Clinical Performance of Viscous Glass Ionomer Cement in Posterior Cavities over Two Years

Evaluating Glass Ionomer Cement Longevity in the Primary and Permanent Teeth-An Umbrella Review

The aim of this umbrella review was to evaluate the longevity of glass ionomer cement (GIC) as a restorative material for primary and permanent teeth. Research in the literature was conducted in three databases (MedLine/PubMed, Web of Science, and Scopus). The inclusion criteria were: (1) to be a systematic review of clinical trials that (2) evaluated the clinical longevity of GICs as a restorative material in primary and/or permanent teeth; the exclusion criteria were: (1) not being a systematic review of clinical trials; (2) not evaluating longevity/clinical performance of GICs as a restorative material; and (3) studies of dental restorative materials in teeth with enamel alterations, root caries, and non-carious cervical lesions. Twenty-four eligible articles were identified, and 13 were included. The follow-up periods ranged from 6 months to 6 years. Different types of GICs were evaluated in the included studies: resin-modified glass ionomer cement (RMGIC), compomers, and low- and high-viscosity glass ionomer cement. Some studies compared amalgam and composite resins to GICs regarding longevity/clinical performance. Analyzing the AMSTAR-2 results, none of the articles had positive criteria in all the evaluated requisites, and none of the articles had an a priori design. The criteria considered for the analysis of the risk of bias of the included studies were evaluated through the ROBIS tool, and the results of this analysis showed that seven studies had a low risk of bias; three studies had positive results in all criteria except for one criterion of unclear risk; and two studies showed a high risk of bias. GRADE tool was used to determine the quality of evidence; for the degree of recommendations, all studies were classified as Class II, meaning there was still conflicting evidence on the clinical performance/longevity of GICs and their recommendations compared to other materials. The level of evidence was classified as Level B, meaning that the data were obtained from less robust meta-analyses and single randomized clinical trials. To the best of our knowledge, this is the first umbrella review approaching GIC in permanent teeth. GICs are a good choice in both dentitions, but primary dentition presents more evidence, especially regarding the atraumatic restorative treatment (ART) technique. Within the limitation of this study, it is still questionable if GIC is a good restorative material in the medium/long term for permanent and primary dentition. Many of the included studies presented a high risk of bias and low quality. The techniques, type of GIC, type of cavity, and operator experience highly influence clinical performance. Thus, clinical decision-making should be based on the dental practitioner's ability, each case analysis, and the patient's wishes. More evidence is needed to determine which is the best material for definitive restorations in permanent and primary dentition.

Do bioactive materials show greater retention rates in restoring permanent teeth than non-bioactive materials? A systematic review and network meta-analysis of randomized controlled trials

OBJECTIVES

To answer the following research question: does the clinical evaluation of restorations on permanent teeth with bioactive materials show greater retention rates than those with non-bioactive materials?

MATERIALS AND METHODS

A search strategy was used in the following databases: MEDLINE via PubMed, Scopus, Web of Science, LILACS, BBO, Embase, The Cochrane Library, and OpenGrey. Randomized controlled trials (RCTs), with a minimum of 2-year follow-up and evaluating at least one bioactive material in permanent teeth were included. Risk of bias was detected according to the Cochrane Collaboration tool for assessing the risk of bias (RoB 2.0), and network meta-analysis was performed using a random-effects Bayesian-mixed treatment comparison model.

RESULTS

Twenty-seven studies were included. The success of the restorations was assessed using modified USPHS system in 24 studies and the FDI criteria in 3 studies. Network meta-analysis revealed three networks based on restoration preparations. Resin composites were ranked with higher SUCRA values, indicating a greater likelihood of being the preferred treatment for class I, II, and III restorations. In class V, resin-modified glass ionomer cement was ranked with the highest value.

CONCLUSION

Bioactive restorative materials showed similar good clinical performance in terms of retention similarly to conventional resin composites.

CLINICAL SIGNIFICANCE

The findings must be interpreted with caution because many RCT on restorative materials aim to verify the equivalence of new materials over the gold standard material rather than their superiority. The present systematic review also suggests that new RCT with longer follow-up periods are necessary.

