Clinical effectiveness of direct anterior restorations—A meta-analysis

Combining a CAD-CAM composite resin palatal wall with a direct composite resin layering technique for the restoration of a large Class IV fracture: A clinical report

This clinical report presents combining a computer-aided design and computer-aided manufacturing (CAD-CAM) composite resin palatal wall with a direct composite resin layering technique for the esthetic and functional restoration of a large Class IV fracture of a maxillary central incisor to achieve optimal esthetic and functional outcomes.

SURVIVAL AND COMPLICATION RATES OF RESIN COMPOSITE LAMINATE VENEERS: A SYSTEMATIC REVIEW AND META-ANALYSIS

OBJECTIVES

The aim of this systematic review was to evaluate the survival and complication rates of resin composite laminate veneers.

METHODS

Randomized controlled trials and cohort studies with a minimum 2-year follow-up assessing survival and complication rates of resin composite laminate veneers on permanent dentition from 1998 to May 2022. Literature searches were conducted in MEDLINE (PubMed), Scopus, and the Cochrane Central Register of Controlled Trials electronic databases. References cited in the related reviews and included full-text articles were also hand-searched to further identify potentially relevant studies.

RESULTS

A total of 827 articles were identified. Twenty-two studies were considered for full-text review after the title and abstract screening stage. After exclusion, 7 studies (3 randomized controlled trials and 4 cohort studies) were included in the systematic review. Three published scales were adopted for the quality and risk of bias assessment. At the survival rate threshold, the overall heterogeneity (I2) for randomized controlled trials was 50.5% (P = .108). The overall pooled survival rate of the randomized controlled trials was 88% (95% CI: 81%-94%), with the mean follow-up time ranging from 24 to 97 months. Surface roughness, color mismatch, and marginal discoloration were the most reported complications.

CONCLUSION

Resin composite laminate veneers demonstrated moderately high survival rates for the entire sample and the direct laminate veneer group demonstrated higher survival rates than the indirect approach. Most of the complications were regarded as clinically acceptable with or without reintervention.

Effect of layering strategy and prolonged water aging on masking ability of composite resins

STATEMENT OF PROBLEM

Layered composite resins may adequately mask discolored substrates. However, whether color changes that occur over time affect masking ability is unclear.

PURPOSE

The purpose of this in vitro study was to investigate the effect of layering and water aging on the masking ability of 2 composite resins.

MATERIAL AND METHODS

Disk specimens (1.5 mm-thick and shade A1) from Charisma Diamond (CD) and Filtek Z350XT (Z350) were made according to the composite resin shade combination used in the layering strategies: bilayer for CD (enamel/dentin) and for Z350 (enamel/body and enamel/dentin) and trilayer for Z350 (enamel/body/dentin) (n=5). Color measurements were obtained with a spectrophotometer over an A3.5 ceramic substrate, and the whiteness index for dentistry (WID) was calculated. The specimens were aged in water at 37 °C and evaluated at different times: 24 hours, 1 week, 1 month, 2 months, 6 months, 12 months, 18 months, and 24 months. CIEDE2000 color differences (ΔE00) and WID differences (ΔWID) were calculated and interpreted by 50:50% color and whiteness perceptibility and acceptability thresholds. Changes among strategies and aging times were analyzed using the Kruskal-Wallis test (α=.05). Contrasts were made using the Mann-Whitney U test with Bonferroni correction (α=.001).

RESULTS

ΔE00 decreased from 24 hours to 2 months of aging. From 2 months onwards, ΔE00 increased for all layering strategies and times, without significant changes in lightness for CD (P>.004). Overall, for the CD restorative system, an increase in ΔWID was observed after 1 month of aging (P<.001), while for the Z350 restorative system, ΔWID decreased after aging (P<.001), except for the Z350 bilayer strategy (enamel + dentin) at 1 week and 2 months (P>.004). For all layering strategies and aging times, color differences were higher than the 50:50% perceptibility threshold for ΔE00 and, after 6 months, higher than the 50:50% acceptability threshold for ΔE00 and the 50:50% whiteness acceptability threshold.

CONCLUSIONS

The ability of the tested composite resins to mask a discolored substrate was affected by the layering approach applied and by prolonged water aging.

Toward esthetically and biomechanically reliable anterior resin composite restorations: Current clinical experiences among dental practitioners in Saudi Arabia

Background: Esthetic anterior composite restorations are very challenging. They constitute a main part of the clinical practice of restoring teeth with resin composites. Distinctive variations in composite material selection and technique of application in anterior teeth exist when compared to the practice of restoring posterior teeth with resin composites. In a continuation of a previous assessment of class II resin composite practice,  a cross-sectional survey study was performed to determine the awareness of general dental practitioners in Saudi Arabia about resin composite restorations in anterior teeth and to provide evidence-based recommendations to improve their practice. Methods: A total of 500 dental practitioners from different provinces in Saudi Arabia were invited to participate in an online questionnaire which comprised four domains and included a total of sixteen questions addressing aspects regarding the selection of resin composites, cavity configuration, etching protocol, light-curing technique, liner application, application of poly-chromatic composite, as well as finishing and polishing procedures. Chi square testing and descriptive statistics were used to analyze the attained data. Results: From 250 respondents, the greatest participation was from the Eastern and Middle provinces of Saudi Arabia. Female dentists participated less than males. There was no general agreement between participants regarding the resin composite material or the employed technique of application in restoring anterior tooth defects. Respondents indicated that discoloration and hypersensitivity were the most common reasons for patient's dissatisfaction with resin composites in anterior teeth. Conclusions: Dental practitioners are highly encouraged to improve their clinical practice of restoring anterior teeth using resin composites with the focus upon continuous education programs, online webinars, and workshops.

The Effect of Ground and Unground Enamel on the Clinical Performance of Direct Composite Build-up After Orthodontic Treatment: Five Years of Follow-up

PURPOSE

To assess the clinical performance of restorations with ground and unground enamel for diastema closure.

METHODS AND MATERIALS

Twenty-four patients attended and received two to ten composite build-ups for diastema closure. The restorations were performed separately by grinding and not grinding the enamel on the proximal surfaces on symmetric teeth. A nanofill direct composite (Filtek Ultimate Universal Restorative System, 3M ESPE, St Paul, MN, USA) was used with a three-step etch-and-rinse adhesive (Scotchbond Multi-Purpose, 3M ESPE) for restorations. Restorations were evaluated according to the modified United States Public Health Service (USPHS) criteria at baseline and 1-, 2-, 3-, 4-, and 5-year recalls.

RESULTS

The cumulative success rate of direct composite build-up with ground and unground enamel was 100% and 88.7%, respectively. Six restorations with unground enamel failed due to fracture. No significant difference was found between the restorations with ground enamel and unground enamel with regard to the evaluation criteria.

CONCLUSION

The 5-year success rates of restorations with ground and unground enamel were excellent. The success rate of restorations with ground enamel was higher than that of restorations with unground enamel. Fracture was the reason for failure in the restorations with unground enamel.

Clinical performance of an alkasite-based bioactive restorative in class II cavities: a randomized clinical trial

OBJECTIVE

This clinical study aimed to evaluate the clinical performance of an alkasite-based bioactive material by comparing it with a resin composite (RC) in the restoration of Class II cavities over a year.

