A randomized, prospective clinical study evaluating effectiveness of a bulk-fill composite resin, a conventional composite resin and a reinforced glass ionomer in Class II cavities: one-year results

Abstract Bulk-fill restorative materials such as bulk-fill composite resins and high viscous glass ionomer cements have become very popular materials in operative dentistry because their application is easy and time-saving. Objectives: The aim of this clinical study was to evaluate the clinical performance of a highly viscous reinforced glass ionomer material, a bulk-fill composite resin and a micro hybrid composite resin in Class II restorations. Methodology: In total, 109 Class II restorations were performed in 54 patients using three different restorative materials: Charisma Smart Composite (CSC); Filtek Bulk Fill Posterior Restorative (FBF); Equia Forte Fil (EF). Single Bond Universal adhesive (3M ESPE, Germany) was used with composite resin restorations. The restorations were evaluated using modified USPHS criteria in terms of retention, color match, marginal discoloration, anatomic form, contact point, marginal adaptation, secondary caries, postoperative sensitivity and surface texture. The data were analyzed using Chi-Square, Fischer's and McNemar's tests. Results: At the end of one year, 103 restorations were followed up. No changes were observed during the first 6 months. At the end of one year, there were small changes in composite restorations (FBF and CSC) but no statistically significant difference was observed between the clinical performances of these materials for all criteria (p>0.05). However, there was a statistically significant difference between EF, FBF and CSC groups in all parameters except marginal discoloration, secondary caries and postoperative sensitivity in one-year evaluation (p<0.05). Conclusion: Bulk-fill composite resins and conventional composite resins showed more successful clinical performance than highly viscous reinforced glass ionomers in Class II cavities.

Bonding of universal adhesive system to enamel surrounding real-life carious cavities

Abstract: This study aimed to evaluate the bond strength of a universal adhesive system to enamel surrounding real-life carious cavities. Twenty-eight permanent molars (n = 7) with carious lesions in dentin were subjected to selective carious tissue removal to firm dentin and had their crowns sectioned longitudinally. A universal adhesive system (Single Bond Universal [SBU] used in either etch-and-rinse and self-etch strategies) was compared with an etch-and-rinse Adper Single Bond 2 (ASB) and a self-etch Clearfil SE Bond (CSE) adhesive systems (control systems). Adhesives were applied on the enamel, assumed demineralized, surrounding the cavity margins and on sound enamel (control substrate). Composite cylinders were built (0.72 mm2) and microshear bond strength (µSBS) test was performed after 24 h of water storage. The µSBS values (MPa) were analyzed using two-way ANOVA and Tukey's post hoc tests (α = 0.05). Bond strength values obtained in demineralized enamel surrounding carious cavity margins were significantly lower than that obtained in sound enamel (distant from carious cavity margins) (p = 0.035). The bonding strategy of the SBU did not influenced the bond strength values, which were higher than that obtained with ASB. CSE showed similar µSBS values to ASB and SBU in the self-etch mode. In conclusion, the bond strength to enamel assumed demineralized is lower than to sound enamel. The enamel surrounding carious cavities jeopardize the bonding of universal adhesive system. The bond strength of universal adhesive is similar, regardless to bonding strategy.

Twenty-four-month clinical performance of different universal adhesives in etch-and-rinse, selective etching and self-etch application modes in NCCL - a randomized controlled clinical trial

Abstract Objective The aim of this randomized, controlled, prospective clinical trial was to evaluate the performances of two different universal adhesives and one etch-rinse adhesive for restoration of non-carious cervical lesions (NCCLs). Material and Methods Twenty patients with at least seven NCCLs were enrolled. Lesions were divided into seven groups according to adhesive systems and application modes: GSE: GLUMA Universal-self-etch, GSL: GLUMA Universal-selective etching, GER: GLUMA Universal-etch-and-rinse, ASE: All-Bond Universal-self-etch, ASL: All-Bond Universal-selective etching, AER: All-Bond Universal-etch-and-rinse, SBE (Control): Single Bond2-etch-and-rinse. A total of 155 NCCLs were restored with a nano hybrid composite (Tetric N-Ceram). Restorations were scored with regard to retention, marginal discoloration, marginal adaptation, recurrent caries and post-operative sensitivity using modified United States Public Health Service (USPHS) criteria after one week, 6, 12 and 24 months. Statistical evaluations were performed using Chi-square tests (p=0.05). Results The recall rate was 81.9% after the 24-month follow-up. The cumulative retention rates for self-etch groups (GSE: 72.2%, ASE:75%) were significantly lower than other experimental groups (GSL: 93.7%, GER: 100%, ASL: 94.1%, AER: 100%, SBE: 100%) at the 24-month follow-up (p<0.05). Regarding marginal adaptation and marginal discoloration, GSE and ASE groups demonstrated more bravo scores after 6 and 12-month observations but differences were not significant (p>0.05). Only one restoration from ASL group demonstrated post-operative sensitivity at 6 and 12-month observations. No secondary caries was observed on the restorations at any recall. At the end of 24-month observations, no significant differences were detected among groups regarding any of the criteria assessed, except retention. Conclusion GLUMA Universal and All-Bond Universal showed better results in etch-and-rinse and selective etching mode compared to the self-etch mode regarding retention. Etch-and-rinse and selective etching application modes of the current universal adhesives tended to provide better clinical outcomes considering the criteria evaluated at the end of 24-month evaluation.

