Comparison of Class II Bulk-Fill, Self-Adhesive Composites, Alkasite, and High-Viscosity Glass Ionomer Restorations in Terms of Marginal and Internal Adaptation.

(1) Background: Restoring decayed teeth in young patients can be challenging. This calls for a simplification of the protocols through new biomaterials. Therefore, the aim of this study was to compare the marginal adaptation delivered by restorative materials applied on class II cavities by using a simplified protocol, before and after fatigue test, followed by the assessment of the internal adaptation. (2) Methods: Forty-eight human teeth were divided into six groups (n = 8). Dentinal fluid simulation was performed before restoring the class II cavities: Gr 1-adhesive (Clearfil Universal Bond Quick) and nanohybrid flowable composite (Clearfil Majesty ES Super Low Flow), Gr 2-adhesive (Clearfil Universal Bond Quick) and nanohybrid composite (Clearfil Majesty ES standard), Gr 3-bulk fill self-adhesive composite (Surefil One), Gr 4-bioactive powder-liquid filling material (Cention Forte), Gr 5-universal adhesive (Adhese Universal) and nanohybrid composite resin (Tetric Powerfill); and control group (CT)-high-viscosity glass ionomer (Equia Forte). Marginal adaptation was observed with scanning electron microscopy (SEM) and compared before and after a fatigue test consisting of repeated thermal and mechanical cycles. The specimens were then cut mesio-distally, and internal adaptation was undertaken using SEM again. Repeated measures and one way ANOVA followed by a Fisher's LSD test and Fisher's LSD post hoc test were used in order to compare the statistically significant differences among groups. (3) Results: As for the marginal adaptation after loading, Cention Forte (58%) and Equia Forte HT (53%) were statistically equivalent and presented the highest results, followed by Clearfil Majesty ES Standard (32%) and Tetric Powerfill (27%), with Surefil One (8%) and Clearfil Majesty ES Flow Super Low (7%) showing the worst results. In terms of internal adaptation, Cention Forte (85%) and Clearfil Majesty ES Standard (74%) had the highest percentages of continuous margins. Tetric powerfill (56%) and Equia Forte HT (44%) showed statistically significantly lower results, followed by Clearfil Majesty ES Flow Super Low (33%) and eventually Surefil One (17%). (4) Conclusions: This in vitro study showed promising results for the marginal and internal adaptation of alkasite dual cured Cention Forte in the restoration of class II cavities. This material could be considered an interesting restorative alternative for the restoration of deciduous teeth.

Marginal Adaptation of In Vitro Class II Restorations Made Out of Bulk or Conventional Composite Using Single- or Multi-Layered Techniques.

Objective: Testing the influence of various restorative materials (conventional or bulkfill composites) and filling techniques (single- or multi-layered techniques) on the in vitro marginal adaptation of large class II direct composites with supra and sub-gingival margins subjected to thermomechanical loading (TML). Methods: A total of 40 prepared teeth were attributed randomly to five experimental groups. In Group 1, restorations were made of multi-layered high-viscosity conventional composite (Tetric EvoCeram); in Groups 2 and 3, restorations were made of a high viscosity bulkfill composite (Tetric EvoCeram Bulk Fill) applied in one (Group 2) or three layers (Group 3); in Groups 4 and 5, restorations were made of a flowable bulkfill composite (SDR flow) applied in one (Group 4) or two layers (Group 5), covered with a layer of high-viscosity conventional composite (Ceram-X Universal). A single adhesive (OptiBond FL) was used in all groups. All specimens were submitted to a staged TML comprising three phases (2 × 500,000 and 1,000,000 cycles) at 50 N with 3350 thermal cycles (5 to 55 °C) every 500,000 cycles. The tooth-restoration interfaces on proximal surfaces were evaluated quantitatively by scanning electron microscopy, before and after each TML phase, hence at three timepoints (T0, T1, T2 and T3). The following segments were considered for evaluation: proximal, vertical enamel margins (assessed individually on both restoration sides), cervical enamel (restoration side above CEJ) and cervical dentin margin (restoration side below the CEJ). Results: TML induced a significant reduction in continuous adaptation at both enamel and dentin margins in all groups, with percentages of continuous margins ranging from 75.2 to 91.8% at T0, and decreasing to values ranging from 21.3 to 73.9% at T3. Both composite systems and layering protocols had a significant influence on marginal adaptation of the restorations, with statistical associations depending on the restoration group and the timepoint considered. Defective margins in enamel were all of a cohesive nature with micro-fractures, while in dentin, interfacial gaps were the main defect observed. Conclusions/Clinical significance: The present results highlighted significant degradation of marginal adaption after long-term in vitro fatigue test using materials even with high-viscosity conventional resin composites, applied with a proper layering approach in medium-large sub-gingival cavities. While no significant differences were observed at the dentin cervical margins, there was a tendency for better adaptation at the enamel margin when using a higher modulus material with a multi-layered technique.

