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REVIEW ARTICLE
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Role of nanotechnology in dentistry: Systematic review


1 Department of Oral and Dental Health, College of Applied Health Sciences in Ar Rass, Qassim University, Saudi Arabia
2 Department of Biomedical Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
3 Department of Prosthodontist, Faculty of Dentistry, AIMST University, Bedong, Kedah, Malaysia
4 Department of Periodontics, Sri Sai College of Dental Surgery, Hyderabad, Telangana, India
5 Department of Restorative Dental Sciences, College of Dentistry, King Khalid University, Abha, Saudi Arabia

Date of Submission20-May-2019
Date of Acceptance20-Jul-2019
Date of Web Publication04-Nov-2019

Correspondence Address:
Muhamood Moothedath,
Assistant Professor, Department of Oral and Dental Health, College of Applied Health Sciences in Ar Rass, Qassim University.
Saudi Arabia
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jispcd.JISPCD_223_19

   Abstract 

Aim: This systematic review aimed to provide an overview of role of nanotechnology in dentistry and to evaluate its applicability in prevention and treatment of oral diseases. Materials and Methods: A systematic literature search was conducted in 2 electronic databases – PMC and Cochrane. The search was restricted to the articles published during the last 5 years. First-level screening was done to select articles for the review on the basis of title and abstract. Then, full texts of selected articles were studied, and relevant articles were selected to be included in this review. Articles selected were critically appraised to evaluate their quality. Results: Literature search revealed 837 articles in PMC, 15 in Clinical trial register of US National library, and 43 in Cochrane. Additional 6 articles were identified by hand search. Eleven clinical trials were included in this review. Conclusion: Advancement in nanotechnology has greatly influenced dental disease prevention and therapy significantly.


Keywords: Dentistry, nanomaterials, nanotechnology



How to cite this URL:
Moothedath M, Moothedath M, Jairaj A, Harshitha B, Baba SM, Khateeb SU. Role of nanotechnology in dentistry: Systematic review. J Int Soc Prevent Communit Dent [Epub ahead of print] [cited 2019 Nov 20]. Available from: http://www.jispcd.org/preprintarticle.asp?id=270228



   Introduction Top


The first definition of “nanotechnology” was given by Norio Taniguchi (Tokyo Science University) in a 1974 paper. According to him, “nanotechnology” mainly consists of the processing of separation, consolidation, and deformation of materials by one atom or one molecule.[1]

Nanomaterials are synthetic or natural materials with components <100nm in at least one dimension, including clusters of atoms, grains <100nm in size, fibers that are <100nm diameter, films <100nm in thickness, nanoholes, and composites that are a combination of these.[2],[3] Nanomaterials due to their small size have a much-increased surface area per unit mass compared to bigger particles. All properties, including electrical, optical and magnetic ones, are altered.[4] Many nanomaterials have been used as nanomedicines in past few decades. The concept of “nanomedicine” was given by Freitas in 1993 and was defined as observing, controlling, and treating the biological systems of the human body at the molecular level using nanostructures and nanodevices.[5]

Nanotechnology offers a broad range of innovations and improvement in prevention, diagnostics, and treatment of oral diseases. Many review articles addressing the potential of nanotechnology in dentistry has been published till now; however, the literature is void of systematic reviews discussing the applications of nanotechnology in the field of dentistry. In this systematic review, we will focus on role of nanotechnology in dentistry.


   Materials and Methods Top


Study identification and selection

Data extraction was done according to a Preferred Reporting Items for Systematic Reviews and Meta-Analyses. A systematic literature search was conducted in PMC, Cochrane, and Clinical trials.gov. The electronic search was done from April 30, 2019 to June 13, 2019. The keywords used in the search of the selected electronic databases were nanotechnology, nanotechnology in dentistry. The search was restricted to the articles published during the last 5 years. An additional hand search was also performed. Duplicate articles were removed. First-level screening was done to select articles for the review on the basis of title and abstract. Then, full texts of selected articles were studied and relevant articles were selected to be included in this review. Articles selected were critically appraised to evaluate their quality.

Inclusion and exclusion criteria

The full text of all studies of possible relevance was obtained for assessment against the following inclusion criteria:

  1. Randomized clinical trials published in English language in the last 5 years.


The applied exclusion criteria for studies were as follows:

  • Not related to dentistry or maxillofacial fields


  • Articles published before July 2014


  • Editorials


  • Letter to editor


  • Review articles


  • Case reports


  • Phase 1 clinical trial


  • Observational studies.


  • Data extraction

    The review author and a research assistant assessed all selected randomized controlled trials to assess risk of bias and extract data using a data extraction form.

    Risk of bias assessment

    Articles selected on the basis of inclusion exclusion criteria were critically appraised to evaluate their quality according to the guidelines provided in Cochrane handbook. Assessment of risk of bias for individual study was done under the following domains: selection bias (random sequence generation and allocation concealment), performance bias (blinding participants), detection bias (blinding outcome assessors), attrition bias (incomplete outcome data), and reporting bias (selective outcome reporting).

