Effect of Cavity Disinfection with Chlorhexidine on Marginal Gap of Class V Composite Restorations Bonded with a Universal Adhesive Using Self-Etch and Etch-and-Rinse Bonding Strategy

Objectives:

This in-vitro study aimed to evaluate the effect of cavity disinfection with chlorhexidine (CHX) on marginal gaps of Class V composite resin restorations bonded with a universal adhesive using self-etch and etch-and-rinse bonding strategy.

Materials and Methods:

Sixty sound human premolars were randomly assigned to two groups (n=30): group 1 (CHX) and group 2 (no CHX). Each group was divided into two subgroups (n=15) according to the bonding strategy of the universal adhesive (self-etch or etch-and-rinse). Class V cavities were prepared on the buccal surfaces of the teeth. The occlusal and gingival margins of the cavities were placed in enamel and dentin, respectively. In the first and second subgroups of both groups, the All-Bond Universal adhesive was applied with self-etch and etch-and-rinse bonding strategy, respectively. After restoration and thermocycling, the samples were sectioned, and marginal gaps at the gingival margins were measured in micrometer (μm) under a stereomicroscope. Two-way analysis of variance (ANOVA) was used to compare marginal gaps between the groups and the subgroups.

Results:

The mean marginal gap size was significantly affected by cavity disinfection (P=0.001) and bonding strategy (P=0.002). However, the interaction effect of these two factors on the mean marginal gap size was not significant (P=0.79).

Conclusion:

The use of CHX resulted in larger marginal gaps at the gingival margins of Class V composite resin restorations. Irrespective of disinfection, the self-etch bonding strategy resulted in larger marginal gaps compared to the etch-and-rinse bonding strategy.

Does Er,Cr:YSGG reduce the microleakage of restorations when used for cavity preparation? A systematic review and meta-analysis

Background

As the member of erbium laser family, Erbium, Chromium: Yttrium Scandium Gallium Garnet (Er,Cr:YSGG) has obtained the approval for caries removal and cavity preparation by Food and Drug Administration (FDA). However, there is still controversy over the beneficial effects of Er,Cr:YSGG preparations on microleakage. The present study is the first systematic review and meta-analysis to compare the microleakage of cavities prepared by Er,Cr:YSGG lasers with that by traditional burs. In addition, the effect of acid etching on the adhesive potential of self-etch and etch-and-rinse adhesives was assessed after laser preparation.

Methods

An electronic search was performed in Pubmed, EBSCO, Embase, and the Cochrane Controlled Register of Trials (CENTRAL).

Results

Totally, 357 articles were identified. Finally, 13 met the inclusion criteria, of which 11 were selected for meta-analysis. All the included studies exhibited a moderate risk of bias. Based on the meta-analysis, no significant difference was observed between the Er,Cr:YSGG and traditional bur groups in terms of the incidence of microleakage. Self-etch adhesives, in combination with prior acid etching, showed less microleakage than those without acid etching in the laser-prepared cavities.

Conclusions

Current studies do not support the beneficial effects of Er,Cr:YSGG preparations on microleakage. Additional acid etching with self-etching adhesives is recommended after Er,Cr:YSGG preparations. Further high-quality studies are needed to draw a convincing conclusion in the future.

The effect of composite resin preheating on marginal adaptation of class II restorations

Background

One of the problems with a high filler content composite resins is gap formation at restorative material-tooth interface. The present study investigated the effect of preheating composite resins on the formation of marginal gap in Cl II restorations.

Material and Methods

In this in vitro study Sixty Cl II cavities were prepared on the mesial and distal surfaces of 30 extracted premolar teeth. The gingival floor of cavities was placed 1 m below the CEJ. The samples were randomly allocated to 4 groups for restoration placement: group 1, Filtek P60 composite resin at room temperature; group 2, Filtek P60 composite resin at 68°C; group 3, X-tra fil composite resin at room temperature; and group 4, X-tra fil composite resin at 68°C. After a thermocycling procedure, the teeth were sectioned longitudinally in a buccolingual direction. Then the marginal gaps of the samples were measured at proximal and gingival margins under a scanning electron microscope at ×2000 magnification in µm. The data were analyzed with SPSS 21, using one-way ANOVA, post hoc Tukey tests and paired t-test (α=0.05).

