Modified Ryge Criteria Research Articles

Microleakage, adaptation ability and clinical efficacy of two fluoride releasing fissure sealants

Retention of fissure sealants and good adaptation to enamel are essential for their success. Fluoride releasing resin-based materials are widely accepted for pit and fissure sealing, but newly designed glass ionomers can serve as a good alternative. The aim of this study was to evaluate microleakage and sealing ability in vitro, and to clinically assess two fluoride releasing fissure sealants. The sample for experimental study consisted of 20 freshly extracted intact human third molars, divided in two experimental groups according to the sealing material: fluoride releasing resin-based (Heliosel F) and glass ionomer (Fuji Triage) material. Digital images and scanning electron microscope were used to assess microleakage and adaptation ability. Sample for clinical study consisted of 60 children, aged 6-8 years, with high caries risk, divided in two groups according to the sealant material. Fissure sealant was applied to all erupted, caries-free first permanent molars. Sealants were evaluated after 3, 6 and 12 months using modified Ryge criteria for retention, marginal adaptation, colour match, surface smoothness and caries. Microleakage was detected in more than half of the specimen, without significant differences between the two groups (p > 0.05). Both materials exhibited acceptable sealing ability. Complete retention at the end of the observation period was 81.8% for resin-based, and 21.1% for glass-ionomer fissure sealant (p < 0.001). The presence of caries in sealed molars has been detected in one patient in both groups. During the 12-month observation period, Helioseal F demonstrated better retention, marginal adaptation and surface smoothness (p < 0.001). There were no differences between the two materials regarding caries and color match (p > 0.05). Both tested materials demonstrate satisfactory clinical and caries prophylactic characteristics that justify their use in contemporary preventive dentistry.

Survival rate of sealed, refurbished and repaired defective restorations: 4-year follow-up

The most common treatment in general dental practice is the replacement of restorations affected by secondary caries or marginal deficiencies. Alternative treatments to replacement of defective restorations, such as marginal sealing, refurbishment and repair, have demonstrated improvement of their clinical properties with minimal intervention. The aim of this clinical study was to estimate the median survival time (MST) of marginal sealing, repair and refurbishment of amalgam and resin-based composite restorations with localized defects as a treatment to increase the restoration longevity. A cohort of 66 patients, with 271 class I and II restorations clinically diagnosed with localized defects was longitudinally assessed. Each restoration was assigned to one of the following 5 groups: Marginal Sealing (n=48), Refurbishment (n=73), Repair (n=27), Replacement (n=42), and Untreated (n=81). Two calibrated examiners assessed the restorations at baseline and annually during 4 years, using the modified Ryge criteria: marginal adaptation, anatomic form, roughness, secondary caries and luster. Fifty-two patients with 208 restorations were assessed after 4 years; the distribution of restorations in the groups was as follows: Marginal Sealing (n=36), Refurbishment (n=63), Repair (n=21), Replacement (n=28) and Untreated (n=60). Kaplan Meier test indicated that the Sealed margins group showed the lowest MST while the Repair group showed the highest MST for restorations examined after 4 years of follow up. Defective amalgam and resin-based composite restorations treated by sealing of marginal gaps, refurbishment of anatomic form, luster or roughness, and repair of secondary caries lesions, had their longevity increased.

Eighteen-month clinical evaluation of microhybrid, packable and nanofilled resin composites in Class I restorations

The aim of this article was to report the results of an 18-month longitudinal randomized clinical trial that evaluated the clinical performance of microhybrid, packable and nanofilled resin composite restorations placed in Class I cavities of molar teeth. Three Class I resin composite restorations were placed in each of 35 patients. Each patient received one microhybrid ('Point 4'; Kerr, Orange, CA, USA), one packable ('Packable Premise'; Kerr, Orange, CA, USA) and one nanofilled ('Nanofilled Premise'; Kerr, Orange, CA, USA) resin composite restoration. Clinical evaluation was performed at baseline (2 weeks after placement), and after 6, 12 and 18 months after placement using modified Ryge criteria. No patients were lost from the study. At the final appointment (after 18 months), 95.4%, 93.7% and 96.2% respectively of the microhybrid ('Point 4'), packable ('Packable Premise' and nanofilled ('Nanofilled Premise') resin composite restorations received Alfa ratings. Regardless of the type of restorative material, no significant changes were observed in the modified Ryge criteria at the baseline and 18-month recalls (P <or=0.05). Three restorations (one from each group) exhibited post-operative sensitivity at the baseline and 6-month appointment. After 18 months, one packable resin composite restoration failed because of secondary caries, while secondary caries was not detected on any of the other restorations. The clinical performance of microhybrid ('Point 4'), packable ('Packable Premise') and nanofilled ('Nanofilled Premise') resin composite restorations was acceptable after 18 months. Further studies with longer follow-up periods are recommended to investigate the long-term survival of these restorations.

