Dental Research

An in vitro study of parameters related to marginal and internal seal

of bonded restorations
Didier Dietschi"' / Pascal Magne^^^'^ /Jacques

The wall-to-wall contraction of the cementing layer of bonded restorations is compen-

sated for mainly by ela.uic and plastic tooth sub.strate-cement deformation but may
result in adhesive fracture. Occlusally flattened teeth and corresponding computer-
designed onlays, both positioned in a special device, were used to study marginal and
intenal seal of the adhe.úve interface with respect to four variables: rigidity of the
restoration-substrate setup, cement thickness, adhesive configuration (enamel-dentin
ratio and bonding agent), and luting agent. The results of dye infiltration tests revealed
the significant influence of the adhesive configuration and rigidity of the setup. A high
enamel-dentin ratio. u.ie of a dentinal adhesive on dentinal margins and relative
restoration-substrate "mobility" are required to preserve satisfactory marginal seai.
However, in the present experimental conditions, no statistically significant differences
were found among the diverse cement thicknesses or ihe iuting agents evaluated.
(Quintessence Int 1993:24:281-291.)

Introduction Among the numerous compensatory phenomena

Composite resin restorations undergo stress and defor-
mation during polymerization of the resinous matrix.'
The development of polymerization stress depends on
the existence of adhesion between the substrate and
the restoration materials." Different studies have
demonstrated that the proportion and the extent of
stress and deformation are related to physicochemical
characteristics of the restoration materials and dental
tissues as well as the spatial and adhesive relations
between restorative materials and tooth substrate.'"'"
The interaction between these different factors deter-
mines the initial adaptation and seal of the restoration.
* Lecturer, Deparlmeni of Preventive and Therapeutic Dentis-
try, University of Geneva, Faculty of Medicine. School of Den-
tistry, 19 me Barthélemy-Menn, t2tt Geneva 11. Switzerland.
** Teaching Assistant. Department of Preventive and Therapeu-
tic Dentislry, University of Geneva.
' * ' Professor of Restorative Dentistry and Endodontics, and
Cttairman, Department of Preventive and Therapeutic Dentis-
try, University of Geneva.
Address all correspondence to Prof Holz.
limiting the buildup of polymerization stress inside the
restoration system, the deformation of the material or
flow occurring at the free (unbonded) surfaces of com-
posite resin obturations seems to play an important
role.' Bonded restorations, sueh as ceramic or compo-
site resin inlays or onlays, represent a peculiar ease
among adhesive restorations. In this situation, the
theoretically high ratio of bonded to unbonded sur-
faces (high configuration factor) should strongly re-
duce polymerization stress compensation. This will
emphasize the influence of other factors such as tooth
deformation, cement thickness and rigidity, and ad-
hesion efficiency and development in relation to
polymerization time.''•'''"
When polymerization forces exceed adhesion of the
cement to the substrate and the plastic or elastic defor-
mation of the system, adhesive or cohesive fractures
will occur Adhesive interfaces between composite
resin and composite resin or ceramic are considered to
be effective."'•* Actually, the main limitations of adhe-
sive restorations are the insufficient dentinal bonding
in clinical conditions'^"" and the problems related to
thin gingival enamel margins.'" Adhesive fractures on

Ouintessence International Volume 24, Number 4/1993 281

Dental Research
dentin or near the cementoenamel junction will lead
to marginal or internal leakage,'^ which is responsible
for dentinal pain, recurrent earies, and injuries to the
pulp.--
The aim of this in vitro study was to evaluate the in-
fluence of polymerization forces on marginal and inter-
nal seal of various models of bonded-ceramic restora-
tions. Attention was given to a differential approach of
the various parameters that determine shrinkage and
microleakage clinically.
Method and materials
Ninety-six freshly extracted, sound human third mo-
lars were used for this study. All teeth were stored in
saline solution at 4°C until completion of the experi-
ment. Each tooth was first scaled and cleaned with a
mixture of sodium hypochlorite and pumice. Then it
was mounted in a metallic tray so that resin embedded
the roots up to 1 mm below the cementoenamel junc-
tion. Occlusal surfaces were reduced on a model trim-
mer and a perfectly flat oeelusal preparation was
achieved by polishing with a 600-grit silicon carbide
paper.
282
Fig 1 The different expérimentai
enamei-dentin ratios and their clini-
cal equivalents.
Finishing procedures varied to obtain different
cnamel-dcntin ratios (EDR) (Fig 1);
1. A 1:8 enamei-dentin ratio with half of the marginal
circumference located in dentin and the other half
in enamel (1;8 DE). The clinical equivalent is a
Class II cavity with proximal margins located below
the eementoenamel junction.
2. A 1;8 enamei-dentin ratio with enamel margins
only (1:8 E). The clinical equivalent is a large Class
II cavity with proximal margins located in enamel
"near" the cementoenamel junction.
3. A 1:1 enamei-dentin ratio with enamel margins
only. The clinical equivalent is a Class I or II eavity
with thick enamel margins.
For eaeh prepared tooth, a ceramic overlay was
fabricated with the CEREC computer-aided design/
computer-aided machining system (Siemens). This
proeedure consisted of taking an optical impression of
the preparation and the computer designing and
machining of a ceramic onlay (porcelain MK 1, Vita
Zahnfabrik). The onlay was flattened to match the
tooth stirface. A special positioning system (Fig 2a)
was desigtied to allow the cementation of the ceramic
Quintessence International Volume 24, Number 4/1993

