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Tanta Dental Journal xx (2013) 1e8 www.elsevier.com/locate/tdj

Effect of different conguration factors on marginal gap formation of two composite resin systems
A.M. El-Marhomy*, T.M. Genaid, A.I. Abdalla
Conservative Dentistry Dep., Faculty of Dentistry, Tanta University, Egypt

Abstract Aim: To evaluate the effect of different conguration factors C-factors on the marginal gap formation of two types of contemporary composite resin systems before and after thermal loading. Materials and methods: One hundred and twenty eight human sound molars were used. The occlusal surface of each tooth was wetground until at dentin surfaces were obtained. Teeth were divided into four main groups in which cylindrical cavities were prepared representing different C-factors. Samples in each group were subdivided into 2 subgroups according to the type of composite resin system. The cavities in subgroup A were restored with Clearl SE bond and Clearl Majesty Esthetic while those in subgroup B were restored with Futurabond DC and Grandio SO. Eight samples in each subgroup were thermo-cycled. All samples were processed for SEM evaluation to examine the restoration margins at (25 and 500) magnication. The marginal gap was measured for all the samples using AutoCAD software. Results: The median values (IQR) of the marginal gap were 0 (0) in all the samples restored with Clearl Majesty Esthetic. The same was found in samples restored with Grandio SO which were not subjected to thermo-cycling, while those subjected to thermocycling, a direct relation was found between C-factor and gap length. Thermo-cycling had a signicant effect on marginal gap particularly in samples restored with Grandio SO with high C-factor preparations. The two tested composite resin systems had a signicant effect on the marginal gap particularly in high C-factor preparations. The C-factor had no signicant effect on the marginal gap except in samples restored with Grandio SO. Conclusion: The different C-factors had no effect on the marginal gap formation in the samples of both subgroups which were not subjected to thermo-cycling but could inuence the marginal gap formation in the samples restored with Grandio SO subjected to thermo-cycling. 2013, Production and Hosting by Elsevier B.V. on behalf of the Faculty of Dentistry, Tanta University.
Keywords: C-factor; Marginal gap formation; Self-etch adhesives; Composite resin; Thermo-cycling

* Corresponding author. E-mail address: zahraa3m@yahoo.com (A.M. El-Marhomy). Peer Review under the responsibility of the Faculty of Dentistry, Tanta University

1. Introduction The use of resin-based composites restoration has expanded considerably over the past few years because of their esthetic and good physical properties [1,2]. However; resin-composite materials still have some signicant disadvantages with regard to wear, inadequate polymerization and microleakage [3].

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1687-8574/$ - see front matter 2013, Production and Hosting by Elsevier B.V. on behalf of the Faculty of Dentistry, Tanta University. http://dx.doi.org/10.1016/j.tdj.2013.12.004 Please cite this article in press as: El-Marhomy AM et al., Effect of different conguration factors on marginal gap formation of two composite resin systems, Tanta Dental Journal (2013), http://dx.doi.org/10.1016/j.tdj.2013.12.004

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Polymerization shrinkage leads to stress on bond interface leading to gap formation between the lling material and cavity walls. The nal outcome of this failure may be microleakage of oral and dentinal uids as well as accumulation of microorganisms and debris that are largely responsible for the major clinical problems experienced with dental composite: postoperative-sensitivity, staining and secondary caries [4]. Polymerization shrinkage stresses are related to several factors, such as cavity geometry [5], properties of resin composite [6], compliance of substrate materials [7] and curing method [8]. The resin composite suffers polymerization shrinkage as it cures, generating stress at the adhesive interface, which might cause its rupture [9]. Stress relief is possible via ow at the early stage of resin composite polymerization [10]. But this is limited by the different constraint levels determined by the cavity conguration or C-factor [11]. Conguration factor C-factor is dened by [11], as the ratio of bonded surface area to free unbonded surface area of a restoration. It was reported as an inuencing factor for dentin adhesion. The presence of a high C-factor is a risk for debonding within the resindentin interface [12]. So, it was reported to affect the marginal sealing and cavity wall adaptation of resin based composite restoration [13]. Methodologies simulating thermal stresses that normally occur in the oral cavity have been applied to in vitro studies, measuring the longevity of restored teeth [14]. The studies evaluating the effects of thermal stress on marginal adaptation of composite resin restoration showed that thermal cycling inuence marginal adaptation, increasing percentage of gaps [15]. Therefore, the current study was directed to reveal the inuence of different C-factors on gap formation with or without thermal loading in two different contemporary composite resin systems. 2. Materials and methods One hundred and twenty eight freshly extracted human sound molars were utilized in this study. The occlusal surface of each tooth was wet-ground using a dental trimmer1 until at dentin surfaces were obtained. The exposed dentin surface was wet-polished with 600egrit silicon carbide (SiC) papers2 to create
1 Changsha Zhongbang Medical Instrument Co., Ltd., [Hunan, China (Mainland)]. 2 Fuzhou Zongteng Technology Co., Ltd., [Fujian, China (Mainland)].

