Longevity of gold restorations in posterior teeth: A retrospective study up to 10-years.

OBJECTIVE: In this retrospective clinical study, we investigated the long-term survival and success of indirect gold restorations, placed by undergraduate students. MATERIAL AND METHODS: The study included 72 gold restorations in 45 patients, placed in a five-year period between 2009 and 2013. Two experienced dentists performed the evaluation following the FDI criteria after 5 to 10 years. Kaplan-Meier test was used for longevity analysis of success and survival. Data were tested for normality with Shapiro-Wilk test. Cox regression analysis, with significance level appointed at p ≤ .05, was performed using success and survival of restorations as dependent variables. Annual failure rates (AFRs) were calculated. RESULTS: Overall, 72 indirect gold restorations prepared in posterior teeth were assessed, with an observation time from 63 months to 117 months. The mean service time was 88.1 months and the median 87 months. No failures, but 2 repairs, were observed during the first five years. From 5 to 10 years 1 replacement and 1 more repair occurred. The survival and success rates of gold restorations were calculated at 9 years with 98.6% and 91%, respectively. Restorations placed on premolars had higher survival and success rates compared to molars. Three cases were categorized as repairs: in two cases, a root canal treatment was needed and, in one other, an occlusal perforation of the restoration was observed. CONCLUSIONS: Posterior indirect gold restorations placed by dental undergraduate students showed a highly predictable clinical performance in terms of success and survival. These results are comparable with survival rates reported in literature for restorations cemented in general dental practices. CLINICAL SIGNIFICANCE: Casted gold restorations placed from dental students in an undergraduate setting show high survival rates, similar to professional dentists.

Six-year results of a randomized controlled clinical trial of two glass ionomer cements in class II cavities.

OBJECTIVES: Long-term survival of two highly viscous glass ionomer cements (Fuji IX GP Fast and Equia Fil) over a period of 6 years in vivo. METHODS: A total of 85 two- or three-surface class II restorations, comprising 43 Equia Fil / Equia Coat and 42 Fuji IX GP Fast / Fuji Coat LC, were placed in 34 patients. The restorations were re-evaluated after 6 years using the FDI criteria. The statistical analysis was performed with Fisher's exact test, the Wilcoxon signed-rank test, the Mann-Whitney U test and the Kaplan-Meier method. RESULTS: Forty-four restorations (22 Equia Fil and 22 Fuji IX GP Fast) could be assessed at the 6-year follow-up. During the whole study period, eight failures, four for each material, were observed. The main reasons for failure were material fractures and retention loss, which were partly combined with poor marginal adaptation or poor proximal anatomical form. Two failures may be attributed to insufficient application of the materials, as suspected according to the radiographs. The Kaplan-Meier survival proportion for Equia Fil restorations at 6 years was 86.5% and that for Fuji IX GP Fast at 6 years was 86.8% (log-rank p = 0.907). During the period from 3 to 6 years, only one filling in each group failed. CONCLUSION: Both materials showed acceptable and comparable survival rates after 6 years. CLINICAL SIGNIFICANCE: Highly viscous glass ionomer cement can be an acceptable restoration material for smaller class II cavities.

Clinical evaluation of the bulk fill composite QuiXfil in molar class I and II cavities: 10-year results of a RCT.

OBJECTIVE: The objective of this RCT was to compare the 10-year clinical performance of QuiXfil with that of Tetric Ceram in posterior single- or multi-surface cavities. METHODS: 46 QuiXfil (Xeno III) and 50 Tetric Ceram (Syntac classic) composite restorations were placed in 14 stress bearing class I and 82 class II cavities in first or second molars. Clinical evaluation was performed at baseline and after up to 10 years by using modified US Public Health Service criteria. At the last recall period, 26 QuiXfil and 30 Tetric Ceram restorations in 11 stress bearing class I and 45 class II cavities, were assessed. RESULTS: Ten failed restorations were observed during the follow-up period, four Tetric Ceram restorations failed due to secondary caries (2), tooth fracture (1) and bulk fracture combined with secondary caries (1) whereas six QuiXfil restorations failed due to secondary caries (1), tooth fracture (2), secondary caries combined with restoration fracture (1), restoration fracture (1) and postoperative sensitivity (1). Fisher's exact test yielded no significant difference between both materials (p=0.487). SIGNIFICANCE: Both materials, bulk fill QuiXfil restorations and Tetric Ceram restorations, showed highly clinical effectiveness during the 10-year follow-up.

