Six-year clinical evaluation of bulk-fill and nanofill resin composite restorations.

OBJECTIVES: This study aims to compare the performance of a bulk-fill and a nanofill resin composite in class II restorations after 6 years. MATERIALS AND METHODS: Fifty patients having at least two class II carious lesions were recruited for the study. One lesion in each patient was randomly assigned to be restored using either the Tetric EvoCeram Bulk Fill (TB) or Filtek Ultimate (FU) resin composites with their respective adhesives. One hundred four restorations were placed by two calibrated operators. Restorations were evaluated at baseline and annually over the course of 6 years by two examiners using modified USPHS criteria. Data were statistically analyzed using the Chi-square and Cochran Q tests (p < 0.05). RESULTS: Sixty-six restorations in 33 patients were evaluated after 6 years. Only one restoration was lost from FU group at 5 years. At the end of 6 years, marginal discoloration was observed in three (9.1%) TB and eight (36.4%) FU restorations creating a significant difference between the groups (p < 0.05). The FU group showed a significant increase in marginal discoloration at 6 years from the baseline (p < 0.05). Marginal adaptation was rated as Bravo for 9.1% and 24.2% of TB and FU restorations, respectively (p > 0.05). Significant degradation was observed within each group in terms of marginal adaptation (p < 0.05). There were no statistically significant differences between the groups for the other criteria tested (p > 0.05). CONCLUSIONS: Bulk-fill restorations performed better for marginal discoloration. The remaining clinical performance criteria of bulk-fill and nanofill resin composite restorations were similar after 6 years. CLINICAL RELEVANCE: Bulk-fill resin might be a better alternative to incrementally placed restorative in terms of marginal discoloration under clinical conditions.

Does a new formula have an input in the clinical success of posterior composite restorations? A chat study.

OBJECTIVE: To compare the clinical behavior of a universal light-curing, ultra-fine particle hybrid composite and successor of this material in class I and II cavities after 60 months. MATERIALS AND METHODS: Forty patients (21 females, 19 males) with ages ranging between 18 and 38 years (23.15 ± 5.15) received 80 (13 Cl I and 67 Cl II) resin composite restorations (Charisma/Charisma Classic, Kulzer GmbH) in combination with an etch and rinse adhesive system (Gluma 2Bond) under rubber dam isolation. Two experienced operators performed all the restorations. Restorations were evaluated by the other two examiners according to the FDI criteria at baseline and at 6, 12, 18, 24, 36, 48 and 60 months. Surface characteristics of one restoration selected randomly were examined under a scanning electron microscope (SEM) at each recall. Data were analyzed statistically (p < 0.05). RESULTS: After 60 months, recall rate was 90%. None of the restorations failed. Three restorations from Charisma and 4 from the Charisma Classic group showed minor surface staining. Twelve Charisma and 14 Charisma Classic restorations were scored as 2 for margin staining. Four restorations from both groups showed minor shade deviations but no significant difference was observed between the two restorative materials for any criteria evaluated after 60 months (p > 0.05). SEM evaluations were in accordance with the clinical findings. CONCLUSIONS: Both materials exhibited clinically similar and successful performance over the 60-month observation period. CLINICAL RELEVANCE: A new formulation of resin composite may not always perform better clinical performances. TRIAL REGISTRATION: ClinicalTrials.gov : NCT02888873.

An 18-month clinical evaluation of three different universal adhesives used with a universal flowable composite resin in the restoration of non-carious cervical lesions.

