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ORIGINAL ARTICLE
“Effect of nano-filled surface coating agent
on fluoride release from conventional glass
ionomer cement: An in vitro trial”
Abstract
Context: To overcome the drawbacks of glass ionomer cement
of sensitivity to initial desiccation and moisture contamination
the use of surface coating agent is recommended. The search
in this area led to invent of use of nanofillers in surface coating
agent, but its effect on fluoride release is not clear. Aim: The
aim of this study is to evaluate and compare the fluoride release
from conventional glass ionomer cement with and without
surface coating agent. Settings and Design: This in vitro
study comprised of total 80 samples (40 samples of each
with and without surface coating). Materials and Methods:
Specimens were prepared, G coat plus was applied and light
cured. Fluoride release of the sample was measured every
24 h for 7 days and weekly from 7th to 21st day using Sension4
pH/ISE/MV Meter. Statistical Analysis Used: Descriptive
Statistics, Repeated Measure ANOVA, Paired Sample t-test,
Independent Sample t-test, Scheffe post hoc test. Results:
Mean values clearly reveal a significant decrease in the fluoride
release from day 1 to day 21 for both groups. Non-coated
group released significantly more fluoride than surface coated
group (P  0.001). Conclusions: It can be concluded that
nanofilled surface coating agent will reduce the amount
of fluoride released into oral environment as compared to
non-coated group and at the same time releasing fluoride into
surrounding cavity walls to create zones of inhibition into the
cavity floor to help internal remineralization.
Key words
Conventional glass ionomer, fluoride release, surface coating
agent
Introduction
Despite the advent of newer restorative techniques and
material, dental caries still remains a critical concern
even today. Although, the prevalence of dental caries in
JOURNAL OF INDIAN SOCIETY OF PEDODONTICS AND PREVENTIVE DENTISTRY | Apr - Jun 2013 | Issue 2 | Vol 31 |
Tiwari S, Nandlal B1
Departments of Paediatric and Preventive Dentistry, Peoples
College of Dental Sciences, Bhopal, Madhya Pradesh, 1JSS
Dental College and Hospital, Mysore, Karnataka, India
Correspondence:
Dr. Shilpi Tiwari, 530/2F, New Dhyan Chand Colony,
Sipri Bazar, Jhansi, Uttar Pradesh, India.
E-mail: shilpi.tiwari1@gmail.com
Access this article online
Quick Response Code: Website:
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DOI:
10.4103/0970-4388.115703
PMID:
***
children has declined markedly over the past 20 years
in the western world, the disease continues to be a
major problem for both adults and children elsewhere
and needs an improved approach to prevention and
therapy.[1]
Fluoride has been well-documented as a major
contributing factor in the decline of the incidence
and severity of dental caries. Delivery of fluoride is
accomplished by several means, one of them being
dental restorations, which facilitate the delivery of
fluoride directly to susceptible tooth surface. Fluoride
may be released from dental restorative material as
a part of setting reaction or it may be added to the
formulation with the specific intention of fluoride
release.[2]
Many researchers have investigated fluoride release
from various restorative materials, one among them
being glass ionomer cement, which is found to reduce
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Tiwari and Nandlal: Fluoride release from nanofiiler coated glass ionomer
secondary caries initiation and propagation significantly
and is well-known for its relative ease of use, chemical
bonding to tooth structure, fluoride ion release, and
recharge properties. It has a low coefficient of thermal
expansion and has acceptable esthetic qualities.[3]
Fluoride in glass ionomer cement does not form a
significant part of the poly acid salt matrix after cement
maturation. This fluoride can then be released into the
oral environment without the significant corresponding
loss of structural integrity.[4] Fluoride released from
glass ionomer cement decreases cementum solubility
as well as enamel solubility, and this effect occurs not
only on adjacent cavity walls, but also on tooth structure
not in direct contact with glass ionomer cement.[5]
In addition, glass ionomer cement has been shown to
impair the growth of cariogenic micro-organism such
as streptococcus mutans in vitro as well as in vivo.[6] This
inhibitory effect of glass ionomer cement on cariogenic
microorganism, along with decreased solubility of
tooth structure, underscore the value of fluoride release
from glass ionomer cement.
