States Public Health Service Criteria Research Articles

The survival and clinical performance of anterior composite resin restorations and posterior indirect and cast restorations used to treat generalised tooth wear

Objective To evaluate the survival and clinical performance of restorative materials used in the rehabilitation of generalised severe tooth wear within a UK NHS postgraduate teaching hospital.Methods The clinical performance of 527 restorations on 20 patients with generalised severe tooth wear was reviewed after a mean period of five years. Anterior teeth were restored with direct composite resin and posterior teeth with indirect restorations. The study used the modified United States Public Health Service criteria for restoration assessment. Survival of the restorations was analysed using Kaplan-Meier survival curves, the log-rank test and the Cox proportional hazards regression analysis.Results The sample included 20 participants: 13 men and 7 women, with a median age of 51.8 years (range: 33-73 years). The median survival time for all restorations was 11.3 years when major failures were considered and 5.9 years for restorations when all types of failure were considered. A median survival time of 5.9 years for composite resin restorations and over seven years for cast restorations was found when considering all failures. Composite resin restorations commonly failed as a result of fracture, wear and marginal discolouration. Factors significantly influencing restoration survival were the material used, aetiology, incisal relationship and tooth location. The biological complications associated with this treatment regime were rare. Patient satisfaction remained generally high, with greatest dissatisfaction related to treatment time.Conclusions The use of anterior composite resin with posterior indirect restorations to treat generalised severe tooth wear is a viable treatment modality with very few major complications.

Performance of Bonded Lithium Disilicate Partial-coverage Crowns in the Restoration of Endodontically Treated Posterior Teeth: An Up to Seven-Year Retrospective Study.

To evaluate the clinical performance of adhesively bonded lithium disilicate glass-ceramic (LDG) partial-coverage crowns in restoring posterior endodontically treated teeth (ETT). A total of 121 morphologically compromised posterior ETT were restored with LDG partial-coverage crowns between October 2015 and January 2018. The restorations were fabricated in the laboratory or at the chairside. Two adhesive systems and resin cements were used to cement the restorations. Tooth and restoration survival rates were calculated. The restorations were evaluated clinically using the modified United States Public Health Service (USPHS) criteria for an observation period of 5-7 years. The Cox proportional hazards model was used to estimate relative failure risks such as tooth type, resin cements, gender, and sleep bruxism. The standard chi-squared test was used to compare the survival of different tooth types for significant differences (α=0.05). In addition, survival probability was calculated using the Kaplan-Meier algorithm. Among seven failed cases, one was a tooth fracture, and six were restoration fractures. According to the Kaplan-Meier analysis, the estimated survival rate of the teeth was 99% for seven years, while the estimated survival rate of the restorations was 94.8% for 5 years and 92.8% for 7 years. Tooth type and resin cements did not influence restoration survival rates (p>0.05), while sleep bruxism and male patients might increase the risk of failure (p<0.05). The indirect adhesively bonded LDG partial-coverage crowns of posterior ETT exhibited favorable clinical outcomes. Ceramic fracture was the most common failure pattern.

Clinical Survival of Reduced-Thickness Monolithic Lithium-Disilicate Crowns: A 3-Year Randomized Controlled Trial.

The aim of this randomized controlled trial was to see if the minimally invasive approach (reduced restoration thickness) would result in good clinical success of monolithic ceramic crowns compared to conventional layered all-ceramic crowns, and thus be an alternative to conventional tooth preparation. The ceramic that was investigated was IPS e.max lithium-disilicate ceramic produced using two different processing methods. A comparison was made between monolithic crowns with reduced thickness and standard layered crowns. Fifty-two patients, who had undergone endodontic treatment on either a premolar or molar, were randomly assigned into two groups. The teeth intended for layered crowns underwent to a 2 mm occlusal reduction with a 1 mm rounded shoulder, whereas the teeth intended for monolithic crowns underwent to a 1 mm reduction in the occlusal area with a 0.6 mm rounded shoulder. The clinical success was evaluated in eight categories using modified United States Public Health Service (USPHS) criteria. The observation period was 36 months, with control appointments every 6 months. There was no significant difference in clinical success between monolithic and conventional layered crowns after 3 years. One monolithic crown fractured while all other crowns were intact and the survival rate was 96%. All layered crowns were intact and the survival rate was 100%. The results of this study indicate that the minimally invasive approach can be a good alternative to conventional tooth preparation. IPS e.max lithium-disilicate ceramic demonstrated an exceptional three-year survival rate independently of the thickness of the material.

