Influence of surface sealants on the quality of posterior restorations with bulk-fill composites: A 4-year randomized clinical trial.

OBJECTIVES: The aim of this study was to evaluate the clinical performance of surface sealants associated with a bulk-fill composite in posterior restorations after 4 years. METHODS: A total of 174 posterior restorations were performed on 57 participants using a self-etch adhesive system and a bulk-fill composite. The groups were then divided into the following categories: 1) without surface sealant (NoS), 2) with surface sealant Biscover (Bisco, SBi), and 3) with surface sealant Permaseal (Ultradent, SPe). Restorations were evaluated using FDI criteria at baseline and after 1 and 4 years. Statistical analysis was conducted using Kaplan-Meier survival analysis and the Chi-square test (α = 0.05). RESULTS: After 4 years, only one restoration was lost (1 in the NoS group). The fracture/retention rate (with 95% confidence interval) was 98% for NoS and 100% for both SBi and SPe (p = 0.76). The majority of secondary outcomes showed minor defects, with no significant differences among the groups (p > 0.05). However, significant differences were observed among the groups in terms of marginal staining and marginal adaptation (p = 0.03). In both items, twelve restorations (nine in NoS, one in SBi, and two in SPe) showed minor marginal discrepancies favoring the sealant groups (SBi and SPe). SIGNIFICANCE: Regardless of the use of surface sealants, the bulk-fill composite restorations showed excellent clinical performance after 4 years. However, the groups that received sealants showed better marginal adaptation and less marginal discoloration compared to those that did not receive sealants.

Five-year clinical evaluation of universal adhesive applied following different bonding techniques: A randomized multicenter clinical trial.

OBJECTIVES: To evaluate the clinical performance of a universal adhesive system (Futurabond U, Voco) when applied following different adhesive strategies in non-carious cervical lesions (NCCLs) after 5 years. METHODS: Fifty participants were included. Futurabond U (Voco) was applied in NCCLs using four adhesive strategies (n = 50 each): only self-etch (SE); selective enamel etching + self-etch (SET + SE); etch-and-rinse with dry dentin (ERD); and etch-and-rinse with wet dentin (ERW). All cavities were restored with Admira Fusion composite resin (Voco). Restorations were evaluated after 1, 3, and 5 years using the World Federation criteria (FDI) and the modified United States Public Health Service (USPHS) criteria. RESULTS: After 5 years, retention rates were 81 % (65.8-90.5) for SE, 87 % (73.2-94.4) for SET + SE, 84 % (69.6-92.6) for ERD, and 78 % (63.6-88.9) for ERW (p > 0.05). Thirty-five restorations were considered to have minor discrepancies in marginal adaptation at the 5-year recall (14 for SE, 9 for SET + SE, 6 for ERD, and 6 for ERW; p > 0.05). Sixteen restorations were detected as a minor marginal discoloration (6 for SE, 4 for SET + SE, 1 for ERD, and 5 for ERW; p > 0.05) and one restoration showed a recurrence of caries (1 for ERW; p > 0.05) at the 5-year recall. No restorations showed postoperative sensitivity after 5 years. SIGNIFICANCE: NCCLs restorations using a universal adhesive showed satisfactory clinical performance after 5 years, regardless of the adhesive strategy.

Can composite packaging and selective enamel etching affect the clinical behavior of bulk-fill composite resin in posterior restorations? 24-month results of a randomized clinical trial.

OBJECTIVES: This is a double-blind, split-mouth, randomized clinical study that aims to evaluate the influence of bulk-fill composite packaging presented in syringes (BSy) and capsules (BCa), and the effect of selective enamel etching (SEE) on the clinical performance of class I and II bulk-fill resin composite restorations after 24 months. METHODOLOGY: A total of 295 class I or class II restorations were performed on 70 patients. One universal adhesive was applied in all restorations. SEE was used in 148 restorations and self-etching mode (SET) in 147 restorations. After the adhesive application, cavities were restored with Filtek Bulk-fill Posterior Restorative in syringes (BSy), Filtek One Bulk-fill in capsules (BCa), or Filtek Supreme Ultra in syringes with the incremental technique (In). All restorations were evaluated using the FDI criteria after one week and after six, 12, and 24 months. Kaplan-Meier survival analysis and Pearson's Chi-square test were used (α=0.05) for statistical analysis. RESULTS: After 24 months, 62 patients were evaluated and four restorations were lost due to fracture (one for SEEBSy, two for SEEIn, and one for SETIn). No significant differences in the fracture and retention rate were found between groups (p>0.05). SEE showed significantly fewer marginal adaptation defects than SET (p<0.05). BCa and BSy groups showed fewer marginal discrepancies compared to In (p<0.05). Restorations performed with BCa showed less color mismatch than BSy or In (p<0.05). CONCLUSION: Although all restorations exhibited satisfactory clinical performance after 24 months of clinical service, the clinical behavior of class I and II restorations' improved when performed with a bulk-fill composite in capsules, mainly when associated with a universal adhesive applied with SEE.

