STSN-Net: Simultaneous Tooth Segmentation and Numbering Method in Crowded Environments with Deep Learning.

Accurate tooth segmentation and numbering are the cornerstones of efficient automatic dental diagnosis and treatment. In this paper, a multitask learning architecture has been proposed for accurate tooth segmentation and numbering in panoramic X-ray images. A graph convolution network was applied for the automatic annotation of the target region, a modified convolutional neural network-based detection subnetwork (DSN) was used for tooth recognition and boundary regression, and an effective region segmentation subnetwork (RSSN) was used for region segmentation. The features extracted using RSSN and DSN were fused to optimize the quality of boundary regression, which provided impressive results for multiple evaluation metrics. Specifically, the proposed framework achieved a top F1 score of 0.9849, a top Dice metric score of 0.9629, and an mAP (IOU = 0.5) score of 0.9810. This framework holds great promise for enhancing the clinical efficiency of dentists in tooth segmentation and numbering tasks.

New generation of orthodontic devices and materials with bioactive capacities to improve enamel demineralization.

OBJECTIVE: The article reviewed novel orthodontic devices and materials with bioactive capacities in recent years and elaborated on their properties, aiming to provide guidance and reference for future scientific research and clinical applications. DATA, SOURCES AND STUDY SELECTION: Researches on remineralization, protein repellent, antimicrobial activity and multifunctional novel bioactive orthodontic devices and materials were included. The search of articles was carried out in Web of Science, PubMed, Medline and Scopus. CONCLUSIONS: The new generation of orthodontic devices and materials with bioactive capacities has broad application prospects. However, most of the current studies are limited to in vitro studies and cannot explore the true effects of various bioactive devices and materials applied in oral environments. More research, especially in vivo researches, is needed to assist in clinical application. CLINICAL SIGNIFICANCE: Enamel demineralization (ED) is a common complication in orthodontic treatments. Prolonged ED can lead to dental caries, impacting both the aesthetics and health of teeth. It is of great significance to develop antibacterial orthodontic devices and materials that can inhibit bacterial accumulation and prevent ED. However, materials with only preventive effect may fall short of addressing actual needs. Hence, the development of novel bioactive orthodontic materials with remineralizing abilities is imperative. The article reviewed the recent advancements in bioactive orthodontic devices and materials, offering guidance and serving as a reference for future scientific research and clinical applications.

Using a structured light scanner to evaluate 3-dimensional soft-tissue changes after extracting 4 premolars in young adult female patients.

INTRODUCTION: Facial esthetics have always received much attention in orthodontic treatment, especially in young adult female patients. Three-dimensional (3D) soft-tissue changes after orthodontic extraction have not been fully explained. This study evaluated the 3D morphologic changes after orthodontic extraction in young female patients using a structured light scanner. METHODS: Forty-five adult female patients aged 20-25 years were enrolled in our study. The treatment group consisted of patients who received orthodontic treatment with 4 premolar extractions, and the control group was composed of young female volunteers who had not undergone any orthodontic treatment. To monitor the soft-tissue changes, 9 morphologic regions and 12 landmarks were identified for the 3D deviation analyses. The spatial deviations of landmarks and regions in the x, y, and z directions were constructed for quantitative analysis. Color map images were constructed to visualize soft-tissue displacement as a qualitative evaluation. The paired sample test was used to compare differences at the beginning of the experiment (T0) and after 24 months (T1) in both groups. An independent t test with Bonferroni correction was performed to compare differences between the treatment and control groups. A linear regression test was performed between incisor retraction and changes in the perioral tissues. RESULTS: Subtracting the effect of aging from the lip changes in the control group, the treatment group showed a statistically significant difference in the displacement of labrale superius (-1.37 mm), labrale inferius (-1.89 mm), the upper lip region (-0.98 mm), and the lower lip region (-1.36 mm) along the z-axis. No significant differences were found between the treatment and control groups in the temporal, parotideomasseteric, and buccal regions. Pearson correlation tests indicated a positive correlation between incisor tip retraction and changes in soft tissues (two-dimensional cephalometric analysis, 3D landmark measurements, and 3D regional measurements). The correlation coefficient ranged between 0.45 and 0.55. CONCLUSIONS: Three-dimensional soft-tissue changes were mainly concentrated in the upper and lower lip regions in adult female patients after the 4 premolars were extracted. For female patients aged 20-25 years with 4 extracted premolars, soft-tissue changes in the temporal, parotideomasseteric, and buccal regions were not clinically significant.

