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DENTAL SCIENCE - ORIGINAL ARTICLE
Year : 2015  |  Volume : 7  |  Issue : 6  |  Page : 518-523  

Evaluation of sealing ability two self-etching adhesive systems and a glass ionomer lining LC under composite restoration in primary tooth: An in vitro study


1 Department of Pedodontics, CSI College of Dental Science and Research, Madurai, India
2 Department of Pedodontics, VMSDC, Salem, Tamil Nadu, India
3 Department of Pedodontics, NIMS Dental College, NIMS University, Jaipur, Rajasthan, India
4 Department of Pedodontics, Khammam Dental College, Khammam, Telangana, India
5 Department of Pedodontics, Mahatma Gandhi Postgraduate Institute of Dental Sciences, Puducherry, India

Date of Submission28-Apr-2015
Date of Decision28-Apr-2015
Date of Acceptance22-May-2015
Date of Web Publication1-Sep-2015

Correspondence Address:
Dr. Ananda Xavier Pragasam
Department of Pedodontics, CSI College of Dental Science and Research, Madurai
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0975-7406.163525

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   Abstract 

Aims and Objectives: To evaluate the sealing ability of two self-etching adhesive systems and glass ionomer cement (GIC) lining  Light cure (LC) under composite restorations in primary teeth. Materials and Methods: Class V cavities are prepared on the cervical third of the facial and lingual surfaces of primary molars. The specimens are then assigned into four experimental groups. The restored primary molars are stored in distilled water and subjected to thermocycling. Each section was examined using a stereomicroscope to assess dye penetration at the margin of the restoration and evaluated via pictures. Statistical Analysis Used: The degree of microleakage was analyzed using Kruskal-Wallis test and the intergroup significance by multiple comparison analysis. Results: The mean rank of the groups are Group I (Adper Prompt TM + Z−100) 19.44, Group II (UniFil BOND + Solare) 5.38, Group III (GIC lining LC + Z−100) 20.06, and Group IV (GIC lining LC + Solare) 21.13 with the P < 0.001. Conclusion: Composite resin restorations bonded with two-step self-etching adhesive system (UniFil Bond) exhibited lesser microleakage than one-step self-etching adhesive system (Adperprompt TM ) in primary teeth.

Keywords: Microleakage, sealing ability, self-etching adhesives


How to cite this article:
Pragasam AX, Duraisamy V, Nayak UA, Reddy V, Rao AP. Evaluation of sealing ability two self-etching adhesive systems and a glass ionomer lining LC under composite restoration in primary tooth: An in vitro study. J Pharm Bioall Sci 2015;7, Suppl S2:518-23

How to cite this URL:
Pragasam AX, Duraisamy V, Nayak UA, Reddy V, Rao AP. Evaluation of sealing ability two self-etching adhesive systems and a glass ionomer lining LC under composite restoration in primary tooth: An in vitro study. J Pharm Bioall Sci [serial online] 2015 [cited 2019 Dec 10];7, Suppl S2:518-23. Available from: http://www.jpbsonline.org/text.asp?2015/7/6/518/163525

Composite resin is the most esthetic direct restorative material currently available for restoring anterior teeth. Problems with composite restorations persist in terms of polymerization shrinkage, which leads to microleakage. [1] Microleakage is defined as the clinically undetectable passage of bacteria and ions between the cavity wall and the restoration. [2] In pediatric dentistry, there is an increasing demand for the esthetic benefits of adhesive dentistry [3] as composite resins have been documented to have a high failure rate in primary teeth. [4] This could be due to lack of cooperation in children leading to inadequate tooth isolation and a higher incidence of marginal leakage. [5]

An important area of research focuses on new methods for producing better dentinal bonding agents, the problem of microleakage is reduced in the permanent dentition. [6] As the three step bonding system is often considered to be too complicated and time-consuming especially in pediatric dentistry, they are replaced by "self-etching" or sixth generation adhesives. [7]

Light cured glass ionomers are useful as liners because of their good compressive strength, adhesiveness to dentin, ability to release fluoride, and chemically bond to composite restorations. [8] Therefore, it is logical to expect that a light cured glass ionomer cement (GIC) could serve as an excellent scaffold for a composite resin to be placed. [9]

Hence, the present study was conducted with the following aims and objectives.

