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Original Article

Surface coatings on glass ionomer restorations in Pediatric dentistry-Worthy or not?

Rekhalakshmi Kamatham, Sharada Reddy J.1
Departments of Pedodontics and Preventive Dentistry, Narayana Dental College, Nellore, 1Pedodontics and Preventive Dentistry, Government Dental College and Hospital, Afzulgunj, Hyderabad, Andhra Pradesh, India

ABSTRACT
Background: To know the effect of surface protective agents used in day-to-day practice on the uoride release property of conventional glass ionomer cements (GIC) and discuss its pros and cons. Materials and Methods: Thirty disc-shaped specimens were fabricated from conventional GIC and block randomized into three groups (Group I, II, and III) of 10 each. Group I specimens were unprotected, group II coated with cavity varnish (Namuvar, Ratnagiri, India) and group III with petroleum jelly (Vaseline, Hindustan lever ltd). After polymerization, the disks were immersed in three individual sealable plastic bottles containing deionized distilled water which was changed every 24 hours for 15 days to measure the uoride release. Statistics and Results: Statistical analysis was carried using software version Systat 10.0, and the data was subjected to one way ANOVA, using Duncan Multiple Range test (Variable LSD) with the level of signicance set at 0.05 (P < 0.05). The greatest amount of uoride was released from the uncoated group, followed in ranking by petroleum jelly and varnish coated and the difference among them was statistically signicant (P < 0.05). Conclusion: Application of varnish over GIC can severely impede its uoride release property. Similarly petroleum jelly also impedes the uoride release, but to a very less extent. We suggest that in situations where the uoride release property is more important than other properties it is better to coat the GIC with petroleum jelly or leave the restoration without any coating.

Address for correspondence:

Dr. Rekhalakshmi Kamatham, Assistant Professor, Department of Pedodontics and Preventive Dentistry, Narayana Dental College, Nellore, Andhra Pradesh, India. E-mail: rekhanagmds@yahoo.co.in
Access this article online
Quick response code Website: www.jisppd.com DOI: 10.4103/0970-4388.121818 PMID: ******

KEYWORDS: Glass ionomer cement, petroleum jelly,

varnish

Introduction
Cariostatic activity in tooth colored restorations has been a desirable characteristic in the entire history of modern dentistry. The glass ionomer cements (GICs) are 229

one of the products developed in this direction and are widely used in Pediatric operative dentistry because of their ability to adhere to/bond with enamel and dentin without any pre-treatment and potential to release uoride ions over a prolonged period of time.[1,2] Other positive characteristics of GIC include biocompatibility with dental tissues, resistance to microleakage, good marginal integrity and dimensional stability at high humidity, coefcient of thermal expansion similar to tooth structure, and uoride rechargibility, whereas the GIC possesses undesirable characteristics like early moisture sensitivity, poor wear resistance, low strength and average esthetics.[1,2] To surmount the problem of moisture sensitivity, the application of different coatings like water proof varnish, petroleum jelly, cocoa butter, or chemical/light cured bonding resins over the surface of the material immediately following the initial set to maintain the water balance during maturation have been suggested[3] and are embedded into practice. However, there is very limited existing literature on the inuence of these protective coatings on GICs[4-6] and even that literature is focused mainly on the manufacturer recommended ones. The recent literature on GICs is concentrating primarily on the procedural aspects,[7] crystal growth,[8] selfreparability[9] and on the properties of GICs containing chlorhexidine diacetate/cetrimide mixtures[10] and poly quaternary ammonium salts,[11] but not on the

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Kamatham and Reddy: Surface coatings on glass ionomer restorations in pediatric dentistry

inuence of surface coatings on GIC. Hence, the present investigation has been performed to evaluate the effect of these protective coatings on uoride release from one of the commercially available GIC, Fuji II, under in vitro conditions. The surface protective coatings selected in the present study were cavity varnish and petroleum jelly (vaseline) as they are routinely used in clinical practice.

