A novel comonomer-free light-cured glass-ionomer cement for reduced cytotoxicity and enhanced mechanical strength

A randomized controlled evaluation of posterior resin restorations of an altered resin modified glass-ionomer cement with claimed bioactivity

OBJECTIVE

The objective of this randomized controlled prospective clinical trial was to evaluate the short time clinical behaviour of an altered resin modified glass-ionomer cement (RMGIC), which is claimed to possess bioactivity, in posterior restorations and to compare it intraindividually with a nanofilled resin composite.

METHODS

Totally 78 pairs Class II and 4 pairs Class I restorations were placed in 29 female and 38 male participants with a mean age of 58.3 years (range 37-86). Each patient received at random at least one pair of, as similar as possible, Class II or Class I restorations. In the first cavity of each pair, the modified flowable RMGIC (ACTIVA Bioactive; AB) was placed after phosphoric acid etching of the cavity and without adhesive, according to the instructions of the manufacturer. In the other cavity a well established nanofilled resin composite (CeramX; RC) with a single step self-etch adhesive (Xeno Select) was placed. The restorations were evaluated using slightly modified USPHS criteria at baseline, 6 and 12 months. Caries risk and parafunctional habits of the participants were estimated.

RESULTS

158 restorations, 8 Class I and 150 Class II, were evaluated at the one year recalls. At baseline two failed restorations were observed (2AB), at 6 months six failures (5AB, 1RC) and at 12 months another thirteen failed restorations were observed (12AB, 1RC). This resulted in annual failure rates of 24.1% for the AB and 2.5% for RC (p<0.0001). The main reasons for failure for AB were lost restorations (5), postoperative symptoms (4) and secondary caries (3). Do to the unacceptable very high one-year failure frequency, the clinical study was stopped and no further evaluation will be performed.

SIGNIFICANCE

The use of the AB restorative in Class II cavities, applied as instructed by the manufacturer after a short phosphoric acid pretreatment but without adhesive system, resulted in a non-acceptable very high failure frequency after a one year period. Further studies should be conducted using a bonding agent.

Physical property investigation of contemporary glass ionomer and resin-modified glass ionomer restorative materials

OBJECTIVES

The objective of this study was to investigate selected physical properties of nine contemporary and recently marketed glass ionomer cement (GIC) and four resin-modified glass ionomer cement (RMGI) dental restorative materials.

MATERIALS AND METHODS

Specimens (n = 12) were fabricated for fracture toughness and flexure strength using standardized, stainless steel molds. Testing was completed on a universal testing machine until failure. Knoop hardness was obtained using failed fracture toughness specimens on a microhardness tester, while both flexural modulus and flexural toughness was obtained by analysis of the flexure strength results data. Testing was completed at 1 h, 24 h, 1 week, and then at 1, 3, 6, and 12 months. Mean data was analyzed with Kruskal-Wallis and Mann-Whitney (p = 0.05).

RESULTS

Physical properties results were material dependent. Physical properties of the GIC and RMGI products were inferior at 1 h compared to that at 24 h. Some improvement in selected physical properties were noted over time, but development processes were basically concluded by 24 h. A few materials demonstrated improved physical properties over the course of the evaluation.

CONCLUSIONS

Under the conditions of this study: 1. GIC and RMGI physical property performance over time was material dependent; 2. Polyalkenoate maturation processes are essentially complete by 24 h; 3. Although differences in GIC physical properties were noted, the small magnitude of the divergences may render such to be unlikely of clinical significance; 4. Modest increases in some GIC physical properties were noted especially flexural modulus and hardness, which lends support to reports of a maturing hydrogel matrix; 5. Overall, GIC product physical properties were more stable than RMGI; 6. A similar modulus reduction at 6 months for both RMGI and GIC produced may suggest a polyalkenoate matrix change; and 7. Globally, RMGI products demonstrated higher values of flexure strength, flexural toughness, and fracture toughness than GIC materials.