restoration to change the following parameters; the
eement thickness (CT)-80. 150, or 300 [im; and the
rigidity of the restoration-substrate setup (RSSU)--rigid
(R) or free (F).
The thickness of the cementing space was defined
with calibrated steel wires of 80. 150, and 300 t-im
(Mierofil Industries). A rigid setup was obtained when
the wires were held between tooth and restoration dur-
ing cementation. For the free setup, the wedging wires
were removed to allow a relative displacement of the
restoration and the substrate because of the elasticity
of the deviee (Fig 2 b).
Prior to eementation. standard etching procedures
were performed on the enamel (H.;PO4 gel, Coltene)
and the ceramic (5% hydroiluoridric acid gel. Vita
Zahnfabrik). These procedures were followed by the
applieation of a silane coupling agent (Silicoup,
Kulzer) on the etched porcelain.
The restorations were then eemented immediately
with a combination of the following products; bonding
agent-Duo Bond (Coltene) without bonding to dentin
(DBA-) or Scotehbond 2 (3M Dental) with bonding to
dentin (DBA-H); and luting cement (LC)-Duo Cement
(Coltene) or an experimental cement (3M Dental)
{both cements are microfine hybrids).
Bonding agents and luting cements were applied in
accordance with the manufacturer's instructions. The
composite resin was light cured for 80 seconds (20 sec-
onds on each side). After removal of excess cement
and polishing cf the margins (Sof-Lex disks, 3M Den-
Ouintessence Internafronai Voiume 24, Number 4/1993
Dentai Research
Fig 2 b Tooth and oniay in position (free setup,
cement thickness).
Fig 2a (left) Positioning device.
tal), specimens were stored in saline solution at 32''C
for 24 hours.
The sixteen experimental groups and the corres-
ponding combinations of variables tested are listed in
Table I.
The specimens were then subjected to a 24-liour dye
infiltration test:
1. External dye infiltration test (groups I to XII) hy
immersion of the restored crown into a 0.5% eresyl
blue solution.
2. Internal dye infiltration test (groups XIII to XVI)
by introducing the same colorant into the pulp
chamber.
Finally, the teeth were embedded in resin and cut in
two with a slowly rotating saw (Isomet. Buehler). For
the rigid setup, samples were sectioned parallel to the
wedging wires. Leakage was evaluated aeeording to
the infiltration method;
1. For external infiltration, the distanee of eolorant
penetration (CP) was measured, in millimeters,
along the eement-tooth interface from the outer
surface; dentin or enamel side (Fig 3a).
2. For internal infiltration, the proportion of the sec-
tion exhibiting colorant accumulation (CA) was
estimated, in thirds (33%, 66%. or 100%), at the
cement-tooth interface {Fig 3, B).
283
Dental Research

Table I ExperitneiUal groups (ti = 6) and variables tested

Adhesive configuratio 1
substrate Enatnel-dentin Bonding Luting Infiltration
setup Cement thickness ratio agent cement method

80 150 300 1:8 1:8

Group Rigid Free fim DE E 1:1 SB DB DC Exp Ext I

I O • A A * X

II O • A A X

111 o • A A X

IV o • A A X

V 0 • A A • X

VI 0 • A A * X

VII o • A A • X

VIH o • A A • X

IX 0 • A A * X
X 0 • A A • X
XI o • A A X

XII o • A A X
XIII o • A A * X
XIV 0 • A A • X
XV 0 • A A X

XVI o • A A X

The means of the measuretncnts obtained from both Restoration -substrate sett ip
sections of the specimens were used fur the analyiiis of
At dentinal margins, the marginal seal was negatively
the results.
influenced by the rigidity of the setup {Fig 4a}. Sig-
Possible differences between experimental groups
nificantly greater eolorant penetration was observed in
for each variable studied were explored statistically
groups with the rigid setup (group XI: CP = 5.6 mm;
with nonparametric tests. For this purpose, the
group Xlf: CP = 7.2 mm) than was found in groups
Nemenyi tnuliirange test was used, except for cases
with the free setup (group IV; CP — L2 mm; group
where two groups had to be eompared with a Mann-
VI: CP = 0.3 mm).
Whitney i/Test.

