Clinical Evaluation of Indirect Composite Resin Restorations Cemented with Different Resin Cements.

PURPOSE: To clinically evaluate the performance of indirect composite resin restorations cemented with conventional and self-adhesive resin cements over a 12-month period. MATERIALS AND METHODS: Ten patients fulfilled all the inclusion criteria. Twenty-four composite resin restorations were performed using an indirect technique and cemented with a resin cement (RelyX ARC) or a self-adhesive resin cement (RelyX U100). Two independent evaluators analyzed the restorations using modified USPHS criteria after periods of two weeks and 6 and 12 months. Statistical significance between the cements at each timepoint was evaluated with the Wilcoxon test and between timepoints with the Mann-Whitney test, both at a significance level of 5%. Fisher's exact test was used to assess the occurrence of absolute failures. RESULTS: No statistically significant differences were found between the groups at the same timepoint nor between groups at different timepoints. The only significant difference was found for color match for both groups after 12 months. CONCLUSION: After 12 months, indirect composite resin restorations cemented with self-adhesive resin cement performed similarly to those cemented with conventional resin cement.

Composite inlays: a systematic review.

The purpose of this study is to review the available literature related to composite inlays. Electronic databases published up to November 2013 were searched. Studies that evaluate composite resin inlays for the restoration of posterior teeth were selected. The studies should compare composite inlays against gold inlays, ceramic inlays and direct composite fillings regarding longevity, aesthetic quality and postoperative sensitivity or comparing the clinical effectiveness of them on premolars versus molars or on 1-2 surface preparations versus multi-surface preparations. Despite the heterogeneity of the available clinical trials composite inlays seem to be an effective method for the restoration of posterior teeth.

The effect of the post length and cusp coverage on the cycling and static load of endodontically treated maxillary premolars.

In endodontically treated teeth, cuspal coverage plays a fundamental role in reducing the risk of fracture. However, the adhesive techniques with or without fiber post increased the possibilities in restoring root-filled teeth. The aim of this study was to determine the effect of the fiber post and/or post length and/or cuspal coverage on the fracture resistance of endodontically treated maxillary premolars. Seventy intact single-rooted maxillary premolars were selected and divided in seven groups of ten each: "intact teeth" (control), "inlay without fiber post" (G1), "inlay with long fiber post" (G2), "inlay with short fiber post" (G3), "onlay without fiber post" (G4), "onlay with long fiber post" (G5), and "onlay with short fiber post" (G6). Except for intact teeth, all specimens were prepared with a mesio-occluso-distal (MOD) cavity, endodontically treated and restored with or without long or short post, with or without cusp coverage. All specimens were thermal-cycled, exposed to a cyclic loading, and then submitted to the static fracture resistance test. Fracture loads and mode of failure were evaluated. A statistically significant difference in fracture resistance was found between group 1 and the other groups (p < 0.001). χ2 test showed statistically significant differences in the patterns of fractures between the groups (p < 0.001). The highest number of favorable fractures was observed in groups 3 and 4. Similar fracture resistance was detected in maxillary premolars endodontically treated with MOD cavity preparations, restored with either direct resin composite with fiber post or cusp capping. The "short post" direct restoration may be a valid alternative in the restoration of root-filled premolars.

Influence of ultrasound application on inlays luting with self-adhesive resin cements.

The study was aimed at assessing the influence of the cement manipulation and ultrasounds application on the bonding potential of self-adhesive resin cements to dentin by microtensile bond strength testing and microscopic observations of the interface. Fifty-six standardized mesio-occlusal class II cavities were prepared in extracted third molars. Class II inlays were made using the nano-hybrid resin composite Gradia Forte (GC Corp, Tokyo, Japan), following the manufacturer's instruction. The sample was randomly divided into two groups (n = 28) according to the luting technique. Half of the specimens were luted under a static seating pressure (P), while the other ones were cemented under vibration (V). The inlays were luted using the following self-adhesive resin cements: G-Cem (G, GC Corp., Tokyo, Japan) Automix (GA) and Capsule (GC); RelyX Unicem (RU, 3 M ESPE, Seefeld, Germany) Clicker (RUC) and Aplicap (RUA). Microtensile sticks and specimens for scanning electron microscope (SEM) observations were obtained from the luted teeth. The interfacial strengths measured for the cements under static pressure or ultrasonic vibration were [median (interquartile range)]: GC/V 4 (2.3-7.9); GC/P 6.8 (4.1-10.1); GA/V 3 (1.9-6.7); GA/P 1.9 (0-5.1); RUC/V 6.6 (4.6-9.8); RUC/P 4.1 (1.8-6.4); RUA/V 6.2 (2.4-10.4); RUA/P 3.4 (0-5.4). The cement formulation influenced dentin bond strength of G. RU bond strength was affected by the luting technique. SEM analysis revealed a homogeneous structure and reduced porosities for both cements as a result of ultrasonic vibration. RU benefited from the application of ultrasounds, while GC achieved higher bond strengths than GA.

