Posterior Resin Composite Restorations Research Articles

Evaluation of Proximal Contact Tightness and Contact Area of Posterior Composite Resin Restorations

The purpose of this study is to evaluate the influence of the matrix system on proximal contact tightness (PCT) of posterior composite resin restorations. Standardized class II cavities on 180 first lower molar dentiform model teeth (Frasaco GmbH, Tettnang, Germany) were prepared. Three groups were formed considering the matrix system: Group-IM: Ivory matrix (Hahnenkratt GmbH, Königsbach-Stein, Germany), Group-OM: Omni matrix (Ultradent, South Jordan, UT, USA), and Group-PM: Palodent V3 sectional matrix (Dentsply, Charlotte, NC, USA). Teeth were restored with resin composite mounted in a manikin head to simulate the clinical environment. Proximal contact tightness (PCT) was measured using a custom-made portable dental pressure meter (PDPM), and the validation of the PCT results was performed with a histogram analysis acquired from bite-wing radiography. All data were statistically analyzed by ANOVA and t-test in SPSS software (v.27.0) (p < 0.05). PM group showed statistically tighter contacts on both mesial (PCTm: 228.28 ± 59.17 N) and distal surfaces (PCTd: 254.91 ± 65.69 N) (p > 0.05). Mesial contacts were found to be significantly tighter than distal contacts among all (p < 0.05). According to the histogram results, only in the PM group, the difference between the mesial and distal areas is significant (p < 0.05). Histogram results confirmed that the tightest contact values were achieved in the PM group, followed by the OM and IM groups, respectively (p < 0.05). The use of sectional matrix systems and separation rings is more effective in creating tighter contact than conventional matrix systems. The use of anatomical wedges will help to create a more natural approximal contour and narrow contact area.

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.

Factors influencing the longevity of posterior composite restorations: A dental university clinic study

ObjectivesThis retrospective study aimed to assess the performance of posterior composite resin restorations (PCRRs) and evaluate the influence of patient-specific factors on restoration outcomes. MethodsA total of 189 PCRRs were examined in 54 patients, with evaluations based on Modified USPHS criteria. Patient-specific factors were analyzed. Statistical analyses, including chi-square tests, independent samples t-tests, and ANOVA tests, were conducted. ResultsPatients aged over 50 exhibited higher DMFT averages and a higher rate of unsuccessful restorations. Despite higher DMFT scores in females, gender doesn't significantly impact restoration outcomes. Secondary caries correlated with.plaque scores, significantly affecting restoration survival. Marginal adaptation, retention deficiencies, and secondary caries were primary causes of failure. Multi-surface restorations faced higher failure risk due to elevated plaque scores. Class-V restorations showed a higher failure rate, challenging the number of surfaces and longevity correlation. ConclusionsThis study identified key factors influencing posterior composite resin restorations-(PCRRs) in patients over 50, including higher DMFT averages and more unsuccessful restorations. No significant difference was found between brushing; frequency and DMFT rates, possibly due to the absence of non-brushers. Secondary caries; correlated with elevated plaque scores, impacting restoration survival. Primary causes of; failure included marginal adaptation issues, retention deficiencies, and secondary caries, with multi-surface restorations facing a higher risk. However, tooth vitality, beverage and acidic food consumption, and oral hygiene habits did not significantly affect PCRR outcomes. Clinical significancePatient-specific factors significantly impact PCRRs' long-term performance. Dentists must tailor strategies, emphasizing regular monitoring and preventive measures for extended survival.

3-year randomized clinical trial to evaluate the performance of posterior composite restorations lined with ion-releasing materials

