Treatment effect of ozone and fluoride varnish application on occlusal caries in primary molars: a 12-month study.

AIM: The aim of this study is to evaluate the effect of ozone and fluoride varnish on occlusal caries in primary molars in a split-mouth study. MATERIALS AND METHODS: Caries risk was estimated by treating Public Dental Health Service dentists. Children with occlusal caries with Ekstrand index scores ≤3 (VI ≤3) were included. Selection of caries lesions was discontinued for ethical reasons due to non-acceptable clinical results during the follow-up. In the continued evaluation pairs of teeth with non-cavitated caries lesions, Ekstrand score ≤2a (VI ≤2) were selected. Fifty pairs of carious primary molars were included, 18 boys and 15 girls (mean 4.7 years, range 3-8). At baseline, the lesions were assessed by visual inspection (VI) and laser-induced fluorescence (LF), in each pair to treatment with 40 s ozone (HealOzone(TM), 2,100 ppm) or fluoride varnish Duraphat®. The treatments and evaluations were repeated at 3, 6 9 months and evaluations only at 12 months. RESULTS: Medium-high caries risk was observed in VI ≤3 children and low-medium risk in VI ≤2a children. In the 15 pairs VI ≤3 lesions, 8 treated with ozone and 9 with fluoride progressed to failure. In the 35 pairs VI ≤2a lesions, one lesion failed. Median baseline LF values in the VI ≤3 group were 76 and 69, for ozone and fluoride lesions, respectively, and 21 and 19 in the VI ≤2a group. At 12 months, LF values in the VI ≤2a group were 15 and 18. No improvement or difference in LF values was found over time between the caries lesions treated with ozone or fluoride. CONCLUSIONS: Neither ozone nor fluoride varnish treatments stopped the progression of caries in cavitated lesions. In low and medium caries risk children, non-cavitated lesions following both treatments showed slight or no progression. The use of ozone or fluoride varnish treatments in this regime as caries preventive method, added to the daily use of fluoridated toothpaste, to arrest caries progression in primary molars must therefore be questioned.

Longevity of extensive class II open-sandwich restorations with a resin-modified glass-ionomer cement.

Several new techniques have been introduced for use in the esthetic restoration of posterior cavities to substitute for the presumed toxicity of amalgam. Composite-laminated glass-ionomer cement restorations, the sandwich technique, have been recommended for caries-risk patients. Clinical evaluation of the use of conventional glass-ionomer cements in the open-sandwich restoration has shown a high failure rate. The aim of this study was to evaluate the durability and cariostatic effect of a modified open-sandwich restoration utilizing a resin-modified glass-ionomer cement (RMGIC) in large cavities. The materials consisted of 274 mostly extensive Class II Vitremer/Z100 restorations performed by four dentists in 168 adults. Six experimental groups were investigated. In four groups a thick and in two groups a thin layer of cement was placed. Cavity conditioning before application of the RMGIC self-etching primer was done in 3 groups with polyacrylic acid and in one group with maleic acid; in two groups, only water rinsing was performed. The restorations were evaluated at baseline and after 6, 12, 24, and 36 months according to modified USPHS criteria (van Dijken, 1986). After 3 years, 239 restorations were evaluated. Twelve (5%) were estimated as non-acceptable. Two were replaced, and seven were repaired with resin composite. Tooth fractures were observed in 2.5%. Slight erosion of the RMGIC part was seen in 4%, and in one case operative treatment was indicated. Post-operative sensitivity was reported for 9 teeth. Forty-three percent of the patients were considered as caries-risk patients. Only one restoration showed secondary caries. The three-year results indicated that the modified open-sandwich restoration is an appropriate alternative to amalgam including extensive restorations.

Clinical evaluation of three adhesive systems in class V non-carious lesions.

OBJECTIVES: The purpose of this study was to evaluate the clinical retention of three new adhesive systems in non-carious cervical lesions during a 3-year period. METHODS: The adhesive systems, a three-step (EBS/Pertac Hybrid), a one-bottle resin bonding agent (One-Step/Pertac Hybrid) and a resin-modified glass ionomer cement (Fuji II LC) were placed in 148 non-carious cervical lesions, 87 with sclerotic dentin and 61 non-sclerotic. Of the sclerotic lesions treated with the two resin bonding systems, 37 were slightly roughened with a diamond bur before conditioning. The restorations were evaluated every 6 months during a 3-year period. RESULTS: All except six restorations were evaluated during the 3 years. The cumulative loss rates for EBS, One-Step and Fuji II LC were, at 1 year: 2, 24 and 2% and at 3 years: 10, 49, 7%, respectively. The one-bottle adhesive showed significantly more failures. The five lost EBS restorations were found in non-sclerotic lesions, while the three lost Fuji II LC restorations had been placed in sclerotic lesions. For the One-Step material the loss frequency for non-sclerotic versus sclerotic lesions was 31.8 and 65.2%, respectively. Slight roughening of the sclerotic dentin surfaces with a diamond bur did not increase retention of the restorations. SIGNIFICANCE: The three-step resin adhesive and the RMGIC showed clinically acceptable retention rates, while a high failure rate was registered for the one-bottle adhesive.

