Clinical Effectiveness of Direct Class II Restorations - A Meta-Analysis

The journal of adhesive dentistry (Impact Factor: 1.31). 10/2012; 14(5):407-31. DOI: 10.3290/j.jad.a28390
Source: PubMed


More than five hundred million direct dental restorations are placed each year worldwide. In about 55% of the cases, resin composites or compomers are used, and in 45% amalgam. The longevity of posterior resin restorations is well documented. However, data on resin composites that are placed without enamel/dentin conditioning and resin composites placed with self-etching adhesive systems are missing.

Material and methods:
The database SCOPUS was searched for clinical trials on posterior resin composites without restricting the search to the year of publication. The inclusion criteria were: (1) prospective clinical trial with at least 2 years of observation; (2) minimum number of restorations at last recall = 20; (3) report on dropout rate; (4) report of operative technique and materials used; (5) utilization of Ryge or modified Ryge evaluation criteria. For amalgam, only those studies were included that directly compared composite resin restorations with amalgam. For the statistical analysis, a linear mixed model was used with random effects to account for the heterogeneity between the studies. P-values under 0.05 were considered significant.

Of the 373 clinical trials, 59 studies met the inclusion criteria. In 70% of the studies, Class II and Class I restorations had been placed. The overall success rate of composite resin restorations was about 90% after 10 years, which was not different from that of amalgam. Restorations with compomers had a significantly lower longevity. The main reason for replacement were bulk fractures and caries adjacent to restorations. Both of these incidents were infrequent in most studies and accounted only for about 6% of all replaced restorations after 10 years. Restorations with macrofilled composites and compomer suffered significantly more loss of anatomical form than restorations with other types of material. Restorations that were placed without enamel acid etching and a dentin bonding agent showed significantly more marginal staining and detectable margins compared to those restorations placed using the enamel-etch or etch-and-rinse technique; restorations with self-etching systems were between the other groups. Restorations with compomer suffered significantly more chippings (repairable fracture) than restorations with other materials, which did not statistically differ among each other. Restorations that were placed with a rubber-dam showed significantly fewer material fractures that needed replacement, and this also had a significant effect on the overall longevity.

Restorations with hybrid and microfilled composites that were placed with the enamel-etching technique and rubber-dam showed the best overall performance; the longevity of these restorations was similar to amalgam restorations. Compomer restorations, restorations placed with macrofilled composites, and resin restorations with no-etching or self-etching adhesives demonstrated significant shortcomings and shorter longevity.

