Sealing of restorations with marginal defects does not affect their longevity.

PURPOSE: To evaluate sealed amalgam and resin-based composite restorations after 12 years to determine whether sealing minor defects (micro-repairs) enhanced the longevity of restorations. METHODS: 34 subjects aged 18-80 were recruited. This sample group underwent 137 restorations, including 51 resin-based composite (RC) and 86 amalgam (AM) restorations. Existing restorations with localized, marginal defects were assigned to one of two groups: (a) the Sealing group (n=48, 27 AM; 21 RC) or (b) the Control group (n=89, 59 AM; 30 RC). The quality of each restoration was scored according to the modified USPHS criteria by two examiners at the beginning of the study and after 1-5, 10, and 12 years. Kaplan Meier survival curves were created and a Cox regression was applied to investigate survival variables. Mantel Cox, Wilcoxon, and Friedman tests were performed for comparisons within groups. RESULTS: After 12 years, no statistically significant differences were observed for the variables "restorative material" (P= 0.538) or "sealing yes/no" (P= 0.136) with respect to the longevity of the restorations. All groups behaved similarly with regard to marginal adaptation, secondary caries, and tooth sensitivity (P≥ 0.05). Cumulatively, after a 12-year observation period, sealing minor restoration defects did not affect the longevity of the restorations. CLINICAL SIGNIFICANCE: Sealing minor marginal defects for resin composites or amalgam restorations did not affect their longevity. This intervention may be considered over-treatment for patients with low-to-medium risks for developing dental caries.

Long-term Performance of Refurbished Amalgam Restorations: 10-year Follow-up.

PURPOSE: This prospective, blinded clinical trial assessed the performance of amalgam restorations that were refurbished, replaced, or not treated. MATERIALS AND METHODS: Twenty-three patients were included, ages 18-80 years, with 63 amalgam restorations that had one or more defects in their clinical features, such as defective anatomic form, roughness and/or luster according to United State Public Health Service (USPHS) criteria. Restorations were randomly assigned to either refurbishment (A: n = 21), replacement (B: n = 21) or untreated (C: n = 21) groups. Two calibrated examiners evaluated the restorations at baseline (Kappa = 0.74) and after 10 years (Kappa = 0.84), according to eight parameters: anatomy, roughness, luster, secondary caries, marginal adaptation, occlusal contact, marginal staining and tooth sensitivity. Wilcoxon tests were performed for within-group comparisons, and Friedman tests were used for multiple within-group comparisons. The Mantel-Cox test was used to compare survival curves. RESULTS: After 10 years, 49 restorations (77.8%) were assessed (group A: n = 19; group B: n = 13; group C: n = 17). Over a decade, the three groups showed similar clinical performances for all studied parameters: anatomy (p = 0.410), roughness (p = 0.930), luster (p = 0.984), secondary caries (p = 1.0), marginal adaptation (p = 0.433), occlusal contact (p = 0.33), marginal staining (p = 0.470), and tooth sensitivity (p = 0.784). CONCLUSIONS: Amalgam restorations that have defective anatomic form, roughness and/or luster performed similarly for all studied parameters, whether they were refurbished, replaced or left untreated after 10 years in patients with low and intermediate caries risk. Most of the restorations were classified as clinically acceptable after ten years. Restorations in all three groups tended to deteriorate over time.

Does refurbishing composites lead to short-term effects or long-lasting improvement?

