Study of ZnO nanoparticle-doped dental adhesives on enamels with fluorosis: Electron microscopy, elemental composition and shear bond strength analysis.

This study aimed to evaluate dental adhesives containing different concentrations of zinc oxide nanoparticles (ZnO-NPs) for their use in the treatment of dental fluorosis, observe the interaction of the adhesive on healthy enamel surfaces and with mild and moderate fluorosis, measure the adhesive strength and fluorosis, and determine the phosphorus (P) and calcium (Ca) content on these surfaces, as a reference for the potential use of this adhesive with ZnO-NPs for dental fluorosis treatment. Transmission electron microscopy (TEM) and field emission scanning electron microscopy (FESEM) were used to characterise the ZnO-NPs and analyse the weight percentages of P and Ca in the enamel using X-ray energy dispersive spectroscopy (EDS) and the adhesive strength using a universal mechanical testing machine. FESEM characterisation revealed that the ZnO-NPs were less than 100 nm in size, with quasi-spherical and hexagonal prism shapes. The synthesis of the ZnO-NPs was confirmed by TEM, revealing their hexagonal crystalline structure. The adhesive strength by the universal mechanical testing machine showed that the adhesive with a 3% wt. concentration of ZnO-NPs was better in the three groups of teeth, showing higher adhesive strength in teeth with mild (15.15 MPa) and moderate (12.76 MPa) fluorosis surfaces, and was even higher than that in healthy teeth (9.65 MPa). EDS analysis showed that teeth with mild and moderate fluorosis had the highest weight percentages of P and Ca, but there were no statistically significant differences compared to healthy teeth and teeth treated with adhesives. Lay description: This study focused on testing a new dental adhesive containing small particles called ZnO nanoparticles (ZnO-NPs). This study aimed to demonstrate whether this adhesive with ZnO-NPs could be useful for treating dental fluorosis by improving its adhesion to teeth. One of the first objectives was to determine whether the dental adhesive could adhere better to teeth affected by mild or moderate fluorosis than to healthy teeth by measuring whether the levels of two important elements for healthy teeth, calcium (Ca) and phosphorus (P), were affected by the adhesive. The size and shape of the small particles and teeth with mild or moderate fluorosis were observed using scanning electron microscopy. The nanoparticles were small (< 100 nm) and had specific quasi-spherical and hexagonal prismatic shapes. More damage to the enamel was observed in teeth with mild or moderate fluorosis than in healthy teeth. The adhesive strength test demonstrated that the dental adhesive with 3% ZnO-NPs had the best adhesion on all healthy conditions of teeth. It was particularly effective in teeth with mild or moderate fluorosis. Finally, the evaluation of the levels of P and Ca on the enamel showed that teeth with fluorosis had higher levels of these elements, but using the dental adhesive with ZnO-NPs did not change the levels of these elements significantly because the adhesive avoided greater detachment because of greater adhesion to these surfaces. In conclusion, adding these small particles to dental adhesives could be an option for treating teeth affected by fluorosis. It stuck well and did not affect the levels of the important elements in the teeth.