Evaluation of Abfraction Lesions Restored with Three Dental Materials: A Comparative Study.

BACKGROUND: Abfraction lesions are manifested as damage to hard tissues in the cervical area of dental crowns. The study aimed to assess the direct restoration of abfraction lesions according to the modified United States Public Health Service (USPHS) criteria for 24 months. The restorations were accomplished with Fuji Bulk-GC, Omnichroma Flow-Tokuyama, and Beautifil® II-Shofu dental materials, and the therapy was or was not associated with wearing thermoformed mouthguards. METHODS: From the 53 selected and analyzed patients (n = 53), 28 patients (with restorations of abfraction lesions) belonged to the 1st group and 25 patients (with 105 restorations, who also wore mouthguards) belonged to the 2nd group. Blind determination assessments were effectuated at baseline and after 2, 6, 12, 18, and 24 months. Results showed that, regardless of the rating score, there are no significant statistical differences in the evaluation criteria between the two groups of patients Conclusions: For each material, the scores of USPHS criterion presented good clinical performances after 24 months, with no significant statistical differences between the fillings and the applied therapy in the two groups of patients.

Effect of Bleaching Agents on Discoloured Resin-Based Composites for Direct Restorations: A Systematic Review.

The purpose of the review was to assess the influence of office and home bleaching on the color durability after staining of resin-based composites (RCs) for direct restorations. A web-based search for possibly relevant scientific papers in the English language between January 2013 and August 2022 was conducted in the databases such as PubMed, Scopus, Cochrane Library, and EMBASE. In-vitro studies that explored the influence of in-office and other bleaching treatments on the discolored RC for direct restorations in extracted human teeth were included. Case studies, case series, animal studies, systematic reviews, and letters to the editor were not considered. A total of 212 articles from a web-based search and 32 studies from a manual search were retrieved. After removal of duplicate records, 181 titles and abstracts were reviewed for eligibility; 92 were chosen for full-text analysis, and nine in-vitro studies matched the inclusion criteria. The two examiners examined the methodological quality of the selected studies independently based on the study design, methodological soundness, and data analysis. Distinct values were assigned to studies evaluating color variations of stained RC subjected to bleaching agents. The methodological quality scores were expressed as a percentage of the highest possible score based on the established scoring system and categorized as indicating a low, moderate, and high level of evidence. The reversal of color alterations following home and office bleaching was found to be dependent on the RC used. Within the limitations of the in-vitro investigations, it was deduced that the bleaching agents were successful in eliminating stains and improving the durability of the color to near baseline values.

Shade matching and blending capabilities of a new single-shade composite: an in vivo study.

Demand for direct esthetic restorations is high, but shade matching can be challenging. Some manufacturers claim that a single product is able to match all colors of the human dentition, eliminating shade matching challenges. This in vivo study, which followed the International Commission on Illumination's (CIE) CIEDE2000 color difference standard (ΔE00), aimed to quantify the shade matching and blending capabilities of a single-shade composite (Omnichroma PLT) used as a direct veneer. A color difference of ΔE00 ≤ 1.8 was set as the acceptability threshold. Ten participants with an unrestored and noncarious maxillary left central incisor were enrolled in the study. Direct spectrophotometric measurements (CIE L*a*b*) were made on the tooth and then on composite cured on the tooth. Consistency in measurements and composite resin placement were attained through the use of a specially designed jig. A digital photograph was then taken with the composite in place, and colorimetric software was used to obtain the L*a*b* values at the most incisal and cervical edges of the restoration. These values were compared to those of the natural tooth structure immediately adjacent to the composite resin. The ΔE00 scores were calculated to determine the composite's ability to match the tooth shade beneath it (ΔEm) and to blend with the incisal (ΔEi) and cervical (ΔEc) tooth shades. Mean scores for ΔEm, ΔEi, and ΔEc were calculated, and an independent t test (α = 0.05) was used to compare means for ΔEi and ΔEc. The mean (SD) ΔE00 values were 6.16 (2.38), 3.90 (2.47), and 6.84 (1.80) for ΔEm, ΔEi, and ΔEc, respectively. A statistically significant difference (P = 0.008) was observed between ΔEi and ΔEc. As a direct veneer, the tested composite did not meet the acceptability threshold for any ΔE00 measurement; however, it was better at matching the incisal third of the tooth than it was the other thirds. More in vivo studies are needed to verify and expand on these results.

