NANOTECHNOLOGY IN PROSTHODONTICS

NANOTECHNOLOGY IN PROSTHODONTICS

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SYNOPSIS

 INTRODUCTION
 HISTORY
 MODES
 CONCEPTS
 ULTRASTRUCTURAL CLASSIFICATION
 APPROACHES
 APPLICATIONS IN PROSTHODONTICS
 CONCLUSION
 REFERENCES

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INTRODUCTION
Nano" is derived from the Greek word “υαυος” which means 'dwarf' which
combines with a noun to form words such as nanometer, nanotechnology, and nano
robot.
Nanotechnology is the science of manipulating matter on molecular and atomic
levels or of matter measured in the billionths of meters or nanometer, roughly the
size of 2 or 3 atoms.
A nanometer is 10-9 or one billionth of a meter.
Nano technology consists mainly of the processing, separating, consolidating, and
deforming of materials by one atom or molecule.
The definition of nanotechnology has generally been extended to include features
as large as 100 nm.
The term ‘‘nanotechnology’ ’was coined by a student at the Tokyo Science
University in1974(Taniguchi, 1974).

HISTORY
Concepts in Nanotechnology was first described byAmerican scientist Richard
Feynman in 1959.
With further research Japanese scientist N.Taniguchi in 1974 defined
Nanotechnology.
In 1980s with invention of Scanning Tunnel Microscope studies were done in
much more depth by Dr. K.Eric. Drexler who promoted the technological
significance of nanoscale phenomena.
In 2002, Filtek Supreme first introduced Nanocomposites.

WHAT IS THE NEED?

Routinely used dental materials having drawbacks of inferior physical and biologic
properties have not been substituted rather can be modified with nanomaterials to
enhance the inherent properties of the material within the economic limits.

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Unique characteristics of the nanoscale material may not only have profound effect
on the physical properties such as tensile strength, fracture resistance, surface
hydrophobicity, but also affect the biological properties like biocompatibility and
cytotoxicity.
Therefore, researcher’s area of interest in the current times has been biological
especially the cytotoxic effects of nanomaterials.
There are more atoms on the surface of the nanoparticle which present with
unbound surfaces compared to the core of the nanoparticle.
This gives them a potential to create new and strong bonds and makes them more
reactive when compared to macro or micro particles which have more core than
surface atoms and are easy to manipulate and use.
Nanotechnology fundamentally changes the health care in following ways:
New diagnostic and preventive modalities.
Customized treatment plan in accordance with the patient’s profile. 3. Drug
delivery and gene therapy

MODES OF NANOTECHNOLOGY
Broadly, nanotechnology is based on three mutually overlapping and powerful
molecular technologies:
Nanoscale-structured materials and devices developed for advanced diagnostics,
targeted drug delivery and smart drugs.
Molecular medicine via genomics, proteomics, artificial biotics (microbial robots).
Molecular machine systems and medical nanorobots allow instant pathogen
diagnosis and extermination, and efficient augmentation and improvement of
natural physiological function.
Researchers observed that material reduced to nanoscale can suddenly show very
different properties;
for instance opaque substance becomes transparent, Inert material becomes
catalyst, stable materials becomes combustible, solid turns in to liquid at room
temperature, insulators become conductors, materials which are chemically inert at

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normal scale when reduce to nanoscale can serve as potential catalyst; hence these
qualities of nanoparticles enables unique.

CONCEPT OF NANOMATERIALS
Nanoscale materials enables unique applications due to the variations observed in
its physical properties.
The fundamental properties of the nanomaterial includes
Small size effect,
Quantum size effect
Quantum tunnelling effect
Surface effect

The small size effect is the minimum amount of energy that is required for
interactions between nanoparticles (interactions like dissolution, melting, boiling,
bonding, molecular reactions).
The extensive aggregation prevents the material from developing discontinuity that
is the quantum size effect.
The quantum tunnelling effect is that when a nanoparticle is made to pass through
a thin barrier (eg. a cell membrane) it would not require much energy as it passes
through the area of least resistance (the membrane in this case), this phenomenon
explains the antimicrobial activity by membrane disintegration.
The surface effect can be explained by the fact that nanoparticles have multiple
surfaces which leads to more area for interactions (precisely the high surface
energy).

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NANOMATERIALS:
Nano materials have small size, large surface area, high surface energy and a large
proportion of atoms.

ULTRA-STRUCTURAL CLASSIFICATION OF NANOPARTICLES

It can be based on multiple factors, primary being the classification based on the
shape and ultra-nanostructure.
Nanorods
Dimensions: Length: 10 - 120 nm.
These are structurally like the enamel rods. Enamel-prism like hydroxyapatite
nanorods exhibiting self-assembly properties were synthesized by Chen and
colleagues.
Material: Metal and metal oxides, carbon.
Application: Drug delivery, bio-imaging, photothermal therapy nanocapacitors.

Nanowires
Dimensions: Diameter: 10 nm Length: Not defined.
Material: Ceramic, metal oxide and metals.
Application: Magnetic devices, nanowires battery, nanogenerator, semiconductor,
etc.

Nanotubes
Dimensions: Expressed in terms of ratio (length / width): 3 - 5 Available as single
or multi-walled tubes.
Material: Carbon.
Application: Scaffolds or templates for the building.

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TWO MAIN APPROCHES

1. Bottom Up Approach:- Where materials and devices are built from molecule
component, which self assemble themselves chemically using principles of
molecular recognition.
It starts with atoms or molecules to build up nanostructures.
Various nanoparticles produced through bottom up method and used in dentistry
are nanopores, nanotubes, quantum dots, nanoshells, dendrimers liposomes,
nanorods, fullerenes, nanospheres, nanowires, nanobelts, nanorings, nanocapsules.

