ORIGINAL RESEARCH |
https://doi.org/10.5005/jp-journals-10005-2790 |
Effect of Different Iron Supplements on Color Stability of Nanocomposite Restorative Materials
1–6Department of Pedodontics and Preventive Dentistry, Chhattisgarh Dental College & Research Institute, Rajnandgaon, Chhattisgarh, India
Corresponding Author: Rashmi S Lokhande, Department of Pedodontics and Preventive Dentistry, Chhattisgarh Dental College & Research Institute, Rajnandgaon, Chhattisgarh, India, Phone: +91 9075583584, e-mail: rashmilokhande97@gmail.com
ABSTRACT
Physical development and growth are significantly influenced by adequate nutrition. Enamel, dentin, and dental pulp are among the tissues that contain iron, which is regarded as a necessary element for human health. The disadvantages of the available iron drops include bad taste and black discoloration of primary teeth. In areas that are decalcified and hypomineralized, this discoloration is more noticeable. Therefore, efforts are being made to create iron drops that have a more pleasant taste and minimal adverse effects (i.e., no or minimal tooth discoloration). Liposomes are minuscule vesicles made of the bilayer of phospholipids that can encase both hydrophilic and hydrophobic drugs to boost their effectiveness and lessen side effects (color staining). Therefore, the goal of the study is to compare the color stability of cosmetic materials with that of pediatric liposomal iron supplements and regular pediatric iron supplements.
How to cite this article: Lokhande RS, PJ N, Deoghare A,et al. Effect of Different Iron Supplements on Color Stability of Nanocomposite Restorative Materials. Int J Clin Pediatr Dent 2024;17(3):274–278.
Source of support: Nil
Conflict of interest: None
Keywords: Colorimeter, Iron supplements, Liposomal
INTRODUCTION
A healthy diet is essential for both physical development and growth. All living tissues, including the enamel, dentin, and dental pulp, contain iron, which is regarded a necessary element for human health. In addition, children require iron for red blood cell synthesis and overall growth and development. Hemoglobin, which is found in red blood cells and plays a crucial role in transferring oxygen from the lungs to the tissues, contains the greatest concentration of iron in the human body.1
The disadvantages of the available iron drops include bad taste and black discoloration of primary teeth. In areas that are decalcified and hypomineralized, this discoloration is more noticeable.2 Parents frequently seek dental treatment for their children due to dark discoloration of their primary teeth, which can even result in the cessation of iron supplementation.3 There is proof that some iron drops made in Iran even discolored surfaces more than those made abroad. Therefore, efforts are being made to create iron drops with a better flavor and fewer adverse effects (i.e., no or minimal tooth discoloration).4
The longevity of treatment depends on color retention during the functional lifetime of restorations. When thermocycling or ultraviolet radiation occurs, intrinsic factors begin to manifest as observable discoloration. Cofactors appear to be material-related variables like initiators, inhibitors, polymerization systems, filler kinds, monomers, and the transformation of the composite resin materials’ carbon–carbon double bonds.5
Perceptible discoloration can also be caused by the extrinsic effects of food and drink components. Additionally, the growing popularity of colored mouth rinses like tea tree oil, sodium fluoride, and chlorhexidine may have an unfavorable esthetic impact on composite resin materials.6
Research into creating materials that mimic natural teeth was prompted by children’s and parents’ demands for a natural appearance.7
Dental-colored restorative materials, such as glass ionomer, composite, giomer, compomer, etc., are frequently used to treat pediatric patients. The combination of mechanical, esthetic, and physical properties in new classes of resin-based composites, dubbed nanocomposites, is making them increasingly popular. For anterior restorations, nanoparticles were added to resin-based composites to increase wear resistance, decrease polymerization shrinkage, and enhance the restorations’ esthetic appeal with better polish and improved optical properties.6
Hydrophilic and hydrophobic drugs can be encapsulated in liposomes, which are microscopic vesicles made of phospholipid bilayers, to boost their effectiveness. A novel way to prevent or treat iron deficiency and iron deficiency anemia is to consume encapsulated micronutrients, such as iron, as a supplement in the form of sprinkles to be added to daily meals.5 This method ensures that iron doesn’t contaminate food or alter its flavor or color. Therefore, comparing the color stability of cosmetic materials to that of pediatric liposomal iron supplements and regular pediatric iron supplements is the aim of this study.
Materials and Methods
-
Standard specimens of Ivoclar Tetric N Nanocomposite (1 × 3 mm)
-
Mylar strip.
-
Light-emitting diode (LED) curing unit.
-
Composite instrument kit.
-
Pediatric iron supplement (Vitcofol Drops).
-
Pediatric liposomal encapsulated iron supplement (Tasiron Drop).
-
Digital colorimeter.
-
Glass slab.
-
Blotting paper.
-
Vaseline.
-
Tweezer (Fig. 1).
