Selamento dentinário imediato em restauração semidireta: relato de caso / Immediate dentin sealing in semi-direct restoration: case report

O selamento dentinário imediato é um procedimento essencial na Odontologia, que envolve a aplicação de agentes de selamento na interface entre a dentina e o material restaurador imediatamente após a remoção da cárie e do preparo da cavidade dentária. Este processo busca selar os túbulos dentinários expostos, proporcionando proteção à polpa dentária. O presente caso foi realizado em um paciente do sexo masculino, 56 anos que se queixou de desconforto no elemento dentário 17. Após avaliação clínica e radiográfica, foi constatado uma ampla restauração desadaptada na porção mesio - oclusal do referido dente, sendo que o elemento em questão não possui tratamento endodôntico. Após planejamento e assinatura do TCLE, os seguintes passos foram realizados: remoção da lesão cariosa do dente 17, seguido da realização do levantamento marginal mesial e a realização do selamento dentinário imediato. Moldagem com silicone de adição do dente em questão e do antagonista, assim como registro da mordida. Foi confeccionada uma restauração semidireta em resina composta sob o modelo de gesso obtido. A cimentação da restauração foi feita na consulta seguinte, cumprindo os requisitos fundamentais para restaurar forma, função e estética, resultando na melhoria da qualidade de vida do paciente(AU)

Immediate dentin sealing is an essential procedure in dentistry, involving the application of sealing agents at the interface between dentin and the restorative material immediately after caries removal and cavity preparation. This process aims to seal exposed dentinal tubules, providing protection to the dental pulp. The present case involved a 56-year-old male patient who complained of discomfort in tooth number 17. After clinical and radiographic evaluation, a wide, maladapted restoration in the mesio-occlusal portion of the tooth was identified, with no endodontic treatment in the affected element. Following planning and informed consent, the following steps were taken: removal of the carious lesion from tooth number 17, followed by the execution of mesial marginal elevation and immediate dentin sealing. Silicone addition molding of the affected tooth and antagonist, along with bite registration, was performed. A semi-direct restoration in composite resin was fabricated based on the obtained gypsum model. The restoration was cemented in the subsequent appointment, meeting the essential requirements to restore form, function, and aesthetics, resulting in an improvement in the patient's quality of life(AU)

Restauração transcirúrgica: passo a passo / Transsurgical restoration: step by step

Sabe-se que para uma restauração ser considerada um sucesso clínico é preciso que haja uma concomitância saudável entre a estrutura dentária, o material restaurador e as estruturas biológicas periodontais. As restaurações transcirúrgicas caracterizam-se como procedimentos alternativos para possibilitar a restauração de dentes com cárie dentária extensa, restaurações subgengivais desadaptadas e fraturas. O presente estudo teve como objetivo realizar um relato de caso de um procedimento cirúrgico-restaurador, através de uma técnica de restauração transcirúrgica. Este estudo tem como justificativa relatar um caso clínico, colaborando com maiores informações sobre a escolha da técnica a ser empregada, mostrando em quais situações devemos escolher uma restauração transcirúrgica e quais seus benefícios. Também, salientar se devemos fazer a recuperação do espaço biológico do periodonto ou não(AU)

It is known that for a restoration to be considered a clinical success, there must be a healthy concomitance between the tooth structure, the restorative material and the periodontal biological structures. Transsurgical restorations are characterized as alternative procedures to enable the restoration of teeth with extensive dental caries, maladapted subgingival restorations and fractures. The present study aims to carry out a case report of a surgical-restorative procedure, using a transsurgical restoration technique. This study is justified by reporting a clinical case, providing more information on the choice of technique to be used, showing in which situations we should choose a transsurgical restoration and what its benefits are. Also, highlight whether we should recover the biological space of the periodontium or not(AU)

Restauração indireta em resina composta: um relato de prontuário / Indirect resin composite restoration: a dental record report

