Detection of marginal defects of composite restorations with conventional and digital radiographs

Radiopacity evaluation of different types of resin restorative materials using a digital radiography system

OBJECTIVES

The aim of the study was to evaluate and compare the radiopacity of 20 current dental resin composites with digital radiography.

METHODS

Ten specimens, 10-mm in diameter and 1-mm thickness, were prepared and radiographed using phosphor plates close to Al step wedges and tooth sections. The mean grey values (MGVs) were measured using an ImageJ software program and converted to equivalent Al thickness. Data were analyzed using one-way analysis of variance (ANOVA) and Tamhane post hoc test (p < 0.05). Correlation between mean radiopacity and filler content (wt% and vol%) of the tested materials was analyzed with linear regression analysis.

RESULTS

The radiopacity of all composites ranged from 1.32 mm Al (Estellite Flow Quick) to 3.41 mm Al (Charisma Classic). All the tested materials, except four restorative materials, had a radiopacity equal or higher than the enamel (p < 0.05). Linear regression revealed low correlation between the radiopacity and filler content of the composite.

CONCLUSION

Majority of the materials has appropriate radiopacity for dental restorations. There was great variation in radiopacity level, may clinically affect the diagnosis.

Effect of Preheating and Vibration on Microhardness and Microleakage of Microhybrid Resin Composite (In Vitro Study)

BACKGROUND: Preheating and sonic vibration are two methods for the treatment of microhybrid resin composites that may effect on their mechanical and physical properties. AIM: This study was conducted to assess the effect of using preheating and sonic vibration on microhardness and microleakage of microhybrid resin composite METHODS AND MATERIALS: For microhardness test, a total of 30 samples of resin composite discs were prepared. Samples were divided into three groups according to the method of treatment of resin composite, controlled group (T0), preheated group (T1), and sonic vibration group (T2). Surface microhardness values were evaluated at baseline and after thermocycling. For microleakage test, a total of 30 Class-V cavities were prepared on the labial surfaces of extracted human anterior teeth. The cavities were then divided into three groups according to the method of resin composite treatment as mentioned before in the microhardness test. All samples were sectioned; then two-dimensional cross-sectional images from each sample. Each cross-sectional image was analyzed using Image J software to quantify interfacial microleakage at the cavity floor. STATISTICAL ANALYSIS USED: Two-way ANOVA analysis was used to test the effects of thermocycling on three groups of each test. One-way ANOVA was used to compare between three different methods of resin composite treatment. RESULTS: For microhardness at baseline revealed that the highest mean value was recorded for the control group, followed by the sonic vibration group meanwhile, the lowest mean value was recorded for the sonic vibration group, followed by preheated group at microleakage test. CONCLUSION: Preheating and sonic vibration of microhybrid resin composite does not improve its microhardness; however, sonic vibration provides better marginal adaptation than the preheating and the conventional methods.

Evaluation of Newly Introduced Bioactive Materials in Terms of Cavity Floor Adaptation: OCT Study

OBJECTIVE

The aim of the present study was to evaluate the adaptation of newly introduced bioactive restorative materials to the cavity floor using cross-polarization optical coherence tomography (CP-OCT).

MATERIALS AND METHODS

Round class V cavities were prepared on the proximal surfaces of sixty non-carious human anterior teeth (0.5 mm depth × 4 mm diameter), which were divided into groups according to the restorative material (n = 15). In the VF group, Vertise flow composite (Kerr, Orange, CA, USA) was used, in the BF group, Beautifil II composite (Shofu, Koyoto, Japan) was used, and in the AB group, ACTIVA BioACTIVE composite (Pulpdent, Watertown, NY, USA) was used. Cavities were restored using the bulk filling technique and cured according to the manufacturers' instructions. Then, the specimens were immersed in a contrasting agent, and image acquisitions were taken by CP-OCT to calculate the adaptation percentage by using an image analysis software.

RESULTS

B-scans showed a diffuse bright band of white pixels at the tooth-resin interface that was interpreted as a micro-gap present between the cavity floor and restorative material. The Kruskal-Wallis test showed a statistically significant difference between all tested groups with the AB group representing the least gap formation, followed by the BF group, and then the VF group, which demonstrated the highest gap formation.

