Packable composites: overview and technical considerations

Clinical performance of preheating thermoviscous composite resin for non-carious cervical lesions restoration: A 24-month randomized clinical trial

OBJECTIVES

This 24-month, double-blind, split-mouth randomized clinical trial aimed to compare the retention rates of a preheated thermoviscous composite resin (PHT) compared to a non-heated composite resin (NHT) in non-carious cervical lesions (NCCLs).

METHODS

A total of 120 restorations were restored on NCCLs using a preheated (VisCalor bulk, Voco GmbH) and a non-heated (Admira Fusion, Voco GmbH) composite resins with 60 restorations per group. A universal adhesive in the selective enamel conditioning was applied. In the PHT group, composite was heated at 68 °C for using a bench heater. In the NHT group, no heating was employed. Both restorative materials were dispensed into caps and inserted into the NCCLs. The restorations were evaluated at baseline, 6, 12, 18, and after 24 months of clinical service using the FDI criteria. Statistical analysis was performed with Kaplan-Meier estimation analysis for retention/fracture rate and Chi-square test for the other FDI parameters (α=0.05).

RESULTS

After 24 months 108 restorations were assessed. Seven restorations were lost (two for PHT group and five for NHT group), and the retention rates (95 % confidence interval [CI]) were 96.7 % (81.5-99.9) for PHT group and 90.8 % (81.1-96.0) for NHT group, with no statistical differences between them (p > 0.05). The hazard ratio (95 % CI) was 0.52 (0.27 to 1.01), with no significant difference within groups. In terms of all other FDI parameters that were assessed, all restorations were deemed clinically acceptable.

CONCLUSIONS

Both composites showed high rates of retention rates after 24 months.

CLINICAL SIGNIFICANCE

The clinical performance of the new preheated thermoviscous was found to be as good as the non-heated composite after 24-month of clinical evaluation in non-carious cervical lesions.

REGISTRATION OF CLINICAL TRIALS

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5-year clinical performance of posterior bulk-filled resin composite restorations: A double-blind randomized controlled trial

OBJECTIVES

The aim of this double-blind, and randomized controlled clinical trial was to evaluate the 5-year clinical performance of posterior resin composite restorations placed with the incremental filling technique [IF] or the bulk-fill technique [BF]. Two different adhesive systems were used: etch-&-rinse (ER) or self-etch (SE).

METHODS

Posterior dental teeth of 72 participants (n = 236), with a cavity depth of at least 3 mm, were randomly divided into four groups. Restorations were applied with either Tetric N-Bond or Tetric N-Bond SE. The composite resin Tetric N-Ceram Bulk-Fill was placed either with IF or BF. Restorations were evaluated using FDI criteria at baseline and after 1, 2, 3, 4, and 5 years. Statistical analysis was performed using the Wilcoxon Signed rank test (a=0.05).

RESULTS

Two hundred and four restorations were evaluated after 5 years. Eleven restorations were considered 'failed', ten due to fracture (4 IF and 6 BF) and one due to secondary caries (IF). The annual failure rate was 1.2% for BF and 1% for IF (p = 0.35). When comparing BF and IF, no significant differences were found for any of the parameters evaluated (p > 0.05). Regarding the adhesive systems, 44 and 51 restorations showed minor problems in terms of marginal adaptation and staining, with significantly more marginal discoloration when the self-etch adhesive was used (p = 0.002).

SIGNIFICANCE

The bulk-fill restorative technique showed good clinical behavior compared to the incremental filling technique, especially when using an etch-&-rinse adhesive, after 5 years of clinical evaluation.

Physical Properties and Clinical Performance of Short Fiber Reinforced Resin-based Composite in Posterior Dentition: Systematic Review and Meta-analysis

OBJECTIVE

This study compares the physical properties and clinical performance of short fiber reinforced composites (SFRC) to those of particulate-filled resin-based composites (PFRC) for class I and II direct restorations in permanent dentition.

METHODS

Systematic review and meta-analysis was conducted using PubMed, Embase (Elsevier), and Dentistry and Oral Sciences Source (EBSCO) databases. The outcomes evaluated were physical properties including flexural strength, flexural modulus, elastic modulus, microhardness, shrinkage, fracture toughness, degree of conversion, and depth of cure. Clinical performance was evaluated with a systematic review.

RESULTS

The meta-analyses favored SFRC for flexural strength and fracture toughness compared to every PFRC subgroup, with a high quality of evidence. For all other properties, the meta-analyses favored SFRC to overall PFRC, with some non-significant differences with certain PFRC subgroups. The most recent clinical trial showed SFRC performed similarly to PFRC, however older studies suggest inferior surface texture and discoloration of SFRC compared to PFRC.

CONCLUSION

This study can aid dental professionals in clinical decision making, supporting that SFRC offers improved physical properties, especially fracture resistance and flexural strength, compared to PFRC.

An In Vitro Staining Effect of Different Children's Health Drinks on Esthetic Restorative Materials

Aim

To evaluate the staining effect of different children's health drinks (Boost, Complan, and Pediasure) on esthetic restorative materials (giomer, nanohybrid composite, and ormocer).

Materials and methods

The specimens consist of giomer, nanohybrid composite, and ormocer. Before the discoloration process, 80 disks of each material were fabricated, each measuring 5 mm in diameter and 2 mm in thickness. These disks were then measured for lightness*red/green*blue/yellow (L*a*b*) values. Around 10 samples from each subgroup were then submerged in each of the four staining solutions. Analysis of discoloration levels was done at baseline and 48 hours after immersion in the staining solution. Each specimen's staining effect was evaluated using a spectrophotometer.Each specimen's L*a*b* values were measured three times by placing it on the measurement head. The internal energy (ΔE) unit, which expresses resistance to the staining effect, was derived using each specimen's L*a*b* values.

Results

All the tested materials showed a color change. However, giomer showed greater ΔE values compared to nanohybrid composite and ormocer. Of all the immersion media used, Boost samples resulted in the highest color change, followed by Complan, Pediasure, and milk.

Conclusion

Out of the three restorative materials used in the study, ormocer showed more resistance to color change than nanohybrid composite and giomer with all the tested media.

How to cite this article

Ponnala SL, Punithavathy R, Birapu UKC, et al. An In Vitro Staining Effect of Different Children's Health Drinks on Esthetic Restorative Materials. Int J Clin Pediatr Dent 2023;16(2):211-217.

Effects of Adjacent Tooth Type and Occlusal Fatigue on Proximal Contact Force of Posterior Bulk Fill and Incremental Resin Composite Restoration

OBJECTIVES

To measure the proximal contact force in newtons (N) between incremental and bulk fill class II resin composite restorations and implant molar teeth or adjacent premolar teeth with simulated periodontal ligament.

