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Novel dental composite resin derived from rice husk natural biowaste: A
systematic review and recommendation for future advancement

Article in Journal of Esthetic and Restorative Dentistry · October 2021

DOI: 10.1111/jerd.12831

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Received: 2 March 2021 Accepted: 22 October 2021
DOI: 10.1111/jerd.12831

REVIEW ARTICLE

Novel dental composite resin derived from rice husk natural

biowaste: A systematic review and recommendation for future
advancement

Galvin Sim Siang Lin DDS, MScD1 | Chia Yee Cher BDS2 | Kah Kei Cheah BDS2 |
Tahir Yusuf Noorani BDS, MResDent1 | Noor Huda Ismail BDS, MDSc3 |
Nik Rozainah Nik Abdul Ghani BDS, MSc1

1
Conservative Dentistry Unit, School of Dental
Sciences, Universiti Sains Malaysia, Health Abstract
Campus, Kubang Kerian, Kelantan, Malaysia Objectives: This review aimed to summarize contemporary evidence related to den-
2
Department of Restorative Dentistry, Faculty
tal composite resin derived from rice husk biowaste and its potential future advance-
of Dentistry, Asian Institute of Medicine,
Science and Technology (AIMST) University, ment. This review paper included the techniques for synthesis, characterization, and
Kedah, Malaysia
preparation of rice husk composite resin. Focus was also given to the flexural
3
Prosthodontics Unit, School of Dental
Sciences, Universiti Sains Malaysia, Health strength and modulus, compressive strength, wear rate, hardness, surface roughness,
Campus, Kubang Kerian, Kelantan, Malaysia color stability, polymerization shrinkage, degree of conversion, and their application

Correspondence onto root canal treated teeth.

Nik Rozainah Nik Abdul Ghani, Conservative
Dentistry Unit, School of Dental Sciences,
Universiti Sains Malaysia, Health Campus,
16150, Kubang Kerian, Kelantan, Malaysia.
Email: rozainah@usm.my
Material and Methods: A search of English peer-reviewed literature (January 1960–
February 2021) was conducted from electronic databases (PubMed Central,
Cochrane, LILACS, Science Direct, Web of Science, SIGLE, EMBASE, EBSCO,
Medline, and Google Scholar).
Results: 11 articles and a book section were finally selected for qualitative analysis.
Studies concluded that the physicomechanical properties and the color stability of
rice husk dental composites showed comparable results to conventional dental com-
posites. Incorporation of zirconia nanopowder into rice husk dental composite
increased the compressive strength and hardness values, associated with lower
shrinkage, a high degree of conversion, and improved fracture strength when applied
on root canal treated teeth.
Conclusions: Due to its low cost, eco-friendliness, and acceptable clinical perfor-
mances, rice husk dental composite resin can be considered as an alternative to con-
ventional composites.
Clinical Significance: Dental composite resin derived from rice husk silica demon-
strated excellent performance, which could potentially substitute currently available
composite resins. This review will give new insight to clinicians and researchers on
the usage of natural biowaste mass in the field of dental restorative materials.

KEYWORDS
dental composite, dental materials, natural resource, rice husk, silica

J Esthet Restor Dent. 2021;1–9. wileyonlinelibrary.com/journal/jerd © 2021 Wiley Periodicals LLC. 1

