TUGAS TAMBAHAN MULOK NANO

The implications and applications of nanotechnology in

dentistry: A review

Oleh:
Dellar Arciantika C
NIM. 210160100111035

PROFESI KEDOKTERAN GIGI

FAKULTAS KEDOKTERAN GIGI
UNIVERSITAS BRAWIJAYA
MALANG
2022
Saudi Dental Journal (2018) 30, 107–116

King Saud University

Saudi Dental Journal

www.ksu.edu.sa
www.sciencedirect.com

REVIEW ARTICLE

The implications and applications of

nanotechnology in dentistry: A review
Rawan N. AlKahtani

Restorative Dentistry Division, Clinical Dental Sciences Department, College of Dentistry, Princess Nourah bint
Abdulrahman University, Riyadh, Saudi Arabia

Received 27 July 2017; revised 8 December 2017; accepted 23 January 2018

Available online 3 February 2018

KEYWORDS Abstract The emerging science of nanotechnology, especially within the dental and medical fields,
Nanodentistry; sparked a research interest in their potential applications and benefits in comparison to conven-
Nanotechnology; tional materials used. Therefore, a better understanding of the science behind nanotechnology is
Nanomaterials essential to appreciate how these materials can be utilised in our daily practice. The present paper
will help the reader understand nanoscience, and the benefits and limitations of nanotechnology by
addressing its ethical, social, and health implications. Additionally, nano-applications in dental
diagnostics, dental prevention, and in dental materials will be addressed, with examples of commer-
cially available products and evidence on their clinical performance.
Ó 2018 The Author. Production and hosting by Elsevier B.V. on behalf of King Saud University. This is an
open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Contents

1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108
2. Implications of nanotechnology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108
2.1. Ethical implications. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108
2.2. Nanotechnology and society . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
2.3. Health implications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
3. Applications of nanotechnology in dentistry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
3.1. Dental diagnostics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
3.2. Preventive dentistry. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110
3.3. Dental materials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110
3.3.1. Prosthodontics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110

E-mail address: r-alkahtani@hotmail.com

Peer review under responsibility of King Saud University.

Production and hosting by Elsevier

https://doi.org/10.1016/j.sdentj.2018.01.002
1013-9052 Ó 2018 The Author. Production and hosting by Elsevier B.V. on behalf of King Saud University.
This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
108 R.N. AlKahtani

3.3.2. Endodontics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111

3.3.3. Conservative and aesthetic dentistry. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
3.3.4. Periodontics, Implantology, and regenerative dentistry. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112
4. Nano-products . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112
5. Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112
Conflict of interest. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114