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.

High-viscosity glass-ionomer cement or composite resin for restorations in posterior permanent teeth? A systematic review and meta-analyses

OBJECTIVES

Answer the PICO question: Do class I and II posterior restorations in permanent teeth placed with high-viscosity glass-ionomer cement (HV-GIC) fail more than composite resin (CR) restorations?

DATA

The study was registered in the PROSPERO database (CRD42020138290). Randomized and controlled clinical trials, comparing the performance of HV-GIC and CR in load bearing cavities of posterior permanent teeth were included. Cochrane risk of bias tool and GRADE were used to assess the quality and certainty of the evidence. Meta-analyses were performed for clinical outcomes on USPHS and FDI criteria for 12-, 24- and 36-months follow-ups.

SOURCES

PubMed, Scopus and Web of Science were last searched on April 2, 2022, without language or date restrictions. Reference lists of primary studies and their related article link in PubMed were manually searched.

STUDY SELECTION

Ten studies were included, while data from 8 were used for the meta-analyses. A total of 849 HV-GIC and 800 CR restorations were followed. The primary outcome was the fracture/retention of the restoration, with a comparable performance for both materials on all follow-ups. The 36 months follow-up for class I restorations (longest) showed risk difference of -0,00 (95%CI -0,03 to 0,03; p = 0,98) and no heterogeneity (p = 0,98, I2=0%). The certainty of the evidence is moderate, as all included studies were at an uncertain risk of bias.

CONCLUSIONS

HV-GIC and CR presented comparable clinical performance in posterior permanent teeth up to 36 months. HV-GIV wear in class I restorations followed by 24 months was the only poorer result compared to CR.

CLINICAL SIGNIFICANCE

Conservative load bearing cavities in permanent posterior teeth can be restored with HV-GIC with comparable clinical performance to CR expected at least up to 3 years. HV-GIC is a valuable direct restorative option for posterior teeth in high caries risk patients, in which CR is frequently associated with failure.

Comparative Evaluation of Fluoride Release from Four Commercially Available Pediatric Dental Restorative Materials

Objectives

The aim of this study was to evaluate the fluoride-releasing abilities of commercially available restorative materials such as-Activa™ BioActive-restorative™ material, Zirconomer (Shofu Inc), Beautifil® II (Shofu Inc), GC Gold Label 9 high strength posterior restorative glass ionomer cement (GIC Corp).

Materials and methods

A total of 40 disk specimens (10 of each material) were placed into distilled/deionized (DI) water and the fluoride release was measured for 30 days. Fluoride ion measurement was performed at the end of the 1st, 3rd, 7th, 15th, and 30th day under normal atmospheric conditions by fluoride ion selective electrode (F-ISE) (Orion 9609 BNWP, Ionplus SureFlow fluoride electrode, Thermo Scientific, United States of America) coupled to a benchtop analyzer (Hachsen Ion+).

Results

All the materials included in the study exhibited fluoride release. Although there were differences in the amounts of fluoride released between Activa™, Zirconomer, and GC Gold Label 9 the mean difference between these three groups was not found to be statistically significant. Beautifil® II showed low amounts of fluoride released at all time intervals.

Conclusion

Among the above-compared materials Activa™ and Zirconomer exhibit both improved mechanical properties as well as they have fluoride-releasing ability so can be preferred over conventional glass ionomer restorations.

How to cite this article

Dhumal RS, Chauhan RS, Patil V, et al. Comparative Evaluation of Fluoride Release from Four Commercially Available Pediatric Dental Restorative Materials. Int J Clin Pediatr Dent 2023;16(S-1):S6-S12.

