Composite Restorations Research Articles

Implementation of machine learning models as a quantitative evaluation tool for preclinical studies in dental education.

Objective, valid, and reliable evaluations are needed in order to develop haptic skills in dental education. The aim of this study is to investigate the validity and reliability of the machine learning method in evaluating the haptic skills of dentistry students. One-hundred fifty 6th semester dental students have performed Class II amalgam (C2A) and composite resin restorations (C2CR), in which all stages were evaluated with Direct Observation Practical Skills forms. The final phase was graded by three trainers and supervisors separately. Standard photographs of the restorations in the final stage were taken from different angles in a special setup and transferred to the Python program which utilized the Structural Similarity algorithm to calculate both the quantitative (numerical) and qualitative (visual) differences of each restoration. The validity and reliability analyses of inter-examiner evaluation were tested by Cronbach's Alpha and Kappa statistics (p=0.05). The intra-examiner reliability between Structural Similarity Index (SSIM) and examiners was found highly reliable in both C2A (α=0.961) and C2CR (α=0.856). The compatibility of final grades given by SSIM (53.07) and examiners (56.85) was statistically insignificant (p>0.05). A significant difference was found between the examiners and SSIM when grading the occlusal surfaces in C2A and on the palatal surfaces of C2CR (p<0.05). The concordance of observer assessments was found almost perfect in C2A (κ=0.806), and acceptable in C2CR (κ=0.769). Although deep machine learning is a promising tool in the evaluation of haptic skills, further improvement and alignments are required for fully objective and reliable validation in all cases of dental training in restorative dentistry.

Synergistic effects of bacteria, enzymes, and cyclic mechanical stresses on the bond strength of composite restorations

Predicting how tooth and dental material bonds perform in the mouth requires a deep understanding of degrading factors. Yet, this understanding is incomplete, leading to significant uncertainties in designing and evaluating new dental adhesives. The durability of dental bonding interfaces in the oral microenvironment is compromised by bacterial acids, salivary enzymes, and masticatory fatigue. These factors degrade the bond between dental resins and tooth surfaces, making the strength of these bonds difficult to predict. Traditionally studied separately, a combined kinetic analysis of these interactions could enhance our understanding and improvement of dental adhesive durability. To address this issue, we developed and validated an original model to evaluate the bond strength of dental restorations using realistic environments that consider the different mechanical, chemical, and biological degradative challenges working simultaneously: bacteria, salivary esterases, and cyclic loading. We herein describe a comprehensive investigation on dissociating the factors that degrade the bond strength of dental restorations. Our results showed that cariogenic bacteria are the number one factor contributing to the degradation of the bonded interface, followed by cyclic loading and salivary esterases. When tested in combinatorial mode, negative and positive synergies towards the degradation of the interface were observed. Masticatory loads (i.e., cycling loading) enhanced the lactic acid bacterial production and the area occupied by the biofilm at the bonding interface, resulting in more damage at the interface and a reduction of 73 % in bond strength compared to no-degraded samples. Salivary enzymes also produced bond degradation caused by changes in the chemical composition of the resin/adhesive. However, the degradation rates are slowed compared to the bacteria and cyclic loading. These results demonstrate that our synergetic model could guide the design of new dental adhesives for biological applications without laborious trial-and-error experimentation.

Reinforcing simulated vital pulpotomized teeth as an alternate to invasive procedures: An in vitro study

ABSTRACT Background/Aim: The aim is to compare and evaluate the fracture resistance of simulated pulpotomy-treated tooth reinforced with different reinforcing materials. Methodology: Forty-five extracted human permanent central incisors were collected of approximately similar dimensions for this in vitro study. To simulate pulpotomy procedure, each tooth was sectioned through the middle third of the crown perpendicular to the long axis of the tooth, resulting in 6 mm cervicoincisal height (mimicking Ellis Class III fracture). Later, all the teeth were divided into four experimental (n = 10 each) and a control group (n = 5), according to the reinforcing materials used: Group A – microhybrid composite, Group B – stainless steel, Group C – polypropylene mesh, Group D – Rebilda post, and Group E – control group (natural tooth). The reinforcing materials were placed parallel to the long axis of the tooth, such that it lies 3 mm into the pulp chamber and 3 mm in the coronal portion, over which the composite restorations were placed. All the specimens were subjected to the universal testing machine for fracture resistance. Results and Conclusion: The data obtained were tabulated and statistically analyzed using Kruskal–Wallis and Tukey’s post hoc test. Stainless steel material exhibited statistically significant values among the experimental groups and the control group, whereas the values of polypropylene mesh, microhybrid composite, and Rebilda post were nonsignificant.

