Mineralization effect of ion-releasing fiber-reinforced composite in teeth with molar–incisor hypomineralization
DOI:
https://doi.org/10.2340/biid.v13.45993Keywords:
molar–incisor hypomineralization, dentin mineral content, Fuji II LC, ion-releasing, short fiber compositeAbstract
Objective: To evaluate the long-term mineralizing effects of an experimental ion-releasing, short fiber-reinforced flowable composite (SFC-active) applied to human teeth with molar–incisor hypomineralization (MIH).
Methods: A total of 16 first permanent molars, extracted due to MIH, received two occlusal restorations each. All cavities were acid-etched for 15 seconds before applying the restorative materials. One of the cavities in each tooth was restored with a commercial conventional particulate-filled composite (PFC; G-aenial Universal Injectable) after placement of the SFC-active liner. The other cavities were restored without the liner, using PFC alone (n = 8) or resin-modified glass ionomer cement (RMGIC; Fuji II LC) alone (n = 8). The teeth were stored in simulated body fluid at 37°C for 30 months. The mineralization effect was assessed at three regions (coronal, middle, and apical) under the restorations using micro-computed tomography (CT) (dentin density), micro-indentation (dentin hardness) and scanning electron microscopy/energy-dispersive spectroscopy (microstructure and calcium-to-phosphorus [Ca/P] ratio) analyses.
Results: Micro-CT analyses revealed no statistically significant differences (p > 0.05) in dentin mineral density between the restorative materials at any of the three regions beneath the restorations. At the coronal region of interface, dentin hardness was higher with SFC-active than with PFC, but lower than with RMGIC (p < 0.05). The Ca/P ratios of dentin varied beneath the different restorations, ranging from 1.49 to 1.60, with the highest ratios observed at the coronal region of the interface with SFC-active. Strontium and fluorine were detected in the dentin adjacent to the RMGIC restorations.
Conclusion: SFC-active demonstrated a positive mineralizing effect on dentin, reflected by higher hardness and Ca/P ratios at the coronal region of the interface. These findings indicate that SFC-active is a promising restorative material for the management of MIH-affected teeth.
Downloads
References
Lygidakis NA, Garot E, Somani C, Taylor GD, Rouas P, Wong FSL. Best clinical practice guidance for clinicians dealing with children presenting with molar-incisor-hypomineralisation (MIH): an updated European Academy of Paediatric Dentistry policy document. Eur Arch Paediatr Dent. 2022;23(1):3–21. DOI: https://doi.org/10.1007/s40368-021-00668-5
Tseveenjav B, Mulic A, Waltimo-Sirén J, Tulek A. Penetration depth and enamel hardness effects of resin infiltrate and fissure sealant in MIH-affected molars: an in-vitro comparison. Eur Arch Paediatr Dent. 2025 (Epub ahead of print). DOI: https://doi.org/10.1007/s40368-025-01122-6
Americano GC, Jacobsen PE, Soviero VM, Haubek D. A systematic review on the association between molar incisor hypomineralization and dental caries. Int J Paediatr Dent. 2017;27(1):11–21. DOI: https://doi.org/10.1111/ipd.12233
Weerheijm KL, Mejàre I. Molar incisor hypomineralization: a questionnaire inventory of its occurrence in member countries of the European Academy of Paediatric Dentistry (EAPD). Int J Paediatr Dent. 2003;13(6):411–16. DOI: https://doi.org/10.1046/j.1365-263X.2003.00498.x
Ahmed AT, Kratunova E, Dean JA, Wright T, Khader Y, Alrayyes S. Perspectives of US pediatric dentistry faculty on the clinical management of molar hypomineralization. J Am Dent Assoc. 2026;157(2):163–74. DOI: https://doi.org/10.1016/j.adaj.2025.09.005
