Artificial formed caries-like lesions around esthetic restorative materials

Dental restorations fail for a variety of reasons. Secondary caries is one of the primary causes of failure of dental restorations. One method for reducing frequency and severity of this problem is the use of fluoride containing restorative materials. The ability of a material to inhibit secondary caries formation is an important clinical therapeutic property. This investigation assessed the capacity of esthetic restorative materials to resist caries in vitro. Class V cavities were prepared in buccal and lingual surfaces of 50 extracted sound third molars. The occlusal and gingival cavosurface margin of each preparation was on enamel surface. The five materials were used: Conventional glass ionomer cement Ceramfil beta (PSP), two polyacid modified resin composites Compoglass (Vivadent) and Dyract (Dentsply/DeTrey), non fluoride releasing composite resin Valux Plus (3M) and fluoride releasing composite resin Tetric (Vivadent). After 10 weeks in an acid gel for caries-like lesion formation, the teeth were sectioned occluso-gingivally through the middle of the restorations and examined by polarized light microscopy, while immersed in water. The statistical analysis of the results showed that secondary caries initiation and progression might be reduced significantly when fluoride-containing materials were placed. The conventional glass ionomer cement (Ceramfil beta) provided the highest protection against caries attack and the non-fluoride releasing composite resin (Valux Plus) restoration provided the least (p<0.05).     

Two-year clinical evaluation of four polyacid-modified resin composites and a resin-modified glass-ionomer cement in Class V lesions.

OBJECTIVE: The aim of the study was to compare the clinical performances of four polyacid-modified resin composites (F2000, Dyract AP, Compoglass F, and Elan) and one resin-modified glass-ionomer cement (Vitremer) in Class V abrasion/erosion lesions. METHOD AND MATERIALS: Twenty restorations of each of the five restorative materials were placed in noncarious cervical abrasion/erosion lesions by one dentist. No cavity preparation was attempted. All teeth were isolated with cotton rolls and gingival retraction cord. The materials were manipulated according to the manufacturer's instructions and placed with the help of cervical matrixes. Restorations were finished and polished immediately after the placement. Evaluations were performed at baseline and 6 months, 1 year, and 2 years after placement for retention, color match, cavo-surface marginal discoloration, anatomic form, marginal adaptation, secondary caries, and postoperative sensitivity. RESULTS: Retention levels at 2 years were 90% for F2000, 90% for Dyract AP, 89% for Compoglass F, 84% for Elan, and 95% for the Vitremer restorations. No statistically significant differences were found among the materials after 2 years for any evaluation category. CONCLUSION: Polyacid-modified resin composite and resin-modified glass-ionomer cement restorations showed acceptable clinical performance after 2 years.     

Application of a dental adhesive using the self-etch and etch-and-rinse approaches: an 18-month clinical evaluation

BACKGROUND: Laboratory investigations have demonstrated that the application of multiple adhesive coats can increase adhesive infiltration, thereby increasing bond strength values. The authors conducted an 18-month, randomized, controlled prospective study to evaluate the clinical performance of a self-etch and an etch-and-rinse adhesive in noncarious cervical lesions. METHODS: Twenty-nine patients with at least two pairs of similarly sized lesions participated in this study. The authors placed 116 restorations in one of four groups: OS2 (phosphoric acid and dental adhesive [One-Step Plus, Bisco, Schaumburg, Ill.], following the manufacturer's recommendation [two coats]); OS4 (phosphoric acid and One-Step Plus, with four coats); TY2 (Tyrian SPE [Bisco] and One-Step Plus, following the manufacturer's recommendation [two coats]); and TY4 (Tyrian SPE and One-Step Plus, with four coats). The authors evaluated the restorations at baseline and at six, 12 and 18 months, according to modified U.S. Public Health Service criteria. (Eight of the 116 restorations were unavailable for follow-up.) RESULTS: The retention rate for the TY2 group (55.5 percent) was statistically lower than that for the TY4 (77.8 percent) and OS4 (88.9 percent) groups. Only teeth in OS4 exhibited a retention rate at 18 months that was similar to that observed at baseline. Marginal discoloration occurred in all groups, and it was statistically significantly worse in TY2. CONCLUSIONS: Multiple adhesive coats significantly improved retention rates. CLINICAL IMPLICATIONS: Applying multiple coats of adhesive with the etch-and-rinse or self-etch approach can improve retention rates of Class V resin-based composite restorations, although not to the level of the American Dental Association's guidelines for dentin and adhesive materials.     

