Gingival microleakage of class II bulk-fill composite resin restorations.

BACKGROUND: Bulk-fill composites were developed to simplify composite placement and minimize polymerization shrinkage stresses, which can improve gingival marginal adaptation in deep class II cavities. OBJECTIVES: The objective of this study was to compare the gingival microleakage of class II cavities restored with bulk-fill composites to that of incrementally restored ones with a conventional composite at 2 storage periods. MATERIAL AND METHODS: Forty freshly extracted intact molars were employed. Two standardized class II slot cavities, 3-millimeter-wide buccolingually, with the gingival floor 0.5 mm below the cementoenamel junction (CEJ) and the axial wall depth of 1.3 mm were prepared in each tooth (80 cavity preparations). The prepared teeth were divided equally into 3 bulk-fill groups (Tetric EvoCeram® Bulk Fill, X-tra Fil® and QuiXX®) and 1 control group (TPH Spectra® HV). Each group was subdivided into 2 equal subgroups (n = 10) according to the storage period in distilled water (24 h and 6 months). The Adper® Single Bond Plus adhesive was used with all the restorative materials. The cavities in the experimental groups were restored with 4-millimeter bulk-fill composites in 1 increment, while the cavities in the control group were restored with 2 increments of the thickness of 2 mm. The polymerization light was applied from the occlusal surfaces. The teeth were then immersed in 2% procion red dye solution, sectioned and examined under a stereomicroscope to determine the extent of dye penetration. The data was statistically analyzed using the Kruskal-Wallis test and the Mann-Whitney U test. RESULTS: The Kruskal-Wallis test revealed no significant differences in the mean microleakage scores among all the groups after 24-hour and 6-month storage (p = 0.945 and p = 0.928, respectively). The Mann-Whitney U test revealed an increase in the mean microleakage scores in all the groups after 6-month storage; however, the scores were not significantly different from the means obtained after 24 h (p = 0.259 for Tetric EvoCeram Bulk Fill; p = 0.205 for X-tra Fil; p = 0.166 for QuiXX; p = 0.155 for TPH Spectra HV). CONCLUSIONS: Gingival microleakage of bulk-fill composites in class II cavities was not significantly different from that of incrementally restored ones with a conventional composite. The increase in the mean gingival microleakage of the specimens stored for 6 months was not statistically significantly different in comparison to the values obtained after the 24-hour storage period for each composite.

Cuspal Deflection of Premolars Restored with Bulk-Fill Composite Resins.

OBJECTIVE: This in vitro study compared cuspal deflection of premolars restored with three bulk-fill composite resins to that of incrementally-restored ones with a low-shrinkage silorane-based restorative material. MATERIALS AND METHODS: Forty freshly-extracted intact human upper premolars were used. Reference points at buccal and palatal cusp tips were acid-etched and composite rods were horizontally bonded to them (TPH-Spectra-HV, Dentsply). Two acrylic resin guiding paths were made for each premolar to guide beaks of a digital micrometer used for cuspal deflection measurements. Standardized MOD cavities, 3 mm wide bucco-lingually and 3.5 mm deep, were prepared on each premolar. Prepared teeth were then equally divided into four groups (n = 10) and each group was assigned to one of four composite resin (QuiXX, Dentsply; X-tra fil, Voco; Tetric EvoCeram Bulk Fill, Ivoclar Vivadent; low-shrinkage Filtek LS, 3M/ESPE). Adper Single Bond-Plus, 3M/ESPE was used with all bulk-fill restoratives. LS-System Adhesive, 3M/ESPE was used with Filtek LS. For each prepared premolar, cuspal deflection was measured in microns as the difference between two readings between reference points before and after restoration completion. Means and SDs were calculated and data statistically-analyzed using One-way ANOVA and Tukey's test. RESULTS: Filtek LS showed the lowest mean cuspal deflection value 6.4(0.84)µm followed by Tetric EvoCeram Bulk Fill 10.1(1.2) µm and X-tra fil 12.4(1.35)µm, while QuiXX showed the highest mean 13(1.05)µm. ANOVA indicated significant difference among mean values of groups (p < 0.001). Tukey's test indicated no significant difference in mean values between QuiXX and X-tra fil (p = 0.637). CONCLUSIONS: Tetric EvoCeram Bulk Fill had significantly lower mean cuspal deflection compared with the two other bulk-fill composite resins tested. Filtek LS had the lowest significant mean cuspal deflection in comparison to all tested bulk-fill restoratives. CLINICAL SIGNIFICANCE: The use of Tetric EvoCeram Bulk fill composite resin restorative for class II MOD cavities resulted in reduced cuspal deflection in comparison to the two other bulk-fill composite resins tested. The silorane-based Filtek LS restorative resulted in the least cuspal deflection in comparison to all tested bulk-fill composite restoratives.

Determinants and frequency of pharmaceutical compounding in pharmacy practice in Palestine.

OBJECTIVES: The aims of this study were to determine the frequency of prescription compounding by community pharmacists, identify factors that influence pharmacists' decisions to provide compounding services, and evaluate physicians' perspectives on prescribing medications that require compounding. METHODS: The study was a cross-sectional survey administered via face-to-face structured interviews with randomly selected community pharmacists and physicians from different areas of the West Bank. KEY FINDINGS: Of the 260 community pharmacists who were contacted, 212 agreed to participate in the survey, giving a response rate of 81.5%. Overall, 153 (72.2%) of respondent pharmacists provided compounding services. Compounded prescriptions accounted for 1973 (1.55%) of 126,840 prescriptions dispensed in a typical month. Among the compounders, 112 (73.2%) pharmacists reported that their goal in providing full pharmaceutical care to their patients was the most important motivator. The most frequently reported reason for not providing compounding was 'I do not receive prescriptions that require compounding' by 43 out of 59 (72.9%) pharmacists. A total of 179 out of 220 physicians consented to participate in this study giving a response rate of 81.4%. The majority of physicians (142, 79.3%) did not prescribe compounded medicines. The most important reason for their decision to prescribe compounded medicines was the unavailability of the required dosage forms. The most commonly cited reason for not prescribing them was a lack of trust in the quality of the compounded formulations. CONCLUSION: While most respondent pharmacists provide a compounding service this represents only a small percentage of the total volume of dispensed prescriptions. Most responding physicians do not prescribe medications that require compounding because they lack trust in the quality of the compounded formulations.