Adhesive Class VI Resin Composite Restorations of Worn Mandibular Incisal Edges: A Two-year Case Report.

Many authors have advocated retentive tooth preparations for resin composite restorations intended to halt progression of incisal edge attrition with worn concave dentin, probably due to frustration with adhesive restorations being lost from these defects. Unfortunately, this technique further removes the dentin these restorations are intended to preserve. The purpose of this article is to demonstrate a purely adhesive, less invasive technique for restoration of worn concave incisal edges, which includes air particle abrasion and increased etching time for the sclerotic dentin and unprepared enamel. Favorable two-year results for mandibular anterior teeth opposed by natural teeth are reported.

Diagnosis of Pit-and-fissure Caries Using Three-dimensional Scanned Images.

Diagnosis of the extent of pit-and-fissure caries has been subjective and thus difficult to teach and categorize for treatment planning. This in vitro study compares occlusal caries diagnosis of extracted posterior teeth (n=49) using three-dimensional (3D) scanned images vs visual examination, according to the International Caries Detection and Assessment System (ICDAS). The surfaces chosen for study represent all ICDAS classifications. Five experienced restorative faculty members examined scanned images for 60 seconds from a standardized series of views of each surface and scored them independently. One month later, the same teeth were examined visually by the same five raters with magnification and LED headlamps, with compressed air available. Intrarater and interrater agreement and validity were assessed using intraclass correlation coefficients (ICCs). The ICCs, ranging from 0.90 to 0.93, indicated excellent agreement between and within raters and between the raters and the gold standard ICDAS determination. This suggests that both photographs and 3D scans of pits and fissures are equally effective in diagnosing caries.

Use of a Modified Matrix Band Technique to Restore Subgingival Root Caries.

Given the increasing incidence of root caries in the elderly population, clinicians frequently must isolate and restore subgingival preparations. This article demonstrates a technique utilizing a modified Tofflemire matrix band that creates a preparation free of crevicular fluid and blood for restoration with resin-modified glass ionomer cement.

Replacement of a Missing Maxillary Central Incisor Using a Direct Fiber-Reinforced Fixed Dental Prosthesis: A Case Report.

The use of the direct fiber-reinforced fixed dental prosthesis (FDP) restorative technique presented in this article will result in an ideal restoration considering both esthetics and function in a single appointment. Although indirect techniques are available and may be used, they are time-consuming, resulting in higher cost; therefore, a simplified approach combining a prebonded fiber-reinforced mesh with a sculptable micro-hybrid composite will deliver an acceptable esthetic result with proper function.

Restorative Technique Selection in Class IV Direct Composite Restorations: A Simplified Method.

Use of the techniques presented here will yield highly esthetic resin composite restorations in minimal time. Although more elaborate composite layering techniques exist and may be used in complex esthetic scenarios, a simplified approach combining two body shades and implementing basic dental anatomy concepts often will deliver highly acceptable esthetic results.

The critical barrier to progress in dentine bonding with the etch-and-rinse technique.

OBJECTIVES: The lack of durability in resin-dentine bonds led to the use of chlorhexidine as MMP-inhibitor to prevent the degradation of hybrid layers. Biomimetic remineralisation is a concept-proven approach in preventing the degradation of resin-dentine bonds. The purpose of this study is to examine the integrity of aged resin-dentine interfaces created with a nanofiller-containing etch-and-rinse adhesive after the application of these two approaches. METHODS: The more established MMP-inhibition approach was examined using a parallel in vivo and in vitro ageing design to facilitate comparison with the biomimetic remineralisation approach using an in vitro ageing design. Specimens bonded without chlorhexidine exhibited extensive degradation of the hybrid layer after 12 months of in vivo ageing. RESULTS: Dissolution of nanofillers could be seen within a water-rich zone within the adhesive layer. Although specimens bonded with chlorhexidine exhibited intact hybrid layers, water-rich regions remained in those hybrid layers and degradation of nanofillers occurred within the adhesive layer. Specimens subjected to in vitro biomimetic remineralisation followed by in vitro ageing demonstrated intrafibrillar collagen remineralisation within hybrid layers and deposition of mineral nanocrystals in nanovoids within the adhesive. CONCLUSIONS: The impact was realized by understanding the lack of an inherent mechanism to remove water from resin-dentine interfaces as the critical barrier to progress in bonding with the etch-and-rinse technique. The experimental biomimetic remineralisation strategy offers a creative solution for incorporating a progressive hydration mechanism to achieve this goal, which warrants its translation into a clinically applicable technique.