Intraoral Repair of a Glass-Ceramic Restoration With Nanohybrid Ormocers: A Case Report.

The interest in repairing failed restorations has been growing; such a procedure may prolong the life span of defective direct and indirect dental restorations. The intraoral repair using resin-based composite materials has major benefits, as it preserves the main body of the restoration, avoids unnecessary removal of sound tooth structure, is an easy and fast treatment, avoids additional appointments, and is inexpensive. This case report demonstrates the use of nanohybrid Ormocer®, or organically modified ceramic, materials.

Clinical study of indirect composite resin inlays in posterior stress-bearing cavities placed by dental students: results after 4 years.

OBJECTIVES: This longitudinal randomized controlled clinical trial evaluated the longevity of composite resin inlays in single- or multi-surface cavities up to 4 years. METHODS: 21 dental students placed 75 Artglass and 80 Charisma composite resin inlays in class I and II cavities in posterior teeth (89 adult patients) luted with dual-curing resin cements. Clinical evaluation was performed up to 4 years using modified USPHS criteria. RESULTS: 87.2% of Artglass and 76.6% of Charisma inlays were assessed to be clinically excellent or acceptable. Up to the 4-year recall 5 Artglass and 11 Charisma inlays failed mainly because of postoperative symptoms, bulk fracture, and loss of marginal integrity. No significant differences between both composite resin materials could be detected at 4 years for all clinical criteria (Mann-Whitney U-test, p>0.05). The comparison of restoration performance with time yielded a significant increase in marginal discolouration and postoperative symptoms (p<0.05), deterioration of surface texture quality, marginal and restoration integrity (p<0.05) for both inlay systems. However, the changes were mainly effects of scoring shifts from alfa to bravo. Small inlays compared to large inlays and premolar restorations compared to molar restorations showed significant better outcome for some of the tested clinical parameters for the Artglass inlays (p<0.05). For Charisma inlays no such influences were revealed. CONCLUSIONS: Clinical assessment of Artglass and Charisma composite resin inlays exhibited an annual failure rate of 3.2% and 5.9% that is within the range of published data. Within the limitations of this study indirect composite inlays are a competitive restorative procedure in stress-bearing preparations.

Clinical study of indirect composite resin inlays in posterior stress-bearing preparations placed by dental students: results after 6 months and 1, 2, and 3 years.

OBJECTIVE: This longitudinal randomized controlled clinical trial evaluated composite resin inlays for clinical acceptability in single- or multisurface preparations and provides a survey of the results up to 3 years. METHOD AND MATERIALS: Twenty-one dental students placed 75 Artglass (Heraeus Kulzer) and 80 Charisma (Heraeus Kulzer) composite resin inlays in Class 1 and 2 preparations in posterior teeth (89 adults). Clinical evaluation was performed at baseline and up to 3 years by two other dentists using modified USPHS criteria. RESULTS: A total of 89.8% of Artglass and 84.1% of Charisma inlays were assessed as clinically excellent or acceptable with predominating Alfa scores. Up to the 3-year recall, five Artglass and 10 Charisma inlays failed mainly because of postoperative symptoms, bulk fracture, and loss of marginal integrity. No significant differences between composite resin materials could be detected at 3 years for all clinical criteria (P > .05). The comparison of restoration performance with time within both groups yielded a significant increase in marginal discoloration (P < .05) and deterioration of marginal and restoration integrity (P < .05) for both inlay systems. However, both changes were mainly effects of scoring shifts from Alfa to Bravo. No significant differences (P > .05) were recorded comparing premolars and molars. Small inlays showed significantly better outcome for some of the tested clinical parameters (P < .05). CONCLUSION: Clinical assessment of Artglass and Charisma composite resin inlays exhibited an annual failure rate of 3.4% and 5.3% that is within the range of published data. Indirect composite inlays are a competitive restorative procedure in stress-bearing preparations.

