Five-year clinical performance of posterior resin composite restorations placed by dental students

OBJECTIVES: To investigate the survival over a five-year period of posterior resin composite restorations placed by students. METHODS: Class I and II resin composite restorations placed by second-fourth year dental students were evaluated. Patients attended the dental school every 6 months for a regular check-up during which all restorations were checked on their clinical acceptability. In case of replacement or repair of a restoration, this was registered in the patient's record. From each record the survival time and reasons for failure of resin composite restorations were gathered. RESULTS: Seven-hundred three posterior resin composite restorations in 382 patients (49% female and 51% male, age 22-78) were evaluated. At 5 years 560 of the 703 restorations were still considered to be "clinically acceptable". Forty-nine restorations were considered as "functionally present", of which 44 were restored with a crown and four had received a new restoration adjacent to the existing restoration without its removal. Ninety-four restorations had failed. The main reasons for failure were restoration fracture, caries, endodontic treatment, defective margin and lack of proximal contact. The survival rate of the restorations was 87% at 5 years, resulting in an annual failure rate of 2.8%. CONCLUSIONS: Dental students are able to place resin composite restorations in posterior teeth with an acceptable mean annual failure rate.     

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.     

Treatment times for posterior resin-bonded bridges

In a longitudinal clinical trial the treatment times needed for the fabrication of Posterior Resin-Bonded Bridges (PRBB's) were recorded and analyzed. From a total of 200 PRBB's with different designs and retention systems, 152 were selected for this analysis. The selected bridges were made by 12 operators: 3 university staff members and 9 general practitioners. The mean treatment time for PRBB's was 80 min. When posterior composite restorations were made in the abutment teeth, the mean treatment time increased by 25% up to 100 min. From the factors which were considered to influence the treatment time, a significant effect was found for "restorations", "operator" and "experience of the operator". The other factors considered, such as "tooth preparation", "retention system", "isolation method", "occlusion", and "location", showed no detectable effect on the treatment time. The results of this study are considered to be useful in further cost-benefit analyses.     

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.     

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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。     

间接法树脂高嵌体修复磨牙残冠的临床评价

目的:评价间接法树脂高嵌体修复磨牙残冠的临床效果。方法:分别应用HRi美塑树脂通过间接法制作树脂高嵌体和直接法树脂充填修复68颗磨牙残冠的邻牙合面龋损,分别在修复后6、24、36个月随访,对边缘密合、邻接关系、牙周健康及修复体完整性等临床修复效果进行统计学分析并给予评价。结果:第6个月时两组无差别;第24个月时,两组除了在邻接关系方面嵌体组要优于直接组外(P<0.05),其余方面并没有明显差别;但在36个月时,用间接法树脂高嵌体修复的患牙在边缘密合、邻接关系及牙周健康方面与直接法修复有显著性差异(P＜0.05)。结论:应用间接法树脂高嵌体修复磨牙残冠能获得更好的临床修复效果,更能符合不同层次患者的功能及美学需求。     

Long-term deterioration of composite resin and amalgam restorations.

Previous long-term longitudinal studies of two different methods of placing an auto-cured conventional anterior composite resin, and of a low- and a high-copper amalgam alloy, had shown similar restoration survivals despite the different resin treatment methods used or the types of amalgam alloy placed. Therefore, the aim of the present study was to assess several clinical factors or characteristics of these restorations that were believed to affect the survival of the restorative materials. The 950 composite resin and the 1042 amalgam restorations examined were placed by many operators in numerous patients attending a dental hospital. The composite resin restorations were placed using unetched- and etched-enamel-bonding treatment methods, and the amalgam restorations were polished after insertion. Clinical ratings supplemented by color transparencies were used for the assessment of four factors for the resin, and four factors for the amalgam restoration. Significant deterioration differences were found for several of the clinical factors assessed for both the two different composite resin treatment methods, and for the two different amalgam alloys, which were not directly related to the restoration survivals.     

