Search Results (8)

A novel resin-based bulk-fill restorative material (ST; Stela SDI, Bayswater, Victoria, Australia) has been recently introduced as a self-curing alternative to traditional light-cured composites. Promoted for its unlimited depth of cure, enhanced aesthetics, and unique primer composition, it aims to address challenges associated with amalgam and light-curing composites. Thus, the aim of this in vitro study was to investigate the performance of the new self-curing polymer-based restorative material, ST, compared to two conventional light-cured composites for direct restoration. The study evaluated compressive strength with and without aging, antibacterial activity, mineral deposition in contact with Phosphate-Buffered Saline (PBS) and artificial saliva, porosity, and wettability of ST (Tetric EvoCeram (TE; Ivoclar Vivadent, Schaan, Liechtenstein) and Clearfil Majesty ES-2 (CM; Kuraray Noritake Dental, Tokyo, Japan)). The data was statistically analyzed (α = 0.05) through one-way and two-way analysis of variance (ANOVA). ST demonstrated significantly higher compressive strength than TE and CM at baseline and after aging (p < 0.001), while aging significantly reduced compressive strength across all materials (p < 0.001). Fracture mode analysis revealed brittle fractures for TE and CM, whereas ST fractured in multiple smaller fragments. CM showed the highest void volume and diameter, significantly differing from ST and TE (p < 0.001). Scanning electron microscopy (SEM) analysis revealed cubical-like crystalline formations on ST’s surface after 28 days of immersion in PBS and saliva, indicating some level of bioactivity, whereas no changes were observed for TE and CM. Wettability testing showed ST had the lowest contact angle (12.24° ± 2.1°) compared to TE (62.78° ± 4.68°) and CM (64.64° ± 3.72°) (p < 0.001). Antibacterial activity testing displayed a significant decrease in bacterial growth for CM compared to ST (p = 0.001) and TE (p = 0.002); however, ST and TE showed no significant differences (p = 0.950). To conclude, ST Automix demonstrated promising results across several key parameters, making it a potential candidate for long-lasting restorative applications. Future studies should explore its long-term clinical performance and investigate formulations that enhance its antibacterial properties. Moreover, the bond strength of these materials to dentin and the cytotoxicity should be evaluated. Full article

(1) Background: The aim of this in vitro study was to evaluate the success of indirect pulp capping (IPC) procedures over a period of 40 years. (2) Methods: The investigation of 1412 dental records included 159 patients with 366 IPC teeth having been treated from 1969 to 1980. The teeth revealed caries within the inner third of dentin, were symptom-free, and showed no pulp exposure. The caries were excavated thoroughly and teeth with accidentally exposed pulp were excluded. Zinc–oxide–eugenol was used for the IPC procedures. The posterior teeth were restored with amalgam, and the anterior teeth received direct resin composite fillings. The gathered parameters with possible influences on survival rates were age, gender, tooth locations/positions, dates of vital therapy, the number of filled surfaces, types of primary restoration material, successional treatments on each tooth, and the last dates of surveillance. Data collection and statistical analysis were performed using Excel sheets and DataTab. Significant differences among groups were computed by cox regression analysis and the significance level was set at p = 0.05. Kaplan–Meier curves were utilized to illustrate the survival rates. (3) Results: Treatment success was measured by the maintenance of vitality beyond 365 days. The loss of vitality within 365 days was determined as treatment failure. Treatment outcomes were assessed after different time periods (1 and 6 months; 1, 2, 5, 10, 20, and 40 years). Pulp vitality dropped from 95% after 3 months to 32% after 40 years. Cavity size had a significant influence on the survival of pulp, but tooth position did not; however, third molars at least initially showed a better outcome. Beyond the 1-year recall, no differences for the evaluated parameters were present. (4) Conclusions: IPC showed excellent long-term success rates, revealing a 1.7% annual failure rate after 40 years of clinical service. Larger defects suffer more pulp damage in the long run. Full article