1. Introduction addressing the science behind nanotechnology in detail and

Nanotechnology is the art and science of material engineering
in a scale of less than 100 nm (Anisa et al., 2003). It revolution-
ized the medical and dental fields by improving mechanical
and physical properties of materials, helped introduce new
diagnostic modalities and nano-delivery systems (Kanaparthy
and Kanaparthy, 2011).
The first guidelines developed in the field of nanotechnol-
ogy were by K Eric Drexler from the foresight institute. He
presented the science of nanotechnology to the public through
his published book Engines of Creation (Anisa et al., 2003). In
an effort to create an eco-friendly socially acceptable nan-
otechnology, the United States National Human Genome
Research Institute proposed a new approach to the develop-
ment process of new technology. This was accomplished by
addressing the ethical, legal, and social implications before
nano-products reach the market to easily modify and adjust
during the early stages of production (Ramsay, 2001;
Macnaghten et al., 2005).
The ongoing research in the realm of nano, is due to the
unique properties nanoparticles offer. Atoms are the building
blocks in biological tissue, and these atoms are measured using
the nanoscale. Introducing nano-sized particles allows for an
interaction on a molecular level, by that increasing the overall
efficacy and affinity in comparison to biological molecules
interacting with micro or macro sized particles (Li et al.,
2008). The high surface to core ratio, is a unique physical char-
acteristic in nanoparticles, meaning that there are more atoms
on the surface of the nanoparticle than deep within its core.
This is particularly useful since surface atoms have unbound
surfaces in comparison to core atoms, with the potential for
creating new and strong bonds, and hens, nanoparticles are
more reactive in comparison to micro and macro particles
which have more core than surface atoms (Binns, 2010).
In comparison to the same material in bulk (macro or
micro), nano particles can be easily arranged in a number of
packing configurations due to their high surface to core ratio,
making them easily manipulated and utilised in various appli-
cations. The greater thermal vibrations expressed by surface
atoms in comparison to core atoms in any given material
regardless of particle size, contribute to the lower melting tem-
perature in nanomaterials compared to the same material in
bulk (Buffat and Borel, 1976). This might be of particular
importance when using nanomaterials to construct porcelain
fused to metal (PFM) crowns, cast post and cores, or denture
frameworks.
Many authors published review articles discussing the
potential of nanotechnology in dentistry including newly
developed materials, however, the literature is void of reviews
linking it to the implications and applications of nanotechnol-
ogy on the field of dental sciences (Mitra et al., 2003; Raval
et al., 2016). This review addresses the science, implications,
and up-to-date applications of nanotechnology in dentistry,
including commercially available newly developed materials
and supporting literature to aid dentists in understanding the
clinical relevance and effectiveness of such materials in com-
parison to the ones currently used in clinical practice.
2. Implications of nanotechnology
2.1. Ethical implications
After the research and development phase of any dental or
medical nanoproduct, it undergoes extensive preclinical
in vitro testing to investigate its mechanical, toxicological,
and immunological properties. Many agencies such as the U.
S Environmental Protection Agency and the National Institute
of Occupational Safety and Health have introduced guidelines
for investigating the risks of nanomaterials (Resnik and
Tinkle, 2007). However, developing a multidisciplinary regula-
tory framework to assess and control nanotechnology and
resolve ethical concerns that fall under the four categories:
metaphysical, equity, privacy, and security is a constant leg-
islative challenge (Hester et al., 2015). Although animal studies
provide a reasonable understanding of what to expect when
starting a phase I trial, serious adverse reactions have been
recorded when human subjects were exposed to a dose of
nanomedicine 500 times less than the recorded toxic limit in
animal studies (Resnik and Tinkle, 2007). Therefore, subjects
must understand the level of risk associated with the exposure
to novel materials and data and safety monitoring boards must
be appointed in every clinical trial, to carefully track and
record any adverse side effects early on, pick up inconsistencies
in data handling, and insure the safety and wellbeing of test
subjects (Resnik and Tinkle, 2007). The unpredictability of
nanomaterials create an ethical dilemma for dentists when
faced with a wide range of materials to choose from, some hav-
ing very long track records supporting their clinical use such as
hybrid or micro filled composite resins and others such as the
nanofilled composite resins that are appealing in concept and
supported by short term clinical studies. The traditional ethical
decision making process followed, mainly utilitarianism, is
unable to keep up with the rapid pace and uncertain future
of nano-technological developments. For that reason, a more
in depth understanding of the science is required, including
risk/benefit analysis and ethical considerations throughout
the development process. This lead to the proposal of the
anticipatory ethics and governance concept, developed to
The implications and applications of nanotechnology in dentistry
identify and address ethical and societal implications through
ethical analysis models when the technology is in its introduc-
tory stage to be then easily modified and guided towards an
ethically acceptable outcome (Hester et al., 2015; Brey, 2012;
Khushf, 2006).
2.2. Nanotechnology and society
Since society is the consumer, funding party, and policy and
decision maker, the public’s attitude towards nanotechnology
plays a fundamental role in its success and failure, in other
words society is the judge and jury. This is driven by ethics,
morals, and values that have recently became more accepting
of the new sparking technologies as the perceived benefits out-
weigh the perceived risks (Gupta et al., 2015). However,
although nanotechnology is currently integrated in fields that
directly affect the public such as in energy supply, health care
and diagnostics, telecommunications, and pollution control,
this has created fear as these advancements might cost the pub-
lic thousands of jobs to accommodate for a more machinery
reliant system (Kurzweil, 2005). In an effort to address social
concerns, various initiatives were put in place to bridge the
gap between society and nanoscience. The National Nanotech-
nology Initiative report claims that advancement in technology
will require a new generation of trained workers with advanced
set of operational and managerial skills (Macnaghten et al.,
2005). In 2003, Technologist Ray Kurzweil claimed that:
‘‘Portable manufacturing systems will be able to produce virtu-
ally any physical product from information for pennies a
pound, thereby providing for our physical needs at almost
no cost” (Fisher and Mahajan, 2006). This calls for an imme-
diate engagement with the public to address concerns and
spread awareness on current and future applications of nan-
otechnology to gain and maintain public support.
2.3. Health implications
A four stage framework has been adopted by the US federal
and state agencies to assess and evaluate the magnitude of
any health concern, starting with problem identification, fol-
lowed by dose-response assessment, exposure assessment,
and ending with risk characterization (Stander and
Theodore, 2011). The effects of nanomaterials are significantly
size dependant, meaning that nontoxic 100 nm sized particles
could dramatically transform into toxic elements as their size
reduce to 1 nm for example and vice versa. A non-toxic nano-
material could disintegrate or aggregate forming toxic
nanoparticles as well. This unpredictability of how our bodies
react to nanomaterials not only relies on size but in how our
immune system react to the nanoproduct, as studies have
shown that nanoparticles could react differently in a cell cul-
ture than in an organism.
Studies have shown that nanoparticles can be inhaled and
can cross cell membranes and reach the liver, lymph nodes,
spleen, and bone marrow (Resnik and Tinkle, 2007). Although
claims of nano-toxic effects following inhalation have been
clearly expressed, the literature lacks solid scientific evidence
confirming or denying these claims (Stone et al., 2010). There-
fore, although private companies are not required to perform
post marketing studies on their products, governmental bodies
must sponsor and encourage such studies to investigate the
109
long term effects of nanomaterials and report any adverse side
effects to legislative and regulatory bodies such as the U.S.
food and drug administration (FDA). Studies on ethical,
social, and health implications of nanotechnology fall far
behind the science, and regardless of funding availability, seri-
ous attempts to consider the issues at hand fail to exist, instead
hype pieces and controversies which only add to the publics
confusion and mistrust of disrupting new technologies exist,
or as referred to by Bill Joy ‘‘grey goo” (Joy, 2000).
3. Applications of nanotechnology in dentistry
3.1. Dental diagnostics
In an attempt to improve upon medical diagnostics, the con-
cept of nano-biosensing was introduced. A biosensor is ‘‘an
analytical device which incorporates a biologically active ele-
ment with an appropriate physical transducer to generate a
measurable signal proportional to the concentration of chem-
ical species in any type of sample” (Touhami, 2014). Biosen-
sors were introduced in 1962 by Clark and Lyons (1962),
followed by an ongoing extensive research and development
of this promising technology by utilising various detection
principles, leading to potential applications in public health,
environmental monitoring, and food safety Table 1)
(Touhami, 2014). In an effort to improve the biorecognition
process and overall bioreceptor performance, nanobiorecep-
tors were introduced, incorporating nanotubes, nanowires,
and nano-dots in the sensing assembly (Sagadevan and
Periasamy, 2014).
Nanoparticles are created by either following the top down,
bottom up, or molecular self-assembly approach (Foster,
2005). Replacing micro sized particles with nanosized ones
transforms the biosensor into a nanobiosensor, with the
advantage of rapidly identifying targeted biological tissues at
an ultra-low molecular level. Its high sensitivity is particularly
useful in cases of cancer diagnosis for example, as nanobiosen-
sors in comparison to conventional biosensors are able to
Table 1 Detection principles in nano-biosensors.
Detection Definition
Principle
Piezoelectric Piezoelectric biosensors have the ability to
generate an electrical charge in response to
mechanical stress, and the translation of
mechanical energy to electrical energy is called
the piezoelectric effect (Kumar, 2000)
Electrochemical This detection principle starts with the analyte
(target) chemically binding to the highly specific
bioreceptor (e.g. a fixed enzyme), affecting the
electronic properties of the sensor, and
ultimately generating a readable signal
(Hasanzadeh and Shadjou, 2016)
Optical Optical nanosensors give quantitative
measurements on an intracellular level. It
converts the biorecognition of the analyte into an
optical signal (Clark et al., 1999)
Calorimetric Thermal biosensors or calorimetric biosensors
rely on the rate of enzymatic exothermic reaction
to measure the concentration of the analyte
110
detect cancer cell molecules at very early stages and in very low
concentrations (Touhami, 2014; Foster, 2005). Nanobiosen-
sors are also mechanically compliant, as they are easily dis-
placed and deformed in response to very low forces,
therefore, sensitive enough to detect breaking of chemical
bonds (Arlett et al., 2011). This is attributed to its nano size
effects, as the high surface area to core ratio increases the level
of sensitivity, electrical properties, and response time of the
biosensor (Sagadevan and Periasamy, 2014).
Metallic nanoparticles such as gold, silver, platinum, and
palladium are commonly incorporated in nanobiosensor trans-
duction/bioreception systems as they are able to rapidly react
with most biological molecules without affecting their activity
(Sagadevan and Periasamy, 2014). Gold nanoparticles have
been deeply studied, revealing an ability to enhance the elec-
tronic signal when the bioreceptor detects the analyte at very
low concentrations, for example, gold nanoparticle modified
DNA bioreceptor detects an analyte at a concentration as
low as 0.05 nm (Su et al., 2003).
Additionally, carbon nanotubes were utilised for the detec-
tion of circulating cancer cells in the body. The carbon nan-
otubes were arranged by the layer-by-layer assembly
technique and then linked chemically to antibodies of specific
carcinogenic marker which specifically binds to cancer cells,
thus, providing an effective and useful diagnostic tool
(Hasanzadeh and Shadjou, 2016).
This not only enhances the performance of biosensors, it
also creates an opportunity to manufacture very small sizes
of nanobiosensors that can be worn or even implanted as
opposed to larger sizes of conventional biosensors that are
not feasible and cost more to manufacture (Touhami, 2014).
3.2. Preventive dentistry
Researchers developed a nano-toothbrush, by incorporating
nanogold or nanosilver colloidal particles between toothbrush
bristles (Raval et al., 2016). In addition to its ability to improve
upon mechanical plaque removal, researchers reported an
antibacterial effect of the added gold or silver which could ulti-
mately lead to a significant reduction in periodontal disease.
Oral hygiene products such as toothpastes and mouthwash
solutions were also nano-modified according to recent reports.
Nano-calcium fluoride, for instance, was added to mouthwash
products to reduce caries activity, reduce dentine permeability,
and increase labile fluoride concentration in oral fluid (Sun and
Chow, 2008). Toothpastes containing calcium carbonate
nanoparticles and 3% nanosized sodium trimetaphosphate
have been reported to promote remineralisation of early cari-
ous lesions in comparison to a conventional toothpaste with
no nano-additives (Danelon et al., 2015).
According to results from an in vitro study, toothpastes
containing nano-hydroxyapatite crystals (nHA) significantly
increased microhardness values in human enamel following
an erosive challenge, in comparison to the same toothpaste
without nHA (Ebadifar et al., 2017).
The benefits of a nHA containing toothpaste was first
reported in Japan in the 1980s (Kani et al., 1989). In 1983,
three primary schools were enrolled in their 3-year clinical
study. Schools were provided with toothbrushes and tooth-
pastes. One school was given a 5% nHA based toothpaste,
while the other two schools were provided with controls.
R.N. AlKahtani
Students were instructed to brush using the provided tooth-
brush and toothpaste every day during school hours and under
a teacher’s supervision. Results gathered revealed a 56%
reduction in caries incidence in school children brushing with
a nHA toothpaste in comparison to the control groups
(Kani et al., 1989).
The higher reparative capacity of nanomaterials in compar-
ison to the same material in a micro or macro scale, might be
attributed to the fact that the inorganic building blocks in
enamel are 20–40 nm in size, making it logical to assume a
higher affinity to nanosized particles (Robinson et al., 2004;
Tao et al., 2007). This is important to consider when attempt-
ing to develop new materials to improve mechanical, physical,
and reparative characteristics.
3.3. Dental materials
3.3.1. Prosthodontics
Incorporating 0.4% TiO2 nanoparticles into a 3D printed
poly-methylmethacrylate (PMMA) denture base was investi-
