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Influence of viscosity and chemical composition of composite resins in non-carious cervical restorations: 12-month randomized clinical trial
Abstract
Objective: The objective of this double-blind, randomized controlled clinical trial was to evaluate the clinical performance of two methacrylate-based flowable composite and ormocer-based flowable composite in non-carious cervical lesions (NCCLs) of adult patients. Material and Methods: 183 restorations were performed on NCCLs using the Futurabond U adhesive system, applied in the selective enamel etching mode in all cavities. After the adhesive application, the cavities were restored with one out of the three evaluated flowable composites (n = 61 per group): ormocer-based flowable composite (Admira Fusion Flow, ORM), low viscosity methacrylate-based composite (GrandioSO Flow, LV) and high viscosity methacrylate-based composite (GrandioSO Heavy Flow, HV). After 12 months of clinical performance, these restorations were evaluated according to FDI and USPHS criteria in the following items: retention/fracture, marginal adaptation, marginal staining, postoperative sensitivity and caries recurrence. Results: eight restorations were lost/fractured after 12 months of clinical evaluation (1 in the ORM and 7 in the HV group). The retention rates for 12- months (95% confidence interval) were 98.4% (91.3%-99.7%) for the ORM group, 100% (94.5%-100%) for the LV group and 88.5% (78.1%-94.3%) for the HV group, with no statistical difference identified between any pair of groups (p > 0.05). Five restorations presented small marginal adaptation defects at the 12-months evaluation recall, and all of them were considered clinically acceptable. Conclusion: The clinical performance of the universal adhesive associated to ormocer-based or methacrylate-based flowable composite were found to be promising after 12-month of clinical evaluation.
... Recent studies identified the presence of the functional monomer as 10-MDP in its composition. These salts, known for their high hydrolytic stability, form a strong chemical bond with dental substrates, not only protecting collagen fibers but also enhancing adhesive etching potential compared to other functional monomers [56][57][58][59]. Speculation also exists about a potential reaction between MDP and organic molecules in dentin, particularly collagen [60,61]. ...
... In the present study, all restorations were performed with an ORganically MOdified CERamics (Ormocer) [57], which is a material with a resin matrix containing aromatic and aliphatic dimethacrylates in addition to methacrylate-functionalized polysiloxane, instead of a methacrylate-based filling. Despite the first version of the ORMOCER materials showed a tendency of poor clinical performance when compared to methacrylate-based composite in posterior restorations [57], nowadays, the improvement of pure silicate matrix technology combined with nano-hybrid fillers resulted in nano-ormocer with a better clinical performance in posterior and anterior restorations when compared to methacrylate-based filling [57][58][59][60]. Also, additional operatory procedures as a dentin roughening or the application of a flowable resin as a liner were not performed in the present study. ...
... In the present study, all restorations were performed with an ORganically MOdified CERamics (Ormocer) [57], which is a material with a resin matrix containing aromatic and aliphatic dimethacrylates in addition to methacrylate-functionalized polysiloxane, instead of a methacrylate-based filling. Despite the first version of the ORMOCER materials showed a tendency of poor clinical performance when compared to methacrylate-based composite in posterior restorations [57], nowadays, the improvement of pure silicate matrix technology combined with nano-hybrid fillers resulted in nanoormocer with a better clinical performance in posterior and anterior restorations when compared to methacrylate-based filling [57][58][59][60]. Also, additional operatory procedures as a dentin roughening or the application of a flowable resin as a liner were not performed in the present study. ...
Objectives
To evaluate the clinical performance of a new dual-cure universal adhesive system (Futurabond U, Voco) when applied using different application strategies in non-carious cervical lesions (NCCLs) after 36 months.
Material and Methods
Futurabond U was applied in NCCLs of 50 subjects using four adhesion strategies (n = 50 restorations per group): only self-etch (SEE); selective enamel etching + self-etch (SET); etch-and-rinse with dry dentin (ERDry); and etch-and-rinse with wet dentin (ERWet). All cavities were restored using Admira Fusion composite resin (Voco). Restorations were evaluated after 36 months using the World Federation criteria (FDI) and the modified United States Public Health Service (USPHS) criteria.
Results
The after 36-month retention rates were 87% (75–92%) for SEE, 94% (83–98%) for SET, 91% (80–97%) for ERDry, and 94% (83–98%) for ERWet. Forty-three restorations were considered to have minor discrepancies in marginal adaptation at the 36-month recall (18 for SEE, 12 for SET, 7 for ERDry, and 6 for ERWet; p > 0.05). One restoration was detected as a minor marginal discoloration at the 36-month recall (1 for SET; p > 0.05). No restorations showed postoperative sensitivity and caries recurrence at 36 months.
Conclusion
The clinical performance of the Futurabond U did not depend on the employed bonding strategy, and it was considered reliable after 36 months of clinical evaluation. However, greater marginal discrepancy was observed in the self-etch groups.
Clinical Relevance
NCCLs restorations using a dual-cure universal adhesive in self-etch and etch-and-rinse modes showed satisfactory clinical performance after 36 months.
Background
Epidemiological studies of non-carious cervical lesions (NCCLs) are being conducted in all geographical regions, which is completely justified, considering the high frequency of these lesions and possible consequences. Data obtained from such studies are of great importance because, beside describing the extent and degree of lesions, they can also point to specific etiological factors. The purpose of this study was to analyze the frequency and distribution of NCCLs among the patients of Faculty of Dentistry in Pancevo, Serbia, and to investigate the impact of certain etiological factors on the frequency of NCCLs.
Material and Methods
The study included 394 patients, who were clinically examined for the presence of NCCLs and interviewed about potential etiological factors using specially designed questionnaire. Saliva samples were analyzed for 30 patients with multiple NCCLs (≥3) and 30 patients without signs of cervical lesions and restorations. Subject – level logistic regression was used to analyze the association of potential etiological factors and presence of NCCLs and Wilcoxon test for the quantity and quality of saliva.
Results
NCCLs were diagnosed at 68.5% from total number of respondents, 15% from all present teeth were affected. The highest prevalence was recorded on premolars. Presence of lesions significantly increased with age. Frequent consumption of citrus fruit was associated with the presence of NCCLs. Significantly lower frequency of NCCLs was recorded among subjects who frequently chew gums. Significantly lower pH values of unstimulated and stimulated saliva were recorded in the group of patients with multiple NCCLs compared to control group.
Conclusions
This study showed high frequency of NCCLs among subjects of different age. Premolars were the most frequently affected. Age, frequent consumption of citrus fruit and lower salivary pH value were associated with an increased occurrence of NCCLs. Chewing gums habit was associated with an decreased occurrence of NCCLs.