CLINICAL RELEVANCE

As compared to RMGI materials, conventional glass ionomer restorative materials demonstrate more stability in physical properties.

In Vitro Cytotoxicity Evaluation of Novel Nano-Hydroxyapatite-Silica Incorporated Glass Ionomer Cement

INTRODUCTION

Glass Ionomer Cements (GIC) are among the most popular restorative materials, but their use in dentistry is limited due to their physical properties. The hardness of GIC was improved by incorporation of nano-hydroxyapatite-silica into GIC, to expand its applicability.

AIM

To evaluate the cytotoxic effects of nano-hydroxyapatite-silica incorporated glass ionomer cement (HA-SiO₂-GIC) on human Dental Pulp Stem Cells (DPSC) and compare it with conventional GIC and resin modified GIC.

MATERIALS AND METHODS

Material extracts of Fuji IX, Fuji II LC and HA-SiO₂-GIC were prepared into seven serial concentrations and applied to 96-well-plates seeded with DPSC. The 96-well-plates were incubated for 24 and 72 hours. The morphology of DPSC was observed under the inverted phase contrast microscope, and the cell viability was determined using MTT assay at both time intervals. Kruskal-Wallis test was performed for statistical analysis.

RESULTS

At maximum concentration, DPSC appeared fewer in number, but the normal spindle morphology was maintained in all groups except for Fuji II LC. At lower concentrations, DPSC appeared normal and more confluent in all groups. The cytotoxic effects of all groups were dose dependent. Fuji IX demonstrated the lowest cytotoxicity, followed by HA-SiO₂-GIC. Fuji II LC demonstrated the highest cytotoxicity. The difference was significant between all groups at 200 mg/ml concentration (p<0.05). At concentration <100 mg/ml, cytotoxicity of HA-SiO₂-GIC was comparable to that of Fuji IX and lower than that of Fuji II LC.

CONCLUSION

HA-SiO₂-GIC showed a favourable cytotoxicity response and thus holds promise as a future potential restorative material in clinical dentistry.

Composition-structure-property relationships for non-classical ionomer cements formulated with zinc-boron germanium-based glasses

Non-classical ionomer glasses like those based on zinc-boron-germanium glasses are of special interest in a variety of medical applications owning to their unique combination of properties and potential therapeutic efficacy. These features may be of particular benefit with respect to the utilization of glass ionomer cements for minimally invasive dental applications such as the atruamatic restorative treatment, but also for expanded clinical applications in orthopedics and oral-maxillofacial surgery. A unique system of zinc-boron-germanium-based glasses (10 compositions in total) has been designed using a Design of Mixtures methodology. In the first instance, ionomer glasses were examined via differential thermal analysis, X-ray diffraction, and 11B MAS NMR spectroscopy to establish fundamental composition – structure-property relationships for the unique system. Secondly, cements were synthesized based on each glass and handling characteristics (working time, Wt, and setting time, St) and compression strength were quantified to facilitate the development of both experimental and mathematical composition-structure-property relationships for the new ionomer cements. The novel glass ionomer cements were found to provide Wt, St, and compression strength in the range of 48–132 s, 206–602 s, and 16–36 MPa, respectively, depending on the ZnO/GeO2 mol fraction of the glass phase. A lower ZnO mol fraction in the glass phase provides higher glass transition temperature, higher N4 rate, and in combination with careful modulation of GeO2 mol fraction in the glass phase provides a unique approach to extending the Wt and St of glass ionomer cement without compromising (in fact enhancing) compression strength. The data presented in this work provide valuable information for the formulation of alternative glass ionomer cements for applications within and beyond the dental clinic, especially where conventional approaches to modulating working time and strength exhibit co-dependencies (i.e. the enhancement of one property comes at the expense of the other) and therefore limit development strategies.