2 LIN ET AL.
1 | I N T RO DU CT I O N
Composite is a material composed of two distinct stages, typically
involving a combination of components with different structures and
properties.1,2 Dental composite resins are tooth-colored materials intro-
duced in the late 1950s, commonly used in dentistry as restorative
3
materials. Composite resins are used as liners, pits and fissures seal-
ants, inlays, onlays, veneers, core build-up, endodontic posts, and end-
odontic sealers.4 They have many advantages over amalgam, such as
improved esthetic properties, bonding to the tooth surface using the
adhesive system, allowing for better conservation and protection of the
remaining tooth structure.5–7 The use of composite resin has increased
drastically in modern preventive and restorative dentistry. This is due
to the increased esthetic demands of patients, sufficient mechanical
8
properties, and ease of application as a direct or indirect filing material.
Research on developing an optimal dental composite is still ongo-
9
ing, with the filler content being of prime interest. With the current
emphasis on exploring natural bioresources in medical and dental
applications, eco-friendly composite resin have started to gain popu-
larity among researchers in which natural products are incorporated
into composite resins. The benefit of using natural resources in dental
composites is ascribed to lower cost, lower toxicity, higher sustainabil-
10
ity, lighter weight, and more environmentally friendly.
Rice is one of the worlds' primary crops, covering about 1% of the
entire earth's surface.11 Rice husk is an inexpensive biomass waste
from rice with a hard surface, high silica content, low density, high
10,11
strength, and resistance to bacterial decomposition. However,
rice husk incineration is not encouraged because this process will pro-
duce ash and toxic gases, causing air pollution.11 Rice husk consist of
35%–45% cellulose, 20% lignin, 19%–25% hemicellulose, and about
12
14%–17% wax. The high silica content of rice husk (20%) has
drawn several researchers' attention in discovering ways to utilize and
commercialize it. However, only a few researchers have used it in
dental material application.10,13,14 Moreover, by utilizing rice husk as
filler in dental composite resin, two main goals can be achieved: mini-
mizing environmental pollutions and reducing the composite material
costs.
To the best of our knowledge, no review on rice husk dental com-
posite resin has yet been published in the literature. Hence, the pre-
sent study aims to review and critically appraise the available
evidence in the literature through a systematic analysis to provide
adequate information on rice husk dental composites. This review also
highlights some recommendations for future advancement in rice husk
dental composites.
2 | MATERIAL AND METHODS
This review was conducted according to the preferred reporting items
for systematic reviews and meta-analysis (PRISMA) guidelines. The
inclusion criteria included articles addressing rice husk dental compos-
ite resins in randomized and non-randomized controlled trials, pro-
spective and retrospective cohort studies, in vitro and in vivo
experimental or laboratory-based studies. The exclusion criteria were
animal studies, expert opinions, case series, case reports, and system-
atic or literature reviews. Besides, articles that were not written in
English, and non-dental related rice husk composite resin articles were
also excluded. Data were collected independently by two reviewers
(GSSL, NHI) from electronic databases (PubMed Central, Cochrane,
LILACS, Science Direct, Web of Science, SIGLE, EMBASE, EBSCO,
Medline, and Google Scholar) using keywords “rice husk,” “rice husk
silica,” “resin composite,” “dental composite,” and “composite resin.”
Articles published between January 1960 and February 2021 were
included in the screening process according to the eligibility criteria.
Seven Textbooks were hand-searched to identify missing literature,
which including Tooth-colored Restoratives: Principles and Techniques,15
Handbook of Composites from Renewable Materials,16 Composites in Bio-
medical Applications,1 Dental Materials: Clinical Applications for Dental
Assistants and Dental Hygienists,17 Sturdevant's Art & Science of Opera-
tive Dentistry,18 Dental Composite Materials for Direct Restorations,19 and
Resin Composites: Properties, Production, and Applications.20 Finally, ref-
erence lists of relevant articles from electronic and hand searches were
screened again. After removing duplicates, title review, and abstract
selection was carried out. Full-texts were then assessed to verify the
relevance of the article content to the present review. Disagreement
between reviewers was resolved through careful discussion with the
third and fourth reviewers (C.C.Y. and C.K.K.). The corresponding
authors of the selected studies were contacted by e-mail to solve any
doubts if necessary. Cohen's kappa coefficient (k) was performed to
evaluate the search concordance between reviewers. The study charac-
teristics (authors, year of publication, and study descriptions) were col-
lected from each article. Only systematic qualitative synthesis was
performed with the exclusion of quantitative synthesis.
3 | RE SU LT S
A total of 76,788 articles were retrieved during the initial search pro-
cess (Figure 1). After the preliminary screening on the basis of titles and
abstracts, 76,716 irrelevant articles were excluded. An in-depth full-text
assessment of the remaining 72 articles was carried out by two other
investigators (N.R.N.A.G. and T.Y.N.). Finally, 11 articles and one book
section were selected for qualitative analysis. The reasons for excluding
the articles are illustrated in Figure 1, while each included articles' char-
acteristics are summarized in Table 1. The k concordance value
between the reviewers of the first screening (titles and abstracts) was
0.91 and for the second articles screening (full-text assessment) was
0.95, indicating an “almost perfect” agreement.28
3.1 | Synthesis of nano-silica from rice husk
Six selected studies described the synthesis of rice husk sil-
ica.9,10,13,16,21,23 Basically, the process involved two steps: extraction
of silica from rice husk and precipitation of silica. Based on Noushad
et al., rice husks were first washed with water to remove debris and
LIN ET AL.
F I G U R E 1 Flowchart of
study selection based on PRISMA
guidelines. PRISMA, preferred
reporting items for systematic
reviews and meta-analysis
other contaminants, including heavy impurities, and then dried over-

night in an oven at 110 C. The dried rice husks were heated in an
acidic solution at 75 C for 90 min to remove metallic impurities and
washed several times with deionized water. The wet solid was subse-
quently dried overnight at 110 C and heated in sodium hydroxide

