A comparison of the levels of microleakage of five ...

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Original Article

A comparison of the levels of microleakage of five adhesive systems Mehmet Dalli, Fatma Atakul1, Emrullah Bahşi2, Bayram Ince2, Cafer Şahbaz3, Hakan Çolak4, Ertuğrul Ercan4 Department of Restorative Dentistry, Izmir Katip Celebi University Dental School, Izmir, 1Departments of Pediatric Dentistry, and 2Restorative Dentistry, Dicle University Dental School, Diyarbakþr, 3Departments of Restorative Dentistry, Afyon Kocatepe University Dental School, Afyon, 4Kþrþkkal University Dental School, Kþrþkkale, Turkey

Address for correspondence: Dr. Mehmet Dallþ, Department of Restorative Dentistry, Izmir Katip Celebi University Dental School, Izmir, Turkey. E-mail: [email protected]

ABSTRACT

Objective: The aim of this study was a comparative assessment of in vitro microleakage of five different new generation self-etching adhesive systems. Materials and Methods: One hundred recently extracted fresh caries-free human permanent molars were used. Teeth were randomly assigned to one of five groups (n = 20). Clearfil S3 Bond (Group I), Xeno V (Group II), G Bond (guanine-cytosine) (Group III), Optibond All in One (Group IV) and iBond (Group V) were applied, then polymerized with light emitting diode and restored with a nanofill composite. Teeth were coated twice with acid resistant varnish and immersed in 0.5% methylene blue. Specimens were cut bucco-palatinally/lingually, with microleakage scores evaluated on a scale from 0 to 4 under a stereomicroscope and then analyzed under a scanning electron microscope. Results: The differences among the gingival and occlusal microleakage scores of the groups were statistically significant (P < 0.05) (P = 0.043, P = 0.005). Occlusal microleakage scores of Clearfil S3 Bond and Optibond All in One were considerably lower than those of the other three groups. While the highest microleakage was observed with iBond, there was no statistical difference between the Xeno V and G Bond groups (P > 0.05). The highest gingival microleakage scores were in the iBond group; though, statistically there was no significant difference among the other groups (P > 0.05). Conclusion: The occlusal and gingival microleakage scores of self-etching adhesive systems in this study were satisfactory except for one group (Group V-iBond).

Keywords: Bonding, composite, microleakage

INTRODUCTION The use of composite resins is becoming more widespread owing to esthetic superiority and successful results in adhesive restorations.[1] Recent studies have shown that composite resins may be used as an alternative to amalgam in posterior teeth.[2-4] Access this article online Quick Response Code:

Website: www.jresdent.org

DOI: 10.4103/MPWK-0017.116038

The aim of conservative dental treatment is the removal of decay and following cavity shaping, to make the filling with appropriate restorative material.[5] Marginal adaptation between the cavity and the restorative material is significant in the restoration showing long-lasting performance.[6,7] One of the most important reasons for microleakage is a poor connection between the tooth and the restorative material.[8] Other reasons for microleakage are the difference in the thermal expansion coefficient between the filling material used and the tooth tissue, the difference in the thermal expansion coefficient between the enamel and the dentine, the contraction of the filling material used during the polymerization, the wear of the filling surface over time, the occlusal strength of the filling suffering elastic deformity, not conforming to the required guidelines during placement of the filling and carelessness of the dental practitioner.[9]

66 • Journal of Restorative Dentistry / Vol - 1 / Issue - 2 / May-Aug 2013


Dalli, et al.: A comparison of the levels of microleakage of five new generation adhesive systems

