Longevidade clínica das restaurações de resina composta sonificadas e não sonificadas em dentes permanentes posteriores: revisão sistemática e meta-análise / Clinical longevity of sonicated and non-sonicated composite resin restorations on posterior permanent teeth: a systematic review and meta-analysis

Resinas compostas são materiais dentários amplamente utilizados em restaurações diretas na Odontologia. A aplicação da energia sônica na sua técnica restauradora tem sido uma opção para diminuir as consequências das suas tensões de polimerização. O objetivo desse estudo foi avaliar a longevidade clínica de restaurações Classe I e II em resina composta com e sem o uso da energia sônica, através de uma revisão sistemática da literatura e meta-análise. Uma busca sistemática foi realizada nas seguintes bases de dados: PubMed, Biblioteca Cochrane, Web of Science, Scopus, LILACS, BBO e a Literatura Cinzenta sem restrições de idioma ou ano de publicação. Após a remoção das duplicatas foram identificados 5485 estudos. Dezesseis cumpriram os critérios de inclusão após a triagem de resumos. Não foram incluídos artigos após a busca manual da lista de referência dos estudos incluídos. A qualificação do risco de viés foi realizada pelo RoB da Colaboração Cochrane para os estudos randomizados e ROBINS-I para os ensaios clínicos controlados não randomizados. A meta-análise foi realizada utilizando o software RevMan, sendo analisado o número de restaurações com scores UDHS alfa. A heterogeneidade foi avaliada pelo índice I2, com significância definida em p <0,05. Quatro estudos clínicos foram incluídos na análise qualitativa, sendo dois RCTs e dois ensaios clínicos controlados e apresentaram respectivamente moderado e baixo risco de viés. Não foi observada diferença estatística na longevidade das restaurações com o uso da energia da sônica em dentes permanentes (p>0,05), nos critérios avaliados: forma anatômica (IC=1.05[0.95,1.15]; I²=0%; p=0.37); estabilidade de cor (IC=1.02[0.93,1.13, I²=0%, p=0.65); adaptação marginal (IC=1.05[0.95,1.16]; I²=0%; p=0.38); sensibilidade pós-operatória (IC=1.01[0.93,1.10]; I²=0%; p=0.80); cáries secundárias (IC=1.01[0.93,1.10]; I²=0%; p=0.80); descoloração marginal (IC=1.05[0.95,1.16]; I²=0%; p=0.38), rugosidade superficial (IC=1.09[0.97,1.23]; I²=19%; p=0.14) e retenção (IC=1.00[1.91,1.10] I²=0% p=1.00). Com base nos resultados obtidos, não houve diferença na longevidade de restaurações diretas de resina composta com e sem o uso da energia sônica, independente da técnica e do dente restaurado. Significado clínico: A odontologia busca avanços tecnológicos para otimizar a prática clínica dos profissionais e evoluir quanto aos materiais dentários. A indicação de uma técnica restauradora com o uso de novas tecnologias levanta questões sobre a longevidade das restaurações realizadas em comparação a técnicas já sedimentadas na literatura. Estudos in vitro não são capazes de responder esse questionamento, mas a compilação de ensaios clínicos traz uma previsibilidade quanto aos resultados esperados. Através dos resultados obtidos, concluiu-se que não há diferenças estatísticas significativas na longevidade das restaurações em resina composta com e sem o uso da energia sônica. Dessa forma, o estudo esclareceu essa dúvida. (AU)

