Composite Restorations In Primary Teeth Research Articles

Influence of high-irradiance light curing on the marginal integrity of composite restorations in primary teeth

BackgroundReducing the necessary time to restore primary teeth improves the cooperation of paediatric patients. This study aimed to investigate the marginal integrity of restorations prepared with a bulk-fill resin-based composite (RBC) containing additional fragmentation chain transfer (AFCT) compared to a conventional RBC when light cured with a rapid high-irradiance (3 s) and a regular (10 s) curing mode.MethodsForty class-II cavities were prepared in 40 primary molars. The molars were randomly divided into four groups based on the applied light-curing modes (regular: 10 s @ 1200 mW/cm2 or high-irradiance: 3 s @ 3000 mW/cm2) and the used restorative material (AFCT-containing bulk-fill RBC “Power Fill” or AFCT-free conventional RBC “Prime”). After thermo-mechanical loading, the marginal integrity was analysed using scanning electron microscopy. A beta regression model and pairwise comparisons were used to statistically analyse the data.ResultsThe mean marginal integrity (% ± SD) of the restorations for each group was as follows: Power Fill (10 s: 79.7 ± 15.6) (3 s: 77.6 ± 11.3), Prime (10 s: 69.7 ± 11.1) (3 s: 75.0 ± 9.7). The difference between the RBCs for the same light-curing mode was statistically significant (p ≤ 0.05). The difference between the light-curing modes for the same RBC was not statistically significant (p ˃ 0.5).ConclusionsAFCT-containing bulk-fill RBC “Power Fill” achieves similar marginal integrity when light-cured with either high-irradiance or regular light-curing modes. “Power Fill” achieves better marginal integrity than the conventional RBC “Prime” regardless of the applied light-curing mode.

Microleakage and Marginal Integrity of Surface-Coated and Laser-Pretreated Class V Composite Restorations in Primary Teeth.

Introduction: Despite the advanced formulations of resin composites, microleakage is still among the commonest causes of clinical failure of these restorations. We evaluated the effect of surface coating and laser pretreatment on the microleakage of Class V resin composite restorations in primary teeth. Methods: Sixty extracted primary molar teeth having intact lingual or facial surfaces were randomly allocated into the control, G-Coat Plus surface coating, and erbium-doped yttrium aluminum garnet (Er:YAG) laser pretreatment groups. Class V cavities were provided with the coronal and gingival margins in the dentin and enamel, respectively. Restoration of the cavities was done with Z250 resin composite and they were thermocycled, followed by immersing in 2% basic Fuchsin dye for 24 hrs. Samples underwent sectioning occlusogingivally and the microleakage was assessed under a stereomicroscope (40×). Statistical analysis was done via SPSS and Kruskal-Wallis test (α=0.05). Results: The control and G-Coat plus groups were significantly different regarding the microleakage (P<0.001), and G-Coat Plus and laser pretreatment groups (P<0.001) at both gingival and occlusal margins. However, it showed no significant difference between the laser and the control group on the enamel (P=0.063) and dentin margins (P=0.757). Microleakage at the gingival margins was significantly greater compared to the occlusal margins in the control and laser groups (P<0.001), but not in the G-Coat Plus group (P=0.051). Conclusion: G-Coat plus coating significantly reduced microleakage at dentin and enamel margins of Class V composite restorations in primary teeth, in comparison with other groups of the study. Also, dentin margins showed more significant amounts of microleakage versus enamel margins in all groups, except for the G-Coat Plus group.

Nondestructive evaluation of microleakage in restored primary teeth using CP-OCT.

