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| REVIEW ARTICLE |
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| Year : 2022 | Volume
: 12
| Issue : 2 | Page : 54-57 |
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Introduction of alkasite restorative in pediatric dentistry: Will it perish or purge?
Sampada Kaul, Sakshi Rawal, Vedant Kansal
Department of Pediatric and Preventive Dentistry, Subharti Dental College and Hospital, Swami Vivekananda Subharti University, Meerut, Uttar Pradesh, India
| Date of Submission | 20-Sep-2022 |
| Date of Acceptance | 07-Oct-2022 |
| Date of Web Publication | 19-Dec-2022 |
Correspondence Address:
Dr. Sampada Kaul
33 G C/C Gandhi Nagar, Jammu - 180 004, Jammu and Kashmir
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/ijohs.ijohs_23_22
Pedodontists have long sought after a real alternative to basic filling materials, namely amalgam or glass ionomer cements – a cost-effective, fluoride-releasing product that is quick and easy to use without complicated equipment that offers both strength and good esthetics. The use of alkasite material (Cention N) in the clinical field of pediatric dentistry is still in its experimental stages with not much literature available regarding its use. This review article provides insight related to the clinical significance and future of this material in our field.
Keywords: Adhesive material, alkasite material, cention N, esthetic restorative material, pediatric restorative dentistry
How to cite this article:
Kaul S, Rawal S, Kansal V. Introduction of alkasite restorative in pediatric dentistry: Will it perish or purge?. Int J Oral Health Sci 2022;12:54-7 |
| Introduction | |  |
Dental caries, although largely preventable remains one of the biggest threats to oral health and is among the most common chronic diseases in children.[1] Data from the National Health and Nutrition Examination Survey showed that 42% of children aged 2–11 years have had dental caries in their primary teeth. The survey also estimated that 23% of children aged 2–11 years have untreated dental caries.[2] These figures suggest the need for pedodontists, to deliver readily accessible caries treatment, and to perform it in an effective and economical way. Furthermore, the treatment provided should be suitable for the unique emotional and behavioral factors associated with children.
Since ancient times, pediatric dentists, while providing restorative therapy, have typically chosen from a limited set of options, namely stainless steel crowns and amalgam restorations. Although properties such as ease of manipulation, durability, relatively low cost, reduced technique sensitivity, and full coronal coverage were responsible for their immense popularity, the fact that they are highly unesthetic has been the biggest drawback.[3],[4] In the modern era, the general public has become quite self-aware, where even the pediatric population with age as less as 3 years now want to look even better and are thus focused on esthetics.[5]
Pediatric dentists thus place a high priority on products and treatments that are esthetic, efficient, and predictable. The ideal treatment should proceed as swiftly as possible while also providing results that last long and are unlikely to require retreatment. This is not only important for providing quality care but also for establishing trust among the young patients and help them to feel comfortable in the dental chair.
| Alkasite and its Clinical Significance | | |
Despite having many good physical properties, the major shortcomings of composite resin materials include polymerization shrinkage resulting in marginal microleakage, postoperative sensitivity, and secondary caries.[6] The reason why composites like bulk fill composites are considered superior to the conventional packable composite versions are due to increased wear resistance, low polymerization shrinkage, and improved depth of cure. Moreover, filling a cavity in bulk provides additional benefits such as minimized air void entrapment, reduced restorative procedure time, and improved quality of the final restoration.[7]
Cention N (Ivoclar, Vivadent) is a recently introduced material that can be used for bulk placement in retentive preparations with or without the application of an adhesive.[8] It is an “Alkasite” restorative, that refers to a new category of filling material, which like compomer or ormocer materials is essentially a subgroup of the composite material class. This new category utilizes a patented alkasite filler that is capable of releasing acid-neutralizing ions. It is a urethane dimethacrylate (UDMA)-based radiopaque, self-curing filling material with light-curing option, which releases fluoride, calcium, and hydroxide ions. These hydroxide ions regulate the pH value during acid attacks. As a result, demineralization can be prevented. Moreover, the release of large numbers of fluoride and calcium ions forms a sound basis for the remineralization of dental enamel. Cention N can be optionally cured with light in the wavelength range of 400–500 nm. It is intended to be manually mixed and is available in the shade A2.[9] Some of its indications and contraindications are discussed in [Table 1].
