Effect of different application and polymerization techniques on the microleakage of proximal resin composite restorations in vitro

This in vitro study investigated cervical microleakage of proximal resin composite restorations placed with three application and polymerization techniques. Uniform mesio-occlusal-distal (MOD) preparations featuring cervical margins above (mesial) and below (distal) the CEJ suitable for restoration with resin composite were copy milled into 33 recently extracted permanent molars. The teeth were divided randomly into three groups of 11 teeth and restored using a conventional incremental technique (Group A) and two novel curing devices (Groups B and C). After 24 hours, a dye penetration test was used to assess microleakage. Conventional placement in preparations with cervical margins in enamel had significantly lower interfacial leakage scores than those recorded for placement in preparations with margins in cementum regardless of the technique used to place the restorative material. Use of the two novel curing devices conferred no advantage in reducing microleakage irrespective of where preparation margins were placed.     

Adhesion of Indirect MOD Resin Composite Inlays Luted With Self-adhesive and Self-etching Resin Cements

SUMMARY This study investigated the effect of loading on the bond strength to dentin and microleakage of MOD indirect composite restorations bonded with self-adhesive and self-etching resin cements with or without acid etching of the proximal enamel margins. Class II MOD cavities were prepared in 48 molar teeth into dentin and divided into three groups of 16 teeth. Impressions were taken and indirect composite inlays fabricated (Estenia C & B). The enamel margins of the proximal boxes of half the specimens were phosphoric acid etched, and the inlays were cemented with one of three cements (Panavia F 2.0, SA Cement, or Rely X Unicem). After luting, eight teeth in each cement group were mechanically loaded at 2.5 cycles/s for 250,000 cycles. Unloaded teeth acted as controls. Teeth were stored in Rhodamine B solution for 24 hours, sectioned buccolingually at the proximal boxes to examine microleakage using confocal microscopy, and further sectioned for μTBS testing of the resin-dentin interface. Analysis of variance was performed to assess the effect of loading and acid etching on microleakage and bond strength. Acid etching had no effect on microleakage. No significant difference in the dentin bond strengths between the three cements existed after loading. Panavia F 2.0 exhibited a significant reduction in bond strength. With regard to microleakage at the proximal boxes, loading had no effect on dye penetration at the cavity floor. However, at the axial walls, loading had a significant deleterious effect on Panavia F 2.0. No difference in microleakage existed between the three cements at both sites before and after loading. In conclusion, the two tested self-adhesive cements exhibited similar bond strengths before and after loading to the self-etching resin cement. Loading reduced dentin bond strengths and increased microleakage at the resin-dentin interface. However, acid etching of the enamel margins had no significant effect on microleakage in the approximal regions of the bonded inlays.     

Microleakage in MOD resin composite with three dentin bonding agents

The extent of microleakage under MOD composites was studied when an aluminum oxalate dentin bonding agent (Tenure), a phosphonated resin bonding agent (Bondlite), and a glass-ionomer cement (Ketac Silver) were used. Three groups of 10 extracted molars were prepared with MOD cavities; one box ended on enamel, the other on cementum. In Group 1, Bondlite was applied to dentin and etched enamel before the sample was restored with a light-cured hybrid composite. In Group 2, a 2-mm increment of Ketac Silver was placed in each box before Bondlite and composite. In Group 3, Tenure was applied to dentin before being restored. Teeth were thermal-cycled, stained in silver nitrate, sectioned, and scored for microleakage. Microleakage along the gingival floor was significantly less at enamel margins than at cementum margins in all three groups. All groups showed severe marginal microleakage on cementum.     

