Effect of light-curing unit and adhesive system on marginal adaptation of class v composite restorations

The aim of this study was to evaluate the effect of light-curing units (LED or halogen) on the marginal adaptation of composite restorations performed with etch-and-rinse and self-etching adhesive. Class V cavities were prepared on bovine teeth with the gingival margin on dentin and the incisal margin on enamel. The cavities were restored with a micro-hybrid resin composite using an etch-and-rinse (Single Bond 2--SB) or a self-etching adhesive (Clearfil SE Bond--CL). The light-activations were performed using halogen lamp (Optilux 501--QTH) or second-generation light-emitting diode (Radii-Cal--LED) (n = 10). After finishing and polishing the restorations, epoxy replicas were prepared. The marginal adaptation was analyzed under scanning electronic microscopy with 500x of magnification. The greatest gap width at each margin was recorded. Data were submitted to Mann-Whitney and Wilcoxon tests (a = 0.05). SB and CL showed similar behavior of enamel margins when the light-activations were performed with QTH. The same was observed for dentin margins with LED. When the LED was used, higher gap measurements at enamel margins were observed with CL, while higher gap values in dentin were observed for SB within QTH. No significant difference between substrates was found when CL was used. However, SB had significantly higher gap measurements in dentin. The light-curing unit seems to affect the marginal adaptation of resin composite restorations. However this effect was dependent on the adhesive and the location of the margin.     

Effect of eugenol-containing sealer on marginal adaptation of dentine-bonded resin fillings

AIM: Eugenol is claimed to interfere with the polymerization of composite resins and to affect shear bond strengths of dentine-bonded composite restorations. Eugenol-based sealers are used during root canal treatment in teeth that may require build-ups or extensive restorations. Unfortunately, the adverse effect of eugenol has mostly been assessed in shear bond tests and this variable may be clinically inappropriate. The current study evaluate the effect of eugenol in a eugenol-based endodontic sealer on marginal adaptation of composite resin restorations with and without thermo-mechanical stress. METHODOLOGY: Thirty Class V cavities with half of the cavity margins in dentine and half of the cavity margins in enamel were prepared in extracted human premolars and then divided into 5 groups. Teeth in group 1 were not contaminated with eugenol. Cavities in groups 2-4 were contaminated with a eugenol-based sealer (Tubli-Seal, Kerr) and cleaned with: (i) sandblasting, (ii) bur finishing alone or (iii) bur finishing combined with swabbing with alcohol. These 4 groups were temporized for 6 weeks (Ketac, ESPE), whilst group 5 received no eugenol, was not temporized and acted as the control. Cavities were restored with Tetric Ceram using Syntac Classic (Vivadent) as a dentine-bonding agent. The specimens were then thermo-mechanically stressed. The percentages of marginal adaptation in dentinal and enamel margins were assessed in a SEM at x200 magnification before and after stress using a replica method. Mean percentages of marginal adaptation were calculated and compared using a two way-ANOVA (influence of eugenol and cleaning procedure) and non-parametric tests. RESULTS: Marginal adaptation in enamel exceeded 95% and 92% in all specimens before and after thermo-mechanical stress, respectively. Before stress, marginal adaptation in dentine ranged from 92.3 +/- 7.9% to 95.7 +/- 6.2% in groups 1-5. After stress, the percentage of marginal adaptation in dentine decreased significantly overall (P < 0.05, range 39.8 +/- 21.1% to 82.9 +/- 13.7%). The effect of contamination with eugenol was not significant (P > 0.05): in contrast, there was a significantly beneficial effect when the entire cavity was finished with burs (P < 0.01). CONCLUSIONS: Under the conditions of this study, the eugenol containing sealer did not significantly impair marginal adaptation in dentinal margins of mixed Class V restorations when bur finishing was employed before placement. However, no other cleaning method was sufficient to produce acceptable figures of marginal adaptation.     

