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Table of Contents   
ORIGINAL RESEARCH  
Year : 2012  |  Volume : 23  |  Issue : 2  |  Page : 247-250
In vitro study of microleakage of different techniques of surface preparation used in pits and fissures


1 Department of Pediatric Dentistry, Dental School, Islamic Azad University - Khorasgan Branch, Isfahan, Iran
2 Department of Oral Pathology, Dental School, Isfahan University of Medical Sciences, Isfahan, Iran
3 Department of Periodontology, Dental School, Isfahan University of Medical Sciences, Isfahan, Iran

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Date of Submission31-May-2010
Date of Decision28-Jul-2010
Date of Acceptance22-Oct-2010
Date of Web Publication3-Sep-2012
 

   Abstract 

Objective : The purpose of this in vitro study was to evaluate the effect of different techniques of surface preparation on the microleakage of a sealant applied with traditional acid etching and self-etched bonding agent.
Study Design : A total of 60 extracted third molars were randomly assigned into six groups (n = 10/each). The occlusal surfaces were sealed with a sealant (Clinpro) after one of the following pretreatments: (1) phosphoric acid etching; (2) Prompt L-Pop; (3) laser + etching; (4) laser + Prompt L-Pop; (5) air abrasion + etching; (6) air abrasion + Prompt L-Pop. The specimens were immersed in a 0.5% basic fuchsin solution. Buccolingual cuts parallel to the long axis of the tooth were made. The surfaces were scored 0--2 for extent of microleakage using a microscope and the data were analyzed statistically.
Results : The poorest results were obtained with laser + Prompt L-Pop which showed a greater number of specimens with microleakage (80%). Air abrasion surface preparation + phosphoric acid etching showed less microleakage than the other groups (40%). Kruskal--Wallis and t-tests revealed no significant difference in microleakage between six groups.
Conclusion : The self-etching adhesive studied seems an attractive alternative to the acid-etch technique for sealant application in young children where simplifications in the clinical procedure are warranted. No significant difference was noted between the different types of enamel preparation before fissure sealant.

Keywords: Adhesive system, air abrasion, dental sealant, microleakage

How to cite this article:
Nejad SJ, Razavi M, Birang R, Atefat M. In vitro study of microleakage of different techniques of surface preparation used in pits and fissures. Indian J Dent Res 2012;23:247-50

How to cite this URL:
Nejad SJ, Razavi M, Birang R, Atefat M. In vitro study of microleakage of different techniques of surface preparation used in pits and fissures. Indian J Dent Res [serial online] 2012 [cited 2021 Dec 5];23:247-50. Available from: https://www.ijdr.in/text.asp?2012/23/2/247/100435
Pit and fissure sealants are a safe and effective preventive treatment for caries. [1],[2]

The success of pit and fissure sealants over long-time spans depends on an effective marginal seal, retention, and integrity. Sealant microleakage is a very undesirable incident that suggests failure of the adhesion process. [3]

To improve sealant retention several methods of preparing fissures such as pumice prophylaxis, enameloplasty, bonding agents, laser, and air abrasion have been advocated by investigators. [4],[5],[6],[7],[8],[9],[10],[11],[12],[13],[14],[15]

Several studies have focused on investigating the efficiency of erbium: yttrium-aluminum-garnet (Er:YAG) laser on the surface pretreatment. [16],[17],[18],[19]

The ability of the Er:YAG laser to efficiently ablate dental tissues is ascribed to its 2.94-mm wavelength emission, which is coincident with the main absorption band of water (~3.0 mm) and OH- groups in hydroxyapatite (~2.8 mm). [17],[19],[20]

The incident radiation is highly absorbed by water molecules in the dental hard structures causing rapid heating and water evaporation. [16],[19],[21]

The resulting high stream pressure leads to the occurrence of successive microexplosions with ejection of tissue particles, [19],[21],[22] which are characteristic of the ablation process and establish the microcrater-like appearance of lased surfaces. [23],[24]

Furthermore, the Er:YAG laser has been considered a promising substitute for preventive dentistry because of its ability to increase fluoride uptake [25] and decrease acid dissolution, thus creating a surface more resistant to acid dissolution. [26] Therefore, it could be assumed that if the sealant falls out from a laser-pretreated tooth, the surface would be more resistant to acid attack. [27]