Restaurações diretas em resina composta são amplamente utilizadas em odontologia para restaurar dentes posteriores. Todavia, quando há grande destruição coronária, onde a distância do istmo excede dois terços da distância intercuspídea, as restaurações indiretas em resina composta são indicadas. O presente estudo teve como objetivo relatar a análise de um prontuário de um paciente que recebeu uma restauração indireta em resina composta em dente posterior amplamente destruído. Através da análise de prontuários de pacientes atendidos nas disciplinas de Estágios Supervisionados do Curso de Odontologia da FSG Centro Universitário no ano de 2023, foi selecionado um prontuário de um paciente que compareceu a clínica odontológica da FSG com uma restauração em amálgama fraturada com reparo em resina composta que apresentou sintomatologia dolorosa. O procedimento diagnóstico ocorreu através de exame clínico e radiográfico, que constatou a indicação de substituição da restauração insatisfatória e realização de uma restauração indireta em resina composta. Os resultados estéticos e funcionais apresentados demostraram a viabilidade da técnica restauradora indireta em resina composta para reabilitar dentes posteriores com ampla destruição coronária(AU)

Direct composite resin restoration are widely used in dentistry to restore posterior teeth. However, when there is large coronary destruction, that the distance from the isthmus exceeds two- thirds of the intercuspal distance, indirect composite resin restorations are indicated. This study aimed to report the analysis of a dental record of a patient who received an indirect restoration in composite resin in a badly destroyed posterior tooth. Through the analysis of dental records of patients seen in the disciplines of Supervised Internship of the Dentistry Course at FSG Centro Universitário in the year 2023, the dental record of a patient who attended the FSG dental clinic with fractured amalgam restoration with composite resin repair was selected who had painful symptoms. The diagnostic procedure took place through clinical and radiographic examination, which revealed the indication of replacing the unsatisfactory restoration and carrying out an indirect restoration in composite resin.The aesthetic and functional results presented demonstrated the viability of the indirect composite resin restoration technique for rehabilitating posterior teeth with extensive coronal destruction(AU)

Restauração em resina composta semidireta em dente posterior: relato de caso / Semi-direct composite restoration in posterior toth: a case report

A escolha da técnica restauradora desempenha papel fundamental na eficácia e duração de um tratamento reabilitador. O objetivo deste relato de caso foi descrever a utilização da técnica semidireta para a confecção de uma restauração em resina composta em um primeiro molar inferior. A paciente apresentava uma restauração insatisfatória no dente 36, que necessitava ser substituída devido à infiltração por cárie. Optou-se pela técnica semidireta devido à amplitude da cavidade, que envolvia estruturas de suporte, e pela combinação das vantagens das abordagens direta e indireta. O procedimento envolveu a remoção de tecido cariado, a aplicação de hidróxido de cálcio pasta, seguida da aplicação de uma fina camada de ionômero de vidro e, posteriormente, resina fluída para realizar o selamento dentinário. O preparo foi realizado seguindo os princípios necessários. O elemento em questão foi moldado com silicone de adição e o arco antagonista, com alginato. Ambos modelos foram vertidos com silicone para modelos semirrígidos e montados em oclusor de peças de brinquedo. A restauração semidireta foi confeccionada em resina composta Filtek Z350 XT, respeitando a anatomia do dente 36. Pigmentos foram utilizados para aprimorar detalhes estéticos. Após acabamento e polimento, a peça foi condicionada e cimentada com cimento dual Relyx Ultimate. Pode-se concluir que a abordagem restauradora por meio da técnica semidireta construída em modelo semirrígido é uma opção terapêutica conservadora e vantajosa para dentes com extensa destruição coronária. Essa técnica possibilita a restauração de forma eficaz, garantindo tanto a estética quanto a função adequada do dente afetado(AU)

The choice of restorative technique plays a fundamental role in the effectiveness and duration of rehabilitation treatment. The objective of this case report was to describe the use of the semi-direct technique to create a composite resin restoration in a lower first molar. The patient had an unsatisfactory restoration on tooth 36, which needed to be replaced due to cavity infiltration. The semi-direct technique was chosen due to the amplitude of the cavity, which involved support structures, and the combination of advantages of the direct and indirect approaches. The procedure involved the removal of carious tissue, and the application of calcium hydroxide paste, followed by the application of a thin layer of glass ionomer and, subsequently, fluid resin to seal the dentin. The preparation was carried out following the necessary principles. The element in question was molded with addition silicone and the antagonist arch was molded with alginate. Both models were poured with silicone for semi-rigid models and mounted on toy parts occluders. The semi-direct restoration was made in Filtek Z350 XT composite resin, respecting the anatomy of tooth 36. Pigments were used to improve aesthetic details. After finishing and polishing, the piece was conditioned and cemented with Relyx Ultimate dual cement. It can be concluded that the restorative approach using the semi-direct technique built on a semi-rigid model is a conservative and advantageous therapeutic option for teeth with extensive coronal destruction. This technique allows for effective restoration, ensuring both the aesthetics and adequate function of the affected tooth(AU)

Comparative Evaluation of Microleakage of Fiber-reinforced Glass Ionomer Cement and Conventional Glass Ionomer Cement Restorations Immersed in Three Different Beverages: In Vitro Study.