Direct vs indirect restorations for diastema closure: determining the suitable approach.

Determining the appropriate technique for diastema closure is challenging, and the decision must be evidence based. The objective of these case reports is to describe different approaches to diastema closure using direct and indirect techniques, focusing on the characteristics of the patient and clinical requirements to guide treatment. In the first case, a 16-year-old patient had multiple diastemas in the maxillary anterior dentition. The clinical evaluation revealed microdontia of the lateral incisors and malpositioned teeth. The treatment included tooth whitening and placement of composite resin veneers using a direct technique. In the second case, a 54-year-old patient displayed a disharmonious and esthetically compromised smile due to small teeth, color changes, multiple diastemas, incisal wear, and severe dentogingival disproportion. Based on the patient's expectations, the patient's age, and the presence of a "black triangle" interdental space, a multidisciplinary restorative treatment was proposed, including gingivoplasty, tooth whitening, and placement of ceramic laminate veneers using an indirect technique. Both approaches achieved successful esthetic rehabilitation and diastema closure with minimal intervention. The choice of procedure and restorative material, as well as the need for tooth preparation, varied based on the clinical requirements, patient expectations, and financial constraints. Careful treatment planning avoided lengthy and inefficient procedures.

Longevity of Indirect and Direct Restorations in Anterior Teeth.

It is the aim of this paper to present data on the survival of direct and indirect restorations in anterior teeth. Two sources of information are used: previously-published analysis of data from 1990 to 2006 from a 13 million restoration dataset from England and Wales; and evidence from published literature from 2011 to the time of writing (March 2022). The findings suggest that: (1) directly-placed resin composite materials may provide satisfactory survival of restorations in anterior teeth; (2) crowns provide better survival to re-intervention: however, crowning an incisor or canine tooth, as opposed to placement of a direct restoration, will lead to an earlier time to extraction of the restored tooth; (3) veneers perform more favourably than other restorations in terms of time to extraction of the restored tooth, but may have a less favourable time to re-intervention than crowns; (4) lithium disilicate crowns may be considered to perform satisfactorily with regard to time to re-intervention when placed in anterior teeth, but less satisfactorily in posterior teeth; and (5) operator factors influence survival of restorations.

EPA Consensus Project Paper: Failure Rates of Direct Versus Indirect Single-Tooth Restorations. A Systematic Review and Meta-Analysis.

INTRODUCTION: The purpose of this systematic review and meta-analysis was to evaluate and compare the failure rates of direct and indirect restorations for single-tooth restorations. METHODS: A literature search was conducted by using electronic databases and relevant references for clinical studies on direct and indirect dental restorations with a follow-up of at least 3 years. The risk of bias was assessed with the ROB2 and the ROBINS- I tools. The I2 statistic was used for the assessment of heterogeneity. The authors reported summary estimates of annual failure rates of single-tooth restorations using a random-effects model. RESULTS: Of 1415 screened articles, 52 (18 RCTs, 30 prospective, 4 retrospective) met the inclusion criteria. No articles with direct comparisons were identified. No significant difference was found in the annual failure rates of single teeth restored with either direct or indirect restorations, which were calculated as 1% using a random-effects model. High heterogeneity was found, ranging from 80% (P⟨0.01) for studies on direct restorations to 91% (P⟨0.01) for studies on indirect restorations. Most of the studies presented some risk of bias. CONCLUSIONS: Annual failure rates were similar for direct and indirect single-tooth restorations. Further randomized clinical trials are needed to draw more definitive conclusions.

Effects of nanohybrid flowable resin-based composites on fibroblast viability using different light-curing units.

