ABSTRACT
Aim
The study aimed to compare and assess the dissolution rate, color stability, and other mechanical parameters, such as compressive and flexural strength, of three distinct posterior restorative materials used in pediatric dentistry.
Materials and methods
The three posterior restorative materials used in pediatric dentistry are divided into group I—Zirconomer, group II—Composite, and group III—Cention N. Around 111 cylindrical specimens were grouped into three groups of 37 each. According to the manufacturer's standards, all materials were proportioned and handled. The materials were thermocycler in a chewing simulator and were subjected to various tests to estimate the dissolution rate, compressive strength, flexural strength, and color stability of the three individual groups.
Results
The dissolution rate was highest in Zirconomer, followed by Cention N and Composite, which were highly significant (p = 0.05). Compressive strength was highest with Cention N, followed by Composite and Zirconomer, which was highly important (p = 0.05). Cention N had the greatest flexural strength, followed by Composite and Zirconomer, which were highly significant (p = 0.05). Finally, the Composite had the highest color stability, followed by Cention N and Zirconomer among the three groups.
Conclusion
It is concluded that resin-based restorative materials outperform glass ionomer-based Zirconomer cement in terms of dissolution rate, compressive strength, flexural strength, and color stability.
Clinical significance
Because of the widespread improvement in dental materials, many dental restorative types of cement have emerged on the market. The features of good restorative materials are mechanical strength, fluid dissolution rate, and retention.
How to cite this article
Raman V, Srinivasan D, AR SE, et al. A Comparative Evaluation of Dissolution Rate of Three Different Posterior Restorative Materials used in Pediatric Dentistry: An In Vitro Study. Int J Clin Pediatr Dent 2023;16(S-1):S20–S26.
Keywords: Cention N, Composite, Zirconomer
Introduction
Dental caries is the symptom of localized chemical tooth surface disintegration brought on by metabolic activities in a biofilm (dental plaque) that covers the affected area.1 Compared to older kids, children between the ages of 12 and 30 months exhibit a different caries pattern. The tooth is more negatively impacted the longer it is exposed to carious complications. The most vulnerable teeth are the upper incisors, while the mandibular incisors are protected by the tongue and saliva from the submandibular and sublingual glands.1 This kind of dental caries is referred to by the phrases bottle caries, nursing caries, baby bottle tooth decay, and night bottle mouth. These words imply that improper bottle-feeding is the leading cause of dental caries in young children. Conversely, one of the major etiological factors for dental caries is using a sugar-containing liquid in a bottle late at night. As a result, when defining any caries in newborn or preschool children, the name early childhood caries (ECC) is proposed.2,3
White-spot lesions on the upper primary incisors’ gingival edge signal the onset of ECC. Caries can worsen to the point that it destroys the crown if the condition is not treated.3,4 ECC not only affects teeth, but its effects may also trigger more severe health issues. Infants with ECC develop more slowly than those without caries. Because of the pain and inability to feed, some young children with ECC may be extremely underweight5–7 and have iron deficiency.5
Usually, the carious portion is removed and restored by placing biocompatible restorative material. Because of the widespread improvement in dental materials, many dental restorative types of cement have emerged on the market. The features of good restorative materials are mechanical strength, fluid dissolution rate, retention, and biocompatibility.6 Biocompatibility refers to the dental material's harmony with the dental pulp and soft tissue. It is preferable to use restorative materials with a sufficient film thickness, low solubility, long working times and quick setting times, low viscosities, and radio-opacity. Shear/tensile/compressive strength and bond strength measure cement's mechanical properties.
