Long –term antibacterial effects and physical properties

Long –Term Antibacterial Effects And PhysicalLong –Term Antibacterial Effects And Physical
Properties Of A Chlorhexidine-containing GlassProperties Of A Chlorhexidine-containing Glass
Ionomer CementIonomer Cement
L.Sebnem Turkun,Murat Turkun,Mustafa Ates,L.Sebnem Turkun,Murat Turkun,Mustafa Ates,
Fahinur Ertugrul,Stefan BruggerFahinur Ertugrul,Stefan Brugger
Journal of esthetic and restorative dentistry-Journal of esthetic and restorative dentistry-
2008,vol 20;no1;29-442008,vol 20;no1;29-44
www.indiandentalacademy.comwww.indiandentalacademy.com

contentscontents
 IntroductionIntroduction
 AimAim
 Materials and methodsMaterials and methods
 ResultsResults
 LimitationsLimitations
 conclusionconclusion
 referencesreferences

introductionintroduction
 Many regions in the world do not haveMany regions in the world do not have
electicity,water,or access to dentalelecticity,water,or access to dental
facilities that allows the treatment of cariesfacilities that allows the treatment of caries
with dental handpieces&rotary burs.with dental handpieces&rotary burs.
 For restorative techniques used in theseFor restorative techniques used in these
regions, an antibacterial self adherentregions, an antibacterial self adherent
glass ionomer material would contributeglass ionomer material would contribute
considerably….considerably….

AimAim
 To test if CHX diacetate or CHXTo test if CHX diacetate or CHX
digluconate –added chemfil superior GICdigluconate –added chemfil superior GIC
had any long –term bacterial effect.had any long –term bacterial effect.
 To test if these new formulations hadTo test if these new formulations had
similar physical properties compared withsimilar physical properties compared with
the parent materialthe parent material
 To determine the optimal concentration ofTo determine the optimal concentration of
CHX incorporation for obtainingCHX incorporation for obtaining
antibacterial GICs for use with ART.antibacterial GICs for use with ART.

MATERIALS &METHODSMATERIALS &METHODS

 Original ratio of powder/liquid for chemfilOriginal ratio of powder/liquid for chemfil
superior -7.4g:1g & used as reference.superior -7.4g:1g & used as reference.
 CHX diacetate powder+chemfil powder-CHX diacetate powder+chemfil powder-
0.171g +29.829g =0.5%0.171g +29.829g =0.5%
0.852g +29.148g =2.5%0.852g +29.148g =2.5%
half dose was used to obtain =1.25%half dose was used to obtain =1.25%

 3 different GIC liquids-containing different3 different GIC liquids-containing different
amounts of CHX digluconate were prepared.amounts of CHX digluconate were prepared.
 Chemfil powder+undiluted CHX digluconate-Chemfil powder+undiluted CHX digluconate-
2.5%.2.5%.
 Solution was diluted 50%with distill water-1.25%Solution was diluted 50%with distill water-1.25%
 0.5%=4.190g of CHX +95.810g of water.0.5%=4.190g of CHX +95.810g of water.

Agar diffusion testAgar diffusion test
 The anti bacterial activity was evaluated-The anti bacterial activity was evaluated-
streptococcus mutansstreptococcus mutans
lactobacillus acidophiluslactobacillus acidophilus
candida albicanscandida albicans
 Aseptic conditions in laminar airflow cabinetAseptic conditions in laminar airflow cabinet
 70 specimens were prepared -6 antibacterial70 specimens were prepared -6 antibacterial
material –added groupsmaterial –added groups
 N=10-control for initial antibacterial effectN=10-control for initial antibacterial effect
 70 more –testing 24 hr anti bacterial effect.70 more –testing 24 hr anti bacterial effect.

 All bacteria & yeastAll bacteria & yeast were culture overnight-were culture overnight-
tryptic soy broth -S. mutanstryptic soy broth -S. mutans
lactobacilli MRS broth -L.acidophiluslactobacilli MRS broth -L.acidophilus
sabouraud dextrose -C.albicanssabouraud dextrose -C.albicans
 The broth culture was diluted &grown to aThe broth culture was diluted &grown to a
density of 107 cfu/ml confirmed by viable celldensity of 107 cfu/ml confirmed by viable cell
count.count.

