Volume 12 - Issue 69
/ September 2023
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DOI: https://doi.org/10.34069/AI/2023.69.09.26
How to Cite:
Chertov, S.O., Kaminskyy, V., Tatarina, O., Mandych, O., & Oliinyk, A. (2023). Some aspects of using modern innovative
nanotechnologies in dentistry technical solutions, dilemma of implantation. Amazonia Investiga, 12(69), 291-303.
https://doi.org/10.34069/AI/2023.69.09.26
Some aspects of using modern innovative nanotechnologies in dentistry
technical solutions, dilemma of implantation
Algunos aspectos de la utilización de nanotecnologías innovadoras modernas en odontología
soluciones técnicas, dilema de la implantación
Received: August 12, 2023 Accepted: September 17, 2023
Written by:
Sergiy O. Chertov1
https://orcid.org/0000-0001-9867-1061
Valery Kaminskyy2
https://orcid.org/0000-0002-2693-9003
Olha Tatarina3
https://orcid.org/0000-0002-6921-3624
Oleksii Mandych4
https://orcid.org/0000-0002-7921-2385
Andrii Oliinyk5
https://orcid.org/0000-0002-8150-3341
Abstract
In the article, the authors analyze the problem of
using modern innovative nanotechnologies in
dentistry. Currently, nanotechnology is used in
treatment, prosthetics, preventive care of the oral
cavity and teeth. Based on this, the use of
nanotechnology in dentistry has a number of
advantages compared to the traditional materials
used, as they are more effective, affordable,
structured, meet all modern parameters, and have
high quality. Despite the widespread use of
nanotechnology, in some cases, they may carry
certain risks. Nanomaterials have higher activity,
high permeability through the skin, lungs, and
digestive tract. But the impact of nanoparticles
on the body remains unexplored. In addition to
safety problems of nanomaterials, their
production is associated with a number of other
problems: engineering, biological, and social.
Specialists think about new ways to solve current
1
PhD in Medicine, Associate Professor, Head of Department of Propaedeutic and Surgical Dentistry, Medical Faculty No. 3,
Zaporizhzhia State Medical University, Zaporizhzhia, Ukraine.
2
PhD in Medicine, Assistant Professor, Department of Maxillofacial Surgery National Healthcare University of P.L. Shupyk
Stomatology Institute, Kyiv, Ukraine.
3
PhD in Medicine, Assistant Professor of the Department of Orthopedic National Pirogov Memorial Medical University, Vinnytsya,
Ukraine.
4
PhD in Medicine, Assistant professor, Department of therapeutic dentistry FPGE Danylo Halytsky Lviv National Medical
University, Lviv, Ukraine.
5
PhD in Medicine, Assistant Professor, Department of Oral Surgery and Prosthetic Dentistry, Danylo Halytsky Lviv National Medical
University, Faculty of Postgraduate Education, Lviv, Ukraine.
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professional problems. Time will tell how
successful the process of integrating narrow-
profile research into practical activity will be.
The development of new and implementation of
existing nanotechnology medical technologies is
a promising direction of the development of
modern dentistry.
Keywords: nanotechnology, nanomaterials,
nanoparticles, dentistry, medicine.
Introduction
A beautiful smile not only boosts self-
confidence, but also reflects the health of the
body. The oral cavity contains many more
different types of bacteria than other parts of the
gastrointestinal tract, and this number ranges
from 160 to 300 species. Inflammatory diseases
of the oral cavity occur when the normal balance
between the own and foreign microflora is
disturbed. The originality and peculiarity of the
oral cavity lies in the fact that, firstly, two vital
functions of the human body are carried out
through it and with its help - respiration and
nutrition, and, secondly, that it is constantly in
contact with the external environment. The
mechanisms functioning in the oral cavity are
under constant double influence - the influence
of the body, on the one hand, and the external
environment, on the other.
Oral hygiene is very important because it can
have a significant impact on a person's health and
quality of life (Lamster, 2021). Oral health
received a lot of attention at the 74th World
Health Assembly in 2021 (Lamster, 2021). The
main common oral diseases are caries,
periodontal disease, and tooth loss. Therefore,
disease prevention requires special attention and
innovation.
Conventional therapeutic approaches yield
superficial outcomes that fail to achieve the
desired effects. The emerging field of
nanotechnology, particularly within the realms of
dentistry and medicine, has sparked considerable
interest among researchers due to its potential
applications and the distinct advantages it offers
compared to traditional materials.
The integration of nanotechnology into
contemporary dentistry has facilitated the
implementation of cutting-edge principles for
addressing oral health concerns, specifically
those pertaining to gums and teeth. The
widespread adoption of nanotechnology within
the dental field can be attributed to the robust
growth of the oral hygiene industry, a
progression that relies heavily on the
introduction of inventive methodologies for
acquiring products and sourcing raw materials.
Nanotechnology finds application across various
domains within dentistry, including radiography,
orthodontics, surgery, and therapeutic
interventions. Owing to their minuscule
dimensions, nanoparticles exhibit exceptional
penetrative capabilities, enabling effective tissue
infiltration, filling, and pathogen combat. Today,
many studies are being carried out
simultaneously, looking at different ways of
using nanoparticles for various dental purposes.
