|Year : 2021 | Volume
| Issue : 5 | Page : 348-352
Comparative evaluation of internal margin adaptation and integrity of class I preparations using two composites: An In Vitro study
Subhasmita Bhol1, Neha Patwa2, Suprabha Sharan3, Shemil Mohamed Sha4, Muqthadir Siddiqui Mohammed Abdul5, Alen Pius6, Shalini Singh7
1 Department of Pediatric and Preventive Dentistry, Hi Tech Dental College and Hospital, Bhubaneswar, Odisha, India
2 Department of Conservative and Endodontics, Daswani Dental College, Kota, Rajasthan, India
3 Dental Surgeon, Private Practitioner, Patna, Bihar, India
4 Department of Conservative Dentistry and Endodontics, PMS College of Dental Science and Research, Thiruvananthapuram, Kerala, India
5 Registrar, Department of Paediatric Dentistry, Ministry of Health, King Khaled Hospital, Riyadh, KSA
6 Department of Conservative Dentistry and Endodontics, PSM Dental College, Thrissur, Kerala, India
7 Department of Conservative Dentistry and Endodontics, Dr. H.S.R.S.M. Dental College and Hospital, Hingoli, Maharashtra, India
|Date of Submission||18-Nov-2020|
|Date of Decision||18-Nov-2020|
|Date of Acceptance||19-Nov-2020|
|Date of Web Publication||05-Jun-2021|
Department of Pediatric and Preventive Dentistry, Hi Tech Dental College and Hospital, Bhubaneswar, Odisha
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Aim and Objectives: The aim of this study is to evaluate the internal margin adaptation and integrity of Class 1 preparations using two composites types (bulk fill/conventional) with two placement methods (4/2 mm increments). Materials and Methods: Class 1 preparations of 4 mm × 4 mm dimensions were made on 30 extracted human mandibular molars. They were randomly divided into three groups; among them, in Group 1 (n = 10), cavities were filled with SureFil SDR Bulk Fill, Group 2 (n = 10) cavities were filled with Filtek Bulk Fill of 4 mm increments in both groups, and in Group 3 (n = 10), cavities were filled with conventional composite Filtek Z350 with 2 mm increments. Samples were sectioned occlusogingivally. Then, dye was on internal margins, and images of each specimen were recorded using a digital camera to evaluate the marginal integrity and adaptation of restorative material to the tooth surface with image analysis software. Then, collected data were put under the statistical analysis with analysis of variance test and post hoc Tukey's test. Results: There was no significant difference in overall dye penetration in bulk fill and conventional (incremental fill) composite resins; however, when dye penetration was evaluated at different locations, within enamel and mid-dentin, significantly more gap-free margins were found than at the pulpal interface. Filtek Bulk Fill and conventional composite (Filtek Z350) showed comparatively more dye penetration toward the pulpal interface compared to SDR Bulk Fill. Conclusion: There were no significant differences in percentage of gap-free margins between fill types for any of the composite materials. The proportions of gap-free margin were less at the pulpal interface and mid-dentin portions and enamel when filled with 4 and 2 mm increments.
Keywords: Bulk fill composite, Filtek Bulk Fill, Filtek Z350, increment fill composite, marginal adaptation, marginal integrity, SDR bulk fill
|How to cite this article:|
Bhol S, Patwa N, Sharan S, Sha SM, Abdul MS, Pius A, Singh S. Comparative evaluation of internal margin adaptation and integrity of class I preparations using two composites: An In Vitro study. J Pharm Bioall Sci 2021;13, Suppl S1:348-52
|How to cite this URL:|
Bhol S, Patwa N, Sharan S, Sha SM, Abdul MS, Pius A, Singh S. Comparative evaluation of internal margin adaptation and integrity of class I preparations using two composites: An In Vitro study. J Pharm Bioall Sci [serial online] 2021 [cited 2022 May 20];13, Suppl S1:348-52. Available from: https://www.jpbsonline.org/text.asp?2021/13/5/348/317659
| Introduction|| |
Composite resins are material of choice in restorative dentistry for the reason that they have high esthetic results in routine practice. The material is composed of a polymer resin matrix with filler particles. Bowen in 1962 developed the resin which contained bis-GMA in its composition. Furthermore, the presence of filler particles improved the translucency, reduced the coefficient of thermal expansion, and increased the wear resistant.,,, Regardless of the continuous evolution of these resins, complications such as polymerization shrinkage and marginal microleakage still occur. To minimize the polymerization shrinkage stresses, various restoration placement techniques have been introduced. To overcome the clinical consequences of polymerization shrinkage, incremental filling techniques are usually preferred over the bulk filling method to acquire effective marginal integrity. In incremental techniques, the stresses developed within the tooth-restoration system reduce to compensate the polymerization shrinkage of composites. In various studies, it was reported that the incremental technique for composite placement had better marginal quality, marginal integrity, and marginal adaptation., Many clinicians, however, have adopted an incremental cure philosophy since long when placing light-cured composites. Recently, numerous new restorative materials have been marketed as “bulk fill” composites. The concept of “bulk filling,” preparation, is not a novel idea and has been evaluated numerous times in the literature., The newly introduced “bulk-filled” resins claim to offer superior results with 4–6 mm single-increment placement thicknesses, instead of the conventional 2 mm value frequently used for incremental fill resins., Hence, the purpose of this research study is to evaluate the potential for marginal integrity within the enamel, mid-dentin, and pulpal floor areas in controlled-size, Class I preparations made in extracted human mandibular molars when restored using a variety of the newly marketed “bulk-filled” products compared to increment fill resins. The null hypothesis states that there was no significant difference among the bulk fill and increment fill composite resins when the marginal integrity was analyzed.
