Marginal integrity and postoperative sensitivity in Class 2 resin composite restorations in vivo

INTRODUCTION: Problems that may arise in resin composite Class 2 restorations include microleakage and postoperative sensitivity. However, limited in-vivo research is conducted to evaluate these processes. AIM: The aim of this study was to assess postoperative sensitivity, microleakage and the pooling of adhesives in relation to Class 2 box-type composite restorations placed in vivo using various adhesive systems and application techniques. MATERIALS AND METHODS: One hundred and forty-four Class 2 box restorations were placed in the mesial and distal surfaces of 72 premolar teeth in-vivo using one of three combinations of adhesive systems and three filling techniques. After 6 weeks of clinical service postoperative sensitivity was recorded. The teeth were then extracted, immersed in a dye solution and sectioned. Microleakage and pooling of the adhesive was recorded. Statistical analysis involved logistic regression and chi2 tests to identify differences between groups at p < 0.05. RESULTS: Of the 144 restorations, 65 showed minimal cervical leakage in enamel, 5 suffered leakage into dentin and 74 were free of microleakage. No statistically significant differences were found in cervical microleakage between the adhesive systems or between filling procedures. Occlusal microleakage in the enamel was present in 16 of the 160 restorations. Liner Bond 2 restorations leaked significantly more at the occlusal surface (p < 0.05). Pooling of the adhesive was significantly less when PhotoBond was used. No spontaneous postoperative sensitivity was reported. Twenty-eight restorations were sensitive to loading. Postoperative sensitivity was significantly less in patients with Liner Bond 2 restorations. CONCLUSIONS: The adhesive systems used in this study showed minimal leakage into dentin in vivo. Using Liner Bond 2, restorations exhibited more occlusal leakage but were significantly less sensitive to loading.     

Three-year clinical evaluation of the Clearfil Liner Bond system

Modern dental adhesive systems have improved the bond of restorative materials to mineralized tooth structures. The purpose of this study was to evaluate the clinical performance of composite restorations placed in abrasion and erosion lesions using the Clearfil Liner Bond dental adhesive system. Following ADA clinical guidelines for dentin and enamel adhesive materials, 62 facial class 5 smooth surface erosion or abrasion lesions with no undercuts and involving primarily root surfaces were restored in 25 adult male and female patients. The teeth were restored without preparations using Clearfil Liner Bond and Clearfil Photo Anterior composite resin. The clinical performance of the restorations was assessed by two examiners at baseline, 6 months, 1, 2, and 3 years using the following evaluative parameters: color match, marginal discoloration, and marginal integrity according to modified Ryge criteria; the presence or absence of recurrent decay; pre- and postoperative sensitivity; and restoration failure due to loss of retention or other causes. At the end of 3 years, four of the 55 restorations remaining in the study failed due to lack of retention (92.7% retention rate). The evaluations of the other clinical parameters demonstrated excellent performance by this system.     

Amalgam alternatives--micro-leakage evaluation of clinical procedures. Part I: direct composite/composite inlay/ceramic inlay

This study investigated the degree of dye penetration with three different types of tooth-coloured restorations. Twenty-four intact extracted molars were collected. The teeth were immediately stored in water at room temperature. Class II cavity preparations were prepared and restored with three different types of tooth-coloured restorations: A, composite resin in the incremental technique; B, composite inlay technique; and C, ceramic inlay. Specimens were subjected to 700 cycles of thermal stress. They were than immersed in 2% basic fuchsin dye. The teeth were sectioned in three planes before being ranked as to the amount of dye penetration. The highest score obtained on three plano-parallel sections was adopted as the representative value. The three groups were compared using the Kruskal Wallis non-parametric test. Dye penetration was significantly lower at the enamel margins when using the composite inlay system and the incremental technique compared to the ceramic inlay technique. The restorations placed using the composite inlay technique showed less dye penetration than the incremental technique at the dentine margins (P < 0.017).     

