Effect of retention grooves on fracture strength of Class 2 composite resin and amalgam restorations

The effect of approximal retention grooves on fracture strengths of class 2 composite resin and amalgam restorations was tested in vitro. Results indicated that retention grooves significantly improved (P less than 0.05) the compressive strength of amalgam restorations (38.6% stronger). For posterior composite resin restorations, there was no significant difference in mean compressive strength of restorations in preparations with and without retention grooves.     

The effect of retention grooves on gingival marginal leakage in class II posterior composite resin restorations

In this laboratory study, the effect of retention grooves in the proximal portion of class II cavities on the marginal microleakage using light-cured composite resin was examined. The retention grooves were placed at the axio-facial and axio-lingual line angles and in the gingival floor of the cavities. The teeth were restored with Herculite composite resin with etching and dentine bonding and polymerized in two different ways: (i) a single mass of restorative material was polymerized all at once; and (ii) incrementally placed amounts of restorative material were each polymerized separately until the cavity was completely filled. Marginal microleakage was evaluated by the degree of dye penetration at the gingival margin of the restorations after suitable thermocycling procedures. It was concluded that marginal microleakage was significantly reduced when the composite resin was placed and polymerized incrementally, and that no advantage was gained from retention grooves with this incremental technique. However, when polymerizing in one single mass of material, retention grooves were found to be necessary in order to reduce marginal microleakage at the gingival wall.     

Amalgam bonding: visualization and clinical implications of adhesive displacement during amalgam condensation

Resin adhesive was visualized in this in vitro study of amalgam bonding using methylene blue dye incorporated into the resin or by scanning electron microscopy. Class II amalgam cavities were prepared in extracted teeth previously stored in buffered formalin. The preparations were then restored following manufacturers' instructions, but included methylene blue dissolved in ethanol into the adhesive resin mixture. This procedure had little effect on the setting time of the resin. Following condensation and carving, excess resin was incorporated into the body of the restorations as well as onto all adjacent coronal surfaces with significant occlusal and proximal accumulations. Resin also accumulated in significant amounts on the gingival floor of the proximal box and at line angles and retentive grooves within the preparation. In conclusion, radiological studies demonstrated that artifacts produced by resin accumulation at the gingival floor of the box could be mistaken for an open margin or recurrent caries. Other potential clinical consequences of resin residue on tooth surfaces are discussed, including the problem of interproximal ledges and occlusal discrepancies. The incorporation of a radiopaque material in the resin systems should be a universal requirement.     

Critical appraisal. Class II composite resin restorations with gingival margins in dentin

The rising demand for esthetic restorations has considerably increased the number of direct composite restorations being placed in private practices. While composite resin is often selected primarily for its esthetic qualities, another significant advantage of direct composite restorations is the ability to perform conservative cavity preparations. The traditional configuration used for amalgam restorations is no longer mandatory; thus, more sound tooth structure can be preserved.
The technique of composite placement is complex when compared to amalgam placement. The use of adhesive systems prior to placement of composite restorations requires not only excellent isolation to avoid contamination, but also precise manipulation of the adhesive system. While stable bonds to enamel are routinely obtained, the heterogeneous composition and intricate morphology of dentin makes this substrate more challenging to restore. In addition, the cavity configuration (C-factor) and inherent polymerization shrinkage of composite resin play an important role in the durability of the composite–dentin interface. Class II preparations often have gingival margins in root surfaces because of the location of the caries lesion. Clinicians are then faced with a preparation that is challenging to isolate, has a relatively high C-factor, and relies on optimal bonding to dentin to secure long-lasting marginal integrity. Various restorative techniques, such as incremental placement or the use of an intermediate layer (flowable composite or resin-modified glass ionomer cements—open sandwich technique), have been some of the methods proposed to increase the longevity of composite restorations, especially those with margins in dentin. This review evaluates some of the published research on Class II composite resin restorations with margins in the dentin/cementum.     

