Comparative evaluation of the microleakage of Cention N and glass ionomer cements in open-sandwich class II restorations—An in vitro study

Namith Rai; Shobana Shetty; Ravi Gupta

doi:10.4103/jioh.jioh_234_21

ORIGINAL RESEARCH

Year : 2023 | Volume : 15 | Issue : 1 | Page : 113-118

Comparative evaluation of the microleakage of Cention N and glass ionomer cements in open-sandwich class II restorations—An in vitro study

Namith Rai¹, Shobana Shetty², Ravi Gupta³
¹ Department of Conservative Dentistry and Endodontics, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education, Manipal, India
² Department of Pedodontics, AJ Institute of Dental Sciences, Mangalore, India
³ Department of Conservative Dentistry and Endodontics, Manipal College of Dental Sciences, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India

Date of Submission	04-Sep-2021
Date of Decision	24-Apr-2022
Date of Acceptance	25-Apr-2022
Date of Web Publication	28-Feb-2023

Correspondence Address:
Dr. Namith Rai
Department of Conservative Dentistry, Manipal College of Dental Sciences, Manipal Academy of Higher Education, Manipal, Karnataka
India

Source of Support: None, Conflict of Interest: None

Check

DOI: 10.4103/jioh.jioh_234_21

Abstract

Aim: To evaluate the microleakage of Cention N in comparison with glass ionomer-based Giomer and Vitremer in class II open-sandwich cervical lining restorations with Fuji II as a control. Materials and Methods: Cavity preparation and grouping of specimens were performed as follows: the sample size was statistically derived at 50 samples into five groups of n = 10 cavities each. Standardized cavity preparation on the mesial surface at the cementoenamel junction of each tooth was: the width was 5 mm, the occlusal depth was 2 mm, and the axial wall length was 6 mm. The teeth were randomly assigned into five (groups 1–5) groups of n = 10 cavities each; group I and group II are the control groups. The samples were stored in artificial saliva at 37°C for 14 days to ensure resinous hydration of the restorations and then placed in water baths for thermocycling and immersed in methylene blue dye and then sectioned and viewed under a stereomicroscope (20×). The microleakage was scored at the occlusal, cervical, and interfacial surfaces. Results: Statistical analysis for microleakage was done with analysis of variance followed by Tukey’s post hoc test. For the interfacial microleakage, group IV (Cention N as a base) was significantly better than group III (Vitremer as a base) and group V (Giomer as a base) (Table 3, Graph 1). Conclusion: In this in vitro study, microleakage scores of Cention N were better than Giomer and Vitremer and comparable with Fuji II LC, suggesting it could be placed as a cervical lining for class II restoration.

Keywords: Cention N, Microleakage, Open-Sandwich, Resin-modified Glass Ionomer Cement

How to cite this article:
Rai N, Shetty S, Gupta R. Comparative evaluation of the microleakage of Cention N and glass ionomer cements in open-sandwich class II restorations—An in vitro study. J Int Oral Health 2023;15:113-8

How to cite this URL:
Rai N, Shetty S, Gupta R. Comparative evaluation of the microleakage of Cention N and glass ionomer cements in open-sandwich class II restorations—An in vitro study. J Int Oral Health [serial online] 2023 [cited 2023 Apr 1];15:113-8. Available from: https://www.jioh.org/text.asp?2023/15/1/113/370751

Introduction

For a restorative material to be durable, it is pivotal to have a good marginal seal and bond strength.^[1] The microleakage at the interface between the tooth and restoration is a significant concern in restorative dentistry.^[1] Microleakage leads to the movement of fluids, bacteria, ions, or molecules between the tooth and restorations.^[1] The problem of microleakage and its implication on a variety of conditions such as tooth discoloration under amalgams, recurrent or secondary caries, hypersensitivity of restored teeth have been researched.^[1] Mclean et al. in 1985 developed a method to overcome the marginal integrity problems associated with class II composite restorations: the sandwich technique to obtain the benefits of glass ionomer and composite material. When a glass ionomer cement is used as a base, followed by a composite restoration, it results in the decreased surface of the dentin that would otherwise be exposed to acid etching, reducing the postoperative sensitivity.^[2] However also because of difficulty in obtaining a dry field in the subgingival areas of a class II restoration, certain challenges may arise in the marginal integrity of composite resin such as the absence of or weak enamel, bond degradation, wetting abilities, deficient condensation, polymerization method, and surface contamination.^[3],[4] The sandwich technique helps overcome these issues. Glass ionomer cements have long been used as a biocompatible base compared with other cements.

