The clinical performance of a posterior composite resin restorative material, Heliomolar R.O.®: 3-year report

A posterior composite resin restorative material was evaluated over a 3-year period by means of a controlled clinical trial. A total of 52 composite resin restorations and 52 amalgam alloy restorations were included in this trial, and were examined with regard to marginal integrity, surface texture, anatomical form and proximal contact with adjacent teeth. There were no significant differences in clinical performance between test and control materials, which both gave good service over the period of evaluation. Only five restorations (one of amalgam and four of composite resin) failed during the trial. Plastic replica dies were used to support the clinical examinations of the restorations, and such dies were found to be helpful.     

A 5-year study comparing a posterior composite resin and an amalgam

Eighty class I and class II light-cured posterior composite resin restorations were compared with 43 class I and class II amalgam restorations during a 5-year period after placement. The results of this clinical study showed that both materials were satisfactory during the time period and that the only significant statistical differences are a poorer marginal integrity for the amalgam and a greater wear rate for the composite resin.     

Comparison of wear and clinical performance between amalgam, composite and open sandwich restorations: 2-year results

There has been some disquiet over the use of mercury containing restorative materials. The most commonly used alternative is composite resin but this has the potential disadvantage associated with wear and marginal leakage, which in turn, has proven to result in secondary caries and sensitivity. To overcome the shortcomings of a directly placed composite restoration, the glass-ionomer/composite open sandwich technique was introduced followed by the subsequent introduction of compomer systems. The aims of this study were to evaluate the wear and clinical performance of a control group of amalgam restorations compared with that of a group of posterior composite resin restorations fillings and a group of compomer/composite open sandwich restorations placed by a single general dental practitioner. The duration of the study was 2 years. One hundred and thirty three (71.4%) patients were successfully recalled and the wear and clinical performance of each restoration after 6, 12 and 24 months was measured, indirectly. There was no statistically significant difference recorded between the groups at 6 months or 1 year (p > 0.05). However, at the end of the 2-year study, there was a significantly lower rate of wear recorded for the control amalgam restorations compared with other two groups (p = 0.033). There was no statistically significant difference in wear recorded between the two groups of tooth-coloured restorations (p > 0.05). With regards to clinical performance of the restorations, occlusal and proximal contacts in each group of restoration remained satisfactory throughout the study.     

Clinical evaluation of a flowable resin composite in non-carious Class V lesions: two-year results

This in vivo study evaluated the clinical performance and appearance of a flowable resin composite and a hybrid resin composite over two years. Twenty-eight (28) pairs of restorations of a flowable resin composite and a conventional hybrid resin composite were placed in non-carious, asymptomatic facial Class V lesions. The restorations were evaluated at baseline, six, twelve, eighteen and twenty-four (6, 12, 18 and 24) months, using modified Ryge/USPHS criteria. No significant difference (p < 0.05) was observed in the performance or appearance of both materials.     

5-year clinical performance of resin composite versus resin modified glass ionomer restorative system in non-carious cervical lesions

AIM: To comparatively assess the 5-year clinical performance of a 1-bottle adhesive and resin composite system with a resin-modified glass ionomer restorative in non-carious cervical lesions. METHOD AND MATERIALS: One operator placed 70 restorations (35 resin modified glass ionomer restorations and 35 resin composite restorations) in 30 patients under rubber dam isolation without mechanical preparation. The restorations were directly assessed by 2 independent examiners, using modified USPHS criteria at baseline and 6, 12, 24 and 60 months. RESULTS: Twenty-two patients were available for recall after 5 years (73.3% recall rate) and 55 out of 70 restorations were evaluated. Excellent agreement was registered for all criteria between examiners (kappa > or = 0.85). Sixteen composite restorations were dislodged (51.5% retention) and 1 ionomer restoration was lost (96.4% retention). The McNemar test detected significant differences in resin composite restorations between baseline and 5-year recall for marginal integrity (p<0.001) and retention (p=0.004). For resin modified glass ionomer restorations, no significant differences were identified for all criteria (p>0.05). When comparing both materials, the Fisher exact test pointed out significant differences in retention (p=0.002) after 5 years of clinical service. CONCLUSIONS: After 5 years of evaluation, the clinical performance of resin modified glass ionomer restorations was superior to resin composite restorations.     

