Four-year clinical evaluation of Class II nano-hybrid resin composite restorations bonded with a one-step self-etch and a two-step etch-and-rinse adhesive

Factors influencing the longevity of posterior composite restorations: A dental university clinic study

Objectives

This retrospective study aimed to assess the performance of posterior composite resin restorations (PCRRs) and evaluate the influence of patient-specific factors on restoration outcomes.

Methods

A total of 189 PCRRs were examined in 54 patients, with evaluations based on Modified USPHS criteria. Patient-specific factors were analyzed. Statistical analyses, including chi-square tests, independent samples t-tests, and ANOVA tests, were conducted.

Results

Patients aged over 50 exhibited higher DMFT averages and a higher rate of unsuccessful restorations. Despite higher DMFT scores in females, gender doesn't significantly impact restoration outcomes. Secondary caries correlated with.plaque scores, significantly affecting restoration survival. Marginal adaptation, retention deficiencies, and secondary caries were primary causes of failure. Multi-surface restorations faced higher failure risk due to elevated plaque scores. Class-V restorations showed a higher failure rate, challenging the number of surfaces and longevity correlation.

Conclusions

This study identified key factors influencing posterior composite resin restorations-(PCRRs) in patients over 50, including higher DMFT averages and more unsuccessful restorations. No significant difference was found between brushing; frequency and DMFT rates, possibly due to the absence of non-brushers. Secondary caries; correlated with elevated plaque scores, impacting restoration survival. Primary causes of; failure included marginal adaptation issues, retention deficiencies, and secondary caries, with multi-surface restorations facing a higher risk. However, tooth vitality, beverage and acidic food consumption, and oral hygiene habits did not significantly affect PCRR outcomes.

Clinical significance

Patient-specific factors significantly impact PCRRs' long-term performance. Dentists must tailor strategies, emphasizing regular monitoring and preventive measures for extended survival.

Clinical comparison of different glass ionomer-based restoratives and a bulk-fill resin composite in Class I cavities: A 48-month randomized split-mouth controlled trial

OBJECTIVE

The aim of this study is to compare the retention rates (primary outcome) of high-viscosity glass ionomer (GI), glass carbomer (GC), zirconia-reinforced GI (ZIR), and bulk-fill (BF) composite resin restorations. Secondary outcomes included anatomical form, marginal adaptation, marginal discoloration, color match, surface texture, post-operative sensitivity and secondary caries.

METHODS

Two calibrated operators placed 128 restorations in 30 patients with a mean age of 21 years. The restorations were evaluated by one examiner at baseline and at 6, 12, 18, 24, and 48 months using the modified US Public Health Service criteria. The data were statistically analyzed using Friedman test. Differences between restorations were analyzed using Kruskal-Wallis test.

RESULTS

After 48 months, 23 patients and 97 restorations (23 GI, 25 GC, 24 ZIR, and 25 BF) were evaluated. Patient recall rate was 77%. No significant difference was observed between the retention rates of the restorations (p > 0.05). GC showed significantly lower results than the other three fillings in terms of anatomical form (p < 0.05). There was no significant difference in the anatomical form and retention between GI, ZIR, and BF (p > 0.05). No significant change was observed in the postoperative sensitivity or secondary caries for any of the restorations (p > 0.05).

CONCLUSIONS

GC restorations showed statistically lower anatomical form values, indicating lower wear resistance than the other materials. However, no significant difference was observed in the retention rates (as primary outcome) as well as the other secondary outcomes of the four different restorative materials after 48 months.

CLINICAL SIGNIFICANCE

GI-based restorative materials and BF composite resin restorations in Class I cavities yielded satisfactory clinical performance after 48 months.

