Posterior Composite Restorations Research Articles

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.

Influence of Cavity Lining on the 3-Year Clinical Outcome of Posterior Composite Restorations: A Randomized Controlled Clinical Trial.

The purpose of this randomized, split-mouth-designed controlled and single-blinded clinical study was to evaluate the 3-year clinical performance of Class I and Class II resin composite restorations placed with or without cavity lining with a flowable composite. Fifty patients with treatment needs in two premolars or molars were included. One of the teeth was restored using the nanohybrid composite (Grandio®SO, control group), in the test group a high viscosity flowable composite was additionally applied as a first layer. In both groups, the same self-etch adhesive system was applied. Clinical evaluation after 3 years was carried out using the modified USPHS/Ryge criteria. At the 3-year follow-up the recall rate was 92%. Four restorations failed in the test group (8.7%), three due to the loss of vitality and one after fracture. The control group exhibited a cumulative success rate of 100%, while the test group achieved a success rate of 91.3%. This led to significant differences in the annual failure rate (AFR) between the two groups, with rates of 0% and 2.9% (p < 0.05; Mann-Whitney U-test). After 3 years the cumulative survival rate including all restorations was 95.7%. Statistical analysis revealed significant differences for the parameters: tooth vitality, marginal discoloration, success rate, and AFR. The other parameters exhibited no significant differences. Consequently, the nanohybrid composite demonstrated excellent performance over a 3-year period, whereas the utilization of a flowable composite for the cavity lining did not appear to exert a beneficial influence on clinical outcomes.

Evaluation of Knowledge and Attitude of Yazd Dental Students in Connection with the Training of Posterior Teeth Restoration with Composite in 2023

Introduction: Today, composite resins are a suitable choice for tooth restoration, which in relation to posterior teeth, the most important limitations are marginal leakage, secondary decay, poor load bearing capacity, high wear and inability to restore contact. The durability of posterior restorations especially class II restorations is less compared to amalgam restorations. This has been affected by various factors such as polymerization shrinkage, thermal expansion coefficient and abrasion resistance that limits the durability of the posterior composite. Methods: The present study was a cross-sectional descriptive study, which 68 final year dental students of School of Dentistry of Shahid Sadoughi University of Medical Sciences in Yazd City were selected by census and their attitude and awareness were studied using a valid and reliable questionnaire containing demographic characteristics and attitude as well as awareness questions. All the data were analyzed in SPSS 16 statistical software. Likert scale was used to measure awareness and attitude. Results: In the present study, among the 68 final year dental students, 37 students (54.4%) were male 31 students (45/6%) were female the mean and standard deviation of the age of the participants was 25.12 ± 2.3 years. In this study, the mean and standard deviation of total attitude score of final year dental students was equal to 22.80 ± 6.74 and the total attitude score of final year dental students based on Likert Scale was lower than the average. Most of the students reported the quality of posterior composite training to meet practical needs as poor. Conclusion: Based on the results, the awareness and attitude of final year dental students in relation to posterior composite restoration training was less than average and weak, respectively. There was no significant difference was observed between the knowledge and attitude scores with the gender and age.

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.

Current trends in placing posterior composite restorations: Perspectives from Palestinian general dentists: A questionnair study.

The success of composite restorations relies on material selection and practitioner-related factors that shape the overall outcome. This study explores the practices of Palestinian general dental practitioners in placing posterior composites, examining the impact of work sector, experience, and gender on their choices. The study was conducted as an online cross-sectional questionnaire and involved 351 participants, with a response rate of 69.8%. The survey comprised 18 closed-ended questions covering demographics, material selection, and composite placement in special cases, techniques, and factors influencing the choices. Statistical analyses included descriptive statistics, chi-squared tests, and Fisher's exact tests. Composite was the predominant choice for small-size (83.7%) and large-size posterior cavities (60.4%). Practitioners commonly opted for composite restorations in cases involving occlusal parafunctional activity (60%), poor oral hygiene (78%), and subgingival cavities (72.2%). Only 19.6% and 5.3% reported occlusal and gingival beveling, respectively. Rubber dams for isolation stood at 30%, one-step self-etch adhesives at 44.9%, and the oblique layering technique at 51%. Light-emitting diode curing units were popular (97.55%), but monitoring output with a radiometer was infrequent (93.5%). Tofflemire metal matrix usage was 46.1%, whereas a sectional matrix system was employed by 29.8%. A 2 mm layer exposure to light curing for 20 s was reported by 62%, and 27.75% utilized additional light-curing postmatrix band removal. The study highlights the need for Palestinian dental professionals to update their clinical approaches in placing composite restorations in posterior teeth. Gender, work sector, and experience influence practitioners' choices, emphasizing the importance of tailored continuing education programs for improving clinical practices.