Two-Year Clinical Evaluation of Three Restorative Materials in Primary Molars

A variety of alternatives to amalgam are now available for use in Class I and Class II restorations in primary teeth, including glass ionomer cements, compomers and resin modified glass ionomer cements (RMGIC). This study evaluated the two-year clinical performance of three restorative dental materials: A resin modified glass ionomer cement (Fuji IILC), a compomer (Dyract AP) and a high viscosity glass ionomer cement (Fuji IX), in primary molars of pediatric patients with high caries risk activity and compared these results to those reported for amalgam restorations. One hundred and forty nine Class I and Class II cavities in 45 patients aged 6 to 8 years were restored with compomer, glass ionomer cements and amalgam. Restorations were evaluated according to modified Ryge criteria by two examiners at baseline, and after 6, 12, 18 and 24 months of oral function. The data was submitted to statistical analysis (binomial and hyper geometric tests, p<0.05). Two-year recall rate was 62.42%. Class I performed better than class II restorations. The difference in marginal discoloration between compomer and amalgam restorations was statistically significant (p=0.014). No other significant differences were found between GIC, compomer and amalgam restorations. The clinical performance of the three restorative materials compared to amalgam in Class I and Class II cavities at two-year recall was acceptable. The results, even in a population with high caries risk activity, suggest that these materials are suitable alternatives to amalgam in Class I and Class II restorations in primary teeth.

Two years survival rate of class II composite resin restorations prepared by ART with and without a chemomechanical caries removal gel in primary molars.

The aim was to test the null hypotheses that there is no difference: (1) in carious lesion development at the restoration margin between class II composite resin restorations in primary molars produced through the atraumatic restorative treatment (ART) with and without a chemomechanical caries removal gel and (2) in the survival rate of class II composite resin restorations between two treatment groups after 2 years. Three hundred twenty-seven children with 568 class II cavitated lesions were included in a parallel mouth study design. Four operators placed resin composite (Filtek Z 250) restorations bonded with a self-etch adhesive (Adper prompt L pop). Two independent examiners evaluated the restorations after 0.5, 1, and 2 years using the modified Ryge criteria. The Kaplan–Meier survival method was applied to estimate survival percentages. A high proportion of restorations were lost during the study period. Therefore, the first hypothesis could not be tested. No statistically significant difference was observed between the cumulative survival percentages of restorations produced by the two treatment approaches over the 2-year period (ART, 54.1 ± 3.4%; ART with Carisolv™, 46.0 ± 3.4%). This hypothesis was accepted. ART with chemomechanical gel might not provide an added benefit increasing the survival percentages of ART class II composite resin restorations in primary teeth.

Evaluation of the Clinical Success of Class I Cavities Prepared by an Er: YAG laser-2-year follow-up Study

The aim of this study was to evaluate the success of class Ⅰ occlusal restorations prepared by au Er: YAG laser after 24 mouths. Sixty-five teeth of 30 patients were iucluded in the study, and au Er: YAG laser emitting at a wavelength of 2.94 μn was used for the class Ⅰ cavity preparations with not more than 1/3 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 24 months, using modified Ryge criteria. After 2 years, 53 restorations were reviewed in 26 patients. None of the teeth showed signs of secondary caries. Except for 2 teeth subjected to endodontic treatment due to pulpal inflammation, all other restorations were present, and the teeth were vital. Slight marginal discoloration was observed in 5 restorations, having a beta score. With its satisfactory acceptance by patients, class Ⅰ cavity preparation with au Er: YAG laser would be a useful alternative for other couventional methods, especially for teeth which are to be restored with composite resins.

Clinical evaluation of a polyacid-modified resin composite (Dyract) in class V carious lesions: 5-year results

This study evaluated the 5-year clinical performance of polyacid-modified resin composite, Dyract (DeTrey/Dentsply, Konstanz, Germany), restorations in class V carious lesions. Ninety-two class V carious lesions in 28 patients were restored with Dyract. Restorations were clinically evaluated at baseline, 1-, 2-, 3-, 4-, and 5-year recalls and were evaluated according to the modified Ryge criteria by two experienced calibrated examiners in regard to color match, marginal discoloration, wear or loss of anatomical form, caries, marginal adaptation, and surface texture. The retention rate after 5 years compared to baseline in class V carious restorations was 84%, with only 12 restorations failing. Color change and marginal discoloration in restorations were found to be statistically significant (p = 0.0238 and p < 0.0001, respectively) at the end of the 5 years, but did not require replacement of any of the restorations. The results of this study revealed that at the end of 5 years, Dyract exhibited a clinically acceptable success rate but had significant color changes and marginal discoloration in class V carious lesions.

