Deterioration of anterior resin composite restorations in moderate to severe tooth wear patients: 3-year results.

OBJECTIVES: Deterioration in anterior resin composite restorations placed in tooth wear patients was investigated after 36 months. MATERIALS AND METHODS: Data collected prospectively for 47 participants of the Radboud Tooth Wear Project were used (41 ± 8 years, 90% male, n = 270 restorations). Restorations were individually evaluated using intraoral photographs and 3D scans to rate modified FDI scores and to record the presence of degradation features. Four groups with distinct combinations of composites and techniques were assessed, and multivariable logistic regression models were used to analyze the data (p < 0.05). RESULTS: For all groups together, early degradation signs were present at 1 month: irregularities (41.5%) and ditching (7.4%) were observed at the surface and adhesive interfaces. The frequency of irregularities decreased in the 36-month evaluation (37%), but ditching (12.2%) and fractures (10.7%) were more common. The most frequent deterioration (based on photographs) was observed for staining (44%) and loss of luster (31%). In 3D scans, the most frequent were for wear (25%), marginal adaptation (24%), and the presence of irregularities (19%). Canines had 5.5 times more chances of deterioration by ditching than incisors (p < 0.001). The differences between composites and restorative techniques were minor. CONCLUSIONS: A continuous degradation process of restorations placed in tooth wear patients was observed in anterior teeth restored with different composites, with a progression of the deterioration over 36 months. CLINICAL RELEVANCE: When placing anterior resin composite restorations in tooth wear patients, it could be important to establish realistic expectations and the need for checkup appointments.

Restoration of a single darkened central incisor with a modified ceramic veneer.

Restoring a single darkened central incisor can be challenging. Both direct and indirect options may be acceptable to mask discoloration and achieve functional requirements. This report describes placement of a modified feldspathic porcelain veneer to reproduce the appearance of a maxillary central incisor discolored after trauma.

Preoperative education in cholecystectomy in the context of a multimodal protocol of perioperative care: a randomized, controlled trial.

BACKGROUND: Preoperative education is a key point in multimodal protocols of perioperative care. We investigated whether preoperative education for patients undergoing open cholecystectomy would reduce the incidence of perioperative symptoms. METHODS: This was a randomized, single-blinded, clinical trial that included adult (18-65 years old) candidates for elective open cholecystectomy. All patients took part in the ERAS/ACERTO protocol of perioperative care except that only the intervention group received preoperative education. The main endpoints of the study were the presence and intensity of postoperative symptoms (e.g., nausea, vomiting, pain) measured by a visual analogue scale, 24 h after the operation. RESULTS: A total of 74 patients (34 in the intervention group, 40 in the control group) completed the study. The intervention group had significantly lower median (interquartile range) scores for nausea [0 (4) vs. 2.5 (5.8), p = 0.04] and pain [0.2 (2.3) vs. 3.1 (3.45), p < 0.01] than the controls. High well-being (score ≥ 6) was reported by 79.4 % (27 patients) of the intervention group in contrast to 57.5 % (23 patients) of the controls (p = 0.04). CONCLUSIONS: Preoperative education is highly effective in the context of a multimodal protocol for enhancing the recovery of patients submitted to open cholecystectomy.

Laboratory methods to simulate the mechanical degradation of resin composite restorations.

OBJECTIVES: This study reviewed the literature to identify in vitro approaches that have been used to simulate the mechanical degradation and fatigue of resin composite restorations. METHODS: A search for articles was carried out in 4 databases and included studies in which composite restorations were bonded to teeth and subject to cyclic loading. Articles were assessed for eligibility, and the following items were the extracted from the included studies: authors, country, year, materials tested, simulation device and details including load magnitude and frequency, number of cycles, type of antagonist, test medium, and temperature. Data were analyzed descriptively. RESULTS: The 49 studies included showed a high level of heterogeneity in methods, devices, and test parameters. Nineteen different simulation devices were used, applying loads varying between 30 and 2900 N, and frequencies varying between 0.4 and 12 Hz. The load and frequency used most often were ~ 50 N (63.3%) and 1.5-1.7 Hz (32.7%). The number of cycles varied between 10 K and 2.4 M, 1.2 M was the most prevalent (40.8%). The majority of studies combined cyclic loading with at least one additional aging method: static liquid storage, thermo-mechanical cycling applied simultaneously, and thermal cycling as a discrete aging step were the three most frequent methods. The overall evidence indicated reporting problems, and suggested a lack of clinical validation of the research methods used. SIGNIFICANCE: Validation studies, underlying clinical supporting data, and better reporting practices are needed for further improving research on the topic. Specific suggestions for future studies are provided.

