Effect of light-, chemical-, and dual-cured universal adhesives on the internal adaptation of resin composites to pulpal and gingival internal walls.

PURPOSE: To compare the internal adaptation of restorative systems bonded to mid-coronal and gingival dentin using light-cured, chemical-cured, and dual-cured adhesives, both immediately and after aging. METHODS: 60 molars were selected and received occluso-mesial preparations with dentin gingival margins. Restorations were performed using different restorative systems with light-cured, chemical-cured, and dual-cured adhesives. Internal adaptation was assessed by examining the percentage of continuous margin (%CM) at the pulpal and gingival dentin under a scanning electron microscope at x200 magnification. Half of the teeth were stored in sterile water for 24 hours, while the other half underwent 10,000 thermal cycles. Micro-morphological analysis was conducted on representative samples at x1,000 magnification. RESULTS: The restorative system with light-cured adhesive exhibited significantly lower %CM values at the gingival dentin, particularly after aging. Aging had a negative impact on the %CM values of the pulpal and gingival dentin in restorative systems with light-cured and dual-cured adhesives. Regional dentin variations influenced the %CM values, especially after aging, regardless of the restorative system used. The tested restorative system with chemical-cured adhesive is preferable for achieving improved internal adaptation when bonding to both mid-coronal and gingival dentin, compared to the other tested systems. CLINICAL SIGNIFICANCE: The study highlights the variations in adhesive performance between different regional dentin areas using the tested restorative systems.

Clinical performance of different bulk-fill composite resin systems in class II cavities: A 2-year randomized clinical trial.

OBJECTIVES: This study evaluated the clinical performance of bulk-fill resin composite systems with different viscosities in class II cavities. MATERIALS AND METHODS: A total of 80 class II restorations were performed with a single operator in 50 patients using four different bulk-fill resin composite materials: Filtek™ Bulk Fill, Heated Filtek™ Bulk Fill, G-aenial™ BULK Injectable, and SonicFill3. A double-blinded randomized clinical trial was designed to evaluate the two-year clinical performance of the four bulk-fill composite resins using modified FDI criteria. Data were analyzed descriptively. Level of significance was set at 0.05. Differences between groups were tested using Wilcoxon-signed-rank and Mann-Whitney-U test as nonparametric tests. RESULTS: Data were analyzed using Kruskal-Wallis, Mann-Whitney U, and Wilcoxon signed rank tests (p < 0.05). Eighty restorations were available for evaluation, with a survival function of 100%. No statistically significant differences were observed between the four groups regarding assessing esthetic, functional, and biological properties during different follow-up periods. CONCLUSIONS: After 2 years of clinical follow-up, the bulk-fill composite systems with different viscosities seem to be esthetically, functionally, and biologically acceptable, with a promising clinical performance in class II cavities.

Effect of different restorative systems and aging on marginal adaptation of resin composites to deep proximal margins.

OBJECTIVES: To evaluate and compare the marginal integrity of different restorative systems bonded to proximal gingival dentin, and determine the consistency level of the results obtained by two in vitro methods. MATERIALS AND METHODS: Thirty molars received occluso-mesial preparations with dentin/cementum gingival margins. They were divided into three groups and restored using different restorative systems with light-cured (Adhese Universal), self-cured (Palfique universal bond), and dual-cured (Futurabond U) adhesives. The restoration/gingival dentin interfaces were observed using scanning electron microscopy (SEM) and evaluated based on the World Dental Federation (FDI) criteria. After 10,000 thermal cycles, the marginal integrity was re-evaluated. Marginal integrity was evaluated by the percentage of continuous margin (% CM) at ×200 for SEM and as the frequency of each score within the FDI ranking. RESULTS: No significant differences were found between the restorative systems immediately, however, the system with the light-cured adhesive had the lowest marginal integrity after aging. All tested restorative systems were adversely affected by aging. A moderate inverse correlation was identified between evaluation techniques. CONCLUSION: The tested restorative systems utilizing self-cured and dual-cured adhesives may be preferable for achieving optimal marginal integrity when bonding to deep proximal margins, compared to the tested system with light-cured adhesive. CLINICAL SIGNIFICANCE: When performing deep margin elevation, it is important to consider the adhesive system being used.

