Postoperative Sensitivity Research Articles

The role of visual aids in the clinical success of posterior restorations: Randomized controlled clinical trial

ObjectiveThis clinical study aimed to assess the impact of utilizing loupes and dental operating microscopes (DOM) with varying magnifications on the success of class II direct composite restorations. MethodsA total of 130 class II, moderately deep caries teeth from 85 patients were randomly assigned to four groups: naked eye, ×3 loupe, ×5 loupe, and ×8.5 DOM. Cavities were restored with or without magnification. The restorations were evaluated according to World Dental Federation criteria at 1, 6, and 12-month intervals by previously calibrated evaluators. Cochran's Q test was used to compare paired scores across three or more time points within groups, while the Friedman test was employed to compare scores at three or more time points. Multiple comparisons were adjusted using the Bonferroni correction. The significance level was set at p < 0.05. ResultsStatistical analysis revealed no significant differences among the groups at the 1-, 6-, and 12-month follow-up periods (p > 0.05). Although not statistically significant, the magnified groups exhibited higher scores in aesthetic anatomical form, proximal form, postoperative sensitivity, periodontal response, and adjacent mucosalcriteria compared to the naked eye group. ConclusionAlthough no statistically significant difference was observed at the 12-month follow-up between restorations performed with and without magnification, the groups using magnification showed higher scores.

Postoperative sensitivity of composites using novel Bacillus subtilis nanofortified adhesives: a triple-blind study

Nanotechnologyis the art and science of dealing with nanoscale particles. This has transformed contemporary dental practices through myriad contributions to biomaterial science. Titanium dioxide nanoparticles procured from Bacillus subtilis, an eco-friendly and biogenic source, can significantly magnify the physiochemical attributes of dental materials. However, postoperative sensitivity is a major drawback of composite restorations. The incorporation of these nanoparticles into dental adhesives can greatly benefit clinical dentistry by resolving this issue. This trial aimed to evaluate the effectiveness of a novel titanium dioxide nanofortified adhesive on the postoperative sensitivity of composite restorations.MethodsThis triple-blind, parallel-group randomized controlled trial was conducted at the Department of Operative Dentistry and Endodontics, School of Dentistry, Islamabad, from May 15, 2023, to November 25, 2023. Participants (n = 60) with Class I and II primary carious lesions with a minimum cavity depth of 3–5 mm were randomly assigned to two groups (n = 30). After obtaining informed consent, the restorative procedure was accomplished using a minimally invasive approach and etch-and-rinse adhesive strategy. In group A, a nanofortified adhesive was used for composite restoration, whereas in group B, an adhesive without nanoparticles was used. Postoperative sensitivity was evaluated using the Visual Analog Scale (VAS) score at follow-up periods: of one day, one week, two weeks and one month. A Chi-square test was used to compare postoperative sensitivity between the two groups. The level of significance was set at p < 0.05.ResultsA noteworthy association was observed between sensitivity and the group variable at all four evaluation periods: after one day (p = 0.002), 1 week (p = 0.002), 2 weeks (p = 0.007) and one month. In conclusion, participants who underwent restorative intervention using titanium dioxide nanoreinforced adhesives reported a notable reduction in sensitivity at all time intervals. Hence, the occurrence and severity of postoperative sensitivity are significantly reduced using Bacillus subtilis-procured nanofortified adhesives as compared to conventional adhesives without nanoparticles.Trial registrationThis trial was retrospectively registered at ClinicalTrials.gov (ID: NCT06242184) on 03/02/2024. All procedures involving human participants were performed in conformance with this protocol.

