Modified Ryge Criteria Research Articles

Follow-up of first permanent molar restorative treatment with and without Molar Hypomineralization.

Hypomineralization (MH) are controversial. The aim of this study was to compare need for treatment and status of restorations performed on first permanent molars in patients with and without MH. Retrospective design based on the clinical records of 153 patients who had received comprehensive care in 2014 at the Clinic of the Children's Comprehensive Dentistry Department (FOUBA) by 3 pediatric dentists (Kappa MH 0.94), and who attended periodical follow-up visits for at least 24 months. Need for treatment in first molars, and type and longevity of treatment were recorded (modified Ryge criteria /USPHS, Kappa 0.78). Results were compared between patients with MH and without MH. The Kruskal Wallis test was used to compare follow-up time, the asymptotic test was performed to compare proportions, and relative risk (RR) was calculated to compare need for treatment. Mean follow-up times for the 595 teeth analyzed were 61.7±20.1 months for Group without MH, and 57.5±23.9 months for Group with MH (p=0.0504). The percentages of teeth requiring at least one treatment were 7.2% in Group without MH and 27.5% in Group with MH (RR = 3.80, p <0.001). Of the teeth treated in Group with MH 23.1% required retreatment, while none of the teeth in Group without MH did. The need for treatment was approximately 4 times higher in molars affected with MH, with greater probability of retreatment.

ОNE-YEAR CLINICAL EVALUATION OF THE CARIES-PREVENTIVE EFFECT OF GLASS-IONOMER SEALANT ON NEWLY ERUPTED FIRST PERMANENT MOLARS IN CHILDREN

Background: Dental sealant is a material that is applied to pits and fissures in order to prevent the occurrence of occlusal dental caries. The caries-prophylactic effect of sealants on a glass-ionomer basis has not been sufficiently studied, which motivates us to conduct our research. Purpose; To monitor the caries-preventive effect of a glass-ionomer-based sealant after silanization of the newly erupted first permanent molars in children aged 5-6 years. Materials and methods: We started the study with 78 healthy, newly erupted first permanent molars (silanized with Fuji triage, GC), the follow-up was performed at 3,6 and 12 months by visual method on the ICDAS II system, diagnostics under magnification using VistaCam Macro and modified Ryge criteria. After recoding the data obtained from monitoring the occlusal surfaces of the newly erupted first permanent molars, we performed a frequency analysis of the data depending on the absence or presence of caries. Results: In the group of 5-6-year-olds after the application of glass-ionomer-based sealant in the newly erupted first permanent molars, one year after application of the sealant, we assessedver 95% of the examined surfaces as healthy with all diagnostic methods that we used. Conclusion: Glass-ionomer cements used for silanization are the main tool of choice when it is impossible to control moisture, as is the case with newly erupted molars. Despite their significantly low retention, they provide an excellentaries-prophylactic effect.

36 Months’ Clinical Performance of Primary Incisors Restorations Depending on the Type of Restorative Technique Used: A Randomized Controlled Trial

Background: Depending on the stage of the disease and the child’s age, different types of interventions can be used to treat early childhood caries. As a result, there is not enough clinical evidence to show that one kind of restoration is better than another. The objective of this longitudinal study was to compare the results of 36 months of clinical performance of primary incisors restorations using an incremental layering technique with the ceram.x® SphereTECTM nanoceramic composite (Dentsply) or a full coverage technique with transparent strip crowns (Frasaco GmbH) with the same composite in children with or without biological caries risk factors. Methods: 80 patients (females 42/52.5%) were included in the study. A total of 160 restorations were performed. Restorations were evaluated at baseline and at 6, 12, 24, and 36 months, according to modified Ryge criteria. Conclusion: Restorations with both techniques were clinically highly successful and showed similar clinical performance at postoperatively regardless of the presence of biological factors of caries risk.

