Clinical Assessment of Moringa oleifera as a Natural Crosslinker for Enhanced Dentin Bond Durability: A Randomized Controlled Trial.

Abstract

Dentin biomodification is a biomimetic approach that strengthens the collagen network, making it less susceptible to enzymatic degradation and improving the durability of bonded restorative materials, using collagen crosslinkers. This study aimed to assess the effectiveness of Moringa oleifera as a natural crosslinker in improving the clinical success of resin-dentin restorations. A double-blind, controlled, randomized clinical trial was conducted in accordance with Consolidated Standards of Reporting Trials (CONSORT) guidelines, with 50 adult participants with initial carious lesions (ICDAS 4 and 5) enrolled. Participants were randomly assigned to either the experimental group (which received Moringa oleifera as a pretreatment liner) or the control group (standard restorative procedures without a liner). Functional and biological outcomes were assessed at baseline, six months, and 12 months using the FDI criteria. Statistical analysis included Fisher's exact test, Wilcoxon sign rank test, and Mann-Whitney U test. Both groups exhibited excellent functional properties and marginal adaptation at baseline and six months. At the 12-month mark, the test group displayed clinically better functional properties (97.9%, n=47) compared to the control group (95.8%, n=46), but there was no significant difference (p-value>0.05). Marginal gaps were observed in both groups at six and 12 months (8.3%, n=4), with no significant inter-group variation (p-value>0.05). Radiographic examination showed a harmonious restoration-to-tooth transition. Patient satisfaction remained high, with the test group 4.2% (n=2) and control 2.1% (n=1) reporting minor issues at 12 months, though not statistically significant (p-value>0.05). Postoperative sensitivity was minimal, and tooth integrity was well-preserved. Moringa oleifera, as a pretreatment liner, showed promise in enhancing the clinical success of resin-dentin restorations. Despite minor reported issues, the groups had no statistically significant differences regarding functional and biological outcomes.