Materials and Method

Conventional GIC, Fuji II (GC Corporation, Tokyo, Japan), was chosen for this study. Using standardized brass mold, 30 disk shaped specimens 11 0.1 mm in diameter and 5 0.1 mm thick, were fabricated. GIC was mixed according to the manufacturers instructions and immediately covered with polyester strip. A glass slab was laid over the top and held under hand pressure to ensure proper placement. Initially they were protected from dehydration and moisture contamination within their molds for a period of 10 minutes (100% relative humidity at 37C). Any excess material around the periphery was removed with a scalpel and the glass ionomer surfaces were gently polished under water, using wet carborundum paper (32 grit, waterproof, Metallurgy consumables emery papers, Chennai) in a small polishing machine. They were weighed to verify standardization (0.01 g), block randomized into three groups of 10 each using block size of 6 and table of random numbers. Surface coatings that is for one group, cavity varnish (Namuvar, Ratnagiri, India) and for another group, petroleum jelly (Vaseline, Hindustan lever ltd.) were applied with a brush and then gently air dried. Immediately after polymerization, the disks were immersed in three individual sealable plastic bottles containing 50 ml of deionized distilled water to prevent small volume of test solution becoming saturated with uoride. The

average uoride concentration in deionized water was <0.01 ppm. These were then left undisturbed in an incubator set at 37C. After 24 hours, the bottles were removed from incubator and the tooth samples were grasped with clean metal forceps coated with nail varnish and washed with 1 ml of deionized water using a syringe, over the original holding bottle, thus collecting the rinse water in that bottle. The samples were dried for two minutes on absorbent paper and then transferred to a new bottle containing 50 ml deionized distilled water. The deionized distilled water was changed every 24 hours and release of uoride was measured for 15 days. Fluoride release was determined after buffering the solution with equal volumes of total ionic strength adjustment buffer (TISAB II), Orion Research, Inc, Beverly, MA, USA). Fluoride release was measured with a combination of uoride electrode (Orion 9609BN, Orion Research Inc) and an ion analyzer (Orion EA 940, Orion Research Inc). Data concerning uoride was recorded in parts per million (ppm). Statistical analysis was carried using software version Systat 10.0, and the data was subjected to one-way ANOVA, using Duncan Multiple Range test (Variable LSD) with the level of signicance set at 0.05 (P < 0.05).

Results
Total uoride release
All the three groups of GICs evaluated for the uoride release during the entire period of the experiment. The amounts of uoride released from the three groups during 15 days period are presented in Table 1. The greatest amount of uoride was released from the uncoated group, followed in ranking by petroleum jelly coated and varnish coated and the difference among them was statistically signicant. Almost 97%

Table 1: Mean uoride release (in ppm) from GIC with or without surface coatings at different time intervals in de-ionized water
Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 7 Day 8 Day 9 Day 10 Day 11 Day 12 Day 13 Day 14 Day 15 Fluoride release from control specimens in ppm (Mean SD) 13.040.06 10.480.13 8.350.24 7.190.10 6.120.10 4.070.11 3.160.09 3.030.05 2.870.02 2.610.11 2.430.03 2.340.05 2.120.02 1.960.03 1.850.03 Fluoride release from varnish coated specimens in ppm (Mean SD) 0.470.004 0.220.007 0.170.003 0.130.005 0.110.003 0.090.004 0.070.001 0.060.002 0.060.002 0.060.003 0.060.001 0.050.001 0.050.001 0.050.001 0.050.001 Fluoride release from petroleum jelly coated specimens in ppm (Mean SD) 10.270.03 7.250.05 6.320.02 5.430.02 4.260.05 3.740.003 2.570.02 2.480.008 2.130.004 1.980.003 1.850.003 1.750.002 1.700.002 1.620.002 1.560.006

P-value
P < 0.05 P < 0.05 P < 0.05 P < 0.05 P < 0.05 P < 0.05 P < 0.05 P < 0.05 P < 0.05 P < 0.05 P < 0.05 P < 0.05 P < 0.05 P < 0.05 P < 0.05

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Kamatham and Reddy: Surface coatings on glass ionomer restorations in pediatric dentistry

of uoride release was hampered when varnish was used as a protective coating, thus indicating a dramatic decrease in the release [Figure 1]. The uoride release in the present study showed a specic pattern. There was an initial burst of release in the rst 48 hours and there was a gradual decrease in the release day-by-day irrespective of the surface coating employed.

