The burden of root caries: Updated perspectives and advances on management strategies.

BACKGROUND: Root caries has gained much attention in the last few years. As the world's population is ageing and people currently tend to retain more teeth compared with older generations, there is an increased prevalence of periodontal disease and gingival recession, which may accelerate the onset of root caries. OBJECTIVE: This review aims to summarise recent findings related to the diagnosis, prevention and treatment of root caries. MATERIALS AND METHODS: MEDLINE (OVID) and Scopus (Elsevier) searches were performed to identify and discuss articles that address the pathogenicity and clinical management of root caries. RESULTS: Root caries is a multifactorial disease. Cariogenic species involved in root caries are less dependent on carbohydrates since collagen degradation inside the dentinal tubules can provide nutrients and microcavities for the invading microorganisms. Furthermore, the root surface has fewer minerals in comparison with enamel, which may accelerate the onset of demineralisation. Root caries could be prevented by patient education, modification of risk factors, and the use of in-office and home remineralisation tools. The use of non-invasive approaches to control root caries is recommended, as the survival rate of root caries restorations is poor. When plaque control is impossible and a deep/large cavity is present, glass ionomer or resin-based restorations can be placed. CONCLUSION: The assessment of root carious lesions is critical to determine the lesion activity and the required intervention. Dental practitioners should also be aware of different prevention and treatment approaches to design optimum oral health care for root caries-affected patients.

Novel pit and fissure sealant containing nano-CaF2 and dimethylaminohexadecyl methacrylate with double benefits of fluoride release and antibacterial function.

OBJECTIVE: Pit and fissure sealants with antibacterial and remineralization properties have broad application prospects in caries prevention. The objectives of this study were to: (1) develop a novel pit and fissure sealant containing CaF2 nanoparticles (nCaF2) and dimethylaminohexadecyl methacrylate (DMAHDM); and (2) investigate the effects of nCaF2 and DMAHDM on biofilm response and fluoride (F) ion release for the first time. METHODS: Helioseal F was used as a control. Bioactive sealants were formulated with DMAHDM and nCaF2. Flow properties, enamel shear bond strength, hardness and F ion releases were measured. Streptococcus mutans (S. mutans) biofilms were grown on sealants. Biofilm metabolic activity, lactic acid production, colony-forming units (CFU), and pH of biofilm culture medium were measured. RESULTS: Adding 5% DMAHDM and 20% nCaF2 did not reduce the paste flow and enamel bond strength, compared to control (p < 0.05). Hardness of sealants with 20% nCaF2 and DMAHDM was higher than control (p < 0.05). The F ion release from 20% nCaF2 was much higher than that of commercial control (p < 0.05). The sealant with DMAHDM reduced the S. mutans biofilm CFU by 4 logs. The pH in biofilm medium of the new bioactive sealant was much higher (pH 6.8) than that of commercial sealant (pH 4.66) (p < 0.05). SIGNIFICANCE: The new bioactive pit and fissure sealant with nCaF2 and DMAHDM achieved high fluoride release and strong antibacterial performance. This novel fluoride-releasing and antibacterial sealant is promising to inhibit caries and promote the remineralizaton of enamel and dentin.

Antibacterial and remineralizing nanocomposite inhibit root caries biofilms and protect root dentin hardness at the margins.

