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Ning K, Yang F, Bronkhorst E, Ruben J, Nogueira L, Haugen H, Loomans B, Leeuwenburgh S. Fatigue behaviour of a self-healing dental composite. Dent Mater 2023; 39:913-921. [PMID: 37643923 DOI: 10.1016/j.dental.2023.08.172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 08/10/2023] [Accepted: 08/16/2023] [Indexed: 08/31/2023]
Abstract
OBJECTIVE Novel self-healing resin-based composites containing microcapsules have been developed to improve the mechanical performance of dental restorations. However, the long-term fatigue behaviour of these self-healing composites has still been hardly investigated. Therefore, this manuscript studied the fatigue behaviour of self-healing composites containing microcapsules by subjecting the specimens to traditional staircase tests and ageing in a custom-designed chewing simulator (Rub&Roll) to simulate oral ageing physiologically relevant conditions. METHODS To prepare self-healing composite, poly(urea-formaldehyde) microcapsules containing acrylic self-healing liquids were synthesized. Subsequently, these microcapsules (10 wt%) and initiator (benzoyl peroxide, BPO, 2 wt%) were incorporated into a commercial flowable resin-based composite. Microcapsule-free resin-based composites with and without BPO were also prepared as control specimens. A three-point flexural test was used to measure the initial flexural strength (Sinitial). Subsequently, half of the specimens were used for fatigue testing using a common staircase approach to measure the fatigue strengths (FS). In addition, the other specimens were aged in the Rub&Roll machine for four weeks where after the final flexural strength (Sfinal) was measured. RESULTS Compared to Sinitial, FS of all tested specimens significantly decreased as measured through staircase testing. After 4 weeks of ageing in the Rub&Roll machine, Sfinal was significantly reduced compared to Sinitial for microcapsule-free resin-based composites, but not for the self-healing composites (p = 0.3658). However, the self-healing composites are still in the experimental phase characterized by a low mechanical strength, which still impedes further clinical translation. SIGNIFICANCE Self-healing composites containing microcapsules exhibit improved fatigue resistance compared to microcapsule-free non-self-healing composites.
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Affiliation(s)
- Ke Ning
- Radboud University Medical Center, Radboud Institute for Molecular Life Sciences, Department of Dentistry, Regenerative Biomaterials, Philips van Leydenlaan 25, Nijmegen, the Netherlands
| | - Fang Yang
- Radboud University Medical Center, Radboud Institute for Molecular Life Sciences, Department of Dentistry, Regenerative Biomaterials, Philips van Leydenlaan 25, Nijmegen, the Netherlands
| | - Ewald Bronkhorst
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Dentistry, Restorative Dentistry, Philips van Leydenlaan 25, Nijmegen, the Netherlands
| | - Jan Ruben
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Dentistry, Restorative Dentistry, Philips van Leydenlaan 25, Nijmegen, the Netherlands
| | - Liebert Nogueira
- University of Oslo, Institute of Clinical Dentistry, Department of Biomaterials, Oslo 0317, Norway
| | - Håvard Haugen
- University of Oslo, Institute of Clinical Dentistry, Department of Biomaterials, Oslo 0317, Norway
| | - Bas Loomans
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Dentistry, Restorative Dentistry, Philips van Leydenlaan 25, Nijmegen, the Netherlands
| | - Sander Leeuwenburgh
- Radboud University Medical Center, Radboud Institute for Molecular Life Sciences, Department of Dentistry, Regenerative Biomaterials, Philips van Leydenlaan 25, Nijmegen, the Netherlands.
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van Sambeek RMF, de Vos R, Crins LAMJ, Bronkhorst E, Mehta SB, Pereira-Cenci T, Loomans BAC. Perception of oral health related quality of life and orofacial aesthetics following restorative treatment of tooth wear: A five-year follow-up. J Dent 2023; 136:104626. [PMID: 37473829 DOI: 10.1016/j.jdent.2023.104626] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 07/15/2023] [Accepted: 07/17/2023] [Indexed: 07/22/2023] Open
Abstract
OBJECTIVES Non-carious tooth wear often has a multifactorial etiology and may lead to functional or aesthetically related problems. The most common complaints associated with tooth wear are dissatisfaction with dental appearance and a negative impact on the experienced Oral Health Related Quality of Life (OHRQoL). The aim of this study was to investigate the change in OHRQoL and the perception of aesthetics, following restorative treatment of moderate to severe tooth wear patients, with a five-year follow-up. METHODS An explorative study, based on prospective data, was performed. OHRQoL and the perception of aesthetics were measured with the OHIP-NL and OES-NL. These questionnaires were completed before treatment, one month after treatment, and at 1-, 3- and 5-years post-treatment. Treatment involved full mouth reconstruction with composite resin restorations. The data was analysed as repeated measures by using a linear mixed-effects model. RESULTS One hundred and twenty-three tooth wear patients that received restorative rehabilitation were included (97 males, 26 females, 37.5 ± 8.8 years-old). Data showed a statistically significant increase in both experienced OHRQoL and orofacial appearance after restorative treatment. The OHIP-scores remained stable over time, while the OES-scores slightly decreased during the years after treatment. Regarding the seven domains of the OHIP, the largest difference in OHIP-score was found in the domain of 'Psychological Discomfort'. The mean overall OHIP-score was 1.8 at baseline and 1.3 at the 5-years recall. The mean OES score increased from 41.8 at baseline to 66.1 at the 5-years follow-up. CONCLUSIONS Tooth wear patients reported significant improvements in their OHRQoL and their perception of orofacial aesthetics after restorative treatment. This increase remained at least five years post-treatment. CLINICAL SIGNIFICANCE The clinical impact of restorative treatment for tooth wear patients is considerable. This paper emphasizes the need to include a discussion of the patient related outcome measures when planning care.
