Sealing of Minimally Invasive Class II Fillings (slot) Using an Adhesive Patch: Sealant Margin Extension for Prevention

Abstract

©Operative Dentistry, 2007, 32-5, 482-487 PR Schmidlin • R Seemann T Filli • T Attin • T Imfeld Clinical RelevanceThe sealing of minimally invasive restorations using a prefabricated adhesive patch significantly reduces leakage and caries formation. SUMMARYA laboratory study was performed to assess the potential of an adhesive patch to seal small, unbeveled, Class II, box-only (slot) composite fillings.After minimal access cavity preparation with an 80 µm diamond bur, 40 box-only Class II cavities were prepared mesially and distally in 20 extracted human molars using a u-shaped PCS insert (EMS). One cavity per tooth was adhesively filled with a hybrid composite material in one increment. A patch, acting as an adhesive matrice, was applied to the other cavity of each tooth to seal the restoration. The margin of the patch was located in areas easily accessible to oral hygiene measures and self-cleaning. All the teeth were subjected to thermo-mechanical stress in a computer-controlled masticator device. In 10 teeth, caries was induced in a microbial-based artificial mouth model and quantitatively determined by confocal laser scanning microscopy. Microleakage was assessed in the other 10 teeth in two planar sections after immersion in 0.5% basic fuchsin solution.The results showed no demineralization at the filling margins protected with the patch. Microleakage was observed in one sample only and was limited to the enamel. In contrast, the margins of fillings without the patch application showed a mean demineralization depth of 146 ± 42 µm and dye penetration into the dentin in five sections.

Bonding of brackets using a caries-protective adhesive patch

“…Sealing of minimally invasive cavities using this device has already been shown to have the potential to significantly reduce caries formation and microleakage at filling margins. 16 The latter study has also shown that there was no undermining caries at the patch margins. In addition, the caries profile was not deeper as compared to the unprotected surrounding enamel.…”

Prevention of crown and root caries in adults

“…It has been shown in vitro using a caries‐simulating chamber model that such a patch can completely inhibit de‐mineralization of the underlying enamel. The interproximal patch was also assessed for use in sealing small class II cavities and compared with unbeveled class II fillings that were filled with a hybrid resin in one increment (144). After exposure to thermo‐mechanical stress, practically no microleakage was found in the patch‐treated lesions, but dye penetration into dentin was observed in 50% of the filled lesions.…”

Effectiveness of an Infiltrant on sealing of Composite Restoration Margins with/without Artificial Caries

“…Therefore, the concept of sealing occlusal surfaces of enamel lesions, has been transferred to smooth surfaces using surface sealants, infiltrants and patches. 7,8 Today, sealants are mostly used therapeutically on indication, attempting to arrest active noncavitated lesions. 9 While adhesive application or surface sealing acts as a diffusion barrier on the top of the lesion surface, the infiltration technique creates a barrier inside the lesion by replacing the mineral lost with a low-viscosity light-curing resin.…”

“…Use of an adhesive patch especially designed to seal smooth enamel surfaces, is another approach that has been developed for this purpose. 8,11 Additionally, other recently developed materials are nanotechnology liquid polishers. Their objective is to create a marginal seal with the ability to fill micro gaps and reduce micro leakage at composite margins.…”

“…Their objective is to create a marginal seal with the ability to fill micro gaps and reduce micro leakage at composite margins. 12 Previous studies 8,11,[13][14][15][16] on use of rebonding, surface sealants and adhesive patches showed promising result in terms of limiting or possibly eliminating the microleakage in proximal lesions. However, there are no studies on the effect of usage of resin infiltrants on the previously made composite resin restoration-enamel interface and on the same area with the initial stage secondary carious lesions in terms of microleakage and gap formation.…”