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Biological tests on an experimental glass ionomer (silicopolyacrylate) cement.

The biological compatibility of an experimental glass ionomer (silicopolyacrylate) cement has been assessed in in vitro (cell culture) and in vivo (monkey teeth) tests. For comparison a conventional silicate cement (Super Syntrex) was included in the in vivo experiments. In vitro, the glass ionomer cement was toxic when freshly prepared. The toxicity decreased, however, with increasing setting time. In experiments with prolonged cell-material contact time with specimens which had set for 24 h, the material appeared to be non-toxic. The in vivo experiments confirmed previous reports concerning unfavourable pulp reaction caused by silicate cement, while the glass ionomer cement caused mainly a mild pulp reaction after 8 days of observation. Unfortunately no longer-term observations were obtained since the material had been washed out of the cavities within 36 days.

Acrylates↗

An evaluation of the significance of the impinging jet method for measuring the acid erosion of dental cements.

An extensive review has been made of the impinging jet method for evaluating the durability of dental cements. A comprehensive range of 28 dental cements was examined. The initial rate of erosion was found to be essentially constant. Zinc oxide cements were found to be markedly less durable than alumino-silicate cements. Results broadly correlate with those found in clinical studies.

Dental Cements↗

Monkey pulp reactions to restorative materials.

Deep buccal cavities in 99 teeth in eight young monkeys were filled with the following combination of materials: a light-cured microfilled composite with or without a base, a chemically cured composite with a base, a silicate cement, and a zinc oxide-eugenol cement. The acid etch technique and intermediate layer of resin was used in the composite group. Pulp reactions and presence and location of bacteria were studied after 8 days and after 90 days. In the short observation period the inflammatory reactions were more pronounced when unlined composite fillings were evaluated compared with silicate cement fillings and with lined fillings. Bacteria were seen in all unlined cavities and a significant association between presence of bacteria and moderate to severe inflammatory responses was found. The most severe inflammatory reactions were seen when bacteria were found in the dentinal tubules. After 90 days slight inflammatory changes prevailed in all groups. A significant correlation between bacteria and inflammatory reactions could still be observed.

Acrylic Resins↗

Clinical performance of three anterior restorative materials over 10 years.

The long-term performance of two chemically activated composite resins was compared to that of one silicate cement. Bulk and cavosurface marginal discoloration was evaluated with both an indirect photographic method and the direct US Public Health Service evaluation system. The results confirmed that composite resins had superior performance but higher secondary caries incidence than did silicate cements. The macrofilled composite resins showed better clinical performance than the microfilled restorations, as well as similar incidences of bulk and marginal discoloration. The agreement between the scores obtained with the direct evaluation criteria and those resulting from the indirect evaluation method was relatively poor. The indirect scores were usually the same or poorer than the direct clinical scores. The results indicated that the clinical evaluation may be the least sensitive of the two methods. The discrepancy in the scorings may, on the other hand, signify that the indirect photographic method records reflectance spectra that are not normally obtained in vivo.

Adolescent↗

The surface finish of the new microfill restorative materials. A scanning electron microscope study.

Surface smoothness is an important requirement for restorative materials. Recently, restorative materials claimed to be inherently smooth in surface characteristics have been developed. Matrix-formed and finished surfaces of five new microfill restorative materials were compared with two composite resins, an acrylic resin and a silicate cement by means of scanning electron microscopy. The results of this investigation indicated that the matrix-formed surfaces of all the restorative materials studied were not altogether perfect. Polishing using sandpaper and cuttlefish discs produced a very smooth surface finish in the new microfill restorative materials, Estic microfill, Estilux microfill, Isopast, Isolux and Silar which was comparable to that of the acrylic resin, Sevriton. The composite resins, Adaptic and Estilux exhibited the worst surface finish and the silicate cement, Bio-trey was intermediate. Finishing, using other finer polishing devices on four of the materials produced a further improvement in the surface finish.

Acrylic Resins↗

Bacteria in cavities beneath intermediary base materials.