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Affiliation(s)
- Roos M F van Sambeek
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Dentistry, Nijmegen, the Netherlands.
| | - Rien de Vos
- Amsterdam University Medical Center, Department of Medical Education, Amsterdam, the Netherlands
| | - Luuk A M J Crins
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Dentistry, Nijmegen, the Netherlands
| | - Ewald Bronkhorst
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Dentistry, Nijmegen, the Netherlands
| | - Shamir B Mehta
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Dentistry, Nijmegen, the Netherlands; King's College London Faculty of Dentistry, Oral & Craniofacial Sciences, Guy's Campus, London
| | - Tatiana Pereira-Cenci
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Dentistry, Nijmegen, the Netherlands
| | - Bas A C Loomans
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Dentistry, Nijmegen, the Netherlands
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Martins WF, Coelho CSS, Amaral FLBD, França FMG, Turssi CP, Cavalli V, Basting RT. Fracture load and failure mode of semi-direct resin composite occlusal veneers: Influence of design and mechanical cycling. J Mech Behav Biomed Mater 2023; 144:105961. [PMID: 37320893 DOI: 10.1016/j.jmbbm.2023.105961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/05/2023] [Accepted: 06/06/2023] [Indexed: 06/17/2023]
Abstract
AIMS To evaluate the influence of the type of preparation and mechanical cycling on the fracture load and failure mode of semi-direct posterior resin composite restorations. METHODS In total, 70 healthy third molars were used; 10 belonging to the control group (C - unprepared teeth) and 60 teeth prepared and restored with nanoparticle resin composite, divided into 3 groups (n = 20): O - exclusively occlusal preparation (Table Top); OV - occlusal preparation with buccal extension (Veneerlay); OVP - Occlusal preparation with chamfer on the proximal and buccal-lingual/palatal surfaces (Overlay). The preparations were performed with diamond burs with a thickness of 1 mm. The restorations were made with nanoparticulate resin composite (Filtek Z350 XT) and subsequently received additional polymerization (thermoprocessing). Cementation was performed with the use of universal adhesive system (Single Bond Universal) on dental substrate and dual resin cement (RelyX ARC). Half of the teeth in each group (n = 10) were submitted to mechanical cycling, simulating 6 months of clinical service (5 × 105 fatigue cycles), under dynamic loading of 130 N, at a frequency of 2Hz. Fracture load tests were performed in a universal testing machine with a 200 kgf load cell. Failure mode was classified using scores. Generalized linear models and Fisher Exact tests were applied to the data (significance level of 5%). RESULTS There were no significant differences between the types of preparation (p = 0.9435), or relative to cycling (p = 0.3764). The Fisher Exact Test showed a significant association between the groups and the type of failure (p = 0.0006), with preparations O (with cycling) and OVP (with and without cycling) exhibiting most failures with restoration fractures without involvement of the dental remnant. CONCLUSIONS Semi-direct restorations showed resistance to fracture load similar to that of healthy teeth and were capable of withstanding functional masticatory loads. The type of preparation influenced the failure mode of teeth. The Table Top and Overlay types of preparations were those had fewer catastrophic failures, suggesting that since they are more conservative preparations, they made it possible for the tooth to receive a new restorative procedure in the future in cases of failures.
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Affiliation(s)
- Wellington Ferreira Martins
- Faculdade São Leopoldo Mandic, Rua José Rocha Junqueira 13, Bairro Swift, Campinas, CEP: 13045-755, São Paulo, Brazil.
| | - Camila Siqueira Silva Coelho
- Piracicaba Dental School, University of Campinas, 901 Limeira Avenue, Areião, 13414-903, Piracicaba, São Paulo, Brazil.
| | | | | | - Cecilia Pedroso Turssi
- Faculdade São Leopoldo Mandic, Rua José Rocha Junqueira 13, Bairro Swift, Campinas, CEP: 13045-755, São Paulo, Brazil.
| | - Vanessa Cavalli
- Piracicaba Dental School, University of Campinas, 901 Limeira Avenue, Areião, 13414-903, Piracicaba, São Paulo, Brazil.
| | - Roberta Tarkany Basting
- Faculdade São Leopoldo Mandic, Rua José Rocha Junqueira 13, Bairro Swift, Campinas, CEP: 13045-755, São Paulo, Brazil.
