You are on page 1of 6

See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/42832654

Flowable glass ionomer cement as a liner:
Improving marginal adaptation of
atraumatic restorative treatment...

Article in Journal of dentistry for children (Chicago, Ill.) · January 2010
Source: PubMed

CITATIONS READS

9 240

5 authors, including:

Clarissa Calil Bonifácio Marcelo Bönecker
Academisch Centrum Tandheelkunde Am… University of São Paulo
43 PUBLICATIONS 203 CITATIONS 110 PUBLICATIONS 1,725 CITATIONS

SEE PROFILE SEE PROFILE

Some of the authors of this publication are also working on these related projects:

High-viscosity glass-ionomers in dentistry View project

EFFECTIVENESS OF TWO CLINICAL RECALL INTERVALS IN THE INCIDENCE OF CARIES IN
PRESCHOOL CHILDREN WHO HAS HIGH CARIES RISK View project

All content following this page was uploaded by Clarissa Calil Bonifácio on 31 January 2015.

The user has requested enhancement of the downloaded file.

MS.4 found no difference in survival rate between Pediatric Dentistry. Atrau. University of Sao Paulo. Regarding the SEM evaluation. and Dr.Bonifacio@acta. ART's material of choice is the high viscous glass Correspond with Dr. This approach was fully de- matic restorative treatment (ART) is one of the existing scribed by Frencken and Holmgren 1 and has been de- treatment approaches that fit this philosophy. van Amerongen is asso. Sao Paulo. Raggio is senior lecturer.2009. Department of Hof et al.3 and van't ciate professor and Head of the Department.Ol) better result for G2. School of Dentistry. Dr. which confirmed better adaptation as seen in the microleakagetest. after field research contributions prevention and minimum intervention. Frencken et a]. storations.5 Pediatric Dentistry. from Frencken in Tanzania. Evert van Amerongen. rinsed and sectioned mesio-distally. ]DC SCIENTIFIC ARTICLE Flowable Glass lonomer Cement as a Liner: Improving Marginal Adaptation of Atraumatic Restorative Treatment Restorations Clarissa Calil Bonifacio. Results: The data analysis (Mann-Whitney) showed a significant (P<O. and Dr. PhD Marcelo Bonecker. Brazil.1 due to its well-known properties 12 Bonifacio et al F10wableGICliner in proximal ARTrestorations Journal of Dentistry for Children-77: " 2010 .2 Dr. DDS Daniela Procida Raggio. DDS. Microleakege evaluation was carried out by 3 evaluators. Conclusion: the insertion of a flowable GIC layer in proximal cavities before the in- sertion of a regular GIC layer improves the material adaptation to the tooth. irregularities were observed in the G 1 at the tooth/GIC interface. (J Dent Child 2010. In 2 recent meta-analyses. as one of the treatments indicated in the Basic Package of Oral Care. immersed in 0. This kind scribed around the world by the World Health Orga- nization.nl ionomer cement (GIC). MS.2008. GLASS IONOMER CEMENT C ontemporary treatments in pediatric dentistry of treatment was proposed and introduced to dentists search for restorative techniques with maximum in the early 1990s. Amsterdam.5% methylene blue solution (4h). DENTAL MATERIALsl BIOMATERIALS. PhD Tatiana Galindo Meschini. G 1 was restored with a regular powderlliquid ra- tio GIC. Bonifacio at C. the teeth were made impermeable with the exception of the restoration area and 1 mm of their surrounding. After 24h water storage (37"C). RevisionAccepted March 30. it was not possible to observe any displacement of the GIC in relation to the tooth structure. Bonifacio is PhD student.77:12-6) ReceivedOctober 15. Last Revision March 29. DDS. MS. G2 firstly received a flowable layer of GIC and secondly a regular GIC layer. For G2. Academic Centre for Dentsitry Amster- dam (ACTA). DDS. One side was polished and analyzed under light microscope. Replicates from the other side were observed under SEM. The Netherlands. 2009. Meschini glass ionomer (ART) and amalgam in single-surface re- is graduate student. and Dr. Methods: Forty primary molars received proximal cavity preparations and were ran- domly divided in two groups. These findings contribute to scientific evi- Bonecker is associate professor. all in the Department of dence for the ART approach and reinforce its indication. PREVENTIVE DENTISTRY. MS W. KEYWORDS: REsTORATIVE DENTISTRY. PhD ABSTRACT Purpose: The present study aims to evaluate the in vitro microleakage of two layers GIC proximal restorations in primary molars. DDS.

