Mutlu Özcan
Lucas da Fonseca Roberti Garcia
Claudia Angela Maziero Volpato- 1Division of Dental Materials, Center for Dental and Oral Medicine, Clinic for Reconstructive Dentistry, University of Zürich, Zurich, Switzerland
- 2Department of Dentistry, Health Sciences Center, Federal University of Santa Catarina, Florianópolis, Brazil
Currently, minimally invasive restorations could be made in dentistry applying adhesive materials and adhesion principles to the dental structures. Following this philosophy, endodontic interventions have been avoided largely, preserving hard tissues, and maintaining dental vitality. Advances in biologically favorable bioactive materials enabled clinicans to induce repair and regeneration of dental tissues. Such materials are primarily used for pulp protection and cementation of indirect restorations. This review highlights current bioactive materials available, principles of bioactivity and their mechanisms of action.
Introduction
Minimally invasive approaches aim to restore the shape, function and aesthetics of teeth, preserving hard tissues and preventing damage, especially in relation to the dentin-pulp complex (1, 2). The main objective of these strategies is to extend the functional life of the restored teeth, with the least possible restorative intervention (3). These approaches that are frequently increasing in dentistry, are governed by a therapeutic philosophy in which traditional restorations are replaced by direct or indirect adhesive restorations, performed on conservative dental preparations (4, 5).
Direct adhesive restorations may be inserted in cavity preparations resulting, basically, from the removal of dental caries and/or old restorative materials (6). In the past, sound dental structure was sacrificed to compensate for the limitations of tecnhiques and restorative materials (3). Currently, based on the minimally invasive philosophy, the preparation of a cavity takes the preservation of the sound dental tissue into account, giving a chance for the tissues for potential remineralization (7). Therefore, this philosophy integrates concepts of prevention, control and dental treatment (2), using restorative materials of low cost and easy repair (8).
In indirect restorations, classic approaches are based on subtractive techniques, where the tooth must be prepared to create enough space for the restorative material (9). In order to avoid undesirable prosthetic overcontours, often a greater amount of tooth preparation is performed by the clinician, which may result in loss of pulp vitality. In addition, devitalized abutment teeth associated with these prostheses generally have intraradicular posts, which require more removal of dental tissue, impacting negatively the clinical survival of these restorations (10, 11).
Crowns, onlays, veneers and small fixed dental prostheses, made with ceramic materials may react to acid etching techniques (12), as well as CAD-CAM polymers and hybrid materials (13, 14), are considered as alternatives to traditional metal-ceramic crowns with high success rates (15–17). Due to the bonding agents and the adhesive cements currently available on the market, thinner restorations may be performed, which results in conservative dental preparations and the maintenance of dental vitality (18, 19). Therefore, due to the advancement of esthetic materials and the introduction of adhesive techniques, dental vitality has been preserved after restorative procedures, decreasing the cycle of invasive dental interventions (9). Supported by the minimally invasive philosophy, direct and indirect restorations are increasingly applied in vitalized teeth. Hence, it is important to keep in mind that vital dental tissues must be carefully handled and protected, as the survival of the tooth is prolonged due to the maintenance of pulp vitality and preservation of sound hard tissues (4, 9).
Based on this philosophy, biomaterials and bioactive materials have been suggested in the literature to be used as pulp protection materials, or for the cementation of indirect restorations, due to their ability in inducing the dental tissue repair and regeneration (20, 21). Biomaterials and bioactive protective materials applied on pulp may be effectively and be permanently used in cases of indirect and direct pulp capping or pulpotomy (22, 23). Cements, such as traditional glass ionomer cements (GICs), GICs modified by resin (RMGICs), or more recently, GICs associated with calcium aluminate, have been used to lute indirect restorations, especially in vital dental preparations and/or preparations with sub-gingival cervical margins (21, 24, 25).
Pulp Response to External Injuries
The pulp is a loose, highly differentiated, innervated and vascularized connective tissue, which is responsible for the vitality of the tooth (26). In addition to its nutritive, sensitive and defensive potential, the pulp tissue is mainly composed by odontoblasts, and their odontoblastic extensions inside the dentinal tubules account for the dentin deposition (26, 27).
The pulp is protected from external irritating agents by the enamel and dentin walls, although these tissues limit its expansion and vasodilation in injury episodes. In its central region, it is formed by blood vessels, nerve fibers and cells distributed in a matrix composed of collagen fibers and a fundamental substance (27). A layer of primary odontoblasts is present in the peripheral pulp region. When the pulp is subjected to mechanical, thermal, chemical or bacterial injuries, an effective defense reaction is triggered (28). This response depends on the factors such as the intensity and duration of the irritating stimulus and the previous condition of the pulp tissue (29, 30).
Tertiary dentin formed after an aggressive stimulus, may be reactive or reparative (31). The primary odontoblasts secreted dentin matrix of the reactive-type, while the reparative dentin is secreted by odontoblast-like cells originated from differentiate pulp cells originated after the primary odontoblast destruction (29). The dentin-pulp complex also has biologically active molecules, such as transforming growth factors-ß1 (TGF-ß1) and bone morphogenetic proteins-7 (BMP-7), which act by stimulating and/or inhibiting specific events, as the modulation of embryogenic development, cell differentiation, immunoregulation, repair process and tissue regeneration (32, 33).
Bioactivity
Biocompatibility is the ability of a material in interacting with a living tissue without causing damage or adverse effects to it (34). All materials capable of presenting a certain degree of biological compatibility with the tissues are called “biomaterials.” However, when a biomaterial comes into contact with a living tissue, and despite its biocompatibility, it chemically interacts with the tissue, this phenomenon is called bioactivity (35, 36). Therefore, bioactive materials may be described as those that promote a specific biological response in organisms or cells, inducing chemical bonding or tissue formation, as occurs in the pulp, enamel, dentin and bone (37). A good example of a bioactive material widely used in dentistry is the GICs (38). These cements release fluoride ions that are replaced by hydroxyl ions of hydroxyapatite present in dental tissue, forming the fluorohydroxyapatite crystal (FHA). FHA is more resistant to acid demineralization caused by the oral microbiota and may release fluoride ions whenever the pH of the oral environment becomes acidic (38). In addition, GICs are capable to bond to the dental tissues, due to the chemical bonds of carboxylic radicals to calcium ions present in the dentin and enamel (38).
Several types of bioactive materials have been used in dentistry, some of which are based on calcium hydroxide and mineral aggregate-based materials (39, 40). Calcium hydroxide is able to induce the organism in forming mineralized tissue, assisting the repair of an injured area. The same phenomenon may be observed in mineral aggregate-based cements, which release calcium hydroxide during their hydration process (39, 40). These materials may be used in different clinical situations such as the repair of root and furcation perforations, apical surgery (retrofilling), apexification, treatment of root resorption and dentin hypersensitivity, and indirect or direct pulp capping (41).
Bioactive Materials for Pulp Protection
The pulp capping procedure, whether indirect or direct, consists of applying a specific biomaterial on a thin dentinal remnant (indirect), or on the pulp tissue exposed accidentally (direct) (42). Such protective material is characterized by its ability in stimulating the pulp tissue to produce specific and intentional mineral bonds with the dentinal substrate, maintaining its function and vitality (7). Ideally, these materials should be radiopaque (43), non-resorbable, non-toxic, resistant to bacterial infiltration and insoluble in tissue fluids (40, 44). In addition, they must enable an efficient marginal sealing to minimize infiltrations and secondary caries (45).
Calcium Hydroxide Cements
Several studies have already proved the effectiveness of calcium hydroxide as a material for pulp protection in its different forms of presentation (cement, powder, and paste) (46–48). When in direct contact with the pulp, calcium hydroxide causes necrosis on the surface of this tissue, inducing the organism to promote the deposition of mineralized tissue in the affected area, leading to its repair (47, 48). Despite the widespread use for decades, and still being one of the most used materials in this type of procedure, doubts regarding the clinical performance of calcium hydroxide, mainly due to its low mechanical resistance and poor sealing ability, still persist (49).
