Marginal Adaptation of Compomer Ciass V

Restorations in Vitro
Uwe BlunckVJean-Franois Roulet^

Purpose: The purpose of this in vitro study was to determine the marginal adaptation of different adhesives, including recently developed self-etching phmers, in combination with compomers in Class V cavities.
Materiais and Methods: In 80 extracted human teeth, divided into 10 groups ot 8, Class V cavities were
prepared (ca. 4 mm high, 3 mm wide, and 1.5 mm deep) with one half ofthe margin iength in dentin. The
one-bottie adhesiues Prime & Bond 2.1, Syntac SC, and Espe OSB, and the seif-etching primers Rasant
F 2000 and Prompt L'Pop were used in combination with compomers. Before and after thermocycling
(TC), repiicas were taken and a quantitative margin anaiysis using the SEM was performed at a magnification of 200x using defined criteria.
Resuits: The statistical analysis using Kruskal-Wallis and Bonferroni tests showed a significantly (p < 0.05)
better marginal adaptation in enamei and dentin for the self-etching primers, and when the one-bottle adhesives were used in combination with the total-etch technique.
Conciusion: Self-etching primers improve the marginal adaptation of oompomer restorations in enamei.
} AOhesive Dent 1999,1:143-151

Submitter] for pubiication: 16.02.99; accepted for publication: 23.02.99

ihce glass-ionomer cements were introduced in

1969, they have been continuously modified.
While glass-ionomer materials harden by an acidbase reaction,22 the resin-modified glass ionomers^^ include an additional polymerization reaction. This results in more favorable working characteristics, such as prolonged application time, and
improved properties, such as reduced sensitivity to
early water contamination. The more recently developed "compomers" are polyacid-modified resin
composites,i8 and were introduced to the dental
profession as a restorative material which com-

bines the advantages of glass-ionomer cements

(fluoride release) and composite resins (wear resistance and better esthetics). These materials consist
of polyacid-modified dimethacrylate monomers reinforced with ion-leaching glass particles similar to
those in glass ionomers. Since they contain no
water, the setting reaction can only take place as a
polymerization reaction as in composite resins. Unlike glass ionomers, compomers cannot establish a
bond to tooth structure by themselves, and therefore have to be placed in combination with an adhesive system.^'^

The kinetics of polymerization and the lower

Young's modulus of elasticity of compomers'^'^^ are
the reason for reduced polymerization shrinkage
' Professor Associate, Dept of Operative Dentisfry. Preventive Denstress during the setting reaction of compomers.
tistry, ana Endodontics, School of Dental Medicine, Hurnbolt UniTherefore, in comparison to composite resins, only
versity Berlin (Charit), Germany.
" Professor, Dept. of Operative Dentistry, Preventive Dentistry, andreduoed forces interfere with the bonding capacity
Endodontics, School of Dental Medicine, Humtiolt University
of the adhesive to enamel and dentin when comBerlin (Charit), Germany
pomers are used. Several n vivo studies have
Repiint requests; Dr. Uwe BluncK Dspt. of Operative Dentistry, Pre- shown that the application of one-bottle adhesives
ventive Dentistry, and Endodontics, School of Dental Medicine, Humboldt University Berlin (Charit), Augustenburger Piatz 1, D-13353 without acid-etching enamel and dentin is effective
Berlin, Germany. E-mail: ubtLinckcharite.de

Voi 1, No 2 . 1 9 9 9

143

Blunck/Roulet

Tabie i List of evaiuated adhesive/ restorative materiai combinations

Gtou

Dentin adhesive

Batch Number

Compomer

Batch Number

Rasant

CM002

F 2000

CMOOl

Prime & Bond 2.1

# 9805000697

Dyract AP

# 9803000113
2000-02

Dyract

# 9710001126
2000-06

2001-05

Ptime&Bcnd 2.1

# 9805000697
2001-05

Syntac SC

# 926758: 1999-12 Compoglass F

ESPE OSB

#002/1998-07

Hytac

#004/1998-11

Prompt L" Pop

#001:07/98

H/tac

# FW 0044472
1999-10

Prompt L'Pop

# 001:07/98

Dyract AP

# 9803000113
2000-02

Primes Bond 2.1

-1- total-etch tech.

9805000697
2001-05

Dyract AP

# 9803000113
2000-02

Prime & Bond 2.1

+ total-etch teoh.

# 9805000697
2001-05

Dytact

# 9710001126
2000-06

ESPE EBS

#159/1998-07

Hytac

#004/1998-11

10

# 909420: 2000-07

* total-etch tech.

