Direct Esthetic Restorations Research Articles

Direct Resin Composite Restoration in Anterior Tooth: 10 Years of Clinical Follow-Up

The emergence and development of resin-based materials, such as resin composites and adhesive systems, have shifted the restorative treatment of anterior teeth with caries lesions and/or fractures. Thus, based on the disadvantages of indirect restorations, direct esthetic restorations are restorative options even for anterior teeth with exten sive loss of hard tissues. This study aimed to describe and discuss the direct resin composite restoration performed to solve the esthetic and functional impairments of the upper anterior teeth with diastemas. The upper left central incisor received total crown preparation for indirect restoration. Clinical results after 10 years were recorded. Considering the clinical characteris tics of dental restorations, it is possible to conclude that direct resin composite restorations reestablished the esthetic and functional properties satisfactorily, even in a tooth with extensive coronal destruction. The success of the restorative treatm ent was dependent on factors related to the materials´ properties, oral habits of the patient, and mostly the clinical skills of th e dental clinician.

Deep proximal margin rebuilding with direct esthetic restorations: a systematic review of marginal adaptation and bond strength.

This review aimed to characterize the effect of direct restorative material types and adhesive protocols on marginal adaptation and the bond strength of the interface between the material and the proximal dentin/cementum. An electronic search of 3 databases (the National Library of Medicine [MEDLINE/PubMed], Scopus, and ScienceDirect) was conducted. Studies were included if they evaluated marginal adaptation or bond strength tests for proximal restorations under the cementoenamel junction. Only 16 studies met the inclusion criteria and were included in this review. These studies presented a high degree of heterogeneity in terms of the materials used and the methodologies and evaluation criteria of each test; therefore, only a descriptive analysis could be conducted. The included studies were individually evaluated for the risk of bias following predetermined criteria. To summarize the results of the included studies, the type of restorative material affected the test results, whereas the use of different adhesive protocols had an insignificant effect on the results. It could be concluded that various categories of resin-based composites could be a suitable choice for clinicians to elevate proximal dentin/cementum margins, rather than the open sandwich technique with resin-modified glass ionomers. Despite challenges in bonding to proximal dentin/cementum margins, different adhesive protocols provided comparable outcomes.

A Two-Year Comparative Evaluation of Clinical Performance of a Nanohybrid Composite Resin to a Flowable Composite Resin.

Objective: This prospective in vivo study aimed to compare the clinical behavior of a flowable composite resin (Genial Universal Flo, GC) and a nanohybrid universal composite resin (Tetric Evo Ceram, Ivoclar Vivadent) used in Class I and II direct esthetic restorations in posterior teeth. Methods: A total of 108 Class I and II direct restorations were performed in patients aged between 20 and 60 years. The originality of this study lies in the fact that both materials were placed in pairs, in the same clinical environment (i.e., the same patient and the same type of tooth). The evaluations were performed now of restoration and after 2-weeks, 6-, 12-, and 24-months intervals using clinical examination, clinical photographs, and radiological examination, according to modified USPHS criteria. Statistical analysis was performed using the Fisher exact test and chi-square analysis. Results: At baseline, the universal composite resin showed better esthetic properties such as surface luster, surface staining marginal staining. Both materials regressed significantly over time with no significant difference between groups. Conclusions: Both flowable and nanohybrid composite resins exhibit acceptable clinical performance. The present 24 months of evaluation of different composites showed that the G-ænial Universal Flo could be an effective esthetic material for posterior restoration. No significant difference between both materials over time concerning surface luster, surface staining, and marginal staining.