Microleakage of Class V resin-modified glass ionomer and compomer restorations

STATEMENT OF PROBLEM: Resin-modified glass ionomers and polyacid-modified resin composites (compomers) have been introduced to provide esthetic restorations. However, there is concern about the marginal sealing ability of these materials, especially at the dentin (cementum) aspects of restorations. PURPOSE: This in vitro study evaluated the microleakage of Class V restorations made with resin-modified glass ionomers or a compomer. MATERIAL AND METHODS: Thirty noncarious human molar teeth were used. Standardized kidney-shaped Class V cavity preparations were placed in the buccal and lingual surfaces at the cementoenamel junction. Teeth were randomly assigned to 3 experimental groups of 10 teeth each and restored as follows: group 1, Fuji II LC; group 2, Vitremer; and group 3, Dyract. In all cases, the manufacturers' instructions were strictly followed. All materials were placed in a single increment. Unfinished restorations were immediately coated with the respective manufacturers' sealer or varnish and this was either light cured for 20 seconds or allowed to air-dry. After 24 hours, teeth were finished to contour and to the cavosurface margins, coated with nail varnish except for 1 mm around the restoration margin, thermocycled (1000x, 5-55 degrees C) and placed in a solution of 2% basic fuchsin dye for 24 hours at room temperature. The staining along the tooth restoration interface was recorded. RESULTS: Kruskal-Wallis 1-way analysis of variance revealed significant differences among all restorative materials for the overall, occlusal, and gingival scores (P =.03, P =.01, P =.01, respectively). Occlusal and gingival scores for each matched pair of restorative materials using the Wilcoxon test showed statistically significant differences between Fuji II LC glass ionomer cement and Dyract composite, both for the occlusal (P =.005) and gingival (P =.005) margins and also as an overall evaluation (P =.01), with Fuji II LC showing the least dye penetration. Vitremer revealed dye penetration scores not significantly different from Fuji II LC glass ionomer cement or Dyract composite. CONCLUSION: Resin-modified glass ionomers showed less or similar microleakage than the polyacid-modified composite resin tested.     

Effect of home-use bleaching gels on fluoride releasing restorative materials

To evaluate the effects of two home-use bleaching gels (Nite-White and Contrast PM) on the surface roughness of one high-viscosity glass ionomer cement (Fuji IX GP), four polyacid-modified resin-based composites (Dyract AP, F2000, Elan and Compoglass F), two resin-modified glass-ionomer cements (Vitremer and Fuji II LC), a microfilled fluoride-releasing resin-based composite (Tetric) and a microfilled non-fluoridated resin-based composite (Valux) were used as controls. The null hypotheses tested were: (1) the use of bleaching gels would not result in surface roughness values different from those obtained at baseline; (2) differences in the amount of carbamide peroxide present in the gels would not influence surface roughness. Thirty specimen disks (the first 10 used for controls and the balance divided randomly into two groups) were made for each material according to the manufacturers' instructions. Finishing and polishing of the test and control specimens was performed after 24 hours using a sequential series of three (medium, fine and superfine) Sof-Lex disks, keeping the restoration surface wet. For every sequence, 10 strokes were made in one direction using a low-speed handpiece. Ultrasonic cleaning of the polished specimens was performed for two minutes in distilled water to remove any surface debris. Prior to bleaching treatment, the specimens were stored in 37 degrees C deionized water for 24 hours. The specimens were exposed to the bleaching gels for a period that simulated the equivalent of 15 days (eight hours/day) under bleaching treatment. The average surface roughness (Ra) of the control and treated specimens was measured. Three separate Ra measurements along the direction of rotation of the finishing and perpendicular to the finishing direction and edge of the mold were made for each specimen surface. After treatment with bleaching gels, there was an increase in surface roughness for F2000, Dyract AP, Elan, Valux and Tetric, while Fuji IX, Fuji II LC, Vitremer and Compoglass F displayed decreased surface roughness values, suggesting that the effects of the gels appear to be material-dependent. Although Contrast PM contains 5% more carbamide peroxide as the active ingredient, the second null hypothesis was rejected for Fuji IX, Vitremer, Dyract AP, Compoglass F, Elan and Valux.     

