The effect of a nano-filled resin coating on the 3-year clinical performance of a conventional high-viscosity glass-ionomer cement

Clinical comparison of high-viscosity glass-hybrid systems with a sculptable bulk-fill composite resin in different cavity types

OBJECTIVE

This randomized, double-blind clinical investigation assessed the performance of two high-viscosity glass-ionomer systems and a bulk-fill composite in different cavity types.

MATERIALS AND METHODS

In 146 participants, 360 (class I, II, and V) cavities were restored using three different materials (Equia Forte HT, Chemfill Rock, and SonicFill 2) with equal allocation. Using modified World Dental Federation criteria, restorations were assessed after 1 week, 6 months, and 18 months by an experienced examiner. Statistical analysis was conducted using Fisher's exact and Wilcoxon signed rank tests (α = 0.05).

RESULTS

After 18 months, 267 restorations were assessed in 116 participants. After 18 months, 5 Equia Forte HT restorations failed due to debonding and fracture. Only one loss was observed in the Chemfill Rock restorations. Equia Forte HT exhibited significantly lower retention than SonicFill 2 after 18 months (p = 0.019), irrespective of cavity type. At 1 week, 3 Class I restorations with SF showed postoperative sensitivity. The type of cavity did not affect the performance of the restorative materials used (p > 0.05).

CONCLUSION

Equia Forte HT and Chemfill Rock presented similar clinical performance regardless of color match. Equia Forte HT showed a lower performance compared to SonicFill 2.

CLINICAL SIGNIFICANCE

Glass-hybrid materials presented a lower performance in terms of color match or retention when compared to a sculptable bulk-fill composite resin.

Could bulk fill glass hybrid restorative materials replace composite resins in treating permanent teeth? A randomized controlled clinical trial

OBJECTIVE

This study aims to compare the clinical and radiographic efficacy of Equia system bulk fill glass hybrid material with composite resins in the permanent restoration of pediatric patients' permanent teeth.

MATERIALS AND METHODS

The study included 44 pediatric patients aged 8-16 who applied to Necmettin Erbakan University Pediatric Dentistry Department. The groups were formed as symmetrical teeth in the same patient using the split-mouth design. The study included class I caries lesions of 144 permanent teeth. Group 1 was restored with the Equia system bulk fill glass hybrid material (Equia Forte HT + Equia Forte Coat [GC, Co, Tokyo, Japan]) (n = 72) and Group 2 with the Charisma Smart universal composite resin (Kulzer, Gmbh, Hanau, Germany) + Clearfil SE Bond (Kuraray, Noritake, Sakazu, Okayama) (n = 72). Evaluations were performed clinically and radiographically by two physicians in 2nd week, 3rd month, 6th month, and 12th month and the results were recorded. Clinical evaluation was carried out using modified-USPHS criteria. Obtained data were statistically analyzed using Kendall's W test and Cochran's Q test for the comparison within the group, and the Chi-square test for the comparison between groups.

RESULTS

Among the materials utilized in the study, there was no statistically significant difference in marginal adaptation, marginal discoloration, retention, anatomical form, postoperative sensitivity, and secondary caries according (p > 0.05). Group 2 outperformed statistically significant Group 1 in terms of color match in all periods (p < 0.05). While there was no statistically significant difference in surface structure between the groups in 2nd week and 3rd month (p > 0.05), there was a statistically substantial difference in 6th, and 12th months (p < 0.05). No secondary caries or periapical lesions were found in any restorations during radiographic evaluation.

CONCLUSION

After a year, the clinical performance of both Equia and composite resins was equivalent and successful in the majority of the measures against which they were evaluated.

CLINICAL SIGNIFICANCE

Based on the results of the research, Equia system bulk fill glass hybrid restorations are considered a viable alternative to composite resins in class I permanent teeth restorations.

The preventive effect of glass ionomer cement restorations on secondary caries formation: A systematic review and meta-analysis

OBJECTIVE

The objective is to compare the preventive effect on secondary caries of glass ionomer cement (GIC) restorations with amalgam or resin-composite restorations.

METHODS

Two independent researchers conducted a systematic search of English publications in PubMed, Web of Science, Cochrane and Scopus. They selected randomized clinical trials comparing secondary caries incidences around GIC restorations (conventional GIC or resin-modified GIC) with amalgam or resin-composite restorations. Meta-analysis of the secondary-caries incidences with risk ratio (RR) and 95% confidence interval (95% CI) as the effect measure was performed.

RESULTS

This review included 64 studies. These studies included 8310 GIC restorations and 5857 amalgam or resin-composite restorations with a follow-up period from 1 to 10 years. Twenty-one studies with 4807 restorations on primary teeth and thirty-eight studies with 4885 restorations on permanent teeth were eligible for meta-analysis. The GIC restorations had a lower secondary caries incidence compared with amalgam restorations in both primary dentition [RR= 0.55, 95% CI:0.41-0.72] and permanent dentition [RR= 0.20, 95% CI:0.11-0.38]. GIC restorations showed similar secondary caries incidence compared with resin-composite restorations in primary dentition [RR= 0.92, 95% CI:0.77-1.10] and permanent dentition [RR= 0.77, 95% CI:0.39-1.51]. Conventional GIC restorations showed similar secondary caries incidence compared with resin-modified GIC-restored teeth in both primary dentition [RR= 1.12, 95% CI:0.67-1.87] and permanent dentition [RR= 1.63, 95% CI:0.34-7.84].

CONCLUSIONS

GIC restorations showed a superior preventive effect against secondary caries compared to amalgam restorations, and a similar preventive effect against secondary caries compared to resin-composite restorations in both primary and permanent teeth. [PROSPERO Registration ID: CRD42022380959].