In vitro marginal adaptation of high-viscosity resin composite restorations bonded to dentin cavities

PURPOSE: The aim of this study was to evaluate the marginal adaptation of high-viscosity resin composite restoratives bonded to dentin in a cylindrical cavity model. MATERIALS AND METHODS: The buccal enamel of 64 human premolars was removed and cylindrical cavities 3 mm in diameter and 1.3 mm in depth were prepared on each dentin surface. The cavities were divided into 8 groups of 8 cavities each and restored according to the manufacturers' instructions with the following adhesive/composite systems: Bond 1/Alert, Stae/Glacier, OptiBond Solo/Prodigy Condensable, One-Step/Pyramid, Solidbond/Solitaire, Prime&Bond NT/Surefil, One Coat Bond/Synergy, and Scotchbond 1/Z250. The composite surfaces were pressed against mylar strips, covered with cover slips, and photopolymerized in a single increment for 40 s. The restorations were polished with wet SiC papers of 320 to 1000 grit size to expose dentin margins. The marginal adaptation was evaluated immediately after photopolymerization and again after 1 week of storage in water at 37 +/- 1 degrees C. Evaluation was performed under a metallographic microscope at 200X magnification by recording the frequency of gap-free restorations (GF), the percentage length of the debonded margins relative to the cavity periphery (DM), the width of the maximum marginal gap (MG), and the marginal index (MI = MG x DM / 100). The results were statistically analyzed with one-way ANOVA and the Mann-Whitney U-test at alpha = 0.05. RESULTS: No incidence of gaps was found in 62.5% of One Coat Bond/Synergy and 37.5% of OptiBond Solo/Prodigy Condensable restorations. All the other restorative systems exhibited restorations with gaps. One Coat Bond/Synergy, Scotchbond 1/Z250, and OptiBond Solo/Prodigy Condensable were the groups with the lowest DM values, while Stae/Glacier showed the highest DM values. One Coat Bond/Synergy and OptiBond Solo/Prodigy Condensable revealed the lowest MI values and Stae/Glacier the highest. No statistically significant differences were recorded between immediate evaluation and evaluation after 1 week of water storage. CONCLUSION: The results showed that all the adhesive/composite systems examined failed to achieve gap-free margins with dentin. The restorative systems One Coat Bond/Synergy, Optibond Solo/Prodigy Condensable, and Scotchbond 1/Z250 presented the best marginal adaptation of all the systems tested. No improvement was recorded on the quality of marginal adaptation following 1 week of water storage.     

Long-term effect of dentin primers on enamel bond strength and marginal adaptation

Contamination of etched enamel with dentin adhesive systems is unavoidable in clinical situations. The aim of this in vitro study was to evaluate the long-term effect of dentin adhesives and application technique on resin composite bond strength and marginal adaptation to enamel. Six hundred freshly extracted mandibular bovine incisors were used. Three hundred teeth were flat ground, and the enamel was etched for 30 seconds with 32% phosphoric acid. The etched surface was treated by different dentin adhesive systems with and without intensive rubbing by use of application brushes. As a control, only the enamel adhesive resin was applied and air thinned. Furthermore, contamination with saliva was performed after the etching process. Etched and silanated CEREC blocks were bonded onto the enamel specimens with different adhesive resins and stored for 1 and 365 days (37 degrees C, aqua dest). After storage, the specimens were thermocycled for 24 hours (1150 cycles between 5 degrees C and 55 degrees C), and subjected to shear bond testing. Three hundred box-shaped cavities were prepared on buccal surfaces of the incisors and filled with one resin composite using the same pretreatment modes as in the shear bond test groups. After 1 and 365 days of storage, a margin analysis was performed using a SEM (X200 magnification). Dentin adhesive systems did not show an adverse effect on long-term enamel bond strength and marginal adaptation. Rubbing application of the primers decreased the bond strength by values of approximately 20% after 24 hours and approximately 40% after 1 year of storage. Marginal adaptation showed 94-98% gap-free margins in the control and dentin adhesive system-only groups; however, after rubbing of primers, the proportion of gap-free margins decreased significantly to 85-88%. The lowest bond strength (8-10 MPa) and margin quality (49-69% gap-free margins) were recorded for the groups with saliva contamination.     

