Teaching of posterior composites for the restoration of permanent teeth in undergraduate dental training programmes: Systematic review and meta-analysis.

OBJECTIVES: To systematically assess aspects of teaching of posterior composite restorations (PCRs) in permanent teeth in dental schools. STUDY SELECTION: Quantitative studies reporting on dental schools' teaching regarding the placement of PCRs in permanent teeth. Random-effects meta-analyses and meta-regressions were performed. Risk of bias was assessed based on the Medical Education Research Study Quality Instrument (MERSQI). SOURCES: Electronic databases (MEDLINE via PubMed, EMBASE via Ovid, Web of Science, and Scopus) were searched in January 2023. DATA: Forty sources reporting on 34 studies having surveyed 1,286 dental schools were included. Overall, 92.7% (95%-CI: 88.2-95.5) of dental schools reported to teach PCRs. PCRs in three-surface Class II cavities are taught by 82.0% (95%-CI: 70.4-89.7). The mandatory use of liners in deep cavities is taught by 78.3% (95%-CI: 68.9-85.5), and 44.0% (95%-CI: 34.3-54.2) reported to teach bulk-fill composites. While most posterior restorations placed by students were composites (56.1%; 95%-CI: 46.0-65.8), 94.7% (95%-CI: 86.6-98.0) of dental schools (still) teach posterior amalgam restorations. The proportion of dental schools teaching PCRs in three-surface Class II cavities increased and the mean proportion of PCRs among all posterior restorations increased over time (padj.≤0.003). CONCLUSIONS: The teaching of PCRs in dental schools around the world reflects the increased use of resin composite in clinical practice, with students in countries where dental amalgam continues to be used, placing more posterior composites than restorations of dental amalgam. The teaching of PCRs, which is anticipated to increase, will continue to be refined with further developments in adhesive materials, devices, instrumentation, and techniques. CLINICAL SIGNIFICANCE: Graduating dentists can be expected to be familiar with the use of resin composites for the restoration of posterior teeth.

A retrospective clinical study on the survival of posterior composite restorations in a primary care dental outreach setting over 11years.

OBJECTIVES: To investigate the survival in terms of time to re-intervention of composite restorations in posterior teeth among patients attending for treatment at a primary care dental outreach setting over an 11-year period and to determine whether dental, patient or operator factors influenced this. METHODS: Electronic primary dental care data were collected on individual patients, including information on their dental treatment and socio-demographics as well as service provision, key performance indicators and student activity. RESULTS: A total of 1086 patients had at least one posterior composite placed between 2007 and 2018. This amounted to 3194 restorations placed of which 308 had a re-intervention within the 11-year period. For all restorations, the annual failure rate at 1 year was 5.73 %, at 5 years was 16.78 % and at 10 years was 18.74 %. A logistic regression showed that when compared to the least deprived 5th quintile, the most deprived 1st and 2nd quintiles were significantly less likely to have a re-intervention, being 49.2 % (p = 0.022) and 53.2 % (p = 0.031) less likely, respectively. CONCLUSIONS: The survival rates of posterior composite restorations placed at a single outreach centre providing undergraduate dental training in the South of England, mirrors other studies. The new findings presented suggest similar re-intervention rates between dental students and dental hygiene-therapy students. This study's findings around patient deprivation and rate and time of re-intervention raises important questions related to the need for targeted dental and after care for certain groups in the population. CLINICAL SIGNIFICANCE: Understanding the factors associated with re-intervention of restorations provided to patients has an impact on patients and dental practices. Also, as we consider widening use of skill mix in dentistry to increase access to care, parity in provision of treatments within the dental team increases opportunities for delegation of tasks.

Contemporary teaching of posterior composites at dental schools in Austria, Germany, and Switzerland.

