Clarissa Calil Bonifácio

Physical-mechanical properties of glass ionomer cements indicated for atraumatic restorative treatment

BACKGROUND This study evaluated mechanical properties of glass ionomer cements (GICs) used for atraumatic restorative treatment. Wear resistance, Knoop hardness (Kh), flexural (F(s)) and compressive strength (C(s)) were evaluated. The GICs used were Riva Self Cure (RVA), Fuji IX (FIX), Hi Dense (HD), Vitro Molar (VM), Maxxion R (MXR) and Ketac Molar Easymix (KME). METHODS Wear was evaluated after 1, 4, 63 and 365 days. Two-way ANOVA and Tukey post hoc tests (P = 0.05) analysed differences in wear of the GICs and the time effect. F(s), C(s), and Kh were analysed with one-way ANOVA. RESULTS The type of cement (p < 0.001) and the time (p < 0.001) had a significant effect on wear. In early-term wear and Kh, KME and FIX presented the best performance. In long-term wear, F(s) and C(s), KME, FIX and HD had the best performance. Strong explanatory power between F(s) and the Kh (r(2) = 0.85), C(s) and the Kh (r(2) = 0.82), long-term wear and F(s) of 24 h (r(2) = 0.79) were observed. CONCLUSIONS The data suggested that KME and FIX presented the best in vitro performance. HD showed good results except for early-term wear.

Coating glass-ionomer cements with a nanofilled resin

Abstract Objectives. The objective of this study was to investigate the effect of a nanofilled resin coat on the flexural strength (FS) and the early wear (after 50 000 and 200 000 cycles) of the glass-ionomer cements Fuji IX GP Extra (FIXE) and Ketac Molar Aplicap (KM). Materials and methods. Specimens were prepared and half of them were coated with G-Coat plus. The uncoated specimens were used as controls. Flexural strength (n = 10) was evaluated after 24 h using a 3-point bending test on a universal testing machine (ISO 9917-2). Wear (n = 20) was evaluated after 50 000 and 200 000 cycles using the ACTA wear machine. One-way, two-way ANOVA and Tukey post-hoc tests were used to analyze differences in FS and wear. Results. For FIXE the coat significantly increased the FS and the wear along the two time spans. KM did not show a significant difference in FS with the coat. Improvements in wear were observed only after 50 000 cycles. Conclusion. Based on these laboratory results, it is concluded that G-coat Plus is indicated in association with GP IX Extra with the aim to improve the mechanical properties of the former. However, this study is limited to a short-term observation.

The effect of GIC-brand on the survival rate of proximal-art restorations

BACKGROUND Laboratory studies show diverse behaviour of different brands of glass-ionomer cements (GIC). AIM This study investigated the clinical performance [survival rate (SR)] of three GIC brands applied to proximal atraumatic restorative treatment (ART) restorations. Additionally, the SR of the tooth was evaluated. DESIGN Proximal cavities of 262 primary molars were restored. The patients had been randomly allocated to two operators and three GIC brands: Fuji IX, Hi-Dense, and Maxxion R. Restorations were evaluated after 1, 6, 12, 18, 24, 30, and 36 months. Failed restorations were, if possible, repaired or replaced. Linear regression analyses were used to evaluate the effect of GIC brand, operator, and surface of restoration. Kaplan-Meier survival analysis and log-rank test were performed for both restoration survival and tooth survival (α = 5%). RESULTS After 3 years, 82.4% of the restorations were evaluated. The SR of the restorations was 24.4%, and there was no difference among GIC brands (log-rank test, P = 0.6). In the first 18 months, a significant operator effect and significantly higher failures in distal surfaces were found. The SR of the tooth was 81.7%. CONCLUSIONS The SR of proximal ART restorations was relatively low when compared with the SR of the tooth. There are no differences in the performance among the GIC brands used in the study.