Clinical evaluation of the posterior composite Quixfil in class I and II cavities: 4-year follow-up of a randomized controlled trial.

PURPOSE: This longitudinal randomized controlled clinical trial evaluated direct composite restorations for clinical acceptability as posterior restoratives in single- or multi-surface cavities and provides a survey of the 4-year results. MATERIALS AND METHODS: Three dentists placed 46 Quixfil (Xeno III) and 50 Tetric Ceram (Syntac Classic) composite restorations in stress-bearing Class I and II cavities in first or second molars (43 adult patients). Clinical evaluation was performed at baseline and after 4 years by 2 other dentists using modified USPHS criteria. At the last recall period, 37 Quixfil and 46 Tetric Ceram restorations were assessed. RESULTS: A total of 89.2% of Quixfil and 97.8% of Tetric Ceram posterior composites were assessed to be clinically excellent or acceptable with predominating alfa scores. Up to the 4-year recall, four Quixfil restorations failed because of bulk fracture, partial tooth fracture (2x) and postoperative symptoms. One Tetric Ceram restoration was lost due to problems with tooth integrity. No significant differences between the two composites could be detected at 4 years for any of the evaluated clinical criteria (p > 0.05). The comparison of restoration performance with time within both groups yielded a significant increase in marginal discoloration and decrease in marginal integrity for both materials. After 4 years, small restorations exhibited significantly less marginal discoloration than large restorations. CONCLUSION: Clinical assessment of stress-bearing Quixfil and Tetric Ceram posterior composite restorations showed good clinical results with predominantly alfa scores for both materials.

Marginal adaptation of an etch-and-rinse adhesive with a new type of solvent in class II cavities after artificial aging.

This in vitro study evaluated the marginal adaptation of etch-and-rinse adhesives. Standardized class II cavities were cut in 40 human molars with one proximal box limited within enamel and one proximal box extending into dentin. Teeth were assigned randomly to five groups (n = 8) and restored with incrementally placed composite restorations. Five combinations were tested: G1, XP Bond + Ceram-X Mono; G2, P&B NT + Ceram-X Mono; G3, Optibond Solo Plus + Ceram-X Mono; R1, Syntac Classic + Tetric EvoCeram; R2, Scotchbond 1 XT + Z250. After finishing and polishing, teeth were stored for 48 h in water at 37°C before subjected to artificial aging by thermal stress (5/55°C; ×2,000; 30 s) and mechanical loading (50 N; ×50,000). Marginal adaptation of the restorations was evaluated in a SEM (×200) using a replica technique. Statistical analysis was performed with nonparametric test methods (p < 0.05). The percentages of "perfect margin" after aging ranged from 95.9% to 99.6% in enamel and 85.9% to 96.0% in dentin. "Marginal opening" was observed between 0.1% to 2.6% in enamel and 2.6% to 11.8% in dentin. In enamel and dentin, both, G3 showed significantly more gap formation than G1 and G2. Comparing marginal adaptation to enamel and dentin within each group yielded only for G1 no significant differences. Tert-butanol-based XP Bond showed excellent marginal adaptation in both enamel and dentin.

Three-year results of a randomized controlled clinical trial of the posterior composite QuiXfil in class I and II cavities.