METHODS

The model used was created with a typodont first molar tooth with two bilateral occlusal-proximal class II cavities, an adjacent tooth simulating an implanted molar tooth (Titamax CM, Neodent, Curtiba, PR, Brazil) and a premolar with simulated periodontal ligament. Two resin composite restorative techniques were used: Inc-Z350XT, (Filtek Z350, 3M Oral Care, St. Paul, MN, USA) inserted incrementally and Bulk-OPUS, (Opus Bulk Fill APS, FGM, Joinville, SC, Brazil) high viscosity bulk fill resin composite (n=10). As a control, a typodont having intact teeth without restorations was used. After the restorative procedure, each specimen was radiographed using a digital system (Dürr Dental, Bietigheim-Bissingen, Germany). The proximal contact force (N) was measured using dental floss with a microtensile machine (Microtensile ODEME, Luzerna, SC, Brazil). The specimens were then subjected to mechanical fatigue cycling to simulate 5 years of aging. All the parameters were measured after aging. The X-rays were blindly qualitatively analyzed by two operators to identify the loss of proximal contact. One-way ANOVA was used for comparing the initial contact force between restored and intact teeth. Two-way ANOVA followed by Tukey testing was performed for contact area data and for the contact force/contact area ratio. The proximal contact force data were analyzed using one-way repeated measurement ANOVA followed by Tukey testing (α=0.05). The X-ray proximal contact analyses were described by the frequency.

RESULTS

The initial proximal contact force was similar for intact and restored teeth. The contact force and contact area with the molar were significantly higher than with the premolar; however the contact force/contact area ratio was similar for all tested groups. The bulk fill technique showed a contact force similar to the incremental filling technique. Fatigue resulted in a significant reduction in the proximal contact force (p<0.001), irrespective of the region analyzed or restorative material used. The digital X-rays detected no alteration in the proximal contact after occlusal fatigue.

CONCLUSIONS

Larger contact area resulted in higher proximal contact force. Proximal contact force decreased with 5 years of simulated occlusal fatigue. The bulk fill technique showed a proximal contact force similar to that of the incremental filling technique.

Rheological and Mechanical Properties of Resin-Based Materials Applied in Dental Restorations

Resin-based materials have been prevalent for dental restorations over the past few decades and have been widely used for a variety of direct and indirect procedures. Typically, resin-based dental materials are required to be flowable or moldable before setting and can provide adequate mechanical strength after setting. The setting method may include, but is not limited to, light-curing, self-curing or heating. In this review, based on different indications of resin-based dental materials (e.g., dental filling composite, dental bonding agent, resin luting cement), their rheological and mechanical properties were reviewed. Viscous and flexible properties were focused on for materials before setting, while elastic properties and mechanical strength were focused on for materials after setting. At the same time, the factors that may affect their rheological and mechanical properties were discussed. It is anticipated that the insightful information and prospections of this study will be useful to the future development and fabrication of resin-based dental restorative materials.

Comparative Evaluation of Fracture Resistance of Endodontically Treated Teeth Restored with Different Core Build-up Materials: An In Vitro Study

The aim is to evaluate the fracture resistance of endodontically treated teeth restored with posterior direct composite (PRC) resin, bulk-fill composite resin, dual-cure composite (DCC) resin, and short fiber-reinforced composite (SFC) resin material.

Probing the hierarchy of evidence to identify the best strategy for placing class II dental composite restorations using current materials

OBJECTIVE

The objective of this review is to present a synopsis of the existing clinical and in vitro evidence regarding placement of direct class II restorations with dental composites of varying viscosities, focusing on the marginal integrity achievable.

OVERVIEW

The literature on class II composites placed with various techniques was searched through PubMed, Scopus, and the citations of identified articles, focusing on aspects related to adaptation and clinical performance. Studies comparing layering of conventional composite to layering with a flowable liner, including the "snow plow technique," use of warmed composite, flowable bulk-fill liners with a conventional composite capping layer, and bulk-fill restorative in a single or incremental fill (including placement with sonic energy and dual-curing) CONCLUSIONS: In vitro and clinical evidence does not support any one specific method or material type for achieving optimal performance when restoring class II cavity preparations with current dental composites.

CLINICAL SIGNIFICANCE

Although there are many available placement methods and types of composite materials on the market for use in class II restorations, the reasonable success presented in the clinical and laboratory literature for the various approaches suggests that the most important factor for achieving success is likely careful and proper placement and light-curing technique, independent of the approach.

Hydro-Thermal Fatigue of Polymer Matrix Composite Biomaterials

This study discusses a quantitative fatigue evaluation of polymer-ceramic composites for dental restorations, i.e., commercial (Filtek Z550) and experimental Ex-nano (G), Ex-flow (G). Their evaluation is based on the following descriptors: mechanical strength, elastic modulus and strain work to fracture. Supposed to reflect factors of environmental degradation conditions, thermal fatigue was simulated with a special computer-controlled device performing algorithms of thermocycling. The specimens intended for the strength test underwent 10⁴ hydro-thermal fatigue cycles. This procedure of thermocycling was preceded by aging, which meant immersing the specimens in artificial saliva at 37 °C for 30 days. The strength tests after aging only and after aging and thermocycles were performed in line with the three-point flexural strength (TFS) test, specified in ISO 4049, and the biaxial flexural strength (BFS) test, specifically piston-on-three-ball in accordance with ISO 6872. Based on the results, it can be stated that composites with higher volume content of inorganic particles after aging only show higher strength than materials with lower filler particle content. For example, the average flexural bending strength of the Ex-flow (G) composite was about 45% lower than the value obtained for the Ex-nano (G) material. The residual strength after thermocycles is significantly lower for the experimental composites, whereas a smaller decrease in strength is recorded for the commercial composites. Decreases in strength were about 4% (Filtek Z550), 43% (Ex-nano (G)), and 29% (Ex-flow (G)) for the BFS test; and about 17% (Filtek Z550), 55% (Ex-nano (G)), 60% (Ex-flow (G)) for the TFS test. The elastic modulus of the experimental composites after only aging is higher (about 42%) than that of the commercial composite, but the elastic modulus of the commercial composite increases significantly after thermocycling. A descriptor known as strain work to fracture turns out to be a good descriptor for evaluating the hydro-thermal fatigue of the tested polymer-ceramic composites.

The Evolution of Dental Materials over the Past Century: Silver and Gold to Tooth Color and Beyond

The field of dental materials has undergone more of a revolution than an evolution over the past 100 y. The development of new products, especially in the past half century, has occurred at a staggering pace, and their introduction to the market has been equally impressive. The movement has mostly come in the area of improved esthetics, marked by the gradual replacement of dental amalgam with dental composite and all-metal and porcelain-fused-to-metal indirect restorations with reinforced dental ceramics, all made possible by the rapid improvements in dental adhesive materials. This article covers the time course of dental materials development over the past century in which the Journal of Dental Research has been published. While there have been advances in nearly all materials used in the field, this article focuses on several areas, including dental amalgam, dental composites and light curing, dental adhesives and dental cements, ceramics, and new functional repair materials. A few short statements on future advances will be included at the end.