OBJECTIVES: Senior patients have a high incidence of tooth root caries. The objectives of this study were to: (1) develop a bioactive composite with calcium (Ca) and phosphate (P) ion-release and antibacterial capabilities via nanoparticles of amorphous calcium phosphate (NACP) and dimethylaminohexadecyl methacrylate (DMAHDM); (2) inhibit root biofilms of Streptococcus mutans, Lactobacillus acidophilus and Candida albicans in a biofilm-based recurrent root caries model to protect root dentin hardness under biofilms for the first time. METHODS: Five groups were tested: (1) Heliomolar nanocomposite (Commercial control); (2) Experimental composite control (0% NACP, 0% DMAHDM); (3) Remineralizing composite (30% NACP); (4) Antibacterial composite (3% DMAHDM); (5) Remineralizing and antibacterial composite (NACP + DMAHDM). Colony-forming units (CFU), lactic acid and polysaccharide of biofilms were evaluated. Demineralization of bovine root dentin with restorations was induced via multi-species biofilms, and root dentin hardness was measured. RESULTS: Adding NACP and DMAHDM into composite did not compromise the mechanical properties (p >  0.05). Biofilm lactic acid, polysaccharides and CFU were greatly reduced via DMAHDM (p < 0.05). Ca and P ion releases were substantially increased at cariogenic low pH. With multi-species biofilm acid attack, root dentin hardness (GPa) decreased to 0.12 ± 0.03 for Commercial control, and 0.11 ± 0.03 for Experimental control. Root dentin hardness was 0.20 ± 0.04 for NACP group, 0.21 ± 0.04 for DMAHDM group, and 0.30 ± 0.03 for NACP + DMAHDM group which was more than 2-fold that of control groups (p < 0.05). CONCLUSIONS: The novel NACP + DMAHDM nanocomposite had strong antibacterial effects and Ca and P ion release. When tested in a multi-species recurrent root caries model, NACP + DMAHDM nanocomposite substantially reduced root dentin demineralization and protected dentin hardness around the restorations under biofilms. Therefore, this novel bioactive composite is promising to inhibit root caries and protect tooth structures.

Novel rechargeable nano-CaF2 orthodontic cement with high levels of long-term fluoride release.

OBJECTIVES: Fluoride-containing orthodontic cements are used to combat white spot lesions (WSLs) in enamel. However, the fluoride (F) ion releases from these cements are relatively low and short-term. The objectives of this study were to develop a novel rechargeable orthodontic cement with nanoparticles of calcium fluoride (nCaF2) to provide long-term and high levels of F release, and to investigate F recharge and physical and cytotoxic properties. METHODS: The nCaF2 with a mean particle size of 58 nm were synthesized using a spray-drying method. Pyromellitic glycerol dimethacrylate (PMGDM), ethoxylated bisphenol A dimethacrylate (EBPADMA), 2-hydroxyethyl methacrylate (HEMA) and bisphenol A glycidyl dimethacrylate (BisGMA) were used to prepare the cements (denoted PE and PEHB resins). A resin-modified glass ionomer (RMGI) served as control. Enamel shear bond strength (SBS), cytotoxicity, and F ion recharge and re-release were evaluated. RESULTS: nCaF2 cements had good SBS and excellent biocompatibility that were comparable to RMGI (p > 0.1). After a recharge for 1 min, the F re-release from PEHB + 30%nCaF2 cement was 80% higher than RMGI (p < 0.05). Increasing nCaF2 content from 20% to 30% greatly increased the F ion re-release (p < 0.05). The F ion re-release of nCaF2 cements did not decrease with increasing the number of recharge and re-release cycles (p > 0.1). CONCLUSIONS: A novel F ion-rechargeable orthodontic cement containing nCaF2 was developed with clinically acceptable enamel SBS, good biocompatibility, and sustained F ion recharge and re-release that were 1.8 folds that of a commercial RMGI. CLINICAL SIGNIFICANCE: Novel rechargeable nCaF2 orthodontic cement is promising to provide the needed long-term and high levels of F ion releases to inhibit WSLs in orthodontics.

A nano-CaF2-containing orthodontic cement with antibacterial and remineralization capabilities to combat enamel white spot lesions.