Results Cement thickness

Figures 4a to 4c and Fig 5 summarize the results and No significant differenees or even tendencies appeared
the statistical analysis according to each variable. among results for marginal or intertial seal for the
Enamel margins did not exhibit marginal or intertial Ihree cement thicknesses evaluated (Figs 4b and 5). The
leakage in any of the experimental conditions. Duo Bond/Duo Cement groups (I to III) and Scotch-

284 Quintessence International Volume 24. Number 4/1993

 Dental Research

Distance of Extent of coicrant

colorant accumulation
penetration (mm) (7o of total width)

Fig 3 Evalution methods: (A) for

eííternal dye intUtration test; (B) for
internal dye infiltration test.

Figs 4 a to 4 c and Fig 5 Graphs

use the following codes: |RSSU]
restoration-substrate setup: ff^free Mean (± SD) colorani penetration <mm>
and fRJ rigid; (CT) cement thickness 10 I I Significantly different
(fim^; (AC) adhesive configuration: (P < ,05)
(EDR) enamel-dentin ratio, ¡DBA)
dentinal bonding agent - (+) Scototi-
bond 2 and (-) Duo Bond; (LC) luting
cement: (Coltene) Duo Cement and
(EXP. 3M) experimental cement.

IV X! VI XII
Group

RSSU

CT

EDR 1:8 DE

PC
[»A
Fig 4a Results of the marginal
seal evaluation with the external
dye infiltration test. Evaluation of LC EXP, 3M
the infiuence of rest oration-sub-
strate setup.

285
Quintessence International Volume 24, Number 4/1993
Dental Research

Mean (± SD) colorant penetration (mm)

Significantly different
(P < .05)

I
6 -

2 -

o o
IV V VI XI XII
Group
RSSU J [
CT 80 150 300 80 150 300

EDR 1:8 DE

DBA
J L
LC I CCLTENE I L EXP. 3M

Fig 4b Results ot tne marginal seal evaluation with the external dye infiltration test. Evaluation of the influence of eement
thickness-

bond 2/expe rimen tal cement groups (IV to VI) with
the free setup presented mean values of colorant pene-
tration on the dentinal side varying from 2.8 to 4.3
mm (groups I to III) and 0.3 to 1.2 mm (groups IV to
VI). In the groups with the rigid setup, this absence of
a significant difference was confirmed with both exter-
nal (group XI: CP = 5.6: group XII: 7.2 mm) and in-
ternal (groups XIII to XVI: CA - 45.4% to 88.8%)
infiltration tests.
Adhesive configuration
More significant results were obtained when the var-
ious adhesive configurations were compared (Fig 4c).
A total absence of leakage was achieved in restora-
tions with a high enamel-dentin ratio (1:1, group IX
and X) or more precisely for all enamel margins. In
the same experimental conditions, dentinal margins
exhibited a mean colorant penetration of 5,6 mm, and
7.2 mm, respectively, for 80- and 300-|.im cement
thicknesses (groups XI and XII). Dentinal leakage
was also significantly influenced by the use of a den-
tinal bonding agent in the free setup groups. Applica-
tion of Scotchbond 2 with the corresponding experi-
mental cement allowed a significant improvement ot
marginal seal {group V: CP = 1.1 mm) compared to
the other combinations of bonding-luting agents using
Duo Bond (group VIII: CP = 5.6 mm; group II; CP =
4.3 mm). Use of Seotchbond 2 also tended to improve
the marginal seal of free setup restorations cemented
with Duo Cement (group VII: CP = 1.4 mm).

286 Quintessence International Voiume 24, Number 4/1993

 Dental Research

Mean (± SD) colorcint penetration (mm)

Significantiv different
(P < .05)

i
B •

2 .

O -^

Vil V VIII IX XI X XII

Group
RSSU 1 F

CT 1 150

EDR 1 1.BDE
AC
- + + .

