Cavity preparation factors and microleakage of Class II composite restorations filled at intraoral temperatures

Purpose: To determine if alteration of any of the following factors could reduce microleakage following placement of Class II resin-based composites (RBC) at intraoral temperature: cavity preparation (vertical wall bevels), finishing technique (delayed vs. immediate), or postoperative re-bonding (marginal sealing). An additional purpose was to determine if a decalcification/clearing protocol was a valid technique for assessing three-dimensional microleakage. Materials and Methods: Twenty recently extracted human molars had standardized Class II slot cavities prepared on the mesial and distal surfaces with the gingival floor located on dentin. The teeth were imbedded in a stone template, warmed to 37°C and restored immediately upon removal from the oven with visible light-cured (VLC) adhesive (All-Bond 2) and three horizontal increments of VLC RBC (Bisfil P) using a metal matrix. Teeth were placed into one of four groups: (1) Control; (2) The preparation was modified to include 0.5 -1.0 mm enamel bevels on the vertical walls (facial and lingual); (3) Finishing of the RBC was delayed 24 hours; (4) Following immediate finishing, all margins of the RBC restorations were sealed by dentin bonding agent application. Teeth were stored at 37°C for 2 weeks, thermocycled 1000x at 5/55°C, stained with silver nitrate, underwent a decalcification and clearing protocol, and evaluated for three-dimensional dye penetration. Results: Axial-occlusal enamel margins exhibited minimal leakage and no differences among the groups. Vertical walls without bevels exhibited pronounced microleakage. Beveled vertical proximal walls exhibited significantly less facial and lingual wall microleakage compared to all other groups, and less gingival marginal leakage compared to the control group.