concave-beveled cavity preparations may reduce but
T. C. Lopes Coutinho, M. Almeida Tostes
Department of Paediatric Dentistry, School of Dentistry,
Fluminense Federal University, Niteri, Rio de Janeiro, Brazil
e-mail: chris_coutinho@terra.com.br
Comparison
of microleakage
of different margin
types around Class V
resin restorations
in primary teeth
abstract
Aim This in vitro study compared the effect of a
concave with a straight-bevelled cavity margin on the
microleakage of Class V composite resin restorations in
primary teeth.
Materials and methods Standardised Class V cavity
preparations were made in vitro on the buccal (all
margins placed in enamel) and on the lingual (margins
placed in enamel and cementum) surfaces of 20 sound
primary molars. The teeth were randomly assigned to
two groups of 10 each: in Group 1, a concave bevel was
made with a high-speed No. 04 tungsten carbide bur and
in Group 2, a straight bevel was made with a high-speed
No. 556 tungsten carbide bur. The teeth were restored
incrementally with Adper Single Bond 2 (3M) adhesive
and Filtek Z 350 (3M) composite resin. All specimens
were subsequently thermocycled and immersed in 50%
silver nitrate solution. Microleakage of the restorations
was then assessed by silver penetration. A grading scale
of 0 to 4 was used as the scoring criterion.
Results At the enamel margins no statistically
significant differences were observed between the two
groups (p >0.05). Occlusal walls in enamel, in both
groups, exhibited less leakage than the cervical walls
in cementum (p <0.01) and Group 1 showed better
results than Group 2 in decreasing microleakage at the
cementum margins (p <0.05).
Conclusion Based on the results, it was concluded that
246
did not totally eliminate microleakage at the cementum
margins of Class V composite resin restorations in
primary teeth.
Keywords Adhesion; Microleakage; Primary teeth.
Introduction
In paediatric dentistry there is an increasing demand
for the aesthetic benefits of adhesive dentistry [Atash
and Abbeele, 2004] with more conservative cavity
preparation and increased aesthetic properties being
strong reasons for using resin-based composite
restorations (RBCs). However, failure of RBCs in primary
teeth is still a common problem in paediatric dentistry,
due in part to the fact that RBCs are technique sensitive
[Casagrande et al., 2005], the lack of cooperation in
small children, leading to inadequate tooth isolation
and subsequent higher incidence of marginal leakage
[Atash and Abbeele, 2004]. Microleakage is defined
as the clinically undetectable passage of bacteria,
fluids, molecules, or ions between a cavity wall and
the restorative material applied to it [Kidd, 1976].
Studies have shown that marginal percolation can be
caused by polymerisation shrinkage, thermal changes,
and water absorption of the materials, which result
in gap formation at the tooth/restoration interface
[Kemp-Scholte and Davidson, 1988; Carvalho et al.,
1996; McCoy et al., 1998; Campanella and Meiers,
1999; Ferracane, 2005]. It may lead to negative
clinical consequences such as postoperative sensitivity,
discoloration of the restoration, recurrent caries, and
damage to the pulp [Owens et al., 1998; Mjr et al,
2002; Ferracane and Mitchem, 2003; Yazici et al.,
2003].
The advent of the acid-etch technique to increase
bond strength to enamel, introduced by Buonocore
in 1955, has proven effective in reducing but not
eliminating microleakage at the margins of restorations
[Munro et al., 1996; Swift et al., 2001]. Nonetheless,
bonded interfaces are not yet perfect and confidence
in their long-term durability is not complete. Gingival
margin continues to be a significant source of
microleakage and dentistry continues to seek improved
restoration margins and material properties [Swanson
et al., 2008].
To achieve clinical success for Class V cervical
restorations with a gingival margin in dentin and
cementum, marginal leakage must be minimised or
eliminated [Fitchie et al., 1995; Starr, 2006]. Studies
have been carried out to investigate various restorative
techniques [Santini and Mitchell, 1998; Santini et al.,
European Journal of Paediatric Dentistry vol. 14/3-2013