METHODOLOGY

A hundred Class II cavities were restored at 31 participants. Groups were as follows: Cention N (CN) (Ivoclar Vivadent, Schaan, Liechtenstein) and G-ænial Posterior (GP) (GC, Tokyo, Japan) in combination with G-Premio Bond (etch&rinse). Restorative systems were applied following manufacturers' instructions. They were finished and polished immediately after placement and scored based on retention, marginal discoloration, marginal adaptation, sensitivity, surface texture, and color match using modified USPHS criteria after 1 week (baseline), 6 months, and 12 months. Statistical analyses were performed using chi-square, McNemar's, and Kaplan Meier tests.

RESULTS

After 12 months, the recall rate was 87%. Survival rates of CN and GP restorations were 92.5% and 97.7%, respectively. Three CN and one GP restorations lost retention. Seven CN (17.9%) and five (11.6%) GP restorations were scored as bravo for marginal adaptation and no significant difference was seen between groups (p=0.363). One (2.7%) CN and two GP (4.7%) restorations were scored as bravo for marginal discoloration, but no significant difference was observed between groups(p=1.00). For surface texture, three (8.1%) CN and three (7%) GP restorations were scored as bravo (p=1.00). None of the restorations demonstrated post-operative sensitivity or secondary caries at any examinations.

CONCLUSION

The tested restorative materials performed similar successful clinical performances after 12 months. ClinicalTrials.gov (NTC04825379).

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

OBJECTIVES

The FDI criteria for the evaluation of direct and indirect dental restorations were first published in 2007 and updated in 2010. Meanwhile, their scientific use increased steadily, but several questions from users justified some clarification and improvement of the living document.

MATERIALS AND METHODS

An expert panel (N = 10) initiated the revision and consensus process that included a kick-off workshop and multiple online meetings by using the Delphi method. During and after each round of discussion, all opinions were collected, and the aggregated summary was presented to the experts aiming to adjust the wording of the criteria as precisely as possible. Finally, the expert panel agreed on the revision.

RESULTS

Some categories were redefined, ambiguities were cleared, and the descriptions of all scores were harmonized to cross-link different clinical situations with possible management strategies: reviewing/monitoring (score 1-4), refurbishment/reseal (score 3), repair (score 4), and replacement (score 5). Functional properties (domain F: fracture of material and retention, marginal adaptation, proximal contact, form and contour, occlusion and wear) were now placed at the beginning followed by biological (domain B: caries at restoration margin, hard tissue defects, postoperative hypersensitivity) and aesthetic characteristics (domain A: surface luster and texture, marginal staining, color match).

CONCLUSION

The most frequently used eleven categories of the FDI criteria set were revised for better understanding and handling.

CLINICAL RELEVANCE

The improved description and structuring of the criteria may help to standardize the evaluation of direct and indirect restorations and may enhance their acceptance by researchers, teachers, and dental practitioners.

Effect of prerestorative short-term clear aligner therapy in restorative treatment planning

STATEMENT OF PROBLEM

One of the major challenges in restorative dentistry is to provide optimal esthetics in a minimally invasive way. The optimization of dental esthetics and function is directly related to the position and alignment of the anterior teeth, but whether prerestorative clear aligner therapy will enhance esthetics and minimize restorative needs is unclear.

PURPOSE

The purpose of this clinical study was to evaluate the effect of prerestorative maxillary and mandibular second premolar to second premolar clear aligner therapy in minimizing the need for restorative treatment.

MATERIAL AND METHODS

Fifty adult patients treated with clear aligners (Invisalign Go; Align Technology) were included in this study. Previously generated 3-dimensional orthodontic simulations and clinical photographs in the ClinCheck/6.0 software program were used. Three restorative treatment plans for each participant were generated for initial (no aligners), Express (after using 7 aligners), and Lite Packages (after using 20 aligners) by 2 blinded restorative dentistry instructors. The maxillary and mandibular teeth in the smile-line (to the second premolars) were included. Assessment criteria were the estimated number of restorations, restoration surfaces and preparations and incisal edge inclusion, and the need for gingival leveling. The Friedman test and Cochran Q test were used for statistical analyses (α=.05).

RESULTS

A strong positive correlation was found between the 2 instructors (P<.001). Estimated number of restorations (10 [3 to 16]^a) decreased significantly for Express (6 [0 to 14]^b) and Lite Packages (4 [0 to 8]^c) (P<.001). The estimated number of restoration surfaces (28.5 [9 to 48]^a) decreased significantly for Express (15 [0 to 42]^b) and Lite Packages (9.5 [0 to 24]^c) (P<.001). While the estimated number of teeth to be prepared for recontouring (7 [0 to 16]^a) was significantly less for Express (3 [0 to 10]^b) and Lite Packages (0 [0 to 4]^c) (P<.001), the incisal edge inclusion (10 [3 to 16]^a) was significantly less for Express (6 [0 to 14]^b) and Lite Packages (4 [0 to 8]^c) (P<.001). The need for gingival leveling (26 [52%]^a) decreased significantly for Express (20 [40%]^a) and Lite Packages (7 [14%]^b) (P<.001).

CONCLUSIONS

Prerestorative short-term clear aligner therapy might conserve tooth structure and reduce the number of restorations. The application of the Invisalign Lite Package was more effective than the Invisalign Express Package for second premolar to second premolar alignment.

Evidence-based fact checking for selective procedures in restorative dentistry

OBJECTIVES

Similar to other dental specialties, there are many clinical procedures in restorative dentistry that may or may not be supported by good evidence. Thus, the effectiveness of these procedures is uncertain. The aim of this paper is to reduce this knowledge gap by critically inspecting selective procedures in restorative dentistry and exploring if these well-established or widely advocated treatment modalities are necessary for improving treatment outcomes based on the best available evidence.

MATERIALS AND METHODS

A MEDLINE search was conducted to identify research on selective procedures while focusing on clinical trials and systematic reviews. Due to their practical relevance in the decision-making process, cost-effectiveness analyses were also included.

RESULTS

Mixed results were identified regarding the included interventions. Some procedures had adequate evidence supporting them while others were mostly based on beliefs.

CONCLUSIONS

A critical review of the available literature indicates that some common restorative procedures lack adequate support from high-quality research evidence.

CLINICAL RELEVANCE

This paper attempts to highlight the need to critically examine the scientific validity of traditional knowledge and techniques through the context of current research evidence. This will not only help generate consensus between educators, clinicians, and researchers regarding restorative procedures but will also lead to improved patient care and outcomes.

Effect of shape of titanium dioxide nanofillers on the properties of dental composites

The main objective of the present study was to evaluate the effect of the morphology of titanium dioxide nanofillers on the flexural strength and shear bond strength of the dental composite. Spherical and rhombic-shaped nano titanium dioxide fillers were synthesized via solvothermal method and were characterized. Subsequently, these fillers were incorporated into a flowable composite (Filtek^™ Z350 XT Flowable Restorative) at 0.5 wt.% and 1.5 wt.% and the prepared specimens were stored in water for 24 h. The specimens were then evaluated for flexural strength using a universal testing machine. Similarly, the shear bond strength of modified composites to the tooth was evaluated and bond failures were analyzed using stereomicroscope magnification. Incorporation of nanofillers significantly enhanced the flexural strength of flowable composite (p = 0.009) with a significant increase at 0.5wt.% of spherical (p = 0.015) and rhomboidal-shaped fillers (p = 0.010). However, no statistically significant difference in flexural strength was observed among the different shapes of nanofillers. The results of our study did not show a significant effect on the shear bond strength of the composites. Thus the reinforcing ability of titanium dioxide nanofillers on dental composite was confirmed in this study, although the effect of using nanofillers with different morphology was not significant.

