Amr S. Fawzy

Riboflavin as a dentin crosslinking agent: Ultraviolet A versus blue light

OBJECTIVES To investigate the effect of photo-activation of riboflavin either by ultraviolet (UVA) or visible blue light (BL) on the biodegradation resistance, strength of demineralized dentin matrix, bond strength to dentin and resin/dentin interface morphology. METHODS Dentin beams were demineralized, treated with 0.1% or 1% riboflavin solution for 5min and photo-activated with UVA or BL for 20s. The ultimate tensile strength (UTS) and hydroxyproline (HYP) release were assessed after 24h collagenase challenge. For micro-tensile bond strength (μTBS) testing and resin/dentin interface morphology investigation, dentin was acid-etched, crosslinked with riboflavin and bonded with an etch-and-rinse adhesive system. Riboflavin was photo-activated separately with UVA or BL followed by photo-polymerization of the bonding resin with BL (two-step) or both riboflavin photo-activation and bonding resin photo-polymerization were done in one-step using BL. RESULTS Significant improvement in the UTS and biodegradation resistance against collagenase challenge was found when riboflavin was photo-activated either with UVA or BL. However, UVA showed more significant improvement compared to BL. After 4months of water-storage, both UV and BL two-step photo-activation methods significantly preserved higher values of the μTBS compared to the non-crosslinked control group, where UVA showed significantly higher μTBS than BL. SIGNIFICANCE Although UVA most effectively activated riboflavin, visible blue light showed to be a promising substitute for UVA as it is clinically more applicable and acceptable, and still managed to increase the biodegradation resistance, enhance the mechanical properties of dentin collagen and improve and maintain the bond strength and interface integrity after short-term water storage.

Effect of chitosan/riboflavin modification on resin/dentin interface: Spectroscopic and microscopic investigations†

The aim of this study is to investigate the morphological and chemical changes of demineralized dentin collagen-matrix and resin/dentin interface associated with chitosan/riboflavin modification. Dentin disc specimens were prepared from sound molars, acid-etched with 35% phosphoric acid and modified with either 0.1% riboflavin or chitosan/riboflavin (Ch/RF ratios 1:4 or 1:1) and photo-activated by UVA. Morphological and chemical changes associated with surface modification were characterized by SEM and micro-Raman spectroscopy. Dentin surfaces of sound molars were exposed, acid-etched, and modified as described before. Etch-and-rinse dentin adhesive was applied, light-cured, and layered with resin-restorative composite. The resin infiltration and resin/dentin interface were characterized by micro-Raman spectroscopy and SEM. An open-intact collagen network-structure, formation of uniform hybrid-layer and higher resin infiltration were found with 0.1%RF and Ch/RF 1:4 modifications. Raman analysis revealed chemical changes and shifts in Amide bands with the modification of dentin collagen-matrix. The use of riboflavin and chitosan/riboflavin formulations to modify dentin-collagen matrix, with the defined ratios, stabilizes the collagen fibrillar network and enhances resin infiltration and hybrid layer formation. These preliminary results are encouraging for subsequent consideration of chitosan/riboflavin modification in adhesive dentistry.

Characterization of Riboflavin-modified Dentin Collagen Matrix

Crosslinking is considered a possible approach to increasing the mechanical and structural stability and biodegradation resistance of the dentin collagen matrix. The aim of this study was to investigate the mechanical and chemical variations and collagen degradation resistance associated with crosslinking of the dentin collagen matrix with UVA-activated riboflavin. Dentin collagen matrix specimens were treated with 0.1 and 1% riboflavin for 2 min and photo-activated with 7 mW/cm2 UVA (368 nm) for 2 min. The structural change of the dentin collagen network with collagenase exposure was investigated by AFM and SEM at different time-points. The variations in surface/bulk mechanical properties and biodegradation resistance were characterized by nano-indentation, conventional mechanical testing, and hydroxyproline liberation at different time-points. Chemical changes associated with riboflavin/collagen-matrix interaction were analyzed by micro-Raman spectroscopy. UVA-activated riboflavin increased the mechanical properties, mechanical stability, and biodegradation resistance of the dentin collagen matrix. Higher collagen-network structural resistance against collagenolytic challenges was found with crosslinking. micro-Raman spectroscopy showed a strong dependency, in both intensity and wave-number, of certain Raman bands (1242-1667 cm-1) with crosslinking indicating the collagen/riboflavin interactions. UVA-activated riboflavin (1%) more efficiently crosslinked the dentin collagen matrix within a relatively clinically acceptable time-frame compared with 0.1% riboflavin.

