Comparative study of fluoride released and recharged from conventional pit and fissure sealants versus surface prereacted glass ionomer technology

One-year follow-up of microscopical and clinical behavior of bioactive self-etching resin sealant

Background

The development of early carious lesions can be prevented with the use of sealants. This study aimed to evaluate the retention and sealant quality of conventional and bioactive self-etching sealants by direct (clinical) and indirect (microscopical) assessment.

Materials and Methods

Sixty newly erupted mandibular second molars (International Caries Detection and Assessment System ≤2) from adolescents were selected for the split-mouth trial study. The tooth was randomized and treated with conventional Fluoroshield (FS) and BeautiSealant (BS) bioactive self-etching sealants. Molds were taken and cast with epoxy resin after treatment. Indirect and direct assessments of retention degree and sealant remnant quality were performed after baseline, 1 month, and 1 year. The Chi-square test, ordinal regression, reasons of chance, and Fleiss' kappa statistical test were employed.

Results

After 1 month, greater total retention was observed for FS, but 1-year follow-up demonstrated no retention difference for FS and BS. The odds ratios showed an 86% greater chance of FS showing better marginal adaptation, after 1 month. At 1 year, the clinical assessment showed better anatomical shape and marginal adaptation scores for FS, but no microscopical difference was observed. A pour agreement between clinical and microscopical data was observed.

Conclusions

The 1-year follow-up showed no significant difference in the degree of retention, and in the microscopic evaluation of the conventional sealant (FS) and the bioactive self-etching sealant (BS), but in the clinical evaluation, better marginal and anatomical adaptation scores for FS were observed.

Evaluation of the clinical performance of GIOMERs and comparison with other conventional restorative materials in permanent teeth: a systematic review and meta-analysis

Aim The aim of this systematic review and meta-analysis was to analyse the clinical performance of GIOMER restorative composites and compare them with other conventional restorative materials in permanent teeth.Methods Searches in PubMed, Web of Science, Scopus, Ovid and Cochrane Library were conducted. Grey literature search was also performed. Clinical trials that evaluated the clinical performance of restorations with GIOMER restorative composites in permanent teeth compared to those using composite resin, glass ionomer cement, resin-modified glass ionomer cement (RMGIC) and other GIOMERs were included. Meta-analyses comparing GIOMER restorative composites with RMGIC at 6- and 12-month follow-ups and comparing two types of GIOMER were feasible.Results Ten studies fulfilled the inclusion criteria. In these studies, GIOMER was compared to different types of dental restoration materials. Dental restorations were evaluated by United States Public Health Service criteria in all included studies. Four studies were suitable for meta-analysis, which showed significant differences between GIOMER and RMGIC surface roughness at 6-month (odds ratio [OR] = 6.56; 95% confidence interval [CI] = 2.38-18.13) and 12-month (OR = 8.76; CI = 3.19-24.07) follow-ups. No significant differences between GIOMER restorative composites and RMGIC for marginal adaptation were found at 6- and 12-month follow-ups. When comparing two GIOMERs, significant differences were seen between Beautifil II and Beautifil Flowable Plus F00 for marginal staining (OR = 2.58; CI = 1.42-23.27; I2 = 0%) and surface roughness (OR = 4.59; CI = 1.11-18.97; I2 = 0%) at the 36-month follow-up. No significant differences between Beautifil II and Beautifil Flowable Plus F00 were seen for marginal adaptation and anatomic form at 6-, 18- and 36-month follow-ups.Conclusions GIOMER restorative composites presented similar performance concerning marginal adaptation and better surface roughness when compared to RMGIC. GIOMER Beautifil II presented similar performance to GIOMER Beautifil Flow Plus F00 concerning marginal adaptation and anatomic form and worse marginal staining and surface roughness when compared to Beautifil Flowable Plus F00.

Effect of nano-hydroxyapatite incorporation on fluoride-releasing ability, penetration, and adaptation of a pit and fissure sealant

BACKGROUND

Dental caries is one of the most common multifactorial oral diseases and can be prevented using pit and fissure sealants.

AIM

To evaluate the effect of nano-hydroxyapatite (nanoHAP) incorporation on fluoride-releasing ability, penetration, and adaptation of a pit and fissure sealant.