Composite resins are dental materials widely used in direct restorations in dentistry. The application of sonic energy in its restorative technique has been an option to reduce the consequences of its polymerization stresses in reducing the consequences of its polymerization shrinkage stresses. The objective of this study was to evaluate the clinical longevity of Class I and II restorations in composite resin with and without the use of sonic energy, through a systematic review of the literature and meta-analysis. Searches were conducted on PubMed, Cochrane Library, Web of Science, Scopus, LILACS, BBO and Gray Literature without language restrictions or year of publication. After removing duplicates, 5485 studies were identified. Sixteen met the inclusion criteria after screening abstracts. Articles were not included after manual search of the reference list of the included studies. The qualification of the risk of bias was carried out by the Cochrane Collaboration for randomized studies and ROBINS-I for controlled clinical trials. The meta-analysis was performed using RevMan software, analyzing the number of restorations with alpha UDHS scores. Heterogeneity was assessed using the I² index, with significance set at p<0.05. Four clinical studies were included in the qualitative analysis, two RCTs and two controlled clinical trials, showed, respectively, moderate and low risk of bias. No statistical difference was observed in the longevity of restorations with the use of sonic energy in permanent teeth (p> 0.05), in the evaluated criteria: anatomical shape (CI = 1.05 [0.95,1.15]; I²= 0%; p = 0.37); color stability (CI = 1.02 [0.93,1.13, I² = 0%, p = 0.65); marginal adaptation (CI = 1.05 [0.95,1.16]; I² = 0%; p = 0.38); postoperative sensitivity (CI = 1.01 [0.93,1.10]; I²= 0%; p = 0.80); secondary caries (CI = 1.01 [0.93,1.10]; I² = 0%; p = 0.80); marginal discoloration (CI =1.05 [0.95,1.16]; I² = 0%; p = 0.38), surface texture (CI = 1.09) [0.97,1.23]; I² = 19%; p = 0.14) and retention (CI=1.00[1.91,1.10]; I²=0% p=1.00). Based on the results obtained, there was no difference in the longevity of direct composite resin restorations with and without the use of sonic energy, regardless of the technique and the restored tooth. Clinical significance: Dentistry seeks technological advances to optimize the clinical practice of professionals and evolve in terms of dental materials. The indication of a restorative technique with the use of new technologies raises questions about the longevity of the restorations performed in comparison to techniques already established in literature. In vitro studies are not able to answer this question, but the compilation of clinical trials provides predictability of the expected results. Therefore, this study clarified that doubt.

Denture Liners: A Systematic Review Relative to Adhesion and Mechanical Properties.

PURPOSE: The objective of this systematic review is to compare results concerning the properties of adhesion, roughness, and hardness of dental liners obtained in the last ten years. METHODS: Searches on the databases LILACS, PubMed/Medline, Web of Science, and Cochrane Database of Systematic Reviews were supplemented with manual searches conducted between February and April of 2018. The inclusion criteria included experimental in vitro and in vivo, clinical, and laboratory studies on resilient and/or hard liners, assessment of hardness, roughness, and/or adhesion to the denture base, and physical/mechanical changes resulting from the disinfection process and changes in liners' composition or application. RESULTS: A total of 406 articles were identified and, from those, 44 are discussed. Twenty-four studies examined the bond strength, 13 surface roughness, and 19 the hardness. Of these 44 studies, 12 evaluated more than one property. Different substances were used in the attempt to improve adhesion. Considering roughness and hardness, the benefits of sealants have been tested, and the changes resulting from antimicrobial agents' incorporation have been assessed. CONCLUSION: Adhesion to the prosthesis base is improved with surface treatments. Rough surfaces and changes in hardness compromise the material's serviceability.

Optimizing quality and safety of dental materials.

This paper discusses aspects of quality and safety improvement of the most commonly used dental restorative materials, the resin-based composites. From a patient's perspective, long-lasting resin-based restorations without complications are important. Recurrent caries and fracture are the most common causes for restoration failures. Proper handling and curing of the composites improve the mechanical properties of the restorations and increase safety by reducing exposure to residual methacrylate monomers. A number of compounds have been introduced in restorative materials to reduce the risk of recurrent caries, even though a real breakthrough has not yet been achieved. It is concluded that simple measures may improve the quality and safety of resin-based composite restorations.

[Correspondence between advances of dental composites and adhesives and clinical guidelines for direct restorations].

The longevity of direct adhesive restoration is related to the restorative materials, the patient and the professional. On one hand, dental composites/adhesives have been modified and developed to fulfill the criteria for clinical application. On the other hand, the clinical guidelines for adhesive restorations have been released and updated accordingly, which would prolong the longevity of restorations. In this commentary, the removal of carious tissues, interface preparation for bonding and application of adhesives are emphasized. The administrative measures for registration and clinical evaluation criteria for adhesive restorative material are also introduced.

Effect of surface finishing on the colour stability and translucency of dental ceramics.

BACKGROUND: The purpose of this study was to investigate the effects of staining solutions and surface finishing on the colour stability and translucency of hybrid ceramic (HC) and resin nanoceramic (RNC) materials. METHODS: Twenty four groups consisting of 10 specimens (240 specimens in total) were created out of HC and RNC, including six groups to be stored in distilled water served as the controls groups. The Vita Enamic technical set, Shofu polishers, medium and fine rubber wheels and Sof-Lex polishing discs were used as polishing instruments. Cola, tea, and coffee were used as staining solutions. The colour differences (∆E*) and translucency parameter (TP) were evaluated by a spectrophotometer. Data were analysed by a One-way Analysis of Variance (ANOVA) and Mann-Whitney U test. RESULTS: There was a statistically significant difference between the ∆E* values of the HC specimens in the coffee groups and the ∆E* values of the other HC groups (p < 0.05). The ∆E* values of the RNC specimens in the coffee and tea groups were not different from the specimens in the cola groups (p > 0.05). The TP values of the polished groups were higher than the Sof-Lex groups and the Shofu groups on both HC and RNC materials (p < 0.05). CONCLUSIONS: Increased ∆E* values were observed in HC specimens stored in a coffee solution compared to the specimens stored in a tea or cola solution. Both of the RNC specimens stored in coffee and tea had higher ∆E* values than the RNC specimens stored in the cola. The TP values of both HC and RNC specimens stored in the coffee solution decreased.

