Marginal fracture of posterior composite resins

Direct composite resin fillings versus amalgam fillings for permanent posterior teeth

BACKGROUND

Traditionally, amalgam has been used for filling cavities in posterior teeth, and it continues to be the restorative material of choice in some low- and middle-income countries due to its effectiveness and relatively low cost. However, there are concerns over the use of amalgam restorations (fillings) with regard to mercury release in the body and the environmental impact of mercury disposal. Dental composite resin materials are an aesthetic alternative to amalgam, and their mechanical properties have developed sufficiently to make them suitable for restoring posterior teeth. Nevertheless, composite resin materials may have potential for toxicity to human health and the environment. The United Nations Environment Programme has established the Minamata Convention on Mercury, which is an international treaty that aims "to protect the [sic] human health and the environment from anthropogenic emissions and releases of mercury and mercury compounds". It entered into force in August 2017, and as of February 2021 had been ratified by 127 governments. Ratification involves committing to the adoption of at least two of nine proposed measures to phase down the use of mercury, including amalgam in dentistry. In light of this, we have updated a review originally published in 2014, expanding the scope of the review by undertaking an additional search for harms outcomes. Our review synthesises the results of studies that evaluate the long-term effectiveness and safety of amalgam versus composite resin restorations, and evaluates the level of certainty we can have in that evidence.

OBJECTIVES

To examine the effects (i.e. efficacy and safety) of direct composite resin fillings versus amalgam fillings.

SEARCH METHODS

An information specialist searched five bibliographic databases up to 16 February 2021 and used additional search methods to identify published, unpublished and ongoing studies SELECTION CRITERIA: To assess efficacy, we included randomised controlled trials (RCTs) comparing dental composite resin with amalgam restorations in permanent posterior teeth that assessed restoration failure or survival at follow-up of at least three years. To assess safety, we sought non-randomised studies in addition to RCTs that directly compared composite resin and amalgam restorative materials and measured toxicity, sensitivity, allergy, or injury.

DATA COLLECTION AND ANALYSIS

We used standard methodological procedures expected by Cochrane.

MAIN RESULTS

We included a total of eight studies in this updated review, all of which were RCTs. Two studies used a parallel-group design, and six used a split-mouth design. We judged all of the included studies to be at high risk of bias due to lack of blinding and issues related to unit of analysis. We identified one new trial since the previous version of this review (2014), as well as eight additional papers that assessed safety, all of which related to the two parallel-group studies that were already included in the review. For our primary meta-analyses, we combined data from the two parallel-group trials, which involved 1645 composite restorations and 1365 amalgam restorations in 921 children. We found low-certainty evidence that composite resin restorations had almost double the risk of failure compared to amalgam restorations (risk ratio (RR) 1.89, 95% confidence interval (CI) 1.52 to 2.35; P < 0.001), and were at much higher risk of secondary caries (RR 2.14, 95% CI 1.67 to 2.74; P < 0.001). We found low-certainty evidence that composite resin restorations were not more likely to result in restoration fracture (RR 0.87, 95% CI 0.46 to 1.64; P = 0.66). Six trials used a split-mouth design. We considered these studies separately, as their reliability was compromised due to poor reporting, unit of analysis errors, and variability in methods and findings. Subgroup analysis showed that the findings were consistent with the results of the parallel-group studies. Three trials investigated possible harms of dental restorations. Higher urinary mercury levels were reported amongst children with amalgam restorations in two trials, but the levels were lower than what is known to be toxic. Some differences between amalgam and composite resin groups were observed on certain measures of renal, neuropsychological, and psychosocial function, physical development, and postoperative sensitivity; however, no consistent or clinically important harms were found. We considered that the vast number of comparisons made false-positive results likely. There was no evidence of differences between the amalgam and composite resin groups in neurological symptoms, immune function, and urinary porphyrin excretion. The evidence is of very low certainty, with most harms outcomes reported in only one trial.

AUTHORS' CONCLUSIONS

Low-certainty evidence suggests that composite resin restorations may have almost double the failure rate of amalgam restorations. The risk of restoration fracture does not seem to be higher with composite resin restorations, but there is a much higher risk of developing secondary caries. Very low-certainty evidence suggests that there may be no clinically important differences in the safety profile of amalgam compared with composite resin dental restorations. This review supports the utility of amalgam restorations, and the results may be particularly useful in parts of the world where amalgam is still the material of choice to restore posterior teeth with proximal caries. Of note, however, is that composite resin materials have undergone important improvements in the years since the trials informing the primary analyses for this review were conducted. The global phase-down of dental amalgam via the Minamata Convention on Mercury is an important consideration when deciding between amalgam and composite resin dental materials. The choice of which dental material to use will depend on shared decision-making between dental providers and patients in the clinic setting, and local directives and protocols.