Key words:NCCL, abrasion, erosion, abfraction, saliva.
Objectives:
Tooth-colored composites have emerged as a standard restorative material in caries therapy and have largely replaced materials such as silver amalgam or glass ionomer cements. In addition to their superior esthetics and desirable mechanical properties, composites also comprise negative characteristics, such as wear, shrinkage, and an adverse biocompatibility. Modifications of classic resin-based dental composites have been developed to overcome these shortcomings. For example, ormocers are innovative inorganic-organic hybrid polymers that form a siloxane network modified by the incorporation of organic groups. Recently, a new ormocer, Admira Fusion (VOCO), was introduced to composite technology. The absence of cytotoxic matrix monomers leads to the hypothesis that ormocers have improved biocompatibility compared to resin-based dental restorative materials.
Materials and methods:
The aim of this study was to compare the cytotoxic effects of Admira Fusion to a nanohybrid composite (GrandioSO, VOCO) and a nanofiller composite (Filtek Supreme XTE, 3M Espe) on the standard dermal mouse fibroblasts (L929) and human gingival fibroblasts (GF-1) via a Cell Counting Kit-8 (CCK-8) assay.
Results:
Admira Fusion was significantly less cytotoxic than GrandioSO and Filtek Supreme XTE to both the standard mouse dermal fibroblasts (L929) and human gingival fibroblasts.
Conclusions:
Compared to other resin-based dental restorative materials, the ormocer (Admira Fusion) possesses a superior biocompatibility in vitro. Future research studies are needed to confirm our results.
Clinical significance:
Clinically, dental practitioners and their patients might benefit from Admira Fusion in terms of reduced adverse biologic reactions compared to resin-based dental restorative materials.
Polymerization shrinkage of resin composite can compromise the longevity of restorations. To minimize this problem, the monomeric composition of composites have been modified. The objective of this study was to conduct a meta-analysis to assess the clinical behavior of restorations performed with low polymerization shrinkage resin composite in comparison with traditional methacrylates-based resin composite. This systematic review was registered at Prospero data system (CRD42015023940). Studies were searched in the electronic databases PubMed, Web of Science, Scopus, Lilacs and EMBASE according to a predefined search strategy. The inclusion criteria were as follow: (1) randomized controlled clinical trials with at least six months of follow-up; (2) studies investigating composites with monomers designed to reduce polymerization shrinkage; (3) studies conducted with class I or II restorations in the permanent dentition; and (4) studies that assessed at least one of the following criteria: marginal integrity/adaptation, marginal discoloration, recurent caries, retention of composite restorations, and postoperative sensitivity. Two independent reviewers analyzed the articles to determine inclusion and risk of bias. The search conducted in the databases resulted in a total of 14,217 studies. After reviewing the references and citations, 21 articles remained. The longest clinical follow-up time was 60 months. The meta-analysis of the data in the included studies demonstrated that only one variable (marginal adaptation after 12 months) showed statistically significant outcomes, in which methacrylates-based composites presented significantly better results than resin composites containing modified monomers. The good level of the scientific evidence as well as the overall low risk of bias of the included studies indicate that composites with silorane, ormocer or bulk-fill type modified monomers have a clinical performance similar to conventional resin composites.
Background
Non carious cervical lesions associated to muscle hyperfunctions are increasing. Microhybrid resin composites are used to restore cervical abfractions. The purpose of this study was to investigate if resin composites modify tooth plaque, inducing an increment of cariogenic microflora and evaluate their effect, in vivo and in vitro, against S. mutans.
Material and Methods
Eight abfractions were restored with two microhybrid resin composites (Venus, Heraeus-Kulzer® and Esthet-X, Dentsply®), after gnatological therapy, in three patients with muscle hyperfunctions. For each abfraction three samples of plaque were taken from the cervical perimeter: before the restoration, one week and three months after restoration. The samples were evaluated both by traditional microbiological methods and by Polymerase Chain Reaction (PCR). In vitro, disk-shaped specimens of the two composites were prepared to estimate the effects against pre-cultured S. mutans, after incubation at 37°C for 24h and assessed by a turbidimetric technique.
Results
In vivo no differences were found in plaque growth, for all samples, before and after restoration with both composites; in vitro, instead, a significant reduction of S. mutans growth was found between specimens of two composites (Mann-Whitney U-test p>0,06).
Conclusions
In this study a relevant consideration was elicited: composite materials, in vivo, do not modify plaque composition of non carious cervical lesions to a potential cariogenic plaque.
Key words:Abfraction, restoration, S. mutans, composite, class V.
Background
This study compared the storage modulus (E’), the loss modulus (E’’) and the loss tangent (tan δ) of various flowable resin composites.
Material and Methods
Grandio Flow (GRF), GrandioSo Heavy Flow (GHF), Filtek Supreme XTE (XTE) and Filtek Bulk Fill (BUL) flowable resins and Clinpro Sealant (CLI) ultra-flowable pit and fissure sealant resin were used. 25 samples were tested using a dynamical mechanical thermal analysis system in bending mode. Measurements were taken within a temperature range of 10 to 55°C. The results were statistically analyzed using mixed-effect and repeated-measure analysis of variance followed by paired multiple comparisons.
Results
For all the materials, the E’ values decrease with temperature, whereas the tan δ values increase. Irrespective of the temperature, GHF and GRF present E’ and E’’ values significantly higher than all the other materials and CLI presents values significantly lower than all the other materials. Observation of the values for all the materials reveals a linear progression of the tan δ values with temperature.
Conclusions
A variation in temperature within a physiological range generates modifications in mechanical properties without damaging the material, however. Filler content in volume terms appears to be the crucial parameter in the mechanical behavior of tested materials.
Key words:Dynamic mechanical thermal analysis, elastic modulus, filler content, flowable resin composites, loss modulus, loss tangent.
Objective:
To explore the prevalence of NCCL and associated risk indicators in 35- to 44-year-olds and 65- to 74-year-olds from both urban and suburban districts of Guangzhou, Southern China.
Methods:
A cross-sectional survey was conducted on NCCL with a sample of 768 35- to 44-year-olds and 991 65- to 74-year-olds, and the Tooth wear index was applied to record the tooth wear. Data on socioeconomic status, health behaviour and general health condition were obtained from a structured questionnaire.
Results:
The prevalence of NCCL was 76.8% and 81.3% in middle-aged and elderly populations, respectively. The results from the analysis of covariance (ANCOVA) demonstrated that for the 35- to 44-year-olds, those who were male, older, living in the suburban district and used toothpicks frequently, they tended to have more teeth with NCCL. Men, who were aged between 65 and 74 years old, who used toothpicks frequently, drank vinegar beverages, ate hard food and had not visited a dentist in a year; tended to have more teeth with NCCL.
