Influence of Cavity Lining on the 3-Year Clinical Outcome of Posterior Composite Restorations: A Randomized Controlled Clinical Trial

The purpose of this randomized, split-mouth-designed controlled and single-blinded clinical study was to evaluate the 3-year clinical performance of Class I and Class II resin composite restorations placed with or without cavity lining with a flowable composite. Fifty patients with treatment needs in two premolars or molars were included. One of the teeth was restored using the nanohybrid composite (Grandio®SO, control group), in the test group a high viscosity flowable composite was additionally applied as a first layer. In both groups, the same self-etch adhesive system was applied. Clinical evaluation after 3 years was carried out using the modified USPHS/Ryge criteria. At the 3-year follow-up the recall rate was 92%. Four restorations failed in the test group (8.7%), three due to the loss of vitality and one after fracture. The control group exhibited a cumulative success rate of 100%, while the test group achieved a success rate of 91.3%. This led to significant differences in the annual failure rate (AFR) between the two groups, with rates of 0% and 2.9% (p < 0.05; Mann-Whitney U-test). After 3 years the cumulative survival rate including all restorations was 95.7%. Statistical analysis revealed significant differences for the parameters: tooth vitality, marginal discoloration, success rate, and AFR. The other parameters exhibited no significant differences. Consequently, the nanohybrid composite demonstrated excellent performance over a 3-year period, whereas the utilization of a flowable composite for the cavity lining did not appear to exert a beneficial influence on clinical outcomes.

New Technique for Wedge Selection in Direct Class II Restorations: A Pilot Study

Background: Performing an appropriate Class II direct restoration is a great challenge. The correct selection of the matrix system and the elements used for its stabilization will have a great impact on the result. The aim of this study is to show a new digital method for a predictable selection of the wedge and compare it with the conventional method. Methods: Sixty patients were randomly divided into two groups. In Group 0, the wedge was selected intraoperatively by visual examination, while in Group 1 the wedge was selected preoperatively through the measurement of the cervical embrasure on the bite-wing radiography. The number of wedges used, modifications to them, and tissue damage were registered, along with the quality of the proximal contact and the marginal adaptation. Results: Student's t-test revealed a statistical difference between the number of wedges used, which was higher in Group 0 (p < 0.05). Pearson Chi-square test showed that tissue damage was statistically higher in Group 0 (p < 0.05), while there was no statistically significant difference between groups in wedge modifications (p > 0.05). Group 1 revealed a higher frequency of satisfactory proximal contact and marginal adaptation (p < 0.05). Conclusions: This new technique reduces wedges waste and tissue damage and provides an adequate interproximal anatomy.

Clinical performance of different bulk-fill composite resin systems in class II cavities: A 2-year randomized clinical trial

OBJECTIVES

This study evaluated the clinical performance of bulk-fill resin composite systems with different viscosities in class II cavities.

MATERIALS AND METHODS

A total of 80 class II restorations were performed with a single operator in 50 patients using four different bulk-fill resin composite materials: Filtek™ Bulk Fill, Heated Filtek™ Bulk Fill, G-aenial™ BULK Injectable, and SonicFill3. A double-blinded randomized clinical trial was designed to evaluate the two-year clinical performance of the four bulk-fill composite resins using modified FDI criteria. Data were analyzed descriptively. Level of significance was set at 0.05. Differences between groups were tested using Wilcoxon-signed-rank and Mann-Whitney-U test as nonparametric tests.

RESULTS

Data were analyzed using Kruskal-Wallis, Mann-Whitney U, and Wilcoxon signed rank tests (p < 0.05). Eighty restorations were available for evaluation, with a survival function of 100%. No statistically significant differences were observed between the four groups regarding assessing esthetic, functional, and biological properties during different follow-up periods.

CONCLUSIONS

After 2 years of clinical follow-up, the bulk-fill composite systems with different viscosities seem to be esthetically, functionally, and biologically acceptable, with a promising clinical performance in class II cavities.

