Revised FDI criteria for evaluating direct and indirect dental restorations-recommendations for its clinical use, interpretation, and reporting

Clinical performance of posterior restorations using a universal adhesive over moist and dry dentin: A 36-month double-blind split-mouth randomized clinical trial

OBJECTIVES

To evaluate the influence of dentin moisture on the clinical behavior of a universal adhesive on posterior teeth after 36 months of follow-up.

METHODS

Forty-five patients participated in this study. Following a split-mouth design, three operators placed 90 Class I/Class II restorations over moist dentin (MD) or dry (DD) (n = 45) with resin composite (Filtek Bulk Fill) and a universal adhesive used in the etch-and-rinse mode (Single Bond Universal). Each restoration was evaluated according to the FDI and USPHS criteria (postoperative sensitivity, fracture and retention, marginal staining, marginal adaptation, and recurrence of caries) at baseline and after 6-, 12-, and 36 months. For statistical analysis, Kruskal Wallis analysis of variance rank (α = 0.05) and Kaplan-Meier survival analysis were used.

RESULTS

No significant difference between groups was observed in each FDI criterion after 36 months of clinical evaluation (p > 0.05). The retention rates (confidence interval 95 %) were 97.37 % (86.5 - 99.5) for both MD and DD without significant difference between them (p > 0.05). Eight restorations (MD = 4; DD = 4) showed minimal marginal staining defects (p > 0.05). Two restorations were lost (MD = 1; DD = 1). Fifteen restorations (MD = 8; DD = 7) presented minor marginal discrepancies according to the FDI criteria (p > 0.05).

CONCLUSION

The clinical performance of the universal adhesive when applied in etch-and-rinse mode was not influenced by dentin moisture in posterior bulk-fill composite restorations.

CLINICAL SIGNIFICANCE

The level of dentin moisture appears not to influence the clinical efficacy of a universal adhesive when applied using the etch-and-rinse technique in posterior composite resin restorations.

5.5-year-survival of CAD/CAM resin-based composite restorations in severe tooth wear patients

OBJECTIVES

Aim of this prospective study was to assess full mouth rehabilitation of severe tooth wear patients using minimally invasive CAD/CAM resin-based composite (RBC) restorations and direct veneers by evaluating restoration survival up to 5.5-years.

METHODS

Twenty-two patients with generalized severe tooth wear with functional and/or esthetic problems were included. Following minimally invasive preparation, CAD/CAM RBC restorations (LAVA Ultimate,3M) were adhesively luted, direct RBC veneers (Filtek Supreme XTE, 3M) were applied in the aesthetic region. Patients were recalled after 1m,1y,3y,5y and seen in between recalls by their general dentists or at the clinical study center if complaints occurred. Failures were categorized as F1 (severe deficiencies requiring replacement/extraction), F2 (localized deficiencies requiring re-cementation/repair) and F3 (small chippings requiring refurbishment/monitoring). Survival of indirect restorations was evaluated using lifetables and Kaplan-Meier-graphs, distinguishing between failure categories and tooth type (front teeth=FT, premolars=PM, molars=M). F1 + F2 and F1 + F2 + F3 failures were analyzed using Cox regression on the variables tooth type/ location, age, gender and VDO increase (p < 0.05).

RESULTS

568 indirect restorations and 200 direct veneers in 21 patients evaluated for up to 5.5-years. For indirect restorations, 96 failures were recorded (F1:6;F2:41;F3:49) and annual failure rates were 0.29%(FT), 1.56%(PM), 2.93%(M) for F1 +F2 and 0.53%(FT), 2.42%(PM), 6.11%(M) for F1 + F2 + F3. Reasons for failure were chipping fracture (48), adhesive fracture (32), complete debonding (7), caries (4), endodontic treatment (1) and reasons unknown (documentation general dentists, 4). Molar tooth type had a statistically significantly increased probability of failure compared with front teeth and premolars for F1 + F2 + F3 (p < 0.006). Direct veneer restorations showed 18 failures (F1:2;F2:9;F3:7).

SIGNIFICANCE

Minimally invasive CAD/CAM RBC restorations combined with direct RBC veneers showed an acceptable clinical mid-term survival for restorative rehabilitation of severely worn dentitions.

Clinical evaluation of posterior restorations over wet and dry dentin using an etch-and-rinse adhesive: A 36-month randomized clinical trial

OBJECTIVES

To evaluate the clinical performance of posterior restorations over wet and dry dentin with an etch-and-rinse adhesive after 36 months of clinical service.