gated in 2017, in an attempt to improve its antibacterial char-
acteristics and mechanical properties (Totu et al., 2017).
According to measurements using Fourier Transform Infrared
Spectroscopy (FTIR), Scanning Electron Microscopy, and
tests for antimicrobial efficacy against Candida species,
improvements in the chemical and structural properties was
reported, and the antibacterial effects specifically against Can-
dida species was significant.
Researchers also investigated the tribological behaviour of
a 7 wt% nano-zirconium oxide modified heat cured PMMA
(Ahmed and Ebrahim, 2014). The addition of zirconium oxide
nanoparticles significantly improved hardness levels, flexural
strength, and fracture toughness of the heat cured PMMA
denture base. Nano sized fillers were used due to their superior
dispersion properties, less aggregation potential, and biocom-
patibility with the organic polymer. Nano zirconium not only
improved physical properties of denture bases during the con-
struction phase, they were reported to improve the transverse
strength of a repaired denture base as well (Gad et al., 2016).
Results show that repairs using an autopolymerised resin,
modified with 2% or 5 wt% zirconium oxide exhibited the
highest transverse strength levels using a three-point bending
test. Researchers concluded that the incorporation of nano-
modified zirconium oxide particles in resins matrices has a
wide potential not only in removable prosthodontics but in
many other disciplines as well.
Researchers additionally investigated the antifungal prop-
erties of a chlorhexidine coating with a range of nanoparticle
additives, to inhibit fungal infestations in dental silicones com-
monly used as denture soft liners and obturators (Garner et al.,
2015). Solutions of chlorhexidine mixed with sodium triphos-
phate (TP), trimetaphosphate (TMP) or hexametaphosphate
(HMP) nanoparticles were used.
The addition of nanoparticles did not affect the
hydrophilicity and water uptake of denture silicons following
immersion in artificial saliva for 16 weeks. Furthermore, the
nano-modofied chlorhexidine coatings released soluble
chlorhexidine into artificial saliva, with a slow and sustained
release by the chlorhexidine-HMP coating, and a rapid, more
concentrated release by the chlorhexidine-TP and
chlorhexidine-TMP coatings. The chlorhexidine-HMP coating
The implications and applications of nanotechnology in dentistry
proved to be the most effective in its antifungal activity by
inhibiting the metabolic activity of Candida albicans. These
coatings might potentially become clinically essential for insur-
ing longevity of the dental prosthesis and maintenance of oral
health at a much lower cost.
Nano-particle impregnated luting cements proved to be sig-
nificantly effective in increasing the bond strength to enamel
and dentine in comparison to conventional luting cements.
They bond particularly well to dentin, as these very small sized
particles penetrate deeper into the dentinal tubules, therefore,
increasing the elastic modulus, and reducing polymerization
shrinkage (Sadat-Shojai et al., 2010). Researchers in 2011 cre-
ated a novel approach to improve compressive and tensile
strength of zinc poly carboxylate, by incorporating ZnO and
MgO nanoparticles. Results revealed excellent physical and
mechanical strength when compared to conventional zinc poly
carboxylate cements (Zebarjad, 2011). Researchers concluded
that strength of cements depend on composition size scale,
clearly evident through the significant differences observed
between a nanomodified and a conventional zinc poly carboxy-
late cement in this study. Similarly, the addition of nano-hydro
xyapatite/fluoroapatite particles to glass ionomer cements, sig-
nificant increased the compressive, tensile, and biaxial flexural
strength in comparison to conventional glass ionomer cements
(Moshaverinia et al., 2008; Lucas et al., 2003).
Tribological improvements were also observed in the newly
introduced resin nano-ceramic computer-aided design and
computer-aided manufacturing (CAD/CAM) blocks. The
LavaTM ultimate resin nano ceramic blocks manufactured by
3 MTM ESPE, showed superior aesthetics, durability, and frac-
ture resistance (Chen et al., 2014). Blocks are made of a nano-
ceramic impregnated highly cured resin matrix, which can be
easily modified and customized after milling (Koller et al.,
2012). The nano-ceramics and resin hybrid created materials
with superior properties as compared to when using one or
the other.
Although some nanoparticles prove advantageous,
researchers are required to insure safety in using such materials
in everyday clinical practice, by addressing their long term bio-
compatibility, toxicity, mechanical, and physical properties.
3.3.2. Endodontics
Applications of nanotechnology in endodontics include the
incorporation of bio-ceramic nanoparticles such as bioglass,
zirconia, and glass ceramics in endodontic sealers. It has been
found that the use of nano-particles enhances the adaptation
of the adhesive to nano-irregularities, in addition to its fast set-
ting time in comparison to conventional sealers, its dimen-
sional stability, insolubility in tissue fluid, chemical bond to
tooth tissue, and osseoconductivity (Utneja et al., 2015). This
was corroborated by a recent study, testing the antibacterial
effects against endodontic biofilm, bond strength to dentine,
and the ionic release of calcium and phosphate when a novel
bioactive endodontic sealer was used (Wang et al., 2017).
The sealer was a mix of dimethylaminohexadecyl methacrylate
(DMAHDM), 2-methacryloyloxyethyl phosphorylcholine
(MPC), and amorphous calcium phosphate nanoparticles
(NACP). The sealer was able to inhibit the formation of
endodontic strains, while the nano-particles were particularly
useful in accelerating the remineralization process and in
increasing bonding strength to dentine.
111
In an effort to improve upon intracanal medicaments in
inhibiting the growth of Enterococcus faecalis, the short term
and long term effects of calcium hydroxide intracanal medica-
ment with silver nanoparticles suspension was investigated
(Afkhami et al., 2015). Its effectiveness against Enterococcus
faecalis was superior when compared to calcium hydroxide
alone, and calcium hydroxide mixed with chlorhexidine.
Nano-silver particles were significantly effective after one
week, and showing no significant antibacterial effect after
one month in comparison to the other materials used.
Researchers, therefore, concluded that nanosilver particals
proved to be an effective antibacterial agent specifically against
Enterococcus faecalis in short term. An In-vitro study con-
ducted in 2014, concluded that nanosilver particles were not
efficient in inhibiting Enterococcus faecalis after one week
(Mozayeni et al., 2014). Nano-silver particles were introduced
into a gel matrix and applied as a root canal sealer. This nano-
silver gel proved to be less efficient than chlorhexidine and tri-
ple antibiotic paste in inhibiting the spread of Enterococcus
faecalis. Researchers attributed the lack of efficiency exhibited
by the nanosilver gel to its synthesis method which was differ-
ent than that of chlorhexidine and triple antibiotic paste, in
addition to the gel consistency, which might have inhibited
the release of nanoparticles.
Studies were additionally conducted to improve upon gutta
percha (GP), by incorporating nano-diamond particles (Lee
et al., 2015). Digital radiography and micro-computed tomog-
raphy imaging revealed that obturation following a conven-
tional technique, using nanodiamond impregnated GP,
demonstrated superior chemical properties, biocompatibility,
and superior mechanical properties. Additionally, high quality
adaptation to the canal walls and minimum void formation
was reported, which demonstrates the great potential for the
use of nano-GP as an improved endodontic filling.
3.3.3. Conservative and aesthetic dentistry
The new development of a rechargeable nano-amorphous cal-
cium phosphate (nACP) filled composite resin has been
recently reported. The nanoparticles were able to not only
improve composites’ remineralising properties, it also main-
tained the same level of Ca and P release through recharge
and release (Xie et al., 2016). Researchers described it as a
‘‘smart” material through its constant ability to rapidly neu-
tralise bacterial acids released along the restoration/tooth mar-
gins through the release of Ca and P, therefore was able to
inhibit the initiation of secondary caries. This was corrobo-
rated by Wu et al., reporting a significant remineralising ability
of nACP and its effectiveness in inhibiting the initiation of sec-
ondary caries (Wu et al., 2015). Researchers also reported that
their results create a possibility for integrating nACP in other
dental materials such as luting cements and bonding agents.
This was corroborated by another study, showing a significant
remineralising ability in a dental bonding agent with nACP
through the recharge and release of Ca and P ions for up to
3 week, without altering the bonding strength to dentine
(Zhang et al., 2015).
An additional attempt to enable restorative materials to
actively prevent the initiation and progression of secondary
caries, was through the application of a nanocomposite coat-
ing consisting of lactose-modified chitosan (Chitlac) with silver
nanoparticles (nAg) (Ionescu et al., 2015). Nanoparticles were
112
evenly dispersed and were able to significantly reduce biofilm
formation on the restoration surface by 80% after 48 h of
application, in comparison to a control with no Chitlac-nAg
coating. Images obtained by Confocal Laser Scanning Micro-
scopy (CLSM) revealed that the coating had no bactericidal
activity, however, it had the ability to alter the biofilm mor-
phology, and by that inhibiting the development of mature
biofilm species.
Incorporating cross–linked quaternised polyethyleneimine
(QPEI) nanoparticles in resin composites was also reported
to have antibacterial effects against various oral pathogens,
such as Enterococcus faecalis, Streptococcus mutans, Actino-
myces viscousus, Lactobacilus casei, and whole saliva. The
addition of QPEI nanoparticles were reported to have a long
lasting antibacterial effect, stable within the matrix, and did
not leach out into the surrounding environment (Shvero
et al., 2015). The addition of QPEI nanoparticles caused the
disruption of ionic exchange through bacterial membranes
within the biofilm, and therefore, leading to cell death. Its bac-
tericidal properties might create a second generation of
restorative materials with significantly lower incidences of fail-
ure by secondary caries.
Tooth whitening agents were additionally nano-modified to
increase their whitening efficiency and minimise their harmful
side effects. Calcium peroxide nanoparticles, for instance, were
able to penetrate deeper into the tooth structure through micro
and nano cracks, leading to a longer surface contact and there-
fore an increase in the effectiveness of the whitening agent as
its deeper penetration into the tooth structure allows for a
longer action time and ultimately a significant improvement
in aesthetics when compared to a whitening agent with micro
or macro particles (Velkoborsky, 2010). Additionally, the
incorporation of nano-lipobelle H-EQ10 into the whitening
agent significantly improved the chemical and mechanical con-
dition of whitened enamel. Nano-lipobelle H-EQ10 are lipo-
somes loaded with 10% vitamin E and 5% coenzyme. The
use of nano-liposome carriers enables the delivery of higher
quantities of vitamin E and coenzymes which aid in the protec-
tion of tooth structure and the stimulation of cell regeneration
respectively (Velkoborsky, 2010).
3.3.4. Periodontics, Implantology, and regenerative dentistry
Scientists were able to create a novel drug delivery system for
the treatment of periodontal disease, through triclosan or
tetracycline loaded nanoparticles.
These nanoparticles are uniformly dispersed within a
matrix, which gradually biodegrades, releasing loaded drugs
in increments to provide a longer contact duration with the
diseased site (Sharma et al., 2016). Niosomes, for instance,
are chemically stable non-ionic vesicles, which offer a con-
trolled and targeted drug delivery with enhanced penetration
through biological tissue especially when the particles are less
than 100 nm in size (Pradeepkumar et al., 2012). Furthermore,
fullerenes have been heavily studied for their many potential
applications, one of which is its effectiveness in drug delivery.
Fullerenes are hollow carbon molecules which come in differ-
ent shapes (spheres, tubes, and ellipsoids). The buckminster-
fullerene (C60) was the first and most stable fullerene
discovered in the 1980s, which resembled the geodesic domes
designed by Buckminster Fuller, hence, named after him.
These fullerenes can be constructed by either a bottom up
R.N. AlKahtani
approach, building it atom by atom, or by a top down
approach from lager atoms, which according to the literature
proved to produce a more stable fullerene structure
(Andreoni, 2000). It was additionally used for other purposes
in the medical field, such as radical scavenging and as
antioxidants.
The literature also reports the benefits of combining a light
curable, methacrylate resin matrix, with nACP as a bone graft-
ing agent. This injectable material has the ability to strongly
adhere to wet bone, and in recrystallizing nACP to hydroxya-
patite in a matter of minutes (Pradeepkumar et al., 2012).
It has been theorised that the osseointegration of implants
within the jaw bone would be maximised if the implant surface
was mimicking the surface topography of the extracellular
matrix within natural tissue, which is typically between 10
and 100 nm in size (Tomsia et al., 2011). Published data
proved this theory, as not only surface coatings such as
hydroxyapatite, gold, silver, and titanium oxide nanoparticles
have the ability to improve the adhesion of the fibrin clot
which serves as a bridge for osteogenic cells and the overall
osseointegration of implants, the presence of mechanical
nano-features such as nano-grooves or nano pillars have been
proved effective as well, with particular emphasis on the distri-
bution and order of such features on the implant surface
(Tomsia et al., 2011; Cheng et al., 2012; Besinis et al., 2017).
4. Nano-products
Various range of nano-additives have been introduced into
many commercially available products, making it overwhelm-
ingly difficult for dentists to choose from. Commonly used
commercially available nanomaterials, and studies on their
nano-additives in Table 2 will shed some light on the effective-
ness of such nanomaterials in comparison to their conven-
tional counterparts.
5. Conclusion
The science and applications of nanotechnology are constantly
evolving as we witness new products being introduced into the
market. This comes with great responsibility to insure the
safety, efficiency, and applicability of such new technologies.
Their level of effectiveness as shown in the literature diverge,
being more effective than some materials and less effective
than others. Although nanomaterials generally offer superior
aesthetics and polishability, their mechanical properties fall
short in comparison to microfilled resin composites for exam-
ple. Therefore, the choice to use nanomaterials is dependent on
the clinical scenario and tooth to be restored, paying close
attention to aesthetic demand, loading, and the presence of
any risk factors such as parafunctional habits. Research to
improve upon existing nanomaterials is still ongoing, with
future directions towards more efficient and cost effective
nano-biosensing devices to diagnose in high accuracy oral can-
cer for example, in addition to new oral drug delivery systems
to disrupt biofilm formation and reduce the incidence of caries
and periodontal disease. Although the science behind nan-
otechnology is intriguing, the lack of long term clinical evi-
dence addressing their clinical performance restricts their
wide clinical use.
The implications and applications of nanotechnology in dentistry 113

