Clinical Effectiveness of Different Polishing Systems and Self-Etch Adhesives in Class V Composite Resin Restorations: Two-Year Randomized Controlled Clinical Trial

Toward esthetically and biomechanically reliable anterior resin composite restorations: Current clinical experiences among dental practitioners in Saudi Arabia

Background: Esthetic anterior composite restorations are very challenging. They constitute a main part of the clinical practice of restoring teeth with resin composites. Distinctive variations in composite material selection and technique of application in anterior teeth exist when compared to the practice of restoring posterior teeth with resin composites. In a continuation of a previous assessment of class II resin composite practice,  a cross-sectional survey study was performed to determine the awareness of general dental practitioners in Saudi Arabia about resin composite restorations in anterior teeth and to provide evidence-based recommendations to improve their practice. Methods: A total of 500 dental practitioners from different provinces in Saudi Arabia were invited to participate in an online questionnaire which comprised four domains and included a total of sixteen questions addressing aspects regarding the selection of resin composites, cavity configuration, etching protocol, light-curing technique, liner application, application of poly-chromatic composite, as well as finishing and polishing procedures. Chi square testing and descriptive statistics were used to analyze the attained data. Results: From 250 respondents, the greatest participation was from the Eastern and Middle provinces of Saudi Arabia. Female dentists participated less than males. There was no general agreement between participants regarding the resin composite material or the employed technique of application in restoring anterior tooth defects. Respondents indicated that discoloration and hypersensitivity were the most common reasons for patient's dissatisfaction with resin composites in anterior teeth. Conclusions: Dental practitioners are highly encouraged to improve their clinical practice of restoring anterior teeth using resin composites with the focus upon continuous education programs, online webinars, and workshops.

The Effect of Different Finishing and Polishing Systems on Surface Properties of New Flowable Bulk-fill Resin Composite

AIM

The purpose of this research was to explore how various finishing and polishing techniques affect the surface roughness (Ra) and gloss of flowable bulk-fill injectable resin composite utilized for posterior teeth restoration, following exposure to a range of food-simulating liquids (FSLs) over three months.

MATERIALS AND METHODS

This study comprised fifty-six disk specimens of G-aenial™ Bulk Injectable flowable resin composite which were created using a Teflon mold (10 × 4 mm). Two techniques of finishing and polishing (F/P) were employed: The two-step 3M™ Sof-Lex™ F/P spiral wheels system and the multiple-step 3M™ Sof-Lex™ XT finishing disks supplemented by the Ultradent Jiffy HiShine polisher cup system. The Ra and gloss of the prepared specimens were measured using an interference microscope system and Horiba gloss checker respectively, immediately post-finishing and polishing and then reassessed after three months in artificial saliva and Coca-Cola.

RESULTS

The two-step system showed a statistically significant difference, exhibiting greater "surface roughness (Ra)" and lower "surface gloss (GU)" mean values compared to the multiple-step system under different storage conditions, particularly after 3 months of storage (p = 0.001).

CONCLUSION

The multiple-step polishing system improved the "Ra" and "GU" of resin composite, suggesting their suitability for posterior resin composite restorations. Acidic media had a deleterious impact on the "Ra" and "GU" of resin composite restoration.

CLINICAL SIGNIFICANCE

The quality of resin composite restorations can be significantly improved with the correct use of finishing and polishing systems, particularly in complex areas of posterior teeth restorations, leading to successful dental procedures.

Patients´ satisfaction concerning direct anterior dental restoration

The objective of this study was to observe patients' satisfaction with their in-service direct anterior dental restorations and to compare it with clinical evaluation using FDI (Federation Dental International) criteria. Patients scored their own anterior dental restorations regarding satisfaction (satisfactory /dissatisfactory). If dissatisfaction was mentioned, then, they would be interviewed about the complaint. In the same session, the dental restorations were clinically evaluated by two dentists using FDI criteria (1-5 score) concerning esthetic, functional, and biological domains. Descriptive statistics were used for frequencies of scores attributed by patients and clinicians. In order to compare patients' to clinicians' frequencies, the Chi-square test was applied (p ≤ 0.05). A total of 106 restorations were evaluated by patients and clinicians. Patients reported 52.8% of restorations satisfactory and 47.8% dissatisfactory. Overall, clinicians reported the same restorations as 82,3% satisfactory and 17,6% dissatisfactory. Patients' most frequent complaints referred to color, followed by anatomical form, fracture of material and retention, and approximal anatomical form. Comparing patients' satisfaction and dissatisfaction rates to clinicians' evaluation per criteria, there was no difference regarding esthetics. The frequency of dissatisfactory restorations by clinicians was significantly lower when functional and biological properties were compared with patients' opinions. Direct anterior dental restorations were more frequently reported as satisfactory by patients and clinicians, being the main complaints related to esthetic issues. When clinicians and patients' evaluations were compared, it was observed that the frequencies of satisfactory restoration by patients and clinicians were similar regarding esthetic properties, and significantly different regarding functional and biological properties.

