Effect of various incremental techniques on the marginal adaptation of class II composite resin restorations.

The effects of various placement techniques on the formation of microgaps were compared at the gingival margins of class II composite resin restorations. Three incremental techniques (occlusogingival layering, oblique layering, and faciolingual layering) and two one-bulk techniques of placing composite resin were studied. In the first one-bulk placement technique the composite resin was photocured occlusally; in the second one-bulk technique the composite resin was irradiated from three directions; facial, lingual, and occlusal. None of the incremental placement techniques improved the adaptation at the gingival margin compared with a one-bulk technique irradiated occlusally. However, the one-bulk placement technique that was irradiated from three directions created a substantial marginal discrepancy.     

Microleakage and marginal adaptation of composite resin restorations.

It has been shown that the use of a sealant offers no advantage with respect to the retentive strength of a composite resin restoration. However, for the improvement of marginal seal and adaptation, the present findings indicate that enamel etching and the application of a sealant, in conjunction with use of a cavity geometry which reduces shrinkage strain, are absolute necessities.     

Quality and durability of marginal adaptation in bonded composite restorations

Excellent marginal adaptation extends the longevity of restorations. Unfortunately, polymerization shrinkage of composite restorations adversely affects this quality requirement. The residual stress within the cured resin compromises the material's properties, causes marginal openings, and flexes cavity walls. In this study, the wall-to-wall contraction in MOD cavities was measured for different placement techniques. In addition, the restoration margins were quantitated before and after thermo-cycling and mechanical stressing. Factors which enhanced adaptation also optimized marginal quality and reduced the amount of residual stress. The latter was expressed by intercuspal narrowing after the restoration was completed. Both quality and stress resistance of the marginal adaptation were inversely correlated to the intercuspal narrowing caused by the polymerization contraction of bonded and excellently adapted resin restorations. The most effective factors which optimized marginal quality included: guidance of the shrinkage vectors; reducing the ratio of bonded to free, unbonded restoration surfaces; and minimizing the mass of in situ-cured composite. The latter principle was followed best in the adhesive inlay technique. In medium-sized adhesive MOD composite inlays, the volume loss induced by the polymerization contraction of the composite cement was non-destructively compensated for by an inward flexing of each cavity wall of approximately 10 microM.     

Effect of flowable composite liner and glass ionomer liner on class II gingival marginal adaptation of direct composite restorations with different bonding strategies

Objectives

The purpose of the present study was to comparatively evaluate the effect of flowable composite resin liner and resin modified glass ionomer liner on gingival marginal adaptation of class II cavities restored using three bonding agents (Single Bond 3M ESPE, One Coat Self Etching Bond Coltene Whaledent; Adper Easy Bond Self-Etch Adhesive 3M ESPE) and respective composite resins, under cyclic loading. The marginal adaptation was evaluated in terms of ‘continuous margin’ (CM) at the gingival margin.

Materials and methods

Ninety class II cavities with margins extending 1 mm below the cement–enamel junction were prepared in extracted mandibular third molars. The samples were divided into three groups: no liner placement; 0.5–1 mm thick flowable resin liner placement (Filtek Z350 XT flowable resin) on gingival floor and; light cure glass ionomer (Ketac N100) liner. The groups were further subdivided into three sub-groups on the basis of the bonding agents used. Cavities were restored with composite resins (Z350 for Single Bond and Adper Easy Bond; and Synergy D6 Universal, for One Coat Self Etching Bond) in 2 mm increments and the samples were mechanically loaded (60 N, 1,50,000 cycles). Marginal adaptation was evaluated using a low vacuum scanning electron microscope. Statistical analysis was done with two way ANOVA with Holm–Sidak's correction for multiple comparisons.

Results

Placement of flowable composite liner significantly improved the CM values of Single Bond (78 ± 11%) and One Coat Self Etching Bond (77 ± 9%) compared with no liner group, but the values of CM of Adper Easy Bond were not improved (61 ± 12%). Placement of glass ionomer liner significantly improved the values of CM in all the sub-groups (78 ± 9%, 72 ± 10% and 77 ± 10% for Single Bond, One Coat Self Etching Bond & Adper Easy Bond respectively) compared with no liner group.

Conclusions

Placement of liners improved the values of ‘continuous margin’ in the gingival floor of the proximal cavities restored with composite resins using different bonding agent.

Clinical relevance

Placement of flowable composite liner or glass ionomer liner will improve the marginal integrity of composite restorations using etch-and-rinse and two bottle-two step self etch adhesives. To improve the marginal integrity of a single bottle adhesive, glass ionomer liner should be applied.     