PURPOSE: To investigate the in vitro cytotoxic effects of Bis-GMA-containing and Bis-GMA-free flowable resin-based composites (RBCs) on primary human gingival fibroblast cells (hGFc) using direct and indirect curing methods and three different light-curing units (LCUs). MATERIALS AND METHODS: Cells were isolated and cultured in vitro in 24-well plates. The plates were divided into treatment (cells with RBC), control (cells only), and blank (media only) groups. In the treatment groups, two types of nanohybrid flowable RBCs were used: Bis-GMA-free and Bis-GMA groups. Each treatment group was subdivided according to the curing method, i.e., direct curing (RBC was injected into the wells and cured directly on the attached cells) and indirect curing (the samples were pre-cured outside of the well plate and then added to the well plate with cells). To vary the LCU, the subgroups were further divided into three groups: multiple-emission peak light-emitting diode, single-emission peak light-emitting diode, and quartz-tungsten-halogen units. Curing was conducted for 20 seconds. The hGFc cytotoxicity was evaluated via 3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide (MTT) assay after 24, 48, and 72 hours of culturing. RESULTS: The MTT assay results showed that both RBCs were significantly cytotoxic toward hGFc compared to the control group (p < 0.0001). The Bis-GMA group was significantly more cytotoxic to the cells compared to the Bis-GMA-free group. In addition, the curing method and time interval affected cell viability regardless of the LCU used. CONCLUSION: The Bis-GMA flowable RBC and direct curing method had the highest cytotoxic effects on hGFc regardless of the LCU used. Careful selection of flowable RBCs and proper curing techniques are required to decrease the cytotoxic effects on hGFc and improve the clinical handling of oral tissues.

[Evolution and effectiveness of seventh and eighth generation adhesive systems in direct restorations. a review]. / Evolución y efectividad de los sistemas adhesivos de séptima y octava generación en restauraciones directas. una revisión.

Introduction: : Dental adhesion is responsible for the chemical processes of dentin-enamel union for a correct choice before its application in restorative treatments; it is important to know properly the generation to which it belongs, its properties, application techniques, etc. All this is to ensure success in the procedures to be performed. Currently, adhesive systems have evolved, and 8 generations are available in the market, each with a better-quality standard than the previous one. Objective: To identify which generation of the adhesive system is the most viable to be applied in direct dental restorative treatments. Materials and methods: We reviewed and compiled 133 articles published from 20 years ago to date. After analyzing them according to their clinical relevance, 88 were excluded, the remaining articles were reanalyzed, of which only those focused on describing the generations of adhesive systems applied in direct restorations were selected, leaving a total of 56 articles, which included clinical case reports. The Google Scholar search engine, SciELO and databases of interest, such as PubMed, Scopus and Medigraphic, were used, three reviewers independently performed the analysis and search of data, and the keywords were used; adhesive systems, generations of adhesive systems, evolution, and direct restorations. Results: : 56 articles were evaluated, according to their relationship with the subject and with the information previously sought, it was determined that the seventh generation of adhesive systems is the most viable to be applied in dental treatments, due to the improvements it presents in its characteristics, and the results with good prognosis mentioned by both dental professionals, as in research. Conclusion: The advancement of technology implies new knowledge; therefore, the effectiveness of adhesive systems has changed significantly. Scientific evidence has shown that seventh-generation adhesives are more effective in direct restorations.

Color stability of resin-based composites: Staining procedures with liquids-A narrative review.

OBJECTIVE: The objective of this study was to review the experimental staining procedures performed in in-vitro studies for evaluating color stability of resin-based composites used for direct restorations. OVERVIEW: A review was performed with the purpose to identify in vitro procedures carried out to establish staining and color stability of resin-based composites used for direct restorations. A literature search was performed on four online databases (PubMed, Scopus, Embase and Web of Science) for articles published from January 1st 2001 till March 20th 2021, using a combination of free words and Medical Subject Headings (MESH) terms: "Composite Resins" AND "Color Stability" OR "Staining." Two reviewers screened titles and/or abstracts of 1728 unique studies. In total, 208 studies were selected for full-text reading, from which 178 were included in the review. The assessed variables were specimen dimensions, shape, and surface finishing; time before immersion; staining media type, dwell time, temperature and renewal interval; type of composite; color and translucency assessment parameters and measuring system. One hundred and seventy-eight articles analyzed color stability with staining liquids. Coffee was the most used staining medium (n = 102), followed by tea (n = 61), and red wine (n = 55). A disc-shaped specimen was used in most studies (n = 170) with a 2 mm thickness (n = 116). Spectrophotometers were the most used color assessment devices (n = 154), followed by colorimeters (n = 17). Color differences were quantified with ΔE (n = 154), ΔE00 (n = 23). Acceptability and or perceptibility thresholds were also taken into consideration (n = 126). CONCLUSIONS: The large variety of staining procedure suggests the need for standardization. CLINICAL SIGNIFICANCE: Aesthetic failure due to discoloration is a relevant clinical problem. Evaluating benefits and drawbacks of resin based composites artificial staining procedures will improve to predict materials clinical performances.

