Margin Integrity of Conservative Composite Restorations

after Resin Infiltration of Demineralized Enamel

Philipp Körnera / Mohamed El Gedailyb / Rengin Attinc / Daniel B. Wiedemeierd / Thomas Attine /
Tobias T. Tauböckf

Purpose: To investigate the influence of pretreating demineralized enamel with a caries infiltrant on the margin in-
tegrity of Class V composite restorations bonded with different adhesives.
Materials and Methods: A total of 60 specimens from bovine incisors were demineralized (21 days, acid buffer, pH
4.95) to create artificial enamel lesions, and circular Class V cavities were prepared. Cavities of half of the speci-
mens were treated with either an unfilled etch-and-rinse adhesive (Syntac Classic; Ivoclar Vivadent), a filled etch-
and-rinse adhesive (Optibond FL; Kerr), or a self-etch adhesive (iBond Self Etch; Heraeus Kulzer) (n = 10 per
group). Demineralized enamel of the other half of the specimens was pretreated with a caries infiltrant (Icon; DMG)
prior to adhesive application. All cavities were restored with a nanofilled composite material and thermocycled
(5000×, 5°C–55°C). Margin integrity was evaluated using scanning electron microscopy, and the percentage of
continuous margin was statistically analyzed (p < 0.05).
Results: The significantly highest margin integrity was observed for Optibond FL, whether or not demineralized
enamel was pretreated with the infiltrant. Pretreatment of demineralized enamel with the infiltrant resulted in a sig-
nificant increase in margin integrity when the unfilled etch-and-rinse adhesive (Syntac Classic) or the self-etch ad-
hesive (iBond Self Etch) was subsequently applied, but showed no significant improvement in combination with the
filled etch-and-rinse adhesive (Optibond FL).
Conclusion: Application of a caries infiltrant can improve margin integrity of composite fillings in demineralized
enamel when used in combination with the examined self-etch and unfilled adhesives.
Keywords: caries infiltrant, margin integrity, demineralized enamel, resin composite

J Adhes Dent 2017; 19: 483–489. Submitted for publication: 13.07.17; accepted for publication: 20.09.17
doi: 10.3290/j.jad.a39280

a Resident, Clinic of Preventive Dentistry, Periodontology and Cariology, Center of

Dental Medicine, University of Zurich, Zurich, Switzerland. Wrote the manuscript.
b Master’s Student, Clinic of Preventive Dentistry, Periodontology and Cariology,
Center of Dental Medicine, University of Zurich, Zurich, Switzerland. Per-
formed the experiments in partial fulfillment of requirements for a master’s
degree, proofread the manuscript.
c Dentist in Private Practice, Senior Research and Teaching Assistent, Clinic of
Orthodontics and Pediatric Dentistry, Center of Dental Medicine, University of
Zurich, Zurich, Switzerland. Research idea, proofread the manuscript.
d
Research Associate in Data Analysis and Statistics, Center of Dental Medi-
cine, University of Zurich, Zurich, Switzerland. Performed statistical evalu-
ation, proofread the manuscript.
e Professor and Director, Clinic of Preventive Dentistry, Periodontology and Cari-
ology, Center of Dental Medicine, University of Zurich, Zurich, Switzerland.
Research idea, contributed substantially to discussion, proofread the manu-
script.
f Head of Division of Cariology, Clinic of Preventive Dentistry, Periodontology
and Cariology, Center of Dental Medicine, University of Zurich, Zurich, Switzer-
land. Research idea, hypothesis, experimental design, contributed substan-
tially to discussion and writing the paper, proofread the manuscript.
Correspondence: Dr. Philipp Körner, Clinic of Preventive Dentistry, Periodontol-
ogy and Cariology, Center of Dental Medicine, University of Zurich,
Plattenstrasse 11, CH-8032 Zurich, Switzerland. Tel: +41-44-634-3386;
e-mail: philipp.koerner@zzm.uzh.ch
I n the era of adhesive dentistry, healthy dental tissues can
be conserved through lesion-oriented, minimally invasive
caries treatment. The fundamental prerequisite is the real-
ization of optimum bond strength on dental hard tissues
and a high degree of margin integrity between tooth and
restoration.16 In order to achieve this aim, traditional exca-
vation concepts recommend complete removal of softened
dentin and demineralized enamel margins.2,8 Especially in
non-cavitated areas of demineralized enamel, this concept
may lead to a disproportionately high loss of dental hard
tissue.23
Infiltration of caries lesions with low viscosity resins is
considered a treatment option for non-cavitated lesions
which are not expected to arrest or remineralize.21 This
idea seems to be supported by a recent paper, in which
marginal adaptation of fissure sealants in natural, non-exca-
vated occlusal lesions was shown to benefit from resin infil-
trant pretreatment.23 Through low viscosity, low contact
angle to enamel, and high surface tension, caries infiltrants
have been optimized to penetrate the porous lesion body
deeper than conventional adhesives, and can act as a diffu-