OBJECTIVE: The aim of this randomized, controlled prospective clinical trial was to evaluate and compare the performances of three different universal adhesives using a flowable universal composite resin in the restoration of non-carious cervical lesions (NCCLs) over an 18-month period. MATERIALS AND METHODS: Eighteen participants recieved 99 restorations from a single operator. NCCLs were divided into three groups according to adhesive systems used: Clearfil Universal Bond (CU), iBOND Universal (IU), and G-Premio Bond (GP). No enamel bevel was placed and no mechanical retention was created for the NCCLs. Prior to adhesive procedures, selective etching was performed with 37% phosphoric acid. Adhesive systems were applied following manufacturers' instructions and the lesions were restored with a flowable composite resin (G-ænial Universal Flo). Restorations were finished and polished immediately after placement and scored with regard to retention, marginal discoloration, marginal adaptation, sensitivity, surface texture, and color match using modified USPHS criteria after a week (baseline) and 6, 12, and 18 months. Descriptive statistics were performed using chi-square tests. RESULTS: The 18-month recall rate was 88.8% and retention rates for CU, IU, and GP were 100%, 96.8%, and 100%, respectively. No restorations exhibited post-operative sensitivity and secondary caries. After 18 months, CU, IU, and GP groups showed similar alpha rates for marginal adaptation (CU 93.1%, IU 90%, GP 81.8%) and marginal discoloration (CU 100%, IU 90%, GP 87.9%). A total of ten (CU 2, IU 3, GP 5) restorations exhibited bravo scores for surface texture and three (CU 2, GP 1) restorations showed bravo score for color match. No statistical differences were found among the tested adhesives for any criteria evaluated (p > 0.05). CONCLUSION: The three adhesive systems demonstrated similar performances during the 18-month follow-up in the restoration of NCCLs. CLINICAL RELEVANCE: Universal adhesives could be used successfully in the restoration of NCCLs.

Clinical performance of a glass ionomer restorative system: a 6-year evaluation.

OBJECTIVES: The aim of this study is to evaluate the long-term clinical performance of a glass ionomer (GI) restorative system in the restoration of posterior teeth compared with a micro-filled hybrid posterior composite. MATERIALS AND METHODS: A total of 140 (80 Cl1 and 60 Cl2) lesions in 59 patients were restored with a GI system (Equia) or a micro hybrid composite (Gradia Direct). Restorations were evaluated at baseline and yearly during 6 years according to the modified-USPHS criteria. Negative replicas at each recall were observed under SEM to evaluate surface characteristics. Data were analyzed with Cohcran's Q and McNemar's tests (p < 0.05). RESULTS: One hundred fifteen (70 Cl1 and 45 Cl2) restorations were evaluated in 47 patients with a recall rate of 79.6% at 6 years. Significant differences were found in marginal adaptation and marginal discoloration for both restorative materials for Cl1 and Cl2 restorations (p < 0.05). However, none of the materials were superior to the other (p > 0.05). A significant decrease in color match was observed in Equia restorations (p < 0.05). Only one Cl2 Equia restoration was missing at 3 years and another one at 4 years. No failures were observed at 5 and 6 years. Both materials exhibited clinically successful performance after 6 years. SEM evaluations were in accordance with the clinical findings. CONCLUSIONS: Both materials showed a good clinical performance for the restoration of posterior teeth during the 6-year evaluation. CLINICAL RELEVANCE: The clinical effectiveness of Equia and Gradia Direct Posterior was acceptable in Cl1 and Cl2 cavities subsequent to 6-year evaluation.

Influence of extremely high irradiances on the micromechanical properties of a nano hybrid resin based composite.

PURPOSE: To investigate in vitro the effect of extremely high irradiance light-emitting diode (LED) light curing units (LCU) with different exposure distances and curing modes on the micromechanical properties of a nano hybrid resin based composite. METHODS: 72 resin based composite (RBC) (Kalore) specimens with 2 mm thickness were cured using two high irradiance LED LCUs (Bluephase 20i and FlashMax P3) at 0 and 7 mm exposure distances. The curing conditions were:a) Bluephase 20i - 10 seconds - High power; b) Bluephase 20i - 15 seconds - High power; c) Bluephase 20i - 5 seconds - Turbo; d) Bluephase 20i - 15 seconds - Soft start; e) FlashMax P3 - 4 mm tip cover - 3 seconds; f) FlashMax P3 - without tip cover - 3 seconds. The incident and transmitted irradiance and radiant exposure were evaluated in real time during curing, with a radiometer (MARC Resin Calibrator). The micromechanical properties (Vickers hardness, HV and indentation modulus, E) were measured with an automatic universal hardness indenter after storing specimens for 24 hours in distilled water. Data were analyzed with one- and two-way ANOVA tests followed by Tukey test and partial eta-square statistics (α= 0.05). RESULTS: For both LCUs, incident irradiance decreased progressively with increased exposure distance, reaching at 7 mm exposure distance less than 50% of the value measured when the LCU was applied directly on specimen's surface. In descending order of strength of their effects, the parameters incident irradiance (HV; η P2 =0.828, E; 0.693), LCU (HV, 0.257, E, 0.043) and exposure distance (HV, 0.031, E, 0.028) were significant factors affecting HV and E (P < 0.05). The localized radiant exposure (the incident and transmitted) as well as the position of HV and E measurements (top-bottom of the specimen) were additional factors affecting significantly only HV (P < 0.05), but not E (P > 0.05). CLINICAL SIGNIFICANCE: Extremely high irradiances were less efficient in adequate curing of the analyzed nano hybrid composite. Using a protection tip, as clinically indicated, reduces the irradiance of FlashMax P3 from 7,681.7 (160.53) mW/cm2; to 3052.5 (71.61) mW/cm2;.

