Comparative evaluation of shear bond strength and penetration of self-etch sealant with and without enamel deproteinization: an in vitro study

AIM

To compare the shear bond strength and penetration ability of self-etch sealant with and without enamel deproteinization.

MATERIALS AND METHODS

A total of 37 sound extracted teeth were selected and 31 teeth were used for testing shear bond strength of self-etch sealant. For this, crowns portions of selected teeth were cut longitudinally with a diamond disc into a mesial and distal half, thereby yielding 62 samples. They were further divided into two groups; in Group 1, samples were deproteinised with 5.25% sodium hypochlorite and a sealant cylinder was built on the proximal surface. In Group 2, sealant cylinders were built without deproteinising the surface. Shear bond strength was tested using Universal Testing Machine. The remaining six teeth were used for penetration evaluation of self-etch sealant. In Group 1, the occlusal surface was deproteinised with 5.25% sodium hypochlorite and self-etch sealant was directly applied. In Group 2, sealant was applied without deproteinisation. The samples obtained after sectioning were observed under scanning electron microscope for sealant penetration. Mann-Whitney test and Chi-square analysis were utilised for statistical analysis.

RESULTS

The results showed that the shear bond strength of the two groups was statistically not significant (p = 0.23). However, the comparison of % penetration revealed a statistically significant difference between the groups (p = 0.016).

CONCLUSION

Deproteinising the enamel surface prior to application of self-etch sealant enhanced the penetration ability of the sealant but did not show any effect on shear bond strength.

COMPARATIVE EVALUATION OF A FISSURE SEALANT AND A FLOWABLE COMPOSITE: A 36-MONTH SPLIT-MOUTH, RANDOMIZED CLINICAL STUDY

OBJECTIVES

The purpose of the present clinical evaluation was to investigate the effect of a fissure sealant and a flowable composite at fissures of permanent molars in terms of retention and caries-incidence rates over a 36-month period.

METHODS

Thirty-four patients, ages varied from 16 to 22 years, diagnosed with at least 2 non-cavitated pit-and-fissure caries in the first and second molars were involved in the study. A total of 220 sealants, were placed in 117 upper molars and 103 lower molars. Teeth were sealed with either a flowable resin composite (Tetric Evo Flow) or a sealant material (Helioseal F)(n=110). Each restoration was evaluated in terms of retention and caries incidence at 6, 12, 24 and 36 months according to their location as well. Data were analyzed using Mann-Whitney U, Friedman and 1-way ANOVA tests at p < 0.05.

RESULTS

Tetric Evo Flow showed total retention with 95.5%, 93.8%, 88.5% and 80.2% at 6, 12, 24 and 36-month follow-ups respectively, while Helioseal F had retention rates of 95.5%, 94.8%, 85.4% and 80.2% respectively. After 36-months, there were 6 subjects totally lost in Helioseal F group, whereas 7 of the Tetric Evo Flow sunjects were totally lost. Caries development was firstly detected at 12-month evaluation for both of the materials however, no significant differences were observed among materials in retention rates or caries incidence after 36-month follow-ups (p>0.05).

SIGNIFICANCE

Using the flowable composite found as effective as the fissure sealant after 36-months regarding retention and caries incidence rates.

Comparison of Retention between Conventional and Nanofilled Resin Sealants in a Paediatric Population: A Randomized Clinical Trial

Background: This study compared conventional-resin-sealant versus nanofilled-sealant retention at different intervals. Methods: A double-blinded split-mouth randomized control trial was performed on sixty-two children aged from six to nine years. Participants with one pair of contralateral permanent first molars with deep fissures or noncavitated carious lesions were randomly selected for sealant application. Conventional resin sealant was applied on one molar and nanofilled sealant on the contralateral molar. Evaluations were performed at one, three, six, twelve and eighteen months to check for retention. The chi-squared test, McNemar test, Wilcoxon signed-rank test and Friedman test were used for statistical analysis. Results: Conventional resin sealant showed complete retention in 91.4%, 86.2%, 74.1%, 62.1% and 55.2% of the teeth, and nanofilled sealant showed complete retention in 89.7%, 81%, 77.6%, 69% and 67.2% of the teeth, at the end of 1 month, 3 months, 6 months, 12 months and 18 months evaluation, respectively. Each sealant exhibited a statistically significant change (p < 0.05) in the retention rate during the evaluation period. However, when both the sealants were compared with each other, there was no statistically significant difference in any phase. At the end of 18 months, caries development was observed in 13.8% of the teeth sealed with conventional sealant, and in 10.3% of the teeth sealed with nanofilled sealant. Conclusion: At eighteen months, the nanofilled resin sealant exhibited complete retention in 12% more teeth than the conventional sealant. However, the difference was not statistically significant. The nanofilled resin sealant yielded an acceptable performance in sealing the occlusal pits and fissures of mandibular permanent first molars, compared to conventional pit-and-fissure sealants.

