A Randomised Controlled Trial of a Universal Bonding Agent at Three Years: Self Etch vs Total Etch.

General dental practice is increasingly being recognised as the ideal situation for the conduct of clinical trials into the longevity of restorations. The aim of this study was to investigate the survival of 64 nanofilled resin composite (Filtek Supreme XTE) restorations placed principally in loadbearing cavities using a Universal dentine bonding agent (Scotchbond Universal), in five UK dental practices by members of the UK-based practice-based research group, the PREP Panel. A split mouth design was used, comprising patients who required two restorations, with one of the restorations receiving a total etch approach using phosphoric acid and the other being placed using a self-etch approach. The results indicated good performance of the restorations examined, with no difference, in terms of marginal characteristics, between the restorations which received total etching and those which did not.

A randomised controlled trial of a nanofilled composite at three years: Did selective enamel etching have an effect?

General dental practice is increasingly being recognised as the ideal situation for the conduct of clinical trials into the longevity of restorations. The aim of this study was to investigate the survival of 75 nanofilled resin composite restorations placed in an assortment of cavities using a self-etch dentine bonding agent, in five UK dental practices by members of the UK-based practice-based research group, the PREP Panel, with half of the restorations receiving a selective enamel etch and the other half being placed using a self-etching approach. The results indicated good performance of the restorations examined, with no failures being identified and excellent surface characteristics, in terms of colour stability, minimal surface roughness and optimal anatomic form. Selective enamel etching tended to produce less marginal discolouration, although these results were not statistically significant.

Five Year Clinical Evaluation of Restorations Placed in a Low Shrinkage Stress Composite in UK General Dental Practices.

This paper evaluates the five year clinical evaluation of restorations formed in a low shrinkage stress resin composite material (3M ESPE Filtek Silorane, Seefeld, Germany) and placed in the general dental practices of five members of the PREP Panel, a group of UK practice-based researchers. Results indicated satisfactory performance of the material under evaluation, other than for marginal staining, which affected 60% of the restorations evaluated after five years, albeit with less than 10% of the circumference of the restorations being affected. CLINICAL RELEVANCE: The low shrinkage stress material, Filtek Silorane™, demonstrated good clinical performance in the majority of parameters which were assessed at five years.

What's New in Dentine Bonding?: Universal Adhesives.

The ability to bond restorations to dentine successfully is central to minimally invasive restorative dentistry. While dentine-bonding agents have gone through a variety of 'generations', it is the purpose of this paper to describe the latest dentine-bonding agents, the Universal Bonding Agents. These materials may be considered 'Universal' insofar as they may be considered to be capable of being used for direct and indirect dentistry, as well as being suitable for use in whichever etching modality the clinician considers appropriate, namely self-etch, etch and rinse or selective enamel etch. Laboratory investigations and initial clinical studies hold the promise that Universal Bonding Agents are a forward step in the quest for the ultimate bond to tooth substance. Clinical relevance: New Universal Bonding Agents appear to present a promising advance in bonding to dentine.

A Practice-Based Clinical Evaluation of a Bulk Fill Restorative Material.

OBJECTIVE: To evaluate the handling, by a group of practice-based researchers, of a recently introduced bulk fill resin-based composite restorative material, Filtek Bulk Fill Restorative (3M ESPE). METHODS: The twelve selected evaluators were sent explanatory letters, a pack of the material under investigation to use for 8 weeks, and a questionnaire. RESULTS: The evaluators rated the ease of use of the bulk fill restorative the same as the previously used posterior composite material. The provision of one shade only for evaluation may have compromised the score for aesthetic quality. No post-operative sensitivity was reported. CONCLUSIONS: The bulk fill material was well received as indicated by the high number of evaluators who would both purchase the material and recommend it to colleagues. CLINICAL REVELANCE: A recently introduced bulk fill restorative material achieved a rating for handling which was similar to the evaluators' previously used resin composite, although there were some concerns regarding the translucency of the material.

Relating Aesthetics to Clinical Need: Improved Aesthetics of an Ill-Fitting Crown and Anterior Toothwear.

This case report presents a case in which a patient attended because of the poor appearance of an anterior crown, but she was unaware that she had a number of teeth affected by toothwear. Clinical relevance: The quest for aesthetic improvement may be a reason for a patient presenting for dental treatment.

British Society of Prosthodontics Debate on the Implications of the Minamata Convention on Mercury to Dental Amalgam--Should our Patients be Worried?.

