Flowable resin composite as a class II restorative in primary molars: A two-year clinical evaluation

Objective. To evaluate the clinical durability of flowable resin composite and resin-modified glass ionomer cement when used as class II restoratives in primary molars. Material and Methods. A total of 190 restorations were placed in 61 children, age in the range of 5–11 years. The restoratives, Tetric Flow, in combination with the adhesives, Excite or Prompt-L-Pop and Vitremer, were used in class II cavities in primary molars. An intra-individual study design was used and the restorations were evaluated by modified USPHS criteria over a 2-year period. Results. 146 of the restorations could be evaluated at 2 years. The cumulative failure rate was 10.6% for Vitremer and 13.6% for Tetric Flow. No statistically significant differences were found in failure rates between different materials or between bonding systems. The main cause of failure for Tetric Flow was secondary caries and for Vitremer wear and dissolution. Conclusions. Vitremer and Tetric Flow showed no significant difference concerning clinical durability at 2 years when used as class II restoratives in primary molars. Both materials demonstrated acceptable clinical results.     

Clinical and radiographic assessment of Class II esthetic restorations in primary molars

PURPOSE: The aim of the study was to access the clinical performance of two esthetic materials (Vitremer and Z100 + Scotchbond Multipurpose) when used as Class II restorations in primary molars, and compare them to amalgam controls. METHODS: A total of 102 restorations were placed in primary molars of 29 schoolchildren; 40 were of Vitremer, 38 of Z100 + Scotchbond Multipurpose, and 24 of amalgam (Dispersalloy). The restorations were evaluated clinically at baseline and after 6, 12, 18, 24 months, or until tooth exfoliation or patient drop-out, following the modified Cvar and Ryge criteria. Radiographs were taken at yearly intervals, and the radiograph of the last examination available was assessed and scored. RESULTS: The majority of the restorations examined clinically up to 18 months was good (Alpha according to Cvar and Ryge), and no statistically significant differences between the groups was observed. However, at the 19-24 months evaluation, Z100 rated better than Vitremer for surface appearance and color match. The prevalence of radiolucent defects at the cervical margin for the Z100 (47%) was significantly higher than for amalgam (11%) restorations (P = 0.002) and for Vitremer (13%) restorations (P = 0.008). CONCLUSION: The three materials evaluated (Vitremer, Z100 and Dispersalloy) presented satisfactory clinical performance during the time evaluated (approximately 2 years). Approximately half of the composite resin restorations presented radiographic defects that might require replacement at a later date. In contrast, glass ionomer and amalgam restorations presented significantly less radiographic defects at the time of the final examination. This study suggests that composite resins are indicated for classII restorations in primary molars that are expected to exfoliate within two years.     

Conventional versus resin-modified glass-ionomer cement for Class II restorations in primary molars. A 3-year clinical study

Summary. Objective. To compare the clinical performance of two glass‐ionomer cements (GICs)for Class II restorations in primary molars: a conventional cement (Fuji II®) and a resin‐modified cement (Vitremer®). Design. Split mouth and random assignment to the two materials were used for the majority of the molars. Sample and methods. Forty consecutive 4–7‐year‐old children were included. One operator made 115 restorations: 53 with Vitremer and 62 with Fuji II. The restorations were evaluated clinically, radiographically and from colour photographs. Results. The cumulative success rate of the Vitremer restorations was 94% and that of the Fuji II restorations 81%. The difference is statistically significant. The risk of a failed restoration was more than five times higher with Fuji II than with Vitremer as the restorative material. Of the 13 unsuccessful restorations, seven had lost their retention, four had secondary caries, and two were fractured. Conclusions. The resin‐modified GIC offered advantages over the conventional GIC for restoring approximal caries in primary molars.     