6-8 mix was achieved. the cavities were pre. using Express (3M/ESPE. Forty noncarious. measured with a preci.16 The specimens were stored in distilled water at microleakage of 2-layered glass ionomer cement pro. MA. and fi- available for chemical bonding to the tooth structure. 10% ners of the cavity. Formula and Ac. direction using a cleaver. Germany) as the impression material. the This material presents a viscous consistency.:aoFarmacia. Two nail polish layers (Impala. To far from ideal compared to single-surface restorations. Henkel Loctite Products. Haverhill. Subsequently. a 1200-grit silicon carbide paper (Buehler Ltd. The GIC was applied in small increments by being pushed into the cor. were taken of the other side. set.14indicating that remaining polyacrylic ions are overfilling the cavity.9-12 fill the cavity. For the 2-layered group: the cavities received The numbers shown in the bars represent the number of cases per group the same pretreatment as in the control group. The ingredients 30% were hand-mixed until a homogeneous consis- 20% tency was achieved. Figure 1. Japan).5% methylene Sao Paulo. Paulo. Results in percentage for each group and microleakage score. In the control group.13. The first layer was inserted with a con- GIC's clinical behavior in proximal ART restorations is ventional application instrument on the cavity floor. The specimens were sectioned once in a mesiodistal The cavities were 3-mm wide (buccolingual direction). Conn) in the apical region to pre- METHODS vent dye penetration.2. ob.(ie. the GIC was pressed. the second layer was hand-mixed accord- The insertion of the material must be done when the ing to the manufacturer's instructions (powder/liquid consistency is not too thick and the appearance is still 1:1) and applied before the first layer hardened. Sao Paulo. and chemical set reaction). using cyanoacrylate ester (Super Bonder. Germany) liquid (10 seconds).15After Microleakage score the initial setting time (3 minutes). margin around the entire restoration. Sao paper for 2 hours. and 3-mm deep. intact primary molars.l. Seefeld. Brazil. surface of all restorations to avoid water uptake and The purpose of this study was to evaluate the in vitro 10SS. the cavities received pre- treatment with Ketac Molar Easy mix (3M/ESPE. Ill) to be analyzed under a light microscope file was used. Guarulhos. All the cavities and restorations were per. After shiny. This study was started after approval of the Ethical Com. Replica impressions groups (N=20). Lake For standardization purposes. Subsequently. petroleum jelly was applied on the viscous consistency layer can reduce adverse effects.5:1). a millimeter ruler and a K Bluff. Replicas the evaluation. within each score. biocompatibility. 37°C for 24 hours and later were made impermeable ximal restorations. Specimens were randomly assigned into 2 (Olympus SZ-PT. Tokyo. Rocky Hill. In the first layer. bonding to enamel and dentin. and 80% the restorations were made in accordance with 70% Frencken and Holmgren. formed by a single operator who did not participate in Seelfeld. which GIC was hand-mixed with half a portion of powder makes it a cement with complex manipulation and in. Metal bands were placed. Brazil) in a water-cooled. One side was polished with 2-mm long (mesiodistal direction). high-speed handpiece. mittee of the School of Dentistry (University of Sao with the exception of the restoration area and a 1-mm Paulo). Mter overfilling the cavity. were cleaned with pumice blue solution (pH=7. more flowable consistency before the insertion of a high Mter 6 minutes. The 100% specimens were then rinsed in water and dried 90% 14 4 1 with cotton pellets. the 0% GIC was firmly pressed into the cavity with a o 2 3 gloved index finger with petroleum jelly. fluoride release and Metal bands were placed and the restorations were uptake. Sao Paulo) were applied on all tooth surfaces. tained from the Human Tooth Bank at the University of The specimens were immersed in 0.1 GIC was mixed ac- 60% cording to the manufacturer's instructions: 1 • 2 layers powder scoop (142 mg. Journal of Dentistry for Children-77: " 2010 F10wable GIC liner in proximal ART restorations Bonifacio et al 13 . 40% • Control USA) and 1 liquid drop (1:1). 3101. and a Robinson brush in low-speed hand piece and Sao Paulo) for 4 hours. made using 2 different G IC layers. nished following the same procedures used for the It is unknown if the use of a thin layer of GIC with a control group. they were rinsed washed with water.4. in tap water for 1 minute and placed on absorbent pared with a diamond bur (no. 50% sion balance Ohaus Adventurer. (71 mg) and 1 liquid drop (0. A flowable consistency sertion characteristics. the restora- tion was finished with a carving instrument. KG Sorensen.