Pattern of uoride release

Discussion
The uoride release property of GICs is very important especially in Pediatric dentistry, as GIC is the material of choice in techniques such as indirect pulp capping, alternative restorative treatment and interim therapeutic restorations. The benet of uoride released from GIC is seen not only in enamel adjacent to the restoration, but also has been reported in areas up to three millimeters away from the restorations margin and may even offer protection for the entire tooth.[12,13] The protective role will be more on decalcied dental tissues as they are proved to be more reactive with uoride, thus preventing further demineralization.[14,15] Fluoride has been found to neutralize the acid solutions and slightly inhibit the acid production.[16] Also the concentrations of uoride released from freshly mixed GIC samples have been reported to be sufcient to inhibit and alter bacterial metabolism in vitro,[17] though not substantiated by in vivo studies.[18,19] Hence the present study has been conducted to determine the effect of the surface coatings on this very important property of GIC. Despite the wide variations in the amounts of uoride released in the present study, the pattern of release remained consistent irrespective of the surface coating. There was an initial burst of uoride release followed

by low, prolonged elution. This result is similar to the ndings of other studies on conventional and resin modied glass ionomers.[20-27] Studies done using ion chromatography and ion selective electrodes have also given consistent ndings.[28-32] This pattern can be explained by the proposed mechanisms concerning uoride release from GICs, that is supercial rinse, diffusion through pores and micro fractures and mass diffusion. Of these mechanisms initial supercial rinsing effect is credited for the high level of uoride release on the rst day, and diffusion through cement pores and fractures for the constant release in the following days, whereas mass diffusion requires more time than considered and consequently occurs with a longer cement contact with storage media.[33] When the amount of uoride release is considered, application of either varnish or petroleum jelly resulted in decrease of the release. However, the decrease was dramatic in case of varnish. Thus surface protection of GICs denitely impedes the uoride release property which might be due to the associated reduction in the movement of water. The surface coating might have occluded the mechanism of supercial rinse and diffusion through pores. Thus these ndings of the present study afrm those of others done on manufacturer recommended surface protective agents. Parenthetically, it is a proved fact that exposure of GIC immediately to oral uids after placement without any surface protection will disturb the water balance in turn affecting the setting reaction.[34] Disintegration of the surface structure, increased surface roughness, inferior translucency and discoloration are documented.[35,36] Correlation between early exposure to water and poor clinical performance has also been reported.[37] The reason for this has been attributed to washing out of Ca+2 and Al+3 ions and impaired acid base setting reaction, leading to improper matrix formation with inferior mechanical properties with lower compressive strength.[38] It has also been documented in vitro that the sealing of the GIC material for at least 1 hour during the initial setting will produce specimens of optimum compressive strength[29] and it has been attributed to increase in the amount of bound water in the cement; contrarily higher shear punch strength of GIC at 24 hours for uncoated specimens than for coated ones with no signicant difference at longer time interval is also reported and they suggested for additional hydration in order to develop maximum shear punch strength rapidly.[5] All these suggest that the subject of water balance in GICs is complicated, and though for most of the purposes, early protection of cements is desirable, it does not favor every aspect of cement maturation. Thus varnish application on the surface of GI restorations for the sake of improving the strength properties cannot be recommended in primary dentition, where the life span of tooth itself is limited and as the chewing forces will be comparatively less in children. If at all the dentist prefers to use a surface protective agent, petroleum jelly can be a viable alternative which has less hindrance on uoride release.

Figure 1: Mean uoride release (in ppm) from GIC with or without surface coatings at different time intervals in de-ionized water

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Kamatham and Reddy: Surface coatings on glass ionomer restorations in pediatric dentistry

The major limitation of the present study is that we did not compare the uoride release from the specimens in different media, as studies have proved that amount of uoride release under in vitro conditions was more in acidic and demineralizing-remineralizing regimens, followed by distilled water and the least in articial saliva.[39] As uoride release is intermediate in distilled water among the three, we have used it in the present study. Another limitation is that we continued the study for only 15 days, the reason for this being a proved fact that the initial high amounts of uoride decrease rapidly after 24-72 hours and get plateaued to a nearly constant level within 10-20 days.[20,40] Being an in vitro study is also a drawback as the inuence of tooth brushing and dietary habits on the retention of these surface protective agents could not be assessed. Clinical studies are also necessary to compare the advantages of different protective agents over conventional GICs, as results obtained from in vivo studies can differ from those of in vitro studies. Further studies on the inuence of these protective agents on the uoride rechargeability and re-release are also necessary, as they are very important properties of GIC to be called a smart material in dentistry.

