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PubMed2005

In vitro evaluation of microleakage of indirect composite inlays cemented with four luting agents.

STATEMENT OF PROBLEM: Microleakage around dental restorations is implicated in the occurrence of secondary carious lesions, adverse pulpal response, and reduced restoration longevity. PURPOSE: The aim of this in vitro study was to evaluate the microleakage of indirect resin composite inlays cemented with 4 luting agents. MATERIAL AND METHODS: Standardized Class V inlay preparations overlapping the cemento-enamel junction were prepared on the buccal and lingual surfaces of 40 extracted human mandibular third molars. Eighty postpolymerized, heat-treated resin composite inlays (Targis, 72 specimens, 8 controls) were processed in stone replicas and cemented into the preparations using 4 luting agents (n = 18 + 2 controls for each cement group): a resin composite used with a bonding agent (Variolink II/Excite), a resin composite used with a self-etching primer, but without bonding agent (Panavia F/ED Primer), a modified resin composite used with a bonding agent (Resinomer/One Step), and a resin-modified glass-ionomer cement (Fuji Plus). Thirty-six inlays (n = 9 + 1 control) were subjected to thermal cycling (2000 cycles, 5 degrees C/55 degrees C), whereas the other 36 were not. All the teeth were then immersed in 1% methylene blue dye solution for 48 hours. Microleakage score, margin location (enamel/cementum), thermal cycling history, and preparation location (buccal/lingual) were analyzed using a multivariate model (alpha = .05). Multivariate analysis was performed using a polychotomous logistic regression. RESULTS: The preparation location had no significant effect on dye penetration. The margin location (enamel or cementum) and the thermal cycling had a significant effect on microleakage (odds ratios [ORs] = 17.6 and 8.04, respectively). In comparing the 3 resin-based luting agents (Variolink II, Panavia F, and Resinomer) to Fuji Plus, Panavia F exhibited the lowest significant overall microleakage (OR = 0.09), followed by Variolink II (significant OR equal to 0.43), whereas Resinomer demonstrated the greatest significant overall microleakage (OR = 1.35). CONCLUSION: Within the experimental conditions of this in vitro study, thermal cycling significantly increased microleakage (OR = 8.04). The overall microleakage at the enamel margins was significantly lower than the overall microleakage at the cementum margins for the 4 luting agents tested (OR = 17.6).

Acid Etching, Dental↗
PubMed2005

Fracture resistance of endodontically treated maxillary premolars restored with CAD/CAM ceramic inlays.

STATEMENT OF PROBLEM: Endodontically treated posterior teeth are more likely to fracture compared to posterior teeth with vital pulps. Reinforcement with an extracoronal restoration that covers the cusps is the most commonly recommended method for reducing the risk of fracture. It is not known whether bonded intracoronal restorations without cuspal coverage will reduce the risk of fracture. PURPOSE: The aim of this in vitro study was to investigate whether reinforcement of endodontically treated premolars with MOD preparations could be achieved by insertion of bonded CAD/CAM ceramic inlays. MATERIAL AND METHODS: Forty-five extracted maxillary premolars were equally distributed among 3 groups (END, CER, CTR). In group END (n=15), root canals were enlarged with a rotary NiTi system and obturated with heat-softened gutta-percha around a plastic carrier (Thermafil). After filling of the endodontic access cavities with autopolymerizing composite resin (Luxacore), standardized MOD cavity preparations were made and CAD/CAM ceramic inlays (CEREC) were fabricated and then bonded to the teeth with composite resin (Tetric) and an adhesive system (Syntac Classic). In group CER (n=15), teeth without endodontic treatment were restored with bonded inlays (CEREC). Sound premolars served as controls (group CTR, n=15). Teeth were then thermal cycled (1445 cycles, dwell time: 30 seconds, 5 degrees /55 degrees C). An eccentric load was applied on the buccal incline of the palatal cusp in a universal testing machine until cusp fracture (N). Fracture load was evaluated with the Mann-Whitney test, and type of fracture, with a chi-square analysis (alpha=.05). The type of fracture was determined by visual inspection: type I - supragingival fracture within the palatal cusp; type II - fracture below cemento-enamel junction of palatal cusp; and type III - fracture of palatal cusp and central portion of the tooth exposing the root canal cavity. RESULTS: No significant difference was found among the 3 groups with respect to load required for fracture. Mean fracture load +/- SD was recorded as follows: 291.6 +/- 113.7 N for group END, 363.2 +/- 140.3 N for group CER, and 296.5 +/- 170.5 N for group CTR. Regarding fracture modes, significantly more teeth from group END exhibited fractures of type III and II compared with control specimens. CONCLUSION: Teeth restored with bonded CAD/CAM ceramic inlays (CEREC) fractured with a significantly higher number of severe fractures compared to the control group.