Periodontal Evaluation of Subgingival Open Sandwich Restorations: 2-Year Results of a Randomized Double-Blind Trial.

This study aimed to evaluate the periodontal responses of subgingival proximal margins elevated using different restorative materials. A total of 120 proximal cavities with dentin/cementum gingival margins were elevated using one of four materials (resin-modified glass ionomer, glass hybrid, flowable bulk-fill resin composite, or bioactive ionic resin) and completed with the same overlaying resin composite. At 2 weeks (baseline), 6 months, 1 year, and 2 years postrestoration, periodontal parameters and the radiographic distance between the restoration margin and bone crest were evaluated. Appropriate statistical analyses were performed. The values of all periodontal parameters increased with time, although only the increases in Plaque Index and probing depth within each material group were statistically significant. There were no statistically significant differences in any of the periodontal parameters between the different materials within the same evaluation period, nor between different time points or material groups in the radiographic distances. Both glass ionomer-based and resin-based materials were periodontally safe as subgingival open sandwich restorations.

Clinical performance comparison between lithium disilicate and hybrid resin nano-ceramic CAD/CAM onlay restorations: a two-year randomized clinical split-mouth study.

A total of 20 lithium disilicate glass-ceramics (IPS e.max CAD, Ivoclar Vivadent) and 20 resin nano-ceramic (Voco Grandio Blocks) onlay restorations were performed in 20 patients using a split-mouth design to compare the two-year clinical performance of lithium disilicate and resin nano-ceramic onlay restorations. Both restorations were evaluated at baseline, one-year, and two-year clinical follow-ups based on the modified United States Public Health Service (USPHS) criteria. Chi-square and Fisher's exact tests showed no statistically significant difference between Voco Grandio and IPS e.max ceramic restorations for all evaluated parameters during the different follow-up periods (p > 0.05). Cochrane's and MC-Nemar's tests indicated statistically significant differences regarding color match within the Voco Grandio group. They also indicated statistically significant differences in marginal discoloration, marginal adaptation, surface texture, and postoperative hypersensitivity within both ceramic material groups (p < 0.05). Kaplan-Meier curve indicated that the survival rate of both ceramic materials was 90%. After two years of clinical service, IPS e.max CAD and Voco Grandio onlay restorations exhibited similar clinical performance.

Clinical evaluation of subgingival open sandwich restorations: 3-year results of a randomized double-blind trial.

OBJECTIVES: To provide a 3-year follow-up of previously treated patients to assess and compare the periodontal responses and clinical performance of proximal subgingival open sandwich restorations. MATERIALS AND METHODS: Ninety-five adults participated in the study, with a combined total of 120 compound Class II cavities. These cavities had gingival margins located below the CEJ. Four different restorative materials were used to elevate the dentin/cementum gingival margins of the cavities: resin-modified glass ionomer, glass hybrid, flowable bulk-fill composite, or ion-releasing material, which were then completed with the same overlaying composite. Different periodontal and clinical evaluations, based on the criteria set by the World Dental Federation (FDI) criteria, were performed at different time intervals, including baseline, 6 months, 1, 2, and 3 years. RESULTS: The type of base material did not affect the periodontal evaluations. There were no statistically significant differences between different time intervals or base material groups in any of the evaluated FDI parameters. However, the ion-releasing material scored significantly worse in the radiographic evaluation than any of the other groups. CONCLUSIONS: All tested materials are suitable for proximal subgingival open sandwich restorations, as long as the restoration/tooth margin is at least 2-mm away from the bone crest. CLINICAL SIGNIFICANCE: Clinicians can confidently choose any of the tested materials for proximal subgingival open sandwich restorations, as they have shown good outcomes from both periodontal and clinical perspectives.