2001; St Georges et al., 2002; Mllejans et al., 2003;
Sensi et al., 2005; Hassan and Kier, 2007], dentin
adhesives [Santini and Mitchell, 1998; Santini et al.,
2000; Santini et al., 2001; Brackett et al., 2004],
and different cavity preparations to study the seal at
the interface between the prepared cavity and the
restoration [Ferracane and Mitchem, 2003; Pamir and
Tkn, 2005].
Bevelled enamel margins have been advocated to
decrease microleakage of cervical restorations [Opdam
et al., 1998; Owens et al., 1998; Hoelscher et al.,
2000] and provide more prepared enamel surface
area where exposed enamel rod ends are available for
acid conditioning and subsequent bonding. A bevel
increases bonding to the enamel rod ends without
overcontouring the restoration [Swanson et al., 2008].
The question then arises whether a cavosurface bevel
plays a role in providing an improved seal around
gingival dentin/cementum margins of Class V RBCs.
Furthermore, little work has been reported on the use
of bevelled margins on primary tooth enamel [Atash
and Abbeele 2004; Casagrande et al 2005; Swanson
et al 2008].
Studies evaluating the primary enamel have reported
the presence of a 20- to 100-m thick prismless or
aprismatic zone at its surface, though the nature of
this zone may vary in any individual tooth [Ripa et al.,
1966; Kodaka et al., 1989]. Within the prismless zone,
all the crystals are aligned parallel to each other and
perpendicular to the surface, the zone being generally
more highly mineralised due to the parallel nature of
the crystals and the lack of prism boundaries [Kodaka
et al., 1989].
The difference in the enamel structure of primary
teeth suggests that the results and conclusions of
bonding experiments on permanent enamel should
not be applied directly to primary enamel and that
experimental testing should be carried out separately
on primary teeth [Swanson et al., 2008].
N=10 N=10 N=10
buccal
N=20
straight concave
N=10 N=10 N=10
lingual
European Journal of Paediatric Dentistry vol. 14/3-2013
microleakage in resin restorations
The purpose of this study was to investigate in vitro,
by using primary molars, the effect of concave and
straight-bevelled cavity preparations on the marginal
leakage of Class V RBCs.
Materials and methods
Twenty non-carious primary first and second, upper
or lower molar teeth, obtained from the Human Teeth
Bank of the School of Dentistry, Fluminense Federal
University, Niteri, Brazil were included in the study.
These had been extracted for orthodontic reasons or
because of physiological advanced root resorption.
Immediately after the extraction, teeth were rinsed,
stored and sterilised in 2% formaldehyde solution at
pH 7.0, for 30 days at room temperature. The teeth
were cleaned with slurry of pumice and water with a
rubber cup in a low-speed handpiece for 15 seconds
and stored refrigerated at 4 C in distilled water until
preparation.
The experimental design of the study is shown in
Figure 1.
Cavity preparation
Two standardised class V cavities (4 mm in width x 3
mm in height x 2 mm in depth) were prepared in the
cervical third of the buccal (occlusal and gingival margins
in enamel) and lingual (occlusal margin in enamel and
gingival margin in cementum) surfaces of the teeth
with a No. 330 tungsten carbide bur (KG Sorensen,
Barueri, SP, Brazil) under air-water spray using a high-
speed dental handpiece. Cavity standardisation was
obtained by means of a digital caliper rule (Mitutoyo,
Kyoto, Japan). The length of the bur (2 mm) was used
as a guide for the cavity depth. New burs were used
after every five preparations. The teeth were then
randomly assigned to two groups of 10 teeth each (20
preparations). In Group 1, a 1 mm concave bevel was
N=20
D E
4 3 2 1 0
0 - No dye penetration
1 - Penetration up to 0.5 mm
2 - Penetration up to 1 mm
3 - Penetration up to 1.5 mm
4 - Penetration up to the pulpal wall fig. 1 Illustration of the
experimental design.
247
Lopes Coutinho T.C. AND Almeida Tostes M..
made on the occlusal and gingival margins with a high-
speed No. 04 tungsten carbide bur (KG Sorensen,
Barueri, SP, Brazil) and in Group 2, a 1 mm straight
bevel was made on the occlusal and gingival margins
with a high-speed No. 556 tungsten carbide bur (KG
Sorensen, Barueri, SP, Brazil). The preparations were
pumiced with a rubber cup in a slow-speed handpiece
and then washed thoroughly with water.
Cavity restoration
The prepared surfaces were etched with 37%
phosphoric acid gel (Dentsply/Caulk Ind. e Com. Ltda.,
Petrpolis, RJ, Brazil) for 15 seconds, rinsed with water
