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18]

Original Research

Comparative Evaluation of Microleakage in Class V Cavities Restored

with Giomer, Resin‑Modified Glass Ionomer, Zirconomer and
Nano‑ionomer: An In vitro Study
K Mohammed Salman, Savitha B Naik, N Kiran Kumar, Seema Merwade, Biji Brigit, Reshu Jalan

Department of Conservative Aims and Objective: Clinically, microleakage is the major cause for the failure
Dentistry and Endodontics,
Abstract
Government Dental College
of restorations in Class V cavities which may cause postoperative sensitivity and
and Research Institute, secondary caries. The newer generation of glass ionomers has been introduced
Bengaluru, Karnataka, India in market with superior characteristics compared to conventional glass ionomers.
The aim of this study was to evaluate the adaptability of new novel restorative
material Nano‑ionomer with resin‑modified glass ionomer, Zirconomer, Giomer to
tooth surface by measuring the degree of microleakage at gingival and occlusal
restorative margins of Class V cavities and compare the same among the groups
using stereomicroscopic study. Methodology: A total of 60 Class V cavities were
prepared with occlusal margin in enamel, and the cervical margin in dentin and
cementum of sound extracted premolars. Restorations were randomly assigned
to one of the four groups (n = 15) and were restored with various type of
glass ionomers (resin‑modified glass‑ionomer cements [RMGIC], Zirconomer,
Giomer, Nano‑ionomer), respectively. Specimens were thermocycled, immersed
in Methylene blue dye, sectioned longitudinally and analyzed for leakage at the
occlusal and cervical interfaces. Analysis of variance test, followed by post hoc
Bonferroni Test was used to determine the inter‑ and intra‑group difference and
Paired t‑test was used to determine the significant difference at enamel and
cementum margins. Results: The intergroup comparison of occlusal and gingival
scores showed a significant difference between RMGIC and Giomer, Zirconomer
and Nano‑Ionomer and Giomer and Nano‑Ionomer (P < 0.05). Conclusion: It was
concluded that all the restorative materials tested shows microleakage to an extent.
Nano‑ionomer was better than the other three types of glass ionomers in reducing
the microleakage.

Received: January, 2019.

Keywords: Cementum, dental restoration, dentin, enamel, giomer,
Accepted: February, 2019. glass ionomers, Nano‑ionomers, Zirconomer

Introduction Address for correspondence: Dr. K Mohammed Salman,

T he aim of restorative dentistry is to restore the

tooth to its function and form. It has been given
more importance to the retentive ability of a material
Government Dental College and Research Institute, Room
No. 4, Victoria Campus, Fort Road, Bengaluru ‑ 560 002,
Karnataka, India.
E‑mail: [email protected]
and adhesion of dental restorative materials to the
cavity walls to seal the cavity against passage of This is an open access journal, and articles are distributed under the terms of the
microorganisms and oral fluids.[1] The inability of the Creative Commons Attribution‑NonCommercial‑ShareAlike 4.0 License, which allows
others to remix, tweak, and build upon the work non‑commercially, as long as
restorative materials to attain the complete marginal appropriate credit is given and the new creations are licensed under the identical
terms.
Access this article online
Quick Response Code: For reprints contact: [email protected]
Website: www.jicdro.org

How to cite this article: Salman KM, Naik SB, Kumar NK, Merwade S,
Brigit B, Jalan R. Comparative evaluation of microleakage in Class V cavities
DOI: 10.4103/jicdro.jicdro_2_19 restored with giomer, resin‑modified glass ionomer, zirconomer and
nano‑ionomer: An in vitro study. J Int Clin Dent Res Organ 2019;11:20-5.