Clinical Efficiency of Self-etching One-Step and Two-Step Adhesives in NCCL: A Systematic Review and Meta-analysis

CLINICAL RELEVANCE

One-step self-etch adhesive systems provide a clinical time gain, decreasing the number of clinical steps. When a clinician is able to follow a simpler process of adhesion there is less chance of adhesive failure.

SUMMARY

Objective: A systematic review and meta-analyses were performed to evaluate whether one-step self-etching (1SSE) adhesive systems are as effective as two-step self-etching (2SSE) adhesives in noncarious cervical lesion (NCCL) restorations.Methods: This systematic review was conducted according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and recorded in the PROSPERO (CRD42018096747). Electronic systematic searches were conducted in the following databases: PubMed/MEDLINE, Scopus, and Cochrane Library for published articles. Only randomized clinical trials that compared 1SSE with 2SSE adhesives systems were selected. The outcomes were retention, postoperative sensitivity, secondary caries, color match, marginal discoloration, marginal adaptation, and anatomical form.Results: The searches resulted in 476 studies. After applying the eligibility criteria, five randomized controlled trials were selected in which 822 restorations in NCCLs were distributed in 237 patients. The results showed no statistical difference between 1SSE and 2SSE in relation to retention (p=0.23; relative risk [RR]=1.55; 95% confidence interval [CI]=0.76, 3.19), postoperative sensitivity ( p=0.50; RR=3.00; 95% CI=0.13, 70.64), Secondary caries (p=0.63; RR=0.68; 95% CI=0.14, 3.31), color match (p=0.41; RR=0.64; 95% CI=0.23, 1.83), marginal discoloration (p=0.93; RR=1.02; 95% CI=0.65, 1.61), and anatomical form (p=0.56; RR=1.38; 95% CI=0.46, 4.13). However there was statistical difference in relation to marginal adaptation ( p=0.01; RR=1.95; 95% CI=1.14, 3.34).Conclusion: This systematic review with meta-analysis revealed that both 1SSE and 2SSE adhesive systems have comparable clinical effectiveness in a follow-up period of 12 to 24 months, except in relation to marginal adaptation.

Meta-analysis of the longevity of commonly used pit and fissure sealant materials

OBJECTIVE

This systematic literature review and meta-analysis compared the clinical retention of primed or adhesively bonded sealants to that of conventional sealant materials.

METHODS

A search of the MEDLINE, EMBASE and CENTRAL databases identified 3707 abstracts published prior to 12/31/2017, of which 335 clinical publications were analysed in detail. A total of 67 studies included information about sealant retention after 24, 36, or 60 months of follow-up. A meta-analysis using a random effects model was conducted to calculate the pooled estimate of the retention rates for the five groups of sealants. Subgroup moderator analysis was performed to compare the pooled retention rate estimate (RRE) of primed sealants against those of the other groups.

RESULTS

Primed sealants had a 2-year pooled RRE of 43.2% (95% CI: 30.5-55.8), which was significantly inferior to those of auto-polymerizing (80.8%, 95% CI: 72.2-89) and light-polymerizing sealants (68.4%, 95% CI: 60.2-76.7). Fluoride-releasing and light-polymerizing sealants had the highest 3-year pooled RREs (86.4%, 95% CI: 73.4-99.3 and 83.1%, 95% CI: 75.6-90.7, respectively).

SIGNIFICANE

The results of this meta-analysis suggest that primed sealants cannot be fully recommended for clinical practice due to their moderate survival rates. Auto-polymerizing, light-polymerizing and fluoride-releasing sealants continue to be considered the reference standards for pit and fissure sealants. However, future generations and developments of primed sealant materials may change this position.

