186 Indian Journal of Multidisciplinary Dentistry, Vol.

1, Issue 4, May-June 2011

C
omposite resins are commonly used
dental restorative materials and signicant
improvements have been made in their
microstructure and properties in improving the
performance of composite so that their use may
be extended to the posterior segment. One of the
most signicant problem associated with the use
of posterior composite resin restorative materials
is the predisposition for marginal leakage due to
polymerization shrinkage.
1,2
When resin composite restoration is placed in function,
the stress will be absorbed by the resin matrix and is
transferred via the coupling agent to the stier, stronger,
inorganic ller particles. Hence, the bond between the
ller and matrix is essential for the longevity of the
materials.
3
Te ller loading in the resin has a limit beyond
which the properties are not favorable. More the
ller content lesser the polymerization shrinkage and
hence the marginal adaptation improves. Various
ller systems have been tested for reinforcement of
resin composite to improve marginal adaptation.
4
In
recent years, megallers are being used to overcome
polymerization shrinkage. Megallers are inserts that
*Reader
**Senior Lecturer

Lecturer
Dept. of Conservative Dentistry and Endodontics
Sree Balaji Dental College and Hospital, Pallikaranai, Chennai
Address for correspondence
Dr R Mensudar
25/8, Tandavarayan Street, Old Washermenpet, Chennai - 600 021
E-mail: r_mensudar@hotmail.com
ABSTRACT
Composites are being widely used in day-to-day clinical practice. Tough, numerous researches are being successfully carried
out, polymerization shrinkage still seems to be a clinical hindrance. Megallers are being used to overcome this. Only few
types of megallers are available but their cost is a major drawback. In this study, three innovative megallers are used to
reduce the polymerization shrinkage and hence improve the marginal adaptation of resin composite. Te ecacy of these
megallers was evaluated using dye leakage.
Key words: Megaller, polymerization shrinkage, ber-insert
Use of Innovative Megafillers for Improving the
Marginal Adaptation of Composite Restoration
R Mensudar,* A Karthick,** D Amudha,

Aparna Dash

ORIGINAL RESEARCH
were designed to ll as much of cavity as possible and
to reduce the composite volume needed for restorations
(50-70%).
5,6
Te decrease in composite material causes
the restorations to exhibit less overall shrinkage and
smaller marginal gaps. But the cost-eectiveness is the
major drawback.
In this study, three new innovative llers were used
as megallers to improve the marginal adaptation of
resin composite restorations and their ecacy was
evaluated by dye leakage.
Material and Methods
Megallers are generally glass inserts ranging in dierent
sizes and shapes. In this study, custom made megallers
were used in order to reduce the cost and simplify the
procedure. Te various megallers used were:
Prepolymerized balls: Made by using silicone
mould, into which the resin composite is packed
and cured for 40 seconds.
Fiber reinforced llers: Commercially available
(Vectris, Ivoclar Vivadent, NY) glass bers are cut
and light cured.
Fiberoptic tips: Glass bers are used as megallers
after the removal of protective covering (cladding).
Forty freshly extracted noncarious, human premolars
stored in saline were used for this study. Te teeth
were prepared to receive mesio-occlusal composite
restorations of standardized outline form and size;
2 mm wide occlusally, extending in to all major grooves
and proximally it was 4 mm buccolingually, 4 mm
occlusogingivally and 3 mm axially. All preparations

