Marginal adaptation of resin-bonded light-cured glass ionomers in dentin cavities

PURPOSE: To investigate the marginal adaptation of resin-modified glass ionomer cements in dentin cavities placed with or without additional application of resin bonding systems. MATERIALS AND METHODS: Three resin-modified materials (Fuji II LC, Photac-Fil, Vitremer), one compomer (Dyract) and as reference an adhesively bonded resin composite system (Gluma CPS-Pekafill) were used. Flat peripheral dentin surfaces on human molar teeth were produced by wet grinding on SiC paper. Cylindrical cavities, 3.5 mm wide, were prepared in these dentin areas and restored with the individual materials. Sixty cavities were pretreated and restored as requested by the respective manufacturers. Following water storage of the specimens for 15 minutes or 24 hours, excess was gently removed by wet grinding for microscopic inspection of the marginal area. Additionally, in 30 cavities an experimental one-component adhesive resin system, a proprietary dimethacrylate and HEMA mixture dissolved in acetone, was combined with each of the restoratives for evaluation after 15-minutes water storage. Finally, in six cavities each, Dyract was combined with Prime and Bond 2.0, and Vitremer with Scotchbond Multi-Purpose Plus for assessment after 15 minutes. Maximum marginal gap widths (MGW) were measured. One-way ANOVA by ranks (Kruskal-Wallis-Test) followed by Wilcoxon's Two-Sample test were used to study the statistical difference of MGW among the treatment groups at a rejection level P = 0.05. RESULTS: Neither the conventionally placed material systems nor the restorations in combination with adhesives showed consistently gap-free margins after 15-minute water storage. After 24-hour storage with Vitremer 4 of the 6 restorations were gap-free, whereas with all other materials only perfect margins were registered. There was, however, no significant difference between the groups. Application of the experimental and/or the specific resin bonding agents had no effect on early MGW except for the Photac-Fil group, which was significantly reduced.     

Increased apoptotic cells in bone marrow biopsies from patients with aplastic anaemia

PURPOSE: To evaluate the 2-year clinical performance of two polyacid-modified resin composites and two resin-modified glass ionomers in Class V carious cavities. MATERIALS AND METHODS: A total of 120 Class V cavities were selected and 30 cavities were restored with one of two resin-modified glass ionomer materials (Fuji II LC Improved and Vitremer) and two polyacid-modified resin composites (Dyract and Compoglass) in Class V carious cavities after 2 years. The restorations were clinically evaluated after 1 and 2 years using the USPHS criteria. RESULTS: One-year findings revealed a significant difference in color match between Vitremer and other materials (P < 0.05) and no significant difference was found for the other criteria. Two-year results indicated a significant difference between resin-modified glass ionomers and polyacid-modified resin composite materials. The difference between Compoglass and Dyract was not statistically significant whereas the difference between Vitremer and Fuji II LC was statistically significant. Caries was not recorded at any evaluation period.     

Comparison of marginal fit and microleakage of ceramic and composite inlays: an in vitro study

The purpose of this in vitro study was to evaluate the marginal fit and microleakage of four types of ceramic or resin composite inlays. Sixty extracted human third molar teeth were randomly assigned into four groups. MOD cavities without bevels were prepared. The mesiogingival margin was cut in enamel, whereas the distogingival margin was placed below the amelocemental junction. The preparations and inlays were made according to the manufacturers' instructions. After acid-etching and treatment with a dentine bonding agent the inlays were cemented with dual curing CEREC resin composite luting material. After placement and polishing 10 teeth of each group were thermocycled 2500 times between 14 degrees C and 62 degrees C. Each tooth was bisectioned and from each part, one occlusal and three proximal sections of 75-100 microns thickness were cut and ground (EXAKT Cutting and Grinding system). The marginal discrepancy and the thickness of the luting cement were measured microscopically at each section and an average for each tooth was calculated. Considerable variation of marginal fit was seen, within inlays, and among different types of inlays. In general, the Vita Dur N inlays showed the best fit, e.g. the thickness of the luting cement for Vita Dur N was 114 microns occlusally and 119 microns mesiogingivally compared to 199 microns occlusally for CEREC and 219 microns mesiogingivally for Estilux. At enamel margins, a tendency of less microleakage was seen for ceramic inlays compared to composite inlays.     

