A randomized controlled evaluation of posterior resin restorations of an altered resin modified glass-ionomer cement with claimed bioactivity.

OBJECTIVE: The objective of this randomized controlled prospective clinical trial was to evaluate the short time clinical behaviour of an altered resin modified glass-ionomer cement (RMGIC), which is claimed to possess bioactivity, in posterior restorations and to compare it intraindividually with a nanofilled resin composite. METHODS: Totally 78 pairs Class II and 4 pairs Class I restorations were placed in 29 female and 38 male participants with a mean age of 58.3 years (range 37-86). Each patient received at random at least one pair of, as similar as possible, Class II or Class I restorations. In the first cavity of each pair, the modified flowable RMGIC (ACTIVA Bioactive; AB) was placed after phosphoric acid etching of the cavity and without adhesive, according to the instructions of the manufacturer. In the other cavity a well established nanofilled resin composite (CeramX; RC) with a single step self-etch adhesive (Xeno Select) was placed. The restorations were evaluated using slightly modified USPHS criteria at baseline, 6 and 12 months. Caries risk and parafunctional habits of the participants were estimated. RESULTS: 158 restorations, 8 Class I and 150 Class II, were evaluated at the one year recalls. At baseline two failed restorations were observed (2AB), at 6 months six failures (5AB, 1RC) and at 12 months another thirteen failed restorations were observed (12AB, 1RC). This resulted in annual failure rates of 24.1% for the AB and 2.5% for RC (p<0.0001). The main reasons for failure for AB were lost restorations (5), postoperative symptoms (4) and secondary caries (3). Do to the unacceptable very high one-year failure frequency, the clinical study was stopped and no further evaluation will be performed. SIGNIFICANCE: The use of the AB restorative in Class II cavities, applied as instructed by the manufacturer after a short phosphoric acid pretreatment but without adhesive system, resulted in a non-acceptable very high failure frequency after a one year period. Further studies should be conducted using a bonding agent.

Bulk-filled posterior resin restorations based on stress-decreasing resin technology: a randomized, controlled 6-year evaluation.

This randomized study evaluated a flowable resin composite bulk-fill technique in posterior restorations and compared it intraindividually with a conventional 2-mm resin composite layering technique over a 6-yr follow-up period. Thirty-eight pairs of Class II restorations and 15 pairs of Class I restorations were placed in 38 adults. In all cavities a single-step self-etch adhesive (Xeno V) was applied. In the first cavity of each pair, the flowable resin composite (SDR) was placed, in bulk increments of up to 4 mm. The occlusal part was completed with a layer of nanohybrid resin composite (Ceram X mono). In the second cavity of each pair, the hybrid resin composite was placed in 2-mm increments. The restorations were evaluated using slightly modified US Public Health Service (USPHS) criteria at baseline and then annually for a time period of 6 yr. After 6 yr, 72 Class II restorations and 26 Class I restorations could be evaluated. Six failed Class II molar restorations, three in each group, were observed, resulting in a success rate of 93.9% for all restorations and an annual failure rate (AFR) of 1.0% for both groups. The AFR for Class II and Class I restorations in both groups was 1.4% and 0%, respectively. The main reason for failure was resin composite fracture.

Durability of a low shrinkage TEGDMA/HEMA-free resin composite system in Class II restorations. A 6-year follow up.

OBJECTIVE: The objective of this randomized controlled prospective trial was to evaluate the durability of a low shrinkage and TEGDMA/HEMA-free resin composite system in posterior restorations in a 6-year follow up. METHODS: 139 Class II restorations were placed in 67 patients with a mean age of 53 years (range 29-82). Each participant received at random two, as similar as possible, Class II restorations. In the first cavity of each pair the TEGDMA/HEMA-free resin composite system was placed with its 3-step etch-and-rinse adhesive (cmf-els). In the second cavity a 1-step HEMA-free self-etch adhesive was used (AdheSe One F). The restorations were evaluated using slightly modified USPHS criteria at baseline and then yearly during 6 years. Caries risk and parafunctional habits of the participants were estimated. RESULTS: Three molar teeth showed mild post-operative sensitivity during 3 weeks for temperature changes and occlusal forces. After 6 years, 134 Class II restorations were evaluated. Twenty-one restorations, 8 cmf-els (11.4%) and 13 ASE-els (20%) failed during the 6 years (p<0.0001). The annual failure rates were 1.9% and 3.3%, respectively. The main reasons for failure were fracture followed by recurrent caries. Most fractures and all caries lesions were found in high risk participants. SIGNIFICANCE: The Class II resin composite restorations performed with the new TEGDMA/HEMA-free low shrinkage resin composite system showed good durability over six years.