Influence of flowable liner and margin location on microleakage of conventional and packable class II resin composites

This in vitro study evaluated gingival wall microleakage in packable and microhybrid conventional composite restorations with and without a flowable composite liner. Each group was evaluated with gingival margins situated in both enamel and cementum/dentin. Two hundred and forty Class II cavities were prepared in extracted third molars, half with gingival margins in enamel and half with margins in dentin/cementum. In groups of 30, restoration was undertaken with packable alone (3M Filtek P60), conventional alone (3M Z250), packable plus flowable liner (3M Filtek Flow) and conventional plus flowable liner. All used 37% phosphoric acid etch and Scotchbond 1 (3M) as the bonding system. After restoration, the teeth were thermocycled (between 5 degrees C, 37 degrees C and 60 degrees C) 1,500 times, soaked in 0.1% methylene blue, sectioned and microleakage from the gingival margin scored. Statistical analysis was performed using Kruskal Wallis and Mann-Whitney U tests. There was no significant difference between systems in terms of leakage scores when gingival margins were situated in enamel (p=0.70). All restorations with margins in cementum/dentin leaked significantly more than those with margins in enamel (p<0.001). There was no significant difference between leakage scores of 3M Z250 and Filtek P60 with cementum/dentin gingival margins (p=0.68). Use of a flowable composite liner (3M Filtek Flow) against cementum/dentin was associated with increased microleakage (p<0.001). In this study, leakage scores suggest that gingival margins should be placed in enamel. The conventional and packable resin composites tested were not associated with differences in microleakage. Leakage data do not support the use of flowable resin composite linings in Class II resin composite restorations.     

The effect of different types of flowable restorative resins on microleakage of Class V cavities

This study evaluated the microleakage of Class V cavities restored with three different types of flowable resin restorative material and compared the effects of using their respective manufacturer's dentin adhesive or a different brand. Class V cavities with the occlusal margin in enamel and the gingival margin in dentin were prepared on the buccal and lingual surfaces of 48 non-carious human molars. The teeth were randomly assigned to three equal groups of 16. The first eight teeth in each group were restored with one of the flowable restorative materials (Filtek Flow, Dyract Flow, Admira Flow) using the manufacturer's recommended dentin adhesive (Single Bond, Prime & Bond NT, Admira Bond), and the remaining eight molars were restored using a different brand of dentin adhesive (Gluma Comfort Bond). The samples were thermocycled 200 times (5 degrees C-55 degrees C) with a one-minute dwell time. They were then immersed in a 2% basic fuchsin solution for 24 hours, sectioned and analyzed by stereomicroscopy. There was no statistically significant difference at the occlusal margins for either restoration used with its respective dentin adhesive. At the gingival margins, there was a significant difference among all groups. Flowable ormocer (Admira Flow/Admira Bond) displayed the least leakage at the gingival margins. When these flowable restoratives were used with a different brand of dentin adhesive, statistically significant differences were observed both on enamel and dentin. None of the restoratives tested fully prevented leakage at the gingival margins. No significant differences in microleakage were observed among the restorative materials used with respect to the manufacturer's dentin adhesive or a different brand except for Admira Flow restorative at the gingival margins. The gingival margins had significantly more microleakage than the occlusal margins (p < 0.05) except in the Admira Flow group, where microleakage at the occlusal and gingival margins was almost equal.     

Microleakage study of flowable composite resin systems

The purpose of this in vitro microleakage study was to evaluate four low-viscosity composite resin systems. Each resin system included the corresponding bonding agent for each respective flowable composite. A hybrid material was used as a control. A total of 75 noncarious, freshly extracted human teeth were prepared with a Class 5 occlusal preparation and a gingival preparation at the cementoenamel junction. The materials were inserted according to the manufacturers' recommendations using the single-component bonding agent for each system. Teeth were thermocycled 800 times between 5 degrees C and 55 degrees C with 30-second dwell times. The teeth were then coated with nail polish 1 mm short of the restoration, placed in a basic fuchsin dye for 24 hours, and sectioned with a diamond wheel. Enamel and dentin/cementum margins were analyzed for microleakage on a scale of 0 (no leakage) to 3 (axial wall). Results were evaluated with the Fisher's exact test. The results of the study indicate that there was no leakage at the enamel margin of any restorations. No statistically significant differences in microleakage were found in dentin/cementum margins among the samples in the experimental group or between the experimental group and control group. The results indicate flowable composites demonstrate resistance to microleakage in both enamel and cementum/dentin margins similar to TPH hybrid composite.     

