Clinical performance of pulpotomized primary molars restored with resin-based materials. 24-month results

PURPOSE: To evaluate the clinical and radiographic success rates of pulpotomized (formocresol) primary molar teeth restored with a resin-based composite (TPH) or a polyacid-modified resin composite (Dyract AP) over a 2-year period. METHODS: 100 composite and 100 compomer restorations were placed over pulpotomized teeth by two clinicians in 84 patients. Two other calibrated clinicians evaluated the restorations using the modified USPHS/Ryge criteria observing the following characteristics: marginal discoloration, marginal adaptation, wear/anatomic form, enamel loss and caries. Mann Whitney U test, Friedman test and Wilcoxon signed ranks tests were used for statistical analysis (P= 0.05). RESULTS: At 24 months, 80 composite and 72 compomer restorations were available for evaluations. Except for baseline, compomer restorations showed significantly more marginal discoloration (P= 0.001) and marginal disintegrity (P= 0.001) than did the resin composite. Compomer restorations demonstrated a significant increase in minor enamel cracks along restoration margins over time (P= 0.001), but no chipping or loss of enamel was detected. Caries was observed only in 2.8% of compomer restorations and was restricted to restoration margins. 2% of composite and 17% of compomer restoration-treated teeth were extracted due to radiographic evidence of failure. Pathological root resorption patterns observed beneath failed compomer restorations were strongly suggestive of coronal microleakage.     

Clinical survival and performance of premolars restored with direct or indirect cusp-replacing resin composite restorations with a mean follow-up of 14 years

ObjectivesThe objective is to evaluate the long-term clinical survival and performance of direct and indirect resin composite restorations replacing cusps in vital upper premolars.MethodsBetween 2001 and 2007, 176 upper premolars in 157 patients were restored with 92 direct and 84 indirect resin composite restorations as part of an RCT. Inclusion criteria were fracture of the buccal or palatal cusp of vital upper premolars along with a class II cavity or restoration in the same tooth.ResultsForty patients having 23 direct and 22 indirect composite restorations respectively, were lost to follow-up (25.6%). The cumulative Kaplan-Meier survival rates were 63.6% (mean observation time: 15.3 years, SE 5.6%) with an AFR of 2.4% for direct restorations and 54.5% (mean observation time: 13.9 years, SE: 6.4%) with an AFR of 3.3% for indirect restorations. The Cox regression analysis revealed a statistically significant influence of the patient’s age at placement on the survival of the restoration (HR 1.036, p = 0.024), the variables gender, type of upper premolar, type of restoration, and which cusp involved in the restoration had no statistically significant influence. Direct composite restorations failed predominantly due to tooth fracture, indirect restorations primarily by adhesive failure (p < 0.05).SignificanceThere was no statistically significant difference in survival rates between direct and indirect composite cusp-replacing restorations. Both direct and indirect resin composite cusp-replacing restorations are suitable options to restore compromised premolars. The longer treatment time and higher costs for the indirect restoration argue in favor of the direct technique.     

A clinical evaluation of resin-based composite and glass ionomer cement restorations placed in primary teeth using the ART approach: results at 24 months

BACKGROUND: The authors evaluated the 24-month performance of a packable resin-based composite/dentin bonding system and a high-viscosity glass ionomer cement (GIC) in restorations placed in primary molars with the atraumatic restorative treatment (ART) approach. METHODS: Three dentists placed 419 restorations in 219 children aged 6 through 10 years who had bilateral matched pairs of carious posterior Class I and II primary teeth. They used a split-mouth design to place the two materials, which were assigned randomly to contralateral sides. The authors evaluated the restorations according to U.S. Public Health Service Ryge criteria. RESULTS: After 24 months, 96.7 percent of the Class I GIC restorations and 91 percent of the resin-based composite restorations survived, while the success rates for the Class II restorations were 76.1 percent and 82 percent for the GIC and resin-based composite restorations, respectively. The survival rate of the Class II resin-based composite restorations was 5.9 percent higher than that of the GIC restorations at the 24-month evaluation, but this difference was not statistically significant. However, the study results showed a statistically significant difference in survival rates between Class I and II restorations for both materials. CONCLUSION AND CLINICAL IMPLICATIONS: The two-year clinical performance of both materials was satisfactory for the restoration of Class I and II primary molars using the ART approach.     

