Five-year clinical follow-up of bulk-fill restorative materials in class II restorations

This study evaluates the 5-year clinical performance of Class II restorations performed with different bulk-fill restorative materials. In the study, Class II restorations performed with Tetric Bulk-Fill (TBF), Filtek Bulk-Fill (FBF), and Equia Forte Fil (EF) were evaluated. One hundred-nineteen restorations were included in the study. Restorations were assessed during the 6th month, 1st, 2nd, and 5th year. Cochran Q, Pearson chi-square, and Fisher-Freeman-Halton tests were used for statistical analysis. In the 5th year, significant differences were observed in terms of retention, color match, marginal adaptation, marginal discoloration, surface texture, and anatomical form in all materials. There was a significant difference between EF and bulk-fill composites only in terms of retention and anatomical form. EF was significantly less successful than bulk-fill composites with regard to retention and anatomical form, but bulk-fill composites have shown similar clinical performance. EF cannot be an alternative to bulk-fill composites for Class II restorations.

Single crown vs. composite for glass fiber post-retained restorations: An 8-year randomized clinical trial

OBJECTIVES

This study aimed to compare the success and survival rates of metal-ceramic crowns and composite resin restorations applied in root filled teeth that received a glass fiber post.

METHODS

A prospective, randomized controlled trial, with equivalent parallel groups was designed. Eighty-two teeth were randomly allocated to the metal-ceramic or composite resin groups. Multivariate Cox regression analysis with shared frailty for patients and Kaplan-Meier curves were performed using success and survival rates (p<0.05).

RESULTS

Seventy-five post-retained restorations (34 metal-ceramic crowns and 41 composite restorations) in 62 patients were analyzed. The median follow-up was 8.1 years [IQR 4.0-9.9]. Twenty-seven failures were observed. Twenty-two failures (81.5 %) were observed in the composite resin group, of which six (27.3 %) were not repairable. Five failures (18.5 %) were observed in the metal-ceramic crown group, of which three (66.6 %) were non-repairable. The cumulative success rate at 8 years was 85.0 % for crowns (AFR=1.31 %) and 43.2 % for composite resins (AFR=6.58 %), while the survival rate was 93.8 % for crowns (AFR=0.52 %) and 97.6 % for composite resins (AFR=0.20 %). Considering the success rates, adjusted multivariate Cox regression showed that composite resin had a Hazard Ratio of 5.07 (95 %CI, 1.99-12.89) greater than the metal-ceramic crown. No significant difference in the failure risk was observed when the survival rates were considered (HR=0.38, 95 %CI (0.10 - 1.44), p = 0.156). Co-variables did not affect the success and survival rates (p>0.05).

CONCLUSIONS

Metal-ceramic crowns showed a higher success rate than composite restorations. The survival rates were similar, but composite restorations presented a higher need for repairs.

CLINICAL SIGNIFICANCE

Post-retained composite restorations may need more reinterventions during the lifecycle, although more preservation of sound tooth structure is expected with a large restoration of resin post-and-core. These aspects have to be discussed with the patient for decision-making planning.

Dental decision-making for persons with dementia: A systematic narrative review

Dental decision-making represents the establishment of a common understanding between the dental professional and the recipient of the intervention, which determines oral healthcare and dental treatment policies. Dental decision-making for persons with dementia can be challenging, and there have been no systematic reviews on this topic. Therefore, this systematic narrative review aimed to identify the current state of dental decision-making in persons with dementia. Literature search was performed using PubMed, Web of Science, Cochrane Library, CINAHL, and Google Scholar databases. Through the process of research selection, 7 articles with a high risk of bias were included in this study. This review clarified that there is limited information on the dental decision-making processes for persons with dementia. In conclusion, although this may be difficult due to different medical and socioeconomic conditions, the dilemma between the need to establish evidence for dental decision-making and medical ethics that prioritize a patient-centered position should be discussed globally in the future.

Computer-aided design and computer-aided manufacturing indirect versus direct composite restorations: A randomized clinical trial

OBJECTIVE

This study compared the clinical performance of large indirect restorations (IRs) versus direct restorations (DRs) in posterior teeth.

