COMPARATIVE EVALUATION OF SEALING

ABILITY OF ALKASITE RESTORATIVE

MATERIAL AND RESIN MODIFIED GLASS
IONOMER CEMENT IN PRIMARY MOLARS –
AN IN VIVO STUDY

DR SHAILANATHAN
1ST YEAR PG
 AUTHORS
M. P. Pooja,Y. M. Karuna , Arathi Rao , Ethel Suman, Srikant Natarajan , B. S. Suprabha
Department of Pediatric and Preventive Dentistry,
Manipal College of Dental Sciences, Mangalore, Manipal

Academy of Higher Education, Karnataka, India,

Department of Microbiology, KMC, Manipal
Academy of Higher Education,
Mangalore, Karnataka, India,

Department of Oral Pathology,

Manipal College of Dental
Sciences, Mangalore, Manipal
Academy of Higher Education,
Karnataka, India
 GLASS IONOMER CEMENT

 INTRODUCED BY WILSON AND KENT IN 1972

 COMPOSED OF CALCIUM ALUMINOFLUOROSILICATE GLASS AND

POLYACYLIC ACID

 ADHERES WITH TOOTH STRUCTURE WELL AND FORMS A TIGHT

SEAL WITH INTERNAL ENVIRONMENT

 BUT GIC HAD LACKED MECHANICAL RETENTION AND HENCE RESIN

MODIFIED GIC HAVE BEEN INTRODUCED

 PRODUCES FLUORIDE IONS WHICH INHIBITS DEMINERALISATION

AND PROMOTES REMINERALISATION
 ALKASITE RESTORATIVE MATERIAL ( CENTION N)
 IT HAS BEEN DEVELOPED WITH THE MAIN PURPOSE TO
REPLACE AMALGAM MATERIAL.

 IT IS A BULK- FILL MATERIAL AVAILABLE FOR BOTH DUAL- AND

SELF-CURE MODES PROMISING CHEMICAL AND PHYSICAL
PROPERTIES AS A DIRECT DENTAL MATERIAL.

 PREVIOUS RESULTS FOR MICROLEAKAGE, FLEXURAL

STRENGTH , SHEAR BOND STRENGTH , COMPRESSIVE
STRENGTH , AND MICROHARDNESS INDICATE THAT DIRECT
FILLING RESTORATIVE MATERIAL IS PROMISING.

 BASED ON ITS MECHANICAL AND OPTICAL PROPERTIES ADDED

TO ITS BIOACTIVE PROPERTIES OF ION RELEASE LIKE CALCIUM,
HYDROXYL, AND FLUORIDE

 IT IS INDICATED TO STABILIZE ORAL PH AND FORMAPATITE BY

REDUCING DEMINERALIZATION AND INDUCING DENTAL
 For any restoration to be successful, one of the criteria is good marginal sealing ability and
integrity.

 Maintenance of the marginal seal enhances the longevity of the restoration.

 Thus, the purpose of the present study was to comparatively evaluate the sealing ability of
Cention N and RMGIC.

 The null hypothesis was set as there is no significant difference in the sealing ability of
Cention N and RMGIC when used as restorative materials in primary molars.
 MATERIALS AND METHODS

 SPLIT MOUTH STUDY

 CONDUCTED AT DEPT OF PEDIATRIC AND PREVENTIVE

DENTISTRY

 GOT APPROVED FROM ETHICAL COMMITTEE

 PARENTS WERE INFORMED PRIOR AND OBTAINED

CONSENT.
 SAMPLE SIZE – 20

 AGE GROUP – 4-10 YEARS

 BILATERAL CLASS I OR CLASS II DEEP DENTINAL CARIES IN

PRIMARY MOLARS

 ICADS 6

EXCLUSION

 DEFINITELY NEGATIVE

 ON SYSTEMIC ANTIBIOTICS
CENTION N RMGIC
 PROCEDURE

SAMPLE
CARIES SOFT
OBTAINED
EXACAVATE CARIES
USING CAVITY
ISOLATED D AND REMOVED RESTORED
SMALL CLEANED
WITH CAVITY WITH WITH
PELLETE OF WITH
RUBBERDA MARGINS SPOON EITHER
COTTON WATER AND
M UNDER 2% REDEFINED EXCAVATOR RMGIC OR
ROLL OILFREE
LA WITH HIGH ( STEPWISE CENTION N
DIPPED IN AIR
SPEED EXCAVATION
PBS
HANDPIECE )
SOLUTION
 FOR CENTION RESTORATION
RESTORED WITH
DENTIN BONDING CENTION N AND
CAVITY
AGENT APPLIED LIGHT CURED
CONDITIONED
AND LIGHT FOR 30s WITH
FOR 10s
CURED FOR 20s LIGHT CURING
UNIT