Glass lonomer Cement 116x 75mm. between the GIC and the tooth structure. I .interface tooth/restoration. GIC . number of cross-links and a better wettability.19 A better adhesion also con- kappa test. (Figure 2). Sao Paulo). according to a scale proposed by Salama Despite the fact that the GIC bonding mechanism et a16: to the tooth structure is not completely clear. independently examined a hard copy of tional ART restorative method proposed by Frencken the images taken using a microscope (model SZ-PT. indicating the absence of an intimate contact Lake Bluf.78 to 0. The ex. 14 Bonifacio et al F10wable GIC liner in proximal ART restorations Journal of Dentistry for Children-77: " 2010 . Bauru. Cracks were not observed in the 2-layered group. I .1 The restorations made with the flowable Olympus.were made with epoxy resin (Epo-thin Buehler Ltd. structure for the control group as well as some gaps Figure 2.05.dentin. the presence of a flowable-GIC Regarding the SEM evaluation. D .17 tributes to an increased resistance to microleakage.OI). ference between the 2 groups (Ps. Figure 1 shows the results in the first flowable-GIC layer and the second conventional- percentage for each group. and monstrated a better adaptation (Figure 3). voids. favoring the examiner agreement was calculated by Cohen's micromechanical adhesion. Ill) and prepared for viewing under a scan. it was not possible to observe any failure or gap tron Microscopy Ltd. GIC layer. chemi- O=no penetration of the tracer agent.OI) and no aminers had attributed values to the penetration of the voids at the tooth/restoration interface. Cambridge. For the 2-layered ning electron microscope (SEM. and cracks. Inter. related to the tooth structures' adhesion. between the GIC and the tooth. ximal cavities of primary teeth compared to the tradi- tion to groups.Glass lonomer Cement 182 x 131mm. GIC as a liner showed less microleakage (P<.13. 200X. The data analysis showed a statistically significant dif. These Data were analyzed using a GMC software 7. based on Ps. scope (1000x). and both mechanisms are enhanced by the flow- The interexaminer agreement ranged from 0.5 facts can explain the lower microleakage and no voids (GMC. previously trained and blind in rela.2o The GIC presents a chemical and a micromechanical adhe- RESULTS sion. group. Apparently. IOOOXmagnifications to observe the interface between tooth structure and GIC. D . as the former displace phosphate and calcium 2=penetration of the tracer agent in all extensions ions from the latter.interface tooth/restoration. irregularities were layer in the dental cavity allows for better adaptation of observed in the interface between GIC at the tooth the whole material in the cavity. LEO 440i. apatite. with better results neither at the tooth/restoration interface nor between for the 2-layered group. Ten unidentified specimens of DISCUSSION each group were analyzed in random order to observe The restorations made with the flowable GIC as a liner interface differences.89. able layer. adaptation. tracer agent. seemed to improve the cavity walls' adaptation in pro- Three evaluators. Control Group Scanning Electronic Microscope Figure 3.18 The lower powder-liquid ratio of the occlusal or gingival face. including the axial wall. Leo Elec. GIC. performed to determine statistically significant dif. without achieving used for the flowable layer has important characteristics the axial wall. Mann-Whitney test was in the 2-layered group. which de- The SEM evaluation was made with 50X.dentin. Tokyo. UK). Japan) at I5X magnification. and Holmgren. cal adhesion is achieved by an interaction between the l=penetration of the tracer agent in the superficial carboxylic groups from the polyacids and the hydroxy- interface of the occlusal or gingival face. The adhesion principles suggest that the most fluid ferences between the groups. Two layers group Scanning Electronic Micro- (1000x). materials penetrate better in the substrate. The higher 3=penetration of the tracer agent in all extensions of polyacrylic acid available can be responsible for a higher the occlusal or gingival face.

