Dental materials in pediatric dentistry.

Dental materials for the restorative armamentarium in pediatric dental care continue to improve in esthetics and function. This review describes the application of some contemporary materials and concepts. Fluoride-releasing glass ionomers are appropriate for use as luting cements and as liners and bases. The glass ionomer cements have minimal solubility in oral fluids and possess the capability of inhibiting secondary caries. Amalgam and composite resin are effective for class II restorations, although amalgam placement is considerably less time consuming and less technique sensitive. Composite resins, particularly more highly filled resins, are appropriate for anterior restorative care. The use of ceramic glass inserts may provide strength and decrease restorative time for composite resin restorations in the future. When planning treatment for pediatric dental patients, each patient and restorative material to be used should be evaluated on an individual basis, in order to provide appropriate care within each material's limitations. Pediatric restorative dentistry involves the use of many materials. As materials improve in durability, strength, esthetics, and anticariogenic properties, the concepts of contemporary pediatric restorative dentistry change. Certainly, the traditional principles of restorative dentistry remain practical and significant in the practice of dentistry. Although these traditional concepts are extremely relevant, newer materials allow for modifications to be made during treatment planning in restorative dentistry. This review presents some newer materials and concepts and their applications in current pediatric restorative dentistry.     

Wear of materials used in dentistry: a review of the literature

This is a review of the literature concerning wear related to the following materials used in dentistry: dental amalgam, composite resins, and glass-ionomer cements, as well as natural tooth substance. Discussions are included on both in vivo and in vitro studies in which various methods were used to help determine wear resistance.     

Management of rampant caries in children.

Because research has resulted in a better understanding of the etiology of dental caries as well as the introduction of new techniques and materials in the practice of dentistry, approaches toward the management of rampant caries should be reevaluated. The development of the acid-etching technique and the improvements in the physical properties and clinical performance of composite resins and glass-ionomer cements have completely changed the concepts of prevention, conservative dentistry, and dental esthetics. Several methods for the treatment of rampant caries are described and management of two cases is documented.     

聚酸改性复合树脂的性能及其在口腔中的应用

聚酸改性复合树脂(复合体)是较新的一种牙色修复材料,其组分中不含水,固化方式包括光固化和化学固化两种。复合体具有一定的吸水性和释放氟能力,会影响其机械性能以及在临床中的应用。本文就复合体的组成、吸水性、机械性能、释氟性及临床应用等方面作一综述。     

Alternatives to silver amalgam and resin composite in pediatric dentistry.

Silver amalgam has become a less attractive dental restorative material for restoration of primary teeth. After many decades of scientific and nonscientific controversy, use of silver amalgam for primary teeth is waning, not because of its mercury content but because dentistry has come up with more suitable materials. This article reviews the development and use of glass-ionomer silver-cermet cements, resin-modified glass-ionomer cements, and polyacid-modified resin composites (compomers) for restoration of primary teeth.     

Comparison of the abrasive wear resistance between amalgams, hybrid composite material and different dental cements

This paper reports on the abrasion wear of various restorative dental materials (three amalgams and two dental cements and a hybrid composite material) commonly used in dentistry. The mechanical properties, surface roughness and the volume loss by abrasion were determined for the different materials studied. The results showed a better profile for the amalgams versus the composite materials due to the failure of the polymeric matrix of the latter materials. However, the amalgams exhibited corrosion observed by means of Scanning Electron Microscopy.     

Simplified adhesion of compomers in pediatric dentistry.

A self-etching adhesive agent for bonding polyacid-modified resin-based composite materials ("compomers") to enamel and dentin is now available. The Prompt L-Pop system simplifies and hastens dental bonding procedures and has proved itself useful in many adhesive dentistry applications. This article describes the bonding system and shows clinical examples of its use in children and teenagers. The concept will have further application in adhesive dentistry with introduction of a new formulation of Prompt, to be used with traditional resin-based composite materials.     

Updates in dental materials--Part 1: Dental composites.

Recent years have seen a number of innovations and developments with respect to dental materials and their applications in clinical dentistry. This series of short articles considers the more important aspects of these developments under the general term 'Updates in Dental Materials'. Dental composite systems and bonding to tooth material are discussed in Part 1. Resin cements are treated in Part 2. Part 3 presents dental amalgams and Part 4 advances in ceramic materials.     

Changing trends of dental restorative materials

Esthetic dentistry evolved through advancements in dental materials and techniques. This article cites these trends, particularly the adhesive systems such as dentin bonding agents and polyacrylic acid based materials. In particular, the expanding role of glass ionomer cements is explored with attention to the various formulations and manipulative factors that influence performance. Also, a classification system for composite resins is offered with suggestions for proper selection.     

