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Robert Elsenpeter is a freelance writer and frequent contributor to Dental Products Report and Dental Lab Products. He is also the author of 18 technology books, including the award-winning Green IT: Reduce Your Information System's Environmental Impact While Adding to the Bottom Line. As such, he’s particularly interested in the technological side of dentistry.
Pulpdent’s Fred Berk tells DPR what sets this bioactive material apart from passive materials.
Pulpdent’s ACTIVATM BioACTIVE is a dental filling material that behaves much like natural teeth. The material is “bioactive,” meaning it stimulates the formation of apatite (the building blocks of teeth) and chemically bonds to teeth, which helps seal them against decay.
We talked to Fred Berk, vice president of Pulpdent, about the product and how it encourages the body’s natural remineralization process.
What are bioactive materials?
Bioactive dental materials imitate nature, play a dynamic role in the mouth and deliver the minerals teeth need to stay healthy. They stimulate the natural remineralization process with the release of beneficial ions, such as calcium, phosphate and fluoride. In the presence of saliva, they elicit a biological response that forms a layer of apatite and a natural bond at the material-tooth interface. Bioactive materials transport or store water, interact with saliva and tooth structure, and actively participate in the cycles of ionic exchange that regulate the natural chemistry of teeth and saliva and contribute to the maintenance of oral health.
How are they used clinically?
There are different categories of bioactive materials for various indications. Most are non-esthetic materials used for endodontic purposes, as dentin replacement materials, or for cementation. These would include calcium-based materials, such as calcium hydroxide, calcium silicate (MTA) and calcium aluminate. ACTIVA BioACTIVE materials are the only esthetic bioactive restorative materials. They are flowable, resin-based bioactive restoratives with the same indications as traditional and flowable composites, and syringe dispensing provides ease of application.
What qualities set them apart from passive materials?
Biochemistry only occurs in the presence of water. So first and foremost, bioactive materials are moisture-friendly. They have the capability to transport or store water, and they may even contain water. Bioactive materials can play a dynamic role in the mouth and respond to pH changes in the oral environment. They release and recharge their ionic components, providing teeth with the essential minerals they need to stay healthy. Passive materials, such as traditional composites, are hydrophobic, repel water, do not stimulate remineralization and have no capacity for bioactivity. They are designed to be neutral and do no harm, and as a result, they do not provide any benefits other than filling a space.
What kinds of results can a doctor expect from bioactive materials?
Dentists and their patients expect esthetic, durable restoratives with better long-term outcomes, and bioactive materials, such as ACTIVA, deliver these results. The NIH/NIDCR reports that the average life expectancy of traditional composite restorations is 5.7 years. This is not acceptable; amalgams lasted two or three times longer. The degradation of bonding agents, which leads to microleakage at the material-tooth interface, has been identified as the primary contributor to restoration failure. In addition, the brittleness of traditional composites can result in fracture and chipping, and traditional cavity preps, designed for amalgams, may also be a factor in restoration failure.
Bioactive materials that mimic the physical and chemical properties of teeth, and that are moisture-friendly and easy to use, are an attractive alternative to traditional materials. They stimulate apatite formation at the material-tooth interface that knits the restoration and tooth together, guards against secondary caries, and seals against microleakage and failure. ACTIVA has the advantage of esthetics, strength and durability, and it contains a patented rubberized-resin molecule that absorbs stress and resists fracture and chipping.
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Does the dentist experience this difference chairside?
This has been one of the most interesting things to us. Practitioners observe that ACTIVA has an affinity for tooth structure and wants to become part of the tooth. They have seen this with glass ionomers and MTA, but those materials have limited uses, and they have never seen it before with an esthetic restorative resin material.
Traditional passive composites have no bond strength whatsoever. In fact, they are repelled by teeth, and a bonding agent is always required. Practitioners have told us that ACTIVA “appears to melt into the tooth.” They immediately observe that something different is happening, and it is intuitive to them that the penetration and integration improves marginal integrity. The ionic exchange, stimulation of apatite formation and sealing of margins cannot be observed immediately at chairside, but SEM and EDS analysis prove this definitively, and the practitioner sees the results at recall visits.
What are the financial advantages of bioactive materials? That is, are they less expensive than passive materials? Do they last longer and don’t need to be replaced as often?
The greatest cost to dentists is their time. Materials represent only about 6 percent of revenue, and the cost of bioactive materials is comparable to passive materials. Patients are researching online and are increasingly aware of options for dental care. Dentists who use bioactive materials that provide direct benefits for oral health have a powerful story to tell that resonates with an informed public and helps build their practice. The injection technique used with ACTIVA takes a fraction of the time of placing a traditional composite. In a majority of cases, ACTIVA does not require a bonding agent, which saves considerable time and money. We are seeing cases that are more than four years, and they look the same as they did the day they were placed.
What do you expect for the future of these materials?
We are in the age of biomaterials. Dentists want to do what is best for their patients and their practice. Materials that mimic nature, behave favorably in the moist oral environment, neutralize conditions that cause dental caries, provide prevention benefits and maximize the potential for remineralization will become the standard of care. Bioactive materials that are strong, esthetic and long-lasting offer a welcome alternative to traditional passive materials. In both public health and private practice, prevention is becoming the model for dental care, and bioactive materials are ideally suited for this model.
How did Pulpdent become a leader in this new field of bioactive materials?
Pulpdent is focused on research and the development of advanced bioactive materials for everyday use in clinical practice. The passive approach to dental materials is a vestige of the 20th century when better options were not available. Those materials may have been the best at the time, but our science team had ideas on how to overcome problems associated with traditional passive materials. We invested heavily in those ideas over a period of many years and developed ACTIVA BioACTIVE products and other bioactive materials that will be introduced in the future.
Our background may also be a contributing factor. We grew up in dentistry. Our father, a dentist and researcher, taught us that nature has tremendous healing powers, and one of the responsibilities of the practitioner is to create an environment that is favorable for the natural healing process. Dad believed that the best thing we can do for people is help them smile with confidence and live in comfort. With this in mind, we have always been committed to making a difference in people’s lives through oral health.