Posterior bulk-filled resin composite restorations: A 5-year randomized controlled clinical study.

OBJECTIVE: To evaluate in a randomized controlled study the 5-year clinical durability of a flowable resin composite bulk-fill technique in Class I and Class II restorations. MATERIAL AND METHODS: 38 pairs Class I and 62 pairs Class II restorations were placed in 44 male and 42 female (mean age 52.4 years). Each patient received at least two, as similar as possible, extended Class I or Class II restorations. In all cavities, a 1-step self-etch adhesive (Xeno V+) was applied. Randomized, one of the cavities of each pair received the flowable bulk-filled resin composite (SDR), in increments up to 4mm as needed to fill the cavity 2mm short of the occlusal cavosurface. The occlusal part was completed with the nano-hybrid resin composite (Ceram X mono+). In the other cavity, the resin composite-only (Ceram X mono+) was placed in 2mm increments. The restorations were evaluated using slightly modified USPHS criteria at baseline and then yearly during 5 years. Caries risk and bruxing habits of the participants were estimated. RESULTS: No post-operative sensitivity was reported. At 5-year 183, 68 Class I and 115 Class II, restorations were evaluated. Ten restorations failed (5.5%), all Class II, 4 SDR-CeramX mono+ and 6 CeramX mono+-only restorations. The main reasons for failure were tooth fracture (6) and secondary caries (4). The annual failure rate (AFR) for all restorations (Class I and II) was for the bulk-filled-1.1% and for the resin composite-only restorations 1.3% (p=0.12). For the Class II restorations, the AFR was 1.4% and 2.1%, respectively. CONCLUSION: The stress decreasing flowable bulk-fill resin composite technique showed good durability during the 5-year follow-up. CLINICAL SIGNIFICANCE: The use of a 4mm incremental technique with the flowable bulk-fill resin composite showed during the 5-year follow up slightly better, but not statistical significant, durability compared to the conventional 2mm layering technique in posterior resin composite restorations.

A randomized controlled 27 years follow up of three resin composites in Class II restorations.

OBJECTIVE: To evaluate the durability of three conventional resin composites in Class II restorations during 27 years. METHODS: Thirty participants, 25 female and 5 male (mean age 38.2 years, range 25-63), received at least three (one set) as similar as possible Class II restorations of moderate size. The three cavities were chosen at random to be restored with a chemical-cured (Clearfil Posterior) and two visible light-cured resin composites (Adaptic II, Occlusin). A chemical-cured enamel bonding agent (Clearfil New Bond) was applied after Ca(OH)2 covering of dentin and enamel etch. Marginal sealing of the restorations was performed after finishing. One operator placed 99 restorations (33 sets). Evaluation was performed with slightly modified USPHS criteria at baseline, 2, 3, 10 and 27 years. RESULTS: Postoperative sensitivity was observed in 5 patients. Three participants with 11 restorations (11%) could not be evaluated at the 27 year recall. Thirty-seven restorations failed (13 AII, 10 CP and 14 O). The overall success rate after 27 years was 56.5% (AII 55.2%, CP 63.0%, O 51.7%; p=0.70), with an annual failure rate of 1.6%. The main reason for failure was secondary caries (54.1%), followed by occlusal wear (21.6%) and material fracture (18.9%). Non-acceptable color match was seen in 24 (28.3%) of the restorations (AII 2, CP 16, O 6). Cox regression-analysis showed significant influence of the covariates tooth type, caries risk, and bruxing activity of the participants. CONCLUSIONS: Class II restorations of the three conventional resin composites showed an acceptable success rate during the 27 year evaluation.

A randomized controlled 30 years follow up of three conventional resin composites in Class II restorations.

