Clinical evaluation of packable and conventional hybrid resin-based composites for posterior restorations in permanent teeth: results at 12 months

The influence of different placement techniques on the clinical success of bulk-fill resin composites placed in Class II cavities: a 4-year randomized controlled clinical study

OBJECTIVE

The purpose of this double-blind and split-mouth randomized controlled clinical trial was to evaluate the clinical success of the placement technique (bulk-filling and incremental techniques) of a bulk-fill resin composite in Class II carious lesions.

MATERIALS AND METHODS

Two different bulk-fill resin composites, X-tra fil (Voco) and Filtek Bulk Fill (3M ESPE), were used in the bulk-filling and incremental techniques for 20 patients. The study was carried out in 4 groups, with 20 restorations in each group. Restorations were appraised at baseline, 6-month, 2-year, and 4-year recall. World Dental Federation (FDI) and the US Public Health Service (USPHS) criteria were used in the evaluations. The Friedman, Kruskal-Wallis, and Mann-Whitney U tests were used for the statistical analysis.

RESULTS

At the end of year 4, there was no loss of restoration in any group. According to the USPHS and FDI criteria, there was a difference in the baseline and 4-year in marginal adaptation and marginal discoloration of the restorations (P < 0.05). When Filtek-Bulk was placed as an incremental technique, there was a minor fracture in four restorations (P > 0.05). In addition, Filtek-Bulk showed a color change according to the results based on both the USPHS and FDI criteria (P < 0.05). The difference between the two placement techniques of each resin composite was not significant at the year 4 recall when all criteria were evaluated (P ˃ 0.05).

CONCLUSIONS

The 4-year clinical success of the evaluated bulk-fill composites is not dependent on the placement technique used.

CLINICAL RELEVANCE

This study can help clinicians choose which technique (bulk fill and incremental techniques) bulk-fill composites can be used.

TRIAL REGISTRATION

US National Library of Medicine, www.

CLINICALTRIALS

gov , ID: NCT04565860 Registered on 10/09/2020. Clinical Evaluation of Bulk-fill resin Composites in Class II Restorations.

Microleakage Analysis of Different Bulk-Filling Techniques for Class II Restorations: µ-CT, SEM and EDS Evaluations

This study aimed to compare two different bulk-filling techniques, evaluating the internal and external adaptation of class II resin-composite restorations, by analysing the gap formation using microcomputed tomography (µ-CT) and scanning electronic microscopy (SEM) coupled with energy-dispersive X-ray spectroscopy (EDS). Two standardized mesio/disto-occlusal (MO/DO) cavities were prepared in eight extracted human third molars that were divided, according to the filling technique used, in the following two groups (n = 4): BG (Bulk&Go group) and BT (Bulk Traditional group). After universal bonding application, followed by the light curing, all teeth were restored using a bulk-fill composite. Specimens were scanned with µ-CT to evaluate 3D interfacial gaps. Acquired µ-CT data were analysed to quantify the gap formation. Complementary information to the µ-CT analysis were obtained by SEM. Thereafter, the chemical composition of tooth-restoration interface was analysed using EDS. The µ-CT analysis revealed gaps formation at the tooth-restoration interface for both the BG and BT groups, while within the restoration, only in the BT group there was evidence of microleakage formation. The scanning electron micrographs of both groups showed that the external marginal integrity of the restoration was preserved, while EDS showed the three different structures (tooth surface, adhesive layer and resin composite) of the tooth-restoration interface, highlighting the absence of gap formation. In both BG and BT, the two filling techniques did not show significant differences regarding the internal and external marginal adaptation of the restoration. To achieve a successful restoration, the clinician could be advised to restore a class II cavity using a single increment bulk-filling technique (BG), thus treating it as a class I cavity.

Effects of Different Application Techniques on Nanohybrid Composite Restorations Clinical Success

Introduction:

Dental composites have been used as a restorative material for a long time. However, they have their limitations.

Aims:

This study evaluated the effects of placement techniques on the clinical performance of class I composite resin restorations.

