Nadia Inayat1 , Faisal Bhanger2 , Saqib Rashid3 , Tasleem Hosein4
1 Assistant Professor Head, Dept Of Peadodontics, Hamdard University Dental Hospital, Karachi
2 Assistant Professor, Department of Operative Dentistry, IslamMedicalAndDentalCollege, Sialkot
3 Head of Operative Department, Fatima Jinnah Dental Hospital, Karachi
4 Dean of Fatima Jinnah dental College & Hospital
Correspondence: Nadia Inayat
How to CITE:
Inayat N, Bhanger F, Rashid S, Hosein T. Comparison of conventional glass ionomer cement and compomer in class ii restorations in primary molars: six months studyJ Pak Dent Assoc. 2012, 21(1): 24-27
Restorations in primary teeth continue to be an important facet of restorative dentistry. Traditionally, posterior primary teeth have been restored with amalgam. Recently, there has been a range of tooth-colored materials available for restoring primary and young mixed dentitions. These materials are conventional glass ionomer cements and composite resins, resin-modified glass ionomer cements and compomers.
To compare the clinical performance of conventional glass ionomer cement with compomer, in class II restorations in primary molars.
This was a quasi experimental study conducted at Operative Department of Fatima Jinnah Dental College Hospital, Karachi during period of six months, on 132 patients meeting the inclusion criteria (2 proximally carious primary molars, 264 carious lesions) were included in the study. All 132 patients enrolled in the study were recalled after six months and restorations were clinically examined for marginal adaptation and anatomic form.
Out of 264 restorations, 10 teeth were lost because of the normal exfoliation of primary teeth.124 restorations failed during the follow-up period from which 123 (93.2%) were conventional glass ionomer cement and only 1(0.8%) was compomer.
In terms of marginal adaptation and anatomic form, compomer performed significantly better than Conventional glass ionomer cement in class II cavity in primary molars.
Class II Restorations, Compomer, Conventional glass ionomer cement, Primary Molars.
Restoration of primary dentition is an integral part in the maintaining child’s oral health and his/her mixed and permanent dentitions. Until the 1990s amalgam and stainless steel crowns were the material of choice for posterior restorations in primary teeth. However since than, in pediatric dentistry there has been an expansion in the tooth-colored restorative materials, which are also adhesive in nature with improved physical and mechanical properties.
These materials are conventional glass ionomer cements, resin-modified glass ionomer cements, cermet cement, poly-acid modified resin composite (compomers), ormocer, and composite resin.
Glass ionomer offers distinct advantages over other restorative materials, due to its compatability, adhesive nature (chemically bond to the tooth structure) and its fluoride release. However, Glass ionomer cements are brittle materials and are susceptible to fracture and wear especially in the load bearing areas like class II. On the other hand, compomer is becoming one of the most promising restorative materials for pediatric dentition. They are poly-acid modified resin composite. They were developed to combine the advantages of glass ionomer cements and composite. (Fluoride release, chemical adherence to tooth structure and its biocompatibility of glass ionomer cement and ease of handling and aesthetic properties, stability and strength of composite). Many clinical studies have shown that compomer has a clear potential to be used in load bearing areas like class II in primarymolars.
This clinical trial will compare the clinical performance of conventional glass ionomer cement with compomer, used for class II (approximal) restorations in primarymolars, over a period of sixmonths.
It was a Quasi experimental study and sampling technique was Non Probability Purposive sampling.The inclusion criteria for selection of the sample were Patients between 4 and 8 years. At least one homologous pair of class II carious lesion in first/second primary molar were present. Fractured or broken down teeth, restored teeth or pulpally involved teethwere excluded from the study. 132 patientswith two proximally carious primary molars (264 teeth) were selected for the study. In each of the patients, one molar was restored with conventional GIC (Chemfil superior, Dentsply Detray) and other with compomer (Dyract Extra, Dentsply Detray) and this distribution was done at the time of operation. Single operator performed all restorations. Before the restorations were placed, proper consentwas taken fromthe parents.