 25mm of respective culture mediums with agar25mm of respective culture mediums with agar
were evenly distributed over surface of 15cmwere evenly distributed over surface of 15cm
diameter petri dishes to a thickness of 5mm.diameter petri dishes to a thickness of 5mm.
 7 standardized wells with diameter of 4mm were7 standardized wells with diameter of 4mm were
punched into agar –blunt end of pipette.punched into agar –blunt end of pipette.
 Bacterial inoculation –bent glass rod over agarBacterial inoculation –bent glass rod over agar
surfaces with 0.5 ml of micro organisms.surfaces with 0.5 ml of micro organisms.
 Materials were mixed for 30secs&inserted inMaterials were mixed for 30secs&inserted in
wells within 1min.wells within 1min.

 For immediate anti bacterial effect of testedFor immediate anti bacterial effect of tested
groups(day 0)-plates were incubated at 37±1°cgroups(day 0)-plates were incubated at 37±1°c
for 48 hrsfor 48 hrs
 Diameter of circular inhibition zones –measuredDiameter of circular inhibition zones –measured
with digital caliperwith digital caliper
 These specimens were left in the same platesThese specimens were left in the same plates
for 5 more days in incubator &then transferredfor 5 more days in incubator &then transferred
to freshly inoculated plates-left for 48 hrs toto freshly inoculated plates-left for 48 hrs to
obtain inhibition zones for day 7.obtain inhibition zones for day 7.

 The long term bacterial effect was carried atThe long term bacterial effect was carried at
7,14,21,30,40,50,60,70,80,90 days-on 6 tested7,14,21,30,40,50,60,70,80,90 days-on 6 tested
groups.groups.

 Net settingNet setting time:time:
tthe period of time measured from the end ofhe period of time measured from the end of
mixing until the material has set.mixing until the material has set.
 Test was undertaken at 37±1°c & humidity of 95Test was undertaken at 37±1°c & humidity of 95
±5% using indentor(gilmore needle) with a mass±5% using indentor(gilmore needle) with a mass
of 400±5g.of 400±5g.
 5 specimens per group were prepared in a5 specimens per group were prepared in a
stainless steel blocks of 8mm*75mm*100mmstainless steel blocks of 8mm*75mm*100mm
positioned on aluminum folds &filled to a levelpositioned on aluminum folds &filled to a level
with mixed GICswith mixed GICs

 90 secs after end of mixing,the indentor was90 secs after end of mixing,the indentor was
carefully lowered vertically onto the surface ofcarefully lowered vertically onto the surface of
cement &remained for 5 secs.cement &remained for 5 secs.
 The process was repeated,starting theThe process was repeated,starting the
indentation at 30 secs before the approximateindentation at 30 secs before the approximate
setting time was determined,makingsetting time was determined,making
indentations at 10 sec interval.indentations at 10 sec interval.

 Compressive strengthCompressive strength
5 specimens per group were prepared using5 specimens per group were prepared using
split stainless steel mold with inner dimensionssplit stainless steel mold with inner dimensions
of 6±0.1mm height &4±0.1mm diameter.of 6±0.1mm height &4±0.1mm diameter.
 Molds were treated with 5%solution of beeswaxMolds were treated with 5%solution of beeswax
in volatile petroleum etherin volatile petroleum ether
 Within 60 secs after the end of mixing ,the GICsWithin 60 secs after the end of mixing ,the GICs
were packed into the splitmolds &covered withwere packed into the splitmolds &covered with
plates .plates .