Methods:

A total of 40 patients with split-mouth design participated in this study. Each patient had two fillings according to the placement technique (either bulk or incremental packing) of the composite resin restorations. Group (A): was packed by Tetric EvoCeram bulk-fill composite resin and Group (B): was incrementally packed with Tetric EvoCeram composite resin. Restorations of the teeth were evaluated on the same day, at one week, 3 months and 6 months to determine any signs of failure according to the modified United States Public Health Service (USPHS) criteria.

Results:

At different follow-up periods, the results showed no significant differences for retention, marginal integrity, surface stain, gingival bleeding, and secondary caries; however, there were significant differences in color match, surface texture, and postoperative sensitivity.

Conclusion:

This study concluded that the nanohybrid resin composites demonstrated excellent clinical performance for 6 months follow up period.

Comparison of Er,Cr:YSGG Laser Handpieces for Class II Preparation and Microleakage of Silorane- or Methacrylate-Based Composite Restorations

OBJECTIVE

The aim of this study was to evaluate the influence of cavity preparation with different Er,Cr:YSGG laser handpieces on microleakage of different posterior composite restorations.

METHODS

Fifty-four extracted intact human premolars were randomly assigned to three groups according to cavity preparation method: Bur Group: high-speed diamond bur (Diatech), MD Group: Er,Cr:YSGG laser Waterlase MD handpiece (Biolase Millennium II), and Turbo Group: Er,Cr:YSGG laser Waterlase MD TURBO handpiece (Biolase Millennium II). One hundred eight Class II slot cavities were prepared on the mesial and distal proximal surfaces of each tooth, and the cavity preparation times required were determined. The groups were then subdivided according to the restorative systems used (n = 12): a conventional methacrylate-based microhybrid composite (Filtek P60+Adper Single Bond 2/3M); a silorane-based resin composite (Filtek Silorane+Silorane System Adhesive/3M); and a nanohybrid methacrylate-based composite (Kalore+G-Bond/GC). The restorative systems were applied according to the manufacturers' recommendations. Following thermocycling (X5000; 5°C-55°C), the teeth were coated with nail varnish except the restoration margins, immersed in 0.5% basic fuchsin dye solution, and sectioned in a mesiodistal direction. Dye penetration was evaluated under a light microscope for occlusal and cervical margins. Data were analyzed with one-way ANOVA and chi-square tests (p < 0.05).

RESULTS

The cavity preparation time (mean ± SD) required for Bur, MD, and Turbo group was 31.25 ± 3.82, 222.94 ± 15.85, and 92.5 ± 7.42 sec, respectively, and the differences among the groups were statistically significant (p < 0.05). Comparing the occlusal and cervical microleakage scores, no statistically significant differences were found among the groups and subgroups (p > 0.05).

CONCLUSIONS

Er;Cr:YSGG laser cavity preparation with the Turbo handpiece needed shorter time than the MD handpiece, although it needed longer time than the conventional diamond bur. The use of different handpieces of Er,Cr:YSGG laser did not differ from conventional preparation with diamond bur in terms of microleakage with the tested methacrylate- and silorane-based posterior composite restorative systems.

Clinical Performance and Epidemiologic Aspects of Fractured Anterior Teeth Restored with a Composite Resin: A Two-Year Clinical Study

PURPOSE

To investigate the etiologic factors, effect of age and gender on dental trauma, and to evaluate the performance of composite resin on the fractured crown of permanent anterior teeth.

MATERIALS AND METHODS

Over a 2-year period, 73 permanent teeth from 51 patients with dental trauma were treated with direct composite resin restoration. Informed consent and standardized trauma forms were completed by the patient; teeth were restored with a submicron hybrid composite resin (Spectrum TPH) and respective adhesive system (Prime&Bond NT). Sixty-nine teeth were directly restored without fiber posts, while four were treated with fiber posts. Two experienced clinicians, besides the operator, evaluated each restoration at 6-, 12-, and 24-month follow-ups according to US Public Health Service (USPHS) criteria for the following characteristics: anatomical form, marginal adaptation, color match, marginal discoloration, surface roughness, and caries. Data were analyzed using the Wilcoxon Signed Rank, Kruskal-Wallis, Mann-Whitney U, and Siegel and Castellan tests.