One of the first materials to be used as restorative material was a dental amalgam with limitations like corrosion, a lack of esthetics, the need for mechanical undercuts for retention, and mercury toxicity.7 Glass ionomer cement (GIC) was developed as a restorative material in the 1970s which failed by low fracture strength, toughness, and wear resistance.8 This limited their usage in stress-bearing areas. The rate of degradation and biological compatibility of dental restorative materials are affected by the solubility of restorative cement. A good restoration material should be adhesive, wear-resistant, biocompatible with the tissues, and esthetic. GIC's mechanical attributes, including its diametral tensile strength, flexural strength, and compressive strength, have demonstrated that it is less resistant to occlusal forces in stress-bearing areas.9
On the contrary, the Composite resin has an organic resin matrix, inorganic fillers and a coupling agent, and polymerization is initiated by visible light. Polymerization shrinkage can lead to excessive wear, secondary caries, pulpitis, fluid penetration, sensitivity, pulpal damage, and failure of the restoration.10
Zirconomer (white amalgam), newer material, is supplemented with Zirconia fillers.11 In dentistry, it is regarded as a substitute for GIC. White and crystalline zirconium oxide is known as zirconia. It comes in different shapes and is a polycrystalline ceramic without a glassy phase. The Arabic term zargon, which means “golden color,” is whence zirconium is derived. A subgroup of Composite resin called Cention N is available as powder and liquid. The liquid contains monomer, which enhances the material's flowability, while the powder contains alkaline ions like fluoride and calcium and 78.4% inorganic fillers, which balance the surrounding acidic ions of restoration. It is essentially a Composite resin subgroup. It has self-curing and visible light-curing properties.
The study aimed to compare and evaluate the dissolution rate, compressive strength, flexural strength, and color stability between three posterior restorative materials—Zirconomer, Composite, and Cention N in an in vitro setting.
Materials and Methods
This in vitro study was carried out to compare and evaluate the dissolution rates, compressive strength, flexural strength, and color stability of three posterior restorative materials (Zirconomer, Composite, and Cention N) used in pediatric dentistry. Ethical approval was obtained from the Institutional Human Ethics Committee (proposal number: 672/IHEC/12-19). The sample size was estimated using G*power statistical software. The sample size was calculated to be 111, with an effect size of 0.30 and an 80% power. Three groups of materials were created—Zirconomer is in group I, Composite is in group II, and Cention N is in group III. Three groups of 37 cylindrical specimens each were created from a total of 111 total specimens. All materials were manipulated and proportioned in accordance with the manufacturer's instructions. To create the specimens, a round metal mold with a 6 mm high and 4 mm diameter was created. The inner surfaces were coated with petroleum jelly before being placed on a Mylar strip on a glass slab. The mold was slightly overfilled in order to reduce air inclusion, and the materials were handled in accordance with the manufacturer's specifications. To extrude the extra material and create a uniformly flat surface, a second Mylar strip was placed on top of the mold, which was then covered with a second glass slab and squeezed for 30 seconds.
After mixing for about 1 hour, the specimens were taken out of the mold. First, dry grinding on both sides was used to gently remove any surplus material. Next, the surfaces were polished with a Composite polishing kit (Shofu). Cylindrical specimens with dimensions of 4 mm in diameter and 6 mm in height were created for each group, which had 37 numbers. Zirconomer samples were submerged in the fake saliva while being covered in a piece of gauze. Likewise, before being submerged in the fake saliva, Cention N and Composite samples were similarly covered in a piece of gauze.
Thermocycling was carried out for 500 cycles with dwell times of 30 seconds at 55 and 5°C. Chewing simulator CS 4.4.111's thermocycling was performed on the samples. To evaluate the samples’ solubility, they were placed in fake saliva for 48 hours. The samples were weighed using a precision weighing machine, weighing machine (Wensar) (W1), and then they were submerged in synthetic saliva for 3 days.
The pH of the artificial saliva was adjusted by adding 10 N sodium hydroxide until it reached 6.75 ± 0.15. The next step was to weigh the specimens after they had been dehydrated in an oven for 24 hours using the same precision weighing machine (W2) (W3). Solubility was calculated as the difference between the initial and final drying masses of each sample (W1–W3).
By adjusting the specimens in accordance with the recommendations of their individual manufacturers, compressive strength was estimated. Then, the specimens were taken in a Compression mold measuring 10 × 2 mm to prepare the specimens. Next, the specimens were prepared, and excess material was removed and polished. For each material, 111 cylindrical specimens (2 mm in diameter and 10 mm in height) of the 37 in each group were produced.