solution at 90 C for 1 h and finally, filtered to obtain sodium silicate
10
solution (SSS), which is the source for silica.
Majority of the selected studies used fixed alcohol (propanol or
ethanol) as a solvent.9,13,16,23 Nonetheless, Noushad et al. used differ-
ent solvents, which are ethanol, 2-propanol, toluene, and diethyl
ether, in the fabrication of rice husk silica.21 Zulkifli et al., on the other
hand, added water and stirred the solution for 10 min before precipi-
tation to study the effect of water on the size of rice husk silica parti-
13
cle. Different organic acid solutions were used in different studies
during the precipitating process, such as acetic acid,9 phosphoric
acid,13,21 sulfuric acid,16 and nitric acid.21 Gelation was noted to begin
as the pH of the SSS decreased. When the pH dropped to 8, the pre-
cipitation process stopped, and the gel was further stirred for 45 min
and centrifuged at 4000 RPM to obtain an acid-free white precipi-
tate.9,10 Finally, the white precipitate was calcined at 500 C for
30 min in a muffle furnace to obtain pure white silica powder.23
3.2 | Characterization of rice husk silica
The rice husk silica characterization, degree of agglomeration, and
filler distribution were performed using a scanning electron
microscope,14,21,22,24 and transmission electron microscopy.9,10,13,23
3
Most studies revealed that the rice husk silica extracted using the sol–
gel method was spherical, making them suitable for dental composite
resin. However, Noushad et al. found that the use of nonpolar solvent
in the synthesis of rice husk silica using precipitating method resulted
in irregularly shaped nano-silica particles.21 The size of the spherical-
shaped rice husk silica ranged from 15 to 534 nm.9,10,13,14,23,24 Zulkifli
et al. noted an increase in the silica particle size as the pH increased
during the synthesis process. Meanwhile, the addition of water led to
more sparse and smaller silica particles.13 For the degree of agglomer-
ation, Noushad et al. revealed that a greater degree of agglomeration
could be achieved when nitric acid was used as a precipitant com-
pared to orthophosphoric acid.21 Another study done by Noushad
et al. reported that the feed rate of precipitant affected the degree of
agglomeration. A 0.2 ml/min precipitant feeding rate showed the
highest degree of agglomeration, while 5 ml/min showed a reduction
in the degree of agglomeration and 1 ml/min demonstrated the lowest
degree of agglomeration.23
Some articles reported the use of Fourier transform infrared spec-
troscopy (FTIR) and concluded that the silica produced from rice husk
was typically composed of silica in the range of 4000–400 cm 1
.9,10,13,23 X-ray diffractometry was also performed to indicate the
amorphous nature of the rice husk silica produced.13,23 The specific
surface area of the silica was measured by using the Brunauer Emmett
Teller method showing a surface area of 30 m2/g with an average
pore diameter of 5.6 nm.10 Another study by Noushad et al. reported
that the surface area of rice husk silica ranged from 7.4–15 m2/g with
an average pore diameter of 24–33 nm when different feed rates of
precipitant were applied.23
4 LIN ET AL.