OBJECTIVE: To investigate current teaching and operative techniques for posterior composite resin restorations in dental schools in Austria, Germany, and Switzerland. METHODS: Data on teaching, including operative techniques applied in the placement of posterior composites, were collected by means of a 25-item validated questionnaire sent to the Heads of Department of Operative/Restorative Dentistry at all 38 dental schools in Austria, Germany, and Switzerland. Responses were compiled in Excel and analysed. RESULTS: Thirty-three schools responded to the survey, resulting in a response rate of 87 %. All dental schools indicated teaching of 2- and 3-surface posterior composite restorations. About one third only of the preclinical teaching is assigned to teaching posterior composite restorations, while the vast majority of posterior restorations placed by students in their clinical instruction are composite (89.6 ±â€¯9.3 %). Most dental schools teach few contraindications to posterior composites, except for adverse reactions such as allergies. All dental schools consider moisture control to be important, while approaches to the management of exposed dentine differ. CONCLUSIONS: The teaching of the placement of posterior composite restorations is common to all the dental schools in Austria, Germany, and Switzerland which participated in the present study. Most aspects of the teaching were found to be consistent amongst the schools. However, marked variations were observed in respect of operative techniques for the placement of posterior composites. CLINICAL SIGNIFICANCE: Graduates from dental schools in Austria, Germany, and Switzerland may be found to have received theoretical, preclinical, and clinical instruction in posterior composites, but do show some variation in approach to the management of exposed dentine.

Evaluation of Mechanical Properties of Newer Nanoposterior Restorative Resin Composites: An In vitro Study.

INTRODUCTION: Tooth coloured restorative materials are subjected to various physical, mechanical conditions in oral conditions. Many newer composites with improved physical and mechanical properties are introduced for clinical use. There are not many clinical studies on recent composites. The aim of this study was to compare the mechanical properties of five commercially available nano composite restorative materials. MATERIALS AND METHODS: Specimens of five nano posterior composite SureFil SDR, ClearFil Majesty, Ever X, Tetric Evo Ceram bulk fill and Filtek Z350 were tested in the study. All samples were prepared According ISO 4049 and polymerized with a LED light for 40 seconds and subjected to mechanical tests for compressive strength, flexural strength, flexural modulous and nano hardness. STATISTICAL ANALYSIS: Results obtained were subjected to one way ANOVA and Turkey's post hoc test at significance (p <0.05). RESULTS: There was significant differences among composites restorative resins tested. CFM Nano hybrid composite exhibited highest hardness values. Flexural strength, flexural modulous and hardness properties of Ever X and Z350 were almost similar. Compressive strength value of Ever X was high compared with other four composites. SDR exhibited least values when compared with other composites. CONCLUSION: Differences in compressive strength, hardness, flexural strength and modulous is due to differences in percentage and type of filler particles in all composite resin material tested.

Teaching of posterior composites in dental schools in Japan - 30 years and beyond.

OBJECTIVES: The teaching of posterior composites has been a major part of the curriculum in Japanese dental education for several decades. The aim of this paper was to investigate the current trends in the teaching of posterior composites to undergraduate dental students in Japan by comparing the results of surveys conducted for over 30 years. METHODS: In late 2016-early 2017, a questionnaire seeking information on the teaching of posterior composites was distributed via e-mail to the persons responsible for teaching operative dentistry in 29 dental schools having undergraduate dental degree programs in Japan. The results obtained were compared to those from surveys conducted in 1986, 1997, and 2007. RESULTS: All 29 schools that were sent the questionnaire completed the responses (response rate = 100%). All 29 schools reported teaching the placement of composite in occlusal and two-surface occluso-proximal cavities in both premolars and molars. Four schools reported not teaching the placement of three-surface occluso-proximal composites in premolars and five schools reported not teaching it for molars. Twenty-seven (93%) schools taught composite first as a part of the preclinical curriculum, whereas 15 (65%) schools did so in the survey of 2007. Variations were noted between schools in the teaching of, cavity design. In contrast, greater consistency was observed in the teaching of techniques for protecting exposed dentin and light-curing technologies. CONCLUSIONS: It is hoped that measures intended to increase the clinical experience of restoring teeth with direct composite-resin for dental students in Japan will be effective, providing opportunity to bring dental education in Japan more into line with international norms.

An end to linings under posterior composites?