Influence of Filler Composition on the Refractive Index of Four Different Enamel Shades of Composite Resins

The purpose of this study was to measure the refractive index of four commercially available enamel resin composites, using optical coherence tomography (OCT) and their relationship with the atomic composition of the composite resin fillers utilizing an energy-dispersive X-ray fluorescence spectrometer (EDX). Four different enamel composites, namely Enamel HRi color UE3, Enamel HFO color GE3, Vit-l-escence color Pearl Frost, and Amelogen Plus color Enamel White were tested. For each composite, disks with different thicknesses were fabricated and then light-cured according to the manufacturer's instructions. The disks were then stored in deionized water under 36.5 °C for at least 7 days. Each of the samples from the four different groups was measured in five distinctive points to analyze the optical and physical length using optical coherence tomography (OCT). Elemental analysis of all four different enamel shades of the composite was done using an EDX. The filler contents showed interesting differences in elemental composition and concentration; however, Si seemed to be a common filler component. The HRi composite presented a distinctive composition compared to other materials and was the only composite that showed a smaller percentage of SiO2, and also was the only composite that contained compounds, such as P2O5, ZnO, CaO, La2O3, and V2O5. The optical coherence tomography analysis showed the refractive index values of all tested enamel composites. Among the four different enamel composite resins tested, the enamel HRi composite demonstrated the most ideal refractive index to mimic natural enamel. The enamel HRi composite demonstrated a distinctive filler composition and this could be the main reason behind its higher refractive index. Nonetheless, it remains unclear how much of an impact this feature has in the final esthetic outcome of anterior composite restorations, where many other optical phenomena are also important. The clinical success of any esthetic restorative procedure depends on diagnosing the proper treatment plan and also on executing this treatment with the right materials. On direct esthetic restorations, knowing the optical properties of such materials is fundamental, as they should be able to replicate both natural enamel and dentin. How to cite this article: Beolchi RS, Mehta D, Pelissier B, et al. Influence of Filler Composition on the Refractive Index of Four Different Enamel Shades of Composite Resins. J Contemp Dent Pract 2021;22(5):557-561.

Evaluation of micro leakage of two direct esthetic restorations with different preparation techniques

ObjectivesIn recent times, the term “minimal intervention dentistry” has coined to describe a new approach to the treatment of the disease of caries. This study was carried out to evaluate the marginal integrity of class V cavity in permanent posterior teeth prepared with different air abrasion parameters compared with classical rotary cavity preparation. MethodsA total number of 150 sound caries for free human posterior teeth were used in this study. Teeth were extracted for periodontal disease or orthodontic reasons and the average age of patients between 20 and 35 years. Teeth were divided according to the type of restoration into two main groups: Group I (n = 75) restored with low shrinkable posterior composite (P90) and Group II (n = 75) restored with Ketac nano ionomer (N100). Each main group was divided into five groups (n = 15), then each group was further subdivided into three subgroups (n = 5) according to the storage time (immediately, three months, and six months). All teeth would be tested at both occlusal and gingival margins of prepared class V cavity according to the method of cavity preparation. ResultsA high significant difference was found in the mean ranks of micro-leakage at both occlusal enamel and gingival dentin walls among Groups 1–5 (p-value of <0.05). For main groups that restored with low shrinkable composite resin material (P90) and Ketac nano ionimer (N100), results revealed that scores of micro-leakage between (P90) or (N100) and both occlusal enamel or gingival dentin walls were significantly higher in group (AS1P1) than those in groups (B), (AS1P2), and (AS2P2) respectively. While no statistical significant difference was detected between groups (AS1P1) and (AS2P1). High scores of micro-leakage were detected at groups with six months, three months and immediately storage time respectively. ConclusionLow shrinkable silorane based composite yielded better results of micro-leakage scores along the occlusal enamel and gingival dentin walls when the cavity of class V was prepared with air abrasion technique with large size alumina particles under high pressure at immediate storage time as compared with Ketac N100.