The effect of fiber placement or flowable resin lining on microleakage in Class II adhesive restorations

PURPOSE: The aim of this in vitro study was to evaluate the effect of two fibers (polyethylene or glass) and a flowable resin liner on microleakage in Class II adhesive restorations. MATERIALS AND METHODS: Class II adhesive cavities were prepared on mesial and distal surfaces of 40 extracted sound human molars. The cavity margins were below or above the CEJ. The teeth were randomly divided into four groups according to the restoration technique: group 1: restored with a resin composite (AP-X, Kuraray) in bulk after SE Bond (Kuraray) treatment; group 2: flowable resin liner (Protect Liner F, Kuraray) was used before composite restoration; in group 3, a polyethylene fiber (Ribbond) and in group 4, a glass fiber (everStick NET, StickTech) was placed into the bed of flowable resin before composite restoration. Samples were finished, stored in distilled water for 7 days at room temperature, and then thermocycled for 300 cycles between 5 degrees C and 55 degrees C. After sealing the apices, the teeth were varnished within 1 mm of the margins and placed in 0.5% basic fuchsin dye for 24 h at 37 degrees C. After rinsing, the teeth were sectioned longitudinally through the restorations and microleakage was evaluated with a stereomicroscope. Marginal penetration was scored on a 0 to 4 scale, and the data were statistically analyzed using Kruskal-Wallis and the Mann-Whitney U-test. RESULTS: Flowable resin, everStick NET, and Ribbond THM used in combination with flowable resin significantly reduced leakage at occlusal margins in cavities with enamel margins (p < 0.05). When the leakage values on cervical dentin margins were evaluated, there was no statistically significant difference among the tested groups (p > 0.05). CONCLUSION: Use of flowable composite alone or in combination with polyethylene or glass fibers reduces occlusal leakage in Class II adhesive cavities with enamel margins.     

Microleakage of different resin composite types.

OBJECTIVE: The purpose of this study was to evaluate the microleakage of Class V cavity preparations restored with three different types of resin composite and an ormocer. METHOD AND MATERIALS: Forty Class V cavities were prepared in buccal and lingual surfaces of 20 recently extracted molar teeth. The occlusal margin of each restoration was on enamel and the gingival margin on dentin. Teeth were randomly assigned to four groups of 5 teeth each and restored as follows: Group I, flowable resin composite (Tetric Flow); Group II, hybrid resin composite (Z100); Group III, packable resin composite (Solitaire 2); Group IV, organically modified ceramics-ormocer (Admira). In all groups, the manufacturers' instructions were strictly followed. All restorative resin composite materials were placed in one increment. All teeth were then immersed in 0.5% basic fuchsin solution for 24 hours after thermocycling (200 cycles; between 4 degrees C to 60 degrees C). The teeth then were longitudinally sectioned and observed under a stereomicroscope. The degree of dye penetration was recorded and analyzed with the Kruskal-Wallis and Mann-Whitney tests. RESULTS: No statistically significant differences in microleakage were observed between groups either on enamel or dentin. CONCLUSION: All restorative materials demonstrated equal effectiveness in reducing microleakage.     

Evaluation of the cervical integrity during occlusal loading of Class II restorations