Restorative Direct Management of Cavitated Proximal Carious Lesions of Permanent Molars using Elastic Separators in Children and Adolescents

Purpose: The purpose of this study was to assess the longevity of direct amalgam and composite restorations placed on the mesial surface of permanent molars after separation with elastic separators. Design: One hundred and seventy seven (177) restorations placed on the mesial surfaces of first and second permanent molars in 140 patients aged 10-25 years-old (median age 12.2 years) were followed for a period of 1 to 12 years (median time 4.3 years). Eighty four (84) amalgam and 93 composite resin restorations were placed randomly on carious lesions that were detected by bite-wing x-rays at the dentino-enamel junction and verified as cavitated after tooth separation. Restorations were evaluated clinically according to the modified Ryge criteria. Flexible parametric proportional-hazards and proportional-odds models for censored survival data was used to analyze the data, with application to prognostic modelling and estimation of treatment effects at 95% CI. Results: Of the 177 restorations, 13 (7.2%) failed in a median time to failure of 8.8 years. There was no statistically significant difference on the cumulative median time to failures between amalgam and composite while statistically significant difference was found between patients that were using fluoride mouthrinse or not (p<0.048) and if there was bleeding detected at the interproximal area of the restoration or not (p<0.001). Conclusions: Restorative management of cavitated proximal carious surfaces of permanent teeth with amalgam or composite resin, using elastic separators, seems to be a very good and promising alternative technique in the context of the minimal invasive dentistry in children and adolescents.

Flowable Bulk-Fill Materials Compared to Nano Ceramic Composites for Class I Cavities Restorations in Primary Molars: A Two-Year Prospective Case-Control Study.

Background: The aim of this split-mouth study is to compare the results of 24 months’ clinical performance of primary molar Class I restorations with a nano-ceramic composite, Ceram•X mono (Dentsply) with a flowable bulk-fill material regular viscosity, SDR (Dentsply). Methods: Following the ethical approval, 27 patients with at least two class I cavities in primary molars were included in the study. A total number of 54 restorations were conducted (n = 27 for Ceram X and n = 27 for SDR). Restorations were evaluated at baseline, 6, 18, and 24 months, according to the modified Ryge criteria. The cavosurface marginal discoloration and color match were evaluated visually after air-drying the tooth and after removing the plaque (if necessary). Results: At 24 months’ follow-up, 54 restorations showed similar clinical performance. The statistical analysis did not reveal any statistical significance in the values between the groups in 7 out of 7 modified Ryge criteria. However, two restorations in both groups received Bravo ratings in the cavosurface marginal discoloration scoring. No side effects were reported by the participants of the study. Conclusion: Restorations with both materials (Ceram•X mono and SDR) have provided almost identical results.

Clinical Performance of Self- Adhering Flowable Composite in Class V Restorations with EDTA Surface Pretreatment: Three Years Evaluation

Aim: This randomized clinical study evaluated and compared the three years clinical performance of self-adhering flowable composite with or without EDTA surface treatment in Class V restorations. Materials and Methods: Thirty patients, each with three moderate cervical carious lesions, were enrolled in the present single – center study. Total 90 restorations were randomly assigned by one operator not involved in the restoration or the evaluation procedures, in each patient, one lesion was allocated to be restored using self-adhering flowable composite (Fusio liquid Dentin (FL)) without surface treatment, the second using self-adhering flowable composite (Fusio liquid Dentin after EDTA(EFL)) surface treatment, the third to be restored using conventional flowable composite (Tetric Flow (FF)). The allocation sequence of restorations was concealed from the operator in sealed and stapled envelopes. A single operator restored all the preparations according to the manufacturer’s instructions. The restorations were finished and polished immediately after placement. Clinical evaluation was performed at one week, six, 12,18,24,30, and 36 months, by independent examiner according to United States Public Health Services (USPHS), modified Ryge criteria. Statistical analysis was performed by IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY: IBM Corp. Results: Two cases could not be reassessed at 18 and 30 months follow up. Time significantly affects the clinical performance within the tested groups except the marginal integrity criterion with the EFL group. However there was significant different between the three groups at 36 months interval in marginal discoloration, marginal integrity criteria. No significant differences were observed between the tested materials from baseline to those of three years in the other USPHScriteria. Conclusions: Self-adhering light cured resin composite achieved clinical acceptable performance at three years follow up interval. The combination of EDTA/ self-adhering light cured resin composite reveals enhancement of the clinical stability and durability of the restorations over time.