Mineral Aggregate-Based Cements
The need for a more appropriate material for pulp therapy stimulated the development of the Mineral Trioxide Aggregate (MTA) (50). This cement was initially conceived as a material for apical surgery (retrograde filling) and for the treatment of perforations located at the root and furcation (39, 40, 51, 52). However, the remarkable clinical performance of this cement has led to its use in several other clinical situations, such as apexification (53), treatment of root resorption (54, 55), in pulpotomies (56–58) and pulp protection (59–62).
MTA is a calcium silicate-based cement, being composed mainly (% by weight) by Portland cement (75.0), widely used in civil engineering in the construction area, in addition to Bi2O3 (20.0), its radiopacifying agent and dehydrated CaSO4 (5.0), for the setting-time control (44, 63). In turn, the main components of Portland cement are SiO2 (21.2), CaO (68.1), Al2O3 (4.7), MgO (0.48), and Fe2O3 (1.89) (64).
As it is a hydraulic cement, water is added to the MTA powder for manipulation, starting its hydration process (44, 65). During the hydration process of MTA, calcium disilicate and trisilicate react, leading to the formation of calcium hydroxide and hydrated calcium silicate gel (44, 66). The calcium ions released during the setting process of MTA diffuse within the dentinal tubules and increase their concentration over the course of time. This phenomenon raises the pH of the medium, making it alkaline, ensuring the bioactivity of the cement (66, 67).
In comparison with the calcium hydroxide, MTA is more capable in maintaining the pulp tissue integrity after conservative treatments (68). Studies have shown that the pulp tissue submitted to capping with MTA presented the formation of a thick-mineralized barrier (58, 69, 70). In addition, the underlying pulp tissue had a mild inflammatory response, significantly less intense than observed in pulps treated with calcium hydroxide (62, 68, 71). Other studies have reported that MTA stimulates pulp cells to synthesize and deposit mineralized dentin matrix faster than calcium hydroxide (62, 72). During the hydration of MTA, a by-product of calcium hydroxide, the hydrated calcium silicate is formed (73). The hydrated calcium silicate reaction results in the hydrogenation of CaO and Ca(OH)2. Then, a large concentration of Ca++ ions is released into the medium (66). These Ca++ ions are produced from the Ca(OH)2 formed during the MTA setting reaction, and from the decomposition of hydrated calcium silicate, which is deposited at a slower rate than observed in pulps treated with hydroxide calcium cement (73). However, the mechanism of action of MTA on the pulp tissue has not been fully explained yet. It is speculated that the MTA action is similar to calcium hydroxide, with an initial inflammatory response, followed by a necrosis limited to the area below the connective tissue submitted to protection (74, 75).
In addition to the superior mechanical resistance and greater sealing ability (76) of MTA, when compared to calcium hydroxide, it also stands out for its lower solubility and better marginal adaptation (77, 78). However, some negative characteristics of MTA must be considered as well, such as its poor handling, which results in the formation of several pores in the cement microstructure and makes it highly unstable (79); high cost (80); staining of dental tissues (55, 81); arsenic release (82–84) above the safety limits proposed by the ISO 9917-1 (2001) (85); low adhesion to the dentin substrate (86, 87) and long setting-time (88).
During the last two decades, it was the clinical success of MTA, combined with its undesirable properties that led to the development of several other mineral aggregate-based cements containing calcium silicate as main component, (89). Among these cements, Biodentine (Septodont, France) stands out. This cement is known as “dentin substitute” due to its mechanical resistance similar to that of the human dentin (89, 90) and is basically composed of tricalcium silicate, calcium carbonate and zirconium oxide, as a radiopacifying agent (91, 92). The liquid to be mixed with the cement powder contains calcium chloride significantly reduces its setting-time in comparison to MTA, and a water-soluble polymer in the composition acts as a water-reducing agent, in addition to sodium and magnesium (91, 92). According to Stefaneli Marques et al. (93), Biodentine has physicochemical properties similar to Portland cement. Moreover, the biocompatibility and bioactivity promoted by this cement are similar to that of MTA, making both cements, the main choice for several conservative therapies involving the dentin-pulp complex (94, 95).
In the same way as calcium silicate-based cements, calcium aluminate cement (CAC), also coming from civil engineering, where it is used for manufacturing refractory castables (96), started to be used in dentistry, mainly in areas involving pulp therapy. The main difference between Portland cement, the basic component of MTA, and CAC, is the nature of the active phase responsible for the setting process of both cements (96). The main oxides of Portland cement are CaO and SiO2, which are presented in the forms of tricalcium (3CaO SiO2) and dicalcium silicates (2CaO SiO2). The main hydrates formed from the manipulation of the cement with water are amorphous hydrated calcium silicate (C-S-H) and crystalline calcium hydroxide (CH) (96). In CAC, the main oxides are CaO and Al2O3, which are combined in order to form calcium monoaluminate (CA). After manipulation with water, calcium aluminate hydrates and aluminum hydroxide are formed (97), making up the main active phase of the cement during its setting process (96).
CAC is composed of (% by weight) Al2O3 (≥68.0), CaO ( ≤ 31), SiO2 (0.3–0.8), MgO (0.4–0.5), and Fe2O3 (<0.3), and the cement consists of three main phases, responsible for its hydraulic setting process, namely, anhydrous CA phase (CaO.Al2O3), comprising about 40–70% of the cement; phase CA2 (CaO.2Al2O3), which is the second in proportion (>25%), and phase C12A7 (12CaO.7Al2O3), with about 10% of the cement (98).
Three different phenomena occur during the CAC hydration process: ion dissolution, nucleation and precipitation of the hydrated phases (98). When the particles of the cement powder come into contact with the water during manipulation, anhydrous calcium aluminate phases are formed and dissociate, releasing Ca++ and HO− ions (99). As the ion concentration reaches saturation, the dissolution phase ends, initiating the precipitation of calcium aluminate hydrates by nucleation and growth mechanism (98). The precipitation of these particles decreases the concentration of Ca++ ions and hydroxyl at levels below of the saturation, leading to the formation of anhydrous phases, resulting in a continuous dissolution/precipitation process (98). This process prolongs the release of Ca++ ions into the medium (100), and significantly increases the bioactivity of the cement (98, 101).
More recently, the use of materials for pulp protection containing active molecules aims to simulate the behavior of the dentin-pulp complex, allowing events, as repair, regeneration, control of the inflammatory process and deposition of mineralized tissue. Among these materials, the Activa BioActive-Base/Liner, combine the release and recharge of calcium, phosphate and fluoride ions (102) with the physical properties of the resin-based materials (103). These properties are due to its hydrophilicity and different composition (glass particles and a hydrophilic ionic resin matrix) and, according to the manufacturer, the material induces mineralization at the tooth restoration interface with resilient ionic resin matrix. Moreover, Activa showed potential to stimulate biomineralization at the same level as MTA and Biodentine, based on the release of the same amount of Ca++ and OH− ions (supplemented ionic conditions) (104). This hybrid cement may be both chemically or photo-polymerized, resulting in a favorable setting time of about 3 min.
Bioactive Materials for Cementation of Indirect Restorations
Historically, zinc phosphate-based cements are used for fixing dental prostheses. Its powder consists of a basic reagent (zinc oxide, 90%) and a retarding agent (magnesium oxide, 10%), while the liquid contains orthophosphoric acid, water and metal salts (105). An ionic reaction occurs between orthophosphoric acid and zinc oxide after manipulation, forming an amorphous mass with a low pH (106). However, due to its high solubility, an effective link between zinc phosphate cement and dentin is not achieved, leading to the chemical dissolution of the cement, followed by microleakage and an increased risk of recurrent caries (107, 108).
The advent of the adhesive technology allowed partial restorations, as inlays, onlays and veneers, to be bonded to prepared or non-prepared dental tissues using resin-based composite cements (109). After dentin substrate etching, these cements are able to infiltrate within the dentinal tubules and the demineralized collagen fibril network, bonding to the dentin by micro-mechanical retention (109, 110). When adhesive cements containing functional monomers such as 10-methacryloyloxidecyl dihydrogen phosphate (10-MDP) are used, chemical bonding is also achieved due to the strong ionic bonds established between the adhesive and the calcium ions of the hydroxyapatite crystals (110, 111).