Fracture strength of Class I versus Class II restored premolars tested at the marginal ridge. I. Standard preparations

Two groups of maxillary premolars with Class I cavities were prepared with one marginal ridge thickness to a width of 1.0 mm. One group was restored with amalgam and the other group with composite resin. Two groups of Class II cavities also were prepared and restored with amalgam and composite resin. The teeth in the four treatment groups were subjected to a centric load at the marginal ridge until fracture occurred. A two-factor analysis of variance revealed a statistically significant difference between the class of preparation (Class I preparations were weaker than were Class II preparations) but differences in strength between restorative materials (composite resin versus amalgam) and the interaction effect (class of preparation x restorative materials) were not found to be statistically significant (alpha = .05). A Newman-Keuls sequential range test found no statistically significant differences in strength between groups (alpha = .05). Fracture patterns were observed under scanning electron microscope. Fractures extended into the enamel and into the material in the Class I composite resin, Class I amalgam, and Class II composite resin restorations. Fractures extended only into the material in Class II amalgam restorations.     

The benefits of glass ionomer self-adhesive materials in restorative dentistry

Bonded, resin-based composite restorative materials have potential advantages. If the dentin bond achieved is not greater than the polymerization stress, loss of retention is likely, resulting in areas of microleakage and postoperative sensitivity. Class 5 lesions restored with no preparation have been used for testing the clinical performance of new adhesive restorative systems. Laboratory studies have demonstrated that bond strength varies according to the depth of dentin and the degree of calcification. Until the later generations of dentin bonding agents, retention rates for bonded, resin-based composites were typically more erratic and lower than glass ionomer (GI) and resin-modified glass ionomer (RMGI) restorative materials. Providing stress relief during setting is inherent in GI and RMGI materials, which helps to explain their good retention rates, despite their low bond strengths. GI and RMGI liners and lightly filled resin bonding agents provide similar stress relief. Current evidence supports the use of both RMGI and composite restorations placed with a liner of lightly filled resin in adhesive Class 5 restorations. Bonded, resin-based composite has the advantage of finishing to a high-gloss surface, making it more acceptable in areas of the mouth that are highly visible.     

Marginal adaptation of amalgam and resin composite restorations in Class II conservative preparations.

OBJECTIVE: The purpose of this study was to compare and contrast the performance, in terms of marginal adaptation, of a non-gamma-2 amalgam alloy with a compact-filled light-cured composite in the restoration of Class II preparations of conservative design. METHOD AND MATERIALS: Fifty recently extracted teeth were selected for the study. The teeth were restored with either a non-gamma-2 amalgam alloy, Dispersalloy, or a compact-filled resin composite, Z100, using standard techniques. The marginal adaptation of the restorative materials to the proximal surface outline form of each preparation was assessed at magnification x30. RESULTS: Highly significant differences were demonstrated in the mean percentages of perfect margins in all 3 segments of the proximal boxes of the restorations with the resin composite performing significantly better than the amalgam. The percentages of marginal fissuring were significantly higher in the amalgam restorations, except at the cervical margin, where the incidence of fissuring was almost the same for the amalgam and resin composite restorations. The resin composite restorations had significantly fewer underfilled margins than the amalgam restorations. CONCLUSION: In the conservative Class II preparations, the amalgam restorations were of poor quality with respect to marginal adaptation, compared with the resin composite restorations. It is suggested that the use of amalgam as a control in a clinical evaluation of resin composite restorations in conservative preparations cannot be justified, because it is apparently not possible to compare restorations of equivalent initial quality.     

Effect of cyclic loading on the bond strength of class II restorations with different composite materials

This study evaluated the effect of cyclic loading on the bond strength of Class II restorations using different composite materials. Class II preparations with gingival margins located in dentin were performed on the mesial surface of 80 bovine incisors. The teeth were randomly allocated to eight groups (n=10) according to resin composite (Filtek Z250, Filtek Supreme, Tetric Ceram HB and Esthet-X) and use of cyclic loading. The restorations were bonded with the Single Bond adhesive system. Simulated aging groups were cyclic loaded for 200,000 cycles with 80N load (2Hz). The specimens were vertically sectioned (two slabs per restoration) and further trimmed into an hour-glass shape at the adhesive interface to obtain a final bonded area 1 mm2. Samples were placed in an apparatus and tested under tension using a universal testing machine. The data were analyzed using two-way ANOVA and Tukey test with a 95% confidence level. Aged groups presented significantly lower means when compared to the groups that were not aged (p=0.03). However, significant differences among composite materials were not observed (p=0.17). Regardless of the restorative composite material used, it could be concluded that the bond strength of Class II restorations at the gingival wall was affected by simulated cyclic loading.     

