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Objective: The aim of this study was to evaluate the clinical performance of a glass ionomer restorative system compared with a microfilled hybrid posterior composite in a four-year randomized clinical trial., Methods: A total of 140 (80 Class 1 and 60 Class 2) lesions in 59 patients were either restored with a glass ionomer restorative system (Equia, GC, Tokyo, Japan), which was a combination of a packable glass ionomer (Equia Fil, GC) and a self-adhesive nanofilled coating (Equia Coat, GC), or with a microfilled hybrid composite (Gradia Direct Posterior, GC) in combination with a self-etch adhesive (G-Bond, GC) by two experienced operators according to the manufacturer's instructions. Two independent examiners evaluated the restorations at baseline and at one, two, three, and four years postrestoration according to the modified US Public Health Service criteria. Polyvinyl siloxane impression negative replicas at each recall were observed under scanning electron microscopy (SEM) to evaluate surface characteristics. The statistical analyses were carried out with McNemar, Pearson Chi-square, and Cochran Q-tests (p<0.05)., Results: After four years, 126 (76 Class 1 and 50 Class 2) restorations were evaluated in 52 patients, with a recall rate of 88.1%. None of the restorations showed trends to downgrade in anatomical form, secondary caries, surface texture, postoperative sensitivity, and color match (p>0.05). Significant differences in marginal adaptation and discoloration were found at four years compared to baseline for both restorative materials for Class 1 and Class 2 restorations (p<0.05). Only one Class 2 Equia restoration was missing at three years (3.9%), and another one was missing at four years (7.7%) (p>0.05). SEM evaluations were in accordance with the clinical findings., Conclusions: The use of both materials for the restoration of posterior teeth exhibited a similar and clinically successful performance after four years.

Objective: The objective of this study was to evaluate the surface roughness (SR), water sorption (WS), and solubility (SO) of four composite resins after finishing/polishing and after one year of water storage., Materials and Methods: Two low-shrinkage composites (Filtek Silorane [3M ESPE] and Aelite LS [Bisco Inc]) and two composites of conventional formulations (Heliomolar and Tetric N-Ceram [Ivoclar Vivadent]) were tested. Their respective finishing and polishing systems (Sof-Lex Discs, 3M ESPE; Finishing Discs Kit, Bisco Inc; and Astropol F, P, HP, Ivoclar Vivadent) were used according to the manufacturers' instructions. Ten disc-shaped specimens of each composite resin were made for each evaluation. Polished surfaces were analyzed using a profilometer after 24 hours and one year. For the WS and SO, the discs were stored in desiccators until constant mass was achieved. Specimens were then stored in water for seven days or one year, at which time the mass of each specimen was measured. The specimens were dried again and dried specimen mass determined. The WS and SO were calculated from these measurements. Data were analyzed by two-way analysis of variance and Tukey post hoc test (α=0.05)., Results: Filtek Silorane showed the lowest SR, WS, and SO means. Water storage for one year increased the WS means for all composite resins tested., Conclusions: The silorane-based composite resin results were better than those obtained for methacrylate-based resins. One-year water storage did not change the SR and SO properties in any of the composite resins.

The aim of the present study was to evaluate the three-year clinical performance of a nanofilled resin composite, a packable resin composite, and silorane-based resin restorations in Class I occlusal cavities. Twenty-eight patients with at least three similar-sized occlusal lesions in molar teeth participated in the study. A total of 84 Class I occlusal restorations were placed: 28 with nanofilled resin composite (Filtek Supreme), 28 with packable resin composite (P60), and 28 with silorane-based resin (Filtek Silorane). Filtek Supreme and P60 were used with their respective etch-and-rinse adhesive system, Adper Single Bond 2, and Filtek Silorane was used with its respective self-etch adhesive, Filtek Silorane Adhesive. All restorations were placed by the same operator. The restorations were evaluated at baseline, at six months, and annually for three years according to modified US Public Health Service criteria by two calibrated examiners who did not know which restorative resin had been used. The three restorative materials for each category were compared using the χ (2) test at a significance level of 0.05. Cochran's Q test was used to compare the changes across the five time points for each restorative material. McNemar's test followed by Bonferroni adjustment was used when significance differences were found. At the end of the three years, 60 restorations were evaluated in 20 patients, with a recall rate of 71.4%. The retention rate was 100% for all restorative resins. Eight restorations from the P60 group, ten from the Filtek Supreme group, and nine from the Filtek Silorane group were rated Bravo for marginal discoloration. For marginal adaptation, three P60, five Filtek Supreme, and 11 Filtek Silorane restorations were rated Bravo. No statistically significant differences in overall clinical performance were found between the restorative materials except for marginal adaptation. P60 showed the best marginal adaptation at the end of the three years. No differences were observed between the restorative resins for any of the evaluation criteria tested (p>0.05). None of the restorations showed postoperative sensitivity, secondary caries, or loss of anatomic form. All restorative resins performed equally well in clinical conditions during the three-year evaluation, and no significant differences were found among them, except for marginal adaptation, in which P60 showed superior results.