There are many concerns regarding the clinical behavior of packable composite restorations in Class II cavities, particularly when those restorations are subjected to axial mechanical loads. This study evaluated microleakage in vitro in proximal vertical "slot"-type cavities with walls located in enamel and dentin, filled with packable composite, associated or not associated with a flowable composite, a reinforced light-curing glass-ionomer or a compomer, after being submitted to occlusal load cycling. These preparations were subjected to either occlusal load cycling or no occlusal load cycling. Eighty human molars with enamel and dentin margins were treated with standardized cavity preparations (proximal vertical "slot" preparations). After completing the filling process using a packable composite (Filtek P60) with or without a cervical increment of flowable composite (Filtek flow), light-curing glass-ionomer (Vitremer) or compomer (Dyract AP), the molars were separated into two groups: control (without occlusal loading) and test, in which 4,000 one-second cycles of 150 N occlusal loading were applied. All 80 teeth were submitted to a microleakage test, then evaluated utilizing silver nitrate dye penetration. Significant statistical differences (Wilcoxon test, p<0.05) in the amount of leakage in enamel and dentin were found in both the control and test groups. After a paired comparison of the control and test groups, a significant statistical difference was found at the enamel level (Mann-Whitney test, p<0.05). In dentin, the only statistically significant difference found was the relation to the flow material. The Kruskal-Wallis test did not detect any statistically significant difference in the amount of leakage among the four materials studied, with a 5% level of significance for both enamel and dentin. Based on this data, it was concluded that restorations with margins located in dentin had greater microleakage than those restorations with margins located in enamel. When the samples were submitted to occlusal loading, they were negatively influenced, which increased microleakage values in enamel and dentin. There was no statistically significant difference among the four tested materials, when comparing their performance.     

In vitro evaluation of microleakage of a flowable composite in Class V restorations

The aim of this study was to evaluate microleakage around class V restorations using a flowable composite compared to a hybrid composite. Forty class V cavities were prepared on buccal and lingual surfaces of 20 human teeth, with occlusal and cervical margins at the enamel and cementum/dentin levels, respectively. Specimens were divided into 2 groups with 10 samples each. Group 1: buccal cavities received Paama 2 (conventional bonding agent) + Wave (flowable composite); lingual cavities were restored with Paama 2 + Glacier (hybrid composite). Group 2: buccal cavities received Optibond Solo (self-priming bonding agent) + Wave; lingual cavities were restored with Optibond Solo + Glacier. After being stored in distilled water and finished, the teeth were thermocycled, immersed in a 50% silver nitrate solution and embedded in resin. They were sectioned and the depth of tracer penetration was scored. The results were analyzed using Kruskal-Wallis and Wilcoxon tests. The restorations with flowable composite and those with hybrid composite from the same group showed similar results of microleakage for both occlusal and cervical margins. Optibond Solo improved the sealing of the restorations when compared with Paama 2 (p < 0.01). None of the restorative materials completely sealed the tooth/restoration interface at the cervical margins.     

Influence of resin composite shade and location of the gingival margin on the microleakage of posterior restorations

OBJECTIVE: The objective of this in vitro study was to evaluate the influence of resin composite shade and location of the gingival margin (enamel or dentin) on the microleakage of proximal restorations on posterior teeth. Methods and MATERIALS: Sixty freshly extracted human third molars were prepared with standardized Class II box-shaped cavities with proportional size and shape, with distal gingival margins located on the enamel and mesial gingival margins on dentin. The teeth were randomly divided into 6 groups according to resin shade (n=10): G1-Incisal; G2-A1; G3-A2; G4-A3; G5-A3.5; G6-A4. The cavities were restored with a total-etch 1-bottle adhesive system and microhybrid resin composites inserted in 4 increments, light cured for 20 seconds through the occlusal surface, then an additional 60 seconds for each surface. After 1 week of immersion in distilled water, the specimens were thermocycled (500 cycles, 5 degrees -55 degrees C, 30 seconds dwell time), sealed with nail polish and immersed in 0.5% basic fuschin solution for 24 hours. The restorations were sectioned longitudinally, and microleakage was evaluated using a 0-3 score scale. RESULTS: Data were subjected to Kruskal-Wallis and Wilcoxon tests at p<0.05. No statistically significant differences between groups were observed regarding the shade of resin composite (p=0.8570). When margins (enamel or dentin) were considered separately, statistically significant differences were observed between groups (p<0.0001), with enamel margins exhibiting lower degrees of microleakage. CONCLUSION: The variation of resin composite shades utilized in this study did not influence the microleakage of Class II restorations. However, the location of the gingival margin influenced the microleakage.     