This longitudinal randomized controlled clinical trial evaluated direct composite restorations for clinical acceptability as posterior restoratives in single- or multi-surface cavities and provides a survey of the 3-year results. Three dentists placed 46 QuiXfil (Xeno III) and 50 Tetric Ceram (Syntac Classic) composite restorations in stress-bearing class I and II cavities in first or second molars (43 adult patients). Clinical evaluation was performed at baseline and after 3 years by two other dentists using modified US Public Health Service criteria. At the last recall period, 40 QuiXfil and 46 Tetric Ceram restorations were assessed. A total of 92.5% of QuiXfil and 97.8% of Tetric Ceram posterior composites were assessed to be clinically excellent or acceptable with predominating alpha scores. Up to the 3-year recall, three QuiXfil restorations failed because of bulk fracture, partial tooth fracture, and postoperative symptoms. One Tetric Ceram restoration was lost due to problems with tooth integrity. No significant differences between both composites could be detected at 3 years for all evaluated clinical criteria (p > 0.05). The comparison of restoration performance with time within both groups yielded a significant increase in marginal discoloration (p = 0.007) and deterioration of marginal integrity (p = 0.029) for QuiXfil and significant increase in marginal discoloration (p = 0.009) for Tetric Ceram. However, both changes were mainly effects of scoring shifts from alpha to bravo. Clinical assessment of stress-bearing QuiXfil and Tetric Ceram posterior composite restorations exhibited for both materials good clinical results with predominating alpha scores.

Clinical performance of the posterior composite QuiXfil after 3, 6, and 18 months in Class 1 and 2 cavities.

OBJECTIVE: This longitudinal randomized controlled clinical trial evaluated direct composite restorations for clinical acceptability of posterior restoratives in single- or multisurface cavities and provided a preliminary survey of the 3-, 6-, and 18-month results. METHOD AND MATERIALS: Three clinicians placed 46 QuiXfil (Xeno III; Dentsply DeTrey) and 50 Tetric Ceram (Syntac Classic; Vivadent) composite restorations in stress-bearing Class 1 and 2 cavities in first or second molars (43 adult patients). Clinical evaluation was performed at baseline and after 3, 6, and 18 months by 2 other clinicians using modified US Public Health Service criteria. At the final recall period, 45 QuiXfil and 49 Tetric Ceram restorations were assessed. RESULTS: A total of 97.8% of QuiXfil and 100% of Tetric Ceram posterior composites were assessed to be clinically excellent or acceptable with predominating Alpha scores. At the 18-month recall, 1 QuiXfil restoration had failed because of bulk fracture. No significant differences between either composite could be detected at 18 months for all evaluated clinical criteria (P > .05). Small QuiXfil restorations exhibited significantly less marginal discoloration (P = .003) and better restoration integrity (P = .008) than large restorations. The comparison of restoration performance with time within both groups yielded a significant increase in marginal discoloration for QuiXfil (P = .011) and significant deterioration for anatomic form at the marginal step for Tetric Ceram (P = .011). However, both changes were only effects of scoring shifts from Alpha to Bravo. CONCLUSION: Clinical assessment of stress-bearing QuiXfil and Tetric Ceram posterior composite restorations exhibited for both materials good clinical results with predominating Alpha scores.

Longevity of occlusally-stressed restorations in posterior primary teeth.

PURPOSE: To compile a survey of the longevity and reasons for failure of stainless steel crowns, amalgam, glass-ionomer, composite and compomer restorations in stress-bearing cavities of primary molars. METHODS: This work reviewed the dental literature of 1971 up to July 2003 for longitudinal, controlled clinical studies and retrospective cross-sectional studies. Only studies investigating the clinical performance of restorations in primary teeth with an observation period of at least 2 years were included. Annual failure rates of stainless steel crowns, amalgam, glass-ionomer, composite and compomer restorations were determined and failure reasons were discussed. RESULTS: Annual failure rates in stress-bearing cavities of primary molars were determined to be: 0-14% for stainless steel crowns, 0-35.3% for amalgam restorations, 0-25.8% for glass-ionomer restorations, 2-29.1% for atraumatic restorative treatments, 0-15% for composite restorations, and 0-11 for compomer restorations. Main reasons for failure were secondary caries, marginal deficiencies, fracture, and wear.

Buonocore Memorial Lecture. Review of the clinical survival of direct and indirect restorations in posterior teeth of the permanent dentition.

