Using packable composites for direct posterior placement

Performance of bulk-fill versus conventional nanocomposite resin restorations supporting the occlusal rests of removable partial dentures: An in vitro investigation

STATEMENT OF PROBLEM

Placing removable partial denture (RPD) rests on composite resin restorations has long been a debatable issue. Despite developments in composite resins such as nanotechnology and bulk-filling techniques, studies investigating the performance of composite resin restorations when used to support occlusal rests remain scarce.

PURPOSE

The purpose of this in vitro study was to investigate the performance of bulk-fill versus incremental (conventional) nanocomposite resin restorations when they are used to support RPD rests under functional loading.

MATERIAL AND METHODS

Thirty-five caries-free intact maxillary molars of similar coronal size were collected and divided into 5 equal groups (n=7): Enamel (Control) group: rest seats prepared entirely in enamel; Class I Incremental group: Class I cavities restored with incrementally placed nanohybrid resin composite resin (Tetric N-Ceram); Class II Incremental group: Mesio-occlusal (MO) Class II cavities restored with Tetric N-Ceram; Class I Bulk-fill group: Class I cavities restored with high-viscosity bulk-fill hybrid resin composite (Tetric N-Ceram Bulk-Fill); and Class II Bulk-fill group: MO Class II cavities restored with Tetric N-Ceram Bulk-Fill. Occlusal rest seats were prepared mesially in all groups, and clasp assemblies were fabricated and cast in cobalt-chromium alloy. Specimens with their clasp assemblies were subjected to thermomechanical cycling using a mechanical cycling machine (250 000 masticatory cycles) and 5000 thermal cycles (5 °C to 50 °C). Surface roughness (Ra) was measured with a contact profilometer before and after cycling. Fracture analysis was done using stereomicroscopy, and margin analysis was done with a scanning electron microscope (SEM) before and after cycling. Statistical analysis of Ra was conducted using ANOVA followed by the Scheffé test for between-group comparison and paired t test for within-group comparison. The Fisher exact probability test was used for fracture analysis. The Mann-Whitney test was used for between-group comparison and Wilcoxon signed rank test for within-group comparison for the SEM images (α=.05).

RESULTS

Mean Ra increased significantly after cycling in all groups. Significant differences in Ra were found between enamel and all 4 resin groups (P<.001), with no significant differences between incremental and bulk-fill resin groups for both Class I and II specimens (P>.05). No significant differences were found between the 2 resin groups with regard to fracture and margin analysis (P>.05).

CONCLUSIONS

The surface roughness of enamel was significantly lower than that of both incremental and bulk-fill nanocomposite resins before and after functional loading. Incremental and bulk-fill nanocomposite resins showed comparable performance in terms of surface roughness, fracture behavior, and marginal adaptation.

Effect of different adhesive systems on dental defects and sensitivity to teeth in composite resin restoration: a systematic review and meta-analysis

OBJECTIVES

This meta-analysis aimed to elucidate the effects of various acid etching patterns on the sensitivity of teeth and their clinical effectiveness following composite resin repair.

MATERIALS AND METHODS

PubMed, Cochrane Library, Web of Science, and Embase databases were searched for relevant studies on the postoperative sensitivity (POS) of composite resin restorations after using different bonding systems. The retrieval was from the inception of the databases to August 13, 2022, with no filter of written language. Literature screening was conducted by two independent researchers. The Cochrane risk-of-bias assessment tool was adopted for quality evaluation, and Stata 15.0 for analysis.

RESULTS

Twenty-five randomized controlled trials were included in the present study. Following resin composite restoration, 1309 restorations were bonded by self-etching (SE) adhesives, whereas 1271 restorations were bonded by total-etching (TE) adhesives. The meta-analyses showed that there is no evidence to prove the SE and TE will affect POS at present when measured using the modified United States Public Health Service (USPHS) criteria [RR = 1.00 (95% CI: 0.96, 1.04)], the World Dental Federation (FDI) [RR = 1.06 (95% CI: 0.98, 1.15)], or the visual analog scale (VAS) [SMD = 0.02 (95% CI: -0.15, 0.20)] scales. At a certain follow-up time, TE adhesives provide better outcomes in terms of color match, marginal staining, and marginal adaptation. In other words, TE adhesives have better esthetic results.