TABLE 1 Characteristics of the selected studies

Author Year Descriptions

21
Noushad et al. 2012 Describe synthesis of nanosilica from risk husk.
Characterized rice husk silica particle's morphologies, particle size, and degree of agglomeration using Scanning
Electron Microscopy (SEM) and Image analysis Olympus “Cell B.”
Noushad et al.9 2013 Extract spherical nanosilica from rice husk, fabricate and characterize rice husk dental composite using transmission
electron microscopy (TEM), image analysis using Olympus “Cellsens” and Fourier transform infrared spectroscopy
(FTIR).
Evaluate the flexural strength and flexural modulus of rice husk dental composite performed using three-point bending
test under Universal Tesing Machine.
Yusoff et al.22 2018 Characterize experimental rice husk flowable composite resins using SEM.
Evaluate the hardness of two experimental dental flowable composite from rice husk with Bis-GMA to TEGDMA ratio
of 50:50 and 40:60, respectively, to other commercially available flowable resin composites (Filtek Z350 Flow and
Tetric N Flow) using Vicker's hardness test.
Yusoff et al.14 2019 Fabricate and characterize experimental rice husk flowable composite with different Bis-GMA to TEGDMA ratios of
50:50, 45:55, and 40:60, respectively, using SEM.
Evaluate the physical and mechanical properties of rice husk flowable composites in comparison with their commercial
counterpart (Revolution Formula 2).
Surface roughness was evaluated using 2D surface profilometer; Vickers hardness test using Vickers Hardness
Machine: compressive strength and compressive modulus using Universal Testing Machine.
Noushad et al.10 2016 Fabricate low specific surface area rice husk silica dental composite resin with different filler to matrix ratios of 40:60
and 50:50, respectively.
Comparative rice husk dental composites with commercialized microhybrid composite, Filtek™ Z250 in terms of
flexural strength and flexural modulus using three-point bending test; compressive strength using Universal Testing
Machine; hardness test using Vickers Hardness machine; and surface roughness using 2D profilometer.
Noushad et al.23 2014 Obtain rice husk nanosilica using an organic acid and manipulate the feed rate (0.2, 1, and 5 ml/min) and the mixing
speed.
Characterize the rice husk dental composites using TEM.
13
Zulkifli et al. 2013 Synthesis of rice husk silica nanoparticles for dental restoration applications and characterized with SEM, TEM, FTIR,
and X-ray diffractometry (XRD).
Ismail et al.24 2020 Fabricate and Characterize 3 and 5 wt% of zirconia reinforced rice husk nanohybrid dental composite with different
mixing method using SEM and EDS.
Evaluate ziroconia reinforced rice husk nanohybrid dental composites on their Vickers hardness, compressive strength
using Universal Testing Machine, and degree of conversion using FTIR.
Raja et al.25 2019 Evaluate the color stability of rice husk dental nanocomposite as compared to four conventional composites (G-aenial
Universal Flo, Solare-X, Ceram X One
Universal, Neofil), after exposure to commonly consumed beverages in Malaysia (distilled water, coco-based drink,
Chinese tea, milk tea) according to the CIE L*a*b* (Commission Internationale de I'Eclairage, L*, a*, b*) system.
Lin et al.26 2020 Compare the fracture strength, fracture pattern, and type of fracture of endodontically treated maxillary lateral
incisors restored with new 10 wt% zirconia reinforced rice husk nanohybrid composite compared to nanofilled
(Filtek Z350 XT) and microhybrid (Zmack) composites.
Lin et al.27 2020 Compare the polymerization shrinkage using both buoyancy and optical methods and the degree of conversion using
FTIR of new zirconia-reinforced rice husk nanohybrid composite with commercialized microhybrid (Zmack Comp) and
nanofilled (Filtek-Z350-XT) composites.
Bhat et al.16 2017 Synthesis nano-rice husk silica and characterize using SEM.
Investigate the mechanical properties (hardness, flexural strength) and the effect of chewing on wear characteristics in
both food slurry and citric acid condition of 0, 1, 2, and 3 wt% of rice husk silica dental composite.