Conclusion:
NCCL was very common amongst middle-aged and elderly populations in South China. Older men who had unhealthy oral habits like using toothpicks, eating hard food and drinking vinegar beverages tended to have more teeth with NCCL. Oral health education would benefit those at risk.
An equivalence randomized controlled trial within the subject was organized to evaluate the clinical long-term success of a new 2-step etch & rinse adhesive and a new nano-filled ormocer.
50 subjects, 21 males and 29 females aged between 21 and 65, were randomized to receive 150 restorations, 100 with the new restorative material, 50 with the composite as control, placed in non-carious cervical lesions with the same bonding system. The main outcome measure was the cause of failure at 8 years. Randomization was number table-generated, with allocation concealment by opaque sequentially numbered sealed and stapled envelopes. Subjects, examiner, and analyst were blinded to group assignment. Two interim analyses were performed. Data were analyzed by ANOVA and Cox test (P < 0.05).
After 8 years, 40 subjects and 120 teeth were included in the analysis of the primary outcome. There were eight failures in the experimental group and four failures in the control group. The cumulative loss rate was 7% for both restorative materials, with the annual failure lower than 1%, without any statistically significant difference. There were two key elements of failure: the presence of sclerotic dentin and the relationship between lesion and gingival margin.
SUMMARY The aim of this study was to evaluate the polymerization behavior and depth of cure (DOC) of recently introduced resin composites for posterior use: highly filled flowable composite and composites for bulk fill. A highly filled flowable (G-aenial Universal Flo [GUF]), two bulk-fill flowables (Surefil SDR Flow [SDR] and Venus Bulk fill [VBF]), and a bulk-fill nonflowable composite (Tetric N-Ceram Bulk fill [TBF]) were compared with two conventional composites (Tetric Flow [TF], Filtek Supreme Ultra [FS]). Linear polymerization shrinkage and polymerization shrinkage stress were each measured with custom-made devices. To evaluate DOC, the composite specimen was prepared using a mold with a hole of 4 mm depth and 4 mm internal diameter. The hole was bulk filled with each of the six composites and light cured for 20 seconds, followed by 24 hours of water storage. The surface hardness was measured on the top and the bottom using a Vickers microhardness (HV) indenter. The linear polymerization shrinkage of the composite specimens after photo-initiation decreased in the following order: TF and GUF > VBF > SDR > FS and TBF (p<0.05). The polymerization shrinkage stress of the six composite groups decreased in the following order: GUF > TF and VBF > SDR > FS and TBF (p<0.05). The mean bottom surface HV of SDR and VBF exceeded 80% of the top surface HV (HV-80%). However, the bottom of GUF and TBF failed to reach HV-80%. A highly filled flowable (GUF) revealed limitations in polymerization shrinkage and DOC. Bulk-fill flowables (SDR and VBF) were properly cured in 4-mm bulk, but they shrank more than the conventional nonflowable composite. A bulk-fill nonflowable (TBF) showed comparable shrinkage to the conventional nonflowable composite, but it was not sufficiently cured in the 4-mm bulk.
Objective:
The aim of this study was to evaluate the void frequency (V(F)) and void volume (V(V)) in different flowable composites using swept-source optical coherence tomography (SS-OCT).
Methods:
Standard class I cavities were prepared and filled with six different flowable composites: Clearfil Majesty LV (MJ; Kuraray), MI Flow (MW; GC), MI Fil (ML; GC), Beautifil flow plus (BF; Shofu), Palfique Estelite low flow (EL; Tokuyama) and Surefil SDR flow (SF; Dentsply). The restorations were scanned under OCT. The OCT tomograms were analyzed and average V(F) and V(V) per restoration for each composite were calculated. Scanning electron microscope (SEM) was used to observe the structure of each composite. In addition, the flowability of the materials was evaluated measuring the displacement of each material placed up-right on a glass slide. V(F) and V(V) obtained by OCT were also compared to those calculated using micro-computed tomography (micro-CT).
Results:
Kruskal-Wallis ANOVA and Mann-Whitney U tests revealed significantly different V(F) and V(V) values (p<0.05) among the composites. Voids ranging from 35 to 785 μm in diameter were detected in OCT tomograms. MJ showed highest V(F) and V(V) values followed by MW, but ML, BF, EL and SF showed no significant difference. Filler volume in composites showed a positive correlation with void formation, but flowability did not show a specific trend. Micro-CT evaluation validated the V(F) and V(V) calculation by OCT, with a significant correlation in void size (p<0.001, r=0.94).
Conclusion:
The results of this study indicate the reliability of SS-OCT for real-time void characterization of composite materials and restorations. Void formation in flowable composites is material dependent.
The immediate bonding effectiveness of contemporary adhesives is quite favorable, regardless of the approach used. In the long term, the bonding effectiveness of some adhesives drops dramatically, whereas the bond strengths of other adhesives are more stable. This review examines the fundamental processes that cause the adhesion of biomaterials to enamel and dentin to degrade with time. Non-carious class V clinical trials remain the ultimate test method for the assessment of bonding effectiveness, but in addition to being high-cost, they are time- and labor-consuming, and they provide little information on the true cause of clinical failure. Therefore, several laboratory protocols were developed to predict bond durability. This paper critically appraises methodologies that focus on chemical degradation patterns of hydrolysis and elution of interface components, as well as mechanically oriented test set-ups, such as fatigue and fracture toughness measurements. A correlation of in vitro and in vivo data revealed that, currently, the most validated method to assess adhesion durability involves aging of micro-specimens of biomaterials bonded to either enamel or dentin. After about 3 months, all classes of adhesives exhibited mechanical and morphological evidence of degradation that resembles in vivo aging effects. A comparison of contemporary adhesives revealed that the three-step etch-and-rinse adhesives remain the 'gold standard' in terms of durability. Any kind of simplification in the clinical application procedure results in loss of bonding effectiveness. Only the two-step self-etch adhesives approach the gold standard and do have some additional clinical benefits.
Clinical Relevance
Different types of flowable resin materials placed in non-carious cervical lesions demonstrated acceptable clinical performance, except for the retention rates of Dyract Flow restorations, after two years.
Objective
The aim of this study was to evaluate the influence of a liner on the clinical performance of deep posterior restorations performed with bulk-fill composite.
Methods
30 subjects received two restorations on deep preparations in posterior teeth, without pulpal exposure, after selective carious-tissue removal in one-stage. The internal walls reached the inner quarter of dentin, but with a radiographically detectable zone of firm dentin remaining. The pulpal protection using a layer of glass ionomer composite liner (Ionoseal, Voco) was applied in just one preparation. The adhesive system Futurabond U (Voco) was applied in all preparations, which were restored with the bulk-fill pure Ormocer nanohybrid composite (Admira Fusion Xtra - Voco), in up to 4 mm thick increments. All restorations were evaluated using the FDI criteria after 7 days, 6, 12 and 24 months postoperatively.