Chitosan/Riboflavin-modified demineralized dentin as a potential substrate for bonding.

Previous studies have suggested different approaches to modify dentin collagen for potential improvement in bonding to dentin. Here, we are proposing a new approach to reinforce dentin collagen fibrils network by chitosan as a reinforcement phase and UVA-activated riboflavin as crosslinking agent within clinically acceptable time-frame as potential substrate for bonding. The effect of modifying demineralized dentin substrates with chitosan/riboflavin, with a gradual increase in chitosan content, was investigated by SEM, nano-indentation, conventional-mechanical testing and hydroxyproline (HYP) release at collagenolytic and/or hydrolytic challenges. The resin/dentin interface morphology, immediate bond strength and short-term bond durability were also investigated using etch-and-rinse dentin adhesive. Modification with chitosan/riboflavin increased the mechanical properties, enhanced the mechanical stability of demineralized dentin substrates against hydrolytic and/or collagenolytic degradation challenges and decreased HYP release with collagenase exposure. When chitosan was added to riboflavin at 20%v/v ratio, significant improvement in bond strength at 24 h and 6 months in distilled water was found indicating the positive dual effect on bonding to dentin. With the gradual increase in chitosan content, obliteration of interfibrillar-spaces that might adversely affect bonding to dentin was found. Although it has a synergetic effect, chitosan content is crucial for any subsequent application in adhesive dentistry.

The effect of proanthocyanidins on the bond strength and durability of resin sealer to root dentine

AIM To investigate the effect of proanthocyanidins (PAs)-rich grape seed extract on the biodegradation resistance of demineralized root dentine and on the bond strength and durability between resin-based sealer and root dentine. METHODOLOGY Single-rooted premolars (n = 28) were divided into PAs-treated and nontreated specimens. Root canals were instrumented to apical size 40, filled with RealSeal SE sealer/Core, sectioned into slices of 1 mm thickness from middle and coronal thirds and stored for 1 week or 3 months in distilled water. Specimens were subjected to push-out strength testing with the load applied perpendicularly in an apical to coronal direction using a universal testing machine. Remaining apical thirds were viewed by scanning electron microscopy after 3-months storage. Additional root canals were filled with rhodamine-B-labelled sealer and viewed by confocal laser scanning microscopy. Unfilled roots (n = 6) were sliced, demineralized, PAs-treated or left untreated and exposed to 24 h collagenase to determine hydroxyproline release in the supernatant. Two-way anova was used to test the effect of both dentine treatment with PAs and anatomical locations on bond strength and hydroxyproline release. Tukey-Kramer multiple comparison post hoc test was used to compare between groups. RESULTS No difference in bond strength was found after 1-week storage between both PAs-treated (crosslinked) and untreated (noncrosslinked) groups in the coronal thirds. However, treatment with PAs revealed higher 1-week bond strength values (P ≤ 0.05) in the middle thirds. Generally, 3-month storage decreased the bond strength compared to 1-week within each of the crosslinked and noncrosslinked groups. However, the decrease in the bond strength after 3 months was less for the crosslinked specimens compared to the noncrosslinked specimens. Confocal images revealed a relatively uniform fluorescent interfacial layer and tubular penetration after 1 week in both groups. SEM images revealed more intact resin sealer/dentine interfaces with PAs crosslinking after 3 months. In addition, hydroxyproline release was significantly less (P ≤ 0.05) with crosslinked specimens. CONCLUSION Treating root dentine with PAs-rich grape seed extracts improved the biodegradation resistance of demineralized root dentine and enhanced the bond strength and durability between resin-based sealer and root dentine after short-term water storage.

