1

INTRODUCTION

DEFINITION

POSSIBLE ROUTES OF MICROLEAKAGE

CLINICAL IMPLICATIONS

FACTORS THAT INFLUENCE MICROLEAKAGE

PROPERTIES OF RESTORATIVE MATERIALS

COEFFICIENT OF THERMAL EXP

POLYMERIZATION SHRINKAGE
ADHESION

INFLUENCE BY OPERATOR
2
ROLE OF SMEAR LAYER
Factors controlling bacterial penetration
Size and nature of the gap

Host defense factors

Restorations

Restorative materials micro leakage

and measures to reduce
Amalgam restorations
GIC
Composite restorations
Direct gold restorations
Cast restorations 3
Methods to detect micro leakage
Dyes
Chemical tests
Radioactive isotopes
Neutron activation analysis
Scanning electron microscopy
Bacterial studies
Electrochemical studies
Air pressure
Artificial caries
Pain perception
Reverse diffusion method

References
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Conclusion
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 DEFINITION

“The clinically undetectable passage of

DEFINITION
bacteria,
bacterial products, fluids, molecules or
ions
between a cavity wall and the restorative
material
applied to it”
(Kidd,1976)

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 CLINICAL IMPLICATIONS
 Microleakage at the tooth/restoration interface is considered
to be a major factor influencing the longevity of dental
restorations. It may lead to:

 1. Staining at the margins of restorations

 2. A hastening of breakdown at marginal areas of the
restorations
 3. Recurrent caries at the tooth/restoration interface

 4. Hypersensitivity of restored tooth

 5. Development of pulpal pathology.

(Going,1972)

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 POSSIBLE ROUTES OF MICROLEAKAGE

POSSIBLE ROUTES OF MICROLEAKAGE

 Within/via the smear layer

 smear layer and varnish/cement

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 varnish/cement and the restoration
ROLE OF SMEAR LAYER

 Removing the smear layer and plugs if they are near to pulp may interfere with adhesion
due to an increase in the dentinal fluid flow.
 If they are away from the pulp where dentinal fluid is much lesser, removal of smear 9
layer increases surface area and retention and reduces microleakage.
 Thus, removal of smear layer is controversial.
FACTORS THAT INFLUENCE MICROLEAKAGE
PROPERTIES OF RESTORATIVE MATERIALS
COEFFICIENT OF THERMAL EXPANSION

TOOTH (ENAMEL) 11.4

DENTIN 8.3
PORCELIN 6.6
TITANIUM 8.5
GIC (TYPE II) 11.0
GOLD 14.0
AMALGAM 25.0
COMPOSITES 25-50
DENURE RESIN 81.0
PIT & FISSURE RESIN 85.0
INLAY WAX 400.0

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POLYMERIZATION SHRINKAGE

COMPOSITES SHRINK AS THEY POLYMERISE, CREATING

STRESSES WHICH CAUSE MICROLEAKAGE.

ACRYLIC HEAT CURE 7%

COLD CURE 3.5%
CON COMPOSITES 1.5-2.0%
MICRO COMPOSITES 1.3-1.5%
HYBRID COMPOSITES 2.2-2.5%

ADHESION
IT IS THE ATTRACTION BETWEEN MOLECULES OF TWO
DIFFERENT SUBSTANCES, BEING INFLUENCED BY SURFACE
ENERGY. 11
 Methods to detect micro leakage

DETECTION OF MICRO LEAKAGE

• Dyes • Electrochemical studies

• Chemical tests • Air pressure

• Radioactive isotopes • Artificial caries

• Neutron activation analysis • Pain perception

• Scanning electron microscopy • Reverse diffusion method

• Bacterial studies

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 Methods to detect micro leakage

Dyes
Agents used
• Methylene blue

• Indian ink

. Crystal violet
• Fluoroscein

• Rhodamine B

• Eosin

• Basic fuschin
13

• Erythrosine
 Methods to detect micro leakage

Requirements :

 Should not bond to tooth / restoration

 Should be color stable under all conditions of investigation

Availability :

 Solutions

 Particle suspensions

Technique
Limitations :
 vary penetrations times from 5min-1 hr

 bind to tooth / restorations

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 not color stable
 Methods to detect micro leakage

Chemical tracers

50% silver nitrate solution


1% silver chloride

benzene 1,4-diol (hydroquinone)

Technique

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 Methods to detect micro leakage

Radioactive isotopes
Ca, I, P, C, S
TECHNIQUE:

Advantages :
can detect minute micro leakage

Because of their small size – 40nm

Whereas dye smallest size is – 120nm

Limitations :
Subjective assessment

High energy isotopes produce scatter on film

Ca – have affinity to tooth

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Expensive and technique sensitive
 Methods to detect micro leakage

Neutron activation analysis

Restored tooth soaked in an aqueous
Technique: solution
of non-radioactive manganese salt