Although the demand for esthetic filling of primary teeth with resin composite is increasing, there is no enough data on the adhesive performance of composite restorations in primary teeth. Despite the improvements in resin composites, interfacial gap is still a disadvantage as it may cause marginal staining, secondary caries, and restoration failure. Previous studies have validated the efficiency of optical coherence tomography (OCT) in the evaluation of adhesive interface in permanent teeth, but not in primary teeth. The aim of this study was to assess microleakage upon composite restorations in primary teeth using cross-polarization OCT (CP-OCT). Cylindrical class-V cavities were prepared in extracted human primary second molars and divided into four groups randomly. In groups 1 and 2, cavities were restored using Tetric N-Universal adhesive in the self-etch mode followed by IPS Impress Direct Composite and Ceram.x One Universal composite, respectively. In groups 3 and 4, one-step self-etch Prime and Bond Elect adhesive was used followed by ID composite and CX composite in groups 3 and 4, respectively. The specimens were then immersed in a contrasting solution followed by interfacial microleakage examination under CP-OCT. The recorded images were analyzed to quantify the mean gap percentages. All tested groups showed variable degree of interfacial microleakage under composite restorations. Two-way ANOVA showed the composite factor was significantly influencing the results, unlike the adhesive. Group 1 and 2 had the lowest and highest mean gap percentage, respectively, which were significantly different from the other groups. Groups 3 and 4 were not significantly different. Based on the current finding, a polymeric restorative system from the same manufacturer reduces the risk of interfacial microleakage in primary teeth.

Comparison of Partial and Complete Caries Excavation in Permanent Teeth: An 18 Months Follow-up

Objective: To compare performance and survival of composite restorations in primary teeth using partial caries removal (PCR) versus complete caries removal (CCR). Methodology: In this trial, 70 permanent molars having deep caries lesions were selected and divided equally into CCR and PCR groups. The study duration was Jan-2018 to Jan-2020. In CCR group, complete dentin removal was done and confirmed by applying dentin detector dye for 10 seconds. In PCR group, visual &amp; tactile criteria were followed for dentin removal. After dentin removal all cavities were filled using RMGIC cement resin. Follow-up was done at 06, 12 and 18 months. Results: Mean age in CCR group was 23.4+5.5 years and 25.6+4.9 years in PCR group. Male patients were 19 and 17 in CCR and PCR groups respectively (p= 0.59). Regarding lesion type, 25 patients in CCR were having occlusal and 5 having Occluso-proximal lesion. In PCR group, 27 teeth were diagnosed with occlusal lesion and 3 with occluso-proximal lesion (p=0.44). At 18 months’ follow-up, success rate was 100% in CCR group and 93.3% in PCR group (p=0.49). Pulp exposure occurred in 23.3% procedures in CCR group and none in PCR group. Conclusion: Partial caries removal has nearly similar success rates as that of complete caries removal and is associated with significantly less pulp exposure rate as compared to CCR. Keywords: Deep carious lesions, Partial caries removal, Complete caries removal, Randomized clinical trial

Margin Integrity of Bulk-Fill Composite Restorations in Primary Teeth.

This in vitro study examined the margin integrity of sculptable and flowable bulk-fill resin composites in Class II cavities of primary molars. Standardized Class II cavities were prepared in human primary molars and restored with the following resin composite materials after application of a universal adhesive: a sculptable bulk-fill composite (Tetric EvoCeram Bulk Fill (TEC) or Admira Fusion x-tra (AFX)), a flowable bulk-fill composite (Venus Bulk Fill (VBF) or SDR), or a conventional composite (Filtek Supreme XTE (FS)). The bulk-fill materials were applied in 4 mm layers, while the conventional composite was applied in either 2 mm (FS2, positive control) or 4 mm layers (FS4, negative control). The specimens were exposed to thermo-mechanical loading (TML) in a computer-controlled masticator. A quantitative margin analysis was performed both before and after TML using scanning electron microscopy, and the percentage of continuous margins (margin integrity) was statistically analyzed (α = 0.05). All composites showed a significant decline in margin integrity after TML. AFX exhibited the significantly highest margin integrity of all materials after TML (97.5 ± 2.3%), followed by FS2 (79.2 ± 10.8%), TEC (73.0 ± 9.1%), and FS4 (71.3 ± 14.6%). SDR (43.6 ± 22.3%) and VBF (25.0 ± 8.5%) revealed the lowest margin integrity. In conclusion, the tested sculptable bulk-fill materials show similar or better margin integrity in primary molars than the conventional resin composite placed in 2 mm increments.

Effect of photodynamic therapy on microleakage of class V composite restorations in primary teeth.