 1hr ,later specimens were ground with wet1hr ,later specimens were ground with wet
500 grit silicon carbide paper &stored at500 grit silicon carbide paper &stored at
37±1°c in water for 24 hrs.37±1°c in water for 24 hrs.
 Diameter of specimen was determined –Diameter of specimen was determined –
micrometer guagemicrometer guage
 The maximum force applied whenThe maximum force applied when
specimens fracture was recorded &specimens fracture was recorded &
calculated ascalculated as
cs=4F/¶pd²cs=4F/¶pd²

 Acid erosionAcid erosion
5 specimens /group were prepared in5 specimens /group were prepared in
5mm×30mm diameter PMMA disks with hole of5mm×30mm diameter PMMA disks with hole of
5±0.5 mm in diameter ×2±0.5mm deep in center.5±0.5 mm in diameter ×2±0.5mm deep in center.
 PMMA disks filled with mixed cements&coveredPMMA disks filled with mixed cements&covered
with separating sheets ,pressed firmlywith separating sheets ,pressed firmly
&clamped.&clamped.
 After 24 hrs ,these were flattened with 1,200 gritAfter 24 hrs ,these were flattened with 1,200 grit
abrasive paper.abrasive paper.

 Do value –the specimen were immersedDo value –the specimen were immersed
horizontally into individual bottles -30 ml ofhorizontally into individual bottles -30 ml of
eroding solution(0.1 ml/L lacticeroding solution(0.1 ml/L lactic
acid/sodium lactate buffer solutionacid/sodium lactate buffer solution
adjusted to ph 2.74±0.02 for 24 hrs atadjusted to ph 2.74±0.02 for 24 hrs at
37°c.37°c.
D=Dt-DoD=Dt-Do
 Dt=depth of GICs after erosionDt=depth of GICs after erosion
 D=eroded depth in mmD=eroded depth in mm

 HardnessHardness
a stainless steel mold with inner dimensions ofa stainless steel mold with inner dimensions of
6±0.1mm ht &3±0.1mm diameter-to prepare 66±0.1mm ht &3±0.1mm diameter-to prepare 6
samples/groupsamples/group
 Within 60 secs after end of mixing ,the GICsWithin 60 secs after end of mixing ,the GICs
were packed into conditioned molds .were packed into conditioned molds .
 1hr after ,the specimens were removed from1hr after ,the specimens were removed from
molds&stored 37±1°c in water .molds&stored 37±1°c in water .
 After 24 hrs &10 days vickers hardness wasAfter 24 hrs &10 days vickers hardness was
measured by a load of 29.42Nmeasured by a load of 29.42N

 Diametral tensile strengthDiametral tensile strength
6 cylindrical specimens (3mm×6mm)/group were6 cylindrical specimens (3mm×6mm)/group were
prepared using split metal molds.prepared using split metal molds.
 Specimens were ground with wet 500 grit siliconSpecimens were ground with wet 500 grit silicon
carbide paper to flatten surfaces,removed fromcarbide paper to flatten surfaces,removed from
molds &stored at 37±1°c in water for 24 hrs.molds &stored at 37±1°c in water for 24 hrs.
 the maximum force applied when specimensthe maximum force applied when specimens
fracture was recordedfracture was recorded
DTS=2F/¶dtDTS=2F/¶dt

 Biaxial flexural strengthBiaxial flexural strength
6 shell like specimens/group6 shell like specimens/group
(20mm×1mm)were prepared in teflon(20mm×1mm)were prepared in teflon
molds.molds.
 The specimens were then loaded withThe specimens were then loaded with
2N/min at a cross head speed of2N/min at a cross head speed of
1.5mm/min.1.5mm/min.
 The biaxial flexural strength wasThe biaxial flexural strength was
calculated usingcalculated using

 biaxFS =3F/2¶t²[(1+v1n[ds/dl]+biaxFS =3F/2¶t²[(1+v1n[ds/dl]+
(1-v)[ds²+dl²/2d²](1-v)[ds²+dl²/2d²]

 Working timeWorking time
time at which it is possible to manipulate atime at which it is possible to manipulate a
dental material without an adverse effect on itsdental material without an adverse effect on its
properties-measured by determing the viscosityproperties-measured by determing the viscosity
over time using a cycloviscosimeter.over time using a cycloviscosimeter.
 Mixed for 30 secs &transferred on probe headMixed for 30 secs &transferred on probe head
adjusted to 23°cadjusted to 23°c