Influence of different viscosity and chemical composition of flowable composite resins: A 48-month split-mouth double-blind randomized clinical trial

ObjectivesTo evaluate the clinical performance of two flowable composites based on methacrylate and one based on ormocer in treating non-carious cervical lesions (NCCLs) after 48-month evaluation in a split-mouth double-blind clinical study design. MethodsA total of 183 restorations were performed on NCCLs using a universal adhesive system (Futurabond U, Voco GmbH) with selective enamel etching on 27 participants: two participants received twelve restorations each, three received nine restorations each, and 22 participants received six restorations each. Three different flowable composites were employed (n = 61): a low-viscosity methacrylate-based composite (GrandioSO Flow, LVM), a high-viscosity methacrylate-based composite (GrandioSO Heavy Flow, HVM), and an ormocer-based flowable composite (Admira Fusion Flow, ORM). All restorations were evaluated using FDI and USPHS criteria after 48 months. Statistical analysis was conducted using Kaplan-Meier Survival analysis and Kruskal-Wallis analysis of variance rank (α = 0.05). ResultsAfter 48 months, 17 restorations were lost: LVM 6, HVM 9, ORM 2. The retention rates (95 % confidence interval) were 89.4 % for LVM, 80.4 % for HVM, and 95.6 % for ORM, with a significant difference between HVM vs. LVM and HVM vs. ORM (p < 0.05). Minor defects were observed in 30 restorations for marginal staining criteria (LVM 12, HVM 10, ORM 8) and in 71 restorations for marginal adaptation criteria (LVM 24, HVM 20, ORM 27) without significant difference between groups (p > 0.05). No restorations showed postoperative sensitivity or recurrence of caries. SignificanceThe increased viscosity of flowable composites could reduce the clinical longevity in NCCLs after 48 months. Ormocer-based and low-viscosity methacrylate-based flowable composites showed a successful clinical performance in NCCLs after 48 months.

CLINICAL PERFORMANCE OF EQUIA FORTE FILL. GAENIAL POSTERIOR, CENTION N IN CLASS II CAVITY IN PRIMARY TEETH- AN IN VIVO STUDY

Context: Aims:The aim of this study is to compare clinical performance of EQUIA Forte Fill. G-Aenial Posterior, Cention N in class II cavity in primary teeth- An In vivo study Setting and design:The study was conducted at Himachal Institute of dental sciences, Department of Pediatrics and Preventive dentistry, Paonta Sahib, Himachal Pradesh Subject and methods:In total 45 class II restorations were performed in patients aged 4-9 years using three different restorative materials: EQUIA Forte Fill [EF], GAenial Posterior [GP], Cention N [CN]. The restorations were evaluated using method USPHS criteria in terms of anatomic form, secondary caries, color match, retention, marginal adaptation, polishability, surface staining, pre and post operative sensitivity, soft tissue health, proximal contact point. The data was analized using chi-square test, McNemars test, marginal homogeneity test. Statistical analysis used: The statistical analysis was done using Statistical Package for Social Sciences (SPSS for Windows, Version 19.0). Descriptive statistics were calculated as frequency and percentage. The comparison of study parameters at various time periods among the three study groups was done using chi-square test. Comparison of change in study parameters at various time periods was assessed using McNemars test and marginal homogeneity test. The level of significance for the present study was fixed at a p-value of less than 0.05. Result:The clinical performance of GAenial Posterior was superior to EQUIA Forte Fill and Cention N Conclusion:GAenial Posterior is a promising user-friendly restorative material that can be used to restore carious primary teeth. It offers a better restorative properties like aesthetics, improved radiopacities and can be manipulated with ease by the clinicians.

Clinical evaluation of a new chemically-cured bulk-fill composite in posterior restorations: 6-month multicenter double-blind randomized clinical trial

