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Table of Contents   
ORIGINAL RESEARCH  
Year : 2012  |  Volume : 23  |  Issue : 6  |  Page : 806-810
An in vitro comparison of microleakage of two self-etched adhesive and the one-bottle adhesive used in pit and fissure sealant with or without saliva contamination


1 Department of Pediatric Dentistry, School of Dentistry, Ahvaz University of Medical Sciences, Ahvaz, Iran
2 Department of Orthodontic, School of Dentistry, Ahvaz University of Medical Sciences, Ahvaz, Iran
3 Department of Operative Dentistry, School of Dentistry, Ahvaz University of Medical Sciences, Ahvaz, Iran

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Date of Submission01-Mar-2010
Date of Decision27-Jun-2012
Date of Acceptance10-Sep-2012
Date of Web Publication3-May-2013
 

   Abstract 

Aims and Objectives: To minimize the deleterious effects of contaminated enamel on bonding, some authors have advocated the use of adhesive systems under the sealant. The aim of this study was to compare the microleakage of two self-etch and the one-bottle adhesive used in pit and fissure sealant with or without saliva contamination.
Materials and Methods: Sixty extracted premolar teeth were assigned to the six groups. Group 1: Acid +saliva +single bond +sealant, Group 2: Acid +single bond +sealant, Group 3: Saliva +S 3 bond +sealant, Group 4: S 3 bond +sealant, Group 5: Saliva +protect bond +sealant, Group 6: Protect bond +sealant. The teeth were thermocycled and immersed in 2% basic fuchsine dye for 24 h, then sectioned and examined with a stereomicroscope under ×40 magnification. The results were evaluated with Kruskal-Wallis and Dunn tests.
Results: Group 2 has the lower microleakage scores than Groups 4 and 6. Also, Group 6 has the lower microleakage scores than Group 4, and generally an increase in microleakage was observed in each group related to contamination.
Conclusion: The best technique of sealant therapy in saliva contaminated and non- contaminated condition is the use of acid-etching and bonding agent.

Keywords:  Bonding, fissure sealant, self-etch adhesive

How to cite this article:
Bassir L, Khanehmasjedi M, Nasr E, Kaviani A. An in vitro comparison of microleakage of two self-etched adhesive and the one-bottle adhesive used in pit and fissure sealant with or without saliva contamination. Indian J Dent Res 2012;23:806-10

How to cite this URL:
Bassir L, Khanehmasjedi M, Nasr E, Kaviani A. An in vitro comparison of microleakage of two self-etched adhesive and the one-bottle adhesive used in pit and fissure sealant with or without saliva contamination. Indian J Dent Res [serial online] 2012 [cited 2020 Apr 5];23:806-10. Available from: http://www.ijdr.in/text.asp?2012/23/6/806/111267
The susceptibility of pits and fissures has drawn the attention since the 19 th century. In 1967, Bounocore introduced the fissure sealant technique in which resin materials were used. [1]

Children with caries in pits and fissures in the primary dentition present an elevated risk for dental caries in the mixed dentition. [2] The sealing material interrupts dental caries by sealing the pits and fissures. [3] One of the principal problems in dentistry is the lack of a perfect adhesion between the restorative material and the tooth tissues. The saliva and bacteria can penetrate the formed gap and cause secondary caries and pulp damage. The microleakage has been reduced by using various adhesive systems but is not totally eliminated. [4] It is impossible to eliminate the saliva while practicing in pre-school or handicapped children. [5] In addition, the use of rubber dam for children is not as simple as adults and isolation with cotton roles needs a lot of practice and use of four-handed dentistry. Even with the use of cotton rolls, contamination with saliva may still happen while swallowing and tongue movements.

The flowable sealant materials cannot tolerate even low amounts of salivary contamination. [2] In order for reducing deleterious effects of contamination with saliva, the use of an adhesive system under the sealant has been recommended. [6] In the 5 th generation adhesives (total etch), the primer and resin are used in one-bottle form after etching. The recent enhancements have led to the production of self-etch bondings (6 th generation) with the aim of simplifying the practical stages. These bondings contain acidic hydrophilic monomers, which perform etching and monomer penetration simultaneously; therefore separated etching, rinsing and drying phases do not exist when using these materials. Reduced number of working phases has diminished the technical sensitivity and the possibility of errors while using.