Results

Groups 2 and 4 exhibited significantly lower marginal gaps, compared to groups 1 and 3, at both enamel (P<0.0001 and P=0.001, respectively) and dentinal walls (P<0.0001). In all the groups, there was significantly less marginal gaps at composite-enamel wall compared to composite-dentin wall interfaces (P<0.0001). There was no significant difference between groups 1 and 3 and groups 2 and 4 in enamel walls (p= 0.96, p= 0.99 respectively) and dentinal walls (p= 0.85, p=0.98 respectively).

Conclusions

Preheating resulted in a decrease in marginal gaps in both composite resins. The effect of composite resin type on marginal adaptation was the same. Key words:Composite resin, dental marginal adaptation, preheating.

Evaluation of gap formation at the composite resin-tooth interface after using universal adhesives: In vitro SEM study using the replica technique

The aim of this study was to evaluate gap formation after using two universal adhesives, Peak Universal Bond (P), which contains chlorhexidine and Adhese Universal (A), which contains 10-MDP monomer, and to compare them with two gold standard adhesives. The adhesives were tested in different etching modes, etch-and-rinse (ER) or self-etch (SE), and under thermomechanical loading (TML). Two identical Class V cavities were prepared in each of 30 human third molar teeth, and resin-composite restorations were made. Before and after TML, replicas of the restorations were prepared. Gap formation and their frequency according to the modified classification of Blunck and Zaslansky and the width of the maximum marginal gap (MG) were separately evaluated in enamel and dentin. Gap frequency did not differ significantly only in the enamel before TML, despite the use of different adhesives or etching modes. At both timepoints, the highest MG values were obtained with the Peak Universal Bond self-etch (PSE) group in enamel (6.2 μm before TML, 12.2 μm after TML) and the Peak Universal Bond etch-and-rinse (PER) group in dentine (21.3 μm before TML, 35.5 μm after TML). After TML, there was a significant increase of gap frequency for Adhese universal self-etch (ASE) group and MG values for PER, PSE, ASE groups at the resin-enamel interface, and gap frequency and MG values for all groups at the resin-dentin interface. Universal adhesive with 10-MDP monomer have beneficial effect on the resin-dentin interface, while chlorhexidine may reduce the resistance of the universal adhesive system to oral cavity conditions.

Comparison of Er,Cr:YSGG Laser Handpieces for Class II Preparation and Microleakage of Silorane- or Methacrylate-Based Composite Restorations

OBJECTIVE

The aim of this study was to evaluate the influence of cavity preparation with different Er,Cr:YSGG laser handpieces on microleakage of different posterior composite restorations.

METHODS

Fifty-four extracted intact human premolars were randomly assigned to three groups according to cavity preparation method: Bur Group: high-speed diamond bur (Diatech), MD Group: Er,Cr:YSGG laser Waterlase MD handpiece (Biolase Millennium II), and Turbo Group: Er,Cr:YSGG laser Waterlase MD TURBO handpiece (Biolase Millennium II). One hundred eight Class II slot cavities were prepared on the mesial and distal proximal surfaces of each tooth, and the cavity preparation times required were determined. The groups were then subdivided according to the restorative systems used (n = 12): a conventional methacrylate-based microhybrid composite (Filtek P60+Adper Single Bond 2/3M); a silorane-based resin composite (Filtek Silorane+Silorane System Adhesive/3M); and a nanohybrid methacrylate-based composite (Kalore+G-Bond/GC). The restorative systems were applied according to the manufacturers' recommendations. Following thermocycling (X5000; 5°C-55°C), the teeth were coated with nail varnish except the restoration margins, immersed in 0.5% basic fuchsin dye solution, and sectioned in a mesiodistal direction. Dye penetration was evaluated under a light microscope for occlusal and cervical margins. Data were analyzed with one-way ANOVA and chi-square tests (p < 0.05).

