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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    • "Composite adhesive restorations are a durable and reliable method for the rehabilitation of posterior teeth affected by caries.[1] [2] [3] [4] The success of a restoration and its durability depend on many factors related to the various stages of the restorative procedure. Among them, an often overlooked aspect is the finishing of cavity margins. "
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    ABSTRACT: Objectives: The finishing of the gingival floor and its margins is regarded to be necessary in Class II cavities, so the aim of this research was to evaluate 4 finishing systems for the cervical margins of Class II cavities, with regard to surface roughness and waviness. Methods: Eighty Class II cavities were prepared in 20 intact molars by a single operator, using a diamond-coated bur (granulometry 80 μm) mounted on a parallelometer, under magnification (5x, Zeiss) in order to reduce variability. In every tooth, 4 different finishing methods were randomly applied: A: carbide bur; B: straight hand chisel; C: diamond-coated bur 60 μm; and D: diamond-coated sonic instrument. After that, the gingival floor of each cavity was analysed with an optical profilometer. Mean surface roughness (Ra) and mean surface waviness (Wa) were evaluated with an optical device. Results were analysed with ANOVA after ln-transformation of data. One- and two-way ANOVA was applied. Results: There was no statistically significant difference between the 4 test groups for Ra which was in the range between 0.76 and 0.92 μm. For Wa, the diamond bur produced significantly lower waviness values (mean Wa 5.2 μm) than the other three instruments (mean Wa between 5.7 and 7.7 μm). The variability of Ra and especially Wa was very high: the coefficient of variation of Ra was between 23% and 38%, that of Wa between 52 and 57%. Conclusions: As there was no difference between the four instruments considering surface morphology, the efficient and safe sonic instruments should be chosen over the other three instruments for finishing proximal boxes of Class II cavities.
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    • "In clinical dentistry, there is a shift toward placing metalfree restorations. For direct restorations, resin composite has become the standard material that, depending on risk factors of tooth and patient, provides restorations with good longevity [1] [2] [3]. Indirect restorations allow the dentist to have greater control of the form and function of a restoration, especially for teeth with considerable amount of tooth substance loss. "
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    ABSTRACT: Abstract: Objective: To elucidate the fatigue behavior of CAD/CAM resin composite molar crowns using a mouth-motion step-stress fatigue test. Monolithic leucite-reinforced glass-ceramic crowns were used as reference. Methods: Fully anatomically shaped monolithic resin composite molar crowns (Lava Ultimate, n = 24) and leucite reinforced glass-ceramic crowns (IPS Empress CAD, n = 24) were fabricated using CAD/CAM systems. Crowns were cemented on aged dentin-like resin composite tooth replicas (Filtek Z100) with resin-based cements (RelyX Ultimate for Lava Ultimate or Multilink Automix for IPS Empress). Three step-stress profiles (aggressive, moderate and mild) were employed for the accelerated sliding-contact mouth-motion fatigue test. Twenty one crowns from each group were randomly distributed among these three profiles (1:2:4). Failure was designated as chip-off or bulk fracture. Optical and electronic microscopes were used to examine the occlusal surface and subsurface damages, as well as the material microstructures. Results: The resin composite crowns showed only minor occlusal damage during mouth-motion step-stress fatigue loading up to 1700 N. Cross sectional views revealed contact-induced cone cracks in all specimens, and flexural radial cracks in 2 crowns. Both cone and radial cracks were relatively small compared to the crown thickness. Extending these cracks to the threshold for catastrophic failure would require much higher indentation loads or more loading cycles. In contrast, all of the glass ceramic crowns fractured, starting at loads of approximately 450 N. Significance: Monolithic CAD/CAM resin composite crowns endure, with only superficial damage, fatigue loads 3 - 4 times higher than those causing catastrophic failure in glass-ceramic CAD crowns.
    Full-text · Article · Dec 2015 · Dental Materials
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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.
    Full-text · Article · Aug 2015 · Dental materials: official publication of the Academy of Dental Materials
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