Simple guidelines for aesthetic success with composite resin--part II: posterior restorations.

Aesthetics are as valuable in the posterior region as they are in the anterior. While the former is sometimes overlooked due to the limited visibility of posterior teeth, it is important that the clinician follow guidelines to ensure a high-quality restoration in this region. Restoring posterior teeth with direct resin can be accomplished through conservative and aesthetic treatment; however, it can also be challenging and time consuming to achieve exceptional aesthetics. Highlighting the importance of occlusal anatomy to the success of a direct resin restoration, this presentation outlines requisites to achieve this result. Learning Objectives: This article discusses guidelines for the aesthetic buildup of posterior restorations with direct resin techniques. Upon reading this article, the reader should Realize how the aesthetics of posterior restorations can be enhanced through the application of intensive composite shades. Understand the importance of occlusal design when building the restoration.     

Finishing and polishing of direct posterior resin restorations.

Direct composite resin materials have revolutionized the delivery of minimally invasive treatment in the posterior region. Contemporary resin formulations provide improved strength, wear resistance, and aesthetics. Microhybrid formulations have also been associated with enhanced polishability. Development of an optimal surface polish in turn reduces stain and plaque accumulation, minimizes wear, and enhances the appearance of the definitive restoration. This article presents a simplified technique and protocol for finishing and polishing composite resin materials following restoration of the posterior region. LEARNING OBJECTIVES: This article discusses techniques and a protocol for finishing and polishing posterior direct resin restorations. Upon reading this article, the reader should: Understand the clinical protocol necessary to create direct posterior resin restorations that require minimal finishing. Be able to select appropriate instrumentation for direct posterior resin finishing and polishing procedures. Understand the importance of correct finishing and polishing on plaque accumulation, stain resistance, and wear resistance.     

Pin-retained composite resin cores for posterior teeth

Two techniques for the fabrication of pin-retained composite resin cores for posterior teeth have been described.The advantage of using a composite resin in place of amalgam as a core material is that the restoration can be completed in a single appointment rather than the two appointments required when amalgam is used.A disadvantage of the use of the composite resins as core material is the difficulty in identifying the demarcation line between the resin and tooth structure. This lack of definition presents the possibility of placing the finish line of the final preparation on the resin rather than on sound tooth structure. Application of a Dycal demarcation bead or use of the ultraviolet light-activated resin offers a solution to this problem.     

Attitudes of some European dental undergraduate students to the placement of direct restorative materials in posterior teeth

Summary The aim of this article was to report on the attitudes, opinions and confidences of final year dental students in three European schools towards the restoration of posterior teeth and in particular towards the use of amalgam and resin composite. One hundred and twenty‐eight pre‐piloted questionnaires were distributed to final year dental students in Cardiff, Dublin and Malmö. The questionnaire sought information relating to various opinions and attitudes towards the use of amalgam and resin composite in posterior teeth. Information was returned anonymously. Ninety‐one completed questionnaires were returned (response rate = 71%; Cardiff: n = 40, Dublin: n = 24, Malmö: n = 27). Ninety‐three per cent of Malmö students (n = 24), 67% of Dublin students (n = 16) and 60% of Cardiff students (n = 24) reported that they feel confident when placing posterior resin composites. One hundred per cent of Malmö students (n = 27), 75% of Cardiff students (n = 30) and 33% of Dublin students (n = 8) would prefer to have a resin composite rather than amalgam, placed in one of their own posterior teeth. Eighty‐five per cent of Malmö students (n = 23), 30% of Cardiff students (n = 12) and 25% of Dublin students (n = 6) perceive amalgam as being harmful to the environment. For the restoration of a posterior tooth in a pregnant female, 44% of students (n = 40) would place a resin composite restoration, and 7% (n = 6) would place an amalgam restoration, while 32% (n = 29) would place a temporary restoration. Students at Malmö report that they place more posterior resin composites and have greater confidence at placing posterior resin composites than students at Cardiff or Dublin. There was confusion relating to the choice of restorative materials for pregnant females. Large variations in restorative strategies among graduates must be considered as dental professionals can practice in all countries within the European Union.     

Functional and aesthetic guidelines for stress-reduced direct posterior composite restorations

Amalgam has been used in the restoration of structurally compromised posterior teeth for many years. When placing large amalgam restorations, replacement of weak cusps with restorative material is recommended to prevent tooth fracture. This recommendation can be modified with new guidelines using modern adhesive techniques. Semidirect and indirect inlay/onlay composite restorations have progressively replaced amalgam restorations over the past 20 years. Lately, single visit direct resin-bonded composite (RBC) restorations have also been used as a viable alternative to conventional indirect restorations. This paper is intended to introduce a step-by-step protocol for the direct restoration of structurally compromised posterior teeth using RBCs with stress-reducing protocols.     

