Systemic and Local Biocompatibility Assessment of Graphene Composite Dental Materials in Experimental Mandibular Bone Defect

Application of nanotechnology to dentistry: Impact of graphene nanocomposites on clinical air quality

Concerns about air quality in dental clinics where aerosol generation during procedures poses significant health risks, have prompted investigations on advanced disinfection technologies. This editorial describes the strengths and limitations of ventilation and aerosol control measures in dental offices, especially with respect to the use of graphene nanocomposites. The potential of graphene nanocomposites as an innovative solution to aerosol-associated health risks is examined in this review due to the unique properties of graphene (e.g., high conductivity, mechanical strength, and antimicrobial activity). These properties have produced promising results in various fields, but the application of graphene in dentistry remains unexplored. The recent study by Ju et al which was published in World Journal of Clinical Cases evaluated the effectiveness of graphene-based air disinfection systems in dental clinics. The study demonstrated that graphene-based disinfection techniques produced significant reductions in suspended particulate matter and bacterial colony counts, when compared with traditional methods. Despite these positive results, challenges such as material saturation, frequency of filter replacement, and associated costs must be addressed before widespread adoption of graphene-based disinfection techniques in clinical practice. Therefore, there is need for further research on material structure optimization, long-term safety evaluations, and broader clinical applications, in order to maximize their positive impact on public health.

Composite Graphene for the Dimension- and Pore-Size-Mediated Stem Cell Differentiation to Bone Regenerative Medicine

As one of the most promising means to repair diseased tissues, stem cell therapy with immense potential to differentiate into mature specialized cells has been rapidly developed. However, the clinical application of stem-cell-dominated regenerative medicine was heavily hindered by the loss of pluripotency during the long-term in vitro expansion. Here, a composite three-dimensional (3D) graphene-based biomaterial, denoted as GO-Por-CMP@CaP, with hierarchical pore structure (micro- to macropore), was developed to guide the directional differentiation of human umbilical cord MSCs (hucMSCs) into osteoblasts. GO-Por-CMP@CaP could act as a high-efficiency living composite material without a "dead space", effectively regulating the cellular response. The 3D topological structure generated via the two-step modification on two-dimensional graphene could effectively mimic the natural 3D microenvironment of cells, enhancing the stem cell attachment, which is not only conducive for the proliferation of stem cells but also beneficial for the osteogenic differentiation. Meanwhile, the wide existence of interconnected macropores was favorable for bone ingrowth, capillary formation, as well as the nutrients transportation. Furthermore, the concurrent existence of micro- and mesopores significantly promoted the extracellular matrix (ECM) adsorption, which ensured cellular attachment, leading to multiscale osteointegration. Both in vitro and in vivo assay demonstrated the above three factors collaborated mutually with nanosized calcium phosphate (CaP, with chemical similarities to the inorganic components of bone), which provided abundant adhesive sites to adequately induce osteogenic differentiation in the absence of any soluble growth factors. Proteomic analysis experiments confirmed that GO-Por-CMP@CaP promoted the differentiation of hucMSCs cells into osteoblasts by affecting the PI3K-Akt signaling pathway through the up-regulation of SPP1 protein. Our study offers a pure material-based stem cell differentiation regulating behavior via engineering the dimension and porosity of material, which provides insights into the design and development of substitutes to bone repair materials.

3D-printed polycaprolactone/collagen/alginate scaffold incorporating phlorotannin for bone tissue regeneration: Assessment of sub-chronic toxicity

The development of effective scaffolds for bone regeneration is crucial given the increasing demand for innovative solutions to address bone defects and enhance healing process. In this study, a polycaprolactone/fish collagen/alginate (P/FC/A) 3D scaffold incorporating phlorotannin was developed to promote bone tissue regeneration. While the efficacy of the P/FC/A scaffold has been demonstrated through in vitro and in vivo experiments, its sub-chronic toxicity in animal models remains understudied, raising concerns regarding its safety in clinical application. Therefore, this study assessed the sub-chronic toxicity of the P/FC/A scaffold over 12 week using a New Zealand White rabbit model. Our results indicate no significant adverse effects in the group exposed to the P/FC/A scaffold compared with the negative control group implanted with a high-density polyethylene scaffold. These findings underscore the non-toxicity and safety profile of the P/FC/A scaffold, further supporting its potential suitability for clinical use in bone regeneration.