Fig. 1: Materials
Procedure
A total of 30 samples were made by using Teflon mold (1 × 3 mm) and were cured by a light curing unit and divided into two groups. Color measurements were done using a digital colorimeter and recorded as baseline values. The specimen was separately immersed in two vials, according to their group, containing 20 mL of pediatric iron supplement (Vitcofol) and liposomal encapsulated iron supplement (Tasiron) agitated for 2 minutes every 8 hours for a maximum of 1 week. After 1 week of cumulative immersion, the specimen was dried with blotting paper, and a second measurement was performed. The data were statistically analyzed.
Preparation of Samples
A total of 30 standard specimens were made by gradually packing the material into a Teflon mould (1 × 3 mm) and pressing a mylar strip to create a smooth, flat surface. An LED light curing unit was used to polymerize each material (Fig. 2).
Fig. 2: Samples cured by light curing unit
Color Change Measurement
After the polymerization of restorative materials, color measurements were done using a digital colorimeter and recorded as baseline values.
Each group consists of 15 specimens:
-
Group I: Specimens of nanocomposite immersed in the conventional pediatric iron supplement.
-
Group II: Specimens of nanocomposite immersed in liposomal encapsulated pediatric iron supplement.
The specimen was separately immersed in two vials, according to their group, containing 20 mL of pediatric iron supplement (Vitcofol) and liposomal encapsulated iron supplement (Tasiron) agitated for 2 minutes with 8-hour intervals up to 1 week (Fig. 3).
Fig. 3: Samples immersed in iron supplements
After 1 week of cumulative immersion, the specimen was dried with blotting paper, and a second measurement was performed. The CIE L*a*b* color scale, which is a roughly uniform color space that coordinates for white/black (L), red/green (a), and yellow/blue (b), was used to analyze values using colorimeters (Fig. 4).
Fig. 4: Samples tested in colorimeter
Statistical Analysis
The Statistical Package for the Social Sciences version 22 was used to analyze the data after it was entered into an Excel spreadsheet. Frequency, percentage, mean, and standard deviation were obtained for descriptive statistics. The threshold for statistical significance is set at p < 0.005 (95% confidence interval). Inferential tests (Mann–Whitney U test, unpaired sample t-test) were used to compare three groups.
RESULTS
The mean pH levels of the conventional iron supplement group were 40.6, and salivary buffering capacity was found to be 34.84. The color stability was increased in the liposomal iron supplement group compared to the control group (Fig. 5).
Fig. 5: The descriptive statistics of color change (ΔE*) of nanocomposite when immersed in two types pediatric iron supplements—group I (conventional) pediatric iron supplement and group II (liposomal encapsulated) pediatric iron supplement, respectively were shown in this graph
The descriptive statistics of color change (ΔE*) of nanocomposite when immersed in two types pediatric iron supplements—group I (conventional) pediatric iron supplement and group II (liposomal encapsulated) pediatric iron supplement, respectively were shown in this graph. The mean color change (ΔE*) was 34.84 in the liposomal iron supplement group compared to the control group (40.6) with a standard deviation of 3.82 and 1.6, respectively (Table 1).
| ΔE* | Mean | Standard deviation (SD) | Standard error (SE) | Minimum | Maximum |
|---|---|---|---|---|---|
| Group I (conventional) | 40.6 | 3.82 | 0.98 | 34.34 | 52.03 |
| Group II (liposomal encapsulated) | 34.84 | 1.6 | 0.41 | 30.79 | 37.18 |
Descriptive statistics of color change (ΔL*, Δa*, Δb*) of nanocomposite when immersed in two types of pediatric iron supplements—group I (conventional) pediatric iron supplement and group II (liposomal encapsulated) pediatric iron supplement were shown in Figure 6.
Fig. 6: Descriptive statistics of color change (ΔL*, Δa*, Δb*) of nanocomposite when immersed in two types of pediatric iron supplements—group I (conventional) pediatric iron supplement and group II (liposomal encapsulated) pediatric iron supplement
L* represents the variation between the L* values. The difference of the a* values is a*. The difference in the b* values is b*. For statistical analysis, the mean groups of the two groups were created. In a rectangular coordinate system, CIE L*a*b* color values offer a comprehensive numerical description of the color. With 0 denoting a perfect black with 0% reflectance or transmission, 50 a middle grey, and 100 a perfect white with 100% reflectance or a perfect clear with 100% transmission, L* stands for lightness.
The color’s reddish–green hue is represented by a*. Red corresponds to positive values of a*, green to negative values of a*, and 0 to neutral. The color’s yellow–blue balance is represented by b*. b* has three values—0 is neutral, negative values are blue, and positive values are yellow. A comprehensive numerical description of the color variations between a sample or lot and a standard or target color is provided by the ΔL*, Δa*, and Δb* values. The difference in lightness between the sample and standard colors is represented by ΔL*.
