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Marginal microleakage of composite resin restorations bonded by

desensitizing one step self etch adhesive

Article · December 2014

DOI: 10.1016/j.tdj.2014.10.001

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Tanta Dental Journal 11 (2014) 180e188
www.elsevier.com/locate/tdj

Marginal microleakage of composite resin restorations bonded by

desensitizing one step self etch adhesive
H.Y. El Sayed*, A.I. Abdalla, M.E. Shalby
Faculty of Dentistry, Operative Dentistry, Tanta University, Egypt
Received 20 April 2014; revised 30 September 2014; accepted 10 October 2014
Available online 19 December 2014

Abstract

Aim: The aim of this study was to investigate the effect of desensitizing agents on microleakage of composite resin restorations
bonded by one step desensitized self etch adhesive.
Materials and methods: Class V cavities (3
4
2 mm) were prepared on the buccal surfaces of 30 human molars, Teeth were
classified into three groups according to the type of adhesive used (n ¼ 10). Group 1: Adper Single Bond2. Group 2: l-bond. Group
3: is a control group of composite resin restoration without bonding agent. All cavities were restored with Filtek Z250 composite
resin, stored in distilled water at 37  C for 24 h and thermal cycled for 500 cycles. The root apices were sealed with utility wax, and
all the surfaces, except for the restorations and 1 mm from the margins, were coated with two layers of nail varnish. The teeth were
immersed in a 3% methylene blue dye solution for 24 h, and then rinsed in running water, blot-dried and sectioned longitudinally
through the center of restorations from the facial to lingual surface. The sections were blindly assessed for microleakage of dye
penetration by two independent evaluators using a stereomicroscope at 30
magnification for both the occlusal and gingival
margins. Data were collected and statistically analyzed.
Results: A ManneWhitney test demonstrated the highest significantly dye penetration rate for group 3 versus tested groups
comparing the occlusal and gingival scores for each group, Wilcoxon Rank test showed significant difference for all groups. Etch
and rinse adper single bond2 adhesive record a lower significant scores of dye penetration than self etch adhesive I-bond at both
enamel and dentin margins.
Conclusion: All adhesive systems exhibited dye penetration at both occlusal and gingival margins. Etch and rinse system is still
considered a gold standard adhesive. Adper single bond2 revealed significantly less leakage compared to I-Bond.
© 2014, Hosting by Elsevier B.V. on behalf of the Faculty of Dentistry, Tanta University.
Open access under CC BY-NC-ND license.

Keywords: Dentin hypersensitivity; Self etch desensitized adhesive; Marginal leakage; Composite resin; Thermocycling

1. Introduction

* Corresponding author. Dentin hypersensitivity due to dentin exposure, or

E-mail addresses: dr-hussein-yehia@hotmail.com, hussien. after tooth restoration, has been effectively explained
abdrabo@dent.tanta.edu.eg (H.Y. El Sayed), ali_abdalla79@yahoo.
com, ali.elsayed@dent.tanta.edu.eg (A.I. Abdalla), magda.shalabi@
as the hydrodynamic theory of pain, attributed to fluid
dent.tanta.edu.eg (M.E. Shalby). flow in the dentinal tubules which stimulates the nerve
Peer review under the responsibility of the Faculty of Dentistry, fibers within the dentinal tubules, resulting in pain [1].
Tanta University.

