The use of resin-based composite restorations in pulpotomized primary molars

The purpose of this retrospective clinical study was to report a 12- to 54-month follow-up, in which a resin-based composite filling material was used in direct contact with a fast-setting zinc oxide eugenol cement to restore the function and anatomy of 51 pulpotomized primary molars in 2- to 11-year-old children who needed a Class I or II restoration. Formocresol pulpotomy using Temrex cement was performed in all cases. The total-etch technique was used with: (1) 35% phosphoric acid; (2) OptiBond Solo Plus bonding agent; and (3) Filtek P60/shade B2 resin-based composite material. The restored teeth were sealed with Embrace pit and fissure sealant, monitored, and evaluated with periodic radiographs and clinical exams at 6-month recall visits. The results revealed that none of the 51 pulpotomized primary molars had evidence of periapical or furcation pathosis, recurrent decay, open margins, or broken restorations. In conclusion, this clinical study demonstrated that resin-based composite restorations--combined with the total-etch technique and a fifth-generation bonding agent and in direct contact with a fast-setting zinc oxide eugenol cement were long-lasting, quality clinical alternatives to restore the anatomy and function of pulpotomized primary molars.     

A comparative evaluation of the fracture strength of pulpotomized primary molars restored with various restorative materials

Sixty extracted primary molars were used in the study. After pulpotomy, these were divided into four groups on the basis of restorative materials to be used. Results showed that the Ormocer had the maximum fracture strength while the posterior Glass Ionomer Cement showed the least fracture strength among the various restorative materials used in the study.     

Evaluation of fracture resistance of pulpotomized second primary molars restored with fiber-reinforced composite

ObjectivesFiber reinforcement of composite restorations can help decrease the fracture risk in restored pulpotomized teeth with severe coronal lesions.This study aimed to evaluate the fracture resistance of pulpotomized second primary molars restored with fiber-reinforced composite (FRC).MethodsThis experimental study was done on 40 extracted primary second molars in four groups (n = 10). The negative controls were intact untreated teeth; while, other samples were pulpotomized with the mesio-occlusal-distal (MOD) access cavities prepared on their buccal and lingual surfaces. Positive control group was left unrestored. Composite group received glass ionomer on Zonalin and was restored with flowable composite and then composite. The FRC group received glass ionomer as the preceding group; the glass fiber was embedded within flowable composite, and the cavity was restored with composite. The compressive forces leading to fracture were recorded in Newton. Comparisons were made through one-way ANOVA and Tukey's post-hoc test (α = 0.05).ResultsThe highest mean fracture resistance belonged to the intact teeth (604.45 ± 59.02 N), then the FRC group (584.31 ± 57.18 N). Unrestored teeth had the lowest fracture resistance (235.60 ± 45.60 N); however, they were not significantly different from composite group in this regard (P = 0.47). Although FRC group had significantly higher fracture resistance than the unrestored and composite group, it was not significantly different from intact teeth.ConclusionsFiber reinforcement improved the fracture resistance of pulpotomized primary molar with large MOD cavities.     

Radiographic assessment of primary molar pulpotomies restored with resin-based materials

PURPOSE: The aims of this study were to: (1) retrospectively assess the overall performance of formocresol pulpotomies in primary molars when definitively restored with a resin-based material; and (2) compare the results to previously published studies using more traditional restorative techniques (stainless steel crown, amalgam). METHODS: Records of a 2-operator pediatric dental office using this novel restorative technique were reviewed. Pre- and postoperative radiographs of pulpotomized primary molars restored with Z-100 and with a minimum of 6 months of follow-up were compared to the contralateral nonpulpotomized tooth. Radiographic success was determined by the absence of furcation/periapical osseous radiolucency and internal/external pathologic root resorption. Patient's age, gender, tooth type and arch, follow-up time, ZOE base type used (IRM only or IRM with glass ionomer overlay), and number of surfaces involved were the variables analyzed in the study. Statistical analysis was performed using chi-square analysis. RESULTS: Fifty-nine teeth in 52 patients met the selection criteria. Patient's age at treatment ranged between 44 and 118 months, with an average follow-up time of 21 months (range = 7 to 43). Significant failure rate was found in the mandibular arch (P = .035). When only the occlusal surface was restored, 100% success was obtained. With proximal restorations, 83% (15/18) success was obtained when the base was IRM followed by glass ionomer and 69% (22/32) success for IRM only (P = .259). CONCLUSIONS: Overall, restoration of pulpotomized primary molars with resin-based material was inferior to reported success rates using stainless steel crowns. When proximal surfaces were restored, the failure rate (26%) was comparable to amalgam (23%). Prospective studies with larger sample size are necessary for definitive conclusions.     

