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Objective: This study aimed to compare the wear behavior of a microhybrid composite vs. a nanocomposite in patients suffering from severe tooth wear.Methods: A convenience sample of 16 severe tooth wear patients from the Radboud Tooth Wear Project was included. Eight of them were treated with a microhybrid composite (Clearfil APX, Kuraray) and the other eight with a nanocomposite (Filtek Supreme XTE, 3M). The Direct Shaping by Occlusion (DSO) technique was used for all patients. Clinical records were collected after 1 month (baseline) as well as 1, 3 and 5 years post-treatment. The maximum height loss at specific areas per tooth was measured with Geomagic Qualify software. Intra-observer reliability was tested with paired t-tests, while multilevel logistic regression analyses were used to compare odds ratios (OR) of “large amount of wear”.Results: Intra-observer reliability tests confirmed that two repeated measurements agreed well (p > 0.136). For anterior mandibular teeth, Filtek Supreme showed significantly less wear than Clearfil APX; in maxillary anterior teeth, Clearfil APX showed significantly less wear (OR material = 0.28, OR jaw position = 0.079, p < 0.001). For premolar and molar teeth, Filtek Supreme showed less wear in bearing cusps, whereas Clearfil APX showed less wear in non-bearing cusps (premolar: OR material = 0.42, OR bearing condition = 0.18, p = 0.001; molar: OR material = 0.50, OR bearing condition = 0.14, p < 0.001).Significance: Nanocomposite restorations showed significantly less wear at bearing cusps, whereas microhybrid composite restorations showed less wear at non-bearing cusps and anterior maxillary teeth.

Objective The study aimed to evaluate survival and failure behavior of Direct Composite Restorations (DRC) and Indirect Composite Restorations (ICR) on molars and anterior teeth, in a Randomized Controlled Trial (RCT). Methods Patients with generalized severe tooth wear were included, and randomly assigned to one of 2 protocols: (1) DCR: All teeth were restored with directly applied micro-hybrid composite restorations (Clearfil AP-X, Kuraray) for load bearing areas and nano-hybrid composite restorations (IPS Empress Direct, Ivoclar Vivadent) for buccal veneers; (2) ICR: First molars were restored with indirect composite ‘tabletop’ restorations and maxillary anterior teeth were restored with indirect palatal veneer restorations (Clearfil Estenia C&B, cemented with Panavia F, Kuraray). Remaining teeth were restored directly. Restorations were evaluated after 3 years, focusing on clinical acceptability. Statistical analysis was performed using Kaplan Meier curves, Annual Failure Rates (AFRs), and univariate Cox regression analyses (p Results 41 patients (age: 36.6 ± 6.6y) were evaluated after 3 years (40.0 ± 2.2 m). 408 restorations on first molars and palatal veneers on maxillary anterior teeth were part of this RCT, with 220 DCRs and 188 ICRs. No differences in survival between treatment modality for palatal veneers for any failure criteria were found. Tabletop restorations on first molars showed a considerable higher failure rate for ICR compared to DCR (p = 0.026, HR: 3.37, 95%CI = 1.16–9.81). Significance In this RCT, directly applied composite restorations showed superior behavior compared to the indirect composite restorations, when used in the molar region.

Contains fulltext : 238755.pdf (Publisher’s version ) (Open Access) OBJECTIVES: To evaluate the 5.5-year performance of direct resin composite restorations, prescribed for patients with severe tooth wear, requiring full-mouth rehabilitation. METHODS: A convenience sample of 34 patients were recruited to a prospective trial between December 2010 and June 2013. The participants were provided 1269 full-mouth direct resin composite restorations (Clearfil AP-X) by 5 experienced operators, using the DSO-technique. Treatment resulted in an increase in the vertical dimension of occlusion (VDO). Failure was assessed at three levels. Frequencies of failure were analysed using Kaplan Meier survival curves and the effects of the relevant variables calculated with a multifactorial Cox regression (p < 0.05). RESULTS: Annual failure rates (for all levels of failure, 'Level 3- ') of ≤ 2.2% and ≤ 2.9% were respectively reported for the anterior and posterior restorations with a mean observation time of 62.4 months. The completion of an anterior restoration with the need for further appointments resulted in significantly more Level 2- & 3- failures. An evaluation of the performance of the premolar and posterior maxillary restorations showed significantly lowered risks of certain types of failures, compared to the molar and posterior mandibular restorations. CONCLUSIONS: At 5.5 years, 2.3% of the overall restorations displayed catastrophic, (Level 1) failures. Molar restorations, posterior mandibular restorations and the anterior restorations requiring two further sessions for completion, were associated with significantly higher risks for failure. CLINICAL SIGNIFICANCE: Direct resin composite can offer an acceptable medium-term option for the treatment of severe, generalized tooth wear; molar restorations may require higher maintenance.

