ORIGINAL RESEARCH


https://doi.org/10.5005/jp-journals-10015-2052
World Journal of Dentistry
Volume 13 | Issue 4 | Year 2022

Impact of Pediatric Drugs on Color Stability of Different Aesthetic Restorative Materials Used in Pediatric Dentistry: An In Vitro Study


AlWaleed Abushanan1, Abdulfatah Alazmah2, Uthman S Uthman3, Mazin Algahtani4, Abdulhamid Al Ghwainem5, Narendra V Penumatsa6

1-3,5,6Department of Preventive Dental Sciences, College of Dentistry, Prince Sattam Bin Abdulaziz University, Al-Kharj, Kingdom of Saudi Arabia

4Department of Preventive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia

Corresponding Author: AlWaleed Abushanan, Department of Preventive Dental Sciences, College of Dentistry, Prince Sattam Bin Abdulaziz University, Al-Kharj, Kingdom of Saudi Arabia, Phone: +966 115886281, e-mail: a.abushanan@psau.edu.sa

ABSTRACT

Aim: The current in vitro research aims to assess the effect of pediatric drug formulations on color steadiness of different aesthetic restorative materials employed in pedodontics.

Materials and methods: This research studied three different aesthetic restorative agents based on which allocation was performed to three different investigational groups as under group 1: Composite resin, group 2: Giomer, group 3: Zirconia-reinforced GIC. Forty disk-like specimens were prepared for each of these materials, employing molds to attain a uniform size of 10 mm diameter by 2 mm thickness. For every specimen, the material was manipulated in accordance with the manufacturer’s recommendations followed by adaptation to the mold. The specimen’s from every material, that is, 20 for each medicinal liquid formulation, were subjected to immersion in two drugs in liquid form—Antibiotics (Amoxicillin and Clavulanic acid) and Analgesics (Ibuprofen and Paracetamol) thrice daily for 2 minutes at 37°C during the investigational tenure of 1 week. The shade/ specimen color was evaluated employing a spectrophotometer in agreement with the CIELAB.

Results: Following immersion in the antibiotic liquid, maximum resisting power toward color alteration was delineated by Giomer (2.62 ± 0.16–4.24 ± 0.06), pursued by Zirconia-strengthened GIC (2.40 ± 0.11–7.18 ± 0.10), then Composite resin (2.36 ± 0.03–9.02 ± 0.08) in that order. Following immersion in the analgesic liquid, maximum resisting power toward color alteration was delineated by Giomer (2.63 ± 0.14–4.88 ± 0.02), pursued by Zirconia-strengthened GIC (2.38 ± 0.10–8.48 ± 0.14), then Composite resin (2.42 ± 0.02–10.39 ± 0.12) in that order.

Conclusion: According to the results of the current research, a conclusion may be derived that, although each of the aesthetic restorative materials depicted staining following exposure to two different medicinal liquid formulations, Giomer exhibited maximum resistance to color alteration than zirconia-strengthened GIC and composite resin.

Clinical significance: The unceasing advice of pediatric medicines can display staining of both natural dentition as well as restorations. The esthetic appearance being a key apprehension for parents as well as their children these days, the enduring color steadiness of restorative materials is of the highest significance.

How to cite this article: Abushanan A, Alazmah A, Uthman US, et al. Impact of Pediatric Drugs on Color Stability of Different Aesthetic Restorative Materials Used in Pediatric Dentistry: An In Vitro Study. World J Dent 2022;13(4):316-319.

Source of support: Nil

Conflict of interest: None

Keywords: Aesthetic restorative materials, Analgesics, Antibiotics, Spectrophotometer

INTRODUCTION

A significant prerequisite for choosing an appropriate restorative material is its color steadiness. The pediatric patient and their parents both yearn for good esthetics. In order to rise to the enhanced esthetic concerns, multiple restorative agents with varying constitutions are being produced for clinical utilization. Conventional glass ionomers, composite resins, as well as resin-modified glass ionomers are among the various restorative agents that have been launched. However, of the more recent preamble are compomer, giomer as well as ormocer restorative agents that possess enhanced features and may be utilized for the restoration of cavities in both deciduous and permanent teeth as well as fulfill the esthetic requirements.1