Can composite packaging and selective enamel etching affect the clinical behavior of bulk-fill composite resin in posterior restorations? 24-month results of a randomized clinical trial

Abstract Objectives This is a double-blind, split-mouth, randomized clinical study that aims to evaluate the influence of bulk-fill composite packaging presented in syringes (BSy) and capsules (BCa), and the effect of selective enamel etching (SEE) on the clinical performance of class I and II bulk-fill resin composite restorations after 24 months. Methodology A total of 295 class I or class II restorations were performed on 70 patients. One universal adhesive was applied in all restorations. SEE was used in 148 restorations and self-etching mode (SET) in 147 restorations. After the adhesive application, cavities were restored with Filtek Bulk-fill Posterior Restorative in syringes (BSy), Filtek One Bulk-fill in capsules (BCa), or Filtek Supreme Ultra in syringes with the incremental technique (In). All restorations were evaluated using the FDI criteria after one week and after six, 12, and 24 months. Kaplan-Meier survival analysis and Pearson's Chi-square test were used (α=0.05) for statistical analysis. Results After 24 months, 62 patients were evaluated and four restorations were lost due to fracture (one for SEEBSy, two for SEEIn, and one for SETIn). No significant differences in the fracture and retention rate were found between groups (p>0.05). SEE showed significantly fewer marginal adaptation defects than SET (p<0.05). BCa and BSy groups showed fewer marginal discrepancies compared to In (p<0.05). Restorations performed with BCa showed less color mismatch than BSy or In (p<0.05). Conclusion Although all restorations exhibited satisfactory clinical performance after 24 months of clinical service, the clinical behavior of class I and II restorations' improved when performed with a bulk-fill composite in capsules, mainly when associated with a universal adhesive applied with SEE.

Universal Simplified Adhesive applied under different bonding technique's: 36-month Randomized Multicentre Clinical Trial.

OBJECTIVES: To evaluate the clinical performance of a new dual-cure universal adhesive system (Futurabond U, Voco) when applied using different application strategies in non-carious cervical lesions (NCCLs) after 36 months. MATERIAL AND METHODS: Futurabond U was applied in NCCLs of 50 subjects using four adhesion strategies (n = 50 restorations per group): only self-etch (SEE); selective enamel etching + self-etch (SET); etch-and-rinse with dry dentin (ERDry); and etch-and-rinse with wet dentin (ERWet). All cavities were restored using Admira Fusion composite resin (Voco). Restorations were evaluated after 36 months using the World Federation criteria (FDI) and the modified United States Public Health Service (USPHS) criteria. RESULTS: The after 36-month retention rates were 87% (75-92%) for SEE, 94% (83-98%) for SET, 91% (80-97%) for ERDry, and 94% (83-98%) for ERWet. Forty-three restorations were considered to have minor discrepancies in marginal adaptation at the 36-month recall (18 for SEE, 12 for SET, 7 for ERDry, and 6 for ERWet; p > 0.05). One restoration was detected as a minor marginal discoloration at the 36-month recall (1 for SET; p > 0.05). No restorations showed postoperative sensitivity and caries recurrence at 36 months. CONCLUSION: The clinical performance of the Futurabond U did not depend on the employed bonding strategy, and it was considered reliable after 36 months of clinical evaluation. However, greater marginal discrepancy was observed in the self-etch groups. CLINICAL RELEVANCE: NCCLs restorations using a dual-cure universal adhesive in self-etch and etch-and-rinse modes showed satisfactory clinical performance after 36 months.

Thirty-six-month follow-up of cervical composite restorations placed with an MDP-free universal adhesive system using different adhesive protocols: a randomized clinical trial.

