Development of new collagen cross-linkers for adhesive bonding stabilization

Aims: This thesis aimed to investigate the influence of different collagen cross-linkers, as separate primers or contained within desensitizing agents, on the longevity of dental restorations and on the dentinal enzymatic activity immediately, or after aging in vitro. Methods: A series of studies was conducted using several different cross-linking molecules and several adhesive systems. Four studies investigated the longevity of the hybrid layer by means of microtensile bond strength test, and the enzymatic activity using gelatin and in situ zymography, immediately or after 1 year of aging in the artificial saliva. The first study tested samples bonded with or without a cross-linking agent, that were previously aged for 5 years. The degradation of the hybrid layer was observed using transmission electron microscopy, the enzymatic activity in the hybrid layer using in situ zymography. Raman spectroscopy was used to investigate whether the active substance was still within the hybrid layer after 5 years. Results: The results of the studies showed that collagen cross-linkers were efficient in preserving bond strength after aging in vitro when used as separate primers on demineralized or partially demineralized dentin. In the cases when the cross-linker was utilized on mineralized dentin, bond strength results were higher than in the control groups immediately and after aging, however, no difference in enzymatic activity was detected after aging. Conclusions: The tested cross-linker molecules used as separate primers in etch-and-rinse and self-etch adhesives seem to be clinically applicable, since the procedure is not overly time-consuming and seems to preserve the hybrid layer over time. As for the cross-linkers contained in the desensitizing agent, when utilized before the adhesive procedures, it has shown to increase the bond strength of self-etch adhesives, but further studies are needed to better understand its effect on the enzymatic activity and crosslinking effects on mineralized dentin.

Analisi morfologica e molecolare di cellule da colture primarie umane esposte a resine biocompatibili

The cytotoxicity of dental composites has been attributed to the release of residual monomers from polymerized adhesive systems due to degradation processes or the incomplete polymerization of materials. 2-Hydroxyethyl methacrylate (HEMA) is one of the major components released from dental adhesives. Cytotoxic effects due to high concentrations of HEMA have already been investigated, but the influence of minor toxic concentrations for long-term exposition on specific proteins such as type I collagen and tenascin has not been studied in depth. The objective of this project was to study the effect of minor toxic concentrations of HEMA on human gingival fibroblasts (HGFs) and human pulp fibroblasts (HPFs), investigating modification in cell morphology, cell viability, and the influence on type I collagen and tenascin proteins. Different concentrations of the resin monomer and different times of exposition were tested on both cell lines. The cell vitality was determined by MTT assay, and high-resolution scanning electron microscopy analysis was performed to evaluate differences in cell morphology before and after treatment. To evaluate the variability in the expression and synthesis of procollagen α1 type I and tenascin proteins on HGFs and HPFs treated with HEMA at different concentrations immunofluorescence, RT-PCR and western blot analysis, were carried out. The treatments on HGFs with 3mmol/L HEMA, showed a strong reduction of procollagen α1 type I protein at 72h and 96h, demonstrating that HEMA interferes both with the synthesis of the procollagen α1 type I protein and its mRNA expression. The results obtained on HPFs treated with different concentrations of HEMA ranging from 0,5mmol/L to 3mmol/L and for different exposition times showed a strong reduction in cell viability in specimens treated for 96h and 168h, while immunofluorescence and western blotting analysis demonstrated a reduction of procollagen α1 type I and an overexpression of tenascin protein. In conclusion, our results showed that the concentrations of HEMA we tested, effect the normal cell production and activity, such as the synthesis of some dental extracellular matrix proteins.

Evaluation of fluid transport processes in dental enamel. Methods to assess the relevance of enamel permeability in caries prevention and etching treatments.