Microleakage in class V gingiva-shaded composite resin restorations

The purpose of this study was to evaluate the microleakage in Class V cavities restored with a new gingiva-shaded microhybrid composite resin and with a conventional microhybrid composite resin using three different dentin bonding systems (DBS). Class V cavities were prepared in sixty freshly extracted human teeth with the incisal margin in enamel and the apical margin in dentin/cementum. Restored specimens, after thermocycling, were placed in 2% methylene blue solution for 24 hours. Longitudinal sections were obtained and studied with a stereomicroscope for assessment of the microleakage according to degree of dye penetration (scale 0-3). Data were analyzed with Kruskal-Wallis test and with Mann-Whitney U-test.IN THIS STUDY THERE WAS NO LEAKAGE IN ENAMEL: all the cavities showed no dye penetration at the incisal margins (located in enamel). None of the DBS used eliminated microleakage in apical margins (located in dentin or cementum): three-step total-etch and single-step self-etch were more effective in reducing microleakage in dentin margins when compared with two-step total-etch. This in vitro study concluded that microleakage in Class V cavities restored with the composite resins tested is similar.     

EFFECT OF ADDITIONAL ENAMEL ETCHING AND A FLOWABLE COMPOSITE TO THE INTERFACIAL INTEGRITY OF CLASS II ADHESIVE COMPOSITE RESTORATIONS

Objective : The purpose of this study was to evaluate microleakage of Class II composite restorations using a self‐etching adhesive system with additional enamel etching and/or a flowable resin composite material. Materials and Methods : Fifty standardized Class II cavities were prepared in the mesial and distal surfaces of extracted human third molars. All teeth were bonded with a self‐etching primer adhesive system (Clearfil® Liner Bond 2, Kuraray Co. Ltd., Osaka, Japan) according to the manufacturer's instructions and were restored with a resin composite (Clearfil® AP‐X, Kuraray Co. Ltd.). In the control group, only a self‐etching adhesive system was used. In the various experimental groups, the preparation surfaces were coated with a layer of flowable resin composite (Protect® Liner F, Kuraray Co. Ltd.) before the placement of resin composite, etched with 37% phosphoric acid (K‐Etchant®, Kkraray Co. Ltd.) before the application of the adhesive system, or treated with both of these options. In four groups of specimens, the preparation had a gingival margin in enamel. In a fifth group, the gingival margin was in dentin. All teeth were subjected to thermocycling, 300 cycles between 4°C and 60°C, and were sectioned in half through the restorations. Gaps or cracks at the resin‐tooth interfaces were observed directly using a laser scanning microscope and were recorded as percentages of the entire interface length. Results : Separate enamel etching with phosphoric acid did not improve the resin‐enamel seal produced by the self‐etching primer alone. Flowable resin composite produced gap‐free resin‐dentin interfaces but could not prevent cracks and gap formation at the resin‐enamel interface. Conclusions : Neither flowable resin composite nor enamel etching could prevent gap formation at enamel‐resin interfaces and crack formation in enamel walls when used with a self‐etching primer adhesive system. However, the flowable composite provided gap‐free resin‐dentin interfaces.     

Repair of non-carious amalgam margin defects

This study investigated the microleakage associated with the repair of non-carious amalgam defects using flowable resin composite. Occlusal amalgam preparations were accomplished on 36 non-carious mandibular molars. A standardized 40-micron marginal defect was made by condensing amalgam against a mylar matrix strip. Specimens then underwent a corrosion protocol designed to simulate intraoral corrosion seen with amalgam restorations. The resultant specimens were divided into three treatment groups: 1) No treatment (control); 2) Air abrasion of the amalgam defect surface, acid etching of both amalgam and enamel surfaces, then placement of a flowable composite and 3) Air abrasion of the amalgam defect, application of a fifth-generation dentin bonding agent and placement of the flowable composite. Specimens were thermocycled, sealed with glass ionomer and fingernail polish to within 1 mm of repaired margins, then immersed in basic fuchsin for 24 hours. Specimens were sectioned and microleakage assessed. Results indicated that a flowable resin composite significantly reduced marginal microleakage compared to the control (p < 0.05). There was no difference in microleakage between flowable resin composite repairs done with or without the use of a dentin-bonding agent.     