To evaluate the impact of using ion-releasing liners on the 3-year clinical performance of posterior resin composite restorations after selective caries excavation with polymer burs. 20 patients were enrolled in this trial. Each patient had two deep carious lesions, one on each side of the mouth. After selective caries removal using polymer bur (PolyBur P1, Komet, Brasseler GmbH Co. KG, Lemgo, Germany), cavities were lined with bioactive ionic resin composite (Activa Bioactive Base/Liner, Pulpdent, Watertown, MA, USA) or resin-modified glass ionomer liner (Riva Light Cure, SDI, Bayswater, Victoria, Australia). All cavities were then restored with nanofilled resin composite (Filtek Z350XT, 3M Oral Care, St. Paul, MN, USA). All the tested materials were placed according to the manufacturers’ instructions. Clinical evaluation was accomplished using World Dental Federation (FDI) criteria at baseline and after 6 months, 1, 2, and 3 years. Data were analyzed using Mann–whitney U and Friedman tests (p < 0.05). The success rates were 100% for all resin composite restorations either lined with ion-releasing resin composite or resin-modified glass ionomer liner. Mann–whitney U test revealed that there were no statistically significant differences between both ion-releasing lining material groups for all criteria during the follow-up periods (p > 0.05). Resin composite restorations showed acceptable clinical performance over 3 years either lined with bioactive ionic or resin-modified glass ionomer liners after selective caries excavation preserving pulp vitality. After the 3-year follow-up period, Activa Bioactive and Riva Light Cure liners were clinically effective and they exhibited with the overlying composite restorations successful clinical performance.Trial registration number: NCT05470959. Date of registration: 22/7/2022. Retrospectively registered.

Attitudes regarding a warranty and the expected longevity of dental treatment amongst New Zealand dentists, dental students, and patients: a mixed methods survey

ObjectivesTo investigate and compare estimates of the longevity of dental treatment, expectations for free remedial treatment, and attitudes about formal dental warranties among dentists, students, and patients.Materials and methodsThis is a mixed-method cross-sectional questionnaire survey with convenience sampling from dentists, dental students, and patients in New Zealand. A questionnaire was distributed to New Zealand dentists (n = 28) and final-year dental students (n = 27). A separate questionnaire was provided to patients in a university dental clinic (n = 43). Mann-Whitney U, Chi-square and Pearson Correlation, and Binary logistic regression tests were used to test for differences between groups and correlations amongst variables. Qualitative data were analysed thematically.ResultsDentists believed that their posterior composite resin restorations would last longer (p = 0.014), would remediate failed crowns for longer (p = 0.002) and would provide longer crown warranties (p = 0.003) compared to students. Patients had higher expectations for restoration longevity and free remediation for failed treatment. Students were generally more willing to provide warranties. Crowns were perceived to be the most warrantable, while endodontic treatment was the least warrantable. Recall attendance, mechanical failure, and adequate oral hygiene were commonly proposed as warranty conditions for restorations and crowns. There was little consensus about complete dentures and endodontic treatment.ConclusionsThere are significant disparities between the expectations of patients and clinicians regarding treatment longevity and free remediation times. Clinicians, in general, are willing to provide free remediation within a specified time frame, except for endodontic treatment, but are hesitant to provide formal dental warranties.

5-year clinical performance of posterior bulk-filled resin composite restorations: A double-blind randomized controlled trial

ObjectivesThe aim of this double-blind, and randomized controlled clinical trial was to evaluate the 5-year clinical performance of posterior resin composite restorations placed with the incremental filling technique [IF] or the bulk-fill technique [BF]. Two different adhesive systems were used: etch-&-rinse (ER) or self-etch (SE). MethodsPosterior dental teeth of 72 participants (n = 236), with a cavity depth of at least 3 mm, were randomly divided into four groups. Restorations were applied with either Tetric N-Bond or Tetric N-Bond SE. The composite resin Tetric N-Ceram Bulk-Fill was placed either with IF or BF. Restorations were evaluated using FDI criteria at baseline and after 1, 2, 3, 4, and 5 years. Statistical analysis was performed using the Wilcoxon Signed rank test (a=0.05). ResultsTwo hundred and four restorations were evaluated after 5 years. Eleven restorations were considered 'failed', ten due to fracture (4 IF and 6 BF) and one due to secondary caries (IF). The annual failure rate was 1.2% for BF and 1% for IF (p = 0.35). When comparing BF and IF, no significant differences were found for any of the parameters evaluated (p > 0.05). Regarding the adhesive systems, 44 and 51 restorations showed minor problems in terms of marginal adaptation and staining, with significantly more marginal discoloration when the self-etch adhesive was used (p = 0.002). SignificanceThe bulk-fill restorative technique showed good clinical behavior compared to the incremental filling technique, especially when using an etch-&-rinse adhesive, after 5 years of clinical evaluation.

Glutaraldehyde-based desensitizer does not influence postoperative sensitivity and clinical performance of posterior restorations: A 24-month randomized clinical trial.