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Ning K, Bronkhorst E, Crins L, van der Meer W, Pereira-Cenci T, Yang F, Leeuwenburgh S, Loomans B. Wear behaviour of direct composite restorations in tooth wear patients: a 5-year clinical study. J Dent 2022; 127:104354. [PMID: 36351488 DOI: 10.1016/j.jdent.2022.104354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 10/24/2022] [Accepted: 10/28/2022] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE This study aimed to investigate the wear behaviour of direct composite restorations after 5 years and associated patient factors. METHODS 38 patients (6 females, 32 males; 35.2 ± 7.6y) from the Radboud Tooth Wear Project with generalized moderate to severe tooth wear were treated with direct composite restorations on all teeth. Ethical approval was sought and granted before the study was undertaken. Intraoral 3D scans were recorded at 1 month (baseline) and 5 years (recall) after treatment. The amount of height loss was measured at six index teeth (first molars and upper central incisors). Patient factors (age, vertical dimension of occlusion increase, bite force, aetiology score, jaw position and bearing/ non-bearing cusps) were included in the analysis. Multilevel multiple regression with bootstrapping was used to analyse the influence of these factors on wear behaviour of restorations. Observer reliability was tested by paired t-tests and Band-Altman plots (p<0.05) RESULTS: After 5 years, the mean height loss was 0.23± 0.19 mm for incisors and 0.43± 0.24 mm for molars (p≤0.001). Patient factors did not show any significant influence on height loss of the composite restorations, while bearing cusps showed significant more wear compared to non-bearing cusps (p≤0.001). The observer reliability tests confirmed the repeatability (correlation of 0.809, DME 0.103). CONCLUSIONS Wear of composite restorations is a significant and relevant factor over time in patients treated with severe tooth wear. Within the limitations of this clinical study, patient factors were found not to have a significant effect on wear behaviour of direct composite restorations.
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Affiliation(s)
- Ke Ning
- Radboud University Medical Center, Radboud Institute for Molecular Life Sciences, Department of Dentistry - Regenerative Biomaterials, Philips van Leydenlaan 25, Nijmegen, the Netherlands
| | - Ewald Bronkhorst
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Dentistry - Restorative Dentistry, Philips van Leydenlaan 25, Nijmegen, the Netherlands
| | - Luuk Crins
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Dentistry - Restorative Dentistry, Philips van Leydenlaan 25, Nijmegen, the Netherlands
| | - Wicher van der Meer
- University of Groningen, University Medical Center Groningen, Department of Orthodontics, Groningen, the Netherlands; W.J. Kolff Institute of Biomedical Engineering and Materials Science, Groningen, the Netherlands
| | - Tatiana Pereira-Cenci
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Dentistry - Restorative Dentistry, Philips van Leydenlaan 25, Nijmegen, the Netherlands
| | - Fang Yang
- Radboud University Medical Center, Radboud Institute for Molecular Life Sciences, Department of Dentistry - Regenerative Biomaterials, Philips van Leydenlaan 25, Nijmegen, the Netherlands
| | - Sander Leeuwenburgh
- Radboud University Medical Center, Radboud Institute for Molecular Life Sciences, Department of Dentistry - Regenerative Biomaterials, Philips van Leydenlaan 25, Nijmegen, the Netherlands
| | - Bas Loomans
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Dentistry - Restorative Dentistry, Philips van Leydenlaan 25, Nijmegen, the Netherlands.
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Lima VP, Crins LAMJ, Opdam NJM, Moraes RR, Bronkhorst EM, Huysmans MCDNJM, Loomans BAC. Deterioration of anterior resin composite restorations in moderate to severe tooth wear patients: 3-year results. Clin Oral Investig 2022; 26:6925-6939. [PMID: 35879624 DOI: 10.1007/s00784-022-04647-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 07/12/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Deterioration in anterior resin composite restorations placed in tooth wear patients was investigated after 36 months. MATERIALS AND METHODS Data collected prospectively for 47 participants of the Radboud Tooth Wear Project were used (41 ± 8 years, 90% male, n = 270 restorations). Restorations were individually evaluated using intraoral photographs and 3D scans to rate modified FDI scores and to record the presence of degradation features. Four groups with distinct combinations of composites and techniques were assessed, and multivariable logistic regression models were used to analyze the data (p < 0.05). RESULTS For all groups together, early degradation signs were present at 1 month: irregularities (41.5%) and ditching (7.4%) were observed at the surface and adhesive interfaces. The frequency of irregularities decreased in the 36-month evaluation (37%), but ditching (12.2%) and fractures (10.7%) were more common. The most frequent deterioration (based on photographs) was observed for staining (44%) and loss of luster (31%). In 3D scans, the most frequent were for wear (25%), marginal adaptation (24%), and the presence of irregularities (19%). Canines had 5.5 times more chances of deterioration by ditching than incisors (p < 0.001). The differences between composites and restorative techniques were minor. CONCLUSIONS A continuous degradation process of restorations placed in tooth wear patients was observed in anterior teeth restored with different composites, with a progression of the deterioration over 36 months. CLINICAL RELEVANCE When placing anterior resin composite restorations in tooth wear patients, it could be important to establish realistic expectations and the need for checkup appointments.
