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Liang X, Yu B, Ye L, Lin D, Zhang W, Zhong HJ, He J. Recent Advances in Quaternary Ammonium Monomers for Dental Applications. MATERIALS (BASEL, SWITZERLAND) 2024; 17:345. [PMID: 38255513 PMCID: PMC10820831 DOI: 10.3390/ma17020345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 12/30/2023] [Accepted: 01/08/2024] [Indexed: 01/24/2024]
Abstract
Resin-based dental materials have been one of the ideal choices among various materials in the treatment of dental caries. However, resin-based dental materials still have some drawbacks, such as the lack of inherent antibacterial activity. Extensive research has been conducted on the use of novel quaternary ammonium monomers (QAMs) to impart antibacterial activity to dental materials. This review provides a comprehensive overview of the recent advances in quaternary ammonium monomers (QAMs) for dental applications. The current progress and limitations of QAMs are discussed based on the evolution of their structures. The functional diversification and enhancement of QAMs are presented. QAMs have the potential to provide long-term antibacterial activity in dental resin composites, thereby prolonging their service life. However, there is a need to balance antibacterial performance with other material properties and the potential impact on the oral microbiome and general health. Finally, the necessity for further scientific progress in the development of novel quaternary ammonium monomers and the optimization of dental resin formulations is emphasized.
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Affiliation(s)
- Xiaoxu Liang
- Foundation Department, Guangzhou Maritime University, Guangzhou 510725, China;
| | - Biao Yu
- School of Chemistry and Chemical Engineering, Lingnan Normal University, Zhanjiang 524048, China;
| | - Liuqi Ye
- International Cooperative Laboratory of Traditional Chinese Medicine Modernization and Innovative Drug Development of Chinese Ministry of Education (MOE), College of Pharmacy, Jinan University, Guangzhou 510632, China; (L.Y.); (D.L.); (W.Z.)
| | - Danlei Lin
- International Cooperative Laboratory of Traditional Chinese Medicine Modernization and Innovative Drug Development of Chinese Ministry of Education (MOE), College of Pharmacy, Jinan University, Guangzhou 510632, China; (L.Y.); (D.L.); (W.Z.)
| | - Wen Zhang
- International Cooperative Laboratory of Traditional Chinese Medicine Modernization and Innovative Drug Development of Chinese Ministry of Education (MOE), College of Pharmacy, Jinan University, Guangzhou 510632, China; (L.Y.); (D.L.); (W.Z.)
| | - Hai-Jing Zhong
- International Cooperative Laboratory of Traditional Chinese Medicine Modernization and Innovative Drug Development of Chinese Ministry of Education (MOE), College of Pharmacy, Jinan University, Guangzhou 510632, China; (L.Y.); (D.L.); (W.Z.)
| | - Jingwei He
- School of Materials Science and Engineering, South China University of Technology, Guangzhou 510641, China
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Ribeiro JS, Xavier SR, Cuevas Suárez CE, Pappen FG, Piva E, Lund RG, Bottino MC. Synthesis and characterization of calcium-releasing elastomeric resin-based endodontic sealers. Clin Oral Investig 2023; 27:3447-3456. [PMID: 36947264 DOI: 10.1007/s00784-023-04952-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 03/17/2023] [Indexed: 03/23/2023]
Abstract
OBJECTIVES To evaluate the incorporation of halloysite nanotubes (HNTs) loaded with one of two calcium sources (i.e., calcium hydroxide/CaOH2 or beta-tricalcium phosphate/β-TCP) on the physicochemical and biological properties of an experimental resin-based dual-cured endodontic sealer. MATERIALS AND METHODS HNTs were encapsulated with CaOH2 or β-TCP at 10 wt.%. HNTs containing CaOH2 or β-TCP were added into the experimental sealers at 50 wt.%. The control sealers were the calcium-free HNT-modified resin-based experimental sealer and AH Plus™, a commercially available endodontic sealer. Degree of conversion, setting time, flow, film thickness, radiopacity, dimensional stability, and calcium ions release were determined. Antibiofilm properties and cytocompatibility of the formulated sealers and commercial control were also evaluated. One and two-way ANOVA analysis followed by Tukey's post hoc test was conducted to evaluate the effect of the independent variable on the evaluated properties. RESULTS FTIR confirmed the encapsulation of calcium sources into HNTs. Regarding flow and film thickness, the values obtained from these sealers were in accordance with the specifications provided by ISO 6876. For radiopacity, AH Plus™ achieved the highest radiopacity (p<0.05). Among the experimental formulations, all experimental HNT-containing compositions exhibited values below 3 mm Al. The experimental sealers showed greater dimensional changes when compared to the commercial (AH Plus™) control. The release of calcium ions was observed for the HNT_CaOH2 and HNT_β-TCP sealers without statistical differences. Experimental sealers containing HNT_CaOH2 and HNT_β-TCP significantly reduced the CFU/mL count and showed cell compatibility. CONCLUSIONS The findings of this study demonstrate that the incorporation of HNT_CaOH2 or HNT_β-TCP into resin-based experimental sealers promoted antimicrobial effects and gradual calcium release without impairing cytocompatibility or physicochemical properties of the sealers. Still, an adjustment to reach the minimal radiopacity established by ISO 6876 is needed. CLINICAL RELEVANCE The experimental resin-based sealers seemed to be an alternative for endodontics. The incorporation of calcium sources exerts promising antimicrobial effects while displaying low cell toxicity.
