One-year clinical evaluation of bulk-fill flowable vs. regular nanofilled composite in non-carious cervical lesions

Novel Resin-Based Antibacterial Root Surface Coating Material to Combat Dental Caries

Root caries caused by cariogenic bacteria are a burden on a large number of individuals worldwide, especially the elderly. Applying a protective coating to exposed root surfaces has the potential to inhibit the development of caries, thus preserving natural teeth. This study aimed to develop a novel antibacterial coating to combat root caries and evaluate its effectiveness using the antibacterial monomer dimethylaminohexadecyl methacrylate (DMAHDM). DMAHDM was synthesized and incorporated into a resin consisting of 55.8% urethane dimethacrylate (UDMA) and 44.2% TEG-DVBE (UV) at a 10% mass fraction of glass filler. Multiple concentrations of DMAHDM were tested for their impact on the resin's mechanical and physical properties. S. mutans biofilms grown on resin disks were analyzed for antibacterial efficacy. Cytotoxicity was assessed against human gingival fibroblasts (HGFs). The results showed an 8-log reduction in colony-forming units (CFUs) against S. mutans biofilm (mean ± sd; n = 6) (p < 0.05) when 5% DMAHDM was incorporated into the UV resin. There was a 90% reduction in metabolic activity and lactic acid production. A low level of cytotoxicity against HGF was observed without compromising the physical and mechanical properties of the resin. This coating material demonstrated promising physical properties, potent antibacterial effects, and low toxicity, suggesting its potential to protect exposed roots from caries in various dental procedures and among elderly individuals with gingival recession.

Evaluation of surface microhardness and gingival marginal adaptation of three different bulk-fill flowable resin composites: A comparative study

OBJECTIVES

To evaluate surface microhardness and gingival marginal adaptation of three different bulk-fill flowable resin composites (FB-RBCs) in Class V cavities with enamel or dentin margins before and after thermocycling (TMC).

MATERIALS AND METHODS

Three available FB-RBCs were used; Palfique Bulk Flow (PaBF) (Tokuyama Dental), SDR Flow+ Bulk Fill Flowable (Dentsply Sirona), and I-Flow Bulk Fill (I-Dental). Thirty discs were prepared from each type of FB-RBCs. The discs were subjected to Vickers microhardness tester machine. Class V cavities were prepared on 180 molars. Gingival margins of half the specimens were prepared above CEJ and the other half below CEJ. Cavities were restored with FB-RBCs for gingival marginal adaptation test. Two-way ANOVA was used in microhardness, while three-way ANOVA was used for marginal adaptation.

RESULTS

The used materials showed statistically significant differences in microhardness and marginal adaptation.

CONCLUSIONS

Regarding microhardness, PaBF showed the highest value before TMC and SDR was the highest after TMC. Regarding marginal adaptation, SDR revealed the best marginal adaptation than PaBF and I-flow, either subjected to TMC or not.

CLINICAL SIGNIFICANCE

The longevity of cervical restorations depend on both the location of the cavity margin and the material used. The microfractures in resin composite surface due to low surface microhardness as well as marginal gaps seen in laboratory studies could be considered as an indicative parameter for clinical problem associated with marginal differences.

Clinical performance of preheating thermoviscous composite resin for non-carious cervical lesions restoration: A 24-month randomized clinical trial

OBJECTIVES

This 24-month, double-blind, split-mouth randomized clinical trial aimed to compare the retention rates of a preheated thermoviscous composite resin (PHT) compared to a non-heated composite resin (NHT) in non-carious cervical lesions (NCCLs).

METHODS

A total of 120 restorations were restored on NCCLs using a preheated (VisCalor bulk, Voco GmbH) and a non-heated (Admira Fusion, Voco GmbH) composite resins with 60 restorations per group. A universal adhesive in the selective enamel conditioning was applied. In the PHT group, composite was heated at 68 °C for using a bench heater. In the NHT group, no heating was employed. Both restorative materials were dispensed into caps and inserted into the NCCLs. The restorations were evaluated at baseline, 6, 12, 18, and after 24 months of clinical service using the FDI criteria. Statistical analysis was performed with Kaplan-Meier estimation analysis for retention/fracture rate and Chi-square test for the other FDI parameters (α=0.05).