In vitro evaluation of marginal and internal adaptation of class II resin composite restorations after thermal and occlusal stressing

The aim of this in vitro trial was to evaluate the external and internal adaptation of class II composite restorations to tooth structure by means of replica scanning electron microscope (SEM) observation. Standard MOD preparations were cut in human extracted teeth with margins located above and below the cementoenamel junction. Cavities were restored with either a direct multilayered technique, inlays (using conventional or dual DBA application) or prepolymerized composite inserts, using similar restorative material (Syntac, Variolink and Tetric). Evaluations were performed after mechanical and thermocycling. For the marginal adaptation in enamel, the bevelled margins of the direct group resulted in higher percentages of "continuity" (92.5% mesially and 94.6% distally), while the "marginal tooth fracture" was the most commonly found defect in groups with a butt preparation (up to 29.4%, with inserts). For the marginal adaptation in dentin, "continuity" percentages varied from 59% (inlay) to 87.9% (insert). As regards the internal adaptation, results for the whole dentin interface varied from 43.1% (inlay) to 63.9% (inlay with dual bonding) of "continuity". No regional difference in internal adaptation was found between the different preparation areas, except between gingival dentin and gingival enamel (44.9% vs. 80.7% of continuity, all group pooled data). Debonding occurred only at the dentin-restoration interface and consistently took place at the top of the hybrid layer. In the present experimental conditions, the inlay or insert techniques, which make use of the Dual bonding concept, proved to have the best potential to maintain the integrity of dentin-restoration interface.     

Interfacial characteristics of resin-modified glass-ionomer materials: a study on fluid permeability using confocal fluorescence microscopy

The tooth interface with resin-modified glass-ionomer cements (RM GICs) is poorly understood. This study examined the interface, especially with dentin. Cervical cavities in extracted teeth were restored with Fuji II LC, Vitremer, Photac-Fil, or a conventional GIC, Fuji Cap II. Fluorescent dye was placed in the pulp chambers for 3 hrs before the specimens were sectioned. Examination of the tooth/material interface with a confocal microscope showed that dye uptake by the restoration varied among materials. A "structureless", non-particulate, highly-stained layer of GIC was observed next to dentin in Fuji II LC. This layer varied in width, was prominent where the dentin tubules were cut "end-on" and in areas closer to the pulp, and was not seen adjacent to enamel. Vitremer showed minimal dye uptake, and the "structureless" layer was barely discernible. Photac-Fil showed more uniform uptake and absence of this layer. Cracking of enamel was also noted with these materials. The conventional GIC did not show any dye uptake, presence of a "structureless" layer, or enamel cracking. We elucidated the potential mechanisms involved in the formation of a "structureless" interfacial layer in Fuji II LC by studying the variables of cavity design, surface pre-treatment, water content of the tooth, time for it to develop, early finishing, and coating of the restoration. This layer, the "absorption layer", is probably related to water flux within the maturing cement, depending on environmental moisture changes and communication with the pulp in a wet tooth. The "micropermeability model" was useful in this study of the interfacial characteristics of RM GICs.     

Race, life style and renal disease in South Africa

PURPOSE: Clinical evaluation of repairing old amalgam restorations using composite inlays cemented with two different bonding agents. MATERIALS AND METHODS: Occluso-proximal Class II inlay cavities were prepared in 50 old defective amalgam restorations. Extra oral system (EOS) composite inlays were cemented with two different bonding agents (All-Bond 2 or Geristore). After final finishing and polishing of each restoration, evaluation was carried out at baseline, 6 months, 12 months, and 24 months using US Public Health Service criteria. The data were collected and statistically analyzed using Chi-square test. RESULTS: No significant difference was found between the two bonding materials at any time interval.     

Analgesic, hemodynamic, and respiratory effects of caudal epidurally administered xylazine hydrochloride solution in mares

The present study investigates the effect of storage in water on hygroscopic expansion and shear bond strength to dentin at periods up to 1 week, of the resin-modified glass ionomers for base/liner, and to analyze the effect on the marginal gaps in dentin cavities. For polishing after storage in water for 1 day, the material indicated significantly smaller marginal gaps both in dentin and in Teflon cavities than in those immediately after light-activation. For the results of after storage in water for 1 day, the material indicated significantly greater bond strength than material immediately after light-activation. The improvement of marginal sealability in dentin cavities may be performed not only by hygroscopic expansion during storage in water but also by greater bond strength after the setting reaction which continues to advance during storage in water.     

Adhesive luting cements--classes, criteria, and usage

Clinical studies have shown that recurrent decay and lack of retention are the major causes of traditional crown and bridge failure. Optimal marginal accuracy and preparation retention form are important pre-requisites for longevity, as well as good patient oral hygiene. In an effort to provide improved clinical success, new classes of luting agents with improved physical properties and new therapeutic capabilities have been developed. Conventional glass ionomer cements provide fluoride release and adhesive properties. Recently introduced resin-modified glass ionomer luting materials add the potential for increased resistance to dissolution and improved physical and biological attributes. The resin luting cements are more difficult to use but provide greatly increased bonding capabilities and are necessary for strength requirements of all-ceramic restorations. This article describes the three classes of adhesive luting materials, provides a comparison of biological and physical properties, describes the indications and limitations of each class, and makes recommendations for clinical usage.     

