Resin Composite Versus Amalgam Restorations Placed in United States Dental Schools.

OBJECTIVES: To investigate the latest teaching policies for posterior resin composite placement versus amalgam and to determine the actual numbers of posterior resin composites versus amalgam restorations placed in American dental schools from 2008 to 2018. METHODS: Emails were sent to the deans of all 66 dental schools in the United States to collect data in the forms of: 1) Questionnaire on current teaching policies of posterior composite and amalgam restorations; and 2) Data entry form to collect the actual numbers of posterior composite and amalgam restorations placed in their clinics. Descriptive statistics were used to summarize ratios of posterior restorations. Inferential analysis (chi-square test and z-test) was employed to compare posterior restoration proportions over time and within each year. Level of significance was set at 0.05. RESULTS: For the teaching questionnaire, the response rate was 52% (n=34). Seventy-six per cent of the responding schools reported that they assign 50% or more of their preclinical restorative teaching time towards posterior resin composite placement, while 50% of the responding schools devoted 25% or less towards amalgam teaching. Data entry response rate was 26% (n=17). In 2008, amalgam and resin composite restorations were placed almost equally. However, resin composite restorations were placed significantly more frequently from 2009 onwards in all responding schools. The results revealed a significant ongoing increasing trend in placing posterior resin composites in all responding schools over time (p<0.05). CONCLUSIONS: Data analysis revealed a clear trend towards an increase in posterior resin composite restoration placement and a decrease in the number of amalgam restorations. However, the time assigned for posterior resin composite teaching is not aligned with quantity of restorations placed. Review and adjustment of the time allocated for teaching and training of each material are suggested.

The Ability of Dental Practitioners to Light-Cure Simulated Restorations.

OBJECTIVES: To determine the ability of dental professionals to deliver a radiant exposure of at least six J/cm2 in 10 seconds to simulated restorations. METHODS AND MATERIALS: The study initially examined 113 light-emitting-diode (LED) light polymerization units (LPUs) used in dental offices to determine if they could deliver at least 6 J/cm2 radiant exposure (RE) in 10s. This assessment was completed by using a laboratory-grade light measuring device (checkMARC, BlueLight Analytics, Halifax, NS, Canada). The participating dental professionals whose LPUs could deliver 6 J/cm2 then used their own LPU to light-cure simulated anterior and posterior restorations in the MARC Patient Simulator (BlueLight Analytics). They then received specific instructions and were retested using the same LPUs. Data were statistically analyzed with a series of one-way analysis of variance (ANOVA), two-way ANOVA, paired-samples t-tests, Fisher post hoc multiple comparison tests, and McNemar tests with a preset alpha of 0.05 (SPSS Inc). RESULTS: Ten (8.8%) LPUs could not deliver the required RE to the checkMARC in 10s and were eliminated from the study. For the anterior restoration, most dental practitioners (87.3%) could deliver at least 6 J/cm2 before instructions. After receiving additional light-curing instructions, only two (1.9%) participants were unable to deliver 6 J/cm2 to the anterior location. At the posterior location, only 55.3% (57) participants could deliver at least 6 J/cm2 before the instructions. After receiving these instructions, an additional 32 participants delivered at least 6 J/cm2. Overall, after receiving instructions on how to use the LPU correctly, the participants improved the amount of RE they delivered to anterior and posterior restorations by 22.5% and 30%, respectively. CONCLUSION: This study revealed that at the baseline, 44.7% of participating dental professionals failed to deliver 6 J/cm2 in 10s to the posterior simulated restoration when using their own LPU.

Composite versus Amalgam Restorations Placed in Canadian Dental Schools.

OBJECTIVES: To investigate the latest teaching policies of posterior composite placement versus amalgam and to determine the actual numbers of posterior composites versus amalgam restorations placed in Canadian dental schools, over the years from 2008 to 2018. METHODS: Emails were sent to Chairs/Heads of Restorative Departments and Clinic Directors of all 10 Canadian dental schools to collect data in the forms of: 1) Questionnaire on current teaching policies of posterior composite and amalgam restorations; 2) data entry form to collect the actual numbers of posterior composite and amalgam restorations placed in their clinics. RESULTS: For the teaching questionnaire, the response rate was 90% (n=9). Seven (78%) of the responding schools reported that they assign 25%-50% of their preclinical restorative teaching time towards posterior composite placement. While, three (33%) of the responding schools allocated 50%-75% of their restorative teaching towards amalgam placement. Data entry response rate was 80% (n=8). Amalgam material was dominant in the restoration distribution from 2008 to 2012. While from 2013 to 2018, resin composite material was dominant in all eight responding schools. Linear regression analysis revealed a significant increasing trend in placing posterior composites in all the responding schools over time (p<0.05). CONCLUSIONS: Data analysis revealed a clear trend towards an increase of posterior composite restoration placement and a decrease in the number of amalgam restorations placed. However, the teaching time assigned for posterior composite is not aligned with quantity placed. Review and adjustment of time allocated for teaching and training of each material are recommended.