ObjectiveTo evaluate the postoperative sensitivity (POS), as well as the clinical performance of posterior restorations using a new chemically-cured bulk-fill composite (Stela Automix and Stela Capsule, SDI) comparing with a light-cured bulk-fill composite after 6 months. MethodsFifty-five participants with at least three posterior teeth needing restoration were recruited. A total of 165 restorations were performed on Class I or Class II cavities. After the application of Stela primer, the chemically-cured composite (Stela Automix or Stela Capsule) was inserted. For the light-cured composite group, a universal adhesive (Scotchbond Universal) was applied with a bulk-fill composite (Filtek One). Participants were evaluated for spontaneous and stimulated POS in the baseline, after 48 h, 7 days, and 6 months. Additionally, each restoration was assessed using the updated version of FDI criteria after 6 months. The differences in the proportions of the groups were compared by Cochran test statistics (α = 0.05). ResultsBoth chemically-cured composites showed a lower risk of POS compared to the light-cured composite at baseline and up to 48 h (p < 0.04). A significantly lower surface luster and texture was observed for the Stela Capsule composite compared to the light-cured bulk-fill composite (baseline and 6 months; p = 0.03). A significant color mismatch was observed for the light-cured bulk-fill composite compared to the chemically-cured composites (baseline and 6 months; p = 0.03). No significant differences were observed in any other item evaluations (p > 0.05). ConclusionChemically-cured composites exhibit lower postoperative sensitivity and less color mismatch compared to a light-cured bulk-fill composite after 6 months of clinical service. Clinical significanceThe chemically-cured composites appear to be an appealing option for restoring posterior teeth, as they exhibit lower postoperative sensitivity compared to a light-cured bulk-fill composite, both at baseline and up to 48 h, and less color mismatch.

Clinical performance of different composite materials in class II cavities bonded with universal adhesives.

To assess the clinical performance of two composite materials with two universal adhesives and a two-step self-etch adhesive on class II restorations for 18 months. Two hundred and fifty-two class II cavities were bonded with G-Premio Bond, Single Bond Universal, and Clearfil SE Bond 2. A nanohybrid composite (Filtek Z550 Universal) or a microhybrid composite (G-aenial Posterior) was used to fill the bonded cavities. World Dental Federation criteria were used to evaluate the restorations at 1 week, 6, and 18 months. Statistical analysis was performed using Friedman and Fisher's exact tests (α = 0.05). Retention loss and fracture were not observed in any restorations during the 18 months. The adhesives used showed no significant differences for all criteria examined (p > 0.05) regardless of composite material. After an 18-month follow-up, seven G-aenial Posterior and three Filtek Z550 Universal restorations presented slight marginal discrepancies, with no significant differences (p = 0.246). At 1 week, Filtek Z550 Universal (9.5%) led to significantly higher postoperative sensitivity compared with G-aenial Posterior (0.8%) (p = 0.001). Universal adhesives showed similar clinical performance to Clearfil SE Bond 2. The restorations with Filtek Z550 Universal had a relatively higher risk of postoperative sensitivity. Universal adhesives were clinically successful for 18 months. At 1 week, the type of composite material used significantly affected the occurrence of postoperative sensitivity.

Effect of Various Vital Bleaching Systems on Clinical Outcomes and Patient Satisfaction.

Objective To evaluate the clinical behavior of different bleaching products - the hydrogen peroxide (H2O2), carbamide peroxide (CP), and titanium dioxide bleaching systems. Methods Three bleaching systems with different concentrations (H2O2 15%, 38%, CP 15%, 35%, and titanium dioxide 20% H2O2) were used. Sixty participants with discolored teeth were enrolled and equally divided into six groups. Each group was rendered the assigned bleaching protocol against the control group, which received plain dentifrice polishing.Each case was evaluated immediately, two weeks, three months, six months, and one year after the bleaching treatment. The clinical evaluation was made for color change by (shade guide and digital images with L*a*b* parameters), tooth sensitivity, gingival irritation, and participants' satisfaction. Results All bleaching systems showed color improvement after bleaching regimens with significant effect showed by in-office titanium dioxide 20% H2O2 followed by 38% H2O2 with Δ=10.26 and Δ=6.52, respectively, when compared to other bleaching techniques. Higher sensitivity was recorded in group III with 50% of the participants reporting postoperative sensitivity. Higher gingival irritation was recorded in group IV (15% CP) where 60% of the patients reported gingival irritation. Thirty-five of the 60 participants (58.5%) recorded that the treatment whitened their teeth "moderately" and "a lot" while seven participants recorded "a slight" difference. There was a highly significant difference in participants' satisfaction between all bleaching groups (p < 0.05). Conclusion It is evident that there is a development of dental sensitivity and gingival irritation irrespective of the bleaching system used. The color assessment showed that the desired result can be achieved with variable levels of patientsatisfaction with excellent overall results with the titanium dioxide system.