This thesis evaluated in vivo and in vitro enamel permeability in different physiological and clinical conditions by means of SEM inspection of replicas of enamel surface obtained from polyvinyl siloxane impressions subsequently later cast in polyether impression ma-terial. This technique, not invasive and risk-free, allows the evaluation of fluid outflow from enamel surface and is able to detect the presence of small quantities of fluid, visu-alized as droplets. Fluid outflow on enamel surface represents enamel permeability. This property has a paramount importance in enamel physiolgy and pathology although its ef-fective role in adhesion, caries pathogenesis and prevention today is still not fully under-stood. The aim of the studies proposed was to evaluate enamel permeability changes in differ-ent conditions and to correlate the findings with the actual knowledge about enamel physiology, caries pathogenesis, fluoride and etchinhg treatments. To obtain confirmed data the replica technique has been supported by others specific techniques such as Ra-man and IR spectroscopy and EDX analysis. The first study carried out visualized fluid movement through dental enamel in vivo con-firmed that enamel is a permeable substrate and demonstrated that age and enamel per-meability are closely related. Examined samples from subjects of different ages showed a decreasing number and size of droplets with increasing age: freshly erupted permanent teeth showed many droplets covering the entire enamel surface. Droplets in permanent teeth were prominent along enamel perikymata. These results obtained through SEM inspection of replicas allowed innovative remarks in enamel physiology. An analogous testing has been developed for evaluation of enamel permeability in primary enamel. The results of this second study showed that primary enamel revealed a substantive permeability with droplets covering the entire enamel sur-face without any specific localization accordingly with histological features, without changes during aging signs of post-eruptive maturation. These results confirmed clinical data that showed a higher caries susceptibility for primary enamel and suggested a strong relationship between this one and enamel permeability. Topical fluoride application represents the gold standard for caries prevention although the mechanism of cariostatic effect of fluoride still needs to be clarified. The effects of topical fluoride application on enamel permeability were evaluated. Particularly two dif-ferent treatments (NaF and APF), with different pH, were examined. The major product of topical fluoride application was the deposition of CaF2-like globules. Replicas inspec-tion before and after both treatments at different times intervals and after specific addi-tional clinical interventions showed that such globule formed in vivo could be removed by professional toothbrushing, sonically and chemically by KOH. The results obtained in relation to enamel permeability showed that fluoride treatments temporarily reduced enamel water permeability when CaF2-like globules were removed. The in vivo perma-nence of decreased enamel permeability after CaF2 globules removal has been demon-strated for 1 h for NaF treated teeth and for at least 7 days for APF treated teeth. Important clinical consideration moved from these results. In fact the caries-preventing action of fluoride application may be due, in part, to its ability to decrease enamel water permeability and CaF2 like-globules seem to be indirectly involved in enamel protection over time maintaining low permeability. Others results obtained by metallographic microscope and SEM/EDX analyses of or-thodontic resins fluoride releasing and not demonstrated the relevance of topical fluo-ride application in decreasing the demineralization marks and modifying the chemical composition of the enamel in the treated area. These data obtained in both the experiments confirmed the efficacy of fluoride in caries prevention and contribute to clarify its mechanism of action. Adhesive dentistry is the gold standard for caries treatment and tooth rehabilitation and is founded on important chemical and physical principles involving both enamel and dentine substrates. Particularly acid etching of dental enamel enamel has usually employed in bonding pro-cedures increasing microscopic roughness. Different acids have been tested in the litera-ture suggesting several etching procedures. The acid-induced structural transformations in enamel after different etching treatments by means of Raman and IR spectroscopy analysis were evaluated and these findings were correlated with enamel permeability. Conventional etching with 37% phosphoric acid gel (H3PO4) for 30 s and etching with 15 % HCl for 120 s were investigated. Raman and IR spectroscopy showed that the treatment with both hydrochloric and phosphoric acids induced a decrease in the carbonate content of the enamel apatite. At the same time, both acids induced the formation of HPO42- ions. After H3PO4 treatment the bands due to the organic component of enamel decreased in intensity, while in-creased after HCl treatment. Replicas of H3PO4 treated enamel showed a strongly reduced permeability while replicas of HCl 15% treated samples showed a maintained permeability. A decrease of the enamel organic component, as resulted after H3PO4 treatment, involves a decrease in enamel permeability, while the increase of the organic matter (achieved by HCl treat-ment) still maintains enamel permeability. These results suggested a correlation between the amount of the organic matter, enamel permeability and caries. The results of the different studies carried out in this thesis contributed to clarify and improve the knowledge about enamel properties with important rebounds in theoretical and clinical aspects of Dentistry.

Considerations on indirect adhesive restorations at the material and tooth interfaces

Objective: Lithium-silicate (LiSi) ceramic is nowadays widely used in dentistry. However, for the longevity of LiSi indirect restorations, it is important to pretreat the material and the dental substrate adequately. However, is not certain how the simplification of the manufacturing and conditioning procedures influences the bonding performances of LiSi ceramic restorations. Accordingly, the aims of this thesis were to investigate the effect of: 1) different LiSi ceramic surface decontamination procedures on the shear bond strength (SBS) to resin composite; 2) different types of lithium-disilicate (LiDi) (pressed vs CAD-CAM) on SBS to resin composite; 3) an experimental metal salt-based zirconium oxynitrate etchant [ZrO(NO3)2] on bonding performances to dentin. Materials and Methods: SBS test was used to investigate the influence of different cleaning protocols applied, or different processing techniques (CAD or PRESS) on the bond strength to composite resin. The third study tackled the interface between restorative materials and dentin, and investigated the microtensile bond strength test (µTBS), nanoleakage expression analysis (NL), gelatin zymography and in situ zymography of dentin conditioned with an experimental metal salt-based zirconium oxynitrate etchant [ZrO(NO3)2]. Results: MEP showed comparable bond strength to the double HP etching and higher compared to other groups. BS of press LiSi to composite was higher than that of CAD/CAM LiSi. ZON pretreatment increased bond strength to dentin when used with a universal adhesive, and inhibited dentinal endogenous enzymes. Conclusions: While simplification of the LiSi conditioning and cleaning procedures seems to yield bond strength comparable to the traditional procedures, it could be recommended in the clinical practice. However, pressed LiSi still seems to perform better in terms of bond strength compared to the CAD/CAM LiSi. Further, the novel ZON etchant seems to perform better compared to the traditional phosphoric dentin etching.