BACKGROUND AND OVERVIEW: There is an uncertainty among dentists as to whether to place a lining under a direct posterior composite restoration and, if so, what material or combination of materials to use. In this article, the authors consider the evidence for the placement of a lining under posterior composites of different depths, including indications and contraindications for different lining materials. CONCLUSIONS: The available evidence does not support the use of linings under direct, bonded posterior composites, unless being placed in deep cavities for therapeutic reasons. PRACTICAL IMPLICATIONS: The best available evidence indicates that dentists can place posterior composites without linings, except for therapeutic purposes, with no adverse effect on postoperative complications, with possible improvements in performance in clinical service, and with efficiency savings in chairside time.

Effect of the different finishing and polishing procedures on the surface roughness of three different posterior composite resins.

Finishing and polishing techniques have great importance on the long term success and aesthetics of the composite restorations. In this study it was aimed to examine the effect of three different posterior composites on surface texture with various finishing and polishing procedures. Three different posterior composites, Filtek P60, Clearfil Majesty Posterior and Cavex Quadent Posterior Dense, and three different finishing and polishing procedures diamond finishing burs, tungsten carbide burs and Sof-Lex discs were used in the study. The specimens were 5 mm in diameter and 2 mm in height. The surface roughness was measured at three seperate points with a profilometer device and the Ra values were recorded. A one-way analysis of variance (ANOVA) and Kruskal-Wallis variance analysis was applied for statistical analysis and p < 0.05 was accepted significant. No statistically significant differences were found between the composite resins with respect to surface roughness (p > 0.05). A statistically significant difference was found between the groups of diamond, carbide, and Sof-Lex groups (p < 0.05). Sof-Lex polishing system was more successful than the diamond and carbide burs in the finishing and polishing procedures of composites. SCANNING 38:448-454, 2016. © 2016 Wiley Periodicals, Inc.

Comparative evaluation of surface hardness and depth of cure of silorane and methacrylate-based posterior composite resins: An in vitro study.

AIM: This in vitro study was carried out to compare the effect of LED light curing system on polymerization and hardness of silorane-based and methacrylate-based posterior composite resin. MATERIALS AND METHODS: A total of 40 samples, 20 of silorane-based composite Filtek P-90 and 20 of methacrylate-based composite Heliomolar HB measuring 2 mm thickness and 8 mm diameter were prepared using Teflon molds and cured using LED curing light. The samples were polished and tested in Knoop hardness tester using a 50-gram load and dwell time of 15 seconds on top and bottom surfaces. The percentage depth of cure was calculated, and statistical analysis was performed using two-way ANOVA test and Student t- test. RESULTS: Higher statistically significant values were seen for both the top and bottom surface hardness in silorane-based resins than methacrylate-based resins on LED light curing. CONCLUSION: Greater depth of cure was achieved in silorane-based posterior composite than in methacrylate-based posterior composite resins with a statistically significant difference.

Assessment of Microleakage in Class II Cavities having Gingival Wall in Cementum using Three Different Posterior Composites.

BACKGROUND: Dental composites are one of the most desired restorative materials today. Composite materials can be bonded successfully to human tooth enamel; however, developing the same degree of adhesion to dentin or cementum is a more challenging task. Polymerization contraction stress of dental composites is often associated with marginal and interfacial failures of bonded restorations. The magnitude of stress depends on composite composition and its ability to flow before gelation, which is related to the cavity configuration and curing characteristics of the composite. MATERIALS AND METHODS: This study was carried out on 24 extracted human molars and divided into three groups. Class II (slot) cavities were prepared on the mesial and distal surfaces of the teeth with the gingival wall in dentin/cementum, and the microleakage was observed. After preparation the teeth were randomly assigned into three groups of eight specimens each. The cavities were restored with: Group 1: Packable composite (Surefil, Dentsply); Group 2: Hybrid composite (Filtek Z250, 3M Dental Products); Group 3: Nanocomposite (Filtek Z350, 3M Dental Products). Sixteen samples of each group were subjected to 500 cycles of thermocycling between 5°C and 55°C. All the teeth were immersed in methylene blue for 8 h and then left in tap water for 12 h. The teeth were sectioned mesiodistally with a diamond disc, and examined under a stereomicroscope. RESULTS: The analysis indicated that packable composite showed more microleakage than all the other groups. Hybrid composite showed less microleakage than packable composite, but more leakage than nanocomposite. CONCLUSION: All composites under the study exhibited a certain amount of microleakage in the dentin/cementum margin. Packable composite showed the most microleakage and nanocomposite showed least microleakage. Since these results were obtained in vitro, long-term clinical trials are needed to fully understand the performance of these materials.

