Four-year evaluation of the effect of 10% polyacrylic acid or water rinsing pretreatment on retention of glass polyalkenoate cement

Retrospective Clinical Evaluation of RMGIC/GIC Class V Restorations

The aim of this retrospective study was to evaluate the clinical performance of glass-ionomer cement (GIC) and resin-modified glass-ionomer cement (RMGIC) materials in Class V carious cervical lesions restored by dental students. Ninety-six (96) restorations performed with either GIC (Fuji IX) (n = 39) or RMGIC (Fuji II LC) (n = 57) were evaluated using the modified USPHS criteria by two independent investigators at two follow-up evaluations (two years apart). The Fisher statistical test was used to compare USPHS criteria and examine significant differences, with a significance level set at p < 0.05. The Kaplan-Meier algorithm was used to calculate the survival probability. The overall success rate of Class V restorations was 72.9% at the second follow-up evaluation, with restorations ranging in age from 2.5 to 3.5 years. The RMGIC (Fuji II LC) restorations exhibited a significantly higher overall success rate compared to the GIC (Fuji IX) restorations (p = 0.0104). Significant differences were observed in retention (p = 0.0034) and color match (p = 0.0023).

The Chemical and Morphological Study of Calcium Silicate-Based Material (Biodentine®) and Glass Ionomer Cement (GIC®)

Background:

Attention was paid to the chemical properties of bioactive materials, and the reaction that could occur on their surface.

Objective:

The evaluation of the chemical properties includes the solubility, water sorption, pH changes and calcium release of two dental materials (BD and GIC). In addition, the morphological structure of each material was studied after its immersion in two different solutions,i.e.deionized water and phosphate solution.

Methods:

The chemical study was carried out for two sets of samples; 28 samples of each material. Samples were immersed in 10 mL of deionized water and stored at 37 °C for different times. The morphological structure and elemental analysis of BD and GIC samples were studied after immersion in the two solutions for 1, 7, 14 and 28 days.

Results:

Solubility of BD increased with time reaching a maximum value after 60 days (13.63 ± 2.08%). The solubility of GIC was negatively correlated with time, with a maximum value of 4.11 ± 0.47% for 3 h. The released Ca+2ions varied between 1.0 ± 0.3 mg (3 h) and 5.3 ± 0.8 mg (60 days) for BD. However, calcium was not detected in the GIC samples. The formation of calcium hydroxy-fluorapatites and strontium-fluoro-alumino-silicate, on the surface of BD and GIC, respectively, was clarified for the first time in this study.

Conclusion:

A comparative study was carried out revealing the difference in the chemical properties and the morphological structure between the two studied materials. The results confirmed the biointeractivity and the bioactivity of BD and GIC.

Retention of tooth-colored restorations in non-carious cervical lesions--a systematic review

OBJECTIVES

The aim of this review was to assess the effect of different adhesive systems and tooth preparation on the retention of tooth-colored restorative materials placed in non-carious cervical lesions (NCCLs).

METHODS

Randomized clinical trials with a minimum of 3 years of follow-up that evaluated the effectiveness of tooth-colored materials, adhesive systems, and preparation techniques for the restoration of NCCLs were selected. The Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE (OVID), the Latin American and Caribbean Health Sciences Literature database (LILACS), and Medline (OVID) electronic databases were searched from 1990 to 2013.

RESULTS

Twenty-seven randomized clinical trials were included and reviewed. Meta-analysis was used to determine the relative risk of loss of tooth-colored NCCL restorations between different categories of adhesive systems. The effect of tooth preparation could not be similarly analyzed.

CONCLUSION

The current best evidence indicates that a glass ionomer cement has a significantly lower risk of loss of a NCCL restoration compared to either a three-step etch-and-rinse or a two-step etch-and-rinse adhesive system; a three-step etch-and-rinse adhesive system has a significantly lower risk of loss of a NCCL restoration compared to a two-step etch-and-rinse adhesive system. No significant difference could be observed in the risk of loss of a tooth-colored NCCL restoration between a three-step etch-and-rinse adhesive system and either a two-step self-etch or a one-step self-etch adhesive system.

Glass ionomer cements and their role in the restoration of non-carious cervical lesions

Glass ionomer based materials are clinically popular in several areas of restorative dentistry, but restoration of cervical lesions has proven particularly successful. Various etiologies, conformations, locations and structural characteristics make non-carious cervical lesions more challenging to adhesive restorative procedures and marginal seal in the long run. Due to their characteristics, glass ionomer cements (GICs) have precise indication for these cases. Moreover, the use of a GIC base underneath composite resin, the so-called "sandwich" or mixed technique, allows associating the good characteristics of composite resins and GICs, and has been considered quite useful in the restoration of non-carious cervical defects. The aim of this paper is to critically review the literature and discuss peculiar features of GICs regarding their role in the restoration of non-carious cervical lesions.

