Gel phase formation at resin-modified glass-ionomer/tooth interfaces

Ionic bonding between polyalkenoic acid and hydroxyapatite may explain the excellent bonding retention of glass-ionomers in clinical trials. We have here investigated the extent to which the self-adhesiveness of resin-modified glass-ionomers (RMGIs) can be attributed to this chemical bonding capacity. Therefore, the interaction of 3 RMGIs with tooth substrates was comprehensively characterized, with electron and atomic force microscopy correlated with x-ray photoelectron spectroscopy (XPS). Interfacial ultrastructural analysis for 2 RMGIs disclosed a shallow hybridization of hydroxyapatite-coated collagen, on which a submicron gel phase was deposited through reaction of the polyalkenoic acid with calcium extracted from the dentin surface. One RMGI, however, bonded to dentin without hybrid layer or gel phase formation. XPS indicated that polycarboxylic acids included in the RMGIs electrostatically interacted with hydroxyapatite. We conclude that the self-adhesiveness of RMGIs should be attributed to ionic bonding to hydroxyapatite around collagen, and to micro-mechanical interlocking for those RMGIs that additionally hybridize dentin.     

Effect of saliva contamination on the bond of dentin to resin-modified glass-ionomer cement

This in vitro study compared the shear bond strength of a resin-modified glass-ionomer restorative material (Fuji II LC) bonded to saliva-contaminated dentin versus non-contaminated dentin. Seventy-five extracted human molar teeth were randomly divided into five groups of 15 samples each. The dentin was treated with 10% polyacrylic acid for 20 seconds, rinsed, and dried. The acid-treated dentin surfaces in Groups 1-4 were contaminated with saliva. In Group 1, the saliva was air thinned. In Groups 2-4, saliva was dried completely with compressed air. The saliva-contaminated dentin in Group 3 was rinsed and dried. The saliva-contaminated dentin in Group 4 was rinsed, dried, treated with 10% polyacrylic acid, and dried. Specimens in Group 5 received no contamination. The resin-modified glass-ionomer cement restorative material was mixed and applied to the dentin surfaces. Following placement of the restorative material and 7 days of storage, the specimens were thermo-cycled 300 times. Using the Instron Universal Testing Machine, a shear force was applied to the restorative material. Shear bond strength values were compared among the groups using a one-way ANOVA and Student-Neuman-Keuls Multiple Range Test (alpha = 0.05). The non-contaminated specimens (Group 5) were significantly stronger than the contaminated specimens (Groups 1-4). There were no significant differences in bond strength among the groups containing contaminated specimens. Salivary contamination occurring after dentin etching significantly reduced the bond strength of the resin-modified glass-ionomer restorative material to dentin. Neither rinsing nor rinsing and re-etching resulted in bond strengths as great as to non-contaminated dentin.     

Network competition in a resin-modified glass-ionomer cement.

Attempts have been made to improve the mechanical properties and convenience of use of glass-ionomer cement (GIC) by various modifications, in particular by including a free radical-polymerizable component ("resin-modified" GIC, RMGIC). Necessarily, the one replaces part of the other, but the chemistry suggests that the formation of each network separately would inhibit diffusion and thus the other reaction. OBJECTIVE: To ascertain whether interference occurs between the components of an RMGIC by variation of the irradiation regime. MATERIALS AND METHODS: Cylindrical specimens (6 mm x 3 mm diameter) of one brand of RMGIC (Shades A3, D2; Fuji II LC, GC; capsules) were prepared in ptfe moulds. After machine-mixing for 10s, each of the three increments was irradiated from the top for various times (0-60s). In addition, extra irradiation from the bottom; from the bottom before, and from the side after, ejection from the mould; the same using two curing lamps; and at various delays after mixing (0-18 h), with four replicates of each. After exposure, or as appropriate, specimens were wrapped tightly in aluminium foil for dry storage in the dark at 37 degrees C for testing at 24h after mixing. Specimens with evident defects were replaced before testing. RESULTS: No increase in strength was found beyond the recommended 20-s irradiation, indeed further exposure reduced the strength. For top-only irradiation, strength rose from the unirradiated value (66+/-9 MPa) to a peak at 20s (215+/-25 MPa), after which it declined steadily. Adding bottom irradiation gave a small decrease in peak value (194+/-36 MPa); adding side irradiation reduced it substantially (113+/-7 MPa). Delay for 2 min gave a marked reduction (155+/-15 MPa), declining to the unirradiated value at 18 h (70+/-15 MPa). No effect due to shade was detected. SIGNIFICANCE: Competition between network-forming reactions leads to a sensitive balance between the two, and a critical optimum irradiation: too much may be detrimental, as is delay. The essential compromise involved in such mixed chemistry jeopardizes reliability. It is advisable to follow the duration of exposure prescribed by the manufacturer to achieve optimal performance.     