CONCLUSIONS

In class V cavities, better adaptation to the cavity floor can be obtained when using ACTIVA BioACTIVE more than Vertise flow and Beautifil II composites. In addition, CP-OCT is considered a non-destructive imaging tool that helps in evaluating the quality of the tooth-restoration interface when bioactive composites are used.

In vitro comparison of high-definition US, CBCT and periapical radiography in the diagnosis of proximal and recurrent caries

OBJECTIVE

To assess the in vitro performance of high-definition (HD) US, CBCT and periapical radiography for the visibility of proximal and recurrent caries in teeth with and without restoration.

METHODS

A total of 240 molar teeth were divided into eight groups each comprised of 30 teeth. Control groups consisted of teeth without caries (Group 1-4; N = 120), whereas diseased groups consisted of teeth with proximal caries (Group 5-8; N = 120 teeth). Finally, a total of four image sets were obtained as follows: i) PSP periapical radiography, ii) CBCT 0.075 mm voxel size, iii) CBCT 0.2 mm voxel size and iv) HD US images. The image sets were viewed separately by four observers by using a 5-point confidence scale. Intraclass correlation coefficients were calculated. The areas under the ROC curves were compared using chi-square tests. Significance level was set at α = 0.05.

RESULTS

Intraobserver agreement for both readings for the four observers ranged between 0.848 and 0.988 for CBCT (0.075 mm) images; 0.658 and 0.952 for CBCT (0.2 mm) images; 0.555 and 0.810 for periapical images; 0.427 and 0.676 for US images. Highest AUC values were found for CBCT (0.075 mm) images and lowest for US images. Statistically significant differences were found among CBCT (0.075 mm) images and US images (p < 0.001), CBCT (0.2 mm) images and US images (p < 0.001) and periapical images and US images (p < 0.001) for the detection of proximal caries.

CONCLUSION

Periapical and CBCT images outperformed HD US imaging in the detection of proximal dental caries.

Optical comparison between micro-CT and OCT in imaging of marginal composite adaptation: Observational study

Dental composite is the most used aesthetic restorative biomaterial worldwide. However, it undergoes polymerisation shrinkage that could lead to loss of the interfacial seal between tooth and resin in some circumstances. This demands high-resolution imaging technologies to detect these defects. This study carried out a comparison between microcomputed tomography (micro-CT; Shimadzu, Japan) and swept-source optical coherence tomography (SS-OCT; Santec, Japan) in the detection of marginal adaptation defects at the tooth-resin interface. Unlike in micro-CT, it was possible to outline interfacial gaps along with tooth-resin interfaces with SS-OCT, which was attributed to the Fresnel diffraction of light. This in vitro comparison demonstrates SS-OCT has great potential in dental imaging to effectively assess dental composite adaptation and marginal defects when high resolution is desired in real time. LAY DESCRIPTION: Detection of tooth-colored restoration defects had been assessed by different radiographic methods. However, most of these methods are either invasive or suffer from low-resolution. In this study, a comparison has been carried out between two different high-resolution imaging systems; microcomputed tomography and optical coherence tomography, to explore their potentials in detecting restorations defects. The results showed optical coherence tomography has a great accuracy in locating the underlying defects when the obtained images were validated against confocal laser scanning microscopy images.

Adaptation Assessment of Three Bonded Resin Restorations at the Cavity Floor Using Cross-Polarization Optical Coherence Tomography

Objective: The aim of the study was to compare the composite adaptation of three systems by using cross-polarization optical coherence tomography (CP-OCT). Background data: Most polymer-based restorations suffer from polymerization shrinkage that affects the interfacial seal. This shrinkage cannot be detected by conventional X-ray methods. Optical coherence tomography was proved to be a reliable non-invasive imaging tool to examine biological structures and biomaterials at micron scale. Methods: Twenty-four cylindrical class-V cavities were prepared on the buccal surfaces of the extracted human molars. After cavity preparation, samples were randomly divided into three groups (n = 8) according to the restoration system: one-step self-etch Clearfil Tri-S Bond Plus with Clearfil Majesty ES-2 composite (TS; Kuraray Noritake Dental), Single Bond Universal in self-etch mode with Filtek Z350 XT composite (SB; 3M ESPE), and one-step self-etch Plafique Bond with Plafique LX 5 composite (PB; Tokuyama Dental). The restoration placement was carried out according to the manufacturers' recommendations. Later, the specimens were immersed in a contrasting agent; then, image acquisitions were taken by CP-OCT to calculate the adaptation percentage by using an image analysis software. Results: Mann-Whitney U test showed no statistical significant difference in the adaptation percentage between TS (91.72 ± 11.6) and SB (93.43 ± 6.9) groups (p > 0.05). However, the adaptation percentage in PB (41.83 ± 28.5) was significantly lower than in the other tested groups (p < 0.05). Conclusions: Within the limitation of the study, TS and SB groups showed better adaptation than PB. Moreover, CP-OCT is a useful imaging tool that can display composite adaptation at micron scale.

