Exploration of Medicine

Special Issue Topic

Biomaterials and Biomarkers in Dentistry: Up to Date

Guest Editor

Prof. Gaetano Isola E-Mail

Professor, Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, Catania, Italy

Research Keywords: Periodontal disease, periodontal regeneration, biomaterials, salivary diagnostics, oral medicine, biomarkers, oral health, general health, quality of life

About the Special Issue

In the current era of tissue engineering and regenerative medicine strategies, biomaterials in dentistry are key research areas, and these new advances define the frontier in many medical disciplines. Biomaterials play a pivotal role in the growth of maxillofacial regenerative therapies, enabling more complex oral rehabilitation for patients with missing teeth.
Moreover, as evidenced by current scientific literature, the development of new molecular biomarkers constitutes an innovative diagnostic and therapeutic strategy. The classification of patients based on changes in local/systemic levels of biomolecules may enable the customization of entire treatment pathways. Oral health professionals—both clinicians and researchers—have embraced the challenge to close the gap with other medical disciplines where customized therapy is a well-established reality. For breast cancer and melanoma, genetic profiling of tumors has led to significant improvements in early diagnosis and identification of treatment targets, substantially improving prognosis and survival.
Despite robust findings in animal models and successful outcomes reported for existing regenerative procedures and materials in humans, there is a lack of rigorous evidence on whether clinical benefits represent genuine bone and periodontal regeneration.
Consequently, this Special Issue aims to update and consolidate existing knowledge on the influence of biomaterials in bone reconstruction and periodontal defects/atrophies, using various biomaterial types to enhance periodontal wound healing or regeneration.
We invite interventional research aiming to advance understanding of biomaterials and biomarkers in dentistry. Review studies employing conceptual frameworks on these themes are also encouraged.

Keywords: Biomaterials, periodontal regeneration, bone regeneration, adjuvants, periodontal disease, peri-implant disease, growth factors, oral surgery, periodontal surgery

Published Articles

Open Access

Original Article

Fracture resistance of CAD/CAM provisional crowns with two different designs: an in vitro study
Aim: To evaluate the fracture resistance of printed crowns with two different designs. Methods: Forty restorations (n = 20/group) were fabricated using resin matrix ceramic (VarseoSmile^TM) [...] Read more.

Aim:

To evaluate the fracture resistance of printed crowns with two different designs.

Methods:

Forty restorations (n = 20/group) were fabricated using resin matrix ceramic (VarseoSmile^TM) with different designs as follows: group 1: overlay restoration with chamfer margin; group 2: overlay restoration with chamfer margin located 3 mm above the gingiva. Restorations were bonded to resin dies using 3M RelyX Luting Cement. Compression forces were applied with a 4 mm diameter steel bar at the midline fissure of each crown using the universal testing machine. Restorations were loaded until fracture, and fracture resistance at maximum load was recorded. Statistical analysis: A t-test was used for statistical comparison between groups.

Results:

No difference in the fracture resistance was detected for both groups.

Conclusions:

Different designs of composite resin crowns fabricated using CAD/CAM techniques can be used, however further research is needed to assess the clinical outcomes.

Salwa Mekled ... Geraldine Weinstein

Published: August 01, 2024 Explor Med. 2024;5:566–573
DOI: https://doi.org/10.37349/emed.2024.00240

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Aim:

To evaluate the fracture resistance of printed crowns with two different designs.

Methods:

Forty restorations (n = 20/group) were fabricated using resin matrix ceramic (VarseoSmile^TM) with different designs as follows: group 1: overlay restoration with chamfer margin; group 2: overlay restoration with chamfer margin located 3 mm above the gingiva. Restorations were bonded to resin dies using 3M RelyX Luting Cement. Compression forces were applied with a 4 mm diameter steel bar at the midline fissure of each crown using the universal testing machine. Restorations were loaded until fracture, and fracture resistance at maximum load was recorded. Statistical analysis: A t-test was used for statistical comparison between groups.

Results:

No difference in the fracture resistance was detected for both groups.

Conclusions:

Different designs of composite resin crowns fabricated using CAD/CAM techniques can be used, however further research is needed to assess the clinical outcomes.

Open Access

Original Article

Influence of dental implant site preparation method on three aspects of the site: magnetodynamic mallet versus conventional drill
Aim: Magnetodynamic surgery has assumed increasing importance in recent years. The purpose of the present study was to compare in vitro, using dry porcine ribs, two methods of dental implant site [...] Read more.

Aim:

Magnetodynamic surgery has assumed increasing importance in recent years. The purpose of the present study was to compare in vitro, using dry porcine ribs, two methods of dental implant site preparation (conventional drill and magnetic mallet) on three aspects of the site. These were the difference between the diameter of the site and the diameter of the last drill used (an index of the accuracy of the preparation), the weight loss of the specimen on which the site was prepared (index of the bone loss in the site), and the change of temperature at the site (an index of the change to the material at the site).

