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Year : 2023  |  Volume : 14  |  Issue : 1  |  Page : 32-35

Effect of Amoxicillin and Azithromycin Suspensions on Microhardness of Sliver Reinforced and Nano Resin-Modified Glass Ionomers: An In Vitro Study

1 Pedodontics Department, College of Dentistry, University of Baghdad, Baghdad, Iraq
2 Department of Basic Sciences, College of Dentistry, University of Baghdad, Baghdad, Iraq
3 Pedodontics Department, College of Dentistry, Al-Mustansiriya University, Baghdad, Iraq
4 Department of Orthodontics, College of Dentistry, University of Baghdad, Baghdad; Centre for Oral, Clinical and Translational Sciences, Faculty of Dentistry, Oral & Craniofacial Sciences, King’s College London, London, UK, Iraq

Date of Submission22-Nov-2022
Date of Decision22-Jan-2023
Date of Acceptance24-Jan-2023
Date of Web Publication20-Mar-2023

Correspondence Address:
Zainab R Hasan
Pedodontics Department, College of Dentistry, University of Baghdad, Baghdad
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/denthyp.denthyp_149_22

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Introduction: We aimed to examine the effect of amoxicillin and azithromycin suspensions on the microhardness of sliver-reinforced glass ionomer and nano-resin modified glass ionomer (GI). Method: Thirty discs (2 mm height x 4 mm diameter) of each type of GI were prepared, which were randomly assigned to amoxicillin, azithromycin, and artificial saliva groups. Microhardness was evaluated by Vickers hardness test before and after three immersion cycles. Results: The overall model (P <  0.001), before/after intervention (P <  0.001), intervention group (type of antibiotic) (P = 0.013), and type of glass ionomer (P <  0.001) showed significant differences among study groups (P <  0.001). Post hoc test showed only non-significant before/after difference for Azithromycin and artificial saliva (control) groups regarding nano resin-modified GI. Conclusion: We found significant microhardness loss for sliver reinforced GI in comparison to nano resin-modified GI after the immersion cycles. Yet, sliver reinforced GI would have higher level of microhardness than nano resin-modified GI after the immersion cycles. Longer time studies are required to assess trend of microhardness loss.

Keywords: Amoxicillin suspension, azithromycin suspension, glass ionomer, sliver reinforced glass ionomer, nano resin-modified glass ionomer, Vickers microhardness

How to cite this article:
Hasan ZR, Al-Hasani NR, Mahmood MA, Ibrahim AI. Effect of Amoxicillin and Azithromycin Suspensions on Microhardness of Sliver Reinforced and Nano Resin-Modified Glass Ionomers: An In Vitro Study. Dent Hypotheses 2023;14:32-5

How to cite this URL:
Hasan ZR, Al-Hasani NR, Mahmood MA, Ibrahim AI. Effect of Amoxicillin and Azithromycin Suspensions on Microhardness of Sliver Reinforced and Nano Resin-Modified Glass Ionomers: An In Vitro Study. Dent Hypotheses [serial online] 2023 [cited 2023 May 30];14:32-5. Available from:

  Introduction Top

Oral suspension is one of the most preferred drug delivery systems in pediatrics Yet might cause damage to dental tissues and filling materials because of their pH level. Amoxicillin is a commonly prescribed antibiotics.[1] Some people experience penicillin allergies, which necessitates the use of an alternative antibiotic such as azithromycin. It has good oral bioavailability, excellent tissue penetration and persistence, and long elimination half −lives, which allow for a once-daily dose instead of three-daily doses of amoxicillin.[2] Glass-ionomer restorative material (GI) is widely used in clinical pediatric dental practice. Some restorative materials, like sliver-reinforced glass ionomer and nano resin-modified glass ionomer, exhibited better mechanical properties than the conventional types of GIs, as they have higher bonding strengths, tensile strengths, hardness, and appropriate clinical handling.[3],[4] In addition, the nano resin-modified glass ionomer has improved properties such as enhanced wear resistance, super polishing ability, and excellent esthetics.[5] Recently, Guler et al. reported that the prolonged use of multivitamin syrups and effervescent tablets might have negative effects on the physical properties of restorative GIs.[6]

This study aimed to examine the effect of amoxicillin and azithromycin suspensions on the microhardness of sliver-reinforced and nano resin-modified GIs.