METHODS

Thirty subjects received two class II restorations (n = 60), one fabricated from a precured composite block (Grandio Blocs, VOCO) for the indirect technique (IT) and the other with light-cured composite (GrandioSO, VOCO) for the direct technique (DT). For IT, the restoration was created using the computer-aided design and computer-aided manufacturer (CAD/CAM) system. For DT, the material was applied light-cured by using a layering technique. All restorations were evaluated by using the World Dental Federation criteria.

RESULTS

Twenty-three subjects attended the 2-year recall, and 46 restorations were evaluated. No significant differences were detected between the techniques for most parameters analyzed (p > 0.05). For "color match" at 7 days and 6 months, better results were observed for the DT. In relation to the overall scores, all restorations were esthetically acceptable after 2 years, while 93.3% of DT and 90% of IT showed acceptable function. For biological scores, 96.67% of DRs and 100% of IRs was acceptable after 24 months. Considering all properties, the success rates were 93.3% for DRs and 90% for IRs.

CONCLUSIONS

After 2 years, both restorations presented similar and good clinical behavior for all the properties analyzed.

CLINICAL SIGNIFICANCE

Light-cured direct posterior composite restorations may perform similarly to indirect composite restorations made with precured CAD/CAM composite blocks up to 2 years.

Influence of the coronal restoration on the outcome of endodontically treated teeth

Objective: The tooth weakens due to removal of hard tissue during an endodontic procedure. Many dentists find it difficult to choose between different coronal restorations after root canal treatment (RCT). Studies show that the coronal restoration may affect the endodontic prognosis. This student-based study had three aims. (1) Examine the choice of coronal restoration of endodontically treated teeth at a Scandinavian dental school, (2) examine the survival of these restorations and (3) evaluate the influence of the coronal restoration on the outcome of the RCT. Material and methods: Radiographic and clinical examination was performed on 127 posterior teeth. The quality of the root canal treatment and the periapical status (PAI-index) were evaluated. Results: 43.8% of the teeth were restored with an indirect coronal restoration and 47.2% with a direct coronal restoration. The period from finished root canal treatment until placement of a permanent coronal restoration was significantly longer for an indirect restoration than a direct restoration. The teeth treated with a PAI score of 1 and 2 following pulpectomy, necrotic pulp treatment and endodontic retreatment was 93.8%, 82.6% and 69.4%, respectively.Conclusion: There was no significant association between choice of coronal restoration and PAI-score.

Functional and aesthetic rehabilitation in posterior tooth with bulk-fill resin composite and occlusal matrix

The restorative procedure in posterior teeth involves clinical steps related to professional skill, especially when using the incremental technique, which may fail in the long term. A recent alternative is bulk-fill resins, which can reduce polymerization shrinkage, decreasing clinical problems such as marginal leakage, secondary caries, and fracture. This scientific study aims to report a clinical case using bulk-fill resin with an occlusal matrix. As determined in the treatment plan, an acrylic resin matrix was produced to establish an improved oral and aesthetic rehabilitation of the right mandibular first molar, which presented a carious lesion with dentin involvement. The occlusal matrix is a simple technique that maintains the original dental anatomy, showing satisfactory results regarding function and aesthetic rehabilitation.

Direct bilayered biomimetic composite restoration: The effect of a cusp-supporting short fiber-reinforced base design on the chewing fracture resistance and failure mode of molars with or without endodontic treatment

