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.     

Clinical performance of Class II restorations in which resin composite is laminated over resin-modified glass-ionomer

This study evaluated the one-year functioning of resin-composite/resin-modified glass-ionomer open-laminate restorations when used for restoring Class II cavities. It also investigated the effect of the thickness of the resin composite layer on the performance of such restorations. The test restorations were made of Vitremer glass ionomer, Scotchbond Multipurpose Plus and Z100 resin composite, and the control restorations were made of Z100 with Scotchbond Multipurpose Plus. Forty pairs of restorations were placed in 40 patients aged 16 years and over. The thickness of the resin composite layer was measured both clinically and in the laboratory using a reflex microscope. The completed restorations were assessed in vivo and in vitro at baseline, six-month and one-year recalls using a modified Ryge system. The reflex microscope measurements showed that the majority of restorations had a resin composite layer of more than 1.5 mm in thickness, as intended. At one year, 37 pairs of restorations were examined. Apart from a few minor problems, all performed satisfactorily. Thus, it appears that the resin composite/resin modified glass ionomer open laminate is a suitable technique for restoring Class II cavities.     

The clinical performance of a glass polyalkenoate (glass ionomer) cement used in a 'sandwich' technique with a composite resin to restore Class II cavities.

The use of glass polyalkenoate (GPA) cement in conjunction with composite resin using an acid etch technique is now well known and a 'sandwich' of tooth/GPA cement/composite resin has been recommended to form the cervical seal at the base of approximal boxes in Class II cavities. This paper reports on the 2-year results of a controlled clinical trial using a commercial GPA lining cement. The trial was designed to evaluate the efficacy of this 'sandwich' technique. Sixty-four restorations in the mouths of 22 patients were evaluated during the 2.5 year period of the trial. The composite resin component of the restorations performed well. Five restorations failed, all in the region of the approximal box. Four failures were related to the exposed GPA cement component of the 'sandwich'. Failure was probably related to placement difficulties of the technique. The use of GPA cement laminated with composite resin when the GPA cement was enclosed within the final restoration appeared to be a successful technique.     

Clinical evaluation of a flowable resin composite in non-carious Class V lesions: two-year results

This in vivo study evaluated the clinical performance and appearance of a flowable resin composite and a hybrid resin composite over two years. Twenty-eight (28) pairs of restorations of a flowable resin composite and a conventional hybrid resin composite were placed in non-carious, asymptomatic facial Class V lesions. The restorations were evaluated at baseline, six, twelve, eighteen and twenty-four (6, 12, 18 and 24) months, using modified Ryge/USPHS criteria. No significant difference (p < 0.05) was observed in the performance or appearance of both materials.     

Clinical evaluation of a nanofilled composite in posterior teeth: 12-month results

This study compared the clinical performance of a nanofilled resin composite for posterior restorations with 2 microhybrid and 1 packable composite after 12 months of clinical service. Forty-two patients with at least 5 Class I or II restorations under occlusion were enrolled in this study. A total of 148 restorations were placed, 25% for each material (Filtek Supreme, Pyramid, Esthet-X or Tetric Ceram). Two calibrated operators placed all restorations, according to the manufacturers' instructions. One week later, the restorations were finished/polished. Two independent examiners evaluated the restorations at baseline and after 12 months according to the USPHS modified criteria. All patients attended the 12-month recall and 148 restorations were evaluated. Friedman repeated measures analysis of variance by rank and Wilcoxon sign-ranked test for pair-wise comparison was used for data analysis (alpha=0.05). All materials showed only minor modifications, and no differences were detected between their performance at baseline and after 12 months. After 1 year, the nanofilled resin composite showed similar performance to the other packable and microhybrid resin composites.     

Durability of resin composite restorations in high C-factor cavities: A 12-year follow-up

Objective

Polymerization shrinkage and shrinkage stress has been considered as one of the main disadvantages of resin composite restorations. Cavities with high C-factors increase the risk for interfacial failures. Several restorative techniques have been suggested to decrease the shrinkage stress. The purpose of this study was to evaluate the durability of techniques as oblique layering, indirect curing and/or a laminate with a poly-acid modified resin composite in direct Class I resin composite restorations in a 12-year follow-up.

