A protein-repellent and antibacterial nanocomposite for Class-V restorations to inhibit periodontitis-related pathogens

Resin infiltrant with antibacterial activity: effects of incorporation of DMAHDM monomer and NACP on physical and antimicrobial properties

OBJECTIVES

Considering the fact that resin infiltrants lack antibacterial activity, this study assessed the influence of the quaternary ammonium monomer dimethylaminohexadecyl methacrylate (DMAHDM) and amorphous calcium phosphate nanoparticles (NACP) on the physical and antibacterial properties of an experimental resin infiltrant (ERI).

METHODOLOGY

The following groups were established: ERI (75/25 wt.% TEGDMA/BISEMA), ERI + 2.5% DMAHDM (2.5DM), ERI + 5% DMAHDM (5DM), ERI + 2% NACP (NACP), ERI + 2.5% DMAHDM + 2% NACP (2.5DM_NACP), ERI + 5% DMAHDM + 2% NACP (5DM_NACP), and Icon® (IC), a commercial resin infiltrant. Degree of conversion (DC; n=4), sorption and solubility (SO/SOL; n=8), and contact angle (CA; n=10) tests were conducted. Biofilm biomass (BB; n=6) and bacterial metabolism (BM; n=8) were evaluated after Streptococcus mutans (UA159) cultivation for 48 h on material samples. Data were evaluated by one-way ANOVA and Tukey or Games-Howell post hoc tests (α=0.05).

RESULTS

IC exhibited the highest DC, with no difference from 2.5DM and 5DM. IC showed the lowest CA. IC had the lowest SO, followed by ERI, which had the lowest SOL, with no difference from IC. 5DM_NACP showed the lowest biofilm biomass, similar to 2.5DM and 5DM. Resin infiltrants containing DMAHDM showed reduced bacterial metabolism.

CONCLUSIONS

DMAHDM, with or without NACP, demonstrated significant antibacterial activity, while NACP impaired DC. Both DMAHDM and NACP increased the contact angle, sorption, and solubility of the resin infiltrant, which may affect the material's clinical performance.

Silica nanoparticles containing nano-silver and chlorhexidine to suppress Porphyromonas gingivalis biofilm and modulate multispecies biofilms toward healthy tendency

Objectives

This research first investigated the effect of mesoporous silica nanoparticles (nMS) carrying chlorhexidine and silver (nMS-nAg-Chx) on periodontitis-related biofilms. This study aimed to investigate (1) the antibacterial activity on Porphyromonas gingivalis (P. gingivalis) biofilm; (2) the suppressing effect on virulence of P. gingivalis biofilm; (3) the regulating effect on periodontitis-related multispecies biofilm.

Methods

Silver nanoparticles (nAg) and chlorhexidine (Chx) were co-loaded into nMS to form nMS-nAg-Chx. Inhibitory zone test and minimum inhibitory concentration (MIC) against P. gingivalis were tested. Growth curves, crystal violet (CV) staining, live/dead staining and scanning electron microscopy (SEM) observation were performed. Biofilm virulence was assessed. The 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) assay and Quantitative Real Time-PCR (qPCR) were performed to validate the activity and composition changes of multispecies biofilm (P. gingivalis, Streptococcus gordonii and Streptococcus sanguinis).

Results

nMS-nAg-Chx inhibited P. gingivalis biofilm dose-dependently (p<0.05), with MIC of 18.75 µg/mL. There were fewer live bacteria, less biomass and less virulence in nMS-nAg-Chx groups (p<0.05). nMS-nAg-Chx inhibited and modified periodontitis-related biofilms. The proportion of pathogenic bacteria decreased from 16.08 to 1.07% and that of helpful bacteria increased from 82.65 to 94.31% in 25 μg/mL nMS-nAg-Chx group for 72 h.

Conclusions

nMS-nAg-Chx inhibited P. gingivalis growth, decreased biofilm virulence and modulated periodontitis-related multispecies biofilms toward healthy tendency. pH-sensitive nMS-nAg-Chx inhibit the pathogens and regulate oral microecology, showing great potential in periodontitis adjunctive therapy.

Photocatalytic Deposition of Au Nanoparticles on Ti3C2Tx MXene Substrates for Surface-Enhanced Raman Scattering

Surface-enhanced Raman scattering (SERS) is a promising technique for sensitive detection. The design and optimization of plasma-enhanced structures for SERS applications is an interesting challenge. In this study, we found that the SERS activity of MXene (Ti3C2Tx) can be improved by adding Au nanoparticles (NPs) in a simple photoreduction process. Fluoride-salt-etched MXene was deposited by drop-casting on a glass slide, and Au NPs were formed by the photocatalytic growth of gold(III) chloride trihydrate solutions under ultraviolet (UV) irradiation. The Au-MXene substrate formed by Au NPs anchored on the Ti3C2Tx sheet produced significant SERS through the synergistic effect of chemical and electromagnetic mechanisms. The structure and size of the Au-decorated MXene depended on the reaction time. When the MXene films were irradiated with a large number of UV photons, the size of the Au NPs increased. Hot spots were formed in the nanoscale gaps between the Au NPs, and the abundant surface functional groups of the MXene effectively adsorbed and interacted with the probe molecules. Simultaneously, as a SERS substrate, the proposed Au-MXene composite exhibited a wider linear range of 10-4-10-9 mol/L for detecting carbendazim. In addition, the enhancement factor of the optimized SERS substrate Au-MXene was 1.39 × 106, and its relative standard deviation was less than 13%. This study provides a new concept for extending experimental strategies to further improve the performance of SERS.

Novel antibacterial titanium implant healing abutment with dimethylaminohexadecyl methacrylate to combat implant-related infections

OBJECTIVE

Implant-related infections from the adhesion and proliferation of dental plaque are a major challenge for dental implants. The objectives of this study were to: (1) develop novel antibacterial titanium (Ti) healing abutment; (2) investigate the inhibition of implant infection-related pathogenic bacteria and saliva-derived biofilm, and evaluate the biocompatibility of the new material for the first time.

METHODS

Dimethylaminohexadecyl methacrylate (DMAHDM) and hydroxyapatite (HAP) were polymerized via polydopamine (PDA) on Ti. Staphylococcus aureus (S. aureus), Streptococcus sanguinis (S. sanguinis) and human saliva-derived biofilms were tested. After 4 weeks of DMAHDM release, the antibacterial efficacy of the DMAHDM remaining on Ti surface and the DMADHM in medium was tested. Biocompatibility was determined using human gingival fibroblasts (HGFs) and periodontal ligament stem cells (PDLSCs).

RESULTS

The DMAHDM-loaded coating filled into the nano-voids in Ti surfaces. The modified Ti showed potent antibacterial activity, reducing the CFU of S. aureus, S. sanguinis and saliva-derived biofilms by 8, 7 and 4 log, respectively (P < 0.05). After 4 weeks of release, the modified Ti was still able to reduce S. aureus and S. sanguinis biofilm CFU by 1-3 log (P < 0.05). This provided strong antibacterial function for more than 4 weeks, which were the high-risk period for implant infections. The new material showed excellent biocompatibility when compared to control (P > 0.05).

CONCLUSION

Novel DMAHDM-loaded Ti healing abutment had strong antibacterial effects, reducing biofilm CFUs by orders of magnitude, and lasting for over four weeks to cover the high-risk period for implant infections. The novel antibacterial Ti is promising to combat implant-related infections in dental, craniofacial and orthopedic applications.

Silica nanoparticles containing nano-silver and chlorhexidine respond to pH to suppress biofilm acids and modulate biofilms toward a non-cariogenic composition

OBJECTIVES

Dental caries is caused by acids from biofilms. pH-sensitive nanoparticle carriers could achieve improved targeted effectiveness. The objectives of this study were to develop novel mesoporous silica nanoparticles carrying nanosilver and chlorhexidine (nMS-nAg-Chx), and investigate the inhibition of biofilms as well as the modulation of biofilm to suppress acidogenic and promote benign species for the first time.

