Partial glass-ceramic posterior restorations with margins beyond or above the cemento-enamel junction: An observational retrospective clinical study.

PURPOSE: This observational retrospective clinical study aimed to investigate the survival and success rates of partial indirect lithium disilicate restorations with margins extending above or beyond the cementoenamel junction (CEJ). METHODS: The study included patients who underwent partial indirect lithium disilicate restorations with immediate dentin sealing (IDS) between January 2008 and October 2018. All the restorations were placed in a single general dental practice following a standardized protocol. The impact of various predictive variables on the survival rates was assessed. Moreover, modified United States Public Health Service (USPHS) criteria were used to evaluate the survival quality. RESULTS: Totally 1146 partial indirect lithium disilicate restorations in 260 patients were evaluated over an average period of 7.5 years. The cumulative survival and success rates were 97.3% and 95.3%, respectively. Margins extending beyond the cemento-enamel junction did not increase the risk of success or survival failure (P > 0.05). Patients with a high risk of caries, male sex, or non-vital teeth had a significantly higher risk of restoration failure (P < 0.05). Restorations with longer clinical service times exhibited marginally lower clinical quality (P < 0.001). CONCLUSIONS: Partial indirect glass-ceramic restorations demonstrated survival and success rates of 97.3% and 95.3%, respectively, over an extended period. However, a higher risk of restoration failure existed in patients with a high caries risk for (pre)molars that had undergone endodontic treatment and in males. In terms of the risk of success or survival failure, comparable results were obtained for the positions of the restoration margin in relation to the cemento-enamel junction.

Prospective clinical evaluation of 765 partial glass-ceramic posterior restorations luted using photo-polymerized resin composite in conjunction with immediate dentin sealing.

OBJECTIVES: To evaluate the clinical performance of partial glass-ceramic (IPS e.max Press) posterior restorations. MATERIALS AND METHODS: A total of 765 restorations in 158 patients were placed between 2008 and 2018 and evaluated in a prospective study during regular dental care visits between 2015 and 2018. The restorations were luted with a conventional photo-polymerized resin composite (HFO) in conjunction with an Immediate Dentin Sealing procedure (IDS). Intra-oral photographs and radiographs were made and evaluated using USPHS criteria. RESULTS: The mean observation time was 53.3 months (range 3-113 months). Three absolute failures occurred (tooth fractures, n = 2; apical re-infection, n = 1) all leading to the loss of the restored tooth. Repairable and salvageable failures occurred in 9 teeth (endodontic complications, n = 7; secondary caries, n = 1; debonding, n = 1). The survival and success rates according to Kaplan-Meier after 5 years cumulated to 99.6% and 98.6%, respectively. Location (premolar/molar and mandibula/maxilla), pre-restorative endodontic status (vital/devitalised) and extension of the indirect ceramic restoration (number of sides and cusps involved) did not significantly affect the cumulative success rate (log rank test, p > 0.05). The condition of the vast majority of the restorations remained unaffected for 5 years. CONCLUSIONS: Partial glass-ceramic posterior restorations (pressed lithium disilicate (IPS e.max press, Ivoclar Vivadent) luted by means of a conventional photo-polymerized resin composite in conjunction with the use of an IDS procedure have an excellent medium-term prognosis. CLINICAL RELEVANCE: Partial glass-ceramic posterior restorations can be considered as a highly reliable treatment option. Location and extension of the restoration and pre-restorative endodontic status do not affect success rate.

Effect of immediate dentine sealing on the fracture strength of lithium disilicate and multiphase resin composite inlay restorations.

PURPOSE: Limited information is available on the effect of Immediate Dentin Sealing (IDS) on the fracture strength of indirect partial posterior restorations. This study evaluated the effect of IDS on the fracture strength and failure types of two indirect restorative materials. MATERIALS AND METHODS: Standard MOD inlay preparations were made on sound molars (N=40, n=10 per group) and randomly divided into four groups to receive the inlay materials with and without the application of IDS: Group L-IDS-: Li2Si2O5 (Lithium disilicate, IPS e.max) without IDS; Group L-IDS+: Li2Si2O5 with IDS; Group MR-IDS-: Multiphase resin composite (MR, Lava Ultimate) without IDS; MR-IDS+: MR with IDS. Inlays made of L were etched with 5% hydrofluoric acid, and MR inlays were silica coated. After silanization, they were cemented using adhesive resin cement (Variolink Esthetic DC). The specimens were thermo-mechanically aged (1.2×106 cycles, 1.7Hz, 8000 cycles, 5-55°C) and then subjected to load to failure (1 mm/min). Failure types and locations of debondings were classified. Data were statistically analyzed using ANOVA, Mann Whitney U-test and Chi-square tests (α=0.05). Two-parameter Weibull distribution values including the Weibull modulus, scale (m) and shape (0), values were calculated. RESULTS: After aging conditions, no apparent changes were observed in marginal integrity but occlusal wear facets were more common with MR than with L (p<0.001). Material type and the application of IDS significantly affected the results (p=0.013). While group L-IDS- showed the lowest mean fracture strength (1358±506N) among all groups (p<0.05), application of IDS significantly increased the results significantly (L-IDS+: 2035±403N) (p=0.006). MR groups with and without IDS, did not show significant difference (MR-IDS-: 1861±423, MR-IDS+: 1702±596 N) (p=0.498). When materials without IDS are compared, L showed significantly lower results than that of MR (p=0.035). With the application of IDS, no significant difference was noted between L and MR materials (p=0.160). Weibull distribution presented the highest shape (0) for L-IDS+ (5.66) compared to those of other groups (3.01-4.76). Neither the material type (p=0.830), nor the application of IDS (p=0.54) affected the severity of the failure types. In 95% of the cases, the IDS layer left adhered on the tooth surface after fracture tests. In groups where no IDS was used, resin cement remained on the tooth surface in 44% of the cases (p=0.001). No significant differences were observed between the materials with respect to cement remnants or IDS after fracture (p=0.880). The incidence of repairable failure types (83%) was more common with L than with MR (75%) material (p>0.05). CONCLUSION: Immediate dentin sealing improves adhesion, and thereby the fracture strength of inlays made of lithium disilicate but not that multiphase resin composite.

Cementation of Glass-Ceramic Posterior Restorations: A Systematic Review.

AIM: The aim of this comprehensive review is to systematically organize the current knowledge regarding the cementation of glass-ceramic materials and restorations, with an additional focus on the benefits of Immediate Dentin Sealing (IDS). MATERIALS AND METHODS: An extensive literature search concerning the cementation of single-unit glass-ceramic posterior restorations was conducted in the databases of MEDLINE (Pubmed), CENTRAL (Cochrane Central Register of Controlled Trials), and EMBASE. To be considered for inclusion, in vitro and in vivo studies should compare different cementation regimes involving a "glass-ceramic/cement/human tooth" complex. RESULTS AND CONCLUSIONS: 88 studies were included in total. The in vitro data were organized according to the following topics: (micro)shear and (micro)tensile bond strength, fracture strength, and marginal gap and integrity. For in vivo studies survival and quality of survival were considered. In vitro studies showed that adhesive systems (3-step, etch-and-rinse) result in the best (micro)shear bond strength values compared to self-adhesive and self-etch systems when luting glass-ceramic substrates to human dentin. The highest fracture strength is obtained with adhesive cements in particular. No marked clinical preference for one specific procedure could be demonstrated on the basis of the reviewed literature. The possible merits of IDS are most convincingly illustrated by the favorable microtensile bond strengths. No clinical studies regarding IDS were found.