and experimental dental adhesives in terms of shear bond strength and microtensile bond strength (µTBS) to human dentin and the µTBS bond stability under extended thermocycling challenges. In addition, the resins' infiltration to dentin tubules, mechanical performance, and chemical properties were assessed by scanning electron microscopy, ISO standard flexural strength and modulus measurements, contact angle measurements, and water sorption/solubility measurements. The hybrid TEG-DVBE-containing dental adhesives generated equivalent shear bond strength and µTBS in comparison with the controls. Significantly, these adhesives outperformed the controls after being challenged by 10,000 thermocycles between 5 °C and 55 °C. Water contact angle measurements suggested that the hybrid dental adhesives were relatively more hydrophobic than the Bis-GMA/HEMA controls. However, both TEG-DVBE-containing adhesives developed more and deeper resin tags in dentin tubules and formed thicker hybrid layers at the composite-dentin interface. Furthermore, the water solubility of UDMA/TEG-DVBE resins was reduced approximately 89% in comparison with the Bis-GMA/HEMA controls. The relatively hydrophobic adhesives that achieved equivalent/enhanced bonding performance suggest great potentials in developing dental restoration with extended service life. Furthermore, the TEG-DVBE-containing materials may find wider dental applications and broader utility in medical device development.

Novel metformin-containing resin promotes odontogenic differentiation and mineral synthesis of dental pulp stem cells

This represents the first report on the development of metformin-containing dental resins. The objectives were to use the resin as a carrier to deliver metformin locally to stimulate dental cells for dental tissue regeneration and to investigate the effects on odontogenic differentiation of dental pulp stem cells (DPSCs) and mineral synthesis. Metformin was incorporated into a resin at 20% by mass as a model system. DPSC proliferation attaching on resins was evaluated. Dentin sialophosphoprotein (DSPP), dentin matrix phosphoprotein 1 (DMP-1), alkaline phosphatase (ALP), and runt-related transcription factor 2 (Runx2) genes expressions were measured. ALP activity and alizarin red staining (ARS) of mineral synthesis by the DPSCs on resins were determined. DPSCs on metformin-containing resin proliferated well (mean ± SD; n = 6), and the number of cells increased by 4-fold from 1 to 14 days (p > 0.1). DSPP, ALP, and DMP-1 gene expressions of DPSCs on metformin resin were much higher than DPSCs on control resin without metformin (p < 0.05). ALP activity of metformin group was 70% higher than that without metformin at 14 days (p < 0.05). Mineral synthesis by DPSCs on metformin-containing resin at 21 days was 9-fold that without metformin (p < 0.05). A novel metformin-containing resin was developed, achieving substantial enhancement of odontoblastic differentiation of DPSCs and greater mineral synthesis. The metformin resin is promising for deep cavities and perforated cavities to stimulate DPSCs for tertiary dentin formation, for tooth root coatings with metformin release for periodontal regeneration, and for root canal fillings with apical lesions to stimulate bone regeneration.

Dental remineralization via poly(amido amine) and restorative materials containing calcium phosphate nanoparticles

Tooth decay is prevalent, and secondary caries causes restoration failures, both of which are related to demineralization. There is an urgent need to develop new therapeutic materials with remineralization functions. This article represents the first review on the cutting edge research of poly(amido amine) (PAMAM) in combination with nanoparticles of amorphous calcium phosphate (NACP). PAMAM was excellent nucleation template, and could absorb calcium (Ca) and phosphate (P) ions via its functional groups to activate remineralization. NACP composite and adhesive showed acid-neutralization and Ca and P ion release capabilities. PAMAM+NACP together showed synergistic effects and produced triple benefits: excellent nucleation templates, superior acid-neutralization, and ions release. Therefore, the PAMAM+NACP strategy possessed much greater remineralization capacity than using PAMAM or NACP alone. PAMAM+NACP achieved dentin remineralization even in an acidic solution without any initial Ca and P ions. Besides, the long-term remineralization capability of PAMAM+NACP was established. After prolonged fluid challenge, the immersed PAMAM with the recharged NACP still induced effective dentin mineral regeneration. Furthermore, the hardness of pre-demineralized dentin was increased back to that of healthy dentin, indicating a complete remineralization. Therefore, the novel PAMAM+NACP approach is promising to provide long-term therapeutic effects including tooth remineralization, hardness increase, and caries-inhibition capabilities.