Increased apoptotic cells in bone marrow biopsies from patients with aplastic anaemia

PURPOSE: To evaluate the 2-year clinical performance of two polyacid-modified resin composites and two resin-modified glass ionomers in Class V carious cavities. MATERIALS AND METHODS: A total of 120 Class V cavities were selected and 30 cavities were restored with one of two resin-modified glass ionomer materials (Fuji II LC Improved and Vitremer) and two polyacid-modified resin composites (Dyract and Compoglass) in Class V carious cavities after 2 years. The restorations were clinically evaluated after 1 and 2 years using the USPHS criteria. RESULTS: One-year findings revealed a significant difference in color match between Vitremer and other materials (P < 0.05) and no significant difference was found for the other criteria. Two-year results indicated a significant difference between resin-modified glass ionomers and polyacid-modified resin composite materials. The difference between Compoglass and Dyract was not statistically significant whereas the difference between Vitremer and Fuji II LC was statistically significant. Caries was not recorded at any evaluation period.     

The epidemiology of Neisseria gonorrhoeae isolates in Greenland 1979-1990: the emergence, spread and disappearance of non-PPNG strains carrying the conjugative 38.9 kb plasmid

The aim of this study was to compare the clinical performance of an amalgam, a glass polyalkenoate (ionomer) cerment material and a resin-based composite material used in small Class II cavities in permanent teeth. All restorations were inserted under rubber dam. They were examined yearly for 3 years. One clinician continued the study up to 5 years. The clinical examination focused on two criteria: clinically acceptable and failure. In addition, impressions were taken of the prepared cavities immediately before restoration and at each clinical examination using an elastomeric material. The study comprised 274 Class II restorations (88 amalgams, 95 cerments and 91 resin composites) placed in 142 adolescent patients. One hundred and sixty-seven restorations were in molar and 107 in premolar teeth. Patient dropout after 5 years resulted in the loss of 161 restorations, evenly distributed for restorative material and type of tooth involved. Four amalgam restorations, 22 glass ionomer cerment and nine resin composite restorations failed. The glass ionomer cerment and amalgam restorations failed primarily due to bulk fractures, while the resin composite restorations failed due to secondary caries and bulk fractures.     

Effect of aging on microleakage of restorative systems

This study evaluated the sealing properties of AP.H/Prisma Universal Bond 3, Z100/Scotchbond MultiPurpose, AP.H/Imperva Bond, Charisma/Denthesive, Bisfil M/All-Bond 2, resin composite/dentin adhesive systems and Fuji II LC light-cured glass ionomer, in Class V preparations following 6 months of storage in a 37 degrees C water bath. The Class V preparations extended just beyond the cemento-enamel junction of extracted human molars. The restored teeth were placed in 37 degrees C water for 24 hours and then thermally stressed for 100 temperature cycles. Half of the specimens were tested for microleakage at this time. The other specimens were returned to water storage and thermally stressed every 30 days during the following 6 months and then assessed for microleakage by dye penetration. AP.H/Imperva Bond, Z100/Scotchbond Multi-Purpose and Fuji II LC were not affected by the storage, while AP.H/Prisma Universal Bond 3, Charisma/Denthesive and Bisfil M/All-Bond 2 revealed some increase in microleakage at the dentin/cememtum margin.     

Influence of finishing time on marginal sealing ability of new generation composite bonding systems

Although variation in finishing techniques has been shown to affect microleakage, little research has been published on the influence of finishing time on the marginal sealing ability of new generation composite bonding systems. The objective of the present study was to evaluate the influence of finishing time on the enamel and dentine marginal sealing ability of four new generation composite systems. Two class V preparations, which were solely in enamel or dentine, were made on the buccal surfaces of 96 freshly extracted molar teeth. The teeth were randomly divided into four groups of 24 and restored with composite resin (Silux Plus) utilizing the following bonding systems: Scotchbond Multi-purpose, Fuji Bond LC, Prime & Bond 2.0 and Bisco One-step. Half of the restorations in each group were finished immediately after light polymerization and stored for 1 week. For the remaining restorations, finishing was delayed for 1 week. The storage medium was isotonic saline at 37 degrees C throughout the experiment. All restorations were then thermocycled, subjected to dye penetration testing, sectioned and scored. The results suggest that the finishing of composite restorations, bonded with the bonding systems evaluated, should be carried out immediately after light polymerization. Delayed finishing does not improve but instead can be detrimental to the marginal seal of the restorations. The effects of delayed finishing are, however, both bonding system and tissue specific.     