Clinical performance of Class II adhesive restorations in pulpectomized primary molars: 12-month results

The purpose of this report was to present the 12-month results of a prospective, randomized study evaluating the clinical and radiographic success rates of Class II adhesive restorations in pulpectomized primary molars. A total of 75 restorations were placed over root canal-treated primary molars, filled with a calcium hydroxide paste. The restorative systems tested were: (1) group 1: amalgam (negative control); (2) group 2: a hybrid resin composite (TPH, Dentsply) with prior acid conditioning and bonding with an etch-and-rinse adhesive (Prime&Bond NT, Dentsply); (3) group 3: a polyacid-modified resin composite (Dyract, Dentsply) bonded with Prime&Bond NT; (4) group 4: Dyract with prior nonrinse conditioner (NRC) treatment and bonding with Prime&Bond NT; and (5) group 5: a polyacid-modified resin composite (F2000) in conjunction with a self-etch adhesive (Prompt-L-Pop, 3M/ESPE). The restorations were evaluated clinically using the modified USPHS/Ryge criteria at 1, 2, 3, 4, 5, 6, 9, and 12 months. Radiographic evaluations were made in accordance with predetermined criteria. During the evaluation period, 12 teeth (group1=4, group2=1, group3=4, group4=3, and group5=2) were extracted due to radiographic evidence of failure. There was no difference between groups regarding the clinical evaluation criteria (P>.05) except marginal discoloration at 9 and 12 months (P<.05). The overall success rate at 12 months was 81% (group 1=73%, group 2=93%, group 3=73%, group 4=80%, and group 5=87%). Teeth restored with the resin composite+total-etch/bonding (group 2), followed by those with F2000+self-etch adhesive (group 5) exhibited the highest clinical and radiographic success rates. Radiographic failures observed beneath failed restorations were strongly suggestive of coronal microleakage.     

Caries progression in primary molars: 24-month results from a minimal treatment programme

Abstract A 2-stage topical treatment regimen (AgF followed by SnF₂) was used in an attempt to limit caries progression in the primary molars of children participating in a minimal treatment programme. The children lived in an isolated community in western New South Wales (fluoride in water < 0.2 parts/10⁶) and were from a low socioeconomic background. The progression, over a 24-month period, of 281 established lesions in the approximal and occlusal surfaces of primary molars in 54 subjects (mean age 7.0 years) was determined from bilewing radiographs. Of the lesions studied, the majority (69%) were in dentine at baseline. At 24 months, 74% of the approximal surface lesions and 90% of the occlusal surface lesions that were in enamel at baseline remained unchanged. The greatest change occurred in the approximal surface lesions that were within 1 mm of the pulp at baseline. Only 35% of the lesions required any treatment other than topical metal fluoride therapy during the 24-month period.     

Microleakage of restorative techniques for pulpotomized primary molars

PURPOSE: This study's purpose was to assess in vitro microleakage of different restorative materials after pulpotomies in primary molars. METHODS: Proximo-occlusal cavity preparations were prepared in 60 extracted primary molars. The selected teeth had at least 3 sound walls and one half to two thirds of root length remaining. Carious tissue was removed, pulpotomy was performed, and IRM filled the pulp chamber. The teeth were then randomly divided equally into 5 groups and restored as follows: (1) group 1 with a compomer; (2) group 2 with a reinforced glass ionomer material; (3) group 3 with amalgam; (4) group 4 with a stainless steel crown (SSC); and (5) group 5 with IRM only (control). After thermocycling for 500 cycles, teeth were immersed in dye for 24 hours and progressively ground prior to microleakage evaluation. The worst result for each section was logged and results were statistically analyzed (Kruskal-Wallis and Mann-Whitney). RESULTS: Group 1 showed the highest percentage of no leakage of all groups. Leakage from occlusal and cervical margins was markedly shown for all specimens of groups 2, 3, and 5. CONCLUSIONS: (1) Bonding agents and resin based restorations were able to provide the best total margin protection. (2) SSCs cemented with glass ionomer cement were unable to hermetically seal teeth; and (3) Tytin, Ketac Molar, and IRM restorations did not appear to be leakage-resistant materials for pulpotomies of primary molars.     