The effect of flowable resin composites as gingival increments on the microleakage of posterior resin composites

Microleakage has been a major concern in restorative dentistry. The curing contraction of composites still presents a problem with controlling microleakage and postoperative sensitivity. This study investigated the effect of flowable materials on gingival microleakage of microhybrid and packable resin composite restorations. Ninety Class II cavities with cervical margins 1 mm below the CEJ were prepared in 45 extracted human premolars. The teeth were randomly divided into three groups (n=15). In each group, one side of each tooth was restored incrementally with respective composites-SureFil, Filtek P60 and Tetric Ceram; whereas, on the other side, flowable materials-Dyract Flow, Filtek Flow or Tetric Flow-were placed respectively as a 1-mm thick gingival increment before the resin composite restoration. The restored teeth were stored for one week in distilled water at 37 degrees C, thermocycled between 5 degrees C and 55 degrees C and immersed in 0.5% basic fuchsin for 24 hours. Dye penetration was evaluated using a stereomicroscope at 10x magnification. The data were analyzed statistically by Kruskal-Wallis analysis of variance and Mann-Whitney U-tests. The effect of flowable increments on reducing the gingival microleakage was found to be statistically significant for all restorative materials tested (p<0.05).     

Cuspal deflection and microleakage in premolar teeth restored with resin-based composites with and without an intermediary flowable layer

OBJECTIVES: To assess cuspal deflection and cervical enamel microleakage with and without an intermediary flowable RBC layer for the incremental restoration of mesio-occluso-distal (MOD) cavities with two resin-based composites (RBCs). METHODS: Forty sound upper premolar teeth had standardised MOD cavities prepared. Restoration of the teeth involved the placement of the RBCs (Filtek P60 or Filtek Supreme) in eight increments with the appropriate bonding system with and without an intermediary flowable RBC layer (Filtek Flow). Buccal and palatal cusp deflections were recorded post-irradiation using a twin channel deflection measuring gauge. Following restoration, the teeth were thermocycled, immersed in a 0.2% basic fuchsin dye for 24h, sagittally sectioned and examined for cervical enamel microleakage. RESULTS: A significant reduction in cuspal deflection was evident when both RBC materials were used to restore the cavity by employing an intermediary flowable (P<0.001) compared with when no intermediary flowable was utilised. No statistically significant differences were identified in microleakage between the teeth restored with Filtek P60 or Filtek Supreme when an intermediary flowable (Filtek Flow) was employed. CONCLUSIONS: The results of the current study suggest that there was a benefit to the operator in terms of a reduction in cuspal deflection but not from the maintenance of the synergism of the adhesive bond, namely microleakage at the cervical enamel cavosurface margin, when an intermediate layer of a flowable RBC was used under higher elastic modulus RBCs.     

