Search

Mandibular incisors show variations in their root canal anatomy from regular pattern in some cases. Magnification plays a vital role to identify those unusual canal morphologies. A certain modification in access cavity preparation is required to locate those extra canals. Not only the functional restoration but also aesthetic harmony should be restored while treating anterior teeth. In these cases, post space preparation should be done with extra care to prevent vertical root fracture. This case report illustrates the importance of proper radiograph and magnification in the successful identification and management of complex canal systems in mandibular incisors., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

The curing light in direct composite resin adhesive restorations is a common technique and treatment method in oral clinic. It has many advantages, such as matching the color of the teeth, less removing the hard tissues of the teeth, resistance to abrasion, good masticatory performance and so on. It has almost replaced the traditional amalgam filling in the clinical dentistry repair. However, in clinical practice, improper use of the technique can also lead to increased loss of restorations and postoperative sensitivity. The reason is related not only to the physical and chemical properties of the material itself, but also the operator's lack of understanding and mastering the properties of the light cured material, especially the use rules of the light curing lamp. To this end, in September 2017, the vice chairman of Society of Cariology and Endodontology, Chinese Stomatological Association, professor Liang Jingping, organized a part of professional experts in this field, and invited the chief expert in 3M company, Dr. Joe Oxman, held a meeting about the use principle, operation mode and specification symposium of light curing lamp. Experts at the meeting had a very heated discussion, forming the following consensus.

This case report describes preventive and restorative treatment planning for a 56-year-old female patient with severe, chronic, poorly controlled gastroesophageal reflux disease and resulting loss of vertical dimension of occlusion. First, the demineralization process was controlled through collaboration with the patient's physician, and measures were taken to restore adequate stimulated salivary flow. Then, for financial reasons, indirect laboratory-fabricated composite resin restorations were adhesively bonded to replace lost tooth structure and reestablish the patient's collapsed vertical dimension. Indirect-laboratory fabricated restorations can be a cost-effective alternative to direct composite resin or all-ceramic restorations for the treatment of chronic severe erosion, but there are no long-term clinical reports in the current literature to support or contraindicate the use of indirect composites for this type of clinical application. Therefore, careful, long-term follow-up evaluations are planned for this patient.

Objective: To compare the 18-month retention rates of composite restorations in non-carious cervical lesions [NCCLs] bonded with a self-etch adhesive with and without preliminary conditioning with EDTA., Methods: Forty-eight patients with two similar-sized NCCL were selected and randomly allocated to one of two groups. Two calibrated operators placed 96 restorations with a one-step self-etch adhesive (Adper Easy One, 3M ESPE). Half of the restorations were placed according to the manufacturer's instructions while, for the other half, the surfaces of the lesions were conditioned with 17% EDTA for 2 min prior to adhesive application. Two blinded and independent examiners evaluated the restorations at baseline, 6, 12, and 18 months, according to the FDI criteria. The comparison between groups in each period was conducted with the Fisher's exact test, and the performance of each group at the different periods was evaluated by McNemar's test (α=0.05)., Results: After 18 months, significantly higher retention rates (95% CI) were observed for the EDTA group (95.5 [84.9-98.7]) than the control group (79.6% [65.5-88.9]) (p=0.02). Significant deterioration of the marginal adaptation and marginal discoloration were observed for both groups over the 18-month evaluation., Conclusions: The preliminary conditioning with EDTA before application of a one-step self-etch adhesive significantly improved the retention rates of composite restorations in cervical lesions., Clinical Significance: Conditioning with EDTA is an alternative that improves the 18-month retention rate of cervical restorations bonded with a self-etch adhesive., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Objectives: Biofilm acids contribute to secondary caries, which is a main reason for dental restoration failures. The objectives of this study were to: (1) develop a protein-repellent and antibacterial composite, and (2) investigate the effects of combining 2-methacryloyloxyethyl phosphorylcholine (MPC) with quaternary ammonium dimethylaminohexadecyl methacrylate (DMAHDM) on composite mechanical properties and biofilm response for the first time., Methods: MPC, DMAHDM and glass particles were mixed into a dental resin composite. Mechanical properties were measured in three-point flexure. Protein adsorption onto the composites was measured by a micro bicinchoninic acid method. A human saliva microcosm model was used to grow biofilms on composites. Colony-forming unit (CFU) counts, live/dead assay, metabolic activity, and lactic acid production of biofilms were determined., Results: Incorporation of 3% MPC and 1.5% DMAHDM into composite achieved protein-repellent and antibacterial capabilities without compromising the mechanical properties. Composite with 3% MPC+1.5% DMAHDM had protein adsorption that was 1/10 that of a commercial composite (p<0.05). The composite with 3% MPC+1.5% DMAHDM had much greater reduction in biofilm growth than using MPC or DMAHDM alone (p<0.05). Biofilm CFU counts on composite with 3% MPC+1.5% DMAHDM were more than three orders of magnitude lower than that of commercial control., Conclusions: Dental composite with a combination of strong protein-repellent and antibacterial capabilities was developed for the first time. Composite containing MPC and DMAHDM greatly reduced biofilm growth and lactic acid production, without compromising mechanical properties of the composite., Clinical Significance: Novel composite with MPC and DMAHDM greatly reduced biofilm activity and is promising to inhibit secondary caries. The dual agents of MPC plus DMAHDM may have wide applicability to other dental materials., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Data Sources: Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase and LILACS. Hand searched relevant journals and attempted contact with authors of unpublished studies and manufacturers., Study Selection: Randomised controlled trials comparing dental resin composites with dental amalgams in permanent posterior teeth with a minimum follow up of three years were eligible., Data Extraction and Synthesis: Data were extracted independently by a minimum of two review authors using specially designed data extraction forms. Risk of bias was assessed using the Cochrane risk of bias tool. Relative risks and 95% CIs were extracted for dichotomous data and mean difference (MD) or standardised mean difference (SMD) for continuous data. Relative risk was combined in a meta-analysis., Results: Seven studies were included. Two were parallel and five split-mouth design. Data from 871 participants were available from the two parallel studies but several of the split-mouth studies did not report the number of participants. All studies were considered at high risk of bias. Only data from the two parallel studies were included in the primary meta-analysis. Failure rates in these studies were recorded for between five and seven years. The risk ratio of failure for composite versus amalgam was 1.89 with 95% CI of 1.52-2.35. The increased failure was primarily due to caries rather than fracture., Conclusions: There is low-quality evidence to suggest that resin composites lead to higher failure rates and risk of secondary caries than amalgam restorations.