DESIGN

This was an in vitro study with two groups: conventional sealant and nanoHAP-incorporated sealant. Sealant penetration and adaptation were assessed using stereomicroscope and scanning electron microscope (SEM) (15 and 10 samples per group, respectively). Fluoride release was analyzed using ion-selective electrode (15 samples per group). The chi-square test was used to compare penetration and adaptation between the 2 groups, and an independent Student t test was used to compare fluoride release.

RESULTS

The nanoHAP group showed significantly more samples with no bubbles (P = .001) and no debris (P < .001). SEM analysis showed a significantly greater percentage of adequate fissures in the test group (P = .007). The fluoride release was significantly higher in test samples with p values of .001 and .016 on day 1 and day 60, respectively.

CONCLUSION

The incorporation of nanoHAP into the conventional pit and fissure sealant improved its penetration and adaptation properties along with fluoride release.

Remineralizing Effects of Resin-Based Dental Sealants: A Systematic Review of In Vitro Studies

The incorporation of remineralizing additives into sealants has been considered as a feasible way to prevent caries by potential remineralization through ions release. Thus, this systematic review aimed to identify the remineralizing additives in resin-based sealants (RBS) and assess their performance. Search strategies were built to search four databases (PubMed, MEDLINE, Web of Science and Scopus). The last search was conducted in June 2020. The screening, data extraction and quality assessment were completed by two independent reviewers. From the 8052 screened studies, 275 full-text articles were assessed for eligibility. A total of 39 laboratory studies matched the inclusion criteria. The methodologies used to assess the remineralizing effect included microhardness tests, micro-computed tomography, polarized-light microscopy, ions analysis and pH measurements. Calcium phosphate (CaP), fluoride (F), boron nitride nanotubes (BNN), calcium silicate (CS) and hydroxyapatite (HAP) were incorporated into resin-based sealants in order to improve their remineralizing abilities. Out of the 39 studies, 32 studies focused on F as a remineralizing agent. Most of the studies confirmed the effectiveness of F and CaP on enamel remineralization. On the other hand, BNN and CS showed a small or insignificant effect on remineralization. However, most of the included studies focused on the short-term effects of these additives, as the peak of the ions release and concentration of these additives was seen during the first 24 h. Due to the lack of a standardized in vitro study protocol, a meta-analysis was not conducted. In conclusion, studies have confirmed the effectiveness of the incorporation of remineralizing agents into RBSs. However, the careful interpretation of these results is recommended due to the variations in the studies’ settings and assessments.

Bioactive self-etching sealant on newly erupted molars: A split-mouth clinical trial

OBJECTIVES

This randomized clinical trial compares retention, survival rate, and evolution of caries of newly erupted permanent molars sealed with bioactive self-etching sealants with pre-reacted glass ionomer (S-PRG).

METHODS

A split-mouth clinical trial was conducted with 56 permanent second molars in stages 2 and 3 of crown eruption; ICDAS (International Caries Detection and Assessment System) was between 0 and 2. The molars were randomized and blinded in relation to the side (right or left) that would receive the sealants; the conventional resin sealant (FS), Fluroshield (Dentsply), or bioactive self-etch sealant (BS), BeautiSealant with S-PRG (Shofu). The sealants were compared in terms of retention, quality of sealant remnant (anatomical shape, marginal adaptation, surface texture, and marginal discoloration), and development of caries by ICDAS after 1, 6, and 12 months. The Wilcoxon, x² of independence, Kaplan-Meier, and Mantel-Cox survival statistical tests were applied (α = 5%).

RESULTS

The total retention was higher for FS (57.1%) at all periods, and there was no difference in the quality of sealants at all periods. The ICDAS decreased after 6 (p = 0.025) and 12 months (p = 0.027) for both materials. Despite the lower retention of BS, the clinical quality of sealants over 12 months were similar.

CONCLUSION

Teeth sealed with BS presented higher sound teeth predominance (ICDAS 0) compared to FS sealant, even with a higher loss of material.

CLINICAL RELEVANCE

Eruption of permanent molars is a relevant period, and the prevention/management of initial caries is essential in these critical stages. Sealants can be an important prevention strategy. After 12 months of follow-up, there was a major failure of the bioactive sealant but without the development of caries lesions.

