Clinical Performance Of Composite Restorations Research Articles

Resin Composites in Posterior Teeth: Clinical Performance and Direct Restorative Techniques.

Resin composites are the most versatile restorative materials used in dentistry and the first choice for restoring posterior teeth. This article reviews aspects that influence the clinical performance of composite restorations and addresses clinically relevant issues regarding different direct techniques for restoring posterior teeth that could be performed in varied clinical situations. The article discusses the results of long-term clinical trials with resin composites and the materials available in the market for posterior restorations. The importance of photoactivation is presented, including aspects concerning the improvement of the efficiency of light-curing procedures. With regard to the restorative techniques, the article addresses key elements and occlusion levels for restoring Class I and Class II cavities, in addition to restorative strategies using different shades/opacities of resin composites in incremental techniques, restorations using bulk-fill composites, and shade-matching composites.

Evaluation of composite restorations in primary molars subjected to selective caries removal associated with antimicrobial photodynamic therapy: A randomized controlled trial.

Antimicrobial photodynamic therapy (aPDT) has been used as an adjunct treatment of deep caries lesions; however, studies on the effects of aPDT on the longevity of restorations are still limited. To evaluate the clinical performance of composite restorations in primary molars subjected to selective caries removal (SCR) associated with aPDT. A randomized clinical trial was designed. Primary molars of patients (mean age 6.15years) with deep caries lesions without signs and symptoms of pulpal involvement were selected. A total of 64 teeth were randomly divided into groups G1 (SCR, 32 teeth) and G2 (SCR+aPDT, 32 teeth) for treatment, restored with composite, and evaluated after a week (T0 ), 6months (T1 ), and 12months (T2 ) according to the criteria of FDI. Groups were compared using the Rao-Scott chi-squared test and the logistic regression analysis for complex designs to account for multiple observations per subject (alpha=0.05). From all FDI criteria evaluated, the marginal adaptation for the SCR+aPDT group was significantly better in comparison with the SCR group at T0 and T2 in the logistic regression analysis (T0: OR=0.151; 95% CI=0.03-0.068, P=.015; and T2: OR=0.201; 95% CI=0.05-0.79, P=.022). The marginal adaptation of primary molar resin restorations was positively affected by aPDT after 12months of follow-up.

A three-year randomized clinical trial evaluating direct posterior composite restorations placed with three self-etch adhesives

Aim To compare the clinical performance of composite restorations placed with a universal adhesive, one-step and two-step self-etch adhesives in class I and II posterior cavities. Materials and methods In this in vivo study, 46 volunteers presenting with at least three carious lesions were included. Each participant received the three restorative systems: universal adhesive/nanofilled composite (Scotchbond Universal/Filtek Z350 XT: SBU/FZXT), one-step self-etch adhesive/microhybrid composite (G-aenial bond/G-aenial Posterior: GB/GP) and the two-step self-etch adhesive/nanohybrid composite (OptiBond XTR/Herculite Ultra: OBX/HU). The adhesives were all placed in self-etch mode. In total, 138 restorations were evaluated at baseline and at 6,12 and 36 months using the modified United States Public Health Service criteria. Data were analysed using Kruskal–Wallis, Mann–Whitney U, Friedman and Wilcoxon non-parametric tests (p < .05). Ninety-one restorations were evaluated at 36 months. Results Seven restorations, three SBU/FZXT, three GB/GP and one OBX/HU failed during this study. The reasons for failure were marginal fracture and secondary caries. SBU/FZXT restorations showed significant marginal deterioration in all parameters. Overall success rates were: 93.5% (SBU/FZXT), 96.6% (GB/GP) and 96.8% (OBX/HU). Conclusions After three years, the three restorative systems have comparable clinical effectiveness and success rates, except for the marginal integrity, that was suboptimal for both the SBU/FZXT and GB/GP restorations in comparison to the OBX/HU restorations.