Due to the favorable survival rates of partial indirect restorations (112), adhesive cementation techniques have also been used for the fixation of single crowns and fixed dental prostheses (109). However, these techniques are sensitive to moisture, requiring that cementation protocols be performed in an operative field free of saliva and moisture, in order to guarantee the durability of the adhesive interface (113). Thus, adhesive cementation of crowns and fixed dental prostheses in preparations with subgingival margins is a major clinical challenge. The difficulty to control the local moisture and in performing an adequate isolation of the area often leads the clinician to choose a non-adhesive cement (114, 115). Bioactive cements, as GICs, resin-modified glass ionomers cements (RMGICs) and glass ionomers associated with calcium aluminate are interesting alternatives to lute fixed dental protheses in moisture conditions.
Glass Ionomer Cements (GICs)
Glass ionomer cements are cements composed of a powder of fluoroaluminosilacate glass and aqueous solution containing polyalkenoic acids (24). The powder is responsible for the resistance, stiffness and fluoride release, while the liquid modulates the setting time of the cement (116). The setting takes place due to the crosslinking of the polyacrylic acid polymer chains with the calcium and aluminum ions present in the powder (24). Despite being sensitive to moisture when newly placed in the oral cavity, GICs have good mechanical properties after long-term storage in water (117, 118).
These cements have the ability to chemically adhere to dental structures by chelating the carboxyl group of acidic polymer chains and calcium ions (), with the apatite of the enamel and dentin (116). In addition, they release fluoride ions when they come into contact with the dental tissue (119, 120). Hydroxyl ions are replaced by fluorine ions, leading to the formation of fluorohydroxyapatite crystal (FHA). FHA is quite resistant to acid demineralization promoted by bacteria associated with caries, in addition to being chemically more stable than other forms of hydroxyapatite (121). Even after the final setting of the cement, the GIC matrix remains porous, allowing free and constant movement of fluoride ions within the material. Thus, the release of fluoride occurs during the entire useful life of the restoration, direct or indirect, helping it to maintain the marginal seal (122, 123).
Despite their chemical bonding capacity and active fluoride release, the adhesive potential and wear resistance of GICs are lower than the resin composites and resinous cements (124, 125). Pulp reactions and post-operative sensitivity have been reported after the use of GICs (126), although the marginal infiltration rate of these materials is low (127–129). According to several studies, these clinical findings may be related to the pH (≥3) of the initial period of the cement in contact with the dental tissue, resulting in an acidity responsible for pulp sensitivity (107, 126).
Due to their antimicrobial and anticariogenic properties, GICs are indicated mainly for patients with high cariogenic activity (130), and may also be used to seal fissures; temporary sealing of cavities; primary tooth restorations; repairing defective margins for restorations; conservative class I and II restorations without involvement of the marginal ridge; cervical restorations; lining material in deep cavities; filling cores; cementation of intraradicular posts; crowns and fixed dental prostheses, and bonding of orthodontic brackets (130–134).
Resin-Modified Glass Ionomer Cements (RMGICs)
In order to minimize the mechanical limitations of GICs, resinous components such as HEMA and/or bis-GMA, and photosensitive components were added to the GIC (135), resulting in a product with greater wear resistance, better surface finishing and less solubility (136–138). RMGICs are hybrid materials that contain a basic ionizable leachable glass, a water-soluble polymeric acid, organic monomers and an initiator system (38). They aim to combine the mechanical properties of a composite resin with the anticariogenic potential of GICs (139).
The polymerization of RMGICs occurs by the acid-base reaction of conventional GICs and by the photoactivation of resin monomers (135, 136). Photoactivation allows for the formation of additional cross-links, while the acid-base reaction that occurs after about 15–20 min, enabling the maturation process and final strength of the cement. The flexural strength of RMGICs after final setting is higher (about 70 MPa) than the flexural strength of conventional GICs (11 MPa) (140). However, despite its adequate flexural strength, disadvantages, such as greater polymerization contraction and cytotoxicity have been reported (141).
RMGICs have a daily fluoride ion release of 8–15 ppm for the first 24 h, decreasing after 1 week (1–2 ppm) and stabilizing in 10 days to 3 weeks (142–144). The level of fluoride ions released by RMGICs is similar to the conventional GIC (145), and the process of fluoride release by these cements is very complex, being affected by different variables, such as cement composition; powder/liquid ratio; manipulation method; amount of fluoride available for release, type and amount of resin used, and pH of the environment (146–149).
Nanostructurally Integrating Bioceramics Materials
More recently, bioactive cements based on calcium aluminate have been introduced into the market for the cementation of indirect restorations, mainly on vital dental preparations (21, 115, 150). These cements combine the favorable properties of GICs, with the advantages of CAC. The glass ionomer allows adhesion to the tooth structure and low initial pH, while calcium aluminate contributes to the bioactivity-apatite formation, reduced solubility/degradation and stable pH over time (21, 151). Some cements available on the market have up to 50% calcium aluminate in their composition (e.g., Calibra Bio Cement, Dentsply Sirona, USA).
The setting mechanism of these hybrid cements is a combination of the reaction of the glass ionomer and an acid-base reaction that occurs in hydraulic cements. The cement is easy to handle, and a creamy and smooth mixture is obtained right after its manipulation (150, 152). Working and setting times [2–2.5 and 4–5 min, respectively] are comparable to the GICs values (150). A basic pH (~8.5) is reached after 3–4 h after mixing (150, 151) and an oxygen-inhibiting layer is not formed after using this cement, making removal of the cement easier and faster (152).
These cements, which have been called nanostructurally integrating bioceramics (NIB) cements (115), aim to combine principles of adhesion, integration and dentin sealing by the association of different materials (21). Such principles are based on the potential for chemical adhesion, remineralization of the dental structure and formation of hydroxyapatite (HAp), helping to reduce the incidence of secondary caries and post-operative sensitivity, and improving the marginal sealing of the restoration (150, 153). In addition, the introduction of nano-sized glass particles allows the reduction of the setting time and enhance the compressive strength and elastic modulus of the GICs (154, 155).
Hydroxyapatite (HAp) was formed after immersing samples of a calcium aluminate/glass ionomer luting cement in physiological phosphate-buffered saline (PBS) solution. The formation of HAp was observed after 7 days, demonstrating that the cement has dynamic self-sealing properties (156). In this way, areas of marginal degradation that emerge over time could be treated by means of bioactive resealing via hydroxyapatite deposition (21, 156). However, one study noted that HAp, or another phase of calcium phosphate, developed on the surfaces of samples of a calcium aluminate/glass ionomer luting cement did not last for 30 days (115). According to the authors, this finding may be related to the content of phosphorus, 10 times lower compared to PBS, suggesting the need for further follow-up studies.
The microleakage of crowns cemented with calcium aluminate/glass ionomer luting cements was also evaluated in vitro, where the scores were significantly lower than the scores found for conventional GICs (157). Local irritation and induction of genetic mutations were not observed after using this cement (21), and physical properties (compressive strength, film thickness, setting time) and in vitro/in vitro biocompatibility (21) showed favorable results.
A clinical evaluation of indirect restorations cemented with a calcium aluminate/glass ionomer luting cement was performed at different periods of observation [pilot study (158), 1 year (152), 2 years (150), and 3 years (151)]. Thirty-eight crowns and fixed dental prostheses were fabricated and cemented on 31 vital and 7 non-vital abutment teeth. The authors observed the working time and setting time of the cement, the laying characteristics and the ease of removing excess cement. Parameters, such as gingival tissue reaction, post-cementation sensitivity, marginal integration and discoloration were also observed. After 2 years, no secondary caries, marginal discoloration and dentin sensitivity were observed (150). After 3 years, the restorations were still adequate, without gingival inflammation or discoloration, and were classified as excellent in relation to marginal integrity (151), confirming the clinical performance of this cement as a luting agent for crowns and fixed prostheses. Patients also did not report any pain or discomfort in relation to cemented restorations.
Future Trends
The therapeutic approaches involving bioactive materials are able to promote the repair and/or regeneration of the injured tissues through an intimate interaction between these materials and dental substrates. However, such materials still have a number of limitations, which must be overcome through new basic and clinical research over time. It is consolidated in the scientific literature that bioactive proteins present in the dentin substrate interact with several types of cells through their surface receptors. Therefore, the development process of a novel bioactive material must consider the presence of such proteins in the composition of materials in order to activate potential bioactivity. The effect of these proteins may range according to their dosage, activation state, differentiation stage of the cells or interaction with other bioactive molecules and extracellular matrix. Conversely, the development of bioactive materials containing dentinal matrix proteins requires a high-cost production, and further studies envolving the extraction of dentin proteins at low-cost is imperative to produce feasible alternatives in the future.