PURPOSE: To evaluate the clinical performance of refurbished resin composite restorations compared to untreated (negative control) restorations over a period of 10 years. METHODS: 26 subjects (having a total of 52 composite restorations) were recruited. All restorations in the refurbished group showed clinical features rated bravo according to modified USPHS criteria. Untreated restorations were those that had been deemed acceptable (alpha or bravo rated); these were used as controls. Two examiners performed assessments at baseline and during the 5th and 10th years after the intervention. Wilcoxon tests were performed for within-group comparisons, Friedman tests were used for multiple within-group comparisons, and Mann Whitney tests were used for between-groups comparisons. Kaplan-Meier survival curves were calculated, and the Mantel-Cox test was used to compare curves. P < 0.05 was considered statistically significant. RESULTS: In both groups, 10-year scores were significantly different from baseline scores in all clinical parameters except secondary caries. There were no statistically significant differences in the survival analysis of groups (log-rank test, P = 0.376). Refurbishing treatment improved the anatomy, roughness, luster, and marginal adaptation of restorations with a short-term effect, with most properties rated acceptable after 10 years of clinical service. The clinical characteristics were similar for all groups at the 10th year.

Two-year clinical performance of dimethacrylatebased composite restorations repaired with a silorane-based composite.

PURPOSE: To investigate the clinical performance of a silorane-based composite resin used for repairing dimethacrylate- based composite restorations. MATERIALS AND METHODS: One operator repaired defective dimethacrylate-based resin restorations that were randomly assigned to one of two treatment groups: control (n=50), repaired with Adper SE Plus and Filtek P60 Posterior Restorative (3M ESPE); or test (n=50), repaired with P90 System Adhesive Self-Etch Primer and Bond and Filtek P90 Low Shrink Posterior Restorative (3M ESPE). After 1 week, restorations were finished and polished. Two calibrated examiners (weighted Kappa≥0.78) evaluated the repaired restorations, blindly and independently, at baseline, after 6 months, 1 and 2 years. The parameters examined were marginal adaptation, anatomic form, surface roughness, marginal discoloration, postoperative sensitivity, and secondary caries. The restorations were classified as Alfa, Bravo, or Charlie, according to modified US Public Health Service criteria. Variation in the levels of clinical parameters over time was evaluated by Friedman's ANOVA (α=0.05). The Mann-Whitney test assessed the differences between the materials for all clinical criteria at baseline, 6-month, 1- and 2-year recalls (α=0.05). The Wilcoxon test compared each composite resin for all clinical criteria at the same recalls (α=0.05). RESULTS: After two years, 79 repaired restorations were re-examined. No statistically significant differences were found between the materials at baseline or at the 2-year recall (p>0.05). Comparing baseline and 2-year recall, there was a statistically significant difference for marginal discoloration (p=0.029) in silorane-based composite restorations. CONCLUSION: After two years, the clinical performance of the silorane-based composite was similar to that of the dimethacrylate-based composite when used to make repairs.

A clinical evaluation of a giomer restorative system containing surface prereacted glass ionomer filler: results from a 13-year recall examination.

BACKGROUND: The authors' objective was to evaluate the long-term performance of a resin-based composite restorative material (Beautifil, Shofu, Kyoto, Japan) in combination with a self-etching primer (FL-Bond, Shofu) for posterior restorations. METHODS: Two clinicians placed 61 restorations, 26 Class I and 35 Class II, in 31 patients. They placed restorations while using rubber dam isolation. Two other clinicians examined the restorations according to the modified U.S. Public Health Service (USPHS) criteria, observing color match, marginal adaptation, anatomy, surface roughness, marginal staining, interfacial staining, proximal and occlusal contacts, secondary caries, postoperative sensitivity and luster. Clinicians examined restorations at baseline as well as at one-, two-, four-, eight- and 13-year recall visits. RESULTS: All restorations were examined at one year, 58 (95 percent) at two years, 39 (64 percent) at four years and 41 (67 percent) at eight years; at the 13-year recall examination, 41 (67 percent) either were examined or had a known outcome. Of the 41 restorations seen at the 13-year examination, 25 restorations (14 Class I and 11 Class II) were intact and acceptable, two had secondary caries and 14 either were not present or had failed (two were missing, 10 had received crowns and two had been replaced). No changes were observed in the modified USPHS criteria for 12 of the 25 restorations that were intact (48 percent). Areas of change observed in 13 of the 25 intact restorations included color match (12 percent), marginal adaptation at the occlusal (20 percent) and proximal surfaces (4 percent), marginal staining on occlusal (24 percent) and proximal surfaces (8 percent), and interfacial staining on occlusal (4 percent) and proximal surfaces (12 percent). CONCLUSION: The study results showed that most of the restorations observed at the 13-year recall examination maintained acceptable clinical qualities. PRACTICAL IMPLICATIONS: Beautifil restorative material demonstrated long-term successful results for restoration of posterior teeth.

