In vitro remineralization by various ion-releasing materials of artificially demineralized dentin: A micro-CT study

OBJECTIVE

The aim of this study was to evaluate the remineralizing properties of ion-releasing restorative materials on pH cycling-induced carious dentin.

METHODS

Fifty sound molars were freshly extracted. The occlusal surfaces were abraded using water-cooled sandpaper (800 grit). The residual crowns were embedded in self-cured acrylic resin with the flat dentin surface exposed. A mesio-distal trench was created using a calibrated 0.5 mm deep occlusal reduction burr, and artificial dentin caries were generated by pH cycling. Then, teeth were randomly assigned to five groups according to the ion-releasing material used. For each sample, micro-CT acquisitions were performed at various intervals. Remineralization was assessed by mean gray value (MGV) measurements after registration and segmentation of the region of interest with 3D Slicer software. One-way repeated-measures ANOVA followed by Tukey's post hoc test was used to investigate the difference in MGVs among the various groups.

RESULTS

Only Cention Forte showed significantly increased MGVs after 4 weeks compared to demineralized dentin. MGVs were higher, but not significantly, after placement of the restorative materials, including in the resin composite control group. These results can be explained by the radiopacity of the materials.

SIGNIFICANCE

Cention Forte, the material with the highest radiopacity, showed a significant increase in the MGVs of artificially carious dentin after 4 weeks. However, the study of dentin remineralization by micro-CT could be impacted by the radiopacity of the restorative materials used. The relevance of this examination for the study of dentinal remineralization should be investigated.

Glass ionomer cement with calcium-releasing particles: Effect on dentin mineral content and mechanical properties

OBJECTIVE

to evaluate the effect a glass ionomer cement (GIC) containing hydroxyapatite (HAp) or calcium silicate (CaSi) particles on mineral content and mechanical properties of demineralized dentin. Ion release and compressive strength (CS) of the cements were also evaluated.

METHODS

GIC (Fuji 9 Gold Label, GC), GIC+ 5%HAp and GIC+ 5%CaSi (by mass) were evaluated. Ion release was determined by induced coupled plasma optical emission spectroscopy (Ca2+/Sr2+) or ion-specific electrode (F-) (n = 3). A composite (Filtek Z250, 3 M ESPE) was used as control in remineralization tests. Demineralized dentin discs were kept in contact with materials in simulated body fluid (SBF) at 37 °C for eight weeks. Mineral:matrix ratio (MMR) was determined by ATR-FTIR spectroscopy (n = 5). Dentin hardness (H) and elastic modulus (E) were determined by nanoindentation (n = 10). CS was tested after 24 h and 7d in deionized water (n = 12). Data were analyzed by ANOVA/Tukey test (α = 0.05).

RESULTS

Ca2+ and Sr2+ release was higher for the modified materials (p < 0.05). Only GIC+ 5%HAp showed higher F- release than the control (p < 0.05). All groups showed statistically significant increases in MMR, with no differences among them after 8 weeks (p > 0.05). No differences in dentin H or E were observed among groups (p > 0.05). HAp-modified GIC showed increased initial CS, while adding CaSi had the opposite effect (p < 0.05). After 7 days, GIC+ 5%CaSi presented lower CS in relation to control and GIC+ 5%HAp (p < 0.05).

SIGNIFICANCE

GIC modification with HAp or CaSi affected CS and increased ion release; however, none of the groups showed evidence of dentin remineralization in comparison to the negative control.

Novel biomimetic peptide-loaded chitosan nanoparticles improve dentin bonding via promoting dentin remineralization and inhibiting endogenous matrix metalloproteinases

OBJECTIVE

This study aims to synthesize novel chitosan nanoparticles loaded with an amelogenin-derived peptide QP5 (TMC-QP5/NPs), investigate their remineralization capability and inhibitory effects on endogenous matrix metalloproteinases (MMPs), and evaluate the dentin bonding properties of remineralized dentin regulated by TMC-QP5/NPs.

METHODS

TMC-QP5/NPs were prepared by ionic crosslinking method and characterized by dynamic light scattering method, scanning electron microscopy, transmission electron microscope, atomic force microscope, Fourier transform infrared spectroscopy, and differential scanning calorimetry. The encapsulation and loading efficiency of TMC-QP5/NPs and the release of QP5 were examined. To evaluate the remineralization capability of TMC-QP5/NPs, the mechanical properties, and the changes in structure and composition of differently conditioned dentin were characterized. The MMPs inhibitory effects of TMC-QP5/NPs were explored by MMP Activity Assay and in-situ zymography. The dentin bonding performance was detected by interfacial microleakage and microshear bond strength (μSBS).

