Direct Composite Resin Restorations Research Articles

Fracture Resistance of Direct versus Indirect Restorations on Posterior Teeth: A Systematic Review and Meta-Analysis

The aim of this systematic review and meta-analysis was to compare static compression forces between direct composite resin restorations and indirect restorations for posterior teeth. All studies comparing mechanical properties of direct versus indirect restorations of posterior teeth were included from 2007 up to February 2024. A meta-analysis was conducted for static compression fracture resistance. Medline, Central, and Embase databases were screened. Twenty-four articles were included in the qualitative synthesis, and sixteen studies were finally included in the quantitative synthesis. There was no difference in terms of fracture resistance between direct and indirect restorations for posterior teeth (p = 0.16 for direct and indirect composite resin restorations and p = 0.87 for direct composite resin restorations and indirect ceramic restorations). Also, sub-group analysis with or without cusp coverage in each group revealed no discernable difference. Based on this study, it can be concluded that the choice between direct and indirect restoration approaches may not significantly impact fracture resistance outcomes. There was no statically significant difference between direct and indirect restorations for posterior teeth in all cases of restorations with or without cusp coverage and no matter the used materials. However, to better evaluate these materials, further studies are warranted.

The Evaluation of the Cervical Marginal Sealing of Direct vs. Indirect Composite Resin Restorations in MOD Cavities.

The aim of this in vitro study was to compare the quality of marginal sealing at the cervical margins of indirect and direct composite resin restorations in mesio-occluso-distal (MOD) cavities. MOD preparations were performed on 30 extracted teeth. The mesial cervical margin of each tooth was relocated using a flow composite resin (Enamel Plus HRi Flow, Micerium, Avegno, GE, Italy), then the samples were divided into three groups. In group A, the cavities were directly restored using a nanohybrid composite resin (Miris 2 Coltène Whaledent, Altstaetten, Switzerland) and a universal adhesive (ScotchBond Universal, 3M ESPE, St. Paul, MN, USA) by the etch-and-rinse strategy, for group B, the restoration procedure was similar but the self-etch strategy was used, and the samples in group C were filled using the inlay technique. Each sample was stored for 48 h in a 2% methylene blue solution, then it was cut in a mesio-distal direction using a Struers Secotom 50 device (Cleveland, OH, USA). The marginal sealing and adhesive interface were assessed for each sample at the cervical margin by optical microscopy (OM) and scanning electron microscopy (SEM). One-way ANOVA and Bonferroni post-hoc tests were used with a significance level of 0.05. Significant differences were recorded within groups A and C, between mesial and distal margins (p = 0.02 in group A and p = 0.043 in group C). The marginal sealing is more effective in MOD inlay restoration compared to direct restorations. Relocation of the cervical margin with flow composite resin and the use of different adhesive strategies do not improve the marginal sealing.

Treatment of wedge-shaped lateral incisors with direct composite veneer restorations: two case presentations

Wedge-shaped lateral incisors are teeth associated with dental anomalies, often encountered in maxillary teeth, characterized by being smaller than normal and having cylindrical or pointed shapes. For achieving an aesthetic appearance in treatment, ceramic or composite restorations are commonly preferred. However, ceramic restorations are not recommended as the primary choice for treating wedge-shaped lateral teeth due to their tendency to cause more substance loss in dental tissues, higher costs, and challenging repairs compared to composite restorations. In cases where patients presented with bilateral wedge-shaped lateral incisors seeking aesthetic improvements, various treatment options were explained to them, and after evaluating their preferences, the decision was made to use direct resin composite restorations for aesthetic enhancement. The color of the teeth was determined, and an appropriate composite resin was selected. Following the completion of the restorations, finishing and polishing procedures were applied. The purpose of presenting these two cases is to demonstrate the use of direct composite veneer restorations in achieving aesthetic treatment.

Transitioning from injectable resin composite restorations to resin composite CAD/CAM veneers: A clinical report.