Vol 19, No 6, 2017 483

Körner et al
Enamel
Dentin
200 μm
Fig 1 Cross-section of an artificially demineralized enamel lesion
after 21 days in acid buffer (left) vs no demineralization (right).
sion barrier to prevent acid penetration.28,35 Nevertheless,
extensive areas of demineralized enamel might also exhibit
cavitated defects.22 As caries infiltrants are able to pene-
trate most parts of demineralized enamel, but cannot fill
the cavitation itself,32 the question arises whether resin
infiltration might be combined with conventional adhesives
prior to placement of a composite restoration to enable res-
toration of cavitated and infiltration of demineralized
areas.19
In this context, the applicability of different adhesives
(unfilled etch-and-rinse, filled etch-and-rinse, self-etch) in
combination with a caries infiltrant, and their influence on
the margin integrity of composite restorations, are of great
interest. While the filled adhesive Optibond Fl is considered
the gold standard of etch-and-rinse adhesives,39 the un-
filled adhesive Syntac Classic and self-etch adhesive iBond
Self Etch were chosen, as they are frequently used in vari-
ous in vitro and in vivo studies and can be regarded as
sound representatives of their respective group.4,6,40 The
distinct adhesives not only differ in filler content and poly-
merization shrinkage, but also in their viscosity, which
might have an influence on their penetration into demineral-
ized enamel.
Therefore, the aim of the present study was to evaluate
margin integrity of composite restorations in demineralized
enamel after application of three different adhesives with
and without caries infiltrant pretreatment. The null hypoth-
eses were that 1) pretreatment with a caries infiltrant and
2) different kinds of adhesives do not affect the margin in-
tegrity of composite restorations in demineralized enamel.
MATERIALS AND METHODS
Specimen Preparation and Demineralization
A total of 60 specimens were prepared from the crowns of
freshly extracted, undamaged, permanent bovine incisors
stored in tap water until use. The cementum layer was en-
tirely removed using polishing disks (Sof-Lex Pop-on; 3M
484
ESPE, St Paul, MN, USA). In order to avoid internal demin-
eralization, the pulp cavum of the specimens was blocked
and sealed with nail polish. The enamel was demineralized
by storing the specimens for 21 days at 37°C in an acid
buffer containing 3 mM CaCl2 × 2 H2O, 3 mM KH2PO4,
6 μM MHDP, 50 mM CH3COOH, KOH (to adjust the pH to
4.95), and distilled water.6 The solution was renewed every
day to keep the pH constant. A cross-sectional cut of an
artificially demineralized enamel lesion is illustrated in
Fig 1. After demineralization, standardized Class V cavities
(diameter: 3 mm, depth: 2 mm, bevel edge: 1 mm) were
prepared on the labial surface using spherical-head dia-
mond burs (D126, Garant; Munich, Germany). The entire
margin was located in enamel.
Infiltration and Bonding Procedure
The experimental design is illustrated in Fig 2. Demineral-
ized, prepared specimens were randomly assigned to six
groups of ten specimens each. While in groups 1–3 the
cavities were solely treated with either an unfilled etch-and-
rinse adhesive, a filled etch-and-rinse adhesive, or a self-
etch adhesive, demineralized enamel in groups 4–6 was
pretreated with a caries infiltrant prior to adhesive applica-
tion. Detailed information and composition of the infiltrant
system and adhesives are given in Table 1.
The infiltration and bonding procedure in the different
groups was strictly based on the manufacturers’ instruc-
tions for use, and was performed as follows:
y Group 1: Unfilled etch-and-rinse adhesive (Syntac Clas-
sic)
Enamel and dentin surfaces were etched with 37% phos-
phoric acid gel (Total Etch; Ivoclar Vivadent, Schaan,
Liechtenstein) for 15 s before rinsing with water for
30 s. After gently air drying, the adhesive (Syntac Clas-
sic; Ivoclar Vivadent) consisting of Syntac Primer (15 s),
Syntac Adhesive (10 s) and Heliobond (15 s), was ap-
plied and light cured (20 s). Photoactivation was per-
formed using a polywave LED curing unit (Bluephase G2,
Ivoclar Vivadent) at an irradiance of at least 1100 mW/
cm2. Output irradiance of the curing unit was checked
periodically with a calibrated power meter (FieldMaxII-TO,
Coherent; Santa Clara, CA, USA).
y Group 2: Filled etch-and-rinse adhesive (Optibond FL)
Prior to application of the filled etch-and-rinse adhesive
(Optibond FL, Kerr; Orange, CA, USA), enamel and dentin
surfaces were etched with 37% phosphoric acid gel for
15 s and rinsed for another 30 s. After primer application
for 15 s and gently air drying for 5 s, the adhesive was ap-
plied for 15 s, gently air thinned, and light cured for 20 s.
y Group 3: Self-etch adhesive (iBond Self Etch)
Enamel and dentin surfaces were conditioned by apply-
ing the self-etch adhesive (iBond Self Etch, Heraeus Kul-
zer; Hanau, Germany) for 20 s, followed by gentle air dry-
ing (5 s) and light curing (20 s).
y Group 4: Caries infiltrant + unfilled etch-and-rinse adhe-
sive (Syntac Classic)
Demineralized enamel around the circular cavity (bevel
edge included) was etched with 15% hydrochloric acid
The Journal of Adhesive Dentistry
 Körner et al