Conclusions
Due to their ability in inducing repair and regeneration of the dental tissue, biocompatible and bioactive materials, such as MTA-like cements, CAC, GICs, RMGICs, and other bioceramics materials have been routinely indicated for the protection of the dentin-pulp complex. According to their rheological properties, these materials may be used for pulp protection in direct restorations, or for the cementation of indirect restorations. Their bioactivity is one of the most favorable characteristics for the maintenance and preservation of pulp vitality, reinforcing the application of these materials in vital dental preparations.
Author Contributions
MÖ conceived and designed, critically revised, and wrote the paper. LG analyzed the data and drafted the paper. CV analyzed the data and wrote the paper. All authors contributed to the article and approved the submitted version.
Funding
This study was supported by University of Zurich.
Conflict of Interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
References
1. Ericson D, Kidd E, McComb D, Mjör I, and Noack MJ. Minimally invasive dentistry-concepts and techniques in cariology. Oral Health Prev Dent. (2003) 1:59–72.
2. Featherstone JDB, and Doméjean S. Minimal intervention dentistry: Part 1. From “compulsive” restorative dentistry to rational therapeutic strategies. Br Dent J. (2012) 213:441–5. doi: 10.1038/sj.bdj.2012.1007
3. Peters MC, and McLean ME. Minimally invasive operative care. Minimal intervention and concepts for minimally invasive cavity preparations. J Adhes Dent. (2001) 3:7–16.
4. Vailati F, and Carciofo S. Treatment planning of adhesive additive rehabilitations: the progressive wax-up of the three-step technique. Int J Esthet Dent. (2016) 11:356–77.
5. Reis GR, Vilela ALR, Silva FP, Borges MG, de Freitas Santos-Filho PC, and de Sousa Menezes M. Minimally invasive approach in esthetic dentistry: composite resin versus ceramics veneers. Biosci J. (2017) 33:238–46. doi: 10.14393/BJ-v33n1a2017-34617
6. Demarco FF, Collares K, Coelho-de-Souza FH, Correa MB, Cenci MS, Moraes RR, et al. Anterior composite restorations: a systematic review on long-term survival and reasons for failure. Dent Mater. (2015) 31:1214–24. doi: 10.1016/j.dental.2015.07.005
7. Duncan HF, Galler KM, Tomson PL, Simon S, El-Karim I, Kundzina R, et al. European society of endodontology position statement: management of deep caries and the exposed pulp. Int Endod J. (2019) 52:923–34. doi: 10.1111/iej.13080
8. Dong JK, Jin TH, Cho HW, and Oh SC. The esthetics of the smile: a review of some recent studies. Int J Prosthodont. (1999) 12:9–19.
9. Edelhoff D, Liebermann A, Beuer F, Stimmelmayr M, and Güth JF. Minimally invasive treatment options in fixed prosthodontics. Quintessence Int. (2016) 47:207–16. doi: 10.3290/j.qi.a35115
10. Sagsen B, and Aslan B. Effect of bonded restorations on the fracture resistance of root filled teeth. Int Endod J. (2006) 39:900–4. doi: 10.1111/j.1365-2591.2006.01176.x
11. Cobankara FK, Unlu N, Cetin AR, and Ozkan HB. The effect of different restoration techniques on the fracture resistance of endodontically-treated molars. Oper Dent. (2008) 33:526–33. doi: 10.2341/07-132
12. Özcan M, and Volpato CA. Surface conditioning protocol for the adhesion of resin-based materials to glassy matrix ceramics: how to condition and why? J Adhes Dent. (2015) 17:292–3. doi: 10.3290/j.jad.a34590
13. Özcan M, and Volpato CÂ. Surface conditioning and bonding protocol for nanocomposite indirect restorations: how and why? J Adhes Dent. (2016) 18:82. doi: 10.3290/j.jad.a35629
14. Özcan M, and Volpato CAM. Surface conditioning and bonding protocol for polymer-infiltrated ceramic: how and why? J Adhes Dent. (2016) 18:174–5. doi: 10.3290/j.jad.a35979
15. Beier US, Kapferer I, Burtscher D, and Dumfahrt H. Clinical performance of porcelain laminate veneers for up to 20 years. J Prosthet Dent. (2012) 25:79–85.
16. Aslan YU, Uludamar A, and Özkan Y. Clinical performance of pressable glass-ceramic veneers after 5, 10, 15, and 20 years: a retrospective case series study. J Esthet Restor Dent. (2019) 31:415–22. doi: 10.1111/jerd.12496
17. Guess PC, Selz CF, Voulgarakis A, Stampf S, and Stappert CF. Prospective clinical study of press-ceramic overlap and full veneer restorations: 7-year results. Int J Prosthodont. (2014) 27:355–8. doi: 10.11607/ijp.3679
18. Vailati F, Gruetter L, and Belser UC. Adhesively restored anterior maxillary dentitions affected by severe erosion: up to 6-year results of a prospective clinical study. Eur J Esthet Dent. (2013) 8:506–30.
19. Schlichting LH, Maia HP, Baratieri LN, and Magne P. Novel-design ultra-thin CAD/CAM composite resin and ceramic occlusal veneers for the treatment of severe dental erosion. J Prosthet Dent. (2011) 105:217–26. doi: 10.1016/S0022-3913(11)60035-8
20. Prati C, and Gandolfi MG. Calcium silicate bioactive cements: Biological perspectives and clinical applications. Dent Mater. (2015) 31:351–70. doi: 10.1016/j.dental.2015.01.004
21. Jefferies SR. Bioactive and biomimetic restorative materials: a comprehensive review. Part II. J Esthet Restor Dent. (2014) 26:27–39. doi: 10.1111/jerd.12066
22. Miyashita H, Worthington HV, Qualtrough A, and Plasschaert A. Pulp management for caries in adults: maintaining pulp vitality. Coch Database Syst Rev. (2007) 18:CD004484. doi: 10.1002/14651858.CD004484.pub2
23. Smith AJ, Duncan HF, Diogenes A, Simon S, and Cooper PR. Exploiting the bioactive properties of the dentin-pulp complex in regenerative endodontics. J Endod. (2016) 42:47–56. doi: 10.1016/j.joen.2015.10.019
24. Wilson AD, and Kent BE. The glass-ionomer cement, a new translucent dental filling material. J Appl Chem Biotechnol. (2007) 21:313. doi: 10.1002/jctb.5020211101
25. Coutinho E, Cardoso MV, De Munck J, Neves AA, Van Landuyt KL, Poitevin A, et al. Bonding effectiveness and interfacial characterization of a nano-filled resin-modified glass-ionomer. Dent Mater. (2009) 25:1347–57. doi: 10.1016/j.dental.2009.06.004
27. Mjör IA, Sveen OB, and Heyeraas KJ. Pulp-dentin biology in restorative dentistry. Part 1: Normal structure and physiology. Quintessence Int. (2001) 32:427–46.