RESULTS

TMC-QP5/NPs were successfully synthesized, with uniform size, good stability and biosafety. The encapsulation and loading efficiency of TMC-QP5/NPs was respectively 69.63 ± 2.22% and 13.21 ± 0.73%, with a sustained release of QP5. TMC-QP5/NPs could induce mineral deposits on demineralized collagen fibers and partial occlusion of dentin tubules, and recover the surface microhardness of dentin, showing better remineralization effects than QP5. Besides, TMC-QP5/NPs significantly inhibited the endogenous MMPs activity. The remineralized dentin induced by TMC-QP5/NPs exhibited less interfacial microleakage and higher μSBS, greatly improved dentin bonding.

SIGNIFICANCE

This novel peptide-loaded chitosan nanoparticles improved resin-dentin bonding by promoting dentin remineralization and inactivating MMPs, suggesting a promising strategy for optimizing dentin adhesive restorations.

Effect of the use of bromelain associated with bioactive glass-ceramic on dentin/adhesive interface

OBJECTIVES

To evaluate the effect of bromelain associated with Biosilicate on the bond strength (BS) of a universal adhesive system to sound (SD) and caries-affected dentin (CAD), and on the proteolytic activity.

MATERIALS AND METHODS

Cavities were prepared in 360 molars, half submitted to cariogenic challenge. Teeth were separated into groups (n=20): Control-No treatment; CHX-0.12% chlorhexidine; NaOCl-5% sodium hypochlorite; Br5%-5% bromelain; Br10%-10% bromelain; Bio-10% Biosilicate; NaOClBio-NaOCl+Bio; Br5%Bio-Br5%+Bio; Br10%Bio-Br10%+Bio. Following treatments, the adhesive system was applied, and cavities were restored. Samples were sectioned into sticks and stored at 37 °C for 24 h, 6 months, and 1 year. Microtensile BS (2-way ANOVA, Bonferroni's test, α=0.05), fracture patterns (SEM), and adhesive interfaces (TEM) were evaluated. Bacterial collagenase assay and in situ zymography were performed.

RESULTS

In CAD, Br10% presented higher BS (p=0.0208) than Br5%Bio. Br5% presented higher BS (p=0.0033) after 6 months than after 24 h; and association of treatments, higher BS (p<0.05) after aging than after 24 h. Mixed fractures were the most prevalent. Association of treatments promoted a more uniform hybrid layer with embedded Bio particles. Experimental groups presented lower (p<0.0001) relative fluorescence units than Control. Bromelain, associated or not with Bio, showed collagenolytic degradation.

CONCLUSIONS

Bromelain associated with Biosilicate did not affect the BS to SD. In CAD, Br5%Bio decreased immediate BS but had no long-term influence. This association decreased the proteolytic activity.

CLINICAL RELEVANCE

Bromelain and Biosilicate may enhance the longevity of adhesive restorations by inhibiting endogenous proteases.

Effect of a calcium silicate cement and experimental glass ionomer cements containing calcium orthophosphate particles on demineralized dentin

OBJECTIVE

The study aims to evaluate the effect of a glass ionomer cement (GIC; Fuji 9 Gold Label, GC) with added calcium orthophosphate particles and a calcium silicate cement (CSC; Biodentine, Septodont) regarding ion release, degradation in water, mineral content, and mechanical properties of demineralized dentin samples.

METHODS

GIC, GIC + 5% DCPD (dicalcium phosphate dihydrate), GIC + 15% DCPD, GIC + 5% β-TCP (tricalcium phosphate), GIC + 15% β-TCP (by mass), and CSC were evaluated for Ca2+/Sr2+/F- release in water for 56 days. Cement mass loss was evaluated after 7-day immersion in water. Partially demineralized dentin disks were kept in contact with materials while immersed in simulated body fluid (SBF) at 37 °C for 56 days. The "mineral-to-matrix ratio" (MMR) was determined by ATR-FTIR spectroscopy. Dentin hardness and elastic modulus were obtained by nanoindentation. Samples were observed under scanning and transmission electron microscopy. Data were analyzed by ANOVA/Tukey test (α = 0.05).

RESULTS

Ca2+ release from CSC and GIC (μg/cm2) were 4737.0 ± 735.9 and 13.6 ± 1.6, respectively. In relation to the unmodified GIC, the addition of DCPD or β-TCP increased ion release (p < 0.001). Only the dentin disks in contact with CSC presented higher MMR (p < 0.05) and mechanical properties than those restored with a resin composite used as control (p < 0.05). Mass loss was similar for GIC and CSC; however, the addition of DCPD or β-TCP increased GIC degradation (p < 0.05).

CONCLUSION

Despite the increase in ion release, the additional Ca2+ sources did not impart remineralizing capability to GIC. Both unmodified GIC and CSC showed similar degradation in water.