2.Top Down Approach: - Where nanoobjects are manufactured from larger

entities without atomic level control.
(Bachmann, 1998; Freitas, 1999; Pool, 1990; Roukes, 2001; Whitesides& Love,
2001).
Rybachunk AV, Chelkman IS. Nanotechnology and nanoparticles in
dentistry.Pharmacol Pharm 2009;1:18-21
3. Functional: This approach does not give importance to the method of
production of nanoparticles. Its objective is to produce nanoparticle with a specific
functionality.

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BOTTOM UP APPROACH
Bottom up approach deals with fabrication methods for manufacture of the nano
goods and the methods used for producing nanoscale structures. Nano dentistry as
bottom-up approach:
Local anaesthesia.
Hypersensitivity cure.
Major tooth repair
Nanorobotic dentifrice [dentifrobots].
Dental cosmetics.
Orthodontic treatment.
Photosensitizers and carriers.
Diagnosis of oral cancer. (Nanodiagnostics) Treatment of oral cancer.

TOP DOWN APPROACH

The top down techniques that are used to manufacture nanoscale structures are
mostly extensions of methods already employed in small scale assembly at the
micron scale. By further miniaturization, the nano dimension is entered.
Nano-dentistry as top-down Approach:
Nanocomposites.
Nanosolution.
Impression materials.
Nanoneedle.

NANOROBOTS
Nanorobots possess the ability to swim about thus enabling it to cross over and
reach the surfaces that are beyond the scope of toothbrush bristles or dental floss.

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They could be built to serve short term purposes as daily hygiene measures to
prevent tooth decay and periodontal breakdown at an early age.
These nanorobots generally wane off in the oral cavity itself in the form of dietary
fibers

TOOL USED: -
Atomic force microscope Scanning tunnel microscope.
So refined processes of chemistry and new generation analytical instrument allow
the deliberate manipulation of nanostructures and in turn leads to the observation
of novel phenomena.

NANOMATERIALS IN PROSTHODONTICS
Research in nano technology of dental materials is mainly focused on two ways :
Preparation of new inorganic nano particles
Modifying the surface with inorganic nano fillers.

These materials are widely used in ceramics, metals, resins and composites
providing huge space for the improvement and innovation of dental material.
Studies of nano metal shows that it has better antibacterial property.

IMPRESSION MATERIALS
NANOCERAMICS
DENTAL CEMENTS
DENTURE BASE MATERIAL
TISSUE CONDITIONERS, SOFT LINERS
MAXILLOFACIAL MATERIALS

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IMPLANTS
BONE REPLACEMENT MATERIALS

1. IMPRESSION MATERIALS
Nanofillers are integrated in vinylpolysiloxanes,
producing a unique addition of siloxane impression materials. The material has
better flow, improved hydrophilic properties hence fewer voids at margin and
better model pouring. (Trade name: Nanotech Elite H-D)
Advantages:
Increased fluidity
High tear resistance,
Hydrophilic properties
Resistance to distortion and heat resistance Addition siloxane impression material
5. Snap set that consequently reduces errors caused by micro with incorporated
nanofillers
movements
Patil M, Mehta DS, Guvva S. Future impact of nanotechnology on medicine and
dentistry. J Indian SocPeriodont 2008 May; 12(2):34-40.
Chandki R, Kala M, Kumar NK, Brigit B, Banthia P, Banthia R. Nanodentistry:
exploring the beauty of miniature. J ClinExp Dent 2012;4(2):119-124.

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Conclusion
Contact angle measurement showed that all testedmaterials were hydrophilic
specially VPES and PE which recorded the highest wettability
All tested materials showed accepted dimensionalchanges according to
ANSI/ADA No. 19 (<0.5%), PVS containing nanofillers showed the greatest
dimensional stability
All materials recorded accepted flexibility withinthe recommended range (2–20%)
according to ANSI/ADA No. 19. PE, VPES and PVS recorded higher flexibility
than PVS containing nanofillers • PVS containing nanofillers and VPES showed
the highest tear resistance.

2.NANOCERAMICS
Routinely used alumina ceramics though have superior
mechanical properties but one of its major drawbacks is
that it is more likely to crack.

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Zirconia ceramics have significantly overcome the shortcomings of alumina

ceramics, but they lack toughness.
“Nanoceramic” refers to “the ceramic material with nanoscale dimensions in the
microstructures phase”. primarily the property of brittleness causes the
shortcoming of ceramic material;
Nanoceramic demonstrates improved toughness and ductility, this is attributed to
the atomic arrangement in nanoceramic interface.
Inorganic-organic hybrid particles where the inorganic part consisting of siloxane
and the methacrylic organic part blends all the particles with resin matrix.
Propagating cracks are either more often reflected or absorbed by the nanoceramic
particles.
Carbon nanotubes (CNTs) have attracted remarkable attention as reinforcements of
materials because of their exceptional mechanical and electronic properties.
Lava Ultimate Resin Nano Ceramic (RNC) blocks , (3M ESPE) are innovative new
CAD/CAM materials with superior esthetic results, durability and fracture
resistance.

Advantages of nanoceramics are:

Super plasticity.
Superior mechanical properties :good toughness , ductility, superior strength and
hardness.

Series of studies were conducted with regards to toughness and strength of

nanoceramics like, Wang et al (2006) in his experiment, compared addition of 20
% of Nano ZrO2 to a composite of AL203 and conventional ZrO2 in terms of
toughness.
Nanoceramic yielded better results.
Li et al (2011) through his study revealed the hardness of traditional ZrO2 was
1500 while that of nano ZrO2 is 1750.3 V.