FOR RMGIC RESTORATION

RESTORED WITH
CAVITY
RMGIC AND LIGHT
CONDITIONED FOR
CURED FOR 30s WITH
10s
LIGHT CURING UNIT
 PATIENTS RECALLED AFTER 6 WEEKS FOR CARIES REMOVAL

 DURING SECOND VISIT, THE RESTORATIONS WERE REMOVED

WITH TUNGSTINE CARBIDE BUR MOUNTED IN LOW SPEED
HANDPIECE WITH RUBBERDAM ISOLATION

 SAMPLES COLLECTED IN THE SAME METHOD

 CARIES REMOVED UNTIL HARD DENTINE AND RESTORED

USING SAME MATERIALS
 The collected cotton pellet was emulsified in 500 µL of PBS solution with a pH between
7.2 7.4. 0.01 ml of this solution was taken for bacterial counting using the surface plating
method
 These plates were incubated at 37°C for 24 h in a carbon dioxide incubator.
 The number of bacterial colonies was multiplied by the dilution factor and the numbers of
colonies were expressed in terms of CFU/ml
 RESULTS

 All data were analyzed using the SPSS (version 20.0) software package.
 The level of significance was set at 5% (P < 0.05).
 The mean colony counts and standard deviation for each group along with
differences between the groups and their P value are given in Table . \
 The pretreatment, posttreatment values, and the differences between the groups were
analyzed using paired t‑test.
 The pretreatment values were similar in Cention N and RMGIC group (P = 0.238)
 There was a significant fall in the post treatment values when compared to the
pretreatment values in both the groups (P < 0.001).
 The posttreatment drop in the colony count was more in the Cention
N group , however it was not statistically significant compared to the
RMGIC group (P = 0.056).
 Out of 20 patients included in the study, 6 patients had bilateral class
I cavities and 14 had bilateral class II cavities.
 The comparison of the sealing ability of Cention N and RMGIC used
for the restoration of class I and Class II cavities was done using an
independent t‑test .
 There was no statistically significant difference between the
subgroups, namely class I and class II (P = 0.479).
MEAN VALUE WITH STANDARD DEVIATION OF VARIOUS GROUPS
COMPARISION OF MICROLEAKAGE IN CLASS I AND CLASS II CAVITIES
 DISCUSSION
 Cention N is a tooth‑colored material used for direct restorations.
 It is self‑cured with additional light‑curing option.
 It is radiopaque and releases fluoride, calcium, and hydroxide ions.
 Fluoride helps in preventing enamel demineralization and enhances remineralization
 Restoration using Cention N can be done with or without the use of adhesives
 This property sets them apart from the conventional composite resin restorations
 A retentive cavity similar to that of amalgam filling is required if the restoration is being done
without the use of adhesives.
 In cases wherein adhesives are used, the cavity preparation can be kept to a minimum
following the principles of minimally invasive dentistry.
 In the present study, the restoration of the cavity with Cention N was done using adhesives.
 RMGIC was used in the present study as a control group, as it is one of the most preferred
restorative materials in children and has fluoride‑releasing property
 The sealing ability of a restorative material is its ability to prevent the passage of clinically undetectable
fluids, molecules, bacteria, or ions between the tooth and the restorative material.

 There are various methods used like radioactive isotopes, air pressure, neutron activation analysis, bacterial
activity, microcomputed tomography, dye method, and scanning electron microscope.

 In the present study, we used a microbiological method, in the form of estimation of total viable count
beneath the restoration to evaluate the sealing ability.

 This method was used as it allows to assess the microleakage under natural conditions, where the restoration
is subjected to the oral conditions and functions.

 There are very few studies in the literature, which evaluated the sealing ability of Cention N. The results of
the present study showed, Cention N has a comparable sealing ability to that of RMGIC. Although less number
of colonies were seen post restoration in the Cention N group than the RMGIC group, the difference was not
statistically significant.
 The present study was a split‑mouth trial and all the selected samples had bilaterally
either class I cavities or class II cavities.
 When subgroup analysis of the sealing ability of Cention N and RMGIC was done,
no significant difference was observed between class I and class II cavities.
 The inclusion of both class I and class II cavities, however, created a heterogeneity
in our study sample.
 Thus, future studies clinically evaluating the sealing ability of Cention N, which
includes homogenous sample are recommended.
 CONCLUSION

Within the limitations of the study, it concluded that both

Cention N and RMGIC have performed well in terms of
marginal leakage following restorations in primary molars.