Effect of light curing units on marginal adaptation and hardness of Class II composite resin restorations

AIMS: The aim of this study was to test the influence of different curing protocols on dentin marginal adaptation and the hardness of two composites. METHODS AND MATERIALS: Three light-curing-units (LCUs): Quartz-Tungsten-Halogen (QTH: 541 mW/cm2), Argon-Ion-Laser (AL: 277 mW/cm2), and Plasma-Arc-Curing (PAC: 1818 mW/cm2) and two composites FiltekZ250 (F) and Tetric Ceram HB (TC) were tested. Sixty standardized "vertical-slot-Class II-cavities" were prepared at the mesial surface of bovine incisors and divided into six groups (n=10). Composites were placed using the Single Bond adhesive system and cured in 2 mm increments according to the manufacturers' instructions. After polishing, epoxy replicas were processed for scanning electron microscopy (SEM) marginal adaptation analysis at 500x magnification. The specimens were then sectioned transversally to the dental long axis, embedded in polyester resin, then polished and submitted to the Knoop hardness test at gingival and occlusal portions of the restoration. Data were analyzed using two-way analysis of variance (ANOVA) and Tukey's test (p=0.05). RESULTS: The gap margins ranged between 4.3 to 5.8 microm, and no statistically significant differences were revealed in marginal adaptation for LCUs or for composites (p>0.05). Location influenced hardness (p=0.01). The occlusal portion presented significantly higher KHN than the gingival portion for all composite-LCU combinations. Regardless of the LCU used, TC produced statistically significant lower hardness values (ranging between 82.8 to 110.7 KHN) than F (ranging between 105.9 to 117.3 KHN). CONCLUSIONS: Hardness and gap formation were not dependent on the LCUs tested in this study. Different resin composite was found to be a significant factor with regards to hardness but not gap formation.     

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 mastication on marginal adaptation of composite restorations in vivo

The marginal adaptation of composite restorations placed in vivo in acid-etched cavities in teeth with and without antagonists was compared. The results showed that functional mastication has a major influence on the marginal adaptation of composite restorations in the oral environment and must therefore be considered in the planning of future leakage experiments.     

Early marginal microleakage in class II resin composite restorations

The aim of this study was to evaluate in vitro the early marginal microleakage around conventional and sandwich Class II (MOD) restorations. Ten different combinations of dentin bonding agents, glass-ionomer cements, and posterior resin composites were used. Class II cavities were prepared in freshly extracted third molars whose root surfaces had previously been coated. All gingival margins were prepared at the cementum-enamel junction. Teeth were filled by use of a multi-incremental technique, finished with discs, and immediately immersed in 2% erythrosin B for 12 h at 37 degrees C. Three transverse sections were made at 0.5 mm, 2 mm, and 3.5 mm over the cementum-enamel margin and evaluated under a stereomicroscope. Microleakage was scored linearly along the dentin/enamel-restoration interface. Sections at the cementum-enamel level showed significantly higher microleakage than the other two. Significant differences were observed between the various combinations of materials. Early marginal microleakage in Class II restorations depends not only on filling technique and on dentin bonding systems but also on the resin composite. Glass-ionomer cements significantly reduce early marginal microleakage in Class II restorations.     

Effect of lining with a flowable composite on internal adaptation of direct composite restorations using all-in-one adhesive systems

The purpose of this study was to evaluate the effect of lining with a flowable composite on internal adaptation of composite restorations using three all-in-one adhesive systems; Bond Force (BF), G-Bond Plus (GP), and OptiBond All-in-one (OP), and a two-step self-etching adhesive system; Clearfil SE Bond (SE). They were applied to each cylindrical cavity prepared on the human dentin. The cavity surface was lined with/without a flowable resin composite prior to filling with a resin composite (FL/NL). After water storage for 24 h, the specimens were sectioned and polished, and internal adaptation of the restorations was assessed using a confocal laser scanning microscopy. For SE, a perfect cavity adaptation was recognized in both FL and NL. For BF, GP and OP, cavity adaptation was material dependent in NL, whereas no gap formation was observed in FL. However, voids formation was observed at the composite-adhesive-dentin interface in every all-in-one adhesive system.     