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Raj et al (2014) compared the micro hardness and toughness of conventional TiO2
ceramics Vs nano TiO2 ceramics. Nano TiO2 exhibited 13000 kN / m2 micro
hardness and superior hardness while conventional TiO2 ceramics had value less
than 2000 kN / M2.2

3.DENTAL CEMENTS

Antibacterial activity of dental luting cement is a very important property when

applying dental crowns, bridges, inlay, onlay, veneers because bacteria may be still
present on the walls of preparation or gain access to the cavity if there is
microleakage present after cementation.
In order to overcome this, addition of silver nanoparticles in dental cements took
place. Silver has been used for its bactericidal properties for many years. It has
been used in water purification, wound care, bone prosthesis, cardiac devices and
surgical appliances.
Innovations and modifications by incorporating nanoparticles as fillers have
enhanced the properties of cements.
Glass ionomer cement with up to 5% w/wTiO2 nano particles have shown
increased fracture toughness, flexural strength, compressive strength and
antibacterial activity.
For restorations in higher stress bearing sites.
In this product, conventional glass ionomer technology has been interlaced with
nanotechnology to give its unique handling characteristics.
The ‘new material’ comprises two stable hydrates: the minerals katoite and
gibbsite.
Katoite is a calcium-alumina-hydrate and is built as crystals, each being between
10 and 40 nanometers in size.
Gibbsite is an aluminum-hydroxide and is formed first as an amorphous gel which
transforms over time into crystalline gibbsite. The material attaches itself to the
tooth surface by so-called nanostructural integration and therefore, by definition,

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product, belongs to the material group, nanostructurally integrating bioceramics

(NIB).

Composition:
Chemistry of nano ionomer is based on the methacrylate modified polyalkenoic
acid, which is capable of both crosslinking via pendate methacrylate groups as well
as the acid–base reaction between the fluoroaluminosilicate glass (FAS) and the
acrylic and itaconic acid copolymer groups. It contains surface treated nanofillers
(approx. 5–25 nm) and nanoclusters (approx. 1 to 1.6 microns).
Filler loading is approx. 69% by weight of which the relative proportion of two
filler types (FAS and combination of nanofillers) are approx. 2/5 and 3/5,
respectively.
All nanofillers are further surface modified with methacrylate silane coupling
agents to provide covalent bond formation into free radically polymerized matrix.

Nano filled Resin-Modified Glass Ionomer

Light-cure
• Blends Nanotechnology originally developed for Filtek™ Supreme Universal
Restorative with fluoraluminosilicate (FAS) technology.
✓ Commercially available as Ketac N100 light curing nano-ionomer (3M ESPE).
Advantages:
Superb polish.
Excellent esthetics.
Improved wear resistance
Clinical Indications: -
Primary teeth restorations. - Transitional restorations. - Small Class I restorations.
Sandwich restorations. - Class III and V restorations. - Core build-ups.

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4. NANOPARTICLES IN POLYMETHYLMETHACRYLATE RESIN

PMMA resin has been widely used as a denture base material and in making
orthodontic appliances. However owing to the surface porosities they have been
prone to plaque accumulation, thus increasing the cariogenic oral flora.
Inclusion of carbon nanotubes into heat cure monomer has decreased
polymerization shrinkage and has enhanced the mechanical properties.
Incorporation of metal oxide nanoparticles into conventional polymethyl

methacrylate has improved the flexural strength, antimicrobial property and

reduced porosity.
Oral pathological condition like denture stomatitis is mainly caused by adherence
of biofilm onto the denture base. Incorporation of nanoparticles into the denture
base materials is mainly in the form of silver and platinum nanoparticles as an
effective antimicrobial agent.
The silver nanoparticles incorporation within the acrylic denture base material can
improve its viscoelastic properties.
Metallic particles

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Similarly incorporation of nanoparticles like silver, platinum, titanium and iron

have shown increase in flexural strength, antimicrobial properties, surface
hydrophobicity, viscoelasticity, decrease in porosity and biomolecular adherence.
Although silver nanoparticles have antibacterial activity, their incorporation in
acrylic resin have shown a colour change in concentrations above 80 ppm and
cytotoxity in concentrations more than 40 ppm.
Addition of zirconium dioxide nanoparticles in heat cure PMMA has increased
abrasion resistance, tensile and fatigue strength.

Hua et al (2013) performed a study in which the saturation of reinforcing effect

was studied for conventional PMMA and TiO2 reinforced PMMA.

Results were:
A nano particle could nearly make the reinforcing effect .

Cooper et al (2002) showed that addition of small amount of CNT will

significantly improve the impact strength of PMMA.

Hong et al (2003) added Methacryloxy-Propyltrimethoxy-Silane (MPS) modified

silica nanoparticles to PMMA which increased the tensile strength .
Mudhaffar (2012) evaluated the effect of addition of different percentage of
modified ZrO2 to heat activated PMMA. He concluded that significant results
were obtained at 3 % and 5 % nanofillers in terms of abrasion resistance, tensile
and fatigue strength.
In the quest of exploring the antimicrobial properties of nanoparticles, Yoshida et
al (1999) demonstrated a long-term inhibitory effect of resin composite admixed
with silver nanoparticles against S. mutans.
Laura et al (2011) prepared the PMMA composites along with addition of TiO2
and Fe3O2 nanoparticles, for enhanced aesthetic as well as antimicrobial
properties. The study concluded that PMMA containing nanoparticles

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demonstrated decreased rate of Candida albicans (C. albicans) cell adhesion and a
reduced porosity as compared to standard / control sample.