A novel star-shaped poly(carboxylic acid) for resin-modified glass-ionomer restoratives

We have developed a novel glass-ionomer cement (GIC) system composed of photo-curable star-shaped poly(acrylic acid-co-itaconic acid)s. These polyacids were synthesized via a chain-transfer radical polymerization using a newly synthesized multi-arm chain-transfer agent. The star-shaped polyacids showed significantly lower viscosities in water as compared to the linear polyacids. Due to the lower viscosities, the molecular weight (MW) of the polyacids can be significantly increased for enhancing the mechanical strengths while keeping the ease of mixing and handling. The effects of MW, GM-tethering ratio, P/L ratio, and aging on the compressive properties of the experimental cements were significant. The light-cured experimental cements showed significantly improved mechanical strengths i.e. 49% in yield strength, 41% in modulus, 25% in CS, 20% in DTS, and 36% in FS, higher than commercial Fuji II LC. After aging in water for 1 month, the compressive strength of the novel light-cured experimental cement reached 343 MPa, which was 34% and 42% higher than Fuji II and Fuji II LC, respectively. This one-month aged experimental cement was also 23% higher than itself after one day aging, indicating that aging in water can significantly enhance salt-bridge formation for this novel star-shaped polyacid-comprised GIC.

Synthesis of poly(alkenoic acid) with L-leucine residue and methacrylate photopolymerizable groups useful in formulating dental restorative materials

To develop resin-modified glass ionomer materials, we synthesized methacrylate-functionalized acrylic copolymer (PAlk-LeuM) derived from acrylic acid, itaconic acid and N-acryloyl-L-leucine using (N-methacryloyloxyethylcarbamoyl-N'-4-hydroxybutyl) urea as the modifying agent. The spectroscopic (proton/carbon nuclear magnetic resonance, Fourier transform infrared spectroscopy) characteristics, and the gel permeation chromatography/Brookfield viscosity measurements were analysed and compared with those of the non-modified copolymer (PAlk-Leu). The photocurable copolymer (PAlk-LeuM, ~14 mol% methacrylate groups) and its precursor (PAlk-Leu) were incorporated in dental ionomer compositions besides diglycidyl methacrylate of bisphenol A (Bis-GMA) or an analogue of Bis-GMA (Bis-GMA-1), triethylene glycol dimethacrylate and 2-hydroxyethyl methacrylate. The kinetic data obtained by photo-differential scanning calorimetry showed that both the degree of conversion (60.50-75.62%) and the polymerization rate (0.07-0.14 s(-1)) depend mainly on the amount of copolymer (40-50 wt.%), and conversions over 70% were attained in the formulations with 40 wt.% PAlk-LeuM. To formulate light-curable cements, each organic composition was mixed with filler (90 wt.% fluoroaluminosilicate/10 wt.% hydroxyapatite) into a 2.7:1 ratio (powder/liquid ratio). The light-cured specimens exhibited flexural strength (FS), compressive strength (CS) and diametral tensile strength (DTS) varying between 28.08 and 64.79 MPa (FS), 103.68-147.13 MPa (CS) and 16.89-31.87 MPa (DTS). The best values for FS, CS and DTS were found for the materials with the lowest amount of PAlk-LeuM. Other properties such as the surface hardness, water sorption/water solubility, surface morphology and fluorescence caused by adding the fluorescein monomer were also evaluated.

A novel furanone-modified antibacterial dental glass ionomer cement

A novel furanone derivative and a polyacid constructed from it were synthesized, characterized and formulated into experimental high strength cements. The compressive strength (CS) and Streptococcus mutans viability were used to evaluate the mechanical strength and antibacterial activity of the cements. The effect of human saliva and aging were investigated. The antibacterial activity against Lactobacillus sp. and cytotoxicity to human pulp cells were also evaluated. The results show that all the formulated furanone-containing cements showed antibacterial activity, with an initial reduction in CS. The effect of the furanone derivative loading was significant. Increasing loading enhanced the antibacterial activity but reduced the initial CS of the formed cements. The derivative showed antibacterial activity against both S. mutans and Lactobacillus sp. Human saliva did not affect the antibacterial activity of the cement. The cytotoxicity study with human dental pulp cells shows that the furanone-modified cement was biocompatible. A 30 day aging study indicated that the cements may have long-lasting antibacterial activity. Within the limitations of this study it appears that the experimental cement could be a clinically attractive dental restorative due to its high mechanical strength and antibacterial function.