In vitro inhibition of caries around a resin composite restoration containing antibacterial filler

Class V cavities were prepared and restored with resin composite containing antibacterial filler powder (Apacider-AW, Ap-AW) using experimental restorations. The restored teeth were incubated in vitro with the cariogenic bacteria Streptococcus mutans IFO 13955. Ground sections were then prepared and examined using macrophotography. Lesions of the outer and inner wall were noted, and the depths of which the lesions penetrated were measured. We found that, in restorations containing 1-5 wt% Ap-AW, caries penetrated the marginal area, while in restorations containing 10 wt% Ap-AW the margin remained free of caries out to a distance of about 1.1 and 1.8 mm on the occlusal and gingival sides, respectively.     

New England eye care survey

Amalgambond Plus with a high-performance additive was evaluated for its ability to bond a resin composite or an amalgam alloy to deep dentin in primary teeth with nonretentive cavity preparations. The clinical performance of amalgam and resin composite mesio-occlusodistal restorations bonded with Amalgambond Plus was evaluated at 15 months and 2 and 3 years. There was no statistically significant difference in the retention, marginal adaptation, secondary caries, and post-operative sensitivity over the times of the evaluation or between amalgam and resin composite restorations. After 3 years, most of the teeth were extracted because it was their exfoliation time, and 29 restorations limited within buccal and lingual cusps were evaluated for marginal leakage. There were no significant differences in microleakage between amalgam and resin composite restorations lined with Amalgambond Plus. Amalgambond Plus has the potential for serving successfully as a cavity liner with either amalgam or resin composite restorations.     

Ten-year clinical assessment of three posterior resin composites and two amalgams

OBJECTIVE: The long-term clinical performance of three posterior resin composites and two amalgams was assessed. METHOD AND MATERIALS: Thirty Class II restorations each of P-30, Occlusin, Clearfil Posterior (composites), New True Dentalloy, and Solila Nova (amalgams) were placed. Reviews took place at 6 months and at 1, 2, 3, 4, 5, and 10 years. At each visit the gingival condition, the contact point status, and the presence of ledges, gaps, or recurrent caries were assessed. The color match, cavosurface marginal stain, general surface stain, tarnish, and corrosion were also scored where applicable. Epoxy resin replicas were used to measure the maximum depth of wear. RESULTS: After 10 years, there had been corrosion of both the high- and low-copper amalgams and a slight deterioration in color match of a number of composite restorations. Eighteen (of 20) Occlusin restorations had obvious cavosurface marginal stain, attributed to staining of the unfilled bonding resin layer. Statistical analysis indicated that New True Dentalloy, Solila Nova, and Clearfil-P exhibited significantly less wear than Occlusin and P-30. None of the restorations examined at the 10-year recall required replacement. CONCLUSION: The five materials, placed in a dental school environment, provided adequate clinical service for 10 years.     

Hematological changes in infectious diseases. Hematological consequences of bacterial, protozoal and spirochetal infections (2)

Thirty-six Class V amalgam restorations were placed in 29 patients. Prior to insertion of the amalgam in 12 cavities the walls were treated with Amalgam Liner and in another 12 cavities with Copalite. The remaining 12 cavities were not treated before amalgam insertion. The margin quality was determined quantitatively with the SEM using replicas obtained immediately after the polishing of the restorations and 6 months later. At baseline the cavities treated with Copalite showed a margin quality identical to the untreated cavities. Cavities treated with Amalgam Liner showed an inferior margin quality. After 6 months the margin quality of the three groups showed no statistical differences. With neither of the liners tested was it possible to improve the margin quality of amalgam restorations.     

Marginal adaptation of resin in relation to application technique and use of a dental adhesive system

Class V abrasion, erosion and caries lesions restored with composite resin seem to be more susceptible to microleakage, because the gingival margin is usually placed in cementum and/or dentine. The purpose of this study was to evaluate the microleakage, in vitro, of a dentinal bonding system using a technique of restoration with a positive and a negative control. This study was accomplished using extracted human teeth and dye penetration technique. The teeth were examined for microleakage after one month. It was concluded that in the gingival wall of the cavity microleakage was significantly reduced when the dentinal bonding agent and composite resin was placed and polymerized incrementally from enamel, to cementum.     