To describe a shift from injectable resin composite technique to composite resin computer-aided design and computer-aided manufacturing (CAD/CAM) veneers in addressing esthetic concerns associated with diastemas between anterior lower teeth in a clinical case. Among several techniques proposed for direct resin composite restoration, the "Injectable resin composite technique" has gained popularity for its time-efficiency, reduced technique sensitivity, and diminished reliance on clinician skills. However, challenges such as staining and the need for frequent polishing follow-ups may prompt the consideration of more stable alternatives such as indirect veneer restorations. While ceramic veneers offer superior mechanical and optical properties, resin ceramic veneers, especially those milled from CAD/CAM resin ceramic blocks, offer advantages such as rapid, cost-effective production, simplified intra-oral repairs, less susceptibility to fracture, superior stress absorption, and requires minimal tooth preparation, making them an appealing option for many patients. Moreover, a fully-digital approach not only streamlines the process but also saves time and labor while ensuring the delivery of high-quality restorations to patients. In addressing a patient's dissatisfaction with constant polishing of direct resin composite restorations, a shift to resin composite CAD/CAM veneers was implemented. Utilizing a fully-digital approach with CAD/CAM resin ceramic restorations successfully restored both esthetics and function. While the injectable resin composite technique achieves immediate esthetic results, its low color stability necessitates frequent polishing sessions. The replacement of direct resin composite restorations with CAD/CAM resin composite veneers becomes a viable option for patients seeking more stable restorations that require fewer follow-ups. This transition addresses both esthetic concerns and the need for enduring solutions in restorative dentistry.

Management of midline diastema using the direct composite resin technique - A case report

Diastema or space between the anterior teeth is a common aesthetic complaint of patients. Direct composite resins in midline diastema cases allow dentists to have complete control in formation of natural smiles. This case report describes midline diastema closure with esthetic composite layering technique. A 25-year-old male patient reported to the clinic, with a complaint of spacing in the upper front tooth region of the jaw. The direct aesthetic composite laminate veneer was considered as the treatment of choice for the build-up of both maxillary central incisors as a more conservative, inexpensive, aesthetic, and quicker option. A2 & A3 shades were selected; prepared tooth surface was etched for 15 seconds using 37% phosphoric acid, rinsed with water for 20 seconds, and air dried with slight air pressure. Bonding agent was applied (Adper single Bond, 3M ESPE, USA) and cured for 20 seconds using (Vivadent Blue phase) curing light. The labial surface of the restoration was flattened using red banded knife-edge tip diamond bur. The natural look of the restored teeth was achieved after finishing and polishing. At six-month and one-year recalls the general outlook of the maxillary anterior teeth was considered natural and aesthetical. Clinically, both restorations have no fractures and also the restoration margins on both maxillary central incisors demonstrated no discolorations. By taking this into consideration and according to the positive results, an experienced dentist with proper case selection, using an appropriate technique and modern materials, can perform highly aesthetic and durable direct composite resin restorations that can satisfy patients as under the conditions of the case presented.

A Minimally Invasive Esthetic Approach for Teeth with Molar Incisor Hypomineralization: a Clinical Case Report

Molar incisor hypomineralization (MIH) is a qualitative defect of enamel, clinically characterized by white or yellow/brownish demarcated opacities that affect permanent molars, often associated with permanent incisors. The etiology is multifactorial, including systemic and genetic/epigenetic factors. Defects of anterior teeth can negatively impact children since they might present lower self-esteem and socialization problems. Purpose: To describe a minimally invasive treatment for anterior teeth affected by molar incisor hypomineralization, performed with direct composite resin restoration and a universal adhesive system. Case Report: An 8-year-old patient sought dental care with complaints about her dental appearance, reporting suffering from school bullying. She presented a white-yellowish opacity on the maxillary right central incisor. After a clinical examination, she was diagnosed with molar incisor hypomineralization. To improve dental esthetics, a direct composite resin restoration was proposed. The enamel surface was prepared and etched with 35% phosphoric acid etchant solution for 15 seconds before applying the universal adhesive system. Two different shades of the composite were used for layering the material to disguise the defect without extensive removal of the dental structure. The result was satisfactory as it was possible to mask the opacity, reestablish enamel thickness, and improve the patient's quality of life. Conclusion: Conservative restorations comprising a universal adhesive system seem to bring desirable esthetic results for anterior teeth with molar incisor hypomineralization.