CLINICAL EVALUATION OF OSCILLATION METHOD FOR APPLICATION OF A PACKABLE COMPOSITE RESIN

INTRODUCTION: Despite all improvements in dental composites, marginal microleakage is one of the most common causes of resincomposite restoration failure. In order to address this concern, efforts have been focusing on dealing with different aspects of composite consistency, polymerization stresses and packing techniques. OBJECTIVES: The aim of this work is to clinically evaluate the effect of two oscillating packing instruments (ET3000 & Compothixo) on improving the outcome and the longevity of Quixfil dental packable composite in the everyday practice of general practitioners without the need for placing flowable composite underneath it. MATERIALS AND METHODS Twenty patients were selected according to specific inclusion and exclusion criteria to participate in this study. Each patient received three posterior class II cavities preparations. The cavities were divided into three groups (n=20 each) according to the method of composite packing. Test Group I: Quixfil packable composite packed with ET3000, Test Group II: Quixfil packable composite packed with Compothixo & Group III (Control): incremental placement of Quixfll composite. The twenty patients were followed up for one and a half years according to modified RYGE Criteria. All the data obtained were then statistically analyzed using Friedman test at significance level 5% (P< 0.05). RESULTS: All restorations evaluated in this study demonstrated acceptable clinical performance within the evaluation period based on the Alfa and Bravo ratings for clinically satisfactory restorations. Statistical analysis detected no significant differences between the packing techniques. CONCLUSIONS: Good clinical results can be achieved with oscillation packing techniques when using QuiXfil packable posterior composite.

Comparison of retention of two proximal sealants in mandibular first molars of 12-year-old school children - A split-mouth randomized trial

Aim: This study was done to assess and compare the retention properties of a proximal sealant made of polyurethane dimethacrylate and a resin-based adhesive system for sealing proximal surfaces of permanent mandibular first molars in 12-year-old children over a period of 6 months. Methodology: A split-mouth randomized trial was conducted among 50 school children. Pre-operative and post-operative bitewing radiographs were taken bilaterally prior at baseline and the end of the sixth month. Separators were placed for those children who did not have physiological spacing. The interventions were delivered on the left and right sides after randomization as per the manufacturer’s instructions, and post-operative instructions were given to the participants. The interventions were assessed for retention primarily and other criteria such as color match, marginal discoloration, marginal adaptation, anatomic form, caries formation (using bitewing radiographs), post-operative sensitivity, and surface roughness at the end of the 1st, 3rd, and 6 months using United States Public Health Service Modified Ryge Criteria for Direct Clinical Evaluation of Restorations proposed by Cvar and Ryge, 1980. The data were compiled, analyzed using SPSS and results were generated. Conclusions: The study results revealed that the resin-based adhesive system was better than the adhesive patch in terms of retention over a period of 6 months. Hence, the feasibility of including proximal sealants as a part of the preventive regimen for caries risk children should be positively considered.

Performance of Self-adhering Flowable Composite in Class V Restorations: 18 Months Clinical Study

The present randomized clinical study compared the 18 months performance of self-adhering flowable composite with a conventional flowable composite in anterior Class V restorations. Totally, 20 patients, each with two moderate cervical carious lesions, participated in this single-center study. Forty restorations were allocated on a random basis by one examiner not involved in the restoration or the evaluation procedures, In each patient, one lesion was allocated to be restored using self-adhering flowable composite [Fusio liquid dentin (FL)] and the other to be restored using conventional flowable composite [Tetric Flow (FF)]. The allocation sequence of the restorations was concealed from the operator in sequentially numbered, opaque, sealed, and stapled envelopes. An operator restored all the preparations in accordance to the manufacturer's instructions. Finishing and polishing of the restorations were done immediately after placement. Evaluation of the restorations was done in accordance to the United States Public Health Services (USPHS), modified Ryge criteria. Statistical analysis was completed with Statistical Package for the Social Sciences (SPSS) version 20.0 (IBM Product, Chicago, USA). One case could not be reassessed at 18 months follow-up in both groups. No significant differences were detected between the tested materials from baseline to those of 18 months using the modified USPHS criteria. Self-adhering flowable composite exhibited acceptable clinical performance comparable with the conventional flow-able composite in anterior Class V restorations over an 18-month period. Nevertheless, the findings of this study must be validated by a longer clinical study. Self-adhering flowable composite exhibited clinical performance comparable with the conventional flowable composite in Class V restoration.

