Direct Adhesive Restorations Research Articles

Uncommon Restoration on Nonvital Premolar with Porcelain Inlay: A Case Report with Five-year Follow-up

Introduction: In fixed prosthodontics, the old paradigm on endodontically treated teeth leads to more fragilization due to the architectural preparation needed for a full coverage crown. Endodontically treated premolars with class II defects are common in daily practice. When only one proximal surface is affected, direct adhesive restorations are the most used. The use of porcelain inlay is quite uncommon in this situation despite its advantages. Case Presentation: This article illustrates a clinical case of a 31-year-old female with healthy teeth except for the non-vital first maxillary premolar, presenting a class II mesio-occlusal cavity. The occlusion exam revealed functional anterior guidance and canine guidance on both sides during lateral mandibular translation. Based on mini-invasive dentistry principles, the decision was to restore the nonvital bicuspid with a porcelain inlay. Although scientific literature did not report restoration of the premolars with a ceramic inlay in clinical practice, this option was retained. The realization of a porcelain inlay was described step by step. A follow-up up to 5 years was done. Results: The iatrogenic tooth fragilization was avoided by a mini-invasive approach. At the end of this follow-up period, there was no complication or complaint. The patient was satisfied with the final result. Conclusion: Porcelain inlay seems to be a good option to restore the occluso-proximal cavity on nonvital premolars in a context of a favourable occlusion. Porcelain inlay is respectful of the principles of minimally invasive dentistry and allows to achieve the objectives of function, aesthetics and biocompatibility. However, clinical studies should be conducted to investigate the longevity of porcelain inlay on ETPs.

Direct adhesive reconstructions for restoration of posterior teeth with erosive tooth wear

The restorative treatment of dental hard tissue loss, e.g., due to erosion, and the rehabilitation of the original vertical bite dimension confronts the dentist with problems when implementing the therapy. Traditionally, this therapy is conducted with laboratory-fabricated workpieces made of ceramics which usually require a preparation of the remaining tooth substance and also causes high costs for the patient. Therefore, alternative methods should be considered. This article presents the use of direct adhesive composite restorations as a way of reconstructing a dentition severely altered by erosion. To reconstruct the occlusal surfaces, transfer splints are used that are made on the basis of individual wax-up models. The procedure described is a well-researched and proven method for restoring teeth with erosion-related loss of hard tooth substance. As with all new procedures, there will be a certain learning curve for the practical dentist after which high-quality restorations can be implemented with this technique.

Recent Advances in Direct Adhesive Restoration Resin-Based Dental Materials With Remineralizing Agents

Resin-based dental materials are popular restorative materials especially in direct adhesive restoration because of the excellent mechanical and esthetic properties. Toward the realization of minimally invasive dental procedures, direct composite resin adhesive restoration has become the main treatment for dental defects. In addition, for caries-affected dentin close to the pulp, conservation remineralization has been advocated to save the living pulp. However, the resin–dentin interface can be destabilized by various factors, especially the enzymatic degradation of collagen fibrils within the hybrid layer and polymer hydrolysis. Furthermore, for resin-based restorative materials, the marginal gap remains a major problem that can lead to the occurrence of secondary caries. To address these issues, research efforts have focused on the remineralization of mineral-depleted dental hard tissues using remineralizing bioactive substances. In this review, we first described various bioactive agents with remineralizing properties. Furthermore, we discussed recent advances in resin-based dental materials for enamel or dentin remineralization. Finally, we examined the current challenges and prospects of these emerging materials. This work aims to provide a theoretical foundation for the future development of resin-based dental materials in direct adhesive restoration with remineralizing agents.

Adhesion to enamel and dentin: A review

Bonding agents play a crucial role in the effective sealing and retention of resin-based composite restorations, which have been increasingly placed and replaced by dentists in many countries around the world. In fact, direct adhesive restoration with composite resins has become the procedure of choice for the treatment of anterior and posterior teeth. However, long-term durability of those restorations may be compromised due to progressive loss of the integrity of adhesive interfaces. This means that no adhesive strategy is free from technique sensitivity. The specificity and proportion of different constitutive molecules, the interaction between them and substrates can differ greatly from one class of adhesive system to another, which can affect bond quality. Protocol simplification has been an inevitable trend that has boosted the use of self-etching and universal systems in adhesive dentistry. This study shows that to satisfy the growing esthetic demands of today’s dental patients, improvements in materials and procedures have been made to make it possible to reproduce the natural appearance of natural teeth with direct and/or indirect esthetic restorations.