CONCLUSIONS

The type of bonding technique (ER and SE) does not affect the risk and degree of POS in class I/II and class V restorations. Further research is required to verify whether these findings apply to different forms of composite resin restorations.

CLINICAL RELEVANCE

Besides the fact that TE barely increase postoperative sensitivity, it also yields superior cosmetic results.

Evaluation of remineralizing effect of zinc-carbonate hydroxyapatite on the reduction of postrestorative sensitivity: A randomized controlled clinical trial

Background

The adhesive bonding ability of composite resins makes it unnecessary to remove tooth structure for retention, prevention, and convenience. However, postoperative sensitivity after placing composite restoration has been a significant problem experienced by clinicians.

Aim

The present randomized controlled trial was conducted to assess the role of dentin remineralization in the reduction of postoperative sensitivity after composite placement.

Materials and Methods

Eighty participants with occlusal carious teeth were randomly allocated to one of the four study groups, each having 20 participants, and are as follows: Group A with test group, Group A with control group, Group B with test group, and Group B with control group. Postoperative sensitivity was assessed using the Visual Analog Scale (VAS) and the United States Public Health Service (USPHS) criteria at different time intervals such as baseline, 1 week, 1 month, and 3 months. Data were analyzed using the Kruskal-Wallis ANOVA test, Mann-Whitney U-test, and Wilcoxon matched-pair test.

Results

All 80 participants were analyzed at the baseline, 1 week, 1 month, and the end of 3 months for the postoperative sensitivity using the VAS score and USPHS criteria. One restoration in Group A with control group reported mild sensitivity at the end of 1 week and one restoration in Group B with control group reported severe sensitivity at the end of 3 months, necessitating its replacement followed by root canal treatment. No relationship was reported between postoperative sensitivity and tooth type. There was no statistically significant difference in postoperative sensitivity in any of the treatment modalities.

Conclusion

Class I restoration using self-etch or selective-etch as well as with or without zinc-carbonate hydroxyapatite is a viable and predictable solution for the reduction of postoperative sensitivity if all the aspects of restorative techniques are considered precisely.

Effects of Adjacent Tooth Type and Occlusal Fatigue on Proximal Contact Force of Posterior Bulk Fill and Incremental Resin Composite Restoration

OBJECTIVES

To measure the proximal contact force in newtons (N) between incremental and bulk fill class II resin composite restorations and implant molar teeth or adjacent premolar teeth with simulated periodontal ligament.

METHODS

The model used was created with a typodont first molar tooth with two bilateral occlusal-proximal class II cavities, an adjacent tooth simulating an implanted molar tooth (Titamax CM, Neodent, Curtiba, PR, Brazil) and a premolar with simulated periodontal ligament. Two resin composite restorative techniques were used: Inc-Z350XT, (Filtek Z350, 3M Oral Care, St. Paul, MN, USA) inserted incrementally and Bulk-OPUS, (Opus Bulk Fill APS, FGM, Joinville, SC, Brazil) high viscosity bulk fill resin composite (n=10). As a control, a typodont having intact teeth without restorations was used. After the restorative procedure, each specimen was radiographed using a digital system (Dürr Dental, Bietigheim-Bissingen, Germany). The proximal contact force (N) was measured using dental floss with a microtensile machine (Microtensile ODEME, Luzerna, SC, Brazil). The specimens were then subjected to mechanical fatigue cycling to simulate 5 years of aging. All the parameters were measured after aging. The X-rays were blindly qualitatively analyzed by two operators to identify the loss of proximal contact. One-way ANOVA was used for comparing the initial contact force between restored and intact teeth. Two-way ANOVA followed by Tukey testing was performed for contact area data and for the contact force/contact area ratio. The proximal contact force data were analyzed using one-way repeated measurement ANOVA followed by Tukey testing (α=0.05). The X-ray proximal contact analyses were described by the frequency.

RESULTS

The initial proximal contact force was similar for intact and restored teeth. The contact force and contact area with the molar were significantly higher than with the premolar; however the contact force/contact area ratio was similar for all tested groups. The bulk fill technique showed a contact force similar to the incremental filling technique. Fatigue resulted in a significant reduction in the proximal contact force (p<0.001), irrespective of the region analyzed or restorative material used. The digital X-rays detected no alteration in the proximal contact after occlusal fatigue.

