Modified United States Public Health Service Criteria Research Articles

Clinical evaluation of “Snowplow” technique versus Bulk-fill technique in restoration of class II cavities: A randomized clinical trial

Abstract Aim: This study assessed the clinical performance of the “Snowplow” technique compared with the Bulk-fill technique in restoration of proximal cavities for 1 year using modified United States Public Health Service (USPHS) criteria. Materials and Methods: The study was a 12-month, double-blinded, two parallel arms, randomized clinical trial with a 1:1 allocation ratio. A total of 32 patients with proximal caries were separated into two groups (n = 16): group 1: “Snowplow” technique using co-cured X-tra base flowable Bulk-fill composite/X-tra Fil Bulk-fill composite, whereas group 2: Bulk-fill technique using X-tra Fil Bulk-fill composite. Modified USPHS criteria were employed to assess the restorations at baseline, after 3, 6, 9, and 12 months. The MedCalc software, version 19 for Windows was used to statistically analyze the collected data. Intergroup comparisons were carried out using the chi-squared test with a statistical significance level set at P ≤ 0.05 after Bonferroni correction. Results: The results suggested that there was no statistically significant difference found between “Snowplow” and Bulk-fill techniques at different time intervals in terms of marginal integrity, marginal discoloration, anatomic contour, surface texture, gross fracture, and secondary caries, where P = 0.150550. Conclusion: This study concluded that the clinical performance of the “Snowplow” technique and Bulk-fill technique was similar and clinically acceptable following a full year of clinical use. Bulk-fill and “Snowplow” techniques are highly recommended restorative techniques in proximal cavities.

Evaluation of Clinical Performance and Colour Match of Single and Multiple Shade Composites in Class-I Restorations: A Randomised Clinical Study

Introduction: Biomimetic dentistry primarily focuses on achieving aesthetics that closely resemble natural enamel and dentin. This approach ensures that dental restorations seamlessly match the appearance of enamel and dentin, rendering them virtually invisible. Additionally, biomimetic dentistry aims to mimic not only the visual characteristics but also the physical properties of enamel and dentin, thereby ensuring functional acceptability. The introduction of new composite materials in the market is a gradual progression aimed at attaining the mentioned objectives. Aim: To compare clinical performance and colour matching of single and multiple shade composites in simple Class-I carious lesions after one year. Materials and Methods: This randomised clinical study included 21 patients with a total of 72 Class-I carious lesions with patients who provided informed consent. Teeth were randomised into two groups: Group-A (n=36) received multishade composite (3M Filtek z350), and Group-B (n=36) received single-shade composite (Omnichroma). Clinical performance was assessed by two blinded evaluators at baseline, six months, and one year using modified United States Public Health Service (USPHS) criteria. Colour matching was evaluated by capturing digital photographs with a DSLR camera, ring flash, and 100 mm macro lens. Colour measurements (L*, a*, b*) were analysed using Adobe Photoshop, and ΔE was calculated immediately after restoration. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) 21.0 software, employing Chi-square test, Friedman test, and independent t-test. Results: No significant difference was found in clinical outcomes after one year using modified USPHS criteria (p>0.05). However, both Group-A (p=0.002) and Group-B (p=0.007) showed increased marginal discolouration, and decreased colour match (p<0.001) from baseline to one year. There was no statistically significant difference in colour matching potential between the two groups (p=0.056). Conclusion: Single-shade composites effectively treat Class-I carious lesions, demonstrating satisfactory colour matching and clinical performance.

Clinical performance of nano-hydroxyapatite-modified glass ionomer cements in class V cavities: split mouth, randomized controlled trial

BackgroundTo evaluate the effect of modifying conventional glass ionomer (CGIC) and resin-modified glass ionomer (RMGIC) with nano-hydroxyapatite (Nano-HA) on their clinical performance as restorations for class V cavities.MethodsThe wet-chemical precipitation method was utilized to prepare the nano-hydroxyapatite particles. Nano-HA was then characterized using Scanning Electron Microscopy, Elemental Dispersive X-ray and thermal gravimetric analysis. Five wt% of the nano-hydroxyapatite (Nano-HA) was then incorporated into the powder portion of the CGIC and RMGIC. Sixty Class V cavities were prepared in thirty patients with at least two cervical caries lesions. Prepared cavities were restored using the tested materials. Modified United States Public Health Service (USPHS) criteria were used to evaluate the restorations at base line, after three, six and nine months.ResultsRegarding the investigated modified USPHS criteria, the tested restorative materials showed no statistically significant difference throughout the study period. While color match, surface texture and marginal integrity criteria showed a statistically significant change in nano-HA-GIC. Surface texture and marginal integrity showed a significant change with CGIC. A significant change in surface texture was only found with nano-HA-RMGIC.ConclusionsThe investigated restorative materials showed an equivalent clinical performance at the nine months follow-up.

COMPARATIVE CHARACTERISTICS OF THE EFFECTIVENESS OF DIRECT AND INDIRECT RESTORATIONS ON TEETH WITH DISCOLORATION

COMPARATIVE CHARACTERISTICS OF THE EFFECTIVENESS OF DIRECT AND INDIRECT RESTORATIONS ON TEETH WITH DISCOLORATION

Thirty-six-month clinical evaluation of different adhesive strategies of a universal adhesive.

