Long-term performance of ceramic in/-onlays vs. cast gold partial crowns - a retrospective clinical study.

OBJECTIVES: To assess the long-term clinical performance of ceramic in-/onlays (CIOs) and cast gold partial crowns (CGPCs) in posterior teeth in terms of success, survival, complications (biological, technical) and quality. MATERIAL AND METHODS: In a retrospective study, a total of 325 patients were recorded after up to 24.8 years (mean 13.9 ± 3.8 years) having (pre-)molars restored with CIO (Empress I, Ivoclar Vivadent, n = 161) and CGPC (Degunorm, DeguDent, n = 164) by supervised undergraduate students. A total of 296 restorations were assessed clinically and radiologically in healthy and endodontically treated teeth using modified United States Public Health Service (USPHS) criteria. Cumulative success and survival rates of the restorations were calculated using Kaplan-Meier estimates. Biological and technical complications were recorded. Status of oral health comprising caries risk and localized periodontitis were assessed. RESULTS: The cumulative success rates of CIOs were 92.1% and of CGPCs 84.2% after mean service times of 14.5 years. The annual failure rates of total service times were 0.5% in teeth restored with CIO (n = 155) and 0.7% in teeth restored with CGPC (n = 163). The cumulative survival rates of CIOs were 93.9% after a mean service time of 15.2 years and decreased to 91.7% after 23.5 years. The cumulative survival rates of CGPCs were 92.6% after a mean service time of 14.9 years and 91.8% after 23.5 years. Complications in CIOs (n = 149) were ceramic fracture (6.7%), secondary caries (4.7%), endodontic complication (2.7%) and tooth fracture (1.3%) compared to CGPCs (n = 147) with endodontic complication (8.8%), secondary caries (4.8%) and decementation (2.0%). Endodontically treated teeth restored with CIO or CGPC revealed significantly less often success compared with corresponding vital teeth (p = .02). CIOs and CGPCs revealed clinically and radiographically good and excellent qualities with 71.8% (107/149) and 68% (100/147) without any significant differences regarding type of restoration. CONCLUSIONS: Both CIOs and CGPCs achieved high survival rates up to 24.8 years when performed by supervised undergraduate students. The longevity of the restorations may benefit from the intraoral repair of accessible defects and, in case of pulp infection or necrosis, an adequate endodontic management. CLINICAL RELEVANCE: CIOs and CGPCs made by supervised undergraduate students are proper restoration types in posterior teeth in the long-term. An adequate preparation design, meticulous care in the inserting technique and constant biofilm removal due to proper oral hygiene combined with professional maintenance care are substantial. The clinical long-term performance was mostly limited by ceramic fractures in CIOs and endodontic complications in CGPCs.

Two-year clinical performance of indirect resin composite restorations in endodontically treated teeth with different cavity preparation designs: a randomized clinical trial.

TRIAL DESIGN: This is a randomized, controlled, superiority, double-blinded, parallel-group, two-arms trial with an allocation ratio of 1:1. This study aimed to assess whether the cavity design could affect the clinical performance of the CAD/CAM generated indirect resin composite restoration in endodontically treated teeth (ETT) evaluated using the Modified USPHS criteria after a two-year follow up. METHODS: A total of 30 participants who underwent endodontic treatment for MOD cavities in permanent molars were divided randomly into two parallel groups (n = 30 restorations) according to the performed cavity design to group 1 in which there was no cuspal reduction (inlay) and group 2 in which cuspal reduction was performed (overlay). All pulp chambers were filled with bulk fill flowable composite, and the cavities were prepared following the criteria of the cavities for indirect restorations and restored using nano-hybrid composite resin blocks (Brilliant, Coltene, Switzerland). The restorations were evaluated using the modified USPHS criteria at baseline, six months, one-year and two years follow-up visits. For qualitative data, frequencies (n) and percentages (%) were used to display the data, while mean and standard deviation (SD) were used for quantitative data. The normality of the data was evaluated using the Shapiro-Wilk and Kolmogorov-Smirnov tests. For every test, P ≤ 0.05 was used as the significance threshold. RESULTS: Twenty-six individuals completed the follow-up period after receiving the assigned intervention.The inter-group comparison showed that, at the 6- months and 12- months observation points, the overlay design had significantly better marginal adaptation, less incidence of discoloration or tooth/restoration fracture, and similar marginal integrity and caries incidence to the inlay design. After 24- months, the overlay design still had better marginal adaptation, less incidence of discoloration or tooth/restoration fracture and less caries incidence in comparison to the inlay design, while there was no difference in the marginal integrity between either design. CONCLUSIONS AND CLINICAL RELEVANCE: Cuspal reduction in endodontically treated teeth showed better clinical performance than the cusp preservation thus, the former is more reliable.