Three-year results of a randomized controlled clinical trial of the posterior composite QuiXfil in class I and II cavities

This longitudinal randomized controlled clinical trial evaluated direct composite restorations for clinical acceptability as posterior restoratives in single- or multi-surface cavities and provides a survey of the 3-year results. Three dentists placed 46 QuiXfil (Xeno III) and 50 Tetric Ceram (Syntac Classic) composite restorations in stress-bearing class I and II cavities in first or second molars (43 adult patients). Clinical evaluation was performed at baseline and after 3 years by two other dentists using modified US Public Health Service criteria. At the last recall period, 40 QuiXfil and 46 Tetric Ceram restorations were assessed. A total of 92.5% of QuiXfil and 97.8% of Tetric Ceram posterior composites were assessed to be clinically excellent or acceptable with predominating alpha scores. Up to the 3-year recall, three QuiXfil restorations failed because of bulk fracture, partial tooth fracture, and postoperative symptoms. One Tetric Ceram restoration was lost due to problems with tooth integrity. No significant differences between both composites could be detected at 3 years for all evaluated clinical criteria (p > 0.05). The comparison of restoration performance with time within both groups yielded a significant increase in marginal discoloration (p = 0.007) and deterioration of marginal integrity (p = 0.029) for QuiXfil and significant increase in marginal discoloration (p = 0.009) for Tetric Ceram. However, both changes were mainly effects of scoring shifts from alpha to bravo. Clinical assessment of stress-bearing QuiXfil and Tetric Ceram posterior composite restorations exhibited for both materials good clinical results with predominating alpha scores.     

The influence of composite resin restorations and lining on radiographic diagnosis and decision-making: an in vitro investigation

The objective of this study was to evaluate the influence of resin-based restorations on the interpretation of digital and conventional radiographic images and to correlate the proposed diagnosis with decision-making. Class II cavities were prepared in one of the proximal surfaces of extracted human molars. Teeth were divided into five groups (n = 10) according to the restoratives used: Natural Flow (NF) and Filtek Supreme (FS); Filtek Flow (FF) and FS; Tetric Flow (TF) and FS; Protect Liner F (PLF) and FS; and FS alone. Bitewing radiographs were taken using conventional and digital systems. Subjective analysis was performed for each surface: no restoration; restored teeth; or restored teeth with gap. Based on the given diagnosis, clinical conduct was then indicated. Material radiopacity was determined according to ISO 4049. A Fisher exact test evaluated the influence of the restoratives on the diagnosis. Means were compared using ANOVA and the Games-Howell test. A Friedman test was used to analyze the influence of the systems on the diagnosis, and a binomial test was used to analyze the association between the presence of gaps and the decision to replace the restoration (P = 0.05). For each system, TF+FS was significantly associated with a high percentage of correct diagnoses. The opposite was the case for PLF+FS, which differed from all other groups. Radiographic systems presented similar behaviors, except for NF+FS. Apart from PLF, adequate radiopacity was observed. Diagnosis was influenced by restorative materials, regardless of the radiographic system used. The low radiopacity of PLF led to a greater number of erroneous diagnoses. Moreover, the decision-making process was influenced strongly by the given diagnosis.     

Three-year clinical evaluation of direct and indirect composite restorations in posterior teeth

STATEMENT OF THE PROBLEM: Objective long-term clinical data are necessary to assess the performance of modern posterior composites as direct and indirect restorations. PURPOSE: This prospective, long-term clinical trial evaluated direct and indirect composite restorations for clinical acceptability as posterior restoratives in single or multisurface cavities and provided a survey on the 3-year results. MATERIAL AND METHODS: Under the supervision of an experienced dentist, 9 dental students placed 88 composite restorations (Tetric, blend-a-lux, Pertac-Hybrid Unifil), 43 direct composite restorations, and 45 indirect inlays. Clinical evaluation was performed at baseline and in yearly intervals after placement by 2 other experienced dentists, using modified USPHS criteria. A third follow-up of 60 restorations took place within 33 to 36 months after placement. RESULTS: A total of 93% of indirect and 87% of direct restorations were assessed to be clinically excellent or acceptable. During the third year, 1 direct restoration in a molar failed because of margin opening. Indirect inlays exhibited a significantly better anatomic form of the surface than direct composite restorations. Premolars revealed a significantly better marginal integrity and anatomic form of the surface than molars. Restorations in molars exhibited a significantly higher failure rate compared with premolars. CONCLUSION: Posterior composite restorations provided a satisfactory clinical performance over a 3-year period, even if placed by relatively inexperienced but supervised students.     