Comparison and Evaluation of the Retention, Cariostatic Effect, and Discoloration of Conventional Clinpro 3M ESPE and Hydrophilic Ultraseal XT Hydro among 12-15-year-old Schoolchildren for a Period of 6 Months: A Single-blind Randomized Clinical Trial

Introduction

Pit and fissures are more prone to caries as compared to smooth surfaces. Sealing the pit and fissures with sealants is considered to be highly effective in the prevention of pit and fissure caries. Hydrophobic sealants are technique sensitive in nature. Ultraseal XT Hydro sealant is moisture tolerant which incorporates the benefits of both hydrophilic and hydrophobic sealants into one unique chemistry. Hence, the study was conducted to compare and evaluate the retention, cariostatic effect, and discoloration of conventional Clinpro™ 3M™ ESPE™ and hydrophilic Ultraseal XT Hydro sealants among 12–15-year-old schoolchildren for 6 months.

Materials and methods

It was a single-blinded, randomized split-mouth clinical trial. Schoolchildren aged 12–15 years were recruited in this clinical trial. Clinpro sealant and Ultraseal XT Hydro were placed in the right and left quadrant molars, respectively, and were assigned as group I and II. The sample size arrived was 60 teeth per group and at 30 patients based on the computer-generated random sequence. Sealant coverage between the two sealants was compared using Mann–Whitney test and Z test for proportions.

Results

After 6 months, it was seen that 10 teeth out of 44 (22.72%) with Clinpro had the sealant covering all the fissures compared to Ultraseal XT Hydro which was only 9%. Fifty-nine percent of retention rate was seen with Clinpro compared to Ultraseal XT Hydro sealant (27.27%). Caries incidence was higher in the case of group II. No difference was observed with regard to the discoloration of the sealants.

Conclusion

It was concluded that for a longer follow-up period conventional Clinpro™ 3M™ ESPE™ was better than Ultra XT Hydro seal in terms of retention and cariostatic effect.

How to cite this article

Mohapatra S, Prabakar J, Indiran MA, et al. Comparison and Evaluation of the Retention, Cariostatic Effect, and Discoloration of Conventional Clinpro 3M ESPE and Hydrophilic Ultraseal XT Hydro among 12–15-year-old Schoolchildren for a Period of 6 Months: A Single-blind Randomized Clinical Trial. Int J Clin Pediatr Dent 2020;13(6):688–693.

Retention and remineralization effect of moisture tolerant resin-based sealant and glass ionomer sealant on non-cavitated pit and fissure caries: Randomized controlled clinical trial

INTRODUCTION/OBJECTIVES

Pit and fissure sealants are an essential part of preventive dentistry and should be adopted as a crucial part of the minimally invasive dentistry due to their profound benefit to our patients.

METHODS

The study design is a single-blind, split-mouth, randomized controlled clinical trial. Forty patients between age 6-9 were selected. First permanent molars' occlusal surfaces with scores of 1, or 2 according to the International Caries Detection and Assessment System II (ICDAS II) and with scores between 14-30 by using DIAGNOdent device (Kavo®, Biberach, Germany) were selected and readings recorded. One side of the mouth was randomly chosen to have either the moisture tolerant resin sealant or the glass ionomer sealant placed, and then the second material was placed on the other side. The retention of these materials was analyzed at 3 and 6 months. The sealants were then removed and DIAGNOdent readings were subsequently taken.

RESULTS

After three months, full retention was found in 38/40 (95%) teeth in Group A (Embrace™ WetBond™) and 35/40 (87.5%) teeth in Group B (Fuji TRIAGE®). Additionally, no sealant suffered a total loss in group A, whereas, three sealants were totally lost (7.5%) in group B. The difference in sealant retention in two groups in this period was not found to be statistically significant (P >  0.05). At six months, full retention was found in Group A 34/40 (85%) and 25/40 (62.5%) in Group B. Also, the partial loss in Group A was 2/40 (5%) whereas in Group B 7/40 (17.5%). Also, the total loss was 4/40 (10%) and 8/40 (20%) in Group A and B, respectively. The difference in sealant retention in two groups after six months follow-up was found statistically significant (P < 0.05). The initial mean values of DIAGNOdent readings were 22.42 and 22.8 in Group A and Group B, respectively. After six months, DIAGNOdent mean values revealed a drop in both groups, and this difference was statistically significant. Nevertheless, when Group A was compared to Group B in terms of remineralization effect, the differences were found not to be statistically significant (p > 0.05).

CONCLUSIONS

Within the limitation of this study, we affirmed that occlusal caries lesions, which is restrictive to enamel and in need of surgical intervention, can be arrested clinically by sealing the lesion with both a hydrophilic resin sealant and glass ionomer sealant materials. Embrace™ WetBond™ showed superiority over the glass ionomer sealant tested in retention after six months follow up.