An influence of preheating composites on microleakage- An invitro study

Resin composites have become one of the widely used restorative materials in the field of dentistry. Resin composite Pre-heating is a recent innovative method that is clinically beneficial by improving handling and marginal adaptation of the resin to the tooth. The study aims to determine the effect of temperature on the degree of microleakage in resin composite restorations. In the present study, Class 1 cavity was prepared in 30 extracted non-carious human premolars and divided into two groups. Group A (n=15) - filled with nano-hybrid resin composite (3M™ Filtek™ Z350 XT Universal Composite) at room temperature. Group B (n=15) - filled with the same resin preheated and then checked for micro-leakage under SEM. Mann-Whitney test was used to compare the mean Marginal Leakage scores between the 2 groups. There was a statistically significant difference in the micro-leakage score between group A and group B. Group B showed minimal or no micro-leakage in comparison to Group A. Preheating the resin composite has better adaptability to the walls thus reducing micro-leakage and postoperative sensitivity.

Assessment of the Efficacy and Bond Strength of Different Dentin-bonding Agents with Adhesives on Primary Teeth: An In Vitro Study.

The purpose of this study was to evaluate the effectiveness and strength of three various dentin-bonding agents used with adhesives on primary teeth. The study used 80 recently extracted, healthy human maxillary anterior primary teeth that had undergone physiologic resorption, or over-retention. Teeth were cut to expose a flat dentin surface at a depth of 1.5 mm. All samples were divided into four groups (20 samples in each group) as follows: Group I-Control group, Group II-Primary teeth bonding with 6th-generation bonding agent, Group III-Primary teeth bonding with 7th-generation bonding agent, Group IV-Primary teeth bonding with 8th-generation bonding agent. All of the samples' dentinal surfaces were covered with composite resin using a Teflon mold after adhesive had been applied. A universal testing machine (INSTRON) was used to assess the shear bond strength. Data were collected and statistically analyzed. The maximum mean shear bond strength was found in 8th-generation bonding agent (30.76 ± 0.16), followed by 7th-generation bonding agent (26.08 ± 0.21), 6th-generation bonding agent (25.32 ± 0.06), and control group (6.18 ± 0.09). Statistically significant difference was found between the three different bonding agents (p < 0.001). On conclusion, the 8th-generation bonding agent demonstrated a greater shear bond strength to dentin than the 7th and 6th-generation bonding agent. The emergence of different bonding techniques to the market improves the durability and quality of restorations. An effective bonding to the tooth would also reduce bacterial penetration, marginal microleakage, possibility of pulpal inflammation preserve tooth structure, and postoperative sensitivity by allowing less cavity preparation. How to cite this article: Alqarni AS, Al Ghwainem A. Assessment of the Efficacy and Bond Strength of Different Dentin-bonding Agents with Adhesives on Primary Teeth: An In Vitro Study. J Contemp Dent Pract 2024;25(4):342-345.

A Randomised Controlled Trial of Postoperative Sensitivity after Class II Restoration with Bulk-Fill vs Conventional Composites.

Bulk-fill composites may simplify posterior restorations, saving time and reducing technical complexity. Post-operative sensitivity is a risk of posterior composites; bulk-fill composites could mitigate this. This single centre, double-blinded, parallel groups randomised controlled trial compared postoperative sensitivity following restoration of class II carious lesions with bulk-fill or conventional, layered composite. there will be no difference in post-operative sensitivity between the two materials. Participants requiring class II restoration of posterior teeth were randomised to bulk-fill (FU) (Coltene Fill-UpTM) or conventional, layered (BE) (Coltene Brilliant Everglow) composite. Allocation was concealed during cavity preparation. Only the operating dentist knew allocation. The outcome was 24 h post-operative sensitivity. 41 patients were randomised (20/group). Two patients from FU group were excluded from analysis (factors unrelated to intervention). There was no difference in postoperative sensitivity at 24 h nor any time point. Only participant age and baseline sensitivity scores significantly impacted post-operative sensitivity. One restoration debonded in FU group at 10 days, with no other adverse effects. No difference in time taken to place restorations was seen. Within the study's limitations, post-operative sensitivity after class II posterior restorations was no different in bulk-fill restorations compared with conventional, incrementally cured composite.