OBJECTIVES: To evaluate the influence of different application strategies on the clinical behavior of an MDP-free universal adhesive placed in non-carious cervical lesions (NCCLs) over the course of 36 months. MATERIALS AND METHODS: Thirty-one patients participated in this study (N = 31). One hundred twenty-four restorations were assigned to four groups: We used the self-etch strategy on groups with (SE-et) and without (SET) selective enamel etching, and the etch-and-rinse strategy on groups with dry (ER-D) and moist (ER-M) dentin. After applying the MDP-free universal adhesive (Xeno Select universal adhesive, Dentsply Sirona), cavities were filled using EvoluX composite resin (Dentsply Sirona). The restorations were evaluated at baseline and after 36 months according to World Dental Federation (FDI) and US Public Health Service (USPHS) criteria. Friedman's repeated-measures analysis of variance rank (α = 0.05) was used for statistical analysis. RESULTS: We evaluated the 31 patients after 36 months. Forty-two restorations were lost (ER-D = 5, ER-M = 7, SE-et = 14, SET = 16). The 36-month retention/fracture rates (95% confidence interval) were 83.9% for ER-D, 77.4% for ER-M, 54.9% for SE-et, and 48.4% for SET. ER strategy showed better retention rate than SE strategy (p < 0.05). Thirty-four restorations (ER-D = 6, ER-M = 10, SE-et = 10, SET = 8) showed marginal staining per FDI criteria and 15 restorations (ER-D = 1, ER-M = 2, SE-et = 6, SET = 6) showed marginal staining per USPHS criteria. No restorations showed postoperative sensitivity or recurrence of caries. CONCLUSION: The retention rate of Xeno Select universal adhesive was poor, mainly in the self-etch strategy. TRIAL REGISTRATION: REBEC clinical registry under protocol RBR-4wh4sh. CLINICAL RELEVANCE: MDP-free universal adhesive behavior depends on the bonding strategy used.

Nanofilled/nanohybrid and hybrid resin-based composite in patients with direct restorations in posterior teeth: A systematic review and meta-analysis.

OBJECTIVE: A systematic review and a meta-analysis were performed to answer the following research question: Are there differences in the color match and surface texture of nanofilled/nanohybrid and hybrid composite in patients with direct posterior restorations? DATA: Randomized clinical trials that compared nanofilled/nanohybrid and hybrid composite in direct restoration in posterior teeth were included. For the analysis of the bias the risk of bias tool (RoB) was used. Meta-analyses of different pairs (nanofilled vs. hybrid and nanohybrid vs. hybrid composite) were conducted for surface texture and color match and other secondary outcomes at different follow-ups, using a random effects model. Heterogeneity was assessed with the Cochran Q test and I2 statistics. GRADE was used to assess the quality of the evidence. SOURCES: A search was performed in PubMed, Scopus, Web of Science, LILACS, BBO, Cochrane Library and SIGLE, without restrictions. IADR abstracts (2001-2019), unpublished and ongoing trials registries, dissertations and theses were also searched. STUDY SELECTION: 28 studies remained. No study was considered to be at low RoB; four studies were judged to have high RoB, and the remaining were judged to have unclear RoB. RESULTS: For the primary and secondary outcomes variables no significant differences were detected between nanofilled/nanohybrid restorations and hybrid composite restorations in any of the study follow-ups (p > 0.08). The body of evidence for surface texture and color match was classified as moderate or low. CONCLUSION: No evidence of difference was found between nanofilled/nanohybrid and hybrid composite in any of the clinical parameters evaluated.

Clinical time and postoperative sensitivity after use of bulk-fill (syringe and capsule) vs. incremental filling composites: a randomized clinical trial.

The objectives of this double-blind randomized clinical trial were to compare (a) the clinical times and (b) the occurrence and severity of postoperative sensitivity, of posterior restoration that used a universal adhesive, in a self-etch or selective enamel-etching technique, along with incremental or bulk-fill composites (presented in syringes or capsules). A total of 295 posterior restorations were placed according to the following groups: SETB - self-etch/bulk-fill in syringe; SETC - self-etch/bulk-fill in capsules; SETI - self-etch/incremental; SEEB - selective enamel-etching/bulk-fill in syringe; SEEC - selective enamel-etching/bulk-fill in capsules; and SEEI - selective enamel-etching/incremental. Clinical time was assessed by a reason (s/mm3) between the total volume of resin inserted and the total time required to perform the restorations. Postoperative sensitivity was evaluated using two scales (Numeric Rating Scale and Visual Analogue Scale). Mean clinical time results, analyzed by Wald's Chi-square, showed significant statistical differences among all groups (p<0.001), indicating that the restorative strategy affected the time required for the restoration. A generalized estimating equation model statistical analysis, performed to compare postoperative sensitivity, showed that neither the restorative technique, the adhesive strategy nor the presentation mode of the bulk-fill composite affected the overall risk of postoperative sensitivity (4.06 [2.22-6.81]). The use of bulk-fill composite, presented in capsules or syringes, is less time consuming and does not increase the risk or intensity of postoperative sensitivity relative to the traditional incremental technique.