RESULTS

A total of 73 traumatized teeth in 51 patients aged from 14 to 64 years (mean age 25.47 ± 14.058 years) were assessed according to the Ellis classification and restored over a 2-year period. Crown fractures were more common in the maxilla (84.9%) and caused by falls (58.8%). At the end of 24 months, a total of ten restorations were lost. The survival rate after 24 months was 82.14%. There were statistically significant differences in marginal adaptation between the 6-, 12-, and 24-month follow-ups. Although changes in marginal discoloration over time were not significant (p = 0.194), changes in color match were significant (p = 0.029).

CONCLUSION

Within the limitations of this study, direct composite restorations were accepted as clinically satisfactory.

Effectiveness of a resin-modified glass ionomer liner in reducing hypersensitivity in posterior restorations: a study from the practitioners engaged in applied research and learning network

BACKGROUND

The objectives of this randomized comparative effectiveness study conducted by members of the Practitioners Engaged in Applied Research and Learning (PEARL) Network were to determine whether using a resin-modified glass ionomer (RMGI) liner reduces postoperative hypersensitivity (POH) in dentin-bonded Class I and Class II resin-based composite (RBC) restorations, as well as to identify other factors (putative risk factors) associated with increased POH.

METHODS

PEARL Network practitioner-investigators (P-Is) (n = 28) were trained to assess sensitivity determination, enamel and dentin caries activity rankings, evaluation for sleep bruxism, and materials and techniques used. The P-Is enrolled 341 participants who had hypersensitive posterior lesions. Participants were randomly assigned to receive an RBC restoration with or without an RMGI liner before P-Is applied a one-step, self-etching bonding agent. P-Is conducted sensitivity evaluations at baseline, at one and four weeks after treatment, and at all visits according to patient-reported outcomes.

RESULTS

P-Is collected complete data regarding 347 restorations (339 participants) at baseline, with 341 (98 percent) (333 participants) recalled at four weeks. Treatment groups were balanced across baseline characteristics and measures. RBC restorations with or without an RMGI liner had the same one-week and four-week POH outcomes, as measured clinically (by means of cold or air stimulation) and according to patient-reported outcomes.

CONCLUSIONS

Use of an RMGI liner did not reduce clinically measured or patient-reported POH in moderate-depth Class I and Class II restorations. Cold and air clinical stimulation findings were similar between groups. Practical Implications. The time, effort and expense involved in placing an RMGI liner in these moderate-depth RBC restorations may be unnecessary, as the representative liner used did not improve hypersensitivity outcomes.

Review of nanomaterials in dentistry: interactions with the oral microenvironment, clinical applications, hazards, and benefits

Interest in the use of engineered nanomaterials (ENMs) as either nanomedicines or dental materials/devices in clinical dentistry is growing. This review aims to detail the ultrafine structure, chemical composition, and reactivity of dental tissues in the context of interactions with ENMs, including the saliva, pellicle layer, and oral biofilm; then describes the applications of ENMs in dentistry in context with beneficial clinical outcomes versus potential risks. The flow rate and quality of saliva are likely to influence the behavior of ENMs in the oral cavity, but how the protein corona formed on the ENMs will alter bioavailability, or interact with the structure and proteins of the pellicle layer, as well as microbes in the biofilm, remains unclear. The tooth enamel is a dense crystalline structure that is likely to act as a barrier to ENM penetration, but underlying dentinal tubules are not. Consequently, ENMs may be used to strengthen dentine or regenerate pulp tissue. ENMs have dental applications as antibacterials for infection control, as nanofillers to improve the mechanical and bioactive properties of restoration materials, and as novel coatings on dental implants. Dentifrices and some related personal care products are already available for oral health applications. Overall, the clinical benefits generally outweigh the hazards of using ENMs in the oral cavity, and the latter should not prevent the responsible innovation of nanotechnology in dentistry. However, the clinical safety regulations for dental materials have not been specifically updated for ENMs, and some guidance on occupational health for practitioners is also needed. Knowledge gaps for future research include the formation of protein corona in the oral cavity, ENM diffusion through clinically relevant biofilms, and mechanistic investigations on how ENMs strengthen the tooth structure.

Microleakage in Class II composite restorations with margins below the CEJ: in vitro evaluation of different restorative techniques

OBJECTIVES

The purpose of this in vitro study was to evaluate the microleakage in "deep" Class II composite restorations with gingival cavosurface margin below the CEJ (cemento-enamel junction) and restored with different techniques.

