Clinical Performance Of Class Research Articles

Bulk-Fill Ormocer versus Methacrylate-Based Resin Composite Restorative Systems: The Effect of Flowable Lining on Two-Year Clinical Performance in Class II Cavities

Bulk-Fill Ormocer versus Methacrylate-Based Resin Composite Restorative Systems: The Effect of Flowable Lining on Two-Year Clinical Performance in Class II Cavities

Clinical performance of different bulk-fill composite resin systems in class II cavities: A 2-year randomized clinical trial.

This study evaluated the clinical performance of bulk-fill resin composite systems with different viscosities in class II cavities. A total of 80 class II restorations were performed with a single operator in 50 patients using four different bulk-fill resin composite materials: Filtek™ Bulk Fill, Heated Filtek™ Bulk Fill, G-aenial™ BULK Injectable, and SonicFill3. A double-blinded randomized clinical trial was designed to evaluate the two-year clinical performance of the four bulk-fill composite resins using modified FDI criteria. Data were analyzed descriptively. Level of significance was set at 0.05. Differences between groups were tested using Wilcoxon-signed-rank and Mann-Whitney-U test as nonparametric tests. Data were analyzed using Kruskal-Wallis, Mann-Whitney U, and Wilcoxon signed rank tests (p < 0.05). Eighty restorations were available for evaluation, with a survival function of 100%. No statistically significant differences were observed between the four groups regarding assessing esthetic, functional, and biological properties during different follow-up periods. After 2 years of clinical follow-up, the bulk-fill composite systems with different viscosities seem to be esthetically, functionally, and biologically acceptable, with a promising clinical performance in class II cavities.

Two-year clinical performance of dual- and light-cure bulk-fill resin composites in Class ӀӀ restorations: a randomized clinical trial

ObjectiveThis study aimed to compare the clinical performance of dual- and light-cure bulk-fill resin composites (BFRCs) in Class ӀӀ restorations after 2 years.Materials and methodsA double-blinded, prospective, randomized clinical trial (RCT) was conducted following the CONSORT (Consolidated Standard of Reporting Trials) guidelines. Forty patients were enrolled in the study. Each patient received three compound Class ӀӀ restorations. One dual-cure (Fill-Up; Coltene Waledent AG) and two light-cure (QuiXfil; Dentsply, and Tetric N-Ceram Bulk Fill; Ivoclar Vivadent) BFRCs were used for 120 Class ӀӀ restorations. A universal adhesive (ONE COAT 7 UNIVERSAL; Coltene Waledent AG) was used with all restorations. Restorations were clinically evaluated after 1 week (baseline), 6 months, 12 months, 18 months, and finally after 24 months using the FDI World Dental Federation (FDI) criteria. The Kruskal–Wallis test was used for comparison between BFRCs groups at baseline and at each recall period, and the Wilcoxon signed-rank test was used for comparing different follow-up times of each BFRC to baseline. The level of significance was set at p < 0.05.ResultsAll BFRCs restorations showed only minor changes and revealed no statistically significant differences between their clinical performance for all evaluated parameters at all recall periods; also, there was no statistically significant difference between all recall periods and baseline for all evaluated parameters.ConclusionThe two-year clinical performance of dual-cure BFRC was comparable to light-cure BFRCs in Class ӀӀ restorations.Clinical relevanceDual- and light-cure BFRCs showed excellent clinical performance in Class ӀӀ restorations after a 2-year clinical follow-up.

Comparative Evaluation of Clinical Performance of Three Different Glass Hybrid Restorations in High Caries Risk Patients: A Randomized Control Trial

