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AROUND CLASS V CAVITIES RESTORED WITH FIVE DIFFERENT TOOTH COLOURED RESTORATIVE

MATERIALS – AN IN VITRO STUDY

DISSERTATION

submitted to

THE TAMILNADU Dr.M.G.R.MEDICAL UNIVERSITY

In partial fulfilment of the degree of

MASTER OF DENTAL SURGERY

BRANCH IV

CONSERVATIVE DENTISTRY AND ENDODONTICS

2017 – 2020

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This is to certify that this dissertation titled “A Comparative Evaluation of Microleakage Around Class V Cavities Restored With Five Different Tooth Coloured Restorative Materials – An In Vitro Study” is a bonafide record of the work done by Dr. L.ASHOK under our guidance during his post graduate study during the period of 2017-2020 under The Tamil Nadu Dr. M.G.R Medical University, Chennai, in partial fulfilment for the degree of Master Of Dental Surgery in Conservative Dentistry and Endodontics, Branch IV. It has not been submitted (partial or full) for the award of any other degree or diploma.

Dr. J. MANO CHRISTAINE ANGELO, MDS Professor &Co-Guide

Department of Conservative Dentistry & Endodontics,

Sree Mookambika Institute of Dental Sciences,

Kulasekharam.

Dr RAJESH S, MDS Professor,HOD &Guide Department of Conservative Dentistry &Endodontics,

Sree Mookambika Institute of Dental Sciences,

Kulasekharam.

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This is to certify that this dissertation work titled “A Comparative Evaluation of Microleakage Around Class V Cavities Restored With Five Different Tooth Coloured Restorative Materials – An In Vitro Study” of the candidate Dr. L.ASHOK, with registration number 241717251 for the award of Master of Dental Surgery in the branch of Conservative Dentistry and Endodontics, [Branch- IV]. I personally verified the urkund.com website for the purpose of plagiarism Check. I found that the uploaded thesis file contains from introduction to conclusion pages and result shows 7 percentage of plagiarism in the dissertation.

Guide & Supervisor sign with Seal.

Date:

Place:

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SCIENCES, KULASEKHARAM

ENDORSEMENT BY THE PRINCIPAL / HEAD OF THE INSTITUTION

This is to certify that the dissertation entitled “A Comparative Evaluation of Microleakage Around Class V Cavities Restored With Five Different Tooth Coloured Restorative Materials – An In Vitro Study” is a bonafide research work done by Dr. L.ASHOK the guidance of Dr. Rajesh S., M.D.S, Professor and Head of the Department, Department of Conservative Dentistry and Endodontics, Sree Mookambika Institute of Dental Sciences, Kulasekharam.

Dr.Elizabeth Koshi, MDS, PRINCIPAL

Sree Mookambika Instituteof Dental Sciences, V.P.M Hospital Complex,

Padanilam, Kulasekharam,

Kanyakumari District, Tamil Nadu - 629161

Date:

Place:

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I hereby declare that this dissertation “A Comparative Evaluation of Microleakage Around Class V Cavities Restored With Five Different Tooth Coloured Restorative Materials – An In Vitro Study” is a bonafide record of work undertaken by me and that this thesis or a part of it has not been presented earlier for the award of degree, diploma, fellowship or similar title of recognition.

Dr. L.ASHOK PG Student

Department of Conservative Dentistry & Endodontics Sree Mookambika Institute of Dental Sciences

Kulasekharam.

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I would like to Thank Lord Almighty for his guidance and blessings given to complete this research study successfully.

I would like to express my deep gratitude and sincere thanks to our Chairman Dr. C.K Velayuthan Nair , M.B.B.S., M.S and Director Dr. Rema V.Nair M.B.B.S., M.D, D.G.O for their academic support and facilities provided for me to complete my study .

I would like to thank our Trustees Dr.Vinu Gopinath .M.B.B.S., M.S.,M.Ch and Dr. R.V Mookambika M.B.B.S.,M.D.,D.M., for their help and support to complete my study.

I would like to extend my profound gratitude and sincere thanks to my guide Dr.Rajesh.S MDS, Professor & Head Of The Department ,Department Of Conservative Dentistry And Endodontics , for his skillful suggestions ,boundless patience ,timely help, constant advice, and emotional support all through my study as well as during my post-graduation period.

I express my sense of gratitude and heartfelt thanks to my co-guide Dr. Mano Christaine Angelo Professor, Department Of Conservative Dentistry And Endodontics, for his brilliant advices, and constant support throughout my postgraduation period and throughout this study.

I would like to acknowledge my heartfelt gratitude and respect to Dr. Vijay Mathai, M.D.S, professor, Department Of Conservative Dentistry And Endodontics for his help and support to complete my study.

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Christopher M.D.S., Reader, Dr.Vineesh K M.D.S., Dr.Mohammed Riyaz., M.D.S., Dr.Elizabeth Issac M.D.S., Senior lecturers and Dr.Manoj Kumar B.D.S for their constant encouragement and inspiring guidance throughout the course of this study.

I would like to thank Dr. Rimal issac, Assistant professor, Noorul Islam Centre For Higher Education, Kumarakovil, for his constant encouragement and guidance throughout the course of this study.

I would like to extend my sincere thanks to Dr.Radhika, Assistant Professor Department of Pathology and Dr Vishwajyothi, Post graduate student, College of Agriculture, Vellayani, Thiruvanathapuram for their guidance in doing stereomicroscopic analysis.

I would like to extend my thanks to Dr. Porchelvan and Dr.Sharath Babu for helping me with statistical works.

I would like to thank my seniors, Dr.Soumya .T.S, Dr.Sreelekshmi.V.J. MDS Dr. Priya Alice Mathew and Dr. Sanjana Paul for their constant moral support and encouragement.

I would like to thank my fellow post graduates Dr.Swathi.V.S, Dr. Rajesh S, Dr. Nandhini.G, Dr. Reshve P Verghese, Dr. R. Deepak for their whole hearted cooperation and encouragement.

I would like to thank my parents and relatives for their love, prayers and continuing support rendered throughout my post-graduation period.