Comparison of Self-Etching Adhesives and Etch-and-Rinse Adhesives on the Failure Rate of Posterior Composite Resin Restorations: A Systematic Review and Meta-Analysis

The aim of this study was to perform a systematic review with meta-analysis on the comparison of self-etching adhesives and etch-and-rinse adhesives with respect to the failure rate of posterior composite resin restorations. The study protocol was registered in PROSPERO (CRD42017078015), following PRISMA recommendations and PICO search strategy. Literature search was performed in the following databases: MEDLINE, ISI Web of Science, LILACS, SCOPUS, and Cochrane Library through July 2021. Six studies from five randomized clinical trials were included in the qualitative synthesis. The funnel plot detected important bias (all studies out of the funnel area). The meta-analysis showed a positive summary Cohen H effect size of 0.406 (95% CI: 0.100; 0.713, p = 0.009), favoring etch-and-rinse adhesives. The total number of failures (including restorations that required replacement and those that did not require replacement) were attributed to either marginal adaptation (five studies) or marginal staining (one study). A very low certainty of the evidence was obtained through GRADE analysis. In conclusion, current available evidence indicates that etch-and rinse adhesives performed better (with a low effect size) than self-etching adhesives in terms of failure rates in posterior composite restorations.

Compliance of randomized controlled trials in posterior restorations with the CONSORT statement: a systematic review of methodology

OBJECTIVES

This study aims to investigate the compliance of randomized controlled trials (RCTs) in posterior restorations with the Consolidated Standards of Reporting Trials Statement (CONSORT) statement and to analyze the risk of bias (RoB) of these studies.

METHODS

A systematic search was performed in PubMed, Scopus, Web of Science, LILACS/BBO, and Cochrane Library. Only RCTs published in peer-reviewed journals were included. The compliance with the CONSORT was evaluated in a 0-2 scale where 0 = no description, 1 = poor description and 2 = adequate description. Descriptive analyses of the CONSORT mean score by journal, country, and RoB were performed. The RoB in RCTs was evaluated by using the Cochrane Collaboration's tool version 1.0.

RESULTS

A total of 15,476 studies were identified after duplicates removal. O only 202 meet the eligibility criteria, among which 31 were follow-up studies. Concerning the overall RoB, only 29 out of 171 were classified as low risk of bias. The overall mean CONSORT score was 19 ± 5.4 points, which means compliance of approximately 59%. Significant differences among countries, publication period, and RoB were observed (p < 0.001). The journal's impact factor was not correlated with the overall CONSORT score (p = 0.36).

CONCLUSIONS

The adherence of RCTs conducted in posterior restorations to the CONSORT Statement is still low. In addition, most studies were classified as at unclear risk of bias. These results call up an urgent need for improvement.

CLINICAL RELEVANCE

Most RCTs conducted in posterior teeth have poor reporting and are mainly classified as having an unclear risk of bias.

Adhesive dentistry: Current concepts and clinical considerations

OBJECTIVES

To address contemporary concepts in adhesive dental materials with emphasis on the evidence behind their clinical use.

OVERVIEW

Adhesive dentistry has undergone major transformations within the last 20 years. New dental adhesives and composite resins have been launched with special focus on their user-friendliness by reducing the number of components and/or clinical steps. The latest examples are universal adhesives and universal composite resins. While clinicians prefer multipurpose materials with shorter application times, the simplification of clinical procedures does not always result in the best clinical outcomes. This review summarizes the current evidence on adhesive restorative materials with focus on universal adhesives and universal composite resins.

CONCLUSIONS

(a) Although the clinical behavior of universal adhesives has exceeded expectations, dentists still need to etch enamel to achieve durable restorations; (b) there is no clinical evidence to back some of the popular adjunct techniques used with dental adhesives, including glutaraldehyde-based desensitizers and matrix metalloproteinase inhibitors; and (c) the color adaptation potential of new universal composite resins has simplified their clinical application by combining multiple shades without using different translucencies of the same shade.

CLINICAL SIGNIFICANCE

New adhesive restorative materials are easier to use than their predecessors, while providing excellent clinical outcomes without compromising the esthetic quality of the restorations.