A four-year clinical evaluation of a highly filled hybrid resin composite in posterior cavities

PURPOSE: To evaluate the four-year performance of a highly filled resin composite in Class II and Class I cavities. MATERIALS AND METHODS: Each of 63 participants received at least one pair of restorations of the same size: one resin composite (Tetric Ceram) and one calcium aluminate cement. Seventy-one pairs were placed. The restorations were evaluated clinically according to slightly modified USPHS criteria at baseline, after 6 months, 1, 2, 3, and 4 years. At 3 years, the calcium aluminate cement material showed an inacceptable clinical cumulative failure frequency of 57% and its evaluation was discontinued. RESULTS: Postoperative sensitivity was reported for 5 restorations (2 resin composite, 3 calcium aluminate cement). At 4 years, a cumulative failure frequency of 7.5% was observed for the resin composite material. Reasons for failure were partial material fracture (2), cusp fracture (2) and endodontic treatment (1). CONCLUSION: An annual failure rate of 1.9% for the resin composite material provided a good clinical performance during the 4-year period, which fulfills the ADA criteria for posterior resin composite materials.     

Clinical evaluation of indirect resin composite and ceramic onlays over a 24-month period

The purpose of this study was to compare the clinical performance of ceramic and indirect resin composite onlays over a 24-month period. A total of 94 onlay restorations in 47 patients were included in this study. Cavities were prepared, full-arch impressions were taken, and onlays were fabricated in the laboratory. All restorations were placed with a dual-cured luting resin composite system. Restorations were evaluated at baseline and at 6, 12, 18, and 24 months. Differences between Alpha scores were analyzed statistically. The recall rate of this study was 93.6%. At the six-month evaluation, one onlay failed due to pulpitis. Other than the color match, there was no significant difference between indirect resin composite and ceramic onlays (p > 0.05). For indirect resin composites, Alpha score differences pertaining to color match, marginal adaptation, and surface texture were found to be statistically significant (p < 0.05) between the baseline and the 24-month recall. For ceramic restorations, marginal adaptation criteria was the only significant difference over the 24-month period (p < 0.05). At the end of 24 months, both indirect resin composite and ceramic onlays were considered to be successful clinically.     

Clinical performance of a nanofilled resin composite with and without an intermediary layer of flowable composite: a 2-year evaluation

The objective of this prospective clinical follow-up was to evaluate the 2-year clinical performance of a nanofilled resin composite in class II restorations. The restorations were made with and without intermediary layer of a nanofilled flowable resin composite studied in an intraindividual comparison. Each participant received at least two, as similar as possible, class II restorations of the nanofilled resin composite. One restoration of each pair (54) was chosen at random to be restored with an intermediary layer with flowable nanofilled resin composite. The other was restored without. The restorations were evaluated with slightly modified US Public Health Services criteria at baseline, 1, and 2 years. Ninety-two restorations, 46 pairs, were evaluated at 2 years. A prediction of the caries risk showed that 22 of the evaluated 48 patients were considered as high-risk patients. Two failures were observed, one in each group, resulting in a 2.2% failure rate. No statistical difference was seen between the restorations restored with and without layer of flowable resin composite. The nanofilled resin composite showed very good surface characteristics and color match, which did not change significantly during the follow-up period. The nanofilled resin composite showed a good clinical performance with a 2.2% failure rate after 2 years. No differences were observed between the restorations with and without the nanofilled flowable resin intermediary layer.     

Evaluation of dental adhesive systems with amalgam and resin composite restorations: comparison of microleakage and bond strength results

A variety of laboratory tests have been developed to assist in predicting the clinical performance of dental restorative materials. Additionally, more than one methodology is in use for many types of tests performed in vitro. This project assessed and compared results derived from two specific laboratory testing methods, one for bond strength and one for microleakage. Seven multi-purpose dental adhesives were tested with the two methodologies in both amalgam and resin composite restorations. Bond strength was determined with a punch-out method in sections of human molar dentin. Microleakage was analyzed with a digital imaging system (Image-Pro Plus, Version 1.3) to determine the extent of dye penetration in Class V preparations centered at the CEJ on both the buccal and lingual surfaces of human molar teeth. There were 32 treatment groups (n = 10); seven experimental (dental adhesives) and one control (copal varnish, 37% phosphoric acid) followed by restoration with either amalgam or resin composite. Specimens were thermocycled 500 times in 5 degrees and 55 degrees C water with a one-minute dwell time. Bond strength and microleakage values were determined for each group. ANOVA and Student-Newman-Keuls tests demonstrated an interaction between restorative material and adhesive system with a significant difference among adhesives (p < 0.05). Using a multi-purpose adhesive system resulted in both a statistically significant increase in bond strength and a statistically significant decrease in extent of microleakage (p < 0.05). The effect of the adhesive upon both microleakage and bond strength was greater in the resin composite restorations than in the amalgam restorations. Bond strength testing was more discriminating than microleakage evaluation in identifying differences among materials.     