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.

Background: Amalgam has been the traditional material for filling cavities in posterior teeth for the last 150 years and, due to its effectiveness and cost, amalgam is still the restorative material of choice in certain parts of the world. In recent times, however, there have been concerns over the use of amalgam restorations (fillings), relating to the mercury release in the body and the environmental impact following its disposal. Resin composites have become an esthetic alternative to amalgam restorations and there has been a remarkable improvement of its mechanical properties to restore posterior teeth.There is need to review new evidence comparing the effectiveness of both restorations., Objectives: To examine the effects of direct composite resin fillings versus amalgam fillings for permanent posterior teeth, primarily on restoration failure., Search Methods: We searched the Cochrane Oral Health Group's Trials Register (to 22 October 2013), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2013, Issue 9), MEDLINE via OVID (1946 to 22 October 2013), EMBASE via OVID (1980 to 22 October 2013), and LILACs via BIREME Virtual Health Library (1980 to 22 October 2013). We applied no restrictions on language or date of publication when searching the electronic databases. We contacted manufacturers of dental materials to obtain any unpublished studies., Selection Criteria: Randomized controlled trials comparing dental resin composites with dental amalgams in permanent posterior teeth. We excluded studies having a follow-up period of less than three years., Data Collection and Analysis: We used standard methodological procedures expected by The Cochrane Collaboration., Main Results: Of the 2205 retrieved references, we included seven trials (10 articles) in the systematic review. Two trials were parallel group studies involving 1645 composite restorations and 1365 amalgam restorations (921 children) in the analysis. The other five trials were split-mouth studies involving 1620 composite restorations and 570 amalgam restorations in an unclear number of children. Due to major problems with the reporting of the data for the five split-mouth trials, the primary analysis is based on the two parallel group trials. We judged all seven trials to be at high risk of bias and we analyzed 3265 composite restorations and 1935 amalgam restorations.The parallel group trials indicated that resin restorations had a significantly higher risk of failure than amalgam restorations (risk ratio (RR) 1.89, 95% confidence interval (CI) 1.52 to 2.35, P value < 0.001 (fixed-effect model) (low-quality evidence)) and increased risk of secondary caries (RR 2.14, 95% CI 1.67 to 2.74, P value < 0.001 (low-quality evidence)) but no evidence of an increased risk of restoration fracture (RR 0.87, 95% CI 0.46 to 1.64, P value = 0.66 (moderate-quality evidence)). The results from the split-mouth trials were consistent with those of the parallel group trials.Adverse effects of dental restorations were reported in two trials. The outcomes considered were neurobehavioral function, renal function, psychosocial function, and physical development. The investigators found no difference in adverse effects between composite and amalgam restorations. However, the results should be interpreted with caution as none of the outcomes were reported in more than one trial., Authors' Conclusions: There is low-quality evidence to suggest that resin composites lead to higher failure rates and risk of secondary caries than amalgam restorations. This review reinforces the benefit of amalgam restorations and the results are particularly useful in parts of the world where amalgam is still the material of choice to restore posterior teeth with proximal caries. Though the review found insufficient evidence to support or refute any adverse effects amalgam may have on patients, new research is unlikely to change opinion on its safety and due to the decision for a global phase-down of amalgam (Minamata Convention on Mercury) general opinion on its safety is unlikely to change.