Postthermocycling, 111 specimens were subjected to Instron E3000 universal testing machine (UTM) for compressive strength. Similarly, flexural strength was calculated using a flexural strength mold of 25 height × 2 widths × 2 mm thickness. Again, the flexural strength was recorded by positioning the specimen horizontally, and the specimens were subjected to Instron E3000 UTM for flexural strength. Again, the values obtained were recorded. The specimens were then adjusted in size and position in accordance with the manufacturer's instructions to determine the color difference. Then, a circular metal mold 6 mm high and 4 mm diameter was fabricated to prepare the specimens. Next, the specimens were prepared, and excess material was removed and polished. Finally, the color change was recorded using a spectrophotometer CM-5 (Konica Minolta) and the difference in the color, hue, and value was recorded.
Statistical analysis was performed using the analysis of variance (ANOVA) test to find the significant difference in mean for the dissolution rate, compressive strengths, flexural strength, and color between the test materials and Scheffe's post hoc analysis.
Results
The specimen was separated into three groups of 37 for the current in vitro testing. Group I was made up of 37 samples having Zirconomer, group II was made up of 37 samples comprising Composite, and group III was made up of 37 samples containing Cention N. Following a thermocycling process, these samples were put through a number of tests in the lab to determine various physical characteristics such as compressive strength, flexural strength, discoloration, and dissolving rates (Table 1).
Table 1.
The mean, standard deviation, standard error, confidence interval, minimum and maximum values of dissolution rates of Zirconomer, Composite, and Cention N for preweight, postweight, and weight difference categories
| Dissolution rate | Group (I) | Group (J) | Mean difference (I–J) | Standard error | p-value |
|---|---|---|---|---|---|
| Preweight | Zirconomer | Composite | −0.0421676* | 0.0017951 | 0.000 |
| Cention N | −0.0095676* | 0.0017951 | 0.000 | ||
| Composite | Zirconomer | 0.0421676* | 0.0017951 | 0.000 | |
| Cention N | 0.0326000* | 0.0017951 | 0.000 | ||
| Cention N | Zirconomer | 0.0095676* | 0.0017951 | 0.000 | |
| Composite | −0.0326000* | 0.0017951 | 0.000 | ||
| Postweight | Zirconomer | Composite | −0.0493892* | 0.0015719 | 0.000 |
| Cention N | −0.0123162* | 0.0015719 | 0.000 | ||
| Composite | Zirconomer | 0.0493892* | 0.0015719 | 0.000 | |
| Cention N | 0.0370730* | 0.0015719 | 0.000 | ||
| Cention N | Zirconomer | 0.0123162* | 0.0015719 | 0.000 | |
| Composite | −0.0370730* | 0.0015719 | 0.000 | ||
| Weight different | Zirconomer | Composite | 0.0072432* | 0.0007935 | 0.000 |
| Cention N | 0.0022432* | 0.0007935 | 0.015 | ||
| Composite | Zirconomer | −0.0072432* | 0.0007935 | 0.000 | |
| Cention N | −0.0050000* | 0.0007935 | 0.000 | ||
| Cention N | Zirconomer | −0.0022432* | 0.0007935 | 0.015 | |
| Composite | 0.0050000* | 0.0007935 | 0.000 |
Table 1 shows the mean, standard deviation, standard error, confidence interval, and minimum and maximum values of dissolution rates of Zirconomer, Composite, and Cention N for preweight, postweight, and weight difference categories. The dissolution rates between Zirconomer, Composite, and Cention N based on pre and postweight have been highly significant (Table 2 and Fig. 1).
Table 2.
Post hoc test for dissolution rate
| Dissolution rate | N | Mean | Standard deviation | Standard error | |
|---|---|---|---|---|---|
| Preweight | Zirconomer | 37 | 0.1439 | 0.01204 | 0.00198 |
| 24 | 53 | 02 | |||
| Composite | 37 | 0.1860 | 0.00369 | 0.00060 | |
| 92 | 19 | 69 | |||
| Cention N | 37 | 0.1534 | 0.00448 | 0.00073 | |
| 92 | 56 | 74 | |||
| Total | 111 | 0.1611 | 0.01968 | 0.00186 | |
| 69 | 03 | 80 | |||
| Postweight | Zirconomer | 37 | 0.1329 | 0.01008 | 0.00165 |
| 35 | 91 | 86 | |||
| Composite | 37 | 0.1823 | 0.00401 | 0.00066 | |
| 24 | 44 | 00 | |||
| Cention N | 37 | 0.1452 | 0.00438 | 0.00072 | |
| 51 | 51 | 09 | |||
| Total | 111 | 0.1535 | 0.02212 | 0.00209 | |
| 04 | 43 | 99 | |||
| Weightdifference | Zirconomer | 37 | 0.0106 | 0.00509 | 0.00083 |
| 22 | 00 | 68 | |||
| Composite | 37 | 0.0033 | 0.00158 | 0.00026 | |
| 78 | 73 | 10 | |||
| Cention N | 37 | 0.0083 | 0.00255 | 0.00041 | |
| 78 | 33 | 98 | |||
| Total | 111 | 0.0074 | 0.00454 | 0.00043 | |
| 59 | 83 | 17 | |||
Fig. 1.
