Factors influencing fluoride release in atraumatic restorative treatment (ART) materials: A review

Ion release of the glass ionomer restoration with silver diamine fluoride dentin pretreatment

OBJECTIVE

To assess the fluoride and silver ion release of glass ionomer cement (GIC) restorations, including conventional GIC (CGIC) and resin-modified GIC (RMGIC) restorations, with 38 % silver diamine fluoride (SDF) solution dentin pretreatment.

METHODS

Eighty dentin blocks were allocated into 4 groups and restored with SDF+CGIC, CGIC, SDF+RMGIC and RMGIC, respectively. Each block was stored in deionized water at 37 °C for 2 years. Fluoride and silver ion concentration in storage solution was measured using ion-selective electrode and inductively coupled plasma-optical emission spectrometry for up to 2 years. The cross-sectional surfaces of restored dentin blocks were assessed by X-Ray diffraction analysis (XRD), scanning electron microscope (SEM) with energy-dispersive X-ray spectroscopy (EDS) after 1 week and 2 years, respectively.

RESULTS

The mean ± standard deviation (SD) of accumulative fluoride releasing in SDF+CGIC, CGIC, SDF+RMGIC and RMGIC for 2 years were 0.13±0.005 mg, 0.09±0.006 mg, 0.15±0.008 mg and 0.05±0.003 mg, respectively (Groups SDF+RMGIC > SDF+CGIC > CGIC >RMGIC, p < 0.05). The mean ± SD of accumulative silver releasing in SDF+CGIC, CGIC, SDF+RMGIC and RMGIC for 2 years were 0.03±0.009 mg, 0.00±0.00 mg, 0.01±0.003 mg, and 0.00±0.00 mg, respectively (Groups SDF+CGIC > SDF+RMGIC > CGIC&RMGIC, p < 0.05). Groups SDF+CGIC and SDF+RMGIC showed sustainably higher fluoride and silver releasing compared to Groups CGIC and RMGIC (p < 0.05). XRD analysis indicated the fluorapatite and silver chloride were observed only in Groups SDF+CGIC and SDF+RMGIC, but not in Groups CGIC and RMGIC. SEM images of the cross-sectional view of the dentin blocks showed silver crystals within dentinal tubules 1 week and 2-year in Groups with SDF pretreatment.

CONCLUSION

The 38 % SDF dentin pretreatment sustainably increased the fluoride and silver release of GIC and RMGIC restorations for up to 2 years.

Evaluation of setting kinetics, mechanical strength, ion release, and cytotoxicity of high-strength glass ionomer cement contained elastomeric micelles

BACKGROUND

Low mechanical properties are the main limitation of glass ionomer cements (GICs). The incorporation of elastomeric micelles is expected to enhance the strength of GICs without detrimentally affecting their physical properties and biocompatibility. This study compared the chemical and mechanical properties, as well as the cytotoxicity, of elastomeric micelles-containing glass ionomer cement (DeltaFil, DT) with commonly used materials, including EQUIA Forte Fil (EF), Fuji IX GP Extra (F9), and Ketac Molar (KT).

METHOD

Powder particles of GICs were examined with SEM-EDX. Setting kinetics were assessed using ATR-FTIR. Biaxial flexural strength/modulus and Vickers surface microhardness were measured after immersion in water for 24 h and 4 weeks. The release of F, Al, Sr, and P in water over 8 weeks was analyzed using a fluoride-specific electrode and ICP-OES. The toxicity of the material extract on mouse fibroblasts was also evaluated.

RESULTS

High fluoride levels in the powder were detected with EF and F9. DT demonstrated an initial delay followed by a faster acid reaction compared to other cements, suggesting an improved snap set. DT also exhibited superior flexural strength than other materials at both 24 h and 4 weeks but lower surface microhardness (p < 0.05). EF and F9 showed higher release of F, Al, and P than DT and KT. There was no statistically significant difference in fibroblast viability among the tested materials (p > 0.05).

