Revisiting the Microleakage in Tooth-coloured Sandwich Restorations
Keywords:sandwich technique, tooth-coloured restorative materials, polymerization shrinkage, microleakage
The placement of glass ionomer cement as lining material below composite fillings was introduced by McLean and Wilson in 1977. This technique incorporated different layers of restorative materials placed onto tooth, similar to layers of a sandwich. It was proposed this technique will provide a molecular seal to dentine in addition to mechanical and aesthetic properties of composite resin. Placement of liner or an intermediate layer underneath the main bulk of restorative materials reduces polymerization shrinkage stress and resultant microleakage of the final restoration. To date, dentine adhesion and polymerization shrinkage are limitations of resin-based restorative materials. At present, wide array of tooth-coloured restorative materials with different formulations is available. Despite advancements in restorative dentistry, no single technique or material is ideal in both clinical effectiveness and simplicity. Clinicians may find themselves in a dilemma when choosing restorative materials and techniques that provide the best clinical results with minimal technique sensitivity or chairside time. The aim of this review is to present existing scientific evidence in microleakage and sandwich technique in restorations, and to discuss multiple approaches in sandwich restorations in effort to reduce microleakage of dental restorations. Clinical recommendations will be given based on evidence from multiple studies.
Mali P, Deshpande S and Singh A. Microleakage of restorative materials: an in vitro study. J Ind Soc Pedod Prev Dent. 2006;24(1):15-18.
Mazumdar P, Das A, Das UK. Comparative evaluation of microleakage of three different direct restorative materials (silver amalgam, glass ionomer cement, Cention N), in class II restorations using stereomicroscope: an in vitro study. Ind J Dent Res. 2019;30(2):277-281.
Malhotra N and Acharya S. Strategies to Overcome Polymerization Shrinkage− Materials and Techniques. A Review. Dent Update. 2010;37(2):115-125.
Mark AM. Amalgam fillings: safe, strong, and affordable. J Am Dent Assoc. 2019;50(10):894.
Patel MU, Punia SK, Bhat S, Singh G, Bhargava R, Goyal P, Oza S and Raiyani CM. An in vitro evaluation of microleakage of posterior teeth restored with amalgam, composite and zirconomer–A stereomicroscopic study. J Clin Diagn Res. 2015;9(7):ZC65-ZC67.
Burke FJ, Wilson NH, Cheung SW and Mjör IA. Influence of patient factors on age of restorations at failure and reasons for their placement and replacement. J Dent. 2001;29(5): 317-324.
McLean JW and Wilson AD. The clinical development of the glass‐ionomer cement. II. Some clinical applications. Aust Dent J. 1997;22(2):120-127.
Mount GJ. Esthetics with glass-ionomer cements and the “sandwich” technique” Quintessence Int. 1990;21(2):93-101.
Suzuki M and Jordan RE. Glass Ionomer–Composite Sandwich Technique. J Am Dent Assoc. 1990;120(1):55-57.
Cho SY and Cheng AC. A review of glass ionomer restorations in the primary dentition. J Can Dent Assoc. 1999;65(9):491-495.
Soares CJ, Rodrigues MD, Vilela AB, Pfeifer CS, Tantbirojn D, Versliuis A. Polymerization shrinkage stress of composite resins and resin cements–What do we need to know?. Braz Oral Res. 2017;31.
Miyazaki M, Tsujimoto A, Tsubota K, Takamizawa T, Kurokawa H and Platt JA. Important compositional characteristics in the clinical use of adhesive systems. J Oral Sci. 2014;56(1):1-9.
Stockton LW and Tsang ST. Microleakage of Class II posterior composite restorations with gingival margins placed entirely within dentin. J Can Dent Assoc. 2007;73(3):255.
Tiba A, Zeller GG, Estrich CG and Hong A. A laboratory evaluation of bulk-fill versus traditional multi-increment–fill resin-based composites. J Am Dental Assoc. 2013;144(10):1182-1183.