Retentive Force of Zirconia Implant Crowns on Titanium Bases Following Different Surface Treatments.

PURPOSE: Screw-retained zirconia implant crowns with an internal titanium base have favorable mechanical properties compared with single-piece zirconia implant crowns; however, the screw-retained implant crowns require adequate bonding between the zirconia crown and the titanium base. This study measured the retention between a titanium base and a full-contour zirconia implant crown following different surface treatments of their bonded surfaces. MATERIALS AND METHODS: Full-contour screw-retained zirconia implant crowns were fabricated to fit a titanium base. The crowns were bonded to the titanium bases following one of four treatment protocols (n = 15 per protocol group): no surface treatment (Control), 10-methacryloyloxydecyl dihydrogen phosphate (MDP) primer on the intaglio of crown and exterior of base (MDP), alumina airborne-particle abrasion of the intaglio of crown and exterior of base (Alu), and alumina airborne-particle abrasion and an MDP primer on the intaglio of crown and exterior of base (Alu+MDP). All crowns were bonded to the base with resin cement. Specimens were stored in water for 24 hours at 37°C and then thermocycled in water, with a temperature range of 5°C to 55°C, for 15,000 cycles with a 15-second dwell time. Crowns were separated from the titanium bases using a universal testing machine. The four treatment protocols were compared using one-way analysis of variance (ANOVA), followed by Tukey post hoc tests (P < .05). Sectioned specimens were examined with scanning electron microscopy (SEM). RESULTS: Retention forces for Control (737.8 ± 148.9 N) and MDP (804.1 ± 114.5 N) were significantly greater than Alu+MDP (595.5 ± 122.2 N), which was significantly greater than Alu (428.2 ± 93.8 N). Visual inspection of the debonded specimens showed that the majority of the cement remnants were seen on the external surface of the titanium bases. Microscopic examination of the interface between the crown and the unaltered base shows that the cement gap is approximately 13 µm at the crest of the microgrooves and 50 µm within the channel of the microgrooves. After airborne-particle abrasion, the microgrooves became significantly dulled, and the cement gap increased to 27 to 40 µm at the crest and 55 to 58 µm in the channels. CONCLUSION: Airborne-particle abrasion of titanium bases that contain retentive microgrooves prior to bonding is contraindicated. Application of an MDP primer demonstrated limited improvement in the retention of the zirconia implant crowns.

Evaluation of thickness of CAD/CAM fabricated zirconia cores by digital microscope.

Despite several advantages of digitalized workflow, researchers have noted discrepancies in the precision and trueness. This study investigated the accuracy in the final thickness of Zirconia (Zr) cores fabricated by five CAD/CAM systems. Standardized manufacturing of the cores with 1 mm thickness were carried out. Cores were then sectioned into two halves and measurement made with Digital Microscope at 5 points in micrometers. Overall, mean thickness for the groups was 1048.81 ± 94.01, which was 48 µm higher than the thickness programmed in the software. Anova showed a statistically significant difference between the groups (p= 0.000). Presence of variations in the thickness and 5 measurement points for the CAD/CAM systems investigated was found. No significant difference was observed and the thickness of the cores were within acceptable level.

Evaluation of Surface Roughness of Nanofilled Composite Restorations after Simulated Tooth Brushing using Various Dentifrices.

