Health counselling in dental care for expectant parents: A qualitative study.

OBJECTIVES: Interventions during pregnancy and early childhood have been shown to impact dental health. Thus, Antenatal Care and Dental Care collaborated in an intervention called Health Counselling in Dental Care (HCDC). HCDC was offered free of charge to first-time expectant parents and was aimed at reducing the frequency of dental caries in children and their parents. However, the intervention reached less than 50% of the parents. The aim of this study was to explore facilitators of, barriers to, and suggestions for increased participation in HCDC. METHODS: Data were collected through semi-structured, face-to-face interviews with expectant parents. Participants were purposively sampled based on having been invited to HCDC and to achieve a variation in socio-demographics. Interviews were audio recorded, transcribed verbatim and analysed using conventional qualitative content analysis. RESULTS: In total, 16 interviews were conducted (10 women, 6 men). Six categories representing three facilitators and three barriers for participation emerged. The facilitators were the midwife's crucial role for disseminating information about HCDC and motivating participation, that the parents perceived HCDC as valuable for themselves and their offspring, and a desire for new or more knowledge. The barriers included a shortage of information regarding the counselling, a perceived lack of value for the parents and offspring, and the timing of the counselling during pregnancy. CONCLUSIONS: The midwives were crucial in providing information and motivation for HCDC participation. To increase attendance, sufficient information regarding the benefits of counselling is required, and the timing needs to be flexible and family-centred.

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.

Three-year Randomized Clinical Study of a One-step Universal Adhesive and a Two-step Self-etch Adhesive in Class II Composite Restorations.

PURPOSE: To evaluate in a randomized clinical evaluation the 3-year clinical durability of a one-step universal adhesive and compare it intraindividually with a 2-step self-etch adhesive in Class II restorations. MATERIALS AND METHODS: Each of 57 participants (mean age 58.3 years) received at least two extended Class II restorations that were as similar as possible. The cavities in each of the 60 individual pairs of cavities were randomly distributed to the 1-step universal adhesive (All-Bond Universal: AU) and the control 2-step self-etch adhesive (Optibond XTR: OX). A low shrinkage composite (Aelite LS) was used for all restorations, which were evaluated using slightly modified USPHS criteria at baseline and 1, 2, and 3 years. RESULTS: 114 Class II restorations were evaluated at three years. Eight restorations, 3 AU and 5 OX, failed during the follow-up, resulting in 94.7% (AU) and 91.2% (OX) success rates (p > 0.05). Annual failure rates were 1.8% and 2.9%, respectively.The main reason for failure was composite fracture. CONCLUSION: Class II composite restorations placed with a 1-step universal adhesive showed good short-term efficacy.

A randomized controlled cross-over study of the effect of alcohol-free chlorhexidine and essential oils on interleukin-1 levels in crevicular fluid.

Aim of the study was to determine the effect of an alcohol-free chlorhexidine mouth rinse and an essential oils containing mouth rinse on pro-inflammatory cytokine levels in gingival crevicularfluid in participants who continue to perform their regular mechanical oral hygiene regimes and normal dietary practice. Twenty adult volunteers (mean age: 59 years) participated in the double-blind randomised controlled cross-over study.Three mouth rinses were used during 16-day periods as an adjunctiveto regular mechanical oral hygiene: a solution with alcohol-free chlorhexidine (CHX; Paroex), a solution with essential oils (EO; Listerine), and water (negative control).The mouth rinse periods were separated by 3-month washout periods. At days o (baseline) and 17 (end) of each mouth rinse period, gingival crevicular fluid (GCF) was collected at different tooth sites and analyzed with ELISA technique for IL-1α, IL-1ß and IL-ira levels. No significant correlations between clinical parameters (QHI and GI) and cytokine concentra- tions were observed, regardless of mouth rinse regimen.The generalized linear models revealed that none of the mouth rinses had a statistically significant impact on IL-1 concentrations in GCF. Large inter-individual variations were observed for the levels of IL-iα, IL-1ß and IL-ira. Also the changes in concentrations between day o and day 17fo r the mouthrinses showed large intra-individual variations. It can be concluded that neither the alcohol-free chlorhexidine nor the mouth rinse contain- ing essential oils reduced the levels of IL-iα, IL1ß and IL-ira in GCF.

Randomized 3-year clinical evaluation of Class I and II posterior resin restorations placed with a bulk-fill resin composite and a one-step self-etching adhesive.