Nanocomposite containing CaF(2) nanoparticles: thermal cycling, wear and long-term water-aging

OBJECTIVES

Fluoride (F) releasing dental restoratives are promising to promote remineralization and combat caries. The objectives of this study were to develop nanocomposite containing calcium fluoride nanoparticles (nCaF(2)), and to investigate the long-term mechanical durability including wear, thermal-cycling and long-term water-aging behavior.

METHODS

Two types of fillers were used: nCaF(2) with a diameter of 53 nm, and glass particles of 1.4 μm. Four composites were fabricated with fillers of: (1) 0% nCaF(2)+65% glass; (2) 10% nCaF(2)+55% glass; (3) 20% nCaF(2)+45% glass; (4) 30% nCaF(2)+35% glass. Three commercial materials were also tested. Specimens were subjected to thermal-cycling between 5°C and 60°C for 10(5) cycles, three-body wear for 4×10(5) cycles, and water-aging for 2 years.

RESULTS

After thermal-cycling, the nCaF(2) nanocomposites had flexural strengths in the range of 100-150 MPa, five times higher than the 20-30 MPa for resin-modified glass ionomer (RMGI). The wear scar depth showed an increasing trend with increasing nCaF(2) filler level. Wear of nCaF(2) nanocomposites was within the range of wear for commercial controls. Water-aging decreased the strength of all materials. At 2 years, flexural strength was 94 MPa for nanocomposite with 10% nCaF(2), 60 MPa with 20% nCaF(2), and 48 MPa with 30% nCaF(2). They are 3-6 fold higher than the 15 MPa for RMGI (p<0.05). SEM revealed air bubbles and cracks in a RMGI, while composite control and nCaF(2) nanocomposites appeared dense and solid.

SIGNIFICANCE

Combining nCaF(2) with glass particles yielded nanocomposites with long-term mechanical properties that were comparable to those of a commercial composite with little F release, and much better than those of RMGI controls. These strong long-term properties, together with their F release being comparable to RMGI as previously reported, indicate that the nCaF(2) nanocomposites are promising for load-bearing and caries-inhibiting restorations.

Preparation and evaluation of a novel glass-ionomer cement with antibacterial functions

OBJECTIVE

The objective of this study was to use the newly synthesized poly(quaternary ammonium salt) (PQAS)-containing polyacid to formulate the light-curable glass-ionomer cements and study the effect of the PQAS on the compressive strength and antibacterial activity of the formed cements.

MATERIALS AND METHODS

The functional QAS and their constructed PQAS were synthesized, characterized and formulated into the experimental high-strength cements. Compressive strength (CS) and Streptococcus mutans viability were used to evaluate the mechanical strength and antibacterial activity of the cements. Fuji II LC cement was used as control. The specimens were conditioned in distilled water at 37°C for 24 h prior to testing. The effects of the substitute chain length, loading as well as grafting ratio of the QAS and aging on CS and S. mutans viability were investigated.

RESULTS

All the PQAS-containing cements showed a significant antibacterial activity, accompanying with an initial CS reduction. The effects of the chain length, loading and grafting ratio of the QAS were significant. Increasing chain length, loading, grafting ratio significantly enhanced antibacterial activity but reduced the initial CS. Under the same substitute chain length, the cements containing QAS bromide were found to be more antibacterial than those containing QAS chloride although the CS values of the cements were not statistically different from each other, suggesting that we can use QAS bromide directly without converting bromide to chloride. The experimental cement showed less CS reduction and higher antibacterial activity than Fuji II LC. The long-term aging study suggests that the cements may have a long-lasting antibacterial function.

CONCLUSIONS

This study developed a novel antibacterial glass-ionomer cement. Within the limitations of this study, it appears that the experimental cement is a clinically attractive dental restorative due to its high mechanical strength and antibacterial function.