Comparison of Marginal Fracture Between Conventional and Bonded Amalgam Restorations in Posterior Permanent Molar Teeth

Background/objectives Dental amalgam has been a successful restoration for over a century. However, restoration failures due to secondary caries, fractured teeth or restorations, marginal deficiencies, tooth wear, and secondary caries remain significant concerns. Amalgam-bond, known for its ability to bond amalgam to the tooth structure and prevent percolation, forms a strong bond with vital dentin. This study aimed to compare the outcome of marginal fractures in bonded amalgam and conventional amalgam posterior restorations among patients at a tertiary care dental hospital. Materials and methods Sixty consecutive patients aged 25-35 years, meeting the inclusion and exclusion criteria, participated in this study. A thorough history, clinical examination, and standardized periapical radiographs were conducted. Patients were divided randomly into two equal groups, group A and group B. Group A received bonded amalgam restorations, while group B received conventional amalgam restorations. Polishing was performed at a recall visit after seven days, and a follow-up evaluation was done after two months. The final assessment of marginal fractures was recorded after six months. Results After six months, 28 (46.7%) patients showed no marginal fractures, including 11 males and 17 females. On the other hand, 32 (53.3%) patients exhibited marginal fractures, comprising 17 males and 15 females. The clinical success rate of group A was better than group B (p = 0.001). Conclusion Bonded amalgam demonstrates a high success rate and should be a routine choice for treating carious permanent molars in dental practice.

A Three-step Etch-and-Rinse vs a Universal Adhesive in Nanohybrid Composite Anterior Restorations: A Retrospective Clinical Evaluation

PURPOSE

To retrospectively evaluate the clinical behavior of direct anterior composite restorations performed with a universal adhesive or with a three-step etch-and-rinse (E&R) adhesive.

MATERIAL AND METHODS

Patients were randomly treated with a three-step E&R adhesive (Optibond FL, Kerr) or a universal adhesive (Clearfil Universal Bond Quick, Kuraray Noritake) applied in E&R mode. All restorations were performed with a nanohybrid composite (ClearFil Majesty ES-2, Kuraray Noritake) by the same experienced operator. Two calibrated examiners evaluated the restorations using a dental mirror and explorer, in accordance with modified United States Public Health Service (USPHS) procedures. Clinical events were registered and classified as either failure (F), survival (SR), or success (S).

RESULTS

168 restorations were evaluated in 90 patients with an average follow-up period of 37.9 (± 22.9) months. A total of 132 restorations were performed on vital teeth, and 36 were performed on endodontically treated teeth (ETT). A total of 128 Class-IV and 40 Class-III restorations were performed. In 89 restorations, a three-step E&R adhesive was applied (14 Class-III and 75 Class-IV), while in 79, a universal adhesive was used (26 Class-III and 53 Class-IV, p = 0.0091). A Cox regression analysis was performed (p < 0.05) to analyze which factors were involved in the failure of the restorations, considering failure (F) as restorations that needed re-intervention at the follow-up period of 37.9 (± 22.9) months. No statistically significant differences were observed when considering parameters directly involved with the adhesives tested. Endodontically treated teeth were more prone to fractures (p = 0.0006) compared to vital teeth. Restorations made with universal adhesives failed by fracturing significantly more frequently (p = 0.0234), while restorations made on endodontically treated teeth had a significantly worse outcome (p = 0.0001). Restorations made on canines also failed significantly more frequently (HR = 3.8, 95% CI = 1.4-10.1, p = 0.0062).

CONCLUSIONS

Based on the obtained results, both the universal adhesive and the three-step E&R adhesive proved to be good treatment choices for direct anterior restorations after 37.9 (± 22.9) months of follow-up. Tooth vitality seems fundamental for the prognosis of a direct anterior composite restoration over time.

Ceramic Onlay: A Case Report

With the growing demand for minimally invasive dental restoration, conservative treatment options offer good aesthetic outcomes and durability with minimal tooth reduction. The use of ceramics in dental restoration has been on the rise in the past two decades due to its long-term benefits and capacity to produce a superior bond to tooth structure when used in conjunction with adhesive cement and acid-etch procedures. A ceramic onlay, which covers one or more cusps, also helps to preserve dental tissue. These materials enable the dentist to conservatively prepare the tooth for restoration while also strengthening the patient's own tooth structure. This case report discusses the preparation of a functional and aesthetic ceramic onlay for a patient with a cracked tooth.