Clinical evaluation of the bulk fill composite QuiXfil in molar class I and II cavities: 10-year results of a RCT

OBJECTIVE

The objective of this RCT was to compare the 10-year clinical performance of QuiXfil with that of Tetric Ceram in posterior single- or multi-surface cavities.

METHODS

46 QuiXfil (Xeno III) and 50 Tetric Ceram (Syntac classic) composite restorations were placed in 14 stress bearing class I and 82 class II cavities in first or second molars. Clinical evaluation was performed at baseline and after up to 10 years by using modified US Public Health Service criteria. At the last recall period, 26 QuiXfil and 30 Tetric Ceram restorations in 11 stress bearing class I and 45 class II cavities, were assessed.

RESULTS

Ten failed restorations were observed during the follow-up period, four Tetric Ceram restorations failed due to secondary caries (2), tooth fracture (1) and bulk fracture combined with secondary caries (1) whereas six QuiXfil restorations failed due to secondary caries (1), tooth fracture (2), secondary caries combined with restoration fracture (1), restoration fracture (1) and postoperative sensitivity (1). Fisher's exact test yielded no significant difference between both materials (p=0.487).

SIGNIFICANCE

Both materials, bulk fill QuiXfil restorations and Tetric Ceram restorations, showed highly clinical effectiveness during the 10-year follow-up.

Influence of Adhesive Type and Placement Technique on Postoperative Sensitivity in Posterior Composite Restorations

PURPOSE

This double blind, randomized clinical trial compared the postoperative sensitivity of the placement technique (incremental and bulk fill) in posterior composite resin restorations bonded with two different adhesive strategies (self-etch and etch-and-rinse).

METHODS

Posterior dental cavities of 72 participants (n=236), with a cavity depth of at least 3 mm, were randomly divided into four groups. The restorations were bonded using either the etch-and-rinse Tetric N-Bond (Ivoclar Vivadent) or the self-etch Tetric N-Bond SE (Ivoclar Vivadent). The composite resin Tetric N-Ceram Bulk Fill (Ivoclar Vivadent) was placed either incrementally or using the bulk-fill technique. Two experienced and calibrated examiners evaluated the restorations using World Dental Federation criteria after one week of clinical service. Spontaneous postoperative sensitivity was assessed using a 0-4 numerical rating scale and a 0-10 and 0-100 visual analog scale up to 48 h after the restorative procedure and after one week.

RESULTS

The risk (p>0.49) and intensity of spontaneous postoperative sensitivity (p>0.38) was not affected by the adhesive strategy or the filling technique. The overall risk of postoperative sensitivity was 20.3% (95% confidence interval 15.7-25.9) and typically occurred within 48 hours after the restorative procedure.

CONCLUSIONS

The overall risk of immediate postoperative sensitivity was 20.3% and was not affected by either the adhesive strategy (etch-and-rinse/self-etch) or the filling technique (incremental/ bulk).

Replacement of glass particles by multidirectional short glass fibers in experimental composites: Effects on degree of conversion, mechanical properties and polymerization shrinkage

OBJECTIVE

To test the null hypothesis that the replacement of a small fraction of glass particles with random short glass fibers does not affect degree of conversion (DC), flexural strength (FS), fracture toughness (FT) and post-gel polymerization shrinkage (PS) of experimental composites.

METHODS

Four experimental photocurable composites containing 1 BisGMA:1 TEGDMA (by weight) and 60vol% of fillers were prepared. The reinforcing phase was constituted by barium glass particles (2μm) and 0%, 2.5%, 5.0% or 7.5% of silanated glass fibers (1.4mm in length, 7-13μm in diameter). DC (n=4) was obtained using near-FTIR. FS (n=10) was calculated via biaxial flexural test and FT (n=10) used the "single edge notched beam" method. PS at 5min (n=8) was determined using the strain gage method. Data were analyzed by ANOVA/Tukey test (DC, FS, PS) or Kruskal-Wallis/Dunn's test (FT, alpha: 5% for both tests).

RESULTS

DC was similar among groups (p>0.05). Only the composite containing 5.0% of fibers presented lower FS than the control (p<0.001). FT increased significantly between the control (1.3±0.17MPam(0.5)) and the composites containing either 5.0% (2.7±0.6MPam(0.5)) or 7.5% of fibers (2.8±0.6MPam(0.5), p<0.001). PS in relation to control was significantly reduced at 2.5% fibers (from 0.81±0.13% to 0.57±0.13%) and further reduced between 5.0% and 7.5% (from 0.42±0.12% to 0.23±0.07%, p<0.001).

SIGNIFICANCE

The replacement of a small fraction of filler particles with glass fibers significantly increased fracture toughness and reduced post-gel shrinkage of experimental composites.

Polymerization stress of experimental composites containing random short glass fibers

OBJECTIVE

To test the null hypotheses that (1) the replacement of particles by short fibers does not affect polymerization stress (PS), flexural modulus (FM) or volumetric shrinkage (VS) of experimental composites and (2) PS is not affected by specimen thickness.

METHODS

Three experimental composites were prepared, each containing similar mass fractions of BisGMA and TEGDMA and 60 vol% of fillers, being 0%, 3% or 6% constituted by 1.6-mm long glass fibers and the remaining by 1μm glass particles. PS (n=5) was tested in a high compliance system, using two specimen heights (1.5mm and 4.0mm). VS and maximum shrinkage rate were obtained in a mercury dilatometer (n=3). FM was tested in three-point bending (n=10). As an additional control, a commercial composite (Filtek Z250, 3M ESPE) was tested. Data were recorded 10min after the onset of photoactivation and analyzed by ANOVA/Tukey test (FM only) and Kruskal-Wallis (alpha: 5%).

RESULTS

At both specimen heights, the composite with 3% of fibers presented significantly higher PS than the controls (which showed similar PS values). Replacing 6% of particles by fibers did not increase PS significantly. FM was reduced in the presence of fibers, and 6% of fibers led to a decrease in VS. Shrinkage rate was not affected by the fibers.

SIGNIFICANCE

Replacing 3vol% of particles by fibers resulted in significantly higher PS, which was associated to a decrease in FM compared to the control. PS was not affected by specimen height for any of the tested materials.

Microshear bond strength of preheated silorane- and methacrylate-based composite resins to dentin

The aim of this study was to investigate the effect of preheating on microshear bond strength (MSBS) of silorane and methacrylate-based composite resins to human dentin. The teeth were randomly divided into three main groups: (1) composite resins were heated upto 68 °C; (2) cooled to 4 °C; and (3) control [room temperature (RT)]. Each group was then randomly subdivided into four subgroups according to adhesive system used [Solobond M (Voco), All Bond SE (Bisco), Clearfil SE Bond (CSE) (Kuraray), Silorane adhesive system (SAS) (3M ESPE)]. Resin composite cylinders were formed (0.9 mm diameter × 0.7 mm length) and MSBS of each specimen was tested. The preheated groups exhibited the highest MSBS (p < 0.001) and the groups cooled to 4 °C exhibited the lowest MSBS (p < 0.001). The CSE showed higher MSBS than the other adhesives (p < 0.001). This study concludes that preheating of composite resins may be an alternative way to increase the MSBS of composites on dentin.