The aim of this clinical trial was to evaluate and compare the performance of a universal adhesive with different adhesive strategies in the restoration of non-carious cervical lesions (NCCLs) over a 36-month period. One hundred sixty-five NCCLs in 35 patients (13 female, 22 male) with at least 3 lesions each were included in this study. Three groups were formed according to the adhesive strategy used (n = 55): selective-etch mode, etch-and-rinse mode, or self-etch mode of a universal adhesive, Single Bond Universal. The same nanofilled resin composite, Filtek Ultimate, was used for all restorations by a single operator. The restorations were evaluated by two calibrated examiners at baseline and at 6, 12, 18, 24, and 36months in accordance with the modified USPHS criteria. The chi-square test was used for intergroup comparison and Cochran's Q test for intragroup comparison (∝ = 5%). At 36months, the recall rate was 98.1% and three restorations, one from each group, had failed because of retention loss (P > 0.05). The self-etch mode group showed 17 bravo scores for both marginal staining and marginal adaptation after 3years, which was significantly different from the selective-etch and etch-and-rinse groups (P < 0.05). For all groups, the only statistically significant difference was found when baseline and 36-month evaluations were compared in terms of marginal staining (P = 0.000). When the marginal adaptation values at 36months were compared with those at the baseline, statistically significant differences were found in the etch-and-rinse and self-etch mode groups (P < 0.05). Neither secondary caries nor postoperative sensitivity was observed at any recall. All adhesive modes showed similar retention rates. Although all restorations were clinically acceptable, restorations in self-etch mode showed less satisfying performance for marginal staining and marginal adaptation. At the end of 36months, the Single Bond Universal adhesive received acceptable scores according to the modified United States Public Health Service (USPHS) criteria. However, clinicians should be aware that its use in self-etch application mode tends to result in marginal staining and marginal deterioration when compared with etch-and-rinse and selective-etch application modes.

Marginal Adaptation of Cerec 3 CAD/CAM Composite Crowns Using Two Different Finish Line Preparation Designs

The purpose of this study was to compare marginal discrepancies of Cerec 3 CAD/CAM composite crowns, fabricated on human prepared teeth with two different finish line designs, chamfer and shoulder. Sixteen human molar teeth were used to prepare full crowns. Eight teeth were prepared with a 1-mm-wide chamfer finish line and the other eight with a 1.2- to 1.5-mm circumferential shoulder. Cerec 3 crowns were fabricated from optical impressions using Paradigm MZ100 composite polymer. Marginal adaptation was evaluated in two ways: (1) using modified United States Public Health Service (USPHS) criteria to evaluate eight preselected sites on each crown margin, and (2) using scanning electron microscopy (SEM) to measure marginal gaps on all four axial walls with 15 measurements on each wall (60 measurements per crown). An evaluation of the number of acceptable crowns, determined by having all measured sites per tooth with margin gap size less than 100 microm, as a function of finish line design was also conducted. In both chamfer and shoulder groups, there were only two crowns (out of eight) with clinically acceptable ratings for all eight measurement sites according to USPHS criteria. Fisher's chi-square analysis showed that there was no statistically significant difference in marginal adaptability as a function of finish line design ( p>0.05). With SEM imaging, overall mean marginal gaps for the chamfer group were 65.9+/-38.7 microm (range 35.0 to 130.0 microm), and for the shoulder group were 46.0+/-9.2 microm (range 26.3 to 55.6 microm); this difference was not found to be statistically significant ( p>0.05). While crown assessment based on mean marginal discrepancy measurements indicated that both the chamfer and shoulder groups were considered clinically acceptable (<100 microm); crown acceptability based on all measurement sites being less than 100 mum indicated that in the chamfer and shoulder groups there were four and three acceptable crowns out of eight, respectively. The Fisher's chi-square test indicated no statistically significant difference between the groups ( p>0.05). An agreement rate of 81.2% was calculated between the two evaluation methods, modified USPHS criteria and SEM measurements. Based on mean marginal discrepancy measurements, the typical marginal assessment technique, Cerec 3 Paradigm MZ100 crown restorations appear to have acceptable marginal adaptability (mean discrepancies <100 microm). Thus, the evidence from this investigation would suggest that the finish line preparation design had no effect on marginal adaptation for Cerec 3 composite crowns.

Short‐Term Results of IPS‐Empress Inlays and Onlays

A leucite-reinforced, glass-ceramic material was recently introduced for clinical use. In this clinical trial, IPS-Empress inlays and onlays were evaluated using the modified United States Public Health Service (USPHS) criteria. The teeth of 36 patients were restored with 105 posterior inlays and 25 onlays, fabricated by an indirect technique. After etching the restorations with hydrofluoric acid, they were silanized and luted using composite cements. The restorations were evaluated visually, clinically with a mirror and probe, and by bitewing radiographs and clinical photographs, using modified USPHS criteria. Restorations having neither charlie nor delta criteria were defined as successful, and their survival rate was calculated according to Kaplan-Meier analysis. The mean observation period for the 130 restorations was 23.4 +/- 6.1 months. After 2 years, 127 restorations were successful with an estimated survival rate of 97.5%. Three restorations failed because of fractures. The esthetic results were excellent. The initial clinical results of this esthetic restorative material are encouraging. However, because of fatigue phenomena for all ceramic materials, a longer observation period is needed to provide a definitive prognosis of the long-term clinical behavior.