The two-year clinical performance of esthetic restorative materials in noncarious cervical lesions

Clinical Effectiveness of Ion-Releasing Restorations versus Composite Restorations in Dental Restorations: Systematic Review and Meta-Analysis

BACKGROUND

To compare the clinical effectiveness of ion-releasing restorations (IRR) vs. composite resin (CR) in dental restorations.

METHODS

A systematic search was carried out from articles published until January 2024, in the biomedical databases: PubMed, Cochrane Library, Scielo, Scopus, Web of Science and Google Scholar. Randomized clinical trials were included, with a follow-up time greater than or equal to 1 year, without time and language limits and which reported the clinical effect of IRR compared to CR in dental restorations. The RoB 2.0 tool was used to assess the risk of bias of the included studies and the GRADEPro GDT tool was used to assess the quality of evidence and the strength of recommendation of the results.

RESULTS

The search yielded a total of 1109 articles. After excluding those that did not meet the selection criteria, 29 articles remained for the quantitative synthesis. The analysis found no statistically significant difference when comparing the dental restorations with IRRs or CRs.

CONCLUSION

The literature reviewed suggests that there are no differences between the IRRs and CRs in dental restorations.

Comparative Evaluation of GC Gold Label IX with GC Gold Label IX Extra and GC Gold Label Hybrid in Cavitated Lesions Prepared by Hand Instrumentation Technique in Primary Molars: An In Vivo Study

Aim

The purpose of the present study was to compare the clinical efficacy of GC Gold Label IX, GC Gold Label IX Extra, and GC Gold Label Hybrid in occlusal surface cavities in primary molars prepared by hand instrumentation technique.

Materials and methods

Ninety primary molars were selected from the children according to the inclusion and exclusion criteria. The selected teeth were randomly allocated into the following three groups, with 30 teeth in each group, according to the restorative material used: group I: GC Gold Label IX, group II: GC Gold Label IX Extra, and group III: GC Gold Label Hybrid. Occlusal cavities were prepared using hand instruments. Caries removal efficacy was verified using caries detector dye. The restorative materials were mixed and condensed into the prepared cavities. The restorations were assessed using modified United States Public Health Service (USPHS) evaluation criteria at 1, 3, and 6 months.

Results

The results were tabulated and statistically analyzed using the Chi-squared test. No significant difference was found in terms of color match, marginal discoloration, marginal integrity, surface roughness, and secondary caries, but a significant difference was observed in terms of retention and anatomic form between group I and group III.

Conclusion

GC Gold Label Hybrid exhibited better clinical performance with respect to GC Gold Label IX and comparable clinical performance with respect to GC Gold Label IX Extra.

Clinical significance

GC Gold Label Hybrid is a newly developed glass ionomer cement (GIC), and its clinical performance needs to be studied.

How to cite this article

Mittal M, Bajaj N, Bhola M, et al. Comparative Evaluation of GC Gold Label IX with GC Gold Label IX Extra and GC Gold Label Hybrid in Cavitated Lesions Prepared by Hand Instrumentation Technique in Primary Molars: An In Vivo Study. Int J Clin Pediatr Dent 2024;17(5):570-575.

Do bioactive materials show greater retention rates in restoring permanent teeth than non-bioactive materials? A systematic review and network meta-analysis of randomized controlled trials

OBJECTIVES

To answer the following research question: does the clinical evaluation of restorations on permanent teeth with bioactive materials show greater retention rates than those with non-bioactive materials?

MATERIALS AND METHODS

A search strategy was used in the following databases: MEDLINE via PubMed, Scopus, Web of Science, LILACS, BBO, Embase, The Cochrane Library, and OpenGrey. Randomized controlled trials (RCTs), with a minimum of 2-year follow-up and evaluating at least one bioactive material in permanent teeth were included. Risk of bias was detected according to the Cochrane Collaboration tool for assessing the risk of bias (RoB 2.0), and network meta-analysis was performed using a random-effects Bayesian-mixed treatment comparison model.

RESULTS

Twenty-seven studies were included. The success of the restorations was assessed using modified USPHS system in 24 studies and the FDI criteria in 3 studies. Network meta-analysis revealed three networks based on restoration preparations. Resin composites were ranked with higher SUCRA values, indicating a greater likelihood of being the preferred treatment for class I, II, and III restorations. In class V, resin-modified glass ionomer cement was ranked with the highest value.