This gives us strong confidence to Netherlands: STI. 2002. as it requires tests in vivo for con. Centre for Oral Health Care Planning and Future Increasing the number of samples could lead to more ro.midentistry. this study 4. layer seems to present less voids. van Amerongen WE. Mickenautsch S.:ag 0. widely registered in literature/. Smales R]. caries: A meta-analysis. Frencken ]E. Roeleveld AC. Van Amerongen WE. Residual caries and marginal integrity in relation It is also relevant to ponder whether the 2-layered to Class II glass ionomer restorations in primary technique is better than the traditional GIC viscosity molars. CONCLUSION 11. 1. Bezerra AC. Leal SC. can be hypothesized that there is not much differences Access November 15th. Songpaisan Y. Int Dent] 2004. Mandari G]. confirmed with in vivo studies. Holmgren C].54:42-6. bust conclusions. The fact that. due to some of its drawbacks. van Amerongen WE. On the other hand. in this study (N=10) is. research should be carried out to enhance the longev. Yengopal V.] Clin Pediatr Dent 1995. a significant contribu. The images are reliable. which resemble the tooth surface with out. ment (ART) and conventional cavity preparations: 2-year results. van Palenstein Helder- investigated only marginal adaptation brings up ques. Oliveira LB.83: 120-3. vant Hof MA. A clinical evaluation of resin-based firm that the insertion of a flowable glass ionomer ce. Gao X]. and marginal gap formation of glass ionomer resin lar powder-liquid ratio but also because the flowable restorations. Mandari G]. Abdel Megid FY. firmation of its conclusions. Aykut A. Yip HK. It Available at: ••www. Ersin NK. An needed and the additional time spent for it. Candan U. Bonecker M. Eur Arch Paediatr Dent 2006. Holmgren C]. The fact that this is an in vitro study also re.21-23will be achieved. ] Am Dent Assoc 2006. 1529-36. van Palenstein samples in the present study. ] Dent Res 2004. 5. however. These replicas were confec. Eur Arch Paediatr Dent 2006.7:81-4. man WH. REFERENCES plicas. not only 6. com-po site and glass ionomer cement restorations ment layer within proximal cavities before the insertion placed in primary teeth using the ART approach: of a regular glass ionomer cement layer improves the Results at 24 months.html ••. We would like to thank the Research Support Foun- tioned due to the fact that the previous dehydration dation of the State of Sao Paulo (FAPESP) for funding needed for the SEM observation may lead to cracks in this study.137: material's adaptation to tooth structures. It is important to emphasize that the SEM was carried ACKNOWLEDGMENT out in acrylic resin replicas. nat C.com/micomp. Deng OM. as GIC is a water-based material. Kose T. strength properties. observe the presence of cracks and air bubbles in control 2.56:345-51. Ero- Based on this in vitro study's results. which currently lacks access to 460-4. tions. the material. Riad MI.20:31-6.44: part of the population. additional 10. Frencken ]E. clarify the strength properties of the 2-layered GIC. Frencken ]E. between the 2-layered and single-layered GIC. 1999. presents a limitation. Scenarios. Mhaville R]. Nijmegen. study. Minimum intervention Additional in vitro studies should be conducted to compendium (MI): A new approach in dentistry. 8. tion to the reduction of failure ART approximal restora. it is possible to af. The number of samples per group used 3. Microleakage because the former has the superficial layer with a regu. vant Hof MA. This study's sample size was not large enough to Nijmegen. Salama FS. which can improve the 7. 2006. Helderman WHo WHO: Basic Package of Oral Care. it is possible to conclude that the Treatment (ART) for Dental Caries. Onc. Frencken ]E.6 The results have raised complementary research restorations in the permanent dentition: A meta- questions.7:85-91. supported by the lite. Survival of glass ionomer restorations placed in pri- ity of proximal restorations in primary teeth carried out mary molars using atraumatic restorative treat- by ART. Holmgren C]. The Netherlands: WHO Collaborating make the SEM evaluation of all the replicas possible. conventional restorative dentistry treatment. Influence of residual caries and cervical gaps on the If the results found in the present in vitro study are survival rate of Class II glass ionomer restorations. Atraumatic Restorative standing quality. Yu C. among many properties. which also revealed some limitations of this analysis. Phantumvanit P. atraumatic restorative treatment (ART) technique: Aiming to improve the oral health of a significant Evaluation after one year. Journal of Dentistry for Children-77: " 2010 F10wable GICliner in proximal ART restorations Bonifacio et al 15 . The atraumatic restorative tions regarding other properties like adhesion and treatment (ART) approach for managing dental strength. Int Dent] 2006. like the extra material 9. Holmgren C]. Effectiveness of single-surface ART rature. Int Dent] 1994. as the observations were made in resin re. Frencken ]E.

