Postoperative sensitivity: bonded cavity liners revisited.
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Acid Etching, Dental↗
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A two-year randomized, controlled clinical evaluation of bonded amalgam restorations.
PURPOSE: The clinical performance of adhesively bonded dental amalgam restorations was compared with that of traditionally placed non-bonded control amalgams in a randomized prospective study. MATERIALS AND METHODS: One-hundred thirteen Class II Dispersalloy amalgams were placed in permanent molars and premolars of 31 (21 males, 10 females) human subjects with their informed consent. By random assignment, 60 amalgam restorations were adhesively bonded using ED Primer and Panavia 21 TC (both Kuraray Co, Japan), and 53 traditional non-bonded restorations were placed. Most preparations involved replacement of defective amalgam restorations. Clinical recalls were conducted by experienced evaluators using modified USPHS criteria for occlusal and proximal anatomic form, occlusal and proximal marginal adaptation, and occlusal and proximal surface roughness. RESULTS: For the categories of anatomic form, marginal adaptation, surface quality, and temperature sensitivity, there were no significant differences between bonded and non-bonded amalgam restorations (chi-square analysis, p > 0.05). Three non-bonded restorations were lost at 4, 7, and 24 months from preparations with no deliberate retention. CONCLUSION: After two years' clinical service, there were no failures among the amalgam restorations adhesively bonded using ED Primer and Panavia 21 TC, but three non-bonded restorations failed due to lack of retention. For traditional preparations, adhesively bonded amalgams of the type investigated perform as well as non-bonded amalgams over two years' clinical service.
Bicuspid↗
Using flowable composite as a base for amalgam restorations.
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Composite Resins↗
Amalgam repair: evaluation of bond strength and microleakage.
This study evaluated the tensile bond strength of "repaired" amalgams and compared the degree of microleakage. Amalgam (Cavex avalloy) was condensed into plastic tubes (3 mm in diameter, 10 mm in height) to the half-length. After storage in water at 37 degrees C for two days, the remaining parts of tubes were filled with amalgam (A), cavity varnish (CV)+A, Liner Bond 2V (LB2V)+A, 3M Opal Luting Cement (3MOLC)+A, Panavia F(PF)+A, Metabond(MB)+A, Fuji BondLC(FB)+A, HytacOSB(HOSB)+Hytac Aplitip (H), Liner Bond2V+Clearfil AP-X(CAP). The bond strengths for 15 samples of each restoration group were determined. For the microleakage study, MOD cavities of 90 extracted human premolars were used. The distal half of cavities were filled with amalgam. After storage in water at 37 degrees C for two days, the mesial half of the cavities were filled to simulate a clinical repair. The "repair" was placed using the procedures applied in the bond strength study. The teeth were stained with basic fuchsine (0.5%), sectioned and evaluated for dye penetration. In both parts of study, the data were analyzed by ANOVA and Duncan's multiple range tests. Bond strength values (MPa) were: A+PF+A 3.84+/-1.08, A+LB2V+A 3.15+/-0.97, A+LB2V+CAP 3.05+/-0.53, A+MB+A 2.86+/-0.88, A+HOSB+H 2.58+/-0.51, A+3MOLC+A 2.11+/-0.75, A+FB+A 0.68+/-0.59. The repaired A+A and A+CV+A groups were separated before testing. The A+PF+A group showed the highest bond strength (p<0.05). Microleakage in the cervical margins of repaired restorations was lower in the amalgam groups than microleakage in the resin composite and compomer groups. PF, MB, 3MOLC and FB performed better at the amalgam "repair" interface. The A+LB2V+A group showed no microleakage at both the occlusal and gingival test regions.
Analysis of Variance↗
Effect of pulp protection technique on the clinical performance of amalgam restorations: three-year results.