PURPOSE: To evaluate the 3-year clinical durability of the flowable bulk-fill resin composite SDR in Class I and Class II restorations. MATERIALS AND METHODS: Thirty-eight pairs of Class I and 62 pairs of Class II restorations were placed in 44 male and 42 female patients (mean age 52.4 years). Each patient received at least two extended Class I or Class II restorations that were as similar as possible. In all cavities, a one-step self-etching adhesive (XenoV+) was applied. One of the cavities of each pair was randomly assigned to receive the flowable bulk-fill resin composite SDR in increments up to 4 mm as needed to fill the cavity 2 mm short of the occlusal cavosurface. The occlusal part was completed with an ormocer-based nanohybrid resin composite (Ceram X mono+). In the other cavity, only the resin composite CeramX mono+ was placed in 2 mm increments. The restorations were evaluated using slightly modified USPHS criteria at baseline and then annually for 3 years. Caries risk and bruxing habits of the participants were estimated. RESULTS: No post-operative sensitivity was reported. At the 3-year follow-up, 196 restorations - 74 Class I and 122 Class II - were evaluated. Seven restorations failed (3.6%), 4 SDR-CeramX mono+ and 3 CeramX mono+ only restorations, all of which were Class II. The main reason for failure was tooth fracture, followed by resin composite fracture. The annual failure rate (AFR) for all restorations (Class I and II) was 1.2% for the bulkfilled restorations and 1.0% for the resin composite-only restorations (p > 0.05). For the Class II restorations, the AFR was 2.2% and 1.6%, respectively. CONCLUSION: The 4-mm bulk-fill technique showed good clinical effectiveness during the 3-year follow-up.

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.

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 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 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.

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.

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.

Fracture frequency and longevity of fractured resin composite, polyacid-modified resin composite, and resin-modified glass ionomer cement class IV restorations: an up to 14 years of follow-up.

The aim of this study was to evaluate the fracture frequency and longevity of fractured class IV resin composite (RC), polyacid-modified resin composite (compomer; PMRC), and resin-modified glass ionomer cement (RMGIC) restorations in a longitudinal long-term follow-up. Eighty-five class IV RC (43: Pekafil), PMRC (24: Dyract (D), Hytac (H)), and RMGIC (18: Fuji II LC (F), Photac Fil (P)) restorations were placed in ongoing longitudinal follow-ups in 45 patients (mean age 54.5 years). The restorations were evaluated during 14 years by slightly modified USPHS criteria at yearly recalls especially for their fracture behavior. For all restorations, 36.5% were fractured, with a Kaplan-Meier (KM) estimate of 8.8 years (standard error (SE) 0.5, confidence interval (CI) 7.9-9.8). The number of fractures per material was 11 RC (25.6%; KM 9.9 years, CI 8.7-11.0), 13 PMRC (54.2%; D 66.6%; H 50.0%; KM 7.5 years, CI 5.8-9.2), and seven RMGIC (36.5%; F 22.2%, P 71.4%; KM 6.9 years, CI 7.9-9.8). Significant differences were seen between RC and PMRC (p = 0.043). A significant higher fracture rate was observed in teeth 12 + 22 compared to teeth 11 + 21. No significant differences were observed between male and female patients. Restorations in bruxing patients (45) showed 22 fractures (KM 8 years; CI 6.9-9.3) and in non-bruxing patients (39) nine fractures (KM 9.9 years, CI 8.7-11.1; p = 0.017). With regard to the longevity of the replaced failed restorations, for RC, the mean age was 4.5 years; for PMRC, 4.3 years; and for RMGIC, 3.3 years. It can be concluded that fracture was the main reason for failure of class IV restorations. An improved longevity was observed for class IV restorations compared to those presented in earlier studies. RC restorations showed the lowest failure frequency and the highest longevity.

Effects of mouthrinses containing essential oils and alcohol-free chlorhexidine on human plaque acidogenicity.

The aim of this in vivo study was to evaluate the effect of two antimicrobial mouthrinses on dental plaque acidogenicity after a sucrose challenge. Twenty subjects, with a mean age of 59 years, participated in a double-blind intraindividual randomized study. Three mouthrinses were used in 16-day rinsing periods in addition to their regular mechanical oral hygiene: a solution with essential oils (EO), solution with alcohol-free chlorhexidine (CHX) and water (negative control). The three test periods were separated by 3-month washout periods. Changes in plaque acidogenicity were evaluated after a sucrose challenge at day 0 (baseline) and at day 17 of each mouthrinse period using the microtouch method. Both CHX and EO resulted at day 17 in statistically significant less attenuated pH falls compared to the water rinse. The CHX mouthrinse resulted in the least pronounced pH values compared with EO (ns) during the whole 30-min period. When calculated as area under the curve (AUC), significantly lower values (AUC(6.2) ) were found for CHX and EO at day 17 compared to day 0. A significant difference for AUC(6.2) between CHX and water was found at day 17. No statistically significant differences were found for any of the comparisons with AUC(5.7). The results from this study indicate that both the essential oils and the alcohol-free chlorhexidine reduced plaque acidogenicity after a sucrose challenge. Large interindividual variations were observed.