RESULTS

The cavity preparation time (mean ± SD) required for Bur, MD, and Turbo group was 31.25 ± 3.82, 222.94 ± 15.85, and 92.5 ± 7.42 sec, respectively, and the differences among the groups were statistically significant (p < 0.05). Comparing the occlusal and cervical microleakage scores, no statistically significant differences were found among the groups and subgroups (p > 0.05).

CONCLUSIONS

Er;Cr:YSGG laser cavity preparation with the Turbo handpiece needed shorter time than the MD handpiece, although it needed longer time than the conventional diamond bur. The use of different handpieces of Er,Cr:YSGG laser did not differ from conventional preparation with diamond bur in terms of microleakage with the tested methacrylate- and silorane-based posterior composite restorative systems.

Factors affecting marginal integrity of class II bulk-fill composite resin restorations

Background. Bulk-fill composite resins are a new type of resin-based composite resins, claimed to have the capacity to be placed in thick layers, up to 4 mm. This study was carried out to evaluate factors affecting gap formation in Cl II cavities restored using the bulk-fill technique.

Methods. A total of 60 third molars were used in this study. Two Cl II cavities were prepared in each tooth, one on the mesial aspect 1 mm coronal to the CEJ and one on the distal aspect 1 mm apical to the CEJ. The teeth were divided into 4 groups: A: The cavities were restored using the bulk-fill technique with Filtek P90 composite resin and its adhesive system and light-cured with quartz tungsten halogen (QTH) light-curing unit. B: The cavities were restored similar to that in group A but light-cured with an LED light-curing unit. C: The cavities were restored using the bulk-fill technique with X-tra Fil composite resin and Clearfil SE Bond adhesive system and light-cured with a QTH curing unit. D: The cavities were restored similar to that in group C but light-cured with an LED light-curing unit. The gaps were examined under a stereomicroscope at ×60. Data were analyzed with General Linear Model test. In cases of statistical significance (P<0.05), post hoc Bonferroni test was used for further analyses.

Results. The light-curing unit type had no effect on gap formation. However, the results were significant in relation to the composite resin type and margin location (P<0.001). The cumulative effects of light-curing unit*gingival margin and light-curing unit*composite resin type were not significant; however, the cumulative effect of composite rein type*gingival margin was significant (P=0.04)

Conclusion. X-tra Fil composite exhibited smaller gaps compared with Filtek P90 composite with both light-curing units. Both composite resins exhibited smaller gaps at enamel margins.

Effect of hemostatic agent on marginal gaps of class V giomer restorations

Background

Contamination of dentin with hemostatic agents might exert a deleterious effect on adhesive procedures on dentin. The present study was undertaken to investigate the effect of aluminum chloride hemostatic agent on marginal gaps in Cl V giomer restorations.

Material and Methods

Fifty sound bovine permanent incisors were selected for the purpose of this in vitro study and Cl V cavities were prepared on their buccal surfaces; the gingival margins of the cavities were placed in dentin. The tooth samples were randomly assigned to two groups (n=25). The samples in groups 1 and 2 underwent a restorative procedure without and with the application of aluminum chloride hemostatic agent in the cavity, respectively, before application of the adhesive. BeautiBond one-step self-etch adhesive and Beautifil II giomer restorative material were used for the restoration of the cavities in both groups. The samples were thermocycled and sectioned, followed by measuring the gap sizes at gingival margins in µm under a stereomicroscope. The marginal gaps were compared with Mann-Whitney U test. Statistical significance was set at P<0.05.

Results

The results showed significant differences in the mean marginal gaps between the two groups under study (P<0.001); the mean marginal gaps were higher in group 2 (with hemostatic agent) compared to those in group 1 (without hemostatic agent) (P<0.0005).

Conclusions

Contamination with aluminum chloride hemostatic agent in giomer restorations gave rise to higher gingival margin gaps.

Key words:Dental adhesives, giomer restorative material, hemostatic agent, marginal adaptation.