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Sl. No TITLE PAGE NO

1 List of Tables i

2 List of Figures ii

3 Abstract iii

4 Introduction 1-5

5 Aims & Objectives 6

6 Review of Literature 7-33

7 Materials & Methods 34-38

8 Results & Observations 39-40

9 Discussion 41-48

10 Summary & Conclusion 49-50

11 Tables iv-xi

12 Figures xii-xx

13 Bibliography xxi-xxviii

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i

LIST OF TABLES

Table-1 Mean occlusal microleakage scores

Table-2 Mean gingival microleakage scores

Table-3 Occlusal and gingival Microleakage scores of all the tested specimens

Table-4 (a) Oneway statistical analysis of gingival microleakage

Table-4(b) Post Hoc analysis of gingival microleakage scores

Table-4(c) Non parametric statistical test of gingival microleakage scores

Table-5(a) Oneway statistical analysis of occlusal microleakage

Table-5(b) Post Hoc analysis of occlusal microleakage scores

Table-5(c) Non parametric statistical test of occlusal microleakage scores

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ii

LIST OF FIGURES

Fig. 1 Selected specimens

Fig 2 Conventional galss ionomer Fig 3 Zirconomer

Fig 4 Giomer Fig 5 Cention N Fig 6 Ionoseal

Fig 7 Silver nitrate dye

Fig 8 Specimen immersed in a dye for dye penetration Fig 9 Cross section of specimen for microleakage evaluation Fig 10 Stereomicroscope examination of specimens

Fig 11 Stereomicroscopic picture of Conventional GIC restoration Fig 12 Stereomicroscopic picture of Zirconomer restoration Fig 13 Stereomicroscopic picture of Giomer restoration Fig 14 Stereomicroscopic picture of Cention N restoration Fig 15 Stereomicroscopic picture of Ionoseal restoration

Fig16 Mean Comparision of Occlusal Microleakage scores Fig 17 Mean Comparision of Gingival Microleakage scores

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ABSTRACT

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iii Aim: The aim of this study is to compare and evaluate the microleakage of five different tooth coloured restorative materials.

Methodology: Forty caries free human permanent maxillary premolar of comparable dimensions extracted for orthodontic purposes were selected divided into five groups of 8 each. Class V cavities were prepared and restored using Conventional GIC (Group I), Zirconomer (Group II) and Giomer (Group III), Cention N (Group IV), Ionoseal (Group V) restorative materials. All samples were then submitted to thermocycling. The external surfaces of each tooth were coated with nail varnish except a 1 mm wide margin surrounding the restoration. Samples were then immersed in 50% Wt silver nitrate dye for 6 hours in a dark container at room temperature for dye penetration. Specimens were sectioned buccolingually through the restoration and evaluated under stereomicroscope 30X magnification for microleakage.

Statistical Analysis Used: One way analysis of variance (ANOVA) followed by post hoc Tukey HSD test and non-parametric Kruskal-wallis test to determine the

significant difference at occlusall and gingival margin. P< 0.05 will be considered to be statistically significant.

Results: Stereomicroscopic evaluation shows maximum microleakage is seen in Conventional GIC (Group I) and minimum microleakage seen in Ionoseal (GroupV), a resin reinforced light cure glass ionomer composite.

Conclusion: Under the limitation of this in vitro study, among all the groups Ionoseal, a resin reinforced light cure glass ionomer showed the least microleakage at the gingival and occlusal wall.

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INTRODUCTION

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1 The fundamental goal of a restoration is to restore the proper function, tooth form and esthetics while maintaining the physiologic integrity of the teeth in harmony with the oral environment. The integrity and durability of the marginal seal is an important factor in the longevity of dental restorative materials.1 A marginal gap is left between the cavity wall and the restorative material leading to microleakage.2

Microleakage is defined as the clinically undetectable passage of bacteria, molecules or ions, fluids between the cavity wall and the restorative materials.3

Microleakage is the major clinical cause for the failure of restorations in class V cavities, as margins of such restorations are generally located in dentin/cementum. The ideal requirements for restorative material are that it should have a coefficient of thermal expansion and biocompatibility similar to that of natural tooth structure, have a good color stability, excellent marginal seal, and the ability to adhere chemically to enamel and dentin.4

According to Bergenholtz et al., Microleakage has been used to evaluate the success of any restorative material used in the oral cavity since it is a major contributing factor to secondary caries and pulpal irritation.

Microleakage induced by polymerisation shrinkage continues to be a major concern for the clinical longevity of dental restorations.5

With the constant increase in aesthetic demands, tooth coloured restorative materials are widely used in restoration of class V cavities.6

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2 Tooth coloured aesthetic restorative materials commonly used in practice are Conventional Glass Ionomer cements, Zirconomer, Giomer, Ionoseal, Cention N etc.,

Glass Ionomer Cements (GICs) was invented by Wilson and kent in early 1970s. Advantages of glass ionomer cement include, ability to bond chemically to dental hard tissues and release of fluoride. Co-efficient of thermal expansion of glass ionomers are similar to tooth structure provides good marginal adaptation, good retention of restoration and less microleakage in clinical conditions.3

Giomers are hybrid between resin composites and glass ionomers. Giomers have several advantages includes increased wear resistance, increased radiopacity, improved light diffusion, shade conformity, high fluoride release and fluoride rechargability which are similar to GIC. Giomers uses pre-reacted glass filler technology where fluroaluminosilicate glass fillers are pre reacted with polyacrylic acid to form a “wet siliceous hydrogel” stable phase, which is then freeze dried, milled, silane treated and ground to form PRG fillers. Depending on the degree of reaction of the glass ionomer cement with acid PRG fillers are divided into two types, S-PRG and F-PRG. In S-PRG (surface reaction type) reaction occurs only on the surface and it has the benefits of fluoride release and recharge, reinforcement of tooth structure, remineralization of dentin acid buffering capacity and antiplaque effect. In F-PRG (full reaction type) reaction occurs throughout. F-PRG undergo degradation faster than S-PRG.3 Beautifil II uses S-PRG (surface reaction type) where only the surface of the glass filler is attacked by polyacrylic acid and a glass core remains unaltered.4

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3 Zirconomer defines a recently introduced class of restorative glass ionomer that promises the strength and durability of amalgam with the protective benefits of glass ionomer while completely eliminating the hazard of mercury and overcome the disadvantages of traditional glass ionomer. The incorporation of zirconia fillers in the glass component of zirconomer reinforces the structural integrity of the restoration and imparts enhanced mechanical properties for the restoration of posterior load bearing areas where the conventional restorative of choice is amalgam. Hence, it is also termed as White Amalgam.5 Combination of outstanding strength, sustained fluoride protection and durability deems it ideal for permanent posterior restoration in patients with high caries incidence as well as cases where strong structural cores and bases are required.

Cention N is a newer class of restorative material offers tooth-coloured esthetics together with high flexural strength. Cention N belongs to the materials group of Alkasites. Material is supplied as powder and liquid. The liquid composed of dimethacrylates and initiators. Powder consists of initiators, patented glass fillers and pigments. This patented alkaline filler (Isofiller) increases the release of hydroxide ions to regulate the pH value during acid attacks, thereby, preventing the demineralization. The Moreover, the release of large numbers of fluoride and calcium ions are responsible for the remineralization of dental enamel. The highly cross-linked polymer structure is responsible for the high flexural strength. The initiator system enables good chemical self-curing. It has optional additional light curing. The ratio of organic/inorganic content and monomer composition of the material is also responsible for the low volumetric shrinkage leading to decreased microleakage.6

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4 Ionoseal is a resin reinforced glass ionomer liner. It is a light-curing glass ionomer composite cement used for lining under restorations, extended fissure sealing and smaller lesions. Ionoseal has several advantages includes time saving, easy, quick and hygienic application, ready for use one-component material, It has high compressive strength (226 mpa), High biocompatibility, important property of fluoride release against secondary caries and Radiopaque. Ionoseal is delivered in the NDT-syringe (Non-Dripping-Technology) which is used for fine flowing materials.