The aim of this study was to assess the chewing fracture resistance of compromised molars restored with direct composite resin (CR) restorations, with and without a short-fiber reinforcing (short-FRC) base. Wide extension of MOD cavities with removed palatal cusps preparations were simulated on 48 extracted maxillary molars. Five groups (n = 12) were designed: 1. control (intact teeth), 2. non-endodontically treated and 3. endodontically treated teeth with direct CR restorations (GC-Posterior), and 4. non-endodontically treated and 5. endodontically treated teeth with direct biomimetic bilayered restorations. Groups 4 and 5 included an anatomically shaped short-FRC base (everX Posterior), covered with a 2 mm CR layer (GC-Posterior). Restorations were subjected to chewing in water (1.5 Hz), with load of 85 N. Specimens were loaded until fracture or to a maximum of 120 000 cycles. Restorations that survived the chewing cycle were submitted to static load test (post-chewing test). The data were statistically analyzed using two-way ANOVA (p = 0.05) and fracture types with the chi-square test (p = 0.05). Fractures were classified into reparable, possibly reparable or non-reparable. All specimens survived the chewing cycle. The chewing fracture resistance of the direct biomimetic restorations prepared on non-endodontically treated teeth (2889 N) was statistically significantly higher than the direct CR counterparts (1966 N) (p = 0.00015), which was not the case for the groups with endodontically treated teeth (p = 0.257). Inclusion of a short-FRC base also influenced the fracture type resulting in most reparable fractures (67-75% versus 25% for biomimetic and CR groups respectively) (p = 0.054). Anatomically shaped i.e. a cusp-supporting design made of short-FRC base (everX Posterior) improved the chewing fracture resistance and fracture manner of compromised molars regardless of whether they were endodontically treated or not.

A Two-year Clinical Comparison of Three Different Restorative Materials in Class II Cavities

OBJECTIVES

The aim of this clinical study was to evaluate the clinical performance of Class II restorations of a high-viscosity glass ionomer material, of a bulk-fill composite resin, and of a microhybrid composite resin.

METHODS AND MATERIALS

One hundred nine Class II restorations were performed in 54 patients using three different restorative materials: Charisma Smart Composite (CSC; a conventional composite resin), Filtek Bulk Fill Posterior Restorative (FBF; a high-viscosity bulk-fill composite), and Equia Forte Fil (EF; a high-viscosity glass ionomer). Single Bond Universal adhesive (3M ESPE, Neuss, Germany) was used for both conventional and bulk-fill composite resin restorations. The restorations were evaluated using modified US Public Health Service criteria in terms of retention, color match, marginal discoloration, anatomic form, contact point, marginal adaptation, secondary caries, postoperative sensitivity, and surface texture. The data were analyzed using the chi-square, Fisher, and McNemar tests.

RESULTS

Eighty-four restorations were evaluated at two-year recalls. There were clinically acceptable changes in composite resin restorations (FBF and CSC). In addition, no statistically significant difference was observed between the clinical performances of these materials in terms of all criteria (p>0.05). However, there was a statistically significant difference between the EF group and the FBF and CSC groups in all parameters except for marginal discoloration, secondary caries, and postoperative sensitivity (p<0.05).

CONCLUSIONS

The tested bulk-fill and conventional composite resins showed acceptable clinical performance in Class II cavities. However, if EF is to be used for Class II restoration, its use should be carefully considered.

Risk Factors for Dental Restoration Survival: A Practice-Based Study

To improve patient dental care, it is necessary to identify possible risk factors for the failing of restorations. This practice-based cohort study investigated the performance and influence of possible risk factors at the level of the practice, patient, tooth, and restoration on survival of direct class II restorations. Electronic patient files from 11 Dutch general practices were collected, and 31,472 restorations placed between January 2015 and October 2017 were analyzed. Kaplan-Meier statistics were performed; annual failure rates (AFRs) were calculated; and variables were assessed by multivariable Cox regression analysis. The observation time of restorations varied from 0 to 2.7 y, resulting in a mean AFR of 7.8% at 2 y. However, wide variation in AFRs existed among the operators, varying between 3.6% and 11.4%. A wide range of patient-related variables is related to a high risk for reintervention: patient age (elderly: hazard ratio [HR], 1.372), general health (medically compromised: HR, 1.478), periodontal status (periodontal problems: HR, 1.207), caries risk and risk for parafunctional habits (high: HR, 1.687), restorations in molar teeth (HR, 1.383), restorations placed in endodontically treated teeth (HR, 1.890), and multisurface restorations (≥4 surfaces: HR, 1.345). Restorations placed due to fracture were more prone to fail than restorations placed due to caries. When patient-related risk factors were excluded, remaining risk factors considerably changed in their effect and significance: the effect of operator, age of the patient, and endodontic treatment increased; the effect of the diagnosis decreased; and the socioeconomic status became significant (high: HR, 0.873). This study demonstrated that a wide variation of risk factors on the practice, patient, and tooth levels influences the survival of class II restorations. To provide personalized dental care, it is important to identify and record potential risk factors. Therefore, we recommend further clinical studies to include these patient risk factors in data collection and analysis.