The ability of six different intermediary base materials to prevent bacterial entrance beneath silicate cement fillings was investigated in vivo in primary molars. After an observation period of 1 month, bacteria were found on the pulpal wall in two out of 10 cavities beneath Fluoritec and four out of 10 cavities beneath Durelon solid mixed, De Trey phosphate cement solid or creamy mixed. Beneath the intermediary base materials Dycal, zinc oxide-eugenol cement, Dropsin and Durelon creamy mixed, no bacteria were found. In cavities filled with silicate cement or silver amalgam only, bacteria were observed in nine out of 10 and in five out of 10 cavities, respectively.

Bacteria↗

Long-term monitoring of microleakage of dental cements by radiochemical diffusion.

Radioactive 14C sucrose was found to be an ideal marker for microleakage because it did not penetrate tooth tissue, dental cement, or mounting resin. The main finding is that the adhesive cements--the glass-ionomer and polycarboxylate--are significantly more effective at preventing microleakage than are the traditional phosphate cements--silicate and zinc phosphate. The differences can be as high as two orders of magnitude. The adhesive cements provide almost perfect and reliable seals. By contrast, the nonadhesive cements are erratic sealants with most of the restorations leaking.

Carbon Radioisotopes↗

Pulp reactions to resin cements.

Several formulas of a resin-filled cement that successfully passed a series of laboratory tests were evaluated for their pulp reactions in primates. Their performance was compared to three controls: a positive control (silicate cement), a negative control (zinc oxide-eugenol) and a control group with the protection of calcium hydroxide. The chemical cure resin cement scored the lowest reactions for the 5-day evaluation. The intermediate and prolonged periods demonstrated no significant differences while average, acceptable responses were recorded. No resin cement formula scored as low as the negative control for the three time periods. Silicate cement, the positive control, scored the greatest inflammatory reaction of any material in the intermediate period, but this response was resolved after 60 days. When the resin cements were used with calcium hydroxide, the traditional reactions to calcium hydroxide were observed; an initial mild irritation that diminished with time and was completely resolved after 60 days. The resin cements, with or without the calcium hydroxide, compared favorably to the negative control IRM after 60 days. If the resin cements are appropriately applied, they are expected to be well tolerated by the human pulp. The microorganisms associated with microleakage (MLM) were minimal and there appeared to be no correlation between the MLM and pulp inflammation.

Analysis of Variance↗

Fluoride release from a glass ionomer cement.

The release of fluoride from a glass ionomer cement (ASPA) was compared with that from a silicate cement. Test specimens were shaken in a solution with hydroxyapatite for 7 weeks. The solution was changed every week and the fluoride taken up by the hydroxyapatite measured. The specimens released considerably more fluoride during each of the first 2 weeks than during each of the subsequent 5 weeks. The continued release did not decrease very much with time. Slightly more fluoride was released from the glass ionomer cement than from the silicate.

Dental Cements↗

Discoloration of dental cements and composites in a sulfide solution.

In an early study the discoloration of certain hardened silicate cements, after exposure to an atmosphere of hydrogen sulfide (H2S) for 24 h at room temperature, was ascribed to the formation of dark-colored sulfides of base metal impurities (Paffenbarger et al. JADA 25,32,1938). A recent study noted that, in general, silicate and glass ionomer cements were more prone to color shifts than composites after exposure to H2S for 9 weeks (Sugawara, Ph. D. Thesis, Nihon Univ.). The aim of the present study was to devise a simple, aqueous sulfide exposure test for esthetic restorative materials. The general procedure was to expose specimen disks to a 0.1% (w/v) sodium sulfide solution, adjusted to pH 9, for 1-7 days at 37 degrees or 55 degrees C. The 55 degrees C-Na2S exposure was designed as an accelerated test. Materials studied included: 1 silicate and 2 silicophosphate cements of known lead content, a glass ionomer cement (FIIF), several commercial composites and an experimental, hydrophilic composite. Known amounts of base metal contaminants in the form of appropriate salt solutions were added to the liquid components of FIIF and the composites. Specimens exposed to distilled water under the same conditions served as controls. Exposure to the aqueous sulfide medium resulted in the following ranking in order of decreasing discoloration: Glass ionomer cement greater than silicophosphate cement greater than silicate cement greater than hydrophilic composite greater than hydrophobic composite. Generally, the results of the aq. Na2S test paralleled those obtained with H2S. The degree of discoloration is dependent on a number of factors: the nature, concentration and leachability of the metal impurities, and the hydrophilicity and permeability to sulfide of the esthetic restoratives.

