Marginal breakdown of 5-year-old direct composite inlays

Objectives: The marginal fit of tooth-coloured inlays luted with composite resin luting materials has been considered to be the weak link of the inlays. The marginal breakdown of 5-year-old direct composite resin inlays was evaluated by scanning electron microscopy.

Methods: Replica impressions were made of the occlusal, axial-proximal and accessible cervical-proximal margins of 21 inlays and the marginal quality was quantified.

Results: More than 84% of the total investigated length of the enamel/luting composite agent-luting composite/composite inlay interfaces revealed gap free margins. Proximal margins showed the largest breakdown at the enamel/composite resin interface, while the occlusal margin interfaces showed only a slight difference between the interfaces. The composite inlay and the luting composite resin showed a similar degree of wear in more than 50% of the evaluated marginal length. Medium gap width varied between 60 μm for the occlusal and axial-proximal and 87 μm for the cervical-proximal margins, with a range of 7.6–266 μm.

Conclusion: The direct composite inlays investigated showed good marginal integrity after 5 years in clinical service.     

The marginal quality of luted ceramic inserts in bovine teeth and ceramic inlays in extracted molars after occlusal loading

PURPOSE: To compare the marginal adaptation of adhesively luted ceramic inserts in standardized cylindrical cavities of bovine dentin and enamel with the marginal adaptation of adhesively luted ceramic inlays in extracted molars after mechanical loading, and to calculate the minimum sample size required to differentiate between material groups based on the findings of this investigation. MATERIALS AND METHODS: Ceramic inserts of similar dimension were luted in standardized cylindrical cavities of bovine dentin and enamel (n = 6, O = 4 mm) with seven different adhesive/resin cement systems (Syntac/Variolink, Prime & Bond NT/Variolink, Excite DSC/Variolink, AdheSE/Variolink, Excite DSC/Multilink, Multilink Primer/ Multilink, RelyX Unicem). The same materials were used to lute ceramic inlays (Empress II) in three-surface cavities of extracted human molars (n = 6 per group). All specimens were submitted to 2000 cycles of thermocycling. In addition, restored teeth were submitted to cyclic loading (640,000 cycles, 50 N) in a chewing simulator. Replicas after stressing were analyzed with SEM, and the percentage of continuous margin of the inserts and the inlays was calculated, differentiating the proximal part of the inlay into cervical dentin/enamel and axio-proximal enamel. The mean percentage values per material group of the insert and inlay groups were ranked using relative ranks. Sample size estimation was done for pooled standard deviations comparing between two and seven materials and assuming 20% or 10% of the mean of continuous margin to be statistically significant. RESULTS: The Spearman correlation coefficient between the variables "insert dentin" and "inlay cervical dentin" was 0.71 (p = 0.07), between "insert enamel" and "inlay axio-proximal enamel" 0.07 (p = 0.9). The variability of the test results was large for both the insert and inlay variables, especially at the resin-dentin interface. No statistically significant difference between the materials could be found for the insert method when ANOVA and Bonferroni post-hoc tests were applied (p > 0.05), while the inlays luted with Prime & Bond NT/Variolink showed significantly less continuous margin at the cervical dentin than all other groups with the exception of RelyX Unicem. At least 16 (63) inlays and 14 (57) inserts had to be used per group for differences of 20% (10%) of the mean of continuous margin. CONCLUSION: To evaluate luting agents with regard to their ability to reduce marginal discrepancies, the inlay model is inadequate due to high sample numbers which make the test time-consuming and expensive; furthermore its clinical relevance is uncertain. Alternatively, the insert method may be a suitable screening method for dentinal margins, although its clinical relevance is also unknown.     

Influence of resin cement viscosity on microleakage of ceramic inlays.

