The biocompatibility of resin-modified glass-ionomer cements for dentistry

OBJECTIVES: The biological effects of resin-modified glass-ionomer cements as used in clinical dentistry are described, and the literature reviewed on this topic. METHODS: Information on resin-modified glass-ionomers and on 2-hydroxyethyl methacrylate (HEMA), the most damaging substance released by these materials, has been collected from over 50 published papers. These were mainly identified through Scopus. RESULTS: HEMA is known to be released from these materials and has a variety of damaging biological properties, ranging from pulpal inflammation to allergic contact dermatitis. These are therefore potential hazards from resin-modified glass-ionomers. However, clinical results with these materials that have been reported to date are generally positive. CONCLUSIONS/SIGNIFICANCE: Resin-modified glass-ionomers cannot be considered biocompatible to nearly the same extent as conventional glass-ionomers. Care needs to be taken with regard to their use in dentistry and, in particular, dental personnel may be at risk from adverse effects such as contact dermatitis and other immunological responses.

Water transport in resin-modified glass-ionomer dental cement

Water uptake and water loss have been studied in a commercial resin-modified glass-ionomer cement, Fuji II LC, under a variety of conditions. Uptake was generally non-Fickian, but affected by temperature. At room temperature, the equilibrium water uptake values varied from 2.47 to 2.78% whereas at low temperature (12 degrees C), it varied from 0.85 to 1.18%. Cure time affected uptake values significantly. Water uptake was much lower than in conventional glass-ionomer restorative cements exposed to water vapor. Loss of water under desiccating conditions was found to be Fickian for the first 5 h loss at both 22 and 12 degrees C. Diffusion coefficients were between 0.45 and 0.76 x 10( -7) cm(2)/s, with low temperature diffusion coefficients slightly greater than those at room temperature. Plotting water loss as percentage versus s(-(1/2)) allowed activation energies to be determined from the Arrhenius equation and these were found to be 65.6, 79.8, and 7.7 kJ/mol respectively for 30, 20, and 10 s cure times. The overall conclusion is that the main advantage of incorporating HEMA into resin-modified-glass-ionomers is to alter water loss behavior. Rate of water loss and total amount lost are both reduced. Hence, resin-modified glass-ionomers are less sensitive to water loss than conventional glass-ionomers.

Review paper: role of aluminum in glass-ionomer dental cements and its biological effects

The role of aluminum in glass-ionomers and resin-modified glass-ionomers for dentistry is reviewed. Aluminum is included in the glass component of these materials in the form of Al(2)O(3) to confer basicity on the glass and enable the glass to take part in the acid-base setting reactions. Results of studies of these reactions by FTIR and magic-angle spinning (MAS)-NMR spectroscopy are reported and the role of aluminum is discussed in detail. Aluminum has been shown to be present in the glasses in predominantly 4-coordination, as well as 5- and 6-coordination, and during setting a proportion of this is converted to 6-coordinate species within the matrix of the cement. Despite this, mature cements may contain detectable amounts of both 4- and 5-coordinate aluminum. Aluminum has been found to be leached from glass-ionomer cements, with greater amounts being released under acidic conditions. It may be associated with fluoride, with which it is known to complex strongly. Aluminum that enters the body via the gastro-intestinal tract is mainly excreted, and only about 1% ingested aluminum crosses the gut wall. Calculation shows that, if a glass-ionomer filling dissolved completely over 5 years, it would add only an extra 0.5% of the recommended maximum intake of aluminum to an adult patient. This leads to the conclusion that the release of aluminum from either type of glass-ionomer cement in the mouth poses a negligible health hazard.