  • To evaluate the sealing ability of two self-etching adhesive systems under composite resin restorations in primary teeth
  • To evaluate the sealing ability of glass ionomer lining LC cements under two different composite resin restorations in primary teeth.



   Materials and Methods Top


A total of 16 non-carious primary molars, which were extracted because of their over retention, were collected and stored in distilled water. The teeth were mounted in acrylic resin and stored in distilled water.

Class V cavities are prepared on the cervical third of the facial and lingual surfaces of each primary molars. Oval cavities of 4 mm in mesiodistal width, 2 mm of cervical occlusal width, and 1.5 mm deep in dentin were prepared using the straight fissure bur on a high-speed handpiece with water-cooling. The length of the bur (1.5 mm) was used as a guide for cavity depth.

The specimens were then assigned into four experimental groups. Each group consisted of four teeth on which eight restorations were done.

Groups in the study

  • Group I: Adper Prompt TM + Z−100
  • Group II: UniFil Bond + Solare
  • Group III: GIC lining LC + Z−100
  • Group IV: GIC lining LC + Solare.


In the prepared class V cavities, restoration was carried out as follows:

Group I

The prepared cavity was cleaned with water spray and dried conventionally and Adperprompt TM self-etching adhesive (3M) was dispensed as per manufacturer's instructions and brushed on the entire cavity surface and massaged it into the cavity for 15 s and a gentle stream of air was used to dry thoroughly the adhesive to a thin film and a second coat of the adhesive was applied with the brush tip and again a gentle stream of air was used to dry thoroughly the adhesive to a thin film and light-cured for 10 s. Then, Z-100 composite resin (3M) was placed with a plastic instrument and cured for 20 s with the light curing unit held as close to the restoration as possible.

Group II

The prepared cavity was cleaned with water spray and dried conventionally and Unifil Bond self-etching primer was applied to both enamel and dentin surface for 20 s and dried gently for 5 s with air syringe. This was followed immediately by the application of UniFil Bond bonding agent to both enamel and dentin surfaces with a cotton tip applicator and light-cured for 10 s. Then, Solare hybrid composite resin (GC India Private Limited) was placed with a plastic instrument and cured for 20 s with the light curing unit held as close to the restoration as possible.

Group III

In the prepared cavity, one drop of dentin conditioner (25% polyacrylic acid, GC Dental Industrial Corporation) was applied using a cotton pellet for 20 s. The tooth was rinsed for 10 s and dried conventionally. Then the glass ionomer lining LC Paste Pak cement was dispensed and mixed as per manufacturer's recommendations. The liner is applied on all internal dentinal surfaces with a calcium hydroxide applicator and as close to the gingival cavosurface angle as possible to allow room for the composite resin to cover it and the liner is cured with light curing unit for 20 s. [10] Then, the remaining enamel was etched with 37% phosphoric acid for 30 s and rinsed with water and dried. Then, Z-100 composite resin (3M) was placed with a plastic instrument and cured for 20 s with the light curing unit held as close to the restoration as possible.

Group IV

In the prepared cavity, one drop of dentin conditioner (25% polyacrylic acid, GC Dental Industrial Corporation) was applied using a cotton pellet for 20 s. The tooth was rinsed for 10 s and dried conventionally. Then the glass ionomer lining LC Paste Pak cement was dispensed and mixed as per manufacturer's recommendations. The liner is applied on all internal dentinal surfaces with a calcium hydroxide applicator and as close to the gingival cavosurface angle as possible to allow room for the composite resin to cover it. The GIC lining LC is cured with the light curing unit for 20 s. Then, the remaining enamel was etched with 37% phosphoric acid for 30 s and rinsed with water and dried. Then, Solare hybrid composite resin (GC) was placed with a plastic instrument and cured for 20 s with the light curing unit as close to the restoration as possible.