Clinical Efficiency of Self-etching One-Step and Two-Step Adhesives in NCCL: A Systematic Review and Meta-analysis

CLINICAL RELEVANCE

One-step self-etch adhesive systems provide a clinical time gain, decreasing the number of clinical steps. When a clinician is able to follow a simpler process of adhesion there is less chance of adhesive failure.

SUMMARY

Objective: A systematic review and meta-analyses were performed to evaluate whether one-step self-etching (1SSE) adhesive systems are as effective as two-step self-etching (2SSE) adhesives in noncarious cervical lesion (NCCL) restorations.Methods: This systematic review was conducted according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and recorded in the PROSPERO (CRD42018096747). Electronic systematic searches were conducted in the following databases: PubMed/MEDLINE, Scopus, and Cochrane Library for published articles. Only randomized clinical trials that compared 1SSE with 2SSE adhesives systems were selected. The outcomes were retention, postoperative sensitivity, secondary caries, color match, marginal discoloration, marginal adaptation, and anatomical form.Results: The searches resulted in 476 studies. After applying the eligibility criteria, five randomized controlled trials were selected in which 822 restorations in NCCLs were distributed in 237 patients. The results showed no statistical difference between 1SSE and 2SSE in relation to retention (p=0.23; relative risk [RR]=1.55; 95% confidence interval [CI]=0.76, 3.19), postoperative sensitivity ( p=0.50; RR=3.00; 95% CI=0.13, 70.64), Secondary caries (p=0.63; RR=0.68; 95% CI=0.14, 3.31), color match (p=0.41; RR=0.64; 95% CI=0.23, 1.83), marginal discoloration (p=0.93; RR=1.02; 95% CI=0.65, 1.61), and anatomical form (p=0.56; RR=1.38; 95% CI=0.46, 4.13). However there was statistical difference in relation to marginal adaptation ( p=0.01; RR=1.95; 95% CI=1.14, 3.34).Conclusion: This systematic review with meta-analysis revealed that both 1SSE and 2SSE adhesive systems have comparable clinical effectiveness in a follow-up period of 12 to 24 months, except in relation to marginal adaptation.

The differences between three performance measures on dental restorations, clinical success, survival and failure: A matter of perspective

OBJECTIVES

The aim of this retrospective methodology study was to investigate the influence of using different definitions for restoration failure and inclusion criteria on restoration longevity expressed in AFR.

METHODS

EPF from fifteen general dental practices were used for collecting the data for this study. From the EPF, 321,749 composite restorations placed in 52,245 patients by forty-seven GDPs between January 2000 and December 2011 were included. Kaplan-Meier statistics were applied and mean AFRs over 2, 5 and 10 years were calculated. The effect on the AFR of using different levels of failure: based on Claims data (CD), Success (SUC), Survival (SUR) and different inclusion criteria of tooth/restoration variables were reported.

RESULTS

Highest AFRs were found for level CD, in which every intervention was considered as failure, and the lowest AFRs for level SUR in which repairs and an endodontic treatments were not considered as a failure. AFRs increased when the observation period prolonged especially for SUR, followed by SUC and CD. An overview of long-term survival studies showed a wide variation in study design, performed clinical examination (USPHS criteria or GDP), number of restorations included, description of restoration failure and found AFRs for CD, SUC and SUR.

SIGNIFICANCE

Using failure criteria, Success and Survival, in future clinical studies would enable a better comparison of studies as well as demonstrate the impact of more conservative restorative intervention protocols on patient care.

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

A randomized controlled evaluation of posterior resin restorations of an altered resin modified glass-ionomer cement with claimed bioactivity

OBJECTIVE

The objective of this randomized controlled prospective clinical trial was to evaluate the short time clinical behaviour of an altered resin modified glass-ionomer cement (RMGIC), which is claimed to possess bioactivity, in posterior restorations and to compare it intraindividually with a nanofilled resin composite.