Management of Class I and Class II Amalgam Restorations with Localized Defects: Five-Year Results.

Replacement of dental restorations has been the traditional treatment for defective restorations. This five-year prospective clinical trial evaluated amalgam restorations with localized defects that were treated by means of repair or refurbishing. Fifty-two patients (50% female and 50% male, mean age 28.3 ± 18.1 years, range 18-80) with 160 class I and class II defective restorations were included. The study focused on the application of two minimally invasive treatments for localized restoration defects and compared these with no treatment and total replacement as negative and positive controls, respectively. Restorations were assessed by two calibrated examiners according to modified U.S. Public Health Service criteria, including marginal adaptation, anatomic form, secondary caries, and roughness. At five years, recall was examined in 45 patients with 108 restorations (67.5%). The results suggest that repair treatment is as effective as total replacement of restorations with localized defects, reducing biological costs to the patient and providing new tools to the clinician. Refinishing restoration is a useful treatment for localized anatomic form defects.

Alternative treatments to replacement of defective amalgam restorations: results of a seven-year clinical study.

BACKGROUND: The authors conducted a prospective cohort clinical study to investigate the effectiveness of alternative treatments to the replacement of defective amalgam restorations. METHODS: Fifty patients aged 21 through 77 years (mean age, 56 years) with 113 defective amalgam restorations that were diagnosed during treatment planning participated in the study. The authors assigned each tooth to one of five treatment groups: repair with amalgam (n = 20), sealing of defective margins (n = 23), refinishing (n = 23), replacement (n = 22) or no treatment (n = 25). The replacement and no-treatment groups served as comparison groups, and the authors assigned 47 teeth randomly to these groups. Two clinicians examined the restorations before and after the assigned treatment and at subsequent recall visits by using modified U.S. Public Health Service criteria including marginal adaptation, anatomic form, occlusal and proximal contact, postoperative sensitivity and secondary caries. RESULTS: The clinicians examined 94 restorations (83 percent) at the one-year recall visit, 74 (65 percent) at the two-year recall visit and 54 (48 percent) at the seven-year recall visit. They observed most of the downgraded and failed restorations after the first two years of clinical service. CONCLUSIONS: The study results show that some degree of degradation occurred in all treatment groups, including the replacement group, at the seven-year recall examination, with no significant failure rate. The results support the repair of defective amalgam restorations as an alternative to replacement. Furthermore, the study findings show that in future controlled clinical trials, all teeth may receive random assignment. CLINICAL IMPLICATIONS: The study findings support repair rather than replacement of amalgam restorations with localized defects. Randomized controlled trials are needed to confirm these findings.

Survival rate of sealed, refurbished and repaired defective restorations: 4-year follow-up.