CONCLUSIONS

Elastomeric micelles-containing glass ionomer cement (DT) exhibited satisfactory mechanical properties and cytocompatibility compared with other materials. DT could, therefore, potentially be considered an alternative high-strength GIC for load-bearing restorations.

Acemannan-containing bioactive resin modified glass ionomer demonstrates satisfactory physical and biological properties

Background/purpose

Resin-modified glass ionomers (RMGIs) have been recommended as liner and cement to provide the teeth with mechanical support, a chemical barrier, and thermal insulation. Acemannan, the main polysaccharide extracted from Aloe vera, is a promising inductive material in vitro and in vivo. This study aimed to develop acemannan-containing bioactive resin-modified glass ionomers (RMGIs).

Materials and methods

Acemannan (3%, 5%, and 10%) was added to the three types of RMGIs (RU-HBM1/Fuji II LC/Vitrebond) to generate 3%, 5%, and 10% aceRMGIs (aceRU/aceFuji/aceVB). The materials were evaluated for depth of cure/flexural strength/cumulative fluoride ion release. Cell viability and vascular endothelial growth factor (VEGF) and bone morphogenetic protein-2 (BMP-2) secretion were determined using MTT/apoptosis/necrosis assays, and ELISA kits, respectively. RMGI without acemannan were used as controls.

Results

The aceRMGIs met the ISO requirements for depth of cure and flexural strength. Adding 10% acemannan increased the cumulative fluoride release in the RU and FJ groups, but slightly decreased it in the VB group (P < 0.05). The MTT assay revealed 10% aceRU and all aceFJ groups significantly increased cell viability compared with each control group (P < 0.05). Apoptosis/necrosis assay showed the biocompatibility of all aceRMGIs. Adding acemannan to RMGIs significantly induced VEGF expression in a dose dependent manner while 5% and 10% aceRU significantly induced BMP-2 expression compared with RU group (P < 0.05).

Conclusion

We conclude that 5-10% acemannan in RMGI is the optimal concentration based on its physical properties and ability to induce pulp cell proliferation and growth factor secretion.

Mechanical Properties and Ion Release from Fibre-Reinforced Glass Ionomer Cement

The aim of this study was to compare the mechanical properties and ion release from a commercially available resin-modified glass ionomer cement to a formulation reinforced by the addition of short glass fibres at various percentages. Methods: Three experimental groups were prepared by adding a mass ratio of 10%, 15% and 20% of short glass fibres to the powder portion of the cement from a capsule (GC Fuji II LC), while the control group contained no fibres. Microhardness (n = 12), fracture toughness, and flexural, compressive and diametral tensile strength (n = 8) were evaluated. To study ion release, readings were obtained utilising fluoro-selective and calcium-selective electrodes after 24 h, 7 days and 30 days (n = 12). The spatial distribution of fibres within the material was evaluated through scanning electron microscopy. The data were analysed using one-way ANOVA with a Bonferroni adjustment. Results: The findings suggest that elevating fibre weight ratios to 20 wt% results in improved mechanical properties (p < 0.05) in microhardness, flexural strength, diametral tensile strength and fracture toughness. In terms of ion release, a statistically significant difference (p < 0.001) was observed between the groups at the conclusion of 24 h and 7 days, when the fluoride release was much higher in the control group. However, after 30 days, no significant distinction among the groups was identified (p > 0.05). Regarding calcium release, no statistically significant differences were observed among the groups at any of the evaluated time points (p > 0.05). SEM showed the fibres were homogeneously incorporated into the cement in all experimental groups. Conclusions: Resin-modified glass ionomer enhanced with short glass fibres at a weight loading of 20% showcased the most favourable mechanical properties while concurrently maintaining the ability to release fluoride and calcium after a 30-day period.

