UNIVERSIDADE ESTADUAL PAULISTA

“JÚLIO DE MESQUITA FILHO”

Instituto de Ciência e Tecnologia

Campus de São José dos Campos

ORIGINAL ARTICLE DOI: https://doi.org/10.4322/bds.2023.e3925

Braz Dent Sci 2023 July/Sept; 26 (3): e3925

The Eﬀect of Immediate Dentin Sealing on the Marginal Adaptation of Lithium

Disilicate Overlay Restorations using diﬀerent types of luting agents

Efeito do selamento imediato da dentina na adaptação marginal de restaurações overlay de dissilicato de lítio utilizando diferentes

tipos de agentes de cimentação: estudo in vitro

Yousif Hussam YOUSIF1 , Alaa Jawad KADHIM1 

1 - University of Baghdad, College of Dentistry, Department of Restorative and Aesthetic Dentistry, Baghdad, Iraq.

How to cite: Yousif YH, Kadhim AJ. The Effect of Immediate Dentin Sealing on the Marginal Adaptation of Lithium Disilicate Overlay

Restorations using different types of luting agents. Braz Dent Sci. 2023;26(3):e3925. https://doi.org/10.4322/bds.2023.e3925

ABSTRACT

Objective: This study evaluated the effect of immediate dentin sealing on the marginal adaptation of lithium disilicate overlays

with three different types of resin-luting agents: preheated composite, dual-cure adhesive resin, and owable composite.

Materials and Methods: Forty-eight maxillary rst premolars of similar size were prepared with a butt joint preparation design.

The teeth were separated into two primary groups, each with twenty-four teeth: Group DDS: Delay dentin sealing (non-IDS) teeth were

not treated. Group IDS: dentin sealing was applied immediately after teeth preparation. Each group was subsequently separated into

three separate subgroups. Subgroups (DDS+Phc, IDS+Phc): cemented with preheated composite (Enamel plus HRi, Micerium, Italy),

Subgroups (DDS+Dcrs, IDS+Dcrs): cemented with dual-cured resin cement (RelyX Ultimate, 3M ESPE, Germany) and Subgroups

(DDS+Fc, IDS+Fc): Cemented with owable composite (Filtek supreme owable, 3M ESPE, USA). Using a digital microscope

with a magnication of 230x, the marginal gap was measured before and after cementation at four different locations from each

surface of the tooth, and the mean of measurements was calculated and analyzed statistically using the independent t-test, one-way

ANOVA test, Bonferroni correction at a signicance level of 0.05. Results: The samples that were immediately sealed with dentin

bonding agent showed lower marginal gaps than delayed dentin sealing, both pre-and post-cementation for all subgroups, with a

statistically signicant difference (p˂0.01). The marginal gap was signicantly lower in the IDS+Fc (48.888 ±5.5 μm) followed by

the IDS+Dcrs group (53.612 ±5.8 μm) and IDS+Phc (79.19 9±6.9 μm) respectively, while the largest marginal gaps were observed

in the DDS+Phc group (86.505 ±5.4 μm). Conclusion: Generally, the teeth with IDS showed better marginal adaptation than teeth

without IDS. The marginal gap was smaller with owable composite and dual-cure resin cement than with preheated composite.

KEYWORDS

CAD-CAM; Cementation; Dental marginal adaptation; Dental Porcelain; Resin cement.

RESUMO

Objetivo: Esse estudo avaliou o efeito do selamento imediato da dentina na adaptação marginal de overlays em dissilicato de lítio

com três tipos diferentes de agentes de cimentação resinosos: resina composta pré-aquecida, adesivo resinoso dual e resina uida.

Materiais e métodos: Quarenta e oito primeiros pré-molares maxilares com tamanho similar foram preparados com término em ombro.