Effects of flowable composite lining and operator experience on microleakage and internal voids in class II composite restorations

STATEMENT OF PROBLEM: When inexperienced clinicians perform class II composite restorations, improper placement techniques can lead to problems, including marginal adaptation and void formation. PURPOSE: The aim of this study was to determine the influence of flowable composite linings on marginal microleakage and internal voids in class II composite restorations performed by practitioners with different levels of experience. MATERIAL AND METHODS: Eighty extracted molars were prepared with mesial and distal class II cavity preparations and divided into 4 groups. Each group was restored separately with the following materials: Prodigy/Revolution lining (group I), Prodigy (group II), Tetric Ceram/Tetric Flow lining (group III), and Tetric Ceram (group IV). Each group was equally divided and restored by 2 practitioners, one experienced and another untrained in composite restorations. After restoration, all teeth were stored for 24 hours, thermocycled (at 5 degrees C to 60 degrees C) 1500 times, and soaked in 2% basic Fuchsin dye for 24 hours. After soaking, the teeth were sectioned, and gingival marginal microleakage and internal voids (at the gingival wall interface and in the cervical and the occlusal parts) were recorded. Data were analyzed with the Kruskal-Wallis test. RESULTS: There was no significant reduction in microleakage for either practitioner. There were fewer interface voids within pairs with or without flowable composite linings made by the experienced practitioner (P<.05). CONCLUSION: When flowable composite lining was placed at the gingival floor of a class II composite restoration by an experienced practitioner, voids in the restored interface were reduced. Gingival marginal sealing was not improved by the same technique.     

Clinical behaviour of glass ionomer restorations in primary teeth.

OBJECTIVE: To compare a silver-reinforced glass ionomer material (cermet) with a resin-modified glass ionomer in minimal Class II preparations in primary teeth. METHODS: Matched pairs of primary molars with approximal caries that required operative treatment were used. Each cavity was filled with either Vitremer or Ketac-Silver. The restorations were followed for at least 36 months and examined annually using bitewing radiographs and clinical inspections. Impressions were taken at each recall and models were examined microscopically. RESULTS: After 36 months, one of the resin-modified glass ionomer (RMGI) restorations and 13 (26.5%) of the silver cermet restorations had failed. The RMGI failed because of secondary caries, while most of the failures of the silver cermet fillings were marginal defects alone or in combination with secondary caries. The median survival time (MST) for the silver cermet restorations was 37 months. The RMGI restorations had a MST exceeding 42 months, but MST could not be calculated exactly because of the low failure rate during the study period. CONCLUSIONS: The resin-modified glass ionomer had the overall best performance of the two materials under comparison. The silver cermet material cannot be recommended for Class II restorations in primary teeth.     

One-year clinical evaluation of tooth-colored materials in non-carious cervical lesions

The purpose of this study was to assess the clinical performance of bonded composite (Excite/Tetric Ceram - Vivadent) versus a resin-modified glass ionomer cement (Vitremer - 3M) for restoring non-carious cervical lesions. A total of 70 restorations (thirty-five per material) were placed in 30 patients, 18-50 aged, by one operator. Rubber dam was employed in all cases, lesions were pumiced, enamel margins were not beveled, and no mechanical retention was placed. The restorations were directly assessed by two independent evaluators using modified-USPHS criteria for six clinical categories. The ratings for clinical acceptability restorations (alfa plus bravo) were as follows (Tetric Ceram/Vitremer): retention (86%/100%), marginal integrity (100%/100%), marginal discoloration (100%/100%), wear (97%/100%), postoperative sensitivity (100%/100%) and recurrent caries (100%/100%). Statistical analysis was completed with Fisher's exact or Pearson Chi-square tests at a significance level of 5% (P<0.05). Results showed that almost all restorations were clinically satisfactory with no significant differences between materials groups. Five restorations of Excite/Tetric Ceram failed. No restorations of Vitremer have yet failed.     

