ГлавнаяНовостиComparative analysis of the usage of titanium and fiberglass pins in the light of the compliance of galvanic alertnes

Comparative analysis of the usage of titanium and fiberglass pins in the light of the compliance of galvanic alertnes

12 февраля 2017

V.G.Tatintsyan, R.V.Mamikonyan

Yerevan State Medical University after M. Heratsi (Yerevan, Armenia)

Department of Therapeutic and Family Dentistry, Dental Clinic "Mirana-dent" (Moscow, Russia)

 

 

Summary

On the basis of our own clinical and laboratory findings, as well as using material published in recent years related to galvanism, showed how the use of titanium pins increases, albeit slightly, galvanic currents in the mouth, which does not occur when using, with the similar starting data, fiberglass pins.

For statistically significant confirmation of this conclusion the studied patients were divided into two groups, one of which had a single metallic inclusion in the mouth, and the second group – none. Initial measurement was made of the potential difference in the oral cavity. Thereafter, for half of the patients in each group was set a titanium pin, and for the other half – fiberglass pin. Re-measuring the potential difference was made six months after the installation of the pin. The figures gave a statistically significant result, in which the amount of galvanic currents in the mouth increased in the half of the group, where titanium pin was installed. Among people with installed fiberglass pins galvanic currents increase was insignificant, or even statistically unreliable.

Provided that we use these results, we can boldly assert that the usage of fiberglass pins is more rational in the light of concern of dentists to observe principles of galvanic alertness, the essence of which is the avoidance of installation in the patient's mouth diverse metal structures. Found statistically significant increase of galvanic currents in such a short period of time acquires clinical significance, since in the light of appearance in the oral cavity of patients other metal structures (crowns, implants), it will continue, and may cause the emerging syndrome of galvanism.

Keywords: galvanic currents; syndrome of galvanism; titanium pins, fiberglass pins; galvanic alertness.

 

Introduction

With the constant increase in the types of materials used in everyday dental practice (including metal) and with a consequent increase in natural combinations between different materials in the oral cavity, the problem of galvanism of oral cavity and ways to prevent it becomes particularly urgent. (Dubova LV, Volojin AI, Babakhin AA 2006 ; Lebedev KA, Juruli NB, Mitronin AV et al. 2007 ; Ponyakina ID, Mitronin AV, Sagan NN et al. 2009; Bianco P. D., DucheyneP, CucklerJ. M. 1996 ) However, if on the study and treatment of already existing syndrome of galvanism quite a lot of scientific papers have been written, the issues of prevention of the syndrome of oral galvanism are either bypassed, or limited by few lines on the desirability of uniformity of metals. (Volojin AI, Babakhin AA 2006 ; Al-Ali S., Oshida Y., Andres CJ2005) The attention of dental community is not stressed on the urgent need to comply mentioned uniformity, as well as on practical recommendations of materials and methods to choose in order to prevent this problem. (Lebedev KA, Mitronin AV, Ponyakina ID 2010 ; Ponyakina ID, Yanushevich OO, Juruli NB 2001 ; Pozdeev AI, Olesova VN, Filonov MR et al 2007)

In this article we would like to use and fix the reader's attention to this new phrase as galvanic alertness. By this we do not mean just a set of measures to prevent the occurrence of a syndrome of oral galvanism, but basic clinical reasoning, which nips the possibility of galvanism. Thinking consisting in the profound and responsible weighting the pros and cons before deciding on those or other materials to solve clinical problems. This will create an opportunity to escape the congestion of metal structures which accumulate galvanic potential for years and translate it into such a serious complication as galvanic syndrome. (Ponyakina ID, Lebedev KA, Maximovskiy YNet al 2009)

For a long time among dentists there was a common misconception, that titanium being bio-inert material cannot create galvanic connections and cause galvanic syndrome, and the emergence of galvanism has not been associated with the available oral implants and other titanium inclusions, simultaneously they forgot about convincing studies of the last century. (Bianco PD, DucheyneP, CucklerJ. M. 1996zh Nordenstrom BEW 1983 ; Robinson K. 1989 ; Reilly JP 1998) However, works of recent years have convincingly shown one more time that titanium, as well as other metals used in dental practice can create galvanic currents, increase levels of galvanic currents in the mouth, and in perspective, be the cause of the syndrome of galvanism. Especially this can occur while ignoring the principle of uniformity of metals and thoughtless use of metals in practice. The capability of titanium to increase galvanic currents is not anyhow related to its remarkable bio-inert features. (Lebedev KA, Ponyakina ID 2000 , 2003 , 2010 ; Ponyakina ID, Yanushevich OO, Juruli NB 2001 ; Pozdeev AI, Olesova VN, Filonov M. 2007 ; Yokoyama K., Ichikawa T. , Murakami H. et al 2002)

In this article, which is based on the author's research, we have a concrete example of comparative analysis of titanium and fiberglass pins for their ability to increase the galvanic currents in a relatively short period of time, and tried to show how you can change for the better galvanic situation in the mouth, using the above-named galvanic alertness. Experience has clearly shown how an adequate choice of materials can prevent those accumulative processes, the development of which can lead to a syndrome of oral galvanism.