Effect of Desensitizing Agents on the Bond Strength of Mild and Strong Self-etching Adhesives

BACKGROUND

Desensitizing agents are used, almost as routine practice, in many adhesive restorative procedures. There is still debate as to their effect in dentin bonding, particularly with self-etching adhesives. The present study aimed to evaluate the effect of different desensitizing agents on the bond strength of mild and strong self-etching adhesive systems to dentin.

MATERIALS AND METHODS

One hundred twenty recently extracted, noncarious human molars were used to obtain superficial dentin substrate for bonding. No desensitizer was used in the control groups. The experimental groups were pretreated with Gluma Desensitizer, MicroPrime B, and Dentin Desensitizer immediately prior to bonding with self-etching adhesives Optibond XTR, Xeno IV, and iBond. A bonding jig was used to fabricate composite cylinders, which were stored for either 24 hours or three months, after which the shear bond strength (SBS) was evaluated using a notched-edge testing device at a crosshead speed of 1 mm/min. Failure mode distribution was also evaluated at 24 hours and three months. A two-way analysis of variance, Tukey test, and Student t-test, with a significance level of p<0.05, were used for data analysis.

RESULTS

At 24 hours, there was no significant difference in SBS when the same adhesive was used with any of the experimental desensitizing agents compared with the control group without desensitizer. However, at three months, Dentin Desensitizer bonded with Optibond XTR demonstrated significantly lower SBS (p<0.001), while Gluma bonded with iBond showed significantly higher SBS values (p=0.034) relative to their corresponding control group. Only MicroPrime B bonded with Xeno IV and iBond with no desensitizer demonstrated a significant reduction in SBS after three months (p=0.034 and p=0.002, respectively). The most prevalent type of failure was adhesive.

CONCLUSION

Desensitizing agents can be used in combination with self-etching adhesives to control hypersensitivity without adversely affecting their bond strength to dentin.

Three-year Clinical Evaluation of Different Restorative Resins in Class I Restorations

The aim of the present study was to evaluate the three-year clinical performance of a nanofilled resin composite, a packable resin composite, and silorane-based resin restorations in Class I occlusal cavities. Twenty-eight patients with at least three similar-sized occlusal lesions in molar teeth participated in the study. A total of 84 Class I occlusal restorations were placed: 28 with nanofilled resin composite (Filtek Supreme), 28 with packable resin composite (P60), and 28 with silorane-based resin (Filtek Silorane). Filtek Supreme and P60 were used with their respective etch-and-rinse adhesive system, Adper Single Bond 2, and Filtek Silorane was used with its respective self-etch adhesive, Filtek Silorane Adhesive. All restorations were placed by the same operator. The restorations were evaluated at baseline, at six months, and annually for three years according to modified US Public Health Service criteria by two calibrated examiners who did not know which restorative resin had been used. The three restorative materials for each category were compared using the χ2 test at a significance level of 0.05. Cochran's Q test was used to compare the changes across the five time points for each restorative material. McNemar's test followed by Bonferroni adjustment was used when significance differences were found. At the end of the three years, 60 restorations were evaluated in 20 patients, with a recall rate of 71.4%. The retention rate was 100% for all restorative resins. Eight restorations from the P60 group, ten from the Filtek Supreme group, and nine from the Filtek Silorane group were rated Bravo for marginal discoloration. For marginal adaptation, three P60, five Filtek Supreme, and 11 Filtek Silorane restorations were rated Bravo. No statistically significant differences in overall clinical performance were found between the restorative materials except for marginal adaptation. P60 showed the best marginal adaptation at the end of the three years. No differences were observed between the restorative resins for any of the evaluation criteria tested (p&gt;0.05). None of the restorations showed postoperative sensitivity, secondary caries, or loss of anatomic form. All restorative resins performed equally well in clinical conditions during the three-year evaluation, and no significant differences were found among them, except for marginal adaptation, in which P60 showed superior results.

Comparative evaluation of compressive strength and flexural strength of conventional core materials with nanohybrid composite resin core material an in vitro study

Several dental materials have been used for core build-up procedures. Most of these materials were not specifically developed for this purpose, but as a consequence of their properties, have found application in core build-up procedures. Improvements in composites and the development of nanocomposites have led to their use as a core build up material due to their superior mechanical properties, optical properties and ease of handling. However it is not clear if they have better mechanical properties than the conventional core build up materials like amalgam, GIC and dual cure composite core build up material. The strength of the core material is very important and this study was undertaken to compare the mechanical properties of materials used for direct core foundations. The differences between the compressive strength and flexural strength of Filtek Z350 nanocomposite with conventional core build up materials like Amalgam, Vitremer GIC and Fluorocore were tested. Cylindrical plexi glass split molds of dimension 6 ± 1 mm [height] x4 ± 1 mm [diameter] were used to fabricate 15 samples of each core material for testing the compressive strength and rectangular plexi glass split molds of dimension 25 ± 1 mm [length] x 2 ± 1 mm[height] x2 ± 1 mm [width] used for fabricating samples for flexural strength. The samples were stored a water bath at 250 °C for 24 h before testing. The samples were tested using a Universal Instron testing machine. The results of the study showed that Fluorocore had the highest compressive strength and flexural strength followed by Filtek Z350 [nanocomposite] Amalgam had the least flexural strength and Vitremer GIC had the least compressive strength. Thus flurocore and nanocomposite are stronger than other core build up materials and hence should be preferred over other conventional core build up materials in extensively damaged teeth.

Comparative evaluation of residual monomer content and polymerization shrinkage of a packable composite and an ormocer

Aim:

The aim of this study is to evaluate the residual monomer content and polymerization shrinkage of a packable composite (Surefil) and an ormocer (Admira).

Materials and Methods:

The study was conducted in two parts. In Part I, 10 samples of each material were prepared in a standardized split brass mould, using incremental curing technique. The residual monomer content was measured by observing change in weight before and after Soxhlet Extraction procedure. In part II, the volumetric polymerization shrinkage was calculated by measuring the difference in specific gravities of 10 uncured and 10 cured samples of each material using a modified version of ASTM D-792 method. The data obtained was put to statistical analysis using student's ‘t’ test.

Results:

Part I - The percentage change in weight for Surefil was 0.525% while that for Admira was 0.374%, which was found to be statistically significant. Part II - The volumetric percentage shrinkage for Surefil ranged between 1.04-3.42% and that for Admira between 1.01-2.31%, which was not found to be significant statistically.