OBJECTIVES: The objectives of this study were to develop a resin-modified glass ionomer containing nanoparticles of calcium fluoride (nCaF2) and dimethylaminohexadecyl methacrylate (DMAHDM) for the first time and investigate the antibacterial and remineralization properties. METHODS: nCaF2 was synthesized using a spray-drying method and characterized using a transmission electron microscope. Twenty weight percentage (wt%) nCaF2 and 3 wt% DMAHDM were incorporated into a RMGI (GC Ortho LC). Enamel shear bond strength (SBS) and cytotoxicity were determined. Fluoride (F) and calcium (Ca) ion releases were assessed. Biofilm live/dead staining, metabolic activity, polysaccharide and lactic production, and colony-forming units (CFU) were evaluated. The remineralization ability was determined by measuring the effects of cements on enamel surface hardness and lesion depth. RESULTS: Incorporating 20 wt% nCaF2 and 3 wt% DMAHDM did not compromise the SBS (p > 0.1). The decrease of pH from 7.0 to 4.0 significantly increased the F and Ca ion releases. The new cement greatly reduced the metabolic activity, polysaccharide and lactic acid productions, and lowered the biofilm CFU by 3 log, compared to commercial control (p < 0.05). The new cement increased the enamel hardness by 56% and decreased the lesion depth by 43%, compared to control (p < 0.05). The cell viability at 7 days against the new cement extracts was 82.2% of that of the negative control in culture medium without any extracts. CONCLUSIONS: The novel orthodontic cement containing nCaF2 and DMAHDM achieved much stronger antibacterial and remineralization capabilities and greater enamel hardness than the commercial control did, without compromising the orthodontic bracket-enamel SBS and biocompatibility. CLINICAL SIGNIFICANCE: The novel bioactive and nanostructured orthodontic cement is promising to inhibit enamel demineralization, white spot lesions and caries in orthodontic treatments.

Current Concepts and Best Evidence on Strategies to Prevent Dental Erosion.

Dental erosion is a multifactorial condition associated with chemical, biological, and behavioral factors whereby a non-bacterial chemical process leads to an irreversible loss of dental structure. Consequences of this erosive process include painful sensitivity, susceptibility to further erosion, mechanical wear, changes in occlusion, exposure of dental pulp, and poor esthetics. Substantial evidence has revealed new insights to diagnosing early stages of dental erosion and enabling novel preventive approaches to control its progression. In the context of outpatient medical/dental practice, clinicians often encounter patients with progressive dental erosion. This article summarizes published research in this area of dentistry to suggest guidelines that are clinically oriented but scientifically fundamental. It is aimed at helping clinicians effectively integrate this information into their professional evaluations of dental erosion with regard to diagnosis, risk factors, clinical signs, assessment, and clinical preventive strategies and treatment. Clinicians should address patient diet habits, educate patients on prevalence data, and inform them regarding potential acidic interactions, such as medically induced acidic conditions, that may ultimately lead to tooth destruction. Prevention of dental erosion, including the recognition of initial erosive lesions and the implementation of the early intervention, involves the clinical expertise of both the dentist and physician.

Protein-repelling adhesive resin containing calcium phosphate nanoparticles with repeated ion-recharge and re-releases.

OBJECTIVES: The objectives were to develop a calcium (Ca) and phosphate (P) ion-rechargeable and protein-repellent adhesive containing nanoparticles of amorphous calcium phosphate (NACP) and 2-methacryloyloxyethyl phosphorylcholine (MPC), and investigate the MPC effects on ion recharge and re-releases for the first time. METHODS: Pyromellitic glycerol dimethacrylate and ethoxylated bisphenol-A dimethacrylate were used to fabricate adhesive PEHB. Six adhesives were tested: (1) Scotchbond (SBMP); (2) PEHB, (3) PEHB + 20%NACP; (4) PEHB + 30%NACP; (5) PEHB + 20%NACP+3%MPC; (6) PEHB + 30%NACP+3%MPC. Dentin shear bond strength, Ca/P ion release, recharge and re-release, and protein adsorption were measured. A microcosm biofilm model was tested for lactic-acid production and colony-forming units (CFU). RESULTS: Adding NACP + MPC did not negatively affect dentin bond strength (p > 0.1). With increasing the number of recharge/re-release cycles, the Ca/P ion re-release reached similarly higher levels (p > 0.1), indicating long-term remineralization capability. One recharge enabled the adhesives to have continued re-releases for 21 days. Incorporation of 3% MPC yielded 10-fold decrease in protein adsorption, and 1-2 log decrease in biofilm CFU. CONCLUSIONS: The new rechargeable adhesive with MPC + 30%NACP greatly reduced protein adsorption, biofilm growth and lactic acid. Incorporation of MPC did not compromise the excellent Ca/P ion release, rechargeability, and dentin bond strength. CLINICAL SIGNIFICANCE: Novel bioactive adhesive containing MPC + NACP is promising to repel proteins and bacteria, and inhibit secondary caries at the restoration margins. The method of NACP + MPC to combine CaP-recharge and protein-repellency is applicable to the development of a new generation of materials including composites and cements to suppress oral biofilms and plaque formation and protect tooth structures.