5.DENTURE BASE MATERIAL

Researchers have developed polymer of the denture base material by
nanotechnology.
The non-agglomerated and non-aggregated and nonfumed silica particles of 200
nm diameters were taken.
The surface of this nanosized particle was treated with silane. These particles were
mixed with water and alcohol and then this dispersion was spray dried to get the
nanosized filler particles.
These filler particles where dispersed in either methacrylate or epoxy resin added
with hardening substance like zirconium dioxide .
Advantages:-
Strength:- extremely dense material reduces the chance of breakage.
Cleanliness:- non porous surface greatly lessens odor causing plaque and bacteria .
Comfortable because reduced irritation to the gums. Thin and light in weight .
Natural looking as it allows patient’s natural tissuetone to appear through the
material.

6. TISSUE CONDITIONER
Tissue conditioners have been commonly used to enhance the recovery of denture
bearing tissues from trauma, damage or residual ridge resorption usually caused by
illfitting dentures.
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However, these materials are degenerated with time and are susceptible to
colonization by microorganisms. Tissue conditioners could be kept clean by
mechanical and chemical methods but this can cause considerable damage to tissue
conditioners.
Silver has been well known for its antimicrobial characteristic. So, to overcome
this problem silver nanoparticles are added in tissue conditioners because of their
smaller size they provide large surface area.

According to study conducted by Ki-Young Nam the modified tissue conditioner

combined with silver nanoparticles displayed antimicrobial properties against
S.aureus, S. mutans at 0.1% and C. albicans at 0.5% after a 24 hrs and 72 hrs
incubation period.

7.SILICONE SOFT LINERS

Silicone soft liners are most often used to line obturators to reduce the irritation
and utilize the bony and soft tissue undercuts in the patient’s mouth [Beyth et al
2015].
One of the main drawbacks seen with theses soft liners is that they do not resist
antimicrobial colonization. Microorganisms like Candida albicans not only adhere
to the surface but also penetrate the soft liners [M. I. Issa et al. 2015].
Silver nano particles (AgNPs) are used as antimicrobial agents in many medical
fields.
In vitro studies have shown the efficacy of silver nano particles as antimicrobial
agents. They reduce or prevent the biofilm layer formation [M. I. Issa et al 2015].
Silver nanoparticles act by inhibiting the replication by binding to the microbial
DNA and they also switch off important enzymes, leading to microbial death [Hsu
et al 2010].
In fact, this metal has a broad antimicrobial activity spectrum against both
Grampositive and Gram-negative bacteria. The biosafety of AgNPs have been of
concern

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[Saulou et al 2010]. Studies associated with the toxicity of these AgNPs in the
biological and ecological systems are yet to be reported.
Titaniumdioxide, Zinc oxide and Cerium dioxide nano particles have been added
as opacifiers for silicone elastomers and Titanium dioxide and Cerium dioxide
nano particles have exhibited the least colour instability.
Addition of surface treated Silicone dioxide nano particles in 3% concentration
have improved the mechanical properties, especially the tear strength.

8.MAXILLOFACIAL PROSTHODONTICS
Various types of materials have been used for the fabrication of maxillofacial
prosthesis. They are Polyvinyl chloride, Polymethyl methacrylate, Polyurethanes,
Chlorinated polyethylene and silicones [Al-Harbi et al 2015].
Out of these materials, silicones are the choice of material for extraoral prosthesis
fabrication due to its favourable properties like acceptable tear and tensile strength,
chemical inertness, high elongation, ease of fabrication [Al-Harbi et al 2015].
However, there are several drawbacks like discoloration of the material,
deterioration of the physical and mechanical properties, difficulties related to its
repair which results in a short service life time thereby leading to the failure of the
prosthesis [Nguyen et al 2013].
These materials undergo drastic changes in their structure and appearance during
their lifetime, mainly due to aging caused by exposure to solar irradiation,
temperature changes, humidity, etc.
The best materials remain aesthetically suitable and functional for an average of
only 1 to 2 years with a decline in patient satisfaction within 3 years of service.
Hence, most silicone prostheses must be replaced frequently due to these
drawbacks [Chamariaet al 2017]. This frequent replacement is not always
affordable for the patient.
Nano-oxides when incorporated into polymers provided materials with better
strength and flexibility [Akash et al 2015].
The nanosized material particle results in the optimization of characteristics and
controls the biological, mechanical, electrical, magnetic, and optical characteristics
as well [Akash et al 2015].
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Nano sized rutile TiO2 and ZnO have a high ultraviolet (UV) absorbing and
scattering effect that results in UV protection.
Nano sized SiO2, TiO2, and ZnO are characterized by their small size, large
specific area, active function, and strong interfacial interaction with organic
polymer.
Therefore, they can improve the physical properties and optical properties of the
organic polymer, as well as provide resistance to environmental stress related
aging.

Meran et al (2017): conducted an in-vitro study to check the efficacy of silver

nanoparticles against C. albicans by coating it on silicone, the study was carried
out of human fibroblasts. He observed that the AgNP coating effectively
prevented the fungal growth as determined by measurements of ethanol production
by the yeast, without any cytotoxic damage to the fibroblasts.
Shakir DA et al (2018) analysed the changes in the physical properties like tear
strength, tensile strength, elongation percentage, and hardness of Room–
Temperature-Vulcanized (RTV) VST50F and High Temperature-Vulcanized
(HTV) Cosmesil M511 maxillofacial silicone elastomers after addition of Titanium
Oxide (TiO2) nanofillers.
The findings of the study were:
Statistically significant improvement was observed in the mean values of physical
properties such as tear strength, tensile strength, elongation percentage, and
hardness of the materials after the addition of 0.25 wt % and 0.2 wt % TiO2
nanofiller into VST50F and Cosmesil M511 elastomers, respectively.