Side effects
In rare cases, ingredients of Cention N may cause a sensitizing reaction. The product must not be used in such cases. To avoid possible irritation of the pulp, areas close to the pulp should be protected with a suitable pulp/dentin protector (selectively apply a calcium hydroxide-based preparation in areas close to the pulp and cover it with a suitable cavity liner if necessary). Children may also complain of the unpleasant taste of the material during the use. Furthermore, Cention N restorations may also undergo discoloration when combined with cationic mouthwashes, plaque disclosing agents, and chlorhexidine.
| Discussion | | |
Cention N is intended for restoring deciduous teeth as well as for permanent restorations of a Class I, II, or V nature. When used without an adhesive, no etching with phosphoric acid is carried out. Cention N can be used with or without an adhesive. If without, then retentive preparation (for example, undercuts) similar to that used with amalgam restoration is required and enamel margins should not be bevelled. When used along with an adhesive, then the cavity is prepared according to the modern principles of minimally invasive dentistry, i.e., by preserving as much natural tooth structure as possible.
The resin/monomer matrix of Cention N is present in the “LIQUID” and is made up of four different dimethacrylates which represent 21.6% wt. of the final mixed material. A combination of UDMA, DCP (dimethanol dimethacrylate), an aromatic aliphatic-UDMA and PEG-400 DMA (polyethylene glycol 400 dimethacrylate), cross-links during polymerization resulting in strong mechanical properties and good long-term stability. Cention N does not contain Bis-GMA, HEMA, or TEGDMA.
Due to the sole use of cross-linking methacrylate monomers in combination with a stable, efficient self-cure initiator, Cention N exhibits a high polymer network density and degree of polymerization over the complete depth of the restoration. This is a good basis for long lasting restorations.
The filler composition of Cention N is present in its “POWDER.” The various fillers contained in Cention N and their respective function are tabulated in [Table 2]. | Table 2: Filler particles of Cention N along with their respective function
Click here to view |
Once mixed (Powder: Liquid 4.6:1 parts by weight, which corresponds to 1 measuring scoop of Powder +1 drop of Liquid) - Cention N contains 78.4 wt%, or 57.6 vol% of inorganic fillers. The particle size of the inorganic fillers is generally 0.1 μm.
The presence of the special patented filler, namely Isofiller in Cention N acts as a shrinkage stress reliever, and due to its low elastic modulus, this shrinkage stress reliever within Cention N reduces polymerization shrinkage and microleakage.[10]
Cention N is a relatively translucent material (transparency 11%) as compared to other glass ionomer-based products.
Mazumdar et al. compared the shear bond strength of Cention N with hybrid composite and glass ionomer cement to dentine which revealed that Cention N displays the highest.[11]
Mazumdar et al. designed a study to evaluate the bond strength of composite resin (nanohybrid) and Cention N to enamel and dentin with and without etching (in permanent molars) and came to a conclusion that Cention N displays a higher bond strength value when compared to composite resin. Furthermore, when etching was taken into consideration, etched samples showed better bond strength as compared to the nonetched ones.[11] On the contrary, studies by Koliniotou-Koumpia et al. and Sampaio et al. revealed no significant difference of bond strength between nanohybrid composite and bulk fill composite on etching.[12],[13]
One of the goals of restorative dentistry is to create a biocompatible restoration that maintains a proper marginal seal without damaging the pulp. Microleakage can cause hypersensitivity, secondary caries, pulpal pathosis, and restorative failure.[14] Hence, microleakage is a crucial feature which evaluates the success of any restorative material. In a different study conducted by Samanta S et al.[9] to compare and evaluate the microleakage in permanent class V cavity filled with flowable composite resin, glass ionomer cement and Cention N using dye penetration, it was seen that flowable composite exhibited the highest micro leakage followed by glass ionomer while Cention N displayed the least microleakage. However, when Punathil et al.[15] conducted a similar study, but on primary molars, it was seen that significantly less microleakage was associated with the nano-filled resin-modified glass ionomers when compared to nanocomposite resin and Cention N.