  Materials and Methods Top

This single-blinded in vitro study was conducted at the Department of Pedodontics & Preventive Dentistry and ethically approved by the Ethical Committee at the University of Baghdad, College of Dentistry (Reference number 573 on 02-06-2022).

Sample size calculated by G power ( with a power of study 80%. Alpha error of probability 0.05%, effect size of 0.4, a total of 60 GI disc-shaped samples were prepared via nano resin-modified GI (3M, ESPE, Ketac Nano, St. Paul, USA) and silver reinforced GI (Riva Silver, SDI, Bayswater, Australia) using a cylinder Teflon split mold (2 mm height x 4 mm diameter). For each sample, the GIC material was applied in the mold (which was placed on a transparent celluloid strip fixed on glass cement slab) and covered with a matrix strip. Glass cement slides with a pressure of 200 g were applied to expel the excess material. After that, the specimen was light-cured (Eighteenth, Germany; model curing (LOT# G2108030)) and the GIC sample was polymerized according to manufacturer instructions. To ensure a full polymerization of the bottom of the sample, another exposure to light curing (for 40 s) was applied.[7] For measurement standardization, a polishing process was conducted for GIC discs using a sequential polishing protocol with silicon carbide abrasive discs at a speed of 200 rpm: 600 grit for 10 seconds, 1200 grit for 20 seconds, 2500 grit for 30 seconds, and 4000 grit for 60 seconds. This standardized polishing protocol allows for the removal of approximately 400 μm from the outer layer.[8]

Each type of GI discs was randomly assigned (using to three intervention groups (n = 10) including amoxicillin, azithromycin, and artificial saliva.

Over a period of 25 days (7 days for three successive immersion protocols with 2-day intervals in between), the immersion cycles were conducted by immersing the GI discs separately in immersion liquids according to the following sessions: for 2 minutes, three times daily for amoxicillin suspension (250 mg/5 mL, pH 4.1) (Athlone, Roscommon, Ireland); once daily for azithromycin suspension (200 mg/5 mL, pH 9.2) (AZi-Once, Jamjoom Pharma, Riyadh, Saudi Arabia). After each immersion of the samples, the GI discs were washed and stored in artificial saliva until the next immersion time. The control samples were kept in artificial saliva for the entire day, with daily solution refreshment. Surface microhardness was evaluated blindly before the immersion cycle (baseline reading) and after the 3rd immersion cycle using a microhardness machine (micromet tester, Otto Worlpert, Germany) via the Vickers test.

To prepare one liter of artificial saliva, combine sodium carboxymethyl cellulose (10 g) (Avonchem, Macclesfield, UK), sodium chloride (1 g) (Avonchem), sodium fluoride (0.0002 g) (HiMedia, Kennett, USA), calcium chloride (0.05 g) (Avonchem), potassium thiocyanate (0.01 g) (CDH, New Delhi, India), sorbitol (1 g) (Thomas Baker, Mumbai, India), potassium chloride (1 g) (Panreac, Barcelona, Spain), magnesium chloride (0.05 g) (HiMedia), potassium phosphate (0.04 g) (Qualikemis, Vadodara, India), and sodium carboxymethyl cellulose (Avonchem) were dissolved in 100 mL boiling water. After cooling, the pH of the prepared artificial saliva was adjusted to 7.[9]

Data were analyzed via a three-way ANOVA and the Tukey post hoc test using R 3.6.3 software (R Foundation for Statistical Computing, Vienna, Austria).