Efficacy of bioactive materials in preventing Streptococcus mutans-induced caries on enamel and dentine

The study investigated the ability of bioactive materials used to restore enamel and dentine specimens to prevent caries. Enamel (n = 50) and dentine (n = 50) specimens were obtained from bovine incisors, prepared, and randomly allocated to one of five groups according to the restorative treatment: alkasite without adhesive system; alkasite with adhesive system; high viscosity glass ionomer cement; resin composite; no restoration; negative control group. Specimens were restored, exposed to a thermal cycling aging protocol, sterilized, and exposed to a cariogenic challenge induced by Streptococcus mutans and then submitted to surface and subsurface microhardness tests and polarized light microscopy to verify the caries lesion development in enamel or dentine surrounding the restorative materials. Data were analyzed using one-way ANOVA. In enamel and dentine, glass ionomer cement, alkasite without and with adhesive system presented a lower percentage surface microhardness loss than resin composite and negative control. Enamel subsurface microhardness presented no statistically significant differences between glass ionomer cement, alkasite without and with adhesive system. Glass ionomer cement also did not present statistically significant differences from resin composite and the negative control. In dentine, glass ionomer cement showed the highest subsurface microhardness values. In conclusion, bioactive restorative materials provide greater protection to enamel and dentine against surface caries development than resin composite.

Preclinical in vitro evaluation of implantable materials: conventional approaches, new models and future directions

Nowadays, implants and prostheses are widely used to repair damaged tissues or to treat different diseases, but their use is associated with the risk of infection, inflammation and finally rejection. To address these issues, new antimicrobial and anti-inflammatory materials are being developed. Aforementioned materials require their thorough preclinical testing before clinical applications can be envisaged. Although many researchers are currently working on new in vitro tissues for drug screening and tissue replacement, in vitro models for evaluation of new biomaterials are just emerging and are extremely rare. In this context, there is an increased need for advanced in vitro models, which would best recapitulate the in vivo environment, limiting animal experimentation and adapted to the multitude of these materials. Here, we overview currently available preclinical methods and models for biological in vitro evaluation of new biomaterials. We describe several biological tests used in biocompatibility assessment, which is a primordial step in new material's development, and discuss existing challenges in this field. In the second part, the emphasis is made on the development of new 3D models and approaches for preclinical evaluation of biomaterials. The third part focuses on the main parameters to consider to achieve the optimal conditions for evaluating biocompatibility; we also overview differences in regulations across different geographical regions and regulatory systems. Finally, we discuss future directions for the development of innovative biomaterial-related assays: in silico models, dynamic testing models, complex multicellular and multiple organ systems, as well as patient-specific personalized testing approaches.

Fluoride and Calcium Release from Alkasite and Glass Ionomer Restorative Dental Materials: In Vitro Study

This study evaluated the effect of pH and temperature on the ion (F^- and Ca²⁺) release of a resin-based material containing alkaline fillers and a self-setting high-viscous glass ionomer cement. Disks were prepared according to manufacturers' instructions for both materials: the EF group (Equia Forte HT filling, GC) and the CN group (Cention N, Ivoclar). Specimens were immersed in 50 mL buffer solution with three different pHs (4.8, 6.8, and 8.8), and stored at 0°, 18°, 37°, and 44 °C. After 24 h, 7 d, and 28 d, cumulative F^- and Ca²⁺ releases were analyzed by chromatography and mass spectrometry, and pH was measured. Both materials showed minimal changes in pH with final values after 28 d of 5.17 ± 0.56 for CN and 5.12 ± 0.24 for EF. In all experimental conditions, the percentages of ion release were higher for EF than for CF. In particular, both materials showed a significant difference in temperature in F^- release. Regardless of the pH values, the highest Ca²⁺ ion release was after 28 days, with a significant difference in temperature for CN and EF. Within the limit of this study, the temperature storage influenced ion release and the high-viscous glass ionomer showed the maximum values.

