|Year : 2022 | Volume
| Issue : 3 | Page : 96-100
Gauging the upshot of liquid medicaments on surface roughness and stability of color in pit and fissure sealant – In vitro study
CH Chandana Krishna Shree, GK Pallavi Urs, HR Pooja, Andrea Natalia Mascarenhas, Anisha Jenny, Priya Nagar
Department of Paediatric and Preventive Dentistry, Krishnadevaraya College of Dental Sciences, Bengaluru, Karnataka, India
|Date of Submission||30-Jun-2022|
|Date of Decision||08-Aug-2022|
|Date of Acceptance||12-Aug-2022|
|Date of Web Publication||09-Sep-2022|
Dr. C H Chandana Krishna Shree
Department of Paediatric and Preventive Dentistry, Krishnadevaraya College of Dental Sciences, Hunasamaranahalli, International Airport Road, Bengaluru - 562 157, Karnataka
Source of Support: None, Conflict of Interest: None
Background: With esthetics in demand among pediatric patients, maintenance, color stability and surface roughness has become a vital tool to gauge the success of dental restorations. Aim: The aim of the study is to evaluate the effect of liquid medicaments on color stability and surface roughness of three different pit and fissure sealants. Materials and Methods: Twenty-seven premolars indicated for orthodontic extraction were selected and grouped based on sealants applied (n = 9) into three groups, namely PF Seal (PF), Conseal F (C), and Helioseal (H), which were subdivided into antibiotic, analgesic, and multivitamin based on medicament (n = 3). Selected sealant was placed on teeth, respectively, and immediate color stability and surface roughness (Ra) were gauged using Adobe Photoshop software and profilometer, respectively. Sealant-placed teeth were subjected to liquid formulations for 2 min for every 8 h duration. On 7th and 14th day, the color stability and Ra values were re-assessed. The analysis of outcomes was carried out using Statistical Package for the Social Sciences for Windows Version 22.0 Released 2013. Armonk, NY: IBM Corp. Results: Intergroup analysis showed that the color stability was better with Conseal F compared to PF seal and Helioseal F and the mean Ra values showed a significant increase from baseline to 14th-day measurement. Intragroup analysis revealed the highest surface roughness with antibiotic group compared to other medicaments. Conclusion: The prolonged use of liquid drug formulations such as analgesics, antibiotics, and multivitamins has shown to have a negative effect on the stability of color and surface roughness of the sealants.
Keywords: Color science, dental materials, digital dentistry, esthetics, fissure sealants
|How to cite this article:|
Chandana Krishna Shree C H, Pallavi Urs G K, Pooja H R, Mascarenhas AN, Jenny A, Nagar P. Gauging the upshot of liquid medicaments on surface roughness and stability of color in pit and fissure sealant – In vitro study. SRM J Res Dent Sci 2022;13:96-100
|How to cite this URL:|
Chandana Krishna Shree C H, Pallavi Urs G K, Pooja H R, Mascarenhas AN, Jenny A, Nagar P. Gauging the upshot of liquid medicaments on surface roughness and stability of color in pit and fissure sealant – In vitro study. SRM J Res Dent Sci [serial online] 2022 [cited 2023 May 28];13:96-100. Available from: https://www.srmjrds.in/text.asp?2022/13/3/96/355832
| Introduction|| |
In children, liquid drug formulations are usually given to ease intake. The presence of colored additives in liquid formulations is merely responsible for the color change of dental materials, whereas the presence of sugar concentration with increased acidity is responsible to its erosive and cariogenic properties. Staining of dental materials in the oral cavity exposed for a certain duration is noticed, and these negative effects could be caused either due to intrinsic and/or extrinsic factors.
In children as a part of preventive procedure, pit and fissure (PF) sealants are advocated in the teeth with deep grooves. It is for the first time that the three sealants, i.e., PF Seal, Conseal F, and Helioseal F, have been tested for color stability and surface roughness. The sealants chosen for the study are mainly considered as they are the most used sealants in pediatric dentistry. PF Seal is a light-cured sealant that contains amorphous calcium phosphate having excellent remineralizing properties. Helioseal F and Conseal F are considered the most preferred sealants with enhanced flowability, retentiveness, and increased stability due to addition of filler particles with the addition of fluoride-releasing properties. Most commonly used pediatric medications include analgesics, antibiotics, and multivitamin syrups which are obtained as over-the-counter medication. Hence, the present study aims to gauge the upshot of liquid medicaments on surface roughness and stability of color in sealants, such as PF seal, Conseal F, and Helioseal F.
| Materials and Methods|| |
This in vitro study was done after obtaining approval from the Krishnadevaraya College of Dental Sciences and Hospital Ethics Committee, June 6, 2022, KCDS/Ethical Comm/38/2022-23. All procedures performed in the study were conducted in accordance with the ethical standards given in 1964 Declaration of Helsinki, as revised in 2013.