Demineralization of bovine teeth (n = 60) in acid buffer

Preparation of standardized Class V cavities

Random assignment into 6 groups (n = 10 per group)

Infiltration and bonding procedure according to manufacturers’ instructions for use

Group 1 Group 2 Group 3 Group 4 Group 5 Group 6

Unfilled etch-and- Filled etch-and-rinse Self-etch adhesive Caries infiltrant Caries infiltrant Caries infiltrant
rinse adhesive adhesive (Icon) (Icon) (Icon)
iBond Self Etch
Syntac Classic Optibond FL Unfilled etch-and- Filled etch-and-rinse Self-etch
rinse adhesive adhesive adhesive
Syntac Classic Optibond FL iBond Self Etch

Enamel etching Enamel etching Enamel etching

Hydrochloric acid (120 s)
Icon-Dry (30 s)
Enamel infiltration (180 s)
Light curing (40 s)
Enamel infiltration (60 s)
Light curing (40 s)
Hydrochloric acid (120 s)
Icon-Dry (30 s)
Enamel infiltration (180 s)
Light curing (40 s)
Enamel infiltration (60 s)
Light curing (40 s)
Hydrochloric acid (120 s)
Icon-Dry (30 s)
Enamel infiltration (180 s)
Light curing (40 s)
Enamel infiltration (60 s)
Light curing (40 s)

Enamel and dentin etching Enamel and dentin etching iBond Self Etch (20 s) Dentin etching Dentin etching iBond Self Etch (20 s)
Phosphoric acid (15 s) Phosphoric acid (15 s) Light curing (20 s) Phosphoric acid (15 s) Phosphoric acid (15 s) Light curing (20 s)
Syntac Primer (15 s) Optibond FL Prime (15 s) Syntac Primer (15 s) Optibond FL Prime (15 s)
Syntac Adhesive (10 s) Optibond FL Adhesive Syntac Adhesive (10 s) Optibond FL Adhesive
Heliobond (15 s) (15 s) Heliobond (15 s) (15 s)
Light curing (20 s) Light curing (20 s) Light curing (20 s) Light curing (20 s)

Application of a nanofilled composite (Filtek Supreme XTE), light curing (20 s)

Thermocycling 5000x (5–55°C)

Replica production and quantitative margin analysis (scanning electron microscopy)

Statistical analysis

Fig 2 Experimental design.