Efficacy of bioactive materials in preventing Streptococcus mutans-induced caries on enamel and dentine

The study investigated the ability of bioactive materials used to restore enamel and dentine specimens to prevent caries. Enamel (n = 50) and dentine (n = 50) specimens were obtained from bovine incisors, prepared, and randomly allocated to one of five groups according to the restorative treatment: alkasite without adhesive system; alkasite with adhesive system; high viscosity glass ionomer cement; resin composite; no restoration; negative control group. Specimens were restored, exposed to a thermal cycling aging protocol, sterilized, and exposed to a cariogenic challenge induced by Streptococcus mutans and then submitted to surface and subsurface microhardness tests and polarized light microscopy to verify the caries lesion development in enamel or dentine surrounding the restorative materials. Data were analyzed using one-way ANOVA. In enamel and dentine, glass ionomer cement, alkasite without and with adhesive system presented a lower percentage surface microhardness loss than resin composite and negative control. Enamel subsurface microhardness presented no statistically significant differences between glass ionomer cement, alkasite without and with adhesive system. Glass ionomer cement also did not present statistically significant differences from resin composite and the negative control. In dentine, glass ionomer cement showed the highest subsurface microhardness values. In conclusion, bioactive restorative materials provide greater protection to enamel and dentine against surface caries development than resin composite.

High-viscosity glass-ionomer cement or composite resin for restorations in posterior permanent teeth? A systematic review and meta-analyses

OBJECTIVES

Answer the PICO question: Do class I and II posterior restorations in permanent teeth placed with high-viscosity glass-ionomer cement (HV-GIC) fail more than composite resin (CR) restorations?

DATA

The study was registered in the PROSPERO database (CRD42020138290). Randomized and controlled clinical trials, comparing the performance of HV-GIC and CR in load bearing cavities of posterior permanent teeth were included. Cochrane risk of bias tool and GRADE were used to assess the quality and certainty of the evidence. Meta-analyses were performed for clinical outcomes on USPHS and FDI criteria for 12-, 24- and 36-months follow-ups.

SOURCES

PubMed, Scopus and Web of Science were last searched on April 2, 2022, without language or date restrictions. Reference lists of primary studies and their related article link in PubMed were manually searched.

STUDY SELECTION

Ten studies were included, while data from 8 were used for the meta-analyses. A total of 849 HV-GIC and 800 CR restorations were followed. The primary outcome was the fracture/retention of the restoration, with a comparable performance for both materials on all follow-ups. The 36 months follow-up for class I restorations (longest) showed risk difference of -0,00 (95%CI -0,03 to 0,03; p = 0,98) and no heterogeneity (p = 0,98, I2=0%). The certainty of the evidence is moderate, as all included studies were at an uncertain risk of bias.

CONCLUSIONS

HV-GIC and CR presented comparable clinical performance in posterior permanent teeth up to 36 months. HV-GIV wear in class I restorations followed by 24 months was the only poorer result compared to CR.

CLINICAL SIGNIFICANCE

Conservative load bearing cavities in permanent posterior teeth can be restored with HV-GIC with comparable clinical performance to CR expected at least up to 3 years. HV-GIC is a valuable direct restorative option for posterior teeth in high caries risk patients, in which CR is frequently associated with failure.

Exploring the Potential of Nanotechnology in Pediatric Healthcare: Advances, Challenges, and Future Directions

The utilization of nanotechnology has brought about notable advancements in the field of pediatric medicine, providing novel approaches for drug delivery, disease diagnosis, and tissue engineering. Nanotechnology involves the manipulation of materials at the nanoscale, resulting in improved drug effectiveness and decreased toxicity. Numerous nanosystems, including nanoparticles, nanocapsules, and nanotubes, have been explored for their therapeutic potential in addressing pediatric diseases such as HIV, leukemia, and neuroblastoma. Nanotechnology has also shown promise in enhancing disease diagnosis accuracy, drug availability, and overcoming the blood-brain barrier obstacle in treating medulloblastoma. It is important to acknowledge that while nanotechnology offers significant opportunities, there are inherent risks and limitations associated with the use of nanoparticles. This review provides a comprehensive summary of the existing literature on nanotechnology in pediatric medicine, highlighting its potential to revolutionize pediatric healthcare while also recognizing the challenges and limitations that need to be addressed.

Secondary caries and marginal adaptation of ion-releasing versus resin composite restorations: a systematic review and meta-analysis of randomized clinical trials

This systematic review was aimed to evaluate occurrence of secondary caries and marginal adaptation in ion-releasing materials versus resin composite. Electronic search of PubMed, Scopus, and Open Grey databases with no date or language restrictions until May 21st, 2021, was conducted. Randomized clinical trials that compared ion-releasing restorations versus resin composite were included. For quantitative analysis, a random-effects meta-analysis with risk difference as an effect measure and a 95% confidence interval was used. Quality of evidence was assessed using The Grading of Recommendations, Assessment, Development, and Evaluation criteria. The risk of bias was evaluated using the Cochran Collaboration Risk of Bias tool. The inclusion criteria were met by 22 studies, and 10 studies were included in the meta-analysis. Three follow-up periods (1 year, 18 months-2 years, and 3 years) were evaluated. The overall quality of evidence for secondary caries and marginal adaptation outcomes was low. The results of the meta-analysis showed no significant difference (p > 0.05) in both outcomes between ion-releasing materials and resin composite. The occurrence of secondary caries was not dependent on the nature of the restorative material. It is more likely a complex process that involves the same risk factors as primary carious lesions.

Effect of CPP-ACP Modified-GIC on Prevention of Demineralization in Comparison to Other Fluoride-Containing Restorative Materials

BACKGROUND

This study evaluated the ability of a CPP-ACP-modified GIC to inhibit demineralization around the margin of cervical cavities in natural teeth in comparison with a Giomer and conventional GIC with and without coating.

METHODS

Thirty-two sound human molars were used. Box-shaped cavities were prepared along the CEJ. Teeth were randomly divided into 4 groups and restored with Equia Forte Fil, Coated Equia Forte Fil, Fuji VII EP, or Beautifil II. Teeth were subjected to pH cycling. Micromorphological and elemental analyses were done using SEM and EDX. Polarized light microscope analysis and microhardness tests were also performed.