The effect of repeated preheating of dimethacrylate and silorane-based composite resins on marginal gap of class V restorations

Background. One of the problems with composite resin restorations is gap formation at resin‒tooth interface. The present study evaluated the effect of preheating cycles of silorane- and dimethacrylate-based composite resins on gap formation at the gingival margins of Class V restorations.

Methods. In this in vitro study, standard Class V cavities were prepared on the buccal surfaces of 48 bovine incisors. For restorative procedure, the samples were randomly divided into 2 groups based on the type of composite resin (group 1: di-methacrylate composite [Filtek Z250]; group 2: silorane composite [Filtek P90]) and each group was randomly divided into 2 subgroups based on the composite temperature (A: room temperature; B: after 40 preheating cycles up to 55°C). Marginal gaps were measured using a stereomicroscope at ×40 and analyzed with two-way ANOVA. Inter- and intra-group comparisons were analyzed with post-hoc Tukey tests. Significance level was defined at P < 0.05.

Results. The maximum and minimum gaps were detected in groups 1-A and 2-B, respectively. The effects of composite resin type, preheating and interactive effect of these variables on gap formation were significant (P<0.001). Post-hoc Tukey tests showed greater gap in dimethacrylate compared to silorane composite resins (P< 0.001). In each group, gap values were greater in composite resins at room temperature compared to composite resins after 40 preheating cycles (P<0.001).

Conclusion. Gap formation at the gingival margins of Class V cavities decreased due to preheating of both composite re-sins. Preheating of silorane-based composites can result in the best marginal adaptation.

Effect of disinfecting the cavity with chlorhexidine on the marginal gaps of Cl V giomer restorations

Background

Considering the effect of cavity disinfecting agents on the bonding and sealing ability of restorations bonded to dentin, the aim of this study was to evaluate the effect of chlorhexidine (CHX) disinfecting agent on the marginal gaps of Cl V giomer restorations.

Material and Methods

Cl V cavities were prepared on the buccal surfaces of 60 sound bovine permanent incisors in this in vitro study, with the occlusal and gingival margins in enamel and dentin, respectively. The teeth were randomly divided into two groups (n=30). The teeth in groups 1 and 2 were restored without and with the use of the disinfecting agent in the cavity, respectively, before applying the adhesive. BeautiBond one-step self-etch adhesive and Beautifil II giomer were used to restore the cavities in both groups. After thermocycling and sectioning of the samples, the sizes of marginal gaps at gingival margins were measured in µm under a stereomicroscope. Mann-Whitney U test was used to compare marginal gaps at P<0.05 level of significance.

Results

The means of marginal gaps were significantly different between the two study groups (U=180, P<0.001), with higher means of marginal gaps in group 2 (with CHX disinfection) compared to group 1 (without CHX disinfection) (P<0.0005).

Conclusions

Application of CHX for the disinfection of cavities in giomer restorations resulted in an increase in gingival margin gaps.

Key words:Chlorhexidine, dental marginal adaptation, dental restorations.

Effects of Er,Cr:YSGG Laser Pulse Frequency on Microtensile Bond Strength to Enamel