Long-term performance of ceramic in/-onlays vs. cast gold partial crowns – a retrospective clinical study

ObjectivesTo assess the long-term clinical performance of ceramic in-/onlays (CIOs) and cast gold partial crowns (CGPCs) in posterior teeth in terms of success, survival, complications (biological, technical) and quality.Material and methodsIn a retrospective study, a total of 325 patients were recorded after up to 24.8 years (mean 13.9 ± 3.8 years) having (pre-)molars restored with CIO (Empress I, Ivoclar Vivadent, n = 161) and CGPC (Degunorm, DeguDent, n = 164) by supervised undergraduate students. A total of 296 restorations were assessed clinically and radiologically in healthy and endodontically treated teeth using modified United States Public Health Service (USPHS) criteria. Cumulative success and survival rates of the restorations were calculated using Kaplan–Meier estimates. Biological and technical complications were recorded. Status of oral health comprising caries risk and localized periodontitis were assessed.ResultsThe cumulative success rates of CIOs were 92.1% and of CGPCs 84.2% after mean service times of 14.5 years. The annual failure rates of total service times were 0.5% in teeth restored with CIO (n = 155) and 0.7% in teeth restored with CGPC (n = 163). The cumulative survival rates of CIOs were 93.9% after a mean service time of 15.2 years and decreased to 91.7% after 23.5 years. The cumulative survival rates of CGPCs were 92.6% after a mean service time of 14.9 years and 91.8% after 23.5 years. Complications in CIOs (n = 149) were ceramic fracture (6.7%), secondary caries (4.7%), endodontic complication (2.7%) and tooth fracture (1.3%) compared to CGPCs (n = 147) with endodontic complication (8.8%), secondary caries (4.8%) and decementation (2.0%). Endodontically treated teeth restored with CIO or CGPC revealed significantly less often success compared with corresponding vital teeth (p = .02). CIOs and CGPCs revealed clinically and radiographically good and excellent qualities with 71.8% (107/149) and 68% (100/147) without any significant differences regarding type of restoration.ConclusionsBoth CIOs and CGPCs achieved high survival rates up to 24.8 years when performed by supervised undergraduate students. The longevity of the restorations may benefit from the intraoral repair of accessible defects and, in case of pulp infection or necrosis, an adequate endodontic management.Clinical relevanceCIOs and CGPCs made by supervised undergraduate students are proper restoration types in posterior teeth in the long-term. An adequate preparation design, meticulous care in the inserting technique and constant biofilm removal due to proper oral hygiene combined with professional maintenance care are substantial. The clinical long-term performance was mostly limited by ceramic fractures in CIOs and endodontic complications in CGPCs.

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

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

Clinical outcomes of self-glazed zirconia veneers produced by 3D gel deposition: a retrospective study