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Salman, et al.: Microleakage of nanoionomer

seal leads to the occurrence of micro gaps, in which Kyoto, Japan), Group III Giomer (Beautifil II, Shofu,
the seepage of fluids, ions, and bacteria occurs, which Kyoto, Japan.), and Group IV Nano‑ionomer (Ketac
causes secondary caries, hypersensitivity and pulpal N 100, 3M ESPE, St. Paul, MN, USA), respectively.
infections. Microleakage is the major factor responsible All the restorative groups were restored according
for the failure of Class V restorations, as gingival to the manufacturer’s instruction. To simulate the
margins of such restorations are generally situated in oral environment specimens were subjected to a
dentin/cementum and the bonding to dentin is less thermocycling regimen of 500 cycles between 4°C
to be expected than enamel due to its lower mineral and 55°C water baths. Dwell time was 1 min, with a
content and complex pattern.[2] Nowadays, restorative 3 sec transfer time between baths. The specimens were
materials such as glass ionomers, hybrid ionomers, coated with two layers of nail polish, leaving a 1 mm
composite resins, and compomers are commonly used space around the cavity margins to avoid ingress of
for restoration of Class V cavities.[3] The conventional dye through other microfissures and cracks. Teeth were
glass‑ionomer cements (GIC) were water‑based kept in methylene blue dye (Spectrum Reagents and
materials which set by an acid and base reaction. Chemicals Pvt. Ltd.,) for 24 h. The teeth were then
Since these were brittle materials, attempts were made sectioned in a buccolingual direction through the center
to improve the physical properties. Resin Modified of the restorations using a low‑speed diamond disc.
GIC (RMGIC) was introduced (1990) to improve the The sections were scored according to the criteria and
drawbacks of conventional glass ionomers cements.[4] assessed with a stereomicroscope at × 10 magnification
Recently, nano‑filled resin‑modified glass ionomers were to evaluate the depth of dye penetration at the occlusal
developed that combines the benefits of bonded and gingival margins. The depth of dye penetration
nanofiller technology and resin‑modified light‑cured was assessed according to the criteria given by Wahab
glass ionomers.[5] Giomers are hybrid between resin et al.[6]
composites and glass ionomers which uses pre-reacted Statistics
glass filler technology. Another class of restorative glass The data collected by experiments were computerized
ionomer that comprises the durability and strength of and analyzed using Statistical Package for Social
amalgam is developed as a recent restorative material Sciences (SPSS) version 23.0 (IBM SPSS, Chicago).
called Zirconomer, which is also called as white The mean and standard deviation of microleakage scores
amalgam. The aim this study is to evaluate and compare of four study groups was compared using analysis of
the adaptability of new novel restorative material variance (ANOVA) test followed by post hoc Bonferroni
Nano‑ionomer with resin‑modified glass ionomer, Test and paired t‑test to determine the significant
Zirconomer, and Giomer to tooth surface by measuring difference at enamel and cementum margin. P < 0.05
the degree of microleakage at gingival and occlusal will be considered to be statistically significant.
margins of Class V cavities and comparing among this
four restorative materials using stereomicroscopic study. Results
The statistical correlation was done with the mean value
Methodology scores of all the four tested groups for occlusal and
Sixty noncarious freshly extracted human maxillary gingival scores using ANOVA, and it was found to be
premolar teeth extracted for orthodontic purpose were statistically significant (P < 0.05) [Tables 1 and 2].
included in this study. All teeth with previous cervical
defects were excluded from the study. The procedure The intergroup comparison of occlusal and
for cavity preparation and restoration were standardized gingival scores of all the four study groups was
for all groups and performed by a single operator to done using Post hoc test that showed a highly
minimize experimental variables. On the buccal surface significant difference between Groups I (RMGIC)
of each tooth a standardized Class V cavity preparation and III (Giomer), Groups II (Zirconomer) and
was done. The dimensions of the preparations IV (Nano‑ionomer), Group III (Giomer) and
measured 4 mm mesiodistally, 4 mm occlusogingivally, Group IV (Nano‑ionomer) (P < 0.05). And, whereas
and 2 mm depth with the occlusal margin in enamel it was insignificant between Group I (RMGIC)
and the gingival margin in cementum/dentin. The teeth and II (Zirconomer) and Group I (RMGIC) and
were then randomly divided into four experimental IV (Nano‑ionomer) [Table 3 and Figures 1, 2].
groups, each group containing 15 teeth. Group I was The paired test was done to compare the occlusal
restored with RMGIC (GC gold label light cured and gingival microleakage scores of the same group
universal restorative, Tokyo, Japan), Group II with were done. It was shown that there was no significant
Zirconomer (Zirconomer improved SHOFU INC, difference between the microleakage of occlusal and

