Influence of different restorative techniques on marginal seal of class II composite restorations

A Comparison of Laser and Mechanical Surface Pretreatment Methods on Shear Bond Strength of Resin Composite to Resin-Modified Glass Ionomer

Statement of the Problem

Dentin margins have a higher microleakage than enamel in composite restorations due to weaker bond durability. Clinically, most margins are located apical to cementoenamel junction on the dentin or cementum. Different surface preparation methods may have dissimilar effects on the shear bond strength of resin-modified glass ionomer (RMGI) to composite resin, regarding the layering technique employed in restoration of these cavities.

Purpose

This study aimed to investigate the shear bond strength of RMGI to composite resin using different mechanical surface preparation methods.

Materials and Method

In this in vitro study, 72 RMGI samples were prepared in six groups (n=12): control, acid etching, air abrasion with aluminum oxide (Al₂O₃), bur, Er: YAG laser, and Er, Cr: YSGG laser groups. Two samples from each group were randomly examined under a scanning electron microscope (SEM). A bonding layer and composite resin were applied and cured. Then the samples were subjected to 5000-cycles thermocycling procedure. The shear bond strength was then evaluated using a universal testing machine. Finally, the failed surface of the samples was evaluated under a light microscope to examine the failure mode. For the statistical analysis, one-way ANOVA and Games-Howell post hoc test was used to compare quantitative variables and chi-squared test to investigate the relationship between the failure mode and the groups. The significant level was set at 0.05.

Results

The results showed significant differences between the mean of the strength variable in the groups (p< .001). The acid-etch and air abrasion groups exhibited significantly the lowest and highest values, respectively. The chi-squared test results also showed a significant relationship between the failure mode in the study groups (p= .008).

Conclusion

Acid etching before completing RMGI polymerization could adversely affect shear bond strength. The air abrasion and bur methods are among the best methods to increase the shear bond strength between composite resin and RMGI. Using Er, Cr: YSGG and Er: YAG lasers could increase the bond strength results.

Deep Margin Elevation: Current Concepts and Clinical Considerations: A Review

Dietschi and Spreafico first proposed deep margin elevation (DME) in 1998 to address the multiple clinical problems associated with sub-gingival margins, where sub-gingival margins will be repositioned coronally using composite resin restorations. Given that dentistry is directing towards conservatism, its use is currently trending. Materials and Methods: a search was performed through PubMed, Scopus, and Google Scholar search engines to obtain relevant articles with no time restriction. Results: With biological width taken into consideration, well-defined and polished sub-gingival restorations are compatible with periodontal health. Marginal integrity in the DME technique seems to be affected by the type of adhesive, restoration, and incremental layering of the restoration. Regarding fracture resistance, DME has no significant effects. Conclusion: The DME technique seems to be a minimally invasive alternative to surgical crown lengthening (SCL) and orthodontic extrusion (OE) with respect to biological width. Well-controlled clinical trials are limited in this field; further long-term follow-up studies emphasizing the periodontal outcomes and prevention of complications are needed.

Deep proximal margin rebuilding with direct esthetic restorations: a systematic review of marginal adaptation and bond strength

This review aimed to characterize the effect of direct restorative material types and adhesive protocols on marginal adaptation and the bond strength of the interface between the material and the proximal dentin/cementum. An electronic search of 3 databases (the National Library of Medicine [MEDLINE/PubMed], Scopus, and ScienceDirect) was conducted. Studies were included if they evaluated marginal adaptation or bond strength tests for proximal restorations under the cementoenamel junction. Only 16 studies met the inclusion criteria and were included in this review. These studies presented a high degree of heterogeneity in terms of the materials used and the methodologies and evaluation criteria of each test; therefore, only a descriptive analysis could be conducted. The included studies were individually evaluated for the risk of bias following predetermined criteria. To summarize the results of the included studies, the type of restorative material affected the test results, whereas the use of different adhesive protocols had an insignificant effect on the results. It could be concluded that various categories of resin-based composites could be a suitable choice for clinicians to elevate proximal dentin/cementum margins, rather than the open sandwich technique with resin-modified glass ionomers. Despite challenges in bonding to proximal dentin/cementum margins, different adhesive protocols provided comparable outcomes.

Evaluation of marginal sealing quality of restorations with low shrinkage composite resins

Background

This study compared the quality of marginal sealing in the gingival wall of class II preparations of two low-shirinkage resins of the bulk fill type with a conventional resin isolated or associated with a glass ionomer cement (GIC).

Material and Methods

40 human molars were divided into 4 groups and 80 occlusal-mesial and occlusal-distal restorations were performed with the following materials: SureFil SDR flow, Filtek Bulk Fill Posterior, Z250 resins and Riva Light Cure GIC. 40 restorations were evaluated in Scanning Electron Microscopy (SEM) with Elemental Microanalysis Spectrometry (EDS) initially and the remainder after a period of 6 months of aging in a 37 ± 5°C oven. An average of the silver penetration at each restoration was obtained in the two evaluations and the results were statistically analyzed in a descriptive and inferential way, through the paired t-Student and one-way ANOVA F-test.