BackgroundSelf-glazed zirconia (SZ) restorations are made by a novel additive three-dimensional gel deposition approach, which are suitable for a straightforward completely digital workflow. SZ has recently been used as minimally invasive veneer, but its clinical outcomes have not been clarified yet. This study aimed to evaluate the preliminary clinical outcomes of SZ veneers compared with the widely used lithium disilicate glass–ceramic veneers made by either pressing (PG) or milling (MG) process.MethodsFifty-six patients treated with SZ, PG, and MG veneers by 2 specialists between June 2018 and October 2022 were identified. Patients were recalled for follow-up at least 1 year after restoration. Clinical outcomes were assessed by 2 independent evaluators according to the modified United States Public Health Service (USPHS) criteria. Overall patient satisfaction was assessed using visual analogue scale (VAS), and analyzed by one-way ANOVA. Chi-square test was applied to compare the difference in the success and survival rates among the 3 groups.ResultsA total of 51 patients restored with 45 SZ, 40 PG, and 41 MG veneers completed the study, with a patient dropout rate of 8.9%. Mean and standard deviation of follow-up period was 35.0 ± 14.7 months. All restorations performed well at baseline, except for 2 SZ veneers with mismatched color (rated Bravo). During follow-up, marginal discrepancy (rated Bravo) was found in 4 MG veneers and 1 PG veneer, and partially fractured (rated Charlie) was found in another 2 PG veneers. The survival rate of SZ, PG, and MG veneers was 100%, 95%, and 100%, with a success rate of 95.56%, 92.50%, and 90.24%, respectively, none of which were significantly different (p = 0.099 and 0.628, respectively). The mean VAS score of SZ, PG, and MG was 95.00 ± 1.57, 93.93 ± 2.40, and 94.89 ± 2.00 respectively, without significant difference (p > 0.05).ConclusionSZ veneers exhibited comparable preliminary clinical outcomes to PG and MG veneers, which could be considered as a feasible option for minimally invasive restorative treatment.

Clinical performance and wear resistance of milled resin composite material versus direct nanohybrid bulk-fill resin composite in the restoration of endodontically treated posterior teeth over 1 year: Randomized clinical trial.

The restorative complexities associated with endodontically treated teeth surpass those encountered with vital ones. The field of adhesive dentistry experienced a significant advancement that led to a shift in treatment approach toward bonded restorations. The aim of the study was to assess the clinical performance of using indirect Milled composite or direct bulk-fill resin composite restorations for endo-treated teeth, as well as to measure the amount of wear on the occlusal tables of both restorations using a digital scanner. Participants were divided into two groups, where R1 represents the endodontically treated teeth restored with Milled composite, R2 represents the endodontically treated teeth restored with direct bulk-fill composite where 13 patients in each group were treated with a total number of 26 restorations in all patients. Where each restoration was assessed immediately at baseline (T0), 6 months (T6), and 12 months (T12) using the modified United States Public Health Service criteria. Moreover, wear was measured immediately at (T0) and (T12) intraorally and extraorally using intraoral scanners and three-dimensional surface-based superimposition software. Chi-squared test, Mann-Whitney U-test, Friedman's test, Nemenyi post hoc test, Shapiro-Wilk test, paired t-tests, intraclass correlation coefficient. At all intervals, the majority of the cases in both groups had an alpha score. Some cases exhibited bravo scores in both groups at T6 and T12 regarding the color match, marginal adaptation, marginal discoloration, and marginal integrity without statistically significant difference (P > 0.05). Direct nanohybrid bulk-fill resin composite showed a greater amount of wear without a statistically significant difference (P > 0.05). Extraoral measurement was significantly higher than intraoral measurement (P < 0.001). There was no significant reliability/agreement between both methods. Both milled composite and direct bulk-fill resin composite restorations in endodontically treated teeth demonstrated appropriate clinical performance and minimal wear over an 1-year follow-up period.

Clinical evaluation of “Snowplow” technique versus Bulk-fill technique in restoration of class II cavities: A randomized clinical trial

Abstract Aim: This study assessed the clinical performance of the “Snowplow” technique compared with the Bulk-fill technique in restoration of proximal cavities for 1 year using modified United States Public Health Service (USPHS) criteria. Materials and Methods: The study was a 12-month, double-blinded, two parallel arms, randomized clinical trial with a 1:1 allocation ratio. A total of 32 patients with proximal caries were separated into two groups (n = 16): group 1: “Snowplow” technique using co-cured X-tra base flowable Bulk-fill composite/X-tra Fil Bulk-fill composite, whereas group 2: Bulk-fill technique using X-tra Fil Bulk-fill composite. Modified USPHS criteria were employed to assess the restorations at baseline, after 3, 6, 9, and 12 months. The MedCalc software, version 19 for Windows was used to statistically analyze the collected data. Intergroup comparisons were carried out using the chi-squared test with a statistical significance level set at P ≤ 0.05 after Bonferroni correction. Results: The results suggested that there was no statistically significant difference found between “Snowplow” and Bulk-fill techniques at different time intervals in terms of marginal integrity, marginal discoloration, anatomic contour, surface texture, gross fracture, and secondary caries, where P = 0.150550. Conclusion: This study concluded that the clinical performance of the “Snowplow” technique and Bulk-fill technique was similar and clinically acceptable following a full year of clinical use. Bulk-fill and “Snowplow” techniques are highly recommended restorative techniques in proximal cavities.