Dental restoration selection by students at southern Saudi Arabian universities

Dental caries is a serious oral health concern and restoration of teeth is the main solution to this issue. Various restorative materials having different properties are used for posterior restoration. The aim of this study was to find that which factors can affect the choice of selection of material for posterior restoration among dental graduate students. For this purpose, a questionnaire was shared electronically among students of three different universities (King Khalid University, Jazan University, and Najran University). After collection, data were subjected to a chi-square test to check the significance. It has been observed that almost 50% of participants choose composite resin for posterior restoration. Results showed that according to most (more than 50%) of the dental students in Southern Saudi Arabia, different patient and tooth condition related factors can affect the choice for selection of restorative material.

Comparative microleakage outcomes of different techniques used for creating the occlusal anatomy in occlusal direct restorations using the dental operating microscope

OBJECTIVES

Microleakage in direct dental restorations is a primary causal factor in the restoration's failure. The aim of this study was to evaluate whether the technique for occlusal layering of the composite resin (the use of brush adaptation, the use of magnification, cusp build-up, stamp technique) has any effect on microleakage of direct restorations in occlusal cavities.

MATERIALS AND METHODS

One hundred extracted human molars were restored using five restoration techniques (Packable Bulk technique, Occlusal Stamp technique, Successive Cusp Build-up technique, Successive Cusp Build-up technique + Brush adaptation, Successive Cusp Build-up technique + brush adaptation + Dental Operative Microscope magnification). The teeth were subjected to thermal aging for 800 cycles at 5°C and 55°C, infiltrated with basic fuchsin dye for 24 h, and then sectioned buccolingually in the middle of the crown. Infiltration was measured in four areas of the tooth section by five different observers and then given a score from 1 to 3, proportional to infiltration depth.

RESULTS

The lowest mean scores for infiltration (meaning less infiltration observed) were present in Group A (1.41 ± 0.878) and Group C (1.46 ± 0.679), while Group D showed the highest infiltration scores (1.75 ± 0.853). When comparing the groups for differences, no statistically significant difference in infiltration was found between any technique p < .586.

CONCLUSION

The techniques examined for placing the occlusal layer of composite in direct restorations do not differ significantly in terms of marginal infiltration, although a slight improvement was found when using the bulk technique and the successive cusp build-up.

Conservative approach to masking a darkened tooth with a direct composite resin restoration: a case report with 5-year follow-up

The objective of this case report is to describe a direct conservative technique for restoring the esthetics and function of a severely discolored endodontically treated tooth. A 25-year-old man presented with an esthetic complaint about severe darkening of his endodontically treated maxillary left central incisor. The tooth had adequate sound tooth structure, so the placement of a conservative direct composite resin veneer was proposed. The preparation included minimal removal of tooth structure, and a photoactivating opacifier was placed to mask the darkened substrate prior to restoration with composite resin. The restorative composite resin was placed with an incremental layering technique, restoring form, function, and esthetics. A routine follow-up examination 5 years after placement of the veneer revealed that it still provided satisfactory function and esthetics despite slight incisal wear and loss of brightness. The placement of direct composite resin veneers in association with opacifying pigments is a simple, low-cost alternative for providing immediate esthetic restoration of teeth with severe color change without extensive removal of tooth structure.

Treatment of Fissure Caries of Children with Severe Rheumatic Diseases with Difficulty in Opening the Mouth

Background

Pediatric dentists face difficulties in treating tooth decay of children with difficulty in opening the mouth. This is especially true, as the main disease is accompanied by such symptoms as arthritis, osteoarthritis, myositis, myalgia, sclerosis, and oral atrophy.

Aim

The aim was to increase the level of treatment of fissure tooth decay for children with rheumatic diseases, using the silicone key method (SKM).

Materials and Methods

A dental examination of 82 children was carried out, with diagnoses: systemic lupus erythematosus, juvenile systemic scleroderma, juvenile dermatomyositis, and juvenile rheumatoid arthritis. Evaluation of the intensity of caries using indices: decayed, missing, and filled teeth (DMFT)(average). Assessment and measurement of the degree of mouth opening (MMO) by Sh. M. Batashvili. The SKM was used to treat fissure tooth decay.