Tabie 2 Criteria for the marginai examination in the SEiVI at a magnification of 200 X
Margin quality

Defihition

Margin not or hardly visibie, no ot slight marginal irreguiatities; no gap

No gap but sevete marginai irregularities

Gap visibie (hairline crack up to 2 um): no marginal irregularities

Severe gap (more than 2 pm); slight and sevete marginal irregularities

Tlie term "margiral irregularities" means: porosities, marginal restotstion fracture, bulge ir tiie restora-

in providing acceptable marginal adaptatJoti of

oompomer restorations.2."^.i5,i6,20 However, it has
been proven in vitro that etching the enamel significantly increases the shear bond strength of compomers.^'^'I^'^" New developments of adhesive
systems which combine the abilities to condition
and prime both enamei and dentin in one liquid
seem to further simpiify the application technique,
Simpiified appiicationie, without acid-etching
the cavity walls firstis one important advantage of
compomers over ccmposite resins.
144

The purpose of this in vitro study was to determine the marginal adaptation of different adhesives inciuding recently developed self-etching
primers in combination with compomers in Class V
cavities.

IVIATERIALS AND IVIETHODS

For this study, 80 extracted caries-free human maxillary incisors were stored in a 0.1 % thymol solu-

TheJournal of Adhesive Dentistry

tien. The teeth were numbered from 1 to SO and

randomiy assigned to 10 groups. The Ciass V cavities were prepared with a diamond bur (No. 837
KR,314; Gebr. Brasseler GmbH, Lemgo, Germany)
at high speed (80,000 rpm) using water spray as a
coolant. The ovai preparation was approximately
1.5 mm deep, 3.0 mm wide, and 4,0 mm high, Haif
ofthe preparation was situated apical to the cemento-enamel junction. The margins in enamei
were finished (No. 8 8 3 8 / 3 1 4 / 0 1 2 ; Gebr. Brasseler
GmbH) without beveling, and the cavosurfaoe margins in dentin were prepared to a 90" angle.
The cavities were filled with compomer in combination with different adhesives (Table 1), In three
groups, enamel and dentin were etched prior to the
appiication of the adhesive. The adhesive systems
(Table 1] were applied according to the manufacturer's instructions. The oompomers were placed in
two increments starting at the cervicai margins.
Each increment was light oured (Heliolux GT, Vivadent Dentai GmbH, Eiiwangen, Germany) for 60 s.
After polishing (Sof-Lex Pop-on No, 1981 SF/F/M
3M Medica GmbH, Borken, Germany), the teeth
were stored in water for 2 1 days and then thermocycled for 2000 cycies between +5C and +55C,
Before and after the thermocyciing procedure, impressions were taken with a poiyvinyl siioxane
impression material (Silagum light body; DMG,
Hamburg, Germany), Repiicas were produced by
casting the impressions with an epoxy resin (Stycast 1266 Part A + B; Emerson and Cumming,
Westeric, Belgium) and gold-sputtering the surface
(SCD030; Balzers Union, Baizers, Liechtenstein).
The margins of the restorations were examined
and quantified with a scanning eiectron microscope
(AMRAY 1810, Bedford, MA, USA) ata magnification
of 200x using defined criteria (Tabie 2), The teeth
were evaluated in numerical sequence, in order to
prevent disclosing their group assignment to the examiner. The marginal quality criteria were summarized as percent of the total margin iength, given
separately for enamei and dentin in each cavity.
The statisticai analysis was performed with the
Kruskal-Wallis test and Bonferroni adjustment using
the SPSS statistical software.

RESULTS

The results (Table 3) are summarized for the marginal quaiities "continuous margin" and 'marginai
openings" in Figures 1 to 4 as boxpiots, giving the
Vol 1, No 2 , 1 9 9 9