Table 1 Composition of the caries infiltrant and adhesive systems used in the present study

Product Composition Lot number Manufacturer

Icon Icon-Etch: hydrochloric acid, pyrogenic silicic acid, surface-active substances 724868 DMG; Hamburg,
Icon-Dry: 99% ethanol 724860 Germany
Icon-Infiltrant: TEG-DMA-based resin matrix, initiators, additives 72854

Syntac Primer: dimethacrylates, maleic acid, solvent, stabilizer U43425 Ivoclar Vivadent;
Classic Adhesive: dimethacrylates, maleic acid, glutaraldehyde, water V01074 Schaan,
Heliobond: bis-GMA, TEG-DMA, stabilizers and catalysts T15984 Liechtenstein

Optibond Primer: HEMA, GPDM, ethanol, water, CQ, BHT, PAMA 5554307 Kerr; Orange, CA,
FL Adhesive: bis-GMA, HEMA, GDM, CQ, ODMAB, barium aluminumborosilicate, Na2SiF6, 5543327 USA
fumed silicon dioxide, gamma-methacryloxypropyltrimethoxysilane

iBond UDMA, 4-META, glutaraldehyde, acetone, water, photo-initiators, stabilizers 010901 Heraeus Kulzer;
Self Etch Hanau, Germany

4-META: 4-methacryloyloxethyl trimellitate anhydride; BHT: butylhydroxytoluene; bis-GMA: bisphenol-A-glycidyldimethacrylate; CQ: camphorquinone; GDM: glyc-
erol dimethacrylate; GPDM: glycerolphosphatedimethacrylate; HEMA: 2-hydroxylethyl methacrylate; ODMAB: 2-(ethylhexyl)-4-(dimethylamino)benzoate; PAMA:
phthailic acid monomethacrylate; TEG-DMA: triethylene glycol dimethacrylate; UDMA: urethane dimethacrylate.

Vol 19, No 6, 2017 485

Körner et al
B b A a
p = 0.039 p = 0.161
100
80
60
% and 75% quartiles (boxes); the whis-
40
20
0 group 1 group 4 group 2 group 5
Syntac Classic Optibond FL
without infiltrant with infiltrant
gel (Icon-Etch, DMG; Hamburg, Germany) for 120 s fol-
lowed by rinsing with water for 30 s. After drying the sur-
face with ethanol (Icon-Dry, DMG) for 30 s, the caries
infiltrant was applied to the pretreated surface for 180 s
and light cured for 40 s. To complete the infiltration pro-
cedure, the infiltrant was re-applied for 60 s and light
cured for another 40 s. Subsequently, the unfilled etch-
and-rinse adhesive Syntac Classic was applied as de-
scribed in group 1.
y Group 5: Caries infiltrant + filled etch-and-rinse adhe-
sive (Optibond FL)
The caries infiltrant was applied as described above.
Subsequently, the filled etch-and-rinse adhesive Opti-
bond FL was applied as described in group 2.
y Group 6: Caries infiltrant + self-etch adhesive (iBond
Self Etch)
The caries infiltrant was applied as described above.
Subsequently, the self-etch adhesive iBond Self Etch
was applied as described in group 3.
Composite Application and Thermocycling
All pretreated Class V cavities were filled in one increment
with a nanofilled composite material (Filtek Supreme XTE,
3M ESPE; shade A2B, lot N535229), and light cured for
20 s. Excess was removed by using surgical scalpel blades
(No. 12D, Gebr. Martin; Tuttlingen, Germany), and the fill-
ings were finished and polished with silicon instruments
(Brownie Mini-Points and Greenie Mini-Points, Shofu; San
Marcos, CA, USA) and polishing brushes (Occlubrush, Kerr).
The restorations were checked using a microscope at 25X
magnification (Stemi 2000, Zeiss; Oberkochen, Germany).
Afterwards, the specimens were thermocycled 5000 times
in water between 5°C and 55°C with a dwell time of 20 s in
each temperature bath and a transfer time of 10 s (Willy-
tec; Gräfelfing, Germany).49
486
C b
p < 0.001
Fig 3 Percentages of continuous
enamel margins of composite restor-
ations with and without infiltrant pre-
treatment before application of the
different adhesives. The boxplots show
the medians (black lines) with 25%
kers represent 1.5*IQR (interquartile
range) or minima and maxima of the
distribution if below 1.5*IQR; outliers
are shown as circles. Statistically sig-
nificant differences (p < 0.05) in the
group 3 group 6 percentage of continuous margins be-
iBond Self Etch tween different adhesives are marked
with different lower-case (within infil-
trant-pretreated groups) and capital let-
ters (within non-pretreated groups).
Assessment of Margin Integrity
After thermocycling, negative copies of each restoration
were taken with an A-polyvinylsiloxane material (President
Light Body Coltène; Altstätten, Switzerland). To receive pos-
itive replicas, the impressions were poured with epoxy resin
(Epoxyharz L, R&G Faserverbundwerkstoffe; Waldenbuch,
Germany) before being glued to aluminum carriers (Ce-
mentit Universal, Merz&Benteli; Niederwangen, Switzer-
land). The replicas were sputter coated with gold (Sputter
SCD 030, Balzers Union; Balzers, Liechtenstein) and sub-
jected to quantitative margin analysis using scanning elec-
tron microscopy at 20 kV and 200X magnification (Vega
TS5136XM, Tescan; Brno, Czech Republic). Margin quali-
ties were classified as “continuous”, “non-continuous” or
“not judgeable” by one trained and blinded examiner
(M.G.), as performed in previous studies.5,16 The margin
integrity between enamel and restoration was expressed in
percentage of “continuous margin” in relation to the entire
assessable margin.11
Statistical Analysis
Descriptive statistics such as means and standard deviation
were computed. The percentage of continuous margin was
arcsine transformed to achieve homogeneity of variance and
normal distribution of residuals, and thus to accomplish the
model assumption of ANOVA. A two-way ANOVA with the two
factors “infiltrant pretreatment” (2 levels) and “adhesive” (3
levels) including interaction was applied. Differences in the
percentage of continuous margins between different adhe-
sives (within the infiltrant-pretreated and non-pretreated
groups) were analyzed using one-way ANOVA and Tukey’s
HSD post-hoc test. Two-sample t-tests were used to investi-
gate the influence of the infiltrant pretreatment within the
different adhesive groups. The level of significance was set
at 5%. All statistical analyses and plots were performed
using R version 3.2.2 (The R Foundation for Statistical Com-
puting; Vienna, Austria; www.R-project.org).
The Journal of Adhesive Dentistry