Bisphenol A and other compounds in human saliva and urine associated with the placement of composite restorations

BackgroundBisphenol A (BPA) and other related chemical compounds may be components used in the manufacturing process of resin-based composite dental restorative material. The purpose of the authors^# study was to assess salivary and urinary concentrations of BPA and other compounds before and after placement of resin-based composite dental restorations.MethodsThe authors collected saliva and urine from 172 participants receiving composite restorations before and as long as 30 hours after placement of composite restorations. The authors analyzed saliva specimens from 151 participants and urine specimens from 171 participants for concentrations of BPA and five related compounds by using liquid chromatography/mass spectrometry (LC/MS).ResultsSalivary concentrations of BPA and some related compounds increased immediately (within one hour) after composite placement. Salivary concentrations of BPA and most study compounds returned to prerestoration levels within eight hours after composite placement. With the exception of a 43 percent increase in BPA, concentrations of the study compounds in urine returned to prerestoration levels nine to 30 hours after restoration placement. Concentrations in saliva were lower when a rubber dam was used; however, rubber dam use appeared to have no effect on urinary concentrations of the measured compounds during the study period. The authors observed similar changes in study compound levels in both saliva and urine between participants who received anterior restorations and those who received posterior restorations.ConclusionsPlacement of resin-based composite restorations was associated with detectable increases in saliva of BPA and other study compounds within one hour after restoration placement and an increased concentration of BPA in urine nine to 30 hours after restoration placement. Rubber dam use did not reduce the absorption of BPA (measured as BPA level in urine) during the study.Clinical ImplicationsAdditional studies are needed to address how long BPA levels in urine associated with composite placement remain elevated to aid in better understanding of the clearance rates of BPA and other study compounds.     

What German dentists choose for their teeth: A Web-based survey of molar restorations and their longevity

Statement of problemWhich restorative material is best suited for treating the posterior molar region is unclear. As dentists presumably choose the most appropriate restoration, German dentists were asked how their own molars were treated.PurposeThe purpose of this survey study was to examine molar restorations and their durability in German dentists.Material and methodsIn the official journal of the Federal Dental Association, German dentists were asked to participate in an online survey that gathered demographic data and information on the type and durability of their molar restorations. To reduce selection bias, the data were weighted for region, sex, and age of the dentist.ResultsThe data set consisted of 1719 molars from 288 dentists. Restorations included gold inlays (25%), composite resin (24.3%), amalgam (11.8%), ceramic inlays (5.4%), glass ionomer cement or compomer (0.8%), gold crowns (21.8%), ceramic crowns (6.6%), and metal-ceramic crowns (4.3%). Notable differences were identified based on the sex, age, and region of the dentist. Women selected increased esthetic options, as did young dentists. Restorations made of gold, amalgam, and base metal had the highest longevity, at more than 20 yearsConclusionsAmong German dentists, restorations with metallic materials dominated in molars, with gold accounting for the largest share. In recent years, the proportion of tooth-colored restorations has increased, and in particular, young dentists use composite resin and ceramics.     

Clinical performance of posterior resin composite restorations after up to 33 years

ObjectivesThis retrospective study evaluated the performance of posterior composites after up to 33 years of clinical service and investigated factors associated with the risk of failures over time including patient- and tooth-related variables.MethodsPatients who received at least one Class I or Class II direct composite restoration in a private office in 1986–1992 and had follow-up appointments were included. Failures and interventions over time were investigated using the dental records. A follow-up clinical recall was carried out in 2020. Two scenarios were considered: restorations that did not require any intervention (success) or restorations that were repaired and still functional (survival). Multivariate Cox regression analyses and Kaplan-Meier curves were performed using success and survival rates (p < 0.05).ResultsOne hundred patient records and 683 restorations were included. A total of 353 failures were reported (success rate= 48%). Main reasons for failure were fracture and secondary caries. Most interventions after failures were repairs. Replacements were registered in 183 cases (survival rate= 73%). Annual failure rates were below 2.5% (success) and 1.1% (survival). Larger restorations and maxillary molars had higher failure risks. No significant differences in success rates among different resin composites was observed. A typical observation in this sample of restorations was the presence of moderate to advanced signs of aging, including marginal and surface staining, wear, chipping, changes in anatomical shape and translucency. Clearly aged restorations were still clinically satisfactory. Significance: This long-term, practice-based study indicates that resin composites can be used to restore posterior teeth with a long-lasting durability.     