[Amalgam and alternatives-discussions on mercury reduction in the environment]

Dental amalgam has been successfully used for the restoration of carious lesions for more than 180 years. It is clinically characterized by high longevity and low technique sensitivity. For decades, dental amalgam has been discussed in the public, especially due to its roughly 50% mercury content. Since the Minamata Convention was published in 2013 with the primary goal of reducing the anthropogenic mercury release into the environment, the previously muted amalgam discussion has received fresh impetus. Another considerable disadvantage of amalgam is its silver/greyish color, which simply no longer matches patients' esthetic demands.The present paper describes the basic problems with amalgam against the background of multiple biological, clinical, and health policy factors. Possible consequences of the Minamata Convention concerning legal regulations as well as the use of dental biomaterials and therefore also relating to the future national healthcare system are discussed. Finally, possible amalgam alternatives and the urgent need for biomedical research towards restorative dentistry are presented, embedded into the crucial question of whether we are actually conducting the correct debate.

Clinical Performance of a Glass Hybrid Restorative in Extended Size Class II Cavities

Objective:

To evaluate the clinical performance of a glass hybrid restorative compared with a resin composite in the restoration of large and deep Class II cavities after 24 months.

Methods and Materials:

A total of 108 extended size, with the width of the proximal box not interfering with the peak of the cusps and the proximal box in occlusion, Class II lesions in 37 patients were either restored with a glass hybrid restorative or with a micro-hybrid composite resin in combination with selective etching by two experienced operators according to the manufacturer's instructions. Two independent examiners evaluated the restorations at baseline and at the six-, 12-, 18-, and 24-month recalls according to the modified US Public Health Service criteria. Negative replicas at each recall were observed under scanning electron microscopy (SEM) to examine surface characteristics. Data were analyzed statistically.

Results:

After 24 months, 90 restorations were evaluated in 32 patients (recall rate: 86.5%). Four glass hybrid restorations were missing; three were due to bulk and one was due to proximal fracture at 12 months. Only six restorations were scored as bravo at baseline and at the six-, 12-, 18-, and 24-month recalls for color (p<0.05). No significant differences were observed between the two restorative materials for the other criteria evaluated (p>0.05). SEM observations exhibited acceptable surface and marginal adaptation characteristics for both restorative materials at 24 months.

Conclusions:

Although glass hybrid restorations showed significant mismatch in color, both restorative materials exhibited successful performance for the restoration of large Class II cavities after 24 months.

Glass ionomer cement inhibits secondary caries in an in vitro biofilm model

OBJECTIVES

The objective of this study was to investigate the effect of different glass ionomer cements on secondary caries inhibition in a fully automated in vitro biofilm model.

MATERIALS AND METHODS

One hundred and twenty-four extracted third molars received class V cavities and were filled with one conventional (Ketac Molar/KM), and two resin-modified glass ionomer cements (Photac Fil/PF, Ketac N100/KN, 3M Espe). A bonded resin composite (Single Bond Plus/Filtek Supreme XTE) served as control. After 14 days water storage at 37 °C, specimens were thermocycled (10,000 × 5/55 °C). Over a period of 10 days, specimens were subjected to cariogenic challenge for 3/4/6 h/day. Demineralization was caused by Streptococcus mutans (DSM 20523) alternatingly being rinsed over specimens using artificial saliva. After biological loading, teeth were cut longitudinally and demineralization depths were evaluated at the margins and at a distance of 0.5 mm from the margins using fluorescence microscopy. Marginal quality was investigated under a SEM at ×200 magnification.

RESULTS

Four-hour demineralization depths were for enamel margins (EM), enamel (E), dentin margin (DM), and dentin (D) (μm ± SD): KM: EM 12 ± 8, E 33 ± 7, DM 56 ± 11, D 79 ± 6; PF: EM 19 ± 13, E 34 ± 13, DM 53 ± 10, D 77 ± 12; and KN: EM 26 ± 5, E 38 ± 6, DM 57 ± 11, D 71 ± 7. For all glass ionomer cements (GICs), demineralization depth at the margins was less compared to 0.5 mm distance, with demineralization depth having been correlated to duration of cariogenic challenge (ANOVA [mod. LSD, p < 0.05]). Compared to the bonded resin composite, all GICs exhibited caries inhibition at restoration margins in enamel and dentin.

CONCLUSIONS

Fluoride-releasing GIC materials exhibit a secondary caries inhibiting effect in vitro.