METHODS

Forty-five participants were recruited, each one had at least two posterior teeth that needed restoration. Ninety restorations were placed on Class I or Class II cavities. For the restoration protocol, a simplified etch-and-rinse adhesive (Adper Single Bond 2) was applied over wet (WD) or dry dentin (DD) and later restored with a bulk-fill composite (Filtek Bulk Fill) under rubber dam isolation. Each restoration was evaluated using the World Dental Federation (FDI) criteria after 6, 12, and 36 months of clinical service, regarding the following principal restoration characteristics: postoperative sensitivity, marginal discoloration, marginal adaptation, fracture of material and retention, and recurrence of caries. Kruskal Wallis analysis of variance rank (α = 0.05) and Kaplan-Meier survival analysis were used for statistical analysis.

RESULTS

After 36 months of clinical evaluation, no significant difference between groups was observed in each FDI criterion (p > 0.05). Twenty restorations (WD=10, DD=10) showed minor marginal staining, and twenty-two restorations (WD=11, DD=11) presented small marginal adaptation defects (p > 0.05). Four restorations were lost (WD = 2, DD = 2) and the fracture rates (95% confidence interval) were 94.9% for each one, without significant difference between wet and dry dentin (p > 0.05).

SIGNIFICANCE

The degree of dentin moisture does not seem to affect the clinical performance of a simplified etch-and-rinse adhesive in posterior restorations when the adhesive is applied vigorously over the dentine surface.

Prolonged polymerization of a universal adhesive in non-carious cervical lesions: 36-month double-blind randomized clinical trial

OBJECTIVE

To evaluate the effect of prolonged (P) polymerization time of a universal adhesive system applied in etch-and-rinse (ER) or self-etch (SE) strategies on the clinical performance of restorations in non-carious cervical lesions (NCCLs), after 36 months of clinical service.

METHODS

A total of 140 restorations were randomly placed in 35 subjects according to the polymerization time groups: ER (10 s); ER-P (40 s); SE (10 s); and SE-P (40 s) at 1,200 mW/cm2. Composite resin was placed incrementally. The restorations were evaluated immediately and after 6, 12, 18, and 36 months using the FDI criteria. Data were analyzed using the Kaplan-Meier survival test for retention loss, and the Kruskal-Wallis' test for secondary outcomes (α = 0.05).

RESULTS

After 36 months, 19 restorations were lost: ER 6, ER-P 2, SE 9, SE-P 2. The retention rates were 82.3% for ER; 94.1 % for ER-P; 73.5 % for SE; and 94.1 % for SE-P, with a significant difference between ER vs. ER-P and SE vs. SE-P, as well as ER vs. SE-P and ER-P vs. SE (p < 0.0001). Minor defects were observed in 18 restorations for the marginal staining criteria: ER 5, ER-P 2, SE 8, SE-P 3; and in 33 restorations for the marginal adaptation criteria: ER 11, ER-P 4, SE 12, and SE-P 6 (p > 0.05). No restorations showed recurrence of caries or postoperative sensitivity.

CONCLUSIONS

A prolonged polymerization time of 40 s improves the clinical performance of the universal adhesive for both adhesive strategies evaluated, even after 36 months.

CLINICAL SIGNIFICANCE

Prolonging the polymerization time of a universal adhesive from 10 to 40 s has been shown to improve its clinical performance when used in NCCLs.

Influence of surface sealants on the quality of posterior restorations with bulk-fill composites: A 4-year randomized clinical trial

OBJECTIVES

The aim of this study was to evaluate the clinical performance of surface sealants associated with a bulk-fill composite in posterior restorations after 4 years.

METHODS

A total of 174 posterior restorations were performed on 57 participants using a self-etch adhesive system and a bulk-fill composite. The groups were then divided into the following categories: 1) without surface sealant (NoS), 2) with surface sealant Biscover (Bisco, SBi), and 3) with surface sealant Permaseal (Ultradent, SPe). Restorations were evaluated using FDI criteria at baseline and after 1 and 4 years. Statistical analysis was conducted using Kaplan-Meier survival analysis and the Chi-square test (α = 0.05).

RESULTS

After 4 years, only one restoration was lost (1 in the NoS group). The fracture/retention rate (with 95% confidence interval) was 98% for NoS and 100% for both SBi and SPe (p = 0.76). The majority of secondary outcomes showed minor defects, with no significant differences among the groups (p > 0.05). However, significant differences were observed among the groups in terms of marginal staining and marginal adaptation (p = 0.03). In both items, twelve restorations (nine in NoS, one in SBi, and two in SPe) showed minor marginal discrepancies favoring the sealant groups (SBi and SPe).