CONCLUSION

Bioactive restorative materials showed similar good clinical performance in terms of retention similarly to conventional resin composites.

CLINICAL SIGNIFICANCE

The findings must be interpreted with caution because many RCT on restorative materials aim to verify the equivalence of new materials over the gold standard material rather than their superiority. The present systematic review also suggests that new RCT with longer follow-up periods are necessary.

The preventive effect of glass ionomer cement restorations on secondary caries formation: A systematic review and meta-analysis

OBJECTIVE

The objective is to compare the preventive effect on secondary caries of glass ionomer cement (GIC) restorations with amalgam or resin-composite restorations.

METHODS

Two independent researchers conducted a systematic search of English publications in PubMed, Web of Science, Cochrane and Scopus. They selected randomized clinical trials comparing secondary caries incidences around GIC restorations (conventional GIC or resin-modified GIC) with amalgam or resin-composite restorations. Meta-analysis of the secondary-caries incidences with risk ratio (RR) and 95% confidence interval (95% CI) as the effect measure was performed.

RESULTS

This review included 64 studies. These studies included 8310 GIC restorations and 5857 amalgam or resin-composite restorations with a follow-up period from 1 to 10 years. Twenty-one studies with 4807 restorations on primary teeth and thirty-eight studies with 4885 restorations on permanent teeth were eligible for meta-analysis. The GIC restorations had a lower secondary caries incidence compared with amalgam restorations in both primary dentition [RR= 0.55, 95% CI:0.41-0.72] and permanent dentition [RR= 0.20, 95% CI:0.11-0.38]. GIC restorations showed similar secondary caries incidence compared with resin-composite restorations in primary dentition [RR= 0.92, 95% CI:0.77-1.10] and permanent dentition [RR= 0.77, 95% CI:0.39-1.51]. Conventional GIC restorations showed similar secondary caries incidence compared with resin-modified GIC-restored teeth in both primary dentition [RR= 1.12, 95% CI:0.67-1.87] and permanent dentition [RR= 1.63, 95% CI:0.34-7.84].

CONCLUSIONS

GIC restorations showed a superior preventive effect against secondary caries compared to amalgam restorations, and a similar preventive effect against secondary caries compared to resin-composite restorations in both primary and permanent teeth. [PROSPERO Registration ID: CRD42022380959].

Application of orthodontics combined with porcelain laminate veneers in the aesthetic restoration and flora regulation of anterior teeth

To evaluate the effectiveness of orthodontics in combination with porcelain laminate veneers (PLV) in the aesthetic restoration and flora regulation of anterior teeth. A retrospective analysis of 336 patients who underwent aesthetic restoration of anterior teeth in our hospital from April 2019 to September 2022 was performed and divided into a control group (n = 168) and an observation group (n = 168) according to the restorative modality. The restorative modality in the control group was conventional restorative remediation, while the restorative modality in the observation group was orthodontic combined with PLV treatment. To evaluate the excellent rate of aesthetic restoration of anterior teeth in the 2 groups, and compare the color, shape, degree of translucency, edge aesthetic score, complications and satisfaction rate of restoration of anterior teeth in the 2 groups before and after restoration. The observation group had a significantly higher rate of excellent aesthetic restorations (95.23%) compared to the control group (80.95%) (P < .001). The scores of anterior tooth color, morphology, degree of translucency and marginal aesthetics were improved in both groups after restoration compared to before restoration, and the scores were significantly higher in the observation group (P < .05). After restoration, the subgingival Digestive streptococcus, Campylobacter and Propionibacterium increased in both groups, but the number of bacterial strains was significantly less in the observation group (P < .05). Compared with the total complication rate in the control group (16.66%), the total complication rate in the observation group (2.38%) was significantly lower (P < .001). Compared with the control group (85.71%), the observation group had a significantly higher restoration satisfaction rate of 97.61%, with a statistically significant difference (P < .001). The application of orthodontics combined with PLV in the aesthetic restoration of anterior teeth has a significant clinical effect, which is conducive to improving the aesthetic restoration and satisfaction rate of anterior teeth, reducing the subgingival microbial imbalance and decreasing the incidence of complications.