Bone regeneration by a bone substitute biomaterial containing hydroxyapatite, chitosan, xanthan and graphene oxide supplemented with conditioned medium from mesenchymal stem cells

This study analyzed a recently developed bone substitute biomaterial made of chitosan-xanthanhydroxyapatite-graphene oxide (CXHAG). The CXHAG particles underwent in vitro structural and morphological characterization, and in vivo testing with or without osteogenic conditioned medium from mesenchymal stem cells. Aim: The aim of this study was to determine whether the CXHAG novel biomaterial, supplemented with conditioned medium from mesenchymal stem cells, could be useful for bone regeneration. Materials and Method: For the in vitro study, cells were incubated with 20mg of CXHAG granules for 24 hours and a MTT assay was performed to tests for cytotoxicity. For the in vivo study, critical size calvarial bone defects were created in twenty-five rats. One animal had the defect unfilled (Control Group-CG) and was euthanized after 42 days. Twelve rats received the CXHAG particles (Group 1-G1) and the other twelve received the CXHAG particles supplemented with the conditioned medium (Group 2-G2). All G1/G2 grafts were covered with a CXHAG membrane. G1/G2 animals were euthanized after 14 days (T1) or 42 days (T2). The specimens were processed and histologically evaluated. Results: SEM analysis of the CXHAG particles showed granules of 300-400μm, with a rough irregular surface. They were not cytotoxic to dental pulp stem cells in vitro. The CG specimen showed loose immature connective tissue and no bone formation at the center of the defect. G1 and G2 presented remnant biomaterial particles at both time points, but only G2 had bone formation at the enter of the defect. Conclusions: The conditioned medium had a positive effect on bone regeneration in rat calvarial critical size defects when associated with the novel bone substitute biomaterial.

Biomechanics, Bioactive and Biomimetic philosophy in restorative dentistry ̶ Quo vadis?

INTRODUCTION

In recent years, restorative dentistry has embraced various techniques, including direct, semi-direct, and indirect restorations, to address the replacement of lost tooth tissue. The focus has been on integrating the principles of Biomechanics, Bioactivity, and Biomimicry (3-Bio) as key drivers behind these innovations.

METHODS

The aim of this article is to provide a concise overview of three important aspects of restorative dental materials: biomechanics, bioactivity and biomimetics. Further, the aim is to provide readers with relevant information on the 3-Bio concept, offering insights in to the innovative approaches shaping modern restorative dentistry.

RESULTS

Developing restorative materials with interactive properties aligned with the 3-Bio concept poses a significant challenge. Currently, dentistry lacks a comprehensive system in this regard. The development of dental materials based on the 3-Bio concept could potentially elicit positive mechanical and biological responses in targeted tooth tissues.

CONCLUSION

Assessing several parameters through a battery of in vitro and in silico assays could help in tailoring the different aspects of the 3-Bio concept, spanning from bioactivity to biomimetics via biomechanics. This approach could allow the prediction and translation of the clinical performance of the assessed restorative materials.

CLINICAL SIGNIFICANCE

The findings of this opinion article highlight that the development of restorative materials aligned with the 3-Bio concept could enhance the management of dental defects and extend the longevity of bonded restorations, thereby improving patient care through tissue preservation. More collective efforts between clinicians, researchers, and even industrial partners are required to fully understand the correlation between bioactive behavior, biomechanical limitations, and biomimetics to provide suitable restorative materials for specific clinical applications.

Evaluation of Biocomposite Cements for Bone Defect Repair in Rat Models

Repairing or reconstructing significant bone defects is typically challenging. In the present study, two composite cements were used as scaffolds in a sub-critical femoral defect in rats. A control group and two experimental batches were used to compare the outcomes. This research aimed to investigate the osteogenic potential and toxicological tolerance of the bioproducts through histopathology and computed tomography imaging analysis at 14, 28, 56, and 90 days post-implantation. The biomaterials used in the investigation consisted of a 65% bioactive salinized inorganic filler and a 25% weight organic matrix. The organic part of the biomaterial was composed of Bis-GMA (bisphenol A-glycidyl methacrylate), UDMA (urethane dimethacrylate), HEMA (2-Hydroxyethyl methacrylate), and TEGDMA (triethylene glycol dimethacrylate), while the inorganic filler was composed of silica, barium glass, hydroxyapatite, and fluor aluminosilicate glass. The first findings of this research are encouraging, revealing that there is a slight difference between the groups treated with biomaterials, but it might be an effective approach for managing bone abnormalities. Material C1 exhibited a faster bone defect healing time compared to material C2, where bone fractures occurred in some individuals. It is unclear if the fractures were caused by the presence of the biomaterial C2 or whether additional variables were to blame. By the end of the research, the mice appeared to tolerate the biomaterials without exhibiting any inflammatory or rejection responses.

