Dehydration of dentin by some restorative materials

Gunilla Johnson, D.D.S.,* and Martin Briinnstram, Dr. Odont.**

Karolinska Institutet, School of Dentistry, Stockholm, Sweden

lh e c h emical and physical properties of restorative materials may affect the

dentin and pulp in various ways. Some restorative materials, among them silicate
and zinc oxide and eugenol cements, are hygroscopic and may dehydrate dentin,
thus producing a centrifugal flow of fluid in the dentinal tubules. A marked loss
of liquid might elicit pain and aspiration of cells.
This study was undertaken to determine if dehydration of dentin is caused by
some restorative materials and if insulators inhibit the dehydration. So far as tve
are aware, no reports have been made on these subjects.

MATERIALS AND METHOD

The investigation was performed on sound premolar and cuspid teeth of young
individuals; these teeth had been extracted for orthodontic reasons. The teeth were
maintained in isotonic saline solution and were refrigerated until needed. Pilot
studies showed no significant difference in the movement of fluid for teeth stored
for periods up to 3 weeks. The technique was based on an earlier investigation of
the movement of the fluid produced in the dentin and pulp. The direction, magni-
tude, and rate of flow were studied by the movement of a column of isotonic saline
solution in a capillary tube attached to the tooth root (Fig. 1) .I
A cylindrical Class V cavity, prepared at a conventional speed under a water
coolant, provided a preparation 2 to 2.5 mm. deep and 2 mm. in diameter. The cavity
preparation was irrigated and scrubbed with cotton pellets, after which a pellet
moistened with isotonic saline solution was inserted into the cavity to prevent desic-
cation. A polyvinyl tube, ligated to the root, connected the tooth to a capillary tube
0.3 mm. in inner diameter and graduated in millimeters. The tubes were filled xi-ith
normal saline solution and were then coated with polyamide lacquer, inlay casting
wax, and aluminum foil to prevent dehydration. The entire assembly was then em-
bedded in plaster of Paris to prevent movement of the parts. The experiment \vas
not begun until the level of liquid in the capillary tube remained constant for 15
minutes, at which time the system was considered stable.

*Department of Conservative Dentistry.

**Department of Dental Histopathology.
307
Fig. 1. Mounting of the test tooth. A hygroscopic filling material (1) gives rise to a centrifllgai
flow in the dentinal tubules (2) and can be recorded as a pulpward movement of the mrniscu~
in the capillary tube (.?). A ccntripetal flow has the opposite effect.

Part I. The dehydrating effect o/ some restorative materials on delrtin. ‘l‘his

experiment was conducted on 68 teeth which were restored as follows:
Zinc oxide and rugenol ccnlcnt 15 teeth
Silicate cement (Super-Syntrcx) * 16 teeth
Cold-curing acrylic resin (Sevriton ) -%- 18 teeth
Temporary dressing (Cavit) + 6 teeth
Polycarboxylate cement (Durclon) $ 6 teeth
Composite resin (Adaptic) $ 7 ted1
The zinc oxide and eugenol and silicate cerncnts were mixed ernployirlg routines
procedures; other materials were prepared according to the manufacturrrs’ instruc,-
tions. Each cavity preparation was filled twice, once with the test material and cm-c
wi;lth a hydrophobic control material, Plastellina and;‘or petroleum jelly. It was l)r(*-
sumed that these would not alter the liquid in the dentin.
The test and control restorations were placed at random in each tooth. Aftc>l
insertion, the level of the meniscus in the liquid column was recorded at intervals
of 1 to 5 minutes at firsl: and at 10 minutes toward the end of the 90 minllte es-
periment. If the test material was inserted first, it was excavated at the end of thcx
experiment with revolving instruments with water cooling. The cavity was then filled
with isotonic saline solution, and after the system stabilized itself for 1.5 minutes, thr,
cavity was dried and filled with petroleum jelly. When the control material preceded
the restorative material, Plastellina covered with petroleum jelly was used, because it
was easily removed with :L probe. The cavity lvas then restored with the lest ln;i-
t&al for experimentation.
-411 cavities were dried with a 5 second blast of air before the test or control
material was inserted. The exception was Durelon wjtli& should be inserted into :I
moist cavity. All materials were inserted to excess and gently compressed undrr :t
matrix to insure contact between the material and dentin. The restorations \vfxrc
coated with petroleum jelly and were kept moist with wet absorbent cotton to
minimize leakage between the restoration and cavity walls.
Part 11. The effect of some insulating naaterials on dehydration by silicate cc-
me?zf. In this part of the study, silicate cement was the restorative material. Eacll