Methods:

Eight preformed pork ribs were chosen for the study. Four implant preparations were made on each rib, two with Magnetic Mallet (Meta Ergonomica, Turbigo, Italy) and two with traditional drills. Each bone sample was weighed before and after implant site preparation in order to calculate the amount of bone lost during preparation. The diameter of preparations was analyzed with the aid of an optical microscope (MZ6, Leica, Wetzlar, Germany) connected to a dedicated measurement software. For the evaluation of the temperature, eight preparation sites were marked. In correspondence of each preparation site, on the opposite side of the rib, a hole was made for the thermocouple (HI 91530K, Hanna Instruments, Padova, Italy). During the preparations, the thermocouple was kept inserted inside the control hole to record the temperature variation. The results were analyzed using appropriate statistical methods, such as the Kolmogorov-Smirnoff test and the Wilcoxon test.

Results:

It was found that mallet drill provided significantly higher accuracy of preparation, lower amount of damage at the site, and less change to the porcine rib test material at the preparation site.

Conclusions:

A possible clinical implication of this finding is discussed.

Domenico Baldi ... Jacopo Colombo

Published: July 05, 2024 Explor Med. 2024;5:467–476
DOI: https://doi.org/10.37349/emed.2024.00232

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Aim:

Magnetodynamic surgery has assumed increasing importance in recent years. The purpose of the present study was to compare in vitro, using dry porcine ribs, two methods of dental implant site preparation (conventional drill and magnetic mallet) on three aspects of the site. These were the difference between the diameter of the site and the diameter of the last drill used (an index of the accuracy of the preparation), the weight loss of the specimen on which the site was prepared (index of the bone loss in the site), and the change of temperature at the site (an index of the change to the material at the site).

Methods:

Eight preformed pork ribs were chosen for the study. Four implant preparations were made on each rib, two with Magnetic Mallet (Meta Ergonomica, Turbigo, Italy) and two with traditional drills. Each bone sample was weighed before and after implant site preparation in order to calculate the amount of bone lost during preparation. The diameter of preparations was analyzed with the aid of an optical microscope (MZ6, Leica, Wetzlar, Germany) connected to a dedicated measurement software. For the evaluation of the temperature, eight preparation sites were marked. In correspondence of each preparation site, on the opposite side of the rib, a hole was made for the thermocouple (HI 91530K, Hanna Instruments, Padova, Italy). During the preparations, the thermocouple was kept inserted inside the control hole to record the temperature variation. The results were analyzed using appropriate statistical methods, such as the Kolmogorov-Smirnoff test and the Wilcoxon test.

Results:

It was found that mallet drill provided significantly higher accuracy of preparation, lower amount of damage at the site, and less change to the porcine rib test material at the preparation site.

Conclusions:

A possible clinical implication of this finding is discussed.

Open Access

Original Article

Relationship between gingival and peri-implant sulcular fluid active matrix metalloproteinase-8 concentration and clinical indices in healthy and diseased conditions
Aim: The study was to evaluate the active matrix metalloproteinase-8 (aMMP-8) concentration in gingival crevicular fluid (GCF) and in peri-implant sulcular fluid (PISF) in healthy and diseased co [...] Read more.

Aim:

The study was to evaluate the active matrix metalloproteinase-8 (aMMP-8) concentration in gingival crevicular fluid (GCF) and in peri-implant sulcular fluid (PISF) in healthy and diseased conditions, before and after non-surgical treatment, and to compare it with the various clinical parameters used to estimate the gingival and peri-implant inflammation.

Methods:

Plaque index/modified PI (PI/mPI), gingival index/simplified GI (GI/sGI), probing depth (PD), bleeding on probing index/modified BOPI (BOPI/mBOPI), radiographic bone loss/radiographic marginal bone loss (rBL/rMBL), and GCF/PISF samples were evaluated, before and 3 months after non-surgical treatment, GCF/PISF samples were analyzed by a chair-side mouth-rinse test (ImplantSafe^®) in combination with a digital reader (ORALyzer^®).

Results:

In all groups, aMMP-8 median levels were statistically higher in the PISF than in GCF and they did not change after treatment. Moreover, it was statistically higher in Group 3 (periodontitis/peri-implantitis) compared to the other groups. A positive correlation of the GCF/PISF and aMMP-8 median concentration was seen with increasing PD and BOPI/mBOPI values. A higher covariation of aMMP-8 mean levels in GCF with PD was found when compared to PISF levels. aMMP-8 mean levels in PISF expressed a higher covariation with increasing grades of sGI, rMBL, and BOPI while aMMP-8 GCF concentration established a better covariation with PD and PI.