Results

During the dental examination of the oral cavity of all children with RD, multiple caries lesions were found. In the first age group of index indicators (DMFT) (on average) - 4.88, in the second age group DMFT (on average) - 7.58 - these values corresponded to high scores for the degree of dental caries, which requires frequent appointment to the dentist. Oral hygiene of children with difficult opening of the mouth is unsatisfactory, which leads to a rapid increase of caries. Restriction of moth opening <4 mm was found in 57 children with RD (69, 51%) that made it difficult to treat caries.

Conclusion

Using SKM will improve the quality of caries treatment and provide a stable result of treatment in patients with difficulty opening the mouth in severe somatic pathologies.

Fracture Behavior and Integrity of Different Direct Restorative Materials to Restore Noncarious Cervical Lesions

The purpose of this study was to analyze the fracture resistance and marginal leakage of noncarious cervical lesion (NCCL) restorations made of different restorative materials. Eighty upper premolars were randomly divided into four groups (n = 20/group). Standardized NCCL cavity preparations were performed on the buccal surface of the teeth and then restored with four different materials. Group 1: Packable resin composite (PC); Group 2: Highly flowable resin composite (HF); Group 3: Low flowable resin composite (LF); Group 4: Resin modified glass ionomer cement (RMGIC). After restorations were completed, cyclic and static fracture behavior was evaluated using a loading testing machine. Extra restored teeth were sectioned and then stained (n = 5/group). The specimens were viewed under a stereo microscope and the percentage of microgaps at the tooth–restoration interface was calculated. All restored teeth survived after fatigue loading. There was no statistically significant (p > 0.05) difference between the tested restorations after the static loading test. NCCLs restored with highly filled flowable composite showed the least microleakage among the tested groups (p < 0.05). The investigated restorative materials are acceptable for NCCL restorations in terms of fracture resistance and microleakage.

The "Pre-Finishing" Approach in Direct Anterior Restorations. A Case Series

In esthetic restorations of anterior teeth the clinician has to manage several aspects in order to have a predictable outcome. A deep knowledge of the anatomy as well as the adhesive procedures and the optical properties of resin-based composites are mandatory to achieve esthetic results. Contemporary restorative materials present either several shades and different translucency properties and therefore they are able to mimic teeth’s optical behavior thus providing a natural aspect to anterior restorations. The wrong thickness of different composite layers may provide unpleasant results such as low value (grayish) restorations that often requires reintervention. A precise step-by-step procedure is therefore mandatory to provide the proper shade at the correct place. There is therefore the need of some corrections and adjustments during the layer procedure in order to avoid errors in shade positioning that could affect final result. The authors present a case series (six clinical cases) treated with the proposed technique with up to five years follow-up.

Workflow of digitally guided direct composite resin restorations using ?open source software and 3D printing: a clinical technique

<p>Objective: To describe how to perform, in a simple manner, a digital wax-up with ?open source software for a clinical application involving direct ?composit?e resin restorations. Report: The clinical technique described presents a simple and highly predictable way of performing direct restorations with the help of a digital wax-up made with ?open source software. ?It uses an open source digital tooth library? to reestablish a more harmonious smile architecture, specifically of teeth that were worn due to parafunction, and restored with direct composite resin restorations.<br /> Conclusions: Thanks to the technology that was used in this case, fast, affordable and accurate results c?ould be obtained. In addition, digital files can be stored, saving material, time, and space, and allowing identical replication of the work either virtually or printed at any time, if needed. (Quintessence Int 2021;52:104-110; doi:&nbsp;10.3290/j.qi.a45426)</p>.

Evidence-based treatment planning for the restoration of endodontically treated single teeth: importance of coronal seal, post vs no post, and indirect vs direct restoration

Every orthograde endodontic procedure requires restoration of the coronal (access) cavity. The specific type of treatment used in individual cases greatly depends on the amount and configuration of the residual coronal tooth structure. In practice there are Class I access cavities as well as coronally severely damaged, even decapitated, teeth and all conceivable manifestations in between. The latest attempts to review results from clinical trials to answer the question of whether post placement or crowning can be recommended for the restoration of endodontically treated teeth or not are inconclusive. For dental practitioners, this is not a satisfactory result. This appraisal evaluates available evidence and trends for coronal restoration of single endodontically treated teeth with a focus on clinical investigations, where available. It provides specific recommendations for their coronal restoration to assist clinicians in their decision making and treatment planning.

