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Introduction :
The goal of operative dentistry, undoubtedly is to restore the tooth to
its form and functions. One of the requisite of a restorative material is to
adapt itself to cavity walls. Inspite of tremendous improvements in means
and technologies, none of the material could actually join chemically with
the tooth surface. The gap left between cavity walls and the restorative
materials plays important role in the prognosis of the restorative treatments.
Previously pulpal reactions to dental procedures were thought to be induced
by mechanical irritations but bacterial leakage is a greater threat to pulp than
the toxicity of restorative materials. Different authors have termed it as
marginal predation liquid diffusion, fluid exchange, capillary penetration
and etc.
Definition :
Microleakage is defined as “The clinically undetectable passage of
bacteria and bacterial products, fluids, molecular or ions from the oral
environment along the various gaps present in the cavity restoration
interface”.
Possible Routes of Microleakage :
1) Within/via the smear layer.
2) Between the smear layer and cavity varnish/cement.
3) Between the cavity varnish/cement and the restoration.
It has been found that minimum of 1.0 µ m space is left at tooth
restoration interface even after employing the adhesive liners and materials.
Clinical implications :
1) Post-operative sensitivity :
• Due to direct communication between oral fluids and pul and it.
• Leads to change into local ionic concentrations.
2) Polymerization Shrinkage :
Occurs with polymeric materials
• Monomer chains are polymerized to form polymer
chain
o Leads to microleakage
(Table 23.2 Page 551)
3) Adhesion :
Adhesion is the attraction of molecular of two different substances to
each other when they are brought in close contact.
• Lack of adhesion – microleakage
• Adhesion influences by –
o Wetting capabilities
o Surface energies
o Presence of water
o Swear layer
o Composition of enamel and dentin
o Surface roughness etc.
b) Influence by operator :
• Improper isolatory
• Poor consternation
• Improper insertion
• Poor cavity designs
• Poor burnishing
• Exposing cement live to the oral cavity.
c) Role of smear layer in microleakage :
Subsequent to instrumentatory of the tooth, the natural deposits
composed of microcrystalline cutting debris embedded within the
denatured collagen is formed on the cut surfaces known as “smear layer”.
• It is 1-2 µ m thick
• Consists of blood, saliva, bacteria, enamel and dentin particles.
• Initial cutting debris – may be pushed into tubules
e) Restorations
GIC, silicates, compromise – release fluoride into gaps
10-15 µ m gap
Decreases microleakage
• Mechanical condensation better.
(Quint Int.23(7)-495-1992)
3) Burnishing :
• Adapt material to margins – (so decrease microleakage)
• Spherical alloys – no reduction in micreleakage.
Leads to microleakage
Decreased wetting
But water uptake – function f resin component
Reduces microleakage
Use of compomer as lining /flourable lining reduces microleakage
3) Finishing
• After 24hours
• Use rotary instrument to finish than menual cutting inst.
Varnish semipermiable
Unfilled resin-more resist water
o Dentinal fluids
Separation of interface
• Masticatory forces
Repeated plastic/elastic deformation of rest
Enhance M.L
• C.T.E.
22-55X10-6/0 C Higher than tooth
so debonding
so microleakage
• Water absorbtion
Absorb water
So decrease M.L.
2) Cavity design :
Conservative :
So decrease polymerization shrinkage
Decrease M.L.
Decrease wear
Modified cavity designs :
• Placement of bevels
• Reduced depths Good marginal adaptation
M.L.
Some say – occlusal bevel – not needed
Because of enamel rod directions and rest may be extended to load bearing
areas
Increase M.L.
Facial and lingual bevels in proximal box
So increase microleakage
Dentin etching :
Earlier – discouraged because of
it opens and widens tubules
hydrophobic resin
Result in increase permeability
So bacterial ingress
Recently hydrophilic resins – create open tubules and porous intertubular
layer
So close adhesion
Occurs within nano metrisized spaces around collagen fibres within fhydrid
layer
They have carboxylic acid groups which attach to dentin and attach
composite to glass ionomer.
Dilute resin modified glass ionomer cements :
Diluted version
Fingi bond II LC
So decreased contraction
No shrinkage/No matresorption.
Prepolymerised composite balls :
• Greater M.L. than inserts
• Better adaptation.
6) Sealing the marginal gaps :
Unfilled low viscosity resins
Because they lead to high conversion (of monomer) rote of inlay and
reduces availability of remaining un converted monomers for
co-polymerization with the luting resin.