Effects of polishing procedures on optical parameters and surface roughness of composite resins with different viscosities

The aims of this study were to evaluate the optical properties of flowable and injectable composites after polishing, such as translucency (translucency parameter [TP], TP₀₀), opalescence (OP-BW), chroma (C*ab), refractive index (RI), and change in surface roughness (Ra, Rz). Ninety disc-shaped samples were prepared from micro-hybrid, flowable, and injectable composites and divided into 3 groups according to the polishing systems (n=10). The RI was measured with an Abbe refractometer, and optical measurements were performed with a spectrophotometer. The surface roughness was measured with a two-dimensional profilometer. Data were analyzed with the generalized linear model method and two-way analysis of variance. The results showed that the polishing procedure did not significantly impact the RI (p=0.987). Injectable composite had the highest translucency (TP=28.67; TP₀₀=13.49) and opalescence (OP-BW=13.11); showed the lowest C*ab value (17.95). Also, the effects of the composite type and polishing procedure on surface roughness were statistically significant (p=0.047 and p<0.001).

Challenging the Concept that OptiBond FL and Clearfil SE Bond in NCCLs Are Gold Standard Adhesives: A Systematic Review and Meta-analysis

PURPOSE

The following PICO (Patient/Population, Intervention, Comparison, and Outcomes) question was proposed: "Are retention rates of composite resin restorations in noncarious cervical lesions (NCCLs) when using adhesives considered "gold standard" (OptiBond FL and Clearfil SE Bond) higher than those obtained with other adhesives brands"?

METHODS

A search was performed in February 2019 (updated in November 2019) in the PubMed/MEDLINE, EMBASE, LILACS, BBO, Web of Science, Cochrane Library, Grey Literature, and IADR abstracts (1990-2018); unpublished and ongoing trial registries, dissertations, and theses were also searched. Only randomized clinical trials (RCTs) conducted in NCCLs that compared either OptiBond FL or Clearfil SE Bond adhesive with other commercially available adhesives were included. The risk of bias (RoB) was applied by using the Cochrane Collaboration tool. A meta-analysis was performed for retention rates at different follow-up times using a random effects model for both the adhesives. Heterogeneity was assessed with the Cochran Q test and I2 statistics. Grading of Recommendations: Assessment, Development and Evaluation (GRADE) assessed the quality of evidence.

RESULTS

After removal of duplicates and noneligible articles, 25 studies remained for qualitative synthesis, as one study was common to the two adhesives, of which 9 studies were used for the OptiBond FL meta-analysis and 14 for the Clearfil SE Bond meta-analysis. No significant differences were observed for retention rates in follow-up periods of 12-24 months (p=0.97), 36-48 months (p=0.72), or 108-156 months (p=0.73) for OptiBond FL; and for 12-24 months (p=0.10) and 36-48 months (p=0.17) for Clearfil SE Bond. A significant difference was only found for OptiBond FL at 60-96 months (p=0.02), but only three studies were included in this meta-analysis.

CONCLUSIONS

The evidence from available RCTs conducted in NCCLs that compared OptiBond FL or Clearfil SE Bond does not support the widespread concept that these adhesives are better than any other competitive brands available in the dental market.

Stain Susceptibility of 3D-Printed Nanohybrid Composite Restorative Material and the Efficacy of Different Stain Removal Techniques: An In Vitro Study

Recent burgeoning development in material science has introduced a 3D-printable, nanohybrid composite resin restorative material. However, its performance has not yet been investigated. This study evaluates the stain susceptibility and efficacy of different stain removal techniques. A total of 120 labial veneers were fabricated using milling (n = 60) and SLA 3D-printing (n = 60). Based on the immersion media: coffee, tea and artificial saliva, each group was divided into three sub-groups (n = 20). Stain susceptibility was evaluated by calculating color difference (∆E00) at 12 and 24 days using a spectrophotometer against black and white backgrounds. Collected data were analyzed with ANOVA and Tukey's post hoc test (p < 0.05). A significant interaction effect was found between the staining mediums and fabrication methods in both black and white backgrounds (p < 0.001). 3D-printed restorations showed significantly higher stain susceptibility than milled restorations (p < 0.001). Prolonged immersion time increased the color difference in both groups. In-office bleaching was more effective in stain removal in both 3D-printed and milled restoration groups. The susceptibility of the presented novel 3D-printed restorative material to color changes in different immersion mediums was clinically not-acceptable. The clinicians might expect the need to replace the restoration after 1-2 years and thus, recommendation for the use of such a material as a permanent restoration cannot be made but rather as a long-term temporary restoration.

Surface roughness and gloss of polished nanofilled and nanohybrid resin composites

Background/purpose

There is limited literature on the polishability of new launched nanofilled and nanohybrid. The aim of this study is to evaluate the polishability of nanofilled and nanohybrid composites by measuring surface roughness and gloss values and explore the surface qualities of composite before and after polishing in vitro.