Twenty-Four-Month Clinical Comparison of Two Bulk-Fill and a Microhybrid Composite Restorations in Class II Cavities.

OBJECTIVES: The aim of this study was to evaluate the clinical performance of two bulk-fill composite resins in Class II cavities for up to twenty-four months. MATERIALS AND METHODS: In total 75 Class II restorations were made in 25 patients using two nanohybrid bulk-fill resin composites and a microhybrid composite. The restorations were evaluated at baseline and at 6, 12, and 24 months, using U.S. Public Health Service (USPHS) criteria. The restoration groups were compared using the Pearson chi-square test, and the Cochran Q-test was used to compare the changes across different time points within restorative materials (p⟨0.05). RESULTS: Two patients who did not attend the appointments were excluded from the study, so 23 patients were evaluated with a 92% recall rate; at the end of the two-year follow-up, 66 restorations were evaluated. Three restorations underwent endodontic treatment and were deemed failures. The overall success rate was 96%. There were statistically significant differences between the three restorative resins in terms of color match parameter (p⟨0.05). No differences were observed between the restorative resins in terms of other criteria (p⟩0.05). CONCLUSIONS: During the two-year follow-up period, the three composite resins showed similar clinical performance except for the color match parameter.

Factors influencing the longevity of posterior composite restorations: A dental university clinic study.

Objectives: This retrospective study aimed to assess the performance of posterior composite resin restorations (PCRRs) and evaluate the influence of patient-specific factors on restoration outcomes. Methods: A total of 189 PCRRs were examined in 54 patients, with evaluations based on Modified USPHS criteria. Patient-specific factors were analyzed. Statistical analyses, including chi-square tests, independent samples t-tests, and ANOVA tests, were conducted. Results: Patients aged over 50 exhibited higher DMFT averages and a higher rate of unsuccessful restorations. Despite higher DMFT scores in females, gender doesn't significantly impact restoration outcomes. Secondary caries correlated with.plaque scores, significantly affecting restoration survival. Marginal adaptation, retention deficiencies, and secondary caries were primary causes of failure. Multi-surface restorations faced higher failure risk due to elevated plaque scores. Class-V restorations showed a higher failure rate, challenging the number of surfaces and longevity correlation. Conclusions: This study identified key factors influencing posterior composite resin restorations-(PCRRs) in patients over 50, including higher DMFT averages and more unsuccessful restorations. No significant difference was found between brushing; frequency and DMFT rates, possibly due to the absence of non-brushers. Secondary caries; correlated with elevated plaque scores, impacting restoration survival. Primary causes of; failure included marginal adaptation issues, retention deficiencies, and secondary caries, with multi-surface restorations facing a higher risk. However, tooth vitality, beverage and acidic food consumption, and oral hygiene habits did not significantly affect PCRR outcomes. Clinical significance: Patient-specific factors significantly impact PCRRs' long-term performance. Dentists must tailor strategies, emphasizing regular monitoring and preventive measures for extended survival.

Clinical Performance of Zirconia Reinforced versus Conventional Viscous Glass Ionomer in Class I Cavities of Geriatric Patients: A 1-year Randomized Controlled Clinical Trial.

