Dental human enamel wear caused by ceramic antagonists: A systematic review and network meta-analysis.

PURPOSE: Fixed restorations and dental enamel have different structures that produce different wear on opposing teeth, resulting in clinical problems. Therefore, it is necessary to determine the type of restoration that causes less wear on naturally opposing teeth to make recommendations. The objective of this study was to systematically analyze the evidence from observational studies and clinical trials on enamel wear in different ceramic restorations. STUDY SELECTION: The designs of the included studies were randomized clinical trials (RTCs), non-randomized clinical trials (non-RTCs), and observational studies (OS). The studies must answer the research question, be available in full text, be written in English or Spanish, and have had at least six months of follow-up. Protocol number: CRD42023397759. RESULTS: After screening 499 records, 20 RTCs were subjected to data extraction, 10 were excluded, 10 were included in the systematic review, and only 5 were included in the network meta-analysis. The risk of bias assessment reported moderate to high risk of bias, quality, and certainty of evidence was evaluated and rated as moderate. Network meta-analysis showed higher enamel wear was observed in natural dental enamel against metal-ceramic antagonists. CONCLUSIONS: Enamel wear occurs in all teeth, even when the antagonist is a natural tooth. The wear is larger on surfaces with the ceramic crown antagonists studied (metal-ceramic, glazed zirconia, and polished zirconia). It is necessary to conduct additional clinical trials with larger follow-up periods and sample sizes.

Evaluation of cellular viability in chitosan/L-arginine hydrogels.

BACKGROUND: There is a lack of studies evaluating the toxicity of nitric oxide (NO) precursors in chitosan/L-arginine hydrogels and their topical administration. However, clarifying the characteristics of these elements is essential for their possible use in non-surgical techniques of tooth movement acceleration. Such characteristics include interaction with different cell types, metabolism and drug safety. OBJECTIVES: This in vitro study aimed to assess the cytotoxicity of chitosan hydrogels on human HeLa cells using different concentrations of L-arginine. MATERIAL AND METHODS: The hydrogels were synthesized in a materials engineering laboratory, with a controlled environment, using 4 different L-arginine concentrations of 0%, 10%, 15%, and 20%. Once the hydrogels were prepared, their physical and chemical properties were characterized, and viability analysis was performed using 2 different methods, including a 48-h assay with Artemia salina nauplii and a 24-h cell culture with human HeLa cells followed by a 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) proliferation assay. Data analysis was performed using a Mann-Whitney U test to evaluate positive and negative controls in the cell culture, with a significance level of 0.01. A Wilcoxon paired test contrasted the 24-h compared to 48-h Artemia salina assays, with a Kruskal-Wallis and post hoc Dunn test used to compare groups using a significance level of 0.05. RESULTS: In the more viscous hydrogels, Artemia salina nauplii decreased drastically in 24 h, while the 15% and 20% hydrogels had no statistical differences from the negative control. The 10% and 20% hydrogels were statistically different from the negative control when comparing cell culture data. CONCLUSIONS: Our findings suggest that chitosan/L-arginine hydrogels could be used in humans without toxic effects. However, more trials and tests are needed to evaluate tooth movement rate during orthodontic treatment.

Osteoregeneration of Critical-Size Defects Using Hydroxyapatite-Chitosan and Silver-Chitosan Nanocomposites.

Bone is a natural nanocomposite composed of proteins and minerals that can regenerate itself. However, there are conditions in which this process is impaired, such as extensive bone defects and infections of the bone or surrounding tissue. This study evaluates the osteoregenerative capacity of bone grafting materials in animals with induced bone defects. Colloidal chitosan dispersion nanocomposites, nanohydroxyapatite−chitosan (NHAP-Q) and nanosilver−chitosan (AgNP-Q), were synthesized and characterized. Non-critical-size defects in Wistar rats were used to evaluate the material's biocompatibility, and critical-size defects in the calvarias of guinea pigs were used to evaluate the regenerative capacity of the bones. Moreover, the toxicity of the nanocomposites was evaluated in the heart, liver, spleen, kidneys, and skin. Histological, radiographic, and electron microscopy tests were also performed. The results showed that neither material produced pathological changes. Radiographic examination showed a significant reduction in defects (75.1% for NHAP-Q and 79.3% for AgNP-Q), angiogenesis, and trabecular formation. A toxicological assessment of all the organs did not show changes in the ultrastructure of tissues, and the distribution of silver was different for different organs (spleen > skin > heart > kidney > liver). The results suggest that both materials are highly biocompatible, and AgNP-Q achieved similar bone regeneration to that reported with autologous bone. The main research outcome of the present study was the combination of two types of NPs to enhance antimicrobial and osteoregeneration activities. These colloidal chitosan dispersions show promise as future biomaterials in the medical field for applications in fast-healing fractures, including broken bones in the oral cavity and hip replacement infections.