The 6 th generation bondings are divided into two groups:

  • Two-step: Conditioner and primer are used in one step and the adhesive in the next step. Example: Clearfil Protect Bond, Clearfil SE Bond.
  • One-step: Conditioner, primer and resin are used in a one single step, but need mixing before application. Example: Prompt L-pop.
In 7 th generation bonding systems, conditioner, primer and resin are included in one bottle. These materials are called all-in-one materials. The all-in-one bonding systems are real single-step materials. Example: Clearfil S 3 Bond, I Bond. [7]

Little researches has been performed on the clinical durability of self-etch systems, and their ability to bond to the enamel still needs more research. [8] The aim of this study was to compare the microleakage between the teeth sealed with two-step (6 th generation), one-step (7 th generation) and 5 th generation adhesive systems with or without contamination with saliva.


   Materials and Methods Top


This study has been performed on 60 intact maxillary premolars extracted for orthodontic purposes. The teeth were immersed in distilled water at room temperature between the working periods. The samples were cleaned using a brush and water. The teeth were randomly divided into six groups; each included 10 teeth. The occlusal surfaces of the teeth were dried using an air syringe at first. In Group 1, the occlusal surfaces were etched using phosphoric acid gel 35% (Ultradent, USA) for 30 s and then were washed with water for 20 s and dried for 20 s. The occlusal surfaces were then contaminated with fresh human saliva using a brush, and air blow was applied on the teeth to push away the excess saliva before making the surface dry. Two layers of bonding agent (Single Bond-3M-USA) were applied on the teeth surfaces and then were light-cured for 10 s using a light cure system (Coltolux - Coltene, Switzerland). After light curing, the bonding agent fissure sealant (Clinpro 3M ESPE-USA) was placed on occlusal surfaces in an order in which at least one-third of cusps were covered with the sealant material. The fissure sealant was light-cured for 20 s. In Group 2 all stages were similar to Group 1 except the saliva contamination. In Group 3, after saliva contamination, Clearfil S 3 Bond (Kuraray- Japan) was applied on tooth surface for 20 s and then dried with air syringe intense air blow for 10 s and then cured for 10 s. The fissure sealant material were then applied and cured for 20 s. In Group 4, all stages were similar to Group 3 except the saliva contamination. In Group 5, a self-etching primer (Clearfil Protect Bond, Kuraray, Japan) were used for 20 s after saliva contamination stage. Then the bonding agent was applied and cured for 10 s and finally the fissure sealant material was placed and cured for 20 s. In Group 6 all stages were similar to Group 5 except the saliva contamination.

In order for making the conditions more similar to clinical environments, the teeth were thermocycled for 1000 cycles between 5 (±2) and 55 (±2) centigrade degrees with interval times of 15 s. In preparation for dye penetration test, the apices of the teeth were sealed using wax and all teeth surfaces were covered with two layers of nail varnish until 1 mm distance of the fissure sealant margins. The samples were immersed in 2% fuchsine solution for 24 h in room temperature. Thereafter the nail varnish and wax were removed with a sharp instrument and the teeth were rinsed, dried and embedded in chemically activated acrylic resin. After polymerization, the teeth/resin blocks were washed using water and sectioned in buccolingual direction using a water-cooled diamond disk. The sections were examined under Stereomicroscope (MGC-Russian) with ×40 magnification, and dye penetration degrees were assessed and scored using the following scoring system:

Score 0: No dye penetration
Score 1: Dye penetration limited to the outer half of the sealant thickness
Score 2: Dye penetration extending to the inner half of the sealant thickness
Score 3: Dye penetration extending to the underlying fissures

The scores were compared using Kruskal-Wallis and Dunn tests with P < 0.05.