The effect of chlorhexidine primer application on the clinical performance of composite restorations: a literature review

To discuss the effectiveness of chlorhexidine (CHX) used as therapeutic dentin primer in adhesively bonded composite restorations. OVERVIEW: An electronic search in MEDLINE database, accessed through PubMed was conducted. No restrictions of languages and date of publication were made. The following key words were used: "chlorhexidine", "composite" and "composite resins." Clinical studies in which CHX was used during bonding procedures were included in this review. Six studies met the inclusion criteria. Of these, five studies were carried out on noncarious cervical lesions (NCCL). Only one study was carried out on class II preparation of permanent molars. In all studies, either etch-and-rinse and self-etch adhesive systems were used during bonding procedures. On the basis of the reviewed clinical trials, it can be concluded that CHX primer application does not seem to influence clinical outcome of composite restorations. CLINICAL SIGNIFICANCE: Current scientific evidence cannot neither strongly recommend nor discourage the application of CHX as therapeutic primer in composite restorations. Studies with longer follow-up periods with adhesive restorations placed on dentin after caries removal, rather than only on NCCL, are desirable to further investigate the therapeutic effect of CHX during bonding procedures.

Does the Type of Solvent in Dental Adhesives Influence the Clinical Performance of Composite Restorations Placed in Noncarious Cervical Lesions? A Systematic Review and Meta-analysis.

According to the clinical and scientific evidence presented in this systematic review and meta-analysis, dental adhesives containing either organic solvent (acetone or alcohol) can be used to achieve similar clinical performance and longevity of composite restorations. Objectives: This systematic review and meta-analysis compared the clinical performance and survival rates of composite restorations placed in noncarious cervical lesions (NCCLs) using dental adhesives containing acetone or alcohol-based solvents.Methods and Materials: PubMed, Scopus, Web of Science, Virtual Health Library (VHL) LILACS, Cochrane Library, OpenGrey, Clinical Trials, and Rebec were searched. MeSH terms, supplementary concepts, synonyms, and free keywords were used in the search strategy. All references were crosschecked by two independent investigators following the PICOS strategy (population, NCCLs; intervention, acetone-based bonding agent; comparison, alcohol-based bonding agent; outcome, clinical evaluation parameters and survival rates; study design, randomized controlled clinical trials). Cochrane Collaboration's tool was used to assess risk of bias, and two distinct meta-analyses were performed using the RevMan software. The prevalence of success and the total number of restorations for each group (acetone- or alcohol-based) were used to calculate the risk difference at a confidence interval of 95%. Random-effects models were applied, and heterogeneity was assessed using the I2 index in the pooled and subgrouped meta-analyses. The certainty of evidence was evaluated through the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach.Results: A total of 7876 studies were retrieved, from which 27 studies were selected for the systematic review. Ten studies were classified as "low risk of bias" and included in the meta-analyses. Overall heterogeneity was not significant (I2 = 0.00%). The clinical performance of restorations placed with bonding agents based on both solvents for each of the available parameters presented no statistical significance for any of the meta-analyses (p>0.05).Conclusion: Scientific evidence suggests composite restorations placed with acetone or alcohol-based dental adhesives present similar clinical performance and survival rates in NCCLs.

Influence of Neuroticism on the Prognosis of Nanoceramic and Microhybrid Composite Restoration: A Comparative 1-year Clinical Study.

