Monitoring of cariogenic demineralization at the enamel-composite interface using swept-source optical coherence tomography

Assessments of polymerization shrinkage by optical coherence tomography-based digital image correlation analysis-Part I: Parameter identification

OBJECTIVE

To investigate the feasibility of optical coherence tomography (OCT)-based digital image correlation (DIC) analysis and to identify the experimental parameters for measurements of polymerization shrinkage.

METHODS

Class I cavities were prepared on bovine incisors and filled with Filtek Z350XT Flowable (Z350F). One OCT image of the polymerized restoration was processed to generate virtually displaced images. In addition, the tooth specimen was physically moved under OCT scanning. A DIC software analyzed these virtual and physical transformation sets and assessed the effects of subset sizes on accuracy. The refractive index of unpolymerized and polymerized Z350F was measured via OCT images. Finally, different particles (70-80 µm glass beads, 150-212 µm glass beads, and 75-150 µm zirconia powder) were added to Z350F to inspect the analyzing quality.

RESULTS

The analyses revealed a high correlation (>99.99%) for virtual movements within 131 pixels (639 µm) and low errors (<5.21%) within a 10-µm physical movement. A subset size of 51 × 51 pixels demonstrated the convergence of correlation coefficients and calculation time. The refractive index of Z350F did not change significantly after polymerization. Adding glass beads or zirconia particles caused light reflection or shielding in OCT images, whereas blank Z350F produced the best DIC analysis results.

SIGNIFICANCE

The OCT-based DIC analysis with the experimental conditions is feasible in measuring polymerization shrinkage of RBC restorations. The subset size in the DIC analysis should be identified to optimize the analysis conditions and results. Uses of hyper- or hypo-reflective particles is not recommended in this method.

Polarization-Sensitive Optical Coherence Tomography for Monitoring De- and Remineralization of Bovine Enamel In Vitro

Early caries diagnosis still challenges dentistry. Polarization-sensitive optical coherence tomography (PS-OCT) is promising to detect initial lesions non-invasively in depth-resolved cross-sectional visualization. PS-OCT with determined degree of polarization (DOP) imaging provides an intuitive demineralization contrast. The aim of this study is to evaluate the suitability of DOP-based PS-OCT imaging to monitor controlled de- and remineralization progression for the first time and to introduce it as a valid, non-destructive in vitro detection method. Twelve standardized bovine enamel specimens were divided in different groups and demineralized with hydrochloric acid (HCl) as well as partly remineralized with fluoride over a 14-day pH-cycling experiment. The specimens were stored in artificial saliva and sodium chloride (NaCl), respectively. Progress measurements with PS-OCT were made with polarization-sensitive en faceand B-scan mode for qualitative evaluation. The specimens demineralized in HCl showed the most pronounced surface change (lowest DOP) and the most significant increase in depolarization. Additional fluoride treatment and the storage in artificial saliva resulted in the opposite (highest DOP). Therefore, DOP-based PS-OCT imaging appears to be a valuable technique for visualization and monitoring of enamel demineralization and remineralization processes in vitro. However, these findings need to be confirmed in human teeth ex vivo or in situ.

The germicidal effect, biosafety and mechanical properties of antibacterial resin composite in cavity filling

In recent years, dental resin materials have become increasingly popular for cavity filling. However, these materials can shrink during polymerization, leading to microleakages that enable bacteria to erode tooth tissue and cause secondary caries. As a result, there is great clinical demand for the development of antibacterial resins. The principle of antibacterial resin includes contact killing and filler-release killing of bacteria. For contact killing, quaternary ammonium salts (QACs) and antibacterial peptides (AMPs) can be added. For filler-release killing, chlorhexidine (CHX) and nanoparticles are used. These antibacterial agents are effective against gram-positive bacteria, gram-negative bacteria, fungi, and more. Among them, QACs has a lasting antibacterial effect, and silver nanoparticles even have a certain ability to kill viruses. Biocompatibility-wise, QACs, AMPs, and CHX have low cytotoxicity to cells when added into the resin. However, nanoparticles with smaller particle sizes have higher cytotoxicity. In terms of mechanical properties, QACs, AMPs, and CHX do not negatively affect the resin. However, the addition of magnesium oxide can have a negative impact. This paper reviews the types and antibacterial principles of commonly used antibacterial resins in recent years, evaluates their antibacterial effect, biological safety, and mechanical properties, and provides references for selecting clinical filling materials.

Microtensile bond strength to sealer-contaminated dentin after using different cleaning protocols

Background/purpose

Sealer residues on dentin may affect bonding to restorative materials. This study aimed to evaluate the bond strength to sealer-contaminated dentin after using different cleaning protocols.