   Results Top


Amounts of microleakage of test groups are presented in [Table 1].
Table 1: Microleakage in study groups based on scores

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In initial comparison of six groups, the results of this test showed that there were significant statistical differences between some groups (P < 0.001) [Table 2]. Dunn test was used to compare each pair of groups [Table 3].
Table 2: Mean of microleakage in groups


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Table 3: Comparison of difference of mean scores between groups

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The results showed that there was significant difference between Groups 1 and 3, 1 and 4, 1 and 5, 2 and 3, 2 and 4, 2 and 5, 3 and 6, 4 and 6, 5 and 6 (P < 0.05).

Dunn test results showed that microleakage scores in Group 2 were significantly lower than Groups 4 and 6, and microleakage scores in Group 6 were significantly lower than in Group 4.

This clarifies that Group 2, where acid-etching and single-bond were used, presents lower microleakage than Groups 4 and 6 in which self-etching system were used. Furthermore, Group 6 in which self-etching, primer and protect bond were used showed lower microleakage scores compared with Group 4 in which one-step self-etching bonding (S 3 bond) were used.

Kruskal-Wallis test results showed that microleakage in Group 1 was significantly higher than Group 2 (P = 0.040) and in Group 5 was higher than in Group 6 ( P = 0.031); also microleakage score in Group 3 was higher than in Group 4. The difference between these two groups was not significant, but was close to the significance level ( P = 0.056).

According to these results, microleakage has grown in all three bonding systems following saliva contamination [Figure 1].
Figure 1: Microleakage mean in groups based on Kruskal-Wallis test

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   Discussion Top


Modifying the surface of enamel using the chemical effect of acids is an effective means for improving the adhesion between resins and the enamel. This concept was first proposed by Bounocore [9] in 1955. Applying acid phosphoric and then primer and resin separately or simultaneously provides an acceptable bond with enamel and dentin.

Watanabe [10] invented a self-etching adhesive system and suggested to limit a separated etching and rinsing step.

The widespread use of acidic primers on dentin has proposed their use on enamel as a substitute for the conventional etching with phosphoric acid. Bearing in mind that an effective bond of resin to etched enamel has been proved clinically, providing an acceptable bond on enamel using acidic primers is still under question.

There is always a great risk for saliva contamination in the process of fissure sealant therapy. [1] The contamination of the enamel surface with saliva before applying a bonding agent will prevent an acceptable bonding. [9] In this study, we compared the microleakage of fissure sealants where different bonding systems were applied. Fissure sealants were placed using different bonding systems: Two-step self-etching system (6 th generation), one-step self-etching system (7 th generation) and one-bottle bonding system (5 th generation). The least microleakage between the first three groups (not contaminated with saliva) was seen in group where acid-etching and bonding has (single bond) were used (Group 2). The highest microleakage scores between these three groups was seen in groups where self-etching primer and bonding were used (Groups 4 and 6).

According to Hanning et al.[11] applying phosphoric acid alone will provide less microleakage compared with two self-etching bondings: Resulcin Aqua Prime and Clearfil Linear Bond 2.

Miranda et al.[12] reported that total etch single bond system would provide better bond strength compared with SE Bond and Adper Prompt L-Pop self-etching systems.

Perry et al.[13] investigated the effect of acidic primer or conventional acid etching on the microleakage of a light-cured sealant. Their result showed that applying an acidic primer would result in higher microleakage scores and could not be an acceptable substitute for conventional etching procedure.

Studies show that self-etching primers would result in different etching compared with conventional acid etching. The penetration of acidic monomers in the enamel makes resin tags, but simultaneous etching and priming cause imperfect penetration of acidic monomers and the resulting resin tags will not tolerate thermal stresses. On the other hand, due to the limitation of the rinsing step, there is a possibility of calcium deposits on the enamel surface and interfering with resin tags. If resin tags do not penetrate the etched enamel completely, some areas of enamel rods will be left unsupported. These areas may get hydrolyzed with time. Also fine cracks and porosities between the enamel and the adhesive material may result. Therefore, resin tags do not have enough tolerance to the thermal changes and after a while their mechanical properties will weaken. Accordingly, the advantage of using these adhesive systems that is simplifying the clinical procedure will be opposed by the mentioned disadvantage. [14]

The comparison between Groups 4 and 6 showed that microleakage in Group 4 in which one-step self-etching bonding S 3 bond was used was more than Group 6 where two-step self-etching bonding Protec bond was used. This shows that using a two-step self-etching primer in which a conditioner and primer is used as the first step and a resin is used as a separate step will result in less microleakage compared with a one-step self-etching where conditioner, primer and resin are mixed.

