Surface Pre-reacted Glass-ionomer Research Articles

Effectiveness of S-PRG Filler-Containing Toothpaste in Inhibiting Demineralization of Human Tooth Surface.

Objectives:Using an established pH-cycling caries model, the authors evaluated the effectiveness of toothpastes containing Surface Pre-reacted Glass-ionomer filler (S-PRG) in preventing tooth surface demineralization.Materials and Methods:210 tooth blocks were randomly assigned to seven experimental groups (30 blocks/group): no treatment (A), and toothpaste containing either NaF (B), 0 wt% S-PRG (C), 1 wt% S-PRG (D), 5 wt% S-PRG (E), 20 wt% S-PRG (F) or 30 wt% S-PRG (G). Groups were subjected to 14-day demineralization for development of early caries lesions using a pH-cycling caries model. Demineralization was assessed using Quantitative Light-induced Fluorescence (QLF) and Transverse Microradiography (TMR). All pairwise contrasts (between treatments) were tested using Analysis of Variance (ANOVA), and then Tukey’s HSD for multiple comparisons. All p-values are considered significant if <0.05.Results:With QLF, there was a significant (ANOVA; p<0.001) difference in mean percent fluorescence loss (∆F) observed among the groups. Relative to control, all S-PRG-containing toothpastes significantly (Tukey’s; p<0.0001) inhibited demineralization at varying percentages (48.6%, 61.3%, 67.4% and 69.8% reduction with S-PRG 1%, 5%, 20% and 30% respectively). Demineralization reduction was not significant with either NaF (15.6% reduction) or 0% S-PRG (-2.5% reduction i.e. 2.5% more demineralization than the Control) when compared to control group. Mineral loss assessed using TMR followed a similar trend as fluorescence loss.Conclusion:Toothpaste containing S-PRG filler can serve as an effective caries control tool. S-PRG filler-containing dentifrice to be more effective in preventing tooth demineralization than 1100 ppm fluoride provided as sodium fluoride.

Application of a direct pulp capping cement containing S-PRG filler.

To evaluate new pulp capping cements containing surface pre-reacted glass ionomer (S-PRG) filler and to investigate ion release kinetics and pH shift of eluates from the cement. Molars of Wistar rats were directly pulp capped using three kinds of cement containing S-PRG filler and mineral tri-oxide aggregate (MTA) was used as a control. After 1, 2, or 4weeks, histological evaluation was performed and differences of tertiary dentin formation were analyzed. Release of Sr2+, BO33-, SiO32-, Na+, and Al3+ ions was determined by inductively coupled plasma-atomic emission spectrometry, and F- ion release was measured using a fluoride ion selective electrode. The pH of the eluate from each cement after mixing was measured with a pH electrode. One of S-PRG cements promoted tertiary dentin formation to the same extent as the control (p > 0.05) and it showed a tendency of less inflammatory response. This cement released more BO33- and SiO32-, but less Sr2+, Na+, and F- than other S-PRG specimens. Each cement recovered nearly neutral compared with glass ionomer cement. S-PRG cement induced tertiary dentin formation based on multiple ion releases, suggesting that it is suitable as a pulp capping material. This new material can be an alternative pulp capping agent to MTA.

Fluoride-Releasing Effect of a Modified Resin Denture Containing S-PRG Fillers on Salivary Fluoride Retention: A Randomized Clinical Study

This study aimed to evaluate the clinical effect of a resin denture base containing 20wt% surface prereacted glass ionomer (S-PRG) fillers on saliva fluoride concentrations as a surrogate evaluation of caries control. The study was a double-blind randomized clinical trial with a total of 110 participants aged 35–60 years who wore a removable partial resin denture for 1.5 years. Subjects were randomly assigned to receive a partial resin denture fabricated either with or without 20wt% S-PRG fillers (n = 55 per group). After 14 days of wearing the dentures, 5,000 ppm fluoride gel was applied nightly on both sides of the denture before storing it in a denture box overnight every night for 1.5 years. The salivary fluoride concentration was measured at baseline, on days 1, 14, and 15, and at 3 months and 1.5 years of wearing the denture. A significant increase in salivary fluoride concentration in the S-PRG denture group was observed from baseline to day 1, followed by a significant decrease to an approximate baseline level. After recharge with 5,000 ppm fluoride gel, salivary fluoride increased markedly on day 15 and remained elevated at month 3 through to 1.5 years. The resin denture base containing 20wt% S-PRG fillers demonstrated an initial fluoride release that increased saliva fluoride concentrations, but the fluoride release from within the material was short lived. The long-term effect of sustained fluoride release from the denture when combined with a regular fluoride recharge regimen may be beneficial for caries prevention.