OBJECTIVE: The aim of this 30 year randomized controlled study was to evaluate, by intraindividual comparisons, the durability of three conventional resin composites in Class II restorations. METHODS: Each of 30 participants, 21 female and 9 male (mean age 30 years, range 20-43), received at least three (one set) as similar as possible Class II restorations of moderate size. After cavity preparation, the three cavities were chosen at random to be restored with two chemical-cured (P10, Miradapt) and one light-cured resin composite (P30). A chemical-cured enamel bonding agent was applied after etching of the enamel. The chemical-cured resin composites were placed in bulk and the light-cured in increments. One operator placed 99 restorations (33 sets). The restorations were evaluated with slightly modified USPHS criteria at baseline, 2, 3, 5, 10, 15, 20 and 30 years. Statistical analyses were performed by the Kaplan-Meier, log-rank test and Cox regression analyses. RESULTS: After 30 years, 5 participants with 15 restorations (15%) could not be evaluated during the whole evaluation. Seven participants were considered as caries risk and eight participants as having active parafunctional habits. Postoperative sensitivity was observed in 24 teeth. In total 28 restorations, 9 P10, 12 P30 and 7 Miradapt restorations failed during the 30 years. The main reasons for failure were secondary caries (39.2%) and material fracture (35.7%). Sixty-four percent of the secondary caries lesions were found in high caries risk participants and 70% of the material fractures occurred in participants with active parafunctional habits. The overall success rate at 30 years was 63%, with an annual failure rate of 1.1%. 68-81% of the restorations showed non-acceptable color match. No statistical significant difference in survival rate was found between the three resin composites (p=0.45). The variables tooth type, cavity size, age, and gender of the participants did not significantly affect the probability of failure. SIGNIFICANCE: The three conventional resin composites showed good clinical performance during the 30 year evaluation. The chemical cured resin composites showed better performance than the light-cured composite.

A 15-year randomized controlled study of a reduced shrinkage stress resin composite.

OBJECTIVES: The aim of this randomized controlled study was to evaluate the long term effectiveness of a reduced shrinkage stress resin composite in Class II restorations. The material was compared intra-individually with a microhybrid resin composite. MATERIALS AND METHODS: Each of 50 patients with at least one pair of two similar sized Class II cavities participated (22 female, 28 male, mean age 43 years, range 18-64). Each participant received in each pair, in a randomized way, one Class II restoration performed with a reduced shrinkage stress resin composite (InTen-S) and the other restoration with a microhybrid resin composite restoration (Point 4). Both restorations were placed with an etch-and-rinse bonding system and an oblique layering technique. A total of 106 restorations, 33 premolar and 73 molars, were placed. The restorations were evaluated blindly each year using modified USPHS criteria. The overall performance of the experimental restorations was tested after intra-individual comparison using the Friedmans two-way analysis of variance test. The hypothesis was rejected at the 5% level. RESULTS: At 15 years, 91 restorations were evaluated. The drop out frequency was 15 restorations (5 male, 3 female participants; 2 premolar and 13 molar restorations). Except for 2 participants, who reported slight symptoms during a few weeks after placement, no post-operative sensitivity was observed at the recalls. The overall success rate at 15 years was 77%. Twenty-one non acceptable restorations were observed during the 15 years follow up, 10 InTen-S (21.7%) and 11 Point 4 (24.4%) restorations (p>0.05). Annual failure rates for the resin composites were 1.5% and 1.6%, respectively. The main reasons for failure were secondary caries (8) and resin composite fracture (7). The differences between premolar vs. molar restorations and between restorations in male vs. female participants were not significant. Significant differences were observed between 2-surface vs. 3-surface restorations. SIGNIFICANCE: During the 15-year follow up, the reduced shrinkage stress resin composite showed a good clinical durability in Class II cavities, but not significantly better than the control microhybrid resin composite. Secondary caries and material fracture were the main reasons of failure.

Longevity of posterior resin composite restorations in adults ­ A systematic review.