METHODS

Totally 78 pairs Class II and 4 pairs Class I restorations were placed in 29 female and 38 male participants with a mean age of 58.3 years (range 37-86). Each patient received at random at least one pair of, as similar as possible, Class II or Class I restorations. In the first cavity of each pair, the modified flowable RMGIC (ACTIVA Bioactive; AB) was placed after phosphoric acid etching of the cavity and without adhesive, according to the instructions of the manufacturer. In the other cavity a well established nanofilled resin composite (CeramX; RC) with a single step self-etch adhesive (Xeno Select) was placed. The restorations were evaluated using slightly modified USPHS criteria at baseline, 6 and 12 months. Caries risk and parafunctional habits of the participants were estimated.

RESULTS

158 restorations, 8 Class I and 150 Class II, were evaluated at the one year recalls. At baseline two failed restorations were observed (2AB), at 6 months six failures (5AB, 1RC) and at 12 months another thirteen failed restorations were observed (12AB, 1RC). This resulted in annual failure rates of 24.1% for the AB and 2.5% for RC (p<0.0001). The main reasons for failure for AB were lost restorations (5), postoperative symptoms (4) and secondary caries (3). Do to the unacceptable very high one-year failure frequency, the clinical study was stopped and no further evaluation will be performed.

SIGNIFICANCE

The use of the AB restorative in Class II cavities, applied as instructed by the manufacturer after a short phosphoric acid pretreatment but without adhesive system, resulted in a non-acceptable very high failure frequency after a one year period. Further studies should be conducted using a bonding agent.

Four-year outcomes of restored posterior tooth surfaces-a massive data analysis

OBJECTIVES

There is only sparse knowledge concerning the outcomes of treatments with posterior permanent restorations in general practice settings. This study aimed at evaluating outcomes based on a large dataset by using a novel approach on a tooth surface basis.

MATERIALS AND METHODS

The study based on routine data from a major German national health insurance company. Respective treatment fee codes allowed for tracking the clinical courses on a tooth surface level. The study intervention was defined as the placement of a restoration on an interproximal or occlusal posterior tooth surface regardless of its actual extension and material on which no information was available. All surfaces restored between January 1st, 2010 and December 31st, 2013 were included. Kaplan-Meier survival analyses were conducted to estimate four-year survival. The primary outcome was a restorative re-intervention on the same tooth surface. Separate analyses were performed for the secondary outcomes "crowning" and "extraction".

RESULTS

Over ten million interproximal surfaces and eight million occlusal surfaces in nine million posterior teeth had been restored. At 4 years, the cumulative survival rates concerning the primary outcome "re-intervention" for mesial surfaces (81.4%; CI 81.3-81.5%) and distal surfaces (81.2%; CI 81.1-81.2%) differed significantly from those for occlusal surfaces (77.0%; CI 76.9-77.0%). Restored surfaces in premolars showed significantly higher survival rates compared to molars. Four-year survival rates for the secondary outcome "crowning" were 91.9% (CI 91.8-91.9%) for mesial surfaces, 92.1% (CI 92.1-92.2%) for distal surfaces and 93.3% (CI 93.2-93.3%) for occlusal surfaces. The respective rates for the secondary outcome "extraction" were 94.5% (CI 94.5-94.5%) for mesial surfaces, 94.8% (CI 94.7-94.8%) for distal surfaces and 95.4% (CI 95.4-95.5%) for occlusal surfaces.

CONCLUSIONS

Re-interventions after restorative treatment play a significant role in general practice settings. Surface-related survival rates of restorations reveal a need for improvement.

CLINICAL RELEVANCE

This study allows the estimation of the probability of re-interventions after restoring posterior tooth surfaces. It is based on several million cases from general practises under the terms and conditions of a national health insurance system.

Does the adhesive strategy influence the post-operative sensitivity in adult patients with posterior resin composite restorations?: A systematic review and meta-analysis

OBJECTIVES

A systematic review and meta-analysis were performed on the risk and intensity of postoperative sensitivity (POS) in posterior resin composite restorations bonded with self-etch (SE) and etch-and-rinse (ER) adhesives.

