A long-term study on the setting reaction of glass ionomer cements by (27)Al MAS-NMR spectroscopy

Long-Term Water Balance Evaluation in Glass Ionomer Restorative Materials

The complex role of water in glass ionomer cement (polyalkenoate) dental restorative materials has been studied, but much of the present understanding concerning water balance within these materials is based on very early studies and short-term experiments. This study evaluated the nature of the water species of six conventional and four resin modified glass ionomer restorative materials over 3 years using thermogravimetric analysis techniques. Materials were prepared, placed in crucibles, and stored in physiologic phosphate buffered saline and evaluated at 24 h, 1 week, and then at 1, 3, 6, 9, 12, 18, 24, 30 and 36 months. All materials demonstrated a significant increase in unbound water percentage content but except for the resin modified materials, the enthalpy required to remove the unbound water species did not significantly change over 36 months. Also, bound water content percentage and removal enthalpy was established at 24 h, as no significant increase was noted in both bound water content and removal enthalpy over the course of this evaluation. This study suggests that unbound water species may increase with time and is loosely held except for the resin modified materials. Protective coatings placement and re-evaluation are prudent to prevent unbound water loss.

Bioactive Materials for Direct and Indirect Restorations: Concepts and Applications

Currently, minimally invasive restorations could be made in dentistry applying adhesive materials and adhesion principles to the dental structures. Following this philosophy, endodontic interventions have been avoided largely, preserving hard tissues, and maintaining dental vitality. Advances in biologically favorable bioactive materials enabled clinicans to induce repair and regeneration of dental tissues. Such materials are primarily used for pulp protection and cementation of indirect restorations. This review highlights current bioactive materials available, principles of bioactivity and their mechanisms of action.

Commercially Available Fluoride-Releasing Restorative Materials: A Review and a Proposal for Classification

Resin composite and glass ionomer cement (GIC) are the most commonly used dental materials to perform direct restorations. Both have specific characteristics that explain their popularity and their limits. More than 20 years ago, the first attempt (followed by others) to combine the advantages of these two families was performed with compomers, but it was not very successful. Recently, new formulations (also called 'smart materials') with claimed ion release properties have been proposed under different family names, but there are few studies on them and explanations of their chemistries. This comprehensive review aims to gather the compositions; the setting reactions; the mechanical, self-adhesive, and potential bulk-fill properties; and the ion release abilities of the large existing families of fluoride-releasing restorative materials and the new restorative materials to precisely describe their characteristics, their eventual bioactivities, and classify them for an improved understanding of these materials. Based on this work, the whole GIC family, including resin-modified and highly viscous formulations, was found to be bioactive. Cention N (Ivoclar Vivadent, AG, Schaan, Lietschentein) is the first commercially available bioactive resin composite.

In vitro evaluation of the shear bond strength and bioactivity of a bioceramic cement for bonding monolithic zirconia

STATEMENT OF PROBLEM

Adhesive cementation is the most common bonding strategy for zirconia restorations. Although cementation with a bioactive luting agent has been proposed as an alternative, how the bond strength compares is unclear.

PURPOSE

The purpose of this in vitro study was to evaluate shear bond strength after cementing a monolithic zirconia ceramic to human dentin with a bioceramic cement, compare it with a traditional cement, and evaluate its bioactive properties.

MATERIAL AND METHODS

A total of 120 dentin specimens and 120 yttria-stabilized tetragonal zirconia polycrystal (Y-TZP) (BruxZir) cylindrical specimens were used. Zirconia and dentin specimens were randomly divided into 8 study groups (n=15) based on 2 luting cement types (a bioceramic cement or glass ionomer cement as control), 2 airborne-particle abrasion protocols (50 μm or 110 μm), and 2 water storage durations (24 hours or 30 days). After the shear bond strength test using a universal machine at a crosshead speed of 1 mm/min, fracture patterns were evaluated under a stereomicroscope and a scanning electron microscope. Strength values were statistically analyzed with a 3-factor ANOVA model (α=.05). Bioactivity was evaluated in simulated body fluid (SBF).

