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Biomaterials for Dental Healing

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A special issue of Materials (ISSN 1996-1944). This special issue belongs to the section "Biomaterials".

Deadline for manuscript submissions: closed (31 March 2021) | Viewed by 40615

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Prof. Dr. Regina Maria Puppin-Rontani

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Department of Health Sciences and Pediatric Dentistry, University State of Campinas, Piracicaba, Brazil
Interests: tooth tissue as substrate for dental materials adhesion (enamel and dentin); preventive and restorative dental materials; dentin permeability; chemical, mechanical and biological degradation of dental materials; tooth substrate and tooth/material interfaces; mineralization and biomineralization of enamel and dentin; artificial caries producing methods; tissue regeneration; bioactive materials
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Dear Colleagues,

Understanding of the healing and bioreparation of affected and surrounding dental tissues as a focus of the maintenance of oral health has been sought. In the last decades, researchers have had the opportunity to study the relationships between the microcosm and the oral tissues, including hard and soft tissues and their implications in tissue bioengineering for oral health maintenance. Many benchmarks have been reached in terms of this target, and research has been carried out into biomaterials, cells and biofilm functions, and how to control them. Bioengineering and stem cell research may create the possibility of a cure, even in cell-free tissues; through the use of self-assembly systems, nanotechnology has also shown promise in this area. To date, it is known that cells are the main factors in healing and tissue repair. Nevertheless, dental caries, when installed in the enamel, for example, which is an acellular tissue, can be controlled by controlling the virulence of the biofilm and the presence of Ca and PO4 with the help of self-assembly peptides. In addition, using biomaterials with a slow release of biomodifying agents, biomarkers and healing inducers has also been extremely important, and will be further available in the future, along with other concepts. On the other hand, nowadays the repair of damaged hard tissues has been achieved by the use of restorative materials that have been modified based on biological knowledge acquired over the last decades, providing another bench of research. Thus, this Special Issue aims to present the latest in biomaterials research and the development of new materials for dental healing, as well as techniques and perspectives on healing in the dental sciences related to these topics, to highlight the remaining challenges, and to provide perspectives for future directions.

Prof. Regina Maria Puppin-Rontani
Guest Editor

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Keywords

biomaterials
biomodifiers
growth factor
biofilms
biofilm control
pulp healing
biomineralization
cellular biology
nanotechnology
biomechanics

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Published Papers (9 papers)

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Research

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8 pages, 2632 KiB

Open AccessArticle

Antibiofilm and Protein-Repellent Polymethylmethacrylate Denture Base Acrylic Resin for Treatment of Denture Stomatitis

by Salwa O. Bajunaid, Bashayer H. Baras, Abdulrahman A. Balhaddad, Michael D. Weir and Hockin H. K. Xu

Materials 2021, 14(5), 1067; https://doi.org/10.3390/ma14051067 - 25 Feb 2021

Cited by 17 | Viewed by 2060

Abstract

Candida albicans (C. albicans) biofilm is a common etiological factor in denture stomatitis. The purpose of this study was to investigate the effects of incorporating 2-methacryloyloxyethyl phosphorylcholine (MPC) as a protein repellent into a new high-impact denture acrylic (HIPA) resin on the surface roughness, solution pH, and C. albicans biofilm adhesion to the denture base. The new acrylic denture resin base was formulated by mixing MPC into HIPA resin at mass fractions of 1.5%, 3%, and 4.5%. Surface roughness was measured using a Mitutoyo surface roughness tester. C. albicans biofilm growth and viability were assessed via colony forming unit counts. The pH of the biofilm growth medium was measured using a digital pH meter. Adding MPC to the HIPA resin at percentages of 1.5% and 3% increased the roughness values significantly (p < 0.05), while adding 4.5% MPC resulted in no difference in roughness values to that of the control group (p > 0.05). All experimental groups demonstrated neutral pH values (pH ≅ 7) and were not significantly different from each other (p > 0.05). Incorporating 2-methacryloyloxyethyl phosphorylcholine at 4.5% resulted in a significant (≅1 log) colony-forming unit reduction compared with the control group with 0% MPC (p < 0.05). A fungal-retarding denture acrylic resin was developed through the incorporation of MPC for its protein-repelling properties. This newly developed denture acrylic material has the potential to prevent oral microbial infections, such as denture stomatitis. Full article