RESULTS

Microhardness tests on enamel showed a significant difference between the coated Equia group, Equia, and Beautifil II groups (p<0.05). Dentin results showed significant differences between the coated Equia group and all other groups (p<0.05). Elemental analysis showed significant differences in calcium weight percentage among the first and second observation levels in all groups (p<0.05). A significant difference was found between the coated Equia group and the other three groups (p<0.05).

CONCLUSIONS

All tested materials showed some ability to resist demineralization at the restoration margins. The coated GIC restoration showed better outcomes compared with the other tested materials. © 2022 Australian Dental Association.

Survival estimates of atraumatic restorative treatment versus traditional restorative treatment: a systematic review with meta-analyses

Objectives The hypothesis tested was that there is no significant difference between the survival estimates of atraumatic restorative treatment/high-viscosity glass-ionomer cement (ART/HVGIC) restorations, in posterior primary and permanent teeth, and traditional amalgam and resin composite restorations.Data sources The databases PubMed, DOAJ, LILACS, IndMed, Google Scholar and CNKI were searched.Data selection Using inclusion and exclusion criteria led to 14 eligible randomised trials. A low risk of bias was observed for two reports. Homogeneity was obtained for single-surface ART restorations after one and two years in the primary dentition.Data synthesis No statistically significant difference was found between the weighted mean survival percentages of ART/HVGIC and traditional treatments in both single- and multiple-surface restorations in primary molars and in single-surface restorations in posterior permanent teeth at years 1, 2, 3 and 5. At years 4.3 and 6.3, the difference between the two treatments was statistically significant, favouring the ART/HVGIC restorations. No statistically significant difference was found between the weighted mean survival percentages of ART/HVGIC and traditional treatments in multiple-surface restorations in posterior permanent teeth.Conclusion The ART method using HVGICs can be considered as a replacement for traditional restorations in single- and multiple-surface cavities in primary molars, and in single-surface cavities in posterior permanent teeth, particularly for amalgam.

A prospective and randomized clinical trial evaluating the effectiveness of ART restorations with high-viscosity glass-ionomer cement versus conventional restorations with resin composite in Class II cavities of permanent teeth: two-year follow-up

OBJECTIVE

To compare the effectiveness of ART restorations using High Viscosity Glass-ionomer cement (HVGIC) with conventional restorations using resin composite in Class II cavities of permanent teeth, in a 2-year follow-up.

METHODOLOGY

Seventy-seven restorations were made with each restorative material, Equia Fil-GC Corporation (ART restorations) and Z350-3M (conventional restoration), in 54 participants in this parallel and randomized clinical trial. Restorations were evaluated at 6 months, 1 and 2 years using the ART and the modified United States Public Health Service (USPHS) criteria. Chi-square test and Survival Analysis (p<0.05) were used for statistical analysis.

RESULTS

The success rates for ART restorations were 98.7% (6 months) and 95.8% (1 year) for both criteria. At 2 years, success rate was 92% and 90.3% when scored by the modified USPHS and ART criteria (p=0.466), respectively. The success rates for conventional restorations were 100% (6 months), 98.7% (1 year) and 91.5% (2 years) for both assessment criteria. ART restorations presented a lower survival rate by the criterion of ART (83.7%) when compared to the modified USPHS criterion of (87.8%), after 2 years (p=0.051). The survival of conventional restorations was 90.7% for both evaluation criteria.

CONCLUSION

At the 2-years follow-up evaluation, no statistically significant difference was observed between the success rate of ART restorations with HVGIC compared to conventional restorations with resin composite in Class II cavities of permanent teeth.

Clinical study on resin composite and glass ionomer materials in II class restorations in permanent teeth

Background

Glass ionomer cements (GIC) used for restoration of missing dental structures have high biocompatibility and remineralization potential. However, low mechanical resistance excludes their use for long-term restorations of extensive lesions, particularly on approximal surfaces in permanent dentition. GIC with increased viscosity have much better physical properties, which involves better bonding and wear resistance, so they can be considered as an alternative to composite resin materials. The aim of this study was to perform a clinical and radiological assessment of restorations in permanent teeth, made with an increased viscosity GIC - Equia Fil (Ivoclar Vivadent) with Equia Coat (Ivoclar Vivadent) and composite material - Tetric EvoCeram (Ivoclar Vivadent) in young patients.

Material and Methods

A total of 100 cavities on approximal surfaces were filled with the composite material or GIC in 49 patients aged from 12.08 to 19.58 years. During control examinations, the condition of each restoration was assessed with criteria acc. to Hickel et al. Bitewing radiographs had been taken before fillings were placed and after 12 and 24 months.

Results

After two years of observations, two GIC restorations were replaced due to loss of retention and staining. The other 96 restorations were given a satisfactory grade. The clinical efficacy of Equia Fil after 24 months was assessed at 95.83%, the Tetric EvoCeram at 100%. The difference was not statistically significant (P=0.145). When GIC was used, there was a higher risk of marginal adaptation deterioration and the occurrence of staining and erosion. Radiographic efficacy of the Equia Fil material for cavity restoration after 24 months was assessed at 93.75%, for the Tetric EvoCeram material at 100%. Differences were not significant statistically (P=0.073).

Conclusions

Tetric EvoCeram and Equia Fil used for the restoration of approximal lesions in premolars and permanent molars have similar efficacy in a 2-year period of observation. Key words:Dental restoration, permanent, composite resins, glass ionomer cements, clinical study.

Effect of Nano-Filled Protective Coating and Different pH Enviroment on Wear Resistance of New Glass Hybrid Restorative Material

The purpose of the study was to determine the wear rate of Equia Forte HT Fil with Equia Forte Coat or without coating and compare it with Fuji IX GP high-viscosity glass ionomer cement (GIC) in conditions with acid load or at neutral pH. The samples were stored for 7 days: (1) in artificial saliva, (2) in artificial saliva and cyclically exposed to low pH, and (3) in distilled water and cyclically exposed to low pH. Wear was determined by measuring the difference in mass before and after brushing in an abrasion testing device. The wear of Fuji IX GP was significantly higher than that of Equia Forte HT Fil with or without coating (p = 0.000). The difference between Equia Forte HT Fil with and without Coat was not statistically significant (p < 0.803). The differences in wear resistance between samples stored in saliva and in distilled water were not significant (p = 0.588). Periodic exposure to the low pH solution significantly affected the wear resistance of all materials (p = 0.000). Equia Forte HT Fil was more resistant to wear than Fuji IX GP in all storage conditions. A resinous coat did not significantly increase wear resistance.