Background: For the elderly population, efforts are made to simplify the restorative procedure while maintaining good clinical performance. Glass ionomer (GI) cements are showing signs to fulfill many of these qualities. With their new properties and ease of use, they can be developed further to become a useful group of materials to overcome the problems of elderly patients. Aim: The aim of the study was to evaluate the clinical performance of zirconia-reinforced versus conventional viscous GI restorations in Class I cavities of geriatric patients. Setting and Design: The study design was in vivo randomized clinical trial, parallel-arms, allocation ratio: 1:1. Subjects and Methods: A total of 28 Class I carious lesions in 21 geriatric patients were restored randomly either by zirconomer-improved or Ketac Molar Quick Aplicap (n = 14) each. Restorations were evaluated for 1 year by modified USPHS criteria. Statistical Analysis: Data were analyzed with the Chi-square test and Cochran's Q-test. Survival rate was analyzed using the Kaplan-Meier and log-rank test. Results: Twenty-four restorations were evaluated in 19 patients with a recall rate of 85.7% at 12 months. Significant differences were found in marginal integrity and marginal discoloration within both restorative materials between different time intervals (P < 0.05). However, none of the materials were superior to another regarding all assessed criteria. Conclusions: Both zirconia-reinforced GI and conventional highly viscous GI have acceptable clinical performance.

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.

The impact of extended pulp chamber preparations on the clinical performance of endocrowns in Indian patients: A 1-year observational study.

Purpose: The limitations of foundation restorations have been reduced with the advent of endocrowns. Despite their success, the extent of endocrowns tooth preparation into the pulp chamber has not been fully explored in the literature. The study aimed to evaluate the clinical performance of endocrowns with 5 mm extended pulp chamber tooth preparations in Indian patients over a 1- year period using modified USPHS criteria. Methods: The observational study recruited 36 participants with definite criteria. Ceramic crown was planned for all the participants. Conventional endocrown tooth preparation was made with 5 mm pulpal extension. Clinical assessments were made at 0-, 6- and 12-months intervals using modified USPHS criteria. The data was statistically analyzed using Friedman test and Wilcoxon signed rank test. Results: One patient (2.8%) experienced loss of retention, marginal adaptation, and loss of anatomical form during 1-year follow up period. The majority of the participants (97.3%) reported no discomfort and high satisfaction. (P < .05) No opposing tooth wear was observed at 0- and 6-months. The results showed statistical significance in the parameters of retention, marginal adaptation, loss of anatomical form, and patient satisfaction. (P < .05). Conclusion: The clinical performance of endocrowns with extended pulp chamber preparation was satisfactory for a period of 12 months.

Is There an Association Between Clinical and SEM Quantitative Marginal Analysis in a 90-month Trial?

PURPOSE: To assess possible correlations between clinical outcomes and SEM marginal analysis in a prospective long-term clinical study using two adhesives in incisors and canines. Materials and Methods: Thirty-five patients received class III and IV restorations with two different adhesives, either the one-step self-etch adhesive iBond Gluma inside (1-SE) or the two-step etch-and-rinse adhesive Gluma Comfort Bond (2-ER) combined with the fine particle hybrid composite Venus. The restorations were clinically evaluated (modified USPHS criteria) over 90 months. Based on resin replicas, a quantitative marginal SEM analysis was performed using the criteria "gap", "perfect margin", "overhang", and "underfilled". The results of the quantitative marginal analysis were statistically compared and related to clinical evaluations. The SEM data were analyzed statistically using the Kolmogorov-Smirnov test, Wilcoxon test, and mixed models test. Results: Of the 35 subjects at baseline, 16 (1-SE) and 17 (2-ER) were clinically re-examined after 90 months. 13 patients were included in the SEM analysis due to uninterrupted documentation over 90 months or until restoration loss. SEM analysis showed larger discriminative power between groups than did the clinical examination, but the trend was the same. Marginal analysis ("gap", "perfect margin") showed significant differences between the materials after 12 months, which clinically began to show a trend from 12 months, and were statistically verified after 48 and 90 months. "Overhang" and "underfilled" did not reveal significant differences between the systems or over time. Conclusion: SEM marginal analysis using the replication technique is a powerful tool to reveal differences between adhesives. Compared to clinical evaluation, group differences can be detected earlier, with both outcome parameters confirming each other over long observation periods.

