Search Results (78)

Background/Objectives: We evaluated whether resin infiltration treatment of demineralized enamel improves shear bond strength (SBS). Methods: Thirty permanent bovine incisor teeth were assigned randomly into three groups (n = 10 per group): control group, demineralized enamel pretreated with ICON^® resin infiltrant (Exp1 group), and demineralized enamel without pretreatment (Exp2). Demineralization was induced using a pH 4.5 solution for 21 days and was monitored using swept-source optical coherence tomography on days 0, 7, 14, and 21. The lesion depth (LD) was quantified and evaluated using ImageJ software. In the Exp1 group, ICON^® was applied prior to bracket bonding; no pretreatment was applied in the Exp2 group. In all groups, brackets were bonded using Super-Bond/Clear fluoride-free self-cure adhesive resin (4-META/MMA-TBB, Sun Medical) following Phosphoric acid (65%; Red Activator, Sun Medical). After debonding, enamel surfaces were evaluated to determine the adhesive remnant index (ARI). Results: No significant difference (p = 0.631) was noted in LD between Exp1 and Exp2 groups. The SBS values significantly differed (p < 0.05) between the control (4.1 ± 1.0 MPa) and Exp1 (5.5 ± 1.4 MPa) groups and between the Exp1 and Exp2 (3.8 ± 1.3 MPa) groups. However, SBS did not differ significantly between the control and Exp2 groups. Furthermore, ARI scores showed no significant difference between the control and Exp1 groups, whereas the Exp2 group recorded significantly elevated ARI scores relative to the control group (p = 0.0127). Conclusions: These findings suggest that resin infiltration with ICON^® may improve bracket adhesion on demineralized enamel. Full article

This study aimed to assess how various remineralizing agents affect the demineralized enamel calcium/phosphorus ions (Ca/P) ratio and micro-tensile bond strength (μTBS) of orthodontic adhesive modified by Sepiolite nanoparticles (Sep-NPs). In addition, rheological properties and degree of conversion (DC) of the adhesive were investigated. One hundred and forty-four human premolars underwent a cariogenic challenge to induce artificial demineralization. Based on the remineralizing agents used, the samples were divided into four categories: silver diamine fluoride (SDF), rosmarinic acid (RMA), ROCS Medical Mineral Gel System (ROCS MMG), and control. The Ca/P ratio was evaluated using energy-dispersive X-rays. Thirty samples were divided into two subgroups: unmodified adhesive and 1% Sep-infiltrated adhesive. Brackets were bonded, and the μTBS was evaluated. Scanning electron microscopy was used to evaluate the resin–bracket interface. The modified and unmodified adhesives were subjected to DC and rheological testing. The Ca/P ion ratio was highest in the ROCS-MMG group and lowest in the no-remineralization group. Group 3B (ROCS MMG + SepNPs-Orthodontic adhesive) samples displayed the highest bond strength. The lowest μTBS was observed in Group 4A (no remineralization + orthodontic adhesive). ROCS MMG conferred the greatest improvement in µTBS and Ca/P ratio before bracket bonding, followed by SDF, whereas RMA did not enhance bonding outcomes. Sep-NP incorporation at 1% improved µTBS but compromised DC and rheological properties, necessitating concentration optimization before clinical application. Full article

The orthodontic landscape is currently witnessing a significant technological evolution with the emergence of direct 3D-printed aligners (DPAs), which promise to close the digital workflow loop by eliminating the geometric limitations and solid model waste inherent to traditional thermoformed clear aligners (TCAs). This review provides a comprehensive analysis of the material science governing this transition from inert thermoplastic sheets to reactive photocurable resins. We explore the fundamental chemistry of DPA materials, and the pivotal role of post-processing in ensuring mechanical integrity and biocompatibility. Beyond passive mechanics, this review highlights preclinical research in functional material engineering, detailing how experimental DPAs are being investigated for the integration of antibacterial agents, remineralization fillers, and drug delivery systems. Furthermore, we evaluate the limited but emerging clinical data on DPAs, contrasting their shape-memory properties and force delivery profiles with conventional appliances, while critically addressing emerging safety concerns regarding monomer elution and microplastic generation. We conclude that while DPA technology offers superior dimensional control, comprehensive life cycle assessments and long-term in vivo trials are essential to fully substantiate their clinical efficacy, overall sustainability, and potential as advanced orthodontic appliances. Full article

