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At least 163 records · Page 9Linked to original sources
PubMed2000

Direct composite inlays versus conventional composite restorations: 5-year follow-up.

OBJECTIVES: To determine at 5 year follow-up the failure rate, wear rates and other aspects of clinical performance of direct composite inlays compared with conventional composite restorations placed incrementally. METHODS: 100 matched pairs of restorations were originally entered into the trial. Each pair consisted of a direct composite inlay and a conventional composite restoration made from the same material. At 5 years it was possible to recall 65 pairs, of which 54 were complete. Clinical assessments were made using USPHS criteria (indirect measurements of occlusal wear were made using Ivoclar standard dies) and annual bite wing radiographs. RESULTS: There was a trend to more failure of inlays than conventional composites (17.4 c.f. 7.5%) but this was not significant. The clinical performance of both types of restoration was similar and compared favourably with the results of studies of other materials. Secondary decay was diagnosed in only one restoration. Between 3 and 5 years there was some deterioration in cavo-marginal discoloration, marginal adaptation (occlusally) and surface roughness (occlusally). There was no apparent deterioration in colour match, proximal contact, shim stock contacts and Gingival Index. Wear rates of both types of restoration showed no significant difference and were essentially linear with a mean of 33-34 microm per year. CONCLUSIONS: Both inlays and conventional composite restorations complied with ADA specification minimum requirements for posterior composite restorations. In this study the direct inlay technique gave no clinical advantage over conventional, incremental placement.

Adult↗
PubMed2001

Eighteen-month clinical evaluation of a filled and unfilled dentin adhesive.

OBJECTIVE: The purpose of this study was to evaluate the performance of a filled (OptiBond Solo) and an unfilled (Prime & Bond 2.1) "one-bottle" adhesive in Class V restorations after 18 months of clinical service. METHODS: Thirty-three patients with non-carious cervical lesions were enrolled in the study. A total of 101 lesions were restored using one of the adhesives and a hybrid composite resin. Enamel was not beveled, nor was any mechanical retention placed. The restorations were evaluated at baseline, and at 6 and 18 months after placement using modified USPHS criteria. RESULTS: Cumulative 18-month retention rates were 93.6% for OptiBond Solo and 98.0% for Prime & Bond 2.1. The difference in retention rates was not statistically significant. For OptiBond Solo, the only notable problems were interfacial staining and marginal adaptation, both of which were less than ideal in 9% of restorations. Marginal problems were slightly less frequent for Prime & Bond 2.1 restorations, but the difference was not significant. CONCLUSIONS: Both adhesives provided Class V retention rates exceeding the 18-month, full acceptance guidelines set by the American Dental Association. Any additional benefit provided by the use of a filled adhesive was not detected in this 18-month clinical trial.

Adhesives↗
PubMed1998

Fired ceramic inlays: a 6-year follow up.

OBJECTIVES: The aim of this study was to evaluate feldspathic ceramic inlays luted with dual-cured resin composite or glass polyalkenoate (ionomer) cement (GIC) during a 6-year follow-up. METHODS: One-hundred and eighteen Class II fired feldspathic ceramic inlays were placed in 50 patients. In each patient half of the inlays were luted with a dual-cured resin composite and the other half with a conventional glass ionomer cement. The inlays were evaluated clinically, according to modified USPHS criteria, at baseline, after 6 months and then annually over a 6-year period. RESULTS: Of the 115 inlays evaluated at 6 years, 12% in the resin composite group and 26% in the GIC group were assessed as having failed. The main reason for failure in both groups was partial fracture or total loss of the inlays. Secondary caries was found to be associated with three inlays in one high caries risk patient. One inlay was replaced because of postoperative sensitivity. CONCLUSION: A relatively high and increasing failure rate was observed over the 6-year period of the study. The failure rate was more pronounced in the GIC group.

Adult↗
PubMed1999

Clinical evaluation of a posterior composite 10-year report.