Clinical performance of posterior restorations using a universal adhesive over moist and dry dentin: A 36-month double-blind split-mouth randomized clinical trial

ObjectivesTo evaluate the influence of dentin moisture on the clinical behavior of a universal adhesive on posterior teeth after 36 months of follow-up. MethodsForty-five patients participated in this study. Following a split-mouth design, three operators placed 90 Class I/Class II restorations over moist dentin (MD) or dry (DD) (n = 45) with resin composite (Filtek Bulk Fill) and a universal adhesive used in the etch-and-rinse mode (Single Bond Universal). Each restoration was evaluated according to the FDI and USPHS criteria (postoperative sensitivity, fracture and retention, marginal staining, marginal adaptation, and recurrence of caries) at baseline and after 6-, 12-, and 36 months. For statistical analysis, Kruskal Wallis analysis of variance rank (α = 0.05) and Kaplan-Meier survival analysis were used. ResultsNo significant difference between groups was observed in each FDI criterion after 36 months of clinical evaluation (p > 0.05). The retention rates (confidence interval 95 %) were 97.37 % (86.5 - 99.5) for both MD and DD without significant difference between them (p > 0.05). Eight restorations (MD = 4; DD = 4) showed minimal marginal staining defects (p > 0.05). Two restorations were lost (MD = 1; DD = 1). Fifteen restorations (MD = 8; DD = 7) presented minor marginal discrepancies according to the FDI criteria (p > 0.05). ConclusionThe clinical performance of the universal adhesive when applied in etch-and-rinse mode was not influenced by dentin moisture in posterior bulk-fill composite restorations. Clinical significanceThe level of dentin moisture appears not to influence the clinical efficacy of a universal adhesive when applied using the etch-and-rinse technique in posterior composite resin restorations.

Evaluation of pre-heated composite resins with soft-start polymerization and conventional composite restorations in class-I carious lesions – A randomized clinical trial

BackgroundBy increasing fluidity and conversion, pre-heated composites enhance adaptability and strength, while soft-start polymerization decreases internal stresses. AimOver a period of a year, this split-mouth design, randomized controlled clinical trial (RCT) compared pre-heated composites with soft-start polymerization to conventional composites in class-I lesions, with the goal of improving restoration outcomes. Methodsand Findings: Immediately following ethical approval and registration with CTRI, 37 patients with in-formed permission who met specified inclusion and exclusion criteria for class-I lesions were chosen for enrollment. Using a 1:1 ratio, teeth were randomly assigned to Group-A (pre-heated composite with soft-start polymerization) or Group-B (traditional composite restoration). At three-time intervals, the evaluation was blinded and calibrated using Modified United States Public Health Service (USPHS) criteria: baseline, six-month, and one-year marks. Statistical analysis was performed using SPSS 21.0 and the Mann-Whitney U test for inter-group comparisons and the Friedman test for intra-group comparisons. InterpretationPre-heated composites with soft-start polymerization performed better in terms of marginal adaptation with a statistically significant difference (p = 0.019) and in terms of color match they performed better clinically (p = 0.062) at 12 months. Other variables like marginal discolouration, sec-ondary caries, anatomic form, post-operative sensitivity, surface texture and retention showed no statistically significant difference (p < 0.05). Pre-heated composites with soft-start mode performed marginally better than nanofilled composites. However, both techniques can be used to successfully restore simple class-I carious lesions.

