Biomimetic remineralization of demineralized dentine using scaffold of CMC/ACP nanocomplexes in an in vitro tooth model of deep caries

Biomimetic mineralization effect of a self-etch adhesive loaded with amorphous fluorinated calcium phosphate nanoparticles

OBJECTIVES

The study investigated the biomimetic mineralization effect of a self-etch adhesive loaded with amorphous fluorinated calcium phosphate (AFCP) nanoparticles.

METHODS

In this study, fluoride was applied to synthesize AFCP nanoparticles, which were characterized by high resolution transmission electron microscope, selected area electron diffraction and Fourier-transform infrared spectroscopy. Subsequently, the self-etch adhesive (Clearfil S3 Bond) was mixed throughly with 20 wt% of AFCP. The single-layer reconstituted collagen fibrils and demineralized dentin were used to investigate the mineralization effects of AFCP nanoparticles as well as Clearfil S3 Bond loaded with AFCP. Moreover, the Cell Counting Kit-8 assay was conducted to evaluate the cytotoxicity of AFCP-loaded adhesive.

RESULTS

The AFCP nanoparticles were successfully synthesized and characterized as an amorphous phase, which demonstrated better effectiveness in collagen fibril mineralization compared to amorphous calcium phosphate nanoparticles. Both AFCP nanoparticles and adhesive loaded with AFCP induced intrafibrillar mineralization of single-layer collagen fibrils. The incorporation of AFCP nanoparticles into adhesive led to the formation of remineralized crystals within the demineralized dentin. Moreover, cytotoxicity tests confirmed the biocompatibility of the AFCP-loaded adhesive.

CONCLUSIONS

The incorporation of AFCP nanoparticles into the self-etch adhesive facilitated collagen fibril mineralization and remineralization of demineralized dentin.

CLINICAL SIGNIFICANCE

Incorporating fluoride, a commonly used anti-caries element, into the self-etch adhesive in the form of AFCP nanoparticles enables its biomimetic mineralization in restorative treatments, presenting a potential approach for developing a novel adhesive system to prevent dental caries clinically.

Injectable in situ forming hydrogel based on carboxymethyl chitosan for sustained release of hyaluronic acid: A viscosupplement for biomedical applications

The reduction in hyaluronic acid concentration and viscosity in the synovial fluid of patients struggling with osteoarthritis increases the abrasion of articular cartilage. The aim of this study was to design a semi-IPN hydrogel based on genipin-crosslinked carboxymethyl chitosan (CMCh) and glycerol to achieve long-term release of hyaluronic acid. The results showed that hydrogel comprising CMCh (3 % wt.), HA (0.3 % wt.), and glycerol (1.25 % wt.), with high structural sustainability (over 45 % within 30 days of exposure to PBS/lysozyme medium), swelling ratio of 368.6 %, compression modulus of 8.4 kPa, elongation at break of 64.4 %, and cell viability of >90 % (in 48 h exposure), provides a long retention time and release of HA, which leads to gradual absorption, minimizes pain, and maintains joint mobility, as well as preventing multiple injections. The non-Newtonian behavior of the hydrogel (before crosslinking) along with the favorable gelation time help the viscosupplement to be easily injected and then maintain its position till the end of the crosslinking process within 18min. Considering all the data obtained, it is hypothesized that the optimum sample, namely CHG4Gly1.25, resulting in excellent injectability and moldability, can serve as a novel and promising substrate for biomaterial applications.

Next-Generation Biomaterials for Vital Pulp Therapy: Exploring Biological Properties and Dentin Regeneration Mechanisms

The advancement of Vital Pulp Therapy (VPT) in dentistry has shown remarkable progress, with a focus on innovative materials and scaffolds to facilitate reparative dentin formation and tissue regeneration. A comprehensive search strategy was performed across PubMed, Scopus, and Web of Science using keywords such as "vital pulp therapy", "biomaterials", "dentin regeneration", and "growth factors", with filters for English language studies published in the last 10 years. The inclusion criteria focused on in vitro, in vivo, and clinical studies evaluating traditional and next-generation biomaterials for pulp capping and tissue regeneration. Due to the limitations of calcium-based cements in tissue regeneration, next-generation biomaterials like gelatin, chitosan, alginate, platelet-rich fibrins (PRF), demineralized dentin matrix (DDM), self-assembling peptides, and DNA-based nanomaterials were explored for their enhanced biocompatibility, antibacterial properties, and regenerative potential. These biomaterials hold great potential in enhancing VPT outcomes, but further research is required to understand their efficacy and impact on dentin reparative properties. This review explores the mechanisms and properties of biomaterials in dentin tissue regeneration, emphasizing key features that enhance tissue regeneration. These features include biomaterial sources, physicochemical properties, and biological characteristics that support cells and functions. The discussion also covers the biomaterials' capability to encapsulate growth factors for dentin repair. The development of innovative biomaterials and next-generation scaffold materials presents exciting opportunities for advancing VPT in dentistry, with the potential to improve clinical outcomes and promote tissue regeneration in a safe and effective manner.

Effect of Bioactive Glass into Mineral Trioxide Aggregate on the Biocompatibility and Mineralization Potential of Dental Pulp Stem Cells

Introduction: Previous studies have shown that bioactive glass (BG) can enhance the formation of hydroxyapatite under simulated body fluid (SBF) conditions when combined with mineral trioxide aggregate (MTA). This study aims to assess the impact of BG-supplemented MTA on the biocompatibility and mineralization potential of dental pulp stem cells (DPSCs). Methods: We prepared ProRoot MTA (MTA) and MTA supplemented with 2% and 4% BG. Five passages of DPSCs were utilized for the experiments. The DPSCs were subjected to various tests to determine their morphology, viability, cell migration, and adhesion assay. Additionally, mineralization ability was assessed through SBF immersion treatment, alkaline phosphatase (ALP) activity test, Alizarin red S (ARS) staining, and real-time quantitative polymerase chain reaction (RT-qPCR) analysis. Results: The biocompatibility of BG-supplemented MTA was found to be comparable to that of conventional MTA, as demonstrated by the cell counting kit-8 (CCK-8) assay, cell migration, adhesion assays, and cell morphology on cement surfaces. Under SBF treatment, MTA supplemented with BG, particularly at a concentration of 4%, exhibited higher mineralization potential than conventional MTA in the ALP activity assay. This was supported by denser ARS staining, increased ALP activity, and higher expression of dentin sialophosphoprotein (DSPP), ALP, and bone morphogenetic protein-2 (BMP-2) in the SBF-treated MTABG group. Conclusion: Our study revealed that the biocompatibility of BG-supplemented MTA is similar to that of conventional MTA. Additionally, under SBF treatment, BG-supplemented MTA displayed enhanced mineralization potential, indicating that BG supplementation can augment the mineralization capabilities of MTA.

Evaluation of Physical Properties in Carboxymethyl Chitosan Modified Glass Ionomer Cements and the Effect for Dentin Remineralization: SEM/EDX, Compressive Strength, and Ca/P Ratio

OBJECTIVE

 The aim of this article was to evaluate the effects of modifying glass ionomer cement (GIC) with carboxymethyl chitosan (CMC) on surface morphology and remineralization outcomes by examining dentin morphology and calcium ion composition changes.

MATERIALS AND METHODS

 Thirty holes in a cylindrical acrylic mold were filled with three groups of restorative materials: GIC, GIC modified with CMC (GIC-CMC) 5%, and GIC-CMC10%. The surface morphology of each group's materials was observed using scanning electron microscopy (SEM). The compressive strength measurement was performed using a universal testing machine. The dentin remineralization process was performed by applying GIC, GIC-CMC5%, and GIC-CMC10% materials for 14 days on demineralized dentin cavities treated with 17% ethylenediamine tetraacetic acid (EDTA) for 7 days. A morphological evaluation was conducted using SEM. The calcium ion composition and calcium-to-phosphorous (Ca/P) ratio were examined using an energy-dispersive X-ray (EDX).

STATISTICAL ANALYSIS

 The one-way ANOVA and post-hoc Bonferroni test were used to evaluate the compressive strength within the three groups (p < 0.05). The Kruskal-Wallis and subsequent Mann-Whitney U tests were conducted to compare the four groups of calcium ions (p < 0.05).

RESULTS

 The modification of GIC with CMC affected the morphological changes in the materials in the form of reduced porosity and increased fractures. A significant difference was found in compressive strength between the GIC-CMC modification materials of GIC-CMC5% and GIC-CMC10% and the GIC control group. The dentin tubule morphology and surface changes were observed after applying GIC, GIC-CMC5%, and GIC-CMC10% materials for 14 days, as evaluated by SEM. The EDX examination showed an increase in calcium ion content and hydroxyapatite formation (Ca/P ratio) after applying the GIC-CMC10% material.

CONCLUSION

 The surface porosity of the GIC modification material with the addition of CMC tended to decrease. However, an increase in cracked surfaces that widened, along with the rise in CMC percentage, was found. This modification also reduced the compressive strength of the materials, with the lowest average yield at 10% CMC addition. Therefore, the modification of GIC with CMC affects changes in morphology, calcium ion composition, and Ca/P ratio in demineralized dentin.