Survival of sealants in molars affected by molar-incisor hypomineralization: 18-month follow-up

Abstract The objective of this study was to evaluate the clinical survival of sealants applied in first permanent molars (FPMs) affected by molar-incisor hypomineralization (MIH), at 18 months of follow-up. Forty-one first permanent molars were selected from 21 children, 6–8 years of age. MIH was classified by one calibrated examiner (kappa = 0.80) according to EAPD criteria. The inclusion criteria were fully erupted FPMs with MIH or sound FPMs (without MIH) for which sealant treatment was indicated. The FPMs were assigned to two groups: CG (control group) and HG (MIH group). Both groups were treated with sealant (FluroShield). Clinical follow-up was performed from baseline to 18 months to assess anatomical form, marginal adaptation, retention and presence of caries, according to criteria set by the United States Public Health Service-Modified, and was conducted by a blinded examiner (kappa = 0.80). The actuarial method was used to evaluate the survival of the sealants. The survival rates for the groups were compared using Fisher’s exact test (α = 5%). The cumulative survival rates were 81% at 1 month, 68.8% at 6 months, 68.8% at 12 months, and 62.6% at 18 months for CG, and 88% at 1 month, 84% at 6 months, 76% at 12 months, and 72% at 18 months for HG. No significant difference was found between the groups. The sealants in molars affected by MIH presented a survival rate similar to the sealants in the control, suggesting that sealants may be an adequate approach for preventing carious lesions in MIH-affected molars.

Longevity of metal-ceramic crowns cemented with self-adhesive resin cement: a prospective clinical study

Abstract Resin cements are often used for single crown cementation due to their physical properties. Self-adhesive resin cements gained widespread due to their simplified technique compared to regular resin cement. However, there is lacking clinical evidence about the long-term behavior of this material. The aim of this prospective clinical trial was to assess the survival rates of metal-ceramic crowns cemented with self-adhesive resin cement up to six years. One hundred and twenty-nine subjects received 152 metal-ceramic crowns. The cementation procedures were standardized and performed by previously trained operators. The crowns were assessed as to primary outcome (debonding) and FDI criteria. Statistical analysis was performed using Kaplan-Meier statistics and descriptive analysis. Three failures occurred (debonding), resulting in a 97.6% survival rate. FDI criteria assessment resulted in scores 1 and 2 (acceptable clinical evaluation) for all surviving crowns. The use of self-adhesive resin cement is a feasible alternative for metal-ceramic crowns cementation, achieving high and adequate survival rates.

A 12-month clinical evaluation of pit-and-fissure sealants placed with and without etch-and-rinse and self-etch adhesive systems in newly-erupted teeth