The first composite increment: Dependency on placement technique for interaction behavior with maturing dentin-adhesive bond at pulpal floors in deep occlusal cavities – A comprehensive review

Abstract Introduction: When the traditional incremental technique is used for direct placement of composite resin in a deep occlusal cavity, each increment (2 mm or thicker) is individually cured where it undergoes hardening and shrinkage. As increments are bonded to all cavity walls, a constrained shrinkage develops in tooth, composite, and/or interfaces. In the first composite increment, this constrained shrinkage generates tensile stresses which are distributed in a nonuniform pattern within that increment, resulting in premature stressing of the dentin bond of the hybrid layer at the pulpal floor before it reaches full maturation. This premature stressing leads to initiation of interfacial debonding and propagation to form a microgap. This behavior is associated with persistent postoperative sensitivity and tooth pain, over the time, which subsequently results in restoration failure. Aims: This paper provides a comprehensive review on the first composite increment and its dependency on placement technique for the interaction behavior with the maturing dentin-adhesive bond at pulpal floors in deep occlusal cavities. Materials and Methods: The dental database was searched, and 59 articles were collected and included in this review, spanning the years from 1984 to 2023. Results and Discussion: Three biomimetic direct restorative techniques were reported in the literature for incrementally restoring large occlusal cavities. These techniques are the decoupling with time, the decoupling with fiber, and the decoupling with split-increment. They all aim at minimizing the generated shrinkage stresses in the first composite increment for protecting the developing dentin bond of the hybrid layer until it reaches full maturation and thus preventing the initiation and propagation of interfacial defects at pulpal floors of deep occlusal cavities. Finally, the restoration is completed by placing and curing successive increments of 1.5 mm each to fill the cavity; their number depends on the cavity depth. These increments can each be cured immediately following placement. Conclusions: In deep occlusal cavities, the interaction behavior between the first composite increment and the maturing dentin-adhesive bond at the pulpal floor depends on the technique used for the increment placement. This behavior is either favorable with the direct biomimetic techniques or unfavorable with the traditional incremental technique. With the direct biomimetic techniques, no premature shrinkage stressing of the dentin bond is induced at the pulpal floor. This prevents the initiation of interfacial debonding and propagation to form microgaps and results in the absence of postoperative sensitivity and persistent tooth pain.

Comparison of the clinical parameters of restorations performed with total-etch and self-etch adhesive techniques

AIM. To conduct a systematic review to evaluate the differences between the clinical performance of restorations made with total-etch and self-etch techniques.MATERIALS AND METHODS. A literature search was conducted in the Pubmed, Google Scholar and Cyberleninka databases. The research was done according to the PICO strategy. Articles from the last 10 years (2013–2023) were included in the review.RESULTS. After screening 1005 articles, 52 studies were subjected to data extraction. There were no statistically significant differences in any study regarding recurrence of caries. In 9 of 14 articles, retention was higher with the total-etch technique. Total-etch groups showed better marginal adaptation in 11 of 19 studies. 11 of 17 studies recorded the least marginal staining using the total-etch technique. None of the studies found statistically significant results for the presence of post-operative sensitivity at the end of the follow-up period. However, three studies reported statistically significant evidence of post-operative sensitivity at baseline, and after 12 months (1/2 follow-up) in the total-etch groups only.CONCLUSIONS. Both methods show effective and clinically acceptable restoration performance.

Comparative evaluation of bond strength of diode and neodymium-doped:Yttrium aluminum garnet-assisted bleached enamel with nanofilled composite: An in vitro study.

The world of esthetic dentistry is constantly making efforts toward the management of tooth staining. Laser-assisted bleaching is needed before adhesive restorations and has become common and advantageous as it accelerates bleaching action, reduces postoperative sensitivity, and promotes recrystallization of enamel. The study aimed to evaluate and compare the bond strength of diode (Biolace: EpicX) and neodymium-doped:yttrium aluminum garnet (Nd:YAG) (LightWalker, Fotona, Slovenia) assisted bleached (Pola Office, SDI) enamel with nanofilled composite (GC Solare Sculpt). The samples were divided into three groups (n = 11): Group A - Conventionally bleached enamel, Group B - Diode laser-assisted bleached enamel, Group C - Nd:YAG laser-assisted bleached enamel. After storing samples in Artificial Saliva for 2 weeks, bonding was performed, and nanofilled composite resin was applied through an incremental method. Samples were subjected to shear bond strength (SBS) analysis. The use of Nd:YAG laser on bleached enamel significantly increases the bond strength with nanofilled composite resin.