Clinical performance of short fiber reinforced composite and glass hybrid on hypomineralized molars: A 36-month randomized split-mouth study

ObjectivesThis study aimed to assess the clinical performance outcome at 36 months of molars with molar incisor hypomineralization and carious lesions, treated with two different restorative approaches following selective caries removal. MethodsThe children aged 6 to 12 years (18 female, 13 male) included in the study had at least two carious permanent first molars diagnosed with molar incisor hypomineralization. Sixty-two molars were restored in a split-mouth design. In all subjects, selective caries removal was performed so that caries was completely removed from the cavosurface walls and only soft dentin was left above the pulp chamber. Short fiber reinforced composite (SFRC; EverX Flow™) covered by micro-hybrid composite (G-Aenial® posterior composite) and Glass Hybrid (GH; Equia Forte® HT) were used as restorative materials. The restorations were evaluated according to modified United States Public Health Service (USPHS) criteria at baseline, 6, 12, 18, 24, and 36 month follow-ups. ResultsDuring the 36-month follow-up, eight GH and four SFRC restorations failed. The clinical success of both restorations decreased statistically over time (p < 0.001 for both). When variables such as restoration type, sex, age, tooth type, and time were included in the model, the risk of failure of the restorations of the left lower first molar was statistically significantly higher than that of the left upper first molar (p < 0.002). ConclusionDirect composite restorations with SFRC and GH restorations perform similar clinical success with selective caries removal in the management of permanent molars affected by molar incisor hypomineralization. Clinical significanceSFRC or GH restorations with similar clinical success might be preferred for the management of MIH-affected molars.

Optical behavior and marginal discoloration of a single shade resin composite with a chameleon effect: a randomized controlled clinical trial

Objective/aimEvaluating the optical behavior and marginal discoloration of a Single-shade universal resin composite over 12 months. To achieve this, a split-mouth with a double-blinded randomized strategy was employed.Materials and methodsTwenty adult patients, each presenting with at least two caries lesions in their posterior teeth, were selected and randomly subdivided into two identical groups: Group I received Single-shade universal resin composite (Omnichroma), and Group II received multi-shade nanohybrid resin composite (Tetric®N-Ceram). Color measurements and marginal discoloration were assessed visually by three blinded operators at baseline followed after 1,3,6,9, and 12‑month periods utilizing the Modified United States Public Health Services (USPHS) criteria. Statistical analysis was adopted utilizing the Wilcoxon test with a 0.05 significance level.ResultsThe two groups revealed non-statistically significant differences up to 6 months regarding color match and color stability. After 9 and 12 months, the multi-shade group demonstrated a statistically significant higher prevalence of color match (Alpha) scores than the single-shade universal group. Regarding marginal discoloration, all restorations in the two groups had no discoloration (Alpha scores).Discussion/conclusionSince the percentage of Alpha and Bravo scores was considered clinical success, both the single-shade universal and the multi-shade nanohybrid resin composites demonstrated satisfactory optical performance and marginal discoloration as posterior restorations after a 12-month follow-up period.

Alkasite restorative material for endodontically treated teeth: a randomized controlled pilot study.