Objectives: The purpose of this study was to evaluate the effect of the introduction of nanofillers on the mechanical properties of fiber-reinforced composites (FRCs) for stabilization and conservative treatment of multiple traumatized anterior teeth. In particular, the aim of the research was to point out the force levels of two sizes (diameters 0.6 and 0.9 mm) of both conventional and nanofilled FRCs., Methods: Eighty FRCs samples were divided into eight groups, each consisting of 10 specimens. Conventional (groups 1, 2, 3, and 4) and nanofilled (groups 5, 6, 7, and 8) FRC samples were evaluated. Each FRC was tested in two diameters (0.6 and 0.9 mm) and under two deflections (1 and 2 mm). Each sample was polymerized with the same halogen curing unit and then evaluated with a 3-point bending test on a universal testing machine after 48 h of dry storage., Results: Nanofilled FRCs showed significantly higher load values than conventional FRCs. Moreover, 0.9-mm-diameter FRCs showed significantly higher load value than 0.6-mm-diameter FRCs. Specimens tested at 2-mm deflection showed significantly higher load values than those tested at 1-mm deflection., Conclusions: Nanofilled FRCs showed significantly higher load values than conventional FRCs. Higher flexural strength values were recorded with 1-mm deflection for both FRC tested., (© 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objective: The objective of this 6 year prospective randomized equivalence trial was to evaluate the long-term clinical performance of a new nano-hybrid resin composite (RC) in Class II restorations in an intraindividual comparison with its well-established conventional hybrid RC predecessor., Methods: Each of 52 participants received at least two, as similar as possible, Class II restorations. The cavities were chosen at random to be restored with an experimental nano-hybrid RC (Exite/Tetric EvoCeram (TEC); n=61) and a conventional hybrid RC (Exite/Tetric Ceram (TC); n=61). The restorations were evaluated with slightly modified USPHS criteria at baseline and then annually during 6 years., Results: Two patient drop outs with 4 restorations (2TEC, 2TC) were registered during the follow-up. A prediction of the caries risk showed that 16 of the evaluated 52 patients were considered as high risk patients. Eight TEC (2 P, 6M) and 6 TC (2P, 4M) restorations failed during the 6 years. The main reason of failure was secondary caries (43%; including the failure fracture+secondary caries it increases to 57.1%). 63% of the recurrent caries lesions were found in high caries risk participants. The overall success rate at six years was 88.1%. No statistical significant difference was found in the overall survival rate between the two investigated RC., Significance: The nano-hybrid RC showed good clinical performance during the 6 year evaluation, comparable to the well-established conventional hybrid RC., (Copyright © 2012 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.)

Secondary caries and restoration fracture are common problems in restorative dentistry. The aim of this study was to develop Ca-PO(4) nanocomposite having improved stress-bearing properties and Ca and PO(4) ion release to inhibit caries, and to determine the effects of filler level. Nanoparticles of dicalcium phosphate anhydrous (DCPA), two larger DCPA powders, and reinforcing whiskers were incorporated into a resin. A 6 x 3 design was tested with six filler mass fractions (0, 30, 50, 65, 70, and 75%) and three DCPA particle sizes (112 nm, 0.88 mum, 12.0 mum). The DCPA nanocomposite at 75% fillers had a flexural strength (mean +/- SD; n = 6) of 114 +/- 23 MPa, matching the 112 +/- 22 MPa of a commercial non-releasing, hybrid composite (P > 0.1). This was 2-fold of the 60 +/- 6 MPa of a commercial releasing control. Decreasing the particle size increased the ion release. Increasing the filler level increased the ion release at a rate faster than being linear. The amount of ion release from the nanocomposite matched or exceeded those of previous composites that released supersaturating levels of Ca and PO(4) and remineralized tooth lesions. This suggests that the much stronger nanocomposite may also be effective in remineralizing tooth lesion and inhibiting caries. In summary, combining calcium phosphate nanoparticles with reinforcing co-fillers in the composite provided a way to achieving both caries-inhibiting and stress-bearing capabilities. Filler level and particle size can be tailored to achieve optimal composite properties.

