Four-year clinical evaluation of posterior resin-based composite restorations placed using the total-etch technique

Purpose : To report the 4-year clinical performance of posterior resin-based composite restorations placed using the total-etch technique.
Materials and Methods : Over a period of 1 year, 726 restorations (248 molars, 478 premolars; 260 Class I, 466 Class II; 540 replacements, 186 primary decay) were placed on conservative preparations, using the incremental placement technique in a clinical environment. Baseline data were collected, and the restorations were evaluated after 4 years. Z100 and Scotchbond Multipurpose (SBMP) (3M Dental Products, St. Paul, Minnesota) were used as the restorative system. The criteria evaluated were color match, marginal adaptation, anatomic form, cavosurface marginal discoloration, axial contour, interproximal contact, secondary caries, postoperative sensitivity, and tooth vitality.
Results : At baseline, 24% of the teeth restored presented postoperative sensitivity; 86% of the sensitive teeth were from the replacement group. At 4 years, all teeth were vital to cold test. Eighteen restorations (2.5%) presented clinically detectable marginal fracture. The shade was acceptable in all restorations. Cavosurface marginal discoloration was observed in 47 restorations (6.5% bravo scores). Axial contour, interproximal contact, and marginal adaptation received 100% alfa scores. No secondary caries was diagnosed in any of the teeth examined. None of the examined restorations required replacement.
CLINICAL SIGNIFICANCE
Under controlled clinical conditions, posterior resin-based composite restorations placed with the total-etch technique and restorative Z1OO/SBMP have the potential to present a high success rate at 4 years. None of the examined restorations required replacement, and there was no clinically detectable wear in any of the restorations. Simultaneous etching of enamel and dentin followed by the application of a resin adhesive can be considered an adequate modality of pulp protection in nonexposed tooth preparations.     

Effect of various surface treatments on the microleakage and ultrastructure of resin-tooth interface

This study evaluated the effect of collagen removal and sodium ascorbate treatment of acid-etched dentin on the microleakage and ultrastructure of resin-tooth interface under moist and dry conditions using an acetone-based 1 bottle adhesive system. Class V cavities were made on the buccal surfaces of 90 premolars scheduled for orthodontic extraction. The cavities were etched with 37% phosphoric acid (DPI tooth conditioning gel/India) for 15 seconds. The teeth were divided into six groups with 15 teeth each. In Group 1, the etched surface was blot dried with a dry cotton pellet, leaving it visibly moist, and Prime & Bond NT (Dentsply Detrey/ Germany) was applied. In Group 2, after acid conditioning, the cavity surface was air dried for five seconds, followed by application of Prime & Bond NT. In Group 3, 3% NaOCl (Hyposol, Prevest Denpro Ltd/India) was applied to the acid-conditioned cavity surface for two minutes. The surface was blot dried before bonding. In Group 4, after NaOCl treatment, the surface was air dried for five seconds, followed by application of the bonding agent. In Group 5, 10% sodium ascorbate (chemically pure) was applied to the NaOCl-treated acid conditioned tooth surface for one minute. The surface was blot dried before bonding. In Group 6, after sodium ascorbate treatment as in Group 5, the cavity surface was air dried for five seconds before bonding. The cavities were restored with the hybrid composite Spectrum TPH (Dentsply Detrey, Konstanz, Germany). The teeth were extracted immediately after restoration, and the specimens were prepared for microleakage testing using 2% methylene blue dye and for scanning electron microscopic evaluation. The results of the dye penetration were analyzed with Kruskal-Wallis non-parametric analysis followed by the Mann-Whitney U test at a significance level of p = 0.05. After acid etching, the conventional acid etched groups and groups with NaOCl treatment demonstrated extensive leakage. Sodium ascorbate treatment of the NaOCl-treated dentin significantly reduced microleakage. No statistically significant difference between moist and dry bonding was observed in all groups. Although resin tag penetration improved in both the NaOCl-treated and NaOCl/ascorbate-treated groups, an absence of gap at the resin dentin interface was observed only for the NaOCl/ascorbate-treated groups.     

