Effect of pre-heated composites and flowable liners on Class II gingival margin gap formation

One-year clinical evaluation of bulk-fill composite resin restorations plasticized by preheating and ultrasonics: A randomized clinical trial

Introduction:

Aim:

Methodology:

Results:

Conclusion:

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.

Application of Scanning Electron Microscopy in the observation of dentin-adhesive interface

The objective of this study was observation of the adhesive interface on original tooth samples, as well as their epoxy replicas, under SEM. A light-cure flowable composite was incrementally placed and light-polymerized in previously prepared cylindrical dentinal cavities on the buccal surfaces of extracted human third molars. After finishing procedures, impressions of the composite/dentin margin were made using polyvinylsiloxane in order to obtain accurate epoxy replicas for SEM analysis. Ultrastructural morphology of the adhesive surface was observed at high magnifications (≥1,000×) on original tooth samples, which were previously prepared to expose the part of the dentin surface, which participates in the formation of adhesive bond. SEM micrographs showed that marginal adaptation was mostly of acceptable quality. In some of the SEM micrographs of original tooth samples, marginal gap formation, and resin tag breakdown were noted, which were ascribed to polymerization shrinkage. Profound understanding of ultrastructural morphology is necessary for achieving more predictable and durable margin between composite restorations and surrounding tooth structures, and SEM analysis can serve that purpose.

The effect of composite resin preheating on marginal adaptation of class II restorations

Background

One of the problems with a high filler content composite resins is gap formation at restorative material-tooth interface. The present study investigated the effect of preheating composite resins on the formation of marginal gap in Cl II restorations.

Material and Methods

In this in vitro study Sixty Cl II cavities were prepared on the mesial and distal surfaces of 30 extracted premolar teeth. The gingival floor of cavities was placed 1 m below the CEJ. The samples were randomly allocated to 4 groups for restoration placement: group 1, Filtek P60 composite resin at room temperature; group 2, Filtek P60 composite resin at 68°C; group 3, X-tra fil composite resin at room temperature; and group 4, X-tra fil composite resin at 68°C. After a thermocycling procedure, the teeth were sectioned longitudinally in a buccolingual direction. Then the marginal gaps of the samples were measured at proximal and gingival margins under a scanning electron microscope at ×2000 magnification in µm. The data were analyzed with SPSS 21, using one-way ANOVA, post hoc Tukey tests and paired t-test (α=0.05).

Results

Groups 2 and 4 exhibited significantly lower marginal gaps, compared to groups 1 and 3, at both enamel (P<0.0001 and P=0.001, respectively) and dentinal walls (P<0.0001). In all the groups, there was significantly less marginal gaps at composite-enamel wall compared to composite-dentin wall interfaces (P<0.0001). There was no significant difference between groups 1 and 3 and groups 2 and 4 in enamel walls (p= 0.96, p= 0.99 respectively) and dentinal walls (p= 0.85, p=0.98 respectively).

Conclusions

Preheating resulted in a decrease in marginal gaps in both composite resins. The effect of composite resin type on marginal adaptation was the same. Key words:Composite resin, dental marginal adaptation, preheating.

Minimally invasive rehabilitation of the worn dentition: a case report utilising adhesive additive techniques and digital technologies

The management of the worn dentition presents an increasing challenge that is encountered more frequently in daily dental practice. The consequences of tooth wear tend to be multifactorial and while they may initially only involve the loss of surface enamel it can progressively lead to significant destruction of the dentition. This paper discusses the management of a tooth wear case where a significant amount of tooth structure has been lost from both the anterior and posterior teeth. Protocols for assessment, treatment planning and restorative management of the tooth wear case are presented demonstrating the use of adhesive additive techniques and digital technologies to achieve functional and aesthetic rehabilitation of the dentition.

Marginal Integrity of Bulk Versus Incremental Fill Class II Composite Restorations