Effects of Protective Surface Coating on Fluoride Release and Recharge of Recent Uncoated High-Viscosity Glass Ionomer Cement

The ability to release and recharge fluoride is a property of glass ionomer cement materials, which is an advantage for patients with a high caries risk. The purpose of this study was to evaluate the amount of released and recharged fluoride in recent uncoated high-viscosity glass ionomer cement (KetacTM Universal AplicapTM) with different surface coatings and at different time points. In total, 135 cylindrical-shaped specimens were equally divided into the following three groups: KetacTM Universal AplicapTM, KetacTM Molar AplicapTM, and KetacTM Fil Plus AplicapTM. The different coatings performed on each group were as follows: uncoated, coated with KetacTM Glaze, and coated with G-Coat PlusTM. The amounts of released and recharged fluoride were measured at 24 h and at weeks 1, 2, 3, and 4. The recharging agent was a 1.23% APF gel. KetacTM Universal AplicapTM showed the highest released fluoride at all time points and the highest recharged fluoride at weeks 1, 2, and 3. Both the KetacTM Glaze- and G-Coat PlusTM-coated specimens presented significantly lower released and recharged fluoride ions than the uncoated group at all time points (p < 0.001). Coating with G-Coat PlusTM significantly decreased the released and recharged fluoride compared to the coating with KetacTM Glaze at almost all time points (p < 0.05), except for weeks 1 and 2. The application of coating agents reduced the amount of released and recharged fluoride by the KetacTM Universal AplicapTM.

Evaluation of a Method to Determine Wear Resistance of Class I Tooth Restorations during Cyclic Loading

The aim of this study was the development of a test regime to determine the wear resistance and predict the clinical performance of conventional glass ionomer cement (GIC) restorations in Class I tooth cavities. Cavities were prepared in excised human teeth and restored using three conventional glass ionomer restorative materials: DeltaFil, Fuji IX GP and Ketac Universal. The restored teeth were mechanically and thermally stressed using a chewing simulator with a maximum number of 1,200,000 load cycles. Besides determining the number of cycles achieved, the abrasion volume after termination of the chewing simulation was calculated using µCT images. All teeth restored with DeltaFil reached 1,200,000 cycles without any restoration failure. Only 37.5% of the restorations each with Ketac Universal and Fuji IX GP were able to achieve the maximum cycle number. A significant lower abrasion volume for restorations with DeltaFil compared to Ketac Universal (p = 0.0099) and Fuji IX GP (p = 0.0005) was found. Laboratory chewing simulations are a useful tool to study basic wear mechanisms in a controlled setting with in-vivo related parameters. DeltaFil shows an improved wear resistance compared to other conventional GICs, indicating the high potential of this material for long-lasting Class I restorations.

Effectiveness of glass ionomer cements in the restorative treatment of radiation-related caries - a systematic review

PURPOSE

The aim of this systematic review was to investigate the clinical effectiveness of glass ionomer cements (GICs) compared to other restorative materials in the treatment of radiation-related caries.

METHODS

Two independent researchers searched literature databases (PubMed, Scopus, Web of Science, Cochrane Library, Lilacs/BBO) and the grey literature to identify clinical trials that compared GICs with other restorative materials for the treatment of radiation-related caries. The clinical criteria considered for the performance of the restorations were based on the parameters of marginal adaptation/anatomical form, secondary caries, retention, and cumulative failures of the restorations. The methodological quality and risk of bias were evaluated using the Cochrane Collaboration tool.

RESULTS

From a total of 511, only four articles fulfilled the inclusion criteria. Conventional GIC restorations presented higher marginal adaptation failures than the resin-modified glass ionomer cements (RM-GICs) and composite restorations in all of the follow-up periods. Secondary caries was not observed in conventional GIC restorations throughout the follow-up periods, in three out of four of the included studies. RM-GICs and composite restorations showed significantly lower cumulative failure rates than conventional GICs at 6-, 12-, and 18-month follow-ups.

CONCLUSION

Due to insufficient scientific evidence, it was not possible to conclude that GICs are more effective than other restorative materials for the treatment of radiation-related caries.