OBJECTIVE: The 10-year findings of one of the studies which comprised the multicentre clinical evaluation of a light-cured posterior composite restorative are reported, with special emphasis on the reasons and timing of failure of restorations included in the study. Effects of the use of rubber dam or cotton rolls and aspiration for isolation at the time of placement are considered. METHOD: One hundred Class I and II restorations of the resin composite investigated were placed by a single operator in a group of selected, predominantly young-adult patients under highly controlled conditions, with the use of rubber dam or cotton rolls and aspiration for isolation being determined according to a scheme of randomisation. The restorations were reviewed clinically after 1 week and within 1 month of placement (baseline) and, thereafter, at 6 months, 1, 2, 3, 4, 5, 6 and 10 years using modified USPHS codes and criteria. Epoxy models and photographs were obtained for retrospective analysis. RESULTS: After 10 years, 37 restorations were reviewed and 32 restorations were known to have failed. Regarding the reasons for failure, loss of occlusal anatomic form during the first 5 years and loss of approximal contacts near the end of the study accounted for most of the failures. Only two failures were attributed to recurrent caries. Few of the restorations found to be clinically satisfactory at 10 years had retained ideal functional characteristics. Location, Class and size of restoration and the method of isolation were not found to significantly influence 10-year performance and survival. CONCLUSION: The actual 10-year failure rate, estimated to have been between 40 and 50% is considered to have been high, notably given the limited incidence of recurrent caries and bulk fracture. However, the findings indicate that certain restorations of the material investigated, despite the use of outdated operative techniques, may be found to perform satisfactorily over periods in excess of 10 years.

Adult↗
PubMed1999

IPS Empress inlays and onlays after four years--a clinical study.

OBJECTIVE: Ceramic inlays are used as esthetic alternatives to amalgam and other metallic materials for the restoration of badly damaged teeth. However, only limited clinical data are available regarding adhesive inlays and onlays with proximal margins located in dentine. In a prospective, controlled clinical study, the performance of IPS Empress inlays and onlays with cuspal replacements and margins below the amelocemental junction was examined. MATERIALS AND METHODS: Ninety-six IPS Empress fillings were placed in 34 patients by six clinicians. The restorations were luted with four different composite systems. The dentin bonding system Syntac Classic was used in addition to the acid-etch-technique. At baseline and after 6 months, one, two and four years after placement the restorations were assessed by two calibrated investigators using modified USPHS codes and criteria. A representative sample of the restorations was investigated by scanning electron microscopy to evaluate wear. RESULTS: Seven of the 96 restorations investigated had to be replaced (failure rate 7%; Kaplan-Meier). Four inlays had suffered cohesive bulk fractures and three teeth required endodontic treatment. After four years in clinical service, significant deterioration (Friedman 2-way Anova; p < 0.05) was found to have occurred in the marginal adaptation of the remaining restorations. Seventy-nine percent of the surviving restorations exhibited marginal deficiencies, independent of the luting composite. Neither the absence of enamel margins, nor cuspal replacement significantly affected the adhesion or marginal quality of the restorations. CONCLUSION: After four years, extensive IPS Empress inlays and onlays bonded with the dentin bonding system Syntac Classic were found to have a 7% failure rate with 79% of the remaining restorations having marginal deficiencies.

Adult↗
PubMed2000

Three-year clinical evaluation of a polyacid-modified resin composite in minimally invasive occlusal cavities.

OBJECTIVE: The aim of this study was to evaluate the 3-year clinical performance of one polyacid-modified resin composite material (PMRC). Dyract, in minimally invasive occlusal cavities and its neighbouring fissures. METHODS: One hundred and sixteen restorations of the material investigated were placed by a single operator in a group of selected children under controlled conditions. Isolation of the restorations was accomplished with the use of cotton rolls and aspiration. Using modified US Public Health Service (USPHS) codes and criteria, the restorations were reviewed clinically within 1 week of placement (baseline), and thereafter at 6 months, 1, 2 and 3 years. RESULTS: After 3 years, marginal discolouration was present in 8.6% of the restorations. The marginal adaptation was rated as partly sealed (Oscar-Alpha) in 107 (92.2) of the restorations. Five restorations had lost their sealant components, while four restorations were partly sealed with explorer-catch after 3 years. Although wear of the restorations was considerable, restorations rated as 'partly sealed' had at least two-thirds of their sealant components fully retained. Recurrent caries was associated with four (3.4%) restorations. CONCLUSION: In this clinical study, the retention rate of the tested PMRC material was good, although a marked occlusal wear was evident. The marginal adaptation of the PMRC at the enamel site would probably have been better by the use of enamel-etching. Provided the marginal adaptation and wear resistance of the material is further improved, clinical use of PMRCs in minimally invasive occlusal cavities can be advocated.