Influence of volumetric shrinkage and curing light intensity on proximal contact tightness of class II resin composite restorations: in vitro study.

BACKGROUND: Proximal contact tightness of class II resin composite restorations is influenced by a myriad of factors. Previous studies investigated the role of matrix band type and thickness, consistency of resin composite, and technique of placement. However, the effect of volumetric shrinkage of resin and intensity of curing light has yet to be determined. Thus, the aim of this study was to identify the influence of these factors on the proximal contact tightness when restoring class II cavity preparations in vitro. METHODS: Sixty artificial molars were restored with either a low-shrinkage (Filtek Silorane, 3M ESPE) or a conventional (Z100, 3M ESPE) composite and polymerized with low-intensity (Smartlite IQ2, Dentsply) or high-intensity light curing units (Demi(TM), Kerr). Proximal contact tightness was measured using the Tooth Pressure Meter. Data were statistically analyzed using one-way analysis of variance and Tukey post hoc test. RESULTS: Use of low-shrinkage composite (Filtek Silorane) resulted in significantly tighter proximal contacts compared to the use of conventional composite (Z100) when cured with the same polymerization unit (p<0.001). Moreover, the low-intensity curing unit (IQ2) resulted in significantly tighter contacts than the high-intensity unit when material is constant (p<0.001). CONCLUSIONS: Low-shrinkage resin composite and low curing light intensity is associated with tighter proximal contact values.

Creating tight proximal contacts for MOD resin composite restorations.

OBJECTIVE: The purpose of this study was to compare proximal contact tightness (PCT) of MOD resin composite restorations placed with different matricing protocols. METHODS: Forty-five ivorine lower right first molars with standardized MOD cavities were equally divided into three groups according to the restoration protocol. Group 1: Sectional matrix (Standard matrix, Palodent, Dentsply) secured with a wedge (Premier Dental Products Co.) and separation ring (BiTine I, Palodent, Dentsply, York, PA, USA) was used to restore the mesial surface first and then removed and repeated for the distal surface. Group 2: Identical to group 1, but separation rings were placed at both the mesial and distal sides (BiTine I+II, Palodent) prior to restoration. Mesial surface was restored followed by distal. Group 3: Walser matrix (O-form, Dr. Walser Dental GmbH) was used. Following composite resin restoration, PCT was measured using the tooth pressure meter. Data were analyzed using analysis of variance and a Tukey post hoc test (p<0.05). RESULTS: PCT values for mesial contacts were 2.99 ± 0.47N for group 1, 4.57 ± 0.36N for group 2, and 3.03 ± 0.79N for group 3. For the distal contacts, the values were 4.46 ± 0.44N for group 1, 5.12 ± 0.13N for group 2, and 0.76 ± 0.77N for group 3. Significantly tighter contacts were obtained for mesial and distal contacts for group 2 compared to groups 1 and 3 (p<0.05). For groups 1 and 3, mesial contacts were not significantly different (p=0.993), while distal contacts for group 1 were significantly tighter (p<0.001). CONCLUSION: Within the limitations of this study, tighter contacts can be obtained when sectional matrices and separation rings are applied to both proximal surfaces prior to placement of the resin composite in MOD cavities.

Hardening of new resin cements cured through a ceramic inlay.

This study investigated the degree of hardening achieved through self-curing only and through dual-curing a group of eight new resin-based cements. In addition, the effect of ceramic inlay thickness on cement hardness was determined. Disk specimens measuring 6 mm in diameter and 2.5 mm thick were prepared from eight cements: Adherence, Choice, Duolink, Enforce, Lute-It, Nexus, Resinomer, and Variolink. Eight specimens were prepared from each material; half were self-cured, while the remainder were dual-cured. Knoop hardness measurements were then made at 1-hour, 1-day, and 1-week intervals. In addition 12 specimens of the same dimensions were prepared from each cement and were dual-cured through ceramic spacers of varying thickness (1-6 mm). Hardness measurements were made as above. ANOVA showed significant differences in hardness of self-cured versus dual-cured specimens for all cements (P < 0.0001). Significant differences were also found in the hardness of specimens dual-cured through ceramic spacers 2-3 mm in thickness or more compared with those that were dual-cured without spacer. It is concluded that for some materials self-curing alone was not adequate to achieve sufficient hardening; cement hardness was significantly reduced when ceramic inlay thickness was 2-3 mm or more.

Cuspal deflection of maxillary premolars restored with bonded amalgam.

