Restor Dent Endod.  2024 Aug;49(3):e24. 10.5395/rde.2024.49.e24.

Alkasite restorative material for endodontically treated teeth: a randomized controlled pilot study

• Bepu DAN
• Scatolin RS
• Franco NSJ
• Sanchez LP
• Souza-Gabriel AE
• Corona SAM

• KMID: 2559737
• DOI: http://doi.org/10.5395/rde.2024.49.e24

Abstract

Objectives
This study aimed to evaluate the clinical performance of an alkasite restorative material in molars that had undergone root canal treatment.
Materials and Methods
The research was registered in Brazilian Registry of Clinical Trials. The randomized clinical trial involved 33 patients, each with at least 1 mandibular molar requiring restoration after receiving endodontic treatment. Patients were randomly assigned to receive either bulk-fill resin composite (Tetric N Ceram Bulk Fill, Ivoclar Vivadent) or the alkasite restorative material (Cention N, Ivoclar Vivadent). Upon completion of the restorations, 3 calibrated professionals utilized the United States Public Health Service criteria to assess various factors, including retention, secondary caries, marginal adaptation, restoration color, marginal pigmentation, and anatomical form. Evaluations were conducted at intervals of 7 days, 6 months, and 17 months. Additionally, the assessment encompassed the presence of radiolucent lines adjacent to the restoration, material deficiencies or excess, contact points, and caries recurrence. The data underwent analysis using the Friedman and Mann-Whitney tests (α = 0.05).
Results
After 17 months, the results revealed that the alkasite restorative material exhibited greater wear of anatomical shape compared to the bulk-fill resin composite (p = 0.0189). Furthermore, the alkasite restorative material significantly differed from the natural tooth color in most cases (p = 0.0000). However, no other criteria displayed significant differences between the materials or over time (p > 0.05).
Conclusions
The alkasite restorative material (Cention N) emerges as a viable option for restoring endodontically treated teeth, displaying clinically acceptable alterations after a 17-month evaluation period.

Keyword

Bioactive composite; Dental restoration; Root canal

Figure

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  Figure 1 Consolidated Standards of Reporting Trials diagram, form of recruitment, allocation, follow-up and analysis of research subject.

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  Figure 2 Restorations made with alkasite restorative material (Cention N, Ivoclar). The figures illustrate teeth at: (A) Initial condition; (B) Baseline (after polishing); (C) 6 months after restoration; (D) 17 months after the restoration; (E) Initial radiography; (F) Baseline radiography; (G) 6 months radiography; (H) 17 months radiography.

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  Figure 3 Restorations made with bulk-fill resin composite (Tetric N Ceram Bulk Fill, Ivoclar). The figures illustrate teeth at: (A) Initial condition; (B) Baseline (after polishing); (C) 6 months after restoration; (D) 17 months after the restoration; (E) Initial radiography; (F) Baseline radiography; (G) 6 months radiography; (H) 17 months radiography.

Reference

1. Lempel E, Lovász BV, Bihari E, Krajczár K, Jeges S, Tóth Á, et al. Long-term clinical evaluation of direct resin composite restorations in vital vs. endodontically treated posterior teeth - retrospective study up to 13 years. Dent Mater. 2019; 35:1308–1318. PMID: 31278018.

2. Yassen GH, Platt JA. The effect of nonsetting calcium hydroxide on root fracture and mechanical properties of radicular dentine: a systematic review. Int Endod J. 2013; 46:112–118. PMID: 22970899.

3. Koçak MM, Çırakoğlu NY, Koçak S, Sağlam BC, Çiçek E, Türker SA, et al. Effect of retreatment instruments on microcrack formation: a microcomputed tomography study. Int J Artif Organs. 2017; 40:123–127.

4. Lukarcanin J, Sadıkoğlu İS, Yaşa B, Türkün LŞ, Türkün M. Comparison of different restoration techniques for endodontically treated teeth. Int J Biomater. 2022; 2022:6643825. PMID: 35186088.

5. Angeletaki F, Gkogkos A, Papazoglou E, Kloukos D. Direct versus indirect inlay/onlay composite restorations in posterior teeth. A systematic review and meta-analysis. J Dent. 2016; 53:12–21. PMID: 27452342.

6. Veloso SR, Lemos CA, de Moraes SL, do Egito Vasconcelos BC, Pellizzer EP, de Melo Monteiro GQ. Clinical performance of bulk-fill and conventional resin composite restorations in posterior teeth: a systematic review and meta-analysis. Clin Oral Investig. 2019; 23:221–233.

7. Yazici AR, Kutuk ZB, Ergin E, Karahan S, Antonson SA. Six-year clinical evaluation of bulk-fill and nanofill resin composite restorations. Clin Oral Investig. 2022; 26:417–426.

8. Gomes de Araújo-Neto V, Sebold M, Fernandes de Castro E, Feitosa VP, Giannini M. Evaluation of physico-mechanical properties and filler particles characterization of conventional, bulk-fill, and bioactive resin-based composites. J Mech Behav Biomed Mater. 2021; 115:104288. PMID: 33383377.

9. Ballal NV, Jalan P, Rai N, Al-Haj Husain N, Özcan M. Evaluation of new alkasite based restorative material for restoring non-carious cervical lesions- randomized controlled clinical trial. Eur J Prosthodont Restor Dent. 2023; 31:72–77. PMID: 35659319.