STUDY DESIGN

Fifty human teeth were used. In each tooth two standardized Class II slot cavities (on mesial and on distal surfaces) were prepared: the buccolingual extension of the cavities was 4 mm; the gingival wall was located in dentin/cementum (2 mm beyond the CEJ). The prepared teeth were randomly assigned to 5 experimental groups (of 10 specimens and 20 cavities each) and restored. Group 1: Filtek TM Supreme XTE Flowable (3MESPE) + Universal Filtek Supreme XTE (3MESPE), Group 2: GrandioSO Heavy Flow (Voco) + GrandioSo (Voco), Group 3: SDR™ (Dentsply Caulk) + Esthet-X® HD (Dentsply Caulk), Group 4: SonicFill (Kerr), Group 5: Grandio (Voco). After thermocycling, the specimens were immersed in a 0.5% basic fuchsine dye solution and incubated at 37°C for 24 hours. The teeth were subsequently sectioned mesiodistally. All specimens were examined at 25 in a stereomicroscope and standardized digital images were obtained. Dye penetration was measured from gingival margins.

RESULTS

The results demonstrated no significant leakage differences between Group 4 and Group 5, that both showed significantly higher frequency distribution of Score 0. Group 2 and Group 3 showed a significant prevalence of Score 1, whereas Group 1 showed significantly higher frequency of Score 2.

CONCLUSIONS

None of the restorative techniques tested completely eliminated microleakage dye penetration in dentin margins; marginal adaptation in Class II composite restorations with gingival wall below the CEJ varied in both substrates and from different restorative techniques used.

Two-year Clinical Performance of Self-etching Adhesive Systems in Composite Restorations of Anterior Teeth

Objective

The aim of this study was to evaluate the two-year clinical performance of Class III, IV, and V composite restorations using a two-step etch-and-rinse adhesive system (2-ERA) and three one-step self-etching adhesive systems (1-SEAs).

Material and Methods

Two hundred Class III, IV, and V composite restorations were placed into 50 patients. Each patient received four composite restorations (Amaris, Voco), and these restorations were bonded with one of three 1-SEAs (Futurabond M, Voco; Clearfil S3 Bond, Kuraray; and Optibond All-in-One, Kerr) or one 2-ERA (Adper Single Bond 2/3M ESPE). The four adhesive systems were evaluated at baseline and after 24 months using the following criteria: restoration retention, marginal integrity, marginal discoloration, caries occurrence, postoperative sensitivity and preservation of tooth vitality. After two years, 162 restorations were evaluated in 41 patients. Data were analyzed using the χ2 test (p&lt;0.05).

Results

There were no statistically significant differences between the 2-ERA and the 1-SEAs regarding the evaluated parameters (p&gt;0.05).

Conclusion

The 1-SEAs showed good clinical performance at the end of 24 months.

56-month clinical performance of Class I and II resin composite restorations

OBJECTIVE

This study evaluated the 56-month clinical performance of Class I and II resin composite restorations. Filtek P60 was compared with Filtek Z250, which are both indicated for posterior restorations but differ in terms of handling characteristics. The null hypothesis tested was that there is no difference in the clinical performance of the two resin composites in posterior teeth.

MATERIAL AND METHODS

Thirty-three patients were treated by the same operator, who prepared 48 Class I and 42 Class II cavities, which were restored with Single Bond/Filtek Z250 or Single Bond/Filtek P60 restorative systems. Restorations were evaluated by two independent examiners at baseline and after 56 months, using the modified USPHS criteria. Data were analyzed statistically using Chi-square and Fisher's Exact tests (a=0.05).

RESULTS

After 56 months, 25 patients (31 Class I and 36 Class II) were analyzed. A 3% failure rate occurred due to secondary caries and excessive loss of anatomic form for P60. For both restorative systems, there were no significant differences in secondary caries and postoperative sensitivity. However, significant changes were observed with respect to anatomic form, marginal discoloration, and marginal adaptation. Significant decreases in surface texture were observed exclusively for the Z250 restorations.

CONCLUSIONS

Both restorative systems can be used for posterior restorations and can be expected to perform well in the oral environment.