Clinical evaluation of four dentin bonding agents in Class V abrasion lesions: a four-year follow-up.

OBJECTIVES: The purpose of this study was to clinically evaluate the long-term retention of four dentin bonding agents in Class V abrasion/erosion lesions during a four-year period. METHODS: Two hundred twenty-three restorations were placed in 81 patients. Four bonding agents and composite resins (Mirage bond/Silux, Tenure/Opalux, Tripton/Opalux and Scotchbond 2/Silux) were placed according to the manufacturers' instructions. No additional undercuts or etching of adjacent enamel was done. The restorations were evaluated every six mon during a four-year period. RESULTS: Two restorations developed secondary caries during the study. After six mon, three y, and four y, respectively, the loss rates for the dentin bonding agents were: Mirage bond, 38.6%/73.0%/74.6%; Tenure, 8.5%/51.2%/56.1%; Tripton, 30.2%/83.0%/83.0%; and Scotchbond 2, 9.6%/21.2%/23.1%. Scotchbond 2 showed significantly fewer failures than the other three bonding agents. No correlation was found between retention failure frequency and age of the patients. After two years, 88.0% of all the retention failures were registered. SIGNIFICANCE: Despite the promise of dentin bonding agents to form a resin-reinforced layer in the dentin, a high clinical failure rate was registered for three of the four evaluated bonding agents in Class V restorations.

Effects of GLUMA and GLUMA/Scotchbond on in vivo marginal adaptation of a composite resin to dentin.

The effect of GLUMA alone or in combination with another dentin adhesive (Scotchbond) was tested in vivo. The light-cured composite restorative resin was applied by one- or two-step application techniques. After a one-month experimental period, the formation of gaps was measured from SEM photomicrographs. All fillings showed gaps along the dentin margins in the four restorative techniques tested. The smallest gaps were found when the GLUMA/Scotchbond bonding was followed by the two-step placement of the composite resin.

Direct resin composite inlays/onlays: an 11 year follow-up.

OBJECTIVES: The aim of this study was to present an 11-year assessment of direct resin composite inlays/onlays. METHODS: One-hundred Class II direct resin composite inlays and 34 direct resin composite restorations were placed in 40 patients. The restorations were evaluated clinically, according to modified USPHS criteria, annually over a 11-year period. RESULTS: Of the 96 inlays/onlays and 33 direct restorations evaluated at 11 years, 17. 7% in the inlay/onlay group and 27.3% in the direct restorations group were assessed as unacceptable. The differences in longevity were not statistically significant. The main reasons for failure for the inlays/onlays and direct restorations were fracture (8.3 and 12. 1%, respectively), occlusal wear in contact areas (4.2 and 6.1%, respectively) and secondary caries (4.2 and 9.1%, respectively). Eight of the non-acceptable inlays/onlays and five of the direct restorations were replaced, while the other ones were repaired with resin composite. Unacceptable wear was observed in occlusal contact areas of six restorations, in patients who were severe bruxers. For the other restorations occlusal wear was not found to be a clinical problem and no difference was observed between the inlays/onlays and direct composite restorations. The marginal adaptation of the inlays/onlays was still good at the end of the study. Ditching was only observed in a few inlays. A higher failure rate was observed in molar teeth than in premolar teeth. CONCLUSIONS: Good durability was observed for the direct resin composite inlay/onlay technique. Excellent marginal adaptation and low frequency of secondary caries in patients with high caries risk were shown. No apparent improvement of mechanical properties was obtained by the secondary heat treatment of the inlays. Also, the difference in failure rate between the resin composite direct technique and the inlay technique was not large, indicating that the more time-consuming and expensive inlay technique may not be justified. The direct inlay/onlay technique is recommended to be used in Class II cavities of high caries risk patients with cervical marginal placed in dentin.

Marginal breakdown of fired ceramic inlays cemented with glass polyalkenoate (ionomer) cement or resin composite.

