Nobio has produced the first real advancement in dental restoratives with a new non-leaching, long-acting antimicrobial technology.

When William Gies addressed a dental association about dental caries over 100 years ago, it was known that bacteria on the tooth surface creates an acidic environment, causing enamel wear and dentin exposure (Gies, 1918). Consequently, the proposed solution to preventing tooth decay was to identify and destroy the bacteria. And yet, we haven’t seen much progress to address dental caries since then.

Until now.

Nobio has produced the first real advancement in dental restoratives with a new non-leaching, long-acting antimicrobial technology.

 
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THE CARIES PROCESS

The oral cavity is in a constant state of biomineralization, in which minerals flow in and out of the surface of the tooth. When minerals flow out of the tooth surface (demineralization), the structure is weakened. When they flow in (remineralization), the structure is strengthened.

Caries disease exists when the biomineralization process is out of balance. Cariogenic bacteria generate acids when they metabolize fermentable carbohydrates. These acids dissolve tooth enamel and dentin, leading to cavities or carious lesions (Featherstone, 2018).

 
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CARIES TREATMENT

The common clinical response to cavities is to place a restoration, but merely restoring decayed teeth is not a solution to the problem, it is a Band-Aid. Many restorations fail, most as a result of recurrent, or secondary, caries (Mjör and Toffenetti, 2000).

Secondary caries refers to the process occurring at the interface between the tooth and the restoration, a vulnerable micro-gap that increases as bacteria work their way in and cause a carious lesion.

This susceptible area is mostly untouched by the other technologies on the market today: fluoride-releasing materials and chlorhexidine kill the bacteria from the top down, so they don’t make an impact where it really counts. When incorporated into a composite material, the Nobio technology kills bacteria at the surface of the restoration and the tooth-restoration interface, where the damage occurs.

I think we should consider creating a graphic(s), which depict leaching vs. non-leaching technology (we can discuss further tomorrow)

To make matters worse, the move from amalgam restorations to resin composite restorations brought with it an increased risk of secondary caries.

Amalgam restorations could leak mercury, so this change was in the best interest of patients’ health. However, we have paid a price in other ways, as amalgam restorations are more effective at preventing secondary caries due to the metal corroding, killing the bacteria and sealing the tooth-restoration interface.

Although more aesthetically appealing, placing resin composite restorations is a technique-sensitive procedure that shows higher failure rates due to polymerization shrinkage and unstable adhesion to dentin. The final restoration is also more susceptible to plaque accumulation. As a result, studies show that composite restorations are twice as likely to fail as amalgam restorations (Rasines Alcaraz MG et al., 2014).

To help combat the risk of recurrent caries, patients are often advised to incorporate fluoride therapy into their oral health regimen, but it is not enough to prevent secondary caries (Chaffee, Featherstone, Zhan, 2017).

THE IDEAL SOLUTION

Studies have shown that Nobio technology can act as the barrier between the tooth-restoration interface and may prevent bacteria from destroying it. The antimicrobial technology can be integrated into resin composites and bonding agents, killing bacteria that come in contact with the tooth-restoration interface and possibly preventing secondary caries.

 
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Nobio technology utilizes a high concentration of quaternary ammonium (QA) bound to silica particles (Si). These QASi particles react to the threat of bacteria in a physical manner: they act as spikes that burst the membrane of bacteria, resulting in lysis, or cell death. Because this technology provokes a physical reaction, it is less receptive to antimicrobial resistance, since there is no chemical to which the bacteria can adapt.

In a study published in Proceedings of the National Academy of Sciences of the United States of America, researchers measured the amount of living and dead bacteria on composites that were worn by 10 volunteers for four hours (Beyth N, Yudovin-Farber I, Perez-Davidi M, Domb AJ, Weiss EI, 2010). The experimental composites, which incorporated 1% of the Nobio nanoparticle, showed significantly less living bacteria.

 
Live bacteria (green) on the control composite versus dead bacteria (red) on the Nobio composite

Live bacteria (green) on the control composite versus dead bacteria (red) on the Nobio composite

 

In contrast with other antimicrobials that have been integrated into composite materials (such as fluoride or silver), Nobio does not rely on an active agent being released from the composite to affect the contaminated surroundings, which means it doesn’t affect the normal flora of the mouth. Instead, Nobio kills microbes that come in direct contact with the surface of the restoration, targeting the issue where it counts: at the tooth-restoration interface.

Any release-based antimicrobial approach will result in the restoration losing mass over time, compromising its physical, mechanical, and optical properties. Because Nobio is a non-leaching technology, it preserves the integrity of the restoration and shouldn’t lose its effect over time.

After conducting numerous studies on the effects of this antimicrobial technology in dental bonding agents and resin composites, Nobio has incorporated their QASi particles into a new line of dental restoratives called Infinix.