Dissolution rates of materials Zirconomer showing highest dissolution and Composite with least dissolution
Scheffe's post hoc analysis was carried out since the test materials differed significantly. Table 2 and Figure 1 give the dissolution rates of materials. Zirconomer showed the highest dissolution and the Composite with the least dissolution (Table 3).
Table 3.
Compressive strengths for Zirconomer, Composite, and Cention N
| N | Mean |
Standard
deviation |
Standard
error |
Confidence interval for the mean | Minimum | Maximum | |||
|---|---|---|---|---|---|---|---|---|---|
| Lotta bound | Upper bound | ||||||||
| Maximum force (N) | Zirconomer | 3 | S52.0S3 | 20.1436 | 3.3115 | 845.367 | 853.799 | 828.0 | 868.4 |
| 7 | 243 | 451 | 949 | 018 | 469 | 200 | 900 | ||
| Composite | 3 | 1472.46 | 486.537 | 79.986 | 1310.24 | 1634.68 | 828.0 | 2292 | |
| 7 | 8108 | 2130 | 2251 | 8525 | 7691 | 200 | 3200 | ||
| 3 | 1909.53 | 377.718 | 62.096 | 1783.59 | 2035.46 | 1546. | 2292 | ||
| 7 | 1622 | 1098 | 4747 | 4134 | 9110 | 8900 | 3200 | ||
| Total | 1 | 1411.36 | 560.572 | 53.207 | 1305.91 | 1516.80 | 828.0 | 2292 | |
| 1 | 0991 | 0646 | 1457 | 6917 | 5065 | 200 | 3200 | ||
| 1 | |||||||||
| Compressive stress at maximum force (Mna) | Zirconomer | 3 | 67.8046 | 1.60273 | 26349 | 67.1702 | 68.3390 | 65.89 | 69.11 |
| 7 | |||||||||
| Composite | 3 | 117.177 | 38.7198 | 6.3655 | 104.267 | 130.036 | 65.89 | 182.4 | |
| 7 | 0 | 6 | 1 | 2 | 9 | 2 | |||
| 3 | 151.958 | 30.0581 | 4.9415 | 141.936 | 161.930 | 123.1 | 182.4 | ||
| Total | 1 | 112.313 | 44.6112 | 4.2343 | 103.921 | 120.704 | 65.89 | 182.4 | |
| 1 | 3 | 1 | 1 | 9 | 7 | 2 | |||
| 1 | |||||||||
Table 3 depicts the compressive strength between the three test materials. The mean compressive strength of materials was 67.80, 117.17, and 151.96 MPa for Zirconomer, Composite, and Cention N, respectively. In the present study, the order of compressive strength was found to be Cention N > Composite > Zirconomer, which was highly significant. There was a very significant difference between the test materials (Table 4 and Fig. 2).
Table 4.
