Are Some Combinations of

Resin Liners and Impression

Materials Incompatible with
Immediate Dentin Sealing?
Greciana Bruzi, MS
PhD Student, Department of Operative Dentistry, Federal University of
Santa Catarina, Florianópolis, Santa Catarina, Brazil.

Adriana O. Carvalho, DDS, MS, PhD

Feira de Santana State University, Feira de Santana, Bahia, Brazil.

Hamilton P. Maia, DDS, MS, PhD

Professor of Operative Dentistry, Federal University of Santa Catarina,
Florianópolis, Santa Catarina, Brazil.

Marcelo Giannini, DDS, MS, PhD

Associate Professor, Department of Restorative Dentistry, Piracicaba Dental
School, Campinas State University, Piracicaba, São Paulo, Brazil.

Pascal Magne, DMD, PhD

Don and Sybil Harrington Professor of Esthetic Dentistry, Department of
Restorative Sciences, Ostrow School of Dentistry, University of
Southern California, Los Angeles, California, USA

Correspondence to: Greciana Bruzi Brasil Pinto

Universidade Federal de Santa Catarina, Campus Universitário, Centro de Ciências da Saúde,
Odontologia, bloco A, sala 138, Florianópolis, SC, Brazil 88040-900. Email: [email protected]

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This study aimed to explore the interactions between adhesive resins/liners and
impression materials when using immediate dentin sealing (IDS). Inlay prepara-
tions were performed on extracted molars. Impressions of the specimens were
made with (test) or without (control) IDS. Four different adhesive systems were
used: Optibond FL, Scotchbond Universal, Optibond XTR, and Filtek LS. Two
impression materials were used: Express STD or Impregum F. For each adhe-
sive and impression material, six surface treatments were evaluated. Additional
groups were tested by adding a liner on top of the IDS layer. The surfaces were
scored in terms of adhered or unpolymerized impression material. No interactions
were observed in control groups. The combination of vinyl polysiloxane (VPS) and
simplified adhesives showed 100% unpolymerized impression material. Opti-
bond FL demonstrated VPS inhibition (66.6%) only when untreated. The combi-
nation of polyether and IDS showed unpredictable results with varying amounts
of negative interactions (0% to 100%). No interactions were observed when a
liner was applied. Only the combination of VPS and Optibond FL yielded 100%
perfect impressions when used in conjunction with any of the surface treatments.
All other adhesives resulted in significant unpolymerized VPS even after surface
treatment. Am J Esthet Dent 2013;3:200–208. doi: 10.11607/ajed.0073

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 BRUZI ET AL

I n the early 1990s,1–3 an innovative

technique known as immediate den-
tin sealing (IDS) was introduced. In IDS
the potential for adherence between
the resin base material and polyether
still calls for possible surface treatment.
procedures, the freshly cut dentin is It is likely that some products used for
sealed and desensitized immediately stone-to-resin separation or cleaning
after tooth preparation but before mak- tooth preparations16 may help to avoid
ing the impression.2,4 Some cases also this negative interaction.
require the use of a buildup or resin lin- Therefore, this study aimed to as-
er to cover the adhesive layer because sess the interactions between two im-
of its reduced thickness. Compared to pression materials and various dentin
traditional bonding procedures, IDS bonding agents when used with IDS.
offers improved bond strength, fewer In addition, the effect of various sur-
gap formations, decreased bacterial face treatments of the resin coating and
leakage, and reduced dentin sensi- additive composite resin liners were
tivity.4–8 The disadvantage of IDS is evaluated. The hypothesis was that
that possible interactions9,10 may oc- interactions would be found between
cur between impression materials and the various adhesives/resin bases and
resin coatings. These interactions can impression materials and that the pro-
be categorized as either adherence, in posed surface treatments of the resin
which part of the impression material substrate would limit those interactions.
remains attached to the tooth prepara-
tion, or inhibition, in which the impres-
sion material shows an unpolymerized MATERIALS AND METHODS
layer in contact with the resin materi-
als9,10 or latex.11,12 It is well established This study was approved by the Uni-
that oxygen inhibits resin polymeriza- versity of Southern California Institu-
tion13–15; thus, attempts have been tional Review Board.
made to employ surface treatments First, 12 freshly extracted, sound hu-
such as air blocking, pumicing, and man molars were selected and stored
use of a round diamond wheel9,10 on in a solution saturated with thymol.
the resin substrate to eliminate the oxy- Each tooth received a 5-mm-deep and
gen-inhibited layer (OIL) and possibly 5-mm-wide inlay preparation. To fa-
limit the occurrence of interactions with cilitate handling, teeth were mounted
impression materials. In addition to the on an acrylic resin base (Palapress
lack of studies addressing the material Vario, Heraeus Kulzer), embedding the
interactions of impression and resin- root up to 3.0 mm below the cemento­
based materials, the existing literature enamel junction.
is limited to the evaluation of a few ad- Impressions of the specimens were
hesives10 or modified glass-ionomer made with (test) or without (control)
bases.9 While air blocking and pum- IDS. Four adhesive systems were
icing seem to have a favorable effect evaluated: Optibond FL (OFL; Kerr),
when using vinyl polysiloxane (VPS), Scotchbond Universal (SU; 3M ESPE),