Sezer B, Şen Yavuz B, İşseven Cİ, Tuğcu N, Çalışkan C, Durmuş B, et al. Six-year survival and clinical performance of glass hybrid restorations following selective caries removal in teeth with molar incisor hypomineralization: a prospective cohort study. Clin Oral Investig. 2025;29(5):284. DOI: https://doi.org/10.1007/s00784-025-06358-6
Denis R, Marty M, Esclassan R, Noirrit-Esclassan E, Canceill T. Description and durability of the various direct restoration techniques in molar-incisor hypomineralization: a systematic review. Eur J Prosthodont Restor Dent. 2025;33(1):113–22. DOI: https://doi.org/10.1922/EJPRD_2760Denis10
Krämer N, Bui Khac NN, Lücker S, Stachniss V, Frankenberger R. Bonding strategies for MIH-affected enamel and dentin. Dent Mater. 2018;34(2):331–40. DOI: https://doi.org/10.1016/j.dental.2017.11.015
Garoushi S, Vallittu PK, Lassila LV. Short glass fiber reinforced restorative composite resin with semi-inter penetrating polymer network matrix. Dent Mater. 2007;23(11):1356–62. DOI: https://doi.org/10.1016/j.dental.2006.11.017
Garoushi S, Vallittu PK, Lassila L. Reinforcing effect of discontinuous microglass fibers on resin-modified glass ionomer cement. Dent Mater J. 2018;37(3):484–92. DOI: https://doi.org/10.4012/dmj.2017-234
Lassila L, Keulemans F, Säilynoja E, Vallittu PK, Garoushi S. Mechanical properties and fracture behavior of flowable fiber reinforced composite restorations. Dent Mater. 2018;34(4):598–606. DOI: https://doi.org/10.1016/j.dental.2018.01.002
Wayakanon K, Totiam P, Naorungroj S. Effect of short fiber-reinforced resin-based composite on fracture resistance of extensive direct restorations: a systematic review and network meta-analysis. J Prosthet Dent. 2026;135(2):277.e1–13. DOI: https://doi.org/10.1016/j.prosdent.2025.09.034
Bijelic-Donova J, Bath AK, Rocca GT, Bella ED, Saratti CM. Can fiber-reinforced composites increase the fracture resistance of direct composite restorations in structurally compromised teeth? A systematic review and meta-analysis of laboratory studies. Oper Dent. 2025;50(1):E1–29. DOI: https://doi.org/10.2341/24-032-LIT
Garoushi S, Gargoum A, Vallittu PK, Lassila L. Short fiber-reinforced composite restorations: a review of the current literature. J Investig Clin Dent. 2018;9(3):e12330. DOI: https://doi.org/10.1111/jicd.12330
Vallittu PK, Boccaccini AR, Hupa L, Watts DC. Bioactive dental materials – do they exist and what does bioactivity mean? Editorial. Dent Mater. 2018;34(5):693–4. DOI: https://doi.org/10.1016/j.dental.2018.03.001
Vallittu PK. High aspect ratio fillers: fiber-reinforced composites and their anisotropic properties. Dent Mater. 2014;31:1–7. DOI: https://doi.org/10.1016/j.dental.2014.07.009
Attik N, Richert R, Garoushi S. Biomechanics, bioactive and biomimetic philosophy in restorative dentistry–Quo vadis? J Dent. 2024;148:105036. DOI: https://doi.org/10.1016/j.jdent.2024.105036
Garoushi S, Vallittu P, Lassila L. Development and characterization of ion-releasing fiber-reinforced flowable composite. Dent Mater. 2022;38(10):1598–609. DOI: https://doi.org/10.1016/j.dental.2022.08.006
Garoushi S, Peltola T, Siekkinen M, Hupa L, Vallittu PK, Lassila L, et al. Retention of strength and ion release of some restorative materials. Odontology. 2025;113(2):714–23. DOI: https://doi.org/10.1007/s10266-024-01010-3
Yoshiyama M, Tay FR, Doi J, Nishitani Y, Yamada T, Itou K, et al. Bonding of self-etch and total-etch adhesives to carious dentin. J Dent Res. 2002;81(8):556–60. DOI: https://doi.org/10.1177/154405910208100811
