An in Vitro Study of Microleakage Comparing Total-Etch with Bonding Resin and Self-Etch Adhesive Luting Cements for All-Ceramic Crowns

Abstract

Aim: The aim of the study was to assess the dye leakage present following cementation of all-ceramic crowns with 7 currently used cements to compare total-etch (TE) with dentine bonding agent (DBA) and self-etch (SE) systems. Methods: Forty-two Authentic® crowns were fabricated and cemented onto extracted human teeth using 7 currently available cements (2 two-stage adhesives (TE + DBA): Panavia 21 Kuraray; Paracore, Coltene Whaledent and 5 all-in-one adhesives (SE): MaxCem Kerr; Panavia F2.0 Kuraray; RelyX Unicem 3MEspe; seT SDI). Following storage in water and thermal cycling, the teeth were exposed to dye, sectioned and examined under confocal microscopy. Leakage was determined by two blinded examiners and scoring was carried out on a scale of 0 - 8 per tooth (0 = no leakage, 8 complete leakage across the section). One overall reading was obtained per tooth with 6 teeth per material. Results: The results showed a wide range of scores between the different cements. Only a few specimens which used TE + DBA showed slight marginal leakage: Paracore (mean score 0 ± 0) and Panavia 21 (0.3 ± 0.5). The majority of specimens using SE showed leakage: RelyX Unicem (0.8 ± 0.8), SmartCem (1.7 ± 2.1), MaxCem (3.2 ± 1.7), Panavia F2.0 (4.5 ± 2.4) then seT (5.2 ± 2.5). Statistical analysis was carried out showing that Paracore and Panavia 21 were significantly less prone to leakage than MaxCem, (P = 0.002) and seT (P < 0.001). Conclusion: In conclusion, the choice of luting cement is important in reducing dye leakage. This study strongly favours the use of a TE with separate adhesive system placed prior to the composite luting resin.