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ORIGINAL RESEARCH Table of Contents   
Year : 2009  |  Volume : 20  |  Issue : 2  |  Page : 159-163
Influence of flowable materials on microleakage of nanofilled and hybrid Class II composite restorations with LED and QTH LCUs


Department of Restorative Dentistry, Dental School, Rafsanjan University, Rafsanjan, Iran

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Date of Submission09-Dec-2007
Date of Decision15-Mar-2008
Date of Acceptance03-May-2008
Date of Web Publication23-Jun-2009
 

   Abstract 

Background: Class II composite restorations are more frequently being placed with margins apical to the cementoenamel junction (CEJ) and margins within the dentin are prone to microleakage. Aims: This in vitro study was used to evaluate the influence of flowable composite and flowable compomer as gingival liner on microleakage in Class II composite restorations and compare a light-emitting diode (LED) unit with a quartz tungsten halogen (QTH) unit for light-activating composite resins.
Materials and Methods: Mesioocclusal and distoocclusal Class II cavity preparations were made in 72 sound extracted premolars. The buccolingual width was 2.5 mm and the gingival margins of all the cavities were placed 1.0 mm apical to the CEJ. The boxes were prepared 1.5 mm deep axially, making 144 slot cavities. Teeth were randomly divided into the following two groups (n = 72): (I) Universal Filtek Supreme XT; Universal Filtek Supreme XT + Flwable Filtek XT and Universal Filtek Supreme XT + Dyract Flow and (II) Filtek Z250; Filtek Z250 + Flwable Filtek XT and Filtek Z250 + Dyract Flow. Flowable materials were injected into the gingival floor of the cavity to a thickness of 1.0 mm. Each increment was cured for 20 s. One-half of the subgroups in each group were cured with QTH and the other half with LED light curing units (LCUs). After 1 week of incubation at 37°C, the specimens were thermocycled (5-55°C, x1500), immersed in 0.5% basic fuchsine dye for 24 h and sectioned and microleakage was evaluated at the gingival margin by two examiners using a 0-3 score scale. The data were analyzed using the Kruskal-Wallis and Mann-Whitney U tests.
Results: The groups utilizing flowable liners had significantly less microleakage (P < 0.05). No significant difference was identified between Universal Filtek Supreme XT and Filtek Z250 composites with and without flowable materials. There was no significant between utilizing flowable composite or flowable compomer and between each similar subgroup when polymerized with either the LED or the QTH LCUs.
Conclusions: A layer of flowable materials at the gingival floor of Class II composite restorations may be recommended to improve the marginal seal of a restoration.

Keywords: Flowable compomer, flowable composite, hybrid composite, light-emitting diode, microleakage, nanofilled composite, posterior composite restoration, quartz tungsten halogen

How to cite this article:
Sadeghi M. Influence of flowable materials on microleakage of nanofilled and hybrid Class II composite restorations with LED and QTH LCUs. Indian J Dent Res 2009;20:159-63

How to cite this URL:
Sadeghi M. Influence of flowable materials on microleakage of nanofilled and hybrid Class II composite restorations with LED and QTH LCUs. Indian J Dent Res [serial online] 2009 [cited 2019 Sep 18];20:159-63. Available from: http://www.ijdr.in/text.asp?2009/20/2/159/52891
The use of posterior composite restorations is increasing because of esthetic demands by the general public, [1] despite their higher costs and shorter longevity in comparison with amalgam and gold. [2] One of the major disadvantages of restoring posterior teeth with composite resins is the lack of adaptation of the material to tooth structure, particularly at the gingival margin. [3] Class II composite restorations can be performed to an acceptable standard if the gingival margin is in sound enamel, but the quality of the margin of an adhesive restoration located below the cementoenamel junction (CEJ) is questionable. [2] Especially when the bond with dentin is weaker, the polymerization shrinkage can result in gap formation between the cavity walls and the composite resin. Gap formation contributes to microleakage, permitting the passage of bacteria and oral fluids from the oral cavity. Post-operative sensitivity, pulpal inflammation and secondary caries may occur because of microleakage. [4]

Recently, a new category of resin composite was developed and named as nanofilled composites. Restorative composite systems made by the use of nanotechnology can offer high translucency, high polish and superior polish retention. [5],[6] Clinically, the nanofilled resin has a proper resistance in high stress-bearing areas, which is typical in the posterior area. [5],[7] The microfilled composites present nearly 37-40% volume filler loading while the nanofilled resins have approximately 60% volume filler loading, making the nanofilled resins as strong as the hybrid and microhybrid resins. [8]