Our study aimed to compare Cention N, a tooth-colored alkasite restorative material by Ivoclar Vivadent, which claimed to inhibit demineralization by increasing the release of hydroxide ions to regulate pH value during acid attack due to the alkaline filler.^[5] Fuji II LC by GC is most commonly used material as a dentin substitute, which is light-cured glass ionomer cement with characteristics similar to conventional glass ionomers. Giomer is a hybrid restorative material, based on pre-reached glass-ionomer technology.^[6] Giomers contain both essential components of resins and glass-ionomer cements.^[7] Vitremer tri-cure glass ionomer system has the following three distinct curing reactions: acid–base reaction, dark, and photoinitiated free radical methacrylate cure.^[7]

The null hypothesis is: there is no difference in microleakage between Cention N and glass ionomers when used a base under composite restoration in class II cervical lining restorations as compared to glass ionomer cements. The study aimed to evaluate the microleakage of Cention N with Giomer and Vitremer in class II open-sandwich cervical lining restorations with Fuji II as a control.

Materials and Methods

Tooth selection and cavity preparation

The Institutional Ethics Committee of AJ Ethical Policy and Institutional Review board ethically approved this in vitro study (AJEC/Rev/114/2017–18). Fifty freshly extracted noncarious teeth, free of cracks and restorations, collected from the Department of Oral and Maxillofacial Surgery, AJ Institute of Dental Sciences, Mangalore were included in the study. Transillumination was done to rule out any cracks or defects in them. Specimens were then scaled and cleaned with pumice slurry used within a month of storage in aqueous chloramine solution (1%) at 4°C. The total duration for the completion of the study was 54 days. Standardized cavity preparation on the mesial surface at the cementoenamel junction of each tooth was made using a 245 bur under a water-cooled, high-speed, air-rotor hand piece: the width was 5 mm, the occlusal depth was 2 mm, and the axial wall length was 6 mm. The bur was discarded after five tooth preparations. The enamel and gingival margin in dentin/cementum was prepared to a butt joint.

Grouping of specimens

Samples were randomly assigned into five groups of n = 10 cavities each:

Group I—Cention N as a filling material (negative control)

Group II—glass ionomer cement (Fuji II LC) as a filling material (positive control)

Group III—glass ionomer cement (Giomer) as a base + Prime N Bond NT + Ceram X Mono

Group IV—Cention N as a base + Prime N Bond NT+ Ceram X Mono

Group V—glass ionomer cement (Vitremer) as a base + Prime N Bond NT + Ceram X Mono

Group I and group II were the control groups. Group II, Fuji II LC was used as the control group, the most commonly used glass ionomer cement. All materials were manipulated according to the manufacturer’s instructions.

Control group I (group I) (Cention N) (negative control)

The material was manipulated according to the manufacturer’s instructions (Ivoclar Vivadent) with the mixing time of 60 s followed by placing the material into the prepared cavity.

Control group II (group II) (Fuji II LC) (positive control)

Cavities were conditioned for 20 s with 10% polyacrylic, followed by 20 s of thorough water rinse and restoration with Fuji II LC (GC; Tokyo, Japan).

Experimental group III (group III) (Giomer, Prime and Bond NT, Ceram X Mono)

Beautifil Flow Plus was filled as in group I and was then reduced to just below the height of contour of the tooth. Selective etching of enamel with 37% phosphoric acid for 30 s and 15 s for dentin, followed by a thorough rinse (10 s), and the specimens were dried. Prime and Bond NT (Dentsply DeTrey; Konstanz, Germany) was applied on all surfaces (dentin, enamel, and Giomer) and light-cured for 20 s. The resin composite (Ceram X Mono, shade A3, Dentsply) was placed in small layered increments of 2 mm, light-cured for 40 s and finished.

Experimental group IV (group IV) (Cention N, Prime and Bond NT, Ceram X Mono)

Cention N was filled as in group I and was then reduced as a base to just below the height of contour of the tooth. Ceram X Mono was filled as in group III.

Experimental group V (group V) (Vitremer 3M, Prime and Bond NT, Ceram X Mono)

A primer was applied according to the manufacturer’s instructions before the placement of Vitremer and was then reduced as a base to just below the height of contour of the tooth. Ceram X Mono was filled as in group III.