3.3 | Preparation and fabrication of rice husk
composite resin
Two selected studies described the preparation of packable composite
resin using rice husk silica as filler,10,16 other two described the prepa-
ration of flowable rice husk composite,14,22 while another two studies
described the incorporation of zirconia particles as filler in the rice
husk composite preparation.24,27 The materials used for the prepara-
tion of rice husk composites were almost similar in all selected studies
of which bisphenol A glycidyl methacrylate (Bis-GMA) was used as
rigid resin monomer and triethyleneglycol dimethacrylate (TEGDMA)
used as a diluent with different ratios. Both Noushad et al.,10 and
LIN ET AL.
Ismail et al.,24 prepared the resin matrix with the highest Bis-GMA to
TEGDMA ratio of 60:40, whereas Bhat et al. fabricated rice husk com-
posite with a Bis-GMA to TEGDMA ratio of 50:49.16 Yusoff et al. fab-
ricated rice husk composite with resin matrix composed of three
14,22
different Bis-GMA to TEGDMA ratios, 50:50, 45:55, and 40:60.
Meanwhile, Lin et al. produced rice husk composite resin with Bis-
27
GMA to TEGDMA ratio of 50:48.
The photoinitiators used in the selected articles include
camphorquinone (CQ), 2-(dimethylamino) ethyl methacrylate
(DMAEMA), and ethyl-4-dimethylaminobenzoate (EDMAB) with
10,14,16,22,24,27
weightage range from 0.01 to 2 wt%. Silanisation of
rice husk nano-silica with 6 wt% methacryloxypropyl-triethoxysilane
(y-MPTS) was also mentioned in some of the selected articles to
modify the surface of the nano-silica to reduce agglomeration and
10,24
improve material bonding. Most of the filler to resin matrix
10,14,22,24
ratios were set at 50:50, while Noushad et al. manipulated
a filler resin ratio of 60:40,10 and finally Lin et al. produced rice husk
silica composite resin with the highest filler to resin ratio, which is
27
75:25.
3.4 | Flexural strength and flexural modulus
Flexural strength and flexural modulus are considered essential for
characterizing the brittleness of a material. It is one of the most
widely evaluated mechanical properties of dental restorative mate-
rials. Three studies addressed the flexural strength and flexural mod-
ulus of rice husk composite resin.9,10,16 Noushad et al. investigated
the flexural strength and flexural modulus of rice husk composite
resin with a three-point bending test to fracture the composite spec-
9
imens under a universal testing machine. The study reported that
the rice husk composite's mean flexural strength was 83.14 MPa,
whereas the flexural modulus of the rice husk dental composites was
at an average of 7.4 GPa. Noushad et al. conducted another similar
study using rice husk dental composites with different filler to resin
monomer ratios and compared it with a microhybrid composite,
Filtek™ Z250 (3 M ESPE).10 No significant difference was observed
between the experimental rice husk composite and microhybrid
composite for the flexural strength test. However, the flexural
strength and modulus of experimental rice husk composites were
still inferior to Filtek™ Z250. The flexural modulus of rice husk com-
posite with higher filler loading was significantly greater than its
counterpart with lower filler loading.
Bhat et al. evaluated the flexural strength 0%, 1%, 2%, and 3% of
rice husk silica in dental composites and reported that the strengths
were 129, 98.2, 85.6, and 70.5 MPa, respectively.16 Surprisingly, the
finding showed a decreasing trend with increasing rice husk silica
which is not in accordance with other similar studies.9,10 However, all
studies demonstrated that rice husk dental composites fulfilled the
ISO 4049 standard of which the flexural strength should not be less
29
than 50 MPa. None of the selected studies compared the flexural
strength and flexural modulus of rice husk dental composite resins
with different Bis-GMA to TEGDMA ratios.
5
3.5 | Compressive strength and wear rate
Based on the selected articles, three studies evaluated and compared
the compressive strength of rice husk dental composites.10,14,24
Noushad et al. compared the compressive strength of two experimen-
tal rice husk composites with different filler to resin ratios with com-
mercialized microhybrid composite, Filtek™ Z250, using a universal
testing machine at a speed of 0.75 mm/min.10 The finding revealed
that Filtek™ Z250 showed significantly higher compressive strength
than the other two experimental groups. The compressive strength of
experimental rice husk dental composite was noted to be below
200 MPa. Yusoff et al. compared three experimental rice husk com-
posites with different Bis-GMA concentrations and a hybrid flowable
composite, Revolution Formula 2 (Kerr Corporation), using a Universal
Testing machine under a load of 20 kN.14 The results were similar to
that of flexural strength, in which Filtek™ Z250 demonstrated higher
compressive strength than the experimental rice husk composites. All
experimental groups exhibited compressive strength ranging between
200 and 250 MPa.
Ismail et al. evaluated the compressive strength of 0, 3, and 5 wt%
zirconia reinforced rice husk composite resins with Filtek™ Z250 and
revealed that the compressive strength increased with the addition of
zirconia.24 However, 5 wt% of zirconia did not show promising results
as compared to 3 wt% and all experimental rice husk composites were
found to demonstrate inferior compressive strength than Filtek™ Z250.
The mean compressive strength of 0, 3, and 5 wt% falls in the range of
132–188 MPa, far lower than Filtek™ Z250, 316 MPa. An ideal com-
pressive strength of dental composite resins should be between
250 and 350 MPa close to enamel and dentin,30 but none of the rice