Periodontopathic bacterial adhesion to different restorative materials used to elevate proximal subgingival margins.

This study compared the periodontopathic bacterial adhesion to four restorative materials used for deep margin elevation at 2, 24, and 48-h after incubation. Discs were produced from four restorative materials: resin modified glass ionomer, glass hybrid, flowable bulk fill resin composite, and bioactive ionic resin. Root dentin was used as control. Specimens were coated with saliva and used to culture a biofilm comprised of three strains of periodontopathic bacteria; Porphyromonas gingivalis, Prevotella intermedia, and Aggregatibacter actinomycetemcomitans. Bacterial adherence was assessed by colony count assay, crystal violet staining, and visualized using confocal laser scanning microscopy. Data were analyzed by two-way ANOVA followed by Tukey's post hoc tests. The adhesion values for the control specimens were significantly higher than for other materials, while those for the flowable bulk fill were significantly lower than for any other material within all evaluation assays. The 2-h incubation period showed the lowest adhesion values regardless of the group. The 48-h adhesion values were higher than the 24-h results in all groups except the flowable bulk fill. Microscopic imaging partially supported the findings of the measurements. In terms of periodontopathic bacterial adhesion, the tested flowable bulk fill may be preferable for subgingival use over other tested materials.

Correlation between different methodologies used to evaluate the marginal adaptation of proximal dentin gingival margins elevated using a glass hybrid.

Objectives: This study aimed to evaluate the effect of aging on the marginal quality of glass hybrid (GH) material used to elevate dentin gingival margins, and to analyze the consistency of the results obtained by 3 in vitro methods. Materials and Methods: Ten teeth received compound class II cavities with subgingival margins. The dentin gingival margins were elevated with GH, followed by resin composite. The GH/gingival dentin interfaces were examined through digital microscopy, scanning electron microscopy (SEM) using resin replicas, and according to the World Dental Federation (FDI) criteria. After initial evaluations, all teeth were subjected to 10,000 thermal cycles, followed by repeating the same marginal evaluations and energy dispersive spectroscopy (EDS) analysis for the interfacial zone of 2 specimens. Marginal quality was expressed as the percentage of continuous margin at ×200 for microscopic techniques and as the frequency of each score for FDI ranking. Data were analyzed using the paired sample t-test, Wilcoxon signed-rank test, and Pearson and Spearmen correlation coefficients. Results: None of the testing techniques proved the significance of the aging factor. Moderate and strong significant correlations were found between the testing techniques. The EDS results suggested the presence of an ion-exchange layer along the GH/gingival dentin interface of aged specimens. Conclusions: The marginal quality of the GH/dentin gingival interface defied aging by thermocycling. The replica SEM and FDI ranking results had stronger correlations with each other than either showed with the digital microscopy results.

Color stability and surface roughness of ormocer- versus methacrylate-based single shade composite in anterior restoration.

BACKGROUND: The blending ability of universal shade composites and their stability in the oral environment are of great concern in restoring anterior teeth. This study aims to evaluate and compare the color stability and surface roughness of two single-shade composite restorations, ormocer-based composite (OBC) and methacrylate resin-based composite (RBC), after storing them in different staining media. MATERIALS AND METHODS: In this study, two universal shade composite restorative materials were tested: a nanohybrid OBC (Admira fusion X-tra, Voco) and a supra-nanofilled RBC (Omnichroma, Toukyama). In total, 60 cylindrical centralized cavities (diameter: 5 mm, depth: 2 mm) were prepared in sound extracted-human central incisors and divided into two equal groups according to the restorative material used (n = 30). According to the storage media, the teeth of each group were divided into three subgroups (n = 10): artificial saliva, black tea, and cola. The restoration color was evaluated for all teeth at baseline and after four weeks of storage. The color stability (∆E) was measured using a reflective spectrophotometer (X-Rite, model RM200QC, Neu-Isenburg, Germany). The surface roughness (Ra) was evaluated using three-dimensional optical profilometry (Wyko, Model NT 1100, Veeco, Tucson, USA). Additionally, the extracted data were analyzed using two-way analysis of variance (ANOVA), one-way ANOVA and Student's t-test. RESULTS: In the baseline evaluation, there were no statistically significant differences with respect to color matching or surface roughness results between the two studied restorative materials. However, the differences were statistically significant after storing them in different media. CONCLUSION: Universal composites showed satisfactory color matching with different teeth colors and accepted surface smoothness, whereas the aging procedure exerted a negative effect on their color stability and surface characteristics.