Aims: The purpose of the present study was to measure the intrapulpal temperature rise occurring during polymerisation of different shades of resin-based composites (RBCs), and two light-emitting diode (LED) units., Methods: Seventy non-carious permanent molars, that had been extracted for orthodontic purposes and stored in 2% thymol for not more than four months, were selected. Patient age range was 11-18 years. Standard cavity preparation with standardised remaining dentine thickness and placement of thermocouples (TCs) was prepared using a novel split-tooth technique. Cavities were filled with one of two shades of RBC (A2 and C4, Filtek Z250, 3M ESPE, Seefeld, Germany), and cured with two LED high-intensity units (Elipar Freelight2, 3M ESPE, Seefeld, Germany; Bluephase, Ivoclar Vivadent, Schaan, Liechtenstein) and a conventional halogen light-curing unit (LCU) (Prismetics Lite 2, Dentsply, Weybridge, Surrey, UK) as a control., Results: Pulp temperature rises during bonding [A2 results: H;2.67/0.48:E;5.24/1.32;B;5.99/1.61] were always greater than during RBC curing [A2 results: 2.44/0.63;E3.34/0.70;B3.38/0.60], and these were significant for both LED lights but not for the halogen control, irrespective of shade (Mann-Whitney test: 95% confidence limits). Temperature rises were at times in excess of the values normally quoted as causing irreversible pulp damage. Pulp temperature rises during bonding were higher with the LED lights than with the halogen control. There was no significant difference in temperature rise between the two LED lights when bonding but there was a significant difference between the two LED lights and the halogen control LCUs (Kruskal-Wallis Test: 95% confidence limits)., Conclusions: The results support the view that there is a potential risk for heat-induced pulpal injury when light-curing RBCs. The risk is greater during bonding and with high energy, as compared to low-energy output systems. As the extent of tolerable thermal trauma by the pulp tissues is unknown, care and consideration should be given to the choice of LCU and the exposure time when curing RBCs, and especially during bonding.

Aim: The aim of this study was to compare the caries-preventive effect of two types of sealant modalities and to evaluate whether the caries-preventive effect is related to sealant retention. A hypothesis was tested in which a glass ionomer sealant, once applied to the occlusal surface, was able to protect the fissure from caries even if the sealant appeared lost at visual inspection., Design: A 3-year randomized split-mouth trial evaluating two sealant modalities was performed at a public health centre in Finland. A chemically curing glass ionomer cement (GIC) and light-curing resin-based (RB) sealant material were applied randomly to the permanent second molars. Sealant application as a routine treatment procedure was carried out to 599 children in the age group of 12-16 years. Caries rate of the sealed teeth and sealant retention with both materials were analysed by a modified McNemar's test. The effectiveness, rate difference, and relative risk with both sealant materials were measured., Results: The difference in caries rate between the two modalities was highly significant. When compared to the GIC sealant method, the effectiveness of RB sealant method was 74.1% and the rate difference 3.2% (95% CI 1.44%, 4.98%). The relative risk for RB-sealed surfaces vs. GIC-sealed surfaces of having detectable dentin caries was 0.26 (95% CI 0.12, 0.57). The retention rate of sealants was higher with RB than GIC (P < 0.001). The effectiveness of the retention rate for RB sealants was 94.8% and the rate difference 87.2% (95% CI 83.86%, 90.50%). The relative risk during the 3-year study period of having a defective or lost RB sealant was 0.052 (95% CI 0.036, 0.075) when compared to having a defective or lost GIC sealant., Conclusion: It is concluded that in preventing dentin caries a RB sealant programme including resealing when necessary was more effective than a single application of GIC. The original hypothesis was thus falsified.

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.

Objectives: The role of fluoride in preventing erosion and abrasion on dentine remains unclear. The aim of this study was to investigate the effect of repeated applications of a 0.05% fluoride mouthwash and an adhesive on wear of dentine using stainless steel discs reference points and a laser profilometer., Methods: Small stainless steel discs were bonded to 60 caries free extracted molars which had previously been sectioned horizontally. The teeth were equally divided and subjected to four modalities in an erosion and abrasion laboratory model. Step heights were measured from the metal discs using a non-contacting laser profilometer at 100, 500, 1000, 2500 and 5000 cycles., Results: The results after 5000 cycles showed that dentine coated with a dentine adhesive (0.015 microm, S.D. 0.090) had statistically less wear than fluoride (0.127 microm, S.D. 0.150), abrasion and erosion (0.182 microm, S.D. 0.150) or abrasion only (0.096 microm, S.D. 0.090) (p<0.001)., Conclusion: In conclusion dentine surfaces coated with a resin-based adhesive provided more protection against erosion and abrasion than a fluoride mouthrinse. There were no statistical differences between the modalities for cycles less than 5000.

Posterior composite resin restorations are an established feature of contemporary dental practice and all new dental graduates should be competent in providing such treatments for their patients. Surveys of educational curricula in this area in the United Kingdom and Ireland, as well as North America, have demonstrated variations both within and between dental schools. Such inconsistency does not help new dental school graduates, and may lead to confusion. At the British Association of Teachers of Conservative Dentistry Annual Conference held in Birmingham in September 2005, a session was devoted to the development of guidelines for dental schools on teaching posterior composite resin restorations to dental undergraduates. The theme of the conference concerned the teaching implications for changing from amalgam to composite. Two of the principal speakers at the meeting (Joost Roeters and Niek Opdam) were from the dental school at the University of Nijmegen in the Netherlands. This school was the first in Europe to discontinue the use of dental amalgam in its undergraduate curriculum over a decade ago. This paper reports the consensus views of those present on guidelines for teaching posterior composite resin restorations to dental undergraduate students.