Table 2 Commonly used commercially available nanomaterials.

Discipline Classification Material Brand Nanoparticles Literature
Prosthodontics Denture Nano- NHC SR Silicon oxide – Significantly higher wear in comparison
teeth hybrid PhonaresÒ; Ivoclar to interpenetrating polymer network (IPN)
composite Vivadent and double crosslinking
polymethylmethacrylate (PMMA) denture
teeth (Munshi et al., 2015)
Veracia (Shofu, Spherical pre-polymerised – Superior to conventionally used
Kyoto, Japan) silica composites and acrylics in regards to
hardness, smoothness, and stain resistance.
However, its hardness was less than
microfilled and double crosslinked acrylics.
(Kumar and Seshan, 2014)
– Higher hardness values and more wear
resistant than acrylic, with comparable
results to cross-linked and microfilled
composites. (Suzuki, 2004)
Conservative Restorations Nano- KetacTM Nano Zirconia/silica nanofillers – Higher shear bond strength to enamel
Resin 3M ESPE & nanoclusters compared to GIC, and glass carbomer.
modified (Shebl et al., 2015)
GIC – Comparable fluoride release to conven-
tional RMGIC (Paschoal et al., 2011)
– Comparable micro-leakage levels to high
viscosity GIC in class five cavities. (Eronat
et al., 2014)
Nano- Herculite XR Ultra, Nanosilica – Both materials exhibited high gloss values
Composite Kerr in comparison to micro-hybrid composites.
Resins Tetric Evo ceram, SO2 spherical nanofillers – Nanocomposites were not mechanically
IvoclarVivadent superior to micro-hybrids (Flexural
strength, flexural modulus, and
compressive strength). (Khalid, 2012)
Filtek Supreme – Non-aggregated 20 nm – Lower compressive strength in
(3M) silica filler, comparison to hybrid composite resin
– Non- aggregated 4 to 11 (Moezzyzadeh, 2012)
nm zirconia filler. – Superior diametral tensile strength, and
– Aggregated zirconia/ flexural strength, and comparable com-
silica cluster filler (20 nm pressive strength, wear volume, and poly-
silica and 4 to 11 nm merisation shrinkage to microfilled and
zirconia). microhybrid composites (Lu et al., 2006)
Ceram.xÒ MonoTM Organically modified nano – Comparable compressive strength in
and Ceram.xÒ sized ceramic fillers comparison to hybrid composite. (Hegde
DuoTM. Dentsply comprising polysiloxane et al., 2011)
backbone (10 nm) – Ceramic nanoparticles produce restora-
tions with high translucency and polish
comparable to microfilled resins, and
superior physical properties and wear
resistance comparable to hybrid compos-
ites. (Mitra et al., 2003)
TM
Nano-GIC GCP Glass Fill , Carbomised fluorapatite/ – Lower hardness and bond strength to
GCP Dental. hydroxyapatite nano dentine than high viscosity GIC. (Olegário
particles et al., 2015)
– Lowest surface roughness values in
comparison to GIC and RMGIC
(Arslanoglu et al., 2015)
Cavity Mineral NanoCare goldÒ Spherical silver – Moderately anti-bacterial.
Disinfectant solution DNTTM nanoparticles (48 nm) – The aggregation of nanoparticles will
possibly cause an interaction with the
restorative material (Mackiewicz and
Olczak-Kowalczyk, 2014)
Endodontics Sealer Silicon GuttaFlowTM Nano-silver – Comparable sealing ability to AH Plus
based Colténe-Whaledent (Patil et al., 2016)
– The sealing ability is double that of AH
plus after 9 weeks (De-Deus et al., 2007)
(continued on next page)
114
Table 2 (continued)
Discipline Classification Material Brand
Periodontics Grafts Bone grafts NanoBoneÒArtoss
GmbHÒ
Ostims, Heraeus
Kulzer, Hanau,
Germany
Implantology Nano- – NonoTite BIOMET
implant 3i
coating
Conflict of interest
The author has no conflict of interest to declare.
References
Afkhami, F., Pourhashemi, S.J., Sadegh, M., Salehi, Y., Fard, M.J.K.,
2015. Antibiofilm efficacy of silver nanoparticles as a vehicle for
calcium hydroxide medicament against Enterococcus faecalis. J.
Dentistry 43 (12), 1573–1579.
Ahmed, M.A., Ebrahim, M.I., 2014. Effect of zirconium oxide nano-
fillers addition on the flexural strength, fracture toughness, and
hardness of heat-polymerized acrylic resin. World J. Nano Sci. Eng.
Andreoni, W., 2000. The Physics of Fullerene-based and Fullerene-
related Materials. Springer Science & Business Media.
Anisa, M., Abdallah, S.D., Peter, A.S., 2003. ’Mind the gap’: science
and ethics in nanotechnology. Nanotechnology 14 (3), R9.
Arlett, J., Myers, E., Roukes, M., 2011. Comparative advantages of
mechanical biosensors. Nat. Nanotechnol. 6 (4), 203–215.
Arslanoglu, Z., Altan, H., Sahin, O., Tekin, M., Adigüzel, M., 2015.
Evaluation of surface properties of four tooth-colored restorative
materials. Acta Phys. Polon. A 128 (2B).
Besinis, A., Hadi, S., Le, H., Tredwin, C., Handy, R., 2017.
Antibacterial activity and biofilm inhibition by surface modified
titanium alloy medical implants following application of silver,
titanium dioxide and hydroxyapatite nanocoatings. Nanotoxicol-
ogy 11 (3), 327–338.
Binns, C., 2010. Introduction to nanoscience and nanotechnology.
John Wiley & Sons.
Brey, P.A.E., 2012. Anticipatory ethics for emerging technologies.
NanoEthics 6 (1), 1–13.
Buffat, P., Borel, J.P., 1976. Size effect on the melting temperature of
gold particles. Phys. Rev. A 13 (6), 2287–2298.
Chen, C., Trindade, F.Z., de Jager, N., Kleverlaan, C.J., Feilzer, A.J.,
2014. The fracture resistance of a CAD/CAM Resin Nano Ceramic
(RNC) and a CAD ceramic at different thicknesses. Dental Mater.
30 (9), 954–962.
Cheng, Z., Guo, C., Dong, W., He, F.-M., Zhao, S.-F., Yang, G.-L.,
2012. Effect of thin nano-hydroxyapatite coating on implant
osseointegration in ovariectomized rats. Oral Surgery, Oral Med.,
Oral Pathol. Oral Radiol. 113 (3), e48–e53.
Chitsazi, M.-T., Shirmohammadi, A., Faramarzie, M., Pourabbas, R.,
Rostamzadeh, A., 2011. A clinical comparison of nano-crystalline
hydroxyapatite (Ostim) and autogenous bone graft in the treatment
of periodontal intrabony defects. Med. Oral Patol. Oral Cir. Bucal.
16 (3), 448–453.
R.N. AlKahtani
Nanoparticles Literature
Nanocrystalline – Comparable to BioOssÒ in its low
hydroxyapatite cytotoxicity and good biocompatibility. It
additionally exhibited superior MTT
proliferation results (Liu et al., 2011)
Nanocrystalline – Comparable clinical results in cases of
hydroxyapatite two and three wall intra-bony defects to
autogenous bone grafts. (Chitsazi et al.,
2011)
Nano-hydroxyapatite – Clinically favorable osseointegration with
(around 50% of total minimum marginal bone loss (1.01 mm),
surface area) however studies were not randomized, had
no controls, and were followed up for only
one year (Smeets et al., 2016)
Clark, H.A., Hoyer, M., Philbert, M.A., Kopelman, R., 1999. Optical
nanosensors for chemical analysis inside single living cells. 1.
Fabrication, characterization, and methods for intracellular deliv-
ery of PEBBLE sensors. Anal. Chem. 71 (21), 4831–4836.
Clark, L.C., Lyons, C., 1962. Electrode systems for continuous
monitoring in cardiovascular surgery. Ann. New York Acad. Sci.
102 (1), 29–45.
Danelon, M., Pessan, J.P., Neto, F.N.S., de Camargo, E.R., Delbem,
A.C.B., 2015. Effect of toothpaste with nano-sized trimetaphos-
phate on dental caries: in situ study. J. Dentistry 43 (7), 806–813.
De-Deus, G., Brandao, M.C., Fidel, R.A., Fidel, S.R., 2007. The
sealing ability of GuttaFlow in oval-shaped canals: an ex vivo study
using a polymicrobial leakage model. Int. Endodontic J. 40 (10),
794–799.
Ebadifar, A., Nomani, M., Fatemi, S.A., 2017. Effect of nano-
hydroxyapatite toothpaste on microhardness ofartificial carious
lesions created on extracted teeth. J. Dental Res., Dental Clin.,
Dental Prospects 11 (1), 14–17.
Eronat, N., Yilmaz, E., Kara, N., Topaloglu, A.A., 2014. Comparative
evaluation of microleakage of nano-filled resin-modified glass
ionomer: an in vitro study. Eur. J. Dentistry 8 (4), 450–455.
Fisher, E., Mahajan, R.L., 2006. Contradictory intent? US federal
legislation on integrating societal concerns into nanotechnology
research and development. Sci. Public Policy 33 (1), 5–16.
Foster, L.E., 2005. Nanotechnology: Science, Innovation, and Oppor-
tunity. Prentice Hall PTR.
Gad, M., ArRejaie, A.S., Abdel-Halim, M.S., Rahoma, A., 2016. The
reinforcement effect of nano-zirconia on the transverse strength of
repaired acrylic denture base. Int. J. Dentistry 2016, 7094056.
Garner, S.J., Nobbs, A.H., McNally, L.M., Barbour, M.E., 2015. An
antifungal coating for dental silicones composed of chlorhexidine
nanoparticles. J. Dentistry 43 (3), 362–372.
Gupta, N., Fischer, A.R.H., Frewer, L.J., 2015. Ethics, risk and
benefits associated with different applications of nanotechnology: a
comparison of expert and consumer perceptions of drivers of
societal acceptance. Nanoethics 9 (2), 93–108.
Hasanzadeh, M., Shadjou, N., 2016. Electrochemical nanobiosensing
in whole blood: recent advances. TrAC Trends Anal. Chem. 80,
167–176.
Hegde, M.N., Hegde, P., Bhandary, S., Deepika, K., 2011. An
evalution of compressive strength of newer nanocomposite: an
in vitro study. J. Conserv. Dentistry 14 (1), 36.
Hester, K., Mullins, M., Murphy, F., Tofail, S.A.M., 2015. Anticipa-
tory Ethics and Governance (AEG): towards a future care
orientation around nanotechnology. NanoEthics 9 (2), 123–136.
Ionescu, A., Brambilla, E., Travan, A., Marsich, E., Donati, I., Gobbi,
P., et al, 2015. Silver–polysaccharide antimicrobial nanocomposite
The implications and applications of nanotechnology in dentistry
coating for methacrylic surfaces reduces Streptococcus mutans
biofilm formation in vitro. J. Dentistry 43 (12), 1483–1490.
Joy, B., 2000. Why the future doesn’t need us. Nanoethics The Ethical
and Social Implications of Nanotechnology, pp. 17–30.
Kanaparthy, R., Kanaparthy, A., 2011. The changing face of dentistry:
nanotechnology. Int. J. Nanomed. 6, 2799–2804.
Kani, T., Kani, M., Isozaki, A., Shintani, H., Ohashi, T., Tokumoto,
T., 1989. Effect to apatite-containing dentifrices on dental caries in
school children. J. Dental Health 39 (1), 104–109.
Khalid, A., 2012. Physical properties of dental resin nanocomposites.
University of Manchester https://www.escholar.manchester.ac.uk/
api/datastream?publicationPid=uk-ac-man-scw:156407&datas-
treamId=FULL-TEXT.PDF.
Khushf, G., 2006. An Ethic for Enhancing Human Performance
through Integrative Technologies. Managing Nano-Bio-Info-
Cogno Innovations. Springer, pp. 255–278.
Koller, M., Arnetzl, G.V., Holly, L., Arnetzl, G., 2012. Lava ultimate
resin nano ceramic for CAD/ CAM: customization case study. Int.
J. Comput. Dentistry 15 (2), 159–164.
Kumar, A., 2000. Biosensors based on piezoelectric crystal detectors:
theory and application. JOM-e 52 (10), 1–6.
Kumar, R., Seshan, S., 2014. Microhardness evaluation of nano-
composite denture teeth. Int. J. Curr. Res. Rev. 6 (6), 58.
Kurzweil, R., 2005. The Singularity is Near: When Humans Transcend
Biology. Penguin.
Lee, D.-K., Kim, S.V., Limansubroto, A.N., Yen, A., Soundia, A.,
Wang, C.-Y., et al, 2015. Nanodiamond–gutta percha composite
biomaterials for root canal therapy. ACS Nano 9 (11), 11490–
11501.
Li, L., Pan, H., Tao, J., Xu, X., Mao, C., Gu, X., et al, 2008. Repair of
enamel by using hydroxyapatite nanoparticles as the building
blocks. J. Mater. Chem. 18 (34), 4079–4084.
Liu, Q., Douglas, T., Zamponi, C., Becker, S.T., Sherry, E., Sivanan-
than, S., et al, 2011. Comparison of in vitro biocompatibility of
NanoBoneÒ and BioOssÒ for human osteoblasts. Clin. Oral
Implants Res. 22 (11), 1259–1264.
Lu, H., Lee, Y., Oguri, M., Powers, J., 2006. Properties of a dental
resin composite with a spherical inorganic filler. Operat. Dentistry
31 (6), 734–740.
Lucas, M.E., Arita, K., Nishino, M., 2003. Toughness, bonding and
fluoride-release properties of hydroxyapatite-added glass ionomer
cement. Biomaterials 24 (21), 3787–3794.
Mackiewicz, A., Olczak-Kowalczyk, D., 2014. Microscopic evaluation
of surface topography and chemical composition of Nanocare
Gold. J. Stomatol. (Czasopismo Stomatologiczne) 1 (67), 826–840.
Macnaghten, P., Kearnes, M.B., Wynne, B., 2005. Nanotechnology,
governance, and public deliberation: what role for the social
sciences? Sci. Commun. 27 (2), 268–291.
Mitra, S.B., Wu, D., Holmes, B.N., 2003. An application of
nanotechnology in advanced dental materials. J. Am. Dental
Assoc. 134 (10), 1382–1390.
Moezzyzadeh, M., 2012. Evaluation of the compressive strength of
hybrid and nanocomposites. JDS 1, 24–29.
Moshaverinia, A., Ansari, S., Movasaghi, Z., Billington, R.W., Darr,
J.A., Rehman, I.U., 2008. Modification of conventional glass-
ionomer cements with N-vinylpyrrolidone containing polyacids,
nano-hydroxy and fluoroapatite to improve mechanical properties.
Dent Mater. 24 (10), 1381–1390.
Mozayeni, M.A., Haeri, A., Dianat, O., Jafari, A.R., 2014. Antimi-
crobial effects of four intracanal medicaments on enterococcus
faecalis: an in vitro study. Iranian Endod. J. 9 (3), 195–198.
Munshi, N., Rosenblum, M., Jiang, S., Flinton, R., 2015. In Vitro
Wear resistance of nano-hybrid composite denture teeth. J.
Prosthodontics.
Olegário, I.C., Malagrana, A.P.V.F.P., Kim, S.S.H., Hesse, D.,
Tedesco, T.K., Calvo, A.F.B., et al, 2015. Mechanical properties
of high-viscosity glass ionomer cement and nanoparticle glass
carbomer. J. Nanomaterials 16 (1), 37.
115
Paschoal, M.A.B., Gurgel, C.V., Rios, D., Magalhães, A.C., Buzalaf,
M.A.R., Machado, M.A.d.A.M., 2011. Fluoride release profile of a
nanofilled resin-modified glass ionomer cement. Brazilian Dental J.
22 (4), 275–279.
Patil, P., Rathore, V.P., Hotkar, C., Savgave, S.S., Raghavendra, K.,
Ingale, P., 2016. A comparison of apical sealing ability between
GuttaFlow and AH plus: an in vitro study. J. Int. Soc. Prevent.
Community Dentistry 6 (4), 377.
Pradeepkumar, Y., Panishankar, K., Saraswathi, P., Saravanan, A.,
2012. Current research in Nano periodontics. SRM J. Res. Dental
Sci. 3 (1), 46.
Ramsay, S., 2001. Ethical implications of research on the human
genome. The Lancet 357 (9255), 535.
Raval, C., Vyas, K., Gandhi, U., Patel, B., Patel, P., 2016. Nanotech-
nology in dentistry: a review. J. Adv. Med. Dental Sci. Res. 4 (3),
51.
Resnik, D.B., Tinkle, S.S., 2007. Ethics in nanomedicine. Nanomedi-
cine (London, England). 2 (3), 345–350.
Robinson, C., Connell, S., Kirkham, J., Shore, R., Smith, A., 2004.
Dental enamel—a biological ceramic: regular substructures in
enamel hydroxyapatite crystals revealed by atomic force micro-
scopy. J. Mater. Chem. 14 (14), 2242–2248.
Sadat-Shojai, M., Atai, M., Nodehi, A., Khanlar, L.N., 2010.
Hydroxyapatite nanorods as novel fillers for improving the
properties of dental adhesives: Synthesis and application. Dental
Mater. 26 (5), 471–482.
Sagadevan, S., Periasamy, M., 2014. Recent trends in nanobiosensors
and their applications – a review. Rev. Adv. Mater. Sci. 36, 62–69.
Sharma, V.K., Trivedi, H., Bey, A., Gupta, N., 2016. Nanotechnology:
rise of a new era in periodontics. Univ. J. Dental Sci.
Shebl, E.A., Etman, W.M., Genaid, T.M., Shalaby, M.E., 2015.
Durability of bond strength of glass-ionomers to enamel. Tanta
Dental J. 12 (1), 16–27.
Shvero, D.K., Zatlsman, N., Hazan, R., Weiss, E.I., Beyth, N., 2015.
Characterisation of the antibacterial effect of polyethyleneimine
nanoparticles in relation to particle distribution in resin composite.
J. Dentistry 43 (2), 287–294.
Smeets, R., Stadlinger, B., Schwarz, F., Beck-Broichsitter, B., Jung,
O., Precht, C., et al, 2016. Impact of dental implant surface
modifications on osseointegration. BioMed Res. Int. 2016.
Stander, L., Theodore, L., 2011. Environmental implications of
nanotechnology—an update. Int. J. Environ. Res. Public Health
8 (2), 470–479.
Stone, V., Hankin, S., Aitken, R., Aschberger, K., Baun, A.,
Christensen, F., et al, 2010. Engineered Nanoparticles: Review of
Health and Environmental Safety (ENRHES). Project Final
Report. European Commission.
Su, M., Li, S., Dravid, V.P., 2003. Microcantilever resonance-based
DNA detection with nanoparticle probes. Appl. Phys. Lett. 82 (20),
3562–3564.
Sun, L., Chow, L.C., 2008. Preparation and properties of nano-sized
calcium fluoride for dental applications. Dental Mater.: Off. Publ.
Acad. Dental Mater. 24 (1), 111–116.
Suzuki, S., 2004. In vitro wear of nano-composite denture teeth. J.
Prosthodontics 13 (4), 238–243.
Tao, J., Pan, H., Zeng, Y., Xu, X., Tang, R., 2007. Roles of
amorphous calcium phosphate and biological additives in the
assembly of hydroxyapatite nanoparticles. J. Phys. Chem. B 111
(47), 13410–13418.
Tomsia, A.P., Launey, M.E., Lee, J.S., Mankani, M.H., Wegst, U.G.
K., Saiz, E., 2011. Nanotechnology approaches for better
dental implants. Int. J. Oral Maxillofacial Implants 26 (Suppl),
25–49.
Totu, E.E., Nechifor, A.C., Nechifor, G., Aboul-Enein, H.Y.,
Cristache, C.M., 2017. Poly (methyl methacrylate) with TiO 2
nanoparticles inclusion for stereolitographic complete denture
manufacturing the fututre in dental care for elderly edentulous
patients? J. Dentistry 59, 68–77.
116
Touhami, A., 2014. Biosensors and nanobiosensors: design and
application. Nanomedicine, 374–400.
Utneja, S., Nawal, R.R., Talwar, S., Verma, M., 2015. Current
perspectives of bio-ceramic technology in endodontics: calcium
enriched mixture cement - review of its composition, properties and
applications. Restorative Dentistry Endod. 40 (1), 1–13.
Velkoborsky, V., inventor, 2010. Google Patents, assignee. Toothpaste
patent US20100239618 A1.
Wang, L., Xie, X., Li, C., Liu, H., Zhang, K., Zhou, Y., et al, 2017.
Novel bioactive root canal sealer to inhibit endodontic multispecies
biofilms with remineralizing calcium phosphate ions. J. Dentistry.
Wu, J., Zhou, H., Weir, M.D., Melo, M.A.S., Levine, E.D., Xu, H.H.,
2015. Effect of dimethylaminohexadecyl methacrylate mass
R.N. AlKahtani
fraction on fracture toughness and antibacterial properties of
CaP nanocomposite. J. Dentistry 43 (12), 1539–1546.
Xie, X., Wang, L., Xing, D., Arola, D.D., Weir, M.D., Bai, Y.,
et al, 2016. Protein-repellent and antibacterial functions of a
calcium phosphate rechargeable nanocomposite. J. Dentistry 52,
15–22.
Zebarjad, S.M., 2011. Synthesis and characterization of nanoparticles
and nanocomposite of ZnO and MgO by sonochemical method and
their application for zinc polycarboxylate dental cement prepara-
tion. Int. Nano Lett.
Zhang, L., Weir, M.D., Hack, G., Fouad, A.F., Xu, H.H., 2015.
Rechargeable dental adhesive with calcium phosphate nanoparti-
cles for long-term ion release. J. Dentistry 43 (12), 1587–1595.
Implikasi dan aplikasi dari nanoteknologi dalam kedokteran gigi:

Pengantar

Nanoteknologi adalah seni dan ilmu rekayasa material dalam skala

kurang dari 100 nm (Anisa dkk., 2003). Ini merevolusi bidang medis dan
gigi dengan meningkatkan sifat mekanik dan fisik bahan, membantu
memperkenalkan modalitas diagnostik baru dan sistem pengiriman nano
(Kanaparti dan Kanaparthy, 2011).
Pedoman pertama yang dikembangkan di bidang nanoteknologi adalah
oleh K Eric Drexler dari institut pandangan ke depan. Ia
mempresentasikan ilmu nanoteknologi kepada publik melalui bukunya
yang diterbitkan Engines of Creation (Anisa dkk., 2003). Dalam upaya
menciptakan nanoteknologi ramah lingkungan yang dapat diterima secara
sosial, Institut Riset Genom Manusia Nasional Amerika Serikat
mengusulkan pendekatan baru untuk proses pengembangan teknologi
baru. Ini dicapai dengan mengatasi implikasi etika, hukum, dan sosial
sebelum produk nano mencapai pasar untuk dengan mudah dimodifikasi
dan disesuaikan selama tahap awal produksi (Ramsay, 2001;
Macnaghten et al., 2005).
Penelitian yang sedang berlangsung di bidang nano, adalah karena
sifat unik yang ditawarkan nanopartikel. Atom adalah blok bangunan
dalam jaringan biologis, dan atom-atom ini diukur menggunakan skala
nano. Memperkenalkan partikel berukuran nano memungkinkan interaksi
pada tingkat molekuler, dengan meningkatkan efisiensi dan afinitas
keseluruhan dibandingkan dengan molekul biologis yang berinteraksi
dengan partikel berukuran mikro atau makro (Li dkk., 2008). Rasio
permukaan terhadap inti yang tinggi, merupakan karakteristik fisik yang
unik dalam nanopartikel, yang berarti bahwa ada lebih banyak atom di
permukaan nanopartikel daripada jauh di dalam intinya. Ini sangat
berguna karena atom permukaan memiliki permukaan yang tidak terikat
dibandingkan dengan atom inti, dengan potensi untuk menciptakan ikatan
baru dan kuat, dan ayam, nanopartikel lebih reaktif dibandingkan dengan
 partikel mikro dan makro yang memiliki lebih banyak inti daripada atom
permukaan.Binn, 2010).
Dibandingkan dengan material yang sama dalam jumlah besar (makro
atau mikro), partikel nano dapat dengan mudah diatur dalam sejumlah
konfigurasi pengepakan karena rasio permukaan terhadap inti yang
tinggi, membuatnya mudah dimanipulasi dan digunakan dalam berbagai
aplikasi. Getaran termal yang lebih besar yang diekspresikan oleh atom
permukaan dibandingkan dengan atom inti dalam bahan apa pun terlepas
dari ukuran partikel, berkontribusi pada suhu leleh yang lebih rendah
dalam bahan nano dibandingkan dengan bahan yang sama dalam jumlah
besar (Buffat dan Borel, 1976). Ini mungkin sangat penting ketika
menggunakan nanomaterial untuk membuat mahkota porcelain fused to
metal (PFM), pasak dan inti cor, atau kerangka gigi tiruan.
Banyak penulis menerbitkan artikel ulasan yang membahas potensi
nanoteknologi dalam kedokteran gigi termasuk bahan yang baru
dikembangkan, namun literatur tidak memiliki ulasan. membahas ilmu di
balik nanoteknologi secara rinci dan menghubungkannya dengan
implikasi dan aplikasi nanoteknologi di bidang ilmu kedokteran gigi (Mitra
dkk., 2003; Raval dkk., 2016). Tinjauan ini membahas ilmu pengetahuan,
implikasi, dan aplikasi terbaru dari nanoteknologi dalam kedokteran gigi,
termasuk bahan yang baru dikembangkan dan literatur pendukung yang
tersedia secara komersial untuk membantu dokter gigi dalam memahami
relevansi klinis dan efektivitas bahan tersebut dibandingkan dengan yang
ada saat ini. digunakan dalam praktek klinis.