Bicuspid↗
PubMed1997

Longitudinal study of pressed glass-ceramic inlays for four and a half years.

STATEMENT OF PROBLEM: Some restorative materials used in the posterior region of the mouth present conventional problems, such as microleakage, recurrent caries, wear, and poor color stability. PURPOSE: This study determined the reliability of the IPS Empress ceramic material for fabricating inlays and onlays in the posterior region of the mouth. MATERIAL AND METHODS: A total of 125 IPS Empress pressed glass ceramic inlays were placed for 29 patients in a private practice. The restorations were observed for a period of 7 to 56 months, with a mean of 40.3 months. All inlays were constructed in the same dental laboratory and the restorative materials used according to the manufacturers' instructions. The restorations were evaluated clinically according to modified U.S. Public Health Service criteria at the time of insertion and at periodic recall appointments. Kaplan-Meier statistics were used to calculate survival rates. RESULTS: Clinical evaluation revealed that pressed glass ceramic inlays, with the exception of four fractured restorations, were rated from Alpha to Bravo for each criteria. Marginal discoloration recorded the lowest percentage of alpha ratings (65.3%). The estimated survival rate after approximately a 4.5-year follow-up period was 95.63% (95% confidence interval; 90.77% to 99.95%).

Adult↗
PubMed1999

Clinical and scanning electron microscopic evaluation of fiber-reinforced inlay fixed partial dentures: preliminary results after one year.

STATEMENT OF PROBLEM: Restorative dentistry searches for nonmetal reinforcement of esthetic fixed partial dentures (FPDs). PURPOSE: This clinical study evaluated conservative fiber-reinforced composite FPDs bonded to inlay abutments. MATERIAL AND METHODS: Twenty fiber-reinforced composite inlay FPDs were made for 15 patients. Restorations were manufactured with the Targis Vectris glass-fiber-reinforced composite system and a simplified laboratory technique. The 20 bonded inlay FPDs were examined clinically and by SEM after 1 year. RESULTS: All 20 FPDs were intact at the 1-year examination. There were no signs of fracture, surface defects, or excessive wear with SEM. SEM marginal analysis exhibited 91.6% +/- 5% excellent margins at the tooth-luting composite interface and 86. 1% +/- 8% excellent margins at luting composite/restoration interface. CONCLUSION: On the basis of the results of this descriptive study, bonded glass-fiber-reinforced composite inlay FPDs were considered clinically successful at the 1-year examination.

Composite Resins↗
PubMed2000

Interface dimensions of CEREC-2 MOD inlays.

OBJECTIVES: To quantify the width of the cement interface between ceramic inlays generated by the CEREC-2 CAD-CAM system and the tooth, and to determine the effect of cement viscosity on the interface width. METHODS: Standardised MOD cavities were cut in 15 human premolar teeth using a custom paralleling device. A ceramic inlay was made with a CEREC-2 CAD-CAM machine for each tooth. The inlays were cemented using one of three resin-based composite systems of varying viscosity; a hybrid microfilled posterior composite, a compomer restorative and a dual-cure luting composite. The teeth were subsequently sectioned and measurements were taken at 21 key points with the aid of an image-analysis light microscopy system. RESULTS: Statistical significance tests were applied to examine for difference in interface dimensions at specific points within each of the cement-groups and amongst groups. The interface space at the occlusal walls has a distinct wedge shape, being narrower at the external interface (50 microns, SD 15) than internally (211 microns, SD 38). There is no statistically significant difference in the interface dimensions of the gingival floor between the boxes that lie above and below the CEJ. There is no statistically significant difference in the width of the interface at any given point between the three cement groups. SIGNIFICANCE: There is a significant improvement in the fit of CEREC-2 restorations when compared with the original CEREC system. Cements of varying viscosity (within the measured range) may be used for cementation of these inlays, without adversely affecting the width of the interface. Caution must be exercised with light-activated composite cements to ensure adequate transmission of light through the ceramic and the underlying composite cement.