Results
After 24-months, 25 patients attended the recall and 50 restorations were evaluated. The Fisher’s statistical analysis (5%) showed no difference between the techniques for the esthetic, functional and biological properties. No postoperative sensitivity was reported for both groups.
Conclusion
The application of a liner did not influence the clinical performance of deep restorations with bulk-fill Ormocer composite.
Clinical relevance
The application of a liner with a GIC-based material has not a significant effect on the clinical performance of bulk-fill restorations and seems to be unnecessary for the material tested.
Objectives
To compare the clinical performance of a universal adhesive in class V non‐carious cervical lesions (NCCLs) using two surface treatment protocols (self‐etch [SfE] vs selective‐enamel‐etch [SelE]).
Material and methods
Thirty‐three adults, each with ≥2 NCCLs, received one resin composite restoration utilizing a SfE universal adhesive and another utilizing the adhesive and SelE with 37% phosphoric acid. Restorations were evaluated for sensitivity, retention, marginal discoloration, marginal adaptation, and clinical acceptability through 24 months using Cochran‐Mantel‐Haenszel tests for stratified, ordered categorical outcomes.
Results
Sixty‐six restorations (35 SfE, 31 SelE; 27 volunteers) were evaluated at 24 months. There were no significant differences between SfE and SelE for sensitivity, retention, marginal adaptation, or clinical acceptability. One SfE restoration was lost. Marginal adaptation was significantly worse at 24 months than baseline for SelE (P = 0.01), but not for SfE. Marginal discoloration was significantly worse for SfE (P = 0.02), but not for SelE. Sensitivity improved from baseline to 24 months for both groups (SelE P = 0.004, SfE P = 0.002).
Conclusions
Twenty‐four‐month data indicated significantly reduced sensitivity for both groups, worse marginal discoloration for SfE, and worse marginal adaptation for SelE. No changes in retention or clinical acceptability were observed in either group. All retained restorations were clinically acceptable at 24 months.
Clinical Significance
Both self‐etch and selective enamel etch techniques with a universal adhesive produced clinically acceptable results in resin composite restorations for NCCLs over 2 years.
Objectives
This double-blind randomized clinical trial evaluated the influence of pre-treatment with proanthocyanidins (PA) from grape seed extract on the clinical behavior of a simplified etch-and-rinse adhesive placed in non-carious cervical lesions (NCCLs) over 6- and 24-months.
Materials and methods
A total of 135 restorations were randomly inserted in 45 subjects. The NCCLs were etched with 37% phosphoric acid for 15 s and distributed into 3 groups: Control (PA0) - adhesive ExciTE F applied as per the manufacturer's recommendations; PA2 and PA5 groups – 2 wt% and 5 wt% PA solution, respectively, were applied for 60 s and washed for 30 s prior to application of the adhesive. The resin composite was placed incrementally and light-cured. The restorations were evaluated at baseline, 6 months (6 m) and 24 months (24 m) using both the FDI and USPHS criteria. Statistical analyses were carried out using Friedman repeated-measures analysis of variance by rank and the Wilcoxon test (α = 0.05).
Results
The retention rates were 98% (PA0), 98% (PA2) and 83% (PA5) after 6 m and 93% (PA0), 89% (PA2) and 70% (PA5) after 24 m. Only PA5 resulted in a significant lower retention rate at 6 m and at 24 m compared with that of baseline (p = 0.03). All groups resulted in a significantly worse marginal adaptation and marginal staining for the FDI criteria when the baseline vs. the 24 m recall data were compared. These differences were considered clinically acceptable under the FDI criteria.
Conclusions
The application of PA as a primer did not result in clinical advantages after 24 m of clinical service, regardless of the concentration used.
Clinical Relevance
It has been reported that PA, a collagen crosslinking agent, increases the durability of the dentin-resin interface. However, no effects were found clinically after 24 months.
Objective:
This study aimed to evaluate the addition of copper nanoparticles (CuNp) on the clinical performance of a universal adhesive system used as etch-and-rinse (ER) and self-etch (SE).
Methods:
216 restorations were randomly placed in 36 subjects according to the following groups: ERcu = etch-and-rinse with 0.1% CuNp; ERct = etch-and-rinse without CuNp; SEcu = self-etch with 0.1% CuNp; SEct = self-etch without CuNp. Resin composite was placed incrementally and light-cured. The restorations were evaluated at baseline and 6, 12 and 18 months using the FDI and USPHS criteria. Statistical analyses were performed using appropriate tests (α = 0.05).
Results:
The addition of CuNp did not increase the clinical performance (FDI / USPHS) of the universal adhesive tested after 18-month when applied in the ER mode (p > 0.05). The addition of CuNp in SE restorations increased the retention rate significantly and decreased the marginal discrepancies after 18 months (p < 0.05).
Conclusion:
The clinical performance of universal adhesive was significantly increased when applied in the SE mode with the addition of copper nanoparticles.
Clinical relevance:
This is the first study that demonstrates a slight improvement in the clinical performance of universal adhesive systems in non-carious cervical lesions when added CuNp in lower concentration.
Objectives:
To answer the following PICO question (participant, intervention, comparator and outcome): Does flowable resin composite restorations compared with regular resin composites improve the marginal adaptation, marginal discoloration and retention rates of restorations placed in non-carious cervical lesions [NCCLs] of adults?, through a systematic review and meta-analysis.
Source:
MEDLINE, Scopus, Web of Science, LILACS, BBO, Cochrane Library and SIGLE were searched without restrictions, as well as the abstracts of the IADR, clinical trials registries, dissertations and theses in May 2016 (updated in April 2017).
Study selection:
We included randomized clinical trials (RCTs) that answered the PICO question. RCTs were excluded if cavities other than NCCLs were treated; indirect restorations; polyacid-based resins instead of composite resins were employed, restorations in primary teeth and restorations were placed in carious cervical lesions. The risk of bias tool of the Cochrane Collaboration was applied in the eligible studies and the GRADE tool was used to assess the quality of the evidence.
Data:
After duplicates removal, 5137 articles were identified. After abstract and title screening, 8 studies remained. Six were at "unclear" risk of bias. The study follow-ups ranged from 1 to 3 years. No significant difference was observed between groups for loss of retention and marginal discoloration in all follow-ups. Better marginal adaptation was observed for restorations performed with flowable composites. At 1-year (risk ratio=0.27 [0.10 to 0.70]) and 3-year (risk ratio=0.34 [0.17 to 0.71]) follow-ups, flowable composites showed a risk 73% and 66% lower than regular composites for lack of adaptation, respectively. The evidence was graded as moderate quality for loss or retention at 3 years due to risk of bias and low and very low for all other outcomes due to risk of bias, imprecision and inconsistency.
