Zhang et al., 2016 [20] |
(1) 20% NACP with QAM CL16 a
Comparison group:
(2) 20% NACP |
1, 3, 7, 14, 21 and 28 days |
Release of Ca and P ions |
(1) released lower levels of Ca and P ions than (2) |
Xiao et al., 2017 [23] |
(1) 0.12% AgNPs + 3% MPC + 3% DMAHDM + 30% NACP
(2) 0.12% AgNPs + 3% MPC + 3% DMAHDM + 30% NACP + PAMAM
Comparison groups:
(3) Demineralized root dentine specimen
(4) Demineralized root dentine specimen + PAMAM |
1, 3, 5, 7, 10, 14 and 21 days |
Concentration of Ca and P ions |
(1) and (2) demonstrated greater concentrations of Ca and P concentrations than PAMAM and control groups |
Acid neutralization |
(1) and (2) had greater acid neutralization than PAMAM and comparison groups. |
Dentine hardness |
(2) had the greatest dentine hardness, remineralization and mineral growth. |
SEMexamination |
(2) had the greatest remineralization and mineral growth. |
No |
Yes |
Al-Dulaijan et al., 2018 [1] |
(1) 20% NACP + 3% DMAHDM
(2) 20% NACP
Comparison group:
| Yes |
No |
Yes |
Medium risk |
Metabolic assay (MTT) |
Metabolic activity—(4) was 96% lower than (5) |
(3) Heliomolar commercial composite |
1, 3, 5, 7, 14, 21, 28, 35, 42, 49, 56, 63 and 70 days |
Concentration of Ca and P ions |
No differences in concentrations of Ca and P ions, their recharge and re-release between (1) and (2) groups |
Xie et al., 2016 [41] |
No |
Yes |
No |
Yes |
Yes |
No |
Yes |
Medium risk |
Production of Lactic Acid |
Increasing DMAHDM mass fraction caused a monotonic decrease in the production of lactic acid |
1, 2, 3, 5, 9, 11 and 14 days |
Recharge and rerelease of Ca and P |
Specimens could release the ions for 42 days after one charge |
Zhang et al., 2016 [20] |
No |
Yes |
No |
Yes |
Yes |
Bhadila et al., 2020 [2] |
(1) 20% NACP
(2) 3% DMAHDM + 20% NACP
Comparison group:
| No |
Yes |
Medium risk |
(3) Heliomolar commercial composite |
Xiao et al., 2017 |
CFUc counts |
Antibacterial activity increased and CFU decreased with increase in the mass fraction of DMAHDM |
1, 3, 5, 7, 14, 21, 28, 35, 42, 49, 56, 63 and 70 days |
Release of Ca and P ions |
No significant difference in Ca and P ion release between (1) and (2) |
[23] |
No |
Yes |
No |
1, 3, 5, 7, 9 and 14 days | Yes |
Yes |
No |
Yes |
Medium risk |
Zhang et al., 2015 [40] |
(1) 1.5% DMAHDM
(2) 3% MPC
(3) 1.5% DMAHDM + 3% MPC
Comparison groups:
(4) 0% DMAHDM + 0% MPC
(5) Heliomolar commercial composite |
Total microorganisms
Total streptococci
S. mutans |
2 days |
Live/dead assay |
(1) demonstrated lower bacterial adhesion but most bacteria were alive
(1) showed high amounts of dead bacteria |
CFU |
(3) had higher reduction of CFU than (1) and (2), by >3 log on all four biofilm types |
Recharge and rerelease of Ca and P |
Both composites showed increasing ion concentration with time, and release continued after each recharge. |
Zhang et al., 2017 [42] |
No |
Yes |
No |
Zhou et al., 2020 [47 | Yes |
] |
(1) 30% NACP
(2) 3% DMAHDM
(3) 30% NACP + 3% DMAHDM
Comparison groups:
(4) 0% NACP+ 0% DMAHDM
(5) Heliomolar commercial composite |
1, 3, 7, 14, 21, 28, 35, 42, 49, 54, 63 and 70 days | Yes |
No |
Yes |
Medium risk |
Metabolic assay (MTT) |
(3) had the least metabolic activity and higher reduction in biofilm growth compared to (1) or (2) |
Release of Ca and P ions |
No difference in release of Ca and P ions between (1) and (3) |
Lower pH increased ion release |
Al-Dulaijan et al., 2018 [1] |
No |
Yes |
No |
Yes |
Yes |
No |
Production of Lactic Acid | Yes |
Medium risk |
Dentine hardness | (3) had the least lactic acid production |
Wang et al., 2019 [43] |
No |
Yes |
No |
Yes |
Yes |
No |
Yes |
Medium risk |
CFU counts |