9.NANOTECHNOLOGY IN IMPLANTS
Researchers have experimented with implants made of metals that look more
natural than titanium. There has been some success with the metal zirconia and a
rare metal called tantulum, was discovered. These metals are still not widely used.
Implants that are porous actually help with healing. So many implants now come
with tiny holes or rough surfaces.

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•Implants improved with nanotechnology are used to create coatings that promote
healing. The biologically active coating creates a more stable bond, according to
several large studies.
These nanofeatures can be arranged in an organized manner (isotropic) or
unorganized manner (anisotropic), usually it is anisotropic.
When these concepts are applied to the endosseous implant surface, implied is the
embellishment of the surface with nanometer- scale features that lead to novel
physicochemical behavior (e.g. bone bonding) or biochemical events (e.g. altered
protein adsorption, cell adhesion with changes in cell behavior).
The common problems that have been encountered were bacterial biofilm
formation on the implant surface which has led to infection, inflammation and
implant rejection.
The surface of the implant plays a critical role in determining biocompatibility and
bio integration because it is in the direct contact with the tissues.
Implant surface composition, surface energy, surface roughness and surface
topography are the four material factors which can influence events at bone
implant interfaces. Various surface textures have been created and used to
successfully influence cell and tissue responses.
The surface textures are of three types macro, micro and nano. The nano structured
materials can exhibit enhanced mechanical, electrical, magnetic and optical
properties compared with their conventional micro scale or macro scale
counterparts.
Nano structured materials contain a large volume fraction of defects such as grain
boundaries, inter phase boundaries and dislocations and this strongly influences
their chemical and physical properties.
Biomimetic implant may be the next development in the field. Coating implants
with nano textured titanium, hydroxyl apatite and pharmacological agents such as
bisphosphonates may induce cell differentiation and proliferation, and promote
greater vascularity in cortical bone thereby improving conditions for early and
long-term bone remodelling.
Surface Modifications:

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It is a powerful way of altering protein interactions with the surface. There is an

increase vitronectin adsorption on nano structured surfaces when compared to
conventional surfaces. This led to increased osteoblast adhesion when compared to
other cell types such as fibroblast on the nano surfaces. Variety of techniques are
used to create nano features on dental implant surfaces. These can be divided into
physical and chemical process.
Nano particle coated implant surface
1. Chemical modification:
Anodic oxidation: It has created nanostructures with diameter of less than 100nm
on Titanium implants. Voltage and direct current (Galvanic current) have been
used to thicken the oxide layer of implant surface.
Combination of acid and oxidants : Combination of strong acids have created a
thin grid of Nanopits of diameter 20-40nm on the Titanium surface.
2. Physical modification:
Plasma spray- It has created a nano structure less than 100nm and has enhanced
osteoblasts density on implant surface.
Blasting- alumina has been used for obtaining microporosties.
Bioceramic grit blasting and acid etching has been the improved version of this
technology.
Though titanium has superior properties like specific strength, high corrosion
resistance, good biological security and elastic modulus, biological integration is
the most crucial element for perennial success of implants.
Titanium has high fracture resistance with adequate ductility and strength. But it
does not stimulate osteoblast adhesion and proliferation (Salata, 2004).
Therefore, use of titanium nanoparticle was experimented by Dorkhan et al in his
study. He carried out anodic oxidation to modify the surface of titanium implant
into nanoscales with 50 nm range pores. It was noted that similar level of
adherence of soft-tissue cells i.e. keratinocytes and fibroblasts amongst altered and
unaltered implant surfaces. While, attachment of oral streptococci was significantly
lower on the nanostructured surface.

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Anodization is a simple and less expensive process to promote osteoblastic

adhesion according to the various studies. This was demonstrated by Yao et al
(2015) in his study to create nano-surface on titanium and Ti6Al4V implant by
anodization. It was observed that the altered surface displayed higher roughness at
nanoscale dimensions as compared to the unanodized Ti-based surfaces. Thus,
enhancing osteoblastic adhesion on the anodized metal substrates.
The addition of nanoscale deposits of hydroxyapatite and calcium phosphate
creates a more complex implant surface for osteoblast formation (Albrektsson
etal.,2008;Goeneetal.,2007).
OTHER FEATURES
Antibiotics or growth factors may be incorporated as CaP coating is placed on Ti
implants. eg: Nanotite™ Nano-Coated Implant.
Nanoparticles may be incorporated in materials and instruments to achieve
radiopacity without affecting properties or the risk of toxicity and carcinogenicity
associated with heavy metals.
Nanostructured hydroxyapatite (HA) coating for implants has promoted bone
formation around implants and has increased osteoblasts formation such as
adhesion, proliferation andmineralization.
Dual layered Silver hydroxyapatite nanocoating on Titanium alloy implants has
created a surface with antibiofilm properties without compromising the
biocompatible HA surface needed for successful osseointegration and accelerated
bone healing.
Nanoporous ceramic implant coatings has caused anodization of aluminium.This
non porous alumina has facilitated osseo- inductive activity.
Calcium phosphate (CaP) coating on implant surfaces has increased the
osseoconductivity of implants and has shown favourable slow delivery systems of
growth factors and other bioactive molecules.
Implant surface can also be coated with nanohydroxyapatite crystals but studies
have demonstrated that this material has no role in osteoblastic activity around
implant surface (Schouten,2010 and Svanborg, 2011).
Nanohydroxyapatite coating in conjunction with silver nanoparticles have also
tried to improve osteoblastic activity and antibacterial property, and it have been