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.

Clinical evaluation of posterior flowable short fiber-reinforced composite restorations without proximal surface coverage.

The purpose of this clinical trail was to assess the clinical behavior of posterior composite restorations supported by a substantial foundation of flowable short fiber-reinforced composite SFRC (everX Flow, GC, Japan) used without proximal surface coverage with particulate filler resin composite (PFC). Seventy patients (20 males, 50 females; mean age: 30 ± 10years) were randomly enrolled in this trial. Patients received direct restorations of either SFRC covered only on the occlusal surface (1-2mm) by conventional PFC composite (G-ænial Posterior, GC), or plain conventional PFC composite without fiber-reinforcement, in Class II cavities in premolar and molar vital teeth. One operator made all restorations using one-step, self-etch bonding agent (G-ænial Bond, GC) according to manufacturers' recommendations. Two blinded trained operators evaluated the restorations at baseline, at 6, 12 and 18months using modified USPHS criteria. Results indicated that, in both groups and at different follow-up intervals, according to evaluated criteria, restorations were rated mostly with best score (Alpha) (p > 0.05). For the marginal integrity after 6months, a single case in the intervention [increased to 3 (8.8%) after 18months] and 3 (9.7%) cases of the control group [increased to 4 (12.9%) after 18months] had Bravo score but with no significant difference (p > 0.05). For color match measured after 6 and 18months, three (8.8%) cases had Bravo score in the intervention group. The use of flowable SFRC composite without any PFC surface coverage proximally in Class II restorations demonstrated satisfactory clinical outcome throughout the 18-month follow-up.

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.

Survival analysis of posterior composite restorations in National Dental PBRN general dentistry practices

ObjectiveQuantify the survival of posterior composite restorations (PCR) placed during the study period in permanent teeth in United States (US) general dental community practices and factors predictive of that survival. MethodsA retrospective cohort study was conducted utilizing de-identified electronic dental record (EDR) data of patients who received a PCR in 99 general dentistry practices in the National Dental Practice-Based Research Network (Network). The final analyzed data set included 700,885 PCRs from 200,988 patients. Descriptive statistics and Kaplan Meier (product limit) estimator were performed to estimate the survival rate (defined as the PCR not receiving any subsequent treatment) after the first PCR was observed in the EDR during the study time. The Cox proportional hazards model was done to account for patient- and tooth-specific covariates. ResultsThe overall median survival time was 13.3 years. The annual failure rates were 4.5–5.8 % for years 1–5; 5.3–5.7 %, 4.9–5.5 %, and 3.3–5.2 % for years 6–10, 11–15, and 16–20, respectively. The failure descriptions recorded for < 7 % failures were mostly caries (54 %) and broken or fractured tooth/restorations (23 %). The following variables significantly predicted PCR survival: number of surfaces that comprised the PCR; having at least one interproximal surface; tooth type; type of prior treatment received on the tooth; Network region; patient age and sex. Based on the magnitude of the multivariable estimates, no single factor predominated. ConclusionsThis study of Network practices geographically distributed across the US observed PCR survival rates and predictive factors comparable to studies done in academic settings and outside the US. Clinical significanceSpecific baseline factors significantly predict the survival of PCRs done in US community dental practices.

Vitamin D deficiency and chronological hypoplasia with hypomineralisation: a case report.

Patients being reported for vitamin D deficiency (VDD) are increasing, particularly among the children and adolescents. This study aims to manifest the clinical and dental evaluations of a child with VDD, referred to the dental office. A 10-year-old British Asian boy was referred to the paediatric specialist dentistry clinic by the general dentist for dental management. The medical history depicted that the patient was diagnosed with VDD, secondary hyperparathyroidism and delayed growth. Moreover, his mother had the VDD during pregnancy. The patient was breast fed and had rickets in infancy. He was prescribed vitamin D supplements at the age of 16 months. He had received multiple dental treatments under local anaesthesia but with limited cooperation. Clinical examination revealed that the patient had chronological enamel hypoplasia shown as bands at the occlusal third on specific teeth. Suboptimal hygiene with general plaque induced gingivitis, dental caries in permanent and primary teeth, and delayed the teeth eruption. Preventions included appropriate oral hygiene and dietary advice, fluoride varnish application and fissure sealant placement. The treatments included anterior direct composite restoration, posterior composite restoration, stainless steel crowns and extractions. Thorough medical history is essential to understand the underlying causes of dental defects. Early dental intervention can restore the patient appearance and function and prevent further dental damage.