AIM: The aim of the study was to compare and evaluate the microleakage of fiber-reinforced glass ionomer cement (GIC) and conventional glass ionomer cement restorations immersed in three different beverages. MATERIALS AND METHODS: A total of 96 human exfoliating deciduous molars were selected which were cleaned and disinfected. Standardized Class V cavity preparations were done and buccal surface were restored with experimental fiber-reinforced glass ionomer cement (Exp-FRGIC), lingual surface were restored with Type II conventional GIC. They were divided into four groups according to the test beverage. The samples were subjected to various immersion regimes and evaluated for microleakage under stereomicroscope. RESULTS: Intragroup comparison for (Exp-FRGIC) showed significant microleakage when immersed in fresh fruit juice at high immersion whereas intragroup comparison in conventional GIC, showed highest microleakage with soft drink. Intergroup comparison of (Exp-FRGIC) in high immersion regime, showed more microleakage with specimen immersed in soft drink followed by fresh fruit juice. CONCLUSION: It can thus be concluded that the three beverages used in the study affected the microleakage of both restorative materials significantly. CLINICAL SIGNIFICANCE: Increasing usage of fruit juices in the pediatric diet has a definite impact on the progression of caries and it directly or indirectly affects the quality of restorations placed in the oral cavity. How to cite this article: George MA, Chandak SA, Khekade SH, et al. Comparative Evaluation of Microleakage of Fiber-reinforced Glass Ionomer Cement and Conventional Glass Ionomer Cement Restorations Immersed in Three Different Beverages: In Vitro Study. J Contemp Dent Pract 2024;25(4):346-353.

Occlusal veneer restoration treatment outcomes of cracked tooth syndrome: A 22.4-month follow-up study.

OBJECTIVES: The aims of this clinical study were to investigate success rate, vital pulp survival rate, tooth survival rate and patient-reported masticatory ability by evaluating the pain symptoms and signs of the cracked teeth as well as Index of Eating Difficulty (IED) and Oral Health Impact Profile-14 (OHIP-14) questionnaire after cracked teeth were restored with occlusal veneers. MATERIALS AND METHODS: 27 cracked teeth of 24 patients with cold and/or biting pains without spontaneous/nocturnal pains were recruited in this study. The cracked teeth were restored with occlusal veneers fabricated by lithium disilicate ceramic. Cold test and biting test were used to evaluate pain signs. IED and OHIP-14 questionnaire were used to evaluate masticatory ability. FDI criteria was used to evaluate restorations. The paired Wilcoxon test was used to analyze significant differences of detection rate of pain signs, OHIP scores and IED grade before and after restorations. Kaplan-Meier survival curve was used to describe the success rate, vital pulp survival rate, and tooth survival rate. RESULTS: 27 cracked teeth were restored with occlusal veneers with average of 22.4-month follow-up. Two cracked teeth had pulpitis and pain signs of the other cracked teeth completely disappeared. OHIP total scores were significantly reduced after treatment. Scores of 'pain', 'occlusal discomfort', 'uncomfortable to eat', 'diet unsatisfactory' and 'interrupted meals' reduced significantly after treatment. After treatment, IED grades of 25 vital teeth were significantly lower than those before treatment. FDI scores of 25 restorations except for 2 teeth with pulpitis were no greater than 2. The 12 months accumulated pulp survival rate of the cracked teeth was 92.6%. The 12 months accumulated tooth survival rate was 100%. The success rate at the latest recall was 92.6%. CONCLUSION: Occlusal veneer restorations with success rate of 92.6% and the same pulp survival rate might be an effective restoration for treating the cracked teeth. CLINICAL RELEVANCE: The occlusal veneer restorations might be an option for treating the cracked teeth when cracks only involve enamel and dentin, not dental pulp.

The Impact of Repeated Steam Sterilization Cycles on the Efficacy of Chairside Adjustment Kits for Polishing Monolithic Multi-Layered Zirconia Dental Restoration Material.