Ilie N and Hickel R. Investigations on a methacrylate-based flowable composite based on the SDR™ technology. Dent Mater. 2011;27(4):348-355.
Moazzami SM, Sarabi N, Hajizadeh H, Majidinia S, Li Y, Meharry MR and Shahrokh H. Efficacy of four lining materials in sandwich technique to reduce microleakage in class II composite resin restorations. Oper Dent. 2014;39(3):256-263.
Gupta A, Tavane P, Gupta PK, Tejolatha B, Lakhani AA, Tiwari R, Kashyap S and Garg G. Evaluation of microleakage with total etch, self etch and universal adhesive systems in class V restorations: an in vitro study. J Clin Diagn Res. 2017;11(4):ZC53-ZC56.
Alavi AA and Kianimanesh N. Microleakage of direct and indirect composite restorations with three dentin bonding agents. Oper Dent. 2002;27(1):19-24.
Berry TG and Osborne JW. Dentin bonding vs. enamel bonding of composite restorations: a clinical evaluation. Dent Mater. 1989;5(2):90-92.
Barnes DM, Blank LW, Gingell JC and Gilner PP. A clinical evaluation of a resin-modified: glass ionomer restorative material. J Am Dent Assoc. 1995;126(9):1245-1253.
Gonzalez MAG, Kasim NHA and Aziz RD. Microleakage testing. Annal Dent Univ Malaya. 1997;4(1):31-37.
Tavangar M, Davalloo RT, Darabi F, Karambin M and Kazemi R. A comparative evaluation of microleakage of two low-shrinkage composites with a conventional resin composite: an in vitro assessment. J Dent. 2016;17(1):55-61.
Heintze S, Forjanic M and Cavalleri A. Microleakage of Class II restorations with different tracers-comparison with SEM quantitative analysis. J Adhes Dent. 2008;10(4):259-267.
Andersson‐Wenckert IE, Van Dijken JW and Hörstedt P. Modified Class II open sandwich restorations: evaluation of interfacial adaptation and influence of different restorative techniques. Eur J Oral Sci. 2002;110(3):270-275.
Forss H and Widström E. Reasons for restorative therapy and the longevity of restorations in adults. Acta Odontol Scand. 2004;62(2):82-86.
Fabianelli A, Pollington S, Davidson CL, Cagidiaco MC and Goracci C. The relevance of microleakage studies. Int Dent SA. 2007;9(3):64-74.
Idriss S, Abduljabbar T, Habib C and Omar R. Factors associated with microleakage in Class II resin composite restorations. Oper Dent. 2007;32(1):60-66.
Olmez A, Oztas N and Bodur H. The effect of flowable resin composite on microleakage and internal voids in Class II composite restorations. Oper Dent. 2004;29(6):713-719.
Hilton TJ, Schwartz RS and Ferracane JL. Microleakage of four Class II resin composite insertion techniques at intraoral temperature. Quintessence Int. 1997;28(2):135-144.
Darsan J, Pai VS, Gowda VB, Krishnakumar GR and Nadig RR. Evaluation of gingival microleakage in deep class II closed sandwich composite restoration: An in vitro study. J Clin Diagn Res. 2018;12(1):ZC01-ZC05.
Liebenberg W. Return to the resin-modified glass-ionomer cement sandwich technique. Br Dent J. 2006;200(5):297-297.
Perdigão J. Current perspectives on dental adhesion:(1) Dentin adhesion–not there yet. Jpn Dent Sci Rev. 2020;56:190-207
Forsten L. Clinical experience with glass ionomer for proximal fillings. Acta Odontol Scand. 1993;51(4):195-200.
Knibbs PJ. The clinical performance of a glass polyalkenoate (glass ionomer) cement used in a sandwich technique with a composite resin to restore Class II cavities. Br Dent J. 1992;172(3):103-107.
Fabianelli A, Sgarr A, Goracci C, Cantoro A, Pollington S and Ferrari M. Microleakage in class II restorations: open vs closed centripetal build-up technique. Oper Dent. 2010;35(3):308-313.
