Artificial recurrent caries in glass ionomer-lined amalgam restorations

The purpose of this study was to examine artificial recurrent caries when a conventional glass ionomer liner was placed under amalgam restorations. An additional aim was to evaluate the effect of using an unfilled resin with or without etching on the margins of the amalgam restoration. Class V preparations in extracted third molars were used with gingival margins on root surfaces. Ten restorations were used for each of the following groups: 1) Amalgam alone; 2) Two layers of copal varnish and amalgam; 3) Glass ionomer, amalgam; 4) Glass ionomer, amalgam, unfilled resin; 5) Glass ionomer, amalgam, acid-etching, unfilled resin. The teeth were thermocycled and artificial caries were created using a liquid system acidified to pH 4.10 and saturated with HAP but without fluoride. The teeth were sectioned, polished and photographed using polarized light. Areas of recurrent caries were measured using a sonic digitizing pad. The data were analyzed using ANOVA and Duncan's Multiple Range Test. Areas for enamel lesions for the different groups were: 1) 1.29 +/- 0.41; 2) 1.61 +/- 0.49; 3) 0.92 +/- 0.26; 4) 0.87 +/- 0.31; 5) 0.99 +/- 0.39. Root lesions areas were: 1) 2.17 +/- 0.35; 2) 1.90 +/- 0.40; 3) 1.40 +/- 0.27; 4) 0.82 +/- 0.25; 5) 1.34 +/- 0.31. Duncan's groups for root lesions were A = B/ C = D/ and E separately. This study indicates that artificial recurrent caries under amalgam can be reduced with a conventional glass ionomer. An additional benefit was observed when unfilled resin was placed on the cavosurface margins but not when it was acid-etched first.     

Fluoride release from glass ionomer-lined amalgam restorations

This study evaluated the amount of fluoride released from glass ionomer-lined amalgam restorations. 50 human extracted molars were divided into five groups of 10 teeth each. Group 1: No restorations. Group 2: Class V cavities (2 x 2 x 7 mm) were made on the facial and lingual surfaces and restored with Dispersalloy amalgam. Group 3: Same as Group 2 except 1 mm of Ketac-Bond glass ionomer cement (GIC) was placed on the axial wall before amalgam insertion. Group 4: Same as Group 2 except 1 mm of Chelon-Silver glass ionomer cement (GIC) was placed on the axial wall before amalgam insertion. Group 5: Same as Group 2 except 1 mm of Ketac-Silver GIC was used before amalgam insertion. Before any treatment, all samples were placed in polyethylene vials with 4 ml of deionized water and thermocycled (100x) for baseline fluoride release levels. After restoration, each tooth was placed in a vial with 4 ml of fresh deionized water. At weekly intervals, each tooth was removed from its aqueous medium and transferred to another vial containing 4 ml of deionized water. Fluoride release was measured four times at weekly intervals with an Orion #9609 fluoride-ion electrode. At one week, Ketac-Bond released significantly more fluoride than Ketac-Silver (P less than 0.01) which released significantly more fluoride than Chelon-Silver (P less than 0.01). At four weeks, there was no significant difference in fluoride release between Chelon-Silver and Ketac-Silver, but Ketac-Bond released significantly more fluoride than either of the other materials (P less than 0.01).     

Secondary caries related to various marginal gaps around amalgam restorations in vitro

Secondary caries lesions were produced in vitro by immersing human tooth-blocks with amalgam restorations every third day for 4 weeks in glucose- or sucrose-containing broth inoculated with a strain of Streptococcus mutans. The lesions at the cavity walls were related to various standardized micro-spaces (0, 30, 40, 60 and 80 microns) around the restorations. When a thick, sucrose induced layer of plaque covered the margin, dentine caries was found in all cases where a gap was present (30 microns or more). In the presence of a thin, glucose induced layer of plaque, dentine caries was detected only in the specimens with 60 and 80 microns gap-widths. Caries lesions were detected on the outer free enamel surfaces in all specimens. Lesions in the enamel of the cavity walls were observed with polarized light in 46% in the presence of sucrose- and in 21% in the presence of glucose-induced plaque.     

Long-term fluoride release from glass ionomer-lined amalgam restorations.