OBJECTIVES: The aim of the present investigation was to evaluate the effect of the different viscosities of two resin luting cements on microleakage of ceramic inlays at dentinal margins. The effect of the width of the space between inlay and tooth, on the quality of the marginal seal was also investigated. METHODS: Mesial and distal class V cavities were prepared in 48 extracted third molars. The incisal margins of the cavities were in enamel and the cervical margins in dentin. Subsequently, Empress inlays with different cervical margin gap dimensions were fabricated. The mean cervical gap dimensions in the respective groups were as follows: group 1 (27 microm); group 2 (232 microm); group 3 (406 microm). Half the inlays in each group (16) were cemented with a low viscous resin luting cement, and half (16) with a highly viscous resin luting cement. The teeth were subjected to occlusal loading with synchronized thermal cycling in a masticatory simulator. Then, the specimens were immersed in basic fuchsin solution, and dye penetration along the cavity walls was measured. In addition, marginal adaptation was analyzed in the SEM at baseline and after loading, using a replica technique. RESULTS: With regard to dye penetration at dentinal margins, the highly viscous cement performed statistically significantly better at dentin/composite margins than the low viscous cement (p=0.0158). These findings are supported by SEM analysis. SIGNIFICANCE: It is assumed that polymerization stress within the luting cement could not be completely compensated for by larger luting spaces. Highly viscous luting cements are recommended for cementing class V inlays in larger luting spaces.     

Three-dimensional finite element analysis of strength and adhesion of composite resin versus ceramic inlays in molars

STATEMENT OF PROBLEM: Previous studies on strength of teeth reconstructed with ceramic or composite resin inlays have not resolved which restoration material provides the highest strength and marginal integrity. PURPOSE: The purpose of this study was to compare strength of mandibular molars restored with composite resin inlays to those restored with ceramic inlays, according to the Mohr-Coulomb failure criterion, and to analyze contact stresses in cement-tooth adhesive interfaces of these inlays. MATERIAL AND METHODS: The investigation used a 3-dimensional (3-D) finite element analysis with the use of contact elements. Seven 3-D models of first molars of the same shape and size were created: IT, intact tooth; UT, unrestored tooth with an MOD cavity preparation; CRIT, tooth restored with composite resin inlays (True Vitality) with an elastic modulus equal to 5.4 GPa; CRIH, tooth restored with composite resin inlays (Herculite XRV) (9.5 GPa); CRIC, tooth restored with composite resin inlays (Charisma) (14.5 GPa); CRIZ, tooth restored with composite resin inlays (Z100) (21 GPa); and CI, tooth restored with a ceramic (IPS Empress) inlay with an elastic modulus equal to 65 GPa. Each model was subjected to a force of 200 N directed to the occlusal surface. The stresses occurring in the tested inlays, composite resin cement layer, and tooth tissues were calculated. To evaluate the strength of materials, the Mohr-Coulomb failure criterion was used. Contact stresses in the cement-tissue adhesive interface were calculated and compared to tensile and shear bond strength of the luting cement to enamel and dentin. RESULTS: In the teeth restored with composite resin and ceramic inlays, the values of the Mohr-Coulomb failure criterion were lower than in the unrestored tooth with a preparation (UT), but still 2.5 times higher than in the intact tooth (IT). For the ceramic inlay (CI), the values of the Mohr-Coulomb failure criterion were nearly 3 times higher than in the composite resin inlays. For the luting agent for the ceramic inlay model, these values were 2-4 times lower than for the luting agents for the composite resin inlay models. At the adhesive interface between the cement and tooth around the ceramic inlays, contact tensile and shear stresses were lower than around the composite resin inlays. In the cervical enamel surrounding the proximal surface of the inlays, the stresses exceeded the tissue strength. CONCLUSIONS: Adhesively bonded composite resin and ceramic inlays reinforce the structure of prepared teeth, but do not restore their original strength. The proximal enamel surrounding inlays is prone to failure. The value of the Mohr-Coulomb failure criterion for ceramic inlays was higher than for composite resin inlays. With an increase in the elastic modulus of inlay materials, the values of the Mohr-Coulomb failure criterion decrease in the luting cement. Contact tensile and shear stresses on the cement-tissue adhesive interface decrease as well.     

Marginal adaptation of ceramic and composite inlays in minimally invasive mod cavities

Objectives

This study aims to evaluate the effect of a minimally invasive mesial–occlusal–distal (mod) preparation on the marginal adaptation of ceramic and composite inlays with the aim of saving sound dental substance.