Comparative evaluation of different adhesive strategies of a universal adhesive in class II bulk-fill restorations: A 48-month randomized controlled trial.

OBJECTIVES: To compare the clinical performance of the universal adhesive used in etch-and-rinse (ER) and self-etch (SE) adhesive strategies for 48-month in class II bulk-fill restorations. METHODS: A total of 84 class II bulk-fill resin composite (Tetric EvoCeram Bulk Fill) restorations were placed in 35 participants by one operator using the universal adhesive's (Adhese Universal VivaPen) etch-and-rinse or self-etch mode randomly. The restorations were evaluated by two calibrated examiners at baseline and after 6-, 12-, 24-, 36- and 48-month using modified USPHS criteria. The comparison of the two adhesive strategies for each evaluation criteria was performed with the chi-square test. The baseline scores were compared with those at the recalls using the Friedman and Cochran's Q-test (p < .05). RESULTS: At 48-month, 74 restorations were evaluated in 30 participants (recall rate: 85.7%). Marginal discoloration was statistically more frequent in SE approach (p < .05), whereas no significant difference was observed between the two strategies in terms of marginal adaptation (p > .05). There were statistically significant differences between the baseline and 48-month recall in the SE group in terms of marginal adaptation and discoloration (p < .05). In ER group, significant differences were found between baseline and 48-month only for marginal adaptation (p < .05). None of the restorations showed post-operative sensitivity. Secondary caries was observed in one restoration from SE group. CONCLUSIONS: The tested bulk-fill restorative exhibited better clinical performance only in terms of marginal discoloration when the universal adhesive was used with ER strategy. CLINICAL RELEVANCE: Though ER approach of the tested universal adhesive appears to be advantageous in terms of marginal discoloration, both adhesive strategies had similar impact on the clinical success of bulk-fill resin restorations.

A randomized controlled 10 years follow up of a glass ionomer restorative material in class I and class II cavities.

OBJECTIVE: To evaluate the durability of a glass ionomer restorative material in Class I and Class II cavities during 10 years compared with a micro filled composite resin. METHODS: Fifty-nine participants (mean age 24 years) received 140 (80 Class I and 60 Class II) glass ionomer (GI) or composite resin (CR) restorations. Evaluation was performed with slightly modified USPHS criteria at baseline, and yearly during the 10 years. Data were analyzed with Cohran's Q and McNemar's tests. RESULTS: Fifty-one patients and 124 restorations (61 GI / 38 Class I - 23 Class II, 63 CR / 38 Class I, 25 Class II) were evaluated after 10 years. The recall rate was 86.4%. The overall clinical recall rate of restorations was 88.6%. The success rate of Class I and II restorations were calculated as 100% for both materials. The cumulative failure rate (CRF) of all Cl I and Cl II GI restorations was 3.17% in total, but CFR was 8 % for Cl II GI restorations. A significant difference was observed between the marginal discoloration scores of restorations at 10 years (p = 0.022). No significant difference was seen between two restorative materials in terms of marginal adaptation (p > 0.05). A significant change was seen in color match of GI restorations at 10 years (p < 0.05). No significant change was found for the anatomical form, secondary caries, postoperative sensitivity, surface texture, and retention for either restorative material (p > 0.05). CONCLUSIONS: Both tested restorative materials showed an acceptable success rate in the restoration of Class I and Class II cavities during the 10-year follow up.

Mechanical properties and water sorption of two experimental glass ionomer cements with hydroxyapatite or calcium fluorapatite formulation.