Effect of resin coating and occlusal loading on microleakage of Class II computer-aided design/computer-aided manufacturing fabricated ceramic restorations: a confocal microscopic study.

OBJECTIVE: To evaluate the effect of resin coating and occlusal loading on microleakage of class II computer-aided design/computer-aided manufacturing (CAD/CAM) ceramic restorations. MATERIAL AND METHODS: Molars were prepared for an mesio-occlusal-distal (MOD) inlay and were divided into two groups: non-coated (controls); and resin-coated, in which the cavity was coated with a combination of a dentin bonding system (Clearfil Protect Bond) and a flowable resin composite (Clearfil Majesty Flow). Ceramic inlays were fabricated using the CAD/CAM technique (CEREC 3) and cemented with resin cement (Clearfil Esthetic Cement). After 24 h of water storage, the restored teeth in each group were divided into two subgroups: unloaded or loaded with an axial force of 80 N at a rate of 2.5 cycles/s for 250,000 cycles while stored in water. After immersion in 0.25% Rhodamine B solution, the teeth were sectioned bucco-lingually at the mesial and distal boxes. Tandem scanning confocal microscopy (TSM) was used for evaluation of microleakage. The locations of the measurements were assigned to the cavity walls and floor. RESULTS: Loading did not have a significant effect on microleakage in either the resin-coated or non-coated group. Resin coating significantly reduced microleakage regardless of loading. The cavity floor exhibited greater microleakage compared to the cavity wall. TSM observation also revealed that microleakage at the enamel surface was minimal regardless of resin coating. In contrast, non-coated dentin showed extensive leakage, whereas resin-coated dentin showed decreased leakage. CONCLUSIONS: Resin coating with a combination of a dentin-bonding system and a flowable resin composite may be indicated prior to impression-taking when restoring teeth with CAD/CAM ceramic inlays in order to reduce microleakage at the tooth-resin interface.

Effect of acid neutralization and mechanical cycling on the microtensile bond strength of glass-ceramic inlays.

OBJECTIVES: To evaluate the hypothesis that a process of hydrofluoric acid precipitate neutralization and fatigue load cycling performed on human premolars restored with ceramic inlays had an influence on microtensile bond strength results (MTBS). METHODS: MOD inlay preparations were performed in 40 premolars (with their roots embedded in acrylic resin). Forty ceramic restorations were prepared using glass-ceramic (IPS Empress). The inner surfaces of all the restorations were etched with 10% hydrofluoric acid for 60 seconds, rinsed with water and dried. The specimens were divided into two groups

Effect of cyclic loading on marginal adaptation and bond strength in direct vs. indirect class II MO composite restorations.

This study evaluated the effect of cyclic loading on the marginal adaptation and microtensile bond strength of direct vs indirect Class II composite restorations in an in-vitro model. Forty Class II cavities were prepared on the mesial surface of extracted human maxillary first premolars and divided into two groups: Group I--direct composite restorations and Group II--indirect composite restorations. Groups I and II were further divided into subgroups: A (without cyclic loading) and B (with cyclic loading of 150,000 cycles at 60N). The gingival margin of the proximal box was evaluated at 200x magnification for marginal adaptation in a low vacuum scanning electron microscope. The restorations were sectioned perpendicular to the bonded surface into 1 mm thickslabs. The slabswere further trimmed at the interface to produce a cross-sectional surface area of approximately 1 mm2. All specimens were subjected to microtensile bond strength testing. The marginal adaptation was analyzed using descriptive studies and bond strength data were analyzed by one-way ANOVA test. The indirect composite restorations performed better under cyclic loading.

A retrospective clinical study on the longevity of posterior Class II cast gold inlays/onlays.