Performance of self-cured versus light-cured universal adhesive in patients with non-carious cervical lesions: 18-month randomized clinical trial

ObjectiveTo evaluate the clinical performance of self versus light-cured universal adhesive in non-carious cervical lesions (NCCLs) after 18 months.Materials and methodsSixty-eight NCCLs in 28 patients were divided into two equal groups; G1: self-cured universal adhesive (Palfique,Tokuyama,Japan) and G2: light-cured universal adhesive (Single Bond Universal,3 M ESPE,USA). Nanohybrid resin composite (Z350XT, 3 M ESPE, USA) was used as a final restoration. Evaluation for fracture, loss of retention, marginal adaptation and discoloration were done after 1 week, 6,12, and 18 months using FDI criteria. Postoperative sensitivity was assessed after 1 week. Chi-Square and Mann-Whitney tests with statistical significance at (P ≤ 0.05) were used for intergroup comparison,while the intragroup one was performed using the Cochran’s Q and Friedman’s tests. Survival rate was analyzed using Kaplan-meier and Log-rank test.ResultsBoth groups exhibited fracture and retention loss, however, there was statistically significant difference favoring the control group at 6 months (p = 0.0114,0.0016). For secondary outcomes, marginal adaptation and discoloration revealed no significant differences. For postoperative sensitivity, there was a significant difference favoring the control group (p = 0.0007, 0.0011). Palfique had 1.5 Relative-Risk (RR) after 6 months (95% CI 0.5659–4.2617; P = 0.3928) and 20% less risk of failure after 18 months (RR 0.8) (95% CI 0.4618–1.3858; P = 0.4260). Tested adhesives showed equal survival rate (P = 0.5685).ConclusionsBoth adhesives revealed similar clinical performance in restoring the NCCLs after 18 m, however, the early failure was more frequent in the self-cured universal adhesive.

Clinical comparison of high-viscosity glass-hybrid systems with a sculptable bulk-fill composite resin in different cavity types.

This randomized, double-blind clinical investigation assessed the performance of two high-viscosity glass-ionomer systems and a bulk-fill composite in different cavity types. In 146 participants, 360 (class I, II, and V) cavities were restored using three different materials (Equia Forte HT, Chemfill Rock, and SonicFill 2) with equal allocation. Using modified World Dental Federation criteria, restorations were assessed after 1 week, 6 months, and 18 months by an experienced examiner. Statistical analysis was conducted using Fisher's exact and Wilcoxon signed rank tests (α = 0.05). After 18 months, 267 restorations were assessed in 116 participants. After 18 months, 5 Equia Forte HT restorations failed due to debonding and fracture. Only one loss was observed in the Chemfill Rock restorations. Equia Forte HT exhibited significantly lower retention than SonicFill 2 after 18 months (p = 0.019), irrespective of cavity type. At 1 week, 3 Class I restorations with SF showed postoperative sensitivity. The type of cavity did not affect the performance of the restorative materials used (p > 0.05). Equia Forte HT and Chemfill Rock presented similar clinical performance regardless of color match. Equia Forte HT showed a lower performance compared to SonicFill 2. Glass-hybrid materials presented a lower performance in terms of color match or retention when compared to a sculptable bulk-fill composite resin.

