Risk aspects of dental restoratives: From amalgam to tooth-colored materials

Class II resin composite restorations-tunnel vs. box-only in vitro and in vivo

Purpose

In a combined in vitro/in vivo approach, tunnel vs. box-only resin composite restorations should be evaluated using thermomechanical loading (TML) in vitro and a restrospective clinical trial in vivo.

Materials and methods

For the in vitro part, box-only and tunnel cavities were prepared in 32 extracted human third molars under simulated intraoral conditions in a phantom head. Specimens were randomly assigned to four groups (n = 8; 16 box-only/16 tunnel) and received bonded resin composite restorations with Amelogen Plus (box A/tunnel A) or lining with Ultraseal and Amelogen plus (box B/tunnel B) both bonded using PQ1 (all Ultradent). Specimens were subjected to a standardized aging protocol, 1-year water storage (WS) followed by TML (100,000 × 50 N; 2500 × + 5/+ 55 °C). Initially and after aging, marginal qualities were evaluated using replicas at × 200 magnification (SEM). For the corresponding in vivo observational study, 229 patients received 673 proximal resin composite restorations. From 371 tunnel restorations, 205 cavities were filled without flowable lining (tunnel A), and 166 tunnels were restored using UltraSeal as lining (tunnel B). A total of 302 teeth received conventional box-only fillings. Restorations were examined according to modified USPHS criteria during routine recalls up to 5 years of clinical service.

Results

In vitro, all initial results showed 100% gap-free margins when a flowable lining was used. Tunnels without lining exhibited some proximal shortcomings already before TML and even more pronounced after TML (p < 0.05). After TML, percentages of gap-free margins dropped to 87–90% in enamel with lining and 70–79% without lining (p < 0.05). In vivo, annual failure rates for box-only were 2.2%, for tunnel A 6.1%, and for tunnel B 1.8%, respectively (p < 0.05). Tunnels had significantly more sufficient proximal contact points than box-only restorations (p < 0.05). Flowable lining was highly beneficial for clinical outcome of tunnel-restorations (p < 0.05).

Conclusions

With a flowable lining, tunnel restorations proved to be a good alternative to box-only resin composite restorations.

Clinical relevance

Class II tunnel restorations showed to be a viable alternative for box-only restorations, however, only when flowable resin composite was used as adaptation promotor for areas being difficult to access.

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.

Effects of Fiber-reinforced Composite Bases on Microleakage of Composite Restorations in Proximal Locations

Objectives:

The aim of this study was to evaluate the microleakage of direct restorative composite resin upon the addition of an intermediate glass fiber-reinforced composite (GFRC) layer of various fiber orientations between tooth and particulate filler composite resin (PFRC).

Materials and Methods:

Cavities were prepared both on the mesial and distal surfaces of sixty extracted human molars with one margin placed below and the other above the cementoenamel junction (CEJ). Teeth were assigned to five different groups. Four of the groups received a layer of semi-interpenetrating polymer network (semi-IPN) resin system impregnated E-glass GFRC at the bottom of the cavity: Group 1; unidirectional continuous GFRC (EVS) in buccolingual direction (EVS-BL), Group 2; EVS in mesiodistal direction (EVS-MD), Group 3; bidirectional woven GFRC (EVN), Group 4; multidirectional short GFRC (EXP-MLT), Group 5; PRFC only (control). After acid etching and priming of the cavities and insertion of GFRC layer with the adhesive resin (Scotchbond Multipurpose 3M-ESPE), the cavities were filled incrementally with PRFC (Filtek Z250, 3M-ESPE) and each layer was light cured for 20 s. After finishing and polishing, the restored teeth were water-stored for 24 h at 37 °C and then thermocycled for 6000 cycles between 5-55 °C, before immersion in 0.5 % basic fuchsin dye for 24 h. After sectioning by 3-5 sagittal cuts, each sequential section was imaged and digitally analyzed to determine the stain depth.

Results:

All GFRC groups in dentin revealed significantly lower microleakage compared to control (p<0.05). The orientation of FRC intermediate layer did not reveal significant differences in microleakage (p>0.05). The microleakeage in enamel was not different between the groups (p>0.05).

Conclusion:

Use of intermediate GFRC layer between tooth and PFRC could provide alternative method to minimize microleakage.

Clinical Relevance:

Use of GFRC intermediate layer underneath the particulate filler composite can be used to minimize the leakeage of the restorations.

Biodegradation of composite resin with ester linkages: identifying human salivary enzyme activity with a potential role in the esterolytic process

OBJECTIVES

The ester linkages contained within dental resin monomers (such as Bisphenol A-glycidylmethacrylate (BisGMA) and triethylene glycol dimethacrylate (TEGDMA)) are susceptible to hydrolytic degradation by salivary esterases, however very little is known about the specific esterase activities implicated in this process. The objective of this work was to isolate and identify the dominant proteins from saliva that are associated with the esterase activities shown to be involved in the degradation of BisGMA.

METHODS

Human whole saliva was collected and processed prior to separation in a HiPrep 16/60 Sephacryl S-200 HR column. The fraction with the highest esterase activity was further separated by an anion exchange column (Mono-Q (10/100G)). Isolated fractions were then separated by gel electrophoresis, and compared to a common bench marker esterase, cholesterol esterase (CE), and commercial albumin which has been reported to express esterase activity. Proteins suspected of containing esterase activity were analyzed by Mass Spectroscopy (MS). Commercially available proteins, similar to the salivary esterase proteins identified by MS, were used to replicate the enzymatic complexes and confirm their degradation activity with respect to BisGMA.

RESULTS

MS data suggested that the enzyme fraction with the highest esterase activity was contained among a group of proteins consisting of albumin, Zn-α2-glycoprotein, α-amylase, TALDO1 protein, transferrin, lipocalin2, and prolactin-induced protein. Studies concluded that the main esterase bands on the gels in each fraction did not overlap with CE activity, and that albumin activity emerged as a lead candidate with significant esterase activity relative to BisGMA degradation, particularly when it formed a complex with Zn-α2-glycoprotein, under slightly basic conditions.

SIGNIFICANCE

These enzyme complexes can be used as a physiologically relevant formulation to test the biostability of composite resins.