In vitro and in vivo evaluations of glass-ionomer cement containing chlorhexidine for Atraumatic Restorative Treatment

Abstract

Objectives:Addition of chlorhexidine has enhanced the antimicrobial effect of glass ionomer cement (GIC) indicated to Atraumatic Restorative Treatment (ART); however, the impact of this mixture on the properties of these materials and on the longevity of restorations must be investigated. The aim of this study was to evaluate the effects of incorporating chlorhexidine (CHX) in the in vitro biological and chemical-mechanical properties of GIC and in vivo clinical/ microbiological follow-up of the ART with GIC containing or not CHX.Material and Methods:For in vitro studies, groups were divided into GIC, GIC with 1.25% CHX, and GIC with 2.5% CHX. Antimicrobial activity of GIC was analyzed using agar diffusion and anti-biofilm assays. Cytotoxic effects, compressive tensile strength, microhardness and fluoride (F) release were also evaluated. A randomized controlled trial was conducted on 36 children that received ART either with GIC or GIC with CHX. Saliva and biofilm were collected for mutans streptococci (MS) counts and the survival rate of restorations was checked after 7 days, 3 months and one year after ART. ANOVA/Tukey or Kruskal-Wallis/ Mann-Whitney tests were performed for in vitro tests and in vivo microbiological analysis. The Kaplan-Meier method and Log rank tests were applied to estimate survival percentages of restorations (p<0.05).Results:Incorporation of 1.25% and 2.5% CHX improved the antimicrobial/anti-biofilm activity of GIC, without affecting F release and mechanical characteristics, but 2.5% CHX was cytotoxic. Survival rate of restorations using GIC with 1.25% CHX was similar to GIC. A significant reduction of MS levels was observed for KM+CHX group in children saliva and biofilm 7 days after treatment.Conclusions:The incorporation of 1.25% CHX increased the in vitro antimicrobial activity, without changing chemical-mechanical properties of GIC and odontoblast-like cell viability. This combination improved the in vivo short-term microbiological effect without affecting clinical performance of ART restorations.

Glass ionomer cements with milled, dry chlorhexidine hexametaphosphate filler particles to provide long-term antimicrobial properties with recharge capacity

“…Although in vivo studies of these experimental materials are rare, there are a few small studies of note. Supplementation of a resin-modified GIC with 1.25% CHX digluconate resulted in elimination of St. mutans populations following indirect pulp treatment in vivo [14] , and incorporation of CHX digluconate into a GIC reduced microbial counts in cavities in first primary molars in 6–9 year olds, although the CHX digluconate GICs also exhibited a higher failure rate than the controls [15] ; similar results were observed in a study of CHX digluconate doped GICs in children receiving atraumatic restorative therapy, where the CHX GICs resulted in reduced St. mutans counts at 7 days but not 3 or 12 months after placement [16] . These tentative findings highlight the potential benefit of CHX-functionalised restorative materials as well as the challenges, in that the other properties of the GIC are often compromised by the new component.…”

“…There was a numerical reduction in DTS for 2.5% CHX diacetate and digluconate of ∼30% but this was not statistically significant; 0.5 or 1.25% had no effect on DTS either. Ahluwalia observed similarly that 1% CHX diacetate had no adverse effect on the CS or DTS of a GIC, but did not investigate higher or lower concentrations [28] ; whereas Mittal who utilised concentrations of 1.5 and 3% CHX diacetate observed a ∼30% reduction in CS compared to unmodified GIC [29] , while Duque observed no decrease in CS when adding 1.25 and 2.5% CHX digluconate to a GIC [30] . While it is therefore not possible to draw a definitive conclusion as to what concentration of CHX salts has a significant (whether statistical or clinical) effect on strength, a likely explanation of the reduction in CS and DTS observed by some authors with higher concentrations may be explained Marti’s observation that increased concentration of CHX diacetate or digluconate is accompanied by an increase in porosity [10] which is likely to reduce strength.…”

Management of Streptococcus mutans-Candida spp. Oral Biofilms’ Infections: Paving the Way for Effective Clinical Interventions

“…Chlorhexidine is the most commonly studied active agent [81,82]. It is widely used for preventing dental plaque or treating mouth yeast infections.…”

Biosynthesis and application of silver nano-biotics for enhancing the antimicrobial activity of glass-ionomer cement against studied microorganisms and its effect on compressive strength

“…The urge for restorative dental materials that have antimicrobial properties has stimulated the introduction of materials containing different antibacterial agents. Among the antimicrobials incorporated into the dental restorative material, the monomers 12-methacryloyloxydo-decylpyridinium bromide (MDPB), chlorhexidine digluconate (CHX), silver nanoparticles (AgNPs) and antibiotics are the most frequently used [5][6][7][8]. Although the addition of antibiotics to glass ionomer cement (GIC), may enhance its antibacterial effect, however, this may increase the possibility of developing antibiotic resistance [8].…”