Restor Dent Endod.  2022 Nov;47(4):e36. 10.5395/rde.2022.47.e36.

Correlation between different methodologies used to evaluate the marginal adaptation of proximal dentin gingival margins elevated using a glass hybrid

• Ismail HS
• Morrow BR
• Ali AI
• Mehesen RE
• Garcia-Godoy F
• Mahmoud SH

• KMID: 2548140
• DOI: http://doi.org/10.5395/rde.2022.47.e36

Abstract

Objectives
This study aimed to evaluate the effect of aging on the marginal quality of glass hybrid (GH) material used to elevate dentin gingival margins, and to analyze the consistency of the results obtained by 3 in vitro methods.
Materials and Methods
Ten teeth received compound class II cavities with subgingival margins. The dentin gingival margins were elevated with GH, followed by resin composite. The GH/gingival dentin interfaces were examined through digital microscopy, scanning electron microscopy (SEM) using resin replicas, and according to the World Dental Federation (FDI) criteria. After initial evaluations, all teeth were subjected to 10,000 thermal cycles, followed by repeating the same marginal evaluations and energy dispersive spectroscopy (EDS) analysis for the interfacial zone of 2 specimens. Marginal quality was expressed as the percentage of continuous margin at ×200 for microscopic techniques and as the frequency of each score for FDI ranking. Data were analyzed using the paired sample t-test, Wilcoxon signed-rank test, and Pearson and Spearmen correlation coefficients.
Results
None of the testing techniques proved the significance of the aging factor. Moderate and strong significant correlations were found between the testing techniques. The EDS results suggested the presence of an ion-exchange layer along the GH/gingival dentin interface of aged specimens.
Conclusions
The marginal quality of the GH/dentin gingival interface defied aging by thermocycling. The replica SEM and FDI ranking results had stronger correlations with each other than either showed with the digital microscopy results.

Keyword

Deep margin elevation; Open sandwich technique; Marginal quality; Glass hybrid; In vitro FDI ranking

Figure

• 

  Figure 1 Methodology for a representative specimen. (A) Proximal cavity outline and dimensions, cervical margin 1 mm below the cemento-enamel junction (CEJ). (B) Occlusal view of the Tofflemire matrix band (black arrow: the pencil mark 1 mm above the CEJ). (C) Occlusal view of the Tofflemire matrix band (black arrow: intimate adaptation against the gingival margin). (D) Proximal view after glass hybrid (GH) placement. (E) Occlusal view after a new circumferential matrix system and universal adhesive application. (F) Proximal view of the final restoration after overlying resin composite placement and finishing and polishing (black arrow: the GH/gingival margin interface and blue arrow points to GH/overlying resin composite interface). (G) Recording of the GH/gingival dentin interface using addition silicone impression materials. (H) Pouring the impression with epoxy resin for creating the resin replica. (I) Proximal view after gold sputter coating for the resin replica (black arrows: the GH/gingival margin interface).

• 

  Figure 2 Representative digital microscopy (A) and scanning electron microscopy (SEM) (B) images of the immediate group: Overall views (A1, B1) at the glass hybrid (GH)/gingival dentin interfaces (A2-5, B2-8). A1: Digital microscopy, overall view at ×30 (black arrow: the GH/gingival dentin interface; blue arrow: the GH/overlying resin composite interface). A2: Example of a gapped GH/gingival dentin interface at ×200 (black arrow: marginal gap). A3: Example of a continuous GH/gingival dentin interface at ×200 (black arrow: continuous margin). A4 and A5: Examples of stitched images for the entire GH/gingival dentin interfaces at ×200 (black arrows: GH/gingival dentin interfaces). B1: SEM overall view at ×20 (black arrow: the GH/gingival dentin interface). B2 and B3: Examples of gapped GH/gingival dentin interfaces at ×200 (black arrows: marginal gaps). B4 and B5: Examples of continuous GH/gingival dentin interfaces at ×200 (black arrows: continuous margins). B6: GH/gingival dentin interface at ×200 (black arrows: detached particles from the material at the interface). B7 and B8: GH/gingival dentin interfaces at ×200 (black arrows: gaps within the material, near the margin, representing an example of cohesive failure in the material itself).