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found that there is significant reduction in biofilm formation around implant

surface when silver nanoparticles are used (Allaker, 2010; Almaguer-Flores, 2010)
Ceria nanoparticles are promising in alleviating peri-implantitis and can be used to
achieve successful osseointegration of the dental implants (Meenakshi et al, 2021)

10. BONE REPLACEMENT MATERIALS

Autograft, allograft, synthetic biomaterials and composites are used as bone
substitutes.
Autografts are associated with the need for an additional surgery (for harvesting
the bone) and donor site morbidity whereas in allografts there is a risk of immune
rejection owing to the presence of cells and proteins that may be left behind during
sterilization.
Several synthetic biomaterials are being used in dentistry and some of the most
commonly used biomaterials include calcium phosphate bioceramics such as (HA,
βtricalcium phosphate (β-TCP)), and their composites with polymers such as
collagen or gelatin.
Bone is comprised of natural nano composite made up of nanohydroxyapatite
(HA), which is reinforced by collagen fibrils and this interaction is known to
significantly dictate its strength and toughness.
The fibrous collagen matrix transfer load to apatite crystals and provide resistance
to fracture (i.e. high toughness), whereas the apatite deposit between fibrils can
mechanically stabilize the collagenous fibers. In addition, trace elements in bone
are known to be involved in its growth and mineralization.
This architecture should be simulated for orthopaedic and dental use. Also, with
the reduction in particle size, the surface area increases manifold. This rule has
been utilized by Nano-Bone.
Properties of an ideal bone graft substitute
Developing an ideal bone graft still remains a challenge despite extensive research
in materials science. As majority of the graft materials available are used as a filler
within a localized defect, severely resorbed alveolar bone defects are still
unrecoverable or not adequately treated.

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An ideal bone graft material is expected to have a balance between the properties
that aids in bone regeneration which include biocompatibility, osseointegration,
osteoconductivity, osteoinductivity, porosity, mechanical stability, biodegradation
and vascularisation.
Porosity is an essential criterion required for new bone regeneration. The scaffold
pore size, porosity volume fraction, and interconnectivity determine the rate and
quality of bone growth and integration.
The scaffold pores allow enhanced protein adsorption, cellular infiltration and
vascular ingrowth as well as the diffusion of nutrients and oxygen for cell
survivability.
Strength and stiffness to tolerate the mechanical load until the biodegradation of
the material is quite essential for the bone substitute.
An ideal scaffold should also be able to degrade in par with new tissue formation.
Various HA nanoparticles used in repairing osseous defects include Ostim® HA,
VITOSS ® HA+ TCP, NanOss HA.
Conventional calcium sulphate has been used to plug small osseous defects like in
post extraction sockets and periodontal bone defects and in addition to bone graft
material.
A new calcium sulphate-based composite has been developed by, known as Bone
Gen –TR which breaks down more slowly and regenerates bone more effectively.
Bone biomaterial is an easily flowable, moldable paste that conforms to and
interdigitates with host bone. It supports growth of cartilage and bone cells.

Characteristics of nano bone graft materials are:

Osteo inductive
Completely synthetic
Non-sintered
Extremely porous
Nano-structured
Degradation by osteoclasts

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Excellent processability
No products in ionic solution
Bone targeting nanocarriers

11.NANOCOMPOSITES
Nano Filled Composites: Nano fillers of 1-100nm have been incorporated into the
resin matrix to produce nanocomposites.
The two types of nanoparticles that have been used are nanomers and nanoclusters.
NANOMERS: They are mono dispersed, non-aggregated and non-agglomerated
particles(5-75 nm,) of silica treated with 3methacryloxy-propyltrimethoxysilane
(MPTS). MPTS has helped in chemical bonding of the nanomer filler to the resin
whilst curing.
Advantages: Good optical properties, Good dispersion rate, high polish and polish
retention, superior hardness, flexural strength and good esthetics.
Disadvantages: Poor rheological and handling properties.

NANOCLUSTERS:
Nanocluster fillers range from 2-20 nm. They have been formed by lightly
sintering nanomeric oxides to form clusters of a controlled particle size
distribution.
Nanoclusters of silica sol exclusively and mixed oxides of silica and zirconia have
been synthesized. They have shown the same advantages as nanomers with better
rheological properties but the disadvantage of poor handling has still persisted.
Nanohybrid Composites:
Pre-polymerized organic fillers have been incorporated in nanomers to improve the
desirable rheological properties of composites.
Advantages: Improved esthetics and rheological properties.
Disadvantages: Decreased polish retention and surface gloss.
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Materials used to reinforce composites

• Nanomaterials available as titanium dioxide, aluminum oxide and silica oxide are
used in small amounts (1%–5%) to improve powder flow of composites.
Eg.Isopast® and Heliomolar® by IvoclarVivadent
TIO2 Reinforced Resin Based Composite:
Titanium dioxide nanoparticles treated with organosilaneallytriethoxysilane
(ATES) have been used to improve microhardness and flexural strength of
composites.
Nanocomposites with Alumina Nano particles:
Alumina nanoparticles have shown increased hardness, strength and modulus of
elasticity of the nano composites.
Calcium Phosphate and Calcium Fluoride Nanoparticles Based Composites:
Materials that release Calcium phosphate and calcium fluoride have shown
remineralization of tooth structure and hence have been incorporated in
composites.
They have also maintained the level of Calcium (Ca) and Phosphate (P) ion release
through recharge and release and hence has been called a “smart” material whereby
it has inhibited secondary caries.
Nanohydroxyapatites (HAP) of 20 nm size has mimicked natural building blocks
of human enamel and shown anti caries repair effect.
• Nanoporous Silica-Filled Composite
Nanoporous silica filled composite is a fairly new material still in experimental
form, proven to increase wear resistance in posterior applications.
Nano sized porous silica fillers allow the monomer to inter- penetrate it, through a
capillary force; the monomer is drawn in and out of the filler, reinforcing the
composite and increasing the durability of the bonding between the two phases.
By impregnating organic monomer into the pores & adding a light cure system a
solid organic/inorganic nanostructure is formed.
Ormocers
Ormocer® is an acronym for organically modified ceramics. •