Trends in material choice for posterior restorations in an Israeli dental school: composite resin versus amalgam

According to a recent American Dental Association survey, posterior composite resin restorations now outnumber amalgam restorations in the United States. Dental schools around the world vary considerably in the extent to which they teach the use of composite resins. We aimed to determine if there has been an increase in the placement of posterior composite restorations in an Israeli dental school and if faculty experience affects the type of posterior restoration placed. In this retrospective study, we recorded and analyzed all the restorations performed by undergraduate students in the last five academic years at the Hebrew University Hadassah School of Dental Medicine in Jerusalem. All clinical records of student treatments between 2004 and 2009 were screened, and direct restorations were registered. Out of 6,094 posterior restorations performed during the study period, 42.3 percent were made of composite resin, increasing from 36.8 percent in 2004-05 to 48.5 percent in 2008-09, an increase of 11.7 percent. When clinical instructors were asked to state their preference if they themselves were to undergo posterior restoration, similar results were obtained. Instructors with less than ten years' experience preferred posterior composite resin restorations in 54.8 percent of the hypothetical situations, compared with 37.2 percent preferred by instructors with ten years of experience or more. It appears that the use of composite resin was influenced mainly by the prevailing trend and was not based on scientific evidence. Dental faculties should define criteria, based on up-to-date clinical studies, for using new materials, taking into consideration differences among instructors regarding treatment concept.     

A randomized clinical trial on proximal contacts of posterior composites

OBJECTIVE: The objective of this study was to investigate clinical changes in proximal contact strength inserting Class II composite resin restorations according to one of three randomly assigned protocols. MATERIALS AND METHODS: Seventy-one Class II restorations (MO/DO) were placed by two calibrated operators. Restorations were randomly assigned to one of three groups: one using a circumferential and two a sectional matrix system with separation rings. Proximal contacts were measured by one independent observer with a Tooth Pressure Meter immediately before treatment, and directly after finishing the restoration. RESULTS: Compared to the situation before treatment groups with a sectional matrix system resulted in a statistical significant stronger mean proximal contact strengths (p<0.05), whereas the use of a circumferential matrix system with hand-instrument resulted in a lower proximal contact strength (p<0.05). CONCLUSION: Class II posterior composite resin restorations placed with a combination of sectional matrices and separation rings resulted in a stronger proximal contact than when a circumferential matrix system was used.     

Survey on the teaching and use in dental schools of resin-based materials for restoring posterior teeth

A survey was conducted of 100 dental schools worldwide to investigate the current teaching of posterior resin composite restorations. A 20 multi-part question questionnaire was emailed to the selected schools. Schools were selected by ability to understand and respond in English. The questionnaire consisted of four open-ended questions and 16 closed questions on topics such as material selection for restoring posterior teeth, preclinical teaching of resin composite for posterior teeth, restoration size, contraindications, matrix placement methods, lining use, adhesive selection and finishing. Forty-six schools responded. The outcomes showed all schools included the teaching of resin composite for posterior restorations but varied. The majority of schools (63%) no longer taught amalgam as the preferred posterior restorative material. Half of the schools surveyed set numerical clinical requirements for restoration placement. Australian schools had no requirements whilst 92% of Asian schools did. There was a consensus that larger restorations were less suitable for resin composite. Selection of adhesives depended on region. Generally, the schools surveyed showed minor variations philosophically in teaching of the use and placement of resin composite restorations.     

A 4- to 6-year retrospective clinical study of cracked teeth restored with bonded indirect resin composite onlays