Preliminary In Vitro Study of Fluoride Release from Selected Ormocer Materials

The purpose of the in vitro study presented in this paper was to determine the long-term release of fluoride ions from selected ormocer materials (Admira (A), Admira Flow (AF), Admira Seal (AS)). The release of fluoride ions from these materials into a saline solution (0.9% NaCl) and deionized water was tested for 14 weeks. In a long-term study the measurements were taken after 1 and 3 h, then 1, 2, and 3 days and then at weekly intervals for 14 weeks. In a short-term study the measurements were made after 3, 24, 48, 72, 69, 168 h, i.e., within 7 days. All materials used in the test showed a constant level of fluoride release. The highest level of cumulative release of fluoride ions into deionized water was found in the AS material (23.95 ± 4.30 μg/mm²), slightly lower in the A material (23.26 ± 4.16 μg/mm²) and the lowest in the AF material (16.79 ± 2.26 μg/mm²). The highest level of cumulative release into saline solution was found in AF (8.08 ± 1.30 μg/mm²), slightly lower in AS (7.36 ± 0.30 μg/mm²) and the lowest in A (6.73 ± 1.10 μg /mm²). After 1 h of immersion of the samples in the saline solution, the highest level of fluoride was released by AF (0.57 ± 0.06 μg/mm²) followed by A (0.20 ± 0.03 μg/mm²) and AS (0.19 ± 0.02 µg/mm²). Moreover, in the 14-week study, the total amount of fluoride release into the saline, which imitates the environment of the oral cavity, was observed as the highest in the AF sample.

Influence of Laser and Ozone Pretreatment on the Shear Bond Strength of Fissure Sealants: An In Vitro Comparative Study

Aim:

To evaluate the shear bond strength (SBS) of 3 fissure sealants used alone and with ozone and laser pretreatment.

Materials and Methods:

For the SBS test, the flattened enamel surfaces of 90 healthy third molars were randomly divided into nine groups ( n  =  10 for each groups), based on different sealants (BeautiSealant, Fuji Triage, and Grandio Seal) and pretreatment conditions (no pretreatment, pretreatment with ozone, and pretreatment with neodymium-doped yttrium aluminum garnet [Nd:YAG laser]). Ozone was applied for 30 s in caries superficial mode, and Nd:YAG laser was applied for 60 s. After the pretreatment procedures, sealants were placed inside a mold on the enamel surface. SBS was measured with a universal testing machine. Data were analyzed using analysis of variance. Tukey’s multiple comparison tests were applied to determine the difference between the groups (α  = 0.05).

Results:

The lowest SBS was observed in the Fuji triage group. Nd:YAG laser and ozone did not affect the SBS of BeautiSealant. However, significant differences were determined in the Fuji triage and Grandio Seal groups after pretreatment procedures ( P  < .05).

Conclusion:

Ozone and laser can be employed to disinfect fissures before BeautiSealant application.

Prevention and caries risk management in teenage and orthodontic patients

As patients progress from childhood through to teenage years, they progress through periods of high caries risk as they undergo changes in lifestyle and oral microflora. Removable or fixed orthodontic treatment also alters the oral microflora and can dramatically increase caries risk. This paper outlines ways to identify the transition to higher caries risk, and practical ways to lower the risk of hard tissue loss from dental caries during orthodontic treatment across the teenage years, including tooth surface protection, optimised use of mechanical and chemical plaque control, and appropriate delivery of remineralising agents over time.

Giomers in dentistry - at the boundary between dental composites and glass-ionomers

Introduction

From the variety of direct restorative dental materials, composite resins are considered as having the most esthetic and functional properties. The conservative preparation, esthetic results, good mechanical qualities and surface finishing properties of dental composites, combined with the protective properties of fluoride from glass-ionomers, led to a new generation of dental materials: the giomers.

Objective

The purpose is to review the available literature about the giomers, regarding the chemical composition, handling properties and esthetics, adhesion and microleakage, fluoride releasing and protection offered, clinical indications.

