Margin quality and microleakage of Class II composite resin restorations

Marginal Adaptation and Micropermeability of Class II Cavities Restored with Three Different Types of Resin Composites-A Comparative Ten-Month In Vitro Study

The development of composite materials is subject to the desire to overcome polymerization shrinkage and generated polymerization stress. An indicator characterizing the properties of restorative materials, with specific importance for preventing secondary caries, is the integrity and durability of marginal sealing. It is a reflection of the effects of polymerization shrinkage and generated stress. The present study aimed to evaluate and correlate marginal integrity and micropermeability in second-class cavities restored with three different types of composites, representing different strategies to reduce polymerization shrinkage and stress: nanocomposite, silorane, and bulk-fill composite after a ten-month ageing period. Thirty standardized class ΙΙ cavities were prepared on extracted human molars. Gingival margins were 1 mm apical to the cementoenamel junction. Cavities were randomly divided into three groups, based on the composites used: FiltekUltimate-nanocomposite; Filtek Silorane LS-silorane; SonicFill-bulk-fill composite. All specimens were subjected to thermal cycles after that, dipped in saline for 10-mounds. After ageing, samples were immersed in a 2% methylene blue. Thus prepared, they were covered directly with gold and analyzed on SEM for assessment of marginal seal. When the SEM analysis was completed, the teeth were included into epoxy blocks and cut longitudinally on three slices for each cavity. An assessment of microleakage on stereomicroscope followed. Results were statistically analyzed. For marginal seal evaluation: F.Ultimate and F.Silorane differ statistically with more excellent results than SonicFill for marginal adaptation to the gingival margin, located entirely in the dentin. For microleakage evaluation: F.Ultimate and F.Silorane differ statistically with less microleakage than SonicFill. Based on the results obtained: a strong correlation is found between excellent results for marginal adaptation to the marginal gingival ridge and micropermeability at the direction to the axial wall. We observe a more significant influence of time at the gingival margin of the cavities. There is a significant increase in the presence of marginal fissures (p = 0.001). A significant impact of time (p < 0.000) and of the material (p < 0.000) was found in the analysis of the microleakage.

Class II restorations with margins below the CEJ

INTRODUCTION

Historically, Class II restorations using resin composite with margins below the dentino-enamel junction (dej) have fared poorly in investigations, exhibiting significant dye penetration along the marginal interfaces. In all reports located by the authors the gingival margins of sub-CEJ restorations have been finished, even though in actual practice this is not feasible in the vast majority of cases.

PURPOSE

The purpose of this study was to examine the effect of finishing on gingival margins located below the cemento-enamel junction of Class II resin composite restorations.

MATERIALS AND METHODS

Class II resin composite restorations with margins below the dej were placed in 40 extracted human molars using a dentin-enamel adhesive, a flowable resin composite, and a universal microhybrid resin composite restorative material. In all groups the adhesive was light activated for ten seconds and the restorative resin composite was light activated for ten seconds. The flowable increments were 1 mm in thickness and the restorative resin composite increments were 2 mm in thickness. In groups 1, 3, and 4 the flowable was light activated for ten seconds while in group 2 the flowable was light activated for 40 seconds. In groups 1, 2, and 4 the sub-CEJ margins were finished with finishing discs while in group 3 the sub-CEJ margins were unfinished. In group 4 the dentin adhesive was reapplied following finishing procedures. All groups were immersed in dye for 24 hours.

RESULTS

The two groups in which the margins were finished exhibited varying degrees of dye penetration. There was no dye penetration in the unfinished and the resealed groups.

CONCLUSIONS

It was concluded that the finishing procedure itself causes damage to the resin-dentin interface, which allows dye penetration to occur. This could potentially explain why resin adhesive materials have fared so poorly in Class II in vitro investigations, which is not the common clinical experience.

Shear Bond Strength with Increasing Light-Guide Distance from Dentin

BACKGROUND

In Class II composite restorations, the adhesive covering the gingival floor of the deep cavity preparation is 2 to 8 mm from the light guide and may not be adequately cured with a typical 10-second curing time.