A novel hyperbranched poly(acrylic acid) for improved resin-modified glass-ionomer restoratives

OBJECTIVE

The objective of this study was to synthesize and characterize novel hyperbranched poly(acrylic acid)s via atom-transfer radical polymerization (ATRP) technique and tether the photo-curable methacrylate onto the poly(acrylic acid), use these polymers to formulate the resin-modified glass-ionomer cements, and evaluate the mechanical strengths of the formed cements.

MATERIALS AND METHODS

The hyperbranched poly(acrylic acid)s were synthesized using a self-condensing vinyl polymerization initiator via ATRP. The effects of the concentrations of both catalyst and initiator on molecular weight (MW) and degree of branching (DB) were studied. Compressive, diametral tensile as well as flexural strengths, fracture toughness, hardness and wear-resistance of the experimental cement were evaluated and compared to those of Fuji II LC cement. The specimens were conditioned in distilled water at 37°C for 24h prior to testing.

RESULTS

The concentrations of both catalyst and initiator had significant effects on MW and DB of the synthesized polymers. The concentration of the initiator also significantly affected both CS and DTS values of the cement. The experimental cement showed significantly higher mechanical properties, i.e., 53% in CS, 50% in compressive modulus, 125% in DTS, 95% in FS, 21% in FT and 96% in KHN, higher than Fuji II LC. The experimental cement was only 5.4% of abrasive and 6.4% attritional wear depths of Fuji II LC.

CONCLUSIONS

This study developed a novel resin-modified glass-ionomer cement system composed of newly synthesized hyperbranched poly(acrylic acid)s. It appears that this novel experimental cement is a clinically attractive dental restorative and may potentially be used for high-wear and high-stress-bearing site restorations.

Rapid prototyping of scaphoid and lunate bones

In this study, a novel rapid prototyping technology was used to fabricate scaphoid and lunate bone prostheses, two carpal bones that are prone to avascular necrosis. Carpal prostheses were fabricated with an Envisiontec Perfactory SXGA stereolithography system using Envisiontec eShell 200 photocurable polymer. Fabrication was guided using 3-D models, which were generated using Mimics software (Materialise NV, Leuven, Belgium) from patient computer tomography data. The prostheses were fabricated in a layer-by-layer manner; approximately 50-microm thick layers were observed in the prostheses. Hardness and Young's modulus values of polymerized eShell 200 material were 93.8 +/- 7.25 MPa and 3050 +/- 90 MPa, respectively. The minimum compressive force required for fracture was 1360 N for the scaphoid prosthesis and 1248 N for the lunate prosthesis. Polymerized Envisiontec eShell material exhibited high human neonatal epidermal keratinocyte cell viability rate in an MTT assay. The results of this study indicate that small bone prostheses fabricated by stereolithography using eShell 200 polymer may have suitable geometry, mechanical properties, and cytocompatibility properties for in vivo use.

Bioactive glass-ionomer cement with potential therapeutic function to dentin capping mineralization

We have developed a novel bioactive resin-modified glass-ionomer cement system with therapeutic function to dentin capping mineralization. In the system, the newly synthesized star-shape poly(acrylic acid) was formulated with water, Fuji II LC filler, and bioactive glass S53P4 to form resin-modified glass-ionomer cement. Compressive strength (CS) was used as a screening tool for evaluation. The commercial glass-ionomer cement Fuji II LC was used as a control. All the specimens were conditioned in simulated body fluid (SBF) at 37 degrees C prior to testing. The effect of aging in SBF on CS and microhardness of the cements was investigated. Scanning electron microscopy was used to examine the in vitro dentin surface changes caused by the incorporation of bioactive glass. The results show that the system not only provided strengths comparable to original commercial Fuji II LC cement but also allowed the cement to help mineralize the dentin in the presence of SBF. It appears that this bioactive glass-ionomer cement system has direct therapeutic impact on dental restorations that require root surface fillings.