CONCLUSIONS

Larger contact area resulted in higher proximal contact force. Proximal contact force decreased with 5 years of simulated occlusal fatigue. The bulk fill technique showed a proximal contact force similar to that of the incremental filling technique.

Water Aging Reverses Residual Stresses in Hydrophilic Dental Composites

Dental composites develop residual stresses during polymerization due to shrinkage. These stresses may change with time because of relaxation and water sorption in the oral environment. This phenomenon is likely dependent on the composition of the materials, specifically their hydrophilic characteristics, and could result in deleterious stresses on restorative materials and tooth structure. The purpose of this experiment was to use the thin ring-slitting method to compare the residual stress generated within composite materials of varying hydrophilicity when aged in wet and dry conditions after polymerization. Water sorption, solubility, elastic modulus, and residual stresses were measured in 6 commercial composites/cements aged in water and dry conditions. The self-adhesive resin cement showed the highest water sorption and solubility. All composites showed initial residual contraction stresses, which were maintained when aged dry. Residual stresses in 2 of the self-adhesive cements and the polyacid-modified composite aged in wet conditions resulted in a net expansion. This experiment verified that residual shrinkage stresses in dental composites can be reversed during aging in water, resulting in a net expansion, with the effect directly related to their hydrophilic properties.

Effect of dentin sealers on postoperative sensitivity of complete cast crowns cemented with glass ionomer cement

PURPOSE

The purpose of this study was to clinically evaluate the effects of pretreatments with copal/ether varnish and dentin bonding system on postoperative sensitivity of complete cast crowns cemented with glass ionomer cement.

MATERIALS AND METHODS

Three posterior teeth with no pain symptoms were selected from each of 17 patients, totaling 51 teeth, for which a crown was indicated. Rexillium III complete cast crowns were prepared using conventional laboratory techniques. For each patient, the first tooth, which served as the control, received only glass ionomer cement (Ketac-Cem). Copal/ether varnish (Bosworth Copaliner) was applied to the second tooth preparation prior to cementation. Dentin bonding agent (OptiBond Solo Plus) was used on the third tooth before cementation. Sensitivity to different stimuli (cold, heat) was assessed at 7 days, 1 month, and 6 months following restorative procedures by questionnaire.

RESULTS

There were no statistically significant differences between the three groups regarding applied stimulus and day of the study (p > 0.05). No statistically significant differences were found between the postoperative sensitivity responses from 7 days to 1 month, and from 1 month to 6 months (p > 0.05).

CONCLUSIONS

Postoperative sensitivity resulting from glass ionomer cement with complete cast crowns cannot be completely eliminated with the prior use of a cavity varnish or bonding agent.

Morphological analysis of proximal contacts in class II direct restorations with 3D image reconstruction

OBJECTIVES

To evaluate the proximal contact on class II composite restorations constructed using various restorative approaches by a morphological analysis.

METHODS

Sixty plastic premolar teeth were prepared for class II cavities. These teeth were divided into six groups and restored using different materials and matrix systems. Two composite materials used were a microhybrid composite Filtek Z100 (3M/ESPE) and a packable composite P60 (3M/ESPE). Three interproximal matrix systems were two circumferential metal matrices (0.05 mm and 0.03 mm thin, respectively) combined with a Tofflemire retainer, and a pre-contoured sectional matrix system (Palodent). The contact morphologies of the restorations were visually inspected with regard to their buccolinugal and mesiodistal aspects. The contact tightness was measured by inserting different amounts of metal strips. For quantitatively morphologic analysis, three-dimensional (3D) scans of proximal contacts were performed. The results were analysed with two-way ANOVA and the Tukey test.

RESULTS

Under visual observation, contact surfaces in sectional matrix groups showed anatomic profile but concave in the centre, whilst the circumferential matrix groups showed flat profiles. The sectional matrix improved the contact tightness. The 3D analysis revealed that the matrix system was correlated with the contact morphology, since the sectional matrix generated significantly deeper and wider surface concavity.

CONCLUSIONS

All the interproximal matrix systems presented some deficiency in either the contact tightness or contours. Although the sectional matrix system enhanced contact tightness, it caused contact concavity by formation of interproximal marginal overhang. The quantitative morphologic analysis helps to examine improper proximal contact and the associated problems.