Although, fluoride release from glass ionomer
restorations has been shown to occur for long periods,
the greatest fluoride release takes place in the first
24-48 h followed by a low prolonged elution. There has
been found a wide variation in the reported amounts of
fluoride release from dental material in previous studies,
but the pattern of fluoride release remains consistent,
there is high burst of fluoride release followed by a low,
prolonged elution.[7]
However, the use of glass ionomer cement in clinics
is limited due to its poor mechanical properties and
sensitivity to initial desiccation and moisture. Recent
developments are aimed towards overcoming some
of these shortcomings. To protect glass ionomer
cement from moisture contamination and dehydration
during initial setting, immediate application of surface
coating agent is recommended. Failure to protect the
cement during initial setting allows either hydration
or dehydration, resulting in crazing, cracking, early
erosion, reduced physical property and translucency
of glass ionomer cement.[8]
A variety of surface coating agents have been examined,
with the council on dental material, instruments
and equipments; recommending a varnish or a light
activated bonding agent. Any untoward effect that
a surface coating would have on long-term fluoride
release would be a disadvantage and lessen the
attractiveness of cement as the material of choice for
92 JOURNAL OF INDIAN SOCIETY OF PEDODONTICS AND PREVENTIVE DENTISTRY | Apr - Jun 2013 | Issue 2 | Vol 31 |
caries active patients. Search in this field led to the use
of nanofillers in surface coating agents to improve its
wear resistance, but their effect on fluoride release is
not clear.
Therefore, the aim of this study was to evaluate and
compare the fluoride release from conventional glass
ionomer cement with and without surface coating.
Materials and Methods
Materials used in this study were conventional Glass
Ionomer Cement (GC Gold Level High Strength
Posterior Restorative Material. GC Corporation Tokyo,
Japan) and G coat plus-Nanofilled self-adhesive light
cured protective coating (GC Corporation, Tokyo,
Japan). A total of 80 specimens were taken for the
study. Specimens were fabricated by placing restorative
materials into the teflon mold (5 mm diameter × 2 mm
height) supported by glass slide in the mounting jig.
Prior to placement in the jig, Mylar strip was attached
to each glass slide. A second glass slide was placed on
the top of the teflon mold in the slot made in the jig
followed by tightening of the screw embedded in the
vertical arms of the jig to apply gentle and uniform
pressure on the upper slide to extrude the excess
material. [9] After 10 min, specimens were gently
demolded. G coat plus varnish was applied in surface
coated group specimens. Specimens were suspended
individually in 25 ml of distilled water stored at 37°C.
Distilled water was renewed every 24 h for 21 days. At
the predetermined measurement time each specimen
was taken out of the distilled water quickly, dried with
filter paper and immediately immersed in another 25 ml
fresh distilled water for further equilibration.
The media solutions were buffered with 5 ml of Total
Ionic Strength Adjustment Buffer II. This reagent
matches the ionic background of standards to sample
and helps to fix the ionic strength at a stable value. By
matching the conductivity of both solutions, offsets
in readings and measurement errors were eliminated.
Fluoride release of the sample was measured every
24 h for 7 days and weekly from 7th to 21st day using
Sension4 pH/ISE/MV Meter.
