Journal club presentation

Nanomaterials in preventive
dentistry
(Authors – Matthias Hannig & Christian Hannig
27 June 2010 | doi: 10.1038/nnano.2010.83)

Presented by –
Somya Jain
PG Ist year
RCDS & RC
1
2
Cross section of a human molar
tooth – enamel, dentine & pulp
chamber
3
Dental Caries
Most widespread oral disease.
Caused by bacterial biofilms on the tooth
surface.

4
Biofilm /
dental plaque

5
Coaggregation

6
Quorum Sensing

7
 Lotus Effect
Both natural and synthetic superhydrophobic surfaces are believed to
achieve self-cleaning by the so-called “lotus effect”.
The lotus effect typically refers to the removal of the contaminating
particles by impacting and/or rolling water droplets.
The superhydrophobicity( high water repellency ) is important because
of the associated large contact angle and small hysteresis , which
promotes the rolling motion carrying away contaminants.
Two factors necessary for obtaining a high degree of water-repellency:
1. low energy surfaces being hydrophobic and
2. surface structures that significantly increase
hydrophobicity.

(Katrina M. Wisdoma,1, Jolanta A. Watsonb,1, Xiaopeng Qua,1, Fangjie Liua, Gregory S.

Watsonb,2, and Chuan-Hua Chena,2 : Self-cleaning of superhydrophobic surfaces by self-
propelled jumping condensate . 2013 )
( Andreas Solga, Zdenek Cerman, Boris F Striffler, Manuel Spaeth and Wilhelm Barthlott :
The dream of staying clean: Lotus and biomimetic surfaces . BIOINSPIRATION &
BIOMIMETICS 2007 ) 8
Nanomaterials for managing oral biofilms

Nanocomposites surface coatings

1. Integrating nanometer sized inorganic

particles into fluoropolymer matrix.
2. Bioinspired apatite nanoparticles , either
alone or in combination with
proteinaceous additives such as casein
phosphopepetides. ( CPP-ACP)
3. Hydroxyl apatite nanocrystallite particles.

9
1- Integrating nanometer sized inorganic
particles into fluoropolymer matrix
Easy to clean properties achieved .
Biocompatible surface coating- surface free
energy 20-25mJ/m² ( theta surfaces ).
The “theta surface” is that characteristic expression of outermost atomic
features least retentive of depositing proteins. Biomaterials applications
requiring strong bioadhesion must avoid this range, while those requiring
easy release of accumulating biomass should have “theta surface”
qualities.

(Robert Edward Baier: Surface behaviour of biomaterials: The theta surface

for biocompatibility. J Mater Sci: Mater Med (2006)

10
The low-surface-free-energy coating of
nanocomposite causes poor protein–protein
binding. Shear forces in the mouth can easily
detach the outer layer of the pellicle and
bacterial biofilm from the surface.
11
2-Bioinspired apatite nanoparticles , either alone or in
combination with proteinaceous additives such as
casein phosphopepetides. ( CPP-ACP)

CPP–ACP inhibits bacterial

adhesion and oral biofilm
formation. CPP attaches to the
pellicle and limits bacterial
adhesion.
It competes with calcium for
plaque–calcium binding sites (I),
and decreases the amount of
calcium bridging the pellicle and
bacteria, and between the
bacterial cells. Specific receptor
molecules (red) in the pellicle
layer and on the bacterial surfaces
(brown) are blocked, further
reducing adhesion and coadhesion
(II). This affects the viability of the
bacteria (III).

12
3- Hydroxyl apatite nanocrystallite particles

Non –aggregated & clustered hydroxyl

apatite nanocrystallite particles ( avg size –
100 * 10 * 5 nm ) can adsorb onto the
bacterial surface and interact with bacterial
adhesins to interfere with the binding of
microorganisms to the tooth surface.

13
 Hierarchical structure of the dental enamel.

c , e – micrometer sized prisms

Atomic b , c - SEM
force
microscope

a , b, d – 3
dimensionally
organized
nanosized hydroxyl
apatite crystallites
TEM SEM 14
Early stages of tooth decay caused by
bacterial biofilm
Bacteria metabolize sugar and other
carbohydrates to produce lactate
(HL) and other acids that, in turn,
dissociate to form H+ ions that
demineralize the enamel beneath the
surface of the tooth; calcium and
phosphate are dissolved in the
process. This is known as a white-
spot lesion. Owing to
reprecipitation, a pseudo-intact
surface layer (red arrow) is observed
on top of the body of the carious
lesion in this early stage of tooth
decay. This pseudo-intact layer is
permeable to ions (indicated by
white chevrons).

15
Dental erosion caused by acidic beverages or
food in the oral cavity

Low pH, caused by acidic

beverages or gastric juices
(pH 1–4), destroys the
enamel surface by partial
and complete dissolution of
the enamel crystallites,
resulting in the release of
Ca2+ and HPO42– ions.
This loosens the
microstructure of the
enamel and hydroxyl apatite
crystallites (pale blue)
become demineralized, or
are lost.

16
Nanomaterials for remineralization of
sub micrometer sized tooth defects
1.CPP-ACP
Mechanism of action –
CPP stabilizes Ca²⁺ & PO₄²⁻ thru formation of
amorphous nanocomplexes. Phosphorylated
seryl residues are regarded responsible for
interactions b/w casein & Ca²⁺ and PO₄²⁻ in
nanocomplexes , which ensure ions are
available for biomineralization.