Conclusions:
We have moderate confidence that the resin composite viscosity does not influence the retention rates at 3 years. Similar marginal discoloration and better marginal adaptation was observed for flowable composites but the quality of evidence is doubtful. (PROSPERO CRD42015019560).
Objectives:
This study evaluated the effect of the pre-treatment with 2% chlorhexidine digluconate (CHX) as coadjutant in restoration retention of noncarious cervical lesions (NCCL), after 36 months of follow-up.
Methods:
A randomized controlled split-mouth and triple-blind (operators, patients and evaluator) trial was carried out. Patients (n=42) with at least two non-carious cervical lesions were included. The teeth with NCCL were randomly assigned to two treatment groups: application of 2% CHX (experimental group) or a placebo solution (control group) for 60 s after acid etching and before the adhesive application. A trained and calibrated examiner evaluated the restorations at baseline (1 week) and at each recall (6, 12, 24 and 36 months) using the FDI criteria. A total of 225 restorations were evaluated after 36-month follow-up. Data were subjected to survival analysis using the Kaplan-Meier method, and the log-rank test was used to evaluate the existence of differences between the survival curves (α=0.05).
Results:
The restorations survival rate after 36 months of follow-up was 76.1%. There was no difference in the retention and failure rates between the experimental and the control group (p=0.968). There was an increased failure trend when restorations were located subgingival compared to those at the gingival level or supragingival.
Conclusion:
The pre-treatment with 2% chlorhexidine digluconate did not promote further restoration retention of noncarious cervical lesions.
Clinical significance:
The cavity pre-treatment with chlorhexidine for inhibition of hybrid layer degradation does not add any beneficial effect to the clinical performance of restorations.
Objectives:
In-vitro experiments on ormocers (ORganically MOdified CERamics) have provided controversial results. Consequently, the objectives of this meta-analysis were to (1) compare clinical performances of first generation ormocers versus conventional composite restorations, (2) explore the influence of various clinical factors and the impact of the quality of studies on published results.
Methods:
The following databases were explored until 2017/01/08: Ovid MEDLINE In-Process, Pubmed, CENTRAL, HTA, DARE, LILACS and Google Scholar. Studies of more than two years with quantitative comparisons between ormocers and control groups were selected. Outcome was the failure of a restoration (need to repair, remove or replace). Multivariate random-effects Poisson's regression was used to obtain a summary estimate.
Results:
75% of the 8 included trials concerned Class I/II restorations. Although non-significant, the global failures were higher for ormocers (0.22 [-0.16; 0.61]). For Class I/II restorations, a significantly higher sensitivity was observed for ormocer-based materials compared to other composites (0.75 [0.01; 1.50]). An increase of the number of restorations per patient was associated with higher marginal adaptation failures for ormocers in Class I/II obturations (0.59 [0.11; 1.08]).
Significance:
This study did not identify clear advantages of using the first generation of ormocer-based fillings rather than conventional composites. Given the recent development of new, dimethacrylate-diluent-free ormocer matrices, potentially more stable and resistant, new randomized clinical trials should be developed comparing this new family of pure ormocers with current composites.
Objectives:
The objectives of this study were to determine the filler content, the surface microhardness (at baseline and after immersion in water for 2 years), and the rheological properties of various flowable resin composites.
Methods:
Three flowable resin composites (Grandioso Heavy Flow [GHF], Grandio Flow [GRF], Filtek Supreme XTE Flow [XTE]), one pit and fissure sealant resin composite (ClinPro [CLI]), and three experimental flowable resin composites with the same matrix and a variable filler content (EXPA, EXPB, EXPC) were tested. The filler content was determined by calcination. The Vickers surface microhardness was determined after polymerization and then after immersion in distilled water at 37°C for 7, 60, 180, 360, and 720 days. The rheological measurements were performed using a dynamic shear rheometer.
Results:
The determined filler contents differed from the manufacturers' data for all the materials. The materials with the highest filler content presented the highest microhardness, but filler content did not appear to be the only influencing parameter. With respect to the values recorded after photopolymerization, the values were maintained or increased after 720 days compared with the initial microhardness values, except for GHF. For the values measured after immersion for 7 days, an increase in microhardness was observed for all the materials over time. All the materials were non-Newtonian, with shear-thinning behavior. At all the shear speeds, GRF presented a lower viscosity to GHF and XTE.
Conclusions:
GRF presented a low viscosity before photopolymerization, associated with high filler content, thereby providing a good compromise between spreadability and mechanical properties after photopolymerization.
This study investigated the prevalence, risk factors and association of occlusive wear with non-carious cervical lesions (NCCLs) in the general Chinese population. A total of 1320 subjects were recruited, and multi-stage and random sampling methods of survey spots were performed. All age groups comprised similar numbers of participants and equal numbers of males and females. Each subject completed a structured interview, and all teeth of each subject were examined by a practitioner to determine NCCLs and occlusive wear. Binary logistic regression was conducted by analysing the association of risk factors with the occurrence of NCCLs. Bivariate correlation analysis was performed by determining the association of NCCLs dimension or depth with the range of occlusive wear facets. Clinical assessment showed that the overall prevalence of subjects diagnosed with NCCLs was 63%. The proportion of subjects or teeth with NCCLs significantly increased with age. Premolars were the most commonly affected teeth. Single variables and interactive effects of variables associated with the occurrence of NCCLs include the following: age group, intensity of toothbrushing, frequency of fresh fruit consumption and interactive effect between intensity of toothbrushing and frequency of fresh fruit consumption. A weak positive correlation of the grading index was found between NCCLs dimension, size or depth and range of occlusive wear facets. This study reported the higher prevalence of NCCLs in the general Chinese population. Implementation of a combined strategy to reduce risk factors of NCCLs could be more effective than individual techniques; meanwhile, the occurrence of NCCL could be related to the wear degree of occlusive defects in the population studied. This article is protected by copyright. All rights reserved.
Purpose:
The objective of this double-blind, randomized clinical trial was to evaluate the six-month clinical performance of a new universal adhesive (Xeno Select, Dentsply) in noncarious cervical lesions (NCCLs) using two evaluation criteria: World Dental Federation (FDI) and the US Public Health Service (USPHS).
