MODIFICATION OF GLASS IONOMER POWDER BY ADDITION OF RECENTLY FABRICATED NANO FILLERS

HEMISECTION INMOLAR TOOTH AND PREMOLAR TOOTH

1. Modifications of Glass Ionomer Cement Powder by Addition of Recently Fabricated Nano-Fillers and Their Effect on the Properties: A Review European Journal of Dentistry, 2019 JOURNAL CLUB PRESENTATION BY DR. ABDUL KADIR MDS 3RD YEAR DEPARTMENT OF CONSERVATIVE DENTISTRY AND ENDODONTICS

2. INTRODUCTION Glass ionomer cements (GICs) - Developed in the 1960s by Alan Wilson and his team. ADVANTAGES Aesthetic properties Self-adhesive capability Antibacterial properties Good biocompatibility DISADVANTAGES Low mechanical properties Sensitivity to moisture

3. Hypothesis: Greater polysalt bridges can be formed in the GIC matrix as a result of increasing the chemical affinity between the filler particles and GIC matrix. This will in turn enhance the mechanical properties of the material and make them a suitable posterior dental restorative material. AIM AND OBJECTIVE To provide an insight regarding the recent studies and recommendations related to the modifications to GIC powder in order to improve their properties.

4. Glass Ionomer Cement Powder Modifications and Filler Incorporations METALLIC POWDERS – Paiva et al – Nano –Ag particles Paiva et al - Higher concentration of nano-Ag particles (0.50% wt ) improved handling Characteristics and increased the compressive strength (CS) by 32% along with significant inhibition of microbial growth

5. Titanium Oxide Significant increase in flexural strength (FS) and CS. However, there was no significant difference in shear bond strength (MPa) to natural tooth structure (enamel and dentin) between TiO2-added GIC and cGIC

6. BIOACTIVE GLASS Bioactive glass (BAG) - Larry L Hench in 1969 BAG - Apatite layer - Stable bond or interface with biological tissues BAG (45S5 or Bioglass ) - 46.1 mol % silicon dioxide (SiO2), 24.4 mol % sodium oxide (Na2O), 2.6 mol % phosphorus pentoxide (P2O5), and 26.9 mol % calcium oxide ( CaO ).

7. STUDY METHODOLOGY CONCLUSION Yli et al (2015) 10 and 30 wt % of BAG particles with cGIC and resin-modified GIC (RMGIC) powders CS – Decreased with increase of BAG filler particles 55% higher surface microhardness Amount of fluoride (F) ion release was significantly higher on all BAG-added RMGIC De Caluwé et al (2016) Al3+ and BAG particles to cGIC Improve bioactivity Al3+ decrease bioactivity but improve mechanical property.

8. GLASS FIBER STUDY METHODOLOGY CONCLUSION Kobayashi et al (2000) Short glass fiber + GIC Increase - Mean diametral tensile strength and flexural strength L ohbauer et al (2001) Short fiber + GIC Increase in fracture toughness and total energy release Garoushi et al (2017) Hollow and solid discontinuous glass fiber + GIC and RMGIC Increase in fracture toughness No change in compressive strength

9. Hydroxyapatite (Ca10 (PO4)6 (OH)2) Hydroxyapatite (HA) - Similar composition and crystal structure to the natural apatite found in human dental hard tissues as well as the human skeletal system. Nano-HA added GIC - Increase in mechanical properties Ionic interaction between the polyacrylic acid and the apatite crystals

10. SILICA STUDY CONCLUSION Shiekh et al (2014), Moheet et al (2018) nano-hydroxyapatite-silica Vickers microhardness – 73% increase Felemban et al (2016) Increased the mechanical properties and water sorption rates but decreased microleakage and water solubility Yan et al (2017) chlorhexidine-encapsulated mesoporous silica nano-particles ( CHX@pMSN ) 1 wt % CHX@pMSN to GIC effectively inhibited the growth of streptococcus mutans without affecting the mechanical properties of the material

11. Hydroxyapatite (Ca10 (PO4)6 (OH)2 and Zirconia (ZrO2) Zirconium - Good dimensional stability and high strength Used for fortifying and strengthening the brittle HA bioglasses in biomedical practices Ab Rahman et al- Nano- Zr -Si-HA powder substituted at 1 to 20 wt % with GIC powder. Vickers hardness in general was increased at lesser wt % (1–5%) and decreased as the concentration of the nano- Zr -Si-HA powder was increased in GIC powder.