Good prognosis for resin-modified glass-ionomer cement in primary teeth

J Evid Base Dent Pract 2002;2:126-7     

Bonding effectiveness and interfacial characterization of a nano-filled resin-modified glass-ionomer

Glass-ionomers (GIs) exhibit excellent clinical bonding effectiveness, but still have shortcomings such as polishability and general aesthetics. The aims of this study were (1) to determine the micro-tensile bond strength (μTBS) to enamel and dentin of a nano-filled resin-modified GI (nano-RMGI; Ketac N100, 3M-ESPE), and (2) to characterize its interfacial interaction with enamel and dentin using transmission electron microscopy (TEM).MethodsThe nano-RMGI was used both with and without its primer, while a conventional RMGI restorative material (conv-RMGI; Fuji II LC, GC) and a packable conventional GI cement (conv-GI; Fuji IX GP, GC) were used as controls. After bonding to freshly extracted human third molars, microspecimens of the interfaces were machined into a cylindrical hourglass shape and tested to failure in tension. Non-demineralized TEM sections were prepared and examined from additional teeth.ResultsThe μTBS to both enamel and dentin of nano-RMGI and conv-GI were not statistically different; the μTBS of non-primed nano-RMGI was significantly lower, while that of conv-RMGI was significantly higher than that of all other groups. TEM of nano-RMGI disclosed a tight interface at enamel and dentin without surface demineralization and hybrid-layer formation. A thin filler-free zone (<1 μm) was formed at dentin. A high filler loading and effective filler distribution were also evident, with localized areas exhibiting nano-filler clustering.ConclusionsThe nano-RMGI bonded as effectively to enamel and dentin as conv-GI, but bonded less effectively than conv-RMGI. Its bonding mechanism should be attributed to micro-mechanical interlocking provided by the surface roughness, most likely combined with chemical interaction through its acrylic/itaconic acid copolymers.     

Effect of the application of dentin primers and a dentin bonding agent on the adhesion between the resin-modified glass-ionomer cement and dentin.

OBJECTIVES: This study was designed to evaluate the influence of the application of dentin primer and/or dentin bonding agent on the adhesion of a resin-modified glass-ionomer cement to dentin. METHODS: Bovine dentin was pretreated with Dentin Conditioner or EDTA 3-2 solution, primed by an experimental dentin primer, and applied with a dentin bonding agent. A resin-modified glass-ionomer cement, Fuji II LC, was then adhered to the dentin. The tensile bond strength between the light-cured glass-ionomer cement and the pretreated dentin was measured. The components of the experimental dentin primers were 2-hydroxyethyl methacrylate (HEMA), glyceryl methacrylate (GM) and a water-soluble photo-polymerization initiator, 2-hydroxy-3-(3,4-dimethyl-9-oxo-9H-thioxanthen-2-yloxy)-N,N, N-trimethyl-1- propanaminium chloride (OTX). Significant differences in the data were examined by an analysis of variance and Scheffe's test for multiple comparisons between the means at p = 0.05. RESULTS: A significantly higher mean bond strength between the Fuji II LC and dentin was obtained by EDTA 3-2 pretreatment, QTX/GM priming, and LB Bond application. This value was comparable with that obtained with the resin composite system. Scanning electron microscopy observation showed the formation of a hybrid layer with a thickness of 1-1.5 microns. SIGNIFICANCE: The data obtained in this investigation suggest that the adhesion of Fuji II LC to dentin is closer to that provided by a resin composite system than to that of conventional glass-ionomer cements.     

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.     

Short-term clinical evaluation of a resin-modified glass-ionomer luting cement.