A three-year randomized clinical trial evaluating direct posterior composite restorations placed with three self-etch adhesives.

AIM: To compare the clinical performance of composite restorations placed with a universal adhesive, one-step and two-step self-etch adhesives in class I and II posterior cavities. MATERIALS AND METHODS: In this in vivo study, 46 volunteers presenting with at least three carious lesions were included. Each participant received the three restorative systems: universal adhesive/nanofilled composite (Scotchbond Universal/Filtek Z350 XT: SBU/FZXT), one-step self-etch adhesive/microhybrid composite (G-aenial bond/G-aenial Posterior: GB/GP) and the two-step self-etch adhesive/nanohybrid composite (OptiBond XTR/Herculite Ultra: OBX/HU). The adhesives were all placed in self-etch mode. In total, 138 restorations were evaluated at baseline and at 6,12 and 36 months using the modified United States Public Health Service criteria. Data were analysed using Kruskal-Wallis, Mann-Whitney U, Friedman and Wilcoxon non-parametric tests (p < .05). Ninety-one restorations were evaluated at 36 months. RESULTS: Seven restorations, three SBU/FZXT, three GB/GP and one OBX/HU failed during this study. The reasons for failure were marginal fracture and secondary caries. SBU/FZXT restorations showed significant marginal deterioration in all parameters. Overall success rates were: 93.5% (SBU/FZXT), 96.6% (GB/GP) and 96.8% (OBX/HU). CONCLUSIONS: After three years, the three restorative systems have comparable clinical effectiveness and success rates, except for the marginal integrity, that was suboptimal for both the SBU/FZXT and GB/GP restorations in comparison to the OBX/HU restorations.

Clinical behavior of universal adhesives in non-carious cervical lesions: A randomized clinical trial.

OBJECTIVES: This randomized, double-blind clinical trial, , evaluated the behavior of two universal adhesives used in etch-and-rinse (ER) or self-etch (SE) approach in non-carious cervical lesions (NCCLs). METHODS: Two hundred and eleven NCCLs were selected in 54 participants and randomly allocated into four experimental groups: Scotchbond Universal Adhesive - SBU (3M Oral Care) and Prime & Bond Elect - PB (Dentsply Sirona) used in ER and SE modes. Two trained operators placed all resin composite restorations (Filtek Z250, 3M Oral Care). Restorations were evaluated at baseline and after 6 months using both FDI and USPHS modified criteria by a blinded calibrated examiner. Kruskal-Wallis and Mann-Whitney U non-parametric tests were used to compare the restoration failures among experimental groups. RESULTS: Statistically significant differences were found among groups regarding failures (p=0.000 for both FDI and USPHS criteria). PB-SE presented more failures (p<0.05) than other experimental groups. No significant difference was found between any other pair of groups (p>0.05). CONCLUSIONS: The etch and rinse approach affected the clinical performance of Prime and Bond Elect. For this material, the self-etch approach generated lower criteria scores after a six-month follow-up. The bonding strategy did not influence Scotchbond Universal Adhesive clinical performance. (RBR-2GQMVF) CLINICAL SIGNIFICANCE: The clinical behavior of mild universal adhesive Prime & Bond Elect depends on the bonding strategy. The etch-and-rinse approach is recommended for this adhesive system. Scotchbond Universal Adhesive can be used in both bonding strategies without impairing clinical performance.

Clinical Comparison of Three Tooth-colored Full-coronal Restorations in Primary Maxillary Incisors.