Laser versus LED polymerization: Comparison of in vitro preventive sealing procedures

Introduction:

The technique of sealing is a widely accepted procedure for prevention of caries. The aim of our in vitro study was to compare the effect of two different curing units (traditional LED source and innovative laser diode lamp) on the integrity of fissure sealant material and its interface with tooth enamel.

Materials and methods:

Sixty healthy third molars were randomly assigned to two groups. In group A were teeth intended for polymerization by LED B lamp, and group B comprised teeth to be polymerized by an innovative laser diode. Both groups were treated with the traditional sealing technique, subjected to a metallization process, and analyzed by scanning electron microscope.

Results:

Micro-gaps between the sealant and the enamel were found in specimens in both A (43%) and B (40%) groups ( p=0.793), and sealant shrinkage was seen. Significant differences between the groups emerged in the percentage of perimetric micro-erosion sites (80% vs. 100%, p=0.010) and the presence of holes and micro-bubbles on the sealant surface (21% vs. 63%, p=0.001).

Conclusions:

Although macroscopic clinical polymerization occurred with both instruments, the microscopic evaluation showed significant differences between the studied groups in terms of perimetric micro-erosion sites and micro-bubbles, which were higher in laser-cured samples.

Clinical evaluation of a surface pre-reacted glass (S-PRG) filler-containing dental sealant placed with a self-etching primer/adhesive

AIMS

To clinically evaluate the retention rates and caries-prevention effect of a resin-based, non-etch and rinse, self-etch primed pit and fissure sealant containing Sealant Pre-reacted Glass Ionomer Cement (S-PRG) fillers, in comparison to a conventional resin-based sealant over an 18-month period.

METHODS

There were 81 children, aged 6-12 years old, who were randomly assigned to one of two sealant-groups, either the self-etch primed sealant (Beautisealant, Shofu) or the conventional etch and rinse sealant (Seal it, Spident). A total of 218 sealants of both groups were placed on first permanent molars with either sound surfaces (The International Caries Detection and Assessment System [ICDAS], code 0) or incipient enamel caries lesions (ICDAS code 1) according to the manufacturers' instructions. Each sealant restoration was independently evaluated in terms of retention and caries status at 6, 12 and 18 months. The data were statistically analysed with the Chi-squared test and z-test and the level of significance was preset at α = 0.05.

RESULTS

The differences between the complete retention rates of the two sealant groups were statistically significant in all periods of evaluation (p < 0.01). Survival rates of each sealant-group were comparable on sound (ICDAS 0) and enamel caries lesions (ICDAS1). Caries prevention effect of the two sealant groups was similar at the end of the evaluation period.

CONCLUSIONS

The clinical performance of the S-PRG filler-containing dental sealant placed with a self-etching primer was poor regarding its retention. Its significantly higher loss did not lead to more carious occlusal surfaces at the 18-month recall.

Comparative Evaluation of Retention, Cariostatic Effect and Discoloration of Conventional and Hydrophilic Sealants - A Single Blinded Randomized Split Mouth Clinical Trial

Introduction:

Pit and fissures are approximately eight times vulnerable than the smooth surface caries lesion. Sealants are effective in preventing, arresting, and progression of pit-and-fissure occlusal caries lesions. The failure of sealant resin-based retention is mainly attributed to the moisture contamination. To overcome this drawback, UltraSeal XT^® hydro, a moisture-friendly sealant, has been introduced.

Aim:

This study aimed to compare and evaluate the retention, cariostatic effect, and discoloration of conventional Clinpro™ 3M™ ESPE™ and hydrophilic UltraSeal XT^® sealants among 12 to 15-year-old schoolchildren for 3 months.

Materials and Methods:

A single-blinded, randomized, split-mouth clinical trial was conducted among thirty schoolchildren aged 12–15 years. Sealants used in the present study were Group I – Clinpro™ and Group II – UltraSeal XT^® hydro. Sealants were provided in the school by two operators based on the computer-generated random sequence and the study participants were evaluated after 3 months for sealant coverage, caries incidence, and discoloration using Color, Coverage and Caries sealant evaluation system. Sealant coverage between the two sealants was compared using Mann–Whitney U-test and Z-test for proportions.