Bicuspid↗
PubMed1998

Survival rate of ceramic inlays.

OBJECTIVES: The aim of the present study was to evaluate the survival rate of ceramic inlays provided in a practice environment by one of the authors over the past decade. METHODS: 183 inlays were examined in 67 patients. The interval between placement and assessment was, on average, 4 years (s.d. 2.75 years) and varied from 4 months to 10 years. Kaplan-Meier survival-type curves were used to assess the survival rate. RESULTS: Five inlays failed: four due to endodontic reasons and one due to fracture. Four failures were in permanent molar teeth while the other was in a premolar tooth. A success rate of 97% at 10 years was estimated. CONCLUSIONS: The clinical durability of the resin-bonded ceramic inlays investigated was satisfactory.

Adult↗
PubMed1991

Current status and rationale for composite inlays and onlays.

Composite inlay systems, now available to the dental profession, are classified and evaluated. Principle motives for their deployment are the aviodance or reduction of in situ polymerisation shrinkage and the optimisation of restoration contour and adaptation. The criteria for placement of direct or indirect composite inlay restorations are critically reviewed in relation to alternative materials and operative procedures. Dimensions of typical molar and premolar inlay cavities are presented and interim guidelines for inlay cavity design are discussed.

Composite Resins↗
PubMed1998

Amalgam alternatives-microleakage evaluation of clinical procedures. Part II: direct/indirect composite inlay systems.

This study investigated the degree of dye penetration of two composite inlay systems with different adhesive and bonding protocol. Forty whole extracted premolars and molars were collected. The teeth were immediately stored in water at room temperature. Class II cavity preparations were prepared and restored both, in the direct and the indirect techniques (Coltene Brilliant) and (Kulzer Estilux posterior CVS). The inlays were cemented with a composite luting cement (ART-Bond) and (Kulzer, Adhesive cement). Specimens were subjected to 750 cycles of thermal stress. They were than immersed in 2% Basic fuchsin dye. The teeth were sectioned in three planes before being ranked as to the amount of dye penetration. The data were analysed by the Wilcoxon's rank test at the 95% confidence level. There was no statistically significant difference between the direct and indirect technique considered separately for each composite inlay material, at the cervical margin location. The fuchsin staining in the occlusal area was limited to the enamel in all groups. By using the composite inlay, the factor of adaptation and bonding of composites to dentine become the significant factor contributing to leakage.

Coloring Agents↗
PubMed2003

Clinical evaluation of class II Targis inlays: preliminary results after 1 year.

The aim of this study was to evaluate the clinical performance of a new generation of restorative resin, Targis (Vivadent), in class II inlay restorations. Forty class II Targis inlays were placed (18 premolars, 22 molars) in 26 patients (mean age=25.5). All test teeth were vital. All restorations were in occlusion and were placed adhesively using Variolink II high viscosity (Vivadent) in combination with Syntac adhesive system under rubber-dam by the same operator. The restorations were evaluated at baseline and after 6 months and 1 year, according to modified United States Public Health Service (USPHS) criteria by two examiners. The parameters evaluated were: anatomical form, marginal adaptation, marginal discoloration, colour match, surface finish, gingival index and secondary caries. Post-operative sensitivity was determined by direct questioning. Regarding all of the clinical evaluation criteria all 40 inlays exhibited clinically acceptable scores after 1-year evaluation period. Relying on these early 1-year results, the new restorative material (Targis) seems to be promising in class II inlays.