To evaluate the influence of a glutaraldehyde-based desensitizer (GL) on postoperative sensitivity (POS) in posterior bulk-fill resin composite restorations using an adhesive applied in the self-etch (SE) and etch-and-rinse (ER) strategies; and to assess the clinical performance of the restorations. Posterior resin composite restorations (n=228) at least 3mm deep were inserted in 57 subjects using a split-mouth design. The adhesive was applied with/without prior application of a GL. A resin composite was used for all restorations. Spontaneous POS (risk and intensity), as well as POS caused by stimulation with an air blast and assess the response to horizontal and vertical percussion was assessed using two scales in the baseline and after 7, 14, and 30 days. In addition, some parameters were evaluated using FDI criteria up to 24 months of clinical service. No significant POS was observed (p>0.05). A higher absolute risk and intensity of spontaneous POS was observed within 7 days (35.1%), without statistically significant differences among groups. At 24 months 5 restorations were considered clinically unsatisfactory, and 73 restorations showed minor discrepancies in adaptation, with no significant differences between groups (p>0.05). A GL agent does not influence POS in posterior restorations with bulk-fill resin composite. It may be considered a dispensable clinical step in the restorative protocol.

Clinical Evaluation of Reasons for Immediate Composite Restoration Failure Placed by Dental Students: A Cross-sectional Study in Jordan

Objective: The present study aims to investigate the reasons for the immediate failure of direct anterior and posterior resin composite restorations placed by dental students. Methods: A cross-sectional study on resin composite restorations placed by fourth- and fifth-year dental students (n=436). Variables included in the study were; the operative field isolation method, the time needed to complete the restoration after cavity preparation to polishing and finishing, and the plaque index of the patient. Restoration class distribution according to the type of tooth and cavity classification was examined and recorded. Restorations were clinically evaluated immediately after placement. It involved the assessment of the restoration’s mobility, marginal discoloration, and lack of anatomy. Results: A total of 233 direct anterior and posterior resin composite restorations which were placed by 127 students were diagnosed as failed restorations. The mode of failure was distributed as mobility/debonding (61.80%), marginal discoloration (29.18%), and lack of anatomy (9.02%). Cl III restorations demonstrated the highest failure on tooth type and cavity classification (30%), followed by Cl II restorations in molars (18.45%). Failure-associated factors were proper restoration manipulation, field isolation, and patients’ plaque index. Conclusion: In the current study, the most frequent reason for the immediate failure of resin composite restorations was the quick application of the restoration either as the only associated factor or coupled with other failure-associated factors. Failure to maintain proper field isolation and the poor oral hygiene of the patient were the other two failure-associated factors.

Fracture load and failure mode of semi-direct resin composite occlusal veneers: Influence of design and mechanical cycling

AimsTo evaluate the influence of the type of preparation and mechanical cycling on the fracture load and failure mode of semi-direct posterior resin composite restorations. MethodsIn total, 70 healthy third molars were used; 10 belonging to the control group (C - unprepared teeth) and 60 teeth prepared and restored with nanoparticle resin composite, divided into 3 groups (n = 20): O - exclusively occlusal preparation (Table Top); OV - occlusal preparation with buccal extension (Veneerlay); OVP - Occlusal preparation with chamfer on the proximal and buccal-lingual/palatal surfaces (Overlay). The preparations were performed with diamond burs with a thickness of 1 mm. The restorations were made with nanoparticulate resin composite (Filtek Z350 XT) and subsequently received additional polymerization (thermoprocessing). Cementation was performed with the use of universal adhesive system (Single Bond Universal) on dental substrate and dual resin cement (RelyX ARC). Half of the teeth in each group (n = 10) were submitted to mechanical cycling, simulating 6 months of clinical service (5 × 105 fatigue cycles), under dynamic loading of 130 N, at a frequency of 2Hz. Fracture load tests were performed in a universal testing machine with a 200 kgf load cell. Failure mode was classified using scores. Generalized linear models and Fisher Exact tests were applied to the data (significance level of 5%). ResultsThere were no significant differences between the types of preparation (p = 0.9435), or relative to cycling (p = 0.3764). The Fisher Exact Test showed a significant association between the groups and the type of failure (p = 0.0006), with preparations O (with cycling) and OVP (with and without cycling) exhibiting most failures with restoration fractures without involvement of the dental remnant. ConclusionsSemi-direct restorations showed resistance to fracture load similar to that of healthy teeth and were capable of withstanding functional masticatory loads. The type of preparation influenced the failure mode of teeth. The Table Top and Overlay types of preparations were those had fewer catastrophic failures, suggesting that since they are more conservative preparations, they made it possible for the tooth to receive a new restorative procedure in the future in cases of failures.