ABSTRACTAim:This study aimed to compare the clinical performance of nanoceramic and microhybrid-based composite restorations in adult patients with different personality traits.Materials and Methods:Patients in accordance with the inclusion and exclusion criteria were asked to complete the BFI (Big Five Inventory) questionnaire. Of a total of 323 patients, 124 (67 males and 57 females) patients were categorized into agreeableness and neuroticism traits and were included in the study. The patients were randomly divided into two subgroups: SG I A (n = 31) and II A (n = 31) for microhybrid composite (Spectrum TPH 3, Dentsply/DeTrey, Konstanz, Germany), SG I B (n = 31) and II B (n = 32) for nanoceramic composite restorations (Ceram X mono, Dentsply/DeTrey, Germany). At baseline, 6 and 12 months, the restorations were evaluated using the Modified USPHS (United States Public Health Service) evaluation criteria. The Pearson chi-square and the Fisher’s exact test were used to assess the difference between the personality traits and restorative material groups where a probability value of P < 0.05 was considered to be statistically significant.Result:Most of the restorations scored alfa (A), whereas very few scored bravo (B) in all the subgroups. However, there were no charlie (C) or delta (D) scores. Overall, Spectrum TPH and Ceram x mono displayed superior performances in retention and postoperative sensitivity than all the other clinical parameters. Furthermore, Ceram x mono restorations showed more surface roughness than Spectrum TPH. No statistical differences in the restoration performance were found between both personalities and restorative material types.Conclusion:Although neuroticism has an effect on various health outcomes, its impact on the clinical performance of composite restorations during the follow-up period was not observed. In addition, there was no difference between the performance of nanohybrid and microhybrid composite.

Clinical Evaluation of Resin Composite Restorations Placed by Dental Students in Shahid Sadoughi University of Medical Science

Introduction: To perform a proper restoration, we are required to observe the principles in a framework of the restorative dentistry. Regardless of these criteria, rapid repair failure occurs. The purpose of this study was to evaluate the clinical performance of composite restorations placed by dental students in Shahid Sadoughi University of Medical Science in 2014-2016. Methods: In this cross-sectional study, 200 restorations were performed in the Faculty of Yazd Dentistry in the years 2014-2016 through a clinical examination and completion of the questionnaire by the patients were examined. The results were evaluated by descriptive statistics and Chi-squared / Fisher's exact test using SPSS Inc., Chicago, IL; Version 16. Results: In general, 5% of the restoration were completely defective and considered as successful repairs. 12% of the restoration failed in the clinical examination. The main reason for the failure of these restorations was the secondary caries with irreversible pulpitis. Finally, 83% of the restoration had defects, but these teeth were considered as functionally present. Conclusion: Dental students are able to place resin composite restorations in teeth with an acceptable annual failure (P&gt;.05).

Assessment of tooth-composite bond vs. clinical performance of composite restorations

Assessment of tooth-composite bond vs. clinical performance of composite restorations

Clinical Performance of Composite Restorations with Resin-modified Glass Ionomer Lining in Root Surface Carious Lesions.

The purpose of this study was to evaluate the clinical performance of composite restorations in root surface carious lesions with or without resin-modified glass ionomer lining. The sample consisted of 25 female and 14 male patients. A maximum of four lesions were included for each patient. After caries removal, the depth, length, and width of the cavity were measured. Lesions in the same patient were randomly divided into two groups, and the dentin surfaces were either lined with resin-modified glass ionomer liner (Glass Liner II) or left as they were. Self-etch adhesive (All Bond SE) was applied and cured for 20 seconds. All cavities were restored with nanohybrid anterior composite resin (Clearfil Majesty Esthetic). Two experienced clinicians evaluated the marginal adaptation (retention) rate, anatomic form, secondary caries, sensitivity, and marginal staining of restorations at the end of the first week and at six, 12, and 18 months posttreatment. The data were statistically analyzed using the Chi-square and two-way repeated measures tests. At the end of 18 months, a total of five lined and three unlined restorations were lost. There was no significant relationship between marginal adaptation and cavity lining at six, 12, and 18 months (p>0.05). Although marginal stainings of restorations were mostly localized, the total number of localized or generalized discolored restorations increased with time (p<0.001). There was a statistically significant relationship between marginal staining and smoking (p>0.05). There was no significant relationship between marginal staining and frequency of toothbrushing at six, 12, and 18 months (p=0.286, p=0.098, and p=0.408, respectively). Within the limitations of this study, both restorative applications were accepted as clinically appropriate.