28. Jontell M, Okiji T, Dahlgren U, and Bergenholtz G. Immune defense mechanisms of the dental pulp. Crit Rev Oral Biol Med. (1998) 9:179–200. doi: 10.1177/10454411980090020301
29. Murray PE, Smith AJ, Windsor LJ, and Mjör IA. Remaining dentine thickness and human pulp responses. Int Endod J. (2003) 36:33–43. doi: 10.1046/j.0143-2885.2003.00609.x
30. Arana-Chavez VE, and Massa LF. Odontoblasts: the cells forming and maintaining dentine. Int J Biochem Cell Biol. (2004) 36:1367–73. doi: 10.1016/j.biocel.2004.01.006
31. Mahmoud SH, Grawish Mel-A, Zaher AR, El-Embaby A, Karrouf GI, and Sobh MA. Influence of selective immunosuppressive drugs on the healing of exposed dogs' dental pulp capped with mineral trioxide aggregate. J Endod. (2010) 36:95–9. doi: 10.1016/j.joen.2009.10.019
32. Zhao S, Sloan AJ, Murray PE, Lumley PJ, and Smith AJ. Ultrastructural localisation of TGF-beta exposure in dentine by chemical treatment. Histochem J. (2000) 32:489–94. doi: 10.1023/A:1004100518245
33. Piva E, Silva AF, and Nör JE. Functionalized scaffolds to control dental pulp stem cell fate. J Endod. (2014) 40:S33–40. doi: 10.1016/j.joen.2014.01.013
34. Souza Costa CA, Hebling J, Scheffel DLS, Soares DG, Basso FG, and Ribeiro AP. Methods to evaluate and strategies to improve the biocompatibility of dental materials and operative techniques. Dent Mater. (2014) 30:769–84. doi: 10.1016/j.dental.2014.04.010
35. Graham L, Cooper PR, Cassidy N, Nor JE, Sloan AJ, and Smith AJ. The effect of calcium hydroxide on solubilisation of bio-active dentine matrix components. Biomaterials. (2006) 27:2865–73. doi: 10.1016/j.biomaterials.2005.12.020
36. Hertz A, and Bruce IJ. Inorganic materials for bone repair or replacement applications. Nanomedicine. (2007) 2:899–918. doi: 10.2217/17435889.2.6.899
37. Turkistani A, Islam S, Shimada Y, Tagami J, and Sadr A. Dental cements: bioactivity, bond strength and demineralization progression around restorations. Am J Dent. (2018) 31:24B−31B.
38. McLean JW, Nicholson JW, and Wilson AD. Proposed nomenclature for glass-ionomer dental cements and related materials. Quintessence Int. (1994) 25:587–9.
39. Torabinejad M, and Ford TRP. Root end filling materials: a review. Dent Traumatol. (1996) 12:161–78. doi: 10.1111/j.1600-9657.1996.tb00510.x
40. Torabinejad M, and Chivian N. Clinical applications of mineral trioxide aggregate. J Endod. (1999) 25:197–205. doi: 10.1016/S0099-2399(99)80142-3
41. Torabinejad M, Parirokh M, and Dummer PMH. Mineral trioxide aggregate and other bioactive endodontic cements: an updated overview - Part II: Other clinical applications and complications. Int Endod J. (2018) 51:284–317. doi: 10.1111/iej.12843
42. Olsson H, Petersson K, and Rohlin M. Formation of a hard tissue barrier after pulp cappings in humans. A systematic review. Int Endod J. (2006) 39:429–42. doi: 10.1111/j.1365-2591.2006.01116.x
43. Tanomaru-Filho M, da Silva GF, Duarte MA, Gonçalves M, and Tanomaru JM. Radiopacity evaluation of root-end filling materials by digitization of images. J Appl Oral Sci. (2008) 16:376–9. doi: 10.1590/S1678-77572008000600004
44. Camilleri J, and Pitt Ford TR. Mineral trioxide aggregate: a review of the constituents and biological properties of the material. Int Endod J. (2006) 39:747–54. doi: 10.1111/j.1365-2591.2006.01135.x
45. Torabinejad M, and Parirokh M. Mineral trioxide aggregate: a comprehensive literature review - art II: Leakage and biocompatibility investigations. J Endod. (2010) 36:190–202. doi: 10.1016/j.joen.2009.09.010
46. Pereira JC, Segala AD, and Costa CA. Human pulpal response to direct pulp capping with an adhesive system. Am J Dent. (2000) 13:139–47.
47. de Souza Costa CA, Lopes do Nascimento AB, Teixeira HM, and Fontana UF. Response of human pulps capped with a self-etching adhesive system. Dent Mater. (2001) 17:230–40. doi: 10.1016/S0109-5641(00)00076-2
48. Accorinte Mde L, Loguercio AD, Reis A, Muench A, and de Araújo VC. Response of human pulp capped with a bonding agent after bleeding control with hemostatic agents. Oper Dent. (2005) 30:147–55.
49. Stanley HR. Pulp capping: conserving the dental pulp - Can it be done? Is it worth it? Oral Surg Oral Med Oral Pathol. (1989) 68:628–39. doi: 10.1016/0030-4220(89)90252-1
50. Torabinejad M, Hong CU, McDonald F, and Pitt Ford TR. Physical and chemical properties of a new root-end filling material. J Endod. (1995) 21:349–53. doi: 10.1016/S0099-2399(06)80967-2
51. Al-Kahtani A, Shostad S, Schifferle R, and Bhambhani S. In-vitro evaluation of microleakage of an orthograde apical plug of mineral trioxide aggregate in permanent teeth with simulated immature apices. J Endod. (2005) 31:117–9. doi: 10.1097/01.don.0000136204.14140.81
52. Vosoughhosseini S, Lotfi M, Shahi S, Baloo H, Mesgariabbasi M, Saghiri MA, et al. Influence of white versus gray mineral trioxide aggregate on inflammatory cells. J Endod. (2008) 34:715–7. doi: 10.1016/j.joen.2008.03.005
53. Simon S, Rilliard F, Berdal A, and Machtou P. The use of mineral trioxide aggregate in one-visit apexification treatment: a prospective study. Int Endod J. (2007) 40:186–97. doi: 10.1111/j.1365-2591.2007.01214.x
54. Hsien HC, Cheng YA, Lee YL, Lan WH, and Lin CP. Repair of perforating internal resorption with mineral trioxide aggregate: a case report. J Endod. (2003) 29:538–9. doi: 10.1097/00004770-200308000-00011
55. Jacobovitz M, and de Lima RK. Treatment of inflammatory internal root resorption with mineral trioxide aggregate: a case report. Int Endod J. (2008) 41:905–12. doi: 10.1111/j.1365-2591.2008.01412.x
56. Menezes R, Bramante CM, Letra A, Carvalho VG, and Garcia RB. Histologic evaluation of pulpotomies in dog using two types of mineral trioxide aggregate and regular and white Portland cements as wound dressings. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. (2004) 98:376–9. doi: 10.1016/j.tripleo.2004.03.008
57. Accorinte Mde L, Holland R, Reis A, Bortoluzzi MC, Murata SS, Dezan E, et al. Evaluation of mineral trioxide aggregate and calcium hydroxide cement as pulp-capping agents in human teeth. J Endod. (2008) 34:1–6. doi: 10.1016/j.joen.2007.09.012
58. Shahravan A, Jalali SP, Torabi M, Haghdoost AA, and Gorjestani H. A histological study of pulp reaction to various water/powder ratios of white mineral trioxide aggregate as pulp-capping material in human teeth: a double-blinded, randomized controlled trial. Int Endod J. (2011) 44:1029–33. doi: 10.1111/j.1365-2591.2011.01916.x
59. Saunders WP. A prospective clinical study of periradicular surgery using mineral trioxide aggregate as a root-end filling. J Endod. (2008) 34:660–5. doi: 10.1016/j.joen.2008.03.002
60. Nair PNR, Duncan HF, Pitt Ford TR, and Luder HU. Histological, ultrastructural and quantitative investigations on the response of healthy human pulps to experimental capping with mineral trioxide aggregate: a randomized controlled trial. Int Endod J. (2009) 42:422–44. doi: 10.1111/j.1365-2591.2009.01558.x
61. Bogen G, and Kuttler S. Mineral trioxide aggregate obturation: a review and case series. J Endod. (2009) 35:777–90. doi: 10.1016/j.joen.2009.03.006
62. Leye Benoist F, Gaye Ndiaye F, Kane AW, Benoist HM, and Farge P. Evaluation of mineral trioxide aggregate (MTA) versus calcium hydroxide cement (Dycal®) in the formation of a dentine bridge: a randomised controlled trial. Int Dent J. (2012) 62:33–9. doi: 10.1111/j.1875-595X.2011.00084.x
63. Belío-Reyes IA, Bucio L, and Cruz-Chavez E. Phase composition of ProRoot mineral trioxide aggregate by x-ray powder diffraction. J Endod. (2009) 35:875–8. doi: 10.1016/j.joen.2009.03.004