Materials and methods

Freshly extracted bovine incisors were prepared and exposed the buccal pulp chamber dentin, obtaining segments measuring 5 mm × 5 mm with a height of 3 mm. The segments were randomly distributed into 4 groups (n = 7) according to different protocols. Control group: no contamination was performed. In the three experimental groups, the segments were contaminated with epoxy resin-based sealer for 5 min, and different cleaning protocols were performed. Acetone group: acetone-saturated cotton pellets were used to wipe the sealer. Ultrasound group: ultrasonic ET-20D tip cleaning. Acetone combined with ultrasound group: cleaning with acetone-saturated cotton pellets and ultrasonic tip. All segments were bonded using a self-etch adhesive. Two samples in each group were scanned by swept-source optical coherence tomography (SS-OCT) to evaluate sealer residues. A microtensile test was performed on the remaining 5 samples, which were built up with composite resin.

Results

Sealer residues were observed in 3 of 14 (21.4%) sections of acetone group by SS-OCT. Compared to the control, ultrasound alone or in combination with acetone preserved the bond strength (P > .05). The ultrasound group exhibited the highest bond strength (39.38 MPa), which differed from that of the acetone group, which provided the lowest bond strength (32.88 MPa) (P < .05).

Conclusion

Cleaning epoxy resin-based sealer-contaminated dentin surfaces using ultrasound or combined with acetone could preserve the bond strength.

Antimicrobial Peptide-Polymer Conjugates for Dentistry

Bacterial adhesion and growth at the composite/adhesive/tooth interface remain the primary cause of dental composite restoration failure. Early colonizers, including Streptococcus mutans, play a critical role in the formation of dental caries by creating an environment that reduces the adhesive's integrity. Subsequently, other bacterial species, biofilm formation, and lactic acid from S. mutans demineralize the adjoining tooth. Because of their broad spectrum of antibacterial activity and low risk for antibiotic resistance, antimicrobial peptides (AMPs) have received significant attention to prevent bacterial biofilms. Harnessing the potential of AMPs is still very limited in dentistry-a few studies have explored peptide-enabled antimicrobial adhesive copolymer systems using mainly nonspecific adsorption. In the current investigation, to avoid limitations from nonspecific adsorption and to prevent potential peptide leakage out of the resin, we conjugated an AMP with a commonly used monomer for dental adhesive formulation. To tailor the flexibility between the peptide and the resin material, we designed two different spacer domains. The spacer-integrated antimicrobial peptides were conjugated to methacrylate (MA), and the resulting MA-AMP monomers were next copolymerized into dental adhesives as AMP-polymer conjugates. The resulting bioactivity of the polymethacrylate-based AMP conjugated matrix activity was investigated. The antimicrobial peptide conjugated to the resin matrix demonstrated significant antimicrobial activity against S. mutans. Secondary structure analyses of conjugated peptides were applied to understand the activity differential. When mechanical properties of the adhesive system were investigated with respect to AMP and cross-linking concentration, resulting AMP-polymer conjugates maintained higher compressive moduli compared to hydrogel analogues including polyHEMA. Overall, our result provides a robust approach to develop a fine-tuned bioenabled peptide adhesive system with improved mechanical properties and antimicrobial activity. The results of this study represent a critical step toward the development of peptide-conjugated dentin adhesives for treatment of secondary caries and the enhanced durability of dental composite restorations.

The effect of base material composition on demineralization assessment in CPOCT dental imaging

Cross-polarization optical coherence tomography (CP-OCT) is a promising imaging modality to detect demineralization under the margins of composite restorations. The aim of this study was to assess how base materials applied under composite resin may affect CP-OCT image assessment. Base materials are commonly used for managing deep dentinal decay but once applied residual amounts of the base materials can be inadvertently left on the inner enamel walls. This study determined that base materials have significantly different scattering properties. The order grouping in the mean backscattered reflectivity (mR) of the base material was Dycal>caries phantom>Fuji IX, Vitrebond, Fuji II (p<0.05). The calcium hydroxide base (Dycal) had a higher mR than demineralized dentin and Vitrebond before and after the resin restoration was placed (p<0.05). While calcium hydroxide maybe a confounder in CPOCT imaging, several protective base materials are compatible with this type of imaging modality.

Three-dimensional diagnosis of dentin caries beneath composite restorations using swept-source optical coherence tomography

The aims of this study were to assess the diagnostic accuracy of swept-source optical coherence tomography (SS-OCT) for detection of caries beneath composite restorations and to compare the results with those obtained by radiography. Flat dentin surfaces with and without natural caries were bonded with 1- or 2-mm thick composite restorations. SS-OCT scanning was performed over the composite restorations to construct three-dimensional (3D) images of the resin-dentin interface. Images were chosen from the 3D constructions to detect caries beneath the restorations. The sensitivity, specificity, false positive and negative predictive values for caries detection, and Az values from receiver-operating characteristic analysis were calculated and compared with those of digital dental radiography at a significance level of α=0.05. Intraexaminer and interexaminer reproducibility was compared between SSOCT and radiography. SS-OCT could detect caries, which appeared as a bright zone beneath composite up to 2-mm thick. SS-OCT provided greater diagnostic accuracy than radiography.