Extensive composite molar restorations: 3 years clinical evaluation

Abstract

Objective. To evaluate the clinical performance of extensive direct composite restorations in molars after 1 and 3 years and to find out the importance of extent of the restorations and other factors related to their performance. Materials and methods. Seventy-four patients with a molar tooth in need of a restoration covering at least three surfaces and one cusp were selected. Patient-related factors were registered and the tooth was prepared and restored by using a nano-filled composite. A topographic system for classification of extensive posterior restorations was developed. At baseline, the operator recorded a clinical evaluation, using modified USPHS-criteria. After 1 and 3 years, an independent observer evaluated the restorations. Post-operative problems arising during the observation period were registered. Results. A change in clinical score from baseline to the 1 and 3 year recall was recorded for all clinical criteria. A total of nine restorations were graded as unacceptable after 3 years (3-year survival rate of 87.7% and a mean annual failure rate of 4.2%). Except for gender (p = 0.022), none of the patient-related factors investigated (age, caries risk, extension of the restoration and presence of cervical enamel) had a significant influence on the survival of the restorations. Conclusions. Extensive direct posterior composite restorations showed an acceptable clinical performance after 3 years. Men had a significantly greater restoration failure rate than women.     

One-year clinical evaluation of bulk-fill flowable vs. regular nanofilled composite in non-carious cervical lesions

Objective

The aim of this double-blind, randomized trial was to evaluate the 1-year clinical performance of a bulk-fill flowable and a regular nanofilled composite in non-carious cervical lesions (NCCLs).

Methods

Twenty-two subjects with at least two NCCLs were enrolled in the study. A total of 89 restorations were performed by a single operator using Filtek Supreme (FS) Ultra Universal or Filtek Bulk (FB) Fill Flowable. A universal adhesive (Scotchbond™ Universal Adhesive) was used with a self-etching approach in dentin. The restorations were evaluated by two independent and previously calibrated examiners at baseline (7 days), 6 months and 1 year, according to the USPHS modified criteria. Mann–Whitney U test was used to analyze the differences between composites and Wilcoxon signed rank test for comparisons between the baseline and follow-ups (α = 5%).

Results

One restoration was considered clinically unacceptable due to loss of retention after 6 months in the FS group. FS presented statistically high scores for surface roughness when compared to FB after 1 year (p < 0.05), but both were considered clinically acceptable. After 1 year, the frequency of clinically unacceptable rates was 3.3% for anatomical form in the FB group, 1.1% for retention in the FS group, and 2.2% for marginal adaptation in both groups. All restorations, in both groups, presented score 0 over the 1-year period for marginal staining, postoperative sensitivity, and secondary caries.

Conclusion

Both composite resins showed acceptable clinical performances for the restoration of NCCLs after 1 year.

Clinical relevance

Both bulk-fill flowable and regular nanofilled composites showed good clinical performances for the restoration of NCCLs after 1 year.

     

Is high-viscosity glass-ionomer-cement a successor to amalgam for treating primary molars?