Candida albicans enriched in orthodontic derived white spot lesions and shaped focal supragingival bacteriome.

White spot lesions (WSLs) are common enamel infectious diseases in fixed orthodontic treatment, which might attribute to the dysbiosis of oral microbiome. However, the correlation of Candida albicans with oral bacteriome in WSLs still remains unrevealed. This study investigated the carriage of C. albicans and how it shaped the bacterial community in disease or healthy supragingival plaque, to explore the potential role of interkingdom interaction in orthodontic WSLs. In this study, 31 patients with WSLs (WSLs) and 23 healthy patients (Health) undergoing fixed orthodontic treatment were enrolled. The supragingival microbiota in both groups were determined using 16S rRNA gene sequencing. Colonization and abundance of C. albicans in the plaque were determined via culture-dependent and -independent methods. Among WSLs patients, the correlation of C. albicans and bacteriome was analyzed under QIIME2-based bioinformatics and Spearman's correlation coefficient. The raw reads were deposited into the NCBI Sequence Read Archive (SRA) database (Accession Number: SRP404186). Significant differences in microbial diversity as well as composition were observed between WSLs and Health groups. Leptotrichia remarkably enriched in the WSLs group, while Neisseria and Cardiobacterium significantly enriched in the Health group. In addition, 45% of WSLs patients were C. albicans carriers but none in patients without WSLs. Among all WSLs patients, beta diversity and microbial composition were distinguished between C. albicans carriers and non-carriers. In C. albicans carriers, Corynebacterium matruchotii and Streptococcus mutans significantly enriched whereas Saccharibacteria_TM7_G-1 significantly depleted. The abundance of C. albicans was positively associated with bacteria such as Streptococcus mutans, while the negative correlation was detected between C. albicans and several bacteria such as Cardiobacterium hominis and Streptococcus sanguinis. Our study elucidated the distinguished supragingival plaque microbiome between orthodontic patients with and without WSLs. C. albicans frequently existed and enriched in orthodontic derived WSLs. The carriage of C. albicans shape plaque bacterial community in demineralized lesions and might play roles in WSLs pathogenesis.

Yttrium aluminum garnet-based filler resin composites used as clear aligner attachments.

The objective of this study was to develop a novel resin composite containing yttrium aluminum garnet (Y3Al5O12, YAG) nanoparticles for clear aligner attachments. After the silanization of YAG, their Fourier-transform infrared (FT-IR) and thermogravimetric (TGA) analyses were performed. By conducting flexural and compressive strength measurements, the optimal YAG concentration was selected for the subsequent experiments. Next, Vickers microhardness values, fluidities, attachment volumes, conversion degrees, and volumetric shrinkages of the resin were determined. The obtained FT-IR and TG results revealed that γ-methacryloxypropy ltrimethoxysilane coupling agent was successfully grafted onto the surface of YAG, which enabled their use as inorganic fillers. Furthermore, adding 9 wt% YAG in the resin can increase Vickers hardness and fluidity, reduce polymerization shrinkage, and enhance the restoration of the clear aligner attachment shape on the premise of guarantee proper flexural and compressive strength of the resin, which can help control tooth movement and increase orthodontic efficiency.

Polymethyl methacrylate resin containing ε-poly-L-lysine and 2-methacryloyloxyethyl phosphorylcholine with antimicrobial effects.