Direct composite resin fillings versus amalgam fillings for permanent or adult posterior teeth

BACKGROUND

Amalgam has been the traditional material for filling cavities in posterior teeth for the last 150 years and, due to its effectiveness and cost, amalgam is still the restorative material of choice in certain parts of the world. In recent times, however, there have been concerns over the use of amalgam restorations (fillings), relating to the mercury release in the body and the environmental impact following its disposal. Resin composites have become an esthetic alternative to amalgam restorations and there has been a remarkable improvement of its mechanical properties to restore posterior teeth.There is need to review new evidence comparing the effectiveness of both restorations.

OBJECTIVES

To examine the effects of direct composite resin fillings versus amalgam fillings for permanent posterior teeth, primarily on restoration failure.

SEARCH METHODS

We searched the Cochrane Oral Health Group's Trials Register (to 22 October 2013), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2013, Issue 9), MEDLINE via OVID (1946 to 22 October 2013), EMBASE via OVID (1980 to 22 October 2013), and LILACs via BIREME Virtual Health Library (1980 to 22 October 2013). We applied no restrictions on language or date of publication when searching the electronic databases. We contacted manufacturers of dental materials to obtain any unpublished studies.

SELECTION CRITERIA

Randomized controlled trials comparing dental resin composites with dental amalgams in permanent posterior teeth. We excluded studies having a follow-up period of less than three years.

DATA COLLECTION AND ANALYSIS

We used standard methodological procedures expected by The Cochrane Collaboration.

MAIN RESULTS

Of the 2205 retrieved references, we included seven trials (10 articles) in the systematic review. Two trials were parallel group studies involving 1645 composite restorations and 1365 amalgam restorations (921 children) in the analysis. The other five trials were split-mouth studies involving 1620 composite restorations and 570 amalgam restorations in an unclear number of children. Due to major problems with the reporting of the data for the five split-mouth trials, the primary analysis is based on the two parallel group trials. We judged all seven trials to be at high risk of bias and we analyzed 3265 composite restorations and 1935 amalgam restorations.The parallel group trials indicated that resin restorations had a significantly higher risk of failure than amalgam restorations (risk ratio (RR) 1.89, 95% confidence interval (CI) 1.52 to 2.35, P value < 0.001 (fixed-effect model) (low-quality evidence)) and increased risk of secondary caries (RR 2.14, 95% CI 1.67 to 2.74, P value < 0.001 (low-quality evidence)) but no evidence of an increased risk of restoration fracture (RR 0.87, 95% CI 0.46 to 1.64, P value = 0.66 (moderate-quality evidence)). The results from the split-mouth trials were consistent with those of the parallel group trials.Adverse effects of dental restorations were reported in two trials. The outcomes considered were neurobehavioral function, renal function, psychosocial function, and physical development. The investigators found no difference in adverse effects between composite and amalgam restorations. However, the results should be interpreted with caution as none of the outcomes were reported in more than one trial.

AUTHORS' CONCLUSIONS

There is low-quality evidence to suggest that resin composites lead to higher failure rates and risk of secondary caries than amalgam restorations. This review reinforces the benefit of amalgam restorations and the results are particularly useful in parts of the world where amalgam is still the material of choice to restore posterior teeth with proximal caries. Though the review found insufficient evidence to support or refute any adverse effects amalgam may have on patients, new research is unlikely to change opinion on its safety and due to the decision for a global phase-down of amalgam (Minamata Convention on Mercury) general opinion on its safety is unlikely to change.

Effect of polishing direction on the marginal adaptation of composite resin restorations

PROBLEM

Polishing composite resin restorations may lead to marginal defects and gap formation.

PURPOSE

To assess the effect of polishing direction on the marginal adaptation of composite resin restorations using two composite resins and two polishing systems.