Materials and methods

Class II mod cavities were prepared in 50 extracted human molars and randomly allocated to five groups (n?=?10). In all groups, the mesial–proximal box margins were located in the dentin, 1 mm below the cementoenamel junction (CEJ), while the distal box margins were 1 mm above the CEJ. In groups A and B, conventional standard preparations with a divergent angle of α?=?6° were prepared. In groups C, D, and E, minimally invasive standard preparations with a convergent angle of α?=?10° were prepared. In groups A and D, composite inlays and, in groups B and C, ceramic inlays were fabricated (chairside economical restoration of esthetic ceramics (CEREC)) and adhesively inserted. In group E, a direct composite filling using the incremental technique was placed. Replicas were taken before and after thermomechanical loading (1,200,000 cycles, 50/5 °C, max. load 49 N). Marginal integrity (tooth–luting composite, luting composite–inlay) was evaluated by scanning electron microscopy (×200). The percentage of continuous margins in the different locations was compared between and within groups before and after cycling, using ANOVA and Scheffé post hoc test.

Results

After the thermomechanical loading, no significant differences were observed between the different groups with respect to the interface of luting composite–inlay. At the interface of tooth–luting composite for preparations involving the dentin, groups A and B behaved significantly better compared to the control group E, which in turn were not different to groups C and D.

Conclusion

Composite and ceramic inlays inserted in minimally invasive prepared mod cavities result in margins not different from those of inlays placed in conventional mod preparations. Direct composite filling margins, however, were inferior to those attained by conventional indirect restorations.

Clinical relevance

Minimally invasive preparations for mod inlays with undercuts show marginal adaptation equal to that of conventional inlay preparation design.     

Marginal adaptation of heat-pressed glass-ceramic veneers to dentin in vitro.

The purpose of the present study was to examine the marginal adaptation of ceramic veneers to dentin at the cervical margins and to enamel at the palatoincisal margins using four dual-curing composite resin cements of different viscosity with their corresponding dentin bonding systems. Thirty-six caries-free human maxillary incisors were prepared for facial ceramic veneers with cervical cavity margins located in dentin. Heat-pressed glass-ceramic veneers (IPS Empress) were inserted adhesively using one of the following luting systems: Sono-Cem (SC) with EBS; Variolink Ultra (VU), Variolink High Viscosity (VHV), and Variolink Low Viscosity (VLV) with Syntac. Both the cervical and the palatoincisal margins of the veneers (tooth/composite resin cement interface and ceramic/composite resin cement interface) were evaluated before and after thermocycling and mechanical loading (TCML) by quantitative margin analysis under a scanning electron microscope (SEM) using an image analysis system. Microleakage was assessed by dye penetration after TCML. Before TCML, SC and VU showed statistically significantly fewer marginal gaps than VHV and VLV. After TCML, SC, VU, and VHV revealed significantly fewer marginal gaps than VLV. TCML had a statistically significant influence on marginal gap formation at both the dentin and enamel margins. After TCML, the percentage of marginal gaps was not significantly different at the cervical dentin than at the palatoincisal enamel margins. Cervical dye penetration after TCML showed no statistically significant differences in microleakage among the four luting systems. In conclusion, this in vitro study showed that similarly favorable marginal adaptations of ceramic veneers to dentin and enamel can be achieved using Sono-Cem, Variolink Ultra, or Variolink High Viscosity with their corresponding dentin bonding systems.     

Marginal integrity of ceramic inlays luted with a self-curing resin system.

