How much do resin-based dental materials release? A meta-analytical approach.
ABSTRACT Resin-based dental materials are not inert in the oral environment, and may release components, initially due to incomplete polymerization, and later due to degradation. Since there are concerns regarding potential toxicity, more precise knowledge of the actual quantity of released eluates is necessary. However, due to a great variety in analytical methodology employed in different studies and in the presentation of the results, it is still unclear to which quantities of components a patient may be exposed. The objective of this meta-analytical study was to review the literature on the short- and long-term release of components from resin-based dental materials, and to determine how much (order of magnitude) of those components may leach out in the oral cavity.
Out of an initial set of 71 studies, 22 were included. In spite of the large statistical incertitude due to the great variety in methodology and lack of complete information (detection limits were seldom mentioned), a meta-analytical mean for the evaluated eluates was calculated. To relate the amount of potentially released material components with the size of restorations, the mean size of standard composite restorations was estimated using a 3D graphical program.
While the release of monomers was analyzed in many studies, that of additives, such as initiators, inhibitors and stabilizers, was seldom investigated. Significantly more components were found to be released in organic than in water-based media. Resin-based dental materials might account for the total burden of orally ingested bisphenol A, but they may release even higher amounts of monomers, such as HEMA, TEGDMA, BisGMA and UDMA. Compared to these monomers, similar or even higher amounts of additives may elute, even though composites generally only contain very small amounts of additives. A positive correlation was found between the total quantity of released eluates and the volume of extraction solution.
There is a clear need for more accurate and standardized analytical research to determine the long-term release from resin-based materials. Several guidelines for standardization are proposed.
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ABSTRACT: Resin monomers of dental composites like 2-hydroxyethyl methacrylate (HEMA) disturb cell functions including responses of the innate immune system, mineralization and differentiation of dental pulp-derived cells, or induce cell death via apoptosis. The induction of apoptosis is related to the availability of the antioxidant glutathione, although a detailed understanding of the signaling pathways is still unknown. The present study provides insight into the causal relationship between oxidative stress, oxidative DNA damage, and the specific signaling pathway leading to HEMA-induced apoptosis in RAW264.7 mouse macrophages. The differential expression of the antioxidative enzymes superoxide dismutase, glutathione peroxidase, and catalase in HEMA-exposed cells indicated oxidative stress, which was associated with the cleavage of pro-caspase 3 as a critical apoptosis executioner. A 2-fold increase in the amount of mitochondrial superoxide anions after a 24 h exposure to HEMA (6-8 mM) was paralleled by a considerable decrease in the mitochondrial membrane potential (MMP). Additionally, expression of proteins critical for the signaling of apoptosis through the intrinsic mitochondrial pathway was detected. Transcription-dependent and transcription-independent mechanisms of p53-regulated apoptosis were activated, and p53 was translocated from the cytosol to mitochondria. HEMA-induced transcriptional activity of p53 was indicated by increased levels of PUMA localized to mitochondria as a potent inducer of apoptosis. The expression of Bcl-xL and Bax suggested that cells responded to stress caused by HEMA via the activation of a complicated and antagonistic machinery of pro- and anti-apoptotic Bcl-2 family members. A HEMA-induced and oxidative stress-sensitive delay of the cell cycle, indicating a DNA damage response, occurred independent of the influence of KU55399, a potent inhibitor of ATM (ataxia-telangiectasia mutated) activity. However, ATM, a protein kinase which responds to DNA double-strand breaks, and the signaling pathway downstream were activated in HEMA-exposed cells. Likewise, expression and phosphorylation of the ATM targets H2AX and p53 was reduced in the presence of KU55399. Moreover, the percentage of cells undergoing apoptosis drastically decreased in HEMA-exposed cell cultures pre-treated with KU55933. These findings demonstrate that HEMA-induced apoptosis is mediated through the intrinsic mitochondrial pathway as a consequence of p53 activation via ATM signaling upon oxidative DNA damage.Biomaterials 01/2014; · 7.60 Impact Factor
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ABSTRACT: Objectives The aims of this study were to investigate an alternative pre-treatment method for resin infiltration using 37% H3PO4 with a brush applicator and to evaluate the penetration effect of the infiltrant for masking the natural white spot lesions (WSLs) in human teeth. Methods Seventy extracted human molars and pre-molars with non-cavitated WSLs were collected. Thirty teeth met criteria of ICDAS code 2, and were sectioned, providing a total of sixty paired halves. For the control group, 15% HCl gel was applied for 120 s, and 37% H3PO4, gel was gently rubbed with a brush applicator for 30 s to the experimental group. Also, to evaluate the penetration effect of the infiltrant by pre-treatment, the specimens were treated with the infiltrant (Icon®). Thicknesses of the removed surfaces and percentages of the infiltrated areas (IA%) were evaluated by CLSM, and micro-morphological changes were observed by SEM. Results The mean thicknesses of removed surface layers were significantly different between the control group (36 ± 7.62 ㎛) and the experimental group (13 ± 2.76 ㎛) (p< 0.001). But, the means of IA% were similar in both groups (p > 0.05). In the SEM images, the prism cores were preferentially dissolved in the control group, while the prism peripheries were preferentially dissolved in the experimental group. Conclusions Applying 37% H3PO4 gel with an applicator brush for 30 s could increase the permeability and minimize removal of the surface layer of natural WSLs. Moreover, the effect of resin infiltration was similar to the control group which was pretreated 15% HCl gel for 120 seconds in vitro study. Clinical significance: For resin infiltration, applying 37% H3PO4 gel with a brush applicator can preserve the protective surface layers of the WSLs with reduced application time.Journal of dentistry 01/2014; · 2.00 Impact Factor
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ABSTRACT: Objective To examine whether greater exposure to resin-based composite materials, which may intra-orally release bisphenol A (BPA), is associated with worse renal function outcomes in children.Design Prospective multi-centre study.Setting Community health dental clinics in Boston and Maine from 1997-2005.Subjects and methods Five hundred and thirty-four New England Children's Amalgam Trial participants aged six to ten years were randomised to treatment with amalgam or resin-based composite restorations over five years of follow-up.Interventions Restorations were placed according to treatment arm, and sealants placed per standard of care. Cumulative composite exposure was calculated using surface-years (each treated surface weighted by number years present).Main outcome measures Urinary excretion of albumin, gamma-glutamyl transpeptidase (gamma-GT), and N-acetyl-β-D-glucosaminidase (NAG) were available for 417 children.Results Analysis of covariance showed no association between exposure to dental composites, polyacid-modified compomer, or flowable composite dental sealants and preventative resin restorations with levels of renal function. There was no association between composite materials and thresholds indicating renal damage in logistic regression models.Conclusions This study found no harmful associations between dental composite materials and renal function in children. Therefore, concerns about renal function need not be a consideration in the choice of dental restoration material or placement of preventative dental sealants.British dental journal official journal of the British Dental Association: BDJ online 01/2014; 216(2):E4. · 1.09 Impact Factor