Secondary caries and marginal adaptation of ion-releasing versus resin composite restorations: a systematic review and meta-analysis of randomized clinical trials

This systematic review was aimed to evaluate occurrence of secondary caries and marginal adaptation in ion-releasing materials versus resin composite. Electronic search of PubMed, Scopus, and Open Grey databases with no date or language restrictions until May 21st, 2021, was conducted. Randomized clinical trials that compared ion-releasing restorations versus resin composite were included. For quantitative analysis, a random-effects meta-analysis with risk difference as an effect measure and a 95% confidence interval was used. Quality of evidence was assessed using The Grading of Recommendations, Assessment, Development, and Evaluation criteria. The risk of bias was evaluated using the Cochran Collaboration Risk of Bias tool. The inclusion criteria were met by 22 studies, and 10 studies were included in the meta-analysis. Three follow-up periods (1 year, 18 months-2 years, and 3 years) were evaluated. The overall quality of evidence for secondary caries and marginal adaptation outcomes was low. The results of the meta-analysis showed no significant difference (p > 0.05) in both outcomes between ion-releasing materials and resin composite. The occurrence of secondary caries was not dependent on the nature of the restorative material. It is more likely a complex process that involves the same risk factors as primary carious lesions.

Finite element analysis of V-shaped tooth defects filled with universal nanohybrid composite using incremental technique

The aim of the present paper is to study the stresses and strains in fillings of V-shaped tooth defects made of universal photo-cured nanohybrid composite (UPC) using incremental technique. Numerical modeling with FEA and microleakage test are performed. Inhomogeneous distribution of the equivalent Von Mises stresses after polymerization of the two UPC layers is found, as the maximal value after polymerization of the first layer is 1.5 times lower compared to that of second one. In the first layer, maximum stresses are concentrated on dentin surface in cervical region of the obturation border and in occlusal region of the obturation volume. In the second layer, maximum stresses are generated in cervical area of the obturation volume and on dentin surface occlusally along the obturation border. The displacement after polymerization of each layer is inhomogeneous, as its values are more than 2 times smaller compared to that in fillings of glass-ionomer cement and flowable composite. In the first layer, the displacement is maximal on surface in the cervical region, while in the second layer it is maximal on surface occlusal of the obturation. The adequacy of the model used is confirmed by the microleakage test results. It is proven that UPC is better choice for filling of V-shaped defects due to the lower microleakage.

Glass ionomer cements compared with composite resin in restoration of noncarious cervical lesions: A systematic review and meta-analysis

OBJECTIVE

Restoring noncarious cervical lesions are challenging to clinical practice. This study aimed to compare the clinical performance/longevity of glass ionomer cements (GIC) and composite resins (CR) used for noncarious cervical lesions (NCCL) through a systematic review and meta-analysis (MA).

DATA

Randomized and controlled clinical trials and nonrandomized clinical trials, which compared the clinical performance/longevity of CR and GIC (conventional and/or resin-modified) in the treatment of NCCL, were included.

SOURCE

The methodological quality and risk of bias were evaluated using the Cochrane Collaboration tool. Seven MAs were performed considering (1) the clinical performance of the parameters in common: retention, marginal discoloration, marginal adaptation, secondary caries, color, anatomic form, surface texture and (2) a follow-up time of 12, 24 and 36 months. The prevalence of successful restorations and the total number of restorations per clinical parameter/follow-up time were used to calculate the relative risk (95% CI).

STUDY SELECTION

After screening of the studies, 13 studies were used for quantitative synthesis. The risk difference (CI 95%, α, I2) between GIC and CR for anatomic form was 0.00 (-0.02, 0.02; p = 0.83; 0%); for color was -0.02 (-0.08, 0.04; p = 0.48; 80%); for surface texture was -0.02 (-0.06, 0.02; p = 0.31; 63%); for secondary caries was -0.00 (-0.01, 0.01; p = 0.87; 0%); for marginal discoloration was 0.01 (-0.01, 0.03; p = 0.23; 3%); for marginal adaptation was 0.01 (-0.01, 0.04; p = 0.34; 32%) and for retention was 0.07 (0.02, 0.12; p = 0.003; 76%).

CONCLUSION

GIC showed a clinical performance significantly higher than CR in regard to retention, whereas for the other parameters, GIC was similar to CR.

CLINICAL SIGNIFICANCE

NCCLs is increasingly prevalent among the population and this type of lesion causing defects in the tooth that affect not only aesthetics but also everyday habits, such as drinking, eating and teeth brushing, due to the sensitivity these lesions cause.