Delayed vs. immediate placement of restorative materials over Biodentine and RetroMTA: a micro-shear bond strength study

BackgroundThe aim of the present study was to investigate the micro-shear bond strength (µSBS) of various restorative materials applied on two different fast-setting calcium silicate-based materials and to evaluate the effect of restoration time on µSBS.MethodsA total of 180 acrylic blocks with a cavity in the center were randomly divided into 2 main groups according to the capping material to be used (Biodentine or RetroMTA). The specimens were also randomly divided into 3 groups according to the restoration time (3 min, 12 min, 24 h). After the specified waiting periods, glass hybrid material (EQUIA Forte HT), resin composite (Filtek Z550) and light-cured calcium silicate material (Theracal LC) were placed on the specimens with tygon tubes. The specimens were kept for 24 h and then subjected to µSBS test. Statistical analysis was performed by 3-way ANOVA followed by Tukey test for pairwise comparisons (α = 0.05).ResultsThere is a statistically significant difference (p < 0.05) between the µSBS values obtained by applying resin composite on RetroMTA after different setting times (24 h > 12 min > 3 min). The µSBS obtained for the Biodentine-resin composite at the end of the 3 min setting time is significantly lower (p < 0.05) than the µSBS values at 12 min and 24 h. For both calcium silicate cements, at the end of all time periods, the µSBS obtained when resin composite was applied at the end was higher than the other materials (p < 0.05).ConclusionsFor Biodentine-resin composite bonding, the manufacturer’s recommendation of 12 min can be considered an appropriate time, whereas for RetroMTA-resin composite bonding, the µSBS increased as the waiting time increased. Regardless of the waiting time, it is recommended to prefer direct composite resin restoration over Biodentine and RetroMTA.

Multidisciplinary Treatment: Follow-Up of Dental Autotransplantation for 10 Years.

The objective is to present a clinical case of dental autotransplantation managed with surgery, orthodontics, endodontics, periodontics, and aesthetic rehabilitation. A 10-year-old boy sought treatment after avulsion of the maxillary left central incisor, which was not reimplanted. Based on anamnesis, clinical examination, and complementary examinations, agenesis of the maxillary and mandibular second premolars except the mandibular right second premolar was observed. After a multidisciplinary planning, the space in the maxillary left central incisor region was opened to receive the transplanted mandibular right second premolar. The receptor site was created in a single surgical procedure. Pulp necrosis was noted in the transplanted tooth, which was treated endodontically, and the agenesis spaces were closed using fixed orthodontic appliances. After removing the appliance, gingivectomy with osteotomy was performed in the maxillary right central incisor and the transplanted tooth regions to harmonize the height and shape of the gingival contour. Next, aesthetic readjustment was performed with tooth whitening, using office and home techniques, followed by microabrasion of the vestibular surface of the maxillary right central incisor. Direct composite resin restorations were placed in the maxillary incisors, and the teeth were rehabilitated using incisal and palatal guides. A multidisciplinary approach is essential for reestablishing the function and aesthetics of complex cases involving dental autotransplantation.

Performance of direct and indirect onlay restorations for structurally compromised teeth

Research is lacking on the restoration of structurally compromised posterior teeth using direct composite resin or indirect restorations. The purpose of this in vitro study was to measure the fracture resistance and microleakage of different onlay restorations fabricated by using conventional and digital computer-aided design and computer-aided manufacturing (CAD-CAM) to restore structurally compromised teeth. Mandibular molars (n=54) were prepared for onlay restorations. Teeth were allocated to 3 groups (n=18) according to the type of restoration materials, nanohybrid composite resin (Grandio blocs), resin hybrid ceramic (SHOFU Block HC), and fiber-reinforced composite resin (everX Posterior). Onlays were bonded using a dual-polymerized adhesive resin cement. All specimens were thermocycled, followed by cyclic loading. Based on the type of investigation conducted, fracture resistance, and microleakage test, each group was then divided into 2 equal subgroups (n=9). The collected data were statistically analyzed with the chi-square of the Fischer exact test (α=.05). Fracture resistance testing revealed a statistically significant difference between groups (P<.001). The fiber-reinforced composite resin demonstrated the highest fracture resistance, with statistically significantly less microleakage compared with the other groups (P=.013). Direct fiber-reinforced composite resin could be considered a suitable alternative to CAD-CAM composite resin for the restoration of structurally compromised teeth.

