Evaluation of Compressive and Flexural Strengths of Two Resin-based Core Materials with an Alkasite Material: An In Vitro Study

AIM

To compare and evaluate the compressive and flexural strengths of two resin-based core build-up materials with an alkasite material.

MATERIALS AND METHODS

ParaCore, Tetric N ceram Bulk-fill composite, and Cention N were used. A total of 90 specimens were prepared. Customized cylindrical split molds of dimension 6 ± 1 mm (height) × 4 ± 1 mm (diameter) were used to fabricate 15 samples of each core material for testing the compressive strength and rectangular split metal molds of dimensions 25 ± 1 mm (length) × 2 ± 1 mm (width) × 2 ± 1 mm (height) were used to fabricate 15 samples of each core material for testing the flexural strength. Then the samples were tested using a Universal testing machine (UTM).

RESULTS

The compressive and flexural strengths of Cention N were significantly less than ParaCore® but higher than Tetric® N-CeramTM Bulk-fill core build-up material.

CONCLUSION

Within the limitations of this study, it was concluded that Cention N may be used as an alternative to other core build-up materials after further in-vitro and in-vivo studies.

CLINICAL SIGNIFICANCE

Cention N had the added advantage that self-cure polymerization alone was sufficient to achieve good physical properties when compared to the other two resin-based core build-up materials.

Clinical effectiveness of alkasite versus nanofilled resin composite in the restoration of occlusal carious lesions in permanent molar teeth of children: a randomized clinical trial

PURPOSE

To evaluate and compare the clinical effectiveness of alkasite with nanofilled resin composite restorations for occlusal caries lesions in permanent molar teeth of children, at one-year follow-up.

METHODS

In this randomized controlled clinical trial with parallel design, 38 children aged 7-13 years with occlusal caries lesions on 59 first permanent molars were randomly allocated into two groups, Group 1: Filtek™ Z350XT (nanocomposite) and Group 2: Cention N^® (alkasite resin composite). The restorations were evaluated at one year using the United States Public Health Service (USPHS) criteria. Data were analyzed using Chi-square or Fisher's exact test.

RESULTS

All restorations had either Alpha or Bravo scores at one-year follow-up. In Group 1, all restorations scored Alpha, while one restoration each (3.6%) in Group 2 scored Bravo for fracture and marginal adaptation. All restorations in both groups scored Alpha for retention, secondary caries, and post-operative sensitivity. For anatomic form, all restorations in Group 1 scored Alpha, while three (10.7%) restorations in Group 2 had Bravo scores. For marginal discolouration, three restorations in both groups scored Bravo (11.5% and 10.7%, respectively). For surface roughness, one restoration (3.8%) in Group 1 and three restorations in Group 2 (10.7%) scored Bravo. The comparative results between the two groups for all the variables in the USPHS criteria were not statistically significantly different.

CONCLUSIONS

The performances of the nanofilled composite and alkasite were clinically acceptable and comparable. Alkasite can be an alternative material for the restoration of occlusal caries lesions in permanent molars of children.

CLINICAL TRIAL REGISTRATION

The clinical trial was registered at Clinical Trials Registry-India (CTRI Reg no: CTRI/2020/12/029830 Dated: 15/12/2020).

The impact of an alkasite restorative material on the pH of Streptococcus mutans biofilm and dentin remineralization: an in vitro study

BACKGROUND

It has been claimed that an alkasite restorative material can neutralize acids produced by cariogenic bacteria from released hydrogen ions and enable to remineralization via calcium and fluoride ions. However, there is no evidence to support this assertion. Therefore, the aims of this study were to investigate the effect of the alkasite restorative material on the pH of Streptococcus mutans biofilm and dentin hardness.

METHODS

Streptococcus mutans biofilms were formed on Filtek™ Z350 (FZ, a resin composite) and Cention® N (CN, the alkasite restorative material) and their pH determined after 24 h. Hydroxide, fluoride, and calcium-ions released from the materials were determined at 6 h, 1, 3, 7, 14, and 28 days. Dentin specimens were prepared from 14 human molars and divided into four quadrants. Quadrant 1 was a sound dentin control, quadrants 2-4 were chemically demineralized, and a cylinder of FZ and CN placed on the surfaces of quadrants 2 and 4, respectively. The microhardness of quadrants 1 and 3 were measured at depths of 20, 40, and 60 µm from the occlusal surface, and similarly of quadrants 2 and 4, after 30 days. Independent t-test, Mann-Whitney-U, and repeated-measure-ANOVA were used for data analysis.