STATEMENT OF PROBLEM: Polymethyl methacrylate (PMMA) is commonly used in dentistry, including as a denture base material. However, the colonization of a PMMA surface by microbial microorganisms could increase the risk of oral diseases such as denture stomatitis and gingivitis. The development of PMMA with antibacterial properties should improve its clinical application, but whether adding ε-poly-L-lysine (ε-PL) and 2-methacryloyloxyethyl phosphorylcholine (MPC) provides antimicrobial effects is unclear. PURPOSE: This in vitro study aimed to develop a novel antibacterial PMMA resin containing the natural nontoxic antibacterial agent ε-PL and the protein repellent agent MPC. The mechanical properties, protein repellency, and antimicrobial activities of the resin were then evaluated. MATERIAL AND METHODS: Different mass fractions of ε-PL and MPC were mixed into PMMA as the experimental groups, with unaltered PMMA as the control group. The flexural strength (n=10) and surface roughness (n=6) of the resulting mixtures were measured to determine their mechanical properties. The antiprotein properties were measured by using the micro bicinchoninic acid method (n=6). The antimicrobial effect of the resin was assessed using live/dead staining (n=6) and methyltransferase (MTT) assays (n=10). According to the variance homogeneity and normal distribution results, 1-way analysis of variance followed by the Tukey honestly significant difference test or the Welch test and the Games-Howell test were used (α=.05 for all tests). RESULTS: No significant differences were found in the flexural strength values and surface roughness of the specimens containing 1.5% MPC and 1.5% ε-PL compared with those of the control (P>.05). The addition of ε-PL to the PMMA resin alone significantly increased its bactericidal properties (P<.05). Adding both ε-PL and MPC further increased the antibacterial activity of the PMMA resin without increasing protein adhesion more than in the control group. CONCLUSIONS: The incorporation of both ε-PL and MPC into PMMA improved its antibacterial capacity without affecting its mechanical properties and did not increase protein adhesion. Therefore, the novel PMMA fabricated in this study shows promise for dental applications.

External apical root resorption in orthodontic tooth movement: the risk factors and clinical suggestions from experts' consensus.

External apical root resorption is among the most common risks of orthodontic treatment, and it cannot be completely avoided and predicted. Risk factors causing orthodontic root resorption can generally be divided into patient- and treatment-related factors. Root resorption that occurs during orthodontic treatment is usually detected by radiographical examination. Mild or moderate root absorption usually does no obvious harm, but close attention is required. When severe root resorption occurs, it is generally recommended to suspend the treatment for 3 months for the cementum to be restored. To unify the risk factors of orthodontic root resorption and its clinical suggestions, we summarized the theoretical knowledge and clinical experience of more than 20 authoritative experts in orthodontics and related fields in China. After discussion and summarization, this consensus was made to provide reference for orthodontic clinical practice.

Novel protein-repellent and antibacterial polymethyl methacrylate dental resin in water-aging for 6 months.

BACKGROUND: The present study aimed to develop a novel protein-repellent and antibacterial polymethyl methacrylate (PMMA) dental resin with 2-methacryloyloxyethyl phosphorylcholine (MPC) and quaternary ammonium dimethylaminohexadecyl methacrylate (DMAHDM), and to investigate the effects of water-aging for 6 months on the mechanical properties, protein adsorption, and antibacterial activity of the dental resin. METHODS: Four groups were tested: PMMA control; PMMA + 3% MPC; PMMA + 1.5% DMAHDM; and PMMA + 3% MPC + 1.5% DMADDM in acrylic resin powder. Specimens were water-aged for 1 d, 3 months, and 6 months at 37 ℃. Their mechanical properties were then measured using a three-point flexure test. Protein adsorption was measured using a micro bicinchoninic acid (BCA) method. A human saliva microcosm model was used to inoculate bacteria on water-aged specimens and to investigate the live/dead staining, metabolic activity of biofilms, and colony-forming units (CFUs). RESULTS: The flexural strength and elastic modulus showed a significant loss after 6 months of water-ageing for the PMMA control (mean ± SD; n = 10); in contrast, the new protein repellent and antibacterial PMMA resin showed no strength loss. The PMMA-MPC-DMAHDM-containing resin imparted a strong antibacterial effect by greatly reducing biofilm viability and metabolic activity. The biofilm CFU count was reduced by about two orders of magnitude (p < 0.05) compared with that of the PMMA resin control. The protein adsorption was 20% that of a commercial composite (p < 0.05). Furthermore, the PMMA-MPC-DMAHDM-containing resin exhibited a long-term antibacterial performance, with no significant difference between 1 d, 3 months and 6 months (p > 0.05). CONCLUSIONS: The flexural strength and elastic modulus of the PMMA-MPC-DMAHDM-containing resin were superior to those of the PMMA control after 6 months of water-ageing. The novel PMMA resin incorporating MPC and DMAHDM exhibited potent and lasting protein-repellent and antibacterial properties.