Finite Element Analysis in Setting of Fillings of V-Shaped Tooth Defects Made with Glass-Ionomer Cement and Flowable Composite

The aim of the present paper is to investigate the deformation–stress state of fillings of V-shaped tooth defects by finite element analysis (FEA). Two different materials are used—auto-cured resin-reinforced glass-ionomer cement (GIC) and flowable photo-cured composite (FPC). Two materials are placed into the cavity in one portion, as before the application of the composite the cavity walls are covered with a thin adhesive layer. Deformations and equivalent von Mises stresses are evaluated by FEA. Experimental study of micro-leakage is performed. It is established that there is an analogous non-homogeneous distribution of equivalent Von Mises stresses at fillings of V-shaped defects, made with GIC and FPC. Maximum stresses are generated along the boundaries of the filling on the vestibular surface of the tooth and at the bottom of the filling itself. Values of equivalent Von Mises stresses of GIC fillings are higher than that of FPC. Magnitude and character of deformation distribution at GIC and FPC fillings are similar—deformation is maximum along the vestibular surface of the filling and is 0.056 and 0.053 mm, respectively. In FPC fillings, the adhesive layer, located along the cavity/filling boundary, is characterized with greatest strain. The experimental study of micro-leakage has confirmed the adequacy of models used in FEA.

Clinical performance of resin-modified glass ionomer cement, flowable composite, and polyacid-modified resin composite in noncarious cervical lesions: One-year follow-up

Background:

The restoration of noncarious cervical lesions (NCCLs) often poses a challenge to the clinician. Various restorative materials are available in the market for the restoration of the same. Each material has various advantages and shortcomings.

Aim:

The aim of this study was to compare and to evaluate the clinical performance of capsulated resin-modified glass ionomer cement (RMGIC), flowable composite, and polyacid-modified composite resin (PMCR) in NCCLs.

Materials and Methods:

A total of 101 restorations were placed among healthy controls in this clinical trial. A total of 101 restorations were divided into three groups with n = minimum 32 per group (Group 1: 33 restorations, Group 2: 34 restorations, and Group 3: 34 restorations). The restorative materials used were capsulated RMGIC, flowable composite and PMCR. After the placement, the restorations were evaluated for the United States Public Health Services criteria for six parameters, namely retention, marginal adaptation, marginal discoloration, color stability, surface roughness, and sensitivity. The restorations were evaluated at baseline, 6 and 12 months.

Statistical Analysis:

Statistics was performed using SPSS 21.0 version. Chi-square test was done to compare the proportions between groups. Fisher's exact test was used to compare proportion change between time points.

Results:

There was no statistically significant difference seen among the three groups for retention, color stability, surface roughness, and hypersensitivity. RMGIC had shown superior characteristics in marginal adaptation and marginal discoloration compared to flowable composite and PMCR, and the difference was statistically significant.

Conclusion:

Within the limitations of this study, all the three restorative materials are clinically acceptable for the restoration of NCCLs. RMGIC is superior regarding marginal adaptation and esthetics for restoring NCCLs.

Epidemiological investigation of non-carious cervical lesions and possible etiological factors

Background

Epidemiological studies of non-carious cervical lesions (NCCLs) are being conducted in all geographical regions, which is completely justified, considering the high frequency of these lesions and possible consequences. Data obtained from such studies are of great importance because, beside describing the extent and degree of lesions, they can also point to specific etiological factors. The purpose of this study was to analyze the frequency and distribution of NCCLs among the patients of Faculty of Dentistry in Pancevo, Serbia, and to investigate the impact of certain etiological factors on the frequency of NCCLs.

Material and Methods

The study included 394 patients, who were clinically examined for the presence of NCCLs and interviewed about potential etiological factors using specially designed questionnaire. Saliva samples were analyzed for 30 patients with multiple NCCLs (≥3) and 30 patients without signs of cervical lesions and restorations. Subject – level logistic regression was used to analyze the association of potential etiological factors and presence of NCCLs and Wilcoxon test for the quantity and quality of saliva.

Results

NCCLs were diagnosed at 68.5% from total number of respondents, 15% from all present teeth were affected. The highest prevalence was recorded on premolars. Presence of lesions significantly increased with age. Frequent consumption of citrus fruit was associated with the presence of NCCLs. Significantly lower frequency of NCCLs was recorded among subjects who frequently chew gums. Significantly lower pH values of unstimulated and stimulated saliva were recorded in the group of patients with multiple NCCLs compared to control group.

