Assuring restorative integrity in extensive posterior resin composite restorations: pushing the envelope.

Clinicians are increasingly being called on to satisfy the restorative demands of patients who request tooth-colored restorations but are unable to afford an optimum indirect restorative option. Consequently, in clinical practice, the limits of the direct posterior resin composite technique are being stretched. There is a need for techniques that will satisfy the complex variables of clinical practice and allow for successful utilization of posterior resin composite in large cavity preparations. The objective of this article is to explain the rationale behind the materials and techniques involved in the delivery of these complicated restorations.     

Bonded composite resin crowns for primary incisors: technique update

A technique for restoration of carious primary maxillary incisors with a hybrid visible light-curing composite resin and a dentinal bonding agent is described. Careful use of this technique and the new materials can provide a restoration that is esthetic and resistant to fracture and displacement. The technique requires careful preparation of the operative field and precise handling of the restorative materials. The method is illustrated by the placement of bonded composite resin crowns in a 3-year-old boy.     

An alternative aesthetic restoration for extensive coronal destruction in primary molars: indirect restorative technique with composite resin

The indirect restorative technique with composite resin has presented efficient results when used in primary teeth. This technique enables the oral rehabilitation. Based on the results presented in the literature concerning clinical performance, this technique is presented as an alternative treatment to the primary teeth with extensive decay by showing a case of rehabilitation of primary molars. The oral rehabilitation using indirect resin composite restoration showed an important concept to be applied in primary dentition due to feasible, low cost, and lower chairside time.     

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复合树脂材料用于牙科已有20余年历史。这类材料既可用于前牙也可用于后牙。复合树脂发展到今天已经出现了许多专门应用于后牙的修复材料,并已取得满意的临床效果。银汞合金的许多缺点都可以为复合树脂所克服。因此,后牙复合树脂修复已为越来越多的患者和牙科医生所接受。然而,直接充填复合树脂材料仍旧被认为有许多局限性。比如边缘缺陷、面磨损、牙尖变形以及术后的牙髓敏感等。因此,近年来发展了复合树脂的一种新技术——间接性复合树脂嵌体与高嵌体修复技术。它的临床应用在某种程度上克服了上述直接充填树脂的局限性。复合树脂嵌体或高嵌体是作为固体黏固在预备洞型中的一种修复体。这种呈固态的修复体由复合树脂材料采用间接的方法制成,最后再黏固于口内。本文将最近的有关间接性复合树脂嵌体和高嵌体方面的资料进行综述,包括它的临床应用,优缺点以及面临的问题等。     

The Influence of Finishing Technique on Microleakage

Four different finishing techniques were used in a dentin bonding agent/composite resin restoration to evaluate the possible influence of finishing technique on microleakage. Results indicated that finishing technique affects the ability of the restorative system to resist microleakage. Under the conditions of this study, best results were achieved with a 30-fluted bur followed by a short wet polish. Samples finished dry with polishing disks demonstrated considerable microleakage. This study also suggests that homogeneous nonagglomerated microfilled composite resin does not require disk finishing.     

Primate pulp response to an ultraviolet light cured restorative material

Abstract. The present toxicity study investigated the pulpal response of an experimental u.v. light cured composite product as a Class V restorative material. Seventy-eight Class V cavities were prepared on the buccofacial surfaces of cynomolgus monkeys using a high-speed, air-water spray cutting technique. The experimental product was compared to a self-curing composite resin and a zinc oxide and eugenol formula. The animals were sacrificed at 3, 14 and 60 days. All categories exhibited about the same minimal degree of pulpal response at the three-day post-operative interval. However, focal hemorrhage occurred in 80% of the u.v. light cured resin category. After 60 post-operative days, the u.v. cured resin specimens presented persistent or increasing responses as compared to the specimens treated with either a self-curing composite resin or zinc oxide and eugenol. Should this u.v. light cured resin be used as a restorative material such as employed in this study, a calcium hydroxide liner is suggested in order to minimize the pulpal responses observed 60 days post-operatively.     

Primate pulp response to an ultraviolet light cured restorative material

Abstract. The present toxicity study investigated the pulpal response of an experimental u.v. light cured composite product as a Class V restorative material. Seventy-eight Class V cavities were prepared on the buccofacial surfaces of cynomolgus monkeys using a high-speed, air-water spray cutting technique. The experimental product was compared to a self-curing composite resin and a zinc oxide and eugenol formula. The animals were sacrificed at 3, 14 and 60 days. All categories exhibited about the same minimal degree of pulpal response at the three-day post-operative interval. However, focal hemorrhage occurred in 80% of the u.v. light cured resin category. After 60 post-operative days, the u.v. cured resin specimens presented persistent or increasing responses as compared to the specimens treated with either a self-curing composite resin or zinc oxide and eugenol. Should this u.v. light cured resin be used as a restorative material such as employed in this study, a calcium hydroxide liner is suggested in order to minimize the pulpal responses observed 60 days post-operatively.     