After having applied pressure to it, it pulls back, preventing any running or dripping of the syringe. The desired amount of Ionoseal can be dosed and and helps to place the material precisely. In addition, proven properties of Ionoseal, are high compressive and transverse strength, have been maintained while its viscosity was improved and least microleakage.

The relationship between marginal leakage in restorations and type of restorative materials used has been extensively studied both in laboratorical and clinical experiments. In the absence of definitive clinical data, laboratory microleakage studies are a well-accepted method of screening adhesive restorative materials for marginal seal.

Thus, the creation of a perfect seal on the restoration-tooth interface is still one of the prime goals of restorative dentistry in order to prevent the penetration of contaminants and attain the lost peripheral seal of dentin.2

The utmost important criteria of a restorative material is to provide a adequate seal in tooth-restoration interface to prevent the ingress of microorganisms, oral fluids, molecules or ions beneath the restoration thereby to improve the longevity of restoration.

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5 Microleakage around dental restorative materials is a major problem in clinical dentistry.7 Microleakage can cause a variety of adverse effects, such as secondary caries, higher sensitivity of the restored tooth, and interfacial staining leading to pulp pathology.8

Tooth-colored restorative materials have gained popularity due to increasing demand of esthetics.9 It is an elemental goal to determine the microleakage of such materials to maintain the physiological integrity of the teeth. This study was done to comparatively evaluate the microleakge of five tooth coloured restorative materials, namely, Conventional Glass Ionomer cements, Zirconomer, Giomer, Ionoseal, Cention N restored in class V cavities.

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AIMS & OBJECTIVES

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6 Aim:

To compare and evaluate the microleakage of five different tooth coloured restorative materials.

Objective:

To compare and evaluate the microleakage of five different tooth coloured restorative materials to determine the tooth coloured restorative material showing the least amount of microleakage.

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REVIEW OF LITERATURE

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7 REVIEW OF LITERATURE

Kaplan et al.199210 compared the microleakage of GIC and a bonded composite resin restoration in retentive and nonretentive cavity preparations of cervical cavities using Ketac Fil GIC (ESPE-Premier, Norristown, Pa.) and Scotchbond 2 dentinal bonding agent (DBA) (3M Co., St. Paul, Minn.) and Silux Plus composite resin (3M Co.). Ketac Fil glass ionomer cement (GIG) and Scotchbond 2 dentinal bonding agent (DBA)/Silux Plus composite resin restorations were inserted in cervical cavity preparations of extracted human teeth. After thermocycling, the specimens were invested and sectioned longitudinally and horizontally through the center of the restoration. Microleakage was evaluated as a ratio of the extent of methylene blue dye penetration at the tooth-restoration interface.and concluded that Both the GIC (Ketac Fil) and the bonded composite resin (Scotchbond 2/Silux Plus) restorations exhibited some leakage. Both types of restorations displayed considerably less overall leakage in retentive than in nonretentive cavity preparations. The most desirable results in this study were recorded with Scotchbond 2 adhesive/Silux Plus composite resin in retentive cavity preparations. Ketac Fil GIC restorations inserted without a matrix strip exhibited less leakage than those inserted with a matrix strip. More teeth with non retentive composite resin restorations showed dye penetration in the dentin toward the pulp than teeth with corresponding glass ionomer restorations.

Hallett & Garcia-Godoy et al.199311 compared the Microleakage of two resin-modified glass ionomer cement (GIC) restorative material with two conventional galss ionomer cement. Forty-five noncarious extracted human molars were prepared with standardized Class V cavity outlines on the buccal and lingual

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8 surfaces. The occlusal margin was in enamel and the gingival margin was in dentin/cementum. All were restored according to the manufacturers' instructions.

After thermocycling, 30 teeth were placed in 2% basic fuchsin dye for 24 h, sectioned and viewed with a stereomicroscope to assess microleakage. The other 15 teeth were sectioned, replicated and prepared for marginal gap evaluation using a SEM and he concluded that resin-modified GIC restorative material showed significantly less microleakage against enamel and dentin/cementum compared to the conventional GIC restorative (p<0.01). Marginal gap formation for both resin modified GIC restorations was limited to the axial wall of the restorations.

Franca FMG et al. 200412 evaluated quantitatively the microleakage in class V cavities restored with one-bottle and self-etching adhesive systems with and without previous acid etching. Single Bond and Prime & Bond one-bottle adhesive systems and Clearfil Mega Bond self-etching adhesive system were analysed. One hundred and twenty sound human premolar teeth were randomly divided into 6 groups, and 20 class V restorations were prepared in the root dentin to test each bonding system. Each bonding system was used with and without acid etching.

Specimens were prepared, dyed with 2% methylene blue, sectioned, triturated, and evaluated with an absorbance spectrophotometer test in order to quantify the infiltrated dye. Results showed that No significant differences in microleakage val- ues were found among the adhesive systems when no etching agent was used. Single Bond showed statistically lower microleakage than Clearfil Mega Bond and Prime

& Bond 2.1 when 37% phosphoric acid was used to acid etch the dentin. Single Bond and Clearfil Mega Bond adhesive systems presented the same behavior when

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9 the manufacturers instructions were followed, the first used with previous etching and the latter with no etching.

Mali P et al.20067 evaluated and compared the microleakage of glass ionomer, composite resin and compomers in class V cavities using silver nitrate dye penetration and analysed under stereomicroscope. Class V cavities were made in thirty intact caries free premolars and restored with restorative materials to be tested respectively. The teeth were thermocycled and subjected to silver nitrate dye penetration. They were subsequently sectioned buccolingually. Microleakage was evaluated under a stereomicroscope. Study concluded that microleakage was evident in all restorative materials, with glass ionomer showing maximum leakage followed by composite resin. Compomer demonstrated the best results with minimum leakage.

Awliya & El-Sahn et al.200813 investigated the leakage pathway of facial and lingual Class V cavities restored with different flowable resin composites bonded with one bonding agent by examining the resin/dentin interface in Class V cavities. Flowable composites used were Grandio Flow, Filtek Flow and Admira Flow. Hybrid composite used is Z250. Forty Class V cavities were etched with 37%

phosphoric acid gel; Single Bond dental adhesive was applied, then the cavities were randomly divided into four groups (n=10). Three groups were restored with one of three flowable resin composites (Grandio Flow, Filtek Flow and Admira Flow). The fourth group was restored with Z250 (hybrid resin composite) to serve as a control.

The specimens were then placed in 50% w/v silver nitrate solution for 24 hours and immersed in a photo developing solution for eight hours. Thereafter, the specimens were sectioned bucco-lingually, polished, mounted on stubs, gold sputter coated and

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10 examined by scanning electron microscope. Silver particle penetration length with and without gap formation was measured directly on the scanning electron microscope monitor and calculated as a percentage of the total length of the cut dentin surface that was penetrated by silver nitrate.And concluded that Filtek Flow and Admira Flow resin composite showed a significant microleakage pattern with gap formation at the restoration/dentin interface. Grandio Flow showed a similar leakage pattern to Z250 hybrid resin composite, where no gaps were seen at the restoration/dentin interface. Silver ions penetrated beneath the resin impregnated layer, which is consistent with nanoleakage. The bonding system used in this study did not achieve perfect sealing at the restoration/dentin interface.