Clinical performance of a compomer and amalgam for the interproximal restoration of primary molars: a 24-month evaluation

OBJECTIVES: To evaluate the clinical performance of a compomer material (Dyract) in comparison with dental amalgam (Contour) for management of proximal caries in primary molars in young children. SETTING: General dental practice, and a dental hospital paediatric clinic. METHOD: This was a prospective study. A split mouth design was used with identical pairs of minimal Class II cavities, of matched tooth type in the same dental arch, usually diagnosed with the use of bitewing radiographs. Seventy-eight pairs of restorations were completed of which 60 pairs were available for evaluation after 24 months. RESULTS: Comparable retention rates were observed for both Dyract and amalgam. The retention rates were high for both materials, with only four amalgam and two Dyract restorations failing over 24 months. Significantly better marginal integrity (P < 0.05) was observed for Dyract compared with amalgam with no significant differences between the two materials for recurrent caries, wear or surface texture. CONCLUSIONS: Dyract seemed to be a suitable alternative to amalgam for proximal restorations in primary molars of young children for use in general dental practice.     

Fatigue performance of endodontically treated molars restored with different dentin replacement materials

ObjectivesThe aim was to investigate the fatigue performance of endodontically treated (ET) molars restored by various dentin-replacing materials and material configurations. Moreover, the impact of additional adhesive treatment with glass-ionomer cement (GIC) was evaluated.Methods250 intact molars were collected and randomly distributed into ten groups (n = 25). After endodontic procedure standard Class I cavities were prepared and restored with different direct restorative techniques and dentin-replacing materials. Two-group were restored with either packable or flowable short fiber-reinforced composites (SFRCs). Two-group were restored by experimental fiber-reinforced GIC with and without adhesive treatment. Four-group were restored by conventional and resin-modified GICs with or without adhesive treatment. One-group was restored with a dual-cure composite resin and last group was restored with only conventional composite resin (control). Fatigue-survival was measured for all specimens using a cyclic-loading machine until fracture occurred or a number of 40.000 cycles were achieved. Kaplan-Meyer survival analysis was conducted, followed by pairwise log-rank post hoc comparisons. Fracture mode was then examined by means of optical microscopy and SEM.ResultsGroup restored with flowable SFRC showed significantly higher survival (p < 0.05) compared to all of the groups, except for group restored with packable SFRC (p > 0.05). Group restored with fiber-reinforced GIC had significantly (p < 0.05) higher survival rates compared to other commercial GICs. SEM demonstrated change of the fracture line when fracture reached the SFRC layer.SignificanceDirect restoration of Class I in ET molars with the use of SFRCs as dentin-replacing materials demonstrated its ability to reinforce the dental structures and to increase the fatigue resistance in this specific clinical situation.     

Success of mineral trioxide aggregate in pulpotomized primary molars

The aim of the present study was to compare, clinically and radiographically, the mineral trioxide aggregate (MTA) to formocresol (FC) when used as medicaments in pulpotomized vital human primary molars. METHODS: The sample consisted of 120 primary molars, all teeth were treated with the same conventional pulpotomy technique. Sixty molars received FC and 60 received MTA throughout a random selection technique. RESULTS: At the end of 24-month evaluation period, 74 molars (36 FC, 38 MTA) were available for clinical and radiographic evaluation. None of the MTA treated teeth showed any clinical or radiographic pathology, while the FC group showed a success rate of 86.8% radiographically and 98.6% clinically. The difference between the two groups in the radiographic outcomes was statistically significant. It was concluded that MTA treated molars demonstrated significantly greater success. MTA seems to be a suitable replacement for formocresol in pulpotomized primary teeth.     