husk composite resins achieved it. Only one study compared the wear
rate of rice husk composite resins.16 Bhat et al. evaluated the chewing
effect on the wear rate of 0, 1, 2, and 3 wt% of rice husk silica compos-
ite resins in food slurry and citric acid conditions. The study revealed
that the wear rate of rice husk composites increased with increasing
chewing load, whereas increased filler content decreased the compos-
ites' wear rate. Besides, increased wear on the experimental rice husk
composite resins was noted in citric acid condition.
3.6 | Hardness
Five included studies assessed the hardness value of rice husk com-
posite resins.10,14,16,22,24 Noushad et al. compared two experimental
rice husk composite resins with different resin filler ratios using
Vickers hardness tester under 1 kg load with a 15 min dwell time.10
The results showed that Filtek™ Z250 had a significantly higher hard-
ness value (approximately 80 HV) than the other two experimental
rice husk composite resins. The hardness value of experimental rice
husk composite resins ranged between 35 and 40 HV. Besides,
Noushad et al. also found that the hardness value of experimental rice
husk composite resin increased with increasing the filler loading. Bhat
et al. evaluated the hardness of rice husk composites using a micro-
hardness tester with a 300 g load applied for 10 s.16 The findings
6 LIN ET AL.
show that hardness value of 0, 1, 2, and 3 wt% of rice husk silica were
27, 30.5, 35.5, and 36.6 HV, respectively. An increasing hardness
value trend was also noted in which higher rice husk silica content led
to a higher hardness value.
Yusoff et al. compared two experimental rice husk composite
resins with different Bis-GMA concentrations and two commercialized
flowable composite resins, namely Filtek Z350 flow (3 M ESPE) and
Tetric N Flow (Ivoclar Vivadent), using a Vickers' hardness tester with a
1 kg load for 15 s.22 Based on the result from the study, Filtek Z350
flow demonstrated significantly higher hardness value, followed by Tet-
ric N Flow and lastly, the remaining two experimental rice husk com-
posite resins. However, experimental rice husk composite with lower
Bis-GMA content showed a higher hardness value (34.5 HV) than its
counterpart with higher Bis-GMA content (32.3 HV). Yusoff et al. con-
ducted another similar study in 2019 comparing three experimental rice
husk composite resins with different Bis-GMA to TEGDMA ratios with
a commercialized hybrid flowable composite, Revolution Formula
2 (Kerr Corporation).14 The Vickers hardness values of the experimental
rice husk composite resins fall in the range of 29–31 HV, which are
comparable with Revolution Formula 2. The study also concluded that
the concentration of Bis-GMA has no significant effect on the Vickers
hardness value. Ismail et al. evaluated the hardness value of rice husk
composite resin reinforced by either 3% or 5% of zirconia with a micro-
hybrid composite, Filtek™ Z250 (3 M ESPE), under a load of 9.81 N and
15 s of dwell time.24 The Vickers hardness value increased as the per-
centage of zirconia increased, but the hardness values were still inferior
to that of Filtek™ Z250.
3.7 | Surface roughness
Two selected studies evaluated the surface roughness of rice husk
10,14
composite resin using a profilometer. Noushad et al. compared
experimental rice husk composites with different filler to resin mono-
mer ratios with a microhybrid composite, Filtek™ Z250.10 The findings
revealed that both experimental rice husk composites showed higher
roughness value than Z250. The experimental rice husk composite
group with higher rice husk silica filler content exhibited a lesser
roughness value. Meanwhile, Yusoff et al. compared experimental rice
husk composite with different Bis-GMA to TEGDMA ratios with com-
mercialized hybrid flowable composite, Revolution Formula 2.14 No
significant difference in the surface roughness was noted among the
experimental groups and Revolution Formula 2. When comparing the
roughness value (Ra) obtained from both studies, the rice husk com-
posite produced by Noushad et al. showed a higher roughness value
which ranged from 0.6 to 0.75 Ra, while those produced by Yusoff
et al. demonstrated a roughness value below 0.2 Ra.10,14
3.8 | Color stability
One included article addressed the color stability of the new rice husk
25
composite resin. Raja et al. compared the new rice husk dental
composite resin with commercially available dental composite resins,
namely, G-aenial Universal Flow (GC Dental Products Corporation),
Solare-X (GC Dental Products Corporation), Ceram X One Universal
(Dentsply DeTrey GmbH), and Neofil (Kerr Corporation).25 These
composite resins were immersed in five different infusion media, dis-
tilled water, coco-based drink, coffee, Chinese tea, and milk tea for up
to 4 weeks. The rice husk dental composite exhibited clinically unac-
ceptable ΔE value (>2.7) in all the infusion media after 4 weeks. How-
ever, the new rice husk composite demonstrated better color stability
than Neofil and Solare-X, but significantly inferior to G-aenial Univer-
sal Flo and Ceram X One Universal. Besides, coffee stained the rice
husk composite more than the other infusion media.
3.9 | Polymerization shrinkage and degree of
conversion
One study evaluated the polymerization shrinkage of rice husk dental
composite.27 They compared 10% zirconia reinforced rice husk com-
posite with commercialized nanofilled and microhybrid composite
resins, which are Filtek Z350 XT (3 M ESPE) and Zmack Comp
(Zhermack), respectively. The study used two different methods
(buoyancy and optical) to evaluate composite resins' shrinkage and
reported that the new zirconia reinforced rice husk composite resin