BACKGROUND: Finding a restorative material that can survive and be quite resistant in high caries risk patients is very challenging, that’s why three different glass hybrid restorations were tested for their clinical performance for one year in high caries risk patients. AIM: This study was conducted to evaluate the clinical performance of three glass hybrid restorations; nano-ionomer restoration (Ketac Nano), bioactive ionomer glass fillers (Activa bioactive), and alkasite restorative material (Cention N) in Class I cavity in high caries risk patients after 1 year according to the FDI criteria for the assessment of dental restorations. METHODS AND MATERIALS: Fifteen cooperative patients, males or females with high caries risk who were approving to participate in the trial of age range 18–50 years, were selected in the present study. Every patient should have three or more posterior teeth having occlusal pits and fissure carious lesions. Three Class I cavities were performed for every patient and restored randomly with Ketac Nano™, Activa Bioactive™, and Cention N™. All three restorations were applied, according to the manufacturers’ instructions. Restorations were evaluated at baseline (immediately), after 3 months, 6 months, and 1 year by two blinded assessors using FDI criteria for the assessment of dental restorations measuring functional properties. STATISTICAL ANALYSIS USED: Evaluation of functional properties was checked by Kruskal–Wallis non-parametric test statistics at 0.05 level. Collected data were analyzed for descriptive statistics both graphically and mathematically in terms of frequency, percent, median, interquartile range, and mean and standard deviations. Differences in evaluations between materials (M1, M2, and M3) were carried out by Chi-squared test at 0.05 level. However, differences between follow-up times (T0, T1, T2, and T3) were carried out by Friedman’s test for related samples for non-parametric data. Variations caused by the three materials and follow-up times in addition to interaction between them were assessed by repeated measures ANOVA for ranked data at significance levels of 0.05. Data analysis was carried out using computer software Statistical Package for the Social Sciences SPSS (IBM-SPSSver.23.0 for MacOS). RESULTS: Results of functional properties of the three restorative materials revealed that at baseline (T0) and 3 months (T1), all cases (100%) of the three materials were clinically successful, with no significant difference between them. However, after 6 months, 58 cases (97%) of M1, 56 cases (93%) of M2, and 54 cases (90%) of M3 were clinically successful, with non-significant difference between them. Moreover, after 12 months, 55 cases (91.6%) of M1, 56 cases (93%) of M2, and 53 cases (88%) of M3 were clinically successful, with non-significant difference between them. CONCLUSION: In the purpose of restoring posterior permanent teeth in high caries risk patients, all three restorative materials demonstrated acceptable clinical performance in Class I cavities with the same success rate.

36-Month Randomized Clinical Trial Evaluation of Preheated and Room Temperature Resin Composite.

This study evaluated the effect of preheating resin composites (RCs) on the clinical performance of class I restorations during a 36-month period using a split-mouth, double-blinded randomized design. A total of 35 patients were selected. Every patient received one pair of class I nanofilled resin composite (RC, Filtek Z350 XT) posterior restorations (n=70). One side of the mouth received preheated composites; on the other side, the composite was placed in a nonheated state following the manufacturer's instructions. These restorations were evaluated at 1-week (baseline), 12-months, 24-months, and 36-months using the FDI World Dental Federation criteria. The statistical analyses were also performed using the Wilcoxon and Friedman tests with the level of significance set at 0.05. After 36 months, 33 patients attended the recall visits, and 66 restorations were evaluated. The Friedman and Wilcoxon signed-rank tests revealed insignificant differences between both groups (p>0.05) for all FDI parameters. However, a significant difference was detected for staining as a criterion at 36 months (p=0.01). Moreover, a significant difference in the staining was detected when the baseline and 36 months were compared in the nonheated RC group (p=0.001). For esthetic, functional, and biological properties, the nonheated composite exhibited 93.9%, 100%, and 100% of the clinically accepted scores, respectively, and the preheated group presented 100% for all properties. Four restorations had postoperative sensitivity at baseline for nonheated (11.4%) and five for preheated (14.2%), but the postoperative sensitivity scores were considered highly acceptable at 12-, 24-, and 36-months. After 36 months, preheated nanofilled RCs showed an acceptable clinical performance similar to that of the nonheated ones in class I restorations, but with better resistance to marginal staining.

Clinical performance of class I cavities restored with bulk fill composite at a 1-year follow-up using the FDI criteria: a randomized clinical trial.