OBJECTIVE: Aim of this study was to observe the efficacy of two different composite cements on the prevention of marginal deterioration around adhesive ceramic inlay restorations, under laboratory conditions, and to test the null hypothesis that different luting procedures cannot affect sealing ability of luted inlays. METHODS: Twenty-six standardized mesio-occlusal Class II cavities were prepared in extracted posterior teeth. Class II inlays were fabricated with IPS Empress II system following the manufacturer's instructions. The samples were divided into two groups of 13 teeth each at random. Group 1: The ceramic inlays of Group 1 were luted using Excite DSC and an experimental self-curing resin cement (Multilink, Vivadent); in this group, Excite DSC was self-activated and not light-cured. Group 2: Excite DSC in combination with a dual-curing resin cement (Variolink II, Vivadent) was used (as control). In this group Excite DSC was light-cured for 20s separately, before resin cement application. The 'wet' bonding technique was followed. Three samples of each group were selected at random for SEM observations, while the other 10 samples were processed for marginal leakage. The bonding mechanism to dentin and resin cement thickness was evaluated. RESULTS: Samples of both groups showed resin tag and adhesive lateral branch formation. In Group 1 the hybrid layer was mainly uniform along the interface between dental substrates and adhesive material, and resin cement thickness was between 20 and 85 microm. At the cervical margin no gap was detected. In Group 2 the cement thickness was between 30 and 110 microm and hybrid layer formation was observed along the interface but at the cervical margin it was not always uniform and continuous. Resin tag formation was uniform in both groups. At cervical margins, 80% of Group 1 samples showed a perfect seal at the dentin-cementum margins, and 90% at enamel margins. Group 2 samples showed only 50% of cervical margins free from leakage and 80% at the occlusal enamel margins. Statistically significant differences were found at cervical margins between the two groups, while no significant differences were found at enamel site.CONCLUSIONS: It can be concluded that the self-curing adhesive-resin cement combination can properly seal Class II porcelain inlays.     

Marginal adaptation of four tooth-coloured inlay systems in vivo.

This study investigates the margin quality of four different tooth-coloured inlay systems using computer-aided quantitative margin analysis under scanning electron microscopy. Three types of restorations involved chairside procedures using a commercial CAD-CAM apparatus: one type of inlay restoration was milled from preformed glass ceramic blocks, the other two inlay types were milled from preformed porcelain blocks. The fourth system was based on an experimental indirect composite inlay system. Each inlay type was luted with its respective dual-curing luting composite, which was supplied with the system. After 6 months of clinical service, all four systems revealed a significant percentage of submargination indicating occlusal wear of the luting composite. The porcelain inlays and the composite inlays luted with their respective experimental luting composite showed the best marginal adaptation. Luted glass ceramic inlays, in particular, suffered from a significantly higher percentage of inlay margin fractures (9 per cent) and marginal openings (4 per cent) than the other systems. A possible explanation is that the glass ceramic subsurface structure at the inlay-lute interface was weakened by etching with ammonium bifluoride.     

Influence of a proximal margin elevation technique on marginal adaptation of ceramic inlays

Abstract

Purpose. Evaluating the effect of a proximal margin elevation technique on marginal adaptation of ceramic inlays. Methods. Class II MOD-cavities were prepared in 40 human molars and randomly distributed to four groups (n = 10). In group EN (positive control) proximal margins were located in enamel, 1 mm above the cementoenamel junction, while 2 mm below in groups DE-1In, DE-2In and DE. The groups DE-1In, DE-2In and DE simulated subgingival location of the cervical margin. In group DE-1In one 3 mm and in group DE-2In two 1.5 mm composite layers (Tetric) were placed for margin elevation of the proximal cavities using Syntac classic as an adhesive. The proximal cavities of group DE remained untreated and served as a negative control. In all groups, ceramic inlays (Cerec 3D) were adhesively inserted. Replicas were taken before and after thermomechanical loading (1.200.000 cycles, 50/5°C, max. load 49 N). Marginal integrity (tooth-composite, composite-inlay) was evaluated with scanning electron microscopy (200×). Percentage of continuous margin (% of total proximal margin length) was compared between groups before and after cycling using ANOVA and Scheffé post-hoc test. Results. After thermomechanical loading, no significant differences were observed between the different groups with respect to the interface composite-inlay and tooth-composite with margins in dentin. The interface tooth-composite in enamel of group EN was significantly better compared to group DE-2In, which was not different to the negative control group DE and DE-1In. Conclusion. Margin elevation technique by placement of a composite filling in the proximal box before insertion of a ceramic inlay results in marginal integrities not different from margins of ceramic inlays placed in dentin.     