exhibited comparably low shrinkage value to Filtek Z350 XT, which is
around 1.95%. Furthermore, Lin et al. also investigated the degree of
conversion of this new zirconia reinforced rice husk composite resin
using FTIR.27 It was reported that the new zirconia rice husk compos-
ites' conversion value was comparable to the conversion value of
microhybrid composite and significantly higher than nanofilled com-
posite. However, no correlation between shrinkage and conversion
values was observed in the study by Lin et al.27
Another study by Ismail et al. also reported the degree of conver-
sion of different percentages of zirconia reinforced rice husk dental
composite and compared it with Filtek™ Z250, using FTIR spectrome-
ter.24 A decrease in the degree of conversion among experimental zir-
conia rice husk composite resin was observed compared to the
control group. Still, the addition of 5% zirconia showed a higher con-
version value than the 3% zirconia rice husk composite. Nonetheless,
3% and 5% of zirconia reinforced rice husk dental composite resins
still exhibited an inferior degree of conversion to Filtek™ Z250. Even
so, the conversion value of 3%, 5%, and 10% zirconia reinforced rice
husk composite resins fall within the acceptable range, which is above
60%.24,27
3.10 | Application on root canal treated teeth
Lin et al. compared the fracture strength of root canal treated teeth
restored with rice husk composite resin reinforced with zirconia to
another two types of composite resin, Filtek Z350 XT (nanofilled) and
Zmack Comp (microhybrid).26 This is by far the only available study
that translates the application of rice husk dental composite resin
LIN ET AL.
from a laboratory-based to an in vitro clinical set-up. It was reported
that root canal treated lateral incisors restored with zirconia
reinforced rice husk composite showed significantly higher fracture
toughness even after simulated aging using thermocycling machine
for 2500 cycles. The results also revealed that root canal treated lat-
eral incisors demonstrated a more favorable fracture pattern when
restored with the new rice husk dental composite.
4 | FUTURE RECOMMENDATION
Most recent research attempts in the field of dental composite resin
are intended to reduce polymerization shrinkage, strengthen the phys-
ical and mechanical properties, and provide biocompatibility to sur-
2
rounding tissue. Several innovative approaches can be made to
improve dental composite resins derived from rice husk silica by
emphasizing their composite compositions. Resin matrix plays a role
as the backbone of the composite resin network and the currently
available rice husk dental composites are composed of mainly Bis-
GMA and TEGDMA with different concentration levels. The benefits
of using Bis-GMA include higher modulus of elasticity, lower shrink-
age, and faster hardening.31 Due to its high viscosity, low molecular
weight monomer TEGDMA is usually added to dilute it, but TEGDMA
was found to cause higher water sorption, lower color stability, and
greater polymerization shrinkage with an increased risk of marginal
restoration leakage.31,32
Due to these drawbacks, dental resin matrix polymers have been
explored to substitute the existing composite compositions for better
result. Other resin monomers which are commonly used in current
commercial composite products are urethane dimethacrylate (UDMA),
ethoxylated bisphenol-A-di-methacrylate (Bis-EMA), hydroxyethyl
methacrylate (HEMA), decane diol di-methacrylate (D3MA), polyethyl-
ene glycol di-methacrylate (PEGDMA), and urethane tetra-
methacrylate (UTMA).31 Silorane-based monomer, also known as
oxirane, is a ring-opening epoxy resin that was reported to reduced
polymerization shrinkage associated with high bond strength values in
cavities with high C-factor.33 However, mixed results were noted
across the literature on the physical and mechanical properties of
34
silorane-based composites as compared to methacrylate-based.
Ormocer, or called as Organically Modified Ceramic, is a new hybrid
inorganic–organic copolymer that is claimed to reduce shrinkage with
excellent esthetics and good wear properties.35 Conversely, Ormocers
have high viscosity that makes them difficult to manipulate and con-
dense into cavities.36 Hence, future studies should be conducted by
incorporating these resin monomers to provide a better understanding
of the effect of different advanced resin monomers on the properties
of rice husk composites.
Another aspect that should be further discussed is filler loading.
Most available studies on rice husk composite composed of low filler
to resin monomer ratio of which the filler loading ranged from 40 to
9,10,24
50 wt%. On the other hand, Lin et al. produced rice husk com-
posites with higher filler loading (75 wt%), which is comparable to
commercially available composite resins.26,27 Although Yusoff et al.
7
made rice husk flowable composites,14,22 the filler loading is still con-
sidered low compared to other flowable composites in the market
with filler beyond 60 wt%.37,38 A lower filler loading will lead to higher
shrinkage and lower physical and mechanical properties of composite
resin. Therefore, it can be hypothesized that the available rice husk
composites demonstrated inferior physical and mechanical strengths
compared to commercialized composite resins probably due to their
low filler loading.37,38 Hence, future rice husk dental composite stud-
ies should be conducted by fabricating rice husk composite with
increased filler loading to warrant its clinical significance.
Improvement in rice husk dental composites can also be per-
formed by reinforcing them with strong elements.5 Lin et al.