Evaluation of Micro Leakage of Two Direct Esthetic Restorations with Different Preparation Techniques

Objectives: In recent times, the term “minimal intervention dentistry” has coined to describe a new approach to the treatment of the disease of caries. This study was carried out to evaluate the marginal integrity of class V cavity in permanent posterior teeth prepared with different air abrasion parameters compared with classical rotary cavity preparation. Methods: A total number of 150 sound caries for free human posterior teeth were used in this study. Teeth were extracted for periodontal disease or orthodontic reasons and the average age of patients between 20 - 35 years. Teeth were divided according to the type of restoration into two main groups: Group I (n = 75) restored with low shrinkable posterior composite (P90) and Group II (n = 75) restored with Ketac nano ionomer (N100). Each main group was divided into five groups (n = 15), then each group was further subdivided into three subgroups (n = 5) according to the storage time (immediately, three months, and six months). All teeth would be tested at both occlusal and gingival margins of prepared class V cavity according to the method of cavity preparation. Results: A high significant difference was found in the mean ranks of micro-leakageat both occlusal enamel and gingival dentin walls among Groups 1 - 5 (p-value of <0.05). For main groups that restored with low shrinkable composite resin material (P90) and Ketac nano ionimer (N100), results revealed that scores of micro-leakage between (P90) or (N100) and both occlusal enamel or gingival dentin walls were significantly higher in group (AS1P1) than those in groups (B), (AS1P2), and (AS2P2) respectively. While no statistical significant difference was detected between groups (AS1P1) and (AS2P1). High scores of micro-leakage were detected at groups with six months, three months and immediately storage time respectively. Conclusion: Low shrinkable silorane based composite yielded better results of micro-leakage scores along the occlusal enamel and gingival dentin walls when the cavity of class V was prepared with air abrasion technique with large size alumina particles under high pressure at immediate storage time as compared with Ketac N100.

Effects of Preheated Composite on Micro leakage-An in-vitro Study.

Resin composites have been the pinnacle of direct esthetic restorations ever since its discovery. However, it comes with its own disadvantages. Post-operative sensitivity and marginal discoloration frequently occur due to polymerization shrinkage and micro leakage, which is the major cause of failure in resin composite restorations. To evaluate the effects of preheated composite at different temperatures on microleakage. A total of 60 extracted non-carious human premolars were collected and class 1 cavity (1.5x4x 3mm) was prepared in each and were randomly divided into three groups. Group 1 (n=20) was filled with microhybrid resin composite (Heraeus Charisma Smile) at room temperature. Group 2 (n=20) was filled with the same resin composite which was preheated to 50°C and Group 3 (n=20) was filled with resin composite preheated to 60°C. Teeth were subjected to a thermocycling regime (500X, 5 - 55°C), followed by a dye infiltration by immersing in basic fuschin for 24 hours. The tooth was sectioned longitudinally and the extent or absence of micro-leakage was determined by the amount of dye penetration along the resin composite-tooth interface using a confocal microscope. There was minor micro-leakage detected at the occlusal margin of the control tooth specimen. The sample with preheated composite restoration at 50°C showed an intact tooth-restoration interface with no micro leakage. However, the preheated composite at 60°C showed large amount of microleakage. Under the current limitation of the study, preheated composite at 50°C showed the least micro-leakage.

Color stability and polymerization behavior of direct esthetic restorations.

The current study evaluated the effect of accelerated artificial aging (AAA) on the color stability (CS) and degree of conversion (DC) of nanofilled and nanohybrid resin composites associated to different adhesive systems in direct esthetic restorations. Eighty bovine incisors were used to obtained dentin blocks (4 × 4 × 1 mm). The restorative systems were bonded to the blocks and photoactivated according to the manufacturer's instructions. Three adhesive systems were used: Adper Scotchbond Multi-Purpose (conventional of three steps), Tetric N-Bond (conventional of two steps) and ClearFill SE Bond (self-etching). Also, two composites were used: Filtek Z350 XT (nanofilled) and IPS Empress Direct (nanohybrid). The restorations were made using a silicone mold placed on top of the prepared dentin blocks (N = 10). CS was measured after 300 hours of AAA by means of ultraviolet light using a spectrophotometer and CIE L*a*b* parameters on the top surface of the composite and at the bonded interface. The DC was performed using Fourier transform infrared spectroscopy (N = 10). Data were analyzed using two-way analysis of variance and Tukey's test (α = 0.05). The adhesive systems had no significant influence on the color stability (ΔE) of either the restoration surface (α = 0.90) or the bonded interface (α = 0.78). However, composite influenced the color as measured by ΔE and isolated coordinates (α < 0.001). The nanohybrid composite showed increased DC values (67%) compared with the nanofilled (61%) with statistically significant differences (α < 0.001). The adhesive system did not affect the final color of direct esthetic restorations. The nanohybrid composite demonstrated a higher DC and increased color stability after AAA compared to the nanofilled composite. The long-term color stability of composite restorations is a critical aspect of esthetic restorative procedures. Optimal Polymerization behavior of resin composite as indicated by the degree of conversion also influence on the color stability after artificial aging of composite restorations.