Photodynamic therapy (PDT) is a treatment by which, light sensitive chemicals are activated at a specific wavelength, generating reactive oxygen species which can be antimicrobial and assist in disinfection. However, the oxygen radicals may interfere with the bonding process. The purpose of this study was to assess the effect of PDT with different photosensitizers on microleakage of composite restorations. Seventhy-two primary teeth with sound labial/buccal and lingual surfaces were collected for this study. The teeth were randomly divided into four groups of control, PDT with indocyanine green, PDT with methylene blue, and PDT with toluidine blue. Next, the cavities were restored with composite resin. The specimens were stained with 0.5 % Fuchsine and sectioned. The specimens were observed under a microscope to determine the microleakage score. The microleakage was compared between the groups and between the occlusal and cervical walls in each group. Data were analyzed using SPSS version 25. According to the kruskal-wallis test, no significant difference was observed in microleakage between the groups in the occlusal wall (p = 0.859). However, there was a significant difference in the cervical wall between the control and toluidine blue (p = 0.019), and the control and methylene blue (p = 0.008) groups. The Wilcoxon test showed a significant difference in microleakage (p < 0.05) between the occlusal and cervical walls within each group. PDT may be used in cavities with enamel margins to decrease the microbial load and prevent secondary caries. PDT is not recommended for cavities with cementum margins. Alternatively, it can be performed with indocyanine green as photosensitizer in such cases.

Repair of defective resin composite restorations in primary teeth: current trends in Brazilian undergraduate Dental programs

Este estudo investigou o ensino do reparo de restauração direta de resina composta em dentes decíduos nos cursos de graduação em Odontologia no Brasil. Um questionário referente a este tópico foi desenvolvido e enviado por e-mail para 205 cursos de Odontologia entre maio e setembro de 2019. Os dados obtidos foram analisados descritivamente. A taxa de resposta foi de 43,4% e dos cursos respondentes, 82% incluíram esse tópico em seu currículo. As duas razões mais comumente relatadas para o ensino do reparo de restaurações de resina composta foram preservação da estrutura dentária (95,9%) e redução do risco de complicações pulpares (71,2%). No que diz respeito ao protocolo para reparo, poucos instituições (24,7%) ensinaram o desgaste mecânico da porção da resina a ser reparada com pontas diamantadas. Por outro lado, o condicionamento com ácido fosfórico da superfície preparada foi recomendado por 87,7% das instituições e 76,7% indicaram aplicação de adesivo na superfície preparada. O material mais comumente ensinado para reparo foi resina composta convencional. O ensino do reparo de restaurações de resina composta com falhas foi estabelecido dentro do currículo dos cursos de graduação em Odontologia no Brasil. No entanto, não há consenso sobre o protocolo clínico para reparo.

Choosing the Criteria for Clinical Evaluation of Composite Restorations: An Analysis of Impact on Reliabilty and Treatment Decision

Objective: To assess the reproducibility of two clinical criteria for the evaluation of restorations in primary teeth and the impact on treatment decision. Material and Methods: A cross-sectional study was performed selecting 71 resin-based composite restorations placed in primary molars of children who had sought dental treatment at a dental school. Two trained examiners evaluated independently the restorations using modified FDI and USPHS criteria. All restorations were assessed separately with each system in random order to avoid memory bias. Kappa statistics were used to determine inter-examiner reliability considering each parameter of both criteria and score final about treatment decision. McNemar test was used to compare the treatment decision with two criteria. The significance level was set at 5%. Results: Kappa values ranged from 0.28 to 0.93 with USPHS and 0.28 to 0.88 with FDI, considering each parameter separately. Inter-examiner agreement for treatment decision was excellent for both criteria (Kappa: 0.85-0.90). For clinical decision-making, no difference between criteria was found, irrespective of examiner. Conclusion: Low inter-examiner agreement for evaluation of each parameter of USPHS and FDI criteria does not reflect on reproducibility for treatment decision. Both criteria may be suitable for evaluation of composite restorations in primary teeth.

Performance of resin composite restorations in the primary dentition: a retrospective university-based study.