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Affiliation(s)
- Juliana S Ribeiro
- Department of Cariology, Restorative Sciences, and Endodontics, University of Michigan School of Dentistry, Ann Arbor, MI, 48109, USA
- Department of Restorative Dentistry, School of Dentistry, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Samantha R Xavier
- Department of Restorative Dentistry, School of Dentistry, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Carlos E Cuevas Suárez
- Dental Materials Laboratory, Academic Area of Dentistry, Autonomous University of Hidalgo State, Circuito Ex Hacienda La Concepción S/N, 42160, San Agustín Tlaxiaca, Hidalgo, Mexico
| | - Fernanda G Pappen
- Department of Restorative Dentistry, School of Dentistry, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Evandro Piva
- Department of Restorative Dentistry, School of Dentistry, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Rafael G Lund
- Department of Restorative Dentistry, School of Dentistry, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Marco C Bottino
- Department of Cariology, Restorative Sciences, and Endodontics, University of Michigan School of Dentistry, Ann Arbor, MI, 48109, USA.
- Department of Biomedical Engineering, College of Engineering, University of Michigan, Ann Arbor, MI, USA.
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He J, Lassila L, Garoushi S, Vallittu P. Tailoring the monomers to overcome the shortcomings of current dental resin composites - review. Biomater Investig Dent 2023; 10:2191621. [PMID: 37090482 PMCID: PMC10120559 DOI: 10.1080/26415275.2023.2191621] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023] Open
Abstract
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.
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Affiliation(s)
- Jingwei He
- College of Materials Science and Engineering, South China University of Technology, Guangzhou, China
- Department of Biomaterials Science and Turku Clinical Biomaterials Center-TCBC, Institute of Dentistry, University of Turku, Turku, Finland
- CONTACT Jingwei He College of Materials Science and Engineering, South China University of Technology, Guangzhou, China
| | - Lippo Lassila
- Department of Biomaterials Science and Turku Clinical Biomaterials Center-TCBC, Institute of Dentistry, University of Turku, Turku, Finland
| | - Sufyan Garoushi
- Department of Biomaterials Science and Turku Clinical Biomaterials Center-TCBC, Institute of Dentistry, University of Turku, Turku, Finland
| | - Pekka Vallittu
- Department of Biomaterials Science and Turku Clinical Biomaterials Center-TCBC, Institute of Dentistry, University of Turku, Turku, Finland
- Wellbeing Services County of South-West Finland, Turku, Finland
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He X, Ye L, He R, He J, Ouyang S, Zhang J. Antibacterial dental resin composites (DRCs) with synthesized bis-quaternary ammonium monomethacrylates as antibacterial agents. J Mech Behav Biomed Mater 2022; 135:105487. [PMID: 36179614 DOI: 10.1016/j.jmbbm.2022.105487] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/20/2022] [Accepted: 09/21/2022] [Indexed: 11/28/2022]
Abstract
Three bi-quaternary ammonium methacrylates (biQAMA-12, biQAMA-14, and biQAMA-16) with different alkyl chain length were synthesized with the purpose of endowing dental resin composites (DRCs) with antibacterial activity without sacrificing physicochemical properties of DRCs. All of biQAMAs were confirmed by 1H-NMR spectra and incorporated into Bis-GMA/TEGDMA (60 wt/40 wt) resin matrix with a mass fraction of 5 wt% as antibacterial agent. The obtained resin matrixes were mixed with commercial silaned glass fillers at a mass ratio of 30 wt/70 wt to prepare antibacterial DRCs. The double bond conversion (DC), antibacterial activity against S. mutans., surface charge density, water contact angle, water sorption (WS) and solubility (SL), mechanical properties, and cytotoxicity of biQAMAs containing DRCs were investigated. The DRC without biQAMAs was used as control. The results showed that all biQAMAs containing DRCs had antibacterial rate higher than 90%, and DRC with biQAMA-12 had the highest antibacterial rate due to its highest surface charge density. Adding 5 wt% of biQAMAs would not bring out negative effect on physicochemical properties of DRCs, except for increasing WS, but the resultant WS still met the ISO requirement on WS of restorative materials. Both biQAMA-14 and biQAMA-16 containing DRCs showed higher cytotoxicity than control, thus biQAMA-12 was considered as the optimal antibacterial agent in this research.
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Affiliation(s)
- Xiaoling He
- Key Laboratory of 3D Printing Technology in Stomatology, The First Dongguan Affiliated Hospital, Guangdong Medical University, Dongguan, 523710, Guangdong, China
| | - Linyan Ye
- Key Laboratory of 3D Printing Technology in Stomatology, The First Dongguan Affiliated Hospital, Guangdong Medical University, Dongguan, 523710, Guangdong, China
| | - Rouye He
- Key Laboratory of 3D Printing Technology in Stomatology, The First Dongguan Affiliated Hospital, Guangdong Medical University, Dongguan, 523710, Guangdong, China
| | - Jingwei He
- College of Materials Science and Engineering, South China University of Technology, Guangzhou, 510641, Guangdong, China.
| | - Suidong Ouyang
- Guangdong Provincial Key Laboratory of Medical Molecular Diagnostics, Guangdong Medical University, Dongguan, 523710, Guangdong, China
| | - Jingying Zhang
- Key Laboratory of 3D Printing Technology in Stomatology, The First Dongguan Affiliated Hospital, Guangdong Medical University, Dongguan, 523710, Guangdong, China.