This study evaluated the influence of the pulp protection technique on clinical performance of amalgam restorations after three years, with particular reference to post-operative sensitivity and secondary caries. One hundred and twenty (120) Class II amalgam restorations (68 premolars, 52 molars; 78 MOD, 42 OD/MO) were placed in 30 participants (four restorations per participant). The restorations were divided into four groups according to the pulp protection technique used: copal varnish; 2% neutral sodium fluoride; adhesive resin and no pulp protection. The parameters evaluated were post-operative sensitivity, staining of the dental structure, tooth vitality, partial or total loss of the restoration and secondary caries. One hundred and eight (108) restorations were available for evaluation after three years. No partial or total loss of restorations had occurred; all teeth were vital, no tooth structure staining or secondary caries was detected in any of the restored teeth. Post-operative sensitivity was observed only in two restorations at baseline and at seven-days. The three-year clinical performance of teeth restored with a high copper dispersed phase amalgam was not affected by the choice of pulp protection technique.
Adolescent↗
The influence of a packable resin composite, conventional resin composite and amalgam on molar cuspal stiffness.
Packable resin composites may offer improved properties and clinical performance over conventional resin composites or dental amalgam. This in vitro study examined the cuspal stiffness of molars restored with a packable resin composite, a conventional posterior microfilled resin composite and amalgam. Forty-eight intact caries-free human third molars were distributed into four treatment groups (n=12) so that the mean cross-sectional areas of all groups were equal. Standardized MOD cavity preparations were made and specimens restored using one of four restorative materials: (1) a spherical particle amalgam (Tytin); (2) Tytin amalgam with a dentin adhesive liner (OptiBond Solo); (3) a conventional microfilled posterior resin composite (Heliomolar); (4) a packable posterior resin composite (Prodigy Posterior). Cuspal stiffness was measured using a Bionix 200 biomaterials testing machine (MTS). Specimens were loaded vertically to 300 N at a crosshead speed of 1.0 mm/minute. Stiffness was measured at 10 intervals: (1) prior to cavity preparation (intact); (2) following cavity preparation, but before restoration; (3) seven days after restoration; then (4) 1, 2, 3, 4, 5, 6 and 12 months after restoration. All specimens were stored at 37 degrees C in deionized water throughout the study and thermocycled (5 degrees/55 degrees C; 2000 cycles) monthly for 12 months. Repeated Measures ANOVA revealed significant differences among treatment groups over time (p<0.0001). Cavity preparation reduced cuspal stiffness by more than 60%. At 12 months, the cuspal stiffness of restored teeth was, on average, 58% that of intact specimens. Neither the packable nor the conventional resin composite increased cuspal stiffness over that of amalgam.
Acrylic Resins↗
Clinical performance of resin composite restorations after 2 years.
The objective of this study was to evaluate the clinical performance of a packable restorative material, after 2 years in stress-bearing posterior cavities, according to the Ryge criteria. At least two Class 2 restorations (occluso-mesial, mesial-occlusal-distal, occlusal-distal) were placed in 46 patients (36.7 +/- 16 years). In each of the restorations (lot 221, metal matrix band system, glass ionomer-cement-base in 53% of the cavities, mostly no rubber dam) an adhesive system was used. Additionally, in each patient a flowable composite was used in one of the two fillings. After 2 years, 70% of the patients were available for reevaluation. Two restorations needed to be replaced as a result of postoperative sensitivities within the observation period, and one tooth received root canal treatment. All other restored teeth remained vital. One restoration with marginal discoloration received a score of Charlie; another with secondary caries received a score of Bravo. All the others revealed excellent and clinically acceptable results. No statistically significant difference (Chi-square-test) was observed between the two groups, with and without an additional flowable composite. After 2 years, the restorative material performed clinically well, with no observable fractures in the restoration.
Bicuspid↗
Glass ionomer cements.
Glass ionomer cements have been used in pediatric restorative dentistry for 20 years. Their usefulness in pediatric restorative dentistry is preferential relative to other materials because of their fluoride release, chemical adhesion to tooth structure, and availability to use in a variety of clinical scenarios. This paper reviews the use of glass ionomer materials in pediatric restorative dentistry. The paper provides a look at glass ionomer cements' use as sealants and restorative materials and examines glass ionomers as adhesives, as a stand-alone material and in the sandwich technique. This paper also provides a useful guide to connecting to other references regarding specific aspects of glass ionomers in children.
