Miswak-Infused Glass Ionomer Cement: A Comparative In Vitro Analysis of Antibacterial Efficacy and Compressive Strength

Background: Glass ionomer cement (GIC) restorations are commonly used in primary dentition, due to their aesthetic appeal, self-adhesive nature, and biocompatibility. However, the material's limited antibacterial activity and inadequate mechanical strength highlight the necessity for modifying the material. Aim: The study aims to evaluate and compare the antimicrobial potency and compressive strength of GIC-incorporated Miswak extract with that of conventional GIC. Materials and methods: After obtaining the Miswak extract, a modified GIC was formulated by combining the extract with the conventional GIC powder and liquid components, in three different ratios (Powder: Extract and Liquid), Group I (2:1:1), Group II (3:1:2), Group III (3:2:1), and the Group IV as control, which consist of unmodified/conventional GIC. To evaluate and compare the antibacterial efficacy of the modified and unmodified GIC, standard strains of Streptococcus mutans and Lactobacillus were utilized. For each group, the minimal inhibitory concentration (MIC) assay was tested. For the evaluation of compressive strength, cylindrical moulds were utilized in compliance with ISO 9917-1:2007 standards and tested using the universal testing machine (Instron, ElectroPuls (R), Bangalore, IND). The highest force exerted at the point of specimen fracture was recorded to calculate the compressive strength values in MPa. The data obtained were analyzed using the Statistical Package for the Social Sciences (IBM SPSS Statistics for Windows, IBM Corp., Version 24.0, Armonk, NY) software. The statistical analysis was conducted utilizing repeated measures of analysis of variance (ANOVA) to calculate the mean MIC values and compressive strength, with pairwise comparisons assessed using Tukey's post hoc test. Results: The results proved that the antimicrobial properties of Miswak containing GIC performed better against S. mutans and Lactobacillus with a statistically significant difference when compared with group IV (p<0.05), it has been found that an increase in the concentration of extract increased the antimicrobial potency. Significant results were obtained in compressive strength where Group II (41.49 +/- 3.6) and Group III (15.23 +/- 4.96) proved to be weaker than the control (62.69 +/- 2.58), while Group I showed no differences from the control group (p>0.05). Conclusion: It can be concluded that Group I was found to be better in terms of both antimicrobial properties and compressive strength, where no significant difference in compressive strength was identified when comparing Group I with Group IV. Thus, the overall study depicts that a lesser concentration of extract can be the best option in terms of good antimicrobial properties without altering its strength. Hence, the Miswak containing GIC could be a promising restorative material; further studies should include considering intraoral variables such as masticatory stress, moisture levels and in-vivo tests of this combination.