Effect of pre-heating resin composite on restoration microleakage

Improving the adaptation of resin composites during placement is necessary to increase durability and reduce microleakage. Flowable resin liners have been introduced to improve adaptation in composite restorations. In addition, a device that lowers the viscosity of regular dental composites has been introduced (Calset, AdDent Inc, Danbury, CT, USA). This device lowers the viscosity of composites by preheating them to 54.4 degrees C, which should lead to improved adaptation. This study compared microleakage in Class II composite restorations prepared using: 1) preheated resin composite, 2) unheated composite and 3) a flowable liner followed by unheated composite. Class II cavities were prepared on the mesial and distal surfaces of extracted third molars. Ten preparations were restored with resin composite (Esthet-X, Dentsply, York, PA, USA) for each of the following four techniques: Control (Esthet-X with Prime & Bond NT, Dentsply), Flowable (f) (as Control but used Esthet-X Flow liner), Preheated (p) (as Control but with preheating composite to 54.4 degrees C) and Delay (d) (as Preheated but followed by a 15-second delay before curing). The teeth were restored, finished, stored in distilled water for 24 hours, then thermocycled between water bath temperatures of 5 degrees C and 55 degrees C with a one-minute dwell time for 1000 cycles. Tooth apices were sealed with epoxy and varnish was applied to within 1 mm of the restoration margins. The teeth were placed in 0.5% basic fuschin dye for 24 hours, rinsed, then embedded in self-curing resin. The embedded teeth were sectioned mesiodistally with a slow-speed diamond saw, providing multiple sections per restoration. Microleakage was rated by two evaluators using a 0-4 ordinal scale at the occlusal and cervical margins of each restoration and light microscopy (40x). The data were analyzed with Kruskal-Wallis ANOVA and pairwise testing with the Sign test (alpha=0.05). No statistical differences were observed among materials at the occlusal margin. However, at the cervical margin, the preheated samples P showed statistically lower microleakage than the controls and all other treatments. The D samples showed higher microleakage than the P and F samples. Ranked sum scores for the cervical were D (4516), C (3974), F (2756) and P (1958). There was a statistically greater amount of leakage at the cervical margins compared to the occlusal p<0.05. Preheating the composite resulted in significantly less microleakage at the cervical margins compared to the flowable liner and control. Delaying light curing of the preheated composite for 15 seconds (D) was counterproductive and led to increased microleakage.     

The marginal seal of Class II restorations: flowable composite resin compared to injectable glass ionomer

The objective of this study was to investigate the effect of a flowable composite resin (Tetric Flow) versus an injectable glass ionomer (Fuji II LC) on microleakage at the cavosurface margin of the proximal box of Class II restorations in permanent teeth in-vitro. Thirty caries and restoration-free human bicuspids were prepared with mesial and distal slot preparations and were filled either with a bonding agent (Optibond) plus a flowable composite resin (Tetric Flow), Group I; bonding agent (Optibond) plus a flowable glass ionomer (Fuji II LC), Group II; or a flowable glass ionomer (Fuji II LC) with no bonding agent, Group III. All specimens were then immersed in a 2% solution of basic fuschin dye for 24 hours to allow for dye penetration into possible existing gaps. These teeth were then carefully sectioned mesially/distally into two pieces using an Isomet saw. The teeth were then studied under a binocular microscope to measure depths of dye penetrations as an indication of marginal microleakage at the gingival cavosurface margin and scored as follows: 0 = no dye penetration, 1 = dye penetration into enamel only, 2 = dye penetration into enamel and dentin, 3 = dye penetration into the pulp. The specimens were also evaluated using a SEM. The results showed that there were statistically significant differences between Groups I (Tetric Flow) and (Fuji II LC plus bonding agent), II in favor of Group I; between Groups I and (Fuji II LC with no bonding agent), III in favor of Group I; as well as Groups II and III in favor of Group II (Fuji II LC plus bonding agent). Group I (bonding agent plus flowable composite resin) showed significantly less microleakage. Group II (bonding agent plus flowable glass ionomer) demonstrated a bond that existed between the bonding agent and the glass ionomer but microleakage within microgaps of the glass ionomer itself Group III (flowable glass ionomer plus no bonding agent) demonstrated significant microleakage between the glass ionomer and tooth structure, microgaps within the glass ionomer, and lack of retention of the restoration. It appears that the use of a flowable composite resin (Tetric Flow) plus a bonding agent (Optibond) in the proximal box of a Class II restoration in permanent teeth will significantly reduce the microleakage at the cavosurface margin when compared with an injectable glass ionomer (Fuji II LC) with or without a bonding agent (Optibond).     