Awareness of toothbrushing and dentifrice habits in regularly dental care receiving adults.

The aim of this study was to investigate toothbrushing and dentifrice habits in a Swedish adult population with relatively high caries frequency, which received regularly dental care and to evaluate the awareness of their toothbrush technique. Sixty adult participants with high caries frequency, 29 woman and 31 men, answered a self-reporting questionnaire with 42 questions concerning their oral care, brushing technique and -habits.The responses were related to their clinical behaviour observed during a customary toothbrushing session. Fifty-three participants fulfilled both the questionnaire and the clinical observation. Half of these used toothpaste containing 1450-1500 ppm fluoride but only one of all participants was aware of the fluoride concentration used. The majority used a manual toothbrush and 95% brushed their teeth twice a day using 0.9 g toothpaste. A wide range of brushing methods and habits was observed. Sixty percent did not brush systematically. Spitting of toothpaste-saliva during brushing was performed by 60% and after brushing by 15%.The observed brushing times were significantly higher than the self reported. The observed brushing times were <1 min: 3.4%, 1-2 min: 36.7% and >2 min: 47.0%. There was a significant correlation between observed brushing time and caries activity. Rinsing with water after brushing was performed once (32%) or twice (44%) during the observations. Only 9% rinsed with toothpaste slurry after brushing. It can be concluded that the awareness of the individual toothbrushing, post-brushing behaviour and the use of fluoride toothpaste was non-optimal in the adult participants. Oral health promotion by optimalized use of fluoride toothpaste and improved post-brushing behaviour should be recommended.

Clinical effectiveness of a low-shrinkage resin composite: a five-year evaluation.

PURPOSE: To study the durability of a recently developed low-shrinkage resin composite, suggested to counter the stress formation in direct resin composite restorations. MATERIALS AND METHODS: Each of 50 patients received one or two pair(s) of Class II restorations. The first restoration in the pair was a low-shrinkage resin composite (InTen-S) and the second a hybrid 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 annually. RESULTS: At 5 years, 97 restorations were evaluated. Two participants reported slight postoperative sensitivity symptoms for a few weeks after placement. Twelve non acceptable restorations were observed during the 5 years, five InTen-S (10.4%) and 7 Point 4 (14.3%) (not significant). Secondary caries was the main reason for failure (8) followed by composite fracture (2) and tooth fracture (2). CONCLUSION: The low-shrinkage resin composite showed good durability, but not significantly better than the control resin composite in Class II cavities. Most failures occurred at the last part of the study. Secondary caries was the main reason for failure.

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.

Adhesion and marginal adaptation of a claimed bioactive, restorative material.

Objectives: Adhesion and marginal adaptation of a claimed bioactive restorative material (ACTIVA BioACTIVE Restorative) to human teeth were compared with those of a resin-modified glass ionomer cement (Fuji II LC) and a control resin composite (Ceram X Mono). Material and Methods: Shear bond strength and marginal adaptation to enamel and dentine were assessed after no pretreatment of the hard tissues or after etching with phosphoric acid (ACTIVA BioACTIVE Restorative and Ceram X Mono) or polyacrylic acid (Fuji II LC). For ACTIVA BioACTIVE Restorative, the effect of applying a self-etch adhesive (Xeno Select, Dentsply Sirona) was also investigated. Data were analyzed using non-parametric tests (α = 0.05). Results: Bond strength and marginal adaptation in enamel and dentine were significantly different among the investigated materials (p<.05). Due to loss of restorations, it was not possible to measure bond strength of ACTIVA BioACTIVE Restorative if no pretreatment was performed or if dentine was etched; however, use of the self-etch adhesive resulted in similar bond strength as Ceram X Mono. Etching improved adhesion of Fuji II LC to enamel and dentine. Regarding marginal adaptation, ACTIVA BioACTIVE Restorative showed the highest wall-to-wall contraction to enamel in all pretreatment groups and the overall highest wall-to-wall contraction to dentine after etching. Due to loss of restorations, no marginal assessment was possible on cavities with margins in dentine when no pretreatment was used. The use of a self-etch adhesive with ACTIVA BioACTIVE Restorative resulted in similar adaptation to dentine compared to the other materials. Conclusion: The self-adhesive property of ACTIVA BioACTIVE Restorative is nonexistent.