MATERIALS AND METHODS

Forty extracted human molars were sectioned along their mesio-distal axis. Buccal and lingual enamel was flattened and a triangular preparation, 0.87-mm deep and 3-mm wide, representing two 60° bevels, was performed. Specimens were randomly assigned to eight groups (N = 20) and restored with two composite resins: a nanofilled (Filtek Supreme Ultra, 3M ESPE, St. Paul, MN, USA) or a microhybrid (Point 4, Kerr, Orange, CA, USA) and finished with two polishing techniques: polishing discs (Sof-Lex XT, 3M ESPE) or rubber polishers (HiLuster Plus, Kerr, Bioggio, Switzerland). On each specimen, both margins were polished with the same technique, one margin from composite resin to tooth and the other from tooth to composite resin. Replicas were made for field emission scanning electron microscope observation (200×) and quantitative margin analysis was performed based on four criteria. Data were analyzed with a paired-sample t-test, a two-sample t-test, and one-way analysis of variance or their nonparametric analog.

RESULTS

Significant differences were found in most groups between polishing directions with better marginal adaptation from composite resin to tooth than from tooth to composite resin. Differences between composite resins and polishing techniques seemed to be dependent on certain combinations of composite resin, polishing technique, and polishing direction.

CONCLUSION

Polishing from composite resin to tooth leads to better marginal adaptation than polishing from tooth to composite resin.

CLINICAL SIGNIFICANCE

The results obtained from this in vitro study suggest that polishing direction influences the marginal adaptation of composite resins and that polishing from composite resin to tooth structure should be clinically performed whenever possible on accessible margins to preserve marginal integrity and esthetics.

Edge strength of resin-composite margins

OBJECTIVES

Marginal integrity is a major clinical problem in restorative dentistry. The aim of this study was to evaluate the applicability of an edge strength measurement device in an in vitro test to determine the force required to fracture flakes of material by a Vickers indentation at progressively increasing distances from an interface edge of bulk material.

METHODS

Five representative resin-composites were investigated. Fourteen disks of specimens (12mm diameter x 2.5mm thick) were prepared for each material. These were divided into seven sub-groups corresponding to different edge-distances (0.4, 0.5, 0.6, 0.7, 0.8, 0.9 and 1.0mm). An edge strength measurement device (CK10) (Engineering Systems, Nottingham, UK) was used. The mode of the failure of each specimen was examined under the integral microscope of the CK10.

RESULTS

The force (N)-to-fracture at a distance of 0.5mm from the edge was defined as the edge strength. The highest failure force (edge strength) was observed for Tetric Ceram (174.2N) and the lowest for Filtek Supreme (enamel) (87.0N). Correlations between the failure-forces to fracture materials with edge-distance were regression analyzed giving coefficients (r) ranging from 0.94 (p=0.02) to 0.99 (p=0.01). Two modes of failure were observed: chipping and--generally at greater distances--cracking.

SIGNIFICANCE

Edge strength is a definable and potentially useful parameter to characterize this aspect of clinically related behavior. A standardized distance of 0.5mm from the specimen's edge, when chipping failure prevails, is suitable and convenient as a reference point.

Discontinuous fiber-reinforced composites above critical length

Micromechanical physics of critical fiber length, describing a minimum filament distance for resin impregnation and stress transfer, has not yet been applied in dental science. As a test of the hypothesis that 9-micron-diameter, 3-mm-long quartz fibers would increase mechanical strength over particulate-filled composites, photocure-resin-pre-impregnated discontinuous reinforcement was incorporated at 35 wt% into 3M Corporation Z100, Kerr Corporation HerculiteXRV, and an experimental photocure paste with increased radiopaque particulate. Fully articulated four-point bend testing per ASTM C 1161-94 for advanced ceramics and Izod impact testing according to a modified unnotched ASTM D 256-00 specification were then performed. All photocure-fiber-reinforced composites demonstrated significant improvements over particulate-filled compounds (p < 0.001) for flexural strength, modulus, work of fracture, strain at maximum load, and Izod toughness, with one exception for the moduli of Z100 and the experimental reinforced paste. The results indicate that inclusion of pre-impregnated fibers above the critical aspect ratio yields major advancements regarding the mechanical properties tested.

Self-etching primer and resin-based restorative material: two-year clinical evaluation

PURPOSE

This study was undertaken to evaluate the performance of posterior restorations placed using a self-etching primer (Fluorobond, Shofu Inc., Kyoto, Japan) and a universal resin-based restorative material (Beautifil, Shofu Inc., Kyoto, Japan).

MATERIALS AND METHODS

The 61 restorations evaluated were 26 Class I and 35 Class II that were placed by two clinicians in 31 patients. Two other calibrated clinicians evaluated the restorations using United States Public Health Service (USPHS)/Ryge criteria observing the following characteristics: color match, marginal adaptation, anatomy, roughness, marginal staining, interfacial staining, contact, secondary caries, and luster. Restorations were placed under rubber dam isolation. Chi-squared and Fisher's exact tests were used for statistical analysis (p = .05).