Kinetic studies of water uptake and loss in glass-ionomer cements

The water sorption and desorption behaviour of three commercial glass-ionomer cements used in clinical dentistry have been studied in detail. Cured specimens of each material were found to show slight but variable water uptake in high humidity conditions, but steady loss in desiccating ones. This water loss was found to follow Fick's law for the first 4-5 h. Diffusion coefficients at 22 degrees C were: Chemflex 1.34 x 10(-6) cm(2) s(-1), Fuji IX 5.87 x 10(-7) cm(2) s(-1), Aquacem 3.08 x 10(-6) cm(2) s(-1). At 7 degrees C they were: Chemflex 8.90 x 10(-7) cm(2) s(-1), Fuji IX 5.04 x 10(-7) cm(2) s(-1), Aquacem 2.88 x 10(-6) cm(2) s(-1). Activation energies for water loss were determined from the Arrhenius equation and were found to be Chemflex 161.8 J mol(-1), Fuji IX 101.3 J mol(-1), Aquacem 47.1 J mol(-1). Such low values show that water transport requires less energy in these cements than in resin-modified glass-ionomers. Fick's law plots were found not to pass through the origin. This implies that, in each case, there is a small water loss that does not involve diffusion. This was concluded to be water at the surface of the specimens, and was termed "superficial water". As such, it represents a fraction of the previously identified unbound (loose) water. Superficial water levels were: Chemflex 0.56%, Fuji IX 0.23%, Aquacem 0.87%. Equilibrium mass loss values were shown to be unaffected by temperature, and allowed ratios of bound:unbound water to be determined for all three cements. These showed wide variation, ranging from 1:5.26 for Chemflex to 1:1.25 for Fuji IX.

Marginal adaptation and performance of bioactive dental restorative materials in deciduous and young permanent teeth

Objective: The aim of this study was to investigate the adaptation of different types of restorations towards deciduous and young permanent teeth. Materials and Methods: Class V cavities were prepared in deciduous and young permanent teeth and filled with different materials (a conventional glass-ionomer, a resin-modified glass-ionomer, a poly-acid-modified composite resin and a conventional composite resin). Specimens were aged in artificial saliva for 1, 6, 12 and 18 months, then examined by SEM. Results: The composite resin and the polyacid-modified composite had better marginal adaptation than the glass-ionomers,though microcracks developed in the enamel of the tooth. The glass-ionomers showed inferior marginal quality and durability, but no microcracking of the enamel. The margins of the resin-modified glass-ionomer were slightly superior to the conventional glass-ionomer. Conditioning improved the adaptation of the composite resin, but the type of tooth made little or no difference to the performance of the restorative material. All materials were associated with the formation of crystals in the gaps between the filling and the tooth; the quantity and shape of these crystals varied with the material. Conclusions: Resin-based materials are generally better at forming sound, durable margins in deciduous and young permanent teeth than cements, but are associated with microcracks in the enamel. All fluoride-releasing materials give rise to crystalline deposits.

The influence of alkali metal chlorides on the loss of water from glass-ionomer dental cements

The water loss behaviour of a clinical glass-ionomer dental cement has been studied with and without the addition of alkali metal chlorides. Dehydrating conditions were provided by placing specimens in a desiccator over concentrated sulphuric acid. Cements were prepared using either pure water or an aqueous solution of metal chloride (LiCl, NaCl, KCl) at 1.0 mol/dm(3). In addition, NaCl at 0.5 mol/dm(3) was also used to fabricate cements. Disc-shaped specimens of size 6 mm diameter x 2 mm thickness were made, six performulation, and cured at 37 degrees C for 1 hour They were then exposed to desiccating conditions, and the mass measured at regular intervals. All formulations were found to lose water in a diffusion process that equilibrated after approximately 3 weeks. Diffusion coefficients ranged from 2.27 (0.13) x 10(9) with no additive to 1.85 (0.07) x 10(9) m(2)/s with 1.0 mol/dm(3) KCl. For the salts, diffusion coefficients decreased in the order LiCl > NaCl > KCl. There was no statistically significant difference between the diffusion coefficients for 1.0 and 0.5 mol/dm(3) NaCl. For all salts at 1.0 mol/dm(3) and also additive-free cements, equilibrium losses were, with statistical limits, the same, ranging from 6.23 to 6.34%. On the other hand, 0.5 mol/dm(3) NaCl lost significantly more water 7.05%.