ObjectivesThe present study aimed to evaluate the survival rate and clinical performance of class 1 composite restorations restored with the Filtek Bulk Fill composite material using either the bulk fill technique or the incremental technique at baseline (1 week) and at 3, 6 and 12 months of follow-up.Materials and MethodsForty-two patients with at least 2 carious teeth were selected. Following randomization, one tooth was restored with the Filtek Bulk Fill composite using the incremental fill technique, and the other tooth was restored with the same material using the bulk fill technique. Patients were recalled for follow-up at baseline (1 week) and 3, 6, and 12 months and evaluated using the FDI criteria.ResultsThe data were analyzed using the McNemar χ2 test. No statistically significant differences were found between the scores of teeth restored with either technique. At baseline and at 3, 6, and 12 months of follow-up; there were no significant difference in the clinical status of both groups of restorations.ConclusionsWithin the limitations of this study, using the bulk fill technique for restorations with the Filtek Bulk Fill material seems to be equally efficient to using the incremental fill technique.Trial RegistrationClinical Trials Registry-India Identifier: CTRI/2017/07/008961

A Two-year Clinical Comparison of Three Different Restorative Materials in Class II Cavities.

The aim of this clinical study was to evaluate the clinical performance of Class II restorations of a high-viscosity glass ionomer material, of a bulk-fill composite resin, and of a microhybrid composite resin. One hundred nine Class II restorations were performed in 54 patients using three different restorative materials: Charisma Smart Composite (CSC; a conventional composite resin), Filtek Bulk Fill Posterior Restorative (FBF; a high-viscosity bulk-fill composite), and Equia Forte Fil (EF; a high-viscosity glass ionomer). Single Bond Universal adhesive (3M ESPE, Neuss, Germany) was used for both conventional and bulk-fill composite resin restorations. The restorations were evaluated using modified US Public Health Service criteria in terms of retention, color match, marginal discoloration, anatomic form, contact point, marginal adaptation, secondary caries, postoperative sensitivity, and surface texture. The data were analyzed using the chi-square, Fisher, and McNemar tests. Eighty-four restorations were evaluated at two-year recalls. There were clinically acceptable changes in composite resin restorations (FBF and CSC). In addition, no statistically significant difference was observed between the clinical performances of these materials in terms of all criteria (p>0.05). However, there was a statistically significant difference between the EF group and the FBF and CSC groups in all parameters except for marginal discoloration, secondary caries, and postoperative sensitivity (p<0.05). The tested bulk-fill and conventional composite resins showed acceptable clinical performance in Class II cavities. However, if EF is to be used for Class II restoration, its use should be carefully considered.

Effects of Different Application Techniques on Nanohybrid Composite Restorations Clinical Success

Introduction:Dental composites have been used as a restorative material for a long time. However, they have their limitations.Aims:This study evaluated the effects of placement techniques on the clinical performance of class I composite resin restorations.Methods:A total of 40 patients with split-mouth design participated in this study. Each patient had two fillings according to the placement technique (either bulk or incremental packing) of the composite resin restorations. Group (A): was packed by Tetric EvoCeram bulk-fill composite resin and Group (B): was incrementally packed with Tetric EvoCeram composite resin. Restorations of the teeth were evaluated on the same day, at one week, 3 months and 6 months to determine any signs of failure according to the modified United States Public Health Service (USPHS) criteria.Results:At different follow-up periods, the results showed no significant differences for retention, marginal integrity, surface stain, gingival bleeding, and secondary caries; however, there were significant differences in color match, surface texture, and postoperative sensitivity.Conclusion:This study concluded that the nanohybrid resin composites demonstrated excellent clinical performance for 6 months follow up period.

Comparison of laser- and bur-prepared class I cavities restored with two different low-shrinkage composite resins: a randomized, controlled 60-month clinical trial.

The aim of this study was to compare the clinical performances of two low-shrinkage composite resins (silorane-based and methacrylate-based) in class I cavities prepared by Er,Cr:YSGG laser or conventional diamond bur over 60months. Eighteen patients with four similar-sized occlusal lesions in molar teeth were included to the study. A total of 72 class I cavities were prepared either by Er,Cr:YSGG laser or conventional diamond bur. Cavities were restored with Filtek Silorane (3M-ESPE) (silorane-based) or Kalore (GC) (methacrylate-based) according to the manufacturers' instructions. All restorative procedures were performed by one operator, and the restorations were examined by two evaluators according to the FDI criteria at baseline and at 6, 12, 24, 36, 48, and 60months. Patients' satisfaction about the preparation methods was also evaluated with a questionnaire. Pearson chi-square test was used for statistical analysis (p = 0.05). The 60-month recall rate was 88.8% and the retention rates for experimental groups were 100%. After 60months, no significant differences were detected among groups, regarding marginal adaptation, marginal staining, surface staining, color match, and translucency. None of the restorations exhibited postoperative sensitivity or recurrence of caries. Different preparation techniques had no effect on the longevity of restorations. The two low-shrinkage composite systems tested were both clinically acceptable after 60months. Low-shrinkage composites showed similar clinical performance in class I cavities prepared with a laser or conventional bur after a 60-month observation period.