Preparation of CMC/ACP/PHMB nanocomposites and preliminary study on their antibacterial and remineralization functions

Caries is a chronic oral disease causing a series of complications. This study aims to develop a material that could remineralize demineralized enamel and simultaneously exert antibacterial effects. A carboxymethyl chitosan (CMC)/amorphous calcium phosphate (ACP)/polyhexamethylene biguanide hydrochloride (PHMB) nanocomposite was synthesized for the first time, and its stability, remineralization ability, and antibacterial properties were investigated in this study. PHMB has excellent antibacterial properties, was used as an additive to stabilize ACP. The enamel surface covered with CMC/ACP/PHMB showed a uniform layer with a similar elemental ratio to that of natural hydroxyapatite and the ratio of crystal diffraction peaks was close to that of natural enamel. The mechanical properties, including hardness and elastic modulus, of the enamel in all experimental groups were restored. The antibacterial effect of 240 mg/L CMC/ACP/PHMB was comparable to that of 0.12% CMC/ACP/chlorhexidine. This study provides a theoretical and experimental basis for the development of novel dual-function anticaries agent.

Nanomaterial-based synergistic strategies for combating dental caries: progress and perspectives

Dental caries, as the predominant global oral disease, remains a critical public health issue worldwide, particularly in socioeconomically disadvantaged communities. However, common caries prevention approaches (e.g., oral health education, mechanical plaque removal, and delivery of fluoride agents) are still insufficient for optimal caries management, and therefore, alternative regimens that can supplement existing strategies are highly warranted. Nanomaterials exhibit considerable potential in combating cariogenic pathogens and biofilms owing to their promising antimicrobial capacity, improved penetration into biofilms, targeted precision delivery, and versatile physicochemical properties. As unifunctional materials are limited in caries management, this review underscores the latest advancement in multifunctional anti-caries nanomaterials/nanomedicines. It highlights the cutting-edge materials developed or engineered to (i) incorporate diagnostic capabilities to prevent caries at an early stage, thus enhancing treatment efficiency, (ii) integrate mechanical "brushing" with anti-caries approaches to mechanochemically eradicate biofilms, (iii) exert antimicrobial/antibiofilm effects while preserving dental hard tissue. The current work also outlines future directions for optimizing nanosystems in the management of dental caries while emphasizing the need for innovative solutions to improve preventive and therapeutic efficacies.

3D Printing of a Self-Healing, Bioactive, and Dual-Cross-Linked Polysaccharide-Based Composite Hydrogel as a Scaffold for Bone Tissue Engineering

Although 3D printing is becoming a dominant technique for scaffold preparation in bone tissue engineering (TE), developing hydrogel-based ink compositions with bioactive and self-healing properties remains a challenge. This research focuses on developing a bone scaffold based on a composite hydrogel, which maintains its self-healing properties after incorporating bioactive glass and is 3D-printable. The plain hydrogel ink was synthesized using natural polymers of 1 wt % N-carboxyethyl chitosan, 2 wt % hyaluronic acid aldehyde, 0.3 wt % adipic acid hydrazide, and alginate (ALG) (2, 5, and 10 wt %). Bioactive glass (BG) (0 and 5 w/v %) particles were incorporated into the plain matrix to obtain an osteogenic composite hydrogel. The material was characterized via rheology, field emission scanning electron microscopy/energy-dispersive X-ray spectroscopy (FESEM/EDS), Fourier transform infrared (FTIR) spectroscopy, X-ray diffraction (XRD), swelling, degradation, bioactivity, and in vitro cellular assessments. Rheological evaluations confirmed that the specimen with 0 w/v % BG and 5 wt % ALG exhibited the highest G', G″, and viscosity values. All specimens exhibited self-healing, provided by two reversible dynamic bonds, namely, imine and acylhydrazone. Bioactivity evaluation by SBF immersion revealed the formation of HA particles on the composite hydrogels. MTT cytotoxicity assay on MG63 indicated that the composite sample containing 5 w/v % BG and 10 wt % ALG had the highest cell viability (95 ± 1.02%) by culture day 3. The developed approach presents a promising hydrogel ink formulation with a high potential for extrusion-based 3D printing of bone TE constructs.

Nanoparticles Induced Biomimetic Remineralization of Acid-Etched Dentin

Statement of the Problem

Dentin bonding with etch-and-rinse adhesives involves demineralizing the 5-8µm of the surface dentin to create micro space for resin infiltration. The presence of continuous fluid movement in dentin tubules and positive pulpal pressure prevents complete water replacement by resin monomers. This results in areas of demineralized dentin, which contain collagen fibers without resin infiltration. The exposed collage fibers are subjected to enzymatic degradation leading to less durable hybrid layer.

Purpose

The aim of this study was to evaluate the remineralizing effect of the nanoparticles on the resin dentin bonding interface.

Materials and Method

The three experimental remineralizing nanoparticles were characterized for their morphology, size, and composition. A total of 48 extracted non-carious human third molar teeth were sectioned at 2 mm below the cemento enamel junction. Class I cavity was prepared and the tooth samples were placed in an intra pulpal pressure simulation device. After etching of the prepared cavity, the samples were randomly divided into four groups (n=10) as follows: (1) control group(c) (n=10) (2) Nano-hydroxyapatite (nHAP) (n=10) (3) Chitosan-nanohydroxyapatite (Chi-nHAP) (n=10) (4) Mesoporous silica-hydrox-yapatite (MS-nHAP) (n=10). After 30 days remineralization period, the samples were evaluated for micro tensile bond strength, hybrid layer morphology, and mineral composition of the hybrid layer. The results were analyzed statistically by one-way ANOVA and Tukey's multiple post hoc tests.

Results

Scanning electron microscopic observation of nanoparticles revealed irregular particle shapes with calcium phosphate ratio of 1.60. The zeta analyzer showed a mean diameter of 161.0 nm, 323.0nm, 185.0nm for nHAP, Chi-nHAP, and MS-nHAP respectively. Post hoc Bonferroni test revealed significantly higher bond strength for nHAP, Chi-nHAP, and MS-nHAP when compared to control group. MS-nHAP resulted in the uniform deposition of apatite crystal on the surface without any evidence of dentinal tubules openings and had higher mineral to matrix ratio compared to other groups.

Conclusion

MS-nHAP nanoparticles can be considered as a reliable source of calcium and phosphate for biomimetic remineralization of hybrid layer. Application of nanoparticle remineralization precursors before application of dentin bonding agents results in remeralization of exposed collagen fibers thereby improving the clinical longevity of hybrid layer.

Unraveling Nanomaterials in Biomimetic Mineralization of Dental Hard Tissue: Focusing on Advantages, Mechanisms, and Prospects

The demineralization of dental hard tissue imposes considerable health and economic burdens worldwide, but an optimal method that can repair both the chemical composition and complex structures has not been developed. The continuous development of nanotechnology has created new opportunities for the regeneration and repair of dental hard tissue. Increasingly studies have reported that nanomaterials (NMs) can induce and regulate the biomimetic mineralization of dental hard tissue, but few studies have examined how they are involved in the different stages, let alone the relevant mechanisms of action. Besides their nanoscale dimensions and excellent designability, NMs play a corresponding role in the function of the raw materials for mineralization, mineralized microenvironment, mineralization guidance, and the function of mineralized products. This review comprehensively summarizes the advantages of NMs and examines the specific mineralization mechanisms. Design strategies to promote regeneration and repair are summarized according to the application purpose of NMs in the oral cavity, and limitations and development directions in dental hard tissue remineralization are proposed. This review can provide a theoretical basis to understand the interaction between NMs and the remineralization of dental hard tissue, thereby optimizing design strategy, rational development, and clinical application of NMs in the field of remineralization.

Carboxymethyl chitosan stabilized AuNPs/ACP nanohybrids in enamel white spot lesions

Acidic bacterial biofilms-associated enamel white spot lesions (WSLs) are one of the hallmarks of early caries, causing demineralization and decomposition of dental hard tissues. Therefore, to effectively prevent and treat WSLs, it is important to inhibit the activity of cariogenic bacteria while promoting the remineralization of demineralized enamel. Amorphous calcium phosphate (ACP) favors hard tissue remineralization due to its biological activity and ability to release large amounts of Ca2+ and PO4 3-. However, ACP-based biomineralization technology is not effective due to its lack of antimicrobial properties. Here, carboxymethyl chitosan (CMCS) was employed as a reducing agent and stabilizer, and dual-functional nanohybrids CMCS/AuNPs/ACP with biofilm resistance and mineralization properties were successfully synthesized. The addition of AuNPs enhances the antimicrobial activity and participates in regulating the formation of hydroxyapatite (HAp). The nanohybrids exhibited significant destructive effects against cariogenic bacteria and their biofilms and showed bactericidal activity under bacteria-induced acidic conditions. More importantly, this nanohybrids showed superior results in promoting the remineralization of demineralized enamel, compared to fluoride and CMCS/ACP in vitro. The CMCS/AuNPs/ACP nanohybrids not only reverse the cariogenic microenvironment at the microbial level, but also promote self-repairing of enamel WSLs regarding the microstructure. The present work offers a theoretical and experimental basis for using the CMCS/AuNPs/ACP nanohybrids as a potential dual-functional agent for the clinical treatment of enamel WSLs.

