Effect of food on compomer and glass-ionomer restorations … Dinakaran S Journal of International Oral Health 2015; 7(3):53-58

Received: 21st September 2014  Accepted: 27th December 2014  Conflicts of Interest: None Original Research
Source of Support: Nil

Evaluation of the Effect of Different Food Media on the Marginal Integrity of Class V
Compomer, Conventional and Resin-Modified Glass-Ionomer Restorations: An In Vitro Study
Shiji Dinakaran

Contributor: lesions are the presence of cementum or dentin in the gingival

Associate Professor, Department of Conservative Dentistry, margins. Hence, restorative materials that have good bonding
Government Dental College, Alappuzha, Kerala, India. to both enamel and cementum or dentin should be considered
Correspondence: for restoring such lesions. Since adhesive esthetic restorative
Dr. Dinakaran S. Department of Conservative Dentistry,
materials need minimal or no tooth preparation and have
Government Dental College, Alappuzha, Kerala, India. Phone:
+91-9895402488. Email: drshiji76@ymail.com
color matching with the remaining tooth structure, they are
How to cite the article: specifically indicated for the restoration of cervical lesions.
Dinakaran S. Evaluation of the effect of different food media on the Among them, glass-ionomer cements are more preferred by
marginal integrity of Class V compomer, conventional and resin- clinicians due to their chemical bonding ability and ease of
modified glass-ionomer restorations: An in vitro study. J Int Oral placement. In the long run, the various etiologies, locations,
Health 2015;7(3):53-58. and structural characteristics make cervical lesions more
Abstract: challenging to adhesive restorative procedures and marginal
Background: Cervical lesions of anterior and posterior teeth seal.1
are a common finding in routine dental practice. They are of
much concern to the patient, if present in esthetically sensitive Glass-ionomers are referred to as smart restorative materials as
regions. Adhesive tooth-colored restorative materials are generally
they not only release fluoride to the surrounding tooth structure,
recommended for treating such lesions. The aim of the present
but also have a semi-permeable surface that allows calcium and
study was to evaluate and compare the effect of various food media
(lime juice, tea, coffee, and Coca-Cola) on the marginal integrity phosphate ions present in saliva to pass through the material and
of Class V compomer (Dyract®), conventional glass-ionomer combine with the fluoride to produce remineralization of the
(Fuji II) and resin-modified glass-ionomer (Fuji II LC improved) enamel as a fluorapatite. Furthermore, it provides a high burst
restorations along their cemental and enamel margins with saline of fluoride for remineralization as well as prolonged fluoride
as control media. release over time.2 Conventional glass-ionomer cements are
Materials and Methods: After restoration of prepared Class V hydrolytically unstable in its early stages. They are highly
cavities in human premolars with the three different materials sensitive to water uptake and water loss for up to 24 h, during
(n = 8), they were immersed in the test media for 7 days and then which they have to be isolated from the oral environment with
stained with methylene blue dye. Buccolingual sections were
adequate surface protection.3 Fluoride released from glass-
prepared and examined under stereomicroscope and scores (0-2)
were given.
ionomers also has antimicrobial action against Streptococcus
Results: Data were analyzed statistically using one-way analysis of mutans in plaque.4 Resin-modified glass-ionomers have resin
variance in SPSS version 16.0. P < 0.05 were considered statistically component usually hydroxyethylmethacrylate grafted to the
significant. acidic liquid component resulting in a complex liquid that
Conclusions: Among the three tested materials Compomer maintains acid reactivity and activity to be light polymerized.5
(Dyract®) showed more marginal integrity than the other two. Micro The resin component improves setting characteristics, early
leakage values of Fuji II and Fuji II LC improved were statistically strength, and renders the set matrix less intolerant to the effect
significant in acidic media (lime juice and Coca-Cola) compared of moisture. Compomers contain the major ingredients of both
to saline. Enamel margins showed more marginal adaptation than composites (resin component) and glass-ionomer cements
cemental margins.
(poly alkenoate acid and glass filler component) except for
Key Words: Acidic media, cementum, conventional glass-ionomer, water.6 The dominant setting reaction in these materials is the
lime juice, titratable acidity resinous polymerization, and no acid-base reaction can occur
until later when the material absorbs water.5
Introduction
Non-carious cervical lesions can be of multifactorial origin Marginal ingress of oral fluids and bacteria can cause recurrent
such as erosion, abrasion, and abfractions. Whereas for cervical caries, sensitivity, marginal staining, pulpal pathology, and
carious lesions the etiology may be poor patient oral hygiene, failure of restorations. It is defined as the clinically undetectable
high sugar diet, endocrine disorders, and other conditions passage of bacteria, fluids, molecules or ions between the cavity
that reduce salivary flow. The special characteristics of cervical wall and the restorative material applied to it.7 Chemical factors