In vitro marginal and internal adaptation of four different base materials used to elevate proximal dentin gingival margins.

Background: There is still debate about the most appropriate restorative material category to relocate the proximal deep cervical margins, thus, this study aimed to compare the marginal and internal adaptation of four base materials used for deep margin elevation, and to evaluate each base material/overlying composite interface. Material and Methods: Fifty six molars received class II cavities with dentin/cementum gingival margins. They were divided into four groups and their gingival margins were elevated using either; resin modified glass ionomer (RMGI), highly viscous conventional glass ionomer (HV-GIC), flowable bulk fill resin composite (Bulk Flow) and bioactive ionic resin (Activa). The rest of the cavities were completed with the same overlying composite. Half of each group was either; kept in sterile water for 1 week, or subjected to 18 months water storage and 15,000 thermal cycles. Base materials/gingival dentin interfaces were examined under a scanning electron microscope at different magnifications, and percentage of continuous margin (% CM) and maximum gap width (MGW) were analyzed, in addition to base materials/overlying composite interfaces evaluations. % CM values were statistically analyzed using Two-way analysis of variance, Tukey post hoc tests (at p<0.05) and Pearson's correlation while MGW values were analyzed using Kruskal-Wallis, Mann-Whitney U tests and Spearmen correlation. Results: Both Bulk Flow and Activa had better marginal integrity than RMGI and HV-GIC. All base materials were adversely affected by aging. All base materials/overlying composite interfaces were continuous and age defying. Conclusions: In terms of marginal integrity, Bulk Flow and Activa might be preferable for proximal dentin margin elevation under direct restoration compared to the other tested base materials. Key words:Deep proximal margin, interface analysis, marginal quality, open sandwich technique.

Deep proximal margin rebuilding with direct esthetic restorations: a systematic review of marginal adaptation and bond strength.

This review aimed to characterize the effect of direct restorative material types and adhesive protocols on marginal adaptation and the bond strength of the interface between the material and the proximal dentin/cementum. An electronic search of 3 databases (the National Library of Medicine [MEDLINE/PubMed], Scopus, and ScienceDirect) was conducted. Studies were included if they evaluated marginal adaptation or bond strength tests for proximal restorations under the cementoenamel junction. Only 16 studies met the inclusion criteria and were included in this review. These studies presented a high degree of heterogeneity in terms of the materials used and the methodologies and evaluation criteria of each test; therefore, only a descriptive analysis could be conducted. The included studies were individually evaluated for the risk of bias following predetermined criteria. To summarize the results of the included studies, the type of restorative material affected the test results, whereas the use of different adhesive protocols had an insignificant effect on the results. It could be concluded that various categories of resin-based composites could be a suitable choice for clinicians to elevate proximal dentin/cementum margins, rather than the open sandwich technique with resin-modified glass ionomers. Despite challenges in bonding to proximal dentin/cementum margins, different adhesive protocols provided comparable outcomes.

In vitro biocompatibility testing of different base materials used for elevation of proximal subgingival margins using human gingival epithelial cells.

