Optimizing Class II composite resin esthetic restorations by the use of ceramic inserts

Effect of prolonged thermal cycling on microleakage around Class V cavities restored with glass-ceramic inserts with different coefficients of thermal expansion: an in vitro study

PURPOSE

The purpose of this in vitro study was to evaluate microleakage around Class V glass-ceramic restorations of different coefficients of thermal expansion after prolonged thermal cycling.

MATERIALS AND METHODS

One hundred and twenty noncarious extracted human premolars (patient age range 12-20 years) were randomly assigned to three groups. Standard Class V preparations were cut in the buccal surface using customised Cerana burs, size no. 3. Glass-ceramic inserts from two manufacturers (Cerana, Nordiska Dental AB, Helsingborg, Sweden; Beta-Quartz, Hager & Werken GmbH, Duisburg, Germany) were used to restore the cavities and were luted with a hybrid, high-viscous composite (Tetric Ceram, Ivoclar Vivadent, Schaan, Liechtenstein) and a bonding agent (Excite, Ivoclar Vivadent, Schaan, Liechtenstein). A control group, without inserts, was bulk-filled with the same composite used as the luting agent. In accordance with American Dental Association guidelines, half of the preparation was in enamel, half in dentine/cementum and had a mesio-distal width of 3 mm, an occluso-gingival height of 3 mm, and a depth of 2 mm. All margins had butt joints. Sixty teeth, selected at random, were not thermal cycled; the remaining 60 teeth were thermal cycled 4000 times between water baths held at 5 degrees C and 55 degrees C and the specimens prepared and examined for microleakage using 2.0% Procion Red (ICI, Slough, UK) dye, buffered at pH7, as a marker. The results were analysed using the Kruskal-Wallis test (ANOVA) at a 95% significance level.

RESULTS

At the occlusal margins there was no significant difference in microleakage between the three groups (P>0.5) without thermal cycling. After thermal cycling, microleakage at the occlusal margins was significantly less around cavities restored with Cerana glass-ceramic inserts versus Beta-Quartz and Tetric Ceram (P<0.05 in both cases). At the gingival margins, there was no significant difference in microleakge between the groups before thermal cycling (P>0.5). After thermal cycling, there was significantly less microleakage between Cerana inserts and Tetric Ceram (P<0.05). Comparisons between non-thermal cycled and thermal cycled groups showed there was no significant difference with the Cerana inserts (P=0.5590).

CLINICAL IMPLICATIONS

The results indicate that, after thermal cycling, restorations restored with Cerana glass-ceramic inserts, which have a coefficient of thermal expansion approximating to that of enamel, show a decrease in marginal microleakage, compared with Beta-Quartz glass-ceramic inserts and Tetric Ceram resin-based composite material. Restorative materials, which have a coefficient of thermal expansion approximating to that of enamel, would seem to be the materials of choice in reducing the problem of marginal microleakege.

Eight year results with direct ceramic restorations (Cerana)

BACKGROUND

Single-visit system ceramic restorations are now in use to provide an alternative to resin-based materials. Inserts have been shown to improve characteristics of composite restorations.

OBJECTIVE

To investigate the longevity of Cerana (Nordiska Dental, Sweden) in a prospective clinical trial.

METHODS

Cerana restorations use matched drills with pre-etched and silanated leucite inserts cemented using a conventional restorative composite resin material. The results of 33 Cerana restorations up to eight years (25 Class I, eight class II) are presented. Restorations were reviewed and assessed by two examiners using modified USPHS criteria for anatomical form (AF) A-C, marginal adaptation (MA) A-D, surface roughness (SR) A-D, marginal discoloration (MD) A-C, colour match (CM) A-C and discomfort (DT) A-D as well as retention.

RESULTS

The percentage of A scores for AF, MA, SR, MD, CM and DT at baseline (n = 33) were: 100, 100, 79, 100, 21, 100; after two years (n = 27) 100, 85, 33, 100, 19, 100 and after four years (n = 24) 96, 75, 17, 96, 25, 100. At six years (n = 20) 95, 70, 10, 95, 15, 100 and finally at the eight year recall (n = 18) 94, 61, 0, 94, 6, 100. AF was maintained in all except for one fractured marginal ridge. MA of the insert was good but composite was lost where exposed. SR increased to a B score for all inserts. MD at B grade was observed in 6% between composite and tooth but none between insert and composite. CM was stable in all cases. DT nil in all. There were no scores less than B. All reviewed restorations were retained, clinically acceptable and in function except for two lost for reasons not directly related to the Cerana insert. One class II restoration had a fractured marginal ridge but otherwise remains satisfactory.

CONCLUSIONS

The results suggest that these restorations can be expected to perform well. Cerana is acceptable in terms of aesthetics, patient acceptance, occlusal wear and ease of use and is a good alternative for a single-visit, tooth coloured restoration in suitable cavity shapes.

Microleakage around glass-ceramic insert restorations luted with a high-viscous or flowable composite

PURPOSE

The purpose of this study was to evaluate microleakage around Class V resin restorations restored with glass-ceramic inserts luted with a high-viscous composite resin or a flowable composite resin.