Eden E et al .200914 evaluated the reliability of marginal leakage assessment of self-etch adhesive Class II resin composite restorations in primary molars prepared in vivo using the micro-CT. Fourteen primary molars, divided over seven ART and seven traditional resin composite Class II restorations, were subjected to marginal leakage test using a 50% (w/v) silver nitrate solution for 4 hours by a micro-CT. Two evaluators selected the image with the deepest marginal dye penetration for each restoration from the occlusal and proximal surfaces on consensus. The deepest dye penetration depth and total length of the axial cavity wall from both the occlusal and from the proximal surface were measured manually using morphometric quantification software by three evaluators independently. Results concluded that there was no marginal leakage found in five traditional and one ART restoration. The percentage of silver nitrate penetration depth from the cervical-proximal site ranged from 10.2-92.6%. There was only a statistically significant difference observed in measuring total axial wall length

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11 from the cervical-proximal site between the three evaluators (P = 0.02). This explanatory investigation showed that the micro-CT was a very useful device for developing a standardized method for measuring marginal leakage from samples obtained in vivo. In combination with 50% (w/v) silver nitrate and 4-hour immersion, marginal leakage along the restoration-tooth tissue interface was accurately and reliably measured.

Abd El Halim S et al.201115 compared the microleakage and adaptation of Class V cavity preparations restored with three types of glass-ionomer materials as a function of time. A total of 144 sound, freshly-extracted human premolars were used for the study. One clinician prepared all the teeth for Class V-type cavities on the buccal surface of each tooth. The preparations measured 3 mm long, 2 mm wide and 1.5 mm deep, with the gingival margin in dentin and the occlusal margin in enamel. All the prepared teeth were randomly divided into three groups of 48 teeth, according to the type of glass-ionomer material used: Group (A): Ketac N100 glass ionomer, Group (B): Vitremer glass ionomer and Group (C): Photac Fil Quick glass ionomer. The restorative materials were used according to their manufacturers' recommendations. The teeth were placed in one increment and photocured for 40 seconds. All of the restored teeth were then stored in artificial saliva. Each group was subdivided into three subgroups according to the testing periods (7, 30, 60 days). Next, they were thermocycled at 5°C–55°C for 100 cycles. The teeth used for the dye penetration test were immersed in 1%methylene blue solution for eight hours. They were then sectioned longitudinally in a bucco- lingual direction. The extent of dye penetration at the occlusal and gingival margins of each restoration was studied under a stereomicroscope at 25×

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12 magnification. Randomly selected samples from each group were prepared for scanning electron microscopic evaluation. Dye penetration scores were analysed.

Results concluded that the light-curing nanofilled glass ionomer (Ketac N100) showed the least microleakage.

Rekha C et al.201216 evaluated and compare the tensile bond strength and microleakage of Fuji IX GP, Fuji II LC, and compoglass and to compare bond strength with degree of microleakage exhibited by the same materials. Occlusal surfaces of 96 noncarious primary teeth were ground perpendicular to long axis of the tooth. Preparations were distributed into three groups consisting of Fuji IX GP, Fuji II LC and Compoglass. Specimens were tested for tensile bond strength by mounting them on Instron Universal Testing Machine. Ninety-six primary molars were treated with Fuji IX GP, Fuji II LC, and compoglass on box-only prepared proximal surface. Samples were thermocycled, stained with dye, sectioned, and scored for microleakage under stereomicroscope. Results concluded that Fuji II LC and compoglass can be advocated in primary teeth because of their superior physical properties when compared with Fuji IX GP.

Gupta et al .201217 evaluated the microleakage of nano‑filled resin‑modified glass ionomer restorative in comparison with that of conventional glass ionomer cement (CGIC), and resin‑modified glass ionomer cement (RMGIC). Forty‑five standardized Class V cavity preparations were prepared on sound extracted human molar teeth. Teeth were randomly assigned to three experimental groups of 15 teeth each and restored as follows: Group 1, CGIC; Group 2, RMGIC; and Group 3, nano‑filled RMGI. The specimens were placed in a solution of 2% Rhodamine‑B dye for 24 h at room temperature under vacuum. Staining along the tooth restoration

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13 interface was recorded. Study concluded that no material was able to completely eliminate microleakage at enamel, dentin, or cementum margin. Nano‑filled RMGI showed least microleakage compared to other two cements at gingival margins.

Poggio et al.201318 evaluated the microleakage in Class II composite restorations with gingival cavosurface margin below the CEJ (cemento-enamel junction) and restored with different techniques. Filtek TM Supreme XTE Flowable (3MESPE) + Universal Filtek Supreme XTE (3MESPE), GrandioSO Heavy Flow (Voco) + GrandioSo (Voco), SDR™ (Dentsply Caulk) + Esthet-X® HD (Dentsply Caulk), SonicFill (Kerr), Grandio (Voco) was analysed. Fifty human teeth were used. In each tooth two standardized Class II slot cavities (on mesial and on distal surfaces) were prepared: the buccolingual extension of the cavities was 4 mm; the gingival wall was located in dentin/cementum (2 mm beyond the CEJ). The prepared teeth were randomly assigned to 5 experimental groups (of 10 specimens and 20 cavities each) and restored. Group 1: Filtek TM Supreme XTE Flowable (3MESPE) + Universal Filtek Supreme XTE (3MESPE), Group 2: GrandioSO Heavy Flow (Voco) + GrandioSo (Voco), Group 3: SDR™ (Dentsply Caulk) + Esthet-X® HD (Dentsply Caulk), Group 4: SonicFill (Kerr), Group 5: Grandio (Voco). After thermocycling, the specimens were immersed in a 0.5% basic fuchsine dye solution and incubated at 37°C for 24 hours. The teeth were subsequently sectioned mesiodistally. All specimens were examined at 25× in a stereomicroscope and standardized digital images were obtained. Dye penetration was measured from gingival margins. Study concluded that none of the restorative techniques tested completely eliminated microleakage dye penetration in dentin margins; marginal

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14 adaptation in Class II composite restorations with gingival wall below the CEJ varied in both substrates and from different restorative techniques used.

Donmez et al. 201319 investigated the effect of different Er:YAG laser pulse modes on the microleakage of composite resin restorations using self-etch adhesive systems in class V cavities. The teeth were randomly divided into three groups:

Group 1; acid etching, Group 2; Er:YAG laser etching with MSP mode, Group 3:

Er:YAG laser etching with QSP mode. Cavities were restored with a hybrid composite. Standard class V adhesive cavities were prepared on the buccal and lingual surfaces of sound human premolar teeth. The cervical cavity margins were below the CEJ. The teeth were randomly divided into three groups: Group 1; acid etching, Group 2; Er:YAG laser etching with MSP mode, Group 3: Er:YAG laser etching with QSP mode. Cavities were restored with a hybrid composite (Clearfil

sectioned bucco-lingually. Dye penetration was then scored. Study concludes that none of the group did not completely eliminate microleakage, Er:YAG laser etching with QSP mode was better than conventional acid-etching and MSP mode, however, there were no statistically significant differences between them.