Development of gingivitis around aged restorations of resin-modified glass ionomer cement, polyacid-modified resin composite (compomer) and resin composite

Resin-modified glass ionomer cements (RMGIC) and polyacid-modified resin composites (PMC, compomers) are two recently introduced material groups supposed to replace traditional cements in operative dentistry. The new restoratives release initially fluoride in different relatively high concentrations, which decrease gradually during the first weeks in vivo. Earlier studies showed a stronger subclinical inflammatory reaction around different conventional tooth colored restorative materials than around intact enamel. The aim of this study was to compare intra-individually the initiation of gingival inflammation around, aged RMGIC, PMC and resin composite restorations. Subgingivally located Class III restorations were placed in 17 patients. Each patient received one of each of the experimental materials. All patients were placed on an oral hygiene regime 1-year after finishing of the restorations. Gingivitis was induced during a one-week period without oral hygiene. The gingival condition was assessed by sampling of gingival crevicular fluid (GCF), registration of the amount of bacterial plaque and by registration of bleeding after gentle probing of the entrance of the gingival sulcus (SBI) on the experimental filling- and control-enamel surfaces at days 0 and 7. No differences were seen in plaque and gingival index scores between the materials at both days. The GCF increased significantly for all surfaces during the experimental gingivitis period. At day 7 significantly lower GCF was sampled around the enamel surfaces. In conclusion, the differences between the materials did not result in measurable differences concerning clinical or subclinical signs of gingivitis. Received: 19 September 1998 / Accepted: 26 November 1998     

The effect of polishing systems on microleakage of tooth-coloured restoratives. Part 2: composite and polyacid-modified composite resins

The purpose of this in vitro study was to investigate the effect of polishing systems on the microleakage of composite and polyacid-modified composite resins. Class V cavities were prepared at the cemento-enamel junction of 80 freshly extracted posterior teeth. The prepared teeth were randomly divided into two groups and restored with conventional or polyacid-modified composite resins. The restored teeth were stored in distilled water at 37 degrees C for 1 week after removal of excess restorative with diamond finishing burs. The restored teeth were then divided into four groups of ten and finished/polished using the following systems: Two Striper micron finishing system (MFS), Sof-Lex XT (Sof-Lex), Enhance composite finishing and polishing system (Enhance), and Shofu composite finishing kit (Shofu). The finished restorations were subjected to dye penetration testing. Results showed that the microleakage resistance at both enamel and dentin margins of composite and polyacid-modified composite resins are not significantly affected by the different polishing systems.     

The properties of polymerizable luting cements

The properties of a polyacid-modified composite resin and two resin-modified luting cements have been studied. The polyacid-modified composite resin had the slowest setting reaction and, in this respect, it did not conform to the current international standard for luting cements. The compressive strength of all of the materials was studied after varying periods of storage from 24 h to 1 year. The polyacid-modified composite resin showed a distinct dip in strength at 1 month in all of the storage media, but otherwise it showed no significant variation with either age or storage medium. The resin-modified glass-ionomers showed variation at 24 h with storage medium (deionized water, 0.9% NaCl or 20 mmol dm(-3) lactic acid), but thereafter they showed little variation, until 1 year, when Vitremer luting showed a significant decline in strength in pure water. However, at 24 h and when stored in water, all of the materials had strengths that easily exceeded the minimum requirement of the current standard (70 MPa). They all took up water on storage, with diffusion coefficients ranging from 1.32 to 17. 19x10(-7) cm2 s(-1). These values were found to depend on whether the specimens were stored in pure water or in physiological saline. However, equilibrium water contents varied only slightly between water and saline. The polyacid-modified composite resin, Dyract-Cem, took up the least water, as well as showing the smallest variation in strength with age. By contrast, it was more difficult to mix than the other materials and the high viscosity of the paste led to the formation of voids and other imperfections in the specimens.     

Cost-effectiveness of composite resins and amalgam in the replacement of amalgam Class II restorations

OBJECTIVES: The replacement of an old amalgam Class II restoration is a common treatment and will remain so for decades. In addition to effectiveness, possible adverse health effects and esthetics, the costs of the treatment options will play a role in the choice of material. The aim of this study was to yield information on the relative cost-effectiveness of the use of composite resins and amalgam for the rerestoration of amalgam Class II restorations. METHODS: As part of a larger randomized clinical trial, treatment effectiveness and treatment costs were estimated in 73 composite and amalgam Class II posterior re-restorations. The main treatment outcome was longevity. Secondary outcomes included need of repair and quality of the margin while in situ. Costs were analyzed from the perspective of dentistry, assuming a treatment strategy aimed at offering 'value for money'. From this perspective, differential costs were based on personnel costs as approximated by treatment time. RESULTS: Replacing an amalgam Class II restoration with amalgam is associated with lower costs than replacing with a composite resin. A sensitivity analysis, considering type of composite, increasing proficiency with the material, and time needed for future removal of material, demonstrated that these differences are fairly robust. The materials performed equally well for the first 5 years after placement with respect to longevity. Differences in secondary outcomes were minor and not all in favor of the same material. CONCLUSIONS: It is tentatively concluded that amalgams are more cost-effective than composites for replacing existing Class II amalgam restorations.     

