Since 1970s, a lot of effort has been devoted toward the development of dental implants. Dental implants are nowadays an indispensable part of clinical dentistry. The global dental implant market is expected to reach $13 billion in 2023. Although, the survival rate of dental implants has been reported above 90%, compromised bone conditions promote implant failure and endanger the current high success rates. The main concern is related to the aging population. Diabetes, osteoporosis, obesity and use of drugs are all medical conditions, which can hamper bone healing around dental implants. In view of this, research toward developing better methods of enhancing implant osseointegration have to be continued, especially in the presence of impaired bone condition. In this paper, the current changes and their future perspective are discussed.

Circadian rhythms are approximately 24-h cell-autonomous cycles driven by transcription and translation feedback loops of a set of core circadian clock genes, such as circadian locomoter output cycles kaput (Clock), brain and muscle arnt-like protein-1 (Bmal1), period (Per), and cryptochrome (Cry). The genetic clockwork of these genes produces circadian rhythms in cells throughout the body, including the craniofacial region. During development, dento-alveolar bone tissue formation could be regulated by site-specific circadian patterns. Studies using knockout mice and mesenchymal stem cells (MSCs) to evaluate clock genes revealed regulatory effects of clock function on bone remodeling, suggesting involvement of the circadian clockwork in osseointegration of titanium implants. Indeed, rough surface titanium modulates specific clock genes, Neuronal PAS domain protein-2 (Npas2) and Per, in MSCs to facilitate osseointegration. Further understanding of the bone clock machinery associated with biomaterial surface properties might improve preoperative diagnosis for dental implant treatments.

The molecular precursor method is an easy and simple method for coating thin carbonate-containing apatite (CA) films onto titanium surfaces. A molecular precursor solution containing ethanol, calcium-EDTA complex, and phosphate salt was dropped onto a titanium surface and then heated at 600°C for 2 h. An adherent thin CA coating was achieved. Animal implantation experiments showed that CA-coated implants had significantly higher bone-to-implant values than non-coated implants (p<0.05). The molecular precursor method was also used to coat three-dimensional titanium webs (TWs). Thin CA films could be coated inside the center area, as well as the surface of the TW, with excellent bone formation inside the CA-coated TW. Furthermore, the molecular precursor method was used to coat partially stabilized zirconia with CA. Better bone response was observed for CA-coated zirconia. From this, it is concluded that the molecular precursor method is useful for producing thin CA coatings on implant materials.

Octacalcium phosphate (OCP) is a material that can be converted to hydroxyapatite (HA) under physiological environments and is considered a mineral precursor to bone apatite crystals. The structure of OCP consists of apatite layers stacked alternately with hydrated layers, and closely resembles the structure of HA. The performance of OCP as a bone substitute differs from that of HA materials in terms of their osteoconductivity and biodegradability. OCP manifests a cellular phagocytic response through osteoclast-like cells similar to that exhibited by the biodegradable material β-tricalcium phosphate (β-TCP). The use of OCP for human cranial bone defects involves using its granule or composite form with one of the natural polymers, viz., the reconstituted collagen. This review article discusses the differences and similarities in these calcium phosphate (Ca-P)-based materials from the viewpoint of the structure and their material chemistry, and attempts to elucidate why Ca-P materials, particularly OCP, display unique osteoconductive property.

This study was to prepare and screen a novel root canal sealing agent modified by polyhexamethylene biguanide (PHMB) that was in accordance with the ISO 6876:2001 standard and to study its physical and antimicrobial properties. The modified sealers were produced by mixing a certain amount of zinc oxide with eugenol containing different concentrations of PHMB (0.05, 0.1, 0.2, 0.4, 0.6 and 0.8%) at a ratio of 1:1 (w/v). The setting time, flow, film thickness, solubility and dimensional change after solidifying were assessed to screen out the modified sealing agents that the physical properties met the mentioned standards. The modified direct contact test (DCT) was used to evaluate the antimicrobial activity against Enterococcus faecalis. The results suggested that when the concentrations of PHMB were 0.05, 0.1 and 0.2%, the modified root canal sealers showed the best performance in physical and antimicrobial properties.

