Clinical and microbiological effects of different restorative materials on the periodontal tissues adjacent to subgingival class V restorations. 1-year results

OBJECTIVES

The relationship between subgingival dental restorations and periodontal health has been thoroughly investigated for many years. However, longitudinal data on the subgingival microflora features after the placement of well-finished subgingival restorations are still lacking. Therefore, this study compares the short-term clinical and microbiological features occurring in the gingiva after the completion of different subgingival restorations.

MATERIAL AND METHODS

Sixteen systemically healthy subjects, 10 males and six females (ages: 31.7-45.8 years; mean age 39.3+/-5.1 years), who were non-smokers and were positive for the presence of three cervical abrasion/erosion defects to be restored in three different adjacent teeth were enrolled in this study. The cervical abrasion/erosion defects were each restored by using one of three different materials: amalgam, glass ionomer cement, or composite resin. Immediately before class V cavity preparations and restorations (baseline), clinical monitoring and subgingival plaque sampling were performed in the mid-buccal aspect of each experimental restored tooth and in one adjacent sound, non-treated, control tooth. These procedures were repeated every 4 months over the following 1 year.

RESULTS

Throughout the study, the clinical parameters recorded did not change significantly in any of the experimental groups, and no differences were detected among them at each clinical session. Over this time, no significant changes in the composition of the subgingival microflora were observed in amalgam, glass ionomer cement, and control groups. Conversely, in the composite resin group, there was a significant increase in the total bacterial counts, and a significant (p<0.05) decrease in Gram-positive, aerobic bacteria, which was associated with a significant (p<0.05) increase in the Gram-negative, anaerobic microbiota.

CONCLUSIONS

Over a 1-year observation period, amalgam, glass ionomer cement, and composite resin subgingival restorations do not significantly affect the clinical parameters recorded. However, composite resin restorations may have some negative effects on the quantity and quality of subgingival plaque.

Durability of three simplified adhesive systems in Class V non-carious cervical dentin lesions

PURPOSE

To investigate the durability of three simplified systems in Class V non-carious abrasion/erosion lesions.

METHODS

144 non-carious cervical dentin lesions were restored either with Clearfil Liner Bond 2, a 2-step self-etching primer (n = 46), One Coat Bond, a one bottle total-etch system applied with one coat (n = 46), or Prompt-L-Pop, a 1-step self-etching primer ("all-in-one") (n = 52), in 90 individuals. Ninety-eight of the lesions showed sclerotic dentin and 46 were non-sclerotic. Sixty-one were slightly roughened with a diamond bur before conditioning. The restorations were evaluated every 6 months during a 2-year period with slightly modified USPHS criteria.

RESULTS

All except three restorations were evaluated over 2 years. The cumulative loss rates for Clearfil Liner Bond 2, One Coat Bond and Prompt-L-Pop were at 6 months: 4.3, 2.2 and 3.9%, at 18 months: 4.3, 10.9 and 15.4% and at 24 months: 8.7, 13.0 and 21.2%, respectively. The cumulative loss rates of the materials in sclerotic lesions (15.7%) versus non-sclerotic lesions (14.0%) were not significanty different. Restorations placed with a diamond bur-roughened lesions showed a loss rate of 14.5%, while for the non-roughened lesions the frequency was 14.8%.

Perioesthetic approach to the diagnosis and treatment of carious and noncarious cervical lesions: Part I

Several factors can contribute to the development of noncarious cervical lesions. Therefore, these lesions can be described and classified according to their primary etiology. Traditionally, most dentists have treated noncarious cervical lesions only with restorative methods, for example, composite resin restorations. However, in many cases, a periodontal or a combined restorative/periodontal approach provides a better esthetic and functional result. In part I of this two-part report, we provide a review of noncarious cervical lesions and a series of clinical case reports showing surgical techniques used and the importance of the periodontal aspect of lesion management.

Use of Tooth-coloured Restorations in the Management of Toothwear

The problem of toothwear appears to be increasing in both children and adults. Recent developments in bonding and aesthetic restorations have added to the dentist's armamentarium for restoring worn teeth. Bonded ceramic and composite restorations offer the possibility of conservative restoration of teeth already damaged by toothwear. Despite this, concern still remains regarding the durability and clinical performance of these restorations. This paper reviews the currently available techniques for providing tooth-coloured restorations in toothwear cases.

Two-year clinical effectiveness of a resin-modified glass-ionomer adhesive

PURPOSE

To evaluate the clinical effectiveness of a resin-modified glass-ionomer adhesive FujiBond LC (GC) in non-carious Class V cervical lesions.

METHODS

28 patients and 52 abrasion-erosion lesions were restored using FujiBond LC and a microfilled resin composite in a cavity design with the adjacent enamel margins beveled. Clinical parameters as retention, marginal integrity, clinical microleakage, caries recurrence, esthetics, gingival response, tooth vitality and post-operative sensitivity were evaluated at 6 months, 1 and 2 years.