The properties of adhesive systems, which have been developed reduce microleakage by strengthening the adhesion between the tooth and the restoration.[10-13] Greater technical sensitivity is required in the total-etch application than in traditional and single-bottle adhesives. However while excessive roughening of the dentine may weaken the bond, excessive drying of the dentine following acid application contracts the collagen fibers.[14] In self-etch adhesive systems, less technical sensitivity is required as there is no acid and washing procedure. Self-etching adhesives do not remove the smear layer, but only dissolve it and partially demineralize the smear layer found below the dentine.[14,15] Self-etch adhesives demineralize the enamel and dentine simultaneously and contain acidic monomers, which cause primary infiltration.[14,15] As there is no acid application and washing procedure, the smear layer and results of demineralization are not removed and are included in the adhesive resin.[16] At the same time, in the collagen structure, which is left open as a result of excess drying of the surface, the risk of remaining moist to a degree, which will prevent collapse or bonding, is reduced.[17] As acid application and resin infiltration are performed together, the possibility of lack of infiltration is low or non-existent. Therefore, there is not expected to be any post-operative sensitivity.[17] Two-bottle self-etch adhesive systems consist of the application of a hydrophylic primer solvent added to acidic monomer at the first stage and hydrophobiic adhesive resin application at the second stage. In a single bottle self-etch adhesives; however, acidic monomer added to primer and the adhesive are together and are applied at the same time. Single bottle self-etch adhesive systems are a mixture of hydrophylic and hydrophopic components. Another advantage of the single bottle self-etch adhesive systems is the simultaneous application of acid and resin infiltration and thus there is no or little risk of insufficient infiltration. Associated with that is the expectation that there will not be post-operative sensitivity. The aim of self-etch adhesive systems is to facilitate the application by making it in a single stage. The stages of roughening with acid and the application of primer and bonding are gathered into a single stage in self-etch systems. Thus, surface dentine demineralization and dentine hybridization by partially dissolving the smear layer aided by acidic monomers (primer) are created in a single stage.[18] The aim of this study was to evaluate the amount of microleakage in the new generation 5 self-etch adhesive system using a nanophyl composite resin in comparative in vitro conditions.

MATERIALS AND METHODS This study used 100 human molar teeth, which had been newly-extracted for orthodontic and peridontal reasons. The teeth had no decay, no restoration and no cracks on the enamel. After extraction, the soft-tissue and residue on the teeth were removed using a scalar, pumice and brush. The teeth were kept in distilled water at room temperature. All teeth were prepared with a standard Class V cavity on the buccal surface using a cylindrical diamond burr (Diatech, Swiss Dental Instruments, Heerbrugg, Switzerland) with water cooling. Then, the teeth were randomly allocated to 5 groups of 20 teeth each.

Group 1 (Clearfil S3 Bond) Single stage self-etch adhesive system Clearfil S3 Bond (Kuraray Medical Inc. Japan) was applied to the Class V cavities, was air-dried for 5 s and polymerized with 1000 mW/cm2 strength (light emitting diode [LED]-Elipar Freelight, 3M ESPE, Germany) light source for 10 s. The nanophyl composite Filtek Supreme XT (3M ESPE, USA) was applied to the cavity as a restorative material and polymerized using the LED light source for 20 s.

Group 2 (Xeno V) Single stage self-etch adhesive system Xeno V (Dentsply DeTrey, Konstanz, Germany) was applied to the Class V cavities, was air-dried for 5 s and polymerized with LED light source for 10 s. The nanophyl composite Filtek Supreme XT (3M ESPE, USA) was applied to the cavity as restorative material and polymerized using LED light source for 20 s.

Group 3 (G Bond) Single stage self-etch adhesive system G Bond (guanine-cytosine America) was applied to the Class V cavities was air-dried for 5 s and polymerized with LED light source for 10 s. The nanophyl composite Filtek Supreme XT (3M ESPE, USA) was applied to the cavity as a restorative material and polymerized using LED light source for 20 s.

Group 4 (Optibond All in One) Single stage self-etch adhesive system Optibond All in One (Kerr Corporation) was applied to the Class V cavities was air-dried for 5 s and polymerized with LED light source for 10 s. The nanophyl composite Filtek Supreme XT (3M ESPE, USA) was applied to the cavity as restorative material and polymerized using LED light source for 20 s.

Group 5 (iBond) Single stage self-etch adhesive system iBond (Heraeus Kulzer, Germany) was applied to the Class V cavities,

