Sub Specialty Dentistry

Bioactive in Various Dental active in Various Dental Sub-Specialities

Sub Speciality

Endodontics

Restorative Materials

PERIODONTICS

A review of present literature supports clinical applications of prefabricated implants made of Bioglass ceramics, as has been used in calvarial and midface bone reconstructions as well as for the repair of orbital floor fractures. Also, present experience with Bioglass in particulate form, preferably mixed with small amount of autogenous bone, support the convenience of this biomaterial over alternate forms of synthetic graft materials.

ORTHODONTICS

Enamel Remineralization

DentoClude™ F contains Bioactive glass which promotes remineralization of the demineralized enamel. Demineralization of teeth occurs when an acidic by-product of plaque wears away the enamel of the teeth. When a tooth is subjected to tooth decay, the minerals such as calcium and phosphate in the tooth begin to wear away hence “demineralization” and make the enamel in the tooth porous, sometimes leading to cavities or other dental issues. The standard of care to treat early caries lesions like White Spot Lesions (WSLs), regular plaque removal and fluoride application. Recently, phosphopeptide-amorphous calcium phosphate (CPP-ACP) is also used as an alternate therapy.

IMPLANTOLOGY

DentoClude™ F coated Dental Implants

DentoClude™ F has Bioactive glass as an active ingredient which is a clinically proven and well accepted oral tissue regenerative material. Bioactive glass has the ability of bonding to hard and soft tissues without rejection. They are osteoinductive, stimulate the proliferation of bone cells, and also are totally resorbable. The particle size of bioactive glass in DentoClude™ F being less than 1micron aids in coating the dental implant surfaces that promotes remineralization to create stronger post implants etc. Additionally, DentoClude™ F formulation is comprised of botanical excipients to prevent anti-inflammation/ infections.

PEDODONTICS

The pulp in the primary teeth has immense potential for repair because of a high degree of cellularity and vascularity in this tissue. Bioactive Glass exhibits pulpal biocompatibility, antibacterial property, osteogenic property and good bonding to tooth structure. Bioactive Glass was found to be promising regenerative materials for pulpotomy in primary teeth.

ORAL AND MAXILLOFACIAL SURGERY

Bioactive glass (BG) is biocompatible, osteoconductive, form a strong bond with living tissue via the formation of a hydroxyapatite layer on their surface and have been used to repair hard tissues in a variety of craniofacial, maxillofacial, and periodontal applications. It has also been established that BG has good mechanical properties and a higher bioactivity in comparison to hydroxyapatite.

Sub Speciality

Endodontics

Restorative Materials

Restorative dental materials are used to prevent or repair damage to teeth caused by oral disease or trauma. Though the currently available restorative materials like glass ionomer cements, resin restorations etc may serve the purpose by restoring the form and function of the tooth but lacks the bioactivity. Secondary caries caused by polymerization shrinkage and micro leakage are other major contributing factors for the failure of restorations. A micro gap formed due to the shrinkage may widen over a period of time due to changes in mechanical properties of materials and tooth making it inaccessible for maintaining oral hygiene thus making it favourable milieu for bacterial growth leading to secondary caries.

The longevity of dental restorations can be achieved by creating a tight bond to the tooth and a hostile environment for bacteria. Bonding agents with bioactive glass properties may provide a sealed interface by hydroxyapatite precipitation. Bioactive glass has shown to induce dentin remineralisation.

Reference:

Skallevold HE, Rokaya D, Khurshid Z, Zafar MS. Bioactive Glass Applications in Dentistry. Int J Mol Sci. 2019 Nov 27;20(23):5960. doi: 10.3390/ijms20235960. PMID: 31783484; PMCID: PMC6928922

Bond Strength with DentoClude F in restorations

Bond Strength with DentoClude F in restorations In-vitro study demonstrated that Bioactive glass (less than .5 micron) added to the resin-dentin bonded interface that previously has been shown to reduce mico-leakage does not decrease the bond strength. Indeed, it showed superior bond strength compared to the control by three times. No adhesive failure were observed in Cumberland studies to date.