Clinical evaluation of two one-bottle dentin adhesives at three years

BACKGROUND: The method currently used to adhere resin to dentin involves etching, priming and bonding. Many commercial adhesives now combine priming and bonding functions in a single solution, and these are frequently called one-bottle adhesives. The purpose of this study was to compare the 36-month clinical performance of two commercial one-bottle adhesives. METHODS: The authors enrolled 33 patients with noncarious cervical lesions in the study. A total of 101 lesions were restored with either a filled, ethanol-based adhesive (OptiBond Solo, SDS Kerr) or an unfilled, acetone-based adhesive (Prime & Bond 2.1, Dentsply Caulk) and a hybrid resin-based composite. Enamel margins were not beveled, and no mechanical retention was placed. The restorations were evaluated at baseline and six months, 18 months and 36 months after placement using modified Cvar/Ryge criteria. RESULTS: The retention rates at 36 months were 93.3 percent for the ethanol-based adhesive and 89.4 percent for the acetone-based adhesive. The difference in retention rates was not statistically significant. In both groups, 12 percent of the retained restorations had marginal staining, but no recurrent caries was detected around any restoration. Other restoration characteristics such as marginal adaptation and color match remained excellent three years after placement. CONCLUSIONS: The performance of both adhesives was excellent during this 36-month clinical trial. At the most recent recall evaluation (that is, 36 months), the filled, ethanol-based adhesive exhibited slightly better bond durability, but the difference between the two materials was not statistically significant. CLINICAL IMPLICATIONS: The one-bottle adhesives evaluated in this study provided excellent clinical retention of Class V restorations without mechanical retention. When the materials are used properly, restorations are retained at a high rate during at least three years of clinical service.     

In vitro evaluation of the cariostatic action of esthetic restorative materials in bovine teeth under severe cariogenic challenge

Considering that caries around restorations is a serious problem in dentistry, and some restorative materials with fluoride may be important in inhibiting these lesions, this research is aimed at performing an in vitro evaluation of the cariostatic action of some esthetic restorative materials. Standardized cavities were prepared in the center of either intact blocks of bovine enamel or with bovine teeth containing early artificial carious lesions. The specimens were restored with a high viscosity glass ionomer cement (Molar Ketac), a resin-modified glass ionomer cement (Vitremer), a polyacid-modified resin composite (Dyract AP) and a conventional resin composite (Z-250). In addition to the restored specimens, four corresponding control groups were evaluated. All groups, except for two control groups, were subjected to a demineralization/remineralization cycling model for 14 days, simulating a situation of severe cariogenic challenge. The blocks were then longitudinally sectioned through the restorations. Mineral loss was evaluated in these specimens using the Knoop microhardness profiles in longitudinal sections at three different distances of the cavities and at eight distinct depths in relation to the external enamel surface. Statistical analysis of the results showed significant differences (p < 0.05) among the groups, although none of the study materials completely inhibited creation of the lesions. Vitremer demonstrated the best cariostatic action in intact bovine enamel. Ketac Molar, in intact or demineralized enamel, and Vitremer, in demineralized enamel, presented intermediate cariostatic potential. Z-250 and Dyract AP did not demonstrate any cariostatic effect. The data suggests that glass ionomer cements demonstrated better cariostatic action compared to the other restorative materials.     

Effect of 1.23 percent APF gel on fluoride-releasing restorative materials

This study evaluated the effect of a 1.23 percent APF gel on the surface morphological characteristics and surface roughness of one high-viscosity (Fuji IX GP), three polyacid-modified resin-based composites (Dyract AP, F2000 and Compoglass F) (PMRC), and two resin-modified glass-ionomer cements (Vitremer and Fuji II LC). A microfilled nonfluoridated resin-based composite (Silux Plus) was used as a control. All materials were handled according to the manufacturers' instructions. The fluoride gel used in the study was a 1.23 percent acidulated phosphate fluoride gel (APF) (Nupro APF). The specimens were repeatedly exposed to the APF gel with cotton applicators for a period that simulated the equivalent of 4 yrs (1 min/6 mo) under prophylactic fluoride treatment. Average surface roughness (Ra) of the control and treated specimens was measured. Three separate Ra measurements along the direction of rotation of the finishing and perpendicular to the finishing direction and edge of the mold were made for each specimen surface. In each group, specimens with Ra closest to the mean were removed from the molds, sputter-coated with gold and examined using a scanning electron microscope. The results showed that all tested materials, except Vitremer, displayed increased surface roughness values following APF treatment. However, this was not statistically significant for Compoglass F, Vitremer and Fuji II LC. Among PMRC materials, F2000 displayed the highest Ra average value, although the differences between F2000 and Dyract AP and of Compoglass F and Dyract AP was not statistically significant. Comparisons of the Ra values between Silux Plus and the other test materials revealed statistically significant differences except for Dyract AP and Compoglass F. No statistically significant difference was found between the Ra values of Vitremer and Fuji II LC following APF treatment. Among all groups, Fuji IX GP displayed the highest surface roughness.     