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Available from: Siegward Heintze, May 06, 2015
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    • "Inferior bonding and resin composite shrinkage resulted in lack of adaptation to the cavity walls, and as a consequence, an increased susceptibility to caries and high frequency of postoperative symptoms was expected [8]. Secondary caries has been the main reason for replacement of restorative materials as reported in cross sectional and prospective studies [5] [8] [9]. Dental restorations do have a limited lifespan and replacement of a failed restoration leads to increase of cavity size and destruction of tooth tissues [10]. "
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    ABSTRACT: Objective: To evaluate the durability of three conventional resin composites in Class II restorations during 27 years. Methods: Thirty participants, 25 female and 5 male (mean age 38.2 yrs, range 25-63), received at least three (one set) as similar as possible Class II restorations of moderate size. The three cavities were chosen at random to be restored with a chemical-cured (Clearfil Posterior) and two visible light-cured resin composites (Adaptic II, Occlusin). A chemical-cured enamel bonding agent (Clearfil New Bond) was applied after Ca(OH)2 covering of dentin and enamel etch. Marginal sealing of the restorations was performed after finishing. One operator placed 99 restorations (33 sets). Evaluation was performed with slightly modified USPHS criteria at baseline, 2, 3, 10 and 27 years. Results: Postoperative sensitivity was observed in 5 patients. Three participants with 11 restorations (11%) could not be evaluated at the 27 year recall. Thirty-seven restorations failed (13 AII, 10CP and 14 O). The overall success rate after 27 years was 56.5% (AII 55.2%, CP 63.0%, O 51.7%; p=0.70), with an annual failure rate of 1.6%. The main reason for failure was secondary caries (54.1%), followed by occlusal wear (21.6%) and material fracture (18.9%). Non-acceptable color match was seen in 24 (28.3%) of the restorations (AII 2, CP 16, O 6). Cox regression-analysis showed significant influence of the covariates tooth type, caries risk, and bruxing activity of the participants. Conclusions: Class II restorations of the three conventional resin composites showed an acceptable success rate during the 27 year evaluation.
    Dental materials: official publication of the Academy of Dental Materials 08/2015; 31(10). DOI:10.1016/ · 3.77 Impact Factor
    • "These outcomes may be the reason why common causes of restoration failure include bulk fracture of the RBC, secondary caries due to adhesive failure between the tooth and RBC, and breakdown of the margin (Bernardo et al. 2007; Opdam et al. 2007; Sunnegardh- Gronberg et al. 2009; Overton and Sullivan 2012; Rasines Alcaraz et al. 2014). The use of RBCs is increasing (Heintze and Rousson 2012) and will continue to increase with the worldwide phasedown in the use of amalgam (Federation FDI 2014). Although dental "
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    ABSTRACT: For improved interstudy reproducibility, reduced risk of premature failures, and ultimately better patient care, researchers and dentists need to know how to accurately characterize the electromagnetic radiation (light) they are delivering to the resins they are using. The output from a light-curing unit (LCU) is commonly characterized by its irradiance. If this value is measured at the light tip, it describes the radiant exitance from the surface of the light tip, and not the irradiance received by the specimen. The value quoted also reflects only an averaged value over the total measurement area and does not represent the irradiance that the resin specimen is receiving locally or at a different moment in time. Recent evidence has reported that the spectral emission and radiant exitance beam profiles from LCUs can be highly inhomogeneous. This can cause nonuniform temperature changes and uneven photopolymerization within the resin restoration. The spectral radiant power can be very different between different brands of LCUs, and the use of irradiance values derived from dental radiometers to describe the output from an LCU for research purposes is discouraged. Manufacturers should provide more information about the light output from the LCU and the absorption spectrum of their resin-based composite (RBC). Ideally, future assessments and research publications should include the following information about the curing light: 1) radiant power output throughout the exposure cycle and the spectral radiant power as a function of wavelength, 2) analysis of the light beam profile and spectral emission across the light beam, and 3) measurement and reporting of the light the RBC specimen received as well as the output measured at the light tip. © International & American Associations for Dental Research 2015.
    Journal of dental research 07/2015; 94(9). DOI:10.1177/0022034515594786 · 4.14 Impact Factor
    • "Recently a meta-analysis has pointed out that POS is a very infrequent finding, not affected by the type of adhesive strategy (ER or SE) employed [32]. This study [32] has some limitations. Firstly, the authors have not applied a broad and sensitive search strategy and only one database was used. "
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    ABSTRACT: A systematic review and meta-analysis were performed on the risk and intensity of postoperative sensitivity (POS) in posterior resin composite restorations bonded with self-etch (SE) and etch-and-rinse (ER) adhesives. A comprehensive search was performed in the MEDLINE via PubMeb, Scopus, Web of Science, LILACS, BBO and Cochrane Library and SIGLE without restrictions. The abstracts of the annual conference of the IADR (1990-2014), unpublished and ongoing trials registry were also searched. Dissertations and theses were searched using the ProQuest Dissertations and Periodicos Capes Theses databases. We included randomized clinical trials that compared the clinical effectiveness of SE and ER used for direct resin composite restorations in permanent dentition of adult patients. The risk/intensity of POS was the primary outcome. The risk of bias tool of the Cochrane Collaboration was used. The meta-analysis was performed on the studies considered 'low' risk of bias. After duplicates removal, 2600 articles were identified but only 29 remained in the qualitative synthesis. Five were considered to be 'high' risk of bias and eleven were considered to be 'unclear' in the key domains, yielding 13 studies for meta-analysis. The overall relative risk of the spontaneous POS was 0.63 (95% CI 0.35 to 1.15), while the stimuli-induced POS was 0.99 (95% CI 0.63 to 1.56). The overall standardized mean difference was 0.08 (95%CI -0.19 to 0.35). No overall effect was revealed in the meta-analyses, meaning that no influence of the ER or SE strategy on POS. The type of adhesive strategy (ER or SE) for posterior resin composite restorations does not influence the risk and intensity of POS. CRD42014006617. Copyright © 2015 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.
    Dental materials: official publication of the Academy of Dental Materials 06/2015; 31(9). DOI:10.1016/ · 3.77 Impact Factor
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