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Salman, et al.: Microleakage of nanoionomer

gingival margins for each group even though the Discussion

gingival score was more compared to occlusal score for One of the cardinal requirements for the better
all restorative groups [Table 4 and Figure 3]. prognosis of restoration is to prevent the
Thus, the results obtained from the study showed that microleakage, which is achieved with the proper
the maximum microleakage was present in Giomer adhesion of restorative material to the cavity walls.
followed by Zirconomer, resin‑modified glass ionomer, The inability of the restorative materials to attain
and the least was in Nano‑ionomer. the complete marginal seal leads to the occurrence
of microgaps in which the seepage of fluids, ions,
and bacteria occurs, which causes secondary caries,
Table 1: Mean microleakage in the groups at occlusal
hypersensitivity, and pulpal infection. These are
margin and statistical analysis of variance for
microleakage of four study groups the most common reasons to replace or repair an
Groups n Mean SD adhesive restoration.[7] The microleakage is used
Group I 15 1.73 0.79 as criteria by which researchers and clinicians can
Group II 15 2.26 0.59 predict the performance of a restorative material.[8]
Group III 15 2.46 0.63 The need for restorative material with better adhesive
Group IV 15 1.46 0.51 characteristics leads to the more recent advances in
Source of variation Sum of squares Degree of freedom P the restorative materials.
Total 32.98 59 0.000*
*The mean difference is significant at the P<0.05 level. n: Number;
The morphology of Class V cavities with margins partly
SD: Standard deviation in enamel and partly in dentin/cementum presents a
challenging condition for the restorative materials.
Class V cavities were selected for this study because
Table 2: Mean microleakage in the groups at gingival
margin and statistical analysis of variance for of its configuration or “C” factor. The “C” factor of
microleakage of four study groups Class V restoration is 5, which is the reason for the
Groups n Mean SD internal bond disruption as well as microfissures around
Group I 15 1.80 0.67 the restorations and cavity walls,[9] so microleakage
Group II 15 2.33 0.61 is more important in Class V cavities because of this
Group III 15 2.60 0.50 high C factor. At present, restorative materials such as
Group IV 15 1.53 0.51 glass ionomers, hybrid ionomers, composite resins, and
Source of variation Sum of squares Degree of freedom P compomers are recommended to restore Class V cavity
Total 29.733 59 0.000* restoration.[3]
*The mean difference is significant at the P<0.05 level. n: Number;
SD: Standard deviation Nano‑ionomers a novel restorative material with the
incorporation of nanoparticles led to wider particle
Table 3: Comparison of mean microleakage at occlusal size distribution, which resulted in higher mechanical
margin properties. Nanotechnology can, however, improve
Groups Group I Group II Group III Group IV continuity between the tooth structure and the nano‑sized
Mean 1.73 2.26 2.46 1.46 filler particle and provide a more stable and better
SD 0.79 0.59 0.63 0.51 quality interface between the mineralized hard tissues of
Group I ‑ 0.165 0.018* 1.000 the tooth and these restorative materials.[10]
Group II 0.165 ‑ 1.000 0.008*
Group III 0.018* 1.000 ‑ 0.001*
3 MEAN
Group IV 1.000 0.008* 0.001* ‑
*The mean difference is significant at the P<0.05 level. SD: Standard 2.46
2.5 2.26
deviation
2 1.733
1.46
MEAN

Table 4: Intragroup comparison of microleakage at 1.5

occlusal and gingival margin
1
Group P Significance
Resin‑modified GIC 0.707 Not significant 0.5
Zirconomer 0.349 Not significant
0
Giomer 0.876 Not significant GROUP 1 GROUP 2 GROUP 3 GROUP 4
Nano‑ionomer 0.483 Not significant
GIC: Glass‑ionomer cements Figure 1: mean microleakage at occlusal margin

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Salman, et al.: Microleakage of nanoionomer

MEAN 3
3 OCCLUSAL
2.6 2.5
2.5 2.3 GINGIVAL
2
2 1.8

MEAN
MEAN

1.53 1.5
1.5
1
1
0.5
0.5
0
0 GROUP 1 GROUP 2 GROUP 3 GROUP 4
GROUP 1 GROUP 2 GROUP 3 GROUP 4
Figure 3: intragroup comparison of microleakage at occlusal and gingival
Figure 2: mean microleakage at gingival margin margin