Flowable materials as an intermediate layer could improve the marginal and internal adaptation of composite restorations in Class-V-cavities.

OBJECTIVES: The purpose of this in vitro study was to evaluate the marginal and internal adaptation of restorative systems in combination with flowable materials as an intermediate layer in Class-V-cavities. METHODS: Thirty Class-V-cavities with occlusal margins in enamel and gingival margins in dentin/cementum were prepared and randomly assigned to five groups. The following five restorative systems were used: compomer, composite E, flowable compomer/composite E, composite RF and flowable composite/composite RF. The flowable materials were added between the restorative composites and the cervical margins of the cavities. Marginal and internal adaptation were quantitatively evaluated before and after thermal (2,500 times between 5 and 55 degrees C) and mechanical load cycling (25,000 times 100 N) using standard SEM procedures. Statistical analysis was performed using the Kruskal-Wallis and Mann-Whitney U-Test. The morphology of the internal restorative interfaces was also evaluated. RESULTS: The present study revealed that the best marginal adaptation in dentin was attained with the compomer restoration (95.8% perfect margin). The marginal adaptation of composite restorative systems was improved by the use of a flowable compomer (45.5% vs. 68.2% perfect margin in dentin) or a flowable composite (46.7% vs. 80.7% perfect margin in dentin, p<0.05) as an intermediate layer. No differences were observed between the used materials for the parameter internal adaptation. SIGNIFICANCE: In Class-V-cavities compomers showed the best marginal adaptation and the marginal adaptation of composite fillings could be improved by the use of flowable materials as an intermediate layer.     

A new method for sealing composite resin contraction gaps in lined cavities

Composite resin restorations are often applied in cavities where cervical margins are left unetched, resulting in poorer adaptation in this area. Recent experiments have indicated the possibility of impregnating with resin the gap caused by polymerization contraction. Cavities were prepared in vitro and in vivo. A thin liner was applied inside and outside the cavity. Except for the cervical wall, enamel margins were bevelled and acid-etched, and the cavities restored with Concise Enamel Bond and Composite. In another series, cavities with unetched enamel were restored. Since the liner was placed outside the cavity margins, excess material could be removed without blockage of the air-filled gap. Enamel Bond with a fluorescent additive was applied to various margins. Ground sections were prepared, and the penetration of this resin into the gap was examined with a microscope. In most teeth, the resin penetrated from 0.5 to 2 mm from the cervical margins. Similar penetration was seen from unetched margins, except for the occlusal one. No penetration was seen at acid-etched margins. By impregnating gaps with low-viscous resin after the filling has cured, one can obtain an improved seal at unetched margins.     

Internal and marginal adaptation of pressable and computer-aided design/computer-assisted manufacture onlay restorations

The aim of this research was to evaluate internal and marginal adaptation of lithium disilicate partial crowns fabricated using IPS e.max Press and IPS e.max CAD systems. Forty maxillary first molars were divided into two groups. The margins were located above the cementoenamel junction mesially and below it distally. The adaptation of the restoration was evaluated by means of the silicone replica technique. The lowest marginal discrepancy was measured between the preparation margin on the enamel and the IPS e.max Press specimens; the highest discrepancy was observed on the occlusal surface of the IPS e.max CAD specimens. Both systems tested demonstrated acceptable marginal discrepancies in vitro.     

Comparison of pulse activation vs conventional light-curing on marginal adaptation of a compomer conditioned using a total-etch or a self-etch technique.