BACKGROUND Before insertion, chairside adjustment kits are heat sterilized for positioning and polishing dental restorations. This study aimed to evaluate the effects of 2 steam sterilization cycles on the efficacy of polishing highly translucent monolithic zirconia (HTMLZ) dental restoration material. MATERIAL AND METHODS 100 HTMLZ disc-shaped specimens were adjusted (grinding, finishing, polishing) with EVE Diacera kit. Two steam sterilization techniques [standard (Gp S), immediate/flash (Gp (F)] of CAK were further subgrouped based on number of sterilization cycles [cycle 1 (control), cycle 5, 10, 15, and 20 (experimental)] (n=10 each). Each subgroup accordingly was evaluated for average surface roughness (Ra) and root mean square roughness (Rq) using a profilometer. Mean and standard deviation of 5 subgroups were statistically analyzed using one-way ANOVA/post hoc Tukey's test. Scanning electron microscopy complemented Ra, Rq measurements. Statistical differences of P≤0.05 were considered significant. RESULTS HTMLZ specimens in both groups showed increased (Ra/Rq) values after repeated sterilization of EVE Diacera kit, with Gp F showing lesser increase than Gp S (20 cycles). Gp F at 10 cycles and Gp S at 15 cycles showed clinically unacceptable roughness threshold (0.25 µm). Differences between subgroups for Ra and Rq values were significant (P≤0.05) with less differences within groups observed in early cycles (1, 10). Results validate the manufacturer's recommendations of using flash sterilization/10 cycles for EVE Diacera kit. CONCLUSIONS Repeated sterilization reduces efficacy of chairside adjustment kit to produce smooth surfaces on HTMLZ. This study recommends flash sterilization to a maximum of 10 times to get the clinically acceptable results of Ra and Rq.

Comparative evaluation of marginal adaptation and fatigue resistance of endodontically treated premolars restored with direct and indirect coronal restorations: an in vitro study.

BACKGROUND: An optimum restoration for reconstructing endodontically treated teeth should provide excellent marginal adaptation, high fracture resistance as well as maximum tooth structure conservation. The purpose of this study was to evaluate the marginal adaptation and fatigue resistance of different coronal restorations in endodontically treated premolars. METHODS: Thirty sound maxillary first premolars were endodontically treated and received MOD cavities. Teeth were randomly allocated into three groups (n = 10) according to the type of coronal restoration: Group R: polyethylene fibers (ribbond), fibers-reinforced composite (everX posterior) and final layer of nano-hybrid composite. Group O: indirect lithium disilicate overlay and Group C: fiber-post, resin composite restoration, and lithium disilicate crown. Marginal gap assessment was performed before and after thermocycling (5000 cycles) using stereomicroscope. Samples were subjected to stepwise-stress loading starting at 200 N, and increased by 100 N in each step until failure occurred. Statistical analysis was done by One-way ANOVA followed Tukey`s Post Hoc test for multiple comparison. Paired t test was used to compare the marginal adaptation before and after thermocycling. Survival probability was evaluated by Life table survival analysis. Failure mode analysis was performed with Chi-square test. RESULTS: Marginal gap was significantly the lowest in group R (37.49 ± 5.05) and (42.68 ± 2.38), while being the highest in group C (59.78 ± 5.67) and (71.52 ± 5.18) in before and after thermocycling respectively (P < 0.0001). Fatigue resistance was the highest for group O (1310.8 ± 196.7), and the lowest for group R (905.4 ± 170.51) with a significant difference between groups (P < 0.0001). Crown group had the highest percentage (80%) of catastrophic failure, while, overlay group exhibited the lowest (20%). CONCLUSIONS: Direct restoration without cuspal coverage using ribbon fibers with short FRC provided better marginal adaptation than indirect overlays and crowns, but fatigue resistance wasn't significantly improved. Adhesive ceramic overlays showed the best fatigue performance and the least catastrophic failure rate compared to both direct fiber-reinforced composite and indirect ceramic full coverage restorations. CLINICAL SIGNIFICANCE: Indirect adhesive overlays are a suitable, more conservative restorative option for endodontically treated teeth than full coverage restorations, especially when tooth structure is severely compromised.

The effect of different deep margin elevation methods on the fracture strength of CAD-CAM restorations.