SOURCE

A comprehensive search was performed in the MEDLINE via PubMeb, Scopus, Web of Science, LILACS, BBO and Cochrane Library and SIGLE without restrictions. The abstracts of the annual conference of the IADR (1990-2014), unpublished and ongoing trials registry were also searched. Dissertations and theses were searched using the ProQuest Dissertations and Periodicos Capes Theses databases.

STUDY SELECTION

We included randomized clinical trials that compared the clinical effectiveness of SE and ER used for direct resin composite restorations in permanent dentition of adult patients. The risk/intensity of POS was the primary outcome. The risk of bias tool of the Cochrane Collaboration was used. The meta-analysis was performed on the studies considered 'low' risk of bias.

DATA

After duplicates removal, 2600 articles were identified but only 29 remained in the qualitative synthesis. Five were considered to be 'high' risk of bias and eleven were considered to be 'unclear' in the key domains, yielding 13 studies for meta-analysis. The overall relative risk of the spontaneous POS was 0.63 (95% CI 0.35 to 1.15), while the stimuli-induced POS was 0.99 (95% CI 0.63 to 1.56). The overall standardized mean difference was 0.08 (95%CI -0.19 to 0.35). No overall effect was revealed in the meta-analyses, meaning that no influence of the ER or SE strategy on POS.

SIGNIFICANCE

The type of adhesive strategy (ER or SE) for posterior resin composite restorations does not influence the risk and intensity of POS. CRD42014006617.

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

Objective

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

Methods

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

Results

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

Conclusions

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

Ultramorphological assessment of dentin-resin interface after use of simplified adhesives

This study assessed dentin-resin interface integration in Class I cavities restored with simplified adhesives by using a focused ion-beam milling (FIB) and transmission electron microscope (TEM). Class I cavities (1.5-mm depth with dentin thickness of ∼0.5 mm, 4-mm length, and 2-mm width) were prepared on freshly extracted, sound human molars. Two all-in-one adhesive systems (Scotchbond/Single Bond Universal [SUD] and Xeno-V(+) [X5D]) were used and compared with a two-step etch-and-rinse system (Prime&Bond NT [NTD]). The adhesives were applied according to the manufacturers' guidelines. A universal resin composite (Filtek Z350 XT Universal) was used to restore the cavities in one bulk filling and was irradiated at 550 mW/cm(2) for 40 seconds by a quartz-tungsten-halogen light (Optilux 501). After exposure to liquid nitrogen coolant, the specimens were milled to nanoscale thickness by FIB to view and then assess the area of dentin-resin interface by TEM. Unlike the unfilled X5D, a noticeably smooth transition zone at the dentin-resin interface was shown for the SUD and NTD adhesives. The SUD demonstrated an uneven hybrid layer with clearly demineralized collagen bundles. Ultramorphologically, dispersed needlelike apatite crystals were detected within the partially demineralized dentin or the hybrid layer of both compositionally different all-in-one simplified adhesives. Conversely, these crystals were entirely absent from the hybrid layer of the etch-and-rinse NTD adhesive. In the X5D group, a bright band was noted beneath the hybrid layer. The methacryloxydecyl dihydrogen phosphate monomer containing ultramild self-etch adhesive (SUD) was still validated in terms of its capability in dentin adhesion.

Resin composite class I restorations: a 54-month randomized clinical trial

The objective of this longitudinal clinical randomized trial was to evaluate the clinical performance of a nanofilled and a nanohybrid resin composite in Class I occlusal restorations of posterior teeth over the course of 54 months. Forty-one adolescents participated in the study. The teeth were restored with Adper Single Bond 2 (3M ESPE) and nanofilled (Filtek Z350, 3M ESPE), nanohybrid (Esthet-X, Dentsply) and microhybrid Filtek Z250 (3M ESPE) used as a control. After 54 months, the restorations were evaluated in accordance with the modified United States Public Health Service criteria. The McNemar and Friedman tests were used for statistical analysis, at a level of significance of 5%. Five failed restorations were observed during the follow-up. A change to unacceptable restoration occurred for one Esthet-X, two Filtek Z350, and two Filtek Z250 restorations, which received the clinically unacceptable score, Charlie, for both anatomic form and marginal adaptation. Secondary caries and postoperative sensitivity occurred in one Filtek Z250 and one Filtek Z350 restoration. When the five evaluation periods (baseline and six, 12, 30, and 54 months) were compared, significant differences were found in the marginal adaptation of Filtek Z250 and Filtek Z350. Significant differences in the roughness criteria (p=0.005) were also observed when the three composites were compared after 54 months (Filtek Z350 > Filtek Z250 > Esthet-X), always within clinically acceptable limits. The materials investigated showed acceptable clinical performance for Class I restoration after 54 months. Long-term reevaluations are necessary for a more detailed analysis of these composites.