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Affiliation(s)
- Verônica P Lima
- Graduate Program in Dentistry, Federal University of Pelotas, Rua Gonçalves Chaves 457, Pelotas, RS, 96015-560, Brazil. .,Radboud Institute for Health Sciences, Department of Dentistry, Radboud University Medical Center, Ph. van Leydenlaan 25, NL 6500 HB, P.O. Box 9101, Nijmegen, 6525 EX, The Netherlands.
| | - Luuk A M J Crins
- Radboud Institute for Health Sciences, Department of Dentistry, Radboud University Medical Center, Ph. van Leydenlaan 25, NL 6500 HB, P.O. Box 9101, Nijmegen, 6525 EX, The Netherlands
| | - Niek J M Opdam
- Radboud Institute for Health Sciences, Department of Dentistry, Radboud University Medical Center, Ph. van Leydenlaan 25, NL 6500 HB, P.O. Box 9101, Nijmegen, 6525 EX, The Netherlands
| | - Rafael R Moraes
- Graduate Program in Dentistry, Federal University of Pelotas, Rua Gonçalves Chaves 457, Pelotas, RS, 96015-560, Brazil
| | - Ewald M Bronkhorst
- Radboud Institute for Health Sciences, Department of Dentistry, Radboud University Medical Center, Ph. van Leydenlaan 25, NL 6500 HB, P.O. Box 9101, Nijmegen, 6525 EX, The Netherlands
| | - Marie-Charlotte D N J M Huysmans
- Radboud Institute for Health Sciences, Department of Dentistry, Radboud University Medical Center, Ph. van Leydenlaan 25, NL 6500 HB, P.O. Box 9101, Nijmegen, 6525 EX, The Netherlands
| | - Bas A C Loomans
- Radboud Institute for Health Sciences, Department of Dentistry, Radboud University Medical Center, Ph. van Leydenlaan 25, NL 6500 HB, P.O. Box 9101, Nijmegen, 6525 EX, The Netherlands
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Wierichs RJ, Weilenmann W, Jeganathan S, Perrin P. Longevity of immediate rehabilitation with direct metal-wire reinforced composite fixed partial dentures. Dent Mater 2022; 38:e257-e265. [PMID: 35718596 DOI: 10.1016/j.dental.2022.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/04/2022] [Accepted: 06/05/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES This study aimed to analyze the longevity of direct metal-wire reinforced composite fixed partial dentures (MRC-FPD) and factors influencing their survival and success. METHODS Within one private practice 513 MRC-FPD were directly applied. The preparation of a proximal cavity in abutment teeth was not limited. MRC-FPD were reinforced by one to three metal-wires. At the last follow-up MRC-FPD were considered successful, if they were still in function without any need of therapy. MRC-FPD were considered as survived, if they were repaired or replaced. Multi-level Cox proportional hazard models were used to evaluate the association between clinical factors and time. RESULTS Mean follow-up period (range) was 59(2-249) months. Seventy-three bridges did not survive (cumulative survival rate(CSR):86%) and further 129 bridges had received a restorative follow-up treatment (CSR:61%). AFR was 2.2% for survival and 8.6% for success. In multivariate analysis MRC-FPD with> 1 wire showed a up to 2.3x higher failure rate than MRC-FPD with one wire(p ≤ 0.023). Dentist's experience in designing MRC-FDP (p ≤ 0.017), patient's caries risk (p ≤ 0.040) and bruxism (p = 0.033) significantly influenced the failure rate: the more experience, the lower caries risk and bruxism, the lower the failure rate. SIGNIFICANCE For directly prepared metal-wire reinforced composite bridges high survival and moderate success rates were observed. MRC-FPD might, thus, be an immediate, short- and medium-term solution for replacing missing teeth. However, several factors on the levels of practice (dentist's experience in designing MRC-FDP), patient (bruxism, caries risk) and restoration (number of wires) were identified as significant predictors for the failure rate. The study was registered in the German Clinical Trials Register (DRKS-ID: DRKS00021576).
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Affiliation(s)
- R J Wierichs
- Department of Restorative, Preventive and Pediatric Dentistry, University of Bern, Bern, Switzerland.
| | | | - S Jeganathan
- Department of Restorative, Preventive and Pediatric Dentistry, University of Bern, Bern, Switzerland
| | - P Perrin
- Department of Restorative, Preventive and Pediatric Dentistry, University of Bern, Bern, Switzerland; Private clinic, Schaffhausen, Switzerland
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Bijelic-Donova J, Garoushi S, Lassila LV, Rocca GT, Vallittu PK. Crack propagation and toughening mechanism of bilayered short-fiber reinforced resin composite structure -Evaluation up to six months storage in water. Dent Mater J 2022; 41:580-588. [PMID: 35584936 DOI: 10.4012/dmj.2021-321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Clinically relevant parameters, such as stress intensity factor of bilayered resin composite structure with short fiber base and its stability over time, has yet to be investigated. This study investigated the stress intensity factor of pre-cracked bilayered specimens composed of short fiber resin composite base (SFC) and particulate filler resin composite (PFC) as veneering layer, with a crack located in the PFC layer, 0.5 mm away from the PFC-SFC interface. Monolayered specimens served as controls. All specimens were stored in water at 37°C either for 1 week, 1 month or 6 months before testing. Two-way ANOVA (p=0.05) was used to determine the differences among the groups. Results indicated that SFC base improve the brittleness of the PFC. The type of short fibers affected the crack propagation; fiber bridging in millimeter-scale SFC was the main crack arresting mechanism, whereas fiber pulling observed in micrometer-scale SFC mainly deviated the crack path.