The aims of this study were to measure cuspal deflection of premolars restored with bonded amalgam and to investigate bond resistance to thermo-cycling and cyclic loading. Strain gauges were used to measure cuspal deflection of maxillary premolars restored with MOD bonded amalgam restorations. A nondestructive method was used in which teeth were loaded repeatedly to record cuspal deflection following different restorative procedures. Ten extracted premolars with similar dimensions were selected and their roots mounted in resin bases 2 mm below the CEJ. Two single-element strain gauges were bonded to the buccal and lingual surfaces of the cusps of each tooth at a level that corresponded to the pulpal floor of MOD cavities. These were connected to a strain indicator with a built-in wheat-stone bridge. An Instron machine was used to apply a 100 N compressive load. Micro-strain readings were recorded with each loading at the following stages: (1) sound unprepared teeth (baseline reading), (2) following preparation of a medium-size MOD cavity, (3) 24 hours following restoration with amalgam, (4) following amalgam removal, (5) 24 hours following restoration with bonded amalgam. Durability of the bond was further tested by cyclic loading of 2000, 4000, 6000, and 8000 load cycles. Mean micro-strain values recorded at the buccal cusp were: 48.0 (21.6), 126.8(57.2), 121.4(53.3), 120.8(56.1), and 65.2(36.5) for test stages 1, 2, 3, 4, and 5 respectively. Cuspal deflections following cyclic loading recorded at the buccal cusp were: 60.0(41.0), 63.6(51.9), 59.6(36.3), and 61.6(36.8) at the above four cyclic loading stages respectively. A similar trend was also observed for measurements of the lingual cusp. It was concluded that bonding amalgam restorations decreases cuspal deflection and consequently may assist in restoring tooth strength under conditions of the oral environment.

Effect of home-use fluoride gels on resin-modified glass-ionomer cements.

Acidic fluoride gels have been found to significantly damage conventional glass-ionomer cements. In this study the effect to acidulated phosphate fluoride (APF) and neutral fluoride gels on the recently introduced resin-modified glass ionomers and a polyacid-modified composite resin (Variglass) was studied using scanning electron microscopy (SEM). Five materials were examined: Photac-Fil, Fuji II LC, Vitremer, Variglass, and Ketac-Fil (control). Groups of five specimens of each material were treated for 24 hours with one of the following: 1) distilled water, 2) neutral fluoride gel, 3) APF gel. Surface micro-structure of treated specimens was examined using SEM, and microphotographs were evaluated using a three-point scale. APF was found to have a deleterious effect on all examined materials, while minimal effects resulted from the neutral fluoride gel compared to the control group. Although showing greater resistance to the APF gel than conventional glass-ionomer cements, resin-modified glass-ionomer materials revealed characteristic immersion and erosion behavior, substantiating their differentiation from a hybrid material containing a preponderance of resin.

Chemical versus dual curing of resin inlay cements.

Dual-cure inlay resin cements polymerize both chemically and through light activation; however, clinically some aspects of the cement are not readily accessible to the light source. This study investigated the degree of cement hardening achieved through chemical curing only versus dual curing and the effect of inlay thickness on cement hardness. Disks 6 x 2.5 mm were prepared from seven commercially available cements. Eight specimens were prepared from each material; half of the specimens were cured chemically only, and the remainder were dual-cured. Knoop hardness measurements were then recorded at 1-hour, 1-day, and 1-week intervals. In addition, 24 specimens of the same dimensions were prepared from each cement. Twelve specimens were dual-cured through resin composite spacers of varying thicknesses (1 to 6 mm), and the others were cured through similar ceramic spacers, and hardness measurements were recorded. Multivariate analysis of variance revealed significant differences in hardness of chemically cured versus dual-cured specimens at the 5% level of significance for all examined cements. Significant differences were also found in the hardness of specimens dual cured through ceramic or resin composite spacers 2 to 3 mm in thickness or more versus those that were dual cured without spacer regardless of the spacer material. It is concluded that chemical curing alone was not sufficient to achieve maximum hardening of the examined cements. Cement hardness was significantly reduced when inlay thickness was 2 to 3 mm or more.

Effect of home-use fluoride gels on glass ionomer and composite restorations.

The effect of home-use topical fluorides on the surface integrity of two glass ionomers and a composite was studied using SEM. Class V cavities prepared in extracted teeth were restored with two commercial glass ionomers and a composite. Teeth were randomly divided into groups and each group treated for 24 h with one of the following fluoride gels: acidulated phosphate fluoride (pH5), stannous fluoride (pH4.5), sodium fluoride (pH7), and a non-proprietary sodium fluoride (pH5.8). Surface degradation of the restorations was studied using SEM, rated according to specific criteria, and statistically analyzed by the Wilcoxon test (Rank Sums). It was found that the APF and the non-proprietary gel had a significant effect on both Gl matrix and particles and on the composite particles (p < 0.01). The neutral sodium fluoride had no significant effect on the materials (p > 0.01).

An in vivo study on the release of fluoride from glass-ionomer cement.

Fluoride release from a glass-ionomer cement was measured in vivo during an 8-day period. Maxillary acrylic resin appliances, each carrying four glass-ionomer cement specimens, were worn by four subjects at night. Unstimulated whole saliva samples were collected before the subjects retired to bed (pretreatment samples) and in the morning (posttreatment samples). The average fluoride concentration and saliva flow of pretreatment samples were 31 +/- 4 ng/mL and 0.5 +/- 0.1 mL/min, respectively. In all subjects there was a statistically significant posttreatment increase (.005 less than P less than .025) in salivary fluoride concentration. The release of fluoride was nearly constant during the test period.