Bond strengths of two conventional glass-ionomer cements to irradiated and non-irradiated dentin

This study evaluated the influence of irradiation on the dentin shear bond strength of two conventional glass ionomer cements (GICs). Thirty extracted molars were bisected in the mesio-distal direction. One-half of 20 teeth were irradiated with 60 Gy (5 days/week) for 6 weeks, and then GIC was placed on the irradiated dentin surface (Groups A1, B1). For the other halves of these tooth specimens, the GICs were first placed on their dentin surfaces and then the specimens irradiated (Groups A2, B2). The remaining 10 teeth were bisected and used as non-irradiated controls (Groups C1, C2). The GIC-dentin shear bond strengths were examined. Groups A2 and B2 had significantly lower bond strengths than groups A1, B1, C1, and C2 (p < 0.05). No significant differences were found among groups A1, B1, C1, and C2 (p > 0.05). In conclusion, irradiation may have an adverse effect on the bond strength of GICs depending on the application sequence.

Retention of a resin-modified glass ionomer adhesive in non-carious cervical lesions. A 6-year follow-up

OBJECTIVES

The purpose of this study was to evaluate the clinical retention of a new resin-modified glass ionomer cement based adhesive combined with a hybrid resin composite or a poly-acid modified resin composite in non-carious cervical lesions during a 6-year period.

METHODS

The resin-modified glass ionomer adhesive (Fuji Bond LC), was placed in 73 cervical lesions, 36 with a universal hybrid resin composite (Tetric Ceram) and 37 with a poly-acid modified resin composite (Hytac). Fifty-one in lesions with sclerotic dentin and 22 in non-sclerotic ones. Of the sclerotic lesions 38 were slightly roughened with a diamond bur before conditioning. The restorations were evaluated with slightly modified USPHS criteria every six months during a 6-year period.

RESULTS

All except six restorations were evaluated during the 6 years. Twelve (17.9%) were lost, four Tetric Ceram (11.8%) and eight Hytac (24.2%) (p<0.05). Four were found in non-sclerotic lesions (20.0%) and eight in sclerotic lesions (17.0%). The differences between the sclerotic and non-sclerotic and the roughened and non-roughened lesions were not significant.

CONCLUSIONS

The resin-modified glass adhesive showed a superior clinical retention combined with the resin composite material, with an annual failure rate of 2%.

Four-year water degradation of a resin-modified glass-ionomer adhesive bonded to dentin

Glass-ionomers are auto-adhesive to tooth tissue through combined micro-mechanical and chemical bonding. How much each of the two bonding components contributes to the actual bonding effectiveness is, however, not known and there is not much information available on long-term stability. The objective of this study was to assess the bonding effectiveness of a resin-modified glass-ionomer adhesive to dentin after 4 yr of water storage. Fuji Bond LC (GC) was applied without (i) and with pretreatment using (ii) a polyalkenoic acid conditioner and (iii) a 37.5% phosphoric acid etchant. The etchant was used to exclude any chemical interaction with hydroxyapatite. The micro-tensile bond strength ( microTBS) to dentin decreased significantly over the 4 yr period in all three experimental groups. After 24 h and 4 yr, the lowest micro TBS was recorded when dentin was not pretreated. The highest micro TBS was obtained following polyalkenoic acid pretreatment, although this was not significantly different from specimens that were pretreated using phosphoric acid. Pretreating dentin with phosphoric acid intensified micromechanical interlocking at the expense of chemical bonding potential to hydroxyapatite. Nevertheless, correlating the micro TBS data with failure analysis through scanning electron microscopy and transmission electron microscopy indicated that combined micro-mechanical and chemical bonding involving pretreatment with the polyalkenoic acid conditioner yielded the most durable bond.

Bonding of contemporary glass ionomer cements to dentin

OBJECTIVE

The objective of this study was to investigate the microtensile bond strength (microTBS) of contemporary glass ionomer cements (GIC) to sound coronal dentin.

METHODS

Three specimen teeth were prepared for each material tested: Fuji IX GP (GC), ChemFlex (Dentsply) and Ketac-Molar Aplicap (ESPE). GIC buildups were made according to the manufacturers' instructions. After being stored at 37 degrees C, 100% humidity for 24h, the teeth were vertically sectioned into 1x1mm beams for microTBS evaluation. Representative fractured beams were prepared for scanning (SEM) and transmission electron microscopic (TEM) examination.

