|Year : 2021 | Volume
| Issue : 6 | Page : 1210-1214
Evaluation of Class II restoration microleakage with various restorative materials: A comparative In vitro study
Madhura Pawar1, Muhammad Atif Saleem Agwan2, Bushra Ghani3, Megha Khatri4, Pooja Bopache5, Mian Salman Aziz6
1 Department of Pedodontics and Preventive Dentistry, Dr. D. Y. Patil Dental College and Hospital, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, India
2 Department of Restorative Dentistry, College of Dentistry in Alrass, Qassim University, Qassim, KSA
3 Department of Operative Dentistry and Endodontics, Altamash Institute of Dental Medicine, Karachi, Pakistan
4 Department of Oral and Maxillofacial Surgery, SMBT Institute of Dental Sciences, Nashik, Maharashtra, India
5 Department of Conservative Dentistry and Endodontics, Rungta College of Dental Sciences and Research, Bhilai, Chhattisgarh, India
6 Department of Dental Materials, Institute of Dentistry, CMH, Lahore, Pakistan
|Date of Submission||01-May-2021|
|Date of Decision||08-May-2021|
|Date of Acceptance||08-May-2021|
|Date of Web Publication||10-Nov-2021|
Department of Pedodontics and Preventive Dentistry, Dr. D. Y. Patil Dental College and Hospital, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Background and Objectives: The quest for a suitable esthetic material for tooth restoration has resulted in significant advancements in both material properties and application technique. Composites and acid-etch procedures are two significant advancements in esthetic restorative dentistry. Further research has strengthened composites' overall wear resistance and strength, but the problem of polymerization shrinkage has persisted. To reduce polymerization shrinkage and microleakage, a variety of techniques and material modifications have been suggested. The marginal leakage of amalgam, packable composite, flowable composite with packable composite, and high-viscosity traditional glass ionomer cement (GIC) was compared in this analysis to test the mentioned hypothesis. Materials and Methods: We chose 60 freshly extracted teeth and divided them into four classes of 15 teeth each. Class II cavities were prepared in a standardized manner. Group I was treated with amalgam, Group II with packable composite (GC G-aenial Posterior), Group III with flowable composite (G-aenial Universal Flo) as a liner and then restored with packable composite (GC G-aenial Posterior), and Group IV with high-viscosity traditional GIC (EQUI FORTE FILL). After that, the restorations were put through a thermocycling process. The specimens were soaked in 0.5% methylene blue dye before being cut into mesiodistal sections to assess microleakage at the gingival margin. After that, the parts were examined under a stereomicroscope. The degree of dye penetration was used to determine the score. Results: There was no microleakage in the control group, and the gap between the control and experimental groups was statistically significant (P = 0.017). Conclusion: The glass hybrid restorative device had less gingival microleakage than the resin-based restorative material, indicating that it has a better sealing capacity. Clinical acceptability of glass hybrid restorative systems, on the other hand, must be confirmed with a larger sample size and in vivo trials.
Keywords: Amalgam, EQUI FORTE FILL, G-aenial posterior, G-aenial universal flo, gingival microleakage, stereomicroscope
|How to cite this article:|
Pawar M, Saleem Agwan MA, Ghani B, Khatri M, Bopache P, Aziz MS. Evaluation of Class II restoration microleakage with various restorative materials: A comparative In vitro study. J Pharm Bioall Sci 2021;13, Suppl S2:1210-4
|How to cite this URL:|
Pawar M, Saleem Agwan MA, Ghani B, Khatri M, Bopache P, Aziz MS. Evaluation of Class II restoration microleakage with various restorative materials: A comparative In vitro study. J Pharm Bioall Sci [serial online] 2021 [cited 2022 Aug 16];13, Suppl S2:1210-4. Available from: https://www.jpbsonline.org/text.asp?2021/13/6/1210/330108
| Introduction|| |
A healthy mouth is essential for a long-term quality of life. In dentistry, there have been more changes and improvements in the last decade than there have been in the previous 100 years combined, and the rate is picking up. The preservation of tooth structure is critical in today's era of adhesive dentistry or microdentistry. Rather than using extension as a treatment guideline for prevention, the emphasis is now on restriction with conviction.