The management of occlusal caries in permanent molars. A 5-year clinical trial comparing a minimal composite with an amalgam restoration

A clinical trial comparing the efficacy of an occlusal amalgam restoration with a minimal composite restoration and fissure sealant in the management of occlusal caries in young patients has been performed. One hundred and fifty pairs of restorations were placed in 103 patients and assessed during the 5-year follow-up period. Nineteen restorations failed during this period: 11 amalgam and 8 minimal composite. There was some deterioration in anatomical form and marginal integrity of the remaining amalgam restorations. Of the remaining minimal composites, seven suffered clinically detectable wear and a further five had some marginal staining. Forty-nine of the minimal composites needed to have repairs to the fissure sealant. The amalgam restorations occupied, on average, 25% of the occlusal surface of the tooth, compared with 5% for the minimal composite resin. The results after a 5-year follow-up showed no significant difference in median survival times between the amalgam and the minimal composite restorations.     

Clinical Evaluation of a Nanohybrid and a Flowable Resin Composite in Non-carious Cervical Lesions: 24-Month Results

Purpose: To evaluate the 24-month clinical performance of cervical restorations using a nanohybrid and a flowable resin composite with a one-step self-etching adhesive. Materials and Methods: Twenty-one patients with at least one pair of non-carious cervical lesions participated in this study. A total of 134 non-carious cervical lesions were restored (67 with a nanohybrid resin composite, Grandio; 67 with a flowable resin composite, Grandio Flow) using a one-step self-etching adhesive system, Futura Bond NR, by one dentist. The restorations were evaluated for retention, color match, marginal discoloration, marginal adaptation, surface texture, anatomic form, and secondary caries by two calibrated examiners at baseline and after 6, 12, and 24 months using modified USPHS criteria. The survival rates of the restorations were calculated by the Kaplan-Meier estimator. The comparison of resin composites for each category was performed with the Pearson chi-square test, and the performance of restorations at baseline and after each recall time was evaluated using McNemar's test (p < 0.05). Results: All patients attended the 24-month recall. The retention rates at 6 months were 66% and 58%, and 61% and 57% at 12 months for Grandio and Grandio Flow, respectively. At the 24-month recall, the retention rate was 60% for Grandio and 54% for Grandio Flow. No statistically significant differences were found in retention rates among the restorative materials in any evaluation period (p > 0.05). For marginal discoloration and anatomical form, three Grandio and three Grandio Flow restorations showed Bravo scores at the end of 24 months. The restorations in both groups had Alfa ratings of 100% for the rest of the criteria evaluated. Conclusion: The nanohybrid and flowable resin composites showed similar clinical performances in the restoration of non-carious cervical lesions over 24 months.     

A practice-based,randomized, controlled clinical trial of a new resin composite restorative: one-year results

This study evaluated the performance of a low-shrinking resin composite compared with an amalgam for restoration of Class I and II cavities of moderate size in posterior teeth in a general practice setting. Fifty-two pairs of test and control restorations were placed in 49 patients. Clinical evaluations and assessments of replica models were carried out at baseline, six months and one year. Patients recorded their level of satisfaction with the restorations by means of visual analog scales. Apart from one control restoration that failed due to a fractured cusp, all of the restorations reviewed at six months and one year were intact with no unacceptable scores for any of the evaluation criteria. It was concluded that the resin composite evaluated, when used in conjunction with the recommended adhesive system, may be an appropriate alternative to amalgam in the restoration of posterior teeth over one year in clinical service.     

3-Year clinical evaluation of posterior packable composite resin restorations

This study evaluated the clinical performance of four packable resin composite restorative materials in posterior teeth (Class I and II) compared with one hybrid composite after 3 years. Eighty-four restorations were placed in 16 patients. The tested materials were: (i) Solitaire + Solid Bond; (ii) ALERT + Bond-1; (iii) Surefil + Prime & Bond NT; (iv) Filtek P60 + Single Bond and (v) TPH Spectrum + Prime & Bond 2.1. All restorations were made using rubber dam isolation, and the cavity design was restricted to the elimination of carious tissue. Deeper cavities were covered with calcium hydroxide and/or glass-ionomer cement. Each adhesive system and composite resin was placed according to the manufacturer's instructions. One week later, the restorations were finished/polished and evaluated according USPHS modified criteria. Fourteen patients attended the 3-year recall and 75 restorations were evaluated at that time based on the same evaluation criteria. Friedman repeated measures analysis of variance by rank and Wilcoxon sign-ranked test for pair-wise comparison was used for data analysis (alpha = 0.05). The analysis was performed only for the baseline and for the 3-year period. Solitaire showed some fractures at marginal ridges in 25% of the cases. Solitaire and ALERT showed some concerns related to colour match (43 and 77%, respectively) and surface texture (86 and 77%, respectively). TPH Spectrum showed a great percentage of colour mismatch after 3 years, around 50%. Surefil and Filtek P60 showed an excellent clinical performance after 3 years, similar to the hybrid resin tested, TPH Spectrum. Solitaire did not fulfil the ADA acceptance criteria for restorative materials and, therefore, is not recommended for use in posterior restorations.     