Design and Characterization of Chitosan-Based Smart Injectable Hydrogel for Improved Sustained Release of Antinarcotics

The treatment adherence of narcotics-addicted individuals with reduced incidences of relapse can be enhanced by a sustained drug release formulation of antinarcotics. So far, different drug formulations have been reported with sustained drug release periods of 28 and 35 days. To further enhance this duration, different formulations of injectable hydrogels (IHs) have been developed by combining low molecular weight (LMW) and high molecular weight (HMW) chitosan (CS) with guar gum (GG) and crosslinking them by sodium bi phosphate dibasic. The structural, morphological, and physicochemical properties of LMW-CS IH, and HMW-CS IH were evaluated using Fourier transform infrared spectroscopy (FT-IR), thermo-gravimetric analysis (TGA), scanning electron microscopy (SEM), and rheological, swelling, and biodegradation analysis. The HMW-CS IH showed high crosslinking, increased thermal stability, high mechanical strength, elevated swelling, and low biodegradation. The antinarcotic drugs naltrexone (NTX) and disulfiram (DSF) were loaded separately into the HMW-CS IH and LMW-CS IH. The release of NTX and DSF was investigated in phosphate buffer saline (PBS) and ethanol (0.3%, 0.4%, and 0.5%) over a 56-day period using an UV spectrophotometer. The drug release data were tested in zero-order, first-order, and Korsemeyer-Peppas mathematical models. In PBS, all prepared formulations followed non-Fickian drug release, while in ethanol, only NTX HMW-CS IH followed non-Fickian release in all three different concentrations of ethanol.

Biomimetic dentin remineralization using eggshell derived nanohydroxyapatite with and without carboxymethyl chitosan - An in vitro study

The objective of this study was to evaluate the synergistic effect of eggshell-derived nanohydroxyapatite (EnHA) and carboxymethyl chitosan (CMC) in remineralizing artificially induced dentinal lesions. EnHA and CMC were synthesized using simple chemical processes and characterized using FTIR, XRD, HRSEM-EDX, TEM, DLS and TGA/DTA analyses. A total of 64 pre-demineralized coronal dentin specimens were randomly subjected to following treatments (n = 16):artificial saliva (AS), EnHA, CMC, and EnHA-CMC, followed by pH cycling for 7 days. HRSEM-EDX, Vickers-indenter, and micro-Raman analyses were used to assess surface-topography, microhardness, and chemical analysis, respectively. All tested materials demonstrated non-cytotoxicity when assessed on hDPSCs using MTT assay. FTIR, XRD and thermal analyses confirmed the characteristics of both EnHA and CMC. EnHA showed irregular rod-shaped nanoparticles (30-70 nm) with the presence of Ca,P,Na, and Mg ions. Dentin treated with EnHA-CMC exhibited complete tubular occlusion and highest microhardness whereas the AS group revealed the least mineral deposits (p < 0.05). No significant differences were observed between EnHA and CMC groups (p > 0.05). In addition, molecular conformation analysis revealed peak intensities in collagen's polypeptide chains in dentin treated with CMC and EnHA-CMC, whereas other groups showed poor collagen stability. The results highlighted that EnHA-CMC aided in rapid and effective biomineralization, suggesting its potential as a therapeutic solution for treating dentin caries.

Application of Nanomaterials in Endodontics

Recent advancements in nanotechnology have introduced a myriad of potential applications in dentistry, with nanomaterials playing an increasing role in endodontics. These nanomaterials exhibit distinctive mechanical and chemical properties, rendering them suitable for various dental applications in endodontics, including obturating materials, sealers, retro-filling agents, and root-repair materials. Certain nanomaterials demonstrate versatile functionalities in endodontics, such as antimicrobial properties that bolster the eradication of bacteria within root canals during endodontic procedures. Moreover, they offer promise in drug delivery, facilitating targeted and controlled release of therapeutic agents to enhance tissue regeneration and repair, which can be used for endodontic tissue repair or regeneration. This review outlines the diverse applications of nanomaterials in endodontics, encompassing endodontic medicaments, irrigants, obturating materials, sealers, retro-filling agents, root-repair materials, as well as pulpal repair and regeneration. The integration of nanomaterials into endodontics stands poised to revolutionize treatment methodologies, presenting substantial potential advancements in the field. Our review aims to provide guidance for the effective translation of nanotechnologies into endodontic practice, serving as an invaluable resource for researchers, clinicians, and professionals in the fields of materials science and dentistry.

Assessment of physical properties of bioactive glass-modified universal multimode adhesive and its bonding potential to artificially induced caries affected dentin

BACKGROUND

To evaluate the physical properties of bioactive glass-modified universal multimode adhesive and its micro-tensile bond strength (µTBS) to artificially induced caries-affected dentin.

METHODS

All bond universal adhesive was used in the study. Specimens were divided into 2 main groups: control unmodified adhesive and 5 wt% BAG modified adhesive. The degree of conversion, pH, bioactivity, and viscosity of the adhesives were tested with n = 5 for each test. Micro-tensile bond strength evaluation was done in etch & rinse (ER) and selective-etch (SE) modes, where 24 human molar teeth were used (n = 3), 12 teeth for immediate bond strength, and the other 12 were tested after 6 months of storage in simulated body fluid (SBF).

RESULTS

No significant difference was found between the control and the 5wt% BAG groups regarding the degree of conversion (61.01 ± 0.43 and 60.44 ± 0.61 respectively) and the viscosity (109.77 ± 22.3 and 124.3 ± 9.92 respectively). The control group revealed significantly lower pH values than the 5wt% BAG group (3.16 ± 0.5 and 4.26 ± 0.09 respectively). Immediate bond strength results revealed that the 5wt% BAG in the ER mode had the highest bond strength followed by the control group in the ER mode (44.16 ± 7.53 and 44.00 ± 7.96 respectively). SE groups showed that the immediate strength of the 5wt% BAG group was higher than the control group (42.09 ± 6.02 and 39.29 ± 6.64 respectively). After 6 months of storage, bond strength results revealed a decrease in bond strength values for the control groups but not for the 5wt% BAG in both application modes.

CONCLUSIONS

The incorporation of BAG (5wt%) improved the universal adhesive micro-tensile bond strength and bond durability for both adhesive application modes without affecting its degree of conversion or viscosity.

Combination of self-assembling system and N,O-carboxymethyl chitosan improves ocular residence of anti-glaucoma drug

Glaucoma is known to be one of the principal causes of vision loss due to elevated intraocular pressure. Currently, latanoprost eye drops is used as first-line treatment for glaucoma; however, it possesses low bioavailability due to rapid precorneal clearance. A novel delivery system with a mucoadhesive property could overcome this problem. Therefore, we attempt to develop a combination of self-assembling latanoprost nanomicelles (Latcel) and a mucoadhesive polymer (N,O-carboxymethyl chitosan: N,O-CMC) to improve the corneal residence time. Latcel was developed using Poloxamer-407 by thin film hydration method, followed by the addition of N,O-CMC using simple solvation to obtain Latcel-CMC and characterized using various physicochemical characterization techniques. The particle size of Latcel-CMC was 94.07 ± 2.48 nm and a zeta potential of -16.03 ± 0.66 mV, with a sustained release for 24h whereas marketed latanoprost drops released 90 % of the drug within 1h. In vitro cytotoxicity studies, HET-CAM, and in vivo Draize test showed the biocompatibility of Latcel-CMC. Cellular uptake studies performed using fluorescein isothiocyanate (FITC) loaded nanomicelles in human corneal epithelial cells indicates the increased cellular uptake as compare to plain FITC solution. In vivo ocular residence time was evaluated in Wistar rats using Indocyanine green (ICG) loaded nanomicelles by an in vivo imaging system (IVIS), indicating Latcel-CMC (8h) has better residence time than plain ICG solution (2h). The Latcel-CMC showed improved corneal residence time and sustained release of latanoprost due to increased mucoadhesion. Thus, the developed N,O-Carboxymethyl chitosan based nanomicelles eye drop could be a better strategy than conventional eye drops for topical delivery of latanoprost to treat glaucoma.

Zizyphus mauritiana seed extract: Paving the way for next-generation bone constructs with nano-fluorohydroxyapatite/carboxymethyl chitosan nanocomposite scaffold

This is the first study that explored the potential use of Zizyphus mauritiana seed extract (ZSE) to synthesize nano-fluorohydroxyapatite/carboxymethyl chitosan nanocomposite scaffolds at different concentrations (CFZ1, CFZ2 and CFZ3) using co-precipitation method. The proposed scaffolds showed presence of intermolecular H bonding interactions between the constituents, according to the FTIR. The mechanical studies revealed shore hardness of 72 ± 4.6 and optimal compressive modulus in case of CFZ3 [1654.48 ± 1.6 MPa], that was comparable with that of human cortical bone. The SEM, TEM and platelet adhesion images corroborated uniformly distributed needle like particles in case of CFZ3 with an average size ranging from 22 to 26 nm, linked rough morphology, and appropriate hemocompatibility. The markedly up regulation in the ALP activity and protein adsorption upon increasing ZSE concentration demonstrated that CFZ nanocomposite scaffolds were compatible with osteoblastic cells relative to CF nanocomposite. The cytotoxicity study indicated that CFZ nanocomposite do not induce toxicity over MG-63 and did not aggravate LDH leakage in contrast to CF. The histopathological investigations on albino rats confirmed significantly improved regeneration of bone in the repair of a critical-size [8 mm] calvarium defect. Therefore, CFZ3 nanocomposite scaffold represents a simple, off-the-shelf solution to the combined challenges associated with bone defects.