64. Asgary S, Parirokh M, Eghbal MJ, and Brink F. Chemical differences between white and gray mineral trioxide aggregate. J Endod. (2005) 31:101–3. doi: 10.1097/01.DON.0000133156.85164.B2
65. Islam I, Chng HK, and Yap AU. Comparison of the physical and mechanical properties of MTA and Portland cement. J Endod. (2006) 32:193–7. doi: 10.1016/j.joen.2005.10.043
66. Dammaschke T, Gerth HU, Züchner H, and Schäfer. Chemical and physical surface and bulk material characterization of white ProRoot MTA and two Portland cements. Dent Mater. (2005) 21:731–8. doi: 10.1016/j.dental.2005.01.019
67. Ozdemir HO, Ozçelik B, Karabucak B, and Cehreli ZC. Calcium ion diffusion from mineral trioxide aggregate through simulated root resorption defects. Dent Traumatol. (2008) 24:70–3. doi: 10.1111/j.1600-9657.2006.00512.x
68. Faraco IM, and Holland R. Response of the pulp of dogs to capping with mineral trioxide aggregate or a calcium hydroxide cement. Dent Traumatol. (2001) 17:163–6. doi: 10.1034/j.1600-9657.2001.170405.x
69. Leites AB, Baldissera EZ, Silva AF, Tarquinio S, Botero T, Piva E, et al. Histologic response and tenascin and fibronectin expression after pulp capping in pig primary teeth with mineral trioxide aggregate or calcium hydroxide. Oper Dent. (2011) 36:448–56. doi: 10.2341/10-321-L
70. Zarrabi MH, Javidi M, Jafarian AH, and Joushan B. Immunohistochemical expression of fibronectin and tenascin in human tooth pulp capped with mineral trioxide aggregate and a novel endodontic cement. J Endod. (2011) 37:1613–8. doi: 10.1016/j.joen.2011.08.021
71. Eskandarizadeh A, Shahpasandzadeh MH, Shahpasandzadeh M, Torabi M, and Parirokh M. A comparative study on dental pulp response to calcium hydroxide, white and grey mineral trioxide aggregate as pulp capping agents. J Conserv Dent. (2011) 14:351–5. doi: 10.4103/0972-0707.87196
72. Ford TR, Torabinejad M, Abedi HR, Bakland LK, and Kariyawasam SP. Using mineral trioxide aggregate as a pulp-capping material. J Am Dent Assoc. (1996) 127:1491–4. doi: 10.14219/jada.archive.1996.0058
73. Camilleri J. Characterization of hydration products of mineral trioxide aggregate. Int Endod J. (2008) 41:408–17. doi: 10.1111/j.1365-2591.2007.01370.x
74. Andelin WE, Shabahang S, Wright K, and Torabinejad M. Identification of hard tissue after experimental pulp capping using dentin sialoprotein (DSP) as a marker. J Endod. (2003) 29:646–50. doi: 10.1097/00004770-200310000-00008
75. Min KS, Park HJ, Lee SK, Park SH, Hong CU, Kim HW, et al. Effect of mineral trioxide aggregate on dentin bridge formation and expression of dentin sialoprotein and heme oxygenase-1 in human dental pulp. J Endod. (2008) 34:666–70. doi: 10.1016/j.joen.2008.03.009
76. Garcia LFR, Aguilar FG, Sabino MG, Rossetto HL, and Pires-de-Souza FC. Mechanical and microstructural characterisation of new calcium aluminate cement (EndoBinder). Adv Appl Ceram. (2011) 110:469–75. doi: 10.1179/1743676111Y.0000000049
77. Dammaschke T, Wolff P, Sagheri D, Stratmann U, and Schäfer E. Mineral trioxide aggregate for direct pulp capping: a histologic comparison with calcium hydroxide in rat molars. Quintessence Int. (2010) 41:e20–30.
78. Garcia Lda F, Chinelatti MA, Rossetto HL, and Pires-de-Souza Fde C. Solubility and disintegration of new calcium aluminate cement (EndoBinder) containing different radiopacifying agents. J Endod. (2014) 40:261–5. doi: 10.1016/j.joen.2013.07.010
79. Ber BS, Hatton JF, and Stewart GP. Chemical modification of ProRoot MTA to improve handling characteristics and decrease setting time. J Endod. (2007) 33:1231–4. doi: 10.1016/j.joen.2007.06.012
80. Camilleri J. Evaluation of the physical properties of an endodontic Portland cement incorporating alternative radiopacifiers used as root-end filling material. Int Endod J. (2010) 43:231–40. doi: 10.1111/j.1365-2591.2009.01670.x
81. Jacobovitz M, Vianna ME, Pandolfelli VC, Oliveira IR, Rossetto HL, and Gomes BP. Root canal filling with cements based on mineral aggregates: an in vitro analysis of bacterial microleakage. Oral Surg Oral Med Oral Pathol Oral Radiol Endodont. (2009) 108:140–4. doi: 10.1016/j.tripleo.2009.03.013
82. Duarte MA, De Oliveira Demarchi AC, Yamashita JC, Kuga MC, and De Campos Fraga S. Arsenic release provided by MTA and Portland cement. Oral Surg Oral Med Oral Pathol Oral Radiol Endodontol. (2005) 99:648–50. doi: 10.1016/j.tripleo.2004.09.015
83. Monteiro Bramante C, Demarchi AC, de Moraes IG, Bernadineli N, Garcia RB, Spångberg LS, et al. Presence of arsenic in different types of MTA and white and gray Portland cement. Oral Surg Oral Med Oral Pathol Oral Radiol Endodont. (2008) 106:909–13. doi: 10.1016/j.tripleo.2008.07.018
84. Schembri M, Peplow G, and Camilleri J. Analyses of heavy metals in mineral trioxide aggregate and portland cement. J Endod. (2010) 36:1210–5. doi: 10.1016/j.joen.2010.02.011
85. International Standards Organization. Water-Based Cements - Part 1: Powder/Liquid Acid-Base Cements. Geneva (2001). p. 9917–1.
86. Loxley EC, Liewehr FR, Buxton TB, and McPherson JC. The effect of various intracanal oxidizing agents on the push-out strength of various perforation repair materials. Oral Surg Oral Med Oral Pathol Oral Radiol Endodont. (2003) 95:490–4. doi: 10.1067/moe.2003.32
87. Garcia LDFR, Rossetto HL, and Pires-de-Souza FCP. Shear bond strength of novel calcium aluminate-based cement (EndoBinder) to root dentine. Eur J Dent. (2014) 08:498–503. doi: 10.4103/1305-7456.143632
88. Bortoluzzi EA, Broon NJ, Bramante CM, Garcia RB, de Moraes IG, and Bernardineli N. Sealing ability of MTA and radiopaque portland cement with or without calcium chloride for root-end filling. J Endod. (2006) 32:897–900. doi: 10.1016/j.joen.2006.04.006
89. Parirokh M, Torabinejad M, and Dummer PMH. Mineral trioxide aggregate and other bioactive endodontic cements: an updated overview - Part I: Vital pulp therapy. Int Endod J. (2018) 51:177–205. doi: 10.1111/iej.12841
90. Rajasekharan S, Vercruysse C, Martens L, and Verbeeck R. Effect of exposed surface area, volume and environmental pH on the calcium ion release of three commercially available tricalcium silicate based dental cements. Materials. (2018) 11:123. doi: 10.3390/ma11010123
91. Leal F, De-Deus G, Brandão C, Luna AS, Fidel SR, and Souza EM. Comparison of the root-end seal provided by bioceramic repair cements and white MTA. Int Endod J. (2011) 44:662–8. doi: 10.1111/j.1365-2591.2011.01871.x
92. Grech L, Mallia B, and Camilleri J. Characterization of set intermediate restorative material, Biodentine, bioaggregate and a prototype calcium silicate cement for use as root-end filling materials. Int Endod J. (2013) 46:632–41. doi: 10.1111/iej.12039
93. Stefaneli Marques JH, Silva-Sousa YTC, Rached-Júnior FJA, Macedo LMD, Mazzi-Chaves JF, Camilleri J, et al. Push-out bond strength of different tricalcium silicate-based filling materials to root dentin. Braz Oral Res. (2018) 32:e18. doi: 10.1590/1807-3107bor-2018.vol32.0018
94. Brizuela C, Ormeño A, Cabrera C, Cabezas R, Silva CI, Ramírez V, et al. Direct pulp capping with calcium hydroxide, mineral trioxide aggregate, and Biodentine in permanent young teeth with caries: a randomized clinical trial. J Endod. (2017) 43:1776–80. doi: 10.1016/j.joen.2017.06.031
95. Sanz JL, Rodríguez-Lozano FJ, Llena C, Sauro S, and Forner L. Bioactivity of bioceramic materials used in the dentin-pulp complex therapy: a systematic review. Materials. (2019) 12:1015. doi: 10.3390/ma12071015
96. Scrivener KL, Cabiron JL, and Letourneux R. High-performance concretes from calcium aluminate cements. Cem Concr Res. (1999) 29:1215–23. doi: 10.1016/S0008-8846(99)00103-9