A Study was conducted to compare the effect of bioactive glass, hydroxyapatite, and diode laser desensitization on shear bond strength of resin composites to dentin at different time intervals. Seventy-two caries-free maxillary premolars were selected. Buccal surfaces were flattened to expose dentin. Teeth were divided into four groups according to treatment modality (control with no pretreatment, Toothpaste with bioactive glass, Hydroxyapatite Desensitizer, diode laser). Bonding was performed using self-etch adhesive followed by composite buildup. Universal testing machine was used to determine shear bond strengths immediately after bonding, after 3 months, and 5 months storage in artificial saliva. Pretreatment with bioactive glass (BG) and hydroxyapatite desensitizers increased, whereas diode laser decreased mean shear bond strength of composite to dentin as compared to control group. No statistically significant difference in shear bond strength values was seen in groups after storage.

Reference:

Gupta T, Nagaraja S, Mathew S, Narayana IH, Madhu KS, Dinesh K. Effect of Desensitization Using Bioactive Glass, Hydroxyapatite, and Diode Laser on the Shear Bond Strength of Resin Composites Measured at Different Time Intervals: An In vitro Study. Contemp Clin Dent. 2017 Apr-Jun;8(2):244-247. doi: 10.4103/ccd.ccd_155_17. PMID: 28839410; PMCID: PMC5551329.

Usage in Inlays and Onlays

DentoClude F is a USFDA approved novel/proprietary finely ground bioactive glass formula and is indicated to use as a desensitizing agent for dentin surfaces by blocking dentin tubules to help prevent micro-leakage and to use under direct or indirect restorations following dentin etch and prior to dentin adhesive application.

Inlays and onlays are cemented in the mouth using adhesive resin luting cement. These materials are placed in the in-lay/ on-lay and placed onto the prepared tooth. Bonding agents can be applied to dentine before cementation of inlays and onlays.

Literature supports the usage of bioactive glasses in various aspects of dentistry including dental restorative materials. Many luting cements and dental adhesives were enhanced with bioactive glass for its biocompatibility and to decrease the microleakage and improve the bond strength without compromising their mechanical properties.

Studies on Depth of the Penetration.

Energy-dispersive x-ray analysis/EDX maps of a study conducted to test the hypothesis that the presence of bioactive glass, which is known to precipitate hydroxyapatite when placed in aqueous environments that contain calcium and phosphate, will reduce leakage of resin-bonded dentin showed that bioactive glass particles were embedded in the dentin to a depth of 5-10 µm below the surface. The maps further suggested that the materials are present in both the adhesive and the dentin itself.

Reference:

PERIODONTICS

A 5-year evaluation on Bioactive glass cones was conducted to examine the effectiveness of Bioactive cones as space fillers after removal of tooth roots to delay the resorption of alveolar ridges (Stanley et al). High rate (85.7%) of cone retention after 5 years. Placement of Bioactive glass into fresh sockets promoted alveolar ridge preservation and is said to be a material of choice for endosseous ridge maintenance implants to prevent alveolar ridge resorption.

Retrospective review was conducted to evaluate Particulate bioactive glass as a grafting material in the treatment of periodontal intrabony defects. Results demonstrated the efficiency of Bioactive glass as an adjunct to conventional surgery in the treatment of intrabony defects.

Histological observations on biopsies harvested following sinus floor elevation using a bioactive glass material of narrow size range were made to evaluate the bone augmenting capacity of bioactive glass particles in human sinus floor elevations. Results demonstrated that a 1:1 mixture of autogenous bone/Bioactive glass particles seemed a promising alternative to autogenous bone only, when low amounts of bone tissue are available for sinus augmentation.

References:

Clark AE, Stanley HR. Clinical trials of bioglass implants for alveolar ridge maintenance. J Dent Res. 1986; 65:304.

Zamet JS, Darbar UR, Griffiths GS, Bulman JS, Brägger U, Bürgin W, Newman HN. Particulate bioglass as a grafting material in the treatment of periodontal intrabony defects. J Clin Periodontol. 1997 Jun;24(6):410-8. doi: 10.1111/j.1600-051x.1997.tb00205.x. PMID: 9205920.