Direct or indirect composite for restoring permanent first molars affected by Molar Incisor Hypomineralisation (MIH): a randomized clinical controlled trial

AimThis study was undertaken to compare direct composite resin restorations (DCRR) and indirect composite resin restorations (ICRR) for treating permanent first molars affected by MIH in terms of clinical performance.Materials and methodsThis was a controlled, randomized, clinical split-mouth study. The studied sample consisted of 40 asymptomatic first permanent hypomineralised mandibular molars in 20 children aged between 7–11 years, these cases were divided randomly into two groups: Group 1 (experimental): 20 first permanent mandibular molars were restored with ICRR, and Group 2 (control): 20 first permanent mandibular molars that were restored with DCRR. The cavity was prepared using a diamond bur on a high-speed handpiece, and the prepared cavity was wiped with cotton moistened with sodium hypochlorite. The composite was applied directly with a total-etch bonding system. In the ICRR group, an impression for the prepared cavity was taken using a silicon-based material, and the restoration was adhesive with self-adhesive resin cement. The child’s satisfaction with each of the two application techniques was assessed through the scale FACES. Restorations were evaluated during follow-up periods (3, 6, and 12 months) according to Modified USHPH criteria.ResultsThe clinical success rate was 90% in the ICRR group versus 85% in the DCRR group after 12 months of follow-up without statistically significant differences (P = 0.218). Children were significantly more satisfied (P = 0.0351) with ICRR than DCRR.ConclusionsBoth DCRR and ICRR can be considered effective restorations with acceptable clinical performance in the restoration of hypomineralised first permanent molars with an advantage of ICRR in terms of child acceptance of the restoration application technique.

Is surface roughness of direct resin composite restorations material and polisher-dependent? A systematic review.

Direct resin composite bonding offers a highly esthetic, minimally invasive option for the treatment of anterior teeth however the challenge to improve their longevity remains. Direct resin composite restorations are limited by the risk of staining which may be influenced by the final surface roughness (Ra) of composite achieved. The purpose of this review is to investigate, using a systematic approach, whether the final surface roughness of anterior composite restorations is affected by the interaction between resin composite and polishing systems. The review was conducted by 3 independent reviewers and included articles published up to January 21, 2021. Three electronic databases were searched: Medline, Embase, and Web of Science. Studies assessing a quantitative effect of polishing methods on the Ra of direct composite resin materials published after the year 2000 and restricted to the English language were included. The database search for the effect of polishing systems on composite materials retrieved 125 eligible studies. Twelve duplicate records were removed. The resulting records were screened using title and abstract leading to 38 reports which were sought for retrieval. Application of eligibility criteria led to 11 studies included in the review. Hand searching of these studies yielded no additional papers. There is insufficient evidence to determine whether combination of composite and polisher influences final Ra. More research is required to determine if there is an optimum combination of polisher and composite. Polishing should be completed following planned finishing procedures. The approximation to the final surface and which finishing burs to use, if any, should be considered when planning a restoration. Durafill VS predictably achieves an acceptable Ra by different polishers.

The clinical performance of bulk-fill versus the incremental layered application of direct resin composite restorations: a systematic review

ObjectivesTo systematically review the scientific evidence comparing the clinical effectiveness of bulk-fill versus incrementally layered conventional resin composites and to evaluate if one method offers clear merits with specific clinical outcomes.Materials and methodsUsing relevant mesh terms and pre-established eligibility criteria in PubMed, Embase, Scopus and Web of Science, a thorough scientific search was conducted with an end-date of 30.04.2023. Randomized controlled clinical trials that involved the direct comparison of Class I and Class II resin composite restorations applied using incremental layering techniques versus bulk-filled in permanent teeth with an observation period of at least six months were considered. To evaluate the bias risk of the finalized records, a revised version of the Cochrane risk-of-bias tool for randomized trials was implemented.ResultsOut of the 1445 records determined, 18 eligible reports were chosen for qualitative analysis. Data obtained was categorized as per, the cavity design, the intervention, the comparator(s), the methods of success/failure assessment, the outcomes, and follow-up. Two studies demonstrated an overall low-risk of bias, fourteen studies raised some concerns, and two studies exhibited high-risk.ConclusionBulk filled resin composite restorations demonstrated clinical outcomes similar to those of incrementally layered resin composite restorations within a review interval of 6 months to 10 years.