The sample size has been estimated using the GPower software v. 126.96.36.199 (Franz Faul, Universität Kiel, Germany). Considering the effect size to be measured (f) at 57% (based on the results from previous literature by Guler et al., 2020), power of the study at 80%, and the alpha error at 10%, the sample size needed is 27. The samples in each category will be further divided into three samples to obtain triplicate readings for each of the medicaments used. Each study group comprises three samples (3 samples × 3 medicaments × 3 groups = 27 samples).
This in vitro study involves 27 premolars which were grouped into three subgroups based on PF sealant applied – Group 1: PF Seal (PREVESTDenPRO), Group 2: Helioseal F (Ivoclar Vivadent) (n = 9), and Group 3: Conseal F (SDI). Once the sealant is applied, the teeth were then stabilized using the wax for better handling and accessibility. Immediate color stability values (l*a*b value: signifies the measurement of colour at that particular point) were noted with a digital photograph (12 MP) [Figure 1]. To maintain the standardization of the digital image, photographs were captured in normal day light with the camera positioned 25 cm away from the tooth. Occlusal plane was aligned perpendicular and centered horizontally to the digital sensor. The image was taken with the tooth placed on nonreflecting background and then transferred to Adobe Photoshop CS5.1. Immediate surface roughness was estimated using contact profilometer [Figure 2], which was assessed in CMTI (National Accreditation Board for Testing and Calibrating Laboratories Accredited), Bengaluru, India. The tooth wax blocks were then immersed in respective containers containing the medicaments and then were subjected to respective pediatric liquid medications, which include Group A: antibiotic group (BLUMOX-CA Suspension), Group B: analgesic group (IBUGESIC PLUS Syrup), and Group C: multivitamin group (BECOSULE1S Syrup). Containers were then labeled as 1A, 2A, 3A, 1B, 2B, 3B, 1C, 2C, and 3C, respectively, based on sealant applied and medicament subjected.
|Figure 1: Assessment of color stability using Adobe Photoshop Software CS5.1|
Click here to view
The containers were manually agitated every 8 h daily for 2 min up to 1 week. For pediatric population, for longstanding or chronic cases of infections, analgesic and multivitamin syrups are continued for a long period of time, so the study was conducted for 2 weeks to know the severity of the effect of liquid medicament on dental sealants. In between the immersion periods, the tooth was stored in de-ionized water, which is commercially available. After 1 week, teeth were taken out of the formulations followed by distilled water rinse for 5 s. At this point, color values (l*a*b*) were obtained using digital camera and Adobe Photoshop. Then, the tooth was subjected to profilometer for estimating surface roughness. The teeth were then placed back into liquid formulations, and the same procedure was followed. On 14th day, the color values and surface roughness estimation were done. Then, the difference in color stability was calculated using the formulae.
ΔE[l*a*b*] = [(ΔL*)2 + (Δa*)2 + (Δb*)2]1/2
Where ΔL* is the difference between the L* values, Δa* is the difference between the a* values, and Δb* is the difference between the b* values.
Then, difference in surface roughness between 7th and 14th day was calculated, and statistical analysis was done.
The analysis of outcomes was carried out using Statistical Package for the Social Sciences (SPSS) for Windows Version 22.0 Released 2013. Armonk, NY, USA: IBM Corp., which is used to perform statistical analyses by a statistician who was also blinded. One-way ANOVA test followed by Tukey's post hoc test was used to compare the mean delta E1 to E3 values between (b/w) different sealants after being treated with various medications. Repeated measures of ANOVA test was used to compare the mean delta E values b/w different time intervals based on each sealant and medicament. The level of significance was set at P < 0.05.
| Results|| |
On intergroup analysis of color stability in different sealants, Conseal F subjected to any medicament showed significantly least Δ E1*, ΔE2*, and Δ E3* values followed by PF seal and Helioseal F with P < 0.05, which is statistically significant [Figure 3], [Figure 4], [Figure 5]. There was no statistically significant difference in Ra values observed between different sealants during the pretreatment period at P = 0.33 [Table 1]. When Ra values between different medicaments was compared irrespective of sealant applied, it revealed that multivitamin group showed the highest Ra values followed by analgesic and antibiotic group on day 7, while the same values on day 14 showed the highest Ra values with analgesic group followed by antibiotic and multivitamin group at P < 0.001 [Table 2].