  Results Top

Overall model (P <  0.001), before/after intervention (P <  0.001), intervention group (type of antibiotic) (P = 0.013), and type of glass ionomer (P <  0.001) showed significant differences among study groups (P <  0.001). Post hoc test showed only non-significant before/after difference for the azithromycin and artificial saliva (control) group regarding nano resin-modified GI [Figure 1]. All other before/after multiple comparisons were significant (P < 0.05).
Figure 1 Box and whisker plot displaying variations in the Vickers microhardness values (VHN) among different study groups. Post hoc non-significant before/after test also showed.

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  Discussion Top

The GI materials are widely used in pedodontics as filling materials, and their resistance to the occlusal load (represented by the microhardness) might affect the success and longevity of the dental treatment in children. Toras and Hamouda found that the nano-filled GI had the lowest hardness in comparison to a resin modified and conventional GI due to the differences in the particle types. [10] Panahandeh et al., reported that the nano-filled GI exhibited low hardness in comparison to the nano-free GI due to the absence of glass particles in the surface. [11] In addition, it was mentioned that incorporating a silver alloy into the GI could improve its hardness.[4] All the above-mentioned findings came into agreement with the present study outcomes at base line before immersion cycles. We found significant microhardness loss for sliver-reinforced GI in comparison to nano resin-modified GI after the immersion cycles. Yet, sliver-reinforced GI would have a higher level of microhardness than nano resin-modified GI after the immersion cycles [Figure 1]. Longer time studies are required to assess the trend of microhardness loss.

The nano resin-modified GI exhibited better resistance to degradation changes due to the lower surface microhardness changes after separate immersion in acidic, alkaline, and neutral solutions. This finding could be explained by comparing the physical properties of nano resin-modified GI to those of sliver reinforced GI. Lyapina et al. found that incorporating nano-filler particles boosted the chemical energy stored in the covalent bond of nano resin-modified GI, rendering this material more resistant to environmental changes.[5] In addition, they found that the nanoparticle incorporation resulted in a wider particle size distribution and higher mechanical values. This might support the particle occupation process because the empty spaces between the GI particles act as reinforcing material in the glass ionomer.[5] On the other side, the sliver reinforced GI structure may be more porous than the nano resin-modified GI, leading to a higher porosity that could increase water absorption and uptake through polymer chains. This process could alter and reduce the mechanical and physical properties of restoration due to the loss of the chemical bond between filler particles, which ultimately causes lower hardness and material degradation.[12]

This explanation might account for the significant reduction in the hardness values of the sliver reinforced GI in the acidic (amoxicillin, pH = 4.1) and basic (azithromycin, pH = 9.2) medications as well as the neutral solution (artificial saliva, pH = 7) used in this study. The nano resin-modified GI showed different behavior in microhardness changes compared to that of the sliver reinforced GI after the immersion cycles because the nano resin-modified GI exhibited a good resistance to the basic and neutral solutions as the hardness changes were non-significant. However, nano resin-modified GI hardness was significantly affected by the acidic media; this might be attributed to the harsh erosive effect of acidic media as it could soften the dental material and results in low wear resistance and decreased microhardness.[13] Paula et al., proved that the nano resin-modified GI hardness was highly affected by the acidic beverage (Coca cola, pH = 2.5).[14] More recently, Colombo et al., found that the GI has a tendency to solubilize when immersed in acidic beverages, leading to a drop in the GI hardness.[15] These findings could be explained by the hydrophilic properties of the GI because the internally absorbed water diffuses in the resin matrix, filler interface, and pores leading to chemical degradation that could be enhanced by the low pH of the acidic medium.[14] The main reason behind the significant difference in microhardness readings between GI samples that were immersed in Azithromycin and artificial saliva could be attributed to the lower percentage of loss exhibited by the artificial saliva group due to the neutral pH value of artificial saliva.

Nevertheless, as mentioned in a recent systematic review,[16] at this time international regulation or guidelines are not available for the assessment of the microhardness of restorative GIs. Well-known international dental research organizations must be aware of this fact.