Ph-activated nano-amorphous calcium phosphate-based cement to reduce dental enamel demineralization.

Enamel demineralization is destructive, esthetically compromised, and costly complications for orthodontic patients. Nano-sized amorphous calcium phosphate (NACP) has been explored to address this challenge. The 20% NACP-loaded ortho-cement notably exhibited favorable behavior on reducing demineralization of enamel around brackets in a caries model designed to simulate the carious attack. The 20% NACP-loaded ortho-cement markedly promotes higher calcium and phosphate release at a low pH, and the mineral loss was almost two fold lower and carious lesion depth decreased the by 1/3. This novel approach is promising co-adjuvant route for prevention of dental caries dissemination in millions of patients under orthodontic treatment.

Effects of Long-Term Water-Aging on Novel Anti-Biofilm and Protein-Repellent Dental Composite.

The aims of this study were to: (1) synthesize an anti-biofilm and protein-repellent dental composite by combining 2-methacryloyloxyethyl phosphorylcholine (MPC) with quaternary ammonium dimethylaminohexadecyl methacrylate (DMAHDM); and (2) evaluate the effects of water-aging for 180 days on protein resistance, bacteria-killing ability, and mechanical properties of MPC-DMAHDM composite. MPC and DMAHDM were added into a resin composite. Specimens were stored in distilled water at 37 °C for 1, 30, 90, and 180 days. Mechanical properties were measured in three-point flexure. Protein attachment onto the composite was evaluated by a micro bicinchoninic acid approach. An oral plaque microcosm biofilm model was employed to evaluate oral biofilm viability vs. water-aging time. Mechanical properties of the MPC-DMAHDM composite after 180-day immersion matched those of the commercial control composite. The composite with 3% MPC + 1.5% DMAHDM had much stronger resistance to protein adhesion than control (p < 0.05). MPC + DMAHDM achieved much stronger biofilm-eradicating effects than MPC or DMAHDM alone (p < 0.05). Biofilm colony-forming units on the 3% MPC + 1.5% DMAHDM composite were three orders of magnitude lower than commercial control. The protein-repellent and antibacterial effects were durable and showed no loss in water-aging from 1 to 180 days. The novel MPC-DMAHDM composite possessed strong and durable resistance to protein adhesion and potent bacteria-eradicating function, while matching the load-bearing ability of a commercial dental composite. The novel MPC-DMAHDM composite represents a promising means of suppressing oral plaque growth, acid production, and secondary caries.

Novel bioactive nanocomposite for Class-V restorations to inhibit periodontitis-related pathogens.

OBJECTIVES: The occurrence of tooth root caries is increasing as the world population ages and tooth retention in seniors increases. Class V restorations with subgingival margins are difficult to clean and often lead to periodontitis. The objectives of this study were to develop a Class V composite containing dimethylaminohexadecyl methacrylate (DMAHDM) and nanoparticles of amorphous calcium phosphate (NACP), and investigate mechanical properties and the inhibition of six species of periodontitis-related biofilms for the first time. METHODS: Ethoxylated bisphenol A dimethacrylate (EBPADMA) and pyromellitic glycerol dimethacrylate (PMGDM) were mixed at 1:1 mass ratio to form the resin matrix. DMAHDM, NACP, and glass particles were incorporated at 3%, 20% and 50% by mass, respectively. Six species were tested: Porphyromonas gingivalis, Prevotella intermedia, Prevotella nigrescens, Aggregatibacter actinomycetemcomitans, Fusobacterium nucleatum and Enterococcus faecalis. Colony-forming units (CFU), live/dead assay, biomass via crystal violet staining, and polysaccharide production by biofilms were determined on composites. RESULT: Adding 3% DMAHDM to composite did not affect the flexure strength and elastic modulus (p>0.1). For all six species of periodontal pathogens, the DMAHDM composite had biofilm CFU nearly three orders of magnitude less than that without DMAHDM. The killing efficacy of DMAHDM composite against the six species was: E. faecalis

Orthodontic cement with protein-repellent and antibacterial properties and the release of calcium and phosphate ions.