Simple guidelines for aesthetic success with composite resin--Part I: anterior restorations.

Composite restorations have the advantage of being created in the dental office, which can lead to beautiful, natural aesthetics. Laboratory technicians tend to spend minimal time with the patient and reconstruct the restoration based on information provided by the clinician. Dentists, however, are at a great advantage, as they can refer to the surrounding tooth structure when building the restoration. Part I of this article will discuss various guidelines for treating anterior teeth using direct resin restorations, while Part II will address posterior restorations.     

Guidance on posterior resin composites: Academy of Operative Dentistry - European Section

There have been many developments in operative dentistry in recent years, including a progressive shift to the use of resin composites, rather than dental amalgam, in the restoration of posterior teeth. This shift allows the adoption of minimal intervention approaches, thereby helping to conserve and preserve remaining tooth tissues and structures. This paper presents the position of the Academy of Operative Dentistry European Section (AODES) in relation to posterior resin composites. The AODES considers adhesively bonded resin composites of suitable composition and properties to be the “material of choice” for use in direct minimal intervention approaches to the restoration of posterior teeth. In so doing, the AODES emphasises the importance of the practice of evidence-based minimal intervention dentistry, including the use of refurbishment and repair techniques to extend the longevity of restorations. Guidance, based on best available evidence, has been made in relation to certain aspects of resin composite placement techniques in posterior teeth.     

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.     

Composite or amalgam? Not a black or white decision

Amalgam as a restorative material in dentistry is discussed because of believed toxic properties of the material, yet there is no scientific prove for the assumption. Adhesive restorations are a possible alternative for amalgam in restoring posterior teeth. For treatment of primary caries, the direct composite resin restoration has many advantages. When greater defects are to be restored, adhesive composite resin restorations become less favourable. At this moment no long term results are available for indirect adhesive techniques. For the time being it seems necessary to use composite resin as well as amalgam for the restoration of posterior teeth.     

The use of dental amalgam in pediatric dentistry: review of the literature

Dental amalgam is widely used as a restorative material even though it is not esthetic and there has been extensive anti-amalgam rhetoric. Although other materials have improved greatly, amalgam has the proven safety record and best cost-to-benefit ratio. Clinical evidence indicates that, in the posterior permanent dentition--where esthetics is not a primary concern--the small, minimally prepared, amalgam restoration, with its margins and any caries-susceptible fissures sealed with resin fissure sealant, is the restoration with the best survival. Amalgam also remains the best direct restorative option when larger restorations are required. In the primary dentition, the data indicates that resin-based composite and resin-modified glass-ionomer serve very well.     

Dentists' restorative decision‐making and implications for an ‘amalgamless’ profession. Part 1: a review

The Minamata Convention has agreed to a worldwide reduction and ultimate elimination in the production and use of mercury containing products. This will have implications for the practice of dentistry. Australian organizations' pronouncements on the issue are limited and research examining the Australian context dated. The restoration of teeth with direct materials has changed significantly since the 1980s. Up to this time amalgam was the material of choice for direct posterior restorations. Its properties and guidelines for placement were, and remain, well established. Resin composite has replaced amalgam as the material of choice in many clinical situations. Despite inherent clinical disadvantages compared to amalgam, there continues to be a shift toward greater use of resin composite. There is consensus worldwide that the restoration of posterior teeth using resin composite now exceeds that of amalgam. The reasons for this are reviewed in this article along with current evidence and commentary relating to direct restorative and evidence‐based decision‐making, minimally invasive approaches, and approaches to education. The implications for these in an ‘amalgamless’ profession are identified.     

Direct cuspal-coverage posterior resin composite restorations: A case report

The clinical success of direct composite restorations is the result of the correct use and performance of adhesive systems, resin composites and light curing systems. Total-etch adhesive systems and microhybrid resin composites have seen continuous improvement; various clinical techniques have been introduced to address polymerization shrinkage. Manufacturers have introduced sophisticated light-curing devices with the hope of improving performance. Direct resin bonded composites (RBCs) are becoming the first choice in many clinical situations. This article presents an experimental clinical technique that outlines the reconstruction of severely damaged posterior teeth missing multiple cusps; particular attention to incremental and curing techniques is adopted to complete each restoration.     

Trends in material choice for direct restorations by final year students from University College Cork 2004-2009

Traditionally, undergraduate students in University College Cork (UCC) have been taught to use amalgam as the first choice material for direct restoration of posterior cavities. Since 2005 the use of composite resins has replaced amalgam as the first choice material. An audit was conducted of all direct restorations placed by final year students from UCC from 2004 until 2009. Results showed that over a six year period, final year UCC dental undergraduate students placed proportionately more direct composite resin restorations and significantly fewer amalgam restorations. The need for and undergraduate exposure to, provision of amalgam restorations may have to be revisited.     