RESULTS

Results of the microTBS test were: Fuji IX GP (12.4+/-8.6MPa), ChemFlex (15.0+/-9.3MPa) and Ketac-Molar Aplicap (11.4+/-7.7MPa). One-way ANOVA and a multiple comparison test showed that ChemFlex had a statistically higher microTBS (p<0.05). SEM fractographic analysis showed that the predominant failure modes were interfacial and mixed failures. The GIC side of the fractured beams revealed dehydration cracks, a high level of porosity, and voids with an eggshell-like crust. TEM analysis of the demineralized dentin sides of the fractured beams revealed the presence of an intermediate layer along the GIC-dentin interface. This zone was present on the fractured dentin surface in the case of interfacial failure, and beneath GIC remnants in specimens that exhibited a mixed failure mode.

SIGNIFICANCE

The findings suggest that the bonding of GIC to dentin is not weak and that the microTBS values probably represent the weak yield strengths of GICs under tension.

Clinical performance of a condensable metal-reinforced glass ionomer cement in primary molars

OBJECTIVE

Aim of the present study was to evaluate the clinical suitability of the condensable metal-reinforced glass ionomer cement Hi-Dense in classes I and II cavities of primary molars.

METHODS

Seventeen children received a total of fifty four Hi-Dense fillings (nineteen class I and thirty five class II). The restorations were clinically assessed at baseline, after one and after two years of clinical service according to modified USPHS codes and criteria. The restorations were replicated in each recall and representative samples were qualitatively analysed under a SEM.

RESULTS

Over the observation period of two years, five restorations failed due to total retention loss, two fillings needed replacement because of persisting hypersensitivity, one filling was lost because of an unsuccessful endodontic treatment, and four restorations remained intact until natural exfoliation (Two year survival rate: 92% for Class I and 66% for Class II). The SEM analysis of surfaces and marginal areas exhibited an inferior adhesive performance primarily in proximal areas, whereas a negative step formation due to wear was frequently observed in occlusal parts.

CONCLUSIONS

The results clearly indicate that the condensable, metal-reinforced GIC Hi-Dense reveals no enhanced performance and lifetime expectancy for class II restorations in primary molars when compared to other non-resin-modified GICs.

The evaluation of four conditioners for glass ionomer cements using field-emission scanning electron microscopy

OBJECTIVES

The purpose of this study was to evaluate the GIC-dentine interface morphology using FE-SEM after four different conditioners (Ketac Conditioner, Dentin Conditioner, Cavity Conditioner, and an experimental conditioner K-930), used with two RM-GICs and one self-cured GIC, and to observe the effect with an AFM of the four different conditioners on the surface of polished human dentine.

MATERIALS AND METHODS

SAMPLE PREPARATION FOR FE-SEM: Twenty-four 1-mm thick dentine discs were obtained from superficial occlusal dentine of extracted human third molars, and finished with wet 600-grit SiC paper. The discs were treated for each of the GICs using the conditioners according to the manufacturers' instructions. The specimens were kept in tap water for 24 h at 37 degrees C, and then assigned for one of two observational techniques; a fractured technique and an acid-base technique. Specimens were mounted on aluminium stubs, gold sputter-coated and observed using a FE-SEM. SAMPLE PREPARATION FOR AFM: Four rectangular dentine blocks approximately 2mm(3) were prepared from two extracted human third molars, polished and finished with diamond paste down to 0.25 microm particle size. One half of each sample was treated with one of the conditioners according to the manufacturers' instructions, and the other half was not conditioned. The samples were stored in distilled water prior to AFM contact mode observation.

RESULTS

FE-SEM: All specimens of all materials demonstrated good adaptation to the underlying dentine. However, the specimens conditioned with K-930 showed increased demineralization and a thicker acid-base resistant layer (2.8-3.4 microm) compared with the others (1-2 microm). AFM: The images of conditioned specimens showed demineralization of peritubular dentine. Funneling of dentinal tubule orifices of specimens conditioned with K-930 was observed, and was also seen for the FE-SEM specimens.

SIGNIFICANCE

The use of surface conditioners resulted in similar adaptation to the non-conditioned specimens at the GIC-dentine interface. All of the GICs demonstrated intimate adaptation to the dentine surface whether it was conditioned or not.