A Randomized Controlled Clinical Trial Evaluating the Performance of Bis-GMA Free Resin Composite Posterior Restorations

Objective: This study aims to assess the clinical performance of Bis-GMA free resin composites (RCs) in comparison with Bis-GMA based resin composites as posterior restorations during 1,3,6,9, and 12 months, using a split-mouth, double-blinded randomized design. Methods and Materials: The study included 20 participants who received a pair of class I or II bulk-fill composite restorations. One side of the mouth was filled with Bis-GMA free RC (Admira Fusion x-tra), while the other side received Bis-GMA based RC (X-tra fil). Restoration placement was done by a single operator following the manufacturer's guidelines and was finished and polished immediately following placement. Modified United States Public Health Services (USPHS) criteria have been adopted for restoration assessment at baseline (1 week), 1, 3, 6, 9, and 12 months. The statistical analysis was accomplished utilizing Wilcoxon tests, with a 0.05 significance level. Results: After 12 months, all patients attended the recall visits with a 100% recall rate. The Wilcoxon signed rank tests revealed insignificant differences between both groups (p?0.05) for all USPHS parameters. The two studied materials showed a decline from 100% clinically excellent scores, with a few recordings of clinically good scores at 12 months. However, most restorations maintained clinical Alpha and Bravo score throughout the 12-month period. Conclusions: The Bis-GMA-free RCs' clinical performance was comparable to that of Bis-GMA-based RCs in posterior permanent teeth restorations after 12 months. These findings suggest that Bis-GMA-free RCs can be considered a viable alternative to Bis-GMA-based RCs in clinical practice.

Esthetical Properties of Single-Shade and Multishade Composites in Posterior Teeth.

This study aimed to compare the aesthetic properties of posterior composite restorations made with a multishade (MS) or single-shade (SS) material. For that, 23 extracted human molars were used. The shade determination was performed, and the occlusal anatomy was registered by a custom-made stamp. Then, class I preparations were made, and each tooth was restored twice, using two different composites of MS/opacity layering material (Admira Fusion-Voco) and an SS/opacity bulk-fill composite (Admira Fusion X-tra-Voco). After finishing the first restoration with the MS material, a standardized picture was taken, and the restoration was removed. Then, the preparation was restored again with the other composite, obtaining a new picture. The pictures were randomly analyzed by 10 calibrated evaluators regarding color match using the FDI criteria. The evaluators were blinded to the restorative material used. Data were analyzed using an unpaired t-test and Wilcoxon test. The significance level adopted in the study was 5%. As a result, there were nonsignificant differences between the composites evaluated for color match, as well nonsignificant differences were obtained related to which restorative technique produced the best aesthetic results. Only for darker shades (A4, B4, and C4), most of the evaluators considered the restorations made with the MS material more aesthetic than with the SS, while for the other shades, nonsignificant differences were observed. Therefore, the choice of the SS and the MS/opacity composites does not influence the aesthetic outcome of posterior restorations for the lighter shades. However, the use of bulk fill material for dark shades is less favorable than the MS layering ones.

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.

A history of posterior composite restorations as viewed through the pages of Dental Update

Patients today are increasingly seeking tooth-coloured restorations for their posterior dentition, and with the anticipated decline in the use of amalgam as a result of the Minamata Agreement, this trend will increase. However, these are relatively recent considerations, given that the first dedicated resin composite material intended for use in posterior teeth appeared in 1986. Although macro-filled resin composite materials were available prior to 1986, they exhibited poor wear resistance. This article reviews the history of so-called ‘posterior composite’ restorations as gleaned from the pages of Dental Update, including how some of the early techniques described were subsequently proved to be erroneous, and how knowledge from research and clinical experience corrected these, so that clinicians may now place predictable, reliable, aesthetic ‘posterior composite’ restorations. CPD/Clinical Relevance: Lessons from the history of posterior composites may provide the foundation for their successful use in contemporary clinical practice.