SIGNIFICANCE

Regardless of the use of surface sealants, the bulk-fill composite restorations showed excellent clinical performance after 4 years. However, the groups that received sealants showed better marginal adaptation and less marginal discoloration compared to those that did not receive sealants.

3-year randomized clinical trial to evaluate the performance of posterior composite restorations lined with ion-releasing materials

To evaluate the impact of using ion-releasing liners on the 3-year clinical performance of posterior resin composite restorations after selective caries excavation with polymer burs. 20 patients were enrolled in this trial. Each patient had two deep carious lesions, one on each side of the mouth. After selective caries removal using polymer bur (PolyBur P1, Komet, Brasseler GmbH Co. KG, Lemgo, Germany), cavities were lined with bioactive ionic resin composite (Activa Bioactive Base/Liner, Pulpdent, Watertown, MA, USA) or resin-modified glass ionomer liner (Riva Light Cure, SDI, Bayswater, Victoria, Australia). All cavities were then restored with nanofilled resin composite (Filtek Z350XT, 3M Oral Care, St. Paul, MN, USA). All the tested materials were placed according to the manufacturers' instructions. Clinical evaluation was accomplished using World Dental Federation (FDI) criteria at baseline and after 6 months, 1, 2, and 3 years. Data were analyzed using Mann-whitney U and Friedman tests (p < 0.05). The success rates were 100% for all resin composite restorations either lined with ion-releasing resin composite or resin-modified glass ionomer liner. Mann-whitney U test revealed that there were no statistically significant differences between both ion-releasing lining material groups for all criteria during the follow-up periods (p > 0.05). Resin composite restorations showed acceptable clinical performance over 3 years either lined with bioactive ionic or resin-modified glass ionomer liners after selective caries excavation preserving pulp vitality. After the 3-year follow-up period, Activa Bioactive and Riva Light Cure liners were clinically effective and they exhibited with the overlying composite restorations successful clinical performance.Trial registration number: NCT05470959. Date of registration: 22/7/2022. Retrospectively registered.

Clinical Performance of Glass Ionomer Cement in Load-Bearing Restorations: A Systematic Review

Glass ionomer cement (GIC) is a self-adhesive dental restorative material composed of a polyacrylic acid liquid and fluoro-aluminosilicate glass powder. It is commonly used for cementation during dental restoration. This study aimed to systematically review the existing literature regarding the clinical performance of GIC in load-bearing dental restorations. A comprehensive literature search was conducted in EBSCO, PubMed, Embrace, and Cochrane databases. Only randomized controlled trials (RCTs) were included in the search, and a broad search technique was used, where inclusion and exclusion criteria were applied. After a thorough evaluation, 12 RCTs were extensively reviewed, and whether GIC is suitable for load-bearing restorations was determined. Significant variations in staining surface or margin, color match, translucency, esthetic anatomical form, retention, material fracture, marginal adaptation, surface luster, occlusal contour, wear, and approximal anatomical form indicated the unsuitability of GIC. By contrast, significance differences in patient view and periodontal response indicated that GIC is suitable. No significant differences in postoperative sensitivity, recurrence of caries, or tooth integrity were observed. Nevertheless, the results of the review demonstrated that the clinical performance of GIC is comparable to that of traditional restorative materials with regard to the parameters analyzed. GIC is a suitable restorative material for load-bearing restorations regarding surface margin, esthetic anatomical form, material retention and fracture, marginal adaptation, occlusal contour, wear, and approximal anatomical form. It reduces other parameters, such as postoperative sensitivity, recurrence of caries, and tooth integrity.

3D-printed and conventional provisional single crown fabrication on anterior implants: A randomized clinical trial

OBJECTIVES

The present study aims to compare provisional single crowns on anterior implants made using conventional PMMA and 3D-printed workflows. The study assessed the occurrence of failures, color variation, signs of early deterioration, operating time, and patients' satisfaction with the treatment through a randomized controlled trial.

METHODS

This study was conducted as a randomized controlled trial, following the SPIRIT and CONSORT guidelines. Patients were included in the study after meeting the eligibility criteria and were randomly assigned to one of two groups (conventional and 3D-printed). FDI criteria, visible plaque index (VPI), bleeding on probing (BOP), and color variation were considered as the primary outcomes. Operating time and patient satisfaction were also assessed as secondary outcomes. Fisher's exact test was performed to analyze the association between the primary and secondary outcomes and the study groups. Mann-Whitney test was used to compare the mean VAS satisfaction scores between the conventional PMMA and 3D-printed groups (STATA 14™, with an α = 0.05).