OBJECTIVES: White spot lesions often occur in orthodontic treatments. The objective of this study was to develop a novel resin-modified glass ionomer cement (RMGI) as an orthodontic cement with protein-repellent, antibacterial and remineralization capabilities. METHODS: Protein-repellent 2-methacryloyloxyethyl phosphorylcholine (MPC), antibacterial dimethylaminohexadecyl methacrylate (DMAHDM), nanoparticles of silver (NAg), and nanoparticles of amorphous calcium phosphate (NACP) were incorporated into a RMGI. Enamel shear bond strength (SBS) was determined. Calcium (Ca) and phosphate (P) ion releases were measured. Protein adsorption onto specimens was determined by a micro bicinchoninic acid method. A dental plaque microcosm biofilm model was tested. RESULTS: Increasing the NACP filler level increased the Ca and P ion release. Decreasing the solution pH increased the ion release. Incorporating MPC into RMGI reduced protein adsorption, which was an order of magnitude less than that of commercial controls. Adding DMAHDM and NAg into RMGI yielded a strong antibacterial function, greatly reducing biofilm viability and acid production. Biofilm CFU counts on the multifunctional orthodontic cement were 3 orders of magnitude less than that of commercial control (p<0.05). These benefits were achieved without compromising the enamel shear bond strength (p>0.1). CONCLUSIONS: A novel multifunctional orthodontic cement was developed with strong antibacterial and protein-repellent capabilities for preventing enamel demineralization. CLINICAL SIGNIFICANCE: The new cement is promising to prevent white spot lesions in orthodontic treatments. The method of incorporating four bioactive agents may have wide applicability to the development of other bioactive dental materials to inhibit caries.

Do Dental Resin Composites Accumulate More Oral Biofilms and Plaque than Amalgam and Glass Ionomer Materials?

A long-time drawback of dental composites is that they accumulate more biofilms and plaques than amalgam and glass ionomer restorative materials. It would be highly desirable to develop a new composite with reduced biofilm growth, while avoiding the non-esthetics of amalgam and low strength of glass ionomer. The objectives of this study were to: (1) develop a protein-repellent composite with reduced biofilms matching amalgam and glass ionomer for the first time; and (2) investigate their protein adsorption, biofilms, and mechanical properties. Five materials were tested: A new composite containing 3% of protein-repellent 2-methacryloyloxyethyl phosphorylcholine (MPC); the composite with 0% MPC as control; commercial composite control; dental amalgam; resin-modified glass ionomer (RMGI). A dental plaque microcosm biofilm model with human saliva as inoculum was used to investigate metabolic activity, colony-forming units (CFU), and lactic acid production. Composite with 3% MPC had flexural strength similar to those with 0% MPC and commercial composite control (p > 0.1), and much greater than RMGI (p < 0.05). Composite with 3% MPC had protein adsorption that was only 1/10 that of control composites (p < 0.05). Composite with 3% MPC had biofilm CFU and lactic acid much lower than control composites (p < 0.05). Biofilm growth, metabolic activity and lactic acid on the new composite with 3% MPC were reduced to the low level of amalgam and RMGI (p > 0.1). In conclusion, a new protein-repellent dental resin composite reduced oral biofilm growth and acid production to the low levels of non-esthetic amalgam and RMGI for the first time. The long-held conclusion that dental composites accumulate more biofilms than amalgam and glass ionomer is no longer true. The novel composite is promising to finally overcome the major biofilm-accumulation drawback of dental composites in order to reduce biofilm acids and secondary caries.