Adult↗
PubMed2002

Comparison of microleakage of three acid-base luting cements versus one resin-bonded cement for Class V direct composite inlays.

STATEMENT OF PROBLEM: Demineralized dentin beneath set cement may adversely affect microleakage under fixed restorations. PURPOSE: Microleakage of direct composite inlays cemented with acid-base cements and a methyl methacrylate resin cement were evaluated to determine their effect on the integrity of the underlying hybridized dentin. MATERIALS AND METHODS: Sixty Class V box preparations (3 mm x 3 mm x 1.5 mm) were precisely prepared in previously frozen bovine teeth with one margin in enamel and another margin in dentin. Direct composite inlays (EPIC-TMPT) for each preparation were divided into 4 groups of 15 specimens each and cemented with 3 acid-base cements (control group): Elite, Ketac-Cem, Hy-Bond Carbo-Cem, and 1 adhesive resin cement: C&B Metabond. All specimens were stored in distilled water for 24 hours at 37 degrees C before immersion in 0.5% basic fuchsin for 24 hours. The dye penetration was measured on the sectioned specimens at the tooth-cement interface of enamel and cementum margins and recorded with graded criteria under light microscopy (Olympus Vanox-T) at original magnification x 50, 100, and 200. A Kruskal-Wallis and the Mann-Whitney test at P<.05 were used to analyze leakage score. RESULTS: All cementum margins of the 3 acid-base cements tested demonstrated significantly higher leakage scores than cementum margins for inlays cemented with the resin cement tested(P<.01). No leakage along the tooth-cement interface was found for inlays retained with the adhesive resin cement. CONCLUSIONS: Within the limitations of this study, the 3 acid-base cements tested exhibited greater microleakage at the cementum margins than did the adhesive resin cement that was tested.

Animals↗
PubMed2005

Interface evaluation after manual and ultrasonic insertion of standardized class I inlays using composite resin materials of different viscosity.

OBJECTIVE: The aim of the present study was to investigate the effect of manual and ultrasonic insertion of standardized class I inlays (Cerana) using three composite resin materials of different viscosity (Tetric Flow, Tetric, and Tetric Ceram) on time to seat inlays, film thickness, and filler distribution within the materials. METHODS: In a preliminary test, mean loads for manual and ultrasonic insertion were measured using the high viscosity composite resin material (Tetric Ceram). These loads were then applied with all composite resin materials to evaluate the times required to seat the inlays. In addition, film thickness was assessed using scanning electron microscopy, and filler distribution (wt% silicon, barium, ytterbium) was monitored using energy-dispersive spectroscopy. RESULTS: Ultrasonic insertion significantly reduced mean load applied to seat inlays (6.4+/-1.4 N; mean+/-SD) as compared to manual insertion (18.9+/-3.1 N; p < 0.001). Using an ultrasonic device, times for insertion values were significantly lower in the high and medium viscosity composite resin material groups compared to manual insertion (p < 0.05). The widest film thickness was recorded for the high viscosity composite resin material in combination with manual insertion (p < 0.05). However, when ultrasound was applied, there was no difference in film thickness between the three materials at any levels. Furthermore, the analysis of filler distribution revealed no significant differences between groups. CONCLUSION: Highly filled viscous composite resin materials may be used in combination with the ultrasonic insertion technique without untoward effects on film thickness or filler distribution.

Barium↗
PubMedDate not supplied

The effect of base materials with different elastic moduli on the fracture loads of machinable ceramic inlays.