Prospective cohort clinical study assessing the 5-year survival and success of anterior maxillary zirconia-based crowns with customized zirconia copings

Statement of problemStudies evaluating anterior zirconia-based crowns are limited. PurposeThe purpose of this prospective cohort clinical study was to assess the efficacy of zirconia-based anterior maxillary crowns with 0.3-mm customized copings at the cervical third and anatomical design elsewhere for up to 5 years of service. Material and methodsEighteen participants who required an anterior maxillary crown (n=20) and who had signed a consent form approved by the University of Washington Health Sciences Center Human Subjects Division were enrolled. All preparations were standardized and prepared with an occlusal reduction of 1.5 to 2 mm and an axial reduction of 1 to 1.5 mm with 10 degrees of convergence angle. All finish lines were located on the sound tooth structure. Zirconia copings (Lava; 3M ESPE) were custom designed and milled to a 0.3-mm thickness at the cervical third and with selective thickness elsewhere to support the veneering porcelain. All restorations were luted with self-etching self-adhesive composite resin cement. Recall appointments were at 2 weeks, 6 months, and 12 months, and annually thereafter for 5 years. Modified Ryge criteria were used to assess the clinical fracture measurements, esthetics, marginal discoloration, marginal adaptation, radiographic proximal recurrent caries, and periapical pathoses. Descriptive statistics and 95% confidence intervals were used to describe the number and rate of complications and self-reported satisfaction with the crowns. ResultsTwenty crowns with a mean follow-up of 58.7 months were evaluated. All crowns were rated as Alfa for fracture measurements (smooth surface, no fracture/chipping). Twelve crowns were rated esthetically as Romeo (no mismatch in color and shade) and 8 as Sierra (mismatch in color and shade within normal range). Twelve crowns were rated as Alfa (no visible evidence of crevice) and 8 as Bravo (visible evidence of crevice, no penetration of explorer) for marginal integrity. Nineteen were rated as Alfa (no discoloration) and 1 as Bravo (superficial discoloration) for marginal discoloration. No proximal caries or periapical pathoses were detected in 5 years. Participants were highly satisfied with their crowns after 5 years (mean ±SD: 9.8 ±0.4 on 0 to 10 scale). ConclusionsZirconia-based anterior maxillary crowns with customized copings with 0.3-mm thickness at the cervical third and zirconia margins performed well after 5 years of service.

Clinical acceptability of metal-ceramic fixed partial dental prosthesis fabricated with direct metal laser sintering technique-5 year follow-up.

Statement of Problem:In recent years, direct metal laser sintered (DMLS) metal-ceramic-based fixed partial denture prostheses have been used as an alternative to conventional metal-ceramic fixed partial denture prostheses. However, clinical studies for evaluating their long-term clinical survivability and acceptability are limited.Aims and Objective:The aim of this study was to assess the efficacy of metal-ceramic fixed dental prosthesis fabricated with DMLS technique, and its clinical acceptance on long-term clinical use.Materials and Methods:The study group consisted of 45 patients who were restored with posterior three-unit fixed partial denture prosthesis made using direct laser sintered metal-ceramic restorations. Patient recall and clinical examination of the restorations were done after 6months and every 12 months thereafter for the period of 60 months. Clinical examination for evaluation of longevity of restorations was done using modified Ryge criteria which included chipping of the veneered ceramic, connector failure occurring in the fixed partial denture prosthesis, discoloration at the marginal areas of the veneered ceramic, and marginal adaptation of the metal and ceramic of the fixed denture prosthesis. Periapical status was assessed using periodical radiographs during the study period. Survival analysis was made using the Kaplan–Meier method.Results:None of the patients had failure of the connector of the fixed partial denture prostheses during the study period. Two exhibited biological changes which included periapical changes and proximal caries adjacent to the abutments.Conclusion:DMLS metal-ceramic fixed partial denture prosthesis had a survival rate of 95.5% and yielded promising results during the 5-year clinical study.

Evaluation of the clinical success of class I cavities prepared by an Er:YAG laser-5-year follow-up study.

The purpose of this study was to evaluate, after 5 years, the clinical success of preparing class 1 composite resin restorations with an Er:YAG laser. Sixty-five teeth of 30 patients were included in the study, and an Er:YAG laser emitting at a wavelength of 2.94 μm was used for the class I cavity preparations with not more than one third of the mesiodistal width of the occlusal surfaces of each tooth. All cavities were restored with a light-cured composite resin, following a single bond application. After the baseline examination, restorations were reevaluated by the same experienced clinician after 5 years, using the modified Ryge criteria. At the end of 5 years, 41 of the 65 restorations were evaluated in 22 patients and scored. With respect to marginal discoloration, anatomic form, color match, and surface texture, significant differences were found between baselines tested after 5 years. Clinical evaluation of postoperative sensitivity showed that 90.2 % were rated as alpha. All restorations evaluated in this study demonstrated acceptable clinical performance within the evaluation period based on the alpha and bravo ratings for clinically satisfactory restorations. Further evaluations are necessary for a better clinical performance analysis.