Methods and materials:
A total of 124 restorations were randomly placed in 31 patients according to the following groups: ER-D = etch-and-rinse/dry dentin; ER-M = etch-and-rinse/moist dentin; SE-et = selective enamel etching; and SET = self-etch. The composite resin EVOLUX (Dentsply) was placed incrementally. The restorations were evaluated after one week (baseline) and at six months using the FDI and USPHS criteria. Statistical analyses were performed using appropriate tests (α=0.05).
Results:
Fifteen restorations were lost or fractured at six months (one for ER-D, three for ER-M, five for SE-et, and six for SET) (p>0.05 at six-month recall). When ER (ER-D and ER-M) was compared with SE (SE-et and SET) there was a significant difference in the retention rate after six months (p=0.001). Marginal staining and postoperative sensitivity to air were only observed in three (one for ER-M and two for SET) and two restorations (two for ER-D) in both evaluation criteria (p>0.05), respectively. Forty-seven restorations were considered to have minor discrepancies in marginal adaptation at the six-month recall using the FDI criteria (13 for ER-D, 10 for ER-M, 11 for SE-et, and 13 for SET; p>0.05 between groups). However, for all groups, a significant difference was detected when baseline and six-month data were compared (p<0.05).
Conclusions:
The six-month clinical behavior of Xeno Select Universal Adhesive depends on the bonding strategy used. The universal adhesive did not fulfill the American Dental Association criteria for full approval when used in the self-etch mode.
Background:
The aim of this randomized controlled study was to evaluate the clinical performance of a highly-filled flowable composite compared to a conventional paste-type composite in direct posterior restorations after 36 months.
Methods:
A total of 58 mid-size to extensive posterior composite restorations were randomly placed in 32 patients, mean age of 43.9 years (range 25-76), using either a conventional composite Estelite Sigma Quick (Conventional) or a highly-filled flowable composite G-aenial Universal Flo with a 2-step self-etch adhesive. The restorations were evaluated after placement (baseline) and at 6, 12, 24 and 36 months according to the FDI criteria.
Results:
At the 36-month follow-up, 42 restorations were evaluated in 21 patients. After 36 months, the difference between heavily-filled flowable and conventional restorations was not statistically significant with respect to all evaluation parameters (p<0.05). No secondary caries was observed.
Conclusion:
The highly filled flowable composite showed a comparable clinical effectiveness as the conventional paste composite in posterior restorations over 36-months. This article is protected by copyright. All rights reserved.
To compare the clinical performance of Scotchbond™ Universal Adhesive used in self- and total-etch modes and two-bottle Scotchbond™ Multi-purpose Adhesive in total-etch mode for Class 5 non-carious cervical lesions (NCCLs).
37 adults were recruited with 3 or 6 NCCLs (>1.5mm deep). Teeth were isolated, and a short cervical bevel was prepared. Teeth were restored randomly with Scotchbond Universal total-etch, Scotchbond Universal self-etch or Scotchbond Multi-purpose followed with a composite resin. Restorations were evaluated at baseline, 6, 12 and 24 months for marginal adaptation, marginal discoloration, secondary caries, and sensitivity to cold using modified USPHS Criteria. Patients and evaluators were blinded. Logistic and linear regression models using a generalized estimating equation were applied to evaluate the effects of time and adhesive material on clinical assessment outcomes over the 24-month follow-up period. Kaplan-Meier method was used to compare the retention between adhesive materials.
Clinical performance of all adhesive materials deteriorated over time for marginal adaptation, and discoloration (p < .0001). Both Scotchbond Universal self-etch and Scotchbond Multi-purpose materials were more than three times as likely to contribute to less satisfying performance in marginal discoloration over time than Scotchbond Universal total-etch. The retention rates up to 24 months were 87.6%, 94.9% and 100% for Scotchbond Multi-purpose and Scotchbond Universal self-etch and total-etch respectively.
Scotchbond Universal in self- and total- etch modes performed similar to or better than Scotchbond Multipurpose respectively.
24 month evaluation of a universal adhesive indicates acceptable clinical performance, particularly in a total-etch mode.
Copyright © 2015. Published by Elsevier Ltd.
Wear resistance is an important property of the dental materials, particularly for large restorations in the posterior regions and for the patients suffering from parafunctional activities. Additionally, the wear resistance of flowable composite resin materials is a clinical concern, although they are popular among dentists because of their easy handling. The aims of the present study were to evaluate the wear resistance of nine composite resins both condensable (G-aenial posterior, Venus, GrandioSO, Tetric EvoCeram, Ceram X duo, Filtek Supreme XTE) and new-generation flowable resin composites (G-aenial Universal Flo, GrandioSO Flow and GrandioSO Heavy Flow) and to compare these results with amalgam.
Eight specimens of each material were subjected to two-body wear tests, using a chewing simulator. The wear region of each material was examined under profilometer, measuring the vertical loss (μm) and the volume loss (mm(3)) of the materials. Additionally, SEM analysis was performed to assess surfaces irregularities.
The results showed significant difference of the vertical loss and the volume loss of the examined materials (p < 0.001). Although amalgam had the best wear resistance, two condensable resin composites (GrandioSO, Ceram X duo) and all flowable materials had no significant difference with amalgam. GrandioSO had the highest wear resistance and Filtek Supreme XTE the lowest wear resistance.
The majority of resin composites had good wear resistance and similar to amalgam.
Based on the in vitro measurements of two-body wear resistance, the new resin composites could replace amalgam for restorations placed in occlusal stress-bearing regions. New-generation flowable resin materials may also be used in occlusal contact restorations.
The aim of this study was to evaluate the 2-year clinical performance of class II restorations made with a composite resin with two different viscosities.
47 patients received two class II restorations (n=94), one made with GrandioSO (conventional viscosity-CV), and the other with GrandioSO Heavy Flow (flowable viscosity-FV), subjecting both materials to the same clinical conditions. The self-etching adhesive Futurabond M was used for all restorations. The composites were inserted using the incremental technique. The restorations were evaluated using the modified USPHS criteria according to the periods: baseline, six months, one year and two years after restorative procedures.
After 24 months, 40 patients attended the recall and 78 restorations were evaluated. In all periods, no secondary caries was observed. After 6 months, there were slightly overall changes of scores for most parameters. After 24 months, the higher number of changes from score Alfa to Bravo was observed for marginal discoloration (32.5%-CV and 39.5%-FV) and color match (15%-CV and 31.6%-FV), followed by proximal contact (25%-CV and 23.7%-FV) and marginal adaptation (20%-CV and 21.1%-FV). For wear, surface texture and postoperative sensitivity the changes were very small. Just two restorations were lost during the 24-month follow up. Less than 5% of all restorations showed postoperative sensitivity. Chi-square test showed no significant differences between the two materials for all parameters analyzed.