The Ability of Two Chewing Simulation Devices in Emulating the Clinical Deterioration of Anterior Composite Restorations in Severely Worn Teeth.

PURPOSE: This study investigated the ability of two chewing simulation devices to emulate in vitro the clinical deterioration observed in anterior composite restorations in severe tooth-wear patients. MATERIALS AND METHODS: Advanced tooth wear was simulated in bovine incisors, which were restored with palatal and buccal direct composite veneer restorations. The incisal edges of restorations were subjected to 960K cycles of either compressive loading (Biocycle-V2; 125 N at 2 Hz) or wear and mechanical loading (Rub and Roll; 30 N at 20 rpm). Surface degradation was rated using FDI scores to compare the chewing devices (Fisher's test, a = 0.05). Topography and deterioration of restorations was analyzed using SEM. The ability to emulate the deterioration was investigated by comparing the surface degradation observed in vitro with the clinical degradation observed in restorations placed in severe tooth-wear patients after 3.5 years. RESULTS: Distinct degradation patterns were observed between the simulation devices: Biocycle-V2 generated deterioration that was not comparable to the clinical situation, including contact damage, minor wear, and localized roughening. The degradation caused by Rub and Roll was more similar to the in vivo situation, including wear facets, chipping, delamination, staining, and marginal ditching. The FDI scores were different between the chewing devices for surface/marginal staining, material/retention, and marginal adaptation (p = 0.003). SEM analysis showed microcracking at the interface between composite layers at the incisal edges. CONCLUSIONS: The Rub and Roll chewing device was able to emulate the clinical deterioration observed in anterior restorations in severe tooth-wear patients and thus may be used as an oral-cavity simulation method, contributing to translational research.

Ceramic Laminate Veneers Luted with Preheated Resin Composite: A 10-Year Clinical Report.

Resin cement and preheated restorative resin composite may be used for luting laminate veneers. The main advantage of resin composite is increased wear resistance, which could lead to better marginal performance in long term. This article reports a clinical treatment with feldspar laminate veneers luted to the maxillary teeth with preheated resin composite in a private practice. Case was finalized in May 2009 and followed by 10 years. Excellent clinical service and remarkable long-lasting marginal integrity were observed after 123 months. Scanning electron microscopy analysis showed no wear, gaps, or ditching at the margins. Restorative margins showed a smooth transition between ceramic and tooth with no signs of degradation. Preheated resin composite for luting ceramic laminate veneers may be considered an excellent clinical option.

Clinical performance of direct composite resin restorations in a full mouth rehabilitation for patients with severe tooth wear: 5.5-year results.

OBJECTIVES: To evaluate the 5.5-year performance of direct resin composite restorations, prescribed for patients with severe tooth wear, requiring full-mouth rehabilitation. METHODS: A convenience sample of 34 patients were recruited to a prospective trial between December 2010 and June 2013. The participants were provided 1269 full-mouth direct resin composite restorations (Clearfil AP-X) by 5 experienced operators, using the DSO-technique. Treatment resulted in an increase in the vertical dimension of occlusion (VDO). Failure was assessed at three levels. Frequencies of failure were analysed using Kaplan Meier survival curves and the effects of the relevant variables calculated with a multifactorial Cox regression (p < 0.05). RESULTS: Annual failure rates (for all levels of failure, 'Level 3- ') of ≤ 2.2% and ≤ 2.9% were respectively reported for the anterior and posterior restorations with a mean observation time of 62.4 months. The completion of an anterior restoration with the need for further appointments resulted in significantly more Level 2- & 3- failures. An evaluation of the performance of the premolar and posterior maxillary restorations showed significantly lowered risks of certain types of failures, compared to the molar and posterior mandibular restorations. CONCLUSIONS: At 5.5 years, 2.3% of the overall restorations displayed catastrophic, (Level 1) failures. Molar restorations, posterior mandibular restorations and the anterior restorations requiring two further sessions for completion, were associated with significantly higher risks for failure. CLINICAL SIGNIFICANCE: Direct resin composite can offer an acceptable medium-term option for the treatment of severe, generalized tooth wear; molar restorations may require higher maintenance.

