Three-year randomised clinical trial to evaluate the clinical performance, quantitative and qualitative wear patterns of hybrid composite restorations

The aim of the study was to compare the clinical performance, quantitative and qualitative wear patterns of conventional hybrid (Tetric Ceram), micro-filled hybrid (Gradia Direct Posterior) and nano-hybrid (Tetric EvoCeram, TEC) posterior composite restorations in a 3-year randomised clinical trial. Sixteen Tetric Ceram, 17 TEC and 16 Gradia Direct Posterior restorations were placed in human molars and evaluated at baseline, 6, 12, 24 and 36 months of clinical service according to US Public Health Service criteria. The gypsum replicas at each recall were used for 3D laser scanning to quantify wear, and the epoxy resin replicas were observed under scanning electron microscope to study the qualitative wear patterns. After 3 years of clinical service, the three hybrid restorative materials performed clinically well in posterior cavities. Within the observation period, the nano-hybrid and micro-hybrid restorations evolved better in polishability with improved surface gloss retention than the conventional hybrid counterpart. The three hybrid composites showed enamel-like vertical wear and cavity-size dependant volume loss magnitude. Qualitatively, while the micro-filled and nano-hybrid composite restorations exhibited signs of fatigue similar to the conventional hybrid composite restorations at heavy occlusal contact area, their light occlusal contact areas showed less surface pitting after 3 years of clinical service

Clinical performance of direct and indirect adhesive restorations

Continual improvements in adhesive restorative materials and techniques have expanded the indication field of direct and indirect adhesive restorations, resulting in a greater overlap between both restoration types. The goal of this article is to analyze the current status regarding clinical performance of common types of direct and indirect adhesive restorations. The literature was searched for longitudinal medium- and long-term clinical trials. Obviously, more and longer-term clinical trials were available for the indirect partial ceramic restorations, showing lower annual failure rates compared to their similarly sized direct composite restorations. Nevertheless, a highly clinically acceptable result can be obtained with complex direct composite restorations. In addition, these restorations can function quite well in the medium and even long term. Patient and operator are the most important factors determining the longevity of adhesive restorations, followed by the materials and maintenance of the restorations.status: publishe

Hypomineralized molars

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Treatment of noncarious cervical lesions: when, why, and how

Noncarious cervical lesions (NCCLs) involve the loss of hard tissue from the cervical areas of teeth through processes unrelated to caries. NCCLs are nowadays a common pathology caused by changes in lifestyle and diet. The prevalence and severity of cervical wear increase with age. It is generally accepted that the lesions are not generated by a single factor but result from a combination of factors. Among the factors proposed to be related to the formation and progression of NCCLs are biocorrosion (erosion), friction (abrasion), and possibly occlusal stress (abfraction). The clinical appearance of NCCLs can vary depending on the type and severity of the etiologic factors involved. Practitioners should follow a checklist to achieve an accurate diagnosis of the etiology of multifactorial NCCLs. The successful prevention and management of NCCLs require an understanding of the etiology and risk factors, including how these change over time in individual patients. The decision to monitor NCCLs rather than intervene should be based on the progression of the lesions and how they compromise tooth vitality, function, and esthetics. Treatment options include techniques to alleviate dentin hypersensitivity and the placement of an adhesive restoration, eventually in combination with a root coverage surgical procedure. An adhesive restoration is considered the last treatment option for NCCLs. Based on their excellent esthetic properties and good clinical performance, there is a general indication to place composite restorations for NCCLs. The clinical performance of these restorations is highly product-dependent, particularly regarding the adhesive system used. The type of composite material seems to have no significant influence on the clinical performance of NCCL restorations in clinical trials. It is much more important that the operator carries out the clinical procedure correctly. Marginal degradation is frequently seen during aging. Yearly maintenance with the eventual repolishing of the restoration margins will lengthen the lifespan of the restorations.status: publishe

Nonretentive Bonded Ceramic Partial Crowns: Concept and Simplified Protocol for Long-lasting Dental Restorations