METHODS

nMS-nAg was synthesized via a modified sol-gel method. Carboxylate group functionalized nMS-nAg (COOH-nMS-nAg) was prepared and Chx was added via electrostatic interaction. Minimal inhibitory concentration (MIC), inhibition zone, and growth curves were evaluated. Streptococcus mutans (S. mutans), Streptococcus gordonii (S. gordonii), and Streptococcus sanguinis (S. sanguinis) formed multispecies biofilms. Metabolic activity, biofilm lactic acid, exopolysaccharides (EPS), and TaqMan real-time polymerase chain reaction (RT-PCR) were tested. Biofilm structures and biomass were observed by scanning electron microscopy (SEM) and live/dead bacteria staining.

RESULTS

nMS-nAg-Chx possessed pH-responsive properties, where Chx release increased at lower pH. nMS-nAg-Chx showed good biocompatibility. nMS-nAg-Chx exhibited a strong antibacterial function, reducing biofilm metabolic activity and lactic acid as compared to control (p < 0.05, n = 6). Moreso, biofilm biomass was dramatically suppressed in nMS-nAg-Chx groups. In control group, there was an increasing trend of S. mutans proportion in the multispecies biofilm, with S. mutans reaching 89.1% at 72 h. In sharp contrast, in nMS-nAg-Chx group of 25 μg/mL, the ratio of S. mutans dropped to 43.7% and the proportion of S. gordonii and S. sanguinis increased from 19.8% and 10.9 to 69.8% and 56.3%, correspondingly.

CONCLUSION

pH-sensitive nMS-nAg-Chx had potent antibacterial effects and modulated biofilm toward a non-cariogenic tendency, decreasing the cariogenic species nearly halved and increasing the benign species approximately twofold. nMS-nAg-Chx is promising for applications in mouth rinse and endodontic irrigants, and as fillers in resins to prevent caries.

Current antibacterial agents in dental bonding systems: a comprehensive overview

Dental caries is mainly caused by oral biofilm acid, and the most common dental restoration treatment is composite dental restorations. The main cause of failure is secondary caries adjacent to the restoration. Long-term survival of dental materials is improved by the presence of antibacterial agents, which selectively inhibit bacterial growth or survival. Chemical, natural and biomaterials have been studied for their antimicrobial activities and antibacterial bonding agents have been improved. Their usage has been increased to inhibit the growth of invading and residual bacteria in the oral cavity, as biofilm accumulation increases the risk of treatment failure. In this article, the success and applications of antibacterial agents are discussed in dental bonding systems.

Influence of resin modified glass ionomer cement incorporating protein-repellent and antimicrobial agents on supragingival microbiome around brackets: an in-vivo split-mouth 3-month study

Objective

To explore the influence of resin modified glass ionomer cement (RMGIC) adhesives containing protein-repellent and quaternary ammonium salt agents on supragingival microbiome, enamel and gingival health around brackets.

Materials and Methods

Ten patients (21.4 ± 3.5 years) about to receive fixed orthodontics were enrolled in this study. Unilateral upper teeth bonded with RMGIC incorporating 2-Methacryloyloxyethyl phosphorylcholine (MPC) and Dimethylaminohexadecyl methacrylate (DMAHDM) were regarded as experimental group (RMD), while contralateral upper teeth bonded with RMGIC were control group (RMGIC), using a split-mouth design. Supragingival plaque was collected from both groups before treatment (T0), and at 1 month (T1) and 3 months (T2) of treatment. High-throughput sequencing was performed targeting v3-v4 of 16S rRNA gene. Streptococcus mutans and Fusobacterium nucleatum quantification was done by qPCR analysis. Bracket failures, enamel decalcification index (EDI), DIAGNODent scores (Dd), plaque index (PI) and gingival index (GI) were monitored at indicated time points.

Results

Within 3 months, alpha and beta diversity of supragingival plaque had no difference between RMGIC and RMD groups. From T0 to T2, the relative abundance of Streptococcus depleted in RMD but remained steady in RMGIC group. Streptococcus, Prevotella, and Fusobacterium became depleted in RMD, Haemophilus and Capnocytophaga became depleted in RMGIC group but Prevotella enriched. Quantification of Fusbacterium nucleatum and Streptococcus mutans showed significant difference between RMGIC and RMD groups at T2. Teeth bonded with RMD had significant lower plaque index (PI) and DIAGNODent (Dd) score at T2, compared with teeth bonded with RMGIC (p < 0.05). No difference in bracket failure rate was examined between both groups (p > 0.05).

Conclusion

By incorporating MPC and DMAHDM into RMGIC, the material could affect the supragingival microbial composition, inhibit the progress of plaque accumulation as well as the key pathogens S. mutans and F. nucleatum in the early stage of orthodontic treatment.

Dual function of anti-biofilm and modulating biofilm equilibrium of orthodontic cement containing quaternary ammonium salt

The objectives of this study were to incorporate dimethylaminohexadecyl methacrylate (DMAHDM) into resin-modified glass ionomer cement (RMGI) to develop a novel orthodontic cement which endowed RMGI with strong antibacterial ability and investigated its modulation biofilm equilibrium from cariogenic state to non-cariogenic state for the first time. Cariogenic Streptococcus mutans (S. mutans), and non-cariogenic Streptococcus sanguinis (S. sanguinis) and Streptococcus gordonii (S. gordonii) were selected to form a tri-species biofilm model. RMGI incorporated with different mass fraction of DMAHDM was examined: biofilm colony-forming units, metabolic activity, live/dead staining, lactic acid and exopolysaccharides productions. TaqMan real-time polymerase chain reaction was used to determine changes of biofilm species compositions. The results showed RMGI containing 3% DMAHDM achieved strong antibacterial ability and suppressed the cariogenic species in biofilm, modulating biofilm equilibrium from cariogenic state to non-cariogenic state tendency. The novel bioactive cement containing DMAHDM is promising in fixed orthodontic treatments and protecting tooth enamel.

Tailoring the monomers to overcome the shortcomings of current dental resin composites - review

Dental resin composites (DRCs) have become the first choice among different restorative materials for direct anterior and posterior restorations in the clinic. Though the properties of DRCs have been improved greatly in recent years, they still have several shortcomings, such as volumetric shrinkage and shrinkage stress, biofilm development, lack of radio-opacity for some specific DRCs, and estrogenicity, which need to be overcome. The resin matrix, composed of different monomers, constitutes the continuous phase and determine the performance of DRCs. Thus, the chemical structure of the monomers plays an important role in modifying the properties of DRCs. Numerous researchers have taken to design and develop novel monomers with specific functions for the purpose of fulfilling the needs in dentistry. In this review, the development of monomers in DRCs were highlighted, especially focusing on strategies aimed at reducing volumetric shrinkage and shrinkage stress, endowing bacteriocidal and antibacterial adhesion activities as well as protein-repelling activity, increasing radio-opacity, and replacing Bis-GMA. The influences of these novel monomers on the properties of DRCs were also discussed.

Experimental composite containing silicon dioxide-coated silver nanoparticles for orthodontic bonding: Antimicrobial activity and shear bond strength

Objective:

This study aimed to investigate the antimicrobial activity and shear bond strength (SBS) of orthodontic brackets to bovine enamel using experimental composites with different concentrations of silicon dioxide-coated silver nanoparticles (Ag@SiO₂ NPs).

Methods:

Fifty bovine incisors were divided into five groups according to the composite (n = 10): G1 - Control Group (Transbond XT Resin), G2 - Experimental composite without Ag@SiO₂ NPs; G3 - Experimental composite with 0.5% of Ag@SiO₂ NPs; G4 - Experimental composite with 1% of Ag@SiO₂ NPs; G5 - Experimental composite with 3% of Ag@SiO₂ NPs. The SBS test was performed using a universal mechanical testing machine, and the adhesive remnant index (ARI) was analyzed by optical microscopy. For the antimicrobial activity evaluation, Streptococcus mutans (S. mutans) biofilm was formed for three days in hydroxyapatite discs. Posteriorly, S. mutans colony forming units (CFU) were evaluated. For SBS analysis, Analysis of Variance was used, followed by the Tukey test, at a 5% statistical significance level. The CFU data were analyzed by Kruskal-Wallis, followed by Dunn as a post-hoc test. The ARI results were analyzed descriptively.

