Clinical performance of direct composite resin versus indirect restorations on endodontically treated posterior teeth: A systematic review and meta-analysis.

STATEMENT OF PROBLEM: High-level evidence concerning the restoration of endodontically treated posterior teeth by means of direct composite resin or indirect restorations is lacking. PURPOSE: The purpose of this systematic review and meta-analysis was to analyze the current literature on the direct and indirect restoration of endodontically treated posterior teeth. MATERIAL AND METHODS: Databases MEDLINE, CENTRAL, and EMBASE were screened. Risk of bias was assessed by using the ROB2 tool for RCTs and the ROBINS-I tool for prospective and retrospective clinical studies. Randomized clinical trials (RCTs) and prospective and retrospective studies comparing direct composite resin and indirect restorations on endodontically treated posterior teeth were included. Outcomes were tooth and restoration survival. A meta-analysis was conducted for tooth retention and restorative success. RESULTS: Twenty-two studies were included (2 RCTs, 3 prospective, and 17 retrospective). Over the short term (2.5 to 3 years), low-quality evidence suggested no difference in tooth survival. For the prospective and retrospective clinical trials, the overall risk of bias was serious to critical from the risk of confounding because of a difference in restorative indication: Direct restorations were fabricated when one marginal ridge remained or when tooth prognosis was unfavorable. For short-term restorative success, low-quality evidence suggested no difference between the direct and indirect restorations. CONCLUSIONS: For the short term (2.5 to 3 years), low-quality evidence suggests no difference in tooth survival or restoration quality. To assess the influence of the type of restoration on the survival and restorative success of endodontically treated posterior teeth, clinical trials that control for the amount of coronal tooth tissue and other baseline characteristics are needed.

Influence of the ceramic translucency on the relative degree of conversion of a direct composite and dual-curing resin cement through lithium disilicate onlays and endocrowns.

INTRODUCTION: The goal of this study was to investigate the influence of the ceramic translucency, restoration type and polymerization time on the relative degree of conversion of a dual-curing resin cement and a conventional microhybrid resin composite using a high-power light-curing device. METHODS AND MATERIALS: Two 4.0 mm thick onlay (O) and two 7.5 mm thick endocrown (E) lithium disilicate restorations in high and low translucency (HT/LT) were fabricated on a decapitated molar. The pulp chamber was prepared to accommodate a 2 mm layer of a microhybrid resin composite (MHC) or dual-curing resin cement (DCC). Composite specimens were light-cured (n = 15; 1200 mW/cm2) without or through an onlay or endocrown restoration. Fourier-transform infrared spectroscopy (FTIR) absorbance curves were collected for the same composite specimen after 3 × 20, 3 × 40, 3 × 60 and 3 × 90 s of light-curing. The relative degree of conversion (DC%) was calculated and results analyzed using Kruskal-Wallis test and Friedman's ANOVA. Alpha was set at 0.05. RESULTS: After 3 × 60 s, the DC of MHC was significantly lower (p = 0.03; r = 0.61) under LT/EC restorations (Mdn: 77.8%) than HT/EC restorations (Mdn: 95.2%). DC of the DCC was not significantly affected by the ceramic translucency or restoration type. MHC had a significant higher DC than DCC under the HT/O, LT/O and HT/E restorations. There were no significant differences between MHC and DCC cured through LT/E restorations. CONCLUSION: DC for DCC was not significantly affected by the ceramic translucency or restoration type. DC for MHC was significantly lower for LT/EC than HT/EC restorations after 3 × 60s polymerization, but not different for the high translucent restorations and low translucent onlays. CLINICAL RELEVANCE: the use of light-curing microhybrid composite for bonding high translucent onlays and endocrowns and low translucent onlays seems feasible.

Survival of molar teeth in need of complex endodontic treatment: Influence of the endodontic treatment and quality of the restoration.

OBJECTIVES: The objective of this retrospective practice-based study was to evaluate the survival of molar teeth and endodontic success after complex endodontic treatment up to 89 months. METHODS: Endodontically (Endodontic Treatment Classification (ETC) scores II and III) treated first and second molars treated between January 2011-October 2017 within a referral setting were included. Open apices, combined surgical treatment, ETC score I, patients <18 years or with an ASA-score >2 were excluded. Cumulative survival estimates and Cox regression analysis were performed for tooth survival and endodontic healing according to the Glossary of Endodontic Terms. Restoration quality was assessed using the FDI criteria. Alpha was set at 0.05. RESULTS: 279 endodontically treated molars in 245 patients were included for survival analysis and 268 molars for endodontic success. After 89 months, the cumulative survival was 91.7 % [95 % CI: 86.8 %-94.9 %]. Absence of adjacent teeth and deviance in root canal morphology significantly decreased the probability of tooth survival. Cumulative endododontic healing rates after 48 and 89 months were 82.2 % [95 %CI: 75.7 %-87.1 %] and 51.1 [95 % CI: 20.2 %-75.5 %] respectively. Deviance in root canal morphology and inadequate coronal seal significantly decreased the probability of endodontic healing. Indirect restorations obtained higher esthetic and biological FDI scores, however no difference between direct and indirect restorations was found concerning the functional FDI score. CONCLUSIONS: After 89 months, cumulative survival of molars in need of complex endodontic treatment was 91.7 % [95 % CI: 86.8 %-94.9 %]. CLINICAL SIGNIFICANCE: Within daily clinical practice, the dilemma of performing a complex endodontic (re)treatment or to explore other treatment options for molar teeth in need of reintervention is still urgent. Tooth survival of molar teeth with complex endodontic (re)treatment seems satisfactory up to 89 months.

Shear bond strength of two composite resin cements to multiphase composite resin after different surface treatments and two glass-ceramics.

AIM: To compare the shear bond strength (SBS) after aging of two dual-curing composite resin cements to multiphase composite resin (experiment) and glass-ceramics (control). METHODS: Seventy computer-aided design/computer-aided manufacturing (CAD/CAM) blocks were prepared: 24 multiphase composite resin blocks (Lava Ultimate; experiment), and 12 control blocks (groups 5 and 6: 6 IPS e.max CAD, 6 IPS Empress CAD). Surface treatments of the experiment groups were: 1) Al2O3 airborne particle abrasion; 2) bur-roughening; 3) silica-coated aluminum oxide particle abrasion; and 4) hydrofluoric (HF) acid etching. Per study group, Variolink II (a) and RelyX Ultimate (b) were used as cements. Per treatment group, four cement cylinders were adhered to the conditioned blocks (n = 12). After thermocyclic aging (10.000x, 5°C to 55°C), notch-edge shear testing was applied. Modes of failure were examined. A P value of 0.05 was considered significant. RESULTS: Groups 1a (18.68 ± 3.81) and 3a (17.09 ± 3.40) performed equally to 6a (20.61 ± 4.10). Group 5a (14.39 ± 2.80) did not significantly differ from groups 1a, 3a, and 4a (15.21 ± 4.29). Group 2a (11.61 ± 3.39) showed the lowest bond strength. For the RelyX Ultimate specimens, mean bond strengths were: 1b (18.12 ± 2.84) > 4b (15.57 ± 2.31) > 2b (12.34 ± 1.72) = 3b (11.54 ± 2.45) = 6b (12.31 ± 1.87) > 5b (0.78 ± 0.89). Failure mode analysis showed a significant association between bond strength values and modes of failure (chi-square). CONCLUSION: The SBS of the composite cements to the multiphase composite resin that was treated by Al2O3 or silica-coated aluminum oxide particle abrasion is comparable to the bond of the control groups.