Clinical evaluation of a resin composite and bonding agent in Class I and II restorations: 2-year results.

OBJECTIVE: The purpose of this study was to evaluate the clinical performance and longevity of Tetric Ceram and Syntac Sprint restorations in stress-bearing areas performed in general practice. METHOD AND MATERIALS: The light-curing resin composite Tetric Ceram in combination with the bonding material Syntac Sprint were used as restorative materials in three public dental health clinics. All the restorations were done by general practitioners in an ordinary patient pool attending a public health clinic. Before starting, the general practitioners were instructed and trained in performing the restorations according to a standardized clinical procedure, and the evaluations were done according to United States Public Health Service criteria. One hundred forty-eight restorations (27 Class I, 121 Class II) were done in 123 patients. After 2 years, 140 restorations (95%) could be assessed. Color slides and bitewings were taken to supplement the clinical evaluations of color match, marginal discoloration, secondary caries, and marginal adaptation. Wear of the restorations was evaluated according to the Leinfelder method. RESULTS: After 2 years, 7 out of 148 restorations had failed, giving a failure rate of 5% of the tested materials. Five restorations failed due to hypersensitivity, one to secondary caries, and one to fracture. The wear rate was low (mean 37 microm) and did not result in any replacement. CONCLUSION: This 2-year study showed that clinically satisfactory results could be obtained using resin composite Class I and II restorations in stress-bearing areas done in general practice on an ordinary clientele when the clinical procedure is standardized.     

Effect of resin-based material combination on the compressive and the flexural strength

The mechanical properties, elasticity and compressive strength, of restorative materials play a crucial role during mastication for clinical performance of materials in particular stress bearing areas at posterior regions. This in vitro study was objected to evaluate the changes in the compressive and flexural strength of tooth-coloured resin-based dental restorations placed on flowable composites. Specimens in the control group were produced in cylindrical form for testing compressive strength and in quadrangular prism form for flexural strength test. Tetric Ceram, Charisma, Surefil, Admira and two compomers; Dyract AP and Compoglass F in test group specimens were fabricated by placing the control materials on different flowables. The material combinations were as follows: Tetric Ceram/Tetric Flow Charisma/Flowline, Surefil/Dyract Flow, Admira/Admira Flow, Dyract AP/Dyract Flow, Compoglass F/Compoglass Flow. Compressive strength values were measured at the Instron Testing Machine with a cross-head speed of 10 mm min(-1) while flexural strength were determined in three-point bending with a cross-head speed of 1 mm min(-1). One-way anova and Tukey's multiple comparison tests were performed for the statistical analysis. The flexural strength values of Tetric Ceram/Tetric Flow (135.9 +/- 3.2), Charisma/Flowline (120.4 +/- 5.6) and Compoglass F/Compoglass Flow (108.2 +/- 5.2) combinations were statistically greater than Tetric Ceram (110.8 +/- 10.5), Charisma (95.3 +/- 5.3) and Compoglass F (86.9 +/- 4.9). The results of the present study support the idea that the placement of flowable composite as a liner under the resin-based composite restoratives increase the flexural strength.     

Clinical evaluation of the bulk fill composite QuiXfil in molar class I and II cavities: 10-year results of a RCT

Objective

The objective of this RCT was to compare the 10-year clinical performance of QuiXfil with that of Tetric Ceram in posterior single- or multi-surface cavities.

A clinical evaluation of resin-based composite and glass ionomer cement restorations placed in primary teeth using the ART approach: results at 24 months

BACKGROUND: The authors evaluated the 24-month performance of a packable resin-based composite/dentin bonding system and a high-viscosity glass ionomer cement (GIC) in restorations placed in primary molars with the atraumatic restorative treatment (ART) approach. METHODS: Three dentists placed 419 restorations in 219 children aged 6 through 10 years who had bilateral matched pairs of carious posterior Class I and II primary teeth. They used a split-mouth design to place the two materials, which were assigned randomly to contralateral sides. The authors evaluated the restorations according to U.S. Public Health Service Ryge criteria. RESULTS: After 24 months, 96.7 percent of the Class I GIC restorations and 91 percent of the resin-based composite restorations survived, while the success rates for the Class II restorations were 76.1 percent and 82 percent for the GIC and resin-based composite restorations, respectively. The survival rate of the Class II resin-based composite restorations was 5.9 percent higher than that of the GIC restorations at the 24-month evaluation, but this difference was not statistically significant. However, the study results showed a statistically significant difference in survival rates between Class I and II restorations for both materials. CONCLUSION AND CLINICAL IMPLICATIONS: The two-year clinical performance of both materials was satisfactory for the restoration of Class I and II primary molars using the ART approach.     

