Cytotoxicity test of 40 , 50 and 60 % citric acid as dentin conditioner by using MTT assay on culture cell line

Background: Open dentin is always covered by smear layer, therefore before restoration is performed, cavity or tooth which has been prepared should be clean from dirt. The researchers suggested that clean dentin surface would reach effective adhesion between resin and tooth structure, therefore dentin conditioner like citric acid was used to reach the condition. Even though citric acid is not strong acid but it can be very erosive to oral mucous. Several requirements should be fulfilled for dental product such as non toxic, non irritant, biocompatible and should not have negative effect against local, systemic or biological environment. Cytotoxicity test was apart of biomaterial evaluation and needed for standard screening. Purpose: This study was to know the cytotoxicity of 40, 50, 60% citric acid as dentin conditioner using MTT assay. Method: This study is an experimental research using the Post-Test Only Control Group Design. Six samples of each 40, 50 and 60% citric acid for citotoxicity test using MTT assay. The density of optic formazan indicated the number of living cells. All data were statistically analyzed by one way ANOVA. result: The percentage of living cells in 40, 50 and 60% citric acid were 95.14%, 93.42% and 93.14%. Conclusion: Citric acid is non toxic and safe to be used as dentine conditioner.


introduction
The structure of natural tooth is limited structure, therefore it should be maintained and protected as long as possible, consequently, in selecting restorative material, some aspects are necessarily considered in order to obtain the most proper material. 1Open dentin is always covered by smear layer therefore, before restoration is performed, cavity or tooth which has been prepared should be clean from dirt produced during preparation, bacteria produced by carries or should not be contaminated by environment. 2he researchers suggested that clean dentin surface would reach effective adhesion between resin and dentin material, therefore dentin conditioner is used to reach the condition. 3entin conditioner is solution which is polished on dentin surface. 4The term of dentin conditioner can be meant as an effort to make or to prepare dentin surface to be able to accept dentin bonding.Dentin conditioner usually consist of weak acid solution and design to modify or clean the smear layer on dentin surface which has been prepared to be able to function well as supporting material for dentin bonding.The material can also be capable to wet the dentin surface, it can decrease constrain of dentin surface.In this way dentin bonding material can penetrate more into dentin tubule and finally the condition of binding each other can be reached. 5entin conditioner technique for glass ionomer cement bonding in tooth substrate is applied in dentistry field with the aim to increase adhesion between resin and tooth substrate. 5Glass ionomer cement is widely applied in class V cavity on cervical tooth which is bordered by gingival, prior to cement application in the cavity, clean surface is conditioner.In vitro study on the surface of the third molar showed that the effect of 40, 50 and 60% citrate acid dentin conditioner was effective. 6Citric acid is not strong acid but Research Report it can be very erosive due to the capability to bind metal ion.The other researcher found that influence of citrate acid is necessarily observed if it has surface contact either in enamel or dentin.Enamel surface which is polished by citric acid will be erosive.Smear layer will disappear from dentin and open dentin tubule through the loss dentin perihedral. 7Powis et al. 8 suggested that the effect of citric acid is necessarily observed if it gets into contact with the surface either polished enamel or dentin.Enamel surface which is polished by citric acid will be erosive.Optimal adhesion will not be reached using excessive amount of citric acid or citrate acid in excessive high concentration.The loss of smear layer and tubule opening can cause tooth demineralization. 7he requirement of dental product applied in dentistry are non toxic, non irritant, biocompatible and should not have negative effect against local, systemic or biological environment. 9Cytotoxicity test of a material can be done using enzymatic test MTT [3 -(4.5-Dimethylthiazol-2YL); 2.5-diphenyltetrazolium bromide].MTT test is used to measure the capability of living cell based on mitochondria activity of culture cell which can reduce yellow tetrazolium bromide into insoluble purple blue formazan endapan.The product of formazan is solved by solvent in order to be easily detected.In this way, the number of detected living cell using spectrophotometer as the result of MTT product.The darker the color of purple blue, the higher the absorbent score and the higher the number of living cell this test is widely used to measure quantitatively cellular proliferation or the number of living cell. 10The advantage of this test is the accuracy and sensitivity measurement because the spectrophotometer which is used can detest clearly metabolism alteration, can easily be manipulated, and available at the laboratory, can save time and energy and it does not use radioactive isotope.Based on the above reasons, in this study MTT test was used to test the cytotoxicity of dental material using fibroblast culture cell of Baby Hamster Kidney-21 (BHK-21) considering the origin of this cell is embryonic cell so it would be easily grow and repeated subculture is easily done, having stable character, sensitive and mutation does not occur. 11Based on the above aspects, the problem arises whether there is different cytotoxic effect of 40, 50 and 60% citrate acid dentin conditioner on MTT test.
The purpose of this study was to prove the cytotoxicity of 40, 50 and 60% citric acid as dentin conditioner using MTT assay.The advantage of this study would inform the safety of citric acid as dentin conditioner, especially for dentistry colleague before filling the cavity and citric acid can be alternative material for dentin conditioner.