Clinical evaluation of three adhesive systems in class V non-carious lesions

OBJECTIVES

The purpose of this study was to evaluate the clinical retention of three new adhesive systems in non-carious cervical lesions during a 3-year period.

METHODS

The adhesive systems, a three-step (EBS/Pertac Hybrid), a one-bottle resin bonding agent (One-Step/Pertac Hybrid) and a resin-modified glass ionomer cement (Fuji II LC) were placed in 148 non-carious cervical lesions, 87 with sclerotic dentin and 61 non-sclerotic. Of the sclerotic lesions treated with the two resin bonding systems, 37 were slightly roughened with a diamond bur before conditioning. The restorations were evaluated every 6 months during a 3-year period.

RESULTS

All except six restorations were evaluated during the 3 years. The cumulative loss rates for EBS, One-Step and Fuji II LC were, at 1 year: 2, 24 and 2% and at 3 years: 10, 49, 7%, respectively. The one-bottle adhesive showed significantly more failures. The five lost EBS restorations were found in non-sclerotic lesions, while the three lost Fuji II LC restorations had been placed in sclerotic lesions. For the One-Step material the loss frequency for non-sclerotic versus sclerotic lesions was 31.8 and 65.2%, respectively. Slight roughening of the sclerotic dentin surfaces with a diamond bur did not increase retention of the restorations.

SIGNIFICANCE

The three-step resin adhesive and the RMGIC showed clinically acceptable retention rates, while a high failure rate was registered for the one-bottle adhesive.

Longevity of extensive class II open-sandwich restorations with a resin-modified glass-ionomer cement

Several new techniques have been introduced for use in the esthetic restoration of posterior cavities to substitute for the presumed toxicity of amalgam. Composite-laminated glass-ionomer cement restorations, the sandwich technique, have been recommended for caries-risk patients. Clinical evaluation of the use of conventional glass-ionomer cements in the open-sandwich restoration has shown a high failure rate. The aim of this study was to evaluate the durability and cariostatic effect of a modified open-sandwich restoration utilizing a resin-modified glass-ionomer cement (RMGIC) in large cavities. The materials consisted of 274 mostly extensive Class II Vitremer/Z100 restorations performed by four dentists in 168 adults. Six experimental groups were investigated. In four groups a thick and in two groups a thin layer of cement was placed. Cavity conditioning before application of the RMGIC self-etching primer was done in 3 groups with polyacrylic acid and in one group with maleic acid; in two groups, only water rinsing was performed. The restorations were evaluated at baseline and after 6, 12, 24, and 36 months according to modified USPHS criteria (van Dijken, 1986). After 3 years, 239 restorations were evaluated. Twelve (5%) were estimated as non-acceptable. Two were replaced, and seven were repaired with resin composite. Tooth fractures were observed in 2.5%. Slight erosion of the RMGIC part was seen in 4%, and in one case operative treatment was indicated. Post-operative sensitivity was reported for 9 teeth. Forty-three percent of the patients were considered as caries-risk patients. Only one restoration showed secondary caries. The three-year results indicated that the modified open-sandwich restoration is an appropriate alternative to amalgam including extensive restorations.

Glass-ionomer restoratives: a systematic review of a secondary caries treatment effect

It is generally accepted that glass ionomers inhibit secondary caries in vivo, and data from in vitro studies support this effect. The aim of this review was a systematic assessment, from the literature, of clinical evidence for the ability of glass-ionomer restoratives to inhibit secondary caries at the restoration margin. Inclusion and exclusion criteria for selection of the review papers were established prior to commencement of the literature search. Papers which conformed to these criteria, and reported on secondary caries as an outcome, were selected (N = 52). Primary and secondary lists of systematic criteria for use in the assessment of the papers were drawn up. The primary list of 14 criteria was applied to each paper. No paper fulfilled all these criteria, necessitating the use of the secondary measures: (i) a prospective study and (ii) use of an appropriate control. This yielded 28 papers. Tabulation of these papers by occurrence of secondary caries in the glass-ionomer or control groups demonstrated an even distribution between positive and negative outcomes. Valid evidence is considered to be best obtained from randomized, controlled studies of sufficient sample size. No conclusive evidence for or against a treatment effect of inhibition of secondary caries by the glass-ionomer restoratives was obtained from the systematic review. There is a need for appraisal of the methods currently adopted for the clinical evaluation of glass-ionomer restorative materials, and for further development of the methodology to support future systematic reviews.