Results:

There was no statistically significant difference in SBS values between the experimental and control groups (p>0.05). A 3% incorporation of Ag@SiO₂ NPs statistically reduced the SBS values (p<0.05) compared to the 1% group. The addition of 3% of Ag@SiO₂ NPs to the composites significantly reduced S. mutans biofilm formation, compared to group G2 (p<0.05).

Conclusion:

Composites incorporating 3% of Ag@SiO₂ NPs presented similar SBS values compared to the control group, and showed significant antimicrobial activity.

Denture Acrylic Resin Material with Antibacterial and Protein-Repelling Properties for the Prevention of Denture Stomatitis

Denture stomatitis is a multifactorial pathological condition of the oral mucosa that affects up to 72% of denture wearers. It is commonly seen on the palatal mucosa and characterized by erythema on the oral mucosa that are in contact with the denture surface. The aim of this study was to incorporate 2-methacryloyloxyethyl phosphorylcholine (MPC) and dimethylaminohexadecyl methacrylate (DMAHDM) into a high impact polymethylmethacrylate heat-cured denture base acrylic resin as a potential treatment for denture stomatitis. We used a comparative study design to examine the effect of incorporating MPC as a protein repellent agent and DMAHDM as an antifungal agent to prevent the adherence of Candida albicans to the denture base material. The dual incorporation of MPC and DMAHDM reduced C. albicans biofilm colony-forming unit by two orders of magnitude when compared to the control group devoid of the bioactive agents. Although the addition of MPC and DMAHDM alone or in combination significantly reduced the flexural strength of the material, they showed reduced roughness values when compared to control groups. This new denture acrylic resin provides the benefit of enhancing C. albicans biofilm elimination through dual mechanisms of action, which could potentially reduce the prevalence of denture stomatitis.

A comprehensive review of the antibacterial activity of dimethylaminohexadecyl methacrylate (DMAHDM) and its influence on mechanical properties of resin-based dental materials

The repetitive restorative cycle should be avoided, aiming at the smallest number of restorations' replacements to ensure greater tooth longevity. Antibacterial materials associated with the control of caries etiological factors can help improve restoration's durability. This review aimed to analyze the results of in vitro studies that added Dimethylaminohexadecyl methacrylate (DMAHDM), an antibacterial monomer, to restorative materials. The PubMed, SCOPUS, Web of Science, and Biblioteca Virtual em Saúde databases were screened for studies published between 2015 and 2020. After full-text reading, 24 articles were included in the final sample. DMAHDM has demonstrated antibacterial efficacy against several bacteria related to dental caries and periodontal diseases, causing a transition in the biofilm balance without inducing resistance. When DMAHDM was included in acrylic resin, the material cytotoxicity increased, and changes in mechanical properties were observed. In contrast, resin composites had their mechanical properties maintained in most studies; however, toxicity was not examined. The association between DMAHDM and 2-methacryloyloxyethyl phosphorylcholine or silver nanoparticles improved the antibacterial effect. Besides, the association with nanoparticles of amorphous calcium phosphate or nanoparticles of calcium fluoride can provide remineralization capacity. There is a lack of information on the cytotoxicity and bacteria resistance induction, and further studies are needed to address this.

Synthesis of Novel Dental Nanocomposite Resins by Incorporating Polymerizable, Quaternary Ammonium Silane-Modified Silica Nanoparticles

Diverse approaches dealing with the reinforcement of dental composite resins with quaternary ammonium compounds (QAC) have been previously reported. This work aims to investigate the physicochemical and mechanical performance of dental resins containing silica nanofillers with novel QAC. Different types of quaternary ammonium silane compounds (QASiC) were initially synthesized and characterized with proton nuclear magnetic resonance (¹H-NMR) and Fourier transform infrared (FTIR) spectroscopy. Silica nanoparticles were surface modified with the above QASiC and the structure of silanized products (S.QASiC) was confirmed by means of FTIR and thermogravimetric analysis. The obtained S.QASiC were then incorporated into methacrylate based dental resins. Scanning electron microscopy images revealed a satisfactory dispersion of silica nanoclusters for most of the synthesized nanocomposites. Curing kinetics disclosed a rise in both the autoacceleration effect and degree of conversion mainly induced by shorter QASiC molecules. Polymerization shrinkage was found to be influenced by the particular type of S.QASiC. The flexural modulus and strength of composites were increased by 74% and 19%, while their compressive strength enhancement reached up to 19% by adding 22 wt% S.QASiC nanoparticles. These findings might contribute to the proper design of multifunctional dental materials able to meet the contemporary challenges in clinical practice.

The Antibacterial and Remineralizing Effects of Biomaterials Combined with DMAHDM Nanocomposite: A Systematic Review

Researchers have developed novel nanocomposites that incorporate additional biomaterials with dimethylaminohexadecyl methacrylate (DMAHDM) in order to reduce secondary caries. The aim of this review was to summarize the current literature and assess the synergistic antibacterial and remineralizing effects that may contribute to the prevention of secondary caries. An electronic search was undertaken in MEDLINE using PubMed, Embase, Scopus, Web of Science and Cochrane databases. The initial search identified 954 papers. After the removal of duplicates and screening the titles and abstracts, 15 articles were eligible for this review. The amalgamation of 2-methacryloyloxyethyl phosphorylcholine (MPC) and silver nanoparticles (AgNPs) with DMAHDM resulted in increased antibacterial potency. The addition of nanoparticles of amorphous calcium phosphate (NACP) and polyamidoamine dendrimers (PAMAM) resulted in improved remineralization potential. Further clinical studies need to be planned to explore the antibacterial and remineralizing properties of these novel composites for clinical success.

Antibiofilm and Protein-Repellent Polymethylmethacrylate Denture Base Acrylic Resin for Treatment of Denture Stomatitis

Candida albicans (C. albicans) biofilm is a common etiological factor in denture stomatitis. The purpose of this study was to investigate the effects of incorporating 2-methacryloyloxyethyl phosphorylcholine (MPC) as a protein repellent into a new high-impact denture acrylic (HIPA) resin on the surface roughness, solution pH, and C. albicans biofilm adhesion to the denture base. The new acrylic denture resin base was formulated by mixing MPC into HIPA resin at mass fractions of 1.5%, 3%, and 4.5%. Surface roughness was measured using a Mitutoyo surface roughness tester. C. albicans biofilm growth and viability were assessed via colony forming unit counts. The pH of the biofilm growth medium was measured using a digital pH meter. Adding MPC to the HIPA resin at percentages of 1.5% and 3% increased the roughness values significantly (p < 0.05), while adding 4.5% MPC resulted in no difference in roughness values to that of the control group (p > 0.05). All experimental groups demonstrated neutral pH values (pH ≅ 7) and were not significantly different from each other (p > 0.05). Incorporating 2-methacryloyloxyethyl phosphorylcholine at 4.5% resulted in a significant (≅1 log) colony-forming unit reduction compared with the control group with 0% MPC (p < 0.05). A fungal-retarding denture acrylic resin was developed through the incorporation of MPC for its protein-repelling properties. This newly developed denture acrylic material has the potential to prevent oral microbial infections, such as denture stomatitis.