Journal of Restorative Dentistry / Vol - 1 / Issue - 2 / May-Aug 2013 • 67



was air-dried for 5 s and polymerized with LED light source for 10 s. The nanophyl composite Filtek Supreme XT (3M ESPE, USA) was applied to the cavity as restorative material and polymerized using LED light source for 20 s. The application methods of the adhesive systems used in the study are shown detailly in Table 1 Before the finishing procedure, the teeth were kept in an incubator (Nüve Incubator EN 120, Ankara, Turkey) at 37°C for 24 h. For the finishing and polishing procedures of all the restorations, 24 h after finishing the restorations, they were polished under water with a diamond finishing burr (Diatech Dental AG, Heerbrugg, Switzerland) with an aluminum oxide covered disc ((Sof-Lex, 3M ESPE, St. Paul, MN, USA). A new burr was used every 5 teeth and the discs were changed after the polishing of each restoration. After storing the samples in 37°C distilled water in an incubator (Nüve Incubator EN 120, Ankara, Turkey) for 24 h, a 10,000 (30 s application time) thermal cycle process was made in a bath heated to between 5 ± 2°C and 55 ± 2°C. Then, the root tips of the samples were closed with composite resin and the teeth were coated with two coats of acid-resistant nail varnish in such a way as to leave the varnish 1 mm outside the margins of the restoration. All samples were stored in the incubator at 37°C for 24 h, submerged in 0.5% methylene blue solution. Then, the teeth were fixed in prepared rectangular cold acrylic blocks with a cyanoacrylate fixation material with an isomet 1000 device (Isomet 1000 Precision Saw, BUEHLER, USA) and with the teeth in buccco-palatinal/lingual direction, sections were cut with the device so that the restorative material was centered. Each restoration was examined under binocular stereomicroscope (Olympus SZ 40, SZ-PT, Japan) at ×15 magnification and were photographed with a digital camera ([DCM] 300, 3M pixels Universal Serial Bus, DCM for Microscope) fixed to the stereomicroscope and were then scored.

shown in Figure 1. 1. 2. 3. 4. 5.

No stained leakage Stained leakage to as far as half the cavity walls Stained leakage on the entire cavity wall Stained leakage on the cavity walls and base Stained leakage partially or completely reaching the pulp.

RESULTS In the comparison between the groups in respect of occlusal and gingival microleakage, Kruskal-Wallis variance analysis was used. According to the test result [Table 2], differences between the groups in respect of occlusal microleakage were found to be statistically significant (P < 0.05) (P = 0.043). Differences between the groups in respect of gingival microleakage were found to be statistically significant (P < 0.05) (P = 0.005). The occlusal microleakage scores of the Clearfil S3 Bond and Optibond All in One groups were observed to be considerably lower than those of the other three groups. While the highest microleakage was seen in the iBond group, no statistical difference was found in the Xeno V and G Bond groups (P > 0.05). Although the highest gingival microleakage scores were found in the iBond group, there was no statistical difference from the other groups (P > 0.05). Examples of microleakage scores and scanning electron microscope images belonging to the different type bond groups are shown in Figures 2 and 3 respectively.

DISCUSSION Self-etch adhesives are systems which have been named “all in one” or “no bottle” as they bring together all the stages into one (acid, primer and bonding together) without the stages of washing and drying. An important

The obtained microleakage scores were statistically evaluated using SPSS software (SPSS 11.5, Chicago, Illinois, USA) with non-parametric Kruskal-Wallis and Mann Whitney U tests. The differences between the occlusal-gingival areas of each group were evaluated using the Wilcoxon Signed Ranks test. One tooth was selected at random from each group. The teeth were covered with Au in an ion coating unit (Polaron SC 500 Sputter Coater, England). Then the morphology of the surface between the resin-tooth hard tissue was examined under a scanning electron microscope (SEM) (JSM-5600 JEOL SEM, Jeol Co., Tokyo, Japan) and photographs were taken.

Microleakage scores Criteria for the evaluation of microleakage scores were

Figure 1: Criteria for the evaluation of microleakage scoring




b

a

c

e

d

Figure 2: Examples of microleakage scores belonging to the different type of bond groups (a) Clearfil S3 (Occlusal score 0, gingival score 0); (b) Xeno V (Occlusal score 1, gingival score 0); (c) G bond group (Occlusal score 1, gingival score 4); (d) Optibond all in One (occlusal score 0, gingival score 4) and (e) iBond group (occlusal score 1, gingival score 4)

c

b

a

d

e

Figure 3: Examples of scanning electron microscope images belonging to the different type bond groups; (a) Clearfil S3; (b) Xeno V; (c) G bond group (Occlusal score 1, gingival score 4); (d) Optibond all in One (occlusal score 0, gingival score 4) and (e) iBond group (occlusal score 1, gingival score 4)

advantage of these systems is that demineralization and resin infiltration occur at the same time. In addition, clinically, the application period is shorter and simpler. Nowadays, the smear layer has great importance in adhesive systems. The partial dissolving or complete removal of the smear layer is associated with the effects of the adhesive agent. Self-etch systems demineralizes by partial dissolving of the smear layer without blocking the

tubules of the smear layer and the dentine surface below. With developments in the formula and application techniques of adhesives, more appropriate and reliable systems have come onto the market. However no material or technique has been found to completely remove microleakage. Defined factors in the prevention of microleakage are bonding resistance, wetting properties, solvent structure and application properties in dentine