Decision-making of general practitioners on interventions at restorations based on bitewing radiographs

OBJECTIVE

The aim of this study was to compare decision-making based on bitewing analysis of restored proximal surfaces by general dental practitioners (GDPs) with diagnossis and clinical decisions made by experts in cariology and restorative dentistry.

METHODS

This practice-based study used a database of 7 general dental practices. Posterior bitewing radiographs were selected from the electronic patient files of patients, and 770 cases of proximal restored surfaces were selected. Fifty percent of the cases which lead to the restorative decision, and the other half were cases decided for monitoring by the GDPs. Three experts performed radiographic assessment. The outcome variables were agreement of diagnosis and decision of treatment. Cohen's kappa statistic was used.

RESULTS

For the experts, moderate to substantial intraexaminer agreement was observed for the diagnostic criteria, and kappa values of 0.77, 0.79, and 0.88 were obtained for each expert regarding the treatment assignment. Agreement between GDPs and the majority of experts for secondary caries varied between 67 and 83%. One hundred seventy-three out of 385 cases that were treated by GDPs were decided for monitoring by the experts, while 8 cases that were decided for monitoring by the GDPs were decided for treatment. The agreement between experts and GDPs was moderate for secondary caries detection, and fair for treatment decision.

CONCLUSION

The GDPs tend to have a less conservative approach regarding the decision to intervene or not concerning the reassessment of restorations, showing moderate agreement with the experts for secondary caries detection and fair agreement regarding the treatment decision.

CLINICAL SIGNIFICANCE

This study highlights that GDPs tend to have a less conservative approach to the decision to intervene or not in posterior restorations, compared to experts in cariology and restorative dentistry. Efforts should be made to reduce these differences based on minimally invasive dentistry.

Optical Evaluation of Enamel Microleakage with One-Step Self-Etch Adhesives

OBJECTIVE

In this in vitro study, cross-polarization optical coherence tomography (CP-OCT) was used to evaluate microleakage in dental composite restorations bonded to enamel with two types of one-step self-etching (SE) adhesives.

BACKGROUND DATA

One-step SE adhesives were proposed to simplify bonding of composite restorations. However, bonding of these simplified adhesive to dental enamel is still questionable. OCT is a promising diagnostic tool that allows micron-scale imaging of biological tissues and structures.

METHODS

Class-V cavities (4-mm diameter × 1-mm depth) were prepared on the labial surfaces of extracted human anterior teeth with margins and floor located in enamel. The cavities were then divided into two groups (n = 5) and restored with either Tetric N-Bond Universal (Ivoclar Vivadent, Liechtenstein) or Palfique Bond (Tokuyama Dental Corporation, Japan), followed by Estelite Flow Quick flowable composite (Tokuyama Dental Corporation). After storage in 100% humidity for 24 h, specimens were immersed in ammoniacal silver nitrate solution for another 24 h. Later, they were rinsed and immersed in photo-developing solution under fluorescent light for 8 h. CP-OCT at 1310 nm center wavelength was used to scan seven two-dimensional cross-sectional images from each specimen. Each cross-sectional image was analyzed using ImageJ software to quantify interfacial microleakage at the cavity floor.

RESULTS

Student's t-test showed significant difference between the tested adhesives (p < 0.05). Palfique Bond adhesive presented inferior interfacial adaptation as it obtained higher values of floor microleakage compared to Tetric N-Bond Universal adhesive group.

CONCLUSIONS

CP-OCT enabled nondestructive quantitative assessment of microleakage in enamel dental restorations.

