Effects of flowable composite lining and operator experience on microleakage and internal voids in class II composite restorations

Class II restorations: influence of a liner with rubbery qualities on the occurrence and size of cervical gaps

The aim of this study was to evaluate the ability of new rubbery liners, used as a cervical increment, to relieve contraction stress and thereby reduce the formation of cervical gaps in class II composite restorations. The investigated liners were made of polyester-acrylate (PE(1), PE(2) or PE(3)) or silicone-acrylate (S), mixed with UDMA, without (A, B, C, D) or with HEMA (AH, BH, CH, DH). A silanized filler was added to the mixture, DH, to give composites with 20, 40, 60, and 70% (w/w) of filler (DHF20, DHF40, DHF60, DHF70, respectively). The presence and width of cervical gaps were determined using a light microscope. Statistical analysis showed that six of the 12 rubbery liners (AH-DH, DHF20-DHF40) significantly decreased gap formation in comparison with the control group. In addition, the polymerization shrinkage, flow, and strain capacity of these liners were measured and the influence of these factors on gap formation was examined. Two- and three-dimensional regression analyses showed significantly negative linear correlations between gap formation and strain capacity, and between gap formation and flow, and a significantly positive linear correlation between gap formation and shrinkage.

Effect of 1-bottle light-cured adhesive acidity on microleakage of a self-cured composite

This in vitro study examined the effect of 1-bottle light-cured adhesives with different acidities on the microleakage of a self-cured composite in Class II restorations. Forty-five Class II cavities were prepared on the proximal surfaces of extracted human intact third molars that were randomly assigned to 3 groups (15 cavities in each group). The following adhesives were applied according to the manufacturer's instructions: Single Bond (Group 1), Excite (Group 2) and One-Step (Group 3). The teeth were restored with a combination of a self-cured resin composite (Concise) and a light-cured resin composite (Filtek P60). After thermocycling (500 cycles at 5 degrees C/55 degrees C) and immersion in 2% basic Fushin, the teeth were sectioned and evaluated for microleakage using a stereomicroscope (16x). Microleakage was scored on a scale of 0 to 3. Kruskal-Wallis analysis showed that there was a significant-difference in microleakage values of 3 adhesives with a self-cured composite, and low pH may have contributed to high microleakage values. Also, 2 by 2 comparisons with the Mann-Whitney U-test revealed a significant difference at the p<0.05 level between Groups 1 and 2 and between Groups 2 and 3. However, there was no statistically significant difference between Groups 1 and 3.

Microleakage after thermocycling of 4 etch and rinse and 3 self-etch adhesives with and without a flowable composite lining

This study evaluated the microleakage of composite fillings prepared with 4 etch and rinse and 3 self-etch adhesive systems after thermocycling. Also evaluated was the potential improvement of cavity sealing when utilizing a low charged resin lining for cavity preparations. Seventy recently extracted teeth were randomly allocated to 7 experimental adhesive systems: two 3-step etch and rinse adhesive systems, Scotchbond Multipurpose (SBMP) and Optibond Solo Plus (OS); two 2-step etch and rinse adhesive systems, referred to as "one-bottle," Scotchbond 1 (SB1) and Gluma Comfort Bond + Desensitizer (G); and 3 self-etch "all-in-one" adhesives, Adper Prompt-L-Pop (PLP), Xeno III (X-III) and iBond (iB). On each tooth, 2 rectangular cavities were prepared at the cemento-enamel junction: 1 cavity was prepared with adhesive and the hybrid composite and the second was filled with the same adhesive and a thin layer of flowable composite (Filtek Flow) under the resin composite (Z100). All teeth were thermocycled for 800 cycles (5 degrees C-55 degrees C, 30 seconds dwell time). Leakage was evaluated on a 6-point (0-5) severity scale for enamel and dentin on 4 interfaces for each restoration. The results are expressed as means +/- standard deviation (SD). Microleakage scores were analyzed by means of generalized linear mixed models (GLMM), assuming an ordinal logistic link function. Covariates in the model were: (1) adhesives, (2) fluid composite and (3) interface. The model also accounts for repeated measurements on the various teeth. The authors found that the mean score of microleakage per tooth was significantly higher at the enamel rather than at the dentin interfaces (1.21 +/- 0.51 and 0.87 +/- 0.48; p<0.0001). In this study, there was no significant difference among the 4 etch and rinse adhesive systems. On the other hand, these adhesives yielded smaller mean scores of microleakage than the 3 self-etch systems (respectively, 0.85 +/- 0.2 and 1.3 +/- 0.5; p<0.0001). Among the self-etch adhesives, microleakage was significantly greater for PLP (1.74 +/- 0.46) than for the other self-etch products (p<0.0001), while X-III, an intermediary strong self-etch, was found to be as good as the etch and rinse systems, with a mean score of 0.97 +/- 0.27. In addition, results have also shown that an under layer of flowable composite significantly improved the water tightness of the PLP adhesive restorations (p=0.042). This in vitro study concluded that the self-etch adhesives remain less effective than etch and rinse. Nevertheless, X-III, a self-etch adhesive, showed acceptable performance in accordance with this study's 6-point severity scale of microleakage, but this needs to be confirmed in further clinical studies. On the other hand, this study failed to reveal that the addition of a thin layer of fluid composite improved the water tightness of the restoration, except for PLP.

