|Year : 2020 | Volume
| Issue : 4 | Page : 178-184
In vitro comparison of Biodentine and Riva LC interfaces with cervical dentin and Filtek Z350 in posterior class II open sandwich restorations
Aguir Mabrouk Najet1, Kasdallah Sawsan1, Ziada Saida1, Ben Salem Kamel2
1 University of Monastir, Faculty of Dental Medicine, Biological and Clinical Dento-Facial Approach Laboratory (ABCDF) LR12ES10, Tunisia
2 University of Monastir, Faculty of Medicine, Tunisia
|Date of Submission||29-Dec-2018|
|Date of Acceptance||19-Nov-2020|
|Date of Web Publication||05-Feb-2021|
Prof. Aguir Mabrouk Najet
Faculty of Dental Medicine, University of Monastir, Biological and Clinical Dento Facial Approach, LR12ES10, 5019 Monastir
Class II open sandwich restorations are routinely performed with resin-modified glass ionomer cement as a dentin substitute and with composite resin as an enamel substitute. Biodentine™ is a new calcium silicate-based material. Various authors have evaluated the microleakage of composite resin restorations, where different resin-modified glass ionomer cements and Biodentine, used as a dentin base, were compared in class II open sandwich restorations. The aim of this study was to evaluate and to compare in vitro the sealing ability of Biodentine™ and Riva LC with cervical dentin and Filtek Z350 in posterior proximal restorations using the dye penetration test.
Keywords: Biodentine™, cervical interface, dye infiltration, open sandwich technique, Riva LC, sealing ability
|How to cite this article:|
Najet AM, Sawsan K, Saida Z, Kamel BS. In vitro comparison of Biodentine and Riva LC interfaces with cervical dentin and Filtek Z350 in posterior class II open sandwich restorations. SRM J Res Dent Sci 2020;11:178-84
|How to cite this URL:|
Najet AM, Sawsan K, Saida Z, Kamel BS. In vitro comparison of Biodentine and Riva LC interfaces with cervical dentin and Filtek Z350 in posterior class II open sandwich restorations. SRM J Res Dent Sci [serial online] 2020 [cited 2021 Feb 26];11:178-84. Available from: https://www.srmjrds.in/text.asp?2020/11/4/178/308786
| Introduction|| |
Direct approximal restorations are commonly carried out in daily practice. Resin composite is the most used material as it supplies good esthetic results. However, they are known to show more leakage at dentin interface, when the enamel is insufficient or of a poor quality and when polymerization is inappropriate at gingival margins.
To solve these problems, cervical lining restorations have, therefore, arised and resin-modified glass ionomer cements (RM-GIC) have shown very interesting performances. They adhere spontaneously to dentine and showed a gap-free interfacial adaptation to dentin. These materials alleviate polymerization stress when used under composite resin restoration.
However, despite satisfactory clinical results, these materials showed remarkable color and marginal instability.,
In 2009, Septodont launched a new bioactive material based on tricalcium silicates: Biodentine™. Biodentine™ is easy to handle and it requires no prior treatment of dental surfaces. It has a short setting time and good physical properties.,,, Biodentine has been recommended for use as a dentin substitute under adhesive restorations.
The sealing efficacy of the materials used to restore teeth is one of the main factors preventing microleakage at the restorations interfaces. The sealing ability of Biodentine™ to dental tissues and to the overlaying restorative material has been the subject of few studies. These studies evaluated these interfaces using different pretreatments of the dental surfaces and Biodentine surface, used as dentin substitute, in the open sandwich technique. The objective of these studies was to establish relevant protocols to ensure the long-term survival of open sandwich restorations using Biodentine. Contradictory results have been reported regarding Biodentine-dentin and composite interfaces compared to RM-GIC-dentin and composite interfaces.,,, Koubi et al. and Raskin et al. stated that Biodentine is a convenient and efficient dentin replacement material and performed as well as RM-GIC when used against cervical dentin and recovered with composite restorations. Camelleri et al. mentioned that Biodentine™ used as a dentin substitute in proximal cavities exhibited a significant leakage at the interface with dentin. Further studies are consequently required to investigate the leakage arising with Biodentine when used as a dentin substitute in open sandwich technique under composite restorations.