PURPOSE: To evaluate the effect of two resin composites (with different viscosities) and the elevation amount on fracture strength and fracture behavior of molars with and without deep margin elevations (DME). METHODS: 70 extracted, caries-free human molars were selected. All teeth were prepared as MOD onlay cavities with a margin 2 mm below the cemento-enamel junction (CEJ) on the mesial and buccal sides and 2 mm above the CEJ on the distal side. The teeth were divided into two groups according to the type of resin composite used in margin elevation, elevated with flowable composite (Universal Flo) or condensable composite (G-Aenial Posterior). These two groups were further subdivided into subgroups in which the elevation was 2, 3, or 4 mm, and a control group in which the non-elevated indirect restoration was directly bonded to the subgingival margin, making a total of seven groups (n= 10). After elevations, the restorations were completed using a nanoceramic CAD-CAM block (Cerasmart A3 HT) and as adhesive cement, G-Cem Link Force. Static force was applied to the restored teeth using a universal testing machine at an angle of 15° until fracture occurred. Fracture strength values were recorded, and fracture types were examined under 6x magnification. One-way ANOVA was carried out to determine the effect of DME on the fracture strength. A two-way ANOVA was conducted to investigate main and interaction effects of the material type used in the elevation and the amount of elevation made on the fracture strength (P< 0.05). RESULTS: Using flowable or condensable composite as elevation material did not affect the fracture strength of CAD-CAM restorations. Flowable and condensable composites of 2, 3, or 4 mm did not significantly affect fracture strength values for either material. Specimen margins with and without elevation exhibited similar fracture strength values. The type of material used in the elevation and the amount did not affect the fracture strength of teeth. CLINICAL SIGNIFICANCE: The deep margin elevation technique for teeth with carious lesions extending subgingivally, may be useful in routine practice.

Modeler liquids: Effect on the cohesive strength, color and staining resistance of stratified resin composite restorations.

PURPOSE: To evaluate the effect of filled and unfilled modeler liquids on the cohesive strength and color stability when applied in between the resin composite layers in the stratification technique and on the uppermost surface layer. METHODS: For the cohesive strength test (n= 10), 30 cylindrical samples were packed into a Teflon mold (6x2 mm) in 2 mm increments. Firstly, a dentin-shade resin composite (Empress Direct) was placed, followed by the accommodation of a body-shade resin composite (Filtek Z350 XT) and an enamel-shade resin composite (Estelite Omega). Before photoactivation of each increment, an unfilled (Signum Liquid) or filled (Modeling Resin) modeler liquid was applied between the first and second layers and on the uppermost surface layer. The control group (n= 10) did not receive modeler liquid. Cohesive strength was measured in a universal testing machine. For the color test (n= 10), the other 30 samples were fabricated for the cohesive strength test, except for the difference in the diameter (6x6 mm). Before and after the staining of the samples, color was measured using the CIEL*a*b* system with a spectrophotometer (EasyShade). Data were submitted to ANOVA, Kruskal-Wallis test, or Mann-Whitney test (α= 5%). RESULTS: Modeler liquids significantly increased cohesive strength (P= 0.008), while ΔEab (P= 0.003) and ΔE00 (P= 0.005) values presented significantly lower changes for the groups that received modeler liquids, with no significant difference between unfilled and filled modeler liquids. CLINICAL SIGNIFICANCE: Apart from increasing the interfacial strength of stratified restorations, modeler liquids minimized staining.

Simplifying Quadrant Dentistry Using a Single-Shade Composite.

Direct composite restorations are among the most common and useful in dentistry, but shade matching can present challenges. Shade matching with direct composites is often labor intensive and technique sensitive. Utilizing a single-shade composite can simplify the process, reducing the time spent and skill required as well as overall stress on the clinician. In the case presented, which involved multiple restorations in all four quadrants, a single-shade composite was utilized to streamline the workflow and achieve an excellent outcome.

Effect of different surface treatments on the repair bond strength between aged and new alkasite based restorative material.

