The rise of advanced bioactive restorative materials: Are they redefining operative dentistry?

This article proposed specific functional characteristics for developing groundbreaking Advanced Bioactive Restorative Adhesive Materials - "ABRAM" and how they could redefine the future of operative dentistry. It emphasised their capacity, particularly when used with biomimetic agents, to enhance dentine remineralisation, seal the resin-dentine interface and possibly extend the longevity of dental restorations. Their potential antibacterial properties and pulp biofunctionality were also discussed.

The literature analysis focused on experimental and commercial "bioactive" restorative materials, including ion-releasing resin-based materials (e.g., adhesives and composites), as well as bioactive fillers such as bioactive glasses, tailored calcium phosphates, and silicates. It emphasised studies assessing remineralisation potential, interfacial sealing, antibacterial, and bioreductive dentine regeneration properties.

Many dental materials release ions and have temporary antibacterial effects, but few show 'bioactive effects' like inducing mineral deposition, restoring collagen, and providing prolonged antibacterial and bioinductive properties for pulp cells, which help dentine formation or pulp vitality. Current restorative methods fail to effectively remineralise demineralised dentine, repair gaps, or prevent secondary caries. 'Bioactive' materials essentially perform like conventional ones, with little evidence of better outcomes.

Innovative ABRAM with antibacterial, remineralising properties, as well as pulp biofunctionality should be developed to improve dental restoration durability. No restorative material on the market can be classified as bioactive. Indeed, the clinical use of "bioactive" materials is limited by a lack of evidence, and unclear effects. Interdisciplinary collaboration is essential to connect laboratory innovation with clinical practice, allowing the dental community to benefit from ABRAM.

Integrating innovative ABRAM and biomimetic analogues of remineralisation may offer the potential for minimally invasive and longer-lasting biologically-driven restorative treatments. Establishing accepted definitions and in vitro and in vivo methodologies for bioactivity assessment is crucial for validating the therapeutic claims of these materials and supporting their evidence-based adoption.