One-Year Clinical Performance of Activa™ Bioactive-Restorative Composite in Primary Molars.

Restorative procedures for caries affecting primary molars are a daily challenge for pediatric dentistry, and one of the main factors influencing the results of these restorative procedures is the choice of dental material used: bioactive materials were recently introduced, combining the strength of composites and the benefits of glass ionomers. The present study's objective is to clinically evaluate the aesthetic, functional and biological properties of Activa™ Bioactive composite in approximal and occlusal carious lesions for 1 year using the FDI criteria for evaluating direct dental restorations. Forty-five children with occlusal or approximal caries in first or second primary molars were included in the study: the cavities were then randomized to be restored with either Activa BioActive or SDR Bulk-fill and evaluated over time according to Federation Dentaire Internationale (FDI) criteria. Results showed that Activa BioActive composite has similar performance over time compared to Bulk-fill composite, for both functional and aesthetic properties. Thus, within the limitations of this study, including the short follow-up period, it can be concluded that bioactive materials might be the material of choice to restore primary molars. A longer follow-up period is desirable to confirm these findings.

Intrasulcular Restorations of Anterior Teeth According to the BAIR Technique: Evaluation of Periodontal Parameters.

Some clinical situations, such as the closure of pronounced diastemas, and the transformation of malformed, small, or peg-shaped teeth, require a rebalancing of dental proportions accompanied by a modification of the gingival contour. A traditional treatment plan can include surgical, prosthetic, and/or orthodontic treatments. In some cases, it can be considered too invasive, and not all patients are willing to undertake long therapies. To overcome these limitations, a possible solution could be the application of the Biologically Active Intrasulcular Restoration (BAIR) technique, which allows us to modify the natural emergence tooth profile using simple intrasulcular direct restorations. The aims of this paper are to investigate possible effects on gingival health, and to assess the patient satisfaction about the aesthetic intervention performed. Periodontal data were collected, and patient satisfaction was registered using the VAS questionnaire. All sites healed without complications, no adverse events were registered or reported by the patients, and no signs of periodontal morbidity were visible. The results show that the patients evaluated the final aesthetics in a positive way, and they perceived a good condition of periodontal health as well. The intervention is felt as almost painless, and patients do not report significant post-operative distress. In conclusion, the BAIR technique can provide a valid therapeutic alternative for patients for whom traditional treatments are not indicated. It is a minimally invasive intervention where both the operating times and the biologic and economic costs are reduced.

Reparación comparada con reemplazo de restauraciones directas posteriores defectuosas en pacientes con dentición permanente / Repair versus complete replacement for defective direct restorations in permanent teeth

RESUMEN: Introducción: Las restauraciones directas posteriores defectuosas han sido tratadas tradicionalmente a través del reemplazo de la restauración. Sin embargo, por las posibles complicaciones de este procedimiento, la reparación de las restauraciones ha sido ampliamente utilizado en la práctica clínica, pero su uso sigue siendo controvertido. Métodos: Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. Resultados y conclusiones: Identificamos una revisión sistemática que incluyó nueve estudios primarios, todos correspondientes a ensayos aleatorizados. Como conclusión podemos señalar que la reparación comparado con el reemplazo de restauraciones directas posteriores defectuosas podría aumentar el riesgo de necesidad de reintervención, podría resultar en poca o nula diferencia en el riesgo de sensibilidad postoperatoria y podría aumentar el riesgo de caries secundaria, pero la certeza de la evidencia es baja.

ABSTRACT: Introduction: Traditionally, restoration replacement has been widely used for the treatment of defective restorations in permanent teeth. Due to complications related to total replacement, restoration repair has been incorporated into dental practice. However, the use of repair over replacement for defective restorations is still controversial. Methods: We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. Results and conclusions: We identified one systematic review including nine studies overall, of which all were randomized trials. We conclude that repair versus complete replacement may improve the risk of reintervention, may make little or no difference to risk of postoperative sensibility and may improve the risk of secondary caries, but the certainty of the evidence has been assessed as low.

