Could night-guards be used as a simple method to detect leached-elements from dental restorations intra-orally? A study on amalgam restorations

Background: Detection of leached-elements from dental restorations intra-orally has been a subject of prime importance in dental research. However, this is challenging as most of the present techniques have some limitations. In this study, a new simple method was proposed via using night-guards. Thus, the aim of the study was to verify if night-guards could detect leached-elements from restorations as dental amalgam. Methods: : Ten upper custom-made night-guards were fabricated for patients suffering from bruxism, who had amalgam-restorations in their upper molars. The night-guards were delivered to the patients and they were instructed to wear the night-guards during when they were asleep. After six months, the night-guards were taken from the patients to be analyzed. A new unused night-guard was fabricated from the same material to be used as a control. In the used night-guards, two areas were studied: the fitting surfaces contacting the amalgam restorations and the fitting surfaces not contacting amalgam restorations. Scanning Electron Microscopy (SEM) and Energy Dispersive X-ray Analysis (EDXA) were used to examine the structural and elemental changes in the night-guards.   Results: : SEM of the unused night-guard revealed a homogenous structure, and the composition was carbon and oxygen, as shown using EDXA (C=88.9wt% and O=11.1wt%). By contrast, the fitting surfaces of the night-guards contacting amalgam restorations showed numerous lustrous particles. Elemental analysis of these areas showed the presence of mercury and sulfur, in addition to carbon and oxygen (Hg=21.2wt%, S=2.5wt%, C=67.1wt% and O=9.2wt%). The night-guards’ fitting surfaces not contacting amalgam restorations showed slight cracking, and the composition was carbon and oxygen (C=88.3wt% and O=11.7 wt%).  Conclusions: : Analyzing fitting surfaces of night-guards contacting dental restorations, such as amalgam, could aid in understanding the nature of leached-elements from these restorations intra-orally. However, further studies about its application upon dental-restorations other than amalgam are recommended.