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Rao S, B.T N, Preman NK, Johnson RP, Ginjupalli K, P. P, Prabhu A, Das R, K J, Pai V. Synthesis, characterization, and evaluation of quaternary ammonium-based polymerizable antimicrobial monomers for prosthodontic applications. Heliyon 2022; 8:e10374. [PMID: 36090206 PMCID: PMC9449575 DOI: 10.1016/j.heliyon.2022.e10374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 05/19/2022] [Accepted: 08/15/2022] [Indexed: 11/17/2022] Open
Abstract
The present study aims to synthesize and characterize two quaternary ammonium (QAM) based monomers such as - dimethyl-hexadecyl-methacryloxyethyl-ammonium iodide (DHMAI) and 2-dimethyl-2-dodecyl-1-methacryloxyethyl ammonium iodine (DDMAI) and assess their cytotoxicity and antimicrobial properties. The study also aims to incorporate the optimized concentration of these monomers as copolymerizing monomers into conventional Polymethyl methacrylate (PMMA) denture base resin and evaluate their suitability for prosthetic applications. DHMAI and DDMAI monomers were synthesized through a Menschutkin reaction and their chemical structure was characterized using FT-IR and 1H-NMR spectroscopy. Cytotoxicity was determined using Methyl Thiazolyl Tetrazolium (MTT) assay whereas antimicrobial activity was assessed using the agar-disc diffusion method. Subsequently, optimized concentrations of DHMAI or DDMAI, based on the cytotoxicity results, were added to conventional PMMA resin. Antimicrobial activity, cytotoxicity, surface hardness, and water sorption of PMMA denture base rein incorporated with DHMAI or DDMAI were evaluated. FT-IR and 1H-NMR results confirmed the structure of monomers and copolymerization of DHMAI and DDMAI with PMMA resin. DHMAI and DDMAI monomers were found to be cytocompatible with mouse fibroblast cells up to a concentration of 5 μg/mL and 20 μg/mL respectively. In addition, incorporation of DHMAI or DDMAI at 5 μg/mL and 20 μg/mL respectively into PMMA denture base material did not affect their cytocompatibility. PMMA denture base resin incorporated with DHMAI or DDMAI significantly reduced the adhesion of microbes. Further, an increase in the surface hardness and a reduction in the water sorption was observed. Hence DHMAI and DDMAI can be considered as potential candidates for imparting antimicrobial activity to polymeric denture base materials.
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Fu W, Liu Q, Wang L, Huang X, Su Z, Huang Z, He J. Synthesis of polymerizable quaternary thiazole salts and their application as antibacterial agents for dental resin. J Mech Behav Biomed Mater 2022; 130:105183. [DOI: 10.1016/j.jmbbm.2022.105183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/11/2022] [Accepted: 03/13/2022] [Indexed: 12/24/2022]
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Effects of Monomer Composition of Urethane Methacrylate Based Resins on the C=C Degree of Conversion, Residual Monomer Content and Mechanical Properties. Polymers (Basel) 2021; 13:polym13244415. [PMID: 34960966 PMCID: PMC8704249 DOI: 10.3390/polym13244415] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 12/13/2021] [Indexed: 01/30/2023] Open
Abstract
(1) Background: This study investigated the influence of Bis-GMA, TEGDMA, UDMA, and two different polyethylene glycol (PEG)-containing, UDMO-based co-monomers on the Young’s modulus and flexural strength, degree of methacrylate C=C double bond conversion and residual monomer elution of experimental dental resins. (2) Methods: Urethane methacrylate-based monomer was synthesised via a radical chain growth polymerization mechanism using PEG in order to improve the mechanical properties. Dental resins were formulated using Bis-GMA, UDMA, or UDMO as base monomers combined with TEGDMA as a dilution monomer and DMAEM + CQ as the photo-initiator system. Degree of conversion (DC), mechanical properties, and residual monomer content of light-activated methacrylate resin formulations were evaluated and statistically analysed by ANOVA and a Tukey’s test. (3) Results: PEG-containing UDMO resins had lower Young’s modulus and elastic strength than UDMA-derived resin for all irradiation times. The highest DC (67,418%) was observed for the PEG-containing UDMO-based resin formulation when light cured for 40 s. For all samples, DC increased with the photo-polymerization time. The amount of residual monomer decreased after increasing the light-curing period from 20 to 40 s, resin with UDMO content 0.01 mol of PEG having the smallest amount of free eluted monomer. (4) Conclusions: A strong structure–property relationship exists in photo-cured dimethacrylate-based dental resins. The time and quantity of the photochemical initiation system can influence the physical–mechanical properties of the resins but also the monomers in their composition.