Comparison of Cone-Beam Computed Tomography and Intraoral Radiography in Detection of Recurrent Caries under Composite Restorations

Abstract Secondary caries is the most common cause of dental restoration failures. This study aimed to compare the diagnostic accuracy of conventional and digital intraoral radiography and cone beam computed tomography (CBCT) for detection of recurrent caries around composite restorations. mesio-occluso-distal (MOD) cavities were prepared using bur on 45 extracted sound human molar teeth. The teeth were divided into 3 groups. In the control group, cavities were restored with composite resin after etching and bonding (n=15). In Group 2, 500-μm thick wax was placed over the buccal, lingual and gingival walls and the cavities were restored with composite resin. Group 3 specimens were subjected to pH cycling and artificial caries were created on the buccal, lingual and gingival walls. The cavities were restored with composite. Conventional and digital photo-stimulable phosphor (PSP; Optime) radiographs and two CBCTs images (NewTom 3G and Cranex 3D) were obtained from them. Presence or absence of caries in the cavity walls was assessed on these images. Data were analyzed using Kappa statistic. The diagnostic accuracy of CBCT was significantly higher than that of digital and conventional intraoral radiography (p<0.05). The accuracy was 0.83, 0.78, 0.55 and 0.49 for CBCT Cranex 3D, CBCT NewTom 3G, conventional and digital intraoral radiography, respectively. CBCT has a higher diagnostic accuracy than digital and conventional intraoral radiography for detection of secondary caries around composite restorations.

Evaluation of Composite Adaptation to Pulpal Chamber Floor Using Optical Coherence Tomography

INTRODUCTION

A coronal seal is fundamental for a positive outcome to endodontic therapy. In this in vitro study, we evaluated the adaptation of composite resins in postendodontic restorations using optical coherence tomographic (OCT) imaging. Our null hypothesis was that there would be no difference in marginal adaptation to the pulp chamber floor between resin composites of different viscosities.

METHODS

Thirty intact upper molars extracted for periodontal reasons were selected, endodontically treated, and filled with gutta-percha. The excess gutta-percha was entirely removed from the pulp chamber floor, and teeth were randomly divided into 3 groups (n = 10) according to the material used for the restoration: group 1: 0.5-mm horizontal layer of flowable composite followed by nanohybrid composite, group 2: bulk layering of bulk fill flowable composite; and group 3: oblique layering of nanohybrid composite. The degree of adaptation to the cavity floor was assessed using OCT imaging, and images were analyzed with the software program ImageJ (National Institutes of Health, Bethesda, MD) to assess the marginal gap between the composite and the pulp chamber floor. Collected data were statistically analyzed using analysis of variance testing, and statistical significance was set at P < .05.

RESULTS

Flowable composites showed significantly better adaptation than traditional packable nanohybrid composites (P < .05). All significant differences were found between groups 1 and 2.

CONCLUSIONS

Within the limitations of this OCT imaging-based in vitro study, it was concluded that the flowable composite (flow + nanofilled; flow bulk fill composite) adapted better to the pulp chamber floor than the packable nanohybrid composite resin. Further studies are necessary to confirm these results.

Radiographic diagnosis of dental restoration misfit: a systematic review

The objective of this study was to perform a systematic review on the use of radiographic methods for the diagnosis of misfit in dental prostheses and restorations. The MEDLINE bibliographic database was searched from 1950 to February 2014 for reports on the radiographic diagnosis of misfits. The search strategy was limited to English-language publications using the following combined MeSH terms in the search strategy: (Dental Restoration OR Dental Prosthesis OR Crown OR Inlays OR Dental Abutments) and (Dental Leakage OR Prosthesis Fitting OR Dental Marginal Adaptation OR Surface Properties) and (Radiography, Dental OR Radiography, Dental, Digital OR Cone-Beam Computed Tomography). Twenty-eight publications were identified and read in full text, and 14 studies fulfilled criteria for inclusion. Information regarding the use of radiographic methods for the diagnosis of misfits in dental prosthesis and restorations, and in which the methodology/results comprised information regarding how the sample was collected/prepared, the method, imaging protocol, presence of a reference test and the outcomes were evaluated. QUADAS criteria was used to rate the studies in high, moderate or low quality. The evidence supporting the use of radiographic methods for the diagnosis of misfits in dental prosthesis and restorations is limited to low-/moderate-quality studies. The well-established intra-oral orthogonal projection is still under investigation and considered the most appropriate method, both when evaluating the relation between dental restoration to tooth and abutment to implant. Studies using digital radiographs have not evaluated the effect of image post-processing, and tomography has not been evaluated.

