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

OBJECTIVES: This study investigated the impact in survival, when repair is seen as failure or not, in anterior composite restorations with a retrospective 15-year follow-up study. MATERIALS AND METHODS: Data was collected from patients' files of a private dental practice, including patients with direct composite restorations placed in anterior teeth (class III, class IV, or veneer) between January 1994 and December 2009. Data were analyzed considering or not repair as failure. Statistical analysis was performed with log rank test, Kaplan-Meier, and Cox regression (p < .05). RESULTS: One hundred forty-four patients' files were included, with 634 restorations. At 15 years, Class III / IV restorations showed 69% survival and 2.4% annual failure rate (AFR) when repair was not considered as failure, and 64% and 2.9% AFR, respectively, when repair was seen as failure. For direct veneers, at 5 and 10 years of follow-up, survival dropped from 85% to 74% and from 52% to 38% respectively, when repair was considered as failure. In general, restorations placed in the upper jaw showed increased risk for failure compared to the lower jaw (p < .01), and restorations in central incisors presented a higher risk for failure compared to canines (p < .01). CONCLUSION: Composite repair seems a suitable alternative for class III, class IV, and veneer restorations since it was able to increase the survival of restorations performed in anterior teeth. CLINICAL RELEVANCE: Composite repair for anterior restorations is a suitable restorative treatment option and presents benefits over replacement, including the preservation of sound tooth structures, reduced clinical chair time, and patient anxiety.

Pulp responses to the application of a self-etching adhesive in human pulps after controlling bleeding with sodium hypochlorite.

OBJECTIVE: To evaluate the pulp response to direct capping with self-etching adhesive systems using sodium hypochlorite as a hemostatic agent. METHOD AND MATERIALS: Twenty-six human third molars scheduled for extraction were selected from undergraduate students of dentistry. Class I cavities with pulp exposures were performed. To control bleeding, 2.5% sodium hypochlorite was used for 20 seconds, followed by washing with saline solution. The pulp exposures were capped with calcium hydroxide (n = 10) or adhesive system (n = 16). All cavities were restored with adhesive system and composite resin. Half of the samples of each capping material were extracted after 30 days and the remaining after 90 days. The samples were prepared for histological analysis (hematoxylin-eosin) and bacterial detection (Brown & Hopps) and evaluated according to standard ranking. Data were submitted to statistical analysis (Mann-Whitney test). RESULTS: There was a significant difference (P <.05) only in relation to dentin barrier formation. Pulps dressed with calcium hydroxide showed dentin barrier formation in all specimens, obliterating the exposure site. No inflammatory response was associated with material. In the experimental group, after 30 days, there was an attempt for healing with reparative dentin deposition, presenting a mild to moderate inflammatory infiltrate. Similar findings were found after 90 days, decreasing the inflammatory response. Bacteria were not detected in any specimen evaluated. Sodium hypochlorite was effective for hemostatic control. CONCLUSION: Calcium hydroxide produced better biological performance than the self-etching adhesive, and sodium hypochlorite did not interfere with the pulp repair.