• 

  Figure 3 Representative digital microscopy (A) and scanning electron microscopy (SEM) (B) images of the aged group: Overall views (A1, B1), at glass hybrid (GH)/gingival dentin interfaces (A2-6, B2-7). A1: Digital microscopy, overall view at ×30 (black arrow: the GH/gingival dentin interface; blue arrow: the GH/overlying composite interface). A2: Example of gapped GH/gingival dentin interfaces at ×200 (black arrow: marginal gap). A3: Example of continuous GH/gingival dentin interface at ×200 (black arrow: continuous margin). A4: Example of the ion-exchange zone at the GH/gingival dentin interface at ×200 (black arrow: the zone at the interface). A5 and A6: Examples of stitched images for the whole GH/gingival dentin interfaces at ×200 (black arrows: GH/gingival dentin interfaces). B1: SEM overall view at ×20 (black arrow: the GH/gingival dentin interface). B2 and B3: Examples of gapped GH/gingival dentin interfaces at ×200 (black arrows: marginal gaps). B4-B6: Examples of continuous GH/gingival dentin interfaces at ×200 (black arrows: continuous margins and the ion-exchange zones at the interface with their distinct morphology). B7: GH/gingival dentin interfaces at ×1,000 (black arrow: the ion-exchange zone).

• 

  Figure 4 A, B, and C: Scanning electron microscopy (SEM) images for the ion-exchange layer at the glass hybrid (GH)/gingival dentin interface at ×3,000 magnification (blue arrows: the ion-exchange zone). D and E: SEM- energy dispersive spectroscopy (EDS) evaluating the elemental composition of the interfacial zones. D1 and E1: SEM images (×3,000) of the 9 spectra locations for each specimen. D2 and E2: Examples of EDS spectra and tables of elements of GH. D3 and E3: Examples of EDS spectra and tables of elements of the interfacial zone. D4 and E4: Examples of EDS spectra and tables of elements of gingival dentin.

Reference

1. Zhou X, Huang X, Li M, Peng X, Wang S, Zhou X, Cheng L. Development and status of resin composite as dental restorative materials. J Appl Polym Sci. 2019; 136:48180.

2. Kielbassa AM, Philipp F. Restoring proximal cavities of molars using the proximal box elevation technique: Systematic review and report of a case. Quintessence Int. 2015; 46:751–764. PMID: 26159213.

3. Veneziani M. Adhesive restorations in the posterior area with subgingival cervical margins: new classification and differentiated treatment approach. Eur J Esthet Dent. 2010; 5:50–76. PMID: 20305873.

4. Al-Harbi F, Kaisarly D, Michna A, ArRejaie A, Bader D, El Gezawi M. Cervical interfacial bonding effectiveness of Class II bulk versus incremental fill resin composite restorations. Oper Dent. 2015; 40:622–635. PMID: 26151459.

5. Manuja N, Nagpal R, Pandit IK. Dental adhesion: mechanism, techniques and durability. J Clin Pediatr Dent. 2012; 36:223–234. PMID: 22838222.

6. Juloski J, Köken S, Ferrari M. Cervical margin relocation in indirect adhesive restorations: a literature review. J Prosthodont Res. 2018; 62:273–280. PMID: 29153552.

7. Lindberg A, van Dijken JW, Lindberg M. 3-year evaluation of a new open sandwich technique in Class II cavities. Am J Dent. 2003; 16:33–36. PMID: 12744410.

8. Dietschi D, Spreafico R. Current clinical concepts for adhesive cementation of tooth-colored posterior restorations. Pract Periodontics Aesthet Dent. 1998; 10:47–54. PMID: 9582662.

9. Ilgenstein I, Zitzmann NU, Bühler J, Wegehaupt FJ, Attin T, Weiger R, Krastl G. Influence of proximal box elevation on the marginal quality and fracture behavior of root-filled molars restored with CAD/CAM ceramic or composite onlays. Clin Oral Investig. 2015; 19:1021–1028.

10. Vertolli TJ, Martinsen BD, Hanson CM, Howard RS, Kooistra S, Ye L. Effect of deep margin elevation on CAD/CAM-fabricated ceramic inlays. Oper Dent. 2020; 45:608–617. PMID: 32243253.