Biomineralization of calcium phosphates functionalized with hydroxyapatite-binding peptide

Functionalization of calcium phosphates with biomimetic peptides is a promising strategy to increase cellular response for bone tissue repair. In this work, biphasic calcium phosphate pellets were functionalized with the hydroxyapatite-binding peptide pVTK by dropping a suspension of the peptide on the pellet surface. The bioactivity tests were performed in vitro by using McCoy culture medium. Cytotoxicity tests were also performed to assess cell viability. The material was characterized by X-ray diffraction (XRD), Fourier transform infrared spectroscopy (FTIR) and scanning electron microscopy with field emission gun (FEG-SEM). The results showed that functionalization with the biomimetic peptide was most effective in inducing precipitation of bone-like apatite on the pellets surface, when compared to the control groups (two positive control groups and one negative control group). Cytotoxicity tests showed that all samples are biocompatible but the pellets with peptide showed the highest values of cell viability.

Chitosan as a biomaterial for the prevention and treatment of dental caries: antibacterial effect, biomimetic mineralization, and drug delivery

Dental caries is a chronic, progressive disease caused by plaque, influenced by multiple factors and can damage the hard tissues of the teeth. In severe cases, it can also lead to the onset and development of other oral diseases, seriously affecting patients' quality of life. The creation of effective biomaterials for the prevention and treatment of dental caries has become one of the relentless goals of many researchers, with a focus on inhibiting the production of cariogenic plaque and retaining beneficial bacteria, guiding and promoting the reconstruction of dental hard tissues, and delaying the progression of existing caries. Chitosan is a natural cationic polymer extracted from the shells of crustaceans and shellfish. Since its discovery, chitosan has shown to have various biological functions such as antibacterial, biomimetic mineralization, drug delivery, etc., making it one of the most promising biopolymers for new caries prevention and materials of prostheses. Therefore, this article provides an overview of the anti-caries applications of chitosan, which mainly covers the basic research on the application of chitosan in caries prevention and treatment since 2010, with a focus on categorizing and summarizing the following characteristics of chitosan as a caries prevention material, including its antibacterial effect, biomimetic mineralization effect and delivery ability of caries prevention drugs and vaccines. It also explores the limitations of current research on chitosan as a caries prevention biomaterial and the difficulties that need to be focused on and overcome in the future to provide theoretical reference for the clinical implementation of chitosan as a caries prevention biomaterial.

Application of Mineralized Chitosan Scaffolds in Bone Tissue Engineering

Chitosan (CS) is a natural cationic polysaccharide obtained via the N-deacetylation of chitin. It has various outstanding biological properties such as nontoxicity, biodegradability, biocompatibility, and antimicrobial properties. Minerals can be deposited on the CS template using different methods to construct composites with structures and functions similar to those of natural bone tissue. These ideal scaffolds can produce bone via osteogenesis, osteoinduction, and osteoconduction, with good biocompatibility and mechanical properties, and are thus considered promising novel biomaterials for repairing hard tissue defects. In the last decade, the field of mineralized CS scaffolds has provided novel fundamental knowledge and techniques to better understand the aforementioned fascinating phenomenon. This study mainly focused on the basic structures and properties of mineralized CS scaffolds to understand the current research progress and explore further development. Further, it summarizes the types, preparation methods, components, properties, and applications of mineralized CS scaffolds in bone tissue engineering during the last 5 years. The defects and shortcomings of the scaffolds are discussed, and possible improvement measures are put forward. We aimed to provide complete research progress on mineralized CS scaffolds in bone tissue engineering for researchers and clinicians, and also ideas for the next generation of mineralized CS scaffolds.

Carboxymethyl Chitosan-Fluoride-doped Amorphous Calcium Phosphate: A Novel Remineralizing Gel

Background

There is a need for innovative remineralizing gel formulations based on calcium and phosphates that can slowly release fluoride ions and enhance the formation of fluorapatite crystals that are more resistant to dissolution in an acidic environment.

Aim

The aim of the work was to formulate a remineralizing agent that remineralizes enamel through the release of Ca2+, PO₄³-, and F- ions for a prolonged period of time.

Materials and methods

The gel was based on carboxymethyl chitosan (CMC) as a bioinspired gelling agent and on Fluoride-doped Amorphous Calcium Phosphate (F-ACP) as a remineralizing agent. This gel was tested in vitro on the enamel of extracted premolars after demineralization with methacrylic acid gel.

Results

When compared to the control group and demineralized enamel group, the enamel slabs remineralized with CMC/F-ACP showed a higher calcium phosphate ratio in Energy-Dispersive X-ray (EDX) and better surface morphology under scanning electron microscope (SEM).

Conclusion

Remineralization tests performed on demineralized human permanent teeth proved that CMC/F-ACP gel has excellent efficacy, inducing a complete remineralization of the outermost layers of enamel as well as a full restoration of lost mineral content.

How to cite this article

Nimbeni BS, Nimbeni SB, Divakar DD, et al. Carboxymethyl Chitosan-Fluoride-doped Amorphous Calcium Phosphate: A Novel Remineralizing Gel. Int J Clin Pediatr Dent 2023;16(5):734-739.

Comparison of therapies of white spot lesions: a systematic review and network meta-analysis

OBJECTIVE

White spot lesions (WSLs), the earliest evidence of enamel demineralization, are considered amenable to intervention to achieve a remineralized or arrested state of caries. The management of WSLs is quite challenging, and there is no definitive cure as yet. We performed a network meta-analysis to assess the efficacy of seven therapies for WSLs and gave a hierarchy of them.

MATERIALS AND METHODS

We systematically searched the PubMed, EMBASE, Cochrane, and Web of Science databases (last search: July 2022) to identify all relevant studies. We limited our search to studies published in English. Randomized controlled designed in vitro/clinical trials related to the efficacy of the seven therapies for WSLs were included. Data extraction was performed independently by two reviewers. The risk of bias (ROB) 2.0 tool from Cochrane and a previous in vitro methodological tool will be used for the quality assessment. Variations in quantitative light-induced fluorescence (QLF), laser fluorescence (LF), and lesions area were the primary outcome measures. Standard mean difference (SMD) was used as the effect size for the Network meta-analysis (NMA). Consistency and inconsistency tests were conducted. The hierarchy of 7 treatment effects was evaluated using surface probabilities under cumulative ranking (SUCRA). Publication bias was evaluated using a bias plot.

RESULTS

Forty-two articles were included in the systematic review. Thirty-one of them, with a total of 1906 participants, were included in the network meta-analysis. The studies owned a low and moderate risk of bias. This analysis does not suffer from significant inconsistency. The difference between 4 groups 'self-assembled peptide (SAP) P11-4', 'P11-4 + Fluoride Varnish (FV)', 'Resin Infiltration (RI)', 'casein phosphor peptides-amorphous calcium fluoride phosphate (CPP-ACFP)' and the 'Control' group was found to be statistically significant. Compared to the 'FV' and 'casein phosphor peptides-amorphous calcium phosphate (CPP-ACP)' groups, the 'P11-4 + FV" group and 'RI" group made a significant difference. The hierarchy was evident in the SUCRA values of 7 therapies. P11-4 + FV and RI were considered effective therapies compared to the control group or the FV group (gold standard group).

CONCLUSIONS

The available evidence suggests that resin infiltration and P11-4 in combination with fluoride varnish had advantages over gold standard (FV). The effect of tricalcium phosphate-based drugs and fluoride is not very noticeable. Overall, drugs based on P11-4 and resin infiltration will be better therapies. Using more than two drugs in combination also would increase efficacy.

Remineralization of Dentinal Lesions Using Biomimetic Agents: A Systematic Review and Meta-Analysis

The objective of this article was to systematically provide an up-to-date review on the different methods of remineralizing human dentine using different biomimetic agents. The authors performed a systematic search within PubMed, Scopus, and Web of Science in addition to the grey literature in Google Scholar^® using MeSH terms. The PICO question was P: human teeth dentinal sections; I: application of biomimetic remineralizing agents; C: other non-biomimetic approaches; O: extent of remineralization and physical properties of remineralized dentine. The initially identified studies were screened for titles and abstracts. Non-English articles, reviews, animal studies, studies involving the resin-dentine interface, and other irrelevant articles were then excluded. The other remaining full-text articles were retrieved. Bibliographies of the remaining articles were searched for relevant studies that could be included. A total of 4741 articles were found, and finally, 39 full-text articles were incorporated in the current systematic review. From these, twenty-six research studies used non-collagenous protein (NCP) analogs to biomineralize dentine, six studies used bioactive materials derived from natural sources, six studies used zinc hydroxyapatite, and one study used amelogenin peptide to induce hydroxyapatite formation on the surface of demineralized dentine. Additive effects of triclosan and epigenin were assessed when combined with commonly available NCPs. Overall, a moderate risk of bias was observed and, hence, the findings of the included studies could be acceptable. A meta-analysis of some similar studies was performed to assess the depth of remineralization and elastic modulus. Despite having high heterogeneity (I² > 90), all the studies showed a significant improvement in biomimetic remineralization efficacy as compared to the control. All the included studies carried out a functional remineralization assessment and found a 90-98% efficacy in the extent of remineralization while the elastic modulus reached 88.78 ± 8.35 GPa, which is close to natural dentine. It is pertinent to note the limitations of these studies that have been carried out in vitro under controlled settings, which lack the effects of a natural oral environment. To conclude, the authors suggest that the biomimetic remineralization of dentine using NCP analogs, bioactive materials, and natural products carries significant potential in treating dentinal lesions; however, more long-term studies are needed to assess their clinical applications in vivo.