The most common treatment in general dental practice is the replacement of restorations affected by secondary caries or marginal deficiencies. Alternative treatments to replacement of defective restorations, such as marginal sealing, refurbishment and repair, have demonstrated improvement of their clinical properties with minimal intervention. The aim of this clinical study was to estimate the median survival time (MST) of marginal sealing, repair and refurbishment of amalgam and resin-based composite restorations with localized defects as a treatment to increase the restoration longevity. A cohort of 66 patients, with 271 class I and II restorations clinically diagnosed with localized defects was longitudinally assessed. Each restoration was assigned to one of the following 5 groups: Marginal Sealing (n=48), Refurbishment (n=73), Repair (n=27), Replacement (n=42), and Untreated (n=81). Two calibrated examiners assessed the restorations at baseline and annually during 4 years, using the modified Ryge criteria: marginal adaptation, anatomic form, roughness, secondary caries and luster. Fifty-two patients with 208 restorations were assessed after 4 years; the distribution of restorations in the groups was as follows: Marginal Sealing (n=36), Refurbishment (n=63), Repair (n=21), Replacement (n=28) and Untreated (n=60). Kaplan Meier test indicated that the Sealed margins group showed the lowest MST while the Repair group showed the highest MST for restorations examined after 4 years of follow up. Defective amalgam and resin-based composite restorations treated by sealing of marginal gaps, refurbishment of anatomic form, luster or roughness, and repair of secondary caries lesions, had their longevity increased.

Repair of amalgam restorations with composite resin and bonded amalgam: a microleakage study.

BACKGROUND: Total replacement is the most common technique for defective amalgam restorations, and it represents a major part of restorative dental treatment. Repair is an alternative option for amalgam restorations with localized defects. AIMS: This study compared microleakage of amalgam restorations repaired by bonded amalgam or composite resin. MATERIALS AND METHODS: Thirty extracted human pre-molars were prepared and restored with class I amalgam. A simulated defect was prepared that included the cavosurface margin on restorations, and the pre-molars were assigned to two treatment groups (n=15): In group 1, premolars were treated by composite resin (34% Tooth Conditioner Gel + Adper Single Bond 2 + Z100) and in group 2, premolars were repaired by bonded amalgam (34% Tooth Conditioner Gel + Prime and Bond 2.1 + Permite C). The teeth were immersed in a 50% silver nitrate solution, thermocycled, sectioned longitudinally and then observed by three examiners using a stereomicroscope. Microleakage was evaluated using a 0-4 scale for dye penetration, and data was analyzed by Kruskal Wallis and Dunn tests. RESULTS: Neither of the two methods eliminated microleakage completely. Composite resin was significantly the most effective for repair/tooth interface sealing (score 0 = 80.0%; P=0.0317). For the repair/restoration interface, composite resin was also statistically more effective as a sealant (score 0=66%; P=0.0005) when compared to the bonded amalgam technique (score 0=13%; P=0.0005). CONCLUSIONS: The use of adhesive systems significantly affected the ability to seal the repair/ tooth interface. However, at the level of the repair/restoration interface, the bonded amalgam technique may increase microleakage.

Survival rate of sealed, refurbished and repaired defective restorations: 4-year follow-up

The most common treatment in general dental practice is the replacement of restorations affected by secondary caries or marginal deficiencies. Alternative treatments to replacement of defective restorations, such as marginal sealing, refurbishment and repair, have demonstrated improvement of their clinical properties with minimal intervention. The aim of this clinical study was to estimate the median survival time (MST) of marginal sealing, repair and refurbishment of amalgam and resin-based composite restorations with localized defects as a treatment to increase the restoration longevity. A cohort of 66 patients, with 271 class I and II restorations clinically diagnosed with localized defects was longitudinally assessed. Each restoration was assigned to one of the following 5 groups: Marginal Sealing (n=48), Refurbishment (n=73), Repair (n=27), Replacement (n=42), and Untreated (n=81). Two calibrated examiners assessed the restorations at baseline and annually during 4 years, using the modified Ryge criteria: marginal adaptation, anatomic form, roughness, secondary caries and luster. Fifty-two patients with 208 restorations were assessed after 4 years; the distribution of restorations in the groups was as follows: Marginal Sealing (n=36), Refurbishment (n=63), Repair (n=21), Replacement (n=28) and Untreated (n=60). Kaplan Meier test indicated that the Sealed margins group showed the lowest MST while the Repair group showed the highest MST for restorations examined after 4 years of follow up. Defective amalgam and resin-based composite restorations treated by sealing of marginal gaps, refurbishment of anatomic form, luster or roughness, and repair of secondary caries lesions, had their longevity increased.