Methods

Each of 29 patients received one or two pair(s) rather extensive Class I restorations. The first restoration was a poly-acid modified resin composite/resin composite sandwich restoration and the second a direct resin composite restoration. Both restorations, except for the laminate layer, were placed with oblique layering and two-step curing technique. 90 restorations were evaluated annually with slightly modified USPHS criteria during 12 years.

Results

At 12 years, 38 pairs were evaluated. Two cases of slight post-operative sensitivity were observed in one patient. A cumulative failure rate of 2.4% was observed for both the resin composite and the laminate restorations. One laminate restoration showed non-acceptable color match, but was not replaced and one resin composite restoration showed a chip fracture. Five restorations were replaced due to primary proximal caries.

Conclusions

The high failure rate expected in the high C-factor Class I cavity, associated with polymerization shrinkage and shrinkage stress, were not observed. The techniques used resulted in an excellent durability for the Class I resin composite restorations.     

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.     

Composite resin restorations: a cross-sectional survey of placement and replacement in Jordan

AIMS: To record the reasons for first time placement and replacement of composite resin restorations in Jordan, to determine the use of composite resin restorations in common cavity types and to collect data on the age of the replaced composite resin restorations. Subjects and setting: Dentists in Jordan (n = 241). METHOD: Cross- sectional study using postal survey backed up with personal contact. Data were recorded for all restorations placed or replaced over a period of one month. RESULTS: Information was collected on 2,239 restorations from patients aged 12-65 years. Of all restorations, 61.6% were first time placements while 38.4% were replacement of old restorations. The major reason for the first time placement of restorations was primary caries while that for replacement was secondary caries 36.2%, followed by root canal therapy 22.2%, discolouration 14.4%, lost restorations 13.4%, composite fracture 11.3%, pain or sensitivity 2.4%. CONCLUSIONS: The main reason for first time placement of composite restorations is primary caries; the main reason for replacement is secondary caries.     

Clinical performance of a hybrid resin composite with and without an intermediate layer of flowable resin composite: A 7-year evaluation

Objective

The objective of this prospective clinical follow up was to evaluate the long term clinical performance of a hybrid resin composite in Class II restorations with and without intermediate layer of flowable resin composite.

Methods

Each participant received at least two, as similar as possible, Class II restorations of the hybrid resin composite. One resin composite restoration of each pair (59) was chosen at random to be restored with an intermediary layer with flowable resin composite. The other was restored without. The 118 restorations were evaluated using slightly modified USPHS criteria at baseline and then yearly during 7 years.

Results

Four drop outs were registered during the 7-year follow up (2 with and 2 without flowable) restorations. A prediction of the caries risk showed that 18 of the evaluated 46 patients were considered as high risk patients. Seventeen failures were observed, 8 in restorations with and 9 in restorations without an intermediate layer of flowable resin composite, resulting in a 14.9% failure rate after 7 years. The main reasons for failure were: fracture of resin composite (8), secondary caries (4) and cusp fracture (3). No statistical difference was seen between restorations restored with and without flowable layer.

Conclusion

The hybrid resin composite showed a good clinical performance during the 7-year evaluation. The use of flowable resin composite as an intermediate layer did not result in improved effectiveness of the Class II restorations.     

Microleakage of composite resin and glass ionomer cement restorations in retentive and nonretentive cervical cavity preparations.

Ketac Fil glass ionomer cement (GIC) and Scotchbond 2 dentinal bonding agent (DBA)/Silux Plus composite resin restorations were inserted in cervical cavity preparations of extracted human teeth. After thermocycling, the specimens were invested and sectioned longitudinally and horizontally through the center of the restoration. Microleakage was evaluated as a ratio of the extent of methylene blue dye penetration at the tooth-restoration interface. Although all restorations exhibited leakage, both the GIC and bonded composite resin restorations recorded less leakage in retentive than in nonretentive cavity preparations. Composite resin restorations in nonretentive cavity preparations showed significantly more dye penetration toward the pulpal chamber than the GIC restorations. Ketac Fil GIC restorations inserted without a matrix strip exhibited less leakage than those with a matrix strip. The most desirable results were recorded with Scotchbond 2 DBA/Silux Plus composite resin restorations in retentive preparations.     

