Posterior resin-based composite restorations: clinical recommendations for optimal success

Novel Universal Bond Containing Bioactive Monomer Promotes Odontoblast Differentiation In Vitro

The development of multifunctional materials has been expected in dentistry. This study investigated the effects of a novel universal bond containing a bioactive monomer, calcium 4-methacryloxyethyl trimellitic acid (CMET), on odontoblast differentiation in vitro. Eluates from bioactive universal bond with CMET (BA (+), BA bond), bioactive universal bond without CMET (BA (-)), and Scotchbond Universal Plus adhesive (SC, 3M ESPE, USA) were added to the culture medium of the rat odontoblast-like cell line MDPC-23. Then, cell proliferation, differentiation, and mineralization were examined. Statistical analyses were performed using a one-way ANOVA and Tukey's HSDtest. The cell counting kit-8 assay and alkaline phosphatase (ALP) assay showed that cell proliferation and ALP were significantly higher in the 0.5% BA (+) group than in the other groups. In a real-time reverse-transcription polymerase chain reaction, mRNA expression of the odontogenic markers, dentin sialophosphoprotein (DSPP) and dentin matrix protein-1 (DMP-1), was significantly higher in the 0.5% BA (+) group than in the BA (-) and SC groups. Calcific nodule formation in MDPC-23 cells was accelerated in the BA (+) group in a dose-dependent manner (p < 0.01); however, no such effect was observed in the BA (-) and SC groups. Thus, the BA bond shows excellent potential for dentin regeneration.

Resin Composite Versus Amalgam Restorations Placed in United States Dental Schools

OBJECTIVES

To investigate the latest teaching policies for posterior resin composite placement versus amalgam and to determine the actual numbers of posterior resin composites versus amalgam restorations placed in American dental schools from 2008 to 2018.

METHODS

Emails were sent to the deans of all 66 dental schools in the United States to collect data in the forms of: 1) Questionnaire on current teaching policies of posterior composite and amalgam restorations; and 2) Data entry form to collect the actual numbers of posterior composite and amalgam restorations placed in their clinics. Descriptive statistics were used to summarize ratios of posterior restorations. Inferential analysis (chi-square test and z-test) was employed to compare posterior restoration proportions over time and within each year. Level of significance was set at 0.05.

RESULTS

For the teaching questionnaire, the response rate was 52% (n=34). Seventy-six per cent of the responding schools reported that they assign 50% or more of their preclinical restorative teaching time towards posterior resin composite placement, while 50% of the responding schools devoted 25% or less towards amalgam teaching. Data entry response rate was 26% (n=17). In 2008, amalgam and resin composite restorations were placed almost equally. However, resin composite restorations were placed significantly more frequently from 2009 onwards in all responding schools. The results revealed a significant ongoing increasing trend in placing posterior resin composites in all responding schools over time (p<0.05).

CONCLUSIONS

Data analysis revealed a clear trend towards an increase in posterior resin composite restoration placement and a decrease in the number of amalgam restorations. However, the time assigned for posterior resin composite teaching is not aligned with quantity of restorations placed. Review and adjustment of the time allocated for teaching and training of each material are suggested.

Composite versus Amalgam Restorations Placed in Canadian Dental Schools

OBJECTIVES

To investigate the latest teaching policies of posterior composite placement versus amalgam and to determine the actual numbers of posterior composites versus amalgam restorations placed in Canadian dental schools, over the years from 2008 to 2018.

METHODS

Emails were sent to Chairs/Heads of Restorative Departments and Clinic Directors of all 10 Canadian dental schools to collect data in the forms of: 1) Questionnaire on current teaching policies of posterior composite and amalgam restorations; 2) data entry form to collect the actual numbers of posterior composite and amalgam restorations placed in their clinics.

RESULTS

For the teaching questionnaire, the response rate was 90% (n=9). Seven (78%) of the responding schools reported that they assign 25%-50% of their preclinical restorative teaching time towards posterior composite placement. While, three (33%) of the responding schools allocated 50%-75% of their restorative teaching towards amalgam placement. Data entry response rate was 80% (n=8). Amalgam material was dominant in the restoration distribution from 2008 to 2012. While from 2013 to 2018, resin composite material was dominant in all eight responding schools. Linear regression analysis revealed a significant increasing trend in placing posterior composites in all the responding schools over time (p<0.05).

