Evaluation of Restorative Materials Using a New Perfusion System

Purpose: 1) To test a new perfusion device able to alternate demineralizing/nondemineralizing solutions, as an acid attack system, and 2) to standardize the dentin demineralization procedure, in order to define the in vitro secondary caries inhibiting potential of different restorative materials. Materials and Methods: A fluoride-containing adhesive/composite resin (group A), an experimental adhesive/composite resin (group B), and a glass-ionomer cement (group C) were used to restore 24 Class II cavities in extracted molars. Optimal conditions to obtain dentin demineralization inside the perfusion device were identified and applied to restored teeth. Dentin demineralization after perfusion was analyzed by microradiography. The output parameters were lesion morphology, dentin mineral volume percentage, and integrated mineral loss (Delta Z, %volume x µm) of the exposed (outer lesions) and marginal (inner lesions or caries inhibition zones, CIZs) dentin. Results: Demineralization increased as follows: group A group B group C. Group A behaved better than group B, probably due to fluoride content, as indicated by Delta-Z values, higher number of CIZs, and few inner lesions. Group C showed a marginal protective effect, demonstrated by the frequent CIZs and Delta-Z positive values. This effect, however, was unable to reduce the high demineralization, probably due to the critical handling characteristics, inducing the worst marginal adaptation. Conclusion: A new dynamic perfusion device was tested and a reproducible procedure was standardized in order to achieve in vitro conditions that could better simulate the pH changes of oral environment. A limited fluoride protective effect was demonstrated by using the perfusion system, whereas a perfect marginal adaptation was shown as a paramount factor to prevent restoration failure. Keywords: perfusion device, secondary caries, dentin, restoration, microradiography