| Materials and Methods|| |
Thirty freshly extracted, intact, noncarious, and nonrestored, human mandibular molars were used in the study. Teeth with caries, restoration, fracture, and intact tooth fractured during decoronation were excluded from the study. Only the root portions of the extracted teeth were embedded in resin blocks of 1cm × 1cm × 1 cm dimensions. A precise removal of enamel on the occlusal surface was accomplished, to provide a flat occlusal surface which resulted in having centrally located enamel while dentin was slightly exposed at the cusp tips. An outline of cavity preparation which has dimensions of 4.0 mm (L) × 4.0 mm (B) × 4.0 mm deep (±0.2 mm) was marked using metallic scale and marker, and the cavity was prepared using a high-speed airotor handpiece with copious water irrigation and equipped with a flat-ended diamond bur. The dimensions of each preparation were measured using a periodontal probe. Then, all samples were randomly divided into three groups (Group 1 and Group 2 – bulk fill and Group 3 – increment fill) and restored with the following composites:
- Group 1 (n = 10): SureFil SDR Bulk Fill (Dentsply DeTrey, Germany)
- Group 2 (n = 10): Filtek Bulk Fill (3M ESPE, Germany)
- Group 3 (n = 10): Filtek Z 350 XT (3M ESPE, Germany).
Composite restoration was done according to the manufacturer's instructions [Table 1]. After composite restoration, roots were resected in all the samples, and crown portions of all the teeth were sectioned buccolingually as it provides a complete visualization of enamel–dentin–pulp complex to assess the marginal integrity at all the levels. All the sectioned samples were then embedded in elastomeric impression material for stability. Caries indicator dye (Sable Sleek) was used by tracing the internal margins of restoration with the help of ball burnisher [Figure 1]a, [Figure 2]a, and [Figure 3]a; the pooling dye was then immediately wiped off with the help of tissue paper. Images were taken by a digital single-lens reflex camera of 90 mm focal length and macro 1:1, and the photographs were processed in image analysis software (ImageJ v1.46r, National Institutes of Health, Bethesda, MD, USA) [Figure 1]b, [Figure 2]b, and [Figure 3]b. Using this software, the area of the marginal interface was determined at specific locations along the internal tooth/restoration interface: (1) the interface between enamel/composite, (2) within the mid-dentin, and (3) along the pulpal floor.
|Figure 1: Buccolingual tooth sections restored with SureFil SDR – (a) Stained tooth images, (b) images analyzed using Image J Software|
Click here to view
|Figure 2: Buccolingual tooth sections restored with Filtek bulkfill – (a) Stained tooth images, (b) images analyzed using Image J Software|
Click here to view
|Figure 3: Buccolingual tooth sections restored with Filtek Z350 XT – (a) Stained tooth images, (b) images analyzed using Image J Software|
Click here to view
The data were put under Kolmogorov–Smirnov test which was applied to verify that the data were normally distributed. The statistical analysis was accomplished using SPSS, version 23 (SPSS Inc., Chicago, IL, USA) with two-way analysis of variance (ANOVA) and post hoc Tukey's test. The statistical significance level was set at P < 0.05.