Poly(amido amine) and rechargeable adhesive containing calcium phosphate nanoparticles for long-term dentin remineralization

OBJECTIVES

The objective of the present study was to investigate long-term dentin remineralization via the combination of poly(amido amine) (PAMAM) with a novel rechargeable adhesive containing nanoparticles of amorphous calcium phosphate (NACP).

METHODS

The NACP adhesive was immersed in lactic acid at pH 4 to exhaust its calcium (Ca) and phosphate (P) ion release, and then recharged with Ca and P ions. Dentin samples were pre-demineralized with 37% phosphoric acid, and then divided into four groups: (1) dentin control, (2) dentin treated with PAMAM, (3) dentin with recharged NACP adhesive, (4) dentin with PAMAM + recharged NACP adhesive. In group (2) and (4), the PAMAM-coated dentin was immersed in phosphate-buffered saline with vigorous shaking for 77 days to accelerate any detachment of the PAMAM macromolecules from the demineralized dentin. Samples were treated with a cyclic remineralization/demineralization regimen for 21 days.

RESULTS

After 77 days of fluid flow challenge, the immersed PAMAM still retained its nucleation template function. The recharged NACP adhesive possessed sustained ion re-release and acid-neutralization capability, both of which did not decrease with repeated recharge and re-release cycles. The immersed PAMAM with the recharged NACP adhesive achieved long-term dentin remineralization, and restored dentin hardness to that of healthy dentin.

CONCLUSIONS

The PAMAM + NACP adhesive completely remineralizes pre-demineralized dentin even after long-term fluid challenges and provides long-term remineralization to protect tooth structures.

CLINICAL SIGNIFICANCE

The novel PAMAM + NACP adhesive provides long-term bond protection and caries inhibition to increase the longevity of resin-based restorations.

Polymerization kinetics stability, volumetric changes, apatite precipitation, strontium release and fatigue of novel bone composites for vertebroplasty

PURPOSE

The aim was to determine effects of diluent monomer and monocalcium phosphate monohydrate (MCPM) on polymerization kinetics and volumetric stability, apatite precipitation, strontium release and fatigue of novel dual-paste composites for vertebroplasty.

MATERIALS AND METHODS

Polypropylene (PPGDMA) or triethylene (TEGDMA) glycol dimethacrylates (25 wt%) diluents were combined with urethane dimethacrylate (70 wt%) and hydroxyethyl methacrylate (5 wt%). 70 wt% filler containing glass particles, glass fibers (20 wt%) and polylysine (5 wt%) was added. Benzoyl peroxide and MCPM (10 or 20 wt%) or N-tolyglycine glycidyl methacrylate and tristrontium phosphate (15 wt%) were included to give initiator or activator pastes. Commercial PMMA (Simplex) and bone composite (Cortoss) were used for comparison. ATR-FTIR was used to determine thermal activated polymerization kinetics of initiator pastes at 50-80°C. Paste stability, following storage at 4-37°C, was assessed visually or through mixed paste polymerization kinetics at 25°C. Polymerization shrinkage and heat generation were calculated from final monomer conversions. Subsequent expansion and surface apatite precipitation in simulated body fluid (SBF) were assessed gravimetrically and via SEM. Strontium release into water was assessed using ICP-MS. Biaxial flexural strength (BFS) and fatigue properties were determined at 37°C after 4 weeks in SBF.

RESULTS

Polymerization profiles all exhibited an inhibition time before polymerization as predicted by free radical polymerization mechanisms. Initiator paste inhibition times and maximum reaction rates were described well by Arrhenius plots. Plot extrapolation, however, underestimated lower temperature paste stability. Replacement of TEGDMA by PPGDMA, enhanced paste stability, final monomer conversion, water-sorption induced expansion and strontium release but reduced polymerization shrinkage and heat generation. Increasing MCPM level enhanced volume expansion, surface apatite precipitation and strontium release. Although the experimental composite flexural strengths were lower compared to those of commercially available Simplex, the extrapolated low load fatigue lives of all materials were comparable.

CONCLUSIONS

Increased inhibition times at high temperature give longer predicted shelf-life whilst stability of mixed paste inhibition times is important for consistent clinical application. Increased volumetric stability, strontium release and apatite formation should encourage bone integration. Replacing TEGDMA by PPGDMA and increasing MCPM could therefore increase suitability of the above novel bone composites for vertebroplasty. Long fatigue lives of the composites may also ensure long-term durability of the materials.