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Zhu W, Lao C, Luo S, Liu F, Huang Q, He J, Lin Z. Mechanical and antibacterial properties of benzothiazole-based dental resin materials. JOURNAL OF BIOMATERIALS SCIENCE-POLYMER EDITION 2018; 29:635-645. [PMID: 29343187 DOI: 10.1080/09205063.2018.1429861] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Wenbin Zhu
- College of Materials Science and Engineering, South China University of Technology, Guangzhou, China
| | - Chonghui Lao
- Guangdong Provincial Key Laboratory of Stomatology, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangzhou, China
| | - Shuzhen Luo
- College of Materials Science and Engineering, South China University of Technology, Guangzhou, China
| | - Fang Liu
- College of Materials Science and Engineering, South China University of Technology, Guangzhou, China
| | - Qiting Huang
- Guangdong Provincial Key Laboratory of Stomatology, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangzhou, China
| | - Jingwei He
- College of Materials Science and Engineering, South China University of Technology, Guangzhou, China
| | - Zhengmei Lin
- Guangdong Provincial Key Laboratory of Stomatology, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangzhou, China
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Cherchali FZ, Mouzali M, Tommasino JB, Decoret D, Attik N, Aboulleil H, Seux D, Grosgogeat B. Effectiveness of the DHMAI monomer in the development of an antibacterial dental composite. Dent Mater 2017; 33:1381-1391. [PMID: 28964542 DOI: 10.1016/j.dental.2017.09.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 07/28/2017] [Accepted: 09/11/2017] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Development of antibacterial dental composites is the ultimate goal to decrease carious disease occurrence and increase the restoration longevity. For this purpose, the quaternary ammonium dimethyl-hexadecyl-methacryloxyethyl-ammonium iodide (DHMAI) and the methacryloyloxyethylphosphorylcholine (MPC) have been incorporated in experimental methacrylate-based composite resins. This aims to first investigate the effect of each alone and then their combined effect. METHODS Synthesized DHMAI and commercial MPC were added either alone or combined at different concentrations to experimental dental composite. Flexural strength (FS) and modulus (FM) were tested to select the optimal concentrations. Only selected composites were evaluated for Vickers hardness (HV) and the degree of conversion (DC) using fourier transform infrared spectroscopy analysis (FTIR-ATR). Antibacterial activity was assessed using tests on colony-forming unit (CFU), scanning electron microscopy (SEM) and Alamarblue assay to measure the metabolic activity. Streptococcus mutans biofilm was chosen to be grown on the composite surfaces during 96h at 37°C. RESULTS Incorporation of 7.5% DHMAI in composite improved the degree of conversion and gave a strong antibacterial effect with a reduction of (∼98%) in CFU and (∼50%) of metabolic activity with acceptable mechanical properties. Addition of MPC to DHMAI affects mechanical properties of composites without providing a better antibacterial activity. SIGNIFICANCE Composites with DHMAI greatly reduced S. mutans biofilm and improved the degree of conversion without scarifying the composites' mechanical properties. DHMAI may have wide applicability to other dental materials in order to inhibit caries and improve the longevity of restorations.
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Affiliation(s)
- Fatima Zohra Cherchali
- Laboratoire d'Etudes Physico-Chimiques des Matériaux, Application à l'Environnement (LEPCMAE), USTHB, Faculté de Chimie, Bab Ezzouar, Algérie; Laboratoire des Multimatériaux et Interfaces, UMR CNRS 5615, Université Lyon, Université Lyon1, Villeurbanne, France.
| | - Mohamed Mouzali
- Laboratoire d'Etudes Physico-Chimiques des Matériaux, Application à l'Environnement (LEPCMAE), USTHB, Faculté de Chimie, Bab Ezzouar, Algérie
| | - Jean Bernard Tommasino
- Laboratoire des Multimatériaux et Interfaces, UMR CNRS 5615, Université Lyon, Université Lyon1, Villeurbanne, France
| | | | - Nina Attik
- Laboratoire des Multimatériaux et Interfaces, UMR CNRS 5615, Université Lyon, Université Lyon1, Villeurbanne, France; UFR Odontologie, Université Lyon, Université Lyon1, Lyon, France
| | - Hazem Aboulleil
- Laboratoire des Multimatériaux et Interfaces, UMR CNRS 5615, Université Lyon, Université Lyon1, Villeurbanne, France; UFR Odontologie, Université Lyon, Université Lyon1, Lyon, France
| | - Dominique Seux
- Laboratoire des Multimatériaux et Interfaces, UMR CNRS 5615, Université Lyon, Université Lyon1, Villeurbanne, France; UFR Odontologie, Université Lyon, Université Lyon1, Lyon, France; Service de Consultations et de Traitements Dentaires, Hospices Civils de Lyon, Lyon, France
| | - Brigitte Grosgogeat
- Laboratoire des Multimatériaux et Interfaces, UMR CNRS 5615, Université Lyon, Université Lyon1, Villeurbanne, France; UFR Odontologie, Université Lyon, Université Lyon1, Lyon, France; Service de Consultations et de Traitements Dentaires, Hospices Civils de Lyon, Lyon, France
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Jiao Y, Niu LN, Ma S, Li J, Tay FR, Chen JH. Quaternary ammonium-based biomedical materials: State-of-the-art, toxicological aspects and antimicrobial resistance. Prog Polym Sci 2017; 71:53-90. [PMID: 32287485 PMCID: PMC7111226 DOI: 10.1016/j.progpolymsci.2017.03.001] [Citation(s) in RCA: 332] [Impact Index Per Article: 47.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 03/07/2017] [Accepted: 03/07/2017] [Indexed: 12/20/2022]
Abstract
Microbial infections affect humans worldwide. Many quaternary ammonium compounds have been synthesized that are not only antibacterial, but also possess antifungal, antiviral and anti-matrix metalloproteinase capabilities. Incorporation of quaternary ammonium moieties into polymers represents one of the most promising strategies for preparation of antimicrobial biomaterials. Various polymerization techniques have been employed to prepare antimicrobial surfaces with quaternary ammonium functionalities; in particular, syntheses involving controlled radical polymerization techniques enable precise control over macromolecular structure, order and functionality. Although recent publications report exciting advances in the biomedical field, some of these technological developments have also been accompanied by potential toxicological and antimicrobial resistance challenges. Recent evidenced-based data on the biomedical applications of antimicrobial quaternary ammonium-containing biomaterials that are based on randomized human clinical trials, the golden standard in contemporary medicinal science, are included in the present review. This should help increase visibility, stimulate debates and spur conversations within a wider scientific community on the implications and plausibility for future developments of quaternary ammonium-based antimicrobial biomaterials.