    Studies were categorized into three categories

    1. Good quality: Low risk for all domains


    2. Fair quality: 1 criterion not met or 2 criteria unclear but unlikely to affect the outcome of study


    3. Poor quality:
      • a.1 criterion not met or 2 criteria unclear and likely to affect the outcome of study


      • b.Two or more criteria listed as high risk of bias.


    All good and fair quality studies were included for qualitative synthesis.


       Results Top


    Study identification and selection

    The initial electronic and hand search retrieved 895 citations. Additional hand search identified 6 clinical trials. In first screening 193 articles were selected on the basis of title and abstract. Finally 14 clinical trials were selected but 11 were included in the study as full texts of 1 clinical trial were not found and results of 2 studies were not posted. Total 37 review articles, 1 editorial, 18 animal studies, and 1 letter to editor were excluded. Other in vitro and ex vivo studies were also excluded [Chart 1].
    Chart 1: Flow chart for study selection process

    Click here to view


    Data extraction

    All the included studies were randomized clinical trials, conducted in Italy, Egypt, Australia, Brazil, Iran, and 3 studies were conducted in India. In one study, trial site was not mentioned. Sample size estimation was done in 9 studies. In 2 studies, power analysis was not mentioned. Data were recorded under the following headings: study title, study author, aim of study, sample population, and results. Information is presented in [Table 1].
    Table 1: Summary of studies

    Click here to view


    Risk of bias assessment

    Risk of bias assessment was done according to the method described in Cochrane hand book.

    Six studies were categorized as good-quality studies with low risk of bias. Five studies were categorized as fair quality studies with unclear risk of bias unlikely to affect the outcome of study. No study was categorized as poor study. Information is presented in [Table 2].
    Table 2: Risk of bias in included studies

    Click here to view



       Discussion Top


    The studies included in this review evaluated a range of different interventions, and due to heterogeneity, it is not possible to analyze the data quantitatively. However, the results of all clinical trials are summarized to provide overview on role of nanotechnology. According to the included studies, nanotechnology is effective in the management of the following conditions:

    1. Treatment of dental hypersensitivity experimental toothpaste was able to reduce dentin hypersensitivity (DHS) over short duration time period.[6],[10] According to Amaechi et al., 20% nano hydroxyapatite (nHAP) dental cream is an effective method to promote the relief of DHS symptoms when applied daily[13]


    2. Dental remineralization – 10% nHAP solution effectively increases microhardness of the enamel of permanent teeth following soft drink exposure. This randomized double blind clinical trial was conducted in Iran on 20 teeth of 10 individuals of 18–21 years of age[14]


    3. Cariostatic – A randomized clinical trial done on 159 lesions in 50 children of 6–10 years concluded that annual application of 5% nanosilver fluoride is equal to 38% silver diammine fluoride in preventing the progression of dental caries in primary molars without causing any staining of dentinal tissues[15]


    4. Anti-biofilm – Nano sodium fluoride showed bactericidal effect against Streptococcus mutans biofilm when tested in 12 children of 7–8 years in a crossover clinical trial. Therefore, it can be used for clinical control and prevention of dental biofilm formation[11]


    5. Infrabony periodontal defect – Randomized clinical trial done on 16 individuals of 20–64 years of age concluded that Nanogen and BoneGen TR can be considered for treatment of infra-bony periodontal defects. The faster degradation of Dentogen may negatively affect its bone regeneration potential[8]


    6. Nanosurface-treated implant – The results show that the differences between laser collar and nanosurface-treated implants were statistically not significant with regard to the criteria of probing depth, Modified Bleeding Index, and mobility of the dental implants at different observation periods of the study. The amount of bone loss observed was consistent with peri-implant tissue stability observed at 12 months. The bone loss did not cause any implant mobility[9]


    7. The combination of casein phosphopeptide-stabilized amorphous calcium phosphate and SnF2 in oral care products may significantly improve their efficacy in prevention and treatment of dental caries, erosion, and hypersensitivity[16]


    Due to lack of clinical trials, it was not possible to assess effectiveness of various interventions; therefore, a broad overview on all the aspects of dentistry influenced by nanotechnology has been presented here. Nanobiomaterials combined with other medical methods may have a key role in the near future.[17] Many studies have been done on this topic till now. According to Narang and Narang, oral health can be maintained using nanodentistry; the risk and toxicity associated with the use of such nanotherapeutics need more extensive investigation and understanding. Other reviews suggested that before applying nanotechnology in clinical settings, cost needs to be considered.[18],[19]


       Conclusion Top


    It can be concluded that advancement in nanotechnology has greatly influenced prevention and management of dental diseases. The use of nanotechnology in treating dental diseases has been extended to treat DHS, remineralization of dental tissues, surface treatment of dental implants, prevention of biofilm formation, and prevention of progression of dental caries. Nanotechnology is undoubtedly likely to improve dental preventions and treatments but as it is still in development phase and its use in clinical settings is limited by concern of safety and cost-effectiveness, more clinical trials are required to reach to unbiased conclusion.

