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Theisen CER, Amato J, Krastl G, Attin T, Blatz MB, Weiger R, Eggmann F. Quality of CAD-CAM inlays placed on aged resin-based composite restorations used as deep margin elevation: a laboratory study. Clin Oral Investig 2023; 27:2691-2703. [PMID: 36622446 PMCID: PMC10264514 DOI: 10.1007/s00784-022-04841-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 12/26/2022] [Indexed: 01/10/2023]
Abstract
OBJECTIVES To assess the impact of the age of resin-based composite (RBC) restorations used for deep margin elevation (DME) on the marginal quality and fracture resistance of inlays. MATERIALS AND METHODS Permanent human molars with direct RBC restorations, involving the mesial, occlusal, and distal surface (MOD), were allocated to four groups (each n = 12). Half of the teeth underwent thermomechanical loading including 240,000 occlusal load cycles and 534 thermal cycles (TML, 5 °C/55 °C; 49 N, 1.7 Hz). With RBC left in one proximal box as DME, all teeth received MOD inlays, made from lithium disilicate (LDS) or a polymer-infiltrated ceramic network material (PICN). The restored teeth underwent TML including 1.2 million occlusal cyclic loadings and 2673 thermal cycles. The marginal quality was assessed at baseline and after both runs of TML. Load-to-fracture tests were performed. The statistical analysis comprised multiple linear regressions (α = 0.05). RESULTS Simulated aging of RBC restorations had no significant effect on the marginal quality at the interface between the RBC and the tooth and the RBC and the inlay (p ≥ 0.247). Across time points, higher percentages of non-continuous margin were observed between the inlay and the tooth than between the tooth and the RBC (p ≤ 0.039). The age of the DME did not significantly affect the fracture resistance (p ≥ 0.052). CONCLUSIONS Artificial aging of RBC restorations used for DME had no detrimental effect on the marginal quality and fracture resistance of LDS and PICN inlays. CLINICAL RELEVANCE This laboratory study suggests that-in select cases-intact, direct RBC restorations not placed immediately before the delivery of an indirect restoration may be used for DME.
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Affiliation(s)
- Catherine E R Theisen
- Department of Periodontology, Endodontology, and Cariology, University Center for Dental Medicine Basel UZB, University of Basel, Mattenstrasse 40, CH-4058, Basel, Switzerland
| | - Julia Amato
- Department of Periodontology, Endodontology, and Cariology, University Center for Dental Medicine Basel UZB, University of Basel, Mattenstrasse 40, CH-4058, Basel, Switzerland
| | - Gabriel Krastl
- Department of Conservative Dentistry and Periodontology, Center of Dental Traumatology, University Hospital of Würzburg, Würzburg, Germany
| | - Thomas Attin
- Department of Conservative and Preventive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Markus B Blatz
- Department of Preventive and Restorative Sciences, Penn Dental Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Roland Weiger
- Department of Periodontology, Endodontology, and Cariology, University Center for Dental Medicine Basel UZB, University of Basel, Mattenstrasse 40, CH-4058, Basel, Switzerland
| | - Florin Eggmann
- Department of Periodontology, Endodontology, and Cariology, University Center for Dental Medicine Basel UZB, University of Basel, Mattenstrasse 40, CH-4058, Basel, Switzerland.
- Department of Preventive and Restorative Sciences, Penn Dental Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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Deep Margin Elevation: A Literature Review. Dent J (Basel) 2022; 10:dj10030048. [PMID: 35323250 PMCID: PMC8947734 DOI: 10.3390/dj10030048] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 03/04/2022] [Accepted: 03/10/2022] [Indexed: 01/02/2023] Open
Abstract
A conservative approach for restoring deep proximal lesions is to apply an increment of composite resin over the preexisting cervical margin to relocate it coronally, the so-called “deep margin elevation” (DME). A literature search for research articles referring to DME published from January 1998 until November 2021 was conducted using MEDLINE (PubMed), Ovid, Scopus, Cochrane Library and Semantic Scholar databases applying preset inclusion and exclusion criteria. Elevation material and adhesive system employed for luting seem to be significant factors concerning the marginal adaptation of the restoration. This technique does not affect bond strength, fatigue behavior, fracture resistance, failure pattern or repairability. DME and subgingival restorations are compatible with periodontal health, given that they are well-polished and refined. The available literature is limited mainly to in vitro studies. Therefore, randomized clinical trials with extended follow-up periods are necessary to clarify all aspects of the technique and ascertain its validity in clinical practice. For the time being, DME should be applied with caution respecting three criteria: capability of field isolation, the perfect seal of the cervical margin provided by the matrix, and no invasion of the connective compartment of biological width.