The current research aims to compare Riva LC™ and Biodentine™, used as dentin substitute materials, for posterior proximal restorations under Filtek™ Z350 resin composite and to evaluate, in vitro, the sealing ability of the interfaces created between:
- Biodentine ™ (Septodont, St. Maur Des Fosses Val de Marne, France), Riva LC™ (Southern Dental Industries [SDI], Victoria, Australia), and cervical dentin
- A two weeks aged Biodentine ™ (Septodont, St. Maur Des Fosses Val de Marne, France), Riva LC™ (SDI, Victoria, Australia), and Filtek ™ Z350 composite resin (3M ESPE, St. Paul, MN, USA) in combination with Single Bond 2 Adhesive (3M ESPE, St. Paul, MN, USA) while using the open sandwich proximal restorations on posterior teeth.
| Materials and Methods|| |
Three different restorative materials were used: a nano-hybrid resin composite Z350 and two dentin substitutes: Biodentine and a Resin Modified Glass Ionomer Cement Riva LC to assess, in vitro, the microleakage at the interfaces. Adper Single Bond 2 Adhesive was used to seal the resin composite Z350 dental residual tooth structure, Riva LC and Biodentine [Table 1].
Twenty-two human maxillary and mandibular permanent molars, freshly extracted for periodontal reasons, were scaled for surface debridement, then polished with rotative brush and pumice in order to remove tartar, soft tissues, and other debris. The teeth were then stored in water until the operating procedures. All the teeth were examined under a stereomicroscope in order to verify that they are caries free, with no fluorosis or any structural alteration. Each tooth was numbered.
Two amelodentinal cavities box type were prepared at the mesial and the distal surface of each tooth. The cervical margins were located 1 mm apically to the cement-enamel Junction. They were, therefore, positioned within the cement. Each cavity presented the following dimensions: mesiodistal width (3 mm), opening of the occlusal side (3 mm), and cervical length (3 mm). The measurements were verified with a periodontal probe and the cervical angles were rounded. The cavities were prepared with a high-speed handpiece, using a diamond cylindrical bur under heavy water spray. The diamond bur was replaced following every four preparations.
The teeth were randomly divided into two groups of 11 teeth each. 22 cavities (G1) were restored with the open sandwich technique using Riva LC RM-GIC + Adper Single Bond 2 + Filtek™ Z350 composite resin. 22 other cavities (G2) were restored with open sandwich technique using Biodentine™ + Adper Single Bond2 + Filtek™ Z350 composite resin.
- Group 1: In order to remove the smear layer resulting from cavity preparation, a 10% polyacrylic acid solution (GC Dentin Conditioner) was applied to the cavity surfaces for 20 s and then rinsed thoroughly for 10s with water. An Automatrix (Dentsply, Konstanz, Germany) was adjusted and secured around each cavity which was wholly filled with Riva LC™. The RM-GIC (Riva LC™, SDI, Victoria, Australia) was prepared according to the manufacturer's recommendations and placed in bulk to fill the cervical two-thirds of the cavity. Riva LC™ was allowed to chemically set for 5 min and then was light-cured for 40 s; light curing did not occur immediately to permit material spreading and setting stress relaxation
- Group 2: Twenty-two cavities were entirely filled with Biodentine prepared according to the manufacturer's recommendations without any enamel or dentin wall treatment and without dentin-bonding agent between the dentin walls and Biodentine™.
All the teeth of groups 1 and 2 were then stored in an incubator (37°C and 90% relative humidity) for 60 min before the finishing and polishing procedures were carried out with Soflex Disc 3M ESPE.
Composite resin fillings were performed after an interval of 2 weeks. Biodentine™ and Riva LC™ were reduced to a 2 mm layer in each cavity, using a diamond bur mounted on a high-speed handpiece under copious water coolant. The cavities were totally etched with 37% phosphoric acid (3M ESPE) gel for 15 s and were then thoroughly rinsed. The enamel margins were etched for an additional 15 s before being thoroughly rinsed (10 s) and gently dried for 30 s. Adper Single Bond 2 was applied with a microbrush on all the surfaces (dentin, enamel, and Biodentine™ or Riva LC™ RM-GIC) and then light cured for 20 s.
The resin composite was applied in three increments of 2 mm maximum. Each increment was light cured for10 s. At the end of the procedure, the composite resin fillings were light cured for 40 s with a light-curing unit (EliparTrilight, 3M ESPE) in standard mode (800 mW/cm2) and kept at 37° and 90% humidity for 24 h. They were then finished and polished with medium and fine Sof-Lex™ discs (3M ESPE) and silicone tips.
The same resin composite was used for all restorations (Filtek™ Z350, shade A3 E, 3M ESPE, Saint Paul, MN, USA). All materials were handled and applied according to the manufacture's recommendations. The restorations of each experimental group were randomized between two skilled operators so that each operator carried out half of the restorations of each group.