Implikasi nanoteknologi
Implikasi etis
Setelah fase penelitian dan pengembangan nanoproduk gigi atau medis
apa pun, produk ini menjalani pengujian in vitro praklinis yang ekstensif
untuk menyelidiki sifat mekanik, toksikologi, dan imunologinya. Banyak
lembaga seperti Badan Perlindungan Lingkungan AS dan Institut
Nasional Keselamatan dan Kesehatan Kerja telah memperkenalkan
pedoman untuk menyelidiki risiko bahan nano (Resnik dan Tinkle, 2007).
Namun, mengembangkan kerangka peraturan multidisiplin untuk menilai
 dan mengontrol nanoteknologi dan menyelesaikan masalah etika yang
termasuk dalam empat kategori: metafisik, kesetaraan, privasi, dan
keamanan merupakan tantangan legislatif yang konstan (Hester dkk.,
2015). Meskipun penelitian pada hewan memberikan pemahaman yang
masuk akal tentang apa yang diharapkan ketika memulai uji coba fase I,
reaksi merugikan yang serius telah dicatat ketika subjek manusia terkena
dosis nanomedicine 500 kali lebih sedikit dari batas toksik yang tercatat
dalam penelitian pada hewan (Resnik dan Tinkle, 2007). Oleh karena itu,
subjek harus memahami tingkat risiko yang terkait dengan paparan
bahan baru dan papan pemantauan data dan keamanan harus ditunjuk
di setiap uji klinis, untuk melacak dan mencatat efek samping yang
merugikan sejak dini, mendeteksi inkonsistensi dalam penanganan data,
dan menjamin keselamatan dan kesejahteraan subjek uji (Resnik dan
Tinkle, 2007). Ketidakpastian bahan nano menciptakan dilema etika bagi
dokter gigi ketika dihadapkan dengan berbagai macam bahan untuk
dipilih, beberapa memiliki rekam jejak yang sangat panjang yang
mendukung penggunaan klinisnya seperti resin komposit hibrid atau
micro-filled dan lainnya seperti resin komposit nano-filled. yang menarik
dalam konsep dan didukung oleh studi klinis jangka pendek. Proses
pengambilan keputusan etis tradisional yang diikuti, terutama
utilitarianisme, tidak dapat mengikuti langkah cepat dan masa depan
yang tidak pasti dari perkembangan teknologi nano. Untuk itu, diperlukan
pemahaman ilmu yang lebih mendalam, termasuk analisis risiko/manfaat
dan pertimbangan etis selama proses pengembangan. Ini mengarah
pada usulan konsep etika dan tata kelola antisipatif, yang dikembangkan
untuk mengidentifikasi dan mengatasi implikasi etis dan sosial melalui
model analisis etis ketika teknologi berada dalam tahap pengenalan
untuk kemudian dengan mudah dimodifikasi dan dipandu menuju hasil
yang dapat diterima secara etis (Hester dkk., 2015; Brey, 2012; Khushf,
2006).

Nanoteknologi dan masyarakat

Karena masyarakat adalah konsumen, pihak pendanaan, dan kebijakan
dan pengambil keputusan, sikap publik terhadap nanoteknologi
memainkan peran mendasar dalam keberhasilan dan kegagalannya,
dengan kata lain masyarakat adalah hakim dan juri. Hal ini didorong oleh
etika, moral, dan nilai-nilai yang baru-baru ini menjadi lebih menerima
teknologi pemicu baru karena manfaat yang dirasakan lebih besar
daripada risiko yang dirasakan (Gupta dkk., 2015). Namun,Meskipun
nanoteknologi saat ini terintegrasi dalam bidang yang secara langsung
mempengaruhi publik seperti dalam pasokan energi, perawatan kesehatan
dan diagnostik, telekomunikasi, dan pengendalian polusi, hal ini telah
menciptakan ketakutan karena kemajuan ini mungkin merugikan ribuan
pekerjaan publik untuk mengakomodasi lebih banyak pekerjaan. sistem
yang bergantung pada mesin (Kurzweil, 2005). Dalam upaya untuk
mengatasi masalah sosial, berbagai inisiatif dilakukan untuk menjembatani
kesenjangan antara masyarakat dan nanosains. Laporan National
Nanotechnology Initiative mengklaim bahwa kemajuan teknologi akan
membutuhkan generasi baru pekerja terlatih dengan seperangkat
keterampilan operasional dan manajerial yang canggih (Macnaghten dkk.,
2005). Pada tahun 2003, Teknolog Ray Kurzweil mengklaim bahwa:
''Sistem manufaktur portabel akan dapat menghasilkan hampir semua
produk fisik dari informasi untuk sen per pon, sehingga menyediakan
kebutuhan fisik kita hampir tanpa biaya'' (Fisher dan Mahajan, 2006). Ini
panggilan untuk keterlibatan segera dengan publik untuk mengatasi
masalah dan menyebarkan kesadaran pada aplikasi nanoteknologi saat ini
dan masa depan untuk mendapatkan dan mempertahankan dukungan
publik.

Implikasi kesehatan

Kerangka kerja empat tahap telah diadopsi oleh badan federal dan negara
bagian AS untuk menilai dan mengevaluasi besarnya masalah kesehatan
apa pun, dimulai dengan identifikasi masalah, diikuti dengan penilaian
respons dosis, penilaian paparan, dan diakhiri dengan karakterisasi
risiko.Stander dan Theodore, 2011). Efek nanomaterial sangat bergantung
pada ukuran, yang berarti bahwa partikel berukuran 100 nm yang tidak
beracun dapat secara dramatis berubah menjadi elemen beracun ketika
ukurannya berkurang menjadi 1 nm misalnya dan sebaliknya.
Nanomaterial yang tidak beracun dapat hancur atau beragregasi
membentuk nanopartikel beracun juga. Ketidakpastian bagaimana tubuh
kita bereaksi terhadap nanomaterial tidak hanya bergantung pada ukuran
tetapi juga pada bagaimana sistem kekebalan kita bereaksi terhadap
produk nano, karena penelitian telah menunjukkan bahwa nanopartikel
dapat bereaksi secara berbeda dalam kultur sel daripada dalam
organisme.
Penelitian telah menunjukkan bahwa nanopartikel dapat dihirup dan
dapat melintasi membran sel dan mencapai hati, kelenjar getah bening,
limpa, dan sumsum tulang.Resnik dan Tinkle, 2007). Meskipun klaim efek
nano-toksik setelah inhalasi telah diungkapkan dengan jelas, literatur tidak
memiliki bukti ilmiah yang kuat yang mengkonfirmasi atau menyangkal
klaim ini (Stone dkk., 2010). Oleh karena itu, meskipun perusahaan swasta
tidak diharuskan untuk melakukan studi pasca pemasaran pada produk
mereka, badan pemerintah harus mensponsori dan mendorong studi
tersebut untuk menyelidiki. efek jangka panjang dari nanomaterials dan
melaporkan setiap efek samping yang merugikan kepada badan
legislatif dan regulator seperti Food and Drug Administration (FDA) AS.
Studi tentang implikasi etika, sosial, dan kesehatan dari nanoteknologi
tertinggal jauh di belakang ilmu pengetahuan, dan terlepas dari
ketersediaan dana, upaya serius untuk mempertimbangkan masalah
yang dihadapi gagal, alih-alih potongan hype dan kontroversi yang
hanya menambah kebingungan publik dan ketidakpercayaan
mengganggu teknologi baru yang ada, atau yang disebut oleh Bill Joy
''grey goo'' (Sukacita, 2000).

Aplikasi nanoteknologi dalam kedokteran gigi

Diagnostik gigi

Dalam upaya untuk meningkatkan diagnostik medis, konsep nano-

biosensing diperkenalkan. Sebuah biosensor adalah ''perangkat analitik
yang menggabungkan elemen aktif biologis dengan transduser fisik yang
sesuai untuk menghasilkan sinyal terukur yang sebanding dengan
konsentrasi spesies kimia dalam semua jenis sampel" (Touhami, 2014).
Biosensor diperkenalkan pada tahun 1962 olehClark dan Lyons
(1962),diikuti oleh penelitian ekstensif yang sedang berlangsung dan
pengembangan teknologi yang menjanjikan ini dengan memanfaatkan
berbagai prinsip deteksi, yang mengarah ke aplikasi potensial dalam
kesehatan masyarakat, pemantauan lingkungan, dan keamanan
panganTabel 1)(Touhami, 2014). Dalam upaya untuk meningkatkan
proses biorecognition dan kinerja bioreseptor secara keseluruhan,
nanobioreceptors diperkenalkan, menggabungkan nanotube, nanowires,
dan nano-dots dalam perakitan penginderaan (Sagadevan dan
Periasamy, 2014).
Nanopartikel dibuat dengan mengikuti pendekatan top down, bottom
up, atau molekul self-assembly (Mengasuh, 2005). Mengganti partikel
berukuran mikro dengan yang berukuran nano mengubah biosensor
menjadi nanobiosensor, dengan keuntungan mengidentifikasi jaringan
biologis yang ditargetkan secara cepat pada tingkat molekul yang
sangat rendah. Sensitivitasnya yang tinggi sangat berguna dalam
kasus diagnosis kanker misalnya, karena nanobiosensor
dibandingkan dengan biosensor konvensional mampu mendeteksi
molekul sel kanker pada tahap yang sangat awal dan dalam konsentrasi
yang sangat rendah (Touhami, 2014; Asuhan, 2005). Nanobiosensor
juga sesuai secara mekanis, karena mudah dipindahkan dan berubah
bentuk sebagai respons terhadap gaya yang sangat rendah, oleh karena
itu, cukup sensitif untuk mendeteksi pemutusan ikatan kimia (Arlett et al.,
2011). Ini dikaitkan dengan ukuran nanonya efek, karena rasio luas
permukaan terhadap inti yang tinggi meningkatkan tingkat sensitivitas,
sifat listrik, dan waktu respons biosensor (Sagadevan dan Periasamy,
2014).
Nanopartikel logam seperti emas, perak, platinum, dan paladium
umumnya tergabung dalam sistem transduksi/bioresepsi nanobiosensor
karena mereka dapat bereaksi cepat dengan sebagian besar molekul
biologis tanpa mempengaruhi aktivitasnya.Sagadevan dan Periasamy,
2014). Nanopartikel emas telah dipelajari secara mendalam,
mengungkapkan kemampuan untuk meningkatkan sinyal elektronik
ketika bioreseptor mendeteksi analit pada konsentrasi yang sangat
rendah, misalnya, bioreseptor DNA modifikasi nanopartikel emas
mendeteksi analit pada konsentrasi serendah 0,05 nm (Su et al., 2003).
Selain itu, nanotube karbon digunakan untuk mendeteksi sel-sel kanker
yang bersirkulasi di dalam tubuh. Nanotube karbon disusun dengan
teknik perakitan lapis demi lapis dan kemudian dihubungkan secara
kimia dengan antibodi penanda karsinogenik spesifik yang secara
spesifik mengikat sel kanker, sehingga menyediakan alat diagnostik yang
efektif dan berguna (Hasanzadeh dan Shadjou, 2016).
Hal ini tidak hanya meningkatkan kinerja biosensor, tetapi juga
menciptakan peluang untuk memproduksi nanobiosensor berukuran
sangat kecil yang dapat dipakai atau bahkan ditanamkan sebagai
lawan dari biosensor konvensional berukuran lebih besar yang tidak
layak dan biaya pembuatannya lebih mahal (Touhami, 2014).