PURPOSE

The purpose of this study was to evaluate the dentin bond strengths of resin composite when the curing light guide (quartz-tungsten-halogen light) was placed at various distances and to investigate the relationships between radiant exposure, degree of conversion, and shear bond strength.

MATERIALS AND METHODS

Single Bond (3M ESPE, St. Paul, MN, USA) was placed onto the dentin following the manufacturer's directions. Four groups of 10 teeth were cured for 20 seconds through a 0, 2.3, 4.6, or 6.9 mm spacer. Two other groups of 10 teeth were cured through a 4.6 mm spacer for 40 seconds and 60 seconds, respectively. Z100 resin composite (3M ESPE) was placed over the cured adhesive and polymerized at the same distance as the adhesive. After 24 hours of storage in water, the shear bond strengths were tested. The irradiance through each spacer was measured using a digital radiometer. The degree of conversion of the adhesive was determined by near infrared spectroscopy. The data were analyzed using analysis of variance and Tukey-B post hoc tests.

RESULTS

Dentin shear bond strengths decreased significantly with increasing distance, but they increased significantly when the curing time increased from 20 to 40 or 60 seconds. There is a linear correlation between shear bond strength, degree of conversion, and logarithm (radiant exposure).

CONCLUSION

Increasing curing time can compensate for the decreased bond strength owing to a decreased irradiance associated with increased curing distance.

CLINICAL SIGNIFICANCE

Under the conditions of this study, when curing the adhesives in deep proximal boxes with a quartz-tungsten-halogen light, the curing time should be increased to 40 to 60 seconds to ensure optimal polymerization.

Amalgam substitutes: a critical analysis

PURPOSE

Quality standards for restorations recently have been defined in Switzerland. Amalgam substitutes must meet restoration Grade 2 requirements (i.e., pulp and dental hard substance must be preserved, and both form and function of the tooth have to be reconstituted). The pertinent operative technique has to be simple and amalgam-like. A minimum service life of 8 years is required. This in vitro study investigated the clinical potential of several amalgam substitutes, taking into account the operative requirements, the defined restorative guidelines, and the required service life.

MATERIALS AND METHODS

Potential amalgam substitutes evaluated in this study included compomers (Compoglass, Dyract, Dyract AP, Elan, F 2000) and resin-based composites (Alert, Ariston, Definite, Nulite, Solitaire, Surefil). The composites Adaptic and Tetric Cream, using a simplified placement technique, were tested as negative and positive controls, respectively. Marginal adaptation and wear properties were measured in vitro in mixed Class II cavities. Relative radiopacity was measured in terms of millimeters of equivalent aluminum.

RESULTS

All compomers showed a radiopacity of 2.5 mm or more aluminum. Only Dyract AP and Elan were more wear resistant than amalgam. After stressing, the percentage of continuous margin was at best 31% overall and 17% in dentin only. Among resin-based composites, the minimum requirements of radiopacity were fulfilled only by Alert, Surefil, and Tetric. Only Definite, Surefil, Solitaire, and Tetric exhibited wear resistance greater than amalgam. After stressing, the best marginal qualities were 41% continuous margin overall, and 8% in dentin only.

Visco-elastic parameters of dental restorative materials during setting

Contraction stresses generated in restoratives during setting are among the major problems in adhesive dentistry, since they often result in loss of adhesion from the cavity walls or in post-operative pain. The rate of stress development and the ultimate magnitude of the stress, which determine the seriousness of these problems, depend on the relatively unknown visco-elastic behavior of the restoratives during setting. The aim of this study was to determine the visco-elastic parameters during setting, to aid our understanding of the process of contraction stress development. A dynamic mechanical method was used in which the materials were subjected to periodic strain cycles in a universal testing machine during the first 60 min of setting. The visco-elastic parameters (viscosity eta and Young's modulus E) were calculated by analysis of the experimental stress-strain data with a simple mechanical model according to Maxwell. Two restorative materials from different classes were investigated: a two-paste resin composite and a conventional glass-ionomer cement. A comparison of the results showed significant differences in the development of viscosity and stiffness in the early stage of setting. The resultant relaxation time (eta/E) of the glass ionomer remained at a low level during the first 15 min, whereas that of the resin composite increased markedly. This is of clinical importance, since it implies that, during the early setting stage, glass ionomers are better capable of reducing the contraction stresses than resin composites, thus increasing the likelihood that the bond with the cavity walls will form and survive during setting.