CLINICAL RELEVANCE

Glass ionomer cements have a higher secondary caries inhibiting effect than resin composites.

Influence of Hand Instrumentation and Ultrasonic Scaling on the Microleakage of various Cervical Restorations: An in vitro Study

INTRODUCTION

In cervical lesions, various restorative materials can be inserted, which can be affected by the application of periodontal scalers. This study evaluated and compared the marginal seal of class V glass ionomer, composite resin, and amalgam restorations after subjecting them to hand instrumentation and ultrasonic scaling.

MATERIALS AND METHODS

In this experimental study, 30 sound human first premolars were selected. In each tooth, buccal and lingual cavities (4 mm mesiodistal width, 3 mm occlusogingival height, and 2 mm depth) were made. The teeth were randomly assigned to three groups of 10 teeth: (1) Glass ionomer group, (2) composite group, and (3) amalgam group. Teeth were subjected to thermocycling procedure for 1,000 cycles between 5 and 55°C water baths and a 1-minute dwell time. Then, each group was randomly subdivided: (1) Margins of 30 restorations were exposed to hand instrumentation procedures by applying 10 working strokes, (2) margins of 30 restorations were exposed to a periodontal tip mounted on a piezoelectric ultrasonic handpiece working at 25 kHz for 10 seconds. The specimens were serially sectioned mesiodistally. Each section was examined under a stereomicroscope. The extent of microleakage was ranked using a 0 to 4 scale at both occlusal and cervical margins of the restorations. Data were analyzed initially using the Kruskal-Wallis test, followed by multiple comparisons using the Mann-Whitney and Wilcoxon test.

RESULTS

The type of restorative material had a significant influence on dye penetration, whether in the enamel margin or in the dentinal margin (p < 0.001). The microleakage of glass ionomer group was the highest. No statistical differences were found in dye penetration between scaling groups (hand instrumentation and ultrasonic scaling) (p > 0.05).

CONCLUSION

Type of restorative material had a significant influence on microleakage. No statistical differences were found in dye penetration between scaling groups.

CLINICAL SIGNIFICANCE

The microleakage of glass ionomer restoration is greater than amalgam and composite restorations after subjecting them to hand instrumentation and ultrasonic scaling.

A Prospective Six-Year Clinical Study Evaluating Reinforced Glass Ionomer Cements with Resin Coating on Posterior Teeth: Quo Vadis?

Objective:

The aim of this study was to evaluate the long-term clinical performance of two encapsulated glass ionomer cements (GICs) (EquiaFil and Riva SC) covered with two different coatings (Equia Coat and Fuji Varnish) over six years using modified US Public Health Service (USPHS) criteria.

Methods:

Fifty-four patients having class I and II restorations/caries were included in the study. A total of 256 restorations were made with EquiaFil and Riva SC. Equia Coat or Fuji Varnish was used randomly on the surface of the restorations. After cavity preparations, the teeth were randomly restored with one GIC and coated with Equia Coat or Fuji Varnish. The restorations were evaluated at baseline; six, 12, and 18 months; and six years after placement using modified USPHS criteria. Two evaluators checked color match, marginal discoloration, marginal adaptation, caries formation, anatomical form, postoperative sensitivity, and retention rate, and photographs were taken at each recall. The results were evaluated with Pearson chi-square and Mann-Whitney U-test (p&lt;0.05).

Results:

Thirty-seven patients were evaluated. There was a significant difference between EquiaFil and Riva SC regarding retention rate and color match after six years (p=0.033 and 0.046). When comparing baseline to six years, the overall success of EquiaFil was better than Riva SC, having significant problems regarding retention rate and anatomical form (p=0.016 and 0.031). Class II cavities were significantly worse in marginal adaptation, anatomical form, and retention rate in the Riva SC groups (p=0.033, 0.015, and 0.007) but not in the EquiaFil groups. The combination of the coatings had no effect on the overall success of the materials.

Conclusions:

The EquiaFil system was more successful than Riva SC regarding color match, marginal adaptation, anatomic form, and retention rate after a six-year clinical evaluation period.