Adhesion to Enamel and Dentin: A Review

Bonding agents play a crucial role in the effective sealing and retention of resin-based composite restorations, which have been increasingly placed and replaced by dentists in many countries around the world. In fact, direct adhesive restoration with composite resins has become the procedure of choice for the treatment of anterior and posterior teeth. However, long-term durability of those restorations may be compromised due to progressive loss of the integrity of adhesive interfaces. This means that no adhesive strategy is free from technique sensitivity. The specificity and proportion of different constitutive molecules, the interaction between them and substrates can differ greatly from one class of adhesive system to another, which can affect bond quality. Protocol simplification has been an inevitable trend that has boosted the use of self-etching and universal systems in adhesive dentistry.

Monomer release from direct and indirect adhesive restorations: A comparative in vitro study

ObjectivesIndirect dental restorations produced by computer-aided design and computer-aided manufacturing (CAD/CAM) are relatively new in daily dental practice. The aim of the present study was to compare the monomer release between direct composite restorations and indirect CAD/CAM produced restorations (composite, ceramic and hybrid). MethodsIdentical crown restorations were prepared from three indirect materials (Cerasmart, Vitablocs Mark II and Vita Enamic) and one composite material (Clearfil AP-X). For each restoration, eight crown restorations were luted onto tooth samples and immersed into 2.5mL of an aqueous extraction solvent. Additionally, three nonluted crowns of each restoration type were also immersed in the extraction solvent, and served as controls. Every week, the extraction solvent was collected and refreshed, during a period of 8 weeks. The released monomers were quantified using ultra-performance liquid chromatography-tandem mass spectrometry. ResultsIndirect restorations release significantly lower quantities of residual monomers than direct restorations, and the monomers released by the luted indirect restorations are mainly derived from the composite material used for cementation. The quantity of monomers released by direct restorations greatly depended on the time of light polymerization. SignificanceIn terms of monomer release, indirect restorations are a good alternative to direct restorations to limit patient exposure to residual monomers. It is important to ideally design the fit of indirect restoration so that the cement layer is as thin as possible and the monomer release from this cement layer remains as low as possible.

Decision making and restorative planning for adhesively restoring endodontically treated teeth: An update

Restoration of pulpless teeth presents a clinical challenge and a controversial topic of debate even today. The preservation of coronal tooth structure is crucial for clinical success and for maintaining biomechanical, adhesive, functional, and esthetic balance. The advent of adhesive dentistry and advancement in dental materials have resulted in mechanical properties close to the dental tissues, thereby offering a conservative treatment option to restore, reinforce, and protect endodontically treated teeth (ETT). Directly bonded restorations are indicated for teeth with the minimal loss of coronal tooth structure and can be considered effective for short-term success of root canal treated teeth. However, indirect restorations could be considered for the strengthening of the tooth with moderate loss of tooth structure, following the adequate adhesive protocols. The present review assesses literature on direct versus indirect adhesive restorations such as endocrowns, adhesive onlays, and overlays for restoring ETT. Furthermore, the article attempts to present clinical guidelines and decision-making for restoring endodontically treated anterior and posterior teeth.

The effect of a bleaching agent on the pigment removal and the bond strength of bulk-fill resin composites: an in vitro study

Abstract Introduction In order to simplify the technique, reduce the time required for direct adhesive restorations, bulk-fill resin composites have been developed be applied in bulk placement up to 4 mm increments. Objective Evaluating the color change (ΔE) and the microtensile bond strength (μTBS) of bulk fill resin composites (BFRC) to dentin after the immersion in regular beverages and the application of bleaching systems. Method Forty-five human molar teeth were randomly distributed in three groups according to the filling material (n=15): Filtek Bulk Fill, Tetric N Ceram Bulk Fill and Filtek Z100. The restored teeth were immersed in coffee, wine and distilled water (n=5) for 72 hours. The color parameters were measured using a spectrophotometer, having as basis the CIE L*a*b*, before and after tooth staining and application of bleaching processes. Subsequently, the teeth were sectioned to obtain the specimens for the microtensile testing. The ΔE values were analyzed applying the Kruskal-Wallis and the Wilcoxon tests, and the μTBS values were analyzed applying the ANOVA and the Bonferroni tests (p<0.05). Result There were no significant differences in the ∆E values when comparing the BFRCs to the conventional resin composite (CRC) in most of the experimental groups. The ∆E values did not present significant differences before and after the application of bleaching processes for all the tested resin composites. The BFRCs presented higher μTBS values than the CRC after exposure to distilled water, wine and bleaching agent. Conclusion The studied BFRCs presented similar color stability to the CRC. The BFRCs presented higher bond strength to the dentin than the CTC in most of the evaluated conditions. The bleaching agent was not effective in whitening the stained restored teeth.