O dente foi separado em dois grupos primários, cada um com vinte e quatro dentes: Grupo DDS: retardado selamento da dentina (non-IDS)

dente não foi tratado. Grupo IDS: selamento dentinário foi aplicado imediatamente após a preparação do dente. Cada grupo foi separado de

modo subsequente em três subgrupos. Subgrupo (DDS+Phc, IDS+Phc): cimentado com resina pré-aquecida (Enamel plus HRi, Micerium, Italy),

Subgrupo (DDS+Dcrs, IDS+Dcrs): cimentado com cimento resinoso dual (RelyX Ultimate, 3M ESPE, Germany) e Subgrupo (DDS+Fc, IDS+Fc):

cimentado com resina uida (Filtek supreme owable, 3M ESPE, USA). Usando um microscópio digital com magnicação de 230x, o gap

marginal foi medido antes e após a cimentação em quatro diferentes localizações de cada superfície do dente e a média das medidas foi

calculada e estatisticamente analisada através do uso do teste ANOVA um-fator e teste independente de Tukey e correção Bonferroni com

nível de signicância de 0,05. Resultado: As amostras que foram imediatamente seladas com agente adesivo dentinário apresentaram

menores gaps marginais do que o selamento dentinário retardado, ambos pré e pós cimentação para todos os subgrupos apresentaram

diferença estatística signicante (p˂0.01). O gap marginal foi signicativamente menor para IDS+Fc (48.888 ±5.5 μm) acompanhado

do IDS+Dcrs group (53.612 ±5.8 μm) e IDS+Phc (79.19 9±6.9 μm) respectividamente, enquanto o maior gap marginal foi observado

no grupo DDS+Phc (86.505 ±5.4 μm). Conclusão: Geralmente, o dente com IDS apresentou melhor adaptação marginal do que o dente

sem IDS. O gap marginal foi menor com resina uida e cimento resinoso dual do que com a resina composta pré-aquecida.

PALAVRAS-CHAVE

CAD-CAM; Cimentação; Adaptação dental marginal; Porcelana dental; Cimento resinoso.

Braz Dent Sci 2023 July/Sept; 26 (3): e3925

Yousif YH et al.

Effect of immediate dentin sealing on the marginal adaptation of lithium disilicate overlay restorations using different types of luting agents: an in vitro study

Yousif YH et al. Eﬀect of immediate dentin sealing on the marginal adaptation

of lithium disilicate overlay restorations using diﬀerent types

of luting agents: an in vitro study

INTRODUCTION

Indirect restorations are critical since improper

marginal adaptation leads to microleakage,

cement dissolution, caries, and gingivitis [1].

It has been proposed that the sealing of the recently

exposed dentin with a dentin-bonding agent

before impression-taking [2,3], can decrease

postoperative sensitivity, microleakage, and resist

mechanical loading while improving the adhesion

of indirect restorations by the enhanced marginal

adaptation between dentin and the restoration

and reducing the cement space thickness [4,5], by

making preparations with smoother surfaces and

rounded angles [6,7]. This procedure is identied

as immediate dentin sealing (IDS) [8]. However,

Duarte et al. [9] showed that microleakage was

not reduced, even with IDS. On the other hand,

many studies have demonstrated that when

IDS is applied, the interface showed less gap

formation [10,11]. As well as one of the factors

that affect the durability of restorations is the

luting material. These luting agents differ by

degree of conversion, linear shrinkage and color

stability, wear resistance, strength, convenience,

thickness, and ability to flow [12]. In recent

years, preheated and owable composite resin

has been a popular luting material because of

its simplicity and ease of clinical manipulation.

Therefore, the selection of bonding cement has

been an essential aspect for the success of the

restoration with the development of restorative

materials such as lithium-disilicate becoming an

interesting alternative restorative material in

most clinical situations [13]. The benets of IDS

with lithium-disilicate restoring material, when

specic current composite resin materials are

used as a luting, have not been studied much

with its effects on marginal adaptation.

Therefore, the objective of the study was

to estimate the effect of IDS with various

luting agents (preheated composite, dual-cure

adhesive resin, and flowable composite) on

marginal adaptation. The null hypothesis was

that the different luting agents with IDS would

not affect the marginal adaptation of lithium-

disilicate overlay.

MATERIALS AND METHODS

The Research Ethics Committee of the

College of Dentistry, the University of Baghdad

approved this in -vitro study (No. 509522/509).

Forty-eight intact maxillary 1st premolars of

similar size, extracted for orthodontic reasons, were

collected from patients aged 18–22 years [14]. The

butt joint preparation design was used to prepare

the teeth for indirect overlay restoration [7,15].

Occlusal reduction and proximal reduction were

done in two stages of preparation and following the

anatomy of the tooth. The teeth had their occlusal

reduction by 1.5 mm by utilizing a trapezoid bur

(barrel-shaped) (811 314 033, Komet, Germany).

