Clinical evaluation of paired compomer and glass ionomer restorations in primary molars: final results after 42 months

OBJECTIVES: To undertake a clinical trial comparing the efficiency of a compomer restoration with a glass ionomer restoration in the management of caries in primary molar teeth. DESIGN: Subjects were admitted to the trial if they required at least one pair of restorations in primary molar teeth. SETTING: Department of Child Dental Health, Newcastle Dental Hospital and School. SUBJECT: Twenty nine children, aged 4-9 years, had 56 pairs of restorations placed between January 1995 and November 1997. METHOD: The durability of the restorations was assessed during a 42-month follow-up period using modified United States Public Health Service criteria. Survival analysis and the McNemar paired test were used to compare the performance of the two restorative materials. RESULTS: The compomer restorations had a higher mean survival time (42 months, SE 1.40) compared with 37 months (SE 1.90) for the glass ionomer restorations and this was significant at the 5% level. The compomer also performed significantly better in terms of anatomical form, marginal integrity, cavo surface discoloration and maintenance of interproximal contact. CONCLUSIONS: The present trial demonstrated that Dyract compomer performed significantly better than Chemfil Superior a glass ionomer cement for all modified United States Public Health Service criteria over a period of 42 months.     

Five year evaluation of class III composite resin restorations in cavities pre-treated with an oxalic- or a phosphoric acid conditioner

An oxalic acid solution has been proposed as a conditioning agent for resin composite restorations in two commercial adhesive systems. The durability of 163 class III restorations, including 12 class IV restorations, in cavities pre-treated with an oxalic acid total etch technique or an enamel etch with phosphoric acid was studied. Each of 52 patients received at least one of each of three experimental restorations. The restorations were evaluated yearly with slightly modified United States Public Health Service (USPHS) criteria. After 5 years 95% of the restorations were evaluated as acceptable. Reasons for failure were the fracture of four fillings, including three class IV, secondary caries contiguous to two fillings and a non-acceptable colour match for one restoration. For eight class III restorations a fracture of the incisal tooth structure was registered. No differences were seen between the three experimental restorations.     

Targis高嵌体修复无髓后牙缺损的观察

目的：考察Targis瓷聚体作高嵌体修复无髓后牙缺损的临床效果。方法：对47例患者的53个经完善根管治疗术的后牙缺损，采用Targis高嵌体修复。根据改良的USPHS修复体评价标准，分别于修复后1、2,3年对Targis高嵌体进行随访复查。结果：Targis高嵌体的颜色协调性、边缘适合性和边缘着色在观察期内无明显改变，也未见继发龋和余留牙体的折裂，其累计成功率为94．3％。结论：Targis瓷聚体用于无髓后牙缺损的高嵌体修复效果良好，为牙体缺损的美观修复提供了新的选择，但其远期效果有待进一步观察。     

The integrity of bonded amalgam restorations: a clinical evaluation after five years

BACKGROUND: Bonded amalgam restorations have been studied extensively in vitro, but few long term clinical studies exist. The authors examined the clinical performance of bonded amalgam restorations after five years of clinical service an compared it with that of nonbonded amalgam restorations. METHODS: The authors placed 75 bonded and 62 nonbonded amalgam restorations in patients needing restorations. Most of the restorations were placed in conventional preparations; six bonded restorations were placed in nonretentive cavities. They were evaluated after a five-year period of clinical service by two trained dentists using a mirror and explorer and following modified U.S. Public Health Service criteria. RESULTS: Statistical analysis (via Fisher exact test) showed no significant differences between the two techniques when conventional preparations were used. Restorations in nonretentive preparations were successful during this period. CONCLUSIONS: Bonded and nonbonded amalgam restorations yielded similar results in conventional preparations after five years of clinical service. Bonded amalgam restorations were clinically successful in a limited number of nonretentive preparations over a five-year period. CLINICAL IMPLICATIONS: Bonded amalgam restorations can be used successfully in conventional preparations and possibly in nonretentive preparations as well, and can be expected to last at least five years.     

One-year observations on a composite resin for Class II restorations

A study was conducted to compare the clinical performance of a proprietary composite resin with that of amalgam when used in the restoration of Class II cavities. A total of 124 paired restorations were placed. The restorations were evaluated by a team from the United States Public Health Service, Materials &; Technology Branch, Division of Dental Health, San Francisco, Calif.     