Influence of Radiopacity of Dental Composites on the Diagnosis of Secondary Caries: The Correlation Between Objective and Subjective Analyses

This study aimed to objectively evaluate the radiopacity of different dental composites and their subjective influence on diagnosing secondary caries–like lesions and how these results correlate. For objective analysis, three resin specimens (1 mm thick, with a 4-mm internal diameter) were made with four composites: 1) Charisma; 2) Filtek Z250; 3) Prisma AP.H; and 4) Glacier. Three human teeth were selected and then mesio-distally sectioned (1 mm thick) to make the dental specimens. An aluminum (Al) wedge (12 steps, 1 mm thick, 99.8% purity) was used as an internal standard to calculate the radiopacity. For subjective analysis, 20 human teeth were selected and then prepared with a mesio-occluso-distal (MOD) inlay cavity, with half the teeth receiving a round cavity to simulate the carious lesion. The MOD was restored using the composites at four different times. Standardized radiographs were acquired and then digitized (300 dpi and eight-bit TIFF) for both analyses. A histogram objectively measured the pixel intensity values of the images, which were converted into millimeters of Al using linear regressions. Eight observers subjectively evaluated the images using a five-point rating scale to diagnose the caries. The data were statistically analyzed using the Student t-test, the Kappa test, diagnostic testing, and the Pearson correlation coefficient (α=0.05). All materials showed radiopacity values compatible with dental tissues (p&gt;0.05); Glacier was similar to dentin and Prisma AP.H was similar to enamel, while the remaining materials showed a middle radiopacity. Prisma AP.H and Glacier differed (p&lt;0.05) in relation to their accuracy to caries diagnosis, with Glacier having greater accuracy. There was a correlation between objective and subjective analyses with negative linear dependence. An increase in the material's radiopacity could have a subjectively negative influence on the diagnosis of secondary caries; thus, an ideal radiopacity for a dental composite is closer to the dentin image and produces similar attenuation to X-rays than does dentin.

Influence of materials radiopacity in the radiographic diagnosis of secondary caries: evaluation in film and two digital systems

OBJECTIVES

The aim of this study was to evaluate the influence of restorative materials on false-positive diagnoses of secondary caries using three imaging systems.

METHODS

Class II preparations were made on the occlusal and mesial or distal faces of extracted healthy third molar teeth. The teeth were divided into five groups and, with the exception of Group 5, they received a flow resin base. Groups 1, 2, 3 and 4 received a layer of Natural Flow (DFL, Rio de Janeiro, Brazil), Filtek Flow (3M-ESPE, St. Paul, MN), Tetric Flow (Ivoclar/Vivadent, Liechtenstein, Germany) and Protect Liner F (Kuraray, Okayama, Japan) resins, respectively, and were restored with Filtek Supreme resin (3M-ESPE). Group 5 was restored with Filtek Supreme resin. The images on film and on the Digora Optime® (Helsinki, Finland) and charge coupled device (CCD) IOX (IOX, Monninkylä, Finland) digital systems were evaluated by five examiners and the data were analysed using the Fisher's exact and Friedman tests at a 5% level of significance.

RESULTS

Group 3 showed the highest rate of correct answers (restored tooth) and the lowest proportion of secondary caries diagnosis (P ≤ 0.05). Group 4 showed the highest rate of secondary caries diagnosis and the lowest proportion of correct answers (P ≤ 0.05). The systems for obtaining images presented were similar for each material.

CONCLUSIONS

The restorative material was found to have an influence on the diagnosis of secondary caries lesions by imaging. The imaging system had no influence. Materials with greater radiopacity, higher than that of enamel, were favourable for a true-negative diagnosis.