Posterior composite restorations in primary molars: an in vivo comparison of three restorative techniques

This in vivo study evaluated the clinical performance of class II restorations, in primary molars after 12 months. Three restorative techniques were used: filling the cavities in bulk; filling with three horizontal increments and placement in three horizontal increments using pre-polymerized composite inserts. The composite resin used was Prisma TP.H (Caulk-Dentsply) with the adhesive system ScotchbondMultipurpose (3M). Initially 90 class II restorations were placed in 27 patients from 8 to 10 years of age and followed-up for 12 months. After this period 55 restorations were evaluated for anatomic form, color alterations at the margins, presence of decay and marginal adaptation. The results showed that all groups presented similar rates of wear, the bulk insertion technique showed better results for marginal adaptation, color alterations of the margins and less presence of caries at occlusal margins, and that composite resin TP.H could be used in class II restorations in primary molars.     

Clinical evaluation of a compomer and an amalgam primary teeth class II restorations: a 2-year comparative study

PURPOSE: This study was performed to compare the clinical performance between the compomer F2000 and amalgam Dispersalloy in Class II restorations in primary molars over a 2-year period. METHODS: Seventy-five amalgam and 75 compomer restorations were placed in 75 children based on a split-mouth design. The restorations were evaluated after 1 week and after 6, 12, 18, and 24 months of oral function. The evaluation consisted of a clinical assessment according to modified Ryge criteria, a radiographic examination using bite-wing radiographs, and an observation of epoxy casts under scanning electron microscopy. RESULTS: The results showed statistically significant differences in the marginal adaptation and anatomic form between amalgam and compomer restorations. A higher number of compomer restorations were rated as Bravo, while a higher number of amalgam restorations were rated as Alpha at 24 months. Significant differences in the failure of the restoration and development of secondary caries were not found between the materials. CONCLUSIONS: The use of compomer F2000 in Class II resorations in primary molars, although it presents a significantly higher number of restorations rated as Bravo regarding the marginal adaptation and anatomic form vs the amalgam, does not increase the risks of developing secondary caries and failure of the restoration over a period of 2 years.     

Two-year evaluation of a new nano-ceramic restorative material

The purpose of this prospective study was to evaluate the clinical performance of a new restorative material (Ceram·X) in combination with a new primer–adhesive (K-0127). One operator placed two Class I or II restorations in molars of 43 patients. One molar was restored with Ceram·X/K-0127, the other one with Tetric Ceram/Syntac Classic. At baseline, after 1 and 2 years, the restorations were evaluated by one evaluator using modified Ryge’s criteria. After 2 years, 31 patients were examined. One Ceram·X-restoration had to be removed for root canal treatment due to pulpitis. Thus, failure rate of Ceram·X was 3.2% and of Tetric Ceram, 0%. In both groups, no sensitivity, no recurrent caries, and no changes in surface texture were recorded after 2 years. One restoration in each group showed slight changes in color stability (score B). Marginal discoloration (score B) was found concerning three Ceram·X-restorations (10.0%) and two Tetric Ceram-restoration (6.5%). Marginal integrity was score B for four Ceram·X-restorations (13.3%) and for four Tetric Ceram-restorations (12.9%). No statistically significant differences were found (p>0.05). After 2 years of clinical service, 96.8% of Ceram·X/K-0127 and 100% of Tetric Ceram/Syntac Classic restorations were in place and performed clinically well.     

The teaching of Class I and II restorations in primary molars: a survey of North American dental schools.