Observations on a composite resin for Class II restorations: Three-year report

The results of these three-year observations comparing a composite resin with amalgam in Class II restorations do not differ greatly from those reported after two years. Secondary caries has not been a problem to date, regardless of the material used. Anatomic form of the amalgam restorations continued to be maintained while it deteriorated further in the composite resin restorations. On the other hand the composite restorations maintained the same level of superiority for marginal adaptation throughout the three years. No significant increase in the discoloration of the composite restorations or their margins were observed at three years, although most restorations had already shown evidence of discoloration at the previous evaluations.     

Direct resin composite inlays/onlays: an 11 year follow-up

OBJECTIVES: The aim of this study was to present an 11-year assessment of direct resin composite inlays/onlays. METHODS: One-hundred Class II direct resin composite inlays and 34 direct resin composite restorations were placed in 40 patients. The restorations were evaluated clinically, according to modified USPHS criteria, annually over a 11-year period. RESULTS: Of the 96 inlays/onlays and 33 direct restorations evaluated at 11 years, 17. 7% in the inlay/onlay group and 27.3% in the direct restorations group were assessed as unacceptable. The differences in longevity were not statistically significant. The main reasons for failure for the inlays/onlays and direct restorations were fracture (8.3 and 12. 1%, respectively), occlusal wear in contact areas (4.2 and 6.1%, respectively) and secondary caries (4.2 and 9.1%, respectively). Eight of the non-acceptable inlays/onlays and five of the direct restorations were replaced, while the other ones were repaired with resin composite. Unacceptable wear was observed in occlusal contact areas of six restorations, in patients who were severe bruxers. For the other restorations occlusal wear was not found to be a clinical problem and no difference was observed between the inlays/onlays and direct composite restorations. The marginal adaptation of the inlays/onlays was still good at the end of the study. Ditching was only observed in a few inlays. A higher failure rate was observed in molar teeth than in premolar teeth. CONCLUSIONS: Good durability was observed for the direct resin composite inlay/onlay technique. Excellent marginal adaptation and low frequency of secondary caries in patients with high caries risk were shown. No apparent improvement of mechanical properties was obtained by the secondary heat treatment of the inlays. Also, the difference in failure rate between the resin composite direct technique and the inlay technique was not large, indicating that the more time-consuming and expensive inlay technique may not be justified. The direct inlay/onlay technique is recommended to be used in Class II cavities of high caries risk patients with cervical marginal placed in dentin.     

Early failure of Class II resin composite versus Class II amalgam restorations placed by dental students

Using the information from remake request slips in a dental school's predoctoral clinic, we examined the short-term survival of Class II resin composite restorations versus Class II dental amalgam restorations. In the student clinic, resin composite is used in approximately 58 percent of Class II restorations placed, and dental amalgam is used in the remaining 42 percent. In the period examined, Class II resin composite restorations were ten times more likely to be replaced at no cost to the patient than Class II dental amalgam restorations. A total of eighty-four resin composite restorations and six amalgam restorations were replaced due to an identified failure.     

Three-year clinical evaluation of a resin modified glass-ionomer cement and a composite resin in non-carious class V lesions

The purpose of this study was a 3-year clinical evaluation of a resin modified glass-ionomer and a composite resin restorative material in non-carious class V lesions. In 24 patients 98 non-carious class V lesions were restored with either a resin modified glass-ionomer (Vitremer), or a composite resin restoration (Z100). The restorations were clinically evaluated after 6, 12, 24 and 36 months with the US Public Health Service criteria. At 3 years, 88 teeth of 21 patients were evaluated. All restorations were rated clinically acceptable for colour match, marginal discoloration, marginal adaptation and anatomical form. Restoration retention of both groups was high without any statistically significant difference. However, Vitremer restorations showed a lower incidence of Alfa scores for colour match and marginal discoloration than Z100 restorations (P < 0.05).     

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.     

The clinical performance of a posterior composite resin restorative material, Heliomolar R.O.®: 3-year report

A posterior composite resin restorative material was evaluated over a 3-year period by means of a controlled clinical trial. A total of 52 composite resin restorations and 52 amalgam alloy restorations were included in this trial, and were examined with regard to marginal integrity, surface texture, anatomical form and proximal contact with adjacent teeth. There were no significant differences in clinical performance between test and control materials, which both gave good service over the period of evaluation. Only five restorations (one of amalgam and four of composite resin) failed during the trial. Plastic replica dies were used to support the clinical examinations of the restorations, and such dies were found to be helpful.     

