A modified incremental filling technique for Class II composite restorations

The effect of filling technique on the cuspal strain, polymerization shrinkage stress, enamel crack formation and depth of cure of restored molars

OBJECTIVE

Evaluate the effect of different restorative filling techniques on the residual shrinkage stress (ShrS), cuspal strain (CS), depth of cure (DC), and enamel crack formation (Ec) in molars with MOD restorations.

METHODS

Post-gel shrinkage, elastic modulus, compressive and diametral tensile strength of the Filtek One Bulk Fill composite were calculated. Sixty molars with MOD preparations were restored using four filling techniques: Bulk; Horizontal; Oblique; Natural enamel and dentin substitution (NEDS) technique. CS was measured using a strain gauge (n = 10). The DC (n = 5) was measured using Knoop hardness. Shrinkage stress/strain was analyzed using 3D finite element analysis. The Ec analysis was carried out by transillumination. Two-way ANOVA with repeated measures and Tukey's HSD test (α = 0.05) was performed for the CS data. Two-Way ANOVA and Tukey's HSD test was performed for the DC data (α = 0.05).

RESULTS

CS was higher at the lingual cusp for the horizontal and NEDS technique. No statistical difference was found between the buccal and lingual CS values for the Bulk (p = 0.367) or Oblique techniques (p = 0.192). CS values were lower for the Bulk. More enamel cracks were found for the Bulk. DC was lower at 4 mm regardless the filling technique. The Horizontal showed the highest ShrS values. The Bulk generated the lower ShrS values.

SIGNIFICANCE

A Bulk technique caused the lowest shrinkage stress/strain. An Oblique technique yielded the best balance between stress, strain and crack formation. NEDS technique is a good alternative to decrease the number of increments while maintaining the stress levels nearby the Oblique technique.

Comparative evaluation of microleakage in Class II restorations using open vs. closed centripetal build-up techniques with different lining materials

Background:

Evaluation of microleakage is important for assessing the success of new restorative materials and methods.

Aim and Objectives:

Comparative evaluation of microleakage in Class II restorations using open vs. closed centripetal build-up techniques with different lining materials.

Materials and Methods:

Standardized mesi-occlusal (MO) and distoocclusal (DO) Class II tooth preparations were preparedon 53 molars and samples were randomly divided into six experimental groups and one control group for restorations. Group 1: Open-Sandwich technique (OST) with flowable composite at the gingival seat. Group 2: OST with resin-modified glass ionomer cement (RMGIC) at the gingival seat. Group 3: Closed-Sandwich technique (CST) with flowable composite at the pulpal floor and axial wall. Group 4: CST with RMGIC at the pulpal floor and axial wall. Group 5: OST with flowable composite at the pulpal floor, axial wall, and gingival seat. Group 6: OST with RMGIC at the pulpal floor, axial wall, and gingival seat. Group 7: Control — no lining material, centripetal technique only. After restorations and thermocycling, apices were sealed and samples were immersed in 0.5% basic fuchsin dye. Sectioning was followed by stereomicroscopic evaluation.

Results:

Results were analyzed using Post Hoc Bonferroni test (statistics is not a form of tabulation). Cervical scores of control were more than the exprimental groups (P < 0.05). Less microleakage was observed in CST than OST in all experimental groups (P < 0.05). However, insignificant differences were observed among occlusal scores of different groups (P > 0.05).

Conclusion:

Class II composite restorations with centripetal build-up alone or when placed with CST reduces the cervical microleakage when compared to OST.

Microleakage in class II restorations: open vs closed centripetal build-up technique

PURPOSE

This study evaluated whether a Class II restoration in a flowable resin composite has to be placed prior to (open-sandwich technique) or after (closed-sandwich technique) construction of the interproximal wall in the centripetal build-up technique in order to reduce microleakage.

METHODS AND MATERIALS

Thirty non-carious molars were selected and randomly divided into two groups (n = 15). A standardized Class H preparation was made with the cervical margin 1 mm below the cementum-enamel junction. In Group 1, flowable resin composite was applied as a 1 mm base, remaining exposed at the cervical margin. In Group 2, the hybrid resin composite was applied to the interproximal wall, followed by a layer of flowable composite on the pulpal floor, away from the margins. The restorations were then subjected to 500 thermal cycles, each with a dwell time of 20 seconds at 5 degrees C and 55 degrees C. Adaptation at the cervical margin was evaluated by dye penetration and SEM analysis using the replica technique. The data were statistically analyzed using the Mann-Whitney U-test (p < 0.05).

RESULTS

The centripetal open-sandwich technique led to significantly lower dye penetration than the centripetal closed-sandwich technique (p < 0.001).

CONCLUSION

Flowable resin composite placed under hybrid resin composites in Group 1 provided better marginal adaptation and fewer voids. However, neither Group 1 nor Group 2 was able to completely prevent microleakage.

A novel filling technique for packable composite resin in Class II restorations

The use of composite resin restorations in posterior teeth has increased considerably in the past few years. Specific composite resins for posterior teeth, as well as new operative techniques, have been developed to overcome some clinical difficulties. The present article describes a new technique to reconstitute the interproximal contour and contact of Class II restorations using a packable composite resin. Two lower first molars from the same patient are reported in detail, illustrating the technique step by step. The technique indicates the use of a metallic matrix band and wood wedges to provide an interproximal contour and contact with the adjacent tooth as well as to provide an adequate cervical adaptation. The first increment of the packable composite resin is applied on the gingival wall of the proximal box, packed cervically near the axial wall and, automatically, the resin climbs up in contact with the inner surface of the matrix band. This increment is sculpted and light-cured and the metallic matrix band is removed. Thus, the Class II cavities are transformed into Class I, with free access for light-curing. Small incremental layers of composite fill the remaining cavities. This technique is faster than conventional techniques and permits appropriate embrasure, better contour, and contact points.

CLINICAL SIGNIFICANCE

Packable composite resins present primarily new handling characteristics that permit the development of novel filling techniques. The technique proposed in this article allows easier Class II buildup, with proper proximal contact and proximal smooth surfaces, once there are no irregularities among the composite increments. Another advantage is that there is adequate light exposure for polymerization, because the metal matrix can be removed during the restorative procedure.

Amalgam alternatives--micro-leakage evaluation of clinical procedures. Part I: direct composite/composite inlay/ceramic inlay

This study investigated the degree of dye penetration with three different types of tooth-coloured restorations. Twenty-four intact extracted molars were collected. The teeth were immediately stored in water at room temperature. Class II cavity preparations were prepared and restored with three different types of tooth-coloured restorations: A, composite resin in the incremental technique; B, composite inlay technique; and C, ceramic inlay. Specimens were subjected to 700 cycles of thermal stress. They were than immersed in 2% basic fuchsin dye. The teeth were sectioned in three planes before being ranked as to the amount of dye penetration. The highest score obtained on three plano-parallel sections was adopted as the representative value. The three groups were compared using the Kruskal Wallis non-parametric test. Dye penetration was significantly lower at the enamel margins when using the composite inlay system and the incremental technique compared to the ceramic inlay technique. The restorations placed using the composite inlay technique showed less dye penetration than the incremental technique at the dentine margins (P < 0.017).

Direct posterior composite resin restorations: a review. 2. Clinical technique

Despite the increased use of composite resin to restore posterior teeth, there is evidence that clinicians should be selective in their use of these restorations. This paper describes the clinical technique--preparatory procedures, preparation of the cavity, preparation for placement of composite resin, placement of composite resin and finishing of the restoration--for the relatively conservative use of composite resin in posterior teeth and reviews the literature to discuss briefly many of the controversial aspects of the technique.