Evaluation of esthetic parameters of resin-modified glass-ionomer materials and a polyacid-modified resin composite in Class V cervical lesions.

OBJECTIVE: The purpose of this study was to compare the esthetics of 3 resin-modified glass-ionomer materials and 1 polyacid-modified resin composite to the esthetics of a conventional glass-ionomer control material. METHOD AND MATERIALS: One hundred eighty-seven Class V cervical restorations were observed clinically over 18 months. The esthetic index system that was used evaluated color match, translucency or opacity, and surface roughness. RESULTS: The tested materials behaved very dissimilarly and inconsistently. In general, the esthetic results of the resin-modified glass-ionomer materials and the polyacid-modified resin composite were far from optimal. The esthetic appearance of restorations seriously deteriorated during clinical service, mainly because of discoloration of margins, changes in translucency and opacity, and rapidly appearing roughness or dullness on the surface. Both the resin-modified glass-ionomer materials and the polyacid-modified resin composite evaluated in this study performed better esthetically than did the conventional glass-ionomer material. CONCLUSION: Indications for these combination materials are limited to areas where esthetics is not a primary concern but where their ease of application may guarantee a more durable functional result.     

Radiopacity of glass-ionomer/composite resin hybrid materials.

This study visually compared the radiopacity of seven restorative materials (3 resin-modified glass-ionomer cements, 3 polyacid-modified composite resins, and 1 conventional glass-ionomer cement) to a sound tooth structure sample, and an aluminium stepwedge. All hybrid materials were more radiopaque, except for one resin-modified glass-ionomer cement, than both the tooth structure and conventional glass-ionomer cement.     

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.     

Dental materials: 1977 literature review Part I

This paper, which is to be presented in two parts, reviews the work on dental materials published in 1977. Included in Part I are sections on amalgam, casting alloys, acrylic resins, composite filling materials and fissure sealants. A review of the literature relating to impression materials, dental ceramics, model and die materials, cements, dental implants and dental biomechanics will be presented in Part II.     

Dental materials: 1982 literature review. Part 2

This is the second part of the report on the 1982 literature on dental materials. Included are reviews on impression, cast, die and mould materials, polymeric prosthetic materials, aspects of adhesion, fissure sealants, composite resins, cements and endodontic materials.     

Effect of filler fraction on strength,viscosity and porosity of experimental compomer materials

OBJECTIVE: The primary goal is to develop a self-cured polyacid-modified resin composite with good mechanical and rheological properties. To achieve such a goal, the aim of this study is to determine how volume filler fraction (VFF) affects mechanical properties and viscosities of such materials containing different filler volumes. METHODS: A series of self-cured polyacid-modified composites made from polyacid modified resins and TEGDMA, mixed with filler particles, were evaluated regarding compressive strength (CS), diametral compressive strength (DCS) and viscosity. The maximum filler content, which could be incorporated into the materials, was calculated from CS tests as well as from viscosity measurements using Mooney's equation. Porosity contents were also determined in an attempt to explain different failure behaviours. RESULTS: The CS values peaked at 18.9 vol.% filler particles and declined afterwards for self-cured polyacid-modified resin composites cured in air. Using photopolymerisation and barium filler in the polyacid-modified resin composites resulted in the highest CS and DCS values. The viscosity increased continuously with increased VFF. VFF results determined experimentally and with Mooney's equation at shear rates of 0.01, 0.1, 1.0, and 10.0 s(-1) revealed that the maximal filler fraction values were 54.9+/-1.8, 55.9+/-1.3, 56.3+/-0.9, and 56.8+/-0.8 vol.%, respectively. The largest porosity content occurred at a VFF value of 53 vol.% CONCLUSIONS: We conclude that an increase in filler fraction of the investigated experimental polyacid-modified resin composite materials above a certain value (20-30 vol.%) does not result in improved mechanical properties.     

An FTIR study of the effects of artificial saliva on the physical characteristics of the glass ionomer cements used for art.

OBJECTIVE: To investigate the physical and chemical changes of five esthetic restorative materials in an artificial saliva using Fourier transform infrared spectroscopy (FTIR). METHODS: The materials included two glass polyalkenoate (ionomer) cements, one polyacid-modified resin composite, and two resin composites. Five fresh and 20 aged specimens for each material were immersed in 2 ml of artificial saliva at 37 degrees C for 1 week, 2 weeks, 1 month, and 2 months. They were examined by laser surface profilometer and FTIR. RESULTS: Surface roughness average (Ra) value showed significant differences among the physical properties of glass ionomers, polyacid-modified resin composite, and resin composites. SIGNIFICANCE: FTIR spectra showed that a major chemical changes in Fuji IX GP Fast glass ionomer cement in P-NH2 group bonding (900-1000 cm(-1)) that may explain the previously reported increase in microhardness after immersion. There was no direct correlation between surface roughness and spectral changes of the materials tested.