Post hoc tests for compressive strength
| Dependent variable | Group (I) | Group (J) | Mean | Standard error | Significance | 95% confidence interval | |
|---|---|---|---|---|---|---|---|
| Difference (I–J) | Lower bound | Upper bound | |||||
| Maximum force (Ν) | Zirconia | Composite | 82.72337 | 82.72337 45 | 0.00 | 816.973509 | 423.796221 |
| Cention N | 1057.4483784’ | 82.7233745 | 0.000 | 1254.037022 | 860.859734 | ||
| Composite | Ζirconia | 620.3843649* | 82.7233745 | 0.000 | 423.79622 1 | 816.973509 | |
| Cention N | 437.0635135’ | 82.7233745 | 0.000 | 633.652158 | 240.474869 | ||
| Cention N | Zircornia | 14057.4483784’ | 827233745 | 0.000 | 860.859734 | 1254.037022 | |
| Composite | 437.0635135’ | 827233745 | 0.000 | 240.474869 | 633.652158 | ||
| Compressive stress at | Zircoria | Composite | −49.37243’ | 6.58320 | 0.000 | −65.0171 | −33.7277 |
| Maximum force (Mpa) | Cention N | −84.15378’ | 6.58320 | 0.000 | −99.7985 | −68.5091 | |
| Composite | Ζirconia | 49.37243’ | 6.58320 | 0.000 | 33.7277 | 65.0171 | |
| Cention N | −34.78135’ | 6.58320 | 0.000 | −50.4261 | −19.1367 | ||
| Cention N | Zirconia | 84.15378’ | 6.58320 | 0.000 | 68.5091 | 99.7985 | |
| Composite | 34.78135’ | 6.58320 | 0.000 | 19.1367 | 50.4261 | ||
Fig. 2.
Graphical representation of compressive strength between Zirconomer, Composite, and Cention N
Scheffe's post hoc analysis was done (Table 4). Figure 2 gives a graphical representation of the compressive strength between the materials. The compressive strength of Cention N was highest, and that of Zirconomer was lowest (Table 5).
Table 5.
Flexural strength of Zirconomer, Composite, and Cention N
| Flexural strength | N | Mean | Standard deviation | Standard error | |
|---|---|---|---|---|---|
| Maximum force (N) | Zirconomer | 37 | 10.4870 | 7.41777 | 1.21947 |
| Composite | 37 | 21.9581 | 6.08800 | 1.00086 | |
| Cention N | 37 | 21.5189 | 6.43255 | 1.05750 | |
| Flexure displacement at Maximum force (mm) | Zirconomer | 37 | 0.3349 | 0.17021 | 0.02798 |
| Composite | 37 | 0.4714 | 0.18595 | 0.03057 | |
| Cention N | 37 | 0.6970 | 0.22704 | 0.03733 | |
Table 5 depicts the flexural strength between the three materials under study. The mean flexural strength was 0.4714, 0.6970, and 0.3349 MPa for Composite, Cention N, and Zirconomer, respectively. In the present study, the order of flexural strength was found to be Cention N > Composite > Zirconomer, which was highly significant (Table 6 and Fig. 3).
Table 6.
Post hoc tests for flexural strength
| Flexural strength | Group (I) | Group (J) | Mean difference (I–J) | Standard error | p-value |
|---|---|---|---|---|---|
| Maximum force (N) | Zirconomer | Composite | −11.47108* | 1.55073 | 0.000 |
| Cention N | −11.03189* | 1.55073 | 0.000 | ||
| Composite | Zirconomer | 11.47108* | 1.55073 | 0.000 | |
| Cention N | 0.43919 | 1.55073 | 0.957 | ||
| Cention N | Zirconomer | 11.03189* | 1.55073 | 0.000 | |
| Composite | −0.43919 | 1.55073 | 0.957 | ||
| Flexure displacement at maximum force (mm) | Zirconomer | Composite | −0.13649* | 0.04554 | 0.009 |
| Cention N | −0.36216* | 0.04554 | 0.000 | ||
| Composite | Zirconomer | 0.13649* | 0.04554 | 0.009 | |
| Cention N | −0.22568* | 0.04554 | 0.000 | ||
| Cention N | Zirconomer | 0.36216* | 0.04554 | 0.000 | |
| Composite | 0.22568* | 0.04554 | 0.000 |
Fig. 3.
Flexural strength for Zirconomer, Composite, and Cention N
The significant difference between the test materials was evaluated by Scheff's post hoc analysis (Table 6). Figure 3 shows the graphical representation of flexural strength between the materials. Cention N showed the highest flexural strength, and Zirconomer showed the lowest (Table 7).
Table 7.