Preparation of teeth for thermocycling
The teeth roots were tagged and placed in transparent orthodontic resin cubes up to 1 mm from the cervical margin of the restoration in order to facilitate the grasping and sectioning of the crowns. The teeth crowns were then double coated with nail varnish up to 1 mm from the restoration margins. The teeth were stored in a 0.9% KCl solution.
Thermocycling and dye infiltration
The samples were stored in distilled water for 3 days at 37°C and then thermocycled in water baths. The thermocycling technique proposed by Teplitsky et al. was selected for this study. Two cycles of temperature simulated the thermal variations observed in the oral cavity: a daily cycle including 45 min at 6°C, followed by 45 min at 60°C was repeated four times. Thereafter, the teeth were kept for18 h at room temperature. This daily cycle was repeated for 5 consecutive days allowing a total of 15 h exposure at each extreme temperature.
Methylene blue infiltration
A second application of two layers of varnish on each crown was performed. The teeth crowns were subsequently immersed in 2% methylene blue solution for 48 h at room temperature with their apices directed upward. The teeth were then rinsed under running water for 15 min, dried in the open air, and cleaned with abrasive discs to remove any dye trace. A 0.4 mm thick diamonded saw Isomet® chain saw (Buehler) was used at 7 rpm speed to separate the roots of each tooth from the crown and split each crown longitudinally in the mesiodistal direction at the middle of the mesial and distal restorations. Two sections were obtained per restoration, a vestibular and a lingual one. A total of 44 surfaces per substitute were observed for the dye penetration [Figure 1] and [Figure 2].
|Figure 1: a,b,c,d,e and f, Sections of teeth restored with the open sandwich technique using Riva LC/Filtek Z350 after dye infiltration.|
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|Figure 2: a,b,c,d,e and f, Sections of teeth restored with the open sandwich technique using Biodentine/Filtek Z350 after dye infiltration|
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The observation was carried out separately by two observers. Each section was observed at the stereo microscope to evaluate dye infiltration at the different interfaces using the Carl Zeiss™ STEMI 2000C ZOOM 6, 5 stereomicroscope. The level, intensity, and importance of dye penetration were noted separately for each face of the section: buccal and lingual.
The degrees of penetration of methylene blue in each restoration were noted separately for:
- The cervical wall: Riva LC™ RM-GIC/dentine and Biodentine™/dentine interfaces
- Riva LC™ RM-GIC/Filtek™ Z350 and Biodentine™/Filtek™ Z350 interfaces.
Microleakage was assessed in the gingival and axial walls by the extent of dye penetration according to the criteria shown in [Table 2] and [Figure 3].
|Figure 3: Tracer penetration evaluation at substitute/dentin interface, level 1 (l1) and substitute/resin interface, level 2 (l2) |
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|Table 2: Scores of dye penetration at the substitute/dentin interface (level 1) and the substitute resin interface level 2)|
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The score measurements were taken by cavity halves by two operators. Descriptive statistics were used to evaluate the infiltration according to the material used. The total sample size was 89 halves (44 [G1] + 45 [G2]) justifying the use of the Chi-square Pearson test to compare the scores found for the different substitutes (Riva LC™ and Biodentine™) at cervical dentin margins and at the dentin substitute/Filtek™ Z350 interface. The statistical significance level was set at 0.05. Statistical analysis was carried out using data processing software: IBM® SPSS® statistics 20.0. Microsoft Office Excel 2007 Software Japan Ltd was also used to establish some numeric functions and descriptive graphics.
| Results|| |
Evaluation of infiltration by level
At the interface dentin-substitute (L1), the difference is statistically significant (Pearson's Chi-square test = 0.001, P < 0.05 [Table 3]. The percentages of the infiltration presence are 66% and 34%, respectively, for Riva LC™ RM-GIC and Biodentine™.
Scales of infiltration by level according to the substitute
Dye penetration at the dentin cervical margins
The median maximum scores recorded are 0 for the Biodentine™ group and 1 for the Riva LC™ group. Only the Riva LC™ group presented score 1. Both groups presented score 3 [Table 4].
|Table 4: Distribution of infiltration scores at the interface Substitute/Dentin|
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Dye penetration at the interface substitute/Filtek™ Z350
No statistically significant differences were evident between Biodentine™ and Riva LC™. The percentages of the infiltration presence are 47.8% and 52.2%, respectively, for Riva LC™ RM-GIC and Biodentine™ groups [Table 5]. The median maximum scores recorded are 0 for the Biodentine™ group and Riva LC™ group. Only the Riva LC™ group presented score 1. Score 3 was recorded in the Biodentine™ group [Table 6].
|Table 6: Distribution of the infiltration scores at the Substitute / Filetek™ Z350|
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| Discussion|| |
Direct approximal restorations are frequently performed in daily practice. Resin composite is a widely used material for this type of restorations. Nevertheless, this material does not allow a gap-free marginal sealing which is attributed to poor enamel quality or its absence, as well as polymerization shrinkage.,
Therefore, RM-GIC were proposed to be placed between the dentin gingival margins and the occlusal resin composite in case of open sandwich restorations in order to optimize cervical sealing. These materials showed a high percentage of gap-free interface with the dentin.