The marginal breakdown of fired porcelain inlays in vivo, luted with either a dual-cured resin composite or a glass polyalkenoate(ionomer) cement, was evaluated by scanning electron microscopy. Immediately following polishing (baseline) and after 1 year, replica impressions were made of the occlusal and proximal margins of two inlays, one cemented with the resin composite and the other with the glass ionomer cement, in each of 12 patients. At baseline the best marginal adaptation was observed along the proximal margins of the composite luted inlays, while occlusally glass ionomer luted inlays showed better marginal qualities than the composite luted inlays. At 1 year the composite luted inlays showed significantly better marginal adaptation than the glass ionomer luted ones at all interfaces. The greatest breakdown was observed occlusally, especially in the glass ionomer luted inlays. Gap sizes varied proximally between 83 and 100 microns and occlusally between 107 and 143 microns. Severe ditching was observed occlusally in the glass ionomer luted inlays. The overall marginal quality was significantly better for the inlays luted with the resin composite both at baseline and after 1 year.

Marginal breakdown of 5-year-old direct composite inlays.

OBJECTIVES: The marginal fit of tooth-coloured inlays luted with composite resin luting materials has been considered to be the weak link of the inlays. The marginal breakdown of 5-year-old direct composite resin inlays was evaluated by scanning electron microscopy. METHODS: Replica impressions were made of the occlusal, axial-proximal and accessible cervical-proximal margins of 21 inlays and the marginal quality was quantified. RESULTS: More than 84% of the total investigated length of the enamel/luting composite agent-luting composite/composite inlay interfaces revealed gap free margins. Proximal margins showed the largest breakdown at the enamel/composite resin interface, while the occlusal margin interfaces showed only a slight difference between the interfaces. The composite inlay and the luting composite resin showed a similar degree of wear in more than 50% of the evaluated marginal length. Medium gap width varied between 60 microns for the occlusal and axial-proximal and 87 microns for the cervical-proximal margins, with a range of 7.6-266 microns. CONCLUSIONS: The direct composite inlays investigated showed good marginal integrity after 5 years in clinical service.

Fired ceramic inlays: a 6-year follow up.

OBJECTIVES: The aim of this study was to evaluate feldspathic ceramic inlays luted with dual-cured resin composite or glass polyalkenoate (ionomer) cement (GIC) during a 6-year follow-up. METHODS: One-hundred and eighteen Class II fired feldspathic ceramic inlays were placed in 50 patients. In each patient half of the inlays were luted with a dual-cured resin composite and the other half with a conventional glass ionomer cement. The inlays were evaluated clinically, according to modified USPHS criteria, at baseline, after 6 months and then annually over a 6-year period. RESULTS: Of the 115 inlays evaluated at 6 years, 12% in the resin composite group and 26% in the GIC group were assessed as having failed. The main reason for failure in both groups was partial fracture or total loss of the inlays. Secondary caries was found to be associated with three inlays in one high caries risk patient. One inlay was replaced because of postoperative sensitivity. CONCLUSION: A relatively high and increasing failure rate was observed over the 6-year period of the study. The failure rate was more pronounced in the GIC group.

Durability of new restorative materials in Class III cavities.

PURPOSE: The aim of this study was to evaluate the durability of new hybrid tooth-colored restorative materials in Class III cavities. MATERIALS AND METHODS: 154 large-sized Class III restorations were placed in 50 patients. The patients received one of each of the three following materials: a resin composite (RC, Pekafill), a polyacid-modified resin composite (PMRC, Dyract) (compomer), and a resin-modified glass-ionomer cement (RMGIC, Fuji II LC). The restorations were evaluated yearly with slightly modified USPHS criteria. RESULTS: Of 141 restorations evaluated at 6 years, 16 were estimated as unacceptable. Seven of these were replaced: 2 fractures, 3 recurrent caries, and 2 due to unacceptable color match. In 9 other restorations with unacceptable color match, the patients did not request replacements. No significant differences were seen between the materials concerning the occurrence of recurrent caries. The RC showed significantly better color match. Significantly higher surface roughness was seen for the aged RMGIC restorations. Fracture of the incisal enamel corner was observed contiguous to ten restorations in the 6-year evaluation. None of the restorative techniques resulted in postoperative sensitivity or loss of vitality. CONCLUSION: The resin composite showed the best durability.

3-year clinical evaluation of a compomer, a resin-modified glass ionomer and a resin composite in Class III restorations.