Cementation↗
The effectiveness of four-cavity treatment systems in sealing amalgam restorations.
Amalgam does not bond to tooth tissue; therefore, restorations using such material are prone to leakage despite the deposition of corrosion products. This study evaluated the effectiveness of four cavity treatment systems placed in vivo in sealing restorations of amalgam. Four cavity treatment systems were investigated in this study: Cervitec, Gluma One Bond, Panavia 21 and Copaliner Dentin Varnish and Sealant. No cavity treatment was placed in an additional group to serve as a control. The teeth were extracted within 15 minutes of restoration placement. The specimens were thermocycled (5-55 +/- 2 degrees C, 500 cycles), immersed in a dye solution, sectioned and scored for leakage. Scanning electron microscopy also examined features of the tooth/restoration interfaces. There were statistically significant differences among the groups regarding leakage scores (p = 0.00). None of the materials tested consistently prevented leakage; however, use of Copaliner Dentin Varnish and Sealant resulted in less overall, occlusal and cervical microleakage than any other systems tested. Significantly more leakage was observed in relation to the cervical portions of the cavities (p = 0.00). No significant differences were identified between the leakage scores obtained for the buccal and palatal (lingual) cavities and the different tooth types (p = 0.52 and 0.83, respectively). A level of significance of 0.05 was selected in all cases. The benefits of the materials tested in this study need to be evaluated using robust, long-term clinical studies. Further work should continue to develop laboratory tests that predict the behavior and performance of cavity sealants in clinical service.
Adhesives↗
Liners, bases, and cements: a solid foundation.
This in-depth literature review examines materials that can be used as a liner, a base, and/or a cement. Findings from recent research also are included.
Calcium Hydroxide↗
Microleakage of amalgam cavity treatment systems: an in vitro evaluation.
PURPOSE: to evaluate the effectiveness of four cavity treatment systems for their ability to seal standardized Class V restorations of amalgam. MATERIALS AND METHODS: The Celay copy-milling machine was used to prepare twenty-five standardized Class V cavities on the buccal and palatal surfaces of maxillary premolar teeth extracted for orthodontic purposes. The cavosurface margins lay entirely within enamel. Five cavity treatment test groups were employed prior to amalgam placement: Group 1, Cervitec; Group 2, Gluma One Bond; Group 3, Panavia 21; Group 4, Copaliner Dentin Varnish and Sealant and Group 5, Control. Following restoration placement, the teeth were aged at room temperature (25 +/- 2 degrees C) in tap water for 2 months. The specimens were subsequently thermocycled (500 cycles, 5 -55 +/- 2 degrees C), immersed in a dye solution, sectioned and scored for microleakage. Scanning electron microscopy was employed to examine features of the tooth/restoration interface. RESULTS: None of the materials tested consistently prevented microleakage. No statistically significant differences were identified between the groups with respect to the microleakage scores (P > 0.05). The gingival walls exhibited significantly more microleakage than the occlusal walls (P = 0.00). No significant differences were identified between the microleakage scores obtained for the buccal and palatal cavities. Scanning electron microscopy examination failed to demonstrate a consistent pattern of interfacial appearance, showing a combination of cohesive and adhesive failure within and between test groups.
Adhesives↗
Indirect pulp treatment of primary posterior teeth: a retrospective study.