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 BRUZI ET AL

Optibond XTR (OXTR; Kerr), and Filtek with and without air blocking. Impres-
LS (FLSB; 3M ESPE). Two impression sions were obtained using a custom
materials were used: Express STD (3M tray (Triad TruTray, Denstply), and the
ESPE) or Impregum F (3M ESPE). For manufacturers’ instructions were fol-
each adhesive and impression mate- lowed for all materials. Each trial was
rial, six IDS surface treatments were repeated using the same teeth after
applied: nondestructive removal of the adhe-
sive with a blade and gentle refinishing
1. Group IDS: The resin coating was left of the dentin surface with the diamond
as is. bur at low speed with air/water spray.
2. Group IDS/AB: Air blocking was The surface of the preparation was
accomplished by applying a 6-mm- photographed and analyzed under
thick layer of glycerin jelly (K-Y Jelly, magnification (×2 to ×8) before and af-
Personal Products) and an additional ter impression taking. Each specimen
20 seconds of light polymerization was evaluated in terms of inhibition
(Valo, Ultradent) at 1,000 mW/cm2 of polymerization (presence of unpo-
to reduce the OIL of the IDS layer. The lymerized layer) and/or adherence (re-
glycerin jelly was easily removed by sidual impression material left on the
rinsing with water, and the surface tooth preparation). The effect of the sur-
was dried with air spray before im- face treatment was analyzed for each
pression taking. adhesive using the chi-square test. In
3. Group IDS/A: A cotton pellet soaked the absence of multiple zero values ​​or
in alcohol was rubbed on the IDS values below 5%, the Fisher exact test
surface for 15 seconds, followed by was used (α = 0.05) (SPSS version 17
rinsing with water and air drying. and Excel 2011, Microsoft).
4. Group IDS/D: A detergent (Liquid
Soap, Lucky Super Soft) was rubbed
on the IDS surface using cotton RESULTS
pellets for 15 seconds, followed by
rinsing with water and air drying. For both VPS and polyether impres-
5. Group IDS/M: Microfilm (Kerr) was sions, no interactions were observed in
sprayed onto the sealed/air-blocked control groups or in groups using a liner
preparation, followed by air drying. (flowable or regular composite resin),
6. Group IDS/O: The surface was gently even when omitting air blocking. Table 1
cleaned with an Opticlean bur (Kerr) shows the results for all other groups.
at 500 rpm. The use of IDS resulted in significant
interactions, including inhibition of the
Finally, additional groups were tested VPS and adherence/inhibition of the
by adding a liner on top of the IDS layer: polyether. The combination of VPS
OFL + Filtek Supreme Ultra (3M ESPE), and simplified adhesives (SU, OXTR,
OFL + Miris 2 (Coltene/Whaledent), FLSB) resulted in 100% unpolymerized
and FLSB + Filtek LS (3M ESPE) impression material, independent of the