11. Grubbs TD, Vargas M, Kolker J, Teixeira EC. Efficacy of direct restorative materials in proximal box elevation on the margin quality and fracture resistance of molars restored with CAD/CAM onlays. Oper Dent. 2020; 45:52–61. PMID: 31084532.

12. Miletić I, Baraba A, Basso M, Pulcini MG, Marković D, Perić T, Ozkaya CA, Turkun LS. Clinical performance of a glass-hybrid system compared with a resin composite in the posterior region: Results of a 2-year multicenter study. J Adhes Dent. 2020; 22:235–247. PMID: 32435764.

13. Moshaverinia M, Navas A, Jahedmanesh N, Shah KC, Moshaverinia A, Ansari S. Comparative evaluation of the physical properties of a reinforced glass ionomer dental restorative material. J Prosthet Dent. 2019; 122:154–159. PMID: 31326149.

14. Mahmoud SH, Al-Wakeel ES. Marginal adaptation of ormocer-, silorane-, and methacrylate-based composite restorative systems bonded to dentin cavities after water storage. Quintessence Int. 2011; 42:e131–e139. PMID: 22026005.

15. Al-Harbi F, Kaisarly D, Bader D, El Gezawi M. Marginal integrity of bulk versus incremental fill Class II composite restorations. Oper Dent. 2016; 41:146–156. PMID: 26266653.

16. Aggarwal V, Bhasin SS. Application of calcium silicate materials after acid etching may preserve resin-dentin bonds. Oper Dent. 2018; 43:E243–E252. PMID: 29953337.

17. Heintze SD. Systematic reviews: I. The correlation between laboratory tests on marginal quality and bond strength. II. The correlation between marginal quality and clinical outcome. J Adhes Dent. 2007; 9(Supplement 1):77–106. PMID: 18341236.

18. Heintze SD. Clinical relevance of tests on bond strength, microleakage and marginal adaptation. Dent Mater. 2013; 29:59–84. PMID: 22920539.

19. Han SH, Park SH. Incremental and bulk-fill techniques with bulk-fill resin composite in different cavity configurations. Oper Dent. 2018; 43:631–641. PMID: 29630486.

20. Irie M, Suzuki K, Watts DC. Delayed polishing technique on glass–ionomer restorations. Jpn Dent Sci Rev. 2009; 45:14–22.

21. KEYENCE. VHX-1000 series digital microscope data sheet [Internet]. cited December 20, 2021. Available from: https://www.keyence.com/products/microscope/digital-microscope/vhx-1000/models/vhx-1000e/ .

22. Aggarwal V, Singla M, Yadav S, Yadav H. Effect of flowable composite liner and glass ionomer liner on class II gingival marginal adaptation of direct composite restorations with different bonding strategies. J Dent. 2014; 42:619–625. PMID: 24631232.

23. Hickel R, Peschke A, Tyas M, Mjör I, Bayne S, Peters M, Hiller KA, Randall R, Vanherle G, Heintze SD. FDI World Dental Federation: clinical criteria for the evaluation of direct and indirect restorations-update and clinical examples. Clin Oral Investig. 2010; 14:349–366.

24. Cvar JF, Ryge G. Reprint of criteria for the clinical evaluation of dental restorative materials. 1971. Clin Oral Investig. 2005; 9:215–232.

25. Ernst CP, Canbek K, Euler T, Willershausen B. In vivo validation of the historical in vitro thermocycling temperature range for dental materials testing. Clin Oral Investig. 2004; 8:130–138.

26. Boussès Y, Brulat-Bouchard N, Tillier Y. Effects of ageing on glass-polymer dental composites. Comput Methods Biomech Biomed Engin. 2020; 23(Supplement 1):S47–S48.

27. Francois P, Vennat E, Le Goff S, Ruscassier N, Attal JP, Dursun E. Shear bond strength and interface analysis between a resin composite and a recent high-viscous glass ionomer cement bonded with various adhesive systems. Clin Oral Investig. 2019; 23:2599–2608.

28. Kandaswamy D, Rajan KJ, Venkateshbabu N, Porkodi I. Shear bond strength evaluation of resin composite bonded to glass-ionomer cement using self-etching bonding agents with different pH: In vitro study. J Conserv Dent. 2012; 15:27–31. PMID: 22368331.