http://dx.doi.org/10.1016/j.tdj.2014.10.001
1687-8574/© 2014, Hosting by Elsevier B.V. on behalf of the Faculty of Dentistry, Tanta University.
Open access under CC BY-NC-ND license.
 H.Y. El Sayed et al. / Tanta Dental Journal 11 (2014) 180e188
The principles of adhesive dentistry date back to 1955
when Buonocore, using techniques of industrial
bonding, postulated that acids could be used as a sur-
face treatment before application of the resins [2]. As
time went on, variations in duration of the acid-etching
procedure and concentration of the phosphoric acid,
along with alternative acids, were tested for the etching
of enamel [3]. The current thinking is that a 30 to 40
percent phosphoric acid etch of 15 s is acceptable.
Bonding to etched enamel was considered a safe
and reliable procedure for many years. Because of the
inorganic composition of the enamel, the acid attack
produces inter-prismatic and prismatic dissolution,
creating irregularities into which the resin can flow
and, after polymerization, create a mechanical inter-
locking. The demineralization of the enamel depends
on the low pH of the acid and on the etching time. The
pH and the etching time must be sufficient to provide
adequate enamel retention without the need for addi-
tional steps. The morphological studies made on the
first five generations of bonding systems, in which
phosphoric acid was used to etch enamel, showed a
uniform etch pattern. When phosphoric acid was not
used or when self-etching primers (fifth and sixth
generations) were applied, the bonding mechanism of
adhesives to enamel was less effective. The bonding
mechanism to dentin was effective and predictable
when the smear layer was completely dissolved,
intertubular and peritubular dentin were dissolved,
collagen fibers exposed and, after infiltration of resin
monomers, a hybrid layer formed. This bonding
mechanism was evident from fourth to sixth genera-
tions of enamel dentin bonding systems [4e6].
In fact, the mechanical properties of the bonding
mechanism achieved with hybrid layer and resin tag
formation can be greater than the forces of polymeri-
zation contraction. Also, bonding systems are indicated
in any direct esthetic restorations [7].
The ability of composite to bond reliably to enamel is
now well-accepted, but adhesion of restorative materials
to dentin has proved to be more elusive [8]. Early at-
tempts to bond to dentin resulted in poor bond strengths
[9]. This is not surprising given the fact that while
enamel contains little protein, dentin is 17% collagen by
volume. This collagen is inaccessible due to surrounding
hydroxyapatite crystals [10]. The dentinal tubules are
the only pores available for micromechanical retention.
These tubules contain fluid, which would be an imped-
iment to bonding. The number of tubules available for
bond also varies depending on location, with deep dentin
having more tubules than superficial dentin. Other fac-
tors such as age of teeth, direction of tubules, and type of
181
dentin can affect dentin bonding [11]. The bond strength
between restorative material and dentine plays an
important role in the success of a restoration. This bond
is influenced by the surface structure of the restorative
material and dentine. Many factors, including the nature
of the prepared dentine surface, physical and chemical
properties of the restorative material, the operating
limitations of the restorative materials, intra-oral envi-
ronment and the occlusal forces, need to be considered
for long-term restorative applications [12e14]. Both
primer and adhesive agent have to penetrate dentine to
form a micromechanical bond with the microporosities
in the dentinal tubules and collagen fibers [15]. When
using a conventional acid-etching method, total
demineralization of the etched dentinal surfaces opens
up dentinal tubules. In class V cavities with deeper
carious lesions, phosphoric acid may cause post-
operative sensitivity from the damage to the pulp [16].
Using aggressive acids to provide acid etching can
denature collagen fibers, and demineralize a thicker
layer of dentine, into which resins cannot reach to the
same depth [17,18]. A self-etching system uses a weak
acid to etch dentine surface, which hardly damages to
the pulp and prevents sensitivity [12,19]. In addition,
this system reduces the number of application steps and
gives rise to adequate bond strength [18].
To reduce postoperative sensitivity, dentists
increasingly use desensitizers based on hydroxyethyl
metacrylate (HEMA), fluoride, and chlorhexidine glu-
conate after tooth preparation for restorations. The
function of fluoride present in dentin desensitizers is to
seal the dentinal tubules with incorporation of mainly
HEMA, which increases the infiltration ability of
primers [20]. Chlorhexidine is an antiseptic with a wide
spectrum of action that has been used over the past two
decades for the chemical control of bacterial plaque and
the prevention of dental caries [23]. It is the most
effective antimicrobial agent [24], and it has a proven
ability to delay bond degradation [71]. For this reason,
chlorhexidine has been added to the desensitizers in
recent years. Although there is no information con-
cerning the effects of chlorhexidine based desensitizers
on the bonding performance of composites to tooth
tissues, previous studies have shown that application of
chlorhexidine-containing cavity disinfectants before or
after acid-etching procedures does not have a negative
effect on the shear bond strength; in fact, this procedure
may increase bond strength and durability [21,22].
In 2007, report stated that, increasing the strength of
the dentin matrix by using cross-linking agents may
improve both the strength and durability of resin-dentin
bonds, and showing that glutaraldehyde is a collagen
182 H.Y. El Sayed et al. / Tanta Dental Journal 11 (2014) 180e188