Intrafibrillar Mineralization and Immunomodulatory for Synergetic Enhancement of Bone Regeneration via Calcium Phosphate Nanocluster Scaffold

Inspired by the bionic mineralization theory, organic-inorganic composites with hydroxyapatite nanorods orderly arranged along collagen fibrils have attracted extensive attention. Planted with an ideal bone scaffold will contribute greatly to the osteogenic microenvironment; however, it remains challenging to develop a biomimetic scaffold with the ability to promote intrafibrillar mineralization and simultaneous regulation of immune microenvironment in situ. To overcome these challenges, a scaffold containing ultra-small particle size calcium phosphate nanocluster (UsCCP) is prepared, which can enhance bone regeneration through the synergetic effect of intrafibrillar mineralization and immunomodulatory. By efficient infiltration into collagen fibrils, the UsCCP released from the scaffold achieves intrafibrillar mineralization. It also promotes the M2-type polarization of macrophages, leading to an immune microenvironment with both osteogenic and angiogenic potential. The results confirm that the UsCCP scaffold has both intrafibrillar mineralization and immunomodulatory effects, making it a promising candidate for bone regeneration.

Poly(acrylic acid)-Assisted Intrafibrillar Mineralization of Type I Collagen: A Review

The mineralization of type I collagen is a biological process occurring in vertebrates by which some hard tissues such as bone and dentin are constructed. Due to the extensive clinical needs for bone defect repair and remineralization of mineral-depleted dentin, biomimetic mineralization of collagen is attracting more and more interests. Synthetic analogs of noncollagenous proteins are necessary for directing the in vitro mineralization. In this paper, the function and mechanism of poly(acrylic acid) (PAA) in regulating the mineralization, especially intrafibrillar mineralization (IM) of collagen are reviewed. As two mineralization patterns (extrafibrillar and intrafibrillar) co-exist in natural hard tissues, differences between them in terms of microstructure, biodegradation, cytocompatibility, osteoinduction in vitro, and performance in vivo are systematically compared. Then the roles of PAA in biomimetic collagen IM within one-analog and two-analog systems are discussed, respectively. Moreover, mineralization of some self-mineralizable collagen matrices is described. Due to the interactions between collagen and PAA play a crucial role in the processes of collagen mineralization, some reference researches are also provided involving the collagen/PAA interactions in some other fields. Finally, this review is ended with an outlook for future potential improvements based on the collection of existing bottlenecks in this field.

Calcium Phosphate Delivery Systems for Regeneration and Biomineralization of Mineralized Tissues of the Craniofacial Complex

Calcium phosphate (CaP)-based materials have been extensively used for mineralized tissues in the craniofacial complex. Owing to their excellent biocompatibility, biodegradability, and inherent osteoconductive nature, their use as delivery systems for drugs and bioactive factors has several advantages. Of the three mineralized tissues in the craniofacial complex (bone, dentin, and enamel), only bone and dentin have some regenerative properties that can diminish due to disease and severe injuries. Therefore, targeting these regenerative tissues with CaP delivery systems carrying relevant drugs, morphogenic factors, and ions is imperative to improve tissue health in the mineralized tissue engineering field. In this review, the use of CaP-based microparticles, nanoparticles, and polymer-induced liquid precursor (PILPs) amorphous CaP nanodroplets for delivery to craniofacial bone and dentin are discussed. The use of these various form factors to obtain either a high local concentration of cargo at the macroscale and/or to deliver cargos precisely to nanoscale structures is also described. Finally, perspectives on the field using these CaP materials and next steps for the future delivery to the craniofacial complex are presented.

Development and Characterization of Chitosan and Chondroitin Sulfate Based Hydrogels Enriched with Garlic Extract for Potential Wound Healing/Skin Regeneration Applications

Hydrogels can provide instant relief to pain and facilitate the fast recovery of wounds. Currently, the incorporation of medicinal herbs/plants in polymer matrix is being investigated due to their anti-bacterial and wound healing properties. Herein, we investigated the novel combination of chitosan (CS) and chondroitin sulfate (CHI) to synthesize hydrogels through freeze gelation process and enriched it with garlic (Gar) by soaking the hydrogels in garlic juice for faster wound healing and resistance to microbial growth at the wound surface. The synthesized hydrogels were characterized via Fourier-transform infrared spectroscopy (FTIR), which confirmed the presence of relevant functional groups. The scanning electron microscopy (SEM) images exhibited the porous structure of the hydrogels, which is useful for the sustained release of Gar from the hydrogels. The synthesized hydrogels showed significant inhibition zones against Escherichia coli (E. coli) and Staphylococcus aureus (S. aureus). Furthermore, cell culture studies confirmed the cyto-compatibility of the synthesized hydrogels. Thus, the novel hydrogels presented in this study can offer an antibacterial effect during wound healing and promote tissue regeneration.

Efficacy of Rice Husk Nanosilica as A Caries Treatment (Dentin Hydroxyapatite and Antimicrobial Analysis)

OBJECTIVE

 Rice husk nanosilica has a porous, amorphous structure with a silica (SiO2) surface. Silica interacts with calcium ions to form hydroxyapatite and can induce the formation of reactive oxygen species (ROS), which harm microorganisms. This research determines the effect of rice husk nanosilica on the increase in dentin hydroxyapatite and its antimicrobial effects against Streptococcus mutans.

MATERIALS AND METHODS

 We divided 27 dental cavity samples into three groups (n = 9). Group 1: normal dentin, Group 2: demineralized dentin, Group 3: demineralized dentin treated with rice husk nanosilica. The samples were analyzed using X-ray diffraction (XRD) to evaluate the formation of dentin hydroxyapatite. To analyze the viability of S. mutans after exposure to 2% nanosilica rice husk, we conducted an antimicrobial MTT assay.

STATISTICAL ANALYSIS

 The Kruskal-Wallis test evaluates the formation of dentin hydroxyapatite, and the t-test evaluates the viability of S. mutans.

RESULTS

 There was an increase in the amount of dentin hydroxyapatite after the application of rice husk nanosilica compared with the control group (normal dentin), and 2% rice husk nanosilica had an antimicrobial effect (p < 0.005) in the group exposed to it.

CONCLUSION

 Rice husk nanosilica can induce the formation of dentin hydroxyapatite and has antimicrobial effects.

Advanced materials for enamel remineralization

Dental caries, a chronic and irreversible disease caused by caries-causing bacteria, has been listed as one of the three major human diseases to be prevented and treated. Therefore, it is critical to effectively stop the development of enamel caries. Remineralization treatment can control the progression of caries by inhibiting and reversing enamel demineralization at an early stage. In this process, functional materials guide the deposition of minerals on the damaged enamel, and the structure and hardness of the enamel are then restored. These remineralization materials have great potential for clinical application. In this review, advanced materials for enamel remineralization were briefly summarized, furthermore, an outlook on the perspective of remineralization materials were addressed.

Promotion Effect of Carboxymethyl Chitosan on Dental Caries via Intrafibrillar Mineralization of Collagen and Dentin Remineralization

Objective: To observe ultrastructural changes during the process of carboxymethyl chitosan (CMC)-mediated intrafibrillar mineralization, we evaluated the biomimetic remineralization potential of CMC in type-I collagen fibrils and membranes, and further explored the bond strength as well as the bond interfacial integrity of the biomimetic remineralized artificial caries-affected dentin (ACAD). Methods: A mineralized solution containing 200 μg/mL CMC was used to induce type-I collagen biomimetic remineralization in ACAD, while traditional mineralization without CMC was used as a control. The process and pattern of mineralization were investigated by transmission electron microscopy (TEM), scanning electron microscopy (SEM), and energy-dispersive X-ray spectroscopy (EDS) as well as structured illumination microscopy (SIM). The Vickers hardness test was used to quantify the dentin hardness, while the microtensile bond strength (µTBS) test was used to assess the bond strength and durability. The bond interfacial integrity was evaluated by a confocal laser scanning microscope (CLSM). Results: TEM, SEM, and SIM images showed that CMC had a positive effect on stabilizing amorphous calcium phosphate (ACP) and promoting intrafibrillar mineralization, while extrafibrillar mineralization was formed without CMC. Furthermore, hardness evaluation and µTBS proved that CMC significantly increased dentin hardness and bond strength. CLSM indicated that CMC could create a significantly better bond interfacial integrity with less of a micro-gap in ACAD. Significance: CMC possessed the ability to promote intrafibrillar mineralization and remineralization in demineralized caries dentin lesions, as well as improve bond performance, which implied its potential in carious dentin demineralization or dentin hypersensitivity and possibly even as a possible material for indirect pulp-capping, to deal with deep caries. Highlights: CMC possessed the ability to induce intrafibrillar mineralization effectively; the bond strength and bond durability of demineralized caries dentin were improved via CMC-induced remineralization; the CMC-induced remineralization complex is a potential material for indirect pulp-capping, to deal with deep caries.