Clinical evaluation of posterior restorations over wet and dry dentin using an etch-and-rinse adhesive: A 36-month randomized clinical trial

ObjectivesTo evaluate the clinical performance of posterior restorations over wet and dry dentin with an etch-and-rinse adhesive after 36 months of clinical service. MethodsForty-five participants were recruited, each one had at least two posterior teeth that needed restoration. Ninety restorations were placed on Class I or Class II cavities. For the restoration protocol, a simplified etch-and-rinse adhesive (Adper Single Bond 2) was applied over wet (WD) or dry dentin (DD) and later restored with a bulk-fill composite (Filtek Bulk Fill) under rubber dam isolation. Each restoration was evaluated using the World Dental Federation (FDI) criteria after 6, 12, and 36 months of clinical service, regarding the following principal restoration characteristics: postoperative sensitivity, marginal discoloration, marginal adaptation, fracture of material and retention, and recurrence of caries. Kruskal Wallis analysis of variance rank (α = 0.05) and Kaplan-Meier survival analysis were used for statistical analysis. ResultsAfter 36 months of clinical evaluation, no significant difference between groups was observed in each FDI criterion (p > 0.05). Twenty restorations (WD=10, DD=10) showed minor marginal staining, and twenty-two restorations (WD=11, DD=11) presented small marginal adaptation defects (p > 0.05). Four restorations were lost (WD = 2, DD = 2) and the fracture rates (95% confidence interval) were 94.9% for each one, without significant difference between wet and dry dentin (p > 0.05). SignificanceThe degree of dentin moisture does not seem to affect the clinical performance of a simplified etch-and-rinse adhesive in posterior restorations when the adhesive is applied vigorously over the dentine surface.

Comparison of in-office and at-home bleaching techniques: An umbrella review of efficacy and post-operative sensitivity

ObjectivesThe objective of this umbrella review is to evaluate the efficacy and adverse effects of different teeth whitening techniques in-office (IO) and at-home (AH), regarding chromatic changes and teeth sensitivity. Materials and methodsThe search was carried out from several databases. The included studies were all systematic reviews with or without meta-analysis of RCT or quasi-RCT. The participants were patients that underwent external dental bleaching in permanent vital teeth. The interventions were in-office (IO) bleaching techniques and at-home (AT) bleaching techniques with different bleaching agents and concentrations. ResultsThe search resulted in a total of 257 articles, and 28 SR were included in the qualitative analysis and nine in the quantitative analysis. There is no difference between in-office and at-home techniques in terms of color change (p = 0.95) and post-treatment sensitivity (p = 0.85). There is similarity risk and intensity of teeth sensitivity between AH and IO bleaching. IO bleaching with light-activated systems with low concentrations of bleaching agent showed similar results to IO bleaching techniques with high concentrated bleaching gels. With the application of the criteria of the AMSTAR 2 tool, the reviews were considered critically low to high. ConclusionsThere are no significant differences in terms of color change between the different bleaching techniques compared. Teeth sensitivity is always present regardless of the technique used. The use of light activation systems did not increase the intensity and risk of post-operative sensitivity.

What are the emerging trends in dental composite materials in permanent teeth with occlusal cavities: self-adhesive vs traditional?

The research is a systematic review and meta-analysis of randomized controlled trials (RCTs). The study aimed to compare the clinical outcomes of self-adhesive flowable composite resins (SAFCs) versus conventional flowable composite resins (FCs) used in occlusal cavity restorations in permanent teeth. This research included a search for RCTs. Multiple databases were systematically searched for RCTs with a minimum 1-year follow-up comparing SAFCs to FCs. Outcomes evaluated were retention, secondary caries, marginal adaptation, marginal discoloration, and postoperative sensitivity based on modified USPHS criteria. Risk of bias was assessed using Cochrane RoB 2 tool. Random effects meta-analyses were conducted where applicable. Certainty of evidence was rated using GRADE approach. Five RCTs (four parallel and one split mouth) comprising 138 patients were included. During 1- and 2-year recalls, there were generally no significant differences in clinical performance between SAFCs and FCs. However, FCs applied using the etch-and-rinse technique demonstrated statistically better marginal adaptation at 2 years (3 studies, RR 3.21, 95% CI 1.50-6.83) and marginal discoloration (4 studies, RR 3.40, 95% CI 1.10-10.48). The overall quality of evidence ranged from low to moderate. SAFCs showed comparable short-term outcomes to FCs in treating occlusal cavities. Further high-quality RCTs with longer follow-up are warranted to confirm long-term performance of SAFCs. Use of separate enamel etching may improve marginal adaptation and discoloration with FCs.