400 μm
Fig 4 SEM micrograph of continuous margin (group 5; Syntac Clas-
sic with infiltrant pretreatment).
RESULTS
The percentage of continuous margins (margin integrity)
after application of the three adhesives with and without
infiltrant pretreatment is given in Fig 3. Two-way ANOVA
demonstrated statistical significance for the two factors
“adhesive” (p < 0.001) and “infiltrant pretreatment”
(p < 0.001), as well as for their interaction (p = 0.001).
The significantly highest margin integrity was observed
for Optibond FL, whether or not the demineralized enamel
was pretreated with the infiltrant. While Syntac Classic
showed better results in terms of margin integrity compared
to iBond Self Etch when no infiltrant was applied
(p = 0.009), the two adhesives showed similar results after
infiltrant pretreatment (p > 0.05).
Pretreatment of demineralized enamel with the infiltrant
resulted in a significant increase in margin integrity when
the unfilled etch-and-rinse adhesive Syntac Classic
(p = 0.039) or the self-etch adhesive iBond Self Etch
(p < 0.001) was applied, but showed no significant improve-
ment when the filled etch-and-rinse adhesive Optibond FL
(p = 0.161) was used.
SEM micrographs of continuous and non-continuous mar-
gins are illustrated in Figs 4 and 5.
DISCUSSION
The present study demonstrated that pretreatment of de-
mineralized enamel with caries infiltrant prior to adhesive
application improved the margin integrity of composite res-
torations when either the unfilled or self-etch adhesive was
used, but had no positive effect in combination with the
filled adhesive. Thus, the first null hypothesis was partly
rejected.
In this study, margin integrity was evaluated on bovine
teeth, which are widely used in resin infiltration tests and
Vol 19, No 6, 2017
Körner et al
400 μm
Fig 5 SEM micrograph of discontinuous margin (group 3; iBond
Self Etch without infiltrant pretreatment).
proposed as a suitable alternative to human enamel.34
Evaluation of margin integrity was performed by one trained
and blinded examiner, as in previous studies.5,16 Neverthe-
less, the fact that only one examiner evaluated margin qual-
ity might be a shortcoming of the present study. Artificial
enamel lesions were created, similar to previous in vitro
studies investigating resin infiltration, and were proven to
have a histological structure comparable to white-spot le-
sions and enamel caries.25,27,30,38 It should be noted, how-
ever, that natural enamel lesions might be deeper than ar-
tificial ones, possibly leading to different penetration of
infiltrant and adhesives under natural conditions.41
The type of etching, filler content, resin viscosity, and
penetration ability of adhesives are key factors for the de-
gree of margin integrity of adhesive restorations.44,45 To
cover a broad spectrum of these characteristics, the three
different adhesives used in this study were chosen as com-
monly used, sound representatives of their respective
group. In order to create an adequate etching pattern and
enable deep resin penetration, specimens were treated ac-
cording to manufacturers’ recommendations, which is in
conformity with previous studies examining resin infiltration
on artificial lesions.3,19,50 Thus, etching was performed with
15% hydrochloric acid before infiltrant application, with 37%
phosphoric acid before application of the etch-and-rinse ad-
hesives, and acidic self-etch monomers. Previous studies
showed that the surface layer of enamel carious lesions
can be eroded almost completely by etching with
hydrochloric acid, leading to better resin penetration into
the bulk of the carious lesion.3,33,37 The etching efficacy of
acidic monomers in self-etch adhesives is much lower com-
pared to conventional acids, resulting in shallower demin-
eralization, a less regular etching pattern,15,30 and limited
resin penetration into the lesion bulk.9 The enamel margin