RESULTS

A total of 42 provisional single crowns (n = 21) were made for 33 patients. Only the fracture parameter (FDI) showed a statistically significant difference, with 3D-printed provisionals exhibiting higher rates of catastrophic failures compared to conventional ones (p = 0.05). Although the operating time for the 3D-printed group was shorter (p < 0.001), no statistical difference observed in patients' satisfaction regarding esthetics, phonetics, chewing, or comfort.

SIGNIFICANCE

3D-printed and conventional PMMA provisional single crowns showed comparable clinical performance, except for the observed fracture types. Although 3D-printed provisional restorations showed a shorter operating time, overall patients' satisfaction was not affected.

Clinical performance of a glass-hybrid system in comparison with a resin composite in two-surface class II restorations: a 5-year randomised multi-centre study

OBJECTIVE

To evaluate the 5-year clinical performance of a glass hybrid restorative system and a nano-hybrid resin composite in moderate to large two-surface class II cavities.

MATERIALS AND METHODS

This study was carried out by dental schools in Zagreb, Croatia; Izmir, Turkey; Belgrade, Serbia; and Milan, Italy. A total of 180 patients requiring two class-II two-surface restorations in the molars of the same jaw were recruited. The teeth were randomly restored with either a nano-hybrid resin composite (Tetric EvoCeram, Ivoclar Vivadent) or a glass-hybrid material (EQUIA Forte, GC). During the 5-year follow-up, two calibrated evaluators at each centre scored the restorations annually using the FDI-2 scoring system. The survival rates were calculated using the Kaplan-Meier method and compared using non-parametric matched pair tests (p < 0.05).

RESULTS

There were no statistically significant differences between the overall survival and success rates of the two types of restorations (p>0.05). The success rates (FDI-2 scores 1-3) for EQUIA Forte were 81.9% (average annual failure rate: 3.9%) and 90.7% for Tetric EvoCeram (average annual failure rate: 1.9%). The survival rates (FDI-2 scores 1-4) for EQUIA Forte and Tetric EvoCeram were 94.5% and 94.4%, respectively, with an average annual failure rate of 1.1%.

CONCLUSIONS

In terms of success and survival rates, both the glass-hybrid restorative system and the nano-hybrid resin composite have been shown to perform satisfactorily.

CLINICAL RELEVANCE

The results of this study indicate that EQUIA Forte can be one of the therapeutic options for moderate to large two-surface class II restorations of posterior teeth.

Development of clinical criteria for the evaluation of indirect restorations

OBJECTIVE

To propose the development and validation of criteria for evaluating the clinical performance of indirect restorations, considering the variables related to the operator, material, and/or patient.

MATERIALS AND METHODS

The experimental design of this study was divided into three stages. Stage 1: development of the new criteria items by specialists in Prosthodontics. Step 2: creation of the criteria, named UERJ criteria, with the description of the parameters that indicate the quality of the restoration, the possible associated complications, and a detailed description of each classification. As well as the development of a form of variables. Step 3: validation of the UERJ criteria.

RESULTS

Cohen's Kappa statistic registered for both intra- and inter-examiner agreements a coefficient >0.91 with a p-value <0.0001. The validity of the UERJ criteria was evaluated by tests of sensitivity (0.96) and specificity (0.91) and had a satisfactory accuracy (92.7%), a positive (10.99), and negative (0.05) likelihood ratio and high values predictive variables, with positive (PPV) 0.84 (high specificity) and negative (VPN) 0.98 (high sensitivity), with a confidence interval of 95%.

CONCLUSION

The UERJ criteria is a valid instrument for evaluating the clinical performance of indirect restorations.

CLINICAL SIGNIFICANCE

The UERJ criteria, developed exclusively for the analysis of indirect restorations, elucidates the details necessary to identify the causes of failures and complications of these restorations.

Clinical Assessment of Moringa oleifera as a Natural Crosslinker for Enhanced Dentin Bond Durability: A Randomized Controlled Trial

BACKGROUND

Dentin biomodification is a biomimetic approach that strengthens the collagen network, making it less susceptible to enzymatic degradation and improving the durability of bonded restorative materials, using collagen crosslinkers.

OBJECTIVE

This study aimed to assess the effectiveness of Moringa oleifera as a natural crosslinker in improving the clinical success of resin-dentin restorations.

