© Woodhead Publishing Limited, 2013
Non-metallic biomaterials for tooth repair and replacement
© Woodhead Publishing Limited, 2013
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Materials science for dentistry: Ninth edition (ISBN 978-1-84569-529-3)
Dental biomaterials: imaging, testing and modelling (ISBN 978-1-84569-296-4)
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v

3 Enamel and dentin bonding for adhesive
restorations 45
JORGE PERDIGÃO, University of Minnesota, USA and
A
NA SEZINANDO, University Rey Juan Carlos, Spain
3.1 New trends in restorative dentistry 45
3.2 Dental adhesion 49
3.3 Bonding substrates 51
3.4 Current bonding strategies 60
3.5 Dental adhesion mechanisms 70
3.6 In vitro versus in vivo studies 74
3.7 Incompatibility between adhesives systems and
restorative materials 76
3.8 Conclusions 78
3.9 References 79
4 Enamel matrix proteins (EMP) for periodontal
regeneration 90
N. DONOS, UCL-Eastman Dental Institute, UK, X. DEREKA,
National and Kapodistrian University of Athens, Greece
and H. D. AMIN, Imperial College London, UK
4.1 Introduction to principles of periodontal regeneration 90
4.2 Periodontal ligament (PDL) stem/progenitor cells 91
4.3 Secretion and composition of enamel matrix
proteins (EMP) 93
4.4 Modulation of cell differentiation by EMP and enamel
matrix derivatives (EMD) in vitro 96
4.5 In vivo studies (for bone regeneration) 101
4.6 Treatment of periodontal osseous defects with enamel
matrix derivatives 102
4.7 Acknowledgement 113

Germany
7.1 Introduction 194
7.2 Sol-gel-derived glasses and glass ceramics 197
7.3 Sol-gel-derived coatings 210
7.4 Sol-gel-derived composites 217
7.5 Conclusions and future trends 221
7.6 References 221
Part III Dental composites for tooth repair
and replacement 233
8 Composite adhesive restorative materials for
dental applications 235
MICHAEL F. BURROW, The University of Hong Kong,
PR China
8.1 Introduction 235
8.2 Resin composite restorative materials 236
8.3 Polyacid-modifi ed resin composite (compomer) 248
8.4 Glass ionomer (polyalkenoate) cements 252
8.5 Resin modifi ed glass ionomer cement (RM-GIC) 256
viii Contents
© Woodhead Publishing Limited, 2013
8.6 Conclusion 260
8.7 References 261
9 Antibacterial composite restorative materials
for dental applications 270
I
DRIS MOHAMED MEHDAWI, Benghazi University, Libya
and ANNE YOUNG, UCL Eastman Dental Institute, UK
9.1 Introduction 270
9.2 Current direct aesthetic restorative materials 271
9.3 Antibacterial properties of aesthetic restorative materials 273

© Woodhead Publishing Limited, 2013
11.4 Biological response 342
11.5 Clinical considerations and future trends 345
11.6 References 347
12 Fibre-reinforced composites (FRCs) as
dental materials 352
P
EKKA K. VALLITTU, University of Turku, Finland
12.1 Introduction to fi bre-reinforced composites (FRCs) as
dental materials 352
12.2 Structure and properties of fi bre-reinforced composites 353
12.3 Applications of fi bre-reinforced composites in dentistry 357
12.4 Fibre-reinforced fi lling composites 363
12.5 Future trends 364
12.6 Conclusions 365
12.7 References 366
13 Luting cements for dental applications 375
MUTLU ÖZCAN, University of Zurich, Switzerland
13.1 Introduction 375
13.2 Classifi cation of cements 376
13.3 Clinical implications of cement choice 388
13.4 Conclusion and future trends 390
13.5 References 391
Index 395

© Woodhead Publishing Limited, 2013
xi
Contributor contact details
(* = main contact)
Editor and Chapter 12

Therapeutic Micro and
Nanotechnology Laboratory
Department of Bioengineering and
Therapeutic Sciences
University of California
San Francisco
CA, 94158-2330
USA
E-mail:
xii Contributor contact details
© Woodhead Publishing Limited, 2013
Chapter 3
Jorge Perdigão*
University of Minnesota
Department of Restorative
Sciences
Minneapolis, MN 55455
USA
E-mail:
Ana Sezinando
University Rey Juan Carlos
Alcorcón, Madrid
Spain
Chapter 4
Professor Nikolaos Donos*
UCL-Eastman Dental Institute
Periodontology Unit
Department of Clinical Research
UK
E-mail:

Saskatchewan
S7N 5E4
Canada
E-mail:
Chapter 7
X. Chatzistavrou
Department of Orthodontics and
Pediatric Dentistry
School of Dentistry
University of Michigan
1011 N University
Ann Arbor
MI 48109
USA
Contributor contact details xiii
© Woodhead Publishing Limited, 2013
E. Kontonasaki and P. Koidis
Department of Fixed Prosthesis
and Implant Prosthodontics
School of Dentistry
Aristotle University of Thessaloniki
54124 Thessaloniki
Greece
K. M. Paraskevopoulos
Department of Physics
Solid State Section
Aristotle University of Thessaloniki
54124 Thessaloniki
Greece
A. R. Boccaccini*

256 Grays Inn Road
London
WC1X 8LD
E-mail:
Chapter 10
Dr Jack L. Ferracane*
Department of Restorative
Dentistry
Division of Biomaterials and
Biomechanics
Oregon Health & Science
University
611 S.W. Campus Drive
Portland
Oregon 97239
USA
E-mail:
xiv Contributor contact details
© Woodhead Publishing Limited, 2013
Dr William M. Palin
University of Birmingham
College of Medical and Dental
Sciences
School of Dentistry, Biomaterials
Unit
St Chads Queensway
Birmingham
B4 6NN
UK
E-mail:

E-mail: pekka.vallittu@utu.fi
Chapter 13
Professor Mutlu Özcan
University of Zurich
Rämistrasse 71
CH-8006 Zurich
Switzerland
E-mail:
© Woodhead Publishing Limited, 2013
xv
Woodhead Publishing Series in Biomaterials
1 Sterilisation of tissues using ionising radiations
Edited by J. F. Kennedy, G. O. Phillips and P. A. Williams
2 Surfaces and interfaces for biomaterials
Edited by P. Vadgama
3 Molecular interfacial phenomena of polymers and biopolymers
Edited by C. Chen
4 Biomaterials, artifi cial organs and tissue engineering
Edited by L. Hench and J. Jones
5 Medical modelling
R. Bibb
6 Artifi cial cells, cell engineering and therapy
Edited by S. Prakash
7 Biomedical polymers
Edited by M. Jenkins
8 Tissue engineering using ceramics and polymers
Edited by A. R. Boccaccini and J. Gough
9 Bioceramics and their clinical applications
Edited by T. Kokubo
10 Dental biomaterials

tissues
Edited by C. Archer and J. Ralphs
25 Metals for biomedical devices
Edited by M. Ninomi
26 Biointegration of medical implant materials: science and design
Edited by C. P. Sharma
27 Biomaterials and devices for the circulatory system
Edited by T. Gourlay and R. Black
28 Surface modifi cation of biomaterials: methods analysis and
applications
Edited by R. Williams
29 Biomaterials for artifi cial organs
Edited by M. Lysaght and T. Webster
30 Injectable biomaterials: science and applications
Edited by B. Vernon
31 Biomedical hydrogels: biochemistry, manufacture and medical
applications
Edited by S. Rimmer
Woodhead Publishing Series in Biomaterials xvii
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32 Preprosthetic and maxillofacial surgery: biomaterials, bone grafting
and tissue engineering
Edited by J. Ferri and E. Hunziker
33 Bioactive materials in medicine: design and applications
Edited by X. Zhao, J. M. Courtney and H. Qian
34 Advanced wound repair therapies
Edited by D. Farrar
35 Electrospinning for tissue regeneration
Edited by L. Bosworth and S. Downes
36 Bioactive glasses: materials, properties and applications

49 Nanomedicine: technologies and applications
Edited by T. J. Webster
50 Biocompatibility and performance of medical devices
Edited by J-P. Boutrand
51 Medical robotics
Edited by P. Gomes
52 Implantable sensor systems for medical applications
Edited by A. Inmann and D. Hodgins
53 Non-metallic biomaterials for tooth repair and replacement
Edited by P. Vallittu
54 Joining and assembly of medical materials and devices
Edited by Y. N. Zhou and M. D. Breyen
55 Diamond based materials for biomedical applications
Edited by R. Narayan
56 Nanomaterials in tissue engineering: characterization, fabrication
and applications
Edited by A. K. Gaharwar, S. Sant, M. J. Hancock and S. A. Hacking
57 Biomimetic biomaterials: structure and applications
Edited by A. Ruys
58 Standardisation in cell and tissue engineering: methods and protocols
Edited by V. Salih
59 Inhaler devices: fundamentals, design and drug delivery
Edited by P. Prokopovich
60 Bio-tribocorrosion in biomaterials and medical implants
Edited by Y. Yan
61 Microfl uidics for biomedical applications
Edited by X. J. J. Li and Y. Zhou
62 Decontamination in hospitals and healthcare
Edited by J. T. Walker
63 Biomedical imaging: applications and advances