不同树脂修复黏结界面及表面超微结构研究

目的:研究复合树脂、树脂黏结剂与牙体界面超微结构,评价不同处理以及不同树脂修复方法的效果。方法:选用不同复合树脂、刚拔除的离体磨牙制作试样,在扫描电镜和原子力显微镜下观察分析:A组.Renew直接充填;B组.Renew树脂嵌体;C组.Tescera树脂嵌体。结果:复合树脂Tescera材料的图像特征为结构比较致密,与Renew树脂相比,结构内部的孔隙较少,原子力显微镜图象表明该材料表面的粗糙度很低,表面光滑平整。Tescera树脂可以与树脂黏结剂完全密合、相互渗透,而Renew树脂嵌体材料与树脂黏结剂界面清楚,没有明显的融合渗透现象。结论:经过水、热、光、压力综合处理Tescera树脂材料可以有效地提高材料物理性能,并与黏结剂的界面有更好的融合现象。     

Dentin bonding vs. enamel bonding of composite restorations: a clinical evaluation

The effect of dentinal bonding of composite resins was compared with that of enamel bonding. Two operators placed 192 composite resin restorations using enamel bonding or dentinal bonding on the two types of resin chosen for the study. Patients were recalled at the end of one year and two years. The restorations were evaluated clinically in the following categories: color match, cavo-surface discoloration, anatomical form, marginal adaptation, and recurrent caries. It was concluded for the evaluations that dentin bonding is not as effective as enamel bonding in protecting the composite restoration against cavo-surface discoloration and deterioration in marginal adaptation.     

In vivo evaluation of the biocompatibility of three current bonding agents

The aim of this in vivo study was to evaluate the biocompatibility of three current bonding agents and calcium hydroxide cement. Sixty polyethylene tubes filled with the following materials: Group 1: Prime & Bond NT (PB-Dentsply, US; Group 2: Bond 1 (BO-Jeneric/Pentron, US); Group 3: Optibond Solo (OP-Kerr, US); and Group 4 (control): calcium hydroxide cement - Dycal (CH-Dentsply, US) were implanted into the connective tissue of 30 rats. After 15, 30 and 60 days, the implants were excised and the animals sacrificed. The biopsies were immersed in Karnovsky (pH, 7.2) fixative solution for 48 hours, and processed using routine histological technique. Six-micron-thick sections were cut and stained with hematoxilin and eosin and Masson's trichome technique. Microscopic evaluation was used to compare the connective tissue reactions caused by the experimental and control materials adjacent to the tube opening. At 15 days, the experimental and control materials triggered a moderate to intense inflammatory response which gave rise to a thick capsule adjacent to the tube opening. With time, the inflammatory reaction decreased. At 60 days, the connective tissue adjacent to the bonding agents exhibited a persistent inflammatory response mediated by macrophages and giant cells which were engulfing displaced resin components. On the other hand, for the control group (calcium hydroxide) no inflammatory response associated with a thin capsule adjacent to the material was observed even at the 30-day period. The hard-setting calcium hydroxide cement allowed complete healing and was considered more biocompatible than the bonding agents.     

Effect of fiber-reinforced composite at the interface on bonding of resin core system to dentin

The aim of this study was to evaluate the effect of fiber-reinforced composite (FRC) at the interface on bonding of resin core systems to bovine dentin using different adhesive systems. To this end, the labial surfaces of 60 bovine incisors were ground to obtain flat dentin surfaces and then divided into two groups according to the adhesive system used: total-etching (Solobond Plus) versus self-etching (Clearfil SE Bond). Resin core systems were bonded to tooth structure either without or with a FRC layer (everStick Net, StickTech). For groups with FRC layer, a silicon forming aid was used to adapt the latter on the dentin surfaces. After resin core was polymerized with Optilux 501 for 40 seconds, the specimens were tested in a universal testing machine. ANOVA revealed that presence of FRC at the interface had a significantly positive effect on bond strength (p < 0.001). However, differences between groups were not significant for either adhesive system (p = 0.076) or with the use of silicon forming aid (p = 0.348).     

Hybridization efficiency of the adhesive/dentin interface with wet bonding

Although it is generally proposed that dentin bonding results from adhesive infiltration of superficially demineralized dentin, it is not clear how well the resin monomers seal the dentin collagen fibrils under wet bonding conditions. The aim of this study was to determine the quality and molecular structure of adhesive/dentin (a/d) interfaces formed with wet bonding as compared with adhesive-infiltrated demineralized dentin (AIDD) produced under controlled conditions (optimum hybrid). From each extracted, unerupted human 3rd molar, one fraction was demineralized, dehydrated, and infiltrated with Single Bond (SB) adhesive under optimum conditions; the remaining, adjacent fraction was treated with SB by wet bonding. AIDD and a/d interface sections were stained with Goldner's trichrome; corresponding sections were analyzed with micro-Raman spectroscopy. The histomorphologic and spectroscopic results suggest that, under wet bonding, the a/d interface is a porous collagen web infiltrated primarily by the hydrolytically unstable HEMA.     