ResultsResults

 The conventional chemfil superior materialThe conventional chemfil superior material
&all the experimental groups had the&all the experimental groups had the
same acid erosion value of 0.17µsame acid erosion value of 0.17µ

LimitationsLimitations
 Inability of the method to distinguish betweenInability of the method to distinguish between
bacteriostatic &bactericidal effectsbacteriostatic &bactericidal effects
 Does not provide any information about theDoes not provide any information about the
viability of test microorganisms within theviability of test microorganisms within the
inhibition zones.inhibition zones.
 The test does not simulate the clinical conditionThe test does not simulate the clinical condition
where multiple species of bacteria will bewhere multiple species of bacteria will be
growing in complex biofilmsgrowing in complex biofilms

conclusionconclusion
 The incorporation of CHX into GIC has the abilityThe incorporation of CHX into GIC has the ability
to provide a long term antimicrobial effect onto provide a long term antimicrobial effect on
S.mutans &L.acidophilusS.mutans &L.acidophilus
 The new materials immediate compressiveThe new materials immediate compressive
strength for the 1.25% &2.5% groups wasstrength for the 1.25% &2.5% groups was
lower,where as other physical properties oflower,where as other physical properties of
materials were not seriously compromisedmaterials were not seriously compromised
 The 2.5% diacetate added chemfil superior wasThe 2.5% diacetate added chemfil superior was
found to be effective &longer lasting antibacterialfound to be effective &longer lasting antibacterial
groupgroup

Antibacterial activity of Glass ionomerAntibacterial activity of Glass ionomer
restorative cements exposed to cavityrestorative cements exposed to cavity
producing microorganismsproducing microorganisms
M Herrera,A Castillo,P Baca,P CarrionM Herrera,A Castillo,P Baca,P Carrion
conclusion-the use of GICmay be indicated in theconclusion-the use of GICmay be indicated in the
restorative treatment of root surface caries.therestorative treatment of root surface caries.the
antibacterial action of these materials is notantibacterial action of these materials is not
limited to the microorganisms of enamel,such aslimited to the microorganisms of enamel,such as
streptococci,but also is effective on caries ofstreptococci,but also is effective on caries of
cementum,such as actinomyces.cementum,such as actinomyces.

Antibacterial activity of resin adhesives,GICAntibacterial activity of resin adhesives,GIC
&RMGIC & a compomer in contact with&RMGIC & a compomer in contact with
dentin caries samplesdentin caries samples
M Herrera,A Castillo,M Bravo,J LiebanaM Herrera,A Castillo,M Bravo,J Liebana
Conclusion-the growth of caries producingConclusion-the growth of caries producing
microorganisms was effectively inhibited by themicroorganisms was effectively inhibited by the
vitremer &vitrebond cements &to a lesser extentvitremer &vitrebond cements &to a lesser extent
by the scotchbond multipurpose adhesiveby the scotchbond multipurpose adhesive
system.overall,there were significant differencessystem.overall,there were significant differences
in the antibacterial activity of the products testedin the antibacterial activity of the products tested

Antibacterial effects &physical properties ofAntibacterial effects &physical properties of
GICs containing chlorhexidine for the ARTGICs containing chlorhexidine for the ART
approachapproach
Yusuke takahashi,Saoshi imazato,FranklinYusuke takahashi,Saoshi imazato,Franklin
CONCLUSION-the results demonstrate thatCONCLUSION-the results demonstrate that
experimental GICs containing CHX are effectiveexperimental GICs containing CHX are effective
in inhibiting bacteria associated with caries,andin inhibiting bacteria associated with caries,and
incorporation of 1%CHX diacetate is optimal toincorporation of 1%CHX diacetate is optimal to
give appropriate physical &bonding properties.give appropriate physical &bonding properties.

Long –term antibacterial effects and physical properties

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