For both the materials, restorations were placed under careful isolation with cotton rolls to prevent salivary contamination. Using high-speed equipment and ample water-cooling, caries were removed and cavity was prepared, if proximal box was not retentive, occlusal extension of the cavity known as dovetail. Soft carious tissues were removed using low-speed equipment and round burs. The cavity preparations were finished with sharp excavators. In deep cavities, dentine close to the pulp were lined with calcium hydroxide liner e.g. Dycal (Dentsply). A thin steel matrix band was secured around the tooth were made
Chemfil Superior (DentsplyDetrey):
ChemFil Tooth Cleanser was used to condition the dentin surface.ChemFil superiorwasmanuallymixed and packed according to themanufacturer’s recommendations The mixed cement was packed firmly into place and was contouredwith a suitablematrix. To prevent moisture contamination and dehydration, the restoration was coated with ChemFil Varnish according to the manufacturer’s instructions. Any large excess of the material was removed with finishing burs and complete finishing was done with finishing discs or strips. Finally the restoration was buffed to a high luster with polishing cups and paste.
Prior to the application ofDyract eXtra, the cavity was conditioned and should be treated with Prime& Bond NT Nano-Technology Dental Adhesive. Adhesive was applied according to the manufacturer’s instruction. Dyract extra will be dispensed directly into the cavity preparation. In deep cavities, incremental, layering and curing (in 2 mm layers or less) was done to minimize polymerization shrinkage. Finishing was done immediately after curing. Follow-up were done after six months. Examination was done in proper dental unit light using examination instruments (mirror, probe and twizer)with the naked eye. The restorations were evaluated in terms of marginal adaptation and anatomic form and were considered acceptable (successful) or not acceptable (unsuccessful) on the basis of following criteria:
1)Marginal and Approximal Adaptation:
a)Acceptable: Marginal and Approximal adaptation was acceptable when restoration adapted itself to the adjacent tooth along its margins (mesial or distal) and there was no gap between restoration and cavitymargin.
b)Unacceptable: Marginal and approximal adaptation was unacceptable if there was a gap between restoration and adjacent tooth or there was a loss of restoration (restorations may fall off during function i.e.mastication).
a)Acceptable: Anatomic form was acceptable when the restoration duplicated the same anatomy and similar proximal contact (mesial or distal) of the adjacent sound primary molar.
b)Unacceptable: Anatomic form was unacceptable when there was food impaction between restoration and adjacent tooth or there was loss of contact with the adjacent tooth.
Information was entered on patients proforma according to the above mentioned criteria.The data analysis was done by using SPSS for windows, version 11. Frequencies and percentages were calculated for gender marginal and approximal adaptation and anatomic form.
Mean ± SD were calculated for the age of the patient. Mc Nemar test was applied for marginal and approximal adaptation and anatomic form between two groups. P value ≤ 0.05 was taken as significant. Male and female data were analyzed separately to control confounding.
Out of 132 children, 97 (73.5 %) were female and 35(26.5%) were male and in age- wise distribution out of 132 children, fourwere 4 year old followed by 22 five year old, 38 six year old, 26 seven year old and 42 eight year old with themean age of 6.61 (SD1.184).
Out of 132 glass ionomer restorations, 78 were in maxillary teeth and 54 were in mandibular teeth where as out of 132 compomer restorations, 37 were in maxillary teeth and 95were inMandibular teeth.
All 132 patients enrolled in the study were recalled after sixmonths and restorationswere clinically examined for marginal adaptation and anatomic form. Out of 264 restorations, 10 teeth were lost because of the normal exfoliation of primary teeth. (4 had glass ionomer restoration and 6 had compomer). 124 restorations failed during the follow-up period.
All 132 patients enrolled in the study were recalled after six months and restorations were clinically examined for marginal adaptation and anatomic form. Out of 264 restorations, 10 teeth were lost because of the normal exfoliation of primary teeth. (4 had glass ionomer restoration and 6 had compomer). 124 restorations failed during the follow-up period.