The development of microcapsules for the controlled release of active substances offers an innovative strategy in restorative dentistry, expanding the possibilities beyond traditional methods. In this study, microcapsules loaded with triethylene glycol dimethacrylate (TEGDMA) and different concentrations of hydroxyapatite (HAP)—0%, 5%, 10%, 15%, and 20%, referred to as M0, M5, M10, M15, and M20—were synthesized through in situ polymerization within an oil-in-water emulsion. Their morphology, size, and nanostructure were examined using scanning electron microscopy (SEM) and atomic force microscopy (AFM). Fourier-transform infrared spectroscopy (FTIR) confirmed the presence of characteristic chemical bonds, whereas high-performance liquid chromatography (HPLC) quantified residual TEGDMA monomer. Low-field nuclear magnetic resonance (NMR) further confirmed the presence and the distribution of the liquid healing agent inside the microcapsules. The analyses indicated that microcapsules incorporating 20% hydroxyapatite exhibited superior structural organization and improved shell integrity, highlighting their potential in the remineralization processes. Overall, these results support the potential of HAP–TEGDMA microcapsules for incorporation into dental composites to facilitate microcrack repair and promote dental tissue regeneration. Full article

The management of dental caries has evolved from the traditional mechanical approach of “extension for prevention” to a biologically oriented philosophy centered on preserving natural tooth structures. Minimally invasive dentistry (MID) emphasizes early detection, risk assessment, prevention, and conservative intervention based on the lesion’s activity and depth. This review outlines current evidence on non-operative, micro-invasive, and minimally invasive strategies, including fluoride therapy, remineralizing agents such as casein phosphopeptide–amorphous calcium phosphate (CPP-ACP), self-assembling peptides that promote biomimetic enamel repair, sealants, and resin infiltration. Minimally invasive operative methods employ advanced technologies for selective tissue removal—chemomechanical systems (Carisolv, Papacarie, Brix3000), sono-and airabrasion, and new-generation polymeric and ceramic burs (SmartBur, Cerabur) designed to preserve sound dentin. Laser photoablation, particularly with erbium lasers (Er:YAG, Er,Cr:YSGG), enables precise cavity preparation with minimal thermal and mechanical stress. These approaches enhance patient comfort, reduce anesthesia requirements, and maintain tooth vitality. Despite limitations related to cost, equipment, and operator sensitivity, MID represents not only a set of refined clinical techniques but also a comprehensive, evidence-based treatment philosophy founded on biological principles, structural preservation, and the promotion of long-term oral health. Full article

Context: The increasing incidence of secondary caries and the failure of restorations have intensified research into dental restorative materials capable of actively interacting with the oral environment. In this context, antibacterial and bioregenerative nanomaterials have attracted growing scientific interest due to their potential to inhibit biofilm formation while simultaneously supporting mineral repair processes. Objective: This narrative review analyzes recent developments in nanostructured materials for restorative dentistry and oral health applications, with particular emphasis on antibacterial agents, bioactive systems, and emerging dual-function approaches that integrate multiple biological functions into restorative materials. Scope of the Review: The analyzed literature indicates that metallic nanoparticles, cationic monomers, and natural nanopolymers can reduce bacterial adhesion and metabolic activity under experimental conditions. In parallel, bioactive nanomaterials such as nanohydroxyapatite, bioactive glass, and calcium phosphate-based systems have demonstrated the ability to release remineralizing ions and to promote mineral deposition at the tooth–material interface. Dual-function hybrid materials aim to combine these antibacterial and bioregenerative effects within a single restorative system. Interpretative Perspective: Despite these advances, most available evidence derives from in vitro and preclinical studies, with significant heterogeneity across experimental models, evaluation methods, and outcome variables. This variability limits direct comparisons between studies and necessitates a cautious interpretation of claims regarding long-term antibacterial efficacy, functional tissue regeneration, and routine clinical applicability. Conclusions: Antibacterial and bioregenerative nanomaterials represent a relevant and continuously evolving research direction in restorative dentistry. Their successful clinical translation will depend on establishing standardized testing protocols, conducting comprehensive safety assessments, and generating clinically relevant evidence supporting long-term efficacy and biological compatibility. Their successful clinical translation will depend on establishing standardized testing protocols, conducting comprehensive safety assessments, and generating clinically relevant evidence supporting long-term efficacy and biological compatibility. Full article