This study was aimed to evaluate the adaptability of showed least microleakage when compared to RMGIC.
new novel restorative material Nano‑ionomer with Good sealing ability of Nano‑ionomer may be related
resin‑modified glass ionomer, Zirconomer, Giomer to to high filler loading and lower coefficient of thermal
tooth surface by measuring the degree of microleakage expansion which compensate the polymerization
at gingival and occlusal restorative margins of Class V contraction stresses.[15] A study by Gupta et al.[16] also in
cavities and compare the same among the groups accordance to our study results, says that Nano‑ionomer
using Stereomicroscopic study. Microleakage studies shows less microleakage compared to conventional glass
use dyes, radioactive isotopes, air pressure, bacterial ionomers and resin‑modified glass ionomer. The higher
activity, neutron activation analysis, scanning electron mean value scores of RMGIC and Zirconomer compared
microscope, dye penetration, and micro‑computed
to Nano‑ionomer may be due to the reason that primer
tomography all come with both advantages and
was not used with them, while Nano‑ionomer gets the
drawbacks. The dye penetration study of microleakage
benefits of using primer which helps to wet the tooth
using colored agents is the most commonly used
surface adequately and modify the smear layer to
technique. The dye penetration assay has many
facilitate adhesion of the material to the hard tissue.
advantages over other techniques. First, no reactive
chemicals are used along with any radiation. Second, the In our study, RMGIC had higher microleakage score than
technique is highly feasible and easily reproducible,[11] Nano‑ionomer although it is also a type resin‑modified
notably, the most commonly used solutions are 0.5% GIC with nanoparticles may be due to the immediate
basic fuchsin, 2% methylene blue, and 50% silver postrestorative finishing/polishing procedure which was
nitrate.[12] Dye penetration assay was the technique used employed in our study according to the manufacturer’s
in this study. Methylene blue was used as the dye in our instruction. It has been reported by Yap and Mok[17]
study, since it can diffuse easily through the interface, that in addition to increasing the surface roughness,
easily detectable and it is not absorbed by dentinal immediate finishing/polishing compromise the marginal
matrix hydroxyapatite crystals. As its having a lower seal of RMGIC to cavity walls.
molecular weight, it has high penetrability and penetrates
the voids better than isotopes.[13] In this study, we were The microleakage score of Zirconomer indicated that
using the stereomicroscope as an aid to evaluate the true it has lesser microleakage score than Giomer but more
extent of dye leakage. than RMGIC and Nano‑ionomer. These findings were
according to the results obtained in a study by Patel
In this study, almost all the tested restorative materials et al.,[8] who found almost similar outcomes when they
show microleakage to some extent. Gladys et al.[4] tested the dye penetration of Zirconomer in human
suggested that microleakage can be expected with all molar teeth. This could be explained due to the fact that
the restorative materials developed and used till date. the chemical structure of Zirconomer which comprises
According to the results of the present study, we ceramic particles (zirconia) as fillers. It is possible
found that the least microleakage occurred around the that the zirconia fillers would cause interference in the
Nano‑Ionomer group and the maximum microleakage chelating reaction between the calcium ions (Ca2+)
was seen in Giomer group. of hydroxyapatite and carboxylic group (−COOH) of
Results of the present study go in a good agreement with polyacrylic acid, another possible explanation may be the
the previous study by Abd El Halim and Zaki[14] who bigger size of the filler particle in Zirconomer prevents
observed that under in vitro conditions Nano‑ionomer proper adaptation of this material to the tooth structure.

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Salman, et al.: Microleakage of nanoionomer

The giomer showed maximum microleakage, which material, it can be a good choice of restorative material
was in accordance with the study by Deliperi et al.[18] for Class V cavities.
and Yadav et al.[1] A study by Karim et al.[19] said that Financial support and sponsorship
the reason for maximum microleakage may be the high
Nil.
filler content, without bonding of the resin with S‑PRG
filler (surface pre‑reacted glass). Reduced marginal Conflicts of interest
adaptation of giomer in the present in vitro study may There are no conflicts of interest.
also be due to polymerization shrinkage resembling
its typical resin composite like nature. Some authors References
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