Resin-based composites and compomers in primary molars

Resin-based composite resins and polyacid-modified resin-based composites (compomers) have become popular for the restoration of primary anterior and posterior teeth. In some European countries, resin-based composites or glass-ionomers are the materials of choice for primary teeth because of the controversy over dental amalgam and its alleged adverse health effects resulting from the release of mercury, although a clear correlation between amalgam restorations and health has not been determined. Another reason for the worldwide increased use of resin-based composites and glass-ionomers in pediatric dentistry could be attributed to the growing demand from parents to provide esthetic restorations to their children. More conservative preparations can be performed maintaining more tooth structure because of the adhesive properties of the composites and compomers. The most conservative treatment planning and meticulous care in the placement of the resin-based composites and compomers would produce long-term satisfactory results. These restorations should be placed in patients with low-to-moderate caries risk, and after placement the restorations should be monitored carefully to avoid complications mainly produced by recurrent caries and wear.     

Conservative Restoration of a Sensitive Cervical Root Lesion

Certain glass ionomer materials are now available for conservative esthetic restoration of cervical root lesions. Using a premeasured encapsulated glass ionomer system greatly improves and simplifies the restorative procedure. With no mechanical tooth preparation, exposed sensitive root structure can be reliably restored with a remarkably easy technique. A detailed method is described and representative glass ionomer cervical root restorations are shown.     

Determination of changes on tooth-colored cervical restorations in vivo using a three-dimensional laser scanning device

The present study aimed at the determination of changes of tooth-colored cervical restorations in vivo using an optical 3-dimensional laser scanning device. The study was performed on 197 cervical restorations placed on incisors, canines, and premolars. Four different tooth-colored restoration materials, a composite, a polyacid-modified resin composite, and two resin-modified glass ionomer cements, were used for the restoration of the lesions. For the determination of changes, images were taken at baseline and 15, 24 and 36 months after the placement of the fillings using a 3D-laser scanning device. The images were superimposed automatically, and digital subtraction was made by a specially developed image analysis software. The total substance loss on the entire filling surface at 36 months for the resin-modified glass ionomer Photac-Fil was 44 (+/-23) microm, for Fuji II LC 45 (+/-26) microm, for Dyract 71 (+/-47) microm and for Tetric 18 (+/-12) microm. Differentiating between the class of lesion, a higher wear rate was observed at 36 months on restorations which had been placed in erosion/non-carious cervical cavities (66 (+/-33) microm). In conclusion, the composite material demonstrated a distinctly lower surface wear rate over time in comparison to the resin-modified glass ionomer cements and the polyacid-modified resin composite.     

Comparison of post-gel shrinkage strains in light-polymerized composite resins

STATEMENT OF PROBLEM: Polymerization shrinkage is associated with light-polymerized and polyacid-modified composites. PURPOSE: This in vitro study compared the polymerization shrinkage of a light-polymerized hybrid composite, a posterior composite, and a polyacid-modified composite. MATERIAL AND METHODS: Five disk-shaped specimens (1 cm in diameter and 2 mm in thickness) were prepared in a mold from each of the following test materials: a light-polymerized hybrid composite (3M Valux Plus), a posterior composite (Filtek P60), and a polyacid-modified composite (Dyract AP). The hybrid composite served as the control material. A linear strain gauge was placed at the center of each specimen. After the specimens were light-polymerized for 60 seconds under 400-mW/cm(2) light intensity, microstrains were recorded with the strain indicator continuously every 4 seconds for 120 seconds. The data were evaluated with 1-way analysis of variance (P<.05) followed by a post hoc least significant difference test. RESULTS: During the first 20 seconds of light polymerization, all materials exhibited tensile strains between 6 and 55 mu epsilon that quickly converted into compressive strains and continued rising after the light source was removed. The strains for all materials increased at a declining rate until they reached a constant level between 148 and 180 seconds. The polymerization shrinkage recorded for Filtek P60 was the lowest (-190.56 mu epsilon), followed by 3M Valux Plus (-303.94 mu epsilon) and Dyract AP (-345.64 mu epsilon) (P<.05). The dimensional change between Filtek P60 and Dyract AP and between Filtek P60 and 3M Valux Plus was significant (P=.001). However, the difference between Dyract AP and 3M Valux Plus specimens was not significant (P=.208). CONCLUSION: Within the limitations of this study, the light-polymerized posterior composite tested demonstrated less polymerization shrinkage than the polyacid-modified and hybrid composites tested. Polymerization shrinkage velocity significantly affected the magnitude of strains.     