Table 1
Tested materials.
Tested material Composition
Scotch bond Etchant (gel) (pH 0.6) 35% phosphoric acid, colloidal silica
Adper Single Bond2 (pH 4.7) [two Water, ethanol, HEMA,
step, etch& rinse adhesive system] dimethacrylates, methacrylate
Nanofillers functional copolymers of polyacrylic
and politaconic acids, (Bis-GMA),
silica nanofillers and photo initiator
I-Bond - UDMA, 4-Meta
Self etch (pH 2e2.2) [one step, - Acetone and water.
non etch& rinse desensitizing - Camphorquinone.
adhesive system) - Glutaraldehyde.
No fillers - Stabilizers.
Filtek Z250 BIS-GMA and Low-viscosity resin
Micro-hybrid resin TEGMA (Tri ethylene glycol
Composite dimethacrylate). Blend of UDMA
(urethane dimethacrylate) and Bis-
EMA (Bisphenol A polyethylene
glycol diether dimethacrylate) in
place of TEGDMA. . Z250 is filled to
60% by volume with zirconia/silica
particles having a size range of 0.01
e3.5 microns and an average size of
0.6 micron.
Manufacture Manufacturer's instruction for use
3M ESPE, St. paul, - Etching: Apply Etchant, wait 15 s.
MN, USA Rinse for 10 s. Blot excess water
using a mini-sponge. Surface
should appear glistening without
pooling of water.
- Immediately after blotting, apply 2
e3 consecutive coats of adhesive
for 15 s with gentle agitation using
a fully saturated applicator. Gently
air thin for 5 s to evaporate sol-
vents. Light cure for 10 s.
Heraeus Kulzer, Inc., - Saturate microbrush with i-Bond
New York liquid from bottle, Apply three
consecutive coats of i-Bond fol-
lowed by gentle rubbing for 30 s.
- Use gentle air pressure to remove
acetone and water solvent and Cure
for 20 s with a dental curing light
of at least 500 mW/C2.
3M ESPE, St. paul, Application of composite in layers
MN, USA less than 2 mm in thickness and cure
with light cure unit for 20 s
according to Manufacturer's
instructions.