A tapered, rounded edge, depth marking diamond

ssure burs with a at end (845 KRD 314 025,

Komet, Germany) was positioned parallel to the

tooth long axis to create a slot of 1 mm depth

for the interproximal reduction. Connecting the

occlusal preparation with proximal slot boxes

by using extra ne ame bur (856EF 314 012,

Komet, Germany) produces a continuous smooth

round shoulder nishing line with rounded angles

(Figure 1).

This resulted in a round-shoulder nishing

line with an interproximal box 1.5 mm wide and

round internal angles (Figure 2).

The IDS protocol was associated with a

three-step etch-and-rinse system [2], started with

dentinal etching with 37% phosphoric acid gel

(Kerr, Italy) for 15 s, rinsing for 20 s, and air drying for

3 s. A primer was applied (OptiBond FL, Kerr, Italy)

twice, and air dried for 5 s. The adhesive resin was

coated (OptiBond FL, Kerr, Italy) with brushing

motion for 15 s, but no air thinning, and light curing

for 15 s [16] (Figure 3). Then it was once more

cured for 40 s, after of the glycerin gel application

was performed (DeOx, oxygen barrier solution,

ultradent, USA).

Two major groups of twenty-four teeth

each were created from the prepared teeth:

Group DDS: Not sealed immediately with dentin

bonding agents but submitted to scanning

followed by provisional restoration. Group IDS:

Dentin sealing was applied immediately after

teeth preparation, followed by scanning and

provisional restoration placement.

By using CAD/CAM technology [17], the

Intra-Oral Scanner (Medit I700, Korea) was then

used to scan the prepared teeth as it produces the

highest trueness and precision [18].

For IDS samples, to prevent adherences with

a bonding agent when using temporary light-cure

material (Revotek LC, GC, Tokyo, Japan), petroleum

jelly (Vaseline, Unilever, Fabricado na, India) was used

to isolate the IDS before the provisionalization [16].

Braz Dent Sci 2023 July/Sept; 26 (3): e3925

Yousif YH et al.

Effect of immediate dentin sealing on the marginal adaptation of lithium disilicate overlay restorations using different types of luting agents: an in vitro study

Yousif YH et al. Eﬀect of immediate dentin sealing on the marginal adaptation

of lithium disilicate overlay restorations using diﬀerent types

of luting agents: an in vitro study

Figure 1 - Overlay preparation: (A) Planar occlusal reduction with Barrelled-shaped trapezoid bur, (B, C) slots preparation with tapered, rounded edge,

depth marking diamond ﬁssure bur (D) Connecting the occlusal preparation with proximal slot boxes by using extra ﬁne ﬂame bur.

Figure 2 - Occlusal and proximal view of the ﬁnished prepared tooth.

Figure 3 - Immediate dentin sealing procedure: (A) Freshly cut dentin, (B) Application of phosphoric acid etchant gel, (C) water rinsing, (D) Air drying,

(E) Application of primer, (F) Application of adhesive resin, (G) Light curing, (H) resin coat (IDS).

Braz Dent Sci 2023 July/Sept; 26 (3): e3925

Yousif YH et al.

Effect of immediate dentin sealing on the marginal adaptation of lithium disilicate overlay restorations using different types of luting agents: an in vitro study

Yousif YH et al. Eﬀect of immediate dentin sealing on the marginal adaptation

of lithium disilicate overlay restorations using diﬀerent types

of luting agents: an in vitro study

The samples were then preserved in artificial

saliva at 37°C for two weeks while waiting for the

laboratory procedures to be done.

Sirona InLab CAD (20.0 software) and InLab

MC XL milling unit were used to design and

create the overlay restorations [19]. The overlay

restorations fabricated from lithium disilicate blocks

(IPS e.max CAD, Ivoclar Vivadent, Liechtenstein)

were milled out using extra-ne milling mode [20].

Subsequently, the glazing paste (IPS e.max CAD

paste; Ivoclar Vivadent, Liechtenstein) was red

on overlay, using the Programat P500 furnace

(Ivoclar, Germany) at 840°C, for 20 min.

A specially designed specimen-holding

device was then used to set each restoration on its

corresponding tooth while maintaining it below a

typical xed load of 5 kg [21]. Following that, the

marginal gap was measured with Image J software

(Image J 1.53K, National Institutes of Health,

Bethesda, USA) utilizing the digital microscope

(Dino-Lite Pro; AnMo Electronics Corp., New

Taipei, Taiwan) at a magnication of 230X at four

locations on each surface. The pre-cementation

gap was calculated using the mean of all sixteen

readings obtained from each one of the samples.