standardize smear layer [16]. The roots of each tooth were embedded in self cure acrylic resin inside plastic cylinders to the cemento-enamel junction. The teeth were randomly divided into four groups (thirty two each) in which cylindrical cavities were prepared representing different C-factors: 2.6 in group I having 2.5 mm in width and 1 mm in depth, 3 in group II having were 2 mm in width and 1 mm in depth, 4.2 in group III having 2.5 mm in width and 2 mm in depth and 5 in group IV having 2 mm in width and 2 mm in depth. All the cylindrical cavities were prepared with a diamond stone3 with two different diameter (2 mm, 2.5 mm) corresponding to the cavity width using lowspeed straight hand piece. While the cavity depth was judged with a permanent mark on the diamond stone and then veried using a periodontal probe. The Cfactor was calculated according to dos Santos 2009 [16]. Samples in each group were subdivided into 2 subgroups (sixteen each) according to the type of composite resin systems to be used for restoration. The cavities in subgroup A were restored with Clearl SE bond and Clearl Majesty Esthetic4 while those in subgroup B were restored with Futurabond DC and Grandio SO5 according to the manufacturers instructions. Finishing and polishing procedure was performed immediately after composite placement using a set of Sof-Lex discs6. Each subgroup was further subdivided into two equal divisions according to application of thermocycling procedure. Eight samples of division A were thermocycled at 5  C & 55  C in a thermo-cycling apparatus7 for 600 cycles (30 s dwell time, 20 s transfer time). In division B Samples did not undergo any thermal loading. All samples were processed for SEM evaluation8 to examine the restoration margins at (25 and 500) magnication. SEM photographs of the tested samples were used for the gap evaluation. The gap length was measured using AutoCAD software. Degree of marginal gap was determined as the ratio of the length of gaps to the total length of the margins, and then converted to a percentage. So, the length of marginal gap formed was calculated as a percentage of the entire margin length.
Yancheng Diling Medical Instruments Co., Ltd., [Jiangsu, China (Mainland)]. 4 Kuraray, Osaka, Japan. 5 VOCO GmbH, Cuxhaven, Germany. 6 3M ESPE-USA. 7 Custom made apparatus at Conservative dentistry department, Faculty of Dentistry, Tanta University. 8 JSM-5300 scanning microscope, JEOL, Peabody, MA, USA.
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3. Results Scanning electron microscope (SEM) examination revealed that no marginal gaps were detected at the dentin-composite interface in the different tested Cfactor preparations restored with either Clearl Majesty Esthetic or Grandio SO in all the samples that were not subjected to the thermo-cycling (Fig. 1aed). While those subjected to the thermo-cycling there was an observed marginal gap in 1 out of 8 samples in group I C-factor 2.6 of subgroup A only (Fig. 1e,f). While subgroup B revealed marginal gaps in all the different groups representing different C-factors (Fig. 1g,h). The median values (Inter quarter range IQR) of the marginal gap were 0 (0) in all the samples restored with Clearl Majesty Esthetic either subjected or not subjected to thermo-cycling as shown in (Table 1). The same was found in samples restored with Grandio SO that were not subjected to thermo-cycling, while those subjected to thermo-cycling, a direct relation was found between C-factor and gap length recording values of 6(7.3), 12.27(14.33), 23.71 (26.10) and 32.57(13.10) for groups I, II, III and IV respectively as shown in (Table 2). It was found that the samples subjected to thermocycling was not signicantly different from those not subjected to thermo-cycling except in subgroup B restored with Grandio SO of group III, IV (P values of 0.043, 0.018 respectively) using Wilcoxon Signed Ranks Test. The present study conrmed the effect of thermocycling on the marginal gap regardless the composite resin systems and the different C-factor preparations. Wilcoxon Signed Ranks Test analysis revealed that the marginal gap was signicantly affected by thermocycling (P value <0.001). So, the further statistical analysis was performed on samples subjected to the thermo-cycling only. The two composite resin systems utilized in the current study had a signicant effect on the marginal gap (P value <0.001) particularly in high C-factor preparations of group III and IV (P value 0.009 and 0.001 respectively) using ManneWhitney Test. The effect of C-factor on marginal gap was not statistically signicant in subgroup A restored with Clearl Majesty Esthetic. While subgroup B restored with Grandio SO was statistically signicant (P value 0.007) using KruskaleWallis Test. So, further statistical analysis using ManneWhitney Test was performed and revealed a signicant difference between group I (C-factor 2.6) and group II (C-factor 3) vs. group IV (C-factor 5) as shown in (Table 3).