Novas perspectivas para reabilitação de dentes tratados endodonticamente / Novel perspectives for the rehabilitation of endodontically treated teeth

Vários fatores podem influenciar o desempenho clínico de dentes com tratamento endodôntico (DTE). Além disso diversas são as opções restauradoras indicadas em respeito a este cenário, em especial com o notório avanço de novas técnicas e tecnologias para uso clínico. Dentre estas corriqueiramente envolvem-se o uso de restaurações diretas (confeccionadas com resina composta), pinos metálicos ou de fibra de vidro, pinos pré-fabricados ou fresados, assim como restaurações indiretas compostas de coroas cerâmicas, inlays, onlays ou endocrowns; sempre com o foco na reabilitação funcional e estética do caso em tela. Neste trabalho, através de uma revisão narrativa, foram expostos conceitos relativos às modalidades restauradores que se advêm do uso de novas tecnologias na reabilitação de dentes tratados endodonticamente(AU)

Several factors may influence the clinical performance of endodontically treated teeth (ETT). In addition, there are several restorative options indicated regarding this scenario, especially with the notable advance of new techniques and technologies for clinical use. These routinely involve the use of direct restorations (made of composite resin), metal or fiberglass posts, prefabricated or milled posts, as also indirect restorations composed of ceramic crowns, inlays, onlays or endocrown; always focusing on functional and aesthetic rehabilitation of the case in hand. In this study, through a narrative review, concepts related to the restorative modalities that were introduced with the use of new technologies in the rehabilitation of endodontically treated teeth were discussed(AU)

Wear of direct resin composites and teeth: considerations for oral rehabilitation.

Little is known about the wear rate of enamel and dentin opposing resin composite following restoration of the occlusal surface in patients with tooth wear. Hence, the aim of this in vitro study was to evaluate the wear of enamel and dentin surfaces when opposing each of three resin composites in a two-body and three-body wear test. The two-body and three-body wear of dentin, enamel, and three resin composites (Clearfil AP-X, Filtek Z250, and Filtek Supreme) opposing four antagonists (stainless steel and three resin composites) were evaluated using the ACTA wear machine. In addition, all the surfaces were evaluated with scanning electron microscopy. The results showed the lowest wear rate in enamel and the highest in dentine, with the composite showing intermediate wear rates. The three-body wear results were not affected by the antagonist and showed pure wear caused by the abrasive food medium. The in vitro enamel/composite wear ratio was 2.5. The results show that tooth wear accelerates as soon as enamel disappears and dentin is exposed to composite resin. Therefore, it is important to protect dentin with a restorative material.

Direct and Indirect Restorations for Endodontically Treated Teeth: A Systematic Review and Meta-analysis, IAAD 2017 Consensus Conference Paper.

PURPOSE: The primary objective of this systematic review was to compare treatment outcomes of direct and indirect permanent restorations in endodontically treated teeth, and provide clinical suggestions for restoring teeth after endodontic treatment. MATERIALS AND METHODS: Electronic databases (Medline, EMBASE, CENTRAL) and gray literature were screened for articles in English that reported on prospective and retrospective clinical studies of direct or indirect restorations after endodontic treatment with an observation period of at least 3 years. Primary outcomes were determined to be short-term (≤ 5 years) and medium-term (> 5 and ≤ 10 years) survival. Secondary outcomes included restorative and endodontic success of restored teeth. The quality of included studies and risk of bias were assessed using Cochrane Collaboration's tool for RCTs (randomized controlled trials), the Newcastle-Ottawa Scale for cohort studies, and the Agency for Healthcare Research and Quality (AHRQ) methodology checklist for cross-sectional studies. The GRADE system was used for assessing collective strength of the overall body of evidence. RESULTS: Of 2547 screened articles, only 9 (2 RCTs, 3 retrospective cohort studies, 3 cross-sectional studies) met the inclusion criteria, and 8 studies were used in the meta-analysis. In general, indirect restorations (mostly full crowns) showed higher 5-year survival (OR 0.28, 95% CI 0.19-0.43, p < 0.00001) and 10-year survival (OR 0.20, 95% CI 0.12-0.31, p < 0.00001) than direct restorations. However, there was no statistical difference in short-term (≤ 5-years) restorative success (OR 0.32, 95% CI 0.05-2.12, p = 0.24) and endodontic success (OR 0.88, 95% CI 0.72-1.08, p = 0.22). CONCLUSIONS: Based on current evidence, there is a weak recommendation for indirect restorations to restore endodontically treated teeth, especially for teeth with extensive coronal damage. Indirect restorations using mostly crowns have higher short-term (5-year) and medium-term (10-year) survival than do direct restorations using composite or amalgam (GRADE quality of evidence: low to moderate), but no difference in short-term (≤ 5 years) restorative success (low quality) and endodontic success (very low quality). There is a need for high-quality clinical trials, especially well-designed RCTs.