It is believed that the beginning of the active
development of nanotechnology was a report by
Nobel Prize-winning physicist Richard Feynman
in 1959. In 1968, Alfred Cho and John Arthur
developed the theoretical basis for surface
nanotechnology. In 1974, Norio Taniguchi
coined the word “nanotechnology”. In 1986,
nanotechnology became known to the general
public. The American futurist Eric Drexler
published a book in which he predicted that
nanotechnology would soon begin to develop
rapidly. In 2000, the US Administration
announced the National Nanotechnology
Initiative. In 2004, the US Administration
supported the National Nanomedicine Initiative
as part of the National Nanotechnology Initiative.
Research Problem
Modern innovative nanotechnologies offer great
promises for dental treatment enhancement,
diagnostics, and preventive measures. However,
the implementation of these cutting-edge
technologies in dentistry is challenging. This
article explored the research problem concerning
the dilemmas faced in introducing and
integrating modern innovative nanotechnologies
in dentistry and delved the importance of this
issue.
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What are the challenges of implementing modern
and innovative nanotechnologies in dentistry?
How can these challenges be overcome to
improve oral health?
Why is it important to address this problem?
The importance of addressing the dilemmas of
implementing modern innovative
nanotechnologies in dentistry cannot be
overstated. The lacks in the field have significant
consequences for patients, dental health
professionals, and society in general.
What consequences does it have for patients,
dental health professionals or society in general?
For patients, unresolved challenges may result in
limited access to state-of-the-art dental
treatments, diagnostics, and preventive
measures, hindering the improvement of oral
health and overall well-being.
Dental health professionals will face difficulties
i
n adapting and evolving technologies as well as
delivering the highest standard of care if these
challenges persist.
Society may suffer from missed opportunities to
advance oral healthcare, contribute to overall
healthcare system efficiency, and benefit from
the societal and economic advantages that
improved dental health can provide.
In conclusion, the research problem regarding the
implementation of modern innovative
nanotechnologies in dentistry is a critical issue
that must be addressed to unlock the full potential
of these technologies and promote improved oral
health for individuals and society as a whole.
Thus, addressing these challenges is paramount
to harness the full potential of modern
nanotechnologies in dentistry and subsequently
improve oral health.
Research Focus
The focus of the study is innovative
nanotechnologies in dentistry.
Research Aim
The purpose of the study is to analyze some
aspects of the use of modern innovative
nanotechnologies in dentistry, their technical
solutions and implementation dilemmas.
Let us examine the most recent research findings
and publications in the domain of cutting-edge
nanotechnology within the field of dentistry
(Table 1).
Theoretical Framework or Literature Review
Table 1.
Research on the use of nanotechnology in dentistry
Authors
The subject of the study
Abduazimova-Ozsujlu et al. 2021
use of innovative technologies in dentistry
Vasiliu et al., 2021
application of nanotechnology and smart nanomaterials
Amissah et al., 2021
nanotechnology in the prevention and treatment of dental caries
Ni et al., 2019
use of nanoparticles in periodontal treatment
Omanović-Mikličanin et al., 2020
nanocomposites and matrix materials
Song, Ge, 2019
application and basic mechanisms of antibacterial nanoparticles in
dentistry
Sun et al., 2019
nanoparticles in antibacterial applications
Source: author's own development
The analysis of scientific publications presented
in Table 1 above is aimed at studying the field of
dentistry and the introduction of nanotechnology
in this area. We note the growing interest in the
use of innovative technologies and nanomaterials
in dental practice. The main areas of this research
include the treatment of caries with
nanoparticles, the use of nanotechnology for the
prevention and treatment of caries, and the use of
nanoparticles in the treatment of periodontal
diseases. Table 1 of the authors' scientific papers
illustrates the diversity of thematic areas and
opportunities for further research in this area. It
is important to take these scientific achievements
into account when developing new methods and
technologies of dental practice in order to
improve the health of patients.
The results obtained indicate the potential of
nanotechnology and nanomaterials to improve
the quality of dental treatment and prevention.
Therefore, it is necessary to continue research in
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this area to develop new effective methods and
tools in the field of dentistry.
Today, the issue of using innovative technologies
in dentistry is being studied
(Abduazimova-Ozsujlu et.al., 2021). The
replacement of so-called "passive" dental
materials that do not interact with the oral
environment with "smart/intelligent" materials
that have the ability to change their shape, color
or size in response to external stimuli such as
temperature, light, humidity has received much
attention in recent years. A strong trend in
dentistry is the use of nanotechnology and smart
nanomaterials, such as nanoclay, nanofibers,
nanocomposites, nanobubbles, nanocapsules,
solid lipid nanoparticles, nanospheres, metal
nanoparticles, nanotubes, and nanocrystals.
Among nanomaterials, smart nanoparticles have
several advantages over other materials, creating
the possibility of using them in various dental
applications, including preventive dentistry,
endodontics, restoration, and periodontal disease
(Vasiliu et al., 2021). The need for and
improvement of caries treatment methods using
nanotechnology is being emphasized. Tooth
decay occurs due to prolonged acid production
when sugar is metabolized by a bacterial biofilm,
which leads to the loss of calcium and phosphate
from the enamel, so it is effective to use
nanoparticles in the treatment.