This in vitro study evaluated the amount of fluoride released from glass ionomer-lined amalgam restorations over a period of 1 year. Class V cavities (2 x 2 x 7 mm) were prepared on the facial and lingual surfaces of 50 extracted human molars randomly distributed into 5 groups: Group 1: No restorations; Group 2: Dispersalloy amalgam alone; Group 3: same as Group 2 except 1 mm of Ketac-Silver was placed on the axial wall before amalgam insertion; Group 4: GC Lining/amalgam; and Group 5: Miracle Mix/amalgam. After restoration, each tooth was thermocycled (100x) at 5 degrees C and 55 degrees C with a dwell time of 30 seconds for baseline fluoride release levels. The teeth were placed in a polyethylene vial containing 4 ml of deionized water. At weekly intervals, each tooth was transferred to a fresh vial. Fluoride release was measured with a fluoride ion specific electrode for 10 consecutive weeks and then again at the end of 1 year. Calibration curves for low level measurements were prepared so the readings could be expressed in micrograms/ml F. At 1 year, fluoride released in micrograms/ml was: Group 1: less than 0.08; Group 2: less than 0.08; Group 3: 0.28; Group 4: 0.68; Group 5: 1.12. An ANOVA was used to evaluate the statistical difference between the groups. At the end of 1 year, measurable amounts of fluoride were recorded for all glass ionomer-lined groups with Miracle Mix and GC Lining releasing significantly more fluoride than Ketac-Silver (P less than 0.002).     

Inhibition in vitro of caries around amalgam restorations by bonding amalgam to tooth structure

Class 5 preparations in human molars were restored with amalgam. In half of the restorations, an experimental resin liner capable of bonding amalgam to tooth structure was used. The restored teeth were incubated in a bacterial medium containing sucrose and a culture of Streptococcus mutans. Artificial carious lesions were produced around all restorations. The experimental liner inhibited penetration of the lesions along the cavity wall. This inhibition was more effective at the occlusal side.     

Streptococcus mutans-induced secondary caries adjacent to glass ionomer cement, composite resin and amalgam restorations in vitro

The aim of this study was to define, in vitro, the potential to inhibit secondary caries of restorative materials currently used in dental practice. Standard cavities were prepared on the buccal and lingual surfaces of fifty extracted human third molars. The teeth were randomly divided into five groups, each one restored with one of the following materials: glass ionomer cement (GIC); amalgam; light-cured composite resin; ion-releasing composite; and light-cured, fluoride-containing composite resin. The teeth were thermocycled, sterilized with gamma irradiation, exposed to a cariogenic challenge using a bacterial system using Streptococcus mutans, and then prepared for microscopic observation. The following parameters were measured in each lesion formed: extension, depth, and caries inhibition area. The outer lesions developed showed an intact surface layer and had a rectangular shape. Wall lesions were not observed inside the cavities. After Analysis of Variance and Component of Variance Models Analysis, it was observed that the GIC group had the smallest lesions and the greatest number of caries inhibition areas. The lesions developed around Amalgam and Ariston pHc restorations had an intermediate size and the largest lesions were observed around Z-100 and Heliomolar restorations. It may be concluded that the restorative materials GIC, amalgam and ion-releasing composites may reduce secondary caries formation.     

In vitro caries related to marginal leakage around composite resin restorations

The histology of caries-like lesions around composite resin restorations with and without marginal leakage has been studied. The lesions were generated from bacterial plaque growing in an in vitro system. Marginal leakage was prevented by an acid etch technique. Ground sections of the experimental teeth were studied by polarized light and microradiography. The caries lesions penetrated along conventional class V restorations with marginal leakage while restorations bonded to an acid etched enamel surface totally prevented this ingrowth.     

In vivo and in vitro evaluations of microleakage around Class I amalgam and composite restorations

This study evaluated and compared microleakage values of in vivo and in vitro placed Class I amalgam restorations with or without three different lining materials and posterior composite restorations with two dentin bonding agents. For the in vivo group, 72 standardized Class I cavities were prepared on the occlusal surfaces of molars scheduled for extraction. The test groups (n = 12) were: amalgam without lining (A), amalgam with cavity varnish (A+C), amalgam with Clearfil SE Bond (A+CSE), amalgam with Clearfil 2V (A+C2V), composite with Clearfil SE Bond (C+CSE) and composite with Protect Bond (C+PB). The restored teeth were extracted after seven days. The same grouping, materials and techniques were used in 72 extracted molars for the in-vitro part of the study. The specimens were immersed in basic fuchsin for 24 hours and sectioned. Microleakage was examined and scored at 20x magnification. Statistical analyses were performed with the Kruskal-Wallis and Mann-Whitney U-tests with the 5% level of significance. Overall, the in vivo and in vitro test groups were not different from each other. No significant differences in microleakage values were observed between the unlined and lined amalgam groups (p > 0.05). However, since lined amalgam restorations did not reveal any marginal leakage, the application of an adhesive bonding material under the amalgam restorations can be considered. In general, cavity varnish was not as effective as adhesive bonding agents in preventing microleakage in amalgam restorations. Composite restorations demonstrated higher leakage values than amalgam restorations (p < 0.05), except for A+C (p > 0.05) in the in vivo group. There was no significant difference between the two composite groups for in vitro and in vivo conditions (p > 0.05).     

