Packable Resin-based Composites Research Articles

Clinical Evaluation of Two Packable Posterior Composites: A Five-Year Follow-up

Research has suggested that packable resin-based composites inserted with a placement technique similar to amalgam condensation can reduce the sensitivity associated with posterior restorations. The authors evaluated the clinical performance, including associated sensitivity, of two packable composites in a randomized five-year clinical trial. A single operator randomly placed two restorations in each of 33 patients: one restoration consisting of Alert (Jeneric/Pentron, Wallingford, Conn.) and the other consisting of SureFil (Dentsply/Caulk, Milford, Del.). There were 30 Class I and 36 Class II restorations. Two independent evaluators evaluated the restorations by using modified U.S. Public Health Service criteria. The authors analyzed data by means of the Fisher, chi(2) and McNemar tests at P < .05. Of 60 restorations evaluated at five years, two Class II restorations (one SureFil, one Alert) failed. All other restorations received the highest score possible for sensitivity and vitality. The only difference between the composites at the five-year recall was the significantly better surface texture of SureFil. The authors observed significantly different scores between the baseline and at five years for marginal discoloration (Alert and SureFil), surface texture (Alert and SureFil) and color (SureFil). Both packable resin-based composites showed excellent durability during the five-year follow-up. The investigated resin-based composites are suitable for posterior restorations.

Effects of a 10% Carbamide Peroxide Bleaching Agent on Roughness and Microhardness of Packable Composite Resins

Bleaching agents containing 10% carbamide peroxide may be applied to the surface of preexisting packable resin-based composite restorations. The aim of this in vitro study was to evaluate the effect of a 10% carbamide peroxide bleaching agent (Review, SS White, Rio de Janeiro, Brazil) on surface roughness and microhardness of three packable resin-based composites (Fill Magic condensable, Vigodent, Rio de Janeiro, Brazil; Alert, Jeneric Pentron, Wallingford, CT, USA; Definite, Degussa, Hanau, Germany). For the control (no bleaching) and experimental (bleaching treatment) groups, 12 specimens of each material were prepared in cylindrical acrylic molds. The experimental specimens were exposed to the bleaching agent for 6 hours a day for 3 weeks. During the remaining time (18 h), they were stored in artificial saliva. The control specimens remained immersed in artificial saliva throughout the experiment. Surface roughness and microhardness measurements were performed on the top surface of each specimen. Analysis of variance and the Tukey test showed no significant differences in roughness among the packable composites evaluated (p = .18), but those submitted to the treatment with a 10% carbamide peroxide bleaching agent displayed significantly higher mean surface roughness than did the corresponding control group for each material. For the microhardness tests, there were significant differences among materials (p < .0001). Alert showed the highest microhardness values followed by Definite and Fill Magic condensable. Ten percent carbamide peroxide bleaching agents may change the surface roughness of packable composites, but they do not alter their microhardness. Under the conditions of this study, a 3-week bleaching regimen with 10% carbamide peroxide agents affected the roughness of packable composites. Nevertheless, the surface microhardness was not affected, although there were differences among the materials evaluated inherent to their composition.

Clinical evaluation of packable and conventional hybrid resin-based composites for posterior restorations in permanent teeth: Results at 12 months

Packable resin-based composites and simplified resin bonding systems are marketed to offer many advantages over conventional posterior hybrid composites and total-etch bonding systems. The authors conducted a study to evaluate the initial clinical performances of a packable and a conventional hybrid resin-based composite used with a simplified bonding system. A total of 57 Class I and 45 Class II restorations were placed in the permanent teeth of 65 adult patients. The carious lesions were restored with either packable resin-based composite (SureFil, Dentsply DeTrey GmbH, Konstanz, Germany) or conventional hybrid resin-based composite (SpectrumTPH, Dentsply DeTrey GmbH), using a resin adhesive (Non-Rinse Conditioner and Prime & Bond NT, both manufactured by Dentsply DeTrey GmbH). The authors evaluated the restorations using U.S. Public Health Service-Ryge modified criteria (in which Alfa is the highest rating) and by using color transparencies and die stone replicas. Three SureFil restorations failed before their baseline evaluation. There were no failures among the 78 SpectrumTPH restorations evaluated at 12 months. For both resin-based composites, Alfa ratings were 90 percent or higher for marginal discoloration, anatomical form, surface texture and surface staining. Lower percentages of restorations were rated Alfa for color match, marginal integrity and gingival health. Occasional mild postoperative sensitivity was reported for four SureFil restorations and one SpectrumTPH restoration. The mean occlusal wear rate was 38 micrometers for the larger SureFil restorations and 25 microm for the smaller SpectrumTPH restorations. The 12-month clinical performances of the two restorative materials were satisfactory and not significantly different for each of the parameters evaluated. A packable and a conventional hybrid resin-based composite placed with a simplified bonding system in posterior permanent teeth showed satisfactory and similar results after 12 months.