Sooraparaju et al. 201420 compared and evaluated the microleakage in class V lesions restored with composite resin with and without liner and injectable nanohybrid composite resin. 60 class V cavities were prepared in 30 freshly extracted teeth.

After etching and application of bonding agents these cavities were divided into three groups: Group A (𝑛 = 20)—restored with composite resin, Group B (𝑛 = 20)—flowable composite resin liner + composite resin, and Group C (𝑛 = 20)—

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15 restored with injectable composite resin. After curing all the specimens were subjected to thermocycling and cyclic loading. Specimens were stained with 0.5%

basic fuchsin and evaluated for dye penetration. and he concluded that none of the three materials were free from microleakage. All the three materials showed more microleakage at gingival margins compared to occlusal margins. Among all the groups G-aenial Flo showed the least microleakage at the gingival wall.

Diwanji et al.201421 compared the microleakage of glass ionomers (conventional and resin modified) with that of recently introduced nano-ionomers Standardized class I and class V cavities were prepared on 120 young permanent teeth. Samples were equally divided into group I (class I restorations) and group II (class V restorations), and further divided into subgroups. The subgroups were restored with Fuji IX, Fuji II LC, and newly introduced Ketac™ N 100 (KN 100).

Samples were thermocycled and submerged in Acridine dye for 24h. Samples were sectioned to view under fluorescent microscope and evaluated the marginal leakage.

He concluded that Fuji IX showed the maximum microleakage. KN 100 showed minimum leakage, better sealing ability, and was more consistent.

Hussein et al. 20149 investigated the effect of acidic solution on surface roughness and microleakage of tooth-colored restorative materials. A 160 box- shaped cavities were prepared on the buccal surfaces of 160 human molars, and assigned to four groups: Group A restored with Ketac™ Molar Easymix, Group B with Fuji II™ LC, Group C with Ketac™N100, and Group D with Filtek™ Z250, and subdivided into study and control groups (n = 20). Study groups were immersed in lemon juice (pH = 2.79) for 24 h, whilst controlgroups in deionized distilled water. All samples were immersed in 2% methylene blue dye, sectioned into two

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16 equal halves for surface roughness, and microleakage tests. and results showed that there was a significant difference in surface roughness of Ketac™ Molar, Fuji II™LC, and Ketac™N100. No significant difference was found in microleakage of Ketac™ Molar and Fuji II™LC; however, there were significant differences in the gingival margin of Ketac™ N100, and the occlusal margin of Filtek™Z250.

Giray et al. 201422 evaluate the microleakage of the new glass ionomers ChemFil™Rock and IonoluxAC in comparison to Fuji IX GP Extra and the composite AeliteTMLS Posterior in permanent teeth. Class V standardised U-shaped cavities were made on a total of 40 freshly extracted teeth and restored with different glass ionomer materials (4 groups of 10 samples each) After thermocycling, the teeth were immersed in 0.5% basic fuchsin for 24h. They were then sectioned in the buccolingual direction. Microleakage was assessed for the occlusal and gingival margins under a microscope at 40x magnification.and he concluded that the cavities filled with a conventional glass ionomer (Fuji IX GP Extra) had significantly less leakage than cavities filled with the new glass ionomers (ChemFil™ Rock and IonoluxAC), these results do not reflect all the variables present in vivo conditions.

As the in vitro evaluation of new materials does not always reveal their full limitations or possibilities, clinical testing of new systems remains the ultimate proof of effectiveness.

Effat Khodadadi et al.201423 compared the microleakage of flow able resin reinforced glass ionomer (Ionoseal) with other materials used as fissure sealants. In this in vitro study, 50 premolar teeth of human free of any caries were selected.

Fissurotomy was done with fissure bur. The samples were randomly categorized into five groups (Fissurit FX, Fuji II light-cured,Grandio flow, Ionoseal). Ionoseal was

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17 assessed by using two methods: with and without etching and bonding agent prior to sealant application. After sealant placement, all surfaces of the teeth except 2 mm area around the sealant margins were covered with two layers of nail polish. The specimens were thermocycled, and they were sectioned after immersing into a 0.5 % basic fuchsine solution. The amount of microleakage was examined by stereomicroscope. And he concluded that By considering isolation difficulties in children and observing high amount of Ionoseal microleakage (without etching and bonding application), the samples need to be etched and bonded like other resin- based materials before Ionoseal placement in order to achieve clinically desirable microleakage outcomes.

Parolia et al.201424 compared the microleakage around class V cavities restored with silorane and dimethacrylate-based composite resins. Teeth were randomly divided into 3 groups depending on the restorative materials used, Silorane-based composite resin (Filtek P90-SIL), dimethacrylate-based composite resin (Solare P-SOLP) and light-cure glass ionomer cement (GC Fuji II LC - LCGIC). Standard Class V cavities were prepared on the buccal surface of 60 non- carious human molars. Teeth were randomly divided into 3 groups (n=20) depending on the restorative materials used, Silorane-based composite resin (Filtek P90-SIL), dimethacrylate-based composite resin (Solare P-SOLP) and light-cure glass ionomer cement (GC Fuji II LC -LCGIC). The restored teeth with these tooth- coloured restorative materials were thermo-cycled and then immersed in 2%

Rhodamine B dye under vacuum pressure for 48 hours. All teeth were bisected longitudinally in a bucco-lingual direction and observed under stereo-microscope at 30X magnification for the evidence of dye penetration. Study concluded that

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18 Silorane-based composite exhibited least microleakage in restoring class V cavities compared to dimethacrylate-based composite resin and light-cured glass ionomer cement.

Shruthi et al.201525 evaluated the microleakage among conventional, resin modified glass ionomer cements (GIC), and compomer cements in primary teeth.

Teeth randomly divided into three groups. Group A: GC Fuji II; Group B: Vitremer;

Group C: Compoglass F. Forty-five over retained non carious primary molars beyond exfoliation time were collected and randomly divided into three groups (n = 15). Group A: GC Fuji II; Group B: Vitremer; Group C: Compoglass F. A standard Class V cavity was prepared on the buccal surface of each tooth with no mechanical retention and restored accordingly. Then all the samples were subjected to thermocycling for 250 cycles at different temperatures and covered with nail varnish. Later, samples were immersed in 0.5% methylene blue dye for 24 h. Teeth were sectioned buccolingually through the center of the restoration and studied under a stereomicroscope for dye penetration. and concluded that none of the three GICs was free from microleakage.