PURPOSE: Adhesively luted partial ceramic crowns have been documented to be clinically more durable than direct composite restorations when minimally invasively restoring large defects (replacing two cusps or more) in posterior teeth. The clinical longevity of such restorations is largely determined by the tooth-preparation design, material selection and adhesive luting procedure. The most frequently recorded failure in medium- to long-term clinical trials is fracture of the restoration. The clinical protocol of adhesively luted partial ceramic crowns can be optimized by taking the etiology of these restoration fractures into account. In this article, a simplified nonretentive bonded ceramic partial crown concept is presented that aims to achieve an adhesively luted ceramic restoration - composite cement - residual tooth structure biomechanical unit that maximally resists functional aging. Therefore, the three primary components of the bonded restoration-cement-tooth complex must function in synergy. Methods, Results and Discussion: The clinical protocol starts with a tooth preparation designed to optimally absorb chewing stress. A stable, internally rounded and gently sloping tooth-preparation design with all outer margins inclined towards the tooth center assures a favorable and homogenous stress distribution with low cyclic fatigue subjected to the adhesive interface. This preparation form additionally enables the dental technician to fabricate a well-seating and -fitting ceramic restoration of uniform thickness. As restoration material, monolithic lithium-disilicate glass ceramic is sufficiently strong for the partial crown indication and preferred in order to decrease the fracture risk. Clinically essential for a long-lasting restoration is the optimal bond that can be obtained by combined micromechanical interlocking and chemical bonding of composite cement to hydrofluoric acid-etched and silanized glass ceramic. CONCLUSION: The clinical effectiveness of this nonretentive bonded ceramic partial crown concept is confirmed by the overall high success rate as well as the very low fracture and debonding rate, as was recorded in long-term clinical trials.status: publishe

Couronnes partielles collées non rétentives en céramique - Concept et protocole smplifiés pour des restaurations dentaires de longue durée

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Clinical effectiveness of contemporary adhesives for the restoration of non-carious cervical lesions. A systematic review

The aim of this systematic review was to evaluate the clinical effectiveness of contemporary adhesives for the restoration of non-carious cervical lesions (NCCLs) in terms of restoration retention as a function of time.publisher: Elsevier articletitle: Clinical effectiveness of contemporary adhesives for the restoration of non-carious cervical lesions. A systematic review journaltitle: Dental Materials articlelink: http://dx.doi.org/10.1016/j.dental.2014.07.007 content_type: article copyright: Copyright © 2014 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.status: publishe

Clinical trial of tooth whitening with 6% hydrogen peroxide whitening strips and two whitening dentifrices

PURPOSE: To compare tooth whitening with 6% hydrogen peroxide whitening strips and two whitening dentifrices in a 12-week randomized controlled trial at a Belgian dental school. METHODS: After informed consent, 46 healthy adults were randomly assigned to one of three strip + dentifrice treatment groups. Subjects received either 6% hydrogen peroxide whitening strips (Crest Whitestrips) and an anticavity toothpaste (Crest Cavity Protection), placebo strips and a sodium fluoride (NaF) whitening dentifrice (Mentadent Whitening Toothpaste) or placebo strips and a sodium monofluorophosphate (MFP) whitening dentifrice (Rembrandt Low Abrasion Whitening Toothpaste). Strip use (peroxide or placebo) was for 30 minutes, twice daily for 2 weeks, while dentifrice use was at least twice daily for 12 weeks. Efficacy was measured from standardized digital images of the maxillary facial tooth surfaces, while safety was evaluated from oral examination and interview. Treatments were compared after 2 weeks (strip use) and 12 weeks (dentifrice use) using analysis of covariance. RESULTS: All subjects completed the 12-week evaluation. Adjusting for baseline and age, the peroxide strip group had -2.45 Deltab*, 2.39 DeltaL*, and -0.96 Deltaa* at Week 2. Between-group comparisons demonstrated significant (P 0.18) differences between the whitening dentifrice groups at any timepoints. All treatments were well-tolerated, with minor tooth sensitivity and oral irritation representing the most common findings.status: publishe

Thirteen-year randomized controlled clinical trial of a two-step self-etch adhesive in non-carious cervical lesions

The objective of this randomized controlled clinical trial was to evaluate the 13-year clinical performance of a mild two-step self-etch adhesive in non-carious cervical lesions with and without prior selective phosphoric acid-etching of the enamel cavity margins.status: publishe