Streptococcus mutans, an acidogenic bacterial
strain, presents a formidable clinical challenge
owing to its intrinsic resistance to established
conventional therapeutic modalities, such as
cefazolin and ampicillin. Furthermore, topical
agents, notably fluoride, frequently exhibit
suboptimal efficacy due to their susceptibility to
rapid salivary clearance. Nonetheless, the
incorporation of nanoscale drug delivery systems
has yielded notable improvements in therapeutic
outcomes. These enhancements stem from the
enhanced solubility of therapeutic agents,
augmented penetration into the deeper layers of
the biofilm matrix, extended residence within the
buccal cavity milieu, and a concomitant
mitigation of the emergence of drug-resistant
phenotypes. These pioneering advancements
hold substantial potential in the rejuvenation of
therapeutic agents characterized by limited
physicochemical attributes, and they merit
consideration for future research endeavors
within the purview of Streptococcus mutans
management (Amissah et al., 2021).
The restoration of the lost periodontal structure
in the treatment of periodontitis remains a
challenging clinical task due to the limited
regenerative potential of cementum, periodontal
ligament, and alveolar bone under the conditions
of periodontal disease. Achieving periodontal
tissue regeneration necessitates the regulation of
the inflammatory response and subsequent
differentiation of periodontal cells due to the
infectious nature of the disease. It is worth noting
that 45 nm gold nanoparticles (AuNPs) have
demonstrated a significant anti-inflammatory
effect and the ability to enhance the
inflammatory microenvironment in periodontal
tissues by influencing the production of
inflammatory and regenerative cytokines and by
modulating the polarization of macrophages.
Consequently, they have an impact on the
differentiation of human periodontal ligament
cells (hPDLCs). These 45 nm AuNPs not only
directly influence hPDLCs but also play a role in
regulating the initial inflammatory response in
periodontal tissues by modulating macrophage
phenotypes. This creates an environment
characterized by controlled levels of
inflammatory cytokines and the presence of
reparative cytokines such as bone morphogenetic
protein-2 (BMP-2). This, in turn, facilitates
PDLC differentiation, promotes the regeneration
of periodontal tissues, and contributes to the
prevention of periodontitis progression (Ni et al.,
2019; Xue et al., 2019). The fundamental
concepts of nanocomposites are introduced, and
we delve into the types of matrix materials that
categorize nanocomposites into three groups:
metal matrix nanocomposites, ceramic matrix
nanocomposites, and polymer matrix
nanocomposites. Modifying the filling factor of
silver nanoparticles by just 5 percent results in
substantial alterations to both the actual and
imaginary components of the effective
permittivity of the nanocomposite material. In
the context of a graphene-based nanocomposite,
a notable absorption peak is detected when the
silver filling factor reaches 0.2. Conversely, for a
nanocomposite relying on graphene oxide, an
absorption peak becomes evident at a silver
filling factor of 0.1. In both scenarios, the highest
level of absorption is witnessed in the
nanocomposite material containing nanoparticles
with a 5 nm radius (Omanović-Mikličanin et al.,
2020; Khademi et al., 2019; Zafar, 2020). The
above review of the current scientific literature
discusses in detail the possibilities of using
nanomaterials and nanopreparations in dentistry,
which is of interest to various dental
professionals, as these materials demonstrate
new useful properties. Modern theoretical
knowledge is being successfully implemented in
practical dentistry, and nanomaterials have now
become standard components of everyday dental
practice. Some scientists also review the
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development, use, and underlying mechanisms of
antibacterial nanoparticles in dentistry, including
restorative dentistry, endodontics, implantology,
orthodontics, dentures, and periodontics (Song,
& Ge, 2019). Multifunctional nanoparticles also
have great potential in the field of antibacterial
applications aimed at preventing and controlling
the progression of periodontitis (Sun et al.,
2019). To date, many authors have published
review articles discussing the potential of
nanotechnology in dentistry, including newly
developed materials, but the literature lacks
reviews that describe in detail the science behind
nanotechnology and link it to the significance
and application of nanotechnology in dentistry.
Methodology
This review attempts to summarize and present
the current data on the work of scientists and
specialists in the field of using modern
innovative nanotechnologies in dentistry.
General Background
Theoretical methods were used: analysis,
synthesis, and generalisation of literature on the
use of nanotechnology in dentistry. The method
of comparing nanocomposites with other
composite materials was also used.
Nanotechnology has been explored in an attempt
to improve process and overall performance in
dental practice. Therefore, understanding how
these materials can be used in our daily practice
requires a deeper understanding of the science
behind nanotechnology. This article reviews
nanomanufacturing applications in the treatment,
prosthetics, and preventive care of the oral cavity
and teeth.
Data Analysis
Studies by foreign and domestic scientists
analyzing the use of innovative nanotechnologies
in dentistry from 2019 to 2022 have been
included.
The article scrutinizes the application of
nanotechnology and intelligent nanomaterials,
advances in caries treatment methodologies
through nanotechnological interventions, and
assesses nanocomposites, which categorize into
three distinct classes: metal matrix
nanocomposites, ceramic matrix
nanocomposites, and polymer matrix
nanocomposites. A comprehensive overview of
extant literature pertaining to the utilization of
nanomaterials and nanopreparations by dental
experts is provided.