Chlorides↗

Evaluation of the cytotoxicity of four dental materials in vitro assessed by cell viability and enzyme cytochemistry.

The cytotoxic effects of zinc phosphate and silicate cements, Concise composite and zinc oxide/eugenol were evaluated after 24 h in an in vitro system which simulates the clinical usage of the material, and the results compared with those using phenol. Data of gross changes affecting cell viability placed these materials in ranking order of increasing severity: Concise less than zinc phosphate less than Silicap much less than zinc oxide/eugenol. More discrete changes involving alterations in enzyme cytochemistry were assessed and the significance of the results discussed. The presence of dentine powder in the system reduced the cytotoxic effects on these materials.

Animals↗

Column-like structures of human dentin in carious and artificial lesions.

Serial sections of 36 human teeth with minor to medium-sized carious lesions, adequate sections from previous studies of artificial lesions adjacent to fillings of amalgam (AM), silicate cement (SI) and glass ionomer cement (GI) were studied by ordinary light microscopy and microradiography. Six artificial primary root lesions were included. In carious lesions, dentin columns were visible in the demineralization zone and partly also in the translucent/radiopaque zone. A typical feature of the artificial lesions adjacent to SI fillings was highly radiopaque columns alternating with radiolucent ones. In the GI group such columns were seen at the cavity wall and the advancing front of the outer lesion. In the AM group dark columns were unveiled as pegs in the latter localization. The findings led to the assumption that the dark columns of intact dentin are preferred pathways of acid diffusion in artificial and, possibly, carious lesions. Increased radiopacity of columns in the SI and GI groups is explained by continued exposure of the tooth surface to fluoride dissolved from these fluoride-rich filling materials.

Dental Amalgam↗

A method for evaluation of initial tissue response to biomaterials.

In the present paper an implantation technique is described whereby the effect of the surgical operation is eliminated and initial tissue reactions to materials may be studied. A teflon body was implanted intramuscularly in rabbits. After six weeks the overlaying tissue was excised and the implant removed. An intact, nonepithelialized tissue surface was exposed, which due to the shape of the implant showed three indentations. Materials were placed in the indentations for 15 minutes and the tissue reaction was registered by enzyme histochemical methods. Silicate cement, zinc phosphate cement and a 4% phenol solution caused an inhibition in the dehydrogenase enzyme activity in the tissue subjacent to the indentations. The severity of the tissue reaction, indicated by the width of the inhibition zone, varied among the test materials. Silicate cement caused the widest inhibition zone and the phenol solution the narrowest one. These results correlate well with previous tissue compatibility studies and indicate that the method is applicable for in vivo screening of initial tissue response to biomaterials.

Animals↗

Specification test for the solubility and disintegration of dental cements: a critical evaluation of its meaning.