(This article belongs to the Special Issue Biomaterials for Dental Healing)

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13 pages, 5177 KiB

Open AccessArticle

Inflammatory Responses in Oro-Maxillofacial Region Expanded Using Anisotropic Hydrogel Tissue Expander

by Kholoud Mohamed Ali Salim, Aminah Abd Jalil, Zamri Radzi, Siti Mazlipah Ismail, Jan T. Czernuszka and Mohammad Tariqur Rahman

Materials 2020, 13(19), 4436; https://doi.org/10.3390/ma13194436 - 6 Oct 2020

Cited by 1 | Viewed by 2466

Abstract

Objective: Reconstruction of oral and facial defects often necessitate replacement of missing soft tissue. The purpose of tissue expanders is to grow healthy supplementary tissue under a controlled force. This study investigates the inflammatory responses associated with the force generated from the use of anisotropic hydrogel tissue expanders. Methods: Sprague Dawley rats (n = 7, body weight = 300 g ± 50 g) were grouped randomly into two groups—control (n = 3) and expanded (n = 4). Anisotropic hydrogel tissue expanders were inserted into the frontal maxillofacial region of the rats in the expanded group. The rats were sacrificed, and skin samples were harvested, fixed in formalin, and embedded in paraffin wax for histological investigation. Hematoxylin and eosin staining was performed to detect histological changes between the two groups and to investigate the inflammatory response in the expanded samples. Three inflammatory markers, namely interleukin (IL)-1α, IL-6, and tumor necrosis factor-α (TNF-α), were analyzed by immunohistochemistry. Result: IL-1-α expression was only observed in the expanded tissue samples compared to the controls. In contrast, there was no significant difference in IL-6, and TNF-α production. Histological analysis showed the absence of inflammatory response in expanded tissues, and a negative non-significant correlation (Spearman’s correlation coefficient) between IL-1-α immune-positive cells and the inflammatory cells (r = −0.500). In conclusion, tissues that are expanded and stabilized using an anisotropic self-inflating hydrogel tissue expander might be useful for tissue replacement and engraftment as the expanded tissue does not show any sign of inflammatory responses. Detection of IL-1-α in the expanded tissues warrants further investigation for its involvement without any visible inflammatory response. Full article

(This article belongs to the Special Issue Biomaterials for Dental Healing)

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21 pages, 4920 KiB

Open AccessArticle

Efficacy of Bioactive Glass Nanofibers Tested for Oral Mucosal Regeneration in Rabbits with Induced Diabetes

by Noha Elshazly, Abdelaziz Khalil, Manal Saad, Marco Patruno, Jui Chakraborty and Mona Marei