Flexural strengths and porosities of coated or uncoated, high powder-liquid and resin-modified glass ionomer cements

Background/purpose

No study has previously investigated and compared whether resin coating could prevent the effect of dehydration on flexural strengths and porosities of high powder-liquid and resin-modified glass ionomer cements (HPL-GIC and RM-GIC). The purpose of this study is to investigate the effect of resin coating on flexural strengths and porosities of HPL-GIC and RM-GIC under a dry condition.

Materials and methods

HPL-GIC (Equia Forte Fil) or RM-GIC (Fuji II LC) was mixed and loaded into a mold to create a bar-shaped specimen, n = 12 of each. The specimens were randomly divided into two groups, coated and uncoated, n = 6 of each. In the coated group, a resin coating agent (Equia Forte Coat) was applied and light cured for 20 s. After 72 h, each specimen was dried and scanned to detect porosities (% volume) using micro-computed tomography. After scanning, flexural strength (MPa) of the specimen was tested using a three-point bending method.

Results

Porosities of HPL-GIC were significantly higher than RM-GIC, either coated or uncoated group (p < .05). Flexural strengths of coated and uncoated HPL-GIC were 41.47 ± 0.89 and 15.32 ± 1.15 MPa that were significantly lower than those of RM-GIC at 104.77 ± 3.97 and 52.90 ± 2.17 MPa (p < .05). Flexural strengths of coated GICs were significantly higher than uncoated GICs (p < .05).

Conclusion

Resin coating increased flexural strengths of GICs under dry condition. HPL-GIC had higher porosities and lower flexural strength than RM- GIC.

In vitro wear of (resin-coated) high-viscosity glass ionomer cements and glass hybrid restorative systems

OBJECTIVES

The aim of the present study was to investigate the volumetric abrasive wear of a high-viscosity glass ionomer cement (hvGIC; Equia Fil) and a glass hybrid restorative system (ghRS; Equia Forte), each being recommended as amalgam alternatives. Both materials were applied with or without their respective resinous coating, and were compared with a conventional GIC (Ketac Fil) and a hybrid composite resin (CR; G-ænial Posterior).

METHODS

78 standardized occlusal Class I cavities were restored with the various materials (n = 13 per group). Before and after chewing simulation (30,000 cycles at 40 N), each sample underwent optical scanning procedures (Omnicam). A comparison of the total wear using a fluorescence-aided identification technique (OraCheck) followed, and differences (α = 5%) between groups were compared by means of MANOVA.

RESULTS

Regarding the wear rates of hvGIC and ghRS, no differences could be observed (p > .050), and this was not affected by the resinous coating. All hvGIC and ghRS restorations showed significantly higher abrasive wear than CR (p < .001), while the conventional GIC displayed a significant underperformance compared with any other material (p < .001).

CONCLUSIONS

Resinous coating of hvGIC or ghRS does not appear to exert an effective long-term protection against advanced abrasive wear. Compared to the conventional GIC showing a considerable substance loss, both hvGIC and ghRS materials revealed an improved abrasion resistance, but clearly failed to meet the excellent values of the CR.

CLINICAL SIGNIFICANCE

Occlusal loading should be carefully considered when using hvGIC or ghRS as amalgam (or composite resin) alternatives for the restoration of posterior teeth.

One-year clinical evaluation of two high-viscosity glass-ionomer cements in class II restorations of primary molars

BACKGROUND

Little information exists on the clinical performance of restorative materials on primary teeth of preschool children. This study aimed to evaluate clinical performance of compomer, glass-hybrid-added high-viscosity glass-ionomer cement and zinc-added high-viscosity glass-ionomer cement materials in class ΙΙ restorations of primary molars.

METHODS

The study included 251 teeth of 57 patients aged 4-7 years with proximal caries in primary molars. The teeth were divided into three groups, and each restorative material was randomly distributed. Dyract XP, Equia Forte and ChemFil Rock materials were placed after cavity preparation and clinically evaluated at 3, 6, 9 and 12 months using modified United States Public Health Service criteria. Statistical analyses were performed using chi-square and z tests.

RESULTS

At the end of 12 months, a total of three restorations in Dyract XP group, 22 in Equia Forte group and 11 in ChemFil Rock group failed in retention criteria. No statistically significant difference existed between retention, colour match and surface texture criteria of all groups at 3 and 6 months, but a statistically significant difference was found at 12 months (P < 0.05).

CONCLUSION

For class ΙΙ restorations of primary molars, the success of compomer material was superior to high-viscosity glass-ionomer materials.

Minimally invasive judgement calls: managing compromised first permanent molars in children

This paper aims to update the reader on how minimally invasive (MI) techniques may be used to improve the longevity of carious or defective/compromised first permanent molars (cFPMs) in young children. Clinical and radiographic diagnosis and the prognostic factors will be discussed in view of recent studies showing that these teeth can be kept in function and have an improved prognosis as the child gets older. Clinical protocols for their care, based on the latest evidence and techniques for MI restorations, together with longevity information of possible restorative options, are described. This paper also explores the rationale behind enforced extractions and related morbidity, in order to help oral healthcare practitioners to determine the optimal management of these key elements in the dentition for the benefit of the patients.