Chlorhexidine Nanocapsule Drug Delivery Approach to the Resin-Dentin Interface

In this study, we are introducing a new drug-delivery approach to demineralized dentin substrates through microsized dentinal tubules in the form of drug-loaded nanocapsules. Chlorhexidine (CHX) is widely used in adhesive dentistry due to its nonspecific matrix metalloproteinase inhibitory effect and antibacterial activities. Poly(ε-caprolactone) nanocapsules (nano-PCL) loaded with CHX were fabricated by interfacial polymer deposition at PCL/CHX ratios of 125:10, 125:25, and 125:50. Unloaded nanocapsules (blank) were fabricated as control. The fabricated nanocapsules were characterized in vitro in terms of particle size, surface charges, particle recovery, encapsulation efficiency, and drug loading. Nanocapsule morphology, drug inclusion, structural properties, and crystallinity were investigated by scanning and transmission electron microscopes (SEM/TEM), energy-dispersive x-ray analysis, Fourier transform infrared spectroscopy, and x-ray diffraction. Initial screening of the antibacterial activities and the cytotoxicity of the nanocapsules were also conducted. Nanocapsules, as carried on ethanol/water solution, were delivered to demineralized dentin specimens connected to an ex vivo model setup simulating the pulpal pressure to study their infiltration, penetration depth, and retention inside the dentinal tubules by SEM/TEM. Nanocapsules were Ag labeled and delivered to demineralized dentin, followed by the application of a 2-step etch-and-rinse dentin adhesive. CHX-release profiles were characterized in vitro and ex vivo up to 25 d. Spherical nanocapsules were fabricated with a CHX core coated with a thin PCL shell. The blank nanocapsules exhibited the largest z-average diameter with negatively charged ζ-potential. With CHX incorporation, the nanocapsule size was decreased with a positive shift in ζ-potential. Nano-PCL/CHX at 125:50 showed the highest drug loading, antibacterial effect, and CHX release both in vitro and ex vivo. SEM and TEM revealed the deep penetration and retention of the CHX-loaded nanocapsules inside dentinal tubules and their ability to be gradually degraded to release CHX in vitro and ex vivo. Ag-labeled nanocapsules revealed the close association and even distribution of nanocapsules throughout the resin tag structure. This study demonstrated the potential of introducing this novel drug-delivery approach to demineralized dentin substrates and the resin-dentin interface with nanosized CHX-loaded nanocapsules through the microsized dentinal tubules.

In vitro analysis of riboflavin-modified, experimental, two-step etch-and-rinse dentin adhesive: Fourier transform infrared spectroscopy and micro-Raman studies

To modify two-step experimental etch-and-rinse dentin adhesive with different concentrations of riboflavin and to study its effect on the bond strength, degree of conversion, along with resin infiltration within the demineralized dentin substrate, an experimental adhesive-system was modified with different concentrations of riboflavin (m/m, 0, 1%, 3%, 5% and 10%). Dentin surfaces were etched with 37% phosphoric acid, bonded with respective adhesives, restored with restorative composite–resin, and sectioned into resin–dentin slabs and beams to be stored for 24 h or 9 months in artificial saliva. Micro-tensile bond testing was performed with scanning electron microscopy to analyse the failure of debonded beams. The degree of conversion was evaluated with Fourier transform infrared spectroscopy (FTIR) at different time points along with micro-Raman spectroscopy analysis. Data was analyzed with one-way and two-way analysis of variance followed by Tukey’s for pair-wise comparison. Modification with 1% and 3% riboflavin increased the micro-tensile bond strength compared to the control at 24 h and 9-month storage with no significant differences in degree of conversion (P<0.05). The most predominant failure mode was the mixed fracture among all specimens except 10% riboflavin-modified adhesive specimens where cohesive failure was predominant. Raman analysis revealed that 1% and 3% riboflavin adhesives specimens showed relatively higher resin infiltration. The incorporation of riboflavin in the experimental two-step etch-and-rinse adhesive at 3% (m/m) improved the immediate bond strengths and bond durability after 9-month storage in artificial saliva without adversely affecting the degree of conversion of the adhesive monomers and resin infiltration.