Ette S. Tadjoedin, Gert L. De Lange, D. M. Lyaruu, Luit Kuiper, Elisabeth H. Burger. High concentrations of bioactive glass material (BioGran®) vs. autogenous bone for sinus floor elevation. Clinical Oral Implants Research

ORTHODONTICS

Enamel Remineralization

DentoClude F contains Bioactive glass which promotes remineralization of the demineralized enamel. Demineralization of teeth occurs when an acidic by-product of plaque wears away the enamel of the teeth. When a tooth is subjected to tooth decay, the minerals such as calcium and phosphate in the tooth begin to wear away hence “demineralization” and make the enamel in the tooth porous, sometimes leading to cavities or other dental issues. The standard of care to treat early caries lesions like White Spot Lesions (WSLs), regular plaque removal and fluoride application. Recently, phosphopeptide-amorphous calcium phosphate (CPP-ACP) is also used as an alternate therapy.

Bioglass has been extensively studied regarding the remineralization of WSLs. Taha et al. evaluated the effectiveness of bioactive glasses in inducing remineralization compared to topical fluoride and CPP-ACP treatment. They concluded that bioactive glasses may enhance enamel remineralization more effectively and earlier.

DentoClude F is a calcium–sodium–fluorophosphate silicate glass that releases calcium and phosphate ions. These ions increase the pH and result in precipitation of calcium phosphate and mineralization into hydroxyapatite. Advantage of using DentoClude F over the standard of care is that the CPP-ACP or other calcium-based products provide an initial calcium burst, while bioactive glass in DentoClude F exhibits a continuous calcium release.

The undeniable enamel damage in orthodontics occurs during the removal of residual orthodontic adhesive after the treatment. Slow-speed tungsten carbide is commonly used for this purpose. QMAT3 is a novel bioactive glass. In one study, tungsten carbide bur, QMAT3-air-abrasion, and Bioglass 45S5-air-abrasion were examined in vitro to evaluate enamel damage during the processes of removing residual orthodontic adhesive. The results show that QMAT3 bioactive glass has minimal enamel damage in comparison with Bioglass 45S5 air abrasion and tungsten carbide bur. Therefore, QMAT3 seems to offer a conservative approach for orthodontic adhesive removal.

References:

Skallevold HE, Rokaya D, Khurshid Z, Zafar MS. Bioactive Glass Applications in Dentistry. Int J Mol Sci. 2019 Nov 27;20(23):5960. doi: 10.3390/ijms20235960. PMID: 31783484;

PMCID: PMC6928922.

Jafari, N., Habashi, M.S., Hashemi, A. et al. Application of bioactive glasses in various dental fields. Biomater Res 26, 31 (2022). https://doi.org/10.1186/s40824-022-00274-6

IMPLANTALOGY

DentoClude F coated Dental Implants

DentoClude F has Bioactive glass as an active ingredient which is a clinically proven and well accepted oral tissue regenerative material. Bioactive glass has the ability of bonding to hard and soft tissues without rejection. They are osteoinductive, stimulate the proliferation of bone cells, and also are totally resorbable. The particle size of bioactive glass in DentoClude F being less than 1micron aids in coating the dental implant surfaces that promotes remineralization to create stronger post implants etc. Additionally, DentoClude F formulation is comprised of botanical excipients to prevent anti-inflammation/ infections.

DentoCludeF is a bioactive glass comprising SiO2, Na2O, CaO, P2O5, Fluoride, Neem and Dadima. Once in contact with the body fluids, Bioactive glasses immediately undergo ionic dissolution and bioactive glass degradation via the exchange of H+ ions in the solution and Na+ and Ca2+ from the glass network. The ion exchange results in the formation of silanol groups (Si–O–H) due to the hydrolysis of the silica groups. An increased alkaline local environment develops due to the increase in OH- concentration. The silica network is further degraded as the pH rises, forming orthosilicic acid and Si (OH)4 on the surface in the form of a negatively charged gel. The gel layer functions as a matrix for hydroxyapatite with precipitation sites. Beneath the gel layer is a depleted alkaline surface layer on top of the bulk glass. On top of the gel layer, a layer of amorphous calcium phosphate forms. Precipitation and further mineralization occur due to the incorporated carbonate ions from the now supersaturated solution, thus the concentration of Ca- and Si-ions in solution are critical. The newly formed hydroxyapatite enables growth factors to adsorb to the surface, as well as attachment, proliferation, and differentiation of osteoprogenitor cells by cytokines and extracellular matrix components expressed by the upregulation of several genes. Collagen and glycoproteins are believed to incorporate the surrounding bone tissue into the hydroxyapatite layer. As the hydroxyapatite grows inwards, the Bioactive glass starts to resorb and gets replaced by growing bone tissue. Osteoclasts, once incorporated in the growing bone, break down larger particles resulting in a more extended period of resorption and stronger bone.

