Evaluations of Micro-Leakage in Composite Resin Restoration, Glass Ionomer Cement Restoration and Traditional Amalgam Restoration using Streptococcus mutans
Jembulingam Sabarathinam, Mr. N. P. Muralidharan, Dr. Pradeep
1Undergraduate Student, Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Chennai -600077.
2Asst. Professor, Department of Microbiology, Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Chennai -600077.
3Senior Lecturer, Department of Conservative Dentistry, Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Chennai -600077.
*Corresponding Author E-mail: mugaidar@yahoo.com
ABSTRACT:
AIM: The aim of the study was to compare and evaluate the micro-leakage of composite resin restoration, Glass Ionomer cement restoration and traditional amalgam restoration using Streptococcus mutans. MATERIALS AND METHODS: In this study 40 single rooted lower premolar teeth were used. All the samples were made it 10*5 mm cylinders by cutting the coronal and apical portion of the teeth. The orifice were cleaned and shaped using rotary instrument (ProTaper system). A standard 2*2mm cubical cavity was made in the occusal aspect of the prepared teeth which was 1.5mm deep, composite, amalgam and GIC restorations were done. Each of the tooth were fixed to a plastic tube using a sealant were there restored portion of the teeth will be within the tube and the apical part of the tube is outside the tube. Sterilized twice in the autoclave at 121°C for 30minutes. Each tube containing the teeth was transferred to a test tube containing nutrient broth. This is made to visually monitor the leakage if the broth turnsturbid. Then 2ml of nutrient broth was added to each of the plastic tubes and 50 µl of Streptococcus mutans suspension prepared was added to the nutrient broth in the plastic tube containing the tooth and left for incubation at 37°C for 24 hrs. The nutrient broth in the test tube was checked regularly at every 2 hours’ time for the turbidity. RESULTS: Three restorations namely Glass Ionomer cement, amalgam and Composite restoration were compared, the amalgam restoration had the least micro leakage followed by composite restoration. Glass Ionomer cement had the maximum leakage when compared to the other groups. CONCLUSION: In this in vitro study traditional amalgam restoration though less flexible and unaesthetic still prove to be stronger and has reduced micro leakage when compared to modern cements like glass Ionomer cement and composite resin which have less chair side time, ease of use and aesthetically appealing appearances.
KEYWORDS: Microleakage, Composite Restoration, Amalagam, Gic, Resin Cements.
INTRODUCTION:
Micro leakage is the imperceptible movement of microbes, saliva, molecules and ions between the walls of the cavity and the restorative materials[2,3]. Micro leakage is the causative factor of post-operative sensitivity, secondary caries, marginal discoloration, pulpal inflammation and failure of the restoration. Restricting and preventing the micro-leakage has been a challenge in the arena of restorative dentistry. Various restoratives have to been developed to counteract the marginal micro-leakage in recent years which includes Glass Ionomer cements and Resin cements[4].
Dental amalgams remain as a traditional and primary direct restorative material for the load bearing areas. Even though these restorations have a good durability, strength and ease of use, they hold back disadvantages such as the metallic silver color of the restoration which is esthetically not pleasant, increased sensitivity to the tooth and lacks adhesive properties[5,6].
Glass Ionomer cements have been used very widely after their introduction by Kent and Wilson. These materials have increased advantages as they form chemical bonds with the tooth and have a similar color as that of the tooth although they have compromised strength and toughness[7].
Due to the advances in the adhesive resin technology, there has been a tremendous increased demand for the composite resin due their ability to accurately match the shade of the teeth, absence of mercury and biocompatibility. The major drawback associated with the resin cements are the polymerization shrinkage which leads to micro-leakage[8].
Thus the present study was done to compare and evaluate the micro-leakage of composite resin restoration, Glass Ionomer cement restoration and traditional amalgam restoration using streptococcus mutans.
MATERIALS AND METHODS:
SAMPLING:
In this study 40 single rooted lower premolar teeth free of caries and other defects extracted for orthodontic purpose were selected. All samples were disinfected and stored in sterile saline.
STANDARDISATION:
All the samples were made it 10*5 mm cylinders by cutting the coronal and apical portion of the teeth. The orifice were cleaned and shaped using rotary instrument (ProTaper system).
CAVITY PREPARATION:
A standard 2*2mm cubical cavity was made in the occusal aspect of the prepared teeth which was 1.5mm deep
GROUP SELECTION:
GROUP 1: CONTROL GROUP (n=10)
GROUP 2: STUDY GROUP 1 – COMPOSITE RESTORATIONS (n=10)
GROUP 3: STUDY GROUP 2 – GLASS IONOMER RESTORATIONS (n=10)
GROUP 4: STUDY GROUP 3 – AMALGAM RESTORATIONS (n=10)
RESTORATION OF THE CAVITY:
Composite group: acid etching was done using 37% orthophosphoric acid for 20 seconds and rinsed. After drying, dentin bonding agent was applied and cured for 20 seconds and the composite was added in increments and cured for 40 seconds.
Amalgam group: zinc phosphate base was given, amalgam was condensed into the cavity and amalgam carving was done.