Amalgam and composite restorations are used to treat minor dental issues. University of Michigan, School of Dentistry Electronic Health Record (EHR) reports show a 2.31% failure rate for amalgam and 1.14% for composite. Our study aims to determine the true failure rates through manual EHR chart reviews. Patient data from the University of Michigan School of Dentistry were utilized—216 amalgam restorations from 2020 to 2022 and 350 composite restorations in 2021 were searched. We defined failure and retreatment as replacing a restoration with the same material and failure and alternate treatment as replacing restoration with an alternative treatment within one year. The failure rate refers to a combination of replacement with the same and alternative treatment material within one year. For Amalgam: 1.85% failed and were retreated; 7.87% failed and were received an alternate treatment. Composite: 9.71% failed and retreated; 2.86% failed and received alternate treatment. In total anterior composite: 10.5% retreated, 2.6% failed; posterior composite: 9.1% retreated, 3.0% failed. Our study revealed higher restoration failure rates than the reports extracted in the EHR. This highlights the need to foster a culture of precise documentation to align EHR reports with hand-search findings. Full article

Tooth decay, also known as caries, is a significant medical problem that harms teeth. Treatment is based on the removal of the carious material and then filling the cavity left in the tooth, most commonly with amalgam or composite resin. The consequences of filling failure include repeating the filling or performing another treatment such as a root canal or extraction. Dental amalgam contains mercury, and there is a global effort to reduce its use. However, no consensus has been reached regarding whether amalgam or composite resin materials are more durable, and which is the best restorative material, when using randomized clinical trials. To determine which material is superior, we performed a retrospective cohort study using a large database where the members of 58 dental clinics with 440 dental units were treated. The number of failures of the amalgam compared to composite resin restorations between 2014 and 2021 were compared. Our data included information from over 650,000 patients. Between 2014–2021, 260,905 patients were treated. In total, 19,692 out of the first 113,281 amalgam restorations failed (17.49%), whereas significantly fewer composite restorations failed (11.98%) with 65,943 out of 555,671. This study indicates that composite is superior to amalgam and therefore it is reasonable to cease using mercury-containing amalgam. Full article

The aim of this umbrella review was to evaluate the longevity of glass ionomer cement (GIC) as a restorative material for primary and permanent teeth. Research in the literature was conducted in three databases (MedLine/PubMed, Web of Science, and Scopus). The inclusion criteria were: (1) to be a systematic review of clinical trials that (2) evaluated the clinical longevity of GICs as a restorative material in primary and/or permanent teeth; the exclusion criteria were: (1) not being a systematic review of clinical trials; (2) not evaluating longevity/clinical performance of GICs as a restorative material; and (3) studies of dental restorative materials in teeth with enamel alterations, root caries, and non-carious cervical lesions. Twenty-four eligible articles were identified, and 13 were included. The follow-up periods ranged from 6 months to 6 years. Different types of GICs were evaluated in the included studies: resin-modified glass ionomer cement (RMGIC), compomers, and low- and high-viscosity glass ionomer cement. Some studies compared amalgam and composite resins to GICs regarding longevity/clinical performance. Analyzing the AMSTAR-2 results, none of the articles had positive criteria in all the evaluated requisites, and none of the articles had an a priori design. The criteria considered for the analysis of the risk of bias of the included studies were evaluated through the ROBIS tool, and the results of this analysis showed that seven studies had a low risk of bias; three studies had positive results in all criteria except for one criterion of unclear risk; and two studies showed a high risk of bias. GRADE tool was used to determine the quality of evidence; for the degree of recommendations, all studies were classified as Class II, meaning there was still conflicting evidence on the clinical performance/longevity of GICs and their recommendations compared to other materials. The level of evidence was classified as Level B, meaning that the data were obtained from less robust meta-analyses and single randomized clinical trials. To the best of our knowledge, this is the first umbrella review approaching GIC in permanent teeth. GICs are a good choice in both dentitions, but primary dentition presents more evidence, especially regarding the atraumatic restorative treatment (ART) technique. Within the limitation of this study, it is still questionable if GIC is a good restorative material in the medium/long term for permanent and primary dentition. Many of the included studies presented a high risk of bias and low quality. The techniques, type of GIC, type of cavity, and operator experience highly influence clinical performance. Thus, clinical decision-making should be based on the dental practitioner’s ability, each case analysis, and the patient’s wishes. More evidence is needed to determine which is the best material for definitive restorations in permanent and primary dentition. Full article