Interfacial gaps following ceramic inlay cementation vs direct composites

This study compared the interfacial integrity of Class II ceramic inlay restorations and direct resin composite restorations. The influence of a flowable resin composite liner was also evaluated. Class II DO cavities were prepared in 40 recently extracted mandibular molars and assigned to four treatment groups. Group A: direct composite restoration; Group B: Cerec inlays fabricated and cemented with a resin cement; Group C: adhesive lining with a flowable resin composite used prior to resin composite restoration; Group D: lining with a flowable resin composite prior to cementation of Cerec inlays. After finishing, polishing and thermocycling (4 degrees C and 60 degrees C x 500), the samples were cross-sectioned in a mesio-distal direction along the center of the fillings or inlays. The cross-sectioned surface was polished, and the adhesive interfaces between resin and enamel or dentin were observed under a scanning laser measurement microscope. Ceramic inlay restorations showed no interfacial gaps in enamel, but direct resin composite restorations showed a significantly higher incidence of gaps at the interface or cracks in the interfacial enamel (p=0.0002). No differences were found in the resin-dentin interfaces for both the inlay and direct resin composite restorations. The use of a flowable resin composite as an adhesive liner produced a significantly greater gap-free resin-dentin interface in Cerec inlay and direct resin composite restorations (p=0.0233 & 0.0009), but it did not reduce gap formation at the resin-enamel interface.     

Class IV preparation design for microfilled and macrofilled composite resin.

The current standard preparation for Class IV composite restorations is the placement of a bevel on all enamel margins. This study evaluated chamfered and beveled preparations for Class IV restorations of lesions with microfilled and macrofilled composite resin. Forty incisors were obtained and standardized lesions for Class IV restorations were formed. Twenty teeth had a 1.5-mm bevel placed and 20 had a 1.5-mm chamfered preparation placed. Half of the beveled and chamfered preparations were restored with microfilled composite resin; the remaining were restored with macrofilled composite resin. All restorations were fractured with an Instron Testing Machine. The mean force (lbs +/- SD) to fracture the restorations were: (beveled, microfilled composite 16.0 +/- 4.4); (chamfered, microfilled composite 30.6 +/- 20.0); (beveled, macrofilled composite 34.9 +/- 18.6); (chamfered, macrofilled composite 48.8 +/- 14.3). The chamfered preparations provided greater restoration fracture resistance than beveled preparations, for both microfilled and macrofilled composite restorations. Scheffe's test indicated traditional beveled, microfilled Class IV composite resin restorations significantly decreased fracture resistance compared to chamfered, macrofilled composite restorations (P less than 0.001).     

Clinical evaluation of a hybrid composite and a polyacid-modified composite resin in Class-II restorations in deciduous molars

The aim of this prospective study, conducted in a dental practice was to evaluate the success rate of a hybrid composite material (TPH-Spectrum; Dentsply DeTrey, Konstanz, Germany) and a polyacid-modified composite resin (Compoglass; Vivadent, Schaan, Liechtenstein) in Class II restorations in primary molars after 1 year. A total of 190 restorations (96 with TPH-Spectrum and 94 with Compoglass) were inserted in 52 children. TPH-Spectrum was applied using the total etching technique, whereas Compoglass was inserted without acid etching prior to application of the bonding adhesive. The restorations were assessed according to the Ryge criteria, directly after placement and after 1 year. After 12 months, 6.4% of the Compoglass and 3.1% of the TPH-Spectrum restorations were clinically unacceptable and had to be renewed. The fillings with Compoglass revealed a tendency to lower evaluation scores with respect to color matching, cavosurface discoloration, anatomic form, margin integrity and caries assessment than the restorations with TPH-Spectrum. However, these differences were statistically not significant. The results of the present investigation show that, at least for a period of 1 year, both the hybrid composite TPH-Spectrum and the polyacid-modified composite resin Compoglass are suitable materials for restoration of deciduous molars. However, owing to the fewer treatment steps required for application of a polyacid-modified composite resin, this type of material may be more favorable for restoring primary molars. Received: 6 March 1998 / Accepted: 20 May 1998