Na clínica odontológica geral, o tratamento mais comum é a substituição de restaurações com cárie secundária ou defeitos marginais. Tratamentos alternativos às substituições de restaurações defeituosas, como selamento marginal, recuperação, e reparo, têm proporcionado melhorias das propriedades clínicas, com um mínimo de intervenção. O objetivo deste estudo foi avaliar o tempo médio de sobrevida (median survival time - MST, na sigla em inglês) de selamento marginal, recuperação e reparo de restaurações de amálgama e compósitos resinosos com defeitos localizados, como tratamento para aumentar a longevidade das restaurações. Este foi um estudo longitudinal envolvendo 66 pacientes com 271 restaurações classe I e II, clinicamente diagnosticadas e com defeitos localizados. Cada restauração foi incluída num dos seguintes grupos: Selamento Marginal (n=48), Recuperação (n=73), Reparo (n=27), Substituição (n=42) e Sem tratamento (n=81). Dois examinadores calibrados avaliaram as restaurações no início e anualmente durante 4 anos, usando os critérios de Ryge modificados: adaptação marginal, forma anatômica, rugosidade, cárie secundária e brilho. Cinqüenta e dois pacientes com 208 restaurações foram avaliados após 4 anos; a distribuição das restaurações nos grupos foi a seguinte: Selamento Marginal (n=36), Recuperação (n=63), Reparo (n=21), Substituição (n=28) e Sem tratamento (n=60). O teste de Kaplan Meier mostrou que o grupo do Selamento Marginal apresentou o menor valor de MST, enquanto que o grupo do Reparo mostrou o maior valor, para as restaurações avaliadas após o acompanhamento de 4 anos. As restaurações de amálgama e compósitos tratadas com selamento de fissuras marginais, recuperação da forma anatômica, brilho ou rugosidade e reparo de cárie secundária, tiveram aumento de longevidade.

FDI World Dental Federation - clinical criteria for the evaluation of direct and indirect restorations. Update and clinical examples.

In 2007, new clinical criteria were approved by the FDI World Dental Federation and simultaneously published in three dental journals. The criteria were categorized into three groups: esthetic parameters (four criteria), functional parameters (six criteria), and biological parameters (six criteria). Each criterion can be expressed with five scores, three for acceptable and two for non-acceptable (one for reparable and one for replacement). The criteria have been used in several clinical studies since 2007, and the resulting experience in their application has led to a requirement to modify some of the criteria and scores. The two major alterations involve staining and approximal contacts. As staining of the margins and the surface have different causes, both phenomena do not appear simultaneously. Thus, staining has been differentiated into marginal staining and surface staining. The approximal contact now appears under the name "approximal anatomic form" as the approximal contour is a specific, often non-esthetic issue that cannot be integrated into the criterion "esthetic anatomical form". In 2008, a web-based training and calibration tool called e-calib (www.e-calib.info) was made available. Clinical investigators and other research workers can train and calibrate themselves interactively by assessing clinical cases of posterior restorations, which are presented as high quality pictures. Currently, about 300 clinical cases are included in the database which is regularly updated. Training for 8 of the 16 clinical criteria is available in the program: "Surface luster"; "Staining (surface, margins)"; "Color match and translucency"; "Esthetic anatomical form"; "Fracture of material and retention"; "Marginal adaptation"; "Recurrence of caries, erosion, abfraction"; and "Tooth integrity (enamel cracks, tooth fractures)". Typical clinical cases are presented for each of these eight criteria and their corresponding five scores.

Fluorides leaching from restorative materials and the effect on adjacent teeth.