Experimental Glass Ionomer Cement Containing Gallic acid: Antibacterial Effect and Fluoride Release an in vitro Study

Abstract: Aim: Assessment of antibacterial effect and fluoride release on glass ionomer cement (GIC) modified by different concentrations of gallic acid (GA) and their effect on working and setting time. Methodology: Four groups were tested, group I (control non modified group) and groups II-IV represent GIC modified by GA in three different concentrations (125mg/ml, 62.5mg/ml and 31.25mg/ml GA powder / GIC liquid respectively). Antibacterial effect against Streptococcus Mutans (S. Mutans) was determined after 24hr by broth dilution method. Fluoride release was evaluated after three time intervals 24, 48 and 96hr using spectrophotometer. Working and setting time were measured in all groups by indentation method. Results: Increasing the concentration of GA significantly increase the antibacterial effect. For all time intervals, the highest fluoride release were observed in group IV and the lowest were in group I. After 24hr groups II, III and IV were significant to group I, while after 48 and 96hr group IV was significant to group I. In addition, working and setting time significantly increased with increasing the GA concentration. Conclusion: Gallic acid improve the antibacterial effect of GIC against S. Mutans and also improve the fluoride release. The increase in working and setting time of GA modified groups were still within the limit given by ISO 9917–1:2007 specifications.

Effect of fluoride recharge on the microleakage of fluoride-releasing restorative materials: An ex vivo confocal laser scanning microscopy study

Context:

Success or failure of a restoration depends on its ability to bond to the tooth structure, to reduce microleakage, and to inhibit secondary caries. Fluoride-releasing materials have the inherent potential to release fluoride and are also capable of recharging themselves with topical agents.

Aim:

The aim of this study was to compare and evaluate the effect of fluoride recharge on microleakage of different restorative materials.

Materials and Methods:

Eighty extracted teeth were collected and split mesiodistally into 160 specimens. Class V cavities were prepared on buccal and lingual surfaces. Specimens were divided into four groups of 40 each based on the restorative material. Group I: Glass ionomer; Group II: Resin composite; Group III: Giomer; and Group IV: Alkasite. The restored teeth were stored in artificial saliva. Each group was divided into four subgroups for fluoride recharge and subsequent confocal laser scanning microscopy (CLSM) examination: (A) no fluoride recharge and CLSM examination after 24 h, (B) no fluoride recharge and CLSM examination after 3 weeks, (C) fluoride recharge once at third week followed by CLSM examination at 6 weeks, and (D) fluoride recharge twice at third week and sixth week followed by CLSM examination at 9 weeks.

Statistical Analysis:

Kruskal−Wallis and Mann−Whitney U tests were performed to analyze the obtained data.

Results:

A significant difference in microleakage was noted among resin composite and other groups except Cention-N, whereas no significant difference was noted pre- and post-fluoride recharge.

Conclusion:

Increased microleakage was noted post-fluoride recharge, although statistically not significant.

Enamel Demineralization Resistance and Remineralization by Various Fluoride-Releasing Dental Restorative Materials

The aim of this study is to investigate the resistance of various fluoride-releasing restorative materials against the demineralization and remineralization of enamel surfaces, including those that have been recently introduced to the market. Three different fluoride-releasing restorative materials were considered: glass ionomer (FI), resin-modified glass ionomer (RL), and an alkasite restorative material (CN). The acid neutralization ability was investigated using pH measurement, and the concentrations of released fluoride and calcium ions were measured. Finally, the demineralization resistance and remineralization effects of enamel were observed using a microhardness tester and SEM. CN showed an initial substantial increase in pH followed by a steady increase, with values higher than those of the other groups (p < 0.05). All three groups released fluoride ions, and the CN group released more calcium ions than the other groups (p < 0.05). In the acid resistance test, from the microhardness and SEM images, the CN group showed effective resistance to demineralization. In the remineralization test, the microhardness results showed that the FI and CN groups recovered the microhardness from the values of the demineralized enamel surface (p < 0.05). This was confirmed by the SEM images from remineralization tests; the CN group showed a recovered demineralized surface when immersed in artificial saliva for 7 days. In conclusion, alkasite restorative material can be an effective material when used in cariogenic environments.