 

Material and methods

In the course of our study two groups of patients with 256 people in each have been examined. In the first group (group A) there were patients without any metallic inclusions in the mouth. In turn, group A has been divided into two groups – A1 (n = 13) and A2 (n = 13). For patients in the first subgroup titanium pin was installed, the second group of patients received fiberglass pins. In the second group (group B) – patients were gathered with a single metal structure (or metal-ceramic crown or metal-ceramic bridge). Group B was also divided into two subgroups: group B1 (n = 13), where titanium pins were set, and group B2 (n = 13), where fiberglass pins were set.

Patients in both groups displayed potential difference. We carried out measurement of the potential difference in the oral cavity before the installation of pins and in six months later. Potential difference in the oral cavity was measured with a stationary digital multimeter (10 Ohm < 100pF >) Fluke 114 with an internal resistance of 3 kilo ohms (Fluke, Germany). For the measurement of the oral cavity the comparison microelectrodes were used (Ag / AgCl). We determined for each patient the value of the potential difference in mV between the tissues (mucous membrane of the mouth, tongue, teeth) and between metallic inclusions (in our case those are crowns or pins) to more than 15 pairs of points. Based on given measurements the maximum value of the potential difference was set (Umax.) in the mouth. The results were tabulated. Thereafter, for patients according to the indications associated with the destruction of the tooth crown has been installed titanium pins (subgroup A1 and B1) and the fiberglass pins (subgroup A2 and B2). Patients were informed about the necessity to return to the clinic within six months, after which repeated measurements were made of the potential difference. Measurements were carried out in a similar way, only with the addition of pairs of measurements with the newly established pins. (Borgens R. 1984 ; Lebedev KA, Maximovskiy YN, Sagan NN et al 2007 ; Ponyakina ID, Lebedev KA, Maximovskiy YNet al. 2009 ; Ponyakina ID, Mitronin AV, Sagan NN et al 2009 ; Sagan NN Ponyakina ID, Sagan LG et al. 2006)

It is worth stopping and elaborately telling about titanium and fiberglass pins, their composition and physical properties. Fiberglass pins have been used in a wide dental practice for more than twenty years ago. Many of our colleagues believe that this pin is 100% fiberglass, which is not true. Exact scientific name of these pins – standard composite pins, reinforced with glass or carbon fiber. The base of organic matrix of pin formative composite is identical to the base of most common filling materials and cements of dual-cure composite (BIS-GMA and TEG-DMA), however, when fixing this kind of pins into the lumen of the root canal by means of the adhesive systems and composite cements that have a similar structure. Despite the non-ideal adhesion, it is quite a reliable construction. ( Orjonikidze GZ 2008 ; Sakhanov AA, 2011)

Titanium pins in most cases, as well as titanium pins «KADENT» with which we have been working during our research, are made of titanium alloy of corresponding standards ASTM F136 Grade 5 and DIN 3.7165, as well as GOST 19807-91 (VT6S) . Titanium alloys, which are used for making other kinds of titanium pins, have similar standards of conformity and identical physical properties. (Kim H., Johnson JW 1999 ; Pozdeev AI, Olesova VN, Filonov M. R 2007 ; Dubova LV, Volojin AI, Babakhin AA , 2006; )

All statistical analyzes were performed using statistical software package SPSS (version 11.0) for Microsoft Windows (SPSS, Inc., Chicago, IL). Data are presented as mean values ​​with the average error (mean ± SEM). Correlation between values ​​were analyzed using Student's t-test. Comparisons between groups were performed based on t-test.

 

Results

The results of our research have been put in Table 1. Thus, as we can see in the table, after installing the pins galvanic conditions in oral cavity changed. In group A1 it has increased more than in group A2. Six months after the installation of a titanium pin the average value of a statistically significant increase in the potential difference in group A1 was 5 mV, despite the fact that a similar group with fiberglass pin had an increase of only 1 mV.

Table 1.

Comparative analysis of larger amounts of galvanic currents in six months for patient populations with installed titanium and fiberglass pins.

 

 

Before pin installation

(Umax)average.

 

Six months later

(Umax)average.

 

Subgroup А1 (titanium

44,5 (+-1,9) mV

49,5 (+-1,8) mV

Subgroup  А2 (fiberglass)

43,5 (+-1,65) mV

44,5 (+-1,6) mV

Subgroup В1

(titanium)

55,5 (+-1,7) mV

63 (+-1,8) mV

Subgroup В2

(fiberglass)

54,5 (+-2,0) mV

56 (+-2,0) mV

 

 

 

Before pin installation

(Umax)average.(mV)

 

Six months later

(Umax)average. (mV)

 

Subgroup А1 (titanium

44,5 ±1,9

49,5±1,8

Subgroup  А2 (fiberglass)

43,5±1,65

44,5±1,6

Subgroup В1

(titanium)

55,5±1,7

63±1,8

Subgroup В2

(fiberglass)

54,5±2,0

56±2,0

 

In group B (in which naturally there was initially a higher level of potential difference) a similar pattern has been observed. Six months later after the installation of a titanium pin in subgroups B1 potential difference increased by 7 mV, while in the subgroup B2 the increase was only 1.5 mV.