Kedokteran gigi pencegahan

Para peneliti mengembangkan sikat gigi nano, dengan memasukkan

partikel koloid nanogold atau nanosilver di antara bulu sikat gigi.Raval
dkk., 2016). Selain kemampuannya untuk meningkatkan penghilangan
plak secara mekanis, para peneliti melaporkan efek antibakteri dari
emas atau perak yang ditambahkan yang pada akhirnya dapat
menyebabkan penurunan yang signifikan pada penyakit periodontal.
Produk kebersihan mulut seperti pasta gigi dan larutan obat kumur
juga dimodifikasi secara nano menurut laporan terbaru. Nano-kalsium
fluorida, misalnya, ditambahkan ke produk obat kumur untuk
mengurangi aktivitas karies, mengurangi permeabilitas dentin, dan
meningkatkan konsentrasi fluorida labil dalam cairan oral (Matahari
dan Chow, 2008). Pasta gigi yang mengandung nanopartikel kalsium
karbonat dan 3% natrium trimetafosfat telah dilaporkan meningkatkan
remineralisasi lesi karies dini dibandingkan dengan pasta gigi
konvensional tanpa aditif nano.Danelon dkk., 2015).
Menurut hasil dari studi in vitro, pasta gigi yang mengandung kristal
 nano-hidroksiapatit (nHA) secara signifikan meningkatkan nilai kekerasan
mikro pada email manusia setelah tantangan erosif, dibandingkan dengan
pasta gigi yang sama tanpa nHA (Ebadifar dkk., 2017).
Manfaat pasta gigi yang mengandung nHA pertama kali dilaporkan di
Jepang pada 1980-an (Kani dkk., 1989). Pada tahun 1983, tiga sekolah
dasar terdaftar dalam studi klinis 3 tahun mereka. Sekolah diberikan sikat
gigi dan pasta gigi. Satu sekolah diberikan pasta gigi berbasis nHA 5%,
sedangkan dua sekolah lainnya diberikan kontrol.
Siswa diinstruksikan untuk menyikat gigi menggunakan sikat gigi dan
pasta gigi yang disediakan setiap hari selama jam sekolah dan di bawah
pengawasan guru. Hasil yang dikumpulkan mengungkapkan penurunan
56% dalam kejadian karies pada anak sekolah yang menyikat gigi
dengan pasta gigi nHA dibandingkan dengan kelompok kontrol (Kani
dkk., 1989).
Kapasitas reparatif yang lebih tinggi dari bahan nano dibandingkan
dengan bahan yang sama dalam skala mikro atau makro, mungkin
disebabkan oleh fakta bahwa bahan penyusun anorganik dalam email
berukuran 20–40 nm, sehingga logis untuk mengasumsikan afinitas yang
lebih tinggi. partikel berukuran nano (Robinson dkk., 2004; Tao dkk.,
2007). Hal ini penting untuk dipertimbangkan ketika mencoba
mengembangkan material baru untuk meningkatkan karakteristik
mekanis, fisik, dan reparatif.

bahan gigi
Prostodonsia

Memasukkan 0,4% nanopartikel TiO2 ke dalam basis gigi tiruan

polimetilmetakrilat (PMMA) cetak 3D diselidiki pada tahun 2017, dalam
upaya untuk meningkatkan karakteristik antibakteri dan sifat mekaniknya
(Totu dkk., 2017).Menurut pengukuran menggunakan Fourier Transform
Infrared Spectroscopy (FTIR), Scanning Electron Microscopy, dan tes
untuk kemanjuran antimikroba terhadap spesies Candida, perbaikan
dalam sifat kimia dan struktural dilaporkan, dan efek antibakteri
khususnya terhadap spesies Candida adalah signifikan.
 Penambahan nanopartikel zirkonium oksida secara signifikan
meningkatkan tingkat kekerasan, kekuatan lentur, dan ketangguhan
fraktur dari basis gigi tiruan PMMA yang diawetkan dengan panas.
Pengisi berukuran nano digunakan karena sifat dispersinya yang
unggul, potensi agregasi yang lebih kecil, dan biokompatibilitas
dengan polimer organik. Nano zirkonium tidak hanya meningkatkan
sifat fisik basis gigi tiruan selama fase konstruksi, mereka juga
dilaporkan meningkatkan kekuatan transversal basis gigi tiruan yang
diperbaiki (Gad dkk., 2016). Hasil menunjukkan bahwa perbaikan
menggunakan resin autopolimerisasi, dimodifikasi dengan oksida
zirkonium 2% atau 5% berat menunjukkan tingkat kekuatan
transversal tertinggi menggunakan uji tekukan tiga titik. Para peneliti
menyimpulkan bahwa penggabungan partikel zirkonium oksida
termodifikasi nano dalam matriks resin memiliki potensi yang luas
tidak hanya dalam prostodontik lepasan tetapi juga dalam banyak
disiplin ilmu lainnya.
Peneliti juga menyelidiki sifat antijamur dari lapisan klorheksidin
dengan berbagai aditif nanopartikel, untuk menghambat infestasi
jamur pada silikon gigi yang biasa digunakan sebagai soft liner dan
obturator gigi tiruan (Garner dkk., 2015). Larutan klorheksidin
dicampur dengan nanopartikel natrium trifosfat (TP), trimetafosfat
(TMP) atau heksametafosfat (HMP).
Penambahan nanopartikel tidak mempengaruhi hidrofilisitas dan
penyerapan air dari silikon gigi tiruan setelah perendaman dalam saliva
buatan selama 16 minggu. Selanjutnya, pelapis klorheksidin nano-
modifikasi melepaskan klorheksidin terlarut ke dalam air liur buatan,
dengan pelepasan yang lambat dan berkelanjutan oleh pelapisan
klorheksidin-HMP, dan pelepasan yang cepat dan lebih terkonsentrasi
oleh pelapis klorheksidin-TP dan klorheksidin-TMP. Lapisan klorheksidin-
HMP terbukti paling efektif dalam aktivitas antijamurnya dengan
menghambat aktivitas metabolisme Candida albicans. Pelapisan ini
berpotensi menjadi penting secara klinis untuk memastikan umur
panjang dari protesa gigi dan pemeliharaan kesehatan mulut dengan
biaya yang jauh lebih rendah.
 Semen luting impregnasi nano-partikel terbukti secara signifikan efektif
dalam meningkatkan kekuatan ikatan pada email dan dentin dibandingkan
dengan semen luting konvensional. Mereka mengikat dengan sangat baik
ke dentin, karena ukurannya sangat kecil partikel menembus lebih dalam
ke dalam tubulus dentin, oleh karena itu, meningkatkan modulus
elastisitas, dan mengurangi penyusutan polimerisasi (Sadat-Shojai dkk.,
2010). Para peneliti pada tahun 2011 menciptakan pendekatan baru untuk
meningkatkan kekuatan tekan dan tarik seng poli karboksilat, dengan
memasukkan nanopartikel ZnO dan MgO. Hasil mengungkapkan fisik yang
sangat baik dan kekuatan mekanik bila dibandingkan dengan semen seng
poli karboksilat konvensional (Zebarjad, 2011). Para peneliti menyimpulkan
bahwa kekuatan semen tergantung pada skala ukuran komposisi, jelas
terlihat melalui perbedaan signifikan yang diamati antara nanomodified dan
semen poli karboksilat seng konvensional dalam penelitian ini. Demikian
pula, penambahan partikel nano-hidro xiapatit/fluoroapatit ke semen
ionomer kaca, secara signifikan meningkatkan kekuatan lentur tekan, tarik,
dan biaksial dibandingkan dengan semen ionomer kaca konvensional
(Moshaverinia dkk., 2008; Lucas dkk., 2003).
Meskipun beberapa nanopartikel terbukti menguntungkan, peneliti
diharuskan untuk memastikan keamanan dalam menggunakan bahan
tersebut dalam praktek klinis sehari-hari, dengan mengatasi
biokompatibilitas jangka panjang, toksisitas, mekanik, dan sifat fisik.

Endodontik

Aplikasi nanoteknologi dalam endodontik termasuk penggabungan

nanopartikel bio-keramik seperti bioglass, zirkonia, dan keramik kaca
dalam sealer endodontik. Telah ditemukan bahwa penggunaan partikel
nano meningkatkan adaptasi perekat terhadap ketidakteraturan nano,
selain waktu pengikatannya yang cepat dibandingkan dengan sealer
konvensional, stabilitas dimensinya, ketidaklarutan dalam cairan jaringan,
ikatan kimia. ke jaringan gigi, dan osseokonduktivitas (Utneja dkk., 2015).
Hal ini dikuatkan oleh penelitian terbaru, menguji efek antibakteri terhadap
biofilm endodontik, kekuatan ikatan dengan dentin, dan pelepasan ion
kalsium dan fosfat ketika sealer endodontik bioaktif baru digunakan (Wang
dkk., 2017).Sealer adalah campuran dimethylaminohexadecyl methacrylate
(DMAHDM), 2-methacryloyloxyethyl phosphorylcholine (MPC), dan
nanopartikel kalsium fosfat amorf (NACP). Sealer mampu menghambat
pembentukan strain endodontik, sedangkan partikel nano sangat berguna
dalam mempercepat proses remineralisasi dan meningkatkan kekuatan
ikatan pada dentin.