Kokubo T, Takadama H. How useful is SBF in predicting in vivo bone bioactivity? Biomaterials. 2006;27(15):2907–15. DOI: https://doi.org/10.1016/j.biomaterials.2006.01.017
Abdelsalam AE, Ismail HS, Hamama HH. Elemental and micromorphological analysis of ion releasing restoration/carious dentin interface. Sci Rep. 2025;15(1):30712. DOI: https://doi.org/10.1038/s41598-025-13977-2
Christoff V, Ilie N. Amalgam alternatives: susceptibility of novel self-adhesive materials to changes in dentin mineralization. J Dent. 2025;160:105894. DOI: https://doi.org/10.1016/j.jdent.2025.105894
Ionescu AC, Nicita F, Zambelli V, Bellani G, Degli Esposti L, Iafisco M, et al. Ion-releasing resin composites prevent demineralization around restorations in an in-vitro biofilm model. J Dent. 2025;154:105600. DOI: https://doi.org/10.1016/j.jdent.2025.105600
Atmeh AR, Chong EZ, Richard G, Festy F, Watson TF. Dentin-cement interfacial interaction: calcium silicates and polyalkenoates. J Dent Res. 2012;91(5):454–9. DOI: https://doi.org/10.1177/0022034512443068
Cascales ÁF, Moscardó AP, Toledano M, Banerjee A, Sauro S. An in-vitro investigation of the bond strength of experimental ion-releasing dental adhesives to caries-affected dentine after 1 year of water storage. J Dent. 2022;119:104075. DOI: https://doi.org/10.1016/j.jdent.2022.104075
Schwendicke F, Al-Abdi A, Pascual Moscardó A, Ferrando Cascales A, Sauro S. Remineralization effects of conventional and experimental ion-releasing materials in chemically or bacterially-induced dentin caries lesions. Dent Mater. 2019;35(5):772–9. DOI: https://doi.org/10.1016/j.dental.2019.02.021
Tyagi G, Jain S, Deshwal S, Singh S, Poonia N, Sharma S. Comparative study of dentin remineralization with nano-amorphous calcium phosphate-modified bioactive restoratives. J Oral Biol Craniofac Res. 2025;15(4):684–90. DOI: https://doi.org/10.1016/j.jobcr.2025.04.009
Curylofo-Zotti FA, Bim-Júnior O, Leme-Kraus A, Corona SAM, Bedran-Russo AK. Assisted mineralization ability of proanthocyanidins in collagen scaffold and dentin. Dent Mater. 2025;41(10):1313–22. DOI: https://doi.org/10.1016/j.dental.2025.07.006
Gönüllü İ, Devrimci EE, Kemaloğlu H, Peşkersoy C, Türkün M. Remineralization efficacy of nano-hydroxyapatite and potassium nitrate formulations on demineralized enamel and dentin: an in vitro surface hardness and EDX-SEM study. Dent Mater J. 2026;45(2):169–76. DOI: https://doi.org/10.4012/dmj.2025-144
Nalçaci A, Ulusoy N, Atakol O. Time-based elution of TEGDMA and BisGMA from resin composite cured with LED, QTH and high-intensity QTH lights. Oper Dent. 2006;31(2):197–203. DOI: https://doi.org/10.2341/05-10
Thakar S, Hayashi M, Jabbour Z, Kim R, Al Khalifah S, Jo D, et al. Hydrophobic monomer systems for dental composites: development and physicochemical evaluation of UDMA/IBOMA formulations. BMC Oral Health. 2026 (Epub ahead of print). DOI: https://doi.org/10.1186/s12903-026-08088-x
Cavalcante LM, Ferraz LG, Antunes KB, Garcia IM, Schneider LFJ, Collares FM. Silane content influences physicochemical properties in nanostructured model composites. Dent Mater. 2021;37(2):e85–93. DOI: https://doi.org/10.1016/j.dental.2020.10.022
Oral O, Lassila LV, Kumbuloglu O, Vallittu PK. Bioactive glass particulate filler composite: effect of coupling of fillers and filler loading on some physical properties. Dent Mater. 2014;30(5):570–7. DOI: https://doi.org/10.1016/j.dental.2014.02.017
Melo P, Ferreira AM, Waldron K, Swift T, Gentile P, Magallanes M, et al. Osteoinduction of 3D printed particulate and short-fibre reinforced composites produced using PLLA and apatite-wollastonite. Compos Sci Technol. 2019;184:107834. DOI: https://doi.org/10.1016/j.compscitech.2019.107834