OBJECTIVE: Placing a Class II restoration in a tooth changes the local environment, including that for the adjacent tooth. Apart from the change to a less- or non-cariogenic environment for the restored tooth, the effect of leachable components from a restoration in the adjacent tooth should be taken into consideration. METHOD: Practice-based clinical studies comprising of 1341 unrestored proximal surfaces in contact with Class II restorations using different restorative materials were reviewed to assess the effect on the caries development on the adjacent teeth. The caries status of the adjacent un-restored proximal surface was assessed as being clinically sound, having active caries with or without cavitation, or having arrested caries. Restorations from nine clinicians were reviewed. They had attended annual meetings where all aspects of the investigation had been discussed. The surfaces were followed for up to eight years. RESULTS: A reduced rate of caries development and progression were found on surfaces in contact with fluoride releasing materials like glass ionomers, resin modified glass ionomers and compomers compared to surfaces in contact with amalgam. CONCLUSION: Fluoride releasing materials reduce the development and progression of primary caries on adjacent proximal surfaces.

FDI World Dental Federation: clinical criteria for the evaluation of direct and indirect restorations-update and clinical examples.

In 2007, new clinical criteria were approved by the FDI World Dental Federation and simultaneously published in three dental journals. The criteria were categorized into three groups: esthetic parameters (four criteria), functional parameters (six criteria) and biological parameters (six criteria). Each criterion can be expressed with five scores, three for acceptable and two for non-acceptable (one for reparable and one for replacement). The criteria have been used in several clinical studies since 2007, and the resulting experience in their application has led to a requirement to modify some of the criteria and scores. The two major alterations involve staining and approximal contacts. As staining of the margins and the surface has different causes, both phenomena do not appear simultaneously. Thus, staining has been differentiated into marginal staining and surface staining. The approximal contact now appears under the name "approximal anatomic form" as the approximal contour is a specific, often non-esthetic issue that cannot be integrated into the criterion "esthetic anatomical form". In 2008, a web-based training and calibration tool called e-calib ( www.e-calib.info ) was made available. Clinical investigators and other research workers can train and calibrate themselves interactively by assessing clinical cases of posterior restorations which are presented as high-quality pictures. Currently, about 300 clinical cases are included in the database which is regularly updated. Training for eight of the 16 clinical criteria is available in the program: "Surface lustre"; "Staining (surface, margins)"; "Color match and translucency"; Esthetic anatomical form"; "Fracture of material and retention"; "Marginal adaptation"; "Recurrence of caries, erosion, abfraction"; and "Tooth integrity (enamel cracks, tooth fractures)". Typical clinical cases are presented for each of these eight criteria and their corresponding five scores.

Reasons for placement of restorations on previously unrestored tooth surfaces by dentists in The Dental Practice-Based Research Network.

OBJECTIVE: The authors conducted a study to identify and quantify the reasons used by dentists in The Dental Practice-Based Research Network (DPBRN) for placing restorations on unrestored permanent tooth surfaces and the dental materials they used in doing so. METHODS: A total of 229 DPBRN practitioner-investigators provided data from their practices regarding 9,890 consecutive restorations in 5,810 patients. Information the practitioner-investigators provided included their reasons for restoring the teeth, the specific teeth and surfaces they restored and the restorative materials they used. RESULTS: Primary caries (85 percent of teeth, 8,351 of 9,890) and noncarious defects (15 percent, 1,479 of 9,890) were the main reasons participants gave for placing restorations. Participants placed restorations necessitated by caries most frequently on occlusal surfaces (49 percent, 4,091 of 8,351). They used amalgam for 47 percent of the molar restorations and 45 percent of the premolar restorations. They used directly placed resin-based composite (RBC) for 48 percent of the molar restorations, 50 percent of the premolar restorations and 93 percent of the anterior restorations. CONCLUSION: DPBRN practitioner-investigators cited dental caries on occlusal and proximal surfaces of molar teeth as the main reasons for placing restorations on previously unrestored tooth surfaces. RBC was the material they used most commonly for occlusal and anterior restorations. Amalgam remains the material of choice to restore posterior teeth with proximal caries, although the authors noted significant differences in the use of amalgam and RBC by dentists in various regions of the DPBRN.