PURPOSE: The purpose of this study was to retrospectively evaluate the clinical performance of bonded indirect resin composite onlays for the treatment of painful, cracked teeth over a 6-year period. MATERIALS AND METHODS: Forty-three posterior teeth diagnosed as having a crack were selected in the restorative department of the University of Genoa. Inclusion criteria were sensitivity to biting and cold and a clinically visible crack. Direct composite buildup after removal of the existing restoration was performed before definitive cavity preparation. All composite onlay restorations were cemented with an adhesive technique using a 3-step total etch system and a dual-cure composite cement. Patients were interviewed and clinically examined at 1 week, 4 weeks, and every 6 months. RESULTS: The effectiveness of bonded onlay restorations was evaluated for a mean observation time of 4.78 years. At 1 week, 38 (88.37%) restored teeth were free of pain, 3 (6.98%) still had sensitivity to cold, and 2 (4.65%) still had sensitivity to cold and chewing. At 4 weeks, 40 (93.02%) teeth were free of pain, 2 (4.65%) still had sensitivity to cold and chewing, and 1 (2.32%) needed endodontic treatment. Two other teeth (4.65%) also needed endodontic treatment, the first after 2 months and the second after 5 months. During the evaluation period, 3 restorations (6.98%) failed, and upon clinical examination, 40 (93.02%) teeth were free of symptoms with a 6-year survival rate of 93.02% (life table analysis). CONCLUSIONS: Bonded indirect resin composite onlays can be successful in treating painful, cracked teeth. From the findings of this study, it appears that cuspal protection should be incorporated into the design of coronal restorations.     

Amalgam and composite posterior restorations: curriculum versus practice in operative dentistry at a US dental school

This study recorded the number of preclinical lecture and simulation laboratory sessions spent teaching the preparation and placement of amalgam and resin composite posterior restorations. These data were compared to the use of both materials in the operative clinic as placed by third- and fourth-year students. The number of posterior restorations inserted by the students, expressed as a function of the number of restoration surfaces, was also evaluated. The results show that the teaching of posterior restorations pre-clinically has consistently favored amalgam 2.5 to 1 during the last three years. However, clinically, resin composite is being used for posterior restorations 2.3 times more often than amalgam. The only instance that favored amalgam over composite during the last year was in the placement of four surface posterior restorations. This shift in emphasis from amalgam to composite needs to be addressed within dental educational institutions so that newly graduated dentists are prepared to place composite restorations properly.     

后牙病理性磨损树脂修复的临床效果探讨

目的:观察用直接树脂充填法和间接树脂充填法修复后牙病理性磨损的临床效果。方法:选择后牙牙合面有病理性磨损且具有充填空间的患者48例,患牙144颗,其中有牙本质过敏症状者38例98颗牙。患者按门诊顺序随机分为直接法修复组和间接法修复组2组各24例,在不备洞的情况下分别采用可乐丽菲露复合树脂直接或间接修复,比较治疗3个月及1年后树脂充填的临床效果、牙本质敏感情况和咀嚼效率改变情况。结果:治疗后3个月时复查,直接法和间接法两组患牙树脂充填体A级率无显著性差异(卡方检验,P>0.05);治疗1年后复查,间接法组患牙树脂充填体A级率优于直接法组,两组差异有统计学意义(卡方检验,P<0.05)。间接法组牙本质敏感治疗总有效率优于直接法组,两组差异有统计学意义(卡方检验,P<0.05)。治疗3个月及治疗1年后,间接法组的咀嚼效率高于直接法,两组差异有统计学意义(t检验,P<0.01)。结论:间接树脂法比直接树脂充填法修复后牙病理性磨损有较好的临床效果。     

Indirect composite resin crowns as an esthetic approach to treating ectodermal dysplasia: a case report.

This article presents a case report describing the indirect fabrication of composite resin crowns for the restoration of primary anterior teeth. A 3-year-old with a confirmed diagnosis of hypohidrotic ectodermal dysplasia was provided with composite resin crowns that were both esthetic and functional. The indirect method decreases clinical time, provides a durable restoration, and allows treatment of patients who lack the cooperative ability to endure prolonged direct bonding appointments. The indirect technique may be feasible for the restoration of carious teeth as well as the presented case.     

Digital photography vs. clinical assessment of resin composite restorations

Odontology - To compare direct clinical and indirect digital photographic assessment of resin composite restorations. Ninety-two posterior resin composite restorations were classified using World...     