Longevity of posterior composite restorations: a systematic review and meta-analysis

The aim of this meta-analysis, based on individual participant data from several studies, was to investigate the influence of patient-, materials-, and tooth-related variables on the survival of posterior resin composite restorations. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a search resulting in 12 longitudinal studies of direct posterior resin composite restorations with at least 5 years' follow-up. Original datasets were still available, including placement/failure/censoring of restorations, restored surfaces, materials used, reasons for clinical failure, and caries-risk status. A database including all restorations was constructed, and a multivariate Cox regression method was used to analyze variables of interest [patient (age; gender; caries-risk status), jaw (upper; lower), number of restored surfaces, resin composite and adhesive materials, and use of glass-ionomer cement as base/liner (present or absent)]. The hazard ratios with respective 95% confidence intervals were determined, and annual failure rates were calculated for subgroups. Of all restorations, 2,816 (2,585 Class II and 231 Class I) were included in the analysis, of which 569 failed during the observation period. Main reasons for failure were caries and fracture. The regression analyses showed a significantly higher risk of failure for restorations in high-caries-risk individuals and those with a higher number of restored surfaces.

Two-Year Clinical Performance of a Low-Shrinkage Composite in Posterior Restorations

Objectives

The aim of this study was to compare the two-year clinical performance of three restorative systems in posterior restorations, which included a low-shrinkage composite and both etch-and-rinse and self-etch adhesive strategies.

Materials and Methods

After signing an informed consent, 25 patients received three Class I (occlusal) or Class II restorations performed with one of three restorative systems: Filtek Silorane Restorative System, Adper Scotchbond 1 XT (a two-step etch-and-rinse adhesive) with Filtek Z250, and Adper Scotchbond SE (a two-step self-etch adhesive) with Filtek Z250. All materials were applied following the manufacturer's instructions. Two blind observers evaluated the restorations at three different moments (baseline; and after one and two years) according to the US Public Health Service modified criteria. Kruskal-Wallis test and Mann-Whitney U-test were used to compare the behavior of the restorative systems, while Friedman and Wilcoxon tests were applied to analyze the intra-system data (p&lt;0.05).

Results

The three restorative systems showed a statistically similar clinical performance at two years. Intra-system comparisons between baseline and two years showed declining marginal adaptation scores in the restorations placed with all systems. In addition, marginal staining and surface roughness scores were lower after two years for the restorations placed with Adper Scotchbond SE + Filtek Z250.

Conclusions

Although the clinical performance of Filtek Silorane was considered acceptable after two years, no advantage of the silorane-based resin over the methacrylate-based composite was found. Teeth restored with Adper Scotchbond SE showed a tendency for marginal staining, which may compromise the final color of the restorations.

A 6-year prospective evaluation of a one-step HEMA-free self-etching adhesive in Class II restorations

OBJECTIVE

The aim of this study was to evaluate the clinical effectiveness of a one-step HEMA-free self-etching adhesive (SEA) placed with a micro-fine hybrid resin composite in Class II restorations. The restorations were compared intraindividually with 2-step HEMA containing SEA-giomer restorations.