Material properties on enamel and fissure of surface pre-reacted glass-ionomer filler-containing dental sealant

PurposeIn pediatric dentistry, sealants have been used to prevent caries. Due to its material properties such as fluoride-releasing ability and physical strength, surface pre-reacted glass (S-PRG) filler is added primarily to resin-based dental materials for clinical use. In this study, we investigated the properties of S-PRG filler containing sealant. MethodsBefore using sealant, the primer was applied to extracted bovine incisors. Scanning electron microscopy (SEM) observation revealed that the primer treatment caused no structural changes of enamel surface, unlike conventional phosphoric acid etching. Further, shear bond strength test was performed to measure the initial strength and durability after thermal cycling. Bond strength of S-PRG filler containing sealant was comparable to those of other sealants even though the former does not involve phosphoric acid etching. In addition, after treating the enamel surface with the primer or phosphoric acid, it showed excellent flowability in the primer group compared to phosphoric acid treatment. ResultsSEM observation showed that the sealant sealed the enamel surface as it migrated to reach the deep areas of the fissures. When the marginal sealing ability of the sealant was evaluated based on dye penetration, no dye penetration in the marginal region was observed in any specimens. In addition, measurement of the pH of an acid solution containing a cured specimen of the sealant containing S-PRG filler showed that the solution's pH became more alkaline as the immersion time increased. ConclusionThese findings suggest that the sealant is an extremely effective material for preventing caries.

Ions released from a S-PRG filler induces oxidative stress in Candida albicans inhibiting its growth and pathogenicity

Candida albicans causes opportunistic fungal infections usually hidden among more dominant bacteria and does not exhibit high pathogenicity in vivo. Among the elderly, due to reduced host resistance to pathogens attributable to immunoscenesence, oral candidiasis is more likely to develop often leading to systemic candidiasis. Surface pre-reacted glass ionomer filler (S-PRG filler) is an ion-releasing functional bioactive glass that can release and recharge six ions which in turn strengthens tooth structure, inhibits demineralization arising from dental caries, and suppresses dental plaque accumulation. However, its effects on C. albicans have never been elucidated. Here, we evaluated the effects of ion released from S-PRG filler on C. albicans. Results show that extraction liquids containing released ions (ELIS) decreased the amount of hydrogen peroxide and catalase activity in C. albicans. Moreover, ELIS presence was found to affect C. albicans: (1) suppression of fungal growth and biofilm formation, (2) prevent adherence to denture base resin, (3) inhibit dimorphism conversion, and (4) hinder the capability to produce secreted aspartyl proteinase. Taken together, our findings suggest that ELIS induces oxidative stress in C. albicans and suppresses its growth and pathogenicity. In this regard, we propose that ELIS has the potential to be clinically used to help prevent the onset and inhibition of oral candidiasis among the elderly population.

Effect of incorporation of surface pre-reacted glass ionomer filler in tissue conditioner on the inhibition of Candida albicans adhesion.

We investigated the effects of incorporation of surface pre-reacted glass ionomer (S-PRG) filler in tissue conditioner (TC) on Candida albicans adhesion. We prepared specimens containing 0, 5, 10, or 20 wt% of S-PRG filler, and measured the amount of C. albicans on the surface using a colony forming unit (CFU) assay and scanning electron microscopic images. In addition, we measured the consistency, penetration depth, and surface roughness (Ra). CFU values for 10 and 20 wt% were significantly lower than that for the control (p<0.05). Hyphal density on the surface was greater in the control. The 10 and 20 wt% specimens showed significantly higher consistency and Ra, lower penetration depth ratio than control (p<0.05). These results suggest that incorporation of S-PRG filler may reduce C. albicans adhesion onto TC surface; however, the optimal amount of filler is dictated by the influence of filler incorporation on mechanical and surface characters of TC.