RESULTS

All the restorations were assessed at baseline and alfa scores predominated for all criteria. At the 12-month recall examination, one patient dropped out of the study and two restorations were replaced by a clinician not involved in the project. At 24-month recall, 58 restorations were examined (23 Class I and 35 Class II). From baseline to 24 months, 19 of the 44 restorations changed from alfa to bravo and 13 from bravo to alfa for a variety of reasons. No significant differences were found for any of the clinical criteria (p > .05). The 2-year recall substantiated the 1-year results.

CONCLUSION

Beautifil and the self-etching primer Fluorobond provided satisfactory restorations after a 2-year observation period.

CLINICAL SIGNIFICANCE

Beautifil restorative material and Fluorobond bonding system provided satisfactory results when placed in Class I and Class II preparations for a period of 2 years.

In vivo evaluation of the surface of posterior resin composite restorations: a pilot study

STATEMENT OF PROBLEM

Several methods have been used to determine the surface characteristics of resin composites in vivo and compare composite wear rates with enamel wear rates.

PURPOSE

This pilot study describes the surface characteristics of resin composites and the wear of resin composites and enamel during 1 year of in vivo service.

MATERIAL AND METHODS

A single Class II posterior resin composite restoration (Z100) was placed in 10 patients. Restored teeth and unrestored adjacent control teeth were measured for wear 4 times within the first year. A null point contact stylus profiler and fitting software were used to measure epoxy casts. Maximum depth of wear, average depth of wear, and characteristics of the restoration margin were determined. Paired t tests were used to compare the control and restored teeth, and ANOVA was used to assess the progression of wear over time (P<.05).

RESULTS

After 1 year, maximum depth of wear over the entire preparation region was on average 204.8 microm (+/- 129.8), significantly greater than the 36. 8 microm (+/- 10.1) average maximum depth of wear of enamel at occlusal contact areas on control teeth (P=.009). Maximum depth of wear progressed over time (P=.009). Fracture of excess composite, commonly called flash fracture, occurred in 50% of the restored teeth extending over the preparation margin.

CONCLUSION

Composite restorations wore significantly faster than enamel contact areas on control teeth. Also of concern were the marginal flash fractures that could facilitate secondary caries.

In vitro evaluation of the marginal degradation of dental composites under simulated occlusal loading

OBJECTIVES

Our objective was to use an in vitro oral wear simulator to compare the susceptibility to marginal breakdown of different classes of dental composites.

METHODS

Two microfill composites (Silux Plus, 3M and Heliomolar, Vivadent), two minifills (Z100, 3M and Herculite, Kerr) and two midifills (Fulfil, Caulk and Clearfil, Kuraray) were placed in two increments (40 s cure) into class I cavities (5 x 3.5 x 2 mm3 deep) cut into the facial enamel surfaces of bovine incisors treated with an adhesive (Scotchbond MP, 3M). The restored teeth were aged 1 day in water, mounted in the OHSU oral wear simulator, covered with a slurry of poppy seeds/PMMA beads and subjected to 50 K cycles of wear against an enamel stylus [J.R. Condon, J.L. Ferracane, Evaluation of composite wear with a new multi-mode oral wear simulator, Dent. Mater. 12 (1996) 218-226). The specimens (n = 10) were positioned to produce abrasive wear (load = 20 N] across one margin and attrition wear (load = 70 N) across the second margin. Volume loss of material (mm3 x 1000) was estimated from 10 profilometric tracings perpendicular to the attrition margin, and then differentiated into composite and enamel degradation. Fracture toughness of the composites was measured in bending with the single-edge notch technique. Results were compared with ANOVA and Tukey's test at p < 0.05.

RESULTS

Significant wear of the composite was produced at the attrition margin. Enamel degradation at the margin paralleled the composite results. The microfills, and to a lesser extent the minifills, showed more marginal breakdown than the midifill composites. Marginal breakdown shows an excellent inverse correlation with fracture toughness for these composites.

SIGNIFICANCE

These results are in general agreement with clinical studies showing greater marginal degradation for microfill composites and suggest that the OHSU oral wear simulator may be a useful adjunct for the study of the marginal degradation of dental composites.