OBJECTIVE: To investigate the longevity and reasons for failure of posterior cast Class II gold inlays and onlays among a group of Norwegian adults. The term inlay was used for both inlays and onlays. METHODS: A cohort of 138 patients regularly attending a general practice for check-up were examined in 2016. The patients had a total of 391 posterior gold inlays placed in the period 1970-2015. The inlays were categorized as successful, repaired or failed. Reasons for failure were classified as either "secondary caries", "fractures", "lost inlay" or "other". Participation was voluntary and no compensation was given. RESULTS: The mean age of the patients at placement was 50.8 years (SD: 12.7 yr). Most gold inlays were placed in molars (85.9%) and 14.1% in premolars; 49.4% of the inlays were in the maxilla and the 50.6% in the mandibula. Average length of follow-up was 11.6 years (range: 1-46 years, SD: 7.9); 82.9% were classified as successful, 10.7% as repaired and 6.4% as failed. Reasons for failure were secondary caries (41.3%), lost inlay (25.4%), fractures (23.8%) and other (9.5%). Mean annual failure rate (AFR) was 1.69% for repaired and failed inlays combined. However, if repaired inlays were considered as success, the AFR decreased to 0.57%. Multi-level Cox regression analyses identified low age of the patient and high number of restored surfaces as risk factors for failure. CONCLUSION: The present retrospective clinical study demonstrated an acceptable annual failure rate for Class II cast gold inlays.

Antagonist enamel wears more than ceramic inlays.

Wear phenomena of ceramic inlays are not fully understood. The aim of the present study was to evaluate ceramic wear, antagonist enamel wear, and luting cement wear over 8 years. The two-fold null hypothesis was that there would be (1) no difference in wear behavior between ceramic and enamel, and (2) no influence of filler content of luting composites on composite wear. From 96 restorations, 36 Class II inlays from 16 participants were selected. For inlays with opposing enamel cusps (n=17), replicas of inlays and enamel were scanned with a 3-D laser scanner. Luting gaps of inlays (n=36) were analyzed with a profilometer, including 3-D data analysis. Ceramic and enamel wear increased between 4 and 8 years, with significantly higher values for enamel after 6 years (p<0.05). Luting gap wear increased continuously up to 8 years (p<0.05), with no influence of luting composites (p>0.05) and location of teeth (p>0.05).

Time-and-motion study on class II copy-milled ceramic inlays.

OBJECTIVES: To obtain an estimate of working times of Class II copy-milled ceramic inlays as an indication of their efficiency, and to analyse factors of influence. METHODS: In a controlled clinical trial, 173 MO/DO or MOD ceramic inlays of the Celay system were constructed in 101 patients. Treatment was carried out by seven dentists. The inlays were replacements of existing amalgam restorations in both molar and premolar teeth. Net-times needed for the treatment and for the laboratory stage were registered. Variables of influence on the working time were assessed by using ln-working times in ANOVA. Differences of working times were expressed as the relative difference between the upper and lower value of each variable (Delta). RESULTS: The mean clinical treatment time was 67(+/-22)min. The laboratory stage required 60(+/-17)min working time. 'Cavity modification technique' (composite basing/conventional, Delta=17%), 'clinical operator' (seven dentists, Delta=57%), and 'size of the restoration' (large/medium, Delta=16%) significantly influenced the clinical treatment time (p<0.001). Although the dentists were familiar with inlay construction, they showed a 25% decrease in working time towards the end of the study. CONCLUSIONS: Class II copy-milled ceramic inlays in this time-and-motion study required about 125min of working time. Working time increased by applying composite basing and making large restorations. The dentist influenced working times, while efficiency increased over time. Dentists needed more laboratory time to produce an inlay than the dental technician.

The novel use of extracted teeth as a dental restorative material--the 'Natural Inlay'.

OBJECTIVE: This preliminary study aimed to find out whether it is possible to produce a well fitting Class II inlay from an extracted tooth using a copy-milling technique. METHODS: Two pairs of matching sound extracted permanent molar teeth were used. The molars were matched for mesio-distal size of the tooth crown and the convexity of the approximal surfaces. One tooth of each pair was assigned to be the 'donor' tooth, the other tooth being the 'host'. MO inlay preparations were made in the host teeth. These were restored with the milled 'Natural Inlays' produced from the donor teeth using the CELAY system. The restored host teeth were sliced and examined using light-microscopy. RESULTS: The specimens showed the desired location of enamel and dentine, and a clinically acceptable fit. CONCLUSION: This study has shown that by using the CELAY milling machine it is possible to 'recycle' extracted teeth for the production of dental restorations.

Plaque, gingival health and post-operative sensitivity in titanium inlays and onlays: a randomized controlled clinical trial.