|Figure 3: Mean delta E values between different time intervals based on each sealant for antibiotics|
Click here to view
|Figure 4: Mean delta E values between different time intervals based on each sealant for analgesics|
Click here to view
|Figure 5: Mean delta E values between different time intervals based on each sealant for multivitamin|
Click here to view
|Table 1: Comparison of mean surface roughness values between difference sealants during pretreatment period|
Click here to view
|Table 2: Comparison of mean surface roughness values between medicaments in each sealant group on day 7 and 14 using one-way ANOVA test followed by Tukey's post hoc test|
Click here to view
Comparison of mean surface roughness values between different medicaments in each sealant group on day 7 and 14 showed that multivitamin group in Conseal F has the highest mean surface roughness followed by analgesic group in PF seal and the least with antibiotic group in Conseal F on day 7 at P < 0.001, and on the contrary, analgesic group in PF seal showed the highest mean surface roughness followed by antibiotic group in Helioseal F and the least with antibiotic group in PF seal at P < 0.001 [Table 2].
Comparison of mean surface roughness value between different time intervals based on each sealant and medicament using repeated measures of ANOVA test followed by Bonferroni's post hoc test showed the highest mean surface roughness on day 14 which was gradual from pretreatment to 14th day at P < 0.001 for all the groups and P = 0.002 for analgesic group with Helioseal F sealant [Table 3].
|Table 3: Comparison of mean surface roughness values between different time intervals based on each sealant and medicament using repeated measures of ANOVA test followed by Bonferroni's post hoc test|
Click here to view
| Discussion|| |
Failure of PF sealants is mainly attributed to improper placement allowing salivary contamination. This may be attributed to lack of experience of the clinician, lack of patient cooperation, and inadequate amount of sealant material used. Failure of sealant over a period of time leads to leakage of bacteria underneath the sealant, leading to release of acids which erodes enamel. The color changes beneath the sealant were observed as brown or dark brown which grows over time assimilating into the pulp of the tooth causing pain needing pulp therapy.
Resistance to discoloration is the one of the main contributing factors to assess the acceptability of tooth-colored sealants. Color, outline, and surface texture of restorations are key factors that are assessed for characterizing a person's smile. Pediatric drug formulations contain sweetening agents along with the coloring additives to make it permissible to consumption. Exposure of these PF sealants to over-the-counter medications can lead to color changes and loss of surface texture which can determine the stability and success of the sealants placed. Therefore, color stability is one of the most important characteristics of esthetic dental materials, which is used to assess the esthetic success of restorations and is important to determine which ones are susceptible to color change.
There are no similar studies done to assess the surface roughness of PF sealants. However, the study by Kale et al., 2019 has shown that the effect of pediatric liquid medications on surface roughness of dental restorative materials was assessed and the results showed that among all tested materials, zirconomer improved showed the least surface changes compared to composite and glass ionomer cement. Various studies on viscosity of drugs have revealed that liquid medications have high viscosity which tend to retain on the surface of tooth for a longer period with slow salivary clearance rate, leading to enamel erosion.,
Color stability and physical properties are correlated for dental materials as restorations with high mean Ra values are predisposed to staining. Increased surface roughness also attracts plaque accumulation, leading to discoloration. The surface texture of any restoration also affects the color of the restoration which improves the esthetical appearance, as smooth surface tends to reflect greater amount of light than a rough surface.
In our present study, we observed that, among all sealants used, surface roughness was highest with Helioseal F followed by PF seal and least with Conseal F on day 7. PF seal showed the highest mean surface roughness followed by Helioseal F and least with Conseal F on day 14. Conseal F showed better color stability and surface texture stability with least mean surface roughness compared to other sealants. Probable reason could be its composition filled with a submicron filler size of 0.04 μ, which was especially made to withstand surface wear. They can also be correlated to the composition of the Conseal F having higher fillers compared to other sealants which aids in preventing absorption of colored substances from medicaments.
It is the responsibility of pediatric dental surgeon to preintimate or caution the patient about the possibility of staining of the sealant applied due to the liquid medications prescribed. An alternative should always be prescribed to decrease staining. In situations with no alternatives, precautionary recommendations should to be taken to decrease the staining and reduction in surface texture. It involves usage of pediatric formulations during mealtimes to avoid ingestion between them, maintenance of oral hygiene, mouth rinsing with water, chewing sugar-free gum after medication, and usage of topical fluoride agents. In addition to it, a dropper can be used for dispensing liquid medication to the child which can prevent the adherence of the medication to the tooth.