Developing procedural metrics for training in class II posterior composite resin restorations: Outcomes from an international Delphi panel

ObjectiveThe objective of this study was to develop and operationally define procedural performance metrics for the Class II posterior composite resin restoration procedure and to obtain face and content validity through a consensus meeting. MethodsA Metrics Group consisting of 4 experienced Consultants in Restorative Dentistry, an experienced member of staff from the Restorative Dentistry department in CUDSH and a senior behavioural scientist and education/training expert deconstructed the performance of the Class II posterior composite resin restoration and defined performance metrics. At a modified Delphi meeting, 20 experts in the field of Restorative Dentistry from 11 different Dental Institutions critiqued these metrics and their operational definitions before reaching consensus. ResultsInitially performance metrics consisting of 15 Phases, 45 steps, 42 errors and 34 critical errors were identified that characterize the performance of the Class II posterior resin composite procedure. During the Delphi panel these were modified and consensus was reached on 15 Phases (with a change to the initial sequence) with 46 Steps (1 added, 13 modified), 37 Errors (2 added, 1 deleted, 6 reclassified as Critical Error), and 43 Critical Errors (9 added). Consensus on the resulting metrics was obtained and face and content validity verified. ConclusionsIt is possible to develop and objectively define performance metrics that comprehensively characterize a Class II posterior composite resin restoration. It is also possible to achieve consensus on the metrics from a Delphi panel of experts and to confirm the face and content validity of those procedure metrics.

Longevity of Posterior Resin Composite Restorations

Longevity of Posterior Resin Composite Restorations

Light curing

The debate regarding composite resin’s shorter than expected service life is ongoing. The properties of this restorative material seem to only have a minor effect on restoration longevity, and the major reasons for failure can be attributed to the patient and the skills of the operator. Inadequate light curing (photopolymerisation) of the resin is also an important contributing factor in less than optimal patient outcomes involving posterior resin composite restorations.

Is the clinical performance of incremental and bulk-fill resin composite different?

Data sources PubMed, Scopus, Web of Science, Latin American and Caribbean Health Sciences Literature, Brazilian Bibliography in Dentistry and Cochrane Library. The grey literature was searched using the System for Information on Grey Literature in Europe database. Abstracts from the Annual Session of the International Association for Dental Research and its regional subgroups (1990-2020) were searched. Theses and dissertations (full texts) were searched in the ProQuest and Capes databases. Unpublished and ongoing studies were searched in clinical trial databases (Current Controlled Trials, International Clinical Trials Registry Platform, ClinicalTrials.gov, Registro Brasileiro de Ensaios Clínicos and EU Clinical Trials Register).Study selection In total, 14 randomised clinical trials comparing the clinical performance of composite resin restorations in posterior teeth placed with the incremental or the bulk-filling techniques were evaluated.Data extraction and synthesis Relevant information on the research project, participants, interventions and outcomes was collected using extraction forms by three study authors. Data extraction was pilot-tested using a sample of four studies to ensure that the data were consistent with the specific research question. To avoid overlapping, multiple reports of the same study with different follow-ups were extracted into a single form.Results Considering the primary and secondary outcomes (retention/fracture rate, anatomical form, surface texture, colour match, marginal adaption, marginal discoloration, caries and postoperative sensitivity), it is possible to state that there was no difference between incremental or bulk fill resin composite techniques in Class II and I cavities.Conclusions A systematic review and meta-analysis with moderated quality of evidence bulk fill and incremental techniques showed similar clinical performance on posterior resin composite restorations.

Clinical performance of posterior resin composite restorations after up to 33 years

ObjectivesThis retrospective study evaluated the performance of posterior composites after up to 33 years of clinical service and investigated factors associated with the risk of failures over time including patient- and tooth-related variables. MethodsPatients who received at least one Class I or Class II direct composite restoration in a private office in 1986–1992 and had follow-up appointments were included. Failures and interventions over time were investigated using the dental records. A follow-up clinical recall was carried out in 2020. Two scenarios were considered: restorations that did not require any intervention (success) or restorations that were repaired and still functional (survival). Multivariate Cox regression analyses and Kaplan-Meier curves were performed using success and survival rates (p < 0.05). ResultsOne hundred patient records and 683 restorations were included. A total of 353 failures were reported (success rate= 48%). Main reasons for failure were fracture and secondary caries. Most interventions after failures were repairs. Replacements were registered in 183 cases (survival rate= 73%). Annual failure rates were below 2.5% (success) and 1.1% (survival). Larger restorations and maxillary molars had higher failure risks. No significant differences in success rates among different resin composites was observed. A typical observation in this sample of restorations was the presence of moderate to advanced signs of aging, including marginal and surface staining, wear, chipping, changes in anatomical shape and translucency. Clearly aged restorations were still clinically satisfactory. Significance: This long-term, practice-based study indicates that resin composites can be used to restore posterior teeth with a long-lasting durability.