Restoration of cavitated esthetic areas of anterior/posterior portions of the dentition to help the rehabilitation of flawed teeth can be accomplished by use of such restorative materials. Nevertheless, the durability as well as suitability of these restorative materials are directly related to the color steadiness of the restorations employed.2 A noteworthy issue influencing the restorations following long lasting utilization is staining that may occur due to intrinsic/extrinsic parameters. The resin matrix composition as well as the size/ratio of filler components influences intrinsic color alterations. Adsorbing/absorbing food and beverage containing coloring agents constitute the external parameters that can cause the restoration to discolor.3

Employment of drug concentrations in medicines used in children are documented as an important reason for discoloration of restorations.4 The chief pediatric medical formulations that are prescribed in liquid form are analgesics, antibiotics, antihistamines, as well as multivitamins to manage the chronic necessities in children. These medicines enhance and shield health owing to their active constituents, but may cause undesirable adverse effects due to the inactive components they contain.5

Medicinal formulations as suspensions/syrups are traditionally administered to young pediatric patients. Sugars, acids, buffering materials, permitted colorants in the form of oil/water-soluble materials are the key components employed in such medicinal fluids for children. Sucrose composed in these medicinal fluids cause a fall in pH in dental bio-film as well as act as a substrate for fermenting oral microbial flora enhancing dental caries. Undesirable actions like erosion, intrinsic/extrinsic discoloration of teeth/restorations result from decreased endogenous pH and elevated titration capacity of acidic constituents of such formulations along-side the enduring exposure of deciduous teeth to these medicinal liquid preparations cause decrease in enamel hardness, alterations of the surface as well as disintegration of the restoration surface.6 Thus, the current research was performed to assess the effect of pediatric drug formulations on color steadiness of different aesthetic restorative agents employed in pediatric dentistry.

MATERIALS AND METHODS

Sample Preparation

The current research was performed in the Department of Preventive Dental Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj, Kingdom of Saudi Arabia. This research studied three different aesthetic restorative materials based on which allocation was performed to three different investigational groups as under:

  • Group 1: Composite resin (Tetric N-Ceram, Ivoclar Vivadent, Liechtenstein).

  • Group 2: Giomer (Beautifil II®, Shofu Dental Corporation, Japan).

  • Group 3: Zirconia-reinforced GIC (Zirconomer Improved SHOFU INC, UK).

Forty disk-like specimens were prepared for each of these materials employing molds to attain a uniform size of 10 mm diameter by 2 mm thickness. For every specimen, the material was manipulated in accordance with the manufacturer’s recommendations followed by adaptation to the mold. When preparing specimens for composite and giomer, for every specimen, the material was introduced into the mold employing Teflon covered plastic filling equipment plus explorer to meticulously remove the surplus. By sandwiching a mylar strip amid the top surface of composite and a glass side 1–2 mm in thickness, prior to light-curing with an LED unit, the surface was flattened. Following these procedures, each specimen was subjected to curing through the mylar strip plus glass slide, incrementally for a minute and then an extra 20 seconds on either side of the specimen following removal of both the mylar strip plus glass slide. While preparing the specimens for zirconia- strengthened GIC, petroleum jelly was coated on the walls of the mold for every specimen. Following this the mold was placed on glass slab enclosed within a mylar strip. As recommended, the typical powder-liquid ratio (3.6/1.0 g) was placed on the mixing pad, following which the powder was divided into two equivalent halves. The powder was then slowly mixed with the liquid in increments to attain suitable stability of the mixed material. This material was settled within the mold above which an additional mylar strip was positioned and detained in place until the material set. Every specimen was subjected to storage in deionized distilled water until future use.

Sample’s Staining Process

The specimen’s from every material that is 20 for each medicinal liquid formulation, were subjected to immersion in two drug preparations in liquid form antibiotics contains amoxicillin and clavulanic acid (Augmentin suspension, glaxosmithkline, U.S) and analgesics contains ibuprofen and paracetamol (Ibuwell-p suspension, Wellona Pvt Ltd) thrice daily for 2 minutes at 37°C during the investigational tenure of 1 week. Each solution was changed every day as part of renewal. The specimens were placed in artificial saliva (Glandosan®, Helvepharm AG, Frauenfeld, Switzerland) amid the immersion times.