| Results|| |
The two-way repeated-measures ANOVA when applied to evaluate the marginal leakage of bulk fill composite resin and increment fill composite resin, it was reported that there was no significant difference noted among the two bulk fill (SureFil SDR and Filtek Bulk Fill) and one increment fill (Filtek Z350) groups. Although there was no significant difference in the technique for composite placement using bulk fill or increment fill, SureFil SDR Bulk Fill showed better results when compared to Filtek Z350 and Filtek Bulk Fill as seen in figures. The second measure of one-way ANOVA test was applied for location to evaluate the significant difference between the location of the three different composite resins (enamel, mid-dentin, and pulpal floor interfaces), and it was reported that there was a significant difference stating the highest marginal dye penetration in the pulpal floor interface when compared to enamel and mid-dentin interfaces in all the three composite resins (SureFil SDR, Filtek Z350 XT, and Filtek Bulk Fill), and the lowest marginal dye penetration was noted in the enamel interface [Table 2]. In enamel–dentin interface, P value was reported to be 0.187, 0.153, and 0.146 for SureFil SDR, Filtek Z350 XT, and Filtek Bulk Fill, respectively. In dentin–pulp interface, P value was reported to be 0.073, 0.034, and 0.024 for SureFil SDR, Filtek Z350 XT, and Filtek Bulk Fill, respectively, suggestive of significant difference. In enamel–pulp interface, P value was reported to be 0.0038, 0.002, and 0.0009 for SureFil SDR, Filtek Z350 XT, and Filtek Bulk Fill, respectively, suggestive of significant difference as shown in [Table 3].
|Table 2: Mean and standard deviation of marginal dye penetration measured at enamel, dentin, and pulp for all the tested composite resins|
Click here to view
| Discussion|| |
Bulk fill resin-based composites due to their developing trend are materials of interest nowadays among practitioners because of their new technology and easy manipulation and application. The composite resin tested in this study characterizes a new range of bulk fill composites currently available in the market to restore the teeth function and strength., In the present study, we evaluated the marginal leakage and adaptation of Class I cavities restored with two bulk fill composites (SureFil SDR and Filtek Bulk Fill) and one conventional fill composite (Filtek Z350 XT) at enamel, mid-dentin, and pulpal interfaces of the restoration. When marginal leakage was evaluated, the results showed that there was no significant difference among the Class I cavities restored using two bulk fill and one incremental fill composite resins (P > 0.05). The probable reason for this could be the development in photoinitiator dynamics and increased translucency of bulk fill-resined composites, which allow additional light penetration and a deeper cure to the thicker increments, hence giving similar results as compared to increment fill resin composites., According to Scotti et al. and Roggendorf et al., the SureFill SDR showed the best marginal integrity and adaptation when compared to the groups using incrementally layered resin composites, which was not in favor of the study done by Juloski et al.,, According to the studies done by Cadenaro et al. and Ikeda et al., it was observed that the bulk fill composite resins have low modulus of elasticity, which causes lower wettability than the conventional composites, and hence, because of their low viscosity, they can be easily inserted into cavities with proper adaptation and marginal integrity. The results of these studies were in accordance with the results of the present study while comparing the marginal integrity of bulk fill with the conventional composite resin.,, Although there was no significant difference among the composites, interestingly, there was a significant difference reported when the three composite resins were evaluated at three different levels, i.e., enamel, mid-dentin, and pulp interfaces. At enamel and mid-dentin interface, SureFil SDR, Filtek Bulk Fill, and Filtek Z350 XT showed no statistically significant difference for marginal leakage, yet the proportion reported at pulpal interface was statistically significant as compared to other two levels. These differences which result from polymerization shrinkage indicate that when composite resins were inserted and polymerized in bulk, shrinkage stresses were observed less at the enamel and dentin interfaces, which could be because of the ability of unpolymerized composite to “feed” the resulting stress development from the strain of composite curing at shallower depths and causes deformation in deep composite restorations (near dentin–pulpal interface)., During cavity preparation, there is the presence of moist environment near pulpal interface due to the dentinal fluid efflux, which leads to difficulty in dentin bonding and adhesion of composite resins and causes gap formation which results in leakage and compromised marginal integrity and adaptation. Excessive contraction stresses at the tooth-restoration interface cause the gap formation, which can be a result of the polymerization rate of the material and the extent of polymerization contraction. The development of stresses is influenced by curing depth of the material, which also affects the dentin bonding at the interface. Gap formation is apparent if the interfacial stresses exceed the stresses which can be supported by the adhesive layer, thus compromising the adhesive reinforcement of the tooth structure., Similar to our study, Furness et al. evaluated the effect of bulk fill and increment fill on the internal gap formation, and it was concluded that composite placement methods did not affect the marginal integrity and adaptation. SDR Bulk Fill reported the higher gap-free margins at pulpal floor interface than enamel level when compared to Filtek Bulk Fill and Filtek Z350 XT. Percentages of gapfree margins were not significantly different for any of the composite material at the enamel and mid-dentin interfaces. Remarkably, within enamel and mid-dentin, significantly more gap-free margins were found than at the pulpal floor interface.,, Within the limitation of our study, it can be concluded that there was no significant difference noted when the marginal integrity of three composite resins was evaluated (two bulk fill and one increment fill), whereas there was a statistically significant difference noted when marginal integrity and adaptation at enamel, mid-dentin, and pulpal floor interfaces were analyzed, indicating more gap-free margins at enamel and mid-dentin as compared to pulpal floor interface.