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Affiliation(s)
- Jasmina Bijelic-Donova
- Department of Prosthetic Dentistry and Stomatognathic Physiology, Institute of Dentistry, University of Turku
| | - Sufyan Garoushi
- Department of Biomaterials Science, Institute of Dentistry, University of Turku
| | - Lippo Vj Lassila
- Department of Biomaterials Science, Institute of Dentistry, University of Turku
| | | | - Pekka K Vallittu
- Department of Biomaterials Science, Institute of Dentistry, University of Turku.,City of Turku Welfare Division, Oral Health Care
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Ning K, Bronkhorst E, Bremers A, Bronkhorst H, van der Meer W, Yang F, Leeuwenburgh S, Loomans B. Wear behavior of a microhybrid composite vs. a nanocomposite in the treatment of severe tooth wear patients: A 5-year clinical study. Dent Mater 2021; 37:1819-1827. [PMID: 34565582 DOI: 10.1016/j.dental.2021.09.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 09/07/2021] [Accepted: 09/13/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This study aimed to compare the wear behavior of a microhybrid composite vs. a nanocomposite in patients suffering from severe tooth wear. METHODS A convenience sample of 16 severe tooth wear patients from the Radboud Tooth Wear Project was included. Eight of them were treated with a microhybrid composite (Clearfil APX, Kuraray) and the other eight with a nanocomposite (Filtek Supreme XTE, 3M). The Direct Shaping by Occlusion (DSO) technique was used for all patients. Clinical records were collected after 1 month (baseline) as well as 1, 3 and 5 years post-treatment. The maximum height loss at specific areas per tooth was measured with Geomagic Qualify software. Intra-observer reliability was tested with paired t-tests, while multilevel logistic regression analyses were used to compare odds ratios (OR) of "large amount of wear". RESULTS Intra-observer reliability tests confirmed that two repeated measurements agreed well (p > 0.136). For anterior mandibular teeth, Filtek Supreme showed significantly less wear than Clearfil APX; in maxillary anterior teeth, Clearfil APX showed significantly less wear (OR material = 0.28, OR jaw position = 0.079, p < 0.001). For premolar and molar teeth, Filtek Supreme showed less wear in bearing cusps, whereas Clearfil APX showed less wear in non-bearing cusps (premolar: OR material = 0.42, OR bearing condition = 0.18, p = 0.001; molar: OR material = 0.50, OR bearing condition = 0.14, p < 0.001). SIGNIFICANCE Nanocomposite restorations showed significantly less wear at bearing cusps, whereas microhybrid composite restorations showed less wear at non-bearing cusps and anterior maxillary teeth.
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Affiliation(s)
- K Ning
- Radboud University Medical Center, Radboud Institute for Molecular Life Sciences, Department of Dentistry - Regenerative Biomaterials, Philips van Leydenlaan 25, Nijmegen, The Netherlands
| | - E Bronkhorst
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Dentistry - Restorative Dentistry, Philips van Leydenlaan 25, Nijmegen, The Netherlands
| | - A Bremers
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Dentistry - Restorative Dentistry, Philips van Leydenlaan 25, Nijmegen, The Netherlands
| | - H Bronkhorst
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Dentistry - Restorative Dentistry, Philips van Leydenlaan 25, Nijmegen, The Netherlands
| | - W van der Meer
- University of Groningen, University Medical Center Groningen, Department of Orthodontics, Groningen, The Netherlands; W.J. Kolff Institute of Biomedical Engineering and Materials Science, Groningen, The Netherlands
| | - F Yang
- Radboud University Medical Center, Radboud Institute for Molecular Life Sciences, Department of Dentistry - Regenerative Biomaterials, Philips van Leydenlaan 25, Nijmegen, The Netherlands
| | - S Leeuwenburgh
- Radboud University Medical Center, Radboud Institute for Molecular Life Sciences, Department of Dentistry - Regenerative Biomaterials, Philips van Leydenlaan 25, Nijmegen, The Netherlands
| | - B Loomans
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Dentistry - Restorative Dentistry, Philips van Leydenlaan 25, Nijmegen, The Netherlands.
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Crins LAMJ, Opdam NJM, Kreulen CM, Bronkhorst EM, Sterenborg BAMM, Huysmans MCDNJM, Loomans BAC. Randomized controlled trial on the performance of direct and indirect composite restorations in patients with severe tooth wear. Dent Mater 2021; 37:1645-1654. [PMID: 34497023 DOI: 10.1016/j.dental.2021.08.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 07/09/2021] [Accepted: 08/19/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The study aimed to evaluate survival and failure behavior of Direct Composite Restorations (DRC) and Indirect Composite Restorations (ICR) on molars and anterior teeth, in a Randomized Controlled Trial (RCT). METHODS Patients with generalized severe tooth wear were included, and randomly assigned to one of 2 protocols: (1) DCR: All teeth were restored with directly applied micro-hybrid composite restorations (Clearfil AP-X, Kuraray) for load bearing areas and nano-hybrid composite restorations (IPS Empress Direct, Ivoclar Vivadent) for buccal veneers; (2) ICR: First molars were restored with indirect composite 'tabletop' restorations and maxillary anterior teeth were restored with indirect palatal veneer restorations (Clearfil Estenia C&B, cemented with Panavia F, Kuraray). Remaining teeth were restored directly. Restorations were evaluated after 3 years, focusing on clinical acceptability. Statistical analysis was performed using Kaplan Meier curves, Annual Failure Rates (AFRs), and univariate Cox regression analyses (p < 0.05). RESULTS 41 patients (age: 36.6 ± 6.6y) were evaluated after 3 years (40.0 ± 2.2 m). 408 restorations on first molars and palatal veneers on maxillary anterior teeth were part of this RCT, with 220 DCRs and 188 ICRs. No differences in survival between treatment modality for palatal veneers for any failure criteria were found. Tabletop restorations on first molars showed a considerable higher failure rate for ICR compared to DCR (p = 0.026, HR: 3.37, 95%CI = 1.16-9.81). SIGNIFICANCE In this RCT, directly applied composite restorations showed superior behavior compared to the indirect composite restorations, when used in the molar region.