Child↗
PubMed2000

A five-year clinical evaluation of Class II composite resin restorations.

OBJECTIVES: To study the clinical efficacy of posterior composite resin restorations placed in general practice after five years. METHODS: Two commercial composite resin systems were used. Three general practitioners placed the restorations at a Public Dental Health Service Office. The patients were not selected specifically for this study. Class II cavities were restored with Superlux Molar and P-50 APC composite systems on an alternate basis. At baseline, 63 restorations were placed in molars and premolars in 45 patients. For primary caries, generally a conservative cavity design was used (n = 23), while replacements of amalgams resulted in the larger conventional Class II design (n = 40). The restorations were assessed using a modified USPHS criteria. Wear measurements were determined by the Leinfelder method. Photographs and bite-wing radiographs were taken to supplement the clinical evaluation of colour match, marginal adaptation and recurrent caries. Saliva sampling was performed to determine the rate of secretion and the level of mutans streptococci and lactobacilli. RESULTS: At the five-year review 51 restorations were available for examination, of which nine restorations were rated clinically unacceptable. Including the failed restorations (n = 7), at the three-year review, a total of 16 restorations had failed (27.6%) over a five-year period. The most common reasons for failure were recurrent caries (n = 7) and marginal defects (n = 4). The mean wear of Superlux Molar was 167 microns and of P-50 APC 158 microns. Eight of the 11 patients with failed restorations due to caries and marginal defects had high counts of mutans streptococci at baseline. CONCLUSIONS: The failures in the present group of patients did not specifically relate to material, tooth type or cavity design. However, it is suggested that patient factors such as caries activity should be monitored and managed.

Adolescent↗
PubMedDate not supplied

A competency based approach to comprehensive pregnancy care.

This paper assesses the quality and cost of a pregnancy care program based on explicit and achieved patient competencies. By using the USPHS Content of Prenatal Care (1989), key psychosocial/education elements of perinatal care were identified. The goal was a process of patient education that is competency based, integrated, and outcome oriented. Psychosocial assessment, patient education tools, criterion-based length of postpartum stay, and home nursing follow-up were implemented as part of a Comprehensive Pregnancy Program (CPP). Case-control and cohort survey methodology were used to evaluate outcome. There was a significant decrease in hospital length of stay for mothers and newborns after implementation of the CPP. Post-discharge maternal emergency room visits and/or readmits did not increase. Differences in newborn emergency room visits and/or readmits were non-significant. There was a marked reduction in hospital costs for mothers and newborns. Patient satisfaction remained high. Core competencies forming the basis of educational and assessment programs allow the focus of care to be optimal outcome, and provide a useful template against which to measure prenatal, intrapartum, and postpartum care.

Adaptation, Psychological↗
PubMed2000

An 8-year evaluation of sintered ceramic and glass ceramic inlays processed by the Cerec CAD/CAM system.

The purpose of this study was to evaluate Cerec CAD/CAM inlays processed of two industrially made machinable ceramics during an 8-yr follow-up period. Each of 16 patients received two similar ceramic inlays. Half the number of the inlays were made of a feldspathic (Vita Mark II) and the other of a glass ceramic (Dicor MGC) block. The inlays were luted with a dual resin composite and evaluated clinically using modified USPHS criteria at baseline, 8 months, 2, 3, 5, 6 and 8 yr, and indirectly using models. At baseline, 84% of the inlays were estimated as optimal and 16% as acceptable. Postoperative sensitivity was reported by one patient for 8 months. Of the 32 inlays evaluated during the 8 yr, 3 failed due to fracture of the material. No secondary caries was found adjacent to the inlays. No significant differences in the clinical performance were found between inlays made of the two ceramics. It can be concluded that the CAD/CAM inlays processed of the two ceramics functioned well during the 8-yr follow-up period.