How do the optical properties of the bulk fill posterior composites change after 2 years of simulated toothbrushing? / Como as propriedades ópticas de compósitos bulk fill se comportam após 2 anos de escovação simulada?

Objective: The objective of this study was to evaluate the alteration of the optical properties of bulk fill resin-based composites after two years of simulated toothbrushing. Material and Methods: Three high-viscosity bulk fill resin composites and one conventional sculptable resin composite (control) were analyzed. Five specimens of each resin composite were prepared, and roughness, color, translucency and gloss were evaluated initially and after one and two years of simulated toothbrushing. The specimens were submitted to electric simulated toothbrushing (14600 strokes / 100 g) using a commercially available soft bristle toothbrush and toothpaste slurry in a proportion of 1:2 by weight. The brushing scheme was of 40 cycles per day (2 cycles per second / 280 cycles in a week). The optical properties and the roughness data were analyzed by a multifactor analysis of variance (MANOVA) and a Tukey post hoc test. Results: The baseline and final values of Ra and Sa were submitted to linear regression analyses, all of which were performed at a significance level of 5%. Gloss and roughness presented statistical differences between the resin-time interactions in all composite resins. The gloss (72.5%) and roughness (89.4%) worsened significantly after brushing, but the authors didn't find statistically significant differences when evaluating translucency and color. Conclusion: Based in the results, it could be concluded that the simulated brushing degraded the gloss and roughness of the used high-viscosity bulk fill composites. (AU)

Objetivo: O objetivo deste estudo foi avaliar a alteração das propriedades ópticas de resinas compostas do tipo bulk fill após dois anos de escovação simulada. Material e Métodos: Foram analisadas três resinas compostas do tipo bulk fill de alta viscosidade e uma resina composta convencional (controle). Cinco corpos-deprova de cada resina composta foram preparados e a rugosidade, cor, translucidez e brilho foram avaliados inicialmente e após um e dois anos de escovação simulada. Os espécimes foram submetidos a escovação dental simulada (14.600 golpes / 100 g) utilizando-se escova de dentes de cerdas macias comercialmente disponíveis e uma pasta composta de dentifrício e água na proporção de 1:2 em peso. O esquema de escovação foi de 40 ciclos por dia (2 ciclos por segundo / 280 ciclos por semana). As propriedades ópticas e os dados de rugosidade foram analisados por uma análise de variância multifatorial (MANOVA) e um teste post hoc de Tukey. Resultados: Os valores iniciais e finais de Ra e Sa foram submetidos a análises de regressão linear, todas realizadas ao nível de significância de 5%. O brilho e a rugosidade apresentaram diferenças estatísticas entre as interações resina-tempo em todas as resinas compostas. O brilho (72,5%) e a rugosidade (89,4%) pioraram significativamente após a escovação, mas os autores não encontraram diferenças estatisticamente significativas ao avaliar a translucidez e a cor. Conclusão: Com base nos resultados, pôde-se concluir que a escovação simulada degradou o brilho e a rugosidade das resinas compostas do tipo bulk fill avaliadas. (AU)

Clinical time and postoperative sensitivity after use of bulk-fill (syringe and capsule) vs. incremental filling composites: a randomized clinical trial

Abstract The objectives of this double-blind randomized clinical trial were to compare (a) the clinical times and (b) the occurrence and severity of postoperative sensitivity, of posterior restoration that used a universal adhesive, in a self-etch or selective enamel-etching technique, along with incremental or bulk-fill composites (presented in syringes or capsules). A total of 295 posterior restorations were placed according to the following groups: SETB - self-etch/bulk-fill in syringe; SETC - self-etch/bulk-fill in capsules; SETI - self-etch/incremental; SEEB - selective enamel-etching/bulk-fill in syringe; SEEC - selective enamel-etching/bulk-fill in capsules; and SEEI - selective enamel-etching/incremental. Clinical time was assessed by a reason (s/mm3) between the total volume of resin inserted and the total time required to perform the restorations. Postoperative sensitivity was evaluated using two scales (Numeric Rating Scale and Visual Analogue Scale). Mean clinical time results, analyzed by Wald's Chi-square, showed significant statistical differences among all groups (p<0.001), indicating that the restorative strategy affected the time required for the restoration. A generalized estimating equation model statistical analysis, performed to compare postoperative sensitivity, showed that neither the restorative technique, the adhesive strategy nor the presentation mode of the bulk-fill composite affected the overall risk of postoperative sensitivity (4.06 [2.22-6.81]). The use of bulk-fill composite, presented in capsules or syringes, is less time consuming and does not increase the risk or intensity of postoperative sensitivity relative to the traditional incremental technique.