Paula AM, Boing TF, Wambier LM, Hanzen TA, Loguercio AD, Armas-Vega A and Reis A. Clinical Performance of Non-Carious Cervical Restorations Restored with the “Sandwich Technique" and Composite Resin: A Systematic Review and Meta-analysis. J Adhes Dent. 2019;21(6):497-508.
Potin-Gautier M, Dupuis V, Castetbon A and Moya F. Solubility and disintegration of a glass ionomer cement. Chem Speciat Bioavailab. 1997;9(3):95-99.
Fukazawa M, Matsuya S and Yamane M. Mechanism for erosion of glass-ionomer cements in an acidic buffer solution. J Dent Rest. 1987;66(12):1770-1774.
Dietschi D and Spreafico R. Current clinical concepts for adhesive cementation of tooth-colored posterior restorations. Pract Periodontics Aesthet Dent. 1998;10(1):47-54.
Roggendorf MJ, Krämer N, Dippold C, Vosen VE, Naumann M, Jablonski-Momeni A and Frankenberger R. Effect of proximal box elevation with resin composite on marginal quality of resin composite inlays in vitro. J Dent. 2012;40(12):1068-1073.
Frankenberger R, Hehn J, Hajtó J, Krämer N, Naumann M, Koch A and Roggendorf MJ. Effect of proximal box elevation with resin composite on marginal quality of ceramic inlays in vitro. Clin Oral Invest. 2013;17(1):177-183.
Bresser RA, Gerdolle D, van den Heijkant IA, Sluiter-Pouwels LM, Cune MS and Gresnigt MM. Up to 12 years clinical evaluation of 197 partial indirect restorations with deep margin elevation in the posterior region. J Dent. 2019;91:103227.
Lohbauer U. Dental glass ionomer cements as permanent filling materials?–properties, limitations and future trends. Mater. 2010;3(1):76-96.
Powis DR, Follerås T, Merson SA and Wilson AD. Improved adhesion of a glass ionomer cement to dentin and enamel. J Dent Res. 1982;61(12):1416–1422.
Mazaheri R, Pishevar L, Shichani AV and Geravandi S. Effect of different cavity conditioners on microleakage of glass ionomer cement with a high viscosity in primary teeth. Dent Res J. 2015;12(4):337-341.
El-Askary FS and Nassif MS. The effect of the pre-conditioning step on the shear bond strength of nano-filled resin-modified glass-ionomer to dentin. Eur J Dent. 2011;5:150–156.
Sauro S, Faus-Matoses V, Makeeva I, Nuñez Martí JM, Gonzalez Martínez R, García Bautista JA and Faus-Llácer V. Effects of polyacrylic acid pre-treatment on bonded-dentine interfaces created with a modern bioactive resin-modified glass ionomer cement and subjected to cycling mechanical stress. Mater. 2018;11(10):1884.
Fourie J and Smit CF. Cervical microleakage in Class II open-sandwich restorations: an in vitro study: scientific. S Afr Dent J. 2011;66(7):320-324.
Hagge MS, Lindemuth JS, Mason JF and Simon JF. Effect of four intermediate layer treatments on microleakage of Class II composite restorations. Gen Dent. 2001;49(5):489-495.
Andersson-Wenckert IE, Van Dijken JW and Kieri C. Durability of extensive Class II open-sandwich restorations with a resin-modified glass ionomer cement after 6 years. Am J Dent. 2004;17(1):43-50.
Sidhu SK. Glass‐ionomer cement restorative materials: a sticky subject? Aust Dent J. 2011;56(1 Suppl):23-30.
Nicholson JW. Maturation processes in glass-ionomer dental cements. Acta Biomater Odontol Scand. 2018;4(1):63-71.
Wilder Jr AD, Swift Jr EJ, May Jr KN, Thompson JY and McDougal RA. Effect of finishing technique on the microleakage and surface texture of resin-modified glass ionomer restorative materials. J Dent. 2000;28(5):367-373.