Sealing capacity of a photochromatic flowable composite as protective base in nonvital dental bleaching

AIM

To evaluate microleakage of a flowable composite used as a protective isolating base, applied with different adhesive systems.

METHODOLOGY

Seventy root-filled teeth were divided into seven groups. A flowable composite base (Tetric Flow Chroma) was used with three adhesive techniques (Syntac, Excite, Excite DCS; in the three cases with and without acid etching) and in a control group without dentine conditioning or adhesive placement. A 30% hydrogen peroxide solution was applied for 24 h in the pulp chambers, followed by the placement of a dye (silver nitrate) for 4 h. Each tooth was sectioned longitudinally, and examined under 4x magnification to assess the tooth/restoration dye leakage following a four-degree scale. Percentage of dye penetration was registered. Statistical analysis was made through the Tukey and Mann-Whitney U-tests.

RESULTS

Maximum leakage (100% of specimens) was recorded in the control group without an adhesive system. In the groups subjected to acid etching, the percentage of leakage corresponded to Excite DSC (10%), followed by Syntac (20%) and Excite (30%). In the groups in which only an adhesive system was used, 50% of the teeth demonstrated dye leakage. Statistically significant differences in terms of leakage were observed between the control group and the experimental groups (P < 0.05). There were no significant differences among the experimental groups, but comparing the leakage percentages obtained between the groups in which the teeth were subjected to prior acid etching, and those in which no etching was carried out, observed differences were significant (P = 0.04).

CONCLUSIONS

There were no significant differences between the adhesive systems in terms of leakage. Acid etching significantly reduced leakage.

Can a single composite resin serve all purposes?

The consensus view less than a decade ago was that direct posterior composites should be restricted to small restorations, preferably in premolar teeth with little, if any, occlusal function. Major advances in adhesive systems, materials and restorative techniques have combined to allow us to question this view and our increased clinical evidence base makes it appropriate to reconsider this viewpoint.

In vivo interfacial adaptation of class II resin composite restorations with and without a flowable resin composite liner

The aim of this study was to evaluate in vivo the interfacial adaptation of class II resin composite restorations with and without a flowable liner. In 24 premolars scheduled to be extracted after 1 month, 48 box-shaped, enamel-bordered class II cavities were prepared and restored with a flowable liner (FRC, Tetric Flow/Tetric Ceram/Syntac Single-Component) or without (TRC), cured with three different curing modes: soft start and 500- or 700-mW/cm2 continuous irradiation. Interfacial adaptation was evaluated by quantitative scanning electron microscopic analysis using replica method. Gap-free adaptation in the cervical enamel (CE) was observed for FRC and TRC in 96.2 and 90.2%, for the dentin (D) in 63.6 and 64.9%, and for occlusal enamel (OE) in 99.7 and 99.5%, respectively. The difference between the two restorations was not statistically significant (ns). Significant better adaptation was observed for OE than CE and D (p<0.01), and for CE than D (p<0.01). Gap-free adaptation with the soft-start and 500- and 700-mW/cm2 continuous-curing modes was observed for CE: 88.7%, 92.7%, 97.9% (ns); OE: 99.8%, 98.7%, 100% (ns); and D: 64.0%, 63.9%, and 64.6% (ns), respectively. It can be concluded that neither the use of flowable resin composite liner nor the curing mode used influenced the interfacial adaptation.