Glass ionomer or composite resin for primary molars.

Data sourcesPubMed, Scopus, Web of Science, Virtual Health Library (VHL), Cochrane Library, Clinical Trials and OpenGrey.Study selectionRandomised controlled trials comparing the clinical effectiveness of Class II restorations performed with conventional (C-GIC) or resin-modified glass ionomer cement (RM-GIC) and composite resin (CR) in primary molar teeth. No date of publication or language restrictions.Data extraction and synthesisStudy selection was carried out independently by two reviewers, with abstracted data and risk of bias assessment being performed using the Cochrane tool. Data on the restorations were dichotomised as acceptable' (restorations without need of replacement or repair) or 'unacceptable' (restorations presenting failures or requiring repair or replacement) after which a number of meta-analyses were conducted.ResultsTen studies were included in qualitative synthesis, and nine contributing to the meta-analyses. Six studies used a split-mouth design and four a parallel design. Seven studies used USPHS criteria, two applied the FDI criteria and one used their own. Seven studies reported restorations were placed under rubber dam isolation with the other three using cotton roll isolation. Six studies were at low risk of bias and four unclear risk of bias. GIC and CR presented similar failure patterns (Risk Difference [RD] = -0.04 (95%CI; -0.11 to 0.03) p=0.25, I2 = 51%), irrespective of follow-up period, type of GIC used, method of isolation or criteria used for assessment. GICs exhibited significantly lower values of secondary carious lesions ([RD] = 0.06 (95%CI; 0.0 to 0.10), p=0.008, I2 = 0%).ConclusionsGICs and CRs have comparable clinical performance in Class II restorations in primary molars. GICs did show superior performance in the occurrence of secondary carious lesions, especially when RM-GIC under rubber dam isolation was used.

Clinical performance of class I occlusal composite resin restorations: a multicenter double-blinded randomized clinical trial

Objective: The objective of this study was to evaluate the 6-month clinical performance of class I occlusal composite resin restorations through a multicenter, randomized, double-blind, clinical trial. Material e Métodos: Two hundred and eighty class I occlusal restorations were performed in 70 patients (aged between 17 to 50 years). The restorations were divided into four groups: G1 (Filtek P60/3M ESPE); G2 (Rok/SDI); G3 (Filtek™ P90/3M ESPE); G4 (Evolux/Dentsply). Two pre-calibrated dental practitioners performed and evaluated the restorative procedures regarding to color match, marginal discoloration, recurrent caries, wear (anatomic form) and marginal integrity according to the USPHS criteria. Resultados: In 85.8% of the evaluated restorations was observed the ideal score (A) for color match; 91.4% for marginal discoloration; 100% for recurrent caries; 87.7% for wear (anatomic form) and 99.3% for marginal integrity. Conclusion: The composite resins used in this study presented satisfactory and similar clinical performance in a 6-month clinical evaluation.KeywordsDentistry; Composite resins; Permanent dental restoration; Molar; Bicuspid.

Retention of class V restorations placed by dental students: a retrospective evaluation

Objective: The aim of this study was to evaluate the clinical performance of class V restorations made by undergraduate students and determine the factors that might influence retention of restorations. Material and Methods: A survey of the clinical records created between 2007 and 2009 was used to collect data on patients with dental restorations. The USPHS (United States Public Health Service) criteria were used to perform evaluations by direct clinical observation. Statistical analyses were performed using Fisher’s exact test, Chi-square test, and Logistic regression analysis. Results: Clinical records were analyzed, of which 282 (21.3%) described class V restorations performed on a total of 781 teeth. These patients were contacted, and 67 (23.76%) attended the clinic for assessment. Out of the 221 (28.3%) evaluated teeth, 37 restorations were replaced and 184 were analyzed. The logistic regression analysis showed that gingival bleeding index (GBI), decay-missing-filled teeth (DMFT) index, and pulpal protection influenced the retention of the restorations. The association tests demonstrated superiority of the composite resin over the glass ionomer cement with regard to retention, wear, and anatomical form. Conclusion: In this study, retention of cervical composite resin restorations was higher than that of the glass ionomer cement restorations when performed by undergraduate students.Key Words: Composite resins; Glass ionomer cements; Retrospective study.