Rekha CV and Balagopal Varma J. Comparative evaluation of tensile bond strength and microleakage of conventional glass ionomer cement, resin modified glass ionomer cement and compomer: An in vitro study. Contemp Clin Dent. 2012;3(3):282-287.
Toledano M, Osorio E, Osorio R and García-Godoy F. Microleakage of Class V resin-modified glass ionomer and compomer restorations. J Prosthet Dent. 1999;81(5):610-615.
Shruthi AS, Nagaveni NB, Poornima P, Selvamani M, Madhushankari GS and Reddy VS. Comparative evaluation of microleakage of conventional and modifications of glass ionomer cement in primary teeth: An in vitro study. J Indian Soc Pedod Prev Dent. 2015;33(4):279-284.
Gyanani HC, Chhabra N, Shah NC and Jais PS. Microleakage in Sub-Gingival Class II Preparations Restored Using Two Different Liners for Open Sandwich Technique Supplemented With or Without Ultrasonic Agitation: An In Vitro Study. J Clin Diagn Res. 2016;10(3):ZC70-ZC73.
Uno S, Finger WJ and Fritz U. Long-term mechanical characteristics of resin-modified glass ionomer restorative materials. Dent Mater. 1996;12(1):64-69.
Opdam NJ, Bronkhorst EM, Roeters JM and Loomans BA. Longevity and reasons for failure of sandwich and total-etch posterior composite resin restorations. J Adhes Dent. 2007;9(5):469-475.
Powell LV, Gordon GE, Johnson GH. Clinical comparison of Class V resin composite and glass ionomer restorations. Am J Dent. 1992;5(5):249-252.
Feilzer AJ, De Gee AJ and Davidson CL. Setting stress in composite resin in relation to configuration of the restoration. J Dent Res. 1987;66(11):1636-1639.
Baroudi K and Rodrigues JC. Flowable resin composites: a systematic review and clinical considerations. J Clin Diagn Res. 2015;9(6):ZE18-ZE24.
Lokhande NA, Padmai AS, Rathore VP, Shingane S, Jayashankar DN and Sharma U. Effectiveness of flowable resin composite in reducing microleakage–An in vitro study. J Int Oral Health. 2014;6(3):111-114.
Korkmaz Y, Ozel E and Attar N. Effect of flowable composite lining on microleakage and internal voids in Class II composite restorations. J Adhes Dent. 2007;9(2):189-194.
Prati C. Early marginal microleakage in class II resin composite restorations. Dent Mater. 1989;5(6):392-398.
Wibowo G and Stockton L. Microleakage of Class II composite restorations. Am J Dent. 2001;14(3):177-185.
Chuang SF, Jin YT, Lin TS, Chang CH and García-Godoy F. Effects of lining materials on microleakage and internal voids of Class II resin-based composite restorations. Am J Dent. 2003;16(2):84-90.
Ab Malik N, Lin SL, Abd Rahman N and Jamaludin M. Effect of liners on microleakage in class II composite restoration. Sains Malays. 2013;42(1):45-51.
Hervás García A, Lozano M, Cabanes Vila J, Barjau Escribano A and Fos Galve P. Composite resins: a review of the materials and clinical indications. Med Oral Patol Oral Cir Bucal. 2006;11(2):E215-220.
Moldovan M, Balazsi R, Soanca A, Roman A, Sarosi C, Prodan D, Vlassa M, Cojocaru I, Saceleanu V and Cristescu I. Evaluation of the degree of conversion, residual monomers and mechanical properties of some light-cured dental resin composites. Mater. 2019;12(13):2109.
Chitnis D, Dunn WJ and Gonzales DA. Comparison of in-vitro bond strengths between resin-modified glass ionomer, polyacid-modified composite resin, and giomer adhesive systems. Am J Orthod Dentofacial Orthop. 2006;129(3):330.e11-330.e16.