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Grassi EDA, de Andrade GS, Tribst JPM, Machry RV, Valandro LF, Ramos NDC, Bresciani E, Saavedra GDSFA. Fatigue behavior and stress distribution of molars restored with MOD inlays with and without deep margin elevation. Clin Oral Investig 2021; 26:2513-2526. [PMID: 34643807 DOI: 10.1007/s00784-021-04219-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 10/04/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study evaluated the effect of deep margin elevation (DME) and restorative materials (leucite-reinforced glass-ceramics [C] vs. indirect resin composite [R]) on the fatigue behavior and stress distribution of maxillary molars with 2-mm deep proximal margins restored with MOD inlay. METHODS Fifty-two extracted human third molars were randomly assigned into four groups (n = 13): C; DME + C; R; and DME + R. Inlays were fabricated in CAD-CAM and bonded to all teeth. The fatigue behavior was assessed with the stepwise stress test (10,000 cycles/step; step = 50 N; 20 Hz; initial load = 200 N). Fatigue failure loads and the number of cycles were analyzed with 2-way ANOVA and Tukey's test (p < 0.05) and Kaplan-Meier survival plots. The stress distribution was assessed with finite element analysis. The models were considered isotropic, linear, and homogeneous, and presented bonded contacts. A tripod axial load (400 N) was applied to the occlusal surface. The stress distribution was analyzed with the maximum principal stress criterion. RESULTS For fatigue, there was no difference for DME factor (p > 0.05). For the material factor, the load and number of cycles for failure were statistically higher in the R groups (p < 0.05). The finite element analysis showed that resin composite inlays concentrated more stress in the tooth structure, while ceramic inlays concentrated more stress in the restoration. Non-reparable failures were more frequent in the resin composite inlays groups. CONCLUSIONS DME was not negative for fatigue and biomechanical behaviors. Resin composite inlays were more resistant to the fatigue test, although the failure mode was more aggressive. CLINICAL SIGNIFICANCE DME does not impair mechanical behavior. Resin composite inlays failed at higher loads but with a more aggressive failure mode.
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Affiliation(s)
- Elisa Donaria Aboucauch Grassi
- Department of Dental Materials and Prosthodontics, Institute of Science and Technology, São Paulo State University (Unesp), 777th Eng. Francisco José Longo Av., São José dos Campos, SP, 12245-000, Brazil
| | - Guilherme Schmitt de Andrade
- Department of Dental Materials and Prosthodontics, Institute of Science and Technology, São Paulo State University (Unesp), 777th Eng. Francisco José Longo Av., São José dos Campos, SP, 12245-000, Brazil
| | - João Paulo Mendes Tribst
- Post-Graduate Program in Dentistry, University of Taubaté (UNITAU), 09th Rua Dos Operários St., Taubaté, SP, 12020-340, Brazil
| | - Renan Vaz Machry
- Graduate Program of Oral Science, Prosthodontics Unit, School of Dentistry, Federal University of Santa Maria (UFSM), Roraima Av, Santa Maria, RS, 100097105-340, Brazil
| | - Luiz Felipe Valandro
- Graduate Program of Oral Science, Prosthodontics Unit, School of Dentistry, Federal University of Santa Maria (UFSM), Roraima Av, Santa Maria, RS, 100097105-340, Brazil
| | - Nathalia de Carvalho Ramos
- School of Dentistry, São Francisco University (USF), 218th São Francisco de Assis Av., Bragança Paulista, SP, 12916-900, Brazil
| | - Eduardo Bresciani
- Department of Restorative Dentistry, Institute of Science and Technology, São Paulo State University (Unesp), 777th Eng. Francisco José Longo Av., São José dos Campos, SP, 12245-000, Brazil
| | - Guilherme de Siqueira Ferreira Anzaloni Saavedra
- Department of Dental Materials and Prosthodontics, Institute of Science and Technology, São Paulo State University (Unesp), 777th Eng. Francisco José Longo Av., São José dos Campos, SP, 12245-000, Brazil.