OBJECTIVES: This study investigated the effect of two factors: conditioning methods and light-curing techniques on the marginal adaptation of Dyract AP (Dentsply DeTrey, Germany). The 'pulse activation' curing technique was compared with a conventional light-curing technique for their effectiveness in reducing marginal gaps in restorations that were conditioned with three different protocols. MATERIALS and METHODS: Cylindrical cavities, 3mm in diameter, were prepared in extracted human molar teeth. They were restored with Dyract AP using Prime&Bond NT (PBNT; Dentsply DeTrey) as the adhesive. Cavities were etched with: Conditioner36/PBNT (group 1), Non-Rinse Conditioner (NRC)/PBNT (group 2), and PBNT only (group 3). Either conventional or the 'pulse activation' technique was used for light-curing of the material. Epoxy resin replicas were obtained from longitudinal sections of the specimens, and the restoration-tooth interfaces were examined using scanning electron microscopy. Marginal qualities along the resin-dentin interfaces were further measured using image analysis and analyzed using nonparametric statistical methods. RESULTS: With the conventional curing technique, enamel margin fractures were frequently observed. Marginal gaps were found along the compomer-dentin interfaces irrespective of the conditioning protocol. A significantly lower percentage of gap-containing margins were found in cavities that were conditioned with 36% phosphoric acid. With the 'pulse activation' technique, no marginal gap was found along compomer-dentin interfaces that were etched with either Conditioner36 or NRC. More than 90% of the total margin length were excellent. No cohesive failure of enamel could be observed along cavosurface margins. SIGNIFICANCE: The 'pulse activation' curing technique significantly improves the marginal integrity of Dyract AP when Conditioner36/Prime&Bond NT and NRC/Prime&Bond NT are used as conditioning/bonding systems. The use of Prime&Bond NT without etching is not recommended, as marginal gaps are present irrespective of the curing techniques employed.     

Effect of multi-step dentin bonding systems and resin-modified glass ionomer cement liner on marginal quality of dentin-bonded resin composite Class II restorations

The use of resin composites in the restoration of Class II cavities with gingival margins located in dentin is still controversial. The purpose of this in vitro study was to evaluate the effect of four state-of-the-art multi-step dentin-bonding systems (A. R. T. Bond, Syntac, OptiBond DC, Scotchbond Multipurpose) on marginal adaptation and microleakage of dentin-bonded composite Class II restorations. A total of 72 Class II cavities with gingival margins in dentin were prepared in extracted molars and filled with fine-hybrid composites using a three-sited light curing technique. In one half of the cavities the pulpal wall was lined with a resin-modified glass ionomer cement liner (RM-GIC), in the other half a total bonding technique was applied. A. R. T. Bond and Syntac were tested with selective enamel etching (SE) and total etching (TE). Marginal adaptation was evaluated in a scanning electron microscope before and after thermocycling (TC). Microleakage was determined by dye penetration. After TC the proportions of continuous margin in dentin ranged from 37% (Syntac/SE) to 91.2% (A. R. T. Bond/TE). Scotchbond Multipurpose exhibited the lowest degree of microleakage (0.22 mm). Marginal enamel fracture was the most prevalent marginal defect at the enamel margins (8.3–22.2%). The use of the RM-GIC had no beneficial effect on any of the marginal parameters, either in dentin or in enamel. It is concluded that low degrees of marginal gap formation and microleakage can be achieved in totally bonded composite Class II restorations when using state-of-the-art multi-step bonding systems in combination with a meticulous incremental filling technique. Received: 6 April 1998 / Accepted: 25 August 1998     

Influence of a proximal margin elevation technique on marginal adaptation of ceramic inlays

