Beata Czarnecka

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.

The rate of change of pH of lactic acid exposed to glass-ionomer dental cements.

The rate of change of pH of aqueous lactic acid at pH 4.2-4.5 (i.e. a little below that of active caries in vivo) in contact with disks of various commercial glass-ionomer cements has been determined in two configurations. In the first of them, a thin film set-up, 20 microl of solution was spread across the surface of a cement disk (diameter: 13 mm), and its pH determined by pressing a flat-ended electrode against the film at varying time intervals. In the second, a similar disk was immersed in 1.5 ml of solution, removed after varying time intervals, after which the pH of the solution was measured using a round-ended electrode. The latter measurement was more reliable, in that the pH electrode had time to equilibrate, whereas the former was more realistic because the film was approximately the same thickness as that of saliva on a tooth surface. Both series of experiments showed measurable differences in pH after only 30 s, with the thin-film configuration showing a range of pH changes of 0.5-1.2 units depending on the cement and the small volume configuration showing a range of 0.1-0.5 units, also depending on the cement. After 10 min, in the small volume experiments, the pH had generally increased further. The extent and speed of the change in pH led to the conclusion that ability of glass-ionomers to increase pH is likely to be an important mechanism of caries protection under clinical conditions.

Storage of polyacid-modified resin composites ("compomers") in lactic acid solution.

OBJECTIVES The aim of this study was to determine the interaction of four polyacid-modified resin composites with aqueous lactic acid solutions, and to compare changes with those for a glass-ionomer cement and a conventional resin composite. METHODS For each material, namely Compoglass F, Dyract AP, Hytac and Ana Compomer, plus AquaCem (glass-ionomer cement) and Pekafil (conventional composite resin), five cylindrical specimens of 4 mm diameter x 6 mm height were prepared and weighed. They were stored individually in 2.0 cm3 of 0.02 mol l-1 lactic acid solution for 1 week then the pH was determined and the specimens reweighed. The lactic acid solution was replenished, and the specimens were stored for a further week, after which the pH and specimen weights were again measured. This was repeated at 1 week intervals until the specimens were 6 weeks old. Differences were analysed by ANOVA followed by Newman-Keuls post hoc analysis. RESULTS All four polyacid-modified composites increased the pH of the solutions at all time intervals by at least 0.26 pH units (significant to at least p < 0.01). This effect was similar to that of the glass-ionomer (but significantly less, p < 0.05) while significantly greater (p < 0.05) than that for the composite, Pekafil, which, by contrast, had no effect on pH. The observed rise in pH reduced significantly over time (ANOVA, p < 0.05). After 1 week, all pH changes were accompanied by net reductions in specimen mass, indicating susceptibility to acid erosion. Hytac was significantly more resistant to this erosion than the other materials; conversely, it had the least effect on solution pH. SIGNIFICANCE These results show that polyacid-modified resin composites neutralise lactic acid in vitro but suffer erosion in the process.

A preliminary study of the effect of glass-ionomer and related dental cements on the pH of lactic acid storage solutions

Glass-ionomer cements, both self-hardening and resin-modified, have been shown to increase the pH of lactic acid solutions in which they are stored. Similar results have been obtained for a zinc phosphate and a zinc polycarboxylate cement. The pH was increased over a period of 7 days by between 1.54 and 2.65 pH units from an initial value of pH of 2.60, depending on the cement. It is concluded that, as a result of this ability to neutralize surrounding aqueous solutions, these materials may have the beneficial effect in vivo of inhibiting caries development. In the case of glass-ionomers, this mechanism might complement that of fluoride release.

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 Al2O3 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.

Ion-release, dissolution and buffering by zinc phosphate dental cements

The interaction of zinc phosphate dental cement with aqueous solutions has been studied in order to elucidate the relationship between pH change and ion release (dissolution). For each storage medium (deionized water, lactic acid at pH 2.7 and lactate buffer at pH 2.2) five cylindrical specimens of zinc phosphate cement (6 mm diameter×12 mm height) were prepared and weighed. They were stored individually in 8 cm3 of solution for a week, then the pH was determined and the specimens reweighed. The solutions were replaced and the specimens stored for a further week, then the pH and the weight were again measured. This was repeated for four weeks. For each storage solution at each time interval, the concentration of ions leached (Na, Mg, Al, Zn and P) were determined using ICP-OES. The lactate buffer was particularly erosive and reduced specimens to 4.1% (±0.9%) of their original mass after 4 weeks. The lactic acid was also erosive, but in water, specimens showed no significant mass change after 4 weeks. In all media, Na, Al, Mg, Zn and P ions were released, with mole ratios varying at each time interval. In all cases, the pH shifted towards neutral, but the relationship between ion release and solution pH was not straightforward. From the mole ratios of ions, estimates could be made of the relative proportions of attack at matrix to attack at filler, and this showed attack at filler predominated in most solutions at most time intervals.