Flowable composites have been recommended as liners beneath composite resins due to their low viscosity, increased elasticity and wettability. These handling characteristics and a syringe delivery system make flowable resins an ideal choice for use in a sandwich technique where they are placed at the cementum margins of the proximal box of Class II resin composite restorations as a liner, thereby improving the final marginal integrity, [3],[9] resulting in less leakage and post-operative sensitivity. [10] Restorative composites have a relatively high modulus of elasticity and it has been suggested that this high stiffness contributes to their inability to compensate for contraction stress during polymerization. This can lead to either bond failure or fracture of the tooth structure, resulting in microleakage and post-operative sensitivity. Employing an intermediate layer of low-modulus composites can relieve some of the contraction stress during polymerization. Some in vitro studies have shown that use of flowable composites reduces restoration microleakage and the occurrence of voids. [11],[12]

Flowable compomers are polyacid-modified resin composites that possess the characteristics of both flowable composites and glass ionomers. Flowable compomers claim to improve the adhesive and fluoride-releasing properties of conventional glass ionomer cements. These materials are also advocated for use as stress-relieving gingival increments in Class II restorations like flowable composites. [12],[13]

For nearly two decades, conventional quartz tungsten halogen (QTH) light curing units (LCUs) have been the standard equipment used for polymerizing composite resins. [14] The advantage of QTH LCUs is that they are derived from relatively low-cost technology. [15] However, these lights have a number of inherent limitations such as degradation of the bulb, filter, reflector and a limited effective lifetime. Moreover, composite resin is not likely to be completely polymerized with an aged LCU. The reduction of light intensity due to long usage of the LCU is well known. More recently, the use of light-emitting diode (LED) LCUs that produce blue light have been mentioned in conjunction with curing dental materials. LED LCUs are lightweight and portable, with ergonomic handling capabilities, and are highly efficient and have long life spans. Because a narrow band of light is emitted, there is no need for filter systems. Because there is no infrared emission, the LCUs have low amounts of wasted energy, leading to minimum heat generation, which obviates the need for cooling fans. The LED LCUs' power consumption is low and hence batteries can be used to power it. The light output is consistent, there is no bulb to change and the service life is long. [14],[15],[16],[17]

The aim of this in vitro study was to evaluate the influence of a thin layer of flowable composite or compomer on microleakage in Class II nanofilled and hybrid composite resin restorations and compare an LED unit with a QTH unit for light-activating composite resins.


   Materials and Methods Top


Seventy-two sound maxillary first premolar teeth recently extracted for orthodontic reasons were selected. After cleaning with pumice slurry water, the teeth were stored in saline at room temperature for less than 3 months. The teeth were stored in an aqueous buffered solution of formal for 2 h for infection control. Mesioocclusal and distoocclusal Class II cavity preparations were made in each tooth using a #836R cylinder diamond bur (Diatech Dental AG, Heerbrugg, Switzerland) with a head diameter of 1.0 mm and a head length of 6 mm in a high-speed handpiece with water cooling. A new bur was used for every five preparations.

The slot cavity preparations were separated with sound tooth structure. The buccolingual width was 2.5 mm and the gingival margins of all cavities were placed 1.0 mm apical to the CEJ. The buccal and lingual wall of the preparations were approximately parallel and connected to the gingival floor with rounded line angles. The boxes were prepared 1.5 mm deep axially and the margins were not beveled (90° cavosurface angle) but smoothed with a #23 hatchet (Duflex; SS White, Rio de Janerio, RJ, Brazil).

In order to simulate clinical posterior teeth alignment, the teeth were mounted in stone jigs with one canine on the mesial and one second premolar on the distal sides. A matrix retainer (Tofflemire; KerrHawe SA, Bioggio, Switzerland) and a metal band (Tofflemire; KerrHawe SA) were placed on the tooth and tightly held by two wooden wedges (Hawe-Neos Dental, Biogglio, Switzerland). A sharp explorer was used to confirm the fitness between the metal matrix and the cervical margin. The cavity preparations were placed by a single operator and restored according to the manufacturer's instructions.