OBJECTIVES: The objective of this one-year clinical study was to investigate the effect of two adhesive systems (Adper Single Bond, a two-step etch-and-rinse and Clearfil SE Bond, a two-step self-etch system) on pit-and-fissure sealant retention in newly-erupted teeth. This study compared the success of the sealants in mesial and distopalatal grooves with and without these two adhesive systems. MATERIAL AND METHODS: In a clinical trial, 35 children aged 6-8 years undergoing sealant placement were recruited. This one-year clinical study scored 70 mesial and 70 distopalatal sealants of newly-erupted permanent maxillary first molar, with a split-mouth design. All children received sealant alone in one permanent maxillary molar tooth. Children were randomized into two groups. One group received Self-etch (Se) bond plus sealant and the other group received Single Bond plus sealant in another permanent maxillary molar tooth. Clinical evaluation at 3, 6 and 12 months was performed and the retention was studied in terms of the success and failure. RESULTS: The success rate of sealant in the distopalatal groove, using SeB at 3, 6 and 12 months was 93.3% (95% CI: 68.0, 99.8), 73.3% (95% CI: 44.9, 92.2) and 66.7% (95% CI: 38.4, 88.2), respectively. It was greater than that of the distopalatal groove in SB group with a success rate of 62.5% (95% CI: 35.4, 84.8), 31.3% (95% CI: 11.8, 58.7) and 31.3% (95% CI: 11.8, 58.7), at the three evaluation periods. The success rate of sealant in the mesial groove using SeB was 86.6% (95% CI: 59.5, 98.3), 53.3% (95% CI: 26.6, 78.7) and 53.3% (95% CI: 26.6, 78.7), while this was 100% (95% CI: 79.4, 100.0), 81.3% (95% CI: 54.4, 96.0) and 81.3% (95% CI: 54.4, 96.0) using SB, at 3, 6 and 12-month evaluation periods. CONCLUSIONS: These results support the use of these two bonding agents in pit-and-fissure sealants under both isolated and contaminated conditions. Further, Se bond seemed to be less sensitive to moisture contamination.

Two-year clinical evaluation of three adhesive systems in non-carious cervical lesions

OBJECTIVES: Adhesive systems are continuously being introduced to Dentistry, unfortunately often without sufficient clinical validation. The aim of this study was to evaluate the clinical performance of cervical restorations done with three different adhesive systems. MATERIAL AND METHODS: 158 non-carious cervical lesions of 23 patients were restored with a nanofilled composite resin (Filtek Supreme, 3M/ESPE) combined with Single Bond (3M/ESPE, group SI), Clearfil SE (Kuraray Medical Inc., group CL) and Xeno III (De Trey Dentsply, group XE). In groups SI-B, CL-B and XE-B, the outer surface of the sclerotic dentin was removed by roughening with a diamond bur before application of the respective adhesive systems. In groups CL-BP and XE-BP, after removal of the outer surface of the sclerotic dentin with the bur, the remaining dentin was etched with 37% phosphoric acid and the self-etch adhesive systems Clearfil SE and Xeno III were applied, respectively. Lesions were evaluated at baseline, and restorations after 3 months, 1 year and 2 years using modified USPHS criteria. RESULTS: After 2 years, no significant difference was found between the retention rates of the groups (p >0.05). Although groups CL and SI showed significantly better marginal adaptation than group XE (p<0.05) at 2 years, no significant difference was found between the marginal adaptation of the groups SI-B, CL-B and XE-B (p>0.05). After 2 years no significant difference was observed among the marginal staining results of all groups (p>0.05). CONCLUSION: Although all adhesive systems showed similar retention rates, Clearfil SE and Single Bond showed better marginal adaptation than Xeno III after 2 years of follow-up.

Evaluation of the remineralization potential of amorphous calcium phosphate and fluoride containing pit and fissure sealants using scanning electron microscopy.

Aim: To evaluate the remineralization potential of Amorphous Calcium Phosphate (ACP) and Fluoride containing pit and Fissure Sealants using Scanning Electron Microscopy. Materials and Methods: Thirty maxillary first premolars were divided into three groups of ten each and were randomly selected for ACP containing (Aegis- Opaque White, Bosworth Co. Ltd.), Fluoride containing (Teethmate F1 Natural Clear, Kuraray Co. Ltd.), resin based (Concise- Opaque White, 3M ESPE Co. Ltd.) pit and fissure sealant applications. The Concise group served as a control. The teeth weresubjected to the pH-cycling regimen for a period of two weeks. After two weeks, the teeth were sectioned bucco-lingually into 4mm sections and were observed under Scanning Electron Microscope at 50X, 250X, 500X, 1000X and 1500X magnifications. The qualitative changes at the tooth surface and sealant interface were examined and presence of white zone at the interface was considered positive for remineralization. Results: Both ACP containing (Aegis) and Fluoride containing (Teethmate F1) group showed white zone at the tooth surface-sealant interface. The resin based group (Concise) showed regular interface between the sealant and the tooth structure, but no clear cut white zone was observed. Conclusion: Both, Aegis and Teethmate F1 have the potential to remineralize. Release of Amorphous Calcium Phosphate molecules in Aegis group and formation of Fluoroapetite in Teethmate F1 group, were probably responsible for the remineralization.

Evaluation of demineralization adjacent to orthodontic bracket and bond strength using fluoride-releasing and conventional bonding agents.