Bulk-fill composites have been introduced to facilitate the placement of deep direct resin composite restorations. This study aimed at analyzing the cervical marginal integrity of bulk-fill vs incremental and open-sandwich class II resin composite restorations after thermomechanical cycling using replica scanning electron microscopy (SEM) and ranking according to the World Dental Federation (FDI) criteria. Box-only class II cavities were prepared in 91 maxillary premolars with the gingival margin placed 1 mm above and below the cemento-enamel junction. Eighty-four premolars were divided into self-etch and total-etch groups, then subdivided into six restorative subgroups (n=7): 1-Tetric Ceram HB (TC) was used incrementally and in the open-sandwich technique with 2-Tetric EvoFlow (EF) and 3-Smart Dentin Replacement (SD). Bulk-fill restoratives were 4-SonicFill (SF), 5-Tetric N-Ceram Bulk Fill (TN), and 6-Tetric EvoCeram Bulk Fill (TE). In subgroups 1-5, Tetric N-Bond self-etch and Tetric N-Bond total-etch adhesives were used, whereas in subgroup 6, AdheSE self-etch and ExciTE F total etch were used. One more group (n=7) was restored with Filtek P90 Low Shrink Posterior Restorative (P9) only in combination with its self-etch P90 System Adhesive. Materials were manipulated and light cured (20 seconds, 1600 mW/cm(2)), and restorations were artificially aged by thermo-occlusal load cycling. Polyvinyl-siloxane impressions were taken and poured with epoxy resin. Resin replicas were examined by SEM (200×) for marginal sealing, and percentages of perfect margins were analyzed. Moreover, samples were examined using loupes (3.5×) and explorers and categorized according to the FDI criteria. Results were statistically analyzed (SEM by Kruskal-Wallis test and FDI by chi-square test) without significant differences in either the replica SEM groups (p=0.848) or the FDI criteria groups (p>0.05). The best SEM results at the enamel margin were in TC+EF/total-etch and SF/total-etch and at the cementum margins were in SF/total-etch and TE/self-etch, while the worst were in TC/self-etch at both margins. According to FDI criteria, the best was TE/total-etch at the enamel margin, and the poorest was P9/self-etch at the cementum margin. Groups did not differ significantly, and there was a strong correlation in results between replica SEM and FDI ranking.

The evaluation of various restoration techniques on internal adaptation of composites in class v cavities

Aim. The aim of this study was to evaluate the effect of different restoration techniques on the formation of internal microgaps between materials and dentin in class V restorations. Materials and Methods. Twenty-five extracted human premolars were prepared with standardized class V cavity outlines (3 mm × 2 mm × 2 mm). The cavities were randomly divided into 5 groups of 10 cavities each and restored according to manufacturer's instructions: Group 1: preheating (55°C) conventional composite (Filtek Z250), Group 2: flowable composite (Filtek Flow), Group 3: Filtek Flow + Filtek Z250 light-cured separately, Group 4: Filtek Flow + Filtek Z250 light-cured simultaneously, and Group 5 (control): Filtek Z250 at room temperature (23°C). The specimens were then thermocycled and cross-sectioned through the center of the restoration. Subsequently, impressions were taken, and epoxy resin replicas were made. The internal adaptation of the materials to the axial wall was analyzed under SEM. Results. The preheated Filtek Z250 (Group 1) showed better internal adaptation than the room temperature groups (P < 0.05). The combination of Filtek Flow with Filtek Z250 which was light-cured separately (Group 3) exhibited better internal adaptation than control group (P < 0.05). Conclusion. Different restoration techniques exhibit different behavior regarding internal adaptation to dentin after photopolymerization.

Comparison of microleakage and thickness of resin cement in ceramic inlays with various temperatures

Background and aims. Microleakage is still one of the major problems of composite-based restorations.This study compared the microleakage and thickness of resin cement in ceramic inlays with various temperatures. Materials and methods. Class V cavities were prepared on the buccal and lingual aspects of thirty human molars with occlusal margins in enamel and gingival margins in dentin (3 mm wide, 5 mm long and 2 mm deep). Laboratory-made inlays (LMI) were used for buccal cavities, and CAD/CAM inlays (CMI) were used for lingual cavities. All the cavities were divided into six groups (n=10): 1) LMI at -5°C; 2) LMI at 50°C; 3) LMI at room temperature (25°C); 4) CMI at -5°C; 5) CMI at 50°C; 6) CMI at room temperature (25°C). Inlays were bonded to cavities in a pulp pressure- and temperature-simulating device. After thermocycling and dye penetration, the teeth were divided into two mesiodistal halves. Amount of dye penetration and film thickness were measured under a stereomicroscope and analyzed with Kruskal-Wallis, Wilcoxon and Spearman's correlation tests ( = 0.05). Results. There were no statistically significant differences in leakage between different inlay temperatures (P > 0.05). The mean cement thickness in laboratory-made inlays (gingival margin, 83.7 ± 11 and occlusal margin, 84.7 ± 19) was greater than that in CAD/CAM inlays (gingival margin, 69 ± 16 and occlusal margin, 84.7 ± 16). No correlation was found be-tween cement thickness and microleakage either in enamel or dentin for any of the ceramic systems. Conclusion. Differences in inlay temperature had no effect on microleakage. CAD/CAM inlays had lower cement thickness than laboratory-made inlays, but this was not related to their microleakage.