All preparations in each group were rinsed with water, etched with 37% phosphoric acid etching gel (3M ESPE, St Paul, MN, USA) for 15 s, rinsed with a water jet for 20 s and gently air dried to leave the surfaces wet. The bonding agent was Single Bond (3M ESPE), which was applied according to manufacturer's instruction. The prepared teeth were randomly divided into two groups according to the composite resin used to restore the teeth. Each group was subdivided into six subgroups for two flowable materials and two LCUs (n = 12) [Table 1]. The LCUs selected for this study included a QTH (Coltolux 75; Coltene/Whaledent Inc, NJ, USA) and LED (Coltolux LED; Coltene/Whaledent Inc., OH, USA) LCUs. Exposure times for the bonding agent (Single Bond; 3M ESPE) and each increment of the composite resins were 20 s for two LCUs.

In group I, the cavities were restored with the following composite resins: Universal Filtek Supreme XT (3M ESPE), Universal Filtek Supreme XT + Flwable Filtek Supreme XT (3M ESPE) and Universal Filtek Supreme XT + Dyract Flow (Dentsply; DeTrey, GmbH, Konstanz, Germany) and in group II, the cavities were restored with Filtek Z250 (3M ESPE), Filtek Z250 + Flwable Filtek Supreme XT (3M ESPE) and Filtek Z250 + Dyract Flow (Dentsply; DeTrey). One-half of subgroups in each group were cured with QTH (Coltolux 75) and the other half were cured with LED (Coltolux LED) LCUs.

Flowable composite (Flwable Filtek Supreme XT; 3M ESPE) and flowable compomer (Dyract Flow, Dentsply; DeTrey) were injected into the gingival floor of the cavity to a thickness of 1.0 mm, this depth being judged by a periodontal probe (Hu-Friedy Mfg. Co. Inc., Chicago, IL, USA). A horizontal incremental technique with three increments from the cervical to the occlusal surfaces was used for restoring the cavities. A 20 s curing time was used for two LCUs from the occlusal aspect in each layer according to the composites manufacturers' recommendations. Following the restoration procedure, the metallic matrix was removed, light cured for 20 s from the buccal and lingual surfaces and the occlusal surface was finished and polished. The specimens were removed from the stone mounting jigs, washed under running tap water for 2 min, stored in distilled water at 37°C for 2 weeks and then thermocycled for 1500 cycles between 5 and 55°C and a dwell time of 30 s. Before the microleakage test, the apices of the samples were sealed with utility wax. The tooth was painted with two coats of fingernail varnish, except for restoration and 1.0 mm beyond the margins, and allowed to air dry and then immersed in 0.5% basic fuchsine dye for 24 h.

After removal from the dye, the samples were cleaned under running tap water for 2 min and then sectioned mesiodistally through the center of the restorations with a water-cooled diamond disk (Diamant; Horico, Berlin, Germany) to obtain two sections from each tooth. The sections were randomly arranged and assigned code numbers to permit blind evaluation. Dye penetration was examined (both surfaces) at the gingival margins using a stereomicroscope (Olympus Optical Co., Tokyo, Japan) under ×10 magnifications by two independent pre-calibrated examiners and consensus was forced when disagreements occurred. The examiners were blind to the materials and techniques. The following scoring criteria were used to evaluate the microleakage: Score 0 = no dye penetration, 1 = dye penetration less than 1/3 of the gingival wall, 2 = dye penetration beyond 1/3 of the gingival wall, up to the axial wall and 3 = dye penetration along the axial wall. [19] The data were statistically analyzed by the Kruskal-Wallis and Mann-Whitney U tests at a significant level of 0.05.


   Results Top


None of the groups showed complete prevention of dye penetration. [Table 2] shows the number of teeth in each microleakage-rating category. No significant difference was identified between the Universal Filtek Supreme XT and the Filtek Z250 composites with and without flowable materials. When comparing each group individually, the Universal Filtek Supreme XT and the Filtek Z250 composites had significant difference in microleakage with flowable materials than without (P < 0.05). There was no significant between the groups utilizing Flwable Filtek Supreme XT or Dyract Flow as gingival liners. Although there was no significant difference between the flowable composite and the flowable compomer as a gingival liner, the flowable composite showed better results than the flowable compomer. There was no significant difference in microleakage scores between each similar subgroup when polymerized with either the LED (Coltolux LED) or with QTH (Coltolux 75) LCUs, individually.


   Discussion Top


This in vitro study examined microleakage of nanofilled (Universal Filtek Supreme XT; 3M ESPE) and hybrid (Filtek Z250; 3M ESPE) composites with and without the use of flowable material liners. Irradiation was performed using a QTH (Coltolux 75) and LED (Coltolux LED) LCUs.

