Simple guidelines for aesthetic success with composite resin--Part I: anterior restorations.

Composite restorations have the advantage of being created in the dental office, which can lead to beautiful, natural aesthetics. Laboratory technicians tend to spend minimal time with the patient and reconstruct the restoration based on information provided by the clinician. Dentists, however, are at a great advantage, as they can refer to the surrounding tooth structure when building the restoration. Part I of this article will discuss various guidelines for treating anterior teeth using direct resin restorations, while Part II will address posterior restorations.     

Finishing and polishing of direct posterior resin restorations.

Direct composite resin materials have revolutionized the delivery of minimally invasive treatment in the posterior region. Contemporary resin formulations provide improved strength, wear resistance, and aesthetics. Microhybrid formulations have also been associated with enhanced polishability. Development of an optimal surface polish in turn reduces stain and plaque accumulation, minimizes wear, and enhances the appearance of the definitive restoration. This article presents a simplified technique and protocol for finishing and polishing composite resin materials following restoration of the posterior region. LEARNING OBJECTIVES: This article discusses techniques and a protocol for finishing and polishing posterior direct resin restorations. Upon reading this article, the reader should: Understand the clinical protocol necessary to create direct posterior resin restorations that require minimal finishing. Be able to select appropriate instrumentation for direct posterior resin finishing and polishing procedures. Understand the importance of correct finishing and polishing on plaque accumulation, stain resistance, and wear resistance.     

Direct posterior composite resin restorations: A review. 1. Factors influencing case selection

The principal factors that influence case selection for direct composite resin restorations in posterior teeth are discussed. These include the perceived preference for tooth-coloured aesthetics, survival rate and replacement of posterior composites, clinical problems and concerns such as occlusal surface defects and the numerous effects of the material's polymerization contraction, and the availability of alternative tooth-coloured techniques for restoring posterior teeth. Specific guidelines in case selection are suggested. A subsequent paper reviews controversial aspects of the restorative technique for posterior composites and, on this basis, defines important principles in the clinical technique.     

Achieving optimal aesthetics for direct and indirect restorations with microhybrid composite resins.

In aesthetic dentistry, material science has played a key role in the development of natural-appearing restorations. Despite the progress, there have been challenges in achieving a harmonious integration of direct and indirect posterior restorations. Although porcelain restorations provide natural aesthetics, ceramics cannot be applied via direct techniques. Consequently, composite resins are valuable alternatives for conservative posterior restorations. In addition, because of their differing physical and optical properties, optimal aesthetic blending with porcelain and resin cannot be routinely achieved. This article explores the potential of composite resins as a direct and indirect restorative option in achieving the most favorable natural blend in the posterior region.     

Effects of the removal of composite resin restorations on Class II cavities.

Composite resin has such good aesthetic qualities that it is often difficult to identify the tooth-restoration interface, yet this is particularly important should the material require complete removal. Following the in-vitro removal of direct and indirect composite resin restorations from Class II cavities significant changes in cavity size and shape were recorded. Thirty-eight cavities were studied from both occlusal and proximal aspects and the final cavity size was compared to the original cavity. There was a significant increase in cavity size with a mean increase of 37% for the direct composite cavities and 35% for the indirect cavities, although the range of values is large. Following restoration removal, occlusal surfaces were seen to increase in 71% of teeth and proximal surfaces in 75% of teeth. There was no significant difference between the results for direct and indirect composite restorations. Occlusal dovetails and cavity undercuts were created in cavities which did not contain these features initially.     

Composite or amalgam? Not a black or white decision

Amalgam as a restorative material in dentistry is discussed because of believed toxic properties of the material, yet there is no scientific prove for the assumption. Adhesive restorations are a possible alternative for amalgam in restoring posterior teeth. For treatment of primary caries, the direct composite resin restoration has many advantages. When greater defects are to be restored, adhesive composite resin restorations become less favourable. At this moment no long term results are available for indirect adhesive techniques. For the time being it seems necessary to use composite resin as well as amalgam for the restoration of posterior teeth.     

Dentists' restorative decision‐making and implications for an ‘amalgamless’ profession. Part 1: a review

The Minamata Convention has agreed to a worldwide reduction and ultimate elimination in the production and use of mercury containing products. This will have implications for the practice of dentistry. Australian organizations' pronouncements on the issue are limited and research examining the Australian context dated. The restoration of teeth with direct materials has changed significantly since the 1980s. Up to this time amalgam was the material of choice for direct posterior restorations. Its properties and guidelines for placement were, and remain, well established. Resin composite has replaced amalgam as the material of choice in many clinical situations. Despite inherent clinical disadvantages compared to amalgam, there continues to be a shift toward greater use of resin composite. There is consensus worldwide that the restoration of posterior teeth using resin composite now exceeds that of amalgam. The reasons for this are reviewed in this article along with current evidence and commentary relating to direct restorative and evidence‐based decision‐making, minimally invasive approaches, and approaches to education. The implications for these in an ‘amalgamless’ profession are identified.     