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Effect of food on compomer and glass-ionomer restorations … Dinakaran S Journal of International Oral Health 2015; 7(3):53-58

such as acids and components of the restorative materials are Dyract® was placed incrementally, and each layer was light
less significant in causing pulpal injury than bacterial leakage cured (Litex 680 A, Dentamerica) for 40 s. The restorations
along the restoration margins.8 Several factors influence the were finished with abrasive discs (Solf – Lex disks, 3M dental
micro leakage at the tooth restoration interface such as the products), and lightly air-dried and unfilled resin was applied,
nature of restorative material used, polymerization shrinkage, and light-cured. The teeth were then stored in distilled water
hygroscopic expansion, thermal and mechanical stress, and for 24 h.
dietary habits of the patient. The food consumed by an
individual can change the temperature of the oral environment Teeth in Group II were restored with Fuji II after conditioning
to a wide range. These factors may influence the properties of with 10% polyacrylic acid for 10 s. The restored surfaces were
the restorative material as well as the adhesion between tooth coated with GC Fuji varnish (GC Corporation, Tokyo) and
and restoration. Although several studies had been conducted stored in distilled water at room temperature for 24 h, followed
to determine micro-leakage of these three materials in Class V by final finishing with abrasive disks (Soft – Lex Disks, 3M
lesions, there is still controversy regarding which of these Dental Products) and varnish application. Teeth in Group III
materials is more suited for restoring cervical lesions in an acidic were restored using Fuji II LC improved after conditioning
environment, which is a major causative factor for such lesions. with 10% polyacrylic acid (GC Dentin Conditioner, GC
The present study was conducted to compare and evaluate the Corporation, Tokyo) for 10 s. The restoration was light-cured
micro leakage along the incisal and cervical margins of Class V for 20 s from the labial aspect and both mesial and distal
restoration of Dyract® (Compomer), Fuji II (Conventional aspects. Surface of the restoration was coated with GC Fuji
glass-ionomer) and Fuji II LC improved (Resin-modified varnish. The restored teeth were stored in distilled water at
glass-ionomer) immersed in common food beverages such as room temperature for 24 h. Final finishing was done after 24 h
tea, coffee, low PH carbonated drink (Coca-Cola), and lime using abrasive disks (Soft – Lex disks, 3M dental products)
juice with saline as control. under water spray and varnish applied. The composition of
the restorative materials tested is given in Table 1
Materials and Methods
One hundred and twenty freshly extracted human premolars The teeth in three groups were then thermo cycled for
for orthodontic purposes which were free of caries, erosion, 200 cycles ranging from 5 ± 5°C to 55 ± 5°C each with
abfraction or abrasion were selected for this study. They were dwell time of 30  s in thermocycling unit (LTC 100, LAM
thoroughly cleaned and stored in distilled water. Class V tooth technologies, Italy). After thermocycling, the apices of the
preparations were made on the buccal surface using no 330 teeth were sealed with sticky wax. The teeth in the three groups
tungsten carbide bur at high speed with air water coolant. (Group I, II and III) were subdivided into five subgroups (A,
Preparations were centered on the cementoenamel junctions B, C, D and E) of eight teeth each and were immersed in tea,
and were approximately 1.5 mm deep, 4 mm height, and coffee, Coca-Cola, lime juice, and saline respectively for 7 days.
3 mm width. 90° cavosurface angle was maintained at all cavity The media were freshly prepared and changed in every 24 h.
margins. The teeth were then randomly divided into three The test medium, tea was prepared by adding one teaspoon
groups (Group I, Group II, and Group III) with 40 teeth in tea dust to 160 ml of water. Lime juice was prepared by adding
each group. 5  ml of lime extract to 160  ml distilled water. Coffee was
prepared by adding one teaspoon coffee powder to 160 ml of
The teeth in Group I were acid etched with 37% phosphoric water. 0.9% saline (RUSOMA Laboratories, Indore, Madhya
acid gel (Fusion etch, Fusion dental products) for 30 s, followed Pradesh, India) and Coca-Cola (Coca-Cola Co, Kerala) were
by application of prime and Bond® NT and light-cured for 10 s. the other test media used. The pH of the immersion media

