Clinical Assessment of Moringa oleifera as a Natural Crosslinker for Enhanced Dentin Bond Durability: A Randomized Controlled Trial

Background: Dentin biomodification is a biomimetic approach that strengthens the collagen network, making it less susceptible to enzymatic degradation and improving the durability of bonded restorative materials, using collagen crosslinkers. Objective: This study aimed to assess the effectiveness of Moringa oleifera as a natural crosslinker in improving the clinical success of resin-dentin restorations. Method: A double-blind, controlled, randomized clinical trial was conducted in accordance with Consolidated Standards of Reporting Trials (CONSORT) guidelines, with 50 adult participants with initial carious lesions (ICDAS 4 and 5) enrolled. Participants were randomly assigned to either the experimental group (which received Moringa oleifera as a pretreatment liner) or the control group (standard restorative procedures without a liner). Functional and biological outcomes were assessed at baseline, six months, and 12 months using the FDI criteria. Statistical analysis included Fisher's exact test, Wilcoxon sign rank test, and Mann-Whitney U test. Results: Both groups exhibited excellent functional properties and marginal adaptation at baseline and six months. At the 12-month mark, the test group displayed clinically better functional properties (97.9%, n=47) compared to the control group (95.8%, n=46), but there was no significant difference (p-value>0.05). Marginal gaps were observed in both groups at six and 12 months (8.3%, n=4), with no significant inter-group variation (p-value>0.05). Radiographic examination showed a harmonious restoration-to-tooth transition. Patient satisfaction remained high, with the test group 4.2% (n=2) and control 2.1% (n=1) reporting minor issues at 12 months, though not statistically significant (p-value>0.05). Postoperative sensitivity was minimal, and tooth integrity was well-preserved. Conclusion: Moringa oleifera, as a pretreatment liner, showed promise in enhancing the clinical success of resin-dentin restorations. Despite minor reported issues, the groups had no statistically significant differences regarding functional and biological outcomes.