Rizk HM, Al-Ruthea M and Habibullah MA. The effect of three lining materials on microleakage of packable composite resin restorations in young premolars with cavity margins located on enamel and dentin/cementum-An In vitro study. Int J Health Sci. 2018;12(6):8-17.
Dietrich T, Kraemer M, Lösche GM and Roulet JF. Marginal integrity of large compomer Class II restorations with cervical margins in dentine. J Dent. 2000;28(6):399-405.
Yap AU, Tham SY, Zhu LY and Lee HK. Short-term fluoride release from various aesthetic restorative materials. Oper Dent. 2002;27(3):259-265.
Mousavinasab SM and Meyers I. Fluoride release by glass ionomer cements, compomer and giomer. Dent Res J. 2009;6(2):75-81.
Plasse NP, Tran XV and Colon P. Physico-Chemical Properties. Septodont Publ Com. 2010;16-31.
Raju VG, Venumbaka NR, Mungara J, Vijayakumar P, Rajendran S and Elangovan A. Comparative evaluation of shear bond strength and microleakage of tricalcium silicate-based restorative material and radioopaque posterior glass ionomer restorative cement in primary and permanent teeth: an in vitro study. J Indian Soc Pedod Prev Dent. 2014;32(4):304-310.
Raskin A, Eschrich G, Dejou J and About I. In vitro microleakage of Biodentine as a dentin substitute compared to Fuji II LC in cervical lining restorations. J Adhes Dent. 2012;14(6):535-542.
Zhao W, Wang J, Zhai W, Wang Z and Chang J. The self-setting properties and in vitro bioactivity of tricalcium silicate. Biomater. 2005;26:6113-6121.
Camilleri J. Investigation of Biodentine as dentine replacement material. J Dent. 2013;41(7):600-610.
Malkondu Ö, Kazandağ MK, Kazazoğlu E. A review on biodentine, a contemporary dentine replacement and repair material. BioMed Res Int 2014. 2014.
Prati C, Simpson M, Mitchem J, Tao L and Pashley DH. Relationship between bond strength and microleakage measured in the same Class I restorations. Dent Mater. 1992;8(1):37-41.
Kim JH, Park JW, Park JH and Kim SK. Bond strength and microleakage in resin bonding to tooth structure. Rest Dent and Endod. 1999;24(4):570-577.
Sofan E, Sofan A, Palaia G, Tenore G, Romeo U and Migliau G. Classification review of dental adhesive systems: from the IV generation to the universal type. Ann Stomatol. 2017;8(1):1-17.
Arias VG, Campos IT and Pimenta LA. Microleakage study of three adhesive systems. Brazil Dent J. 2004;15(3):194-198.
Karnady JA and Prahasti AE. Comparison of microleakage on Class V composite restoration: Study on total etch, self etch and selective etch technique. Scientific Dent J. 2019;3(2):47-49.
Peumans M, De Munck J, Van Landuyt KL, Poitevin A, Lambrechts P and Van Meerbeek B. Eight-year clinical evaluation of a 2-step self-etch adhesive with and without selective enamel etching. Dent Mater. 2010;26(12):1176-1184.
Van Meerbeek B, Kanumilli P, De Munck J, Van Landuyt K, Lambrechts P and Peumans M. A randomized controlled study evaluating the effectiveness of a two-step self-etch adhesive with and without selective phosphoric-acid etching of enamel. Dent Mater. 2005;21(4):375-383.
Ku SH, Tan YS, Yahya NA. The effect of different dental adhesive systems on hybrid layer qualities. Annal Dent Univ Malaya. 2014;21(1):25-32.
Kermanshah H and Khorsandian H. Comparison of microleakage of Scotchbond™ Universal Adhesive with methacrylate resin in Class V restorations by two methods: Swept source optical coherence tomography and dye penetration. Dent Res J. 2017;14(4):272-281.
Zecin-Deren A, Sokolowski J, Szczesio-Wlodarczyk A, Piwonski I, Lukomska-Szymanska M and Lapinska B. Multi-layer application of self-etch and universal adhesives and the effect on dentin bond strength. Molecules. 2019;24(2):345.