Commercially Available Fluoride-Releasing Restorative Materials: A Review and a Proposal for Classification

Resin composite and glass ionomer cement (GIC) are the most commonly used dental materials to perform direct restorations. Both have specific characteristics that explain their popularity and their limits. More than 20 years ago, the first attempt (followed by others) to combine the advantages of these two families was performed with compomers, but it was not very successful. Recently, new formulations (also called 'smart materials') with claimed ion release properties have been proposed under different family names, but there are few studies on them and explanations of their chemistries. This comprehensive review aims to gather the compositions; the setting reactions; the mechanical, self-adhesive, and potential bulk-fill properties; and the ion release abilities of the large existing families of fluoride-releasing restorative materials and the new restorative materials to precisely describe their characteristics, their eventual bioactivities, and classify them for an improved understanding of these materials. Based on this work, the whole GIC family, including resin-modified and highly viscous formulations, was found to be bioactive. Cention N (Ivoclar Vivadent, AG, Schaan, Lietschentein) is the first commercially available bioactive resin composite.

Clinical Performance of a Glass Hybrid Restorative in Extended Size Class II Cavities

Objective:

To evaluate the clinical performance of a glass hybrid restorative compared with a resin composite in the restoration of large and deep Class II cavities after 24 months.

Methods and Materials:

A total of 108 extended size, with the width of the proximal box not interfering with the peak of the cusps and the proximal box in occlusion, Class II lesions in 37 patients were either restored with a glass hybrid restorative or with a micro-hybrid composite resin in combination with selective etching by two experienced operators according to the manufacturer's instructions. Two independent examiners evaluated the restorations at baseline and at the six-, 12-, 18-, and 24-month recalls according to the modified US Public Health Service criteria. Negative replicas at each recall were observed under scanning electron microscopy (SEM) to examine surface characteristics. Data were analyzed statistically.

Results:

After 24 months, 90 restorations were evaluated in 32 patients (recall rate: 86.5%). Four glass hybrid restorations were missing; three were due to bulk and one was due to proximal fracture at 12 months. Only six restorations were scored as bravo at baseline and at the six-, 12-, 18-, and 24-month recalls for color (p&lt;0.05). No significant differences were observed between the two restorative materials for the other criteria evaluated (p&gt;0.05). SEM observations exhibited acceptable surface and marginal adaptation characteristics for both restorative materials at 24 months.

Conclusions:

Although glass hybrid restorations showed significant mismatch in color, both restorative materials exhibited successful performance for the restoration of large Class II cavities after 24 months.

Effects of surface coating on the flexural strength of fluoridereleasing restorative materials after water aging for one year

Purpose:

To evaluate the effects of surface coating and one-year water storage on the flexural strength of fluoride-releasing restorative materials.

Materials and methods:

Forty specimens were prepared from each material; GCP Glass Fill (GCP), Amalgomer CR (AHL), Zirconomer (Shofu), Fuji IX GP Capsule (GC), Beautifil II (Shofu), Estelite Σ Quick (Tokuyama) and reliaFIL LC (AHL). The specimens were randomly divided into two groups; surface coated with G-Coat Plus (GC) and uncoated. Each group was subdivided into two groups stored in distilled water at 37◦C for 24 h and 1 year before testing (n=10). The flexural strength was evaluated using three-point bending test according to the ISO 4049:2009 standard using a universal testing machine. After flexural strength test, a cross-section of the coated specimens was evaluated with scanning electron microscopy (SEM).

Results:

A significant increase was observed on the flexural strength of Amalgomer CR, Zirconomer and Fuji IX GP after 24 h when G-Coat Plus was applied (p<0.05). This significant increase was observed on the flexural strength of only Amalgomer CR and Zirconomer after 1 year (p<0.05). The highest flexural strength was obtained with Beautifil II, Estelite Σ Quick and reliaFIL LC after 24 h and 1 year (p<0.05). After 1 year, there was decrease on the flexural strength of the other materials except Beautifil II, Estelite Σ Quick and reliaFIL LC.

Conclusion:

The resin coating improved the flexural strength of some glass ionomer-based materials but the water aging decreased the same physical properties.

Compressive Strength of New Glass Ionomer Cement Technology based Restorative Materials after Thermocycling and Cyclic Loading

Objective

The objective of the study was to compare compressive strengths of two glass ionomer-based materials, with and without a light-cured, nano-filled coating, after cyclic loading and thermocycling.

Materials and methods

To determine compressive strength of new restorative materials over a longer period of time, materials were analysed under simulated conditions where cyclic loading replicated masticatory loading and thermocycling simulated thermal oscillations in the oral cavity. Four groups of samples (n=7)—(1) Equia Fil (GC, Tokyo, Japan) uncoated; (2) Equia Fil coated with Equia Coat (GC, Tokyo, Japan); (3) Equia Forte Fil (GC, Tokyo, Japan) uncoated; and (4) Equia Forte Fil coated with Equia Forte coat (GC, Tokyo, Japan)—were subjected to cyclic loading (240,000 cycles) using a chewing simulator (MOD, Esetron Smart Robotechnologies, Ankara, Turkey).

Results

Compressive strength measurements were performed according to ISO 9917-1:2007, using the universal mechanical testing machine (Instron, Lloyd, UK). Scanning electron microscope (SEM) analysis was performed after thermocycling. There were no statistically significant differences between Equia Fil and Equia Forte Fil irrespective of the coating (p<0.05), but a trend of increasing compressive strength in the coated samples was observed.

Conclusions

Coating increases the compressive strength of Equia Fil and Equia Forte Fil, but not significantly.

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.

A randomized, prospective clinical study evaluating effectiveness of a bulk-fill composite resin, a conventional composite resin and a reinforced glass ionomer in Class II cavities: one-year results

OBJECTIVES

Bulk-fill restorative materials such as bulk-fill composite resins and high viscous glass ionomer cements have become very popular materials in operative dentistry because their application is easy and time-saving. The aim of this clinical study was to evaluate the clinical performance of a highly viscous reinforced glass ionomer material, a bulk-fill composite resin and a micro hybrid composite resin in Class II restorations.

METHODOLOGY

In total, 109 Class II restorations were performed in 54 patients using three different restorative materials: Charisma Smart Composite (CSC); Filtek Bulk Fill Posterior Restorative (FBF); Equia Forte Fil (EF). Single Bond Universal adhesive (3M ESPE, Germany) was used with composite resin restorations. The restorations were evaluated using modified USPHS 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 Chi-Square, Fischer's and McNemar's tests.