Objectives To investigate the effects of the level of pre-treatment tooth wear and increasing the VDO on the performance of direct resin composite restorations for the rehabilitation of pathological tooth wear. Methods Full-mouth (pre-treatment) grading was performed on digital greyscale scan records for 34 participants (35.3 ± 8.4 years) with signs of moderate-to-severe generalised tooth wear, using the Tooth Wear Evaluation System and the Basic Erosive Wear Examination. Each participant received full-mouth direct resin composite restorations, with increased VDO. The post-treatment increase in the VDO was determined. Recalls were planned after 1 month, and after 1, 3, and 5 years. Three ‘levels’ of restoration failure were described. The effects of the variables on the frequencies of restoration failure were calculated with a multivariable Cox regression, (p Results 1269 restorations were placed with a mean observation period of 62.4 months. Increasing the VDO by 1 mm significantly reduced the risks of all levels of anterior restoration failure (HR ≤ 0.62, p ≤ 0.025). A higher anterior BEWE surface score was associated with increased risks of Level 2- & 3- failures, (HR ≥ 1.29, p ≤ 0.019). Premolar restorations showed lower risks of Level 2- & 3- failure, compared to the molar restorations, (HR ≤ 0.5, p ≤ 0.005). Conclusion Levels of pre-treatment wear and the applied change in the VDO significantly affected failure risk. Clinical relevance Direct resin composite restorations for the rehabilitation of wear should be made as voluminous as possible, respecting the presenting biological, functional, and esthetic constraints.

Background/Aim: The underlying mechanism of the development of cups and grooves on occlusal tooth surfaces is still unclear. The aim of this study was to evaluate factors contributing to in vitro cup formation, in order to elucidate the clinical process. Methods: A total of 48 extracted human molar teeth were exposed to acidic aqueous solutions at pH of 4.8 and 5.5 in constant motion, in combination with different loading conditions: no load (0N group, control), 30 N (30N group) or 50 N (50N group) (n = 8 per group). Before and after 3 months of exposure (1,422,000 loading cycles), the samples were scanned using a non-contact profilometer. Pre- and post-exposure scans were subtracted and height loss and volume tissue loss were calculated. Representative samples with wear and cupping lesions were imaged using scanning electron microscopy, light microscopy and micro-computed tomography. Results: Average height and volume tissue loss at pH 5.5 was 54 µm and 3.4 mm3 (0N), 52 µm and 3.4 mm3 (30N) and 58 µm and 3.7 mm3 (50N), respectively, with no statistically significant differences. Average height and volume loss at pH 4.8 were 135 µm and 8.7 mm3 (0N), 172 µm and 12.6 mm3 (30N) and 266 µm and 17.8 mm3 (50N), respectively, with a statistically significant difference between 0N and 50N (p < 0.002). Cup-shaped lesions had formed only at pH of 4.8, in the 30N and 50N groups. Conclusion: The study showed that a cup can arise fully in enamel and that mechanical loading in addition to erosive challenges are required.

Clinical research of restorative materials is confounded by problems of study designs, length of trials, type of information collected, and costs for trials, despite increasing numbers and considerable development of trials during the past 50 years. This opinion paper aims to discuss advantages and disadvantages of different study designs and outcomes for evaluating survival of dental restorations and to make recommendations for future study designs. Advantages and disadvantages of randomized trials, prospective and retrospective longitudinal studies, practice-based, pragmatic and cohort studies are addressed and discussed. The recommendations of the paper are that clinical trials should have rational control groups, include confounders such as patient risk factors in the data and analysis and should use outcome parameters relevant for profession and patients.