RESULTS

After 24 months 108 restorations were assessed. Seven restorations were lost (two for PHT group and five for NHT group), and the retention rates (95 % confidence interval [CI]) were 96.7 % (81.5-99.9) for PHT group and 90.8 % (81.1-96.0) for NHT group, with no statistical differences between them (p > 0.05). The hazard ratio (95 % CI) was 0.52 (0.27 to 1.01), with no significant difference within groups. In terms of all other FDI parameters that were assessed, all restorations were deemed clinically acceptable.

CONCLUSIONS

Both composites showed high rates of retention rates after 24 months.

CLINICAL SIGNIFICANCE

The clinical performance of the new preheated thermoviscous was found to be as good as the non-heated composite after 24-month of clinical evaluation in non-carious cervical lesions.

REGISTRATION OF CLINICAL TRIALS

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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.

Color Match of a Universal-shade Composite Resin for Restoration of Non-carious Cervical Lesions: An Equivalence Randomized Clinical Trial

PURPOSE

The objective of this double-blind, split-mouth, randomized clinical trial was to evaluate the color match of a single-shade composite resin Admira Fusion X-tra in comparison with a multi-shade composite resin Admira Fusion in non-carious cervical lesion restorations (NCCLs).

METHODS AND MATERIALS

One hundred and twenty restorations were performed on NCCLs with two restorative materials (n=60). After prophylaxis, the teeth were isolated with a rubber dam, and one universal adhesive was applied in the selective enamel etching strategy. For both groups, the restorations were inserted incrementally and light-cured. The values of the coordinates L*, a*, and b* in the cervical third before vs after the restorations and cervical vs middle third after the restorations were evaluated using a digital spectrophotometer after the coordinate values were used to calculate the CIEDE (ΔE00). The restorations were evaluated at baseline and after 7 days of clinical performance according to the FDI criteria. Statistical analysis was performed using the Chi-square test for all parameters. Color change was analyzed by Student t-test for paired samples (α=0.05).

RESULTS

All restorations were evaluated after 7 days. Regarding the color measurement, no significant difference was observed when Admira Fusion was compared to Admira Fusion X-tra for any of the comparisons performed (p>0.05). However, the values of ΔE00 in the cervical third before vs after the restorations were higher when compared with ΔE00 observed when the cervical vs middle third after restorations were compared. All restorations received the score "clinically very good" after 7 days for all outcomes, including the subjective color match, when evaluated for FDI criterion.

CONCLUSIONS

The single-shade composite resin used achieves the same color match when compared to a multi-shade composite resin after 7 days in NCCLs.

Effect of dentin roughening and type of composite material on the restoration of non-carious cervical lesions: an in vivo study with 18 months of follow-up

Objectives

The purpose of this study was to evaluate the impact of dentin roughening and the type of composite resin used (either bulk-fill flowable or nanohybrid) on the restoration of non-carious cervical lesions (NCCLs) with an 18-month follow-up period.

Materials and Methods

This prospective split-mouth study included 36 patients, each with a minimum of 4 NCCLs. For each patient, 4 types of restorations were performed: unroughened dentin with nanohybrid composite, unroughened dentin with bulk-fill flowable composite, roughened dentin with nanohybrid composite, and roughened dentin with bulk-fill flowable composite. A universal bonding agent (Tetric N Bond Universal) was applied in self-etch mode for all groups. The restorations were subsequently evaluated at 6, 12, and 18 months in accordance with the criteria set by the FDI World Dental Federation. Inferential statistics were computed using the Friedman test, with the level of statistical significance established at 0.05.

Results

The 4 groups exhibited no significant differences in relation to fracture and retention, marginal staining, marginal adaptation, postoperative hypersensitivity, or the recurrence of caries at any follow-up point.

Conclusions

Within the limitations of the present study, over an 18-month follow-up period, no significant difference was present in the clinical performance of bulk-fill flowable and nanohybrid composite restorations of non-carious cervical lesions. This held true regardless of whether dentin roughening was performed.

Various ways of pre-heating a bulk-fill thermoviscous composite in restoration in non-carious cervical lesions: 12-month randomized clinical trial

OBJECTIVE

The objective of the study is to evaluate through a randomized clinical trial the best method to preheat a composite resin, if using a Caps dispenser device associated with Caps Warmer (CD) or with a VisCalor Caps dispenser/warmer (VD) for restorations in non-carious cervical lesions (NCCLs).