RESULTS

At the end of one year, 103 restorations were followed up. No changes were observed during the first 6 months. At the end of one year, there were small changes in composite restorations (FBF and CSC) but no statistically significant difference was observed between the clinical performances of these materials for all criteria (p>0.05). However, there was a statistically significant difference between EF, FBF and CSC groups in all parameters except marginal discoloration, secondary caries and postoperative sensitivity in one-year evaluation (p<0.05).

CONCLUSION

Bulk-fill composite resins and conventional composite resins showed more successful clinical performance than highly viscous reinforced glass ionomers in Class II cavities.

A randomized controlled 10 years follow up of a glass ionomer restorative material in class I and class II cavities

OBJECTIVE

To evaluate the durability of a glass ionomer restorative material in Class I and Class II cavities during 10 years compared with a micro filled composite resin.

METHODS

Fifty-nine participants (mean age 24 years) received 140 (80 Class I and 60 Class II) glass ionomer (GI) or composite resin (CR) restorations. Evaluation was performed with slightly modified USPHS criteria at baseline, and yearly during the 10 years. Data were analyzed with Cohran's Q and McNemar's tests.

RESULTS

Fifty-one patients and 124 restorations (61 GI / 38 Class I - 23 Class II, 63 CR / 38 Class I, 25 Class II) were evaluated after 10 years. The recall rate was 86.4%. The overall clinical recall rate of restorations was 88.6%. The success rate of Class I and II restorations were calculated as 100% for both materials. The cumulative failure rate (CRF) of all Cl I and Cl II GI restorations was 3.17% in total, but CFR was 8 % for Cl II GI restorations. A significant difference was observed between the marginal discoloration scores of restorations at 10 years (p = 0.022). No significant difference was seen between two restorative materials in terms of marginal adaptation (p > 0.05). A significant change was seen in color match of GI restorations at 10 years (p < 0.05). No significant change was found for the anatomical form, secondary caries, postoperative sensitivity, surface texture, and retention for either restorative material (p > 0.05).

CONCLUSIONS

Both tested restorative materials showed an acceptable success rate in the restoration of Class I and Class II cavities during the 10-year follow up.

Mechanical Properties of High Viscosity Glass Ionomer and Glass Hybrid Restorative Materials

Objectives

to determine the mechanical properties of hybrid and high-viscosity glass ionomer cements. Compressive strength and hardness of three glass ionomer cements (GIC) were measured: Ketac ™ Universal Aplicap ™, EQUIA Fil® and EQUIA FORTE Fil®, and the SEM sample analysis were performed.

Materials and Methods

The samples for measuring the compressive strength were prepared using silicone molds with standard dimensions of 6 mm x 4 mm and stored in deionized water for five days, while the samples for hardness measurement were prepared using Teflon molds with a cylindrical opening in the middle, dimensions 2 mm in height and 5 mm in width. For each material, one sample was made (n = 1) and stored in deionized water at 37ºC for 25 days. A representative sample of each material was analyzed using SEM. For the comparison of obtained values, the ANOVA test was used, while Tukey test was used for the multiple comparison.

Results

There were no significant differences between the compressive strength of the three tested materials (p <0.05). The hardness values were: 157 HV0,2 for Ketac ™ Universal Aplicap ™, 47 HV0,2 for EQUIA Fil® and 39 HV0,2 for EQUIA FORTE Fil®, respectively, and were significantly different, implying that Ketac ™ Universal Aplicap ™ has much higher hardness values than the other materials tested. SEM sample analysis revealed similar fracture modes of the tested materials.

Conclusion

It was concluded that there were no statistically significant differences in compressive strength and fracture modes between the tested materials, while Ketac ™ Universal Aplicap ™ hardness results were significantly higher than the ones measured for EQUIA Fil® and EQUIA FORTE Fil®.

Fluoride Release from Glass Ionomer with Nano Filled Coat and Varnish

OBJECTIVE

This in vitro study compares the fluoride release from microlaminated glass ionomer based on glass hybrid technology coated with two different surface coating agents.

MATERIALS AND METHODS

A total of 18 samples were divided into three groups of six samples each: (1) glass ionomer Equia Forte Fil coated with Equia Forte Coat (Equia+EC), (2) glass ionomer Equia Forte Fil coated with GC Fuji Varnish (Equia+VC) and (3) uncoated glass ionomer Equia Forte (EQUIA cont). Fluoride release was measured using an ion-selective electrode (ORION EA 940) after 24 hours, 4 days, 30 days and 64 days. Repeated measures ANOVA, multiple comparisons, Tukey's test and paired t-test were used to test the differences between the groups.

RESULTS

The differences between the groups and four time points were statistically significant (ANOVA, p<0.0001). Cumulative fluoride ion release after 64 days was 66.01 mg/l, 123.54mg/l and 203.22 mg/l for EQUIA+EC, EQUIA+VC and EQUIA cont, respectively. All the differences were statistically significant except the difference between EQUIA+VC and EQUIA cont after 24 hours.

CONCLUSIONS

The amount of released fluoride was significantly lower in the samples coated with nanofilled surface coating agent compared to the samples coated with varnish and uncoated samples.

Clinical wear of approximal glass ionomer restorations protected with a nanofilled self-adhesive light-cured protective coating

High viscous glass ionomer cement (GIC) has gained popularity as a restorative material; however, high wear is pointed as one of the major drawbacks of this material. Protective surface coatings were developed to protect GIC from water contamination with the additional advantage of occluding any surface cracks or porosities commonly found in this material, possibly resulting in an increased wear resistance of the restorations.

Three-year clinical evaluation of high-viscosity glass ionomer restorations in non-carious cervical lesions: a randomised controlled split-mouth clinical trial

OBJECTIVE

To compare the 3-year clinical performance of high-viscosity glass ionomer restorations with that of composite restorations in non-carious cervical lesions (NCCLs).