Clinical performance and marginal adaptation of class II direct and semidirect composite restorations over 3.5 years in vivo

OBJECTIVE: The study evaluated the clinical performance and marginal adaptation of direct and semi-direct class II composite restorations in a split-mouth design over 3.5 years. DESIGN: 44 upper posterior teeth in 11 adults with primary carious lesions were treated with 22 direct and 22 semi-direct restorations. Conventional cavities were prepared for both types of restorations. A fine fine hybrid composite (APH) and a multifunctional adhesive system (Prisma universal bond 3) were used for all restorations. The incremental "3-sited light curing" technique was applied to direct restorations. Semi-direct inlays were prefabricated on silicone casts and post-cured using light and heat. Clinical performance was evaluated using modified USPHS parameters, while marginal adaptation was judged on replicas, using SEM and a standardized evaluation technique. RESULTS: Clinical results after 3.5 years revealed a 100% retention rate with no fractures, sensitivity or recurrent caries for both types of restorations. SEM-evaluation of the occlusal margins showed at the tooth-restoration interface relatively low rates of marginal openings over the observation period (4-8%). Marginal restoration fractures ranged between 1 and 2%, marginal tooth fractures between 3 and 9%. Differences between the restorative techniques and after the different time observation periods were not statistically significant. Proportions of marginal fractures and openings at the restoration-luting composite interface were less than 10% after 3.5 years. CONCLUSION: The results indicated no significant differences for direct and semi-direct fine hybrid composite restorations in medium size cavities in posterior teeth with respect to clinical performance and marginal adaptation over 3.5 years.     

Association of photoactivation methods and low modulus liners on marginal adaptation of composite restorations

The aim of this study was to evaluate the effect of photoactivation methods, resin liners, and the association of these techniques on the marginal adaptation of composite restorations. One‐hundred‐and‐twenty bovine incisors were selected. A circular cavity was prepared in a flat dentin area on the buccal surface and the Scotchbond Multi Purpose system was applied. These teeth were assigned to four groups in accordance with lining technique: control (one adhesive layer), three adhesive layers individually photoactivated, Filtek Flow, and Protect Liner F. Each group was subdivided depending on the photoactivation method: continuous light, soft‐start, or intermittent light. All cavities were restored with Filtek Z250 and then polished. Caries detector was applied on each specimen for 5?s in order to verify marginal adaptation through dye‐staining of the gaps formed on the outer margins. Images of the stained gaps were observed under the stereomicroscope, and transferred to a computer measurement program in order to determine gap length. Data were submitted to ANOVA and Tukey's test (P?相似文献   

Association of photoactivation methods and low modulus liners on marginal adaptation of composite restorations

The aim of this study was to evaluate the effect of photoactivation methods, resin liners, and the association of these techniques on the marginal adaptation of composite restorations. One-hundred-and-twenty bovine incisors were selected. A circular cavity was prepared in a flat dentin area on the buccal surface and the Scotchbond Multi Purpose system was applied. These teeth were assigned to four groups in accordance with lining technique: control (one adhesive layer), three adhesive layers individually photoactivated, Filtek Flow, and Protect Liner F. Each group was subdivided depending on the photoactivation method: continuous light, soft-start, or intermittent light. All cavities were restored with Filtek Z250 and then polished. Caries detector was applied on each specimen for 5 s in order to verify marginal adaptation through dye-staining of the gaps formed on the outer margins. Images of the stained gaps were observed under the stereomicroscope, and transferred to a computer measurement program in order to determine gap length. Data were submitted to ANOVA and Tukey's test (P < 0.05). Significant differences among the lining techniques were only observed using the photoactivation method with continuous light. In this case, the lining technique with Filtek Flow significantly increased marginal adaptation of the composite to the outer dentin margins compared with the results of the control group. The other lining techniques showed intermediate values and no statistical difference from the other groups. For the photoactivation methods, intermittent light showed the best marginal quality of all the methods. This was statistically significant only for the control lining technique.     

Correlation between marginal adaptation of composite resin restorations and bacterial growth in cavities

The purpose of the present study was to correlate the marginal adaptation of composite fillings to the bacterial growth in the cavities. Forty-three cavities prepared in vivo on human third molars were acid etched and filled with the composite resin Concise. After 4 months the teeth were extracted and examined for marginal leakage along the restorations. After histologic preparation an average of 38 sections from each cavity were stained and investigated for bacteria on the cavity walls and in the exposed dentinal tubules. General marginal leakage was found in 14 of the restorations and bacterial growth in 12. For 35 of the 43 restorations there was a agreement between marginal leakage and bacterial growth (P = 0.0002). Based on the results it is concluded that bacteria in a cavity can be used as an indicator of marginal leakage along the restoration.