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Affiliation(s)
- L A M J Crins
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Dentistry, The Netherlands.
| | - N J M Opdam
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Dentistry, The Netherlands
| | - C M Kreulen
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Dentistry, The Netherlands
| | - E M Bronkhorst
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Dentistry, The Netherlands
| | - B A M M Sterenborg
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Dentistry, The Netherlands
| | - M C D N J M Huysmans
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Dentistry, The Netherlands
| | - B A C Loomans
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Dentistry, The Netherlands
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Mehta SB, Lima VP, Bronkhorst EM, Crins L, Bronkhorst H, Opdam NJM, Huysmans MCDNJM, Loomans BAC. Clinical performance of direct composite resin restorations in a full mouth rehabilitation for patients with severe tooth wear: 5.5-year results. J Dent 2021; 112:103743. [PMID: 34229000 DOI: 10.1016/j.jdent.2021.103743] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 06/27/2021] [Accepted: 06/28/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To evaluate the 5.5-year performance of direct resin composite restorations, prescribed for patients with severe tooth wear, requiring full-mouth rehabilitation. METHODS A convenience sample of 34 patients were recruited to a prospective trial between December 2010 and June 2013. The participants were provided 1269 full-mouth direct resin composite restorations (Clearfil AP-X) by 5 experienced operators, using the DSO-technique. Treatment resulted in an increase in the vertical dimension of occlusion (VDO). Failure was assessed at three levels. Frequencies of failure were analysed using Kaplan Meier survival curves and the effects of the relevant variables calculated with a multifactorial Cox regression (p < 0.05). RESULTS Annual failure rates (for all levels of failure, 'Level 3- ') of ≤ 2.2% and ≤ 2.9% were respectively reported for the anterior and posterior restorations with a mean observation time of 62.4 months. The completion of an anterior restoration with the need for further appointments resulted in significantly more Level 2- & 3- failures. An evaluation of the performance of the premolar and posterior maxillary restorations showed significantly lowered risks of certain types of failures, compared to the molar and posterior mandibular restorations. CONCLUSIONS At 5.5 years, 2.3% of the overall restorations displayed catastrophic, (Level 1) failures. Molar restorations, posterior mandibular restorations and the anterior restorations requiring two further sessions for completion, were associated with significantly higher risks for failure. CLINICAL SIGNIFICANCE Direct resin composite can offer an acceptable medium-term option for the treatment of severe, generalized tooth wear; molar restorations may require higher maintenance.
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Affiliation(s)
- Shamir B Mehta
- Department of Dentistry, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands; Department of Conservative & MI Dentistry, Unit of Distance Learning, King's College London Faculty of Dentistry, Oral & Craniofacial Sciences, Guy's Campus, London.
| | - Verônica P Lima
- Department of Dentistry, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands; Graduate Program in Dentistry, Federal University of Pelotas, Pelotas, Brazil
| | - Ewald M Bronkhorst
- Department of Dentistry, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Luuk Crins
- Department of Dentistry, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Hilde Bronkhorst
- Department of Dentistry, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Niek J M Opdam
- Department of Dentistry, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | | | - Bas A C Loomans
- Department of Dentistry, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
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The effect of pre-treatment levels of tooth wear and the applied increase in the vertical dimension of occlusion (VDO) on the survival of direct resin composite restorations. J Dent 2021; 111:103712. [PMID: 34102230 DOI: 10.1016/j.jdent.2021.103712] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 05/28/2021] [Accepted: 06/01/2021] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES To investigate the effects of the level of pre-treatment tooth wear and increasing the VDO on the performance of direct resin composite restorations for the rehabilitation of pathological tooth wear. METHODS Full-mouth (pre-treatment) grading was performed on digital greyscale scan records for 34 participants (35.3 ± 8.4 years) with signs of moderate-to-severe generalised tooth wear, using the Tooth Wear Evaluation System and the Basic Erosive Wear Examination. Each participant received full-mouth direct resin composite restorations, with increased VDO. The post-treatment increase in the VDO was determined. Recalls were planned after 1 month, and after 1, 3, and 5 years. Three 'levels' of restoration failure were described. The effects of the variables on the frequencies of restoration failure were calculated with a multivariable Cox regression, (p < 0.05). RESULTS 1269 restorations were placed with a mean observation period of 62.4 months. Increasing the VDO by 1 mm significantly reduced the risks of all levels of anterior restoration failure (HR ≤ 0.62, p ≤ 0.025). A higher anterior BEWE surface score was associated with increased risks of Level 2- & 3- failures, (HR ≥ 1.29, p ≤ 0.019). Premolar restorations showed lower risks of Level 2- & 3- failure, compared to the molar restorations, (HR ≤ 0.5, p ≤ 0.005). CONCLUSION Levels of pre-treatment wear and the applied change in the VDO significantly affected failure risk. CLINICAL RELEVANCE Direct resin composite restorations for the rehabilitation of wear should be made as voluminous as possible, respecting the presenting biological, functional, and esthetic constraints.