97. Alt C, Wong L, and Parr C. Measuring castable rheology by exothermic profile. Refract Appl News. (2003) 2:15–8.
98. Oliveira IR, Pandolfelli VC, and Jacobovitz M. Chemical, physical and mechanical properties of a novel calcium aluminate endodontic cement. Int Endod J. (2010) 43:1069–76. doi: 10.1111/j.1365-2591.2010.01770.x
99. Luz AP, and Pandolfelli VC. CaCO3 addition effect on the hydration and mechanical strength evolution of calcium aluminate cement for endodontic applications. Ceram Int. (2012) 38:1417–25. doi: 10.1016/j.ceramint.2011.09.021
100. Pires-de-Souza F de CP, Moraes PC, Garcia Lda F, Aguilar FG, and Watanabe E. Evaluation of pH, calcium ion release and antimicrobial activity of a new calcium aluminate cement. Braz Oral Res. (2013) 27:324–30. doi: 10.1590/S1806-83242013000400006
101. Garcia L da FR, Huck C, Scardueli CR, and de Souza Costa CA. Repair of bone defects filled with new calcium aluminate cement (EndoBinder). J Endod. (2015) 41:864–70. doi: 10.1016/j.joen.2014.12.029
102. Abou ElReash A, Hamama H, Abdo W, Wu Q, Zaen El-Din A, and Xiaoli X. Biocompatibility of new bioactive resin composite versus calcium silicate cements: an animal study. BMC Oral Health. (2019) 19:194. doi: 10.1186/s12903-019-0887-1
103. Pameijer CH, Garcia-Godoy F, Morrow BR, and Jefferies SR. Flexural strength and flexural fatigue properties of resin-modified glass ionomers. J Clin Dent. (2015) 26:23–7.
104. Jun SK, Lee JH, and Lee HH. The biomineralization of a bioactive glass-incorporated light-curable pulp capping material using human dental pulp stem cells. Biomed Res Int. (2017) 2017:2495282. doi: 10.1155/2017/2495282
105. Servais GE, and Cartz L. Structure of zinc phosphate dental cement. J Dent Res. (1971) 50:613–20. doi: 10.1177/00220345710500031601
106. Fakiha ZA, Mueninghoff LA, and Leinfelder KF. Rapid mixing of zinc phosphate cement for fixed prosthodontic procedures. J Prosthet Dent. (1992) 67:52–8. doi: 10.1016/0022-3913(92)90049-G
107. Eisenburger M. Acidic solubility of luting cements. J Dent. (2003) 31:137–42. doi: 10.1016/S0300-5712(03)00002-2
108. Karkera R, Raj AP, Isaac L, Mustafa M, Reddy RN, and Thomas M. Comparison of the solubility of conventional luting cements with that of the polyacid modified composite luting cement and resin-modified glass ionomer cement. J Contemp Dent Pract. (2016) 17:1016–21. doi: 10.5005/jp-journals-10024-1974
109. Salz U, Zimmermann J, and Salzer T. Self-curing, self-etching adhesive cement systems. J Adhes Dent. (2005) 7:7–17.
110. Van Meerbeek B, Yoshihara K, Van Landuyt K, Yoshida Y, and Peumans M. From buonocore's pioneering acid-etch technique to self-adhering restoratives. A status perspective of rapidly advancing dental adhesive technology. J Adhes Dent. (2020) 22:7–34. doi: 10.3290/j.jad.a43994
111. Scotti N, Bergantin E, Tempesta R, Turco G, Breschi L, Farina E, et al. Influence of dentin pretreatment with synthetic hydroxyapatite application on the bond strength of fiber posts luted with 10-methacryloyloxydecyl dihydrogen phosphate-containing luting systems. Eur J Oral Sci. (2016) 124:504–9. doi: 10.1111/eos.12289
112. Morimoto S, Rebello de Sampaio FB, Braga MM, Sesma N, and Özcan M. Survival rate of resin and ceramic inlays, onlays, and overlays. J Dent Res. (2016) 95:985–94. doi: 10.1177/0022034516652848
113. Tian T, Tsoi JK, Matinlinna JP, and Burrow MF. Aspects of bonding between resin luting cements and glass ceramic materials. Dent Mater. (2014) 30:147–62. doi: 10.1016/j.dental.2014.01.017
114. Blatz MB, Vonderheide M, and Conejo J. The effect of resin bonding on long-term success of high-strength ceramics. J Dent Res. (2018) 97:132–9. doi: 10.1177/0022034517729134
115. Dandoulaki C, Rigos AE, Kontonasaki E, Karagiannis V, Kokoti M, Theodorou GS, et al. In vitro evaluation of the shear bond strength and bioactivity of a bioceramic cement for bonding monolithic zirconia. J Prosthet Dent. (2019) 122:167.e1–10. doi: 10.1016/j.prosdent.2019.04.016
116. Davidson CL. Advances in glass-ionomer cements. J Appl Oral Sci. (2006) 14:3–9. doi: 10.1590/S1678-77572006000700002
117. Ellakuria J, Triana R, Mínguez N, Soler I, Ibaseta G, Maza J, et al. Effect of one-year water storage on the surface microhardness of resin-modified versus conventional glass-ionomer cements. Dent Mater. (2003) 19:286–90. doi: 10.1016/S0109-5641(02)00042-8
118. Zainuddin N, Karpukhina N, Hill RG, and Law RV. A long-term study on the setting reaction of glass ionomer cements by 27Al MAS-NMR spectroscopy. Dent Mater. (2009) 25:290–5. doi: 10.1016/j.dental.2008.07.008
119. Skrtic D, Antonucci JM, Eanes ED, Eichmiller FC, and Schumacher GE. Physicochemical evaluation of bioactive polymeric composites based on hybrid amorphous calcium phosphates. J Biomed Mater Res. (2000) 53:381–91. doi: 10.1002/1097-4636(2000)53:4<381::AID-JBM12>3.0.CO;2-H
120. Glasspoole EA, Erickson RL, and Davidson CL. A fluoride-releasing composite for dental applications. Dent Mater. (2001) 17:127–33. doi: 10.1016/S0109-5641(00)00051-8
121. ten Cate JM. Contemporary perspective on the use of fluoride products in caries prevention. Br Dent J. (2013) 214:161–7. doi: 10.1038/sj.bdj.2013.162
122. Vermeersch G, Leloup G, and Vreven J. Fluoride release from glass-ionomer cements, compomers and resin composites. J Oral Rehabil. (2001) 28:26–32. doi: 10.1046/j.1365-2842.2001.00635.x
123. Asmussen E, and Peutzfeldt A. Long-term fluoride release from a glass ionomer cement, a compomer, and from experimental resin composites. Acta Odontol Scand. (2002) 60:93–7. doi: 10.1080/000163502753509482
124. Momoi Y, Hirosaki K, Kohno A, and McCabe JF. Flexural properties of resin-modified “hybrid” glass-ionomers in comparison with conventional acid-base glass-ionomers. Dent Mater J. (1995) 14:109–19. doi: 10.4012/dmj.14.109
125. de Gee AJ, van Duinen RN, Werner A, and Davidson CL. Early and long-term wear of conventional and resin-modified glass ionomers. J Dent Res. (1996) 75:1613–9. doi: 10.1177/00220345960750081401
126. Jokstad A, and Mjör IA. Ten years' clinical evaluation of three luting cements. J Dent. (1996) 24:309–15. doi: 10.1016/0300-5712(95)00076-3
127. Yan Z, Sidhu SK, Carrick TE, and McCabe JF. Response to thermal stimuli of glass ionomer cements. Dent Mater. (2007) 23:597–600. doi: 10.1016/j.dental.2006.05.001
128. Feilzer AJ, De Gee AJ, and Davidson CL. Curing contraction of composites and glass-ionomer cements. J Prosthet Dent. (1988) 59:297–300. doi: 10.1016/0022-3913(88)90176-X
129. Croll TP, Bar-Zion Y, Segura A, and Donly KJ. Clinical performance of resin-modified glass ionomer cement restorations in primary teeth. J Am Dent Assoc. (2001) 132:1110–6. doi: 10.14219/jada.archive.2001.0336
130. Chau NP, Pandit S, Jung JE, Cai JN, Yi HK, and Jeon JG. Long-term anti-cariogenic biofilm activity of glass ionomers related to fluoride release. J Dent. (2016) 47:34–40. doi: 10.1016/j.jdent.2016.02.006
131. de Amorim RG, Leal SC, and Frencken JE. Survival of atraumatic restorative treatment (ART) sealants and restorations: a meta-analysis. Clin Oral Investig. (2012) 16:429–41. doi: 10.1007/s00784-011-0513-3
132. Pascotto RC, Navarro MF, Capelozza Filho L, and Cury JA. In vivo effect of a resin-modified glass ionomer cement on enamel demineralization around orthodontic brackets. Am J Orthod Dentofac Orthop. (2004) 125:36–41. doi: 10.1016/S0889-5406(03)00571-7
133. Kampanas NS, and Antoniadou M. Glass ionomer cements for the restoration of non-carious cervical lesions in the geriatric patient. J Funct Biomater. (2018) 9:42. doi: 10.3390/jfb9030042
134. Weerheijm KL, de Soet JJ, van Amerongen WE, and de Graaff J. The effect of glass-ionomer cement on carious dentine: an in vivo study. Caries Res. (1993) 27:417–3. doi: 10.1159/000261573
135. Sidhu SK, and Watson TF. Resin-modified glass ionomer materials. A status report for the American Journal of Dentistry. Am J Dent. (1995) 8:59–67.