Effect of configuration factor on gap formation in hybrid composite resin, low-shrinkage composite resin and resin-modified glass ionomer

AIM

Polymerization shrinkage is one of the important factors in creation of gap between dental structure and composite resin restorations. The aim of this study was to evaluate the effect of configuration factor (C-factor) on gap formation in a hybrid composite resin, a low shrinkage composite resin and a resin modified glass ionomer restorative material.

METHODS

Cylindrical dentin cavities with 5.0 mm diameter and three different depths (1.0, 2.0 and 3.0 mm) were prepared on the occlusal surface of 99 human molars and the cavities assigned into three groups (each of 33). Each group contained three subgroups depend on the different depths and then cavities restored using resin modified glass ionomer (Fuji II LC Improved) and two type composite resins (Filtek P90 and Filtek Z250). Then the restorations were cut into two sections in a mesiodistal direction in the middle of restorations. Gaps were measured on mesial, distal and pulpal floor of the cavities, using a stereomicroscope.

RESULTS

Data analyses using Kruskal-Wallist and Mann-Whitney tests. Increasing C-factor from 1.8 to 3.4 had no effect on the gap formation in two type composite resins, but Fuji II LC Improved showed significant effect of increasing C-factor on gap formation. Taken together, when C-factor increased from 1.8 up to 3.4 had no significant effect on gap formation in two tested resin composites. Although, Filtek P90 restorations showed smaller gap formation in cavities walls compared to Filtek Z250 restorations.

CONCLUSIONS

High C-factor values generated the largest gap formation. Silorane-based composite was more efficient for cavity sealing than methacrylate-based composites and resin modified glass ionomer.

Influence of preheating the bonding agent of a conventional three-step adhesive system and the light activated resin cement on dentin bond strength

Aims:

to evaluate the influence of preheating the bonding agent (Scotchbond Multipurpose Adhesive/3M ESPE) and the light-activated resin cement (RelyX Venner/3M ESPE) on dentin microtensile bond strength.

Materials and Methods:

The exposed flat dentin surface of 40 human third molars were randomly distributed into four groups for cementation (SR Adoro/Ivoclar Vivadent) (n = 10): G1-bond and resin cement, both at room temperature (22°C), G2-bond preheated to 58°C and cement at room temperature (22°C), G3-bond at room temperature (22°C) and the cement preheated to 58°C, G4-bond preheated to 58°C and cement preheated to 58°C. Sticks of dentin/block set measuring approximately 1 mm² were obtained and used for the microtensile bond strength test. All sticks had their failure mode classified.

Statistical analysis used:

Factorial analysis of variance was applied, 2 × 2 (bond × cement) (P < 0.05).

Results:

Preheating the bonding agent (P = 0.8411) or the cement (P = 0.7155), yielded no significant difference. The interaction bond × cement was not significant (P = 0.9389).

Conclusions:

Preheating the bond and/or the light-activated resin cement did not influence dentin bond strength or fracture failure mode.

How can stress be controlled in endodontically treated teeth? A 3D finite element analysis

The aim of this study was to analyze the stresses that develop by oblique and vertical forces in endodontically treated maxillary second premolars that were restored with resin composite. Additionally, in our study the effects of the different restorative approaches and use of different base materials on stress formation were analyzed using three-dimensional finite element stress analysis. For restoration, the models representing both cusp capping, palatinal cusp capping, standard MOD restoration, and use of woven fiber in occlusal part were prepared. In all models, oblique forces caused more stress than did vertical forces. Materials with low elastic moduli cause high amounts of stress, whereas materials with elastic moduli similar to that of dental tissues cause low amounts of stress. Additional approaches such as cusp capping, functional cusp capping, and woven fiber use do not affect stress formation on the tooth after endodontic treatment.

Microleakage resistance of minimally invasive Class I flowable composite restorations

Minimally invasive flowable composite Class I restorations are widely used. However, flowable composites are characterized by low filler contents, modified resin formulations, low moduli of elasticity, low viscosity, generally poor mechanical properties, and decreased long-term stability. The purpose of this study was to compare the microleakage resistance of a wide variety of flowable composites used with their manufacturers' recommended bonding systems to that of a long-used and widely studied microhybrid composite when placed as minimally invasive occlusal restorations. Molar teeth were prepared in a standardized manner, restored, artificially aged, stained, sectioned, evaluated, and analyzed. Microleakage varied substantially, by a whole order of magnitude, among the material groups tested. The control group, a conventional microhybrid composite material, leaked significantly less than all the flowable composite groups. Microleakage varied very slightly among measurement site locations. Tiny microscopic bubbles were seen within many of the flowable composite specimens, as were a few voids.