Results and Discussion
Nanotechnological Advancements in
Dentistry
Abduazimova-Ozsujlu et al. (2021) points to
innovations in dental practice. Dentistry, as a
science, does not stand still, new technologies are
developing, new principles of treatment and
patient management are being applied. Before
moving on to consider innovative
nanotechnologies in dentistry, it is necessary to
first clarify the term “nanotechnology”. The
prefix “nano” is adopted in the International
System of Units (SI) and corresponds to one
billionth of the original unit. For example, a
nanometre (nm) is equal to 1-10-9 m. Highly
dispersed solid-phase objects whose dimensions
range from 1 to 100 nm are called nanoparticles.
Capable of self-organisation, they can form
agglomerates, clusters, and other ordered
structures up to several micrometres (1-10-6 m)
in size.
The word “nanotechnology” does not carry any
negative or fantastic connotations - it is simply
that advances in physics and chemistry have
enabled researchers to operate with objects in the
nanometre range. Nanotechnology is a branch of
science that deals with objects of extremely small
size, on the order of a hundred nanometres. The
processes of nanotechnology are based on the
laws of quantum mechanics and include atomic
assembly of molecules, new methods of
recording and reading information, local
stimulation of physical and chemical reactions at
the molecular level, etc. It is believed that the
active development of nanotechnology began
with a report by Nobel Prize-winning physicist
Richard Feynman in 1959. The scientist
proposed the method of atomic (molecular)
assembly, the essence of which is the
manufacture of materials and parts from the
elementary constituent elements of matter -
atoms or molecules. Dr. Eric Drexler is the
author of the concept of nanotechnology, or, as
he is called, the “father of nanotechnology”. In
1981, he published an article in which he
described the basic principles of molecular
engineering and the directions of scientific
thought on the development of nanotechnology
(Song & Ge, 2019). One of the most progressive
industries is dentistry, where the latest
achievements of science and technology are
successfully applied. The development and
creation of nanocomputers capable of not only
performing quantum computing but also
controlling the nanomachines of the future -
nanobots - opens up new opportunities for
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medicine. In the future, nanobots will adapt to the
environment by sensing its slightest changes,
move as needed, and perform molecular
assembly to repair damaged areas, which will
provide high potential for the use of these devices
for medical purposes, especially in dentistry,
where the doctor is faced with the task of not only
curing and relieving the patient of pain but also
preserving its appearance and functionality to the
maximum extent possible. With the advent of
this technology in dentistry, the boundaries of
possibilities have expanded significantly. The
founder of research in the field of nanodentistry
was Robert Freitas. In 2000, he published an
article about the potential use of nanorobots for
orthodontics and dentin regeneration, as well as
the use of nanomaterials in oral hygiene
products. According to scientist, nanomedicine is
the tracking, correction, design, and control of
human biological systems at the molecular level
using engineered nanoparticles and
nanotechnology. The creation of nanomedicine is
a matter of the near future; it does not exist yet,
but there are rapidly developing technologies that
allow us to create unique devices and
applications that open up new opportunities and
directions in various areas of modern medicine.
The global dental community was introduced to
the “nanoworld” in autumn 2002 when the first
composite material of the new generation, Filtek
Supreme nanocomposite, was presented at the
International Dental Exhibition in Vienna (Fig.
1). A high degree of filling combined with
abrasive wear resistance, good polishability and
high aesthetics allowed this subfamily of
composites to become a standard restorative
material and complete the evolution of inorganic
filler sizes from macrofilled to nanohybrid.
Figure 1. Filtek Supreme nanocomposite
Source: (Chávez-Andrade et al., 2019)
In dental practice, nanotechnology has found
application at all stages. The ability to deliver the
active ingredient directly to the problem area has
brought the treatment and prevention of oral
diseases to a new level of efficiency.
Currently, nanotechnology is used for:
− in treatment (nanocomposite materials, glass
ionomer cement of triple curing, tooth canal
fillers based on modified nanocompounds,
regenerating agents based on short
peptides);
− in prosthetics (elimination of the
consequences of periodontal diseases due to
the compaction of periodontal tissues and
fixation of mobile teeth, implantation of
implants through the root of a loose tooth);
− in preventive oral and dental care
(toothpaste, gels, and rinses with
nanoparticles that have bioantioxidant, anti-
inflammatory, and deodorising effects,
artificial protective plaque for teeth based on
nanotubes).
Nanoparticles are able to pass through biological
barriers, carrying the necessary molecules
precisely to the intended target (Table 2).
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Table 2.
