Microleakage in Conventional and Bonded Amalgam Restorations: Influence of Cavity Volume

Comparison of Marginal Fracture Between Conventional and Bonded Amalgam Restorations in Posterior Permanent Molar Teeth

Background/objectives Dental amalgam has been a successful restoration for over a century. However, restoration failures due to secondary caries, fractured teeth or restorations, marginal deficiencies, tooth wear, and secondary caries remain significant concerns. Amalgam-bond, known for its ability to bond amalgam to the tooth structure and prevent percolation, forms a strong bond with vital dentin. This study aimed to compare the outcome of marginal fractures in bonded amalgam and conventional amalgam posterior restorations among patients at a tertiary care dental hospital. Materials and methods Sixty consecutive patients aged 25-35 years, meeting the inclusion and exclusion criteria, participated in this study. A thorough history, clinical examination, and standardized periapical radiographs were conducted. Patients were divided randomly into two equal groups, group A and group B. Group A received bonded amalgam restorations, while group B received conventional amalgam restorations. Polishing was performed at a recall visit after seven days, and a follow-up evaluation was done after two months. The final assessment of marginal fractures was recorded after six months. Results After six months, 28 (46.7%) patients showed no marginal fractures, including 11 males and 17 females. On the other hand, 32 (53.3%) patients exhibited marginal fractures, comprising 17 males and 15 females. The clinical success rate of group A was better than group B (p = 0.001). Conclusion Bonded amalgam demonstrates a high success rate and should be a routine choice for treating carious permanent molars in dental practice.

Composite Replacement of Amalgam Restoration Versus Freshly Cut Dentin: An In Vitro Microleakage Comparison

OBJECTIVE

The aim of this study was to evaluate the microleakage of the composite restorations when bonded to tooth structure previously restored with amalgam material compared with that of freshly cut dentin.

METHODS AND MATERIALS

Thirty intact, extracted intact human molars were mounted in autopolymerizing acrylic resin. Class II box preparations were prepared on the occluso-proximal surfaces of each tooth (4-mm bucco-lingual width and 2-mm mesio-distal depth) with the gingival cavosurface margin 1 mm above the CEJ. Each cavity was then restored using high copper amalgam restoration (Disperalloy, Dentsply) and then thermocycled for 10,000 thermal cycles. Twenty-five of the amalgam restorations were then carefully removed and replaced with Filtek Supreme Ultra Universal (3M ESPE); the remaining five were used for scanning electron microscopy and energy dispersive x-ray spectroscopy analysis. A preparation of the same dimensions was performed on the opposite surface of the tooth and restored with composite resin and thermocycled for 5000 thermal cycles. Twenty samples were randomly selected for dye penetration testing using silver nitrate staining to detect the microleakage. The specimens were analyzed with a stereomicroscope at a magnification of 20×. All of the measurements were done in micrometers; two readings were taken for each cavity at the occlusal and proximal margins. Two measurements were taken using a 0-3 scale and the percentage measurements.

RESULTS

Corrosion products were not detected in either group (fresh cut dentin and teeth previously restored with amalgam). No statistically significant difference was found between the microleakage of the two groups using a 0-3 scale at the occlusal margins (McNemar test, p=0.727) or proximal margins (Wilcoxon signed-rank test, p=0.174). No significance difference was found between the two groups using the percentage measurements and a Wilcoxon signed-rank test at either the occlusal (p=0.675) or proximal (p=0.513) margins. However, marginal microleakage was statistically significant between the proximal and occlusal margins (p<0.001).

CONCLUSION

Within the limitations of this in vitro study, no significant difference was found between the microleakage of nondiscolored dentin in teeth that were previously restored with amalgam compared with freshly cut dentin. However, marginal microleakage in the proximal surface was higher than that in the occlusal surface.