Impact of dentin conditioning and sealer modification with chitosan-hydroxyapatite nanocomplexes on the antibacterial and mechanical characteristics of root dentin

INTRODUCTION

This study aimed to characterize the effectiveness of dentin-conditioning with bio-mineralizable chitosan-hydroxyapatite precursor (CS-HA) nanocomplexes alone or associated with tricalcium silicate sealer (TCS/CS-HA) on the mechanical property and antibiofilm efficacy in root dentin.

METHODS

Flow tests were performed following ISO6876:2012-specifications. Solubility was measured. Micromorphology was assessed using Scanning Electron Microscopy (SEM). Nanohardness/elastic modulus were also determined. Fracture resistance was determined on lower premolars that were prepared, and randomly distributed among 7-groups (n=8/group), including the control, CS-HA dentin-conditioning and root canal filled groups. Similar canal preparation/distribution procedure was followed to test the antibacterial effect on Enterococcus faecalis-infected roots. Descriptive statistic was used to report SEM findings. Flowability results were analyzed using Paired t-test. Multiple comparisons from solubility, fracture and antibacterial assays were assessed by one-way ANOVA-Tukey's tests.

RESULTS

TCS/CS-HA showed optimal flow and no effect on solubility after immersion for 4 weeks (p>.05). TCS/CS-HA significantly increased nanohardness and elastic modulus (210±11.3MPa, 7.9±0.9GPa) compared to TCS (44.5±7.8MPa, 2.1±0.3GPa,p<.05). SEM revealed needle-shaped mineralized structures resulting in fewer voids and a well-adapted sealer-dentin interface in the TCS/CS-HA groups. NaOCl-EDTA irrigation resulted in reduced fracture resistance (444.34N) while CS-HA dentin-conditioning alone (928.28N, p<.05) and CS-HA dentin-conditioning plus CS-HA/TCS resulted in higher fracture resistance (1134.06N, p<.05). CS-HA dentin-conditioning also reduced bacteria by 2.04 log (4.50±0.43) from the initial bacterial load (6.54±0.07, p<.05). There was further bacterial reduction when CS-HA-conditioned root canals were filled with TCS or TCS/CS-HA (0.00 to 0.98±0.57, p>.05).

CONCLUSION

Dentin modification with CS-HA increased the fracture resistance of root dentin, and decreased the residual bacterial burden. TCS/CS-HA potentiated the nanomechanical and physical properties of TCS.

Application of Amorphous Calcium Phosphate Agents in the Prevention and Treatment of Enamel Demineralization

Enamel demineralization, as a type of frequently-occurring dental problem that affects both the health and aesthetics of patients, is a concern for both dental professionals and patients. The main chemical composition of the enamel, hydroxyapatite, is easy to be dissolved under acid attack, resulting in the occurrence of enamel demineralization. Among agents for the preventing or treatment of enamel demineralization, amorphous calcium phosphate (ACP) has gradually become a focus of research. Based on the nonclassical crystallization theory, ACP can induce the formation of enamel-like hydroxyapatite and thereby achieve enamel remineralization. However, ACP has poor stability and tends to turn into hydroxyapatite in an aqueous solution resulting in the loss of remineralization ability. Therefore, ACP needs to be stabilized in an amorphous state before application. Herein, ACP stabilizers, including amelogenin and its analogs, casein phosphopeptides, polymers like chitosan derivatives, carboxymethylated PAMAM and polyelectrolytes, together with their mechanisms for stabilizing ACP are briefly reviewed. Scientific evidence supporting the remineralization ability of these ACP agents are introduced. Limitations of existing research and further prospects of ACP agents for clinical translation are also discussed.

Development of Carboxymethyl Chitosan Nanoparticles Prepared by Ultrasound-Assisted Technique for a Clindamycin HCl Carrier

Polymeric nanoparticles are one method to modify the drug release of small hydrophilic molecules. In this study, clindamycin HCl was used as a model drug loaded in carboxymethyl chitosan nanoparticles cross-linked with Ca2+ ions (CMCS-Ca2+). The ultrasonication with experimental design was used to produce CMCS-Ca2+ nanoparticles loading clindamycin HCl. The model showed that the size of nanoparticles decreased when amplitude and time increased. The nanoparticle size of 318.40 ± 7.56 nm, decreased significantly from 543.63 ± 55.07 nm (p < 0.05), was obtained from 75% of amplitude and 180 s of time, which was one of the optimal conditions. The clindamycin loading content in this condition was 34.68 ± 2.54%. The drug content in nanoparticles showed an inverse relationship with the size of the nanoparticles. The sodium carboxymethylcellulose film loading clindamycin HCl nanoparticles exhibited extended release with 69.88 ± 2.03% drug release at 60 min and a gradual increase to 94.99 ± 4.70% at 24 h, and demonstrated good antibacterial activity against S. aureus and C. acne with 40.72 ± 1.23 and 48.70 ± 1.99 mm of the zone of inhibition at 24 h, respectively. Thus, CMCS-Ca2+ nanoparticles produced by the ultrasound-assisted technique could be a potential delivery system to modify the drug release of small hydrophilic antibiotics.

Dual Functions of MDP Monomer with De- and Remineralizing Ability

Methacryloyloxydecyl dihydrogen phosphate (MDP) has been speculated to induce mineralization, but there has been no convincing evidence of its ability to induce intrafibrillar mineralization. Polymers play a critical role in biomimetic mineralization as stabilizers/inducers of amorphous precursors. Hence, MDP-induced biomimetic mineralization without polymer additives has not been fully verified or elucidated. By combining 3-dimensional stochastic optical reconstruction microscopy, surface zeta potentials, contact angle measurements, inductively coupled plasma-optical emission spectroscopy, transmission electron microscopy, atomic force microscopy, and Fourier transform infrared spectroscopy with circular dichroism, we show that amphiphilic MDP can not only demineralize dentin by releasing protons as an acidic functional monomer but also infiltrate collagen fibrils (including dentin collagen), unwind the triple helical structure by breaking hydrogen bonds, and finally immobilize within collagen. MDP-bound collagen functions as a huge collagenous phosphoprotein (HCPP), in contrast to chemical phosphorylation modifications. HCPP can induce biomimetic mineralization itself without polymer additives by alternatively attracting calcium and phosphate through electrostatic attraction. Therefore, we herein propose the dual functions of amphiphilic MDP monomer with de- and remineralizing ability. MDP in the free state can demineralize dentin substrates by releasing protons, whereas MDP in the collagen-bound state as HCPP can induce intrafibrillar mineralization. The dual functions of MDP monomer with de- and remineralization properties might create a new epoch in adhesive dentistry and preventive dentistry.

Effects of Silver Diamine Nitrate and Silver Diamine Fluoride on Dentin Remineralization and Cytotoxicity to Dental Pulp Cells: An In Vitro Study

Silver diamine nitrate (SDN) is expected to help control caries similar to silver diamine fluoride (SDF). The aim of this study was to determine the mineral precipitation in demineralized dentin and the cytotoxicity of SDN and SDF to dental pulp cells. Demineralized dentin specimens were prepared, and SDF, SDN, or water (control) was applied. The specimens were then remineralized in simulated body fluid for 2 weeks. The mineral precipitation in the specimens was examined using FTIR-ATR, SEM-EDX, and synchrotron radiation X-ray tomographic microscopy (SRXTM). Additionally, the cytotoxicity of SDF and SDN to human dental pulp stem cells was analyzed using an MTT assay. The increase in FTIR spectra attributable to apatite formation in demineralized dentin in the SDF group was significantly higher compared to the SDN and control groups (p < 0.05). Dentinal tubule occlusion by the precipitation of silver salts was detected in both SDF and SDN groups. The mineral density as shown in SRXTM images and cytotoxicity of both SDN and SDF groups were comparable (p > 0.05). In conclusion, SDF demonstrated superior in vitro apatite formation compared to SDN. However, the degree of mineral precipitation and cytotoxic effects of both were similar.

Characterization of Novel Cement-Based Carboxymethyl Chitosan/Amorphous Calcium Phosphate

OBJECTIVE

 This study aimed to analyze, evaluate, and characterize novel cement-based carboxymethyl chitosan/amorphous calcium phosphate (CMC/ACP).

MATERIALS AND METHODS

 The three cement groups studied were gypsum (Gyp), and CMC/ACP-gypsum cement-based 5% (5% CAG) and 10% (10% CAG). The groups were characterized using Fourier-transform infrared spectroscopy (FTIR), X-ray diffraction (XRD), setting time, and scanning electron microscopy (SEM) data. The characterization results were analyzed qualitatively, but the data for setting time were analyzed using SPSS (p < 0.05).

STATISTICAL ANALYSIS

 Data were statistically analyzed. One-way analysis of variance was used to compare numerical (parametric) data between more than two separate groups followed by post hoc Tukey.

RESULTS

 FTIR showed phosphate groups indicate the presence of calcium phosphate in the form of amorphous (ACP) in the CMC/ACP, CMC/ACP post-milled powder, and CMC/ACP cement-based (5% CAG and 10% CAG). XRD showed no difference in the diffraction spectra among the Gyp, 5% CAG, and 10% CAG groups. SEM images revealed that the CMC/ACP cement-based groups (5% CAG and 10% CAG) showed CMC/ACP cluster filled with hollow spaces between the gypsum crystals and aggregations surrounding the gypsum crystals. The CMC/ACP showed envelopes and attached to the crystalline structures of the gypsum. Setting times of 5% CAG and 10% CAG showed significant differences compared with Gyp (p < 0.05).