In vivo chlorhexidine stabilization of hybrid layers of an acetone-based dentin adhesive.

The current in vivo study evaluated the degradation of dentin hybrid layers in deep occlusal-surface resin composite restorations using TEM. Caries-free premolars scheduled for extraction as part of orthodontic treatment were prepared and restored, then extracted after 12 months. The adhesive used was a single-bottle etch-and-rinse acetone-based product (Prime & Bond NT, Dentsply/Caulk). Control group restorations (n=8) were placed according to the manufacturer's instructions, while the experimental group received application of a 2% solution of chlorhexidine digluconate after etching and rinsing and prior to application of the adhesive. Extensive degradation was observed in all of the teeth in the control group after 12 months, while no degradation was observed in the experimental group. In vitro testing showed no significant difference in immediate microtensile bond strength between the control and experimental adhesive protocols.

Durability of resin-dentin bonds to water- vs. ethanol-saturated dentin.

Higher 24-hour resin-dentin bond strengths are created when ethanol is used to replace water during wet bonding. This in vitro study examined if ethanol-wet-bonding can increase the durability of resin-dentin bonds over longer times. Five increasingly hydrophilic experimental resin blends were bonded to acid-etched dentin saturated with water or ethanol. Following composite build-ups, the teeth were reduced into beams for 24-hour microtensile bond strength evaluation, and for water-aging at 37 degrees C for 3, 6, or 12 months before additional bond strength measurements. Although most bonds made to water-saturated dentin did not change over time, those made to ethanol-saturated dentin exhibited higher bond strengths, and none of them fell over time. Decreased collagen fibrillar diameter and increased interfibrillar spacing were seen in hybrid layers created with ethanol-wet-bonding. Increases in bond strength and durability in ethanol-wet-bonding may be due to higher resin uptake and better resin sealing of the collagen matrix, thereby minimizing endogenous collagenolytic activities.

Postoperative sensitivity: a comparison of two bonding agents.

Historically, postoperative pain associated with temperature was considered a thermal conduction problem. More recently, pulpal hydrodynamics has been used to explain this sensitivity. Relative to restorations placed with dentin bonding agents that require a separate etching step, agents that include an acidic primer are believed to result in a better seal of the dentinal tubules. This study compared pain associated with a standardized cold stimulus in two groups of restorations. One group was placed with a self-priming resin that required a separate etch step, the other with a self-etching, self-priming dentin bonding agent. This was a community-based, randomized, double-blind clinical trial. Two hundred and nine restorations were placed for 76 participants. All teeth were asymptomatic at the start of the trial. Immediately following application of a standardized cold stimulus, participants rated the pain for each restored tooth using a Visual Analog Scale (VAS). For each group of restorations, VAS scores at 13 weeks were compared to preoperative scores. In addition, the preoperative score was subtracted from the 13-week score, and the two groups of restorations were compared. For both groups of restorations, the median scores were significantly reduced at 13 weeks. This decrease in the VAS score reflects a reduction in sensitivity below that which existed preoperatively. There was no significant difference between the two groups of restorations in terms of change in sensitivity at 13 weeks.

One-year clinical performance of a resin-modified glass ionomer and a resin composite restorative material in unprepared Class V restorations.

This study evaluated the clinical performance and appearance of a resin-modified glass ionomer and a resin composite over one year. Thirty-seven pairs of restorations of Fuji II LC and Z250/Single Bond were placed in caries-free cervical erosion/abfraction lesions without tooth preparation. Restorations were clinically evaluated at baseline and 6 and 12 months, using modified Ryge/USPHS criteria. No significant difference (p>0.05) was observed in performance of both materials, although retention of the Z250 restorations was below the minimum specified in the ADA Acceptance Program for Dentin and Enamel Adhesives. Little difference in the restorations' appearance was observed.