Influence of mechanical and chemical degradation on surface gloss of direct and CAD-CAM resin composite materials.

PURPOSE: To compare the gloss retention of four resin based materials, two direct resin composites (Tetric EvoCeram and Filtek Supreme) and two indirect resin composite CAD-CAM blocks (Tetric CAD and Lava Ultimate). METHODS: 36 samples of 1 mm thickness were readied of each test material and manually polished with polishing discs (Sof-Lex) up to the finest grit size. Three gloss measurements per sample were taken (one every 120 degrees of sample rotation) by means of a glossmeter (Novo-Curve) for a total of 60 values obtained per tested material. Samples of each material were then randomly divided into three equal groups and aged with 75% alcohol (Group 1), amine fluoride gel (Elmex gelée) (Group 2) or mechanical brushing (Group 3). Another set of gloss measurements was performed on all samples after 1 hour of aging. Gloss values were statistically evaluated by means of repeated measures ANOVA and Fisher's LSD post-hoc tests. RESULTS: Gloss retention values ranged from 59.0 (Tetric EvoCeram) to 70.9 (Lava Ultimate) for alcohol, from 59.3 (Filtek Supreme) to 67.5 (Lava Ultimate) for Elmex gelèe and from 33.3 (Tetric EvoCeram) to 53.4 (Lava Ultimate) for mechanical brushing. Statistical analysis revealed: (1) significant difference between intial and final gloss values for all materials and groups; (2) significant difference between final gloss values of all the materials in the alcohol group; (3) significant difference between final gloss values of Lava Ultimate and all the other materials in the Elmex gelèe group; (4) significant difference between final gloss values of Lava Ultimate and Tetric CAD with the other tested materials in the brushing group. CLINICAL SIGNIFICANCE: Direct resin composites in general are widely used, and CAD-CAM resin composite materials are becoming progressively more accessible. Making the choice between direct and indirect techniques is still a challenge, and understanding the advantages of CAD-CAM resin composites in the form of higher gloss retention, which translates into higher durability of esthetics, may be one the parameters facilitating the decision.

Protection Against Discolouration by Two Over-the Counter Desensitising Products.

PURPOSE: To determine in vitro the protection potential against discolouration of two OTC (over-the-counter) desensitising products on enamel and dentin in comparison to a standard toothpaste and water by means of a spectrophotometer. MATERIALS AND METHODS: A total of 96 samples of bovine enamel-dentin complex and 48 of bovine dentin were alternatively immersed in red wine, tea, coffee or water after having been treated by a sodium monofluorophosphate- and calcium phosphate-based product (Curodont Protect), an amine fluoride-based toothpaste (Elmex Red), a stannous chloride-based toothpaste (Elmex Protection Erosion) or distilled water (negative control). Initial (T0) and final colour (T1, after 4 weeks of immersion in staining solutions) of each specimen were assessed by a spectrophotometer. Statistical analysis was done by means of repeated measures ANOVA followed by Fisher's LSD post-hoc test. Differences between T0 and T1 were considered stastistically significant at p ≤ 0.05. RESULTS: When enamel samples were measured over a black background, ΔE00 values (T0-T1) varied from 2.2 (SD 0.7) for amine fluoride-based product/water to 53.9 (SD 7.6) for amine fluoride-based-product/red wine. When dentin samples were measured over a black background, ΔE00 values (T0-T1) varied from 5.4 (SD 0.9) stannous chloride based product/water to 61.6 (SD 3.7) amine fluoride-based product/red wine. CONCLUSION: Specifically, the application of the sodium monofluorophosphate was able to statistically significantly (p ≤ 0.05) reduce discolouration induced by the staining solutions tested only on the enamel-dentin complex, while distilled water and the stannous fluoride-based product were able to statistically significantly (p ≤ 0.05) reduce discolouration induced by the staining solutions tested in pure dentin samples.