A 4-year clinical evaluation of direct composite build-ups for space closure after orthodontic treatment.

To evaluate the medium-term clinical performance of direct composite build-ups for diastema closures and teeth recontouring using a nano and a nanohybrid composite in combination with three- or two-step etch-and-rinse adhesives following treatment with fixed orthodontic appliances. A total of 30 patients (mean age, 19.5 years) received 147 direct composite additions for teeth recontouring and diastema closures. A nano and a nanohybrid composite (Filtek Supreme XT and CeramX Duo) were bonded to tooth structure by using a three-step (Scotchbond Multipurpose) or a two-step (XP Bond) etch and rinse adhesive. Ten out of 147 composite build-ups (composite addition) constituted tooth recontouring cases, and the remaining 137 constituted diastema closure cases. The restorations were evaluated by two experienced, calibrated examiners according to modified Ryge criteria at the following time intervals: baseline, 1, 2, 3, and 4 years. The 4-year survival rates were 92.8 % for Filtek Supreme XT/Scotchbond Multi-Purpose Plus and 93 % for CeramX Duo/XP Bond. Only ten restorations failed (5 Filtek Supreme XT and 5 CeramX Duo). Statistical analysis revealed no significant differences between the two composite-adhesive combinations with respect to color match, marginal discoloration, wear/loss of anatomical form, caries formation, marginal adaptation, and surface texture on comparing the five time periods (baseline, 1, 2, 3, and 4 years) The 4-year survival rates in the present study were favorable. The restorations exhibited excellent scores with regard to color match, marginal adaptation, surface texture, marginal discoloration, wear/loss of anatomical form, and caries formation, after 4 years of clinical evaluation. Clinical relevance An alternative clinical approach for correcting discrepancies in tooth size and form, such as performing direct composite restorations following fixed orthodontic treatment, may be an excellent and minimally invasive treatment.

Selective or stepwise removal of deep caries in deciduous molars: study protocol for a randomized controlled trial.

BackgroundFor treating deep caries lesions, selective or stepwise (one- and two-step) incomplete excavation seems advantageous compared with complete caries removal. However, current evidence regarding the success, as defined by not requiring any retreatments, or survival of teeth after different excavations is insufficient for definitive recommendation, especially when treating deciduous teeth. Moreover, restoration integrity has not been comparatively analyzed longitudinally, and neither patients’, dentists’ or parents’ preferences nor the clinical long-term costs emanating from both initial and retreatments have been reported yet.Methods/DesignThe planned study is a prospective multicenter, two-arm parallel group, randomized controlled clinical trial comparing selective and stepwise excavation in deciduous molars with deep, active caries lesions without pulpal symptoms. We will recruit 300 children aged between three and nine-years-old with a minimum of one such molar. Patients participating in another study, or those with systemic diseases, disabilities or known allergies to used materials as well patients with teeth expected to exfoliate within the next 18 months will be excluded. After inclusion, sequence generation will be performed. Initial treatment will follow dental routine. During excavation, leathery, moist and reasonably soft dentin will be left in proximity to the pulp followed by adhesive restoration of the cavity. Afterwards, patients’, dentists’ and parents’ subjective assessment of the treatment will be recorded using visual analogue or Likert scales. Re-examination will be performed after six months, and only then teeth will be allocated to one of the two interventions. Selectively excavated teeth will not be treated further, whilst for stepwise caries removal, a second excavation will be performed until only hard dentin remains. Clinical re-evaluations will be performed after 12, 24 and 36 months. Restorations will be reassessed using modified Ryge criteria. Objectively or subjectively required retreatments will determine success and survival. Retreatments will be evaluated both subjectively and regarding generated costs.DiscussionBased on the results of the trial, decision-making for treating deep caries lesions in deciduous molars based on multiple criteria should be feasible.Trial registrationClinicaltrials.gov identifier: NCT02232828 (registered on 29 November 2014).

Clinical Marginal and Internal Adaptation of Maxillary Anterior Single All-Ceramic Crowns and 2-year Randomized Controlled Clinical Trial.