RESULTS

The pH of biofilm on CN (4.45) was significantly higher (p < 0.05) than that on FZ (4.06). The quantity of all ions released from CN was significantly higher than from FZ. The hardness of demineralized dentin under CN was significantly higher than that of demineralized dentin at all depths, and higher than that of demineralized dentin under FZ at 20 and 40 µm.

CONCLUSIONS

CN released hydroxide, fluoride, and calcium ions, which was associated with raising the biofilm pH and the hardness of demineralized dentin. All results indicated that CN had the potential to reduce the incidence of secondary caries.

Comparison of physical and mechanical properties of three different restorative materials in primary teeth: an in vitro study

OBJECTIVE

Physical and mechanical properties of three different (Ketac Molar Easymix, Dyract XP, Cention N (CN)) restoratives with different ingredients were evaluated.

MATERIALS AND METHODS

Four groups were obtained; Group 1: CN LightCure, Group 2: CN SelfCure, Group 3: Ketac Molar Easymix and Group 4: Dyract XP. Disk-shaped samples (n = 10) were prepared and evaluated for the surface roughness test using a profilometer. For the flexure strength test, 2 × 2 × 25 mm bar-shaped samples (n = 10) were prepared, and a three-point bending test was applied to the samples. After preparing cavities for microleakage tests, teeth were restored with restoratives, immersed in dye, and microleakage was assessed. For the microtensile bond strength (µTBS) test, ten sticks were obtained for each group and were stressed under tension.

RESULTS

According to surface roughness tests, CN SelfCure showed the lowest value (0.13 μm), while Ketac Molar Easymix showed the highest value (0.28 μm), and significant differences were found between the groups. In flexural strength tests, the highest values were seen in CN SelfCure (82.94 MPa), with statistically significant differences between the groups. When CN SelfCure was applied with an adhesive, the teeth showed statistically decreased leakage than other groups on the gingival side. Higher leakage values were seen on the gingival side than the occlusal side in most groups, and the SelfCure groups showed decreased leakage than the LightCure groups. According to µTBS tests, the highest value was obtained in CN SelfCure-Adhesive group, while the lowest was in CN LightCure-Non-adhesive group. When µTBS was evaluated regardless of adhesive use, the SelfCure groups showed higher µTBS values than the LightCure groups. As a result of the µTBS and microleakage test, the difference between the use of CN with and without adhesive, regardless of the polymerization type, was found to be significant (p  < 0.05).

CONCLUSION

Cention N showed better properties in SelfCure mode, compared to the rest materials tested, but further in vitro and in vivo studies are needed to investigate the effect of different polymerization modes and the oral environmental conditions.

An alkasite restorative material effectively remineralized artificial interproximal enamel caries in vitro

OBJECTIVE

To evaluate the remineralization of artificial interproximal enamel caries (AIEC) adjacent to alkasite, high viscous glass ionomer cement (HVGIC), and resin composite in class II restorations.

MATERIALS AND METHODS

Human enamel specimens were randomly assigned to 3 groups (n = 22): Filtek™ Z350, EQUIA Forte^®, and Cention N^®. The baseline hardness was determined using a Knoop microhardness assay. AIEC was formed in the specimens, and they were placed in contact with the proximal restorative materials then subjected to a 7-day pH cycling. Microhardness was determined post-artificial caries formation and post-pH cycling. The differences in the percentage of surface hardness recovery (%SHR) between the groups were compared using the Kruskal-Wallis test. The Dunn's test was used for between-group comparisons (p < 0.05). Specimen surface morphology was evaluated using scanning electron microscopy (SEM), and the calcium, phosphorus, and fluoride contents were analyzed by energy-dispersive spectroscopy (EDS). ANOVA with the post hoc Tukey multiple comparison test was used to evaluate the differences between groups (p < 0.05).

RESULTS

The Cention N^® %SHR was the highest, followed by EQUIA Forte^®, and Filtek™ Z350. There was a significant difference in the %SHR between Cention N^® and Filtek™ Z350 (p < 0.05). In contrast, there were no significant difference between Cention N^® and EQUIA Forte^®. Significantly increased enamel surface fluoride content was observed in the Cention N^® compared with Filtek™ Z350 specimens (p < 0.05). The SEM image of the Cention N^® specimens demonstrated the greatest mineral deposition.