Furthermore, presence of Neem and Dadima in DentoClude F makes it unique as both of them are being used in ayurveda since time immemorial in various oral health issues because of their anti-inflammatory, anti-bacterial and anti-pyrogenic properties.

Reference:

stHench L.L. The story of Bioglass® J. Mater. Sci. Mater. Med. 2006;17:967–978. doi: 10.1007/s10856-006-0432-z. [PubMed] [CrossRef] [Google Scholar].

PEDODONTICS

Bioactive glass holds valuable applications in paediatric dentistry, offering versatile solutions for various dental concerns in young patients. Its application in pulpotomy procedures aids in preserving pulp vitality by promoting dentin bridge formation. In addition, bioactive glass serves as an effective cavity liner and base material, providing a protective barrier and supporting remineralization in deep carious lesions. In addressing dentin hypersensitivity, bioactive glass proves beneficial by occluding dentinal tubules and fostering mineral deposition. It plays a role in enamel remineralization, reinforcing tooth structure, and managing erosive lesions. In cases of traumatic injuries, bioactive glass facilitates reparative processes, and it can be utilized in orthodontics to treat white spot lesions associated with orthodontic treatment. The incorporation of bioactive glass into dental sealants enhances their preventive properties, and its regenerative potential is explored in traumatized primary teeth. Overall, bioactive glass aligns with the principles of minimally invasive and biocompatible dentistry, offering a range of applications to address paediatric dental needs effectively.

A clinical study was conducted on fifty teeth to clinically and radiographically evaluate the potential of bioactive glass and hydroxyapatite crystals as pulpotomy agents in primary molars. A total of fifty teeth were selected from 25 children (14 boys and 11 girls) aged 4 to 9 years, who had no medical condition that would contraindicate pulp therapy. Each child had at least two primary molars (first and/or second primary molar) requiring pulpotomy. A conventional pulpotomy procedure was performed on the selected teeth using bioactive glass and hydroxyapatite crystals. All molars were evaluated clinically and radiographically at regular intervals over 12 months. The results were subjected to statistical analysis using Fischer exact test. Results showed one hundred per cent clinical success and 84% radiographic success in both the groups at the end of the study period. The study concluded that bioactive glass can be used as pulpotomy agent in primary molars.

The current clinical study compared the antimicrobial efficacy of Bioactive glass, combination of 1% Chlorhexidine gluconate gel and Calcium hydroxide powder and 1% Chlorhexidine gluconate gel as intracanal medicament in primary molars. This In-vivo study included 48 subjects within the age group ranging from 4-11 years who were indicated for multi visit Pulpectomy. These subjects were randomly divided into three experimental groups, containing sixteen samples per group. Group 1: Bioactive glass; Group 2:1% Chlorhexidine gel and Calcium hydroxide powder; Group 3:1% Chlorhexidine gel. Under rubber dam isolation, following lesion sterilization so sample was obtained. Following access opening and working length, sample S1 was obtained, and the respective medicament was placed inside the canals after cleaning and shaping and a double seal was done with ZOE and GIC. Patient was recalled after a period of 5 to 7 days and the medicaments were flushed under isolation and sample S2 was obtained. Pulpectomy procedure was then completed. S0, S1, S2 samples were subjected to microbiological analysis and the total bacterial count in CFU/ml was calculated. Statistical analysis used: Kruskal Wallis Test and One-way ANOVA. Results: The mean percentage of reduction of bacterial count from S1- S2 (Before and after placement of medicament) with Group 1: Bioactive glass was 75.7%, with Group 2:1% Chlorhexidine gluconate and calcium hydroxide was 52% and Group 3:1% Chlorhexidine gluconate was 28.6%, revealing that bioactive glass has the superior antibacterial efficacy when compared with other groups. Antibacterial efficacy of bioactive glass was significant in both primary maxillary and mandibular first molar and second molar proving it to work best for all types of root anatomy in mixed dentition population. Superior clinical and microbiological results were found when bioactive glass was used as intracanal medicament in both intraoral and extra oral abscess cases in primary molars.