MATERIALS AND METHODS

One hundred thirty-four NCCLs were randomised into two groups according to a split-mouth design. In the experimental group (Hv-GIC), lesions were restored with a high-viscosity glass ionomer (EQUIA Fil, GC), whereas a composite resin (G-aenial, GC) was applied in the control group (E&Ra/comp). All restorative materials were used according to the manufacturers' instructions. Clinical evaluations were performed after 1 week, 6 months, 1 year, 2 years, and 3 years using FDI (World Dental Federation) criteria. Data were analysed using Friedman's ANOVA and Mann-Whitney U tests (α = 0.05).

RESULTS

While retention rates of the Hv-GIC group were 98.5%, 96%, 91%, and 87% in respective evaluation periods, no retention loss was observed in the E&Ra/comp group at any time. There was a statistically significant difference between study groups regarding the retention criterion in both the second and third years (p = 0.008 and p = 0.003, respectively). Furthermore, there was a statistically significant difference between the groups in terms of surface lustre at the third-year recall, in favour of the E&Ra/comp group (p = 0.022).

CONCLUSIONS

The 3-year clinical performance of E&Ra/comp restorations in NCCLs was better than that of Hv-GIC restorations. The most common problems in Hv-GIC restorations were a loss of retention and reduction in surface lustre.

CLINICAL RELEVANCE

Although the 3-year clinical performance of Hv-GIC restorations in non-retentive lesions was acceptable, it was worse than in composites. The operator should consider the benefit/loss ratio of Hv-GIC when he/she decides to use this material in non-retentive cavities, especially those that are shallow.

Viscoelastic Properties of Contemporary Bulk-fill Restoratives: A Dynamic-mechanical Analysis

This study investigated the viscoelastic properties of contemporary bulk-fill restoratives in distilled water and artificial saliva using dynamic mechanical analysis. The materials evaluated included a conventional composite (Filtek Z350), two bulk-fill composites (Filtek Bulk-fill and Tetric N Ceram), a bulk-fill giomer (Beautifil-Bulk Restorative), and two novel reinforced glass ionomer cements (Zirconomer [ZR] and Equia Forte [EQ]). The glass ionomer materials were also assessed with and without resin coating (Equia Forte Coat). Test specimens 12 × 2 × 2 mm of the various materials were fabricated using customized stainless-steel molds. After light polymerization/initial set, the specimens were removed from the molds, finished, measured, and conditioned in distilled water or artificial saliva at 37°C for seven days. The materials (n=10) were then subjected to dynamic mechanical testing in flexure mode at 37°C and a frequency of 0.1 to 10 Hz. Storage modulus, loss modulus, and loss tangent data were subjected to normality testing and statistical analysis using one-way analysis of variance/Dunnett's test and t-test at a significance level of p < 0.05. Mean storage modulus ranged from 3.16 ± 0.25 to 8.98 ± 0.44 GPa, while mean loss modulus ranged from 0.24 ± 0.03 to 0.65 ± 0.12 GPa for distilled water and artificial saliva. Values for loss tangent ranged from 45.7 ± 7.33 to 134.2 ± 12.36 (10^-3). Significant differences in storage/loss modulus and loss tangent were observed between the various bulk-fill restoratives and two conditioning mediums. Storage modulus was significantly improved when EQ and ZR was not coated with resin.

A Prospective Six-Year Clinical Study Evaluating Reinforced Glass Ionomer Cements with Resin Coating on Posterior Teeth: Quo Vadis?

Objective:

The aim of this study was to evaluate the long-term clinical performance of two encapsulated glass ionomer cements (GICs) (EquiaFil and Riva SC) covered with two different coatings (Equia Coat and Fuji Varnish) over six years using modified US Public Health Service (USPHS) criteria.

Methods:

Fifty-four patients having class I and II restorations/caries were included in the study. A total of 256 restorations were made with EquiaFil and Riva SC. Equia Coat or Fuji Varnish was used randomly on the surface of the restorations. After cavity preparations, the teeth were randomly restored with one GIC and coated with Equia Coat or Fuji Varnish. The restorations were evaluated at baseline; six, 12, and 18 months; and six years after placement using modified USPHS criteria. Two evaluators checked color match, marginal discoloration, marginal adaptation, caries formation, anatomical form, postoperative sensitivity, and retention rate, and photographs were taken at each recall. The results were evaluated with Pearson chi-square and Mann-Whitney U-test (p&lt;0.05).

Results:

Thirty-seven patients were evaluated. There was a significant difference between EquiaFil and Riva SC regarding retention rate and color match after six years (p=0.033 and 0.046). When comparing baseline to six years, the overall success of EquiaFil was better than Riva SC, having significant problems regarding retention rate and anatomical form (p=0.016 and 0.031). Class II cavities were significantly worse in marginal adaptation, anatomical form, and retention rate in the Riva SC groups (p=0.033, 0.015, and 0.007) but not in the EquiaFil groups. The combination of the coatings had no effect on the overall success of the materials.

Conclusions:

The EquiaFil system was more successful than Riva SC regarding color match, marginal adaptation, anatomic form, and retention rate after a six-year clinical evaluation period.

Effect of a self-adhesive coating on the load-bearing capacity of tooth-coloured restorative materials

BACKGROUND

The aim of this study was to compare the flexural strength and Vickers hardness of tooth-coloured restorative materials with and without applying a self-adhesive coating for up to 6 months.

METHODS

Specimens were prepared from three resin composites (RC), two resin-modified glass-ionomer cements (RM-GIC) and two conventional glass-ionomer cements (CGIC). All materials were tested both with and without applying G-Coat Plus (GCP). Specimens were conditioned in 37 °C distilled deionized water for 24 h, and 1, 3 and 6 months. The specimens were strength tested using a four-point bend test jig in a universal testing machine. The broken specimen's halves were used for Vickers hardness testing. Representative specimens were examined under an environmental scanning electron microscope.

RESULTS

Data analysis showed that regardless of time and materials, generally the surface coating was associated with a significant increase in the flexural strength of the materials. Applying the GCP decreased the hardness of almost all materials significantly (P < 0.05) and effect of time intervals on hardness was material dependent.