Failure of single-unit restorations on root filled posterior teeth: a systematic review.

This systematic review investigated the failure rate of conventional single-unit restorations in root filled posterior permanent teeth. Two reviewers independently applied eligibility criteria, extracted data and assessed the quality of the evidence of each included study according to the Cochrane Collaboration's procedures for randomized control trials (RCTs) and the STROBE criteria for observational studies. The MEDLINE (via Ovid), EMBASE (via Ovid), Cochrane Oral Health Group Trials Register and CENTRAL (via Cochrane Library) databases were searched electronically (January 1993 to week 1, February 2015). This was complemented by an additional hand search of selected journals and the references of relevant studies. Clinical studies published on root filled single-unit restorative treatments with a mean follow-up period of at least 3 years were selected. The outcome measured was clinical or radiological failure. Overall, the four RCTs and the single observational study included were of low and high quality, respectively. Therefore, a meta-analysis was not possible. The pooled mean failure rates were reported according to the type of treatment and remaining coronal tooth structure. The current evidence suggested that the failure rates of the treatments may depend on the amount of remaining tooth structure and type of treatment. Post-retained crowns were associated with the most favourable outcome in teeth with one to two remaining coronal tooth wall(s), whereas post-free crowns were superior when greater tooth structure was available. Restorations in teeth without ferrules had such a high rate of failure that other treatment options should be considered.

Factors affecting the placement or replacement of direct restorations in a dental school.

CONTEXT: The knowledge of the reasons for the placement of direct restorations makes possible to trace an epidemiological profile of a specific population and to direct the teaching of dentistry to techniques that are commonly used today and will be continued performed in the future. PURPOSE: The aim of this study was to verify the reasons for placement and replacement of direct restorations in patients treated in the Dental Clinic of the Uberaba University - Brazil. MATERIALS AND METHODS: This study evaluated 306 restorative procedures carried out on 60 patients. During the treatment planning, a form that contained information about the patient's gender, tooth number, the classification of restorations, the reasons for placement and replacement of amalgam and tooth-colored restorations, the material that had to be removed and the new material used to fill the cavities was filled for each patient. Statistical analysis was carried out using Chi-square test (α = 0.05). RESULTS: The data showed that most of the patients were female (66.7%). Of all the restorations placed, 60.45% were 1(st)-time placements, while 39.55% were replacements. For 1(st)-time restorations, the main reason for placement was primary caries (76.76%), followed by non-carious cervical lesions (15.14%). The amalgam restorations were replaced more frequently (67.77%). The primary reason for replacements was the presence of secondary caries (for both previous amalgam (42.68%) and composite (66.67%) restorations (P < 0.05). The resin composite was the most indicated material for the new restorations (98.04%) (P < 0.05). CONCLUSIONS: The main reason for placement of direct restorations was primary caries, while secondary caries was the main reason for replacements. In almost all cases, the material used to fill the cavities was the resin composite.

A 24-month evaluation of amalgam and resin-based composite restorations: Findings from The National Dental Practice-Based Research Network.