Artificial caries formation around fluoride-releasing restorations in roots

Secondary caries is one of the most important factors leading to replacement of dental restorations. This investigation assessed the capacity of fluoride-releasing restorative materials to resist caries in vitro when used in roots. Class 5 cavities were prepared in the buccal and lingual surfaces of 30 extracted premolars. The six materials used were: glass–ionomer cement (Fuji^®), glass–ionomer cement with silver particles added (Ketac-silver^®), fluoride-containing composite resin (Tetric^®), composite resin (Silux plus^®), fluoride-containing amalgam (Fluor-Alloy^®) and high-copper amalgam (Dispersalloy^®). After 5 weeks in an acid gel for caries-like lesion formation, the teeth were sectioned longitudinally and examined with polarized light. The results showed that repair with glass–ionomer materials of a carious lesion may be of great importance in the prevention of secondary caries around the restorations in roots.     

Clinical performance and caries inhibition of resin-modified glass ionomer cement and amalgam restorations

BACKGROUND: The authors clinically examined two restorative materials to evaluate their effectiveness in Class II restorations in primary molars and their ability to inhibit recurrent caries. METHODS: Forty subjects, each in need of two Class II restorations in primary molars, took part in this study. Each patient received one Class II restoration of resin-modified glass ionomer cement and one of amalgam. The authors evaluated the restorations at six-month, one-year, two-year and three-year recall appointments. On exfoliation, teeth with experimental restorations were retrieved and microscopically examined for inhibition of demineralization at restoration margins. RESULTS: The results of the clinical evaluation demonstrated no significant differences between the resin-modified glass ionomer cement restorations and the amalgam restorations (P < .05). Polarized light microscopic examination of the returned teeth that were restored as a part of this study indicated that the resin-modified glass ionomer cement had significantly less enamel demineralization at restoration margins than did amalgam (P < .0001). CONCLUSIONS: The resin-modified glass ionomer cement functioned clinically as well as amalgam for Class II restorations in primary molars. However, the resin-modified glass ionomer exhibited significantly less enamel demineralization at restoration margins than did amalgam. CLINICAL IMPLICATIONS: Resin-modified glass ionomer cement restorative material functions well for Class II restorations in primary molars and exhibits less recurrent caries at restoration margins than does amalgam.     

Combined amalgam and composite restorations

All indirect restorative techniques involving cast metals, ceramics or resin-based materials are expensive compared to directly placed restorations. A restorative technique is presented that combines the esthetic properties of directly bonded resin-based composite material and the wide range of indications for dental amalgam in stress-bearing areas.     

Clinical performance of sealed composite restorations placed over caries compared with sealed and unsealed amalgam restorations

The 2-year clinical evaluations of paired occlusal restorations are presented. Each study participant received a sealed composite restoration placed over a carious lesion and either a traditional outline-form (unsealed) amalgam or an ultraconservative sealed amalgam restoration. Caries was removed before placement of both types of amalgam restorations. No important clinical differences developed among the three groups of restorations.     

An in vitro investigation of marginal dentine caries abutting composite resin and glass ionomer cement restorations

BACKGROUND: There are a number of studies citing the primary reason for replacing auto cure glass ionomer cements was due to recurrent caries. The purpose of this study was to use an in vitro model to measure caries at the dentine restoration interface of bonded composite resin and auto cure glass ionomer cement restorations and to measure the amount of surface degradation occurring in the restorative materials. METHODS: Specimens of auto cure glass ionomer cements (Riva Fast, Fuji IX Fast, Ketac Molar Quick and Fuji VII) and bonded composite resin restorations (Ice, SDI) were placed separately at the dentino-enamel junction of 10 recently extracted human third molar teeth, disinfected and placed into the overflow from a continuous culture of S. mutans for two weeks. Restorations were sectioned and prepared for scanning electron microscopy (SEM) and electron probe microanalysis (EPMA). Restoration tooth interfaces were photographed and the distance from the surface of the teeth to the surface of the restorations measured. EPMA of percentage weights of calcium, phosphorous and fluoride were made outwards from the restoration surface 130pm at a depth of 10 microm below the surface of the dentine. RESULTS: There were significant differences between the surface heights of composite resin, auto cure glass ionomer cements compared to teeth surfaces. Percentage weights of calcium and phosphorus levels were similar to non-demineralized dentine in the auto cure glass ionomer cement samples but there were significant reductions in mineral content of dentine adjacent to bonded composite resin restorations. Fluoride levels were mixed. CONCLUSIONS: This study shows that placing a bonded composite resin restoration into dentine affords little protection to the surrounding tooth from caries attack although insignificant degradation of the restorative surface occurs. Placing a glass ionomer cement restoration into dentine protects the surrounding tooth from caries but degradation of the restoration surface occurs.     