OBJECTIVES: Resin-reinforced glass-ionomer cements were developed by adding resin components to conventional glass-ionomer cement. This improved physical properties and bonding characteristics. FujiCEM is the first paste-paste-type resin-modified glass-ionomer luting cement that enables consistent mixture. The purpose of this study was to evaluate the short-term clinical performance of FujiCEM, which was used for final cementation of indirect restorations, such as inlays, crowns, and fixed partial dentures. METHOD AND MATERIALS: A total of 290 restorations (165 crowns, 71 inlays, 15 onlays, 36 fixed partial dentures, 3 implant superstructures) were placed in 268 patients (137 males, 131 females) with a mean age of 54.4+/-13.0 years. Restorations were luted with FujiCEM mixed for 10 seconds after the teeth surfaces were treated with a conditioner containing 10% citric acid and 2% ferric chloride for 20 seconds, washed, and dried with gentle air flow. Out of the investigated 337 teeth, 99 (29%) teeth were vital, and 238 (71%) were nonvital. These restorations were followed up for a period of 21 months. All the restorations were evaluated for postoperative sensitivity, secondary caries, gingival condition, and pocket depth. RESULTS: No clinical failures (eg, dislodgment, secondary caries, irritation of soft tissue, and postoperative sensitivity) were observed. CONCLUSION: FujiCEM had promising clinical performance with inlays, crowns, onlays, fixed partial dentures, and implant superstructures at 21 months after service.     

Clinical evaluation of a resin-modified glass-ionomer liner for cervical dentin hypersensitivity treatment

PURPOSE: To evaluate the effectiveness of two agents for treating cervical dentin sensitivity associated with gingival recession or noncarious cervical lesions. METHODS: 44 patients with at least mild sensitivity affecting cervical dentin were enrolled in a longitudinal randomized clinical trial. A resin-based desensitizer or an experimental glass-ionomer was assigned to treat at most two teeth from each side of the mouth. Sensitivity was assessed by tactile and cold tests, measured with a Visual Analogue Scale at baseline, after treatment, and at 1 week, 1, 3, 6, and 12 months after treatment. Other noteworthy clinical observations were recorded. RESULTS: Both treatments effectively reduced dentin sensitivity (mixed linear model analysis). Sensitivity score for the glass-ionomer was significantly lower than for the resin-based desensitizer after treatment and at all follow-up periods (P < 0.0001). Some overhanging margins were observed in the glass-ionomer group, which could accumulate plaque and cause gingivitis. Despite material loss from some teeth treated with the glass-ionomer, the follow-up sensitivity scores were still lower than baseline scores.     

Mechanical and biological characterization of resin-modified glass-ionomer cement containing doxycycline hyclate

ObjectivesTo characterize the mechanical and biological properties of a resin-modified glass ionomer cement (RMGIC) containing doxycycline hyclate.MethodsThe antibacterial effect of RMGIC containing 1.5, 3.0 and 4.5% doxycycline hyclate was assessed using two experiments – agar diffusion test for 24 h and biofilm assay for 24 h and 7 days – against some cariogenic bacteria. Briefly, base layers of BHI agar and 300 μL of each inoculum were prepared in Petri dishes with 6 wells that were completely filled with materials. After 24 h incubation, zones of bacterial growth inhibition were measured using a digital caliper. Biofilm assays were conducted using RMGIC specimens immersed in 24-well plates containing the inoculum in BHI broth. After 24 h and 7 days, each specimen were removed, vortexed and the suspension diluted and inoculated in BHI plates for subsequent bacterial counting. Cytotoxicity tests used 50 specimens made in sterilized metal molds, including Vitrebond as positive control. Extracts from every specimen were applied on the MDPC-23 odontoblast-like cells for 24 h. The MTT assay and SEM evaluation determined cell metabolism and morphology, respectively. 80 cylindrical specimens were made from the previously cited groups, and were submitted to testing with a universal testing machine (Instron 4411) using a crosshead speed of 1.0 mm/min for compressive strength and 0.5 mm/min for diametral tensile strength, respectively. Data from antibacterial and cytotoxic effects, and mechanical properties were submitted to appropriated statistical tests.ResultsAll tested groups showed growth inhibition of all tested strains (p < 0.05) in 24 h for both microbiological tests, but only 4.5% doxycycline have antibacterial effect after 7 days. None of doxycycline concentrations caused toxic effect to the MDPC-23 cells or presenting alterations to mechanical properties.ConclusionThe incorporation of up to 4.5% doxycycline hyclate into RMGIC inhibits important oral microorganisms, without modifying biological and mechanical characteristics of the dental material, suggesting a new alternative for the treatment of dental caries.     