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Oudkerk J, Eldafrawy M, Bekaert S, Grenade C, Vanheusden A, Mainjot A. The one-step no-prep approach for full-mouth rehabilitation of worn dentition using PICN CAD-CAM restorations: 2-yr results of a prospective clinical study. J Dent 2019; 92:103245. [PMID: 31747585 DOI: 10.1016/j.jdent.2019.103245] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 11/08/2019] [Accepted: 11/14/2019] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVES To prospectively evaluate the One-step No-prep treatment of full mouth-worn dentition, a minimally invasive and multidisciplinary approach using PICN CAD-CAM composite restorations without provisional phase. METHODS Seven patients (n = 192 restorations) with severe tooth wear were included. Patient data were recorded, and an occlusal analysis and a tissue-guided wax-up were realized. After replacement of old fillings, no-prep Vita Enamic restorations (posterior restorations and palatal veneers) were bonded within 24 h. Direct composites were performed to mask the buccal joint on anterior teeth. Maxillo-facial physiotherapy was performed. Restorations were evaluated following World Dental Federation criteria. Treatment influence on Oral-Health-Impact-Profile-49 (OHIP-49) score was assessed. RESULTS Tooth wear etiology was related to soft drink consumption and bruxism. Mean VDO increase was 5.09 ± 0.85 mm on the incisal pin. The mean restoration thickness on molars was 0.55 ± 0.21 mm, and the lowest was 0.11 mm. 2-year survival rate of restorations was 100 % and success rate was 93.5 %, with 11 minor chippings and one debonding. A significant improvement of the global OHIP-49 score was observed. CONCLUSIONS In this clinical study on high risk patients, PICN restorations, applied in a minimally invasive way, showed high survival and success rates after two years, while minor chipping of very thin occlusal borders constituted the most frequent complication. Moreover, the patient acceptance was good according to OHIP-49 in this multidisciplinary approach. CLINICAL SIGNIFICANCE The use of PICNs allows the development of no prep and simple treatment protocols of worn dentition. The absence of provisionals did not engender any problem, on the basis of the realization of an occlusal analysis, the support of a maxillo-facial physiotherapist, and the use of an easy-to-adjust restorative material.
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Affiliation(s)
- J Oudkerk
- Dental Biomaterials Research Unit (d-BRU), University of Liège (ULiège), 45 Quai G. Kurth, Liège, 4020, Belgium; Department of Fixed Prosthodontics, Institute of Dentistry, University of Liège Hospital (CHU), 45 Quai G. Kurth, Liège, 4020, Belgium
| | - M Eldafrawy
- Dental Biomaterials Research Unit (d-BRU), University of Liège (ULiège), 45 Quai G. Kurth, Liège, 4020, Belgium
| | - S Bekaert
- Dental Biomaterials Research Unit (d-BRU), University of Liège (ULiège), 45 Quai G. Kurth, Liège, 4020, Belgium; Department of Fixed Prosthodontics, Institute of Dentistry, University of Liège Hospital (CHU), 45 Quai G. Kurth, Liège, 4020, Belgium
| | - C Grenade
- Dental Biomaterials Research Unit (d-BRU), University of Liège (ULiège), 45 Quai G. Kurth, Liège, 4020, Belgium; Department of Fixed Prosthodontics, Institute of Dentistry, University of Liège Hospital (CHU), 45 Quai G. Kurth, Liège, 4020, Belgium
| | - A Vanheusden
- Dental Biomaterials Research Unit (d-BRU), University of Liège (ULiège), 45 Quai G. Kurth, Liège, 4020, Belgium; Department of Fixed Prosthodontics, Institute of Dentistry, University of Liège Hospital (CHU), 45 Quai G. Kurth, Liège, 4020, Belgium
| | - A Mainjot
- Dental Biomaterials Research Unit (d-BRU), University of Liège (ULiège), 45 Quai G. Kurth, Liège, 4020, Belgium; Department of Fixed Prosthodontics, Institute of Dentistry, University of Liège Hospital (CHU), 45 Quai G. Kurth, Liège, 4020, Belgium.