Another studies focused on use of air abrasion for enamel conditioning. Air abrasion removes tooth structure using a stream of aluminum oxide particles generated from compressed air or bottled carbon dioxide or nitrogen gas. The abrasive particles strike the tooth with high velocity and remove small amounts of tooth structure. Efficiency of removal is relative to the hardness of the tissue or material being removed and the operating parameters of the air abrasion device. [28] In addition air abrasion has been shown to enhance enamel bonding. [29]

A limited number of studies have compared the effectiveness of use of bonding agents, air abrasion, and laser pretreatment of fissures. The purpose of this in vitro study was to evaluate the effect of two techniques of surface preparation, air-abrasion, and Er:YAG laser irradiation on the microleakage of a fissure sealant. In addition, each of these two groups was further divided into two additional groups to compare self-etched bonding with phosphoric acid etching.


   Materials and Methods Top


A total of 60 freshly extracted sound human third molars were cleaned with pumice and brush in low-speed hand piece and washed with water and were randomly assigned into six groups (n = 10/each). The occlusal surfaces were sealed with a fissure sealant material Clinpro (3M/ESPE, St. Paul, MN, USA) after one of the following pretreatments:

Group 1: phosphoric acid etching only; group 2: Prompt L-Pop only; group 3: laser surface preparation + phosphoric acid etching; group 4: laser surface preparation + Prompt L-Pop; (group 5) air abrasion surface preparation +phosphoric acid etching; (group 6) air abrasion surface preparation + Prompt L-Pop.

Group 1: The pits and fissures were etched with 37% phosphoric acid (3M/ESPE, St. Paul, MN, USA) for 15 seconds, rinsed with water for 20 seconds, and air dried for 30 seconds

Group 2: The adhesive system Prompt L-Pop (3M/ESPE, St. Paul, MN, USA) was used according to the manufacturer's instructions. The L-Pop delivery system allows for easier flow of material from one chamber to the next. When the material moves from the red chamber to the yellow chamber, a new indentation in the yellow chamber pops up to show that the material has properly transferred. Adhesive brushed onto the surface to be sealed; scrubbed for 15 seconds applying moderate pressure. A gentle stream of air was used to thoroughly dry the adhesive to a thin film and light cured for 10 seconds.

Group 3: Enamel was irradiated with a pulsed Er:YAG laser (HT Fidelis, Fotona, Ljubljana, SLOVENIA,) at a wavelength of 2.94 μm, a pulse duration of 250-500 μs under water cooling (5 ml/min). The output power and repetition rate of this equipment was 120 mJ and 4 Hz, respectively. The hand piece was held perpendicular to the enamel surface at a distance of 1 mm. [30] Then the pits and fissures were etched with 37% phosphoric acid ((3M/ESPE, St. Paul, MN, USA), for 15 seconds, rinsed with water for 20 seconds, and air dried for 30 seconds.

Group 4: Enamel was irradiated with a pulsed Er:YAG laser. Then the Prompt L-Pop was used according to the manufacturer's instructions as mentioned for group 2.

Group 5; The enamel surface air abraded with a Prophy-Mate Air Powered Tooth Polishing System (NSK, Japan) with stream of Prophy-Mate Cleaning Powder (sodium bicarbonate with lemon flavor). The position of nozzle was hold at 60° angle with 3-5 mm away from the tooth surface. The air was taken from the compressed air available in the hospital facilities. Then the pits and fissures were etched with 37% phosphoric acid for 15 seconds, rinsed with water for 20 seconds, and air dried for 30 seconds

Group 6: The enamel surface air abraded with a Prophy-Mate Air Powered Tooth Polishing System with stream of Prophy-Mate Cleaning Powder. Prompt L-Pop was used according to the manufacturer's instructions as mentioned for group 2.