Results

There were no significant statistical differences between the materials with respect to silver nanoinfiltration, except for the Bulk Fill Posterior/3M ESPE resin compared to the GIC and conventional resin in the final evaluation.

Conclusions

The low shrinkage resins showed a similar behavior in relation to the marginal sealing quality observed in the GIC or composite resin with the incremental technique, also presenting the advantage of simplicity in the technique of confection of the restorations and reduction of the time of work.

Key words:Resin composites, Bulk fill, dental restorations, marginal quality, adhesion.

Evaluation of the Bond Strength and Marginal Seal of Indirect Restorations of Composites Bonded with Preheating Resin

Objective  Preheated resins (PR) are considered a cementing agent option for indirect adhesive restorations of composite inlays and onlays. The objective of this in vitro study was to evaluate the marginal sealing, adhesive interface, and microtensile bond strength of indirect adhesive restorations of composites in terms of dentin cemented with PR.

Materials and Methods  Standardized Class II preparations were performed on 30 extracted human premolars, impressions were taken, and indirect composite restorations were manufactured. In total, 15 restorations were cemented with PR (ENA HRi, SYNCA), and 15 restorations were cemented with self-adhesive resinous cement (RC) (Relyx U200, 3M ESPE), followed by a thermocycling regime. After that, these were segmented sagittally and longitudinally to evaluate the marginal sealing and the adhesive interface with scanning electron microscopy and confocal microscopy. Microtensile bond strength was assessed with a mechanical device (TA. XT Plus C, Stable Micro System).

Statistical analysis  Statistical analysis was conducted using the two-sample Student’s t -test.

Results  The results showed that there is no statistically significant difference in the degree of microfiltration using PR or RC; however, microtensile bond strength is greater when the restoration is cemented with RC (278.75 N/cm ³ ) than with PR (144.49 N/cm ³ ), and better adjustment and sealing were observed for composite restorations with PR.

Conclusion  PR comprise an alternative cementing agent for indirect composite restorations in Class II cavities in premolars.

Micro-computed tomography evaluation of microleakage of Class II composite restorations: An in vitro study

Objective:

The aim of this study is to investigate the microleakage attained with three resin-based material used to restore deep Class II cavities. A null hypothesis was chosen: there is no difference in microleakage among the tested materials.

Materials and Methods:

A total of 30 Class II cavities were prepared in freshly extracted molars with the proximal mesial and distal margins located, respectively, 1.5 mm apically and 1.5 mm coronally to the cementum-enamel junction. Restorations were completed using a three-step enamel-dentin adhesive system “Etch and Rinse,” margins were relocated using a micro-hybrid, preheated, or flowable composite and restorations were then completed using a conventional composite. All samples were coated with nail varnish with the exception of an area along the margins and apex was sealed using epoxide cement and then thermocycled (30-s dwell time, 5°C/55°C, 1000 cycles). A 50% ammoniac AgNO3 solution was used as tracer according to Tay's protocol. The microleakage analysis was performed using a microtomography system Sky-scan 1072 (SKYSCAN, Kartuizersweg 3B 2550, Konitch, Belgium).

Results:

The mean microleakage of all the tested materials showed greater leakage in the cementum margins; flowable composite exhibit greater leakage among the groups. Significant differences (P < 5%) within groups in both enamel and dentin margins were present. None of the tested materials eliminated marginal microleakage. Preheated composite showed significantly lesser microleakage.

Conclusion:

Tested materials showed statistical differences in microleakage; thus, the null hypothesis has been rejected. Within the limitations of the present experimental procedure, it can be concluded that flowable resin composite should be avoided at the dentin/cementum margin.

Effect of composite/amalgam thickness on fracture resistance of maxillary premolar teeth, restored with combined amalgam-composite restorations

Background

Combined amalgam-composite restorations have been used through many years to benefit from the advantages of both dental amalgam and composite resin. Two variations have been mentioned for this technique, this study investigated the fracture resistance of maxillary premolar teeth with extended mesio-occluso-distal (MOD) cavities, restored with the two variations of combined amalgam-composite restorations.

Material and Methods

Sixty intact extracted premolar teeth were randomly divided into 6 groups (G1-G6) of 10 teeth. G1; consisted of intact teeth and G2; consisted of teeth with MOD preparations were assigned as the positive and negative control groups respectively. Other experimental groups after MOD preparations were as follows: G3, amalgam restoration; G4, composite restoration; G5 combined amalgam-composite restoration with amalgam placement only on 1mm of the gingival floor of the proximal boxes; G6, combined amalgam-composite restoration with amalgam placement to the height of contact area of the proximal surface of the tooth. Fracture strength of the specimens was measured and the data were analyzed using one-way analysis of variance (ANOVA). The level of significance was P<0.05. Fracture mode of the specimens was also recorded.