In this study the mechanical behavior and water sorption (Ws) of experimental glass-ionomer-cements (GICs) with hydroxyapatite (HA) or calcium fluorapatite (CFA) prototype formulations were examined. Specimens from two experimental and one commercially available GIC were prepared in three protocols; (1) according to the manufacturer's instructions, (2) with coating and (3) with heat application. The specimens were stored in distilled water or artificial saliva at 37°C for 7- and 30-days. Flexural strength (FS), Vickers hardness (VHN) and Ws of GICs were evaluated. Experimental GICs showed higher FS values than commercial GIC (p<0.001). Higher FS and VHN values were observed when GICs were prepared according to manufacturer's recommendation. FS was affected only by GIC-type (η2=0.027), whereas VHN was affected by GIC-type (η2=0.331), treatment-protocols (η2=0.067), storage-medium (η2=0.100) and increased storage-duration (η2=0.317). The tested parameters did not significantly influence the Ws of all tested GICs (p>0.05). The GICs with HA or CFA formulations might represent a promising approach due to their FS, VHN and Ws characteristics.

Effect of various bleaching treatments on shear bond strength of different universal adhesives and application modes.

OBJECTIVES: The aim of this in vitro study was to evaluate the bond strength of 2 universal adhesives used in different application modes to bleached enamel. MATERIALS AND METHODS: Extracted 160 sound human incisors were used for the study. Teeth were divided into 4 treatment groups: No treatment, 35% hydrogen peroxide, 16% carbamid peroxide, 7.5% carbamid peroxide. After bleaching treatments, groups were divided into subgroups according to the adhesive systems used and application modes (n = 10): 1) Single Bond Universal, etch and rinse mode; 2) Single Bond Universal, self-etch mode; 3) Gluma Universal, etch and rinse mode; 4) Gluma Universal, self-etch mode. After adhesive procedures nanohybrid composite resin cylinders were bonded to the enamel surfaces. All specimens were subjected to shear bond strength (SBS) test after thermocycling. Data were analyzed using a 3-way analysis of variance (ANOVA) and Tukey post hoc test. RESULTS: No significant difference were found among bleaching groups (35% hydrogen peroxide, 16% carbamid peroxide, 7.5% carbamid peroxide, and no treatment groups) in the mean SBS values. There was also no difference in SBS values between Single Bond Universal and Gluma Universal at same application modes, whereas self-etch mode showed significantly lower SBS values than etch and rinse mode (p < 0.05). CONCLUSIONS: The bonding performance of the universal adhesives was enhanced with the etch and rinse mode application to bleached enamel and non-bleached enamel.

Comparison of two different methods of detecting residual caries.

OBJECTIVES: The aim of this study was to investigate the ability of the fluorescence-aided caries excavation (FACE) device to detect residual caries by comparing conventional methods in vivo. MATERIALS AND METHODS: A total of 301 females and 202 males with carious teeth participated in this study. The cavity preparations were done by grade 4 (Group 1, 154 teeth), grade 5 (Group 2, 176 teeth), and postgraduate (Group 3, 173 teeth) students. After caries excavation using a handpiece and hand instruments, the presence of residual caries was evaluated by 2 investigators who were previously calibrated for visual-tactile assessment with and without magnifying glasses and trained in the use of a FACE device. The tooth number, cavity type, and presence or absence of residual caries were recorded. The data were analyzed using the Chi-square test, the Fisher's Exact test, or the McNemar test as appropriate. Kappa statistics was used for calibration. In all tests, the level of significance was set at p = 0.05. RESULTS: Almost half of the cavities prepared were Class II (Class I, 20.9%; Class II, 48.9%; Class III, 20.1%; Class IV, 3.4%; Class V, 6.8%). Higher numbers of cavities left with caries were observed in Groups 1 and 2 than in Group 3 for all examination methods. Significant differences were found between visual inspection with or without magnifying glasses and inspection with a FACE device for all groups (p < 0.001). More residual caries were detected through inspection with a FACE device (46.5%) than through either visual inspection (31.8%) or inspection with a magnifying glass (37.6%). CONCLUSIONS: Within the limitations of this study, the FACE device may be an effective method for the detection of residual caries.