ObjectivesTo assess and compare the cumulative survival rate of amalgam and atraumatic restorative treatment (ART) restorations in primary molars over 3 years.Methods280 children aged 6–7 years old were enrolled in a cluster randomized controlled clinical trial using a parallel group design covering two treatment groups: conventional restorative treatment with amalgam (CRT) and atraumatic restorative treatment (ART) using a high-viscosity glass-ionomer (HVGIC) Ketac Molar Easymix. Three pedodontists placed 750 restorations (364 amalgam and 386 ART in 126 and 154 children, respectively) which were evaluated at 0.5, 1, 2 and 3 years. The proportional hazard rate regression model with frailty correction, ANOVA and Wald tests, and the Jackknife procedure were applied in analysing the data.ResultsThe cumulative survival rates over 3 years for all, single- and multiple-surface CRT/amalgam restorations (72.6%, 93.4%, 64.7%, respectively) were no different from those of comparable ART/HVGIC restorations (66.8%; 90.1% and 56.4%, respectively) (p = 0.10). Single-surface restorations had higher survival rates than multiple-surface restorations for the both treatment procedures (p < 0.0001). A higher proportion of restorations failed because of mechanical reasons (94.8%) than of secondary caries (5.2%). No difference in reasons for restoration failures between all types of amalgam and ART/HVGIC restorations were observed (p = 0.24).SignificanceThe high-viscosity glass-ionomer used in this study in conjunction with the ART is a viable option for restoring carious dentin lesions in single surfaces in vital primary molars.     

Repair or replacement of defective direct resin-based composite restorations: contemporary teaching in U.S. and Canadian dental schools

BackgroundOpportunities exist to promote minimally invasive dentistry by repairing rather than replacing defective and failing direct resin-based composite restorations. The authors conducted a study to investigate the current teaching of such techniques in U.S. and Canadian dental schools.MethodsIn late 2010, the authors, with the assistance of the Consortium of Operative Dentistry Educators, invited 67 U.S. and Canadian dental schools to participate in an Internet-based survey.ResultsThe response rate was 72 percent. Eighty-eight percent of the dental schools taught repair of defective direct resin-based composite restorations. Of these schools, 79 percent reported providing both didactic and clinical teaching.ConclusionsAlthough teaching repair of defective resin-based composite restorations was included in the didactic curricula of most schools, students in some schools did not gain experience in minimally invasive management of defective resin-based composite restorations by means of performing repair procedures. The American Dental Association's Code on Dental Procedures and Nomenclature does not have a procedure code for resin-based composite restoration repairs, which may limit patients' access to this dental treatment.Clinical ImplicationsTeaching dental students minimally invasive dentistry procedures, including restoration repair, extends the longevity of dental restorations and reduces detrimental effects on teeth induced by invasive procedures, thereby serving the interests of patients.     

Effectiveness of computerized delivery of intrasulcular anesthetic in primary molars

BACKGROUND: Pain measures associated with computerized delivery of intrasulcular anesthestic have not been reported. The authors evaluated a computerized delivery system for intrasulcular (CDS-IS) anesthesia in primary molars. METHODS; The study population consisted of children aged 2 to 13 years who received CDS-IS injections, 159 in mandibular molars and 48 in maxillary molars. Children were treated by one of three modes of behavioral management: behavior modification (BM) only, inhalation of nitrous oxide (N2O) in addition to BM or intrarectal sedation. Variables evaluated included the subjective perception of the child's well-being before and after administration of the anesthetic, the child's pain behavior during anesthetic administration, effectiveness of the anesthetic during dental treatment, incidence of reported postoperative dental pain (PDP) and analgesic use after the CDS-IS injections. RESULTS: The effectiveness of CDS-IS anesthesia in mandibular molars was 97 percent, 92 percent, 63 percent and 71 percent for restorations, preformed stainless steel crowns, extractions and pulpal therapies, respectively (mean effectiveness, 89 percent). The effectiveness of CDS-IS anesthesia in maxillary molars was 96 percent, 50 percent, 92 percent and 78 percent, respectively (mean effectiveness, 90 percent). CDS-IS was less effective in children aged 2 to 4 years who received sedation than it was in older children. The authors found no differences between children's subjective self-reports of well-being before and after anesthetic administration, between the sexes and/or between modes of behavioral management (that is, BM or N2O). Most children exhibited low pain-related behavior during anesthetic administration, with no differences between boys and girls. The overall incidence of PDP was 31.4 percent; 64.9 percent of these patients received pain-relieving medications as a result, with no correlation to age, tooth treated, effectiveness of anesthesia or type of treatment. CONCLUSIONS: CDS-IS is effective for anesthetizing primary molars, mainly for amalgam, resin-based composite and stainless steel crown restorations.     