Randomized Clinical Trial of Composite Restorations in Primary Teeth: Effect of Adhesive System after Three Years

The purpose of this study was to assess the clinical performance of composite restorations placed with different adhesive systems in primary teeth. In 32 patients, 128 composite restorations were placed using a split-mouth design as follows (4 groups/patient): three-step etch-and-rinse (Group 1), two-step etch-and-rinse (Group 2), two-step self-etch (Group 3), and one-step self-etch (Group 4). The restorations were clinically evaluated at baseline and at 6, 18, and 36 months according to the FDI criteria. There was no significant difference between the adhesive systems in retention of the restorations (p > 0.05). Over time, there was a statistically significant decrease in marginal adaptation in all groups, whereas surface and marginal staining significantly increased in Groups 3 and 4 (p < 0.05). The etch-and-rinse adhesive systems resulted in better marginal adaptation than the self-etch adhesive systems (p < 0.05). It was concluded that preetching of the primary enamel might help improve the clinical performance of the self-etch adhesive systems in primary teeth.

Five-year clinical performance of the dentine Deproteinization Technique in non-carious cervical lesions

ObjectiveThe aim of this study was to evaluate the 5-year clinical performance of composite restorations of non-carious cervical lesions (NCCL) using a total-etch adhesive system with or without collagen removal with 10% sodium hypochlorite (NaOCl). MethodsIn this study randomized controlled split-mouth clinical trial, one-hundred and thirty-eight NCCL were restored into 30 patients. Each patient received at least one pair of composite restorations (Filtek A110/3M ESPE), bonded either with 2 techniques: Conventional Technique – acid etching with 37% phosphoric acid+Prime & Bond NT (Denstply DeTrey); Deproteinization Technique – acid etching with 37% phosphoric acid+10% NaOCl for 1min+Prime & Bond NT. The two techniques were evaluated using the United States Public Health Service (USPHS) criteria at baseline, 18 months, 3 and 5 years. After five years, one-hundred and six restorations were evaluated in 24 patients. Data were analyzed using the Chi-Square test (p<0.05). ResultsThere were no statistically significant differences between the two techniques regarding the evaluated parameters (p>0.05). ConclusionAfter 5 years, the application of 10% NaOCl deproteinization on etched dentine did not affect the clinical performance of composite restorations placed in NCCL when compared to the conventional total-etch technique. Clinical significanceClinical studies evaluating the performance of the Deproteinization Technique are scarce. In this study, this technique showed similar clinical performance at the end of 5 years when compared to a conventional total-etch technique.

Three-year clinical performance of composite restorations placed by undergraduate dental students

This retrospective study evaluated the clinical performance and the reasons for failure of anterior and posterior composite restorations placed by undergraduate dental students over a 3-year period. All cavities were restored using Prime & Bond 2.1 and TPH (Dentsply), according to the manufacturer's indications. One hundred and two patients who had received composite restorations by third and forth year undergraduate students were recalled and examined to analyze the quality of the restorations. The restorations were evaluated using the modified USPHS system. Two hundred and fifty-six composite restorations, 170 in anterior teeth and 86 in posterior teeth, were evaluated. Eighty-five percent of the restorations were considered satisfactory after 3 years. Class II and class IV restorations presented the highest prevalence of failure. Loss of the restoration and deficient marginal adaptation were the main causes of failure. No restoration failed due to secondary caries. Most restorations placed by dental students were considered satisfactory after long-term evaluation. Failure was more prevalent in larger restorations and was not associated with secondary caries.

