Particulate Production and Composite Dust during Routine Dental Procedures. A Systematic Review with Meta-Analyses

Abstract

Composite dust generation is most likely a continuous and daily procedure in dental practice settings. The aim of this systematic review was to identify, compile and evaluate existing evidence on interventions and composite material properties related to the production of aerosolized dust during routine dental procedures. Seven electronic databases were searched, with no limits, supplemented by a manual search, on 27 April 2020 for published and unpublished research. Eligibility criteria comprised of studies of any design, describing composite dust production related to the implementation of any procedure in dental practice. Study selection, data extraction and risk of bias (RoB) assessment was undertaken independently either in duplicate, or confirmed by a second reviewer. Random effects meta-analyses of standardized mean differences (SMD) with associated 95% confidence intervals (CIs) were employed where applicable. A total of 375 articles were initially identified, resulting in 13 articles being included in the qualitative synthesis, of which 5 contributed to meta-analyses overall. Risk of bias recordings ranged between low and high, pertaining to unclear/raising some concerns, in most cases. All types of composites, irrespective of the filler particles, released significant amounts of nano-sized particles after being ground, with potentially disruptive respiratory effects. Evidence supported increased % distribution of particles < 100 nm for nanocomposite Filtek Supreme XTE compared to both conventional hybrid Z100MP (SMD: 1.96, 95% CI: 0.85, 3.07; p-value; 0.001) and nano- hybrid Tetric EvoCeram (SMD: 1.62, 95% CI: 0.56, 2.68; p-value: 0.003). For cytotoxicity considerations of generated aerosolized particles, both nanocomposites Filtek Supreme XTE and nanohybrid GradiO revealed negative effects on bronchial epithelial cell viability, as represented by % formazan reduction at 330–400 μg/mL for 24 hours, with no recorded differences between them (SMD: 0.19; 95% CI: −0.17, 0.55; p-value: 0.30). Effective and more rigorous management of dental procedures potentially liable to the generation of considerable amounts of aerosolized composite dust should be prioritized in contemporary dental practice. In essence, protective measures for the clinician and the practices’ personnel should also be systematically promoted and additional interventions may be considered in view of the existing evidence.

Minimizing the aerosol-generating procedures in orthodontics in the era of a pandemic: Current evidence on the reduction of hazardous effects for the treatment team and patients

“…88,89 A mild but gradual reduction of human bronchial epithelial cell viability in laboratory conditions has been documented, giving rise to speculations on the reactive dynamic of such particulates. [62][63][64]72 Composite filler particles and matrix composition of restorative adhesives did not appear to play a role. Interestingly, the latest report encompassing orthodontic adhesive material evaluation at grinding stages after simulated conventional orthodontic treatment, pinpointed the aptitude of aerosolized particles of adhesives comprising of quartz-type fillers to demonstrate disrupting effects on interacting cell membrane integrity and cellular viability, while also to intervene with cellular growth potential of epithelial bronchial populations at an early stage.…”

“…58 Normal composite composition comprises of the resin matrix (usually represented by bisphenol-A [BPA] diglycidyl dimethacrylate, triethylene glycol dimethacrylate, and ethoxylated BPA glycol dimethacrylate), the inorganic filler compounds as well as a coupling agent to guarantee bonding between the two. 59 , 60 , 61 , 62 , 63 Filler compounds usually fall below 0.4 μm and may serve in a wide range of particulate sizes and even fall within the nano-range. 62 , 63 Orthodontic adhesives have also been considered to acquire quartz-type filler particles as well.…”

“… 59 , 60 , 61 , 62 , 63 Filler compounds usually fall below 0.4 μm and may serve in a wide range of particulate sizes and even fall within the nano-range. 62 , 63 Orthodontic adhesives have also been considered to acquire quartz-type filler particles as well. 64 Heavy metal oxides are preferred, namely barium, strontium, zinc, aluminum, or zirconium, while their primary service remains to offer enhanced physical and mechanical properties to the material, including polymerization shrinkage water sorption and solubility, radiopacity, and reduction of biodegradation in-service.…”

COVID-19: What do we know?

“…The bioaerosol contents include live bacteria, fungus, and viruses that increase the contamination of the air and surfaces in the area of patient treatment. [90][91][92][93] Many reports have characterized the bacterial content of this bioaerosol, but there is a lack of research characterizing the production of viable airborne viruses from AGPs used in orthodontic practice. 92,94 Of particular importance is the size difference between viruses and bacteria.…”

Respiratory symptoms of exposure to substances in the workplace among Bulgarian dentists

“…The use of rotary grinding and polishing instruments should be considered to increase the inhalation of composite dust 15 . The content of composites comprises nano‐sized filler particles that may bear the potential to penetrate deep into the lungs surpassing the natural respiratory defence mechanism of mucus and cilia 16 . A recent report from the US Centers for Disease Control and Prevention described a cluster of dental professionals who were diagnosed with idiopathic pulmonary fibrosis (IPF), a progressive form of interstitial pneumonia of unknown cause 17 .…”