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Affiliation(s)
- Yang Jiao
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Key Laboratory of Oral Diseases, Department of Prosthodontics, School of Stomatology, The Fourth Military Medical University, 710032, Xi’an, Shaanxi, China
- Department of Stomatology, PLA Army General Hospital, 100700, Beijing, China
| | - Li-na Niu
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Key Laboratory of Oral Diseases, Department of Prosthodontics, School of Stomatology, The Fourth Military Medical University, 710032, Xi’an, Shaanxi, China
| | - Sai Ma
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Key Laboratory of Oral Diseases, Department of Prosthodontics, School of Stomatology, The Fourth Military Medical University, 710032, Xi’an, Shaanxi, China
| | - Jing Li
- Department of Orthopaedic Oncology, Xijing Hospital Affiliated to the Fourth Military Medical University, 710032, Xi’an, Shaanxi, China
| | - Franklin R. Tay
- Department of Endodontics, The Dental College of Georgia, Augusta University, Augusta, GA, 30912, USA
- Corresponding authors.
| | - Ji-hua Chen
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Key Laboratory of Oral Diseases, Department of Prosthodontics, School of Stomatology, The Fourth Military Medical University, 710032, Xi’an, Shaanxi, China
- Corresponding authors.
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Preparation and characterization of high radio-opaque E-glass fiber-reinforced composite with iodine containing methacrylate monomer. Dent Mater 2016; 33:218-225. [PMID: 28007395 DOI: 10.1016/j.dental.2016.12.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 09/20/2016] [Accepted: 12/05/2016] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The purpose of this study was to prepare radio-opaque E-glass fiber-reinforced composite (EFRC) with synthesized iodine containing methacrylate monomer. METHODS The synthesized iodine containing methacrylate monomer 2-hydroxy-3- methacryloyloxypropyl(2,3,5- triiodobenzoate) (HMTIB) was mixed with Bis-GMA and MMA in different mass ratio to prepare resin impregnating solution (RIS), and RIS without HMTIB was used as control. CQ and DMAEMA were added as photoinitiation system. E-glass fiber was thoroughly wetted by resin impregnating solution to prepare radio-opaque EFRC. Degree of double bond conversion (DC) was investigated by FT-IR analysis. Fiber volume fraction was analyzed by combustion and gravimetric analyzes. The Flexural strength (FS) and modulus (FM) of EFRC were measured using a three-point bending set up. Water sorption (WS) and solubility (SL) were measured until the mass variation of EFRC in distilled water kept stable. Radiographs were taken to determine the radiopacity of EFRC. RESULTS The FT-IR and 1H NMR spectra of HMTIB revealed that it was the same as designed. ANOVA analysis revealed that increasing HMTIB concentration in RIS would decrease DC and increase fiber volume fraction. When compared with control EFRC, all of HMTIB containing EFRCs had higher or comparable FS and FM, no matter before or after water immersion. WS of EFRC decreased with increasing HMTIB concentration, while SL was nearly kept the same. Radiopacity of EFRC increased with increasing HMTIB concentration. SIGNIFICANCE The synthesized monomer HMTIB could be used to prepare EFRC with high radiopacity. Moreover, HMTIB containing EFRC would also have high mechanical properties and low WS.
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Physical and chemical properties of an antimicrobial Bis-GMA free dental resin with quaternary ammonium dimethacrylate monomer. J Mech Behav Biomed Mater 2016; 56:68-76. [DOI: 10.1016/j.jmbbm.2015.10.028] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2015] [Revised: 10/26/2015] [Accepted: 10/31/2015] [Indexed: 12/14/2022]
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do Amaral GS, Negrini T, Maltz M, Arthur RA. Restorative materials containing antimicrobial agents: is there evidence for their antimicrobial and anticaries effects? A systematic review. Aust Dent J 2016; 61:6-15. [PMID: 26018839 DOI: 10.1111/adj.12338] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2015] [Indexed: 01/28/2023]
Abstract
The aim of this systematic literature review was to investigate whether the incorporation of antimicrobial agents into dental restorative materials truly exerts an antimicrobial effect against common cariogenic bacteria (primary outcome), and whether the inclusion of antimicrobial agents is able to prevent caries around restorations (secondary outcome). MEDLINE, via PubMed, was searched for papers published between 1980 and 30 November 2014. A total of 1126 articles were retrieved. After inclusion/exclusion assessment, 147 full text articles were read and included in the review, comprising 130 in vitro, 1 in situ, and 4 in vivo studies, as well as 12 literature reviews. In about 78% of in vitro studies, and in all identified in situ and in vivo studies, a positive antimicrobial effect had been found. However, the anticaries effect had not been tested in any of the selected studies. It was concluded that there is indeed evidence that restorative dental materials containing antimicrobial agents exert an antimicrobial effect, both in laboratory and in clinical studies. However, no evidence has been found regarding the role of these agents in preventing or controlling dental caries, or in preventing caries around restorations.