Thermocycling

The samples are stored in artificial saliva at 37°c for 14 days to ensure hydration of the resinous restorations and then thermocycled for 2500 cycles in water baths, alternatively at 5°C and 55°C, with a dwell and travel time of 15 s.

Dye penetration, sectioning, and microscopic examination

All tooth root apices were sealed with Fuji II LC and layered with two layers of nail varnish prior to the dye penetration test to prevent leakage through other avenues. Specimens were then placed for 72 h in a 2% methylene blue solution, rinsed with water for 2 min, and sectioned using a diamond disc. Each specimen sectioned was subjected to stereomicroscopic evaluation at 20× expressed as ordinal scores from 0 to 3 at occlusal, cervical, and interfacial margins. The scoring system for microleakage was similar to that used by Munro, Hilton, and Hermesch.^[8] Values and its inference used in the present study are as follows:

Score 0—no evidence of microleakage

Score 1—dye penetration up to half of the depth of the cavity–enamel restoration junction

Score 2—microleakage more than half of the depth of the cavity wall–dentin restoration junction

Score 3—dye leakage involves axial wall (cervical microleakage) and three-fourths of the occlusal depth and reaches the cavity floor (for occlusal microleakage). Dye penetration involves the cavity floor and extends further to the interface (microleakage at the interface between base and composite).

Statistical analysis

Statistical analysis was done with IBM SPSS V22 (Chicago, IL). Microleakage was analyzed and compared using the analysis of variance (ANOVA) followed by Tukey’s post hoc test.

Results

Statistical analysis for microleakage was done with ANOVA followed by Tukey’s post hoc test where the P value of <0.05 was considered a level of significance. Occlusal microleakage was compared between five groups, and interfacial microleakage was compared between three experimental groups. The mean occlusal microleakage for group I, group II, group III, group IV, and group V was 1.5 ± 0.84984, 2.2 ± 0.78881, 2.1 ± 0.87560, 1.5 ± 0.84984, and 2.2 ± 0.78881, respectively.

While comparing values for occlusal microleakage of the five groups, the least scores were obtained by group I (Cention N) followed by group IV (Cention N + composite); the three glass ionomer cements had comparable scores, groups II, III, and V. The values recorded between the five groups showed no statistical significance for occlusal microleakage [Table 1] and [Table 2]. Cervical microleakage scores were similar to occlusal microleakage where groups I, IV (Cention+ Composite) had better scores followed by group V (Vitremer), again with no statistical significance, but for the interfacial microleakage between the three experimental groups, group IV (cention + composite) was significantly better than group III (Giomer + composite) and group V (Vitremer + composite) [Table 3], [Graph 1], [Figure 1]. The comparison of dye penetration scores by chi-square test did not have significant difference [Table 4] and [Table 5], [Figure 2].

Table 1: Mean of occlusal microleakage of the five groups

Click here to view

Table 2: Mean of cervical microleakage of the five groups

Click here to view

Table 3: Mean of interfacial microleakage of the three groups

Click here to view

Graph 1: The number of specimens in the interfacial microleakage scoring category

Click here to view

Figure 1: Cervical microleakage

Click here to view

Table 4: Comparison of dye penetration scores of specimens in the five groups performed by chi-square test for occlusal margins

Click here to view

Table 5: Comparison of dye penetration scores of specimens in the five groups performed by chi-square test for cervical margins