Studies evaluating the fluoride release potential of Cention N have shown self-cured Cention-N has the highest fluoride ion release and alkalizing potential in acidic pH as compared to light cured Cention-N and conventional GIC.[16]
Studies comparing the mechanical properties of Cention N versus other conventionally used restorative materials have revealed promising results in favor of the former. For instance, in a study designed by Chole et al.[17] comparing the flexural strength of Cention-N, bulk fill composites, light-cure nanocomposites, and resin-modified glass ionomer cement, it was seen that Cention-N showed highest flexural strength followed by bulk-fill composites, light cure nanocomposites, and least flexural strength is shown by resin-modified glass ionomer cement. However, this study was conducted under ideal laboratory conditions which could be a reason why converse results were seen in a study conducted by Mishra et al.[18] in the same year where composite showed the highest compressive and flexural strength when compared to Cention N, GIC, and amalgam. However, compressive strength of Cention N was considered to be comparable to that of amalgam but definitely higher than GIC while its flexural strength was higher than the both basic filling materials [Figure 1]. | Figure 1: Comparison of compressive and flexural strength between different restorative materials[18]
Click here to view |
| Conclusion | | |
Although similar to convention amalgam and GIC in bulk placement, Cention N (whether used with or without an adhesive) holds several advantages over them in terms of better mechanical properties (compressive and flexural strength), durability, esthetics, ion-releasing capability, and patient acceptability. Thus, this new and improved alkasite filling material could meet the needs of both the child and the pediatric dentist. Extensive research of this material in primary dentition is however suggested as this could prove to be a good alternative to the conventional pediatric restorative materials.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
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| 11. | Mazumdar P, Das A, Mandal D. Comparative evaluation of bond strength of composite resin & Cention-N to enamel and dentin with and without etching under universal testing machine. Univ J Dent Sci. 2018;4:1-6. |
| 12. | Koliniotou-Koumpia E, Kouros P, Dionysopoulos D, Zafiriadis L. Bonding strength of silorane-based composite to Er-YAG laser prepared dentin. Lasers Med Sci 2015;30:509-16. |
| 13. | Sampaio RK, Wang L, Carvalho RV, Garcia EJ, Andrade AM, Klein-Júnior CA, et al. Six-month evaluation of a resin/dentin interface created by methacrylate and silorane-based materials. J Appl Oral Sci 2013;21:80-4. |
| 14. | Venugopal K, Krishnaprasad L, Prabath Singh VP, Ravi AB, Haridas K, Soman D. A Comparative evaluation of microleakage between resin-modified glass ionomer, flowable composite, and cention-N in class V restorations: A confocal laser scanning microscope study. J Pharm Bioallied Sci 2021;13 Suppl 1:S132-6. |
| 15. | Punathil S, Almalki SA, AlJameel AH, Gowdar IM, Vijay Amarnath MC, Chinnari K. Assessment of microleakage using dye penetration method in primary teeth restored with tooth-colored materials: An in vitro study. J Contemp Dent Pract 2019;20:778-82. |
| 16. | Gupta N, Jaiswal S, Nikhil V, Gupta S, Jha P, Bansal P. Comparison of fluoride ion release and alkalizing potential of a new bulk-fill alkasite. J Conserv Dent 2019;22:296-9. [ PUBMED] [Full text] |
| 17. | Chole D, Shah HK, Kundoor S, Bakle S, Gandhi N, Hatte N. In vitro comparison of flexural strength of cention-n, bulkFill composites, light-cure nanocomposites and resin-modified glass ionomer cement. J Dent Med Sci 2018;17:79â. |
| 18. | Mishra A, Singh G, Singh S, Agarwal M, Qureshi R, Khurana N. Comparative evaluation of mechanical properties of cention N with conventionally used restorative materials – An in vitro study. Int J Prosthodont Restor Dent 2018;8:120-4. |
[Figure 1]
[Table 1], [Table 2]
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