Comparative Strength Study of Indirect Permanent Restorations: 3D-Printed, Milled, and Conventional Dental Composites.

Background/Objectives: Limited research has been performed to assess the strength of resin-bonded 3D-printed restorations. Based on that, this study investigates the impact of different manufacturing methods on the fracture load of indirect composite restorations (ICRs) following an aging process. Methods: Three manufacturing techniques-conventional (CRC), milled (MRC), and printed (PRC)-were evaluated using 60 specimens, each with a diameter of 10 mm and a thickness of 1.0 mm. Sandblasting with Al2O3 particles was employed to optimize the bonding process, significantly influencing surface roughness parameters (Ra, Rz, RSm). All specimens were bonded to the dentin analog using composite resin cement and subjected to either 10,000 thermocycles (TC) or storage (ST) at 37 °C in distilled water. Fracture load assessments were performed using a universal testing machine. A finite element analysis was conducted to assess stress distribution. Results: Two-way ANOVA results indicated that the manufacturing method significantly affected mean fracture load values (p < 0.001), with PRC showing the highest mean fracture load (4185 ± 914 N), followed by MRC (2495 ± 941 N) and CRC (599 ± 292 N). The aging protocol did not have a significant impact on fracture load. Conclusions: This study revealed that 3D-printed resin composite exhibited comparable strength to milled resin composite when adhesively cemented, suggesting it is a promising option for indirect composite restorations based on its mechanical performance. However, further research is needed to evaluate its bond strength and optimal surface treatment methods to prevent early debonding.

Direct Composite Restorations on Permanent Teeth in the Anterior and Posterior Region - An Evidence-Based Clinical Practice Guideline - Part 2: Recommendations for Composite Processing.

Part 2 of this German S3 clinical practice guideline provides recommendations for the process of manufacturing composite restorations. It covers key aspects like caries removal, field isolation, matrix and adhesive techniques, as well as light curing and polishing. The outcomes of interest include survival rates and restoration quality. A systematic literature search was conducted by two methodologists using MEDLINE and the Cochrane Library via the OVID platform, including studies up to December 2021. Additionally, the reference lists of relevant manuscripts were manually reviewed. Six PICO questions were developed to guide the search. Consensus-based recommendations were for- mulated by a panel of dental professionals from 20 national societies and organizations based on the collected evidence and ex- pert opinion. The guideline advocates for one-stage selective caries removal near the pulp and underscores the effectiveness of various isolation techniques, adhesive systems, and the crucial role of light polymerization. The use of anatomically pre- formed sectional matrices and phosphoric acid etching is recommended to enhance restoration quality. Additionally, polish- ing composite restorations is advised to improve surface finish. This guideline provides comprehensive recommendations that inform clinicians on optimizing the composite restor- ation manufacturing processes. The adoption of these best practices can improve the quality and longevity of dental restorations.

Direct Composite Restorations on Permanent Teeth in the Anterior and Posterior Region - An Evidence-Based Clinical Practice Guideline - Part 1: Indications for Composite Restorations.

This German S3 clinical practice guideline offers evidence-based recommendations for the use of composite materials in direct restorations of permanent teeth. Outcomes considered were the survival rates and restoration quality and process quality of the manufacturing process. Part 1 of this two-part presentation deals with the indication classes. A systematic literature search was conducted by two methodologists using MEDLINE and the Cochrane Library via the OVID platform, including studies up to December 2021. Six PICO questions were developed to guide the search. Recommendations were formulated by a panel of dental professionals from 20 national societies and organizations based on the collected evidence. Composite materials are a viable option for the direct restoration of cavity Classes I-V and may also be used for restorations with cusp replacement, and tooth shape corrections. In the posterior region, direct composite restorations should be preferred over indirect composite inlays. For Class V restorations, composite materials can be used if adequate contamination control and adhesive technique are ensured. The guideline is the first to provide comprehensive evidence on the use of direct composite materials. However, further long-term clinical studies with comparators such as (modified) glass-ionomer cements are necessary. Regular updates will detail the future scope and limitations of direct composite restorations.