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 BRUZI ET AL

Table 1 Material Interaction Results*

Scotchbond
Surface Optibond FL Universal Optibond XTR Filtek LS
treat­ Inter­
ment action VPS Polyether VPS Polyether VPS Polyether VPS Polyether

IDS Adherence 0%aA 8.3%aA 0%aA 16.6%aA 0%aA 0%aA 0%aA 0%aA
Inhibition 66.6%aB 25%aA 100%aA 66.6%aA 100%aA 100%aA 100%aA 0%bA
IDS/AB Adherence 0%aA 75%bB 0%aA 25%aA 0%aA 100%bB 0%aA 100%bB
Inhibition 0%aA 0%aA 58.3%aB 0%bB 100%aA 0%bB 100%aA 0%bA
IDS/A Adherence 0%aA 8.3%aA 0%aA 25%aA 0%aA 16.6%aA 0%aA 8.3%aA
Inhibition 0%aA 0%aA 16.6%aC 8.3%aB 83.3%aA 0%bB 91.6%aA 0%bA
IDS/D Adherence 0%aA 66.6%bB 0%aA 0%aA 0%aA 100%bB 0%aA 0%aA
Inhibition 0%aA 8.6%aA 33.3%aBC 0%aB 100%aA 0%bB 100%aA 0%bA
IDS/M Adherence 0%aA 8.3%aA 0%aA 0%aA 0%aA 8.3%aA 0%aA 75%bBC
Inhibition 0%aA 0%aA 8.3%aC 0%aB 100%aA 0%bB 100%aA 0%bA
IDS/O Adherence 0%aA 25%aA 0%aA 8.3%aA 0%aA 8.3%aA 0%aA 58.3%bC
Inhibition 0%aA 0%aA 75%aAB 0%bB 100%aA 0%bB 100%aA 0%bA
*Percentages followed by the same superscript lowercase letter across each row (evaluated for each method) do not differ at a significance
level of 5%. Percentages followed by the same superscript capital letter in columns (for comparison between surface treatments) do not
differ at a significance level of 5%.

IDS treatment. On the other hand, OFL teractions, some post-IDS surface
demonstrated VPS inhibition (66.6%) treatments have been proposed to re-
only when untreated (group IDS). The move the OIL. The goal of removing
combination of polyether and different the OIL is supported by previous re-
adhesives showed totally unpredict- ports showing that this layer may in-
able results, with varying amounts of hibit polymerization of the impression
adherence and inhibition phenomena material.10 However, 8.3% to 100% of
(0% to 100%) (Fig 1). unpolymerized VPS was found when
the simplified adhesives were used.
For Scotchbond Universal, a low per-
DISCUSSION centage of unpolymerized impression
material was observed. This low value
The working hypothesis was confirmed can be explained by the fact that such
in part because interactions were found thin adhesives are partially removed
between the various adhesives and im- after cleaning with water spray, thus
pression materials as well as because re-exposing the dentin. Because the
the proposed surface treatments of the OIL can potentially reach up to 84 µm
resin substrate, including the use of lin- in size,13–15 it is recommended to use a
er, had an effect on those interactions. thick and substantially filled adhesive
The IDS technique is a universal ap- such as Optibond FL or an additional
proach that has proved its efficiency resin liner, as suggested by some man-
and usefulness in many aspects4–8 ufacturers. In cases with large/deep
but has also shown interaction prob- preparations, the liner/base material
lems with impression materials.10 not only protects the bond but also
As a method of preventing those in- helps remove retentive areas in the

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 BRUZI ET AL

a b c

d e f

g h i

Figs 1a to 1j   Material interactions (microscopic views).