Influence of finishing technique on microleakage

Four different finishing techniques were used in a dentin bonding agent/composite resin restoration to evaluate the possible influence of finishing technique on microleakage. Results indicated that finishing technique affects the ability of the restorative system to resist microleakage. Under the conditions of this study, best results were achieved with a 30-fluted bur followed by a short wet polish. Samples finished dry with polishing disks demonstrated considerable microleakage. This study also suggests that homogeneous nonagglomerated microfilled composite resin does not require disk finishing.     

Effectiveness of reciprocal-action instrumentation for polishing composite resin: an in vitro study.

This in vitro study investigates the use of reciprocal-action instrumentation for polishing composite resin restorative materials. Electron photomicrographs were made of surfaces of a microfilled and a hybrid composite resin restorative material polished by various reciprocal-action polishing procedures, including several types of polishing pastes used with nonabrasive plastic tips. The best polish on the microfilled composite resin restorative material tested was produced by ending with 3-mu diamond polishing paste. The best polish on the hybrid composite resin restorative material tested was produced by ending with 0.5-mu diamond polishing paste. The surfaces produced were comparable to those produced by polishing discs.     

Controlling contacts and contours using preformed ceramic inserts

Current adhesive techniques and materials that seal both enamel and dentin have revolutionized modern restorative dentistry. Unfortunately, the durability problems associated with direct polymeric materials of the past have not been adequately solved. Nevertheless, when cost and esthetics form part of the treatment decision process, patients presenting with Class 2 defects are most often provided with a direct restorative option. Direct composite resin restorations are fraught with problems largely related to the mechanical stresses that accompany polymerization shrinkage. A partial solution is to incorporate prefabricated ceramic inserts into the substance of the composite resin, thereby decreasing the volume of directly cured restorative material and effectively reducing the magnitude of the polymerization stresses. SONICSYS approx is a unique addition to the restorative continuum that takes the insert strategy one step further by using specifically shaped sonically driven diamond-coated preparation tips to adjust the cavity form to fit presized ceramic proximal inlays. The SONICSYS approx system represents a technique intermediate between a direct resin composite and a laboratory fabricated inlay. This article describes the background of this development, and the components and application of the system. In addition, within the presentation of a case study, operative innovations are introduced that improve interfacial integrity and allow for the conveyance of predictable contacts and proper physiological contour.     

Using opaquers under direct composite resin veneers: an illustrated review of the technique

In restorative dentistry direct composite resin materials can be used to conservatively resolve many esthetic problems. Opaque resins are often necessary to mask discolorations and/or dark backgrounds when restoring anterior teeth. This article presents a direct composite resin veneer technique using opaquers. Potential problems with the tone of restorations after the use of opaquers are discussed. Advantages, limitations, and the clinical technique are presented. Training, as well as attention to the technique, contributes to an acceptable result.
CLINICAL SIGNIFICANCE
Resinous opaquers can be used as a valid adjunct to the direct composite resin veneer technique when conservatively restoring dark teeth.     

Effectiveness of Reciprocal-Action Instrumentation for Polishing Composite Resin: An In Vitro Study

This in vitro study investigates the use of reciprocal-action instrumentation for polishing composite resin restorative materials. Electron photomicrographs were made of surfaces of a microfilled and a hybrid composite resin restorative material polished by various reciprocal-action polishing procedures, including several types of polishing pastes used with nonabrasive plastic tips. The best polish on the microfilled composite resin restorative material tested was produced by ending with 3-μ diamond polishing paste. The best polish on the hybrid composite resin restorative material tested was produced by ending with 0.5-μ diamond polishing paste. The surfaces produced were comparable to those produced by polishing discs.     

An in-vitro investigation of the effect of a water additive and a new acidic primer on the tensile bond strength of composite resin to human enamel and dentine

The aim of this study was to investigate the effect of a water additive on the bond strength of a composite restorative material to enamel and dentine which have undergone a range of surface treatments regimes. Human enamel and dentine specimens were prepared and divided into 3 surface treatment groups. Composite resin restorative material was bonded to the surface prepared enamel and dentine specimens. The tensile bond strength of the composite resin was measured using a Lloyd's testing machine. The tensile bond strength of composite resin to etched enamel surfaces using a standard etch technique was significantly greater than that to dentine (p < 0.05). For those specimens subjected to the addition of the water additive 'Alpron' the bond strength to the enamel was still significantly greater than to the dentine (p< 0.005). The addition of 'Alpron' to the water significantly improved the bond strength of composite to enamel and dentine when etched and placed with 'Prime&BondNT' (p < 0.05). There was no significant difference in bond strength of enamel and dentine specimens bonded using Xeno III (p> 0.05). However, the bond strength of dentine specimens bonded with Xeno III was significantly greater than other dentine specimens bonded with Prime&BondNT (p< 0.05). For those groups of specimens which included the water additive 'Alpron' in the regime, the tensile bond strength of the composite resin restorative material to enamel and dentine was greater than for those non water additive groups. The tensile bond strength of composite resin bonded to enamel surfaces prepared with 'Alpron' was significantly higher than that bonded to dentine surfaces.     