So difficult to cure.
Microfilled preferred than hybrid luting reins.
Because less heavily filled materials (hybrid) tend to lose earlier by wear
mechanism.
Composite inlay :
Better
• Decrease M.L.
II. MICROLEAKAGE
AROUND DIRECT GOLD RESTORATIONS:
Adapt to cavity walls more efficiently
Because :
1) High malleability and ductility
Adapts strong.
Microleakage may be due to :
• Improper compaction – in spaces / voids
• Non uniform stepping
• Type of gold selected
• Improper lines of force
• Inadequate condensation pressure.
Measures to reduce leakage :
1) Cohesive gold foils preffered – good seal because mat and
powdered gold are porous:
- Former should be gold foil – internal bulk
Prevent leakage
2) Uniform stepping preffered:
- Half to 1.4th stepping – drive away air spaces
Proper adaptation
5) Restoration build up:
Done in convex form
Good seal.
V. Microleakage around cast restorations :
No close adaptation – 10-160µ ms gap
↓
so luting agent required
↓
low viscous luting agent preferred
↓
because it penetrate into irregularities of both tooth and rest
↓
so micromechanical retention
Advantages :
Now – adhesive luting agents available
↓
and also have chemical retention
•Excessive taper
↓
excessive loads
↓
rest gives away by rotating on preparation surfaces
↓
break in the cement lute
Measures to reduce microleakage :
• Adhesive luting agents should be preferred
↓
chemical bonding
• In case of gold –
o Bevels placed properly
o Burnishing margins (malleable and ductile)
↓
so close proximity to cement surface, due to permanent deformation
o Good percentage of elongation
Type II and III – 20-35% elongation
o In case of high soluble cements (Zp, ZnSi phosphate, silicole >
0.04 – 0.10% solubility) burnishing should be delayed 24 hrs
↓
This allows for superficial few microns of cement to dissolve
↓
Then burnished
o In case of nonsoluble cements
↓
burnishing done immediately
o If rest have close fit within 20µ ms
↓
degradation of cement is resisted
↓
increase life of restoration
Microleakage around porcelain restorations :
• Dental porcelain is a brittle material
↓
low tensile strength
↓
if strain exceeds 0.1%
↓
fracture
↓
so bonded properly
• Earlier – bonded with luting cements
↓
high rate of failure
• Recently – luting resin cements
↓
dual cure
• Chemical bond strength
Initially improved
↓
later weakened by hydrolysis
↓
decrease bond strength after 1 year
↓
wear of cement lute at interfaces with inlay and tooth
• Interfacial gaps
Varies with diff. systems because of technique sensitivity
• Difficult to prepare ceramic inlays that precisely fit cavity.
• Fired ceramic inlays – depend on operator skill
• Ceramic inlays gaps wider than composite inlays
Measures to reduce microleakage :
• Operator skill and patience.
• Advances in adhesive technology
Resin luting cements better than luting cements
↓
as bond degrates with time
↓
ceramic inlay surface treated both mechanically and chemically
↓
st
1 – acid etching done
- Hydrofluoric acid – for fired porcelain
- Ammonium bifluoride – for milled / cast ceramics
↓
give micromechanical retention
↓
etched surface than silanated to increase wetting and so improves
chemical retention.
• Resin luting cements should not be applied with one prior tooth bonding
procedures.
• Closure fit of restoration
o Operators skill and patience
o Glass ceramic restorations (dicor) – excellent marginal
adaptation.
Methods to detect microleakage :
Invitro tests tries to simulate oral environment by thermocycling. Yet
the dynamic nature of pulpodentinal complex and its defence mechanisms
cannot be easily simulated in-vitro. More so, the accumulation of plaque
and other agents might vary the microleakage results in vivo.
The various methods are described, however none of these method is
considered perfect till now.