All specimens were thermocycled for 500 cycles between 5°C and 55°C, with a 30-second dwell time. Following thermocycling, the root apexes of the teeth were sealed with wax and the teeth were coated with two layers of nail polish, except for the restorations and leaving exposed a 1.5-mm window around the sealant margins. The samples were and immersed in a 0.5% basic fuchsin solution. They were then thoroughly rinsed in tap water. Next, the teeth were embedded in self-curing acrylic resin. Buccolingual cuts parallel to the long axis of the tooth were made. After the above procedures, the length of dye penetration at the sealant/tooth interface was examined under a stereomicroscope with 40× magnification and a ranked scale was used to score dye penetration: 0= no dye penetration; 1= dye penetration less than 500 micro meters; 2= dye penetration more than 500 μm. The Kruskal-Wallis nonparametric test and Mann-Whitney U-test were used to compare the groups for statistically significant differences at 5% significance level.


   Results Top


Microleakage scores for all groups are presented in [Table 1].
Table 1: Treatment groups and their microleakage scores (n=10)

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Higher microleakage values were found in group 4, where laser and self-etch bonding had been used, and lower values were found in group 5 where air abrasion and acid etching had been used. Microleakage showed no significant differences among all treatment groups (P>0.05). No statistically significant differences (P>0.05) were found between acid etching and bonding groups but microleakage was less in all groups when enamel was acid etched.


   Discussion Top


Considering that the microretentive pattern obtained after Er:YAG laser and air abrasion has been described as suitable for adhesion [16],[23],[29] the current study assessed the microleakage of a sealant after such surface preparations.

The hypothesis that Er:YAG laser and air abrasion combined with the conventional treatment with acid would increase the surface adhesion could not be confirmed in the present research because groups that received laser irradiation and air abrasion were not more effective than those pretreated with phosphoric acid and self-etching primer solely.

The results of study by Mazzoleni s. showed that the air abrasion technique is able to guarantee a reliable seal of occlusal surfaces. Hatibovic-Kofman et al. concluded that air abrasion with acid etch showed significantly less microleakage than either bur with acid etch or acid etch alone which is contrary to our finding. [4],[5]

This difference may be explained, in part, by the differences in sealant material used and by the different characteristics of the laser and air abrasion used.

The findings of several studies have shown that no significant difference was noted between mechanical conditioning of the laser or air abrasion when etching was performed. Borsatto, Lupi-Pégurier, Blackwood, Zyskind, and Manhart found that complementing either air abrasion or Er:YAG laser irradiation with a subsequent acid conditioning did not lessen microleakage at the enamel-sealant interface when compared with an acid-etched group. [6],[7],[8],[9],[10] These reports are also in agreement with the results of our study.

The second part of the study evaluated the microleakage of two different methods: total etch (phosphoric acid) and self-etching primer with Prompt. Two studies assessed marginal microleakage of prompt and are in agreement of our study: Asselin et al., believed that self-etching adhesive (prompt) seems to be an attractive alternative to the acid etch and adhesive technique for sealant application in young children, since it would simplify the procedure. [11] Gillet showed that self-etching primer prompt is very efficient versus phosphoric acid in obturating the fissures of noncarious bicuspids. [12]

Camacho, Castro, and Al-Sarheed assessed bond strength of Prompt-L-Pop and showed that the use of bonding agent improves the mean enamel shear bond strength of fissure sealants. [13],[14],[15]

The present study had some limitations. The dye material used was a 0.5% solution of basic fuchsin. Using other dye solutions (e.g. 0.2% rhodamine, 1% methylene blue or 50% silver nitrate) could have produced different results. In addition the laser and air abrasion were evaluated only with respect to marginal leakage. It may be that different environmental situations for teeth may influence the microleakage of the sealant placed using either technique. Furthermore, other factors must be considered when evaluating both techniques, such as long-term retention, the integrity of the sealant, or the shear strength of the sealant.

In addition further studies with other laser parameters and long-term clinical trials are required to determine which protocol is preferred to improve the mechanism of adhesion to the laser-irradiated surface before this technology becomes routine in dental practice.


   Conclusion Top


The self-etching adhesive studied seems an attractive alternative to the acid-etch technique for sealant application in young children where simplifications in the clinical procedure are warranted. Overall, Er:YAG laser and air abrasion was not able to increase the effectiveness of conventional acid etching of enamel in the bond of sealants.

 
   References Top

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Correspondence Address:
Shahrzad Javadi Nejad
Department of Pediatric Dentistry, Dental School, Islamic Azad University - Khorasgan Branch, Isfahan
Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9290.100435

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