PURPOSE: The purpose of this study was to obtain an overview of materials and restoratives techniques taught for Class I and Class II restorations in primary molars in different pediatric dentistry departments in North America. METHODS: A form with response alternatives was mailed to 63 dental schools in the United States and Canada. The forms were addressed to the chairman/undergraduate program director of the department of pediatric dentistry. Questions regarding the restorative materials taught, indications and contraindications for the use of tooth-colored materials and the type of cavity preparation indicated for those materials were among the topics assessed. RESULTS: Eighty-six percent of the dental schools responded to the survey. Amalgam continues to be the material of choice for Class I and II restorations in primary molars, although hybrid composites and compomers are gaining some popularity. When tooth-colored materials were indicated, the slot-type of cavity preparation was the preferred one. CONCLUSIONS: The diversity in teaching may reflect uncertainty related to requirements for optimal restorations of primary teeth. Data from dental schools of other countries may be important to obtain to establish universally accepted criteria and standards for restorative techniques of primary teeth.     

Two-year clinical evaluation of direct and indirect composite restorations in posterior teeth.

STATEMENT OF PROBLEM: Few long-term clinical studies have reported data of modern posterior composites as direct and indirect restorations. PURPOSE: This prospective, long-term clinical trial (1) evaluated direct and indirect composite restorations for clinical acceptability as posterior restoratives in single or multisurface carious teeth and (2) provided a survey on the 2-year results. MATERIAL AND METHODS: Nine dental students placed 88 composite restorations (Tetric, blend-a-lux, Pertac-Hybrid Unifil), 43 direct composite restorations and 45 indirect inlays, under the supervision of an experienced dentist. The first clinical evaluation was performed 11 to 13 months after placement by 2 other experienced dentists, using modified USPHS criteria. A second follow-up of 60 restorations took place within 20 to 26 months after placement. RESULTS: A total of 93% of indirect and 90% of direct composite restorations were assessed to be clinically excellent or acceptable. Two restorations (1 indirect composite inlay and 1 margin of a direct composite restoration) failed during the second year because of fracture. Indirect inlays demonstrated a significantly better "anatomic form of the surface" than direct composite restorations. Premolars revealed a significantly better margin integrity and postoperative symptoms than molars. CONCLUSION: Posterior composite restorations provided a satisfactory clinical performance over a 2-year period when placed by relatively inexperienced but supervised students.     

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.     

Marginal adaptation of direct composite and sandwich restorations in Class II cavities with cervical margins in dentine

OBJECTIVES: The aim of this study was to evaluate the marginal adaptation of direct Class II sandwich restorations with resin-modified glass-ionomer cements and compomers in comparison to base and total bond restorations. For sandwich restorations with a triple cure resin-modified glass-ionomer cement the influence of different light curing techniques was also evaluated. METHODS: Large butt-joint class II cavities with cervical margins 1 mm below the cemento-enamel junction were cut into 120 extracted human molars. The cavities (15 groups, n = 8) were filled using a sandwich, base or total bond technique with materials from five different manufacturers. A three-sited light curing technique was used in 13 groups. For the material combination Vitremer/Z100 two additional groups with a different wand positioning and a metal matrix were evaluated. After water storage for 21 days and thermocycling (2000x, 5-55 degrees C), replicas were quantitatively analysed in the SEM. Statistical analysis was performed with the Kruskal-Wallis test and the Bonferroni test at p < 0.05. RESULTS: The marginal adaptation of vertical enamel margins was not dependent on the restorative technique. For margins in dentine, marginal adaptation was significantly better with the sandwich technique than with a base or total bond technique for all materials. There were no significant differences between the base and total bond technique. Overall, resin-modified glass-ionomer cements showed somewhat better results than compomers in sandwich restorations, though differences were not significant for some criteria. Vitremer/Z100 sandwich restorations applied with a metal matrix showed the highest mean percentage of excellent margins of all experimental groups. CONCLUSIONS: Both resin-modified glass-ionomer cements and compomers can improve the marginal quality when used in a sandwich technique. Further research is necessary to determine the ideal material combination for sandwich restorations.