Method

The search was carried out using ScienceDirect and PubMed databases with the following keywords: giomer, esthetic properties giomers and fluoride releasing giomers. A total of 232 articles were initially selected, with the following inclusion criteria: full text articles, written in English, with topics on the properties and the clinical implications of giomers. Papers presented as abstract were not included. In the next step, review articles, duplicates, and articles in other languages were removed; as a result, a total of 44 sources published between 2004 and 2017 were selected.

Results

The selected articles referred to the following aspects about the giomers: chemical composition (8 articles), adhesion and microleakage (10 articles), fluoride releasing and pulp protection (15 articles), clinical indications (6 articles), effects of additional treatments and dietary habits (11 articles).

Combination of ions promotes cell migration via extracellular signal‑regulated kinase 1/2 signaling pathway in human gingival fibroblasts

Wound healing is a dynamic process that involves highly coordinated cellular events, including proliferation and migration. Oral gingival fibroblasts serve a central role in maintaining oral mucosa homeostasis, and their functions include the coordination of physiological tissue repair. Recently, surface pre‑reacted glass‑ionomer (S‑PRG) fillers have been widely applied in the field of dental materials for the prevention of dental caries, due to an excellent ability to release fluoride (F). In addition to F, S‑PRG fillers are known to release several types of ions, including aluminum (Al), boron (B), sodium (Na), silicon (Si) and strontium (Sr). However, the influence of these ions on gingival fibroblasts remains unknown. The aim of the present study was to examine the effect of various concentrations of an S‑PRG filler eluate on the growth and migration of gingival fibroblasts. The human gingival fibroblast cell line HGF‑1 was treated with various dilutions of an eluent solution of S‑PRG, which contained 32.0 ppm Al, 1,488.6 ppm B, 505.0 ppm Na, 12.9 ppm Si, 156.5 ppm Sr and 136.5 ppm F. Treatment with eluate at a dilution of 1:10,000 was observed to significantly promote the migration of HGF‑1 cells. In addition, the current study evaluated the mechanism underlying the mediated cell migration by the S‑PRG solution and revealed that it activated the phosphorylation of extracellular signal‑regulated kinase 1/2 (ERK1/2), but not of p38. Furthermore, treatment with a MEK inhibitor blocked the cell migration induced by the solution. Taken together, these results suggest that S‑PRG fillers can stimulate HGF‑1 cell migration via the ERK1/2 signaling pathway, indicating that a dental material containing this type of filler is useful for oral mucosa homeostasis and wound healing.

Retention and caries-preventive effect of glass ionomer and resin-based sealants: An 18-month-randomized clinical trial

The objective of this study was to compare the retention and caries-preventive effect of glass ionomer (Fuji Triage) and resin-based (Clinpro) sealants among 6-9-year-old children. This split-mouth, randomized clinical trial covered 35 children/140 fully erupted permanent first molars. Evaluation was conducted by two independent examiners after 6, 12, and 18 months and the data were compared in relation to the children's caries risk and age groups. The Kaplan-Meier survival method and chi-square test were used for analysis. There were no statistically significant differences in the survival of partial and fully retained sealants or in the survival of caries-free pits and fissures between glass-ionomer and resin-based sealants. In terms of retention, both sealants performed better in the younger age group at the end of the study, and showed better caries prevention in moderate caries risk children. After 18 months, both sealants had comparable retention and caries-preventive effects in 6-9-year old children.

Long-term release of fluoride from fissure sealants-In vitro study

The intensity of the cariostatic activity of fluoride ions can be attributed to their multidirectional influence on the caries process. They are an irreplaceable factor that helps sustain mineral balance of dental tissues, simultaneously demonstrating antibacterial properties. As a consequence, many manufacturers of fissure sealants include fluoride ions in their products. The aim of this in vitro study was to determine long-term fluoride release from four fissure sealants (Conseal F, Fissurit FX, Delton Fs+, Admira Seal). During a 14-week-long observation, all the materials showed a relatively constant level of F- release; however, it is crucial to mention that within the first 48h, the most significant increase in fluoride release was found for Fissurit and Delton sealants. Based on the overall assessment, the highest total amount of the released fluoride ions was observed for Delton, and the lowest level was reported for Admira Seal.