10. Di Lauro A, Di Duca F, Montuori P, Dal Piva AM, Tribst JP, Borges AL, et al. Fluoride and calcium release from alkasite and glass ionomer restorative dental materials: in vitro study. J Funct Biomater. 2023; 14:109. PMID: 36826908.

11. Francois P, Fouquet V, Attal JP, Dursun E. Commercially available fluoride-releasing restorative materials: a review and a proposal for classification. Materials (Basel). 2020; 13:2313. PMID: 32443424.

12. Mazumdar P, Das A, Das UK. Comparative evaluation of microleakage of three different direct restorative materials (silver amalgam, glass ionomer cement, cention N), in class II restorations using stereomicroscope: an in vitro study. Indian J Dent Res. 2019; 30:277–281. PMID: 31169163.

13. Tiskaya M, Al-Eesa NA, Wong FS, Hill RG. Characterization of the bioactivity of two commercial composites. Dent Mater. 2019; 35:1757–1768. PMID: 31699444.

14. Kini A, Shetty S, Bhat R, Shetty P. Microleakage evaluation of an alkasite restorative material: an in vitro dye penetration study. J Contemp Dent Pract. 2019; 20:1315–1318. PMID: 31892684.

15. Panpisut P, Toneluck A. Monomer conversion, dimensional stability, biaxial flexural strength, and fluoride release of resin-based restorative material containing alkaline fillers. Dent Mater J. 2020; 39:608–615. PMID: 32037385.

16. Pai S, Naik N, Patil V, Kaur J, Awasti S, Nayak N. Evaluation and comparison of stress distribution in restored cervical lesions of mandibular premolars: three-dimensional finite element analysis. J Int Soc Prev Community Dent. 2019; 9:605–611. PMID: 32039081.

17. Sujith R, Yadav TG, Pitalia D, Babaji P, Apoorva K, Sharma A. Comparative evaluation of mechanical and microleakage properties of Cention-N, composite, and glass ionomer cement restorative materials. J Contemp Dent Pract. 2020; 21:691–695. PMID: 33025941.

18. Meshram P, Meshram V, Palve D, Patil S, Gade V, Raut A. Comparative evaluation of microleakage around class V cavities restored with alkasite restorative material with and without bonding agent and flowable composite resin: an in vitro study. Indian J Dent Res. 2019; 30:403–407. PMID: 31397416.

19. Cvar JF, Ryge G. Reprint of criteria for the clinical evaluation of dental restorative materials. 1971. Clin Oral Investig. 2005; 9:215–232.

20. Dias KR, de Andrade CB, Wait TT, Chamon R, Ammari MM, Soviero VM, et al. Efficacy of sealing occlusal caries with a flowable composite in primary molars: a 2-year randomized controlled clinical trial. J Dent. 2018; 74:49–55. PMID: 29800637.

21. Heintze SD, Zellweger G, Peschke A. Wear of an ion-releasing powder/liquid polymer resin in relation to that of glass-ionomer and conventional resin composites. Am J Dent. 2020; 33:171–177. PMID: 32794389.

22. Ruengrungsom C, Burrow MF, Parashos P, Palamara JE. Evaluation of F, Ca, and P release and microhardness of eleven ion-leaching restorative materials and the recharge efficacy using a new Ca/P containing fluoride varnish. J Dent. 2020; 102:103474. PMID: 32941973.

23. Firouzmandi M, Alavi AA, Jafarpour D, Sadatsharifee S. Fracture strength and marginal adaptation of conservative and extended MOD cavities restored with Cention N. Int J Dent. 2021; 2021:5599042. PMID: 34306083.

24. Sharma A, Das S, Thomas MS, Ginjupalli K. Evaluation of fracture resistance of endodontically treated premolars restored by alkasite cement compared to various core build-up materials. Saudi Endod J. 2019; 9:205–209.

25. Albelasy EH, Hamama HH, Chew HP, Montasser M, Mahmoud SH. Clinical performance of two ion-releasing bulk-fill composites in class I and class II restorations: a two-year evaluation. J Esthet Restor Dent. 2024; 36:723–736. PMID: 38174898.

26. Arora D, Jain M, Suma Sogi HP, Shahi P, Gupta I, Sandhu M. 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; 40:23–29. PMID: 35439879.

27. Sharma H, Suprabha BS, Shenoy R, Rao A, Kotian H. Clinical effectiveness of alkasite versus nanofilled resin composite in the restoration of occlusal carious lesions in permanent molar teeth of children: a randomized clinical trial. Eur Arch Paediatr Dent. 2023; 24:301–311. PMID: 36947344.

28. Oz FD, Meral E, Gurgan S. Clinical performance of an alkasite-based bioactive restorative in class II cavities: a randomized clinical trial. J Appl Oral Sci. 2023; 31:e20230025. PMID: 37377309.

29. Kurinji Amalavathy R, Sahoo HS, Shivanna S, Lingaraj J, Aravinthan S. Staining effect of various beverages on and surface nano-hardness of a resin coated and a non-coated fluoride releasing tooth-coloured restorative material: an in-vitro study. Heliyon. 2020; 6:e04345. PMID: 32637714.

30. Rai S, Kumari RA, Meena N. Comparative assessment of fluoride release and recharge through newer fluoride releasing posterior restorative materials: an in vitro study. J Conserv Dent. 2019; 22:544–547. PMID: 33088062.

31. Theerarath T, Sriarj W. An alkasite restorative material effectively remineralized artificial interproximal enamel caries in vitro . Clin Oral Investig. 2022; 26:4437–4445.