Nanoparticle types and their applications in medicine
Liposomes
(nanospheres of aqueous substance enclosed in a lipid membrane) are unique carriers of
medicinal substances
Ceramic nanoparticles
are often used as drug carriers in the treatment of tumours
Iron oxide nanocrystals
can be used in the diagnosis of diseases using magnetic resonance methods
Composite shells
are used as drug carriers
Silver nanocrystals
are used for the topical treatment of infected skin wounds
Fullerenes (a new allotropic
form of carbon)
have their own biological activity, exhibiting antioxidant properties
Carbon nanotubes
are a plane rolled into a cylinder and are of great interest as drug carriers with
controlled release capabilities
Quantum particles
are used in the diagnosis of tumours and other diseases
Source: (Moradpoor et al., 2021)
Japanese scientists have used advanced
nanotechnology to create a material called
nanocrystalline medical hydroxyapatite (nano-
mHA). This artificially synthesised material is
completely similar to natural hydroxyapatite (or
calcium hydroxide phosphate), the main mineral
in bone and hard tooth tissue. It consists of 97%
tooth enamel and 70% tooth bone. The health and
beauty of teeth depends on the condition of the
enamel, which protects the tooth from external
factors. The enamel of a healthy tooth is
translucent, its natural colour is close to the
colour of ivory. However, under the influence of
the environment, diet and individual
characteristics of the body, teeth lose their supply
of valuable hydroxyapatite, the enamel becomes
covered with plaque and stains, dull and cloudy,
tooth sensitivity increases and caries develops.
One of the most effective methods of its
prevention and treatment is nanotechnology
(Amissah et al., 2021). Ensuring the timely
supply of the required amount of minerals to the
tooth tissue can prevent the development of
caries at an early stage. The ability of tooth tissue
to regenerate is provided mainly by
hydroxyapatite. In the process of
remineralisation, new hydroxyapatite crystals are
formed. Medical nano-hydroxyapatite is
designed to solve the problem of restoring the
structure of tooth tissue (Blinova & Rumyantsev,
2021). The nanoscale form of hydroxyapatite
was developed by Japanese researchers who have
been studying this problem since 1978. Today,
thanks to the development of nanotechnology,
the improved formula of nano-mHAP consists of
two-dimensional nanoparticles - on average 50
nanometres instead of nanoparticles. Particles
with a size of 300 nanometres were used
previously (1 nanometre = 1 millionth of a
millimetre). This has significantly increased the
restorative properties of nanohydroxyapatite
when acting on tooth enamel and bone tissue
(Moradpoor et al., 2021). During toothbrushing,
hydroxyapatite nanoparticles are incorporated
into tooth tissues and repair microscopic defects
and enamel damage. The ability of nano-mHA to
form strong bonds with proteins leads to the
destruction of plaque and its effective removal
(Martin et al., 2019). As a result, the enamel
becomes smooth and more resistant to bacteria.
A standard oral hygiene kit can only act
superficially. Products with nanoscale
components are able to penetrate deeply into the
organs and tissues of the oral cavity. This makes
it possible and significantly increases the
effectiveness of the impact on the roots of the
teeth and gum layers. For example, for the most
effective remineralisation of teeth,
hydroxyapatite particles are added to toothpaste
and gels. Thanks to these particles, the rate of
tooth enamel restoration is significantly
increased (Sun et al., 2019).
Nowadays, the drug “VIVAX Dent” has proven
itself well, offering a number of therapeutic and
prophylactic agents, including:
− balms-rinse containing a complex of amino
acids, aloe vera;
− anti-inflammatory toothpaste containing a
complex of amino acids, with bisabolol, with
betulavit;
− gel with bioantioxidant and amino acid
complex Neovitin (Tong et al., 2019).
A study by American scientists from the
University of Texas Health Science Centre at San
Antonio has shown that nano-hydroxyapatite not
only prevents caries but can also eliminate caries
at an early stage. This is due to the ability of
nano-mHAP ions to penetrate the microscopic
spaces between the enamel prisms, integrating
into the crystal lattice of tooth enamel
hydroxyapatite crystals. Due to its
biocompatibility and bioactivity,
nanohydroxyapatite, unlike fluoride, which has
toxic properties, does not add anything “foreign”
to tooth enamel. It naturally ensures the supply of
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minerals to the tooth tissues and restores the
enamel structure.
The ability of nanomaterials to reproduce the
mechanical, physicochemical, and aesthetic
properties of dentin and tooth enamel is a
significant advantage for their use in dental
restoration (Ali Sabri et al., 2021). Some of
the composite materials used in dentistry today
are nanomaterials, which include ceramics,
silicon, sapphire, or even diamond nanoparticles.
Such materials are similar to natural teeth in
terms of aesthetics, but they are significantly
superior in terms of strength and hardness.
The advantage of nanomaterials over traditional
composites is primarily due to the optical
properties of nanoparticles, their better polishing
ability, and the preservation of the polished
surface for a long time. There are two main types
of dental composite materials containing
nanoparticles: nanocomposites and nanohybrids,
which differ in the size of the particles they
contain. Thus, nanohybrid composites include
fillers of different sizes, for example, large glass
particles (on average, about 2000 nm) mixed
with particles of about 10 nm, and
nanocomposites contain particles of more
uniform size (particles of about 75 nm are mixed
with particle sizes from 5 to 25 nm)
(Loyola-Rodríguez et al., 2019). The advantages
of nanoscale fillers are increased wear resistance,
reduced shrinkage, reduced shrinkage stresses,
better polishability, more pronounced gloss, and
special fillers. The mechanical strength of true
nanocomposites is comparable to that of the best
microhybrid composites. On the other hand,
nanocomposites are highly aesthetically pleasing
(Valerio et al., 2019). Liquid nanocomposites are
widely used in medical practice. Improved
strength and aesthetic characteristics make it
possible to use these materials in situations that
previously required long and labour-intensive
treatment.