OBJECTIVES: Few clinical data on the use of titanium for restorative appliances are available. The aim of this study was to clinically evaluate titanium restorations compared to gold alloy restorations with regard to plaque, gingival health and post-operative sensitivity. METHODS: In 54 patients, 99 titanium restorations were placed. The control group comprised 56 patients with 96 high gold alloy restorations. The material was chosen by random. Each patient received one or two Class II restorations. Plaque Index (Silness and Löe, 0-3), Gingival Index (Löe and Silness, 0-3), and post-operative sensitivity (1-4, 1=none) were rated at 2 weeks, 3 months, 6 months, 12 months, and 18 months, post-operatively. RESULTS: The mean plaque scores ranged from 0.89 to 0.99 in the titanium group, and from 0.88 to 1.04 in the gold group. The mean gingival scores ranged from 0.91 to 1.07 in the titanium group, and from 0.82 to 0.99 in the gold group. The mean plaque and gingival scores of the titanium and gold group did not differ significantly at any visit (P>0.05). To evaluate post-operative sensitivity, patients with one MOD restoration each were included, resulting in 46 titanium and 44 high gold restored teeth. Mean values of the post-operative sensitivity scores in the titanium group were significantly higher than in the gold group (P<0.05). The restoration material was found to be the dominating variable with regard to post-operative sensitivity, which was not influenced by age, sex and the application of calcium hydroxide liner. CONCLUSIONS: It is concluded that neither higher plaque scores nor adverse effects on gingival health are to be expected in titanium restorations.

Indirect posterior restorations using a new chairside microhybrid resin composite system.

A plethora of choices is available as potential tooth-colored restoratives for the posterior dentition. Advances in adhesive technology and esthetic chairside microhybrid composite resins have permitted clinicians to perform inlay/onlay restorations. The use of adhesive indirect procedures offers advantages such as better control of polymerization shrinkage and anatomical form, when compared to conventional, direct restorative techniques. This article describes the use of a new chairside microhybrid composite system as an indirect restorative material, using semidirect and indirect techniques that can be accomplished within the realm of a dental operatory.

Tooth-colored inlays and onlays.

Today's dental patient concerned about attractive restorations is looking for a dentist who incorporates the newest and best techniques into practice. This article discusses a newer concept that pleases both the patient and dentist: restorations that are bonded into acid-etched tooth preparations with composite resin cement--tooth-colored inlays and onlays. Basic questions asked by practitioners about these esthetic restorations are addressed; characteristics, performance expectations, comparisons with cast gold inlays and onlays, and comparisons with amalgam are presented, in addition to other relevant information for today's dental practitioner.

Leucite-reinforced glass ceramic inlays after six years: wear of luting composites.

Wear of luting composites is still an unsolved problem with adhesive inlays. However, only limited clinical research has been conducted regarding this phenomenon. This study evaluated the substance loss within the luting gap over a six-year period in vivo. In the course of a controlled prospective clinical study, 16 patients received 39 Class-II IPS Empress inlays. Variolink Low (Vivadent; n = 18) was used as conventional low-viscosity luting composite, the hybrid-type restorative resin composite Tetric (n = 21; Vivadent) was applied according to the ultrasonic insertion technique. The restorations were clinically assessed after 6, 12, 24, 36, 48 and 72 months and replicas were made. The contact-free occlusal areas of the replicas were scanned by use of a computer-controlled profilometer (Perthen S3P), the analysis of the data was computed using a newly developed software (Xpert for Windows 95) and statistically analyzed with non-parametric tests. After six months all restorations exhibited marginal ditching. The percentage of detectable luting gap abrasion increased between each recall appointment (32% after six months, 48% after 12 months, 46% after 24 months, 55% after 36 months, 59% after 48 months and 65% after 72 months). Except for the 48-months results, no significant difference between the materials used for luting was evident (p > 0.05). Between the width and the depth of the luting space a linear regression was computed. The quantitative evaluation clearly demonstrated that hopes of relevantly reduced wear of luting composites were not confirmed when using the higher filled luting material.

Effects of cavity form and setting expansion of refractory dies on adaptability of Class II (MO and MOD) fired ceramic inlays.

This study investigated the effects of cavity divergence and setting expansion of refractory die material on the adaptability of Class II (MO and MOD) fired ceramic inlays. Standardized Class II (MO and MOD) cavities with two kinds of lateral wall divergence (10 and 20 degrees) were prepared in epoxy resin blocks. A refractory die was prepared from an impression of the epoxy resin cavity in which the setting expansion ranged from 0.04 to 1.14%. A ceramic inlay was fired on each die. The fabricated inlay was inserted into the epoxy resin cavity, and the interfacial distance between the ceramic inlay and the cavity wall at the margin was measured using a reflecting microscope at x100 magnification. The internal fit was measured after sectioning the specimen longitudinally. The results indicate that the setting expansion of the refractory die materials and the divergence of the lateral walls had significant effects on the adaptability of Class II (MO and MOD) fired ceramic inlays. The inlays fabricated on the refractory dies with small setting expansion showed small internal gaps in Class II (MO) cavities. Significantly good adaptation was achieved when the setting expansion was 0.32% or less (p < 0.05). The inlays fabricated on the refractory dies with large setting expansion showed small internal gaps in Class II (MOD) cavities. Significantly good adaptation was achieved when the setting expansion was 0.87% and greater (p < 0.05).