Abstract

Purpose. Evaluating the effect of a proximal margin elevation technique on marginal adaptation of ceramic inlays. Methods. Class II MOD-cavities were prepared in 40 human molars and randomly distributed to four groups (n = 10). In group EN (positive control) proximal margins were located in enamel, 1 mm above the cementoenamel junction, while 2 mm below in groups DE-1In, DE-2In and DE. The groups DE-1In, DE-2In and DE simulated subgingival location of the cervical margin. In group DE-1In one 3 mm and in group DE-2In two 1.5 mm composite layers (Tetric) were placed for margin elevation of the proximal cavities using Syntac classic as an adhesive. The proximal cavities of group DE remained untreated and served as a negative control. In all groups, ceramic inlays (Cerec 3D) were adhesively inserted. Replicas were taken before and after thermomechanical loading (1.200.000 cycles, 50/5°C, max. load 49 N). Marginal integrity (tooth-composite, composite-inlay) was evaluated with scanning electron microscopy (200×). Percentage of continuous margin (% of total proximal margin length) was compared between groups before and after cycling using ANOVA and Scheffé post-hoc test. Results. After thermomechanical loading, no significant differences were observed between the different groups with respect to the interface composite-inlay and tooth-composite with margins in dentin. The interface tooth-composite in enamel of group EN was significantly better compared to group DE-2In, which was not different to the negative control group DE and DE-1In. Conclusion. Margin elevation technique by placement of a composite filling in the proximal box before insertion of a ceramic inlay results in marginal integrities not different from margins of ceramic inlays placed in dentin.     

Marginal adaptation of ceramic inserts after cementation

The advantage of using ceramic inserts is to prevent major drawbacks of composite resins such as polymerization shrinkage, wear and microleakage. This in vitro study evaluated the marginal adaptation of two approximal ceramic insert systems after cementation to the cavities opened with ultrasonic tips. Proximal cavities with margins in enamel were prepared in 20 intact molars using ultrasonic tips (SONICSYS approx tips [microtorpedo size #2 and #3]; Siplus Instrument approximal [U-shaped]). Inserts of similar sizes (n=10) from two systems corresponding to the ultrasonic tips were placed in the cavities (SONICSYS Inlay; SDS-Inlay system), one on the mesial side and the other on the distal side of the same molar. Following cementation and thermocycling (5000 cycles, between 5-55 degrees C), cement thickness was measured at the buccal, lingual walls and pulpal floors of the proximal boxes under light microscope (x150). The mean cement thickness values recorded for SONICSYS inserts #2 (25 microm) was not significantly different (p>0.05) from that of SDS inserts of similar size (26 microm). There was a significant difference (p<0.05) in cement thickness values between SONICSYS #3 inserts (34 microm) and SDS inserts of similar size (23 microm). Comparison of mean values between the ceramic insert systems examined revealed that marginal adaptation was better at the buccal and lingual proximal walls than those at the pulpal floor in the SDS system, however, there was no difference for SONICSYS at both sizes. Ceramic inserts placed in cavities prepared with ultrasonic tips provide clinically acceptable marginal quality.     

Influence of beveling and ultrasound application on marginal adaptation of box-only Class II (slot) resin composite restorations

A laboratory study was performed to assess the influence of beveling the margins of cavities and the effects on marginal adaptation of the application of ultrasound during setting and initial light curing. After minimal access cavities had been prepared with an 80 microm diamond bur, 80 box-only Class II cavities were prepared mesially and distally in 40 extracted human molars using four different oscillating diamond coated instruments: (A) a U-shaped PCS insert as the non-beveled control (EMS), (B) Bevelshape (Intensiv), (C) SonicSys (KaVo) and (D) SuperPrep (KaVo). In groups B-D, the time taken for additional bevel finishing was measured. The cavities were filled with a hybrid composite material in three increments. Ultrasound was also applied to one cavity per tooth before and during initial light curing (10 seconds). The specimens were subjected to thermomechanical stress in a computer-controlled masticator device. Marginal quality was assessed by scanning electron microscopy and the results were compared statistically. The additional time required for finishing was B > D > C (p < or = 0.05). In all groups, thermomechanical loading resulted in a decrease in marginal quality. Beveling resulted in higher values for "continuous" margins compared with that of the unbeveled controls. The latter showed better marginal quality at the axial walls when ultrasound was used. Beveling seems essential for good marginal adaptation but requires more preparation time. The use of ultrasonic vibrations may improve the marginal quality of unbeveled fillings and warrants further investigation.     