The influence of resin composite and bonded amalgam restorations on dentine permeability in Class II cavities in vitro

OBJECTIVES: This study was conducted to measure and compare dentine permeability reduction in Class II preparations, after restoration with resin composite or bonded amalgam, using either a multi-step or one-bottle dental adhesive system. METHODS: An in vitro fluid transport model was used to measure initial dentine permeability in Class II cavities with an intact smear layer in crown segments from extracted human premolars. One week and 3 months after restoration with resin composite or bonded amalgam, using either multi-step or one-bottle dental adhesive system, the measurements were repeated and the reduction in permeability was calculated as a percentage of the initial values. The data were analyzed statistically using a one-way ANOVA and Least Significant Difference tests. RESULTS: After 1 week the resin composite with one-bottle dental adhesive system provided the highest reduction in dentine permeability, whereas after 3 months the bonded amalgam caused the highest reduction. At both time intervals the resin composite with multi-step adhesive system provided the lowest reduction. (P=0.036 at 1 week, P=0.016 at 3 months). After 3-months storage in water a significant increase in dentine permeability reduction was found in the bonded amalgam group only (P=0.017). The reduction in dentine permeability provided by resin composite with one-bottle dental adhesive system and bonded amalgam in Class II cavities was similar at both time intervals. (P=0.182 at 1 week, P=0.750 at 3 months). SIGNIFICANCE: The results of this study indicated that on the basis of reducing dentine permeability in vitro, resin composite restorations with the investigated one-bottle adhesive system was superior to its multi-step equivalent and bonded amalgam can also be preferred in Class II restorations.     

The effect of retention grooves on posterior composite resin restorations: an in vitro microleakage study.

An in vitro study was undertaken to evaluate the effect of retention grooves on the gingival marginal seal of class 2 posterior composite resin restorations when filled by the bulk and incremental techniques. Class 2 cavities were prepared in 40 extracted molar teeth. Retention grooves were prepared at the axioproximal line angles in 20 teeth. The teeth were then filled with Herculite posterior composite resin using the bulk and incremental techniques. Microleakage was assessed by radioisotope (I125) diffusion at the gingival margin, quantitatively by radiation counting on an I125 Gamma Counter and qualitatively by autoradiographs. Those class 2 cavities that were prepared with retention grooves and filled in layers showed the least radioisotope diffusion (a mean radiation count of 1588.5), while bulk insertion of the composite resin in cavities without retention grooves showed the most microleakage (mean count of 6092.4).     

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.     

A comparison of the marginal and internal adaptation of amalgam and resin composite restorations in small to moderate-sized Class II preparations of conventional design.

OBJECTIVE: The purpose of this study was to compare the marginal and internal adaptation of a non-gamma-2 amalgam and an ultrafine compact-filled light-cured composite in small to moderate-sized Class II restorations of conventional design. METHOD AND MATERIALS: Fifty recently extracted human premolar and permanent molar teeth were selected for the study. The teeth were restored with either a non-gamma-2 amalgam alloy or a light-cured resin composite. The marginal adaptation of the restorative materials to the proximal surface outline form of each preparation was assessed. The mean percentages of perfect margins, marginal fissuring, and underfilled margins for the 2 restorative materials were recorded and statistically analyzed. RESULTS: Both materials performed equally well in the buccal and lingual segments of the proximal box. At the cervical margin, the resin composite restorations showed a significantly greater number of imperfect margins and marginal fissuring. The incidence of underfilled margins was low for both restorative materials even at the cervical margin. CONCLUSION: Although there was some cause for concern about the marginal adaptation of the resin composite restorations along the cervical margin, the findings support contemporary teaching that small to moderately sized conventional Class II preparations may justifiably be restored with an appropriate resin composite.     