(a) Adherence of Impregum F in group IDS/D, OFL. (b) Adherence
of Impregum F in group IDS/O, OFL. (c) Unpolymerized
Express STD in group IDS, OFL. (d) Adherence of Impregum
F in group IDS/AB, SU. (e) Unpolymerized Express STD in
group IDS, SU. (f) Adherence of Impregum F in group IDS/AB,
OXTR. (g) Unpolymerized Impregum F in group IDS, OXTR.
(h) Unpolymerized Express STD in group IDS, OXTR. (i) Adherence
of Impregum F in group IDS/AB, FLSB. (j) Unpolymerized Express
STD in group IDS/M, FLSB.
j

preparation and strengthen weakened importance in this study and proved to

cusps that may otherwise break during be the only way to achieve predictable
the provisional stage.17,18 Simulation of results with polyether impression mate-
a liner/base material was of paramount rials, even when omitting air blocking.

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 BRUZI ET AL

a b c

Figs 2a to 2d   SEM and EDS

images for Impregum F. (a) SEM
of an IDS, OFL specimen before
impression taking (magnification
×1,000); note the rough
surface. (b) SEM of an IDS,
OFL specimen after impression
taking (magnification ×2,500).
(c and d) EDS of adhered
Impregum F in an IDS,
OFL specimen (magnification
×370); note the binding layer
of the impression material
intimately adapted to the rough
surface of the adhesive.

The use of IDS alone resulted in signif- VPS inhibition due to residuals of the
icant interactions, especially inhibition OIL. Those residuals did not prevent
of VPS and adherence/inhibition of poly­ polymerization of Express STD, indicat-
ether. The simplified adhesives were not ing that the type of VPS impression ma-
compatible with the IDS technique and terial is also instrumental.
yielded highly unpredictable impres- Another potentially critical element is
sion quality. Optibond FL followed by the acidity of the adhesive resin. Even
air blocking and a VPS impression was after physically removing the OIL, there
the only way to obtain 100% predict- was still 83% to 100% VPS inhibition with
able results. The OIL is the primary fac- Optibond XTR or Filtek LS (pH ~2.4 to
tor to explain those problems. The type 2.7). Impregum F demonstrated signifi-
of adhesive can make a difference in cant adherence with Optibond FL after
the results based on the thickness and air blocking and detergent cleaning,
filler content,19,20 but only in part.10 In a but this adherence was reduced when
previous study10 with Extrude (Kerr), air the OIL was left intact. This result is in
blocking was not sufficient to prevent agreement with previously published

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 BRUZI ET AL

Figs 3a and 3b   (a) Micro-

scopic view (×4) of the visually
clean surface of an IDS/AB,
OFL specimen after impression
taking with Impregum F. (b) SEM
image (×1,000) of adhered
Impregum F.

data.10 For the other adhesives used sion material intimately adapted to the
in conjunction with polyether impres- rough surface of the adhesive (Fig 2).
sions, there was no predictable way It can be hypothesized that these bub-
to prevent adherence/inhibition other bles weaken the polyether material and
than using a flowable or composite increase the chance of tearing.
resin liner. Even the silorane bonding The SEM also showed that the sur-
agent (FLSB), with its distinctive chem- face of Optibond FL specimens looked
istry, displayed a thinner but present rougher after polyether impression tak-
OIL and was not exempt of interaction ing. Very small adhered fragments of
problems. This result was in agreement polyether materials were also found
with previous research.20 in apparently clean surfaces (Fig 3).
In general, one might anticipate a These findings may explain why the
certain level of adherence of the im- clean surfaces of the adhesive often
pression material that can be explained looked shiny following use of VPS but
simply by the roughness of the IDS dull following use of polyether.
surface. During impression removal, From a clinical perspective, most
silicone materials are more likely to of the negative interactions revealed
“debond” from the surface by defor- in this study can be resolved by using
mation and peeling due to their high a flowable or regular composite resin,
flexibility and tear resistance.21 In con- regardless of the adhesive system or
trast, polyether is more likely to fail co- impression material used. However,
hesively and leave adhered fragments in some cases, such as those with
on the tooth due to its rigidity and low large-bur, shallower preparations (eg,
resistance to tearing.22 To elucidate the minimally invasive posterior occlusal
mechanism of these interactions, spec- veneers and anterior porcelain lami-
imens were fabricated and analyzed nate veneers), IDS cannot be covered
under scanning electron microscopy with a liner to avoid reducing clearance
(SEM) and energy-dispersive x-ray for the restoration. In these cases, Opti-
spectroscopy (EDS). It was found that bond FL in combination with any of the
large adhered fragments of polyether proposed surface treatments repre-
displayed a significant amount of bub- sents the first choice to achieve IDS in
bles and that a binding layer of impres- combination with a VPS impression.