Table 1: Composition of the test materials.

Group Materials Powder: liquid Type of material Composition Manufacturer
ratio (g/g)
I Dyract® Compule Compomer UDMA resin, TCB resin, strontium‑fluoro – silicate glass, De Trey, Dentsply
Prime and Bond® Liquid Bonding agent strontium fluoride, photo initiators, stabilizers
NT Di and trimethacrylates resins, functionalized amorphous De Trey, Dentsply
silica, PENTA, photoinitiators stabilizers, cetylamine
hydrofluoride, acetone
II Fuji II 2.7:1 Conventional Powder‑fluoroalumino silicate glass GC Corp.; Tokyo, Japan
glass‑ionomer Liquid‑copolymer of acrylic and maleic acids polybase
carboxylic acid, water
III Fuji II LC 3:1 Resin‑modified Powder‑aluminosilicate glass, pigments GC Corp.; Tokyo, Japan
Improved glass‑ionomer Liquid‑polyacrylic acid, distilled water, HEMA (17%)
dimethacrylate monomer, camphoroquinone
UDMA: Urethane dimethacrylate, TCB: Carboxylic acid modified dimethacrylate, HEMA: Hydroxyethylmethacrylate, PENTA: Dipentaerythritol pentacrylate phosphoric acid ester

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Effect of food on compomer and glass-ionomer restorations … Dinakaran S Journal of International Oral Health 2015; 7(3):53-58

were detected using pH meter (pH probe, Mettler Toledo Discussion

International Inc.; India) and is given in Table 2. Adhesion to the walls of the tooth preparation is an important
property for any restorative material to prevent micro leakage.
After removing from the test media, the teeth were washed This bond should not be affected by environmental changes
and dried. All teeth surfaces except 1 mm wide zone around and functional stresses in the oral environment, in order to
the margins of each restoration were coated with a layer of prevent the development of secondary caries and further
fingernail varnish. The coated teeth were immersed for 4 hrs deterioration of tooth structure. So while considering a material
in 10% solution of methylene blue dye. After removal from for restoration, marginal integrity is an important concern.
the dye, the coatings were removed from the teeth and lightly With the desire for aesthetic dentistry and concern over the
pumiced to remove the superficial dye. Buccolingual sections
through the restoration were prepared by placing a grove on
the labial and palatal surfaces with diamond discs and the
teeth sectioned using chisel and mallet The sections were
then examined and photographed using stereomicroscope
(Olympus, Japan) at ×20 magnification. Scorings were given
for micro leakage ranging from 0 to 2 as given in table 3.

