Effect of Two Different Haemostatic Agents on Microleakage in Subgingival Class II Restorations Restored with Flow Bulk-Fill Composite and Universal Restorative Composite by Co-curing Technique: An in vitro Study
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Abstract
Background: Microleakage at subgingival margins is a persistent challenge in composite restorations, particularly when gingival fluid and blood are contaminated. Haemostatic agents such as ferric sulfate and aluminium chloride are frequently used to control bleeding; however, their effects on marginal integrity and bonding remain controversial.
Aim: To evaluate the effect of two different haemostatic agents—aluminium chloride and ferric sulfate—on microleakage in subgingival Class II restorations restored with flow bulk-fill and universal restorative composites using the co-curing technique.
Materials and methods: Forty-five extracted human molars were divided into three groups (n=15 each): Group I: No haemostatic agent (control), Group II: Aluminium chloride (Ultradent Viscostat Clear), and Group III: Ferric sulfate (Ultradent Viscostat). Standardized Class II cavities were prepared 1.5 mm below the CEJ. After applying the respective agents, cavities were restored using a universal adhesive (3M ESPE Single Bond), flow bulk-fill composite (3M ESPE Filtek), and nano-hybrid composite (3M ESPE Filtek Z350 XT) via the co-curing technique. Samples were thermocycled, immersed in 2% methylene blue dye, and evaluated under a stereomicroscope (10×). Data were analysed using the Kruskal–Wallis test and the Mann–Whitney U test.
Results: The control group exhibited the least microleakage, followed by the aluminium chloride group and ferric Sulfate group. Statistically significant differences (p < 0.05) were observed among the groups.
Conclusion: Ferric sulfate significantly increased microleakage compared to aluminium chloride and control. Aluminium chloride demonstrated better compatibility with adhesive procedures. Thorough rinsing and drying of haemostatic residues are critical to achieve optimal bonding and reduce restoration failure.
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This work is licensed under a Creative Commons Attribution 4.0 International License.
This work is licensed under a Creative Commons Attribution 4.0 International License.
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1. Poggio C, Chiesa M, Scribante A, Mekler J, Colombo M. Microleakage in Class II composite restorations with margins below the CEJ: in vitro evaluation of different restorative techniques. Med Oral Patol Oral Cir Bucal. 2013;18(5):e793-e798. https://doi.org/10.4317/medoral.18344.
2. Majety KK, Pujar M. In vitro evaluation of microleakage of class II packable composite resin restorations using flowable composite and resin modified glass ionomers as intermediate layers. J Conserv Dent. 2011;14(4):414–7. https://doi.org/10.4103/0972-0707.87215.
3. Güngör HC, Canoğlu E, Cehreli ZC. The effects of dentin adhesives and liner materials on the microleakage of Class II resin composite restorations in primary and permanent teeth. J Clin Pediatr Dent. 2014;38(3):223–228. https://doi.org/10.17796/jcpd.38.3.h551um6313618465.
4. Feiz A, Sajedi M, Jafari N, Swift EJ. Evaluation of microleakage in Class II composite restorations: Bonded-base and bulk-fill techniques. Dent Res J (Isfahan). 2021;18:89.
5. Jacob G, Goud KM. A comparative study on microleakage of two low shrinkage composite materials in Class II cavities: A stereomicroscopic analysis. J Conserv Dent. 2023;26(1):83-87. https://doi.org/10.4103/jcd.jcd_444
6. Knight GM, McIntyre JM, Mulyani. Bond strengths between composite resin and auto cure glass ionomer cement using the co-cure technique. Aust Dent J. 2006;51(2):175-9. https://doi.org/10.1111/j.1834-7819.2006.tb00423.x.
7. Vukelja J, Klarić Sever E, Sever I, Jukić Krmek S, Tarle Z. Effect of Conventional Adhesive Application or Co-Curing Technique on Dentin Bond Strength. Materials (Basel). 2021;14(24):7664. https://doi.org/10.3390/ma14247664.
8. Mendonça ECD, Vieira SN, Kawaguchi FA, Powers JM, Matos AB. Influence of blood contamination on bond strength of a self-etching system. Eur J Dent. 2010;4:280-286.
9. Abdalla AI, Davidson CL. Bonding efficiency and interfacial morphology of one-bottle adhesives to contaminated dentin surfaces. Am J Dent. 1998;11(6):281-285.
10. Ebrahimi SF, Shadman N, Abrishami A. Effect of ferric sulfate contamination on the bonding effectiveness of etch-and-rinse and self-etch adhesives to superficial dentin. J Conserv Dent. 2013;16:126-130.
11. Mohammadi N, Kimyai S, Bahari M, Pournaghi-Azar F, Mozafari A. Effect of aluminum chloride hemostatic agent on microleakage of class V composite resin restorations bonded with all-in-one adhesive. Med Oral Patol Oral Cir Bucal. 2012;17(5):e841–e844. https://doi.org/10.4317/medoral.17683.
12. Khoroushi M, Keshani F, Esmaeili M, Hosseini Shirazi M. Marginal integrity of cervical restorations with caries-affected dentinal walls: effect of contamination with hemostatic agents. J Dent (Tehran). 2018;15(4):213-221.
13. Abu-Nawareg MM, Hajjaj MS, AbuHaimed TS, Ajaj RA, Abuljadayel R, AlNowailaty Y, Alnoury A, Khouja N, Naguib GH, Alzahrani SJ, Abuelenain DA. The effect of hemostatic agents and dentin cleansing protocols on shear bond strength of resin composite using universal adhesive: an in vitro study. BMC Oral Health. 2024;24(1):1413. https://doi.org/10.1186/s12903-024-05125-5.
14. Saad A, Inoue G, Nikaido T, Abdou AMA, Sayed M, Burrow MF, Tagami J. Effect of dentin contamination with two hemostatic agents on bond strength of resin-modified glass ionomer cement with different conditioning. Dent Mater J. 2019;38(2):257–263. https://doi.org/10.4012/dmj.2018-059.
15. Bandi M, Mallineni SK, Nuvvula S. Clinical applications of ferric sulfate in dentistry: a narrative review. J Conserv Dent. 2017;20(4):278-281. https://doi.org/10.4103/JCD.JCD_259_16.
16. Kuphasuk W, Harnirattisai C, Senawongse P, Tagami J. Bond strengths of two adhesive systems to dentin contaminated with a hemostatic agent. Oper Dent. 2007;32(4):399–405. https://doi.org/10.2341/06-121.
17. Nguyen AD, Bitter K, Gernhardt CR. Class-I and Class-II restorations with the application of a flowable composite as an intermediate layer—A narrative review of clinical trials. J Funct Biomater. 2025;16:111. https://doi.org/10.3390/jfb16030111.
18. Aggarwal V, Singla M, Yadav S, Yadav H. Effect of Flowable composite liner and glass ionomer liner on class II gingival marginal adaptation of direct composite restorations with different bonding strategies. J Dent. 2014;42(5):619–25. https://doi.org/10.1016/j.jdent.2014.02.016.