For Better Dentistry

SDR provides a high level of marginal integrity when compared to other bulk filling materials!

Tight marginal seal and absence of microleakage are two of the main factors that help to determine the success and longevity of restored teeth.  When microleakage does occur, a patient is at risk of developing secondary caries, pulp inflammation, post-operative sensitivity and marginal discolouration - all of which impact the longevity of the restoration.  

In recent years, the increased demand for aesthetic posterior restorations has resulted in the replacement of amalgams with composite materials.  As a consequence, the placement of a posterior restoration has become more time consuming as the majority of mainstream composite materials require to be placed in 2mm increments to ensure that they are sufficiently polymerized.  In larger posterior cavities such as those that follow an endodontic procedure, there is an increased risk of air bubbles or contaminants being trapped between each 2mm composite layer.  The development of bulk-filling materials has helped to simplify the restorative procedure by allowing the dentist to place the material in increments of 4mm without impacting the materials ability to polymerize fully.  Whilst this new composite technology has resolved the problem of microleakage occurring between the composite increment layers, Orlowski et al1 (2014) from the University of Lublin in Poland, initiated a clinical evaluation to primarily observe whether the bulk-filling technique had an impact on the restorations marginal adaptation.

The study consisted of dye penetration testing on 120 class II restorations to compare the marginal integrity of 4 different bulk-fill materials (SDR®, SonicFill2, Tetric Evo Ceram Bulk-Fill2, and Filtek Bulk- Fill2).  The degree of dye penetration was established via a five grade scale that ranges from no dye penetration present, to dye penetration into the filling material or along the filling-tooth interface along both lateral walls to the bottom of the cavity/pulpal wall.

The five grade scale can be seen in the below table.
Score Degree of dye penetration
(0) No dye penetration into the filling material or along the filling-tooth interface
(1) Dye penetration into the filling material or along the filling-tooth interface up to half of either lateral wall
(2) Dye penetration into the filling material or along the filling-tooth interface along either lateral wall to the bottom of the cavity /pulpal wall
(3) Dye penetration into the filling material or along the filling-tooth interface up to half of both lateral walls
(4) Dye penetration into the filling material or along the filling-tooth interface along both lateral walls till the bottom of the cavity/pulpal wall
The study showed that in 93.3% of the SDR restorations there was no dye penetration into the filling material or along the filling tooth interface – score (0).  The same results were achieved with 90% of the SonicFill2 restorations, 86.6% of Filtek Bulk-Fill2 restorations and only 73.3% of the Tetric Evo Ceram Bulk-Fill2 restorations.  Restorations made with Tetric Evo Ceram Bulk-Fill2 exhibited dye penetration into the filling material or along the filling-tooth interface up to half of either lateral wall – score (1) in 23.3% of cases, only 3.33% of the restorations made with Filtek Bulk-Fill2, SonicFill2 and SDR, exhibited dye penetration to the same level.  

The remainder of the results are summarised in the below table.
    % of restorations that
exhibited dye penetration
   
 
Score Degree of dye penetration SDR Tetric Evo Ceram Bulk-Fill2 Filtek Bulk-Fill2 SonicFill2
(0) No dye penetration into the filling material or along the filling-tooth interface  93.33% 73.33% 86.66% 90%
(1) Dye penetration into the filling material or along the filling-tooth interface up to half of either lateral wall 3.33% 23.33% 3.33% 3.33%
(2) Dye penetration into the filling material or along the filling-tooth interface up to half of both lateral walls 3.33%   6.66%  
(3) Dye penetration into the filling material or along the filling-tooth interface up to half of both lateral walls     3.33% 6.66%
(4) Dye penetration into the filling material or along the filling-tooth interface along both lateral walls till the bottom of the cavity/pulpal wall   3.33%    
The results from this study confirm that when compared to Tetric Evo Ceram Bulk-Fill2 (p<0.04), Filtek Bulk-Fill2 (p=ns) and SonicFill2 (p=ns), SDR’s unique self-levelling and cavity adaptation properties allow a tight marginal seal to be achieved.  Restorations completed with SDR have a low chance of the occurrence of microleakage which means that there is a reduced possibility of a patient needing to return to the practice for a replacement restoration.  Orlowski et al1 (2014) conclude that bulk-fill flowable or sonic-activated flowable composites achieve better marginal sealing in comparison with bulk-fill paste-like composites.

Click here to find out more about how you and your patients can benefit from SDR.

References
1Orlowski et al (2014). Evaluation of marginal integrity of four bulk-fill dental composite material: in vitro study. The Scientific World Journal.  Volume 2015, Article ID 701262
2 Not a registered trademark of DENTSPLY International, Inc.
 
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