Background: The purpose of this study was to histomorphometrically evaluate the response of periodontal tissues covering Class V resin restorations in dogs., Methods: After raising a mucoperiosteal flap, bony defects measuring 5 x 5 mm were created on the buccal aspect of the canines of five dogs followed by cavity preparations on the root surface measuring 3 x 3 x 1 mm. Before repositioning the flap to cover the bone defect, the cavities were restored with composite resin (CR) or resin-modified glass ionomer cement (RMGIC) or were left unrestored as control (C). The dogs were euthanized 90 days after surgery. Specimens comprising the tooth and periodontal tissues were removed, processed routinely, cut into longitudinal serial sections in the buccolingual direction, and stained with hematoxylin and eosin (H&E) or Masson's trichrome. The most central sections were selected for histomorphometric analysis., Results: Histomorphometric analysis revealed apical migration of epithelial tissue onto the restorative materials (RMGIC and CR). The C group presented significantly longer connective tissue attachment (P <0.05) than the RMGIC and CR groups and significantly higher bone regeneration (P <0.05) compared to the RMGIC group. Histologically, the cervical third (CT) of all groups had the most marked chronic inflammatory infiltrate., Conclusions: Within the limits of this study, it can be concluded that the restorative materials used exhibit biocompatibility; however, both materials interfered with the development of new bone and the connective tissue attachment process.

Patients who require restorative intervention in the anterior teeth expect esthetics to be integrated with other teeth that compose the smile. Therefore, not only should clinicians have a scientific technique for restoration of dental biology and function, but also their esthetic sense should direct them in the reproduction of polychromatic and anatomic characteristics of the tooth, rendering the restoration imperceptible. The introduction of new resin composites with better mechanical and optical properties, combined with better understanding of the optical behavior of dental tissues, has allowed a more artistic approach for accomplishment of direct bonded restorations with resin composite. Reproduction of optical behavior characteristics in restorations requires proper interpretation of shade variations, with use of resources and effects with resin composite to allow correspondence with the tooth substrates, and correct use of resin composite at the proper place and of exact thickness. This article describes, with the aid of a case report, a technique for shade selection and choice of resin composites. Moreover, a clinical sequence for application of resin composites is presented that allows reproduction of the interaction between tooth structures and light in proximoincisal restorations. With this technique, the restorative procedure achieves a satisfactory and predictable final esthetic outcome.

Objective: To compare, retrospectively, the influence of different types of restorative materials on caries in vivo., Method and Materials: Twenty-three primary teeth restored by a single operator with amalgam and 2 polyacid-modified resin composites, and with a band of tooth structure beyond the floor of the cervical box, were selected for microscopic evaluation. The teeth were sectioned mesiodistally with the aid of a hard tissue microtome, polished, and cleaned. A confocal laser scanning microscope was used to measure caries-related autofluorescence in the tooth tissue adjacent to the restorative material. A band of about 400 Mum along the interface between the restoration and the tooth structure was observed. The extent of the fluorescent regions was recorded in relation to the total interface length. The specimens were then categorized according to the restorative material used: group A: amalgam (Spherodon, Silmet, n = 11); group D: polyacid-modified resin composite (Dyract, Dentsply DeTrey, n = 6); and group C: polyacid-modified composite (Compoglass, Ivoclar Vivadent, n = 6. The data were analyzed using a one-way analysis of variance (ANOVA) model (alpha = .05) and Pearson correlation coefficient., Results: No significant differences were found between the materials (P >.05)., Conclusion: Within the limits of this clinical study, the data obtained using a small sample size suggests that the effect of the restorative material in primary molars does not have a predominant influence on secondary or residual caries.

Composite restorations have the advantage of being created in the dental office, which can lead to beautiful, natural aesthetics. Laboratory technicians tend to spend minimal time with the patient and reconstruct the restoration based on information provided by the clinician. Dentists, however, are at a great advantage, as they can refer to the surrounding tooth structure when building the restoration. Part I of this article will discuss various guidelines for treating anterior teeth using direct resin restorations, while Part II will address posterior restorations.

Anterior diastemata may compromise the harmony of a patient's smile. Consideration of etiologic factors, previous gingival conditioning, and individual treatment planning are essential in the proper management of anterior diastemata. An integrated orthodontic-restorative approach may enhance the aesthetic results when orthodontic therapy itself is not feasible. This article presents integrated orthodonticrestorative solutions of anterior diastemata, associated with the conditioning of the gingival tissue with composite resin, and discusses the most relevant aspects related to their etiology and treatment planning.