Biodentine (Septodont, Saint-Maur-des Fosses, France), a Portland-based tricalcium cement was developed in 1990. This biocompatible and bioactive material was conceived and proposed by the manufacturer as a suitable and reliable dentin substitute for direct posterior restorations.
An adequate contact of a restorative material with the surrounding material (dentin, enamel, and dental material) is basic and it is a required feature., Marginal integrity and longevity of the interface ensure the restoration survival in clinical conditions.
Various authors have evaluated the microleakage of composite resin restorations, where resin-modified glass ionomer cements and Biodentine™ lined class II open sandwich restorations were used with different dentin conditionings.,,,
The current study compares and evaluates, in vitro, the sealing ability of the interfaces between Biodentine™/dentin, Riva LC™/dentin, and Biodentine™/Filtek™ Z350, Riva LC™/Filtek™ Z350, in posterior class II open sandwich restorations using the dye penetration test.
The results of our study showed that none of the substitutes eliminated infiltration at 100%. The statistical difference is significant only at the substitute/dentine interface [Table 2]. At this level, Biodentine ™ presented less leakage with an infiltration percentage of 34%, compared to 66% for the Riva LC™ (P = 0.001). This is in agreement with the work of Solomon et al. which showed that percolation is less important with Biodentine ™ than with Fuji II LC, justifying the use of Biodentine ™ as an alternative in deep proximal restorations.
At the dentin cervical margins, the median maximum scores recorded are 0 for the Biodentine group and 1 for the Riva LC™ group. Only the Riva LC™ group presented score 1. Both groups presented score 3.
In the current study, Biodentine was used as a dentin substitute in cervical approximal cavities without any prior treatment of dentin. These low scores were achieved by the alkaline feature of calcium hydroxide in Biodentine™, which allowed it to gain dentin tubules after caustic erosion and to form a hybrid layer with the dentin.
At level 1 of the group Biodentine™, we noticed a score 0 (no infiltration) in 69% of the observations; this asserts that Biodentine ™ is more water resistant than Riva LC™. Indeed, during the hydration of Biodentine™, the initial contraction was followed by an expansion which improved adhesion. Unlike RM-GIC, Biodentine™ does not alter in saliva or acidic environments, but instead, it forms crystals similar to hydroxyapatites. Aggarwal et al. 2015 showed that the marginal adaptation of Biodentine™ increases with time. The presence of extreme scores (score 3) results from the presence of air bubbles, a lack of finishing, and especially a change in Biodentine™ consistency between the mixing moment and the last quantity placement.
In the current study, the marginal sealing of approximal restorations with gingival margins below the cementoenamel junction presented higher leakage with Riva LC. Comparing the infiltration scores at level 1 of the RivaLC™ group, we noticed that score 0 is present in only 31% of the observations. Score 1 is predominant.
RMGIs contain polyacrylic acid (polyalkenoic acid chains). They are recognized to be “soft” self-etching and mild self-conditioners; this enables them to bond chemically to the smear layer and to form a hybrid layer reaching 500 nm. Imbery et al. proved that the use of cavity conditioner does not significantly improve the bond strength of the three RM-GICs compared with leaving the smear layer intact. The smear layer contains calcium ions that may provide bonding sites for chemical bonding with the polyalkenoic acid chains in the RMGI. Furthermore, the inherent dentin irregularities produced during specimen preparation provided micromechanical retention.,
SDI, the manufacturer of Riva LC™, recommends using either polyacrylic or phosphoric acid for dentin conditioning. In this study, the dentin substrate was conditioned with polyacrylic acid before using Riva LC™. Despite this, score 1 was predominant in the Riva LC™ group.
Since RMGIs contain resin, it has been hypothesized that the bond strength of RMGIs can be improved by the application of dentin bonding agents. Several investigations compared, with other conditioning agents, the effect of the bonding agents on the adhesion of RM-GICs to dentin., It was proved that dentin bonding agents are able to form a chemical union with RMGIs due to the presence of HEMA and other resins in RM-GICs. Imbery et al. proved that RMGIs, including Riva LC™, obtain their highest bond strengths when Optibond Solo Plus is applied after etching the dentin with phosphoric acid.