Results

G1 had the highest value of fracture resistance (1736.90 N). G2 and G3 had the lowest fracture resistance (775.70 N and 874.70 N, respectively). The difference between G 4, 5 and 6 was not statistically significant. However, G4, G5 and G6 showed significantly higher resistance to fracture compared to G2 and G3. Fracture modes were favorable in all of the study groups except in G6.

Conclusions

Fracture resistance of the premolars restored with the two variations of combined amalgam-composite restoration was similar to that achieved with composite restoration alone and more than that of amalgam restoration alone. It can be concluded that the thickness of amalgam in combined amalgam-composite restorations did not affect fracture resistance of the teeth.

Key words:Amalgam, composite, fracture resistance, restoration.

Evaluation of micro-shear bond strength of resin modified glass-ionomer to composite resins using various bonding systems

AIM

The aim was to compare the micro-shear bond strength between composite and resin-modified glass-ionomer (RMGI) by different adhesive systems.

MATERIALS AND METHODS

A total of 16 discs of RMGI with a diameter of 15 mm and a thickness of 2 mm were randomly divided into four groups (n = 4). Four cylinders of composite resin (z250) were bonded to the RMGI discs with Single Bond, Clearfil SE Bond and Clearfil S3 Bond in Groups 1-3, respectively. The fourth group was the control. Samples were tested by a mechanical testing machine with a strain rate of 0.5 mm/min. Failure mode was assessed under a stereo-microscope.

RESULTS

The means of micro-shear bond strength values for Groups 1-4 were 14.45, 23.49, 16.23 and 5.46 MPa, respectively. Using a bonding agent significantly increased micro-shear bond strength (P = 0.0001).

CONCLUSION

Micro-shear bond strength of RMGI to composite increased significantly with the use of adhesive resin. The bond strength of RMGI to composite resin could vary depending upon the type of adhesive system used.

Microleakage in Class II composite restorations with margins below the CEJ: in vitro evaluation of different restorative techniques

OBJECTIVES

The purpose of this in vitro study was to evaluate the microleakage in "deep" Class II composite restorations with gingival cavosurface margin below the CEJ (cemento-enamel junction) and restored with different techniques.

STUDY DESIGN

Fifty human teeth were used. In each tooth two standardized Class II slot cavities (on mesial and on distal surfaces) were prepared: the buccolingual extension of the cavities was 4 mm; the gingival wall was located in dentin/cementum (2 mm beyond the CEJ). The prepared teeth were randomly assigned to 5 experimental groups (of 10 specimens and 20 cavities each) and restored. Group 1: Filtek TM Supreme XTE Flowable (3MESPE) + Universal Filtek Supreme XTE (3MESPE), Group 2: GrandioSO Heavy Flow (Voco) + GrandioSo (Voco), Group 3: SDR™ (Dentsply Caulk) + Esthet-X® HD (Dentsply Caulk), Group 4: SonicFill (Kerr), Group 5: Grandio (Voco). After thermocycling, the specimens were immersed in a 0.5% basic fuchsine dye solution and incubated at 37°C for 24 hours. The teeth were subsequently sectioned mesiodistally. All specimens were examined at 25 in a stereomicroscope and standardized digital images were obtained. Dye penetration was measured from gingival margins.

RESULTS

The results demonstrated no significant leakage differences between Group 4 and Group 5, that both showed significantly higher frequency distribution of Score 0. Group 2 and Group 3 showed a significant prevalence of Score 1, whereas Group 1 showed significantly higher frequency of Score 2.

CONCLUSIONS

None of the restorative techniques tested completely eliminated microleakage dye penetration in dentin margins; marginal adaptation in Class II composite restorations with gingival wall below the CEJ varied in both substrates and from different restorative techniques used.

In Vitro Performance of Class I and II Composite Restorations: A Literature Review on Nondestructive Laboratory Trials—Part I

Posterior adhesive restorations are a basic procedure in general dental practices, but their application remains poorly standardized as a result of the number of available options. An abundant number of study hypotheses corresponding to almost unlimited combinations of preparation techniques, adhesive procedures, restorative options, and materials have been described in the literature and submitted to various evaluation protocols. A literature review was thus conducted on adhesive Class I and II restorations and nondestructive in vitro tests using the PubMed/Medline database for the 1995-2010 period. The first part of this review discusses the selected literature related to photoelasticity, finite element analysis (FEM), and microleakage protocols. Based on the aforementioned evaluation methods, the following parameters proved influential: cavity dimensions and design, activation mode (light or chemical), type of curing light, layering technique, and composite structure or physical characteristics. Photoelasticity has various limitations and has been largely (and advantageously) replaced by the FEM technique. The results of microleakage studies proved to be highly inconsistent, and the further use of this technique should be strictly limited. Other study protocols for adhesive Class II restorations were also reviewed and will be addressed in part II of this article, together with a tentative relevance hierarchy of selected in vitro methods.