Literature regarding the influence of Er,Cr:YSGG laser pulse frequency with different output power levels on adhesion properties of adhesive resin to lased enamel is limited. Therefore, the aim of the present study was to evaluate the effects of laser pulse frequency (20, 35, and 50 Hz) at two different output power settings (3 and 6 W) of Er,Cr:YSGG on the microtensile bond strength (μTBS) of adhesive resin to enamel. Crowns of 35 intact bovine incisors were embedded into self-cure acrylic resin individually, and then flat enamel surfaces were prepared with 600-grit silicon carbide papers under water cooling. Teeth were divided randomly into seven groups. Enamel surfaces were irradiated with Er,Cr:YSGG laser operated at one of six output power–pulse frequency combinations (6 W20 Hz, 6 W–35 Hz, 6 W–50 Hz, 3 W–20 Hz, 3 W–35 Hz, and 3 W–50 Hz) in groups 1-6, respectively. Bur-treated surfaces served as a control in group 7. After surface treatments and bonding procedures, composite build-ups were done in three layers up to a height of 4 mm. Next, all bonded teeth were sectioned into the resin-enamel sticks to be tested in a μTBS testing machine. The μTBS data were analyzed with univariate analysis of variance under a general linear model with the factor ‘tooth' added as a random effect to the design. Resin-enamel interfaces were evaluated with scanning electron microscopy (SEM). The μTBS to laser-irradiated enamel in group 1 (6 W–20 Hz) was significantly lower than those of bur-treated enamel (p&lt;0.05). However, group 6 (3 W–50 Hz) showed significantly higher μTBS values than did bur-treated teeth (p&lt;0.05). SEM evaluation revealed enormous morphological alterations of laser-irradiated specimens, such as extensive vertical and horizontal microcracks and gaps, with the exception of group 6. The bonding effectiveness of adhesive resin to laser-irradiated enamel was affected by the pulse frequency of the Er,Cr:YSGG laser. Although the parameters recommended by the manufacturer lowered μTBS, increasing the pulse rate may maintain optimum μTBS.

Effect of two prophylaxis methods on marginal gap of Cl Vresin-modified glass-ionomer restorations

Background. This study evaluated the effect of two prophylaxis techniques on the marginal gap of CI V resin-modified glass-ionomer restorations.

Methods. Standard Cl V cavities were prepared on the buccal surfaces of 48 sound bovine mandibular incisors in this in vitro study. After restoration of the cavities with GC Fuji II LC resin-modified glass-ionomer, the samples were randomly assigned to 3 groups of 16. In group 1, the prophylactic procedures were carried out with rubber cup and pumice powder and in group 2 with air-powder polishing device (APD). In group 3 (control), the samples did not undergo any prophylactic procedures. Then the marginal gaps were measured. Two-way ANOVA was used to compare marginal gaps at the occlusal and gingival margins between the groups. Post hoc Tukey test was used for two-by-two comparisons. Statistical significance was set at P < 0.05.

Results. There were significant differences in the means of marginal gaps in terms of prophylactic techniques (P < 0.001), with significantly larger marginal gaps in the APD group compared to the pumice and rubber cup group, which in turn exhibited significantly larger marginal gaps compared to the control group (P < 0.0005). In addition, the means of marginal gaps were significant in terms of the margin type (P < 0.001), with significantly larger gaps at gingival margins compared to the occlusal margins (P < 0.0005).

Conclusion. The prophylactic techniques used in this study had a negative effect on the marginal gaps of Cl V resin-modified glass-ionomer restorations.

Evaluation of cervical marginal and internal adaptation using newer bulk fill composites: An in vitro study

OBJECTIVE

To evaluate the cervical marginal and internal adaptation of posterior bulk fill resin composites of different viscosities, before and after thermo-cycling (TMC).

MATERIALS AND METHODS

Eighty box-only class II cavities were prepared in 40 extracted human premolars with the distal proximal box beneath the enamel-cementum junction (CEJ). The teeth in the experimental groups were restored with bulk fill resin composite restorations (Gr. I- Sonic Fill, Gr. II- SDR, Gr. III- Tetric N Ceram Bulk Fill or a conventional composite designed for 2-mm increments (Gr. IV- Tetric N Flow along with Tetric N Ceram). Before and after thermal cycling, the gap-free marginal length was analyzed using SEM of epoxy resin replicas. After thermal cycling, specimens were cut longitudinally in order to investigate internal dentine adaptation by epoxy replicas under SEM (500 × magnification).

RESULTS

Statistical analysis was performed using the ANOVA and Tukey Post Hoc tests (P < 0.05). In enamel, high percentages of gap-free margins were initially identified for all the groups, which declined after thermal cycling. However, no significant differences were identified among any of the groups (P > 0.05). In dentine, bulk fill groups performed at par with the incremental placement; for both marginal and internal adaptation (P < 0.05), for all materials except Tetric N Ceram Bulk Fill.

CONCLUSIONS

Viscosity of the bulk fill restorative material influenced the proportion of gap-free marginal interface and the internal adaptation in dentin.