PURPOSE: This study was performed to assess retrospectively the clinical and radiographic success of indirect pulp treatment (IPT) on primary posterior teeth, and to compare the influence of caries risk, skills of the operator, and restorative material on the success of IPT. METHODS: A retrospective review of records of patients treated with IPT in the pediatric dental clinic at The University of Michigan, School of Dentistry from July 1993 through July 1999 was completed in January 2000. Two hundred fifty-five records with IPT were reviewed, from which 132 patients met the inclusion criteria, with 187 primary posterior teeth treated with an IPT. The patients were followed clinically and radiographically for a time ranging between 2 weeks to 73 months. Data were analyzed using survival analysis methods. RESULTS: The success of IPT was 95% (178/187 teeth), with only 9 failures. The 1-year probability of survival of each tooth was estimated to be 96% using an exponential survival model. The use of a base over a calcium hydroxide liner significantly increased the success rate of IPT (P = .0095). The use of a stainless steel crown (SSC) after an IPT was significantly more successful than the use of an amalgam (P=.026). IPT performed on primary first molars failed more frequently than on second primary molars (P = .045). There was no significant difference between maxillary and mandibular primary molars. CONCLUSIONS: Indirect pulp treatment is a successful technique and should be considered as an alternative pulp therapy procedure in deeply carious primary posterior teeth. The use of a base over the liner in addition to a SSC dramatically increases the success of an IPT.
Adolescent↗
Marginal adaptation, retention and fracture resistance of adhesive composite restorations on devital teeth with and without posts.
This in vitro study generated data on the quality of marginal adaptation, fracture resistance and retention of several indirect adhesive composite configurations on root-treated premolars before and after a long-term fatigue test and compared these results to a control group of adhesive onlays on "vital" teeth. Six root-treated extracted human premolars per group, with four different restorative configurations with and without adhesive fiber posts, were evaluated. Another group of six premolars, "revitalized" by using diluted horse serum to simulate pulpal fluid and restored with adhesive composite onlays, served as the control. Marginal adaptation before and after long-term occlusal loading (1,200,000 occlusal loading cycles at max 49 N) was assessed by using the replica technique and quantitative evaluation in SEM at 200x magnification. The number of lost restorations was recorded after loading. Fracture resistance and fracture patterns were evaluated by using a universal-testing machine on the fatigued samples. No significant differences (p > 0.05) between groups were detected before and after loading for the percentage of "continuous margin" at the total marginal length. Loading had a significant (p < 0.05) effect on the percentage of "continuous margin" for the total marginal length of two groups only. No significant difference (p > 0.05) for fracture resistance was detected and no lost restorations were observed. The results suggest that for both the less decayed and the more significantly decayed devital teeth, the minimally invasive adhesive restorative approach is promising.
Analysis of Variance↗
Fluoride-releasing resin bonding of amalgam restorations in primary teeth: in vitro secondary caries effect.
PURPOSE: To evaluate the effects of a fluoride-releasing resin designed for amalgam bonding on secondary caries formation in primary teeth restored with amalgams. MATERIALS AND METHODS: Primary teeth with caries-free buccal and lingual surfaces were selected and underwent a fluoride-free prophylaxis. Cavity preparations were performed in the buccal and lingual smooth surfaces of 20 primary teeth. A fluoride-releasing dimethacrylate resin bonding agent (Alloybond) was placed prior to amalgam restoration (Dispersalloy) of the cavity preparations in 10 teeth. Amalgam restorations placed in 10 teeth following copal cavity varnish (Copalite) served as controls. The teeth were thermocycled in synthetic saliva (500 cycles, 5 degrees-50 degrees C), and then coated with an acid-resistant coating, leaving a 1mm rim of sound enamel surrounding the restorations. Artificial secondary caries were created (2.2 mM calcium, 2.2 mM phosphate, 50 mM acetic acid, 0.5 ppm fluoride, pH 3.90). Following lesion formation, longitudinal sections (five per tooth) were prepared for polarized light evaluation. Mean depths for the primary surface lesions were determined using a computer-interfaced digitized tablet. Cavity wall lesion frequencies were also evaluated. Comparisons were made between groups (ANOVA, DMR). RESULTS: Primary surface lesion depth was reduced significantly (P < 0.05) with Alloybond-amalgams (135 +/- 14 microm) when compared with Copalite-amalgams (184 +/- 21 microm). Cavity wall lesion frequency was decreased (P < 0.05) significantly with Alloybond-amalgams (57%) compared with Copalite-amalgams (89%). The beneficial effect of the fluoride-releasing amalgam bonding agent was not limited to the cavosurface enamel. The caries susceptibility of enamel surfaces adjacent to amalgams with the fluoride-releasing bonding agent was decreased considerably. The incorporation of the amalgam-bonding resin with fluoride-releasing capabilities provided greater protection against a constant cariogenic attack over that for a conventional amalgam restoration.