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13
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Impact of restorative treatment of tooth wear upon masticatory performance. J Dent 2019; 88:103159. [DOI: 10.1016/j.jdent.2019.06.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 05/22/2019] [Accepted: 06/21/2019] [Indexed: 11/23/2022] Open
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Mackenzie L, Banerjee A. Minimally invasive direct restorations: a practical guide. Br Dent J 2018; 223:163-171. [PMID: 28798466 DOI: 10.1038/sj.bdj.2017.661] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2017] [Indexed: 11/09/2022]
Abstract
The primary objectives of minimum intervention dentistry (MID) are to prevent or arrest active disease using non-operative management techniques. However, patients commonly present with cavitated caries lesions or failed restorations that are in need of operative intervention. Although much of clinical practice is devoted to preventing and managing the effects of caries and subsequent failure of the tooth-restoration complex, the clinical survival of restorations is often poor and becomes significantly worse as they increase in size and complexity. Minimally invasive (MI) restorative techniques present a range of well-documented advantages over more tissue-destructive traditional restorations by minimising unnecessary tooth tissue loss, insult to the dentine-pulp complex and reducing the risk of iatrogenic damage to adjacent hard and soft tissues. They also maximise the strength of the residual tooth structure by use of optimal adhesive restorative materials designed to restore function and aesthetics with durable, long-lasting restorations that are easy for the patient to maintain. In contemporary oral healthcare practice, if patients are to give valid consent for operative interventions, minimally invasive options must be offered, and may be expected to be the first choice of fully informed patients. This paper describes concepts of MID and provides an update of the latest materials, equipment and clinical techniques that are available for the minimally invasive restoration of anterior and posterior teeth with direct restorations.
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Affiliation(s)
- L Mackenzie
- Conservative Dentistry, University of Birmingham School of Dentistry, Mill Pool Way, Edgbaston, Birmingham, B4 6NN
| | - A Banerjee
- Conservative &MI Dentistry, King's College London Dental Institute at Guy's Hospital, King's Health Partners, Floor 26, Tower Wing, Guy's Dental Hospital, London, SE1 9RT
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The facial effects of tooth wear rehabilitation as measured by 3D stereophotogrammetry. J Dent 2018; 73:105-109. [DOI: 10.1016/j.jdent.2018.04.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 04/17/2018] [Accepted: 04/18/2018] [Indexed: 11/20/2022] Open
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Abstract
This paper explains a conservative, pragmatic and minimally invasive intervention concept for the treatment of severe tooth wear patients based on the Radboud Tooth Wear Project in the Netherlands. Guidelines and flowcharts for management of severe tooth wear patients and rehabilitation in increased vertical dimension of occlusion are presented. We concluded that: (a) Restorative treatment is not always indicated, even for patients with severe tooth wear. (b) If the patient has no complaints, counselling and monitoring is probably the best option. (c) Minimally invasive and adhesive restorative strategies are preferred when severe tooth wear patients are to be treated in increased vertical dimension, especially when young patients are involved. (d) Clinical evidence for a suitable restorative treatment protocol is limited to five-year follow up for direct composites. This material seems to be suitable for rehabilitation in increased vertical dimension on the middle long term. Clinical results for indirect techniques are not available yet. (e) Restorations, including those that are considered 'definitive' may prove to have a limited lifetime in patients with severe tooth wear due to bruxism and erosion. Explanation of the possible treatment options and expected complications should be included in the informed consent.
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Loomans B, Kreulen C, Huijs-Visser H, Sterenborg B, Bronkhorst E, Huysmans M, Opdam N. Clinical performance of full rehabilitations with direct composite in severe tooth wear patients: 3.5 Years results. J Dent 2018; 70:97-103. [DOI: 10.1016/j.jdent.2018.01.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 12/30/2017] [Accepted: 01/05/2018] [Indexed: 11/26/2022] Open
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The influence of management of tooth wear on oral health-related quality of life. Clin Oral Investig 2018; 22:2567-2573. [PMID: 29397468 PMCID: PMC6097042 DOI: 10.1007/s00784-018-2355-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Accepted: 01/23/2018] [Indexed: 11/04/2022]
Abstract
Objective The purpose of this study was to identify the level of oral health-related quality of life and orofacial appearance in patients with moderate to severe tooth wear. Patients with and without a request for restorative treatment were included. Methods One hundred twenty-four patients (98 men, 26 women, mean age: 40.5 ± 8.8 years) with moderate to severe tooth wear were included. Patients without a request for help received a non-restorative treatment of counseling and monitoring. Patients with a request for restorative treatment were treated with a full rehabilitation using composite resin restorations. Oral Health Impact Profile (OHIP-NL) and Orofacial Esthetic Scale (OES-NL) questionnaires were filled in at baseline and after 1 year. Results Counseling and monitoring group: baseline OHIP-NL score was 0.4 ± 0.3, baseline summary score of OES-NL was 48 ± 7.0, and baseline impression score was 7.1 ± 1.2. Scores had not changed significantly after 1 year (p = 1.00 after Bonferroni correction).Restoration group: baseline OHIP-NL score was 0.8 ± 0.6, baseline summary score of OES-NL was 38 ± 10, and baseline impression score was 5.9 ± 1.5. Scores had improved significantly after 1 year (p < 0.001 after Bonferroni correction). Conclusions Counseling and monitoring did not result in a significant deterioration and restorative treatment resulted in a significant improvement of oral health-related quality of life (OHRQoL) and orofacial appearance in this patient group. Clinical significance In patients with moderate to severe tooth wear, without functional and esthetical problems, counseling and monitoring may be an appropriate treatment option. Restorative treatment in patients with a need for treatment results in an improved OHRQoL. OHIP and OES questionnaires may be used to monitor changes in clinically relevant symptoms.
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Effect of different surface treatment techniques on the repair strength of indirect composites. J Dent 2017; 59:18-25. [DOI: 10.1016/j.jdent.2017.01.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 01/20/2017] [Accepted: 01/29/2017] [Indexed: 11/19/2022] Open
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