Functional and aesthetic guidelines for stress-reduced direct posterior composite restorations

Amalgam has been used in the restoration of structurally compromised posterior teeth for many years. When placing large amalgam restorations, replacement of weak cusps with restorative material is recommended to prevent tooth fracture. This recommendation can be modified with new guidelines using modern adhesive techniques. Semidirect and indirect inlay/onlay composite restorations have progressively replaced amalgam restorations over the past 20 years. Lately, single visit direct resin-bonded composite (RBC) restorations have also been used as a viable alternative to conventional indirect restorations. This paper is intended to introduce a step-by-step protocol for the direct restoration of structurally compromised posterior teeth using RBCs with stress-reducing protocols.     

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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 evaluation of direct composite restorations for the worn mandibular anterior dentition - clinical performance and patient satisfaction

This prospective split-mouth clinical trial evaluated the performance and patient satisfaction of 168 Herculite XRV direct composite restorations bonded to the worn anterior dentition of 18 patients with localized anterior tooth surface loss. One hundred and six of these restorations were placed on the mandibular anterior teeth. The restorations increased the anterior occlusal vertical dimension between 0.5 and 5 mm and the posterior occlusal contacts were restored after a mean duration of 6.2 months (range: 3-13 months) in 14 out of the 15 'Dahl' sub-group patients. The restorations were evaluated after 2.5 years of service by five examiners. Four patients and 23 mandibular restorations were lost to follow-up. Multiple clinical and restorative variables were assessed to determine their influence on restoration performance. Complete failure occurred in 6% of the restorations. Circumferential preparation and height of the restorative addition did not influence the performance of the restorations. A Visual Analogue Scale (VAS) was used to assess the patient's opinion regarding sensitivity, aesthetics, longevity and function of the worn mandibular anterior teeth. A statistically significant difference (95% CI) was found between the pre-operative and 1-month review VAS responses for aesthetics and longevity and this was maintained at the 2.5-year review. Direct composite restorations placed at an increased occlusal vertical dimension are a simple and time-efficient method of managing the worn mandibular anterior dentition. Patient's acceptance and adaptation to the technique is good and the results are accompanied with a high level of patient satisfaction that is maintained for the medium-term.     

Achieving form and function for Class II restorations using aesthetic resin stratification.

It can be challenging to reproduce the appropriate three-dimensional contours when the proximal walls of posterior teeth have been lost. This presentation will demonstrate the fundamentals required to achieve predictable success when placing direct posterior composites in these Class II sites. The keys to successful placement of resin materials (eg, adhesive technique, integration of form and function, color match) are covered herein. When placing a direct resin restoration, clinicians must have a sound understanding of tooth morphology, combined with the proper techniques, outlined in the clinical case, in order to obtain an acceptable aesthetic restoration.     

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.     

Marginal seal comparisons between resin-bonded Class II porcelain inlays, posterior composite restorations, and direct composite resin inlays

The microleakage of indirect porcelain and direct composite resin-bonded inlays was compared with that of posterior composite resin restorations using Class II preparations of extracted molar teeth. The resin-bonded inlay restorations provided a better marginal seal at the cervical restoration/dentin interface than did the composite resin restoration. The efficacy of this marginal seal varied with the particular treatments and materials used. Resin-bonded porcelain inlays had a higher incidence of cervical excess from the composite resin luting agent than did the posterior composite resin restorations.     

Conservative full-mouth resin renewal

The treatment of this patient involved the coordination of periodontal, orthodontic, restorative, and aesthetic considerations. It was unique because it involved only resin as the primary restorative material, which allowed for conservative preparations and restorations. In the posterior, the use of direct and indirect resins resulted in the removal of little or no healthy tooth structure. In the anterior, the use of direct resin veneers required minimal removal of enamel, while still achieving proper function and aesthetics. Resin restorations in this particular case allowed for an acceptable clinical result and a highly satisfied patient.     

Guidance on posterior resin composites: Academy of Operative Dentistry - European Section

There have been many developments in operative dentistry in recent years, including a progressive shift to the use of resin composites, rather than dental amalgam, in the restoration of posterior teeth. This shift allows the adoption of minimal intervention approaches, thereby helping to conserve and preserve remaining tooth tissues and structures. This paper presents the position of the Academy of Operative Dentistry European Section (AODES) in relation to posterior resin composites. The AODES considers adhesively bonded resin composites of suitable composition and properties to be the “material of choice” for use in direct minimal intervention approaches to the restoration of posterior teeth. In so doing, the AODES emphasises the importance of the practice of evidence-based minimal intervention dentistry, including the use of refurbishment and repair techniques to extend the longevity of restorations. Guidance, based on best available evidence, has been made in relation to certain aspects of resin composite placement techniques in posterior teeth.     