AIM: The aim of this in vivo study was to evaluate the surface texture, anatomical form, marginal integrity, marginal discoloration, and secondary caries of three different types of crowns in primary anterior teeth at different time intervals of 3, 6, and 9 months. MATERIALS AND METHODS: Total 45 primary maxillary incisors were randomly selected and divided into three groups of 15 each: group I-strip crowns (Pedoform strip crowns, 3M, United States), group II-zirconia crown (kids-e-crown, India), and group III-luxa crown (DMG, Germany). All the full-coronal restorations were evaluated at 3, 6, and 9 months. The modified USPHS criteria were used to evaluate different parameters. Data were collected and the nonparametric test (Chi-square) was used to analyze the intergroup data. RESULTS: Statistically nonsignificant difference was observed for most of the parameters except marginal integrity and secondary caries. Resin strip crowns showed maximum cases with distorted marginal integrity and secondary caries. CONCLUSION: Zirconia crown performed best among the three full-coronal restorations. Luxa crown performed similar to zirconia crown. It can be used as an alternative economical esthetic full-coronal restoration for primary maxillary anterior incisors. CLINICAL SIGNIFICANCE: This study illustrates the advantage of the temporization material as a full-coronal restoration option in primary maxillary anterior teeth. HOW TO CITE THIS ARTICLE: Nischal M, Gupta T, Mehra M, et al. Clinical Comparison of Three Tooth-colored Full-coronal Restorations in Primary Maxillary Incisors. Int J Clin Pediatr Dent 2020;13(6):622-629.

Composite restorations placed in non-carious cervical lesions-Which cavity preparation is clinically reliable?

The purpose of this in-vivo study was to evaluate the clinical performance of restorations placed in non-carious cervical lesions (NCCLs), using different cavity preparation designs, after 7.7 years. A total of 85 NCCLs with coronal margins in enamel and cervical margins in dentin were randomly assigned to the following treatment protocols: dentin surface cleaning, dentin surface roughening with round bur plus flowable composite, dentin surface roughening/cervical groove preparation with round bur, dentin surface roughening/cervical groove preparation with round bur plus flowable composite. After enamel beveling and selective enamel etching, the defects were restored with composite. The restorations were assessed by two independent, calibrated and blinded investigators, using modified USPHS criteria. At 7 years (7.7 (± 0.35)), a total of 64 restorations (75.3%) were available for follow-up examination. The total retention rate, irrespective of the test groups, was 82.8%. Restorations placed without any preparation showed the highest loss rate (27.8%). Esthetic appearance, marginal adaptation, anatomic form and marginal discoloration did not differ significantly between the groups. Composites are long-term stable materials for restoring NCCLs. Restorations placed without any dentin preparation (cavity cleaning only) showed the highest loss rate.

Clinical performance of occlusal onlays made of lithium disilicate ceramic in patients with severe tooth wear up to 11 years.

OBJECTIVES: Evaluation of survival and complication rate of monolithic occlusal onlays made of lithium disilicate ceramic used in patients with severe tooth wear up to 11years of clinical service. METHODS: In a prospective non-randomized clinical study 7 patients (4 male, 3 female; median age: 44.3±6.56years old) were restored full mouth with a total of 103 adhesively bonded occlusal onlays made of lithium disilicate ceramic (IPS e.max Press, Ivoclar Vivadent, Schaan, Liechtenstein). All restorations were examined during annual recall visits using periodontal parameters according to the modified United States Public Health Service (USPHS) criteria: (a) marginal discoloration, (b) secondary caries, (c) marginal integrity, (d) surface texture, (e) restoration fracture, and (f) occlusal wear, rating with Alpha, Bravo and Charlie over an observation period up to 11years (68-139 months; median: 94.9±26.1 months). Data was statistically analyzed using the Kaplan-Meier estimation. RESULTS: Monolithic lithium disilicate occlusal onlays presented a 100% survival rate. Four restorations within one patient (3.9%) presented marginal discoloration, one after 60 and three after 108 months (all rated Bravo). One restoration (1%) showed a marginal crack formation (technical complication) after 120 months, rated Bravo. No biological complication, debonding or secondary caries could be found and tested periodontal parameters showed excellent results. SIGNIFICANCE: Based on the analyzed data up to 11years, monolithic occlusal onlays made of lithium disilicate ceramic can be considered as a reliable treatment option for full-mouth rehabilitations in patients with severe tooth wear.