Finite element stress analysis of three filling techniques for class V light-cured composite restorations

An important disadvantage of current dental resin composites is polymerization shrinkage. This shrinkage has clinical repercussions such as sensitivity, marginal discoloration, and secondary caries. The objective of this study was to compare three filling techniques in terms of the transient stresses induced at the resin composite/tooth interface during polymerization. The techniques were: bulk filling (B), three horizontal increments (HI), and three wedge increments (WI). A simple Class V cavity preparation was modeled in finite element analysis. Polymerization shrinkage was simulated by a thermal stress analogy, thereby causing 1% shrinkage due to an arbitrary coefficient of thermal expansion. Interface normal and shear stresses were calculated at nine steps during polymerization, proceeding from 0% to 100% volume of cured resin. The importance of the interface transient stresses was revealed by the finding that, in most cases, their peak values exceeded the final or residual stress. Also, the WI and B techniques consistently exhibited the highest and lowest maximum transient stresses, respectively. These results from the simple model of a Class V restoration suggest that bulk filling of light-cured resin composites should be used in restorations which are sufficiently shallow to be cured to their full depth.

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.

Marginal adaptation

A critical review of studies assessing the marginal adaptation of direct placement, plastic restorations is presented. The effects upon adaptation of cavity design and location of cavity margins are examined, together with the effects of differing placement and finishing techniques. Both the choice of restorative material and the use of liners/bases are shown to influence the quality of restoration margins. Techniques used in both in vivo and in vitro assessment are reviewed, however it appears that a wide variety of methodologies exist and the establishment of standard, published criteria for the qualitative assessment of marginal adaptation is recommended.

Saucer-shaped cavity preparation for composite resin restorations in class II carious lesions: three-year results

This study determined the feasibility of saucer-shaped cavity preparations for composite resins in class II lesions. Saucer-shaped class II cavity preparations were restored with composite resin and subjected to clinical, radiographic, and replica cast evaluation (39 restorations) after 6, 18, and 36 months. The results indicated that the retention, resistance form, and wear resistance of the class II saucer-shaped cavity preparations were satisfactory after 3 years.

Microleakage of indirect composite inlays. An in vitro comparison with the direct technique

Microleakage occurring around directly and indirectly made class-II composite restorations was evaluated on extracted human premolars. Before the evaluation was made, the teeth were thermocycled and stained with an organic dye. Direct class-II composite restorations demonstrated extensive microleakage at their dentin cavosurface margins. Indirect class-II composite inlays luted with a dual-curing composite cement displayed much less microleakage than restorations made using the direct technique. The use of glass-ionomer cement rather than composite cement as the luting material resulted in more microleakage. Rather than being a true microleakage, the leakage of glass-ionomer cement might be the result of a diffusion of the water-soluble organic dye in the water-based cement. The results suggest that the indirect composite technique is superior to the direct technique when it comes to reducing microleakage.

Marginal adaptation of four tooth-coloured inlay systems in vivo

This study investigates the margin quality of four different tooth-coloured inlay systems using computer-aided quantitative margin analysis under scanning electron microscopy. Three types of restorations involved chairside procedures using a commercial CAD-CAM apparatus: one type of inlay restoration was milled from preformed glass ceramic blocks, the other two inlay types were milled from preformed porcelain blocks. The fourth system was based on an experimental indirect composite inlay system. Each inlay type was luted with its respective dual-curing luting composite, which was supplied with the system. After 6 months of clinical service, all four systems revealed a significant percentage of submargination indicating occlusal wear of the luting composite. The porcelain inlays and the composite inlays luted with their respective experimental luting composite showed the best marginal adaptation. Luted glass ceramic inlays, in particular, suffered from a significantly higher percentage of inlay margin fractures (9 per cent) and marginal openings (4 per cent) than the other systems. A possible explanation is that the glass ceramic subsurface structure at the inlay-lute interface was weakened by etching with ammonium bifluoride.