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 BRUZI ET AL

CONCLUSION 5. Magne P, Kim TH, Cascione D, Donovan TE.

Immediate dentin sealing improves bond strength
of indirect restorations. J Prosthet Dent 2005;94:
Within the limitations of this in vitro study, 511–519.
6. Magne P. Immediate dentin sealing: A fundamental
it can be concluded that when using vi- procedure for indirect bonded restorations.
nyl polysiloxane impression materials, J Esthet Restor Dent 2005;17:144–154.
7. Choi YS, Cho IH. An effect of immediate dentin
only Optibond FL yielded 100% perfect sealing on the shear bond strength of resin cement
impressions in conjunction with one of to porcelain restoration. J Adv Prosthodont 2010;2:
39–45.
the six proposed surface treatments. 8. Hu J, Zhu Q. Effect of immediate dentin sealing on
preventive treatment for postcementation hyper-
All other adhesives resulted in signifi-
sensitivity. Int J Prosthodont 2010;23:49–52.
cant inhibition of the vinyl polysiloxane 9. Moon MG, Jarrett TA, Morlen RA, Fallo GJ. The
effect of various base/core materials on the setting
material, probably due to their insuffi- of a polyvinyl siloxane impression material.
cient thickness, oxygen inhibition, and J Prosthet Dent 1996;76:608–612.
10. Magne P, Nielsen B. Interactions between impres-
low pH. The use of a liner (flowable or sion materials and immediate dentin sealing.
regular composite resin, no air block- J Prosthet Dent 2009;102:298–305.
11. Browning GC, Bromme JC Jr, Murchison DF.
ing required) on top of the IDS layer is Removal of latex glove contaminants prior to taking
required to obtain 100% perfect poly- poly (vinylsiloxane) impressions. Quintessence Int
1994;25:787–790.
ether impressions. Except for when us- 12. Baumann MA. The influence of dental gloves on
the setting of impression materials. Br Dent J 1995;
ing Optibond FL, the use of a liner is
179:130–135.
recommended. 13. Ruyter IE. Unpolymerized surface layers on
sealants. Acta Odontol Scand 1981;39:27–32.
14. Rueggeberg FA, Margeson DH. The effect of
oxygen inhibition on an unfilled/filled composite
system. J Dent Res 1990;69:1652–1658.
ACKNOWLEDGMENTS 15. Peutzfeldt A, Asmussen E. Oxygen-inhibited
surface layers on Microfill Pontic. Acta Odontol
Scand 1989;47:31–33.
The authors wish to express their gratitude to Coltene/ 16. Bachmann M, Paul SJ, Lüthy H, Schärer P. Effect of
Whaledent for providing Miris 2; 3M ESPE for providing cleaning dentine with soap and pumice on shear
Scotchbond Universal, Filtek LS, Express STD, and bond strength of dentine-bonding agents. J Oral
Impregum F; and Kerr for providing Optibond FL, Opti- Rehabil 1997;24:433–438.
bond XTR, Microfilm, and Opticlean. This study was 17. Duarte RM, de Goes MF, Montes MA. Effect of time
supported in part by CAPES Foundation 4979/11-7 (GB) on tensile bond strength of resin cement bonded to
and CNPq 20092/2011-6 (AC). The authors reported no dentine and low-viscosity composite. J Dent 2006;
conflict of interest related to this study. 34:52–61.
18. De Goes MF, Giannini M, Di Hipólito V, Carrilho MR,
Daronch M, Rueggeberg FA. Microtensile bond
strength of adhesive systems to dentin with or
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