In Vitro Effects of Sof-Lex, Eve, and Astropol Polishing Systems on Composite Resin Surface Roughness After Aging

Objectives: Surface roughness is one of the important properties of composite restorations. Different polishing systems are used to provide an appropriate composite restoration surface. The aim of this study was to evaluate the effects of Sof-Lex, Eve, and Astropol polishing systems on composite resin surface roughness after aging. Materials and Methods: In this in vitro study, 36 composite discs (8×2mm) were fabricated. The specimens were randomly divided into three groups (N=12) for polishing with (I) Sof-Lex (3M ESPE), (II) Eve (Ernst Vetter GmbH), and (III) Astropol (Ivoclar/Vivadent) polishing systems. The specimens were then subjected to thermocycling. Surface roughness of the specimens was measured before and after polishing, and after thermocycling by a contact profilometer. Repeated Measures ANOVA was used to analyze the data (α=0.05). Results: Although Astropol showed slightly higher surface roughness in comparison to Sof-Lex and Eve, the level of surface roughness before and after polishing and after aging was not significantly different among the three polishing systems (P=0.704). Conclusion: Within the limitations of this in vitro study, Sof-Lex, Eve, and Astropol showed similar acceptable results with regard to composite resin surface roughness.

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 &lt; 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 &gt; 0.05). Mesial contacts were found to be significantly tighter than distal contacts among all (p &lt; 0.05). According to the histogram results, only in the PM group, the difference between the mesial and distal areas is significant (p &lt; 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 &lt; 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.

Seeking Endurance: Designing Smart Dental Composites for Tooth Restoration

Seeking Endurance: Designing Smart Dental Composites for Tooth Restoration

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.

RESISTÊNCIA DA UNIÃO DE SISTEMAS ADESIVOS À DENTINA: INFLUÊNCIA DO HIPOCLORITO DE SÓDIO

The modification of the root canal system is of paramount importance to the success of endodontic treatment. This study aimed to evaluate the influence of sodium hypochlorite at concentrations of 2.5% and 4.5% in times of 30 and 60 minutes on the bond strength of composite resin to dentin. We used for this study teeth 20, which were divided into five groups of four elements, each element of the experimental group was immersed in a characteristic time and concentration of sodium hypochlorite of their group and the control immersed in saline. Later there were three composite restorations on each tooth, totaling a sample of 60 restorations. Each restaurant had its bonding to dentin submitted to microshear test, and the results were analyzed through statistical tests: the normal, anova and multiple variations. No significant influence on the adhesion of composite resins to dentin at a concentration of 2.5% at times of 30 and 60 minutes, and concentration of 4.5% in 30 minutes time. There was only influences the concentration 4.5% after a time of 60 minutes. It is concluded that sodium hypochlorite at 4.5% in contact with the dentine for a time of 60 minutes because influence on the bond strength of resin composite, which may cause recontamination of the channel system.

Four-year Outcomes of Class III and IV Anterior Restorations Based on a Subset of German Health Insurance Data.

Numerous studies report on the outcome performance of posterior composite restorations. However, there are fewer studies providing data for anterior restorations. The aim of this study was to evaluate the clinical outcome performance of anterior permanent restorations by analyzing a large dataset from a German national health insurance company. Routine claims data from a major German national health insurance company were assessed. Fee codes were used for tracing restoration careers on a day-count basis. The treatment was defined as a placed restoration (Class III and IV) on a mesial or distal tooth surface, irrespective of the extension. The restorations were placed between January 1, 2010 and December 31, 2013. Statistical analyses were conducted using Kaplan-Meier survival analysis to determine cumulative 4-year survival rates. The primary outcome was re-intervention on the same surface. Secondary outcomes were crowning and extraction which were analyzed separately. A total of 2,417,791 restorations involving mesial surfaces and a number of 2,409,031 restorations involving distal surfaces were observed. At 4 years, the cumulative survival rates concerning the primary outcome 're-intervention' were 79.9% for mesial and 80.9% for distal restorations. The respective annual failure rates (AFR) were 5.5% and 5.2%. Four-year survival rates for the secondary outcome 'crown' were 93.8% for mesial and 94.1% for distal anterior restorations. The respective AFRs were 1.6% and 1.5%. For the secondary outcome 'extraction,' the respective rates were 94.6% for mesial and 93.9% for distal restorations. The respective AFRs were 1.4% and 1.6%. The performance of permanent anterior restorations which were placed in general dental practices in Germany can be rated as acceptable.