Limited data is available on variables influencing the survival of composite restorations in primary teeth. This retrospective university-based study assessed the survival and risk factors associated with failures of resin composite restorations performed in primary teeth. The sample was composed of 961 restorations from records of 337 patients (178 girls and 159 boys) attended in a university dental clinic. The restorations' longevity up to 48months of follow-up was assessed using the Kaplan-Meier survival test. Multivariate Cox regression analysis with shared frailty was used to evaluate the factors associated with failures (P<0.05). Mean survival time was 41.5months (95% CI: 39.7-43.3), with 70.6% of the restorations surviving after 48months of evaluation. The overall annual failure rate up to 48months follow-up was 8.3%. Restorations placed in lower arch had lower survival rate than those in upper arch (HR: 1.82, 95% CI: 1.02-3.28). Restorations involving two or more surfaces had more risk offailure than restorations placed in cavities involving only one surface (HR: 2.55 95% CI: 1.34- 4.83). Girls had less risk of failure in their restorations (HR: 0.43, 95% CI: 0.19-0.96). Individual and dental variables such as gender, arch type and number of restored surfaces were associated with failure of composite restorations performed in children under daily life clinical environment.

Comparative microtensile bond strength of universal adhesives in primary teeth

IntroductionAlmost 50 % of carious lesions in primary teeth remain untreated either due to limited compliance, or due to technique sensitivity of multi-step bonding systems or due to doubts about durability of resin composite restorations in primary teeth. Universal self-etch adhesives have been introduced in order to overcome the material- and technique-related problems because of their easy handling and their functional monomers, which have been reported to enhance bonding performance. Objective of the study was to compare 3 universal adhesives to a self-etch adhesive used as control.Material and methodsMid-coronal dentin was exposed in 20 primary molars, adhesives were applied followed by composite resin build-up: 1. Prime & Bond NT [PBNT] (control); 2. One Coat 7 Universal [OC7U]; 3. Futurabond U [FU]; 4. Prime & Bond active [PBA]. Beams were cut from specimen slabs and subjected to µ-tensile bond strength and mode of failure evaluation.ResultsFollowing bond strength values were re — corded (in MPa [SD]): PBNT (48.2 [14.3]), OC7U (69.7 [17]), FU (71.3 [17.7]), PBA (77.9 [23.5]). Sta — tistically significant differences were computed for all test groups compared to PBNT (p < 0.001, Bonferroni). PBA exhibited significantly higher values than OC7U (p < 0.05, Bonferroni). OC7U showed the lowest percentage of adhesive failures.ConclusionAll tested universal adhesives exhibited higher bond strength values in primary tooth dentin, in comparison to the traditional self-etch approach and can therefore be suggested as an alternative option in adhesive restorations in paediatric dentistry.

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.

Risk factors for secondary caries in direct composite restorations in primary teeth.

Secondary caries or caries adjacent to restorations is the most frequent reason for replacement of dental restorations. Though, limited data is available on variables influencing the development of secondary caries in primary teeth. To investigate risk factors for the development of secondary caries adjacent to direct composite restorations in primary teeth. For this retrospective study, data of 2417 composite restorations, which were placed due to primary carious lesions, were considered. A total of 212 restorations failed due to secondary caries within a maximum observation period of 8 years. A control group was randomly selected. Mann-Whitney U-test, binomial logistic regression with backward elimination and Cox regression with frailty model were performed (P < 0.05). The overall caries experience amounted to 6.3 dmft and 13.3 dmfs. 72.5% of restorations failed within the first 2 years. Older children and children from families with a higher socio-economic status showed a lower risk for secondary caries. Further, the dentist and the adhesive had a significant influence on the longevity. Posterior restorations had a higher risk to fail in comparison with anterior restorations. Within the limitation of this study, it is concluded that the development of secondary caries is influenced by several factors. Nevertheless, the secondary caries rate was found to be relatively low in this high-risk population.

Survival characteristics of composite restorations in primary teeth.