CONCLUSION

 The result of our study showed that CMC/ACP cement-based (5% CAG and 10% CAG) demonstrated amorphous characteristic, which can stabilize calcium ions and phosphate group (ACP). In addition, the modification of gypsum using CMC/ACP as cement-based extended the time of setting.

Role of Chitosan in Remineralization of Enamel and Dentin: A Systematic Review

Aim and objective

The purpose of this research was to analyze the role of chitosan in the remineralization of enamel and dentin.

Materials and methods

An electronic search was done for articles published from January 2009 to January 2020. A manual search was done from bibliographies of selected articles for relevant articles that were unexplored. Only in vitro studies conducted on the application of chitosan for remineralization of enamel and dentin were included in the study.

Results

Of the 162 articles that were searched, only 15 in vitro studies were selected for the study. These studies met the inclusion criteria and were published from January 2009 to January 2020.

Conclusion

The review provides insight into the mechanism of remineralization of enamel and dentin. The properties of chitosan make it an ideal biomaterial that can be employed in the formulation of a novel remineralizing gel. However, more in vivo studies, clinical trials, and research are essential to transform chitosan-based remineralizing gels from research to clinical use.

Clinical significance

This review article opens a new window of opportunities for remineralizing enamel and dentin which have been long considered a challenging job.

How to cite this article

Nimbeni SB, Nimbeni BS, Divakar DD. Role of Chitosan in Remineralization of Enamel and Dentin: A Systematic Review. Int J Clin Pediatr Dent 2021;14(4):562–568.

Synthetic amorphous calcium phosphates (ACPs): preparation, structure, properties, and biomedical applications

Amorphous calcium phosphates (ACPs) represent a metastable amorphous state of other calcium orthophosphates (abbreviated as CaPO4) possessing variable compositional but rather identical glass-like physical properties, in which there are neither translational nor orientational long-range orders of the atomic positions. In nature, ACPs of a biological origin are found in the calcified tissues of mammals, some parts of primitive organisms, as well as in the mammalian milk. Manmade ACPs can be synthesized in a laboratory by various methods including wet-chemical precipitation, in which they are the first solid phases, precipitated after a rapid mixing of aqueous solutions containing dissolved ions of Ca2+ and PO43- in sufficient amounts. Due to the amorphous nature, all types of synthetic ACPs appear to be thermodynamically unstable and, unless stored in dry conditions or doped by stabilizers, they tend to transform spontaneously to crystalline CaPO4, mainly to ones with an apatitic structure. This intrinsic metastability of the ACPs is of a great biological relevance. In particular, the initiating role that metastable ACPs play in matrix vesicle biomineralization raises their importance from a mere laboratory curiosity to that of a reasonable key intermediate in skeletal calcifications. In addition, synthetic ACPs appear to be very promising biomaterials both for manufacturing artificial bone grafts and for dental applications. In this review, the current knowledge on the occurrence, structural design, chemical composition, preparation, properties, and biomedical applications of the synthetic ACPs have been summarized.

Antibacterial and osteogenic activities of clindamycin-releasing mesoporous silica/carboxymethyl chitosan composite hydrogels

Conventional treatment of jaw bone infection is often ineffective at controlling bacterial infection and enhancing bone regeneration. Biodegradable composite hydrogels comprised of carboxymethyl chitosan (CMCS) and clindamycin (CDM)-loaded mesoporous silica nanoparticles (MCM-41), possessing dual antibacterial activity and osteogenic potency, were developed in the present study. CDM was successfully loaded into both untreated and plasma-treated MCM-41 nanoparticles, denoted as (p)-MCM-41, followed by the incorporation of each of CDM-loaded (p)-MCM-41 into CMCS. The resulting CDM-loaded composite hydrogels, (p)-MCM-41-CDM-CMCS, demonstrated slow degradation rates (about 70% remaining weight after 14-day immersion), while the CDM-free composite hydrogel entirely disintegrated after 4-day immersion. The plasma treatment was found to improve drug loading capacity and slow down initial drug burst effect. The prolonged releases of CDM from both (p)-MCM-41-CDM-CMCS retained their antibacterial effect against Streptococcus sanguinis for at least 14 days in vitro. In vitro assessment of osteogenic activity showed that the CDM-incorporated composite hydrogel was cytocompatible to human mesenchymal stem cells (hMSCs) and induced hMSC mineralization via p38-dependent upregulated alkaline phosphatase activity. In conclusion, novel (p)-MCM-41-CDM-CMCS hydrogels with combined controlled release of CDM and osteogenic potency were successfully developed for the first time, suggesting their potential clinical benefit for treatment of intraoral bone infection.

The effect of rice husk nanosilica hydroxyl compound on dentin biomineralization

Rice husk nanosilica contains hydroxyl for dentin remineralization. The aim of this study was to analyze and correlate the ability of rice husk nanosilica to induce hydroxyapatite dentin. The detachment of hydroxyl from rice husk nanosilica was analyzed using the sol-gel and pyrolysis methods with Fourier transform infrared spectroscopy. Subsequently, exposing of the demineralized dentin to rice husk nanosilica was performed for a comparison. The formation of hydroxyapatite on dentin was analyzed using X-ray diffraction. The amount of hydroxyl released from the two methods was then correlated with the hydroxyapatite that formed at the dentin. The extraction of hydroxyl on rice husk nanosilica with two methods was the same. Analysis of the amount of hydroxyapatite dentin with both the methods corresponds to each other. The correlation test obtains the value of R = 0.656. Rice husk nanosilica has a similar capability to release hydroxyl compound and form hydroxyapatite dentin using two methods. The creation of hydroxyapatite dentin is not only caused by the exposure of rice husk nanosilica but also owing to other factors that might reinforce the process of hydroxyapatite formation.

Effects of Different Application Times of Silver Diamine Fluoride on Mineral Precipitation in Demineralized Dentin

Silver diamine fluoride (SDF) is a cost-effective method for arresting active dental caries. However, the limited cooperation of patients may lead to an SDF application time that is shorter than the recommended 1-3 min for carious lesions. Therefore, the aim of this study was to assess the effect of different application times of SDF on the degree of mineral precipitation in demineralized dentin. Demineralized dentin specimens from permanent maxillary molars were treated by applying 38% SDF for 30, 60, or 180 s. Water was applied in the control group. The specimens were immersed in simulated body fluid for 2 weeks, and the mineral precipitation in demineralized dentin was then analyzed using FTIR-ATR, SEM-EDX, and synchrotron radiation X-ray tomographic microscopy (SRXTM). The FTIR-ATR results showed a significant increase in mineral precipitation in the 180 s group after 1 week. However, after 2 weeks, the SRXTM images indicated comparable mineral density between the 30, 60, and 180 s groups. The precipitation of silver chloride and calcium phosphate crystals that occluded dentinal tubules was similar in all experimental groups. In conclusion, an application time of either 30, 60, or 180 s promoted a comparable degree of mineral precipitation in demineralized dentin.

The dual anti-caries effect of carboxymethyl chitosan nanogel loaded with chimeric lysin ClyR and amorphous calcium phosphate

In this study, we evaluated the anti-biofilm and anti-demineralization abilities of a novel material, CMC-ClyR-ACP nanogel, designed by loading the chimeric lysin ClyR and amorphous calcium phosphate (ACP) into a nanocarrier material carboxymethyl chitosan (CMC), in a demineralization model. Dynamic light scattering, transmission electron microscopy, and Fourier transmission infrared spectroscopy showed that CMC-ClyR-ACP nanogel was synthesized successfully. Enamel samples prepared from premolars were divided into five groups according to their treatments with: (i) double distilled water ddH₂ O, (ii) CMC-ACP, (iii) CMC-ClyR-ACP, (iv) ClyR, or (v) 0.12% chlorhexidine. Streptococcus mutans was allowed to form biofilms on the teeth for two days before treatment procedures were carried out from day 3 to day 6. The relative biofilm viability analyzed by Cell Counting Kit-8 showed that it was significantly lower (at 55.7%) for CMC-ClyR-ACP than seen for ddH₂ O (89.9%), which was consistent with result of confocal laser scanning microscopy. The percentage surface hardness loss of CMC-ClyR-ACP (29.2%) was significantly lower than that of CMC-ACP (51.0%) and ClyR (58.7%) alone, and there was no significant difference between CMC-ClyR-ACP and chlorhexidine (26.9%), which was confirmed by scanning electron microscopy. Therefore, CMC-ClyR-ACP nanogel may be an effective strategy for the control of enamel demineralization.

A Novel Self-Mineralizing Antibacterial Tissue Repair Varnish to Condition Root-end Dentin in Endodontic Microsurgery

INTRODUCTION

A novel 2-part varnish system containing chitosan nanoparticles (part 1) and chitosan-grafted hydroxyapatite precursor nanocomplex (part 2) was developed to condition the root-end dentin using the principle of biomineralization while rendering both antimicrobial efficacy and bioactivity. This in vitro study aimed to characterize and assess the effectiveness of the chitosan nanoparticles and chitosan-grafted hydroxyapatite precursor nanocomplex containing self-mineralizing antibacterial tissue repair varnish to condition as well as seal root-end dentin during endodontic microsurgery.