Physicochemical properties, bond strength and dual-species biofilm inhibition effect of dental resin composites with branched silicone methacrylate

Dental resin composites (DRCs) with 15 wt% (EC-15%) and 20 wt% (EC-20%) synthesized branched silicone methacrylate (BSM) in resin matrix have showed anti-adhesion effect against Streptococcus mutans. With the aim to evaluate the BSM containing DRCs further, water sorption (WS), solubility (SL), mechanical properties before and after water immersion, anti-adhesion effect against dual-species, bonding strength to adhesive treated dentin, and cytotoxicity of BSM containing DRCs were investigated. DRC without BSM was used as control. The WS and SL were obtained until the mass variation of composite in distilled water kept stable. Three-point bending test was used to evaluate flexural strength (FS) and modulus (FM) of composite before and after water immersion. Mixture of Streptococcus mutans and Lactobacillus acidophilus was used to study the anti-adhesion effect against dual-species. Bonding strength of composite to adhesive treated dentin was measured through macro-shear test. Extract of composite was used to evaluate its cytotoxicity effect on L-929 mouse fibroblasts, and cell viability was obtained by MTT assay. The results showed that EC-15% and EC-20% had similar WS and SL as control (p < 0.05); After water immersion, FS and FM of all composites decreased (p < 0.05), but there was no significant difference in value of FS and FM between different groups (p > 0.05); More bacteria were recovered from the surface of control than those from the surface of EC-15% and EC-20% (p < 0.05); Extract of EC-15% was less cytotoxic (higher cell viability) than those EC-20% and control (p < 0.05). All of results revealed that incorporation of 15 wt% or 20 wt% BSM in resin matrix could endow DRC with inhibition effect on dual-species biofilm formation without impairing physiochemical properties, bonding strength to adhesive treated dentin, and cytotoxicity of DRC.

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.

Biocompatible Nanocomposite Enhanced Osteogenic and Cementogenic Differentiation of Periodontal Ligament Stem Cells In Vitro for Periodontal Regeneration

Decays in the roots of teeth is prevalent in seniors as people live longer and retain more of their teeth to an old age, especially in patients with periodontal disease and gingival recession. The objectives of this study were to develop a biocompatible nanocomposite with nano-sized calcium fluoride particles (Nano-CaF₂), and to investigate for the first time the effects on osteogenic and cementogenic induction of periodontal ligament stem cells (hPDLSCs) from human donors.Nano-CaF₂ particles with a mean particle size of 53 nm were produced via a spray-drying machine.Nano-CaF₂ was mingled into the composite at 0%, 10%, 15% and 20% by mass. Flexural strength (160 ± 10) MPa, elastic modulus (11.0 ± 0.5) GPa, and hardness (0.58 ± 0.03) GPa for Nano-CaF₂ composite exceeded those of a commercial dental composite (p < 0.05). Calcium (Ca) and fluoride (F) ions were released steadily from the composite. Osteogenic genes were elevated for hPDLSCs growing on 20% Nano-CaF₂. Alkaline phosphatase (ALP) peaked at 14 days. Collagen type 1 (COL1), runt-related transcription factor 2 (RUNX2) and osteopontin (OPN) peaked at 21 days. Cementogenic genes were also enhanced on 20% Nano-CaF₂ composite, promoting cementum adherence protein (CAP), cementum protein 1 (CEMP1) and bone sialoprotein (BSP) expressions (p < 0.05). At 7, 14 and 21 days, the ALP activity of hPDLSCs on 20% Nano-CaF₂ composite was 57-fold, 78-fold, and 55-fold greater than those of control, respectively (p < 0.05). Bone mineral secretion by hPDLSCs on 20% Nano-CaF₂ composite was 2-fold that of control (p < 0.05). In conclusion, the novel Nano-CaF₂ composite was biocompatible and supported hPDLSCs. Nano-CaF₂ composite is promising to fill tooth root cavities and release Ca and F ions to enhance osteogenic and cementogenic induction of hPDLSCs and promote periodontium regeneration.

An antibacterial and injectable calcium phosphate scaffold delivering human periodontal ligament stem cells for bone tissue engineering

Osteomyelitis and post-operative infections are major problems in orthopedic, dental and craniofacial surgeries. It is highly desirable for a tissue engineering construct to kill bacteria, while simultaneously delivering stem cells and enhancing cell function and tissue regeneration. The objectives of this study were to: (1) develop a novel injectable calcium phosphate cement (CPC) scaffold containing antibiotic ornidazole (ORZ) while encapsulating human periodontal ligament stem cells (hPDLSCs), and (2) investigate the inhibition efficacy against Staphylococcus aureus (S. aureus) and the promotion of hPDLSC function for osteogenesis for the first time. ORZ was incorporated into a CPC-chitosan scaffold. hPDLSCs were encapsulated in alginate microbeads (denoted hPDLSCbeads). The ORZ-loaded CPCC+hPDLSCbeads scaffold was fully injectable, and had a flexural strength of 3.50 ± 0.92 MPa and an elastic modulus of 1.30 ± 0.45 GPa, matching those of natural cancellous bone. With 6 days of sustained ORZ release, the CPCC+10ORZ (10% ORZ) scaffold had strong antibacterial effects on S. aureus, with an inhibition zone of 12.47 ± 1.01 mm. No colonies were observed in the CPCC+10ORZ group from 3 to 7 days. ORZ-containing scaffolds were biocompatible with hPDLSCs. CPCC+10ORZ+hPDLSCbeads scaffold with osteogenic medium had 2.4-fold increase in alkaline phosphatase (ALP) activity and bone mineral synthesis by hPDLSCs, as compared to the control group (p < 0.05). In conclusion, the novel antibacterial construct with stem cell delivery had injectability, good strength, strong antibacterial effects and biocompatibility, supporting osteogenic differentiation and bone mineral synthesis of hPDLSCs. The injectable and mechanically-strong CPCC+10ORZ+hPDLSCbeads construct has great potential for treating bone infections and promoting bone regeneration.

Biomimetic Aspects of Oral and Dentofacial Regeneration

Biomimetic materials for hard and soft tissues have advanced in the fields of tissue engineering and regenerative medicine in dentistry. To examine these recent advances, we searched Medline (OVID) with the key terms “biomimetics”, “biomaterials”, and “biomimicry” combined with MeSH terms for “dentistry” and limited the date of publication between 2010–2020. Over 500 articles were obtained under clinical trials, randomized clinical trials, metanalysis, and systematic reviews developed in the past 10 years in three major areas of dentistry: restorative, orofacial surgery, and periodontics. Clinical studies and systematic reviews along with hand-searched preclinical studies as potential therapies have been included. They support the proof-of-concept that novel treatments are in the pipeline towards ground-breaking clinical therapies for orofacial bone regeneration, tooth regeneration, repair of the oral mucosa, periodontal tissue engineering, and dental implants. Biomimicry enhances the clinical outcomes and calls for an interdisciplinary approach integrating medicine, bioengineering, biotechnology, and computational sciences to advance the current research to clinics. We conclude that dentistry has come a long way apropos of regenerative medicine; still, there are vast avenues to endeavour, seeking inspiration from other facets in biomedical research.

Regulating Oral Biofilm from Cariogenic State to Non-Cariogenic State via Novel Combination of Bioactive Therapeutic Composite and Gene-Knockout

The objectives were to investigate a novel combination of gene-knockout with antimicrobial dimethylaminohexadecyl methacrylate (DMAHDM) composite in regulating oral biofilm from a cariogenic state toward a non-cariogenic state. A tri-species biofilm model included cariogenic Streptococcus mutans (S. mutans), and non-cariogenic Streptococcus sanguinis (S. sanguinis) and Streptococcus gordonii (S. gordonii). Biofilm colony-forming-units (CFUs), lactic acid and polysaccharide production were measured. TaqMan real-time-polymerase-chain reaction was used to determine the percentage of each species in biofilm. The rnc gene-knockout for S. mutans with DMAHDM composite reduced biofilm CFU by five logs, compared to control (p < 0.05). Using parent S. mutans, an overwhelming S. mutans percentage of 68.99% and 69.00% existed in biofilms on commercial composite and 0% DMAHDM composite, respectively. In sharp contrast, with a combination of S. mutans rnc knockout and DMAHDM composite, the cariogenic S. mutans percentage in biofilm was reduced to only 6.33%. Meanwhile, the non-cariogenic S. sanguinis + S. gordonii percentage was increased to 93.67%. Therefore, combining rnc-knockout with bioactive and therapeutic dental composite achieved the greatest reduction in S. mutans, and the greatest increase in non-cariogenic species, thereby yielding the least lactic acid-production. This novel method is promising to obtain wide applications to regulate biofilms and inhibit dental caries.

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.

