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Nizami MZI, Yeung C, Yin IX, Wong AWY, Chu CH, Yu OY. Tunnel Restoration: A Minimally Invasive Dentistry Practice. Clin Cosmet Investig Dent 2022; 14:207-216. [PMID: 35873904 PMCID: PMC9296866 DOI: 10.2147/ccide.s372165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 07/12/2022] [Indexed: 11/23/2022] Open
Abstract
With advances in technology, dentists nowadays manage dental caries with the philosophy of minimally invasive dentistry. Dental restoration is now performed most conservatively with minimal destruction of tooth structure when operative dentistry is indicated. Some operative dentists suggested using tunnel restoration for treating proximal caries as a conservative alternative to the conventional box preparation. The main advantage of tunnel restoration over the conventional box or slot preparation includes being more conservative and increasing tooth integrity and strength by preserving the marginal ridge. However, tunnel restoration is technique sensitive and requires advanced operative skills. Tunnel restoration can be an option to restore proximal caries if the dentist selects the proper case and pays attention to the details of the restorative procedures. With the dentist's advanced training, advanced light-emitting diode handpieces, magnifying loupes, precise digital imaging and new generation restorative materials, good results can be obtained in selected cases. This study reviews the literature on tunnel restoration and provides updated techniques and clinical data that can be used in tunnel restoration to oversee its limitations and the perspective on restorative treatment.
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Affiliation(s)
- Mohammed Zahedul Islam Nizami
- Faculty of Dentistry, The University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
| | - Conson Yeung
- Faculty of Dentistry, The University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
| | - Iris Xiaoxue Yin
- Faculty of Dentistry, The University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
| | - Amy Wai Yee Wong
- Faculty of Dentistry, The University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
| | - Chun Hung Chu
- Faculty of Dentistry, The University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
| | - Ollie Yiru Yu
- Faculty of Dentistry, The University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
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Preusse PJ, Winter J, Amend S, Roggendorf MJ, Dudek MC, Krämer N, Frankenberger R. Class II resin composite restorations-tunnel vs. box-only in vitro and in vivo. Clin Oral Investig 2020; 25:737-744. [PMID: 33169273 PMCID: PMC8364904 DOI: 10.1007/s00784-020-03649-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 10/16/2020] [Indexed: 11/26/2022]
Abstract
Purpose In a combined in vitro/in vivo approach, tunnel vs. box-only resin composite restorations should be evaluated using thermomechanical loading (TML) in vitro and a restrospective clinical trial in vivo. Materials and methods For the in vitro part, box-only and tunnel cavities were prepared in 32 extracted human third molars under simulated intraoral conditions in a phantom head. Specimens were randomly assigned to four groups (n = 8; 16 box-only/16 tunnel) and received bonded resin composite restorations with Amelogen Plus (box A/tunnel A) or lining with Ultraseal and Amelogen plus (box B/tunnel B) both bonded using PQ1 (all Ultradent). Specimens were subjected to a standardized aging protocol, 1-year water storage (WS) followed by TML (100,000 × 50 N; 2500 × + 5/+ 55 °C). Initially and after aging, marginal qualities were evaluated using replicas at × 200 magnification (SEM). For the corresponding in vivo observational study, 229 patients received 673 proximal resin composite restorations. From 371 tunnel restorations, 205 cavities were filled without flowable lining (tunnel A), and 166 tunnels were restored using UltraSeal as lining (tunnel B). A total of 302 teeth received conventional box-only fillings. Restorations were examined according to modified USPHS criteria during routine recalls up to 5 years of clinical service. Results In vitro, all initial results showed 100% gap-free margins when a flowable lining was used. Tunnels without lining exhibited some proximal shortcomings already before TML and even more pronounced after TML (p < 0.05). After TML, percentages of gap-free margins dropped to 87–90% in enamel with lining and 70–79% without lining (p < 0.05). In vivo, annual failure rates for box-only were 2.2%, for tunnel A 6.1%, and for tunnel B 1.8%, respectively (p < 0.05). Tunnels had significantly more sufficient proximal contact points than box-only restorations (p < 0.05). Flowable lining was highly beneficial for clinical outcome of tunnel-restorations (p < 0.05). Conclusions With a flowable lining, tunnel restorations proved to be a good alternative to box-only resin composite restorations. Clinical relevance Class II tunnel restorations showed to be a viable alternative for box-only restorations, however, only when flowable resin composite was used as adaptation promotor for areas being difficult to access.