spray for 30 seconds and gently air dried. The teeth
were incrementally restored in approximately three
1-mm increments with Filtek Z 350 composite resin
(3M ESPE Dental Products Division, St. Paul, MN, USA),
using Adper Single Bond 2 (3M ESPE Dental Products
Division, St. Paul, MN, USA) as the enamel/dentin
adhesive. The adhesive was light cured for 10 seconds
with an Optilux 401 (Demetron Research Corp.,
Danbury, CT, USA) visible-light curing unit. A preliminary
increment, about 1 mm thick was set horizontally in
the cervical wall using a plastic instrument. The second
and third increments were placed diagonally in the
cavity. Each increment was cured for 40 seconds with
an Optilux 401 (Demetron Research Corp., Danbury,
CT, USA) visible-light-curing unit. All materials were
handled according to the manufacturers instructions.
After storing in distilled water at 37C for 24 hours in
individual plastic bottles, the restorations were finished
and polished, using a high-speed No. 7901 finishing
bur (KG Sorensen, Barueri, SP, Brazil) and Sof-Lex
XT extra thin discs (3M ESPE Dental Products Division,
St. Paul, MN, USA) of decreasing abrasiveness with a
continuous water spray.
Silver penetration
Samples were thermocycled 5,000 times between
water baths held at 5C and 55C for 15 seconds at
each temperature with a dwell time of 15 seconds
and a 15-second transfer time. After thermocycling,
the teeth were covered with 2 coats of nail polish
up to approximately 1 mm of the periphery of each
restoration. Once dry, the teeth were placed in a freshly
prepared 50% solution of silver nitrate for 24 hours and
kept in darkness. They were then rinsed in tap water at
room temperature for one minute and immersed for
eight hours in photodeveloping solution [Sano et al.,
1995]. Then specimens were rinsed in tap water to
remove the solution.
The teeth were embedded in acrylic resin (L.D.
Caulk/Dentsply International, Milford, DE, USA) and
1 mm thick samples were prepared by sectioning
longitudinally in a buccolingual direction through
the centre of the restorations using a water-cooled
diamond disc (KG Sorensen, Barueri, SP, Brazil).
248
Each surface was subsequently examined using a x40
stereoscopic microscope (Mitutoyo, Kyoto, Japan).
The occlusal and gingival margins were qualitatively
evaluated separately and scored for silver penetration
according to the following criteria [Salim et al., 2005]:
0: no dye penetration;
1: penetration up to 0.5 mm;
2: penetration up to 1.0 mm;
3: penetration up to 1.5 mm;
4: penetration up to the pulpal wall.
Two experienced evaluators were calibrated in
using this rating scale and independently scored each
specimen. Evaluators were blinded as to which group
was being evaluated. Discrepancies were rescored to
reach consensus. The interexaminer reliability was at
the same level (Kappa = 0.9, p<0.01).
Statistical analysis
The results obtained were compared using non-
parametrical statistical analysis (Mann-Whitney U
test and Kruskal-Wallis H test) followed by a Multiple
Comparison test (Dunns test) to identify significant
differences between the two groups. Statistical software
(version 15.0, SPSS Inc., Chicago, IL, USA) was used and
results were considered significant for p<0.05.
Results
The microleakage scores are summarised in Figures
2 and 3.
No statistically significant differences were found
between the groups with either concave or straight
bevels at the enamel margins (Z = 1.96; H = 4.39;
p>0.05) (Fig. 2). Dunns test indicated that significant
differences existed in the overall comparison of
microleakage scores between enamel and cementum
surfaces (p<0.01). For both cavosurface bevels used,
microleakage was significantly greater in cementum
surfaces than in enamel surfaces (H = 55.51; p<0.05)
(Fig. 3). Comparing the two groups, Group 1 (concave
bevel) showed decreasing microleakage at the
cementum margins compared to Group 2, though
microleakage was not completely eliminated.
Discussion
Restoration of Class V cervical lesions involves
replacing tooth structure lost through wear, erosion,
and/or the carious process [Sidhu and Henderson,
1992]. These lesions can have margins in dentin or
cementum as well as enamel, and numerous restorative
techniques have been described in the literature in an
effort to achieve a reliable gingival seal along the tooth/
restorative material interface [Nozaka et al., 1999;
Atash and Abbeele, 2004; Swanson et al., 2008; Khier
European Journal of Paediatric Dentistry vol. 14/3-2013
 microleakage in resin restorations