Clinical performance of Class I nanohybrid composite restorations with resin-modified glass-ionomer liner and flowable composite liner: A randomized clinical trial.

Background:Liners play a vital role in minimizing polymerization shrinkage stress by elastic bonding concept and increase the longevity and favorable outcome for composite restorations.Aims:The aim of this study was to evaluate the clinical performance of nanohybrid composite restorations using resin-modified glass-ionomer and flowable composite liners.Settings and Design:A single-centered, double-blinded randomized clinical trial, with split-mouth design and equal allocation ratio that was conducted in the Department of Conservative Dentistry and Endodontics.Materials and Methods:In forty patients, a total of eighty Class I restorations were placed with resin-modified glass-ionomer cement (RMGIC) liner (FUJI II LC, GC America) in one group and flowable composite liner (smart dentin replacement/SDR, Dentsply Caulk, Milford, DE, USA) in another group. All restorations were clinically evaluated by two examiners, immediately (baseline), 3, 6, and 12 months using US Public Health Service modified criteria.Statistical Analysis Used:Statistical analysis was performed using McNemar's test (P < 0.05).Results:There was no significant difference in the color match, marginal discoloration, surface roughness, and marginal adaptation. Restorations with RMGIC liner group show 20% Bravo scores on anatomic form at 12 months but are still clinically acceptable.Conclusion:Nanohybrid composite restorations with RMGIC (Fuji II LC) and flowable composite liner (SDR) demonstrated clinically acceptable performance after 12 months.

Nine-year clinical evaluation of composite resins in Class III restorations

Objective: The aim of this study was to evaluate the nine-year clinical performance of Class III composite restorations using two microhybrid anterior composite resins [Magic™-Vigodent/(F) and Z100™-3M ESPE/(Z)]. Material and Methods: The study was a randomized controlled trial, following the split mouth design. Seventy restorations were placed, thirty-five for each resin composite into 35 patients. The restorations were placed by one operator according to the manufacturers’ specifications. Two independent evaluators conducted the clinical evaluation using modified USPHS criteria. After nine-years, 56 restorations (28F-28Z) were evaluated. Data were analyzed using Chi-square, Exact Fisher and McNemar tests (p&lt;0.05). Results: No postoperative sensitivity, secondary caries and loss of anatomic form was observed after nine-years for both composites. There were no significant differences between the two composites tested at baseline and after nine-years. Significant differences for Z and F restorations between baseline and nine-year with respect to color matching and for F regarding the marginal integrity were detected. Conclusion: The clinical performance of both materials was considered acceptable after the 9-year evaluation.

Meta-Analysis of the Influence of Bonding Parameters on the Clinical Outcome of Tooth-colored Cervical Restorations.

