Dental Tribune Pakistan Edition No.5, 2016

Bioactive materials: A new approach to dental care 2016 Pakistan Edition DENTAL TRIBUNE 13 September By Larry Clark, FIADFE, CAED, and Fredrick M. Berk, BA, FIADFE, Pulpdent Corp. T oday’s new and innovative technologies hold a great potential to improve oral health and advance dental care. One of those budding technologies is evident in the ACTIVA BioACTIVE product range (Pulpdent, USA). As part of a new class of esthetic, bioactive restorative dental materials, it offers an alternative to traditional composite restoratives and delivers direct benefits to dentists and patients. Bioactive materials are “smart,” moisture-friendly and dynamic. By responding to ambient conditions in the mouth, they play an active role in the oral environment[1] and stimulate formation of a layer of protective, apatite-like crystal deposits at the material-tooth interface[2] that forms a natural bond between the material and living tissue.[3] This natural protective remineralization process knits the restoration and the tooth together. A crystalized connective layer penetrates and fills micro-gaps, seals margins, guards against recurrent caries and prevents the staining associated with microleakage and failure. ACTIVA BioACTIVE materials are the first dental restoratives with a bioactive resin matrix, shock- absorbing resin component and reactive glass fillers designed to mimic the physical and chemical properties of natural teeth. ACTIVA responds to pH cycles in the mouth with release and recharge of calcium, phosphate and fluoride. ACTIVA BioACTIVE products resist fracture and chipping at the margins[4–6] while maintaining the high compressive and tensile strength[7] and wear resistance[8,9] required of an esthetic restorative resin. It can be used for all patients and contains no Bisphenol A, no Bis- GMA and no BPA derivatives. Over a period of five to seven years, failure may become visible at the marginal interface between the cement or restorative material and the tooth. Some materials are soluble and wash out at the margins, others are brittle and chip, and still others do not adapt intimately to tooth structure and form gaps, allowing microleakage to undermine the integrity of the restoration. These problems are compounded by constant acid attacks, the solubility and degradation of b o n d i n g a g e n t s a n d t h e incompatibility of the materials with the soft tissues, all leading to a p r o l i f e r a t i o n o f r e s t o r a t i o n failure[10–14] (Figs. 1, 2). A C T I V A B i o A C T I V E - RESTORATIVE solves the problem of microleakage as the primary cause of restoration failure.[15–17] As flowable/injectable materials, they easily adapt to irregular tooth surfaces a n d e x h i b i t w e a r r e s i s t a n c e comparable to traditional composites. The Mixpac Colibri mixing tip (Sulzer Mixpac, Switzerland) mixes the base and catalyst of the two- component material, prevents air bubbles with the 360-degree fully turnable and bendable needle and allows for precise placement of material, even in post holes and hard- to-reach areas. Placing the Mixpac Colibri mixing tip along the wall at the floor of the cavity, allowing the restorative material to flow ahead of the needle, and keeping it submerged Fig 1: Recurrent caries and wash out of cement on three-unit bridge. Fig 2: Repair with ACTIVA BioACTIVE-RESTORATIVE. Fig 3: Top, Colibri metal cannula and, bottom, easy access to cavity floors with the Colibri mix tip. Fig 4: Top, Colibri metal cannula and, bottom, easy access to cavity floors with the Colibri mix tip. in the material at all times ensures intimate adaptation with tooth structure and a gap-free restoration (Fig. 3). ACTIVA BioACTIVE-CEMENT stimulates continuous formation of calcium and phosphate crystals that strengthen the surrounding dentition and ensure marginal integrity (Fig. 4). This crystalline seal is virtually insoluble and friendly to surrounding tissues. These unique chemical and physical properties provide a durable, long-lasting seal for crown and bridge placements fabricated with both traditional and newer materials. ACTIVA BioACTIVE-CEMENT has self-etching, self-adhesive properties and is both light-curing and self-curing. Its syringe delivery system in combination with the Mixpac Colibri mixing tip provides an easy and simplified cementation procedure. After more than three years of clinical use and more than 25 p u b l i s h e d s t u d i e s , A C T I VA BioACTIVE materials have been validated and proven successful. A one-year Clinical Performance Report from The Dental Advisor awarded ACTIVA its highest 5-plus rating (+++++) and a 98 percent approval rating.[20] A 36-month recall visit of an early ACTIVA placement looked like newly placed. This provides further clinical proof of the material’s ability to penetrate and integrate with tooth structure and form a positive seal against microleakage. DT, USA Children’s oral health remains of concern in Hong Kong DT International H ONG KONG - Over the past 50 years, dental public health measures and policies have been implemented by the government in Hong Kong to help improve the oral health of the population and children in particular. A historical analysis has now shown that these efforts have led to a general improvement in the oral health of schoolchildren. However, dental disease is still prevalent among children, especially preschoolers, in the country. In order to provide a historical and epidemiological overview of the oral health of Hong Kong children, dental researchers at the University of Hong Kong reviewed all available oral health epidemiological data and information from published literature before 2014 through electronic database searches, supplemented with information obtained from government-archived oral health reports. In 1961, water fluoridation was implemented in Hong Kong and remarkably reduced the prevalence of dental caries. The researchers found that caries experience and severity among schoolchildren and schoolchildren in Hong Kong. The programme contributed to raising awareness of oral health among schoolchildren and overcoming many social barriers to dental care access. Education changed children’s lifestyles and improved their self-care practices and use of fluoride oral health care products, which have become increasingly available in the country. Despite these favourable results, the dental caries experience has remained unchanged for preschool children, the researchers highlighted. This might mainly be due to the fact that preschool children in Hong Kong are not routinely eligible for the school- based dental care programme. Moreover, the researchers observed that the overall periodontal health of Hong Kong children remains unsatisfactory, although there is evidence of improvement. In addition, a decrease in the prevalence and severity of enamel defects among Hong Kong children was observed, but there has recently been a slight increase. Continued on page 15 Up to half of preschool children in Hong Kong suffer from dental caries. adolescents decreased significantly, from more than 90 per cent in the 1960s to approximately 50 per cent in the 1980s and 90s and to less than 25 per cent currently. However, in the past two decades, no substantial changes in the caries status among preschool children have been observed. The caries incidence in preschool children remains similar, with a reported prevalence of 35–51 per cent, they stated. In 1979, the School Dental Care Service was introduced to provide prevention and dental treatment and oral health education to primary

Dental Tribune Pakistan Edition No.5, 2016

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