Glass Ionomer cement group: Dentin conditioner was applied and GIC cement was mixed and placed. Final finishing was done.
Bacterial indicator:
In this study standard strain of streptococcus mutans is used as an indicator to identify the leakage. Streptococcus mutans was cultured in Brain Heart Infusion Agar (BHI Agar) overnight at 37°c aerobically. This fresh culture is made as a suspension in normal saline turbidity matching 0.5 Mcfarlandstandard.
Assessment of Bacterial Leakage:
Each of the tooth were fixed to a plastic tube using a sealant were there restored portion of the teeth will be within the tube and the apical part of the tube is outside the tube. This set up was sterilized twice in the autoclave at 121°C for 30minutes. Each tube containing the teeth was transferred to a test tube containing nutrient broth. This is made to visually monitor the leakage if the broth turn turbid.
Then 2ml of nutrient broth was added to each of the plastic tubes and 50 µl of Streptococcus mutans suspension prepared was added to the nutrient broth in the plastic tube containing the tooth and left for incubation at 37°C for 24hrs. The nutrient broth in the test tube was checkedregularly at every 2 hours time for the turbidity.
RESULTS:
Composite
Figure1
GIC
Figure2
Amalgam
Figure3: Diagram Showing The Leakage in The 3 Test Groups
Table 1: Mean Duration of Appearance of Turbidity
|
Groups |
Number of Samples |
Mean |
|
Control Group |
N=10 |
0 |
|
Composite Group |
N=10 |
24 hours |
|
Gic group |
N=10 |
6 hours |
|
Amalgam Group |
N=10 |
48 hours |
In the amalgam group, there was no turbidity in 80% of the samples whereas there was turbidity in 20% of the tubes in which the mean duration of the appearance of turbidity was in 48 hours. [FIGURE 3]
In the composite group, there was no turbidity in 60% of the tubes whereas there was turbidity in 40% of the samples in which the mean duration of the appearance of turbidity was in 24 hours. [FIGURE 1]
In the GIC group, there was turbidity in 100% of the samples in which the mean duration of the appearance of turbidity was in 6 hours. [FIGURE 2]
DISCUSSION:
Micro-leakage is of supreme importance in restorative dentistry as it prime cause of pulpal alteration, sensitivity and secondary caries which are the lead factors which causes the failure of the restorations[9].
In this study, the cause of turbidity is the presence of Streptococcusmutans in the broth which determines micro leakage. Three restorations namely Glass Ionomer cement, amalgam and Composite restoration were compared, the amalgam restoration had the least micro leakage followed by composite restoration. Glass Ionomer cement had the maximum leakage when compared to the other groups [TABLE 1].
It is evident that micro leakage is not a phenomenon cause by a single factor and it involves a series of events which depends upon the various physical factors of the restorations like property of adhesion, polymerization shrinkage, and coefficient of expansion, compressible strength and marginal adaptation[3].
Composite restorations are preferred over amalgam restorations these days due to the esthetic considerations, but at the same time the composite restoration exhibit high polymerization shrinkage. Therefore cause less stable dentin Cementum substrate for bonding[10]. The modern composite reveals volumetric contraction and has high coefficient of expansion which is one of the prime reasons for the marginal micro-leakage. In-vitro and in-vivo studies done by alpekin T et al reveals that composite restorations have higher micro-leakage when compared to amalgam restoration which coincides with the results of our current study[8].
Glass Ionomer cements bond chemically to the tooth structure by formation of calcium-polyacralate bond[11]. The high liquid - powder ration and the reduced particle size, increases the viscosity which leads to micro leakage, not allowing the wetting of the tooth structure prevent a good seal between the restoration and the tooth surface. The cements are sensitive to moisture, were increase in moisture leads to decrease bond strength and the sealing ability[12]. Also excessive dehydration can lead to chalky, crazed and cracked restoration surface which considerably increase the micro leakage.in our current study GIC showed the highest micro leakage compared to amalgam and composites[1].
Amalgam shows delayed expansion which seals the margins reducing micro leakage. It has also been reported that the amalgam restorations can seal the restoration margin by corrosion products over sometime which contributes to the decreased micro-leakage ability of the restoration[13]. Though the restoration is unaesthetic, it has a better sealing property when compared to GIC and composite restorations. The main disadvantage of amalgam restorations is that it develops new marginal gaps due to thermal and mechanical stress which could possibly increase the micro leakage over a period of time[14].
CONCLUSION:
Micro leakage is the reason for complication and loss of the restored tooth. Failure in this case is contributed by many factors like, the physical property of the material, chemical nature and their antimicrobial activity. Manual error can also be a valid reason, more number of studies to be conducted to ascertain the clinical implication especially in invivo conditions. In this in vitro study traditional amalgam restoration though less flexible and unaesthetic still prove to be stronger and has reduced micro leakage when compared to modern cements like glass Ionomer cement and composite resin which have less chair side time, ease of use and aesthetically appealing appearances.
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Received on 19.05.2019 Modified on 16.06.2019
Accepted on 02.07.2019 © RJPT All right reserved
Research J. Pharm. and Tech. 2019; 12(11): 5341-5344.
DOI: 10.5958/0974-360X.2019.00927.2