Blunck/Roulet

percent of the entire margin length in dentin or

enamei after thermocyciing.
The "continuous margin" results in dentin after
thermocyciing show the highest percentages for the
groups using Rasant/ F2000 and Prompt L ' P o p /
Dyract AP (Fig 1), The median vaiues of 100% for
these two groups were significantly higher than
those of the group using Prime & Bond 2,1 / Dyract
and ESPE OSB / Hytac, The total-etch technique increased the percent of continuous margins in dentin significantly when Prime & Bond 2,1 was used in
combination with Dyract. The proportion of marginal openings corresponds to these resuits. The
groups using Rasant or Prompt L'Pop, as weil as
those groups in which the totai-etch technique was
aiso used, showed the icwest proportion of marginai openings (Fig 2), Again, acid-etching the
dentin improved the marginal adaptation, as shown
by a significantly smaller proportion of gaps in the
groups using Prime & Bond 2,1,
The resuits regarding the marginal adaptation in
enamel show better margins (Fig 3) for the groups
using either the acid-etching technique or the seifetching primer systems Rasant or Prompt L'Pop.
Only when Prompt L'Pop was used in combination
with Dyract AP the proportion of "continuous margins" was statisticaiiy significantly (p < 0.05) higher
in comparison to the group using Hytac as a restorative material. However, this ccuid not be found for
the proportion of "marginai openings" (Fig 4),
where no statisticaiiy significant difference could be
found. In aii groups using Prime & Bond 2.1, Syntac
SC, and ESPE OSB without enamel etching, marginal openings were much more frequent.

DISCUSSION
The method this study empioyed to evaiuate the efficiency of dentin adhesives has been used successfully for years,^-^'^'^^ The sampies were stored
in water for 3 weeks in order to avoid changing the
marginai adaptation due to water sorption by the
restorative materiai during thermocyciing. Composite resins, resin-modified giass ionomers, and polyacid-modified composite resins show the highest
amount of water sorption within the first 14 days,2i
After this time, the effect of water sorption on marginal adaptation should be minimized. The thermal
stress to which the fiiiings were exposed leads to
debonding at the interface whenever the dentin
bond strength is too low to withstand poiymeriza-

145

Blunck/Roulet

Table 3 Results (median and mean) for the different groups tested in
the margin analysis of enamel and dentin
Margin auaiity*
Group

Margin

Time of evaiuation

Rasanl/
F2000

Enamei

Before TC
After TC

Dentin

Before TC
After TC

Prime & Bond 2 . 1 / Enamel

Dyract AP

Before TC
After TC

Dentin

Before TC
After TC

Pnme&Bond 2 . 1 / Enamel
Dyract

Before TC
After TC

Dentin

Before TC
After TC

Syntac SC/
Compogiass

Enamel

Before TC
After TC

Dentin

Before TC
After TC

ESPE OSB/
Hytac

Enamel

Before TC
After TC

Dentin

Before TC
After TC

Prompt L'Pop/
Hytac

Enamel

Be ore TC
After TC

Dentin

Before TC
After TC

146

Median
Mean
Median
Mean
Median
Mean
Median
Mean
Median
Mean
Median
Mean
Median
Mean
Median
Mean
Median
Mean
Median
Mean
Median
Mean
Median
Mean
Median
Mean
Median
Mean
Median
Mean
Median
Mean
Median
Mean
Median
Mean
Median
Mean
Median
Mean
Median
Mean
Median
Mean
Median
Mean
Median
Mean

99.0 1.1
9S.9 1.1
96.3 3.5
96.2 2.8
100.0 0.0
9S.1 0.0
100.0 0.0
98.2 0.0
86.5 10.8
87,8 11.2
63.0 11.1
54.9 13.3
95.2 2.4
88.3 4.3
84.1 6.9
78.1 11.1
73.9 22.5
73.7 22.5
59.7 14.9
59.7 16.2
98.9 1.1
96.2 2.9
63.5 10,9
69.2 14,1
69.2 26.7
66.5 29.8
41.9 14.7
39.8 14.0
98.1 1.9
93.5 4.0
88.8 11.2
83.8 12.6
96.6 3.4
96.0 4.0
39.2 3.3
38,2 14.0
97,2 2.8
91.2 8 . 1
74.4 7.3
71.3 10,1
91.2 8,8
91.0 9.0
73.9 26.1
62.0 38.0
98.7 1.2
98,5 1.2
95.6 3.6
91.4 7.4

0.0

0.0

0.0

0.0

1.1

0.0

1.0

0.0

0.0

0.0

0.0

1.9

0.0

0,0

0.0

1.8

0.8

0.0

1.0

0.0

9.2

6.4

14.0 17.8
4.8

0,8

6.6

0.8

5.7

0.7

10.1 0.7
1.3

1.2

1.8

2.0

17.0 0.9
18,9 5.2
0.9

0.0

0.9

0.0

15.1 1.6
15.1 1.6
3.4

0,0

3.7

0.0

37.1 1.6
41.4 4.8
2.4

0.5

2,0

0.5

2,7

0.7

?Q

0.7

0.0
0.0
39.2
36.3

0.0

.0

0,0

0.0

11.6
11.6
0.7
0.0
0.7 CD
14.0 0.0
18.5 0.0
0,0

0.0

0.0

0.0

0.0

0.0

0.0

0.3

0.0

0.3

0.6

0.5

0.6

0,5

TheJournai of Adhesive Dentistry

Table 3 (continued)

