Restorative materials containing antimicrobial agents: is there evidence for their antimicrobial and anticaries effects? A systematic review

Abstract

The aim of this systematic literature review was to investigate whether the incorporation of antimicrobial agents into dental restorative materials truly exerts an antimicrobial effect against common cariogenic bacteria (primary outcome), and whether the inclusion of antimicrobial agents is able to prevent caries around restorations (secondary outcome). MEDLINE, via PubMed, was searched for papers published between 1980 and 30 November 2014. A total of 1126 articles were retrieved. After inclusion/exclusion assessment, 147 full text articles were read and included in the review, comprising 130 in vitro, 1 in situ, and 4 in vivo studies, as well as 12 literature reviews. In about 78% of in vitro studies, and in all identified in situ and in vivo studies, a positive antimicrobial effect had been found. However, the anticaries effect had not been tested in any of the selected studies. It was concluded that there is indeed evidence that restorative dental materials containing antimicrobial agents exert an antimicrobial effect, both in laboratory and in clinical studies. However, no evidence has been found regarding the role of these agents in preventing or controlling dental caries, or in preventing caries around restorations.

Biostable, antidegradative and antimicrobial restorative systems based on host-biomaterials and microbial interactions

“…Many studies of antimicrobial materials investigate only short-term effects on a low number of species, which may not be indicative of medium- and long-term capability [98]. Many of these studies claim a potential secondary-caries reducing effect, despite not demonstrating this [99]. Ideally studies would be performed in vivo in animal models of caries, however this is not always practical, especially in the development stage of the materials, when optimization requires testing of multiple formulations under standardised conditions.…”

In Situ Generated Medical Devices

“…Alternative strategies to prevent or fight infections are based on adding silver or gold nanoparticles, known for their antibacterial activity, to the cement . In their recent work, Russo et al reported a bone cement containing preformed gold nanoparticles in the 10–20 nm range that improved the antibacterial activity of the cement .…”

Optimizing quality and safety of dental materials

“…Despite the design of a range of antibacterial dental materials and observed antibacterial effects in vitro, recent reviews conclude that there is insufficient clinical evidence to support the effectiveness of antibacterial dental materials against recurrent caries in patients . Furthermore, the problem of microbial resistance against antimicrobial agents is increasing, and this is no different in the case of QAMs .…”