Development of a multifunctional adhesive system for prevention of root caries and secondary caries.

OBJECTIVES: The objectives of this study were to: (1) develop a novel adhesive for prevention of tooth root caries and secondary caries by possessing a combination of protein-repellent, antibacterial, and remineralization capabilities for the first time; and (2) investigate the effects of 2-methacryloyloxyethyl phosphorylcholine (MPC), dimethylaminohexadecyl methacrylate (DMAHDM), and nanoparticles of amorphous calcium phosphate (NACP) on dentin bond strength, protein-repellent properties, and dental plaque microcosm biofilm response. METHODS: MPC, DMAHDM and NACP were added into Scotchbond Multi-Purpose primer and adhesive. Dentin shear bond strengths were measured. Adhesive coating thickness, surface texture and dentin-adhesive interfacial structure were examined. Protein adsorption onto adhesive resin surface was determined by the micro bicinchoninic acid method. A human saliva microcosm biofilm model was used to investigate biofilm metabolic activity, colony-forming unit (CFU) counts, and lactic acid production. RESULTS: The resin with 7.5% MPC+5% DMAHDM+30% NACP did not adversely affect dentin shear bond strength (p>0.1). The resin with 7.5% MPC+5% DMAHDM+30% NACP produced a coating on root dentin with a thickness of approximately 70µm and completely sealed all the dentinal tubules. The resin with 7.5% MPC+5% DMAHDM+30% NACP had 95% reduction in protein adsorption, compared to SBMP control (p<0.05). The resin with 7.5% MPC+5% DMAHDM+30% NACP was strongly antibacterial, with biofilm CFU being four orders of magnitude lower than that of SBMP control. Significance The novel multifunctional adhesive with strong protein-repellent, antibacterial and remineralization properties is promising to coat tooth roots to prevent root caries and secondary caries. The combined use of MPC, DMAHDM and NACP may have wide applicability to bonding agents, cements, sealants and composites to inhibit caries.

Erosive potential of processed and fresh orange juice on human enamel.

PURPOSE: The purpose of this study was to analyze the erosive potential of processed and fresh orange juice on human enamel. METHODS: Sixty enamel slabs, incubated in human saliva to develop acquired pellicle, were exposed to processed and freshly squeezed juice from oranges and lime oranges. Daily erosive cycles were performed by immersing the slabs in the juices for 20 minutes over five days. During the intervals, the samples were immersed in artificial saliva. The pH, titratable acidity (TA), and buffer capacity (ß) of the juices were determined. Analysis of variance and Tukey's tests were used to compare the percentage of surface hardness loss and the amount of wear between groups. RESULTS: The ranges of pH, TA, and ß were 3.66 to 3.75, 3.33 to 110 mmol/L, and 2.98 to 40.97 mmol/L × pH, respectively. A similar erosive potential was found for all groups, except for the lime orange juices (P<.05). CONCLUSION: Both processed and freshly squeezed orange juices were erosive to enamel. However, the lime orange juice was acidless and, therefore, not able to produce any significant changes in enamel.

The influence of dentin demineralization on morphological features of cavities using Er:YAG laser.