Shear bond strengths of glass-ionomer cements to sound and to prepared carious dentine

The aim of this study was determine whether bonding of glass-ionomer cements to non-carious dentine differed from that to carious dentine. Five commercial cements were used, namely Fuji IX GP, Fuji IX capsulated, Fuji IX Fast capsulated (all GC, Japan), Ketac-Molar and Ketac-Molar Aplicap (both 3M-ESPE, Germany). Following conditioning of the substrate with 10% poly (acrylic acid) for 10 s, sets of 10 samples of the cements were bonded to prepared teeth that had been removed for orthodontic reasons. The teeth used had either sound dentine or sclerotic dentine. Shear bond strengths were determined following 24 h storage. For the auto-mixed cements, shear bond strength to sound dentine was found not to differ statistically from shear bond strength to sclerotic dentine whereas for hand-mixed cements, shear bond to sound dentine was found to be higher than to carious dentine (to at least p < 0.05). This shows that the chemical effects arising from interactions of glass-ionomer cements with the mineral phase of the tooth are the most important in developing strong bonds, at least in the shorter term.

Ion release by endodontic grade glass-ionomer cement

Cylindrical specimens (6 mm high x 4 mm diameter) of the endodontic grade glass-ionomer (Ketac Endo) were exposed to various media for 1 week, after which changes in their mass, pH of storage medium, and ion release were determined. In water, this cement was shown to release reasonable amounts of sodium, aluminium and silicon, together with smaller amounts of calcium and phosphorus, as well as taking up 2.41% by mass of water. A comparison with the restorative grade materials (Ketac Molar, ex 3M ESPE and Fuji IX, ex GC) showed both ion release and water uptake to be greater. All three cements shifted pH from 7 to around 6 with no significant differences between them. Other storage media were found to alter the pattern of ion release. Lactic acid caused an increase, whereas both saturated calcium hydroxide and 0.6% sodium hypochlorite, caused decreases. This suppression of ion-release may be significant clinically. Aluminium is the most potentially hazardous of the ions involved but amounts released were low compared with levels previously reported to show biological damage.

Kinetic studies of the effect of varnish on water loss by glass-ionomer cements

OBJECTIVES: This paper reports a study of the water loss behaviour of two commercial glass-ionomer cements coated with varnishes. METHODS: For each cement (Fuji IX Fast or Chemflex), specimens (6mmdiameterx2mm depth) were prepared and cured for 10min at 37 degrees C. They were exposed to a desiccating environment over H(2)SO(4) either uncoated or coated with the appropriate varnish (Fuji Varnish, a solvent-based lacquer, or Fuji Coat, a light-cured varnish). Four specimens were prepared for each material. They were weighed at hourly intervals for 6h, daily for up to 5 days, then weekly thereafter until equilibration. RESULTS: Unlike the uncoated specimens, water loss from varnished cements was not Fickian, but followed the form: mass loss=A/t+B, where t is time, A and B are constants specific to each cement/varnish combination. A varied from 1.22 to 1.30 (mean 1.26, standard deviation 0.04), whereas B varied from 1.54 to 2.09 (mean -1.83, standard deviation 0.29). At equilibrium, varnished specimens lost much less water than unvarnished ones (p>0.01) but there was no significant difference between the solvent-based and the light-cured varnishes. SIGNIFICANCE: Varnishes protect immature glass-ionomer cements from drying out by altering the mechanism of water loss. This slows the rate of drying but does not necessarily change the total amount of water retained. It confirms that, in clinical use, glass-ionomer restoratives should be varnished to allow them to mature satisfactorily.