PURPOSE: To evaluate and compare intra-individually a polyacid-modified resin composite, commonly called compomer (Dyract), a resin-modified glass ionomer cement (RM GIC)(Fuji II LC) and a resin composite (Pekafill) in Class III cavities. MATERIALS AND METHODS: In 50 patients, 154 Class III restorations were placed. Most patients received one of each of the experimental materials. At baseline, 6 months, 1, 2 and 3 years the restorations were evaluated by slightly modified USPHS criteria. RESULTS: At 3 years, 152 restorations were evaluated. Two restorations were replaced, one due to fracture and one due to secondary caries. The resin composite showed significantly better color match. A slight but still acceptable color shift and increased surface roughness was seen for the RM GIC. The compomer and the resin composite performed significantly better than the RM GIC. No postoperative sensitivity was reported and no loss of vitality was seen after use of the three different total etch techniques.

Directed polymerization shrinkage versus a horizontal incremental filling technique: interfacial adaptation in vivo in Class II cavities.

PURPOSE: (1) To evaluate the interfacial adaptation to dentin and enamel of Class II composite resin restorations placed in vivo with the directed shrinkage technique, a combination of a self-curing (Bisfil 2B) and a light-curing composite resin (AElitefil); (2) To compare this technique with a horizontal incremental filling technique, where the gingival layer of the light-curing composite resin was cured with a transparent light-tip; (3) To evaluate the effect of a hydrophilic bonding system (All-Bond 2) on the marginal adaptation of both application techniques. MATERIALS AND METHODS: In each of 34 premolars, scheduled to be extracted for orthodontic reasons, a mesial and a distal cavity was restored with composite resin filling material using the directed shrinkage technique (Bisfil 2B/AElitefil) and a horizontal incremental filling technique (AElitefil). In six groups, a hydrophilic dentin bonding system (All-Bond 2) was applied. As control, an enamel bonding agent (Gluma 4) was used in one of the directed shrinkage and in one of the horizontal incremental filling groups. For conditioning of the cavities a 10% phosphoric acid gel was used in six groups and a 32% acid gel in the other two groups. The teeth were extracted after 1 month, sectioned and replicas of the sections were made. Quality of the interfacial adaptation was studied with a scanning electron microscope. RESULTS: On the pairwise comparisons between the two application groups, no significant differences were found between the directed shrinkage technique and the horizontal incremental filling technique. The groups using the hydrophilic bonding system showed a significant better adaptation, with gap-free attachment in 77%-87% of the length of the dentin margins investigated. No significant differences for adaptation to enamel were seen between the investigated groups. The adhesive failures were found mostly between the hybrid layer and the composite resin, while the dentin was still sealed. No significant difference in interfacial quality was seen between the cavities using the 10% or the 32% phosphoric acid conditioning. A relative high frequency of enamel fractures, parallel to the interfaces, was found in the 10% phosphoric acid-conditioned cavities, especially in the cervical enamel interfaces.

A six year follow-up of three dental alloy restorations with different copper contents.

Class II restorations of three amalgam alloys, with 6%, 12% and 23% copper content, respectively, were evaluated and compared intraindividually during a six year follow-up. In total 10.3% of the restorations were replaced during the test period. The reasons for replacement were bulk fracture (5.6%), tooth fracture (2.4%), marginal ridge fracture (0.8%), and secondary caries (1.6%). The intraindividual ranking of the three alloys, including evaluation of anatomical form, marginal adaptation and secondary caries, showed significantly better results for the two high copper alloys than for the conventional low copper alloy. No difference was seen between the two high copper containing alloys.

Resin-modified glass ionomer cement restorations in primary molars.

The aim of this multicenter study was to evaluate the 3-year performance of a resin-modified glass ionomer cement in primary molars. A total of 174 class II restorations were placed in 85 children by 6 dentists. The restorations were evaluated during a 3-year period using slightly modified USPHS criteria (van Dijken 1986). Of the 174 restorations 161 were evaluated after 1 year, 121 after 2 years and 68 after 3 years. A total of 81, restorations exfoliated or was extracted during the study. The cumulative failure rate after 1, 2 and 3 year was 8.1%, 11.7% and 19.8% respectively. The main reasons for failure were secondary caries and loss of retention.

All-ceramic restorations: classification and clinical evaluations.

In the search for alternative and esthetic restorative materials, many all-ceramic systems have been introduced for the general practitioner. They are used as veneers, inlays/onlays, crowns, and as enamel/dentin bonded partial or total coverage without macroretention. This article describes a classification of the different commercial all-ceramic systems and gives a review of their clinical durability. Reasons for failures are given for the different restorations. Fracture is the main reason for failure, especially for all-ceramic crowns and inlays. The frequency of secondary caries contiguous to resin composite luted ceramics is very low. Wear of the luting agent, called ditching, is not an enduring clinical problem. The use of certain ceramic materials as well as luting agents have been shown to be contraindicated, especially in molar teeth. Newer reinforced ceramics showed better durability then the earlier fired ceramic reconstructions.