Conclusion:

Admira may be considered more biocompatible than Surefil due to the lower residual monomer content in the former; however, both are comparable with regards to their polymerization shrinkage.

Effect of repeated preheating cycles on flexural strength of resin composites

The aim of this study was to assess the flexural strengths of three resin composites prepared at room temperature or cured after 20 or 40 cycles of preheating to a temperature of 45°C. Three resin composites were evaluated: Enamel Plus HFO (Micerium) (HFO), Enamel Plus HRi (Micerium) (HRi), Opallis + (FGM) (OPA). One group of specimens for each composite was fabricated under ambient laboratory conditions, whereas in the other groups, the composites were cured after 20 or 40 preheating cycles to a temperature of 45°C in a preheating device. Ten specimens were prepared for each group. A three-point bending test was performed using a universal testing machine at a crosshead speed of 0.5 mm/min. Data were analyzed with a two-way analysis of variance (ANOVA) test and a Games-Howell test (α = 0.05). The two-way ANOVA showed that both the material and the number of heating cycles were significant factors, able to influence the flexural strength values (p<0.05). However, there was not a statistically significant interaction (p>0.05). For all three composites flexural strengths were not affected after 20 preheating cycles in comparison with the control groups (0 preheating cycles) but were, however, significantly decreased when 40 prewarming cycles were conducted. The HRi and OPA groups had the highest flexural strengths, with no statistically significant differences among them. HFO presented significantly lower flexural strengths in comparison with HRi.

A method for assessing force/work parameters for stickiness of unset resin-composites

OBJECTIVES

To evaluate the stickiness of unset resin-composites, at different speeds and temperatures, in terms of maximum probe separation-force (F(max)) and work-of-separation (W(s)).

MATERIALS AND METHODS

Eight commercial light-cured resin-composites were selected. Each material was placed in a cylindrical mold (φ=7 mm × 5 mm depth) held at 25 °C or 37 °C. The maximum force (F(max), N) and work probe separation (W(s), N mm) were measured by using a texture analyzer to register force/displacement. A flat-ended stainless-steel probe (φ=6mm) was mechanically lowered onto and into the surface of the unset sample. When a 'trigger' compressive force of 0.05 N was registered, data-acquisition commenced. Descent continued until a compressive force of 1N was reached, which was held constant for 1s. Then the probe was moved vertically upward at constant speed. This was varied over the range 2, 4, 6 and 8mm/s. The tensile force produced on the probe by the sticky resin-composite was plotted against displacement and the maximum value was identified (F(max)). W(s) was obtained as the integrated area. Data was analyzed by multivariate ANOVA and multiple pair wise comparisons was done by using a Tukey post hoc test to establish homogenous subsets (at p=0.05).

RESULTS

F(max) and W(s) were taken as potential measures of stickiness. They ranged from 0.47 to 3.68 N and from 0.11 to 2.84 N mm, respectively. Multivariate ANOVA showed a strong interaction of withdrawal speed, temperature and materials on both F(max) and W(s) (p<0.001).

CONCLUSION

F(max) and W(s) are useful parameters for characterizing the handling-stickiness of resin-composite materials, additional to previously reported stickiness-strain or 'peak-height'. The resin-composites investigated could be differentiated, mostly showing increases in F(max) and W(s) stickiness with increased temperature and probe-withdrawal speed.

Morphological analysis of proximal contacts in class II direct restorations with 3D image reconstruction

OBJECTIVES

To evaluate the proximal contact on class II composite restorations constructed using various restorative approaches by a morphological analysis.

METHODS

Sixty plastic premolar teeth were prepared for class II cavities. These teeth were divided into six groups and restored using different materials and matrix systems. Two composite materials used were a microhybrid composite Filtek Z100 (3M/ESPE) and a packable composite P60 (3M/ESPE). Three interproximal matrix systems were two circumferential metal matrices (0.05 mm and 0.03 mm thin, respectively) combined with a Tofflemire retainer, and a pre-contoured sectional matrix system (Palodent). The contact morphologies of the restorations were visually inspected with regard to their buccolinugal and mesiodistal aspects. The contact tightness was measured by inserting different amounts of metal strips. For quantitatively morphologic analysis, three-dimensional (3D) scans of proximal contacts were performed. The results were analysed with two-way ANOVA and the Tukey test.

RESULTS

Under visual observation, contact surfaces in sectional matrix groups showed anatomic profile but concave in the centre, whilst the circumferential matrix groups showed flat profiles. The sectional matrix improved the contact tightness. The 3D analysis revealed that the matrix system was correlated with the contact morphology, since the sectional matrix generated significantly deeper and wider surface concavity.

CONCLUSIONS

All the interproximal matrix systems presented some deficiency in either the contact tightness or contours. Although the sectional matrix system enhanced contact tightness, it caused contact concavity by formation of interproximal marginal overhang. The quantitative morphologic analysis helps to examine improper proximal contact and the associated problems.

Effect of light curing modes and ethanol immersion media on the susceptibility of a microhybrid composite resin to staining

The aim of this in vitro study was to evaluate the susceptibility of a hybrid composite resin (Filtek Z250 – 3M ESPE) to staining, when light cured in four different modes and immersed in two different media. Composite resin specimens were randomly prepared and polymerized according to the experimental groups (conventional - 550 mW/cm² / 30 seconds; soft start - 300mW/cm²/ 10 seconds + 550 mW/cm² / 20 seconds; high intensity - 1060 mW/cm² – 10 seconds; pulse delay – 550 mW/cm² – 1 seconds + 60 seconds of waiting time + 550 mW/cm² – 20 seconds) and immersed in one of two media (distilled water or absolute ethanol) for 24h. Next, the specimens were immersed in a 2% methylene blue solution for 12 hours. Afterwards, the specimens were washed and prepared for the spectrophotometric analysis. For statistical analysis, two-way ANOVA (4×2) and Tukey's test were performed on the data at 0.05 confidence level. Soft start showed the least staining, and was statistically different from the high intensity and pulse delay light curing modes (p<0.05). Conventional light curing unit did not show statistically significant differences from any other groups (p>0.05). There were no significant differences between the two immersion media (p>0.05). The soft start polymerization mode showed lower susceptibly of the composite resin to staining than high intensity and pulse delay, irrespective of the immersion medium.

Post-gel shrinkage strain and degree of conversion of preheated resin composite cured using different regimens

OBJECTIVES

This study investigated the influence of resin composite preheating temperature, light curing regimen (mode and duration) on post-gel shrinkage strain (PGSS) and degree of conversion (DC) of a restorative resin composite.

METHODS

A hybrid resin composite preheated to three different temperatures (37 degrees C, 54 degrees C and 68 degrees C) was cured using a high intensity light emitting diode (LED) curing unit. The light source was used in 40- and 20-second continuous mode as well as soft start mode. The resin composite was monitored for PGSS during curing and 10 minutes following light irradiation using strain gauges. DC was measured using FTIR spectrometer. The results were analyzed using two-way ANOVA followed by the Duncan's Multiple Range Test for pairwise comparisons. The significance level was set at p < or = 0.05.