Micro-mechanical bond strength tests for the assessment of the adhesion of GIC to dentine

Abstract Background. The aim of this study is to critically evaluate the bond strength (BS) of Glass-Ionomer Cements (GIC) to dentine with microtensile (μTBS) and microshear (μSBS) BS tests by assessing their rankings and failure patterns. Methods. Samples were made on flat dentine surfaces and submitted to μTBS and μSBS. The materials used were: high viscosity GIC (Ketac™ Molar Aplicap-KM), resin-modified GIC (Fuji II-FII), nano-filled resin-modified GIC (Ketac™ N100-N100) and an etch-and-rinse adhesive system with a composite resin (Adper™ Single Bond 2 and Z100™-Z100). All tests were performed with a Universal Testing Machine (24 h water storage, crosshead speed of 1 mm/min). Debonded surfaces were examined with a stereomicroscope (×40) to identify the failure mode. The data was analyzed with two-way ANOVA (p < 0.05) and LSD test. Results. Means were statistically different regarding the tests and materials, indicating that values for BS obtained for each material depend on the test performed. Failure analysis revealed that failures produced by μTBS were mainly cohesive for KM and FII. μSBS failures were mainly adhesive or mixed for all materials. For the μTBS, the rank was Z100 > FII > KM = N100, whereas for the μSBS it was Z100 = FII = KM > N100. Conclusion: It may be concluded that distinct micro-mechanical tests present different failure patterns and rankings depending on the material to be considered.

Evaluation of the dental structure loss produced during maintenance and replacement of occlusal amalgam restorations

The aim of this in vitro study was to evaluate four different approaches to the decision of changing or not defective amalgam restorations in first primary molar teeth concerning the loss of dental structure. Ditched amalgam restorations (n = 11) were submitted to four different treatments, as follows: Control group - polishing and finishing of the restorations were carried out; Amalgam group - the ditched amalgam restorations were replaced by new amalgam restorations; Composite resin group - the initial amalgam restorations were replaced by composite resin restorations; Flowable resin group - the ditching around the amalgam restorations was filled with flowable resin. Images of the sectioned teeth were made and the area of the cavities before and after the procedures was determined by image analysis software to assess structural loss. The data were submitted to ANOVA complemented by the Student Newman Keuls test (p < 0.05). The cavities in all the groups presented significantly greater areas after the procedures. However, the amalgam group showed more substantial dental loss. The other three groups presented no statistically significant difference in dental structure loss after the re-treatments. Thus, replacing ditched amalgam restorations by other similar restorations resulted in a significant dental structure loss while maintaining them or replacing them by resin restorations did not result in significant loss.

Effect of insertion method on knoop hardness of high viscous glass ionomer cements

The aim of this study was to assess the Knoop hardness of three high viscous glass ionomer cements: G1 - Ketac Molar; G2 - Ketac Molar Easymix (3M ESPE) and G3 - Magic Glass ART (Vigodent). As a parallel goal, three different methods for insertion of Ketac Molar Easymix were tested: G4 - conventional spatula; G5 - commercial syringe (Centrix) and G6 - low-cost syringe. Ten specimens of each group were prepared and the Knoop hardness was determined 5 times on each specimen with a HM-124 hardness machine (25 g/30 s dwell time) after 24 h, 1 and 2 weeks. During the entire test period, the specimens were stored in liquid paraffin at 37ºC. Significant differences were found between G3 and G1/G2 (two-way ANOVA and Tukeys post hoc test; p<0.01). There was no significant difference in the results among the multiple ways of insertion. The glass ionomer cement Magic Glass ART showed the lowest hardness, while the insertion technique had no significant influence on hardness.

A preliminary clinical trial using flowable glass-ionomer cement as a liner in proximal-ART restorations: The operator effect

Objectives: This in vivo study was carried out to assess the influence of the operator experience on the survival rate of proximal-ART restorations using a two-layer technique to insert the glass-ionomer cement (GIC). Study Design: Forty five proximal cavities in primary molars were restored in a school setting according to the ART technique. The cavities were restored by two operators with Ketac Molar Easymix, and received a flowable layer of GIC prior to a second GIC layer with a regular consistency. The operators had different clinical experiences with ART (no experience or two years of experience), but both completed a one-week training to perform the restorations and the GIC mixing in this study. Results: After a 12-month follow-up, 74% of the restorations survived; the main reason for failure was bulk fracture or total loss of the restoration.There was no operator influence (log-rank test p=0.2) Conclusion: The results encourage future well designed controlled clinical trials using the two-layer technique for insertion of GIC in proximal-ART restorations, after training the operators. Key words:Atraumatic Restorative Treatment (ART), Glass-ionomer, proximal restorations.