potential to create minimally invasive restorations. It is the methodology,
however, of the preparation and fabrication that allows a minimally inva-
sive result. With that understanding, the question may be posed, how may
these modern materials be leveraged to create less invasive restorations for
the patient? The defi nitive answer is yet unknown, but many results are very
xx Foreword
© Woodhead Publishing Limited, 2013
encouraging. These non-metallic materials provide clinicians with the pos-
sibility of imitating biological structures when restoration is the course of
treatment. This biomimicry is a great opportunity to parallel the character-
istics of teeth and other anatomic structures when resect and restore is the
predominant course of action. While esthetic mimicry has long held the
attention of clinician and patient, imitating other materials and biological
properties will continue to gain in importance. Consequently, for this bio-
mimicry to be more fully realized, current materials will need to be improved
and skillfully employed.
Lastly, what is our obligation and responsibility as clinicians, researchers
and readers? Perhaps it is to be inspired. Certainly, it is to encourage current
and future generations of investigators. The editor asks us to bring our best
science, to let us compare and learn. Either prove these concepts and ideas
wrong, or push them forward. Regardless, consider that when our task is to
restore prosthetically, we may create and use materials in a manner that
preserves and parallels the natural biology.
‘To read is to borrow; to create out of one’s readings is paying off one’s
debts.’ Charles Lilliard
Scott R. Dyer, DMD, MS, PhD
Portland, Oregon, USA
© Woodhead Publishing Limited, 2013
3
1

Tooth enamel is the hardest tissue in the body, with a hardness comparable
to that of window glass, and is highly fatigue- and wear-resistant. Human
enamel is laid down by cells in a programmed temporal and spatial sequence
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4 Non-metallic biomaterials for tooth repair and replacement
© Woodhead Publishing Limited, 2013
to provide the overall shape of the tooth. The cells that make enamel
develop from the invagination of epithelial tissue during fetal development.
In what is known, because of its shape, as the ‘bell stage’ of tooth develop-
ment (ca. 14th week of intrauterine life), the epithelial cells on the inside
of the bell align with a concentration of mesenchyme cells in what appears
to be a one-to-one relationship. More accurately the latter are ‘ectomesen-
chyme’ cells, as the fi rst branchial arch, whose ectodermal cells migrates
into the mesenchyme in the area of the developing jaws (Nanci, 2008).
During this alignment an extracellular collagen network is created that
extends from the epithelial cells to the mesenchyme cells. The epithelial
cells begin to elongate and transform into ameloblasts, and the mesenchyme
cells transform into odontoblasts (Nanci, 2008). The elongation of the
ameloblasts when compared with the odontoblasts leads to pulling on the
collagen network formed between the two, creating a local puckering of
this structure that will become the dentin–enamel junction (DEJ). Seen in
cross-section the DEJ appears as scalloped, but viewed in three dimensions
(3-D), when the enamel has been dissolved, the circular ridges and pits of
the DEJ structure become apparent. The gene expression controlling this
process is not fully understood, but a large number of genes involved in

Enamel crystallites
∗
1.1 Ameloblasts arranged next to one another (upper right). Each
cell has a head (dotted black oval) and a tail (dotted black box) that
extends between its neighbors. Observe the discontinuity of the
enamel crystallites. Asterisk shows secondary territories. Each arrow
in the upper right denotes a sectioning plane through the enamel.
Each arrow points to the diagram depicting the microscopic view of
that sectioning plane in the enamel. Image modifi ed from Boyde
(1989).
5 μm
1.2 Scanning electron micrograph of enamel rods: alignment of
enamel prisms observed when the enamel surface is etched by acid.
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6 Non-metallic biomaterials for tooth repair and replacement
© Woodhead Publishing Limited, 2013
The tensile strength of enamel is lower when loaded perpendicular to the
prism direction (11.4 ± 6.3 MPa) than when it is when loaded parallel (24.7
± 9.6 MPa) (Carvalho et al., 2000). When acid etched, the shear bond of
adhesive applied end-on to the prism direction (enamel surface) is approxi-
mately 40% higher than when the adhesive is applied parallel to the enamel
prism direction (Ikeda et al., 2002). However, self-etch adhesives, which
do not employ a separate etching step, do not result in a signifi cant differ-
ence in bond strength relative to enamel prism orientation (Shimada and
Tagami, 2003).