Marginal integrity of large compomer Class II restorations with cervical margins in dentine

OBJECTIVES: The aim of the present study was to investigate the marginal integrity of total-bond Dyract AP restorations in large Class II restorations with cervical margins in dentine. The efficacy of a new non-rinse conditioner and the effect of beveling the enamel margins were also studied. METHODS: Large MOD cavities with cervical margins located 1mm below the CEJ were prepared in 48 extracted human molars. Six groups (n=8) were filled using a total-bond technique with Spectrum TPH or Dyract AP or a sandwich technique with Dyract in combination with Spectrum TPH. For Dyract AP total-bond restorations, a new non-rinse conditioner was tested vs. a total-etch with 36% phosphoric acid in beveled and butt-joint cavities. After water storage for 21 days and thermocycling (2000x, 5-55 degrees C), replicas were produced for quantitative marginal analysis in the SEM. Afterwards, teeth were immersed in 0.5% basic fuchsin for 24h and dried. Percent dye penetration over the total margin length was analysed in three layers using a sequential grinding technique. Statistical analysis was performed with non-parametric tests and the Bonferroni correction for multiple comparisons at p<0.05. RESULTS: All restoration types showed microleakage. On cervical margins in dentine, Dyract AP restorations showed better marginal adaptation than Spectrum TPH total-bond restorations (marginal openings (MO), median 33.8 vs. 79.6%), but were inferior to Dyract/Spectrum TPH sandwich restorations (MO: 0. 0%). The non-rinse conditioner improved the marginal adaptation of Dyract AP restorations in dentine (MO: 4.7 vs. 38.4%, p=0.0206 for beveled cavities, 12.2 vs. 33.8%, p=0.0238, for butt-joint cavities) and yielded similar results in enamel margins provided that enamel margins were beveled. Beveling of enamel significantly reduced the occurrence of enamel microcracks. CONCLUSIONS: The use of a non-rinse conditioner in combination with Dyract AP may improve the marginal adaptation of Class II restorations compared to composite restorations. The sandwich technique with Dyract results in better marginal adaptation in cervical dentine compared to all other restorative techniques tested in this study. However, microleakage cannot predictably be prevented with the sandwich technique.     

冷热循环对自粘接树脂水门汀边缘适合性的影响

目的：对自粘接树脂水门汀（RelyX Unicem）与传统树脂水门汀系统（Panavia F,Variolink Ⅱ,Vtique）粘接嵌体边缘适合性进行对比研究。方法：48个新鲜拔除的第一磨牙分为4组,每组12个,分别选用d种树脂水门汀系统粘接嵌体,每组试件选取4个分别冷热循环0次,5000次,10000次后,放置于0．5％的品红溶液中染色24h,顺着嵌体长轴纵剖后在体视显微镜下观察微渗漏情况。结果：4种树脂水门汀系统在不同的冷热循环次数沿着粘接界面表现出低的微渗漏,4种树脂水门汀系统粘接嵌体无明显统计学差异义。结论：自粘接树脂水门汀具有与传统树脂水门汀相似的良好的边缘适合性。     

Marginal adaptation of different esthetic filling materials under the effect of heat treatment

The aim of the study was to examine the marginal adaptation of six tooth coloured restoratives to the tooth hard tissues before and after heat treatment considering the filling method and the placement of the cavity margin. The study showed that 1) the composite marginal adaptation was better with enamel bonding technique than with total bonding technique; 2) the microleakage was less before heat treatment; 3) the best fit was at the occlusal surface and the worst at the gingival tooth-filling junction with the composites; 4) non-composites showed the best adaptation at the approximal enamel-filling junction and the worst at the occlusal surface; 5) the best marginal adaptation could be achieved with Charisma and SpectrumTPH among the composites, and Dyract among the non-composites.     

Self-etch vs etch-and-rinse adhesives: effect of thermo-mechanical fatigue loading on marginal quality of bonded resin composite restorations.