4. Discussion This in vitro study was performed to evaluate the effect of C-factor on the marginal gap formation of two composite resin systems. Investigation of the marginal adaptation of composite resin restorations to the tooth structure is very important factor in providing a continuous and stable link between the adhesive restorative materials and the dentin substrate [17]. The two types of composite tested in this study represent nanocomposite due to their potential ability to improve the continuity between the tooth structure and the nanosized ller particle providing a more stable and natural interface between the mineralized hard tissues of the tooth and these advanced restorative biomaterials [18]. The use of the self-etch adhesives in the current study is based on its ability to simplify the bonding procedures and reduce the technique sensitivity of the adhesive systems by eliminating the need for acid conditioning, rinsing and drying of etched dental substrate, as a result, the clinician does not need to be concerned about the level of dentin wetness [19]. Cylindrical dentinal cavities with different C-factors of 2.6, 3, 4.2 and 5 were produced in the current study by varying the depth and the diameter of the cavity. This was selected to simulate a more realistic clinical situation according to dos Santos et al. [20]. The use of the thermo-cycling of 600 cycles (5e55  C) was selected to subject the bonded interface of composite resin to thermal stresses generated by the different thermal conductivities and coefcient of thermal expansion of the substrates and bonded materials simulating the clinical situation [21]. This particular temperature range was used according to the International Organization for Standardization (ISO) TR 11405 standard [22], that estimate the range that has been reported on the surfaces of molar teeth in the mouth of the patient [23]which corresponds to 12 months of clinical service [24]. Scanning Electron Microscope (SEM) was used to measure the marginal gap as it provides highresolution transmission electron micrographs, elemental maps of the same specic area can be analyzed [25]and it can also provide a more accurate picture of the marginal leakage [26]. This is in consistent with others [27,28]. SEM evaluation followed by the marginal gap measurement using AutoCAD software allowing a quantitative and qualitative evaluation of the interface of the composite biomaterials and the tooth biostructure as inuenced by the restoring materials [17].

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Fig. 1. Some representative samples of scanning electron micrographs. (a) Displaying the whole parameter of Clearl Majesty Esthetic restoration division B with no marginal gap formation (Mag. 25). (c) Representing the whole parameter of Grandio SO restoration division B with no marginal gap formation (Mag. 25). The higher magnication (500) in (b,d) showing the interface with no gap formation arrow. (e) Clarifying the whole parameter of Clearl Majesty Esthetic restoration division A with marginal gap formation arrow (Mag. 25). (g) Showing the whole parameter of Grandio SO restoration division A with marginal gap formation arrow (Mag. 25). The higher magnication (500) in (f,h) showing the interface with gap formation arrow. Please cite this article in press as: El-Marhomy AM et al., Effect of different conguration factors on marginal gap formation of two composite resin systems, Tanta Dental Journal (2013), http://dx.doi.org/10.1016/j.tdj.2013.12.004