Dental erosion has emerged as a significant modern oral health problem, characterized by the chemical dissolution of tooth structure resulting from frequent exposure to intrinsic or extrinsic acids. With a high global prevalence ranging from 30% to 50% in children and 20% to 40% in adults, its management is a clinical priority to prevent long-term complications like dentine hypersensitivity and functional impairment. This review outlines the multifactorial etiology of erosion, encompassing dietary acids, gastroesophageal reflux, and reduced salivary flow. The historical context of oral care is explored, leading to a discussion on contemporary management strategies centered on remineralization. Fluoride ions play a crucial role by inhibiting demineralization, facilitating the formation of acid-resistant fluorapatite, and exerting antibacterial effects. A major focus is placed on advanced biomimetic, calcium phosphate-based topical agents such as Casein Phosphopeptide–Amorphous Calcium Phosphate (CPP-ACP), functionalized Tricalcium Phosphate (fTCP), and Hydroxyapatite (HAP), which effectively replenish lost minerals. The review further explores innovative methods, such as laser-assisted and electrically enhanced remineralization. Finally, it outlines next-generation regenerative strategies, including self-assembling peptides (P11-4), stem cell therapies, 3D bioprinting, and gene-editing (CRISPR) technologies, which aim to biologically regenerate lost enamel and dentine. The field is rapidly evolving from a preventive to a restorative paradigm, with future directions focusing on biologically based, minimally invasive therapies to fully restore tooth structure and function. Full article

This study aimed to develop bioactive toothpaste and compare its remineralization potential on initial enamel lesions with toothpaste containing other active agents. Sixty extracted human maxillary incisors were randomly assigned to six groups: Group EXP (Experimental toothpaste), Group SRP (Sensodyne Repair & Protect), Group ZAC (Zubio Active Carbon Whitening), Group GTM (GC Tooth Mousse), Group CSP (Colgate Sensitive Pro-Relief), and Group ASS (Artificial saliva, control). Artificial caries were induced by immersion in a demineralization solution for three days. Specimens then underwent a seven-day pH-cycling protocol, during which toothpaste was applied twice daily for two minutes. Analyses were performed at baseline, post-demineralization, and post-remineralization using ATR-FTIR, SEM-EDS, and Vickers micro-hardness testing. Statistical analyses were conducted using SPSS (version 27.0, IBM Corp., Chicago, IL, USA). All treatment groups, except the control, showed significant microhardness recovery after remineralization, with the highest increase in group CSP followed by group EXP (p < 0.05). Granular surface deposits were observed, most pronounced in groups SRP and GTM (p < 0.05). Calcium and phosphorus contents increased in all groups (p < 0.05), with calcium highest in group GTM and phosphorus in group EXP. The mineral-to-matrix ratio increased in all groups, and a statistically significant difference was identified between the experimental toothpaste (EXP) and the other toothpaste formulations (p < 0.05). It is hypothesized that pomegranate seed essential oil may exhibit a remineralizing effect due to its content of anthocyanidins, anthocyanins, and various polyphenolic compounds. Therefore, the development of a toothpaste with enhanced remineralization potential was targeted by incorporating pomegranate seed essential oil into the experimental formulation in addition to bioactive agents such as bioactive glass, hydroxyapatite, and casein phosphopeptide. Full article

Minimally invasive treatment is increasingly successful in managing carious lesions in primary teeth, owing to the regenerative capacity of the dental pulp and the possibility to influence the pulp–dentin complex. Chemo-mechanical caries excavation (CME) with Brix 3000, a papain-based enzymatic agent, allows selective removal of infected dentin while preserving affected dentin for potential remineralization. Fluorescence-aided caries excavation (FACE) enables visualization of porphyrins produced by cariogenic microorganisms, guiding selective dentin removal. In this study, 42 children aged 4–7 years with ICDAS II code 05–06 lesions in primary molars were treated, and the correlation between fluorescence intensity and cariogenic microbial load was evaluated. CME was performed using Brix 3000, and residual dentin was categorized by fluorescence as red, red with pale-pink areas, pale-pink, or non-fluorescent. Microbiological samples were collected pre- and post-excavation, cultured under standardized laboratory conditions, and quantitatively analyzed. Results showed that higher fluorescence intensity corresponded to increased presence of S. mutans (ρ = 0.945, p < 0.001), while other species were present in lower quantities. CME with Brix 3000 significantly reduced microbial load, and fluorescence reliably indicated areas requiring removal. These findings demonstrate that combining FACE with Brix 3000 allows precise, minimally invasive caries removal in primary teeth, providing an objective method to guide tissue-preserving excavation while effectively controlling cariogenic microorganisms. Full article

