Comparison of microleakage on Class V composite restoration: Study on total etch, self etch and selective etch technique

Josephine Amanda Karnady; Anastasia Elsa Prahasti

doi:10.4103/SDJ.SDJ_7_19

ORIGINAL ARTICLE

Year : 2019 | Volume : 3 | Issue : 2 | Page : 47-49

Comparison of microleakage on Class V composite restoration: Study on total etch, self etch and selective etch technique

Josephine Amanda Karnady, Anastasia Elsa Prahasti
Department of Conservative Dentistry, Faculty of Dentistry, Trisakti University, Jakarta, Indonesia

Date of Web Publication

18-Jun-2019

Correspondence Address:
Dr Anastasia Elsa Prahasti
Department of Conservative Dentistry, Faculty of Dentistry, Trisakti University, Jakarta
Indonesia

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/SDJ.SDJ_7_19

Abstract

Background: A Class V restoration with composite resin poses a number of challenges, which can result in microleakage. Methods for minimizing microleakage include the use of adhesive materials and adhesive systems. Adhesive systems include total etch, self-etch, and selective etch. Each adhesive system has various advantages and disadvantages. Therefore, in a Class V cavity with little enamel attachment, research is needed to compare microleakage in total etch, self-etch, and selective etch systems to determine the best adhesion system to achieve treatment success. Objective: The purpose of this study was to compare total etch, self-etch, and selective etch adhesive systems in Class V composite resin restorations. Method: Class V cavities on premolar teeth (n = 24) were prepared on buccal and lingual surfaces. The teeth were divided into three groups: total etch, self-etch, and selective etch. All the samples of 3 mm mesiodistal, 2 mm occlusal–gingival, and 2 mm deep were prepared using a high-speed round bur. After the preparation of the samples, all the teeth were restored using a flowable composite resin. All the restored samples were immersed in 2% methylene blue for 24 h. They were then sectioned in a buccolingual direction and observed under a stereomicroscope at ×10 magnification. The data were analyzed using the Kruskal–Wallis test and post hoc Mann–Whitney U-test (P < 0.05). Result: There were significant differences in microleakage among the groups. The total etch group had the least microleakage, followed by the selective etch and self-etch groups. Conclusion: The use of phosphoric acid (37%) in total etch and selective etch technique reduced microleakage in composite restorations.

Keywords: Microleakage, selective etch, self-etch, total etch

How to cite this article:
Karnady JA, Prahasti AE. Comparison of microleakage on Class V composite restoration: Study on total etch, self etch and selective etch technique. Sci Dent J 2019;3:47-9

How to cite this URL:
Karnady JA, Prahasti AE. Comparison of microleakage on Class V composite restoration: Study on total etch, self etch and selective etch technique. Sci Dent J [serial online] 2019 [cited 2023 Apr 2];3:47-9. Available from: https://www.scidentj.com/text.asp?2019/3/2/47/260561

Background

Defects in the cervical area of the teeth are usually due to bad habits such as brushing the teeth with the wrong technique that caused abrasion on the cervical of the teeth. Defects are also caused due to occlusal compressive forces and tensile stresses, resulting in microfractures of hydroxyapatite crystals of the enamel.^[1] These defects are classified as Class V cavities. Noncarious cervical lesion treatment is important to restore the structural integrity of the teeth, reduce dentin sensitivity, improve the esthetic appearance, retain tooth vitality, and prevent caries.^[2] Such treatment includes a composite resin restoration. Composite resin Class V restorations involve isolation, adhesion, restoration, finishing, and polishing, all of which pose various challenges in dentistry and can result in microleakage.^[3] Microleakage occurs following polymerization shrinkage of the composite resin, leading to a gap between the tooth and composite restoration. Microleakage can be overcome using adhesive materials with improved quality, which reduce polymerization shrinkage and increase adhesion.^[4] Each adhesive system has its advantages and disadvantages. In Class V cavities with little enamel attachment, microleakage using total etch, self-etch, and selective etch systems needs to be compared to determine the best adhesion system to achieve treatment success.

Method

Twenty-four human premolar teeth extracted for orthodontic purposes in a dental clinic in Jakarta, Indonesia, were used in this study. The teeth were cleaned using an ultrasonic scaler and then stored in saline. Class V cavities were prepared on buccal and lingual surfaces coronal to the cementoenamel junction using a high-speed diamond bur. The cavity dimensions were as follows: 3 mm mesiodistal, 2 mm occlusal–gingival, and 2 mm deep. The teeth were divided into three groups of 8 teeth, each containing 16 cavities, as below:

Group 1 (total etch group): The cavities were etched with 37% phosphoric acid for 15 s on enamel and dentin, rinsed, and air dried for 5 s. An all-in-one bonding agent G-aenial Bond (GC, Tokyo, Japan) was applied to the cavities. The samples were then left undisturbed for 10 s, dried for 5 s, and light cured for 10 s.