Antibacterial Properties of Nanoparticles in Dental Restorative Materials. A Systematic Review and Meta-Analysis

Background and Objectives: Nanotechnology has become a significant area of research focused mainly on increasing the antibacterial and mechanical properties of dental materials. The aim of the present systematic review and meta-analysis was to examine and quantitatively analyze the current evidence for the addition of different nanoparticles into dental restorative materials, to determine whether their incorporation increases the antibacterial/antimicrobial properties of the materials. Materials and Methods: A literature search was performed in the Pubmed, Scopus, and Embase databases, up to December 2018, following PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) guidelines for systematic reviews and meta-analyses. Results: A total of 624 papers were identified in the initial search. After screening the texts and applying inclusion criteria, only 11 of these were selected for quantitative analysis. The incorporation of nanoparticles led to a significant increase (p-value <0.01) in the antibacterial capacity of all the dental materials synthesized in comparison with control materials. Conclusions: The incorporation of nanoparticles into dental restorative materials was a favorable option; the antibacterial activity of nanoparticle-modified dental materials was significantly higher compared with the original unmodified materials, TiO₂ nanoparticles providing the greatest benefits. However, the high heterogeneity among the articles reviewed points to the need for further research and the application of standardized research protocols.

Incorporation of zwitterionic materials into light-curable fluoride varnish for biofilm inhibition and caries prevention

We incorporated zwitterionic materials into light-curable fluoride varnish (LCFV) in order to inhibit biofilm accumulation and prevent dental caries, and the properties of LCFV with three different zwitterionic materials, namely, 2-methacryloyloxyethyl phosphorylcholine (MPC), carboxybetaine methacrylate (CBMA), and sulfobetaine methacrylate (SBMA) polymers (each at a weight percentage of 3%), were compared; unmodified LCFV without any zwitterionic material was used as a control. Material properties including film thickness and degree of conversion (DC) of each type of LCFV were evaluated. In addition, protein-repellent effects and inhibitory effects on Streptococcus mutans adhesion and saliva-derived biofilm accumulation of LCFV were estimated. Finally, the preventive effect of LCFV on enamel demineralization was assessed in vitro on extracted human teeth specimens stored in S. mutans-containing medium. The film thickness of LCFV significantly decreased with the incorporation of zwitterionic materials compared to the control LCFV, whereas there were no significant differences in the DC among all of the LCFV groups. Furthermore, the amount of adsorbed protein, adherent S. mutans colony-forming unit (CFU) counts, and saliva-derived biofilm thickness and biomass were all significantly lower for LCFV with incorporated zwitterionic materials compared with the control. All LCFV groups including the control showed certain preventive effects against enamel demineralization during a 14-day immersion in the medium with S. mutans and sucrose, and the depth of demineralization was significantly lower in LCFV with zwitterionic materials than in the control. Thus, the incorporation of zwitterionic materials such as MPC, CBMA, and SBMA appears to confer superior antifouling effects to LCFV.

Effects of S. mutans gene-modification and antibacterial calcium phosphate nanocomposite on secondary caries and marginal enamel hardness

Secondary caries at the restoration-tooth margins is a main reason for dental restoration failures. Gene-modification for Streptococcus mutans (S. mutans) and composites containing dimethylaminohexadecyl methacrylate (DMAHDMA) and nanoparticles of amorphous calcium phosphate (NACP) all have the potential to suppress bacterial acids and promote remineralization. However, there has been no report of their effects on marginal caries-inhibition and enamel hardness. The objective of this study was to investigate the effects of gene-modification and DMAHDM-NACP composite restoration on enamel demineralization and hardness at the margins under biofilm acids for the first time. Parent S. mutans and rnc gene-deleted S. mutans were tested side by side. The bioactive composite contained 3% DMAHDM and 30% NACP. Mechanical properties and calcium (Ca) and phosphate (P) ion releases were measured. Colony-forming units (CFU), MTT, lactic acid and polysaccharide of biofilms were evaluated. Demineralization of bovine enamel with composite restorations was induced via biofilms, then enamel hardness was measured. The dual strategy of combining rnc-deletion with DMAHDM+30NACP: (1) achieved the strongest biofilm-inhibition, with the greatest reduction in biofilm CFU by 6 logs; (2) decreased biofilm lactic acid and polysaccharide production by more than 80%; (3) achieved enamel hardness that was 140% higher than that of a commercial fluoride-releasing composite under 30 days of biofilm acids. Therefore, the novel dual approach of rnc gene-deletion and DMAHDM+NACP nanocomposite is promising to inhibit secondary caries at the margins and increase the longevity of tooth restorations.

Comparison of the use of d-enantiomeric and l-enantiomeric antimicrobial peptides incorporated in a calcium-chelating irrigant against Enterococcus faecalis root canal wall biofilms

OBJECTIVES

To compare the anti-biofilm efficacy of two antimicrobial peptides (AMPs), 1018 and DJK-5, in disrupting canal wall biofilms in the isthmus, canal and dentinal tubules of single-rooted maxillary premolars.

METHODS

Enterococcus faecalis single-species biofilms were formed in-situ in the root canal system of the premolars (n = 91). Confocal laser scanning microscopy, bacterial sampling, colony-forming unit counting, XTT assay, lactate dehydrogenase assay and phenol-sulphuric acid method were used to identify the anti-biofilm efficacy of both AMPs and their influence on bacterial metabolic activity.

RESULTS

Both AMPs disrupted in-situ E. faecalis biofilms and altered their metabolic activity. At 20 μg/mL, the d-enantiomeric AMP DJK-5 killed 55.5 %, 57.3 % and 55.8 % of biofilm bacteria in the isthmus, canal and dentinal tubules, respectively, in 1 min. In contrast, the l-enantiomeric AMP 1018 only eradicated 25.6 %, 25.5 % and 27.5 % of biofilm bacteria in the isthmus, canal and dentinal tubules, respectively, within the same time. Anti-biofilm efficacy of the root canal irrigants tested were in the order: 6 % NaOCl > 20 μg/mL DJK-5 > 10 μg/mL DJK-5 > 20 μg/mL 1018 > 10 μg/mL 1018 > 0.9 % NaCl.

CONCLUSIONS

The present results are confirmatory of previous studies, in that d-enantiomeric AMPs exhibit more potent antibacterial properties than l-enantiomeric AMPs against E. faecalis biofilms within the canal space. Nevertheless, the potency of both AMPs are concentration-dependent. Incorporation of these agents into EDTA, a non-antibacterial calcium-chelating irrigant for removal of the inorganic component of the canal space debris, does not reduce the efficacy of either AMP.

CLINICAL SIGNIFICANCE

The present study provides the proof of concept that incorporation of an antimicrobial peptide into a calcium-chelating root canal irrigant enhances the disinfection of intratubular single-species biofilms during smear layer and smear plug removal.

Anti-Biofilm Property of Bioactive Upconversion Nanocomposites Containing Chlorin e6 against Periodontal Pathogens

Photodynamic therapy (PDT) based periodontal disease treatment has received extensive attention. However, the deep tissue location of periodontal plaque makes the conventional PDT encounter a bottleneck. Herein, upconversion fluorescent nanomaterial with near-infrared light excitation was introduced into the treatment of periodontal disease, overcoming the limited tissue penetration depth of visible light in PDT. Photosensitizer Ce6 molecules were combined with upconversion nanoparticles (UCNPs) NaYF4:Yb,Er with a novel strategy. The hydrophobic UCNPs were modified with amphiphilic silane, utilizing the hydrophobic chain of the silane to bind to the hydrophobic groups of the UCNPs through a hydrophobic-hydrophobic interaction, and the Ce6 molecules were loaded in this hydrophobic layer. This achieves both the conversion of the hydrophobic to the hydrophilic surface and the loading of the oily photosensitizer molecules. Because the excitation position of the Ce6 molecule is in the red region, Mn ions were doped to enhance red light, and thus the improved PDT function. This Ce6 loaded UCNPs composites with efficient red upconversion luminescence show remarkable bacteriological therapeutic effect on Porphyromonas gingivalis, Prevotella intermedia and Fusobacterium nucleatum and the corresponding biofilms under 980 nm irradiation, indicating a high application prospect in the treatment of periodontal diseases.