This study aimed to evaluate the clinical performance of an alkasite restorative material in molars that had undergone root canal treatment. The research was registered in Brazilian Registry of Clinical Trials. The randomized clinical trial involved 33 patients, each with at least 1 mandibular molar requiring restoration after receiving endodontic treatment. Patients were randomly assigned to receive either bulk-fill resin composite (Tetric N Ceram Bulk Fill, Ivoclar Vivadent) or the alkasite restorative material (Cention N, Ivoclar Vivadent). Upon completion of the restorations, 3 calibrated professionals utilized the United States Public Health Service criteria to assess various factors, including retention, secondary caries, marginal adaptation, restoration color, marginal pigmentation, and anatomical form. Evaluations were conducted at intervals of 7 days, 6 months, and 17 months. Additionally, the assessment encompassed the presence of radiolucent lines adjacent to the restoration, material deficiencies or excess, contact points, and caries recurrence. The data underwent analysis using the Friedman and Mann-Whitney tests (α = 0.05). After 17 months, the results revealed that the alkasite restorative material exhibited greater wear of anatomical shape compared to the bulk-fill resin composite (p = 0.0189). Furthermore, the alkasite restorative material significantly differed from the natural tooth color in most cases (p = 0.0000). However, no other criteria displayed significant differences between the materials or over time (p > 0.05). The alkasite restorative material (Cention N) emerges as a viable option for restoring endodontically treated teeth, displaying clinically acceptable alterations after a 17-month evaluation period. Brazilian Registry of Clinical Trials (ReBEC) Identifier: RBR-97kx5jv.

Clinical performance of computer-aided design/computer-aided manufacture lithium disilicate ceramic endocrown restorations: A 2-year study.

Optimal restoration methods for endodontically treated teeth (ETTs) have always remained an ongoing discussion among physicians in this day and age. ETTs have a tendency to fracture when chewing, compared to initial teeth. From the perspective of biology, preserving and restoring tooth structure is critical to maintaining biomechanical, functional, and esthetic harmony. Dental bonding techniques have lessened the necessity for post-and-core restorations in ETTs with severe substance loss. A minimally invasive endodontic restoration technique called "endocrown" was initially introduced by Bindl and Mörmann in 1999. The aim of the study was to clinically evaluate all-ceramic mandibular molar endocrowns made using computer-aided design/computer-aided manufacturing (CAD/CAM) following 2 years of follow-up. This unblinded study contains 56 patients with 56 mandibular molars, which had severe substance loss. After teeth preparation, lithium disilicate ceramic endocrowns were manufactured with the CEREC CAD/CAM system, and cementation was performed using a composite luting agent. The endocrowns were assessed using the modified United States Public Health Service criteria at baseline, 6 months, 1 year, and 2 years following placement. Patient satisfaction was evaluated using a questionnaire. This study used descriptive statistics, including mean, standard deviation, and 95% confidence intervals. Data were processed using STATA version 14.0 (StataCorp LLC, USA). Two endocrowns (3.6%) failed throughout the period of observation. The high clinical rating criteria (96.4%, count of 54) and the increased satisfaction percentage (94.6%, count of 53) remained practically stable during the follow-up assessments at 6 months and after 1-2 years. Endocrown offers a less invasive treatment option that may be a better method for endodontically treated mandibular molars. With contemporary CAD/CAM technology and new materials, time in the chair and esthetics optimally improved, bringing satisfaction to the patient.

Management of severity lesions of hypomineralized molars (MIH) with different treatment alternatives: 9-month results of a clinical trial.

The aim of this study was to evaluate the 9-month clinical performance of different materials and treatment procedures in teeth with MIH in children, and to evaluate the effectiveness of Papacarie gel as a deproteinization agent. The study included 90 children (aged 8-15) who had 189 first permanent molars with MIH were restored randomly with 4 different materials/methods. Equia Forte HT (GC, Tokyo, Japan) was used in Group 1; In Group 2, G-eanial composite (GC, Tokyo, Japan) was used with a Fuji IX (GC, Tokyo, Japan) base; In Group 3 and Group 4, EverX Posterior (GC, Tokyo, Japan) base and G-eanial composite (GC, Tokyo, Japan) were used. In group 4, deproteinization was performed with Papacarie Duo gel (F&A, Sao Paulo, Brazil). The restorations were evaluated at 3-month intervals for 9 months using modified United States Public Health Service (USPHS) criteria. The overall recall rate was 94.1% for every 3-month clinical evaluation over 9 months. A total of 9 restorations were unsuccessful. Surface roughness of Group 1 was statistically different from all other groups in all control periods (p < 0.05). Marginal adaptation of Group 2 was found to be significantly different from Groups 3 and 4 at the both of 6th and 9th month controls. There was no significant difference between the groups in terms of retention, color match, marginal discoloration and secondary caries in all control months. Restoration of MIH with Equia Forte HT is almost as successful as composites. The use of dentin replacement materials instead of glass ionomer cements as a base in composite restorations shows better results. Papacarie deproteinization showed similar success with other composite groups. This study was the first clinical study in which Papacarie was used for deproteinization in teeth with MIH and will thus contribute to the literature.