This study investigated the effect of two base materials with different elastic moduli (F2000 and Vitrebond) on the fracture load of machinable ceramic inlays. Standardized MOD cavities were prepared in 18 human maxillary first or second premolars. The teeth were randomly assigned to three groups of six premolars each; Group 1 (control: no base); Group 2 (base with a polyacid-modified resin composite: F2000); Group 3 (base with a resin-modified glass-ionomer cement: Vitrebond). The inlays were fabricated from Vitablocs Mark II using a Cerec II machine. After the inlays were cemented with Tetric Ceram and the Syntac adhesive system, using the Ultrasonic Insertion Technique (USI), they were stored in distilled water at 37 degrees C for 24 hours prior to fracture testing in a universal testing machine using a crosshead speed of 0.5 mm/minute. The static transverse elastic moduli of base materials were measured using a three-point bending test. The mean fracture loads and standard deviations of the Cerec inlays in Groups 1, 2 and 3 were 1.15 +/- 0.39 KN, 1.13 +/- 0.36 KN and 0.58 +/- 0.11 KN, respectively. Statistical analysis showed that the mean fracture load of Group 3 was significantly lower than that of Groups 1 and 2 (p < .05). There was no significant difference in fracture load between Groups 1 and 2. The means and standard deviations of the elastic moduli of F2000 and Vitrebond were 15.63 +/- 0.32 and 2.16 +/- 0.55 GPa, respectively. The results indicated that the fracture load increased significantly as the elastic modulus of a base material increased.

Analysis of Variance↗
PubMed1992

The clinical performance of two groups of functioning class-II cast gold inlays.

The length of service and the clinical performance of two groups of functioning class-II cast gold inlays in patients attending a private practice were assessed by conventional clinical and radiographic examination. In one group all inlays were older than 25 years (median age, 34 years), and they had an extended outline form. The impression technique was based on a thermoplastic material in a copper ring. In the other group, comprising inlays inserted during the past 25 years (median age, 16.5 years), the outline form was minimal and an elastic impression material in a copper ring was used. The inlays in the older group appeared to perform better than those in the younger group. In both groups recurrent caries appeared to be the predominant reason for repair.

Adult↗
PubMedDate not supplied

Tensile bond strength of two ceramic and three resin composite inlay materials placed using a resin luting agent.

The tensile bond strength of inlay materials to dentin was evaluated. Five materials, two direct resin composite inlay products, one hybrid resin composite, a preformed ceramic block, and a conventional porcelain material were bonded to bovine dentin and bonded together using a dual-polymerizing resin luting agent. Specimens were tested with and without thermocycling. Some bar-to-bar bonding groups fractured through the bar. Significantly higher (P < .05) bar-to-bar bonds were recorded than the bar-dentin bonds, irrespective of the inlay materials. VitaDur N showed the lowest bar-to-bar failure values (7.6 MPa) compared to the four other inlay materials (14.4 MPa to 22.2 MPa), but had the highest dentin bond strength (4.5 MPa). Unexpectedly, thermal loading increased the bond strength to bovine dentin, although this was only statistically significant for VitaDur N. The dentin bond strength of Charisma (1.4 MPa) was inferior (P < .02) to all other materials (2.6 MPa to 4.5 MPa) when thermocycled before testing.

Aluminum Oxide↗
PubMedDate not supplied

Eight-year clinical evaluation of fired ceramic inlays.

This study evaluated the quality of fired ceramic inlay restorations consisting of a feldspathic porcelain system (G-Cera Cosmotech II, GC Co, Tokyo, Japan) after eight years in vivo. Forty-five fired ceramic inlays (for 26 premolars and 19 molars; Class I in 12 teeth, Class II in 31 teeth and onlay in two teeth) were placed in 25 patients. All restorations were evaluated at the time of placement and at 6 months, 1, 2, 4, 6 and 8 years after placement using modified USPHS criteria. Replicas of the restorations were observed with a scanning electron microscope (SEM) to evaluate the degradation of the marginal area and wear loss of the restoration. Longevity was observed in 80% of the fired ceramic inlay restorations at eight years (Kaplan-Meier method), although it was 92% at the six-year observation. Marginal fracture was detected in 11 restorations (22%), including bulk fracture in five (11%), which had first occurred during the last two years. Recurrent caries was observed in three (7%) cases and marginal discoloration in 14 (31%). SEM evaluation disclosed marginal microfractures in 77% of the restorations, wear in 36% and wear of the resin cement along the margin in 74% at eight years. No significant difference was observed in each of these three characteristics between molars and premolars. This longitudinal eight-year clinical observation suggested that fired ceramic inlay restorations made by the G-Cera Cosmotech II system are clinically acceptable. However, critical failure as bulk fracture may become a future problem since marginal disintegration was detected in 77% of the restorations from microscopic and macroscopic perspectives.