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Conclusion
1. Application of varnish over GIC can severely impede its uoride release property. 2. Application of petroleum jelly also impedes the uoride release, but to a very less extent. 3. In situations where the uoride release property is more important than other properties it is better to coat the GIC with petroleum jelly or leave the restoration without any coating. Thus the pediatric dentist should wisely decide whether to apply surface coating or not, and if decided to apply which one to be used.
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References
1. 2. 3. Mount GJ. Glass-ionomer cements: Past, present and future. Oper Dent 1994;19:82-90. Croll TP, Nicholson JW. Glass ionomer cement in pediatric dentistry - review of the literature. Pediatr Dent 2002;24:423-9. Serra MC, Navarro MF, Freitas SF, Carvalho RM, Cury JA, Retief DH. Glass ionomer cement surface protection. Am J Dent 1994;7:203-6. Hattab FN, Amin WM. Fluoride release from glass ionomer restorative materials and the effects of surface coating. Biomaterials 2001;22:1449-58. Leirskar J, Nordbo H, Mount GJ, Ngo H. The inuence of resin coating on the shear punch strength of a high strength auto-cure glass ionomer. Dent Mater 2003;19:87-91. Brito CR, Velasco LG, Bonini GA, Imparato JC, Raggio DP. Glass ionomer cement hardness after different materials for surface protection. J Biomed Mater Res A 2010;93:243-6. Gurunathan D, Tandon S. A clinical evaluation of two glass ionomer cements in primary molars using atraumatic

22.

23. 24. 25.

4.

5.

26.

6.

27.

7.

28.

restorative treatment technique in India: 1 year follow up. Int J Paediatr Dent 2010;20:410-8. Endo K, Hashimoto M, Haraguchi K, Ohno H. Crystal growth by restorative lling materials. Eur J Oral Sci 2010;118:489-93. Abduo J, Swain M. Self-reparability of glass-ionomer cements: An in vitro investigation. Eur J Oral Sci 2011;119:187-91. Tuzuner T, Kusgoz A, Er K, Tasdemir T, Buruk K, Kemer B. Antibacterial activity and physical properties of conventional glass-ionomer cements containing chlorhexidine diacetate/ cetrimide mixtures. J Esthet Restor Dent 2011;23:46-56. Weng Y, Guo X, Gregory R, Xie D. A novel antibacterial dental glass-ionomer cement. Eur J Oral Sci 2010;118:531-4. Retief DH, Bradley EL, Denton JC. Enamel and cementum uoride uptake from a glass ionomer cement. Caries Res 1984;18:250-7. Swartz MM, Phillips RW, Clark HE. Fluoride distribution in teeth using a silicate model. J Dent Res 1980;59:1596-603. Tantbirojn D, Feigal RJ, Ko C, Versluis A. Remineralized dentin lesions induced by glass ionomer demonstrate increased resistance to subsequent acid challenge. Quintessence Int 2006;37:273-81. Featherstone JD. Fluoride, remineralization and root caries. Am J Dent 1994;7:271-4. Czarnecka B, Limanowska-Shaw H, Nicholson JW. Buffering and ion-release by a glass ionomer cement under near neutral and acidic conditions. Biomaterials 2002;23:2783-8. Maltz M, Emilson CG. Susceptibility of oral bacteria to various uoride salts. J Dent Res 1982;61:786-90. Forss H, Nase L, Seppa L. Fluoride concentration, mutans streptococci and lactobacilli in plaque from old glass ionomer llings. Caries Res 1995;29:50-3. Van Dijken JW, Kalfas S, Litra V, Oliveby A. Fluoride and mutans streptococci levels in plaque on aged restorations of resin-modied glass ionomer cement, compomer and resin composite. Caries Res 1997;31:379-83. DeSchepper EJ, Berr EA 3rd, Cailleteau JG, Tate WH. A comparative study of uoride release from glass ionomer cements. Quintessence Int 1991;22:215-9. de Araujo FB, Garcia-Godoy F, Cury JA, Conceicao EN. Fluoride release from uoride containing materials. Oper Dent 1996;21:185-90. Verbeeck RM, de Moor RJ, Van Even DF, Martens LC. The short term uoride release of a hand-mixed vs capsulated system of a restorative glass ionomer cement. J Dent Res 1993;72:577-81. Swartz ML, Phillips RW, Clark HE. Long term uoride release from glass ionomer cements. J Dent Res 1984;63:158-60. Tay WM, Braden M. Fluoride ion diffusion from polyalkenoate (glass ionomer) cements. Biomaterials 1988;9:454-6. Asmussen E, Peutzfeldt A. Long term uoride release from a glass ionomer cement, a compomer and from experimental resin composites. Acta Odontol Scand 2002;60:93-7. Yap AU, Khor E, Foo SH. Fluoride release and anti bacterial properties of new-generation tooth colored restoratives. Oper Dent 1999;24:297-305. Yap AU, Tham SY, Zhu LY, Lee HK. Shortterm uoride release from various aesthetic restorative materials. Oper Dent 2002;27:259-65. Verbeeck RM, De Maeyer AP, Marks LA, De Moor JG, De Witte AM, Trimpenners LM. Fluoride release process of (resin

