The effect of incremental versus bulk fill techniques on the microleakage of composite resin using a glass-ionomer liner.

Incremental placement of composite resin has been suggested to reduce microleakage, particularly at the gingival margin of class 5 cervical restorations. It has become clinically advantageous to place a glass-ionomer liner over dentin to further minimize microleakage resulting from a bond between the dentin and glass ionomer, and glass ionomer and resin. The objective of this study was to compare the microleakage behavior of three hybrid composite/bonding agent systems using bulk and incremental filling techniques utilizing a glass-ionomer liner. This was accomplished in vitro using freshly extracted bovine incisors and a Ca45 radioisotope and autoradiography. Sixty bovine incisors were divided into six experimental groups of 10 specimens per group. Class 5 preparations were cut at the cementoenamel junction and restored with the appropriate combination of Herculite XR/Bondlite, P50/Scotchbond 2, or Pertac Hybrid/Pertac Bond. All teeth were lined with the glass ionomer Ketac Bond before the final restoration was placed. The samples were finished and stored for 24 hours in distilled water before thermocycling. The samples were tested for microleakage using a Ca45 radioisotope technique and autoradiography. Incisal (enamel) and gingival (dentin) margins were scored separately for microleakage but grouped for statistical analysis. Results were analyzed using the Kruskal-Wallis H test. Pertac Hybrid exhibited more leakage than Herculite XR or P50. The difference between microleakage of bulk and incremental filling techniques was only significant for P50.