Dalam upaya untuk meningkatkan obat intrakanal dalam menghambat

pertumbuhan Enterococcus faecalis, efek jangka pendek dan jangka
panjang dari obat intrakanal kalsium hidroksida dengan suspensi
nanopartikel perak diselidiki (Afkhami dkk., 2015). Efektivitasnya terhadap
Enterococcus faecalis lebih unggul bila dibandingkan dengan kalsium
hidroksida saja, dan kalsium hidroksida dicampur dengan klorheksidin.
Partikel nano-perak secara signifikan efektif setelah satu minggu, dan tidak
menunjukkan efek antibakteri yang signifikan setelah satu bulan
dibandingkan dengan bahan lain yang digunakan. Oleh karena itu, para
peneliti menyimpulkan bahwa partikel nanosilver terbukti menjadi agen
antibakteri yang efektif secara khusus melawan Enterococcus faecalis
dalam jangka pendek. Sebuah studi in-vitro yang dilakukan pada tahun
2014, menyimpulkan bahwa partikel nanosilver tidak efisien dalam
menghambat Enterococcus faecalis setelah satu minggu (Mozayeni dkk.,
2014). Partikel nano-perak dimasukkan ke dalam matriks gel dan
diaplikasikan sebagai sealer saluran akar. Gel nano-perak ini terbukti
kurang efisien dibandingkan klorheksidin dan pasta antibiotik tiga kali lipat
dalam menghambat penyebaran Enterococcus faecalis. Para peneliti
menghubungkan kurangnya efisiensi yang ditunjukkan oleh gel nanosilver
dengan metode sintesisnya yang berbeda dari klorheksidin dan pasta tiga
antibiotik, selain konsistensi gel, yang mungkin telah menghambat
pelepasan nanopartikel.
Studi juga dilakukan untuk memperbaiki gutta percha (GP), dengan
memasukkan partikel nano-berlian (Lee dkk., 2015). Radiografi digital
dan pencitraan tomografi mikro-komputasi mengungkapkan bahwa
obturasi mengikuti teknik konvensional, menggunakan GP yang diresapi
nanodiamond, menunjukkan sifat kimia yang unggul, biokompatibilitas,
dan sifat mekanik yang unggul. Selain itu, adaptasi kualitas tinggi pada
dinding saluran akar dan pembentukan rongga minimum telah
dilaporkan, yang menunjukkan potensi besar untuk penggunaan nano-
GP sebagai penambalan endodontik yang lebih baik.

Kedokteran gigi konservatif dan estetik

Perkembangan baru dari resin komposit berisi kalsium fosfat (nACP)

nano-amorf yang dapat diisi ulang baru-baru ini dilaporkan. Nanopartikel
mampu tidak hanya meningkatkan sifat remineralisasi komposit, tetapi
juga mempertahankan tingkat pelepasan Ca dan P yang sama melalui
pengisian dan pelepasan (Xie et al., 2016). Para peneliti
menggambarkannya sebagai bahan "pintar" melalui kemampuannya
yang konstan untuk dengan cepat menetralkan asam bakteri yang
dilepaskan di sepanjang restorasi/margin gigi melalui pelepasan Ca dan
P, oleh karena itu mampu menghambat inisiasi karies sekunder. Hal ini
dikuatkan oleh Wu et al., melaporkan kemampuan remineralisasi yang
signifikan dari nACP dan efektivitasnya dalam menghambat inisiasi
karies sekunder (Wu et al., 2015). Para peneliti juga melaporkan bahwa
hasil mereka menciptakan kemungkinan untuk mengintegrasikan nACP
dalam bahan gigi lainnya seperti semen luting dan bahan pengikat. Hal
ini dikuatkan oleh penelitian lain, yang menunjukkan kemampuan
remineralisasi yang signifikan pada bahan bonding gigi dengan nACP
melalui pengisian ulang dan pelepasan ion Ca dan P hingga 3 minggu,
tanpa mengubah kekuatan bonding ke dentin (Zhang dkk., 2015).
Upaya tambahan untuk mengaktifkan bahan restoratif untuk secara
aktif mencegah inisiasi dan perkembangan karies sekunder, adalah
melalui penerapan lapisan nanokomposit yang terdiri dari kitosan
termodifikasi laktosa (Chitlac) dengan nanopartikel perak (nAg) (Ionescu
dkk., 2015). Nanopartikel adalah tersebar merata dan mampu secara
signifikan mengurangi pembentukan biofilm pada permukaan restorasi
sebesar 80% setelah 48 jam aplikasi, dibandingkan dengan kontrol tanpa
pelapisan Chitlac-nAg. Gambar yang diperoleh dengan Confocal Laser
Scanning Microscopy (CLSM) mengungkapkan bahwa lapisan tersebut
tidak memiliki aktivitas bakterisida, namun memiliki kemampuan untuk
mengubah morfologi biofilm, dan dengan itu menghambat perkembangan
spesies biofilm dewasa.
Menggabungkan nanopartikel quaternised polyethyleneimine (QPEI)
cross-linked dalam komposit resin juga dilaporkan memiliki efek
antibakteri terhadap berbagai patogen oral,seperti Enterococcus faecalis,
Streptococcus mutans, Actinomyces viscousus, Lactobacilus casei, dan
air liur utuh. Penambahan nanopartikel QPEI dilaporkan memiliki efek
antibakteri yang tahan lama, stabil dalam matriks, dan tidak tidak
merembes ke lingkungan sekitar (Shvero dkk., 2015). Penambahan
nanopartikel QPEI menyebabkan gangguan pertukaran ion melalui
membran bakteri dalam biofilm, dan oleh karena itu, menyebabkan
kematian sel. Sifat bakterisidanya dapat menciptakan bahan restorasi
generasi kedua dengan insiden kegagalan karies sekunder yang jauh
lebih rendah.
Bahan pemutih gigi juga dimodifikasi secara nano untuk meningkatkan
efisiensi pemutihan dan meminimalkan efek samping yang berbahaya.
Nanopartikel kalsium peroksida, misalnya, mampu menembus lebih
dalam ke dalam struktur gigi melalui retakan mikro dan nano, yang
mengarah ke kontak permukaan yang lebih lama dan oleh karena itu
peningkatan efektivitas zat pemutih karena penetrasinya yang lebih
dalam ke dalam struktur gigi memungkinkan untuk waktu tindakan yang
lebih lama dan pada akhirnya peningkatan signifikan dalam estetika bila
dibandingkan dengan zat pemutih dengan partikel mikro atau makro
(Velkoborsky, 2010). Selain itu, penggabungan nano-lipobelle H-EQ10 ke
dalam bahan pemutih secara signifikan meningkatkan kondisi kimia dan
mekanik dari enamel yang diputihkan. Nano-lipobelle H-EQ10 adalah
liposom yang mengandung 10% vitamin E dan 5% koenzim. Penggunaan
pembawa nano-liposom memungkinkan pengiriman jumlah vitamin E dan
koenzim yang lebih tinggi yang masing-masing membantu dalam
perlindungan struktur gigi dan stimulasi regenerasi sel (Velkoborsky,
2010).
Periodontik, Implantologi, dan kedokteran gigi regeneratif

Para ilmuwan mampu menciptakan sistem penghantaran obat baru untuk

pengobatan penyakit periodontal, melalui nanopartikel bermuatan
triclosan atau tetrasiklin.
Nanopartikel ini tersebar merata dalam matriks, yang secara bertahap
terurai, melepaskan obat yang dimuat secara bertahap untuk memberikan
durasi kontak yang lebih lama dengan situs yang sakit.Sharma et al.,
2016). Niosom, misalnya, adalah vesikel non-ionik yang stabil secara
kimia, yang menawarkan pengiriman obat yang terkontrol dan ditargetkan
dengan penetrasi yang ditingkatkan melalui jaringan biologis terutama
ketika partikel berukuran kurang dari 100 nm (Pradeepkumar dkk., 2012).
Lebih lanjut, fullerene telah banyak dipelajari untuk banyak aplikasi
potensialnya, salah satunya adalah efektivitasnya dalam penghantaran
obat. Fullerene adalah molekul karbon berongga yang datang dalam
berbagai bentuk (bola, tabung, dan ellipsoid). Buckminster-fullerene (C60)
adalah fullerene pertama dan paling stabil yang ditemukan pada 1980-an,
yang menyerupai kubah geodesik yang dirancang oleh Buckminster
Fuller, oleh karena itu, dinamai menurut namanya. Fullerene ini dapat
dibangun dengan baik dari bawah ke atas pendekatan, membangun atom
demi atom, atau dengan pendekatan top down dari atom bir, yang
menurut literatur terbukti menghasilkan struktur fullerene yang lebih stabil
(Andreoni, 2000). Itu juga digunakan untuk tujuan lain di bidang medis,
seperti pemulung radikal dan sebagai antioksidan.
Literatur juga melaporkan manfaat menggabungkan matriks resin
metakrilat yang dapat disembuhkan dengan cahaya, dengan nACP
sebagai agen pencangkokan tulang. Bahan injeksi ini memiliki
kemampuan untuk melekat kuat pada tulang basah, dan dalam
rekristalisasi nACP menjadi hidroksiapatit dalam hitungan menit
(Pradeepkumar dkk., 2012).
Telah berteori bahwa osseointegrasi implan di dalam tulang rahang
akan dimaksimalkan jika permukaan implan meniru topografi permukaan
matriks ekstraseluler dalam jaringan alami, yang biasanya berukuran
antara 10 dan 100 nm (Tomsia dkk., 2011). Data yang dipublikasikan
 membuktikan teori ini, karena tidak hanya pelapis permukaan seperti
nanopartikel hidroksiapatit, emas, perak, dan titanium oksida yang
memiliki kemampuan untuk meningkatkan adhesi bekuan fibrin yang
berfungsi sebagai jembatan untuk sel osteogenik dan osseointegrasi
implan secara keseluruhan, kehadiran fitur nano mekanis seperti alur
nano atau pilar nano telah terbukti efektif juga, dengan penekanan
khusus pada distribusi dan urutan fitur tersebut pada permukaan implan
(Tomsia dkk., 2011; Cheng dkk., 2012; Besinis et al., 2017).

Produk nano

Berbagai macam nano-aditif telah diperkenalkan ke dalam banyak

produk yang tersedia secara komersial, sehingga sangat sulit bagi dokter
gigi untuk memilihnya. Nanomaterial yang tersedia secara komersial
yang umum digunakan, dan studi tentang aditif nanonya diMeja 2akan
menjelaskan efektivitas bahan nano tersebut dibandingkan dengan
rekan-rekan konvensional mereka.

Kesimpulan

Ilmu pengetahuan dan aplikasi nanoteknologi terus berkembang saat kita

menyaksikan produk baru diperkenalkan ke pasar. Ini datang dengan
tanggung jawab besar untuk memastikan keamanan, efisiensi, dan
penerapan teknologi baru tersebut. Tingkat efektivitas mereka seperti
yang ditunjukkan dalam literatur berbeda, lebih efektif daripada beberapa
bahan dan kurang efektif daripada yang lain. Meskipun nanomaterial
umumnya menawarkan estetika dan kemampuan poles yang superior,
sifat mekaniknya kurang baik dibandingkan dengan komposit resin yang
diisi mikro misalnya. Oleh karena itu, pilihan untuk menggunakan
nanomaterial tergantung pada skenario klinis dan gigi yang akan
direstorasi, memperhatikan permintaan estetika, pemuatan, dan adanya
faktor risiko seperti kebiasaan parafungsional. Penelitian untuk
memperbaiki nanomaterial yang ada masih berlangsung, dengan arah
masa depan menuju perangkat nano-biosensing yang lebih efisien dan
hemat biaya untuk mendiagnosis kanker mulut dengan akurasi tinggi
misalnya, di samping sistem penghantaran obat oral baru untuk
mengganggu pembentukan biofilm dan mengurangi kejadian karies dan
penyakit periodontal. Meskipun ilmu di balik nanoteknologi menarik,
kurangnya bukti klinis jangka panjang yang membahas kinerja klinisnya
membatasi penggunaan klinisnya secara luas.