The teaching of posterior resin composites: planning for the future based on 25 years of research.

OBJECTIVES: The restoration of posterior teeth affected by caries, trauma or wear remains one of the commonest procedures in the practice of dentistry. Over the past 20 years the first author and latterly the second author have led a series of surveys around the world to capture information on the teaching of posterior resin composites. The aim of this paper is to identify trends, reflect on the findings and make recommendations for the further development of this important aspect of the curriculum for primary dental qualifications. METHODS: Surveys on the teaching of posterior resin composites were completed in 1986, 1997-99, 2004-05 and 2007-2009. The findings from these surveys were reviewed and drawn together to allow historical and contemporary international trends to be identified. Recommendations for further developments in the teaching of posterior resin composites were formulated from the cumulated data and trends identified. RESULTS: Information was available from a total of 679 survey returns. Increased teaching of posterior resin composites has been observed over the period of the surveys: while 90% of dental school curricula did not include any didactic teaching of posterior resin composites in the mid-1980s, this dropped to 4% or less in the late 1990s, and to 0% in the early 2000s. In the late 2000s, however, 21% of dental schools still did not teach the placement of resin composites in three-surface cavities in permanent molar teeth. Areas of confusion were reported in the teaching of certain aspects of cavity design, notably the use of bevels, and in the protection of operatively exposed dentine. CONCLUSIONS: While there has been steady growth in, and trends towards evidence-based teaching of posterior resin composites in dental schools around the world over the last 20-25 years, there is a need for further developments and harmonisation in this important aspect of curricula for primary dental qualifications. This need is now pressing, subsequent to the signing of the Minamata Convention. It is recommended that all new graduates, from no later than 2020, should have the knowledge, skills, competences and confidence to effectively restore damaged and diseased posterior teeth with state-of-the-art resin composite systems.

Guidance on posterior resin composites: Academy of Operative Dentistry - European Section.

There have been many developments in operative dentistry in recent years, including a progressive shift to the use of resin composites, rather than dental amalgam, in the restoration of posterior teeth. This shift allows the adoption of minimal intervention approaches, thereby helping to conserve and preserve remaining tooth tissues and structures. This paper presents the position of the Academy of Operative Dentistry European Section (AODES) in relation to posterior resin composites. The AODES considers adhesively bonded resin composites of suitable composition and properties to be the "material of choice" for use in direct minimal intervention approaches to the restoration of posterior teeth. In so doing, the AODES emphasises the importance of the practice of evidence-based minimal intervention dentistry, including the use of refurbishment and repair techniques to extend the longevity of restorations. Guidance, based on best available evidence, has been made in relation to certain aspects of resin composite placement techniques in posterior teeth.

Clinical evaluation of resin-based composites in posterior restorations: 12-month results.

OBJECTIVES: The purpose of this study was to evaluate and compare the 12 month clinical performances of two different posterior composites in Class I and Class II restorations. METHODS: Thirty-one patients (10 male, 21 female) were recruited into the study. A total of 82 Class I and Class II cavities were restored with either a nanohybrid composite (Grandio) or a low-shrinkage composite (Quixfil), using their self etch adhesives (Futura Bond and Xeno III) according to manufacturers' instructions. The restorations were clinically evaluated 1 week after placement as baseline, and after 6 and 12 months post-operatively using modified USPHS criteria by two previously calibrated operators. Statistical analysis were performed using Pearson Chi-square and Fisher's Exact Test (P<.05). RESULTS: All patients attended the 12-month recall. Lack of retention was not observed in any of the restorations. With respect to color match, marginal adaptation, secondary caries and surface texture, no significant differences were found between two restorative materials tested after 12 months (P>.05). None of the restorations had marginal discoloration and anatomic form loss on the 12 month follow-up. Restorations did not exhibit post-operative sensitivity at any evaluation period. CONCLUSIONS: Clinical assessment of nanohybrid (Grandio) and low-shrinkage posterior composite (Quixfil) exhibited good clinical results with predominating alpha scores after 12 months. However; further evaluations are necessary for the long-term clinical performance of these materials.