‘Gebr. De Trey, A. G., Zurich.

fESPE, GmbH., Seefeld, Oberbay.
ZJohnson & Johnson, New Brunswick, N. J
Volume 26 Dehydration of dentin by restorative materials 309
Number 3

Table I. The dehydrating effect of 6 restorative materials on dentin manifested by

displacement* of the column in the capillary tube
Displacement of water column (mm.)
30 Min.
5 Min. I ,1 60 Min.
Filling material MeLLIZ S.E. Mean S.E. Mean / S.E.
Cavit 3.7 0.6 8.0 0.9 10.7 1.2
Silirate cement (Super-Syntrex) 2.2 0.3 4.8 0.3 6.0 0.5
Zinc oxide and eugenol cement 0.3 0.1 3.0 0.3 4.5 0.5
Adaptic 0 0 2.9 0.3 4.1 0.5
Sevriton 0.5 0.1 2.2 0.1 3.1 0.2
Durelon 1.3 0.3 2.0 0.3 2.5 0.3
*A displacement of 1 mm. corresponds to 0.07 ~1 of liquid.
cavity preparation in 18 teeth was filled twice at random, once without and once with
an insulating material. The insulating materials were Copalite” varnish. Tubulitect
liner, and Durelon cement. Durelon is weakly hygroscopic.
After the cavity had been dried with a gentle air blast for 5 seconds, two
applications of Copalite were made with a brush; each film was dried with a 30
second air blast. Tubulitec was also applied as two films. Neither of these insulators
was removed from the margins of the cavity. After drying with absorbent paper,
Durelon was applied to the cavity with a probe.
The silicate cement was mixed and inserted into the cavity within 2 minutes
after starting spatulation. The restoration was covered with cervical foil and
petroleum jelly. After 6 minutes, the foil was removed and the restoration coated
with petroleum jelly. Wet absorbent cotton was placed over the restoration 10
minutes later. The movement of the liquid column was recorded for 60 minutes.
After this period, the first restoration was removed with a bur under a water
coolant. If the first restoration was insulated, the dentin surface was superficially
removed with a bur. Isotonic saline solution was then placed in the cavity, and after
the liquid system stabilized, the second restoration was inserted.

RESULTS
Part I. The dehydrating effect of 6 restorative materials on dentin. All materials
gave rise to centrifugal flow in the dentinal tubules as manifested by a pulpward
displacement of the liquid column in the capillary tube (Fig. I ) . Cavit displayed
the most powerful dehydrating effect; the loss of liquid from the dentin was 0.7 ~1
after 60 minutes. This was twice the effect of silicate cement which ranked second
and four times as great as the effect of Durelon (Table I).
Silicate cement, like Durelon, gave rise to a centrifugal flow in the dentin im-
mediately after placement. Zinc oxide and eugenol cement. Adaptic, and Sevriton
produced a more steady dehydration (Fig. 2). For the first 2 or 3 minutes after
the application of Adaptic, there was a distal movement of the liquid column, i.e., a
centripetal flow in the dentinal tubules in 4 out of 7 teeth (Fig. 2 j . The same effect

*Bosworth Company, Chicago, Ill.

tForssbergs Dental AB, Stockholm, Sweden, and Buffalo Dental Mfg. Company, Brook-
lyn, N. Y.
 J, Prosthet. Dent.
310 Johnson and Briinnstrijm September, 1971

mm
*_-*1
12 1. cavit ,I’
2. silicate /’
3. zincoxide-eugenol I /
t1 4. adapt ic I /’
5. sevriton ,
,
6. durelon I ‘a
I
IO /’
I

‘ .
I,
9
I’

7 ,’
*;