Clinical and quantitative marginal analysis of feldspathic ceramic inlays at 4 years

The aim of this clinical study was to evaluate feldspathic ceramic inlays both by clinical criteria and quantitative margin analysis in continuation of an earlier, identically conducted 2-year study. Fifty feldspathic ceramic inlays were adhesively luted in Class II preparations with all margins located in enamel. The inlays were evaluated clinically according to modified USPHS criteria after 3 and 4 years. Quantitative margin analysis was performed with a scanning electron microscope (SEM). Clinically, the inlays showed no recurrent caries and no changes in colour, but superficial marginal discolouration (6%) was apparent after 4 years. Margins were perceptible clinically in 64% of the cases after 4 years. Quantitative margin analysis showed significantly more marginal gaps at the composite/ceramic interface than at the enamel/composite interface. There was neither a significant decrease in perfect margins nor a significant increase in marginal gaps and marginal imperfections at both interfaces between the third and fourth year. Clinically, the inlays performed very well up to 4 years. Clinical evaluation using an explorer only detected substance loss in the cementation gap. The SEM evaluation showed significantly higher changes in marginal qualities during the first 2-year interval of clinical service compared to the second 2-year interval following an exponential mathematical regularity. Quantitative margin analysis should be included in clinical long-term trials to detect early marginal deficiencies at the luting interfaces. Received: 1 September 1997 / Accepted: 31 October 1997     

In vitro evaluation of marginal and internal adaptation after occlusal stressing of indirect class II composite restorations with different resinous bases

Composite inlays are indicated for large cavities, which frequently extend cervically into dentin. The purpose of this study was to compare in vitro the marginal and internal adaptation of class II fine hybrid composite inlays (Herculite, Kerr) made with or without composite bases, having different physical properties. Freshly extracted human molars were used for this study. The base extended up to the cervical margins on both sides and was made from Revolution (Kerr), Tetric flow (Vivadent), Dyract (Detrey-Dentsply) or Prodigy (Kerr), respectively. Before, during and after mechanical loading (1 million cycles, with a force varying from 50 to 100 N), the proximal margins of the inlay were assessed by scanning electron microscopy. Experimental data were analysed using non-parametric tests. The final percentages of marginal tooth fracture varied from 30.7% (no base) to 37.6% (Dyract). In dentin, percentages of marginal opening varied from 9.2% (Tetric Flow) to 30.1% (Prodigy), however, without significant difference between base products. Mean values of opened internal interface with dentin varied from 11.06% (Tetric Flow) to 28.15% (Prodigy). The present results regarding dentin adaptation confirmed that the physical properties of a base can influence composite inlay adaptation and that the medium-rigid flowable composite Tetric Flow is a potential material to displace, in a coronal position, proximal margins underneath composite inlays.     

Marginal adaptation of Class V restorations using different restorative techniques

This in vitro study compares the marginal adaptation of Class V restorations with margins located half in enamel and half in dentine, which were placed using different restorative techniques. Five operative procedures were evaluated both in saucer-shaped erosion lesions and in box-shaped cavities with bevels in enamel. The five procedures included a composite inlay technique using both the chemically and the light curing versions of a resin based composite cement, a bulk placement technique using a chemically curing composite resin, an incremental technique and an incremental technique combined with a built-up base, using a light curing composite resin. A combination of Gluma/Clearfil served as the dentinal adhesive. The micromorphology of the tooth/restoration interface was analysed before and after thermal cycling; the marginal seal was analysed after thermal cycling only. In the conventional cavities, the restorations showed less leakage, and micromorphologically a better, but statistically insignificant superior marginal adaptation. The inlay technique rendered the best marginal quality in both enamel and dentine before and after thermal cycling. Due to the unique curing characteristics of the chemically cured composite resin and cement resulting in a significantly reduced rigid contraction, the inlays cemented with the chemically curing cement and the restorations placed with the chemically curing composite resin were superior to their light cured counterparts. The built-up base yielding a reduction of the composite mass did not enhance marginal adaptation because of the partial replacement of the strong adhesion to dentine mediated by the Gluma/Clearfil combination by the weaker bond promoted by the etched glass ionomer cement.     