RESULTS

The control glass ionomer cement achieved significantly greater shear bond strength compared with the tested bioceramic cement. Mean bond strength values ranged from 2.52 MPa to 5.23 MPa for the bioceramic cement tested and from 4.20 MPa to 6.61 MPa for the control cement. The duration of water storage played a significant role in the bond strength, with groups stored for 30 days reaching higher bond strength values, whereas the particle size of airborne-particle abrasion did not have a significant effect. Failure types were primarily mixed. No apatite formation was recorded on the surface of the specimens even after 30 days of immersion in SBF.

CONCLUSIONS

The evaluated cement did not develop apatite in SBF, and its bond strength values were below the control glass ionomer cement.

Nuclear Magnetic Resonance Spectroscopy for Medical and Dental Applications: A Comprehensive Review

Nuclear magnetic resonance (NMR) spectroscopy is one of the most significant analytical techniques that has been developed in the past few decades. A broad range of biological and nonbiological applications ranging from an individual cell to organs and tissues has been investigated through NMR. Various aspects of this technique are still under research, and many functions of the NMR are still pending a better understanding and acknowledgment. Therefore, this review is aimed at providing a general overview of the main principles, types of this technique, and the advantages and disadvantages of NMR spectroscopy. In addition, an insight into the current uses of NMR in the field of medicine and dentistry and ongoing developments of NMR spectroscopy for future applications has been discussed.

Effects of Polyacrylic Acid Pre-Treatment on Bonded-Dentine Interfaces Created with a Modern Bioactive Resin-Modified Glass Ionomer Cement and Subjected to Cycling Mechanical Stress

OBJECTIVES

Resin-modified glass ionomer cements (RMGIC) are considered excellent restorative materials with unique therapeutic and anti-cariogenic activity. However, concerns exist regarding the use of polyacrylic acid as a dentine conditioner as it may influence the bonding performance of RMGIC. The aim of this study was to evaluate the effect of different protocols for cycling mechanical stress on the bond durability and interfacial ultramorphology of a modern RMGIC applied to dentine pre-treated with/without polyacrylic acid conditioner (PAA).

METHODS

The RMGIC was applied onto human dentine specimens prepared with silicon-carbide (SiC) abrasive paper with or without the use of a PAA conditioner. The specimens were immersed in deionised water for 24 h then divided in 3 groups. The first group was cut into matchsticks (cross-sectional area of 0.9 mm2) and tested immediately for microtensile bond strength (MTBS). The second was first subjected to load cycling (250,000 cycles; 3 Hz; 70 N) and then cut into matchsticks and tested for MTBS. The third group was subjected to load cycling (250,000 cycles; 3 Hz; 70 N), cut into matchsticks, and then immersed for 8 months storage in artificial saliva (AS); these were finally tested for MTBS. The results were analysed statistically using two-way ANOVA and the Student⁻Newman⁻Keuls test (α = 0.05). Fractographic analysis was performed using FE-SEM, while further RMCGIC-bonded dentine specimens were aged as previously described and used for interfacial ultramorphology characterisation (dye nanoleakage) using confocal microscopy.

RESULTS

The RMGIC applied onto dentine that received no pre-treatment (10% PAA gel) showed no significant reduction in MTBS after load cycling followed by 8 months of storage in AS (p > 0.05). The RMGIC⁻dentine interface created in PAA-conditioned SiC-abraded dentine specimens showed no sign of degradation, but with porosities within the bonding interface both after load cycling and after 8 months of storage in AS. Conversely, the RMGIC⁻dentine interface of the specimens with no PAA pre-treatment showed no sign of porosity within the interface after any of the aging protocols, although some bonded-dentine interfaces presented cohesive cracks within the cement after prolonged AS storage. However, the specimens of this group showed no significant reduction in bond strength (p < 0.05) after 8 months of storage in AS or load cycling (p > 0.05). After prolonged AS storage, the bond strength value attained in RMGIC⁻dentine specimens created in PAA pre-treated dentine were significantly higher than those observed in the specimens created with no PAA pre-treatment in dentine.

CONCLUSIONS

PAA conditioning of dentine prior to application of RMGIC induces no substantial effect on the bond strength after short-term storage, but its use may increase the risk of collagen degradation at the bonding interface after prolonged aging. Modern RMGIC applied without PAA dentine pre-treatment may have greater therapeutic synergy with saliva during cycle occlusal load, thereby enhancing the remineralisation and protection of the bonding interface.