Thermocycling

The primary molars that were restored were stored in distilled water for 24 h and then they were subjected to thermocycling. The cycles consisted of 100 times in baths at 5°C and 50°C, with a dwell time of 30 s in each bath. [4]

Microleakage examination

All the tooth surfaces except the restoration and a 1 mm zone adjacent to its margin were covered with two coats of nail varnish. [5] All the specimens were immersed in a 1% rhodamine-B (fluorescent dye) solution for 24 h at 37°C. The teeth were then sectioned buccolingually through the middle of the restoration using water cooled diamond disc. [11]

Each section was examined using a stereomicroscope (Wild Heerbrugg Wild MZ3) at ×16 magnification to assess dye penetration at the margin of the restoration and evaluated via pictures (Kodak Gold 100 Film).

The degree of microleakage is evaluated and scored as: [5]

  • Score 0: No dye penetration
  • Score 1: Dye penetrated along incisal or gingival wall less than the total length of the wall
  • Score 2: Dye penetrated along the entire length of incisal or gingival wall
  • Score 3: Dye penetrated along the entire length of incisal or gingival wall, as well as the axial wall.


Statistical analysis

The obtained data were analyzed using Kruskal-Wallis test for statistical analysis of the degree of microleakage for all the groups at the incisal wall, as well as the gingival wall of the restorations, and then subjected to multiple comparison analysis for to find out the intergroup significance.

The results are obtained using the formula:

ǀR.j−R.iǀ ≥ Zα1/2 √nN (n −1)/6

1/2 = 1.96, n = 8 subjects, n = 32 subjects.

Further Spearman's rank correlation is used to assess the microleakage in both the incisal and gingival walls of the restorations in all the groups.


   Results Top


The microleakage scores of the groups at the incisal walls of the restorations showed that in Group I, 37.5% of the restorations showed minimal leakage in the incisal wall and 62.5% of the restorations showed maximum leakage. In Group II, 75% of the restorations showed no leakage and 25% of the restorations showed minimal leakage in the incisal wall. Whereas in Group III and Group IV, 25% of the restorations showed minimal leakage in the incisal wall and 75% of the restorations showed maximum leakage extending along the entire length of the incisal wall, as well as the axial wall.

The microleakage scores of all the groups at the gingival walls of the restorations showed that in Group I, 12.5% of the restorations showed minimal leakage in the gingival wall and 87.5% of the restorations showed maximum leakage. In Group II, 12.5% of the restorations showed no leakage and 62.5% of the restorations showed minimal leakage in the gingival wall and 25% of the restorations showed maximum leakage extending along the entire length of the gingival wall, as well as the axial wall. Whereas, in Group III and Group IV showed maximum leakage extending along the entire length of the gingival wall, as well as the axial wall.

[Table 1] shows the mean rank and Kruskal-Wallis test of all the groups at the incisal wall of the restoration. Group I (Adper Prompt TM + Z−100) 19.44, Group II (UniFil Bond + Solare) 5.38, Group III (GIC lining LC + Z−100) 20.06, and Group IV (GIC lining LC + Solare) 21.13. On comparing all the groups, the value was found to be 17.869 with the P < 0.001. It indicated that there was a statistical significant difference among the four groups. Group II restorations (UniFil Bond + Solare) exhibited least microleakage compared to all other groups at the incisal wall of the restorations.
Table 1: Mean rank and Kruskal-Wallis test result of all the groups at the incisal wall of the restoration