integrity of self-etch adhesives has been shown to benefit
from pre-etching with phosphoric acid.43,46 The results of
the present study indicate that a positive effect on margin
487
Körner et al
quality can also be achieved through pre-etching enamel
with hydrochloric acid, in case a self-etch adhesive is com-
bined with a caries infiltrant.
Besides adequate etching, resin penetration ability is
affected by the viscosity and filler content of the infiltrant/
adhesive.48 In previous studies, it has been shown that
resin infiltrants containing high amounts of TEG-DMA and
ethanol can decrease the viscosity and contact angle to
enamel, allowing a better penetration coefficient and
deeper penetration into demineralized enamel compared to
resins containing bis-GMA or UDMA.28,36 On the other
hand, it has also been reported that an increased amount
of TEG-DMA may lead to higher polymerization shrinkage
and shrinkage stress,13,14,26,47 which in turn might nega-
tively affect bond strength to enamel.1,18,50 However, as no
decrease in margin integrity was found when demineralized
enamel was pretreated with the infiltrant, it can be as-
sumed that the subsequently applied adhesive layer might
strengthen the outermost part of the infiltrated enamel.50
Through infiltrant pretreatment, a thick oxygen-inhibited
layer is created,42 which allows a stable chemical connec-
tion between infiltrant and monomers of the subsequently
applied adhesive. A recent study found that pretreatment of
demineralized enamel with caries infiltrant did not impair
the bond strength of adhesives, and even increased shear
bond strength of iBond Self Etch.19 Furthermore, it was
shown that contamination of dentin surfaces with infiltrant
did not reduce shear bond strength values.20 However, ac-
cording to this study, contamination of dentin with hydro-
chloric acid should be avoided due to the detrimental effect
on the adhesive properties of conventional adhesives.
Thanks to better resin penetration in demineralized enamel
and a stable bond to different adhesives, caries infiltrants
might function as an anchor to conventional adhesives and
thus facilitate improvement of margin integrity. This as-
sumption is in agreement with a recent study reporting pro-
nounced interlocking between infiltrant and enamel sur-
faces in combination with well-adapted, adhesive
anchoring.23
As previously reported, resin penetration might be re-
duced by addition of fillers.48 Nevertheless, the enhanced
physical properties of filled adhesives may improve bond
strength29 and, potentially, margin integrity. The present
study revealed that the type of adhesive (unfilled, filled, or
self-etch) affected margin integrity of composite restor-
ations in demineralized enamel. Therefore, the second null
hypothesis was rejected. The filled etch-and-rinse adhesive
Optibond FL showed the highest degree of margin integrity
among the tested adhesives, which is in accordance with
previous in vitro and in vivo findings.6,12,24,39 It can be as-
sumed that the high margin integrity of Optibond FL did not
allow a significant improvement through infiltrant pretreat-
ment. While the significantly lower percentage of margin
integrity of the unfilled adhesive Syntac Classic compared
to Optibond FL might be due to its inferior physical proper-
ties,44 the significantly lower values of the self-etch adhe-
sive iBond Self Etch is in agreement with other studies,4
and is likely associated with less effective etching of
488
enamel, leading to shallower demineralization, a more ir-
regular etching pattern, and thus limited resin penetra-
tion.10,17,31
CONCLUSION
The use of a caries infiltrant in demineralized enamel prior
to adhesive application can improve margin integrity of com-
posite restorations bonded with the tested self-etch and
unfilled adhesives.
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