In 2013, the Minamata Convention on Mercury called for a global phase-down of amalgam use, with a view to reduce environmental mercury pollution. This will significantly impact UK dentistry, given the still extensive use of amalgam in U.K. general dental practice. However, until now there has been little national discussion or debate. In Spring 2015, The British Society of Prosthodontics dedicated a significant part of its Annual Conference to debating the implications of this issue. Clinical case examples were discussed with audience interaction and voting facilitated using innovative Audience Response System Technology. A remarkable range of concerns and opinions were given. The debate elicited specific concerns amongst clinicians regarding the suitability of mercury-free alternatives to amalgam; particularly where cavities are large and extend beneath the gingival anatomy. There are also anecdotal reports of Dental Foundation (DF) dentists not being adequately taught the use of dental amalgam in undergraduate dental schools. CPD/CLINICAL RELEVANCE: Many clinicians, especially those treating patients for whom moisture control is challenging, feel that amalgam should remain available for clinicians to choose in certain clinical circumstances for the restoration of posterior teeth, even in the event of a complete phase-down.

Technique Tips--The Cost of One Post-Operative Sensitivity following Placement of a Posterior Composite Restoration.

Use a low shrinkage stress composite but, if not, use incremental placement and a layer of flowable at the gingival box; Ensure good bonding to dentine and enamel and avoid (over) etching the dentine; Ensure good adaptation at the gingival floor of a Class II box; Make sure that the restoration has received sufficient light; Provide good isolation; Use reliable and tested materials throughout.

Dental Materials: What Goes Where? Class V Restorations.

A large number of Class V restorations are placed per annum to restore cervical lesions. This paper evaluates the pathogenesis of these lesions, with particular reference to the role of occlusal factors, and reviews the literature in order to provide advice on the material(s) which are most likely to produce optimal longevity of a Class V restoration. CPD/CLINICAL RELEVANCE: Resin-modified glass ionomer materials appear to provide optimal survival for a Class V restoration, but a (flowable) comDosite miaht Droduce a better aesthetic result.

A PREP Panel, Practice-Based, Evaluation of the Handling of the Kerr Demi-Ultra Light Curing Unit.

This paper describes the handling evaluation (by a group of practice-based researchers, the PREP Panel) of a recently introduced Light Curing Unit (LCU), the Kerr Demi-Ultra, which possesses a number of novel features such as its ultracapacitor power source, and the Light Emitting Diodes (LEDs) which provide the light output being placed close to the tip of the light guide. CPD/CLINICAL RELEVANCE: Testing of new devices and materials with respect to their handling is of importance, given that an easy to handle device should produce better clinical results than one which is difficult to use.

Information for patients undergoing treatment for toothwear with resin composite restorations placed at an increased occlusal vertical dimension.

UNLABELLED: Toothwear is affecting increasing numbers of the population. In the past, treatment of patients whose teeth were affected by toothwear often involved the reduction of these teeth for crowns; a severe form of toothwear. Contemporary management of such cases is by the bonding of resin composite restorations to the worn and wearing surfaces, with these restorations being placed at an increased occlusal vertical dimension. The advantage of the technique is its minimal- or non-intervention nature and its high reported degree of patient satisfaction. There are, however, short-term disadvantages to the technique, such as the potential for lisping, pain from the teeth which will be subject to axial orthodontic tooth movement, and difficulty in chewing on the posterior teeth if these are discluded. It is therefore important, as with any treatment, that the advantages and disadvantages are fully explained to the patient. This paper therefore describes the clinical technique and presents a Patient Information Leaflet that the author has used for over five years. CLINICAL RELEVANCE: Patients should be advised regarding the disadvantages and advantages of any technique.

Evaluation of a novel compule-based gingival retraction system in UK general dental practices.

Twelve members were selected at random from the PREP panel, a group of UK-based dentists who are prepared to carry out research in their practices. A questionnaire was designed to determine the views of the participants, who were asked to use the retraction paste capsules where clinically indicated. They were asked to return the questionnaire after 8 weeks and the information contained therein was collated and presented mainly on visual analogue scales (VAS). A total of 160 impressions were taken using the Astringent Retraction Paste (3M ESPE, Seefeld, Germany) plus use in the placement of 25 restorations. Of evaluators, 83% (n = 10) agreed that Astringent Retraction Paste was a suitable product for gingival retraction and 75% (n = 9) agreed that it had good haemostatic properties. Overall dispensing and handling of the paste was rated as 4.9 on a VAS scale where 1 = Inconvenient and 5 = Convenient. The viscosity of the paste was rated as 3.6 on a VAS where 1 = too thin and 5 = too thick. Good scores were achieved across all criteria for the product. Clinical Relevance: Practitioners may wish to be aware of a novel compule-based gingival retraction system.