Then tooth placed in core of nuclear
reactor

Bombardment with neutrons takes place

Activates Mn55 to Mn56

Radiation is emitted by tooth is
measured
Limitations: to quantify the volume of tracer
present.
Inability to identify
Heavy costs
nuclear engineers and dentists required 17
Mn may be absorbed by tooth / rest
 Methods to detect micro leakage

Scanning electron microscope

Earlier – used replicas of tooth

Recently – evaluates rubber base impressions directly

Limitations:

artifacts during specimen preparation

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 Methods to detect micro leakage

Electrochemical studies
Technique

Insertion of electrode

Then immersed in a electrolytic
bath

Leakage assessed by measuring
current flow across as serial
resistor

Drawback:

Unsuitable for metallic restorations

Inability in in-vivo situations 19
 Methods to detect micro leakage

Air pressure

Technique:
Compressed air is introduced through the root canal and pulp
chamber

Disadvantages :

Inability to use in vivo

Drying effect of compressed air

Some air may leak before it enters tooth

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 Methods to detect micro leakage

Artificial caries

Pain perception

Reverse diffusion method

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 Microleakage around amalgam restorations

Restorative materials and micro leakage

Microleakage around amalgam restorations

Fresh mix condensed-does not adapt closely

10-15 m gap

but it is self sealing

with time
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Due to corrosive products: Microleakage around amalgam restorations

In low copper – corrosive products like

chlorides and oxides accumulate
on the gaps
In high copper – greater resistance to corrosion

Dimensional changes:

small contraction initially

Followed by small expansion

20 m/cm is allowable
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C T E of Amalgam = 25x10-6/0 C
Measures to reduce amalgam micro
leakage:
Types of alloys

Spherical alloy – more leakage

Better to select lathe cut/admixed alloys

Condensation of amalgam

Condense immediately

10 pounds with 2 mm condenser tip

Center to periphery(stepping process)

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Mechanical condensation

Quint int. 23(7)-495-1992

 Measures to reduce amalgam micro leakage:

Burnishing :
Adapt material to margins

Spherical alloys -particles pushed aside, thus no

reduction in microleakage
Alloys with lesser creep values :
Low copper alloys – 0.8 –8%

High copper alloys – 0.1 – 1%

Sealing the cavity wall with varnish :

Prevents microleakage until corrosion products are formed.
Limited to six months 25
 Measures to reduce amalgam micro leakage:

Sealed amalgam restorations

Coating of unfilled resin

Bonded amalgams

Use of gallium alloys

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Have high wetting ability.
 Microleakage around GIC

Microleakage around GIC

Chemical bond

Hydrophilic

C.T.E – closely matches tooth

Fluoride releasing

Ability to renew broken ionic bonds

Highly technique sensitive

1st 30 minmoisture  ions leach out

1st 24 hoursexcessive dessication/dehydration 27

 Microleakage around GIC

excess dehydration/desiccation

Chalky /crazed/cracked
appearance
Which extends to margins

Leads to micro
leakage

So coated with varnish/unfilled resins

Sharp hand instruments for finishing before material has completely set
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 Measures to reduce micro leakage in G I C restorations

Measures to reduce micro leakage in G I C restorations

Proper manipulation

Conditioning of tooth surface before insertion

Finishing

Protection from moisture

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 Microleakage around composite restorations

Microleakage around composite restorations

 Unable to bond on their own to tooth

 not completely decrease M.L.

Due To clinical composition of dentin

Dentinal fluids

Smear layer etc

• insufficient enamel thickness
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 Microleakage around composite restorations

Polymerization shrinkage
•1.67 – 5.68%

.If DB agents used

bonds
But tensile/shear
stresses
at tooth rest
interface
Within
limits

plastic/elastic
deformation

Separation at interface 31
 Microleakage around composite restorations

Repeated plastic/elastic deformation of restoration

-6 0
• C.T.E. 22-55X10 / C

so debonding

Water absorption

Absorb water
cause restoration to expand

Compensate poly. Shrinkage – but mechanical prop impaired

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•Technique sensitive in class II
 Measures to Reduce Marginal Leakage in composites

Measures to Reduce Marginal Leakage in composites

Choice of material
Micro filled :
Better marginal
adaptation

Greater flexibility during shrinkage

decreases contracting forces

It has larger water absorption

capability

So decrease 33
M.L.
 Measures to Reduce Marginal Leakage in composites

Cavity design :
Conservative:
•decrease polymerization shrinkage
•Decrease wear

Modified cavity designs:

Placement of bevels
Reduced depths
Rounded internal angles

Shape :
V-shaped has less M.L. than box shaped
cavities

Decrease ratio of Volume  decrease micro leakage

Bond area
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Bevels:
 Measures to Reduce Marginal Leakage in composites