In vitro comparison of microleakage of posterior resin composites with and without liner using two-step etch-and-rinse and self-etch dentin adhesive systems

BACKGROUND AND AIMS

Composite restorations frequently have gingival margins apical to the cemento-enamel junction (CEJ). Microleakage at the cementodentinal margins is one of the most important causes of failure in these restorations. The current study evaluated microleakage at the occlusal and gingival margins of Class II packable composite restorations using resin-modified glass ionomer and flowable composite as liners, using the two-step etch-and-rinse and self-etch dentin-bonding systems.

MATERIALS AND METHODS

This in vitro study was carried out on 48 intact human premolars. Class II preparations were made with the gingival margins placed 1.0 mm apical to the CEJ. The teeth were randomly assigned to six groups of 16 boxes and restored using the following techniques: Group 1: Single Bond (3M ESPE) + Filtek P60 (3M ESPE); Group 2: Clearfil SE Bond (Kuraray) + Filtek P60; Group 3: Single Bond + Filtek Flow (3M ESPE) + Filtek P60; Group 4: Clearfil SE Bond + Filtek Flow + Filtek P60. Group 5: Single Bond + Fuji II LC (GC) + Filtek P60; Group 6: Clearfil SE Bond + Fuji II LC + Filtek P60. The restorations were thermocycled for 1000 cycles at 5{degree sign}C and 55°C, soaked in 2% methylene blue for 48 hours, then sectioned mesiodistally and viewed under a stereomicroscope for leakage at the gingival margin. The data were statistically analyzed using the Kruskal-Wallis, two-way ANOVA and Mann-Whitney U-tests.

RESULTS

The resin-modified glass-ionomer liner demonstrated significantly less leakage than flowable composite (p<0.05). There was no difference between restorations with flowable resin composite liners and those without the liner; in addition, no significant difference was observed between the two kinds of adhesive systems.

CONCLUSIONS

The current study supports the use of resin-modified glass ionomer as a liner in closed-sandwich technique to decrease microleakage of Class II packable composite restorations, applying either the two-step etch-and-rinse or the self-etch dentin adhesive system.

Clinicians choices of restorative materials for children

BACKGROUND

Recently, there has been an expansion in the range of tooth-coloured restorative materials available. In 1999, the National Health and Medical Research Council recommended clinicians use alternatives to amalgam in children 'where appropriate'.

METHODS

A three-part 29-item questionnaire was developed, tested in a focus group, and distributed to members of the Australasian Academy of Paediatric Dentistry (AA; paediatric dentists and paediatric dentistry postgraduate students; n=55), and the Australian and New Zealand Society of Paediatric Dentistry, Victorian Branch (SPD; general dentists and dental therapists; n=50). Participant information, material choices, and six hypothetical clinical scenarios were addressed.

RESULTS

The overall response rate was 74 per cent. For both groups, the first ranked factor influencing choice of restorative material for vital primary teeth was child age, and caries experience for vital first permanent molars. For moderate-sized Class I and II restorations in primary molars, a tooth-coloured material was chosen by 92 and 84 per cent respondents respectively. For restoring two separate proximal lesions in a primary molar, 65 per cent chose a tooth-coloured material followed by a stainless steel crown (27 per cent; all AA members), then amalgam (8 per cent). The SPD respondents were significantly more likely to choose glass ionomer cement for Class I and II restorations and for restoring two proximal lesions (all p=0.000) in primary molars than AA respondents, who were more likely to choose composite resins/compomers or amalgam/stainless steel crowns for these restorations. Younger respondents (21-40 years) were significantly more likely to choose composite resins/compomers or amalgam/stainless steel crowns (p=0.048) than older respondents (41-65 years), who were likely to choose glass ionomer cement.

CONCLUSIONS

For Class I and II restorations in primary molars, glass ionomer cement was the material chosen most frequently (SPD respondents); preference for amalgam or stainless steel crowns was low (both SPD and AA groups). The wide range of materials chosen for the hypothetical clinical scenarios suggests the need for guidelines on selection of restorative materials, and the need for longitudinal studies to follow actual clinical outcomes of the materials chosen.