Evaluation of Compressive Strength and Microhardness of Composites Associated to Light Curing Characterizing Materials

ABSTRACT Aim This study evaluated the microhardness and compressive strength of composite and light curing characterizing materials (LCCMs) by intrinsic technique. Materials and methods Eighty composite specimens with a cylindrical shape were prepared and divided into eight groups (n = 10): Group E—composite-Enamel shade (ES); Group T— composite-Translucent shade (TS); Group W—White Tetric Color Pigment (Ivoclar/Vivadent) LCCM; Group B—Black Tetric Color Pigment (Ivoclar/Vivadent) LCCM; Group E/W/E—TS/ White Tetric Color Pigment LCCM/ES; Group E/B/E—ES/ Black Tetric Color Pigment LCCM/ES; Group E/W/T—ES/White Tetric Color Pigment LCCM/TS; Group E/B/T—ES/Black Tetric Color Pigment LCCM/TS. The specimens were submitted to a microhardness and compressive strength tests. Data were subjected to ANOVA, Tukey tests (5%) and pearson correlation. Results and conclusion There were significant differences among the groups (p = 0.00). The Pearson correlation showed a p = 0.85. The mean values for microhardness: Group E—73.30a; Group T—66.47b; Group E/W/T—63.71bc; Group E/W/E—62.08bc; Group E/B/E—57.47c; Group E/B/T—55.61c; Group W—39.69d; Group B—37.87d. The mean values for compressive strength: Group E—493.12a; Group T—481.96a; Group E/B/E—359.45b; Group E/W/T—358.64b; Group E/B/T— 357.01b; Group E/W/E—353.73b; Group W—136.62c; Group B—41.22d. The use of LCCM by intrinsic technique reduced the microhardness and compressive strength of composite. There is a strong correlation between microhardness and compressive strength. Clinical significance The use of light curing characterizing materials combined with direct resin restorations can adversely reduce microhardness and compressive strength of direct esthetic restorations. How to cite this article Barcellos DC, Batista GR, Pleffken PR, Valera MC, Torres CRG, de Araújo MAM. Evaluation of Compressive Strength and Microhardness of Composites Associated to Light Curing Characterizing Materials. World J Dent 2014;5(1):6-10.

Direct Esthetic Restorations Based on Translucency and Opacity of Composite Resins

Light dynamics is a relevant phenomenon with respect to esthetic restorations, as incorrect analysis of the optical behavior of natural dentition may lead to potential clinical failures. The nature of incident light plays a major role in determining the amount of light transmission or reflection, and how an object is perceived depends on the nature of the light source. Natural teeth demonstrate translucency, opalescence, and fluorescence, all of which must be replicated by restorative materials in order to achieve clinical success. Translucency is the intermediary between complete opacity and complete transparency, making its analysis highly subjective. In nature, the translucency of dental enamel varies from tooth to tooth, and from individual to individual. Therefore, four important factors must be considered when appraising translucency. Presence or absence of color, thickness of the enamel, degree of translucency, and surface texture are essential components when determining translucency. State-of-the-art resin composites provide varying shades and opacities that deliver a more faithful reproduction of the chromaticity and translucency/opacity of enamel and dentin. This enables the attainment of individualized and customized composite restorations. The objective of this article is to provide a review of the phenomena of translucency and opacity in the natural dentition and composite resins, under the scope of optics, and to describe how to implement these concepts in the clinical setting. Choosing composite resins, based on optical properties alone, in order to mimic the properties of natural tooth structures, does not necessarily provide a satisfactory esthetic outcome. In many instances, failure ensues from incorrect analysis of the optical behaviors of the natural dentition as well as the improper use of restorative materials. Therefore, it is necessary to implement a technique that enables a restorative material to be utilized to its full potential to correctly replicate the natural teeth.