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Affiliation(s)
- Peter J Preusse
- , Marburg, Germany
- Department of Operative Dentistry, Endodontics, and Pediatric Dentistry Medical Center for Dentistry, University Medical Center Giessen and Marburg, Campus Marburg, Georg-Voigt-Str. 3, 35039, Marburg, Germany
| | - Julia Winter
- Department of Operative Dentistry, Endodontics, and Pediatric Dentistry Medical Center for Dentistry, University Medical Center Giessen and Marburg, Campus Marburg, Georg-Voigt-Str. 3, 35039, Marburg, Germany
| | - Stefanie Amend
- Department of Pediatric Dentistry, Medical Center for Dentistry, University Medical Center Giessen and Marburg, Campus Giessen, Schlangenzahl 14, 35392, Giessen, Germany
| | - Matthias J Roggendorf
- Department of Operative Dentistry, Endodontics, and Pediatric Dentistry Medical Center for Dentistry, University Medical Center Giessen and Marburg, Campus Marburg, Georg-Voigt-Str. 3, 35039, Marburg, Germany
| | - Marie-Christine Dudek
- Department of Operative Dentistry, Endodontics, and Pediatric Dentistry Medical Center for Dentistry, University Medical Center Giessen and Marburg, Campus Marburg, Georg-Voigt-Str. 3, 35039, Marburg, Germany
| | - Norbert Krämer
- Department of Pediatric Dentistry, Medical Center for Dentistry, University Medical Center Giessen and Marburg, Campus Giessen, Schlangenzahl 14, 35392, Giessen, Germany
| | - Roland Frankenberger
- Department of Operative Dentistry, Endodontics, and Pediatric Dentistry Medical Center for Dentistry, University Medical Center Giessen and Marburg, Campus Marburg, Georg-Voigt-Str. 3, 35039, Marburg, Germany.
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Manhart J, García-Godoy F, Hickel R. Direct posterior restorations: clinical results and new developments. Dent Clin North Am 2002; 46:303-39. [PMID: 12014036 DOI: 10.1016/s0011-8532(01)00010-6] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The longevity of dental restorations is dependent on many different factors, including those related to materials, the dentist, and the patient. The main reasons for restoration failure are secondary caries, fracture of the bulk of the restoration or of the tooth, and marginal deficiencies and wear. The importance of direct-placement, aesthetic, tooth-colored restorative materials is still increasing. Amalgam restorations are being replaced because of alleged adverse health effects and inferior aesthetic appearance. All alternative restorative materials and procedures, however, have certain limitations. Direct composite restorations require a time-consuming and more costly treatment procedure and are actually only indicated for patients with excellent oral hygiene. Glass ionomers can be considered only as long-term provisional restorations in stress-bearing posterior cavities. Future treatment regimens that are made possible by the development of sophisticated preparation techniques, improved dentin bonding agents, and resin-based restorative materials will result in the therapy of more small-sized lesions rather than large restorations. The importance of indirect inlay techniques will shift more and more toward the direct restoratives. As the cavities become smaller, it is to be expected that the use of improved direct restorative materials will provide excellent longevity even in stress-bearing situations.
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Affiliation(s)
- Juergen Manhart
- Department of Restorative Dentistry, Ludwig-Maximilians-University, Goethe Street 70, D-80336 Munich, Germany.
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Strand GV, Nordbø H, Tveit AB, Espelid I, Wikstrand K, Eide GE. A 3-year clinical study of tunnel restorations. Eur J Oral Sci 1996; 104:384-9. [PMID: 8930587 DOI: 10.1111/j.1600-0722.1996.tb00096.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Tunnel restorations (n = 161) performed by 4 dentists were evaluated after a mean of 35 months in situ. Demineralized enamel was to be spared during preparation. The preparations were filled with a cermet glass ionomer (polyalkenoate) cement. Evaluation was carried out using clinical and radiographical criteria. During the observation period, approximately 16% of the restorations were replaced due to caries in dentin and 14% due to marginal ridge fracture. Cavitation in the approximal surface and/or increased radiolucency of the approximal enamel were observed in 34% of the remaining tunnel-restored teeth. A significantly higher frequency of failures were registered when treating patients with a high caries activity, where the initial lesion was large, and where the restoration did not reach the approximal surface.
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Affiliation(s)
- G V Strand
- Department of Cariology and Endodontics, University of Bergen, Norway
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