Histologic evaluation of the bone/graft interface after mandibular augmentation with hydroxylapatite/purified fibrillar collagen composite implants

Samples of the bone/graft interface were evaluated histologically in five patients 1 year after mandibular ridge augmentation with a composite of hydroxylapatite particles in a matrix of purified fibrillar collagen (HA/PFC). The resulting defects were refilled with HA/PFC after the biopsy specimens were obtained. Histologic examination of the specimens yielded no evidence of purified fibrillar collagen. Hydroxylapatite particles were surrounded by dense fibrous host connective tissue, trabeculae of woven and lamellar bone, or both. HA/PFC was found to be biocompatible with human tissue and receptive to direct bone apposition on the hydroxylapatite particles.     

Clinical evaluation of two posterior composite resins retained with bonding agents

Two hundred thirteen carious cavities were restored with two brands of chemically adhesive posterior composite resins by totally etching both the enamel and dentin walls after removing only the caries detector-stainable tissue and with no mechanical retention form in the cavity preparation. Most cavities were extensive, involving more than two surfaces in 74%. The dentin floor was not covered with cement although a spot lining was placed when the cavity was deep. All restorations were examined, usually after 4 years, by photographs and scanning electron microscope observation of replicas, and by criteria established by the U.S. Public Health Service. The materials and the technique proved to be clinically useful.     

The etched metal/composite resin interface

This study examined the interface between composite resin and two electrolytically etched alloys using different etching times. A new technique allowed this interface to be tested under both tensile and shear loading. The resultant surface morphology of the etched metal was also examined. There was a very large difference in the bond strengths and surface morphologies between the alloys. The bond strength results indicate the sensitivity of this interface to alterations in etching time, and this is also shown in the resultant surface morphology. The clinical significance of these findings is discussed and clinical recommendations made.     

Effect of posterior resin composite placement technique on the resin-dentin interface formed in vivo.

OBJECTIVE: The aim of this study was to evaluate the morphology of the resin-dentin interface formed in vivo with two posterior resin composite placement techniques (incremental and bulk). METHOD AND MATERIALS: After approval from the patients, 12 Class II cavities with margins in enamel (2.5 x 2.5 x 4.5 mm) were prepared in caries-free premolars scheduled to be extracted for orthodontic reasons (n = 6). The cavities were restored with Single Bond + Filtek P60 as a bulk condensable technique or Single Bond + Filtek Z250 as an oblique incremental technique. After 1 week, the teeth were extracted with minimal trauma to the restored area. After the teeth were sectioned, a polyvinyl siloxane impression was taken from the resin-dentin interface to control for artifacts created during preparation for scanning electron microscopy. The specimens were subsequently processed for and observed under a scanning electron microscope to assess gap formation. RESULTS: The mean percentage of gap formation was 6.1% for teeth restored with the incremental placement technique and 18.7% for teeth restored with the bulk placement technique. The difference was statistically significant. CONCLUSION: The incremental placement of posterior resin composites may still provide better seal than the new bulk condensable technique.     

An investigation of the composite resin/porcelain interface.

Failures at composite resin/porcelain interfaces under shear-like loading were examined. Porcelain surfaces were treated with hydrofluoric acid and/or one of two silane coupling agents, using two different composite resin cements. The results showed that after seven days storage, bond strengths of specimens which had undergone porcelain surface treatment were greater than the cohesive strength of the porcelain itself, resulting in brittle fracture of the porcelain. The diluted restorative composite resin performed as well as the commercial composite resin cement. Silane pretreatment of porcelain was important as the bond strength of etched/silane primed specimens was significantly higher than the etched only specimens. However, one primer appeared to be more efficient than the other in bond promotion. Some explanations for the differences in bond strengths are offered.     

Comparison of in vivo vs. in vitro bonding of composite resin to the dentin of canine teeth

Dogs were utilized in a study to compare the bond strengths of dentin bonding agents made to dentin in vivo and then again in vitro in the same teeth 30 min, one day, one week, and one month post-extraction. No statistically significant differences were observed between bonds made in vivo and those made in vitro at any time period. Contamination of the dentin surfaces with blood or saliva lowered the bond strengths, but these could be restored to control values by re-surfacing of the dentin with a bur.     

Strength of posterior composite repairs using different composite/bonding agent combinations.

Posterior composites are becoming a viable alternative to amalgam in selected cases. As the use of posterior composites increases, the necessity of repair of fractured, discolored, or worn restorations will increase. A number of studies have demonstrated that clinically acceptable repairs can be obtained for anterior composites. This study examined the bond strength of repairs made to aged posterior composite substrates when different bonding agent/composite pairs were used. Dentin bonding agent/composite pairs gave the highest bond strengths and were greater than the bond strength of resin to etched enamel. An enamel bonding agent/composite repair gave the lowest bond strengths, which were less than resin/etched enamel bond strengths.     