| Conclusion|| |
Bulk fill composite resins could be the better alternative of the increment fill for the restoration of the Class I cavities. As it is a less time-consuming procedure, photoinitiator dynamics increase translucency of bulk fill resin composites, which allows additional light penetration and a deeper cure to the thicker increments, hence giving similar results as compared to increment fill resin composites.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Bowen RL. Dental Filling Material Comprising Vinyl-Silane Treated Fused Silica and a Ginder Consisting of the Reaction Product of GB-Phenol and Glycidyl Acrylate. US Patent No. 3066; 1962. p. 112.
Talukder MF, Hossai M, Moral MA. Clinical evaluation of bulk-fill composite resin and layered composite resin restoration in class I cavity of permanent molar teeth. Bangabandhu Sheikh Mujib Med Univ J 2018;11:29-33.
Alkhudhairy FI. The effect of curing intensity on mechanical properties of different bulk-fill composite resins. Clin Cosmet Investig Dent 2017;9:1-6.
Tuncdemir AR, Güven ME. Effects of fibers on color and translucency changes of bulk-fill and anterior composites after accelerated aging. Biomed Res Int 2018;2018:2908696.
Ibrahim HA, Shalaby ME, Abdalla AI. Marginal fit of Class II cavities restored with bulkfill composites. Tanta Dent J 2018;15:1-6. [Full text]
Campos EA, Ardu S, Lefever D, Jassé FF, Bortolotto T, Krejci I. Marginal adaptation of Class II cavities restored with bulk-fill composites. J Dent 2014;42:575-81.
Yu P, Yap A, Wang XY. Degree of conversion and polymerization shrinkage of bulk-fill resin-based composites. Oper Dent 2017;42:82-9.
Furness A, Tadros MY, Looney SW, Rueggeberg FA. Effect of bulk/incremental fill on internal gap formation of bulk-fill composites. J Dent 2014;42:439-49.
AlSagob EI, Bardwell DN, Ali AO, Khayat SG, Stark PC. Comparison of microleakage between bulk-fill flowable and nanofilled resin-based composites. Interv Med Appl Sci 2018;10:102-9.
Mosharrafian S, Heidari A, Rahbar P. Microleakage of two bulk fill and one conventional composite in Class II restorations of primary posterior teeth. J Dent (Tehran) 2017;14:123-31.
Gamarra VSS, Borges GA, Júnior LH, Spohr AM. Marginal adaptation and microleakage of a bulk-fill composite resin photopolymerized with different techniques. Odontology 2018;106:56-63.
Scotti N, Comba A, Gambino A, Paolino DS, Alovisi M, Pasqualini D, et al
. Microleakage at enamel and dentin margins with a bulk fills flowable resin. Eur J Dent 2014;8:1-8. [Full text]
Roggendorf MJ, Krämer N, Appelt A, Naumann M, Frankenberger R. Marginal quality of flowable 4-mm base vs. conventionally layered resin composite. J Dent 2011;39:643-7.
Juloski J, Carrabba M, Aragoneses JM, Forner L, Vichi A, Ferrari M. Microleakage of Class II restorations and microtensile bond strength to dentin of low-shrinkage composites. Am J Dent 2013;26:271-7.
Cadenaro M, Biasotto M, Scuor N, Breschi L, Davidson CL, Di Lenarda R. Assessment of polymerization contraction stress of three composite resins. Dent Mater 2008;24:681-5.
Ikeda I, Otsuki M, Sadr A, Nomura T, Kishikawa R, Tagami J. Effect of filler content of flowable composites on resin-cavity interface. Dent Mater J 2009;28:679-85.
Van Ende A, De Munck J, Lise DP, Van Meerbeek B. Bulk-fill composites: A review of the current literature. J Adhes Dent 2017;19:95-109.
Bayraktar Y, Ercan E, Hamidi MM, Çolak H. One-year clinical evaluation of different types of bulk-fill composites. J Investig Clin Dent 2017;8:1-9.
Benetti AR, Havndrup-Pedersen C, Honoré D, Pedersen MK, Pallesen U. Bulk-fill resin composites: Polymerization contraction, depth of cure, and gap formation. Oper Dent 2015;40:190-200.
Chesterman J, Jowett A, Gallacher A, Nixon P. Bulk-fill resin-based composite restorative materials: A review. Br Dent J 2017;222:337-44.
[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2], [Table 3]