Effect of Dentin Bonding Agents, Various Resin Composites and Curing Modes on Bond Strength to Human Dentin

This study investigated the influence of several dentin bonding agents, resin composites and curing modes on push-out bond strength to human dentin. 360 extracted caries-free third molars were prepared, cut into slices, embedded in epoxy resin and perforated centrally. One half of the specimens (180) were treated by using one-step adhesive systems and the other half (180) with multi-step adhesive systems. Subsequently, the cavities were filled with either universal, flowable or bulk-fill resin composite according to the manufactures’ product line and cured with either turbo or soft start program. After storage the push-out test was performed. The data was analyzed using Kolmogorov-Smirnov, three- and one-way ANOVA followed by the Scheffé post-hoc test, unpaired two-sample t-test (p < 0.05). The strongest influence on push-out bond strength was exerted by the resin composite type (partial eta squared η_P² = 0.505, p < 0.001), followed by the adhesive system (η_P² = 0.138, p < 0.001), while the choice of the curing intensity was not significant (p = 0.465). The effect of the binary or ternary combinations of the three parameters was significant for the combinations resin composite type coupled adhesive system (η_P² = 0.054, p < 0.001), only. The flowable resin composites showed predominantly mixed, while the universal and bulk-fill resin composite showed adhesive failure types. Cohesive failure types were not observed in any group. Multi-step adhesive systems are preferable to one-step adhesive systems due to their higher bond strength to dentin. Flowable resin composites showed the highest bond strength and should become more important as restoration material especially in cavity lining. The use of a soft start modus for polymerization of resin composites does not enhance the bond strength to dentin.

Micro-computed tomography evaluation of microleakage of Class II composite restorations: An in vitro study

Objective:

The aim of this study is to investigate the microleakage attained with three resin-based material used to restore deep Class II cavities. A null hypothesis was chosen: there is no difference in microleakage among the tested materials.

Materials and Methods:

A total of 30 Class II cavities were prepared in freshly extracted molars with the proximal mesial and distal margins located, respectively, 1.5 mm apically and 1.5 mm coronally to the cementum-enamel junction. Restorations were completed using a three-step enamel-dentin adhesive system “Etch and Rinse,” margins were relocated using a micro-hybrid, preheated, or flowable composite and restorations were then completed using a conventional composite. All samples were coated with nail varnish with the exception of an area along the margins and apex was sealed using epoxide cement and then thermocycled (30-s dwell time, 5°C/55°C, 1000 cycles). A 50% ammoniac AgNO3 solution was used as tracer according to Tay's protocol. The microleakage analysis was performed using a microtomography system Sky-scan 1072 (SKYSCAN, Kartuizersweg 3B 2550, Konitch, Belgium).

Results:

The mean microleakage of all the tested materials showed greater leakage in the cementum margins; flowable composite exhibit greater leakage among the groups. Significant differences (P < 5%) within groups in both enamel and dentin margins were present. None of the tested materials eliminated marginal microleakage. Preheated composite showed significantly lesser microleakage.

Conclusion:

Tested materials showed statistical differences in microleakage; thus, the null hypothesis has been rejected. Within the limitations of the present experimental procedure, it can be concluded that flowable resin composite should be avoided at the dentin/cementum margin.

Acquisition of Skills in Operative Dentistry Following a Contemporary Technique Skills Course: A Retrospective Study

The aim of this study was to evaluate the impact of a contemporary preclinical technique skills course on early dental student performance in a preclinical operative course. Ivorine teeth prepared for Class I resin restorations by the Classes of 2020 and 2021 in one U.S. dental school were evaluated in this study (N=184). Ivorine teeth were prepared during the first practical exam of the operative dentistry course. Students in the Class of 2021 had been enrolled in a contemporary technique skills course a semester prior to the operative dentistry course, while students in the Class of 2020 were not. The preparations were randomly evaluated by three calibrated and blinded faculty members using magnification loupes, an explorer, and a periodontal probe to evaluate external outline form, internal form, depth, and margin following an established rubric. The results showed that students in the Class of 2021 (who had taken the technique skills course) performed significantly better than students in the Class of 2020 for all criteria evaluated (p<0.05). In this study, incorporation of the preclinical technique skills course improved student performance in the subsequent operative dentistry course.