A three-year clinical evaluation of two-bottle versus one-bottle dentin adhesives

BACKGROUND: The authors conducted an in vivo investigation to compare the clinical performance of two commercial one-bottle adhesives and a two-bottle adhesive for restoration of noncarious cervical lesions (NCCLs). METHOD: The patient pool consisted of 57 patients and 171 teeth (three teeth per patient), with one NCCL per tooth. Each patient received three resin-based composite restorations, each with a different adhesive: one tooth with a two-bottle, water-based adhesive as the control; another tooth with a one-bottle, ethanol-based adhesive; and a third tooth with a one-bottle, solvent-free adhesive. The authors assessed restorations in terms of retention, marginal integrity, margin discoloration and air sensitivity at baseline, six months, one year, two years and three years after initial placement. RESULTS: The retention rates at 36 months were 88 percent for the first adhesive, 81 percent for the second adhesive and 90 percent for the third adhesive. No statistically significant differences in retention rates could be shown, with 86 percent of restorations retained overall. Measures of marginal integrity, marginal discoloration and sensitivity also had no statistically significant differences between the three adhesives (P > .05). CONCLUSIONS: All three adhesives performed with acceptable outcomes after a 36-month period, with small differences between the one- and two-bottle systems and between the various solvents. Retention rate was moderately high and air sensitivity was markedly reduced; however, superficial marginal discoloration and marginal degradation was notable. Certain lesion, tooth and patient characteristics may predispose restorations to retention failure. CLINICAL IMPLICATIONS: The type of solvent may not be a major factor in retention of Class V restorations in NCCLs. Both single-bottle adhesives and conventional two-bottle adhesives performed acceptably.     

Esthetic noncarious Class V restorations: a case report

When restoring anterior and posterior teeth affected by noncarious cervical lesions, many clinicians overlook the etiologic factors responsible for the lesions'development, resulting in frequent restorative failures. The treatment approach for noncarious cervical lesions must not be based only on restorative procedures since a variety of causative and aggravating factors are related to their formation. This article discusses a treatment protocol and techniques for the restoration of noncarious Class V lesions and presents a clinical case in which esthetic restorations are achieved.     

Two-year clinical evaluation of One-Up Bond F in noncarious cervical lesions

PURPOSE: To evaluate the retention of restorations placed in non-undercut, noncarious cervical lesions using One-Up Bond F and Palfique Estelite resin composite. MATERIALS AND METHODS: Fifty-one non-undercut, noncarious cervical lesions were restored with One-Up Bond F and Palfique Estelite in 15 patients (mean age 57.7 years). Teeth were cleaned with pumice and water and restored following the manufacturer's instructions. Restorations were evaluated at 6 months, 1 and 2 years for presence or absence, and for the degree of marginal staining using standardized colour photographs for comparison. RESULTS: At 1 year, 42 restorations were evaluated, and all were intact. Slight marginal staining was observed in three restorations. At 2 years, 37 restorations were evaluated from 11 patients, and all were intact. Marginal staining was observed around nine restorations. ANOVA for marginal staining showed a significant increase of staining at both the enamel and cervical margins over the 2 years of the study. No caries was detected in association with any restoration. CONCLUSION: Although a number of restorations could not be evaluated, the retention of 100% at 2 years showed very good promise for the treatment of noncarious cervical lesions. The marginal staining was limited to a small number of patients.     