BASE SURFACE TEMPERATURE OF BULK FILL RESIN COMPOSITE WITH DIFFERENT THICKNESS

Background: The material thickness is one factor that influences the polymerization of resin composites. Bulk fill resin composite is an efficient dental resin composite restoration material because it can be cured to a thickness of up to 4-5 mm. The thickness of the material can also affect the temperature rise, while maintaining the temperature is very important because a significant increase can damage the pulp. Purpose: This research aimed to analyze the base surface temperature of bulk fill resin composite with different thicknesses. Methods: Thirty bulk fill resin composite samples with a diameter of 5 mm were divided into three groups with different thicknesses, namely group I (3 mm), group II (4 mm), and group III (5 mm). Each group of samples was cured using an LED Light Curing Unit for 20 seconds, and carried out simultaneously with the measurement of the base surface temperature using a type-K digital thermocouple. Data analyzed using One Way ANOVA and LSD post hoc tests. Results: The mean and standard deviation of the base surface temperature of bulk fill resin composite in groups I, II, and III, respectively, is 37.56 ± 1.06oC, group II 36.89 ± 1.23oC, and group III 36.00 ± 1.2 oC. It showed significantly different between the groups (p&lt;0,05). Conclusion: The thicker the bulk fill resin composite, the lower the base surface temperature.

Comparison of proximal contact and contours of class II restoration in premolars and molars restored with three different matrix systems using FDI criteria: An in vivo study.

Sectional matrix systems, namely, Garrison and Bioclear with contact rings, are valuable aids to establish proximal contact tightness and contours in Class II composite restorations when compared with the circumferential matrix system Tofflemire. This study aimed to compare the proximal contact and contours of Class II restoration in premolars and molars restored with Tofflemire, Garrison, and Bioclear matrix system by FDI criteria of approximal anatomical form using floss or 25-µm metal blade and radiographic examination. Sixty Class II patients were selected, and a preoperative bitewing radiograph was taken. Initially, caries removal was done by round diamond bur, followed by 245 carbide bur. Samples were divided randomly into three groups based on the type of matrix system used for restoration. Group 1 (n = 20): Tofflemire, Group 2 (n = 20): Garrison matrix system, and Group 3 (n = 20): Bioclear matrix system. Matrix systems were applied according to the manufacturer's instructions, and composite restoration was done. The clinical evaluation of proximal contact and contour was done by a blinded observer immediately after placement of composite restoration using FDI criteria by passing dental floss or 25-µm metal blade, whereas marginal gaps and overhangs were checked using a radiograph. Results were statistically analyzed. The statistical analysis was done using the Statistical Package for the Social Sciences (SPSS for Windows, Version 19.0). Descriptive statistics was calculated as frequency and percentage. The comparison of characteristics of the contact points, contour, and radiographic examination was carried out using the Chi-square test. Multiple comparisons were done by comparing column proportions with Bonferroni adjustments. The level of significance for the present study was fixed at P < 0.05. There were significantly higher proportions of normal contacts in Garrison (60%) and Bioclear (70%) compared to that in the Tofflemire (20%) matrix system (Bioclear > Garrison > Tofflemire). Comparison of contours showed normal contours with Garrison (50%), Bioclear (50%), and Tofflemire (15%) matrix system (Bioclear = Garrison > Tofflemire). In radiographic examination, harmonious transitions between the restoration and the tooth were similar in Garrison (30%) and Bioclear (30%) compared to the Tofflemire (15%) matrix system (Bioclear = Garrison > Tofflemire). Garrison and Bioclear sectional matrix systems established superior contacts and contours than the Tofflemire circumferential system.

Effect of adding sodium fluoride and nano-hydroxyapatite nanoparticles to the universal adhesive on bond strength and microleakage on caries-affected primary molars.