Ultrathin Partial Ceramic Veneers in the Esthetic Zone with Tooth Whitening: A 5-year Case Report.

This case report describes a minimally invasive approach with tooth whitening and partial ceramic veneers in the esthetic zone with a 5-year follow-up. The patient was initially concerned about the tooth color and previous direct resin composite restorations that chipped on the incisal edges of both maxillary central incisors. Tooth whitening and partial veneers for both central incisors were recommended after clinical evaluation. Two sessions of in-office tooth whitening, first with 35% hydrogen peroxide and later with 10% carbamide peroxide from first premolar to first premolar, were provided. Minimal tooth preparation that only removed the fractured composite restorations was performed followed by placement of feldspathic porcelain ultrathin partial ceramic veneers for both central incisors. We emphasize the benefits of minimal tooth preparation paired with partial ceramic veneers and the importance of masking discolored tooth structure with such thin veneers, including potential tooth whitening. Overall, we demonstrate a well-planned and executed restorative procedure combining tooth whitening and ultrathin partial ceramic veneers to achieve desired results in the esthetic zone that remained successful for five years.

Clinical application of direct composite resin in esthetic restoration

The direct composite resin bonding is widely used in the esthetic restorations of anterior teeth. Due to the technique sensitive procedure, the esthetic effect and long-term clinical performance of direct composite resin restoration have long been the focus of dental clinicians. This article will analyze the influencing factors of esthetic effect of composite resin from three aspects, including materials, teeth and technology. Also, it will summarize the clinical performance of direct composite resin from the perspective of esthetic evaluation. Eventually, this article will provide guidance for the clinical application of esthetic restoration of direct composite resin bonding.

Diastema closure with direct composite restoration-Case report

Maxillary midline diastema is a frequently occurring malocclusion found to be a common aesthetic complaint of patients. It occurs due to of multifactorial etiology such as labial frenum, microdontia, and oral habits such as thumb sucking, Tongue thrusting, or Dental malformations. Proper technique and materials for successful treatment are grounded on time and the patient's physical, psychological, and economical conditions. The use of Direct composite resin restoration in diastema closure permits the dentist and patients to gain complete control of the above-mentioned and recreation of an aesthetic natural smile. The case report describes a case of midline diastema closure using direct composite resin restoration. The patient was recalled for follow-up for 1 year. No discoloration, sensitivity, line of demarcation, or fracture lines were seen. Therefore, midline diastema closure using direct composite resin restoration is considered highly aesthetic, and durable and could fulfill the aesthetic need of the patient in the present case.

Effectiveness, longevity, and color stability of in-office bleaching (6% H2O2 gel/Violet LED) and diastema closure with direct composite: 3-year follow-up

To reduce bleaching side effects, the use of low concentrations of Hydrogen Peroxide (HP) agents associated with hybrid light (violet LED/Diode Laser) has gained interest. Case report: The aim of this report is to describe a case of a 16-year-old patient that presented a complaint related to the color of his teeth and a maxillary midline diastema. In-office bleaching with 6% HP associated with hybrid light (violet LED/Diode Laser) was performed. The bleaching gel was applied once on the teeth and light-activated for 1 minute (15 times) followed by 1min intervals (15 times) with a total bleaching time of 30 minutes. After the bleaching procedure, the teeth were polished and the desensitizer was applied for 4 minutes. Two bleaching sessions were performed at a 1-week interval. The diastema was closed with direct resin composite restorations without any tooth preparation. The conventional 3-step bonding agent was used and A1 dentin shade and B1 enamel shade were used followed by polishing discs. At 3-year recall, discoloration and fractures were not found on the the teeth or restorations and patient was completely satisfied. Conclusion: the conservative and safe option of bleaching with a low-concentrated HP gel associated with violet LED light is an interesting option for young patients and presents longevity over time.

Technique to restore the midline space of central incisors using a two-in-one template: A clinical report.

Using composite resin restoration of full-coverage crowns to obtain a completely symmetrical esthetic restoration of individual central incisors remains difficult. Freehand direct composite resin restoration is challenging even for highly skilled dentists. This clinical report describes a digital protocol for achieving symmetrical restoration of two central incisors using a custom-designed, two-in-one template.

Indications for the use of direct composite restorations in the management of tooth wear.