Maturation processes in glass-ionomer dental cements

Glass-ionomer cements are used for a variety of tooth-repair functions in clinical dentistry. They are formed by reaction of a basic glass powder with a solution of polymeric water-soluble acid, usually polyacrylic acid. After the initial neutralization reaction, by which the cement hardens, various maturation reactions occur. Changes induced by these maturation reactions are identified as: increase in strength; reduction in plasticity; improvement in opacity; and increase in proportion of tightly bound water. In addition, in contact with the tooth, an ion-exchange interfacial layer is gradually formed. This is mechanically strong and chemically-resistant. These changes are described in the current paper, which reviews the extent to which they occur, and reports what is know about the chemistry that underlies them. Processes involving slow diffusion of various ions and of water through the set cement bring about these changes. They include a secondary setting reaction to form a phosphate-based phase, binding of water to co-ordination sites around metal cations and to a hydration sheath around the polymer molecules, and possibly reaction of water with glass particle surfaces to form silanol groups. Evidence from a wide range of literature sources is used to be build up a detailed picture of the chemistry of the maturation processes, and gaps in our understanding are highlighted. The article concludes that, given the importance of glass-ionomers in contemporary dentistry, it is important to know the extent to which such maturation processes occur in current cement formulations, and also to determine how rapidly they take place.

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.

Percutaneous upper extremity fracture fixation using a novel glass-based adhesive

Objective

To develop a surgical technique for percutaneous upper extremity fracture fixation using a novel glass-based adhesive.

Methods

Three intact upper extremity cadaveric specimens with undisturbed soft tissues were obtained. Two were used to model a wrist fracture, and the third to model a proximal humerus fracture. Fractures were produced using a small osteotome in a percutaneous fashion. Banna Bone Adhesive (BBA) was delivered to the fracture site percutaneously using a 16 gauge needle under bi-planar fluoroscopic guidance. After setting of the adhesive, the specimens were dissected to qualitatively assess BBA delivery and placement.

Results

The adhesive could readily be delivered through the 16 gauge needle with an appropriate amount of pressure applied to the syringe. Using the fluoroscope, the adhesive could be seen to flow into the fracture site with minimal extravagation into the surrounding soft tissues. Successful bonding of the fracture fragments was observed.

Conclusions

Percutaneous delivery of BBA into a fracture of the distal radius and proximal humerus may be a feasible fracture fixation technique. Biomechanical testing and animal model testing are required to further develop this procedure.

Modifications in Glass Ionomer Cements: Nano-Sized Fillers and Bioactive Nanoceramics

Glass ionomer cements (GICs) are being used for a wide range of applications in dentistry. In order to overcome the poor mechanical properties of glass ionomers, several modifications have been introduced to the conventional GICs. Nanotechnology involves the use of systems, modifications or materials the size of which is in the range of 1–100 nm. Nano-modification of conventional GICs and resin modified GICs (RMGICs) can be achieved by incorporation of nano-sized fillers to RMGICs, reducing the size of the glass particles, and introducing nano-sized bioceramics to the glass powder. Studies suggest that the commercially available nano-filled RMGIC does not hold any significant advantage over conventional RMGICs as far as the mechanical and bonding properties are concerned. Conversely, incorporation of nano-sized apatite crystals not only increases the mechanical properties of conventional GICs, but also can enhance fluoride release and bioactivity. By increasing the crystallinity of the set matrix, apatites can make the set cement chemically more stable, insoluble, and improve the bond strength with tooth structure. Increased fluoride release can also reduce and arrest secondary caries. However, due to a lack of long-term clinical studies, the use of nano-modified glass ionomers is still limited in daily clinical dentistry. In addition to the in vitro and in vivo studies, more randomized clinical trials are required to justify the use of these promising materials. The aim of this paper is to review the modification performed in GIC-based materials to improve their physicochemical properties.

A Review of Glass-Ionomer Cements for Clinical Dentistry

This article is an updated review of the published literature on glass-ionomer cements and covers their structure, properties and clinical uses within dentistry, with an emphasis on findings from the last five years or so. Glass-ionomers are shown to set by an acid-base reaction within 2–3 min and to form hard, reasonably strong materials with acceptable appearance. They release fluoride and are bioactive, so that they gradually develop a strong, durable interfacial ion-exchange layer at the interface with the tooth, which is responsible for their adhesion. Modified forms of glass-ionomers, namely resin-modified glass-ionomers and glass carbomer, are also described and their properties and applications covered. Physical properties of the resin-modified glass-ionomers are shown to be good, and comparable with those of conventional glass-ionomers, but biocompatibility is somewhat compromised by the presence of the resin component, 2 hydroxyethyl methacrylate. Properties of glass carbomer appear to be slightly inferior to those of the best modern conventional glass-ionomers, and there is not yet sufficient information to determine how their bioactivity compares, although they have been formulated to enhance this particular feature.

