International Journal of Civil Engineering and Technology (IJCIET)
Volume 10, Issue 04, April 2019, pp. 1933–1939, Article ID: IJCIET_10_04_202
Available online at http://www.iaeme.com/ijmet/issues.asp?JType=IJCIET&VType=10&IType=4
ISSN Print: 0976-6308 and ISSN Online: 0976-6316
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COMPARATIVE EVALUATION OF
EFFECTIVENESS OF RESTORATIONS IN
CERVICAL TEETH REGION BY DIRECT AND
INDIRECT METHOD
Andrey Sevbitov
I.M. Sechenov First Moscow State Medical University (Sechenov University)
Yulianna Enina*
I.M. Sechenov First Moscow State Medical University (Sechenov University)
Svetlana Derevianchenko
Volgograd State Medical University
Aleksey Dorofeev
I.M. Sechenov First Moscow State Medical University (Sechenov University)
*Corresponding Author
ABSTRACT
Restoration of defects of hard tissues in cervical region of teeth is one of the most
topical problems of modern dentistry. Defects of cervical region have different
etiology, pathophysiology of development of defect formation process. The most
frequently used method for restoration of lost hard tissues of teeth is method of direct
filling. However many authors believe that this method is not effective enough. One of
the main goals of restorative dentistry is to replace lost tooth structure by a material
whose structure and physical properties are similar to natural tissues of tooth. This
goal can be achieved by CAD/CAM technology. Chemical stability of hybrid ceramics
secures its good mechanical and optical properties as well as excellent
biocompatibility. A restoration of cervical region must be subjected to several different
types of loads, one of them are temperature fluctuations in oral cavity. The article studies
influence of thermocyclic loads on state of boundary "filling-tooth". The experiment
proved that indirect restoration of hybrid ceramics is more resistant to thermocyclic
loads.
Key words: direct restoration, indirect restoration, inlay, thermal cycling, abfraction
defect
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1933
editor@iaeme.com
Andrey Sevbitov, Yulianna Enina, Svetlana Derevianchenko, Aleksey Dorofeev
Cite this Article: Andrey Sevbitov, Yulianna Enina, Svetlana Derevianchenko,
Aleksey Dorofeev, Comparative Evaluation of Effectiveness of Restorations in
Cervical Teeth Region by Direct and Indirect Method, International Journal of Civil
Engineering and Technology 10(4), 2019, pp. 1933–1939.
http://www.iaeme.com/IJCIET/issues.asp?JType=IJCIET&VType=10&IType=4
1. INTRODUCTION
Several forms of lesions are distinguished in cervical region: caries and non-carious lesions
among which erosions, cuneiform defects and abfractions are distinguished. International
Classification of Dental Diseases (ICD-10) determines that the following lesions can be
diagnosed in cervical region of a tooth: caries of enamel, caries of dentine and caries of
cement. Additionally, such non-carious lesions of teeth as erosion of enamel (K03.2) and
cuneiform defect (K03.10) in section of teeth stripping can be diagnosed in cervical region of
a tooth. Abfraction lesions, which are localized in cervical region too, are not singled out into
a separate group in ICD-10; this fact hinders their classification, singling-out into a separate
nosologic form and hinders development of specific pathogenetically oriented methods for
their prevention and treatment [1-3].
Restoration of defects of hard tissues of teeth is one of the most topical problems of
dentistry. The most frequently used method for restoration of lost hard tissues of teeth is
method of direct filling. This method is not effective enough because development of
secondary caries takes place: after six months - in 30% of clinical situations; after one year in 50%; after 2 years - in 70% . Use of composite restorations on teeth, which are subjected to
loads, is limited because of low physical-mechanical properties of these materials [4-6].
During diagnostics and treatment of lesions of hard tooth tissues the most important goal
of a modern dental therapist is to take a decision which is optimal and well-balanced from the
medical, economic, aesthetic, biomechanical and ergonomic point of view in respect to a
specific clinical situation [7-9].
Interest in this question is explained by the fact that an incorrect determination of causes
and incorrect diagnostics of the above mentioned lesions result in inappropriate approaches to
prevention and therapy what causes further progression, development of complications and
new pathology. While studying the available sources of literature we found out that the
method of filling cannot solve the problem of restoration of form and function of teeth
reliably and for a long time. Therefore specialists' aspiration for search for new biologically
inert materials and methods for replacement of defects of hard tooth tissues remains topical
today [10].
Interest in hybrid materials in dentistry has grown in recent years.
Hybrid ceramics combines positive properties of traditional ceramics with the ones of a
polymer for CAD/CAM what provides considerable advantages in prosthetics. Elasticity of
this ceramics is similar to the one of natural dentine and its abrasive properties are identical to
natural enamel. This allows to use it at places of increased loads in cervical region.
Goal of the study was a comparative evaluation of quality of marginal fit of "inlay - tooth"
and "filling - tooth" before and after thermal cycling.
2. METHODS AND MATERIALS
This work was done at Sechenov University with supported by the "Russian Academic
Excellence Project 5-100".