36-month clinical evaluation of two adhesives and microhybrid resin composites in Class I restorations

PURPOSE: To compare the clinical performance of a self-etching adhesive with that of a popular etch-and-rinse adhesive in Class I posterior composite restorations. METHODS: 60 Class I resin composite restorations (30 per group) were placed in matched pairs using either the self-etch adhesive Xeno III and the microhybrid resin composite Esthet-X or the etch-and-rinse adhesive OptiBond Solo Plus and Point 4 microhybrid resin composite. Subjects were interviewed via telephone 1 week after restoration placement to assess early post-operative sensitivity. In addition, the restorations were evaluated clinically for post-operative sensitivity, marginal quality, wear, and other characteristics immediately after placement and at 6, 12, 18, and 36 months from baseline. RESULTS: During the first week after placement, subjects reported that 23% of restorations in each group had post-operative sensitivity. Sensitivity decreased greatly with time, and differences between the two groups were never statistically significant. Marginal integrity and discoloration were similar for each group at each recall evaluation. Wear of both resin composites increased over time, but mean wear remained at less than 100 microm for each resin composite at 3 years.     

Cariostatic and ultraconservative sealed restorations: six-year results.

The objective of this clinical study was to determine the ability of an ultraconservative, sealed composite resin restoration, without a traditional cavity preparation and without the removal of the carious lesion, to arrest Class I caries. Tooth preparation was limited to placing a bevel in the enamel. These restorations were compared, over 6 years, with (1) ultraconservative, localized, sealed amalgam restorations with no extension for prevention and (2) traditional, unsealed amalgam restorations with the usual extension for prevention outline form. Caries was arrested by the ultraconservative, sealed composite resin restorations for 6 years. Complete sealant retention on the sealed amalgam restorations was somewhat lower than that on the sealed composite resin restorations; conversely, partial sealant retention was higher for the sealed amalgam group. The marginal integrity of the sealed amalgam restorations was significantly superior to that of the unsealed amalgam restorations. The sealant also protected Class I posterior composite resin restorations against wear.     

Effect of operators' skills on increase in cavity volume of restorations.

OBJECTIVE: The purpose of this in vitro study was to evaluate the change in cavity volume after removal of amalgam and resin composite restorations, based on the dental skills of the operators. METHOD AND MATERIALS: A high-speed turbine and diamond burs were used to prepare Class II cavities in 60 acrylic resin mandibular first molar teeth. After the teeth were weighed with precision scales, the cavities were restored with amalgam or posterior resin composite. The restored teeth were then stored in distilled water at room temperature for 48 hours. Three undergraduate students with 2 years' practical experience on patients, and three postgraduate students with an additional 4 years' practical experience in the Department of Operative Dentistry, removed the restorations from the cavities with a high-speed turbine, and the teeth were all weighed again. After cavities were rerestored with the same materials, each restoration was removed once more by the same operator. The weighing procedure was repeated before and after the removal of the restorations. The data were subjected to paired and unpaired t tests. RESULTS: Every time a restoration was removed from a tooth, the cavity preparation became significantly larger, but the postgraduate students caused significantly smaller increases in cavity volume. CONCLUSION: Increases in cavity volume are not based on the nature of t he restorative material; however, the individual experience levelsand dental skills of the operators lead to significant differences in the cavity volume increase.     

A practice-based,randomized, controlled clinical trial of a new resin composite restorative: one-year results

This study evaluated the performance of a low-shrinking resin composite compared with an amalgam for restoration of Class I and II cavities of moderate size in posterior teeth in a general practice setting. Fifty-two pairs of test and control restorations were placed in 49 patients. Clinical evaluations and assessments of replica models were carried out at baseline, six months and one year. Patients recorded their level of satisfaction with the restorations by means of visual analog scales. Apart from one control restoration that failed due to a fractured cusp, all of the restorations reviewed at six months and one year were intact with no unacceptable scores for any of the evaluation criteria. It was concluded that the resin composite evaluated, when used in conjunction with the recommended adhesive system, may be an appropriate alternative to amalgam in the restoration of posterior teeth over one year in clinical service.     

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.