Simulations reveal the role of composition into the atomic-level flexibility of bioactive glass cements

Bioactive glass ionomer cements (GICs), the reaction product of a fluoro-alumino-silicate glass and polyacrylic acid, have been in effective use in dentistry for over 40 years and more recently in orthopaedics and medical implantation. Their desirable properties have affirmed GIC's place in the medical materials community, yet are limited to non-load bearing applications due to the brittle nature of the hardened composite cement, thought to arise from the glass component and the interfaces it forms. Towards helping resolve the fundamental bases of the mechanical shortcomings of GICs, we report the 1st ever computational models of a GIC-relevant component. Ab initio molecular dynamics simulations were employed to generate and characterise three fluoro-alumino-silicate glasses of differing compositions with focus on resolving the atomic scale structural and dynamic contributions of aluminium, phosphorous and fluorine. Analyses of the glasses revealed rising F-content leading to the expansion of the glass network, compression of Al-F bonding, angular constraint at Al-pivots, localisation of alumino-phosphates and increased fluorine diffusion. Together, these changes to the structure, speciation and dynamics with raised fluorine content impart an overall rigidifying effect on the glass network, and suggest a predisposition to atomic-level inflexibility, which could manifest in the ionomer cements they form.

Atomic and vibrational origins of mechanical toughness in bioactive cement during setting

Bioactive glass ionomer cements (GICs) have been in widespread use for ∼40 years in dentistry and medicine. However, these composites fall short of the toughness needed for permanent implants. Significant impediment to improvement has been the requisite use of conventional destructive mechanical testing, which is necessarily retrospective. Here we show quantitatively, through the novel use of calorimetry, terahertz (THz) spectroscopy and neutron scattering, how GIC's developing fracture toughness during setting is related to interfacial THz dynamics, changing atomic cohesion and fluctuating interfacial configurations. Contrary to convention, we find setting is non-monotonic, characterized by abrupt features not previously detected, including a glass-polymer coupling point, an early setting point, where decreasing toughness unexpectedly recovers, followed by stress-induced weakening of interfaces. Subsequently, toughness declines asymptotically to long-term fracture test values. We expect the insight afforded by these in situ non-destructive techniques will assist in raising understanding of the setting mechanisms and associated dynamics of cementitious materials.

Clinical study of the caries-preventive effect of resin-modified glass ionomer restorations: aging versus the influence of fluoride dentifrice

AIM

The use of fluoride-releasing materials could be compromised due to aging and might also be influenced by other ordinary sources of fluoride. The aim of the present study was to investigate the aging effect on caries development around resin-modified glass ionomer cement (RMGIC) restorations and the influence of fluoride dentifrice use in this process under the oral environment.

METHODS

A clinical study was performed in two phases of 14 days each. A total of 16 volunteers wore palatal devices containing dental slabs restored with either a composite resin or RMGIC, either aged or unaged by thermocycling. To simulate a clinical situation of high caries risk, the slabs were exposed to a 20% sucrose solution 10 times per day via the in situ model, where non-fluoride or a fluoride dentifrice was used. Integrated demineralization was determined by cross-sectional microhardness at both margins of the restoration: enamel and dentin.

RESULTS

For enamel, higher demineralization around the composite restorations was observed, regardless of dentifrice or aging. For dentin, higher demineralization was observed around the aged composite restorations regardless of the dentifrice type used.

CONCLUSIONS

The RMGIC restorations provided more enhanced protection against secondary caries for dentin under aging, and the fluoride dentifrice used in this condition had either no clinically relevance or only a minimal effect.