The aim of this study was to evaluate the effects of the kinds of veneering ceramics and veneering methods on the debonding/crack initiation and 3-point flexural strengths in bilayered zirconia core and veneering ceramic composites. Zirconia block was used as core material, and Cerabien ZR and Lava Ceram for the layering technique and IPS e.max ZirPress and Amber LiSi-POZ for the heat pressing technique were used as veneering materials. Both debonding/crack initiation and 3-point flexural strengths of bilayered zirconia core and veneering ceramic composites as well as the bi-axial flexural strengths of veneering materials, were higher when using heat pressing technique than layering technique. It was identified that not only bonding strength between zirconia core and veneering materials but also the intrinsic strength of veneering ceramic should be high to prevent chipping of veneering material.

Success of dental implant is associated with the surface modification. To evaluate whether the selective laser melting-superfinished titanium (Ti6Al4V) implants have a better early osseointegration in type 2 diabetes mellitus rats compare to pure titanium implants and acid-etched treated (SLA) implants, we designed a screw-shaped implant which was batch-fabricated by selective laser melting (SLM). Then the implants were randomly inserted in tibias of rats with type 2 diabetes mellitus (T2DM). After surgical operation, the SLM group showed the best bone formation around the implants with the highest bone–implant contact rate among the three groups.Removal torque tests and histomorphological analyses all revealed a stronger connection between the bone because its good surface characteristics and mechanical properties. SLM implant may be a novel implant for T2DM patients.

This study evaluated the osteogenic differentiation of human dental pulp stem cells in response to substances released by the pulp capping agents, Biodentine (BD), mineral trioxide aggregate (MTA) and two-paste calcium hydroxide cement (CHC), along with their physicochemical characteristics. The dimensional stability test showed that of the materials studied, only BD met the standards recommended by the International Organization for Standardization (ISO) for pulp capping materials and thus can be used safely. In the chemical tests, BD was the most stable material. In the Alizarin red S test, BD formed the higher amount of mineralized nodules in the mineralizing medium and also formed mineralized nodules in a non-mineralizing medium. BD releases substances that can significantly induce formation of the human dental pulp stem cell-mineralized extracellular matrix, with physicochemical characteristics that are more conducive to pulp repair than those of MTA and CHC.

The goal of non-surgical treatment is to obtain an access to the root canal system in order to remove the previous filling. We analized 45 human single-canal roots, mesial roots of mandibular molars and distal roots of maxillary molars without previous endodontic treatment, fractures, resorptive defects or open apices. We evaluated the time required to retreat root canals obturated by a new generation of GuttaCore, GuttaCore Pink^®, compared to Thermafil^® and Warm Vertically compacted gutta-percha, by using ProTaper^® Retreatment and ProTaper^® Universal. Moreover, a quantitative analysis of residual filling material in the canal after retreating and shaping was performed. The Kruskal-Wallis and Dunn’s test were used to determine significant differences. Our data show that the GuttaCore Pink^® can be removed from the root canal system in a lower amount of time compared to the Thermafil^®. Concerning the amount of residual filling material, there are no significant differences between the three groups.

This study evaluated the effect of different adhesive protocols on the shear bond strength (SBS) of bulk-fill resin composite repaired with bulk-fill or conventional composite. Cylindrical bulk-fill resin composite specimens were prepared and allocated into groups according to the bonding strategy: no treatment, Silane+Scotch Bond Multipurpose (S+SBMP), Tetric N Bond Universal, and Single Bond Universal. Following bonding strategy, bulk-fill or conventional composite buildups were performed. After 24 h of storage in distilled water at 37°C, shear force was applied to the interface using a universal testing machine. The data were analyzed by two-way ANOVA and Tukey test (α=0.05). SBS was influenced by the bonding strategy and the composite used (p<0.001). Irrespective of the composite used, the group S+SBMP yielded the highest SBS values (p<0.001). Repair bond strength of bulk-fill composites can be improved by using a silane coupling agent followed by a hydrophobic resin.

The study aimed to investigate the effects of surface treatments, including plasma, on the peel bond strength between two maxillofacial silicones and two resins with and without thermocycling. Forty-eight experimental groups (n=10) were generated incorporating the two different resins (auto-polymerizing acrylic resin and light-curing urethane dimethacrylate resin [AR and LR, respectively]), two different silicones (M511 and Z004), aging (thermocycled/no thermocycling), and six different surface treatments, including polishing, grinding, polishing+argon plasma, polishing+oxygen plasma, grinding+argon plasma, and grinding+oxygen plasma. Surface topography of a specimen from each surface treatment group was examined by atomic force microscopy. After surface treatments, silicones were polymerized. The peel bond strength values of the control and thermocycled groups were determined. Atomic force microscopy showed that surface topographies of the ground specimens were irregular. Polished specimens showed higher peel bond strength than ground specimens. Plasma application appeared to have improved the bond strength between the resins and silicones.