Aluminum Silicates↗
PubMed1999

Ceramic inlays: clinical assessment and survival rate.

PURPOSE: This study evaluates the clinical behavior of ceramic inlays placed during the past decade. MATERIALS AND METHODS: One hundred eighty-two inlays were examined in 66 patients. The interval between placement and assessment was on average 5.9 years +/- 2.7, ranging from 2 to 11.7 years. Restorations still present at the time of evaluation were clinically assessed according to modified USPHS criteria. Kaplan-Meier statistical analysis was used to assess the survival rate. RESULTS: According to USPHS criteria, good results were obtained for color match, marginal discoloration, recurrent caries, contour, and marginal integrity. Six inlays failed: four for endodontic reasons, one due to recurrent caries, and the other due to fracture. The results indicate that a success rate of 95% could be predicted at 11.5 years. CONCLUSION: The lack of recurrent caries, the only slight changes in marginal discoloration and color match, combined with the excellent longevity prove that ceramic inlays are a valuable tool for the restoration of posterior teeth.

Adult↗
PubMed1999

Cerana--a direct ceramic inlay technique.

Ceramic materials provide aesthetic restorations which are able to withstand the oral environment but two appointments are needed to fabricate ceramic restorations by means of an indirect technique. However, single-visit systems are becoming available and a recent development, Cerana, utilises matched drills with pre-etched and silanated leucite inlays. The cavity is refined using one of three conical burs and a size- and shaped-matched conical inlay is cemented using a conventional restorative resin material. The final restoration consists of a leucite inlay surrounded by a small amount of composite resin. The exposed resin, being a restorative composite resin, has a higher filler loading than that of a luting cement and an overlap technique can be used to reduce the area of exposed surface resin. This paper describes the technique and illustrates some cases. The initial results are promising in terms of aesthetics, patient acceptance, occlusal wear and ease of use. The major clinical application of this new technique is the ability to restore a cavity with a leucite inlay at a single visit thereby offering a cost-saving alternative to current aesthetic restorations. The technique requires only a little more time than a direct placement composite restoration yet reduces polymerisation contraction, and the occlusal contacts can be placed on the ceramic surface, rather than on the composite resin, for longer-term stability.

Aluminum Silicates↗
PubMedDate not supplied

The effect of a "resin coating" on the interfacial adaptation of composite inlays.

The relatively low bond strengths of resin cements to dentin may result in poor interfacial adaptation of composite inlays. This study determined whether the interfacial adaptation of composite inlays could be improved by applying an adhesive system and a low viscosity microfilled resin to the prepared cavity walls before making an impression. Ten MOD cavities were prepared on extracted human premolars with gingival margins located above and below the cemento-enamel junction. A "resin coat" consisting of a self-etching primer system (Clearfil SE Bond) and a low viscosity microfilled resin (Protect Liner F) was applied to the cavities of half of the prepared teeth, while the remaining teeth served as non-coated control specimens. All the teeth were restored with composite inlays (Estenia) fabricated by the indirect method and cemented with a dual-cured resin cement (Panavia F). After finishing the margins with superfine burs, the bonded inlays were thermocycled between 4 degrees C and 55 degrees C for 400 cycles. Specimens were sectioned with a diamond saw and the tooth-restoration interfaces were observed with a confocal laser scanning microscope. The data were analyzed with two-way ANOVA and Fisher's PLSD test (p < 0.05). The percentage length of gap formation at the dentin-restoration interface of the "resin coated" teeth (7.1 +/- 3.5) was significantly less than that of the non-coated teeth (85.7 +/- 6.7) (p < 0.05). The concept of coating the prepared cavity with an adhesive system and a low viscosity microfilled resin resulted in observing fewer gaps at the internal dentin-restoration interface compared with the non-coated specimens.

Analysis of Variance↗