Results:

A total of 47 teeth (78.3%) with UltraSeal XT^® Hydro had the sealant covering in all the fissures compared to Clinpro™ 3M™ ESPE™ which was 46.7% (28 teeth) and the difference was observed to be statistically significant.

Conclusion:

Hydrophilic UltraSeal XT^® Hydro yielded better sealant coverage (retention) compared to the conventional Clinpro™ 3M™ ESPE™. No difference was observed with regard to cariostatic effect and discoloration.

Clinical Follow-up of a Fissure Sealant Placed Using Different Adhesive Protocols: A 24-month Split-mouth Study

The purpose of this study was to evaluate the retention rates of a fissure sealant placed using different adhesive protocols over 24 months. Twenty-four subjects with no restorations or caries received fissure sealants (Clinpro Sealant, 3M ESPE) placed using different adhesive protocols. A total of 292 sealants were placed as follows by two previously calibrated dentists using a table of random numbers (n=73): group I, acid-etch/without adhesive; group II, with a self-etch adhesive (Adper Easy Bond, 3M ESPE); group III, with an etch-and-rinse adhesive (Adper Single Bond 2, 3M ESPE); group IV, with acid + self-etch adhesive (Adper Easy Bond). Two other calibrated examiners independently evaluated the sealants at baseline and at six-, 12-, 18-, and 24-month recalls. Each sealant was evaluated in terms of caries formation being present or absent and retention using the following criteria: 1 = total retention, 2 = partial loss, and 3 = total loss. Pearson's χ² test was used to evaluate differences in retention rates among the sealants for each evaluation period. At the end of 24 months, total retention rates were 57.5%, 27.4%, 84.9%, and 76.7% in the acid-etch, self-etch adhesive, etch-and-rinse adhesive, and acid + self-etch adhesive groups, respectively. Although there were no statistically significant differences between the retention rates among the adhesive protocols at 6 months ( p=0.684), significant differences were observed at the 12-, 18-, and 24-month evaluations. At 24 months, the lowest retention rates were observed in the self-etch group ( p<0.05). No caries development was observed in any of the groups. The retention rate of sealants placed using self-etch adhesive was poor compared with the other groups.

Effectiveness of pit and fissure sealants bonded with different adhesive systems: a prospective randomized controlled trial

OBJECTIVES

To evaluate and compare the clinical retention of a resin-based fissure sealant placed with an intermediate layer of etch-and-rinse (ER) or self-etch (SE) adhesives.

MATERIALS AND METHODS

Two hundred twenty-eight sealants were placed in 57 children with previously unsealed, caries-free permanent first molars, employing a split-mouth design. The teeth were randomized into four groups (n = 57 teeth/groups) according to the adhesive system placed under the tested sealant (Delton FS+; Dentsply). Group 1 (control): no bonding agent (conventional acid-etch sealant); group 2: prior enamel etch + ER adhesive (XP Bond; Dentsply); group 3: SE adhesive (Clearfil SE Bond; Kuraray) without prior etching; and group 4: prior enamel etch + SE adhesive (Clearfil SE Bond). Clinical assessments were performed according to modified USPHS criteria at 1, 3, 6, 12, 18, and 24 months. The data were analyzed statistically using Fisher's Exact test, the Kaplan-Meier analysis, and the Log-rank test.

RESULTS

At 24 months, sealants bonded with XP Bond and Clearfil SE Bond with prior enamel etching showed similar retention rates (p > 0.05), and these rates were significantly better than the rates of the conventional sealant and Clearfil-SE groups (p < 0.05). There was no significant difference between the retention rates of the latter two groups (p > 0.05). The cumulative survival rates on palatal/buccal surfaces showed similar outcomes as with occlusal surfaces: XP Bond (94%), Clearfil SE Bond + acid-etch (94%), conventional sealant (52%), and Clearfil SE Bond only (37%).

CONCLUSIONS

Application of the tested ER adhesive and the SE adhesive with enamel etching significantly improved the clinical retention of Delton-FS over the 24-month period.

CLINICAL RELEVANCE

The use of a resin-based fissure sealant placed with ER or SE adhesive with prior acid-etching yielded better retention than the conventional sealant over the 24-month period.

Are self-etch adhesive systems effective in the retention of occlusal sealants? A systematic review and meta-analysis

BACKGROUND

Occlusal sealants are an effective method for caries prevention, although the effectiveness of different application strategies has not been established yet.

AIM

This systematic review compared the retention rate of sealants placed on occlusal surfaces following the use of self-etch adhesive systems and traditional acid etching, with or without the application of adhesive system.