References:

Neeraja Govindaraj, Kinjal Shah Virani, Priya Subramaniam, Megha Gupta. Evaluation of bioactive glass and hydroxyapatite crystals as pulpotomy agents in primary molars: A clinical study. Contemp Pediatr Dent 2020:1(1):42-51.

Skallevold HE, Rokaya D, Khurshid Z, Zafar MS. Bioactive glass applications in dentistry. Int J Mol Sci. 2019;20:5960.

Dr. Abinaya R, Dr. Pallavi Urs, Dr. Priya Nagar, Dr. Arul Selvan, Dr. Smitha S, Dr. Janani J. Comparative evaluation of antimicrobial efficacy of bioactive glass, 1% chlorhexidine gluconate with calcium hydroxide and 1% chlorhexidine gluconate, as intracanal medicament in primary molars: An in vivo study. Int J Appl Dent Sci 2021;7(4):82-88. DOI:https://doi.org/10.22271/oral.2021.v7.i4b.1355.

ORAL AND MAXILLOFACIAL SURGERY

Bioactive glass has been used in cranio-maxillofacial reconstruction especially on the repair. of periodontal and alveolar ridge defects although its use is also extended for successful reconstruction of other areas of the head and neck. Bioactive glass has been utilized for the repair of orbital floor.

Acting as a resorbable framework in which bone cells can grow biologically active glasses are an important consideration when choosing the optimal biomaterial to be used as a bone substitute in craniomaxillofacial applications. Their bioactive properties allow for an osteoproductive environment in which the bone–biomaterial interface is uniquely stronger than it would be with other forms of alloplastic materials. A review of the present literature supports clinical applications of prefabricated implants made of B-G ceramics, as has been used in calvarial and midface bone reconstructions as well as for the repair of orbital floor fractures. Also, present experience with B-G in particulate form, preferably mixed with small amount of autogenous bone, support the convenience of this biomaterial over alternate forms of synthetic graft materials. This protocol has been highly successful for elevation of the maxillary sinus floor in preparation for titanium implant placement in the atrophic maxilla. A similar protocol may prove useful in reconstruction of other areas of the head and neck.

Preservation of the alveolar process after tooth extraction is desirable because it facilitates placement of endosseous implants and minimizes adverse esthetic results associated with fixed partial dentures. The purpose of this study was to evaluate the clinical effectiveness of bioactive glass used as a graft material combined with calcium sulphate used in the form of a mechanical barrier in preserving alveolar ridges after tooth extraction. Sixteen patients who required extraction of 2 anterior teeth or bicuspids participated in the study (split mouth design). After tooth extraction and elevation of a buccal full-thickness flap, experimental sockets were filled with bioactive glass, which in turn was covered with a layer of calcium sulphate. Control sites did not receive any graft or calcium sulphate. Titanium pins served as fixed reference points for measurements. No attempt was made to advance the flap to cover the socket areas on control or experimental sites (open socket approach). Re-entry surgeries were performed at 6 months. Re-entry surgeries showed that experimental sites presented with (1) significantly more internal socket bone fill (6.43 ± 2.78 mm vs 4.00 ± 2.33 mm on control sites), (2) less (although not statistically significantly less) resorption of alveolar bone height (0.38 ± 3.18 mm vs 1.00 ± 2.25 mm on control sites), and (3) similar degree of horizontal resorption of the alveolar bony ridge as compared with controls (3.48 ± 2.68 mm vs 3.06 ± 2.41 mm on control sites). This study suggests that treatment of extraction sockets with a combination of bioactive glass and calcium sulphate is of some benefit in preserving alveolar ridge dimensions after tooth extraction.

Reference:

Profeta, Andrea Corrado and Christoph Huppa. “Bioactive-glass in Oral and Maxillofacial Surgery.” Craniomaxillofacial Trauma & Reconstruction 9 (2016): 001 – 014.

Camargo PM, Lekovic V, Weinlaender M, Klokkevold PR, Kenney EB, Dimitrijevic B, Nedic M, Jancovic S, Orsini M. Influence of bioactive glass on changes in alveolar process dimensions after exodontia. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000 Nov;90(5):581-6. doi: 10.1067/moe.2000.110035. PMID: 11077380.