Prevention of postoperative tooth sensitivity: a preliminary clinical trial

The purpose of this study was to evaluate clinically the effects of pre-treatments with a 35% hydroxyethyl metacrylate/5% glutaraldehyde dentine desensitizer (Gluma Desensitizer) and a 2% chlorexidine-based cavity disinfectant (Cav-Clean) on postoperative sensitivity. Three premolar teeth with no pain symptoms were selected from each one of 17 patients, totalling 51 teeth, for which Class II restoration using a composite was indicated. Each one of the three premolar teeth of the same patient was submitted to a different treatment. After acid etching, only a dental adhesive was applied to the first tooth, which served as the control. Gluma Desensitizer dentinal desensitizer was applied to the second premolar tooth prior to applying the dental adhesive. Cav-Clean cavity disinfectant was used on the third premolar tooth before applying the dental adhesive. Only one tooth was restored per session, and all premolar teeth were restored with a condensable composite, according to current restoration technique guidelines. Sensitivity to different stimuli (cold, heat, sweet and dental floss) was assessed on Day 1, Day 4 and Day 7 by questionnaire following restorative procedures. The results of this clinical research showed that, as far as the investigated stimuli and postoperative course are concerned, there was no statistically significant difference in the three different treatments (P>0.05). Postoperative sensitivity resulting from Class II restorations using composite resin cannot be completely eliminated with the prior use of a dentinal desensitizer or a cavity disinfectant. In day-to-day clinical treatment, postoperative sensitivity may possibly be related to the technique employed.

Surface roughness of flowable and packable composite resin materials after finishing with abrasive discs

The aim of this study was to compare surface roughness of flowable (Admira Flow, Filtek Flow, Tetric Flow) and packable (Admira, Filtek P60, Tetric HB) composite resin restorative materials finishing with Sof-Lex discs by means of average surface roughness (Ra) measurement using a surface profilometer and scanning electron microscopy (SEM). For each test group five specimens were prepared and roughness was measured in five different positions using a profilometer with a traversing distance of 4 mm and a cut-off value of 0.8 mm. The radius of the tracing diamond tip was 5 microm and measuring force and speed was 4 mN and 0.5 mm/s, respectively. The surface roughness of each individual disk was taken as the arithmetic mean of the Ra values measured in five different positions. Additionally, one specimen of each test group after finishing was observed under SEM with the magnification of x800 and x2500. Before finishing with Sof-Lex discs, flowable composite materials showed a smoother surface than packable composites restoratives (P < 0.05). However, after the finishing procedures similar surface textures were observed both from packable and flowable composites (P > 0.05).

Stickiness prior to setting of some light cured resin-composites

OBJECTIVES

To describe and evaluate a method for deriving a laboratory measure of stickiness, and to compare a set of dental resin-composites by this procedure.

MATERIALS AND METHODS

Twelve commercial resin composites were selected. Each material was placed in a cylindrical mold (phi=6.1 x 2.2 mm(2) depth) held either at 23 or at 37 degrees C. A flat-ended stainless-steel instrument was placed onto the surface of the unset sample with a force 350 g. After 2s it was moved vertically at 2 cm/s. This caused a sticky composite to be elevated to a maximum height between 0.2 and 1.8 mm until detachment from the instrument occurred. The elevated material was immediately solidified by light curing at 600 mW/cm(2) for 40s. These elevated profiles were mapped for both height and projected area of elevation. An instrument was constructed for this purpose in our laboratories. Both the projected heights and areas were evaluated as potential measures of stickiness. One-way ANOVA and Duncan's multiple range test were used for statistical analysis.

RESULTS

Projected heights ranged from 0.2 to 1.8 mm and projected areas of elevation ranged from 4.0 to 23.9 mm(2). The greatest values were found for microfine anterior composites (Silux plus, Filtek A110). There was a significant difference (p<0.05) between the material (SX) with the highest stickiness and all of the others. The set of profile height and area values were found to be strongly correlated (r(2)=0.9600).

SIGNIFICANCE

Once inserted and the load removed, the ideal material stays in place. This is generally assisted by an increase in viscosity and a decrease in stickiness. The stickiness test described is original and may prove to be useful as a standard test method for characterizing the handling stickiness of resin composite materials.