OBJECTIVE: To conduct a systematic review of the literature on the longevity of posterior resin composite restorations in adults. MATERIAL AND METHODS: A systematic literature search was conducted according to pre-determined criteria for inclusion and exclusion. The studies selected were prospective clinical trials with a minimum follow-up time of 4 years, 40 restorations per experimental group and an annual attrition rate of less than 5%. Initially, abstracts and full-text articles were assessed independently and the assessment was subsequently agreed on by five reviewers. The methodological quality of the studies was assessed according to the Swedish Council on Health Technology Assessment (SBU) standard checklist for determining the extent to which studies meet basic quality criteria. RESULTS: In all, the literature search identified 4275 abstracts and 93 articles were read in full-text. There were eighteen studies which met the criteria for inclusion, eight of which were included in the analysis. There were 80 failures of restorations with a total follow-up time at risk for failure of 62,030 months. The overall incidence rate for all causes of failure was 1.55 lost restorations per 100 restoration years. The most common biological reason for failure (a total of 31 restorations) was secondary caries, with or without fracture of the restoration. The quality of the evidence was low. CONCLUSIONS: In an efficacy setting, the overall survival proportion of posterior resin composite restorations is high. The major reasons for failure are secondary caries and restoration fracture which supports the importance of adequate follow-up time. CLINICAL SIGNIFICANCE: The overall survival proportion of posterior composite restorations was high, but the results cannot be extrapolated to an effectiveness setting. The importance of adequate follow-up time is supported by the finding that secondary caries often occurred after 3 years or later.

Eight-year randomized clinical evaluation of Class II nanohybrid resin composite restorations bonded with a one-step self-etch or a two-step etch-and-rinse adhesive.

OBJECTIVES: The aim of this study is to observe the durability of Class II nanohybrid resin composite restorations, placed with two different adhesive systems, in an 8-year follow-up. METHODS: Seventy-eight participants received at random at least two Class II restorations of the ormocer-based nanohybrid resin composite (Ceram X) bonded with either a one-step self-etch adhesive (Xeno III) or a control two-step etch-and-rinse adhesive (Excite). The 165 restorations were evaluated using slightly modified United States Public Health Services (USPHS) criteria at baseline and then yearly during 8 years. RESULTS: One hundred and fifty-eight restorations were evaluated after 8 years. Three participants with five restorations (three Xeno III, two Excite) were registered as dropouts. Twenty-one failed restorations (13.3%) were observed during the follow-up. Twelve in the one-step self-etch adhesive group (13.5%) and nine in the two-step etch-and-rinse group (13.0%). This resulted in nonsignificant different annual failure rates of 1.69 and 1.63%, respectively. Fracture of restoration was the main reason for failure. CONCLUSION: Good clinical performance was shown during the 8-year evaluation and no significant difference in overall clinical performance between the two adhesives. Fracture was the main reason for failure. CLINICAL RELEVANCE: The one-step self-etch adhesive showed a good long-term clinical effectiveness in combination with the nanohybrid resin composite in Class II restorations.

A randomized controlled clinical study of the effect of daily intake of Ascophyllum nodosum alga on calculus, plaque, and gingivitis.

OBJECTIVE: The aim of this study is to evaluate, in a randomized controlled cross-over study, the effect of daily intake of the alga Ascophyllum nodosum on supragingival calculus, plaque formation, and gingival health over a 6-month period. MATERIAL AND METHODS: Sixty-one adults with moderate to heavy calculus formation since their last yearly recall visit participated. In a randomized order over two 6-month periods, they swallowed two capsules daily, comprising a total of 500 mg dried marine alga powder (Ascophyllum nodosum, ProDen PlaqueOff®) or two negative control tablets. During the study, the participants maintained their regular oral habits. Their teeth were professionally cleaned at the start of each period and after the 6-month registrations. A wash out period of 1 month separated the two 6-month periods. Supragingival calculus (Volpe Manhold), gingivitis (Löe and Silness), gingival bleeding (Ainamo and Bay), and plaque (Quigley-Hein) were registered at screening and at the end of the two periods. Differences in oral health between the test and control periods were analyzed using a paired t test and Wilcoxon signed rank test. RESULTS: Fifty-five participants completed the study. After the alga intake, the mean calculus reduction was 52% compared to the control (p < 0.0001). Fifty-two participants showed less calculus formation in the alga group than in the control group. Plaque (p = 0.008) and gingival bleeding (p = 0.02) were also significantly less in the alga group. However, no significant difference was found between the groups for gingivitis (p = 0.13). CONCLUSIONS: The alga intake significantly reduced the formation of supragingival calculus and plaque and occurrence of gingival bleeding. The alga has a systemic effect on oral health. CLINICAL RELEVANCE: Daily intake of the alga Ascophyllum nodosum as an adjunct to customary oral hygiene showed a major reduction of supragingival calculus formation and reduced plaque formation. In addition, the calculus in the alga group was characterized by a more porous and less solid structure and was easier to remove than the calculus in the control group.