Inhibitory effect of surface pre-reacted glass-ionomer (S-PRG) eluate against adhesion and colonization by Streptococcus mutans

Surface Pre-reacted Glass-ionomer (S-PRG) filler is a bioactive filler produced by PRG technology, which has been applied to various dental materials. A S-PRG filler can release multiple ions from a glass-ionomer phase formed in the filler. In the present study, detailed inhibitory effects induced by S-PRG eluate (prepared with S-PRG filler) against Streptococcus mutans, a major pathogen of dental caries, were investigated. S-PRG eluate effectively inhibited S. mutans growth especially in the bacterium before the logarithmic growth phase. Microarray analysis was performed to identify changes in S. mutans gene expression in the presence of the S-PRG eluate. The S-PRG eluate prominently downregulated operons related to S. mutans sugar metabolism, such as the pdh operon encoding the pyruvate dehydrogenase complex and the glg operon encoding a putative glycogen synthase. The S-PRG eluate inhibited several in vitro properties of S. mutans relative to the development of dental caries especially prior to active growth. These results suggest that the S-PRG eluate may effectively inhibit the bacterial growth of S. mutans following downregulation of operons involved in sugar metabolism resulting in attenuation of the cariogenicity of S. mutans, especially before the active growth phase.

Antibacterial Effect and Inhibition Ability of Enamel Demineralization by Surface Pre-Reacted Glass Ionomer Filler Containing Composite

Antibacterial Effect and Inhibition Ability of Enamel Demineralization by Surface Pre-Reacted Glass Ionomer Filler Containing Composite

Inhibitory effect of resin composite containing S-PRG filler on Streptococcus mutans glucose metabolism

ObjectivesResin composites containing surface pre-reacted glass-ionomer (S-PRG) fillers have been reported to inhibit Streptococcus mutans growth on their surfaces, and their inhibitory effects were attributed to BO33− and F− ions. The aim of this study was to evaluate S. mutans acid production through glucose metabolism on resin composite containing S-PRG fillers and assess inhibitory effects of BO33− and F− on S. mutans metabolic activities. MethodsThe pH change through S. mutans acid production on experimental resin composite was periodically measured after the addition of glucose. Inhibitory effects of BO33− or F− solutions on S. mutans metabolism were evaluated by XTT assays and measurement of the acid production rate. ResultsThe pH of experimental resin containing S-PRG fillers was significantly higher than that of control resin containing silica fillers (p < 0.05). OD450 values by XTT assays and S. mutans acid production rates significantly decreased in the presence of BO33− and F− compared with the absence of these ions (p < 0.05). ConclusionspH reduction by S. mutans acid production was inhibited on resin composite containing S-PRG fillers. Moreover, S. mutans glucose metabolism and acid production were inhibited in the presence of low concentrations of BO33− or F−. Clinical significanceBO33− or F− released from resin composite containing S-PRG fillers exhibits inhibitory effects on S. mutans metabolism at concentrations lower than those which inhibit bacterial growth.

Water-soluble factors eluated from surface pre-reacted glass-ionomer filler promote osteoblastic differentiation of human mesenchymal stem cells.

Surface pre-reacted glass-ionomer (S-PRG)-containing dental materials, including composite and coating resins have been used for the restoration and/or prevention of dental cavities. S-PRG is known to have the ability to release aluminum, boron, fluorine, silicon, and strontium ions. Aluminum ions are known to be inhibitors whereas boron, fluorine, silicon, and strontium ions are known to be promoters of mineralization, via osteoblasts. However, it remains to be clarified how an aqueous eluate obtained from S-PRG containing these ions affects the ability of mesenchymal stem cells (MSCs), which are known to be present in dental pulp and bone marrow, to differentiate into osteogenic cell types. The present study demonstrated that 200- to 1,000-fold-diluted aqueous eluates obtained from S-PRG significantly upregulated the mRNA expression level of the osteogenic differentiation marker alkaline phosphatase in human MSCs (hMSCs) without exhibiting the cytotoxic effect. In addition, the 500- to 1,000-fold-diluted aqueous eluates obtained from S-PRG significantly and clearly promoted mineralization of the extracellular matrix of hMSCs. It was additionally demonstrated that hMSCs cultured on the cured resin composites containing S-PRG fillers exhibited osteogenic differentiation in direct correlation with the weight percent of S-PRG fillers. These results strongly suggested that aqueous eluates of S-PRG fillers promoted hard tissue formation by hMSCs, implicating that resins containing S-PRG may act as a useful biomaterial to cover accidental exposure of dental pulp.