The resulting statistical data have been processed by the program the Biostat to determine reliability of the results. Results of determining the reliability of the data are displayed in Table 2.

 

Tab. 2. Determining the reliability of the data by Biostat.

 

Before

After

 

M±m

σ

Mmax

Mmin

Me

M±m

σ

Mmax

Mmin

Me

Group  A1 P<0,05

 

44,46±1,9

6,8

56

34

44

49,77±1,8

6,5

59

38

49

Group A 2 P<0,05

 

43,5±1,65

5,7

52

34

42,5

44,67±1,6

5,59

52

35

44

 

 

Before

After

 

 

M±m

σ

Mmax

Mmin

Me

M±m

σ

Mmax

Mmin

Me

Group  B 1 P<0,05

 

55,46±1,7

6,3

68

46

56

63,23±1,8

6,3

74

50

64

Group  B2 *P>0,05

54,4±2,0*

7,1

74

50

64

56,08±2,0*

6,9

65

45

57,5

 

 

Groups

Before

After

M

 

±m

σ

Mmax

Mmin

Me

M

±m

σ

Mmax

Mmin

Me

P

A1(n=?)  

44,5

±1,9

6,8

56

34

44

49,77

±1,8

6,5

59

38

49

<0,05

A2 (n=?)

43,5

±1,6

5,7

52

34

42,5

44,67

±1,6

5,59

52

35

44

<0,05

B1 (n=?)

55,5

±1,7

6,3

68

46

56

63,23

±1,8

6,3

74

50

64

<0,05

B2 *(n=?)

54,4

±2,0*

7,1

74

50

64

56,08

±2,0*

6,9

65

45

57,5

>0,05

 

 

Thus as shown by the figures in Table 2, the data of galvanic currents increase are statistically significant in all groups, except the subgroup B2, which has a slight statistically non-significant increase in the potential difference. However, the statistical unreliability of the subgroup B2 only confirms predicted conclusions of the authors.

Our results, in particular the marked dynamics of changes in the level of galvanic currents in the mouth, fully correspond with the conclusions that are framed in the newest works of leading researchers of syndrome of galvanism. (Lebedev KA, Juruli NB, Mitronin AV et al. 2007 ) In particular the observations of some authors are confirmed that even composites and plastics can affect the increase of galvanic currents (which is why, when a syndrome of galvanism occurs plastic crowns are also removed), although to a much lesser extent than the metal. (Lebedev KA, Ponyakina I. D 2006 ; Sagan NN Ponyakina ID, Sagan LG et al. 2006) It is also clear that inclusion of metal, including titanium, even in the absence of other metal elements increases the number of galvanic currents. But it is natural, that the presence of a second inclusion greatly enhances the dynamics of the increase of the potential difference. These facts are obvious to scientists, but not fully realized by all dental practitioners. (BumgardnerJ. D., Johansson B. I. 1998 ; Kuserova H., Dostalova T. , Prochazkova J., et al.2002; Taher N. M. , Jabab AS 2003)

 

Conclusion

The results of our study again clearly demonstrated, that such a serious disease, as galvanic syndrome in oral cavity is a disease of incremental nature, and the basics lie in a thoughtless usage of metals during many years by specialists who often do not even think about the complications of this kind.

The authors, of course, does not call for an end of usage of titanium pins, or any type of metal structures. We only encourage to treat with more responsibility and chose materials better and in a more balanced manner, bearing in mind that the patient in the future can have numerous metal parts, and a much-needed uniformity of metals is best to start at the earliest stages – just by setting pins. Therefore, if possible, you should avoid installing metal elements where you can use a non-metallic material, which would be equal to the final results of the metal and even surpassing it. When installing a metal element it is needed to register the type of metal in medical report for competent conduction of further treatment.

 

Comparative analysis of the usage of titanium and fiberglass pins in the light of the compliance of galvanic alertness.

V.G.Tatintsyan,  R.V. Mamikonyan

Yerevan State Medical University after Mkhitar Heratsi

Department of Therapeutic and family dentistry, Dental Clinic "Mirana Dent"

Based on my personal clinical and laboratory research, as well as medical literature of the recent years, I noticed that the usage of titanium pins encreases, although slightly, the galvanic currents inside oral cavity. This effect does not occur when using ion pins. This fact presents medical solemnity, when the appearance of other metallic constructions inside the oral cavity of the patients is taken into consideration.

Keywords: galvanic currents; galvanism syndrome; titan pins; fiberglass pins; galvanic allertness.

 

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