CONCLUSIONS

Data analysis revealed a clear trend towards an increase of posterior composite restoration placement and a decrease in the number of amalgam restorations placed. However, the teaching time assigned for posterior composite is not aligned with quantity placed. Review and adjustment of time allocated for teaching and training of each material are recommended.

Reduced-step composite polishing systems - a new gold standard?

OBJECTIVES

To compare the surface gloss and surface roughness of three contemporary composites when polished with reduced-step polishing systems or a conventional multiple-step technique.

METHODS

Fifty Discs (8 mm ø x 2 mm) were each fabricated from three composites; Essentia (ES), BRILLIANT EverGlow (EG), and Filtek Universal, (FU). 5 different polishing systems were randomly assigned 10 specimens from each composite group. The 'gold standard' multiple-step system consisted of Sof-Lex XT discs followed by DiaPolisher diamond paste (GC) (P1). The two-step systems were Polishettes (P2) and DIATECH ShapeGuard (P3) and the one-step systems used were; Opti1Step (P4) and OneGloss (P5). Surface gloss was measured using a glossmeter and surface roughness was measured by a profilometer. Statistical analysis was conducted using one-way ANOVA and Pearson correlation tests. Samples were also imaged across different length scales using scanning electron microscopy and macro-lens photography.

RESULTS

The highest gloss was obtained when P2 and P3 were used in all composite groups (p < 0.05). EG composite showed the lowest Sa (0.08 µm) when polished with P3 and highest gloss when polished with P2 (96.7 GU). Polishing with P5 resulted in highest Sa and lowest surface gloss in all composite groups (p < 0.05). A high correlation was found between Sa and gloss, r = 0.73 (p < 0.05). Both SEM and macro-lens photography supported quantitative data.

CONCLUSION

Both two-step composite polishing systems produced superior gloss compared to the traditional multiple-step polishing system. Mean surface roughness (Sa) and surface gloss are highly correlated with each other.

CLINICAL SIGNIFICANCE

Some reduced step composite polishing systems tested in this study produced superior gloss outcomes compared to the traditional gold-standard multi-step polishing system. This may enable significant clinical chair-time reduction and faster polishing protocols.

Current and future trends in the teaching of direct posterior resin composites in Malaysian dental schools: a cross-sectional study

OBJECTIVE

To investigate the current and future teaching of posterior composite restorations in undergraduate curricula in Malaysian dental schools.

METHODS

A 24-item validated questionnaire including closed and open questions on the teaching of posterior composites was emailed to faculty members in all 13 Dental Schools in Malaysia. Responses were compiled on Excel and analysed.

RESULTS

All 13 dental schools responded to the survey yielding a 100 % response. All schools indicated the use of posterior composites for 2- and 3-surface cavities in premolars and molars. The didactic teaching time devoted to composites was greater than for amalgam (38 h vs 29 h). Clinically, most posterior restorations placed by students were composites (average 74.1 %, range 10 %-100 %); the remaining 25.9 % were amalgams (range, 0 %-50 %). Slot-type cavities were the preparation techniques most commonly taught (n = 11,84.6 %). The use of rubber dam for moisture control was mandatory in most schools (n = 11, 84.6 %). History of adverse reaction to composites was found to be the most common contraindication to composite placement. The phase down of teaching and use of amalgam in Malaysia is expected to occur within the next six years.

CONCLUSION

The trend to increase the teaching of posterior composites reported for other countries is confirmed by the findings from Malaysian dental schools. Notwithstanding this trend, the use of amalgam is still taught, and future studies are required to investigate the implications of the phase down of amalgam in favour of posterior composites.

CLINICAL SIGNIFICANCE

Notwithstanding the increase in the teaching of posterior composites there is a pressing need to update and refine clinical guidelines for the teaching of posterior composites globally.

Effect of Different Polishing Systems on the Surface Roughness and Gloss of Novel Nanohybrid Resin Composites

Objectives  To evaluate the surface roughness and gloss of three nanohybrid resin composites after polishing with three different polishing systems.