Accuracy of Direct Composite Veneers via Injectable Resin Composite and Silicone Matrices in Comparison to Diagnostic Wax-Up

Purpose: To evaluate the discrepancy between the diagnostic wax-up and the resulting direct veneers using different matrices. Materials and method: A total of 48 identical misaligned models, 12 wax-up models and one ‘every other tooth’ wax-up model were 3D printed. Group 1: Transparent silicone matrices with holes for the injection of the flowable composite. Group 2: The same procedure as group 1, but the first three teeth were restored using the matrix constructed from the ‘every other tooth’ wax-up model. Group 3: Transparent silicone matrices cut for each tooth and preheated resin composite. Group 4: The same procedure as group 3, but the loaded matrix was placed first in the clear plastic tray, which was used for the matrix’s fabrication. Group 5: Wax-up models (control group). Scans from the veneers were superimposed with the scans from the wax-up and compared using the Patient Monitoring software. Measurements were made at the incisal, middle and cervical third. Kruskal-Wallis test and Dunn post-hoc test (p < 0.05) were used to analyze the results. Results: No statistically significant differences were found between groups 1 and 2 and the control. Group 3 was different from the control in the incisal and middle third, and group 4 was different in the cervical third. Conclusions: (1) Use of one or two matrices and the injection of flowable composite were accurate techniques. (2) Use of a matrix for each tooth combined with a pre-heated composite was the most inaccurate technique, but the use of the clear tray in combination with the matrix improved the accuracy.

Two‐year retrospective evaluation of monoshade universal composites in direct veneer and diastema closure restorations

OBJECTIVES

The aim of this retrospective evaluation was to assess the short-term outcome of two monoshade universal resin composites with high chameleon effect in anterior direct veneer and diastema closure restorations, and to investigate the possible reasons for failure.

MATERIAL AND METHODS

Patients subjected to veneer and diastema closure restorations with two monoshade universal resin composites (Essentia Universal Shade; EU, GC Corp., and Omnichroma; OC, Tokuyama) operated between January 2018 and March 2019 were selected for the present retrospective evaluation. A total of 159 composite restorations (78 veneers and 81 diastema closure restorations) performed by a single operator in 44 patients (mean age: 33.6) were included in the study. Two blinded and calibrated examiners performed 1- and 2-year assessments of the restorations with respect to FDI criteria, using medical/clinical history and dental photography records. Data were analyzed using Pearson Chi-square with Continuity Correction, Fisher's Exact tests, and Cox regression (a < 0.05).

RESULTS

The cumulative overall survival rates of EU and OC restorations were 94.6% (97.3% for the first year) and 88.6% (95.3% for the first year), respectively, with no significant difference from each other (p = 0.316). The cumulative overall survival rates of direct veneer and diastema closure restoration types were 90.2% (95.1% for the first year) and 92.4% (97.4% for the first year), respectively, with no significant difference (p = 0.559). The reasons for failure were evaluated as fracture of the restoration, failure in esthetic anatomical form, and color mismatch. All the failed direct veneer restorations were due to fractures (FDI score of 5.4), whereas 5 of 6 failed diastema closure restorations were due to color mismatch (FDI score of 3.4). Regarding the composite materials, there were no significant differences between the success rates of the restoration types (p = 0.442 for EU, p = 1.000 for OC). With respect to the restoration types, there were also no significant differences between the success rates of the resin-based composites (p = 1.000 for direct veneer restorations and p = 0.228 for the diastema closure restorations). In addition, no significant difference was observed between male and female patients regarding the acceptable and unacceptable scores (p = 1.000).

CONCLUSIONS

The 2-year clinical performance of the two monoshade universal composites in anterior veneer and diastema closure restorations were both considered successful and similar. Despite the lack of shade selection, both monoshade universal composites presented a successful color match. However, the diastema closure restorations might be more prone to color mismatch compared to the veneers over time, while veneer restorations presented more fractures than the diastema closure restorations.

CLINICAL SIGNIFICANCE

Monoshade universal composites presented successful short-term clinical outcomes regarding both function and esthetics in anterior direct veneer and diastema closure restorations.

Hydroxyapatite Affects the Physicochemical Properties of Contemporary One-Step Self-Etch Adhesives

The study aimed to evaluate the influence of the manipulation surfaces on the physical properties of one-step self-etch adhesives (1-SEAs). Scotchbond Universal (SBU), Clearfil Universal Bond Quick ER (UBQ), and an experimental adhesive (UBQ_exp) were manipulated on different surfaces: manufacturer's Teflon-based dispensing dish (TD) or hydroxyapatite plate (HA). After manipulation of the adhesives, the pH of each 1-SEA was measured. Samples of each adhesive/manipulation surface were prepared and subjected to water sorption (WS)/solubility (SL) and flexural strength tests. The modulus of elasticity (E) was measured in dry and wet conditions before and after 24 h water storage, and the percentage of variation of E (ΔE) was calculated. Results were analyzed using the t-test with Bonferroni corrections (α = 0.05). When adhesives were manipulated on the HA plate, there was a significant increase in the adhesives' pH. WS and SL of all 1-SEAs decreased when the HA was used. Only SBU showed higher flexural strength when manipulated on the HA compared to the manipulation on TD under dry and wet conditions. For each 1-SEA, the use of HA resulted in significantly higher E in dry and wet conditions. ΔE of all adhesives was smaller with the manipulation on HA than on TD. It was concluded that the manipulation of 1-SEA on a hydroxyapatite plate considerably affected the adhesives' properties.

Resin-Based Composites for Direct and Indirect Restorations: Clinical Applications, Recent Advances, and Future Trends

Continuous advancements in resin-based composites can make selection of the appropriate system a daunting task for the clinician. This review aims to simplify this process and clarify some new or controversial topics. Various types of composites for direct and indirect applications are discussed, including microfilled and microhybrid composites, nanocomposites, single shade, bulk fill, fiber-reinforced, high temperature/high pressure processed, CAD/CAM, and three-dimensional printable composites. Recent material advancements that lead to improved seal and toughness, degradation resistance, antimicrobial and self-healing capabilities are presented. Future directions are highlighted, such as the development of "smart" materials that are able to interact with the host environment.