Quantitative measurement of marginal disintegration of ceramic inlays.

The objectives of this study include establishing a method for quantitative measurement of marginal change in ceramic inlays and clarifying their marginal disintegration in vivo. An accurate CCD optical laser scanner system was used for morphological measurement of the marginal change of ceramic inlays. The accuracy of the CCD measurement was assessed by comparing it with microscopic measurement. Replicas of 15 premolars restored with Class II ceramic inlays at the time of placement and eight years after restoration were used for morphological measurement by means of the CCD laser scanner system. Occlusal surfaces of the restored teeth were scanned and cross-sections of marginal areas were computed with software. Marginal change was defined as the area enclosed by two profiles obtained by superimposing two cross-sections of the same location at two different times and expressing the maximum depth and mean area of the area enclosed. The accuracy of this method of measurement was 4.3 +/- 3.2 microm in distance and 2.0 +/- 0.6% in area. Quantitative marginal changes for the eight-year period were 10 x 10 microm in depth and 50 x 10(3) microm2 in area at the functional cusp area and 7 x 10 microm in depth and 28 x 10(3) microm2 in area at the non-functional cusp area. Marginal disintegration at the functional cusp area was significantly greater than at the non-functional cusp area (Wilcoxon signed-ranks test, p < 0.05). This study constitutes a quantitative measurement of in vivo deterioration in marginal adaptation of ceramic inlays and indicates that occlusal force may accelerate marginal disintegration.

Eight-year clinical evaluation of fired ceramic inlays.

This study evaluated the quality of fired ceramic inlay restorations consisting of a feldspathic porcelain system (G-Cera Cosmotech II, GC Co, Tokyo, Japan) after eight years in vivo. Forty-five fired ceramic inlays (for 26 premolars and 19 molars; Class I in 12 teeth, Class II in 31 teeth and onlay in two teeth) were placed in 25 patients. All restorations were evaluated at the time of placement and at 6 months, 1, 2, 4, 6 and 8 years after placement using modified USPHS criteria. Replicas of the restorations were observed with a scanning electron microscope (SEM) to evaluate the degradation of the marginal area and wear loss of the restoration. Longevity was observed in 80% of the fired ceramic inlay restorations at eight years (Kaplan-Meier method), although it was 92% at the six-year observation. Marginal fracture was detected in 11 restorations (22%), including bulk fracture in five (11%), which had first occurred during the last two years. Recurrent caries was observed in three (7%) cases and marginal discoloration in 14 (31%). SEM evaluation disclosed marginal microfractures in 77% of the restorations, wear in 36% and wear of the resin cement along the margin in 74% at eight years. No significant difference was observed in each of these three characteristics between molars and premolars. This longitudinal eight-year clinical observation suggested that fired ceramic inlay restorations made by the G-Cera Cosmotech II system are clinically acceptable. However, critical failure as bulk fracture may become a future problem since marginal disintegration was detected in 77% of the restorations from microscopic and macroscopic perspectives.

Microtensile bond strength to dentin and cavity adaptation of Cerec 2 inlay restoration.

PURPOSE: To examine the bond strength of Cerec 2 inlays both to dentin surface by microtensile testing and to cavity walls by cavity adaptation in Class II restorations, using three luting materials. MATERIAL AND METHODS: VitaMark II disc was bonded to the coronal dentin surface with Clapearl DC (Clearfil DC)/Linerbond IIsigma (Linerbond 2V), AP-X/Linerbond IIsigma or Fluorocement (Panavia F)/ED Primer. After 24-hr storage in water, microtensile bond strengths (MTB) were measured. Additionally, Cerec inlays were luted to the MO cavities prepared in molars with the same materials. After thermocycling (x2000), the restorations were sectioned mesio-distally. Gap formation was microscopically examined along the cavity walls. RESULTS: There was no significant difference in MTB among the materials (Clapearl DC: 20.89 +/- 4.58 MPa, AP-X: 24.22 +/- 5.97 MPa, Fluorocement: 19.82 +/- 6.43 MPa, Scheffé, P > 0.05). The frequency of gap formation was higher in AP-X than in Clapearl DC and Fluorocement (chi2-test, P < 0.05). Debonding occurred more often at the luting material/dentin interface than at the inlay/luting material interface (Sign test, P < 0.05).