Marginal adaptation and retention of a glass-ionomer, resin-modified glass-ionomers and a polyacid-modified resin composite in cervical Class-V lesions

OBJECTIVES

An 18-month follow-up clinical trial of one conventional glass-ionomer (HIFI Master Palette), three resin-modified glass-ionomers (Fuji II LC, Vitremer, 3M Exp. 155) and one polyacid-modified resin composite (Dyract) was conducted to evaluate their clinical effectiveness in Class-V cervical lesions. In addition, the interface between dentin and two resin-modified glass-ionomers and one polyacid-modified resin composite was examined by scanning electron microscopy (SEM).

METHODS

After evaluation of the restorations immediately following placement (baseline), all patients were subjected to a strict recall schedule with controls at 6, 12 and 18 months. The clinical effectiveness was recorded in terms of retention and marginal integrity, clinical microleakage, caries recurrence, and tooth vitality. A chi 2-test (p < 0.05) was used to test for significant differences between materials. In case of restoration loss or special defects, a replica was made to examine the surface texture and restoration margins by SEM. In vitro, the interface was examined by SEM after an argon-ion-beam etching technique was used to enhance surface relief and disclose interfacial substructures.

RESULTS

Retention appeared to be good for all the materials tested. Marginal discrepancies were localized at the incisal enamel and/or the cervical dentin margin, except for the polyacid-modified resin composite that showed most of the defects at the incisal enamel margin. None of the systems could guarantee margins free of microleakage for a long time. In vitro, the type of dentin pre-treatment defines to a great extent the morphology of the resultant interface between dentin and the restorative material tested.

SIGNIFICANCE

In this clinical study, the retention rate of the tested materials was good and even excellent for some products. Perfect marginal adaptation deteriorated too fast. The marginal adaptation of the polyacid-modified resin composite at the enamel site would probably have been better by the use of selective enamel or total acid etching. Marginal sealing remains a problem. Future research should concentrate on improving the marginal adaptation and sealing capacities before a broader clinical use can be advocated.

Resin-modified glass ionomer cements: bonding to enamel and dentin

OBJECTIVES

This study was designed to investigate the effect of storage in water on bonding efficacy to enamel and dentin of four resin-modified (Dyract, De Trey Dentsply; Fuji II LC, GC Dental Corp.; Photac Fil, ESPE; Vitremer, 3M Dental Products), one conventional glass ionomer filling material (Ketac Fil, ESPE) and a resin composite system (Pekafill/Gluma bonding system, Bayer). The hypothesis was that water storage would lead to an adverse effect on bond strength of resin-modified glass ionomer cements to enamel and dentin.

METHODS

The shear bond strength of each material was determined after storage periods of 24 h, 1 wk, 1 mon, 3 mon and 6 mon. The data were subjected to one-way ANOVA. Significant differences were determined by multiple comparison testing (significance level 5%). The failure modes of the debonded specimens were analyzed with a dissecting microscope.

RESULTS

Shear bond strengths to enamel for Dyract, Photac Fil and Pekafill were 5.2 +/- 1.3, 9.9 +/- 1.6 and 17.0 +/- 2.3 MPa, irrespective of storage time (p > 0.05). For Ketac Fil, the average shear bond strength between 1 wk and 6 mon was 4.5 +/- 1.7 MPa, the mean value for Fuji II LC between 24 h and 3 mon was 10.3 +/- 3.9 MPa and after 6 mon was 19.8 +/- 4.4 MPa, while Vitremer showed increasing shear bond strengths between 24 h (2.4 +/- 0.8 MPa) and 1,3 and 6 mon (13.8 +/- 4.3 MPa). Shear bond strengths to dentin were not adversely affected by storage throughout the 6 mon for Dyract (13.0 +/- 2.6 MPa), Fuji II LC (12.7 +/- 1.7 MPa) and Pekafill (14.6 +/- 3.1 MPa), when tested by ANOVA (p > 0.05). Ketac Fil showed 4.9 +/- 1.2 MPa between 1 wk and 6 mon and lower shear bond strength after 24 h. The average shear bond strengths up to 1 mon for Vitremer were 5.4 +/- 2.5 MPa (p > 0.05). However, at 3 and 6 mon immersion in water, three specimens had loosened spontaneously. With Photac Fil, no adhesion to dentin was registered. Most samples showed cohesive failure patterns in the restorative materials. Adhesive or mixed failures were registered only for Vitremer on dentin and enamel up to 1 wk and for Dyract on enamel.

SIGNIFICANCE

Long-term water storage generally had no adverse effect on bonding efficacy of resin-modified glass ionomer cements to dentin and enamel.