A Multidisciplinary Approach to Maxillary Lateral Incisor Agenesis (MLIA): A Case Report

Maxillary lateral incisor agenesis (MLIA) is a condition that significantly compromises smile esthetics and is a particular concern in younger patients. The treatment options include orthodontics for space opening with rehabilitation or space closure with canine camouflage. Currently, there is some controversy regarding the most appropriate treatment. In this case report, we propose a multidisciplinary approach through the combination of orthodontic treatment, frenectomy, and a restorative finishing stage with composite resin and dental implants. More specifically, this treatment was planned to orthodontically close the anterior space by opening the premolar area for subsequent placement of implants and enameloplasty with a composite resin. The replacement of a missing lateral incisor by an implant is a predictable treatment approach, but it might best be deferred until dental maturity and then accurately placed in a well-developed site through a multidisciplinary approach. Precluding the closure of the anterior spaces and the opening of the posterior zone for implant placement, allows for a more stable and appealing esthetic and functional rehabilitation for young patients, in whom esthetic appearance and self-esteem play a primary role.

Longevity of Direct Resin Composite Restorations in Maxillary Anterior Crown Fractures: A 4-year Clinical Evaluation

OBJECTIVES

To investigate the longevity of direct composites for Class IV restorations and the possible reasons of failure.

METHODS AND MATERIALS

The longevity of 168 Class IV restorations in 50 adult patients was evaluated, in terms of modified United States Public Health Service criteria, for 4 years. Restorations were performed using a monochromatic layered microhybrid, resinbased composite (RBC) (Essentia, Universal Shade, GC Corporation, Japan; n=76) and polychromatic layered micro/nanohybrid (MD and LE shades, Essentia, GC Corporation, Japan; n=92) RBCs, by a single operator.

RESULTS

The majority of the teeth (n=156) remained acceptable at the end of 4 years, and the overall survival (OS) rate was considered as 92.86%. Survival rates for the monochromatic layering technique (MLT) and polychromatic layering technique (PLT) were 90.8% and 94.6%, respectively. Mean survival was 46 months for MLT and 47 months for PLT, indicating no significant difference (p=0.343). Fracture of the restoration was the most common reason for failure (4.2% out of 7.1% of general failures) for both the layering techniques.

CONCLUSIONS

Under the conditions of this mid-term clinical study, MLT and PLT as well as microhybrid and nanohybrid resin composite materials, showed similar clinical durability. In terms of simplicity, monochromatic layering can be preferred for Class IV restorations, when the right indication criteria are met.

Effect of Multiple Enamel Surface Treatments on Micro-Shear Bond Strength

Objectives: The aim of this study was to evaluate the effect of different enamel surface treatments on the micro-shear bond strength. Materials and methods: Sixty-four approximal surfaces from freshly extracted molars were randomly assigned to eight groups, according to combinations of the following enamel surface treatments: ground or unground, 37.5% phosphoric acid etching time of 15 or 30 s, and with or without primer application. The same bonding agent (Optibond FL™ Adhesive, Kerr) was then used for all groups, and a 1.8 mm diameter resin composite (Harmonize™, Kerr) cylinder was built up on the bonded surface. Samples underwent a shear force test at a crosshead speed of 1 mm/min until failure. Bond strength was calculated, and failure modes were inspected under an optical microscope. Results: Bond-strength values ranged from 8.2 MPa for 15 s etched unground enamel with primer application to 19.6 MPa for 30 s etched ground enamel without primer application. ANOVA and Fisher’s LSD post hoc tests revealed significant differences between the groups. Conclusions: Etching time and grinding have a statistically significant effect on the micro-shear bond strength of a three-step etch-and-rinse adhesive system on enamel. Primer application does not seem to be beneficial for enamel adhesion.

Direct Restorations for Anterior Esthetic Rehabilitation and Smile Symmetry Recovery: Two Case Reports

Esthetics is an increasing concern for patients, particularly in anterior teeth. The current approaches to manage the esthetic demands include options such as prosthodontic rehabilitation, orthodontic treatment, and direct restorations. Direct restorative procedures for anterior teeth have become a reliable alternative, since current composite materials can mimic teeth’s esthetics and function perfectly. This article describes two clinical cases of anterior esthetic rehabilitations where the direct reshaping of the four maxillary incisors was performed using the buccolingual layering technique with the help of a silicone index. In Case 1, a diastema closure was also performed, whereas in Case 2, the replacement of old restorations was also carried out. It was possible to achieve excellent final esthetic results in both cases, recovering the smile symmetry, and both patients were satisfied. The literature supports the use of direct restorations in the anterior region with very good long-term prognosis. It is a minimally invasive approach that is reversible, repairable, cost-effective, and when combined with layering techniques and adequate restorative materials, it is possible to achieve good esthetic and functional outcomes. However, regular maintenance appointments are mandatory, and all cases should be carefully planned to ensure predictable and long-lasting results.

Clinical decision-making in anterior resin composite restorations: a multicenter evaluation

OBJECTIVE

This study investigated whether a sample of anterior resin composite restorations could be differently evaluated in different centers of evaluation by clinical and lay evaluators.

METHODS

Anterior resin composite restorations on high-quality intraoral digital photography were evaluated using FDI criteria (1-5 score) by pairs of clinical and lay evaluators in Brazil (BR), France (FR), Peru (PE), and the United States of America (USA). Scores were allocated as maintenance (1, 2, 3), repair (4) and replacement (5) when comparing clinical evaluators and, as acceptable (1, 2, 3) and unacceptable (4, 5) when comparing clinical vs. lay evaluators and lay vs. lay evaluators. The Chi-square test compared the frequencies of scores among the centers.

RESULTS

The frequencies of maintaining, repairing, or replacing anterior resin composite restorations given by clinical evaluators varied depending on the evaluation center. BR and PE showed the highest frequencies for repair and replacement, while FR and USA showed the highest frequencies for maintenance. The comparison of frequencies of anterior resin composite restorations accepted or unaccepted by the clinical vs lay evaluators in the same centers showed a significantly higher frequency of acceptable dental restorations coming from clinical evaluators. Comparison between lay evaluators from different centers showed significant higher frequency of unacceptable dental restorations by BR, compared to other centers.

CONCLUSIONS

In the evaluation of anterior resin composite restorations, the maintenance, repair, or replacement trends can vary among different centers. The unacceptable rate came more frequently from lay than from clinical evaluators. Lay evaluators from different centers differed significantly.

CLINICAL SIGNIFICANCE

Clinical and lay evaluators in distant evaluation centers can present different trends when assessing anterior resin composite restoration. Multicenter evaluations can help to understand such differences and it is important because clinical decision-making based on scientific evidence comes from clinical studies done in different research centers.

Needs for re-intervention on restored teeth in adults: a practice-based study

OBJECTIVES

Evaluate the need for re-intervention on dental coronal restorations in adults seen in a network of general dental practitioners (ReCOL).  MATERIALS AND METHODS: This observational, cross-sectional, multicenter study involved 40 practitioners and 400 patients. Coronal restoration failures (needing re-intervention for unsatisfactory outcomes) were assessed with a simplified rating scale of seven criteria from the FDI World Dental Federation. The oral health status, the risk factors, and Oral Health Impact Profile-14 were also examined. Previous restoration characteristics (extent, technique, material) were analyzed according to the need for re-intervention (yes/no), the age group, and the risk profile. Qualitative variables were compared between "re-intervention" and "no re-intervention" group using Fisher exact test.

RESULTS

The need for re-intervention was estimated at 74% (95% CI: 70; 79); it increased with age (49 to 90%), unfavorable risk profile (82 vs. 62%), and extent of the filling (32, 39, 44, and 44% on 1, 2, 3 surfaces, and crowns, respectively). More posterior than anterior teeth were restored (median per patient: 6 vs. 1) or needed re-intervention (median per patient: 1 vs. 0).