Clinical performance of a nanofilled resin composite with and without an intermediary layer of flowable composite: a 2-year evaluation

The objective of this prospective clinical follow-up was to evaluate the 2-year clinical performance of a nanofilled resin composite in class II restorations. The restorations were made with and without intermediary layer of a nanofilled flowable resin composite studied in an intraindividual comparison. Each participant received at least two, as similar as possible, class II restorations of the nanofilled resin composite. One restoration of each pair (54) was chosen at random to be restored with an intermediary layer with flowable nanofilled resin composite. The other was restored without. The restorations were evaluated with slightly modified US Public Health Services criteria at baseline, 1, and 2 years. Ninety-two restorations, 46 pairs, were evaluated at 2 years. A prediction of the caries risk showed that 22 of the evaluated 48 patients were considered as high-risk patients. Two failures were observed, one in each group, resulting in a 2.2% failure rate. No statistical difference was seen between the restorations restored with and without layer of flowable resin composite. The nanofilled resin composite showed very good surface characteristics and color match, which did not change significantly during the follow-up period. The nanofilled resin composite showed a good clinical performance with a 2.2% failure rate after 2 years. No differences were observed between the restorations with and without the nanofilled flowable resin intermediary layer.     

Tunnel restorations placed in routine practice and observed for 24 to 54 months.

OBJECTIVE: The purpose of this study was to evaluate the feasibility and performance of tunnel restorations placed in routine public dental service. METHOD AND MATERIALS: A total of 420 small approximal lesions received tunnel restorations 12 general practitioners. Three hundred two restorations in 179 patients were available for evaluation after a minimum period of 24 months. The restorations were evaluated by modified US Public Health Service criteria. RESULTS: After service periods up to 54 months, 57% of the restorations were found to be clinically and radiographically acceptable. The remainder had already been replaced or were assessed as unacceptable. High levels of carious activity and internal-type preparations resulted in the poorest prognosis. The success rates varied considerably among the operators, but these differences did not reach statistical significance. CONCLUSION: The indications for use of the tunnel restoration technique for the treatment of primary approximal lesions seem to be limited at present. Partial tunnel restorations may have a somewhat better prognosis than the internal tunnels, but high carious activity has a detrimental effect. Tunnel restorations may be considered for particularly cooperative patients with a low caries rate as a semipermanent treatment for small lesions.     

Clinical performance of posterior composite resin restorations.

Two formulations of posterior composite resin (P-30 and Bisfil-P) were evaluated and compared to a high-copper, dispersed-phase amalgam (Dispersalloy). One hundred twenty-eight restorations were placed in 27 patients so that each patient received at least one of each material. After 3 years of clinical service, all three restorative materials produced clinically acceptable restorations, according to US Public Health Service and Leinfelder criteria. The amalgam restorations, however, underwent less wear (44 microns) than did the posterior composite resin restorations (60 to 74 microns). Stratification of data by type of tooth, class of restoration, and size of restoration produced the same ranking of wear from lowest to highest: Dispersalloy, Bisfil-P, and P-30. Resin restorations showed 45% more wear in molars than in premolars, and more wear was associated with moderately sized restorations than with conservative restorations. The surface texture of restorations of composite resin with porous strontium glass filler was nearly as smooth as that of enamel and was significantly smoother than that of the restorations of composite resin with zinc glass filler or of unpolished amalgam.     

Atraumatic restorative treatment (ART): a three-year clinical study in Malawi--comparison of conventional amalgam and ART restorations

OBJECTIVE: This study compares the quality of class I restorations made with the atraumatic restorative treatment (ART) technique and conventional class I amalgam restorations. METHODS: The study was carried out among secondary school students in Mzuzu, Malawi. First-year students in 1987 who needed at least two class I restorations were selected. Based on a split-mouth design, each participant received both ART and conventional restorations. The 89 pairs of class I cavities were divided randomly into two groups, since two different cermet ionomer cement (CIC) filling materials were used. Impressions of the restorations and subsequent models were made shortly after restoration, after six months, one year, two years, and three years. The quality of the restorations was determined on the models following the US Public Health Service criteria. Bulk fracture, contour, marginal integrity, and surface texture of the restorations were recorded and evaluated separately. Survival rates were determined by the resultant score of all criteria. RESULTS: Though conventional amalgam restorations performed better on all criteria, this difference was significant only for the contour criterion. The survival rates of ART restorations after three years (81.0%) were lower than those of amalgam restorations (90.4%) (P=.067). CONCLUSIONS: The quality of ART class I restorations is competitive with that of conventional amalgam restorations.     