Click here to view

Figure 2: Occlusal microleakage

Click here to view

Discussion

Composite restorations in the subgingival areas are techniques that are sensitive because of the inability to obtain total moisture control resulting in a poor marginal seal and increased postoperative sensitivity. Sandwich restorations have long been used to overcome the problems associated with isolation from moisture. The disadvantages of conventional glass ionomer cement have been overwhelmed by recent advances in resin-modified glass ionomers.^[9] No restorative material can provide a perfect seal with cavity walls; there is always a microsurface at the interface between the two, along which microorganisms and fluids can penetrate. Many clinical studies have been published to evaluate cervical lining restorations as an alternative to direct resin composite restorations.^[10],[11] The purpose of this study was to compare the microleakage of a new alkasite material, Cention N, against three different glass ionomer–based cements in cervical lining restorations. There was no interface for the control groups as they were filled with one restoration, whereas for the experimental groups, composite (Ceram X Mono, Dentsply) was placed as a final restoration with Prime and Bond NT, a self-priming dental adhesive with acetone as the solvent.^[12],[13] To evaluate the material’s thermal stability, the samples were placed in artificial saliva to simulate the oral environment. The methodology used for detecting microleakage by dye penetration is considered outdated. Still, microleakage evaluation by scanning electron microscope would give a better view of the adaptation of the restoration. In contrast, dye penetration being one of the oldest methods was thought to be more apt for microleakage. Eosin, methylene blue, methyl violet, hematoxylin and mercuric chloride, protosil soluble red, aniline red, basic fuchsin, chromotrope 2r, crystal violet dye, and fluorescent dye are a few of the many dyes that have been used by countless investigators.^[14] The organic dyes have the advantage that they do not chemically react or cause any destruction to the specimens.^[14]

Our literature search could not find studies with microleakage evaluation between Cention and glass ionomer cements for class II open-sandwich restorations. In our study, even though Cention (groups I, IV) showed lesser microleakage values than Vitremer (group III), Giomer (group V), and the positive control (Fuji II LC), there was no significant difference in the mean microleakage for the occlusal surface and the cervical surfaces for all the groups tested [Table 1] and [Table 2]. For the interfacial microleakage, group IV (Cention N as a base) was significantly better than group III (Vitremer as a base) and group V (Giomer as a base) [Table 3], [Graph 1]. Similar results were obtained in a study by Meshram et al.^[15]; they tested the microleakage of cention on class V cavities and concluded microleakage was significantly lesser with the use of adhesive agent compared with Cention N without an adhesive. Mazumdar et al. in their study concluded that the microleakage of Cention N was comparable to amalgam and glass ionomer cements in class II restorations^[16]; none of the groups in our study were able to eliminate dye penetration through the interfaces. Results of our study show the possibility of Cention N as a base under composite restorations; even though the values are not statistically significant, they are still comparable to the glass ionomer–based cements used for the occlusal microleakage. But for the interface, microleakage Cention’s scores were significantly (P > 0.05) better as compared to Giomer and Vitremer, indicating that Cention N could be used as a substitute for glass ionomer cements. Fuji II LC’s most commonly used glass ionomer cement was used as a control in our study, followed by an experimental group comprising Vitremer, a tri-cure glass ionomer cement, and Giomer, a pre-reacted glass ionomer cement. Vitremer (group III) had comparable scores to other groups. On the other hand, Giomer scored better than Fuji II LC (group II), but no values were statistically significant.

Majety and Pujar^[17] analyzed that the microleakage in composite restorations in their study evaluated whether the different thickness of intermediate layers would influence the microleakage; there was no difference in the cervical marginal microleakage of class II restorations using flowable composite and resin-modified glass ionomer as intermediate layers. Tosco et al. in their study where they tested the microleakage of class II restorations concluded that the microleakage is minimum with bulk fill composite materials as the number of interfaces is reduced,^[18] which is not possible in every case, especially when moisture control is a question.

Sujith et al. studied the mechanical and microleakage properties of Cention N with glass ionomer cement and hybrid composite restorative materials and concluded Cention N to have similar microleakage properties similar to the findings in our study.^[19]

The study is an in vitro study, provides essential information when assessing materials, but does not replace clinical (in vivo) evaluations. Dentin heterogeneity may alter the results due to differences in dentin depth, permeability, and the degree of mineralization and tubular orientation, all of which would affect the microleakage results. Microleakage being a three-dimensional phenomenon reflected as a two-dimensional phenomenon also would be one of the limitations.

Conclusion

The null hypothesis thus was rejected. Microleakage scores of Cention N were better than Giomer and Vitremer and comparable to Fuji II LC. Our study concludes that Cention N could be a viable substitute to resin-modified glass ionomer cement for open-sandwich class II restoration.

List of abbreviation

G1-G5: group 1-5.

Acknowledgement

No acknowledgements.

Financial support and sponsorship

No source of financing (self-financed).

Conflicts of interest

We as authors of this study declare no conflict of interest as per our knowledge.

Authors’ contribution

NR: Investigation design, preparation of samples and writing the manuscript; SS: Preparation of samples, manuscript editing; RG: Scoring under stereomicroscope.

Ethical policy and institutional review board statement

For this in vitro study, ethical approval was obtained from institutional ethics committee (AJEC/Rev/114/2017–18).