CLINICAL RELEVANCE

CSC was able to promote dentin remineralization.

Hyaluronic acid-mediated collagen intrafibrillar mineralization and enhancement of dentin remineralization

Non-collagenous proteins (NCPs) in the extracellular matrix (ECM) of bone and dentin are known to play a critical regulatory role in the induction of collagen fibril mineralization and are embedded in hyaluronic acid (HA), which acts as a water-retaining glycosaminoglycan and provides necessary biochemical and biomechanical cues. Our previous study demonstrated that HA could regulate the mineralization degree and mechanical properties of collagen fibrils, yet its kinetics dynamic mechanism on mineralization is under debate. Here, we further investigated the role of HA on collagen fibril mineralization and the possible mechanism. The HA modification can significantly promote intrafibrillar collagen mineralization by reducing the electronegativity of the collagen surface to enhance calcium ions (Ca2+) binding capacity to create a local higher supersaturation. In addition, the HA also provides additional nucleation sites and shortens the induction time of amorphous calcium phosphate (ACP)-mediated hydroxyapatite (HAP) crystallization, which benefits mineralization. The acceleration effect of HA on intrafibrillar collagen mineralization is also confirmed in collagen hydrogel and in vitro dentin remineralization. These findings offer a physicochemical view of the regulation effect of carbohydrate polymers in the body on biomineralization, the fine prospect for an ideal biomaterial to repair collagen-mineralized tissues.

Dentin remineralization in acidic solution without initial calcium phosphate ions via poly(amido amine) and calcium phosphate nanocomposites after fluid challenges

OBJECTIVES

A previous study showed that the combination of poly(amido amine) (PAMAM) and rechargeable composites with nanoparticles of amorphous calcium phosphate (NACP) induced dentin remineralization in an acidic solution with no initial calcium (Ca) and phosphate (P) ions, mimicking the oral condition of individuals with dry mouths. However, the frequent fluid challenge in the oral cavity may decrease the remineralization capacity. Therefore, the objective of the present study was to investigate the remineralization efficacy on dentin in an acid solution via PAMAM + NACP after fluid challenges for the first time.

METHODS

The NACP nanocomposite was stored in a pH 4 solution for 77 days to exhaust its Ca and P ions and then recharged. Demineralized dentin samples were divided into four groups: (1) control dentin, (2) dentin coated with PAMAM, (3) dentin with recharged NACP composite, and (4) dentin with PAMAM + recharged NACP. PAMAM-coated dentin was shaken in phosphate-buffered saline for 77 days to desorb PAMAM from dentin. Samples were treated in pH 4 lactic acid with no initial Ca and P ions for 42 days.

RESULTS

After 77 days of fluid challenge, PAMAM failed to prevent dentin demineralization in lactic acid. The recharged NACP nanocomposite raised the pH to above 6.5 and re-released more than 6.0 and 4.0 mmol/L Ca and P ions daily, respectively, which inhibited further demineralization. In contrast, the PAMAM + NACP combined method induced great dentin remineralization and restored the dentin microhardness to 0.54 ± 0.04 GPa, which approached that of sound dentin (P = 0.426, P > 0.05).

CONCLUSIONS

The PAMAM + NACP combination achieved dentin remineralization in an acid solution with no initial Ca and P ions, even after severe fluid challenges.

CLINICAL RELEVANCE

The novel PAMAM + NACP has a strong and sustained remineralization capability to inhibit secondary caries, even for individuals with dry mouths.

Effect of poly (γ-glutamic acid)/tricalcium phosphate (γ-PGA/TCP) composite for dentin remineralization in vitro

The poly (γ-glutamic acid)/tricalcium phosphate (γ-PGA/TCP) composite was fabricated as a novel biomineralization material function in preventing caries. Demineralized bovine dentin specimens were prepared and randomly divided into 5 groups (i. α-TCP, ⅱ. γ-PGA, ⅲ. γ-PGA/TCP, ⅳ. CPP-ACP, and ⅴ. deionized water) and subjected to 14 days of pH cycling. Remineralization ability was evaluated by lesion depth, mineral loss and microhardness. The morphology of dentin depositions was observed with scanning electron microscope (SEM), the crystal structure was determined by X-ray diffraction (XRD), and the wettability was tested by contact angle measurements. ANOVA revealed specimens treated by γ-PGA/TCP presented the statistically least lesion depth (p<0.01) and mineral loss (p<0.001), and the highest hardness (p<0.001). SEM revealed prominent intra- and inter-tubular precipitates in both γ-PGA and γ-PGA/TCP groups. The XRD patterns of the deposition structures in all groups were similar to those of sound dentin, and the contact angle of water decreased after γ-PGA/TCP treatment.