Contains fulltext : 225358.pdf (Publisher’s version ) (Closed access) OBJECTIVE: To investigate the impact of an e-training resource with the consistency of tooth wear scoring using the Basic Erosive Wear Examination (BEWE). METHODS: Gold standard (GS) BEWE scores were attained from a trained examiner using the photographic and dental cast records for three conveniently selected cases representing low, medium and severe tooth wear. Four successive cohorts of first year post-graduate students, (n = 76, mean age, 35.4 years) undertook a training exercise. Each was given written guidance on using the BEWE. Following e-training, scoring was repeated, and the results expressed as mean, confidence Intervals, (95% ci) and p-values (values

Objective To investigate the relationship between levels of tooth wear scored using the Basic Erosive Wear Examination (BEWE) and the impact on the quality of life of adult dental patients. Methods BEWE assessments were performed on 319 new dentate adult patients attending the practices of 5 trained recruiters based in primary care in Malta (120), Australia (118) or the UK (81). Oral impacts on the quality of life were measured using a shortened form of the Oral Health Impact Profile (OHIP-26). Regression analysis were performed, adjusted for age, to estimate the relationship between the variables. Data were expressed as Confidence Intervals (95 % CI), p-values (values Results Overall, the sample had a mean age of 42.6 ± 17.1 (range, 18–93 years), a mean cumulative BEWE score of 6.7 ± 4.4 and a mean total OHIP-26 score of 1.84 ± 0.59. For the cumulative sextant BEWE scores, 68.0 % of the participants scored ≤ 8, 24.5 % between 9 and 13 and 7.5 %, ≥ 14. A significant association was found between increasing BEWE score and the overall OHIP-26 total score (effect = 0.028; p = 0.002), implying a higher BEWE to be associated with a larger impact of oral conditions on daily life. Conclusion Higher levels of tooth wear were significantly associated with a deteriorating oral-health related quality of life amongst the participants. Clinical relevance When treatment planning for patients with tooth wear, it is appropriate to consider the psycho-social impact of the condition alongside other clinical findings.

Contains fulltext : 172856.pdf (Publisher’s version ) (Open Access) The service life of defective direct or indirect restorations could be prolonged by repair or relayering actions where durable adhesion of resin-based composite materials is established for longevity of repairs. The advances in adhesive technologies have introduced several surface conditioning concepts to adhere resin composites onto different restorative materials. The purpose of this report is to summarize reasons for failure, survival of repaired reconstructions, elaborate upon types and mechanisms of available surface conditioning methods, and present operative dentists with practical guidelines for intraoral repair procedures.

Objective The purpose of this study was to evaluate the 3D-stereophotogrammetry technique to detect differences in facial appearance after a simulated rehabilitation. Materials and Methods Eleven volunteers without tooth wear participated. A 3D-stereophotograph was taken in five different situations: resting position, teeth in occlusion, and teeth in occlusion with a 1 mm-, 3 mm- or 5 mm resin block between the first molars. Cephalometric measurements were performed on the 3D-stereophotographs using the software program Maxilim® (Medicim NV Mechelen, Belgium). Four anatomical parameters were analyzed: (1) Subnasale–Gnathion, (2) Subnasale–Stomion, (3) Stomion–Gnathion, and (4) Masseter right–Masseter left. A paired Student's T-test was applied to detect significant differences (p

Objective The restorative treatment of generalized tooth wear involves an increase in vertical dimension of occlusion and a comprehensive alteration of occlusal morphology. The aim of this study was to assess the impact of a direct adhesive restorative treatment on masticatory performance parameters. Materials and methods A sample of 23 fully dentate adult generalized tooth wear patients (17 male, 6 female, age 41.7 ± 8.3 years) undergoing direct composite restorative treatment was selected. Before and one month after restorative treatment with resin bonded composite restorations, masticatory performance was evaluated using 1) a comminution test, 2) a maximum voluntary bite force recording and 3) the sum score of five items related to eating and chewing from the Oral Health Impact Profile (OHIP-49) questionnaire. Statistical analysis was performed using a paired t-test, and analysis per OHIP item was done by a McNemar test (p Results There was no statistically significant difference in median particle size (X50) calculated before and after treatment (4.19 ± 0.97 and 4.03 ± 0.76, respectively, p = 0.327). Maximum voluntary bite force decreased significantly after treatment (baseline 389 ± 90 N, one month recall 323 ± 173 N, p = 0.028). The sum score of the five OHIP items significantly decreased after treatment (baseline 10.6 ± 4.8, one month recall 6.6 ± 2.5, p = 0.001), with the item regarding unsatisfactory diet showing the largest significance (p = 0.029). Conclusions This study indicates that the restorative treatment of generalized tooth wear using direct resin bonded composite has no significant short-term effect on masticatory performance as measured with a comminution test, although the self-reported ability to eat and chew, as measured by the sum score of all pertaining OHIP items, did significantly improve. Clinical significance On individual level, food comminution could be influenced by restorative treatment with increase of vertical dimension of occlusion, but at group level no significant effect is observed. Nevertheless, tooth wear patients do perceive improved ability to eat and chew foods, which is clinically relevant.