Posterior dental restoration material choices in privately insured people in the United States, 2017 through 2019

BackgroundIn the context of evolving dental materials and techniques and a national agenda to phasedown use of dental amalgam, estimates of dental amalgam placement are necessary for monitoring purposes. MethodsNumbers of amalgam and composite posterior restorations from 2017 through 2019 were calculated using retrospective dental claims analysis of privately insured patients. Kruskal-Wallis and multilevel, multivariable negative binomial regression models were used to test for differences in rates of amalgam and composite restoration placement by age group, sex, urban or rural area, and percentage race and ethnicity area distribution. Statistical significance was set at 0.05, with Benjamini-Hochberg correction for false discovery rate. ResultsThe rate of amalgam restorations declined over time from a mean of 6.29 per 100 patients in 2017 to 4.78 per 100 patients in 2019, whereas the composite restoration rate increased from 27.6 per 100 patients in 2017 to 28.8 per 100 in 2019. The mean number of amalgam restorations placed per person were lowest in females compared with males, in urban areas compared with rural areas, and in areas with more than 75% non-Hispanic White residents. ConclusionsAmalgam restoration placements in privately insured people in the United States declined from 2017 through 2019. Amalgam restoration placements may be unevenly distributed by location. Practical ImplicationsAchieving further declines of dental amalgam use may require changes to insurance coverage, incentives, and provider training as well as augmented disease prevention and health promotion efforts. These efforts should focus particularly on groups with high caries risk or higher rates of amalgam placement.

Techniques Used by Dental Specialists for Extensive Posterior Composite Restorations

Objective: To assess the techniques used by dental specialists for placement of extensive posterior composite restorations. Methodology: A cross sectional descriptive was conducted in 150 dentists of College of Dentistry, SMDC, Lahore from June 2019 to July 2020 after obtaining ethical approval from Sharif Medical Research Centre (SMRC). Data was collected using a pre validated questionnaire Results: A statistically non-significant association between the specialty of the dentist the technique used for placement of the composite during restoration (p=0.08). The most commonly used techniques for the placement of posterior composite restorations by dentists of all specialties including Periodontology (88%), Prosthodontics (68.4%), Orthodontics (85.7%), Oral Surgery (91.3%), Oral Pathology (71.4%), Oral Biology (33.3%), Dental materials (75%), Community Dentistry (100%), Operative Dentistry (90.9%) and Oral Medicine (75%) is incremental curing. Practical implication: This study will give an insight on the various techniques used by dentists from various specialties for the placement of composite restorations in posterior teeth. This will in turn help them adopt new and revisit old techniques used by them while placing composite restorations. Conclusion: The most commonly used techniques for the placement of posterior composite restorations by dentists of all specialties is incremental curing followed by use of moisture control during the placement of composites both with and without rubber dam isolation. Keywords: Dental Specialists, Composite Restorations, Posterior Dental Restorations, Incremental Curing

A 23-Year Observational Follow-Up Clinical Evaluation of Direct Posterior Composite Restorations.

The purpose of this observational follow-up clinical study was to observe the quality of posterior composite restorations more than 23 years after application. A total of 22 patients, 13 male and 9 female (mean age 66.1 years, range 50-84), with a total of 42 restorations attended the first and second follow-up examinations. The restorations were examined by one operator using modified FDI criteria. Statistical analysis was performed with the Wilcoxon Mann-Whitney U test and Wilcoxon exact matched-pairs test with a significance level of p = 0.05. Bonferroni-Holm with an adjusted significance level of alpha = 0.05 was applied. With the exception of approximal anatomical form, significantly worse scores were seen for six out of seven criteria at the second follow-up evaluation. There was no significant difference in the first and second follow-up evaluations in the grades of the restorations with regard to having been placed in the maxilla or mandible, as well as for one-surface or multiple-surface restorations. The approximal anatomical form showed significantly worse grades at the second follow-up when having been placed in molars. In conclusion, the study results show that significant differences regarding FDI criteria in posterior composite restorations occur after more than 23 years of service. Further studies with extended follow-up time and at regular and short time intervals are recommended.