The color stability between Cention N, Composite, and Zirconomer
| Dental material | N | Mean | Standard deviation | Standard error |
|---|---|---|---|---|
| Zirconomer | 37 | 4.238108 | 1.8194517 | 0.2991160 |
| Composite | 37 | 1.612703 | 1.2121415 | 0.1992748 |
| Cention N | 37 | 4.094595 | 1.1430262 | 0.1879123 |
Table 7 depicts the color stability between Cention N, Composite, and Zirconomer. The mean values for discoloration were 4.23, 4.09, and 1.61 for Zirconomer, Cention N, and Composite, respectively. In the present study, the order of discoloration rates was Composite < Cention N < Zirconomer and was very significant. Post hoc analysis by Scheff evaluated the significance of discoloration between the materials (Fig. 4).
Fig. 4.
The color stability between Cention N, Composite, and Zirconomer
Composite showed the highest color stability among the three materials, and Zirconomer showed the least color stability. The graphical representation of the color difference between the three materials is depicted in Figure 4.
Discussion
To replace amalgam, new technology in restorative materials has been created. For a novel restorative material to be recognized as a permanent restorative material, particularly in pediatric dentistry, it must possess physical and chemical qualities that are equal to or better than our gold standard conventional GIC. Alkasite Composite resin is a new category of Composite restorative materials with a urethane dimethacrylate (UDMA) basis. A patented filler known as isofiller, which is partially functionalized by silanes and functions as a spring by gently expanding when the stresses between the fillers grow during polymerization, is present in Cention N.
Zirconia fillers, which are unstable and can change phase from monoclinic to tetragonal, then cubic, and vice versa, are used in Zirconomer Improved to add volume and reduce volumetric shrinkage brought on by polymerization. In order to further stabilize zirconia, which is unstable, to begin with and remains so even after the addition of yttrium, aluminum is included as an impurity in the Zirconomer powder. Due to the presence of these alumina impurities at the edges of the zirconia, the transgranular fracture mode is increased, which means that any cracks brought on by internal stress or external masticatory load will only manifest at the transgranular structure of the zirconia filler's border. When under stress, zirconia transforms into a monoclinic shape, slightly expands, and stops cracks from spreading, making the structure stiffer. Zirconia has been used in GIC modifications to enhance the material's mechanical attributes.
The organic matrix, inorganic matrix, filler, and an organosilane or coupling agent to connect the filler to the organic resin are the three chemically distinct ingredients that make up dental composites. Composite resins with high filler content are known as condensable composites.
Water-sorbed dental materials increase the volume of the materials, which acts as a plasticizer and results in the deterioration of the resin matrix structure. The resin cross-linking, which is present in Composite, prevents the early dissolution of cement. Zirconomer, which is chemically set, does not have a resin matrix phase, which causes faster dissolution of the material. Cention N has an isofiller whose main action is to relieve stress. Due to the dual-cure property, Cention N is more hydrophobic, causing a lesser dissolution rate.12 In the present study, the dissolution rate was highest with Zirconomer and least with Composite. The liquid of Cention N has UDMA fillers which create rigid networks, causing the least absorption of water. The monomers that are not reacted are released, hampering the rigid matrix phase, which causes less absorption of water. The property of water sorption is associated with the chemical nature of cross-linkages present in cement. The higher the filler content of the Composite, the lesser the water sorption. In clinical scenarios, proper usage of bonding-containing coupling agents also contributes to cement's survival by adequate isolation technique. Generally, the ability of the material to dissolve in the solvent at a given temperature determines the solubility of the material. The degraded surface layer may involve leaching and cause further uptake of fluids. In the present study, the dissolution rate was found to be Zirconomer > Cention N > Composite, which was highly significant.
The mean compressive strength of Zirconomer, Composite, and Cention N in the present study was 67.80, 117.17, and 151.96 MPa, similar to Kaur et al.11 and Mishra et al.,13 who stated the compressive strength of Cention N to be 133.77 and 189.49 MPa, respectively. Also, the mean compressive strength follows Shivakumar et al.,14 who stated Zirconomer's compressive strength to be 29.47 MPa. In the present study, the order of compressive strength was Cention N > Composite > Zirconomer, which was highly significant and similar to the findings of Sujith et al.,15 where Cention N had higher compressive strength than Composite. Shettyet al.16 stated that Cention N had higher compressive strength than Zirconomer. Cention N has the highest compressive strength and is the most resistant to pressures produced in the oral cavity because it contains UDMA particles, which are less elastic and add stiffness to the monomer matrix. The cyclic aliphatic structure of aromatic UDMA promotes stability and mechanical toughness. Compressive strength characterizes the mechanical strength of cement and its ability to withstand occlusal load in a patient's oral environment. Cention N has calcium barium aluminum fluorosilicate glass. This inorganic matrix makes it sustain the heavy occlusal load.