METHODS

In phase 1, the antibacterial properties and cellular response of the varnish were characterized. The antibacterial activity and cellular responses were evaluated using Enterococcus faecalis and periodontal ligament (PDL) fibroblasts, respectively. In phase 2, a resected root-end model was used to apply the 2-part varnish and examine the dentin-varnish interface using transmission electron microscopy. The percentage of root end sealed with time was determined using scanning electron microscopy (n = 6/time point). Statistical analysis was performed using 1-way analysis of variance where applicable.

RESULTS

The part 1 and 2 of the varnish displayed significant antibacterial activity and reduced bacterial adherence/survival (P < .01). The attachment and spreading of PDL fibroblasts on the varnish-conditioned dentin was enhanced compared with unconditioned dentin (P < .01). In the resected root-end model, the 2-part varnish displayed a biomineralized varnish layer with close interaction with the subsurface dentin. Root-end coverage with the biomineralized layer increased with incubation time (P < .01), reaching approximately 95% coverage after 24 hours.

CONCLUSIONS

The 2-part varnish system effectively conditioned/sealed the root end with a biomineralized layer while reducing bacterial load and promoting PDL fibroblast attachment. This therapeutic modification of root-end dentin could provide optimal conditions to enhance healing and improve prognosis in teeth with root-end cracks after endodontic microsurgery.

Influence of nanoparticulated chitosan on the biomodification of eroded dentin: clinical and photographic longitudinal analysis of restorations

To evaluate the influence of the pre-treatment with 2.5% nanoparticulate chitosan (2.5% NanoChi) solution on eroded dentin before the restorative dental treatment. The sample consisted of 22 patients (age between 33 and 52 years) with shallow or medium erosion lesions located in two homologous teeth. The teeth were randomly assigned according to dentin treatment: with 2.5% NanoChi and without with chitosan (control). The NanoChi were applied immediately after acid etching. The teeth were restored with Single Bond Universal (3 M) and Charisma resin (Kulzer). Analyzes were done using modified USPHS (retention, secondary caries, marginal adaptation, and sensitivity) and photographic (color, marginal pigmentation, and anatomical form) criteria at 7 days (baseline) and 1 year. Population demographics, Kaplan-Meier estimates and log-rank test (Mantel-Cox) were calculated for 1 year (α = 0.05). No significant difference was found in the survival rates between groups (p > 0.05) at 7 days and 1 year after treatment. After 7 days, 100% of the restorations were scored as Alpha on all criteria. After 1 year, 91% of the NanoChi restorations were scored as Alpha and 9% as Charlie for the retention, marginal adaptation, and anatomical form criteria, while 86% of the control restorations (without NanoChi) received the Alpha score and 14% received the Charlie. Secondary caries, sensitivity, color, and marginal pigmentation criteria were scored as Alpha in 100% of the restorations. The biomodification of eroded dentin with 2.5% NanoChi did not influence the survival of the restorations after 1 year. The application of 2.5% NanoChi on eroded dentin did not increase failures of resin restorations after 1 year and it can be used as a pre-treatment solution.

Effect of a Combination of Photodynamic Therapy and Chitosan on Streptococcus mutans (An In Vitro Study)

Introduction: This study aimed to assess the effect of photodynamic therapy (PDT) and chitosan separately and in combination on Streptococcus mutans. Methods: This in vitro experimental study evaluated 216 microbial samples in 6 groups. First, 5 µL of 0.5 McFarland standard suspension of S. mutans was added to each well of an ELISA microplate; 100 µL of Mueller Hinton broth was also added to each well; 180 wells contained S. mutans suspension while 36 wells were devoid of bacteria. Group 1 served as the negative control and had no bacteria. Group 2 served as the positive control and S. mutans in the positive control wells did not undergo any intervention. In groups 3 and 4, PDT with a 50 mW low-level laser was performed for 30 and 40 seconds respectively. In group 5, 3 mg/mL of chitosan (100 µL) was used. In group 6, 3 mg/mL (100 µL) of chitosan was used in combination with PDT (50 mW laser for 30 seconds). The laser was irradiated under aseptic conditions at a 660 nm wavelength with 50 mW power. Data were analyzed using one-way ANOVA and Tukey's test. Results: PDT combined with chitosan showed maximum bactericidal effect followed by PDT for 40 seconds and chitosan groups (P < 0.05). PDT for 30 seconds showed a minimum bactericidal effect (P < 0.05). All pairwise comparisons revealed significant differences (P < 0.001). Conclusion: Chitosan and PDT alone can be used to decrease the S. mutans count. However, their combined use has a greater bactericidal effect on S. mutans .

Doping bioactive elements into a collagen scaffold based on synchronous self-assembly/mineralization for bone tissue engineering

Pure collagen is biocompatible but lacks inherent osteoinductive, osteoimmunomodulatory and antibacterial activities. To obtain collagen with these characteristics, we developed a novel methodology of doping bioactive elements into collagen through the synchronous self-assembly/mineralization (SSM) of collagen. In the SSM model, amorphous mineral nanoparticles (AMN) (amorphous SrCO3, amorphous Ag3PO4, etc.) stabilized by the polyampholyte, carboxymethyl chitosan (CMC), and collagen molecules were the primary components under acidic conditions. As the pH gradually increased, intrafibrillar mineralization occurred via the self-adaptive interaction between the AMNs and the collagen microfibrils, which were self-assembling; the AMNs wrapped around the microfibrils became situated in the gap zones of collagen and finally transformed into crystals. Sr-doped collagen scaffolds (Sr-CS) promoted in vitro cell proliferation and osteogenic differentiation of rat bone marrow mesenchymal stromal cells (rBMSCs) and synergistically improved osteogenesis of rBMSCs by altering the macrophage response. Ag-doped collagen scaffolds (Ag-CS) exhibited in vitro antibacterial effects on S. aureus, as well as cell/tissue compatibility. Moreover, Sr-CS implanted into the calvarial defect of a rat resulted in improved bone regeneration. Therefore, the SSM model is a de novo synthetic strategy for doping bioactive elements into collagen, and can be used to fabricate multifunctional collagen scaffolds to meet the clinical challenges of encouraging osteogenesis, boosting the immune response and fighting severe infection in bone defects.

Synthesis and characterization of magnetic clay-based carboxymethyl cellulose-acrylic acid hydrogel nanocomposite for methylene blue dye removal from aqueous solution

Carboxymethyl cellulose/poly(acrylic acid) (CMC-cl-pAA) hydrogel and its magnetic hydrogel nanocomposite (CMC-cl-pAA/Fe₃O₄-C30B) were prepared via a free radical polymerization method and used as adsorbents for adsorption of methylene blue (MB) dye. The samples were characterized using Fourier transform infrared, X-ray diffraction, thermogravimetric analysis, scanning electron microscopy coupled with energy-dispersive X-ray spectrometer, high-resolution transmission electron microscope, and dynamic mechanical analysis. The adsorption performance of the prepared adsorbents was studied in a batch mode. Adsorption kinetics and isotherm models were applied in the experimental data to evaluate the nature as well as the mechanism of adsorption processes. It was deduced that the adsorption followed the pseudo-second-order rate equation and Langmuir isotherm models. The maximum adsorption capacities were found to be 1109.55 and 1081.60 mg/g for CMC-cl-pAA hydrogel and CMC-cl-pAA/Fe₃O₄-C30B hydrogel nanocomposite, respectively. The adsorption thermodynamic studies suggested that the adsorption process was spontaneous and endothermic for CMC-cl-pAA/Fe₃O₄-C30B hydrogel nanocomposite. The homogeneous dispersion of the Fe₃O₄-C30B nanocomposite in the CMC-cl-pAA hydrogel significantly improved the thermal stability, mechanical strength, and excellent regeneration stability. This study demonstrates the application potential of the fascinating properties of CMC-cl-pAA/Fe₃O₄-C30B hydrogel nanocomposite as a highly efficient adsorbent in the removal of organic dyes from aqueous solution.

Chitosan-Based Biomimetically Mineralized Composite Materials in Human Hard Tissue Repair

Chitosan is a natural, biodegradable cationic polysaccharide, which has a similar chemical structure and similar biological behaviors to the components of the extracellular matrix in the biomineralization process of teeth or bone. Its excellent biocompatibility, biodegradability, and polyelectrolyte action make it a suitable organic template, which, combined with biomimetic mineralization technology, can be used to develop organic-inorganic composite materials for hard tissue repair. In recent years, various chitosan-based biomimetic organic-inorganic composite materials have been applied in the field of bone tissue engineering and enamel or dentin biomimetic repair in different forms (hydrogels, fibers, porous scaffolds, microspheres, etc.), and the inorganic components of the composites are usually biogenic minerals, such as hydroxyapatite, other calcium phosphate phases, or silica. These composites have good mechanical properties, biocompatibility, bioactivity, osteogenic potential, and other biological properties and are thus considered as promising novel materials for repairing the defects of hard tissue. This review is mainly focused on the properties and preparations of biomimetically mineralized composite materials using chitosan as an organic template, and the current application of various chitosan-based biomimetically mineralized composite materials in bone tissue engineering and dental hard tissue repair is summarized.