In dentistry, nanocomposites are being actively
introduced into the technology of replacing
wedge-shaped tooth defects, for minimally
invasive filling of carious lesions, direct and
indirect dental restoration, etc. It can be noted
that nanocomposites have a small particle size
and are universal in use, unlike macrofilled,
microfilled, and hybrid composites. In terms of
their positive properties, nanocomposites are
superior to composite materials. For example,
while macrofilled composites have only high
strength, nanocomposites are easy to polish, have
low shrinkage, are highly aesthetic and colourfast
(Omanović-Mikličanin et al., 2020)
Nanocomposites have practically no negative
qualities (except for the high cost of the
material), which cannot be said about other
composite materials (Table 3).
Table 3.
Comparative characteristics of nanocomposites with other composite materials
Macro-filled
Micron-filled
Hybrid
Nanocomposites
Particle size
1-100 microns
0.007 - 0.4 µm
0.04 - 5 microns
Nanocluster up to 1 µm
Average particle
size
5-30 microns
0.2 µm
1 micron
20 - 75 nm
Filler content by
weight (%)
75-85
36-79
75-87
78.5 nm
Indications
Loaded cavities of 1.2
classes; cavities of 5
classes in
unaesthetically
important areas;
superstructure of the
tooth stump for
artificial crowns.
Restoration of
anterior teeth
without high load;
cosmetic contouring
of macrophylls
Universal, but in some
cases of restorations are
not always effective in
cavities of classes 2, 4,
5. (Not ideal filling
surface)
Universal, used for
filling all groups of
teeth and classes of
cavities, correcting the
anatomical shape and
colour of teeth.
Positive
properties
High resistance
Aesthetics; excellent
polish; uniform
wear of the matrix
and filler.
Acceptable aesthetic
properties; sufficient
strength; the quality of
the filling surface is
better than that of
macrofilled composites.
Highly durable; colour
stable; easy to polish;
highly aesthetic;
antagonists do not
erase; low shrinkage
(2.2%).
Negative
properties
High roughness; poor
polish; unaesthetic
appearance;
discolouration;
secondary caries; high
abrasiveness.
Low resistance
Not ideal surface
quality (worse than
microfilled
composites);
insufficient polish, low
dry gloss resistance.
Material cost
Source: (Reduwan Billah, 2019; Abd El-Fattah et al., 2021)
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The inception of nanocomposite technology in
the dental market occurred during the Vienna
trade fair in October 2002, when 3M ESPE
introduced their pioneering product. This
breakthrough was the culmination of extensive
and protracted research efforts dedicated to the
development of the revolutionary 3M ESPE
Filtek Supreme dental filling material, which
incorporated a nanofiller component (3M ESPE,
2010). In the context of nanocomposite
materials, a fundamental distinction exists
between "true" nanocomposites and nanohybrid
composites. "True" nanocomposites are
characterized by their composition comprising
exclusively of nanoparticles and nanoclusters.
The technology employed in nanohybrid
composites entails the integration of
nanoparticles into conventional filler matrices. A
"true" nanocomposite filler, for instance,
combines unbound silicon nanoparticles
measuring 20 nm in size, as well as zirconia
particles with dimensions ranging from 4 to 11
nm. Additionally, these materials contain
agglomerated clusters comprising 20 nm silicon
particles and 4-11 nm zirconia particles. This
amalgamation of nanoparticles and nanoclusters
within a single material result in a material
characterized by a remarkable degree of
homogeneity, exceeding 75%, thereby affording
it substantial mechanical strength. Notable
representatives of "true" nanocomposite
materials in this category include Filtek Supreme
and Filtek Supreme XT, both manufactured by
3M ESPE (Jandt & Watts, 2020).
Nanocomposites are easily and quickly polished
to a “dry” mirror shine and retain this shine for a
long time. This is due to the fact that under
conditions of abrasive wear, as the organic
matrix wears away, only individual nanoparticles
that are not “recognised” by a beam of visible
light are detached from the clusters. The material
has low shrinkage (2.2%) due to the use of high
molecular weight resins Bis-GMA, UDMA, Bis-
EMA in the organic matrix. Low shrinkage
ensures good edge adhesion of the material,
allows the material to be introduced into the
cavity in horizontal layers and non-directional
polymerisation. The small particle size also
provides high transparency and opalescence
(“milky”) colour. In dentistry, opalescence can
be defined as the level of yellow light passing
through the filling compared to the level of blue
light reflected (when looking at the filling in
front of a black background). This effect is called
“Rayleigh colour scattering” in honour of the
19th-century physicist Baron Rayleigh. The
effect is as follows: when light hits a filler
particle, it is either absorbed or scattered. When
white light hits very fine particles, it scatters red,
yellow, and green colours in the forward
direction, while blue rays are reflected in the
opposite direction. This effect explains the
“chameleon” effect or the imperceptible
transition of the filling into the surrounding tooth
tissue, as the effect of multiple light scattering
occurs. The nanocomposite has the property of
plasticity, which makes it possible not to stick to
the working part of the instrument. Quick gloss
and long-term preservation, high strength - all
this makes the material versatile (Kolenko &
Lytvyn, 2019; Jiao et al., 2021). The use of
nanotechnology in implantology is possible by
applying nanoparticles to the surface of implants
that can control the processes of protein
adsorption, cell differentiation, and adhesion. For
example, biologically active calcium phosphate
nanocrystals applied to titanium implants
stimulate the process of osseointegration, which
significantly increases the long-term
effectiveness of implantation (Naik et al., 2020).