Evaluation of Color Changes

The shade/colors of the specimens were evaluated with use of a spectrophotometer in agreement with the Commission International de l’Eclairege (CIE) color space by means of digital image analysis technique. Color expression is based on three parameters, that is, L*, a*, and b* in the CIELAB system, where L* symbolizes brightness or lightness (score) and a* and b* provide numeric correlates for the hue/chroma.

After measuring, the mean of ΔL*, Δa*, and Δb* was calculated and verified by the spectrophotometer without human intervention. Using the formula:

ΔE = (ΔL*2+Δa*2+Δb*2)1/2, shade difference ΔE was estimated from the mean ΔL*, Δa*, and Δb* scores for every specimen.

Where ΔL*, Δa*, and Δb* represent the variations in L*, a*, and b* scores before and postimmersion.

Statistical Analysis

The data thus derived was subjected to statistical analysis using SPSS version 20.0. Calculation of descriptive statistics including mean/standard deviation was performed. The relative assessment of shade variation as a function of different drug formulations was derived with paired ‘t’ test and was then utilized to group the significant groups at an interval of 5%.

RESULTS

Table 1 and Figure 1 shows the mean scores for the color alterations of the three esthetic restorative materials at baseline and following immersion in the antibiotic liquid. Maximum resisting power toward color alteration was delineated by Giomer (2.62 ± 0.16–4.24 ± 0.06), pursued by Zirconia-strengthened GIC (2.40 ± 0.11– 7.18 ± 0.10), then Composite resin (2.36 ± 0.03–9.02 ± 0.08) In that order, differences amid the three esthetic restorative agents used were statistically significant.

Table 1: Mean color changes values for the three aesthetic restorative materials at baseline and after immersion to antibiotic liquid
Restorative materials groups Immersion in antibiotic liquid t-value p-value Significance
Baseline After immersion
Group 1: Composite resin 2.36 ± 0.03 9.02 ± 0.08 9.214 0.001 HS
Group 2: Giomer 2.62 ± 0.16 4.24 ± 0.06
Group 3: Zirconia-reinforced GIC 2.40 ± 0.11 7.18 ± 0.10

HS, highly significant

Fig. 1: Color changes values for restorative materials after immersion to antibiotic liquid

Table 2 and Figure 2 shows the mean scores for the color alterations of the three esthetic restorative materials at baseline and following immersion in the analgesic liquid. Maximum resisting power toward color alteration was delineated by Giomer (2.63 ± 0.14–4.88 ± 0.02), pursued by Zirconia-strengthened GIC (2.38 ± 0.10– 8.48 ± 0.14), then Composite resin 2.42 ± 0.02–10.39 ± 0.12) In that order, differences amid the three esthetic restorative agents used were statistically significant.

Table 2: Mean color changes values for the three aesthetic restorative materials at baseline and after immersion to analgesic liquid
Restorative materials groups Immersion in analgesic liquid t-value p-value Significance
Baseline After immersion
Group 1: Composite resin 2.42 ± 0.02 10.39 ± 0.12 8.310 0.001 HS
Group 2: Giomer 2.63 ± 0.14 4.88 ± 0.02
Group 3: Zirconia-reinforced GIC 2.38 ± 0.10 8.48 ± 0.14

HS, highly significant

Fig. 2: Color changes values for restorative materials after immersion to analgesic liquid

DISCUSSION

Repeated as well as prolonged use of the routinely prescribed pediatric drug formulations can pose challenges in pedodontic practice by reducing the pH thereby leading to enhanced caries-causing as well as erosion-causing capacity. Also, enduring color stability of restorative materials used in pedodontics has been regarded as the key parameter in esthetics. Additionally, increased dental visits lead to various issues like higher cost of restoration replacement, enhanced dental treatment associated anxiousness, and ensuing behavior managing constitute the various other unwanted consequences.7