cross linker, which increases the stiffness of the dem-
ineralized dentin [25]. Since dentin is inherently wet, the
development of hydrophilic primers dissolved in inor-
ganic solvents (acetone/alcohol) was an important
achievement in dentin bonding-embedding the exposed
collagen fibrils with resin. HEMA is a component of
many hydrophilic adhesives because of HEMA's ability
to facilitate and increase the adhesion to dentin collagen
due to its hydrophilic nature [26,27].
Because these glutaraldehyde/HEMA products also
contain water, they act as rewetting agents, and in the
case of total-etch bonding procedures, the “rewetting
after the acid etch acts to expand the demineralized
collagen and increase its surface energy, facilitating the
diffusion of the hydrophilic resin monomer into the
etched dentin [28], and facilitating adhesion translate
into higher and more durable bond strengths. Glutar-
aldehyde is a very effective fixative agent having the
ability to create a coagulation plug inside the dentinal
tubules. It has been accepted extremely well by den-
tists as a material that reduces or totally eliminates
tooth sensitivity [29,30].
2. Aim of the study
The aim of the present study was to investigate the
effect of desensitizing agents on micro-leakage of
composite resin bonded to dentin by two step etch and
rinse adhesive system and one step desensitized self
etch adhesive.
The null hypothesis tested was that the application
of simplified desensitizing adhesive system on enamel
and dentin would have no effect on the microleakage
of resin composite restorations.
3. Material and methods
Materials that have been used in this study illus-
trated in Table 1 including the following:
1- Two step, etch and rinse adhesive system: Adper
Single Bond21
1
3M ESPE, St. Paul, MN, USA.
 H.Y. El Sayed et al. / Tanta Dental Journal 11 (2014) 180e188
2- One step, non-water rinse self-etch desensitizing
adhesive system: I-Bond Self etch2
3- Filtek Z250 Micro hybrid Composite resin
restoration3
3.1. Specimen preparation
Thirty extracted human third molars free from
crakes, restorations or caries were used in this study. A
written consent was taken from patients after the study
was approved by the Ethics Committee of Tanta Uni-
versity to ensure their agreement to use their teeth in
the current study. Immediately after extraction, the
teeth were scraped of any residual tissue tags, pumiced,
and washed under running tap water. The teeth were
stored in distilled water at þ4  C until required, as the
freezing process maintain the dentinal collagen as
closest as the in vivo condition thus avoiding its
denaturation or fixation which occurs in the conven-
tional methods of storage (water, saline solution,
formalin, among others) [31,32].
Standardized, Class V cavities with butt-jointed
margins were prepared on the buccal aspect of each
tooth with round internal angles, 1 mm below the CEJ
with occlusal margins in enamel and cervical margins
in dentin, and with following dimensions: 3 mm
gingival-occlusally, 4 mm mesio-distally and 2 mm
deep, using a water-cooled high-speed diamond bur
#330.4 Used burs were replaced by new ones after each
five preparations. After preparation, the teeth were
randomly divided into three groups 10 specimens each.
The desensitizer tested in this study was I-Bond
self-etch one step, non-water rinse adhesive system.
In Group 1, applying composite resin bonded with
Adper Single Bond2 (two step, etch and rinse adhesive
system) (n ¼ 10).
In Group 2, applying composite resin bonded with
I-Bond self-etch one step, non-water rinse desensitiz-
ing adhesive system (n ¼ 10).
In Group 3, control group applying composite resin
without any adhesive system as negative group
(n ¼ 10).
All the cavities were restored with a shade (3)
micro-hybrid resin composite, Filtek Z250, in two in-
crements and each increment was polymerized for 40 s
2
Heraeus Kulzer, Inc., New York..
3
3M ESPE, St. Paul, MN, USA.
4 6
KG Sorensen, Barueri, SP, Brazil.
5 7
Coltolux 75, Colt
ene/Whaldent AG, Alst€atten, Switzerland,
500 mW/cm2.
183
Fig. 1. Diagram showing the 0e3 point evaluation scales for com-
posite resin micro-leakage.
using a conventional halogen light-curing unit.5 The
restorations were finished and polished with Opti-
Disk.6 The teeth were stored in distilled water at room
temperature for 24 h before being subjected to 500
thermal cycles between 5  C and 55  C water baths
with a 30-second dwell time and a 15-second transfer
time. The root apices were sealed with utility wax, and
all the surfaces, except for the restorations and 1 mm
from the margins, were coated with two layers of nail
varnish. The teeth were immersed in a 3% methylene
blue dye solution for 24 h. They were then rinsed in
running water, blot-dried and sectioned longitudinally
through the center of the restorations from the facial to
lingual surface with a water-cooled diamond wheel
saw.7 The sections (n ¼ 20 for each group) were
blindly assessed for dye penetration by two indepen-
dent evaluators using a stereomi-croscope8at 30