Therefore, nanotechnologies that modify the
surface of dental implants are increasingly used
today. The future of dentistry in this area is seen
in the synthesis of the use of nanotechnology and
the biomimetic approach (biomimetics are
products that mimic the natural structure and
properties of biological materials), ensuring that
they can be used to restore damaged enamel,
taking into account the biological response. To
date, several types of nanocoatings for dental
implant surfaces have been developed: diamond
coating, hydroxyapatite coating, and metal-
ceramic coating. Only a few manufacturers
produce implants with nanoparticle surface
treatment. A number of laboratory and
preclinical studies have shown that the results of
fixation of implants with a nanomodified surface
are significantly higher compared to
conventional implants (Vasiliu et al., 2021; Pinto
et al., 2019). However, to date, there have been
no large randomised clinical trials that could
confirm the high survival rate and durability of
implants with a nanoparticle-treated surface. The
most well-known manufacturers of dental
products using nanotechnology are Nobel
Biocare, Dentsply Sirona, Straumann, 3M,
Danaher, Ivoclar, Heraeus Kulzer, and Zimmer
Biomet Dental. The companies are actively
investing in the development of projects related
to the nanomodification of dental implant
surfaces to maintain high sales volumes in the
market in the future (Ismailov et al., 2022;
Makonin et al., 2022; Xu et al., 2019). According
to expert reports, the demand for implants with
nanomodified surfaces will increase in the
coming years due to the results of studies
confirming the benefits of this product. Sales will
also be boosted by the growing number of elderly
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people with adentia in Western countries and
rising incomes in Asia, Africa, and South
America. In addition, the medical community is
widely promoting the importance of maintaining
healthy teeth and gums and the link between oral
diseases and other systemic diseases. All these
factors will lead to the growth of sales of
nanocoated implants in the market. Currently, the
majority of sales are in Europe and North
America, with progressive growth observed after
the economic crisis of 2009. Representatives of
Straumann said that the first research in the field
of nanotechnology for dentistry began in 2010.
The first works of the company's specialists were
published in 2012 and 2013. SLActive implants
are actively installed in Europe, North and Latin
America, and in 40 countries in the Asia-Pacific
region. The largest number of sales are in
Europe, the USA, Brazil and Japan. To date,
more than 6.5 million implants have been sold.
Nobel Biocare produces Xeal nanostructured
abutments, which are sold in Europe, Canada,
Hong Kong, Australia and New Zealand, Croatia,
Turkey, Greece, India, and Vietnam. Nobel
Biocare has been developing Xeal and TiUltra
anodised surfaces for 5 years. Clinical studies of
the products were published in 2019 and will
continue for several more years.
Thus, it is obvious that modern technologies are
actively used to develop products that are widely
used by dentists. For example, according to
representatives of Nobel Biocare, the most
popular products are implants with new surfaces
- NobelActive and NobelParallel.
Currently, three-dimensional printing (3D
printing) technology is being used in many
industries, using special 3D printers. Such 3D
printing has found application in digital dentistry,
which has become possible thanks to its active
implementation by orthopedic doctors. This
technology makes it possible to manufacture
dentures, bypassing the labour-intensive costs
associated with making an impression of the jaw,
casting a plaster model of it, manufacturing
dentures, fitting dentures to an artificial (model)
jaw, and then fitting dentures to the patient's jaw.
To overcome these difficulties in dentistry, 3D
printers are used to make dentures, which are
much more efficient and productive than
conventional milling machines used in dentistry.
The 3D printer produces moulds for casting
teeth, as well as teeth and crowns themselves, not
only quickly and efficiently, but, most
importantly, taking into account the anatomical
features of the patient's oral cavity (Naik et al.,
2020; Tavares et al., 2021).
Challenges and Dilemmas in Dental
Implantation
Despite the widespread use of nanotechnology,
in some cases, it can carry certain risks.
Nanomaterials are highly active and permeable
to the skin, lungs, and digestive tract. Therefore,
the constant use of such materials can lead to
their penetration through the bloodstream to
various organs and further accumulation in the
organs. This can result in inflammatory processes
and even gene mutations.
But the impact of nanoparticles on the body
remains unexplored. In addition, it is difficult to
separate the effects of nanoparticles from other
factors that affect clinical outcomes. The release
of particles into the bloodstream is considered a
risk factor for the inflammatory process.
However, to date, there is no scientifically
proven evidence of the negative impact of
nanoparticles.
The physical and chemical properties of
nanoparticles vary depending on their origin and
can have different effects on living organisms.
The study of the cytotoxicity of particles formed
during the destruction of nanocomposite
materials has emerged as an urgent problem in
recent years along with the development of
nanotechnology and the widespread use of
nanocomposites in the medical industry.