Clinical evaluation of composite and compomer restorations in primary teeth: 24-month results

PURPOSE: This split-mouth, blind study evaluated the clinical performance of Dyract AP, F2000, and Heliomolar placed in primary molars of 30 children (mean age, 6 years and 2 months). MATERIALS AND METHODS: From a total of 79 restorations accomplished, 27 were built with Heliomolar (18 Class I, and 9 Class II), 30 were with F2000 (21 Class I and 9 Class II), and 22 were built with Dyract AP (14 Class I and 8 Class II). All of teeth restored had primary caries lesions. At 6, 12, 18 and 24 months, 60 restorations (75%) were evaluated using USPHS criteria for: color match (CM), marginal adaptation (MA), marginal discoloration (MD), anatomic form (AF) and secondary caries (SC) by three calibrated operators. The Alpha+Bravo score percentage was considered as clinical success. The data were subjected to statistical analysis by Mann-Whitney and Kruskal-Wallis tests (p<0.05). RESULTS: Heliomolar showed the smallest success clinical at 12 months for marginal adaptation and secondary caries, and at 18 months for marginal discoloration. Regarding color match and anatomic form, no significant differences were found among the groups at each evaluation period. When materials were compared, Heliomolar did not show a significant difference among the evaluated periods for any criteria, remaining with the lowest scores. Significant differences were observed at 12 months for F2000 (marginal adaptation), and at 24 months for Dyract AP (marginal discoloration and secondary caries) and for F2000 (color match and marginal discoloration). CONCLUSIONS: It was concluded that Dyract AP and F2000 showed the best clinical performance over 24 month-evaluations for marginal discoloration and secondary caries, and color match and marginal adaptation, respectively. The use of the resin composite Heliomolar in Class I/II restorations in primary molars should be carefully considered.     

Mineral trioxide aggregate vs. formocresol in pulpotomized primary molars: a preliminary report

PURPOSE: The aim of this study was to compare the effect of mineral trioxide aggregate (MTA) to that of formocresol (FC) as pulp dressing agents in pulpotomized primary molars with carious pulp exposure. METHODS: Forty-five primary molars of 26 children were treated by a conventional pulpotomy technique. The teeth were randomly assigned to the MTA (experimental) or FC (control) group by a toss of a coin. Following removal of the coronal pulp and hemostasis the pulp stumps were covered with an MTA paste in the experimental group. In the control group, FC was placed with a cotton pellet over the pulp stumps for 5 minutes and removed; the pulp stumps were then covered by zinc oxide-eugenol (ZOE) paste. The teeth of both groups were restored with stainless steel crowns. Eighteen children with 32 teeth arrived for clinical and radiographic follow-up evaluation ranging from 6 to 30 months. RESULTS: The follow-up evaluations revealed only one failure (internal resorption detected at a 17 months postoperative evaluation) in a molar treated with formocresol. None of the MTA-treated teeth showed any clinical or radiographic pathology. Pulp canal obliteration was observed in 9 of 32 (28%) evaluated molars. This finding was detected in 2 out of the 15 teeth treated with FC (13%) and in 7 out of the 17 treated with MTA (41%). CONCLUSION: MTA showed clinical and radiographic success as a dressing material following pulpotomy in primary teeth and seems to be a suitable replacement for formocresol in primary teeth.     

A 3-year clinical follow-up study of pulpotomized primary molars treated with the formocresol technique

abstract — The purpose of the present investigation was to evaluate the prognosis of primary molars treated with pulpotomy employing formocresol. The material consisted of 98 primary molars. The study included clinical and radiographic observations 3, 12, 24 and 36 months after treatment. The survival rate at the 3-month follow-up was 91%, whereas the rate was 83%, 78% and 70%– 12, 24 and 36 months respectively after the treatment. The results were computed according to the life table method.     

A 2-year follow-up of primary molars, pulpotomized with a gentle technique and capped with calcium hydroxide.