Two-year clinical performance of a polyacid-modified resin composite and a resin-modified glass-ionomer restorative material.

This study compared the clinical performance of a polyacid-modified resin composite and a resin-modified glass-ionomer restorative material over two years. Thirty-four pairs of restorations of Compoglass and Fuji II LC were placed in caries-free cervical erosion/abfraction lesions without tooth preparation. Restorations were clinically evaluated at baseline, 6, 12, 18 and 24 months using modified Ryge/USPHS criteria. A significantly higher incidence of failed restorations was found with the polyacid-modified resin composite (p < 0.05).

Two-year clinical comparison of a microfilled and a hybrid resin-based composite in non-carious Class V lesions.

The purpose of this double-blind clinical trial was to compare the retention rate in noncarious Class V lesions of two resin-based composite restorative materials with contrasting stiffness. Isolation with retraction cord, pressed paper triangles, and cotton rolls was used to closely mimic the procedures generally used in a practice setting. Thirty pairs of restorations were placed, one using Silux Plus and one using Z100. The assignment of material was randomized, and the subjects were unaware of the material used. All restorations were placed with a fourth-generation adhesive liner, Scotchbond Multi-Purpose. Evaluations were performed at baseline, 6, 12, 18, and 24 months by two independent examiners using criteria developed by Cvar and Ryge in a forced consensus model. Examiners were unaware of the restoration's group identity. No difference between the retention rates for the two groups was found after 24 months, bringing into question the role that a material's stiffness plays in determining retention in a noncarious Class V lesion.

Resistance to condensation of 'condensable' resin composites as evaluated by a mechanical test.

This study compared the resistance-to-condensation forces of recently introduced condensable resin composites to that of amalgams and conventional resin composites. Using the flat platens of a servohydraulic testing machine, cylindrical specimens of each material 2.8 mm in diameter and 5.5 mm in length were compressed diametrally over two seconds to a thickness of 0.75 mm. Peak forces generated during compression were recorded. This method ranked the various classes of restorative material for resistance to condensation in the same order as most clinicians subjectively reported, with the highest forces observed with admixed dental amalgams, followed in order by spherical amalgams, condensable resin composites and conventional resin composites. Although peak forces observed with the condensable resin composites were generally higher than those observed with conventional resin composites, these were significantly lower than the peak forces observed with amalgams.

Effect of plasma arc curing on the microleakage of Class V resin-based composite restorations.

PURPOSE: To evaluate the effect of plasma arc light-curing on the microleakage of Class V resin-based composite (RBC). MATERIALS AND METHODS: Facial and lingual Class V cavities were prepared at the cemento-enamel junction of extracted third molars. Restorations of the two materials (Z250; Amelogen) were placed, using the supplied dentin adhesives (Single Bond; PQ 1, respectively), and light-cured by either a halogen light curing unit (H) or a plasma arc curing unit (P). After thermal cycling, the teeth were immersed in methylene blue dye, then sections of the restored teeth were visually assessed for leakage. RESULTS: No leakage was observed at the interface between enamel and RBC in any restoration in this study. At gingival margins, the incidence of leakage (slight/severe) was: Z250 H = 2/4, P = 6/6; Amelogen H = 3/4, P = 1/12, where n = 16. The greatest incidence of leakage was observed in restorations cured by the plasma arc method. A two-way ANOVA of leakage data rankings showed curing method to be a significant factor (P = 0.002), restorative material not to be a significant factor (P = 0.24), and no significant interaction between material and curing method (P = 0.38).

Two-year clinical performance of a resin-modified glass-ionomer restorative material.