Diagnosis of secondary caries in esthetic restorations: influence of the incidence vertical angle of the X-ray beam

The aim of this study was to evaluate the accuracy on the diagnosis of secondary caries-like lesions simulated on esthetic restorations of different materials, changing the incidence vertical angle (IVA) of the x-ray beam. Twenty human teeth received MOD inlay preparations. In the experimental group (n=10), a round cavity was made in the floor of the proximal box to simulate the caries-like lesion. All teeth were restored with 3 composite resins (Charisma, Filtek-Z250 and TPH-Spectrum) at 3 moments. Two radiographic images were acquired with 0º and 10º IVA. Ten observers evaluated the images using a 5-point confidence scale. Intra- and interobserver reliability was analyzed with the Interclass Correlation Coefficient and the diagnostic accuracy was evaluated using the area under the ROC curve (A(z)), Friedman test and Wilcoxon test (α=0.05). Higher accuracy values were obtained with 10º IVA (A(z)=0.66, Filtek-Z250>A(z)=0.56, TPH-Spectrum) compared to 0º (A(z)=0.55, Charisma>A(z)=0.37, TPH-Spectrum), though without statistically significant difference (p>0.05). The detection of secondary caries-like lesions simulated on esthetic restorations of different materials suffered no negative influence by changing the IVA of the x-ray beam.

Gray Value Differences to Dentin of Root Posts Radiographed with Digital Intraoral Systems and Conventional X-ray Films

Digital radiographs often provide significantly higher gray value differences between root posts and root dentin than conventional x-ray films.

Effects of clinical experience and explorer type on judged crown margin acceptability

PURPOSE

This study was undertaken to simultaneously compare instrumentation type and operator characteristics in judgments of clinical acceptability of crowns exhibiting a controlled range of marginal gaps. The research was conducted in a laboratory setting and generalizability analysis was used as a statistical technique to identify the sources contributing to variation in the judgment outcome.

MATERIALS AND METHODS

A crown was seated on an ivorine tooth in a device that permitted continuous adjustment in intervals of 25 mum to produce known marginal gaps ranging from zero to 250 microm. Forty-nine students and six faculty members used five types of explorers each to determine, by tactile examination, the point on the controlled increasing marginal gap where they would no longer regard the gap as clinically acceptable.

RESULTS

There were no differences across type of explorer. Operators with clinical experience had a threshold that rejected crowns at a smaller gap than did those operators without clinical experience (p= 0.007). Faculty members maintained a higher individual degree of consistency in their personal judgments than did students (p= 0.02); however, the inter-operator consistency was significantly lower for faculty members than for students (p < 0.05).

CONCLUSIONS

Differences among operators in a simulation of the decision regarding gaps in crowns accounted for 63% of the variance; type of explorer used in assisting this decision accounted for about half as much variance. Faculty members making such judgments exhibited high intra-operator consistency but significantly lower inter-operator consistency than did students. The study suggests that the internal standards dentists use for clinical decision making deserves further study as they may be as significant as the equipment used.

Comparison of conventional film with different digital and digitally filtered images in the detection of simulated internal resorption cavities--an ex vivo study in human cadaver jaws

OBJECTIVE

To determine observers' ability to detect experimentally induced simulated internal resorption cavities using conventional film, digital images and digitally filtered images.

STUDY DESIGN

In the coronal plane, 11 single-rooted teeth with radiographically visible pulps were split in half. Four artificial internal resorptions were simulated in each tooth at the coronal, cervical, mid-root, and apical locations of the buccal/labial wall. Conventional and digital radiographs were taken from 3 different views in 4 steps. Three observers examined conventional, digital, and digitally filtered images for the presence of resorption cavities. Data were statistically analyzed using analysis of variance. Pair-wise comparison between receptors, location, and size were made by Tukey post hoc test.

RESULTS

One digital system produced a significantly lower proportion of correct readings, with no significant difference between other imaging types (P < .001). In the apical region, internal resorption was the most difficult to detect. The cervical region had the highest proportion of correct readings (P < .001). False-positive readings were higher in the apical and mid-root locations (P < .001). Defect size increased detection ability. Interaction was significant between receptor and size and between size and location (P < .001).

CONCLUSIONS

All systems, except PSP, produced similar results in detecting simulated internal resorption.

Evaluation of enamel dental restoration interface by optical coherence tomography

Evaluation of molar dental restorations on enamel is performed using optical coherence tomography (OCT) with 10 microm resolution. Images of approximately 50 microm failure gaps in the restorations are demonstrated and the OCT images are compared with x-ray and optical microscopy pictures. The results demonstrate the potential of the technique for clinical evaluation of dental restorations.