17
Commercially available CPP-ACP
containing oral health care products -

18
2- nano sized hydroxyl apatite
particles

 Hydroxyl apatite particles with size 20 nm fits well

with dimensions of the nanodefects caused at the
enamel surface during acidic erosions .

 Nano hydroxyl apatite toothpaste with either

spheroidal or needle- like particles as an active
component was shown to enhance the
remineralization of etched enamel better than
sodium fluoride solutions.
19
 3- carbonate hydroxyl apatite
nanoparticles

Biomimetic carbonate hydroxyl apatite

nanoparticles that mimic the size of natural
dentinal hydroxyl apatite (20 nm) or
enamel apatite (100 nm) were used to
repair micrometre-sized tooth-surface
defects in vitro.

20
Commercially available products -

21
Biomimetic synthesis of enamel and repair
of microcavities
If carious or erosive enamel defects enlarge -
the established way to restore clinically visible
loss of enamel is the application of resin
composites in combination with dental
adhesives.
However, biomimetic synthesis of enamel
could be an alternative reparative approach,
and self-assembling hierarchically organized
enamel like structures composed of hydroxyl
apatite crystals would be ideal.
22
Materials that can be used -
Paste containing fluoride-substituted hydroxyl apatite.
Using different organic additives and scaffold-forming
molecules, predominantly amelogenin, in slow and
precisely controlled crystallization systems.
Self-assembling anionic β-sheet peptides, based mainly
on glutamic acid and glutamine from fibrillar networks.
Surfactants have also been used as reverse micelles or
microemulsions to mimic the biomineralization process.
Sodium bis(2-ethylhexyl) sulphosuccinate as a
structure-directing agent.

23
Critical evaluation -
The article presents a no. of nanosized
particles with their use in prevention of
dental caries but many of the experiments
provide in vitro data only and their effects
are yet to be confirmed in clinical trial .

The mechanical properties of nanomaterials

in comparison with the conventional
materials used is not taken into
consideration.
24
The author in the article itself states that the
biomimetic enamel surfaces are still susceptible
to caries if patients neglect conventional oral
health-care such as tooth brushing or fluoride
application , thus the use of these materials
cannot be considered as a very effective method
for caries prevention.

The use of these nanomaterials for biomimetic

restoration and filling of small clinically visible
cavities is not conceivable at the moment, and
requires extensive further research with respect
to clinical applicability.

25
Conclusion
Oral health-care products based on bioinspired
nanomaterials have moved from the laboratory
to daily application — as a supplement to
conventional approaches — for biofilm
control and remineralization of
submicrometre-sized enamel lesions.

However, biomimetic restoration and filling of

small clinically visible cavities with
nanomaterials is not conceivable at the
moment, and requires extensive further
research. 26
Cross references -
Nanocomposites containing amorphous
calcium phosphate ( ACP) or calcium flouride
( CaF₂) nanoparticles and CHX particles were
found to impart a more potent antibacterial
capability .
 Maintained a growth medium pH at a safe level of
above 6.5 .
 Reduced biofilm acid production & metabolic
activity 10-20 times , compared to conventional
composites.

(Lei Cheng , Michael D.Weir , Hockin et al. antibacterial and physical properties of
calcium – phosphate and calcium fluoride nanocomposites with
chlorhexidine.dental materials 28(2012)573-583) 27
 Mechanical properties of these
nanocomposites matched that of
commercial composites without fluoride.
 Nano CaF₂ composite released F ions
similar amount to that of commercial
RMGIC.

( Lei Cheng , Michael D.Weir , Hockin et al. antibacterial and physical

properties of calcium – phosphate and calcium fluoride nanocomposites
with chlorhexidine.dental materials 28(2012)573-583

28
Immediate application of nanofiller
containing surface coating over GIC
restoration –

 helps to protect the GIC from moisture contamination &

dehydration during initial setting .
 Enhances wear resistance and provides protection against
acid attacks .
 Allows for slow and steady release of fluoride ; thus
improving the effectiveness of GIC restoration used.

( Tiwari S, Nandlal B. effect of nanofilled surface coating agent on

fluoride release from conventional glass ionomer cement : an in vitro
trial . Jisppd 2013;31.91- 95)

29
References -
1-Katrina M. Wisdoma,1, Jolanta A. Watsonb,1, Xiaopeng Qua,1, Fangjie
Liua, Gregory S. Watsonb,2, and Chuan-Hua Chena,2 : Self-cleaning of
superhydrophobic surfaces by self-propelled jumping condensate .
2013. 7992–7997
2- Andreas Solga, Zdenek Cerman, Boris F Striffler, Manuel Spaeth
and Wilhelm Barthlott : The dream of staying clean: Lotus and
biomimetic surfaces . Bioinsp. Biomim. 2 (2007) S126–S134.
3- Robert Edward Baier: Surface behaviour of biomaterials: The theta
surface for biocompatibility. J Mater Sci: Mater Med (2006) 17:1057–
1062
4- Lei Cheng , Michael D.Weir , Hockin et al. antibacterial and physical
properties of calcium – phosphate and calcium fluoride nanocomposites
with chlorhexidine.dental materials 28(2012)573-583
5- Tiwari S, Nandlal B. effect of nanofilled surface coating agent on
fluoride release from conventional glass ionomer cement : an in vitro
trial . Jisppd 2013;31.91- 95

30
31