This study aimed to evaluate the influence of a post-machining thermal treatment on canal-centering ability and torque/force generation of reciprocating nickel-titanium instruments. Simulated J-shaped resin canals were prepared with reciprocating instruments sharing identical geometric architecture and with/without post-machining thermal treatment (Reciproc Blue/Reciproc, VDW, Munich, Germany). Using an original automated root canal instrumentation and torque/force analyzing device, files were operated in a combination of reciprocation and up-and-down motion, and torque/force values were monitored. Canal-centering ratios were measured after superimposition of pre- and post-instrumentation images. Compared with Reciproc, Reciproc Blue showed a significantly lower canal-centering ratio (i.e., less deviation; p<0.05) at 0–1 mm from the apex and generated a significantly smaller upward maximum vertical force (p<0.05). Under standardized conditions using the automated device, Reciproc Blue showed better canal-centering ability and reduced screw-in forces than Reciproc, indicating that the post-machining thermal treatment confers superior performance to reciprocating nickel-titanium instruments.

The artifact volume generated in magnetic resonance (MR) images was quantitatively evaluated to investigate how artifact behavior correlates to the magnetic susceptibility and volume of an implanted metal device. For this, a new low-magnetic-susceptibility Zr-14Nb alloy was compared with two conventional dental alloys, Ti-6Al-7Nb alloy and Co-Cr-Mo alloy, using spherical specimens of each alloy prepared with four different diameters. Then, MR images were recorded under fast spin echo and gradient echo conditions, from which the artifact volume was measured. The artifact volume decreased with the magnetic susceptibility, volume, and mass of the specimens, and significant linear correlations were observed. The artifact volume can be estimated by the equations presented here; nevertheless, further studies are necessary to interpret the influence of some important factors (e.g., imaging conditions, shape, and orientation) to predict the artifact volume more precisely.

The aim of this paper is to study changes in the Ag-Pd-Cu-Au alloy surfaces by alumina air-abrasion process and effect of those changes on the adhesive bonding characteristic. Surface roughness, surface composition and chemical state of the alumina air-abraded alloys were analyzed by a confocal laser scanning microscope, an energy dispersive X-ray spectroscopy and an X-ray photoelectron spectroscopy. The results showed that the alumina air-abrasion changed the alloy surface by mechanical roughening, alumina remain and copper oxidation. Effect of the changes in the alloy surface on the adhesive bonding characteristic was examined by using a methyl methacrylate/tri-n-butylborane derivative (MMA/TBB) resin cement with the 10-methacryloyloxydecyl dihydrogen phosphate (MDP) contained primer. The shear bond strength test results indicated that the surface oxidation by the abrasion is the main contributor that improved the adhesive bonding rather than other effects such as mechanical roughening or alumina remain.

The dentin–enamel junction (DEJ), which is the interface between the outer tooth enamel and the underlying dentin, has unique biomechanical properties that allow the two different materials to function together without fracture. The aim of this study was to investigate the anisotropic ultimate tensile strength of the DEJ. Twenty dumbbell-shaped samples were prepared from 10 extracted human molar teeth for tensile strength testing. The maximum tensile forces at fracture were measured in the direction parallel (10 samples) and perpendicular (10 samples) to the DEJ. The mean tensile strength of the samples was significantly higher under parallel forces (30.9±3.3 MPa) than under perpendicular forces (20.6±4.8 MPa; p<0.05). Our findings confirm the structural anisotropy of the DEJ.

Streptococcus mutans (S. mutans) has been proved to crucial cariogenic pathogens. Antisense vicR RNA reduced the transcription of virulence genes and lead to a reduction in biofilm formation. In the current study, a graphene-oxide plasmid transformation system was developed using interacted GO-polyethylenimine (PEI) complexes loaded with antisense vicR-expressing plasmid (GO-PEI-ASvicR). The particle size distribution and zeta potential of the GO-PEI-based ASvicR were evaluated. Quantitative real-time PCR assays were used to investigate the expression of S. mutans virulence genes. The exopolysaccharide (EPS) production in biofilm were evaluated by confocal laser scanning microscopy and anthrone method. We showed that GO-PEI could efficiently deliver the ASvicR-expressing plasmid into S. mutans cells and support excellent transcripts of ASvicR. Furthermore, GO-PEI-ASvicR significantly reduced virulent-associated gene expressions, suppressed biofilm aggregation and inhibited EPS accumulation. Our reports demonstrated that preserving nano-graphene oxide with antisense vicR RNA will be a more effective strategy for dental caries management.

