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Journal of Indian Society of Pedodontics and Preventive Dentistry Official publication of Indian Society of Pedodontics and Preventive Dentistry
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ORIGINAL ARTICLE
Year : 2009  |  Volume : 27  |  Issue : 4  |  Page : 219-223
 

Why the carioprotective potential of luting cements crucial?


1 Government Dental College, Rohtak, India
2 DAV Dental College, Yamunanagar, India

Date of Web Publication14-Nov-2009

Correspondence Address:
M Rohilla
Bharat Dental Clinic, Jhajjar Road, Rohtak, Haryana-124 001
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-4388.57656

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   Abstract 

Space maintainers make good oral hygiene difficult, modify the oral environment, and increase the chances of enamel demineralization. Demineralization can be prevented or reduced by improving patient oral hygiene or by using topical fluorides. However these methods depend on patient compliance and, therefore, are not very reliable. Thus, caries prevention in banding might be enhanced by using fluoride-releasing cements. The aim of the study was to comparatively evaluate the carioprotective potential of various luting media used for band cementation in permanent as well as deciduous molars. In this study, 100 molars were taken, which were banded and stored in artificial saliva for 1 month after which the teeth were debanded. An area of 2 x 2 mm was spared and the teeth were coated with nail varnish. The coated teeth were dipped in artificial caries solution in one month followed by 1-day immersion in methylene blue dye, after which the samples were sectioned through the window. The depth of dye penetration was measured and the results were statistically analyzed. Minimum dye penetration was observed with glass ionomer, which could be due to the fluoride release from the cement, whereas the control group showed the maximum, probably due to direct contact with the artificial caries solution.


Keywords: Artificial caries, artificial saliva, demineralizing, fluoride releasing


How to cite this article:
Rohilla M, Pandit I K, Srivastava N. Why the carioprotective potential of luting cements crucial?. J Indian Soc Pedod Prev Dent 2009;27:219-23

How to cite this URL:
Rohilla M, Pandit I K, Srivastava N. Why the carioprotective potential of luting cements crucial?. J Indian Soc Pedod Prev Dent [serial online] 2009 [cited 2019 Oct 21];27:219-23. Available from: http://www.jisppd.com/text.asp?2009/27/4/219/57656



   Introduction Top


The use of bands in space maintainers makes these areas difficult to clean, thus rendering oral environment conductive to enamel demineralization. Demineralization can be prevented or reduced by improving patient oral hygiene or by using topical fluoride, but these measures depend on patient compliance and, therefore, are not very reliable. [1]

Gwinett and Ceen recommended that fluoride availability should be independent of patient co-operation and the fluoride ion should diffuse or dissolve into the tooth surface over a prolonged period. [2] Thus, caries prevention in banding might be enhanced by using fluoride-releasing cements. Fluoride, apart from limiting demineralization, reduces plaque formation by inhibiting bacterial acid production and helps to remineralize.

So, keeping in mind the retentive and demineralizing potential of various luting agents, the present study was conducted with an objective to comparatively evaluate the carioprotective effect of reinforced zincoxide eugenol, zinc phosphate, zinc polycarboxylate, and glass ionomer cement.


   Materials and Methods Top


Total 100 molars, 50 permanent molars (extracted for periodontal reasons) and 50 deciduous molars (extracted for orthodontic reasons), were taken for the study. Care was taken to select teeth that had intact buccal surfaces with no evidence of caries, malformation, hypoplasia, or any abnormality affecting the buccal surface. The teeth were randomly divided into five groups according to the cement used: group A-glass ionomer; group B-zinc phosphate; group C-zinc polycarboxylate; group D-reinforced zincoxide eugenol; and group E-nonbanded control group [Figure 1]. The groups were further subdivided into two subgroups consisting of deciduous and permanent molars, i.e., subgroup A1-permanent molars with bands cemented with glass ionomer and subgroup A2-deciduous molars with bands cemented with glass ionomer.