Kaaden [15] performed a study on bond strength of two self-etching bonding systems CSEB (two-step) and PLP (one-step). His results proposed that CSEB would show better outcomes than PLP does.

According to Tolenado, [16] accompanying hydrophilic and hydrophobic monomers and the solvent in the same composition would disturb their function. Therefore this companionship can make an influence on increasing the sealant microleakage.

In one-step adhesives, materials with different characteristics and functions are mixed. This will result in simplifying the clinical procedures and decreasing their technical sensitivity. At the same time, all these materials have low pH so that they can be mixed and this low pH may result in imperfect polymerization, weak bond and water absorption in the resin-dentin interface. [17] Additionally, based on this study findings, the microleakage has been grown in all three bonding systems following salivary contamination. The difference between Groups 3 and 4 has not been significant; however, it has been close to the significance level ( P = 0.56).

In a study performed by Wetzel, [18] on the microleakage of Opti Bond, All-Bond 2 and Scotch Bond MP with and without salivary contamination microleakage was significantly higher in groups with salivary contamination.

According to Borsatto et al., [19] salivary contaminations can significantly increase microleakage scores.

Salivary contamination of the etched enamel surface prior to the placement of sealant is a usual cause for fissure sealant failure. Due to the extreme sensitivity of etched enamel, even a slight contact of saliva as long as 1 s with the surface may construct a pellicle layer that seals a great number of microporosities. This event makes structural and morphological changes in the etched enamel and may disrupt the formation of resin tags and prevent an acceptable mechanical adhesion. Therefore, as long as the formation of resin tags is disrupted by the salivary contamination, an imperfect and weak adhesion and an increase in microleakage and failure would be expected. [20]

The Kruskal-Wallis test in groups with salivary contamination shows that microleakage in Group 1 is significantly lower than in Groups 3 and 5 and the microleakage in Groups 3 and 5 have no significant difference. Based on high mineral content of the enamel, microporosities built by acid etching increase the surface energy and micromechanical retention. Based on the above, some studies show that self-etching adhesives do not tolerate contaminated etched surface with saliva, and total etch techniques has drown attentions to itself. [21]

The one-bottle bonding systems, which are based on acetone and alcohol, are able to flow to deep spaces made by acid-etching, and provide maximum resin tag penetration and maximum adhesion. Moreover, the composition of the latest bonding systems do not appear proper for adhesion to the enamel in the presence of salivary contamination. The one-bottle bonding systems present more hydrophilic nature than self-etching systems and can substitute the saliva on enamel surface and cause the hydrophilic monomers to penetrate the enamel porosities. These hydrophilic monomers convey hydrophobic monomers and resin tags, which are responsible for providing adhesion. [20] Accordingly, once salivary contamination is present, acid-etching and bonding (total etch technique) seems preferable compared with self-etching systems.


   Conclusion Top


The best way to place a sealant with or without salivary contamination is acid-etching and bonding (total etch), and applying self-etching systems to simplify the clinical procedure and limiting the rinsing and drying steps is not recommended.