OBJECTIVE: The purpose of this study was to evaluate the influence of erbium-doped: yttrium-aluminum-garnet (Er:YAG) laser parameters and different degrees of demineralization on morphological features, diameter, and depth of prepared cavities. BACKGROUND DATA: Minimally invasive dentin caries removal has been recommended. Ablation of deep caries lesions using Er:YAG laser should preserve remaining demineralized dentin; however, the influence of the degree of mineralization of this substrate had not been entirely described. MATERIALS AND METHODS: A randomized, factorial design was used to study the effects of two factors. Laser parameter was tested at two levels (250 mJ/4 Hz vs. 200 mJ/2 Hz) and degree of demineralization was tested at four levels (control, two-four-eight cycles). Twelve slabs of human dentin were divided into four groups according to the number of cycles induced by pH-cycling: G1, zero cycles; G2, two cycles, G3, four cycles, and G4, eight cycles. An Er:YAG laser was used at an output energy of 250 mJ/4 Hz and 200 mJ/2 Hz for all groups, for 10 sec at 12 mm distance focus/object. Circumference and depth of the cavities were measured on scanning electron microscopy (SEM) images using image analysis software. The mean values were subjected to two way analysis of variance (ANOVA) and Tukey tests. RESULTS: When using 250 mJ/4 Hz, the mean values of circumferential area increased significantly in relation to control (503.54 µm(2)) with increasing demineralization level (eight cycles) (555.45 µm(2)). Regardless of the demineralization level, there was also significant statistical difference in the studied measurements of the cavities when 250 mJ/4 Hz and 200 mJ/2 Hz were used. SEM also showed that laser cavity preparations left no smear layer, and the dentinal tubules were clear. CONCLUSIONS: The circumferential area and depth measurements were affected by laser parameter and demineralization level (eight cycles). Energy level output represents a relevant factor for increased circumferential area and depth measurements. High demineralized artificially caries-affected dentin may also imply higher ablation. Appropriated parameter of laser pulse frequency/power density for demineralized dentin should be used for effective less-invasive caries treatment.

Protein-repellent and antibacterial dental composite to inhibit biofilms and caries.

OBJECTIVES: Biofilm acids contribute to secondary caries, which is a main reason for dental restoration failures. The objectives of this study were to: (1) develop a protein-repellent and antibacterial composite, and (2) investigate the effects of combining 2-methacryloyloxyethyl phosphorylcholine (MPC) with quaternary ammonium dimethylaminohexadecyl methacrylate (DMAHDM) on composite mechanical properties and biofilm response for the first time. METHODS: MPC, DMAHDM and glass particles were mixed into a dental resin composite. Mechanical properties were measured in three-point flexure. Protein adsorption onto the composites was measured by a micro bicinchoninic acid method. A human saliva microcosm model was used to grow biofilms on composites. Colony-forming unit (CFU) counts, live/dead assay, metabolic activity, and lactic acid production of biofilms were determined. RESULTS: Incorporation of 3% MPC and 1.5% DMAHDM into composite achieved protein-repellent and antibacterial capabilities without compromising the mechanical properties. Composite with 3% MPC+1.5% DMAHDM had protein adsorption that was 1/10 that of a commercial composite (p<0.05). The composite with 3% MPC+1.5% DMAHDM had much greater reduction in biofilm growth than using MPC or DMAHDM alone (p<0.05). Biofilm CFU counts on composite with 3% MPC+1.5% DMAHDM were more than three orders of magnitude lower than that of commercial control. CONCLUSIONS: Dental composite with a combination of strong protein-repellent and antibacterial capabilities was developed for the first time. Composite containing MPC and DMAHDM greatly reduced biofilm growth and lactic acid production, without compromising mechanical properties of the composite. CLINICAL SIGNIFICANCE: Novel composite with MPC and DMAHDM greatly reduced biofilm activity and is promising to inhibit secondary caries. The dual agents of MPC plus DMAHDM may have wide applicability to other dental materials.

Novel antibacterial orthodontic cement containing quaternary ammonium monomer dimethylaminododecyl methacrylate.

OBJECTIVES: Demineralized lesions in tooth enamel around orthodontic brackets are caused by acids from cariogenic biofilm. This study aimed to develop a novel antibacterial orthodontic cement by incorporating a quaternary ammonium monomer dimethylaminododecyl methacrylate (DMADDM) into a commercial orthodontic cement, and to investigate the effects on microcosm biofilm response and enamel bond strength. METHODS: DMADDM, a recently-synthetized antibacterial monomer, was incorporated into orthodontic cement at 0%, 1.5%, 3% and 5% mass fractions. Bond strength of brackets to enamel was measured. A microcosm biofilm model was used to measure metabolic activity, lactic acid production, and colony-forming units (CFU) on orthodontic cements. RESULTS: Shear bond strength was not reduced at 3% DAMDDM (p > 0.1), but was slightly reduced at 5% DMADDM, compared to 0% DMADDM. Biofilm viability was substantially inhibited when in contact with orthodontic cement containing 3% DMADDM. Biofilm metabolic activity, lactic acid production, and CFU were much lower on orthodontic cement containing DMADDM than control cement (p < 0.05). CONCLUSIONS: Therefore, the novel antibacterial orthodontic cement containing 3% DMADDM inhibited oral biofilms without compromising the enamel bond strength, and is promising to reduce or eliminate demineralization in enamel around orthodontic brackets.