Effect of spherical silica filler addition on immediate interfacial gap-formation in Class V cavity and mechanical properties of resin-modified glass-ionomer cement

The aim of this study was to investigate how the addition of silanized spherical silica filler (SF) would influence the formation of summed, immediate interfacial gaps in Class V tooth cavities. Resin-modified glass-ionomer cement (RMGIC) is usually used for Class V restorations. As such, the following aspects of RMGIC were examined in correlation with summed interfacial gaps in the tooth cavity: setting shrinkage of cement in the Teflon mold, as well as mechanical properties in terms of compressive strength, diametral tensile strength, and flexural strength. Spherical silica filler was added to the RMGIC powder (Fuji II LC EM). For comparison purpose, untreated spherical silica filler (UF) was added too. When compared with the control (i.e., original RMGIC mixed with manufacturer-recommended powder/liquid ratio), the addition of SF significantly decreased the formation of summed interfacial gaps in Class V cavities in the immediate condition. In particular, addition of 10 wt% SF increased the compressive strength by 56%, while diametral tensile strength was increased by 28% and flexural strength by 26%.     

Effects of extraction media upon fluoride release from a resin-modified glass-ionomer cement

Previous studies have shown that various factors such as ionic composition or pH of the extraction medium may significantly influence leaching of components from restorative materials. Therefore, it was the aim of this investigation to determine the release of fluoride from a resin-modified glass-ionomer cement (GIC) following storage in various extraction media, including an esterase buffer. Specimens of the resin-modified GIC, Fuji II LC, were stored for 144 h in deionized water, acidic buffer (pH 4.2), neutral buffer (pH 7.0), and neutral buffer supplemented with porcine liver esterase. Fluoride release into the various media was measured every 48 h over a 6-day period. In addition, activity of porcine esterase in neutral buffer (artificial saliva) was measured for up to 144 h. The data were statistically evaluated by three-way ANOVA using the Student-Newman-Keuls test (P<0.05). It was found that esterase activity in neutral artificial saliva decreased during the first 24 h to approximately 40% of the baseline value and then remained constant for up to 6 days. Fluoride release into the various storage media varied significantly (P<0.05). The highest amounts of fluoride were released into deionized water (30.9 ppm±1.1) and acidic buffer (26.9 ppm±0.7) after 48 h. In addition, significantly more fluoride leached into esterase-containing neutral artificial saliva (6.9 ppm±0.2) than into neutral buffer without enzyme (6.3 ppm±0.2) after 96 h. Our data indicate that fluoride release from the resin-modified GIC investigated may be increased under acidic conditions and by hydrolysis in saliva. Received: 23 July 1998 / Accepted: 7 September 1998     

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.     

Fluoride release from a resin-modified glass-ionomer cement in a continuous-flow system. Effect of pH

Fluoride is added to many dental restorative materials, including glass-ionomer cements, for the specific purpose of leaching fluoride into the surrounding tissues to provide secondary caries inhibition. During the caries process, an acidic environment attacks the dental tissues as well as the glass-ionomer cement. We hypothesized that pH significantly affects the rate of release of fluoride from the glass-ionomer cement. A continuous-flow fluoride-measuring system that monitors the amount of fluoride released over time was used to determine the release of fluoride from a resin-modified glass-ionomer cement (KetacFil). The results show that the release rate began with a fast burst of fluoride which quickly diminished to low levels in 3 days. Under neutral pH conditions, the rate of fluoride release at 72 hrs was significantly slower than at pH 4.     

Bioactive glass-ionomer cement with potential therapeutic function to dentin capping mineralization

We have developed a novel bioactive resin-modified glass-ionomer cement system with therapeutic function to dentin capping mineralization. In the system, the newly synthesized star-shape poly(acrylic acid) was formulated with water, Fuji II LC filler, and bioactive glass S53P4 to form resin-modified glass-ionomer cement. Compressive strength (CS) was used as a screening tool for evaluation. The commercial glass-ionomer cement Fuji II LC was used as a control. All the specimens were conditioned in simulated body fluid (SBF) at 37 degrees C prior to testing. The effect of aging in SBF on CS and microhardness of the cements was investigated. Scanning electron microscopy was used to examine the in vitro dentin surface changes caused by the incorporation of bioactive glass. The results show that the system not only provided strengths comparable to original commercial Fuji II LC cement but also allowed the cement to help mineralize the dentin in the presence of SBF. It appears that this bioactive glass-ionomer cement system has direct therapeutic impact on dental restorations that require root surface fillings.