Object: The aim of this study was to report the reasons for placement and replacement of direct restorations in private general dental practices in Brazil., Method and Materials: Thirty-seven practitioners recorded information regarding 16 consecutive direct restorations placed by themselves in a 4-week period. The information recorded reported the patient's age, gender, tooth number, the class of restorations, the restorative material used, and the reasons for placement and replacement of amalgam and tooth-colored restorations. The data were statistically analyzed through chi-square tests., Results: The average age of the patients was 37 years, with female patients occurring more frequently. Of all the restorations placed (n = 551), 39.75% were first-time placements, while 60.25% were replacements. For first-time restorations, the primary reason for placement was primary caries, followed by noncarious tooth substance loss. For amalgam restorations, the main reason for replacement was to obtain improved esthetic appearance with a tooth-colored material. For restorations of resin composite, secondary caries was the principal reason of failure. The resin composite was statistically (P <.01) the most indicated material (88.93%) for the placement and replacement of restorations., Conclusion: Replacements have been the main reason for performing direct restorations, and the chosen restoration material was resin composite.

Background: The aim of this study was to evaluate clinically the treatment of gingival recession associated with non-carious cervical lesions (NCCLs) by resin modified glass ionomer cement (RMGI) or microfilled resin composite (MRC) and coronally positioned flap (CPF) at 6 months following surgery., Methods: Fifty-nine patients were assigned to one of three treatments: root exposure without NCCL treated with CPF (group 1); root exposure with NCCL treated with RMGI restoration plus CPF (group 2); or root exposure with NCCL treated with MRC restoration plus CPF (group 3). Clinical measurements that were assessed at baseline and at 3 and 6 months after surgery included plaque index (PI), bleeding on probing (BOP); probing depth (PD), recession reduction (RR), clinical attachment level gain (CALG), keratinized tissue height (KTH), keratinized tissue thickness (KTT), percentage of root coverage (RC), and percentage of restored root coverage (RRC)., Results: Intra- and intergroup analyses demonstrated no significant differences in PI, BOP, PD, RR, CALG, KTH, or KTT (P >0.05) among the groups at any time. At 6 months, the mean RC was 80.83% +/- 21.08% for group 1; the mean RRCs were 71.99% +/- 18.69% and 74.18% +/- 15.02% for groups 2 and 3, respectively. There were no statistically significant differences in RRC between groups 2 and 3., Conclusion: All treatments showed root coverage improvement without damage to periodontal tissues, supporting the use of CPF for treatment of root surfaces restored with RMGI or MRC as being effective over the 6-month period.

Thin-walled roots restored using conventional cast metal post-cores are at risk of fracture. Placing a thick intermediate layer of resin-based composite (RBC), sandwiched between the root dentine and a small-diameter metal post or dowel, may improve the fracture resistance of such roots. In this initial laboratory study, two similar groups each of six decoronated maxillary central incisor teeth were prepared with approximately 1.0 mm thick tapered root canal walls. Cast metal alloy post-cores and metal-ceramic crowns were fabricated and cemented for one group with, and for the other control group without, a thick intermediate layer of RBC. The mean force (N) to fracture the roots was 639.3 (SD 51.6) for the intermediate layer of RBC group and 360.8 (42.9) for the control group, P < 0.0001. These significantly different findings require clinical confirmation.

Advanced tooth wear was restored with direct resin-based composites (RBCs) in 17 patients, and with indirect ceramo-metal crowns (CMCs) and full gold crowns in 8 other patients. The mean patient age was 64.9 (8.6 SD) years, with each patient having a mean of 13.8 (5.4) restorations. In this retrospective case series study, the mean restoration age was 5.0 (3.0) years for the direct and 5.9 (2.6) years for the indirect restorations. Over 10 years, cumulative survival estimates were 62.0% for direct and 74.5% for indirect restorations (P = 0.23). Survival estimates were 58.9% for anterior RBCs and 70.3% for anterior CMCs (P = 0.06). RBCs usually failed from fractures, and CMCs from complete losses. RBC failures were usually replaced or repaired, while CMC failures often required root canal therapies or extractions. The findings from this relatively small study require confirmation by large long-term controlled clinical trials.

Aim: To consider different conservative options in the literature to restore fractured anterior teeth., Materials and Methods: Only anterior tooth fractures not involving the pulp were considered, without limitation on age. Treatment options were chosen depending on the clinical situation of patients at first visit. The authors considered 15 cases each of: reattachment; porcelain veneers; direct composites., Results and Conclusions: The techniques analysed were revealed to be valid during the period of observation. No failures were recorded with vital teeth keeping their vitality and no radiographic signs of apical or root pathology. With reattachment, two cases have shown the visibility of fracture line after 2 years, depending on the angle of light incidence on the tooth surface. For direct restorations, three adult cases have shown partial discolouration at 24, 28 and 40 months. No fractures or debonding have occurred among porcelain veneers. The authors suggest, whenever possible, to utilise the reattachment technique. Direct restorations are suitable for young patients: they have a higher chance of sustaining further trauma than adults, and composites have a favourable failure mode compared to ceramics. In adults, where long-lasting restorations are needed, restoration with porcelain veneers is the treatment of choice.