Following that, each group was separated into

three smaller groups, each with eight teeth, in line

with the cementation procedure used: Subgroups

(DDS+Phc, IDS+Phc): cemented with preheated

composite (Enamel plus HRi, Dentin shade UD1,

by Micerium, Italy), Subgroups (DDS+Dcrs,

IDS+Dcrs): cemented with Dual-cure resin

cement (RelyX Ultimate, 3M ESPE, Germany) and

Subgroups (DDS+Fc, IDS+Fc): Cemented with

owable composite (Filtek supreme owable,

3M ESPE, USA).

The internal part restorations were treated

by using Hydrofluoric acid (> 5%; Ivoclar

Vivadent, Liechtenstein) for 20 s., then rinsed

for 15 s with water, after that cleaning off

etching remnants in an ultrasonic cleaning

bath with 90% alcohol for 5 minutes before

silane application. Silanization was done using

One bottle (prehydrolyzed porcelain primer,

BISCO, USA) to the inner surface for 20 seconds

followed by heat treatment. A hairdryer for

2 minutes at 100oC/212oF was used [22].

As the heat treatment will signicantly enhance

the effect of the silane [23-25]. The restoration

looks dull/matte again after the saline is applied

and dried (Figure 4).

Figure 4 - Conditioning of ceramic restorations: (A) Final check of restoration, (B) Application of etching gel on the internal surface of indirect

overlay restoration, (C) Application of ceramic primer using a brush applicator, (D) Air blow and hairdryer.

Braz Dent Sci 2023 July/Sept; 26 (3): e3925

Yousif YH et al.

Effect of immediate dentin sealing on the marginal adaptation of lithium disilicate overlay restorations using different types of luting agents: an in vitro study

Yousif YH et al. Eﬀect of immediate dentin sealing on the marginal adaptation

of lithium disilicate overlay restorations using diﬀerent types

of luting agents: an in vitro study

The filled adhesive (OptiBond FL) forms

a consistent resin coating (IDS) on overlay

preparation and was cleansed and reactivated

after the preservation period (two weeks) by

(50 μm) aluminum oxide airborne particle for 5 s

at 15 mm and 2 bar using an airborne-particle

abrasion device (Aqua care, UK) mounted on a

dental surveyor [16,26]. All groups had their

surfaces treated for 30 s with 37% phosphoric

acid (Kerr, Italy), which was then thoroughly

rinsed off for 20 s and dried with an air jet for

3 s. Primer was applied using a soft brush motion

for 15 s, then it was air-dried for 5 s (No prime

was applied to the IDS group). After that, lightly

brushed with the adhesive resin for 15 s, but the

adhesive resin did not polymerize (Figure 5).

For cementation: subgroups (DDS+Phc,

IDS+Phc), micro-hybrid composite (Enamel

plus HRi, Dentin shade UD1, by Micerium, Italy)

were allowed to be preheated in a composite

heater (Ena Heat Micerium, Italy) 68oC/ for

15 min [12].

For subgroups (DDS+Dcrs, IDS+Dcrs), the

resin cement (RelyXTM Ultimate, 3M ESPE, USA)

base and catalyst pastes were blended into a

homogenous paste using a spatula in less than

20 seconds.

For subgroups (DDS+Fc, IDS+Fc), Flowable

composite (Filtek supreme; 3M ESPE, USA) was

introduced directly onto the tting surface of the

restoration.

Figure 5 - Conditioning of the tooth surface: (A) Sand blasting at a distance of 1.5 cm. (B) Application of phosphoric acid etchant gel, (C) water rinsing,

(D) Air drying, (E) Application of primer for DDS group, (F) Application of adhesive agent.

Braz Dent Sci 2023 July/Sept; 26 (3): e3925

Yousif YH et al.

Effect of immediate dentin sealing on the marginal adaptation of lithium disilicate overlay restorations using different types of luting agents: an in vitro study

Yousif YH et al. Eﬀect of immediate dentin sealing on the marginal adaptation

of lithium disilicate overlay restorations using diﬀerent types

of luting agents: an in vitro study

The restorations were slowly seated by

applying nger pressure further down until complete

insertion [27]. The sample was then xed to the

horizontal table of the custom-made holding device.