Comparison of color change (ΔE*) of nanocomposite when immersed in two types of pediatric iron supplements—group I (conventional) pediatric iron supplement and group II (liposomal encapsulated) pediatric iron supplement given in table (Table 2).
| ΔE* | Mean | SD | Mean difference ± SE | Unpaired t-test | p-value, significance |
|---|---|---|---|---|---|
| Group I (conventional) | 40.6 | 3.82 | 5.75 ± 1.07 | t = 5.377 | p < 0.001** (highly statistically significant difference) |
| Group II (liposomal encapsulated) | 34.84 | 1.6 |
**p < 0.001, a highly statistically significant difference. Overall color change (ΔE*) was found to be higher in group I (conventional) compared to group II (liposomal encapsulated), and the difference was found to be of highly statistically significant difference (p < 0.001)
DISCUSSION
Development, both mental and physical, is a dynamic process. Furthermore, sufficient nourishment is essential for healthy physical growth and development, though dietary needs might differ depending on body size, level of physical activity, and overall health. An essential element that the human body needs is iron.1
Following iron supplementation, tooth discoloration may result from metallic stains that are superficial and easily removed or from stains that are deeply ingrained in the tooth structure and cause a persistent color change that is difficult to remove.
Numerous investigations have been conducted to examine the erosive properties of different liquids and beverages that we use on a daily basis. As far as we know, there has been no discussion of how pediatric iron supplements affect the color stability of restorative materials. Previous research used CIE L*a*b* to measure color changes, and colorimetry and proper spectrophotometry, which have advantages like objectivity, sensitivity, and repeatability—to measure color changes. In this investigation, colorimetry was employed. Surface characteristics and thickness affect color stability.5,6 Since we only used Mylar strips to create smooth surfaces and tested color stability between baseline and 1 week, we neglected to calculate the effects of finishing the surfaces with conventional methods, which could also increase the surfaces’ resistance to liquid discoloration.
The current study set out to assess the discoloration of composite restorative material in comparison to commonly used iron drops and new microencapsulated liposomal iron drops, given the high prevalence of tooth discoloration following iron supplementation and parents’ concerns in this regard, which may lead to the discontinuation of the use. This was done to determine whether or not there was a difference in the degree of discoloration between the two types of iron drops.
The results of a study conducted by Abbasi et al. show that the use of nanoliposomal encapsulation technology in the production of iron drops can significantly decrease the resulting tooth discoloration, causing a clinically negligible color change.4
In this study, an innovative new method called Tasiron was used to provide the body with daily iron supplementation. The formulation of Tasiron makes use of microencapsulation iron technology, which is of the 4th generation folate. The unique microencapsulation technology used in this iron supplement sets it apart from other iron preparations. Tasiron facilitates better digestion, reduces the likelihood of stomach irritation, and keeps teeth from becoming discolored.
CONCLUSION
The liposomal microencapsulated iron drop caused significantly lower color change than conventional iron drops, which have drawbacks of teeth staining. Considering the low-cost of liposomal microencapsulated iron drops (Tasiron), it could be a good substitute for the iron drops that are currently on the market.
ORCID
Rashmi S Lokhande https://orcid.org/0000-0001-5225-9303
Anushka Deoghare https://orcid.org/0000-0003-3356-3689
REFERENCES
1. Tayebi S, Esmaeilzade M, Soufi Rezai L, et al. Color change of primary teeth following using 4 types of iron supplements available in the Iranian pharmacopeia. Avicenna J Dent Res 2019;11(2):66–71. DOI: 10.34172/ajdr.2019.12
2. Babaei N, Molaei T, Belyad S, et al. Relationship of pH and the viscosity of five different iron supplements with the absorption of iron ions and enamel discoloration in the anterior primary teeth (an in vitro study). Dent Res J (Isfahan) 2021;18:7. PMID: 34084294.
3. Mehran M, Mohammadi Bassir M, Jafari S. Effect of two kinds of iron drops on the discoloration, atomic absorption and structural changes of primary teeth enamel. J Dent Med 2009;21(4):290–299.
4. Abbasi M, Mazhari F, Jaafari M, et al. Color change of primary teeth following exposure to an experimentally synthesized liposomal nano-encapsulated ferrous sulfate drop versus the commercially available iron drops. Pediat Dent Jr 2021;31(2):256–267. DOI: 10.1016/j.pdj.2021.07.003
5. Zlotkin S, Antwi KY, Schauer C, et al. Use of microencapsulated iron (II) fumarate sprinkles to prevent recurrence of anaemia in infants and young children at high risk. Bull World Health Organ 2003;81(2):108–115. PMID: 12756979.
6. Falkensammer F, Arnetzl GV, Wildburger A, et al. Color stability of different composite resin materials. J Prosthet Dent 2013;109(6):378–383. DOI: 10.1016/S0022-3913(13)60323-6
7. Adusumilli H, Avula JS, Kakarla P, et al. Color stability of esthetic restorative materials used in pediatric dentistry: an invitro study. J Indian Soc Pedod Prev Dent 2016;34(3):233–237. DOI: 10.4103/0970-4388.186740
________________________
© The Author(s). 2024 Open Access. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and non-commercial reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.