How we are assessing the developing antibacterial resin-based dental materials? A scoping review

Maria Salem Ibrahim; Isadora Martini Garcia; Anmar Kensara; Abdulrahman A Balhaddad; Fabrício Mezzomo Collares; Mary Ann Williams; Ahmed S Ibrahim; Nancy J Lin; Michael D Weir; Hockin H K Xu; Mary Anne S Melo

doi:10.1016/j.jdent.2020.103369

How we are assessing the developing antibacterial resin-based dental materials? A scoping review

J Dent. 2020 Aug:99:103369. doi: 10.1016/j.jdent.2020.103369. Epub 2020 May 7.

Affiliations

¹ Ph.D. Program in Dental Biomedical Sciences, University of Maryland School of Dentistry, Baltimore, MD 21201, USA; MPH Program, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; Department of Preventive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia. Electronic address: msibrahim@umaryland.edu.
² Division of Biomaterials and Tissue Engineering, Department of Advanced Oral Sciences and Therapeutics, University of Maryland School of Dentistry, Baltimore, MD 21201, USA; Dental Materials Laboratory, School of Dentistry, Federal University of Rio Grande do Sul, 90035-003, Brazil. Electronic address: isadora.garcia@ufrgs.br.
³ Ph.D. Program in Dental Biomedical Sciences, University of Maryland School of Dentistry, Baltimore, MD 21201, USA; Department of Restorative Dentistry, College of Dentistry, Umm Al Qura University, Makkah, 24381, Saudi Arabia. Electronic address: akensara@umaryland.edu.
⁴ Ph.D. Program in Dental Biomedical Sciences, University of Maryland School of Dentistry, Baltimore, MD 21201, USA; Department of Restorative Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia. Electronic address: abalhaddad@umaryland.edu.
⁵ Dental Materials Laboratory, School of Dentistry, Federal University of Rio Grande do Sul, 90035-003, Brazil. Electronic address: fabricio.collares@ufrgs.br.
⁶ Health Sciences and Human Services Library, University of Maryland, Baltimore, MD 21201, USA. Electronic address: mwilliams@hshsl.umaryland.edu.
⁷ Medical Microbiology Department, Health Monitoring Centers, Ministry of Health, Jeddah 21176, Saudi Arabia. Electronic address: ahsibrahim@moh.gov.sa.
⁸ Biosystems and Biomaterials Division, National Institute of Standards and Technology, 100 Bureau Drive, Gaithersburg, MD 20899, USA. Electronic address: nancy.lin@nist.gov.
⁹ MPH Program, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; Division of Biomaterials and Tissue Engineering, Department of Advanced Oral Sciences and Therapeutics, University of Maryland School of Dentistry, Baltimore, MD 21201, USA. Electronic address: michael.weir@umaryland.edu.
¹⁰ MPH Program, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; Division of Biomaterials and Tissue Engineering, Department of Advanced Oral Sciences and Therapeutics, University of Maryland School of Dentistry, Baltimore, MD 21201, USA. Electronic address: hxu@umaryland.edu.
¹¹ MPH Program, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; Division of Operative Dentistry, Department of General Dentistry, University of Maryland School of Dentistry, Baltimore, MD 21201, USA. Electronic address: mmelo@umaryland.edu.

PMID: 32387506
DOI: 10.1016/j.jdent.2020.103369

Abstract

Objectives: To identify antibacterial additives and screening/assessment approaches used to evaluate the antibacterial activity of resin-based restorative dental materials containing these additives.

Data: In vitro studies that compared the antibacterial effects of resin-based restorative dental materials with and without antibacterial additives were screened. Risk bias was assessed, and the following data were extracted: antibacterial additive, parental dental material, curing mode, bacterial growth outcome assessment, samples used as a substrate for bacterial growth, inoculum complexity, and culture time as an indicator of biofilm maturity.

Source: Arksey and O'Malley's five stages framework using Medline (OVID), EMBASE, and Scopus (Elsevier) databases guided this review.

Study selection: From 6503 studies initially identified, 348 studies were considered eligible for full-text screening, and 153 were included for data extraction. Almost all studies have a high sampling bias related to both sample size and blindness. Quaternary ammonium monomers were the most investigated additive (45 %), and the most prevailing parental material was resin composite (49 %). There was extensive methodological heterogeneity among the studies for outcome assessment with the majority using resin composite disks (78 %), mono-species Streptococcus mutans as the inoculum (54 %), and a relatively short period of biofilm growth (≤24 h).

Conclusion: The findings herein present the urgent need for improved biological efficacy studies in this important and exciting field. There is a need for efforts to improve study designs to mimic the oral environment in vivo and to develop standardized methods to help understand and optimize these materials.

Clinical significance: Most studies that incorporate antibacterial additives into resin-based materials claim promising results by bacterial reduction. However, these results should be interpreted with caution due to significant variation in the methods applied for quantifying bacterial growth, the frequent lack of complexity in the biofilms, and the often-short duration of biofilm growth.

Keywords: Antibacterial; Caries inhibition; Dental materials; Oral biofilm; Polymers; Resin composites.

Publication types

Research Support, Non-U.S. Gov't
Review

MeSH terms

Anti-Bacterial Agents
Biofilms
Composite Resins*
Dental Materials
Materials Testing
Streptococcus mutans*

Substances

Anti-Bacterial Agents
Composite Resins
Dental Materials