RESULTS

A 100% retention rate was recorded after 2 years of clinical service. However, only 15% of the restorations showed a perfect marginal adaptation. All marginal defects were small, either located at the incisal or at the cervical margin. The percentage of small marginal defects was obviously higher at the incisal enamel margin than at the cervical dentin margin. At the 2-year recall, half of the restorations exhibited a superficial, localized discoloration at the restoration margin, however none of the restorations showed deep, generalized discoloration. Remaining criteria of clinical effectiveness were rated as excellent.

Two-year clinical performance of Class V resin-modified glass-lonomer and resin composite restorations

While a one-year report had been previously published, this study was undertaken to evaluate the clinical performance and appearance of a resin-modified glass ionomer and a resin composite over two years. Thirty-seven pairs of restorations of FujI II LC and Z 250/Single Bond were placed in caries-free cervical erosion/abfraction lesions without tooth preparation. Restorations were clinically evaluated at baseline, 6, 12, 18 and 24 months using modified Ryge/USPHS criteria. No statistically significant difference (p = 0.13) was observed in the overall performance of the materials. Retention was 96% for the resin-modified glass ionomer and 81% for the resin composite, with no additional restorations of either material lost after one year. As previously reported, retention of the Z 250 restorations at six months was below the minimum specified in the ADA Acceptance Program for Dentin and Enamel Adhesives. The resin composite restorations generally had a better appearance, with a 100% alpha rating in color match, versus 85% for the resin-modified glass ionomer.

Effect of resin viscosity and enamel beveling on the clinical performance of Class V composite restorations: three-year results

This study evaluated the effect of the elastic modulus and margin configuration on the clinical performance of resin-based composite restorations in Class V non-carious defects. One hundred and five cervical non-carious defects on buccal surfaces of canines and premolars were included in this study. Defects were randomly divided into three Groups and restored according to the following techniques: Group 1--no enamel bevel was placed and the defect was restored with a microfilled resin-based composite (Durafill VS); Group 2--the enamel margin was beveled and the defect restored as in Group 1; Group 3-the enamel margin was beveled and the defect was restored with a flowable resin-based composite (Natural Flow). Each group comprised 35 lesions. A total-etch, one-bottle adhesive (One-Step) was used in all groups. Retention rate, pre- and post-operative sensitivity, marginal discoloration and secondary caries were determined over a three-year period and the data were analyzed statistically. At six months post-insertion, the restorations placed with beveled enamel margins resulted in 100% retention regardless of the composite used compared to a 66% retention of the non-beveled margins. At two and three years, no significant difference in retention rate was found among the three groups. Post-operative sensitivity, marginal discoloration and secondary caries were not affected by enamel beveling and restorative material. Beveled enamel margins resulted in significantly better clinical retention in the first six months only. Enamel beveling and composite viscosity appeared to not significantly affect the clinical performance of Class V non-retentive composite restorations after three years.

[Two-dimensional finite element stress analysis of simulating restored teeth with wedge-shaped defects under loads]

OBJECTIVE

To study the concentration of stresses at the cervix with simulating restoration of tooth defects.

METHODS

A two-dimensional finite element model of a mandible first premolar with defect from longitudinal section was developed. The model was simulatedly restored, respectively by composite resin and glass ionomer cement, and then investigated stress variation in the cervical area.

RESULTS

In the restored models, both of materials improved the concentration of stresses at the cervical area. The composite resin and the glass ionomer cement restorations made the maximum principal stresses declined respectively to 36.2 MPa and 42.5 MPa, which were close to the value of normal tooth in the deepest area of defects.

CONCLUSION

The concentration of stresses are improved in the cervical area with teeth defects restored.

Tooth wear: attrition, erosion, and abrasion

Attrition, erosion, and abrasion result in alterations to the tooth and manifest as tooth wear. Each classification acts through a distinct process that is associated with unique clinical characteristics. Accurate prevalence data for each classification are not available since indices do not necessarily measure one specific etiology, or the study populations may be too diverse in age and characteristics. The treatment of teeth in each classification will depend on identifying the factors associated with each etiology. Some cases may require specific restorative procedures, while others will not require treatment. A review of the literature points to the interaction of the three entities in the initiation and progression of lesions that may act synchronously or sequentially, synergistically or additively, or in conjunction with other entities to mask the true nature of tooth wear, which appears to be multifactorial.

Diagnosis and management of maxillary incisors affected by incisal wear: an interdisciplinary case report

In the attempt to restore anterior teeth affected by erosion and bruxism, many clinicians have been frustrated with the constant restorative failures. Frequently, these failures are attributed to the restorative materials employed, especially in cases in which composite resins are used. However, some flaws of the restorations are related to the oversight of occlusal principles. The purpose of this article is to discuss the etiology, signs, and symptoms of incisal wear, with special attention to that caused by bruxism and chemical erosion. Relatively simple management techniques (e.g., occlusal adjustment, adhesive restorations) are proposed, and the diagnosis and management of a representative clinical case is presented.

CLINICAL SIGNIFICANCE

In some cases of bruxism and/or dental erosion, it is possible to acquire space to recuperate the esthetics and function of maxillary incisors affected by incisal wear through a conservative treatment associated with the control of the etiologic factors.