[Composite inlays]. / Composietinlays.

Composite restorations shrink most during curing. In large cavities more shrinkage may be expected. The composite inlay is especially developed to overcome these disadvantages. After curing of the composite inlay causes secondary polymerization increasing several material properties such as wear resistance and stress relaxation. Clinical results are reviewed and the benefits of the composite inlay technique discussed.

Longevity of posterior composite restorations: a systematic review and meta-analysis.

The aim of this meta-analysis, based on individual participant data from several studies, was to investigate the influence of patient-, materials-, and tooth-related variables on the survival of posterior resin composite restorations. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a search resulting in 12 longitudinal studies of direct posterior resin composite restorations with at least 5 years' follow-up. Original datasets were still available, including placement/failure/censoring of restorations, restored surfaces, materials used, reasons for clinical failure, and caries-risk status. A database including all restorations was constructed, and a multivariate Cox regression method was used to analyze variables of interest [patient (age; gender; caries-risk status), jaw (upper; lower), number of restored surfaces, resin composite and adhesive materials, and use of glass-ionomer cement as base/liner (present or absent)]. The hazard ratios with respective 95% confidence intervals were determined, and annual failure rates were calculated for subgroups. Of all restorations, 2,816 (2,585 Class II and 231 Class I) were included in the analysis, of which 569 failed during the observation period. Main reasons for failure were caries and fracture. The regression analyses showed a significantly higher risk of failure for restorations in high-caries-risk individuals and those with a higher number of restored surfaces.

Antibacterial effect of ozone on cariogenic bacterial species.

OBJECTIVE: The aim was to evaluate the antibacterial effect of ozone on cariogenic bacterial species with and without the presence of saliva and a possible effect on the salivary proteins. METHODS: Suspensions of Actinomyces naeslundii (ACTCC 12104(T)), Lactobacilli casei (N CTC 151) and Streptococcus mutans (NCTC 10449), in salt buffer or in saliva, were exposed to ozone gas delivered by the ozone generator Healozone 2130C. Aliquots of the suspensions were taken after 10, 30 and 60s ozone exposures and cultivated on agar plates. Initial number of bacteria per ml was 8.0 x 10(7) (SD 2.2 x 10(7)) (A. naeslundii), 1.0 x 10(8) (SD 3.1 x 10(6)) (L. casei) and 1.0 x 10(8) (SD 7.0 x 10(5)) (S. mutans), respectively. The proteins were separated by SDS electrophoresis and visualized by silver staining. RESULTS: In salt buffer 92%, 73% and 64% of the initial numbers of A. naeslundii, S. mutans and L. casei, respectively, were killed already after 10s ozone exposure, while approximately 99.9% of the bacteria were dead after a 60s exposure. After 10 and 30s, but not after 60s exposure to ozone, S. mutans and L. casei were less efficiently killed in saliva compared to the salt buffer. Various saliva proteins were degraded by ozone after a 60s exposure. CONCLUSIONS: The cariogenic species S. mutans, L. casei and A. naeslundii were almost eliminated following 60s of ozone treatment. This killing was reduced in the presence of saliva although increasing the ozone application time to 60s overcame these reductants in saliva. Detection of altered salivary proteins indicates that saliva components constitute additional targets for ozone.

Mutans streptococci and lactobacilli in plaque on a leucite-reinforced dental ceramic and on a calcium aluminate cement.

In this in vivo study, the proportions of mutans streptococci and lactobacilli in plaque were examined (1) on proximal surfaces of bonded, leucite-reinforced ceramic crowns and (2) on class V restorations of calcium aluminate cement (CAC). The examined proportions were intraindividually compared with those of resin composite and enamel. Mutans streptococci and lactobacilli in samples from plaque that was accumulated for 10 days on the following surfaces were determined by cultivation on blood agar plates and species-selective plates: (1) proximal leucite-reinforced ceramic crown, class II composite and enamel (n=11); and (2) class V restoration of CAC and composite, and enamel (n=17). Mutans streptococci and lactobacilli in the samples were distributed in three groups: 0, >0-1, and >1% of total bacteria. The surfaces with detected mutans streptococci were similarly distributed between the materials and enamel. The highest proportion of mutans streptococci and lactobacilli were observed on ceramic followed by composite and enamel. A higher proportion of lactobacilli, but not of mutans streptococci, was detected on enamel compared to CAC and composite. However, no significant differences were found between the surfaces. Conclusively, the materials investigated did not show different relative proportions of mutans streptococci and lactobacilli in plaque, compared to enamel.