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.

Objective: This study was designed to investigate the prognosis of restorative caries therapy applied in nursing home residents., Method and Materials: In 25 consecutive patients a total of 42 restorations were placed, 23 of composite resin (APX/SE Bond) and 19 of compomer (Dyract). The working conditions, such as patient cooperation, quantity of saliva, location of cavity margins, cavity size, and gingival inflammation, were evaluated prior to treatment. The restorations were evaluated qualitatively at baseline, after 6 months, and after 12 months., Results: At 12 months, all examined restorations were clinically acceptable (6 patients had died). There was no significant difference between the quality of the restorations in composite resin and compomer. The plaque scores increased significantly during the study period., Conclusions: The study showed that, within the limitation of a short-term follow-up, restorative caries therapy using composite resin or compomer was successful in nursing home residents although rubber dam was not used.

Recent surveys from general dental practice have found increased placement of direct composite resin restorations in occlusal (Class I) and occlusoproximal (Class II) cavities in permanent teeth by general dental practitioners. This has been matched, and possibly driven, at least in part, by the development of new composite resin materials and bonding technologies. Recent studies by the authors have found an increase in the teaching of Class I and Class II composite resin restorations in the UK, Ireland, the US, and Canada. The increased teaching in the UK and Ireland, however, was not as great as in North America, and several worrying trends were observed. The aim of this paper is to discuss these trends and related factors considered important to the necessary further development of the teaching of Class I and Class II direct composite resin restorations, let alone modern operative dentistry in general, in the UK and Ireland.

Combined coronal and vertical root fractures are difficult to treat and extraction of the affected tooth is quite often indicated. In anterior teeth, esthetics and function must be reestablished immediately. This case describes the restoration of a fractured upper right central incisor using a glass fiber post and adhesive composite. At the follow-up appointment, 13 months later, clinical and radiographical examinations revealed the glass fiber post and restoration in place, suggesting the efficacy of the treatment in maintaining fractured tooth.

Post placement in oval-shaped root canals implies the sacrifice of sound dental tissue to adapt the canal shape to fit the post, which can result in one of several significant complications. A semidirect, single-visit, chairside procedure is proposed, which permits the use of an almost anatomically shaped post, starting from a preformed fiber-reinforced composite root canal post of the largest size commercially available. The utilization of this post capitalizes on the advantages of both the fiber post and the anatomical post in oval- and ribbon-shaped canals to provide restoration of endodontically treated teeth.

The loss of anterior teeth is often a serious esthetic concern. While conventional fixed partial dentures and implant-supported restorations may be the treatments of choice, nonimpregnated fibers (NFs) and fiber-reinforced composite (FRC) resins offer a conservative alternative for improving esthetics. This article describes 2 clinical situations in which NF glass ribbon and FRC were successfully used to provisionally restore anterior edentulous areas in an esthetic, functional, and timely manner.

The aim of this article is to describe a simplified layering technique based on a biomimetic approach for large anterior Class 4 restorations. The proposed layering technique is based on a modified layering technique where palatal enamel and dentin masses are replaced with the same quantity of a microhybrid enamel and dentin shade composites, respectively, while for the thin buccal enamel layer a microfilled resin composite is used. Transparencies and, whenever necessary, white spot characterizations, are created by interposing blue and white effect masses between dentin mamelons, under buccal enamel. The combination of a microfilled composite with a microhybrid composite substituting the same quantity of lost enamel and dentin better mimics the physical and optical characteristics of the natural tooth. The biomimetic composite restoration may be considered an interesting alternative to ceramics, minimizing invasiveness, chair time, and costs for patients.

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.

Today's composite resins possess optical and physical characteristics that have expanded their clinical indications. The successful and predictable application of these materials depends on the practitioner's understanding of their material properties as well as the clinical requirements involved in their delivery; identifying the characteristics of the natural tooth is also important. This presentation reviews contemporary resin materials and demonstrates simple and repeatable guidelines for margin and material placement that improve the clinician's ability to implement microhybrid resins in daily practice.

The demand for aesthetic procedures in today's dental arena is increasing exponentially, yet these desires often call for conservative restorative options, especially for the adolescent patient. The use of direct composite resin restorations offers the dentist the most sim-ple and cost-effective manner in which to create an aesthetic change in the anterior portion of the mouth. The combination of improved materials and innovative delivery techniques allows clinicians to reach these aesthetic goals by creating conservative and functional restorations that have excellent longevity. This article demonstrates five direct composite approaches for solving aesthetic dilemmas in the adolescent and young adult patient.