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Table 1 Statistical analysis of the median values (IQR) of the marginal gap of subgroup A utilized in different C-factor preparations in all samples either subjected or not subjected to thermo-cycling. Groups Subgroups thermocycling Group I C-factor 2.6 Median (IQR) Subgroup A Wilcoxon Signed Ranks Test Division A Division B Z P-value 0 (0) 0 (0) 1.000 0.317 Group II C-factor 3 Median (IQR) 0 (0) 0 (0) 1.000 0.317 Group III C-factor 4.2 Median (IQR) 0 (0) 0 (0) 0.000 1.000 Group IV C-factor 5 Median (IQR) 0 (0) 0 (0) 0.000 1.000

The ndings of the current study revealed that no marginal gap at the dentin-composite interface in the different tested C-factor preparations restored with either Clearl Majesty Esthetic or Grandio SO in all the samples in division B while in the samples subjected to the thermo-cycling division A there was a dissimilar behavior between the two tested composite resin systems on the marginal gap that may be attributed to the efciency of the dentin adhesives used to bond the cavities [29]. The samples restored with Clearl SE Bond and Clearl Majesty Esthetic have better marginal adaptation than those restored with Futurabond DC and Grandio SO. This may be attributed to the advantage of the two-step self-etch adhesive system (Clearl SE Bond) compared to the one-step self-etch adhesive system (Futurabond DC) which may be related to the proportions of their chemical constituents rather than their chemical composition as both contain functional monomers, crosslinking monomers, solvent, inhibitors and activator, but in different proportions. The one-step self-etch adhesives generally have less crosslinking monomers [30,31]. This nding expresses the importance of the type of the adhesive system on marginal gap.

Subgroup A utilizing Clearl SE Bond showed no changes with thermal stress. One possible reason for this stability may be the effect of the thick adhesive resin layer of Clearl SE Bond (40e200 mm) which absorbs some of the thermal stresses [13,32,33]. Consequently, this elastic bonding concept may, to a large extent, explain the good resistance of Clearl SE Bond against stresses, even when applied in a high Cfactor cavity [34]. Another reason may be chemical bonding capacity of Clearl SE Bond to hydroxyapatite that remained around collagen brils [37]. This interaction between hydroxyapatite crystals and Methacryloyloxydecyl dihydrogen phosphate (MDP) (functional monomer of the primer of Clearl SE Bond) may create insoluble calcium salts which prevent the loss of resin over time [35,36]. On the contrary subgroup B utilizing Futurabond DC, the marginal gap increased under thermal stress particularly in high C-factors of group III and IV. This could be attributed to high hydrophilicity where onestep self-etch adhesives behave as semipermeable membranes, allowing uids to pass through, and seriously jeopardizing bond durability [37e39]. This came in agreement with Frankenberger and Tay [40] who reported a signicant difference between two

Table 2 Statistical analysis of the median values (IQR) of the marginal gap of subgroup B utilized in different C-factor preparations in all samples either subjected or not subjected to thermo-cycling. Groups Subgroups thermocycling Group I C-factor 2.6 Median (IQR) Subgroup B Wilcoxon Signed Ranks Test Division A Division B Z P-value 6 (7.3) 0 (0) 1.826 0.068 Group II C-factor 3 Median (IQR) 12.27 (14.33) 0 (0) 1.826 0.068 Group III C-factor 4.2 Median (IQR) 23.71 (26.10) 0 (0) 2.023 0.043* Group IV C-factor 5 Median (IQR) 32.57 (13.10) 0 (0) 2.366 0.018*

* indicates that there is signicant difference at (P < 0.05). Please cite this article in press as: El-Marhomy AM et al., Effect of different conguration factors on marginal gap formation of two composite resin systems, Tanta Dental Journal (2013), http://dx.doi.org/10.1016/j.tdj.2013.12.004