Nanoparticles penetrate into cells by endocytosis
and are contained within endocytic bubbles. The
apoptogenic effect of silicon nanoparticles is
associated with both cytotoxic effects, such as
increased lipid peroxidation and subsequent
damage to the plasma membrane, and genotoxic
effects, such as chromosomal aberrations during
mitosis. For example, silicon nanoparticles with
diameters of 14-, 15-, and 16-nm have a toxic
effect (TC(50)) at a concentration of 33-47
μg/cm-2, and nanoparticles with diameters of 19
and 60 nm - at a concentration of 89 and 254
μg/cm-2, respectively. Thus, silicon oxide has
size-, dose-, and time-dependent cytotoxicity. At
the same time, smaller particles exhibit
significantly greater cytotoxicity than larger
particles. In the modern literature, information on
the toxicity of silica is increasingly found. There
are numerous studies proving the cytotoxic effect
of silica nanoparticles when they enter the
respiratory system from production.
Despite the fact that all restorative materials used
in hospitals are certified and recommended for
filling carious cavities of all classes, there are still
a number of questions about limiting the use of
nanocomposites on those tooth surfaces where
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abrasion and accumulation of nanoparticles
occurs more rapidly.
Potential Solutions and Future Directions
In April 2017, the European Parliament
introduced rules on the use of medical devices,
including nanotechnology. They raised the issue
of the need to create a single description of all
nanomaterials to ensure their safe use and the
legitimate use of materials by manufacturers. The
Regulation introduced the concept of
nanomaterials as natural, recycled, or
manufactured materials containing particles in a
free or bound state, 50% or more of which have
an external dimension of 1 to 100 nm.
However, ISO standards for nanomaterials have
not yet been fully developed, so laboratory and
clinical studies are required before a new product
can be marketed. In addition to safety concerns,
the production of nanomaterials poses a number
of other challenges: engineering, biological, and
social. Firstly, due to their tiny size, it is difficult
to arrange the particles correctly according to a
given plan. Secondly, nanomaterials are
pyrogenic, which causes environmental
problems. The third problem is how society will
perceive new types of materials. To indicate the
use of nanocomposites for single-patient
volumetric restorations, additional fundamental
studies of the biocompatibility and biosafety of
modern nanocomposite materials are needed.
However, when assessing the biosafety of a
nanocomposite material, the types of cells
analyzed, the conditions of exposure of
nanoparticles to cells, and cytotoxicity assays
should be taken into account.
The introduction of new nanocomposite
materials into practical medicine requires
fundamental research on their biosafety. The use
of such materials can have different effects on
different cells, tissues, organs, and the human
body as a whole. For example, the universal
restorative material
3MTMESPETMFiltekTMUltimate is
recommended by manufacturers for filling
anterior and posterior groups of teeth (including
occlusal surfaces), for core augmentation,
splinting, and indirect restorations, including
inlays, onlays, and veneers. However, given the
possible negative impact of nanocomposite
particles released during abrasion on body cells,
we consider it advisable to limit the use of the
material on occlusal surfaces, since in this area
restorations are subjected to greater mechanical
stress and wear out faster.
Conclusions
The letter combination “nano” should no longer
surprise a modern dentist. Even at the beginning
of the 21st century, nanotechnology was a
relatively new page in the intellectual epic novel
that humanity is writing. Today, fundamental
theoretical knowledge is being actively
integrated into applied fields of science and
technology, and nanomaterials are becoming a
common attribute of daily dental practice. An
important role in the development of
nanotechnology in dentistry is played by the
development of new nanomaterials that can meet
the necessary properties and requirements. A
review of research on the properties of
nanomaterials allows us to assess the prospects
for the use of nanotechnology in dentistry. Dental
nanomaterials are a new area of research, the
benefits, and risks of which are still unknown.
Long-term clinical trials are required to evaluate
them. Nevertheless, implants with a
nanomodified surface will become increasingly
popular over time due to the current outstanding
results of their placement. The large number of
elderly people with adentia and the growing
prosperity of the population in some regions of
the world will lead to an increase in sales of such
products. Some researchers argue that
nanotechnology has reached such a level that in
the future it will be possible to fully restore
damaged teeth. Let's wait, maybe this incredible
idea will become a reality someday.
Some scoffers say that at this rate, dentists will
soon not be needed. In fact, any process must be
managed by a highly qualified specialist.
Without him, all supertechnologies are like a
computer in the hands of a Neanderthal - a pile
of scrap metal.
Suggestions for Future Research
The integration of novel nanocomposite
materials into clinical dentistry necessitates
comprehensive investigation into their
biocompatibility. These materials may induce
varying effects on distinct cells, tissues, organs,
and the overall human physiological system.
Considering the potential adverse consequences
associated with the release of nanocomposite
particles during wear and tear, it is prudent to
exercise caution and restrict the application of
such materials to occlusal surfaces. This decision
is rooted in the fact that restorations in this region
experience heightened mechanical stresses and
consequently exhibit accelerated wear and tear.
Additional investigation is required to elucidate
the mechanisms of nanomaterial exposure,
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evaluate their potential toxicity and risk to human
health. Assessing the danger posed by
nanoparticles and nanomaterials to the human
organism demands the creation of innovative and
potentially distinctive methodologies. These
methodologies must consider factors such as
size, shape, methods of stabilization,
modification, and alterations in their movement
within both the environment and the human
body.
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