Eighteen-month clinical evaluation of a filled and unfilled dentin adhesive.

OBJECTIVE: The purpose of this study was to evaluate the performance of a filled (OptiBond Solo) and an unfilled (Prime & Bond 2.1) "one-bottle" adhesive in Class V restorations after 18 months of clinical service. METHODS: Thirty-three patients with non-carious cervical lesions were enrolled in the study. A total of 101 lesions were restored using one of the adhesives and a hybrid composite resin. Enamel was not beveled, nor was any mechanical retention placed. The restorations were evaluated at baseline, and at 6 and 18 months after placement using modified USPHS criteria. RESULTS: Cumulative 18-month retention rates were 93.6% for OptiBond Solo and 98.0% for Prime & Bond 2.1. The difference in retention rates was not statistically significant. For OptiBond Solo, the only notable problems were interfacial staining and marginal adaptation, both of which were less than ideal in 9% of restorations. Marginal problems were slightly less frequent for Prime & Bond 2.1 restorations, but the difference was not significant. CONCLUSIONS: Both adhesives provided Class V retention rates exceeding the 18-month, full acceptance guidelines set by the American Dental Association. Any additional benefit provided by the use of a filled adhesive was not detected in this 18-month clinical trial.

Effect of powder/liquid ratio on the clinical and laboratory performance of resin-modified glass-ionomers.

OBJECTIVES: To compare the effects of powder/liquid (P/L) ratio and surface wetness on retention of adhesive Class V restorations. METHODS: One-hundred and six Fuji II LC restorations were placed at two clinical trial sites. In the 'high-dry group (Site A), Fuji II LC was mixed at a P/L ratio of 3.0 and applied to dentine that was visibly dry, but not desiccated. In the 'low-wet' group (Site B), Fuji II LC was mixed at a P/L ratio of 2.25 and applied to dentine that was glisteningly moist. The restorations were evaluated at baseline, 1 and 2 years at both sites, and at 3 years at one site. The P/L ratio effects on viscosity and wetting were evaluated in vitro by determining the film thickness possible at different ratios. RESULTS: At 2 years the retention levels at the two sites differed significantly (p < or = 0.1). Site B ('low-wet' group) exhibited 100% retention, and Site A ('high-dry' group) exhibited 78% retention. At 3 years Site A exhibited 74% retention, and nine of the 12 retention failures occurred in patients 65 years and older. Laboratory measurements demonstrated that the viscosity of 'low-wet' mixtures permitted film thickness that were one-half those of the 'high-dry' group. CONCLUSIONS: The study demonstrated that a higher powder/liquid ratio and a drier dentine surface compromised wetting by a resin-modified glass-ionomer resulting in a decline in retention from baseline to 3 years. This study suggests that the dentine surface should be kept hydrated to promote bonding, and that the powder/liquid ratio should be low enough to create low-viscosity mixtures which promote wetting. In the 'high-dry' dentine group there was still 74% retention at 3 years, indicating that factors other than wetting affect retention.

The clinical performance of CAD-CAM-generated ceramic inlays: a four-year study.

The authors conducted a long-term clinical study of 50 CEREC (Siemens AG) CAD-CAM inlay restorations in 28 patients. After four years, they found the inlays to rate very highly in color matching, interfacial staining, secondary caries, anatomic contour, marginal adaptation, surface texture and postoperative sensitivity. They monitored cement loss along the occlusal margins and found it to be relatively low, with an unusual decrease in measured cement wear from the third to the fourth year. The favorable results of this long-term clinical study of these CAD-CAM restorations portend significant success for this restorative approach.

Using crowns to prevent tooth fracture.

Placing crowns to prevent tooth fracture is thought to be a common but infrequently documented treatment procedure. Two studies are described that provide information about dentists' use of crowns to prevent tooth fracture. North Carolina general dentists indicated that 44% of the crowns they placed were for the principal reason of fracture prevention. However, when groups of dentists examined the same patients, there was little agreement about which teeth should be crowned due to risk of fracture. These results suggest that the placing of crowns to prevent fracture merits a careful determination of effectiveness and appropriateness.

Bonding to resurfaced posterior composites.

Despite significant improvements in the wear resistance of posterior composite restorations, they still undergo occlusal wear, color change, and surface staining with time. One method of repairing these restorations is re-surfacing the old composite. This study investigated the bonding of new composite to the corresponding old composite material by several different mechanical conditioning steps, chemical conditioning steps, primer conditioning steps, and four posterior composites. Aged composite surfaces were conditioned, re-bonded to new composite, stored in artificial saliva for seven days at 37 degrees C, and tested in shear. The mean shear strength for unrepaired composites was 27 MPa. Optimal re-bond strengths were 88% (Estilux), 77% (Ful-Fil), 92% (Occlusin), and 102% (P-10) of original bulk shear strengths. General linear modeling revealed that the best combination tested was roughening with a D830 diamond bur, conditioning the surface with water, and priming with Scotchbond-1 dentin bonding agent.

Three-year clinical evaluation of a self-cured posterior composite resin.

A study was conducted to determine whether the wear resistance of a posterior composite could be improved by maximizing filler particle-to-particle contacts. This was expected to reduce stress concentrations on the resin matrix and thus reduce occlusal wear. A self-curing quartz-filled composite with this design, P-10, was used to restore 90 Class I and II cavity preparations in adult teeth. Restorations were recalled after baseline at six months, one year, two years, and three years to measure wear by direct and indirect evaluation methods. There was no apparent advantage for this material compared with other previously evaluated posterior composites. The average cumulative wear for P-10 after three years was 145 microns. In addition, the restorations were evaluated for color-matching, interfacial staining, secondary caries, marginal adaptation, surface texture, and postoperative sensitivity. This material was not significantly different in those ways from other posterior composite products except in terms of more rapid color change, because it is self-cured.

A state-supported incentive program and distribution of dental manpower.

To encourage dental health practitioners to practice in areas of low dentist/population ratios, an Educational Loan Program has been set up in North Carolina. Through practicing in areas of designated shortage, graduates can fulfill their loan obligations.