Objects of research were 20 extracted teeth having abfraction defects. All teeth had been
treated by sandblast apparatus Dento Prep, size of aluminum oxide particles was 27 µm. The
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1934
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Comparative Evaluation of Effectiveness of Restorations in Cervical Teeth Region by Direct and
Indirect Method
test samples were subdivided into 2 groups according to method of restoration: group 1 (10
teeth) - abfraction defects which were restored by inlays of hybrid ceramics; group 2 (10
teeth) - abfraction defects which were restored by direct restoration in adhesive technique by
the composite filling material Estelyte Asteria.
After restoration all samples were immersed into a reservoir with distilled water; this
reservoir was placed into a thermostat having temperature +37±1°С for 24 hours (Fig. 1).
Figure 1. Thermostat
Within the framework of conducted research, an apparatus had been developed in Federal
State Budgetary Scientific Institution “Technological Institute For Superhard And Novel
Carbon Materials” in order to perform thermal cycling of test samples. The apparatus consists
of two motorized translators on step motors which are controlled from a computer. There are
two glasses of water for imitation of conditions of oral cavity. One glass has a built-in
refrigerator on the basis of a Peltier element and there is a resistance-type heater in the second
glass. Control of temperature is performed by a laboratory power source. Monitoring of
temperature is performed manually by the immersion thermometer LT-300. Temperature of
water in the "cold glass" is - 5 С, temperature of water in the "hot glass" is 60°С. Admissible
deviation of temperature is 1°С (Fig. 2).
Then a half of samples (5 teeth with direct composite restoration and 5 teeth which had
been restored by inlays) were colored after 24 hours and 10 remaining ones were subjected to
thermal cycling with subsequent coloration.
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1935
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Andrey Sevbitov, Yulianna Enina, Svetlana Derevianchenko, Aleksey Dorofeev
Figure 2. Apparatus for thermal cycling
In order to conduct thermal cycling the samples were placed into a perforated cuvette
which was immersed into a water bath with temperature of water +5±0.5 С for 30 seconds,
after that the cuvette was taken out and was kept under room temperature for 20 seconds.
Then the cuvette with samples was immersed into a water bath with temperature +60±0.5°С
for 30 seconds, after that the cuvette was taken out and was kept under room temperature for
20seconds. The conducted complex of manipulations was considered as one cycle. 1500
cycles were conducted in total within 2 weeks according to Russian Standard GOST R5120298, P.6.3 (load corresponds to one year of use of restoration for this localization).
3. RESULT
In order to determine the marginal permeability a coloration of all samples was performed
(before and after thermal cycling) in 2% solution of methylene blue for 2 hours at temperature
37 С. After that the teeth were sawn in sagittal plane and a comparative analysis of depth of
dyestuff penetration into space between an inlay and tooth wall as well as between a filling
and tooth wall was performed All teeth were photographed under 20x magnification. Results
of study are presented in Table 1.
Table 1 Microleakage in teeth with direct and indirect restoration.
Samples without thermal cycling
Microleakage
Samples after thermal cycling
Microleakage
Group 1
Direct restoration
5
0%
5
100%
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1936
Group 2
Indirect restoration
5
0%
5
0%
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Comparative Evaluation of Effectiveness of Restorations in Cervical Teeth Region by Direct and
Indirect Method
4. DISCUSSION
Coloration of "restoration-tooth" boundary in test samples, which were not subjected to
thermal cycling, was observed neither in the first group nor in the second one (Fig. 3, 4).
Figure 4. "Filling-tooth" boundary
without thermal cycling
Figure 3. "Inlay-tooth" boundary
without thermal cycling
After conducted thermal cycling the microleakages in test samples were found only in
teeth of the group 1 (restorations by direct method). One can visually detect a disorder of
marginal fit and coloration of floor of cavity in 100% cases (Fig. 5).
Figure 5. "Filling-tooth" boundary after thermal cycling
Whereas the marginal fit of inlays in samples of the group 2 remained intact (Fig. 6).
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Andrey Sevbitov, Yulianna Enina, Svetlana Derevianchenko, Aleksey Dorofeev
Figure 6. "Inlay-tooth" boundary after thermal cycling
5. CONCLUSIONS
As before, studies of restorations in cervical region remain topical. In 2015 Camila S.
Sampaio et al. conducted a comparative analysis of adhesive systems in cases of direct
restorations in cervical region with thermal cycling and without it. The authors revealed that
the best effect was provided by a self-pickling adhesive system. In 2012 Michal Staninec and
Grant H. Tsuji tested adhesion of ceramic inlays CAD/CAM in a clinical model in case of
non-carious lesions of cervical regions of teeth. Studies showed advantages of fixation of
inlays on a luting composite material over direct restoration in adhesive technique.
The study, which we conducted, showed that inlays of hybrid ceramics provide better
marginal fit than restorations in direct adhesive technique.
Restorations in cervical region are subjected not only to thermal loads but also to various
dynamic loads therefore this issue is topical and that is confirmed by our research as well as
by data of foreign authors, therefore this issue needs a further study.
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Indirect Method
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