Adult↗
PubMed2003

Marginal deterioration as a predictor of failure of a posterior composite.

The purpose of the present study was to undertake a retrospective analysis of the findings of a multicentre clinical trial to test the hypothesis that marginal deterioration and cavomarginal discoloration may be a predictor of the failure of posterior composite restorations. Longitudinal 5-yr data from the multicentre trial of Occlusin were analysed (modified USPHS criteria data were available in respect of 1018 of the 1242 restorations included in the study). The 5-yr failure rate was calculated using three different methods. The various failure rates (maximum 18.8%) and the data pertaining to marginal deterioration and cavomarginal discoloration were then compared and contrasted by means of chi2 test. The analysis revealed that restorations with marginal deterioration at 3 yr were 5.3 times more likely to have failed by 5 yr than restorations with A (Alfa) rated marginal adaptation at 3 yr. Similarly restorations with cavomarginal discoloration at 3 yr were found to be 3.8 times more likely to have failed at 5 yr than restorations with no cavomarginal discoloration at 3 yr. Moreover, restorations with both marginal deterioration and cavomarginal discoloration at 3 yr failed 8.7 times more frequently than restorations with sound margin at 3 yr. It is concluded that clinical investigations of present-day materials for posterior composite should seek to determine if marginal deterioration and cavomarginal discoloration is an important predictor of the failure of posterior composites, especially when marginal deterioration and cavomarginal discoloration occur simultaneously.

Bicuspid↗
PubMed2003

Clinical and SEM evaluation of all-ceramic chair-side CAD/CAM-generated partial crowns.

The effect of hardware and software on the quality of Cerec all-ceramic partial crowns was investigated in this cross-sectional study. Partial crowns (n = 818) had been adhesively placed in 496 patients between 1993 and 1997 using Cerec 1 and Cerec 2 units (groups 1 and 2) as well as Cerec 2 with wall-spacing software (group 3). From each group, 25 randomly selected partial crowns were evaluated using modified United States Public Health Service (USPHS) criteria. Of these, 12 were randomly selected in each group, replicas taken and examined in a scanning electron microscope for marginal interfacial width and for continuous margin adaptation. Interfacial width of group 1 (308 +/- 95 micro m) was significantly larger than those of groups 2 (243 +/- 48 micro m) and 3 (207 +/- 63 micro m). Continuous margin adaptation at the tooth-luting composite and luting composite-restoration interfaces showed only minor differences in groups 1 (94.5 +/- 8% and 95.5 +/- 2%), 2 (98.1 +/- 1% and 97.5 +/- 1.4%) and 3 (96.8 +/- 3% and 96.8 +/- 2%). Pooled clinical rating was excellent or good at 97% for all groups, indicating acceptable restoration quality except for one breakage in group 1.

Adult↗
PubMed2001

Clinical performance of a condensable metal-reinforced glass ionomer cement in primary molars.

OBJECTIVE: Aim of the present study was to evaluate the clinical suitability of the condensable metal-reinforced glass ionomer cement Hi-Dense in classes I and II cavities of primary molars. METHODS: Seventeen children received a total of fifty four Hi-Dense fillings (nineteen class I and thirty five class II). The restorations were clinically assessed at baseline, after one and after two years of clinical service according to modified USPHS codes and criteria. The restorations were replicated in each recall and representative samples were qualitatively analysed under a SEM. RESULTS: Over the observation period of two years, five restorations failed due to total retention loss, two fillings needed replacement because of persisting hypersensitivity, one filling was lost because of an unsuccessful endodontic treatment, and four restorations remained intact until natural exfoliation (Two year survival rate: 92% for Class I and 66% for Class II). The SEM analysis of surfaces and marginal areas exhibited an inferior adhesive performance primarily in proximal areas, whereas a negative step formation due to wear was frequently observed in occlusal parts. CONCLUSIONS: The results clearly indicate that the condensable, metal-reinforced GIC Hi-Dense reveals no enhanced performance and lifetime expectancy for class II restorations in primary molars when compared to other non-resin-modified GICs.