COLJENE EXP. 3M EXP. 3M

Fig 4c Results of the marginal seal evaluation with the external dye infiltration test. Evaluation of the influence of adhesive
configuration.

Luting agent cUnieal environment with cycles of thermal, mechan-

With use of the same bonding agent, no significant dif-
ferenee in the dentinal marginal seal appeared be-
tween microfine hybrid cements (Fig 4c).
Discussion
There are two levels of technical sophistieation in the
in vitro assessment of adhesive materials. The first is
to approach in vivo conditions using natural teeth and
the full clinical procedures of the adhesive techniques
evaluated."" Some authors have tried to reproduce a
ical, and even chemical stresses.""'' However, results
of such trials only allow observation of the global ef-
fect of a complex and multifactorial problem. The
other level of sophistication is to focus attention on a
differentiated analysis of the numerous phenomena in-
volved in adhesion processes. This has been reahzed
through complex experimental devices'^"'"•'" that with-
draw sometimes from clinical reality. Therefore, one
purpose of the present study was to combine differen-
tial and clinical approaches of adhesion.
Four of the factors that may influence adhesion of
bonded restorations to tooth substrate were selected
because of their chnical relevance and variabihty.
Considering the physical nature of tissues and mate-

Quintessence International Volume 24, Number 4/1993 287

Dental Research

Mean (± SD) extent of coloration i

IID

60

40

20

XIII XIV XV XVI

Group
RSSU ß
1 1
Cf 80 300 SO 300

EDR 1:8E
AC 1 1
DBA
Fig 5 Results of internal seal
LC evaiuation with the internai dye in-
filtration test. Evaluation of the in-
fluence ot cement thickness.

rials involved clinically in adhesive techniques, a
perfectly "free" or "rigid" situation eannot exist.'The
experimental device tentatively reproduced this state
by using calibrated wires to stabilize the cementing
space for the rigid situation. For the free situation,
elastic properties of the materials constituting ihe
positioning system were exploited by removing the
calibration wires before cementation. The clinical var-
iability of cement thickness encountered in semidireet
or indirect adhesive techniques^"* was simulated by
using three cement thicknesses. Efficiency of luting
composite resin and dentinal bonding agents, as well
as the clinically related enamel-dentin ratio, were also
evaluated with the assumption that any of these
factors could strongly influence restoration marginal
or internal seal.^-^''^''^'"^-^^
Special attention was given in this study to the role
of dentin in adhesion of bonded restorations. For this
reason, in addition to the traditional external infiltra-
tion test applied to groups I to XII, an internal infiltra-
tion test was performed in groups XII to XVI to
evaluate the ineidenee of adhesive fraetures on the den-
tin-compositc resin interface. Colorant penetration
or accumulation was assessed quantitatively or
semiquantitatively, respeetively, on the hypothesis that
dye penetration was influeneed by the extent of the eon-
traetion gap, whieh was itself modulated by polymeri-
zation shrinkage and compensation phenomena.