Out of these 123 failed glass-ionomer restorations 73 were in the maxillary teeth and 50 were in the mandibular teeth, (Table I) where as 1 failed compomer restoration was present in mandibular arch. (Table II). In terms of marginal adaptation and anatomic form, compomer performed significantly better than Conventional glassionomer cement (P<0.001). (Table III).
Statistical analysis did not reveal an impact on sex of the patient, age of the patient or localization of restoration with respect to upper or lower jaw on the outcome of the study.
In the present study, CGIC showed a high failure rate of 93.2% and a success rate of 3.8%. whereas, compomer showed a high success rate of 94.7%with the failure rate of 0.8%.
Many previous studies agree with our results Study by Pascona FMet al. in 2006 showed 73%Alpha and Bravo scores for marginal adaptation for compomer at the 24- month evaluation. Excellent anatomic form was reported in clinical studies with Dyract AP in primary teeth. A recently published literature review quoted several studies on clinical durability of compomer. Roeters et al. investigated Dyract (Dentsply International) in the course of a prospective clinical trial in Class I and II cavities, and they stated that even solely adhesive preparations without undercuts enable long-term success in the deciduous dentition.
In our study, the success rate of compomer (94.7%) in terms of marginal adaptation and anatomic form were same. If the restoration has good marginal adaptation that is when there is no gap between restoration and cavity margin, then its anatomic form (that is the ability of the restoration to duplicate the original anatomy of the tooth) will be good. On clinical examination, out of 132 compomer restorations, 125 had smooth surface with intact margins. There was no gap between the restoration and the cavity margin except for 1 restorationwhich failed because of marginal breakdown. The failure rate of glass ionomer cement (93.2%) in terms of marginal adaptation and anatomic form were same. For 132 GIC restorations, only 5 restorations had an acceptable margin and 123 GIC restorations showed signs of failure with poor surface margins, ditching and poor proximal contact. Our present study and many other studies have shown that in recent years, poly acid resin composites (compomers) have gained more acceptances in the treatment of primary molars. Several studies have found that they have better physical and clinical properties compared with conventional GICs.
There could be three reasons for the better performance of compomer in our study.One is the priming of enamel and dentine according to the manufacture’s instruction before placement of compomer restoration which improves adhesion. Secondly the conditioner used for compomer has to be only air dried and cured. No rinising required as for all other conditioners like phosphoric or poly-acrylic acid used for GIC, which makes it necessary to replace cotton rolls but for compomers, the cotton rolls can stay in place, resulting in a lower risk of contamination and a more comfortable procedure for the child. A third reason could be the easy delivery of compomer restorative material into the cavity.
As the compomer is delivered in a compule, the material can be injected directly into the cavity prepared and also compomer has a command setting as it immediately sets after light-curing (40 sec).
The presence of failure of glass ionomer restorations in our study may be a result of the fact that GICs are very sensitive to moisture and humidity in the early setting period which may have influenced the solubility of the cements. To reduce bias of environment in our study, the split-mouth design was chosen so that the two restorative materials (compomers and glass ionomer cement) would be exposed to a nearly identical oral environment.
The other reason for the failure of GIC in our study could be bulk fractures of the material as conventional glass ionomer cement is mechanically weak and that is why it is not recommended in load bearing areas like class II. Hickel and colleagues also found that the annual failure rates in stress-bearing cavities like class II restorations of primary molars were 0 to 25.8 % for GIC restorations. Many other studies have also shown poor results for conventional glass ionomer cement especially in class II restorations. Literature review done by Chadwick in 2007 showed that the failure rate for GIC has vide variation. (6.6%-60%).
Only 10 teeth exfoliated during our study. This could be because of premature loss of primary molars or could be because of incorrect age quoted by the patient at the time of restoration placement because the normal exfoliation of primarymolars ranges from9-12 years.
Our six month study has determined the higher success rate of compomer and it is therefore the recommended restorativematerial for primarymolars.
In terms of both, marginal adaptation and anatomic form of restorations, compomer performed significantly better than conventional glass ionomer cement in class II restorations in primary molars. recorded during six months followup.16
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