In this study, both flowable liners (Flwable Filtek Supreme XT; 3M ESPE and Dyract Flow, Dentsply; DeTrey) helped reduce microleakage in all composite restorations on the gingival floors. The microleakage rates of Universal Filtek Supreme XT (3M ESPS) and Filtek Z250 (3M ESPE) composites with flowable liners were significantly higher than those without flowable liners. While flowable composite or compomer liners may provide a better adaptation layer, they may also act as a flexible intermediate layer, which helps relieve stresses during polymerization shrinkage of the composite restorations. [1],[9] This layer would then provide enough flexibility to compensate the tension generated by the polymerization shrinkage. [18] But, the benefit of the gingival liner for reducing polymerization contraction stress is somewhat controversial. [1],[10] The use of flowable materials as a liner underneath the composite resins may have lowered the C-factor. The lower the C-factor, the lower the internal stress. [5],[13]

Nanotechnology is the production of functional materials and structures in the range of 0.1-100 nanometers by various physical and chemical methods. [19] The use of nanofilled composites allows the achievement of esthetic restorations with suitable strength for direct application in posterior teeth. [8] In a clinical study, Filtek Supreme showed good performances in the posterior teeth. [5] Although no statistical difference in microleakage was observed between Universal Filtek Supreme XT and Filtek Z250 with and without flowable liners on the gingival floors, Universal Filtek Supreme XT showed better results than Filtek Z250 in each similar subgroup.

In vitro studies have reported significant effects of using flowable materials as gingival increments in reducing the microleakage of Class II nanofilled and hybrid composite restorations. [4],[20] In contrast, some studies indicated that the use of flowable materials as intermediate material does not reduce microleakage in Class II composite restorations. [9],[21] The author in a study concluded that the flowable composite significantly decreased the microleakage at gingival margins of Class II microhybrid (Tetric Ceram) composite restorations. [3]

In the present study, a QTH (Coltolux 75) and LED (Coltolux LED) LCUs were used to cure composite resins and no significant differences in microleakage scores were identified between the restored teeth that were polymerized with the LED compared with the QTH LCUs. Commercially available LED LCUs were introduced in the past year. However, they may not adequately polymerize resin-based composites, which can lead to restoration failures and adverse pulpal responses to unpolymerized monomers. [17] Fleming et al. reported that no significant difference in microleakage was identified between Z100 (3M ESPE) and Filtek Z250 (3M ESPE) when polymerized with either the LED or QTH LCU. [16] In another study, second-generation LED LCUs were either as effective as or more effective than a QTH LCU for polymerization of the composite used (Filtek Z250). [22] However, some studies reported that significantly less microleakage occurred at the dentin/cementum interface when restorations were cured with an LED unit compared with curing with the standard QTH unit [23] and some others reported that there were no significant differences in microleakage between LED and QTH LCUs, both in enamel and dentin. [4] Hasler et al. concluded that the degree of polymerization achieved by the LED LCU was not significantly different from that achieved by the QTH LCU. [24] Significant gingival microleakage differences were identified between the QTH in conventional and soft- start modes and the LED LCU-polymerized teeth for the microleakage of Mesio-Occlusal-Distal composite restorations. [16]

Within the limitations of this in vitro study, it can be concluded that the use of flowable composite (Flowable Filtek Supreme XT; 3M ESPE) or compomer (Dyract Flow, Dentsply; DeTrey) as a gingival liner of Class II nanofilled (Universal Filtek Supreme XT; 3M ESPE) and hybrid (Filtek Z250; 3M ESPE) composite restorations with QTH (Coltolux 75) or LED (Coltolux LED) LCUs decreases gingival microleakage. The restored teeth polymerized with LED LCU showed similar microleakage scores compared with QTH LCU. However, further in vitro and in vivo researches are needed to support these techniques.


   Acknowledgment Top


The author is grateful to Dr. Y Amirian and Dr. MH Torkamanzadeh for their assistance during the laboratory procedures. This study was supported by a grant of the Vice Chancellor of Research of Rafsanjan University of Medical Sciences.

 
   References Top

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Correspondence Address:
Mostafa Sadeghi
Department of Restorative Dentistry, Dental School, Rafsanjan University, Rafsanjan
Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9290.52891

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    Tables

  [Table 1], [Table 2]

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