Histological changes induced by CO2 laser microprobe specially designed for root canal sterilization: in vivo study

Sixty-six class-II CAD/CAM-manufactured ceramic inlays (Cerec) were placed in 27 patients. Each patient received at least one inlay luted with a dual-cured resin composite and one inlay luted with a chemically cured resin composite. The inlays were examined 5 years after luting using the California Dental Association (CDA) criteria. Eighty-nine percent of the 66 inlays were rated 'satisfactory'. During the follow-up period replacement was required for 3 inlays because of inlay fractures (4.5%) and 1 inlay because of fracture of the tooth substance (1.5%). All those inlays were luted with the dual-cured resin composite luting agent. Of the remaining 62 inlays the CDA rating 'excellent' was given to 84% for color, 97% for surface, and 81% for anatomic form. 'Excellent' margin integrity was seen in 52% of the dual-cured resin composite luted inlays and in 61% of the chemically cured resin composite luted inlays. No statistically significant (P> 0.05) difference was observed between the two luting agents.     

Luting composite thickness of two ceramic inlay systems

The objective of this study was to evaluate the effects of glass-ceramic inserts on reducing the marginal gaps caused by polymerization shrinkage in composite restorations. A light microscope was used to measure the largest gap at margins around restorations made in glass cylinders and tooth cavities with and without adhesion promoters. Where the cylinder was not silanated, the average gap was less in samples containing an insert than in those without. Two preparations were made in the dentin of 20 human molars. In each molar one cavity was restored with a dentin bonding agent and composite and the other with a dentin bonding agent and an insert seated in the composite. The average maximum gap width of restorations containing inserts was statistically less than for those with only composite (paired t-test, P<0.0001). When considering the volume of composite displaced by the insert, these results that the use of a glass-ceramic insert decreased the marginal gaps resulting form polymerization shrinkage.     

In vivo and in vitro evaluation of marginal integrity in ceramic inlays

The marginal integrity is an important factor for the long-term success of ceramic inlays. The long term clinical performance of porcelain inlays depends on a number of factors of which the marginal adaptation is of significant interest. The aim of this study was to determine the margin quality of adhesively luted sintered porcelain inlays both in vivo and in vitro. MOD cavities without bevels were prepared on 10 extracted human mandibular molar teeth. Using the Ducera inlay system, inlays were fired on refractory dies and luted with a dual-curing composite resin. After polishing, each, tooth was sectioned in buccal/lingual and mesial/distal directions and marginal adaptation was assessed microscopically. The mean marginal gap of 78.77 +/- 14.85 microns recorded for occlusal margins was significantly smaller than that of 128.85 +/- 34.34 microns seen at the approximal margins. For in vivo evaluation, 25 fired porcelain inlays, including 7 onlays, were placed in Class II cavities. The assessment of the marginal adaptation of inlays was made according to the scaling system used by Aberg et al. (Acta Odontol Scand 1994; 52:140-149). In 19 of the clinical cases, the restoration was contiguous with the existing anatomic form. Both in vivo and in vitro evaluations showed the margin quality of porcelain inlays to be high.     

Wear resistance of four luting agents as a function of marginal gap distance, cement type, and restorative material

This study investigated the effect of marginal gap width, luting cement, and restorative material on the wear resistance of the luting cement in areas where no occlusal contact is present. Three types of resin luting cement and one resin-modified glass-ionomer cement were used with two inlay systems, a resin composite, and an all-ceramic system. Bovine enamel represented tooth structure. Toothbrush abrasion was the wear modality. Three predetermined gap widths were selected: 240 +/- 30 microns, 150 +/- 30 microns, and 60 +/- 30 microns. All specimens were thermocycled. Regardless of the luting cement or the restorative material, there was a significant difference (P < 0.05) in wear resistance of the cement among the three gap distances at both the enamel and restoration interface. Vertical wear of the luting cement at the enamel interface increased linearly with marginal gap distance when all four cements were considered together (r2 > 0.51), regardless of type of restorative material used. The resin-modified glass-ionomer cement showed the least amount of wear for all variables considered. Significant differences in wear were found between the four luting cements at wide gap distances (240 microns) at the enamel interface, regardless of type of restorative material used. No significant differences were found between the two restorative materials at the enamel interface at the three gap distances.     