Clinical performance of a self‐etching and a total‐etch adhesive system – 2‐year results

The purpose of this controlled prospective clinical study was to compare the clinical performance of the self-etching adhesive system AdheSE and the established total-etch adhesive system Excite in classes I and II cavities for a period of 2 years. Fifty patients participated in this study. Each received two restorations, one with AdheSE, one with Excite by one calibrated, non-blinded operator. The resin composite used to restore the teeth was Tetric Ceram HB. One calibrated, blinded clinician re-evaluated the restorations at baseline, after 6, 12 and 24 months after placement using the modified Ryge criteria. For this, vitality, post-operative sensitivity, visible marginal irregularity, marginal discolouration, secondary caries, surface texture, anatomic form and filling defect were considered. After 2 years, 67 restorations were reviewed in 34 patients. None of the teeth showed signs of secondary caries. Two teeth, one of each group, had to receive endodontic treatment because of pulp inflammation. All other teeth remained vital. Slight marginal discolourations were observed in six AdheSE restorations and three Excite restorations. These restorations were scored as Beta. After 2 years, an overall clinical success rate, summing up all the Alpha and Beta scores, of 97% was found, viewing both adhesive systems together. Statistic analysis using log-rank test showed no statistic differences in the overall survival rate between the two materials tested within the observation period. It can be concluded that both adhesive systems tested demonstrated very good clinical performance in the restoration of classes I and II cavities at the end of 2 years.

Clinical evaluation on aesthetic outcome of anterior tooth restoration using crown lengthening surgery

To evaluate methods and clinical performance of crown lengthening surgery for aesthetic restoration improvement of short anterior teeth. Various surgery methods, proper restoration time after surgery, and indications for crown lengthening surgery were discussed. Crown lengthening surgery and prosthetic treatment were applied to 148 short anterior teeth of 22 cases. Modified Ryge criteria were used to assess the gingival health after treatment. Restoration results before and after treatment were evaluated by use of Kay's altered dental esthetics classification. When patients were re-examined after restoration of two weeks, obvious inflammation was found in 7.4% teeth. After providing the treatment and instruction on oral hygiene, 98.6% gingival health was significantly improved during the follow-up period. Two cases were examined during more than 4-year period and no obvious gingival inflammation and change in dental crown ratio were found. After treatment, all of 22 cases met Kay dental esthetics classification Class II-I (cosmetic) or Class II-I criteria. Right selection of indications, accurate restoration design, delicate surgery operation, enough recover period for the gingival after surgery, and proper oral hygiene training method, all contribute to the satisfactory aesthetic restoration of anterior teeth.

The efficacy of posterior three-unit zirconium-oxide–based ceramic fixed partial dental prostheses: A prospective clinical pilot study

Although zirconium-oxide-based restorations for fixed partial denture prostheses (FPDPs) are available for use, clinical studies evaluating their longevity and related complications have not been published. The aim of this pilot clinical study was to assess the efficacy of zirconia-based posterior 3-unit FPDPs. Twenty 3-unit posterior FPDPs (Lava) were placed in 16 subjects who were missing a second premolar or a first molar, 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. Impressions were made with vinyl polysiloxane (Express) impression material. Frameworks were fabricated using a computer-aided design/computer-assisted manufacturing technique with a 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). Recall appointments were made after 2 weeks and 6, 12, 18, 24, and 36 months. Clinical fracture resistance, marginal discoloration, marginal adaptation, radiographic proximal recurrent decay, and periapical pathoses were assessed over time using modified Ryge criteria. The probability distributions of these variables were calculated for the baseline data as well as for recall data. Mean follow-up was 31.2 months. Fifteen restorations were rated Alpha in all measured parameters. Minor chipping of veneering porcelain was detected in 5 restorations rated Bravo for clinical fracture resistance and Alpha for all other assessed parameters. One restoration was rated Bravo in terms of marginal integrity at 36 months. Zirconia-based posterior 3-unit FPDPs performed well after short-term service.