For any restorative method to preserve pulpal health and improve the restoration's longevity, the marginal seal's integrity and durability are critical. Microleakage at the gingival margin of the proximal box is one of the poor links with class II composite resin restorations, contributing to postoperative vulnerability and a high incidence of secondary caries, which accounts for many clinically failed restorations.,
A marginal microleakage is a mechanism in which bacteria, their metabolites, enzymes, toxins, ions, and other cariogenic factors penetrate between the filling and the cavity wall in clinically undetectable amounts.,
Resin-based composites were advocated as a viable alternative to older restorative materials because they were mercury-free, thermally nonconductive, esthetic, and could bind to the tooth easily with the use of adhesive systems.
G-aenial is a light-cured radiopaque microfilled resin hybrid composite restorative made up of two different forms of prepolymerized resin fillers.
The prepolymerized fillers also help to explain why G-aenial has such a low degree of shrinkage and therefore microleakage. Despite the fact that modern resin-based composites have improved dramatically in terms of wear resistance and can achieve good proximal contact and contour, polymerization shrinkage remains the most significant challenge in direct resin-based composite restorations.
For load-bearing areas, dental amalgam is still the most common filling material. Varnish liners have been used in amalgam restoration to minimize microleakage, but their long-term efficacy is still a question. Over time, amalgam surface corrosion and oxide deposition boost marginal autosealing. In contrast to composite resins, amalgam is dimensionally stable.
GC G-aenial Universal Flo is a blend of injectable viscosity for easy and convenient placement even in deep cavities, high strength and balanced physical properties for durable restorations in all indications, and excellent wear resistance. Flowable composites have been recommended as liners beneath composites due to their low viscosity, increased elasticity, and wettability. This results in an intimate union with the floors and walls of the cavity preparations., However, whether the elastic layer concept can actually decrease microleakage is not yet conclusive as previous in vitro studies have yielded conflicting results.
Furthermore, there is no strong consensus on which type of liner material would have the best results. G-aenial Universal Flo, a newly introduced highly filled flowable material, claims to be a direct restorative material for Class I, II, III, IV, and V cavities.
The glass hybrid invention of EQUIA Forte Fill is accomplished by dispersing ultrafine, highly reactive glass particles within the traditional glass ionomer (GI) Structure. It is a resin surface sealant that is self-adhesive, chemically cured, and strongly packed.
GI cement and composite resin restorative materials have been commonly promoted for restoring posterior teeth due to their ease of use and suitable esthetics. The choice of restorative material must be based on the material's efficiency under simulated and clinical conditions.
The clinician is concerned about microleakage of posterior restorative materials at the margins of the proximal box, especially at the gingival floor of Class II restorations. It is critical that newly developed restorative materials have improved physical and mechanical properties, as well as the ability to efficiently seal the cavity reconstruction margin, allowing them to perform better under oral conditions faster. As a result, the aim of this research was to evaluate the in vitro microleakage of Class II restorations using four different restorative materials.
| Materials and Methods|| |
A total of 60 freshly extracted human maxillary premolar teeth following the extraction for orthodontic purposes from the department of oral surgery were collected, stored, and surfaced, adhering to infection control protocol in the laboratory as prescribed by the Centers for Disease Control global.
Test specimen selection
Maxillary 1st premolar extracted for orthodontic purpose.
Teeth with caries, cracks, and preexisting restoration.
Class II cavities (box preparation) were prepared using high-speed handpiece and diamond burs following the standardized dimensions in each premolar.
The prepared teeth were divided into four groups of 15 teeth each (n = 15) and held in a standard saline solution.
Group I (Amalgam)
Tofflemire matrix and retainer were placed around the tooth and held by finger pressure against the gingival margin of the cavity, so that the preparation would not be overfilled at the gingival margin. Varnish was applied on all the walls and floors of the cavity. Amalgam was then manipulated using an amalgamator and placed into the cavity and condensed properly.
Group II (G-aenial posterior restorative)
Tofflemire matrix and retainer were placed same as in Group I. Intermediate layer was not used here. The cavities were etched with acid etchant (37% phosphoric acid gel) for 10 s, rinsed with water, and air-dried for 2 s. Bonding agent was applied, waited for 10 s, and air-dried for 5 s. Then, the cavity was restored with packable composite and was light-cured for 10 s.