The effect of dentin disinfectants on shear bond strength of resin-modified glass-ionomer materials

The purpose of this study was to investigate the effect of dentinal disinfection with a 2% chlorhexidine or a 0.11% I2-KI/CuSO4 solution on the shear bond strength of three resin-modified glass-ionomer cements: Fuji II LC, Photac-Fil, and Vitremer. The occlusal surfaces of extracted human teeth were flattened to dentin. Specimens were randomly assigned to one of nine treatment groups (n = 12). For each glass-ionomer material, there was a control group and two treatment groups in which the dentin was treated with either a 2% chlorhexidine or a 0.11% I2-KI/CuSO4 solution before the dentin was treated with the recommended dentin conditioner prior to glass-ionomer bonding. Specimens were stored for 1 day in water, thermocycled, and tested in shear until failure. The chlorhexidine solution did not significantly affect the shear bond strengths of any of the cements, but the I2-KI/CuSO4 solution significantly lowered the bond strengths of Vitremer and Fuji II LC compared to the controls.     

Bond strengths and SEM evaluation of Clearfil Liner Bond 2

PURPOSE: To evaluate a dental adhesive system that uses a single conditioning/primer agent. MATERIALS AND METHODS: Twenty-five flat enamel and dentin bonding sites were prepared to 600 grit on human molar teeth. The Clearfil Liner Bond 2 adhesive system was used to bond Clearfil AP-X composite to both enamel and dentin. After 24 hours of water storage, shear bond strengths were determined using an Instron testing machine. Fifty V-shaped cavity preparations were prepared in human molar teeth with an enamel and cementum margin. Composite restorations were placed using the new adhesive system. The teeth were stored for 24 hours, thermocycled, stained with AgNO3 , sectioned and examined for microleakage. SEM examinations were also completed to evaluate the effects of the treatment steps on enamel and dentin surfaces. RESULTS: Mean shear bond strengths for the experimental adhesive to enamel and dentin were 28.2 +/- 4.9 and 19.4 +/- 3.1 MPa. A t-test revealed that the enamel bond strength was significantly greater (P<0.05) than the dentin strength. No marginal leakage was observed from the enamel margins of the restorations. Three restorations showed minimal leakage from the cementum margins. SEM examinations showed resin penetration into both the conditioned enamel and dentin surfaces. The adhesive system produced high bond strengths to both enamel and dentin, exhibited very minimal microleakage and was easy to use.     

Microleakage of dentin bonding systems used with spherical and admixed amalgams

PURPOSE: To evaluate the effectiveness of the dentin bonding systems (DBS) Tenure, Syntac, Amalgambond and All-Bond 2 using a resin-lined amalgam technique in preventing short-term microleakage in Class V cavity preparations restored with a spherical and an admixed alloy. MATERIALS AND METHODS: Class V cavity preparations were made on the mesial and distal surfaces of non-carious human mandibular molars with the occlusal margins in enamel and gingival margins in cementum. Prepared teeth were randomly assigned to 12 treatment groups (n = 10) consisting of each DBS, no liner and Copalite for both amalgam alloys. Samples were thermocycled, stained and sectioned to evaluate microleakage. RESULTS: The DBS-lined restorations had significantly less microleakage at both occlusal and gingival margins than the Copalite and unlined restorations. Among DBS, Syntac had significantly more microleakage with both alloys than either All-Bond 2 or Amalgambond. These results do not totally correlate to a previous study which used the same experimental design but included viscous liners in addition to the same DBS, indicating a potential difference between resin-lined versus resin-bonded amalgam techniques in preventing microleakage.     

A procedure for preparing undecalcified and unembedded bone sections for light microscopy

Recently, new restoratives, such as resin-modified glass ionomer cements (RMGIC) and polyacid-modified resin composites (PMC) were introduced for class III and class V cavities. Both materials use simplified cavity conditioning methods. The well-established treatment of enamel with phosphoric acid has been replaced with treatment using weaker acids. The purpose of this study was to investigate in vivo the quality and durability of the marginal bond to enamel of these restorative system and compare it with a resin composite restorative, Seventeen patients received class III restorations of each of the three restoratives. At baseline and after 1 year replica impressions were made for investigation of the vestibular margins with the scanning electron microscope. Semi-quantitative analysis of the enamel-restorative interfaces was performed at x200 and x1000 magnifications. The three restorative systems showed good marginal adaptation and high percentages of the length of the margins investigated at baseline were gap-free (82%-92%). The resin composite showed significantly better adaptation than the other materials. The marginal quality decreased significantly after 1 year for the resin composite and the polyacid-modified resin composite. The RMGIC showed improved sealing after 1 year in vivo, probably due to continuing water uptake. The percentages of gap-free margins of the total marginal length observed at 1 year were 73%, 90%, and 84%, respectively, for the PMC, the RMGIC and the resin composite. The difference between the PMC and the RMGIC was significant. In conclusion, a good marginal quality was seen for all three restorative systems in class III cavities after a period of 1 year.     