The increasing prevalence of tooth surface loss has been widely reported. Patients present with varying degrees of tooth wear and consideration is given to whether a prevention and monitoring approach, or a treatment and restoration approach, is appropriate. A missed diagnosis or excessively prolonged monitoring risks progression to the detriment of a successful outcome, with the potential compromise on the quality and quantity of tooth structure available for predictable adhesive dentistry. Direct composite resin (DCR) restorations can be considered as a viable treatment option for all extents of tooth wear, including cases that have progressed to a severe degree. This paper aims to review the indications for DCR restorations in the management of tooth wear, using clinical cases to demonstrate their effectiveness.

Fracture Load of Mesio–Occluso–Distal Composite Restorations Performed with Different Reinforcement Techniques: An In Vitro Study

Mesio-occluso-distal (MOD) cavity preparations are often fragile due to the amount of tooth and carious structure removed. MOD cavities can often fracture if left unsupported. The study investigated the maximum fracture load of mesi-occluso-distal cavities restored using direct composite resin restorations with various reinforcement techniques. Seventy-two freshly extracted, intact human posterior teeth were disinfected, checked, and prepared according to predetermined standards for mesio-occluso-distal cavity design (MOD). The teeth were assigned randomly into six groups. The first group was the control group restored conventionally with a nanohybrid composite resin (Group I). The other five groups were restored with a nanohybrid composite resin reinforced with different techniques: the ACTIVA BioACTIVE-Restorative and -Liner as a dentin substitute and layered with a nanohybrid composite (Group II); the everX Posterior composite resin layered with a nanohybrid composite (Group III); polyethylene fibers called "Ribbond" placed on both axial walls and the floor of the cavity, and layered with a nanohybrid composite (Group IV); polyethylene fibers placed on both axial walls and the floor of the cavity, and layered with the ACTIVA BioACTIVE-Restorative and -Liner as a dentin substitute and nanohybrid composite (Group V); and polyethylene fibers placed on both axial walls and the floor of the cavity and layered with the everX posterior composite resin and nanohybrid composite (Group VI). All teeth were subjected to thermocycling to simulate the oral environment. The maximum load was measured using a universal testing machine. The highest maximum load was exhibited by Group III with the everX posterior composite resin, followed by Group IV, Group VI, Group I, Group II, and Group V. A statistically significant difference was demonstrated between groups (p = 0.0023). When adjusting for multiple comparisons, there were statistical differences specific to comparisons between Group III versus I, Group III versus II, Group IV versus II, and Group V versus III. Within the limitations of the current study, it can be concluded that a higher maximum load resistance can be achieved (statistically significant) when reinforcing nanohybrid composite resin MOD restorations with everX Posterior.

Fragment reattachment or direct restoration? An in vitro study.

The fracture resistance of teeth subjected to fragment reattachment may improve when the technique is performed using intermediate materials. The aim of this study was to evaluate the influence of different bonding materials, including pre-heated composite resin, on the fracture resistance of teeth subjected to the reattachment technique compared with a direct composite resin restoration. After simulating a tooth fracture, each specimen was reattached by using one of the following intermediate materials (n=15): G0, negative control (sound teeth); G1, Z100; G2, pre-heated Z100; G3, Filtek Z350 XT; G4, pre-heated Filtek Z350 XT; G5, Filtek Z350 XT Flow; and G6, RelyX Veneer. In G7, direct class IV restorations were performed using Filtek Z350 XT composite resin. The fracture resistance was evaluated using a universal testing machine under a compressive load of 1 mm/min. One-way analysis of variance (ANOVA) and the post hoc Tukey test (5%) were conducted. G0 showed the highest fracture resistance, and this was statistically different from the other experimental groups (p < .05) except for G2 and G4, in which the fragments were bonded using pre-heated resins. A statistically significant difference was found between groups G1 and G6 (one-way ANOVA, p=.04). For G1 and G2, a significant difference was found between bonding with and without pre-heating (p < .05). This difference was not observed in G3 and G4 (p > .05). No statistically significant difference was found between the reattached and directly restored groups (t-test, p=.53). The tooth reattachment technique using pre-heated composite resin showed fracture resistance values similar to those of the sound tooth group. No difference was found between the fragment reattachment and direct composite resin techniques.