Background and Objectives: One of the most difficult problems encountered in orthodontic treatment with fixed appliance is the control of enamel demineralization around the brackets. Fluoride-releasing bonding adhesives were introduced to aid in the prevention of demineralization adjacent to orthodontic brackets. Hence, an in vitro study was conducted to evaluate and compare demineralization adjacent to the orthodontic bracket and the bond strength using fluoride-releasing adhesive and conventional adhesive. Materials and Methods: One hundred and twenty healthy extracted premolars were selected for the study and were divided into two groups, each group consisting of 60 teeth. Both groups were further divided into three subgroups consisting of 20 samples each. Samples of subgroups A and B were bonded with two prototypes of fluoride-releasing adhesives (i.e. Rely-a-bond and Tru-bond). Samples of subgroup C (ortho-one) were bonded with conventional non-fluoride-releasing adhesive. Group I samples were subjected to demineralization in an acidic medium (methyl cellulose buffered with acetic acid at a pH of 4.5) for 4 weeks, which were later observed under a stereomicroscope. Group II samples were tested for shear bond strength using the Instron Universal testing machine. Results: Both fluoride-releasing adhesives showed statistically significant lower enamel demineralization around the bracket when compared with the conventional adhesive. There was no statistically significant difference on comparing the demineralization between the two prototypes of fluoride-releasing adhesive. Evaluation of shear bond strength revealed that there was no significant difference between the subgroups. Conclusion: Fluoride-releasing adhesives might aid in the prevention of demineralization adjacent to the orthodontic bracket with acceptable bond strength.

Effectiveness of sealing active proximal caries lesions with an adhesive system: 1-year clinical evaluation

The objective of this study was to evaluate the effectiveness of a therapeutic sealant to arrest non-cavitated proximal carious lesion progression. The study population comprised 44 adolescents who had bitewing radiographs taken for caries diagnosis. Non-cavitated lesions extending up to half of dentin thickness were included in the sample. In the experimental group (n = 33), the proximal caries-lesion surfaces were sealed with an adhesive (OptiBond Solo, Kerr) after tooth separation. The control group (n = 11) received no treatment, except for oral hygiene instructions including use of dental floss. Follow-up radiographs were taken after one year and were analyzed in comparison with baseline radiographs. In a blind study setting, visual readings were performed by two examiners, blinded to whether the examined radiograph was baseline or follow-up, and whether it concerned a test or control lesion. The efficacy of sealing treatment was evaluated by the McNemar test (0.05). About 22 percent of the sealed lesions showed reduction, 61 percent showed no change and 16 percent showed progression. For the control lesions, the corresponding values were 27 percent, 36 percent and 36 percent respectively. The number of lesions that showed reduction and no changes were merged and therefore 83.3 percent of the sealed lesions and 63.6 percent of the control lesions were considered clinically successful. No statistical significance was detected (p > 0.05). In the course of 1 year, sealing proximal caries lesions was not shown to be superior to lesion monitoring.

Evolución y tendencias actuales en resinas compuestas / Current trends and evolution on dental composites

La introducción de la tecnología de las resinas compuestas dentro de la odontología restauradora, ha sido una de las contribuciones más significativas para la odontología en los últimos veinte años. Las ventajas de las restauraciones adheridas a la estructura dental, incluyen conservación de tejido dental sano, reducción de la microfiltración, prevención de la sensibilidad postoperatoria, refuerzo de la estructura dental y la transmisión / distribución de las fuerzas masticatorias a través de la interfase adhesiva del diente. A pesar de sus ventajas, las resinas compuestas presentan significativas deficiencias en cuanto a su desempeño, sobre todo lo relacionado con la contracción de polimerización y al estrés que esta produce en la interfase diente - restauración. Actualmente, las mejoras en las formulaciones, el desarrollo de nuevas técnicas de colocación y la optimización de sus propiedades físicas y mecánicas, han hecho la restauración de resina compuesta más confiable y predecible. El objetivo principal de este artículo fue analizar los avances en los materiales de restauración de resina compuesta, a través de una exhaustiva revisión de la literatura, donde se valoraron aspectos tales como: composición, clasificación, propiedades físicas y mecánicas, aspectos de manipulación y tendencias actuales de estos materiales

The introduction of composite-based resin technology to restorative dentistry was one of the most significant contributions to dentistry in the last twenty year. The advantages of bonded restorations include conservation of sound tooth structure, reduction of microleakage, prevention of postoperative sensitivity, tooth reinforcement and the transmission / distribution of functional stress across the bonding interface of the tooth. Today, improvements in formulations, development of new placement techniques and the optimization of physical and mechanicals properties had made the direct composite restoration more reliable and predictable. The main objective of this article was analyzing the advances of resin composites restoration material. Trought an exhaustive literature revision. Valuing aspect as composition, classification, phisycal and mechanical properties, manipulation and current trends of this material.