Objectives To evaluate the mid-term clinical performance of direct composite restorations placed in patients with pathological tooth wear needing full rehabilitation with an increase of vertical dimension of occlusion. Methods In a prospective trial 34 patients (34.0 ± 8.4 years; 25 males, 9 females) were treated with a minimal invasive additive technique using composite restorations. The restorative treatment protocol was to provide all teeth with composite build-up restorations in an increased vertical dimension of occlusion (VDO) using the DSO-technique. Recall appointments were planned after 1 month, 1 and 3 years after treatment. Restorations were scored for clinically acceptability (FDI-criteria) and scores 4 and 5 were recorded as clinically unacceptable. Frequencies of failures and Kaplan Meier survival curves are presented and effect of relevant variables was calculated with a multifactorial Cox regression (p Results 1256 Restorations were placed, 687 anterior, 324 premolar, and 245 molar restorations. After a mean observation time of 39.7 months a total of 69 failures were observed, of which 61 restorations were repaired (score 4) and 8 were replaced (score 5). Most common reasons for failure were (chip) fractures (n = 43) and caries (n = 11). Placement of anterior restorations in two sessions led to significant 4.6 times more failures then placed in one session. Conclusions In patients with severe tooth wear a full rehabilitation, in an increased vertical dimension of occlusion, direct composite resin restorations show a 94.8% success and 99.3% survival rate after a period of 3.5 years.

Objective: The purpose of this study was to identify the level of oral health-related quality of life and orofacial appearance in patients with moderate to severe tooth wear. Patients with and without a request for restorative treatment were included. Methods: One hundred twenty-four patients (98 men, 26 women, mean age: 40.5 ± 8.8 years) with moderate to severe tooth wear were included. Patients without a request for help received a non-restorative treatment of counseling and monitoring. Patients with a request for restorative treatment were treated with a full rehabilitation using composite resin restorations. Oral Health Impact Profile (OHIP-NL) and Orofacial Esthetic Scale (OES-NL) questionnaires were filled in at baseline and after 1 year. Results: Counseling and monitoring group: baseline OHIP-NL score was 0.4 ± 0.3, baseline summary score of OES-NL was 48 ± 7.0, and baseline impression score was 7.1 ± 1.2. Scores had not changed significantly after 1 year (p = 1.00 after Bonferroni correction).Restoration group: baseline OHIP-NL score was 0.8 ± 0.6, baseline summary score of OES-NL was 38 ± 10, and baseline impression score was 5.9 ± 1.5. Scores had improved significantly after 1 year (p < 0.001 after Bonferroni correction). Conclusions: Counseling and monitoring did not result in a significant deterioration and restorative treatment resulted in a significant improvement of oral health-related quality of life (OHRQoL) and orofacial appearance in this patient group. Clinical significance: In patients with moderate to severe tooth wear, without functional and esthetical problems, counseling and monitoring may be an appropriate treatment option. Restorative treatment in patients with a need for treatment results in an improved OHRQoL. OHIP and OES questionnaires may be used to monitor changes in clinically relevant symptoms.

Item does not contain fulltext This paper explains a conservative, pragmatic and minimally invasive intervention concept for the treatment of severe tooth wear patients based on the Radboud Tooth Wear Project in the Netherlands. Guidelines and flowcharts for management of severe tooth wear patients and rehabilitation in increased vertical dimension of occlusion are presented. We concluded that: (a) Restorative treatment is not always indicated, even for patients with severe tooth wear. (b) If the patient has no complaints, counselling and monitoring is probably the best option. (c) Minimally invasive and adhesive restorative strategies are preferred when severe tooth wear patients are to be treated in increased vertical dimension, especially when young patients are involved. (d) Clinical evidence for a suitable restorative treatment protocol is limited to five-year follow up for direct composites. This material seems to be suitable for rehabilitation in increased vertical dimension on the middle long term. Clinical results for indirect techniques are not available yet. (e) Restorations, including those that are considered 'definitive' may prove to have a limited lifetime in patients with severe tooth wear due to bruxism and erosion. Explanation of the possible treatment options and expected complications should be included in the informed consent.