Results
The data were analyzed by Descriptive Statistics,
Repeated Measure ANOVA, Paired Sample t-test,
Independent Sample t-test and Scheffe post hoc test
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Tiwari and Nandlal: Fluoride release from nanofiiler coated glass ionomer

(  0.05). Mean (±SD) fluoride release (ppm) from
both groups (surface coated and non-coated) is given in
Tables 1 and 2. Mean values clearly reveal a significant
decrease in the fluoride release from day 1 to day 21
for both groups. Results of repeated measures ANOVA
revealed statistically significant difference between two
groups (P < 0.001). Paired t-test revealed a significant
t value on all the days (P < 0.001) except between
7 and 14 day interval (P > 0.05) for surface coated
group [Table 3]. Paired t-test revealed a significant
t value (P < 0.001) throughout the experimental
period for non-coated group [Table 4]. The pattern of
fluoride release was also different for both the groups
throughout the experimental period [Graphs 1 and 2].
Discussion
To overcome the drawbacks of glass ionomer cement
from moisture contamination and desiccation during
initial setting stage, application of surface coating
agent is recommended. In order to best protect glass
ionomer cement during its critical setting stage many
researchers have favored light activated resin (Mc Lean
and Wilson, 1977.[8] Keeping this in mind, in the
present study G-coat plus varnish was applied in surface
coated group specimens. This material incorporates
dispersion nanofiller technology, which allows a
uniform dispersion of nano sized fillers to enhance the
wear resistance and provides protection against acid
attack. Therefore, allowing slow and steady release of
fluoride for a prolonged period of time.
Various dimensions of the specimens were used in
different studies. In the present study, specimens
of dimensions (5 mm diameter  2 mm height)
were fabricated as explained by Freedman and
Diefenderfer (2003); Dhull and Nandlal (2009).[2,9]
Restorative material was placed into the teflon mold
supported by glass slide in the mounting jig. This is to
apply gentle and uniform pressure to extrude the excess
material as shown in the previous studies conducted by
Dhull and Nandlal (2009).[9]
Various methods have been described to detect fluoride
release previously. Fluoride ion selective electrode is the
most frequently employed technique for measurement
of fluoride release Verbeeck et al. (1993), Yap
et al. (2002).[10,11] In this study, fluoride release of the
sample was measured using a combination ion selective
electrode ISE from HACH company and Sension4
pH/ISE/MV Laboratory pH/ISE/mV Meter. This
method is advantageous over others as being powerful,
versatile and accurate. It is sensitive to a wide range
of concentrations (10-7 to saturated solution) and can
measure fluoride in a variety of solutions. However, the
cost involved is less than other methods.
In the present study, non-coated group released
significantly more fluoride than surface coated group.
The possible explanation for this would be without
protection immature glass ionomer is quite soluble
in water. In this study, application of surface coating

Table 1: Mean (±SD) fluoride release (ppm) from conventional glass ionomer cement from 1 day to 7 day
Treatment group Day 1 Day 2 Day 3 Day 4 Day 5 Day6 Day 7
Surface coated 3.2104±0.2728 2.2675±0.1303 1.7454±0.1012 1.0720±0.0979 0.6879±0.0864 0.2607±0.0618 0.1531±0.2077
Non coated 7.2078±0.2412 6.3881±0.2552 3.3239±0.1678 2.6021±0.1728 2.0875±0.0922 1.8723±0.0838 1.0764±0.0892

Table 2: Mean (±SD) fluoride release (ppm) from conventional glass ionomer cement at 1, 7, 14 and 21 days
Treatment group Day 1 Day 7 Day 14 Day 21
Surface coated 3.2104±0.2728 0.1531±0.2077 0.0095±0.0017 0.0050±0.0012
Non-coated 7.2078±0.2412 1.0764±0.0892 0.4829±0.2351 0.0070±0.0011

Table 3: Comparison of mean changes in fluoride release Table 4: Comparison of mean changes in fluoride release
(ppm) from surface coated subgroup of conventional glass (ppm) from non-coated subgroup of conventional glass
ionomer from 1 day to 21 days ionomer from 1 day to 21 days
Days interval (day-day) Mean difference t value df Significant Days interval (day-day) Mean difference t value df Significant
1-7 3.0573 32.019 9 0.000*** 1-7 6.1314 105.460 9 0.000***
1-14 3.2009 37.043 9 0.000*** 1-14 6.7249 80.677 9 0.000***
1-21 3.2054 37.102 9 0.000*** 1-21 7.2008 94.452 9 0.000***
7-14 0.1436 2.175 9 0.058 7-14 0.5935 8.308 9 0.000***
7-21 0.1481 2.253 9 0.051* 7-21 1.0694 37.991 9 0.000***
14-21 0.0045 8.073 9 0.000*** 14-21 0.4759 6.416 9 0.000***
***P<0.001=Very highly significant, **P<0.01=Highly significant, *P<0.05=Significant ***P<0.001=Very highly significant, **P<0.01=Highly significant, *P<0.05=Significant

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Tiwari and Nandlal: Fluoride release from nanofiiler coated glass ionomer
Graph 1: Mean fluoride release (ppm) from surface coated and
non-coated groups of conventional glass ionomer from day 1 to day 7
Graph 2: Mean fluoride release (ppm) from surface coated and
non-coated groups of conventional glass ionomer at day 1,7,14 and 21
agent led to the reduction (approx. 60%) in the release
rates of fluoride from conventional glass ionomer
cement.