Implications of graphene-based materials in dentistry: present and future

Since the advent of nanoscience, nanobiomaterials have been applied in the dental industry. Graphene and its derivatives have attracted the most interest of all of them due to their exceptional look, biocompatibility, multiplication differential, and antibacterial capabilities. We outlined the most recent developments about their applications to dentistry in our review. There is discussion of the synthesis processes, architectures, and characteristics of materials based on graphene. The implications of graphene and its counterparts are then meticulously gathered and described. Finally, in an effort to inspire more excellent research, this paper explores the obstacles and potential of graphene-based nanomaterials for dental aspects.

Biocompatibility and sub-chronic toxicity studies of phlorotannin/polycaprolactone coated trachea tube for advancing medical device applications

The phlorotannin-polycaprolactone-coated endotracheal tube (PP tube) has been developed with the aim of preventing tracheal stenosis that can result from endotracheal intubation, a factor that can lead to a serious airway obstruction. Its preventive efficacy has been assessed through both in vitro and in vivo investigations. However, there is a lack of studies concerning its biocompatibility and sub-chronic toxicity in animal models, a crucial factor to ensure the safety of its usage as a functional endotracheal tube. Thus, this study aimed to evaluate the biocompatibility and sub-chronic (13 weeks) toxicity of the PP tube through L929 cell line and diverse in vivo models. The cytotoxicity testing was performed using the extracts of PP tube on L929 cells for 72 h. Furthermore, other tests conducted on animal models, including ICR mice (acute systemic toxicity), New Zealand white rabbit (intradermal reactivity and pyrogen tests), guinea pig (maximization sensitization), and Sprague Dawley rats (sub-chronic toxicity). In both biocompatibility and sub-chronic toxicity analyses, no significant adverse effects are observed in the groups exposed to the PP tube, when compared to control group. Altogether, the findings suggested that the PP tube exhibits relative non-toxic and safety, supporting its suitability for clinical usage. However, extended periods of intubation may produce mild irritant responses, highlighting the clinical caution of limiting intubation duration to less than 13 weeks.

A Look Into the Cytotoxicity of Composite Fillings: Friend or Foe?

Dental resin composites are widely used restorative materials in dentistry for the treatment of carious and non-carious lesions as well as pit and fissure sealants, cavity liners, and endodontic sealers. They consist of two parts: an organic resin matrix and an inorganic/organic filler. The organic resin matrix phase is made up of multifunctional monomers and light-sensitive initiators, while the inorganic/organic filler phase is made up of micro/nano-sized fillers that primarily serve as reinforcement. Despite being a very promising dental material, its monomeric component has some drawbacks. It is well known for leaching out during incomplete polymerization, which can result in cytotoxicity. Bis-GMA (bisphenol A-glycidyl methacrylate) is the most cytotoxic of all monomeric components that exhibit synthetic estrogenic effects. The purpose of this article is to assess the cytotoxic effects of dental composite, understand the possible mechanism behind them, and explore ways to screen for and reduce this harmful effect, as well as shed light on its future prospects.

Chemical and Structural Assessment of New Dental Composites with Graphene Exposed to Staining Agents

Among the newest trends in dental composites is the use of graphene oxide (GO) nanoparticles to assure better cohesion of the composite and superior properties. Our research used GO to enhance several hydroxyapatite (HA) nanofiller distribution and cohesion in three experimental composites CC, GS, GZ exposed to coffee and red wine staining environments. The presence of silane A-174 on the filler surface was evidenced by FT-IR spectroscopy. Experimental composites were characterized through color stability after 30 days of staining in red wine and coffee, sorption and solubility in distilled water and artificial saliva. Surface properties were measured by optical profilometry and scanning electron microscopy, respectively, and antibacterial properties wer e assessed against Staphylococcus aureus and Escherichia coli. A colour stability test revealed the best results for GS, followed by GZ, with less stability for CC. Topographical and morphological aspects revealed a synergism between GZ sample nanofiller components that conducted to the lower surface roughness, with less in the GS sample. However, surface roughness variation due to the stain was affected less than colour stability at the macroscopic level. Antibacterial testing revealed good effect against Staphylococcus aureus and a moderate effect against Escherichia coli.