Effect of tooth surface coating material containing S-PRG filler on white spot lesions of young permanent teeth

PurposePre-cavitation carious lesions recognized as white spot lesions (WSLs) are frequently observed on young permanent teeth. A more effective method to remineralize WSLs is needed to prevent not only caries progression, but also esthetic problems. Various coating materials for remineralization have been developed. The aim of this study was to evaluate the effect of a coating material (PRG Barrier Coat, SHOFU) containing surface pre-reacted glass-ionomer (PRG) filler to remineralize WSLs by measuring the area of lesions. MethodsA total of seven children, aged 8–15 years, with WSLs involving 17 teeth attending Asahi University Hospital Department of Pediatric Dentistry were examined. Buccal surfaces of teeth together with color-matching stickers (CasMatch™, Bear Medic, Tokyo, Japan) were photographed with a digital camera (EOS KissX5,Canon). PRG Barrier Coat was applied on WSLs, and the areas of WSLs were measured by imaging software (Image J, NIH, and Photoshop, Adobe) every 3 months for up to 1 year and compared with baseline values. ResultsThe mean reduction in lesion area at 3, 6, 9, and 12 months after treatment were 0.41 ± 0.29 mm2, 0.79 ± 0.61 mm2, 1.15 ± 0.80 mm2, and 1.37 ± 0.82 mm2, respectively. Significant differences were observed in all experimental periods compared to baseline (paired t-test, p < 0.01 for all). There were no cavitated teeth that required restoration during the experimental period. ConclusionThese results suggest that PRG Barrier Coat is an effective material for remineralization of WSLs.

Bacterial adhesion not inhibited by ion-releasing bioactive glass filler

ObjectiveBioactive glasses and surface pre-reacted glass-ionomer (sPRG) filler possess cariostatic properties owing to ion release. Many studies investigated potential cariostatic effects; few studies evaluated the surface stability and the structural changes their surfaces undergo in acidic conditions. MethodsThe surface resistance against acid attack and the surface receptiveness for bacterial adhesion and biofilm formation of a sPRG-filled (Beautifil ll, Shofu) and conventional glass-filled (Herculite XRV Ultra, Kerr) resin-based composite (RBC), and a conventional glass-ionomer cement (GIC; Fuji IX GP Extra, GC) were examined. Specimens (n=3) were immersed in distilled water or lactic acid (pH 4.0) for 3 days. Bacterial growth and biofilm formation were recorded using optical density and SEM. ResultsUpon 3-day immersion in lactic acid, the surface of the sPRG-filled RBC revealed multiple holes, while virtually no change in surface integrity was observed for the conventional RBC and GIC. Bacterial growth measurements revealed that none of the materials inhibited Streptococcus mutans (p<0.05). Remarkably, cross-sectional SEM revealed that S. mutans had penetrated the etch pits induced by lactic acid in/around the sPRG filler. Ion-release measurements revealed that sPRG-filled RBC released boron and fluoride, while GIC only released fluoride. However, the concentration of ions released by both materials appeared not sufficient to inhibit bacterial growth. Moreover, the structural surface change and resultant increased surface roughness appeared to have promoted biofilm formation. SignificanceWhile having bioactive potential through ion release, the stability of surface integrity of bioactive materials is a key-parameter to be assessed with regard to their cariostatic potential.

Adherence of &amp;lt;i&amp;gt;Streptococcus mutans&amp;lt;/i&amp;gt; and Adsorption of Salivary Protein to Resin Composites Containing S-PRG Fillers

The purpose of this study was to measure the amount of adsorption of various salivary proteins to a resin composite having various amounts of surface pre-reacted glass-ionomer (S-PRG) fillers, and to make a comparative study of the adherence of S. mutans to the resin composite covered by various salivary proteins. We experimentally produced resin composites (S-PRG resin) having the basic composition of Bis-GMA/TEGDMA and various amount of the S-PRG fillers ranging between 0 - 60 wt%. Each S-PRG resin block was soaked in 5 kinds of components found in salivary fluid (Mucin 1, Lactoferrin, IgA, Cystatin C, and Lysozyme), and the amount of adsorption was measured by use of a spectrophotometer. The amount of the adsorption of salivary Mucin 1 was higher than that of any other salivary component tested regardless of the percentage of the S-PRG filler. In the case of salivary Lysoxyme used for coating, the amount of its adsorption increased with an increase in the percentage of the S-PRG filler. In addition, resin blocks coated with various salivary proteins were incubated at 37℃ for 2 hours with radio-labeled S. mutans for a quantitative adherence test. Labeled bacteria that adhered to the resin blocks were collected by using an automatic sample combustion system and a liquid scintillation counter. The absorbed salivary components, especially Mucin 1 and Lysozyme, inhibited the adhesion of S. mutans to the S-PRG resin; however, these changes were generally directional rather than statistically significant.