RESULTS

Preheating of the resin composite significantly increased its PGSS and DC. The soft start groups revealed significantly lower PGSS values compared to the 20- and 40-second groups without altering the DC.

CONCLUSIONS

Preheating of resin composite prior to curing increased its DC but also increased its PGSS. The soft-start mode decreased the PGSS of resin composite without altering the DC.

Effect of aging on coronal microleakage in access cavities through metal ceramic crowns restored with resin composites

PURPOSE

The purpose of this in vitro study was to determine if packable resin composite with/without flowable resin composite has the ability to prevent coronal leakage in restored endodontic access openings following aging.

MATERIALS AND METHODS

Eighty simulated standardized access cavities of metal-ceramic crowns were fabricated and fixed on Vitrebond cavities filled with an epoxy resin. The specimens were randomly divided into two main groups: (1) Group A-Access cavities filled with only packable composite (Filtek P60); (2) Group B-Access cavities filled with Filtek P60 and a flowable composite (Filtek Z350) as liner. Each main group was further subdivided randomly into four subgroups according to water storage and thermocycling periods. All specimens were immersed in blue ink solution for 24 hours and then sectioned into quadrants. The extension of blue ink along the metal-ceramic crown/composite resin interface was measured linearly using image analyzer and then analyzed by three-way ANOVA and independent t-test with a Mann-Whitney test. The level of significance was set at p < 0.05.

RESULTS

All tested subgroups demonstrated different levels of microleakage. There was no significant difference related to restorative technique; however, there was a significant difference related to water storage and thermocycling.

CONCLUSIONS

All tested techniques and materials in this study showed microleakage. Packable composite while a flowable liner showed a marginally better result than packable composite alone. Excessive thermocycling resulted in significant differences among the test groups.

Cuspal movement and gap formation in premolars restored with preheated resin composite

OBJECTIVE

The current study aimed to determine the effect of preheating resin composite to three different temperatures on the cuspal movement and gap formation at the tooth/restoration interface.

METHODS

Fifty extracted, sound human upper premolars were subjected to standardized MOD cavity preparations. Five groups of 10 premolars each were restored with either 1) Tetric Ceram HB, 2) a layer of Tetric Flow followed by Tetric Ceram HB, 3-5) preheated composite to 37 degrees C, 54 degrees C and 68 degrees C, respectively, using a chair-side preheating device (Calset thermal assist unit). Cuspal movement was calculated by measuring the intercuspal distance between the indexed cusp tips before restoration 5 minutes and 24 hours after composite curing using a stereomicroscope. The teeth were sectioned longitudinally and examined under a stereomicroscope connected to a digital camera and image analysis software to detect gap formation.

RESULTS

Group 2 showed the least cuspal movement at 5 minutes and 24 hours and the highest gap area, while Groups 4 and 5 showed the highest cuspal movement at 5 minutes and 24 hours. Group 3 had the least gap area.

CONCLUSIONS

Preheating resin composite to temperatures higher than 37 degrees C increases cuspal movement. The adaptation and gap area of preheated resin composite to 37 degrees C and 54 degrees C improved, but it did not change with resin composite preheated to 68 degrees C.

Influence of light curing and sample thickness on microhardness of a composite resin

The aim of this in vitro study was to evaluate the influence of light-curing units and different sample thicknesses on the microhardness of a composite resin. Composite resin specimens were randomly prepared and assigned to nine experimental groups (n = 5): considering three light-curing units (conventional quartz tungsten halogen [QTH]: 550 mW/cm² – 20 s; high irradiance QTH: 1160 mW/cm² – 10 s; and light-emitting diode [LED]: 360 mW/cm² – 40 s) and three sample thicknesses (0.5 mm, 1 mm, and 2 mm). All samples were polymerized with the light tip 8 mm away from the specimen. Knoop microhardness was then measured on the top and bottom surfaces of each sample. The top surfaces, with some exceptions, were almost similar; however, in relation to the bottom surfaces, statistical differences were found between curing units and thicknesses. In all experimental groups, the 0.5-mm-thick increments showed microhardness values statistically higher than those observed for 1- and -2-mm increments. The conventional and LED units showed higher hardness mean values and were statistically different from the high irradiance unit. In all experimental groups, microhardness mean values obtained for the top surface were higher than those observed for the bottom surface. In conclusion, higher levels of irradiance or thinner increments would help improve hybrid composite resin polymerization.

Six-year Clinical Evaluation of Packable Composite Restorations

As a posterior composite, Filtek P60 exhibited very good clinical performance in Class II cavities for six years.

Novel nano-particles as fillers for an experimental resin-based restorative material

The purpose of this study is to compare the properties of two experimental materials, nano-material (Nano) and Microhybrid, and two trade products, Clearfil AP-X and Filtek Supreme XT. The flexural strength and modulus after 24h water storage and 5000 thermocycles, water sorption, solubility and X-ray opacity were determined according to ISO 4049. The volumetric behavior (DeltaV) after curing and after water storage was investigated with the Archimedes principle. ANOVA was calculated with p<0.05. Clearfil AP-X showed the highest flexural strength (154+/-14 MPa) and flexural modulus (11,600+/-550 MPa) prior to and after thermocycling (117+/-14 MPa and 13,000+/-300 MPa). The flexural strength of all materials decreased after thermocycling, but the flexural modulus decreased only for Filtek Supreme XT. After thermocycling, there were no significant differences in flexural strength and modulus between Filtek Supreme XT, Microhybrid and Nano. Clearfil AP-X had the lowest water sorption (22+/-1.1 microg mm(-3)) and Nano had the highest water sorption (82+/-2.6 microg mm(-3)) and solubility (27+/-2.9 microg mm(-3)) of all the materials. No significant differences occurred between the solubility of Clearfil AP-X, Filtek Supreme XT and Microhybrid. Microhybrid and Nano provided the highest X-ray opacity. Owing to the lower filler content, Nano showed higher shrinkage than the commercial materials. Nano had the highest expansion after water storage. After thermocycling, Nano performed as well as Filtek Supreme XT for flexural strength, even better for X-ray opacity but significantly worse for flexural modulus, water sorption and solubility. The performances of microhybrids were superior to those of the nano-materials.

Direct composite restorative materials

Composite dental restorative materials have advanced considerably over the past 10 years. Although composites have not totally replaced amalgam, they have become a viable substitute in many situations. Problems still exist with polymerization contraction stress, large differences in the coefficient of thermal expansion (CTE) of composites compared with tooth structure, and with some technique sensitivity; however, new expanding resins, nanofiller technology, and improved bonding systems have the potential to reduce these problems. With increased patient demands for esthetic restorations, the use of direct filling composite materials will continue to grow. The one major caveat to this prediction is that clinicians must continue to use sound judgment on when, where, and how to use composite restoratives in their practices.