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Da Silva D, Ceballos L, Fuentes MV. Influence of the adhesive strategy in the sealing ability of resin composite inlays after deep margin elevation. J Clin Exp Dent 2021; 13:e886-e893. [PMID: 34603617 PMCID: PMC8464384 DOI: 10.4317/jced.58689] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 07/05/2021] [Indexed: 01/18/2023] Open
Abstract
Background The aim of this study was to determine the influence of the gingival margin position and the adhesive strategy selected to perform deep margin elevation (DME) in marginal sealing of resin composite inlays by a nanoleakage test. Material and Methods 12 sound third molars were selected and expulsive MOD cavities for inlays were prepared. Experimental groups were established according to gingival margin location (enamel: 1 mm above cemento-enamel junction (CEJ), dentin: 1 mm below CEJ, or DME, and the adhesive strategy used to lute inlays and elevate the gingival margin. Therefore, the six experimental groups were: 1) Enamel + etch-and-rinse adhesive (ERA) Adper Scotchbond 1XT (SB1XT); 2) Dentin + SB1XT; 3) DME + SB1XT; 4) Enamel + self-etching adhesive (SEA) with enamel selective etching Clearfil SE Bond (CSE); 5) Dentin + CSE; 6) DME + CSE. Resin composite inlays were constructed (Gradia Indirect) and all luted with the same resin cement (RelyX ARC). Specimens were submitted to nanoleakage test. Results were analyzed by Kruskal-Wallis and Mann-Whitney U tests with Bonferroni correction (p<0.05). Results A perfect sealing ability was evidenced for experimental groups with gingival margins on enamel. Similar nanoleakage values were determined when CSE adhesive was applied regardless the gingival margin position. The highest silver nitrate infiltration was detected for elevated margins with the ERA SB1XT. Conclusions The SEA Clearfil SE Bond showed higher sealing ability than the ERA Adper Scotchbond 1XT when margins were located on dentin, regardless margin elevation. Gingival margins on enamel together with enamel acid etching provided an excellent sealing with both adhesive systems. Key words:Adhesion, composite inlays, gingival margin, deep margin elevation, marginal seal, nanoleakage test.
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Affiliation(s)
- Dayana Da Silva
- DDS, PhD, Assistant Professor, IDIBO Research Group, Nursing and Stomatology Department, Health Sciences Faculty, Rey Juan Carlos University. Av. de Atenas, S/N, 28922. Alcorcón, Madrid, Spain
| | - Laura Ceballos
- DDS, PhD, Professor, IDIBO Research Group, Nursing and Stomatology Department, Health Sciences Faculty, Rey Juan Carlos University. Av. de Atenas, S/N, 28922. Alcorcón, Madrid, Spain
| | - María-Victoria Fuentes
- DDS, PhD, Associate Professor, IDIBO Research Group, Nursing and Stomatology Department, Health Sciences Faculty, Rey Juan Carlos University. Av. de Atenas, S/N, 28922. Alcorcón, Madrid, Spain
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Bertoldi C, Monari E, Cortellini P, Generali L, Lucchi A, Spinato S, Zaffe D. Clinical and histological reaction of periodontal tissues to subgingival resin composite restorations. Clin Oral Investig 2019; 24:1001-1011. [PMID: 31286261 DOI: 10.1007/s00784-019-02998-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 06/28/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To compare the clinical and histological response of supracrestal periodontal tissues to subgingival composite restorations versus natural root surfaces MATERIAL AND METHODS: In 29 subjects with a single tooth requiring subgingival restorations, a deep margin elevation (DME) procedure with composite resin was applied. Full-mouth plaque score (FMPS), full-mouth bleeding score (FMBS), and focal probing depth (PD) were measured at baseline, before DME, and after 3 months. The distance between the coronal marked (CM) point to the apical margin of the composite reconstruction (AMR), at baseline, and to the tip of the periodontal probe inserted to reach the bottom of the sulcus (APP), 3 months later, was measured. An all-around secondary flap, harvested to ensure the subsequent single-crown prosthetic rehabilitation was histologically processed. The histological inflammation degree was evaluated in areas of gingival tissues adjacent to the composite (group B) and adjacent to the natural surface of each single tooth (group A). RESULTS Significant FMPS, FMBS, and PD decreases were observed (p < 0.05). CM-AMR and CM-APP were significantly different (p < 0.05), suggesting an attachment gain after 3-months. The inflammation level of gingival tissue was similar in groups A and B (p > 0.05). CONCLUSIONS For the first time, this topic was clinically and histologically studied in humans. Subgingival restorations resulted compatible with gingival health, with levels similar to that of untreated root surfaces. CLINICAL RELEVANCE Deep margin elevation procedure produces favorable clinical and histological outcomes allowing a routine utilization in reconstructive dentistry.
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Affiliation(s)
- Carlo Bertoldi
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with Transplant Surgery, Oncology and Regenerative Medicine Relevance, University of Modena and Reggio Emilia, Modena, Via del Pozzo 71,, 41124, Italy
| | - Emanuela Monari
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with Transplant Surgery, Oncology and Regenerative Medicine Relevance, University of Modena and Reggio Emilia, Modena, Via del Pozzo 71,, 41124, Italy
| | | | - Luigi Generali
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with Transplant Surgery, Oncology and Regenerative Medicine Relevance, University of Modena and Reggio Emilia, Modena, Via del Pozzo 71,, 41124, Italy.
| | - Andrea Lucchi
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with Transplant Surgery, Oncology and Regenerative Medicine Relevance, University of Modena and Reggio Emilia, Modena, Via del Pozzo 71,, 41124, Italy
| | | | - Davide Zaffe
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
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