136. Liporoni P, Paulillo LAMS, Cury JA, Dos Santos Dias CT, and Paradella TC. Surface finishing of resin-modified glass ionomer. Gen Dent. (2003) 51:541–3.
137. Imataki R, Shinonaga Y, Nishimura T, Abe Y, and Arita K. Mechanical and functional properties of a novel apatite-ionomer cement for prevention and remineralization of dental caries. Materials. (2019) 12:3998. doi: 10.3390/ma12233998
138. Hung CY, Yu JH, Su LW, Uan JY, Chen YC, and Lin DJ. Shear bonding strength and thermal cycling effect of fluoride releasable/rechargeable orthodontic adhesive resins containing LiAl-F layered double hydroxide (LDH) filler. Materials. (2019) 12:3204. doi: 10.3390/ma12193204
139. McCabe JF. Resin-modified glass-ionomers. Biomaterials. (1998) 19:521–7. doi: 10.1016/S0142-9612(98)00132-X
140. Xie D, Brantley WA, Culbertson BM, and Wang G. Mechanical properties and microstructures of glass-ionomer cements. Dent Mater. (2000) 16:129–38. doi: 10.1016/S0109-5641(99)00093-7
141. Xie D, Chung ID, Wu W, and Mays J. Synthesis and evaluation of HEMA-free glass-ionomer cements for dental applications. Dent Mater. (2004) 20:470–8. doi: 10.1016/j.dental.2003.07.003
142. Gao W, Smales RJ, and Gale MS. Fluoride release/uptake from newer glass-ionomer cements used with the ART approach. Am J Dent. (2000) 13:201–4.
143. Yap AU, Tham SY, Zhu LY, and Lee HK. Short-term fluoride release from various aesthetic restorative materials. Oper Dent. (2002) 27:259–65.
144. Attar N, and Turgut MD. Fluoride release and uptake capacities of fluoride-releasing restorative materials. Oper Dent. (2003) 28:395–402.
145. Robertello FJ, Coffey JP, Lynde TA, and King P. Fluoride release of glass ionomer-based luting cements in vitro. J Prosthet Dent. (1999) 82:172–6. doi: 10.1016/S0022-3913(99)70152-6
146. Musa A, Pearson GJ, and Gelbier M. In vitro investigation of fluoride ion release from four resin-modified glass polyalkenoate cements. Biomaterials. (1996) 17:1019–23. doi: 10.1016/0142-9612(96)84678-3
147. Smales RJ, and Gao W. In vitro caries inhibition at the enamel margins of glass ionomer restoratives developed for the ART approach. J Dent. (2000) 28:249–56. doi: 10.1016/S0300-5712(99)00071-8
148. De Witte AM, De Maeyer EA, Verbeeck RM, and Martens LC. Fluoride release profiles of mature restorative glass ionomer cements after fluoride application. Biomaterials. (2000) 21:475–82. doi: 10.1016/S0142-9612(99)00188-X
149. Tjandrawinata R, Irie M, and Suzuki K. Marginal gap formation and fluoride release of resin-modified glass-ionomer cement: effect of silanized spherical silica filler addition. Dent Mater J. (2004) 23:305–13. doi: 10.4012/dmj.23.305
150. Jefferies SR, Pameijer CH, Appleby DC, Boston D, Galbraith C, Lööf J, et al. Prospective observation of a new bioactive luting cement: 2-year follow-up. J Prosthodont. (2012) 21:33–41. doi: 10.1111/j.1532-849X.2011.00790.x
151. Jefferies SR, Pameijer CH, Appleby DC, Boston D, and Lööf J. A bioactive dental luting cement. Its retentive properties and 3-year clinical findings. Compend Contin Educ Dent. (2013) 34:2–9.
152. Jefferies SR, Pameijer CH, Appleby D, Boston D, Lööf J, and Glantz PO. One year clinical performance and post-operative sensitivity of a bioactive dental luting cement - a prospective clinical study. Swed Dent J. (2009) 33:193–9.
153. Engqvist H, Schultz-Walz JE, Loof J, Botton GA, Mayer D, Phaneuf MW, et al. Chemical and biological integration of a mouldable bioactive ceramic material capable of forming apatite in vivo in teeth. Biomaterials. (2004) 25:2781–7. doi: 10.1016/j.biomaterials.2003.09.053
154. De Caluwé T, Vercruysse CW, Fraeyman S, and Verbeeck RM. The influence of particle size and fluorine content of aluminosilicate glass on the glass ionomer cement properties. Dent Mater. (2014) 30:1029–38. doi: 10.1016/j.dental.2014.06.003
155. Moshaverinia A, Ansari S, Moshaverinia M, Roohpour N, Darr JA, and Rehman I. Effects of incorporation of hydroxyapatite and fluoroapatite nanobioceramics into conventional glass ionomer cements (GIC). Acta Biomater. (2008) 4:432–40. doi: 10.1016/j.actbio.2007.07.011
156. Lööf J, Svahn F, Jarmar T, Engqvist H, and Pameijer CH. A comparative study of the bioactivity of three materials for dental applications. Dent Mater. (2008) 24:653–9. doi: 10.1016/j.dental.2007.06.028
157. Pameijer CH, Zmener O, Serrano SA, and Garcia-Godoy F. Sealing properties of a calcium aluminate luting agent. Am J Dent. (2010) 23:121–4.
Keywords: bioactive materials, biomaterials, resin-based luting cements, adhesion, pulp capping agents
Citation: Özcan M, Garcia LFR and Volpato CAM (2021) Bioactive Materials for Direct and Indirect Restorations: Concepts and Applications. Front. Dent. Med. 2:647267. doi: 10.3389/fdmed.2021.647267
Received: 07 January 2021; Accepted: 20 May 2021;
Published: 17 June 2021.
Edited by:
Akikazu Shinya, Nippon Dental University, JapanReviewed by:
Ayako Washio, Kyushu Dental University, JapanSharukh S. Khajotia, University of Oklahoma Health Sciences Center, United States
Igor Robert Blum, King's College London, United Kingdom
Copyright © 2021 Özcan, Garcia and Volpato. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Mutlu Özcan, mutluozcan@hotmail.com