Further clinical studies are required to be done and evaluated as the present study was carried under in vitro condition. Various syrups most used in pediatric population for severe systemic diseases or mild use as cough suppressants or syrups for iron deficiency must be evaluated for its effect on various PF sealants available in the market.
| Conclusion|| |
Our study concluded that Conseal F is the preferred sealant followed by Helioseal F and PF seal, when the child is subjected to liquid medications considering its better color stability and least mean Ra values. Frequent exposure to pediatric drug formulations is directly related to its color stability and surface roughness of PF sealants.
Hence, it is very important for pediatric dentist to instruct patients regarding the alternatives to be used, recommendations to be followed post the PF sealant application.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Kale YJ, Nalwade AV, Dahake PT, Dadpe MV, Kendre SB. Effect of different paediatric drug formulations on color stability of composite, zirconia-reinforced glass ionomer cement, and glass ionomer cement. J Indian Soc Pedod Prev Dent 2019;37:151.
Babu KL, Rai K, Hedge AM. Pediatric liquid medicaments – Do they erode the teeth surface? An in vitro
study: Part I. J Clin Pediatr Dent 2008;32:189-94.
Anand D, Kumar GP, Anand DY, Sundar MK, Sharma R, Gaurav A. Shade selection: Spectrophotometer vs. digital camera – A comparative in-vitro
study. Ann Prosthod Restor Dent 2016;2:73-8.
Singh C, Kaur K, Kapoor K. Retention of pit and fissure sealant versus flowable composite: An in vivo
one-year comparative evaluation. J Indian Soc Pedod Prev Dent 2019;37:372-7.
] [Full text]
Babu KG, Doddamani GM, Naik LK, Jagadeesh KN. Paediatric liquid medicaments-are they cariogenic? An in vitro
study. J Int Soc Prev Community Dent 2014;4:108.
Tüzüner T, Turgut S, Baygin O, Yilmaz N, Tuna EB, Ozen B. Effects of different pediatric drugs on the color stability of various restorative materials applicable in pediatric dentistry. Biomed Res Int Epub 2017 Jan 10;1-5.
Guler EB, Bayrak GD, Unsal M, Kuvvetli SS. Effect of pediatric multivitamin syrups and effervescent tablets on the surface microhardness and roughness of restorative materials: An in vitro
study. J Dent Sci 2021;16:311-7.
Chakravarthy Y, Clarence S. The effect of red wine on colour stability of three different types of esthetic restorative materials: An in vitro
study. J Conserv Dent 2018;21:319-23.
] [Full text]
Sreedevi A, Brizuela M, Mohamed S. Pit and Fissure Sealants. 2021 Oct 1. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan. PMID: 28846293.
Bagheri R, Burrow MF, Tyas M. Influence of food-simulating solutions and surface finish on susceptibility to staining of aesthetic restorative materials. J Dent 2005;33:389-98.
Behroozian A, Aghazadeh Z, Sadrabad ZK, Aghazadeh M, Alizadeh V, Esmaili Z, et al
. Evaluation of the success rate of pit and fissure sealants on first molars: 12 months follow-up study. Int J Dent Hyg 2021;20:465-70.
Kazoullis S, Seow WK, Holcombe T, Newman B, Ford D. Common dental conditions associated with dental erosion in schoolchildren in Australia. Pediatr Dent 2007;29:33-9.
Valinoti AC, da Costa LC Jr., Farah A, de Sousa VP, Fonseca-Gonçalves A, Maia LC. Are pediatric antibiotic formulations potentials risk factors for dental caries and dental erosion? Open Dent J 2016;10:420-30.
Mundim FM, Garcia LF, Pires-De-Souza FC. Effect of staining solutions and repolishing on color stability of direct composites. J Appl Oral Sci 2010;18:249-54.
Bollen CM, Lambrechts P, Quirynen M. Comparison of surface roughness of oral hard materials to the threshold surface roughness for bacterial plaque retention: A review of the literature. Dent Mater 1997;13:258-69.
Costa CC, Almeida IC, Costa Filho LC. Erosive effect of an antihistamine-containing syrup on primary enamel and its reduction by fluoride dentifrice. Int J Paediatr Dent 2006;16:174-80.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
[Table 1], [Table 2], [Table 3]