MATERIAL AND METHODS

One hundred and twenty restorations were distributed to two groups (n = 60) according to the pre-heating way of thermoviscous bulk-fill composite resin. For the CD group, pre-heating was carried at 68 °C using a heating bench for 3 min. For the VD group, pre-heating was performed at 68 °C using a heating gun for 30 s. After that, pre-heated bulk-fill composites were directly inserted in the NCCLs. The total working time was recorded. The restorations were evaluated after 6 and 12 months of clinical performance according to the FDI criteria. Statistical analysis was performed using the Student's t test for unpaired samples for working time, and the Chi-square test for restoration clinical performance (α = 0.05).

RESULTS

Working time was shorter for VD with a statistically significant difference compared to CD (p = 0.01). Few restorations were lost or fractured after 12 months of clinical evaluation (p > 0.05). The retention rates were 96.7% (CI 95 %: 88.6-99.1%) for CD and 98.3% (CI 95 %: 91.1-99.7%) for VD. The other FDI parameters were considered clinically acceptable.

CONCLUSIONS

The different pre-heating ways did not influence the clinical performance of thermoviscous bulk-fill composite restorations in NCCLs after 12 months.

CLINICAL RELEVANCE

Regardless of the bulk-fill thermoviscous composite resin pre-heating ways, the restorations are clinically acceptable after 12 months.

[Flexural strength of conventional flowable, bulk fill flowable and highly filled flowable resin composites: in vitro study.]

Objective

To evaluate and compare the flexural strength of conventional flowable, bulk fill flowable and highly filled flowable resins.

Materials and methods

Thirty 2mm x 2mm x 25mm specimens of Tetric N-Flow (TNF), Filtek Bulk Fill Flowable Restorative (FBF) and Beautifil Flow Plus F00 (BFP) flowable resins were made up; they were distributed into three groups according to brand (n=10) and stored in distilled water for 24 hours at 37ºC. The 3-point bending test according to ISO 4049 was performed on a universal testing machine at a speed of 0.5 mm/min until fracture. The results were evaluated with Anova and Tukey tests. P<0.05.

Results

Statistically significant differences were found between the groups with a value of p=0.011. According to the statistical analysis, the groups that showed statistically significant differences were the BFP and TNF groups (p=0.015) and the BFP and FBF groups (p=0.035), while no statistically significant difference was found in the TNF and FBF groups.

Conclusion

The high-filled flowable resin presents better flexural strength compared to the conventional flowable and bulk fill flowable resins, while the conventional and bulk fill flowable resins have no statistically significant difference.

Conservative Treatment of Dental Non-Carious Cervical Lesions: A Scoping Review

This scoping review aims to evaluate methods of conservative reconstruction of dental enamel lesions resulting from abrasions and evaluate the effect of diode laser in reducing the symptoms of tooth sensitivity. The cementoenamel junction is more prone to substance loss because the enamel thickness is substantially decreased, resulting in a much weaker enamel-dentin bond.

METHODS

Dental abrasion was examined in the mechanical cause alone. Pubmed, Scopus, and Web of Science were used to discover publications that matched our topic from 1 January 2018 to 20 March 2023. A comparison of various non-carious cervical lesion (NCCL) restoration treatments was generated mostly by mechanical considerations.

RESULTS

A final number of 11 clinical trials and randomized controlled trials were included in the review for qualitative analysis. Composite resins performed well in clinical trials for the restoration of NCCLs.

CONCLUSIONS

Composite, in its different forms of filling and consistency, preceded by the use of adhesives, is an efficient and effective material for the treatment of NCCLs. Diode laser use prior to NCCL restoration of teeth does not diminish restoration retention rate, may lessen hypersensitivity, and may affect restoration success.

Clinical effectiveness of alkasite versus nanofilled resin composite in the restoration of occlusal carious lesions in permanent molar teeth of children: a randomized clinical trial

PURPOSE

To evaluate and compare the clinical effectiveness of alkasite with nanofilled resin composite restorations for occlusal caries lesions in permanent molar teeth of children, at one-year follow-up.

METHODS

In this randomized controlled clinical trial with parallel design, 38 children aged 7-13 years with occlusal caries lesions on 59 first permanent molars were randomly allocated into two groups, Group 1: Filtek™ Z350XT (nanocomposite) and Group 2: Cention N^® (alkasite resin composite). The restorations were evaluated at one year using the United States Public Health Service (USPHS) criteria. Data were analyzed using Chi-square or Fisher's exact test.