CONCLUSIONS

The needs for re-intervention in adults are still high within a context of ever-changing materials and techniques, simplified and rationalized decision-makings, and demands for patient involvement.

CLINICAL RELEVANCE

Meeting these needs requires the following: (i) consensus definitions and assessment methods for "failure" and (ii) reliable feedbacks on materials, procedures, and satisfaction. Building large and detailed databases fed by networks of motivated practitioners will help analyzing complex success/failure data by artificial intelligence and guiding treatment and research.

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

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

Clinical effectiveness of direct resin composite restorations bonded using one-step or two-step self-etch adhesive systems: A three-year multicenter study

The purpose of this multicenter clinical study was to compare the mid-term clinical effectiveness of direct resin composite restorations using one-step or two-step self-etch adhesives (1-SEAs or 2-SEAs). In total, 352 restorations of class I-V cavities and non-carious cervical lesions in vital teeth (1-SEAs; 52 cases, 2-SEAs; 300 cases) were placed at nine university hospitals and evaluated according to the modified USPHS criteria at baseline, and after 1, 2, and 3 years. The recall rates were 86.6% (1 year), 80.1% (2 years), and 62.2% (3 years). Two restorations failed due to fracture during the follow-up, and there was no significant difference in survival rates between 1-SEAs (97.6%) and 2-SEAs (99.4%). However, 2-SEAs exhibited significantly lower occurrences of discoloration, marginal discoloration, fracture, and plaque retention. Moreover, the subjects reported a significantly lower postoperative hypersensitivity and higher overall satisfaction at all evaluation periods if 2-SEAs were used.

Bond durability of universal adhesives to intact enamel surface in different etching modes

This study aimed at determining the enamel bond durability of universal adhesives to intact enamel (IE) and ground enamel (GE) in different etching modes under thermal cycling (TC) and fatigue stresses. Two universal adhesives and a two-step self-etch adhesive were used. Enamel specimens were divided into four groups by treatment: (i) GE in etch-and-rinse, (ii) IE in etch-and-rinse, (iii) GE in self-etch, and (iv) IE in self-etch. Bonded specimens were subjected to TC, and then shear bond strengths (SBS) were conducted. SBS tests were also conducted after storage in 37°C water for 24 h (baseline). For shear fatigue strength (SFS) testing, bonded specimens were subjected to fatigue stress at a frequency of 10 Hz for 50,000 cycles. At baseline, all adhesives showed significantly higher SBS values with GE than IE in self-etch mode in contrast to in etch-and-rinse mode. After TC, the universal adhesives with IE showed lower SBS values than the baseline, regardless of the etching mode. Universal adhesives showed significantly lower SFS values with IE in etch-and-rinse, but not in self-etch mode. Phosphoric acid pre-etching or grinding of the aprismatic enamel may be helpful in establishing reliable initial and long-term bonds to enamel when using universal adhesives in self-etch mode.

Long-Term Survival and Complication Rates of Porcelain Laminate Veneers in Clinical Studies: A Systematic Review

The presented study aimed to assess the survival rate of porcelain laminate veneers (PLV) based on a systematic review of the literature. An electronic search was last updated in February 2021. Eligibility criteria included clinical series of patients rehabilitated with PLVs published in the last 25 years, with a minimum follow-up of 3 years. Survival analysis methods were applied. Twenty-five studies were included, with 6500 PLVs. The 10-year estimated cumulative survival rate (CSR) of PLVs was 95.5%. The 10-year CSR of PLVs when fracture, debonding, occurrence of secondary caries, and need of endodontic treatment were considered as isolated reasons for failure were 96.3%, 99.2%, 99.3%, and 99.0%, respectively. PLVs without incisal coverage had a higher failure rate than PLVs with incisal coverage. Non-feldspathic PLVs performed better than feldspathic PLVs. As a conclusion, the 10-year CSR of PLVs was 95.5%, when fracture, debonding, occurrence of secondary caries, and need of endodontic treatment were considered as reasons for restoration failure. Fracture seems to be most common complication of PLVs, followed by debonding, with both more commonly happening within the first years after PLV cementation. PLVs with incisal coverage and non-feldspathic PLVs presented lower failure rates than PLVs without incisal coverage and feldspathic PLVs.

Longevity of direct diastema closure and recontouring restorations with resin composites in maxillary anterior teeth: A 4-year clinical evaluation

OBJECTIVES

To evaluate the clinical performance of resin composite restorations and to investigate causes of failure.

MATERIALS AND METHODS

The longevity of 216 restorations in 53 patients (mean age, 33.3 years) was retrospectively evaluated according to Fédération Dentaire Internationale (FDI) criteria. Dental history and photographic data were used to evaluate diastema closure (n = 199) and recontouring (n = 19) restorations comprising microhybrid (Essentia Universal, GC Corp.), nanohybrid (Ceram.x One, Dentsply Sirona), and nanofilled (Estelite Asteria, Tokuyama Dental) composites. Data were analyzed with the Kaplan-Meier log-rank test, Cox regression analysis, Pearson chi-square test. p < 0.05 was considered statistically significant. The overall survival rate was 90.3 % and the mean survival duration was 46.2 months during the for 4 - year study period. The annual failure rate was 0.9 % - 3.4 %. Mean survival durations for diastema closure and recontouring restorations were 46.2 and 45.9 months, respectively (p = 0.328). Mean survival durations for Essentia Universal, Estelite Asteria, and Ceram.x One were 46.1, 46.7, and 45.7 months, respectively (p = 0.677). If we include failed restorations that were repaired and remained functional, the overall survival rate was 100 %.

CONCLUSION

Longevity was similar among composites and restoration types. The long-term clinical performance of monochromatic anterior composite restorations was robust. Composite repair may be suitable for diastema closure and recontouring restorations.

CLINICAL SIGNIFICANCE

There is a lack of long-term clinical evidence regarding the performance of direct anterior composite restorations. Monochromatic direct composite restorations may meet both the esthetic and functional expectations with even simpler restorative techniques. This 4 - year follow-up study evaluated the clinical performance of monochromatic anterior diastema closure and recontouring restorations with three different composite materials. The longevity of the restorations and the reasons for failure were investigated.

Secondary caries risk of different adhesive strategies and restorative materials in permanent teeth: Systematic review and network meta-analysis

OBJECTIVES

Secondary caries is a major long-term complication of dental restorations. Different adhesive strategies and restorative materials may affect secondary caries risk. We aimed to systematically review and synthesize the secondary caries risk of different adhesive strategies and restorative materials.

SOURCES

Medline via PubMed 01/2005-10/2019.

STUDY SELECTION

Randomized controlled studies with minimum 2 years follow-up, comparing different adhesive strategies and/or restorative materials in permanent teeth were included. Our outcome was the occurrence of secondary caries. Bayesian pairwise and network-meta-analysis were conducted.