Conclusions

This study showed high frequency of NCCLs among subjects of different age. Premolars were the most frequently affected. Age, frequent consumption of citrus fruit and lower salivary pH value were associated with an increased occurrence of NCCLs. Chewing gums habit was associated with an decreased occurrence of NCCLs.

Key words:NCCL, abrasion, erosion, abfraction, saliva.

Clinical Effectiveness of a Resin-modified Glass Ionomer Cement and a Mild One-step Self-etch Adhesive Applied Actively and Passively in Noncarious Cervical Lesions: An 18-Month Clinical Trial

OBJECTIVES:

To evaluate the clinical effectiveness of two methods of application of a mild one-step self-etch adhesive and composite resin as compared with a resin-modified glass ionomer cement (RMGIC) control restoration in noncarious cervical lesions (NCCLs).

METHODS:

A total of 294 restorations were placed in 56 patients, 98 in each one of the following groups: 1) G-Bond active application combined with Solare-X composite resin (A-1SEA), 2) G-Bond passive application combined with Solare-X composite resin (P-1SEA), and 3) GC II LC RMGIC. The restorations were evaluated at baseline and after six, 12, and 18 months according to the FDI criteria for fractures/retention, marginal adaptation, marginal staining, postoperative sensitivity, and secondary caries. Cumulative failure rates were calculated for each criterion at each recall period. The effect of adhesive, method of application, and recall period were assessed. The Kruskal-Wallis test for intergroup comparison and Friedman and Wilcoxon signed ranks tests for intragroup comparison were used for each criterion ( α=0.05).

RESULTS:

The retention rates at 18 months were 93.26% for the A-1SEA group, 86.21% for the P-1SEA group, and 90.91% for the RMGIC group. The active application improved the retention rates compared with the passive application of mild one-step self-etch adhesive; however, no statistically significant difference was observed between the groups. Marginal staining was observed in 13 restorations (1 in A-1SEA, 4 in P-1SEA, and 8 in RMGIC) with no significant difference between the groups. The RMGIC group showed a significant increase in marginal staining at 12 and 18 months from the baseline. There was no significant difference between the groups for marginal adaptation, secondary caries, or postoperative sensitivity.

CONCLUSION:

Within the limitations of the study, we can conclude that mild one-step self-etch adhesive followed by a resin composite restoration can be an alternative to RMGIC with similar retention and improved esthetics in restoration of NCCLs. Agitation could possibly benefit the clinical performance of mild one-step self-etch adhesives, but this study did not confirm that the observed benefit was statistically significant.

Compliance of Randomized Clinical Trials in Noncarious Cervical Lesions With the CONSORT Statement: A Systematic Review of Methodology

The literature was reviewed to evaluate the compliance of randomized clinical trials (RCTs) with the CONsolidated Standards of Reporting Trials (CONSORT ) and the risk of bias of these studies through the Cochrane Collaboration risk of bias tool (CCRT). RCTs were searched at Cochrane Library, PubMed, and other electronic databases to find studies about adhesive systems for cervical lesions. The compliance of the articles with CONSORT was evaluated using the following scale: 0 = no description, 1 = poor description, and 2 = adequate description. Descriptive analyses about the number of studies by journal, follow-up period, country, and quality assessments were performed with CCRT for assessing risk of bias in RCTs. One hundred thirty-eight RCTs were left for assessment. More than 30% of the studies received scores of 0 or 1. Flow chart, effect size, allocation concealment, and sample size were more critical items, with 80% receiving a score of 0. The overall CONSORT score for the included studies was 15.0 ± 4.8 points, which represents 46.9% of the maximum CONSORT score. A significant difference among countries was observed (p&lt;0.001), as well as range of year (p&lt;0.001). Only 4.3% of the studies were judged as at low risk; 36.2% were classified as having unclear risk and 59.4% as having high risk of bias. The adherence of RCTs evaluating adhesive systems to the CONSORT is low with unclear/high risk of bias.

Chitosan Biomaterials for Current and Potential Dental Applications

Chitosan (CHS) is a very versatile natural biomaterial that has been explored for a range of bio-dental applications. CHS has numerous favourable properties such as biocompatibility, hydrophilicity, biodegradability, and a broad antibacterial spectrum (covering gram-negative and gram-positive bacteria as well as fungi). In addition, the molecular structure boasts reactive functional groups that provide numerous reaction sites and opportunities for forging electrochemical relationships at the cellular and molecular levels. The unique properties of CHS have attracted materials scientists around the globe to explore it for bio-dental applications. This review aims to highlight and discuss the hype around the development of novel chitosan biomaterials. Utilizing chitosan as a critical additive for the modification and improvement of existing dental materials has also been discussed.

