FDI report on adverse reactions to resin-based materials

Long-term elution of bisphenol A from dental composites

OBJECTIVES

BPA release from composites on the short term has been reported in several in-vitro and in-vivo studies. However, it remains unclear whether these materials also leach BPA on the long term. Even though composites may release various (BPA-based) methacrylate monomers up to one year, quantitative data about BPA have not been reported due to the lack of a sensitive method to accurately quantify low levels of BPA. In this context, the aim of the study was to quantify the one-year release of BPA with an optimized analytical method.

METHODS

Composite disks (n = 6, 6 mm diameter and 2 mm height) from four commercial materials (G-ӕnial Posterior, Venus, Ceram.x mono and Filtek Supreme XTE) were immersed in 1 mL of water or ethanol as extraction solvent and stored in the dark at 37 °C. The extraction solvent was renewed weekly for a period of 52 weeks. Samples were derivatized with pyridine-3-sulfonyl chloride before analysis with ultra-pressure liquid chromatography tandem mass spectrometry (UPLC-MS/MS).

RESULTS

Derivatizing BPA increased the sensitivity of the analytical method and allowed accurate quantification of very low levels of BPA (i.e. 0.78 pmol BPA). BPA eluted continuously in ethanol from all four tested composites over a period of one year. BPA elution was clearly higher when ethanol was used as extraction solution. In water, BPA eluted could be detected up to one year, but levels could not be accurately quantified anymore after several weeks.

SIGNIFICANCE

Composites can be considered as a potential long-term source of BPA, and thus should not be neglected when assessing the overall exposure to endocrine disrupting chemicals.

Material Tissue Interaction--From Toxicity to Tissue Regeneration

The topic of material tissue interaction has gained increasing interest over recent decades from both the dental profession and the public. The primary goal initially was to avoid adverse reactions after the application of dental materials. New laboratory test methods have been developed, and currently premarket testing programs, which attempt to guarantee a basic level of patient safety, are legally required worldwide. The dentist is responsible for selecting the correct indication as well as the proper handling of any newly emerging risk. Apart from this phenomenon-oriented "inert materials concept," the "analytical concept" focuses primarily on analyzing the reasons for adverse reactions, and identifying their associated modifying factors, in order to prevent them or to develop new and more biocompatible materials. The "concept of bioactivity" involves addressing the possibility of positively influencing tissue by materials application, such as the generation of tertiary dentin or antibacterial effects. Finally, tissue regeneration may be supported and promoted by the use of various suitable materials (matrices/scaffolds) into which stem cells can migrate or be seeded, leading to cell differentiation and the generation of new tissue. These new dental materials must also fulfill additional requirements such as controlled degradability in order to be suitable for clinical use. Clearly, the field of material tissue interaction is complex and comprises a wide range of issues. To be successful as dentists in the future, practitioners should remain informed of these important new developments and have the argumentative competence to both properly advise and treat their patients.

Contact allergies to potential allergens in patients with oral lichen lesions

OBJECTIVE

The aim of the present controlled study was to investigate a possible relationship between contact allergies to potential allergens and oral lichen lesions.

METHODS

Eighty-three patients with oral lichen lesions (OLL) and control groups of age- and gender-matched dermatitis patients (DP, n = 83) and patch-tested dermatitis patients randomly selected from files (PSFF, n = 319) were included in the study. OLL and DP groups were patch-tested epicutaneously and examined intraorally.

RESULTS

The frequencies of contact allergy to mercury and carvone were statistically higher in the OLL group than in the DP group. Surfaces of amalgam and composite restorations were statistically more frequent in the OLL group compared to the DP group. Contact allergy to nickel and colophony, the latter with a statistically significant difference, was more common in the DP group. The numerical difference found for nickel allergy was, however, not significant comparing the OLL and PSFF groups.

CONCLUSION

Contact allergy to mercury was overrepresented in patients with OLL and has been reported in previous studies, but the present finding of an overrepresentation of contact allergy to carvone in patients with oral lichen lesions has not been reported previously.

CLINICAL RELEVANCE

Carvone, in addition to mercury and gold, as previously suggested, can be one of the causative or maintenant factors for oral lichen lesions. Carvone-hypersensitive patients with oral lichen lesions should therefore avoid carvone-containing products for oral use.

An in vitro investigation into the cytotoxicity of methyl methacrylate monomer

Aim of this study was to assess the cytotoxicity of monomer. An in vitro study was designed to study the growth inhibitory effect of monomer (Stellon, Denture Material Improved, Type I, Class I, Dental Products of India Limited) on cells seeded in petri dishes and maintained in an incubator with 5% carbon dioxide at 37 °C. The growth of V79 cells (fibroblast cells) maintained in a culture medium to which monomer was added was studied for a period of 5 days. Results of this study pointed out that even at a concentration of 1 µl of monomer, the cell growth was significantly inhibited, when compared to the control group. The number of viable cells decreased dramatically whereas dead cells increased in the culture groups treated with the monomer. The cytotoxic effect was dose dependent. As the concentration increased from 1 to 10 µl there was a marked inhibition of cell growth and a corresponding increase in dead cell count. Results of this study proved beyond doubt that monomer is indeed cytotoxic even in very low concentrations. Thus, it becomes imperative to adopt every possible means to minimize residual monomer content in heat cured resins. Also precautions to minimize tissue contact should be taken while handling monomer by the dentist and dental personnel in the laboratory.

Detection and quantification of monomers in unstimulated whole saliva after treatment with resin-based composite fillings in vivo

Resin-based dental restorative materials contain allergenic methacrylate monomers, which may be released into saliva after restorative treatment. Monomers from resin-based composite materials have been demonstrated in saliva in vitro; however, studies analyzing saliva after restorative therapy are scarce. The aim of this study was to quantify methacrylate monomers in saliva after treatment with a resin-based composite filling material. Saliva was collected from 10 patients at four start points--before treatment, and 10 min, 24 h, and 7 d after treatment--and analysed by combined chromatography/mass spectrometry. The monomers bisphenol-A diglycidyl methacrylate (Bis-GMA), 2-hydroxyethyl methacrylate (HEMA), and urethane dimethacrylate (UDMA) were detected and quantified in the samples collected shortly (10 min) after treatment. The amounts detected ranged from 0.028 to 9.65 μg ml(-1) for Bis-GMA, from 0.015 to 0.19 μg ml(-1) for HEMA, and from 0.004 to 1.2 μg ml(-1) for UDMA. Triethyleneglycol dimethacrylate (TEGDMA) was detected in four of the samples. Ethoxylated bisphenol-A dimethacrylate (Bis-EMA) was not detected. Monomers were not detected in saliva samples collected before treatment, or 24 h or 7 d after treatment, with the exception of one sample, 24 h after treatment, in which HEMA was detected. In conclusion, monomers from the investigated resin-based composite and adhesive system were present in saliva shortly after treatment. One week after treatment, no monomers could be detected in patients' saliva samples.

Reduction of mandible fractures with direct bonding technique and orthodontic appliances: two case reports

Intermaxillary fixation (IMF) with the arch bars or looped wires has been widely used to treat mandible fractures. However, manipulation of these appliances takes time and the medical staff is endangered by wire stabbing injuries. A modified method, the direct bonding technique combined with orthodontic appliances, simplifies the IMF concept to overcome these problems. It is faster, safer and easier to apply while the response of patients, with respect to treatment results, ease of the living and oral hygiene is more favorable. This report presents two cases of mandible fractures treated according to this protocol which resulted in good outcomes as expected.