Thirty-Six-Month Clinical Comparison of Bulk Fill and Nanofill Composite Restorations

OBJECTIVES

The aim of this study was to evaluate the clinical performance of a nanofill and a bulk fill resin composite in class II restorations.

METHODS AND MATERIALS

In accordance with a split-mouth design, 50 patients received at least one pair of restorations, restored with a nanofill resin composite (Filtek Ultimate [FU]) and with a bulk fill resin composite (Tetric EvoCeram Bulk Fill [TB]). Each restorative resin was used with its respective adhesive system according to the manufacturers' instructions. A total of 104 class II restorations were placed by two operators. The restorations were blindly evaluated by two examiners at baseline and at six, 12, 18, 24, and 36 months using modified US Public Health Service Ryge criteria. The comparison of the two restorative materials for each category was performed with the chi-square test (α=0.05). The baseline scores were compared with those at the recall visits using the Cochran Q-test.

RESULTS

At six, 12, 18, and 24 months, the recall rate was 100%, 98%, 94%, and 82%, respectively, with a retention rate of 100%. At 36 months, 81 restorations were evaluated in 39 patients with a recall rate of 78%. For marginal adaptation, four restorations from the TB group and 10 from the FU group rated as Bravo. Two restorations from the TB and eight restorations from the FU group showed marginal discoloration. There were statistically significant differences between the two restorative resins in terms of marginal adaptation and marginal discoloration (p<0.05). No differences were observed between the restorative resins in terms of retention (p>0.05). One restored tooth from the FU group was crowned. The retention rates for the TB and the FU groups were 100%. In the FU group, two restorations showed slightly rough surfaces, and two showed a slight mismatch in color. None of the restorations showed postoperative sensitivity, secondary caries, or loss of anatomic form.

CONCLUSIONS

The tested bulk fill restorative resin demonstrated better clinical performance in terms of marginal discoloration and marginal adaptation.

Semidirect posterior composite restorations with a flexible die technique: A case series

BACKGROUND AND OVERVIEW

Besides indirect use in the laboratory and direct use for restorations, composites can be used in semidirect procedures. The authors describe the semidirect composite restoration technique by using a flexible die for large lesions in posterior teeth.

CASE DESCRIPTION

The authors present illustrations of the clinical steps and the outcomes immediately after the procedures. The authors placed chairside inlay, onlay, and overlay composite restorations. The final esthetic outcome, along with function and anatomic form recovery, demonstrated that this might be a viable cost-effective alternative technique to laboratory-fabricated indirect restorations.

CONCLUSIONS AND PRACTICAL IMPLICATIONS

Clinicians can restore large preparations in posterior teeth successfully with semidirect composite restorations in a single appointment by using the flexible die technique, resulting in satisfactory function and esthetic outcome.

Restoration Survival: Revisiting Patients' Risk Factors Through a Systematic Literature Review

A literature review was conducted to investigate the influence of patient-related factors on restoration survival in posterior permanent teeth as well as to report the methods used to collect these factors. The selection of articles on longitudinal clinical studies investigating the survival of posterior restorations (except full crowns and temporary fillings) and including patient-related factors was performed by applying predefined criteria. The review was organized into two parts, the first describing how patient factors were assessed in the studies (n=45) and the second presenting the statistical significance (n=27) and size of the effect (n=11) of these factors on restoration survival. Patient-related factors mentioned in the studies included age; gender; caries risk; caries activity/severity; decayed, missing, filled teeth; number of restorations; oral hygiene; and bruxism, among others. Sixteen studies included the patient age or age range in the analysis, which was found to be significant in 47% of the studies. Regarding gender, four of 17 reports found a significant effect on survival, showing more failures for men in three studies. The caries risk profile or related variables were included in the analysis of 15 studies, and a significant effect on survival was reported for high-caries-risk individuals (or related variables) in 67% of these studies. Bruxism was also found to influence restoration survival in three of six studies where this variable was investigated. Some issues were found regarding the reporting of methods used to classify patients according to risk and were thoroughly discussed. In view of the information gathered in this review, the assessment of patient factors along with other variables should become part of clinical studies investigating restoration survival, since several of these factors were shown to influence the failure of restorations, regardless of the material type.