Reasons for restorative therapy and the longevity of restorations in adults

The aim of this study was to obtain information on the restorative dental care of adults in Finland. A random sample of private dentists was drawn from the register, and in spring 2000 they were sent a questionnaire requesting them to record information for each restoration placed during one ordinary working day. A total of 800 dentists were contacted and 548 responded. The dentists reported placement of 3,455 restorations. Of these, 5% were Class I, 36% were Class II, 13% were Class III, 9% were Class IV, 21% were Class V, and 16% were extensive restorations including 4 or more surfaces. Overall, composite resin was the most common restorative material, and it was used in 79% of the restorations, whereas amalgam was used in 5%, compomers in 4%, and glass ionomers (either conventional or resin‐modified) in 7% of cases. In 5% of the cases, the tooth was restored with indirect restorative methods, using either gold or ceramic materials. Of the treatments, 65% were replacements of previous restorations. Secondary caries was the most common reason for replacement (36%, 52%, and 41% for composite, glass ionomer, and amalgam, respectively). Other common reasons were fractures of the tooth or restoration (23%, 11%, and 22% for composite, glass ionomer, and amalgam, respectively) and lost composite restorations (16%). The median age of failed restorations was 15 years for amalgam, 6 years for composite, and 7 years for conventional glass ionomer. Although the longevity of tooth coloured restorations was shorter than that of amalgam, comparisons with our previous studies indicate improved survival periods for tooth coloured materials.     

Placement and replacement of restorations by selected practitioners

BACKGROUND: There are few Australian data on the reasons for placement and replacement of restorations, and the extent to which these are carried out in general practice. METHODS: A survey was carried out of approximately 100 consecutive restorations placed by each of 28 general dental practitioners. The data were coded and statistically analyzed for various associations. RESULTS: Resin composite was used twice as frequently as amalgam as a restorative material, and nearly four times as often as glass-ionomer cement. Secondary caries was the principal reason for replacing restorations, affecting predominantly amalgam restorations in Class I and Class V cavities. Teeth restored with amalgam fractured nearly twice as often as teeth restored with resin composite. The average ages of amalgam, resin composite and glass-ionomers at replacement were 13.6, 7.1 and 5.7 years respectively. CONCLUSIONS: Amalgam has the longest clinical service life, but is associated with more tooth fracture. Secondary caries is the main reason for replacing restorations. The anti-cariogenic effect of glass-ionomer cement is equivocal.     

Effects of flowable resin on bond strength and gap formation in Class I restorations.

OBJECTIVES: This study measured resin/dentin bond strengths and evaluated gap formation at the pulpal floor of occlusal composite restorations using a flowable resin as a liner with either bulk or incremental placement of the restorative composite. METHODS: Class I occlusal preparations were made in 16 extracted molars, and were randomly divided into two groups for restoration using either One-Step adhesive (OS, BISCO) and Renew composite (RW, BISCO) or OptiBond SOLO adhesive (SOLO, Kerr) and Herculite XRV composite (XRV, Kerr). A flowable resin [AEliteFlo (AE, BISCO) or Revolution (RV, Kerr)] was applied as a liner in half of the specimens of each group. The lined and unlined groups were restored with composite cured in bulk, or cured in 1.5 mm increments. After 24 h in water, the teeth were sectioned into 0.7-mm thick slabs and were examined with an optical microscope (400 x) to determine the presence of internal resin-dentin gaps. The gap-free specimens were trimmed and were subjected to microtensile bond strength testing. Specimens that contained gaps had Knoop hardness of the restorative material measured. RESULTS: All incrementally filled restorations were well adapted to the pulpal floor but nearly all bulk-cured specimens had gaps between the flowable and the hybrid composites. The use of a flowable resin increased the bond strength of OS, but not SOLO. SIGNIFICANCE: The incremental technique prevented gap formation regardless of the use of a flowable resin. In contrast, the use of a flowable composite did not guarantee gap-free restorations or improved bond strength of resin to dentin in bulk-filled restorations.     

In vitro comparison of marginal adaptation of various filling materials. I. Effect of the filling material on marginal adaptation

In a two-month in vitro experiment cervical marginal adaptation was examined in relation to the preparation, filling method and restorative material. Fifty Class II cavities were prepared in fifty extracted sound human premolar and molar teeth extending to the approximal cement-enamel junction. The cavities to receive composite restorations were bevelled at the vestibulo-occlusal and -approximal enamel margins, the other aspects of the cavity enamel and gingival margins at the cement-enamel junction being prepared conventionally. The cavities for amalgam were prepared and filled conventionally. The specimens were cycled in different buffer solutions and temperature, modelling possible variations in the oral environment and examined with SEM. The results were analysed using ANOVA. The best marginal adaptation among the composites was achieved with Charisma, Estilux Posterior, Durafil and Prisma AP. H at the bevelled enamel margins, the worst marginal fit was with Heliomolar and Polofil. It was concluded, that adhesive technique reduces, but does not eliminate marginal leakage.     