Materials and Methods  A total number of 112 disc specimens (10 × 3 mm) were prepared from nanohybrid—Empress Direct (ID), Grandio (GR), Filtek Z350 (Z350) and a microhybrid resin composite restorative materials—Filtek Z250 (Z250). Following 24-hour storage in 37°C distilled water, each composite group ( n = 28) was assigned into four groups ( n = 7) according to finishing/polishing (F/P) system: Mylar strip, Optrapol, Politip, and Sof-Lex (SL). The surface roughness (Ra, mm) was measured by a novel three-dimensional method using an image analysis software attached to an environmental scanning electron microscope. A glossometer was used to measure the surface gloss.

Results Statistical analysis used was ANOVA test. Two-way Anova test revealed that the “type of composite” and “F/P techniques” had a significant effect on both surface roughness and gloss of the tested resin composite materials ( p < 0.05). Tukey’s post hoc test showed that ID, GR, and Z350 revealed lower surface roughness and higher surface gloss than Z250 within the same polishing system ( p < 0.05). Sof-Lex polishing discs produced the lowest surface roughness and highest surface gloss values compared with Optrapol and Politip ( p < 0.05).

Conclusion  The tested F/P systems provided comparable surface roughness and gloss for nanohybrid composites. The Sof-Lex system provided the best surface roughness and gloss for nanohybrid composites.

Incremental techniques in direct composite restoration

Polymerization shrinkage is one of the dental clinician's main entanglements when placing resin-based composite restorations. None of the method can assure a perfectly sealed restoration for adhesive restorative materials; clinicians must abode problems of polymerization shrinkage and its possible ill effects. The objective of this article is to review different incremental techniques that can ruin the polymerization shrinkage stress of direct composite restoration.

Evaluation of the bond strength of resin cements used to lute ceramics on laser-etched dentin

OBJECTIVE

The purpose of this study was to investigate the shear bond strength (SBS) of two different adhesive resin cements used to lute ceramics on laser-etched dentin.

BACKGROUND DATA

Erbium, chromium: yttrium, scandium, gallium, garnet (Er,Cr:YSGG) laser irradiation has been claimed to improve the adhesive properties of dentin, but results to date have been controversial, and its compatibility with existing adhesive resin cements has not been conclusively determined.

MATERIALS AND METHODS

Two adhesive cements, one "etch-and-rinse" [Variolink II (V)] and one "self-etch" [Clearfil Esthetic Cement (C)] luting cement, were used to lute ceramic blocks (Vita Celay Blanks, Vita) onto dentin surfaces. In total, 80 dentin specimens were distributed randomly into eight experimental groups according to the dentin surface-etching technique used Er,Cr:YSGG laser and Er:YAG laser: (1) 37% orthophosphoric acid+V (control group), (2) Er,Cr:YSGG laser+V, (3) Er,Cr:YSGG laser+acid+V, (4) Er:YAG laser+V, (5) Er:YAG laser+acid+V, (6) C, (7) Er,Cr:YSGG laser+C, and (8) Er:YAG laser+C. Following these applications, the ceramic discs were bonded to prepared surfaces and were shear loaded in a universal testing machine until fracture. SBS was recorded for each group in MPa. Shear test values were evaluated statistically using the Mann-Whitney U test.

RESULTS

No statistically significant differences were evident between the control group and the other groups (p>0.05). The Er,Cr:YSGG laser+A+V group demonstrated significantly higher SBS than did the Er,Cr:YSGG laser+V group (p=0.034). The Er,Cr:YSGG laser+C and Er:YAG laser+C groups demonstrated significantly lower SBS than did the C group (p<0.05).

CONCLUSIONS

Dentin surfaces prepared with lasers may provide comparable ceramic bond strengths, depending upon the adhesive cement used.

Evaluation of light-curing units in rural and urban areas

OBJECTIVES

To evaluate the distribution of light-curing units (LCU) used in an urban area (Riyadh) and a rural area (Kharj) of Saudi Arabia, and to compare their irradiance values.

METHODS

The study involved three dental centers in urban areas and two in rural areas, all of which were parts of a single healthcare institution providing dental services. The light outputs (power mW) from 140 LCUs were measured by laboratory-grade spectrometry, and the irradiance (mW/cm(2)) was calculated from the tip area of each LCU. The minimum acceptable irradiance outputs for the quartz-tungsten-halogen (QTH) and light-emitting diode (LED) units were set at 300 and 600 mW/cm(2), respectively. The ages of these units and the protocol used to light-cure the resins were also determined.