Evaluation of micro tensile bond strength (μTBS) and marginal leakage of sodium fluoride (NaF) and nano-hydroxyapatite (n-HA) modified universal adhesives (UAs) bonded using etch-and-rinse (ER) and self-etch (SE) bonding technique to the carious affected dentin (CAD). One hundred and twenty primary molars were prepared for CAD on the occlusal surface. The occlusal CAD surface was flattened and underwent a polishing procedure. The specimens were divided into six groups using a random allocation method based on the UAs applied and the mode of etching used (n = 20) Group A1: UAs (ER), Group B1: UAs (SE), Group A2: UAs (NaF) + ER, Group B2: UAs (NaF) + SE, Group A3: UA (n-HA) + ER and Group B3: UAs (n-HA) + SE. Composite restoration was placed and samples were thermocycled. Microleakage, μTBS, and failure mode assessment were performed using a dye penetration test, universal testing equipment, and stereomicroscope respectively. The μTBS and microleakage results (mean ± SD) were examined using analysis of the variance (ANOVA) and Tukey post hoc tests. Group B1 (UAs + SE) demonstrated the maximum scores of microleakage (25.14 ± 9.12 nm) and minimum recorded value of μTBS (14.16 ± 0.55 MPa). In contrast, Group A3 (UAs (n-HA) + ER) displayed a minimum value of marginal leakage (12.32 ± 6.33 nm) and maximum μTBS scores (19.22 ± 0.92 MPa). The outcomes of the intergroup comparison analysis showed that Group A2 (UAs (NaF) + ER), Group B2 (UAs (NaF) + SE), Group A3 (UA (n-HA) + ER) and Group B3 (UAs (n-HA) + SE) presented comparable outcomes of marginal seal outcomes and μTBS scores (p > 0.05). NaF and n-HA-modified UAs displayed favorable bond strength and minimum marginal leakage to the deciduous affected dentin surface.

Effect of Radiotherapy on the Adhesive Interface of Caries-affected Dentin and Bioactive Restorations: A Micro-CT Analysis.

This study aimed to analyze the presence of defects within the adhesive interface formed with five bioactive dental materials and caries-affected dentin concerning the timing of radiotherapy (before or after the restorative procedures) by micro-CT. A total of 96 carious human molars were randomly allocated into the following groups based on the timing of the radiotherapy sequence: radiotherapy followed by restoration (RT1) or restoration followed by radiotherapy (RT2). Then, six subgroups were established within these groups based on the type of materials used (n=8). Following cavity preparation and caries removal, a universal adhesive (G-Premio Bond) was administered in self-etch mode or accompanied by applying suitable cavity conditioners according to the manufacturers' guidelines. Subsequently, restorations were performed using five bioactive restorative materials (resin-modified glass-ionomer [Fuji II LC], high-viscosity glass-ionomer hybrid [EQUIA Forte HT], giomer [Beautifil II], alkasite [Cention N], and dual-cure bulk-fill composite [Activa Bioactive Restorative]) and a conventional microhybrid resin composite (Filtek Z250). The radiotherapy regimen encompassed 60 Grays (Gy) administered at a rate of 2 Gy/day over 6 weeks, 5 days a week. Micro-CT analysis was employed to assess adhesive defects at the interface between caries-affected dentin and the restorations. The data were analyzed using Kruskal-Wallis, Mann-Whitney U, and Dunn tests (α=0.05). RT2 caused significantly higher adhesive defects than RT1 for the Filtek Z250 and Activa Bioactive Restorative subgroups (p<0.05). For RT1, no significant differences were found in adhesive defects among all tested subgroups (p>0.05). By contrast, for RT2, adhesive defects were significantly higher for the Activa Bioactive Restorative and Cention N subgroups than for the EQUIA Forte HT and Beautifil II subgroups (p<0.05). When using most bioactive restorative materials, the timing of radiotherapy had no significant influence on the adhesive interface. Regarding restoration following a radiotherapy protocol, a favorable impact was identified with high-viscosity glass ionomer hybrid cement and giomer bioactive restorations compared with dual-cure bioactive bulk-fill composite and alkasite restorations.

Evaluation of Fracture Resistance of Fiber-Reinforced Resin Composite Restorations in Deep Class I Cavities: A Comparative In Vitro study.