Clinical evaluation of two "packable" posterior composite resins

The purpose of this study was to evaluate the clinical performance of two "packable" posterior composites: Prodigy Condensable (P) (Kerr) and Definite (D) (Degussa). Thirty-six patients participated in the study. A total of 78 restorations were made, 40 with D and 38 with P. Each patient received at least two restorations, one of each studied material. The materials were handled according to the manufacturer's instructions. The restorations were finished and polished after 1 week. They were evaluated at baseline and after 1 year by two independent evaluators using the United States Public Health Service (USPHS) criteria. Colored slides were made of all the restorations. After 1 year, 35 patients and 76 restorations (39 with D and 37 with P) were available for evaluation. All restorations received A criteria except the following ones, which received B criteria: color P (one restoration) and D (one restoration), marginal staining P (three restorations) and D (two restorations), surface staining P (nine restorations) and D (three restorations), anatomic form P (one restoration) and D (three restorations), and marginal adaptation P (one restoration) and D (eight restorations). The obtained data were tabulated and statistically analyzed using the Fisher and McNemar tests. After 1 year, P showed a significant increase in superficial staining. For D, the marginal adaptation became significantly worse than baseline and P. The studied materials can be considered acceptable during this evaluation period. Further evaluations are necessary for a better clinical performance analysis.     

Long-term survival estimates of cast gold inlays and onlays with their analysis of failures

The aim of the present study was to assess the clinical behaviour of cast gold restorations with respect to define a gold control against current and future ceramic and composite restorations. The study sample included 50 patients with 303 cast gold restorations. All restorations were cemented with a non-adhesive technique. A total of 303 restorations were evaluated clinically and radiographically using modified United States Public Health Service criteria. Restorations recorded as having an A- or a B-rating were defined as successful. Of the 303 restorations, 42 were judged as failures, which resulted in a failure rate of 13.8% for a mean observation time (+/- s.d.) of 18.7 ( +/- 9.5) years. The estimated Kaplan-Meier survival rates (s.e.) were 96.1% (+/- 1.1%) at 10 years, 87.0% (+/- 2.2%) at 20 years and 73.5% (+/- 5.4%) at 30 years. In total, biological reasons were counted 25 times in comparison to 17 technical reasons for those 42 failed cast gold restorations, with 17 secondary caries (40%) as the most common biological reason and with 13 retention losses (31%) as the most common technical reason. The endodontically treated tooth was exclusively identified as a risk factor. The restoration type (inlay versus onlay) did not influence the survival rate.     

优化设计Upcera超透氧化锆全瓷修复体的临床应用

目的：总结运用CAD/CAM系统优化设计Upcera超透氧化锆材料针对修复空间有限的病例进行修复的效果,并探讨其临床应用价值。方法：选择21例(23件)修复空间有限且要求行氧化锆全瓷修复患者,通过Sirona inEOS采集诊断蜡型与代型的光学印模,并将两者叠加,运用系统软件设计出面与诊断蜡型面一致、而颊面和邻面虚拟回切约1~1.5 mm的氧化锆底核,经Sirona inLab MC XL加工Upcer超透氧化锆材料后,完成局部饰瓷。嘱患者定期随访,并参照改良美国加州牙科协会评价标准对修复体进行评价,同时对患者进行满意度问卷调查。结果：经过6~12个月随访,除1件修复体因基牙根折拔除外,其余修复体均保持形态完整、色泽协调、边缘密合、咀嚼功能良好、无食物嵌塞等现象,患者对修复体美观和功能均满意(满意度>95.5%)。结论：通过CAD/CAM系统优化设计,制作了类似“颊烤”的超透氧化锆全瓷冠,在针对某些特殊病例修复时,如修复空间有限、紧咬牙、夜磨牙等患者,短期效果较好。     

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.     