Postoperative sensitivity in posterior resin composite restorations with prior application of a glutaraldehyde-based desensitizing solution: A randomized clinical trial

ObjectivesTo evaluate the effect of a glutaraldehyde-based desensitizer on the postoperative sensitivity (POS) in posterior resin composite restorations up to 12 months using a universal adhesive (Tetric N-Bond Universal) with selective enamel etching (SE) or an etch-and-rinse (ER) strategy. MethodsClass I and class II resin composite restorations (n = 220) at least 3 mm deep were inserted in 55 subjects. The universal adhesive was applied using the SE (self-etch strategy on dentin with selective enamel etching) or the ER strategy, with or without prior application of a glutaraldehyde-based desensitizer (Gluma Desensitizer – GL) to form groups SEGL and ERGL. A bulk-fill resin composite (Tetric NCeram Bulk Fill) was used for all restorations. Spontaneous POS was assessed 7 days after the restorative procedure using the Visual Analog Scale (VAS) and the Numeric Rating Scale (NRS). After 7, 14, and 30 days of completing each restoration, the subjects were reassessed to evaluate POS caused by stimulation with an air blast, horizontal and vertical percussion. In addition, marginal discoloration, marginal adaptation, fracture, and recurrence of caries were evaluated using the FDI (World Dental Federation) criteria after 7 days and at 12 months. ResultsNo significant spontaneous or stimuli-induced POS was observed when restorations with or without GL were compared (p>0.05). A higher risk of spontaneous POS was observed within 7 days (40.0%; 95% CI 28.1 to 53.1), without statistically significant differences among groups. None of the participants reported POS at 12 months, however five restorations were considered clinically unsatisfactory (p > 0.05). ConclusionsThe previous application of GL did not significantly reduce spontaneous or stimuli-induced POS in posterior resin composite restorations at any time, regardless of the adhesive strategy used. Clinical significanceThe use of a glutaraldehyde-based desensitizing agent did not generate lower incidence of postoperative sensitivity in resin composite posterior restorations.

Comparison of Self-Etching Adhesives and Etch-and-Rinse Adhesives on the Failure Rate of Posterior Composite Resin Restorations: A Systematic Review and Meta-Analysis.

The aim of this study was to perform a systematic review with meta-analysis on the comparison of self-etching adhesives and etch-and-rinse adhesives with respect to the failure rate of posterior composite resin restorations. The study protocol was registered in PROSPERO (CRD42017078015), following PRISMA recommendations and PICO search strategy. Literature search was performed in the following databases: MEDLINE, ISI Web of Science, LILACS, SCOPUS, and Cochrane Library through July 2021. Six studies from five randomized clinical trials were included in the qualitative synthesis. The funnel plot detected important bias (all studies out of the funnel area). The meta-analysis showed a positive summary Cohen H effect size of 0.406 (95% CI: 0.100; 0.713, p = 0.009), favoring etch-and-rinse adhesives. The total number of failures (including restorations that required replacement and those that did not require replacement) were attributed to either marginal adaptation (five studies) or marginal staining (one study). A very low certainty of the evidence was obtained through GRADE analysis. In conclusion, current available evidence indicates that etch-and rinse adhesives performed better (with a low effect size) than self-etching adhesives in terms of failure rates in posterior composite restorations.