A clinical evaluation of posterior composite resin restorations: 8-year findings

OBJECTIVES

From a continuing investigation of the clinical performance of three different types of composite resin, the findings of the clinical evaluation at 8 years are presented.

METHODS

One operator placed 330 restorations in Class I and Class II preparations in the posterior teeth of 72 patients. Every patient received at least one restoration of each type of material: a microfilled composite, a small particle hybrid, a relatively coarse particle hybrid, and an amalgam control. Restorations were evaluated using clinical criteria.

RESULTS

Forty six patients attended the 8-year recall. Twenty-five of the 213 restorations (13.7% of the composites and 5.8% of the amalgams) originally placed in these 46 patients had previously failed or been lost from the study or were assessed as requiring replacement at the 8-year recall. Bulk fracture and secondary caries at the margin were the most common forms of failure in the composite restorations. Other failures or losses were associated with a non-margin defect in the composite, caries not associated with the restoration, pulpal considerations, extraction for orthodontics and reasons unknown. One-hundred and ninety-three restorations (including five that required replacement) were available for clinical evaluation at 8 years and these included 17 Class II restorations. Significantly fewer restorations placed with the coarse particle hybrid exhibited evidence of marginal deterioration.

CONCLUSION

At 8 years, composite restorations in posterior teeth had failed at a rate two to three times that of amalgam restorations. The most common types of failure were bulk fracture and secondary caries at the margin.

Wear and marginal breakdown of composites with various degrees of cure

Loss of anatomical form due to wear has been cited as one factor limiting the clinical use of posterior composites. The physical properties and possibly the wear resistance of composite are influenced by the extent to which it is cured. The aim of this study was to vary degree of conversion (DC) in composites to test the hypothesis that resistance to wear and marginal breakdown could be improved by enhanced curing. A light-cured hybrid composite containing a 50% Bis-GMA/50% TEGDMA resin and 62 vol% of strontium glass (1 to 2 microm) with microfill silica was formulated (Bisco). Composite was placed into two 2.5-mm-diameter cylindrical holes in Co-Cr teeth replacing first and second molars in the mandibular dentures of 50 edentulous patients. The composites were light-cured for different time periods (9 s, 12 s, 25 s, 40 s, and 40 s + 10 min at 120 degrees C) and then polished. The microfill Heliomolar was also tested. DC (%) was measured by FTIR and ranged between 55% for 9 s of light-curing and 67% for 40 s of light-curing followed by heat application. Impressions were evaluated at baseline, 6 mo, 1 yr, and 2 yrs. Stone casts were evaluated independently by three observers to determine the % of the total margin exhibiting breakdown. Epoxy replicas were measured with a profilometer for wear. Wear of the hybrid composite at 2 yrs ranged from a high of 144 microm with 9 s of light-curing to a low of 36 microm with 40 s of light-curing followed by heat. Heliomolar exhibited from 11 to 16 microm of wear at 2 yrs. There was a strong negative correlation (r2 = 0.91) between the degree of cure and the abrasive wear of the hybrid composites. Marginal breakdown was negligible for the hybrids, and was reduced for the microfill from 40% to 15% of the margin by heat treatment. This study showed that the resistance to abrasive wear of a dental composite could be improved by enhancement of its degree of conversion.

Influence of light intensity on two restorative systems

OBJECTIVES

High intensity curing lights are recommended almost universally on the basis of immediate curing depth measurements. Although this single factor is well documented, the influence of light intensity on other parameters has not been investigated extensively.

METHODS

Two restorative systems were examined with two light intensities in regard to four properties; polymerization shrinkage (density method), flexural modulus and strength (ISO 4049), hardness profiles after post-cure (Vickers), and marginal adaptation in dentine cavities (quantitative margin analysis).

RESULTS

The variation in light intensity did not significantly affect curing contraction or post-cure hardness profiles to a depth of 4.5 mm for either resin composite. Significant differences were found in flexural modulus with both restoratives; only one material demonstrated a light intensity-related influence on flexural strength. Marginal gap formation increased in each bonding agent/resin composite pair with increased light intensity.

CONCLUSION

In clinically relevant layer thicknesses, curing a resin composite with a higher intensity light may demonstrate significant disadvantages due to increased shrinkage stress.