BACKGROUND: Knowing which factors influence restoration longevity can help clinicians make sound treatment decisions. The authors analyzed data from The National Dental Practice-Based Research Network to identify predictors of early failures of amalgam and resin-based composite (RBC) restorations. METHODS: In this prospective cohort study, the authors gathered information from clinicians and offices participating in the network. Clinicians completed a baseline data collection form at the time of restoration placement and annually thereafter. Data collected included patient factors, practice factors and dentist factors, and the authors analyzed them by using mixed-model logistic regression. RESULTS: A total of 226 practitioners followed up 6,218 direct restorations in 3,855 patients; 386 restorations failed (6.2 percent) during the mean (standard deviation) follow-up of 23.7 (8.8) months. The number of tooth surfaces restored at baseline helped predict subsequent restoration failure; restorations with four or more restored surfaces were more than four times more likely to fail. Restorative material was not associated significantly with longevity; neither was tooth type. Older patient age was associated highly with failure (P < .001). The failure rate for children was 4 percent, compared with 10 percent for people 65 years or older. Dentist's sex and practice workload were associated significantly with restoration longevity. CONCLUSIONS: In this prospective cohort study, these factors were significantly predictive of failure for amalgam and RBC restorations: patient's age, a higher number of surfaces restored at baseline, the dentist's sex and the practice workload. Material choice was not significantly predictive in these early results. Practical Implications. If clinicians can recognize and identify the risk factors associated with early restoration failure, more effective treatment plans may be offered to the patient.

Rehabilitación estética por medio de facetas directas-presentación de casos clínicos / Aesthetic rehabilitation through direct facets - report of cases

En la actualidad, la sociedad prácticamente exige una uniformidad de las características relacionadas con la apariencia física de las personas, lo que hace aumentar la búsqueda por los tratamientos que proporcionen un aspecto más agradable, vinculado a técnicas eficientes y seguras. Las alteraciones dentarias de color, de forma, textura y/o posición contribuyen de modo desfavorable, principalmente en los dientes anteriores, para una armonía facial. El uso de las facetas estéticas, directamente en la boca, es cada vez más enfatizado debido a evolución de los materiales restauradores y de la técnica adhesiva, ofreciendo una mejor relación costo/beneficio para el paciente. El objetivo del presente artículo es presentar casos clínicos en los cuales el tratamiento con facetas directas es una alternativa de tratamiento eficaz, reversible y de fácil realización.

At present, society practically demands uniformity of features in relation to physical appearance, resulting in an increasing number of persons seeking treatment that will provide them with a more pleasant visual appearance, linked to efficient and safe techniques. Alterations in tooth shade, shape, texture and/or position, particularly of anterior teeth, contribute unfavorably to facial harmony. Aesthetic facets placed directly in the mouth have been increasingly emphasized, due to the development of restorative materials and adhesive techniques, offering the patient an even better cost/benefit ratio. The aim of this article is to present clinical cases in which the direct facet was shown to be an efficient, reversible and easy to perform alternative treatment.

Evaluation of bond strength of different adhesive systems: Shear and Microtensile Bond Strength Test.

OBJECTIVES: Aim of this work is the in vitro bond strength evaluation of three bonding agents comparing the results of two kinds of test, Microtensile Bond Strength Test and a Shear Bond Strength Test. Bond strength tests have been used to test both direct and indirect restorative techniques to investigate if methods could give different results. METHODS: 72 human third molars have been collected and stored in physiological solution. Three kinds of test were conducted: 1- SB, 2- "Slice" preparation µTBS1, 3- "Stick" preparation µTBS2. We tested three different adhesive systems (Groups 1-2-3 n=24), two restorative techniques (subgroup A-B n=12). The tested adhesives were: Optibond FL (OFL) (Group 1), Optibond Solo Plus (OSP) (Group 2), Optibond Solo Plus Self-Etch (OSSE) (Group 3). For all tests was used a universal load machine Instron Machine. RESULTS: Best values were found for Optibond FL with mean values of 45-50 MPa. Optibond Solo Plus resulted in values very similar and in some cases almost identical to FL. Optibond Solo Self Etch showed poorer adhesion in both direct and indirect restorative techniques. The parametric and non parametric statistical variance analysis pointed out the absence of significant differences between OFL and OSP, and demonstrated a significant difference for OSSE adhesive. SIGNIFICANCE: The results confirm that a total etch two-step adhesive is the best compromise between easiness and effectiveness.