Split mouth randomized controlled clinical trial of beveled cavity preparations in primary molars: an 18-Month follow up

Objectives This split-mouth, double-blind, randomized controlled study evaluated the clinical performance of composite restorations in Class I beveled margin cavity preparations in primary molars. Methods A total of 94 Class I cavity preparations were performed in the carious primary molars of 32 children aged 4–10 years. Two cavity designs were used: conventional conservative preparation (G1) and modified preparation with cavosurface bevel (G2). All teeth were restored using TPH Spectrum™. The restorations were evaluated by two calibrated investigators at baseline, 6, 12 and 18 months using slight modified USPH criteria. The visible plaque index and fiber optic transilumination (FOTI) were also used. The data were statistically evaluated using Wilcoxon and Friedman tests ( p < 0.05). The rank correlations between secondary caries, visible plaque index and FOTI were obtained using Pearson correlation ( p < 0.01). Results Of the 94 restorations performed and evaluated at baseline, 76 restorations were available after 18 months. Seventy-three restorations were considered as clinical success, 10 were censored for drop out reasons and 5 were lost by natural exfoliation. Four restorations failed by secondary caries and two failed by marginal adaptation discrepancies. For all evaluation there was difference between the baseline, 6, 12 and 18 months ( p < 0.05) but there were no statistically significant difference in G1 and G2 for any criteria evaluated ( p > 0.05) at any period of the study. The visible plaque index was correlated to secondary caries. Conclusion Bevel cavity design preparations did not improve the success of composite restorations in primary molars over 18 months.

2-year Clinical Evaluation of Sodium Hypochlorite Treatment in the Restoration of Non-carious Cervical Lesions: A Pilot Study

This pilot study evaluated the effect of removing acid-etch-exposed dentin collagen on the clinical performance of composite restorations of noncarious cervical lesions placed using 2 different adhesive systems. Fifty-six restorations were placed in 14 subjects, each subject receiving at least 4 restorations. No cavity preparation or mechanical retention form was used. The variables tested were: 1) dentin treatment prior to application of the adhesive (acid-etch only vs acid-etch and collagen removal) and 2) type of adhesive (acetone- vs ethanol-based). For the acid-etch only groups, enamel and dentin were etched with 37% phosphoric acid for 15 seconds, rinsed and blot dried. Prime & Bond 2.1 (Dentsply Caulk) or Single Bond (3M ESPE) was applied and light-cured according to the manufacturer's instructions. For the acid-etch and collagen removal groups, the enamel and dentin were etched and rinsed in the same manner and a 10% sodium hypochlorite (NaOCl) solution was applied for 60 seconds and rinsed before adhesive application. Filtek Z-250 (3M ESPE) was applied to all specimens and light-cured according to the manufacturer's instructions, and the restorations were finished and polished immediately. The restorations were evaluated for pre- and post-operative sensitivity, retention, marginal staining and secondary caries at baseline, 12 and 24 months after placement, using modified USPHS criteria. Data were analyzed using the Kruskal-Wallis and Wilcoxon statistical tests (p=0.05). At 24 months, the retention rates for Prime & Bond 2.1 with and without NaOCl pretreatment were 80% and 63%, respectively. The corresponding retention rates for Single Bond were 70% and 90%. Marginal staining was minimal. Statistical analyses revealed no significant differences at any time interval between groups for retention or marginal staining. No post-operative sensitivity or secondary caries was detected during the study.

Retrospective Study of Five-year Clinical Performance of Direct Composite Restorations Using a Self-etching Primer Adhesive System

This study was conducted to assess the five-year clinical performance of composite restorations using a self-etching primer adhesive system, Clearfil Liner Bond II. Restorations were rated using the following scale: A--Good; B--Clinically acceptable; C--Clinically unacceptable; or D--Already replaced. The ratings were analyzed using Freedman's test (p=0.01) and Steel-Dwass test (p=0.05). A total of 83 restorations from 36 patients were identified from treatment records. Twenty-six restorations (31.3%) presented A rating and 36 restorations (43.4%) were clinically acceptable (B rating), while five (6.0%) received C rating and 16 (19.3%) had already been replaced (D rating). The mean survival rate of serviceable restorations (i.e., combined A and B ratings) after five years was 74.7%. It was found that cavity form, including cavity size, and occlusal contact seemed to influence longevity.