RESULTS

All restorations had either Alpha or Bravo scores at one-year follow-up. In Group 1, all restorations scored Alpha, while one restoration each (3.6%) in Group 2 scored Bravo for fracture and marginal adaptation. All restorations in both groups scored Alpha for retention, secondary caries, and post-operative sensitivity. For anatomic form, all restorations in Group 1 scored Alpha, while three (10.7%) restorations in Group 2 had Bravo scores. For marginal discolouration, three restorations in both groups scored Bravo (11.5% and 10.7%, respectively). For surface roughness, one restoration (3.8%) in Group 1 and three restorations in Group 2 (10.7%) scored Bravo. The comparative results between the two groups for all the variables in the USPHS criteria were not statistically significantly different.

CONCLUSIONS

The performances of the nanofilled composite and alkasite were clinically acceptable and comparable. Alkasite can be an alternative material for the restoration of occlusal caries lesions in permanent molars of children.

CLINICAL TRIAL REGISTRATION

The clinical trial was registered at Clinical Trials Registry-India (CTRI Reg no: CTRI/2020/12/029830 Dated: 15/12/2020).

Effects of lesion size on the 30-month clinical performance of restorations with bulk fill and a regular nanofilled resin composite in noncarious cervical lesions

OBJECTIVE

The aim of this double-blind, randomized trial was to evaluate the influence of the occlusogingival distance (OGD) in noncarious cervical lesions (NCCLs) on the clinical performance of a regular bulk-fill resin composite and a regular nanofilled resin composite.

MATERIALS AND METHODS

One hundred and forty NCCLs in 77 participants were randomly divided into four groups (n = 35), according to OGD (1.5 mm ± 10% or 3 mm ± 10%) and resin composites (Filtek Bulk Fill Posterior [B] or Filtek Z350 XT [C]), namely: 1.5 mm-B, 1.5 mm-C, 3 mm-B, and 3 mm-C. The restorations were bonded using a two-step self-etch adhesive (Clearfil SE Bond), applied following the manufacturer's instructions. Restorations were polished 1 week after placement. Two experienced and calibrated examiners evaluated the restorations using modified US Public Health Service criteria at baseline (7 days) and after 6, 12, 18, 24, and 30 months. Statistical analyses were carried out using Kruskal-Wallis, Friedman's repeated measures analysis of variance, and the Wilcoxon signed rank test (α = 0.05).

RESULTS

After 30 months, the recall rate was 94.2%. Eight restorations were lost (3 for 1.5 mm-C, 2 for 1.5 mm-B, 1 for 3 mm-C, and 2 for 3 mm-B). All groups resulted in a significantly worse marginal discoloration and surface texture at 30 months in comparison with the baseline (1 week). No significant difference was found for the other parameters.

CONCLUSION

The restorations performed with both resin composites produced clinically acceptable restorations. The OGD of NCCLs did not influence the clinical performance of restorations.

CLINICAL SIGNIFICANCE

The OGD of NCCLs did not have a significant effect on the clinical performance of a regular bulk-fill and nanofilled restorations. Both materials showed a very good performance on 30-month evaluation.

Quality of Cure in Depth of Commercially Available Bulk-fill Composites: A Layer-by-layer Mechanical and Biological Evaluation

