Noncarious cervical lesions: the decision to ignore or restore

Comparison of three methods of critical evaluation of microleakage along restorative interfaces

This in vitro study compared microleakage along the dentin-restorative interface by use of a conventional single-surface and two stereoscopical protocols. The extent of microleakage in class V cylindric cavities that were restored with Scotchbond 2/P-50 was assessed after thermocycling and silver staining were performed. Specimens were randomized into three groups of 10 teeth for the three different protocols to be investigated. The categories were group 1, a single longitudinal section through the midline of the restoration, group 2, a multiple-surface protocol based on computer reconstruction of digitized images from multiple serial abrasions, and group 3, a clearing protocol based on immersion of demineralized specimens in methyl salicylate. The severity of microleakage for all groups was recorded on an ordinal scale and based on linear leakage length. The median leakage score for groups 1 through 3 was 2, 4, and 4, respectively. When comparisons were performed with nonparametric statistical analysis, both the clearing and the multiple-surface protocols recorded significantly more severe leakage than those detected from a conventional, single longitudinal, midline sectioning technique, (x2 = 8.595, p < 0.02). Furthermore microleakage patterns generated from the two stereoscopical protocols revealed extensive microleakage that advanced unilaterally or bilaterally through the dentin-restorative interface along the embrasure regions into the axial wall of the restorations. No significant difference was noted between the two stereoscopical protocols (Q = 0.260, p > 0.05), which suggested that the clearing protocol, which is less labor-intensive than the multiple-surface protocol, may be recommended for future comparative microleakage studies that involve the dentin-restorative interface.

Variability in microleakage observed in a total-etch wet-bonding technique under different handling conditions

Using a stereoscopic clearing protocol and scanning electron microscopy, we investigated the extent and nature of microleakage in a total-etch, current-generation dentin adhesive by a wet-bonding technique under different handling conditions. The hypotheses were that inadequate light curing of the primer or incomplete drying of the primer solvent might adversely affect the sealing ability of an acetone-containing adhesive system. The study consisted of three experimental groups: (I) a control group with an adequate light source and with the primer solvent completely dried; (II) an "inadequate-light" group; and (III) an "incomplete evaporation of primer solvent" group. The extent of microleakage after silver staining and clearing of the specimens was scored based on a modified five-point scale. Nonparametric statistical analysis (Kruskal-Wallis ANOVA) followed by a multiple comparison test (Dunn test) indicated significant differences among the three groups (p < 0.05). SEM examination of the restorative interface revealed that microleakage appeared to be initiated from the bonding resin-hybrid layer interface in all three groups, representing the weak link in the adhesive system. In addition, microleakage was characterized by 5 zones, each delineating a stage in a continuous array of progressively deleterious microleakage patterns variously distributed among the three groups. It was suggested that, while the bonding resin-hybrid layer interface represented the intrinsic weakness in an already much improved dentin adhesive, extrinsic factors such as the adequacy of the curing light and, more importantly, complete removal of the primer solvents can and should be avoided to preserve the structural integrity of the marginal seal.

Dental 'erosion' revisited

The term "erosion," as currently used in dentistry, is not only a misnomer but also is misleading, according to the authors. The authors highlight the critical roles of occlusal function and parafunction in the multifactorial etiology of cervical lesions and relate their significance to clinical practice. They propose a revised nomenclature for and classification of dental hard tissue lesions.