MATERIAL AND METHODS

Fifty-four patients with at least one pair of two similar Class II cavities participated (30 men, 24 women; mean age 57.1yrs). A total of 115 Class II composite restorations were placed with (1) a one step HEMA-free adhesive and a micro-fine hybrid resin composite (Gbond/Gradia Direct: 60; GG) and (2) a 2-step HEMA-containing SEA and a giomer (FL Bond/Beautifil: 55; FB). Each participant received in a randomized way at least one restoration with each of the experimental materials. The restorations were evaluated at baseline and yearly during a 6 year followup using modified USPHS criteria.

RESULTS

During the 6 years, 111 restorations could be evaluated. No post-operative sensitivity was reported by the participants. Fourteen failed restorations (12.6%) were observed during the follow up, 5 GG (8.5%; 4 premolar and 1 molar teeth) and 9 FB (17.7%; 1 premolar and 8 molar teeth) (p<0.05). Annual failure rate at 6 years were 1.4% for GB and 3.0% for FB. Main reasons of failure were bulk fracture of resin composite for FB and tooth fracture for GB.

SIGNIFICANCE

The HEMA-free SEA-hybrid RC restorations showed good clinical durability in Class II cavities after 6 years. The HEMA-containing SEA-giomer restorations showed a rather high failure frequency.

Critical appraisal: post-op sensitivity with direct composite restorations

Sales of self-etch adhesive systems have grown considerably over the last 10 to 12 years. One of the most important factors contributing to this growth is the perception that self-etch adhesives cause less postoperative sensitivity than etch-and-rinse adhesives. Certainly, there is much anecdotal evidence supporting this perception. But what does the science say? This Critical Appraisal presents evidence from several clinical trials of postoperative sensitivity in posterior composite restorations.

A Five-Year Clinical Evaluation of Direct Nanofilled and Indirect Composite Resin Restorations in Posterior Teeth

Aim:

To assess the clinical efficacy of posterior composite resin restorations placed directly and indirectly in posterior teeth after five years.

Materials and Methods:

A total of 108 cavities in 54 patients were restored with three direct composite resins (Filtek SupremeXT [FSXT], Tetric Evo Ceram [TEC], AELITE Aesthetic [AA]) and two indirect composite resins (Estenia [E] and Tescera ATL [TATL]). All restorations were evaluated by two examiners using the United States Public Health Service criteria at baseline and five years after placement. Statistical analysis was completed with Fisher exact and McNemar χ2 tests.

Results:

At baseline, 4% (five) of the restored teeth presented postoperative sensitivity; however, only one of them (a member of the E group) required canal treatment and replacement after two years. At the five-year evaluation, all restorations were retained, with Alpha ratings at 100%. Only one tooth (in the TEC group) required replacement after three years due to secondary caries. Color match, surface texture, and marginal integrity were predominantly scored as Alpha after five years for all groups. After that time, marginal discoloration was scored as Alpha in 64% of AE restorations, 70% of TATL restorations, 73% of E restorations, and 87% of FSXT restorations. There were no Charlie scores recorded for any of the restorative systems.

Conclusions:

Under controlled clinical conditions, indirect composite resin inlays and direct composite resin restorations exhibited an annual failure rate of 2.5% and 1.6%, respectively, after five years. Therefore, the investigated materials showed acceptable clinical performance, and no significant differences were found among them.

The Clinical Effectiveness of Various Adhesive Systems: An 18-Month Evaluation

The aim of this clinical trial was to compare the clinical performance of three different adhesive systems over 18 months in noncarious cervical lesions (NCCLs). Thirty patients, with at least three noncarious cervical lesions, were enrolled in the study. One operator randomly restored a total of 90 lesions with resin composite (Herculite XRV). The restorations were bonded with either Optibond FL (OF), three-step total-etch; Optibond Solo Plus (OS), two-step total-etch; or Optibond All-In-One (OA), one step self-etch. The restorations were clinically evaluated at baseline and after six, 12, and 18 months using the eight United States Public Health Services criteria. Data were analyzed using Friedman and Wilcoxon signed ranks tests (p&lt;0.05). After 18 months, the retention rate was (OF) 96.5%, (OS) 93.1%, and (OA) 89.7%. Differences among the three adhesive systems for evaluated criteria were not observed in comparison of the mean Alfa score percentages. There was a significant increase in marginal discoloration for (OA) adhesive after 18 months compared with baseline (p=0.011). Other restoration criteria had no statistically significant differences among the three adhesives (p&gt;0.05). With the exception of marginal discoloration, the clinical effectiveness of three types of adhesive systems in NCCLs was acceptable after 18 months. However, using the one-step self-etch adhesive may lead to some marginal discolorations.