After two years of clinical service, no significant differences were observed between GrandioSO conventional and GrandioSO Heavy Flow for the parameters analyzed. Both materials provided acceptable clinical behavior in class II restorations.
Laboratory testing of enamel bevel reports many advantages; however clinical studies on this topic are scarce and controversial.
To evaluate the effect of enamel bevel on the retention rates of composite restorations placed in non-carious cervical lesions (NCCLs).
Forty-two patients with more than 20 teeth in occlusion and having at least two NCCLs participated in this study. The cavities were divided into non-beveled (control) and beveled (short bevel [45°, 1-2 mm long] prepared with a diamond bur) groups. The NCCLs were restored with the 2-step etch-and-rinse adhesive ExciTE and the resin composite 4 Seasons (Ivoclar Vivadent). Eight-four restorations were placed and evaluated at baseline, after 6 and 12 months according to the modified U.S. Public Health Service criteria.
The 12-month retention rates (95% confidence interval) for the beveled (91% [77-97%]) and non-beveled [88% (73-95%)] groups were similar. No significant differences were detected between groups in other criteria (Fisher test, p > 0.05). No significant differences were detected in the same group compared across different recall times (McNemar test, p > 0.05).
Enamel beveling may not be clinically relevant for the retention of composite restorations in NCCLs after 12 months.
Beveling enamel margins may not be necessary in NCCL restorations restored with the 2-step etch-and-rinse systems.
The currently used commercial restorative composites contain a mixture of various cross-linking dimethacrylates, glass- and/or silicon dioxide fillers, and a photoinitiator system. They are cured by irradiation with visible light. New developments of polymeric composites for restorative filling materials are mainly focused on the reduction of polymerization shrinkage, and improvement of biocompatibility, wear resistance and processing properties. This can be partially achieved by using new tailor-made monomers and optimized filler particles.This review describes the polymeric chemical aspects of the application of new monomers, e.g. cyclic monomers, liquid-crystalline monomers, ormocers, branched monomers, compomers or Bis-GMA analogues or substitutes for restorative composites. In addition, the contribution of new filler-technologies for the improvement of restorative composites is discussed.
The authors conducted a study to quantify the reasons for restoring noncarious tooth defects (NCTDs) by dentists in The Dental Practice-Based Research Network (DPBRN) and to assess the tooth, patient and dentist characteristics associated with those reasons.
Data were collected by 178 DPBRN dentists regarding the placement of 1,301 consecutive restorations owing to NCTDs. Information gathered included the main clinical reason, other than dental caries, for restoration of previously unrestored permanent tooth surfaces; characteristics of patients who received treatment; dentists' and dental practices' characteristics; teeth and surfaces restored; and restorative materials used.
Dentists most often placed restorations to treat lesions caused by abrasion, abfraction or erosion (AAE) (46 percent) and tooth fracture (31 percent). Patients 41 years or older received restorations mainly because of AAE (P < .001). Premolars and anterior teeth were restored mostly owing to AAE; molars were restored mostly owing to tooth fracture (P < .001). Dentists used directly placed resin-based composite (RBC) largely to restore AAE lesions and fractured teeth (P < .001).
Among DPBRN practices, AAE and tooth fracture were the main reasons for restoring noncarious tooth surfaces. Pre-molars and anterior teeth of patients 41 years and older are most likely to receive restorations owing to AAE; molars are most likely to receive restorations owing to tooth fracture. Dentists restored both types of NCTDs most often with RBC.
With Institutional Review Board approval, 39 patients who needed restoration of noncarious cervical lesions (NCCLs) were enrolled in this study. A total of 125 NCCLs were selected and randomly assigned to four groups: 1) a three-step etch-and-rinse adhesive, Adper Scotchbond Multi-Purpose (MP, 3M ESPE, St Paul, MN, USA); 2) a two-step etch-and-rinse adhesive, Adper Single Bond Plus (SB, 3M ESPE); 3) a two-step self-etch adhesive, Adper Scotchbond SE (SE, 3M ESPE); and 4) a one-step self-etch adhesive, Adper Easy Bond (EB, 3M ESPE). A nanofilled composite resin was used for all restorations. Restorations were evaluated at six months and 18 months using modified U.S. Public Health Service (USPHS) parameters.
At six months after initial placement, 107 restorations (85.6% recall rate) were evaluated. At 18 months, 94 restorations (75.2% recall rate) were available for evaluation. The 6 mo/18 mo overall retention rates (%) were 100/90.9 for MP; 100/91.7 for SB; 100/90.9 for SE; and 96.4/92.3 for EB with no statistical difference between any pair of groups at each recall. Sensitivity to air decreased significantly for all adhesives from the preoperative to the postoperative stage and was stable thereafter. Interfacial staining did not change statistically from baseline to six months; however, interfacial staining at the enamel margins was statistically worse at 18 months than at baseline for the two self-etch adhesives EB and SE. Marginal adaptation was statistically worse at 18 months compared with baseline only for EB. This tendency was already significant at the six-month recall.
Although 18-month retention was similar for the different adhesion strategies, enamel marginal deficiencies were more prevalent for the self-etch adhesives.
This paper surveys the most important developments in resin-based dental composites and focuses on the deficits (e.g. polymerization shrinkage) and strengths of the materials and their clinical implications. Moreover, differences between composite categories, such as hybrid, nanohybrid, microfilled, packable, ormocer-based, silorane-based, polyacid-modified composites (compomers) and flowable composites are highlighted, especially in view of their mechanical behaviour. In addition to the classical dimethacrylate-based composites, special attention is given to alternative monomers, such as siloranes, ormocers or high-molecular-weight dimethacrylate monomers (e.g. dimer acid-based dimethacrylates and tricyclodecane (TCD)-urethane), analysing their advantages, behaviour and abilities. Finally, the paper attempts to establish the needs and wishes of clinicians for further development of resin-based composites.
To describe the prevalence of non-carious cervical lesions (NCCLs) and to assess the relative affects of risk factors on NCCLs in middle-aged and elderly people in Hubei Province, China.
A sample of 2,160 adults, aged 35-44 years and 65-74 years and balanced by age, gender, and urbanization, participated in the cross sectional epidemiological survey. Non-carious cervical lesions were examined using a modified Tooth Wear Index. Data were collected based on structured questionnaires that assessed general information as well as oral health.
The prevalence of non-carious cervical lesions was 38.8% for 35-44-year-olds and 56.6% for 65-74-year-olds. The first premolars, canines, and second premolars showed the highest prevalence of lesions, while the second molars demonstrated the least. Several risk factors such as age (OR = 2.45, p < 0.001), location (OR = 1.68, p = 0.001), frequency of toothbrushing (OR = 1.33, p = 0.016), bruxism (OR = 1.37, p < 0.001), and family income (OR = 1.44, p < 0.001) were found to be associated with lesion occurrence.