I I I I I I I t

/ to 20 30 40 50 60 70 80 90
min
Fig. 2. The dehydrating effect of 6 filling materials on the dentin and displacement of the
column in the capillary tube due to a loss of liquid from the dentin. A dispIacement of 1
mm. corresponds to 0.07 pl of liquid,

occurred in 1 of the 16 teeth restored with silicate cement and 4 of 15 teeth restored
with zinc oxide and eugenol cement.
Cavities restored with Plastellina covered with petroleum jelly exhibited a
negligible flow. When the control material was solely petroleum jelly, there was
no movement of the liquid column. Drying the cavities with an air blast of 5 seconds
always produced a pulpward movement of 1 to 2 mm. of fluid in the capillary tube
indicating a loss of 0.07 to 0.15 yl of fluid from the dentin.
Part II. The effect of 3 insulating materials on the dehydration of dentin ~JJ
silicate cement. All 3 insulators reducedthe dehydrating effect on the dentin (Fit.
3). In the intratooth comparisons, a reduction of the liquid flow caused by silicate
cement occurred in all 6 teeth when Tubulitec was used and in 5 out of 6 with
Copalite and Durelon.
Volume
Number
26
3
Dehydration of dentin by restorative materials 311

mm

6 -

Fig. 3. The reduction in dehydration of the dentin obtained with 3 insulating materials (see
also Fig. 2): a, Silicate cement without insulation; b, insulated with Durelon cement; c,
insulated with Copalite varnish; d, insulated with Tubulitec liner.

After inserting silicate cement in cavities insulated with Tubulitec, the same
phenomenon was observed as that in the experiments with Adaptic. The move-
ment of the meniscus at first indicated a centripetal flow in the tubules. When the
surface of the cavity was covered only with Copalite or Tubulitec, a centrifugal
flow in the tubules was recorded, which indicates evaporation through these ma-
terials. This flow was manifested as a displacement of the meniscus of about 1 mm.
in 5 minutes, which corresponds to a volume of about 0.1 ~1.

DISCUSSION
The centrifugal flow produced in vitro in the dentinal tubules by the restorative
materials was probably of the same order as that occurring in vivo. The flow might
even be slightly more in vivo if one adds the effect of dehydration to a physiologic
pressure gradient, with higher pressure of about 30 mm. Hg in the pulp. This
factor alone gave rise to a continuous centrifugal flow in the dentin with open
tubules.2 The values obtained for the loss of dentinal fluid can probably be regarded
as reliable, since no movement of the liquid column was recorded when the cavity
was filled with petroleum jelly. The insignificant movement of the column observed
when the cavity was filled with the control material was probably due to evaporation
through leakage. Some leakage between the test material and the cavity walls was
possible but negligible, since all the restorations were kept moist and covered with
petroleum jelly. Differences in the flow of liquid between teeth restored with the
same test material might be due to differences in the number of transected tubules
in the cavities and to variations in the volume of the test teeth.
Silicate cement, acrylic resin, and composite resin contract during setting.
 It is possible that liquid fro111 the drsntin may occ~upy the interfaw Ijc~t~\w~i
thr cavity walls and the restoration. Thr spacr brncath a composite wsin rtstoration
might be of the order of i to 10 & l’hc volun~c~ of liquid in sucl~ ;I x~;I(‘P (‘(II -
responds to about 0.5 mm. in the capillary tub?. If the contraction on arrtillg ~I:I\
any (affect on thr obserl-ed loss of liquid front thf* df*ntill. it is probabl!. 01‘ Iwgli,~iblt*
magnitude.
The initial centripetal f-lo\\ \vith Adaptic not\- be ;I result of hf~l-lirc-tic, sc&inq
of the cavity I\-hen the rnatrrial leas applird. Ttle 1wssure applied on inwrtion I~I:I\
then have given rise to a wntripetal displacement of the liquid in the tubulw ‘I&I*
occasional momentarv i>ain 11hich occurs \\-hc*n silicate c‘ement or cmtipositc. wsilr :x

pressed into derp cavities nlight be due to :L centripetnl flow in the tuh~&~.’
<:avit contains zinc oxide. f&Gm~ sulphatr. zinc sulphatc, glyfd ;IfwatcL.