Journal of Indian Society of Pedodontics and Preventive Dentistry | Oct-Dec 2013 | Vol 31| Issue 4 |

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[Downloadedfreefromhttp://www.jisppd.comonSunday,December08,2013,IP:101.219.28.100]||ClickheretodownloadfreeAndroidapplicationforthisjournal

Kamatham and Reddy: Surface coatings on glass ionomer restorations in pediatric dentistry modied) glass ionomer cements versus (polyacid-modied) composite resins. Biomaterials 1998;19:509-19. Forsten L. Fluoride release and uptake by glass ionomers and related materials and its clinical effect. Biomaterials 1998;19:503-8. Shaw AJ, Carrick T, McCabe. Fluoride release from glass ionomer and compomer restorative materials: 6 months data. Dent Mater 1998;26:355-9. Kuhn AT, Wilson AD. The dissolution mechanism of silicate and glass ionomer dental cements. Biomaterials 1985;6:378-82. Mount GJ. Longevity in glass ionomer restorations: Review of a successful technique. Quintessence Int 1997;28:643-50. Hotta M, Hirukawa H, Aono M. The effect of glaze on restorative glass ionomer cements: Evaluation of environmental durability in lactic acid solution. J Oral Rehabil 1995;22:685-9. Asmussen E. Opacity of glass ionomer cements. Acta Odontol Scand 1983;41:155-7. Cho SY, Cheng AC. A review of glass ionomer restorations in the primary dentition. J Can Dent Assoc 1999;65:491-5. 36. Causton BE. The physio-mechanical consequences of exposing glass ionomer cements to water during setting. Biomaterials 1981;2:112-4. 37. Mojon P, Kaltio R, Feduik D, Hawbolt EB, Mac Entee ML. Short-term contamination of luting cements by water and saliva. Dent Mater 1996;12:83-7. 38. Shen C, Grimaudo N. Effect of hydration on biaxial exural strength of a glass ionomer cement. Dent Mater 1994;10:190-5. 39. Karantakis P, Helvatjoglou-Antoniades M, TheodoridouPahini S, Papadogiannis Y. Fluoride release from three glass ionomers, a compomer, and a composite resin in water, articial saliva and lactic acid. Oper Dent 2000;25:20-5. 40. Dionysopoulos P, Kotsanos N, Pataridou A. Fluoride release and uptake by four new uoride releasing restorative materials. J Oral Rehabil 2003;30:866-72. How to cite this article: Kamatham R, Reddy SJ. Surface coatings on glass ionomer restorations in Pediatric dentistryWorthy or not?. J Indian Soc Pedod Prev Dent 2013;31:229-33. Source of Support: Nil, Conflict of Interest: None declared.

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30.

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33.

34. 35.

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