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

Alternative Direct Restorative Materials for Dental Amalgam: A Concise Review Based on an FDI Policy Statement

Dental restorative procedures remain a cornerstone of dental practice, and for many decades, dental amalgam was the most frequently employed material. However, its use is declining, mainly driven by its poor aesthetics and by the development of tooth-coloured adhesive materials. Furthermore, the Minamata Convention agreed on a phase-down on the use of dental amalgam. This concise review is based on a FDI Policy Statement which provides guidance on the selection of direct restorative materials as alternatives to amalgam. The Policy Statement was informed by current literature, identified mainly from PubMed and the internet. Ultimately, dental, oral, and patient factors should be considered when choosing the best material for each individual case. Dental factors include the dentition, tooth type, and cavity class and extension; oral aspects comprise caries risk profiles and related risk factors; and patient-related aspects include systemic risks/medical conditions such as allergies towards certain materials as well as compliance. Special protective measures (eg, a no-touch technique, blue light protection) are required when handling resin-based materials, and copious water spray is recommended when adjusting or removing restorative materials. Cost and reimbursement policies may need to be considered when amalgam alternatives are used, and the material recommendation requires the informed consent of the patient. There is no single material which can replace amalgam in all applications; different materials are needed for different situations. The policy statement recommends using a patient-centred rather than purely a material-centred approach. Further research is needed to improve overall material properties, the clinical performance, the impact on the environment, and cost-effectiveness of all alternative materials.

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

OBJECTIVE

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSION

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

CLINICAL SIGNIFICANCE

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

Clinical Performance of Zirconia Reinforced versus Conventional Viscous Glass Ionomer in Class I Cavities of Geriatric Patients: A 1-year Randomized Controlled Clinical Trial

Background

For the elderly population, efforts are made to simplify the restorative procedure while maintaining good clinical performance. Glass ionomer (GI) cements are showing signs to fulfill many of these qualities. With their new properties and ease of use, they can be developed further to become a useful group of materials to overcome the problems of elderly patients.

Aim

The aim of the study was to evaluate the clinical performance of zirconia-reinforced versus conventional viscous GI restorations in Class I cavities of geriatric patients.

Setting and Design

The study design was in vivo randomized clinical trial, parallel-arms, allocation ratio: 1:1.

Subjects and Methods

A total of 28 Class I carious lesions in 21 geriatric patients were restored randomly either by zirconomer-improved or Ketac Molar Quick Aplicap (n = 14) each. Restorations were evaluated for 1 year by modified USPHS criteria.

Statistical Analysis

Data were analyzed with the Chi-square test and Cochran's Q-test. Survival rate was analyzed using the Kaplan-Meier and log-rank test.

Results

Twenty-four restorations were evaluated in 19 patients with a recall rate of 85.7% at 12 months. Significant differences were found in marginal integrity and marginal discoloration within both restorative materials between different time intervals (P < 0.05). However, none of the materials were superior to another regarding all assessed criteria.

Conclusions

Both zirconia-reinforced GI and conventional highly viscous GI have acceptable clinical performance.

In vitro remineralization by various ion-releasing materials of artificially demineralized dentin: A micro-CT study

OBJECTIVE

The aim of this study was to evaluate the remineralizing properties of ion-releasing restorative materials on pH cycling-induced carious dentin.

METHODS

Fifty sound molars were freshly extracted. The occlusal surfaces were abraded using water-cooled sandpaper (800 grit). The residual crowns were embedded in self-cured acrylic resin with the flat dentin surface exposed. A mesio-distal trench was created using a calibrated 0.5 mm deep occlusal reduction burr, and artificial dentin caries were generated by pH cycling. Then, teeth were randomly assigned to five groups according to the ion-releasing material used. For each sample, micro-CT acquisitions were performed at various intervals. Remineralization was assessed by mean gray value (MGV) measurements after registration and segmentation of the region of interest with 3D Slicer software. One-way repeated-measures ANOVA followed by Tukey's post hoc test was used to investigate the difference in MGVs among the various groups.

RESULTS

Only Cention Forte showed significantly increased MGVs after 4 weeks compared to demineralized dentin. MGVs were higher, but not significantly, after placement of the restorative materials, including in the resin composite control group. These results can be explained by the radiopacity of the materials.

SIGNIFICANCE

Cention Forte, the material with the highest radiopacity, showed a significant increase in the MGVs of artificially carious dentin after 4 weeks. However, the study of dentin remineralization by micro-CT could be impacted by the radiopacity of the restorative materials used. The relevance of this examination for the study of dentinal remineralization should be investigated.