DESIGN

Literature searching was carried out until June 2015 in PubMed/MEDLINE, CENTRAL, and ClinicalTrials databases selecting randomized clinical trials that evaluated self-etch adhesive systems associated with pit and fissure sealants in primary or permanent molars comprising retention as outcome. From 683 potentially eligible studies, 10 were selected for full-text analysis and 5 were included in the meta-analysis. Two reviewers independently selected the studies, extracted the data, and assessed the bias risk. Pooled-effect estimates were obtained by comparing the retention failure rate between groups (self-etch systems vs acid etching with or without adhesive systems).

RESULTS

Significant difference was found between groups, favoring the control group (prior acid etching) (P < 0.05), which showed lower failure rate in the retention of occlusal sealants. High heterogeneity was found on the meta-analysis. Most trials showed good evidence strength.

CONCLUSIONS

Occlusal sealants applied with self-etch systems show lower retention throughout time than sealants applied in the conventional approach, regardless of the use of adhesive systems.

Adhesive systems under fissure sealants: yes or no?: A systematic review and meta-analysis

BACKGROUND

The authors of this systematic review and meta-analysis had 2 aims: to evaluate fissure sealant retention with and without the use of an adhesive system and to compare fissure sealant retention using etch-and-rinse adhesive systems versus self-etching adhesive systems.

TYPES OF STUDIES REVIEWED

The authors conducted a literature search (all articles published through November 1, 2015) to identify studies for inclusion in this systematic review. They assessed the quality of the evidence provided using the modified Jadad scale and performed meta-analyses using a random-effects model.

RESULTS

The authors considered 12 studies that met the inclusion criteria for the systematic review. In addition, they used 5 of 9 studies related to the first part of the study and 3 of 4 studies related to the second part of the study that met the inclusion criteria for meta-analysis. In the analysis of the first part of the systematic review, the authors found that adhesive systems had a significant positive effect on fissure sealant (odds ratio, 3.294; 95% confidence interval, 1.292-8.401; P = .013). In the analysis of the second part of the systematic review, the authors found that etch-and-rinse adhesives were superior to self-etching adhesives in the fissure sealant procedure (odds ratio, 14.569; 95% confidence interval, 2.616-81.131; P = .002).

CONCLUSIONS AND PRACTICAL IMPLICATIONS

The use of adhesive systems beneath fissure sealants can increase the retention of fissure sealants. Also, when adhesive systems are used with fissure sealants, etch-and-rinse systems are preferable.

Four-year Randomized Clinical Trial to Evaluate the Clinical Performance of a Glass Ionomer Restorative System

Objective

The aim of this study was to evaluate the clinical performance of a glass ionomer restorative system compared with a microfilled hybrid posterior composite in a four-year randomized clinical trial.

Methods

A total of 140 (80 Class 1 and 60 Class 2) lesions in 59 patients were either restored with a glass ionomer restorative system (Equia, GC, Tokyo, Japan), which was a combination of a packable glass ionomer (Equia Fil, GC) and a self-adhesive nanofilled coating (Equia Coat, GC), or with a microfilled hybrid composite (Gradia Direct Posterior, GC) in combination with a self-etch adhesive (G-Bond, GC) by two experienced operators according to the manufacturer's instructions. Two independent examiners evaluated the restorations at baseline and at one, two, three, and four years postrestoration according to the modified US Public Health Service criteria. Polyvinyl siloxane impression negative replicas at each recall were observed under scanning electron microscopy (SEM) to evaluate surface characteristics. The statistical analyses were carried out with McNemar, Pearson Chi-square, and Cochran Q- tests (p&lt;0.05).

Results

After four years, 126 (76 Class 1 and 50 Class 2) restorations were evaluated in 52 patients, with a recall rate of 88.1%. None of the restorations showed trends to downgrade in anatomical form, secondary caries, surface texture, postoperative sensitivity, and color match (p&gt;0.05). Significant differences in marginal adaptation and discoloration were found at four years compared to baseline for both restorative materials for Class 1 and Class 2 restorations (p&lt;0.05). Only one Class 2 Equia restoration was missing at three years (3.9%), and another one was missing at four years (7.7%) (p&gt;0.05). SEM evaluations were in accordance with the clinical findings.

Conclusions

The use of both materials for the restoration of posterior teeth exhibited a similar and clinically successful performance after four years.