Click here to view


[Table 2] shows the Mean rank and Kruskal-Wallis test of all the groups at the gingival wall of the restoration. The mean rank of the groups are Group I (Adper Prompt TM + Z−100) 18.06, Group II (UniFil Bond + Solare) 7.94, Group III (GIC lining LC + Z−100) 20.00, and Group IV (GIC lining LC + Solare) 20.00. On applying Kruskal-Wallis test for comparison of the groups, the value was found to be 17.628 with the P < 0.001. It indicates that there was a statistical significant difference among the four groups.
Table 2: Mean rank and Kruskal-Wallis test result of all the groups at the gingival wall of the restoration

Click here to view


This showed that Group II restorations (UniFil Bond + Solare) exhibited least microleakage compared to all other groups at the gingival wall of the restorations.

Spearman's rank correlation was applied in order to know whether the microleakage is similar in both the incisal and gingival walls of all the groups. A significant result in Group II showed that there is a similarity between the incisal and gingival walls of the restoration. Because, Group II (UniFil Bond + Solare) material influences or reduces the leakage both in the incisal and gingival walls of the restoration, whereas other groups are not much influenced [Table 3].
Table 3: Spearman's rank correlation test result of all the groups at the incisal and gingival walls of the restoration

Click here to view



   Discussion Top


Clinicians and researchers use microleakage as a measure of assessing the performance of restorative materials in the oral environment. [12] Microleakage may be the more accurate assessment of dental materials than in vitro bond strength. [13]

In this study, an in vitro model was chosen to standardize the model, to obtain ideal adhesion conditions and to allow thermocycling simulating stress caused by thermal variations. [14] Studies on marginal integrity, usually are performed as studies of class V restorations are easy to standardize. [15] The recommended protocol for the assessment of microleakage is to prepare control class V cavities with butt joints in both enamel and dentin. [16]

Class V and Class I preparations have high "C" factor indicating that they have high-stress concentration. The high "C" factor is the reason for using class V restorations to test the efficacy of the dentin adhesive systems. [17]

Light emitting diode (LED) was used in the study for polymerization of the resins due to the fact that they were able to obtain a deeper cure than with the halogen light (Fujibayashi et al. 1996) with the added advantage of more selective spectral light than conventional lamps. [18] It was stated by the council of dental materials that the degree of conversion of monomer to polymer in specimens cured with LED was greater than in those cured with halogen light source. [19]

The teeth were then subjected to a thermocycling procedure, which is an accepted method for microleakage assessment (Ben Amar 1986). [20] Thermocycling is used in most of the in vitro studies to expose the restorations to thermal stresses and to simulate clinical conditions. [13]

Several methods have been introduced for evaluating in vitro microleakage, including radioisotopes, dyes, air pressure, neutron activation analysis, bacterial penetration, pH changes and SEM. [21] In a study comparing dye and radioisotope, indicated that the dye penetration was a more valuable test with a direct inspection under a dissecting microscope because it was more flexible, less complicated, and provided more information. [13]

Fluorescent dyes were found to be particularly useful as tracers for demonstration of leakage around dental restorations, because they are detectable in dilute concentrations, are sensitive to ultraviolet light, are easy to photograph, permit more reproducible results are inexpensive, contrast sharply with the natural fluorescence of teeth, require short immersion periods, permit direct observation of the total marginal interface during evaluation, and scoring of marginal leakage are nontoxic, permit clinical, as well as laboratory investigations. [22]

The self-etching adhesive Unifil Bond has got less microleakage than Adper-Prompt with the P < 0.001, which is found to be statistically significant.

This result is consistent with the results of the study done by Kimishima et al. [23] where they compared the microleakage of four all-in-one adhesive systems and concluded that the sealing ability of the all-in-one adhesives seemed to be inferior to that of the two-step adhesives.