Higher yield and enhanced therapeutic effects of exosomes derived from MSCs in hydrogel-assisted 3D culture system for bone regeneration.

Exosomes are emerging in tissue engineering as up-and-coming acellular therapeutics, circumventing common restrictions inherent to cell-based therapies. The characteristics and function of exosomes are affected by the bidirectional communication of their original cells and the local microenvironment in which the cells reside (e.g., the stem cell niche). However, mesenchymal stem cells (MSCs) are customarily cultured in a traditional two-dimensional monolayer, with mechanical microenvironments varying substantially in physiological one. Few reports have addressed the effects of the 3D microenvironment on exosomal osteoinductivity. Herein, a 3D culture model is engineered through collagen hydrogel. Exosomes derived from three-dimensional culture (3D-Exos) and the conventional monolayer culture (2D-Exos) are collected and compared. The 3D culture resulted in high yield exosomes and greatly improved the efficiency of exosomes collection. The in vitro results demonstrated that the 3D-Exos induced significant promotions in osteogenic gene and protein expression (e.g., Runx2, OCN, OPN, COL1A1, and ALP), proliferation, and migration of Human bone marrow mesenchymal stem cells (hBMSCs) and inhibited hBMSCs apoptosis. Importantly, mechanistic studies revealed that the upregulation of the YAP signaling pathway is the underlying mechanism. Moreover, the 3D-Exos resulted in enhanced new bone formation and Runx2/OPN activation in rats with alveolar bone defects. These findings proposed a novel idea of the 3D culture strategy used to enhance the osteoinductivity of MSC-derived exosomes. This study also provided valuable references for exosome-based clinical applications for the treatment and regeneration of tissue defects from the perspective of culture dimensions.

Novel nanostructured resin infiltrant containing calcium phosphate nanoparticles to prevent enamel white spot lesions.

OBJECTIVES: The objective of this study was to develop a novel nanostructured resin infiltrant containing nanoparticles of amorphous calcium phosphate (NACP) to treat enamel white spot lesions (WSLs). Physical properties and the therapeutic effect of the new resin infiltrant were investigated for the first time. METHODS: NACP was incorporated into ICON (Icon caries infiltrant, DMG, Germany) with different mass fractions. Cytotoxicity, degree of conversion, surface hardness, calcium (Ca) and phosphorus (P) ions release concentrations were tested. After application to the demineralized enamel samples, the color changes were determined. Surface and cross-sectional hardness were measured, scanning electron microscopy (SEM) images were taken on the cross-section of samples to observe microstructure changes after 14-day pH cycling. RESULTS: Incorporating 10%-30% of NACP did not compromise the biocompatibility and physical properties of the resin infiltrant. ICON + 30% NACP group had long-lasting and high level of Ca and P ion release. After 14-day pH cycling, enamel surface hardness of ICON + 30% NACP group was 1.83 ± 0.21 GPa, significantly higher than the control group (1.32 ± 0.18 GPa) (p < 0.05). ICON + 30NACP group had the highest cross-sectional enamel hardness among all groups (p < 0.05), especially at 50 µm and 100 µm depth. SEM images showed that apparent enamel prism and inter-prism gaps in negative control were masked by mineral deposition in ICON + 30% NACP group. SIGNIFICANCE: The novel ICON+30% NACP infiltrant is promising to inhibit enamel WSLs, protect the enamel and increase its hardness.