Objectives: The aim of the present study was to evaluate the effect of four different sandwich techniques on gingival microleakage of Class II direct composite resin restorations., Materials and Methods: Fifty sound human premolars were selected and randomly divided into five groups (n=10). Class II box only cavities were prepared in one of the proximal surfaces of each tooth with a gingival margin located approximately 0.5 mm below the cemento-enamel junction. Group A (control) was restored incrementally with composite resin (Tetric Ceram). Groups B, C, D, and E were restored with the sandwich technique using a compomer (Compoglass F), flowable composite resin (Tetric Flow), self-cure composite resin (Degufill SC), or resin modified glass ionomer (Fuji II LC), respectively. After thermal-load cycling, the specimens were immersed in 0.5% basic fuschin for 24 hours. Dye penetration (10(-1) mm) was detected using a sectioning technique. Data were analyzed with repeated measurements and Duncan test at α=0.05., Results: The least amount of microleakage was detected in the incremental group (1.28 ± 0.98). The sandwich technique using resin modified glass ionomer (7.99 ± 9.57) or compomer (4.36 ± 1.78) resulted in significantly more leakage than did the sandwich technique using flowable (1.50 ± 1.97) or self-cure composite (2.26 ± 1.52)., Conclusion: According to the results of this study, none of the four sandwich technique composite resin restorations used in this study could reduce gingival microleakage to a greater degree than the incremental technique.

Purpose: To compare marginal leakage and gap formation in large resin composite Class II cavities with their gingival margins in cementum, using three different additional retentions in the proximal box., Methods: Standardized large Class II MOD cavities with gingival margins in cementum were prepared in 40 recently extracted molars and divided into four groups according to their retention in the proximal box: (G1) no retention; (G2) vertical grooves in the buccal and lingual walls; (G3) "pot holes" in the gingival wall and (G4) horizontal grooves in the gingival wall. All groups were restored with the incremental technique using the same resin composite (QuiXfil, Dentsply) and a bonding agent (Prime Bond NT, Dentsply). After polishing, all of the restored teeth were immersed in dye solution and submitted to simultaneous cyclic loading. Impressions of the gingival margins were made before and after loading, and epoxy resin replicas were evaluated for gap formation using a scanning electron microscope. The microleakage and gap extension data were evaluated by ANOVA and Tukey's test (p < 0.05). Gap extension before and after mechanical loading was compared by Student's t-test. A correlation analysis was made between the gap extension and microleakage (Pearson's correlation test)., Results: All groups with additional retention (G2 = 0.565, G3 = 0.346 and G4 = 0.078) showed fewer gap formations than the control group (G1 = 2.076). Similar results were found for microleakage tests. All groups presented an increase in gap extension after loading, with the exception of the group with gingival retention grooves (G4). G4 showed the best results in relation to both parameters. There was a low correlation between gap extension and microleakage.

In large posterior cavities, indirect restorations could provide improved performance when compared to direct restorations, but with higher cost and removal of sound tooth structure. Improved mechanical properties have resulted in good clinical performance for amalgam in large cavities but without an esthetic appearance. Resin composites have become popular for posterior restorations, mainly because of good esthetic results. A restorative technique is presented that combines the esthetic properties of directly bonded resin composite and the wide range of indications for amalgam in stress-bearing areas.

Purpose: The study tested the hypothesis that the application of a rubber dam influences the reconstruction of proximal contact strengths, while the corresponding contra-lateral teeth are not affected., Methods: Seventy-four systemically and periodontally healthy subjects in need of a direct posterior composite restoration were treated with the use of a rubber dam. The proximal contact strengths (PCS) were electronically evaluated by measuring frictional forces during removal of a 50.0 +/- 5.0 microm-thick straight metal band., Results: Proximal contact strengths significantly increased from 2.26 +/- 1.45N before to 3.83 +/- 2.34N after application of the rubber dam; whereas, the variation of PCS at the corresponding contacts in the contra-lateral quadrant remained within the intra-examiner variance of +/- 0.2N. Upon removal of the rubber dam, there was a statistically significantly drop in PCS from 3.54 +/- 1.87N to 2.31 +/- 1.35N. Again, there was only minimal change in the contra-lateral quadrant. It was concluded that application of the rubber dam affects proximal contact strengths.

Amelogenesis imperfecta is a hereditary condition that affects tooth enamel without systemic involvement. In the most severely affected patients, teeth can present alterations in enamel thickness, color and shape, all which compromise aesthetic appearance and mastigatory function. Several treatment options have been described to rehabilitate these patients, ranging from preventive intervention to a prosthodontic approach. Advances in the search for new techniques and bonding materials have provided less invasive treatment options. This study discusses the importance of preventive procedures and describes the clinical procedures of aesthetic and functional rehabilitation of a Brazilian adolescent with autosomal dominant amelogenesis imperfecta (ADAI) involving the use of direct and indirect resin composite restorations.

Gastroesophageal reflux disease (GERD) is a condition where stomach acids are chronically regurgitated into the esophagus and oral cavity, resulting in pathology, such as esophagitis, varices or ulcers. Continual exposure of the teeth to these acids can also cause severe dental erosion. This condition frequently is asymptomatic, and the only evident sign may be the irreversible erosion of tooth structure. The dentist often is the first health care professional to identify the affected dentition. Knowledge of this cause and effect relationship between GERD and dental erosion will better prepare the practitioner to refer patients for appropriate diagnosis and treatment of the underlying medical condition and provide treatment for the affected teeth. This article presents a case report where dental erosion was present due to GERD. After management of the disease with medication, dental treatment of the eroded dentition is described, including diagnosis, treatment planning and restorative reconstruction.