Effect of the composite surface sealant application moment on marginal sealing of compactable composite resin restoration

An analysis was carried out to observe whether the application or not of a composite surface sealant (CSS), as well the moment for CSS application were able to reduce marginal microleakage in compactable composite resin restoration. All the preparations were restored with a compactable composite resin. The restored teeth were randomly assessed. G1 (control group): finished and polished; G2: finished, polished, etched and cover with CSS; G3: immediately after the restoration done the CSS was applied, then finished and polished; G4: CSS applied immediately after the restoration was done, the finished and polished, etched, and covered with CSS. The specimens were isolated with nail polish, thermocycled, immersed in aqueous solution of silver nitrate, and followed in a photo developing solution. The microleakage scores obtained from the occlusal and cervical walls were analyzed with the Kruskall-Wallis nonparametric test. No microleakage was found at the enamel margins. Comparing the microleakage scores at dentin/cementum margins (p < 0.05) it was found that G3 (p = 0.0162) and G4 (p = 0.0187) were able to reduce microleakage when compared with group G2. However the results were not statistically different from the control group. The application of CSS was not able to completely eliminate marginal microleakage at the dentin/cementum margins.

A Study of Microleakage in Class II Composite Restorations Using Four Different Curing Techniques

For bonded direct Class II restorations, the use of transparent matrices or metal matrices combined with light conducting instruments, such as light tips, should be favored because marginal leakage is significantly lower when compared to using metal matrices alone.

Effect of incremental filling technique on adhesion of light-cured resin composite to cavity floor

The purpose of this study was to evaluate the effect of various incremental filling techniques on adhesion between composite and cavity floor using light-cured resin composite. Black ABS resin and hybrid resin composite were used as mold materials--instead of dentin--for the preparation of cavities, and standardized to 5x5x5 mm. Each cavity was then treated with a bonding system (Clearfil SE bond). Resin composite (Clearfil Photo Core) was placed on the bonding resin using different incremental filling techniques or in bulk and irradiated for a total of 80 seconds using a halogen light unit. Specimens were subjected to the micro-tensile bond test at a crosshead speed of 1 mm/min. Data were analyzed by two-way ANOVA. The results indicated that an incremental filling technique was more effective in improving adhesion to the cavity floor than a bulk filling technique.

The effects of thermocycling on the flexural strength and flexural modulus of modern resin-based filling materials

OBJECTIVE

Evaluation of flexural strengths and flexural moduli of hybrids, packables, ormocers, compomers and flowables prior to, and after, thermocycling.

MATERIALS AND METHODS

Twenty specimens, size (25 +/- 2) mm x (2 +/- 0.1) mm x (2+/-0.1) mm, of Herculite (HE), Point 4 (P4), TetricCeram (TC), Miris (MI), TetricCeram HB, (HB), Solitaire 2 (SO), Surefil A (SU), Definte (DE), Admira (AD), Dyract AP (DY), Compoglass (CO) and TetricFlow (TF) were made according to ISO 4049. A three-point-bending test was carried out for the first 10 specimens after 24 h water storage at 37 degrees C and for the second 10 specimens after 30-day water storage at 37 degrees C, followed by 5000 thermocycles between +5 and +55 degrees C. For each test series flexural strengths and flexural moduli were calculated. Statistical significance was p < 0.05.

RESULTS

Flexural strengths of DY and CO missed the 80 MPa limit of ISO 4049 for occlusal fillings prior to and after thermocycling. AD missed it after thermocycling. HE, P4, TC, MI, HB, SO, SU, DE and TF did not significantly differ prior to and after thermocycling. Flexural strength of SO and AD significantly decreased after thermocycling. No change of the flexural moduli could be observed for any of the test materials. Only SU exceeded 10,000 MPa prior to and after thermocycling.

SIGNIFICANCE

Only DY and CO missed the flexural strength limit of ISO 4049 for occlusal fillings. Only SU exceeded a flexural modulus of 10,000 MPa prior to and after thermocycling.

Fiber-reinforced packable resin composites in Class II cavities

OBJECTIVE

To evaluate the 6-year performance of two glass fiber-reinforced packable resin composites in Class II cavities.

METHODS

Sixty-three participants received 87 medium to large, cervically dentin bordered, Class II restorations of two fiber-reinforced resin composites, 42 Nulite F (N) and 45 Alert (A). The restorations were evaluated clinically, according to slightly modified USPHS criteria at baseline, after 6 months, and yearly during 6 years.

RESULTS

At 2 years the cumulative failure frequencies for N and A were 4.8% and 2.2%, respectively, which increased at 6 years to 25.0% and 12.8%. Reasons for failure were secondary caries, material and cusp fracture. The majority of the failures occurred after 3 years. Secondary caries occurred between 4 and 6 years. The incorporation of fibers resulted in very rough surface characteristics.

CONCLUSIONS

A rather high failure rate was observed for one of the fiber-reinforced resin composites, while the other fulfilled the ADA criteria. The occurrence of most failures after 3 years indicated the necessity of long-term evaluations of new materials.

Clinical Evaluation of a Nanofilled Composite in Posterior Teeth: 12-month Results

Nanofilled resin composite showed excellent clinical performance, similar to microhybrid and packable composites after 12-months.

The linear shrinkage and microhardness of packable composites polymerized by QTH or PAC unit