CONCLUSIONS

The load-bearing capacity of the restorative materials was affected by applying self-adhesive coating and ageing. The CGIC had significantly higher hardness but lower flexural strength than the RM-GIC and RC.

Bilayer technique and nano-filled coating increase success of approximal ART restorations: a randomized clinical trial

BACKGROUND

The high-viscosity consistency of glass ionomer cement (GIC) may lead to its incorrect adaptation into the cavity and therefore to restoration failure.

AIM

To compare two different insertion techniques for GIC in approximal atraumatic restorative treatment (ART) restorations and two different surface protection materials.

DESIGN

Approximal caries lesion in primary molars from 208 schoolchildren was randomly assigned into four groups: G1, conventional GIC insertion protected with petroleum jelly (PJ); G2, bilayer technique protected with PJ; G3 conventional GIC insertion protected with nano-filled particles coating for GIC (NPC); G4, bilayer technique protected with NPC. Restorations were evaluated after 1, 6, 12, 18, 24, and 36 months. Kaplan-Meier survival analysis and log-rank test were performed. Cox regression analysis (α = 5%) was used to verify the influence of clinical factors.

RESULTS

Restoration survival was 52.8%. Log-rank test indicated a better survival of the bilayer technique restorations, compared to conventional restorations (P = 0.005), whereas the coated conventional restorations presented higher survival than the uncoated ones (P = 0.035). Cox regression analysis showed no influence of any clinical tested variables.

CONCLUSION

The survival rate of the approximal ART restorations is positively influenced by the bilayer technique, and the application of nano-filled coating increases the longevity of the conventional approximal ART restorations.

Failure Rate of Direct High-Viscosity Glass-Ionomer Versus Hybrid Resin Composite Restorations in Posterior Permanent Teeth - a Systematic Review

Purpose

Traditionally, resin composite restorations are claimed by reviews of the dental literature as being superior to glass-ionomer fillings in terms of restoration failures in posterior permanent teeth. The aim of this systematic review is to answer the clinical question, whether conventional high-viscosity glass-ionomer restorations, in patients with single and/or multi-surface cavities in posterior permanent teeth, have indeed a higher failure rate than direct hybrid resin composite restorations.

Methods

Eight databases were searched until December 02, 2013. Trials were assessed for bias risks, in-between datasets heterogeneity and statistical sample size power. Effects sizes were computed and statistically compared. A total of 55 citations were identified through systematic literature search. From these, 46 were excluded. No trials related to high-viscosity glass-ionomers versus resin composite restorations for direct head-to-head comparison were found. Three trials related to high-viscosity glass-ionomers versus amalgam and three trials related to resin composite versus amalgam restorations could be included for adjusted indirect comparison, only.

Results

The available evidence suggests no difference in the failure rates between both types of restoration beyond the play of chance, is limited by lack of head-to-head comparisons and an insufficient number of trials, as well as by high bias and in-between-dataset heterogeneity risk. The current clinical evidence needs to be regarded as too poor in order to justify superiority claims regarding the failure rates of both restoration types. Sufficiently large-sized, parallel-group, randomised control trials with high internal validity are needed, in order to justify any clinically meaningful judgment to this topic.

Four-year Randomized Clinical Trial to Evaluate the Clinical Performance of a Glass Ionomer Restorative System

Objective

The aim of this study was to evaluate the clinical performance of a glass ionomer restorative system compared with a microfilled hybrid posterior composite in a four-year randomized clinical trial.

Methods

A total of 140 (80 Class 1 and 60 Class 2) lesions in 59 patients were either restored with a glass ionomer restorative system (Equia, GC, Tokyo, Japan), which was a combination of a packable glass ionomer (Equia Fil, GC) and a self-adhesive nanofilled coating (Equia Coat, GC), or with a microfilled hybrid composite (Gradia Direct Posterior, GC) in combination with a self-etch adhesive (G-Bond, GC) by two experienced operators according to the manufacturer's instructions. Two independent examiners evaluated the restorations at baseline and at one, two, three, and four years postrestoration according to the modified US Public Health Service criteria. Polyvinyl siloxane impression negative replicas at each recall were observed under scanning electron microscopy (SEM) to evaluate surface characteristics. The statistical analyses were carried out with McNemar, Pearson Chi-square, and Cochran Q- tests (p&lt;0.05).

Results

After four years, 126 (76 Class 1 and 50 Class 2) restorations were evaluated in 52 patients, with a recall rate of 88.1%. None of the restorations showed trends to downgrade in anatomical form, secondary caries, surface texture, postoperative sensitivity, and color match (p&gt;0.05). Significant differences in marginal adaptation and discoloration were found at four years compared to baseline for both restorative materials for Class 1 and Class 2 restorations (p&lt;0.05). Only one Class 2 Equia restoration was missing at three years (3.9%), and another one was missing at four years (7.7%) (p&gt;0.05). SEM evaluations were in accordance with the clinical findings.

Conclusions

The use of both materials for the restoration of posterior teeth exhibited a similar and clinically successful performance after four years.

Effects of protective resin coating on the surface roughness and color stability of resin-based restorative materials

The aim of this study was to evaluate the effects of nanofilled protective resin coating (RC) on the surface roughness (Ra) and color stability (ΔE) of resin-based restorative materials (RM) (compomer (C), nanofilled composite (NF), and microhybrid composite (MH)) after being submitted to the ultraviolet aging (UV) method. Thirty-six specimens were prepared (n = 6 for each group). The Ra and (ΔE) values and SEM images were obtained before and after UV. Significant interactions were found among the RM-RC-UV procedures for Ra (P < 0.001). After the specimens were submitted to UV, the Ra values were significantly increased, regardless of the RC procedure (with RC; P < 0.01 for all, without RC; C (P < 0.01), NF (P < 0.001), and MH (P < 0.001)) for each RM. Significant interactions were found between the RM-RC (P < 0.001) procedures for the ΔE values. The ΔE values were increased in each group after applying the RC procedures (P < 0.001). Protective RC usage for RM could result in material-related differences in Ra and ΔE as with used UV method.