Polishing is another factor that can influence the tightness of a cervical restoration. In our study, finishing the preparations was performed after 24 h of filling. In previous studies, it has been shown that polishing after water storage for 1 day is recommended to improve the tightness of cervical restorations with RM-GIC.
The presence of score 3 with a percentage of 28.9% and the cracked appearance of Riva LC™ are due to the consistency of the Riva LC™ at the time of placement. Indeed, a capsule of Riva LC™ served to seal more than a cavity. Riva LC™ is both self-curing and light-curing. Daylight initiates its setting and modifies its consistency affecting the quality of the interface of the last cavity.,
Our results are consistent with the work of Raskin et al. and Solomon et al. These works revealed that the water tightness of Biodentine ™ and Riva LC™ is comparable, but Biodentine™ is slightly more efficient, especially at the cervical level which justifies its use as an interim restoration and a dentin substitute.
Koubi et al., 2012, used glucose diffusion to compare the tightness of Biodentine™ and RM-GIC sandwich technology. They concluded that there is no statistically significant difference between the two materials. Biodentine™ is as waterproof as Ionolux when used as a cervical base in open sandwich restorations. The results of this study are in agreement with our results.
Adhesion of Biodentine to the restorative materials is as important as that of Biodentine™ to dental tissues.
Theoretically, a chemical bond is possible between the calcium of Biodentine™ and the functional monomer 10-methacryloyloxydecyl di-hydrogen phosphate, present in the adhesive; hence, promoting chemical adhesion in addition to micromechanical attachment.
Currently, there is limited information in the literature on the interface between Biodentine™ and the overlying adhesive restorations. A 5th generation etch and rinse adhesive type MR2 adhesives are suggested to improve adhesion to composite resin. Indeed, the study of Cengiz et al. showed that Filtek™ Z 250 resin composite exhibits better adhesion to Biodentine™ than to Fuji II™. Filtek™ Z250 adheres better to Biodentine™ with Prime and Bond™ (MR2) than with Clearfil SE Bond™ (SAM2). Applying an MR2 adhesive improves the adhesion of the composite resin to Biodentine.
In the current study, Filtek™ Z350 Resin adheres as well to both Riva LC™ and Biodentine™. The scores 1, 2, and 3 are very low at both interfaces. Dye infiltration at Riva LC™/Filtek™ Z350 does not exceed half of the horizontal interface with score 1 being much more present than scores 2 and 3 in the Riva LC™ group. However, Score 3 is five times more present at the interface Biodentine ™/Filtek™ Z350.
These results are explained by the role of Adper Single Bond™ (3M ESPE, Products, St Paul, MN, USA) which is a total-etch adhesive system containing HEMA and silane-treated silica in its composition. In a research of Raskin et al., silane coupling agent application over a 15 s etched Biodentine™ produces a tight seal against microleakage., Silane improves adhesion and increases resistance to moisture, temperature changes, and chemicals. Filtek™ Z350 contains nanoparticles and nanoclusters (zirconia/silica fillers). Nanoclusters strengthen this resin and significantly improve its strength and reliability. Silane infiltration into the interstices of nanoclusters improves clinical performance.
Filtek™ Z350 used for restorations in the present study responds to the nanotechnology novel technique which exhibits an optimal polish and polish retention, maintains the strength and wear properties, and decreases the degree of conversion and consequently polymerization shrinkage.
These results are also due to the use of the oblique incremental technique which reduces the stress generated through the factor C by the reduction of the composite volume. It is widely accepted that incremental filling decreases shrinkage stress as a result of the reduced polymerization material volume.
In the current study, resin composite restorations were delayed 2 weeks after the placement of dentin substitute in both Riva LC™ and Biodentine™ groups in order to avoid early stress and reduce gap formation at this interface. Nekoofar et al. stated in a previous research that it takes up to 2 weeks to achieve complete maturation of Biodentine™ and to reach its maximum mechanical properties.
Thus, we note that Biodentine™ could be the material of choice to replace RM-GIC guaranteeing the long-term durability of open sandwich-type restorations.
| Conclusion|| |
Within the limits of this study, we concluded that Biodentine used without a dentin conditioner is more water resistant than Riva LC in contact with cervical dentin. Filtek™Z350 bonded to Biodentine™ and Riva LC™ with Adper Single Bond™ adhesive provides a watertight interface seal with these materials. This research suggests that Biodentine may be used as a suitable dentin substitute in cervical approximal cavities under composite resin for posterior restorations.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]