CONFLICTS OF INTEREST

NIL
 CRITICAL APPRAISAL
TITLE – COMPLETED AND MEANINGFUL

AIM – EXPLAINED PROPERLY

STUDY SETTING – EXPLAINED

ABSTRACT – STRUCTURED

METHODOLODY – GIVEN

INCLUSION AND EXCLUSION CRITERIAS – GIVEN

STATISTICAL ANALYSIS – DONE

RESULTS – GIVEN

GIST OF WHOLE TEXT – WELL EXPLAINED

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11. Samanta S, Das UK, Mitra A. Comparison of microleakage in class V cavity restored with flowable
composite resin, glass ionomer cement and cention N. Imperial J Interdiscip Res 2017;3:180 ‑3.
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Clinical Performance of CentionTM Alkasite Restorative Material vs. Glass
Ionomer Cement Used in Deciduous Teeth: One-Year Evaluation Giacomo
Derchi , Vincenzo Marchio * , Maria Rita Giuca and Lisa Lardani - Appl. Sci.
2022, 12, 10845. https://doi.org/10.3390/app122110845

▪ Abstract: Conservative dentistry in primary dentition aims to remove and repair existing
carious lesions and to prevent secondary caries up until exfoliation of the primary tooth
happens, in order to maintain the important role in terms of the space maintenance and
guidance for eruption that deciduous teeth have. Many different materials are used, and some
of them, recently commercialized, show bioactive properties able to prevent secondary caries.
This trial’s primary focus is to evaluate the biological, functional, and aesthetic characteristics
of Cention-N alkasite material compared to glass ionomer cement (GIC) through the use of
standardized FDI criteria for direct restorations. A blinded, split-mouth study was designed for
this purpose, including 112 deciduous molars in 45 children showing class II caries restored
with either GIC or alkasite material. The data from this study indicates that the Cention-N
alkasite material showed equal performance compared with Fuji IX GIC after one year. A
thorough evaluation of exfoliated teeth restored with this material will provide long-term data
and an evaluation on infiltration rates.

▪ Conclusions Based on the results of this study, the Cention-N alkasite material showed no
differences in performance compared to Fuji IX GIC after one year of follow up. These
encouraging results provide an alternative choice to the use of glass ionomer cements.
 Evaluation and comparison of flexural strength of Cention N with resin-modified glass-ionomer
cement and composite - An in vitro study - J Conserv Dent. 2022 May-Jun;25(3):288-291.
Abstract
Aim: The aim of this study was to evaluate and compare the flexural strength of Cention N with resin-
modified glass-ionomer cement and nanohybrid composite.
Materials and methods: Samples were prepared by filling the stainless steel mold of dimension 2 mm × 2
mm × 25 mm with cement/composite immediately after mixing. Excess flash if any was removed by
abrading it with abrasive paper. Then, the specimens were subjected to flexural strength measurement using
universal testing machine. The results were then tabulated and statistically analyzed using one-way ANOVA
followed by Tukey's multiple post hoc test.
Results: The average flexural strength of NT Premium, Vitremer, and Cention N was 90.39 MPa, 46.59
MPa, and 62.88 MPa, respectively. There was a statistically significant difference between NT Premium and
Cention N and NT Premium and Vitremer with P = 0.0002 and 0.0001, respectively.
Significance: The flexural strength study can help us to choose a material for restoring Class V lesions and
can also confirm whether Cention N, a new material, be a definite replacement for amalgam.
Conclusion: Cention N has proved to be a better material and can be a replacement for amalgam and
GIC.
 In vivo evaluation of clinical performance of Cention N and glass ionomer cement in proximal
restorations of primary molars - J Indian Soc Pedod Prev Dent. 2022 Jan-Mar;40(1):23-29. 
Abstract
Introduction: Restoring a proximal lesion in primary tooth has met with many challenges which has led to
evolution of many materials. An alternative to Glass Ionomer Cements which has fluoride releasing capacity,
offers good bond strength and is esthetic have been long looked for.
Aim: This study aimed to compare the clinical performance of GIC and Cention N in proximal restorations of
primary molars.
Materials and methodology: A prospective study was conducted on 154 primary molars in patients aged
between 5 and 8 years using a split-mouth design. Patients were divided into two groups. Control group
restored with GIC and study group received Cention N. Both groups were assessed at baseline 3, 6 and 9
months according to Ryge criteria and data was statistically analysed using Fisher's Exact.
Results: Statistically significant difference was found between GIC and Cention N restorations for color match
at baseline and color stability at 3 months (P < 0.001), while the other parameters did not show any significant
difference among the two restorative materials.
Conclusion: Cention N can be used as a suitable alternative to GIC for restoring Class II restorations in
primary molars.
 Comparative Evaluation of Mechanical and Microleakage Properties of
Cention-N, Composite, and Glass Ionomer Cement Restorative Materials
- J Contemp Dent Pract 21.6 (2020): 691-5.