Posterior composite resins

A quarter of a century ago, composite resin was introduced and quickly outmoded silicate cement and acrylic resin as a restorative material. Although composite resin cannot replace amalgam, it has a strong foothold in dentistry, most notably for its superior color-matching ability. This article contrasts many properties of composite resin to amalgam, and takes a look at new developments in posterior esthetic materials.     

Posterior resin-based composite: review of the literature

The use of direct posterior resin-based composite has increased primarily due to patient esthetic desires and product improvements. Other factors (substantiated or not) contributing to increased use of resin-based composite are environmental and health concerns with dental amalgam. New visible light cured resin-based composite products are introduced yearly, as manufacturers continue to improve this tooth-colored restorative material. This paper will characterize current posterior resin-based composite materials (hybrid, microfill, flowable, and packable), review recent in vitro and clinical research, and recommend indications for these materials. In addition, the literature on compomers will be reviewed and recommendation made for their use. The data indicates that composite resin is a technique sensitive restorative material that can be used in large preparations if proper manipulation and isolation can be maintained. Compomers may also be used as an esthetic posterior restorative if proper isolation is provided.     

Microleakage evaluation of a new low-shrinkage composite restorative material

PURPOSE: This study compared the microleakage of an experimental low-shrinkage resin composite (Hermes), a nanofilled resin composite material (Filtek Supreme) and a hybrid resin composite (Tetric Ceram) using a dye penetration method. METHODS AND MATERIALS: Class I cavities prepared in 60 human molars were randomly divided into 3 groups according to the restorative material used. The preparations were restored using a bulk or an incremental technique. Half of the specimens from each group were subjected to 200,000 cycles of loading at 50 N, while the other half were stored in distilled water for 24 hours at 37 degrees C. All specimens were immersed in 1% methylene blue (pH = 7.0) for 24 hours and sectioned into 3 slabs. The margins were evaluated for microleakage using an ordinal scoring system (0-4) under a stereomicroscope at 40x magnification. Data were subjected to the non-parametric Kruskal-Wallis analysis of variance and Mann-Whitney test (p<0.05). Data were expressed as median leakage scores and mean ranks. RESULTS: All of the restorative systems had microleakage, regardless of the insertion technique and mechanical load cycling. Incremental placement significantly reduced microleakage as compared to the bulk technique, regardless of the restorative system used. Load cycling significantly affected incrementally placed restorations, except for the Hermes system.     

Microleakage of high-strength glass ionomer: resin composite restorations in minimally invasive treatment

Atraumatic Restorative Treatment (ART) has been investigated as an alternative caries treatment. The technique involves removal of loose tooth structure with a spoon excavator, followed by placement of an adhesive restorative material, often a high-strength glass ionomer. This study compares the microleakage of a high-strength glass ionomer/resin composite and two occlusal resin composite restoration techniques.     

Restoring a tooth with massive internal resorption to form and function: report of case

This case report describes an innovative restorative technique using glass ionomer and posterior composite resin materials. It was used to treat a patient with extensive internal resorption of the clinical crown of the maxillary first molar. Although unconventional, this method successfully strengthened and restored the tooth.     

Direct applications of a nanocomposite resin system: Part 1--The evolution of contemporary composite materials.

The delivery of functional, aesthetic restorations has been simplified by the introduction of contemporary composite materials. The most recent innovation in composite resin technology is the revolutionary application of nanocomposite theories in restorative materials. Contemporary nanocomposite materials deliver increased aesthetics, strength, and durability, combining scientific principles for increased longevity. This article discusses the application of nanocomposite resin systems and demonstrates the historical perspective of composite resin technologies in restorative treatment. The second installment to this series will address the clinical applications of such a system in the anterior region. LEARNING OBJECTIVES: This article addresses material selection considerations that must be addressed when selecting an appropriate direct restorative material. Upon reading this article, the reader should: Understand the historical background and application of nanocomposite materials. Be aware of the clinical implications of a nanocomposite resin system.     

The natural tooth pontic; simplified

This paper's objective is to describe a simple, economical and fast method to replace a single tooth. Utilizing an indirectly fabricated composite resin framework reinforced with polyethylene fiber and the existing tooth as pontic. This tooth can be the natural tooth or the restorative crown. In addition, this particular design allows for exact repositioning of the coronal part of the extracted tooth in its original intra-oral 3-dimensional position. This chairside technique does not require laboratory involvement.