Analysis of Variance↗
Management of microleakage in dental compomers.
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Compomers↗
Marginal leakage of impregnated Class 2 composites in primary molars: an in vivo study.
In vivo impregnation of the cervical margin was used in an attempt to prevent leakage of class 2 composite restorations in primary molars. Examination after 18 months demonstrated clinical success of the restorations. However, the exfoliated teeth presented extensive dye penetration at the approximal margins of the restorations, suggesting that impregnation did not prevent marginal leakage.
Bisphenol A-Glycidyl Methacrylate↗
Bond strength of glass-ionomer cement and composite resin combinations.
The tensile bond strength to dentin was measured for three glass-ionomer cement and composite resin combinations: two light-curing glass-ionomer cements (Vitrebond and XR-Ionomer) and one traditional glass-ionomer cement (Ketac-Bond), two adhesive systems (Scotchbond, and XR-Bonding System), and a corresponding composite resin. The bond strength of this "sandwich" was also compared with that of the same cements used in bulk. Vitrebond showed a significantly higher bond strength in bulk than did the other two cements. Of the sandwiches, the XR-Ionomer and XR-Bond combination showed a bond strength significantly higher than that of the Vitrebond and Scotchbond or Ketac-Bond and Scotchbond combination. The fracture of the bond was mainly adhesive for Vitrebond, cohesive for XR-Ionomer when used in bulk and adhesive-cohesive when used in a sandwich, and cohesive for Ketac-Bond.
Acrylic Resins↗
The effect of collagen removal and the use of a low-viscosity resin liner on marginal adaptation of resin composite restorations with margins in dentin.
This study evaluated the influence of collagen removal and the use of a low-viscosity liner on the marginal quality of composite restorations for the total-etch system, Prime & Bond 2.1 (PB) and the self-etching primer system, Clearfil SE Bond (CSEB), in high C-factor cavities with margins in dentin. High C-factor cavities were made on dentin exposed from ground labial surfaces of 100 bovine lower incisors, randomly assigned to 10 treatment groups and restored with composite Z 250, placed in bulk. In Group 1 (PB), control group, PB was applied according to the manufacturer's directions; in Group 2 (PB/PLF), an intermediate layer of low-viscosity composite Protect Liner F (PLF) was applied on the bonding resin surface; in Group 3 (PB/SH) following acid-etching, the surfaces were treated with 10% sodium hypochlorite (SH) for one minute and in Group 4 (PB/SH/PLF), the same procedure was conducted as for Group 3, plus an intermediate layer of PLF was applied as for Group 2. In Group 5 (CSEB), the control group, CSEB was applied according to the manufacturer's directions; in Group 6 (CSEB/PLF), an intermediate layer of PLF was applied; in Group 7 (SH/CSEB), the cavity surface was pre-treated with SH; in Group 8 (SH/CSEB/PLF), SH pre-treatment was conducted as for Group 7, then an intermediate layer of PLF was applied; in Group 9 (CSEB/SH), after CSEB-primer application, the surface was treated with SH, followed by CSEB-adhesive application and in Group 10 (CSEB/SH/PLF), the same was conducted as for Group 9, then an intermediate layer of PLF was applied. The specimens were stored at 37 degrees C for 24 hours, polished, molded and replicas were obtained in epoxy resin. The replicas were gold-sputter coated and observed by SEM (300x) for marginal quality classification. The Kruskal-Wallis non-parametrical multi-comparison Test (p<0.05) was used to obtain statistical analysis of the data. Results demonstrated that both adhesive systems in the control groups presented low marginal quality and a high variability. The use of an intermediate layer of PLF significantly improved the marginal quality with the CSEB system but had no effect with the PB system. Collagen depletion with SH enhanced marginal quality for the PB system and did not influence the CSEB system results.
Acetone↗