Marginal adaptation of class V composite restorations submitted to thermal and mechanical cycling

Objective:

This study evaluated the effect of the margin location and an adhesive system on the marginal adaptation of composite restorations.

Material and Methods:

Class V cavities were prepared in bovine teeth with the gingival margin on the dentin and the incisal margin on the enamel. The cavities were restored with a micro-hybrid composite resin using an etch-and-rinse [Single Bond 2 (SB)] or a self-etching adhesive [Clearfil SE Bond (CL)]. After finishing and polishing the restorations, epoxy replicas were prepared. The marginal adaptation was analyzed using scanning electronic microscopy (SEM, 500 x magnification). The higher gap width in each margin was recorded (T0). After the first evaluation, the samples were submitted to thermal cycling (2,000 cycles of 5ºC±2ºC followed by 55ºC±2ºC - T1) and mechanical cycling (100,000 cycles of 50 kN and 2 Hz - T2). Replicas of samples were rebuilt after each cycling and analyzed under SEM. The data were submitted to Mann-Whitney, Wilcoxon and Friedman testing (a=0.05).

Results:

The SB presented higher gaps in the dentin than the enamel, while there was no difference between the substrate for the CL. In the dentin, the CL showed better marginal sealing than the SB. The opposite occurred in the enamel. There were no significant differences between the baseline, thermal and mechanical cycling for any experimental condition.

Conclusions:

The outcomes of the present study showed that the adhesive system and margin location have an important effect on the marginal adaptation of composite restorations.

Marginal adaptation and microleakeage of directly and indirectly made fiber reinforced composite inlays

Aim:

This study evaluated in vitro microleakage of inlays made by direct or indirect techique with or without fiber reinforced composite (FRC) substructure.

Materials and Methods:

Standardized mesio-occlusal cavities were prepared and restored using direct-technique with composite resin only or FRC-composite resin, and indirect technique with laboratory composite only or FRC-laboratory composite resin. After thermocycling, teeth were immersed in basic fuchsin dye, sectioned and examined under a stereo-microscope (x40).

Results:

No differences of cement thickness and dye penetration were found in gingival area (p>0.05), whereas microleakage revealed statistical differences between groups (p=0.02) in occlusal area, where FRC-groups had lower microleakage than composite restorations. Thickness of cement layer did not show significant difference between groups with indirect technique (p>0.05).

Conclusion:

The present study suggests that insertion of FRC substructure to the inlay cavity by direct composite filling technique does not increase the marginal leakage compared to that of cementing indirectly made restotorations by composite resin luting cement.

Clinical Significance:

On the basis of the results of this in vitro study, the use of direct FRC technique might be an effective way to decrease the marginal leakage.

Microleakage and Micrographic Evaluation of Composite Restorations with Various Bases over ZOE Layer in Pulpotomized Primary Molars

OBJECTIVE

Zinc oxide eugenol (ZOE) under composite restorations should be covered with a suitable material in order to prevent the harmful effect of ZOE on the composite. The aim of this in vitro study was to evaluate microleakage of composite restorations in pulpotomized primary molars with different bases for covering the ZOE layer and to assess the distance between different layers.

MATERIALS AND METHODS

Proximo-occlusal cavities were prepared in 78 extracted second primary molars. Carious lesions were removed and pulpotomy was carried out. Zinc oxide eugenol paste was placed in 2-mm thickness. The teeth were randomly divided in 6 groups and restored as follows: 1. Light-cured composite; 2. Resin-modified glass-ionomer and composite resin; 3. Glass-ionomer and composite resin; 4. Light-cured calcium hydroxide and composite resin; 5. Calcium hydroxide and composite resin; 6. Amalgam and composite resin. The restored specimens were thermocycled for 500 cycles (5°C/55°C) and microleakage was assessed by dye penetration technique. Three specimens from each group were processed for scanning electron microscope evaluation to determine the distance between the layers. The results were analyzed by Kruskal-Wallis and Dunn tests.

RESULTS

Microleakage assessment revealed significant differences between the groups (P=0.04), with the amalgam group exhibiting the lowest microleakage values. In SEM micrographs no significant differences were observed in the distance between ZOE base layers (P=0.94) and base-composite layers (P=0.47); however, the amalgam group had the lowest distances.

CONCLUSION

The use of amalgam over zinc oxide eugenol layer in pulpotomized primary molars decreases microleakage.