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Ormocers represent a new technology based on sol- gel synthesis using particles
comprising silicones, organic polymers, and ceramic glasses that is applicable to
dental composites.
•These nanoparticles consist of a polysiloxane backbone used for glass and
ceramics. Iron oxide, titanium oxide and aluminiumsulfo silicate pigments have
been added for shade.
These nanoceramic particles have prevented the micro crack propagation. It is
commercially available as Ceram X mono (DENTSPLY).
ADVANTAGES
Modifying ormocers with organic moieties such as methacrylate-substituted ZrO2
or SiO2 organosol nanoparticles was found to improve the mechanical properties .
Ormocers also have decreased surface roughness and superior strength as
compared to the other composite systems.
Trade Name: - Filtek supreme standard ,Filtek supreme translucent
In vitro studies were conducted to find out superiority of Nanocomposites to other
commercially available composites
Filtek supreme standard:it contain zirconia nanoclusters and silica nanoparticles
with diameter 20nm
Filtek supreme translucent contains silica nanometric particle with diameter 75 nm
and minor silica nanocluster
Trade names: • Filtek O Supreme Universal Restorative Pure Nano , • Premise,
Kerr/Sybron, Orange, CA
Trade name of nanohybrids: Nanohybrid NANOSIT™ nanohybrid composite
(Nordiska Dental, Angelholm, Sweden
Trade name of nanofills: Filtek™ Supreme Plus [3M ESPE], Estelite® Sigma
[Tokuyama America, Inc., Encinitas, CA, USA])
PROPERTIES:-

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1)It shows that the compressive and diametric tensile strength were either
equivalent or higher than those of the other composites tested.
2)Flexural strength was measured to be either equivalent or higher than that of
other composites
3)Fracture resistance was found to be either equivalent or higher than the other
composites. Because of these properties; Nanocomposites are highly acceptable to
the clinicians.
4)Wear:- wear rate is either statistically equivalent or lower than that of other
composite materials.
Gloss retention:-
Gloss retention after 100 brush strokes for both FST and FSS showed very high
gloss retention at 91 to 95% respectively after 500 tooth brush cycle the gloss
retention of FSS and FST was still having gloss retention of 80% to 90% in
comparison with other composite whose gloss retention reduces to 40% to 50%.
Surface of the worn surfaces were found to be more smooth as nanoparticles are
homogenously distributed.
The worn surface remains smooth as small sized particles are removed from the
surface whereas larger filler particles create larger defects which results in surface
roughness .

OPACITY OF NANOCOMPOSITE :
In Nanocomposite the size of the particle is so small that it is below the size of the
wavelength of light making them unmeasurable by the refractive index.
When light comes in long wavelength light passed directly through and materials
show high translucency this enables to formulate a vast range of shades and
opacity options
Advantages
Mechanical strength and wear resistance comparable to hybrid composites

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Superior flexural strength, modulus of elasticity, and translucency

Superior polish and gloss resistance comparable to microfill composites.
50% reduction in filling shrinkage• Excellent handling properties
They do not thicken the resin.
Size below absorption of visible light (0.4-0.8 mm) –makes fillers invisible. •
Extreme surface to volume ratio and the ability to fit between several
polymer chains-high filler loading in workable consistencies.
Kaira LS. Nanotechnology: the new era of technology. NUJHS 2012 Dec;2(4):88-
92.
Rybachuk AV, Cekman IS. Nanotechnology and nanoparticles in dentistry.
Pharmocol Pharm 2009;1:18-21.
Light cure Nanocomposites:
The introduction of nano fillers into the resin matrix has led to the development of
newer light cure nano composites with numerous advantages as:
Highest mechanical strength and wear resistance
Low polymerization shrinkage 50% reduction
Reliability
Durability
Low thermal expansion coefficient
Low water sorption
Excellent marginal integrity .
Superior flexural strength, modulus of elasticity, and translucency
Superior polish and gloss resistance comparable to microfill composites
Excellent handling characteristics
(Current practicality of nanotechnology in dentistry. Part 1: Focus on
nanocomposite restoratives and biomimetics Clinical, Cosmetic and
Investigational Dentistry 2009:1 47–61)

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 NANOTECHNOLOGY IN PROSTHODONTICS

Nanocomposite have increased hardness, improved handling properties, better

translucency, increased flexural strength and 50 % reduction in polymerization
shrinkage (Kanaparthy, 2011; Chandki, 2012; Nagpal, 2011).
Buen et al. compared the physical properties of nanofilled composite with
universal hybrid and microfilled composite and found higher modulus of elasticity
with nanofilled one (Beun, 2007).
As an antibacterial agent quaternary ammonium nanoparticles can be added to the
composite. Addition of zinc nano particles in composite enhances antibacterial
effect and improves the clinical service of the restoration (Niu, 2010 and Fang,
2007).
Adhesion of microorganism and formation of biofilm can be minimized by
incorporating titanium dioxide nanoparticles in composite that enhances the
hydrophilic activity of the resoration (Farbod, 2010).
Other features of nano composites..
Caries prevention
Optimal delivery of molecules that facilitate tooth structure remineralization and
forestall caries.