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Affiliation(s)
- G S do Amaral
- Department of Preventive and Community Dentistry, Faculty of Dentistry, Federal University of Rio Grande do Sul, Brazil
| | - T Negrini
- Department of Conservative Dentistry, Faculty of Dentistry, Federal University of Rio Grande do Sul, Brazil
| | - M Maltz
- Department of Preventive and Community Dentistry, Faculty of Dentistry, Federal University of Rio Grande do Sul, Brazil
| | - R A Arthur
- Department of Preventive and Community Dentistry, Faculty of Dentistry, Federal University of Rio Grande do Sul, Brazil
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14
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Cocco AR, de Oliveira da Rosa WL, da Silva AF, Lund RG, Piva E. A systematic review about antibacterial monomers used in dental adhesive systems: Current status and further prospects. Dent Mater 2015; 31:1345-62. [DOI: 10.1016/j.dental.2015.08.155] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Accepted: 08/17/2015] [Indexed: 12/21/2022]
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15
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Hamanaka I, Iwamoto M, Lassila LV, Vallittu PK, Shimizu H, Takahashi Y. The effect of cycling deflection on the injection-molded thermoplastic denture base resins. Acta Odontol Scand 2015; 74:67-72. [PMID: 25953322 DOI: 10.3109/00016357.2015.1042039] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the effect of cycling deflection on the flexural behavior of injection-molded thermoplastic resins. MATERIALS AND METHODS Six injection-molded thermoplastic resins (two polyamides, two polyesters, one polycarbonate, one polymethyl methacrylate) and, as a control, a conventional heat-polymerized denture based polymer of polymethyl methacrylate (PMMA) were used in this study. The cyclic constant magnitude (1.0 mm) of 5000 cycles was applied using a universal testing machine to demonstrate plasticization of the polymer. Loading was carried out in water at 23ºC with eight specimens per group (n = 8). Cycling load (N) and deformation (mm) were measured. RESULTS Force required to deflect the specimens during the first loading cycle and final loading cycle was statistically significantly different (p < 0.05) with one polyamide based polymer (Valplast) and PMMA based polymers (Acrytone and Acron). The other polyamide based polymer (LucitoneFRS), polyester based polymers (EstheShot and EstheShotBright) and polycarbonate based polymer (ReigningN) did not show significant differences (p > 0.05). None of the materials fractured during the loading test. One polyamide based polymer (Valplast) displayed the highest deformation and PMMA based polymers (Acrytone and Acron) exhibited the second highest deformation among the denture base materials. CONCLUSION It can be concluded that there were considerable differences in the flexural behavior of denture base polymers. This may contribute to the fatigue resistance of the materials.
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Affiliation(s)
- Ippei Hamanaka
- a 1 Division of Removable Prosthodontics, Fukuoka Dental College , Fukuoka, Japan
- b 2 Department of Biomaterials Science and Turku Clinical Biomaterials Centre-TCBC, Institute of Dentistry, University of Turku , Turku, Finland
| | - Misa Iwamoto
- a 1 Division of Removable Prosthodontics, Fukuoka Dental College , Fukuoka, Japan
- b 2 Department of Biomaterials Science and Turku Clinical Biomaterials Centre-TCBC, Institute of Dentistry, University of Turku , Turku, Finland
| | - Lippo Vj Lassila
- b 2 Department of Biomaterials Science and Turku Clinical Biomaterials Centre-TCBC, Institute of Dentistry, University of Turku , Turku, Finland
| | - Pekka K Vallittu
- b 2 Department of Biomaterials Science and Turku Clinical Biomaterials Centre-TCBC, Institute of Dentistry, University of Turku , Turku, Finland
- c 3 City of Turku, Division for Welfare , Turku, Finland
| | - Hiroshi Shimizu
- d 4 Division of Biomaterials, Kyushu Dental University , Fukuoka, Japan
| | - Yutaka Takahashi
- a 1 Division of Removable Prosthodontics, Fukuoka Dental College , Fukuoka, Japan
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16
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H K, A M, S A. The Temperature Dependence of Micro-Leakage between Restorative and Pulp Capping Materials by Cu Diffusion. Open Dent J 2015; 9:140-5. [PMID: 25926897 PMCID: PMC4407002 DOI: 10.2174/1874210601509010140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 03/18/2015] [Accepted: 03/21/2015] [Indexed: 11/22/2022] Open
Abstract
We used the Cu ions for the leakage analysis between pulp capping and restorative materials. Theoretically, Cu has more advantages than Ag ions due to their smaller radii (rCu2+=73 pm and rAg2+=94 pm), lower mass density (dCu=8.96 g/cm3 and dAg=10.49 g/cm3) and higher radio opacity which can be more useful by X-ray or EDX detectors, cheaper price and more abundance in planet when compared with Ag element which is generally used in the leakage studies. The micro leakage between dental restorations and pulp capping materials has been determined by using Micro Computed Tomography, Scanning Electron Microscopy and EDX analysis. It is found that the leakage has temperature dependent mechanism which increases with the increasing temperature. As a result, using Cu solution for leakage studies in dentine is an effective and easy method which can be used in dental science.