material and method
This study is an experimental research using The Post-Test Only Control Group Design.Fibroblast cell culture (Baby Hamster Kidney-21) was used with the number of samples was 8 based on the estimation, material and tools were applied such as: incubator for cell culture, micro-plate reader, micropipet multi channel, roux bottle, yellow tips, laminar flow, MTT reagent (sigma), saline water, dimetilsulfoksid (DMSO) solution, 40, 50 and 60% citric acid, cell culture of baby hamster kidney (BHK-21), culture media Rosewell Park Memorial Institute-1640 (RPMI-1640) 89%, 1% Penstrep, 10% Fetal Bovine Serum (FBS), 100 until/ml fungizone, Phosphate Buffer Saline (PBS).
Cell culture of BHK-21 in cell-line form was embedded in roux bottle.After it was confluent, the culture was harvested using trypsine versene solution.The result was embedded in media Rosewell Park memorial institute 1640 containing 10% fetal bovine serum albumin incubated for 24 hours at 37° C. the cell was cultured in every microplate 96-well until confluent.Every well contained cell and RPMI media with 2 × 10 5 cell/ml density in 50m then each well was given 20 m of 40, 50 and 60% citric acid.Each group consisted of 8 samples.Control cell was prepared as positive control, and it was considered the percentage of living cell was 100%.Control media as negative control considered the percentage of living cells was 0%.The microplate was incubated at 37° C, then, removed from incubator, added by 5 mg/ml MTT in PBS 20 m for every well, incubated again for 4 hours.Next, every well was added by 50 ml DMSO.Formazan which had been formed was solved by into the solvent and the absorption was measured by a reader using spectrometer with 595 nm ware length.To know the percentage member of living cell, the equation below was used. 12The data tabulated, then, statistical analysis using One-Way ANOVA test with 5% significant rate was done and continued by Tukey HSD test if there was significant difference.The mean of formazan optic density, standard deviation, percentage of living cell could be seen on table 1.In tested group has show significant decrease.Percentage of living cell that is percentage of optic density of dehydrogenase mitochondria enzyme in cell culture of BHK-21 as well as in control media has shown in table 1.
Table 1 shows all distribution group is normal, continued by parametrix test of one way ANOVA to know the difference in the group with 5% significant rate (Table 2).
Table 2 shows there is significant difference in every citric acid group and control, therefore continued by Tukey HSD seen on table 3. Citric acid is weak organic acid, functions as natural preservative substance, cleansing material and anti oxidant, used to add sour taste in food and soft drink, found in fruit especially citrus and vegetable.Lemon and lime have the highest content of citric acid which containing 8 % of the whole fruit weight. 13entin conditioner is solution which is polished on dentin surface. 4The term of dentin conditioner can be meant as an effort to prepare dentin surface so that it can accept dentin bonding.Dentin conditioner usually consist of weak acid solution such as citric acid and designed to clean smear layer on dentin surface which has been prepared so that it can function well as supporting material of dentin bonding.The method is previously wetting dentin surface before polishing by dentin bonding.Then, conditioner is cleansed using water spraying and dried by air blowing.So, dentin conditioner is solution which is polished on dentin surface before being covered by dentin bonding. 5he adhesion mechanism has not been exactly exposed, probably, this material could be wet much better the dentin surface.In this way, dentin bonding material can penetrate deeply into dentinal tubule and then bound each other. 4n this study, citric acid was used as dentin conditioner material.Citric acid would permanently demineralized dentin surface by erasing smear layer and the most superficial dentin.The acidity of dentin conditioner would open dentinal tubule and making tissue of collageneous fibre due to microporousity which is filled by water in intratubular and peritubular dentin. 14,15The use of demineralized material on dentin surface is to improve the bond strength between tooth and restorative material.