A 7-year randomized prospective study of a one-step self-etching adhesive in non-carious cervical lesions. The effect of curing modes and restorative material

OBJECTIVE

The aim of this study was to evaluate the clinical retention of a one-step self-etching adhesive system (Xeno III) in Class V non-carious cervical lesions and the effect of restorative material and curing techniques on longevity of the restorations.

MATERIALS AND METHODS

A total of 139 Class V restorations were placed with the self-etching primer Xeno III and a resin composite (Tetric Ceram) or a poly-acid modified resin composite (Dyract AP) in non-carious cervical lesions without intentional enamel involvement. The materials were cured with a conventional continuous light, a soft-start or a pulse-delay curing mode. The restorations were evaluated at baseline, 6, 12, 18 and 24 months and then yearly during a 7 year follow-up with modified USPHS criteria. Dentine bonding efficiency was determined by the percentage of lost restorations.

RESULTS

During the 7 years, 135 restorations could be evaluated. No post-operative sensitivity was reported by the participants. Overall relative cumulative loss rate frequencies for the adhesive system at 6 and 18 months and 7 years, independent of curing technique and restorative material, were 0.8%, 6.9% and 23.0%, respectively. The self-etching adhesive fulfilled at 18 months the full acceptance ADA criteria. Tetric Ceram showed at 7 years a 20.9% loss of retention and Dyract AP a 25.0% loss rate (Log rank p = 0.48). The loss rates for the 3 curing techniques: continuous, soft start and pulse delay were 17%, 27.9% and 24.4%, respectively (Log rank p = 0.52). No secondary caries was observed.

SIGNIFICANCE

The single-step self-etching adhesive showed acceptable clinical long-time retention rates to dentine surfaces independent of restorative material and curing technique used.

Hydroxyapatite effect on photopolymerization of self-etching adhesives with different aggressiveness

OBJECTIVE

To understand the correlation of the acidic monomer/hydroxyapatite (HAp) reaction with the photopolymerization behaviour of self-etching adhesives with different aggressiveness.

METHODS

Two commercial self-etching adhesives the strong Adper Prompt L-Pop (APLP, pH ~ 0.8) and the mild Adper Easy Bond (AEB, pH ~ 2.5) were used. HAp powders were incorporated into both adhesives to acquire solutions with concentrations of 0, 1, 3, 5, 7 wt%. The attenuated total reflectance Fourier transform infrared (ATR/FT-IR) technique was employed to collect the in situ spectra during light-curing, from which the degree of conversion (DC) and polymerization rate (PR) were calculated. The pH of each tested solution was also measured.

RESULTS

Without HAp incorporation, the DC and PR of the strong APLP (7.8% and 0.12%/s, respectively) were much lower than those of the mild AEB (85.5% and 5.7%/s, respectively). The DC and PR of APLP displayed an apparent increasing trend with the HAp content. For example, the DC increased from 7.8% to 58.4% and the PR increased from 0.12 to 3.8%/s when the HAp content increased from 0 to 7 wt%. In contrast, the DC and PR of AEB were much less affected by the HAp content. The observations were correlated well with the spectral and pH changes, which indicated that APLP underwent a higher extent of chemical reaction with HAp than AEB.

CONCLUSIONS

The results disclosed the important role of the acidic monomer/HAp chemical reaction in improving the photopolymerization of the strong (low-pH) self-etching adhesives such as APLP. The phenomenon of polymerization improvement strongly depended on the adhesive aggressiveness.