Marginal adaptation of a sintered ceramic inlay system before and after cementation

summary The long term clinical performance of porcelain inlays depends on a number of factors and the marginal adaptation is one of significant interest. The purpose of this in vitro study was to evaluate the marginal integrity of a sintered inlay technique (Ducera®), before and after cementation. MOD cavities without bevels were prepared on 10 human mandibular molar teeth and porcelain inlays were fabricated according to the manufacturer's instructions. Inlays were evaluated microscopically for their adaptation to the occlusal and approximal margins of the tooth by means of a replica technique. Inlays were cemented with a dual-cured bybrid composite luting material (Enforce®). After polishing, each tooth was sectioned in buccal/lingual and mesial/distal directions following the same procedure in the sectioning of replicas. The marginal gap and the thickness of exposed cement were measured at each section. The mean marginal gap of 71.83 ± 8.93 μm recorded for the occlusal margin before cementation was significantly smaller than that of 1056 ± 39.33 μm calculated at the approximal margin. Following the cementation, the adaptation of the inlays at the occlusal margin was also found to be superior to that of the approximal margin. Comparison of mean gap values before and after cementation revealed that the marginal gap increased by 6.94 μm and 23.25 μm at the occlusal and approximal margins, respectively. Although polishing was performed after cementation, excess luting material was still observed, that caused an increase in the width of the exposed luting cement.     

In vitro evaluation of microleakage of indirect composite inlays cemented with four luting agents

STATEMENT OF PROBLEM: Microleakage around dental restorations is implicated in the occurrence of secondary carious lesions, adverse pulpal response, and reduced restoration longevity. PURPOSE: The aim of this in vitro study was to evaluate the microleakage of indirect resin composite inlays cemented with 4 luting agents. MATERIAL AND METHODS: Standardized Class V inlay preparations overlapping the cemento-enamel junction were prepared on the buccal and lingual surfaces of 40 extracted human mandibular third molars. Eighty postpolymerized, heat-treated resin composite inlays (Targis, 72 specimens, 8 controls) were processed in stone replicas and cemented into the preparations using 4 luting agents (n = 18 + 2 controls for each cement group): a resin composite used with a bonding agent (Variolink II/Excite), a resin composite used with a self-etching primer, but without bonding agent (Panavia F/ED Primer), a modified resin composite used with a bonding agent (Resinomer/One Step), and a resin-modified glass-ionomer cement (Fuji Plus). Thirty-six inlays (n = 9 + 1 control) were subjected to thermal cycling (2000 cycles, 5 degrees C/55 degrees C), whereas the other 36 were not. All the teeth were then immersed in 1% methylene blue dye solution for 48 hours. Microleakage score, margin location (enamel/cementum), thermal cycling history, and preparation location (buccal/lingual) were analyzed using a multivariate model (alpha = .05). Multivariate analysis was performed using a polychotomous logistic regression. RESULTS: The preparation location had no significant effect on dye penetration. The margin location (enamel or cementum) and the thermal cycling had a significant effect on microleakage (odds ratios [ORs] = 17.6 and 8.04, respectively). In comparing the 3 resin-based luting agents (Variolink II, Panavia F, and Resinomer) to Fuji Plus, Panavia F exhibited the lowest significant overall microleakage (OR = 0.09), followed by Variolink II (significant OR equal to 0.43), whereas Resinomer demonstrated the greatest significant overall microleakage (OR = 1.35). CONCLUSION: Within the experimental conditions of this in vitro study, thermal cycling significantly increased microleakage (OR = 8.04). The overall microleakage at the enamel margins was significantly lower than the overall microleakage at the cementum margins for the 4 luting agents tested (OR = 17.6).     

