molecules

Editorial
Insights and Advancements in Biomaterials for Prosthodontics
and Implant Dentistry
Artak Heboyan 1, * , Muhammad Sohail Zafar 2,3 , Dinesh Rokaya 4 and Zohaib Khurshid 5

1 Department of Prosthodontics, Faculty of Stomatology, Yerevan State Medical University after Mkhitar
Heratsi, Str. Koryun 2, Yerevan 0025, Armenia
2 Department of Restorative Dentistry, College of Dentistry, Taibah University,
Al Madinah Al Munawwarah 41311, Saudi Arabia
3 Department of Dental Materials, Islamic International Dental College, Riphah International University,
Islamabad 44000, Pakistan
4 Department of Clinical Dentistry, Walailak University International College of Dentistry, Walailak University,
Bangkok 10400, Thailand
5 Department of Prosthodontics and Implantology, College of Dentistry, King Faisal University,
Al-Ahsa 31982, Saudi Arabia
* Correspondence: [email protected]

It is always difficult to avoid subjectivism in the assessment of the properties of

prosthodontics materials due to the ambiguity in the evaluation criteria of dental research.
However, over the past five years, the interest in this field of dentistry and its development
in research has been increasing. As a result, a large number of new biomaterials have
been introduced in dentistry. Those worth mentioning include titanium (Ti) and Ti alloys,
yttria-stabilized zirconia (YTZP), zirconium-reinforced lithium silicate, lithium-disilicate-
reinforced glass ceramics, as well as acrylic resins with enhanced mechanical properties.
In addition to these new materials, glass fibers and nanoparticles present high potential
in the reinforcement of other base materials and resinous structures. Remarkably, the
Citation: Heboyan, A.; Zafar, M.S.;
improvement of the mechanical features of polymethyl methacrylate (PMMA) denture base
Rokaya, D.; Khurshid, Z. Insights and
Advancements in Biomaterials for
materials can be achieved by using a hybrid system, hybrid fillers or their combination as a
Prosthodontics and Implant
new reinforcement system. Research in this area is typically performed in vitro, while new
Dentistry. Molecules 2022, 27, 5116.
approaches using in vivo methods are currently in demand [1–7].
https://doi.org/10.3390/ Due to their excellent translucency and esthetic properties, newly developed multi-
molecules27165116 color monolithic ceramic materials are highly durable and can be recommended for use
in applications in which strength is required, and these materials are also associated with
Received: 8 August 2022
aesthetic improvements. Therefore, the increasing prevalence of conservative treatment
Accepted: 10 August 2022
using adhesively luted monolithic restorations is justified. In this Special Issue, we ex-
Published: 11 August 2022
pected positive results to be published based on previous studies on ceramic restauration,
Publisher’s Note: MDPI stays neutral especially in terms of implant-supported single crowns and FDPs [1].
with regard to jurisdictional claims in In addition to a material’s properties, the stress concentration of a material is an im-
published maps and institutional affil- portant factor affected by the type of marginal preparation, endodontic treatment, and
iations. superstructure used. In terms of stress magnitude, contemporary concepts such as the
biologically oriented preparation technique (BOPT) can be a promising choice for anterior
monolithic zirconium crowns, despite the fact that the highest stress magnitude exists at the
restoration margin [2]. From the biological point of view, according to recent cytomorpho-
Copyright: © 2022 by the authors.
metric, bacteriological, and hygienic-based investigations, zirconium restorations showed
Licensee MDPI, Basel, Switzerland.
better results compared with conventional Co-Cr-based ceramic restorations [3–7].
This article is an open access article
distributed under the terms and
According to the literature, ceramic surface conditioning is negatively influenced by a
conditions of the Creative Commons
number of erosive factors, such as the low pH of most beverages. This fact should not be
Attribution (CC BY) license (https:// neglected, and patients who undergo prosthetic treatment should be warned of the effects
creativecommons.org/licenses/by/ of corrosion. A longer period of storage was also noted as a factor which may lead to an
4.0/). increase in roughness on the surface of ceramics [8].

Molecules 2022, 27, 5116. https://doi.org/10.3390/molecules27165116 https://www.mdpi.com/journal/molecules