Different tests –
1) Dyes
2) Chemical tests
3) Radioactive isotopes
4) Neutron activation analysis
5) Scanning electron microscopy
6) Bacterial studies
7) Electrochemical studies
8) Air pressure
9) Artificial caries
10) Pain perception
11) Reverse diffusion method
1) Dyes :
• Coloured agents like organic dyes used
• Have contrasting colour
• Agents used
o Methylene blue
o India ink
o Crystal violet
o Fluoroscein
o Rhodamine B
o Eosin
o Basic fuschin
o Erythrosine etc
Requirements :
• Should not bond to tooth / restoration
• Should be color stable under all conditions of investigation
Availability :
• Solutions
• Particle suspensions of different particle sizes
Technique
• Immersion of restored tooth in dye solution for predetermined period
↓
tooth removed, washed and sectioned
↓
examined under microscope for extent of penetration of dye
Limitations :
• Diff. conc of two dyes vary penetrations times from 5min-1 hr.
• Dyes may bind to tooth / restorations.
Eg : basic fuschin bonds to carious dentin and mistaken for large gap.
• Some dyes may be not colour stable
Eg : aniline blue – colourless in alkaline conditions such as in presence
of Ca(OH)2
2) Chemical tracers :
Reaction bt 1 and more chemicals taken plan
• Chemical used : 50% silver nitrate solution (or) 1% silver chloride
benzene 1,4-diol (hydroquinone) – photographic developer
• Technique
o 2 colourless chemicals react – produce an opaque ppt (usually
silver salt)
o Immerse extracted filled tooth in 50% silver nitrate solutions
which reacts with photographic developer (benzene 1,4 dio)
↓
opaque silver salt produced
Limitations :
• Diff. conc of two dyes vary penetrations times from 5min-1 hr.
• Dyes may bind to tooth / restorations.
Eg : basic fuschin bonds to carious dentin and mistaken for large gap.
• Some dyes may be not colour stable
Eg : aniline blue – colourless in alkaline conditions such as in presence
of Ca(OH)2
3) Radioactive isotopes :
• Ca, I, P, C, S, Rb etc used similar to dyes
• Technique
Immersed in isotope solutions
↓
Removed, washed, sectioned
↓
Autoradiographed to detect tracer
Advantages :
They can detect minute amount of microleakage
↓
Because of their small size – 40nm
Whereas dye smallest size is – 120nm
Limitations :
a) Subjective assessment of results (with using
steriomicroscope – subjectivity minimized)
b) High energy isotopes produce scatter on film –
mistaken for increased leakage.
c) Ca – have affinity to tooth / rest material – may
mislead the results
d) Expensive and technique sensitive
4) Neutron activation analysis :
Technique :
Restored tooth soaked in an aqueous solution of non-radioactive manganese salt
↓
Then tooth placed in core of nuclear reactor
↓
Bombardment with neutrons takesplace
↓
Activates Mn55 to Mn56
↓
Radiation is emitted by tooth is measured to quantify the volume of tracer
present.
Limitations :
a) Inability to identify the points where rest. has leaked
b) Heavy exp costs
c) Effort of nuclear engineers and dentists required
d) Mn may be absorbed by tooth / rest
5) Scanning electron microscope :
• It is direct visual observation of rest adaptation to cavity because of high
magnification and depth.
• Used in both invivo and invitro.
• Earlier – used replicas of tooth
• Recently – evaluates rubber base impressions directly
↓
Reduces many steps (in accuracy decreased)
Limitations :
Potential to induce artifacts during specimen preparation.
6) Bacterial studies :
• Test the possibility of bacteria penetrating through or around rest.
Technique :
Immersed in the cultured broths
↓
Filling is removed
↓
Dentin sharing from the base of cavity cultured.
Limitations :
• Results are qualitative and not quantitative
• Marginal gaps of 0.5-1µ m or larger – allow bacterial penetration
↓
smaller than this gap cannot be detected
↓
smaller than this gap allow toxins
7) Electrochemical studies :
Technique :
Insertion of electrode into extracted tooth in a way that it contacts base of
rest
↓
Once restored teeth sealed to prevent electrical leakage through natural
tooth structure.
↓
Then immersed in a electrolytic bath
↓
Potential is applied between tooth and the bath
↓
Leakage assessed by measuring current flow across as serial resistor
Drawback :
• Unsuitable for metallic rest
• Inability in invivo situations
8) Air pressure :
• Compressed air was used to test the marginal seal
Technique :
Compressed air is introduced through the root canal and pulp chamber
↓
loss of pressure is measured within static system
↓
microscopic examination of air bubbles at margins is noticed – subjective
view.
Disadvantages :
• Inability to use invivo
• Drying effect of compressed air
• Some air may leak before it enters tooth
Advantage :
• Tooth need not be destroyed and result can be quantified
a) Artificial caries :