Demineralization prevention with a new antibacterial restorative composite containing QASi nanoparticles: an in situ study

Peter Rechmann, Charles Q Le, Benjamin W Chaffee, Beate M T Rechmann, Peter Rechmann, Charles Q Le, Benjamin W Chaffee, Beate M T Rechmann

Abstract

Objectives: To investigate whether a newly developed dental composite with quaternary ammonium silica dioxide (QASi) nanoparticles incorporated with other fillers into the restorative material demonstrates antibacterial activity by reducing enamel demineralization in an in situ gap model.

Materials and methods: Twenty subjects wearing a lower removable partial denture (RPD) with acrylic flanges on both sides of the mouth were recruited into the 4-week in situ study. The gap model consisted of an enamel slab placed next to a composite, separated by a 38-μm space. In the split-mouth design on one side of the RPD, the composite was the Nobio Infinix composite (Nobio Ltd., Kadima, Israel), and the contralateral side used a control composite. Each participant received enamel slabs from one tooth. The gap model was recessed into the RPD buccal flange, allowing microbial plaque to accumulate within the gap. After 4 weeks of continuous wearing, decalcification (∆Z mineral loss) of the enamel slabs adjacent to the gap was determined by cross-sectional microhardness testing in the laboratory.

Results: The ∆Z for the antibacterial composite test side was 235±354 (mean±standard deviation [SD]; data reported from 17 participants) and statistically significantly lower compared to ∆Z of the control side (774±556; mean±SD) (paired t-test, P<0.0001; mean of test minus control -539 (SD=392), 95% confidence interval of difference: -741, -338).

Conclusions: This in situ clinical study showed that composites with QASi antibacterial particles significantly reduced demineralization in enamel adjacent to a 38-μm gap over a 4-week period in comparison to a conventional composite.

Clinical relevance: Composites with QASi nanoparticle technology have the potential to reduce the occurrence of secondary caries.

Trial registration: ClinicalTrials.gov #NCT04059250.

Keywords: Antibacterial composite; Enamel demineralization; Gap model; In situ clinical trial; Quaternary ammonium silica dioxide particles; Secondary caries.

Conflict of interest statement

The authors declare no conflict of interest.

© 2021. This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply.

Figures

Fig. 1
Fig. 1
The gap model. a Schematic of the gap model with the enamel slab on the left, the composite on the right, and the defined gap between the composite and the enamel slab, created by a 38-μm-thin matrix band inserted during the composite placement, all prepared inside an acrylic bathtub-like form; red acid–resistant nail varnish covering the top of the enamel slab; “A – arrow” pointing at the level inside the depth of the gap where cross-sectional hardness testing in the laboratory will occur after wear time in the mouth; “W” marking the wall lesion enamel surface. b Enamel slab removed from the acrylic form and ready for embedding in epoxy resin. c Enamel slab ground down 600 to 800 μm from the top surface, exposing flat surface showing cross-sectional microhardness indentations
Fig. 2
Fig. 2
Schematics demonstrating the process from cutting the tooth up to integrating the gap models in the RPD denture flanges, with a cutting off the dental crown at the cemento-enamel junction; b cutting the buccal crown surface into 2 identical slabs; c example of a gap model with the enamel slab, the composite, and the defined gap created by inserting a 38-μm-thin Tofflemire matrix band next to the enamel slab during the incremental placing of the composite at the opposite side of the enamel, in order to simulate a gap “around” a composite filling; d a gap model in front of the right flange and acrylic removed from the flange allowing the gap model to fit inside the flange; e gap model placed inside the flange, firmly locked in the flange using a composite; and f overview of the lower partial denture with one gap model integrated in the right denture flange and the other in the left flange (not visible in this picture)
Fig. 3
Fig. 3
Knoop hardness indent placement for cross-sectional microhardness testing in a schematic graph with typical positions of the indents in a scatter pattern, with “W” marking the wall lesion enamel surface; indents occur on the cross-sectional surface (perpendicular to the wall lesion caused by the microbial plaque in the gap); the light microscopical picture shows typical microhardness indents placed, starting at an area 15 μm under the enamel surface
Fig. 4
Fig. 4
Individual ∆Z mineral loss (vol% × μm) for the control and for the antibacterial composite side for 17 study participants (participants #1 to #17); in all cases, the ∆Z mineral loss for the antibacterial composite side was lower than for the control side

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