 
   References Top

1.Grande RH, Reis A, Loguercio AD, Singer Jda M, Shellard E, Neto PC. Adhesive system used for sealing contaminated surface: A microleakage evaluation. Braz Oral Res 2005;19:17-22.  Back to cited text no. 1
    
2.Tulunoglu O, Bordu H, Uctasli M, Alacam A. The effect of bonding agents on the microleakage and bond strength of sealant in primary teeth. J Oral Rehabil 1999;26:436-41.  Back to cited text no. 2
    
3.McDonald RE, Avery D. Dentistry for the child and adolescent. 7 th ed. USA: Mosby Co.; 2004. p. 356.  Back to cited text no. 3
    
4.Mandras RS, Retief DH, Russell CM. Quantitative microleakage of six dentin bonding systems. Am J Dent 1993;6:119-22.  Back to cited text no. 4
    
5.Al-Sarheed MA. Evaluation of shear bond strength and SEM observation of all- in- one self etching primer used for bonding of fissure sealants. J Contemp Dent Pract 2006;7:1-7.  Back to cited text no. 5
    
6.Gwinnett AJ. Altered tissue contribution to interfacial bond strength with acid conditioned dentin. Am J Dent 1994;7:243-6.  Back to cited text no. 6
    
7.Summitt JB, Robbins JW, Schwartz RS. Fundamentals of operative dentistry. 3rd ed. Hanover Parks, Illinois: Quintessence Publishing Co; 2006. p. 232-4.  Back to cited text no. 7
    
8.Miyazaki M, Hirohata N, Takagaki K, Onose H, Moore BK. Influence of self - etching primer drying time on enamel bond strength of resin composites. J Dent 1999;27:203-7.  Back to cited text no. 8
    
9.Buonocore MG. A simple methed of increasing the adhesion of acrylic filling materials to enamel surface. J Dent Res 1995;34:849-53.  Back to cited text no. 9
    
10.Watanabe I, Nakabayashi N, Pashley DH. Bonding to ground dentin by a phenyl- P self - etching primer. J Dent Res 1994;73:1212-20.  Back to cited text no. 10
    
11.Hannig M, Grafe A, Atalay S, Bott B. Microleakage and SEM evaluation of fissure sealants placed by use of self-etching priming agents. J Dent 2004;32:75-81.  Back to cited text no. 11
    
12.Miranda C, Prates LH, Vieira Rde S, Calvo MC. Shear bond strength of different adhesive systems to primary dentin and enamel. J Clin Pediatr Dent 2006;31:35-40.  Back to cited text no. 12
    
13.Perry AO, Rueggeberg FA. The effect of acid primer or conventional acid etching on microleakage in a photoactivated sealant. Pediatr Dent 2003;25:127-31.  Back to cited text no. 13
    
14.Samimi P, Khathpour K. Adhesive in dentistry. 1 th ed. Esfahan: Mani Publishing Co; 1381. p, 35-82.  Back to cited text no. 14
    
15.Kaaden C, Powers JM, Friedl KH, Schmalz G. Bond strength of self- etching adhesives to dental hard tissues. Clin Oral Investig 2002;6:155-60.  Back to cited text no. 15
    
16.Toledano M, Osorio R, Ceballos L, Fuentes MV, Fernandes CA, Tay FR, et al. Microtensile bond strength of several adhesive systems to different depths. Am J Dent 2003;16:292-8.  Back to cited text no. 16
    
17.Brucia J, Dalin J. The dalin exchange. Dent Econ 2008;98:1-6.  Back to cited text no. 17
    
18.Witzel MF, Grande RH, Singer Jda M. Bonding systems used for sealing: Evaluation of microleakage. J Clin Dent 2000;11:47-52.  Back to cited text no. 18
    
19.Borsatto MC, Corona SI, Dibb R. Microleakage of a resin sealant after acid-etching, Er: YAG laser irradiation and air abrasion of pits and fissures. Braz Dent J 2002;18:45-53.  Back to cited text no. 19
    
20.Townsend DR, Dunn WJ. The effect of saliva contamination on enamel and dentin using a self-etching adhesive. J Am Dent Assoc 2004;135:895-901.  Back to cited text no. 20
    
21.Torres CP, Balbo P, Gomes-Silva JM, Ramos RP, Palma-Dibb RG, Borsatto MC. Effect of individual or simultaneous curing on sealant bond strength. J Dent Child (Chic) 2005;72:31-5.  Back to cited text no. 21
    

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Correspondence Address:
Leila Bassir
Department of Pediatric Dentistry, School of Dentistry, Ahvaz University of Medical Sciences, Ahvaz
Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9290.111267

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