Color and Gloss of Nano-Filled Resin-Modified Glass Ionomers and Resin Composites

OBJECTIVE

The study aims to compare in vitro stain resistance, color stability, gloss, and gloss retention of a nano-filled resin-modified glass ionomers (RMGIs) to a traditional RMGI and resin-based composites (RBCs).

MATERIALS AND METHODS

Specimens (N = 20) were fabricated from a nano-filled RBC (Filtek Supreme Plus, 3M ESPE, St. Paul, MN, USA), a nanohybrid RBC (Clearfil Majesty Esthetic, Kuraray; Tokyo, Japan), a nano-filled RMGI (Ketac Nano, 3M ESPE), and traditional RMGI (Fuji II LC, GC America, Chicago, IL, USA). L*a*b* values were recorded with a spectrophotometer, and gloss was measured with a glossmeter. For each material, 10 specimens were stored in distilled water in darkness for 1 week and 10 specimens were placed in a staining solution for 1 week. After storage, specimens were cleaned and L*a*b* and gloss measurements were remeasured.

RESULTS

Data were analyzed by analysis of variance (ANOVA) and Tukey analyses. Regarding color change, materials ranked: Ketac = Fuji > Filtek > Clearfil in water, and Ketac > Fuji > Filtek > Clearfil in staining solution. Prior to storage, the initial gloss of the materials ranked: Filtek ≥ Clearfil ≥ Ketac > Fuji. After storage, the materials ranked: Filtek = Clearfil > Ketac > Fuji in water, and Filtek > Clearfil > Ketac > Fuji in staining solution. Gloss retention was similar for all materials in water and gloss retention ranked: Filtek = Clearfil > Ketac = Fuji in staining solution.

CONCLUSIONS

The nano-RMGI showed less stain resistance but higher gloss than the traditional RMGI. Both RMGIs had more color change, less stain resistance, lower gloss and less gloss retention than the RBCs.

CLINICAL SIGNIFICANCE

The clinician should be aware that the use of a nano-RMGI may improve the gloss of an RMGI restoration; however, color change will likely occur, particularly if the patient consumes a staining diet.

Clinical evaluation of a new art material: Nanoparticulated resin-modified glass ionomer cement

Context:

The success of atraumatic restorative treatment (ART) technique depends on the restorative material; hence, clinical studies with various materials are necessary.

Aim:

The aim of the present study was to clinically evaluate and compare the nanoionomer and high-viscosity glass ionomer using United States Public Health Services (USPHS) Modified Cvar/Ryge Criteria with ART approach.

Materials and Methods:

Two primary molars in 50 healthy children aged between 5 and 8 years were selected for the study. The teeth were treated with ART and divided into two groups. The group 1 teeth were restored with nanoionomer (Ketac Nano 100 3M ESPE) and group 2 with high-viscosity glass ionomer cement (HVGIC), (Fuji IX GC). Each restoration was evaluated using the USPHS Modified Cvar/Ryge Criteria at baseline and 6 months’ and 12 months’ time interval.

Statistical analysis used:

Chi-squared (χ²) test.

Results:

Nanoionomer was significantly better than HVGIC with respect to color match at baseline, 6 months, and 12 months (P<0.001). Nanoionomers were also significantly better than HVGIC in case of cavosurface marginal discoloration and marginal adaptation (P<0.001) at 6 months and 12 months. There was no significant difference between the two materials with respect to secondary caries at 6 months (P>0.05), but at 12 months, nanoionomer was statistically better than HVGIC (P<0.05). There was no statistical significant difference with respect to anatomical form and postoperative sensitivity (P>0.05).

Conclusion:

The results indicate that nanoionomer can be a successful alternative restorative material for use with ART technique.