Despite their popularity, the use of bulk-fill composites remains controversial, both in terms of their properties and their in-depth development. The objectives of the present work were (1) to provide a more comprehensive evaluation of the quality of cure in depth of commercially available bulk-fill composites by combining various key mechanical and biological characterization methods, (2) to evaluate the inter-material differences when optimally cured, and (3) to evaluate the efficiency of an antioxidant-N-acetyl-cysteine (NAC)-to restrain the adverse effects of the leached components on cell viability. Nine bulk-fill composites (including flowable and high-viscosity materials) were investigated and compared to two conventional resin-based composites, one flowable and one high-viscosity restorative material. The materials were injected or packed into Teflon molds of various configurations, up to 6 mm material thickness. They were then light-cured from the top for 20 seconds with Bluephase G2 (Ivoclar Vivadent, irradiance = 1050 mW/cm2). The following physicomechanical properties were measured for the upper (0-2 mm), intermediate (2-4 mm), and lower (4-6 mm) layers: degree of conversion using Raman Spectrometry (DC, in %), microhardness using a Vickers micro-indenter before (VHN dry) and after 24 hours of storage in ethanol (VHN EtOH), and flexural strength (in MPa) and flexural modulus (in GPa) using a three-point bend test. Each composite layer and an uncured layer were also stored for one week in a standard cell growth medium to generate conditioned media. Human dental pulp cells were then cultured for 24 hours with the latter and cell viability was measured using an MTS assay. A similar experiment was repeated with conditioned media produced in contact with uncured composites, with and without the addition of 4 mM NAC. The data were subjected to a Shapiro-Wilk test, then one-way ANOVA or Kruskal-Wallis test, followed either by Tukey's test (inter-material comparison) or by Dunnett's or Dunn's test (comparison between layers relative to the upper one). The level of statistical significance was set at 0.05. Some materials (EverX, X-traF, VenusBF, X-traB) did not show any significant differences (p>0.05) for any of the properties considered between the intermediate layers compared to the upper one (considered as reference). Others displayed significant differences, at least for some properties, highlighting the value of combining various key mechanical and biological characterization methods when investigating the quality of cure in depth. Significant inter-material differences (p<0.05) were observed when comparing the properties of their upper layer, considered as "optimally" polymerized. Hence, one needs to consider the absolute property values, not only their relative evolution concerning layer thickness. Finally, the use of NAC appeared as beneficial to reduce the risk of harmful effects to dental pulp cells, especially in case of excessive thickness use, and may therefore be of potential interest as an additive to composites in the future.

Influence of the self-adhering strategy on microhardness, sorption, solubility, color stability, and cytotoxicity compared to bulk-fill and conventional resin composites

OBJECTIVES

To analyze and compare, in vitro, the microhardness, sorption, solubility, color stability, and cytotoxicity of three types of resin composites: self-adhesive (SARC) (Dyad Flow (DF)/Kerr), bulk-fill (Filtek Bulk Fill Flow (FBF)/3 M ESPE), and conventional (Filtek Z350XT Flow (Z350)/3 M ESPE).

MATERIALS AND METHODS

Thirty cylindrical specimens were prepared using a split metal mold (15 mm × 1 mm), divided into 3 groups (n = 10) according to the material used. Vickers hardness (VH) was calculated from three indentations (300gf/15 s) per specimen. The sorption and solubility were measured according to the ISO 4049:2009 specification after storing in distilled water for 7 days. The color of each resin composite was measured using a portable digital spectrophotometer according to the CIELAB system. After a 7-day immersion in coffee, the color variation (∆E) was calculated. Following the ISO 10993:2012, the cytotoxicity in Vero cells was evaluated through the MTT assay. The results were analyzed using the Kruskal-Wallis test to compare the studied groups. The Wilcoxon test was used to compare the assessments in each studied group. For cytotoxicity analysis, the data were compared by the ANOVA test (α = 0.05).

RESULTS

DF showed the lowest VH (28.67), highest sorption (0.543 µg/mm³) and solubility (1.700 µg/mm³), and higher ∆E after 7 days of coffee immersion (p = 0.008). The resin composites studied were considered non-cytotoxic.

CONCLUSIONS

The SARC presented inferior mechanical and physical-chemical properties than bulk-fill and conventional resin composites, with comparable cytotoxicity against Vero cells.

CLINICAL RELEVANCE

The simplification of the clinical protocol of SARC can minimize the number of possible failures during the restorative technique. However, considering their inferior physical and mechanical properties, their coverage with materials of higher mechanical properties and physical-chemical stability should be considered.

Eight-year clinical evaluation of two types of resin composite in non-carious cervical lesions

OBJECTIVES

In this clinical study, the 8-year clinical performances of a flowable resin composite was compared with that of a conventional resin composite.

MATERIALS AND METHODS

Ninety non-carious cervical lesions (NCCLs) in 19 participants were involved in this trial. NCCLs were restored with a flowable composite (Clearfil Flow FX: FX, Kuraray Noritake, Japan) or a conventional resin composite (Clearfil AP-X: AP) in conjunction with a one-step self-etch adhesive (Clearfil S3 Bond). Each participant had both types of resin composite restorations that were randomly allocated. The restorations were evaluated at baseline and annually up to 8 years using modified USPHS criteria. The data were statistically analyzed using the Fisher's exact test, Kaplan-Meier method, and a multivariate Cox-regression with frailty models (p < 0.05).