Relative wear of flowable and highly filled composite

STATEMENT OF PROBLEM

By decreasing the proportion of filler, flowable composites are easy to adapt to small cavity preparations. However, the wear resistance of flowable composites is a clinical concern, as improved wear has been related to increased filler percentage.

PURPOSE

The purpose of this study was to compare wear for flowable composites and comparable heavily filled materials.

MATERIAL AND METHODS

Wear by attrition and abrasion (microm) of microfilled flowable (Heliomolar Flow) and heavily filled microfill (Heliomolar HB) was measured and compared to a microhybrid flowable (Tetric Flow) and a heavily filled microhybrid (Tetric HB). There were 5 specimens, 2 mm thick and 15 mm in diameter, in each group. The Oregon Health Sciences University oral wear simulator was used to produce abrasive wear and attrition for all specimens. Abrasion and attrition of the substrates were measured using a profilometer. Data were subjected to a 3-way analysis of variance for the 3 main factors: composite type, filler load, and wear type (alpha=.05)

RESULTS

Composite wear rates were significantly influenced (P <.01) by both the type of wear and the filler amount. Abrasive wear occurred less than wear by attrition, and the heavily filled composites experienced less wear than the flowable composites.

CONCLUSIONS

Results of this in vitro study suggest that highly filled microhybrid composites may have greater wear resistance for contact-supporting posterior restorations. However, in small noncontact restorations where longevity may be dictated by abrasion, flowable microfilled resins may be adequate.

Effects of flowable resin on bond strength and gap formation in class I restorations

OBJECTIVES

This study measured resin/dentin bond strengths and evaluated gap formation at the pulpal floor of occlusal composite restorations using a flowable resin as a liner with either bulk or incremental placement of the restorative composite.

METHODS

Class I occlusal preparations were made in 16 extracted molars, and were randomly divided into two groups for restoration using either One-Step adhesive (OS, BISCO) and Renew composite (RW, BISCO) or OptiBond SOLO adhesive (SOLO, Kerr) and Herculite XRV composite (XRV, Kerr). A flowable resin [AEliteFlo (AE, BISCO) or Revolution (RV, Kerr)] was applied as a liner in half of the specimens of each group. The lined and unlined groups were restored with composite cured in bulk, or cured in 1.5 mm increments. After 24 h in water, the teeth were sectioned into 0.7-mm thick slabs and were examined with an optical microscope (400 x) to determine the presence of internal resin-dentin gaps. The gap-free specimens were trimmed and were subjected to microtensile bond strength testing. Specimens that contained gaps had Knoop hardness of the restorative material measured.

RESULTS

All incrementally filled restorations were well adapted to the pulpal floor but nearly all bulk-cured specimens had gaps between the flowable and the hybrid composites. The use of a flowable resin increased the bond strength of OS, but not SOLO.

SIGNIFICANCE

The incremental technique prevented gap formation regardless of the use of a flowable resin. In contrast, the use of a flowable composite did not guarantee gap-free restorations or improved bond strength of resin to dentin in bulk-filled restorations.

Contraction stress of flowable composite materials and their efficacy as stress-relieving layers

BACKGROUND

The authors compared the polymerization contraction stress produced by flowable resin-based composites with stress values produced by nonflowable composites. They also measured the stress reduction produced by placing a precured layer of flowable composite under a nonflowable composite.

METHODS

The authors first tested four flowable and six nonflowable composite materials for contraction stress in a tensiometer. In the second part of the study, they applied a 1.4-millimeter-thick layer of flowable composite or unfilled resin and precured it in the test apparatus to assess the stress relief produced by a low-modulus material during light curing of a subsequent layer of highly filled composite. Flexural moduli of the precured materials were determined via a three-point bending test.

RESULTS

The stress values ranged between 6.04 and 9.10 megapascals. The authors found no significant differences in stress between flowable and nonflowable composites. Microfilled composites produced lower contraction stress than did hybrids. The flexural modulus of the flowable composites varied between 4.1 and 8.2 GPa. Regarding the effect of a precured layer of composite on contraction stress, the authors observed significant reductions with only one of the flowable materials and with the unfilled resin.

CONCLUSIONS

The flowable composites produced stress levels similar to those of nonflowable materials. Most of the flowable materials tested did not produce significant stress reductions when used under a nonflowable composite.

CLINICAL IMPLICATIONS

Using a flowable resin-based composite as a restorative material is not likely to reduce the effects of polymerization stress. When used in a thin layer under a nonflowable composite, the stress reduction depended on the elastic modulus of the lining material.