Bilayer technique and nano-filled coating increase success of approximal ART restorations: a randomized clinical trial.

BACKGROUND The high-viscosity consistency of glass ionomer cement (GIC) may lead to its incorrect adaptation into the cavity and therefore to restoration failure. AIM To compare two different insertion techniques for GIC in approximal atraumatic restorative treatment (ART) restorations and two different surface protection materials. DESIGN Approximal caries lesion in primary molars from 208 schoolchildren was randomly assigned into four groups: G1, conventional GIC insertion protected with petroleum jelly (PJ); G2, bilayer technique protected with PJ; G3 conventional GIC insertion protected with nano-filled particles coating for GIC (NPC); G4, bilayer technique protected with NPC. Restorations were evaluated after 1, 6, 12, 18, 24, and 36 months. Kaplan-Meier survival analysis and log-rank test were performed. Cox regression analysis (α = 5%) was used to verify the influence of clinical factors. RESULTS Restoration survival was 52.8%. Log-rank test indicated a better survival of the bilayer technique restorations, compared to conventional restorations (P = 0.005), whereas the coated conventional restorations presented higher survival than the uncoated ones (P = 0.035). Cox regression analysis showed no influence of any clinical tested variables. CONCLUSION The survival rate of the approximal ART restorations is positively influenced by the bilayer technique, and the application of nano-filled coating increases the longevity of the conventional approximal ART restorations.

Low-cost glass ionomer cement as ART sealant in permanent molars: a randomized clinical trial

Clinical trials are normally performed with well-known brands of glass ionomer cement (GIC), but the cost of these materials is high for public healthcare in less-affluent communities. Given the need to research cheaper materials, it seems pertinent to investigate the retention rate of a low-cost GIC applied as atraumatic restorative treatment (ART) sealants in two centers in Brazil. Four hundred and thirty-seven 6-to-8-year-old schoolchildren were selected in two cities in Brazil. The children were randomly divided into two groups, according to the tested GIC applied in the first permanent molars. The retention rate was evaluated after 3, 6 and 12 months. Kaplan-Meier survival analysis and the log-rank test were performed. The variables were tested for association with sealant longevity, using logistic regression analyses (α = 5%). The retention rate of sealants after 12 months was 19.1%. The high-cost GIC brand presented a 2-fold-more-likely-to-survive rate than the low-cost brand (p < 0.001). Significant difference was also found between the cities where the treatments were performed, in that Barueri presented a higher sealant survival rate than Recife (p < 0.001). The retention rate of a low-cost GIC sealant brand was markedly lower than that of a well-known GIC sealant brand.

Mechanical behavior of a bi-layer glass ionomer

OBJECTIVE A high-viscosity consistency of the glass-ionomer cement (GIC) may lead to poor adaptation into the cavity. The use of a flowable GIC layer seemed to improve its adaptation in approximal restorations in vitro. In this study we assessed the flexural strength of a two-layered GIC, using a flowable GIC as a liner (two-layer technique). Additionally, finite element analysis on standardized bar-shaped models and on a representative tooth model was performed to rationalize the obtained results. METHODS The flexural strength and Youngs modulus were calculated from the results of a three-point-bending test. Bar-shaped specimens were prepared either with a conventional GIC, with a flowable GIC (powder/liquid ratio 1:2), or with two-layers (either with the flowable layer down or on the top of the specimen). Three dimensional FEA models of the bar-shaped specimens and a model of tooth 46 provided information on the stress distribution of each component of the specimen and on the restoration. RESULTS The apparent flexural strength and Youngs modulus of both two-layered groups were significantly lower than that of the conventional group. FEA showed that the layers of the two-layer specimens with the flowable GIC down separated from each other under load. The tooth model showed better stress distribution for the two-layer restorations. SIGNIFICANCE The two-layer GIC showed inferior flexural strength, which might be explained by the detachment of the layers under load. Nevertheless the tooth model showed that the two-layer GIC provides a lower stress concentration on the occlusal surface of the material.