Human Periodontal Ligament Stem Cell and Umbilical Vein Endothelial Cell Co-Culture to Prevascularize Scaffolds for Angiogenic and Osteogenic Tissue Engineering.

(1) Background: Vascularization remains a critical challenge in bone tissue engineering. The objective of this study was to prevascularize calcium phosphate cement (CPC) scaffold by co-culturing human periodontal ligament stem cells (hPDLSCs) and human umbilical vein endothelial cells (hUVECs) for the first time; (2) Methods: hPDLSCs and/or hUVECs were seeded on CPC scaffolds. Three groups were tested: (i) hUVEC group (hUVECs on CPC); (ii) hPDLSC group (hPDLSCs on CPC); (iii) co-culture group (hPDLSCs + hUVECs on CPC). Osteogenic differentiation, bone mineral synthesis, and microcapillary-like structures were evaluated; (3) Results: Angiogenic gene expressions of co-culture group were 6-9 fold those of monoculture. vWF expression of co-culture group was 3 times lower than hUVEC-monoculture group. Osteogenic expressions of co-culture group were 2-3 folds those of the hPDLSC-monoculture group. ALP activity and bone mineral synthesis of co-culture were much higher than hPDLSC-monoculture group. Co-culture group formed capillary-like structures at 14-21 days. Vessel length and junction numbers increased with time; (4) Conclusions: The hUVECs + hPDLSCs co-culture on CPC scaffold achieved excellent osteogenic and angiogenic capability in vitro for the first time, generating prevascularized networks. The hPDLSCs + hUVECs co-culture had much better osteogenesis and angiogenesis than monoculture. CPC scaffolds prevacularized via hPDLSCs + hUVECs are promising for dental, craniofacial, and orthopedic applications.

Bite Force Transducers and Measurement Devices.

In dental research, bite force has become an important curative effect evaluation index for tooth restoration, periodontal treatment, and orthodontic treatment. Bite force is an important parameter to evaluate the efficacy of the masticatory system. Physicians obtain the therapeutic basis for occlusal adjustment by measuring the bite force and the dynamic changes in occlusal contact at different stages of treatment and objectively evaluate the therapeutic effect. At present, many devices are used to record the bite force. Most of these devices use force transducers to detect bite force, such as strain gauge transducers, piezoresistive transducers, piezoelectric transducers, optical fiber transducers, and pressure-sensitive films. This article summarizes the various equipment used to record bite force, related materials and the characteristics of this equipment. It provides a reference for physicians to make choices during the clinical process and at the same time provides a basis for the development of new occlusal force measurement materials.

A Biphasic Calcium Phosphate Cement Enhances Dentin Regeneration by Dental Pulp Stem Cells and Promotes Macrophages M2 Phenotype In Vitro.

Calcium phosphate cement (CPC) is promising for bone and dentin repair and regeneration. However, there has been no report of biphasic CPC for inducing dentin regeneration. The aim of this study was to develop a novel biphasic CPC containing ß-tricalcium phosphate (ß-TCP), and investigate its effects on odontogenic differentiation of human dental pulp stem cells (hDPSCs) and macrophage polarization. New biphasic CPC was formulated with different ratios of ß-TCP to an equimolar mixture of tetracalcium phosphate and dicalcium phosphate anhydrous. Mechanical properties, biocompatibility, and odontogenic differentiation induction ability of the cements and the inflammatory reaction to the cements were examined. A series of CPC containing ß-TCP were developed. CPC with 20% ß-TCP exhibited homogeneity and injectability, an acceptable setting time, and a twofold increase in compressive strength. Significant increases in hDPSCs' alkaline phosphatase activity, mineral deposit, DMP1 and DSPP gene, and protein expressions were obtained for 20% TCP-CPC, compared with traditional CPC (p < 0.01). The addition of ß-TCP did not promote macrophage polarization to the proinflammation phenotype. The addition of 10% and 20% ß-TCP promoted macrophage polarization to the anti-inflammatory phenotype. In conclusion, a biphasic ß-TCP-modified CPC was developed for the first time, demonstrating substantially increased dentin regeneration capability, while promoting macrophages to an anti-inflammation phenotype. The novel biphasic CPC is promising for tooth tissue engineering and dentin regeneration applications. Impact statement Dental pulp exposure from dental caries, wounds, or deep cavity preparation can cause pain and infection, which may lead to root canal treatment or tooth extraction. Maintaining pulp vitality is a major challenge in stomatology. We developed a new injectable ß-tricalcium phosphate (ß-TCP)-calcium phosphate cement (CPC) for the regeneration of dentin. Compared with traditional CPC, the new CPC +20%TCP possessed good cytocompatibility, acceptable injection force, higher compressive strength (increased by 63%), and greater odontogenic expression and mineral deposits (increased by more than twofolds), while avoiding any proinflammatory drawback. This new biphasic CPC is promising for dental pulp-capping, base, and liner applications to promote dentin regeneration, as well as potentially for bone tissue engineering applications, which warrant further studies.