Dentists' restorative decision-making and implications for an 'amalgamless' profession. Part 4: clinical factor

BACKGROUND

The Minamata Convention embodies a worldwide reduction in the production and use of mercury and mercury-containing products and processes, including a phase-down of dental amalgam. This will change the approach to the use of direct restorative materials in the near future. There is little research as to the influence of clinical factors on dentists' decision-making which may be of use when determining the impact of any change.

METHODS

An online survey relating to aspects of and attitudes to the use of direct restorative materials was distributed to all dentists who were members of the Australian Dental Association and/or members or fellows of the Royal Australasian College of Dental Surgeons. Data were statistically analysed.

RESULTS

There were 408 respondents to the survey. Eighty-seven per cent of respondents (strongly) disagreed that amalgam was a technically more difficult material to place compared with resin composite, 82% (strongly) disagreed that placement time for amalgam was longer than that for resin composite and 69% (strongly) disagreed that amalgam was more difficult to finish than resin composite. Eighty-three per cent of respondents stated they were confident in their ability to place amalgam restorations. Where physical properties were of importance, indirect restorations were preferred (e.g. parafunction) 54%. The factors considered most important when choosing a direct restorative material included moisture control and aesthetics; least important factors were cost and time to place.

CONCLUSIONS

There is consensus that amalgam is not more technically difficult to use, place or finish than resin composite and vice versa. There is recognition that both amalgam and resin composite have limitations in terms of physical properties. When choosing a direct restorative material, clinical factors considered to be of greatest importance are moisture control, aesthetics and the need to apply minimally invasive approaches. There is little difference in the opinions of users and non-users of amalgam with respect to these findings.

The Effect of Composite Thickness on the Stress Distribution Pattern of Restored Premolar Teeth with Cusp Reduction

PURPOSE

Different thicknesses of restorative material can alter the stress distribution pattern in remaining tooth structure. The assumption is that a thicker composite restoration will induce a higher fracture resistance. Therefore, the present study evaluated the effect of composite thickness on stress distribution in a restored premolar with cusp reduction.

MATERIALS AND METHODS

A 3D solid model of a maxillary second premolar was prepared and meshed. MOD cavities were designed with different cusp reduction thicknesses (0, 0.5, 1, 1.5, 2.5 mm). Cavities were restored with Valux Plus composite. They were loaded with 200 N force on the occlusal surface in the direction of the long axis. Von Mises stresses were evaluated with Abaqus software.

RESULTS

Stress increased from occlusal to gingival and was maximum in the cervical region. The stressed area in the palatal cusp was more than that of the buccal cusp. Increasing the thickness of composite altered the shear stress to compressive stress in the occlusal area of the teeth.

CONCLUSION

The model with 2.5 mm cusp reduction exhibited the most even stress distribution.

Dentists' restorative decision-making and implications for an 'amalgamless' profession. Part 1: a review

The Minamata Convention has agreed to a worldwide reduction and ultimate elimination in the production and use of mercury containing products. This will have implications for the practice of dentistry. Australian organizations' pronouncements on the issue are limited and research examining the Australian context dated. The restoration of teeth with direct materials has changed significantly since the 1980s. Up to this time amalgam was the material of choice for direct posterior restorations. Its properties and guidelines for placement were, and remain, well established. Resin composite has replaced amalgam as the material of choice in many clinical situations. Despite inherent clinical disadvantages compared to amalgam, there continues to be a shift toward greater use of resin composite. There is consensus worldwide that the restoration of posterior teeth using resin composite now exceeds that of amalgam. The reasons for this are reviewed in this article along with current evidence and commentary relating to direct restorative and evidence-based decision-making, minimally invasive approaches, and approaches to education. The implications for these in an 'amalgamless' profession are identified.

Dental amalgam: An update

Dental amalgam has served as an excellent and versatile restorative material for many years, despite periods of controversy. The authors review its history, summarize the evidence with regard to its performance and offer predictions for the future of this material. The PubMed database was used initially; the reference list for dental amalgam featured 8641 articles and 13 publications dealing with recent advances in dental amalgam. A forward search was undertaken on selected articles and using some author names. For the present, amalgam should remain the material of choice for economic direct restoration of posterior teeth. When esthetic concerns are paramount, tooth-colored materials, placed meticulously, can provide an acceptable alternative. All alternative restorative materials and procedures, however, have certain limitations.