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Affiliation(s)
- Kamalak H
- Inonu University, Faculty of Dentistry, Department of Restorative Dentistry, 44280, Malatya, Turkey
| | - Mumcu A
- Inonu University, Scienctific and Technological Research Center, 44280, Malatya, Turkey
| | - Altin S
- Inonu University, Science and Art Faculty, Physics Department, 44280 Malatya, Turkey
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17
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He J, Söderling E, Lassila LVJ, Vallittu PK. Preparation of antibacterial and radio-opaque dental resin with new polymerizable quaternary ammonium monomer. Dent Mater 2015; 31:575-82. [PMID: 25743040 DOI: 10.1016/j.dental.2015.02.007] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2014] [Revised: 12/03/2014] [Accepted: 02/10/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE A new polymerizable quaternary ammonium monomer (IPhene) with iodine anion was synthesized and incorporated into Bis-GMA/TEGDMA (50/50, wt/wt) to prepare antibacterial and radio-opaque dental resin. METHODS IPhene was synthesized through a 2-steps reaction route, and its structure was confirmed by FT-IR and (1)H-NMR spectra. IPhene was incorporated into Bis-GMA/TEGDMA (50/50, wt/wt) with a series of mass fraction (from 10 wt.% to 40 wt.%). Degree of monomer conversion (DC) was determined by FT-IR analysis. Polymerization shrinkage was determined according to the variation of density before and after polymerization. The flexural strength, modulus of elasticity, and fracture energy were measured using a three-point bending set up. Radiograph was taken to evaluate the radio-opacity of the polymer. A single-species biofilm model with Streptococcus mutans (S. mutans) as the tests organism was used to evaluate the antibacterial activity of the polymer. Bis-GMA/TEGDMA resin system without IPhene was used as a control group. RESULTS FT-IR and (1)H-NMR spectra of IPhene revealed that IPhene was the same as the designed structure. ANOVA analysis showed that when mass fraction of IPhene was more than 10 wt.%, the obtained resin formulation had lower DC, polymerization shrinkage, FS, and FM than control resin (p<0.05). Polymers with 20 wt.% and 30 wt.% IPhene had higher fracture energies than control polymer (p<0.05). IPhene containing samples had higher radio-opacity than control group (p<0.05), and radio-opacity of IPhene containing sample increased with the increasing of IPhene mass fraction (p<0.05). Only polymers with 30 wt.% and 40 wt.% of IPhene showed antibacterial activity (p<0.05). SIGNIFICANCE IPhene could endow dental resin with both antibacterial and radio-opaque activity when IPhene reached 30 wt.% or more. Though sample with 30 wt.% of IPhene had lower FS and FM than control group, its lower volumetric shrinkage, higher fracture energy, higher radio-opacity, and antibacterial activity still made it having potential to be used in dentistry.
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Affiliation(s)
- Jingwei He
- Department of Biomaterials Science, Institute of Dentistry and Biocity Turku Biomaterial Research Program, University of Turku, Lemminkäisenkatu 2, Turku 20520, Finland; Turku Clinical Biomaterials Centre-TCBC, University of Turku, Itäinen Pitkäkatu 4 B, Turku FI-20520, Finland; College of Materials Science and Engineering, South China University of Technology, Guangzhou 510641, China.
| | - Eva Söderling
- Institute of Dentistry, University of Turku, Turku 20520, Finland
| | - Lippo V J Lassila
- Department of Biomaterials Science, Institute of Dentistry and Biocity Turku Biomaterial Research Program, University of Turku, Lemminkäisenkatu 2, Turku 20520, Finland; Turku Clinical Biomaterials Centre-TCBC, University of Turku, Itäinen Pitkäkatu 4 B, Turku FI-20520, Finland; Institute of Dentistry, University of Turku, Turku 20520, Finland
| | - Pekka K Vallittu
- Department of Biomaterials Science, Institute of Dentistry and Biocity Turku Biomaterial Research Program, University of Turku, Lemminkäisenkatu 2, Turku 20520, Finland; Turku Clinical Biomaterials Centre-TCBC, University of Turku, Itäinen Pitkäkatu 4 B, Turku FI-20520, Finland; Institute of Dentistry, University of Turku, Turku 20520, Finland; City of Turku Welfare Division, Oral Health Care, Turku 20101, Finland
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18
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Liang X, Söderling E, Liu F, He J, Lassila LVJ, Vallittu PK. Optimizing the concentration of quaternary ammonium dimethacrylate monomer in bis-GMA/TEGDMA dental resin system for antibacterial activity and mechanical properties. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2014; 25:1387-1393. [PMID: 24449028 DOI: 10.1007/s10856-014-5156-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2013] [Accepted: 01/12/2014] [Indexed: 06/03/2023]
Abstract
Four novel quaternary ammonium dimethacrylate monomers named IMQ (side alkyl chain length from 12 to 18) were synthesized with the aim to synthesize dental resin with antibacterial activity. All of IMQs were added into bis-GMA/TEGDMA dental resin system with a series of mass ratio (5, 10, and 20 wt%), double bond conversion (DC), flexural strength (FS), modulus of elasticity (FM) and biofilm formation inhibitory effect were studied. According to the results of DC, FS, FM, and the biofilm inhibitory effect, IMQ-16 containing polymer had the best comprehensive properties, and the optimal concentration of IMQ-16 in bis-GMA/TEGDMA dental resin would be in the range of 5-10 wt%.