Surface roughness of flowable resin composites eroded by acidic and alcoholic drinks

Aim:

The aim of this study is to evaluate the surface roughness of four flowable resin composites following exposure to acidic and alcoholic drinks.

Materials and Methods:

SureFil SDR flow, TetricEvoFlow, Esthet-X Flow and Amaris Flow HT samples were immersed in artificial saliva, Coca Cola and Chivas Regal Whisky. Each specimen was examined using a Leica DCM 3D microscope: Arithmetical mean height of the surface profiles was measured (Sa).

Results:

Kruskal-Wallis test showed significant differences among various groups (P<0,001). Mann Whitney test was applied and control groups showed significantly lower Sa values than other groups (P=0,008). Coca Cola groups showed highest Sa values (P<0,021). No significant differences (P=0,14) in surface texture were found among the specimens of the different materials. No significant differences were found among TetricEvoFlow, Esthet-X Flow and Amaris Flow under control conditions nor after Coca Cola application. Under control condition and after Coca Cola application SureFil SDR flow showed significantly higher Sa values. Moreover, after whisky application Amaris Flow showed significantly lower Sa values then the other three groups that showed no significant differences among them.

Conclusions:

Acidic and alcoholic drinks eroded the surface roughness of all evaluated flowable resin composites.

Synthesis and characterization of antibacterial dental monomers and composites

The objective of this study is to synthesize antibacterial methacrylate and methacrylamide monomers and formulate antibacterial fluoride-releasing dental composites. Three antibacterial methacrylate or methacrylamide monomers containing long-chain quaternary ammonium fluoride, 1,2-methacrylamido-N,N,N-trimethyldodecan-1-aminium fluoride (monomer I), N-benzyl-11-(methacryloyloxy)-N,N-dimethylundecan-1-aminium fluoride (monomer II), and methacryloxyldecylpyridinium fluoride (monomer III) have been synthesized and analyzed by nuclear magnetic resonance (NMR) and mass spectrometry (MS). The cytotoxicity test and bactericidal test against Streptococcus mutans indicate that antibacterial monomer II is superior to monomers I and III. A series of dental composites containing 0-6% of antibacterial monomer II have been formulated and tested for degree of conversion (DC), flexure strength, water sorption, solubility, and inhibition of S. mutans biofilms. An antibacterial fluoride-releasing dental composite has also been formulated and tested for flexure strength and fluoride release. The dental composite containing 3% of monomer II has a significant effect against S. mutans biofilm formation without major adverse effects on its physical and mechanical properties. The new antibacterial monomers can be used together with the fluoride-releasing monomers containing a ternary zirconiun-fluoride chelate to formulate a new antibacterial fluoride-releasing dental composite. Such a new dental composite is expected to have higher anticaries efficacy and longer service life.

Clinical Evaluation of Resin-based Composites in Posterior Restorations: Two-year Results

Nanohybrid and low-shrinkage posterior resin composites, placed with self-etch adhesive systems in posterior teeth, showed satisfactory and similar results after two years.

Eighteen-month clinical evaluation of microhybrid, packable and nanofilled resin composites in Class I restorations

The aim of this article was to report the results of an 18-month longitudinal randomized clinical trial that evaluated the clinical performance of microhybrid, packable and nanofilled resin composite restorations placed in Class I cavities of molar teeth. Three Class I resin composite restorations were placed in each of 35 patients. Each patient received one microhybrid ('Point 4'; Kerr, Orange, CA, USA), one packable ('Packable Premise'; Kerr, Orange, CA, USA) and one nanofilled ('Nanofilled Premise'; Kerr, Orange, CA, USA) resin composite restoration. Clinical evaluation was performed at baseline (2 weeks after placement), and after 6, 12 and 18 months after placement using modified Ryge criteria. No patients were lost from the study. At the final appointment (after 18 months), 95.4%, 93.7% and 96.2% respectively of the microhybrid ('Point 4'), packable ('Packable Premise' and nanofilled ('Nanofilled Premise') resin composite restorations received Alfa ratings. Regardless of the type of restorative material, no significant changes were observed in the modified Ryge criteria at the baseline and 18-month recalls (P <or=0.05). Three restorations (one from each group) exhibited post-operative sensitivity at the baseline and 6-month appointment. After 18 months, one packable resin composite restoration failed because of secondary caries, while secondary caries was not detected on any of the other restorations. The clinical performance of microhybrid ('Point 4'), packable ('Packable Premise') and nanofilled ('Nanofilled Premise') resin composite restorations was acceptable after 18 months. Further studies with longer follow-up periods are recommended to investigate the long-term survival of these restorations.

