Reducing Incidences of Secondary Decay With Bioactivity
Beautifil II from Shofu is a composite material that harnesses biochemistry to reduce secondary
decay without sacrificing esthetics. [ by Ankur Gupta, DDS]
In 2016, one of my patients—a frustrated mom who was about the same age as myself—humorlessly asked me, “Isn’t there, like, a magic coating you can put on my teeth so I don’t get any more cavities?” Her husband, who never flossed, snacked on Twizzlers, and would only brush for a minute with a manual toothbrush, just received the good news: He had no cavities. In contrast, his wife, who was in the operatory room just next door to him, had 3 cavities. What’s worse, 1 of these 3 cavities was recurrent decay at the margins of a filling I had done only a few years prior. She has excellent at-home habits; she meticulously and properly uses all the tools when she wakes up and before she goes to sleep, yet she continues to receive bad news at her dental visits while her less-responsible husband is delighted to receive the news that he would be granted another 6-month reprieve from any visits to our office.
As any dentist who has practiced for any length of time would agree, sometimes meticulous home care is not enough.
Some people just have unlucky oral environments. Some people, like the dear patient described above, have a less-than-optimal oral pH, or a poorly balanced diversity of oral microbiota, or even an inability to produce certain enzymes in their saliva. I knew that my approach to her fillings had to be different. Without a doubt, I knew that however thorough and conscientious I intended to be
when restoring her teeth with traditional class I, class II, and class V bonded restorations, she would inevitably return to my office with ugly discolorations at the margins, and I would inevitably question my own clinical expertise.
Fortunately, around that same time, I had attended a continuing education (CE) course in Chicago, Illinois, in which some of the most
incredible minds in general dentistry shared innovative and not-so-well-known techniques and products to the audience. It was at that course where I learned about bioactivity. By now, you have probably heard the word, but I would like to describe bioactivity the way I understand it best.
Our enamel is a bunch of rods held together by a highly mineralized cement substance. This is like holding a bunch of nerf bullets together in your hand, and then squirting superglue all over the bullets. Demineralization, which is caused by acid from bacteria, sugar, and bad luck, weakens the superglue. If the glue weakens enough, you lose some of the nerf bullets, or you then have enamel cavitation. Dentin is made of similar hydroxyapatite crystals but is arranged in a much more porous grouping, such as a really hard block of Swiss cheese, allowing for branches of the pulp to occupy the tubes within the cheese.
Certain minerals act on the dentin, the enamel, and those branches of the pulp in a really convenient way. Fluoride is like superglue to the hydroxyapatite rods in the enamel and hydroxyapatite crystals in the dentin, holding them together and inhibiting demineralization
and eventual cavitation. Additional ions, such as strontium, silicate, aluminum, borate, and sodium, all act either independently or in combination with one another to neutralize the demineralization of acid and inhibit plaque formation.
Moreover, they work together to elicit the growth of new hydroxyapatite. They don’t allow bacteria to grow; instead, they remineralize enamel and dentin that have been subject to acid and elicit growth of new solid healthy tooth structure.
If only there was a product that constantly released these ions.