Materials 2020, 13(11), 2603; https://doi.org/10.3390/ma13112603 - 7 Jun 2020

Cited by 15 | Viewed by 3301

Abstract

The healing of oral lesions that are associated with diabetes mellitus is a matter of great concern. Bioactive glass is a highly recommended bioceramic scaffold for bone and soft tissue regeneration. In this study, we aimed to assess the efficacy of a novel formula of bioactive glass nanofibers in enhancing oral mucosal wound regeneration in diabetes mellitus. Bioactive glass nanofibres (BGnf) of composition (1–2) mol% of B₂O₃, (68–69) mol% of SiO₂, and (29–30) mol% of CaO were synthesized via the low-temperature sol-gel technique followed by mixing with polymer solution, then electrospinning of the glass sol to produce nanofibers, which were then subjected to heat treatment. X-Ray Diffraction analysis of the prepared nanofibers confirmed its amorphous nature. Microstructure of BGnf simulated that of the fibrin clot with cross-linked nanofibers having a varying range of diameter (500–900 nm). The in-vitro degradation profile of BGnf confirmed its high dissolution rate, which proved the glass bioactivity. Following fibers preparation and characterization, 12 healthy New Zealand male rabbits were successfully subjected to type I diabetic induction using a single dose of intravenous injection of alloxan monohydrate. Two weeks after diabetes confirmation, the rabbits were randomly divided into two groups (control and experimental groups). Bilateral elliptical oral mucosal defects of 10 × 3.5 mm were created in the maxillary mucobuccal fold of both groups. The defects of the experimental group were grafted with BGnf, while the other group of defects considered as a control group. Clinical, histological, and immune-histochemical assessment of both groups of wounds were performed after one, two and three weeks’ time interval. The results of the clinical evaluation of BGnf treated defects showed complete wound closure with the absence of inflammation signs starting from one week postoperative. Control defects, on the other hand, showed an open wound with suppurative exudate. On histological and immunohistochemical level, the BGnf treated defects revealed increasing in cell activity and vascularization with the absence of inflammation signs starting from one week time interval, while the control defects showed signs of suppurative inflammation at one week time interval with diminished vascularization. The results advocated the suitability of BGnf as bioscaffold to be used in a wet environment as the oral cavity that is full of microorganisms and also for an immune-compromised condition as diabetes mellitus. Full article

(This article belongs to the Special Issue Biomaterials for Dental Healing)

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14 pages, 1660 KiB

Open AccessArticle

Calcium Phosphate Ceramics Can Prevent Bisphosphonate-Related Osteonecrosis of the Jaw

by Siri Paulo, Mafalda Laranjo, Anabela Paula, Ana Margarida Abrantes, João Martins, Carlos Miguel Marto, Ana Coelho, João Casalta-Lopes, Lina Carvalho, Eunice Carrilho, Arménio Serra, Maria Filomena Botelho and Manuel Marques Ferreira

Materials 2020, 13(8), 1955; https://doi.org/10.3390/ma13081955 - 22 Apr 2020

Cited by 10 | Viewed by 4088

Abstract

Bisphosphonate-associated osteonecrosis of the jaw (BRONJ), a post-surgical non-healing wound condition, is one of the most common side effects in patients treated with nitrogen-containing bisphosphonates. Its physiopathology has been related with suppression of bone turnover, of soft tissue healing and infection. Biphasic calcium phosphates (BCP) are used as a drug delivery vehicle and as a bone substitute in surgical wounds. Due to their capacity to adsorb zoledronate, it was hypothesized these compounds might have a protective effect on the soft tissues in BRONJ wounds. To address this hypothesis, a reproducible in vivo model of BRONJ in Wistar rats was used. This model directly relates chronic bisphosphonate administration with the development of osteonecrosis of the jaw after tooth extraction. BCP granules were placed in the alveolus immediately after tooth extraction in the test group. The animals were evaluated through nuclear medicine, radiology, macroscopic observation, and histologic analysis. Encouragingly, calcium phosphate ceramics were able to limit zoledronate toxicity in vivo and to favor healing, which was evidenced by medical imaging (nuclear medicine and radiology), macroscopically, and through histology. The studied therapeutic option presented itself as a potential solution to prevent the development of maxillary osteonecrosis. Full article

(This article belongs to the Special Issue Biomaterials for Dental Healing)

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15 pages, 4229 KiB

Open AccessArticle

In Vitro Evaluation of Antibacterial Properties and Smear Layer Removal/Sealer Penetration of a Novel Silver-Citrate Root Canal Irrigant

by Riccardo Tonini, Massimo Giovarruscio, Fabio Gorni, Andrei Ionescu, Eugenio Brambilla, Irina Makeeva Mikhailovna, Arlinda Luzi, Paula Maciel Pires and Salvatore Sauro