CONCLUSIONS

Cention N^® markedly increased the surface hardness and fluoride content of adjacent AIEC compared with Filtek™ Z350 restorations.

CLINICAL RELEVANCE

Cention N^® is a promising alternative restorative material to remineralize initial enamel lesions in approximal adjacent surfaces, especially in high-risk caries patients.

Fracture and viscoelastic behavior of novel self-adhesive materials for simplified restoration concepts

OBJECTIVE

The aim of the study was to offer a comparative perspective on the mechanical and viscoelastic behavior of currently developed materials for simplified restoration concepts. These materials have not yet been clearly assigned whether they are complex hybrids of already known material categories or new material classes.

METHODS

A dual-cured, bulk-fill, bioactive resin-based composite (alkasite), a resin-modified glass ionomer cements (RM-GIC) with novel polymerizable acid polymers, and a glass ionomer cement (GIC) with improved adaptation to an acidic environment were compared with regard to their macro-mechanical parameters (3-point bending test, 3-PBT), fracture mechanism, quasi-static and viscoelastic behaviour (instrumented indentation test, IIT), morphology and structural appearance of the filler system (SEM analysis). The influence of surface finishing was quantified on the outcome of the 3-PBT, while the influence of aging and frequency was monitored on the outcome of the IIT. One and multiple-way analysis of variance (ANOVA) with Tukey honestly significant difference (HSD) post-hoc tests (α = 0.05) and Weibull analysis were applied.

RESULTS

Surface finishing strongly influenced the outcome of the 3-PBT for RM-GIC and GIC but not of the alkasite. The highest material reliability (Weibull parameter m) was found with the alkasite, irrespective of the curing mode. Ground specimens showed decrease reliability, except for the alkasite in the light-cured mode. The predominant failure mode originated from sub-surface defects (52.5%), followed by corner (25%), edge (18.1%), and crack arrest (4.4%). The effect of the parameter material on the quasi-static outcome of the IIT was highest on elastic/plastic parameters (p < 0.001; e.g. elastic indentation work, η_P² = 0.875), was moderate on the Martens Hardness (η_P² = 0.420), and was low on the Vickers hardness (η_P² = 0.218). The viscoelastic parameters, in particular the loss factor (tan δ) allow a clear documentation of the ongoing acid-base setting reaction during aging of one month, which was more pronounced in the GIC than in the RM-GIC. The decrease in tan δ with aging for GIC and RM-GIC reflects the maturation process and increased brittleness, while the increase in tan δ with aging reflects the polymer plasticization in the polymer-based alkasite.

CONCLUSIONS

The mechanical and viscoelastic behavior depending on surface refinement, aging and frequency clearly allow to classify the currently developed materials for simplified restoration concepts into known material categories such as RBCs (alkasite), RM-GIC or GIC.

Microleakage Comparative Evaluation of RMGIC and Alkasite with and without Adhesive System in Class V Cavity: An In Vitro Study

AIM AND OBJECTIVE

This study aimed to compare microleakage of resin-modified glass ionomer cement (RMGIC) and alkasite with and without adhesive system in class V cavity.

MATERIALS AND METHODS

Thirty class V cavities were prepared on the buccal surface. All prepared samples were randomly divided into three groups. Group I was restored with RMGIC, group II was restored with Cention N after the application of adhesive system, and group III was restored with alkasite. Samples were subjected to 200 thermocycles between temperature baths at 5ºC and 55ºC. Samples were stained with 2% methylene blue. The teeth were sectioned longitudinally, and the sections were then observed under stereomicroscope at a magnification of 20×.

RESULTS

Statistical analysis showed that there was less microleakage in Cention N using adhesive system in both occlusal margin and gingival margin.

CONCLUSION

There were significant differences between RMGIC, alkasite with adhesive system, and alkasite without adhesive system in class V cavity. Least microleakage at the occlusal margin and gingival margin was seen with Cention N using adhesive system and highest microleakage at the RMGIC.

CLINICAL SIGNIFICANCE

Cention N using the adhesive system affects the microleakage in the class V restoration. The study theorizes that the material restorations showed less microleakage in the occlusal margin than in the gingival margin.