The teeth were cleaned of debris and blood clot in running water and were banded with the respective band materials for deciduous and permanent molars using the band-forming pliers [Figure 2] and [Figure 3]. Specimens were stored in artificial saliva at 37C for 30 days following which thermocycling was done for 24 h at 10C and 50C with dwell time of 30 sec. The samples were mounted in rectangular moulds containing a thin mix of acrylic resin approximating the height of alveolar bone [Figure 4]. The bands were then removed with a customized band removal device attached to the universal testing machine (instron) and the remaining cement was removed with the help of a hand scaler [Figure 5]. The teeth were coated with two coats of nail varnish leaving an area of 2 x 2 mm on the buccal surface [Figure 6]. The coated teeth were placed in artificial caries solution (17% gelatin, 1 g/I synthetic hydroxyappetite, 0.1% thymol, and lactic acid to adjust the pH to 4.3) for a period of 4 weeks. The teeth were rinsed with deionized water followed by immersion in 10% solution of methylene blue for 24 h. After rinsing, the samples were sectioned through the window using safe-sided diamond disk and were examined under 4x magnification using stereomicroscope [Figure 7]. The depth of dye penetration was measured and tabulated accordingly. The results were statistically analyzed using unpaired "t" test, one way analysis of variance (ANOVA) test, and Tukeyhoc test.


   Results Top


The carioprotective potential of the various cements noted was in the following order:

Glass ionomer > zinc polycarboxylate > reinforced zinoxide eugenol > zinc phosphate > control group (no cement used)

In the presence of enamel bound fluoride, demineralization starts at lower critical pH after sugar consumption. Second, fluoride enhances the rate of crystal growth. This could result in larger crystallites and in more resistant enamel and favors mineralization in the dynamic tooth decay-repair process. Third, fluoride exerts an inhibitory effect on acid production by bacteria.

Thus, it is recommended to use glass ionomer cement as the luting material in order to protect the enamel surface from demineralization. Other fluoride-releasing cements such as zinc polycarboxylate or those in which fluoride has been intentionally incorporated can also be used, but keeping in mind the other properties of luting materials. It is important to consider that in vitro studies have multiple limitations and that in situ and in vivo studies more closely replicate reality.


   Discussion Top


Fluoride rinse programs have been shown to significantly reduce the occurrence of white spot lesions although Geiger et al. found that 50% of patients complied poorly with fluoride programs despite a concerted effort to educate and motivate them. [3] Because patient compliance with a home rinse program could be a concern, fluoride release from an adhesive may be a meaningful clinical application, particularly an adhesive that releases sufficient amount of fluoride to prevent decalcification. [4] A desired property of luting cements is anticariogenecity provided by the fluoride release, which could reduce the severity of cariogenic challenges when available during an acid attack. [5]

Intergroup comparison

Highly significant difference between various groups was found except for zinc phosphate with the control group [Table 1] and [Table 2]; [Graph 1]-[Additional file 1]. Glass ionomer cement showed the maximum carioprotective potential and minimum dye penetration [Table 3]. This could be due to the following reasons:

  • Glass ionomer can inhibit demineralization and reduce the risk of caries by releasing fluoride into the adjacent enamel over long periods of time. [6]
  • Glass ionomer is more effective to prevent decalcification and to protect teeth against decalcification release of fluoride over long time. It also has the feature of renewing fluoride in enamel. [7]
  • It also acts as rechargeable, slow release fluoride reservoirs. [3],[8]

    Maximum dye penetration was in control group because the teeth were left nonbanded and there was direct effect of demineralizing solution on the exposed enamel without effect of fluoride or any other ion on the enamel surface.
  • Among the cements, zinc phosphate showed the maximum dye penetration contributing to its minimum carioprotective potential. This could be due to the following reasons:
  • Site of band failure with the zinc phosphate cement was between the cement and enamel, whereas with glass ionomer, it was between stainless steel band and the cement. [9],[10]
  • Significantly greater pore volume was demonstrated in the enamel lesions exposed to zinc phosphate cement and the external environment than their varnished control lesions. [11]
Norris et al. mentioned that zinc polycarboxylate is not quite successful as GIC in releasing fluoride. Moreover, it was also emphasized that the characteristic of zinc polycarboxylate cement of being dissolved under the mouth conditions increases the possible risk of demineralization under the band. [12]

Ettinger et al. and Shinkai, Del Bel Cury, and Cury did not verify any influence of the luting material on the extension of artificial caries on the enamel. [5] Rezk-Lega et al. in a study showed that fluoride released from glass ionomer had cariostatic properties. However, bands should be checked regularly, since fluoride released from the cement may inhibit lesion development incompletely under loose bands or in areas where the cement is missing. [13]

Intragroup comparison

Nonsignificant difference was noted between the subgroups of various cements, though slightly greater demineralization and dye penetration was found in deciduous as compared to permanent teeth in each group, i.e., subgroup 2 as compared to subgroup 1 in each group [Table 4] and [Table 5]; [Graph 2]-[Additional file 2].