METHOD

A double-blind, controlled, randomized clinical trial was conducted in accordance with Consolidated Standards of Reporting Trials (CONSORT) guidelines, with 50 adult participants with initial carious lesions (ICDAS 4 and 5) enrolled. Participants were randomly assigned to either the experimental group (which received Moringa oleifera as a pretreatment liner) or the control group (standard restorative procedures without a liner). Functional and biological outcomes were assessed at baseline, six months, and 12 months using the FDI criteria. Statistical analysis included Fisher's exact test, Wilcoxon sign rank test, and Mann-Whitney U test.

RESULTS

Both groups exhibited excellent functional properties and marginal adaptation at baseline and six months. At the 12-month mark, the test group displayed clinically better functional properties (97.9%, n=47) compared to the control group (95.8%, n=46), but there was no significant difference (p-value>0.05). Marginal gaps were observed in both groups at six and 12 months (8.3%, n=4), with no significant inter-group variation (p-value>0.05). Radiographic examination showed a harmonious restoration-to-tooth transition. Patient satisfaction remained high, with the test group 4.2% (n=2) and control 2.1% (n=1) reporting minor issues at 12 months, though not statistically significant (p-value>0.05). Postoperative sensitivity was minimal, and tooth integrity was well-preserved.

CONCLUSION

Moringa oleifera, as a pretreatment liner, showed promise in enhancing the clinical success of resin-dentin restorations. Despite minor reported issues, the groups had no statistically significant differences regarding functional and biological outcomes.

Comparison of the clinical outcomes of resin-modified glass ionomer and self-adhesive resin cementations for full-coverage zirconia restorations

OBJECTIVES

Both resin-modified glass ionomer cement (RMGIC) and self-adhesive resin cement (SAC) may be suitable for cementation of full-coverage zirconia restorations. This retrospective study aimed to investigate the clinical outcomes of zirconia-based restorations cemented with RMGIC and compare them with those cemented with SAC.

METHODS

Cases of full-coverage zirconia-based restorations cemented with either RMGIC or SAC between March 2016 and February 2019 were evaluated in this study. The clinical outcomes of the restorations were analyzed according to the type of cement used. In addition, cumulative success and survival rates were evaluated according to the cement and abutment types. Non-inferiority, Kaplan-Meier, and Cox hazard tests were conducted (α=.05).

RESULTS

A total of 288 full-coverage zirconia-based restorations (natural teeth, 157; implant restorations, 131) were analyzed. Loss of retention occurred in only one case; a single-unit implant crown cemented with RMGIC, which decemented 4.25 years post-restoration. RMGIC was non-inferior to SAC in terms of loss of retention (<5%). For single-unit natural tooth restorations, the four-year success rates in the RMGIC and SAC groups were 100% and 95.65%, respectively (p=.122). For single-unit implant restorations, the four-year success rates in the RMGIC and SAC groups were 95.66% and 100%, respectively (p=.365). The hazard ratios of all the predictor variables, including cement type, were not significant (p>.05).

CONCLUSIONS

Cementation of full-coverage zirconia restorations of both natural teeth and implants using RMGIC and SAC yields satisfactory clinical outcomes. Furthermore, RMGIC is non-inferior to SAC in terms of cementation success.

CLINICAL SIGNIFICANCE

Cementation with RMGIC or SAC for full-coverage zirconia restorations has favorable clinical outcomes in both natural teeth and implants. Both RMGIC and SAC have advantages in the cementation of full-coverage zirconia restorations to abutments with favorable geometries.

The Dentist's Ability to Detect Different Restorative Procedures on Periapical Radiographs-Results from a Reliability Study

(1) Background: This in vitro reliability study aimed to determine the inter- and intra-examiner reliability for the detection of direct fillings, indirect crown restorations, root canal fillings and implants on periapical radiographs. (2) Methods: Fourteen dentists (<2 years of clinical experience = 11; >2 years of clinical experience = 3) participated in this diagnostic reliability study in which included a theoretical and practical educational training prior to data collection. The image set of periapical radiographs (N = 150) was examined in two evaluation rounds by all the dentists. Cohen's Kappa (CK) and a binary logistic regression model were computed. (3) Results: The inter- and intra-examiner reliability were found to be in almost perfect agreement: direct fillings (1st round 0.859/2nd round 0.844/intra 0.910), indirect crown restorations (0.932/0.926/0.955), root canal fillings (0.920/0.886/0.941) and dental implants (0.994/0.988/0.987). The binary logistic regression model revealed that the "evaluation round" and "dentist's clinical experience" had no significant influence, but for the "diagnostic category"; small, but statistically significant differences were documented. (4) Conclusions: The reliability for detecting direct and indirect restorations, root canal fillings or implants on periapical radiographs was found to be high in the present reliability study on periapical radiographs.