Two-year clinical evaluation of ormocer and nanofill composite with and without a flowable liner

PURPOSE: The aim of this clinical follow-up study was to determine the clinical performance of ormocer and a new nanofill composite material, lined or not lined with flowable composites, after 2 years. MATERIALS AND METHODS: Occlusal restorations (n = 108) were placed in 54 patients with two symmetric restorations per patient. In one of the two restorations in each patient, cavities were first lined with the flowable composite material Admira Flow or Filtek Flow after applying the two-step total-etch one-bottle adhesive (Admira Bond) or single bond adhesive (Single Bond). Admira or Filtek Supreme was then applied. Restorations were examined using the USPHS modified Ryge criteria for retention, color matching, cavosurface marginal discoloration, anatomic form, marginal adaptation, surface texture, and secondary caries by two previously calibrated dentists. The overall performance of the restorations was evaluated by Wilcoxon signed ranks test. The chi-square test was used to determine differences in the performance of the restorations in which the flowable composite was applied first. RESULTS: There was no secondary caries or postoperative sensitivity in any of the restorations at the 6-month, 1-year, and 2-year follow-up examinations. After 2 years, only one Admira restoration had failed; all other restorations were available for evaluation. There were no statistically significant differences among the materials regardless of the prior use of flowable material (p > 0.05). There was no statistically significant difference between the restorations with and without the prior application of flowable materials (p > 0.05). CONCLUSION: The clinical performance of occlusal restorations using ormocer or nanofill composite did not benefit from the additional use of the flowable composite. Both of the restorative materials exhibited ideal clinical performance.     

Retention of a resin-modified glass ionomer adhesive in non-carious cervical lesions. A 6-year follow-up

OBJECTIVES: The purpose of this study was to evaluate the clinical retention of a new resin-modified glass ionomer cement based adhesive combined with a hybrid resin composite or a poly-acid modified resin composite in non-carious cervical lesions during a 6-year period. METHODS: The resin-modified glass ionomer adhesive (Fuji Bond LC), was placed in 73 cervical lesions, 36 with a universal hybrid resin composite (Tetric Ceram) and 37 with a poly-acid modified resin composite (Hytac). Fifty-one in lesions with sclerotic dentin and 22 in non-sclerotic ones. Of the sclerotic lesions 38 were slightly roughened with a diamond bur before conditioning. The restorations were evaluated with slightly modified USPHS criteria every six months during a 6-year period. RESULTS: All except six restorations were evaluated during the 6 years. Twelve (17.9%) were lost, four Tetric Ceram (11.8%) and eight Hytac (24.2%) (p<0.05). Four were found in non-sclerotic lesions (20.0%) and eight in sclerotic lesions (17.0%). The differences between the sclerotic and non-sclerotic and the roughened and non-roughened lesions were not significant. CONCLUSIONS: The resin-modified glass adhesive showed a superior clinical retention combined with the resin composite material, with an annual failure rate of 2%.     

The future of dental amalgam

This paper is a comment on 'The enigma of dental amalgam' by Carl Leinfelder published in 2004 in the Journal of Esthetic and Restorative Dentistry. In that paper a warning is stated against a too abrupt change from amalgam towards resin composite, because this will bring a lot of clinical problems due to the limited skills of todays' dentists in placing posterior composite resin restorations. However, the situation in The Netherlands is different since a gradual changeover from amalgam towards resin composites has taken place during the last decades and dental schools have skipped training in placing amalgam restorations out of the curriculum. Clinical studies on the longevity of amalgam and resin composite restorations placed by dental students and dentists who are experienced in both composite resin and amalgam placement show a comparable and acceptable annual failure rate for those restorations. It is concluded that a gradual changeover from amalgam towards composite resin is preferred to avoid clinical problems.     

Clinical performance of posterior composite resin restorations.