Journal of Restorative Dentistry / Vol - 1 / Issue - 2 / May-Aug 2013 • 69



Table 1: The application methods of the adhesive systems used in the study Adhesive Application method system Clearfil S3 1 drop of adhesive was applied with a disposable brush Bond and 20 s were waited High-intensity air-drying for a minimum of 5 s Light was applied for 10 s Xeno V 2 layers of adhesive were applied with a brush throughout 20 s Air-drying for 5 s Light application for 20 s G Bond The bottle was shaken before use Adhesive was applied with a brush and 5-10 s were waited High-intensity air-drying for a minimum of 5 s Light application for 10 s (if the tip of the light source is more than 10 mm away, then apply for 20 s) Optibond Firstly the bottle was shaken vigorously for 10 s all in one Adhesive was applied with a brush throughout 20 s A second layer of adhesive was applied with a brush throughout 20 s Mild and moderate level pressurized air-drying of the cavity for at least 5 s Light application for 10 s iBond The bottle was shaken 3 layers of adhesive were applied to the cavity with a brush (30 ss were waited) Mild air-drying until there are no moving particles of adhesive Light application for 20 s

Table 2: Distribution of the obtained microleakage scores of the groups

Group 1 Gingival Occlusal Group 2 Gingival Occlusal Group 3 Gingival Occlusal Group 4 Gingival Occlusal Group 5 Gingival Occlusal

0

Microleakage scores 1 2 3

4

10 9

5 9

1

2 1

3 -

9 4

2 13

1 1

-

8 2

9 4

8 15

-

1 1

2 -

13 10

4 9

1

-

3 -

1 1

19

3 -

5 -

11 -

adhesive systems and modular elasticity, contraction and thermal expansion coefficients in composite resins.[19] In studies conducted on the subject, etch and rinse adhesive systems have shown less microleakage in the enamel walls of Class V cavities compared to self-etching

adhesive systems.[20,21] Other studies, however, have found no difference between self-etching adhesive systems and etch and rinse adhesive systems in the degree of microleakage in Class V cavities.[22] In the current study, a statistically significant difference was observed between the microleakage of the five different self-etching adhesive systems applied to restorations. iBond was determined as having high values of gingival microleakage. In an in vitro microleakage study by Nalçacı comparing self-etching bonding systems and single bottle bonding systems, it was reported that self-etching adhesive systems provided the same coverage on the dentine surfaces as the other single bottle bonding systems.[23] In another similar study, Pashley and Carvalho reported that because of the co-monomers in self-etching adhesives, the gaps between the fibrils in the dentine surfaces were completely infiltrated and this resulted in very good coverage.[24] The results of the current study determined that like the single bottle systems, Clearfil S3 Bond and All in One provided good coverage of the dentine surfaces. A similar study by Sensi et al. reported that single-stage self-etching adhesives showed lower bonding strength to the dentine than total-etch and two-stage self-etching adhesive systems.[20] A recent in vitro study, similar to the current study, evaluated coronal and apical microleakage on both the lingual and buccal surfaces of ClassV cavities in molar teeth with the use of iBond, G Bond, Xeno IV and Clearfil S3 Bond. From the result of 1000 thermal cycles, it was stated that the least leakage had formed in the Xeno IV group in the coronal area and in the Clearfil S3 Bond in the apical.[13] The current study was planned in a similar manner and at the end of 10,000 thermal cycles the microleakage scores were found to be low in the Clearfil S3 Bond and All in One groups.

CONCLUSION In this microleakage study of Class V cavities restored with composite resin and five different self-etching adhesives, the result of 10,000 thermal cycles with 0.5% methylene blue determined different scores in the self-etch adhesives. While the Clearfil S3 Bond and All in One groups were determined as the most successful, G Bond showed more microleakage although there was no statistically significant difference when compared with Clearfil S3 Bond and All in One. In the evaluation of occlusal microleakage, Xeno V and iBond were statistically determined as the least successful groups. In gingival microleakage, the iBond group microleakage values were found to be high, although no statistically significant




difference was determined with the other 4 groups. Taking all these results into consideration, further clinical studies are required to support these obtained results.

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How to cite this article: Dalli M, Atakul F, Bahsi E, Ince B, Sahbaz C, Çolak H, Ercan E. A comparison of the levels of microleakage of five adhesive systems. J Res Dent 2013;1:66-71. Source of Support: Nil, Conflict of Intrest: Nil.

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