Long-term dentin retention of etch-and-rinse and self-etch adhesives and a resin-modified glass ionomer cement in non-carious cervical lesions.

OBJECTIVES: The aim of this study was to evaluate the clinical long-term retention to dentin of seven adhesive systems. METHODS: A total of 270 Class V restorations of four etch-and-rinse, one self-etch adhesive system and a resin-modified glass ionomer cement were placed in non-carious cervical lesions without intentional enamel involvement. The restorations were evaluated at baseline, 6, 12, 18, and 24 months and then every year during a 13-year follow-up. Dentin bonding efficiency was determined by the percentage of lost restorations. RESULTS: During the 13 years, 215 restorations could be evaluated. The cumulative loss rate at 13 years was 53.0%, with significant different failures rates for the different systems varying between 35.6 and 86.8%. Four systems fulfilled the ADA 18-month full acceptance retention criteria. Two systems showed at 18 months and earlier high debonding rates. The annual failure rates for the etch-and-rinse systems were Optibond 3.1%, Permagen 13.0%, Scotchbond MP 4.8%, Syntac classic 2.8%; for the self-etch system P&S 4.4%; and the resin-modified glass ionomer cement Vitremer 2.7%. CONCLUSION: It can be concluded that all systems showed a continuous degradation of the bond with a wide variation, which was independent of the adhesion strategy. Three bonding systems showed a cumulative failure rate after 13 years between 36 and 41% with the best retention for the resin-modified glass ionomer cement and a four-step etch-and-rinse system.

Clinical long-term retention of etch-and-rinse and self-etch adhesive systems in non-carious cervical lesions. A 13 years evaluation.

OBJECTIVES: The aim of this study was to evaluate the clinical long-term retention to dentin of seven adhesive systems. METHODS: A total of 337 Class V restorations of three three-step etch-and-rinse, one two-step etch-and-rinse and three self-etch adhesive systems were placed in non-carious cervical lesions without intentional enamel involvement. The restorations were evaluated at baseline and then every 6 months during a 13 years follow-up. Dentin bonding efficiency was determined by the percentage of lost restorations. RESULTS: During the 13 years, 275 restorations could be evaluated. The cumulative loss rate at 13 years was 60.3%, with significant different failures rates for the different systems varying between 26.3 and 94.7%. Three materials fulfilled the ADA 18 months full acceptance criteria. Three systems showed already at 18 months or earlier catastrophical debonding rates. The annual failure rates for the three-step etch-and-rinse systems were: Allbond 2 4.1%, Clearfil LB 2.0% and Denthesive 7.3%. For the two-step etch-and-rinse Gluma 2000 6.5%, and for the self-etch systems ART 3.2%, Denthesive 2 5.7% and PUB 3 4.5% CONCLUSION: A continuous degradation of the resin-dentin bond was observed for all bonding systems during the follow-up expressed by the increasing loss rates. A wide variation of dentin bonding effectiveness was seen between the systems independent to adhesion strategy.

Nine-year evaluation of a polyacid-modified resin composite/resin composite open sandwich technique in Class II cavities.

OBJECTIVES: The aim of this study was to evaluate in an intraindividual comparison the durability of a polyacid-modified resin composite/resin composite open sandwich restoration in a 9 years follow-up. A polyacid-modified resin composite (PMRC; compomer, Dyract) was placed as an intermediate layer and covered with resin composite (RC, Prisma TPH). A direct RC restoration was used as control. METHODS: Each of 57 patients, received at least one pair of Class II restorations, one open sandwich and one resin composite control. In total 75 pairs of Class II restorations, 68 premolars and 82 molars, all in occlusion, were placed by two dentists. Most of the cavities were surrounded by enamel. The restorations were evaluated at baseline, 6, 12, 24, 36 months and 9 years by slightly modified USPHS criteria. Survival of restorations grouped on the two different techniques was determined using Kaplan-Meier survival curves. RESULTS: After 9 years, 14 of 135 evaluated restorations were estimated as unacceptable, 6 in the sandwich group and 8 in the control group. Over all annual failure rate during the 9-year period was 1.1%. The survival rate was not significant different between the two techniques (p=0.604). Reasons of failure were: secondary caries (8), fracture of tooth (1), fracture of restoration (2), endodontic treatment (3). CONCLUSIONS: Both restorative techniques showed good durability during the 9-year period. No clinical advantage was observed for the sandwich technique.