Correspondence between advances of dental composites and adhesives and clinical guidelines for direct restorations

The longevity of direct adhesive restoration is related to the restorative materials, the patient and the professional. On one hand, dental composites/adhesives have been modified and developed to fulfill the criteria for clinical application. On the other hand, the clinical guidelines for adhesive restorations have been released and updated accordingly, which would prolong the longevity of restorations. In this commentary, the removal of carious tissues, interface preparation for bonding and application of adhesives are emphasized. The administrative measures for registration and clinical evaluation criteria for adhesive restorative material are also introduced.

Gingival tissue reaction to direct adhesive restoration: A preliminary study.

It is debated whether composite resin marginal/submarginal direct restoration can be usefully performed without inflammatory consequences. This histological study is the first human analysis aimed to compare, in the same tooth, the gingival tissue close to composite resin restorations with gingival tissue close to hard tissue. Eight healthy patients with almost a residual strategic tooth needing endodontic therapy, and post-and-core restoration, then indirect prosthetic restoration, were selected. Direct margin relocation with composite resin was necessary to perform endodontic treatment. The crown lengthening with a secondary flap harvested was necessary to perform prosthetic rehabilitation. Three months after marginal relocation, the secondary flap was harvested, embedded in PMMA, 4-μm sectioned, and stained to analyze the inflammation degree. All patients completed post-and-core reconstruction and the planned prosthetic therapy, maintaining the stringent hygienic protocol plan. The inflammation level comparison, slightly lower in gingiva close to the teeth (3.62±0.38) than in gingiva close to the composite (3.75±0.26), results in a p-value of 0.11 after Wilcoxon test. Results highlight a minimal, statistically not significant difference in the inflammation degree after margin relocation, conceivably due to patients, teeth and cases selection, together with adopted stringent methodological and supportive measures.

A contemporary approach for the management of generalized tooth wear

Abstract: This paper describes the treatment of a 39-year-old female patient with generalized tooth wear. The causes of the tooth wear were identified and controlled. Following diagnostic planning, a full mouth reconstruction at an increased vertical dimension utilizing a reorganized approach was carried out. Crown lengthening surgery was performed on the maxillary anterior teeth prior to the restorative phase. The restorative treatment included a combination of indirect and direct composite resin restorations and adhesive cast restorations. Very satisfactory functional and aesthetic outcomes were achieved. CPD/Clinical Relevance: This paper demonstrates a practicable approach that can be applied for patients with tooth wear. The approach is conservative which eliminates the need for full coverage crowns to restore aesthetics and function.

Evaluation of the fracture resistance of premolars with extensive and medium cavity preparations restored with direct restoring systems

Studies have been conducted to measure the fracture resistance of restored teeth with the current restorative materials. However, most of those studies disregard the cavity size as an influencing variable. To evaluate the fracture resistance of prepared and restored maxillary premolars with medium and large preparations. Seventy superior and sound premolars were randomly divided: G1 (control) - sound tooth; G2, G3, and G4 received a Class II mesial-occlusal-distal (MOD) preparation with an occlusal box width 1/3 of the intercuspal distance, and were restored with Filtek Z350 XT, IPS Empress Direct, and Charisma Diamond, respectively; G5, G6, and G7 received a Class II MOD preparation with an occlusal box width 2/3 of the intercuspal distance, and were restored with Filtek Z350 XT, IPS Empress Direct, and Charisma Diamond, respectively. After storage in water, at 37°C, the specimens were subjected to a fracture test under compression in a universal testing machine where the loads were applied vertically and at a speed of 0.5 mm/min. Data were analyzed with two-way ANOVA and Tukey's multiple comparison post hoc test (P < 0.05). G1 presented a fracture resistance significantly higher (P = 0.005) than any other experimental groups. Among the experimental groups, only G5 showed a significantly low fracture resistance (P = 0.019) when compared to the other groups. For the other resins, the change in intercuspal distance from 1/3 to 2/3 the intercuspal distance did not significantly reduce the fracture resistance (P > 0.05). The cavity preparation weakens the remaining tooth structure; however, its resistance could be partially restored using direct adhesive restorations.