Results
The data obtained were analyzed statistically using one-
way analysis of variance using SPSS version 16.0 and is
summarized in Table 4. These data are presented graphically
in Graphs 1-3. Stereomicroscopic images at ×20 magnification
for various micro leakages are given in Figures 1-3. P < 0.05
were considered statistically significant and values <0.01 were Figure 1: Microleakage at tooth restoration interphase
statistically highly significant. showing score 0 leakage at enamel and score 1.5 leakage at
cemental margin.
Table 2: pH of immersion media.
Group Immersion media pH
A Tea 5.04
B Coffee 5.32
C Coca‑Cola 2.44
D Lime 3.79
E Saline 7.00

Table 3: Scoring system.

Score Description
0 No leakage cervically/incisally
0.5 Leakage half the length of incisal/cervical wall
1 Leakage extending along the full length of incisal/cervical wall
1.5 Leakage along the full length of cervical/incisal wall and extending
towards the incisal/cervical wall respectively occupying half the
length of this wall
2 Leakage along the full length of incisal and cervical wall and Figure 2: Microleakage at tooth restoration interphase
extending through the dentinal tubules into the pulp chamber showing score 2 leakage at both enamel and cemental margin.

Table 4: One‑way ANOVA comparing micro leakage scores of compomer, conventional, and resin‑modified glass‑ionomer restorations along incisal and
cervical margins in various media.
Margin Material Mean±SD F P
Tea Coffee Coca‑Cola Lime Saline
Incisal Dyract® 0.2500±0.3780b 0.1875±0.3720b 0.4375±0.4955b 0.5625±0.4955b 0.000±0.000a 2.850 <0.05
Fuji II 0.7500±0.4629a 0.8125±0.3720a 1.4375±0.6781b 1.5825±0.6781b 0.5000±0.5345a 5.486 <0.01
Fuji II LC improved 1.0000±0.4629b 0.8750±0.4432b 1.5000±0.5345c 1.8750±0.2315c 0.5000±0.5345a 9.233 <0.01
Cervical Dyract® 0.7500±0.5345b 0.7500±0.5345b 0.8750±0.4432b 1.0625±0.4173b 0.1250±0.3536a 4.657 <0.01
Fuji II 1.2500±0.4629a 1.2500±0.4629a 1.8750±0.2315b 2.000±0.000b 1.0625±0.1768a 13.757 <0.01
Fuji II LC improved 0.5000±0.5345a 0.5000±0.5345a 1.000±0.000b 1.3750±0.5825b 0.1250±0.3536a 11.284 <0.01
Mean with the same superscript do not very significantly (DMRT), ANOVA: Analysis of variance, DMRT: Duncan multiple range test, SD: Standard deviation

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Effect of food on compomer and glass-ionomer restorations … Dinakaran S Journal of International Oral Health 2015; 7(3):53-58

Figure 3: Microleakage at tooth restoration interphase Graph 3: Microleakage of resin-modified glass-ionomer

showing score 1 leakage at enamel and score 2 leakage at restorations along enamel and cemental margins in different
cemental margin. media.

varies from around 4-8.5 while the intake of acidic fruit juices
or alkaline medicament can extend this range from 2 to 11.

Commonly consumed soft drinks and fruit juices cause damage

to the teeth due to their low pH and high titratable acidity
leading to non-carious cervical tooth loss. The sugars in these
drinks are metabolized by plaque microorganism to generate
organic acids that bring about demineralization leading to
dental caries. In the oral cavity, both dissolution of elements
and erosion of the non-soluble components of the restorative
materials occur. Numerous factors such as low pH, acidic foods,
ionic composition, ionic strength of saliva, and enzymatic
attacks are important parameters which may influence the
quality and quantity of the substances released from a restorative
Graph 1: Microleakage of compomer restorations along material as well as its physical and mechanical properties.10
enamel and cemental margins in different media.
Micro leakage tests are the cheapest and fastest method to
evaluate the sealing ability of restorative materials.11 Drawbacks
associated with the test are it is hard to reproduce all the
challenges that a restoration face in the oral environment
through this in vitro method.12 Methylene blue dye was used for
this study as it has a solubility in water, low molecular weight,
no color changes during the test and lack of high transmission
of incident light. Moreover, it has no tendency for bonding to
teeth structure or restorative materials.12 The molecular size
of methylene blue is smaller than typical bacteria, and so it can
penetrate deeper than any other dye.