Marg n qu
Group

Margin

Time of evaluation

Prompt L'Pop/

Enamei

Before TC

Dyract AP
After TC
Dentin

Befcre TC
After TC

Primes Bond 2.1

Enamel

Before TC

'total-etch tech,/
Dyract AP

After TC
Dentm

Before TC
After TC

Prime & Bond 2.1

Enamel

Before TC

+ totai-etch tech./
Dyract

After TC
Dentin

Before TC
After TC

ESPE EBS

Enamel

Before TC

+ total-etch tech./
Hytac

After TC
Dentin

Before TC
After TC

Median 98,2

0.0

0,0

1,8

Mean

1,8

98,2

0,0

0.0

Median 98,1

0,0

0,0

1,9

Mean

2.2

97.8

0,0

0,0

Median 99,6

0.0

0,0

0,4

Mean

99,6

0,0

0.0

0,4

Median 99.2

0,0

0,0

0,8

Mean

99,2

nn

nn

0.8

Median 98,1

0,3

0,0

0,0

Mean

97.5

1,5

1,1

0,0

Median 91,4

5,2

2,9

0,0

Mean

91,6

5,2

3.3

0,0

Median 97,7

2.3

0,0

0,0

Mean

97,4

2,6

0.0

0,0

Median 95.1

4,9

0,5

0,0

Mean

93,2

fi7

05

0,0

Median 95,9

3.2

0,3

0,8

Mean

94,6

3,8

0.8

0.8

Median 94.7

3,9

0.0

0,7

Mean

91.3

5,2

2,9

0,7

Median 99.3

0.7

0,0

0.0

Mean

99.0

1,0

0.0

0,0

Median 91,9

8,1

0.0

0,0

Mean

92,4

7,6

0,0

0,0

Median 98,1

0,3

0,0

0,0

Mean

97,5

1,5

1,1

0,0

Median 94,7

5.3

0,0

0,0

Mean

93,8

6,2

0.0

0,0

Median 98,9

1,1

0,0

0.0

Mean

96,7

3,3

0,0

0,0

Median 93,1

4,9

2,4

0,0

Mean

5,3

2,7

0,0

92,0

*ses T3t>is 2 for sscfiption

bond strength is too low to withstand poiymerization stress and/or thermocyoling, it was not the intent of this study to investigate tiie effect of
long-term water storage on the hydroiysis of the adhesives.
The results cieariy show the effectiveness of the
conditioning primers in achieving better marginai
adaptations. Several investigations came to the
conclusion that etching the enamel can significantiy improve the margina! adaptation of compomers to enamel,3.9.io.ii.ii It was found that
Vol 1, No

2.1999

etching the enamel increases the shear bond

strength of Prime & Bond 2,1 and Syntac SC in
combination with the corresponding compomer. In
clinical studies, however, there was no statistically
significant difference amongthe evaiuated margins
in enamel in Class V cavities.2.'.i5,i6,20 practitioners ocoasionaily find stained margins in enamel
with compomer restorations. The reason is the
rather rough interface at the margins whenever the
enamei margins are not acid-etched.

147

Blunck/Roulet

Rasant / F2000
Prompt LP / Dyract AP
Prompt LP / Hytac
P&B 2.1 + TAT / Dyract AP
ESPE EBS + TAT/Hytac
P&B 2.1 + TAT / Dyract
Syntac SC / Compoglass
P&B 2.1 / Dyract AP
ESPE OBS / Hytac
P&B 2.1 / Dyract

Fig 1 Amount of "continuous margin " in percent of the entire margin iength in dentin in Class V cavities after thermocyciing
(n = 8 (o = outliers). Results of groups oonnected by vertical bar are not significantly (p > .05) different. TAT = total-etch technique.

Fig 2 Amount of "marginal openings" in percertt of entire margin length in dentin in Ciass V cavities atter thermocycling (h
(0 = outiiersl. Results of groups connected by vertical bar are not significantly (p > .05) different. TAT = totai-etch technique.