Patient declaration of consent

Not applicable.

Data availability statement

Not applicable.

References

1.	Breschi L, Mazzoni A, Ruggeri A, Cadenaro M, Di Lenarda R, De Stefano Dorigo E Dental adhesion review: Aging and stability of the bonded interface. Dent Mater 2008;24:90-101.
2.	McLean JW, Powis DR, Prosser HJ, Wilson AD The use of glass-ionomer cements in bonding composite resins to dentine. Br Dent J 1985;158:410-4.
3.	Rocca GT, Daher R, Saratti CM, Sedlacek R, Suchy T, Feilzer AJ, et al. Restoration of severely damaged endodontically treated premolars: The influence of the endo-core length on marginal integrity and fatigue resistance of lithium disilicate CAD-CAM ceramic endocrowns. J Dent 2018;68:41-50.
4.	Choi KK, Ryu GJ, Choi SM, Lee MJ, Park SJ, Ferracane JL Effects of cavity configuration on composite restoration. Oper Dent 2004;29:462-9.
5.	Ruengrungsom C, Burrow MF, Parashos P, Palamara JEA Evaluation of F, Ca, and P release and microhardness of eleven ion-leaching restorative materials and the recharge efficacy using a new Ca/P containing fluoride varnish. J Dent 2020;102:103474.
6.	Itota T, Carrick TE, Yoshiyama M, McCabe JF Fluoride release and recharge in giomer, compomer and resin composite. Dent Mater 2004;20:789-95.
7.	Yap AU Post-irradiation hardness of resin-modified glass ionomer cements and a polyacid-modified composite resin. J Mater Sci Mater Med 1997;8:413-6.
8.	Munro GA, Hilton TJ, Hermesch CB In vitro microleakage of etched and rebonded class 5 composite resin restorations. Oper Dent 1996;21:203-8.
9.	Rai N, Naik R, Gupta R, Shetty S, Singh A Evaluating the effect of different conditioning agents on the shear bond strength of resin-modified glass ionomers. Contemp Clin Dent 2017;8:604-12.
10.	Andersson-Wenckert IE, van Dijken JW, Kieri C Durability of extensive class II open-sandwich restorations with a resin-modified glass ionomer cement after 6 years. Am J Dent 2004;17:43-50.
11.	Lindberg A, van Dijken JW, Lindberg M 3-year evaluation of a new open sandwich technique in class II cavities. Am J Dent 2003;16:33-6.
12.	Osorio R, Pisani-Proenca J, Erhardt MC, Osorio E, Aguilera FS, Tay FR, et al. Resistance of ten contemporary adhesives to resin-dentine bond degradation. J Dent 2008;36:163-9.
13.	Aljamhan AS, Alhazzaa SA, Albakr AH, Habib SR, Zafar MS Comparing the ability of various resin-based composites and techniques to seal margins in class-II cavities. Polymers 2021;13:2921.
14.	Alani AH, Toh CG Detection of microleakage around dental restorations: A review. Oper Dent 1997;22:173-85.
15.	Meshram P, Meshram V, Palve D, Patil S, Gade V, Raut A Comparative evaluation of microleakage around class V cavities restored with alkasite restorative material with and without bonding agent and flowable composite resin: An in vitro study. Indian J Dent Res 2019;30:403-7.
16.	Mazumdar P, Das A, Das UK Comparative evaluation of microleakage of three different direct restorative materials (silver amalgam, glass ionomer cement, cention N), in class II restorations using stereomicroscope: An in vitro study. Indian J Dent Res 2019;30:277-81.
17.	Majety KK, Pujar M In vitro evaluation of microleakage of class II packable composite resin restorations using flowable composite and resin modified glass ionomers as intermediate layers. J Conserv Dent 2011;14:414-7.
18.	Tosco V, Vitiello F, Furlani M, Gatto ML, Monterubbianesi R, Giuliani A, et al. Microleakage analysis of different bulk-filling techniques for class II restorations: µ-CT, SEM and EDS evaluations. Materials 2021;14:31.
19.	Sujith R, Yadav TG, Pitalia D, Babaji P, Apoorva K, Sharma A Comparative evaluation of mechanical and microleakage properties of cention-N, composite, and glass ionomer cement restorative materials. J Contemp Dent Pract 2020;21:691-5.