Article

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

The journal of adhesive dentistry (Impact Factor: 1.44). 10/2012; 14(5):407-31. DOI: 10.3290/j.jad.a28390
Source: PubMed

ABSTRACT Purpose: 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. Results: 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. Conclusion: 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.

Full-text

Available from: Siegward Heintze, May 06, 2015
2 Followers
 · 
139 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: A Michelson interferometer-based approach was developed to accurately measure the axial shrinkage dynamics and topography of fast curing resin-based composites. The main components of the apparatus consist of a helium–neon laser and a charged coupled device camera with an acquisition rate of 122 frames per second capable of measuring shrinkage rates of up to 19.3 μm/s at a spatial resolution of 20.6 μm. The accuracy of the data obtained using this approach was determined by comparison with data obtained using spherical concave mirrors of known focal lengths, and with data collected using a photodiode and stylus-based profilometer.
    Applied Optics 03/2015; 54(7). DOI:10.1364/AO.54.001852 · 1.69 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The aim of this meta-analysis, based on individual participant data from several studies, was to investigate the influence of patient-, materials-, and tooth-related variables on the survival of posterior resin composite restorations. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a search resulting in 12 longitudinal studies of direct posterior resin composite restorations with at least 5 years' follow-up. Original datasets were still available, including placement/failure/censoring of restorations, restored surfaces, materials used, reasons for clinical failure, and caries-risk status. A database including all restorations was constructed, and a multivariate Cox regression method was used to analyze variables of interest [patient (age; gender; caries-risk status), jaw (upper; lower), number of restored surfaces, resin composite and adhesive materials, and use of glass-ionomer cement as base/liner (present or absent)]. The hazard ratios with respective 95% confidence intervals were determined, and annual failure rates were calculated for subgroups. Of all restorations, 2,816 (2,585 Class II and 231 Class I) were included in the analysis, of which 569 failed during the observation period. Main reasons for failure were caries and fracture. The regression analyses showed a significantly higher risk of failure for restorations in high-caries-risk individuals and those with a higher number of restored surfaces.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: This prospective clinical trial evaluated the longevity of direct resin composite (DRC) restorations made on stained dentin that is exposed upon removal of existing amalgam restorations in extensive cavities with severely reduced macro-mechanical retention for amalgam replacement. Methods: Between January 2007 and September 2013, a total of 88 patients (57 women, 31 men; mean age: 51.6 years old) received extensive cusp replacing DRCs (N=118) in the posterior teeth. DRCs were indicated for replacement of existing amalgam restorations where dentin substrates were stained by amalgam. After employing 3-step total-etch adhesive technique (Quadrant Unibond Primer, Quadrant Unibond Sealer, Cavex), cavities were restored using a hybrid composite (Clearfil Photo Posterior, Kuraray). At baseline and thereafter every 6 months, restorations were checked upon macroscopically visible loss of anatomical contour, marginal discoloration, secondary caries, fractures, debonding and endodontic problems. Restorations were scored as failed if any operative intervention was indicated for repair, partial or total replacement.
    Journal of Dentistry 06/2014; 42(11). DOI:10.1016/j.jdent.2014.06.008 · 2.84 Impact Factor