Ruengrungsom C, Burrow MF, Parashos P, Palamara JEA. Evaluation of F, Ca, and P release and microhardness of 11 ion-leaching restorative materials and the recharge efficacy using a new Ca/P containing fluoride varnish. J Dent. 2020;102:103474. DOI: https://doi.org/10.1016/j.jdent.2020.103474
Tiskaya M, Al-Eesa NA, Wong FSL, Hill RG. Characterization of the bioactivity of two commercial composites. Dent Mater. 2019;35(12):1757–68. DOI: https://doi.org/10.1016/j.dental.2019.10.004
Klinger-Strobel M, Makarewicz O, Pletz MW, Stallmach A, Lautenschläger C. TiO2-containing and ZnO-containing borosilicate glass-a novel thin glass with exceptional antibiofilm performances to prevent microfouling. J Mater Sci Mater Med. 2016;27(12):175. DOI: https://doi.org/10.1007/s10856-016-5792-4
Lin YC, Lin WR, Chang K, Teng NC, Yang JC, Chung RJ. Advanced ionic antibacterial solutions for dental caries prevention with enhanced aesthetic and demineralization functions. Dent Mater. 2025;41(10):1189–200. DOI: https://doi.org/10.1016/j.dental.2025.07.002
Bhamra S, Singla R, Kulkarni SD, Shenoy PA, Singla N, Patil V, et al. Antibacterial effect of titanium oxide and cobalt-doped zinc ferrite coated stainless steel orthodontic brackets against Streptococcus mutans – an in-vitro study. Biomater Investig Dent. 2025;12:44819. DOI: https://doi.org/10.2340/biid.v12.44819
Baheiraei N, Eyni H, Bakhshi B, Najafloo R, Rabiee N. Effects of strontium ions with potential antibacterial activity on in vivo bone regeneration. Sci Rep. 2021;11(1):8745. DOI: https://doi.org/10.1038/s41598-021-88058-1
Umemoto S, Furusawa T, Unuma H, Tajika M, Sekino T. In vivo bioresorbability and bone formation ability of sintered highly pure calcium carbonate granules. Dent Mater J. 2021;40(5):1202–7. DOI: https://doi.org/10.4012/dmj.2020-254
Sirkiä SV, Nakamura M, Qudsia S, Siekkinen M, Smått JH, Peltonen J, et al. Structural and elemental characterization of glass and ceramic particles for bone surgery. Dent Mater. 2021;37(9):1350–7. DOI: https://doi.org/10.1016/j.dental.2021.06.004
Sato N, Handa K, Venkataiah VS, Hasegawa T, Njuguna MM, Yahata Y, et al. Comparison of the vertical bone defect healing abilities of carbonate apatite, β-tricalcium phosphate, hydroxyapatite and bovine-derived heterogeneous bone. Dent Mater J. 2020;39(2):309–18. DOI: https://doi.org/10.4012/dmj.2019-084
Prati C, Chersoni S, Acquaviva GL, Breschi L, Suppa P, Tay FR, et al. Permeability of marginal hybrid layers in composite restorations. Clin Oral Investig. 2005;9(1):1–7. DOI: https://doi.org/10.1007/s00784-004-0273-4
de Carvalho LF, Silva MGE, Barboza ADS, Badaró MM, Stolf SC, Cuevas-Suárez CE, et al. Effectiveness of bioactive resin materials in preventing secondary caries and retention loss in direct posterior restorations: a systematic review and meta-analysis. J Dent. 2025;152:105460. DOI: https://doi.org/10.1016/j.jdent.2024.105460
van Dijken JWV, Pallesen U, Benetti A. A randomized controlled evaluation of posterior resin restorations of an altered resin modified glass-ionomer cement with claimed bioactivity. Dent Mater. 2019;35(2):335–43. DOI: https://doi.org/10.1016/j.dental.2018.11.027
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Lippo Lassila, Battsetseg Tseveenjav, Janna Waltimo-Sirén, Pekka Vallittu, Sufyan Garoushi

This work is licensed under a Creative Commons Attribution 4.0 International License.
Biomaterial Investigations in Dentistry is a Diamond Open Access peer-reviewed journal, publishing research in oral biomaterials science. The publishing of articles is free for authors, thanks to the support of Acta Odontologica Scandinavica Society (AOSS), a not-for-profit society. 
