Influence of the Scalpel Finishing Technique on Marginal Gap Formation in Class II Resin Composite Restorations.

Abstract

Modern adhesives and composites allow the restoration of deep defects. In such cases, the matrix technique is particularly challenging, and excess composite is a common problem. Removing such overhangs with a scalpel has already been described as a substance preserving or selective finishing technique. Clinically, restoration margins may appear as a white line after scalpel finishing, and it is unclear whether this line represents a marginal gap and/or whether scalpel finishing promotes marginal gap formation. Therefore, the aim of this study was to investigate the influence of scalpel finishing of deep Class II composite restorations on marginal gap formation. Standardized mesioocclusal-distal (MOD) cavities were prepared and restored in 60 human molars randomly divided into six finishing protocol groups: G1, scalpels (SC); G2, oscillating files (OF); G3, finishing strips (FS); G4, scalpels and finishing strips (SC+FS); G5, scalpels and polishing discs (SC+PD); G6, polishing discs alone (PD, controls). The groups were additionally assigned to finishing and polishing in a phantom head (groups 1-4) or hand-held setting (groups 5-6) to simulate clinical and in-vitro research conditions, respectively. After restoration, artificial aging was performed by thermocycling (5-55°C, 2500 cycles) and mechanical loading (50 newtons (N) with 500,000 cycles) prior to scanning electron microscopy analysis of proximal restoration margin quality on the mesial and distal surfaces (n=120) of each tooth. Outcomes (perfect margin, marginal gap, overhang, marginal fracture) were statistically analyzed by t-test, Mann-Whitney U test, single-factor analysis of variance, post-hoc t-test, Kruskal-Wallis test and Dunn-Bonferroni correction for multiple group comparisons. Cohen's effect size d(Cohen) was calculated to show the strength of the relationship between variables. Overall, marginal quality was significantly better in the hand-held setting (SC+PD and PD) than the phantom head setting (SC, OF, FS, SC+FS). The best marginal quality was achieved with oscillating files in the phantom head setting and with scalpels plus polishing discs in the hand-held setting. Marginal gaps occurred significantly more often with scalpels, but the proportion of gaps was very low and clinically insignificant. Finishing strips were the least effective instruments for removing overhangs but performed better in combination with scalpels. Scalpel finishing can effectively and gently remove overhangs from enamel. However, blades should be used with caution as they can cut the dentin and cementum. Scalpel finishing does not lead to a clinically relevant increase in marginal gaps, but should be followed by polishing, whenever possible, to eliminate any marginal fractures that might be present.