29. Alqudaihi FS, Cook NB, Diefenderfer KE, Bottino MC, Platt JA. Comparison of internal adaptation of bulk-fill and increment-fill resin composite materials. Oper Dent. 2019; 44:E32–E44. PMID: 29856698.

30. Cavalcanti AN, Mitsui FH, Lima AF, Mathias P, Marchi GM. Evaluation of dentin hardness and bond strength at different walls of class II preparations. J Adhes Dent. 2010; 12:183–188. PMID: 20157677.

31. Münevveroğlu AP, Ozsoy A, Ozcan M. Microleakage of high viscosity glass-ionomer and glass-carbomer with and without coating before and after hydrothermal aging. Braz Dent Sci. 2019; 22:79–87.

32. Aydın N, Karaoğlanoğlu S, Aybala-Oktay E, Çetinkaya S, Erdem O. Investigation of water sorption and aluminum releases from high viscosity and resin modified glass ionomer. J Clin Exp Dent. 2020; 12:e844–e851. PMID: 32994873.

33. Troca VB, Fernandes KB, Terrile AE, Marcucci MC, Andrade FB, Wang L. Effect of green propolis addition to physical mechanical properties of glass ionomer cements. J Appl Oral Sci. 2011; 19:100–105. PMID: 21552709.

34. Pinto-Sinai G, Brewster J, Roberts H. Linear coefficient of thermal expansion evaluation of glass ionomer and resin-modified glass ionomer restorative materials. Oper Dent. 2018; 43:E266–E272. PMID: 29953342.

35. de Oliveira BM, Agostini IE, Baesso ML, Menezes-Silva R, Borges AF, Navarro MF, Nicholson JW, Sidhu SK, Pascotto RC. Influence of external energy sources on the dynamic setting process of glass-ionomer cements. Dent Mater. 2019; 35:450–456. PMID: 30709613.

36. Nicholson JW. Glass ionomer dental cements: update. Mater Technol. 2010; 25:8–13.

37. Sidhu SK, Nicholson JW. A review of glass-ionomer cements for clinical dentistry. J Funct Biomater. 2016; 7:16. PMID: 27367737.

38. Ngo H, Mount GJ, Peters MC. A study of glass-ionomer cement and its interface with enamel and dentin using a low-temperature, high-resolution scanning electron microscopic technique. Quintessence Int. 1997; 28:63–69. PMID: 10332357.

39. Nicholson JW. Maturation processes in glass-ionomer dental cements. Acta Biomater Odontol Scand. 2018; 4:63–71. PMID: 30083577.

40. Buldur M, Sirin Karaarslan E. Microhardness of glass carbomer and high-viscous glass Ionomer cement in different thickness and thermo-light curing durations after thermocycling aging. BMC Oral Health. 2019; 19:273. PMID: 31801493.

41. Karadas M, Atıcı MG. Bond strength and adaptation of pulp capping materials to dentin. Microsc Res Tech. 2020; 83:514–522. PMID: 31912929.

42. Hoshika S, Ting S, Ahmed Z, Chen F, Toida Y, Sakaguchi N, Van Meerbeek B, Sano H, Sidhu SK. Effect of conditioning and 1\\xe2\\x80\\xafyear aging on the bond strength and interfacial morphology of glass-ionomer cement bonded to dentin. Dent Mater. 2021; 37:106–112. PMID: 33229039.

43. Garcia-Godoy F, Krämer N, Feilzer AJ, Frankenberger R. Long-term degradation of enamel and dentin bonds: 6-year results in vitro vs. in vivo. Dent Mater. 2010; 26:1113–1118. PMID: 20800270.

44. Bertoldi C, Monari E, Cortellini P, Generali L, Lucchi A, Spinato S, Zaffe D. Clinical and histological reaction of periodontal tissues to subgingival resin composite restorations. Clin Oral Investig. 2020; 24:1001–1011.

45. Ferrari M, Koken S, Grandini S, Ferrari Cagidiaco E, Joda T, Discepoli N. Influence of cervical margin relocation (CMR) on periodontal health: 12-month results of a controlled trial. J Dent. 2018; 69:70–76. PMID: 29061380.

46. Juloski J, Köken S, Ferrari M. No correlation between two methodological approaches applied to evaluate cervical margin relocation. Dent Mater J. 2020; 39:624–632. PMID: 32295986.