Medeiros E. Mount G]. Milestones in adhesion: Glass ionomer cements. Quintessence Int 1995.28:63-9.30:428-33.20:45-50. 12. Bonding Lauris ]R. Bresciani E. van de Hoef N. 22. Peters Me. Three-year survival of Mater Res A 2009. ] Adhes Dent 2003. Heymann HO.26:95-110.62:590-2. 11: among many raters. Caries Res 1996. Kleverlaan q. van Duinen RN. scanning electron microscopic technique. single.] Dent Res 1983. Mecha. 337-43. high-resolution apatite. Tyas M]. Bonini GA. 18. Makoni F. van Gemert-Schriks MC.] Dent Child 2007. A study of glass 13. van Amerongen E. nical properties of glass ionomer cements affected 21. Rosenblatt A. Clinical by curing methods. restorations.] Dent Child 2006. Perdigao ]. Ngo H. Psychological Bulletin 1971. sence Int 1997. Powis OM. 1995. up. the art. different materials for surface protection. Mechanism ionomer cement and its interface with enamel and of adhesion of polyelectrolyte cements to hydroxy. 76:378-82. Influence of local luation after 1 year. Clin Oral Investig 2007. Velasco LG. Feilzer A]. Aartman IH. Navarro ME Clinical evaluation of to enamel and dentin: A brief history and state of multiple-surface ART restorations: 12-month follow. Imparato ]C. 20. ] Biomed ten Cate ]M. van Amerongen WE.and 2-surface ART restorations in a high- 17.74:203-8. 16 Bonifacio et al F10wable GICliner in proximal ART restorations Journal of Dentistry for Children-77: " 2010 View publication stats .73:91-7. Atraumatic molars: A comparison between 2 glass ionomer ce- restorative treatment and glass ionomer sealants in ments. Quintes- 14. a school oral health programme in Zimbabwe: Eva. evaluation of atraumatic restorations in primary 15. Raggio DP Glass ionomer cement hardness after 23. dentin using a low-temperature. Swift]r E]. 17:239-47. Measuring nominal scale agreement caries child population. Wilson AD. Prosser H]. Frencken ]E. Barata T]. Fleiss ]L. Fagundes TC. 19. Brito CR. Dent Mater 2004. Sithole WD. anesthesia on the quality of Class II glass ionomer 16. June. Menezes ]P. Cefaly OF. Int] Paediatr Dent 2007.5:259-66.