DATA

We included 50 trials; 19 assessing secondary caries depending on different adhesive strategies, 31 on restorative materials. Studies were published between 2005 and 2017, largely of unclear risk of bias, and included a mean of 40 (range: 8-90) participants and 46 (range: 14-200) placed restorations. Mean follow-up was 43 (range: 24-180) months. Secondary caries was a rare event; the majority of studies did not find any lesions. Network meta-analysis found great uncertainty. 3-step etch-and-rinse adhesives showed the lowest risk of secondary caries, 2-step etch-and-rinse the highest. For restorative materials, resin-modified glass ionomer showed the lowest risk of secondary caries. Most resin composites showed similar risks.

CONCLUSION

Data from randomized trials comparing different adhesive strategies or restorative materials are extremely scarce. The differences between materials were limited over the observational period of the included studies. The yielded rankings should be interpreted with caution.

CLINICAL SIGNIFICANCE

Despite often claimed to be a major complication of restorations, there is surprisingly little data on secondary caries from randomized trials. Longer-term studies may be needed to identify differences in secondary caries risk between materials.

Viscosity and thermal kinetics of 10 preheated restorative resin composites and effect of ultrasound energy on film thickness

OBJECTIVE

This study investigated viscosity and thermal kinetics of 10 selected preheated restorative resin composites and the effect of ultrasound energy on film thickness.

METHODS

A range of different resin composites was tested: Charisma Diamond, IPS Empress Direct, Enamel Plus HRi, Essentia, Estelite Omega, Filtek Z100, Filtek Z350 XT, Gradia, TPH Spectrum and VisCalor. A flowable resin composite (Opallis Flow) and two resin cements (RelyX Veneer, Variolink Esthetic LC) also were tested. Viscosity (Pa s) was measured at 37 °C and 69 °C (preheating temperature) using a rheometer. Film thickness (μm) was measured before and after application of ultrasound energy. Temperature loss within resin composite following preheating (°C/s) was monitored. Data were statistically analyzed (α = 0.05).

RESULTS

Viscosity at 69 °C was lower than at 37 °C for all materials except the flowable resin composite. Preheating reduced viscosity between 47% and 92% for the restorative resin composites, which were generally more viscous than the flowable materials. Film thickness varied largely among materials. All preheated resin composites had films thicker than 50 μm without ultrasound energy. Application of ultrasound reduced film thickness between 21% and 49%. Linear and nonlinear regressions did not identify any relationship between filler loading, viscosity, and/or film thickness. All materials showed quick temperature reduction following preheating, showing maximum temperature loss rates after approximately 10 s.

SIGNIFICANCE

Distinct restorative resin composites react differently to preheating, affecting viscosity and film thickness. The overall performance of the preheating technique depends on proper material selection and use of ultrasound energy for reducing film thickness.

Influence of Deep Margin Elevation and preparation design on the fracture strength of indirectly restored molars

The objectives of this in-vitro study were to investigate the influence of Deep Margin Elevation (DME) and the preparation design (cusp coverage) on the fracture strength and repairability of CAD/CAM manufactured lithium disilicate (LS₂) restorations on molars. Sound extracted human molars (n = 60) were randomly divided into 4 groups (n = 15) (inlay without DME (InoD); inlay with DME (IWD); onlay without DME (OnoD); onlay with DME (OnWD)). All samples were aged (1.2 × 10⁶ cycles of 50N, 8000 cycles of 5-55 °C) followed by oblique static loading until fracture. Fracture strength was measured in Newton and the fracture analysis was performed using a (scanning electron) microscope. Data was statistically analyzed using two-way ANOVA and contingency tables. DME did not affect the fracture strength of LS₂ restorations to a statistically significant level (p = .15). Onlays were stronger compared to inlays (p = .00). DME and preparation design did not interact (p = .97). However, onlays with DME were significantly stronger than inlays without DME (p = .00). More repairable fractures were observed among inlays (p = .00). Catastrophic, crown-root fractures were more prevalent in onlays (p = .00). DME did not influence repairability of fractures or fracture types to a statistically significant level (p > .05). Within the limitations of this in-vitro study, DME did not statistical significantly affect the fracture strength, nor the fracture type or repairability of LS₂ restorations in molars. Cusp coverage did increase the fracture strength. However, oblique forces necessary to fracture both inlays and onlays, either with or without DME, by far exceeded the bite forces that can be expected under physiological clinical conditions. Hence, both inlays and onlays are likely to be fracture resistant during clinical service.

The effect of artificial accelerated aging on the color stability, microhardness, and surface roughness of different dental laminate veneer materials

OBJECTIVE

This study aimed to evaluate the effect of artificial accelerated aging (AAA) on color stability, surface roughness, and microhardness of three laminate veneer (LV) materials.

MATERIALS AND METHODS

Specimens of ceramic LV (CLV-IPS E.max Press), hand-layered composite LV (hand-layered laminate veneer [HLV]-Tetric N-Ceram), and prefabricated composite LV (prefabricated laminate veneer [PLV]-Componeer Coltene) were prepared as discs (n = 10). CIE L*, a*, and b* color coordinates, the Vickers microhardness, and surface roughness were measured 24 hours after preparation and reevaluated after aging for 300 hours in an ultraviolet (UV)-AAA system (Ci35 Weather-Ometer). Color difference (CIEDE2000 [ΔE₀₀ ]) was calculated. Data were statistically analyzed with the Shapiro-Wilk test and the Kruskall-Wallis test followed by the Mann-Whitney U tests (α = .05).

RESULTS

All of the LV groups showed significant differences in ΔE₀₀ after AAA (P < .001). Comparing the color changes of the HLVs with the PLVs, no significant difference could be found (P = .705). There was a statistically significant difference in the means of changes in microhardness among the LVs materials (P < .001). The changes in surface roughness results showed a significant difference after AAA in all the LVs (P < .001).

CONCLUSIONS

Within the limitations of this in vitro study, the color stability, the microhardness, and surface roughness of tested LVs were influenced by AAA.

CLINICAL SIGNIFICANCE

The prefabricated composite LV system does not replace the individualized ceramic LV technique, but rather offers an alternative to hand-layered LVs, which is delicate and time-consuming technique.

Conservative Esthetic Approach of Anterior Teeth Using Minimal Intervention and Preservation of all Sound Tooth Tissue: a Case Report