McKnight-Hanes and Whitford evaluated the effect
of varnishing on release rates of fluoride from disc
made of three glass ionomer products and concluded
that varnishing the disc caused a reduction of 61-76%
depending upon the product.[12]
The pattern of fluoride release from both the groups
varied. Non-coated group showed initially high fluoride
release for first 2 days then declined sharply on 3rd day
and gradually diminished to a nearly constant level.
Other studies by De Moor et al. (1996), Yip and
Smales (2000), and Yap et al. (2002) have demonstrated
similar fluoride release pattern.[10,13,14] In case of surface
coated group fluoride release was gradual for 1st week
and then reduced to a consistent level for next 2 weeks.
This pattern of fluoride release from surface coated
groups was consistent with study by McKnight-Hanes
and Whitford (1992), Castro et al. (1994), Mazzaoui
et al. (2000).[12,15,16]
94 JOURNAL OF INDIAN SOCIETY OF PEDODONTICS AND PREVENTIVE DENTISTRY | Apr - Jun 2013 | Issue 2 | Vol 31 |
The results suggested that application of a surface
coating agent did not completely inhibit fluoride release.
However, the coating agent reduced the burst effect of
fluoride release during the 1st week and allowed for slow
and steady release of fluoride.
Conclusions
It can be concluded that nanofilled surface coating agent
will reduce the amount of fluoride released into oral
environment and at the same time releasing fluoride into
surrounding cavity walls to create zones of inhibition
and into the cavity floor to help internal remineralization.
Why this paper is important to pediatric dentist:
• Glass ionomer is most widely used esthetic
restorative material in pediatric dentistry but has
its own drawback of sensitivity to initial desiccation
and moisture
• To protect glass ionomer cement from moisture
contamination and dehydration during initial
setting, immediate application of surface coating
agent is recommended. A variety of surface coating
agents have been examined, with the council on
dental material stating the lack of wear resistance
of various materials, leading acid attack on glass
ionomer restoration
• In the present study, G-coat plus varnish is
applied on conventional glass ionomer restoration.
This material incorporates dispersion nano-filler
technology, which allows a uniform dispersion of
nano sized fillers to enhance the wear resistance
and provides protection against acid attack; thus
allowing for a slow and steady release of fluoride;
thus, improving the effectiveness of glass ionomer
restoration to be used in pediatric dentistry.
References
1. Featherstone JD. The science and practice of caries prevention.
J Am Dent Assoc 2000;131:887-99.
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exposures on fluoride release by glass ionomer-based
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How to cite this article: Tiwari S, Nandlal B. "Effect of nano-
filled surface coating agent on fluoride release from conventional
glass ionomer cement: An in vitro trial". J Indian Soc Pedod Prev
Dent 2013;31:91-5.
Source of Support: Nil, Conflict of Interest: None declared.

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