    Future recommendation

    More multicentric clinical trials with larger sample size would be required. Issues such as cost-effectiveness and toxicity associated with the use of nanoparticles need to be considered.

    Financial support and sponsorship

    Nil.

    Conflicts of interest

    There are no conflicts of interest.

     
       References Top

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    Kovvuru SK, Mahita VN, Manjunata BS, Babu BS. Nanotechnology: The emerging science in dentistry. J Orofac Res 2012;2:33-6.  Back to cited text no. 1
        
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    Wahajuddin XX, Arora S. Superparamagnetic iron oxide nanoparticles: Magnetic nanoplatforms as drug carriers. Int J Nanomedicine2012;7:3445-71.  Back to cited text no. 3
        
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    Bhardwaj A, Bhardwaj A, Misuriya A, Maroli S, Manjula S, Singh AK. Nanotechnology in dentistry: present and future. J Int Oral Health 2014;6:121-6.  Back to cited text no. 4
        
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    Freitas RA Jr. Nanodentistry. J Am Dent Assoc 2000;131:1559-65.  Back to cited text no. 5
        
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    Vano M, Derchi G, Barone A, Covani U. Effectiveness of nano-hydroxyapatite toothpaste in reducing dentin hypersensitivity: a double-blind randomized controlled trial. Quintessence Int 2014;45:703-11.  Back to cited text no. 6
        
    7.
    Santos VE Jr, Vasconcelos Filho A, Targino AG, Flores MA, Galembeck A, Caldas AF Jr, et al. A new “silver-bullet” to treat caries in children–nano silver fluoride: a randomised clinical trial. J Dent 2014;42:945-51.  Back to cited text no. 7
        
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    Pandit N, Sharma A, Jain A, Bali D, Malik R, Gugnani S. The use of nanocrystalline and two other forms of calcium sulfate in the treatment of infrabony defects: A clinical and radiographic study. J Indian Soc Periodontol 2015;19:545-53.  Back to cited text no. 8
    [PUBMED]  [Full text]  
    9.
    Hegazy S, Elmekawy N, Emera RM. Peri-implant outcomes with laser vs nanosurface treatment of early loaded implant-retaining mandibular overdentures. Int J Oral Maxillofac Implants 2016;31:424-30.  Back to cited text no. 9
        
    10.
    Wang L, Magalhães AC, Francisconi-Dos-Rios LF, Calabria MP, Araújo D, Buzalaf M, et al. Treatment of dentin hypersensitivity using nano-hydroxyapatite pastes: A randomized three-month clinical trial. Oper Dent 2016;41:E93-E101.  Back to cited text no. 10
        
    11.
    Freire PLL, Albuquerque AJR, Sampaio FC, Galembeck A, Flores MAP, Stamford TCM, et al. Agnps: the new allies against S. Mutans biofilm - A pilot clinical trial and microbiological assay. Braz Dent J 2017;28:417-22.  Back to cited text no. 11
        
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    Priyadarshini BI, Jayaprakash T, Nagesh B, Sunil CR, Sujana V, Deepa VL. One-year comparative evaluation of ketac nano with resin-modified glass ionomer cement and giomer in noncarious cervical lesions: A randomized clinical trial. J Conserv Dent 2017;20:204-9.  Back to cited text no. 12
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    13.
    Amaechi BT, Lemke KC, Saha S, Gelfond J. Clinical efficacy in relieving dentin hypersensitivity of nanohydroxyapatite-containing cream: A randomized controlled trial. Open Dent J 2018;12:572-85.  Back to cited text no. 13
        
    14.
    Yaberi M, Haghgoo R. A comparative study of the effect of nanohydroxyapatite and eggshell on erosive lesions of the enamel of permanent teeth following soft drink exposure: A randomized clinical trial. J Int Oral Health 2018;10:176-9.  Back to cited text no. 14
      [Full text]  
    15.
    Tirupathi S, Svsg N, Rajasekhar S, Nuvvula S. Comparative cariostatic efficacy of a novel nano-silver fluoride varnish with 38% silver diamine fluoride varnish a double-blind randomized clinical trial. J Clin Exp Dent 2019;11:e105-12.  Back to cited text no. 15
        
    16.
    Fernando JR, Shen P, Sim CPC, Chen YY, Walker GD, Yuan Y, et al. Self-assembly of dental surface nanofilaments and remineralisation by snf2 and CPP-ACP nanocomplexes. Sci Rep 2019;9:1285.  Back to cited text no. 16
        
    17.
    Liao J, Shi K, Ding Q, Qu Y, Luo F, Qian Z. Recent developments in scaffold-guided cartilage tissue regeneration. J Biomed Nanotechnol 2014;10:3085-104.  Back to cited text no. 17
        
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    Abou Neel EA, Bozec L, Perez RA, Kim HW, Knowles JC. Nanotechnology in dentistry: prevention, diagnosis, and therapy. Int J Nanomedicine 2015;10:6371-94.  Back to cited text no. 18
        
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