PURPOSE: To analyze the biological effects of four base materials used for elevation of proximal subgingival margins on gingival epithelial cells. METHODS: Twenty-eight specimens for each of the four base materials (total 112 specimens) were used: resin-modified glass ionomer (RMGI), glass hybrid (HV-GIC), flowable bulk fill resin composite (Bulk Flow) and bioactive ionic resin (Activa). Proximal enamel and root dentin were used as controls. Gingival epithelial cell viability was calculated after direct incubation on all four types of material for either 24 h or 72 h using both the methyl tetrazolium and trypan blue dye exclusion assays. Data were analyzed statistically using one-way analysis of variance, Tukey post hoc test and independent sample t-test (P < 0.05). RESULTS: Cell viability values in both assays showed significant differences among the study groups. Bulk Flow showed the highest values, followed in order by Activa and the control groups. Both HV-GIC and RMGI had the lowest values. Cell viability in all of the study groups was higher after incubation for 72 h than after 24 h. CONCLUSION: In terms of biocompatibility with epithelial tissues, bulk fill resin composite appears to be most suitable, followed by bioactive composite, for subgingival placement than glass ionomer-based materials, especially that containing 2-hydroxy-ethyl methacrylate.

Indirect Resin Composite Inlays Cemented with a Self-adhesive, Self-etch or a Conventional Resin Cement Luting Agent: A 5 Years Prospective Clinical Evaluation.

OBJECTIVE: The aim of this study was to clinically evaluate the 5-years clinical performance of indirect resin composite inlays luted with three different resin cement strategies in MOD Class II restorations. MATERIALS AND METHODS: A randomized clinical trial was conducted following CONSORT guidelines. Forty patients with three large cavities indicated for indirect MOD Class II restorations were enrolled in the current study. Then, 120 indirect resin composite inlay restorations (SR Nexco) were placed and luted with three different resin cement strategies (n=40); an etch-and-rinse (Variolink N), self-etch (Panavia F2.0) and self-adhesive (RelyX Unicem). These restorations were evaluated to the periods of 1 week (baseline), 1, 3 and 5 years using modified USPHS criteria. Statistical analyses were performed with Wilcoxon and Friedman tests with level of significance set at 0.05. RESULTS: The outcome of the clinical trial showed that, there was neither loss of restorations nor recurrent caries after 5 years for all luting cements groups. Both self-etch Panavia F2.0 and self-adhesive RelyX Unicem resin cements exhibited significant differences between the evaluation periods regarding to marginal discoloration and marginal adaptation (p=0.03). At baseline, only 8 cases of etch-and-rinse (Variolink N) resin cement group exhibited post-operative sensitivity which were relieved after short time (p=0.04). CONCLUSION: All the three resin cement strategies tested, showed acceptable clinical performance after 5-years recall period. In time, etch-and-rinse resin cement group showed better clinical performance regarding marginal discoloration and marginal adaptation at 5-years recall period. Clinical Relevance statement:In vitro and in vivo studies reveal contradictory evidence of the clinical performance of indirect resin composite inlays luted with different resin cement strategies. Thus, this study revealed that etch-and-rinse resin cement still has the best prognosis for adhesive luting of indirect resin composite inlays.

Effect of double layer application on bond durability of universal adhesives to proximal dentin-cementum gingival margins.

PURPOSE: To evaluate and compare the effect on micro-tensile bond strength (µTBS) of a double layer application of three universal adhesives applied in self-etch mode to proximal dentin/cementum gingival margins of class II direct composite restorations, immediately and after 12 months water storage. METHODS: 66 molars with compound class II cavities, with gingival margin 1 mm below CEJ, were divided into three groups according to the universal adhesive used. The adhesives evaluated included All-Bond Universal (AB), Single Bond Universal (SB), and Prime&Bond Elect (PB). The groups were further subdivided according to adhesive application technique, either single layer or double layer application. All teeth were restored with the same nanofilled resin composite. µTBS were examined at a crosshead speed of 0.5 mm/minute after 24 hours or 12 months water storage. Fracture mode was assessed under stereomicroscope. Data were analyzed by two-way analysis of variance (ANOVA) followed by Tukey's post hoc test (P< 0.05). RESULTS: The double layer application µTBS values were significantly higher than single layer application in all groups. Regardless of the type of adhesive or application technique, all subgroups showed significantly decreased bond strength after aging. There were significant lower µTBS values for AB adhesive compared with the other two adhesives that demonstrated no significant differences between them. The double layer application technique was effective in enhancing µTBS values of all tested adhesives bonded to proximal dentin/cementum gingival margins compared to single layer application. Regardless of application technique, all tested adhesives were incapable of defying long-term water aging. CLINICAL SIGNIFICANCE: The double layer application technique may be recommended to enhance the bonding durability of universal adhesives to face challenges in bonding to dentin-cementum cervical margins.