This study was a 2-year clinical evaluation of a conventional and a resin-modified glass-ionomer restorative material. Thirty-four restorations each of Ketac-Fil and Photac-Fil were placed without tooth preparation in cervical abrasion/abfraction lesions, primarily in premolar teeth. Patients ranged in age from 30 to 73 years, with a median age of 45 years. Isolation for the restorations was accomplished with cotton rolls. Restorations of both materials were retained at the rate of 93%, and both were comparable in appearance, receiving Alfa ratings for more than 85% of the restorations. One occurrence of secondary caries was observed for each material. No significant difference between the materials was observed for any evaluation category (exact binomial test, P > 0.05).

Retention of microfilled and hybrid resin-based composite in noncarious Class 5 lesions: a double-blind, randomized clinical trial.

This double-blind clinical trial was undertaken to compare the retention rate of restorative materials with contrasting stiffness in noncarious class 5 lesions. All restorations were placed using retraction cord and cotton roll isolation to more closely mimic the general practice setting. Thirty subjects with at least two lesions were recruited to participate in the study. Each subject received one restoration using Silux Plus and one using Z100. The assignment of material was randomized, and the subjects were unaware of which tooth had received which material. All restorations were placed with a fourth-generation adhesive liner, Scotchbond Multi-Purpose. Evaluations were performed at baseline, 6, and 12 months by two independent examiners unaware of the restoration's group identity. The restorations were evaluated using criteria developed by Cvar and Ryge in a forced-consensus model. Despite the fact that the two materials have widely different elastic modulus values, after 12 months no difference between the retention rates for the two groups was found, and both groups of restorations performed very well.

1-year clinical evaluation of Compoglass and Fuji II LC in cervical erosion/abfraction lesions.

PURPOSE: This study was undertaken to compare the clinical performance of a polyacid-modified resin-based composite and a resin-modified glass-ionomer restorative material over 1 year. MATERIALS AND METHODS: Thirty-four pairs of restorations of Compoglass (C) and Fuji II LC (F) were placed in 31 patients, with no patient receiving more than two pairs, and with materials assigned at random within the pairs. Caries-free cervical erosion/abfraction lesions of the facial surface were restored without tooth preparation according to manufacturers' instructions, except that tooth structure to be restored was etched with 37% phosphoric acid prior to placement of Compoglass. Restorations were clinically evaluated by two blinded examiners at baseline, 6 months, and 1 year, using modified Ryge/USPHS criteria. Restorations receiving a score of "Charlie" in either retention or secondary caries were classified as failed restorations. The incidence of failures was statistically analyzed as a pairwise comparison, using an exact binomial test. RESULTS: Thirty-one pairs of restorations were available for recall at 1 year. The percentage of Alfa scores for each material in each category were: Retention (C = 84%, F = 100%), Color match (C = 81%, F = 100%), Marginal discoloration (C = 78%, F = 97%), Secondary caries (C = 88%, F = 100%), Anatomic form (C = 92%, F = 100%), and Marginal adaptation (C = 26%, F = 46%). Except for the failed restorations, no other Charlie scores were assigned. A significant difference in the incidence of failed restorations was found between the materials (P = 0.01).

Microleakage of Class V compomer and light-cured glass ionomer restorations.

STATEMENT OF PROBLEM: Resin-modified (light-cured) glass ionomer and polyacid-modified composite resin (compomer) restorations are popular choices for the restoration of root caries and cervical abrasion/erosion lesions, but clinical studies are relatively few and have been published primarily as abstracts. PURPOSE: In the absence of adequate clinical data, the marginal integrity of restorations of the above two types of material was compared in vitro. The microleakage of restorations of two light-cured glass ionomer restorative materials and of one compomer material was evaluated. METHODS AND MATERIAL: Restorations of the three materials were placed in facial and lingual Class V cavity preparations in bovine incisors. All preparations were centered on the cementoenamel junction and were prepared with 45-degree enamel bevels. After thermal cycling, teeth were immersed in methylene blue dye, then sections of the restorations (n = 16) were visually evaluated. RESULTS: Dye penetration was observed at approximately 20% of restoration margins for all three materials, with the greatest incidence of severe leakage in the compomer restorations. CONCLUSION: No significant difference in microleakage among the three materials (ANOVA; p > 0.05) was found.