Background: This study investigates various surface treatment methods to assess shear bond strength between set Cention N (alkasite-based restorative material) and new alkasite based restorative material. Assessing different surface treatments provide insights in optimizing repair procedure that enables durability of the restoration, thus potentially benefitting clinical outcomes. Methods: A total of 48 alkasite based restorative material blocks, measuring 4 mm in depth and 4 mm in diameter, were prepared. The samples were randomly divided into 8 groups (n = 6) according to the surface treatment done. Group I: Surface preparation by bur; Group II: Surface treatment by laser; Group III: Application of 2-step etch and rinse adhesive (Adper Single Bond 2 adhesive),Group IV: Application of single step self-etch adhesive (Scotchbond Universal adhesive); Group V: Bur preparation followed by application of 2-step etch and rinse adhesive; Group VI: Bur preparation followed by application of single step self-etch adhesive; Group VII: Laser preparation followed by application of 2-step etch and rinse adhesive; and Group VIII: Laser preparation followed by application of single step self-etch adhesive. Post-surface preparation, all the specimens were restored with newly mixed alkasite material. Repair bond strength measurements were assessed with universal testing machine. Shapiro-Wilk and Levene's tests were used to check normality and Homogeneity of variance. ANOVA with post-hoc Games-Howell test and two-way ANOVA with post-hoc Bonferroni test was performed to evaluate the influence of surface preparation on the repair bond strength. Results: Using a 2-step etch and rinse adhesive resulted in a higher repair bond strength (26.05±2.12) compared to other surface treatments. In contrast, roughening of the surface with burs led to lowest repair bond strength (17.06±3.29) (P=0.02). Conclusion: Application of 2-step etch and rinse adhesive to the existing alkasite based restorative material provides superior bonding with the newly added alkasite based restorative material.

Giving the pulp another chance: a case report of vital pulp therapy retreatment.

Vital pulp therapy (VPT) has been increasingly advocated due to its advantages in preserving tooth vitality. While VPT is often successful, failures can occur, and traditional root canal therapy is often recommended following VPT failure. This case report provides an example of successful preservation of tooth vitality using coronal pulpotomy (CP), a more invasive type of VPT, after failure of partial pulpotomy (PP) that had been performed in a healthy 10-year-old boy. A mandibular right first molar with a diagnosis of reversible pulpitis was initially treated with PP, which included the use of tricalcium silicate cement as a pulp dressing and a resin-modified glass ionomer cement base, followed by placement of a composite resin restoration. The restoration dislodged after 34 months without complaints from the patient or radiographically detectable lesions. A stainless steel crown was placed on the tooth; however, 15 months after crown placement, the patient returned with symptoms in the treated tooth. The tooth was diagnosed with irreversible pulpitis and asymptomatic apical periodontitis but responded positively to cold testing, and the pulp appeared clinically vital upon direct inspection. The tooth was re-treated with CP, including the use of mineral trioxide aggregate as a dressing material, and examination 21 months posttreatment revealed successful resolution of the periapical lesion. When a tooth remains vital, a more invasive type of VPT may be an alternative to root canal therapy for treating failures in more conservatively treated teeth. Moreover, regular periodic recalls are essential for ensuring tooth survival and early detection of problems (ie, restoration failure) that may worsen treatment outcomes.

Performance of a novel self-adhesive bulk-fill composite hybrid in endodontically treated maxillary premolars: analysis of fracture resistance and failure mode.

This study evaluated the fracture resistance of endodontically treated maxillary premolars restored with a new self-adhesive composite hybrid material (Surefil one [SO]) using different protocols. A total of 72 maxillary premolars were divided into 6 groups (n = 12). The control group included intact teeth, and the other 5 groups included teeth in which disto-occlusal cavities were prepared and endodontic treatment was performed. The prepared cavities were assigned to groups that were based on the restorative procedures: bulk-fill group, universal adhesive plus conventional bulk-fill composite resin plus a layer of conventional composite resin; SO-SC group, self-cured SO; SO-LC group, light-cured SO; SO-UA group, universal adhesive plus SO; or SO-core group, a 4.0-mm layer of SO covered by a layer of conventional composite resin. Specimens in each group underwent thermocycling and load cycling to test the fracture strength and fracture mode. The results were analyzed using analysis of variance and the Tukey test (α = 0.05). The SO-core group showed the highest mean (SD) fracture resistance, 959.9 (171.8) N, among the restored groups. The SO-core group did not differ significantly from the control group (P > 0.05) but did show significantly higher strength than all other test groups (P < 0.05) except SO-SC (P = 0.364). No significant differences were found between the bulk-fill, SO-SC, SO-LC, and SO-UA groups (P > 0.05). The SO-core group showed the highest number of unrestorable fractures, while the main fracture mode for the other groups was restorable fracture. Although the use of SO as a core material restored the fracture strength of endodontically treated premolars to the level of intact teeth, it also resulted in a higher incidence of unrestorable fractures. The SO-SC group demonstrated a high fracture resistance comparable to that of the SO-core group and had a greater tendency to experience restorable fractures.