A thin rubber material was placed at the end of the

vertical arm to distribute the applied load equally

within the occlusal surface of overlay restoration.

The holding device was used for the nal seating

by applying a load of 5 kg (Approximately 50 N) on

the seated restoration to simulate the biting forces

created by the jaw [21,28].

The restorations were light-polymerized for

20 s, from occlusal, buccal, and lingual surfaces.

Air blocking by placing glycerine gel (ultradent, USA)

over the margins and polymerizing for 10 seconds

per surface, then rinsed and drying (Figure 6).

The subsequent procedures were followed

exactly as explained before, and the post-cementation

marginal gap was determined at the same pre-

cementation measurement locations (Figure 7).

The results were then analyzed statistically using

an independent t-test, one-way ANOVA test, and

Bonferroni correction at a signicant level of 0.05.

RESULTS

As shown in Tables I and II, the IDS groups

recorded a better marginal gap than the DDS groups,

both pre-and post-cementation for all subgroups,

with a statistically signicant difference (p˂0.01).

The IDS+Fc and IDS+Dcrs groups demonstrated

the best marginal adaptation (48.888 ±5.5 μm,

53.612 ±5.8 μm, respectively), and no signicant

difference between them (p˂0.01), while the largest

marginal gaps were observed in the DDS+Phc

group (86.505 ±5.4 μm).

Figure 6 - Cementation of the restoration: (A) Removing the excess material with explorer, (B) Seating the restoration under the load of 5K,

(C) Removing the last excess with micro brush, (D) Light curing under the load, (E, F) Application of air blocking material and last light curing.

Braz Dent Sci 2023 July/Sept; 26 (3): e3925

Yousif YH et al.

Effect of immediate dentin sealing on the marginal adaptation of lithium disilicate overlay restorations using different types of luting agents: an in vitro study

Yousif YH et al. Eﬀect of immediate dentin sealing on the marginal adaptation

of lithium disilicate overlay restorations using diﬀerent types

of luting agents: an in vitro study

Figure 7 - Digital microscopic image of the pre-and post-cementation marginal gap: (A) cemented with preheated composite, (B) cemented

with dual-cure resin, (C) cemented with ﬂowable composite.

Table I - The mean marginal gap pre- and post-cementation using analysis of variance, independent t-test, and one-way ANOVA test at a

signiﬁcance level of 0.05

Mean (μm) ± SD Pre-cementation Independent t-test/p-value

DDS+Pc 49.762 ±4.5 IDS+Pc 35.740 ±4.7 0.000

DDS+Dcrs 48.335 ±5 IDS+Dcrs 35.917 ±5.2 0.000

DDS+Fc 49.179 ±3.5 IDS+Fc 34.758 ±5.7 0.000

One-way ANOVA 0.813 0.894

Mean (μm) ± SD Post-cementation

DDS+Pc 86.505 ±5.4 IDS+Pc 79.19 9±6.9 0.034

DDS+Dcrs 60.297 ±6.2 IDS+Dcrs 53.612 ±5.8 0.043

DDS+Fc 58.982 ±4.7 IDS+Fc 48.888 ±5.5 0.000

One-way ANOVA 0.000 0.000

Braz Dent Sci 2023 July/Sept; 26 (3): e3925

Yousif YH et al.

Effect of immediate dentin sealing on the marginal adaptation of lithium disilicate overlay restorations using different types of luting agents: an in vitro study

Yousif YH et al. Eﬀect of immediate dentin sealing on the marginal adaptation

of lithium disilicate overlay restorations using diﬀerent types

of luting agents: an in vitro study

DISCUSSION

The physicomechanical characteristics of the

restoration and its luting cement have an impact

on how long indirect restorations last [29], as well

as, one of the most essential aspects is marginal

adaptation, since it affects their durability [30,31].

Marginal errors can produce recurrent caries,

deterioration of the luting cement, microleakage,

and restoration failure [32]. The majority of

studies showed a marginal gap clinically accepted

when it fell within a range of less than 120 μm [1].

Other studies suggest that CAD/CAM all-ceramic

onlays may be situated between 80-85 μm [33,34]

The design of the cavity, the type of adhesive

employed, the thickness of cement, the methods

used to treat the dentin surface before the

cementation of the nal restoration, and forces

acting on the tooth-restorative interfaces all have

a signicant impact on the adaptation of indirect

restorations [35].