Acid etching technique and bonding

Enamel etching

Removes surface
contaminants

Raise surface energy

Etching depends on :

Thickness of enamel
Cervical enamel
Thin
Irregular prism structure
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 Measures to Reduce Marginal Leakage in composites

Dentin etching :

Earlier hydrophobic resin

Recently  hydrophilic resins

Non uniform bonding due to

Thickness of smear layer

Degrees of etching

Wetting capacity

Forces of polymerization contraction

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 Measures to Reduce Marginal Leakage in composites

NANO LEAKAGE (sano et al,1995)

Inability of adhesive resin to

infiltrate into demineralized
dentin

Leaves pores /spaces

/voids

Predispose to accumulation of water/oral fluids

Degrades the bond

Glass Ionomer bonding agents

Scotch bond multipurpose
Pertac universal bond
Dilute resin modified glass ionomer cements 37
Fuji bond II LC
 Measures to Reduce Marginal Leakage in composites

Cavity filling technique :

Thick / bulk filling – induce significant shrinkage

High stresses
generated

Lead to debonding

Small/multiple increments – Poly. Shrinkage controlled

preferred in class II At gingival

Class V margins
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 Measures to Reduce Marginal Leakage in composites

Inserts
Filler content is more than resin

So decreased contraction

C.T.E. is 4x10 -6/ 0 C

Pre polymerized composite balls

high cumulative internal stresses

C.T.E. close to dentin

reduce additional stresses on the interface. 39

 Measures to Reduce Marginal Leakage in composites

Soft start polymerization

Direction of light source

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Sealing the marginal gaps
 Measures to Reduce Marginal Leakage in composites

Delaying the Finishing

• Fusayama and Kohno 1989

Finishing after 3 month of insertion – considerable M.L.

Finishing after1 day – almost no M.L.

•dry finishing

High heat on marginal

adaptation

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 Measures to Reduce Marginal Leakage in composites

• Recommendations :

Rotary instruments

Slow speed

Light intermittent strokes

With generous air coolants

Use of sof-lex discs – good marginal adaptation

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 Measures to Reduce Marginal Leakage in composites

Use of cavity liners and bases

Ca(OH)2 and G I C

Bilayering technique / sandwich technique

Use of composite inlay restorations

surface treatment:

• ethyl acetate.

• Sand blasting with Alluminium oxide

• Etch cavity side with 10% hydrofluoric acid

Luting agent 43

chemically cured / dual cured

 Measures to Reduce Marginal Leakage in composites

Expanding matrix resins for dental composites

Resins expand slightly during polymerization

Facilitate bulk placement

Decrease M.L.

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 Microleakage around direct gold restorations

Microleakage around direct gold restorations

• High malleability and ductility

• Short bevel on cavosurface margins

• Facilitate burnishing /polishing

• Insoluble in oral fluids

• Condensation – induce elastic compression

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 Microleakage around direct gold restorations

Microleakage may be due to :

• Improper compaction – in spaces / voids

• Non uniform stepping

• Type of gold selected

• Improper lines of force

• Inadequate condensation pressure

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 Measures to reduce leakage in direct gold restorations

Measures to reduce leakage

• Cohesive gold foils V/S mat and powdered
gold
• Uniform stepping preferred:

• Lines of force:

• Condensation force:

10 pounds – 1 mm tip
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• Surface procedures
 Microleakage around cast restorations

Microleakage around cast restorations

• 10-160ms gap

• Intermediate cement layer

• Increased solubility

• Excessive taper

Excessive loads

Restoration rotating on preparation surfaces
 48
Break in the cement lute
 Measures to reduce micro leakage
in cast restorations

Measures to reduce micro leakage

in cast restorations

• Adhesive luting agents - chemical bonding

Bevels placed properly

Burnishing margins

o High soluble cements - burnishing should be delayed 24 hrs

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 Microleakage around porcelain restorations

Microleakage around porcelain restorations

Dental porcelain is a brittle material

if strain exceeds 0.1%

Earlier – bonded with luting cements

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 Measures to reduce micro leakage in porcelain

Measures to reduce micro leakage in porcelain

Operator skill and patience

Advances in adhesive technology

Resin luting cements

surface treated both mechanically and chemically

Closure fit of restoration

Operators skill and patience

Glass ceramic restorations (dicor)

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It is said that “man proposes and god disposes.” there is nothing that
can replace the natural tooth structure no matter how closely it
resembles it or bonds with it. Routes of micro leakage are many , so the
only things in our hands to do is to reduce the amount of micro leakage
by instituting proper restorative techniques and use of the newer
adhesive materials that show less micro leakage.

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•Two-year clinical evaluation of ormocer & nanofill
composite with & without a flowable liner
J adhesive dent,vol 8,119-126,2006.

• Effects of saliva contamination on dentin bond strength

using all-in-one adhesives
J adhesive dent:8; 311- 318,2006.

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