RESULTS

The total number of LCUs was 140, 112 (78%) in urban areas, and 28 (22%) in rural areas. In rural areas, only 7 of the 22 (32%) QTH units delivered irradiances greater than 300 mW/cm(2) and were therefore considered clinically acceptable, whereas 4 of the 6 (66.7%) LED units delivered values greater than 600 mW/cm(2). In urban centers, 43 of 61 (70.5%) LED units and 25 of 61 (49%) QTH units were considered clinically acceptable. Irradiance values for both QTH (P < 0.01) and LED (P < 0.05) units were significantly better in urban than in rural areas.

CONCLUSIONS

Urban areas had a greater distribution of LCUs than rural areas. Overall, irradiance values were significantly higher in urban areas.

Evaluation of Light Intensity Output of QTH and LED Curing Devices in Various Governmental Health Institutions

Evaluating the intensity of a light curing unit regularly prior to the application of tooth-colored restorative materials is essential to assure the quality of restorative procedures.

Effect of different polishing systems on the surface roughness of microhybrid composites

The use of composite resins in dentistry is well accepted for restoring anterior and posterior teeth. Many polishing protocols have been evaluated for their effect on the surface roughness of restorative materials. This study compared the effect of different polishing systems on the surface roughness of microhybrid composites. Thirty-six specimens were prepared for each composite $#91;Charisma (Heraeus Kulzer), Fill Magic (Vigodent), TPH Spectrum (Dentsply), Z100 (3M/ESPE) and Z250 (3M/ESPE)] and submitted to surface treatment with Enhance and PoGo (Dentsply) points, sequential Sof-Lex XT aluminum oxide disks (3M/ESPE), and felt disks (TDV) combined with Excel diamond polishing paste (TDV). Average surface roughness (Ra) was measured with a mechanical roughness tester. The data were analyzed by two-way ANOVA with repetition of the factorial design and the Tukey-Kramer test (p<0.01). The F-test result for treatments and resins was high (p<0.0001 for both), indicating that the effect of the treatment applied to the specimen surface and the effect of the type of resin on surface roughness was highly significant. Regarding the interaction between polishing system and type of resin used, a p value of 0.0002 was obtained, indicating a statistically significant difference. A Ra of 1.3663 was obtained for the Sof-Lex/TPH Spectrum interaction. In contrast, the Ra for the felt disk+paste/Z250 interactions was 0.1846. In conclusion, Sof-Lex polishing system produced a higher surface roughness on TPH Spectrum resin when compared to the other interactions.

An in vitro study on the use of circumferential matrix bands in the placement of Class II amalgam restorations

OBJECTIVE

To compare the effectiveness of a disposable metal matrix band system and the Siqveland matrix system in the restoration of a Class II preparation with amalgam. To assess the difference in amalgam overhang produced between the two systems in vitro.

METHODS

A right maxillary first premolar with a Class II cavity preparation was duplicated in acrylic to produce a standardized cavity. Forty acrylic teeth were individually mounted in a hand-held model of an upper right quadrant and restored with amalgam by twenty dentists. Each dentist restored two replica teeth with amalgam; one using the Omni-matrix system and the other using the Siqveland matrix system. All 40 restored teeth were individually mounted on a standardised jig, viewed under a microscope, photographed and overhangs, if present, measured using Image ProPlus 4.0. A comparison of the overhangs produced by the two systems was analysed using a paired sample t-test.

RESULTS

An overhang was present in all cases. There was a significant difference in the size of the overhangs produced by the two different matrix systems (p-value 0.036). The Siqveland produced a larger overhang than the Omni-matrix system.

CONCLUSION

A commonly used matrix band (Siqveland), when compared to a newer, disposable system (Omni-matrix), was found to result in consistently larger overhangs during the restoration of class II preparations with amalgam. As Omni-matrix is a disposable system, the potential for cross-contamination is removed and it can, therefore, be considered a suitable replacement for the non-disposable Siqveland matrix system.