Materials and methods

One nanofilled resin composite, two nanohybrid resin composites and one microhybrid resin composite were selected. All specimens were light cured against celluloid matrix strips. Then surface roughness(Ra) and gloss(GU) values were tested as negative control. Specimens were roughened with a 600-grit silicon carbide paper for 30 s to serve as positive control and then polished with Sof-Lex polishing disk system. Mean Ra and GU values of each step were measured with a profilometer and a small-area glossmeter. The surface qualities were observed by scanning electron microscope.

Results

Ra values of polished surfaces were significantly higher than negative control and lower than positive control(P < 0.05). All materials showed no significant difference on Ra values after polishing(P > 0.05). GU values of polished surfaces were significantly lower than negative control and higher than positive control(P < 0.05). After polishing the microhybrid resin composite showed lower GU values than nanofilled and nanohybrid resin composite groups. The SEM images showed surface textures and irregularities were corresponded to the results of surface roughness and gloss.

Conclusion

No significant differences were noted on surface roughness among nanofilled, nanohybrid, and microhybrid composites after polishing with Sof-Lex disc system. Microhybrid composite presented lower gloss values than nanofilled and nanohybrid resin composites.

Does Addition of 10-MDP Monomer in Self-etch Adhesive Systems Improve the Clinical Performance of Noncarious Cervical Lesion Restorations? A Systematic Review and Meta-analysis

BACKGROUND

Functional acidic monomers are able to chemically interact with hydroxyapatite, and this bond appears to be very stable. Therefore, this aspect of the 10-MDP molecule made it attractive and added to self-etch adhesives.

OBJECTIVES

The objective of this Systematic Review (SR) and Meta-analysis (MA) was to determine whether systems with the 10-methacryloyloxydecyl dihydrogen phosphate (10-MDP) functional monomer in their formula showed better clinical performance in restorations placed in noncarious cervical lesions (NCCL) when compared to systems without it. The PROSPERO registration number of the MA is CRD42016050538.

DATA AND SOURCES

An e-search was conducted through MEDLINE via PubMed, Cochrane Library, Scopus, Web of Science, OpenGrey, Clinical Trials, Current Controlled Trials, and EU Clinical Trials Register, and a search through the references of included studies was also performed. Randomized Controlled Clinical Trials, in which the effectiveness of self-etch adhesive systems, with or without the 10-MDP functional monomer for NCCL, was discussed, were included. Risk of bias was performed according to the Cochrane Collaboration tool, and the certainty of evidence was evaluated through GRADE.

STUDY SELECTION

The data were grouped, heterogeneity (I2) was tested, and after duplicate removal, 4208 manuscripts were retrieved. From these, 11 studies were included in the qualitative analysis (risk of bias), with nine classified as low risk and two unclear. GRADE analysis detected moderate-to-high certainty of evidence, so the quantitative synthesis [Meta-analysis (MA)] was performed including the 11 studies.

RESULTS AND CONCLUSION

There were no statistical differences in the clinical performance of restorations conducted using "with or without 10-MDP" adhesive types, for all evaluated criteria (p=0.05), with heterogeneity ranging from 0% to 53%. Thus, the presence of 10-MDP functional monomer did not influence the clinical performance of restorations placed in NCCL.

Clinical Performance of Filled/Nanofilled Versus Nonfilled Adhesive Systems in Noncarious Cervical Lesions: A Systematic Review and Meta-analysis

CLINICAL RELEVANCE

The use of filled adhesive systems does not influence the clinical performance of the adhesive restoration in noncarious cervical lesions.

SUMMARY

Adhesive strategies in cervical lesions: systematic review and a network meta-analysis of randomized controlled trials

OBJECTIVES

A network meta-analysis (NMA) was performed to assess which adhesive strategy is most clinically effective in treating non-carious cervical lesions (NCCLs).

MATERIAL AND METHODS

Studies were identified by a systematic search of electronic databases including MEDLINE via PubMed, Brazilian Library in Dentistry (BBO), Cochrane Library, EMBASE, Latin American and Caribbean Health Sciences Literature database (LILACS), Scopus, and Web of Science without restrictions on publication year or language. The grey literature was also consulted. Only randomized clinical trials that compared different adhesive strategies in NCCLs in adult patients were included. The risk of bias was evaluated by using the Cochrane Collaboration tool. A random-effects Bayesian mixed treatment comparison model was used to compare adhesive strategies (3ER, 2ER, 2SE, and 1SE) at different follow-up times. The surface under cumulative ranking curve (SUCRA) was estimated for each strategy. Heterogeneity was assessed by using the Cochran Q test and I² statistics. The quality of evidence was evaluated using the GRADE approach.

RESULTS

A total of 5058 studies were identified, 66 of which met the eligibility criteria and of these 5 were judged "low" risk of bias and 57 were meta-analyzed. We did not observe significant differences in the NMA analysis for any two pairs of adhesives, except for the shortest follow-up for 2ER vs 3ER. The material 2SE ranked highest, although it differed only slightly from the other bonding strategies.

CONCLUSIONS

No bonding strategy is better than the others.

CLINICAL RELEVANCE

Adhesive efficacy cannot be characterized by its bonding strategy.