Exploring the future of cutting-edge technology and what it will mean for the dental industry.

Antimicrobial restoratives

Because secondary caries is the primary cause of failures of composite restorations, researchers have also been looking into developing restoratives that are bacteria-resistant.

One company on the forefront of this technology is Israel-based Nobio, which developed a line of dental restoratives that contain silica dioxide filler with quaternary ammonium (QA) residues that are covalently bonded to the surface. This is intended to reduce the number of bacteria that may remain in the cavity.

“The idea was that none of the existing dental materials had any long-lasting anti-bacterial properties,” says Dr. Ervin Weiss, dean of the Goldschleger School of Dental Medicine at Tel Aviv University and chief technology officer at Nobio. Weiss and other scientists from the Hebrew University of Jerusalem and Hadassah Medical Center first came up with the idea to develop anti-bacterial restoratives 10 years ago.

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The idea was to create a composite with an antibacterial component that wouldn’t degrade or leak into the surrounding area, which is what they’ve created in the final product.

Nobio has designed a line of light-cured restoratives, including a universal bonding agent, a flowable composite, a bulk fill flowable composite and a universal composite. All of these contain the QA filler intended to reduce the number of bacteria that may remain in the cavity and to maintain the functionality and integrity of the restoration.
Weiss says the materials have been laboratory tested and shown to reduce bacteria dramatically. While the technology has applications outside of dentistry (such as for catheters or joint replacements), it has the potential to be a game changer for dentistry.

“The potential is tremendous to be incorporated into nearly every single type of dental material on the market today,” Weiss says. “We have the beginning of a new class of materials. We’re on the verge of an era when we can go into the oral cavity with materials to address the major etiologies of diseases.”

Dentists will not require additional training to use the company’s products, says Yoram Ashery, CEO of Nobio. He says the company has prioritized incorporating the disease-fighting agents at production. “Our whole approach is to keep every aspect of the procedure in the dentist’s office as is,” he says.

While Nobio will soon seek clearance for its products from the FDA, researchers from the University of Toronto have also been exploring antibacterial filling materials.² Utilizing mesoporous silica, a recent development in nanotechnology, the team was able to create a filling that self-assembled the antimicrobial drug octenidine dihydrochloride (OCT). The combination of silica glass and drugs maximized the drug’s density; it can pack over 50 times the amount into the material compared to others, allowing OCT to slowly diffuse over the course of years. It’s also important to note that OCT is an effective broad-spectrum antibiotic that has no known formation of resistance.

The Toronto team’s next goal is to perform in vivo testing of its new material to observe how the harsh environment of saliva and bacteria will affect it.

Caries prevention

While composite advances target the restoration of existing problems, other companies are looking to prevent them altogether with sealants to strengthen enamel and add an extra line of defense against acid and bacteria.

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Premier Dental’s BioCoat is an example of such a product. “The technology is novel,” says Dr. Jason Goodchild, director of clinical affairs at Premier Dental. “It can help protect and repair. It’s the building block of other new products.”

BioCoat, a sealant that features trademarked SmartCap Technology, was developed in partnership with Creighton University. The product utilizes patented semi-permeable resin microcapsules filled with fluoride, calcium and phosphate, which diffuse in and out of the sealant. Goodchild says studies have shown that even at six months, ion release continues at a significant rate. BioCoat also strengthens enamel and seals margins against microleakage to provide an extra line of defense during acid attacks.