Surface pre-reacted glass-ionomer (S-PRG) filler releases several ions, such as fluoride, borate and strontium ions, to exert bioactive effects. We fabricated an endodontic root canal sealer containing S-PRG fillers (S-PRG sealer) and then evaluated the antibacterial and anti-inflammatory properties of S-PRG sealer compared with sealer containing conventional silica fillers (silica sealer). Antibacterial tests showed that S-PRG sealer significantly reduced the turbidity of Enterococcus faecalis compared with silica sealer. Implantation of S-PRG or silica sealer blocks in rat subcutaneous tissue showed that S-PRG sealer decreased the proinflammatory response compared with silica sealer at 10 days post-implantation. In addition, immunostaining revealed that infiltration of CD68- and peroxidase-positive cells around the S-PRG sealer was significantly lower than that in silica sealer. Therefore, it was suggested that S-PRG sealer exhibits antibacterial and anti-inflammatory effects.

The mechanical properties of highly translucent partially stabilized zirconia (PSZ) need to be improved; however, improvement of mechanical properties often decreases translucency. To overcome this problem, a monoclinic ZrO₂ (mZrO₂)/SiO₂ dispersion was prepared and applied as a coating material for PSZ. The influence of surface treatment by the mZrO₂/SiO₂ dispersion on the surface topography, crystallography, and mechanical properties of highly translucent PSZ was investigated in this study. Following the treatment, the mechanical strength of highly translucent PSZ improved by 170% compared with control, for the best mZrO₂/SiO₂ dispersion ratio and heating temperature condition, while maintaining its translucency. The proposed coating is promising for improving the mechanical properties of highly translucent PSZ.

To test the impact of the pressing furnace on flexural strength and facture toughness of the lithium-disilicate-ceramics HS10PC (HS) and IPS e.max Press (IP). Three hundred and sixty specimens (3×4×30 mm) were pressed (n=180/ceramic) using different pressing furnaces, namely Austromat 654 Press-i-dent (AUS), Programat EP5000 (PRO), and Vario Press 300 (VAR). Three-point flexural strength (n=30) and fracture toughness (n=30) were measured. Flexural strength (336–360 MPa) was not affected by pressing furnace or ceramic and showed comparable values between all groups. Fracture toughness (2.65–2.81 MPa√m) provided higher values for HS pressed using AUS compared to specimens pressed in PRO and VAR. For IP, no impact of the pressing furnace on fracture toughness was found. IP presented higher fracture toughness than HS when pressed using PRO. No correlations were found. Both lithium disilicate ceramics showed comparable flexural strength regardless of the pressing furnace. Fracture toughness depended on the ceramic and on the pressing furnace.

The treatment of vertical bone defects caused by severe periodontal disease requires the regeneration of periodontal tissue. Although various bone substitutes have been clinically applied to vertical bone defect correction, the evaluation of these materials in periodontal tissue remains incomplete. The purpose of this study was to examine the bone regeneration abilities of various bone substitutes including Cytrans, Cerasorb, Neobone and Bio-Oss in a 3-wall bone defect animal model. All of these bone substitutes showed a similar healing ability to periodontal ligament and cementum. However, Cytrans showed the fastest bone healing ability compared with the other materials at 4 weeks post-transplantation. In addition, the recruitment of osteoclasts and endothelial cells was observed in Cytrans grafts at 4 weeks, but only detected at 8 weeks in the other materials. These results suggest that Cytrans promotes faster bone healing by inducing bone remodeling and angiogenesis.

This study investigated some mechanical properties of five CAD/CAM materials used for the fabrication of provisional restorations and tooth segments for digitally fabricated dentures. The CAD/CAM blocks were sectioned into bars for flexural strength and elastic modulus testing (n=80), and for surface microhardness (n=80). Half of the specimens were water-stored for 30 days while the other half was dry-stored. Additional specimens were prepared for bond strength (n=40). A 2-way analysis of variance (ANOVA) was conducted to detect the effect of material and water storage (α=0.05). Statistical software (IBM SPSS Statistics v21; IBM) was used for conducting all analyses. Material type and storage significantly affected the flexural strength, flexural modulus and microhardness (p<0.001). The type of material did not have a significant effect on bond strength (p>0.05). The tested materials showed variation in their flexural properties and surface microhardness whereas their bonding properties with resin luting cement were similar.