(3) reduced CFU counts by >3 logs compared to (4) or (5) and had much less biofilm CFU than (1) or (2) |
Xiao et al., 2019 [35] |
No |
Protein adsorption |
(3) had less protein adsorption compared to controls than (1) or (2) | Yes |
No |
Yes |
Yes |
No |
Yes |
Medium risk |
Bhadila et al., 2020 [2] |
Melo et al., 2016 [41] | No |
(1) 5% DMAHDM + 0.1% AgNPs + 30% NACP
Comparison group:
(2) 0% DMAHDM + 0% AgNPs + 0% NACP |
Did not specify |
7 days |
Live/dead assay |
Dental materials containing multiagents resulted in compromised bacteria at tooth-composite interface |
Wang et al., 2016 [42] |
(1) 3% DMAHDM + 20% NACP
Comparison groups:
(2) 20% NACP
(3) Heliomolar commercial composite |
P. gingivalis,
P. intermedia,
Prevotella nigrescens,
A. actinomycetemcomitans,
F. nucleatum,
Enterococcus faecalis |
2 days |
Live/dead assay |
(1) mainly had dead bacteria while (2) and (3) had primarily live bacteria |
CFU counts |
(1) CFU reduction differed between the bacterial species differently, few by <3 log while others by >3 log |
Crystal violet biofilm biomass assay |
(1) had a significantly decreased biomass value compared to (2) and (3) |
Polysaccharide production |
(1) had greatly reduced polysaccharide production for all six species compared to (2) and (3) |
Wang et al., 2016 [43] |
(1) 3% DMAHDM
(2) 3% MPC
(3) 3% DMAHDM + 3% MPC b
Comparison groups:
(4) 0% DMAHDM + 0% MPC
(5) Heliomolar commercial composite |
P. gingivalis,
P. intermedia,
A. actinomycetemcomitans,
F. nucleatum |
2 days |
Live/dead assay |
(2) reduced the adhesion of bacteria, (3) demonstrated mostly dead bacteria |
Metabolic activity (MTT) |
(3) presented lower biofilm metabolic activity on all the tested periodontal pathogens compared to (4) and (5) |
CFU counts |
Addition of DMAHDM or MPC independently into the composite decreased the CFU |
Protein adsorption |
(1) had no effect on protein adsorption
(2) substantially decreased the protein adsorption by one log compared to (4) and (5) |
Polysaccharide production |
(3) had much less polysaccharide production compared to (4) and (5) |
Xie et al., 2016 [44] |
(1) 30% NACP + 3% MPC
(2) 30% NACP + 3% MPC + 1.5% DMAHDM
(3) 30% NACP + 3% MPC + 3% DMAHDM
Comparison groups:
(4) 30% NACP
(5) Heliomolar commercial composite |
Total microorganisms
Total streptococci
S. mutans |
2 days (with 2-day biofilm) and 4 days (pH required 72 h of incubation) |
Live/dead assay |
(4) and (5) were completely covered by live bacteria. Bacterial adhesion was reduced by MPC, DMAHDM produced an antibacterial effect. (3) had the most dead bacteria followed by (2) and (1) |
Metabolic assay (MTT) |
Metabolic activity of biofilms of (3) < (2) < (1)
(3) had the lowest metabolic activity of biofilms among all |
CFU counts |
(3) had the least biofilm CFU, count reduced by 3 logs compared to (4) and (5). |
Protein adsorption |
(1) had protein adsorption one log less than (5); (2) and (3) had no effect on the protein adsorption |
pH of biofilm culture medium |
(3) maintained a pH above 6.5. |
Zhang et al., 2016 [20] |
(1–5) Five variants with 20% NACP with QAM CL of 3, 6, 12, 16 and 18, respectively
Comparison groups:
(6) 20% NACP
(7) Renamel Microfill commercial composite |
Total microorganisms
Total streptococci
S. mutans |
30 days |
Live/dead assay |
(6) and (7) were covered by live bacteria. Dead bacteria increased progressively from CL3 up to CL16 with maximum antibacterial potency at CL16 before decreasing in potency at CL18 as indicated by some live bacteria. |
(3) caused the highest dentine hardness, which was twice |
Metabolic assay (MTT) |
Metabolic activity of biofilms decreased with increase in CL from 3 to 16.