Microbiological and SEM assessment of atraumatic restorative treatment in adult dentition

OBJECTIVES

To investigate the practicability of atraumatic restorative treatment (ART) in adults in terms of marginal adaptation of restorations and microbiological changes in residual carious dentin.

MATERIALS AND METHODS

The occlusal dentin caries of 25 permanent molar teeth were removed with hand instruments. The total counts of bacteria (TCB) and the facultative anaerobic bacteria (FAB), mutans streptococci (MS), and Lactobacillus spp. (LB) counts in the affected dentin were evaluated quantitatively. The weights of the samples were measured with an electronic balance (Shimadzu, Type AX200, Japan). The cavities were restored with glass ionomer cement (Ketac^TM Molar Easymix, ESPE Dental AG, Seefeld, Germany). Twenty replicas of randomly selected ART restorations were prepared and marginal adaptation was evaluated by scanning electron microscopy (SEM). After 6 months, the same protocols were repeated. Data were analyzed with paired sample t-tests, Wilcoxon t-tests, Pearson and Spearman correlations, and chi-square tests (p<0.05).

RESULTS

In the sixth month, restoration loss and pulpitis were not observed. The mean weight of samples removed from the cavity floor was less than the baseline (0.014±0.009 and 0.023±0.013 g, respectively) (p<0.01), and the counts of total bacteria, FAB, MS, and LB significantly decreased compared to baseline (p<0.01). The frequency of marginal gaps was increased (p< 0.01).

CONCLUSIONS

ART showed that the counts of microorganisms decreased after 6 months although the marginal gap rates of restorations increased.

CLINICAL RELEVANCE

ART can be a reliable treatment approach in adults for 6 months due to the decrease in microorganism counts, although gaps exist.

Kinetics of ion release from a conventional glass-ionomer cement

Release kinetics for sodium, silicon, aluminium, calcium and phosphorus from conventional glass-ionomer dental cement has been studied in neutral and acid conditions. Specimens (6 mm height × 4 mm diameter) were made from AquaCem (Dentsply, Konstanz, Germany), 6 per experiment. They were matured (37 °C, 1 h), then placed in 5 cm3 storage solution at 20-22 °C. In the first experiment, deionised water, changed daily for 28 days, was used. In the second, deionised water, changed monthly for 21 months, was used. In the third, lactic acid (20 mmol dm-3, pH: 2.7 ± 0.1), changed monthly for 21 months was used. After storage each solution was analyzed by inductively coupled plasma-optical emission spectroscopy (ICP-OES). Results showed that in neutral conditions, no calcium was released, but in acid, significant amounts were released. The other elements (Na, Al, Si and P) were released in neutral as well as acid conditions, with greater amounts in acid. More frequent changes of water gave greater release. In neutral conditions, release over 21 months followed the equation: [E]c = [E]1t/(t + t½) + β√t ([E]c is the cumulative release of the element). In acid conditions, this became: [E]c = [E]1t/(t + t½) + αt. Hence release of all elements was shown to occur in two steps, a rapid initial one (half-life: 12-18 h) and a longer second one. In neutral conditions, the longer step involves diffusion; in acid it involves erosion. These patterns influence the material's bioactivity.

Fluoride-Releasing Restorative Materials: The Effect of a Resinous Coat on Ion Release

Objective

To determine the effect of two adhesive systems and a glass ionomer coating resin on fluoride release and concurrent pH changes over a period of 168 days.

Material and methods

Four restorative materials were investigated: a giomer Beautiful II, an “alkasite” material Cention, a conventional composite Filtek Z250, and a glass ionomer cement Fuji IX Extra. Light-cured composite specimens were coated using G-aenial Bond and Clearfil Universal Bond Quick. Glass ionomer specimens were coated using GC Fuji Coat LC. Uncoated specimens were used as references. Quantitative fluoride release and pH changes were measured after1 h, 24 h, 2 days, 7 days, 28 days, 84 days, and 168 days.