Effect of different polishing techniques on surface roughness and bacterial adhesion of three glass ionomer-based restorative materials: In vitro study.

BACKGROUND: Although many reports concluded that polishing of glass ionomers is crucial for smoother surface and limiting the adhesion of cariogenic bacteria, there is no specific surface treatment protocol recommended. A novel material in the same category was released recently claimed to have surface smoothness comparable to resin composite and bacterial adhesion less than other types of glass ionomers. In this study, different polishing systems were tested with three glass ionomers one of them is the novel material to find the most appropriate polishing protocol. Objectives: To evaluate and compare the surface roughness and bacterial adhesion to resin modified glass ionomer, bioactive ionic resin and conventional glass ionomer restorative materials after different polishing protocols in vitro. MATERIAL AND METHODS: The materials tested includes resin modified glass ionomer, bioactive ionic resin, and conventional glass ionomer. The polishing protocols were divided into four groups: group 1 = (Mylar matrix strips, Control), group 2 = (one-step, PoGo), group 3 = (two-step, Prisma Gloss) and group 4 = (three-step, Sof-Lex). From each material, eleven cylindrical specimens were prepared for each group according to the manufacturers' instructions. The surface roughness for all specimens was measured using atomic force microscope in tapping mode. the same specimens were subjected to bacterial adhesion testing after being coated with artificial saliva. Data were analyzed with two-way analysis of variance followed by Post hoc multiple comparisons. RESULTS: The highest Ra and S. mutans adhesion values were recorded for all materials in two-step group. The lowest Ra and S. mutans adhesion values were seen in one-step and three step groups. CONCLUSIONS: One-step polishing system was more effective and may be preferable for polishing of the three studied glass ionomer-based materials compared to two-step and three-step systems. Key words:Activa bioactive restorative, glass ionomer, surface roughness, bacterial adhesion, surface treatment.

Evaluation of Marginal Adaptation and Microleakage of Three Glass Ionomer-Based Class V Restorations: In Vitro Study.

OBJECTIVE: The aim of this study was to evaluate and compare the marginal adaptation and microleakage of class V cavities restored with conventional glass ionomer cement (GIC), resin-modified glass ionomer (RMGI), and bioactive ionic resin (BIR) restorative materials after 6 months of water storage. MATERIALS AND METHODS: One hundred twenty standardized class V cavities (2 mm deep, 4 mm in width, and 3 mm in height) were prepared in sound extracted human molar teeth, where the coronal margins were in enamel while the cervical margins were in dentin. Three glass ionomer-based restorations were tested (n = 40): GIC (Equia Fil), RMGI (Fuji II LC), and BIR (ACTIVA Bioactive Restorative). Half of the teeth from each group (n = 20) were evaluated for their marginal adaptation with scanning electron microscopy and the other half submitted to dye penetration test to examine microleakage. Further division for each subgroup (n = 10) occurred to be tested immediately, while the remaining teeth were examined after keeping for 6 months and thermocycling. STATISTICAL ANALYSIS: The outcomes were analyzed by Kruskal-Wallis and Mann-Whitney U tests. RESULTS: No statistically significant differences were observed among the three studied restorative materials. However, the differences were statistically significant in microleakage test between enamel and dentin and after water aging. CONCLUSION: All tested restorative materials exhibited the same marginal adaptation and microleakage. Dentin substrate revealed greater microleakage than enamel, especially with BIR restorative material. Water aging had a negative effect on RMGI with respect to microleakage.