Longevity of direct and indirect resin composite restorations in permanent posterior teeth: A systematic review and meta-analysis

OBJECTIVES

The aim of this systematic review and meta-analysis was to assess the differences in clinical performance in direct and indirect resin composite restorations in permanent posterior teeth.

SOURCES

PubMed, the Cochrane Library, Web of Science, Scopus, LILACS, BBO, ClinicalTrials.gov and SiGLE were searched without restrictions.

STUDY SELECTION

We included randomized clinical trials (RCTs) that compared the clinical performance of direct and indirect resin composite restorations in Class I and Class II cavities in permanent teeth, with at least two years of follow-up. The risk of bias tool suggested by Cochrane Collaboration was used for quality assessment.

DATA

After duplicate removal, 912 studies were identified. Twenty fulfilled the inclusion criteria after the abstract screening. Two articles were added after a hand search of the reference list of included studies. After examination, nine RCTs were included in the qualitative analysis and five were considered to have a 'low' risk of bias. The overall risk difference in longevity between direct and indirect resin composite restorations in permanent posterior teeth (p>0.05) at five-year follow-up was 1.494 [0.893-2.500], and regardless of the type of tooth restored, that of molar and premolars was 0.716 [0.177-2.888] at three-year follow-up.

CONCLUSIONS

Based on the findings, there was no difference in longevity of direct and indirect resin composite restorations regardless of the type of material and the restored tooth.

CLINICAL SIGNIFICANCE

Contemporary dentistry is based on minimally invasive restorations. Any indication of a less conservative technique must have unquestionable advantages. In vitro and in vivo studies reveal contradictory evidence of the clinical performance of direct and indirect resin composite restorations in posterior teeth. Thus this study clarified this doubt.

The impact of the global budget system on dynamics of dental manpower and utilization of dental services

Background:

This study aimed to investigate dentists’ supply and practice patterns following the implementation of the global budget system in Taiwan.

Materials and Methods:

Data of reimbursement claims, municipal socioeconomic status and dental manpower were collected from the National Health Insurance administration, the Ministry of Internal Affair, and the Ministry of Health and Welfare, respectively. A multivariate linear regression method was used for data analysis.

Results:

A municipality that reported a higher percentage of tertiary educated population (t = 3.718, P < 0.001), a higher per capita income (t = 6.172, P < 0.001), a higher population density (t = 6.172, P < 0.001), or a lower percentage of elderly population (t = −2.506, P = 0.014) was more likely to have a higher number of dentists per 100,000 population. A municipality that reported a higher Herfindahl-Hirschman Index (HHI) value (t = 2.880, P = 0.005) was more likely to show a higher move-out rate among dentists. The rate was lower after the implementation of the global budget system (t = −2.436, P = 0.018). A municipality that had a higher percentage of elderly population (t = 3.628, P < 0.001), a lower percentage of young population (t = −2.138, P = 0.035), or a higher rate of population growth (t = 4.412, P < 0.001) was more likely to display a higher move-in rate among dentists. The percentage of amalgam restorations in total claims reduced from 19.82% to 17.94%, while the percentage of tooth-colored material restorations increased from 25.46% to 28.79%.

Conclusion:

This study has demonstrated a stabilizing effect of the global budget system on dynamics of dental manpower in Taiwan. A relationship between HHI and dentists’ move-out rate has been found. The relationship between municipal socioeconomic status and the density of dentists has also been confirmed. In addition, reduced utilization of amalgam restorations was accompanied by increased utilization of tooth-colored material restorations. Further investigations are indicated.