Evaluation of Clinical Performance and Colour Match of Single and Multiple Shade Composites in Class-I Restorations: A Randomised Clinical Study

Introduction: Biomimetic dentistry primarily focuses on achieving aesthetics that closely resemble natural enamel and dentin. This approach ensures that dental restorations seamlessly match the appearance of enamel and dentin, rendering them virtually invisible. Additionally, biomimetic dentistry aims to mimic not only the visual characteristics but also the physical properties of enamel and dentin, thereby ensuring functional acceptability. The introduction of new composite materials in the market is a gradual progression aimed at attaining the mentioned objectives. Aim: To compare clinical performance and colour matching of single and multiple shade composites in simple Class-I carious lesions after one year. Materials and Methods: This randomised clinical study included 21 patients with a total of 72 Class-I carious lesions with patients who provided informed consent. Teeth were randomised into two groups: Group-A (n=36) received multishade composite (3M Filtek z350), and Group-B (n=36) received single-shade composite (Omnichroma). Clinical performance was assessed by two blinded evaluators at baseline, six months, and one year using modified United States Public Health Service (USPHS) criteria. Colour matching was evaluated by capturing digital photographs with a DSLR camera, ring flash, and 100 mm macro lens. Colour measurements (L*, a*, b*) were analysed using Adobe Photoshop, and ΔE was calculated immediately after restoration. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) 21.0 software, employing Chi-square test, Friedman test, and independent t-test. Results: No significant difference was found in clinical outcomes after one year using modified USPHS criteria (p&gt;0.05). However, both Group-A (p=0.002) and Group-B (p=0.007) showed increased marginal discolouration, and decreased colour match (p&lt;0.001) from baseline to one year. There was no statistically significant difference in colour matching potential between the two groups (p=0.056). Conclusion: Single-shade composites effectively treat Class-I carious lesions, demonstrating satisfactory colour matching and clinical performance.

Partial glass-ceramic posterior restorations with margins beyond or above the cemento-enamel junction: An observational retrospective clinical study.

This observational retrospective clinical study aimed to investigate the survival and success rates of partial indirect lithium disilicate restorations with margins extending above or beyond the cementoenamel junction (CEJ). The study included patients who underwent partial indirect lithium disilicate restorations with immediate dentin sealing (IDS) between January 2008 and October 2018. All the restorations were placed in a single general dental practice following a standardized protocol. The impact of various predictive variables on the survival rates was assessed. Moreover, modified United States Public Health Service (USPHS) criteria were used to evaluate the survival quality. Totally 1146 partial indirect lithium disilicate restorations in 260 patients were evaluated over an average period of 7.5 years. The cumulative survival and success rates were 97.3% and 95.3%, respectively. Margins extending beyond the cemento-enamel junction did not increase the risk of success or survival failure (P > 0.05). Patients with a high risk of caries, male sex, or non-vital teeth had a significantly higher risk of restoration failure (P < 0.05). Restorations with longer clinical service times exhibited marginally lower clinical quality (P < 0.001). Partial indirect glass-ceramic restorations demonstrated survival and success rates of 97.3% and 95.3%, respectively, over an extended period. However, a higher risk of restoration failure existed in patients with a high caries risk for (pre)molars that had undergone endodontic treatment and in males. In terms of the risk of success or survival failure, comparable results were obtained for the positions of the restoration margin in relation to the cemento-enamel junction.