The long-term success of composite restorations largely depends on the performance of dental adhesives at the adhesive–tooth interface. Despite ongoing improvements, secondary caries remains the leading cause of restoration failure, primarily due to the adhesive layer’s susceptibility to hydrolytic degradation, bacterial invasion, and limited biological functionality. This review provides a comprehensive overview of recent advances in bioactive dental adhesives for preventing recurrent caries, focusing on their mechanisms of action, material performance, therapeutic functions, and clinical potential. Bioactive adhesives combine durable bonding with biofunctional benefits, including remineralization, antimicrobial activity, enzymatic inhibition, and support for tissue regeneration. By integrating these properties, they enhance both the durability of the adhesive interface and oral health. Recent strategies include the incorporation of ion-releasing fillers such as calcium phosphate and bioactive glass, antimicrobial monomers such as MDPB and quaternary ammonium methacrylates, enzymatic inhibitors, and hydrolytically stable resin matrices. Together, these components strengthen the adhesive interface and provide biologically active effects to prevent recurrent caries. Although in vitro findings are promising, challenges remain, including limited long-term clinical data, the absence of standardized evaluation protocols, and barriers to clinical translation. Addressing these gaps is essential to ensure predictable clinical outcomes. Bioactive dental adhesives represent a paradigm shift in restorative dentistry, evolving from passive bonding agents to multifunctional therapeutic materials. By combining structural durability with biological protection, they hold significant potential to prevent recurrent caries and improve the long-term success of composite restorations. Full article

Background/Objectives: Adhesion to caries-affected dentin remains challenging due to its altered structure and composition. Remineralizing agents have been proposed to strengthen this substrate and improve bonding. This study evaluated the effect of three remineralization treatments, CPP-ACP, self-assembling peptide P11-4, and silver diamine fluoride (SDF), on the microtensile bond strength (μTBS) of universal adhesive systems applied to caries-affected dentin, using both etch-and-rinse and self-etch strategies. Methods: Seventy human molars were sectioned and artificially demineralized to simulate caries-affected dentin. Samples were divided into ten groups: four untreated and six treated with CPP-ACP (MI Paste™), P11-4 (Curodont™ Protect), or SDF (Riva Star™). Universal adhesives were applied via etch-and-rinse or self-etch mode, followed by composite restoration. Microtensile bond strength was measured using a universal testing machine, and results were statistically analyzed with ANOVA and t-tests (p < 0.05). Results: Untreated caries-affected dentin showed significantly lower μTBS than sound dentin (C3: 18.3 ± 5.4 MPa vs. C1: 41.3 ± 2.7 MPa). Remineralization agents improved μTBS considerably. CPP-ACP achieved the highest recovery (S1: 31.8 ± 2.6 MPa; S2: 29.2 ± 4.6 MPa), nearing sound dentin levels. P11-4 yielded moderate gains (S3: 24.4 ± 6.5 MPa; S4: 24.1 ± 4.7 MPa), while SDF provided the lowest, yet significant, improvements (S5: 23.7 ± 7.5 MPa; S6: 21.3 ± 5.3 MPa). Etch-and-rinse generally produced higher μTBS than self-etch, but differences were not statistically significant (p > 0.05). Conclusions: Pre-treatment of caries-affected dentin with CPP-ACP, P11-4, or SDF enhances universal adhesive bond strength, with CPP-ACP showing the most pronounced effect. Remineralization protocols represent a valuable adjunct in restorative procedures involving compromised dentin. Full article

Objective: This in vitro study quantitatively compared the time-dependent remineralization potential of three professional agents on artificially induced enamel lesions using Scanning Electron Microscopy (SEM) and energy-dispersive X-ray analysis (EDX). Methods: Sixty extracted sound molars were randomly assigned to three groups (number = 20): G_CPP-ACP, treated with casein phosphopeptide–amorphous calcium phosphate; G_Zn-HA, treated with zinc-hydroxyapatite; and G_F-ACP, treated with fluoridated amorphous calcium phosphate. The crown of each tooth was divided into three areas: one represented the control (CTRL, sound enamel), one underwent demineralization (DEMIN, demineralized enamel), and the third one was at first demineralized and then treated with a remineralizing agent, allowing intra-sample comparison. Artificial lesions were produced by immersion in 0.1 M lactic acid (72 h). Groups were subdivided according to remineralization time (7, 14, 21, and 28 days). Samples underwent daily treatment under a pH-cycling regimen. Surface morphology and Ca/P ratios were evaluated by SEM-EDX, and data were statistically analyzed (p < 0.05). Results: All agents promoted a progressive increase in Ca/P ratio over time, confirming a time-dependent remineralization effect. At day 7, G_Zn-HA showed higher Ca/P values, but from day 14 onward, G_F-ACP produced significantly greater mineral gain than the other groups (p < 0.05). By day 21, G_F-ACP reached Ca/P values approaching CTRL, while G_CPP-ACP and G_Zn-HA remained at lower levels, reaching a plateau respectively at 21 and 14 days. SEM observations supported these findings: G_CPP-ACP and G_Zn-HA showed partial surface recovery, whereas G_F-ACP exhibited a compact, homogeneous enamel-like structure at 28 days. Conclusions: All tested agents demonstrated time-dependent remineralization, enhanced with prolonged exposure, suggesting that the time of application represents a key factor for clinical success. Full article