Conclusions:

PISF of sites with peri-implant mucositis and peri-implantitis showed higher levels of aMMP-8 compared to sites with gingivitis and periodontitis. Compared to clinical indices, aMMP-8 concentration in GCF/PISF can be a beneficial adjunctive diagnostic tool for early identification and screening of the risk of peri-implant diseases. After non-surgical therapy, PISF aMMP-8 concentration remained mostly unchanged, while the GCF concentration of aMMP-8 significantly decreased.

Renzo Guarnieri ... Luca Testarelli

Published: April 22, 2024 Explor Med. 2024;5:243–256
DOI: https://doi.org/10.37349/emed.2024.00219

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Aim:

The study was to evaluate the active matrix metalloproteinase-8 (aMMP-8) concentration in gingival crevicular fluid (GCF) and in peri-implant sulcular fluid (PISF) in healthy and diseased conditions, before and after non-surgical treatment, and to compare it with the various clinical parameters used to estimate the gingival and peri-implant inflammation.

Methods:

Plaque index/modified PI (PI/mPI), gingival index/simplified GI (GI/sGI), probing depth (PD), bleeding on probing index/modified BOPI (BOPI/mBOPI), radiographic bone loss/radiographic marginal bone loss (rBL/rMBL), and GCF/PISF samples were evaluated, before and 3 months after non-surgical treatment, GCF/PISF samples were analyzed by a chair-side mouth-rinse test (ImplantSafe^®) in combination with a digital reader (ORALyzer^®).

Results:

In all groups, aMMP-8 median levels were statistically higher in the PISF than in GCF and they did not change after treatment. Moreover, it was statistically higher in Group 3 (periodontitis/peri-implantitis) compared to the other groups. A positive correlation of the GCF/PISF and aMMP-8 median concentration was seen with increasing PD and BOPI/mBOPI values. A higher covariation of aMMP-8 mean levels in GCF with PD was found when compared to PISF levels. aMMP-8 mean levels in PISF expressed a higher covariation with increasing grades of sGI, rMBL, and BOPI while aMMP-8 GCF concentration established a better covariation with PD and PI.

Conclusions:

PISF of sites with peri-implant mucositis and peri-implantitis showed higher levels of aMMP-8 compared to sites with gingivitis and periodontitis. Compared to clinical indices, aMMP-8 concentration in GCF/PISF can be a beneficial adjunctive diagnostic tool for early identification and screening of the risk of peri-implant diseases. After non-surgical therapy, PISF aMMP-8 concentration remained mostly unchanged, while the GCF concentration of aMMP-8 significantly decreased.

Open Access

Original Article

The most suitable system to grind the whole tooth to use it as graft material
Aim: In regenerative dentistry, the success is influenced by the graft material, which should act as an osteoconductive scaffold. It provides a mineral substrate during resorption and induces the [...] Read more.

Aim:

In regenerative dentistry, the success is influenced by the graft material, which should act as an osteoconductive scaffold. It provides a mineral substrate during resorption and induces the activity of osteoinductive cells capable of producing new bone, platelet growth factors, and cell differentiation factors that guide the differentiation of undifferentiated mesenchymal cells. Given that dentin shares many biochemical characteristics with bone tissue, it has recently attracted considerable interest as a biomaterial for bone repair. The aim of this study is to compare two grinder types to determine the optimal method for producing dentinal particles using a mechanical grinder.

Methods:

A sample of 40 natural human teeth without restorations, prostheses, or root canal treatments was used and divided into two groups subjected to two different grinder speeds (high-speed and low-speed).

Results:

The high-speed showed a greater dispersion (53.5% ± 9.89% of the tooth) due to the pulverisation (highly thin granules) of part of the tooth. The low-speed grinder did not pulverize the dentin and the percentage of tooth loss is 9.16% ± 2.34%.

Conclusions:

The low-speed grinder allows to save a major part of the tooth and has a maximum quantity of graft material but requires more time. Further studies must be promoted to optimise the grinding procedures.

Elio Minetti ... Francesco Inchingolo

Published: February 06, 2024 Explor Med. 2024;5:1–16
DOI: https://doi.org/10.37349/emed.2024.00202

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Aim:

In regenerative dentistry, the success is influenced by the graft material, which should act as an osteoconductive scaffold. It provides a mineral substrate during resorption and induces the activity of osteoinductive cells capable of producing new bone, platelet growth factors, and cell differentiation factors that guide the differentiation of undifferentiated mesenchymal cells. Given that dentin shares many biochemical characteristics with bone tissue, it has recently attracted considerable interest as a biomaterial for bone repair. The aim of this study is to compare two grinder types to determine the optimal method for producing dentinal particles using a mechanical grinder.

Methods:

A sample of 40 natural human teeth without restorations, prostheses, or root canal treatments was used and divided into two groups subjected to two different grinder speeds (high-speed and low-speed).