Microleakage around direct composite inlays

The purpose of this study was to compare the microleakage around direct composite inlays bonded with a dual cure luting composite into Class V type inlay cavities in extracted molar teeth. Bonding methods which included two cavity cleansing regimes and three bonding treatments were used. Either pumice and rinse or rinse only cavity cleansing was used to remove the separator agent (agar/alcohol) from the cavity surface prior to inlay bonding. Restorations were thermocycled between 5 degrees C and 55 degrees C (with intermediate baths at 36 degrees C) before (240 cycles) and during (12 cycles) silver staining. Microleakage around the sectioned restorations was quantified using digital imaging microscopy at x 40 magnification. Data analysis indicated that failure to include pumice slurry application as part of the cavity cleansing regime prior to bonding lead to a marked increase in microleakage at the enamel/restoration interface following one of the three bonding treatments.

Proximo-occlusal composite restorations in primary molars: marginal adaptation, bacterial penetration, and pulpal reactions

Marginal adaptation and bacterial penetration were studied in 32 primary molars filled with composite resin in shallow class II cavities. The restorations had served in the mouth for 3 years (mean, 3 years and 4 months; range, 8 months to 6 years and 4 months). Ground sections of the retrieved teeth were evaluated with polarized light microscopy and demineralized sections with light microscopy. Clinically excellent restorations, free from bacteria, were found in 25%. Gaps were recorded in 42%, under- or over-contouring and porosities in 95%, caries in the cervical area in 58%. Bacteria were observed subjacent to the fillings in 75% and in the dentin tubules in 61%. Pupal necrosis was found in 7 of 16 teeth. Marginal discoloration, visible crevice, or color mismatch was associated with marginal defects, bacterial leakage, and pulpal reactions.

Clinical evaluation of two posterior composite resins: two-year results

Two composite resins were evaluated for clinical acceptability as restorative materials in Class I and II cavities over a 2-year-period. In addition, dispersed phase alloy was evaluated for comparison. All restorations were assessed for anatomical form, marginal integrity and marginal leakage using modified United States Public Health Service (USPHS) criteria. At the 2-year recall, 96% of the composites and 100% of the amalgams were rated 'alpha' or 'bravo', using the parameters of assessment defined in this study. However, a significant number of shifts from the baseline, within the level of acceptability, had occurred. The two composites showed the greatest number of shifts for anatomical form and marginal leakage, while there were no differences between the composites and the amalgam for shifts in marginal integrity. Although a very high level of acceptability was determined for all of the materials, the frequency of rating change within categories for the composites was a cause of concern with regard to their long-term clinical use.

Microleakage of indirect composite inlays

The purpose of this in vitro study was to evaluate the microleakage of indirect composite inlays and to compare leakage of inlays with directly placed composite restorations. Standardized MOD preparations were cut in 50 extracted human molars. One gingival margin was placed in enamel above the CEJ, and the other was placed in dentin below the CEJ. Two groups of teeth were directly filled with composites (P-30 and Heliomolar) after being etched, and dentin bonding agents were applied. Two groups of teeth were restored with composite inlays that were fabricated on stone dies. The inlays were made and luted with the same two composites. The last group of teeth was restored with Heliomolar inlays luted with Dual cement. The specimens were thermocycled 300 times between 5 and 50 degrees C. Microleakage was evaluated by use of the silver-nitrate staining technique. The depth of leakage was measured microscopically after the teeth were sectioned. Both direct restorations and inlays showed substantial leakage at gingival-dentin margins; however, there was only superficial leakage at enamel margins. P-30 inlays and Heliomolar inlays cemented with Dual leaked less than direct restorations at the gingival-dentin margins. There was no difference in leakage of enamel margins of inlays and direct restorations, except that direct Heliomolar restorations leaked more than the others. There was no difference in leakage between Heliomolar restorations luted with light-cured or dual-cured cement.

Influence of dentin-bonding agents and a glass-ionomer base on the cervical marginal seal of Class II composite restorations

The cervical dentin marginal seal of Class II composite resin restorations was assessed in vitro. Elimination of marginal contraction gaps by specific dentin-bonding treatments led to a reduction in the extent of cervical microleakage as assessed by a silver staining method. The use of a "sandwich" technique employing a glass-ionomer material to seal the cervical cavity margin did not prevent cervical microleakage occurrence.