Group III (G-aenial universal flo + G-aenial posterior restorative)
The procedure was similar to that of Group II till the application of dentin bonding agent. Flowable composite was placed 1 mm and then addition of packable composite was done followed by light-curing for 10 s.
Group IV (Equia-FORTE Fill + Equia-FORTE coat)
Petroleum jelly was applied inside the matrix and conditioned with GC cavity conditioner (10 s) or dentin conditioner (20 s). The cavity was then rinsed and gently dried. The plunger was then depressed and a capsule applier was inserted and activated by clicking once. Mix for 10 s. Prime capsule was then immediately dispensed within 10 s, packed, and contoured. Ensure complete set of EQUIA Forte Fill. Use a probe to separate the bond between matrix and EQUIA Forte Fill. Finishing of the restoration was done by applying the EQUIA Forte Coat, which was then light-cured for 20 s.
The margins of all the restorations were finished with SofLex disks. Restored teeth were then stored in distilled water for a week at room temperature. The teeth were thermocycled in water bath maintained between 5°C, 37°C, and 55°C. The root apex was completely sealed with acrylic resin. Each sample was sealed with two coats of nail varnish, leaving a 1 mm window around the cavity margins. Coated teeth were then immersed in 0.5% methylene blue dye for 48 h. Teeth were rinsed with water and then dried.
After removal from the dye solution, the teeth were sectioned in the mesiodistal direction along the center of the restoration using a slow-speed sectioning disc under water irrigation. Each specimen was examined under a stereomicroscope. Standardized digital images were obtained. Grading was done according to dye penetration.
| Results|| |
When microleakage among the four groups was compared, in group 1; 15 specimens (100%) showed no microleakage, In group 2, 11 samples showed no microleakage, 3 samples with score 1, 1 samples with score 2 and 0 teeth showed gingival microleakage past the axial wall. In group 3, 8 samples (53.3%) showed no microleakage, 4 samples (26.7%) showed score 1, 2 samples showed score3 microleakage and 1 sample showed score 1 microleakage, where as in group 4; 5 specimens (73.3%) showed no microleakage, 3 samples (20%) showed score1 and 4 sample (6.7%) showed score 2; P < 0.017 was considered statistically significant.
| Discussion|| |
Controlling microleakage, which may occur due to dimensional changes or a lack of adaptation of restorative content, resulting in frequent dental caries and pulpal irritation, is one of the most important goals of restorative dentistry.
The increase in demand for tooth-colored restorations together with concerns about mercury toxicity has reflected in a drastic reduction in the use of amalgam restorations. Resin composites are the most widely used materials as an alternative to amalgam. It is largely due to esthetic results, low to no preparation requirement, acceptable longevity, and relatively low cost.
Traditional posterior resin composites experience volumetric contraction of 2.6%–7.1% during polymerization. Microleakage and its consequences result from this shrinkage. Composite resin has a much higher thermal expansion factor (25–60/106/°C) than enamel (11.4/1106/°C) and dentin (8/1 106/°C). This physical property is also thought to be the cause of microleakage in resin-based restorations. In vivo and in vitro experiments by Patel MU et al. showed that resin composite restorations had higher microleakage scores than amalgam restorations.
In the present in vitro study, group 1 and group 4 showed the least microleakage and group 2 showed the highest microleakage. The current study showed that score zero was predominantly reported for amalgam and Equi Forte fill.
After packing the amalgam in the cavity, there was a rapid contraction, followed by a slower expansion, and finally a mild and slow contraction. “Dimensional transition” refers to the net contraction and expansion of an amalgam restoration during environment. If the amalgam contracts during setting, it is considered negative; if it expands during setting, it is considered positive; however, ANSI/ADA states that the dimensional shift between 5 min and 24 h must be within the range of −15 to +20 m/cm.