Three-year clinical evaluation of a polyacid-modified resin composite in minimally invasive occlusal cavities

OBJECTIVE: The aim of this study was to evaluate the 3-year clinical performance of one polyacid-modified resin composite material (PMRC). Dyract, in minimally invasive occlusal cavities and its neighbouring fissures. METHODS: One hundred and sixteen restorations of the material investigated were placed by a single operator in a group of selected children under controlled conditions. Isolation of the restorations was accomplished with the use of cotton rolls and aspiration. Using modified US Public Health Service (USPHS) codes and criteria, the restorations were reviewed clinically within 1 week of placement (baseline), and thereafter at 6 months, 1, 2 and 3 years. RESULTS: After 3 years, marginal discolouration was present in 8.6% of the restorations. The marginal adaptation was rated as partly sealed (Oscar-Alpha) in 107 (92.2) of the restorations. Five restorations had lost their sealant components, while four restorations were partly sealed with explorer-catch after 3 years. Although wear of the restorations was considerable, restorations rated as 'partly sealed' had at least two-thirds of their sealant components fully retained. Recurrent caries was associated with four (3.4%) restorations. CONCLUSION: In this clinical study, the retention rate of the tested PMRC material was good, although a marked occlusal wear was evident. The marginal adaptation of the PMRC at the enamel site would probably have been better by the use of enamel-etching. Provided the marginal adaptation and wear resistance of the material is further improved, clinical use of PMRCs in minimally invasive occlusal cavities can be advocated.     

A five-year clinical evaluation of Class II composite resin restorations

OBJECTIVES: To study the clinical efficacy of posterior composite resin restorations placed in general practice after five years. METHODS: Two commercial composite resin systems were used. Three general practitioners placed the restorations at a Public Dental Health Service Office. The patients were not selected specifically for this study. Class II cavities were restored with Superlux Molar and P-50 APC composite systems on an alternate basis. At baseline, 63 restorations were placed in molars and premolars in 45 patients. For primary caries, generally a conservative cavity design was used (n = 23), while replacements of amalgams resulted in the larger conventional Class II design (n = 40). The restorations were assessed using a modified USPHS criteria. Wear measurements were determined by the Leinfelder method. Photographs and bite-wing radiographs were taken to supplement the clinical evaluation of colour match, marginal adaptation and recurrent caries. Saliva sampling was performed to determine the rate of secretion and the level of mutans streptococci and lactobacilli. RESULTS: At the five-year review 51 restorations were available for examination, of which nine restorations were rated clinically unacceptable. Including the failed restorations (n = 7), at the three-year review, a total of 16 restorations had failed (27.6%) over a five-year period. The most common reasons for failure were recurrent caries (n = 7) and marginal defects (n = 4). The mean wear of Superlux Molar was 167 microns and of P-50 APC 158 microns. Eight of the 11 patients with failed restorations due to caries and marginal defects had high counts of mutans streptococci at baseline. CONCLUSIONS: The failures in the present group of patients did not specifically relate to material, tooth type or cavity design. However, it is suggested that patient factors such as caries activity should be monitored and managed.     

One-year clinical evaluation of five single-step self-etch adhesive systems in non-carious cervical lesions

This study evaluated the clinical performance of five single-step self-etch adhesive systems over a one-year follow-up period in 98 restorations. Independent evaluations were performed at baseline (one week), after three months, six months, and one year, by two trained examiners using the modified US Public Health Service rating criteria. Color match, marginal integrity, anatomical form, surface roughness, marginal or interfacial staining, postoperative sensitivity, and secondary caries were evaluated. Results were analyzed using the Kruskal-Wallis test at a significance level of p<0.05. After one year, the restorations were re-evaluated and 100% retention rate was recorded. No caries were detected in association with any of the restorations. Marginal adaptation was the only measure that showed a slight deterioration over time, and there were no significant differences in this factor among the adhesive systems tested (p=0.464).     

Bulk‐filled posterior resin restorations based on stress‐decreasing resin technology: a randomized,controlled 6‐year evaluation

This randomized study evaluated a flowable resin composite bulk‐fill technique in posterior restorations and compared it intraindividually with a conventional 2‐mm resin composite layering technique over a 6‐yr follow‐up period. Thirty‐eight pairs of Class II restorations and 15 pairs of Class I restorations were placed in 38 adults. In all cavities a single‐step self‐etch adhesive (Xeno V) was applied. In the first cavity of each pair, the flowable resin composite (SDR) was placed, in bulk increments of up to 4 mm. The occlusal part was completed with a layer of nanohybrid resin composite (Ceram X mono). In the second cavity of each pair, the hybrid resin composite was placed in 2‐mm increments. The restorations were evaluated using slightly modified US Public Health Service (USPHS) criteria at baseline and then annually for a time period of 6 yr. After 6 yr, 72 Class II restorations and 26 Class I restorations could be evaluated. Six failed Class II molar restorations, three in each group, were observed, resulting in a success rate of 93.9% for all restorations and an annual failure rate (AFR) of 1.0% for both groups. The AFR for Class II and Class I restorations in both groups was 1.4% and 0%, respectively. The main reason for failure was resin composite fracture.     