Results:

The high-speed showed a greater dispersion (53.5% ± 9.89% of the tooth) due to the pulverisation (highly thin granules) of part of the tooth. The low-speed grinder did not pulverize the dentin and the percentage of tooth loss is 9.16% ± 2.34%.

Conclusions:

The low-speed grinder allows to save a major part of the tooth and has a maximum quantity of graft material but requires more time. Further studies must be promoted to optimise the grinding procedures.

Open Access

Case Report

A successful case of maturogenesis by stepwise excavation using calcium-enriched mixture cement
This case report demonstrates the successful induction of apexogenesis in an extensively carious lower right first molar with immature roots through the use of stepwise excavation and calcium-enrich [...] Read more.

This case report demonstrates the successful induction of apexogenesis in an extensively carious lower right first molar with immature roots through the use of stepwise excavation and calcium-enriched mixture (CEM) cement as an indirect pulp capping material. The patient, an 8-year-old boy, presented with pain and carious pulp exposure. The initial treatment involved removing soft dentin and applying CEM cement as an indirect pulp cap. The patient experienced pain relief after 24 h, and subsequent follow-up appointments showed complete healing and maturation of the tooth. The case highlights the potential of indirect pulp treatment with CEM cement and emphasizes the importance of regenerative biomaterials in promoting healing and dentin bridge formation. Further clinical work and research are recommended to explore the efficacy of this treatment approach.

Saeed Asgary, Laleh Alim Marvasti

Published: October 27, 2023 Explor Med. 2023;4:733–738
DOI: https://doi.org/10.37349/emed.2023.00173

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This case report demonstrates the successful induction of apexogenesis in an extensively carious lower right first molar with immature roots through the use of stepwise excavation and calcium-enriched mixture (CEM) cement as an indirect pulp capping material. The patient, an 8-year-old boy, presented with pain and carious pulp exposure. The initial treatment involved removing soft dentin and applying CEM cement as an indirect pulp cap. The patient experienced pain relief after 24 h, and subsequent follow-up appointments showed complete healing and maturation of the tooth. The case highlights the potential of indirect pulp treatment with CEM cement and emphasizes the importance of regenerative biomaterials in promoting healing and dentin bridge formation. Further clinical work and research are recommended to explore the efficacy of this treatment approach.

Open Access

Review

Impact exerted by scaffolds and biomaterials in periodontal bone and tissue regeneration engineering: new challenges and perspectives for disease treatment
The periodontium is an appropriate target for regeneration, as it cannot restore its function following disease. Significantly, the periodontium’s limited regenerative capacity could be enhanced through the development of novel [...] Read more.

The periodontium is an appropriate target for regeneration, as it cannot restore its function following disease. Significantly, the periodontium’s limited regenerative capacity could be enhanced through the development of novel biomaterials and therapeutic approaches. Notably, the regenerative potential of the periodontium depends not only on its tissue-specific architecture and function but also on its ability to reconstruct distinct tissues and tissue interfaces, implying that the development of tissue engineering techniques can offer new perspectives for the organized reconstruction of soft and hard periodontal tissues. With their biocompatible structure and one-of-a-kind stimulus-responsive property, hydrogels have been utilized as an excellent drug delivery system for the treatment of several oral diseases. Furthermore, bioceramics and three-dimensional (3D) printed scaffolds are also appropriate scaffolding materials for the regeneration of periodontal tissue, bone, and cartilage. This work aims to examine and update material-based, biologically active cues and the deployment of breakthrough bio-fabrication technologies to regenerate the numerous tissues that comprise the periodontium for clinical and scientific applications.

Simona Santonocito ... Gaetano Isola

Published: April 26, 2023 Explor Med. 2023;4:215–234
DOI: https://doi.org/10.37349/emed.2023.00135

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The periodontium is an appropriate target for regeneration, as it cannot restore its function following disease. Significantly, the periodontium’s limited regenerative capacity could be enhanced through the development of novel biomaterials and therapeutic approaches. Notably, the regenerative potential of the periodontium depends not only on its tissue-specific architecture and function but also on its ability to reconstruct distinct tissues and tissue interfaces, implying that the development of tissue engineering techniques can offer new perspectives for the organized reconstruction of soft and hard periodontal tissues. With their biocompatible structure and one-of-a-kind stimulus-responsive property, hydrogels have been utilized as an excellent drug delivery system for the treatment of several oral diseases. Furthermore, bioceramics and three-dimensional (3D) printed scaffolds are also appropriate scaffolding materials for the regeneration of periodontal tissue, bone, and cartilage. This work aims to examine and update material-based, biologically active cues and the deployment of breakthrough bio-fabrication technologies to regenerate the numerous tissues that comprise the periodontium for clinical and scientific applications.

Guest Editor

About the Special Issue

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