A clinical evaluation of posterior composite resin restorations

There is a trend towards manufacturers seeking to provide dentists with a single, all-purpose composite resin, usually of the small particle hybrid type. This three-year clinical study compared the clinical performance of three different types of composite resin used in posterior teeth and identified several modes of failure. Of the 330 restorations (three composite resins and one amalgam control) initially placed in 72 patients, 223 restorations in 48 patients were available for evaluation at three years. Modified clinical criteria for assessing the restorations were able to discriminate among the composite resins. A microfilled composite and a small particle hybrid exhibited increasing evidence of marginal fracture (crevice) with time. In addition, the small particle hybrid showed evidence of wear at the margins more frequently than the other materials. Of the restorations available for assessment, four restorations of each of these two types of composite resin required replacement during the study. Coarse particle hybrid restorations showed evidence of wear but little evidence of marginal fracture.

Meta-analysis on long-term clinical performance of posterior composite restorations

Meta-analysis is a formalized method of combining results of different studies to provide conclusions about the effectiveness of a treatment modality. The aims of this study were to use meta-analysis to determine the clinical performance of posterior composite restorations using the assessment criteria of the USPHS guidelines by combining data from selected multiple studies and to estimate the overall survival rates of posterior composite restorations over time. A computer-aided search of the literature revealed 97 publications on clinical trials of posterior composites in the last 10 years. Following specific selection criteria, which included the year and language of publication, duration of study, class of cavities restored and type of resin composite material used and clinical characteristics assessed; 16 studies were found to be suitable for, and included in a meta-analysis. These involved eight different resin composite materials. Assessment criteria data were extracted from each selected study and tabulated on the basis of years of follow-up and materials. The criteria were coded as binary variables. Homogeneity amongst studies was assessed using Woolf's statistic prior to combining the data. Weighted average proportions and standard errors were determined for each of the assessment criteria. Using Kaplan-Meier estimates, survival analyses of individual assessment criteria (outcomes) for two posterior composite materials were conducted and the resultant survival curves for these outcomes for the two materials are presented. Considering the limited number of studies of variable length available for meta-analysis, the results indicate generally high clinical performance of the various posterior composites for the number of outcomes analysed.

Direct posterior composite resin restorations: a review. 2. Clinical technique

Despite the increased use of composite resin to restore posterior teeth, there is evidence that clinicians should be selective in their use of these restorations. This paper describes the clinical technique--preparatory procedures, preparation of the cavity, preparation for placement of composite resin, placement of composite resin and finishing of the restoration--for the relatively conservative use of composite resin in posterior teeth and reviews the literature to discuss briefly many of the controversial aspects of the technique.

Direct posterior composite resin restorations: a review. 1. Factors influencing case selection

The principal factors that influence case selection for direct composite resin restorations in posterior teeth are discussed. These include the perceived preference for tooth-coloured aesthetics, survival rate and replacement of posterior composites, clinical problems and concerns such as occlusal surface defects and the numerous effects of the material's polymerization contraction, and the availability of alternative tooth-coloured techniques for restoring posterior teeth. Specific guidelines in case selection are suggested. A subsequent paper reviews controversial aspects of the restorative technique for posterior composites and, on this basis, defines important principles in the clinical technique.

Assessment of marginal degradation of restorations on impressions

The study aimed to validate the scoring of the degree of marginal degradation of amalgam restorations by using impressions, as an alternative to other indirect scoring methods using photographs or casts. Ten-year-old condensation silicone elastomer impressions and epoxy replicas made in 1979 were compared in a scanning electron microscope at 5 kV with different magnifications up to x200. The impression material was not distorted or degraded, and the dimensional stability was good after 10 years of storage in a dry environment. The inter-examiner agreement of the scorings of impressions and a six-point scale reference set was satisfactory as evaluated by kappa statistics, demonstrating that degrees of marginal degradation can be distinguished on impressions with relatively high accuracy. The rating distribution of the scorings of impressions showed good correlation to the rating distributions obtained with the clinical USPHS rating method and with photographs for recording marginal degradation. A slight difference between the photographic and impression ratings at the upper and lower levels of the six-point rating scale was observed. The difference varied with the type of alloy, possibly due to a bias depending on the surface quality--that is, whether the restoration kept the glossiness of high polishing or became heavily tarnished.

Report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry

Dental research continued to grow during 1988. Unfortunately the quality does not always parallel the quantity of publications. This report obviously does not encompass all of the literature but focuses on studies that are related to trends and to matters that are considered controversial. Likewise the particular interests of the members of the American Academy of Restorative Dentistry were taken into consideration. The subjects covered include periodontics, preventive dentistry, bulp biology, craniomandibular disorders, ceramics, color in restorative dentistry, and dental materials.