Materials 2020, 13(1), 194; https://doi.org/10.3390/ma13010194 - 2 Jan 2020

Cited by 22 | Viewed by 5487

Abstract

This study aimed at evaluating the efficacy of a novel silver-citrate root canal irrigation solution (BioAKT) on smear layer removal, sealer penetration after root canal instrumentation and antibacterial activity. Single-root teeth were endodontically treated, sealed with an epoxi-amine resin sealer and irrigated using: Group I: 5.25% sodium hypochlorite (NaOCl); Group II: silver-citrate solution (BioAKT); Group III: phosphate buffer solution (PBS); Group IV: 17% ethylenediaminetetraacetic acid (EDTA). Smear layer removal and silver deposition at the coronal, middle and apical portion of each canal were analyzed using scanning electron microscopy (SEM) and energy-dispersive x-ray spectroscopy (EDS). Sealer penetration into dentinal tubules at coronal, middle and apical portion was assessed through dye-assisted confocal microscopy (CSM). Both SEM and CSM micrographs were evaluated by two examiners (κ = 0.86), who were blind to the irrigation regimens; scores were given according to the degree of penetration of the sealer. Data analysis included Pearson’s x² and Sidak’s multiple comparisons. Dentin discs were polished and sterilized. Enterococcus faecalis biofilms were grown using a continuous-flow bioreactor under anaerobic conditions for 72 h. Specimens were irrigated with the tested solutions, and bacterial viability was assessed using a tetrazolium salt assay (MTT). Statistical analysis included one-way ANOVA and Student’s post-hoc t-test (p < 0.05). BioAKT and EDTA were the most efficient solutions both in removing the smear layer and allowing sealer penetration. However, at the apical portion BioAKT performed significantly better compared to EDTA both in smear layer removal and sealer penetration (p < 0.05). BioAKT and NaOCl showed comparable antibacterial effect (p = 0.53). In conclusion, BioAKT represents a suitable smear layer removal agent, which allows for reliable sealer penetration at the apical portion of the root canal system and offers significant antibacterial properties. Full article

(This article belongs to the Special Issue Biomaterials for Dental Healing)

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15 pages, 2587 KiB

Open AccessFeature PaperArticle

Co-Blend Application Mode of Bulk Fill Composite Resin

by Mohammad Al-Nabulsi, Alaa Daud, Cynthia Yiu, Hanan Omar, Salvatore Sauro, Amr Fawzy and Umer Daood

Materials 2019, 12(16), 2504; https://doi.org/10.3390/ma12162504 - 7 Aug 2019

Cited by 10 | Viewed by 4707

Abstract

Objective: To evaluate the effect of a new application method of bulk-fill flowable composite resin material on bond-strength, nanoleakage, and mechanical properties of dentine bonding agents. Materials and methods: Sound extracted human molars were randomly divided into: manufacturer’s instructions (MI), manual blend 2 mm (MB2), and manual blend 4 mm (MB4). Occlusal enamel was removed and flattened, dentin surfaces were bonded by Prime & Bond universal (Dentsply and Optibond FL, Kerr). For the MI group, adhesives were applied following the manufacturer’s instructions then light-cured. For MB groups, SDR flow+ bulk-fill flowable composite resin was applied in 2- or 4-mm increment then manually rubbed by a micro brush for 15 s with uncured dentine bonding agents and the mixture was light-cured. Composite buildup was fabricated incrementally using Ceram.X One, Dentsply nanohybrid composite resin restorative material. After 24-h water storage, the teeth were sectioned to obtain beams of about 0.8 mm² for 24-h and thermocycled micro-tensile bond strength at 0.5 mm/min crosshead speed. Degree of conversion was evaluated with micro-Raman spectroscopy. Contraction gaps at 24 h after polymerization were evaluated and atomic force microscopy (AFM) nano-indentation processes were undertaken for measuring the hardness across the interface. Depth of resin penetration was studied using a scanning electron microscope (SEM). Bond strength data was expressed using two-way ANOVA followed by Tukey’s test. Nanoindentation hardness was separately analyzed using one-way ANOVA. Results: Factors “storage F = 6.3” and “application F = 30.11” significantly affected the bond strength to dentine. For Optibond FL, no significant difference in nanoleakage was found in MI/MB4 groups between baseline and aged specimens; significant difference in nanoleakage score was observed in MB2 groups. Confocal microscopy analysis showed MB2 Optibond FL and Prime & Bond universal specimens diffusing within the dentine. Contraction gap was significantly reduced in MB2 specimens in both adhesive systems. Degree of conversion (DC) of the MB2 specimens were numerically more compared to MS1 in both adhesive systems. Conclusion: Present study suggests that the new co-blend technique might have a positive effect on bond strengths of etch-and-rinse adhesives to dentine. Full article

