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    A new weapon in the fight against recurrent caries

    Researchers are making tremendous progress in formulating caries-resistant composite resins.

    It is impossible not to love the vast shade palette, versatile application and minimally invasive preparation design made possible by composite resin restorative materials.  You and many of your colleagues have assuredly admired the beauty of a well-placed resin composite.

    Fast-forward a few years and you may well be one of the thousands of dentists replacing those meticulously placed composite restorations secondary to recurrent decay. Over half of restorations placed by dentists in the U.S. are replacing failing restorations — the vast majority being of a composite resin material.1

    Read more: 4 big benefits of resin cements

    Even in patients with meticulous oral hygiene and essentially sugar-free diets, composite resins are inherently susceptible to degradation by not only cariogenic bacteria but also intrinsic enzymes of healthy human saliva.2 In the words of an amazing clinician, well-respected researcher and personal friend, “It should be eye opening that composites do not cure caries and are not perfect!” (Dr. Augusto Robles, University of Alabama at Birmingham School of Dentistry).

    Fig. 1

    Posterior resin composite at time of placdement with highly polished surface.

    While a true statement, researchers are making tremendous progress in formulating caries-resistant composite resins. The notion of “bioactive composite resins” has been circulating through the literature since the development of glass ionomer restoratives with a recent resurrection in this field. These composite resin formulations have been deemed capable of releasing fluoride, calcium, phosphorous, or a combination of these elements to aid in remineralizing decalcified areas of the tooth.3

    Fig. 2

    Same composite following six months of clinical service covered in a layer of plaque biofilm.

    In recent years, oral healthcare has been making a transition away from reactionary care to preventative care. For such a transition to be successful, dental materials must also make such a shift. Though bioactive remineralizing dental materials are obviously useful, these agents are treating the signs of decay and not the etiology. Hence, anti-microbial composites have made an entrance into the world of dentistry.

    Anti-microbial composites: What are they? 

    All dentists know of the bacterial biofilm that forms over the protective salivary pellicle in the early stages of plaque accumulation. In this cariogenic bacterial metropolis, adhesion proteins as well as acidic metabolites are deposited and the carious process continues.

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    Anti-microbial/anti-biofilm composite resins act to resist the carious process via:

    1.    Non-selectively killing bacteria contacting the restoration.
    2.    Selectively killing pathogenic bacteria contacting the restoration.
    3.    Repelling proteins necessary for bacterial attachment to the restoration.

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