In vitro evaluation of marginal and internal adaptation after occlusal stressing of indirect class II composite restorations with different resinous bases and interface treatments. “Post-fatigue adaptation of indirect composite restorations”

The present study evaluated the influence of different composite bases and surface treatments on marginal and internal adaptation of class II indirect composite restorations, after simulated occlusal loading. Thirty-two class II inlay cavities were prepared on human third molars, with margins located in cementum. A 1-mm composite base extending up to the cervical margins was applied on all dentin surfaces in the experimental groups; impressions were made and composite inlays fabricated. The following experimental conditions were tested: no liner (control group), flowable composite treated with soft air abrasion (experiment 1), flowable composite sandblasted (experiment 2) and restorative composite sandblasted (experiment 3). All specimens were submitted to 1,000,000 cycles with a 100-N eccentric load. Tooth-restoration margins were analysed semi-quantitatively by scanning electron microscopy before and after loading; internal adaptation was also evaluated after test completion. The percentage of perfect adaptation in enamel was 79.5% to 92.7% before loading and 73.3% to 81.9% after loading. Perfect adaptation to dentin was reduced before loading (54.8% to 77.6%) and after loading (41.9% to 63%), but no difference was found among groups for pre- and post-loading conditions. No debonding occurred between the base and composite luting. A significant, negative influence of cyclic loading was observed. The results of the present study support the use of flowable or restorative composites as base/liner underneath large class II restorations. Soft air abrasion represents a potential alternative to airborne particle abrasion for treating cavities before cementation. The application of a composite base underneath indirect composite restorations represents a feasible non-invasive alternative to surgical crown lengthening to relocate cavity margins from an intra-crevicular to supra-gingival position.     

Clinical and semiquantitative marginal analysis of four tooth-coloured inlay systems at 3 years

Objectives: The marginal quality of four tooth-coloured inlay systems was clinically investigated and subjected to computer-aided semiquantitative marginal analysis under scanning electron microscopy (SEM) after 3 years of clinical service.

Methods: Three of the restoration types were made using the Cerec CAD-CAM apparatus: one was milled from preformed glass ceramic blocks, and the two other inlay types were milled from preformed porcelain blocks. The fourth system was based on an experimental indirect resin composite inlay system. Each inlay type was luted with a different luting resin composite. The clinical evaluation was performed with a mirror and explorer by two clinicians separately, and the marginal analysis was conducted microscopically on replicas (SEM × 200).

Results: After 3 years in situ, all the restorations were clinically acceptable. No recurrent caries was observed. Marginal analysis under SEM detected a high percentage of submargination for all four systems, which suggests that their respective resin composite luting agents were all subject to wear. The percentage of marginal fractures on the enamel side as well as on the inlay side did not increase dramatically compared to the 6-month results.

Conclusion: The first recall after 6 months of clinical service indicated how tooth-coloured inlays behave at their margins. The 3-year results confirmed the early findings, indicating that wear of resin composite lutes is important and present in all systems. The two ceramic materials showed a similar behaviour at the margins. The resin composite inlay performed better at the inlay site than at the enamel site.     

Marginal seal comparisons between resin-bonded Class II porcelain inlays, posterior composite restorations, and direct composite resin inlays

The microleakage of indirect porcelain and direct composite resin-bonded inlays was compared with that of posterior composite resin restorations using Class II preparations of extracted molar teeth. The resin-bonded inlay restorations provided a better marginal seal at the cervical restoration/dentin interface than did the composite resin restoration. The efficacy of this marginal seal varied with the particular treatments and materials used. Resin-bonded porcelain inlays had a higher incidence of cervical excess from the composite resin luting agent than did the posterior composite resin restorations.     