Two-year clinical evaluation of a packable resin-based composite

Packable resin-based composites were introduced in 1998, but few clinical studies have been conducted to evaluate them. The authors conducted a clinical study to determine the two-year performance of SureFil (Dentsply DeTrey GmbH, Konstanz, Germany) packable posterior resin-based composite in Class I and II restorations. An operator (L.S.T.) restored 55 cavities in 36 patients (16 Class I restorations and 39 Class II restorations). After cavity preparation, she etched the enamel with 34 percent phosphoric acid, applied Prime & Bond NT (Dentsply DeTrey GmbH) to dentin and etched enamel for 20 seconds and then cured it for 20 seconds. She restored the cavity using 3- to 5-millimeter increments of SureFil. Independent examiners assessed the restorations after placement and at six months, one year and two years for color matching, marginal discoloration, marginal adaptation, secondary caries, surface texture, anatomical form and postoperative sensitivity, using the Ryge criteria. The authors assessed the changes in the parameters during the two-year period using a software program with Friedman test analysis with a Bonferroni adjustment at significant level of P = .05. At baseline, 31 restorations were graded as Bravo for color match. At the six-month and one-year recall periods (n = 55), 53 restorations remained unchanged. Two restorations from the same patient fell out after one month. After two years (n = 50), there were five Bravos for surface staining and three for marginal adaptation (P < .05). After two years of clinical service, SureFil packable resin-based composite had a success rate of 96 percent, and the authors considered it successful in Class I and II restorations. SureFil packable resin-based composite can be successful in clinical situations with limited-sized cavities and proper application of restorative techniques.

The Leakage of Class II Cavities Restored with Packable Resin-Based Composites

Recently, new resin-based composites, called "packable" or "condensable" resin composites, are being promoted as amalgam alternatives. The purpose of this study was to evaluate leakage in Class II cavities restored with the five packable resin-based composites. On 45 freshly extracted human molars, cavities were prepared following a standardized pattern in which the Class II cavity had a length of 3.0 mm, width of 2.0 mm, and depth of 1.5 mm occlusally. The proximal box had an axial depth of 1.5 mm and a buccolingual width of 4.0 mm. The cervical margin was located 1.0 mm below the cement enamel junction (CEJ). The teeth were randomly divided into five groups of 8 each. The cavity surface was conditioned with 36% phosphoric acid, rinsed, excess water removed, and a dental bonding adhesive (Prime&Bond NT) was used for all the cavities. The teeth were then restored according to the manufacturer's instructions: Group 1, Surefil; Group 2, Solitaire; Group 3, Alert; Group 4, Filtek P60; and Group 5, Prodigy Condensable. After the restorations were completed, the specimens were finished and polished with an aluminum-oxide-coated disc, thermocycled, stained, sectioned, and viewed under a stereomicroscope for leakage at occlusal/enamel and gingival/dentin margins. All test groups showed that leakage of gingival/dentin margins were greater when compared with leakage of occlusal/enamel margins. At the occlusal/enamel margins, there were no significant differences between the materials; however, at gingival/dentin margins, Filtek P60 and Prodigy Condensable demonstrated less leakage, while Solitaire demonstrated greater leakage.

The suitability of packable resin-based composites for posterior restorations

Packable composites, promoted for the restoration of stress-bearing posterior teeth, have captured clinicians' interest. The authors tested three packable composites (Alert, Jeneric/Pentron; Solitaire, Heraeus Kulzer, Wehrheim, Germany; SureFil, Dentsply De Trey, Konstanz, Germany); a new packable organically modified ceramic, or ormocer (Definite, Degussa AG, Hanau, Germany); a hybrid composite (Tetric Ceram, Ivoclar Vivadent, Schaan, Liechtenstein) and an ion-releasing composite (Ariston pHc, Ivoclar Vivadent, Schaan, Liechtenstein). They determined modulus of elasticity according to EN 24049:1993 of the European Committee for Standardization. They measured Vickers hardness using a 200-gram load for 40 seconds. To determine the materials' depth of cure, they used both a scraping method (International Standards Organization standard CD 4049:1997) and a hardness profiling method. The authors calculated means and standard deviations from 10 replications of each test and used one-way analysis of variance and post hoc Tukey tests (alpha = .05). The materials had significant differences (P < .001) in all characteristics. Solitaire had the significantly lowest elastic modulus and microhardness; Alert had the highest values for these characteristics. Ariston pHc exhibited the significantly lowest depth of cure. There was a significant correlation between the two methods of measuring depth of cure (r2 = 0.9945; P = .021). The material group of packable composites is rather inhomogeneous in terms of mechanical and physical data. Our data suggest that bulk curing of packable composites in deep cavities still is not recommendable. The clinician needs to select packable composites carefully, as it seems that not all of these materials quality for stress-loaded posterior restorations.