The flexural strength in the present study was 0.471, 0.6970, and 0.3349 MPa for Composite, Cention N, and Zirconomer, respectively. The ANOVA test done between the materials was significantly similar to Chole et al.17, who stated that Cention N was found to have higher flexural strength than Composite. Flexural strength represents the ability to withstand bonding, stress-causing better material durability under masticatory conditions, which is more relevant in a pediatric clinical situation wherein the role of caries is influenced by multiple factors (host, environment, diet, and time). The higher strength of Cention N is due to 78.5% inorganic filler content compared to Composite, which contains 63.5%. UDMA, dicalcium phosphate, aromatic aliphatic UDMA, and polyethylene glycol- 400 dimethacrylate cross-links during polymerization result in a stronger mechanical strength to Cention N.
The Commission Internationale de l´Eclairage (CIE) 1976 L*a*b* color system was used to calculate the color stability between the test materials. Majeti et al.18 concluded that Cention N had more color variation than Composite after exposure to a staining solution. Kale et al.19 stated that zirconia-reinforced GIC was more color stable than Composite. In the present study, Composite was more color stable than Cention N and Zirconomer. The color stability in the present study was— Composite > Cention N > Zirconomer. In the present study, the change in color ΔE was more in Zirconomer (4.23), followed by Cention N (4.09) and Composite (1.61), respectively. Composite had the least color difference, hence better color stability. According to the guidelines of CIE, the color difference (ΔE) of 1 and below often goes unnoticed by human visual perception. A value between 1 and 3.3 can be appreciated on close observation by professionals. Any ΔE values >3.3 are often perceptible by nonskilled persons. The minimal color difference found in the Composite group can be attributed to the resin and filler components present in the materials. The present study contrasts with Kale et al.,19 who stated that the Composite has poor color stability. The present study follows Majeti et al.,18 who stated that Composite has better color stability than Cention N.
In the present study, it was found that Composite had the least dissolution rate, followed by Cention N and then Zirconomer. The highest to lowest compressive strength was in the order—Cention N, Composite, then Zirconomer. The highest to lowest flexural strength was in the order of Cention N, Composite, and Zirconomer. Color stability was found from maximum to minimum in the Composite, Cention N, and Zirconomer.
Every researcher must test new material that comes into the market. Whenever a new material replaces an existing material, it is important to test the manufacturer's claims. The dissolution rate implies how a restorative material functions in an oral environment. Mechanical properties like compressive strength and flexural strength denote the ability of the material to take occlusal loads. The esthetic component is tested by color stability using a spectrophotometer. Thus, we understand that the material property differs from the manufacturer's claims.
We can conclude that resin-based restorative materials perform better than glass ionomer-based Zirconomer cement.
Clinical Significance
In terms of therapeutic relevance, the values deduced from the study assist us in assessing the calibre of the information used in clinical practice. The study's materials were analyzed for their solubility, compressive strength, flexural strength, and color stability.
The following conclusions can be derived from the findings:
The highest solubility value in artificial saliva was seen with Zirconomer cement, while Composite resin cement and Cention N cement both absorbed less water and were less soluble than other forms of cement. The examined materials showed statistically significant differences.
The Cention N group outperforms the other two in terms of compressive strength—the compressive strength of Zirconomer is the lowest and Composite resin cement has the second-highest value; these differences are statistically significant.
Among the three groups examined, Cention N has the highest flexural strength; Composite is second, and Zirconomer has the lowest value. These differences are statistically significant.
Composite resin has the highest color stability, followed by Cention N, and the least values of color stability are seen in Zirconomer cement, and the differences are statistically significant.
Orcid
Daya Srinivasan https://orcid.org/0000-0001-5453-4380
Senthil Eagappan AR https://orcid.org/0000-0003-2933-6272
Footnotes
Source of support: Nil
Conflict of interest: None
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