Morphological study of fiber-reinforced post-bonding system-root dentin interface by evaluation of two bonding systems

Morphological study of fiber post/bonding system/root dentin interface by evaluation of two bonding systems. OBJECTIVES: The aim of the study was to analyze the interfaces, and thus the seal, between root dentin and bonded fiber-reinforced posts. The interfaces were obtained by applying two enamel-dentin adhesive systems, a one-bottle system used after application of phosphoric acid and a self-etch system, both used with an adhesive cement. The interface was evaluated by SEM observation of the continuity of the hybrid layer and the morphology of the resin tags, in terms of length, density and presence of side branches, at the interface between the fiber-reinforced post, the bonding system and the root dentin. METHODS: Twenty-six anterior single-rooted teeth extracted for periodontal reasons were treated endodontically and then randomly separated into two groups of 13 teeth each: group 1: Excite DSC (Ivoclar Vivadent, Liechtenstein); group 2: AdheSE DC (Ivoclar Vivadent, Schaan, Liechtenstein). After preparation of the root canal and application of the adhesive, each specimen received a Postec translucent FRC post (Ivoclar Vivadent, Schaan, Liechtenstein) that was cemented in with Variolink II dual-curing luting composite (Ivoclar Vivadent, Schaan, Liechtenstein). The specimens were then prepared for SEM observation of the continuity of the hybrid layer and scoring of the morphology of the resin tags in each third of the root (at 1, 4.5 and 8mm from the coronal surface). RESULTS: There was no significant difference (at p<0.05) between the two groups in terms of continuity of the hybrid layer or morphology of the resin tags. The hybrid layer was present, unbroken and uniform in both the group where adhesive was used with a phosphoric acid total etch and the self-etch system group. Whatever the bonding system, the resin tags had side branches, and greater length and density in the cervical third than in the middle or apical thirds. Bubbles were found in the cement layer in most of the specimens. CONCLUSIONS: The one-bottle and self-etch bonding systems gave similar results in terms of interface morphology when a translucent fiber-reinforced post was cemented into the endodontically prepared roots.     

Influence of the bonding interface on bracket adhesion

Adhesion strength may be explained by different theories that allow a better understanding and a better use of orthodontic adhesives. Transmission (TEM) and scanning (SEM) electron microscopy analysis of debonding areas allows to differentiate the location of bonding fractures and the consequences on enamel. Such a knowledge may be useful when choosing the most adapted protocol.     

Incremental layers bonding of silorane composite: the initial bonding properties

OBJECTIVES: Lack of oxygen inhibition layer of silorane composite with cationic polymerization raises the question of the bonding of incremental layers of the composite. This study aimed to evaluate the bond strength of the silorane composite layers. METHODS: Fresh, 20 s, 5 min aged silorane composite (Silorane, 3M-ESPE) was used as substrate to adhere new silorane composite. For a comparison, dimethacrylate-based composite resin (Z250, 3M-ESPE) was adhered to the silorane composite with or without intermediate adhesive resin. As a control, dimethacrylate composite with oxygen inhibition layer was attached to fresh dimethacrylate composite. The bonded specimens (n=12/group) were water stored for 24 h. The shear bond strengths (SBS) were measured with a crosshead speed of 1.0 mm/min. Failure modes were assessed. Data were analysed by ANOVA, Tukey's post hoc tests and Chi-square tests (p=0.05). RESULTS: Dimethacrylate-dimethacrylate composite resin combination showed the highest mean SBS (33.0 MPa) values with no adhesive failures. Fresh silorane-silorane SBS was slightly lower (26.7 MPa) and was further decreased by aging the substrate for 20s (25.4 MPa) and 5 min (22.4 MPa). The percent of adhesive failures increased from 25% to 75%, respectively. The failure modes were significantly different (Chi-square, p<0.001). Silorane-dimethacrylate composite showed the lowest (4.0 MPa) SBS among the groups, which was increased significantly by use of phosphate-methacrylate-based intermediate resin (p<0.05). CONCLUSION: In order to bond dimethacrylate composite to silorane composite, a phosphate-methacrylate-based intermediate resin is required. The silorane composite showed slightly lower incremental bonding properties than conventional dimethacrylate composites.     

不同复合树脂对瓷和树脂黏结强度的影响

目的:比较不同光固化复合树脂对瓷和树脂黏结强度的影响。方法:将3种光固化复合树脂黏固于经过表面处理的瓷表面,制成黏结试件,进行剪切强度测试。结果:Charisma、Esthet-X、AP-X三种树脂与瓷之间产生的黏结强度分别为15. 46、36. 39、25. 72MPa。结论:AP-X树脂与瓷之间的黏结性能较好,但对操作技术较为敏感。