Rengo et al.201526 analysed Class V composite restorations marginal leakage measurements obtained with microcomputed tomography (micro-CT) and scanning electron microscopy (SEM) observations. Tooth restored using Optibond FL (Kerr, Orange, CA, USA) and Premise Flowable (Kerr). Class V cavities were prepared on 10 human molars and restored using Optibond FL(Kerr, Orange, CA, USA) and Premise Flowable (Kerr). Sealing ability was evaluated by assessing silver-nitrate penetration depth along enamel and dentin margins. Leakage was quantified using a scoring system. Micro-CT analysis provided 502 cross-sectional

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19 images for each tooth. Microleakage evaluation was performed first on three cross- sections corresponding to the sections examined by SEM, then on all 502 of the obtained micro-CT images. SEM observations were performed first at 20 magnification, then, if showing a zero score, at 80X magnification. Results shows Micro-CT presents as a valid, non-destructive in vitro method to quantitatively evaluate marginal leakage of adhesive restorations.

Niranjan et al.201627 investigated microleakage of three different bases under composite resin in sandwich technique using dye penetration and dentin surface interface using scanning electron microscope (SEM). Teeth were divided into 3 groups. Group 1 ‑ glass ionomer cement (GIC); Group 2 ‑ mineral trioxide aggregate (MTA); Group 3 ‑ Biodentine™ was placed as a base under composite.

Sixty extracted deciduous molars were stored in distilled water and Class I cavities with a width of about one‑fourth of intercuspal distance and a depth of 0.5–1 mm below the dentino‑enamel junction was prepared without bevels. In Group 1 ‑ glass ionomer cement (GIC); Group 2 ‑ mineral trioxide aggregate (MTA); Group 3 ‑ Biodentine™ was placed as a base under composite. Teeth were longitudinally sectioned in two halves, through the centers of the restoration, immersed in 2%

methylene blue and microleakage was evaluated under stereomicroscope and surface interface between base and dentin was evaluated under SEM. Study concluded that Biodentine™ exhibits superior marginal sealing ability as well as marginal adaptation under composite resin as compared to MTA and GIC.

Sakri et al.201628 evaluated the impact of bulk or incremental curing of hybrid composite resin with different intermediate layers on interfacial microleakage. The recently extracted, sixty noncarious human mandibular molars

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20 were selected for the study. The standardized mesio‑occluso‑distal cavity with the occlusal cavity of 2 mm depth, 3 mm buccolingual width and proximal box dimension of 4 mm buccolingual width and 2 mm depth was prepared on all experimental teeth. The samples were divided into six groups of ten each. Group I was without an intermediate layer. Group II and III had 1 mm flowable composite liner, with incremental and bulk curing cycle, respectively. The Group IV, V, and VI had a self‑cure composite liner with incremental and bulk curing. The teeth subjected to thermocycling and kept in 0.5% basic fuchsine dye for 24 h. The teeth were sectioned and observed under a stereomicroscope to grade them according to the extent of microleakage. Within the limitation of the study, it was concluded that intermediate flowable composite with incremental curing was better suited to reduce microleakage.

Motevaselian et al.201629 compared microleakage of three resin bonding agents namely a universal adhesive, two-step self-etch system and two-step total- etch system. Class V cavities were prepared in the buccal or lingual surfaces of the teeth with occlusal margins in the enamel and gingival margins in dentin. The teeth were then randomly divided into four groups. Group A: Adper Single Bond 2, group B: Clearfil SE Bond, group C: Scotchbond Universal adhesive (self-etch) and group D: Scotchbond Universal adhesive (total-etch). This in vitro, experimental study was conducted on 68 human molars. Class V cavities were prepared in the buccal or lingual surfaces of the teeth with occlusal margins in the enamel and gingival margins in dentin. The teeth were then randomly divided into four groups of 17.

Group A: Adper Single Bond 2, group B: Clearfil SE Bond, group C: Scotchbond Universal adhesive (self-etch) and group D: Scotchbond Universal adhesive (total-

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21 etch). The teeth were then restored using different bonding agents and a microhybrid composite resin. The specimens were then subjected to 1000 thermal cycles between 5-55°C. The entire restoration surface except for 1mm around the margins was coated with nail varnish. The teeth were immersed in 2% methylene blue for 24 hours and sectioned longitudinally in a buccolingual direction and observed under a stereomicroscope to determine microleakage. The teeth were then restored using different bonding agents and a microhybrid composite resin. Results shows different adhesive systems tested in this study showed similar microleakage at the enamel and dentinal margins.

E. Ozel et al.201630 investigated how two cavity-filling techniques affect microleakage in class II resin restorations prepared with Er:YAG laser and diamond bur. Samples were divided into 4 groups. Group-1 Herculite XRV Ultra-burprepared cavity(bp), Group-2 Herculite XRV Ultralaser- prepared cavity(lp), Group-3 (SonicFill-(bp), or Group-4 SonicFill-(lp). For Groups 2 and 4, cavitieswere prepared by using an Er:YAG laser with a wavelength of 2.94mm, output power of 200 mJ/pulse, and repetition rate of 20Hz. Teeth were restored with a one-step, self- etch adhesive material (OptiBond All-in-One), a nanohybrid composite (Herculite XRV Ultra), and a bulk-fill composite (SonicFill) according to the manufacturer’s instructions. Five teeth from each group were chosen for microleakage investigation and two teeth for scanning electron microscope evaluation. Results shows cavities prepared with Er:YAG laser exhibited greater microleakage than those conventionally prepared with bur at both occlusal and cervical margins in this study, regardless of restorative material. At the same time, cervical regions exhibited significantly higher microleakage than occlusal ones in all groups tested. The bulk-

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22 fill resin composite (i.e., SonicFill) thus reduced microleakage compared with the nanohybrid composite for both occlusal and cervical margins.

Govil et al. 20162 evaluated the microleakage of four tooth coloured restorative materials in 80 restored Class V cavities. 40 human premolar teeth samples were selected and eighty standardized class V cavities were prepared on them. These were further divided into four groups, each group comprising of 20 prepared cavities, and were restored with four experimental tooth colored restorative materials (Glass ionomer cement, Resin Modified Glass ionomer cement, Hybrid composite resin and Nano composite resin) respectively. The restored teeth were subjected to thermocycling for 500cycles in 37°C neutral bath,5ºC cold water bath and 55°C hot water bath followed by 2% methylene blue dye penetration for 24 hours at room temperature. Each crown was then sectioned bucco-lingually and the sections were stored in 100% humidity before being examined under stereomicroscope (16 x magnification) to measure the depth of dye penetration. The results showed that minimal microleakage in Group II(Fuji IXGP) followed by Group IV (Z350), Group III(Z100) and Group I(Fuji II LC) showed maximum microleakage.

Somani et al. 201631 determined the microleakage of the 6th, 7th, and 8th generation dentin bonding agents. Forty‑five extracted human premolars were taken for the study. Standardized Class V cavities were prepared on all the teeth. The samples were divided into three groups according to the generation of bonding agent used. Group I was bonded with the 6th generation, Group II with the 7th generation, and Group III with the 8th generation dentin bonding agent. All the Class V

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23 preparations were restored with a nano‑ceramic composite restorative (Ceram X).

The samples were then thermocycled between 5 and 55 ± 2°C for 100 cycles and immersed in 2% methylene blue for 48 h for evaluation of microleakage under a stereomicroscope. The results concluded that the 8th generation dentin bonding showed statistically significant results in terms of lesser microleakage as compared to the 6th and 7th generation dentin bonding agents.