A Novel Dental Sealant Containing Dimethylaminohexadecyl Methacrylate Suppresses the Cariogenic Pathogenicity of Streptococcus mutans Biofilms

Cariogenic oral biofilms are strongly linked to dental caries around dental sealants. Quaternary ammonium monomers copolymerized with dental resin systems have been increasingly explored for modulation of biofilm growth. Here, we investigated the effect of dimethylaminohexadecyl methacrylate (DMAHDM) on the cariogenic pathogenicity of Streptococcus mutans (S. mutans) biofilms. DMAHDM at 5 mass% was incorporated into a parental formulation containing 20 mass% nanoparticles of amorphous calcium phosphate (NACP). S. mutans biofilms were grown on the formulations, and biofilm inhibition and virulence properties were assessed. The tolerances to acid stress and hydrogen peroxide stress were also evaluated. Our findings suggest that incorporating 5% DMAHDM into 20% NACP-containing sealants (1) imparts a detrimental biological effect on S. mutans by reducing colony-forming unit counts, metabolic activity and exopolysaccharide synthesis; and (2) reduces overall acid production and tolerance to oxygen stress, two major virulence factors of this microorganism. These results provide a perspective on the value of integrating bioactive restorative materials with traditional caries management approaches in clinical practice. Contact-killing strategies via dental materials aiming to prevent or at least reduce high numbers of cariogenic bacteria may be a promising approach to decrease caries in patients at high risk.

In situ surface modification on dental composite resin using 2-methacryloyloxyethyl phosphorylcholine polymer for controlling plaque formation

Composite resins (CRs) are widely used as dental restorative materials for caries treatment. They cause problems of secondary caries since Streptococcus mutans stays in the dental plaque, which the surface exists and produces acidic compounds during metabolism. The dental plaque depositions are induced by the protein adsorption on the surface. Therefore, suppression of protein adsorption on the surface of the CRs is important for inhibiting the formation of plaque and secondary caries. In this study we developed a surface treatment to provide an antibiofouling nature to the CRs by chemical reaction with 2-methacryloyloxyethyl phosphorylcholine (MPC) polymers in the oral cavity during dental treatment. To carry out the photochemical reaction on the remaining polymerizable groups of CRs, we synthesized the MPC polymer with a polymerizable group in the side chain. The MPC polymer could bind on the surfaces of the CRs chemically under dental treatment procedures. The treated surface showed significant resistance to oral protein adsorption and bacterial adhesion even when the surface was brushed with a toothbrush. Thus, we concluded that the photochemical reaction of the MPC polymer with the CRs in the oral cavity was good for making an antibiofouling surface and preventing secondary caries.

Application of Antimicrobial Nanoparticles in Dentistry

Oral cavity incessantly encounters a plethora of microorganisms. Plaque biofilm-a major cause of caries, periodontitis and other dental diseases-is a complex community of bacteria or fungi that causes infection by protecting pathogenic microorganisms from external drug agents and escaping the host defense mechanisms. Antimicrobial nanoparticles are promising because of several advantages such as ultra-small sizes, large surface-area-to-mass ratio and special physical and chemical properties. To better summarize explorations of antimicrobial nanoparticles and provide directions for future studies, we present the following critical review. The keywords "nanoparticle," "anti-infective or antibacterial or antimicrobial" and "dentistry" were retrieved from Pubmed, Scopus, Embase and Web of Science databases in the last five years. A total of 172 articles met the requirements were included and discussed in this review. The results show that superior antibacterial properties of nanoparticle biomaterials bring broad prospects in the oral field. This review presents the development, applications and underneath mechanisms of antibacterial nanoparticles in dentistry including restorative dentistry, endodontics, implantology, orthodontics, dental prostheses and periodontal field.

Novel Bioactive and Therapeutic Dental Polymeric Materials to Inhibit Periodontal Pathogens and Biofilms

Periodontitis is a common infectious disease characterized by loss of tooth-supporting structures, which eventually leads to tooth loss. The heavy burden of periodontal disease and its negative consequence on the patient's quality of life indicate a strong need for developing effective therapies. According to the World Health Organization, 10⁻15% of the global population suffers from severe periodontitis. Advances in understanding the etiology, epidemiology and microbiology of periodontal pocket flora have called for antibacterial therapeutic strategies for periodontitis treatment. Currently, antimicrobial strategies combining with polymer science have attracted tremendous interest in the last decade. This review focuses on the state of the art of antibacterial polymer application against periodontal pathogens and biofilms. The first part focuses on the different polymeric materials serving as antibacterial agents, drug carriers and periodontal barrier membranes to inhibit periodontal pathogens. The second part reviews cutting-edge research on the synthesis and evaluation of a new generation of bioactive dental polymers for Class-V restorations with therapeutic effects. They possess antibacterial, acid-reduction, protein-repellent, and remineralization capabilities. In addition, the antibacterial photodynamic therapy with polymeric materials against periodontal pathogens and biofilms is also briefly described in the third part. These novel bioactive and therapeutic polymeric materials and treatment methods have great potential to inhibit periodontitis and protect tooth structures.

Novel dental composite with capability to suppress cariogenic species and promote non-cariogenic species in oral biofilms

Recurrent caries often occurs and is a primary reason for the failure of dental composite restorations. The objectives of this study were to: (1) develop a bioactive composite containing dimethylaminohexadecyl methacrylate (DMAHDM), (2) investigate its antibacterial effects and suppression on biofilm growth, and (3) investigate its ability to modulate biofilm species composition for the first time. DMAHDM was incorporated into a composite at mass% of 0%, 0.75%, 1.5%, 2.25% and 3%. A commercial composite Heliomolar served as a comparative control. A biofilm model consisting of Streptococcus mutans (S. mutans), Streptococcus sanguinis (S. sanguinis) and Streptococcus gordonii (S. gordonii) was tested by growing biofilms for 48 h and 72 h on composites. Colony-forming units (CFUs), metabolic activity and live/dead staining were evaluated. Lactic acid and polysaccharide productions were measured to assess biofilm cariogenicity. TaqMan real-time polymerase chain reaction was used to determine the proportion of each species in the biofilm. DMAHDM-containing composite had a strong anti-biofilm function, reducing biofilm CFU by 2-3 orders of magnitude, compared to control composite. Biofilm metabolic activity, lactic acid and polysaccharides were decreased substantially, compared to control (p < 0.05). At 72 h, the cariogenic S. mutans proportion in the biofilm on the composite with 3% DMAHDM was 19.9%. In contrast, an overwhelming S. mutans proportion of 92.2% and 91.2% existed in biofilms on commercial control and 0% DMAHDM, respectively. In conclusion, incorporating DMAHDM into dental composite: (1) yielded potent anti-biofilm properties; (2) modulated the biofilm species composition toward a non-cariogenic tendency. The new DMAHDM composite is promising for applications in a wide range of tooth cavity restorations to modulate oral biofilm species and combat caries.

Nanoparticles having amphiphilic silane containing Chlorin e6 with strong anti-biofilm activity against periodontitis-related pathogens

OBJECTIVES

The objectives of this study were to: (1) develop the multifunctional nanoparticles containing Chlorin e6 (Ce6), Coumarin 6 (C6) and Fe₃O₄ nanoparticles (NPs); and (2) investigate the inhibitory effects of the nanoparticles via antibacterial photodynamic therapy (aPDT) against three species of periodontitis-related pathogens for the first time.

MATERIALS AND METHODS

Ce6 and C6 were co-loaded into the Fe₃O₄-silane core-shell structure to form multifunctional nanoparticles (denoted "Fe₃O₄-silane@Ce6/C6 MNPs"). The physical and chemical properties of nanoparticles were characterized. Biofilm properties of Streptococcus sanguinis, Porphyromonas gingivalis and Fusobacterium nucleatum were tested. Colony-forming units (CFU), live/dead assay, and metabolic activity of biofilms were determined to evaluate the aPDT function mediated by the Fe₃O₄-silane@Ce6/C6 MNPs. Fluorescence imaging and the targeted antibacterial effects were also investigated.