Longitudinal Results of a 10-year Clinical Trial of Repair of Amalgam Restorations

The aim of this prospective, blind, and randomized clinical trial was to assess the effectiveness of repair of localized clinical defects in amalgam restorations that were initially scheduled for replacement. A cohort of 20 patients with 40 (Class I and Class II) amalgam restorations that presented one or more clinical features that deviated from the ideal (Bravo or Charlie) according to US Public Health Service criteria, were randomly assigned to either the repair or the replacement group—A: repair, n = 19; and B: replacement, n = 21. Two examiners who had calibration expertise evaluated the restorations at baseline and 10 years after according to seven parameters: marginal occlusal adaptation, anatomic form, surface roughness, marginal staining, contact, secondary caries, and luster. After 10 years, 30 restorations (75%) were evaluated (Group A: n = 17; Group B: n = 13). Repaired and replaced amalgam restorations showed similar survival outcomes regarding marginal defects and secondary caries in patients with low and medium caries risk, and most of the restorations were considered clinically acceptable after 10 years. Repair treatment increased the potential for tooth longevity, using a minimally interventional procedure. All restorations trend to downgrade over time.

The assessment of surface roughness and microleakage of eroded tooth-colored dental restorative materials

Objectives:

To investigate the effect of acidic solution on surface roughness and microleakage of tooth-colored restorative materials.

Materials and Methods:

A 160 box-shaped cavities were prepared on the buccal surfaces of 160 human molars, and assigned to four groups: Group A restored with Ketac™ Molar Easymix, Group B with Fuji II™ LC, Group C with Ketac™ N100, and Group D with Filtek™ Z250, and subdivided into study and control groups (n = 20). Study groups were immersed in lemon juice (pH = 2.79) for 24 h, whilst controlgroups in deionized distilled water. All samples were immersed in 2% methylene blue dye, sectioned into two equal halves for surface roughness, and microleakage tests. Data were analyzed using Mann–Whitney and Kruskal–Wallis tests at P < 0.05.

Results:

There was a significant difference in surface roughness of Ketac™ Molar, Fuji II™ LC, and Ketac™ N100. No significant difference was found in microleakage of Ketac™ Molar and Fuji II™ LC; however, there were significant differences in the gingival margin of Ketac™ N100, and the occlusal margin of Filtek™ Z250.

Conclusions:

All glass ionomer cements were eroded after exposure to the acidic drink. Filtek™ Z250 and Ketac™ Molar Easymix showed more microleakage. All materials showed more microleakage at the gingival margins.

In Vivo and In Vitro Evaluations of Microleakage Around Class I Amalgam and Composite Restorations

The lining of amalgam restorations showed no significant effect on microleakage around restoration margins. In vivo and in vitro evaluations confirmed that microleakage was higher in resin composite restorations than in amalgam.

Microleakage beneath brackets bonded with flowable materials: effect of thermocycling

The purpose of this study was to evaluate the effects of thermocycling on microleakage beneath brackets bonded with an orthodontic composite and different flowable materials. Brackets were bonded to 200 bovine incisors divided into five groups: (1) Transbond XT, (2) X-Flow, (3) Dyract-Flow, (4) Admira-Flow, and (5) Beautiful-Flow. Half the teeth in each group were thermocycled. The specimens were dyed with 1 per cent methylene blue for 24 hours to determine the percentage of microleakage into the enamel-adhesive and adhesive-bracket interfaces using image analysis equipment. Data were analysed using the Kruskal-Wallis and Mann-Whitney U-tests (P < 0.05), applying Bonferroni correction when required (P < 0.005). Without thermocycling, microleakage at the enamel-adhesive interface was significantly greater for Admira-Flow than for X-Flow (P < 0.005). At the adhesive-bracket interface, there were no significant differences (P > 0.005). After thermocycling, microleakage of Beautiful-Flow at the enamel-adhesive interface was significantly less than for the other materials tested (P < 0.005), while at the adhesive-bracket interface, Admira-Flow and X-Flow showed significantly more microleakage than Beautiful-Flow and Transbond XT (P < 0.005). Analysis of the effect of thermocycling on each material showed that microleakage increased significantly at the enamel-adhesive interface with Transbond XT (P < 0.05), decreased with Beautiful-Flow (P < 0.05), increased significantly at both interfaces with X-Flow, but not to a statistically significant level with Dyract-Flow and Admira-Flow (P > 0.05). The giomer, Beautiful-Flow, demonstrated the best performance after thermocycling, while composite resins and, in particular, the flowables showed a poorer performance.