Effects of experimental pastes containing surface pre-reacted glass ionomer fillers on inhibition of enamel demineralization.

This study aimed to evaluate the inhibitory effect of experimental pastes containing surface pre-reacted glass ionomer (S-PRG) fillers on enamel demineralization. Bovine blocks were treated twice a day for 4 days by 7 groups; experimental pastes containing 0-30 wt% S-PRG filler (S00, S01, S05, S10, and S30), deionized water (DW) as negative control, and NaF paste (MP) as positive control. The surfaces were demineralized by acetic acid for 3 days. Mineral loss (ML) was calculated by micro-computed X-ray tomography. The treated surface was finally investigated with scanning electron microscope (SEM) and micro-focused particle induced X-ray emission (micro-PIXE). S05, S10 and S30 demonstrated significantly lower ML than S00, S01 and DW (p<0.05). S10 showed the greatest inhibitory effect, which was significantly greater than MP. The S-PRG filler containing experimental pastes demonstrated a potential to inhibit enamel demineralization. Sr ion incorporation was confirmed on the enamel surface with the experimental pastes.

Structural analysis of strontium in human teeth treated with surface pre-reacted glass-ionomer filler eluate by using extended X-ray absorption fine structure analysis

The bioactive effects of strontium released from surface pre-reacted glass-ionomer (S-PRG) fillers may aid in caries prevention. In this study, the local structure of strontium taken up by teeth was estimated by extended X-ray absorption fine structure analysis. Immersing teeth into S-PRG filler eluate increased the strontium content in enamel and dentin by more than 100 times. The local structure of strontium in enamel and dentin stored in distilled water was the same as that in synthetic strontium-containing hydroxyapatite (SrHAP). Moreover, the local structure of strontium in enamel and dentin after immersion in the S-PRG filler eluate was also similar to that of SrHAP. After immersion in the S-PRG filler eluate, strontium was suggested to be incorporated into the hydroxyapatite (HAP) of enamel and dentin at the calcium site in HAP.

Antimicrobial activity of ethylene-vinyl acetate containing bioactive filler against oral bacteria.

We developed an ethylene vinyl acetate (EVA) containing surface pre-reacted glass-ionomer (S-PRG) filler, as a new mouthguard material for preventing intraoral bacterial infection. We examined its physical properties, antimicrobial activity against a major cariogenic bacterium Streptococcus mutans and a periodontopathogen Porphyromonas gingivalis, and its cytotoxicity toward human gingival epithelial cells. S-PRG filler was added to EVA copolymer at 5, 10, 20, or 40 wt% and was processed into disc-shaped test specimens. Only minor differences between the Shore hardness and rebound resilience properties of EVA materials with and without the S-PRG filler were observed. The specimens with S-PRG filler showed bacteriostatic activity toward S. mutans and P. gingivalis and inhibited S. mutans biofilm formation. No cytotoxicity against the gingival epithelial cells was observed. Our findings show that EVA containing S-PRG filler has antimicrobial activity toward pathogenic oral bacteria and may be an effective material for maintaining the oral health of athletes.

Water-soluble factors eluate from surface pre-reacted glass-ionomer promote osteoblastic differentiation of human mesenchymal stem cells

Water-soluble factors eluate from surface pre-reacted glass-ionomer promote osteoblastic differentiation of human mesenchymal stem cells

Evaluation of the caries-preventive effect of toothpaste containing surface prereacted glass-ionomer filler.

Although fluoride interventions have the most consistent benefit in preventing caries, caries still develop in high-risk individuals. Authors have evaluated the effectiveness of toothpastes containing surface prereacted glass-ionomer (S-PRG) filler in preventing tooth demineralization. Human tooth enamel blocks were randomly assigned to six groups (30 blocks/group): no treatment (a), and toothpaste containing either 1500ppm fluoride as sodium monofluorophosphate (NaMFP) (b), 0 wt% S-PRG (b), 1 wt% S-PRG (d), 5 wt% S-PRG (e), or 20 wt% S-PRG (f). Early caries developed on each block by 7-days demineralization using a microbial caries model. Mineral loss (Δz) and lesion depth (LD) were determined using transverse microradiography. Relative to the control, all toothpastes, except 0% S-PRG, significantly (analysis of variance, Tukey's, P<.0001) reduced Δz and LD at varying percentages. With regard to Δz, all comparisons were significant (P<.0001), except 0% S-PRG vs the control. Otherwise, S-PRG 1%, 5%, and 20% had 0.50, 0.37, and 0.27 times Δz compared to the control, respectively, while NaMFP had 0.61 times Δz compared to the control. LD followed an almost similar trend as Δz. The findings of the present study demonstrate the effectiveness of toothpaste containing S-PRG filler in inhibiting tooth demineralization in the presence of bacterial plaque, thus highlighting its potential as an effective caries-control tool for individuals at high risk of developing caries.