Clinical evaluation of the bulk fill composite QuiXfil in molar class I and II cavities: 10-year results of a RCT.

OBJECTIVE: The objective of this RCT was to compare the 10-year clinical performance of QuiXfil with that of Tetric Ceram in posterior single- or multi-surface cavities. METHODS: 46 QuiXfil (Xeno III) and 50 Tetric Ceram (Syntac classic) composite restorations were placed in 14 stress bearing class I and 82 class II cavities in first or second molars. Clinical evaluation was performed at baseline and after up to 10 years by using modified US Public Health Service criteria. At the last recall period, 26 QuiXfil and 30 Tetric Ceram restorations in 11 stress bearing class I and 45 class II cavities, were assessed. RESULTS: Ten failed restorations were observed during the follow-up period, four Tetric Ceram restorations failed due to secondary caries (2), tooth fracture (1) and bulk fracture combined with secondary caries (1) whereas six QuiXfil restorations failed due to secondary caries (1), tooth fracture (2), secondary caries combined with restoration fracture (1), restoration fracture (1) and postoperative sensitivity (1). Fisher's exact test yielded no significant difference between both materials (p=0.487). SIGNIFICANCE: Both materials, bulk fill QuiXfil restorations and Tetric Ceram restorations, showed highly clinical effectiveness during the 10-year follow-up.

Clinical Outcomes of Monolithic Zirconia Crowns with CAD/CAM Technology. A 1-Year Follow-Up Prospective Clinical Study of 65 Patients.

Aim/Purpose: The primary aim of this study was to examine the clinical performance of posterior monolithic single crowns in terms of failure or complications and the secondary aim was to assess the quality of these restorations according to the United States Public Health Service (USPHS) criteria. Methods: Ιn a private dental clinic, 65 patients with need of posterior crowns were restored with monolithic zirconia crowns. All the restorations were evaluated 6 and 12 months after their cementation. The modified United States Public Health Service (USPHS) criteria and periodontal parameters were applied for the clinical evaluation of the crowns. Restorations with Alpha or Bravo rating were considered a success. Results: Descriptive statistics and nonparametric tests were used for statistical analysis. Sixty-five patients (mean age: 49.52) were restored with 65 monolithic zirconia crowns. No fracture of the restorations was recorded. The overall success rate was 98.5%. The clinical quality of all crowns was acceptable except for the marginal discoloration of one crown at the 6- and 12-month follow-up examination. Conclusions: In this study, no fracture of single-tooth monolithic crowns occurred and the success rate was high. Monolithic zirconia restorations fabricated is a viable option for the restoration of single posterior teeth.

Direct resin composite restorations for fractured maxillary teeth and diastema closure: A 7 years retrospective evaluation of survival and influencing factors.

OBJECTIVES: This retrospective study evaluated the survival rate of anterior direct resin based composite (RBC) build-ups in vital teeth made of microhybrid and nanofill RBC materials and the influence of bruxism, beverage consumption and smoking on the long-term performance of restorations. METHODS: Patients receiving anterior restoration between 2006 and 2011, with the diagnosis of fracture or diastema, were selected. A total of 65 adult patients (mean age: 25.2) with 163 restorations (78 Filtek Supreme XT and 85 Enamel Plus HFO) were evaluated using the USPHS criteria. Data were analyzed with Fisher's Exact Test, Extended Cox-regression analysis and Kaplan-Meier method. RESULTS: Mean observation period was 7.2 (±1.4) years and the mean annual failure rate for this period was 1.43%. The reasons of failures included restoration fracture and color mismatch. Nanofill restorations had significantly higher rate of color mismatch (p=0.002), microhybrids more frequently failed in fracture of restoration (p=0.034). The overall difference in potential hazard of using Enamel Plus HFO or Filtek Supreme XT was not significant (p=0.704). Chipping or fracture of the restoration was more frequent in the first year after placement (p=0.036), while beverage consumption was significantly correlated with discoloration of the restorations (p=0.005). SIGNIFICANCE: The application of direct RBC restorations provides an excellent treatment option for fractured teeth and for closing diastemas. The overall survival rate was 88.34% up to 10 years. Microhybrid and nanofill RBC restorations showed similar survival rates, however nanofills discolored at a higher rate, meanwhile chipping of the restoration occurred frequently with microhybrids.