Clinical performance during 48 months of two current glass ionomer restorative systems with coatings: a randomized clinical trial in the field

Background

This study was carried out as a prospective clinical field study with the aim of evaluating the clinical performance of Equia Fil® with a nanofilled resin coating and the conventional Fuji IX GP® fast with an LC coating according to the World Dental Federation (FDI) restoration material evaluation criteria.

Methods

The clinical performance of Equia Fil® and Fuji IX GP® fast was evaluated on permanent posterior teeth of 643 adult patients aged between 20 to 80 years old in randomly selected clinics across Germany. Occlusal cavities in posterior permanent teeth were restored with Equia Fil® with a nanofilled, light-cured resin coating (n = 515) and Fuji IX GP® fast with an LC coating (n = 486). Direct clinical assessment as well as photographic assessment and assessment of stone casts of the restorations were made at 1 year, 2 years, 3 years, and 4 years.

Results

In 4 years, a total of 1001 fillings from both materials were placed by 111 dentists in 643 patients. Random slope models showed that the Equia filling system had overall lower odds of obtaining a delta event (material needs replacement) in comparison to Fuji IX GP® fast with an LC coating within all models. In both materials, filling size/surface was the most important component affecting the clinical performance of the materials. When measuring the odds of obtaining a delta event (material needs replacement), the odds ratios jumped to approximately 43 and 296 times for class II (two surfaces) and class II mesial-occlusal-distal (three surfaces) respectively in comparison to class I fillings.

Conclusion

Both materials showed similar good overall performance in class I cavities; however, when including numbers from both class I and II fillings, the Equia system with a nanofilled resin coating showed better overall performance with fewer failures in all the follow-up intervals. Nonetheless, the percentage of unsatisfactory to poor fillings according to the FDI criteria was relatively high in two-surface class II fillings and higher in three-surface class II fillings for both materials.

Trial registration

Deutsches Register Klinischer Studien (German Clinical Trials Register): DRKS00004220. (www.germanctr.de). Registration date: 6 Sept 2012.

Electronic supplementary material

The online version of this article (doi:10.1186/s13063-016-1339-8) contains supplementary material, which is available to authorized users.

Four-year Randomized Clinical Trial to Evaluate the Clinical Performance of a Glass Ionomer Restorative System

Objective

The aim of this study was to evaluate the clinical performance of a glass ionomer restorative system compared with a microfilled hybrid posterior composite in a four-year randomized clinical trial.

Methods

A total of 140 (80 Class 1 and 60 Class 2) lesions in 59 patients were either restored with a glass ionomer restorative system (Equia, GC, Tokyo, Japan), which was a combination of a packable glass ionomer (Equia Fil, GC) and a self-adhesive nanofilled coating (Equia Coat, GC), or with a microfilled hybrid composite (Gradia Direct Posterior, GC) in combination with a self-etch adhesive (G-Bond, GC) by two experienced operators according to the manufacturer's instructions. Two independent examiners evaluated the restorations at baseline and at one, two, three, and four years postrestoration according to the modified US Public Health Service criteria. Polyvinyl siloxane impression negative replicas at each recall were observed under scanning electron microscopy (SEM) to evaluate surface characteristics. The statistical analyses were carried out with McNemar, Pearson Chi-square, and Cochran Q- tests (p&lt;0.05).

Results

After four years, 126 (76 Class 1 and 50 Class 2) restorations were evaluated in 52 patients, with a recall rate of 88.1%. None of the restorations showed trends to downgrade in anatomical form, secondary caries, surface texture, postoperative sensitivity, and color match (p&gt;0.05). Significant differences in marginal adaptation and discoloration were found at four years compared to baseline for both restorative materials for Class 1 and Class 2 restorations (p&lt;0.05). Only one Class 2 Equia restoration was missing at three years (3.9%), and another one was missing at four years (7.7%) (p&gt;0.05). SEM evaluations were in accordance with the clinical findings.

Conclusions

The use of both materials for the restoration of posterior teeth exhibited a similar and clinically successful performance after four years.