The aims of this randomized-controlled clinical trial were to compare marginal and internal adaptation of all-ceramic crowns fabricated with CAD/CAM and heat-pressed (HP) techniques before luting and to evaluate the clinical outcomes at baseline and at 6, 12, and 24 months after luting. Fifteen CAD/CAM (CC) and 15 HP all-ceramic crowns were placed in 15 patients. A silicone replica was obtained to measure marginal and internal adaptation of each all-ceramic crown before luting, and they were sectioned buccolingually and mesiodistally. Marginal and internal adaptations were measured using computerized light microscope at 40× magnification. Clinical evaluations took place at baseline (2 days after luting) and at 6, 12, and 24 months after luting. Replica scores were analyzed with Mann-Whitney U and Student's t-test (α = 0.05). Survival rate of crowns was determined using Kaplan-Meier statistical analysis. The median marginal gap for the CC group was 132.2 μm and was 130.2 μm for the HP group. The mean internal adaptation for the CC group was 220.3 ± 51.3 μm and 210.5 ± 31 μm for the HP group. There were no statistically significant differences with respect to marginal opening (Mann-Whitney U test; p = 0.95) and internal adaptation (Student's t-test; p = 0.535) between the 2 groups. Based on modified Ryge criteria, 100% of the crowns were rated satisfactory during the 2-year period. In this in vivo study, CAD/CAM and HP all-ceramic crowns exhibited similar marginal and internal adaptations. A 100% success rate was recorded for the 15 CAD/CAM and for the 15 HP all-ceramic crowns during the 2-year period.

One-Year Evaluation of a Simplified Ethanol-Wet Bonding Technique: A Randomized Clinical Trial

The objective of this randomized clinical trial was to evaluate the clinical performance of adhesive restorations using a three-step etch-and-rinse adhesive (TSER), a one-step self-etching adhesive (OSSE), and a simplified ethanol-wet bonding technique (EWBT) prior to the application of a composite resin in non-carious cervical lesions. Ninety-three restorations (31 for each group) were placed in 17 patients by a single operator. No cavity preparation was performed. After 6 and 12 months, the restorations were assessed by two previously trained examiners using modified Ryge criteria for retention (kappa=1.00) and marginal adaptation/staining (kappa=0.81), and the results were analyzed by Fisher's exact and Kruskal-Wallis tests, respectively. No significant differences were observed among groups at the 6- and 12-month time points for any of the assessed criteria (p≥0.05). The intra-group analysis performed by Cochran's test (for retention) and Wilcoxon test (for marginal adaptation/staining) revealed significant differences between the baseline/12-month time intervals in marginal adaptation in OSSE (p=0.0180) and in marginal staining in TSER (p=0.0117). The survival analysis for retention criteria performed using a log-rank test did not show significant differences (p>0.05). The restorations placed using the simplified EWBT performed equally well as the other adhesive strategies employed.

Restoration of primary anterior teeth using intracanal polyethylene fibers and composite: an in vivo study.

To evaluate the clinical performance of polyethylene fiber for anterior primary teeth restorations in children after 2.5 years, according to modified Ryge criteria. Fifty-five maxillary incisors with extensive caries in 24 Iranian patients (mean age 4.2 years) were restored. All teeth were treated endodontically. First, 4-mm layer of paste at the entrance of canal was removed, and a thin base layer of polycarboxylate cement was placed at the bottom of the prepared canal. All tooth surfaces were etched, rinsed and dried, and the dentin adhesive Single Bond (3M ESPE, St Paul, MN, USA) was applied. The teeth received intracanal fiber-reinforced resin (Ribbond Triaxial, Seattle, WA, USA) fixed with a flowable composite and the crowns were reconstructed with microhybrid composite resin (Z250, 3M). All restorations were evaluated every 6 months for 30 months by 2 independent evaluators. Statistical analysis was done with McNemar's test. The surface textures for most of the restorations were judged as excellent. There was no evidence of significant changes in marginal integrity. Most restored incisors (81%) received an Alpha rating for retention. The baseline and recall retention scores differed significantly (p=0.002). Polyethylene fiber posts associated with extensive composite restoration showed excellent clinical performance after 2.5 years in primary anterior teeth after pulp therapy.

A prospective, randomized clinical trial of a two-step self-etching vs two-step etch-and-rinse adhesive and SEM margin analysis: four-year results.