Longevity of occlusally-stressed restorations in posterior primary teeth

PURPOSE: To compile a survey of the longevity and reasons for failure of stainless steel crowns, amalgam, glass-ionomer, composite and compomer restorations in stress-bearing cavities of primary molars. METHODS: This work reviewed the dental literature of 1971 up to July 2003 for longitudinal, controlled clinical studies and retrospective cross-sectional studies. Only studies investigating the clinical performance of restorations in primary teeth with an observation period of at least 2 years were included. Annual failure rates of stainless steel crowns, amalgam, glass-ionomer, composite and compomer restorations were determined and failure reasons were discussed. RESULTS: Annual failure rates in stress-bearing cavities of primary molars were determined to be: 0-14% for stainless steel crowns, 0-35.3% for amalgam restorations, 0-25.8% for glass-ionomer restorations, 2-29.1% for atraumatic restorative treatments, 0-15% for composite restorations, and 0-11 for compomer restorations. Main reasons for failure were secondary caries, marginal deficiencies, fracture, and wear.     

Is composite repair suitable for anterior restorations? A long-term practice-based clinical study

Objectives

This study investigated the impact in survival, when repair is seen as failure or not, in anterior composite restorations with a retrospective 15-year follow-up study.

Materials and methods

Data was collected from patients’ files of a private dental practice, including patients with direct composite restorations placed in anterior teeth (class III, class IV, or veneer) between January 1994 and December 2009. Data were analyzed considering or not repair as failure. Statistical analysis was performed with log rank test, Kaplan–Meier, and Cox regression (p < .05).

Results

One hundred forty-four patients’ files were included, with 634 restorations. At 15 years, Class III / IV restorations showed 69% survival and 2.4% annual failure rate (AFR) when repair was not considered as failure, and 64% and 2.9% AFR, respectively, when repair was seen as failure. For direct veneers, at 5 and 10 years of follow-up, survival dropped from 85% to 74% and from 52% to 38% respectively, when repair was considered as failure. In general, restorations placed in the upper jaw showed increased risk for failure compared to the lower jaw (p < .01), and restorations in central incisors presented a higher risk for failure compared to canines (p < .01).

Conclusion

Composite repair seems a suitable alternative for class III, class IV, and veneer restorations since it was able to increase the survival of restorations performed in anterior teeth.

Clinical relevance

Composite repair for anterior restorations is a suitable restorative treatment option and presents benefits over replacement, including the preservation of sound tooth structures, reduced clinical chair time, and patient anxiety.

     

One-year retrospective clinical evaluation of hybrid composite restorations placed in United Kingdom general practices.

OBJECTIVE: The purpose of this study was to assess Pertac II restorations placed in general dental practice. METHOD AND MATERIALS: A total of 86 restorations (14 Class I, 10 Class II, 17 Class III, 5 Class IV, and 40 Class V) using a hybrid composite material (Pertac II) placed in 56 patients (mean age, 39 years) in 5 dental practices in the United Kingdom were assessed after 1 year by a trained evaluator and the dental practitioner who had placed the restoration. All the restorations were assessed for anatomic form, marginal adaptation, surface roughness, sensitivity or discomfort, gingival condition, and the presence or absence of secondary caries. RESULTS: Thirty-five (43%) restorations were placed in load-bearing situations, 9% of which were assessed as being in "heavy" occlusion. Five (6%) of the restorations were lost (all Class V restorations), 4 from premolars and 1 from a molar. Four were in wedge-shaped cavities and 1 small restoration was actually dislodged during examination. The remaining 81 (94%) restorations were found to be intact, with no secondary caries detected. A high percentage of optimal scores were recorded for both anatomic form and surface roughness. CONCLUSION: It is concluded that the evaluation demonstrated satisfactory clinical performance of Pertac II restorations after 1 year of clinical service in the wide variety of clinical situations seen in general dental practice. However, the potential for failure of hybrid composite materials in Class V situations appears high. It may be argued that clinicians who wish to use a resin-based material in a Class V situation should use a compomer or microfilled composite.     