Fabrication of hybrid crosslinked network with buffering capabilities and autonomous strengthening characteristics for dental adhesives

Ingress of bacteria and fluids at the interfacial gaps between the restorative composite biomaterial and the tooth structure contribute to recurrent decay and failure of the composite restoration. The inability of the material to increase the pH at the composite/tooth interface facilitates the outgrowth of bacteria. Neutralizing the microenvironment at the tooth/composite interface offers promise for reducing the damage provoked by cariogenic and aciduric bacteria. We address this problem by designing a dental adhesive composed of hybrid network to provide buffering and autonomous strengthening simultaneously. Two amino functional silanes, 2-hydroxy-3-morpholinopropyl (3-(triethoxysilyl)propyl) carbamate and 2-hydroxy-3-morpholinopropyl (3-(trimethoxysilyl)propyl) carbamate were synthesized and used as co-monomers. Combining free radical initiated polymerization (polymethacrylate-based network) and photoacid-induced sol-gel reaction (polysiloxane) results in the hybrid network formation. Resulting formulations were characterized with regard to real-time photo-polymerization, water sorption, leached species, neutralization, and mechanical properties. Results from real-time FTIR spectroscopic studies indicated that ethoxy was less reactive than methoxy substituent. The neutralization results demonstrated that the methoxy-containing adhesives have acute and delayed buffering capabilities. The mechanical properties of synthetic copolymers tested in dry conditions were improved via condensation reaction of the hydrolyzed organosilanes. The leaching from methoxy containing copolymers was significantly reduced. The sol-gel reaction provided a chronic and persistent reaction in wet condition-performance that offers potential for reducing secondary decay and increasing the functional lifetime of dental adhesives.

STATEMENT OF SIGNIFICANCE

The interfacial gaps between the restorative composite biomaterial and the tooth structure contributes to recurrent decay and failure of the composite restoration. The inability of the material to increase the pH at the composite/tooth interface facilitates the outgrowth of more cariogenic and aciduric bacteria. This paper reports a novel, synthetic resin that provides buffering capability and autonomous strengthening characteristics. In this work, two amino functional silanes were synthesized and the effect of alkoxy substitutions on the photoacid-induced sol-gel reaction was investigated. We evaluated the neutralization capability (monitoring the pH of lactic acid solution) and the autonomous strengthening property (monitoring the mechanical properties of the hybrid copolymers under wet conditions and quantitatively analyzing the leachable species by HPLC). The novel resin investigated in this study offers the potential benefits of reducing the risk of recurrent decay and prolonging the functional lifetime of dental adhesives.

The Use of Optical Coherence Tomography in Dental Diagnostics: A State-of-the-Art Review

Optical coherence tomography provides sections of tissues in a noncontact and noninvasive manner. The device measures the time delay and intensity of the light scattered or reflected from biological tissues, which results in tomographic imaging of their internal structure. This is achieved by scanning tissues at a resolution ranging from 1 to 15 μm. OCT enables real-time in situ imaging of tissues without the need for biopsy, histological procedures, or the use of X-rays, so it can be used in many fields of medicine. Its properties are not only particularly used in ophthalmology, in the diagnosis of all layers of the retina, but also increasingly in cardiology, gastroenterology, pulmonology, oncology, and dermatology. The basic properties of OCT, that is, noninvasiveness and low wattage of the used light, have also been appreciated in analytical technology by conservators, who use it to identify the quality and age of paintings, ceramics, or glass. Recently, the OCT technique of visualization is being tested in different fields of dentistry, which is depicted in the article.

A Review of the Common Models Used in Mechanistic Studies on Demineralization-Remineralization for Cariology Research

Mechanistic studies on demineralization-remineralization play a critical role in investigating caries pathogenicity, testing effects of new caries prevention methods, and developing new caries-preventing products. Simulating the cariogenic challenges in the mouth, various demineralization-remineralization models have been used for cariology research. This review aimed to provide an overview of the common mechanistic studies on demineralization-remineralization for cariology research in recent literature. Most mechanistic studies were in vitro studies (n = 294, 84%) among the 350 cariology studies indexed in the Web of Science from 2014 to 2016. Among these in vitro studies, most studies (257/294, 87%) used chemical models that could be classified as simple mineralization models (159/257, 62%) or pH-cycling models (98/257, 38%). In vitro studies consumed less expense and time than in vivo studies. Furthermore, in vitro conditions were easier to control. However, they could hardly imitate the complex structures of oral cavities, the microbiological effect of oral biofilm, and the hydrodynamic instability of saliva. The advantages of chemical models included simplicity of the study, low cost, efficiency (time saving), reproducibility, and stability of experiments. However, the “caries” generated were not biological. Moreover, the chemical models were generally basic and could not mimic a carious lesion in the complex oral environment.