Bollu et al.201632 evaluated microleakage in Class V cavities which were restored with Resin Modified Glass Ionomer Cement (RMGIC), Giomer and Nano- Ionomer. This in-vitro study was performed on 60 human maxillary and mandibular premolars which were extracted for orthodontic reasons. A standard wedge shaped defect was prepared on the buccal surfaces of teeth with the gingival margin placed near Cemento Enamel Junction (CEJ). Teeth were divided into three groups of 20 each and restored with RMGIC, Giomer and Nano-Ionomer and were subjected to thermocycling. Teeth were then immersed in 0.5% Rhodamine B dye for 48 hours.

They were sectioned longitudinally from the middle of cavity into mesial and distal parts. The sections were observed under Confocal Laser Scanning Microscope (CLSM) to evaluate microleakage. Depth of dye penetration was measured in millimetres and he concluded that Nano-Ionomer and RMGIC showed significantly less leakage and better adaptation than Giomer and there was no statistically significant difference between Nano Ionomer and RMGIC.

Rajisha KR et al. 201633 evaluated the effect of two curing modes on the microleakage of a bulk-fill flowable composite resin, Surefil SDR Flow.

Standardized class V cavities were prepared on buccal and palatal surfaces of each tooth and restored with the flowable composite, Surefil SDR Flow. Based on the

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24 curing protocol the teeth were divided into two groups. Extracted maxillary premolars were used for this study. Standardized class V cavities were prepared on buccal and palatal surfaces of each tooth and restored with the flowable composite, Surefil SDR Flow. Based on the curing protocol the teeth were divided into two groups. Restoration on the buccal surface of the teeth were subjected to low power polymerization, were grouped as the group I and the restorations on the palatal surfaces were subjected to soft start polymerization and were grouped as group II.

All the samples were immersed in 0.5% basic fuchsin solution and was subjected to microleakage assessment. The samples were then sectioned, evaluated under a stereomicroscope and scored for microleakage. Analysis of variance (ANOVA) has been used to find the significance of study parameters between the groups and concluded that the soft start polymerization mode offered a distinctive advantage over the low power curing protocol using Bluephase curing unit.

Tavangar M et al.201734 compared the microleakage of class V cavities restored with the newly introduced Embrace WetBond class V (EWC) composite resin and conventional Opallis composite resin. In this in vitro study, class V cavities were prepared on 30 extracted bovine incisors, with the gingival floor and the coronal margin of the cavities 1 mm apical and coronal to the cementoenamel junction (CEJ) respectively. The cavities measured 3 mm in length, 2 mm in width, and 1.5 mm in depth. The teeth were randomly divided into two groups. In group I, the cavities were restored with Opallis composite resin in association with ExciTE adhesive system (total-etch); in group II, the EWC composite resin was used for restorations. After 500 thermocycling procedures, the teeth were immersed in 0.5%

fuchsin solution for 24 hours. Then, the samples were placed within a polyester

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25 model and sectioned in the buccolingual direction. The samples were evaluated under a stereomicroscope at ×30 for the penetration of dye. The enamel and dentin margins were evaluated separately. The results concluded that Despite the high speed and the short process of restoration with Embrace WetBond, it is not a reliable restorative material for class V cavities due to its inadequate marginal seal.

Lagisetti et al. 20175 evaluated and compared the sealing ability of EndoSequence BC RRM fast set putty, Proroot mineral trioxide aggregate (MTA), and Zirconomer in the repair of furcal perforation by measuring dye leakage under stereomicroscope. A standard access cavity was made on forty‑eight extracted mandibular and maxillary first molars followed by creating a furcal perforation in the center of the pulp chamber by using No. 4 round bur (creating a perforation of 2 mm diameter). Teeth were categorized into 4 groups containing 12 samples in each group based on material used for furcation repair. Group 1 – Endosequence BC RRM‑fast set putty; Group 2 – Zirconomer; Group 3‑MTA (positive control); Group 4 – negative control. All groups were covered with two layers of clear varnish except for 2 mm around the perforation region. All the teeth were immersed in 2%

methylene blue dye for 48 h for dye penetration. Teeth were sectioned buccolingually using a diamond disk. The sectioned teeth were examined under stereomicroscope with ×10 magnification for dye penetration and results showed that Endosequence and MTA showed less microleakage hence can be used as furcation repair materials. Due to higher microleakage, Zirconomer should be avoided as furcation repair material. Due to its favorable cost, ready availability, and almost similar outcome as bioceramics, MTA is considered as an alternative to Endosequence and is the gold standard in furcation repair.

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26 Kathal et al. 201735 evaluated and compared the microleakage of three different restorative cements, namely zirconomer, amalgomer CR, and conventional glass ionomer cement (GIC, type II). A total of 45 human noncarious primary molars were selected. The selected teeth were extracted for the reason of overretention or orthodontic purpose. Total samples were divided into three groups:

15 samples in each group – group I: zirconomer (Shofu Inc., Kyoto, Japan), group II: amalgomer CR (Advance Health Care, Ltd., Tonbridge, UK), and group III:

conventional GIC (Medicept Type II, Ltd., India). Hand scalers were used to remove calculus if present on the root surface and the teeth were stored in glass container containing normal saline. In all the samples class I cavity was prepared on the occlusal surfaces of the extracted noncarious primary molars using high-speed hand piece. From the previously divided three groups, i.e., groups I, II, and III, each group contains 15 teeth. All teeth were restored with either of the three restorative materials. Restored samples from the three groups were then subjected to thermocycling. The teeth were immersed in an aqueous solution of methylene blue for 48 hours and then sectioned longitudinally in a buccolingual direction through the center of both cavities using a low-speed diamond saw. The dye penetration depth along the occlusal margin was evaluated for each group. Dye penetration scores were analyzed by two calibrated and blinded evaluators and concluded that none of the material was free from microleakage. Although the new materials have certain advantage of strength, they lack microleakage.

Samanta et al. 201736 compared and evaluated the microleakage in class V cavity filled with flowable composite resin, glass ionomer cement and cention. Class V cavities were prepared in 30 freshly extracted teeth.Teeth were randomly assigned

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27 into three experimental groups (n = 10).Group 1 -Restored with Flowable Composite. Group 2-Restored with Glass Ionomer cement.Group 3- Restored with Cention N. All the specimens were subjected to thermocycling. Specimens were stained with 0.1% Methylene Blue Dye and evaluated for dye penetration under stereomicroscope. The results concluded that All materials showed some microleakage at the cervical margin of restoration. However, Group 3(Cention N) exhibited lowest microleakage.

Dennis et al.201737 evaluated the effect of microleakage in class V cavity using self-adhering flowable composite/self-adhesive with the addition of acid etch.