Retention of a resin-based sealant and a glass ionomer used as a fissure sealant: a comparative clinical study.

Sealing occlusal pits and fissures with resin-based sealants is a proven method of preventing occlusal caries. Retention of the sealant is very essential for its efficiency. This study evaluated the retention of glass ionomer used as a fissure sealant when compared to a self-cure resin-based sealant. One hundred and seven children between the ages of 6-9 years, with all four newly erupted permanent first molars were selected. Two permanent first molars on one side of the mouth were sealed with Delton, a resin-based sealant, and the contralateral two permanent first molars were sealed with Fuji VII glass ionomer cement. Evaluation of sealant retention was performed at regular intervals over 12 months, using Simonsen's criteria. At the end of the study period, the retention of the resin sealant was seen to be superior to that of the glass ionomer sealant.

Effects of a glass-ionomer cement on the remineralization of occlusal caries: an in situ study

Esta pesquisa avaliou a remineralização do esmalte de fóssulas e fissuras de terceiros molares humanos previamente desmineralizados e selados com um cimento de ionômero de vidro (Fuji IX, GC Corporation - Japão) ou com um selante de Bis-GMA (Delton-Dentsply). Dez voluntários participaram deste estudo in situ que consistiu de dois períodos de 30 dias com intervalo de 1 semana entre eles, usando dispositivos intra-orais. Quatro procedimentos de tratamento experimental e um controle foram aleatoriamente distribuídos entre os espécimes que foram usados pelos voluntários: Grupo I, sem qualquer tratamento, controle; Grupo II, processo de cárie artificial; Grupo III, igual ao Grupo II, porém selados com Delton (Dentsply); Grupo IV, igual ao Grupo II, porém selados com Fuji IX (GC Corporation - Japão); Grupo V, igual ao Grupo II, mas sem selamento. Os Grupos I e II não foram submetidos ao meio bucal e serviram de controle. Após um período de trinta dias no meio bucal, os espécimes foram removidos dos dispositivos, montados em resina acrílica, planificados e polidos. Realizaram-se então testes de Dureza Knoop com carga estática de 25 g por 15 segundos. As medidas foram realizadas desde a base da fissura até uma abertura de 600 µm, preestabelecida entre os planos inclinados das cúspides. A cada 100 µm, três penetrações foram realizadas: a primeira a 25 µm da superfície da fissura, a segunda a 75 µm, e a terceira a 125 µm (Micromet 2003). Os dados obtidos foram analisados estatisticamente pelos testes "F" de Brieger e de Bonferroni. Concluiu-se que o selamento com o cimento de ionômero de vidro Fuji IX foi capaz de tornar o esmalte de sulcos e fissuras mais resistente pelo aumento do valor de dureza Knoop.

Adhesive systems used for sealing contaminated surfaces: a microleakage evaluation

O propósito deste estudo foi comparar dois sistemas adesivos (OptiBond FLTM e OptiBond SOLOTM) utilizados como material único para selar superfícies oclusais contaminadas com relação à infiltração marginal. Após condicionamento ácido, 56 dentes hígidos foram contaminados com 1 µl de plasma e aleatoriamente divididos em 8 grupos (n = 7). Os adesivos foram fotoativados por 30 s sob duas condições (Optilux VCL-403TM e VCL-500TM). Cada espécime foi exposto a um de dois tratamentos de envelhecimento: ciclos térmicos (4.000 x a 5-55°C por 60 s) mais ciclos mecânicos (225.000 x com carga de 83,3 N); ou ciclos térmicos, mecânicos e de pH (soluções mineralizante/desmineralizante). Os espécimes foram imersos em solução aquosa de AgNO3 a 50%, secionados, e a penetração do corante foi medida em imagem digitalizada. Usou-se ANOVA para determinar os principais efeitos dos fatores e suas interações. Os resultados indicaram diferença significante entre os adesivos (p < 0,05), sugerindo que o OptiBond FLTM apresenta um desempenho melhor com relação à microinfiltração e poderia ser indicado como material único para selamento em condições de umidade ou contaminação acidental.