(This article belongs to the Special Issue Biomaterials for Dental Healing)

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16 pages, 2719 KiB

Open AccessArticle

Synthetic Calcium Phosphate Ceramics as a Potential Treatment for Bisphosphonate-Related Osteonecrosis of the Jaw

by Siri Paulo, Mafalda Laranjo, Ana M. Abrantes, João Casalta-Lopes, Kathleen Santos, Ana C. Gonçalves, Anabela Baptista Paula, Carlos Miguel Marto, Ana Bela Sarmento-Ribeiro, Eunice Carrilho, Arménio Serra, Maria F. Botelho and Manuel M. Ferreira

Materials 2019, 12(11), 1840; https://doi.org/10.3390/ma12111840 - 6 Jun 2019

Cited by 17 | Viewed by 3627

Abstract

(1) Background: Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is one of the most often seen side effects in patients treated with nitrogen-containing bisphosphonates (BPs), a post-surgical non-healing wound condition. Since calcium phosphate (CP) compounds are able to adsorb zoledronate (ZOL) when used as a drug delivery vehicle, we aimed to verify if these ceramics might have a potential protective effect for soft tissues surrounding surgical osseous wounds. (2) Methods: The chemical reaction between ZOL and CP compounds was evaluated through ultraviolet-visible spectroscopy and elemental analysis. A primary culture of human gingival fibroblasts (HGF) was established as a model to evaluate the cytotoxicity of the association of ZOL (5–500 μM) and of ZOL/biphasic calcium phosphates (BCP). Metabolic activity, cell viability, types of cell death, the cell cycle through, and the migration ability of human gingival fibroblasts were evaluated. (3) Results: ZOL was adsorbed by biphasic calcium phosphate compounds in an aqueous solution. The HGF were sensitive to ZOL toxicity; nevertheless, ZOL/BCP showed a significant protective effect regarding metabolic activity, cell viability, and cell migration. (4) Conclusions: BCP interaction with ZOL reduces or abolishes its toxicity in HGF. This finding represents a potential solution for BRONJ in the case of patients undergoing therapy with ZOL. Full article

(This article belongs to the Special Issue Biomaterials for Dental Healing)

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16 pages, 2604 KiB

Open AccessArticle

Biodentine^™ Boosts, WhiteProRoot^®MTA Increases and Life^® Suppresses Odontoblast Activity

by Anabela Paula, Mafalda Laranjo, Carlos Miguel Marto, Ana Margarida Abrantes, João Casalta-Lopes, Ana Cristina Gonçalves, Ana Bela Sarmento-Ribeiro, Manuel M. Ferreira, Maria Filomena Botelho and Eunice Carrilho