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Affiliation(s)
- Xiaoxu Liang
- College of Materials Science and Engineering, South China University of Technology, Guangzhou, 510641, China
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Yu B, Liu F, He J. Preparation of low shrinkage methacrylate-based resin system without Bisphenol A structure by using a synthesized dendritic macromer (G-IEMA). J Mech Behav Biomed Mater 2014; 35:1-8. [PMID: 24721440 DOI: 10.1016/j.jmbbm.2014.03.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2013] [Revised: 03/16/2014] [Accepted: 03/21/2014] [Indexed: 10/25/2022]
Abstract
With the growing attention on estrogenic effect of Bisphenol A (BPA), the application of BPA derivatives like Bis-GMA in dental materials has also been doubted. In this research, new BPA free dental resin systems were prepared with synthesized dendritic macromer G-IEMA, UDMA, and TEGDMA. Physicochemical properties, such as double bond conversion, polymerization shrinkage, flexural strength and modulus, fracture energy, water sorption and solubility of BPA free resin formulations were investigated. Bis-GMA/TEGDMA resin system was used as a control. Results showed that the prepared BPA free resins could have higher double bond conversion, comparable or lower polymerization shrinkage and water sorption, and lower water solubility, when compared with Bis-GMA/TEGDMA resin. Though flexural strength and modulus of prepared BPA free polymers were lower than those of Bis-GMA/TEGDMA polymer, BPA free polymers had higher fracture energies and showed plastic deformation prior to fracture, all of these two phenomena showed that BPA free polymers in this research might have higher fracture toughness which would be good for the service life of dental materials.
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Affiliation(s)
- Biao Yu
- College of Materials Science and Engineering, South China University of Technology, Guangzhou 510641, China
| | - Fang Liu
- College of Materials Science and Engineering, South China University of Technology, Guangzhou 510641, China
| | - Jingwei He
- College of Materials Science and Engineering, South China University of Technology, Guangzhou 510641, China; State Key Laboratory of Pulp and Paper Engineering, South China University of Technology, Guangzhou 510641, China.
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20
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Huang Q, Lin Z, Liang X, Liu F, He J. Preparation and Characterization of Antibacterial Dental Resin with UDMQA-12. ADVANCES IN POLYMER TECHNOLOGY 2013. [DOI: 10.1002/adv.21395] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Qiting Huang
- Department of Conservative Dentistry and Endodontics; Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Stomatology; Guangzhou 510055 People's Republic of China
| | - Zhengmei Lin
- Department of Conservative Dentistry and Endodontics; Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Stomatology; Guangzhou 510055 People's Republic of China
| | - Xiaoxu Liang
- College of Materials Science and Engineering; South China University of Technology; Guangzhou 510641 People's Republic of China
| | - Fang Liu
- College of Materials Science and Engineering; South China University of Technology; Guangzhou 510641 People's Republic of China
| | - Jingwei He
- College of Materials Science and Engineering; South China University of Technology; Guangzhou 510641 People's Republic of China
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21
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Editorial of the special issue antimicrobial polymers. Int J Mol Sci 2013; 14:18002-8. [PMID: 24005863 PMCID: PMC3794765 DOI: 10.3390/ijms140918002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 08/27/2013] [Accepted: 08/28/2013] [Indexed: 02/04/2023] Open
Abstract
The special issue “Antimicrobial Polymers” includes research and review papers concerning the recent advances on preparation of antimicrobial polymers and their relevance to industrial settings and biomedical field. Antimicrobial polymers have recently emerged as promising candidates to fight microbial contamination onto surfaces thanks to their interesting properties. In this special issue, the main strategies pursued for developing antimicrobial polymers, including polymer impregnation with antimicrobial agents or synthesis of polymers bearing antimicrobial moieties, were discussed. The future application of these polymers either in industrial or healthcare settings could result in an extremely positive impact not only at the economic level but also for the improvement of quality of life.
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Imazato S, Ma S, Chen JH, Xu HHK. Therapeutic polymers for dental adhesives: loading resins with bio-active components. Dent Mater 2013; 30:97-104. [PMID: 23899387 DOI: 10.1016/j.dental.2013.06.003] [Citation(s) in RCA: 110] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 06/25/2013] [Accepted: 06/25/2013] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Many recent adhesives on the market exhibit reasonable clinical performance. Future innovations in adhesive materials should therefore seek out novel properties rather than simply modifying existing technologies. It is proposed that adhesive materials that are "bio-active" could contribute to better prognosis of restorative treatments. METHODS This review examines the recent approaches used to achieve therapeutic polymers for dental adhesives by incorporating bio-active components. A strategy to maintain adhesive restorations is the focus of this paper. RESULTS Major trials on therapeutic dental adhesives have looked at adding antibacterial activities or remineralization effects. Applications of antibacterial resin monomers based on quaternary ammonium compounds have received much research attention, and the loading of nano-sized bioactive particles or multiple ion-releasing glass fillers have been perceived as advantageous since they are not expected to influence the mechanical properties of the carrier polymer. SIGNIFICANCE The therapeutic polymer approaches described here have the potential to provide clinical benefits. However, not many technological applications in this category have been successfully commercialized. Clinical evidence as well as further advancement of these technologies can be a driving force to make these new types of materials clinically available.
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Affiliation(s)
- Satoshi Imazato
- Department of Biomaterials Science, Osaka University Graduate School of Dentistry, Osaka, Japan.
| | - Sai Ma
- Department of Prosthodontics, School of Stomatology, Fourth Military Medical University, Xi'an, China
| | - Ji-hua Chen
- Department of Prosthodontics, School of Stomatology, Fourth Military Medical University, Xi'an, China
| | - Hockin H K Xu
- Department of Endodontics, Prosthodontics and Operative Dentistry, University of Maryland Dental School, Baltimore, USA
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