MATERIALS AND METHODS

Twenty extracted human premolars (patient age range 12-18 yr) were randomly assigned to four groups. Class V preparations in two groups were filled using a glass-ceramic insert (Megafiller Standardformen, Hager Werken GmbH, Duisburg, Germany) luted with either a hybrid, high-viscous composite (Tetric, Ivoclar Vivadent, Schaan, Liechtenstein) and a bonding agent (Excite, Ivoclar Vivadent) or a flowable composite (Crystal-Essence, Confi-Dental, Louisville, CO, USA) and a bonding agent (Confi-Quick, Confi-Dental). Two groups without inserts served as controls and were bulk filled with either a hybrid, high-viscous composite (Tetric) or a flowable composite (Crystal-Essence). The preparations were made with a no. 330 tungsten carbide fissure bur (Komet, Lemgo, Germany) in a water-cooled, high-speed handpiece with a mesiodistal width of 3 mm, an occlusogingival height of 3 mm, and a depth of 2 mm. All margins had butt joints. The teeth were thermocycled for 24 hours in water baths held at 5 degrees C and 55 degrees C, and the specimens were prepared and examined for microleakage using basic fuchsin as a marker. Relative leakage was recorded according to the extent of dye penetration on a scale of 0 to 4, with 0 indicating no dye penetration and 4 indicating that dye penetration had progressed as far as the cavity floor. The results were analyzed using the Kruskal-Wallis test (nonparametric analysis of variance) and Dunn's multiple comparisons test (p < .05).

RESULTS

There was no significant difference in microleakage around inserts luted with a high-viscous composite occlusally (p = .7563) or gingivally (p = .6187) and around cavities bulk filled with the high-viscous composite. There was a significant difference in microleakage around inserts luted with a flowable composite both occlusally (p = .0345) and gingivally (p = .0285) and around cavities bulk filled with the flowable composite. Inserts luted with the flowable composite showed significantly less microleakage than those cemented with the high-viscous material only at the gingival margins (p = .0345). Comparisons of microleakage around the high-viscous and flowable composites showed no significant difference in microleakage at either the occlusal or gingival margins (Dunn's multiple comparisons test p > .5 in all cases).

CLINICAL SIGNIFICANCE

In Class V preparations of the size cut in the present study, ceramic inserts are shown to be of value in reducing microleakage when compared with bulk filling with flowable composites. Microleakage was not significantly improved by using a ceramic insert with a viscous composite compared with the viscous composite alone.

Ceramic inserts do not generally improve resin composite margins

summary Ceramic inserts are reported to possibly reduce polymerization shrinkage for posterior resin composite fillings. The aim of the present investigation was to evaluate the effect of different insert systems before and after thermomechanical loading. Sixty sound human third molars received occlusomesial Class II cavities, 40 with proximal margins 2 mm above and 20 with proximal margins 1 mm below the cementum-enamel junction. The specimens were randomly assigned to one of the six experimental groups (n = 10). The enamel-bordered cavities were restored with Syntac classic and Tetric Ceram (ST), Syntac classic, Tetric Ceram and beta-quartz inserts (TB), Syntac classic, Tetric Ceram and Cerana inserts (TC), Syntac classic, Tetric flow and SonicSys approx inserts (TS). The dentin-limited cavities were filled with Syntac classic and Tetic Ceram (DT), Syntac classic, Tetric flow and SonicSys approx inserts (DS). Before and after thermomechanical loading (100 000 x 50 N, 2500 x 5 degrees C/55 degrees C), replicas were made and both interfaces tooth/composite and insert/composite were examined under a scanning electron microscope at 200x. The Cerana and SonicSys insert groups showed significantly less gaps in enamel (P < 0.05). With beta-quartz inserts, no reduction of gaps was found (P > 0.05). Marginal integrity in dentine-bordered specimens could not be improved with SonicSys inserts (P > 0.05). The bonding performance insert/composite was promising for all IPS Empress inserts (Cerana, SonicSys enamel) but worse for beta-quartz inserts. Regarding gap formation between resin composite and tooth, Cerana and SonicSys inserts significantly reduced gaps. The use of SonicSys inserts in deep proximal cavities cannot be recommended.

Effect of different luting materials on the marginal adaptation of Class I ceramic inlay restorations in vitro

OBJECTIVES

The aim of this in vitro study was to assess the marginal adaptation of prefabricated Class I ceramic inlay restorations placed with various luting materials.

METHODS

Forty-two standardized occlusal cavities were prepared in extracted human molars with diamond burs exactly corresponding to the dimensions of prefabricated glass ceramic inlays. The prepared teeth were randomly assigned to seven groups of six teeth each and restored using (1). the composite resin Tetric Ceram in increment technique [Group I] or (2). ceramic inlays (Cerana) luted with: the composite based materials Dual Cement [Gr. II] and Panavia 21 [Gr. III], the compomer material Dyract Cem [Gr. IV], Dyract Cem with additional use of Prime & Bond 2.1 [Gr. V], the silicophosphate cement Trans-Lit [Gr. VI], or the ethylcyanoacrylate Cyano-Veneer [Gr. VII]. Marginal adaptation was evaluated by SEM-analyses before and after thermal cycling (2500 cycles; 5-55 degrees C) and mechanical loading (100N; 500000 cycles) using replica models. Kruskal-Wallis H-test and Mann-Whitney U-test were used for statistical analyses.

RESULTS

Group I (increment technique) as well as Groups II-V (inlay technique) revealed high percentages of perfect marginal adaptation in over 95% of the analyzed margins, both before and after thermo-mechanical loading. Statistical significant differences could not be detected within these groups. All inlays luted with silicophosphate cement (Group VI) and four of six inlays applied with Cyano-Veneer (Group VII) fractured under occlusal load.

SIGNIFICANCE

A stable bonding to the enamel and to the ceramic inlay was achievable with the composite luting resins Dual Cement and Panavia 21 as well as with the compomer based luting material Dyract Cem but not with the use of the silicophosphate cement Trans-Lit or the ethylcyanoacrylate Cyano-Veneer.