Maxillary protraction using customized mini-plates for anchorage in an adolescent girl with skeletal Class III malocclusion.

The treatment of skeletal Class III malocclusion in adolescents is challenging. Maxillary protraction, particularly that using bone anchorage, has been proven to be an effective method for the stimulation of maxillary growth. However, the conventional procedure, which involves the surgical implantation of mini-plates, is traumatic and associated with a high risk. Three-dimensional (3D) digital technology offers the possibility of individualized treatment. Customized miniplates can be designed according to the shape of the maxillary surface and the positions of the roots on cone-beam computed tomography scans; this reduces both the surgical risk and patient trauma. Here we report a case involving a 12-year-old adolescent girl with skeletal Class III malocclusion and midface deficiency that was treated in two phases. In phase 1, rapid maxillary expansion and protraction were performed using 3D-printed mini-plates for anchorage. The mini-plates exhibited better adaptation to the bone contour, and titanium screw implantation was safer because of the customized design. The orthopedic force applied to each mini-plate was approximately 400-500 g, and the plates remained stable during the maxillary protraction process, which exhibited efficacious orthopedic effects and significantly improved the facial profile and esthetics. In phase 2, fixed appliances were used for alignment and leveling of the maxillary and mandibular dentitions. The complete two-phase treatment lasted for 24 months. After 48 months of retention, the treatment outcomes remained stable.

Optimization of clinically applied orthodontic archwire electrothermal treatment conditions by heat tint and mechanical properties: An experimental study.

OBJECTIVE: Electric resistance heat treatment procedures are performed by most orthodontists; however, the effects of electrothermal treatment on the mechanical properties, surface morphology, phase transition, colour and arch width of stainless steel archwires remain controversial and are worthy of investigation. MATERIALS AND METHODS: Stainless steel archwires (0.017×0.025 and 0.019×0.025 inches) were heat-treated using a spot-welder machine at a power setting of 3 for 5, 10, 15 or 20s and were then cooled in air. After the heat treatment, we analysed the surface morphology of the samples by scanning electron microscopy (SEM) and the flexural modulus with a universal testing machine. The changes in phase and the austenite content after heat treatment were determined by X-ray diffraction (XRD). The changes in the colour of the sample were analysed by a digital single-lens reflex (DSLR) camera, and the arch width changes were measured with Vernier calippers. RESULTS: The flexural modulus and austenite content of the orthodontic stainless steel archwires increased after heat treatment (P<0.05). The colour changed from silver to yellow-brown-blue. Heat treatment of the stainless steel wires increased the inter-canine and inter-molar widths only when the amount of heat received was low. CONCLUSION: Heat treatment of stainless steel orthodontic archwires using an electric resistance device is an effective and convenient method to improve their flexural modulus. The colour of the wire surface after heat treatment can help determine the heating conditions, and the maximum flexural modulus of the stainless steel wires was obtained when the colour changed to brownish yellow.