Difference in the thickness of prismless enamel in the deciduous and permanent teeth, which would have accounted for the difference in demineralization of surface enamel thus affecting the caries susceptibility. [14]

No significant difference in the chemical composition of Ca, Na, and CO 2 between deciduous and permanent teeth. However, the enamel of deciduous teeth is less mineralized than the enamel of permanent teeth. Interprismatic fraction and the prism junction density were significantly greater in deciduous than in permanent enamel. [15]

 
   References Top

1.Foley T, Aggarwal M, Hatibovic S. A comparison of in vitro enamel demineralization potential of three orthodontic cements. Am J Orthod Dentofac Orthop 2002;121:526-30.  Back to cited text no. 1      
2.Evernol BI, Kucukkeles N, Arun T, Yarat A. Fluoride release capacities of four different orthodontic adhesives. J Clin Pediatr Dent 1999;23:315-20.  Back to cited text no. 2      
3.Rix D, Foley TF, Banting D, Mamandras A. A comparison of fluoride release. Am J Orthod Dentofac Orthop 2001;120:398-405.  Back to cited text no. 3      
4.Wheeler AW, Mamandras TF. A Comparison of fluoride release protocols for in vitro testing of three orthodontic adhesives. Am J Orthod Dentofac Orthop 2002;121:301-9.  Back to cited text no. 4      
5.Moura JS, Lima EM, Paes Leme AF, Cury AA, Tabchoury CP, Cury JA. Effect of luting cement on dental biofilm composition and secondary caries around metallic restorations in situ. J Operat Dent 2004;29:509-14.  Back to cited text no. 5      
6.Silverstone LM. The effect of fluoride in the remineralisation of enamel caries like lesions in vitro. J Public Health Dent 1982;42:42-53.  Back to cited text no. 6  [PUBMED]  [FULLTEXT]  
7.Dincer B, Ertan Erdinc AM. A comparison between zinc polycarboxylate and glass ionomer cement in the orthodontic band cementation. J Clin Pediatr Dent 2002;107:461-4.  Back to cited text no. 7      
8.White LW. Glass ionomer cement. J Clin Orthod 1986;20:387-91.  Back to cited text no. 8  [PUBMED]    
9.Hamula W, Hamula DW, Brower K. Glass ionomer update. J of Clin Orthod 1993;27:420-5.  Back to cited text no. 9      
10.Worley JL, Hamm RC, Fraunhofer JA. Effects of cement on crown retention. J Pros Dent 1982;48:289-91.  Back to cited text no. 10      
11.Donly KJ, Ister S, Ister T. In vitro enamel remineralisation at orthodontic band margins cemented with glass ionomer cement. Am J Orthod Dentofac Orthop 1995;107:461-4.  Back to cited text no. 11      
12.Norris DS, Mcinnes-Ledoux P, Schwaninger B, Weinber R. Retention of orthodontic bands with new fluoride releasing cements. Am J Orthod 1986;89:206-11.  Back to cited text no. 12      
13.Rezk-Lega F, Ogaard B, Arends J. An in vivo study on the merits of two glass ionomers for the cementation of orthodontic bands. Am J Orthod Dentofac Orthop 1991;99:162-7.  Back to cited text no. 13      
14.Whittaker DK. Structural variations in the surface zone of human tooth enamel observed by scanning electron microscopy. Arch Oral Biol 1982;27:383-92.  Back to cited text no. 14  [PUBMED]    
15.Ando M, Vander veen MJ, Schemehorn BR, Stookey GK. Comparative study to quantify demineralised enamel in deciduous and permanent teeth using laser and light induced fluorescence technique. Caries Res 2001;35:464-70.  Back to cited text no. 15      


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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    Abstract
    Introduction
    Materials and Me...
    Results
    Discussion
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