The aim of this blinded, randomized, prospective long-term study was to evaluate the clinical performance of the two-step self-etching adhesive AdheSE (AS, Ivoclar Vivadent) compared to the etch-and-rinse adhesive system Excite (EX, Ivoclar Vivadent) in combination with the hybrid resin composite Tetric Ceram HB (Ivoclar Vivadent) for Class I and II restorations. In accordance with a split mouth design, 50 patients received 100 restorations in premolars and molars. The restorations were assigned at random to the self-etching (AS) or the etch-and-rinse (EX) group. Each restoration was scored according to the modified Ryge criteria at baseline and after 6, 12, 24 and 48 months. Epoxy resin replicas of 60 restorations were made at each observation period for an additional SEM analysis of the occlusal margins. After 4 years, 60 of 100 restorations could be evaluated. The cumulative survival rate for group EX was 100% and for group AS 96.7%. One restoration in group AS had failed due to marginal gap formation. For the criterion marginal adaption in group AS, significantly more bravo ratings (30%) were observed after 4 years compared to group EX (6.7%) (p < 0.05; Mann-Whitney U-test). The results of the SEM margin analysis revealed no significant differences between groups AS and EX (Mann-Whitney U-test; p > 0.05). Both adhesive systems performed satisfactorily over the four-year observation period. A significant deterioration over time was found for the criterion marginal adaption in AdheSE.

Comparison of different methods for evaluating resin composite restorations in posterior teeth

Aim: To compare different methods for evaluating composite resin restorations in posterior teeth and to evaluate the reliability of each method by determining the intraobserver agreement. &#x0D; Material and methods: 136 class I resin composite restorations were evaluated by a trained examiner using modified Ryge criteria to assess selected restoration characteristics with three different methods: clinical, photographic and dental cast models. &#x0D; Results: The results showed that intraexaminer agreement was better on dental cast models evaluations for marginal integrity and anatomic form and was similar between photographic and clinical evaluations for marginal integrity and marginal discoloration. Surface texture showed the lowest degree of intraexaminer agreement with all the methods tested. Direct clinical method and the two indirect methods were significantly different for all the characteristics assessed (p

Clinical efficacy of veneered zirconium dioxide-based posterior partial fixed dental prostheses: five-year results

In recent years, zirconium dioxide-based partial fixed dental prostheses (FDP) have been suggested as an alternative treatment to traditional metal ceramic FDPs. However, clinical studies evaluating their longevity and related complications are limited. The purpose of this cohort clinical study was to assess the efficacy of zirconium dioxide-based posterior 3-unit FDPs. Twenty 3-unit posterior FDPs (Lava) were placed in 16 participants missing a second premolar or a first molar. All participants met specific inclusion and exclusion criteria and provided informed consent. All teeth were prepared in a standardized manner: occlusal reduction of 1.5 to 2 mm; axial reduction of 1 to 1.5 mm; a 1.0 mm 360-degree rounded shoulder placed 0.5 mm subgingivally on the facial aspect and supragingivally on the lingual aspect on sound tooth structure; and rounded internal line angles. Definitive impressions were made with vinyl polysiloxane impression material. Frameworks were fabricated by using computer-aided design and computer-aided manufacturing (CAD/CAM) technology with a uniform retainer thickness of 0.6 mm and a minimal connector surface area of 9 mm(2). Restorations were luted with resin-modified glass ionomer cement (Rely-X Luting). Participants were recalled at 2 weeks, 6 months, and 12 months, and thereafter, annually for up to 60 months. Clinical fracture measurements, marginal discoloration, marginal adaptation, radiographic proximal recurrent caries, and periapical pathoses were assessed over time by using modified Ryge criteria. The probability distributions of these variables were calculated for the baseline data and for the recall data. An analysis of survival was made by using the Kaplan-Meier method. Eighteen FDPs were clinically evaluated at 5 years and 1 at 48 months. Fifteen were rated Alpha for fracture measurements, and 2 were rated Bravo (minor chipping of veneering porcelain and not requiring restoration replacement). Two were rated Charlie (major chipping of veneering porcelain and requiring restoration replacement). Eighteen FDPs were rated Alpha for marginal integrity, and 1 rated Bravo. All restorations were rated Alpha for marginal discoloration. One participant experienced root fracture after 60 months, while another was treated surgically for a periapical pathosis on an endodontically treated abutment. Zirconium dioxide-based posterior 3-unit FDPs performed well after 5 years of service.