The results presented that the gaps between

all subgroups were less than the clinically

accepted value. This might be attributed to the

simple preparation design used in this study

(butt joint), including flat smooth occlusal

reduction, no retentive features, and fewer

internal angles [36]. Such features allow for a

better ow of cement during cementation and

do not cause hydraulic pressure or problematic

discharge of excess cement [1,36,37]. As a result,

the best mechanical behavior and adaptation

compared to other preparation designs [13].

The IDS procedure was established in the

direction to overcome the problems affecting the

adaptation of restoration as shown in this study,

before and after cementation (regardless of cement

type), for both group types (IDS or DDS), there was

a statistically signicant difference between them.

The samples that were sealed immediately with

dentin bonding agent showed lower marginal gaps

than delayed dentin sealing. Before cementation,

IDS may smoothen the cavity surfaces and round

angles, creating better geometry [38], These are

essential for achieving effective adaption of ceramic

restoration due to the designs of the burs used to

mill the wax molding disc or ceramic block [39].

IDS with round angles and smoother surfaces

are preferred for optical scanning and laboratory

work and affects the thickness of the resin cement

layer by improving restoration adaption compared

to a cavity without IDS application [6,40]. After

cementation, it was possible that covering the dentin

with a hydrophobic monomer or a low-viscosity

composite may have aided in the improvement of

marginal adaptation by absorbing the developing

polymerization shrinkage of the cement [41,42].

This result supports that the IDS produces less

discrepancy in the vertical marginal gap.

Ashy et al. [43] found that Luted ceramic

inlays had a better marginal adaptation

immediately after cementation using IDS

compared with using DDS. Medina et al. [30]

assessed the effect of various materials used with

the resin coating technique and found an efcient

alternative method to maintain the marginal

adaptation and improve the bond strength of

indirect composite resin restorations by first

sealing the dentin with the adhesive system,

then applying it again right before cementation.

Table II - Multiple inter-group comparisons of the marginal adaptation using post hoc (Bonferroni correction) test

groups Subgroups Subgroups Mean Diﬀerence

DDS

DDS+Pc DDS+Dcrs 26.207 0.000

DDS+Fc 27.522 0.000

DDS+Dcrs DDS+Pc -26.207 0.000

DDS+Fc 1.315 1.000

DDS+Fc DDS+Pc -27.522 0.000

DDS+Dcrs -1.315 1.000

IDS

IDS+Pc IDS+Dcrs 25.587 0.000

IDS+Fc 30.311 0.000

IDS+Dcrs IDS+Pc -25.587 0.000

IDS+Fc 4.723 0.413

IDS+Fc IDS+Pc -30.311 0.000

IDS+Dcrs -4.723 0.413

Braz Dent Sci 2023 July/Sept; 26 (3): e3925

Yousif YH et al.

Effect of immediate dentin sealing on the marginal adaptation of lithium disilicate overlay restorations using different types of luting agents: an in vitro study

Yousif YH et al. Eﬀect of immediate dentin sealing on the marginal adaptation

of lithium disilicate overlay restorations using diﬀerent types

of luting agents: an in vitro study

Following cementation, the marginal gap

increased in both group types that were cemented

with three different types of cement. This result is

consistent with the earlier studies, which showed

that the cementation procedure increased the

marginal gap [1,44].

Regarding the type of luting material, the

samples were sealed immediately with a dentin

bonding agent and cemented with three types

of luting agents showed less marginal gap than

delayed dentin sealing as in pre-cementation,

with a statistically signicant difference between

them. This might be due to the IDS group getting

less pre-cementation marginal gap compared to

the DDS group. Furthermore, composite resin

usually shrinks toward the surfaces to which

they are bonded [45]. Unlike inlay, shrinkage

pulls the overlay restoration along the axis of the

tooth to the preparation [12]. The developing

polymerization shrinkage of the cement was

absorbed by the layer of hydrophobic monomer

(IDS) that covers the dentin which improves

marginal adaptation [41].

Regarding to the three luting agents, the

restoration cemented with preheated composite

displayed a higher marginal gap with statistical

differences than resin cement and flowable

composite material. This might be associated

with the change in film thickness of luting

materials since the preheated composite showed

a higher marginal gap after cementation as

compared with resin cement and flowable

composite, which could be correlated to a high

lm thickness of the preheated composite that

produced an increase in marginal discrepancies

in the nal restoration seating.