Five-year double-blind randomized clinical evaluation of a resin-modified glass ionomer and a polyacid-modified resin in noncarious cervical lesions

PURPOSE

The aim of this double-blind randomized study was to compare the clinical performance of a resin-modified glass ionomer (Vitremer, 3M) and a polyacid-modified resin (Dyract, Dentsply DeTrey) in noncarious Class V restorations after 5 years.

MATERIALS AND METHODS

Twelve patients, having at least one pair of equal-sized noncarious cervical lesions under occlusion and a mean age of 40 years (range 19 to 63 years; median 41), were enrolled in this study. A total of 32 restorations (16 with each material) were placed according to the manufacturers' instructions by two calibrated operators. Two other independent examiners evaluated the restorations at baseline and after 5 years according to the USPHS criteria. The assessment criteria were: retention, anatomical form, marginal adaptation and marginal discoloration, color match, surface texture, and secondary caries. Statistical analysis was conducted using Fisher's exact test (alpha = 0.05).

RESULTS

No secondary caries was detected with either material. The retention rate for Vitremer (93%) and for Dyract (78.5%) did not differ significantly (p > 0.05). Regarding anatomical form, only two restorations of each material were recorded as bravo. In terms of marginal adaptation, 38.5% of Dyract restorations were rated alpha and 61.5% bravo, while 84.6% of Vitremer restorations were rated alpha and only 15.4% bravo (p < 0.05). For marginal discoloration, 18.2% of Dyract restorations and 84.6% of Vitremer restorations were rated alpha, with the remaining rated bravo. 86% of Vitremer restorations were rated as bravo and 23% alpha for both surface texture and color match. All Dyract restorations were classified as alpha regarding surface texture, and only two Dyract restorations (18.2%) were classified as bravo in the color match item.

CONCLUSION

The marginal adaptation of the RMGIC (Vitremer) was significantly better, the marginal discoloration lower, and the retention rate higher (though not significantly) than that of the PMRC (Dyract) after 5 years in situ. Dyract performed better in terms of surface texture and color match in noncarious Class V restorations after 5 years.

Restorative and Invisalign: a new approach

This case report describes an interdisciplinary treatment approach using the Invisalign System (Align Technology, Inc., Santa Clara, California) for orthodontics in combination with restorative dentistry. This combined approach was selected for an optimum esthetic and functional result. This case report demonstrates how a restorative case can be improved with prerestorative orthodontic alignment. The Invisalign System was used for opening the bite anteriorly, space distribution, and midline correction. The restorative dentistry procedures involved veneering to enhance the maxillary incisor length-to-width ratio and provide anterior guidance. The cosmetic alternative treatment modality to conventional fixed orthodontics allowed the clinician to accomplish the prerestorative orthodontic goals to help meet the desires of an esthetically conscientious patient.

Technique on restoring cervical lesions

This paper describes a technique of placing a semi-rigid cervical matrix slightly past the cervical border of a lesion that extends below (apical to) the gingival crest and inserting the glass ionomer cement through an opening cut in the matrix above the soft tissue level.

Clinical evaluation of a resin-modified glass ionomer adhesive system: results at five years

One hundred non-carious, non-undercut cervical lesions were restored with Silux Plus or Estio LC and bonded with Fuji Bond LC. The restorations were evaluated yearly for retention and marginal discoloration. After five years, the overall retention rate was 96%. Of the 41 restorations examined at five years, five had clinically evident marginal discoloration.

Crowns and other extra-coronal restorations: resin-bonded metal restorations

Resin-bonded metal restorations is the final part of the series. Cast metal restorations which rely on adhesion for attachment to teeth are attractive because of their potential to be much more conservative of tooth structure than conventional crowns which rely on preparation features providing macromechanical resistance and retention.

Two-year clinical evaluation of four polyacid-modified resin composites and a resin-modified glass-ionomer cement in Class V lesions

OBJECTIVE

The aim of the study was to compare the clinical performances of four polyacid-modified resin composites (F2000, Dyract AP, Compoglass F, and Elan) and one resin-modified glass-ionomer cement (Vitremer) in Class V abrasion/erosion lesions.

METHOD AND MATERIALS

Twenty restorations of each of the five restorative materials were placed in noncarious cervical abrasion/erosion lesions by one dentist. No cavity preparation was attempted. All teeth were isolated with cotton rolls and gingival retraction cord. The materials were manipulated according to the manufacturer's instructions and placed with the help of cervical matrixes. Restorations were finished and polished immediately after the placement. Evaluations were performed at baseline and 6 months, 1 year, and 2 years after placement for retention, color match, cavo-surface marginal discoloration, anatomic form, marginal adaptation, secondary caries, and postoperative sensitivity.

RESULTS

Retention levels at 2 years were 90% for F2000, 90% for Dyract AP, 89% for Compoglass F, 84% for Elan, and 95% for the Vitremer restorations. No statistically significant differences were found among the materials after 2 years for any evaluation category.

CONCLUSION

Polyacid-modified resin composite and resin-modified glass-ionomer cement restorations showed acceptable clinical performance after 2 years.