The specification test for solubility and disintegration is an essential screening test for the quality control of certain cement types. No cement fails it can be considered for use; however, the test has only a limited clinical significance because it does not give an indication of the stability of the fully hardened cement matrix either in oral fluids or water. Instead, it gives a measure of the content of the soluble reaction intermediate present in cements that are still hardening and where the matrix has not fully formed. The test relates, therefore, to early vulnerability to aqueous attack and hardening rate. The period of test is, in fact, an atypical one and the true extent of the erosion of the cement matrix is obscured by the presence of soluble reaction intermediates. Long-term extrapolations cannot be made and so test results for broadly satisfactory cements within a category cannot be used for valid comparisons of clinical excellence, and they can be used even less to compare different cement types with different setting reactions. For example, in general, the dental silicate cement has a higher solubility and distinegration figure than the zinc phosphate cement because it contains soluble sodium salt and hardens more slowly. However, it is more stable under oral conditiont an indication of the vulnerability of the forming matrix to attack. The test is not valid when applied to zinc oxide-eugenol cements because the products of decomposition are either virtually water-insoluble or volatile and therefore not measured under the conditions of the test. A method is suggested for overcoming this deficiency. The test needs to be supplemented by other tests done on fully hardened cements for longer periods of time and in mediums that can represent oral conditions. One example would be to stimulate acid conditions developed in stagnation areas. A total estimation of decomposition products, both soluble and insoluble, is called for rather than the determination of soluble materials only.

Absorption↗

Cytotoxicity of partial-stabilized cement.

Partial-stabilized cement (PSC) is a kind of modified calcium silicate cement used for root-end surgery. Minor transition metal elements Co, Cr, and Zn were added for enhancing the setting property of to PSC. In our previous study, minor transition metal additions greatly improved the setting property of PSC. However, the concern of metal toxicity was raised, as the material would be used in the human body. In this study, we evaluated the cytotoxicity of PSC in comparison with mineral trioxide aggregate (MTA), which is one of the commercialized materials used for dental root-end filling. Primary osteoblast cell was used as the target cell. Cell proliferation, cytotoxicity, viability, function, and senescence were analyzed. The cytotoxicity of the PSC-Zn group (PSC with Zn addition) was similar to that of MTA. PSC-Zn is not only nontoxic at the cellular level but also has adequate mechanical property, which makes it a potential root-end filling material for apical surgery.

Animals↗

Stability and release of antiviral drugs from ethylene vinyl acetate (EVA) copolymer.

The use of polymer based drug delivery systems in dentistry is a relatively new area of research with the exception of the inhibition of secondary caries by the release of fluoride ions from polyalkenoate cements and their predecessors silicate cements. The present study was to test on orally biocompatible material, ethylene vinyl acetate copolymer (EVA), for release of antiviral drugs at oral therapeutic levels over extended periods of time. We also determined their stability during film casting and release. Materials studied include gancyclovir (GCY), acyclovir (ACY), dichloromethane (DCM), and ethylene vinyl acetate (EVA). The square films (3 x 3 x 0.1 cm) were prepared from the dry sheet obtained by solvent evaporation of polymer casting solutions. These solutions were made of EVA and the drug (40:1) in 70 ml of dichloromethane at 38 degrees C. Then drug release characteristics from the drug loaded films were examined at 37 degrees C for a minimum of 14 days in 10 ml medium (ddwater) replaced daily. Kinetics of drug release were followed by spectral measurements using previously determined lambda(max) values (GCY = 250 nm; ACY = 253 nm). A minimum of three samples was tested and reproducible results were obtained. Drug stability (ACY) during film casting and its release was determined using 1H NMR spectrometer (Bruker DRX-500 and 400). Rate of drug release was determined from the part of the curve (rate vs. time) after the onset of the "burst." Although GCY has a larger molecular weight (255) than ACY (225), GCY exhibited about three times higher rate of release than ACY. This difference in rate values may be explained due to its relatively greater solubility in EVA, facilitating faster diffusion of the molecules through the channels present in EVA. This is consistent with the observation that the rate at which drug molecules diffuse through the channels of the polymer, can be increased by decreasing the molecular weight. In the case of ACY, the molecules may be undergoing molecular associations, perhaps dimerization or trimerization in addition to its lower solubility in EVA. The diffusion of ACY tends to be slower under these circumstances compared to GCY resulting in lower rate value than in the case of GCY. Biological studies revealed that ACY exhibited a remarkable decrease in a number of viral organisms present in virus infected cell culture system using real-time polymerase chain reaction (RT-PCR). NMR analysis indicates that the chemical structure of the drug remains stable during film casting process and release.

Acyclovir↗

A polymeric device for delivery of anti-microbial and anti-fungal drugs in the oral environment: effect of temperature and medium on the rate of drug release.