Clinical evaluation of reasons for replacement of amalgam vs composite posterior restorations

BackgroundThe aim of the present study is to evaluate the most common reasons for replacing posterior amalgam and resin composite restorations in patients attending the university dental restorative clinics. MethodsA total of 318 restorations which needed to be replaced were clinically and radiographically evaluated in a period of nine months. The frequencies of reasons for replacing posterior amalgam and resin composite restorations were calculated; secondary caries, restoration/tooth fracture, marginal discoloration/ditching, proximal overhang/open margin, loss of anatomy, pain/sensitivity, and esthetics. ResultsThe sample population comprised of 191 females and 106 males. The majority of the sample population fell in the age group of 40–50 years (n = 110). 318 restorations (n = 318) were examined in this study. 82% of examined teeth were restored with amalgam (n = 261), while posterior composite restorations comprised 18% of the examined teeth (n = 57). Among all restorations demanded to be replaced by the patients (n = 318), aesthetic need was the most common reason (n = 98), followed by Ditching or discoloration (n = 64), secondary caries (n = 57), and fracture (n = 44). Loss of anatomy was the least common cause to replace both amalgam and resin composite restorations (n = 5). The different reasons of failure were all significant between amalgam and resin composite restorations as shown in (Fig. 1) (p < 0.005). The most common reason for amalgam replacement was aesthetic. The most common reason for composite replacement was secondary caries and marginal ditching. ConclusionBoth amalgam and composite had different reasons for replacement. Amalgam had lesser risk of developing secondary caries and higher longevity than composite.

Comparing teaching of amalgam and direct posterior composite restorations to undergraduates: A cross-sectional study among faculties from the Department of Conservative Dentistry &amp; Endodontics in Kerala, India

Abstract Background: Posterior composites are widely used in dental practice today. But whether the undergraduate dental curriculum equip the students with the knowledge and skills in posterior composite placement is questionable. Further, amalgam seems to be an ideal choice of restoration by a few dental professionals. Thus this study aims to compare the theoretical, pre-clinical, and clinical curricular aspects of amalgam and direct posterior restoration from the perspective of dental teaching faculty. Materials and Methods: This observational cross-sectional study was conducted across all dental colleges in Kerala. A questionnaire designed through google forms were sent to 100 dental teaching faculty, selected by random sampling. The responses were entered in Microsoft excel and analysed using Statistical Product and Service Solution (SPSS) trial version 25. Appropriate descriptive and inferential statistics were employed. Results: Only 34.1% of the dental teaching faculty strongly agreed on the adequacy of the theoretical aspects of posterior composite restoration compared to 69.3% for amalgam restorations. Fifty percent of the study participants believed that amalgam will be completely replaced by posterior composite in future. Eighty three percent of the dental teaching faculty pointed out the inadequacy of time in preclinical exercises for posterior composite restorations. Conclusion: The findings highlighted inadequacy in the theoretical, pre-clinical, and clinical aspects of teaching posterior composite restorations among dental undergraduates and warranted the curricular reforms should be made accordingly.

The Effect of Pre-Heating on Fracture Toughness in Three Distinct Composite Resin Systems at Two Different Temperatures: A Protocol for an In-vitro Study

Introduction: Composite resins are considered the pinnacle of esthetic restorations, but they have their own disadvantages, such as polymerization shrinkage, low fracture toughness, and the formation of microcracks, all of which eventually results in failure of the restoration. Fracture toughness is an important factor for failure. Warming the same composites to certain temperatures will show drastic improvements in the abovementioned flaws, especially the fracture toughness. Need for the study: Therefore, the objective of this study is to evaluate and compare the fracture toughness of three different types of composite resin systems at two different pre-heating temperatures. The study aims to provide valuable information to clinicians in choosing the most appropriate restorative material for posterior composite restorations, which can ultimately improve the treatment's success rate and reduce the risk of complications such as secondary caries, postoperative sensitivity and ultimately restoration failure. Objective: In summary, this study will compare and evaluate the fracture toughness of nanohybrid, micro-hybrid, and bulkfill composite resins pre-heated at 50 degrees Celsius and 60 degrees Celsius. Methodology: The methodology involves dividing 72 freshly extracted premolars with intact occlusal anatomy and fully developed apical foramina into three main groups based on three different composites and further dividing each group into two sub-groups based on two different pre-heating temperatures, with 12 teeth in each group. Each tooth will then be prepared with a Class-II Mesio-Occlusal-Distal (MOD) cavity and receive pre-heated composite restoration according to its assigned group and sub-group. The prepared samples will be tested for fracture toughness using a universal testing machine.