Osteogenic stimulation of human dental pulp stem cells with self-setting biphasic calcium phosphate cement.

Calcium phosphate cement (CPC) is widely used as a repair material for bone defects. However, there is no report on the use of biphasic CPC combined with dental pulp stem cells (DPSCs) for bone tissue engineering. The aim of this study was to construct biphasic CPC and to investigate its effect in the osteogenic stimulation of human DPSCs (hDPSCs) and macrophage polarization. Biphasic CPC was developed by adding different ratios of ß-TCP to an equimolar mixture of tetracalcium phosphate (TTCP) and dicalcium phosphate anhydrous (DCPA). The biocompatibility, osteogenic capacity, and inflammatory reactions of the cements were examined. Our results show that biphasic CPC containing both HA and ß-TCP was successfully fabricated. The addition of ß-TCP did not increase necrosis or apoptosis of DPSCs. Significant increases in hDPSC mineral deposition and osteogenic marker (ColI and ALP) expression were observed in 20% TCP-CPC. The addition of ß-TCP did not promote macrophage polarization to a proinflammatory phenotype. In conclusion, biphasic CPC with hDPSCs for bone regeneration was developed for the first time; the biphasic CPC combined with hDPSCs is expected to be used for the repair and regeneration of bone.

Novel nanomaterial-based antibacterial photodynamic therapies to combat oral bacterial biofilms and infectious diseases.

Oral diseases such as tooth caries, periodontal diseases, endodontic infections, etc., are prevalent worldwide. The heavy burden of oral infectious diseases and their consequences on the patients' quality of life indicates a strong need for developing effective therapies. Advanced understandings of such oral diseases, e.g., inflammatory periodontal lesions, have raised the demand for antibacterial therapeutic strategies, because these diseases are caused by viruses and bacteria. The application of antimicrobial photodynamic therapy (aPDT) on oral infectious diseases has attracted tremendous interest in the past decade. However, aPDT had a minimal effect on the viability of organized biofilms due to the hydrophobic nature of the majority of the photosensitizers (PSs). Therefore, novel nanotechnologies were rapidly developed to target the delivery of hydrophobic PSs into microorganisms for the antimicrobial performance improvement of aPDT. This review focuses on the state-of-the-art of nanomaterials applications in aPDT against oral infectious diseases. The first part of this article focuses on the cutting-edge research on the synthesis, toxicity, and therapeutic effects of various forms of nanomaterials serving as PS carriers for aPDT applications. The second part discusses nanomaterials applications for aPDT in treatments of oral diseases. These novel bioactive nanomaterials have demonstrated great potential to serve as carriers for PSs to substantially enhance the PDT therapeutic effects. Furthermore, the novel aPDT applications not only have exciting therapeutic potential to inhibit bacterial plaque-initiated oral diseases, but also have a wide applicability to other biomedical and tissue engineering applications.

Novel endodontic sealer with dual strategies of dimethylaminohexadecyl methacrylate and nanoparticles of silver to inhibit root canal biofilms.

OBJECTIVE: Endodontic treatment failures and recontamination remain a major challenge. The objectives of this study were to: (1) develop a new root canal sealer with potent and long-lasting antibiofilm effects using dimethylaminohexadecyl methacrylate (DMAHDM) and nanoparticles of silver (NAg); (2) determine the effects of incorporating DMAHDM and NAg each alone versus in combination on biofilm-inhibition efficacy; and (3) determine the effects on sealer paste flow, film thickness and sealing ability, compared to a commercial control sealer. METHODS: Dual-cure endodontic sealers were formulated using DMAHDM mass fractions of 0%, 2.5% and 5%, and NAg mass fractions of 0.05%, 0.1% and 0.15%. The sealing ability of the sealers was measured using linear dye penetration method. Colony-forming units (CFU), live/dead assay, and polysaccharide production of biofilms grown on sealers were determined. RESULTS: The sealer with 5% DMAHDM and 0.15% NAg yielded a flow of (22.18 ± 0.58) which was within the range of ISO recommendations and not statistically different from AH Plus control (23.3 ± 0.84) (p > 0.05). Incorporating DMAHDM and NAg did not negatively affect the film thickness and sealing properties (p > 0.05). The sealer with 5% DMAHDM and 0.15% NAg greatly reduced polysaccharide production by the biofilms, and decreased the biofilm CFU by nearly 6 orders of magnitude, compared to AH Plus and experimental controls (p < 0.05). SIGNIFICANCE: A therapeutic root canal sealer was developed using 5% DMAHDM with biofilm-inhibition through contact-mediated mechanisms, plus 0.15% of NAg to release silver ions into the complex and difficult-to-reach root canal environment. The novel root canal sealer exerted potent antibiofilm effects and reduced biofilm CFU by 6 orders of magnitude without compromising sealer flow, film thickness and sealing ability. This method provided a promising approach to inhibit endodontic biofilms and prevent recurrent endodontic infections.