Group 2 (self-etch): G-aenial Bond (GC) was applied to the cavities. The samples were then left undisturbed for 10 s, dried for 5 s, and light cured for 10 s.

Group 3 (selective etch): The cavities were etched with 37% phosphoric acid for 10 s on enamel, rinsed, and dried for 5 s. G-aenial Bond (GC) was then applied to the cavity. The samples were then left undisturbed for 10 s, dried for 5 s, and light cured for 10 s. Flowable composite G-aenial Flo (GC) was then applied to each cavity and cured for 20 s.

The teeth were immersed in 2% methylene blue for 24 h to assess dye penetration. After removal from the dye, the teeth were rinsed and dried. Using a cutting machine, the specimens were then sectioned in a buccolingual direction in the center of the restoration. Dye penetration was observed under a stereomicroscope at ×10 magnification. A standardized scoring system [Table 1] was used to measure the degree of microleakage.^[5] Thermocycling was not applied, as a previous study revealed no significant differences between subjects with or without thermocycling.^[6]

Table 1: Scale used to measure dye penetration at the restoration interface^[6]

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Statistical analysis

The Kruskal–Wallis test and post hoc Mann–Whitney U-test were used to determine the significant difference between scores of dye penetration in three groups for the statistical analysis (P < 0.05).

Result

There were significant differences in microleakage among the three groups. The total etch group (Group 1) had the lowest amount of microleakage, followed by the selective etch (Group 3) and self-etch groups (Group 2).

The post hoc Mann–Whitney U-test revealed significant differences in microleakage between Groups 1 and 2 and Groups 2 and 3 (P < 0.05) There were no significant differences in microleakage between Group 1 and Group 3 (P = 0.164).

Discussion

Esthetic restorations are widely used in dentistry for Class V cavities, with high bond strength.^[6] Microleakage prevention and working times are important aspects of composite resin restoration success.^[7] To address these issues, total etch, self-etch, and selective etch adhesion systems, in addition to all-in-one bonding agents, have been developed.^[8] All-in-one bonding materials contain etching, conditioner, primer, and bonding agents in one package and can be used with all adhesion systems.^[4],[8]

The total etch technique uses 37% phosphoric acid, which is a strong acid, to remove the smear layer on the enamel and dissolve the enamel prism, thus enabling infiltration of the surface by adhesive material.^[9] The smear layer can affect marginal adaptation of a composite resin.^[2],[10] Good adhesion between the composite resin and dental tissue results in reduced microleakage.^[11] Self-etch techniques use phosphoric acid ester monomers, a weak acid, as an etching agent. As the etching in the enamel is not as deep as etching using phosphoric acid, the resulting bond strength is weaker than that obtained using the total etch technique.^[8],[9] Furthermore, the smear layer that forms during cavity preparation does not dissolve thoroughly, which results in a limited resin tag that performed by adhesive system.^[12] The selective etch technique also uses 37% phosphoric acid. Microleakage using this technique can be expected to be similar to that observed using the total etch technique because etching using phosphoric acid on enamel will lead to good adhesion between the tooth and composite resin.

In the present study, the total etch technique resulted in the lowest level of microleakage, with a higher amount of microleakage in the selective etch group. The results are shown in [Table 2] and [Figure 1]. This finding may be explained by the morphologies of the cementoenamel junctions in the randomly selected samples. It is possible that the cementoenamel junctions in the samples in the selective etch group contained more dentin exposure than the samples in the total etch group, which resulted in increased microleakage as compared with that in the total etch group. Dentin and cementum contain more organic material than enamel, and this makes it adhesion more difficult and results in increased microleakage.^[13] These lead to why there are variation results in the previous studies. Sidharta et al.'s research showed significant differences between total etch and self-etch adhesive technique in microleakage,^[11] while Ozel et al.'s research showed no significant differences between total etch, self-etch, and selective etch in performing microleakage.

Table 2: Distribution of microleakage scores among the groups

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Figure 1: Samples observed using a microscope at 10x magnification. Microleakage scores. (a) score 0, (b) score 1, (c) score 2, (d) score 3

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Conclusion

The use of 37% phosphoric acid reduced microleakage in composite restorations. Further studies are needed in different areas of tooth and extensive dentinal exposure to be considered.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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