Cuevas-Suarez CE, de Oliveira da Rosa WL, Lund RG, da Silva AF and Piva E. Bonding Performance of Universal Adhesives: An Updated Systematic Review and Meta-Analysis. J Adhes Dent. 2019;21(1):7-26.
Costa DM, Somacal DC, Borges GA and Spohr AM. Bond capability of universal adhesive systems to dentin in self-etch mode after short-term storage and cyclic loading. Open Dent J. 2017;11:276-283.
Giachetti L, Scaminaci Russo D, Bambi C and Grandini R. A review of polymerization shrinkage stress: current techniques for posterior direct resin restorations. J Contemp Dent Pract. 2006;7(4):79-88.
Nadig RR, Bugalia A, Usha G, Karthik J, Rao R and Vedhavathi B. Effect of four different placement techniques on marginal microleakage in Class II composite restorations: An in vitro Study. World J Dent. 2011;2(2):111-116.
Van Ende A, De Munck J, Lise DP and Van Meerbeek B. Bulk-fill composites: a review of the current literature. J Adhes Dent. 2017;19(2):95-109.
Swapna MU, Koshy S, Kumar A, Nanjappa N, Benjamin S and Nainan MT. Comparing marginal microleakage of three Bulk Fill composites in Class II cavities using confocal microscope: An in vitro study. J Conserv Dent. 2015;18(5):409-413.
Moorthy A, Hogg CH, Dowling AH, Grufferty BF, Benetti AR and Fleming GJ. Cuspal deflection and microleakage in premolar teeth restored with bulk-fill flowable resin-based composite base materials. J Dent. 2012;40(6):500-505.
Webber MB, Marin GC, Saram PA, Progiante LF and Marson FC. Bulk-fill resin-based composites: microleakage of class II restorations. J Surg Clin Dent. 2014;2(1):15-19.
Kirilova J, Topalova-Pirinska S and Kirov D. Evaluation of impact of lining application techniques on marginal microleakage in resin-modified glass ionomer cement in class II composite restorations: An in vitro study. J of IMAB. 2019;25(1):2426-2432.
Chuang SF, Jin YT, Liu JK, Chang CH and Shieh DB. Influence of flowable composite lining thickness on Class II composite restorations. Oper Dent. 2004;29(3):301-308.
Reddy SN, Jayashankar DN, Nainan M and Shivanna V. The effect of flowable composite lining thickness with various curing techniques on microleakage in class II composite restorations: an in vitro study. J Contemp Dent Pract. 2013;14(1):56-60.
Moosavi H, Mohammadipour HS and Karamimoghaddam M. Microleakage evaluation of class II composite resin restorations with different thicknesses of resin-modified glass ionomer. J Islam Dent Assoc Iran. 2018;30(3):119-125.
Natasha V and Suprastiwi E. Effect of the thickness of flowable composite as intermediate layer to reduce microleakage on gingival wall. J Phys Conf Ser. 2017;884(1):012018
Borouziniat A, Khaki H and Majidinia S. Retrospective evaluation of the clinical performance of direct composite restorations using the snow-plow technique: Up to 4 years follow-up. J Clin Exp Dent. 2019;11(11):e964-968.
Moosavi H, Maleknejad F, Forghani M and Afshari E. Evaluating resin-dentin bond by Microtensile Bond Strength Test: Effects of various resin composites and placement techniques. Open Dent J. 2015;9(1):409-413.
Patil BS, Kamatagi L, Saojii H, Chabbra N and Mutsaddi S. Cervical microleakage in giomer restorations: An in vitro Study. J Contemp Dent Pract. 2020;21(2):161-165.
Nematollahi H, Bagherian A, Ghazvini K, Esmaily H and Mehr MA. Microbial microleakage assessment of class V cavities restored with different materials and techniques: A laboratory study. Dent Res J. 2017;14(5):344-350.
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