OBJECTIVES: The use of drug delivery systems in dentistry is a relatively new area of research with the exception of fluoride ion release from polyalkenoate cements and their predecessor silicate cements. The present study is based on the use of a bio-compatible material ethylene vinyl acetate copolymer (EVA) that enables constant release of drugs of therapeutic levels over extended periods of time at doses suitable for the treatment of oral conditions. METHODS: Polymer casting solutions were made by dissolving EVA and the drug in the ratio of 40:1 in 70 ml of dichloromethane at 38 degrees C for 6 h. Thin square films of 3 x 3 cm2 with a thickness of 1 mm were cut from the dry sheet obtained by solvent evaporation technique. Drug loaded samples were extracted for a minimum of 14 days in 10 ml medium (double distilled water or water/ethanol (4:1)) which was replaced daily. Spectral measurements were made to follow changes in optical densities (OD) during release kinetics. Effect of temperature (24 and 37 degrees C) on the rate of drug release was studied and the energies of activation (DeltaE not equal ) were calculated using Arrehenius equation for the diffusion (translocation) of molecules of tetracycline hydrochloride (TTH), doxycycline hydrochloride (DOH), and chlorhexidine diacetate (CDA) in water as extracting medium. Effect of extracting medium (water and water/ethanol (4:1)) was also investigated on the rate of drug release measurements at 24 degrees C. RESULTS: Analysis of variance of the data revealed that significantly enhanced rates were observed at the higher temperature (37 degrees C) and when extracting medium was changed to water/ethanol (4:1) for TTH, DOH and CDA (p<0.0015). The enhanced rate values seem to be due to the formation of channels in the polymer. The largest activation energy (21.83 kcal mol(-1)) observed for CDA was interpreted as due to the highest average molecular weight (626) compared to TTH (481) and DOH (481).Significance. These in vitro rate of drug release measurements will provide a basis for establishing a novel approach (treatment modality) for sustained intra-oral drug delivery over extended time periods using laboratory methods and materials that are readily available to dentists.

Analysis of Variance↗

Controlled drug release for oral condition by a novel device based on ethylene vinyl acetate (EVA) copolymer.

The application of drug delivery systems in oral environment is relatively a new area of research with the exception of release of fluoride ions from polyalkenoate cements and their predecessor silicate cements. The present study addresses development of a novel device based on ethylene vinyl acetate copolymer (EVA), a biocompatible material which enables constant drug release over several days to treat oral infections. Drugs incorporated in EVA included tetracycline, minocycline and nystatin together with combinations (C) of nytatin-tetracycline (1 : 1) and nystatin-minocycline (1 : 1). Polymer casting solutions were prepared by dissolving EVA and the drugs in the ratio of 10 : 1 in 70 ml of dichloromethane at 38 degrees C for 6 h. Thin square films of 3x3 cm and 1 mm thickness were cut from the dry sheet obtained by solvent evaporation. Drug loaded samples were extracted for a minimum of 15 days in 10 ml medium (water or water/ethanol (1 : 2) or 0.9% saline solution) which is replaced daily. Spectral measurements were made to follow changes in optical densities (OD) during release kinetics. Analysis of the data revealed that among all the drugs tested tetracycline exhibited the highest release rate (56.15microg/cm2/day) and % cumulative release (27.92). The observed enhanced values may be interpreted as due to the channels formed due to changes in free volume (microvoids). In case of nystatin-minocycline combination, the observed increased values of release rates and percent cumulative release, may be attributed to the swelling component or channels or relative hydrophobic interactions. Initial "burst" effects due to liberation of surface-bound drug molecules were observed with reference to all the three drugs and the combinations of drugs studied. Among all the drugs, minocycline exhibited the least "burst" effect suggesting that the drug is more homogeneously distributed in the copolymer. Drug loaded EVA thermoplastic copolymer may provide a favorable therapeutic material for the development of a novel, local treatment for oral, mucosal and periodontal infections.

Journal Article↗