Twelve-month randomized controlled trial of 38% silver diamine fluoride with or without potassium iodide in indirect pulp capping of young permanent molars

BackgroundThe clinical and radiographic effectiveness of 38% silver diamine fluoride (SDF) with and without potassium iodide (KI) was tested and compared with resin-modified glass ionomer cement (RMGIC) in indirect pulp capping of deep carious lesions in young permanent molars.MethodsOne hundred eight permanent first molars with deep occlusal cavitated carious lesions in 49 children aged 6 through 9 years were randomly allocated into 3 groups (n = 36 molars per group) and treated with SDF plus KI, SDF, and RMGIC. RMGIC was used as a base and a resin-based composite restoration followed. Clinical assessments for secondary caries (primary outcome), postoperative pain, tooth vitality, and restoration success and quality rates according to Modified US Public Health Service and Ryge Criteria for Direct Clinical Evaluation of Restorations were performed after 3, 6, and 12 months. Periapical radiographs were obtained at baseline, 6 months, and 12 months. Outcomes were assessed using mixed effects multilevel logistic and linear regression analyses.ResultsThere were no significant differences (P = .26) among the groups at all times for secondary caries, postoperative pain, tooth vitality, clinical abscess, radiographic signs of pulpal pathology, restorations’ marginal adaption, anatomic form, and surface roughness. There was a significant difference (P = .03) in restoration color, marginal staining, and luster. The RMGIC group outperformed the 2 SDF groups in color and luster.ConclusionsThe authors did not find differences among the groups in preventing secondary caries or pain or in maintaining pulpal health. The RMGIC group had better restoration color and luster than both SDF groups and better marginal staining than the SDF group.Practical ImplicationsThe results of this study can help guide treatment decision making regarding use of SDF and SDF plus KI as indirect pulp capping materials in deep cavitated lesions.This clinical trial was registered at ClinicalTrials.gov. The registration number is NCT04236830.     

Longevity of posterior resin composite restorations in permanent teeth in Public Dental Health Service: A prospective 8 years follow up

ObjectivesTo investigate in a prospective follow up the longevity of posterior resin composites (RC) placed in permanent teeth of children and adolescents attending Public Dental Health Service.MethodsAll posterior RC placed, in the PDHS clinics in the cities of Copenhagen and Frederiksberg in Denmark between November 1998 and December 2002, in permanent teeth of children and adolescents up to 18 years, were evaluated in an up to 8 years follow up. The endpoint of each restoration was defined, when repair or replacement was performed. Survival analyses were performed between subgroups with Kaplan–Meier analysis. The individual contribution of different cofactors to predict the outcome was performed with Cox regression analysis.ResultsTotally 2881 children with a mean age of 13.7 years (5–18) received 4355 RC restorations placed by 115 dentists. Eighty percent were placed in molars and 49% were Class I. Two percent of restorations with base material and 1% of the restorations without base material showed postoperative sensitivity (n.s.). Replacements were made in 406 and repairs in 125 restorations. Kaplan–Meier analysis showed a cumulative survival at 8 years of 84.3%, resulting in an annual failure rate of 2%. Lower patient age, more than one restoration per patient, placement of a base material and placement of RC: in molars, in cavities with high number of surfaces, in lower jaw teeth, showed all significant higher failure rates. Five variables had significant importance for the end point, replacement/repair of the resin composite restorations: age of patient, age of operator, jaw, tooth type and cavity size.SignificancePosterior RC restorations placed in children and adolescents in Public Dental Health clinics showed an acceptable durability with annual failure rates comparable with those of randomized controlled RC studies in adults.     