SISTEMAS ADESIVOS: EVOLUÇÃO E PERSPECTIVAS – REVISÃO DE LITERATURA

INTRODUÇÃO: A odontologia adesiva desenvolveu materiais e técnicas capazes de preservar o tecido dentário através da união do substrato com sistemas resinosos adesivos. Modernamente os componentes resinosos são utilizados em restaurações adesivas diretas, na cimentação de bráquetes ortodônticos, na cimentação de restaurações indiretas, na obturação de canais radiculares, no selamento de regiões de má coalescência do esmalte como cicatrículas e fissuras, entre outros. OBJETIVOS: O objetivo desse estudo foi fazer uma revisão sobre a evolução dos sistemas adesivos e discutir os principais esforços da atualidade em aprimorá-los no sentido de minimizar seus inconvenientes. MÉTODOS: Seleção de artigos através das bases eletrônicas LILACS e PubMed/ MEDLINE usando os termos de indexação: adesivos dentinários, adesivos e hidrólise entre os anos de 1999 e 2016. RESULTADOS: Os sistemas adesivos têm sido motivo de estudos no sentido de preservar a interface existente entre a resina composta e o esmalte e a dentina. Essa união apresenta problemas como: degradação hidrolítica, separação de fases entre os componentes hidrofílicos e hidrofóbicos, falta de homogeneidade na formação da camada híbrida, exposição de fibrilas colágenas não completamente envolvidas pelos monômeros a serem polimerizados, lixiviação dos monômeros, diferenças no gradiente de concentração osmótico, dificuldade de maior intimidade entre materiais orgânicos e inorgânicos, interação ou remoção da smear layer e presença de bactérias quiescentes nessa interface adesiva. Os maiores inconvenientes são: nanoinfiltração, com invasão bacteriana e cáries secundárias. CONCLUSÕES: Conhecer os avanços nos sistemas adesivos e empregá-los corretamente é fundamental para um prognóstico favorável da qualidade das restaurações estéticas adesivas.

SISTEMAS ADESIVOS: EVOLUÇÃO E PERSPECTIVAS – REVISÃO DE LITERATURA

INTRODUCTION: The adhesive dentistry developed materials and techniques capable to preserve the dental tissues through the union of substrate with adhesive resinous systems. Modernly the resinous components are used in direct adhesive restorations, in orthodontic brackets´ luting, in indirect restorations´ luting, in canal root filling, in sealing areas of bad coalescence like pit and fissures, among others. OBJECTIVE: The aim of this study was to do a review about the evolution of adhesive systems and to discuss the main efforts of the present time in perfecting them in the sense of minimizing their inconveniences. METHODS: Selection of papers through electronic bases LILACS and PubMed/ MEDLINE using indexing terms like: dentin-bonding agents, adhesives and hydrolysis among the years of 1999 and 2016. RESULTS: The adhesive systems have been reason studies in the sense of preserving the existent interface between the composed resin and enamel and dentine. That union presents problems as: hydrolytic degradation, separation of phases among hydrophilic and hydrophobic components, homogeneity lack in the formation of hybrid layer, exhibition of collagenous fibrils no completely involved by the monomers to be polymerized, leaching monomers, differences in osmotic concentration gradient, difficulty of larger intimacy among organic and inorganic materials, interaction or removal of the smear layer and presence of quiescent bacterias in adhesive interface. The largest inconveniences are: nanoleakage, with bacterial invasion and secondary decays. CONCLUSIONS: To know the progresses in the dentin-bonding agents and how to use them correctly is fundamental for a favorable prognostic of the quality of adhesive aesthetic restorations.