Vertical mammaplasty as secondary surgery after other techniques

The effect of ultrasonic insertion on the filler content and the gap width for two brands of composite resin luting agents, intended for luting with the ultrasonic insertion technique, were studied after MOD ceramic inlays (Cerec) had been placed. In addition, the internal and marginal gap widths were determined after MOD ceramic inlays (Celay) bad been luted on extracted premolars with this technique. No statistically significant differences (P > 0.05) were observed for either brand between the filler content obtained from the internal surfaces, from the excess luting agent, or from the luting agent as delivered. There were no statistically significant differences (P > 0.05) between the final internal and marginal gap widths when the two brands of luting agent were compared with each other. Except for the final occlusal and internal gap widths obtained for the inlays luted with the Sono-Cem luting agent, no statistically significant differences (P > 0.05) were observed between the gap widths at the different locations determined. Thus, the ultrasonic insertion technique used did not significantly influence the filler ratio of the hybrid luting agents studied. Judged by the findings in this study, the properties of luting agents seem to greatly influence the final marginal and internal gap widths.     

Initial tensile bond strength of resin-modified glass ionomers and polyacid-modified resins on perfused primary dentin

The objective of this study was to evaluate the initial tensile bond strength of a resin-modified glass ionomer (Photac-Fil) and two polyacid-modified composite resins (Compoglass, Dyract) to primary dentin. A hybrid composite resin (Tetric) and two chemical cured glass ionomers (BaseLine, Hi-Dense) served as controls. Ninety caries-free dentinal discs were ground flat and perfused with Ringer's solution. Dentinal surfaces were conditioned (except for Base Line). From each material, fifteen standardized specimens were attached to the dentin. Light-curing of the respective materials followed (1 min), and adhesion was tested with a universal testing machine 15 min after application. The highest initial bond strength was observed with Tetric (5.17 MPa). Closed test procedure (Kruskal-Wallis) showed significant differences between all materials (P < 0.05), except for Compoglass (1.82 MPa) vs. Dyract (2.35 MPa), and BaseLine (0.37 MPa) vs. Photac-Fil (0.42 MPa). The condensable glass ionomer Hi-Dense revealed a mean tensile bond strength of 0.79 MPa. Adhesion of (polyacid-modified) composite resins is superior to the other tested glass ionomer materials, when applied to perfused primary dentin.     

An in-vitro investigation of microleakage and gap size of glass ionomer/composite resin "sandwich" restorations in primary teeth

Eighty extracted primary molars were divided into four groups of twenty teeth. Class II cavities were prepared in all teeth with equal numbers of proximal boxes having cavosurface margins either in enamel, or dentin/cementum. Each group was allocated to an open or closed sandwich technique using glass ionomer as a lining. Following the placement of the composite resin restorations, the gap size measured at the proximal box was greatest for the closed sandwich group with the cavosurface margin on enamel (0.203 microns) or dentin/cementum (0.174 microns). Microleakage scores were measured at the proximal box and were greatest for the closed sandwich group with the cavosurface margin on dentin/cementum. The best result was obtained for the open sandwich group with the cavosurface margin on enamel.     

Amalgam alternatives--micro-leakage evaluation of clinical procedures. Part I: direct composite/composite inlay/ceramic inlay

This study investigated the degree of dye penetration with three different types of tooth-coloured restorations. Twenty-four intact extracted molars were collected. The teeth were immediately stored in water at room temperature. Class II cavity preparations were prepared and restored with three different types of tooth-coloured restorations: A, composite resin in the incremental technique; B, composite inlay technique; and C, ceramic inlay. Specimens were subjected to 700 cycles of thermal stress. They were than immersed in 2% basic fuchsin dye. The teeth were sectioned in three planes before being ranked as to the amount of dye penetration. The highest score obtained on three plano-parallel sections was adopted as the representative value. The three groups were compared using the Kruskal Wallis non-parametric test. Dye penetration was significantly lower at the enamel margins when using the composite inlay system and the incremental technique compared to the ceramic inlay technique. The restorations placed using the composite inlay technique showed less dye penetration than the incremental technique at the dentine margins (P < 0.017).