To meta-analyze the literature on the clinical performance of Class V restorations to assess the factors that influence retention, marginal integrity, and marginal discoloration of cervical lesions restored with composite resins, glass-ionomer-cement-based materials [glass-ionomer cement (GIC) and resin-modified glass ionomers (RMGICs)], and polyacid-modified resin composites (PMRC). The English literature was searched (MEDLINE and SCOPUS) for prospective clinical trials on cervical restorations with an observation period of at least 18 months. The studies had to report about retention, marginal discoloration, marginal integrity, and marginal caries and include a description of the operative technique (beveling of enamel, roughening of dentin, type of isolation). Eighty-one studies involving 185 experiments for 47 adhesives matched the inclusion criteria. The statistical analysis was carried out by using the following linear mixed model: log (-log (Y /100)) = β + α log(T ) + error with β = log(λ), where β is a summary measure of the non-linear deterioration occurring in each experiment, including a random study effect. On average, 12.3% of the cervical restorations were lost, 27.9% exhibited marginal discoloration, and 34.6% exhibited deterioration of marginal integrity after 5 years. The calculation of the clinical index was 17.4% of failures after 5 years and 32.3% after 8 years. A higher variability was found for retention loss and marginal discoloration. Hardly any secondary caries lesions were detected, even in the experiments with a follow-up time longer than 8 years. Restorations placed using rubber-dam in teeth whose dentin was roughened showed a statistically significantly higher retention rate than those placed in teeth with unprepared dentin or without rubber-dam (p < 0.05). However, enamel beveling had no influence on any of the examined variables. Significant differences were found between pairs of adhesive systems and also between pairs of classes of adhesive systems. One-step self-etching had a significantly worse clinically index than two-step self-etching and three-step etch-and-rinse (p = 0.026 and p = 0.002, respectively). The clinical performance is significantly influenced by the type of adhesive system and/or the adhesive class to which the system belongs. Whether the dentin/enamel is roughened or not and whether rubberdam isolation is used or not also significantly influenced the clinical performance. Composite resin restorations placed with two-step self-etching and three-step etch-and-rinse adhesive systems should be preferred over onestep self-etching adhesive systems, GIC-based materials, and PMRCs.

Two-year clinical evaluation of composite resins in non-carious cervical lesions

The purpose of this double-blind, randomised trial was to compare the clinical performance of a hybrid composite (Clearfil AP-X, Kuraray, Tokyo) and a nanocomposite (Filtek Z350, 3M ESPE, St. Paul, MN) over a period of 2 years in non-carious class V lesions using a modified US Public Health Service (USPHS) system. Forty-six patients with at least one pair of equivalent non-carious cervical lesions under occlusion and a mean age of 44.1 years (range 27-66 years; median 45 years) were enrolled in this study. A total of 116 restorations (58 with each material) were placed according to manufacturer's instructions by two calibrated operators. The restorations were evaluated at baseline and at 6, 12 and 24 months after placement using the USPHS criteria for retention, colour match, marginal discolouration, marginal adaptation, anatomic form, surface texture and secondary caries. Statistical analysis was conducted using the Cochran and the McNemar tests at a significance level of 5% (P < 0.05). No surface texture changes or secondary caries were detected in association with any restorations. The retention rates for Clearfil AP-X (100%) and for Filtek Z350 (91.38%) did not differ significantly (P > 0.05). Two Z350 restorations were completely lost after 2 years. No significant differences were observed in the colour match, marginal discolouration, marginal adaptation or anatomic form. There were no significant differences in the clinical performances between the materials. Both restorative materials exhibited acceptable clinical performance in class V non-carious lesions 2 years post-restoration.

One-year clinical evaluation of compomer restorations in cervical lesions of different aetiology

The aim of this one-year prospective clinical study was to evaluate the treatment results of compomer restorations (Dyract eXtral Dentsply/De Trey, Konstanz, Germany) with a single step self-etching dental adhesive (Xeno III Dentsply/De Trey, Konstanz, Germany) used for restoring class V lesions (non-carious and primary carious cervical lesions). A total number of 62 class V restorations (n = 62) were placed by one dentist in 30 patients on incisors, canines and premolars. The fillings were placed due to different indications: non-carious cervical defects (n = 32) and primary carious lesions (n = 30). The restorations were evaluated by a single-blind design, according to the Modified United States Public Health Service system 6 and 12 months following the placement. The following were evaluated: retention, marginal integrity, marginal discoloration, wear; postoperative sensitivity and secondary caries. The statistical analysis compared the ratings of each criteria between materials using the Pearson chi-square or Fisher's exact test at a level of significance of 5% (p < 0.05). Two restorations of the non-carious lesion group were lost after 6 months, and after 12 months one restoration was lost in the group of primary carious lesions. There were no statistically significant differences between restorations for all evaluated criteria in both groups. The compomer restorations in combination with a single step self-etching dental adhesive showed acceptable clinical performance in Class V lesions after one year of clinical service.