This retrospective study analyzed restoration survival of composite fillings in children with at high caries risk in relation to age, sex, operator, tooth type, filling extension, and material used. Among 667 children treated in 2004-2012 in a university setting without sedation or general anesthesia, 2388 composite fillings were included. Relevant data from regular recall intervals were retrieved from patients' records. Either total-etch or a self-etch adhesive combined with flowable and/or (nano)hybrid composite was used. The Kaplan-Meier estimator and Cox proportional hazard analysis with backward elimination model were applied for survival analysis. For the observation period of 8years (mean 1.7years), the cumulative failure rate was 17.2% with annual failure rates of 10.0%. In 8.8% of the cases, fillings failed due to secondary caries. In 8.3% technical failure due to total filling loss, loosening, marginal gaps, or tooth fracture occurred. Tooth type, filling extension, age, operator, dental dam, and type of adhesive were significant for survival (p < 0.05). Filling survival was comparably lower to composite restorations observed in prospective clinical studies on permanent teeth and other tooth-colored restoratives used in primary teeth. Due to the very high caries risk and young age of the population, frequent loss due to secondary caries was observed. With respect to the high caries risk, composite restorations can be used to treat carious primary teeth, though a strict caries prevention regimen should be followed to minimize restoration failure. Filling loss of composites in the primary dentition is associated with secondary caries on the long term.

Effects of resin luting agents and 1% NaOCl on the marginal fit of indirect composite restorations in primary teeth

ObjectiveThe purpose of this study was to provide information regarding the marginal adaptation of composite resin onlays in primary teeth previously treated with 1% sodium hypochlorite (NaOCl) (pulp irrigant) using two different resin luting agents. Material and MethodsForty extracted sound primary molars had their crowns prepared in a standardized machine and were randomly divided into 4 groups (n=10): G1 (1% NaOCl irrigation+EnForce); G2 (EnForce); G3 (1% NaOCl irrigation+Rely X); G4 (Rely X). The onlays were made with Z250 composite resin on plaster models. After luting, the tooth/restoration set was stored in 100% relative humidity at 37ºC for 24 h and finished with Soflex discs. Caries Detector solution was applied at the tooth/restoration interface for 5 s. The specimens were washed and four digital photos of each tooth were then taken. The extents of the gaps were measured with Image Tool 3.0 software. The percentage data were submitted to a Kruskal-Wallis test (α=0.05). The Relative Risk test analyzed the chance of a gap presence correlated to each group. ResultsThere were no statistically significant differences (p>0.05) among the groups. The relative risk test revealed that some groups were more apt to have a presence of gaps than others. ConclusionNeither the 1% NaOCl treatment nor the resin luting agents caused any alterations in the dental substrate that could have influenced the marginal adaptation of composite onlays in primary teeth.

Effect of Two Disinfecting Agents on the Microleakage of Resin-Based Composite Restorations in Primary Teeth

Introduction: Disinfection of the cavity preparation after caries excavation can lead to the elimination of bacterial remnants that can be responsible for recurrent caries, postoperative sensitivity, and failure of the restoration. The purpose of this study was to evaluate the effects of two disinfectants on microleakage of composite restorations in primary teeth. Methods:In this experimental study, 40 extracted primary canine teeth without caries were randomly divided into four groups of 10 teeth, namely control group (1), pretreatment group with chlorhexidine 2% (2), pretreatment group with sodium hypochlorite 2/5% (3), and pretreatment group with sodium hypochlorite 5% (4). In addition, class V cavities were prepared on all teeth. The cavities were then restored with composite. The teeth were thermocycled and immersed in 2% methylene blue for 24h. Microleakage was assessed by dye penetration in the incisal and gingival surface of the teeth using stereomicroscope. Data were analyzed in SPSS software (version 18) through Kruskal-Wallis and Mann-Whitney U tests. Results: According to the results, the difference among groups was significant (P<0/001). The pair-wise comparison showed significant differences between groups 1 and 2; however, no difference was observed between pretreatment groups with sodium hypochlorite 5% and 2/5%. Furthermore, no statistically significant difference was found in terms of incisal and gingival surfaces. Conclusion:Pretreatment with chlorhexidine and sodium hypochlorite increased microleakage in composite restorations in primary teeth.

Long term cost of restorative therapy using different materials.

The cost of restorative treatment over a 60-yr period has been assessed, based on the present cost of restorations at the time of insertion and the median longevity of the different types of restorations. Such theoretic extrapolations indicate that the long term cost of two- or three-surface gold and composite restorations in permanent teeth is similar and about 4 times more than for amalgam therapy. The cost of one-surface composite restorations would be about 2-2.5 times that of amalgam restorations, while small gold restorations would cost 5 times more than amalgam restorations. Due to the short median longevity of composite restorations in primary teeth, a 5 times higher cost can be estimated compared to amalgam therapy over a 10-yr period.