Marginal adaptation of dentin bonded ceramic inlays: effects of bonding systems and luting resin composites

This in vitro study evaluated the marginal adaptation of bonded inlays of lucite-reinforced glass ceramic (Empress) to dentin as influenced by different bonding systems and by luting resin composites (LRCs) with different curing modes. Forty-eight Empress inlays etched with 5% hydrofluoric acid and treated with a silane-coupling agent (Monobond-S) were bonded to two-surface Class II cavities. Two total-etch bonding systems (OptiBond FL, Nexus) and one bonding system with selective enamel etching and a self-conditioning dentin primer (ART Bond) were included in the study. ART Bond was tested with and without the pre-curing of a first layer of adhesive resin selectively applied to the cervical cavity floor (selective double-bond technique). Each bonding system was used in combination with a light-cured resin composite (Prodigy) and a dual-cured LRC (Nexus or Vita Cerec Duo Cement). Marginal integrity was evaluated before and after thermocycling (TC) in a scanning electron microscope (SEM). Dye penetration tests were performed after TC was completed. The median percentages of continuous margin in dentin ranged from 80% to 100% before TC and from 53.5% to 96.1 % after TC. After TC, the influence of the bonding system was more pronounced than that of the LRC. In combination with the LC resin composite, ART Bond with precuring was significantly higher and the Nexus bonding system had significantly lower proportions of continuous margin than all the other bonding systems investigated. Swelling of the adhesive along the gingival margins was frequently found with the Nexus bonding system and with ART Bond without pre-curing. Microleakage was detected with all bonding system/LRC combinations, with somewhat lower rates in specimens completed using the selective double-bond technique. With the exception of the Nexus bonding system, post-TC marginal integrity was not influenced by the curing mode of the LRC (LC vs DC). In conclusion, the marginal quality of dentin bonded ceramic inlays can be improved by proper selection of the bonding sys- tem/LRC combination. The results of this study indicate the use of the Nexus luting system as directed without substitution.     

Clinical evaluation of heat-pressed glass-ceramic inlays in vivo: 2-year results

In the present study, the 2-year clinical and scanning electron microscope (SEM) results for heat-pressed ceramic inlays are reported. In a selected patient population, 51 cavities were restored with all-ceramic inlays. All margins were located within the enamel. The inlays were luted to the cavities with a high-viscosity, dual-cure luting composite. After 2 days, 1 year, and 2 years, the restorations were evaluated clinically, using the modified USPHS criteria. Quantitative margin analysis was performed in the SEM on the replicas fabricated at the recall times. The data were tested for significant differences, using the chi-square test for the clinical evaluation and the Mann-Whitney U-test for the margin analysis. After 2 years, the clinical evaluation of the margin adaptation revealed Bravo ratings for 14 restorations (27.5%); 37 restorations (72.5%) were rated Alfa. Compared to the baseline data, this difference was statistically significant (p≤0.5). SEM analysis revealed that the ceramic-composite interface exhibited significantly (p≤0.01) more gap formation than the enamel-composite interface at all times of evaluation. Wear of the luting composite could be determined along 50% of the restoration interface during the first year, 53% during the second year. The inlay restorations controlled in this study perform well after a period of 2 years.     

Interfacial gaps following ceramic inlay cementation vs direct composites

This study compared the interfacial integrity of Class II ceramic inlay restorations and direct resin composite restorations. The influence of a flowable resin composite liner was also evaluated. Class II DO cavities were prepared in 40 recently extracted mandibular molars and assigned to four treatment groups. Group A: direct composite restoration; Group B: Cerec inlays fabricated and cemented with a resin cement; Group C: adhesive lining with a flowable resin composite used prior to resin composite restoration; Group D: lining with a flowable resin composite prior to cementation of Cerec inlays. After finishing, polishing and thermocycling (4 degrees C and 60 degrees C x 500), the samples were cross-sectioned in a mesio-distal direction along the center of the fillings or inlays. The cross-sectioned surface was polished, and the adhesive interfaces between resin and enamel or dentin were observed under a scanning laser measurement microscope. Ceramic inlay restorations showed no interfacial gaps in enamel, but direct resin composite restorations showed a significantly higher incidence of gaps at the interface or cracks in the interfacial enamel (p=0.0002). No differences were found in the resin-dentin interfaces for both the inlay and direct resin composite restorations. The use of a flowable resin composite as an adhesive liner produced a significantly greater gap-free resin-dentin interface in Cerec inlay and direct resin composite restorations (p=0.0233 & 0.0009), but it did not reduce gap formation at the resin-enamel interface.