A clinical evaluation of a resin composite and a compomer in non-carious Class V lesions. A 3-year follow-up

PURPOSE: To compare the clinical performance of a resin composite and a polyacid-modified resin composite (compomer) in non-carious cervical lesions using a one-step self-etch adhesive. METHODS: Thirty patients, each with two non-carious cervical lesions (60 restorations), received one composite (Pertac-II) restoration and one compomer (Hytac) restoration, both used in conjunction with a self-etch adhesive (Prompt L-Pop) and placed following the manufacturer's instructions. Evaluations were at baseline, 6, 12 and 36 months after placement for retention, margin adaptation, marginal discoloration, anatomic form, secondary caries and postoperative sensitivity. Statistical analysis with the Pearson Chi-square test was undertaken. RESULTS: Retention rates were 86.6% for composite and 86.7% for compomer at 36 months. 3.3% of composite and 6.7% of compomer restorations showed a deficiency in marginal adaptation. Both materials showed a slight marginal discoloration of 7.7%. More deterioration in anatomic form occurred with the compomer (11.5%) than the composite (3.8%). None of the restorations exhibited secondary caries or postoperative sensitivity problems. There was no significant difference in performance between the materials in any of the categories evaluated.     

Effect of Repairing Endodontic Access Cavities on Survival of Single Crowns and Retainer Restorations

IntroductionThis retrospective study aimed to analyze the effect of repairing endodontic access cavities with composite on the survival of single crowns and retainer restorations of fixed or removable dental prostheses.MethodsDental records of patients attending a university dental clinic were retrospectively screened for single crowns and retainer restorations receiving endodontic treatment after crown placement. Survival (no further intervention) and failure (removal, loss or replacement of crown, replacement of access restoration, or recementation of restoration) of crowns and retainers with repaired endodontic access cavities were recorded. The mean annual failure rates were calculated, and the effect of individual-, tooth-, and restoration-related variables on survival was assessed by univariate log-rank tests and multivariate Cox regression analyses with shared frailty (P < .05).ResultsOne hundred eighty repaired crowns/retainers placed in 151 patients were included (4.5 ± 3.3 years follow-up). Survival after 2, 5, 7, and 10 years amounted to 82.7%, 71.5%, 67.3%, and 48.8% (mean annual failure rate = 9.0%, 6.5%, 5.5%, and 6.9%), respectively. Although tooth type, kind of restoration, endodontic irrigant, repair conditioning methods, and kind of composite affected survival in the univariate regression analyses, only the kind of restoration (single crown vs retainer restoration) remained significant in the multivariate Cox regression model.ConclusionsRepairing endodontic access cavities with composite increases the longevity of single crowns and retainer restorations.     

Clinical performance and SEM marginal quality of extended posterior resin composite restorations after 12 years

ObjectiveTo investigate the clinical behavior of two different resin-based restorative systems in extended Class II cavities in a controlled prospective split-mouth study over 12 years and to assess marginal quality under a SEM using epoxy replicas.MethodsThirty patients received 68 resin composite restorations (Solobond M + Grandio: n = 36; Syntac + Tetric Ceram: n = 32) by one dentist in a private practice. 35% of cavities revealed no enamel at the bottom of the proximal box, 48% of cavities provided <0.5 mm remaining proximal enamel. Restorations were examined according to modified USPHS criteria at baseline, and after six months, one, two, four, six, eight, 10, and 12 years. Expoxy replicas of 21 restoration pairs were analysed under a SEM at 200× magnification regarding marginal quality.ResultsAt the 12-years recall, 59 of the original 68 restorations in 27 of 30 patients were available (drop out 13%). Two restorations failed due to cusp fracture (Tetric Ceram) and marginal fracture (Grandio). The overall success rate of all restorations was 97.1% (Kaplan–Meier survival algorithm) with no differences between the two materials (p = 0.923). After 144 months of clinical service, restorations in molars performed worse than in premolars regarding the integrity of restoration and tooth (p < 0.05) being detected as wear, chippings, and cracks. Beyond the 4-year recall, marginal staining significantly increased. SEM evaluation of replicas revealed that perfect margin (49% baseline vs. 10% after 12 years), overhang (13% at baseline vs. 3% after 12 years), negative step formation (34% at baseline vs. 75% after 12 years), and marginal fractures (0% at baseline vs. 6% after 12 years) significantly changed during the evaluation period (p < 0.001).SignificanceExtended direct resin composite restorations performed satisfactorily over 12 years of clinical service. SEM analysis delivered qualitative data regarding marginal deterioration over time.