The Effect of Flowable Materials on the Microleakage of Class II Composite Restorations That Extend Apical to the Cemento-enamel Junction

The use of a flowable resin composite or compomer may reduce microleakage at the gingival floor of a deep Class II composite restoration that extends apical to the cemento-enamel junction.

Six-year Clinical Evaluation of Packable Composite Restorations

As a posterior composite, Filtek P60 exhibited very good clinical performance in Class II cavities for six years.

Clinical evaluation of two packable posterior composites: 2-year follow-up

The clinical performance of two packable posterior composites, Alert (A)-Jeneric/Pentron and SureFil (S)-Dentsply, was evaluated in 33 patients. Each patient received one A and one S restoration, resulting in a total of 66 restorations. The restorations were placed by one operator according to the manufacturer's specifications and were finished and polished after 1 week. Photographs were taken at baseline and after 2 years. Two independent evaluators conducted the clinical evaluation by using modified United States Public Health Service criteria. After 2 years, 60 restorations (30 A and 30 S), 27 class I (16 A and 11 S) and 33 class II (14 A and 19 S) were evaluated in 30 patients. Criterion A for recurrent caries, vitality, and retention was applicable to all 60 restorations. Criterion B was distributed among 40 restorations as follows: surface texture (15 A; 2 S), color (5 A; 6 S), postoperative sensitivity (1 S), marginal discoloration (8 A), marginal adaptation (3 A), and wear resistance (2 A). Data were analyzed using the Exact Fisher and McNemar tests. After 2 years, S showed a significantly better performance than A with respect to surface texture and marginal discoloration. The clinical performance of both materials was considered acceptable over the 2-year period. Further evaluations are necessary for a more in-depth analysis.

Clinical Evaluation of a Nanofilled Composite in Posterior Teeth: 12-month Results

Nanofilled resin composite showed excellent clinical performance, similar to microhybrid and packable composites after 12-months.

The Microtensile Bond Strength of Self-etching Adhesives to Ground Enamel

Bond strength to ground enamel of single component self-etching adhesive systems was lower than that of etch-and-rinse and self-etching primer systems.

3-Year clinical evaluation of posterior packable composite resin restorations

This study evaluated the clinical performance of four packable resin composite restorative materials in posterior teeth (Class I and II) compared with one hybrid composite after 3 years. Eighty-four restorations were placed in 16 patients. The tested materials were: (i) Solitaire + Solid Bond; (ii) ALERT + Bond-1; (iii) Surefil + Prime & Bond NT; (iv) Filtek P60 + Single Bond and (v) TPH Spectrum + Prime & Bond 2.1. All restorations were made using rubber dam isolation, and the cavity design was restricted to the elimination of carious tissue. Deeper cavities were covered with calcium hydroxide and/or glass-ionomer cement. Each adhesive system and composite resin was placed according to the manufacturer's instructions. One week later, the restorations were finished/polished and evaluated according USPHS modified criteria. Fourteen patients attended the 3-year recall and 75 restorations were evaluated at that time based on the same evaluation criteria. Friedman repeated measures analysis of variance by rank and Wilcoxon sign-ranked test for pair-wise comparison was used for data analysis (alpha = 0.05). The analysis was performed only for the baseline and for the 3-year period. Solitaire showed some fractures at marginal ridges in 25% of the cases. Solitaire and ALERT showed some concerns related to colour match (43 and 77%, respectively) and surface texture (86 and 77%, respectively). TPH Spectrum showed a great percentage of colour mismatch after 3 years, around 50%. Surefil and Filtek P60 showed an excellent clinical performance after 3 years, similar to the hybrid resin tested, TPH Spectrum. Solitaire did not fulfil the ADA acceptance criteria for restorative materials and, therefore, is not recommended for use in posterior restorations.