Item does not contain fulltext The aim was to investigate in vitro the marginal overhang in Class II composite restorations placed with various separation rings and placement techniques. A total of 180 Mesial-Occlusal [MO] preparations in artificial molar teeth were divided into nine groups (n=20). After placement of the sectional matrix, one of three ring systems was applied: Contact Matrix System (Danville Materials), Composi-Tight Gold (Garrison), and V-Ring (Triodent). In each group, rings were placed according to four different techniques (V-Ring placed with technique no. 2 only): 1) occlusally of the wedge, 2) on back end of the wedge, 3) between adjacent tooth and wedge, and 4) between treated tooth and wedge.After application of the adhesive resin, preparations were restored with composite Clearfil AP-X (Kuraray) and polymerized in increments. After matrix removal, overhang was measured on a standardized digital macroscopic image in millimeters squared. For analysis, analysis of variance and Tukey B were used (p

Contains fulltext : 172526.pdf (Publisher’s version ) (Open Access) This article gives an overview of the state of the art of different restorative treatment procedures and techniques needed for placing extended posterior resin composite restorations. Clinical aspects related to the procedure are discussed and reviewed based on the current literature, such as the use of proper adhesive restorative materials, use of liners and bases, moisture control, reconstruction of proximal contacts, extended resin composite restorations, and techniques to address restoring teeth with deep subgingival margins.

Item does not contain fulltext OBJECTIVES: The aim of this systematic review was to evaluate the treatment performance/longevity of dental materials/techniques indicated to restore teeth with severe wear. MATERIALS AND METHODS: A systematic literature search was conducted to select retrospective studies (cohort and case series) and prospective studies that evaluated or compared techniques/materials to restore teeth with severe wear. A search was conducted in Medline (via Pubmed - June 2015) with no limits for publication year or language to identify clinical studies. Two reviewers independently selected studies, extracted data and assessed the risk of bias of randomized controlled trials included. The annual failure rate (AFR%) of restorations was calculated for each study. RESULTS: A total of 511 articles were found and 23 studies were eligible for full-text analysis; hand search included 7 more papers. From the 30 studies, 12 were eligible for the review. Most of these studies presented good performance of the restorations in teeth with severe wear. AFR ranged from 0.4% (microhybrid) to 26.3% (microfilled) for direct resin composite, 0% to 14.9% for indirect resin composite and 2.7% for porcelain veneers. CONCLUSION: There is no strong evidence to suggest that any material is better than another. Direct or indirect materials may be feasible options to restore severely worn teeth.

Contains fulltext : 58422.pdf (Publisher’s version ) (Closed access) OBJECTIVES: To investigate the survival over a five-year period of posterior resin composite restorations placed by students. METHODS: Class I and II resin composite restorations placed by second-fourth year dental students were evaluated. Patients attended the dental school every 6 months for a regular check-up during which all restorations were checked on their clinical acceptability. In case of replacement or repair of a restoration, this was registered in the patient's record. From each record the survival time and reasons for failure of resin composite restorations were gathered. RESULTS: Seven-hundred three posterior resin composite restorations in 382 patients (49% female and 51% male, age 22-78) were evaluated. At 5 years 560 of the 703 restorations were still considered to be "clinically acceptable". Forty-nine restorations were considered as "functionally present", of which 44 were restored with a crown and four had received a new restoration adjacent to the existing restoration without its removal. Ninety-four restorations had failed. The main reasons for failure were restoration fracture, caries, endodontic treatment, defective margin and lack of proximal contact. The survival rate of the restorations was 87% at 5 years, resulting in an annual failure rate of 2.8%. CONCLUSIONS: Dental students are able to place resin composite restorations in posterior teeth with an acceptable mean annual failure rate.