Saline with pH 7 was chosen as a control for this study

because of its natural condition and is usually the medium
Graph 2: Microleakage of conventional glass-ionomer used for dental materials studies. Thermocycling was done to
restorations along enamel and cemental margins in different simulate the temperature changes in the oral cavity. Variation
media in oral temperature can cause contraction and expansion of
both teeth and restorative material, and this may affect the
potential for mercury toxicity, tooth colored restorations adhesion between them because of the difference in coefficient
have gained popularity.9 The acidity or alkalinity of oral cavity of thermal expansion.

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Effect of food on compomer and glass-ionomer restorations … Dinakaran S Journal of International Oral Health 2015; 7(3):53-58

In the present study, the material Dyract® showed least micro components of prime and Bond NT help to dislodge moisture
leakage scores compared to Fuji II and Fuji II LC improved in from the conditioned dentin and attain an intimate interaction
all tested media and control group. No micro-leakage was seen at the demineralized intertubular and peritubular dentin,
along incisal margins for sub-Group IE. Only one specimen of creating hybrid layer essential for an ideal bond to dentin.14
sub-Group ID showed leakage score of 2 along cemental margin. Studies comparing Class V Dyract restorations on etched and
50% showed no leakage along the incisal margin for specimens nonetched human teeth have shown that etched specimens
in sub Group IC but only 25% showed no leakage along incisal demonstrated significantly less micro leakage compared to
margin in sub-Group ID, even though there was no statistically nonetched specimens.15
significant difference between these subgroups (ID and IC).
Peutzfeldt investigated the bond strengths of compomer and
For Group II, the scores were higher than that of Dyract® 50% glass-ionomer cements to dentin and found that the compomers
showed no leakage along incisal margin for the control group. bonded stronger than resin-modified and conventional glass-
87% showed leakage score 2 along incisal margin, and 100% ionomer materials.16 The results of the present study show
showed score 2 along cemental margins for specimens in similar finding. More leakage was observed in Group II
sub-Group IID. 75% showed leakage score 2 along incisal and compared to resin-modified glass-ionomer restorations in
cemental margins for restorations immersed in Coco-Cola. this study which is similar to the results in another study.17
But there was no statistically significant difference between In case of Fuji II LC improved, because of the slowness of
sub-Group IID and IIC. the acid-base reaction in the cement, polycid is available for a
longer period resulting in the formation of a stronger adhesive
In Group III, about 87% showed no leakage along incisal margin bond compared to Fuji II.17 The bonding mechanism of resin-
and 50% showed no cemental micro leakage among specimens modified and conventional glass-ionomers rely on the presence
in Group IIIE. 75% showed a score of 2 along cemental margin of calcium. Hence, the dentin or cementum margins of these
and 50% showed 1.5 score along incisal margin for restoration restorations show weak marginal adaptation and hence higher
in subgroup IIID. In IIIC 100% (all specimens) showed score 1 micro leakage.18 This may be the reason for the lower micro
along incisal margin and 50% showed score 2 and remaining leakage scores along enamel margins for both Group II and III
half showed score 1 along cemental margins. Here also, there in all test media and control, compared to cemental margins.
was no statistically significant difference between the sub-
Group IIIC and IIID. In tea and coffee the leakage scores were The acidic properties of acids are determined by the amount
more or less similar in all subgroups for the three materials. of acid available (titratable acidity) and the amount of acid
Among the tested materials, Fuji II had the greatest micro actually present (concentration of H+ ions).19 Type of acid,
leakage compared to the other two materials. In the case titratable acidity, buffering capacity, and temperature influence
of restorations of the three materials immersed in control the dental erosive capacity of acidic liquids.20 Carbonated
media, saline the P > 0.05 when the leakage scores of the three drinks get neutralized early despite having a lower pH than
materials were compared separately for incisal and cemental fruit drinks.21 In cola drinks, phosphoric acid is normally used
margins. but citric acid predominates in fruit juices and non-cola drinks.
Studies have shown that citric acid causes more erosion than
The single component system of Compomer (Dyract®) phosphoric acid.22 This could be the reason for more micro-
does not allow pockets of air to form in the material which leakage of all the three tested materials in lime juice compared
may occur in case of two-component systems that require to Coca-Cola. Frequent consumption of low pH beverages
mixing. This can be the reason for the less leakage of Group I showed erosion of the enamel in both in vivo and in vitro
compared to Group II and III in this study.13 Acid etching studies.23,24 It is quite possible that the higher micro leakage
with phosphoric acid produces micro retentions on enamel scores seen in low pH media in the present study can be due
that are then filled by fluid resin producing tags, resulting in to the restorative materials being removed along with the hard
adequate and long-lasting adhesion between the restorative tissues by these drinks.
material and the enamel. This may be the reason for the lower
micro leakage scores of compomer in enamel compared to The results of this in vitro study provides some insight
cemental margins for Group I in all the tested media and saline. concerning the performance of the three restorative materials,
Two different mechanisms are responsible for the formation which are widely accepted for restoring cervical lesions in the
of adhesive bonds to the cavity wall in case of Dyract®. Fifty oral environment. But this in vitro study has several limitations
percent of the reactive units of the TCB monomer in Dyract® since these restorations are prone to more kinds of stress in the
consist of hydrophilic carboxyl groups. These carboxyl groups oral cavity which are not tested in the present study and which
form ionic bonds with calcium ions of the tooth structure. may further deteriorate these restorative materials. Moreover,
Second mechanism is adhesion to the tooth surface through the entire variables faced by such restorations during in vivo
the primer/adhesive system.5 Incorporated hydrophilic performance cannot be included in this study.