下颌第一磨牙牙体缺损全冠修复的应力分析

目的：观察下颌第一磨牙根管治疗术后不同程度的远中牙合面（distal oeclusal简称DO）牙体缺损，在银汞合金或复合树脂修复后再用全冠修复的应力分析，了解牙体缺损程度对牙体抗折力的影响，比较两种修复DO洞是否有不同的影响。方法：通过三维激光扫描、三维造型设计建立下颌第一恒磨牙髓室壁未破坏的最小、中等、最大以及髓室壁部分破坏的最大远中黯面牙体缺损的三维有限元模型。观察4种模型4种载荷下牙本质Mohr应力分布，比较牙本质最大Mohr值。结果：在最大、垂直、斜向载荷下，两种修复体牙本质最大Mohr值均明显小于牙本质拉伸极限强度。在水平载荷下，两种修复体牙本质最大Mohr值均有急剧增加。银汞合金、全冠修复应力面积普遍大于复合树脂、全冠修复应力面积。牙本质最大Mohr值总的趋势复合树脂、全冠修复的大于银汞合金、全冠修复的。结论：在正常咬合下，下颌第一磨牙（36、46）DO牙体缺损髓室壁牙体组织未破坏，牙体预备体颊、舌侧厚度不少于1mm；髓室壁牙体组织部分破坏，牙体预备体舌侧厚度至少1mm、颊侧厚度至少2．5mm，临床可考虑用复合树脂、银汞合金修复再加全冠修复。在存在磨牙症情况下，应采取减轻黯力的措施。对较大面积牙体组织DO缺损且破坏到髓室壁的病例以复合树脂加全冠修复为好。     

A clinical evaluation of packable and microhybrid resin composite restorations: one-year report.

OBJECTIVE: The objective of this study was to evaluate the clinical performance of two packable and one microhybrid resin composites placed in occlusal cavities of posterior permanent teeth after 1 year. METHOD AND MATERIALS: Sixty occlusal restorations were placed in 18 male or female patients aged 21 to 44 years. The restorations were divided into three groups according to the restorative material: G1 (Surefil + Prime&Bond NT); G2 (Filtek P60 + Singlebond), and G3 (Suprafill + Suprafill). They were placed by two previously calibrated operators. The restorations were directly evaluated for color matching, marginal discoloration, secondary caries, wear, marginal adaptation, and postoperative sensitivity. RESULTS: Of the total restorations, 66.7% were scored A (ideal) for color matching; 98.2% for marginal discoloration; 100% for secondary caries; 92.6% for wear; and 92.6% for marginal adaptation. Postoperative sensitivity was reported in 5% of the restorations. Fisher's exact, McNamara's, and chi-square tests did not indicate statistical difference between the groups, related to the evaluated criteria. CONCLUSIONS: The packable (Filtek P60 and Surefil) and the microhybrid (Suprafill) resin composites exhibited excellent clinical performance after 1 year and may be considered possible materials for the restoration of posterior teeth.     

Seven-year clinical evaluation of painful cracked teeth restored with a direct composite restoration

The purpose of this study was to investigate long-term clinical effectiveness of treating painful cracked teeth with a direct bonded composite resin restoration. The hypothesis tested was that cracked teeth treated with or without cuspal coverage showed the same performance. Forty-one patients attended a dental practice with a painful cracked tooth that was restored with a direct composite resin restoration. Twenty teeth were restored without and 21 with cuspal coverage. After 7 years, 40 teeth could be evaluated. Three teeth without cuspal coverage needed an endodontic treatment, of which 2 failed as a result of fracture. No significant differences were found for tooth or pulp survival. Three more repairable restoration failures were recorded. Mean annual failure rate of restorations without cuspal coverage was 6%; no failures in restorations with cuspal coverage occurred (P = .009). A direct bonded composite resin restoration can be a successful treatment for a cracked tooth.     

Use of a removable partial denture in the management of chronic screw loosening

Lack of posterior support can result in adverse occlusal forces being placed on anterior teeth. These forces may cause fremitus, splaying of the anterior teeth, and even accelerated wear. When implant-supported restorations are used, a common indicator of overload is screw loosening. This clinical report demonstrated conservative management of a patient who presented with multiple episodes of screw loosening of an implant-supported restoration replacing the maxillary left incisor secondary to developing reduced posterior support. Ideal treatment would be to re-establish posterior support by means of implant-supported restorations; however, this option was constrained by finances.     

Preventive resin restorations: indications, technique, and success.

Although preventive resin restorations have been reported since 1977, there is little uniformity concerning the indications for this procedure, nor is there a standard technique. This article proposes diagnostic criteria for pit and fissure occlusal caries and diagnosis-related considerations for treatment planning for preventive resin restorations. A step-by-step "laminate" technique, which includes, successively, a glass-ionomer cement liner, a posterior composite resin, and a sealant, is described. The success rates reported for several clinical studies of preventive resin restorations are presented, although the criteria for this restoration, treatment methodology, and the determinates of success vary from study to study.