Molecules 2022, 27, 5116 2 of 4

Relevant fields of study to the investigation of the factors that cause the deterioration
of retentive potential of materials are thermal undulation and water dispersion. Thus,
retention loss was found to be higher in nylon and polyetheretherketone (PEEK) (which
contain strong polar groups in polymeric chains) than in polyvinyl siloxane (PVS). However,
all of the polymeric materials evaluated showed a decrease in retention after one year of
artificial aging. Therefore, more investigations regarding attachment systems suitable for
the repair of abutments in vulnerable patients are still necessary [9–11].
The use of an adhesive system allows the creation of a solid bond between copings
and resin cement; resin cement should not be applied on its own. An adhesive should be
applied in clinical practice to achieve better outcomes. Therefore, tensile bond strength
investigations [12] should be performed considering different materials that share the
same indication.
At present, zirconium is the most frequently used restorative material, being the color
of natural teeth, while PEEK can be used as an alternative in more flexible superstructures.
Zirconium crowns were demonstrated to withstand three times more antagonist wear and
had higher color stability. These crowns exhibit the least displacement, as opposed to
crowns made of PEEK. However, PEEK prosthetic crowns demonstrate minimal abrasion,
better stress modulation due to plastic deformation, as well as enhanced color stability,
which means they could be an alternative to zirconium in crown fabrication. The choice
of material used in the manufacture of dentures depends on the purpose of use and,
accordingly, takes into account its properties, advantages, and limitations [13].
The characteristics of PMMA make it the perfect base material for prostheses. This
material can be used in denture rebases, reliners, maxillofacial prostheses, orthodontic
appliances, temporary restorations, and even in splints for surgical procedures. Qualities
that make denture base materials widely used are esthetics, precise fabrication, and an easy
manufacturing technique. They should also be repairable, available, and inexpensive. In
spite of many positive features, PMMA still has some disadvantages. A major shortcoming
of PMMA is its insufficient toughness, resulting in the frequent need for repair during
the span of a year. Another widespread problem is that some individuals exhibit allergic
reactions to acrylic resin, which can be solved by modifying resin prosthesis bases [9–13].
The use of nanoparticles as reinforcements in conventional glass ionomer cement is
another field that requires attention. A previous investigation revealed that the 8% addition
of a titanium reinforcement in glass ionomer cement decreases the wear rate from almost
35 to 25%. The surface hardness, however, was not enhanced. Among the factors which
may have an impact upon the mechanical characteristics of materials are the environment,
mixing time, and proportion of resin [14]. Research into these parameters could contribute
to the scientific literature and improve the field of dentistry.
As an oral implant material, titanium alloy has a minor drawback: its relatively low
wear resistance. Nanostructured ceramic coatings such as TiN, ZrO2 /SiO2 , Si3 N4 /TiO2 ,
and ZrO2 /Al2 O3 are currently used to solve this problem. Due to its improved adhesion
power and lower porosity, a bilayered coating demonstrated a 200- and 500-fold increase
in wear resistance, as opposed to the monolayer Al2 O3 -13TiO2 and ZrO2 , respectively [1].
New coating layers should be developed and applied in clinical scenarios.
Different methods were applied by researchers to manufacture metal surface nano-
crystallization in order to improve the biological activity of a metal. A nano-textured tita-
nium surface was made using chemical etching technology. The effects of a nanotextured Ti
surface on murine preosteoblastic cells’ proliferation, adherence, differentiation, and miner-
alization has been previously investigated. Therefore, nanophase metals seem to have great
potential in both prosthetics and implantation, but more studies are required. Research
revealed that nacre (the innermost layer of mollusk shells) powder promotes peri-implant
osteogenesis in the tibias of domestic pigs. Micro-CT analysis and a histological study
showed that this bioactive material promotes adequate bone formation around an implant
surface. The possibility of nacre powder application in combination with surgical implant
placement can be used as an alternative method to promote osseointegration [15–17].
Molecules 2022, 27, 5116 3 of 4

Dentin matrix protein stimulates adhesion and proliferation and promotes human
stem cell differentiation and mineralized matrix formation. Thus, a biologically modified
Ti surface with dentine matrix protein is recommended to be applied to ensure better
osseointegration in Ti implants [17].
As shown in the previous literature, the direct placement of dental implants with
bone graft materials did not prevent peri-implant bone remodeling, and a reduction in
bone thickness was still observed. Remarkably, the change in the buccal alveolar ridge was
more noticeable. Consequently, this method can be used as an alternative to the existing
treatment protocol for the placement of an implant in posterior areas [16].
We found that the guided implant surgical protocol is beneficial, because the final
outcome can be based on a reliable treatment plan, reducing marginal bone resorption and
improving implant longevity. The guided implant surgical (GIS) protocol is essential to
avoid flap elevation and ensure maximum implant position while preserving marginal bone
in the area around the implant. Bioactive glass can be then applied in grafting for optimal
bone formation as a potential scaffold biomaterial. Further studies into GIS research will
confirm these data and ensure customized, optimized treatment protocols for patients [18].
In terms of the mechanical response exhibited by bone tissue, a homogeneous strain
is desired and can be affected by the different biomaterials used in the reconstruction of
edentulous maxilla. The reduction in stress in zygomatic implants and prosthetic screws
is achieved using zirconium, CoCr, and titanium, which are higher in strength and have
better mechanical behavior than polymeric superstructures [19,20]. Obviously, further
progress in prosthodontic technology largely depends on developments in materials science.
Undoubtedly, the most significant contribution to fundamental scientific innovations and
technological changes that are currently taking place in clinical prosthodontics is that
of nanomaterials. Nanotechnology makes it possible to reduce the size of a material to
the nanoscale, thus enhancing many of its properties, such as the surface hardness, the
modulus of elasticity, the polymerization shrinkage, and the filler content, to improve the
performance of well-known materials.
We very much hope that the information presented in this editorial will prove benefi-
cial for future scientific research and technological innovations in the field of dentistry.

Funding: This research received no external funding.

Conflicts of Interest: The authors declare no conflict of interest.

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