Use of two surface analyzers to evaluate the surface roughness of four esthetic restorative materials after polishing

This study had two aims: determine how well four esthetic restorative materials lent themselves to polishing and compare the results obtained using two different techniques for evaluating surface roughness. The four materials used were two composites modified by the addition of resin, Dyract AP (Dentsply) and Dyract Flow (Dentsply); one composite designed for posterior restorations, SureFil (Dentsply) and one universal micromatrix composite, Esthet-X (Dentsply). Five test pieces were made with each product by inserting the material into cylindrical molds and polymerizing it layer by layer. A single operator polished the specimens on the same day using the Enhance system (Dentsply) and two aluminum oxide pastes. The surfaces were studied successively by means of two surface analyzers: a high-resolution optical profilometer (Nanosurf 488, SAS Technology) and a mechanical profilometer (Mitutoyo Surftest-SV 402). These measurements gave the mean roughness of the surface (Ra). Ten zones were examined for each specimen, and the specimens were observed under an optical microscope (PMG3 inverted metallographic microscope) at 50x magnification. The qualitative and quantitative analyses of the results showed good surface states for all materials. However, the composites based on nano- and micro-filler technology gave the smoothest surfaces after polishing. A comparison of the values obtained with each method of observation showed that mechanical profilometry tended to show roughness caused by polishing, while optical profilometry brought out roughness due to the structure of the material itself.

Direct Composite Resin Restorations: A Review of Some Clinical Procedures to Achieve Predictable Results in Posterior Teeth

The interest of patients in having tooth-colored restorations and the development of techniques and materials that make these restorations easier have contributed to make the esthetic restoration of posterior teeth popular. The direct use of composites in posterior teeth is a technique-sensitive procedure. Some difficulties, nevertheless, can be overcome or at least minimized by a heedful clinician by paying thorough attention to the various stages of the restorative technique. The present article seeks to review some concepts about this adhesive restorative procedure and to illustrate the possibilities of the technique with clinical reports.

CLINICAL SIGNIFICANCE

The direct posterior composite restorative technique offers the possibility of closely matching the natural optical characteristics of the lost tooth structure. Aimed at showing the potential of this technique, this article presents two step-by-step case reports and also reviews some concepts related to these clinical procedures.

Ceramic Inlays and Onlays: Clinical Procedures for Predictable Results

The use of ceramics as restorative materials has increased substantially in the past two decades. This trend can be attributed to the greater interest of patients and dentists in this esthetic and long-lasting material, and to the ability to effectively bond metal-free ceramic restorations to tooth structure using acid-etch techniques and adhesive cements. The purpose of this article is to review the pertinent literature on ceramic systems, direct internal buildup materials, and adhesive cements. Current clinical procedures for the planning, preparation, impression, and bonding of ceramic inlays and onlays are also briefly reviewed. A representative clinical case is presented, illustrating the technique.

CLINICAL SIGNIFICANCE

When posterior teeth are weakened owing to the need for wide cavity preparations, the success of direct resin-based composites is compromised. In these clinical situations, ceramic inlays/onlays can be used to achieve esthetic, durable, and biologically compatible posterior restorations.

Fracture resistance of prepared teeth restored with bonded inlay restorations

STATEMENT OF PROBLEM

intact, prepared, and restored human maxillary premolars.

MATERIAL AND METHODS

Fifty intact, noncarious human maxillary premolars were divided into 5 groups of 10 and were mounted with their roots imbedded in autopolymerized acrylic. In the first group, the teeth were intact with no preparation. In the other 4 groups, Class II MOD preparations were made with a water-cooled high-speed hand piece. In 1 group, the cavity preparations were restored with bonded CAD/CAM ceramic inlays. In 2 groups, the preparations were restored with bonded CAD/CAM composite inlays (acid etched or air particle abraded). In the final group, the teeth were prepared but unrestored. Specimens were tested individually in a universal testing machine, in which a 4.82-mm-diameter steel sphere plunger was mounted in the crosshead moving at 0.5 mm/min. The plunger contacted the facial and lingual triangular ridges beyond the margins of the restorations. Peak load to fracture (N) was measured for each specimen. Means were calculated and analyzed with analysis of variance (P</=.05).

RESULTS

MOD preparations weakened the teeth by approximately 59%. Restoring the teeth with ceramic or composite inlays did not significantly strengthen the teeth under this testing system. Of the restored teeth, those restored with indirect composite inlays cemented following manufacturer's recommendations had the highest fracture resistance.

CONCLUSION

Within the limitations of this study, under static compression load testing, bonded inlay restorations did not strengthen maxillary premolars with large MOD preparations.