RESULTS

The 8-year participant recall rate was 95%. One hundred percent retention was recorded for AP, whereas four out of 46 restorations were lost for FX during the 8 years. The incidence of marginal staining increased over time regardless of the type of resin composite, showing 48% for AP and 57% for FX after 8 years. Wear of the resin composite occurred only for the flowable material and there was a significant difference between the types of resin composite (p = 0.024). Overall survival rates at 8 years for AP and FX were 98% and 82% respectively (p = 0.110).

CONCLUSIONS

The flowable resin composite presented lower wear resistance and showed a lower survival rate compared with the conventional composite after eight years of clinical service.

CLINICAL RELEVANCE

Flowable resin composites may show greater wear after long-term clinical service.

TRIAL REGISTRATION NUMBER

UMIN000028745, Date of registration: August 19, 2017.

Bonding Performance for Repairs Using Bulk Fill and Conventional Methacrylate Composites

This study compared the bond strength of a composite repair made with a bulk fill composite and a conventional one using different surface treatments. Specimens were prepared as truncated cones (bases: 4 mm × 2 mm, height: 4 mm) using a bulk fill (OBFa: Filtek One) or a conventional resin (FTKa: Filtek Z250) (n = 66). They were artificially aged (10,000 cycles, 5°C–55°C, 30 sec) and subdivided according to surface treatments: NT—no treatment (control), Abr—abrasion with a diamond tip, and sand—sandblasting with aluminum oxide (50 μm). Treatments were performed over the smaller diameter surface, followed by adhesive (Scothbond Universal) application. A new specimen with similar dimensions was constructed over it using either the OBF or the FTK, totaling 12 groups (n = 11). Bond strength was assessed by tensile test. The data were submitted to two-way ANOVA separately for OBFa and FTKa, followed by Tukey's test (p < 0.05). For the aged OBFa groups, there was significant differences for composite type and surface treatment, with higher values of bond strength when repaired with the same material (OBFa/OBF > OBFa/FTK), and sandblasting and bur abrasion presented higher values compared to the control group (NT). For the aged FTKa groups, there were no differences for the composite or surface treatment. Therefore, the bulk fill resin composite tested present better repair performance when the same composite was used, while the conventional resin composite was less influenced by the material and the surface treatment performed.

Six-year clinical evaluation of bulk-fill and nanofill resin composite restorations

OBJECTIVES

This study aims to compare the performance of a bulk-fill and a nanofill resin composite in class II restorations after 6 years.

MATERIALS AND METHODS

Fifty patients having at least two class II carious lesions were recruited for the study. One lesion in each patient was randomly assigned to be restored using either the Tetric EvoCeram Bulk Fill (TB) or Filtek Ultimate (FU) resin composites with their respective adhesives. One hundred four restorations were placed by two calibrated operators. Restorations were evaluated at baseline and annually over the course of 6 years by two examiners using modified USPHS criteria. Data were statistically analyzed using the Chi-square and Cochran Q tests (p < 0.05).

RESULTS

Sixty-six restorations in 33 patients were evaluated after 6 years. Only one restoration was lost from FU group at 5 years. At the end of 6 years, marginal discoloration was observed in three (9.1%) TB and eight (36.4%) FU restorations creating a significant difference between the groups (p < 0.05). The FU group showed a significant increase in marginal discoloration at 6 years from the baseline (p < 0.05). Marginal adaptation was rated as Bravo for 9.1% and 24.2% of TB and FU restorations, respectively (p > 0.05). Significant degradation was observed within each group in terms of marginal adaptation (p < 0.05). There were no statistically significant differences between the groups for the other criteria tested (p > 0.05).

CONCLUSIONS

Bulk-fill restorations performed better for marginal discoloration. The remaining clinical performance criteria of bulk-fill and nanofill resin composite restorations were similar after 6 years.

CLINICAL RELEVANCE

Bulk-fill resin might be a better alternative to incrementally placed restorative in terms of marginal discoloration under clinical conditions.

Randomized controlled clinical trial of a highly filled flowable composite in non-carious cervical lesions: 3-year results

OBJECTIVES

This prospective, randomized, split-mouth clinical trial assessed the 3-year clinical performance of a highly filled flowable composite and a conventional paste-type composite in non-carious cervical lesions (NCCLs).