The restorative agents used in dentistry are continually subjected to various oral atmospheric confrontations in the form of temperature/pH changes. This causes a string of external/internal alterations over the surface/inside the material body leading to changes in the physical, mechanical, chemical, and esthetic characteristics. Another important affected feature is the color steadiness that influences the durability and permanence of the dental restorations. Color change occurs following adsorption of the colorants on to the surface as well as beneath the surface, thereby rendering the restoration due for a change leading to financial as well as time constraints for the children, their parents and dentists.8 The color constancy of restorative materials is attributed to manifold causes such as category of matrix of restorative agent, particle dimension, filler composition and type, polymerization deepness, manner of polymerization, plus exposure to colorants. Color change is also associated with the hydrophilic features of the material used.9

Color alterations may be evaluated by visual inspection and use of particular armamentarium. The technique employed in this research was in harmony with prior research employing spectrophotometry as well as the CIE L*a*b* coordinate scheme, which is a suggested technique for dental rationale.10 The CIE L*a*b* coordinate scheme was selected to appraise the color disparity (DE), as it is appropriate for the assessment of minute color modification with benefits like the ability to repeat, being sensitive, as well as objective.11

In this research, higher color alterations were noted with composites versus the remainder experimental groups. These results are in harmony with the research of Kathiria HP et al.12 who found that, composites show noteworthy color alterations owing to their greater water-absorbing characteristics that leads to a poor bond amid the resin matrix and fillers, causing microfractures and interproximal spaces at the matrix and filler edge leading to enhanced penetrability, staining and ensuing discoloration. According to an additional research of Rueggeberg and Craig,13 composite resins with a high amount of resin matrix, low concentration, and larger size filler particles have more tendency toward discoloration.

In the current research lesser color alterations were seen in Giomer pursued by Zirconia-strengthened GIC, then the composites. These results are in accordance with the research by Hotwani K et al.14 who attributed lower scores in Giomer to greater filler load, that is, 83.3% by weight as well as lesser particle dimension of 0.8 μm. Giomer with a lesser particle dimension tends to possess a more uniform and smooth surface thereby retaining lesser stains vs the coarse surfaces. Besides, the poorer staining propensity can also be credited to the reasonably superior TEGDMA quantity.

Zirconia-strengthened GIC depicted greater resisting capacity to color alteration vs composites. Chalissery VP et al.15and Prabhakar AR et al.16 documented that Zirconia-strengthened GIC is chiefly composed of zirconium oxide, glass powder, tartaric acid, polyacrylic acid, plus deionized water as the liquid part. The chief constituent of zirconia-strengthened GIC (Zirconomer Improved) is zirconia filler elements of nano-size with a range of 96.5–98.5%. Such fillers are known to provide greater translucency thereby having a very close equivalence to color of natural dentition. Nevertheless, enhanced vulnerability of “Zirconomer Improved” in means of color alteration can be linked with adding different size inert zirconia units and their associated translucency.

In this research, maximum color alterations were noted for analgesic medicinal fluids for each of the restorative material. Additionally, the greater viscous nature as well as the colorants of fluid drugs bear effects on color steadiness of restorations.17 The enamel of deciduous dentition is lesser mineralized in contrast to enamel of permanent dentition, making it more susceptible to undesirable outcomes like dental caries/erosion, as well as discoloration of the tooth surface and restorative material because of recurrent use of such small pH and more sucrose comprising liquid medicinal preparations.18 Therefore, in children, it is recommended to utilize such fluid medicinal preparations prudently.

The limitations of the current research are that, it being in-vitro research, the ΔE may be subject to exaggeration as the salivary function of oral cleansing thereby delaying the stain building up in the long run has not been replicated as usually occurs in the oral milieu. Nonetheless, additional research is suggested to assess the surface unevenness, water sorption, plus disintegration of such restorative materials employing temperature/pH as variable factors.

CONCLUSION

According to the results of the current research, a conclusion may be derived that, although each of the aesthetic restorative materials depicted staining following exposure to two different medicinal liquid formulations, Giomer exhibited maximum resistance to color alteration than zirconia-strengthened GIC and composite resin.

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