Polyacid-modified composite resins ("compomers") and their use in clinical dentistry

OBJECTIVES: This paper describes the chemistry and properties of polyacid-modified composite resins ("compomers") designed for use in clinical dentistry, and reviews the literature in this area. METHODS: Information has been obtained from over 50 published articles appearing in the dental and biomaterials literature, with studies being principally identified through MedLine. RESULTS: Published work shows that polyacid-modified composite resins constitute a discrete class of polymeric repair material for use in dentistry. Their distinction is that they contain hydrophilic components, and these cause water to be drawn into the material following cure. This triggers an acid-base reaction, and gives the materials certain clinically-desirable properties (fluoride release, buffering capability) that are also associated with glass-ionomer cements. The water uptake leads to a decline in certain, though not all, physical properties. However, clinical studies have shown these materials to perform acceptably in a variety of applications (Class I, Class II and Class V cavities, as fissure sealants and as orthodontic band cements), especially in children's teeth. CONCLUSIONS/SIGNIFICANCE: Polyacid-modified composite resins constitute a versatile class of dental repair material, whose bioactivity confers clinical advantages, and which are particularly useful in children's dentistry.

A revised classification for direct tooth-colored restorative materials

Composite resins and glass-ionomer cements were introduced to dentistry in the 1960s and 1970s, respectively. Since then, there has been a series of modifications to both materials as well as the development other groups claiming intermediate characteristics between the two. The result is a confusion of materials leading to selection problems. While both materials are tooth-colored, there is a considerable difference in their properties, and it is important that each is used in the appropriate situation. Composite resin materials are esthetic and now show acceptable physical strength and wear resistance. However, they are hydrophobic, and therefore more difficult to handle in the oral environment, and cannot support ion migration. Also, the problems of gaining long-term adhesion to dentin have yet to be overcome. On the other hand, glass ionomers are water-based and therefore have the potential for ion migration, both inward and outward from the restoration, leading to a number of advantages. However, they lack the physical properties required for use in load-bearing areas. A logical classification designed to differentiate the materials was first published by McLean et al in 1994, but in the last 15 years, both types of material have undergone further research and modification. This paper is designed to bring the classification up to date so that the operator can make a suitable, evidence-based, choice when selecting a material for any given situation.

Zinc polycarboxylate dental cement for the controlled release of an active organic substance: proof of concept

The potential of employing zinc polycarboxylate dental cement as a controlled release material has been studied. Benzalkonium chloride was used as the active ingredient, and incorporated at concentrations of 1, 2 and 3% by mass within the cement. At these levels, there was no observable effect on the speed of setting. Release was followed using an ion-selective electrode to determine changes in chloride ion concentration with time. This technique showed that the additive was released when the cured cement was placed in water, with release occurring by a diffusion mechanism for the first 3 h, but continuing beyond that for up to 1 week. Diffusion coefficients were in the range 5.62 × 10(−6) cm(2) s(−1) (for 1% concentration) to 10.90 × 10(−6) cm(2) s(−1) (for 3% concentration). Up to 3% of the total loading of benzalkonium chloride was released from the zinc polycarboxylate after a week, which is similar to that found in previous studies with glass-ionomer cement. It is concluded that zinc polycarboxylate cement is capable of acting as a useful material for the controlled release of active organic compounds.

The interaction of polyacid-modified composite resins ("compomers") with aqueous fluoride solutions

OBJECTIVE: The aim of this study was to investigate how the release of fluoride from two compomers and a fluoridated composite resin was affected by exposure to KF solution. MATERIAL AND METHODS: Two compomers (Dyract AP and Compoglass F) and one fluoridated composite (Wave) were prepared as discs (6 mm diameter and 2 mm thick), curing with a standard dental lamp. They were then stored in either water or 0.5% KF for 1 week, followed by placement in water for periods of 1 week up to 5 weeks total. Fluoride was determined with and without TISAB (to allow complexed and decomplexed fluoride to be determined), and other ion release (Na, Ca, Al, Si, P) was determined by ICP-OES. RESULTS: Specimens were found not to take up fluoride from 100 ppm KF solution in 24 h, but to release additional fluoride when stored for up to five weeks. Compomers released more fluoride cumulatively following exposure to KF solution (p<0.001), all of which was decomplexed, though initial (1 week) values were not statistically significant for Dyract AP. Other ions showed no variations in release over 1 week, regardless of whether the specimens were exposed to KF. Unlike the compomers, Wave showed no change in fluoride release as a result of exposure to KF. CONCLUSIONS: Compomers are affected by KF solution, and release more fluoride (but not other ions) after exposure than if stored in water.