Clinical Performance of Two CAD/CAM Fabricated Ceramic Restorations with Different Designs for MIH Rehabilitation: A Randomized Controlled Trial

Background: Molars affected with severe molar incisor hypomineralisation (MIH) require extensive restorations, which do not last for a long time and often require treatment in the form of onlays or full coverage restorations. Objective: A randomized clinical trial evaluated the clinical performance of two CAD/CAM fabricated ceramic restorations, Vita Suprinity (VS) and Vita Enamic (VE), with different preparation designs, occlusal veneer and endocrown, for rehabilitation of the first permanent molar affected by MIH. Materials and Methods: The study was registered with NCT05434884 clinical trial ID with 68 patients ranging from 8 to 13 years old, who attended the dental clinic of Al-Azhar University, Girls Branch, and suffering from a severe form of molar incisor hypomineralization. The patients were divided equally into two groups, group I, i.e., occlusal veneer (OV) group, and group II, i.e., endocrown (EN) group, according to different preparation designs related to different severity levels of first permanent molars’ hypomineralization (moderate and severe); each group was subdivided equally and randomly into two subgroups, subgroup A, i.e., Vita Suprinity (VS), and subgroup B, i.e., Vita Enamic (VE), according to the material used for fabrication of the restoration. The survival and success rates of restorations were assessed using the clinical United States Public Health Service (USPHS) criteria at 1 week, and 3, 6, 12, and 18 months' recall times after cementation, and statistical analysis was performed. Results: There was no statistically significant difference between groups and subgroups in terms of all evaluation parameters during the whole observational period. Conclusion: Based on observations, occlusal veneer and endocrown designs fabricated from CAD/CAM VS and VE showed similar clinical success in the rehabilitation of first permanent molars with severe MIH over 18 months of evaluation.

Prefabricated zirconia crown versus resin-bonded composite strip crown in the restoration of primary incisors: A 36-month parallel randomized controlled trial

AimThe trial aimed to compare the gingival health and clinical performance of prefabricated zirconia crown (PZC) versus resin-bonded composite strip crowns (RCSC) in the restoration of primary maxillary incisors over 36-month. Materials and methodsA parallel randomized controlled trial included 200 maxillary primary incisors (100 teeth per group) restored either with PZCs or RSCS. The gingival health and plaque accumulation were assessed using gingival index (GI) and plaque index (PI) respectively. To evaluate the clinical performance, the modified United States Public Health Service (USPHS) criteria were used. Intergroup comparison was performed using a Chi-square test. Restoration longevity was assessed over the predetermined intervals using Kaplan-Meier analysis. Generalized Estimating Equation (GEE) with robust standard errors was used to test the effect of time over the changes of repeated measures. The significance level was set to 5%. ResultsThe gingival health around PZCs is significantly better than that of RCSCs after 6 months. However, at the following follow-ups, GI scores of both restorations were comparable (p > 0.05). All PZCs showed no plaque accumulation with a significant difference compared to the RCSCs over the follow-up intervals. The clinical performance of PZCs was significantly superior to that of RCSCs over the follow-ups in terms of retention and anatomical contour after 24 and 36 months. The survival rates of PZC and RCSC were 100% and 87% respectively. ConclusionsAfter 36 months, the gingival health of PZC and RCSC was comparable. The retention and anatomical continuity of PZC were superior compared to RCSC.

Prolonged application time effects on universal adhesives in non-carious cervical lesions: An 18-month split mouth randomized clinical trial