Graphene-Based Materials in Dental Applications: Antibacterial, Biocompatible, and Bone Regenerative Properties

Graphene-based materials have been shown to have advantageous properties in biomedical and dental applications due to their high mechanical, physiochemical, antibacterial, and stem cell differentiating properties. Although graphene-based materials have displayed appropriate biocompatible properties when used in implant materials for orthopedic applications, little research has been performed to specifically test the biocompatibility of graphene for dental applications. The oral environment, compared to the body, varies greatly and must be considered when evaluating biocompatibility requirements for dental applications. This review will discuss in vitro and in vivo studies that assess graphene's cytotoxicity, antibacterial properties, and cell differentiation ability to evaluate the overall biocompatibility of graphene-based materials for dental applications. Particle shape, size, and concentration were found to be major factors that affected overall biocompatibility of graphene.

Fibroblasts and macrophages cooperate to create a pro-tumorigenic and immune resistant environment via activation of TGF-β/IL-6 pathway in neuroblastoma

Tumor-associated macrophages (TAM) and cancer-associated fibroblasts (CAF) and their precursor mesenchymal stromal cells (MSC) are often detected together in tumors, but how they cooperate is not well understood. Here, we show that TAM and CAF are the most abundant nonmalignant cells and are present together in untreated human neuroblastoma (NB) tumors that are also poorly infiltrated with T and natural killer (NK) cells. We then show that MSC and CAF-MSC harvested from NB tumors protected human monocytes (MN) from spontaneous apoptosis in an interleukin (IL)-6 dependent mechanism. The interactions of MN and MSC with NB cells resulted in a significant induction or increase in the expression of several pro-tumorigenic cytokines/chemokines (TGF-β1, MCP-1, IL-6, IL-8, and IL-4) but not of anti-tumorigenic cytokines (TNF-α, IL-12) by MN or MSC, while also inducing cytokine expression in quiescent NB cells. We then identified a TGF-β1/IL-6 pathway where TGF-β1 stimulated the expression of IL-6 in NB cells and MSC, promoting TAM survival. Evidence for the contribution of TAM and MSC to the activation of this pathway was then provided in xenotransplanted NB tumors and patients with primary tumors by demonstrating a direct correlation between the presence of CAF and p-SMAD2 and p-STAT3. The data highlight a new mechanism of interaction between TAM and CAF supporting their pro-tumorigenic function in cancer.

Enhancing the mechanical properties and providing bioactive potential for graphene oxide/montmorillonite hybrid dental resin composites

This in vitro study synthetized hybrid composite nanoparticles of graphene oxide (GO) and montmorillonite MMt (GO-MMt) by ultrasound treatments. Samples were characterized by X-ray diffraction, FT-Raman, FTIR, TEM and SEM. The effect of their incorporation (0.3% and 0.5%) on the mechanical properties in a resin-based composite (RBC) and their bioactivity potential were evaluated. The specimens were characterized by evaluating their 3-point flexural strength (n = 6), modulus of elasticity (n = 6), degree of conversion (n = 6), microhardness (n = 6), contact angle (n = 3) and SEM analysis (n = 3). In vitro test in SBF were conducted in the RBCs modified by the hybrid. Overall, the synthetized hybrid composite demonstrated that GO was intercalated with MMt, showing a more stable compound. ANOVA and Tukey test showed that RBC + 0.3% GO-MMt demonstrated superior values of flexural strength, followed by RBC + 0.5% GO-MMt (p < 0.05) and both materials showed higher values of microhardness. All groups presented a contact angle below 90°, characterizing hydrophilic materials. RBCs modified by the hybrid showed Ca and P deposition after 14 days in SBF. In conclusion, RBCs composed by the hybrid showed promising results in terms of mechanical properties and bioactive potential, extending the application of GO in dental materials.