Effects of pastes containing ion-releasing particles on dentin remineralization

We investigated the effects of the weekly application of pastes containing a surface reaction-type pre-reacted glass-ionomer (S-PRG) filler on dentin remineralization. Human dentin blocks were demineralized and polished using pastes containing S-PRG filler (0, 5, and 30%), and then immersed in remineralizing solution for 1 month. Nanoindentation testing was carried out during the immersion period, and the dentin surfaces were examined using scanning electron microscopy. A nano-hydroxyapatite-containing paste was used for comparison. Immersion in demineralization solution had a marked negative effect on the mechanical properties in all specimens. The mechanical properties of specimens polished with S-PRG filler-containing pastes recovered significantly after immersion in remineralization solution for 1 month compared with the other specimens. After remineralization, the open dentinal tubules were filled with a remineralization layer in specimens polished with S-PRG filler-containing and nano-hydroxyapatite-containing pastes. S-PRG filler-containing pastes can aid dentin remineralization.

Poly(amido amine) and calcium phosphate nanocomposite remineralization of dentin in acidic solution without calcium phosphate ions

OBJECTIVE

Patients with dry mouth often have an acidic oral environment lacking saliva that provides calcium (Ca) and phosphate (P) ions. However, there has been no study on dentin remineralization by placing samples in an acidic solution without Ca and P ions. Previous studies used saliva-like solutions with neutral pH and Ca and P ions. Therefore, the objective of this study was to investigate a novel method of combining poly(amido amine) (PAMAM) with a composite of nanoparticles of amorphous calcium phosphate (NACP) on dentin remineralization in an acidic solution without Ca and P ions for the first time.

METHODS

Demineralized dentin specimens were tested into four groups: (1) dentin control, (2) dentin coated with PAMAM, (3) dentin with NACP nanocomposite, (4) dentin with PAMAM plus NACP composite. Specimens were treated with lactic acid at pH 4 without initial Ca and P ions for 21 days. Acid neutralization and Ca and P ion concentrations were measured. Dentin specimens were examined by scanning electron microscopy (SEM), energy dispersive spectroscopy (EDS) and hardness testing vs. remineralization efficacy.

RESULTS

NACP composite had mechanical properties similar to commercial control composites (p>0.1). NACP composite neutralized acid and released Ca and P ions. PAMAM alone failed to induce dentin remineralization. NACP alone achieved mild remineralization and slightly increased dentin hardness at 21days (p>0.1). In contrast, the PAMAM+NACP nanocomposite method in acid solution without initial Ca and P ions greatly remineralized the pre-demineralized dentin, restoring its hardness to approach that of healthy dentin (p>0.1).

SIGNIFICANCE

Dentin remineralization via PAMAM+NACP in pH 4 acid without initial Ca and P ions was demonstrated for the first time, when conventional methods such as PAMAM did not work. The novel PAMAM+NACP nanocomposite method is promising to protect tooth structures, especially for patients with reduced saliva to inhibit caries.

Dentin remineralization in acid challenge environment via PAMAM and calcium phosphate composite

OBJECTIVES

The objective of this study was to investigate the effects of poly (amido amine) (PAMAM), composite with nanoparticles of amorphous calcium phosphate (NACP), and the combined PAMAM+NACP nanocomposite treatment, on remineralization of demineralized dentin in a cyclic artificial saliva/lactic acid environment for the first time.

METHODS

Dentin specimens were prepared and demineralized with 37% phosphoric acid for 15s. Four groups were prepared: (1) dentin control, (2) dentin coated with PAMAM, (3) dentin with NACP composite, (4) dentin with PAMAM+NACP. Specimens were treated with a cyclic artificial saliva/lactic acid regimen for 21days. Acid neutralization and calcium (Ca) and phosphate (P) ion concentrations were measured. The remineralized dentin specimens were examined by scanning electron microscopy (SEM) and hardness testing.

RESULTS

NACP nanocomposite had mechanical properties similar to commercial control composites (p>0.1). NACP composite had acid-neutralization and Ca and P ion release capability. PAMAM or NACP composite each alone achieved remineralization and increased the hardness of demineralized dentin (p<0.05). PAMAM+NACP nanocomposite achieved the greatest mineral regeneration in demineralized dentin and the greatest hardness increase in demineralized dentin, which approached the hardness of healthy dentin (p>0.1).

SIGNIFICANCE

The superior remineralization efficacy of PAMAM+NACP was demonstrated for the first time. PAMAM+NACP induced remineralization in demineralized dentin in an acid challenge environment, when conventional remineralization methods such as PAMAM did not work well. The novel PAMAM+NACP composite approach is promising for a wide range of dental applications to inhibit caries and protect tooth structures.