MATERIALS AND METHODS

A total of 84 NCCLs in 27 subjects were included in this split-mouth design study and randomly divided into two groups: a highly filled flowable composite Clearfil Majesty ES Flow group (ES, n = 42) and a conventional paste-type composite Majesty group (MJ, n = 42). Clearfil SE Bond was used following the manufacturer's instructions. The restorations were evaluated at baseline (BL) and 1, 2, and 3 years using FDI (World Dental Federation) criteria. Data were analysed by a paired chi-squared test for intergroup comparisons and the Friedman test for intragroup comparisons (α = 0.05).

RESULTS

Both groups had a 97.3% retention rate at the 3-year evaluation. The acceptable scores (FDI scores 1-3) for each criterion exhibited no significant difference between the MJ and ES groups at any time point (p = 1.00). The marginal adaptation performance of ES was significantly better than that of MJ at every evaluation point (p < 0.05).

CONCLUSIONS

The 3-year clinical performance of ES in NCCLs was similar to that of MJ. When the restorations were clinically acceptable, ES showed better marginal adaptation than MJ.

CLINICAL RELEVANCE

Compared with conventional paste-type composites, highly filled flowable composites showed similar clinical performance and better marginal adaptation for restoring NCCLs after 3 years.

TRIAL REGISTRATION

TRN: ChiCTR1900028484 . Date of registration: December 22, 2019, retrospectively registered.

A New Dual-cure Universal Simplified Adhesive: 18-month Randomized Multicenter Clinical Trial

CLINICAL RELEVANCE

Non-carious cervical lesion restorations using a dual-cure universal adhesive in self-etch and etch-and-rinse mode showed satisfactory clinical performance after 18 months.

SUMMARY

Objectives: The objective of this multicenter, double-blind, split-mouth randomized clinical trial was to evaluate the clinical performance of a new dual-cure universal adhesive system (Futurabond U, Voco GmBH) when applied using different strategies over a period of 18 months.Methods and Materials: Fifty patients participated in this study. Two hundred non-carious cervical lesions were restored using the adhesive Futurabond U according to four adhesive strategies (n=50 per group): only self-etch (SEE), selective enamel etching + self-etch (SET), etch-and-rinse with dry dentin (ERDry), and etch-and-rinse with wet dentin (ERWet). After the adhesive application, cavities were restored using Admira Fusion composite resin. These restorations were evaluated according to FDI World Dental Federation criteria for the following characteristics: retention/fracture, marginal adaptation, marginal staining, postoperative sensitivity, and caries recurrence.Results: After 18 months, only four patients (12 months: one patient, n=4 restorations; and 18 months: three patients, n=12 restorations) were not evaluated. Fourteen restorations were lost after 18 months of clinical evaluation (four for SEE, three for SET, three for ERDry, and four for ERWet). The retention rates for 18 months (95% confidence interval) were 92% (81%-97%) for SEE, 94% (83%-97%) for SET, 94% (83%-97%) for ERDry, and 92% (81%-97%) for ERWet (p>0.05). Thirty-eight restorations were considered to have minor discrepancies in marginal adaptation at the 18-month recall (13 for SEE, 13 for SET, six for ERDry, and six for ERWet; p>0.05). Fourteen restorations were detected as a minor marginal discoloration at the 18-month recall (six for SEE, six for SET, one for ERDry, and one for ERWet; p>0.05). However, all were considered clinically acceptable. No restorations showed postoperative sensitivity or caries recurrence at the time.Conclusion: The clinical performance of the Futurabond U did not depend on the bonding strategy used, and it was considered reliable after 18 months of clinical evaluation, although more marginal discrepancy was observed in the self-etch group.

Clinical Effectiveness of Bulk-Fill and Conventional Resin Composite Restorations: Systematic Review and Meta-Analysis

The objective of this systematic review and meta-analysis was to determine the clinical effectiveness of bulk-fill and conventional resin in composite restorations. A bibliographic search was carried out until May 2020, in the biomedical databases Pubmed/MEDLINE, EMBASE, Scopus, CENTRAL and Web of Science. The study selection criteria were: randomized clinical trials, in English, with no time limit, with a follow-up greater than or equal to 6 months and that reported the clinical effects (absence of fractures, absence of discoloration or marginal staining, adequate adaptation marginal, absence of post-operative sensitivity, absence of secondary caries, adequate color stability and translucency, proper surface texture, proper anatomical form, adequate tooth integrity without wear, adequate restoration integrity, proper occlusion, absence of inflammation and adequate point of contact) of restorations made with conventional and bulk resins. The risk of bias of the study was analyzed using the Cochrane Manual of Systematic Reviews of Interventions. Sixteen articles were eligible and included in the study. The results indicated that there is no difference between restorations with conventional and bulk resins for the type of restoration, type of tooth restored and restoration technique used. However, further properly designed clinical studies are required in order to reach a better conclusion.