OBJECTIVE: This study evaluated the marginal integrity of dentine adhesives bonded to enamel and dentine, before and after thermo-mechanical loading (TML). METHODS: MO cavities with proximal boxes beneath the CEJ were prepared in extracted human third molars. Direct resin composite restorations (Tetric Ceram) were bonded with 3-step etch-and-rinse (Syntac Classic, Solobond Plus, OptiBond FL), 2-step etch-and-rinse (Admira Bond, Single Bond), 2-step self-etch (AdheSE, Clearfil SE Bond), and 1-step self-etch (all-in-one) adhesives (Adper Prompt, Xeno III, iBond). Marginal gaps were analyzed using SEM of epoxy resin replicas. Bonded interfaces before TML were examined with TEM to identify pre-existing attributes for subsequent marginal disintegration. RESULTS: In enamel, high percentages of gap-free margins were initially identified for all adhesives. After TML, etch-and-rinse adhesives exhibited significantly higher percentages of gap-free margins (approximately 90%) compared with two-step self-etch (approximately 75%) and all-in-one (approximately 55%) adhesives (p<0.05). iBond did not completely etch through the enamel smear layer. In dentine, 89-100% gap-free margins were initially observed. After TML, there were no statistical differences among etch-and-rinse (62-70%) and two-step self-etch (62-63%) adhesives (p>0.05). The all-in-one adhesives exhibited significantly less gap-free margins (<40%) in dentine (p<0.05), with iBond showing the worst marginal integrity (15%). The presence of pre-existing water channels within the adhesives probably expedited water sorption when restorations were under functional stresses. CONCLUSION: Enamel bonding was more effective with phosphoric acid-etching. Etch-and-rinse and 2-step self-etch adhesives showed promising marginal adaptation to dentine and may have a better clinical prognosis than the all-in-one bonding approach.     

Total bonding vs selective bonding: marginal adaptation of Class 2 composite restorations

For improving the marginal integrity of composite restorations, a total bonding method has been advocated besides the conventional selective bonding method. Total bonding avoids the placement of a base. The entire internal cavity surface is available for the adhesive bond. Selective bonding involves the placement of a base covering the pulpal floor as well as the pulpoaxial wall. In this study, five dentin/enamel bonding system/composite combinations were used to restore 60 class 2 cavities with their cervical margins below the cementoenamel junction (CEJ); six teeth per material were restored according to the total bonding and the selective bonding methods. Before and after simultaneous thermo-cycling and mechanical loading (TCML) marginal adaptation was evaluated on replicas in the SEM. Microleakage was determined by dye penetration on the original samples after TCML. The data were statistically evaluated with the Mann-Whitney U-test and the Wilcoxon test. The error rates method was applied. In SEM analysis the error rates method indicated a significant difference between the two restoration methods in general. In the pairwise comparisons, no significant differences between the selective bonding and total bonding methods were found for Syntac/Tetric, Gluma 2000/Pekafill, and Gluma/Pekafill. With Scotchbond Multi-Purpose (SBMP) and All-Bond 2 (AB2), total bonding revealed significantly (P < or = 0.01) less gap formation before and after TCML than selective bonding. Accordingly, total bonding showed significantly less (P < or = 0.01) dye penetration with Scotch-bond Multi-Purpose and All-Bond 2 compared to selective bonding. In conclusion, the reduction of microleakage by application of the total bonding method depended upon the bonding system used. Total bonding could be an alternative procedure for the adhesive restoration of class 2 cavities when their gingival margins are apical to the cementoenamel junction, provided the proper system is used and pulp damage is prevented.     

Marginal adaptation of heat-pressed glass-ceramic veneers to dentin in vitro.