Survival of Hybrid Laminate Veneers using two different tooth preparation techniques: Randomized Clinical Trial

Abstract The aim of this study was to evaluate the survival of laminate veneers constructed using a recent polymer-infiltrated ceramic network material following the aesthetic pre-evaluative temporary (APT) technique of tooth preparation in comparison to traditional technique. Six patients received 54 laminate veneers. They were divided into two equal groups (n=27) according to the technique of tooth preparation: group T: traditional technique and group A: aesthetic pre-evaluative temporary technique. VITA ENAMIC material was used for CAD/CAM construction of laminate veneers. Cementation was performed using a light cured resin cement. The laminate veneers were evaluated at baseline, after 3, 6 and 12 months according to the modified United States Public Health Service (USPHS) criteriea. The data was collected, tabulated and statistically analyzed. Secondary caries, endodontic complications, cracks and loss of retention were not noted in any laminate veneer. Extensive fractures were not detected in both study groups through the study period. There was a statistically significant decrease of color match criteria between the two groups at the 6 and 12 months recalls. Based on this study, both preparation techniques resulted in successful clinical performance. After 12 months, all the veneers in both groups showed no post-operative sensitivity and all patients were highly satisfied regarding their veneers. However, there was a deterioration in color match criteria through the study period in both study groups.

Resumo O objetivo deste estudo foi avaliar a sobrevivência de facetas laminadas construídas utilizando um material recente de rede de cerâmica impregnada de polímero, seguindo a técnica estética pré-avaliadora temporária (APT) de preparação de dentes em comparação com a técnica tradicional. Seis pacientes receberam 54 facetas de laminados. Foram divididos em dois grupos iguais (n=27) de acordo com a técnica de preparação do dente: grupo T: técnica tradicional e grupo A: técnica temporária pré-avaliativa estética. O material VITA ENAMIC foi utilizado para a construção de facetas de CAD/CAM de laminados. A cimentação foi realizada utilizando um cimento de resina fotopolimerizável. Os laminados foram avaliados na linha de base, após 3, 6 e 12 meses de acordo com os critérios modificados do Serviço de Saúde Pública dos Estados Unidos (USPHS). Os dados foram recolhidos, tabulados e analisados estatisticamente. Cáries secundárias, complicações endodônticas, fissuras e perda de retenção não foram observadas em nenhuma faceta laminada. Não foram detectadas fraturas extensas em ambos os grupos de estudo durante o período do estudo. Verificou-se uma diminuição estatisticamente significativa dos critérios de correspondência de cor entre os dois grupos nos 6 e 12 meses. Com base neste estudo, ambas as técnicas de preparação resultaram num desempenho clínico bem sucedido. Após 12 meses, todos os laminados de ambos os grupos não mostraram qualquer sensibilidade pós-operatória e todos os pacientes ficaram altamente satisfeitos com os seus laminados. No entanto, houve uma deterioração dos critérios de correspondência de cor durante o período de estudo em ambos os grupos de estudo.

A split-mouth randomized clinical trial of conventional and heavy flowable composites in class II restorations.