This review provides a survey on the longevity of restorations in stress-bearing posterior cavities and assesses possible reasons for clinical failure. The dental literature, predominantly since 1990, was reviewed for longitudinal, controlled clinical studies and retrospective cross-sectional studies of posterior restorations. Only studies investigating the clinical performance of restorations in permanent teeth were included. Longevity and annual failure rates of amalgam, direct composite restorations, compomers, glass ionomers and derivative products, composite and ceramic inlays and cast gold restorations were determined for Class I and II cavities. Mean (SD) annual failure rates in posterior stress-bearing cavities are: 3.0% (1.9) for amalgam restorations, 2.2% (2.0) for direct composites, 3.6% (4.2) for direct composites with inserts, 1.1% (1.2) for compomer restorations, 7.2% (5.6) for regular glass ionomer restorations, 7.1% (2.8) for tunnel glass ionomers, 6.0% (4.6) for ART glass ionomers, 2.9% (2.6) for composite inlays, 1.9% (1.8) for ceramic restorations, 1.7% (1.6) for CAD/CAM ceramic restorations and 1.4% (1.4) for cast gold inlays and onlays. Publications from 1990 forward showed better results. Indirect restorations exhibited a significantly lower mean annual failure rate than direct techniques (p=0.0031). Longevity of dental restorations is dependent upon many different factors, including material, patient- and dentist-related. Principal reasons for failure were secondary caries, fracture, marginal deficiencies, wear and postoperative sensitivity. We need to learn to distinguish between reasons that cause early failures and those that are responsible for restoration loss after several years of service.

Influence of the pretreatment of occlusal pits and fissures on the retention of a fissure sealant.

PURPOSE: To evaluate different regimens of enamel conditioning on the retention of a pit and fissure sealant. METHODS: 100 extracted human molars were randomized into 10 experimental groups (n = 10). Conditioning of occlusal pits and fissures was performed with either 37% H3PO4, diamond bur and 37% H3PO4, Er:YAG laser, Er:YAG laser and 37% H3PO4, air abrasion (3 different settings), air abrasion (3 different settings) and subsequent acid etching with 37% H3PO4. 24 hours after placing a compomer-based sealant, the specimens were artificially aged by thermocycling (5/55 degrees C; x1000) and immersed in basic fuchsin dye for another 24 hours. After sectioning, dye penetration along the enamel-resin-interface was determined (% of the fissure depth). Data were statistically analyzed with Kruskal-Wallis H test and Mann-Whitney U test. For qualitative investigations, two further specimens of each group were analyzed in the SEM. RESULTS: Conventional acid etching resulted in significantly superior sealant retention than conditioning with either the Er:YAG laser or air abrasion (irrespective of particle size or air pressure). If mechanical conditioning of the laser or air abrasion was followed by acid-etching, results were statistically equal to the acid-etch only group.

Direct posterior restorations: clinical results and new developments.

The longevity of dental restorations is dependent on many different factors, including those related to materials, the dentist, and the patient. The main reasons for restoration failure are secondary caries, fracture of the bulk of the restoration or of the tooth, and marginal deficiencies and wear. The importance of direct-placement, aesthetic, tooth-colored restorative materials is still increasing. Amalgam restorations are being replaced because of alleged adverse health effects and inferior aesthetic appearance. All alternative restorative materials and procedures, however, have certain limitations. Direct composite restorations require a time-consuming and more costly treatment procedure and are actually only indicated for patients with excellent oral hygiene. Glass ionomers can be considered only as long-term provisional restorations in stress-bearing posterior cavities. Future treatment regimens that are made possible by the development of sophisticated preparation techniques, improved dentin bonding agents, and resin-based restorative materials will result in the therapy of more small-sized lesions rather than large restorations. The importance of indirect inlay techniques will shift more and more toward the direct restoratives. As the cavities become smaller, it is to be expected that the use of improved direct restorative materials will provide excellent longevity even in stress-bearing situations.