The longevity of different restorations in primary teeth.

BACKGROUND AND AIM: This paper reviews three published papers and adds results from a fourth study which aimed to determine which restorative material would be the best alternative(s) to amalgam (AM) in primary teeth. DESIGN: All studies had a practice-based design and were part of the routine treatment of children and adolescents. The clinicians were assigned which materials to use in a randomised matter in the first three studies which lasted for 7-8 years. In the fourth study conducted 4 years after the initial studies, the clinicians were free to select the restorative materials. RESULTS AND CONCLUSIONS: Resin modified glass ionomer (RMGI) and compomer (COM) restorations showed similar longevity compared with AM, whereas conventional GI restorations showed significantly shorter longevity. The studies indicated that the 'new and improved' materials based on in vitro tests did not always show enhanced clinical properties. In the last study, where clinicians freely selected the restorative materials they used in their practices, seven used COM, one used conventional GI materials and one used a combination of the two types of material.

Repair of amalgam restorations with conventional and bonded amalgam: an in vitro study / Reparo de restaurações de amálgama com amálgama adesivo e convencional: estudo in vitro

Purpose: This study evaluated microleakage on amalgam restorations repaired by amalgam and bonded amalgam. Methods: Thirty extracted human pre-molars were restored by amalgam. A simulated defect was prepared and assigned to two treatment groups (n=15): G1 - repaired by amalgam (Permite C-SDI); G2 - repaired by bonded amalgam (Caulk 34% Tooth Conditioner Gel - Dentsply + Prime & Bond 2.1 - Dentsply + Permite C- SDI). The teeth were immersed in a 50% silver nitrate solution, thermocycled and then, sectioned longitudinally through the restoration center and examined by 3 examiners using a stereomicroscope. Microleakage was evaluated in a 0-4 scale for dye penetration. Microleakage data were analyzed by Kruskal Wallis and Dunn test. Results: The bonded amalgam technique was significantly the most effective in repair/tooth interfaces sealing (score 0=53.3%, P=0.0012). For repair/restoration interfaces, conventional amalgam was also statistically more effective in the sealing (score 0=86.7%, P<0.001). Conclusion: None of materials eliminated microleakage completely. The use of adhesive systems had significant effect on the ability to seal the repair/tooth interface, however, for repair/restoration interface, it can increase microleakage.

Objetivo: Avaliar a microinfiltração em restaurações de amálgama com reparo em amálgama ou amálgama adesivo. Métodos: Trinta pré-molares humanos extraídos foram restaurados com amálgama. Simulou-se um defeito nas restaurações reparado com: G1 - amálgama (n=15) (Permite C-SDI); G2 - amálgama adesivo (n=15) (Caulk 34% Condicionador dentário Gel - Dentsply + Prime & Bond 2.1 - Dentsply + Permite C-SDI). Os dentes foram imersos em solução de nitrato de prata a 50%, termociclados e então, secionados longitudinalmente através da restauração e examinados por três examinadores usando um estereomicroscópio. A microinfiltração foi avaliada pela penetração de corante com uma escala de 0 a 4. Diferenças entre os grupos foram verificadas pelos testes Kruskal Wallis e Dunn. Resultados: Na interface reparo/dente, a técnica de reparo com amálgama adesivo foi significativamente mais efetiva, apresentando menor microinfiltração (escore 0=53.3%, P= 0,0012). Já na interface reparo/restauração, houve menor microinfiltração nas restaurações reparadas com amálgama convencional (escore 0=86.7%, P<0,001). Conclusão: Nenhum dos materiais eliminou a microinfiltração completamente. O uso de sistemas adesivos tem efeito significativo no selamento da interface reparo/dente, entretanto para interface reparo/restauração, ele pode aumentar a microinfiltração.

A long-term evaluation of alternative treatments to replacement of resin-based composite restorations: results of a seven-year study.