magnification. Dye penetration at the composite/tooth
interface was scored for both the occlusal and gingival
margins from 0 to 3 (Fig. 1):
0 ¼ no leakage visible,
1 ¼ penetration of dye along the cavity wall, but
less than ½ of the cavity depth.
2 ¼ penetration of dye along the cavity wall, more
than ½ of the cavity depth.
3 ¼ penetration of dye spreading to and along the
axial wall.
Data were collected and statistically analyzed using
the KruskaleWallis and ManneWhitney U-tests. A
comparison of the occlusal and gingival margins of the
groups was performed.
Kerr Corporation.
Isomet, Buehler, Lake Bluff, IL, USA.
8
Olympus Co., Tokyo, Japan.
184 H.Y. El Sayed et al. / Tanta Dental Journal 11 (2014) 180e188
Table 2
Dye Penetration Scores, means and standard deviations for the Tested Materials at the occlusal and gingival walls.
Microleakage scores of Z250 Microleakage scores of Z250 composite
composite bonded with I-bond bonded with adper single bond2
Occlusal Cervical Occlusal
N ¼ 20 N ¼ 20 N ¼ 20
Mean ¼ 0.45 Mean ¼ 1.3 Mean ¼ 0.15
s.d. ¼ ±0.5104 s.d. ¼ ±0.9787 s.d. ¼ ±0.3663
T(P): 3.52 (0.0024)** 3.01 (0.0075)**
F (P).
Occlusal margins ¼ 59.58(0.000) **.
Cervical margins ¼ 35.61(0.000) **.
T ¼ T-test of paired samples.
*Significant at P < 0.001.
**Highly significant at P < 0.001.
4. Results
Statistical analysis was performed utilizing the
KruskaleWallis one-way ANOVA followed by a
ManneWhitney test. The difference between the
occlusal and gingival dye penetration scores for each
group was analyzed by the Wilcoxon Signed Rank test.
Statistical analysis was performed using the following
computer program: Statistical Package for the Social
Sciences.9
In the current study, dye penetration mean scores for
the occlusal and gingival walls are presented in Tables
2 and 3 and Fig. 2. KruskaleWallis one-way ANOVA
indicated significant differences between adhesive
groups for occlusal and gingival mean scores, where
the enamel margins subjecting to a lower dye pene-
tration than dentin margins (mean scores at enamel
walls were 0.45, 0.15, 2.15 of I-bond, Adper single
bond2 and composite without bonding respectively
while at dentin walls were 1.3, 0.8 and 2.8 respec-
tively). On the other hand, non-adhesive group subject
to a well significant higher dye penetration scores at
both enamel and dentin margins than the adhesive
groups.
The ManneWhitney test was performed to evaluate
significant differences of occlusal mean scores be-
tween groups. The results demonstrated a significant
high leakage differences between control group
(composite resin eno bonding) and two other bonding
groups (I-Bond and Adper single bond2) at p > 0.05,
and i-Bond had recorded a significantly more dye
penetration score when compared to Adper single
bond2 (0.45, 0.15 respectively, p < 0.001).
9
SPSS Inc, Chicago, IL, USA.
Microleakage scores of Z250
composite (control group)
Cervical Occlusal Cervical
N ¼ 20 N ¼ 20 N ¼ 20
Mean ¼ 0.8 Mean ¼ 2.15 Mean ¼ 2.8
s.d. ¼ ±0.8944 s.d. ¼ ±0.8751 s.d. ¼ ±0.4104
3.64 (0.0019)**
Gingival mean scores between groups also showed a
high significant differences of dye penetration dentin
leakage between control group (composite resin eno
bonding) and two other bonding groups (I-Bond and
Adper single bond2) at p > 0.05: and i-Bond showed
significantly more marginal dentin dye penetration
when compared to Adper single bond2 (1.3, 0.8
respectively, p < 0.001).
When comparing the mean values of occlusal and
gingival mean scores for each group, the Wilcoxon
Rank test showed that, occlusal enamel margins
recorded a lower significant difference of dye pene-
tration scores than gingival dentin walls for I-Bond
(0.45, 1.3) and Adper single bond adhesives (0.15, 0.8)
at (p < 0.001).
5. Discussion
Adhesives are necessary to prevent micro-leakage at
resin composite restoration/tooth interface while dental
composites are not able to bond to dental tissues.
However, clinical microleakage remains the major cause
for composite restoration failures implying post-
operative sensibility, margin colorations, secondary
decay, or pulpal inflammation. When composite resin
restorations used without bonding, the results of the
current study where dye penetration leakage scores at
the enamel and dentin walls are significantly higher than
composite resin with either self etch or total etch adhe-
sives and this result in agreement with reports indicated
by several studies [33e35]. Therefore, manufacturers
have proposed many different adhesives involving
different adhesion strategies, the Etch and Rinse (ER)
adhesive systems (in three or two clinical steps), the
Self-Etch (SE) adhesive systems (in two or one clinical