Multidisciplinary esthetic approach for multiple anterior diastema: 36-month clinical performance

The presence of diastema, between anterior teeth, distorts a pleasing smile by concentrating the observer’s attention on the spaces. The patient’s needs and expectations must be considered in the process of treatment planning to ensure satisfaction with the treatment outcomes. There are many forms of therapy that can be used for diastema closure. A carefully developed diagnosis, which includes a determination of the causal elements and advanced treatment planning, allows the most appropriate treatment to be selected for each case. The aim of this paper is present a multidisciplinary approach as a solution to multiple diastemas in the anterior region using gingival tissue recontouring and direct adhesive restorations, with minimum wear of the dental structure, after the orthodontic intervention discussing the minimal intervention to obtain imperceptive and aesthetic final restoration. Thirty-six months after the treatment was carried out, the final aesthetic was maintained with all dental element details and gingival tissue harmony, without recurrence of periodontal pockets and the preservation of the tooth color and shape.

Single crowns versus conventional fillings for the restoration of root-filled teeth.

Endodontic treatment involves removal of the dental pulp and its replacement by a root canal filling. Restoration of root filled teeth can be challenging due to structural differences between vital and non-vital root-filled teeth. Direct restoration involves placement of a restorative material e.g. amalgam or composite, directly into the tooth. Indirect restorations consist of cast metal or ceramic (porcelain) crowns. The choice of restoration depends on the amount of remaining tooth, and may influence durability and cost. The decision to use a post and core in addition to the crown is clinician driven. The comparative clinical performance of crowns or conventional fillings used to restore root-filled teeth is unknown. This review updates the original, which was published in 2012. To assess the effects of restoration of endodontically treated teeth (with or without post and core) by crowns versus conventional filling materials. We searched the following databases: the Cochrane Oral Health Group's Trials Register, CENTRAL, MEDLINE via OVID, EMBASE via OVID, CINAHL via EBSCO, LILACS via BIREME. We also searched the reference lists of articles and ongoing trials registries.There were no restrictions regarding language or date of publication. The search is up-to-date as of 26 March 2015. Randomised controlled trials (RCTs) or quasi-randomised controlled trials in participants with permanent teeth that have undergone endodontic treatment. Single full coverage crowns compared with any type of filling materials for direct restoration or indirect partial restorations (e.g. inlays and onlays). Comparisons considered the type of post and core used (cast or prefabricated post), if any. Two review authors independently extracted data from the included trial and assessed its risk of bias. We carried out data analysis using the 'treatment as allocated' patient population, expressing estimates of intervention effect for dichotomous data as risk ratios, with 95% confidence intervals (CI). We included one trial, which was judged to be at high risk of performance, detection and attrition bias. The 117 participants with a root-filled, premolar tooth restored with a carbon fibre post, were randomised to either a full coverage metal-ceramic crown or direct adhesive composite restoration. None experienced a catastrophic failure (i.e. when the restoration cannot be repaired), although only 104 teeth were included in the final, three-year assessment. There was no clear difference between the crown and composite group and the composite only group for non-catastrophic failures of the restoration (1/54 versus 3/53; RR 0.33; 95% CI 0.04 to 3.05) or failures of the post (2/54 versus 1/53; RR 1.96; 95% CI 0.18 to 21.01) at three years. The quality of the evidence for these outcomes is very low. There was no evidence available for any of our secondary outcomes: patient satisfaction and quality of life, incidence or recurrence of caries, periodontal health status, and costs. There is insufficient evidence to assess the effects of crowns compared to conventional fillings for the restoration of root-filled teeth. Until more evidence becomes available, clinicians should continue to base decisions about how to restore root-filled teeth on their own clinical experience, whilst taking into consideration the individual circumstances and preferences of their patients.

Fracture strength of root filled premolar teeth restored with silorane and methacrylate-based resin composite