AbstractThis clinical case report describes a conservative approach to a smile harmony rehabilitation performing a gingivoplasty, dental bleaching and resin-based composites to finalize the case. This clinical article describes the case report of a patient in need of an esthetic and corrective solution for the anterior teeth, which presented a disharmonic smile, in its shape and color, besides the gingival smile. As a result, gingivoplasty, dental bleaching and restoration with composite resin were done. Gingivoplasty with bone preservation was possible because there was a large volume of soft tissue, and a distance ≥ 2 mm from the bone crest to the junction cementum enamel was confirmed. Bleaching was performed with the use of associated techniques: office (Whiteness HP 35%) and supervised at-home (Whiteness Perfect 10%) bleaching were performed, and then the "buccolingual technique" using a nanocomposite resin IPS was used from a diagnostic wax-up to perform the restorative procedure for the anterior teeth. The use of minimally invasive techniques is an effective alternative for the  anterior teeth rehabilitation. As in this case, the gingivoplasty, dental bleaching with associated techniques, and restorations with nanocomposites allowed satisfactory esthetic results, even more so in relation to dental preservation, mainly in young patients. Keywords: Tooth Bleaching. Gingivoplasty. Esthetic. Dental RestorationAbstractThis clinical case report describes a conservative approach to a smile harmony rehabilitation performing a gingivoplasty, dental bleaching and resin-based composites to finalize the case. This clinical article describes the case report of a patient in need of an esthetic and corrective solution for the anterior teeth, which presented a disharmonic smile, in its shape and color, besides the gingival smile. As a result, gingivoplasty, dental bleaching and restoration with composite resin were done. Gingivoplasty with bone preservation was possible because there was a large volume of soft tissue, and a distance ≥ 2 mm from the bone crest to the junction cementum enamel was confirmed. Bleaching was performed with the use of associated techniques: office (Whiteness HP 35%) and supervised at-home (Whiteness Perfect 10%) bleaching were performed, and then the "buccolingual technique" using a nanocomposite resin IPS was used from a diagnostic wax-up to perform the restorative procedure for the anterior teeth. The use of minimally invasive techniques is an effective alternative for the  anterior teeth rehabilitation. As in this case, the gingivoplasty, dental bleaching with associated techniques, and restorations with nanocomposites allowed satisfactory esthetic results, even more so in relation to dental preservation, mainly in young patients. Keywords: Tooth Bleaching. Gingivoplasty. Esthetic. Dental Restoration

Investigations on the adhesion of new composites for restoring cervical lesions using energy dispersive X-ray analysis and scanning electron microscopy

Restoration of noncarious cervical lesions with resin composites is one of the treatment options, but the retention of the restorations located at the crown-root junction is still a cause of clinical concern. The aim of this study was to evaluate the adhesive properties of three experimental resin composites and two commercial materials used to restore cavities prepared on extracted teeth as well as to determine the relative elemental composition of these materials. We tested the null hypothesis, which considered that the adhesive behaviours of different resin composites did not differ. The microleakage test using tracers showed that all tested materials exhibited some degree of dentinal microleakage, although they all had good dentinal adhesion. The results failed to reject the null hypothesis. The scanning electron microscopy revealed completely adapted adhesive interfaces underneath the restorations along with well-developed hybrid layers depending on the adhesive system. Energy dispersive X-ray analysis analyses showed that the restorative materials have similar chemical compositions, with some differences between the samples from the same material. The results support the implementation of experimental resins in clinical settings.

Clinical and histological reaction of periodontal tissues to subgingival resin composite restorations

OBJECTIVES

To compare the clinical and histological response of supracrestal periodontal tissues to subgingival composite restorations versus natural root surfaces MATERIAL AND METHODS: In 29 subjects with a single tooth requiring subgingival restorations, a deep margin elevation (DME) procedure with composite resin was applied. Full-mouth plaque score (FMPS), full-mouth bleeding score (FMBS), and focal probing depth (PD) were measured at baseline, before DME, and after 3 months. The distance between the coronal marked (CM) point to the apical margin of the composite reconstruction (AMR), at baseline, and to the tip of the periodontal probe inserted to reach the bottom of the sulcus (APP), 3 months later, was measured. An all-around secondary flap, harvested to ensure the subsequent single-crown prosthetic rehabilitation was histologically processed. The histological inflammation degree was evaluated in areas of gingival tissues adjacent to the composite (group B) and adjacent to the natural surface of each single tooth (group A).

RESULTS

Significant FMPS, FMBS, and PD decreases were observed (p < 0.05). CM-AMR and CM-APP were significantly different (p < 0.05), suggesting an attachment gain after 3-months. The inflammation level of gingival tissue was similar in groups A and B (p > 0.05).

CONCLUSIONS

For the first time, this topic was clinically and histologically studied in humans. Subgingival restorations resulted compatible with gingival health, with levels similar to that of untreated root surfaces.

CLINICAL RELEVANCE

Deep margin elevation procedure produces favorable clinical and histological outcomes allowing a routine utilization in reconstructive dentistry.

Ultra-high-speed videography of resin-dentin interface failure dynamics under tensile load

OBJECTIVES

Ultra-high-speed (UHS) videography was used to visualize the fracture phenomena at the resin-dentin interface during micro-tensile bond strength (μTBS) test. We also investigated whether UHS videography is applicable for failure-mode analysis.

METHODS

Ten human mid-coronal dentin surfaces were bonded using Clearfil SE Bond either in self-etching (SE) or etch-and-rinse (ER) mode. After 24-h water storage, the samples were cut into beams for μTBS test and tested at a cross-head speed of 1 mm/min. The fracture phenomena at the bonded interface were captured using a complementary metal-oxide-semiconductor digital UHS camera at 299,166 frames per second. The failure modes were classified using UHS videography, followed by scanning electron microscopy (SEM) analysis. The failure-mode distributions determined by UHS videography and SEM analysis were statistically analyzed using Fisher's exact test with Bonferroni correction.

RESULTS

The crack-propagation speed exceeded 1,500 km/h. No significant difference was found between the SEM and UHS videography failure-mode distributions in the SE mode. A significant difference appeared between them in the ER mode. Significant differences in the incidence of cohesive failures within the adhesive and at the adhesive-composite interface between the SE and ER modes were identified by both SEM and UHS videography.

SIGNIFICANCE

UHS videography enabled visualization of the fracture dynamics at the resin- dentin interfaces under tensile load. However, the resolution at such high frame rate was insufficient to classify the failure mode as precisely as that of SEM. Nevertheless, UHS videography can provide more detailed information about the fracture origin and propagation.

Wear of dental materials: Clinical significance and laboratory wear simulation methods -A review

This review focusses on tribological aspects of teeth during function, the clinical significance of wear, wear of natural teeth and restorative materials and laboratory methods to simulate wear of restorative materials. Ceramic, metal alloy and amalgam show low material wear, whereas resin-based materials demonstrate substantial wear in the long term. The clinical wear shows a high variability with the patient factor accounts for about 50% of the variability. Wear as such seldomly compromises the function of the stomatognath system or individual teeth and is in most cases an esthetic problem. Particles that are ingested due to attrition and abrasion wear may pose a health risk to the patient, especially those from composite resin materials. However, systematic clinical studies on that issue are not available. For laboratory research many wear simulation devices and methods have been developed but only few are validated and have a moderate correlation with clinical wear.

Prefabricated resin veneer: A case report of a simplified restorative technique

Background: the aim of the study was to describe the step-by-step of clinical cases using prefabricated composite resin veneers (PCRVs), manufactured with the composite Brilliant New Generation (Coltene, Altstätten, Switzerland). Direct composite veneers presented some drawback as the difficult of execution and color instability of the composite over the time. The simplified application of the PCRVs presented as an interesting alternative in cases of smile asymmetry, large deficient restorations and discolored tooth. In the present investigation, the complete description of the PCRVs technique can help the dentist during the planning and execution of treatments with the Componeer system.

Conclusion: the treatment with Componeer Brilliant NG showed excellent aesthetic results. PCRVs technique is simpler than direct composite veneers. The specific characteristics of the system can promote results with greater aesthetic longevity. It is important to highlight that this procedure does not replace the already established veneer technique with dental ceramics.

Clinical implication: PCRVs presented an excellent surface gloss. Their dimensions based on the golden ratio facilitate the technique and turns as an excellent alternative in the aesthetic restorative treatment in the anterior region.