CL16 had maximum reduction on metabolic activity, which remained constant with any increase in CL |
Production of Lactic Acid |
The biofilms on (6) and (7) produced the most acid. Acid production capacity of biofilm increased with an increase in CL from 3 to 16
CL16 minimized lactic acid production by 10-fold compared to (6) and (7) |
CFU counts |
CFU counts decreased with an increase in the CL from 3 to 16. Antibacterial activity was strongest at CL16, which lowered at C18. CL16 reduced all three CFU counts by 2 logs compared to (6) and (7) |
Zhang et al., 2017 [45] |
(1) 1.5% DMAHDM
(2) 3% MPC
(3) 1.5% DMAHDM + 3% MPC
Comparison group:
(4) Heliomolar commercial composite |
Total microorganisms
Total streptococci
S. mutans |
185 days |
Live/dead assay |
(3) had high levels of dead bacteria and lower bacterial attachment. Protein-repellent and anti-biofilm activities remained same from day 1 to 180 |
Metabolic assay (MTT) |
(1) and (2) showed higher reduction of biofilm viability than (4)
(3) had the least metabolic activity
Antibacterial function remained the same from day 1 to 180, being unimpacted by water-aging |
Production of Lactic Acid |
(3) had the least lactic acid production |
CFU counts |
(1) and (2) decreased the CFU compared to (4). (3) had greater antibacterial properties compared to (1) and (2) and was nearly 3 logs lower than (4), both at 1 day and 180 days of water-aging (p < 0.05). |
Protein adsorption |
MPC greatly inhibited protein adsorption with no difference between 1 day and 180 days. (3) had the same protein adsorption as (2) (p > 0.1), which was about one tenth that of (4) and (1) (p < 0.05). |
Al-Dulaijan et al., 2018 [1] |
(1) 20% NACP + 3% DMAHDM
(2) 20% NACP
Comparison group:
(3) Heliomolar commercial composite |
Total microorganisms
Total streptococci
S. mutans |
2 days |
Live/dead assay |
(1) had much less live bacteria compared to (2) and (3). |
Metabolic assay (MTT) |
(1) greatly decreased the metabolic activity of the biofilms compared to (2) and (3) (p < 0.05). (2) had similar metabolic activity to (3) indicating that NACP had little effect on biofilm viability. |
Production of Lactic Acid |
(1) had the least lactic acid production. |
CFU counts |
(1) decreased all three CFU counts by 3–4 logs compared to (2) and (3). |
Wang et al., 2019 [46] |
(1) 3% MPC + 20% NACP
(2) 3% DMAHDM + 20% NACP
(3) 3% DMAHDM + 3% MPC + 20% NACP
Comparison groups:
(4) 20% NACP
(5) Heliomolar commercial composite |
(1) Biofilm with one species: P. gingivalis
(2) Biofilm with three species: P. gingivalis, S. gordonii and F. nucleatum
(3) Biofilm with six species: P. gingivalis, S. gordonii, F. nucleatum, A. naeslundii, P. intermedia and A. actinomycetemcomitans
(4) Nine-species biofilm: P. gingivalis, S. gordonii, F. nucleatum, A. naeslundii, P. intermedia, A. actinomycetemcomitans, P. nigrescens, Tannerella forsythia and Parvimonas micra |
4 days |
Live/dead assay |
(2) had large quantity of dead bacteria, (1) showed lower bacterial adhesion. (3) had large quantity of dead bacteria but lower bacterial adhesion that (4) and (5) which were largely covered by live bacteria |