ObjectivesTo compare fracture characteristics of root-filled teeth with variable cavity design restored with a low shrinkage silorane and methacrylate-based resin composite. Methods77 extracted maxillary premolars were divided randomly into seven groups: (Group 1) intact teeth; (Groups 2–4) MOD plus endodontic access with the buccopalatal width of the occlusal isthmus equals one third of the intercuspal width; (Groups 5–7) MOD plus endodontic access with the buccopalatal width of the occlusal isthmus equals one half of the intercuspal width. Groups 2 and 5 were left unrestored, Groups 3 and 6 were restored with a silorane-based resin composite (Filtek P90) and Groups 4 and 7 with a methacrylate-based resin composite (Z250). Teeth were loaded in a universal testing machine; load and fracture patterns were recorded and compared statistically using 2-way ANOVA and t-test for pairwise comparisons and 1-way ANOVA with Dunnett test for multiple comparisons. ResultsUnrestored teeth became progressively weaker with more extensive preparations, Group 5 (unfilled ½) showed the lowest fracture load among the groups (71±22N, P<0.001). Restorations increased the fracture strength of unrestored teeth regardless of cavity size (P<0.001), but was still significantly weaker than sound teeth, with no significant difference between silorane and methacrylate groups. Failure of restored teeth was mostly adhesive at the tooth restoration interface. ConclusionsSilorane-based resin composite have no superior strengthening effect over the conventional methacrylate-based resin composite in restoration of root filled teeth. Both materials showed similar fracture patterns. Clinical significanceRoot filled teeth are considerably weakened via restorative and endodontic procedures. A direct adhesive restoration will aid in preserving tooth structure as far as it provides enough strength.

Guidelines for Direct Adhesive Composite Restoration.

Direct adhesive composite restoration, a technique to restore tooth defects by bonding composite resin materials, has been widely used in the restoration of dental caries or other tooth defects. Retention of composite resin restoration mainly relies on bonding strength between the materials and dental tissue. The clinical outcomes rely greatly on the regulated clinical practice of dentists. In 2011, the Society of Cariology and Endodontology of Chinese Stomatological Association (CSA) published the 'Practices and evaluation criteria of composite resin bonded restoration (Discussion Version)'. Since then, opinions and comments regarding the 'Discussion Version' have been widely circulated within the Society. The final version of the guideline was based on systematic reviews of scientific literature and requirements for the edit of technical guidelines, and through several rounds of discussions, revisions and supplements. The society recommends this guideline for clinicians to use in their practices, when conducting direct composite restorations.

English

Anterior multiple diastema is a problem when the objective is harmonic an smile. Composite resin direct adhesive restorations provide satisfactory esthetic and function with minimum wear of the dental structures. The treatment success depends mainly on good patient oral health, correct diagnosis and technique. This article describes the step by step of an multiple anterior diastema restoration by using composite resin to mimic the enamel and dentin, improving the smile’s esthetic. This 13-year follow up shows imperceptible restorations that maintain the natural reproduction of the dental structures over the long term.

Does Operatory Field Isolation Influence the Performance of Direct Adhesive Restorations

To evaluate the influence of different adhesive strategies (etch-and-rinse and self-etching adhesives) and type of field isolation (absolute or relative) on the clinical performance of restorations of noncervical carious lesions (NCCLs). One hundred forty NCCLs were selected from 38 patients, according to previously established inclusion/exclusion criteria, and assigned to one of four groups (n = 35): etch-and-rinse/rubber-dam (ERR), etch-and-rinse/cotton roll (ERC), self-etching/rubber-dam (SER) and self-etching/cotton roll (SEC). The adhesive systems used were: Adper Single Bond 2 (3M ESPE) and Adper SE Plus (3M ESPE), with restorations made using a composite resin (Z350, 3M ESPE). Using the USPHS modified criteria, 140 restorations were evaluated by two calibrated examiners at 5 different times: immediately after placement, at 7 days, and 2, 6, and 12 months. In order to evaluate the presence of gingival recession after the use of the #212 rubber-dam clamp, the clinical crowns of the teeth from groups ERR and SER were measured at six different periods (baseline, immediately, and at 7 days, 2, 6, and 12 months). Data were subjected to McNemar's, chi-square, and Student's t-tests. Both adhesive strategies reduced tooth sensitivity beyond the second period of evaluation (7 days); tooth sensitivity disappeared after the third period of evaluation (2 months). There were no statistically significant differences between the adhesive techniques or isolation techniques, except for a Bravo score for marginal discoloration in group SEC at 6 months, which was significantly different from the other groups. The rubber-dam isolation technique was more uncomfortable for the patient and resulted in short-term gingival recession. No significant differences were found between the types of isolation or adhesive strategy in this clinical evaluation, with the exception of 2 restorations in group SEC that showed marginal discoloration, possibly due to inadequate enamel etching by the self-etching adhesive. Class V restorations perform equally well placed with or without rubber-dam.