Clinical guidelines for posterior semidirect composite resin restorations: a case report with a 17-month follow-up.

Patients are always looking for conservative, esthetic, and long-lasting dental restorations, and the technique used directly influences the longevity of the treatment. The location of the restoration in the mouth and the extent of the decay influence the treatment choice. The larger the dimensions of the cavity preparation, the greater the difficulties in restoring the tooth using direct techniques. The semidirect technique, when indicated, can achieve satisfactory results. It is a relatively easy procedure, consisting of tooth preparation to receive an indirect restoration, fabrication of an alginate impression, fabrication of the composite resin restoration on a flexible cast, cementation, removal of excess cement, and occlusal adjustment. The aim of this case report is to present a viable alternative to direct and indirect restorations for posterior teeth with extensive decay. The article describes the extraoral semidirect technique for fabricating a composite resin restoration, highlighting its indications and discussing advantages and disadvantages.

Polishing methods for composites restoration: the influence on human gingival fibroblasts behaviour.

BACKGROUND: Carious/Non-carious cervical lesions with gingival recessions may require both dental and periodontal reconstructive therapy, where flaps/grafts may be placed in contact with a dental filling material. Human Gingival Fibroblasts (HGF-1) response during the early phase of healing could vary according to the procedures employed to cure the dental composite. Moreover, oxygen diffusion into dental composite inhibits the polymerization reaction, creating an oxygen-inhibited layer (OIL) that presents residual unreacted monomers. The aim of this study was to assess the effect of different polishing techniques and OIL on HGF-1. METHODS: Composite discs polished with different techniques (diamond rubber, abrasive discs and tungsten carbide burr) were used. An additional not polished smooth group obtained with and without OIL was used as control. Samples were physically characterized through the analysis of their hydrophilicity and surface topography through contact angle measurement and SEM, respectively; afterwards the biologic response of HGF-1 when cultured on the different substrates was analyzed in terms of cytotoxicity and gene expression. RESULTS: The finishing systems caused alterations to the wettability, even if without a proportional relation towards the results of the proliferation essay, from which emerges a greater proliferation on surfaces polished with one-step diamond rubber and with abrasive discs as well as a direct effect of the glycerin layer, confirming that surface roughness can heavily influence the biological response of HGF-1. CONCLUSIONS: Surfaces wettability as well as cellular behavior seem to be affected by the selection of the finishing system used to lastly shape the restoration. Especially, the presence of OIL act as a negative factor in the regards of human gingival fibroblasts. The present study may provide the first clinical instruction regarding the best polishing system of composite material when the restoration is placed directly in contact with soft tissue cells. Understanding HGF-1 behavior can help identifying the polishing treatment for direct restoration of carious/non-carious cervical lesions associated with gingival recessions.

A 2-Year Randomized Clinical Trial of Three Bonding Techniques in Non-Carious Cervical Lesions.

Background and objective: The aim of this randomized split-mouth study-controlled clinical trial was to compare the 2-year clinical performance of resin composite restorations placed at non-caries cervical lesions (NCCL) with one-step self-etch, total-etch, and selective enamel etch and self-etch adhesive techniques. Materials and methods: Thirty-two patients received three resin composite restorations each at NCCLs (Tetric EvoCeram/Ivoclar/Vivadent), bonded with a total-etch adhesive agent (ExciTE F/Ivoclar/Vivadent) and a self-etch (AdheSE One F/Ivoclar/Vivadent) without and with selective enamel etching. All restorations were evaluated by two examiners at baseline, 6-, 12-, 18-, and 24-months with FDI clinical criteria (post-operation regarding retention, caries occurrence, marginal adaptation, and marginal staining). A logistic regression analysis, a Cohen's kappa statistic, a multifactorial analysis, and X2 were performed with generalized estimating equations. Results: After 2 years, the retention rate was 86.8% for total etch, 92.26% for self-etch, and 93.63% for selective enamel etching and self-etch. No caries was detected on the restorations. Concerning marginal adaptation, the clinically perfect restorations were 26.9% for the total-etch technique, 16% for self-etch, and 25.9% for selective enamel etch and self-etch. The logistic regression model revealed that only time reduced the probability of perfect marginal adaptation. Conclusions: All three adhesive strategies provided restorations with no significant differences in the retention rate or marginal adaptation, whereas the total etch yielded better performance for marginal staining. All restorations were assessed as clinically acceptable after 2 years.