This study evaluated the effectiveness of a plasma arc curing (PAC) unit for packable resin composite curing. The amount and speed of polymerization shrinkage and the microhardness of packable composites were evaluated in order to compare the PAC unit's effectiveness with a quartz tungsten halogen (QTH) unit. Sure Fil (Dentsply Caulk), Pyramid (BISCO Inc) and Synergy Compact (Colténe/Whaledent) were used as the packable composites. In the case of curing with the PAC unit, the composites were light cured with Apollo 95E (DMD System Inc) for 1 second (Group 1), 2 seconds (Group 2), 3 seconds (Group 3), 6 seconds (Group 4) and 12 seconds (Group 5). For light curing with the QTH unit, the composites were light cured for 60 seconds using XL3000 (Group 6). The linear polymerization shrinkage of each composite was measured using a custom made linometer, and the data was stored in a computer every 0.5 to 0.55 seconds for a total of 60 seconds. For each composite, the amount of polymerization was compared using one-way ANOVA with Tukey at the 95% confidence level. In order to compare the speed of polymerization, the peak time (PT), showing the highest speed of polymerization and maximum speed of polymerization (Smax), were determined from the data and compared using one-way ANOVA with Tukey at the 95% confidence level for each material. Based on the statistical analysis among the PAC-cure groups (Groups 1 through 5), the group that was not statistically different from the QTH-cure group (Group 6) in the amount of linear polymerization shrinkage was determined for each material, and the corresponding curing time of the group was defined as the tentative minimum PAC-curing time (TMPT). For microhardness measurements, the samples were placed in a 2-mm thick Teflon plate. Twenty specimens, randomly divided into the PAC-cure group (Group 1) or the QTH-cure group (Group 2), were prepared for each material. In Group 1, each composite was light cured for TMPT with the PAC unit. In Group 2, each composite was light cured for 60 seconds with the QTH unit. Microhardness was measured on the upper and lower surface. For each material, the microhardness of the upper and lower surface of Groups 1 and 2 was analyzed using two-way ANOVA with Tukey at the 95% confidence level. The amount of polymerization was Group 1<Group 2<Group 3<Group 4<Groups 5, 6 in the Sure Fil composite (p<0.05); Groups 1, 2<Group 3<Groups 4, 6<Group 5 in the Synergy Compact composite (p<0.05) and Group 1 <Group 2 <Group 3 <Groups 4, 6 <Group 5 in the Pyramid composite (p<0.05) Regarding the speed of polymerization, the order of PT was G1, G2, G3<G4, G5<G6 (p<0.05). The order of Rmax was G6<G1, G2, G3, G4, G5 in Sure Fil; G6<G1<G2, G3, G4<G5 in Synergy Compact (p<0.05) and G6<G1<G2, G3<G4, G5 in Pyramid (p<0.05) On the upper surface, there was no statistical difference in microhardness between Groups 1 and 2 in all materials. On the lower surface, the microhardness of Group 2 was significantly higher than Group 1 in all materials. In all materials in Group 1 and the Synergy Compact of Group 2, microhardness of the upper surface was significantly higher than the lower surface (p<0.05). In Sure Fil and Pyramid of Group 2, there was no difference in microhardness between the upper and lower surfaces.

3-Year clinical evaluation of posterior packable composite resin restorations

This study evaluated the clinical performance of four packable resin composite restorative materials in posterior teeth (Class I and II) compared with one hybrid composite after 3 years. Eighty-four restorations were placed in 16 patients. The tested materials were: (i) Solitaire + Solid Bond; (ii) ALERT + Bond-1; (iii) Surefil + Prime & Bond NT; (iv) Filtek P60 + Single Bond and (v) TPH Spectrum + Prime & Bond 2.1. All restorations were made using rubber dam isolation, and the cavity design was restricted to the elimination of carious tissue. Deeper cavities were covered with calcium hydroxide and/or glass-ionomer cement. Each adhesive system and composite resin was placed according to the manufacturer's instructions. One week later, the restorations were finished/polished and evaluated according USPHS modified criteria. Fourteen patients attended the 3-year recall and 75 restorations were evaluated at that time based on the same evaluation criteria. Friedman repeated measures analysis of variance by rank and Wilcoxon sign-ranked test for pair-wise comparison was used for data analysis (alpha = 0.05). The analysis was performed only for the baseline and for the 3-year period. Solitaire showed some fractures at marginal ridges in 25% of the cases. Solitaire and ALERT showed some concerns related to colour match (43 and 77%, respectively) and surface texture (86 and 77%, respectively). TPH Spectrum showed a great percentage of colour mismatch after 3 years, around 50%. Surefil and Filtek P60 showed an excellent clinical performance after 3 years, similar to the hybrid resin tested, TPH Spectrum. Solitaire did not fulfil the ADA acceptance criteria for restorative materials and, therefore, is not recommended for use in posterior restorations.

Clinical performance evaluation of a packable posterior composite in bulk-cured restorations

BACKGROUND

The authors evaluated the clinical performance of Prodigy Condensable (Kerr, Orange, Calif.) composite placed and cured in increments up to 5 millimeters thick.

METHODS

The authors placed 57 Class II restorations in 32 patients in composite increments up to 5 mm thick. Using this technique, they placed the majority of restorations in one increment and then carved the occlusal and proximal anatomy before light curing. The authors evaluated the restorations at three, six, 12, 24 and 36 months.

RESULTS

No restorations required replacement; however, 11 developed a defect requiring repair or continued observation. Of these 11, nine restorations developed defects on the margins of the restorations and two developed secondary caries. The Kaplan-Meier estimate of probability that a restoration would develop a defect during 36 months that would require immediate repair was 0.13. Postoperative sensitivity was not significantly different from preoperative sensitivity.

CONCLUSIONS

The authors found that no restorations required replacement and no increased postoperative sensitivity occurred.

CLINICAL IMPLICATIONS

The authors suggest that this composite material can be placed in a single increment up to 5 mm thick for Class II restorations.

Measurement of clinical wear of two packable composites after 6 months in service

Original large-particle composites exhibited poor wear characteristics. With the packable composites, there has been a reintroduction of large particles. The clinical wear characteristics of such packable composites are relatively unknown. The purpose of this study was to compare wear between two types of packable composites: Alert (Jeneric Pentron) and Surefil (Dentsply Caulk). Each material was compared with and without a surface sealant. Fifty-two subjects were included. Subjects had to have two to four eligible teeth, be 21 years of age, in good health and in need of moderate to large class 2 restorations on molars, and/or a two-surface class 1 on molars. Wear was assessed, using the Moffa-Lugassy (ML) scale, by evaluating stone models made from polyvinyl siloxane (PVS) impressions taken at baseline and 6 months. Rating was done by four calibrated examiners using a forced consensus model. The use of a surface sealant with Alert significantly reduced the median wear rate at 6 months compared with that of the SureFil restorations.

Hardness and diametral tensile strength of a hybrid composite resin polymerized with different modes and immersed in ethanol or distilled water media

OBJECTIVES

The aim of this in vitro study was to evaluate the microhardness and diametral tensile strength of a hybrid composite resin (Z250, 3M ESPE) polymerized with four different modes of light exposure and immersed in two different media.

METHODS

Composite resin specimens were randomly polymerized according to the experimental groups (conventional, 550 mW/cm(2)/30 s; soft start, 300 mW/cm(2)/10 s + 550 mW/cm(2)/20 s; high intensity, 1060 mW/cm(2)/10 s; pulse delay, 550 mW/cm(2)/1 s + 60 s of waiting time + 550 mW/cm(2)/20 s) and immersed in one of two media (distilled water or absolute ethanol) for 24 h. After that, microhardness (M) and diametral tensile strength (DTS) tests were performed.

RESULTS

For DTS, there were no statistical differences among the polymerization modes, however, ethanol medium groups presented statistically lower DTS (p < 0.05) than water medium. For the M test, samples immersed in ethanol medium presented lower M for almost all groups. Conventional mode presented higher M values for the groups immersed in water medium. In ethanol medium, conventional and pulse delay groups presented higher M values, statistically different (p < 0.05) from the high intensity group. For all experimental conditions, the top surface showed higher M than the bottom surface.

SIGNIFICANCE

Different polymerization modes can be related to the different polymer structures formed, and consequently with different physical properties of resin composite. The immersion media can alter the physical properties of resin composites of different polymer structures.