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Table 3 Statistical analysis of the median values (IQR) of the marginal gap of the two composite systems used in the different C-factor preparations in the samples subjected to thermo-cycling. Groups Subgroups Group I C-factor 2.6 Median (IQR) Subgroup A Subgroup B ManneWhitney Test 0 (0) 6 (7.30) Z P-value Group II C-factor 3 Median (IQR) 0 (0) 12.27 (14.33) 1.266 0.206 Group III C-factor 4.2 Median (IQR) 0 (0) 23.71 (26.10) 1.861 0.063 Group IV C-factor 5 Median (IQR) 0 (0) 32.57 (13.10) 2.606 0.009* _ 12.098 3.343 0.001* _ 0.007* _ Group Group Group Group Group Group I vs. II I vs. III I vs. IV II vs. III II vs. IV III vs. IV 0.318 0.097 0.001* 0.359 0.004* 0.12 KruskaleWallis test X2 P-value ManneWhitney test Groups P-value

* indicates that there is signicant difference at (P < 0.05).

step and one-step self-etching adhesives in their ability to withstand stresses generated via fatigue testing. Comparing the effect of thermo-cycling on marginal gap regardless different C-factors and type of composite resin systems, it was found that it played an important role inuencing marginal gap of composite restorations. This may be due to the fact that hot water may accelerate hydrolysis of the interface components with subsequent water uptake and leaching of the breakdown products or poorly polymerized resin oligomers [21]. Moreover, thermal cycling may induce stresses between the tooth substrate and the restorative material [41]. These stresses may lead to cracks that propagate along bonded interfaces, accelerating chemical degradation of the bonds [21]. This is congruent with other researchers [42,43] who reported that the application of thermo-cycling signicantly increased the marginal gap. However, these results are in contrary with other studies that reported that the thermo-cycling has no effect on marginal gap of dental restorations [44e47]. Moreover, gap length of both tested subgroups recorded statistically signicant difference in the high C-factors only of group III and IV. This may be attributed to the fact that the shrinkage stresses generated during the polymerization reaction at the walls of the cavity leading to sever microleakage in the deeper restorations [48]. In addition the volume of shrinking composite doubles when depth increases from 1 to 2 mm, where higher shrinkage stress and more severe microleakage was expected in deeper restorations [49], explaining the results in deep cavities which have less free surface area to compensate for polymerization shrinkage stress with ow [50]. The results of this study revealed that the use of different C-factors could inuence the marginal gap

formation in subgroup B using Futurabond DC (onestep self-etch adhesive) only recording direct relation between C-factor and marginal gap formation. This may be explained by the fact that, in cavities with high C-factor the bonded interface increased. Thus, the wall-to-wall shrinkage was increased and so was the gap formation. From the clinical point of view, this nding is extremely important because the absence of gap would increase the longevity of composite resin restorations. On the other hand, the cavities with low C-factor, the composite relaxation provided by the unbonded surface was more efcient for relieving shrinkage stress generated during the polymerization reaction [20]. This nding was supported by those reported by Yoshikawa et al. [51], where they found that cavitywall gap formation signicantly increased when the C-factor increased from 2.3 to 3, and concluded that a C-factor of 2.3 can be considered low. Furthermore, Loguercio et al. [52], showed that the linear polymerization shrinkage and the gap width were higher when the C-factor increased from 0.3 to 3.0. Many authors conrmed this suggestion [13,29]. However, when using Clearl SE Bond, there were no signicant differences in cavity-wall gap formation between different C-factors. This came in agreement with previous investigations that the two-step self-etch adhesives exhibit better marginal sealing than all-inone [53e56]. Under the limitations of the current study it may be assumed that the C-factor was not the only factor inuencing the marginal gap formation where the process of the gap formation is multifactorial depending on other factors such as the type of composite, type of the adhesive systems and thermocycling. This assumption is in accordance with many

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investigators [20,49,57]. Further investigations should be conducted in order to study the effect of different Cfactors on the marginal gap formation of composite resin restoration clinically. References
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Please cite this article in press as: El-Marhomy AM et al., Effect of different conguration factors on marginal gap formation of two composite resin systems, Tanta Dental Journal (2013), http://dx.doi.org/10.1016/j.tdj.2013.12.004