148

The Journal of Adhesive Dentistry

Blutiok/Roulet

Prompt LP / Dyract AP
Rasant/F2000
P&B 2.1+TAT/Dyract
ESPE EBS + TAT/Hytac
P&B 2.1 + TAT/Dyract AP
Prompt LP / Hytac
P&B 2.1 / Dyract AP
P&B 2.1 / Dyract
Syntac SC / Compoglass
ESPE OBS/Hytac
20

40

60

80

100%

Fig 3 Amount cf continuous margin" in percent of entire matgin length in enamel in Ciass V cavities after thermocycling (n
(0 = outliers). Results of groups connected by vertical bar are not significantly (p > ,05] different. TAT = total-etch technique.

Prompt LP / Hytac
ESPE EBS + TAT/Hytac
Rasant/F2000
Prompt LP / Dyract AP
P&B 2.1 + TAT / Dyract
P&B 2.1 + TAT/Dyract AP
P&B 2.1 / Dyract AP
P&B 2.1 / Dyract
Syntac SC / Compoglass
ESPE OBS / Hytac
100%
Fig 4 Amount of "marginal openings" in percent of entire margin length m enamel in Class V cavities after thetmocycling (n
(0 = outliers. Results of groups connected by vesical bar are not significantly (p > .05) different TAT = total-etch techhique.

Vol 1, No 2 , 1 9 9 9

149

Fig 5 Margin in enamel of a Class V cavity restored with

Hytac (SEM, 200X],

Fig 6 Margin in enamel of a Class V cavity restored with

Dyract AP {SEM, 200X).

Fig 7 Enamel surface after pretreatment with Prompt L 'Pop

for 30 s and nnsed with water (SEM, 2000X),

150

Other studies showed an increase of marginai

openings at the cervical margins in dentih after
acid-etching the enamei a l o n e . i ' It was hypothesized that the improved bonding to enamei after
etching can puil the material from the weaker bonding areas in dentin. In the present study, there was
even a statisticaiiy significant increase of the proportion of "continuous margin" when Dyract was
applied in combination with Prime & Bond 2,1 after
totai etching. As in an in vivo study,^^ no effect on
the marginal sealing in dentin could be found when
the enamei was etched aiong with the dentin. It
seems that conditioning the dentin with phosphoric
acid improves the bond strength of Prime & Bond
2,1, Therefore, whenever the enamel margins are to
be etched, the dentinai cavity wails should be included as weil.
There is some controversy about the conclusions
from the studies evaiuatihg the effect of previous
etchingof the cavity walls to improve the margins of
compomer restorations in enamel. Some autiiors
even recommend using the adhesive systems in
combination with compomers only after conditioning the enamel with aoid.^'^ This, however, is contrary to the concept behind compomer use. They
were intended to be a material which could be handled as easily as giass ionomers, which means
without an adhesive system, and still have the better properties of a composite resin, such as esthetic appearance and wear resistance. The use of
a compomer in daiiy practice would be inappropriate if the same time-consuming adhesive technique
had to be performed as for composite resin restorations,
Dyraot's monomer system and particle size were
improved by the manufacturer, yielding Dyract AP,
which has a smoother surface. This is the reason
for the statisticaiiy significantly smaller proportion
of "continuous margin" in enamei for the group
using Prompt L'Pop combined with Hytac in comparison to Dyract AP, as shown in Figures 5 and 6,
There was no difference between these grcups
regarding marginal openings. This means that the
amount of marginai irreguiarities was higher, caused by the rough materiai (see Fig 5),
On the other hand, the conditioning primers, eg,
Rasant and Prompt L'Pop, were as effective as
Prime & Bond 2.1 in combination with the total-etch
technique. The acidic primers seem to increase the
bond strength to enamel. After rinsing the applied
primer Prompt L'Pop with water, the SEM shows an

The Journal of Adhesive Dentistry

Blunck/Roulet

enamel surface etching pattern (Fig 7) with irregularities which facilitate micromechanicai retention.
These favorable results for the acidic primers
Rasant and Prompt L'Pop must be confirmed in
clinical studies. However, the lower polymerization
shrinkage stress of the compomer in combination
with a self-etching primer seems to improve the
marginal adaptation of compomers in enamel without extending the adhesive procedure.

CONCLUSION

From this in vitro investigation, it can be concluded

that the seif-etching primers achieve marginai
adaptation of compomer restorations in enamel
which are comparabie to those of one-bottle adhesives after acid-etching the cavity walls. Further
clinical studies have to investigate whether such a
time-saving technique can provide iong-term success.

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