Two‐Year Clinical Evaluation of Repair versus Replacement of Composite Restorations

To investigate the effectiveness of alternative treatments to the replacement of resin-based composite (RBC) restorations through a prospective longitudinal cohort clinical study. Forty patients aged 27 to 77 years (mean=55) with 88 RBC restorations, with one or more features that deviated from ideal, participated in the study. They were assigned to five treatment groups: repair (N=25), sealing of defective margins (N=13), resurfacing (N=18), replacement (N=16), and the no-treatment group (N=16). The replacement and no-treatment groups served as comparison groups and received random assignment. Two clinicians examined the quality of the restorations (N=88) prior to the assigned treatment, and at subsequent recalls (1 and 2 years) using a modified Ryge criteria (Alfa, Bravo, and Charlie, meaning clinically excellent, clinically acceptable with one or more features that deviated from ideal, and clinically unacceptable, respectively) that observed (1) color, (2) marginal adaptation, (3) anatomic form, (4) surface roughness, (5) marginal staining, (6) bulk discoloration, (7) contact, (8) secondary caries, (9) postoperative sensitivity, and (10) luster. At 1- and 2-year recalls, 66 (75%) and 58 (66%) restorations were examined. Kruskal-Wallis Test showed significant differences for marginal adaptation and marginal staining for both 1- and 2-year recall exams (p < .05). The repair, sealant, and replacement groups presented significant improvement when compared with the no-treatment group for marginal adaptation. The repair and replacement groups showed superior results when compared with the no-treatment group for marginal staining. RBC restorations that present less-than-ideal marginal adaptation and stained margins are better off being repaired. Repair of resin-based composite (RBC) restorations is a conservative option for treatment of RBC restorations with inadequate marginal adaptation and marginal staining.

Replacement of posterior restorations

ABSTRACT 구치부 수복물의 재수복에 관한 연구 This article complies a survey on the replacement of the posterior restorations and accesses possible fac- tors that influence the replacement of posterior restorations. The data was collected from patients that visited department of conservative dentistry from Dec 1st 2003, to Sep 3rd 2004. Teeth was restricted to posterior permanent teeth. 9 dentists recorded age, gender of patients, tooth location, cavity form and restorative material. They rated marginal adaptation, anatomic form, secondary caries of old restoration by modified Ryge criteria system. The statistical analysis was per- formed with Chi square test (p < 0.05) for replacement ratio according to patients, tooth factor and One- way ANOVA was performed for comparison of old restoration according to restorative material. The results were as follows; 1. The female (62%) was statistically higher ratio than the male (38%). 2. The distribution of replacement case according to age, the rate of replacement was in descending order, 20' s (38.3%), 40' s (16.8%), 30' s (15.9%), 10' s (11.1%), 50' s (9.2%), 60' s (8.7%). 3. The rate of replacement was 88% for molar and 12% for premolar (p < 0.05). 4. The rate of replacement was 39% for maxillar and 61% for mandible (p < 0.05). 5. The material of restorations was amalgam (69%), gold inlay (17%), composite resin (13%). 6. In rating system by modified Ryge criteria system on margin adaptation, there was statistically signifi- cant difference between amalgam and gold inlay. But on anatomic form and caries, there was no sta- tistically significant difference among the material of restorations.

The clinical performance of one- and two-step self-etching adhesive systems at one year

The author compared the clinical performance of a two-step self-etching adhesive system and a one-step self-etching adhesive system over one year. Thirty-five patients with noncarious cervical lesions were enrolled in the study. The author restored 163 lesions using a two-step (Clearfil Protect Bond, Kuraray, Osaka, Japan) or a one-step (Xeno III, Dentsply/DeTrey, Konstanz, Germany) self-etching adhesive system. Enamel margins were not beveled, and no mechanical retentions were placed. The author evaluted the restorations at baseline and at three, six, nine and 12 months after placement using modified Ryge criteria for color-matching ability, marginal discoloration, marginal adaptation, initial caries formation, anatomical form, postoperative sensitivity and retention loss. The author assessed the changes in the parameters using the Cochran Q test and the McNemar test at a significance level of .05. At one year, the retention rates for the restorations in the two-step group were 100 percent; they were 96 percent for the restorations in the one-step group. Of the retained 75 restorations from the one-step group, two had marginal discoloration and slight anatomical form problems. In both groups, color-matching ability and postoperative sensitivity remained excellent. The performance of both self-etching adhesive systems was excellent during this one-year clinical trial. However, the two-step system exhibited slightly better retention than the one-step system. The one- and two-step self-etching adhesive systems evaluated in this study provided excellent clinical retention in noncarious lesions without mechanical retention.