Direct placement restorative materials for use in posterior teeth: the current options

The purpose of this paper is to provide guidelines to assist in the selection of dental materials for restoring posterior teeth in adolescents. Currently, amalgam is still the best plastic restorative material for some Class I cavities, and for Class II cavities and all multi-surface restorations. Tooth-coloured materials are preferred by some patients and dentists, however these alternatives are more technique sensitive than amalgam. Composite resin is the most common direct placement alternative to dental amalgam, providing patients with relatively low cost, tooth-coloured restorations. However, composite resins have limited indication, their placement is more time-consuming than for amalgam, cost-benefit considerations are a concern, difficulty in obtaining a marginal seal persists and there are few long-term studies published in the peer reviewed scientific literature. The literature currently supports the use of composite resin for the restoration of a limited range of Class I and Class II cavities. Composite resin restorations are not recommended for MOD or other multi-surface restorations. In selected clinical situations, fissure sealants, preventive resin restorations and glass ionomer cement are also appropriate materials to use to restore posterior teeth. Fissure sealants, when properly maintained, can play a significant role in the prevention and control of dental caries in pits and fissures in primary and permanent teeth. Preventive resin restorations should be placed to restore deep pits and fissures with incipient caries and/or developmental defects in primary and permanent teeth. Glass ionomer cement may be used for restoring Class V cavities where appearance is not the primary concern, for conservative Class III cavities, and as a provisional restorative material. It is not recommended for Class II or IV restorations.     

Overhanging amalgam restorations in young adults attending a periodontal department.

An important factor affecting plaque retention is the presence of amalgam restorations which are poorly contoured at the gingival margin. The aim of the study was to investigate the occurrence and effects of overhanging amalgam restorations in young adults. One hundred patients, aged 20-29 years, referred to the Periodontal Department, School of Dentistry, Belfast were investigated. Bitewing radiographs were used to examine the restorative status of the approximal surfaces of premolar and permanent molar teeth, excluding third molars. Fifty-seven per cent of the patients investigated had at least one amalgam overhang and 27 per cent had three or more overhangs visible on the radiographs. One hundred and seventy-eight (25 per cent) of the restored approximal surfaces had detectable amalgam overhangs. The mean bone level-amelocemental junction (ACJ) distance related to the approximal surfaces with overhangs was 1.77 (s.d. 1.0) mm and 37 (32 per cent) of these surfaces had bone levels which were greater than 2 mm from the ACJ. The mean bone level-ACJ distance for the other approximal surfaces of the teeth with overhangs was 1.63 (s.d. 1.2) mm. The mean bone level-ACJ distance for matching control surfaces on contralateral teeth was 1.86 (s.d. 1.2) mm. It was concluded that overhanging amalgam restorations were common in the restorations of young adults (20-29 years old) referred for periodontal treatment but were not associated with increased levels of bone destruction.     

Five-year study of Class II restorations in permanent teeth using amalgam, glass polyalkenoate (ionomer) cermet and resin-based composite materials

The aim of this study was to compare the clinical performance of an amalgam, a glass polyalkenoate (ionomer) cermet material and a resin-based composite material used in small Class II cavities in permanent teeth. All restorations were inserted under rubber dam. They were examined yearly for 3 years. One clinician continued the study up to 5 years. The clinical examination focused on two criteria: clinically acceptable and failure. In addition, impressions were taken of the prepared cavities immediately before restoration and at each clinical examination using an elastomeric material. The study comprised 274 Class II restorations (88 amalgams, 95 cermets and 91 resin composites) placed in 142 adolescent patients. One hundred and sixty-seven restorations were in molar and 107 in premolar teeth. Patient dropout after 5 years resulted in the loss of 161 restorations, evenly distributed for restorative material and type of tooth involved. Four amalgam restorations, 22 glass ionomer cermet and nine resin composite restorations failed. The glass ionomer cermet and amalgam restorations failed primarily due to bulk fractures, while the resin composite restorations failed due to secondary caries and bulk fractures.     

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.