A clinical comparison of resin composite inlay and onlay posterior restorations and cast-gold restorations at 7 years.

OBJECTIVE: The purpose of this study was to evaluate the clinical performance of Concept indirect posterior heat- and pressure-polymerized restorative material and compare it to the performance of cast gold. METHOD AND MATERIALS: Inlays and onlays placed in a standardized manner as part of a clinical study were evaluated at 7 years. Eighteen patients (45%) who had received 36 Concept restorations returned and were evaluated using the US Public Health Service criteria. Restorations were evaluated in seven categories as the percentage receiving Alfa (ideal), Bravo (clinically acceptable), or Charlie (clinically unacceptable) scores or as restoration no longer present. Fourteen of the restorations were cemented with Heliobond bonding resin and 13 were cemented with Special Bond bonding resin. Each patient also received a cast-gold restoration for comparison. RESULTS: Concept restorations received scores of Alfa at the following rates: color match, 64%; interfacial staining, 47%; secondary caries, 75%; wear, 58%; marginal integrity, 64%; surface texture, 72%; and axial contour, 58% (in 14% this category was not applicable because they were Class I restorations). Nine Concept restorations (25%) were no longer present. Fifteen of 18 gold restorations were present at this recall. Statistical analysis indicated no significant differences in any categories between the two bonding resins used with Concept restorative material and the gold restorations. CONCLUSION: At 7 years in vivo, the Concept indirect posterior restorative system yields clinically acceptable restorations, particularly in premolars.     

Clinical evaluation of hybrid ionomer restoratives in Class V abrasion lesions: two-year results.

Eighty Class V abrasion cavities were selected, and 20 cavities were restored with one of three resin-modified glass-ionomer materials (Fuji II LC, Photac-Fil, and Vitremer) or a polyacid-modified resin composite (Dyract). The restorations were clinically evaluated after 1 and 2 years with the US Public Health Service criteria. The results revealed a statistically significant difference in the percentage of restorations rated Alfa for color match at 2 years. No statistically significant difference was found in the percentage of alfa rating for anatomic form. Restorations of all materials showed some marginal discrepancies that were not statistically significant.     

A 36-month evaluation of self-etch and etch-and-rinse adhesives in noncarious cervical lesions

BACKGROUND: There are two bonding strategies for composite restorations: the etch-and-rinse (ER) approach and the self-etch (SE) approach. Few clinical trials have evaluated the SE approach in Class V restorations for a 36-month period. The authors conducted a study to evaluate whether the SE system can provide retention rates and marginal discoloration similar to that of the ER system. METHODS: Twenty-five patients, each having at least two pairs of equivalent noncarious cervical lesions under occlusion, were enrolled in this study. Two calibrated operators placed 78 restorations, one-half for ER and one-half for SE. Two independent examiners evaluated the restorations at baseline and after six-, 12-, 18- and 36-month periods according to the slightly modified U.S. Public Health Service criteria. Statistical analysis between materials in each period was conducted using a Fisher exact test (alpha = .05), and the performance of the materials at baseline in comparison with each period was evaluated by a McNemar test (alpha = .05). RESULTS: Five SE restorations and one ER restoration were lost after 36 months. After 36 months, 10 SE and five ER restorations were rated Bravo in marginal adaptation (P > .05). Fourteen SE and five ER restorations were rated Bravo in marginal discoloration (P < .05). CONCLUSIONS: Although a significantly increased marginal discoloration was observed with SE, both adhesives showed retention rates in noncarious cervical lesions that were not statistically different after 36 months. CLINICAL IMPLICATIONS: The ER and SE adhesive systems can be used with confidence; however, SE adhesive showed a faster and more progressive enamel marginal degradation.