Readers must note the inherent limitations of in vitro studies, which cannot simulate oral environments. More clinical studies are necessary to assess the effectiveness and safety of sliver-reinforced and nano resin-modified GIs.

Financial support and sponsorship


Conflicts of interest

The authors report no conflicts of interest.

  References Top

Alhamd AKJ. Bioequivalence of two formulations of amoxicillin in human healthy volunteers on (HPLC) technique. Iraqi J Pharm Sci. 2010;19:14­–20.  Back to cited text no. 1
Jaber SH, Salih ZT, Salmo HM. Formulation of azithromycin suspension as an oral dosage form. Iraqi J Pharm Sci 2012;21:61–9.  Back to cited text no. 2
Moshaverinia A, Roohpour N, Chee WW, Schricker SR. A review of powder modifications in conventional glass-ionomer dental cements. J Mater Chem 2011;21:1319­–28.  Back to cited text no. 3
Almuhaiza M. Glass-ionomer cements in restorative dentistry: a critical appraisal. J Contemp Dent Pract 2016;17:331–6.  Back to cited text no. 4
Lyapina MG, Tzekova M, Dencheva M, Krasteva A, Yaneva-Deliverska M, Kisselova A. Nano-glass-ionomer cements in modern restorative dentistry. J IMAB 2016;22:1160­–5.  Back to cited text no. 5
Guler EBG, Bayrak GD, Unsal M, Kuvvetli SS. Effect of pediatric multivitamin syrups and effervescent tablets on the surface microhardness and roughness of restorative materials. J Dent Sci 2021;16:311­–7.  Back to cited text no. 6
Abu-Naila ASa, Baban LM. The effect of cyclic immersion in cola drinks on the surface microhardness and surface roughness of different composite filling resin materials. J Baghdad Coll Dent 2010;22:7–11.  Back to cited text no. 7
Ibrahim A, Thompson V, Deb S. A novel etchant system for orthodontic bracket bonding. Sci Rep 2019;9:1–15.  Back to cited text no. 8
Björklund M, Ouwehand AC, Forssten SD. Improved artificial saliva for studying the cariogenic effect of carbohydrates. Curr Microbiol 2011;63:46–9.  Back to cited text no. 9
Toras F, Hamouda I. Effect of nano filler on microhardness, diametral tensile strength and compressive strength of nano-filled glass ionomer. Int J Dent Oral Sci. 2017;4:413–7.  Back to cited text no. 10
Panahandeh N, Torabzadeh H, Aghaee M, Hasani E, Safa S. Effect of incorporation of zinc oxide nanoparticles on mechanical properties of conventional glass ionomer cements. J Conserv Dent 2018;21:130–5.  Back to cited text no. 11
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Tanthanuch S, Kukiattrakoon B, Siriporananon C et al. The effect of different beverages on surface hardness of nanohybrid resin composite and giomer. J Conserv Dent. 2014;17:261–5.  Back to cited text no. 12
Aliping‐McKenzie M, Linden R, Nicholson J. The effect of Coca‐Cola and fruit juices on the surface hardness of glass-ionomers and ‘compomers’. J Oral Rehabil 2004;31:1046–52.  Back to cited text no. 13
De Paula A, De Fúcio S, Alonso R, Ambrosano G, Puppin-Rontani R. Influence of chemical degradation on the surface properties of nano restorative materials. Oper Dent 2014;39:109–17.  Back to cited text no. 14
Colombo M, Gallo S, Chiesa M et al. In vitro weight loss of dental composite resins and glass-ionomer cements exposed to A challenge simulating the oral intake of acidic drinks and foods. J Compos Sci. 2021;5:298­–306.  Back to cited text no. 15
Menezes-Silva R, Cabral RN, Pascotto RC et al. Mechanical and optical properties of conventional restorative glass-ionomer cements-a systematic review. J Appl Oral Sci. 2019;27:e2018357.  Back to cited text no. 16


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