30 30
score 0 score 0
score 1 score 1
25 25
score 2 score 2
score 3 score 3
20 score 4 20 score 4

15 15

10 10

2 2

0 0
concave concave straight straight concave concave straight straight
occlusal gingival occlusal gingival occlusal (E) gingival (C) occlusal (E) gingival (C)

Leakage was not greater at the gingival margins than at the occlusa margins (p>0.05) Leakage was greater at the gingival margins than at the occlusa margins (p>0.01)

fig. 2 Distribution of specimens according to microleakage fig. 3 Distribution of specimens according to microleakage
scores in enamel. scores in enamel (E) and cementum (C).

and Hassan, 2011]. To date, few microleakage studies frequency at the gingival locations, which was the
have provided information concerning dentin bonding same found in the present study using primary teeth,
with a gingival (dentin/cementum) bevel in primary mainly in the straight-bevel group.
teeth [Atash and Abeele, 2004; Swanson et al., 2008]. The difference of marginal leakage scores between
According to Hembree [1980], beveling the enamel the two groups found in this study was also observed
margins of a Class V RBCs is effective in providing by other authors [Futatsuki et al., 1990; Nozaka et al.,
an increase in surface area for etching, removing 1999; Khattab et al., 2006; Swanson et al., 2008].
the prismless layer of surface enamel, facilitating the These authors obtained a better marginal seal with a
finishing procedure and achieving a more aesthetic concave bevel than with either a straight bevel or non-
restoration, completely exposing the ends of the bevel (butt joint) margins by thermal and load cycling
enamel rods for resin attachment and thus restorative of the specimens.
bonding, and decreasing microleakage. Mandras et al. [1991] suggested that, in the evaluation
The lower scores of dye penetration at the enamel of microleakage in laboratory studies, restored teeth
margins in this study (Fig. 2, 3) with either concave or should be subjected to both thermal and occlusal
straight bevel compared with the gingival cemental stresses so that intra-oral conditions are more closely
margins are consistent with previous studies in primary simulated. Moreover, Barnes et al. [1993] comparing
and permanent teeth [Lee and White, 1998; Owens et the occurrence of microleakage between Class V resin
al., 1998; Nozaka et al., 1999; Swanson et al., 2008; restorations placed in vivo and in vitro, reported that
Khattab et al., 2006]. These results also lend support laboratory microleakage tests of thermocycled resin
to the statement that the resin-bond is not strong restorations predict more leakage than that found in
enough to withstand the polymerisation contraction clinical restorations. On the other hand, Prati et al.
forces in spite of the use of the new dentin adhesives [1994] found that neither thermocycling nor occlusal
[Sindhu and Henderson, 1992]. On the other hand, stresses increased the microleakage of the restorations
some authors [Atash and Abeele, 2004; Santini et al., in vitro. Also Rosales-Leal [2007] observed that
2004; Bagheri and Ghavamnasiri, 2008] reported no thermocycling did not affect the occlusal bonding in
significant difference in microleakage between bevelled Class V resin restorations.
and non-bevelled margins in primary and permanent The present study used only thermal stresses to
enamel. simulate intra-oral environment, and as an in vitro
Zidan et al. [1987] evaluated the effects of dentinal study, it has its limitations as not all variables can be
bonding agents on marginal gaps in Class V resin reproduced, such as pH of the oral cavity, bacteria,
restorations in permanent teeth and observed that diet, salivary content and flow, and medications.
the frequency of gap occurrence followed a consistent Also mechanical stresses of function and enamel
pattern for most of these agents. The lowest frequency rod orientation may influence marginal integrity and
was at the enamel occlusal locations, gradually adhesive bonding ability [Swanson et al., 2008], which
increasing toward the dentin, with the highest were not incorporated in the study.