ObjectiveThis double-blind, split mouth randomized clinical trial aimed to assess the clinical performance of Clearfil Universal Bond Quick (CBUq) universal adhesive under different application times (no waiting and waiting) compared to Clearfil SE Bond adhesive in non-carious cervical lesions (NCCLs) over 18 months. MethodsOne hundred and eighty-three restorations were distributed randomly into three groups based on the adhesive system and waiting time: CUBq without waiting time (CUBq-NW), CUBq with a 20 s waiting time (CUBq-W), and CSE with a 20 s waiting time. After placement, restorations were evaluated after 18 months using the International Dental Federation (FDI) and United States Public Health Service (USPHS) criteria. Statistical analyses involved Friedman repeated measures analysis of variance and Wilcoxon tests, with a significance level set at 5 %. ResultsOver the 18-month period, no restorations were lost across the tested groups. Marginal adaptation evaluation indicated minor discrepancies in 21 restorations (8 CUBq-NW, 6 CUBq-W, and 7 CSE). There were no significant differences observed among the three groups following the 18-month clinical assessment (p > 0.05). Only two restorations showed marginal discoloration after 18 months (1 CUBq-NW and 1 CSE). ConclusionsThe application of Clearfil Universal Bond Quick using either the "waiting" or "no-waiting" technique exhibited excellent clinical results in NCCLs during the 18-month follow-up period, demonstrating comparable performance to Clearfil SE Bond in all assessed outcomes. Clinical significanceThe findings suggest that the new universal adhesive applied using the no-waiting technique demonstrates promising clinical performance when compared to conventional application methods. Trial registrationClinicalTrials.gov identifer RBR-69p7mpr.

Clinical performance of bonded partial lithium disilicate restorations: The influence of preparation characteristics on survival and success

ObjectivesThe aim of this study was to investigate the influence of preparation characteristics on the survival, success, and clinical performance of partial indirect lithium disilicate restorations with immediate dentin sealing. MethodsThis retrospective clinical study evaluated partial indirect lithium disilicate restorations placed in conjunction with Immediate Dentin Sealing (IDS) in (pre)molar teeth between March 2018 and May 2021. The restorations were luted using pre-heated composite. The study focused on survival, success, and clinical performance, which was evaluated using the modified United States Public Health Service (USPHS) criteria. Results were analyzed using the Kaplan-Meier estimates, log-rank tests, and Fisher exact tests. ResultsPartial indirect lithium disilicate restorations (N = 454) were evaluated in 214 patients. The mean evaluation time was 37 months, with a cumulative survival rate of 99.2 % and a cumulative success rate of 97.6 %. Fourteen failures occurred, with endodontic pathology as the predominant failure mode, followed by secondary caries, debonding, and tooth fracture. No statistically significant influence of the preparation variables on survival and success was observed (p > .05). The short-term clinical performance was clinically acceptable in > 90 % of the evaluations. ConclusionsThis retrospective study on partial indirect lithium disilicate restorations in conjunction with IDS demonstrates survival and success rates of 99.2 and 96.7 % over a mean evaluation period of 37 months. A marked influence of the studied preparation characteristics on the survival, success and clinical performance of lithium disilicate partial restorations could not be demonstrated. Partial lithium disilicate restorations exhibit good clinical performance in >90 % of the cases. Clinical significanceThe results of this study suggest that preparation characteristics had no significant impact on the survival, success, and clinical performance of partial lithium disilicate restorations in conjunction with IDS. Results show good clinical performance and high survival and success rates, regardless of preparation characteristics.

Retrospective evaluation of factors affecting long-term clinical performance of CAD-CAM laminate veneers.

The purpose of the study was to assess the clinical performance of CAD-CAM laminate veneers placed by a single operator and systematically evaluated for up to 10 years. A total of 197 laminate veneers fabricated using either feldspathic ceramic (VMII) or lithium disilicate ceramic (EmaxCAD) were followed up to 10 years in 32 patients. Technical, esthetical, and biological findings of each restoration were evaluated using modified United States Public Health Service criteria. The survival and complication rates were assessed using Kaplan-Meier survival analysis and compared using the Log Rank test. Statistical significance was set at p<0.05. The estimated Kaplan-Meier survival rate was 91.9% after the mean observation period. According to ceramic system used, the estimated Kaplan-Meier survival rate amounted to 92.7% for Emax-CAD and to 89.1% for VMII. Survival rates were significantly affected by the location of veneer according to Log Rank test (p < 0.05). A range of survival rates between 83.3% and 98.6% were observed based on the location of veneer. CAD-CAM laminate veneers milled of feldspathic or lithium disilicate ceramics have comparable long-term survival rates. Oral positioning affects the survival of veneer. Veneers of incisors have higher survival rates than the veneers of maxillary canines and premolars.