Results

The cumulative fluoride release after 168 days increased for uncoated specimens in the following order: Filtek Z250 < Beautifil II < Cention < Fuji IX Extra. A comparatively lower fluoride release was measured for the composites coated with Clearfil Universal Bond Quick, with cumulative values after 168 days increasing in the following order: Filtek Z250 < Beautifil II < Cention. The composites coated with G-aenial Bond showed lower fluoride release compared to the uncoated specimens, with cumulative values increasing in the following order: Filtek Z250 < Beautifil II < Cention. The composites coated with G-aenial Bond showed pH values in the acidic range (4.4-5.7) after 1 h and 24 h.

Conclusion

Fluoride release varied among the investigated restorative materials and depended on the use of dental adhesives and coatings. The pH of all materials, coating types and time points varied.

The influence of light-curing time on fluoride release, surface topography, and bacterial adhesion in resin-modified glass ionomer cements: AFM and SEM in vitro study

Reinforced glass ionomer cements have been widely used in pediatric dentistry to prevent dental caries. However, the influence of biomaterial light-curing and its anti-cariogenic effects remain unclear. This study evaluates the influence of the light-curing time on fluoride release, surface topography, and bacterial adhesion in two types of resin-modified glass ionomer cements (RMGICs). One hundred disks were made, and samples were divided into two groups (n = 50 per group), according to each dental material (Vitremer™ and Ketac™ N100), and also divided into different light-cured times (10, 20, 30, 40, and 60 s). They were placed in phosphate-buffered saline solution (PBS) to measure the fluoride release. Subsequently, an independent sample of RMGICs per group was examined using atomic force microscopy (AFM). Four disks per group were incubated in a brain heart infusion (BHI) medium that was inoculated with Streptococcus mutans GS5 to evaluate the bacterial adhesion by 3-4, [5-dimethylthiazol-2-yl]-2,5-diphenyl tetrazolium bromide cell viability assay (MTT assay). The fluoride release was related to the light-curing time and gradually decreased as the light-curing time increased in both materials. Surface topography in Vitremer™ presents more irregular surfaces than Ketac™ N100. For S. mutans adhesion, the smallest number of cells per milliliter (cell/ml) was found at 40 s for Vitremer™ and at 30 s for Ketac™ N100. Thus, the shorter light-curing times allowed for major fluoride release in both materials. However, the RMGICs showed different patterns of bacterial adhesion according to the brand and light-curing time.

Twelve-month evaluation of the atraumatic restorative treatment approach for class III restorations: An interventional study

BACKGROUND

Atraumatic restorative treatment (ART) may be appropriate for populations without accessibility and affordability. More data are required regarding the success rate of ART in anterior teeth.

AIM

To evaluate the clinical performance of restoring class III cavities in anterior teeth of permanent dentition using the ART approach.

METHODS

A longitudinal interventional field study was carried out at two rural primary health centers, Tumkur district, India. A total of 54 teeth in 39 patients were evaluated for the survival rate of class III restorations in permanent anterior teeth using the ART approach in children and adult populations. Evaluation of ART restoration was carried out using Frencken J criteria, the mean procedure time, patient acceptance and reported pain severity during the ART approach were evaluated using a visual analog scale. Calculation of the cost of ART was also performed.

RESULTS

The mean time taken to perform the ART procedure was 14.79 ± 5.8 min with the majority of patients reporting only mild pain. At 6 mo follow-up, 72.2% remained in a good state, but this reduced to 27% at 12 mo. The cumulative survival rate of the restorations was 94.4% at 6 mo and 80.9% at 12 mo follow-up. Estimation of the direct cost for a single class III restoration was 186.50 INR (2.64 USD).

CONCLUSION

ART may be a good comprehensive option for basic oral health care for underserved or inaccessible populations, and preventive care for patients.

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.