Materials 2019, 12(7), 1184; https://doi.org/10.3390/ma12071184 - 11 Apr 2019

Cited by 31 | Viewed by 5784

Abstract

(1) Background: When pulp exposure occurs, reparative dentinogenesis can be induced by direct pulp capping to maintain the vitality and function of the tissue. The aim of this work was to assess the cytotoxicity and bioactivity of three different direct pulp capping materials, calcium hydroxide (Life^®), mineral trioxide aggregate (WhiteProRoot^®MTA) and calcium silicate (Biodentine^™), in an odontoblast-like mouse cell line (MDPC-23). (2) Methods: Metabolic activity was assessed by the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide test (MTT)assay, viability by the sulforhodamine B (SRB) assay, and the type of death and cell cycle analysis by flow cytometry. Alkaline phosphatase was evaluated by polymerase chain reaction (PCR), and dentin sialoprotein expression was assessed by immunocytochemistry. Mineralization was determined by the Alizarin Red S colorimetric assay and quantified by spectrophotometry. (3) Results: Life^® induced a decrease in metabolic activity and viability, which is associated with an increase cell death. WhiteProRoot^®MTA and Biodentine™ induced similar effects in cytotoxicity assays, with an increase in the expression of dentin sialoprotein (DSP) and formation of mineralized deposits, especially with Biodentine™. (4) Conclusions: The results of WhiteProRoot^®MTA confirm its indication for these therapies, justifying its recognition as the “gold standard”. Biodentine™ may be an alternative, since they promote the same cellular response that mineral trioxide aggregate (MTA) does. Full article

(This article belongs to the Special Issue Biomaterials for Dental Healing)

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Review

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30 pages, 756 KiB

Open AccessFeature PaperReview

Bioactivity of Bioceramic Materials Used in the Dentin-Pulp Complex Therapy: A Systematic Review

by José Luis Sanz, Francisco Javier Rodríguez-Lozano, Carmen Llena, Salvatore Sauro and Leopoldo Forner

Materials 2019, 12(7), 1015; https://doi.org/10.3390/ma12071015 - 27 Mar 2019

Cited by 54 | Viewed by 8106

Abstract

Dentistry-applied bioceramic materials are ceramic materials that are categorized as bioinert, bioactive and biodegradable. They share a common characteristic of being specifically designed to fulfil their function; they are able to act as root canal sealers, cements, root repair or filling materials. Bioactivity is only attributed to those materials which are capable of inducing a desired tissue response from the host. The aim of this study is to present a systematic review of available literature investigating bioactivity of dentistry-applied bioceramic materials towards dental pulp stem cells, including a bibliometric analysis of such a group of studies and a presentation of the parameters used to assess bioactivity, materials studied and a summary of results. The research question, based on the PICO model, aimed to assess the current knowledge on dentistry-based bioceramic materials by exploring to what extent they express bioactive properties in in vitro assays and animal studies when exposed to dental pulp stem cells, as opposed to a control or compared to different bioceramic material compositions, for their use in the dentin-pulp complex therapy. A systematic search of the literature was performed in six databases, followed by article selection, data extraction, and quality assessment. Studies assessing bioactivity of one or more bioceramic materials (both commercially available or novel/experimental) towards dental pulp stem cells (DPSCs) were included in our review. A total of 37 articles were included in our qualitative review. Quantification of osteogenic, odontogenic and angiogenic markers using reverse transcriptase polymerase chain reaction (RT-PCR) is the prevailing method used to evaluate bioceramic material bioactivity towards DPSCs in the current investigative state, followed by alkaline phosphatase (ALP) enzyme activity assays and Alizarin Red Staining (ARS) to assess mineralization potential. Mineral trioxide aggregate and Biodentine are the prevalent reference materials used to compare with newly introduced bioceramic materials. Available literature compares a wide range of bioceramic materials for bioactivity, consisting mostly of in vitro assays. The desirability of this property added to the rapid introduction of new material compositions makes this subject a clear candidate for future research. Full article

(This article belongs to the Special Issue Biomaterials for Dental Healing)

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