Antibacterial activity of resin composites containing surface pre-reacted glass-ionomer (S-PRG) filler

ObjectiveA surface pre-reacted glass-ionomer (S-PRG) filler is a technology of interest for providing bio-functions to restorative materials. Resin composites containing S-PRG filler have been reported to show less plaque accumulation and reduced bacterial attachment. In this study, experimental resin composites containing S-PRG filler at various concentrations were fabricated, and the inhibitory effects on bacterial growth on their surface and the association of ions released from S-PRG filler with antibacterial activity were evaluated. MethodsFive kinds of experimental resin composites containing S-PRG filler at 0, 13.9, 27.3, 41.8, or 55.9 (vol.%) were fabricated. Streptococcus mutans was cultured on the cured discs for 18h to examine the growth of bacteria in contact with the surface of the experimental resins. The concentrations of Al3+, BO33−, F−, Na+, SiO32−, or Sr2+ released from each experimental resin into water were measured. The standardized solutions of each ion were prepared at the concentrations determined to be released from the experimental resin, and their inhibitory effects of single ion species on S. mutans growth were evaluated by using each standardized solution. ResultsResin composites containing S-PRG filler at 13.9 (vol.%) or greater inhibited S. mutans growth on their surface. When S. mutans was incubated in the presence of six kinds of ions at the concentrations released from the resin composite containing S-PRG filler at 55.9 (vol.%), a significant reduction in bacterial number was observed for BO33−, F−, Al3+, and SiO32−. Among these four ions, BO33− and F− demonstrated the strongest inhibitory effect on S. mutans growth. SignificanceOur findings suggest that resin composites containing S-PRG filler inhibit the growth of S. mutans on their surface. BO33−, F−, Al3+ and SiO32− released from S-PRG filler have the ability to inhibit S. mutans growth, and the inhibitory effects are mainly attributed to release of BO33− and F−.

Lack of Buffering by Composites Promotes Shift to More Cariogenic Bacteria

Secondary caries (SC) remains a very important problem with composite restorations. The objectives of this study were to test the acid-buffering ability of several restorative materials and to evaluate whether buffering of the restorative material has an impact on the microbial composition of the biofilm. Disk-shaped specimens of conventional composite, composite with surface prereacted glass-ionomer filler particles (so-called giomer), glass-ionomer cement (GIC), amalgam, and hydroxyapatite (HAp) (control) were exposed to aqueous solutions with pH 4, 5, 6, and 7 and to the medium containing bacteria-produced acids, and pH changes were recorded over several days. Next, material specimens were immersed in bacterial growth medium with pH adjusted to 5. After a 24-h incubation, the extracts were collected and inoculated with a cariogenic (Streptococcus mutans) and a noncariogenic (Streptococcus sanguinis) species. The bacterial growth was monitored both in a single-species model by spectrophotometry and in a dual-species model by viability quantitative polymerase chain reaction. Amalgam and HAp showed the strongest acid-buffering ability, followed by the GIC and the giomer, while the conventional composite did not exhibit any buffering capacity. Furthermore, due to the lack of acid-buffering abilities, composite was not able to increase the pH of the medium (pH 5), which, in the absence of antibacterial properties, allowed the growth of S. mutans, while the growth of S. sanguinis, a less aciduric species, was completely inhibited. A similar effect was observed when bacteria were cultured together: there was a higher percentage of S. mutans and lower percentage of S. sanguinis with the conventional composite than with other materials and HAp. In conclusion, conventional composites lack the ability to increase the local pH, which leads to the outgrowth of more acidogenic/aciduric bacteria and higher cariogenicity of the biofilm. Together with lack of antibacterial properties, lack of buffering may account for the higher susceptibility of composites to SC.