A cost-effective technique for fabricating a dentoform by using a complete digital workflow

Direct posterior composite resin restorations are a routine procedure and represent a large part of the restorative work in daily practice1; surprisingly, their complexity may be underestimated by many clinicians. This highly skill-dependent treatment requires well-defined layering protocols and practice by the dentist to make it more predictable and time-efficient,2-5 but many dentists do not invest in perfecting the procedure.6

Clinical performance and SEM marginal quality of extended posterior resin composite restorations after 12 years

ObjectiveTo investigate the clinical behavior of two different resin-based restorative systems in extended Class II cavities in a controlled prospective split-mouth study over 12 years and to assess marginal quality under a SEM using epoxy replicas. MethodsThirty patients received 68 resin composite restorations (Solobond M+Grandio: n=36; Syntac+Tetric Ceram: n=32) by one dentist in a private practice. 35% of cavities revealed no enamel at the bottom of the proximal box, 48% of cavities provided <0.5mm remaining proximal enamel. Restorations were examined according to modified USPHS criteria at baseline, and after six months, one, two, four, six, eight, 10, and 12 years. Expoxy replicas of 21 restoration pairs were analysed under a SEM at 200× magnification regarding marginal quality. ResultsAt the 12-years recall, 59 of the original 68 restorations in 27 of 30 patients were available (drop out 13%). Two restorations failed due to cusp fracture (Tetric Ceram) and marginal fracture (Grandio). The overall success rate of all restorations was 97.1% (Kaplan–Meier survival algorithm) with no differences between the two materials (p=0.923). After 144 months of clinical service, restorations in molars performed worse than in premolars regarding the integrity of restoration and tooth (p<0.05) being detected as wear, chippings, and cracks. Beyond the 4-year recall, marginal staining significantly increased. SEM evaluation of replicas revealed that perfect margin (49% baseline vs. 10% after 12 years), overhang (13% at baseline vs. 3% after 12 years), negative step formation (34% at baseline vs. 75% after 12 years), and marginal fractures (0% at baseline vs. 6% after 12 years) significantly changed during the evaluation period (p<0.001). SignificanceExtended direct resin composite restorations performed satisfactorily over 12 years of clinical service. SEM analysis delivered qualitative data regarding marginal deterioration over time.

Digital photography vs. clinical assessment of resin composite restorations.

To compare direct clinical and indirect digital photographic assessment of resin composite restorations. Ninety-two posterior resin composite restorations were classified using World Dental Federation (FDI) criteria by two different clinical examiners (C1 and C2). In the same appointment of clinical assessment, intraoral high-quality digital photographs were taken and posteriorly two different digital examiners (D1 and D2) classified the images of each restoration. Restorations of each patient were assessed once by C1 and C2 independently. D1 and D2 assessed the digital images from different locations and in different time. Data were analyzed using the Cohen's kappa coefficient, Kruskal-Wallis non-parametric test and Dunn's multiple shared test, with 95% confidence. Agreement levels varied from very good (0.81-1.00) to fair (0.21-0.40). Statistically significant differences (p < 0.05) between assessments were found for surface lustre, staining, color match and translucency, esthetic anatomical form, fracture of material and retention and marginal adaptation. The classification of the resin composite restorations varied significantly according to clinical or high-quality digital photographic assessments. Overall, clinical assessment detected more demand for repair or replacement.

Contemporary teaching of posterior composites at dental schools in Austria, Germany, and Switzerland

ObjectiveTo investigate current teaching and operative techniques for posterior composite resin restorations in dental schools in Austria, Germany, and Switzerland. MethodsData on teaching, including operative techniques applied in the placement of posterior composites, were collected by means of a 25-item validated questionnaire sent to the Heads of Department of Operative/Restorative Dentistry at all 38 dental schools in Austria, Germany, and Switzerland. Responses were compiled in Excel and analysed. ResultsThirty-three schools responded to the survey, resulting in a response rate of 87 %. All dental schools indicated teaching of 2- and 3-surface posterior composite restorations. About one third only of the preclinical teaching is assigned to teaching posterior composite restorations, while the vast majority of posterior restorations placed by students in their clinical instruction are composite (89.6 ± 9.3 %). Most dental schools teach few contraindications to posterior composites, except for adverse reactions such as allergies. All dental schools consider moisture control to be important, while approaches to the management of exposed dentine differ. ConclusionsThe teaching of the placement of posterior composite restorations is common to all the dental schools in Austria, Germany, and Switzerland which participated in the present study. Most aspects of the teaching were found to be consistent amongst the schools. However, marked variations were observed in respect of operative techniques for the placement of posterior composites. Clinical significanceGraduates from dental schools in Austria, Germany, and Switzerland may be found to have received theoretical, preclinical, and clinical instruction in posterior composites, but do show some variation in approach to the management of exposed dentine.