Aim: The longevity of restorative materials depends on the resistance to masticatory forces. The
present study was undertaken to evaluate the mechanical and microleakage properties of Cention-
N with glass ionomer cement (GIC) and composite restorative materials. Materials and methods: A
total of 45 specimen blocks were prepared with 15 samples of each type of restorative material,
namely Cention-N, GIC, and hybrid composite. Samples were subjected to load at crosshead speed
of 0.75 ± 0.25 mm/min till the fracture of sample. Class V cavities were prepared on the buccal
surface of orthodontically extracted premolars followed by restoration of each test material. All the
surfaces of the tooth were coated with clear nail varnish except 1 mm around the margins of the
restorations. These samples were immersed in 0.5% basic fuchsine dye and longitudinally
sectioned and observed under stereomicroscope to check microleakage. The obtained data were
statistically evaluated. Results: We found the highest mean compressive and flexural strength for
hybrid composite followed by Cention-N and least for GIC which is statistically significant (p <
0.001).
Conclusion: Mean microleakage was least for Cention-N. Cention-N is a newer restorative
material having higher mechanical properties with lesser microleakage.
A comparative evaluation of compressive strength of Cention N
with glass Ionomer cement: An in-vitro study - International Journal of
Applied Dental Sciences 2019; 5(1): 05-09

Abstract
Aim: The aim of the present study was to evaluate and compare the compressive strength of
Cention N with Glass Ionomer cement as a restorative material. Materials and Methods:
Customised cylindrical moulds of dimension 6±1mm (height) × 4±1mm (diameter) were used to
fabricate 10 samples each of Cention N (Ivoclar Vivadent) and Glass Ionomer Cement (GC IX High
strength Posterior restoration). Then, samples were tested for evaluation of compressive strength
using Universal Testing Machine (UTM). This was connected to a load measuring cell, which
continuously recorded the load applied to the samples at a crosshead speed of 0.75 ± 0.25 mm per
1 minute till the samples fractured. Results: The values were recorded and subjected to statistical
analysis for comparison of compressive strength (MPa) between the two materials using SPSS
software. In order to compare the means of two materials, Independent T-Test was used. The
results of the study showed that Cention N had high compressive strength than GIC Type IX.
Conclusion: Within the limitation of this study, it can be concluded that Cention N can be used
as a superior alternative to GIC Type IX for restoration of posterior teeth since its compressive
strength was found to be significantly higher. However, long term clinical studies are required
to draw any substantial conclusion.
 Comparative Evaluation of Adhesive Bond Strength of Conventional
GIC and Cention N to Enamel and Dentin of Primary Teeth: An In Vitro
Study - International Journal of Clinical Pediatric Dentistry (2022): 10.5005/jp-journals-10005-2410
Ab s t rac t Aim: The aim of this in vitro study was to evaluate and compare the adhesive bond
strength of conventional glass ionomer cement (GIC) and Cention N to the primary enamel and
dentin using an accelerated fatigue test. Materials and methods: A total of 30 sound human
primary molars were collected and were mounted on a metal cylindrical block using acrylic resin,
embedding the root up to cemento-enamel junction (CEJ). Proximal box was prepared on both
mesial and distal surfaces, one of the cavity was restored with GIC (Type 9) and the other
proximal cavity with Cention N. A nonretentive cavity design was followed for both the materials
so as to maintain the uniformity between the two specimens were then placed under a universal
testing machine (Instron) and subjected to accelerated cyclic loads till a separation fracture
occurs at the tooth-restoration interface. The number of endured cycles a particular restoration
could withstand before getting fractured was registered. Results: Cention N resisted significantly
more number of endured cycles before separation from the cavity as compared to GIC
Conclusion: Within the limitations of the study, it can be concluded that newly developed
material Cention N is preferred alternative over conventional GIC for the restoration of
proximal cavities in primary molars