The aim of this retrospective study was to investigate the clinical performance of posterior complex resin composite (RC) and amalgam (AM) restorations after a five-year period. One hundred and nineteen complex Class II restorations placed by dental students were evaluated using the USPHS criteria. Data were analyzed using Chi-square, Mann–Whitney, and Wilcoxon tests at a 0.05 level of significance. After five years, the percentages of clinically satisfactory complex Class II RC and AM restorations were 78% and 76.8%, respectively. The main reasons for the failure of AM restorations included secondary caries (Bravo—10.1%), defective marginal adaptation (Charlie—8.7%), and fracture of the tooth (Bravo—7.2%). RC restorations presented failures related to the fracture of the restoration (Bravo—16%) and defective marginal adaptation (Charlie—8.2%). There was a significantly higher incidence of secondary caries for AM restorations (AM—10.1%; RC—0%; p = 0.0415) and a higher number of fractures for RC restorations (AM—4.3%; RC—16%; p = 0.05). Regarding anatomy, AM restorations presented a significantly higher number of Alfa scores (49.3%) compared to RC restorations (22.4%) (p = 0.0005). The results of the current study indicate that complex class II RC and AM restorations show a similar five year clinical performance. Full article

Since untreated dental caries remain a worldwide burden, this umbrella review aimed to assess the quality of evidence on the clinical effectiveness of different restorative materials for the treatment of carious primary teeth. A literature search in electronic bibliographic databases was performed to find systematic reviews with at least two-arm comparisons between restorative materials and a follow-up period ≥12 months. Reviews retrieved were screened; those eligible were selected, and the degree of overlap was calculated using the ‘corrected covered area’ (CCA). Data were extracted and the risk of bias was assessed using the ROBIS tool. Fourteen systematic reviews with a moderate overlap (6% CCA) were included. All materials studied performed similarly and were equally efficient for the restoration of carious primary teeth. Amalgam and resin composite had the lowest mean failure rate at 24 months while high-viscosity and metal-reinforced glass ionomer cements had the highest. At 36 months, high-viscosity glass ionomer cements showed the highest failure rate with compomer showing the lowest. Most reviews had an unclear risk of bias. Within the limitations of the review, all materials have acceptable mean failure rates and could be recommended for the restoration of carious primary teeth. Full article

Objective: The aim of this study was to confirm the hypothesis that patients with one or more amalgam restorations have an increased risk for systemic diseases rather than patients with resin-based restorations. Data: The data search produced an initial 3568 total number of records. All titles and abstract were reviewed by five independent examiners, and only 36 records were selected for full text in depth examination. Out of these, only nine publications matched the inclusion criteria and were included in this systematic review. Sources: Electronic databases (MEDLINE, Scopus, Embase, and Web of Knowledge) were searched up to June 2019. In addition, a manual search was carried out on journals related to this topic. Study selection: All selected human clinical studies compared patients with dental amalgam restorations to patients with non-amalgam restorations on restorative material related diseases/health conditions with at least 50 patients and a reasonable follow up. The systemic effects of dental restorations were analyzed. As for any systemic effects, there was no difference between amalgam and composite restoration. Conclusions: With the limitations of the few available randomized controlled trials (RCTs) on the matter, amalgam restorations, similarly to other modern resin-based materials, were not related to an increased risk of systemic diseases or conditions. Clinical significance: On the basis of the available RCTs, amalgam restorations, if compared with resin-based fillings, do not show an increased risk for systemic diseases. There is still insufficient evidence to exclude or demonstrate any direct influence on general health. The removal of old amalgam restorations and their substitution with more modern adhesive restorations should be performed only when clinically necessary and not just for material concerns. In order to better evaluate the safety of dental amalgam compared to other more modern restorative materials, further RCTs that consider important parameters such as long and uniform follow up periods, number of restorations per patient, and sample populations representative of chronic or degenerative diseases are needed. Full article