NANO COMPOSITE TEETH

Conventional denture teeth like Porcelain and acrylic have their own inherent
disadvantages.
Porcelain is highly wear resistant, but is brittle, lacks bonding ability to the denture
base, and is not easy to polish.
Acrylic on the other hand is easy to adjust, but undergoes wear.
Nanocomposite denture teeth are made of Polymethylmethacrylate (PMMA) and
homogeneously distributed nanofillers.
Nanocomposite denture teeth possess unique characteristics in terms of
homogenicity as the material contains nanosized inorganic fillers that are well
dispersed without agglomeration in the matrix. Hence gives smooth appearance to
the worn surfaces.

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 NANOTECHNOLOGY IN PROSTHODONTICS

Stain resistant and harder than other commercially present denture teeth
Trade name: Veracia (Shofu, Kyoto, Japan)]

The three layered Veracia SA teeth consist of MF-H (microfilled hybrid)

composite, reinforced with layered glass.
Advantages:
Excellent polishing ability and stainresistant
Superb aesthetics, lively surface structure
Enhanced wear resistance and surface hardness

12.SILANE BONDING AGENTS

Together with the evolution of nanoparticles for dental composites, sharper focus
is being applied to reformulations of interfacial silanes
Organosilanes such as allyltriethoxysilane have demonstrated good compatibility
with nanoparticle fillers such as TiO2.
In addition,3ethacryloxypropyltrimethoxysilane has also been demonstrated to
enhance dispersion of silica nanoparticles (5–25 nm) within the restorative resin
matrix.
Silanization has been reported as one of several theoretical avenues for increasing
fracture toughness of nanocomposites.
Silanization increased the strength of a novel ion-releasing calcium phosphate
(CaPO4) composite, but decreased the level of release.

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Current practicality of nanotechnology in dentistry. Part 1:Focus on

nanocomposite restoratives and biomimeticsClinical, Cosmetic and Investigational
Dentistry 2009:1 47–61
Nano bond (Bonding agents)
The new bonding agents are prepared from nano solutions which contain
homogenous nanoparticles dispersed in the solution. Silica nanofillers are stable
and do not cluster in the solution so provide the superior bond strength values.
Nano interaction zone (NIZ <300 nm) with minimal decalcification and almost no
exposure to collagen fi bers producing an insoluble calcium compound for a better
bond less likely to deteriorate from enzymes contained in the mouth.
Nanosolutions
These solutions have homogenously dispersed nanoparticles that extend their use
in bonding agents. The new generation of bonding agents are one-step application.
The homogeneously dispersed nanofillers provide the maximum bond strength and
prevent particle settling.
Trade name: Adper O Single Bond Plus Adhesive Single Bond.

14.COATING AGENTS IN PROSTHODONTICS

Figure 10 : Coating agents

These lights cured agents contain nanosized fillers and are used as a final coating
overcomposite restorations, glass ionomer restorations, jacket crowns, veneers and
provisional.
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These coating agents have higher wear resistance, preventing abrasion and
discolouration.
Recently, a nanotechnology liquid polish system was designed to overcome the
limitations of liquid polishers. The addition of nanofillers provides excellent results
such as a glossy surface for direct or indirect resin composite restorations.
(Atabek D et al. Oper Dent 2010; 35:362-69.)

CHALLENGES FACED BY NANOTECHNOLOGY

Precision positioning & manufacture of nanoscale parts.
Cost effective nanorobot mass production techniques.
Biocompatibility.
Inadequate assimilation of clinical research.
Finance and skill.
Social issues of public acceptance, ethical implications and human safety.
Problems for research in nanotechnology
Painfully slow strategic decisions
Sub-optimal funding
Lack of engagement of private industries
Problem of retention of trained manpower

POTENTIAL HEALTH HAZARDS

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The toxicity of nanoparticles has been due to greater surface area volume ratio
leading to increased absorption through skin, lungs and digestive tract. They easily
enter the lungs and reach the alveoli causing inflammation, tissue damage and
subsequent systemic effects.
These nanoparticles have been transported through the blood stream to the vital
organs or tissues throughout the body resulting in cardiovascular and other extra
pulmonary effects.
Their penetration through the skin may cause cell damage due to the production of
reactive molecules.The unpredictability of nanomaterials has created an ethical
dilemma with a wide selection of materials.
For example, hybrid and microfilled composites have long track records to support
their clinical use whereas the concepts of nanocomposites are appealing but are
backed by only short term clinical studies.
Utilitarianism cannot be considered in nanotechnology due to its fast development
and uncertainfuture and hence an indepthknowledge,ethical considerations and
safetymeasures is required.

It discusses the in vitro and in vivo toxological effects of nanoparticles on bacteria,

microalgae, zebrafish, crustacean, fish, rat, mouse, pig, guinea
pig, human cell lines and human.
It also discusses toxological effects on organs such as liver, kidney, spleen, sperm,
neural tissues, liver lysosomes, spleen macrophages, glioblastoma cells, hematoma
cells and various mammalian cell lines.
It provides information about the effects of nanoparticles on the gene-expression,
growth and reproduction of the organisms.

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The cytotoxicity affected cellular functions including differentiation, cell

proliferation and mobility which resulted in apoptosis

CONCLUSION: -
Although the effect of nanotechnology on dentistry is limited at present, rapidly
progressing research will ensure that nanotechnology is going to be the next big
thing. It will have a far-reaching effect on oral health and developments which
seem unrealistic today will help to achieve a near perfect oral health in future.
A day may soon come when nanodentistry will succeed in maintaining near-perfect
oral health through the aid of nanorobotics, nanomaterials and biotechnology.
“You have to be able to fabricate things, you have to be able to analyze things, you
have to be able to handle things smaller than ever imagined in ways not done
before.” - William Philips Richard .P Feynman

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