Gingival tissue reaction to direct adhesive restoration: A preliminary study

INTRODUCTION

It is debated whether composite resin marginal/submarginal direct restoration can be usefully performed without inflammatory consequences. This histological study is the first human analysis aimed to compare, in the same tooth, the gingival tissue close to composite resin restorations with gingival tissue close to hard tissue.

METHODS

Eight healthy patients with almost a residual strategic tooth needing endodontic therapy, and post-and-core restoration, then indirect prosthetic restoration, were selected. Direct margin relocation with composite resin was necessary to perform endodontic treatment. The crown lengthening with a secondary flap harvested was necessary to perform prosthetic rehabilitation. Three months after marginal relocation, the secondary flap was harvested, embedded in PMMA, 4-μm sectioned, and stained to analyze the inflammation degree.

RESULTS

All patients completed post-and-core reconstruction and the planned prosthetic therapy, maintaining the stringent hygienic protocol plan. The inflammation level comparison, slightly lower in gingiva close to the teeth (3.62 ± 0.38) than in gingiva close to the composite (3.75 ± 0.26), results in a p-value of 0.11 after Wilcoxon test.

CONCLUSIONS

Results highlight a minimal, statistically not significant difference in the inflammation degree after margin relocation, conceivably due to patients, teeth and cases selection, together with adopted stringent methodological and supportive measures.

Five-year Clinical Evaluation of a Nanofilled and a Nanohybrid Composite in Class IV Cavities

The purpose of this study was to evaluate a nanofilled and a nanohybrid composite, in combination with manufacturer-recommended etch-and-rinse adhesives, in class IV cavities. Thirty-four patients aged 14-46 years (mean age, 27.1 years) comprised the study group. Twenty-six patients received two class IV restorations and eight patients received four class IV restorations. For each patient, half the number of restorations were performed using a nanohybrid composite (Ceram X duo) and the remaining half used a nanofilled resin composite (Filtek Supreme XT), with two- (XP Bond) and three-step (Scotchbond Multipurpose) etch-and-rinse adhesives, respectively. Two experienced examiners evaluated the restorations for retention, color match, marginal discoloration, wear/loss of anatomic form, caries formation, marginal adaptation, and surface texture to compare the baseline (after placement) and annual recalls over 5 years. The cumulative success rates for the Filtek Supreme XT and Ceram X duo restorations after five years were 86.2% and 89.7%, respectively. Four Filtek Supreme XT and three Ceram X duo restorations failed. There was no statistically significant difference between the nanofilled and nanohybrid composites at any of the evaluation periods for any of the parameters evaluated. Despite the limited number of restorations, all restorations were clinically acceptable regarding retention, color match, marginal discoloration, wear or loss of anatomic form, the formation of caries, marginal adaptation, and surface texture, except the failed restorations. Fracture was the main cause of restoration failure.

Direct restoration of endodontically treated maxillary central incisors: post or no post at all?

OBJECTIVES

The aim of this ex-vivo study was to evaluate the impact of cavity size and glass-fiber post (GFP) placement on the load capability of endodontically treated maxillary incisors directly restored with resin composite.

MATERIALS AND METHODS

Ninety-six extracted human maxillary central incisors were endodontically treated and distributed to four groups (n = 24): access cavity (A), access cavity and uni-proximal class III cavity (U), access cavity and bi-proximal class III cavity (B), and decoronated tooth (D). Specimens were restored with resin composite, and 12 specimen of each group received an adhesively placed glass-fiber post (P). Prior to linear loading, specimens were exposed to thermo-mechanical loading (TCML). Statistical analysis was performed using log-rank test after TCML, Kruskall-Wallis and Mann-Whitney U test to compare load capabilities (F_max).

RESULTS

Significantly more failures occurred in group D for specimens without GFP during TCML (p = 0.001). F_max (mean (SD) in N was (A) 513 (124), (AP) 554 (201), (U) 438 (171), (UP) 537 (232) (B) 483 (219), (BP) 536 (281), D 143 (181), and DP 500 (331), and differed significantly among groups (p = 0.003). Pair-wise comparison revealed lower F_max values for group D compared to all other groups (p < 0.034) except group DP.

CONCLUSIONS

Endodontically treated maxillary central incisors with cavity sizes up to bi-proximal class III may be successfully directly restored with resin composite. Post placement shows no additional effect except for decoronated endodontically treated incisors.

CLINICAL RELEVANCE

Endodontically treated incisors with access cavities to class III cavities can be successfully restored with resin composite. Post placement for decoronated ETT is recommended.

The impact of crown fracture in the permanent dentition on children's quality of life

BACKGROUND/AIM

Among the diseases related to oral health, traumatic dental injuries (TDI) can lead to pain, loss of function and aesthetic problems, with physical, emotional and social consequences for children and their families. The aim of this study was to investigate the relationship between enamel fracture and enamel-dentin fracture with oral health-related quality of life (OHRQoL).

MATERIAL AND METHODS

This cross-sectional study had a representative sample of 1589 children between 8-10 years of age from public schools. The OHRQoL was obtained through the Child Perceptions Questionnaire (CPQ_8-10 ), which is a questionnaire validated for Brazilian children. Clinical data were collected by 4 calibrated examiners (Kappa > 0.7) using the Decay, Missing, Filled Teeth (DMFT) Index, Dental Aesthetic Index (DAI) and TDI. A socio-economic questionnaire was sent to the caregivers to be answered at home. Descriptive statistics and Poisson regression with prevalence ratio (PR) and 95% confidence interval (CI) were used for statistical analysis.

RESULTS

The prevalence of TDI was 10.6%, and among these 10.3% who had an impact on the OHRQoL, it was due to enamel-dentin fracture. Children with enamel-dentin fracture had (PR 1.35; 95% CI 1.07-1.70) higher prevalence of impact on the OHRQoL. Children with enamel fracture had no impact on the OHRQoL (P = .254).

CONCLUSION

Enamel fracture had no significant impact on children's quality of life, while enamel-dentin fracture did have an impact on quality of life.

Restorations in primary teeth: a systematic review on survival and reasons for failures

BACKGROUND

Several restorative materials with specific indications are used for filling cavities in primary teeth.

AIM

To systematically review the literature in order to investigate the longevity of primary teeth restorations and the reasons for failure.

DESIGN

Electronic databases were screened, and eligible studies were hand-searched to find longitudinal clinical studies evaluating the survival of restorations (class I, class II, and crown) placed with different materials in primary teeth with at least one year of follow-up.

RESULTS

Thirty-one studies were included, and a high bias risk was observed. Overall, 12,047 restorations were evaluated with 12.5% of failure rate. A high variation on annual failure rate (AFR) was detected (0-29.9%). Composite resin showed the lowest AFRs (1.7-12.9%). Stainless steel crowns (SSC) had the highest success rate (96.1%). Class I restorations and restorations placed using rubber dam presented better AFR. The main reason for failure observed was secondary caries (36.5%).

CONCLUSIONS

An elevated number of failures were observed due to recurrent caries, highlighting the need for professionals to work with a health-promoting approach. The high variation on failure rate among the materials can be due to children's behavior during the procedure, which demands short dental appointments and a controlled environment.