reinforced rice husk with zirconia powder and revealed a promising
result in restoring root canal treated teeth.26 Zirconia is bioinert,
exhibits high flexural resistance, flexural modulus, and fracture tough-
ness with good optical properties, making it popular in biomedical
applications.39 Similar properties were also noted in alumina, which
demonstrated excellent biocompatibility and wear resistance.40 None-
theless, the incorporation of alumina in rice husk dental composites
has yet to be found in the literature. Besides, one could also postulate
that superior physical toughness and mechanical strengths can be
achieved with the combination of both alumina and zirconia in future
rice husk dental composite studies.
In the present review, most selected studies fabricate rice husk
composites with γ-methacryloxypropyl-triethoxysilane (γ-MPTS)
silane coupling agent.14,16,24 The importance of coupling agent is to
provide bonding with the organic resin matrix that improves the
mechanical properties and reduces wear of the composite resin.31,41
Other types of coupling agent should be tested in future experimental
studies such as zirconate, especially in zirconia reinforced rice husk
composite. A previous study showed that using zirconate as a cou-
pling agent provides a strong adhesion between resin and zirconia
fillers.42
Considering a more conservative approach, the need to develop
more effective antibacterial and bioactive restorative dental compos-
ite materials that can inhibit bacterial colonization and promote tooth
tissue repair has escalated over the years. A variety of methods are
documented in the literature in which antibacterial agents have been
introduced to induce antibacterial activity in restorative dental mate-
rials, including zinc, silver particles, iodine, and chlorhexidine.43 Qua-
ternary ammonium compounds have been used as either monomer or
filler in dental composites and were previously reported to be an
effective long-term antimicrobial agent when incorporated in dental
composites with minimal cytotoxicity.44 Moreover, the addition of sil-
ver nanoparticles in dental composites has also been observed to
inhibit oral microbial such as Streptococcus mutans.45 Hence, future
rice husk dental composites could be fabricated with the addition of
these antibacterial agents to eradicate restoration failure caused by
secondary dental caries.
The prime goal of the modern generation of dental composites
includes using both antibacterial and regenerative actions. Calcium
phosphate nanoparticles have been incorporated into dental compos-
ite resins as ion-releasing fillers and were found to promote
8 LIN ET AL.
remineralization of caries-affected dentine and induce regeneration of
tooth tissue.46 Furthermore, the addition of bioactive glass particles
into dental composite resins have also been studied due to their bio-
activity, apatite formation, and regeneration potential.47 Thus, the
authors believe that with the incorporation of antibacterial and regen-
erative properties into current rice husk dental composite resin, more
benefits toward the reduction of caries decay and longevity of the
composite restoration can be achieved.
In short, rice husk composite resin is considered a potential
emerging biomaterial in dentistry, and a variety of other strategies can
be explored to improve its properties. While most of the proposed
advancements discussed herein remain in the in-vitro stage, future
studies should be translated into clinical practice for better
justification.
5 | C O N CL U S I O N
The current review on rice husk dental composite resins has derived
certain significant conclusions in their compositions. Rice husk dental
composite resin exhibited slightly inferior physical and mechanical
strengths, and lower surface roughness value than commercially avail-
able microhybrid composite resins. Besides, rice husk composite resin
demonstrated comparable color stability with other commercially
available microhybrid and nanohybrid composite resins. Although
flowable rice husk composite showed lower compressive strength
than hybrid flowable composites, the hardness value was more supe-
rior than commercialized flowable composite. Incorporation of zirco-
nia nanopowder into rice husk dental composite increased the
compressive strength and hardness values. This was also associated
with lower shrinkage, an excellent degree of conversion, and
improved fracture strength when applied on root canal treated teeth.
Rice husk dental composite resin demonstrated acceptable clinical
performance in terms of physical, mechanical, and optical properties.
Hence, rice husk can still be considered an inexpensive silica source as
filler particles in dental composites. Therefore, more investigations
should be directed toward improving rice husk dental composites
prior to being commercialized.
DIS CLOSURE
The authors declare that they do not have any financial interest in the
companies whose materials are included in this article.
DATA AVAI LAB ILITY S TATEMENT
The data that support the findings of this study are available from the
corresponding author (N.R.N.A.Ghani), upon reasonable request.
ORCID
Galvin Sim Siang Lin https://orcid.org/0000-0002-3996-5470
Noor Huda Ismail https://orcid.org/0000-0002-5018-6048
Nik Rozainah Nik Abdul Ghani https://orcid.org/0000-0002-2195-
3076
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How to cite this article: Lin GSS, Cher CY, Cheah KK,
Noorani TY, Ismail NH, Ghani NRNA. Novel dental composite
resin derived from rice husk natural biowaste: A systematic
review and recommendation for future advancement. J Esthet
Restor Dent. 2021;1-9. doi:10.1111/jerd.12831