Marginal adaptation of resin-bonded light-cured glass ionomers in dentin cavities

PURPOSE: To investigate the marginal adaptation of resin-modified glass ionomer cements in dentin cavities placed with or without additional application of resin bonding systems. MATERIALS AND METHODS: Three resin-modified materials (Fuji II LC, Photac-Fil, Vitremer), one compomer (Dyract) and as reference an adhesively bonded resin composite system (Gluma CPS-Pekafill) were used. Flat peripheral dentin surfaces on human molar teeth were produced by wet grinding on SiC paper. Cylindrical cavities, 3.5 mm wide, were prepared in these dentin areas and restored with the individual materials. Sixty cavities were pretreated and restored as requested by the respective manufacturers. Following water storage of the specimens for 15 minutes or 24 hours, excess was gently removed by wet grinding for microscopic inspection of the marginal area. Additionally, in 30 cavities an experimental one-component adhesive resin system, a proprietary dimethacrylate and HEMA mixture dissolved in acetone, was combined with each of the restoratives for evaluation after 15-minutes water storage. Finally, in six cavities each, Dyract was combined with Prime and Bond 2.0, and Vitremer with Scotchbond Multi-Purpose Plus for assessment after 15 minutes. Maximum marginal gap widths (MGW) were measured. One-way ANOVA by ranks (Kruskal-Wallis-Test) followed by Wilcoxon's Two-Sample test were used to study the statistical difference of MGW among the treatment groups at a rejection level P = 0.05. RESULTS: Neither the conventionally placed material systems nor the restorations in combination with adhesives showed consistently gap-free margins after 15-minute water storage. After 24-hour storage with Vitremer 4 of the 6 restorations were gap-free, whereas with all other materials only perfect margins were registered. There was, however, no significant difference between the groups. Application of the experimental and/or the specific resin bonding agents had no effect on early MGW except for the Photac-Fil group, which was significantly reduced.     

Microleakage of cervical restorations etched with a weak organic acid

This in-vitro study evaluated the microleakage of Class V restorations prepared using 10 per cent maleic acid and a composite resin. Thirty human premolar teeth were evenly distributed and randomly assigned to three groups. Conventional retentive preparations, etched with 10 per cent maleic acid for either 15, 30, or 60 seconds, were cut in the enamel on the facial surface of each tooth to a 1.5 mm depth (dentin). All teeth were restored with Z-100, a small particle composite resin. The teeth were then stored in deionized water for seven days, thermocycled, stained with methylene blue dye, invested, and sectioned vertically through the centre of the restoration. Leakage was established along each wall of the sectioned restoration. Analysis of variance (ANOVA) tests indicate that the restored teeth in Group 1 (15-second etch) had significantly greater microleakage (p < 0.05) on the enamel wall than the restored teeth in Group 2 (30-second etch) or Group 3 (60-second etch). In addition, Group 1 restorations had significantly greater overall microleakage (p < 0.05) than Group 2 or Group 3 restorations. Although the results were not statistically significant, it would appear that etching with 10 per cent maleic acid for 30 seconds could be clinically significant. Since a 30-second etch time was found to produce the least amount of microleakage (not statistically significant), it can be assumed that this etch time would also be optimal for etching enamel and dentin. Similarly, since Group 1 revealed the most overall microleakage, it can be assumed that a 15-second etch would be inadequate for etching enamel and dentin. Restorations in Groups 2 and 3 displayed statistically significant lower overall microleakage results.     

Microleakage of multi-step and simplified-step bonding systems

PURPOSE: To measure and compare the microleakage of Class V resin composite restorations using the following three pairs of multi- and simplified-step dentin bonding systems (DBS): OptiBond vs. OptiBond FL, All-Bond 2 vs. One-Step, and Tenure vs. Tenure Quik. MATERIALS AND METHODS: V-shaped cavities were prepared in the mesial and distal surfaces of 30 extracted human mandibular molars with margins in both enamel and cementum, and randomly assigned into three equal groups of 10 each. All DBSs were applied strictly following manufacturers' specifications before three incremental layers of resin composite (Pertac-Hybrid) were applied in all cavities. Specimens were stored for 7 days in 37 degrees C water, thermocycled for 300 cycles between 5 degrees C and 55 degrees C, immersed in 0.5% basic fuchsin solution for 24 hours, and embedded in resin before being sectioned longitudinally in multiple sections. Dye solution penetration at the tooth/composite interface was scored from 0 to 4 under a microscope at x100 at both enamel (E) and cementum (C) margins. Data were analyzed by Kruskal-Wallis and Mann-Whitney U tests with alpha = 0.05. RESULTS: OptiBond FL and One-Step showed less microleakage at the cementum margins compared to their multi-step versions. At the enamel margins Tenure Quik showed less microleakage compared to Tenure, and none of the other DBSs tested showed significant dye penetration at that interface. All DBSs showed significantly less microleakage at the enamel margins compared to the cementum margins except for OptiBond FL and One-Step that did not show any significant dye penetration at the cementum margins as well.     

