Bioactive Materials and Biomineralization

You're listening to The Dr. Phil Klein Dental Podcast from Viva Learning.com. Our guest on today's Viva podcast is Dr. John Comisi, and he will be discussing bioactive materials and biomineralization. Dr. Comisi has been in private practice in Ithaca, New York, since 1983. He is a regular speaker on Viva Learning.com, was the founder of Dental Care with a Difference. president and CEO of Sleep Focus Solutions Incorporated, and an assistant professor at the Medical University of South Carolina, James B. Edwards College of Dental Medicine. Dr. Comisi, thanks for joining us again on Dental Talk. We're really happy to have you back. Great to be with you again. So another hot topic, bioactive materials. You're really picking them in your podcast. There's no question about that. We hear about this all the time. And, you know, some of the dentists don't know, are these just... Marketing terms, you know, did they change glass ionomer and some of the remineralization products to bioactive materials and biomineralization? But I guess you'll tell us more about that. But my first question is, what are the challenges with the current composite restorative process? That's a great question. And all of the statements regarding, is it a buzz? Is it real? Is it a real problem? And it's a real concern because we need to know exactly what's going on. The biggest challenge is I teach my students here at the Medical University of South Carolina is that our current materials have a challenge. The National Institute of Health a few years ago. released the study indicating that the average replacement of a composite restoration is 5.7 years. which is rather shocking because most of our amalgam restorations lasted at least three or four times longer than that. And there's a lot of difficulties because our current composite, most of the typical composites that we use out there for aesthetic cosmetic dentistry are mostly passive materials. They're there to fill a hole. that is created by the cavity itself. And as such, if that filling of the hole is not as exacting as it can be, and every composite restoration has some sort of polymerization shrinkage and some kind of polymerization stress, which can leave some micro gaps that can create voids that can become the highway of bacterial invasion. secondary decay and failure. So our current materials need to evolve. We need to look at materials that are going to work with the tooth and actually survive better in the moist and hostile environment of the mouth, which is where bioactive materials have the possibility of doing more. Now, you mentioned glass ionomers and resin-modified glass ionomers. Well, those are actually some of the very first types of bioactive materials used because they elicited a specific biologic response when they interfaced with the tooth structure. They actually formed a union with the tooth that exchanged ions back and forth. Calcium and fluoride ions would transfer back and forth. And they actually worked really well. with the water surrounding them as well. In fact, glass ionomer becomes more durable as the moisture from the tooth permeates into it over the course of time. But the unfortunate reality is that glass ionomer does start to dissolve externally because of the acidity that may be present in the mouth, which is why you'll kind of see glass ionomers kind of cratering out or kind of caving in to itself over the course of time. But if you look at the interface between the tooth and the glass ionomer, it's actually still very intimately engaged. Bioleakage around a glass ionomer is not as significant typically. And it is able to recharge with the fluoride when available in the mouth as well. Again, protecting and mineralizing. So GIs, glass ionomers, were some of my first love of materials when we started playing with them in my practice and on the lab bench many years ago. So certainly bioactivity is a really, it's a real thing. There are certain materials on the market, in addition to the glass ions, which do have ion release of some degree or another. Shofu's beautiful products, which are the geomers, they release fluoride and other ions to try to combat this and be more active. Pulp Dense Activa bioactive materials, they release calcium and phosphates and fluoride. really lovely to be able to have available for the tooth. TheraCal LC by Bisco releases calcium from it to try to help with pulp protection. Biodentine by Septodont, again, another wonderful material that is a good dentin substitute that can help with calcium sealing of our deeply involved carious lesions. So these are just to name some. There are so many others out there nowadays. In fact, Pulp Den came out with their Limelight Enhanced, which is a similar type of a thought process as TheraCal LLC. So more materials are coming out. Bioactive Sealants have been available for a while. And BioCoat by Premier has just come out. Embrace Varnish from Pulp Den has been available for quite a while as well. Glass anima, bioactive materials and sealants too. Yeah, GC has one of those? Yeah, yeah. I think so. GC and SDI. GC triage and SDI is a protect. Again, great materials to help work with the tooth structure. Now, you mentioned the cratering of the glass anima, and those are some of the deficiencies as far as acting as a restorative material. Aren't most of the dentists putting the glass animal down as like a base and then putting the stronger composite restorative on top? And they can. If they're if they do, that's a great thing. But not everybody does. Sometimes we forget that deep. Deep lesions and deep resins sometimes are not the best mix for the pulpal tissue. And then they get deep problems as far as endodontic need to be taken care of. So definitely, if I were to be placing something into the tooth structure nowadays, I would be looking at something like an MTA or a biodentine or a Theracalloc or a Limelight Enhanced to try to protect. my pulp before I would restore with the composite. Because even though GI is a good material, it may not have as much to give as far as calcium and phosphates as those other materials might. Right. So if I asked you just in a couple of sentences, what would define a bioactive material? So to make sure that our listeners, when they purchase some of these products, it's not a marketing buzzword, but what does the material absolutely have to do to be in the bioactive material category? Well, in my mind, it needs to have some therapeutic ion release of some type, albeit fluoride, calcium, or phosphates. Those are the mineralization. If they have all three of those, that's your best bet to try to help things out. mineralization process in my mind. Right. So how can current bioactive materials be improved? Some of the bioactive materials could be improved by the delivery systems. If Septidont were to put its biodentine into a glass ionomer type of delivery capsule, it would be so much easier to use. You wouldn't have to worry about mixing the right amount of drops together. When you say a capsule. Meaning that it has to be triturated? Yeah, yeah. Because a lot of dentists don't even have triturators anymore these days. And that's an unfortunate reality. But the reality is that if you could mix your material up in an activator situation and then dispense it directly into the tooth, it would be so much better than mixing it up by hand. You get a more thorough mix. So there are offices that still do. have or have purchased triturators because of the need to do that. If you had materials that could be directly injected in in a single syringe that had calcium phosphates and fluoride and then worked very similarly to the composites that we are comfortable working with today. that would make it even better in my mind. So we have some dual barrel gun materials that are out there, the Activa materials, which are really nice. But if they ever put that into a single syringe, I think that would be an incredible winner. So are some of these materials packaged in a dual barrel syringe where they mix in the mixing tip? Yes, that would be the material of Activa from Pulp Deck. Okay, and what's the difference? From that being in a single syringe versus mixing in the tip. Basically, it would be so much. more comfortable, I think, for us to be able to use it. Some people have a difficult time with a gun or a dual barrel syringe trying to place it into the tooth. Most of us are very easier to work with an actual syringe into the tooth or perhaps even compuels. That's what most of us are working with nowadays. So if we were to have materials in those kinds of delivery units... It would be an improvement. That much easier for us to adopt and use in a regular basis. I think we're all spoiled, though, Dr. Comisi. I mean, I remember the days we were mixing zinc phosphate cement on a glass slab. On a cold glass slab, right? That was my day. We're on the precipice of a new era in restorative materials anyway. My thinking is that these bioactive type materials are going to become the norm. rather than the exception as we go forward. Because research is working in that arena. Companies are working in that vein with the objective of trying to create better materials for better long-lasting results. And that is definitely on the horizon. Yeah, it's exciting stuff. Thanks, Dr. Comisi, for your input. And we are very happy that you did this podcast and we know that you'll be doing more in the future. Thanks so much for joining us. You're welcome. Thank you, too.