European Journal of Paediatric Dentistry vol. 14/3-2013 249

Lopes Coutinho T.C. AND Almeida Tostes M..
Several microleakage studies [Barnes et al., 1994;
Atash and Abbeele, 2004; Rosales-Leal, 2007; Bagheri
and Ghavamnarisi, 2008; Chandra et al., 2011]
employed both the buccal and lingual surfaces of teeth
in their methodology, as was done in this study. Barnes
et al. [1994] compared microleakage of buccal and
lingual tooth structure and stated that the experimental
technique of using both surfaces appears to introduce
no positional variables in an in vitro research design.
Thus, these surfaces can be prepared and restored in
the same manner, since buccal and lingual enamel,
dentin, and cementum respond in a similar manner
with respect to microleakage.
The results in the present study indicate that there
was good adhesion and marginal sealing with the
enamel at the occlusal margins when a bevel was
prepared to make the bonding surface as extensive
as possible. Swanson et al. [2008] also observed that
the presence of a marginal bevel significantly reduced
microleakage in primary and permanent enamel (70%
overall), regardless of the type of adhesive used. This
would indicate that bevelling the enamel margins of
primary teeth may produce a higher degree of clinical
acceptability and may be the configuration of choice
for the Class V RBCs in primary enamel. On the other
hand, no treatment was successful in preventing the
penetration of dye at cervical (cementum) margins, in
spite of the better results with the concave bevel group.
The lower degree of microleakage exhibited by all
occlusal margins in the present study compared to
cervical margins can be explained by the presence of
enamel at these walls and margins which provided a
stronger adhesive bond that has overcome the weaker
dentin bond at the gingival wall. The gingival wall is
formed by dentin, which consists of minerals, organic
compounds (mainly collagen fibers), and water [Khier
and Hassan, 2011]. Another factor is the adhesive
itself: the chemical composition plays an important
role in achieving a strong, durable, and a biological,
compatible bond [Mjr at el., 2002]. After phosphoric
acid treatment, there is a deep demineralization front
in which the collagen network is exposed, dentin
tubules are open, and water content is increased.
The adhesive have to infiltrate the exposed collagen,
replace the water, and seal the tubules, which turns
sealing complicated [Rosales-Leal, 2007].
The interaction of water and specific enzymes with
the hydrophilic resins and the collagen fibrils additionally
seem to cause long-term breakdown of the transitional
layers. Further improvements to refine the transitional
layer to improve its adaptation to the intact tissue and
enhance its long term resistance to hydrolysis and
breakdown still remain central challenges for future
research [Vaidyanathan and Vaidyanathan, 2009].
The adhesive's acidity may also affect the initial
enamel etch, thus influencing marginal integrity and
bonding ability. Studies have shown that adhesives
250
with low pH demineralize the smear layer and tooth
structure improving the marginal sealing [Ibarra et al.,
2002; Atash and Abbeele, 2004; Perdigo et al., 2006;
Rosales-Leal, 2007]. The adhesive used in the present
study has high pH (pH= 4.7), which may interfere in the
dentin bonding, if the time required to allow complete
diffusion of the adhesive into the denatured dentin is
not respected, thus adequate penetration may not be
achieved. However, the effects of acidity on bonding
ability in primary enamel are still inconclusive [Swanson
et al., 2008].
It is well known that primer and adhesive resin may
incompletely penetrate the demineralized dentinal
collagen layer after etching in total etching bonding
systems. This discrepancy between depth of dentin
demineralization after the acid-etching procedure and
depth of resin infiltration facilitates the formation of
voids or microporous zones underneath and within the
hybrid layer detectable by silver nitrate [Vaidyanathan
and Vaidyanathan, 2009], which was the isotope used in
the present study. Microleakage that facilitates bacterial
percolation occurs only when the gaps at the margins
are 1020 m wide. But Sano et al. [1995] observed
silver nitrate tracer penetration into the hybrid layer
even when they detected no gaps at the margins. The
authors also observed that the relatively smaller tracer
ions (silver) penetrated the full thickness of the hybrid
layer in some areas, and into the adhesive resin. They
called it nanoleakage, which occurred through 20
100 nm gaps at the margins. Several investigators have
since evaluated nanoleakage expression in different
adhesive systems in the last decade [Vaidyanathan
and Vaidyanathan, 2009]. Distinctly different types of
nanoleakage patterns (e.g., spotted, reticular, water-
treeing) have been reported by TEM and SEM studies.
Hydrolytic breakdown of the dentinrestoration bond
has been attributed to the mechanism of nanoleakage
expression in the bonded interface [Vaidyanathan and
Vaidyanathan, 2009]. This phenomenon may have
occurred in this study.
Since these results are in vitro data, and it is difficult
to extrapolate them directly to the clinical situation,
definite conclusions should not be drawn until further
in vivo studies are completed.
Conclusions
Within the limitations of this study, the following
conclusions may be drawn.
In primary teeth, cavity preparations with margins
in enamel exhibited less microleakage than margins
placed in cementum, irrespective of type of bevelling.
Considering margins in cementum, concave bevelled
margins showed less microleakage compared to
straight bevelled margins, though microleakage was
not eliminated completely.
European Journal of Paediatric Dentistry vol. 14/3-2013

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