12. ZINC Aluminum inhibits a stable bond formation between GIC and bone resulting in defective bone mineralization. Zinc oxide ( ZnO ) - Alternative to aluminium Dual effect of ZnO It acts as a network modifying oxide as well Forms an intermediate oxide similar to alumina

13. STUDY METHODOLOGY CONCLUSION Dickey et al Two different glasses with varying Ca2+ concentration based on Zn-silicate system were added to GIC. Novel zinc-based GIC formulation with the addition of germanium dioxide (GeO2), zirconium dioxide (ZrO2), and sodium oxide (Na2O). Poor handling characteristics. Better handling properties

14. Niobium Pentoxide Metal oxide having a monoclinic structure Improving the mechanical properties of the alloys and exhibited fair biocompatibility and bioactivity Bertolini et al. – Increasing the Nb2O5 content of the GIC prolonged setting time of GIC. Negative impact on the mechanical properties of the modified GIC

15. Ytterbium Fluoride and Barium Sulfate Prentice et al ( 2006) - The effect of adding ytterbium fluoride (YbF3) and barium sulfate (BaSO4) particles to cGIC on the working time, setting time, surface hardness and CS of a cGIC . PROPERTY EFFECT Working and initial setting time Surface hardness Compressive strength Reduction Increased – 1 to 2 wt % Decreased – Higher wt % Decreased with increase in concentration

16. Casein Phosphopeptide —Amorphous Calcium Phosphate (CPP- ACP) (CPP–ACP) nano-complexes have been shown to prevent demineralization and promote remineralization of enamel. STUDY METHODOLOGY RESULT AND CONCLUSION Oshiro et al (2007) Used CPP–ACP paste on bovine teeth to demonstrate its remineralizing potential Bovine teeth specimens Lactic acid (Demineralizing solution) CPP–ACP paste solution first and then placed in demineralizing solution. Specimens that were treated with CPP–ACP first showed little morphological changes when exposed to acidic medium as compared to the remaining specimens . Hence, it was suggested by the authors that CPP–ACP has the ability to prevent demineralization

17. STUDY RESULT CONCLUSION Zalizniak I et al (2013) Assessment of effect of different acidic and neutral medium on the surface hardness, mass and ion release property of CPP–ACP-added GIC The incorporation of 3 wt % CPP–ACP into GIC not only enhanced calcium and phosphate ion release , but it also had no adverse effect on the fluoride ion release. No change in surface hardness and mass change was also reported The authors recommended that CPP–ACP-added GIC has the potential to inhibit demineralization of teeth associated with caries and erosion

18. FORSTERITE Forsterite (Mg2SiO4) glass based on magnesia–silica system. As compared to HA, it has demonstrated substantial enhancement in the fracture toughness of the material as well as in vitro osteoblastic adhesion.

19. STRONTIUM According to ISO standard, GIC should be an opaque material. Modify the glass component of GIC by replacing Ca with strontium (Sr). The mechanical properties gradually decreased with further increase in the strontium. Brauer et al added Sr to a bone cement based on BAG. In vitro results showed that the bactericidal action of the cement was enhanced through substituting Sr in BAG containing bone cement

20. Montmorillonite Clay Trilayered smectite clay consisting of stacked platelets constructed of an alumina layer sandwiched between two silica layers.

21. STUDY METHODOLOGY RESULT AND CONCLUSION Dowling et al (2006) Two types of nanoclay , An inorganic calcium montmorillonite (Ca-MMT) An organic ADA-MMT clay to cGIC at 0.5 to 2.5 wt %. ADA-MMT – Increased Compressive strength Ca-MMT – Reduced compressive strength Dowling et al suggested that increased interlayer space between the nano-clay may provide an opening for the polyacid chains in the GIC matrix to interact with the MMT galleries . Thus, it enhanced the CS of the modified GIC

22. STUDY RESULT AND CONCLUSION Fareed and Stamboulis 2014: Dispersion nano-clay with less than 2 wt % (1–2.0 wt %) when added to cGIC may successfully produce a mechanically strong material. 2017: Cements ( Hifi GIC) containing nano-clay (4 wt %) generally presented with increased total wear rate when compared to cGIC . The hardness value reported was between 62 and 89 HV. However, there was no significant difference in hardness between the modified GIC and cGIC

23. Cellulose Microfibers/Cellulose Nano-Crystals Silva et al evaluated the effect of addition of cellulose microfibers ( CmF ) and cellulose nano-crystals ( CnCs ) to GICs. Conclusion: The addition of only small concentrations of CnC to GIC led to significant improvements in all the mechanical properties: CS, DTS, and elastic modulus increased by 110, 53, and 161%, respectively. Therefore, CnC may represent as a new potential permanent filler particle for dental restorative materials

24. Fluorinated Graphene Sun et al have recently attempted an addition of fluorinated graphene (FG) to cGIC . Four different wt % FG (0.5–4 wt %) were added to cGIC powder and submitted for testing Conclusion: The addition of FG to cGIC enhanced their mechanical properties Antibacterial efficacy - Increased. No negative affect on the color , solubility, and F ion release property of the material.

25. CONCLUSION Addition of lower percentage of filler content has demonstrated better mechanical properties and not all modifications produce beneficial results. None of the additions had any beneficial effect on the moisture sensitivity of GIC.

26. Filler Property Barium forsterite. Bio active glass N ano-TiO2, nano-HA, nano-SiO2, and nano-ZrO2 particles. Poor handling characteristics Effected the fluoride release of the GIC Increase the poly-salt bridges in the GIC matrix and forms a stable bond or interface with biological tissues through the formation of an apatite layer, resulting in better mechanical properties. Increase the mechanical properties Significantly More work should be focused on nano-particles as they have greater chemical affinity for GIC matrix as well as the tooth structure; thus, it would enhance the physicochemical properties of GIC.

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