The objective of this study was to investigate the effect of operator variability on the marginal performance of resin composite restorations bonded with an acetone-base one-bottle adhesive in standardized dentin preparations.
Five general practitioners were recruited for this trial. In the first group, each dentist received six extracted human teeth with dentin preparations (Ø 3.5 mm, 1.5 mm deep), cut in flatground proximal dentin, and original packages of Gluma One Bond adhesive and Charisma resin composite (Heraeus-Kulzer, Werheim, Germany) including instructions for use. For the second group, the operators were orally instructed, emphasizing the importance of the moist technique, before they received another six teeth for restoration with the same materials. Finally, a third group of six preparations was restored in order to evaluate a possible training effect. The restored teeth were stored in a hygrophor prior to removal of excess material and microscopic determination of the maximum marginal gap width (MGW). Statistical analyses were performed with the Kruskal-Wallis and Wilcoxon tests at p < 0.05.
Apart from two samples, preparation margins in the first test group showed gaps between 1 and 12 microns. In the second and third groups, 15 and 16 restorations were gap free, respectively. Significant interoperator variation was found in the first group only. Marginal performance of group 1 restorations was significantly inferior to groups 2 and 3, which were not different (p = 0.79).
Application of the one-bottle adhesive is technique-sensitive and requires meticulous attention to the instructions.
"In the second part of the present study, rigorous instructions on the use of the different tested adhesive systems were delivered to the participants before they were asked to perform the three adhesive restorations on the lingual side of each tooth. Our results showed no statistical difference in mean microleakage score between before and after delivery of the instructions, which is in disagreement with the findings of Finger and Balkenhol . Therefore, following the manufacturer's instructions in using adhesive systems is very important for the success of adhesive restorations, but it is not the only important factor: other parameters include the distance between the tip of the air syringe and the surface of the cavity, orientation of the tip, and the air pressure of the syringe. "
[Show abstract][Hide abstract] ABSTRACT: Objectives. The aim of this study was to evaluate the influence of operator skill on microleakage in class V composite restorations. Materials and Methods. A total of 16 dentists and 25 dental students were enrolled, and 123 extracted teeth were allocated according to the adhesive being tested: Scotchbond Multipurpose, Adper Scotchbond 1 XT, and AdheSE. Each operator was asked to restore one tooth from each experimental group: two class V cavities were cut on each tooth and each adhesive was used on the same tooth before and after instructions for its use. After filling cavities with composite (Z100), the teeth were thermocycled. Results. For all of the tested adhesives, the mean microleakage score was lower for the dentists than for the students. The mean scores for the three tested adhesives were statistically similar before and after instructions for use. Conclusion. Our results indicate that the skill of the operator has a significant influence on microleakage.
"(Koliniotou-Koubia et al. 14 , 2001). In spite of its inherent toxicity, the aggressive potential of acetone is controversial due to its high and fast volatilization (Finger, Balkenhol 8 , 1999). The results of the study by Ivanyi et al. 12 (2002) suggest that dental bond materials applied on a very thin layer of dentin may affect the blood supply to the dental pulp. "
[Show abstract][Hide abstract] ABSTRACT: The vascular changes in the subcutaneous connective tissue of rats induced by dentin bonding systems (one step) was studied and compared to those induced by saline solution (negative control) and Furacin (positive control), during the exudative phase of the inflammatory process. Twenty mg/kg of Evan's blue were injected intravenously in the vein of the rats' penises; 0.1 ml of each substance tested was inoculated in the subcutaneous tissue. After a 3 hour period the animals were sacrificed and their skins were excised and punched out with a standard steel 2.5 cm in diameter. The specimens were immediately immersed in 8 ml of formamide and taken to a double boiler for 72 hours at 37 C, to remove the dye. The liquid containing the overflowed dye was filtered, analyzed in the spectrophotometer (620 nm) and classified according to the criteria established by Nagem-Filho, Pereira (1976). After statistical analysis, the irritative potential of the substances was ranked as follows: Furacin (severe) > Single Bond and Bond 1 (moderate - no significant differences between the dentin bonding systems tested) > saline solution (not significant as regards the irritation degree).
"Recognition over the last few years that the largest proportion of restoration failures arises from secondary (recurrent ) caries or complications (Deligeorgi et al., 2000, 2001) has led to technological advancements in dental materials, in an attempt to reduce their leakage characteristics and improve their longevity (Kugel and Ferrari, 2000). Operator handling (Ciucchi et al., 1997; Finger and Balkenhol, 1999) and surgical skill remain important for influencing treatment success, most likely due to the need for restorations to be finished with a very high technical quality (Murray et al., 2001). It is a pity that many student dentists do not have laboratory exercises where they can perfect their bonding technique by measuring bond strengths to teeth bonded in vitro, before they begin using them clinically (D.H. Pashley, personal communication). "
[Show abstract][Hide abstract] ABSTRACT: Every year, despite the effectiveness of preventive dentistry and dental health care, 290 million fillings are placed each year in the United States; two-thirds of these involve the replacement of failed restorations. Improvements in the success of restorative treatments may be possible if caries management strategies, selection of restorative materials, and their proper use to avoid post-operative complications were investigated from a biological perspective. Consequently, this review will examine pulp injury and healing reactions to different restorative variables. The application of tissue engineering approaches to restorative dentistry will require the transplantation, replacement, or regeneration of cells, and/or stimulation of mineralized tissue formation. This might solve major dental problems, by remineralizing caries lesions, vaccinating against caries and oral diseases, and restoring injured or replacing lost teeth. However, until these therapies can be introduced clinically, the avoidance of post-operative complications with conventional therapies requires attention to numerous aspects of treatment highlighted in this review.
Critical Reviews in Oral Biology & Medicine 02/2002; 13(6):509-20. DOI:10.1177/154411130201300607
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