The prognosis for pulpotomy of primary molars with calcium hydroxide as wound dressing was evaluated clinically and radiographically. Thirty-three primary mandibular molars were amputated under the following conditions: (1) chronic coronal pulpitis, (2) the amputation was done with diamond instruments and a high-speed machine under aseptic conditions, and (3) application of calcium hydroxide in contact with the wound surface. After 1 year the treatment was regarded as successful for 22 of the teeth (67%); 11 teeth showed internal dentin resorption. After 2 years the frequency of success, allowing for drop-out, was 59%. Internal dentin resorption was seen in 14 root canals; in 10 of them within the first 6 months. A histologic study of nine root pulps with internal dentin resorption revealed an extra-pulpal blood clot on the wound surface in five.     

磨牙根管治疗后直接充填修复效果的3年临床评价

目的:评价磨牙根管治疗后直接充填修复的临床效果及影响因素。方法:采用回顾性研究的方法,回访检查磨牙根管治疗后直接充填修复3年的牙体和充填物状况,对修复效果和可能的影响因素进行分析。结果:269个磨牙牙体充填修复3年成功率为68.8%。对不同类型牙体缺损的修复效果进行比较发现,剩余牙体组织最多的Ⅰ型缺损成功率最高,为75.8%,剩余牙体组织最少的Ⅲ型最低,为51.6%,三者存在显著性差异(P<0.05)。比较不同充填材料的修复效果,银汞合金充填组的成功率在Ⅰ型缺损略低于树脂充填组,Ⅱ、Ⅲ型缺损均高于复合树脂充填组,且Ⅱ型缺损比较两者存在显著性差异(P<0.05)。结论:牙体缺损的大小影响直接充填的修复效果;对Ⅰ型缺损的磨牙,无论选用何种充填材料,均可获得较好的修复效果。     

A 2-year follow-up of primary molars, pulpotomized with a gentle technique and capped with calcium hydroxide

abstract — The prognosis for pulpotomy of primary molars with calcium hydroxide as wound dressing was evaluated clinically and radiographically. Thirty-three primary mandibular molars were amputated under the following conditions: (1) chronic coronal pulpitis, (2) the amputation was done with diamond instruments and a high-speed machine under aseptic conditions, and (3) application of calcium hydroxide in contact with the wound surface. After 1 year the treatment was regarded as successful for 22 of the teeth (67%); II teeth showed internal dentin resorption. After 2 years the frequency of success, allowing for drop-out, was 5996. Internal dentin resorption was seen in 14 root canals; in 10 of them within the first 6 months. A histologic study of nine root pulps with internal dentin resorption revealed an extra-pulpal blood clot on the wound surface in five.     

Cuspal deflection and microleakage in premolar teeth restored with bulk-fill flowable resin-based composite base materials

ObjectivesTo assess the cuspal deflection and cervical microleakage of standardised Class II cavities incrementally filled with a dimethacrylate RBC or bulk-fill flowable RBC bases.MethodsTwenty-four sound upper premolar teeth with Class II cavities were allocated to three groups (n = 8). Restoration of the teeth involved the placement of an RBC (GrandioSO) in eight oblique increments (Group A) or Groups B and C were restored to within 2 mm of the palatal cusp in a single increment with bulk-fill flowable RBC bases (SDR and x-tra base) before the two occlusal cavity increments were placed with GrandioSO. Buccal and palatal cusp deflections were recorded postirradiation using a twin channel deflection measuring gauge. Following restoration, the teeth were thermocycled, immersed in 0.2% basic fuchsin dye for 24 h, sectioned and examined for cervical microleakage.ResultsThe mean total cuspal deflection for the oblique incremental restoration technique was 11.26 (2.56) μm (Group A) and 4.63 (1.19) μm (Group B) and 4.73 (0.99) μm (Group C) for the bulk-fill flowable RBC bases. A significant increase in the mean total cuspal deflection for the incrementally filled GrandioSO compared with the SDR (P = 0.007) and x-tra base (P = 0.005) restored teeth was evident. No significant difference in the cervical microleakage scores was recorded between groups AC (P > 0.05).ConclusionsThe bulk-fill flowable RBC bases significantly reduced cuspal deflection compared with a conventional RBC restored in an oblique incremental filling technique with no associated change in cervical microleakage recorded.