Four-year clinical evaluation of Class II nano-hybrid resin composite restorations bonded with a one-step self-etch and a two-step etch-and-rinse adhesive

Objective The objective of this prospective clinical trial was to evaluate the 4-year clinical performance of an ormocer-based nano-hybrid resin composite (Ceram X; Dentsply/DeTrey) in Class II restorations placed with a one-step self-etch (Xeno III; Dentsply/DeTrey) and two-step etch-and-rinse adhesive (Ivoclar Vivadent). Methods Seventy-eight participants received at random at least two, as similar as possible, Class II restorations of the nano-hybrid resin composite bonded with either a single step self-etch adhesive or a control 2-step etch-and-rinse adhesive. The 165 restorations were evaluated using slightly modified USPHS criteria at baseline and then yearly during 4 years. Results 162 restorations were evaluated at 4 years. Postoperative sensitivity was observed in 6 patients (3 Xeno III, 3 Exite) between 1 and 3 weeks. Eleven failed restorations (6.8%) were observed during the follow up. Seven in the one-step self-etch adhesive group (7.7%) and four in the 2-step etch-and-rinse group (5.6%). This resulted in non-significant different annual failure rates of 1.9% and 1.4%, respectively. Fracture of restoration was the main reason for failure. Conclusion The ormocer-based nano-hybrid resin composite showed a good clinical performance in Class II cavities during the 4 year evaluation. No significant difference was seen in overall clinical effectiveness between the two adhesives.

Clinical Performance of a Two-step Self-etch Adhesive with Additional Enamel Etching in Class III Cavities

This study evaluated the effect of additional enamel etching on the clinical performance of Class III composite restorations bonded with a mild two-step self-etch adhesive system in a three-year evaluation of clinical service. Using a paired-tooth study design, 38 patients received at least one pair of restorations. In each paired cavity, a mild two-step self-etch adhesive (Clearfil SE Bond) was used, either with (C-SE etch) or without additional enamel etching, using phosphoric acid (C-SE non-etch). Clearfil AP-X was used as the restorative material for all restorations. Evaluation of the restorations was performed at baseline and after six months, one year, two years and three years of clinical service in terms of retention, marginal discoloration, marginal adaptation, postoperative sensitivity and secondary caries using the modified Ryge criteria. A retention rate of 100% both for the C-SE non-etch and C-SE etch groups was noted. Significant differences were observed between the groups regarding the marginal discoloration (p = 0.001) and marginal adaptation (p = 0.002) at three years. C-SE non-etch restorations revealed more small marginal defects and superficial marginal discoloration than the C-SE etch group. Although the clinical performance of the mild two-step self-etch adhesive in Class III cavities was found acceptable after three years, additional etching of the enamel margins improved the marginal quality of this adhesive by preventing small marginal defects and superficial marginal discolorations.

Six-year Clinical Evaluation of Packable Composite Restorations

For decades, resin composites have been used with increasing frequency as posterior restorative materials, because of the demand for aesthetic restoration. This study evaluated the six-year clinical performance of Filtek P60 (3M ESPE) packable composite restorations in combination with a one-bottle etch and rinse adhesive, Single Bond (3M ESPE), in Class II restorations. A total of 47 restorations were placed in the Class II cavity preparations (27 premolars and 20 molars) of 33 patients (22 female/11 male; mean age 34) by the same operator. The restorations were evaluated by two examiners at baseline and 1, 2, 3 and 6 years according to the method developed by Ryge, which also is known as the United States Public Health Service (USPHS) criteria. The following characteristics were observed: marginal adaptation, anatomical form, surface texture, marginal discoloration, surface staining, post-operative sensitivity and secondary caries. The Chi-square and Wilcoxon signed rank test with Bonferroni adjustment were used for statistical analysis (p = 0.05). All the restorations received Alpha scores at baseline assessment, except for one restoration, which showed post-operative sensitivity. At the three-year recall examination, two patients, with a total of three restorations, were not included. From baseline to three years, only two of the 44 restorations changed from Alpha to Bravo, for numerous reasons. At the six-year recall, 44 restorations were available for examination. The majority of restorations exhibited Alpha or Bravo scores for the evaluated criteria. No significant differences were found for any of the clinical criteria (p > 0.05). Only two restorations needed to be repaired due to caries that began independently from the restorations. Three or four restorations showed slight surface staining and marginal discoloration. The clinical performance of the posterior composite restorations that were evaluated was acceptable after six years of service.