OBJECTIVE: In a seven-year prospective cohort study, the authors assessed the longevity of defective resin-based composite (RBC) restorations that were not treated or were treated by means of repair, sealing, refinishing or total replacement. They also aimed to identify and quantify the main reasons clinicians diagnosed restorations as defective. METHODS: Thirty-seven patients--19 women and 18 men--who were aged 27 through 78 years (mean = 57 years, standard deviation [SD] = 13 years) and had a total of 88 defective restorations participated in the study. Two of the authors assigned each restoration to one of five treatment groups, depending on the patient's treatment need: repair (n = 25), sealing of defective margins (n = 12), refinishing (n = 19), replacement (n = 16) and no treatment (n = 16). The authors conducted a survival analysis (according to modified U.S. Public Health Service criteria) at baseline and again at six months, one year, two years and seven years after treatment. RESULTS: The authors determined that the main reasons clinicians diagnosed the 88 restorations as being defective were marginal discoloration (n = 53, 60.2 percent), marginal degradation (n = 18, 20.5 percent) and color mismatch (n = 17, 19.3 percent). The authors examined 69 (78 percent) restorations at six months, 68 (77 percent) after one year, 62 (70 percent) after two years and 53 after seven years (60 percent). The percentages of failed restorations for each treatment after seven years were 0 percent for repair, 0 percent for sealing of defective margins, 18 percent for refinishing, 21 percent for replacement and 23 percent for no treatment. The P value for the log-rank test of equality for these groups was .36. CONCLUSIONS: Restorations degraded to varying degrees in all criteria, and the survival of restorations differed among treatment approaches. Longitudinal data collected across seven years support the viability of all nonreplacement restoration treatment strategies.

Dentin permeability: the basis for understanding pulp reactions and adhesive technology.

Permeability involves the passage of fluids, ions, molecules, particulate matter and bacteria into and through a substance or tissue under different and varying conditions. The permeability of the dentin is essential to support the physiology and reaction patterns of the pulp-dentin organ. Nutrients and impulses are transported from the pulp via the odontoblast process and the contents of its tubules maintain the dentin as a vital tissue. However, the main interest of this paper focuses on penetration from the outside towards the pulp rather than from the pulp towards the outside. The present overview centers on the dentinal tubules; how they are formed and how they change as a result of normal and abnormal function, age, and pathological processes and the effect of these processes on the permeability of dentin. Particular attention is focused on the patency of the dentinal tubules.This overview is largely based on the authors own research, clinical insights and active participation in continuing dental education over the last 50 years. It is not a review of the literature related to the permeability of dentin. Rather it presents interpretation of results related to the permeability of dentin based on experience and opinions acquired over a lifetime in dental research.

Sealing, refurbishment and repair of Class I and Class II defective restorations: a three-year clinical trial.

BACKGROUND: The authors conducted a clinical study to examine the effectiveness of treatments other than replacement for defective Class I and Class II resin-based composite (RBC) and amalgam (AM) restorations. METHODS: The authors recruited 66 patients (age range, 18-80 years) with 271 Classes I and II defective restorations (RBC = 78 and AM = 193). They assigned restorations to one of the following treatment groups on the basis of the type of defect: sealed margins (n = 48), repair (n = 27), refurbishment (n = 73), replacement (n = 42) or untreated (n = 81). They used modified U.S. Public Health Service/Ryge criteria to determine the quality of the restorations. Two examiners assessed the restorations independently at the beginning of the study and three years after treatment (Cohen's kappa = 0.74 at baseline and 0.82 at year 3). They used five parameters in assessing the restorations: marginal adaptation, anatomical form, surface roughness, secondary caries and luster. RESULTS: The authors assessed 237 restorations (RBC = 73, AM = 164) at the three-year recall examination. Restorations that underwent sealing of marginal defects exhibited significant improvements in marginal adaptation (P