Evaluation of Fracture Resistance of Fiber-Reinforced Resin Composite Restorations in Deep Class I Cavities: A Comparative In Vitro study.

Management of Ellis Class II Fracture in Young Permanent Maxillary Central Incisor

Background: Tooth fracture is a condition of missing or lost fragments of a complete tooth. Tooth fracture usually occurs simultaneously with another oral injury. Objective: This case report discussed the management of Ellis class II fractures on an immature permanent central incisor of a patient who reported to Jenderal Achmad Yani University (Unjani) Dental Hospital. Case: An 11-year-old girl revealed a broken upper left tooth, sensitive to cold drinks that interfered with her appearance one year ago. The patient had a good general condition, no abnormalities during an extraoral examination, and a history of pain on the lower back tooth since a year ago. Case Management: Management of Ellis class II fracture in young permanent central incisor was conducted by using a class IV composite resin restoration. Conclusion: The management of Ellis class II fracture should be conducted holistically and systematically with subjective, intraoral, extraoral, and adjunctive examinations which should be performed correctly and considering the child’s psychology.

Survival rate, bond, and fracture strength of laminate veneers bonded to different tooth substrates: A systematic review of in vitro studies.

This study aimed to evaluate how different tooth substrates affect the survival rate, shear bond strength, fracture strength, and mode of failure of laminate veneers (LVs). This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. In vitro studies comparing the bonding of laminate veneers to different substrates were included. Electronic databases and manual searches were performed to identify relevant studies. Data on survival rate, shear bond strength, fracture strength, and failure modes were extracted and analyzed using Review Manager software. A total of 10 studies were included in the review, comprising 621 laminate veneers. The findings revealed that laminate veneersbonded to enamel substrate had lower failure rates than those bonded to tooth substrate with severely exposed dentin or existing composite restorations (ECRs). The failure modes observed were debonding, chipping, cracks, or fractures. Bonding laminate veneers to enamel substrate showed higher survival rates compared to bonding to tooth substrates with severely exposed dentin or ECRs, underscoring the significance of enamel preservation. When dealing with exposed dentine surfaces or ECRs, it is crucial to perform appropriate surface treatment before luting to improve adhesion. This involves immediate dentine sealing, as well as the use of suitable primers and bonding agents.

Two-year clinical performance of indirect resin composite restorations in endodontically treated teeth with different cavity preparation designs: a randomized clinical trial

Trial designThis is a randomized, controlled, superiority, double-blinded, parallel-group, two-arms trial with an allocation ratio of 1:1. This study aimed to assess whether the cavity design could affect the clinical performance of the CAD/CAM generated indirect resin composite restoration in endodontically treated teeth (ETT) evaluated using the Modified USPHS criteria after a two-year follow up.MethodsA total of 30 participants who underwent endodontic treatment for MOD cavities in permanent molars were divided randomly into two parallel groups (n = 30 restorations) according to the performed cavity design to group 1 in which there was no cuspal reduction (inlay) and group 2 in which cuspal reduction was performed (overlay). All pulp chambers were filled with bulk fill flowable composite, and the cavities were prepared following the criteria of the cavities for indirect restorations and restored using nano-hybrid composite resin blocks (Brilliant, Coltene, Switzerland). The restorations were evaluated using the modified USPHS criteria at baseline, six months, one-year and two years follow-up visits. For qualitative data, frequencies (n) and percentages (%) were used to display the data, while mean and standard deviation (SD) were used for quantitative data. The normality of the data was evaluated using the Shapiro-Wilk and Kolmogorov-Smirnov tests. For every test, P ≤ 0.05 was used as the significance threshold.ResultsTwenty-six individuals completed the follow-up period after receiving the assigned intervention.The inter-group comparison showed that, at the 6- months and 12- months observation points, the overlay design had significantly better marginal adaptation, less incidence of discoloration or tooth/restoration fracture, and similar marginal integrity and caries incidence to the inlay design. After 24- months, the overlay design still had better marginal adaptation, less incidence of discoloration or tooth/restoration fracture and less caries incidence in comparison to the inlay design, while there was no difference in the marginal integrity between either design.Conclusions and clinical relevanceCuspal reduction in endodontically treated teeth showed better clinical performance than the cusp preservation thus, the former is more reliable.