The long-term interaction of dental cements with lactic acid solutions

A study of the interaction of dental cements with lactic acid solutions has been carried out in which individual cement specimens were repeatedly exposed to 20 mmol dm−3 lactic acid for periods of a week. After each week of storage, the mass of the specimens was recorded and the pH of the solution determined. The glass-ionomers showed an initial increase in mass, followed by a decline that became steady from 6 weeks. Zinc polycarboxylate and zinc phosphate cements, by contrast, showed no early gain in mass, but eroded steadily more or less from the start of their exposure to lactic acid. For all cements, acid erosion followed linear kinetics, at rates ranging from 0.5%/week for the zinc phosphate to 0.28%/week for one of the glass-ionomers, Chelonfil (ESPE, Germany). At the end of six months, the zinc phosphate had lost 14.2% of its initial mass, the zinc polycarboxylate 9.9% and the glass-ionomers between 6.2 and 7.2%. Erosion was accompanied on every occasion by neutralization of the acid solution. Both erosion and neutralization continued steadily throughout the experiment. The effectiveness of neutralization was in the following order: zinc polycarboxylate>zinc phosphate>glass-ionomer. The pH change in Week 1 was much greater for the glass-ionomers and the zinc polycarboxylate than in all subsequent weeks.

Surface energy of bovine dentin and enamel by means of inverse gas chromatography.

Adhesion between tooth tissues and dental fillings depends on the surface energy of both connected materials. Bond strength can be determined directly or indirectly as a work of adhesion on the basis of values of surface energy of these materials. Inverse gas chromatography (IGC) is one of the methods of surface energy examination. In this study the values of total surface energy components of wet and dry teeth fragments (enamel, crown dentin and root dentin) were determined with the use of inverse gas chromatography. Inverse gas chromatography has never been used for investigation of surface energy of natural tooth tissues. Different storage conditions were examined - wet and dry. Different values of surface energy are observed according to the type of tooth tissue (dentin or enamel), occurring place (crown or root) and storage conditions (dry or wet). The effect of tissue type and occurring place was the greatest, while storage conditions were of secondary importance. Surface energy depends on composition of tissue, its surface area and the presence of pores.

Maturation affects fluoride uptake by glass-ionomer dental cements

OBJECTIVES Four commercial glass-ionomer cements have been studied for their ability to take up fluoride from aqueous solution following variable maturation times in the dry at 37°C. METHODS Sets of five specimens of four different materials were cured for times of 10 min, 24 h and 1 month, then transferred to a neutral solution of NaF at approximately 1000 ppm in fluoride. Fluoride concentration was then measured at regular time intervals up to 1 month using a fluoride ion selective electrode. RESULTS Specimens cured for 1 month showed little or no uptake over 24 h, specimens cured for 24 h showed fluctuating uptake over time, and specimens cured for 10 min showed the greatest fluoride uptake. For the latter specimens, simple kinetic models were found to apply in two cases (pseudo-first order and pseudo-second order for Chemflex and Ketac Molar Quick respectively). SIGNIFICANCE The ability to take up fluoride has been shown to decline with age of cement which suggests that in clinical use glass-ionomers may become less effective at undergoing fluoride recharge than has been previously assumed.

A study of cements formed by aqueous lactic acid and aluminosilicate glass

A study is reported of the formation of cements from aqueous lactic acid and aluminosilicate glass of the type used in dental glass–ionomer cements. These cements were found to set quickly, and were shown by infrared spectroscopy to have undergone a neutralization reaction to yield mainly calcium lactate. They were very soluble in water at 1 h, but became progressively less so over time; when matured for 6 h before being placed in water, they had become almost insoluble. No spectroscopic differences could be detected between the cements at 1 h or 6 h, indicating that insolubilization arises from a reaction that does not alter the part of the infrared spectrum examined. This suggested that a wholly inorganic reaction between the ion-depleted glass fragments is responsible for the formation of the insoluble structure. After 24 h, the cements were found to have compressive strengths in the range 9–35 MPa, the actual value varying with concentration of lactic acid used to form the cement, and there was no statistically significant increase in strength for the strongest of these after one month.