Effect of nanoclay dispersion on the properties of a commercial glass ionomer cement

Objective. The reinforcement effect of polymer-grade montmorillonite (PGV and PGN nanoclay) on Fuji-IX glass ionomer cement was investigated. Materials and Method. PGV and PGV nanoclays (2.0 wt%) were dispersed in the liquid portion of Fuji-IX. Fourier-transform infrared (FTIR) spectroscopy and gel permeation chromatography (GPC) were used to quantify acid-base reaction and the liquid portion of GIC. The mechanical properties (CS, DTS, FS, and E f ) of cements (n = 20) were measured at 1 hour, 1 day, and 1 month. The microstructure was examined by cryo-SEM and TEM. Results. FTIR shows that the setting reaction involves the neutralisation of PAA by the glass powder which was linked with the formation of calcium and aluminium salt-complexes. The experimental GICs (C-V and C-N) exhibited mechanical properties in compliance to ISO standard requirement have higher values than Fuji-IX cement. There was no significant correlation of mechanical properties was found between C-V and C-N. The average Mw of Fuji-IX was 15,700 and the refractive index chromatogram peak area was 33,800. TEM observation confirmed that nanoclays were mostly exfoliated and dispersed in the matrix of GIC. Conclusion. The reinforcement of nanoclays in GICs may potentially produce cements with better mechanical properties without compromising the nature of polyacid neutralisation.

An in vitro study on the maturation of conventional glass ionomer cements and their interface to dentin

The objective of the study was to investigate the influence of long-term storage (up to 1 year) and coating on the variation of micro-mechanical properties of four conventional restorative glass ionomer cements (GICs) within 3.5 mm deep class I cavities. Four commercially available GICs (Riva Self Cure (SDI), ChemFil Rock (Dentsply), Fuji IX Fast and Fuji IX GP Extra/Equia (GC)) were applied to 100 teeth. In each tooth, two similar 3.5 mm deep class I cavities were prepared and filled with the GICs, with and without resin coating. The samples were stored in artificial saliva at 37 °C for 1 week, 1 month, 3 months, 6 months and 1 year. The variation in mechanical properties (indentation modulus (E) and Vickers hardness (HV)) were determined in 100 μm steps starting from the filling surface, through the intermediate layer in between dentine and GIC, and ending 100 μm in dentin. HV and E were strongly influenced by the material (P<0.05, partial eta-squared ηP(2) = 0.31 and 0.23) but less by aging duration (P<0.05, ηP(2) = 0.02 and 0.12) and resin coating (P<0.05, ηP(2) = 0.02 and 0.03). The depth of measurement (0-2 mm) has no influence on HV (P = 0.789). HV shows a gentle increase over the 1 year storage period (P = 0.002). A ∼300 μm GIC zone at the areas close to dentin with weaker properties as those measured in dentin or GIC was identified in all fillings, irrespective of the presence of coating, and at all storage periods. The thickness of this zone is more strongly influenced by storage (P<0.05, ηP(2) = 0.081) than by material type (P<0.05, ηP(2) = 0.056), while coating showed no influence (P = 0.869). Filler morphology and dimension were similar to upper parts of the GIC filling; however, the amount of low cations was higher. We concluded that the development of an intermediate layer in between dentine and GIC with lower mechanical properties might be responsible for the bond quality of GIC to dentine. Moreover, class I GIC restorations are unlikely to feature constant mechanical properties throughout the cavity, regardless of conditions such as aging and coating.

Release of sodium fusidate from glass-ionomer dental cement

Restorative grade glass-ionomer cement has been studied for its potential as a controlled release material for the antimicrobial compound sodium fusidate. Sodium fusidate powder was incorporated into the cement at the mixing stage at levels of 1% and 5% by mass, and disc shaped specimens (6 mm diameter x 2 mm depth) prepared. After curing for 1 hour at 37 degrees C, specimens were placed in water and release of sodium fusidate at set time intervals determined using reverse-phase HPLC. Sets of five specimens were used in all experiments. Early release of sodium fusidate was shown to occur by diffusion for each level of addition, as shown by M(t)/M(infinity) being linear with respect to [square root]time in both cases. Diffusion coefficients were calculated as 4.4 x 10(-8) cm(2) s(-1) and 3.0 x 10(-8) cm(2) s(-1) for 1 and 5% respectively. These were an order of magnitude lower than had been found previously for water transport in glass-ionomer cements, a result that is attributed to the greater size of the sodium fusidate molecule compared with that of water. Cements released 20.4 and 22.8% respectively of the total sodium fusidate added after 2 weeks, values which were not significantly different from each other, and which exceeded total release previously reported for benzalkonium chloride and chlorhexidine.