A randomized 10-year prospective follow-up of Class II nanohybrid and conventional hybrid resin composite restorations.

PURPOSE: To evaluate the 10-year durability of a nanohybrid resin composite in Class II restorations in a randomized controlled intraindividual comparison with its conventional hybrid resin composite predecessor. MATERIALS AND METHODS: Each of 52 participants received at least two Class II restorations that were as similar as possible. The cavities were chosen at random to be restored with a nanohybrid resin composite (Excite/Tetric EvoCeram (TEC); n=61) and a conventional hybrid (Excite/Tetric Ceram (TC); n=61). The restorations were evaluated with slightly modified USPHS criteria at baseline and then annually for 10 years. The overall performance of the experimental restorations was tested after intra-individual comparison and their ranking was tested using Friedman's two-way ANOVA. The level of significance was set at 5%. RESULTS: Four patient drop-outs with 8 restorations (4TEC, 4TC) were registered during the follow-up. A prediction of the caries risk showed that 16 of the evaluated 52 patients were considered as high risk patients. In total, 22 restorations, 11 TEC (3 premolars, 8 molars) and 11 TC (3 premolars, 8 molars) restorations failed during the 10 years. The main reason for failure was secondary caries (50%). 63% of the recurrent caries lesions were found in high caries risk participants. The overall success rate at 10 years was 80.7%, with an annual failure rate of 1.9%. No statistically significant difference was found in the overall survival rate between the two investigated resin composites. CONCLUSION: The nanohybrid and the conventional hybrid resin composite showed good clinical effectiveness in extensive Class II restorations during the 10-year study.

A randomized controlled three year evaluation of "bulk-filled" posterior resin restorations based on stress decreasing resin technology.

OBJECTIVE: The objective of this randomized controlled prospective clinical trial was to evaluate the efficacy of a flowable resin composite (SDR) bulk fill technique in posterior restorations and to compare it intraindividually with a conventional 2 mm resin composite curing technique in a 3-year follow up. MATERIALS AND METHODS: Thirty-eight pairs Class II and 15 pairs Class I restorations were placed in 38 patients with a mean age of 55.3 years (range 32-87). Each patient received at random at least two, as similar as possible, Class II or Class I restorations of two restorative techniques. In all cavities a single step self-etch adhesive (Xeno V) was applied. In one of the cavities of each pair, a flowable resin composite (SDR) was placed, in bulk increments up to 4 mm as needed to fill the cavity 2 mm short of the occlusal cavosurface. The occlusal part was completed with a nano-hybrid resin composite (Ceram X mono) layer. In the second cavity, the hybrid resin composite was placed in 2 mm increments. The restorations were evaluated using slightly modified USPHS criteria at baseline and then yearly during 3 years. Caries risk and parafunctional habits of the participants were estimated. RESULTS: After three years, 76 Class II and 28 Class I restorations could be observed. One molar resin composite-only tooth showed post-operative sensitivity during 3 weeks for temperature changes and occlusal forces. Two failed Class II molar restorations in the resin composite-only group were observed during the first year, one cusp fracture and one resin composite fracture. An annual failure rate of 1.3% was found for the resin composite only restorations and of 0% in the bulk-filled restorations (n.s.). Ten participants were estimated as having high caries risk and eleven showed active bruxing habits. SIGNIFICANCE: The 4 mm bulk-fill technique with the flowable resin composite SDR showed highly clinical effectiveness, which was comparable during the 3-year follow-up with the 2mm resin composite layering technique.

A prospective 8-year follow-up of posterior resin composite restorations in permanent teeth of children and adolescents in Public Dental Health Service: reasons for replacement.