A Retrospective Clinical Study of Cervical Restorations: Longevity and Failure-Prognostic Variables

The aim of this retrospective clinical study was to compare the longevity of cervical restorations between resin composite (RC) and glass ionomer (GI) and to investigate variables predictive of their outcome. The clinical performance of the two restorative materials in function was compared using the ratings of the modified United States Public Health Service (USPHS) criteria. A total of 479 cervical restorations were included in the study. Ninety-one already-replaced restorations were reviewed from dental records. The other 388 restorations still in function were evaluated according to the modified USPHS criteria by two investigators. Longevity and prognostic variables were analyzed with the Kaplan-Meier survival analysis and multivariate Cox proportional hazard model. The clinical performances of the two materials were evaluated according to the ratings of the USPHS criteria and compared using the Pearson chi-square test and Fisher exact test. The longevity was not significantly different between RC and GI (median survival time, 10.4 ± 0.7 and 11.5 ± 1.1 years, respectively). The main reasons for failure were loss of retention (82.2%) and secondary caries (17.8%). The longevity of cervical restoration was significantly influenced by tooth group and operator group (Wald test, p&lt;0.05), while material, gender, presence or absence of systemic diseases, arch, and reason for treatment did not affect the longevity. Contrary to the longevity, the clinical performance of RC was superior to GI in the criteria of retention, marginal discoloration, and marginal adaptation, but similar in secondary caries, wear, and postoperative sensitivity.

A comparative analysis of restorative materials used in abfraction lesions in tooth with and without occlusal restoration: Three-dimensional finite element analysis

Objectives:

The present comparative analysis aimed at evaluating the mechanical behavior of various restorative materials in abfraction lesion in the presence and absence of occlusal restoration.

Materials and Methods:

A three-dimensional finite-element analysis was performed. Six experimental models of mandibular first premolar were generated and divided into two groups (groups A and B) of three each. All the groups had cervical abfraction lesion restored with materials and in addition group A had class I occlusal restoration. A load of 90 N, 200 N, and 400 N were applied at 45° loading angle on the buccal inclines of buccal cusp and Von Mises stresses was chosen for analysis.

Results:

In all the models, the values of stress recorded at the cervical margin of the restorations were at their maxima. Irrespective of the occlusal restoration, all the materials performed well at 90 N and 200 N. At 400 N, only low-shrink composite showed stresses lesser than its tensile strength indicating its success even at higher load.

Conclusion:

Irrespective of occlusal restoration, restorative materials with low modulus of elasticity are successful in abfraction lesions at moderate tensile stresses; whereas materials with higher modulus of elasticity and mechanical properties can support higher loads and resist wear.

Significance:

The model allows comparison of different restorative materials for restoration of abfraction lesions in the presence and absence of occlusal restoration. The model can be used to validate more sophisticated computational models as well as to conduct various optimization studies.

The effect of clinical performance on the survival estimates of direct restorations

Objectives

In most retrospective studies, the clinical performance of restorations had not been considered in survival analysis. This study investigated the effect of including the clinically unacceptable cases according to modified United States Public Health Service (USPHS) criteria into the failed data on the survival analysis of direct restorations as to the longevity and prognostic variables.

Materials and Methods

Nine hundred and sixty-seven direct restorations were evaluated. The data of 204 retreated restorations were collected from the records, and clinical performance of 763 restorations in function was evaluated according to modified USPHS criteria by two observers. The longevity and prognostic variables of the restorations were compared with a factor of involving clinically unacceptable cases into the failures using Kaplan-Meier survival analysis and Cox proportional hazard model.

Results

The median survival times of amalgam, composite resin and glass ionomer were 11.8, 11.0 and 6.8 years, respectively. Glass ionomer showed significantly lower longevity than composite resin and amalgam. When clinically unacceptable restorations were included into the failure, the median survival times of them decreased to 8.9, 9.7 and 6.4 years, respectively.

Conclusions

After considering the clinical performance, composite resin was the only material that showed a difference in the longevity (p < 0.05) and the significantly higher relative risk of student group than professor group disappeared in operator groups. Even in the design of retrospective study, clinical evaluation needs to be included.

Alternative technique for class V resin composite restorations with minimum finishing/polishing procedures

Class V restorations are a very common occurrence in clinics. Some reasons include an increase in non-carious cervical lesions (NCCL), root caries and the elderly population. Unfortunately, Class V restorations also represent one of the less durable types of restorations and have a high index of loss of retention, marginal excess and secondary caries. Some causes for these problems include difficulties in isolation, insertion, contouring, finishing and polishing procedures. This technique demonstrates an alternative isolation and insertion method using photocured gingival barrier in association with a flowable resin and hybrid resin composite to recreate the gingival wall with minimum or no excess.

Clinical Evaluation of Flowable Resins in Non-carious Cervical Lesions: Two-year Results

Different types of flowable resin materials placed in non-carious cervical lesions demonstrated acceptable clinical performance, except for the retention rates of Dyract Flow restorations, after two years.