step(s), and the glass ionomer adhesives [36,37]).
 H.Y. El Sayed et al. / Tanta Dental Journal 11 (2014) 180e188
Table 3
Dye Penetration Scores for the Tested Materials at occlusal and gingival walls.
Group/score
Composite bonded with I-bond. n ¼ 20 (*SE one step
adhesive non-etch & rinse)
Composite bonded with Adper single bond2. n ¼ 20
(*ER two step adhesive)
Composite no bonding (Control group) n ¼ 20
*SE ¼ self etch adhesive, * ER ¼ etch and rinse adhesive.
The major goal of using dentin bonding agents is to
enhance the bonding strength between the resin and the
tooth structure, increase the retention of restoration,
reduce the micro-leakage across dentin-resin interface
[38].
The introduction of the total etches technique and
recent developments in the chemistry of dentin adhe-
sives have made resin based composite restorative
materials nearly free of micro-leakage with bond
strengths approaching those of enamel bonding
[39,40].
Generally, lower bond strength of dental adhesives
to dentin might be attributed to various factors: First,
dentin is less mineralized tissue and has a higher water
content compared to enamel. Second, presence of the
smear layer. Third, fluid filled channels in dentin that
are under slight but constant out ward pressure from
the pulp decrease the stability and durability of the
composite resin-dentin bond [41].
Clinically an adhesive that can bond to any surface
is preferred, as can mild self etch adhesives [42].
The current study, evaluated the microleakage of
different adhesives comparing self-etch and total-etch
and rinse systems, all of which demonstrated dye
penetration scores (leakage) at both the enamel and
dentin margins. According to the Wilcoxon signed
Fig. 2. Represent mean dye penetration scores of I-Bond and Adper
Single Bond2 adhesive systems at both occlusal and cervical margins
of composite restorations.
185
Occlusal Gingival
0 1 2 3 0 1 2 3
11 9 0 0 5 6 7 2
17 3 0 0 10 4 6 0
1 3 8 8 0 0 4 16
rank test, significantly lesser dye penetration score
leakage was recorded at the enamel margins compared
to the dentin margins of the adhesive groups. These
results are in accordance with several studies that
evaluated self-etch and total-etch and rinse adhesive
systems, less microleakage was also reported at the
enamel margins compared to the dentin margins
[43e46].
It was stated that, self etch-adhesive systems can
hybridize the dental hard tissues through one or two
operatory-steps. In part depending on pH, the self etch-
adhesives may be classified according to the interac-
tion depth at dentin into ultramild e (pH > 2.5
“nanointeraction”), mild (pH z 2 e interaction
depth about 1mm), intermediate strong (pH 1e2,
interaction depth between 1 and 2mm), and strong
(pH  1 e interaction of several micrometers' e
depth). The latter e are able to produce an interfacial
ultra morphology resembling that typically produced
by etch and rinse adhesives [47]. Nevertheless, several
in vitro studies have shown that despite the reasonable
bonding potential of the strong self etchadhesives,
reduced bond strength [49,50], and increased interfa-
cial Nanoleakage are recorded in comparison to the
multistep adhesives, especially regarding the strong
simplified adhesives rich in HEMA [48]. In fact, these
less-favorable e in vitro results were confirmed by the
inferior clinical performance of the strong one step-
selfetchadhesives [51].
Analysis of the data from this study revealed
significantly lower mean values of microleakage with a
total-etch and rinse adhesive (Adper Single bond2-
primer þ bonding agent pH 4.7/etchant pH 0.6)
compared to the other self etch one step adhesive I-
Bond (pH 2e2.2) at the enamel and dentin walls. This
finding was in agreement with studies reporting
decreased leakage associated with total-etch especially
at the enamel margins, compared to self-etch adhesive
systems [52e54].
Also, a reduced microleakage scores has been re-
ported when using filled adhesives [55,56]. As Adper
186 H.Y. El Sayed et al. / Tanta Dental Journal 11 (2014) 180e188
single bond2 in comparison to I-bond where no fillers
are present. However, some contradictory results have
been reported by other researchers [44e46], who re-
ported that I-Bond have no significant difference of
leakage at dentin margins in comparable to total etch
and rinse adhesive.
Microleakage of restorations using self-etch no etch
and rinse adhesives could have resulted from incom-
plete etching of enamel and dentin surfaces by acidic
monomers, allowing for higher leakage values than the
total-etch systems using a separate phosphoric acid
etchant. Scanning electron microscopy (SEM) studies
have shown that the use of phosphoric acid as an