Metabolic assay (MTT) |
Protein adsorption |
DMAHDM demonstrated no effect on protein adsorption
(1) decreased the protein adsorption by approximately 1 log, compared to (2) and (5) |
Polysaccharide production |
Single species biofilms produced less polysaccharides than multi species biofilms
(1) and (2) decreased the amount of polysaccharide produced by biofilms, (3) showed least production in all the biofilm types |
Xiao et al., 2019 [38] |
(1) 30% NACP + 3% MPC + 3% DMAHDM
(2) 30% NACP + 3% MPC + 3% DMAHDM + 0.12% AgNPs a,c
Comparison groups:
(3) 30% NACP
(4) Renamel Microfill commercial composite |
(1) P. gingivalis
(2) A. actinomycetemcomitans
(3) F. nucleatum |
2 days |
Live/dead assay |
(1) and (2) had much less biofilms, with mostly dead bacteria compared to (3) and (4), which were mostly covered by live bacteria. |
Metabolic assay (MTT) |
Metabolic activity of (1) and (2) lower than (3) and (4)
(2) showed lower biofilm metabolic activity for all three bacteria species than (1) |
Production of Lactic Acid |
(1) had significantly decreased CFU counts for all three species, (2) showed the lowest CFU.
(1) reduced the CFU counts by 4 logs on P. gingivalis and A. actinomycetemcomitans, while (2) reduced the CFU counts by 5 log.
(1) and (2) reduced the CFU counts for F. nucleatum, by 3 and 5 logs, respectively. |
Protein adsorption |
(1) and (2) decreased protein adsorption, it was e tenth of (3) and (4) |
Polysaccharide production |
(1) had much less polysaccharide production than (3) and (4
The lowest production of polysaccharides from biofilms was caused by (2) |
Bhadila et al., 2020 [2] |
(1) 20% NACP
(2) 3% DMAHDM + 20% NACP
Comparison group:
(3) Heliomolar commercial composite |
S. mutans |
2 days |
Live/dead assay |
(2) had primarily dead bacteria compared to (1) and (3) which were primarily covered by live bacteria. |
Production of Lactic Acid |
(2) caused lowest production of lactic acid production from biofilms than (1) and (3) |
CFU counts |
(2) showed a CFU reduction of 3–4 logs less than (1) and (3). |
Zhou et al., 2020 [47] |
(1) 30% NACP
(2) 3% DMAHDM
(3) 30% NACP + 3% DMAHDM
Comparison groups:
(4) 0% NACP + 0% DMAHDM
(5) Heliomolar commercial composite |
S. mutans
L. acidophilus
C. albicans
Multi-species |
2 days |
Live/dead assay |
(2) had substantial dead bacteria for all species tested while (1), (4) and (5) were covered with live bacteria. |
Metabolic assay (MTT) |
(2) reduced the metabolic activity of biofilms significantly |
Production of Lactic Acid |
(1), (4) and (5) showed higher lactic acid production from S. mutans and polymicrobial biofilms while (2) and (3) inhibited. All materials produced lower levels of lactic acid from L. acidophilus and C. albicans |
CFU counts |
(2) and (3) greatly reduced S. mutans and C. albicans CFU levels by 5 and 3 logs respectively |
Polysaccharide production |
(2) and (3) inhibited production of extracellular matrix from the bacterial associated with root caries |