The teeth were prepared in class V cavities and filled with self-adhering flowable composite, total-etch adhesive system and flowable composite resin. All the teeth were randomly assigned into 3 groups. Study was conducted on extracted 27 lower premolars. The teeth were prepared in class V cavities and filled with self-adhering flowable composite, total-etch adhesive system and flowable composite resin. All the teeth were randomly assigned into 3 groups: Group 1: 9 cavities restored with self-adhering flowable composite without etching, Group 2: 9 cavities restored with self-adhering flowable composite with etching only and Group 3: 9 cavities restored with flowable composite with total etch system. After being polished, the teeth were thermocycled 200 times, then it was coated with nail polish and immersed in methylene blue for 24 hours. They were sectioned longitudinally and using the stereomicroscope with 20 times magnification dye penetration was measured. The results concluded that Self-adhering flowable composite alone was enough to establish good marginal sealing with enamel margins but was inadequate to establish good marginal sealing with dentin margins.

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28 Athanasios Synarellis et al.201738 compared the degree of microleakage on enamel and dentin margins of class V cavities prepared with either a high-speed drill or an Er,Cr:YSGG laser (2780 nm) and to associate their use with a beveling method for the margin. Sixty bovine incisors were randomly distributed into three groups.

Group 1 (G1) cavities were laser prepared and bur beveled, group 2 (G2) cavities were bur prepared and beveled, while cavities of group 3 (G3) were laser prepared and beveled. Cavities were restored with selective enamel etching, using the same bonding agent and nano-hybrid resin composite for all groups. After thermocycling, microleakage was assessed using a methylene blue dye penetration method. Results shows The conventional cavity preparation method seems to perform better in terms of microleakage than the Er,Cr;YSGG laser. Laser-prepared cavities could perform better in terms of microleakage if an additional step of enamel bur-beveling is performed prior to restoration.

Shathi et al.201739 compared the marginal microleakage of ormocer restorative material with that of giomer in vivo. The results showed that no microleakage (score 0) was detected in 15 ormocer and 5 giomer restorations. The remaining restorations were associated with dye penetration which was due to gap formation as seen in stereoscopic and scanning electron microscopic observations.

The differences between ormocer and giomer restorative materials in respect to dye penetration were statistically significant. It can be concluded that ormocer restorative material shows less microleakage than that of giomer.

Khamverdi et al.201740 evaluated the microleakage in class V composite resin restorations using two bulk filled resin-composites and one conventional composite. In this study, in the buccal and lingual surfaces of 30 extracted

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29 premolars, V-shaped cavities were prepared and samples using a single bond bonding were restored in three groups as follows: Group 1: Composite bulk filled (Filtek). Group 2: Composite bulk filled (X-tra base). Group 3: conventional composite Grandio. After thermocycling of the samples, microleakage was evaluated on occlusal and gingival of the restorations by dye penetration technique under a microscope with a magnification of 20. The results of this study showed that the use of Bulk filled composites rather than conventional composites in class V cavities expanded on the root surface reduced leakage. But there was no statistical difference between Bulk filled composites (X-tra base and Filtek).

Bansal et al.201741 measured the microleakage of class V glass ionomer restorations over two different periods of enamel microabrasion. Microabrasion treatment was performed with Opaluster (Ultradent Product Inc.,South Jordan, UT, USA) for 0 (control no treatment), 60 and 120 s. the teeth were classified into six groups (n = 20). Microabrasion treatment was performed with Opaluster (Ultradent Product Inc., South Jordan, UT, USA) for 0 (control no treatment), 60 and 120 s.

Then, teeth were thermocycled between 5°C and 55°C, immersed in rhodamine B solution (24 h), and sectioned longitudinally in buccolingual direction. Dye penetration was examined with stereomicroscope (×10). Microleakage scores were statistically analyzed. Study concluded that the least microleakage scores were observed in occlusal margins of control groups (without microabrasion). Moreover, in both restorations, the microleakage scores in occlusal margins were higher than gingival margins.

Mohita Gupta et al.201742 evaluated microleakage associated with three placement techniques for compomer restorations in primary molars. This

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30 experimental study assessed the microleakage associated with bulk‑fill, horizontal‑incremental, and oblique‑incremental compomer placement techniques.

Result shows microleakage was observed with all the three techniques but was comparatively lower with the incremental placement techniques. The oblique‑incremental technique offered the least microleakage.

Paul George et al.201843 evaluated the microleakge of a newly introduced restorative material, Cention N, with the commonly used posterior restorative materials. Teeth were randomly assigned into five experimental groups and restored using amalgam, GIC, packable composite, cention with adhesive and without adhesive.50 single rooted premolars free of caries or any other defects and extracted for orthodontic reasons were chosen for the study. Subsequently class 2 cavities were prepared and teeth were randomly assigned into five experimental groups (n = 10) and restored using amalgam, GIC, packable composite, cention with adhesive and without adhesive,respectively. All the specimens were subjected to thermocycling. Specimens were stained with 0.1% Methylene Blue Dye and evaluated for dye penetration under stereomicroscope. The study therefore showed Cention N to have lesser microleakage compared to GIC and composite restorations, thereby having better sealing ability.

Hussin et al.201844 evaluate the in vitro microleakage of new modified glass ionomer cement (GIC) nanozirconia‑silica‑hydroxyapatite (GIC‑nanoZrO2‑SiO2‑HA) hybrid material by comparing the depth of microleakage with conventional GIC (Fuji IX). Forty samples of standardized oval‑shaped cavity preparation (4 mm × 3 mm × 2 mm) on buccal or lingual surfaces of freshly extracted human premolar and molar teeth were prepared. The samples were divided

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31 in two groups (n = 20) by simple random sampling method and restored with the new modified GIC‑nanoZrO2‑SiO2‑HA hybrid material and Fuji IX (control), respectively; following the manufacturer’s recommendations. All samples were then submitted to thermocycling (500 cycles at 5°C–55°C). The external surfaces of each tooth were coated with nail varnish except a 1 mm wide margin surrounding the restoration. Samples were then immersed in 2% methylene blue at room temperature for 24 h before rinsed under running water. Each sample was sectioned mesiodistally before microleakage evaluation was done using a stereomicroscope under × 20 magnifications and graded accordingly. and concluded that the new modified GIC‑nanoZrO2‑SiO2‑HA hybrid material was found to have more microleakage than conventional GIC.

Nagy et al.201845 evaluate and compared the marginal seal of Class V composite restored with different cavosurface margins. The teeth were divided into two main groups: group I, cavosurface angle was 90° butt‑joint; group II, beveled enamel and dentin cavosurface margins. Each group subdivided into three subgroups: group A, restored with Filtek bulk‑fill flowable composite. Group B, restored with Filtek bulk‑fill posterior composite. Group C, restored with Filtek Z250XT Universal composite. Restorations were cured with LED light curing unit.

A standardized Class V cavity, 4 mm wide, 3 mm high, and 3 mm deep, were prepared on the buccal surface of 60 extracted molars with the occlusal margin located in enamel and the gingival margin located in dentin‑cementum 1.0 mm below the cementoenamel junction. The teeth were divided into two main groups:

group I, cavosurface angle was 90° butt‑joint; group II, beveled enamel and dentin cavosurface margins. Each group subdivided into three subgroups: group A, restored

References

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