Two formulations of posterior composite resin (P-30 and Bisfil-P) were evaluated and compared to a high-copper, dispersed-phase amalgam (Dispersalloy). One hundred twenty-eight restorations were placed in 27 patients so that each patient received at least one of each material. After 3 years of clinical service, all three restorative materials produced clinically acceptable restorations, according to US Public Health Service and Leinfelder criteria. The amalgam restorations, however, underwent less wear (44 microns) than did the posterior composite resin restorations (60 to 74 microns). Stratification of data by type of tooth, class of restoration, and size of restoration produced the same ranking of wear from lowest to highest: Dispersalloy, Bisfil-P, and P-30. Resin restorations showed 45% more wear in molars than in premolars, and more wear was associated with moderately sized restorations than with conservative restorations. The surface texture of restorations of composite resin with porous strontium glass filler was nearly as smooth as that of enamel and was significantly smoother than that of the restorations of composite resin with zinc glass filler or of unpolished amalgam.     

Clinical evaluation of different posterior resin composite materials: a 7-year report.

OBJECTIVES: The aim of this study was to investigate the clinical performance of 120 posterior composite restorations placed in 38 patients after a period of 7 years. METHOD AND MATERIALS: Eighty-eight Class I and 32 Class II restorations were made (93 molars and 27 premolars) using three different resin composite materials: Z100, Clearfil Ray-Posterior, and Prisma TPH. The restorations were evaluated using Ryge's criteria for color match, marginal discoloration, marginal adaptation, secondary caries, surface texture, and anatomic form at baseline, 1,2, 5, and 7 years. Photographs and radiographs were taken at each recall period. RESULTS: At 7-year recalls, 70 restorations were available for examination. Four restorations had failed due to secondary caries. Saliva sampling was performed to determine the level of mutans streptococci and lactobacilli for the four failed restorations at the last recall. No statistically significant differences were found among the materials in regard to color match, anatomic form, and secondary caries. Clearfil Ray-Posterior had statistically significantly rougher surface texture than the surrounding enamel compared to the other resin composites. Z100 showed more cavosurface margin discoloration after 5 years than the other two resin composites. All materials had slight marginal adaptation problems at the 7-year recall. There was no apparent relationship between the levels of mutans streptococci and lactobacilli in saliva and the failed restorations. CONCLUSION: The three posterior composites tested had acceptable clinical performance after 7 years.     

Three-year clinical evaluation of cuspal coverage with combined composite-amalgam in endodontically-treated maxillary premolars

This clinical study evaluated the clinical performance of cuspal coverage with combined composite-amalgam restorations in endodontically-treated maxillary premolars over a three-year period. Thirty-six maxillary premolars, each with a Class II cavity in 36 patients ranging in age between 28 and 52 years, were selected after endodontic treatment. After reduction of the buccal and palatal cusps, internal coverage and veneering of the reduced buccal cusp was performed with composite. The remaining cavity and reduced palatal cusp were restored with high-copper amalgam. The restorations were evaluated at baseline and in one-, two- and three-year recalls with USPHS criteria. Changes in characteristics of the restorations were analyzed with the Cochran Q-test at a significance level of p < 0.05. Most of the restorations received an overall score of alpha, except two restorations, which showed a slight discrepancy at the composite-amalgam interface after one year (p > 0.05). Four restorations exhibited slight discoloration of the composite veneering after three years (p < 0.05). No restoration exhibited fracture after three years. It was concluded that combined composite-amalgam cusp coverage of endodontically-treated maxillary premolars showed acceptable clinical performance after three years.     

Nine-year evaluation of a polyacid-modified resin composite/resin composite open sandwich technique in Class II cavities

OBJECTIVES: The aim of this study was to evaluate in an intraindividual comparison the durability of a polyacid-modified resin composite/resin composite open sandwich restoration in a 9 years follow-up. A polyacid-modified resin composite (PMRC; compomer, Dyract) was placed as an intermediate layer and covered with resin composite (RC, Prisma TPH). A direct RC restoration was used as control. METHODS: Each of 57 patients, received at least one pair of Class II restorations, one open sandwich and one resin composite control. In total 75 pairs of Class II restorations, 68 premolars and 82 molars, all in occlusion, were placed by two dentists. Most of the cavities were surrounded by enamel. The restorations were evaluated at baseline, 6, 12, 24, 36 months and 9 years by slightly modified USPHS criteria. Survival of restorations grouped on the two different techniques was determined using Kaplan-Meier survival curves. RESULTS: After 9 years, 14 of 135 evaluated restorations were estimated as unacceptable, 6 in the sandwich group and 8 in the control group. Over all annual failure rate during the 9-year period was 1.1%. The survival rate was not significant different between the two techniques (p=0.604). Reasons of failure were: secondary caries (8), fracture of tooth (1), fracture of restoration (2), endodontic treatment (3). CONCLUSIONS: Both restorative techniques showed good durability during the 9-year period. No clinical advantage was observed for the sandwich technique.