Comparison of Microleakage of Composite and Glass Ionomer Restorations in Primary Molars Pretreated with Silver Diamine Fluoride at Two Time Intervals: An In Vitro study :Mais Zubair Jasim, Muna Saleem Khalaf, Dental Hypotheses

ORIGINAL RESEARCH
Year : 2022 | Volume : 13 | Issue : 4 | Page : 145--148

Comparison of Microleakage of Composite and Glass Ionomer Restorations in Primary Molars Pretreated with Silver Diamine Fluoride at Two Time Intervals: An In Vitro study

Mais Zubair Jasim, Muna Saleem Khalaf
Department of Pedodontics and Preventive Dentistry, College of Dentistry, University of Baghdad, Baghdad, Iraq

Correspondence Address:
Mais Zubair Jasim
Department of Pedodontics and Preventive Dentistry, College of Dentistry, University of Baghdad, Baghdad
Iraq

Abstract

Introduction: We aimed to evaluate the microleakage of composite resin and self-cure glass ionomer (GI) restorations in primary molars when the restorations were applied at the same day of silver diamine fluoride (SDF) treatment, and after 14 days. Methods: Class V cavities made at the buccal surface of 64 deciduous molars. For the experimental group of 32 teeth treated with SDF (eight teeth filled with composite and eight teeth filled with GI after 1 day and 14 days), the remaining 32 teeth without application of SDF served as a control group. All samples were then thermocycled and immersed in 2% methylene before being molded in epoxy resin to facilitate cutting into two sections. The dye penetration was then measured using a stereomicroscope at 20× magnification. Results: Overall model test showed statistical significant difference among study groups (P < 0.001). Post hoc test showed significant difference for usage of silver diamine fluoride (P < 0.001) and non-significant differences for type of restoration (P = 0.21) and time (P = 0.43). Conclusion: There was a significant reduction in microleakage following the usage of SDF before restoration over time.

How to cite this article:
Jasim MZ, Khalaf MS. Comparison of Microleakage of Composite and Glass Ionomer Restorations in Primary Molars Pretreated with Silver Diamine Fluoride at Two Time Intervals: An In Vitro study.Dent Hypotheses 2022;13:145-148

How to cite this URL:
Jasim MZ, Khalaf MS. Comparison of Microleakage of Composite and Glass Ionomer Restorations in Primary Molars Pretreated with Silver Diamine Fluoride at Two Time Intervals: An In Vitro study. Dent Hypotheses [serial online] 2022 [cited 2023 Mar 25 ];13:145-148
Available from: http://www.dentalhypotheses.com/text.asp?2022/13/4/145/363433

Full Text

Introduction

Despite the fact that it is mostly avoidable, dental caries still is a significant oral health challenge in children.[1] Traditionally, carious lesions are treated clinically by removing the carious tissue and replacing it with an appropriate restorative material.[2] Silver diamine fluoride (SDF) is a topical fluoride which is often used in high concentration (38%) for preventing and halting dental caries.[3] It has been suggested that the chemical components of SDF give the following advantages: fluoride assists in remineralization and prevention, silver salts promote dentin sclerosis/calcification, and exhibit germicidal effect.[4] The dark staining effect on carious tissue is the most glaring drawback of silver compounds.[5] Applying a saturated solution of potassium iodide (KI) soon after the application of SDF has been recommended as a remedy to this issue.[6] The SDF at first applied to halt and prevent caries, after that the restoration is applied, which might be made of amalgam, composite, or glass ionomer (GI).[7] Thus, this in vitro study aimed to evaluate the microleakage of composite resin and self-cure glass ionomer restorations in primary molars when the restorations were applied at the same day of SDF treatment, and after 14 days.

Materials and Methods

The ethical committee of the College of Dentistry/University of Baghdad (ref.no.553322 in Apr 17, 2022) approved the study protocol.

Sample preparation

By using G power 3.1.9.7 (http://www.gpower.hhu.de/) with 95% power, effect size of 0.61, and significance level at 0.05 the sample size was determined to be 64 primary molars. The teeth were numbered and randomly distributed by an independent person by using random number generator (TextMagic tool, https://freetools.textmagic.com/random-number-generator). The teeth were extracted for orthodontic reasons, late shedding, and should be with sound buccal and lingual surfaces.[8] Then they were placed in 0.1% thymol solution (M Dent, Nakhon Pathom, Thailand) for 24 hours[9] and stored for not more than 3 months in distilled water which was changed weekly.[10] An especially plastic mold was fabricated and elastomeric silicon impression material (HUGE Perfit, Rizhao, China) were placed inside it then teeth were mounted in the silicon with a level shorter than CEJ. Class V cavity with 3 mm width, 2 mm length, and 2 mm depth prepared on the buccal surface of these teeth by using a modified dental surveyor (Dentarum, Langhorne, PA, USA) with high speed handpiece attached to its arm in way that the bur (NTI, Kerr, CA, USA) perpendicular to the long axis of tooth. A digital caliper (Dentirak, Baghdad, Iraq) and periodontal probe were used to measure the depth and diameter of the cavity.[11]

Silver diamine fluoride treatment

For the experimental group 32 teeth treated with 38% silver diamine fluoride (Riva Star, SDI, Bayswater, Australia) according to the manufacturer’s instructions. All specimens were left for 3 minutes and then washed for 10 seconds with copious volumes of distilled water before being air dried for 10 seconds.[12] The remaining 32 teeth without application of 38% silver diamine fluoride served as control group.