Cermet Cements↗
PubMed1995

Direct composite inlays versus conventional composite restorations: three-year clinical results.

A clinical trial of direct composite inlays versus conventionally (incrementally) placed restorations made from the same material was started in January 1989. Restorations were randomly allocated to matched pairs of cavities. This study reports the 3-year performance of 71 of the 100 pairs of restorations placed over a 2-year period and followed-up every 6 months. Clinical assessments were made using USPHS criteria (indirect measurements of occlusal wear were made using Ivoclar standard dies) and annual bite wing radiographs. Direct inlays showed significantly less occlusal wear than conventional restorations, but the difference was small. The clinical performance of both types of restoration was similar and compared favourably with studies of other materials. No secondary decay was diagnosed. The direct inlays, however, took longer to place and did not reduce postoperative sensitivity or failure rate (8% failure of inlays and 4% of conventional composites over 3 years). Contouring of proximal and occlusal aspects was not facilitated with direct inlays but may be easier with indirect inlays on removable dies.

Adult↗
PubMed1997

Clinical evaluation of an anterior hybrid composite resin over 8 years.

AIM: To evaluate the performance of an anterior hybrid composite resin restorative material (Opalux). DESIGN: Single-centre clinical trial. MATERIALS AND METHODS: Scores were obtained based on USPHS criteria for marginal adaptation, anatomic form, colour match, surface roughness and marginal discolouration. INTERVENTIONS: The restorative material was evaluated in suitable cavities in 24 patients (12 male, 12 female). Ethical permission and consent were obtained. MAIN OUTCOME MEASURES: Baseline data was collected on 44 restorations (25 Class III, 3 Class IV, 16 Class V) and reviewed independently by two of the three clinicians who contributed to the study who then reached a consensus score. Restorations were reviewed and scored in the same way at 3 months and 1, 2, 3 and 8 years. RESULTS: The total number of alpha ratings at baseline and review (3 months and 1, 2, 3 and 8 years) appointments for the following parameters were: marginal adaptation (33, 28, 29, 27, 12, 17), anatomic form (39, 30, 32, 26, 17, 15), surface roughness (34, 26, 24, 23, 11, 4), colour match (24, 25, 26, 24, 15, 12) and marginal discolouration (39, 31, 30, 25, 10, 9). The incidence of secondary caries was very low. Life table analysis suggests a 73% survival, with no scores below B, at 8 years. CONCLUSIONS: The majority of these restorations continued to perform satisfactorily. Although this particular material is no longer available, these results may be applicable to currently available similar materials.

Adolescent↗
PubMed2006

Eight year results with direct ceramic restorations (Cerana).

BACKGROUND: Single-visit system ceramic restorations are now in use to provide an alternative to resin-based materials. Inserts have been shown to improve characteristics of composite restorations. OBJECTIVE: To investigate the longevity of Cerana (Nordiska Dental, Sweden) in a prospective clinical trial. METHODS: Cerana restorations use matched drills with pre-etched and silanated leucite inserts cemented using a conventional restorative composite resin material. The results of 33 Cerana restorations up to eight years (25 Class I, eight class II) are presented. Restorations were reviewed and assessed by two examiners using modified USPHS criteria for anatomical form (AF) A-C, marginal adaptation (MA) A-D, surface roughness (SR) A-D, marginal discoloration (MD) A-C, colour match (CM) A-C and discomfort (DT) A-D as well as retention. RESULTS: The percentage of A scores for AF, MA, SR, MD, CM and DT at baseline (n = 33) were: 100, 100, 79, 100, 21, 100; after two years (n = 27) 100, 85, 33, 100, 19, 100 and after four years (n = 24) 96, 75, 17, 96, 25, 100. At six years (n = 20) 95, 70, 10, 95, 15, 100 and finally at the eight year recall (n = 18) 94, 61, 0, 94, 6, 100. AF was maintained in all except for one fractured marginal ridge. MA of the insert was good but composite was lost where exposed. SR increased to a B score for all inserts. MD at B grade was observed in 6% between composite and tooth but none between insert and composite. CM was stable in all cases. DT nil in all. There were no scores less than B. All reviewed restorations were retained, clinically acceptable and in function except for two lost for reasons not directly related to the Cerana insert. One class II restoration had a fractured marginal ridge but otherwise remains satisfactory. CONCLUSIONS: The results suggest that these restorations can be expected to perform well. Cerana is acceptable in terms of aesthetics, patient acceptance, occlusal wear and ease of use and is a good alternative for a single-visit, tooth coloured restoration in suitable cavity shapes.