COMMENTARY. direct esthetic restorations based on translucency and opacity of composite resins

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Effect of light-activation methods and water storage on the flexural strength of two composite resins and a compomer

The present study evaluated the flexural strength of three composite resins recommended for direct esthetic restorations: a polyacid modified composite (Dyract AP), a unimodal composite resin (Filtek Z250) and a hybrid composite resin (Point 4). The variation factors, apart from the type of composite resin, were the light activation method and the water storage period. The composite resins were light-cured in continuous mode (40 s, 500 mW/cm2) or in ramp mode (0-800 mW/cm2 for 10 s followed by 30 s at 800 mW/cm2) and stored for 24 hours or 30 days in distilled water at 37 degrees C. The data were analyzed by ANOVA and Tukey test for multiple comparisons (alpha = 0.05). The composite resin Z250 presented the highest mean flexural strength (166.74 MPa) and Dyract AP presented the lowest one (129.76 MPa). The storage for 30 days decreased the flexural strength in ramp mode (24 h: 156.64 MPa; 30 days: 135.58 MPa). The light activation method alone did not lead to different flexural strength values.

The evaluation of amalgam and composite restorations in Mosul private clinics

The aim of this study was to evaluate amalgam and composite resin restorations work in private practice in Mosul City. A list of dentist practicing in private clinics was obtained from the Iraqi Dental Association in Mosul City. One hundred sixty dentists involved in the questionnaire were selected rand-omly from a total of 200 dentists in the list supplied. The questionnaire concerned with the step–by–step restorative treatment including diagnosis and case selection, cavity preparation, types of liners and ba-ses used, amalgam restoration and direct esthetic restorations. The results revealed that 100% of the respondents perform restorative dental therapy in their private clinics. The results also revealed an evaluation (as percentage) for most of steps concerned with direct restorative techniques.

Method for Immediate Measurement of In Vitro Bond Strength of Bonded Direct Esthetic Restorations

There are many different ways to measure the bond strength of direct esthetic restorations to various dental substrates. Unfortunately, most methods cannot measure bond strengths immediately after a restoration has been placed. This lack of clinically-relevant information seriously affects the clinician's ability to select and use various bonding agents and procedures. The aim of this article is to provide a very detailed method for immediate measurement of in vitro bond strengths of direct bonded esthetic restorations. It focuses on the steps that should be taken to select and prepare various tooth substrates for bond strength testing, the steps to "restore" various tooth substrates, and to measure the immediate in vitro bond strength. A fundamental understanding of a standardized testing protocol should provide clinicians with a clearer appreciation of bond strengths associated with various bonding procedures.

Immediate and 24-Hour Bond Strengths of Two Dental Adhesive Systems to Three Tooth Substrates

Bond strengths of bonded composite resins to tooth substrates vary depending on when they were measured. Most bond strengths reported in the literature are a result of one hour, 24-hour, or longer periods of time that do not simulate actual clinical practice when occlusal adjustment and finishing and polishing procedures are performed within seconds after restoration placement. There are many different ways to measure the bond strength of direct esthetic restorations to various dental substrates. This research uses a method published previously that compares immediate and 24-hour bond strengths of a single-bottle dental adhesive and a self-etching primer adhesive to prepared enamel, unprepared enamel, and prepared dentin substrates. Significant differences were found between immediate and 24-hour bond strengths, but there were essentially no differences between substrates or adhesives.