Restorations placement

At first day, among 16 teeth that treated with SDF, 8 of them restored with composite (Aura bulk fill, SDI, Bayswater, Australia). Dentin bonding (self-etch universal, 3M, St. Paul, MN, USA) was applied according to manufacturer’s instructions, light cured for 20 seconds (Eighteeth, Changzhou, China) and then composite filling was applied and then cured for 40 seconds, after that the filling was finished and polished with a polishing bur (NTI CeraGlaze, Kerr, CA, USA). Another eight teeth restored with self-cure glass ionomer filling material (Riva, SDI, Bayswater, Australia) according to manufacturer’s instructions. Glass ionomer (GI) filling was also finished and polished. While the other 16 teeth not treated with SDF, eight of them restored with composite and eight restored with GI in the same manner. The remaining 16 teeth stored in artificial saliva which was refreshed daily. After 14 days, the teeth removed and cleaned and restored at the same manner.

Microleakage determination

A thermocycler device (Custom made, Baghdad, Iraq) was used for thermocycling to simulate the thermal changes that occur in the oral cavity and result in changes between cavity restoration and tooth surface. Thermocycling was carried out by soaking all specimens alternatively into (5–55 ± 1–2C) water bath chambers with 30 seconds immersion time in each bath and 10 seconds transition time for 500 cycles according to ISO/TS (E) 11405:2003.[13],[14] Then, all samples coated with two layers of nail polish (Golden rose, Istanbul, Turkey) except for 1 mm around the restoration margins, and submerged in 2% methylene blue dye (Zuhair Lab, Baghdad, Iraq) for 24 hours. The samples were then cleaned and dried under running water.[15] The samples were immersed in clear epoxy resin to form blocks with dimensions (3 × 2 × 1) cm; the teeth were then sectioned by using sectioning saw device (XP Precision sectioning saw, Ted Pella, CA, USA), and 0.01 mm disc (Ted Pella, CA, USA) with water coolant in bucco-lingual direction at the center of the filling into two sections.[16]

After that, microleakage represented by dye penetration was measured in millimeters (mm) by Optika Vision lite 2.1 software (OPTIKA, Ponteranica, Italy) using a stereomicroscope (KRÜSS, Hamburg, Germany) under (20×) magnification, the measurements were done by one calibrated operator blinded to treatment allocations. The image was taken for each tooth section by a camera (OPTIKA, Ponteranica, Italy) mounted on the stereomicroscope. Both sections were measured and the greatest microleakage was recorded.[17]

Statistical analysis

Data analysis was performed by the three-way ANOVA and the Tukey post hoc test using R software (R Foundation for Statistical Computing, Vienna, Austria). Data analysts were blinded to the type of restorations and time intervals.

Results

Overall model test showed statistical significant difference among study groups (P < 0.001). Post hoc test showed significant difference for usage of SDF (P < 0.001) and non-significant differences for type of restoration (P = 0.21) and time (P = 0.43) [Figure 1].{Figure 1}

Discussion

Because in vitro testing are still an essential tool for initial screening of dental materials and may establish a theoretical maximum amount of leakage that could be present in vivo, microleakage evaluation was carried out using an in vitro method.[18] Ideally, the preferred approach relies on multiple application of SDF, followed by placement of restoration, however there may be situations in which a practitioner will only be able to see the patient once.[19] If there is concern that the patient may not return to second visit for multiple application of SDF, or if a patient has large numbers of active lesion or particularly large lesion that is difficult to restore all teeth at single appointment, less time consuming techniques such as SDF with immediate filling placement may be considered.[20] Occluding dentinal tubules by the effect of SDF could explain why microleakage was reduced in experimental group, especially at 14 days’ interval that SDF had more time to work and occlude dentinal tubules and this came in agreement with Willershausen et al.,[21] who stated that pain was reduced after 1 week when they used SDF for dentin hypersensitivity when they measured the penetration of SDF by using scanning electron microscope (SEM).

However, the results of this study showed that there was significant reduction in microleakage following usage of SDF over time. This finding is in contrast with the report of Soliman et al.,[22] who found that there was no significant difference in microleakage of GI restorations between teeth treated and not treated with SDF when they use primary teeth in their study and Uzel et al.,[23] who also found that there was no significant difference in microleakage of composite resin restorations between teeth treated and not treated with SDF when they used third molars in their study. Likewise, Gupta et al.,[24] reported a non-significant difference in microleakage following usage of SDF for resin-modified glass ionomer restorations. Nevertheless, this controversy may be related to different formulations among commercially available SDF solutions. For instance, formulation of the Riva Star included potassium iodide in conjunction with SDF. Also in some studies such as Gupta et al.,[24] chlorhexidine gluconate was combined with SDF. Usage of negative ions of F in combination with positive ions of chlorhexidine is a controversial concern.[25]

Nevertheless, readers must note to the limitations of this study. The black staining after SDF treatment made a confusion during the microleakage measurement, it was hard to discarnate between black discoloration and methylene blue dye at tooth restoration interface. Other limitation of this study is limited sample size. Additionally, due to several factors relating to the oral environment, in vivo confirmation of the result is necessary.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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