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Effect of food on compomer and glass-ionomer restorations … Dinakaran S Journal of International Oral Health 2015; 7(3):53-58

Conclusion degradation in vivo. Dent Mater 1986;2(5):225-7.

Within the limitation of the present study, it can be concluded 11. Alani AH, Toh CG. Detection of microleakage around dental
that among the three restorative materials tested Dyract® was restorations: a review. Oper Dent 1997;22(4):173-85.
found to have better marginal adaptation to both cementum 12. Raskin A, D’Hoore W, Gonthier S, Degrange M, Déjou J.
and enamel followed by Fuji II LC improved and then Fuji II. Reliability of in vitro microleakage tests: a literature review.
The three materials showed better adaptation to enamel margin J Adhes Dent 2001;3(4):295-308.
than to cemental margins. Fruit juice (lime juice) was found 13. Cenci MS, Pereira-Cenci T, Donassollo TA, Sommer L,
to increase the micro leakage for all three materials followed Strapasson A, Demarco FF. Influence of thermal stress on
marginal integrity of restorative materials. J Appl Oral Sci
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2008;16(2):106-10.
no statistically significant difference noted between lime juice
14. Gladys S, Van Meerbeek B, Lambrechts P, Vanherle G.
and Coca-Cola immersion groups for three materials. Further Marginal adaptation and retention of a glass-ionomer,
clinical researches are needed to detect the influence of other resin-modified glass-ionomers and a polyacid-modified
types of stresses on these restorative materials. The results of resin composite in cervical Class-V lesions. Dent Mater
this study indicate that dietary counseling regarding reducing 1998;14(4):294-306.
the intake of acidic foods and drinks is essential along with 15. Kugel G, Perry RD, Hoang E, Hoang T, Ferrari M. Dyract
restorations, for managing cervical lesion and preventing new compomer: comparison of total etch vs. no etch technique.
occurrences of such lesions. Regular recall checkups are needed Gen Dent 1998;46(6):604-6.
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