In vivo study of the behavior of glass ionomer restorations in patients with special needs.

BACKGROUND: Glass ionomers may be a good alternative to composite resin restorations in special needs patients with challenging behaviours. The present study was carried out to evaluate the restorative efficacy of glass ionomer in the occlusal cavities of permanent molars among patients with special needs after one year of follow-up. MATERIAL AND METHODS: A randomized split-mouth study was made of a cohort of patients with special needs. First and second permanent molars with occlusal caries were treated with glass ionomer, silver amalgam and composite resin. Assessments were made at 3, 6 and 12 months, using a scale based on the original code of Ryge and the USPHS criteria. RESULTS: A total of 34 patients and 102 restorations comprised the study sample. The survival rate of both the glass ionomer and silver amalgam was 100%, versus 97.1% in the case of composite resin. The glass ionomer afforded good marginal adaptation and stable color, with no fractures or secondary caries. CONCLUSIONS: The glass ionomer remained successfully for one year in the occlusal cavities of the permanent molars, with the same survival rate as silver amalgam, and better survival than composite resin, in the patients with special needs.

Color change of tooth-colored restorative materials bonded to silver diamine fluoride-treated dentine: a systematic review.

BACKGROUND: The desirable properties of silver diamine fluoride (SDF) make it an effective agent for managing dental caries and tooth hypersensitivity. There are several clinical instances that SDF application might precede the placement of direct tooth-colored restorations. On the other hand, SDF stains demineralized/carious dental tissues black, which might affect the esthetic outcomes of such restorations. Color is a key parameter of esthetics in dentistry. Therefore, this study aims to systematically review dental literature on color/color change of tooth-colored restorations placed following the application of SDF on dentine. METHODS: Comprehensive search of PubMed, Embase, Scopus and ISI Web of Science databases (until August 2023) as well as reference lists of retrieved studies was performed. In vitro studies reported color or color change of tooth-colored restorative materials applied on SDF-treated dentine were included. Methodological quality assessment was performed using RoBDEMAT tool. Pooled weighted mean difference (WMD) and 95% confidence interval (95% CI) was calculated. RESULTS: Eleven studies/reports with a total of 394 tooth-colored restorations placed following a) no SDF (control) or b) SDF with/without potassium iodide (KI)/glutathione dentine pre-treatments were included. Color change was quantified using ∆E formulas in most reports. The pooled findings for the comparison of resin-based composite (RBC) restorations with and without prior 38% SDF + KI application revealed no statistically significant differences in ∆E values at short- and long-term evaluations (~ 14 days: WMD: -0.56, 95% CI: -2.09 to 0.96; I2: 89.6%, and ~ 60 days: WMD: 0.11; 95% CI: -1.51 to 1.72; I2: 76.9%). No studies provided sufficient information for all the items in the risk of bias tool (moderate to low quality). CONCLUSIONS: The limited evidence suggested comparable color changes of RBC restorations with and without 38% SDF + KI pre-treatment up to 60 days. The included studies lacked uniformity in methodology and reported outcomes. Further studies are imperative to draw more definite conclusions. PROTOCOL REGISTRATION: The protocol of this systematic review was registered in PROSPERO database under number CRD42023485083.

Applications of artificial intelligence in restorative dentistry: a scoping review.

OBJECTIVE: Artificial intelligence (AI) applications in restorative dentistry have remarkably increased in the past 5 years. This review outlines the applications, promises, and limitations of AI in the most performed procedures in restorative dentistry. METHOD AND MATERIALS: An electronic search was performed in four databases: MEDLINE/PubMed, Embase, Web of Science, and Scopus. The search included articles published in English language without date restriction. Two independent reviewers assessed the eligibility of the studies and performed data extraction. Any discrepancy was resolved by the consensus of a third reviewer. RESULTS: A total of 33 studies were included in this review. For AI applications in restorative dentistry, the included studies were classified into three main groups: (1) diagnosis, detection, and prediction of the disease, (2) detection and prediction of the longevity of dental restorations, and (3) teeth detection and treatments. For each study, the AI model, type of dataset, sample size, and main results (accuracy, precision, sensitivity, and specificity) were reported. CONCLUSIONS: AI systems are promising as advantageous aids for diagnosis, prediction, and treatment in dentistry, with a high degree of accuracy. Despite the AI promises, several limitations are still unresolved and must be addressed to bridge the gap between technology and clinical applications.