The thickness of the dental cement layer

along the preparation walls determines the

gap size, and this layer also affects how the

restoration will be seated [46], As lm thickness

decreases, the tness of restoration increases [47].

Sampaio et al. [48] investigated the luting agents

with varying film thickness. They found, no

matter whether they were preheated or not, that

the restorative composite resin lm thickness was

higher than that of the owable composite resins

and the veneer cement.

Blalock et al. [49] stated that regardless of

heating temperature, the conventional composite had

a lm thickness superior to that of owable composite

resins that could be used at room temperature

(at 54oC, 140 μm, and 35 μm respectively).

A study estimated the effect of the ller shape and

viscosity of luting resin on a marginal gap and

showed that the higher composites viscosity used

for cementation of ceramic partial restoration

would increases displacement and marginal

inaccuracy [50]

Furthermore, by evaluating and comparing the

lm thickness of resin cement and two composite

resins (preheated and/or ultrasonically vibrated).

The study found resin cement had the lowest lm

thickness, and preheating and ultrasonic vibration

reduced the lm thickness of composites, but vary

between composites type, and not all could be

reduced below 50 μm [51].

The dual-cure (relyX ultimate) resin cement

showed a slight increase in the marginal gap

over (Filtek supreme) owable composite with

no signicant differences found between them.

Mounajjed et al. [44] considered the marginal

adaptation of lithium disilicate pressed crowns

with a different cement: preheated composite

resin, Resin cement, and Flowable composite

resin. They found that heated composite showed

the maximum marginal gap with a significant

difference between resin cement and owable

composite, and no signicant difference between

the latter two types of cement. Alajrash and

Kassim [52] identify the outcome of various

resin cement on the marginal gap using Emax,

CAD/CAM crowns. They found that the preheated

composite had a higher degree of marginal gap

than the owable composite and resin cement.

Nevertheless, the limitation of this study

is the evaluation of the marginal gap without

reproduction of the oral situation. Therefore,

coming research should focus on the thermocycling

technique. Different restorative materials and novel

reinforcing materials (Fiber reinforced composite,

and ribbons) have been used as a bio-base to

improve the fracture strength may affect the seating

of restoration and produce marginal inaccuracy.

CONCLUSION

Within the limitations of the study, teeth

treated with Immediate Dentin Sealing exhibited

better marginal adaptation compared to teeth

without IDS. When flowable composite and

dual cure cement were used as luting materials,

they demonstrated the most substantial

improvement in overall marginal adaptation,

followed by preheated composite, respectively.

Braz Dent Sci 2023 July/Sept; 26 (3): e3925

Yousif YH et al.

Effect of immediate dentin sealing on the marginal adaptation of lithium disilicate overlay restorations using different types of luting agents: an in vitro study

Yousif YH et al. Eﬀect of immediate dentin sealing on the marginal adaptation

of lithium disilicate overlay restorations using diﬀerent types

of luting agents: an in vitro study

However, it is important to note that the results of

the study showed that the marginal gaps of all luting

agents were within the clinically acceptable limit.

Author’s Contributions

YHY: Conception, design, data acquisition,

and interpretation, drafted and critically

revised the manuscript, and performed all

statistical analyses. AJK: Conception, design,

data acquisition, and interpretation, drafted and

critically revised the manuscript. All authors gave

their nal approval and agree to be accountable

for all aspects of the work.

Conict of Interest

No conicts of interest declared concerning

the publication of this article.

Funding

The authors declare that no nancial support

was received.

Regulatory Statement

This study was conducted in accordance with

all the provisions of the local human subjects

oversight committee guidelines and policies

of: The College of Dentistry, the University of

Baghdad. The approval code for this study is:

509522/509.

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Effect of immediate dentin sealing on the marginal adaptation of lithium disilicate overlay restorations using different types of luting agents: an in vitro study

Yousif YH et al. Eﬀect of immediate dentin sealing on the marginal adaptation

of lithium disilicate overlay restorations using diﬀerent types

of luting agents: an in vitro study

Yousif Hussam YOUSIF

(Corresponding address)

University of Baghdad, College of Dentistry, Department of Restorative and

Aesthetic Dentistry, Baghdad, Iraq.

Email: youssef.hossam1204a@codental.uobaghdad.edu.iq

Date submitted: 2023 June 11

Accept submission: 2023 July 31

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