Fluoride releasing and enamel demineralization around orthodontic brackets by fluoride-releasing composite containing nanoparticles.

INTRODUCTION: Fluoride-containing materials have been suggested to control enamel demineralization around orthodontic brackets during the treatment with fixed appliances. The improvement of their properties has been made through innovations, such as the application of nanotechnology by incorporation of nanofillers. OBJECTIVE: This in vitro study evaluated the capacity of fluoride releasing and enamel demineralization inhibition of fluoride-releasing nanofilled cement around orthodontic brackets using an artificial caries biofilm model. MATERIALS AND METHODS: Forty bovine enamel discs were selected by evaluating surface microhardness and randomized into four groups (n = 10): non-fluoride-releasing microfilled composite, fluoride-releasing microfilled composite, resin-modified glass ionomer cement (RMGI), and fluoride-releasing nanofilled composite (FN). After brackets bonding in each disc, the specimens were subjected to a cariogenic challenge through a Streptococcus mutans biofilm model. After the experimental period, the biofilm formed around the brackets was collected for fluoride analysis and the mineral loss around the brackets was determined by integrated demineralization via cross-sectional microhardness measurement at 20 and 70 µm from the bracket margin. Additionally, samples of each group were subjected to energy-dispersive X-ray spectroscopy (EDX) analysis examined under a scanning electron microscopy (SEM). ANOVA followed by Tukey test were applied for fluoride concentration and mineral loss data, respectively. RESULTS: At both distances, only RMGI statistically differed from the other groups presenting the lowest demineralization, although there was a trend to a lower demineralization of enamel around brackets in FN group. Similar condition was found to fluoride concentration and EDX/SEM analysis. CONCLUSIONS: Under the cariogenic exposure condition of this study, the fluoride-releasing nanofilled material had similar performance to fluoride-releasing microfilled materials. CLINICAL RELEVANCE: The presence of nanofillers in the fluoride-releasing materials studied did not promote further benefits against caries lesion development around brackets and presented inferior demineralization inhibition than the resin-modified glass ionomer material.

In Situ Response of Nanostructured Hybrid Fluoridated Restorative Composites on Enamel Demineralization, Surface Roughness and Ion Release.

Recurrent caries at the tooth-restoration margins is the main reason for composite failure. Fluoride-releasing nanohybrid composite resin may reduce the recurrent caries rates. A fluoride-releasing resin (FCR) and non-fluoride-releasing resin (CR) were tested using an in situ model. Demineralization (ΔS), ion release and surface roughness of composite specimens were determined. The F concentration in the group FCR was higher than the CR group. ΔS (Mean ± SD) was 2579 ± 1582 and 1705 ± 1292, respectively, for FCR and CR. Surfaces roughness was altered by biofilm accumulation. The hybrid fluorated restorative composites containing nanoparticles have a slight anticaries action without alteration of surface smoothness of the material.

Nanotechnology-based restorative materials for dental caries management.

Nanotechnology has been applied to dental materials as an innovative concept for the development of materials with better properties and anticaries potential. In this review we discuss the current progress and future applications of functional nanoparticles incorporated in dental restorative materials as useful strategies to dental caries management. We also overview proposed antimicrobial and remineralizing mechanisms. Nanomaterials have great potential to decrease biofilm accumulation, inhibit the demineralization process, to be used for remineralizing tooth structure, and to combat caries-related bacteria. These results are encouraging and open the doors to future clinical studies that will allow the therapeutic value of nanotechnology-based restorative materials to be established.