RESULTS

Fe₃O₄-silane@Ce6/C6 MNPs showed superparamagnetic properties, chemical stability and water-solubility, with no cytotoxicity. Fe₃O₄ NPs did not compromise the emission peaks of C6 and Ce6. The Fe₃O₄-silane@Ce6/C6-mediated aPDT had much greater reduction in biofilms than the control groups (p < 0.05). Biofilm CFU was reduced by about 4-5 orders of magnitude via Fe₃O₄-silane@Ce6/C6-mediated aPDT. The co-loading of Ce6 and C6 enabled the real-time aPDT monitoring by ratio emissions with the same wavelength. Fe₃O₄ with magnetic field enabled the targeting of infection sites by killing bacteria via magnetic field.

CONCLUSION

The multifunctional nanoparticles exerted strong anti-biofilm activity against periodontitis-related pathogens, with excellent biocompatibility, real-time monitoring, and magnetically-targeting capacities. The multifunctional nanoparticles have great potential in antibacterial applications to inhibit the occurrence and progression of periodontitis.

Novel multifunctional nanocomposite for root caries restorations to inhibit periodontitis-related pathogens

OBJECTIVES

The objectives of this study were to: (1) develop a novel multifunctional composite with nanoparticles of silver (NAg), 2-methacryloyloxyethyl phosphorylcholine (MPC), dimethylaminohexadecyl methacrylate (DMAHDM) and nanoparticles of amorphous calcium phosphate (NACP); and (2) investigate biofilm-inhibition via the multifunctional nanocomposite against three species of periodontal pathogens for the first time.

METHODS

The multifunctional nanocomposite was fabricated by incorporating NAg, MPC, DMAHDM and NACP into the resin consisting of pyromellitic glycerol dimethacrylate (PMDGDM) and ethoxylated bisphenol A dimethacrylate (EBPADMA). Three species (Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans and Fusobacterium nucleatum) were tested for metabolic activity (MTT), live/dead staining, polysaccharide production and colony-forming units (CFU) of biofilms grown on resins.

RESULTS

Incorporation of 0.08% to 0.12% NAg, 3% MPC, 3% DMAHDM and 30% NACP did not compromise the mechanical properties of the composite (p > 0.1). The multifunctional nanocomposite reduced protein adsorption to nearly 1/10 of that of a commercial control (p < 0.05). For all three species, the biofilm CFU was reduced by about 5 and 1 orders of magnitude via the nanocomposite containing NAg + MPC + DMAHDM, compared to commercial control and the composite with MPC + DMAHDM, respectively.

CONCLUSIONS

The novel multifunctional nanocomposite achieved the greatest reduction in metabolic activity, polysaccharide and biofilm growth of three periodontal pathogens.

CLINICAL SIGNIFICANCE

The strongly-antibacterial, multifunctional composite is promising for treating root lesions, alleviating periodontitis and protecting the periodontal tissues.

Anti-biofilm efficacy of root canal irrigants against in-situ Enterococcus faecalis biofilms in root canals, isthmuses and dentinal tubules

OBJECTIVE

To investigate the anti-biofilm efficacy of root canal irrigants in canal spaces, isthmi and dentinal tubules of root canals ex vivo.

METHODS

Fifty-one single-rooted premolars, each containing an isthmus, were instrumented, autoclaved and inoculated with Enterococcus faecalis for 4 weeks. One specimen was sectioned for bacteria-specific staining to confirm the presence of biofilms using light microscopiy. The remaining specimens were randomly divided to five groups: (1) 0.9% NaCl, (2) SilverSol/H₂O₂, (3) HYBENX, (4) QMix 2 in1, (5) 6% NaOCl. Bacterial sampling was performed before (S1) and after (S2) canal irrigation. Diluted bacteria suspension was cultured for 48 h for counting the colony forming units (CFU). Percentages of dead bacteria and biofilm thickness were evaluated by confocal laser scanning microscopy (CLSM). Metabolic activity, lactic acid and polysaccharide synthesis of E. faecalis derived from S2 samples were analysed.

RESULTS

The percentages of dead bacteria were significantly affected by the factor "irrigant" (p < 0.001) and the factor "location" (p = 0.017). The percentages of dead bacteria in the isthmi and canals were both in the ordor: NaCl < SilverSol/H₂O₂ < HYBENX < QMix 2 in1 < NaOCl (p < 0.05). Only 6% NaOCl disrupted biofilms and significantly reduced their thickness. The CFU, metabolic activity, polysaccharide and lactic acid production of E. faecalis were all reduced by the disinfecting solutions.

CONCLUSIONS

SilverSol/H₂O₂ and HYBENX were less adept than QMix 2 in1 at killing biofilm bacteria in root canals. None of these antibacterial irrigants were effective, compared with 6% NaOCl, in disrupting biofilms.

CLINICAL SIGNIFICANCE

There is advantage in using HYBENX or QMix 2 in1 to kill intratubular bacteria biofilms because of their capability in removing the inorganic component of the smear layer. SilverSol/H₂O₂ requires extra time to eradicate intratubular biofilms upon removal of the organic and inorganic components of the smear layer by other root canal irrigants.

Protein-repellent nanocomposite with rechargeable calcium and phosphate for long-term ion release

OBJECTIVE

There has been no report on the effect of incorporating protein repellent 2-methacryloyloxyethyl phosphorylcholine (MPC) into a composite containing nanoparticles of amorphous calcium phosphate (NACP) on calcium (Ca) and phosphate (P) ion rechargeability. The objectives of this study were to develop a Ca and P ion-rechargeable and protein-repellent composite for the first time, and investigate the effects of MPC and NACP on mechanical properties, protein-repellency, anti-biofilm effects, and Ca and P ion recharge and re-release.

METHODS

NACP were synthesized using a spray-drying technique. The resin contained ethoxylated bisphenol A dimethacrylate (EBPADMA) and pyromellitic glycerol dimethacrylate (PMGDM). Three NACP composites were made with 0 (control), 1.5%, and 3% of MPC. NACP (20%) and glass particles (50%) were also added into the resin. Protein adsorption was measured using a micro-bicinchoninic acid (BCA) method. A human saliva microcosm biofilm model was used to determine biofilm metabolic activity, lactic acid, and colony-forming units (CFU). Ca and P ion recharge and re-release were measured using a spectrophotometric method.

RESULTS

Flexural strengths and moduli of CaP-rechargeable composites matched those of a commercial composite without CaP rechargeability (p>0.1). Adding 1.5% and 3% MPC reduced protein adsorption to 1/3 and 1/5, respectively, that of commercial composite (p<0.05). Adding 3% MPC suppressed biofilm metabolic activity and lactic acid production, and reduced biofilm CFU by nearly 2 logs. All three NACP composites had excellent ion rechargeability and higher levels of ion re-releases. One recharge yielded continuous ion release for 21 days. The release was maintained at the same level with increasing number of recharge cycles, indicating long-term ion release. Incorporation of MPC did not compromise the CaP ion rechargeability.

SIGNIFICANCE

Incorporating 3% MPC into NACP nanocomposite greatly reduced protein adsorption, biofilm growth and lactic acid, decreasing biofilm CFU by nearly 2 logs, without compromising Ca and P recharge. This protein-repellent NACP-MPC rechargeable composite with long-term remineralization is promising for tooth restorations to inhibit secondary caries.