Background: Composite resins have esthetic properties; they join the ability to preserve and reinforce sound tooth structure. Conservation is becoming popular for both small to medium defects and more compromised teeth., Purpose: This study aimed to evaluate the clinical performance of Class II cuspal coverage direct composite restorations., Materials and Methods: Twenty patients, 18 years or older, were included in this clinical trial restoring 25 vital molar teeth with one or two missing cusps. Criteria for inclusion are two or three surface restorations, replacement of composite and amalgam fillings (secondary decay, fracture of either filling material or tooth structure, aesthetic considerations), or virgin teeth with decay undermining a cusp. Teeth with residual cavity walls less than 1 mm or with complete loss of the clinical crown were excluded. Teeth were restored using a combination of Ultra-Etch 35% phosphoric acid, PQ1 adhesive system, and Vit-l-escence microhybrid composite resin (Ultradent Products, Inc., South Jordan, UT, USA). The enamel peripheral skeleton of the restoration was built up first, followed by dentin and enamel occlusal surface stratification. Wedge-shaped increments of composite resin were placed and cured using the variable intensity polimerizer (VIP) light (Bisco Inc., Schaumburg, IL, USA) through a combination of a pulse and progressive curing technique., Results: All 25 restorations were evaluated at 6-month intervals during the 30-month period using a modified US Public Health Service (USPHS) criteria by two independent evaluators precalibrated at 85% reliability. No failures were reported and alpha scores were recorded for all parameters. Statistical analysis was performed using a Chi-square test (chi(2)) and the Fisher's exact test. Sixteen of the 25 samples (64%) exhibited preoperative sensitivity to air (chi(2)=10.6; p=0.001). A significant difference in tooth sensitivity was reported after completion of the restorations. No teeth exhibited sensitivity both at the 2-week recall and the 30-month follow-up (chi(2)=23.5; p < 0.0001)., Conclusion: Microhybrid composite resin demonstrated excellent clinical performance in direct cuspal coverage at completion of a 30-month evaluation. CLINICAL SIGNIFICANCE In selected clinical situations, cuspal coverage direct posterior composite restorations may represent a valid alternative to conventional indirect restorations.

Dental fractures of the anterior teeth are a relatively frequent accident during childhood. However until maxillary maturation is completed, the employment of porcelain crowns is not recommended, the treatment of choice, instead, would be direct composite restoration. The procedure for restoration of two extensive superior central incisor fractures is presented. Composite crowns were customized directly over the teeth. Root canal treatment was performed in one of the pieces and subsequently a post was cemented, around which a composite core was constructed. Acetate crowns were filled with composite, adapted to the dental contour and photo cured before removal to reproduce the anatomy. After follow-up of 8 years restorations remained esthetic and fully functional.

Fractured anterior teeth can be restored by adhesive bonding of the fractured fragment to the remaining tooth structure. One of the major challenges for the practitioner treating traumatized anterior teeth with immediate fragment reattachment is disguising the fracture line, through the correct use of masking and restorative resins to make the restorations imperceptible to the eye as well as improve the retention of the restoration. This paper discusses a modified technique for reattaching a permanent tooth fragment following dental trauma. The initial procedure involved simple reattachment using light cured composite resin between the fragment and the remnant part of the tooth, without additional preparation. The surplus resin was spread across it in an attempt to optimize marginal seal and improve the aesthetics of the restoration. Finally, after taking into account the occlusion, the lingual surfaces of the teeth were veneered with microfilled composite to improve the retention of the reattached fragments.

The use of indirect posterior composite restorations has facilitated the generation of ideal anatomic form, marginal adaptation, and appropriate proximal contact and contour. Unfortunately, however, the use of post-cure heat treatments has done little to enhance the overall clinical performance of the restoration. The development of new curing techniques in conjunction with modifications of the formulae have contributed to a substantial improvement in both the mechanical characteristics and long-term clinical performance of indirect posterior composite resins.

Composite resins are increasingly used for the restoration of anterior and posterior teeth. Although adhesives and composites have become easier to use than earlier generations of these materials, the use of composite resins is still technique-sensitive. This article reviews the current recommendations for the use of direct composite resins and summarizes the technique for both anterior and posterior restorations.

The indirect restorative technique with composite resin has presented efficient results when used in primary teeth. This technique enables the oral rehabilitation. Based on the results presented in the literature concerning clinical performance, this technique is presented as an alternative treatment to the primary teeth with extensive decay by showing a case of rehabilitation of primary molars. The oral rehabilitation using indirect resin composite restoration showed an important concept to be applied in primary dentition due to feasible, low cost, and lower chairside time.