Bioactive and biomimetic restorative materials: a comprehensive review. Part II

This second part (Part II) of a two-part comprehensive review of bioactive and biomimetic restorative materials reviews the calcium aluminate-based restorative dental materials. Part II explores the development, composition, properties, and application of the bioactive calcium aluminate-based materials that have been developed for several indications in restorative dentistry.

CLINICAL SIGNIFICANCE

Bioactive materials have evolved over the past three decades from relatively specialized, highly biocompatible, but low-strength dental materials to now emerge in product compositions for expanded clinical uses in restorative dentistry. Further developments to meet additional restorative clinical needs are anticipated in the newly emerging category of dental materials.

The effect of a nano-filled resin coating on the 3-year clinical performance of a conventional high-viscosity glass-ionomer cement

OBJECTIVES

The main aim of the study was to compare the clinical performance of the conventional high-powder/liquid ratio glass-ionomer cement (GIC) Fuji IX GP Extra (F IX), Fuji IX GP Extra with a low-viscosity nano-filled resin coating, G-Coat Plus (F IX+GCP), and a resin composite, Solare (S), as a comparison material.

MATERIALS AND METHODS

Moderate-depth occlusal cavities in the first permanent molars of 91 11-12-year-old children (1-4 restorations per child) were restored with either F IX (87 restorations), F IX+GCP (84 restorations) or S (83 restorations). Direct clinical assessment, photographic assessment and assessment of stone casts of the restorations were carried out at 6 months, 1 year, 2 years and 3 years.

RESULTS

The colour match with the tooth of the GIC restorations improved over the 3 years of the study. Marginal staining and marginal adaptation were minimal for all restorations; three restorations exhibited secondary caries at 3 years. From the assessment of the casts, at 2 years, there was significantly less wear of the F IX GP Extra+GCP restorations than the F IX GP Extra restorations (P < 0.005). At 3 years, approximately 37 % of F IX GP Extra restorations showed wear slightly more than the adjacent enamel, compared to 28 % of F IX GP Extra+GCP restorations and 21 % of Solare restorations. Although this was not statistically significant, there was a trend that GCP can protect F IX GP Extra against wear.

CONCLUSION

Although both Fuji IX GP Extra and Fuji IX GP Extra with G-Coat Plus showed acceptable clinical performance in occlusal cavities in children, the application of G-Coat Plus gave some protection against wear.

CLINICAL RELEVANCE

The application of G-Coat Plus to Fuji IX GP Extra glass-ionomer cement may be beneficial in reducing wear in occlusal cavities.

Effect of gloss and heat on the mechanical behaviour of a glass carbomer cement

OBJECTIVES

The effect of gloss and heat on the mechanical behaviour of a recently launched glass carbomer cement (GCP, GCP dental) was evaluated and compared with resin-modified glass ionomer cements (Fuji II LC, GC and Photac Fil Quick Aplicap, 3M ESPE).

METHODS

120bar-shaped specimens (n=20) were produced, maintained in distilled water at 37°C and tested after one week. The GCP specimens were cured with and without heat application and with and without gloss. The flexural strength and modulus of elasticity in flexural test as well as the micro-mechanical properties (Vickers Hardness, indentation modulus, creep) of the top and bottom surface were evaluated. The amount and size of the fillers, voids and cracks were compared using a light and a scanning electron microscope.

RESULTS

In the flexural test, the resin-modified glass ionomer cements performed significantly better than GCP. Fuji II LC and Photac Fil (Weibull parameter: 17.7 and 14.3) proved superior reliability in the flexural test compared to GCP (1.4-2.6). The highest Vickers Hardness and lowest creep were achieved by GCP, whereas Fuji II LC reached the highest indentation modulus. The results of this study proved that relationships exist between the compositions, microstructures and mechanical properties of the cements.

CONCLUSIONS

Heat treatment and gloss application did not influence the mechanical properties of GCP. The mechanical properties were basically influenced by the type of cement and its microstructure.

CLINICAL SIGNIFICANCE

Considering the measured mechanical properties, there is no need of using gloss or heat when restoring teeth with GCP.