There are some controversial opinions on dentin conditioner.Currently, dentin conditioner of third generation is made of weak acid, one of them is citric acid.However, the safety of citric acid in high concentration is still doubtful, considering strong acid such as 37% phosphate acid has proven that dentin bonding containing strong acid is very dangerous for the vitality of pulp tissue.Citric acid as dentin conditioner can wash smear layer by hydroxiapatite dentin reaction.Citric acid will release hydrogen ion so dentin structure would be demineralized.Citric acid will bind calcium ion substrate phosphate ion in hydroxiapatite structure. 16ne of the requirement of dental product to be applied in oral cavity should be biocompatible such as nontoxic substance. 9In vitro study of cytotoxicity using MTT assay on culture cell lines are used due to the advantages such as passage can be done 50-70 times, high rate cell growth, well maintained cell integrity, cell is capable of multiplying in suspension cell lines have been widely applied in toxicity test for dental material and medicine, such as cell of BHK-21. 17The result using BHK-21 can be applied as accurate basic test. 18MTT is yellow soluble molecule which can be used to evaluate cellular enzymatic activity based on the capability of living cell to reduce MTT.The mechanism is yellow tetrazolium salt would be reduced in cell which has metabolic activity. 19,20Mitochondria are the principle sites for synthesis of adenosine triphosphate, surrounded by two membranes, which are structurally and functionally distinc.2][23] If dehydrogenase is not active due to cytotxicity effect, formazan will not be formed.The number of formed formazan is equal to enzymatic activity of living cell.
The result of this study shows the living cell of 40% citrate acid = 95.14%, group 50% = 93.42%, group 60% = 93.14%.The result of HSD test shows significant difference between control group and citric acid group.Decreasing number of living cell in each tested group shows cytotoxicity of citric acid basically due to the effect of acidity than the content of citrate acid it self.Most common case of dead cell due to citric acid can be prevented by regulating pH of culture media to be 7.5.In the study using sodium citric in 47.6% mmol/L concentration can cause almost no dead cell effect. 24The percentage of living cell in every tested group is almost 100%, meaning dentin conditioner of 40, 50 and 60% citric acid is safe due to good biocompatibility limit for the number of living cell 92.3-100%. 19This score is higher compared to the limit used by Telli et al., 25 suggested that the parameter of toxicity based on CD 50 meaning that material which is thought to be toxic if the percentage of living cell is below 50%.The number of living cell after citrate acid application in this study shows citric acid is relatively safe and it is supported by other study indicates that this acid can cause less dentin resorption and less coagulation in blood and tissue compared to other acid materials, reaction on the pulp will not occur and can have reaction with hydroxiapatite dentin. 16The advantages of using citric acid are: cheap, easily applied and bought.However, the pulp is necessarily protected before the acid is applied.Especially thin dentin in deep caries of the occurrence of channel on root surface.
The conclusion is cytotoxicity test using MTT Assay shows 40, 50 and 60% citric acid is not toxic and safe for dentin conditioner.Further in vivo study is necessarily done to know completely the biocompatibility effect.Citric acid concentration in clinical use is essentially observed considering the acid concentration as dentin conditioner is different from the concentration as material of root canal irrigation.

table 1 .
Mean of formazan optic density, standard deviation, percentage of living cell

table 3 .
The result of Tukey HSD test shows the difference of living cell percentage between control group and 40, 50 and 60% citric acid group S for significant and NS for non significant discussion

table 2 .
The ANOVA result from fibroblast cell on citric acid and control cell