187 Indian Journal of Multidisciplinary Dentistry, Vol. 1, Issue 4, May-June 2011

ORIGINAL RESEARCH
were made without ares or bevels with diamond burs
at high speed and adequate water cooling. Te teeth
were then randomly divided into four groups of 10
specimens each viz:
Group I: Bulk lling.
Group II: Prepolymerized balls.
Group III: Fiber reinforced composite
Group IV: Fiberoptic tips
Cavities were restored with resin composite (solitaire).
Te inserts were silanized using a commercially
available silane coupling agent and were then
placed into the composite within the proximal box
and was light cured for 40 seconds at a distance of
2 mm with intensity of 400 mW/cm
2
. Te matrix
band conned the composite within the preparation.
After completion of curing and removal of the matrix,
the restorations was nished and polished. Te various
custom made megallers used in this study are shown
in Figure 1.
After 24-hour storage in saline, the specimens were
coated with nail varnish to 1 mm within the cavity
margins and were immersed in methylene blue dye for
24 hours. Te teeth were then longitudinally sectioned
with diamond disc at slow speed with copious amount
of water coolant. Te leakage pattern was scored as
given below:
0 - No leakage
1 - Dye penetration along the gingival margins
2 - Dye penetration upto axial walls
3 - Dye penetration upto pulpal oor
Te specimens were viewed under intraoral camera and
statistical analysis was done with one way ANOVA.
Results
Examinations of teeth subjected to the dye leakage are
shown in Figures 2-5. Group I (bulk lling) scored

Figure 1. Custom made inserts.

Figure 2. Leakage pattern of Group I.
Figure 3. Leakage pattern of Group II.
Figure 4. Leakage pattern of Group III.
Figure 5. Leakage pattern of Group IV.
Indian Journal of Multidisciplinary Dentistry, Vol. 1, Issue 4, May-June 2011 188
ORIGINAL RESEARCH
more leakage along the pulpal oor. No statistical
signicant dierence was seen between Group III and
Group IV when compared to Group II (p < 000.1).
Te data are summarized graphically in Figure 6.
Te summary of the data for all margins and for all
the teeth indicated that the insert-resin composite
restorations demonstrated markedly lower microleakage
compared to the teeth with composite alone.
Discussion
Marginal adaptation has been a major factor as far as
resin composite restorations are considered.
7
Tis is a
hindrance for the clinician to use it in the posterior
region. To overcome this problem number of methods
has been tried with varying degree of success. Few
of which include, changing the method of curing,
using indirect restorations, varying light sources and
use of llers. Use of megallers seems to be a viable
alternative.
Megallers are glass inserts which have low expansion
properties, low polymerization shrinkage and high
strength and the stiness has been proposed to
increase the performance and longevity of composite
resin restorations.
4,8
To achieve these objectives, some
important characteristics of insert-composite resin
complex must be considered.
3
2.5
2
1.5
1
0.5
0
Group I Group II Group III Group IV
Figure 6. Graphical representation of dye leakage.
Te most signicant is the integrity of the interface
between the insert and the composite material into
which it is placed. It has been shown that silanization
of the inserts is vital in developing high bond strength.
It binds the ller particles to the resin matrix and allows
the more exible polymer matrix to transfer stresses to
stier ller particles.
8,9
With the availability of recent
silane coupling agent the bond of these inserts are
increased to a greater extent. It has been shown that
the use of megallers improved the physical property
to a greater extent, but the commercially available
glass insert megallers are expensive. To overcome
this, less expensive custom made megallers were
used in this study which was taken up to evaluate the
ecacy of these custom made megallers on marginal
adaptation.
It was found that all groups other than those with
bulk lling showed lesser leakage. Tus, improved
resistance to marginal leakage of resin restorations by
the inclusion of megallers was demonstrated.
Te innovative llers like prepolymerized balls are easy
to fabricate and are less expensive. Te use of bers
not only improves the marginal adaptation but also
reinforces the composite. Similarly, the beroptic tip
acts as inserts and in addition transmits light to the
deeper portion of the cavity.
Similar conclusions were drawn by Tjan et al in 1993,
who reported marked reduction in polymerization
shrinkage with the use of glass insert megallers.
10

Further, George et al in 1995, used light microscopy
to measure marginal gaps and showed that inserts
improve the marginal adaptation of resin composite.
11
Conclusion
Improved resistance to marginal leakage of resin
composite restorations by inclusion of megallers was
dramatically demonstrated. Tese less expensive custom
made megallers are easy to fabricate and can be used
in our day-to-day practice.
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ORIGINAL RESEARCH
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