OBJECTIVES: The aim of the study was to investigate reasons for replacement and repair of posterior resin composite (RC) restorations placed in permanent teeth of children and adolescents attending Public Dental Health Service in Denmark. MATERIAL AND METHOD: All posterior RC placed consecutively by 115 dentists over a period of 4 years were evaluated at baseline and up to 8 years later. The endpoint of each restoration was defined when repair or replacement was performed. The influence of patient, dentist and material factors on reasons for repair or replacement was investigated. RESULTS: A total of 4,355 restorations were placed. Replacements comprised 406 and repairs 125 restorations. The cumulative survival rate at 8 years was 84 %. Failed restorations were most frequently seen due to secondary caries (57 %), post-operative sensitivity (POS) (10 %) and RC fracture (6 %). POS was observed in 1.5 % of the evaluations and reported more often in girls and from teeth restored with a base material. Older dentists showed lower proportion of replaced restorations due to secondary caries than younger dentists. CONCLUSION: Posterior RC restorations in children and adolescents performed in general practice showed a good durability with annual failure rates of 2 %. The main reason for failure was secondary caries followed by post-operative sensitivity and resin composite fracture. A high proportion of replaced/repaired RC restorations were caused by primary caries in a non-filled surface. CLINICAL RELEVANCE: Secondary caries was the main reason for failure of RC in children and young adults. More teeth with post-operative sensitivity and a shorter longevity of restorations were observed when a base material was used.

A randomized controlled 5-year prospective study of two HEMA-free adhesives, a 1-step self etching and a 3-step etch-and-rinse, in non-carious cervical lesions.

OBJECTIVE: The aim of this study was to evaluate the 5 year clinical dentin bonding effectiveness of two HEMA-free adhesives in Class V non-carious cervical lesions. MATERIAL AND METHODS: A total of 169 Class V restorations were placed in 67 patients with a self-etching adhesive (G-Bond; 67), a 3-step HEMA and TEGDMA free etch-and-rinse (cfm; 51) and a control HEMA-containing etch-and-rinse adhesive (XP Bond; 51) in non-carious cervical lesions without intentional enamel involvement. The restorations were evaluated at baseline and yearly during a 5 year follow-up with modified USPHS criteria. Dentin bonding efficiency was determined by the percentage of lost restorations. RESULTS: During the 5 years, 159 restorations could be evaluated. Good short time dentin retention was observed for the three adhesives, there all adhesives fulfilled at 18 months the full acceptance ADA criteria. At 5 years a cumulative number of 22 lost restorations (13.8%) was observed. The HEMA-free adhesives showed significantly higher dentin retention compared to the HEMA-containing one. Loss of retention was observed for 5 G-Bond (7.9%), 4 cfm (8.3%) and 13 XP Bond (27.1%) restorations (p<0.05). No post-operative sensitivity was reported by the participants. No secondary caries was observed. SIGNIFICANCE: The durability in non-carious cervical lesions of the HEMA-free adhesives was successful after 5 years. Despite concerns which have been raised, showed the 1-step SEA one of the best reported clinical dentin bonding effectiveness.

A 6-year prospective evaluation of a one-step HEMA-free self-etching adhesive in Class II restorations.

OBJECTIVE: The aim of this study was to evaluate the clinical effectiveness of a one-step HEMA-free self-etching adhesive (SEA) placed with a micro-fine hybrid resin composite in Class II restorations. The restorations were compared intraindividually with 2-step HEMA containing SEA-giomer restorations. MATERIAL AND METHODS: Fifty-four patients with at least one pair of two similar Class II cavities participated (30 men, 24 women; mean age 57.1yrs). A total of 115 Class II composite restorations were placed with (1) a one step HEMA-free adhesive and a micro-fine hybrid resin composite (Gbond/Gradia Direct: 60; GG) and (2) a 2-step HEMA-containing SEA and a giomer (FL Bond/Beautifil: 55; FB). Each participant received in a randomized way at least one restoration with each of the experimental materials. The restorations were evaluated at baseline and yearly during a 6 year followup using modified USPHS criteria. RESULTS: During the 6 years, 111 restorations could be evaluated. No post-operative sensitivity was reported by the participants. Fourteen failed restorations (12.6%) were observed during the follow up, 5 GG (8.5%; 4 premolar and 1 molar teeth) and 9 FB (17.7%; 1 premolar and 8 molar teeth) (p<0.05). Annual failure rate at 6 years were 1.4% for GB and 3.0% for FB. Main reasons of failure were bulk fracture of resin composite for FB and tooth fracture for GB. SIGNIFICANCE: The HEMA-free SEA-hybrid RC restorations showed good clinical durability in Class II cavities after 6 years. The HEMA-containing SEA-giomer restorations showed a rather high failure frequency.

