الفهرس 
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Abstract
Summary
This in-vivo study was designed to assess the antibacterial effect of different GIC formulations and their clinical performance over a nine-month period.
GIC was modified by CHX, CS, and TiO2 forming three groups divided randomly by the type of restoration:
The selected teeth were divided into groups randomly according to the type of restoration:
• group CS: Glass ionomer cement liquid was mixed with chitosan hydrogel.
• group CTI: In which CS hydrogel was added to GIC liquid and TiO2 nanoparticles powder was mixed with GIC powder.
• group CHX: Positive control group where the glass ionomer powder was mixed with chlorhexidine diacetate powder.
Thirty-nine restorations in primary molars were placed for 20 children, the teeth did not have any pathology other than an occlusal caries D2 (ADA CCS) that did not have any signs or symptoms. the caries was removed from all the walls, then only soft caries was removed from the floor, a dentine sample was taken for the baseline levels of bacteria and then different formulations of GIC were placed, then the WBFS was used to evaluate the pain produced by the procedure.
Nine months later the clinical performance of the restorations was evaluated using the USPHS criteria, then the restorations were removed, and another dentine sample was taken for the follow-up antibacterial test, and another WBFS assessment was done.
One-Way ANOVA followed by Tukey’s post-hoc test was used to compare percentage change in streptococcus mutants count between different modified GIC restorative materials. Kruskal-Wallis test followed by Mann-Whitney test were conducted to compare percentage change in total bacterial count between different modified GIC restorative materials. Chi-square test was conducted to compare the frequency of modified USPHS scores of each outcome between restorative materials. Kruskal Wallis followed by Mann-Whitney test was used to compare mean scores of WBFS between different modified GIC restorative materials. Wilcoxon signed rank test was used to compare mean scores of WBFS between two visits.
The results showed that:
1. CTI showed the highest antibacterial effect against S.mutans at 97.48% S.mutans reduction and with CS showing a similar reduction of S.mutans by 96.37% with a statistically non-significant difference between them, and the least effective was CHX at 73.01% with a statistically significant difference.
2. Total bacterial count was reduced mostly by CTI by 91.84%, by 80.80% by CS, CHX reduced it by 72.55% these differences were statistically non-significant but might have a clinical significance.
3. The difference in clinical performance scores were non-significant except for the CTI group where there was a significant difference of mostly bravo scores due the bright white color of the restorative.
4. There was no significant difference in pain in the groups with the highest mean of pain on the scale being 2.33 out of 10.
Based on the results of the study, adding CS and TiO2 to GIC may act as a suitable supplementary method for inhibiting the residual bacteria in dentine. Furthermore, this might increase the success and acceptance of MID indirect pulp capping approach where carious dentine is left behind without resorting to pulp therapy in all cases.