Bioactive Composites: Cutting-Edge Innovation or Overhyped Solution?

Objectives: Currently used dental composites are predominantly inert and they focus solely on restoring the structural integrity of a tooth. This study explores a new generation of bioactive composites designed to reverse caries and restore functionality. A common reason for dental composite restoration failure is recurrent caries at the margins which often results from the material's inability to bond effectively with the surrounding tooth structure over time. By incorporating bioactive properties, these new materials may offer a solution to the challenges faced by conventional composites, potentially improving the longevity and performance of dental restorations. The study aims to evaluate whether bioactive composites can meet the high expectations set by recent claims.
Methods: Extracted teeth with natural caries (ICDAS-II score 4-5) and sound teeth were selected and scanned using x-ray microtomography (XMT). Eight samples were included and subdivided into two groups. G1: Natural caries, G2: Artificial caries (n=4). For G1, cavity preparation was done according to selective caries removal principles until sound enamel margins were reached, and only leathery dentin was preserved. For G2, a standardised cavity was prepared with the dimensions of 1x2x3 mm and demineralised using an acetate buffer solution for 72 hours. After preparation, the cavities were etched and bonded then restored with either the test materials; (Activa Presto™ Pulpdent, Cention F™ Ivoclar Vivadent), an experimental composite (BAG-comp) or a conventional non-bioactive control (Tetric powerfil™ Ivoclar Vivadent). The samples were kept in artificial saliva and XMT was performed at baseline and at follow-up points up to 12 Months for evaluation of changes in mineral density.
Results: CentionF and (BAG-comp) showed a consistent increase in mineral density overtime. Activa presto showed fluctuations and no significant increase while Tetric-powerfill showed no change overtime.
Conclusions: CentionF and (BAG-comp) have the potential of remineralising marginal gaps thereby prolonging the lifetime of the restoration.