Resin composites in minimally invasive dentistry

The concept of minimally invasive dentistry will provide favorable conditions for the use of composite resin. However, a number of factors must be considered when placing composite resins in conservatively prepared cavities, including: aspects on the adaptation of the composite resin to the cavity walls; the use of adhesives; and techniques for obtaining adequate proximal contacts. The clinician must also adopt an equally conservative approach when treating failed restorations. The quality of the composite resin restoration will not only be affected by the outline form of the preparation but also by the clinician's technique and understanding of the materials.     

间接法树脂高嵌体修复磨牙残冠的临床评价

目的:评价间接法树脂高嵌体修复磨牙残冠的临床效果。方法:分别应用HRi美塑树脂通过间接法制作树脂高嵌体和直接法树脂充填修复68颗磨牙残冠的邻牙合面龋损,分别在修复后6、24、36个月随访,对边缘密合、邻接关系、牙周健康及修复体完整性等临床修复效果进行统计学分析并给予评价。结果:第6个月时两组无差别;第24个月时,两组除了在邻接关系方面嵌体组要优于直接组外(P<0.05),其余方面并没有明显差别;但在36个月时,用间接法树脂高嵌体修复的患牙在边缘密合、邻接关系及牙周健康方面与直接法修复有显著性差异(P＜0.05)。结论:应用间接法树脂高嵌体修复磨牙残冠能获得更好的临床修复效果,更能符合不同层次患者的功能及美学需求。     

A polychromatic composite layering approach for solving a complex Class IV/direct veneer-diastema combination: part I.

Direct resin bonding represents a conservative means of providing aesthetic restoration of the anterior dentition. Such techniques enable chairside control of colors, morphology, and ultimately, aesthetic results. For optimal integration, the clinician must thoroughly understand the capabilities of resin materials and their behavior when layered in direct resin buildups. This article demonstrates an advanced clinical technique for enhancing the appearance of the anterior dentition as achieved via tooth whitening and a combination of a Class IV restoration and a direct resin veneer     

Modified technique for vital bleaching of teeth pigmented by amalgam: a case report

The aim of this study was to describe a technique and report the success of a clinical case in which a modified technique of in-office bleaching with hydrogen peroxide at 35% was performed for two sessions in a premolar pigmented by amalgam followed by placement of a posterior direct composite resin restoration.     

Cariostatic and ultraconservative sealed restorations: six-year results.

The objective of this clinical study was to determine the ability of an ultraconservative, sealed composite resin restoration, without a traditional cavity preparation and without the removal of the carious lesion, to arrest Class I caries. Tooth preparation was limited to placing a bevel in the enamel. These restorations were compared, over 6 years, with (1) ultraconservative, localized, sealed amalgam restorations with no extension for prevention and (2) traditional, unsealed amalgam restorations with the usual extension for prevention outline form. Caries was arrested by the ultraconservative, sealed composite resin restorations for 6 years. Complete sealant retention on the sealed amalgam restorations was somewhat lower than that on the sealed composite resin restorations; conversely, partial sealant retention was higher for the sealed amalgam group. The marginal integrity of the sealed amalgam restorations was significantly superior to that of the unsealed amalgam restorations. The sealant also protected Class I posterior composite resin restorations against wear.     

Long-term cost-effectiveness of single indirect restorations in selected dental practices

OBJECTIVE: To determine the relative cost-effectiveness of alternative methods for restoring large tooth substance loss in adults. METHODS: Long-term survival estimates and discounted costs for 245 large indirect restorations were used to calculate their incremental cost-effectiveness over 15 years when compared with direct placement Class II cusp-overlay amalgams and Class IV multisurface resin composites, placed in 100 patients from three private dental practices. RESULTS: The direct placement restorations were more cost-effective than the indirect restorations at all time intervals over the 15-year study period. The full gold crown and the ceramometal crown were the most cost-effective indirect posterior and anterior restorations respectively. The cast gold onlay and the porcelain jacket crown were the least cost-effective indirect posterior and anterior restorations respectively. CONCLUSIONS: When clinically practicable, large direct placement restorations should be placed initially in preference to indirect restorations.     

Preparation forms and filling techniques for posterior composite restorations

The operator is a very important factor in achieving high quality posterior composite resin restorations. Specific clinical procedures are required to obtain a clinical successful restoration. Tooth saving preparations are made when primary caries is treated. However, tunnel preparations have major disadvantages. The application of a liner or base under a composite restoration is not required anymore since it does not improve the marginal seal when using an total-etch adhesive. The handling and application of the composite should be done with an injection technique and in layers, whereas low viscous composites are giving the best results in preventing voids.