poly\-inyl acetat?. and polyvinyl chloride ac~c~tatc~.L2.c Ilave found thaw ( :a\it (XI
evoke pain or aching upon application to sound dentin: this was :11so ohsrrvc%ti IX
Eamcs, Serene,. and \Viderln;rn. ‘I’hew ituthors ;tlso dcxtc,cted aspiration 4 odonto-
blasts into the dentinal tuhulcs under C;a\.ir. Sinw l)ain-producing qgc~~ts such :i
sugar and calciunl chloride qi\.ct riw to drllvdratic,n.‘~ thf> tf*mporary paill follow il!e
that application of CIavit may br caused by dell)-dration as establishf,d iri this reporl.
Mechanical stinluli, such ai; a11 air blast ;md drntitl reduction. cat] alao t&licit lJ;iill
through the action of capillary forws which product* :I rapid ccntrifrlgai flow irr
the dentinal tubules. Gth consequent clisplawlnc*nt of nerve fibers alld; or (,cll~ iI1
thcx pulp.~

C:old-curing acrylic resin and silicate wment nray c‘auxc aspiratiorl (11 odorltc~-
blasts.?, !’ These materials rr~a)- be poorl) :idaptrd to thfa cavity walls and. thus.
facilitate centrifugal flokv as a rcwlt of thtb pwssuw gradient. but that this waction
is dw. in some Il1easure. to the dehydratiq cxfl‘ect of the material. itself. cannot br*
ruled out.
A varnish or liner such as (:opalite or Tubulitc~c rcdured the dehydrating efI’ec.t
of silirate cement by about one half. A similar reduction lnight well brs obtaillc*d
under zinc oxide and eugenol wnlcnt and C:a\.it. ‘I’he IISe of a lining in c.;,\itic’*.
e\‘cn under such tculpornr!- dressinKs. is rwolllrwndrd.

CONCLUSIONS
Cavit and silicate cenwnt dehydrated dentin. Zinc oxide and cllgenol (wIllrn[.
Adaptic, and. to some extent. Sevriton and IIurefon. displayed a less pronounced
dehydrating effect. The drhydration of dentin under C:a\rit and, to sol)lt’ c,xtent.
under silicate cement may c,oncei\.ably elicit pain and rwult in aspir;ition (If oc]ontc,-
blasts into the tubules.
Copalite, Tubulitec, and l>urelon reduwd the dehydration of dentin urldf~r
silicate cement and probably lvould cxcrt a similar &ect under other hygroscopic,
restorative materials. A varnish or liner is also recolnmended for protection uncic.r
temporary restorative materials tvhich have :I hygroscopic ($frct.

References
1. BtinnstrGm. M.. Lindkn. L.--k. and Johnson, G.: Movement of Dentinal and Pulpal Fluid
Caused by Clinical Procedure>. J. Dent. Res. 47: 679-682. 1968.
Volume 26 Dehydration o/ dentin by restorative materials 313
Number 3

2. Johnson, G., Olgart, L., and Brannstrom, M.: The Centrifugal Liquid Flow in Dentinal
Tubules Due to a Physiologic Pressure Gradient. Unpublished data.
3. Bergvail, O., and Brannstrom, M.: Measurements of the Spaces Between Composite Resin
Fillings and the Cavity Walls, Swed. Dent. J. In press.
4. BkmstrGm, M., Johnson, G., and Linden, L.-A.: Fluid Flow and Pain Response in the
Dentine Produced by Hydrostatic Pressure, Odontol. Revy 20: 1-16, 1969.
5. Eames, W. B., Serene, T. P., and Widerman, F. H.: Physical and Biological Propertics of
Cavit, Int. Assoc. Dent Res., Abst. No. 251, 1969.
6. Linden, L.-A., and Brannstrom, M.: Fluid Movement in Dentine and Pulp, Odontol. Revy
18: 227-236, 1967.
7. BrannstrGm, M.: Sensitivity of Dentine, Oral Surg. 21: 517-526, 1966.
8. Kramer, I., and McLean, J. W.: Response of the Human Pulp to Selfpolymerizing Acrylic
Restorations, Br. Dent. J. 92: 255-261, 1952.
9. Brannstrom, M., and Nyborg, H.: The Presence of Bacteria in Cavities Filled With Silicate
Cement and Composite Resin Material, Swed. Dent. J. 64: 149-155, 1971,

DR. JOHNSONAP~DDR.BR~NXSTR~~M:
KAROLINSKA INSTITUTET
SCHOOL OF DEXTISTRY
Box 3207
STOCKHOLM, SWEDEN