Aluminum Silicates↗
PubMed1999

Longevity of new hybrid restorative materials in class III cavities.

The aim of this study was to evaluate the durability of two new tooth-colored restorative materials, a polyacid-modified resin composite (compomer) and a resin-modified glass ionomer cement. In an intra-individual comparison with a resin composite, the materials were studied during a 5-yr period. In 50 patients, 154 large class III restorations were placed. Most patients received one of each of the three materials. The restorations were evaluated by modified United States Public Health Service (USPHS) criteria. Of the 144 restorations evaluated, 15 were found unacceptable. No significant differences were seen between the materials concerning recurrent caries incidence. The resin composite showed a significantly better color match. No difference was found between resin composite fillings in enamel- or total-etched cavities. Significantly higher surface roughness was found in the aged resin-modified glass ionomer cement restorations. Fracture of the incisal enamel corner was observed adjacent to 10 restorations. None of the three total-etch techniques resulted in postoperative sensitivity or loss of vitality. All the restorative techniques showed a low failure rate during the 5-yr follow-up.

Acid Etching, Dental↗
PubMed2003

The atraumatic restorative treatment (ART) approach to restoring primary teeth in a standard dental clinic.

OBJECTIVES: The aims of this study are to assess the feasibility of the Atraumatic Restorative Treatment (ART) approach in primary teeth and to compare the ART approach with traditional amalgam restorations in primary molars. METHODS: This study was conducted in a paediatric dentistry clinic in Kuwait between April 1999 and December 2001. The ART and amalgam restorations were placed randomly on comparable pairs of primary molars, if available. In addition, the ART approach was used for other primary teeth that had no pulpal involvement and no perceived pain before treatment. The restorations were assessed by both the ART evaluation criteria and USPHS criteria in August-September 2000 and in August-December 2001. The mean follow-up period for the restorations was 8.3 months in the first assessment (2000) and 22 months in the second assessment (2001). The assessment was possible for 35 children (mean age = 5.7 years), 18 of whom had comparable pairs (n = 35 pairs) of restorations in their primary molars. In addition, 48 other ART restorations were assessed in 2000 and 42 in 2001. RESULTS: In a 2-year follow-up, 89.6% of all ART restorations were considered successful. The failure rate of the comparable pairs of ART and amalgam restorations was 5.7%. There was no significant difference in success rate between ART and amalgam techniques. CONCLUSIONS: Based on a 2-year follow-up evaluation, the class I ART restorations seemed to have a high success rate, indicating the appropriateness of the ART approach in primary teeth.

Chi-Square Distribution↗
PubMed1999

Five year evaluation of class III composite resin restorations in cavities pre-treated with an oxalic- or a phosphoric acid conditioner.

An oxalic acid solution has been proposed as a conditioning agent for resin composite restorations in two commercial adhesive systems. The durability of 163 class III restorations, including 12 class IV restorations, in cavities pre-treated with an oxalic acid total etch technique or an enamel etch with phosphoric acid was studied. Each of 52 patients received at least one of each of three experimental restorations. The restorations were evaluated yearly with slightly modified United States Public Health Service (USPHS) criteria. After 5 years 95% of the restorations were evaluated as acceptable. Reasons for failure were the fracture of four fillings, including three class IV, secondary caries contiguous to two fillings and a non-acceptable colour match for one restoration. For eight class III restorations a fracture of the incisal tooth structure was registered. No differences were seen between the three experimental restorations.

Acid Etching, Dental↗