Fabrication and evaluation of electrohydrodynamic jet 3D printed polycaprolactone/chitosan cell carriers using human embryonic stem cell-derived fibroblasts:

Biological function of adherent cells depends on the cell–cell and cell–matrix interactions in three-dimensional space. To understand the behavior of cells in 3D environment and their interactions with neighboring cells and matrix requires 3D culture systems. Here, we present a novel 3D cell carrier scaffold that provides an environment for routine 3D cell growth in vitro. We have developed thin, mechanically stable electrohydrodynamic jet (E-jet) 3D printed polycaprolactone and polycaprolactone/Chitosan macroporous scaffolds with precise fiber orientation for basic 3D cell culture application. We have evaluated the application of this technology by growing human embryonic stem cell-derived fibroblasts within these 3D scaffolds. Assessment of cell viability and proliferation of cells seeded on polycaprolactone and polycaprolactone/Chitosan 3D-scaffolds show that the human embryonic stem cell-derived fibroblasts could adhere and proliferate on the scaffolds over time. Further, using confocal microscopy we demonstrate the ability to use fluorescence-labelled cells that could be microscopically monitored in real-time. Hence, these 3D printed polycaprolactone and polycaprolactone/Chitosan scaffolds could be used as a cell carrier for in vitro 3D cell culture-, bioreactor- and tissue engineering-related applications in the future.

Characterization of antibacterial and adhesion properties of chitosan-modified glass ionomer cement:

Objectives The aim is to investigate the effect of modifying the liquid phase of a conventional glass ionomer restorative material with different chitosan volume contents on the antibacterial properties and adhesion to dentin. Methods The liquids of commercially available restorative glass ionomer cements (GIC) were modified with chitosan (CH) solutions at different volume contents (5%, 10%, 25%, and 50%). The GIC powders were mixed with the unmodified and the CH-modified liquids at the desired powder/liquid (P/L) ratio. For the characterization of the antibacterial properties, Streptococcus mutans biofilms were formed on GIC discs and characterized by scanning electron microscope (SEM), confocal microscopy, colony forming unit (CFU) count, and cell viability assay (MTS). The unmodified and CH-modified GICs were bonded to dentin surfaces and the micro-tensile bond strength (µTBs) was evaluated and the interface was investigated by SEM. Results Modification with CH solutions enhanced the antibacterial properties against S. mutans in terms of resistance to biofilm formation, CFU count, and MTS assay. Generally, significant improvement in the antibacterial properties was found with the increase in the CH volume content. Modification with 25% and 50% CH adversely affected the µTBs with predominant cohesive failure in the GIC. However, no difference was found between the control and the 5% and 10% CH-modified specimens. Conclusion Incorporation of acidic solutions of chitosan in the polyacrylic acid liquid of GIC at v/v ratios of 5–10% improved the antibacterial properties of conventional glass ionomer cement against S. mutans without adversely affecting its bonding to dentin surface.

Characterization of Chitosan/TiO2 Nano‐Powder Modified Glass‐Ionomer Cement for Restorative Dental Applications

OBJECTIVES We are introducing novel glass-ionomer cement (GIC) dually-modified with chitosan (CH) in the liquid phase and titanium-dioxide nano-powder (TiO2 /NP) in the powder phase. The aim was to investigate the effect of this dual-modification on the antibacterial properties against S. mutans biofilms and on the bulk and surface mechanical properties. METHODS Commercially available powder/liquid restorative GIC was used in this study. The GIC specimens were modified with 3% (w/w) TiO2 /NP, 10% (v/v) CH solution, or dually-modified with TiO2 /CH. The non-modified GIC was used as a control. The biofilms formations were characterized by SEM, live/dead assay using confocal-microscopy, colony-forming unit counts, and MTS assay. The bulk and surface mechanical properties were characterized in terms of flexural and compressive strengths and surface hardness, respectively. RESULTS With the dual-modification, a significant improvement in the antibacterial properties was found both qualitatively and quantitatively. The synergetic effect of the dual-modification was also reflected on the enhancement of the flexural and compressive strengths. However, no difference was found in surface hardness. CONCLUSIONS The modification of GIC powder with TiO2 /NP showed to be more effective in enhancing the mechanical properties. However, the enhancement in the antibacterial properties was more evident with CH incorporation in GIC liquid. CLINICAL SIGNIFICANCE This study introduced novel glass ionomer cement dually-modified with TiO2 NP and chitosan with superior mechanical and antibacterial properties for potential applications in restorative and preventive dentistry. The modification of GIC powder with TiO2 NP showed to be more effective in enhancing the mechanical properties. However, the enhancement in the antibacterial properties was more evident with CH incorporation in GIC liquid. Although of the promising synergetic effect of the dual-modification of GIC with TiO2 NP/CH, further clinically-related studies are recommended. (J Esthet Restor Dent 29:146-156, 2017).