Clinical Evaluation of Noncarious Cervical Lesions of Different Extensions Restored With Bulk-fill or Conventional Resin Composite: Preliminary Results of a Randomized Clinical Trial

PURPOSE

This randomized clinical trial evaluated the influence of the occlusogingival distance (OGD) of noncarious cervical lesions (NCCLs) on the clinical performance of a regular bulk-fill resin composite and a regular nanofilled resin composite.

METHODS AND MATERIALS

A total of 140 restorations were randomly placed in 77 participants by one operator. NCCLs were divided into four groups (n=35) according to OGD (1.5 mm±10% or 3 mm±10%) and resin composites (Filtek Bulk Fill Posterior [B] or Filtek Z350 XT [C]) used: 1.5 mm-B, 1.5 mm-C, 3 mm-B, and 3 mm-C. A two-step self-etch adhesive (Clearfil SE Bond) was applied following manufacturer instructions in all restorative procedures. Restorations were polished 1 week after placement. Clinical evaluation was performed at baseline (7 days), 6 months, and 1 year by two calibrated examiners, according to the modified US Public Health Service criteria evaluating fractures/retention, marginal staining, marginal adaptation, recurrence of caries, anatomic form, postoperative sensitivity, and surface texture. The Kruskal-Wallis test was used for intergroup comparison in each follow-up; the Friedman analysis of variance, followed by the least significant difference test (multiple comparisons) was used for intragroup comparison between baseline and follow-up times (α=0.05).

RESULTS

Two restorations were lost at 12 months (1 for 1.5 mm-B and 1 for 3 mm-B). The retention rates at 12 months were 100% for 1.5 mm-C, 97% for 1.5 mm-B, 100% for 3 mm-C; and 97% for 3 mm-B, with no statistical difference among the groups (p=0.570). At 12 months, a statistically significant difference was found among the follow-up times for the same group (1.5 mm-B, 1.5 mm-C, and 3 mm-B) regarding the marginal staining criterion; moreover, the 3 mm-C group showed a significant difference from 6 months. No significant difference was found for the other parameters.

CONCLUSION

Both resin composites showed acceptable clinical performance, and the OGD of NCCLs did not influence the clinical performance of resin composite restorations after 12 months.

Clinical performance and chemical-physical properties of bulk fill composites resin -a systematic review and meta-analysis

OBJECTIVES

The objective of this study was to perform a meta-analysis of clinical and laboratory studies to compare the performance of bulk-fill and conventional composite resins in terms of polymerization shrinkage, polymerization stress, cusp deflection, marginal quality, degree of conversion, microhardness, flexural strength, fracture strength and clinical performance.

DATA

One hundred three articles were included in this study, and the Peto method was used to compare the bulk-fill and conventional composites using the RevMan software.

SOURCES

Searches were performed in the PubMed and Scopus databases.

STUDY SELECTION

Laboratory studies and randomized clinical trials comparing one of the previous detailed outcomes between bulk-fill and control composites were included.

CONCLUSIONS

The bulk-fill composite resins showed less shrinkage, polymerization stress, cusp deflection and microhardness than conventional composites, while both materials presented a similar marginal quality, flexural strength and fracture strength. Also, bulk-fill materials with regular viscosity showed similar shrinkage. The conversion of bulk-fill materials with flowable consistency were similar to conventional composite resins with a thickness of up to 2mm and greater than conventional composites with a thickness greater than 2mm. Despite these in vitro differences, the clinical performance of bulk-fill and conventional composite resins was similar in randomized clinical trials, with one to ten years of follow up. In conclusion, the bulk-fill materials show better or similar performance to the conventional materials in clinical trials and laboratory studies in terms of volumetric shrinkage, polymerization stress, cusps deflection and marginal quality, with the only exception being the lower level of microhardness observed for bulk-fill composites with thickness up to 2mm.