Marginal adaption of Class V restorations with and without "softstart-polymerization"

Polymerization shrinkage causing marginal gap formation is still a major problem in light curing restorations. The aim of the present study was to test the influence of "softstart polymerization" (prepolymerization at a low light intensity followed by a final cure at a high light intensity) on the marginal integrity of polyacid-modified resin and composite resin restorations in Class V cavities using a commercially available curing unit with two defined curing intensities. Sixty standardized Class V cavities were prepared. Twenty cavities at a time were filled either with a composite resin [Spectrum + Prime & Bond 2.1 (SP)], or with polyacid-modified resins [Dyract + Prime & Bond 2.1 (DY); Hytac + OSB Primer (HY)]. Ten fillings of each group were either conventionally cured (40 seconds, 800 mW/cm2), or they were cured with a lower starting intensity (10 seconds, 150 mW/cm2) and then with the full intensity (30 seconds, 800 mW/cm2). Margins were evaluated before and after thermomechanical loading (TCML) by quantitative margin analysis. Microleakage was assessed by dye penetration. The softstart polymerization showed no significant influence on gap formation for each material and interface before and after TCML. Quantitative margin analysis after TCML showed significantly fewer marginal gaps at the enamel/restoration interface for SP (0%) compared to DY (15.5%) and HY (44.5%) using softstart polymerization. At the dentin/restoration interface the corresponding results for gap formation were 29.6% for SP, 8.5% for DY, and 21.0% for HY. These results were not significantly different from each other. Dye penetration was significantly higher for SP at the dentin/restoration interface. SP showed significantly more marginal swelling at the dentin/restoration interface compared to DY. In conclusion, softstart polymerization using a very low starting intensity did not improve the marginal adaptation of polyacid-modified resins or composite resins in Class V cavity preparations. The best marginal adaptation in Class V cavities at the enamel/restoration interface was achieved with SP, using the acid-etch technique. In dentin, however, the polyacid-modified resins showed a superior marginal adaptation.