enamel and dentin etchant improves penetration and
the subsequent attachment of adhesive monomers
[57,58].
On the other hand, mild self-etch adhesives produce
hybrid layers (HL) thinner than total-etch systems. As
dentin demineralization is less pronounced, smear
plugs occlude the orifice of the dentinal tubules, which
are partially infiltrated by resin; a reduced resin tag
formation occurs with these systems [59,60]. It was
suggested that the bonding effectiveness of mild self-
etch adhesives may result from a combined micro-
mechanical and chemical interaction with tooth
substrate [37,61]. The chemical component may be
able to compensate for the reduced bonding effec-
tiveness from decreased micromechanical interlocking.
Also in the current study, Adper single bond2 is
etch-rinse and alcohol-based solvent system and record
a highly significantly lower mean scores of dye pene-
tration at enamel and dentin margins than I-Bond
desensitizing self etch which is acetone-based solvent
and containing Glutaraldehyde/HEMA solution as a
cross-linking agent. This result is disagreed with Al-
Ammar et al. [62] who found that “the application of
selective collagen cross-linkers during adhesive
restorative procedures may be a new approach to
improve dentin bond strength properties” and showed
that the chemical modification to the dentin matrix
promoted by glutaraldehyde increased bond strengths.
It has also been shown that a Glutaraldehyde/HEMA
solution does not interfere with the bonding procedure
to dentin when either an acetone primer or an alcohol-
based primer is used [63].
Authors Reported advantages of self-etch systems
include “simple” application procedures and a reduc-
tion and/or elimination of post-treatment sensitivity;
however, because of numerous uncontrolled variables
encountered during patient treatment, perceived
advantages can potentially become disadvantages
[64,65].
In the present study, the microleakage of adhesively
bonded composite resin was evaluated in Class V
cavities. The reason for studying Class V cavities was
that (1) Class V cavities have unfavorable C-factors,
resulting in high contraction scores within an adhe-
sively fixed resin material, (2) Class V restoration
margins are located in enamel as well as in dentin, (3)
preparation and restoration of Class V lesions are
minimal and relatively easy, thereby somewhat
reducing practitioner variability, and (4) it is easier to
standardize the preparation of Class V cavities than
Class II cavities [66,67].
The dye penetration method used in the current
study is a gross assessment of the quality of the
interface. Although microleakage increases as dentin
permeability rises [68], a reduction in dentin perme-
ability does not necessarily result in a drop in micro-
leakage. Any interference with hybrid layer formation
and adaptation/bonding to the composite would
adversely affect marginal microleakage. A significant
role of hybridization on marginal leakage and bond
strength has previously been reported [69].
On this base, in the current study, highest significant
scores of dye penetration were observed in the negative
control group composite resin without any adhesive
application followed by using I-Bond self etch adhe-
sive, while Adper single Bond2 record a significant
lowest score of mean dye penetration.
Since the hybrid layer morphology was not evalu-
ated microscopically in this study, the specific nature
of restoration failure (microleakage) for each adhesive
system is unknown, although anecdotally four factors
are strongly suspected: inefficiency of acidic mono-
mers in alteration of the smear layer for classic hybrid
layer formation, cavity C-factor, orientation of dentinal
tubules to the CEJ and post-treatment stresses caused
by polymerization contraction [70,71].
6. Conclusions
Within the limitations of this in vitro study, the
following conclusions were reached:
1- The null hypothesis that desensitizer do not
adversely affect micro-seal of composite resin res-
torations is rejected
2- All adhesive system groups exhibited dye penetra-
tion (leakage) at both occlusal (enamel) and
gingival (dentin) margins.
3- An inter-group comparison revealed highly signif-
icantly lower leakage at the enamel margin versus
the dentin margin of all adhesive groups.
 H.Y. El Sayed et al. / Tanta Dental Journal 11 (2014) 180e188
4- At enamel and dentin margins, Adper Single Bond2
revealed significantly less leakage compared to the
other adhesive group I-Bond.
5- Clinical trials should be performed to assess the
performance of these adhesive systems before
definitive conclusions are formulated.
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