Can composite packaging and selective enamel etching affect the clinical behavior of bulk-fill composite resin in posterior restorations? 24-month results of a randomized clinical trial

Objectives: This is a double-blind, split-mouth, randomized clinical study that aims to evaluate the influence of bulk-fill composite packaging presented in syringes (BSy) and capsules (BCa), and the effect of selective enamel etching (SEE) on the clinical performance of class I and II bulk-fill resin composite restorations after 24 months. Methodology: A total of 295 class I or class II restorations were performed on 70 patients. One universal adhesive was applied in all restorations. SEE was used in 148 restorations and self-etching mode (SET) in 147 restorations. After the adhesive application, cavities were restored with Filtek Bulk-fill Posterior Restorative in syringes (BSy), Filtek One Bulk-fill in capsules (BCa), or Filtek Supreme Ultra in syringes with the incremental technique (In). All restorations were evaluated using the FDI criteria after one week and after six, 12, and 24 months. Kaplan-Meier survival analysis and Pearson’s Chi-square test were used (α=0.05) for statistical analysis. Results: After 24 months, 62 patients were evaluated and four restorations were lost due to fracture (one for SEEBSy, two for SEEIn, and one for SETIn). No significant differences in the fracture and retention rate were found between groups (p>0.05). SEE showed significantly fewer marginal adaptation defects than SET (p<0.05). BCa and BSy groups showed fewer marginal discrepancies compared to In (p<0.05). Restorations performed with BCa showed less color mismatch than BSy or In (p<0.05). Conclusion: Although all restorations exhibited satisfactory clinical performance after 24 months of clinical service, the clinical behavior of class I and II restorations’ improved when performed with a bulk-fill composite in capsules, mainly when associated with a universal adhesive applied with SEE

Desgaste dentário guiado por mock-up para correção estética com facetas de porcelana

Objetivo: as facetas dentárias constituem uma alternativa restauradora com a possibilidade de mínimo desgaste, principalmente, para pacientes com insatisfação estética em área anterior. Relato de Caso: paciente apresentou-se a clínica do Instituto de Saúde de Nova Friburgo insatisfeito com a estética dos incisivos laterais superiores, os quais se encontravam com tamanho e formato esteticamente desfavoráveis em comparação aos outros elementos presentes. Para correção foi proposto a confecção de facetas de Cerâmica do tipo E-Max. Foi obtido modelo de gesso da arcada superior, realizado enceramento diagnóstico e guia de reconstrução com silicone de adição. Após o ensaio elaborado com resina Bisacrílica (Mock-up), o desgaste foi modulado e guiado sobre aquele mock-up, proporcionando o mínimo de desgaste possível para posterior cimentação da faceta. Os dentes foram moldados e o modelo enviado para laboratório profissional de prótese dentária para confecção das facetas, as quais, quando enviadas, foram provadas, ajustadas, e em seguida, foram cimentadas com cimento resinoso fotopolimerizável conforme as instruções do fabricante. O paciente encontra-se em acompanhamento. Conclusão: concluiu-se que a realização do preparo sobre o mock-up permitiu um menor desgaste de estrutura dentária sadia, servindo como excelente guia para esta etapa

A New Universal Simplified Adhesive: 6-Month Randomized multi-center clinical trial

The objective of this multi-centric, double-blind, randomized clinical trial was to evaluate the clinical performance of a new universal adhesive system (Futurabond U, Voco GbmH, Germany) when applied with different application strategies over a period of six months. For this, 200 restorations were performed on non-carious cervical lesions using the adhesive Futurabond U in the four adhesive strategies (n=50 per group): self-etch without previous conditioner (SEE); self-etch associated with selective enamel etching (SET); etch-and-rinse with dry dentin (ERDry) and; etch-and-rinse with wet dentin (ERWet). After the use of the adhesive system, the cavities were restored with Admira Fusion composite resin (Voco GmbH). After 6 months of clinical performance, these restorations were evaluated according to FDI criteria in the following items: retention/fracture, marginal adaptation, marginal staining, postoperative sensitivity and caries recurrence. Seven restorations were lost/fractured after six months of clinical evaluation (2 in the SEE group, 1 in the SET group, 1 in the ERDry group, and 3 in the ERWet group). The retention rates for six months (95% confidence interval) were 96% (86%-98%) for the SEE group, 98% (89%-99%) for the SET group, 98% (89%-99%) for the ERDry group and 94% (83%-97%) for the ERWet group, with no statistical difference identified between any pair of groups (p> 0.05). Twenty-four restorations presented small marginal adaptation defects at the six-months evaluation recall, and all of them were considered clinically acceptable. The clinical performance of the universal adhesive Futurabond U associated to Admira Fusion unidoses resin composite was found to be promise after 6-month of clinical evaluation when applied in noncarious cervical lesions and it was not depending on the bonding strategy employed