288 Quintessenoe international Volume 24, Number 4/1993


Fig 6 Sample section showing the perfect seal of the
enamel margin: rigid setup, CT = 300 \im. Scotchbond 2
with expérimentai cement. (Original magnification x 20.)
Surprisingly, no marginal leakage was observed on
the enamel side in any of the specimens either by ititer-
nal or external infiltratton tests (Fig 6). Therefore, it
can be assutned that even in the most critical condi-
tions of this experiment (rigid setup, 3ÜO-|im cemcni
thickness), adhesion forces of resin to etched etiamel
overcame polymerization stresses, although prisms
were sectioned more or less parallel to their long axis.
However, the influence of stress absorption in
porosities as well as small cohesive fractures or slight
peneiratton of wedging wires in dental tissues cannot
be excluded.
Res tora tio n-substrate setup
The negative influence of rigidity in the experimental
setup was clearly demonstrated on dentin marginal
leakage (Fig 7). This observation, in agreement with
results of Davidson and coworkers,'''- showed that
adhesive fractures occurred on dentin when the com-
pensative displacement between restoration and sub-
strate was restrained during resin polymerization.
Cement thickness
fn the present experimental conditions, the eement
thickness did not influence the external or internal
seal. This finding suggests that in a unidirectional
wall-to-wall contraction, theoretical polymerization
stresses related to cement thickness were more effi-
ciently counteracted in thick cement layers by compen-
sative factors, such as molecular rearrangement, air-
porosities, eement deformation, or cohesive fractures.
Ouiniessence Intemational Volume 24, Number 4/1993
Dental Research
Fig 7 Sample section demonstrating the deep colorant in-
filtration along the composite resin-dentin interface: rigid
setup, CT = 300 |.tm, Scotchbond 2 with expérimentai ce-
ment. ¡Original magnification x 12.)
However, the protocol of the present study was not de-
signed to evaluate these phenomena. It is also possible
that variations in the restoration seal related to the dif-
ferent cement thicknesses were under the sensibility
threshold of the evaluation methods.
Adhesive configuration
With respect to the adhesive configuration, the results
concerning enamel-dentin ratio emphasize the impor-
tant intluence of enamel on the marginal seal. Denti-
nal leakage was also significantly reduced, but not to-
tally prevented, by the use of a dentinal bonding agent
(Fig 8). These results are in agreement with the recent
hterature eoncerning dentin adhesion."'""^
Luting cement
Both cements tested are microfine hybrids and bis-
GMA based products. However. Duo Cement pre-
sents a higher viscosity than does the experimental
cement. This physical property did not influence the
restoration seal in this study.
Internal seal
Internal seal was revealed not to be satisfactory with
the rigid setup and, surprisingly, was not enhanced by
the application of a dentinal bonding agent when all
margins were located in enamel (Fig 9). Clinically,
sueh failure of the dentin-resin bond will lead to
gap fonnation and dentinal fluid percolation. This
phetiomenon is now recognized as a major cause of den-
tinal pain during function-''"''-' Moreover, consider-
289
Dental Research
Fig 8 Sample section showing the limited ooiorant infiltra-
tion along the composite resin-dentin interface: free setup,
CT = 300 ¡im, Sootchbond 2 with expérimentai cement,
(Originai magnification x 20,)
ing the cotitroversial biocompatibility of dentinal
bonding agents it can be questioned if direct appli-
cation of resin on dentin is suitable for such bonded
restorations.
Clinical impiications
From a clinical standpoint, when a sufficient surface of
enamel is not available lor sate bonding, the quality of
the seal will mainly depend on the possibility tor the
restoration or dental tissues to deform. This will be
possible only if the inlay or onlay fits the cavity with-
out friction. As the cetnent thickness does not seem to
influence marginal or internal seal, it can be suggested
that thick cementing spaces, as obtained with Cerec
system,"" are preferable to the relative aeeuracy of in-
direct techniques,""' Even with margins entirely lo-
cated in thick enamel, residtial stress after composite
resin polymerization may be redueed if the restoration
or cusps can move or hcnd. However, a larger exposed
cement surfaee will be subjected to increased occiusal
wear and undoubtedly further research is needed to
assess the optimal cement thickness in regard to
polymerization and wear stresses.
Conclusions
In the present experimental conditions, which used a
model of bonded ceramic onlays, marginal seal proved
to be favorably influenced hy the presence of enamel,
mobility, or elasticity of the tooth-restoration whole
290
Fig 9 Sampie section (second perpendicuiar section) de-
monstrating the coiorant accumulation at the oomposite
resin-dentin interface resulting from adhesive fracture: rigid
setup witin a calibrated wire, CT = 300 |.im, Scotchbond 2
with experimental cement (Original magnification x 20,)
and application of a dentinal bonding agent where
marginal enamel was absent. However, the cement
thickness and the luting cements evaluated did not
significantly intiuenee the marginal or the internal
seal.
In a clinical perspective, suceessftil restorations will
probably depend on the possibility for dental tissues
and restorations to move or deform to compensate for
eomposite resin shrinkage. It seems reasonable to
suggest that a restoration that fits the cavity without
friction, as a result of a "thicker " and regular cementing
space, will present a better seal with reduced strain in
the adhesive interface than will a perfectly wedged
restoration.
Usual recommendations claiming that margins of
adhesive restorations have to stay in enamel slill seem
to he pertinent. Adhesion to dentin remains the
weakest part of bonded restorations. Even new den-
tinal bonding agents are not able to promote fhe abso-
lutely satisfactory marginal or internal seal on dentin
that is the basic requirement to extend the indications
of adhesive dentistry and litnit clinical failures.
Acknowledgments
We express our appreciation to Dr R, Lang (University of
Geneva, Instilute of Sociale and Preventive Medicine) for the
statistical analysis of data presented in this report; to Dr A. Wis-
kott (University of Geneva, Department of Fixed P ros th« don Lies)
for assistance in the preparation of the English draft; and to
Siemens AG for providing the CEREC system.
Quintessence International Volume 24, Number 4/1993

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