Effects of single species versus multispecies periodontal biofilms on the antibacterial efficacy of a novel bioactive Class-V nanocomposite.

OBJECTIVE: The objectives of this studywere to: (1) develop a novel bioactive nanocomposite for Class V restorations with subgingival margins to inhibit periodontal pathogens; and (2) investigate if the bioactive nanocomposite could inhibit multi-species periodontal biofilms with a potency as strong as that against single species biofilms. METHODS: Nanocomposite was fabricated using dimethylaminohexadecyl methacrylate (DMAHDM), 2-methacryloyloxyethyl phosphorylcholine (MPC) and nanoparticles of amorphous calcium phosphate (NACP). Biofilms with 1, 3, 6 and 9 species of periodontal pathogens were grown on the composites and tested for live/dead staining, colony-forming units (CFU), metabolic activity, and biofilm matrix polysaccharide production. RESULTS: The bioactive composite reduced protein adsorption by an order of magnitude (p < 0.05) and greatly reduced biofilm viability. It decreased the biofilm CFU by more than 3 orders of magnitude for all four types of periodontal biofilms, compared to control composite. With increasing the biofilm species from 1 to 9, the antibacterial efficacy of DMAHDM composite decreased; the CFU reduction folds decreased from 947 folds to 44 folds. In contrast, the MPC + DMAHDM composite maintained a CFU reduction folds of greater than 3000, showing a similar antibacterial potency from 1 to 9 species in the biofilms (p > 0.1). CONCLUSION: Dual agents MPC + DMAHDM achieved the greatest inhibition in biofilm, without decreasing its antibacterial potency when the biofilm species was increased from 1 to 9. A single agent became less effective when the biofilm species was increased from 1 to 9. SIGNIFICANCE: The multifunctional MPC + DMAHDM composite is promising for root caries treatment and Class V restorations with subgingival margins to effectively inhibit multispecies periodontal biofilms, combat periodontitis and protect the periodontium.

Novel rechargeable calcium phosphate nanoparticle-filled dental cement.

The objectives were to develop a novel rechargeable cement containing amorphous calcium-phosphate nanoparticles (nanoACP) to suppress tooth decay. Five cements were made with: (1) 60% glass particles (experimental control); (2) 40% glass+20% nanoACP; (3) 30% glass+30% nanoACP; (4) 20% glass+40% nanoACP; (5) 10% glass+50% nanoACP. Groups 1-4 had enamel bond strengths similar to Transbond XT (3M) and Vitremer (3M) (p>0.1). The nanoACP cement had calcium and phosphate ion release which increased with increasing nanoACP fillers. The recharged cement had substantial ion re-release continuously for 14 days after a single recharge. Ion re-release did not decrease with increasing recharge/re-release cycles. Groups 3-5 maintained a safe pH of medium (>5.5); however, control cements had cariogenic pH of medium (<4.5) due to biofilm acid. Therefore, nanoACP cement (1) had good bond strength to enamel, (2) possessed calcium and phosphate ion recharge/re-release capability, and (3) raised biofilm pH to a safe level to inhibit caries.