A six-year prospective randomized study of a nano-hybrid and a conventional hybrid resin composite in Class II restorations.

OBJECTIVE: The objective of this 6 year prospective randomized equivalence trial was to evaluate the long-term clinical performance of a new nano-hybrid resin composite (RC) in Class II restorations in an intraindividual comparison with its well-established conventional hybrid RC predecessor. METHODS: Each of 52 participants received at least two, as similar as possible, Class II restorations. The cavities were chosen at random to be restored with an experimental nano-hybrid RC (Exite/Tetric EvoCeram (TEC); n=61) and a conventional hybrid RC (Exite/Tetric Ceram (TC); n=61). The restorations were evaluated with slightly modified USPHS criteria at baseline and then annually during 6 years. RESULTS: Two patient drop outs with 4 restorations (2TEC, 2TC) were registered during the follow-up. A prediction of the caries risk showed that 16 of the evaluated 52 patients were considered as high risk patients. Eight TEC (2 P, 6M) and 6 TC (2P, 4M) restorations failed during the 6 years. The main reason of failure was secondary caries (43%; including the failure fracture+secondary caries it increases to 57.1%). 63% of the recurrent caries lesions were found in high caries risk participants. The overall success rate at six years was 88.1%. No statistical significant difference was found in the overall survival rate between the two investigated RC. SIGNIFICANCE: The nano-hybrid RC showed good clinical performance during the 6 year evaluation, comparable to the well-established conventional hybrid RC.

Effect of essential oils containing and alcohol-free chlorhexidine mouthrinses on cariogenic micro-organisms in human saliva.

OBJECTIVE: The aim of this study was to evaluate the effect on mutans streptococci and lactobacilli in saliva of mouthrinsing with essential oils and an alcohol-free chlorhexidine. MATERIALS AND METHOD: Twenty healthy volunteers (mean age 59 years) participated in the double-blind randomized cross-over study. Three mouthrinses were used in 16 days rinsing periods in addition to their regular mechanical oral hygiene: a solution with essential oils (EO; Listerine), a solution with alcohol-free chlorhexidine (CHX; Paroex) and water (negative control). The mouthrinse periods were separated by 3-month washout periods. At days 0 (baseline) and 17 (end) of each mouthrinse period, paraffin stimulated whole saliva was collected in order to analyse CFU/ml saliva of mutans streptococci and lactobacilli. RESULTS: Only the CHX rinse showed a significant difference for CFU mutans streptococci between baseline and end (p = 0.004). The CFU mutans streptococci at the end of the rinse periods showed statistically significant differences between CHX vs EO (p = 0.039) and CHX vs water (p = 0.022). The difference in CFU lactobacilli between baseline and end was significant for CHX (p = 0.031), but not for the other rinses. No statistically significant differences for lactobacilli were found at the end of the rinse periods between the mouthrinses. CONCLUSION: A significant reduction in amount of cariogenic bacteria in saliva was observed after 16 days of alcohol-free chlorhexidine mouthrinse but not after the essential oils rinse. The high number of participant's not changing to a bacterial class with a reduced number of micro-organisms showed that both rinses had little clinical significance as a caries preventing treatment method, which can decrease the number of CFU cariogenic micro-organisms.

Longevity of posterior resin composite restorations in permanent teeth in Public Dental Health Service: a prospective 8 years follow up.