Background Teeth restored with direct composite resin are constantly exposed to specific challenges of the oral cavity. These challenges can modify the material properties and, when associated with daily brushing, eventually change its surface roughness, allowing bacterial growth and retention of extrinsic pigments. Dentifrices plays an important role in dental wear (abrasion) and over time, can also cause an increase in the surface roughness of restorative materials. Objective To assess the effect of dentifrices on the longevity of direct nanofilled composite resins restorations as far as wear and roughness is concerned. Method Class V cavity were prepared on 90 extracted human teeth and restored with Filtek Z350 composite. Teeth were randomly divided into 6 experimental groups of 15 each labelled as Group-1 (Colgate Dental cream) Group-2 (Colgate Active Salt toothpaste), Group-3 (Pepsodent Regular toothpaste), Group-4 (Dabur red toothpaste), Group-5 (Dabur Lal tooth powder) and Group-6 Control (water). The samples were fixed on tooth brushing machine and subjected to mechanical tooth brushing using various dentifrices according to respective groups in 3 phases and reading of surface roughness (Ra) was recorded. Result Surface roughness (Ra) had increased in following order: Group 6 < Group 3 < Group 2 < Group 1 < Group 4 < Group 5. All the tooth pastes were compared, their behaviour was found to be similar as there was no statistically significant difference amongst them. Though all of them were inferior to control group and the difference was statistically significant. Whereas the only tooth powder Dabur lal tooth powder gave the maximum roughness when compared with the other tooth pastes and the difference was statistically significant. Conclusion With increase in time of brushing there was increase in surface roughness in all the 5 dentifrices among them Ra was maximum for Dabur lal tooth powder.

Evaluation of ISO 4049: water sorption and water solubility of resin cements.

The aim of this study was to evaluate the water sorption and solubility test design of ISO 4049 for resin cements. Sorption and solubility of six dual-curing resin cements [RelyX Unicem 2 Automix (RUN), Multilink Speed CEM (MLS), Panavia SA Plus (PSA), RelyX Ultimate (RUL), Multilink Automix (MLA), and Panavia V5 (PV5)] were analyzed by storage in distilled water after dual-curing. In addition, sorption and solubility during thermal cycling were assessed with self-cured and dual-cured specimens. After water storage, all cements revealed sorption in the range of 30 µg mm-3 except for PV5, for which sorption was markedly lower (mean ± SD = 20.8 ± 0.4 µg mm-3 ). Solubility values were negative for RUN and RUL (-2.1 ± 0.08 µg mm-3 and -1.9 ± 0.13 µg mm-3 , respectively). All other cements attained positive values in the range of 0.4-0.8 µg mm-3 . Thermal cycling effects were more pronounced. The assessment of water sorption according to ISO 4049 provides reliable results. Solubility results must be interpreted with care because absorbed water may distort the values.

Clinical performance of aesthetic restorative materials in primary teeth according to the FDI criteria.

AIM: The purpose of this study is to evaluate the clinical performance of three different restorative materials in primary teeth according to the FDI criteria. MATERIALS AND METHODS: Resin-modified glass ionomer cement, compomer and composite resin restorations (n=93) were made in 31 patients. The restorations were clinically evaluated at baseline, 6th, 12th and 18th month with the FDI criteria. RESULTS: The cumulative survival rate after 18 months was found to be 90.3% for resin modified glass ionomer cement restorations, 100% for compomer restorations and 80.6% for composite resin restorations. Statistically significant increase in surface roughness, colour mismatch, anatomic form loss and marginal deterioration were detected in resin- modified glass ionomer group (p<0.05). The most frequent reason for restoration failure in composite resin group was restoration fractures. CONCLUSIONS: The resin-modified glass ionomer restorations necessitates close follow-up because of the risk of increase in surface roughness, changes in colour and loss in anatomic form and marginal adaptation. The clinical performance of compomer restorations is superior to resin-modified glass ionomer and composite resin restorations in primary teeth.

Color stability of esthetic restorative materials used in pediatric dentistry: An in vitro study.

BACKGROUND: Children consume foods that are colorful which contain food additives that stain not only the tooth structure but also the restorations. As esthetics is of prime concern for both parents and children nowadays, long-term color stability of restorative materials is of utmost importance. AIM: To evaluate the color stability of two tooth-colored restorative materials (conventional glass ionomer cement [GIC] and giomer) when immersed in various consumable drinks and food (aerated beverage, ice candy, and health drink) at different immersion periods (low, moderate, and high). MATERIALS AND METHODS: A total of 100 specimens were made with each restorative material. Ten were used as a control and remaining (n = 90) as experimental. The experimental specimens were divided into three groups based on media of immersion (n = 30 each) and were further divided into three subgroups based on immersion time (n = 10 each). The color changes (ΔE values) were measured using spectrophotometer. RESULTS: Both the tested materials showed color change; however, conventional GIC showed greater ΔE values when compared to giomer and the samples exposed to aerated beverage resulted in highest color change. It is also noticed that greater the exposure time, higher are the ΔE values. CONCLUSION: Giomer showed more resistance to color change than conventional GIC with all the tested media and immersion regimes.