Tooth-colored filling materials for the restoration of cervical lesions: a 24-month follow-up study

The recently developed resin-modified glass ionomer cements and the polyacid-modified composites are promising alternatives to conventional materials for restoring cervical defects. This clinical study evaluated the clinical condition of cervical fillings 24 months following placement. The study subjects were 197 cervical restorations placed on incisors, canines and premolars in 37 patients for restoration of erosion/non-carious lesions (69 cases), primary carious lesions (57 cases) and the replacement of deficient restorations (71 cases). The teeth were randomly divided into four groups for restoration with either Tetric (composite, Group A: n = 36), Dyract (compomer, Group B: n = 79), Fuji II LC (resin-modified glass ionomer cement, Group C: n = 51) or Photac-Fil (resin-modified glass ionomer cement, Group D: n = 31). The evaluation was done single-blind at baseline, 8 and 24 months after the placement of the fillings, according to a modified USPHS rating scale. The assessment criteria were color stability, anatomical form, surface texture, marginal integrity, marginal discoloration and loss of filling. Statistical analysis was completed using Pearson chi-square and Fisher's exact test at a significance level of 5% (p < 0.05). After the 24-month period, the composite restorations showed superior results. The compomer fillings demonstrated conditions that were only slightly worse. A substantial number of the resin-modified glass-ionomer fillings were evaluated with bravo or even charlie scores in respect to at least one of the criteria assessed.     

A six-month clinical study of a self-etching and an etch-and-rinse adhesive applied as recommended and after doubling the number of adhesive coats

PURPOSE: In an intra-individual comparison, a 6-month randomized, controlled prospective study evaluated the clinical performance of a self-etching and an etch-and-rinse adhesive in noncarious cervical lesions applied as recommended and after doubling the number of adhesive coats. MATERIALS AND METHODS: Twenty-nine patients with at least two pairs of similar sized noncarious cervical lesions participated. One hundred sixteen restorations were placed and divided into the following groups: OS2: phosphoric acid + One Step Plus applied accordingto manufacturer's recommendation (2 coats of adhesive); OS4: phosphoric acid + One Step Plus (4 coats of adhesive); TY2: Tyrian SPE + One Step Plus applied according to manufacturer's recommendation (2 coats of adhesive); TY4: Tyrian SPE + One Step Plus (4 coats of adhesive). The restorations were evaluated at baseline and after 6 months according to the modified USPHS criteria. Statistical analysis was performed with Friedman repeated measures ANOVA by rank and the Wilcoxon sign-ranked test for pairwise significance (alpha = 0.05). RESULTS: One hundred eight restorations were evaluated at 6 months. The retention rate of the group TY2 was statistically significantly lower than the other groups. Marginal discoloration occurred in all groups, being significantly worst in the group TY2. CONCLUSION: Tyrian SPE + One Step Plus applied according to manufacturer's recommendations did not meet the ADA provisional acceptance criteria for enamel-dentin bonded restorative materials. The use of four coats of the One Step Plus in the self-etching approach can improve its clinical performance.     

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.     

Cements for use in esthetic dentistry

Dental cements are designed to retain restorations, appliances, and post and cores in a stable and, presumably, long-lasting position in the oral environment. Conventional glass ionomer and zinc phosphate cements are among the most popular materials for luting metallic restorations and posts, whereas resin-based cements are preferred for esthetic applications. Successful cementation of esthetic restorations is largely dependent on the appropriate treatment and silane application to the internal surface of the restoration. Clinicians are frequently advised to use three-step total-etch or two-step self-etch adhesive for luting purposes to avoid problems of incompatibility between adhesives and chemical- or dual-cure cements. A reliable cementation procedure can only be achieved if the operator is aware of the mechanisms involved and the material limitations.     

Perioesthetic approach to the diagnosis and treatment of carious and noncarious cervical lesions: Part II

Several classes of tooth-colored materials are available for restoring carious and noncarious cervical lesions. Included are the composite resins, which can be bonded into the cervical area to provide predictable form, function, and esthetics. Part I of this two-part report reviewed the etiology of noncarious cervical lesions and provided a series of clinical case reports showing the importance of the periodontal aspect of lesion management. In part II we present information about adhesive preparation design and esthetic restoration of the noncarious cervical lesion.
CLINICAL SIGNIFICANCE
When used with proper attention to preparation design and restoration placement and finishing, resin composites can be used to successfully restore form, function, and esthetics to defective cervical areas of teeth.