OBJECTIVES: To investigate in a prospective follow up the longevity of posterior resin composites (RC) placed in permanent teeth of children and adolescents attending Public Dental Health Service. METHODS: All posterior RC placed, in the PDHS clinics in the cities of Copenhagen and Frederiksberg in Denmark between November 1998 and December 2002, in permanent teeth of children and adolescents up to 18 years, were evaluated in an up to 8 years follow up. The endpoint of each restoration was defined, when repair or replacement was performed. Survival analyses were performed between subgroups with Kaplan-Meier analysis. The individual contribution of different cofactors to predict the outcome was performed with Cox regression analysis. RESULTS: Totally 2881 children with a mean age of 13.7 years (5-18) received 4355 RC restorations placed by 115 dentists. Eighty percent were placed in molars and 49% were Class I. Two percent of restorations with base material and 1% of the restorations without base material showed postoperative sensitivity (n.s.). Replacements were made in 406 and repairs in 125 restorations. Kaplan-Meier analysis showed a cumulative survival at 8 years of 84.3%, resulting in an annual failure rate of 2%. Lower patient age, more than one restoration per patient, placement of a base material and placement of RC: in molars, in cavities with high number of surfaces, in lower jaw teeth, showed all significant higher failure rates. Five variables had significant importance for the end point, replacement/repair of the resin composite restorations: age of patient, age of operator, jaw, tooth type and cavity size. SIGNIFICANCE: Posterior RC restorations placed in children and adolescents in Public Dental Health clinics showed an acceptable durability with annual failure rates comparable with those of randomized controlled RC studies in adults.

A 7-year randomized prospective study of a one-step self-etching adhesive in non-carious cervical lesions. The effect of curing modes and restorative material.

OBJECTIVE: The aim of this study was to evaluate the clinical retention of a one-step self-etching adhesive system (Xeno III) in Class V non-carious cervical lesions and the effect of restorative material and curing techniques on longevity of the restorations. MATERIALS AND METHODS: A total of 139 Class V restorations were placed with the self-etching primer Xeno III and a resin composite (Tetric Ceram) or a poly-acid modified resin composite (Dyract AP) in non-carious cervical lesions without intentional enamel involvement. The materials were cured with a conventional continuous light, a soft-start or a pulse-delay curing mode. The restorations were evaluated at baseline, 6, 12, 18 and 24 months and then yearly during a 7 year follow-up with modified USPHS criteria. Dentine bonding efficiency was determined by the percentage of lost restorations. RESULTS: During the 7 years, 135 restorations could be evaluated. No post-operative sensitivity was reported by the participants. Overall relative cumulative loss rate frequencies for the adhesive system at 6 and 18 months and 7 years, independent of curing technique and restorative material, were 0.8%, 6.9% and 23.0%, respectively. The self-etching adhesive fulfilled at 18 months the full acceptance ADA criteria. Tetric Ceram showed at 7 years a 20.9% loss of retention and Dyract AP a 25.0% loss rate (Log rank p = 0.48). The loss rates for the 3 curing techniques: continuous, soft start and pulse delay were 17%, 27.9% and 24.4%, respectively (Log rank p = 0.52). No secondary caries was observed. SIGNIFICANCE: The single-step self-etching adhesive showed acceptable clinical long-time retention rates to dentine surfaces independent of restorative material and curing technique used.

Clinical performance of a nanofilled resin composite with and without an intermediary layer of flowable composite: a 2-year evaluation.

The objective of this prospective clinical follow-up was to evaluate the 2-year clinical performance of a nanofilled resin composite in class II restorations. The restorations were made with and without intermediary layer of a nanofilled flowable resin composite studied in an intraindividual comparison. Each participant received at least two, as similar as possible, class II restorations of the nanofilled resin composite. One restoration of each pair (54) was chosen at random to be restored with an intermediary layer with flowable nanofilled resin composite. The other was restored without. The restorations were evaluated with slightly modified US Public Health Services criteria at baseline, 1, and 2 years. Ninety-two restorations, 46 pairs, were evaluated at 2 years. A prediction of the caries risk showed that 22 of the evaluated 48 patients were considered as high-risk patients. Two failures were observed, one in each group, resulting in a 2.2% failure rate. No statistical difference was seen between the restorations restored with and without layer of flowable resin composite. The nanofilled resin composite showed very good surface characteristics and color match, which did not change significantly during the follow-up period. The nanofilled resin composite showed a good clinical performance with a 2.2% failure rate after 2 years. No differences were observed between the restorations with and without the nanofilled flowable resin intermediary layer.