The purpose of the present study was to examine the marginal adaptation of ceramic veneers to dentin at the cervical margins and to enamel at the palatoincisal margins using four dual-curing composite resin cements of different viscosity with their corresponding dentin bonding systems. Thirty-six caries-free human maxillary incisors were prepared for facial ceramic veneers with cervical cavity margins located in dentin. Heat-pressed glass-ceramic veneers (IPS Empress) were inserted adhesively using one of the following luting systems: Sono-Cem (SC) with EBS; Variolink Ultra (VU), Variolink High Viscosity (VHV), and Variolink Low Viscosity (VLV) with Syntac. Both the cervical and the palatoincisal margins of the veneers (tooth/composite resin cement interface and ceramic/composite resin cement interface) were evaluated before and after thermocycling and mechanical loading (TCML) by quantitative margin analysis under a scanning electron microscope (SEM) using an image analysis system. Microleakage was assessed by dye penetration after TCML. Before TCML, SC and VU showed statistically significantly fewer marginal gaps than VHV and VLV. After TCML, SC, VU, and VHV revealed significantly fewer marginal gaps than VLV. TCML had a statistically significant influence on marginal gap formation at both the dentin and enamel margins. After TCML, the percentage of marginal gaps was not significantly different at the cervical dentin than at the palatoincisal enamel margins. Cervical dye penetration after TCML showed no statistically significant differences in microleakage among the four luting systems. In conclusion, this in vitro study showed that similarly favorable marginal adaptations of ceramic veneers to dentin and enamel can be achieved using Sono-Cem, Variolink Ultra, or Variolink High Viscosity with their corresponding dentin bonding systems.     

Analysis of marginal adaptation and sealing to enamel and dentin of four self-adhesive resin cements

This in vitro study compared the marginal adaptation of all-ceramic MOD-inlays luted to human molars with four self-adhesive resin cements. Thirty-two human third molars were randomly assigned to four test groups (n = 8 per group). MOD cavities were prepared with approximal finishing lines in dentin and enamel. All-ceramic Empress 2 inlays were luted with four self-adhesive cements (Clearfil SA, iCEM, Bifix SE, seT). Oral stress was simulated by 90 day storage in water as well as by thermal and mechanical loading (TCML, 1.2 × 10⁶ × 50 N, 6,000× 5°/55°, 1.6 Hz). The marginal fit was evaluated by scanning electron microscopy (SEM) and dye penetration. Data were analyzed with the ANOVA/Tukey's test (α = 0.05). The SEM investigation of the gingival cement margins (cement–tooth interface) showed values of perfect margin [percent] (means ± SD) after simulated aging between 84 ± 9% and 95 ± 5% for enamel and 80 ± 9% and 92 ± 3% for dentin. In enamel, seT showed significantly higher marginal integrity than iCEM after water storage and TCML (post hoc; p = 0.011). Furthermore, the marginal adaptation of iCEM in enamel deteriorated by simulated aging (p = 0.014, ANOVA). Mean values of dye penetration (percentage of dye entry into dentin) at the investigated restorations margins ranged between 3% and 8% for enamel and 12% and 22% for dentin. Clearfil SA, iCEM, and seT showed lower dye penetration in enamel than in dentin (Clearfil SA: p = 0.013, iCEM: p = 0.044, seT: p = 0.003). The results suggest that the four self-adhesive luting agents investigated seem to successfully bond to dentin-restricted as well as to enamel-restricted cavities, predicting good clinical performance.     

Interfacial adaptation of a calcium aluminate cement used in class II cavities,in vivo

The aim of this in vivo study was to evaluate the interfacial marginal adaptation of a calcium aluminate cement, Doxadent (DD), and to compare it intra-individually with a resin composite, Tetric Ceram/Syntac Single-Component (TC/SS), in Class II cavities. Sixteen Class II box-shaped, enamel-bordered cavities were prepared in eight premolars scheduled to be extracted after 1 months service for orthodontic reasons. The interfacial marginal adaptation (internal surfaces) of the restorations was evaluated by a quantitative scanning electron microscope analysis using a replica method. DD showed a statistically significant, lower degree of gap-free adaptation to enamel compared with TC/SS: 84% vs. 93%. To dentin, DD showed a significantly better adaptation than TC/SS: 72% vs. 49%. A high frequency of enamel fractures perpendicular to the margins was observed for the DD restorations, which may be explained by an expansion of the calcium-aluminate cement. It can be concluded that DD showed a better adaptation to dentin while TC/SS showed a better adaptation to enamel. The dimensional changes of DD have to be investigated before clinical use can be recommended.