Developing a New Generation of Therapeutic Dental Polymers to Inhibit Oral Biofilms and Protect Teeth

Polymeric tooth-colored restorations are increasingly popular in dentistry. However, restoration failures remain a major challenge, and more than 50% of all operative work was devoted to removing and replacing the failed restorations. This is a heavy burden, with the expense for restoring dental cavities in the U.S. exceeding $46 billion annually. In addition, the need is increasing dramatically as the population ages with increasing tooth retention in seniors. Traditional materials for cavity restorations are usually bioinert and replace the decayed tooth volumes. This article reviews cutting-edge research on the synthesis and evaluation of a new generation of bioactive dental polymers that not only restore the decayed tooth structures, but also have therapeutic functions. These materials include polymeric composites and bonding agents for tooth cavity restorations that inhibit saliva-based microcosm biofilms, bioactive resins for tooth root caries treatments, polymers that can suppress periodontal pathogens, and root canal sealers that can kill endodontic biofilms. These novel compositions substantially inhibit biofilm growth, greatly reduce acid production and polysaccharide synthesis of biofilms, and reduce biofilm colony-forming units by three to four orders of magnitude. This new class of bioactive and therapeutic polymeric materials is promising to inhibit tooth decay, suppress recurrent caries, control oral biofilms and acid production, protect the periodontium, and heal endodontic infections.

Nanostructured Polymeric Materials with Protein-Repellent and Anti-Caries Properties for Dental Applications

Dental caries is prevalent worldwide. Tooth cavity restorations cost more than $46 billion annually in the United States alone. The current generation of esthetic polymeric restorations have unsatisfactory failure rates. Replacing the failed restorations accounts for 50–70% of all the restorations. This article reviewed developments in producing a new generation of bioactive and therapeutic restorations. This includes: Protein-repellent and anti-caries polymeric dental composites, especially the use of 2-methacryloyloxyethyl phosphorylcholine (MPC) and dimethylaminododecyl methacrylate (DMAHDM); protein-repellent adhesives to greatly reduce biofilm acids; bioactive cements to inhibit tooth lesions; combining protein-repellency with antibacterial nanoparticles of silver; tooth surface coatings containing calcium phosphate nanoparticles for remineralization; therapeutic restorations to suppress periodontal pathogens; and long-term durability of bioactive and therapeutic dental polymers. MPC was chosen due to its strong ability to repel proteins. DMAHDM was selected because it had the most potent antibacterial activity when compared to a series of antibacterial monomers. The new generation of materials possessed potent antibacterial functions against cariogenic and periodontal pathogens, and reduced biofilm colony-forming units by up to 4 logs, provided calcium phosphate ions for remineralization and strengthening of tooth structures, and raised biofilm pH from a cariogenic pH 4.5 to a safe pH 6.5. The new materials achieved a long-term durability that was significantly beyond current commercial control materials. This new generation of bioactive and nanostructured polymers is promising for wide applications to provide therapeutic healing effects and greater longevity for dental restorations.

Trends in restorative composites research: what is in the future?

Clinical trials have identified secondary caries and bulk fracture as the main causes for composite restoration failure. As a measure to avoid frequent reinterventions for restoration replacement, composites with some sort of defense mechanism against biofilm formation and demineralization, as well as materials with lower susceptibility to crack propagation are necessary. Also, the restorative procedure with composites are very time-consuming and technically demanding, particularly concerning the application of the adhesive system. Therefore, together with bulk-fill composites, self-adhesive restorative composites could reduce operator error and chairside time. This literature review describes the current stage of development of remineralizing, antibacterial and self-healing composites. Also, an overview of the research on fiber-reinforced composites and self-adhesive composites, both introduced for clinical use in recent years, is presented.

Do quaternary ammonium monomers induce drug resistance in cariogenic, endodontic and periodontal bacterial species?

OBJECTIVES

Antibacterial monomers were developed to combat oral biofilm acids and caries; however, little is known on whether quaternary ammonium monomers (QAMs) would induce drug resistance in oral bacteria. The objective of this study was to investigate the effects of new antimicrobial monomers dimethylaminohexadecyl methacrylate (DMAHDM) and dimethylaminododecyl methacrylate (DMADDM) on the induction of drug resistance in eight species of cariogenic, endodontic and periodontal bacteria for the first time.

METHODS

Streptococcus mutans (S. mutans), Streptococcus sanguis, Streptococcus gordonii, Enterococcus faecalis (E. faecalis), Aggregatibacter actinomycetemcomitans (A. actinomycetemcomitans), Fusobacterium nucleatum (F. nucleatum), Porphyromonas gingivalis (P. gingivalis), and Prevotella intermedia (P. intermedia) were tested. Minimum inhibitory concentration (MIC) was assessed using chlorhexidine (CHX) as control. Minimal bactericidal concentration (MBC), bacterial growth and membrane permeability properties were also investigated.

RESULTS

CHX induced drug resistance in four species. DMAHDM did not induce any resistance. DMADDM induced drug resistance in only one benign species S. gordonii. The DMADDM-resistant and CHX-resistant S. gordonii had the same MIC and MBC values as S. gordonii parental strain against DMAHDM (p>0.1), hence DMAHDM effectively inhibited the resistant strains. The resistant strains had slower growth metabolism than parental strain.

SIGNIFICANCE

DMAHDM induced no drug resistance, and DMADDM had much less drug resistance than the commonly-used CHX in the eight common oral species. With its potent antimicrobial functions shown previously, the new DMAHDM is promising for applications in restorative, preventive, periodontal and endodontic treatments to combat cariogenic and pathological bacteria with no drug resistance in all tested species.

Developing a New Generation of Antimicrobial and Bioactive Dental Resins

Dental caries is prevalent, and secondary caries causes restoration failures. This article reviews recent studies on developing a new generation of bioactive resins with anticaries properties. Extensive effects were made to develop new antimicrobial composites, bonding agents, and other resins containing quaternary ammonium methacrylates to suppress plaque buildup and bacterial acid production. The effects of alkyl chain length and charge density and the antimicrobial mechanisms for chlorhexidine, nano-silver, quaternary ammonium methacrylates, and protein-repellent agents were discussed. Synergistic effects of contact-killing and protein-repellent properties were shown to yield the greatest biofilm-inhibition effects. The combination of antimicrobial, protein-repellent, and calcium phosphate nanoparticle remineralization was suggested to provide maximal anticaries effects. In addition, for use orally, cytotoxicity and biocompatibility were important considerations for the new bioactive materials. Furthermore, rather than kill all bacteria, it would be more desirable to modulate the oral biofilm compositions via bioactive resins to suppress cariogenic/pathogenic species and promote benign species. For widespread clinical use of the new antimicrobial and therapeutic materials, whether they would induce bacterial drug resistance needs to be determined, which requires further study. Nonetheless, the new generation of bioactive anticaries resins with therapeutic and biofilm acid-inhibiting properties has the potential to substantially benefit oral health.

Combining Bioactive Multifunctional Dental Composite with PAMAM for Root Dentin Remineralization

Objectives. The objectives of this study were to: (1) develop a bioactive multifunctional composite (BMC) via nanoparticles of amorphous calcium phosphate (NACP), 2-methacryloyloxyethyl phosphorylcholine (MPC), dimethylaminohexadecyl methacrylate (DMAHDM) and nanoparticles of silver (NAg); and (2) investigate the effects of combined BMC + poly (amido amine) (PAMAM) on remineralization of demineralized root dentin in a cyclic artificial saliva/lactic acid environment for the first time. Methods. Root dentin specimens were prepared and demineralized with 37% phosphoric acid for 15 s. Four groups were prepared: (1) root dentin control; (2) root dentin with BMC; (3) root dentin with PAMAM; (4) root dentin with BMC + PAMAM. Specimens were treated with a cyclic artificial saliva/lactic acid regimen for 21 days. Calcium (Ca) and phosphate (P) ion concentrations and acid neutralization were determined. The remineralized root dentin specimens were examined via hardness testing and scanning electron microscopy (SEM). Results. Mechanical properties of BMC were similar to commercial control composites (p = 0.913). BMC had excellent Ca and P ion release and acid-neutralization capability. BMC or PAMAM alone each achieved slight mineral regeneration in demineralized root dentin. The combined BMC + PAMAM induced the greatest root dentin remineralization, and increased the hardness of pre-demineralized root dentin to match that of healthy root dentin (p = 0.521). Significance. The excellent root dentin remineralization effects of BMC + PAMAM were demonstrated for the first time. BMC + PAMAM induced effective and complete root dentin remineralization in an acid challenge environment. The novel BMC + PAMAM method is promising for Class V and other restorations to remineralize and protect tooth structures.