Contains fulltext : 57995.pdf (Publisher’s version ) (Closed access) OBJECTIVES: To review the change in teaching of Restorative Dentistry at Nijmegen dental school over the period 1986 to the present. KEY POINTS: In 1986, class I and II resin composite restorations were included in the pre-clinical program. However, these courses still started with class I and II amalgam restorations. From 1990 on, the number of amalgam restorations placed in the clinic gradually decreased while the number of resin composite restorations increased. Meanwhile, resin composite had become the first choice for treatment of primary caries (class I and class II) lesions. Finally in 1994, the pre-clinical training started with resin composite restorations before dental amalgam was taught and the advantage of a minimal preparation was further emphasized. Since 2001 the teaching of dental amalgam ceased at the dental school. This was not an abrupt change but the result of a long transitional stage during which it was gradually substituted by resin composite. This step-by-step introduction allowed the acceptance of composite resin by the staff as an alternative for dental amalgam in posterior restorations. As in 2001 students placed only 2.5 amalgam restorations before graduation, it was decided to stop with the pre-clinical training program. CONCLUSIONS: The introduction of resin composites meant an important change in teaching restorative dentistry at Nijmegen dental school. It was not just a change in materials and techniques but also a change in treatment philosophy. The reduced need for preparation and the strengthening effect on the remaining tooth were the principal reasons for the shift from dental amalgam to adhesive dentistry with resin composite at Nijmegen dental school.

Bij een porseleinfractuur of bij een onesthetische kroonrand van een goed functionerende kroon of brug kan in de meeste gevallen worden gekozen voor een intraorale reparatie of correctie met composiet. Om retentie te bereiken aan metaal, porselein, kunsthars en composiet zijn macromechanische, micromechanische en/of chemische retentievormen beschikbaar. Voor het verkrijgen van macromechanische retentie is het prepareren van putten, groeven en/of ondersnijdingen nodig. Onder micromechanische retentie wordt verstaan het op microscopisch niveau verruwen van het oppervlak door etsen of zandstralen. Voor de chemische retentiemethoden worden speciale primers gebruikt die een chemische reactie kunnen aangaan met de diverse materialen. De keuze van de meest geëigende methode wordt bepaald door het restauratiemateriaal en de uitvoerbaarheid van de methode.

Item does not contain fulltext The aim was to evaluate retrospectively the influence on restoration longevity of a repair and to evaluate longevity of repaired restorations. MATERIALS AND METHODS: In a practice, 1202 amalgam and 747 composite resin restorations were placed. 407 restorations failed (amalgam 293, composite 114), 246 restorations were repaired with composite resin using an etch-and-rinse technique. Of repaired restorations reason for failure and number of surfaces of original restoration, repair date, and date of patients' last visit were recorded. Whenever a new treatment was necessary, this was considered failure. Data were analysed by Kaplan-Meier statistics and log-rank tests (p

Item does not contain fulltext OBJECTIVES: To investigate the influence of cavity preparation (MO/DO/MOD) and type of matrix system on proximal contact tightness of direct posterior composite restorations. MATERIALS AND METHODS: 85 patients in need of a two- or three surface Class II direct composite restoration were randomly divided into two treatment groups. Group 1 was treated with a sectional matrix system combined with a separation ring (Palodent); Group 2 was treated with a circumferential matrix system in combination with a retainer (Tofflemire). Proximal contact tightness was recorded before treatment and directly after finishing the restoration. RESULTS: For the two-surface cavities use of the separation ring resulted in a statistically significantly tighter proximal contacts at both the mesial and distal site (MO: 2.51+/-0.81 N; DO: 2.82+/-1.14 N) compared to the use of the circumferential (MO: -1.08+/-1.04 N; DO: -0.22+/-0.87 N) (p=0.01). Regarding the three-surface (MOD) cavities no statistically significant differences were found between the mesial and distal site, nor was there an effect of the used matrix system. No statistically significant influence of cavity design (mesially/distally) was recorded for all cavities (MO, DO and MOD). CONCLUSIONS: Use of the sectional matrix system in two-surface Class II cavities resulted in statistically significantly tighter proximal contacts than the use of the circumferential matrix system. For the three-surface no statistically significant differences in contact tightness were found between the different matrix systems. Location of the cavity (mesially or distally) did not show to have any statistically significant effect on the obtained proximal contact tightness.