OBJECTIVE: The aim of this study was to evaluate the 2-year clinical performance of class II restorations made with a composite resin with two different viscosities. METHODS: 47 patients received two class II restorations (n=94), one made with GrandioSO (conventional viscosity - CV), and the other with GrandioSO Heavy Flow (flowable viscosity - FV), subjecting both materials to the same clinical conditions. The self-etching adhesive Futurabond M was used for all restorations. The composites were inserted using the incremental technique. The restorations were evaluated using the modified USPHS criteria according to the periods: baseline, 6 months, 1 year and 2 years after restorative procedures. RESULTS: After 24 months, 40 patients attended the recall and 78 restorations were evaluated. In all periods, no secondary caries was observed. After 6 months, there were slightly overall changes of scores for most parameters. After 24 months, the higher number of changes from score Alfa to Bravo was observed for marginal discolouration (32.5% - CV and 39.5% - FV) and colour match (15% - CV and 31.6% - FV), followed by proximal contact (25% - CV and 23.7% - FV) and marginal adaptation (20% - CV and 21.1% - FV). For wear, surface texture and postoperative sensitivity the changes were very small. Just two restorations were lost during the 24-month follow up. Less than 5% of all restorations showed postoperative sensitivity. Chi-square test showed no significant differences between the two materials for all parameters analysed. CONCLUSION: After 2 years of clinical service, no significant differences were observed between GrandioSO conventional and GrandioSO Heavy Flow for the parameters analysed. Both materials provided acceptable clinical behaviour in class II restorations. CLINICAL SIGNIFICANCE: This study presents the possibility of using a flowable composite with high filler content, for performing class II restorations.

The effect of clinical performance on the survival estimates of direct restorations.

OBJECTIVES: In most retrospective studies, the clinical performance of restorations had not been considered in survival analysis. This study investigated the effect of including the clinically unacceptable cases according to modified United States Public Health Service (USPHS) criteria into the failed data on the survival analysis of direct restorations as to the longevity and prognostic variables. MATERIALS AND METHODS: Nine hundred and sixty-seven direct restorations were evaluated. The data of 204 retreated restorations were collected from the records, and clinical performance of 763 restorations in function was evaluated according to modified USPHS criteria by two observers. The longevity and prognostic variables of the restorations were compared with a factor of involving clinically unacceptable cases into the failures using Kaplan-Meier survival analysis and Cox proportional hazard model. RESULTS: The median survival times of amalgam, composite resin and glass ionomer were 11.8, 11.0 and 6.8 years, respectively. Glass ionomer showed significantly lower longevity than composite resin and amalgam. When clinically unacceptable restorations were included into the failure, the median survival times of them decreased to 8.9, 9.7 and 6.4 years, respectively. CONCLUSIONS: After considering the clinical performance, composite resin was the only material that showed a difference in the longevity (p < 0.05) and the significantly higher relative risk of student group than professor group disappeared in operator groups. Even in the design of retrospective study, clinical evaluation needs to be included.

Clinical effectiveness of contemporary dentin bonding agents.

AIM: The purpose of this paper is to review the literature on the clinical effectiveness of contemporary resin-based dentin bonding agents primarily focussing on the longevity of restoration. MATERIALS AND METHODS: The literature published from June 2004 up to September 2010 was reviewed for clinical trials that tested the effectiveness of dentin bonding agents in the longevity of noncarious class V restoration. Results of each study reported using the USPHS criteria for clinical assessment of restoration were included and tabulated. The American Dental Association guidelines for dentin and enamel adhesives were used as a reference to compare the performance of individual bonding agents. Kruskal-Wallis followed by Mann-Whitney U was done to compare the mean Alfa score percentage for the three categories of bonding systems [etch-and-rinse (ER), self-etch primer (SEP), and self-etch-adhesive (SEA)]. RESULTS: A comparison of the mean Alfa score percentages revealed no difference between the ER, SEP, and SEA categories of bonding systems except for marginal adaptation where ER was found to be superior to SEA. CONCLUSION: The clinical effectiveness of resin-based bonding agents is comparable among the three categories.