Clinical Evaluation of a Polyacid-modified Resin Composite in Class V Carious Lesions: 3-Year Results

This study evaluated the three-year clinical performance of Class V restorations made of a polyacid-modified resin composite, Dyract. Ninety-two Class V carious lesions in 28 patients were restored with Dyract. Restorations were clinically evaluated at baseline, first, second, and third year recall visits, according to the modified Ryge criteria by two experienced, calibrated examiners. Retention rate after three years in Class V carious restorations was 92.4%, with only seven failed restorations. Color change and marginal discoloration in restorations were found to be statistically significant (p = 0.013 and p < 0.001, respectively) at the end of third year, but none of the affected restorations required replacement. The results of this study revealed that at the end of three years, Dyract exhibited good clinical success rate but significant color change and marginal discoloration in Class V carious lesions.

Clinical evaluation of 546 tetracycline-stained teeth treated with porcelain laminate veneers

The purpose of this study was to evaluate the clinical result of 546 tetracycline-stained teeth restored with a porcelain laminate veneer system (Cerinate, Den-Mat, USA) for aesthetic reasons. Tetracycline-stained teeth (546) were restored with a porcelain veneer system, and bonded with Ultra Bond resin cement. The restorations were recalled after 0.5, 1.5 and 2.5 years, respectively. Modified Ryge criteria were used to evaluate the veneers marginal adaptation, interfacial staining, secondary caries, postoperative sensitivity and the patients' satisfaction of the colour of the restorations. This study found that 99% veneers had excellent marginal adaptations; and less than 1% veneers required rebonding in the first 6 months; the colour of the veneers was stable and no evident staining was found. Almost all patients were satisfied with the colour match of their restorations 1 year after placement. The research indicated that the porcelain veneer restoration system under investigation provided a reliable and highly satisfactory choice for the aesthetic restoration of tetracycline-stained teeth.

Clinical evaluation of a self-etching and a one-bottle adhesive system at two years.

The clinical performances of a self-etching adhesive system, Clearfil SE Bond, and a one-bottle adhesive system, Prime&Bond NT, were evaluated in non-carious Class V restorations for a period of two years. Ninety-eight restorations were made by one operator for 32 patients. The resin composite used to restore the teeth were Clearfil AP-X and Spectrum TPH for Clearfil SE Bond and Prime&Bond NT, respectively. Two clinicians at the baseline, 6th, 12th and 24th months evaluated the posterior composites according to the modified Ryge criteria's. For this, color match, marginal discoloration, marginal adaptation, recurrent caries, anatomic form, postoperative sensitivity and retention rates were considered. The changes across time and across groups were evaluated statistically. At two years, 88 restorations were reviewed in 28 patients. The retention rates for Clearfil SE Bond were 93 and 91% for Prime&Bond NT. The percentages of the retention rates of both adhesive systems were not found to be different when calculating the failure rates. Recurrent caries, anatomic form and postoperative sensitivity were scored as Alpha for all restorations. Two cases of both adhesive systems showed slight marginal discoloration problems. Three restorations of Prime&Bond NT and one of Clearfil SE Bond had marginal adaptation problems at two years. One case for each adhesive system had slight color change after the same period. We can conclude that both adhesive systems tested exhibited very good clinical performance at the end of two years.

THE CLINICAL LONGEVITY OF PORCELAIN VENEERS: A 48-MONTH CLINICAL EVALUATION

The authors evaluated the clinical longevity of a brand of porcelain veneers and the accompanying cementation system. Fifty-nine porcelain veneers were prepared and placed in 12 patients by one practitioner and evaluated by two evaluators using modified Ryge criteria at baseline and 12 months. Fifty-three veneers were evaluated similarly at 48 months. Plaque index and gingival index scores were recorded as well. At 48 months, the veneers had stable color, all margins were clinically acceptable, there was no secondary caries and the patients reported no sensitivity.

Evaluation of Clinical Performance of Twelve Posterior Composite Resins With a Standardized Placement Technique

The purpose of the study was to evaluate 12 posterior composite resins with a standard clinical placement technique that could be followed in a practice setting. Important points stressed are the use of rubber dam, care taken to detail on manufacturer's directions, incremental placement technique, and a standard finishing technique. Sixty-one Class II restorations were placed by a single operator. All of the restorations were evaluated at baseline, one and three years using the modified Ryge criteria. Indirect evaluation of wear was completed for each restoration using Leinfelder's technique. Two percent of the restorations at 1 year and 17 percent at 3 years were not clinically acceptable.