Contains fulltext : 89725.pdf (Publisher’s version ) (Closed access) Information about the long-term clinical survival of large amalgam and composite restorations is still lacking. This retrospective study compares the longevity of three- and four-/five-surface amalgam and composite restorations relative to patients' caries risk. Patient records from a general practice were used for data collection. We evaluated 1949 large class II restorations (1202 amalgam/747 composite). Dates of placement, replacement, and failure were recorded, and caries risk of patients was assessed. Survival was calculated from Kaplan-Meier statistics. After 12 years, 293 amalgam and 114 composite restorations had failed. Large composite restorations showed a higher survival in the combined population and in the low-risk group. For three-surface restorations in high-risk patients, amalgam showed better survival. 01 oktober 2010

Contains fulltext : 71051.pdf (Publisher’s version ) (Closed access) The purpose of this study was to investigate long-term clinical effectiveness of treating painful cracked teeth with a direct bonded composite resin restoration. The hypothesis tested was that cracked teeth treated with or without cuspal coverage showed the same performance. Forty-one patients attended a dental practice with a painful cracked tooth that was restored with a direct composite resin restoration. Twenty teeth were restored without and 21 with cuspal coverage. After 7 years, 40 teeth could be evaluated. Three teeth without cuspal coverage needed an endodontic treatment, of which 2 failed as a result of fracture. No significant differences were found for tooth or pulp survival. Three more repairable restoration failures were recorded. Mean annual failure rate of restorations without cuspal coverage was 6%; no failures in restorations with cuspal coverage occurred (P = .009). A direct bonded composite resin restoration can be a successful treatment for a cracked tooth.

Contains fulltext : 49546.pdf (Publisher’s version ) (Closed access) OBJECTIVE: The objective of this study was to investigate clinical changes in proximal contact strength inserting Class II composite resin restorations according to one of three randomly assigned protocols. MATERIALS AND METHODS: Seventy-one Class II restorations (MO/DO) were placed by two calibrated operators. Restorations were randomly assigned to one of three groups: one using a circumferential and two a sectional matrix system with separation rings. Proximal contacts were measured by one independent observer with a Tooth Pressure Meter immediately before treatment, and directly after finishing the restoration. RESULTS: Compared to the situation before treatment groups with a sectional matrix system resulted in a statistical significant stronger mean proximal contact strengths (p

Contains fulltext : 49434.pdf (Publisher’s version ) (Open Access) This study investigated the tightness of the proximal contact when placing posterior resin composite restorations with circumferential and sectional matrix systems in an in vitro model using a special measuring device (Tooth Pressure Meter). A manikin model was used with an artificial first molar in which an MO-preparation was ground, simulating the clinical situation of an amalgam replacement. This preparation was duplicated, resulting in 160 identically prepared teeth. These teeth were divided into 8 groups (n=20). In 2 groups, circumferential matrix bands (flat or contoured) in a Tofflemire retainer were applied. In the remaining 6 groups, 3 different separation rings were combined with 2 types of sectional matrix bands. All the cavities were restored using Clearfil Photo Bond and Clearfil AP-X. The tightness of the proximal contact was measured using the Tooth Pressure Meter. Data were statistically analyzed using SPSS 12. ANOVA was used to find differences in proximal contact tightness between the groups. Tukey tests were used to find differences between the homogeneous subgroups. The use of sectional matrices combined with separation rings resulted in tighter proximal contacts compared to when circumferential systems were used (p

Contains fulltext : 52184.pdf (Publisher’s version ) (Closed access) OBJECTIVES: The purpose of this study was to evaluate retrospectively the longevity of class I and II amalgam and composite resin restorations placed in a general practice. METHODS: Patient records of a general practice were used for collecting the data for this study. From the files longevity and reasons for failure of 2867 class I and II amalgam and composite resin restorations placed in 621 patients by two operators between 1990 and 1997 were recorded in 2002. RESULTS: 912 amalgam restorations (502 by operator 1 and 410 by operator 2) and 1955 posterior composite resin restorations (1470 by operator 1 and 485 by operator 2) were placed. One hundred and eighty-two amalgam and 259 posterior composite resin restorations failed during the observation period. The main reasons for failure of the restorations were caries (34%), endodontic treatment (12%) and fracture of the tooth (13%). Life tables calculated from the data reveal a survival for composite resin of 91.7% at 5 years and 82.2% at 10 years. For amalgam the survival is 89.6% at 5 years and 79.2% at 10 years. Cox-regression analysis resulted in a significant effect of the amount of restored surfaces on the survival of the restorations. No significant effect of operator, material as well as combination of material and operator was found. SIGNIFICANCE: In the investigated general practice, two dentists obtained comparable longevity for amalgam and composite resin restorations.