Although caries is declining in industrialized countries, early childhood caries and molar–incisor hypomineralization (MIH) remain clinically relevant. To meet the demand for effective and well-tolerated preventive strategies, hydroxyapatite (HAp) has gained attention as a biocompatible, fluoride-free agent. A structured narrative review was conducted to evaluate recent clinical evidence on the use of HAp. A PubMed search identified clinical trials from the past five years that investigated HAp-based products. Studies were included if they reported clinical outcomes related to remineralization, caries prevention, or desensitization. Fifteen clinical studies met the inclusion criteria. HAp seems to be a safe and effective alternative to flouride, especially for children or individuals at risk of overexposure. While both agents show similar efficacy in caries prevention, HAp may offer additional advantages in managing hypersensitivity and MIH. Compared to other remineralizing agents, such as calcium sodium phosphosilicate, HAp demonstrated comparable efficacy. Combination therapies show the most promising results. Future research should explore synergies of active ingredients and include standardized long-term studies to substantiate the clinical relevance of HAp. Full article

Amorphous calcium phosphate (ACP) is a well-established bioceramic material known to promote the remineralization of dental hard tissues. White spot lesions (WSLs) represent the initial stage of enamel demineralization and are frequently observed in patients with fixed orthodontic appliances or inadequate oral hygiene. Although recommendations for remineralizing agents include both the prevention of lesion progression and the stimulation of tissue remineralization, the clinical efficacy of ACP-based materials remains under debate. This systematic review, registered in the PROSPERO database (CRD42024540595), aims to evaluate the clinical efficacy of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP)-based products in the remineralization of WSLs and to compare these outcomes with those achieved using non-bioceramic approaches. Inclusion criteria comprised randomized clinical trials, prospective cohort studies, and pilot studies conducted on human subjects with WSLs affecting permanent teeth. Studies involving artificial WSLs or non-cariogenic enamel lesions were excluded. The quality of the included studies was assessed using the Cochrane Risk of Bias 2 (RoB 2) tool. Fourteen articles met the inclusion criteria and were analyzed. The main findings indicate that CPP-ACP is clinically effective in promoting the remineralization of WSLs, although the results were inconsistent across studies. Comparisons with placebo and resin infiltration treatments revealed greater efficacy for CPP-ACP. The combination of CPP-ACP with fluoride appeared to further enhance the remineralizing effect on WSLs. Additional standardized clinical studies with longer follow-up periods are warranted to confirm these outcomes. Full article

Tooth bleaching is a widely used esthetic treatment; however, bleaching agents can temporarily alter the surface morphology of enamel, increasing surface roughness and porosity, which may lead to increased susceptibility to discoloration. This in vitro study investigated the effectiveness of fluoride varnish in preventing immediate discoloration of bovine incisors after bleaching. Specimens were bleached with 35% hydrogen peroxide and treated with either Clinpro White Varnish (CW) or Enamelast Fluoride Varnish (EN), whereas control specimens received no treatment after bleaching. The samples were immersed in coffee for 24 h, and the color difference (ΔE₀₀) was calculated using the CIEDE2000 formula. The surface morphology of enamel was examined using SEM. The fluoride varnish groups showed significantly lower color difference values than the control group (p < 0.05), with ΔE₀₀ reduced by approximately two-thirds in both the CW and EN groups. SEM observations showed that the enamel surfaces in the varnish-treated groups exhibited reduced surface irregularities compared to the untreated group, suggesting remineralization. These results suggest that the immediate application of fluoride varnish after bleaching can effectively reduce short-term discoloration by providing physical protection and promoting remineralization. Fluoride varnish may serve as a simple and effective strategy to maintain whitening outcomes and minimize early discoloration. Full article