Since amalgam does not conform rigidly to the tooth structure, a positive dimension shift would result in less space between the amalgam and the tooth structure. Mahler et al. reported that zinc in amalgam alloys is to blame for the faster corrosion of the sealing of amalgams made from zinc-containing alloys in a recent report. They analyzed leakage after 1 week, just like the current report, and found corrosion products in the occlusal margins of restorations. As a result, low leakage scores in the current study's amalgam restorations can be attributed to corrosion sealing of the zinc-containing alloy.
In EQUIA forte, there was less microleakage. The benefit of GC EQUIA Forte is that it is an advanced restorative device based on modern glass hybrid technology that combines more voluminous EQFglass fillers with smaller, highly reactive fillers to reinforce the restoration. The lesser microleakage score of EQUI FORTE as compared to other restorative materials which were used in the study can also be attributed to the fact that EQUIA forte is a premeasured capsule of a single-component metamorphic material which obviated the uncertainties in the powder/liquid ratio and permitted a consistent mix of the restored material.
EQUIA Forte coat is a composite coating that boosts flexural strength by 17% and flexural capacity by almost 30%. EQFCoat penetrates the surface porosities, increasing the overall strength of the EQUIA filling and reducing microleakage around restorations.
As an alternative to amalgam, some manufacturers have launched “condensable” or “packable” composites (Leinfelder, 1997; Leinfelder and others 1998). Packable composites are placed using amalgam techniques, resulting in suitable interproximal contacts (Leinfelder and others, 1998). Packable composite showed the most microleakage in this analysis. Resin-based composites used for some dental adhesives are thought to lose their sealing capacity over time, allowing microleakage to occur.
The shrinkage of composite restorations or posterior restorative materials during polymerization causes stress on the network and its bonding mechanism, which is one of the key disadvantages. This causes marginal staining, bad marginal seal, and persistent caries, both of which shorten the restoration's lifespan.
In previous studies, thermocycling was found to be the most important factor in improving the microleakage method. A previous study of in vitro thermocycling regimens showed the effects of a wide variety of cycle numbers, temperatures, and exposure times.
A proper artificial aging test is described as a thermocycling method that includes a minimum of 500 cycles in water between 5°C and 55°C. The current study's conditions (500 cycles of 5.2°C to 55.2°C with a 20s dwell time) were based on recent research on Class II and Class V restorations. The scoring criteria used in this dye penetration analysis are identical to those used in previous research.
Matloff et al. discovered that dye penetration in an aqueous solution was more sensitive than other methods, and that dye penetration was the most sensitive method for studying leakage. 0.5% basic fuchsin, 2% methylene blue, and 50% silver nitrate are the most widely used solutions.
Because of its low cost, high solubility in water, ease of use, and low molecular weight (which is smaller than bacteria), methylene blue (0.5%) was used in this research. Dye tests could detect leakage where bacteria could not get through. To determine the degree of penetration, methylene blue was used as a tracer. The permeability of dentinal tubules and the smaller particle size can lead to an overestimation of the significance of this infiltration.
The average bacterial cell size is greater than the measured region of methylene blue, which is 0.52 nm2. Since the diameter of a bacterial cell ranges from 0.3 to 1.5 microns, this technique is unable to distinguish between a distance that is too broad or too narrow to enable bacterial leakage. The downside of this method is that it only measures the visible dye.
The use of cross-sections allows for a more precise measurement of leakage. The stereomicroscope was used to evaluate the prepared samples because it offers two-dimensional images of the tooth sections that reveal areas of microleakage that are well magnified.
| Conclusion|| |
Esthetic dentistry has made significant strides in recent years, resulting in the introduction of a variety of improved restorative products. The key questions about these materials' efficiency right now are their toughness and the integrity of marginal sealing. One of the most significant disadvantages of composite restorations is volumetric shrinkage, which can eventually lead to microleakage at the resin restoration and tooth interface, allowing oral fluids to move through and cause secondary caries, secondary caries, discoloration, and cuspal strain. Microleakage control has always been a priority in operative dentistry.
Various restorative materials have been tried and tested for this purpose, each with its own set of benefits and drawbacks. In deep Class II cavities, achieving a peripheral seal at the gingival margin is difficult.
Within the limitations of this analysis, it can be concluded that the glass hybrid restorative device had less microleakage than the resin-based restorative material, indicating that it had better sealing capacity.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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