Research on Graphene and Its Derivatives in Oral Disease Treatment

Oral diseases present a global public health problem that imposes heavy financial burdens on individuals and health-care systems. Most oral health conditions can be treated in their early stage. Even if the early symptoms of oral diseases do not seem to cause significant discomfort, prompt treatment is essential for preventing their progression. Biomaterials with superior properties enable dental therapies with applications in restoration, therapeutic drug/protein delivery, and tissue regeneration. Graphene nanomaterials have many unique mechanical and physiochemical properties and can respond to the complex oral microenvironment, which includes oral microbiota colonization and high masticatory force. Research on graphene nanomaterials in dentistry, especially in caries, periodontitis therapy, and implant coatings, is progressing rapidly. Here, we review the development of graphene and its derivatives for dental disease therapy.

Development of Graphene-Based Materials in Bone Tissue Engineaering

Bone regeneration-related graphene-based materials (bGBMs) are increasingly attracting attention in tissue engineering due to their special physical and chemical properties. The purpose of this review is to quantitatively analyze mass academic literature in the field of bGBMs through scientometrics software CiteSpace, to demonstrate the rules and trends of bGBMs, thus to analyze and summarize the mechanisms behind the rules, and to provide clues for future research. First, the research status, hotspots, and frontiers of bGBMs are analyzed in an intuitively and vividly visualized way. Next, the extracted important subjects such as fabrication techniques, cytotoxicity, biodegradability, and osteoinductivity of bGBMs are presented, and the different mechanisms, in turn, are also discussed. Finally, photothermal therapy, which is considered an emerging area of application of bGBMs, is also presented. Based on this approach, this work finds that different studies report differing opinions on the biological properties of bGBMS due to the lack of consistency of GBMs preparation. Therefore, it is necessary to establish more standards in fabrication, characterization, and testing for bGBMs to further promote scientific progress and clinical translation.

3D and 4D printing in dentistry and maxillofacial surgery: Printing techniques, materials, and applications

3D and 4D printing are cutting-edge technologies for precise and expedited manufacturing of objects ranging from plastic to metal. Recent advances in 3D and 4D printing technologies in dentistry and maxillofacial surgery enable dentists to custom design and print surgical drill guides, temporary and permanent crowns and bridges, orthodontic appliances and orthotics, implants, mouthguards for drug delivery. In the present review, different 3D printing technologies available for use in dentistry are highlighted together with a critique on the materials available for printing. Recent reports of the application of these printed platformed are highlighted to enable readers appreciate the progress in 3D/4D printing in dentistry.

Synthesis and characterization of graphene oxide-zirconia (GO-ZrO2) and hydroxyapatite-zirconia (HA-ZrO2) nano-fillers for resin-based composites for load-bearing applications

OBJECTIVES

The study aims to synthesize two different types of nano-fillers based on zirconia (ZrO₂), which was functionalized with graphene oxide (GO-ZrO₂), and hydroxyapatite (HA-ZrO₂), and to implement them in an experimental methacrylate matrix containing new dimethacrylic oligomers.

METHODS

Nano-particles were synthesized via a modified Hummer's method and a sol-gel route. Bisphenol A-glycidyl methacrylate oligomers (Bis-GMA_336[0-1]) were synthesized from an epoxy resin that reacted with methacrylic acid in the presence of a basic catalyst. Traditional dental glass-fillers (Barium oxide/BaO and Barium fluoride/BaF₂) were synthesized to create an experimental resin-based composite (RBC) used as reference. Filler morphology was evaluated via Transmission Electron Microscopy. RBCs were characterised by real-time Fourier transform infrared spectroscopy (degree of cure/DC, polymerisation kinetics), real-time spectrometry (light transmittance), 3-point bending test (flexural strength and modulus, Weibull parameters), and depth-sensing indentation test (plastic and elastic deformation parameters).

RESULTS

The synthesized nanohybrid fillers proved good dispersing performance. Mechanical properties and materials' reliability are within or above the mean values reported in the literature for RBCs. Addition of HA-ZrO₂-fillers resulted in a decrease light transmission, DC and mechanical properties. Except for the HA-ZrO₂ RBC, materials showed a high resistance to softening in solvent.

CONCLUSIONS

The synthesis of GO-ZrO₂ and HA-ZrO₂ nanohybrid particles and their implementation in experimental RBCs has proven successful. Adjustments of the light transmission through suitable co-fillers in addition to GO-ZrO₂ as well as adjustments of the amount of HA-ZrO₂ are necessary to enable reduced curing time (<20 s).

CLINICAL SIGNIFICANCE

The addition of nanofillers with tailor-made properties can help improving the performance of modern restoratives.