Effect of thickness of flowable resins on marginal leakage in class II composite restorations

Despite limited scientific evaluation, there is an increased use of low elastic modulus flowable resin composite (FRC) as a stress-relieving gingival increment in Class II restorations. This study compared marginal leakage in preparations with gingival margins in enamel or dentin/cementum (sub-CEJ and supra-CEJ) after FRC was used as a gingival increment to hybrid resin composite used alone. In addition, the extent of leakage around restorations with or without the use of FRC gingival increments when light curing the resin composites from occlusal direction only or buccal, lingual and occlusal directions was compared. Sixty extracted human molars were prepared with two identical Class II (MO and OD) preparations (30 were 1 mm sub-CEJ and 30 were 1 mm supra-CEJ) and randomly assigned to six groups. After etching, dentin-bonding agent was applied to all prepared tooth surfaces according to the manufacturer's specifications. One of three different thicknesses of FRC (0.5 mm, 1 mm or 2 mm) was placed on the gingival floor, cured and a hybrid resin composite was placed occlusally to complete the restoration. The control preparation on each tooth was restored in the same manner, except that a hybrid resin composite was used for both the gingival and occlusal increments. The restored teeth were thermocycled (300 cycles), then immersed in 50% silver nitrate prior to the hemi-section and measured for leakage under a light microscope. The data were evaluated using paired measures analysis of variance (ANOVA). Most of the occlusal margins showed no leakage, while almost every gingival margin demonstrated some silver nitrate penetration regardless of whether it was located sub or supra-CEJ, although significantly less leakage was found in restorations with supra-CEJ margins (p=0.0001). Among supra-CEJ restorations, there was a pronounced reduction in leakage as FRC thickness increased (p=0.0005). In the teeth restored with the gingival-margin located supra-CEJ, the 2 mm thickness FRC gingival increment showed significantly less leakage (p<0.01) compared with the 0.5 mm thickness of FRC gingival increment. The direction of the curing light did not affect the extent of leakage (p>0.05). The use of FRC material as a gingival increment sub-CEJ in posterior hybrid resin restorations produced no significant difference in leakage (p>0.05). The results of this study indicated that restorations located supra-CEJ (with gingival margins in enamel) with 2 mm thick FRC gingival increments demonstrated significantly less leakage than did those with 0.5 mm FRC. When the margin of the restoration was located sub-CEJ (in dentin/cementum), neither the thickness nor the presence of FRC as a gingival increment significantly influenced the marginal leakage.     

The effect of flowable resin composite on microleakage in class V cavities

This in vitro study investigated the microleakage of flowable resin composite as a restorative material and as a liner (either light cured separately or co-cured with hybrid resin composite) in Class V cavities. A light-cured hybrid resin composite was used as a control. Twenty extracted human premolars were prepared with standardized Class V cavity outlines on the buccal and lingual surfaces. The occlusal margin of the cavities was on enamel and the gingival margin was on dentin. One bottle adhesive system (Single Bond) was used after etching enamel and dentin with 34.5% phosphoric acid for 15 seconds. The cavities were randomly divided into four groups of 10 each and restored according to the manufacturers' instructions: Group I-Hybrid resin composite (Z100); Group II-Flowable resin composite (Filtek Flow); Group III-Flowable resin composite (Filtek Flow)+Hybrid resin composite (Z100); light cured separately; Group IV-Flowable resin composite (Filtek Flow)+Hybrid resin composite (Z100); co-cured. The samples were thermocycled 200 times with a 30-second dwell time. They were then immersed in a 0.5% basic fuchsin solution for 24 hours, sectioned and analyzed by stereomicroscopy. The degree of dye penetration was recorded and analyzed with the Kruskal-Wallis and Mann-Whitney U tests. The results of this study indicate that there was no leakage at the occlusal margin for either restoration. Statistically significant differences were found among the groups at the gingival margin. No statistically significant difference was observed between the occlusal and gingival margins except in Group IV. The combination of flowable resin composite and hybrid composite light cured separately yielded the best result in this study. The most leakage was observed when this combination was co-cured. The resistance to microleakage of flowable resin composite as a restorative material is similar to that of hybrid resin composite.