The prevalence of non-carious cervical lesions was relatively high in the middle-aged and elderly persons in China and was also associated with socio-behavioural risk factors.
This study evaluated the clinical performance of dentinal adhesives in seven various material/technique combinations. No statistically significant differences were observed among the restorative combinations, or among technique variables after two years in terms of retention, sensitivity or USPHS categories. However, other factors related to tooth flexure--such as occlusal stress, patient age, restorative material and restoration location--showed statistically significant associations with retention failures. These results support a tooth flexural theory of restoration retention.
A plethora of new low-viscosity composite resin materials, or flowable composites, have been marketed during the last two years, but little has been published about them. The authors describe research in which they compared the properties--filler, depth or cure, flow, wear, compressive strength, diametral tensile strength, indented biaxial flexure strength and toughness--of flowable and hybrid composites. Mechanical property tests (ISO 4049, ISO/DIS 6872) of eight flowable composites and two hybrid composites were conducted. The flowable composite with the least flow was similar to traditional composites. Mechanical properties were generally about 60 to 90 percent of those of conventional composites. The authors conclude that flowable materials should be used with caution in high-stress applications for restorative dentistry.
There is increasing reliance on laboratory testing of new products. The clinical significance of many such studies can be questioned. To function clinically, bond strength must develop more quickly than the shrinkage stress. Oxygen inhibition of extremely thin resin layers prohibits establishment of the bond, perhaps particularly relevant for single-component dentin bonding agents. Use of thicker layers of radiolucent hydrophilic bonding materials can lead to difficulties during subsequent radiographic diagnosis and may contribute to degradation at enamel margins. Shrinkage stress is influenced significantly by many factors. The cavity geometry probably plays the most important role but cannot be controlled to any major extent by the operator. Shrinkage and modulus kinetics are also critical, involving variables such as content and type of monomers, the catalyst system, and the light intensity. In general, a high modulus of elasticity or more rapid polymerization leads to increased shrinkage stress. Combining a single-component adhesive as a dentin primer with a highly radiopaque flowable resin composite as a filled adhesive may help overcome these difficulties.
The method currently used to adhere resin to dentin involves etching, priming and bonding. Many commercial adhesives now combine priming and bonding functions in a single solution, and these are frequently called one-bottle adhesives. The purpose of this study was to compare the 36-month clinical performance of two commercial one-bottle adhesives.
The authors enrolled 33 patients with noncarious cervical lesions in the study. A total of 101 lesions were restored with either a filled, ethanol-based adhesive (OptiBond Solo, SDS Kerr) or an unfilled, acetone-based adhesive (Prime & Bond 2.1, Dentsply Caulk) and a hybrid resin-based composite. Enamel margins were not beveled, and no mechanical retention was placed. The restorations were evaluated at baseline and six months, 18 months and 36 months after placement using modified Cvar/Ryge criteria.
The retention rates at 36 months were 93.3 percent for the ethanol-based adhesive and 89.4 percent for the acetone-based adhesive. The difference in retention rates was not statistically significant. In both groups, 12 percent of the retained restorations had marginal staining, but no recurrent caries was detected around any restoration. Other restoration characteristics such as marginal adaptation and color match remained excellent three years after placement.
The performance of both adhesives was excellent during this 36-month clinical trial. At the most recent recall evaluation (that is, 36 months), the filled, ethanol-based adhesive exhibited slightly better bond durability, but the difference between the two materials was not statistically significant.
The one-bottle adhesives evaluated in this study provided excellent clinical retention of Class V restorations without mechanical retention. When the materials are used properly, restorations are retained at a high rate during at least three years of clinical service.
In this intra-individual comparison (an 18-months' randomized, controlled prospective study), we evaluated the clinical performance of one self-etch and one "etch & rinse" adhesive in non-carious cervical lesions.
Twenty-five patients with at least two pairs of similar-sized non-carious cervical lesions participated. Seventy-eight restorations were placed; 39 with etch & rinse (Single-Bond) and 39 with self-etch (Adper Prompt). Both adhesives were combined with the microfilled resin composite Filtek-A110. The restorations were evaluated at baseline, 6, 12, and 18 months according to slightly modified USPHS criteria. Statistical differences between the adhesives was tested with McNemar's test and clinical degradation over time for each material with the Fisher exact test (a=0.05).
Thirty pairs were evaluated at 12 and 18 months. Two self-etch restorations were lost after 18 months. Nine Adper Prompt and four Single-Bond restorations scored bravo for marginal adaptation at 18 months (p<0.05). Nine Adper Prompt and three Single-Bond restorations scored bravo for marginal discoloration (p<0.05).
Both adhesive systems showed acceptable clinical retention rates according to the ADA full acceptance criteria for enamel-bonding systems in class V non-carious lesions. The self-etch adhesive showed a faster progressive marginal degradation.
The purpose of this study was to compare the inorganic fraction and the mechanical properties of three nanofilled composites with four universal hybrid and two microfilled composites. The degrees of conversion of the materials photopolymerized using halogen and LED units were also investigated.
Three nanofilled (Supreme, Grandio and Grandio Flow), four universal hybrid (Point-4, Tetric Ceram, Venus, Z 100) and two microfilled (A 110, Durafill VS) composites were used in this study. Their filler weight content was measured by thermogravimetric analysis. The morphology of the filler particles was determined using scanning-electron microscopy (SEM). Mechanical properties were measured: dynamic and static elastic moduli, flexural strength and Vickers microhardness. The degree of conversion in relation with the depth of polymerization of every material tested was evaluated using Raman spectrophotometry.
Nanofilled resin composites show higher elastic moduli than those of universal and microfilled composites, except for the Z-100. The microfilled composites exhibit by far the lowest mechanical properties. The flexural strength does not appear as a discriminating factor in this study. The degrees of polymerization obtained with the halogen lamp are higher than those obtained with the LED lamp.
Nanofilled resin composites show mechanical properties at least as good as those of universal hybrids and could thus be used for the same clinical indications as well as for anterior restorations due to their high aesthetic properties.
FDI World Dental Federation: clinical criteria for the evaluation of direct and indirect restorations-update and clinical examples
- R Hickel
- A Peschke
- M Tyas
- I Mjör
- S Bayne
- M Peters
Hickel R, Peschke A, Tyas M, Mjör I, Bayne S, Peters M, et al. FDI
World Dental Federation: clinical criteria for the evaluation of
direct and indirect restorations-update and clinical examples.
Clin Oral Investig. 2010;14(4):349-66. http://dx.doi.org/10.1007/
s00784-010-0432-8. PMid:20628774.