The evidence base for 'own label' resin-based dental restoratives.

UNLABELLED: There is anecdotal evidence that sales of 'own-label' (OL) or 'private label' dental products is increasing, as dentists become more cost conscious in times of economic downturn. However, the purchase of such (less expensive) products could be a false economy if their performance falls below accepted standards. So, while the examination of a resin-based product under research conditions alone may not guarantee success, it could be considered that a material which has been subjected to testing under research conditions will demonstrate its effectiveness under laboratory conditions or reveal its shortcomings; either of these being better than the material not being examined in any way. It was therefore considered appropriate to determine the materials on which research was carried out, with particular reference to OL brands. OBJECTIVE: To determine whether there is a research base behind OL resin-based restorative dental materials.

Dental materials--what goes where? The current status of glass ionomer as a material for loadbearing restorations in posterior teeth.

UNLABELLED: Glass ionomer materials have been available for 40 years, but have not been indicated for loadbearing restorations, other than when used in the ART concept. However, there is anecdotal evidence that dentists are using the reinforced versions of this material in posterior teeth, possibly as a result of demands from patients to provide them with tooth-coloured restorations in posterior teeth at a lower cost than resin composite. This paper reviews the existing literature on reinforced glass ionomer restorations in posterior teeth, concluding that, under certain circumstances (which are not fully elucidated) these materials may provide reasonable service. However, the patient receiving such restorations should be made aware of the minimal amount of evidence for the success of these restorations and the potential need for the restorations to be re-surfaced in due course. CLINICAL RELEVANCE: Reinforced glass ionomer restorations may provide patients with tooth-coloured restorations in posterior teeth, but their survival may not equate to restorations in resin composite in loadbearing situations.

Dental materials--what goes where? Class I and II cavities.

UNLABELLED: Dental amalgam has helped maintain dental public health in the developed world for over a century. However, its days appear to be numbered. Notwithstanding the environmental consideration, there is an ever increasing demand from dental patients for non-metallic and tooth-coloured restorations in their posterior teeth. This paper gives a brief history of dental amalgam and critically appraises the alternative materials, the principal of these being resin-based composite. CLINICAL RELEVANCE: The majority of practitioners carry out large numbers of Class I and II restorations, so an appraisal of the pros and cons of the alternatives may assist in decision-making.

Twenty years of handling evaluations and practice-based research by the PREP Panel.

UNLABELLED: Dental materials which are user friendly make clinicians' lives simpler by facilitating their placement in patients' teeth: accordingly, the handling of materials is of relevance to the clinician. This paper traces the history of product handling evaluations and practice-based research by the PREP Panel, a group of practice-based researchers based in the UK. CLINICAL RELEVANCE: The ease of handling of dental materials is important in dental practice, given that practitioners may find that a material which is difficult to handle leads to suboptimal clinical results.

Direct anterior composites: a practical guide.

UNLABELLED: For more than 40 years dentists worldwide have been using directly placed resin-bonded composite to restore damaged anterior teeth. While such techniques are invariably more conservative of tooth tissue than indirect procedures, operative techniques using direct composite can be challenging and are considered technique sensitive. Clinicians require both technical and artistic skill to provide composite restorations that restore function and aesthetics to blend seamlessly with the residual dentition. This paper provides an update on the aesthetic considerations involved in the restoration of anterior teeth with directly placed composite and outlines the contemporary materials, equipment and techniques that are available to optimize every clinical stage. CLINICAL RELEVANCE: Successful restoration of anterior teeth with direct composite is an integral component of contemporary clinical practice.

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.

Survival rates for porcelain laminate veneers with special reference to the effect of preparation in dentin: a literature review.

UNLABELLED: The porcelain laminate veneer is an elective restoration, often placed in the absence of disease for purely esthetic reasons. As such, it would appear desirable that the success rate of the technique was 100%. It is therefore the purpose of this paper to review the literature on porcelain laminate veneer survival by searching dental databases containing clinical trials of porcelain veneer restorations. References of selected trials were also screened to identify relevant studies. Each paper that was included was examined to ascertain if preparation into dentin affected survival. A total of 24 papers were included in the review. It was concluded that survival rates of porcelain laminate veneers are rarely 100%, and there is reasonable evidence indicating that a veneer preparation into dentin adversely affects survival. CLINICAL RELEVANCE: A review of the literature has indicated that porcelain laminate veneer survival is rarely 100%. Accordingly, patients should be made aware of this before embarking on this elective restorative technique. Clinicians should also be aware that the ideal preparation for porcelain veneers remains within enamel.