Low-frequency ultrasound treatment of chronic venous leg ulcers in an outpatient therapy

An in vitro dye leakage study was performed to compare the sealing ability of glass ionomer, composite resin and glass ionomer/resin cement when used as restorative materials for G.V. Black class V cavities. In this research, standard Class V cavities were prepared in sound premolar teeth extracted for orthodontic reasons. The cavities were randomly divided into 3 groups. After filling the cavities with glass ionomer cement, composite resin and light curing glass ionomer/resin cement, the specimens were immersed in silver nitrate solution. Marginal microleakage at the interface between the cavity wall and restoration was evaluated. The results were analyzed by using Kruskal-Wallis and Mann Whitney U tests. Result of this in vitro study indicate that composite resin and glass ionomer/resin cement provide a better seal than glass ionomer cement.     

Establishing approximal contacts in Class 2 composite resin restorations

Ensuring adequate approximal contacts when performing class 2 composite resin restorations is a significant challenge for the dentist. Fabrication of custom composite cylinders for placement into prepared cavity preparations enables the dentist to wedge the matrix band firmly against adjacent teeth, as well as eliminating the curing contraction variable that occurs when composite restorations are placed. Thus, predictable approximal contacts are obtained when class 2 composite restorations are completed.     

Use of granulocyte macrophage colony stimulating factor in children after orthotopic liver transplantation

The objective of this study was to present quantitative data concerning prostatic growth during the foetal period (gestational age: 13 to 36 weeks) and to provide normal curves of the growth of the prostatic volume correlated with foetal age and weight, using the allometric method. This study was performed on 45 non-fixed human male foetuses, in a good state of preservation and not presenting any congenital malformations. The gestational age of the foetuses ranged from 13 to 36 weeks. Analysis of correlations showed that growth curves presented an angle less than 45 degrees, indicating that growth of the foetal prostate is slower than that of the individual as a whole. The authors also found a statistically significant correlation (p < 0.001) between prostatic volume and foetal weight during the foetal period.     

Value of the search for anticardiolipin antibodies during the course of systemic lupus erythematosus

This study investigates the shear bond strengths (SBS) of different products used for bonding amalgam to dentine and the marginal seal provided by these materials. The SBS test was carried out by bonding cylinders of Dispersalloy amalgam to human dentine with an intermediate layer of Amalgambond Plus, All-Bond 2, Imperva Bond/Dual or Scotch Bond Multi-Purpose was first placed. Thereafter the samples were tested to failure in the shear mode. For the microleakage test, standardized class V cavities were prepared in human molars with one cavo margin abutting enamel and another dentine/cementum. Amalgam was condensed into the cavities, pretreated with one of the products mentioned above. In addition two further groups were prepared. One receiving treatment with Polyvar varnish and the other remained untreated as the control. Microleakage was assessed with a reflecting light microscope using I.S.O. criteria and the fracture sites and marginal gaps were examined in a scanning electron microscope. Results indicate that All-Bond 2 and Amalgambond Plus induced similar SBS and Scotchbond Multi-Purpose the weakest. At both enamel and dentine/cementum junctions resin bonding agents reduced microleakage. However, this reduction was greater at the enamel interface than at the other. Varnish allowed the greatest amount of marginal leakage and leakage was similar to the untreated control. Amalgam bonding agents are more effective at preventing marginal leakage at the enamel margin than at the dentine/cementum margin. Cavity varnish is not effective in preventing microleakage around amalgam restorations. There is a correlation between shear bond strength and marginal leakage. Materials giving the highest shear bond strength also exhibited the least marginal leakage. All-Bond 2, Amalgambond Plus and Imperva Bond/Dual are recommended to improve the seal around amalgam restorations.     

Intraoral repair of cosmetic restorations

The longevity of porcelain and composite resin restorations can often be prolonged by using sound principles, up-to-date materials, and judicious attention to repair when fracture problems arise. Careful case selection and correct usage of surface treatment agents, followed by the use of a quality bonding system and restorative materials, can result in a repair that exhibits excellent retention and natural color blending. This article outlines procedures and materials to repair both resin composite and porcelain intraorally.