The effect of pre-treatment levels of tooth wear and the applied increase in the vertical dimension of occlusion (VDO) on the survival of direct resin composite restorations.

OBJECTIVES: To investigate the effects of the level of pre-treatment tooth wear and increasing the VDO on the performance of direct resin composite restorations for the rehabilitation of pathological tooth wear. METHODS: Full-mouth (pre-treatment) grading was performed on digital greyscale scan records for 34 participants (35.3 ± 8.4 years) with signs of moderate-to-severe generalised tooth wear, using the Tooth Wear Evaluation System and the Basic Erosive Wear Examination. Each participant received full-mouth direct resin composite restorations, with increased VDO. The post-treatment increase in the VDO was determined. Recalls were planned after 1 month, and after 1, 3, and 5 years. Three 'levels' of restoration failure were described. The effects of the variables on the frequencies of restoration failure were calculated with a multivariable Cox regression, (p < 0.05). RESULTS: 1269 restorations were placed with a mean observation period of 62.4 months. Increasing the VDO by 1 mm significantly reduced the risks of all levels of anterior restoration failure (HR ≤ 0.62, p ≤ 0.025). A higher anterior BEWE surface score was associated with increased risks of Level 2- & 3- failures, (HR ≥ 1.29, p ≤ 0.019). Premolar restorations showed lower risks of Level 2- & 3- failure, compared to the molar restorations, (HR ≤ 0.5, p ≤ 0.005). CONCLUSION: Levels of pre-treatment wear and the applied change in the VDO significantly affected failure risk. CLINICAL RELEVANCE: Direct resin composite restorations for the rehabilitation of wear should be made as voluminous as possible, respecting the presenting biological, functional, and esthetic constraints.

Viscosity and thermal kinetics of 10 preheated restorative resin composites and effect of ultrasound energy on film thickness.

OBJECTIVE: This study investigated viscosity and thermal kinetics of 10 selected preheated restorative resin composites and the effect of ultrasound energy on film thickness. METHODS: A range of different resin composites was tested: Charisma Diamond, IPS Empress Direct, Enamel Plus HRi, Essentia, Estelite Omega, Filtek Z100, Filtek Z350 XT, Gradia, TPH Spectrum and VisCalor. A flowable resin composite (Opallis Flow) and two resin cements (RelyX Veneer, Variolink Esthetic LC) also were tested. Viscosity (Pa s) was measured at 37 °C and 69 °C (preheating temperature) using a rheometer. Film thickness (µm) was measured before and after application of ultrasound energy. Temperature loss within resin composite following preheating (°C/s) was monitored. Data were statistically analyzed (α = 0.05). RESULTS: Viscosity at 69 °C was lower than at 37 °C for all materials except the flowable resin composite. Preheating reduced viscosity between 47% and 92% for the restorative resin composites, which were generally more viscous than the flowable materials. Film thickness varied largely among materials. All preheated resin composites had films thicker than 50 µm without ultrasound energy. Application of ultrasound reduced film thickness between 21% and 49%. Linear and nonlinear regressions did not identify any relationship between filler loading, viscosity, and/or film thickness. All materials showed quick temperature reduction following preheating, showing maximum temperature loss rates after approximately 10 s. SIGNIFICANCE: Distinct restorative resin composites react differently to preheating, affecting viscosity and film thickness. The overall performance of the preheating technique depends on proper material selection and use of ultrasound energy for reducing film thickness.