Secondary caries susceptibility of teeth with long-term performing composite restorations

The aim of this study was to assess retrospectively the caries susceptibility of posterior teeth with composite restorations after 18 and 20 years. The sample was selected out of the recall of a dental office. Sixteen restorations were reassessed after 18 and 20 years. All findings have been rated according to the C criteria of the CPM index. For the micromorphological evaluation with SEM, replicas were made using a two-step impression technique. All restorations demonstrated marginal imperfections and a predominant rough surface. At the 18 year-evaluation two restorations exhibited secondary caries. Despite of extended marginal gap formations none of the 12 restorations reexamined at 20 years showed secondary caries. Direct composite restorations can serve over a long period of time despite of poor qualitative parameters. Micromorphological marginal deterioration and clinical gap formation do not necessarily result in a higher risk for secondary caries.     

复合树脂和银汞合金充填体周缘继发龋的细菌组成

目的:研究复合树脂和银汞合金充填体周缘继发龋的细菌组成。方法:充填体周缘继发龋采样,常规培养鉴定。结果:继发龋的主要优势菌为不产黑色素普雷沃菌、产黑色素普雷沃菌等。每组中各种细菌的几何均数之间有显著差异(P<0.05)。每组中各菌种占可培养菌的百分比之间有显著差异(P<0.05)。每组中各菌种的检出率有显著差异(P<0.05)。结论:继发龋的主要优势菌为不产黑色素普雷沃菌、产黑色素普雷沃菌、韦荣菌、乳杆菌、变形链球菌、奈瑟菌,其次为放线菌、核梭杆菌、消化链球菌、牙龈卟啉菌。     

Restorative service patterns in Australia: amalgam, composite resin and glass ionomer restorations

AIM: To examine the provision of amalgam, composite resin and glass ionomer restorations, and to assess whether these main restorative services varied by patient, visit and oral health characteristics. DESIGN: A cross-sectional survey incorporating a log of service items provided on a typical day. SETTING: Australian private general practice. METHODS: Data on services and patients were collected by a mailed survey from a random sample of dentists from each State/Territory in Australia in 1998-99 with a response rate of 71%. MAIN OUTCOME MEASURES: Rates per visit of amalgam, composite resin and glass ionomer restorations among dentate adults who had received a restoration. RESULTS: Analysis showed older patients had lower amalgam rates but higher glass ionomer rates, composite resin rates were lower at emergency visits, capital city patients had higher amalgam rates but lower composite resin rates, patients with decayed teeth had higher amalgam and composite resin rates, and use of restorative materials varied by clinical problem. CONCLUSIONS: Despite widespread use of alternative materials, amalgam rates remained high in circumstances such as replacement restorations and restorations involving more than one surface. Other restorative materials also had specific applications. Both amalgam and composite resins were provided at higher rates to patients with active caries but composite resins were also used at higher rates for aesthetic problems. Glass ionomer restorations were used at higher rates for initial and one-surface restorations, and for conditions such as root caries and dentinal sensitivity.     

Artificial caries around restorations in roots

An artificial caries technique was used to produce caries-like lesions in the cavity walls adjacent to microfilled resin restorations with and without dentin bonding agent, and glass-ionomer cement restorations, in the roots of extracted teeth. The lesions had histological characteristics similar to those of natural lesions and to those of the lesions produced by other experimental methods. The zonal pattern of the lesions was examined by means of polarized light microscopy and microradiography, and the depth of the lesions was measured for assessment of the microleakage around the restorations. Three cavity cleaning regimes-water spray alone, 50% citric acid, and a proprietary cleaner-were compared in conjunction with the three restorative methods. Cavity cleaning with the citric acid or the proprietary cleaner, and the use of a fluoride-releasing restorative material, acted to reduce the depths of the lesions. Glass-ionomer cement restorations in cavities cleaned with citric acid showed lesions significantly shallower than those treated with other restorations. The glass-ionomer cement was soluble in the acidic environment but promoted the precipitation of minerals in the lesions. The use of a dentin bonding agent did not affect the depth of demineralization around the microfilled resin restorations.