The probable cause for the decrease in microleakage by the use of two-step self-etching adhesive (UniFil Bond) can be attributed to its less sensitive to variation in dentin wetness compared to traditional acid etching/water rinse systems. [24] UniFil Bond self-etching primer ensures that the collagen will not collapse, because the primer is not washed off the tooth after placement and monomers from the primer remain in the demineralized dentin supporting the collagen network during air drying and this results in increased adhesion and fewer voids between the adhesive and dentin, which minimizes the chance of nanoleakage. [25]

There was no statistical significant difference between the groups which used GIC lining LC under composite restorations.

This result is consistent with the results of the study done by Tjan and Dunn [26] where they compared the microleakage of light-cured, and auto cure glass ionomer liners used in class V composite laminated glass ionomer restorations. The results of the study showed no difference among the groups using the light cure glass ionomer liners and concluded that removal of smear layer using 10% polyacrylic acid solution did not influence microleakage in restorations with light-cured glass ionomer liner.

Light activated bases are primarily resin based and exhibit polymerization shrinkage with contraction gaps. In a study carried out by Chan and Swift on microleakage of composite resin light activated base material, polymerization shrinkage is the reason for microleakage.

The restoration of the class V cavities with resin modified GIC as a liner under composite restoration was thought to decrease the microleakage, but it did not have a significant effect on microleakage in our study. This finding is consistent with the statement made by Chan and Swift. [27]

The probable cause for the severe leakage observed at the cavosurface margins of the restorations by the use of GIC lining LC can be explained because of the difficulty in applying the liner completely to the cavosurface angle.

On comparing microleakage scores of the incisal and gingival walls of the restorations in all the groups. Gingival margins exhibited more severe leakage than did occlusal (enamel margins), which is in agreement with the general findings in the literature. [28]

Nakabayashi and Pashley [6] have stated that dentin demineralization is related to the type of dentin, the direction of dentinal tubules and density. Formation of the hybrid layer is considered mandatory for obtaining a lasting marginal seal. [6]

Santini et al. reported that gingival margin leakage is not prevented by either restoring cavities with self-etching adhesives. [29] Thus, it is concluded from the present study that Group II restorations (UniFil Bond + Solare) exhibited least microleakage compared to all other groups at the incisal, as well as the gingival wall of the restorations.

Bonding is the dentistry of the future. The ability to bond two materials together has positive advantages in clinical dentistry. Depending on the situation, an effective bond may result in a reduction of microleakage at a cavosurface margin, and the ability to conserve tooth structure by avoiding the need for macro mechanical retention. [30] Dentin bonding systems used in association with the appropriate composite resin resulted in a reduction of marginal leakage. Self-etching adhesives are an excellent supplement to existing conventional adhesives, but there is no clinical need to replace the latter entirely.


   Conclusion Top


From the present study, it is concluded that:

  • Composite resin restorations bonded with two-step self-etching adhesive system (UniFil Bond) exhibited lesser microleakage than one-step self-etching adhesive system (Adperprompt TM ) in primary teeth
  • There is no statistical significant difference in the sealing ability of glass ionomer lining LC cement under two different composite resin restorations in primary teeth
  • Restoration of cavities by the use of two-step self-etching adhesive (UniFil Bond) and Solare hybrid composite resin exhibited a significantly lesser microleakage in primary teeth.


Self-etching adhesive systems offer two advantages in pediatric dentistry [9]

  • Tooth isolation: Since the use of a rubber dam is not always possible with young, uncooperative or mouth breathing children
  • Working time reduction: The easy handling of self-etching adhesive systems makes them a good choice in pediatric dentistry.


The use of a valid combination of bonding agent and composite resin represents an essential step that must be evaluated in clinical research. Further in vitro and in vivo studies using dentin adhesives with the recommended composite resin should be considered. Dentin bonding systems are currently a valid but sophisticated material available in clinical practice.

Further studies of testing these materials in vivo are warranted to determine whether the amount of microleakage is the same as in in vitro and whether the observed amount of microleakage, if present, is clinically relevant.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
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    Tables

  [Table 1], [Table 2], [Table 3]



 

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