Journal of International Society of Preventive and Community Dentistry

REVIEW ARTICLE
Year
: 2019  |  Volume : 9  |  Issue : 6  |  Page : 535--541

Role of nanotechnology in dentistry: Systematic review


Muhamood Moothedath1, Muhaseena Moothedath2, Abhishek Jairaj3, B Harshitha4, Suheel Manzoor Baba5, Shafait Ullah Khateeb5,  
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

Correspondence Address:
Dr. Muhamood Moothedath
Assistant Professor, Department of Oral and Dental Health, College of Applied Health Sciences in Ar Rass, Qassim University.
Saudi Arabia

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.



How to cite this article:
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 2019;9:535-541


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 [serial online] 2019 [cited 2019 Dec 11 ];9:535-541
Available from: http://www.jispcd.org/text.asp?2019/9/6/535/270228


Full Text

 Introduction



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



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:

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

Good quality: Low risk for all domains

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

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



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}

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}

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}

 Discussion



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:

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]

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]

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]

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]

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]

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]

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



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.

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