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946 dental materials 3 3 ( 2 0 1 7 ) 944–953

Table 1 – Distribution and size of the experimental restorations.
Surfaces Maxilla Mandibula Total
Premolars Molars Premolars Molars
Table 2 – Resin composites and adhesive system used.
2 surfaces 20 32 15 22 89 Material Composition Type Application steps Manufacturer
3 surfaces 3 7 5 11 26 cfm cmf etch: buffered phosphoric 3-step etch-and-rinse light • Etch for 15 s enamel and Saremco AG, Rebstein,
>3 surfaces 2 12 1 9 24 acid (pH = 1.5) curing adhesive system dentin Switzerland
Total 25 51 21 42 139 cmf primer: metacrylated • Rinse for maximally 10 s
phosphoric salt, alcohol, • Air dried carefully for ca 5 s.
aceton, CQ, co-initiator • The cmf primer was applied
of the study, which was approved by the ethics committee of the evaluated RC restorations belonged to nor of the earlier cmf bonding: hydrophilic using a rubbing motion for
the University of Umeå (Dnr 07-152M). recall evaluation scores. Cohen-kappa values performed dur- ethoxylated Bis-GMA, silanized 30 s, followed by a careful 5 s
barium glass, CQ, co-initiator. air blowing to remove
Reasons for placement of the resin composite restorations ing the follow up were >86%. Bite-wing radiographs were taken solvent. Light cure 20 s
were carious lesions, fracture of old fillings or replacements at the yearly recalls. The participants were asked at their • The cmf bonding was dental
applied using a rubbing
due to esthetic or other reasons. No Class I cavities were next visit and at all recalls if they had experienced symp-
motion for 20 s
HEMA-free resin composite system TEGDMA/HEMA-free low shrinkage were performed under local • Light cure for 20 s
included because of the relative good durability of these
toms in the region of the experimental teeth The caries risk
was developed with low volumetric resin composite (els;Saremco AG, anesthesia if necessary. Sixty-seven AdheSE One F Bis-acrylamide derivative, single-step self-etching, • Dry surface Vivadent Ivoclar, Schaan, materials
of each participant and their parafunctional habits activity at
restorations. Operative procedures were performed under
shrinkage and low contraction Rebstein, Switzerland), and bonded patients, 33 female and 34 male, with bis-methacrylamide light-cured, nano-filled, with • An adequate amount of Liechtenstein
local anesthesia if necessary. Sixty-seven patients, 33 female
baseline and during the follow ups was estimated by treating
stress . In its 3-step etch-and- either with the TEGDMA/HEMA- a mean age of 53 years (range 29–82) dihydrogenphosphate, amino fluoride release in a pen AdheSE One F was directly 3 3
40
clinician by means of clinical and socio-demographic informa-
and 34 male, with a mean age of 53 years (range 29–82) par-
delivery system
applied to the cavity with the
acid acrylamide, hydroxyalkyl
rinse adhesive, smaller hydrophilic free 3-step etch-and-rinse adhesive participated in the study. One hundred methacrylamide 20–40%, water VivaPen.
ticipated in the study. One hundred and thirthy-nine Class II
tion routinely available at the annual clinical examinations,
monomers were omitted resulting in of the system (cmf, Saremco) or a and thirty-nine Class II restorations alcohol solvent 20–30%, • The adhesive was brushed ( 2 0 1 7 )
restorations were placed in 46 premolars and 93 molars by
e.g. incipient caries lesions, former caries history, frequency,
into the entire surface for
stabilizers, initiators. highly
amore hydrophobic resin layer, which single-step HEMA-free self-etching were placed in 46 premolars and 93 dispersed silicon dioxide, pH 30 s.
dietary habits, oral hygiene, medications, salivary properties
one experienced operator (JvD) (Table 1). All, except 5 patients,
is less prone to water absorption adhesive in a pen delivery system molars by one experienced operator 1.4 • Air blow for more than 5 s 944–953
received at random two restorations with the two restorative
and symptoms related to bruxing activity [45,46]. All patients
until a glossy, immobile
fillers <5%, potassium fluoride
and hydrolytic degeneration 41,42 . The (AdheSE One F, VivadentIvoclar, (JvD) (Table 1). All, except 5 patients, liquid film appeared.
techniques. The 5 participants received also one more Class II
were informed about the follow up evaluations according
HEMA substitution for Bis EMA, which teeth were in occlusion. to the rules at received at random two restorations • Light-cure for 10 s.
restoration with the cmf adhesive. All
Schaan, Liechtenstein; ASE). The els the PDHS clinic at the Dental School Umeå.
represents high molecular weight resin composite does not contain treatment was given to the patients in confor- els (extra low shrinkage) Bis-GMA, Bis-EMA, IBMA, low shrinkage resin composite Applied in 2–3 mm layers, Saremco, Switzerland
with the two restorative techniques.
Concomitant
The majority of cavities had dentin bordered proximal cervical
may result in reduced toxicity. Clinical comonomers of low molecular weights clinical routines at the clinic. Patients were catalysts, inhibitors, pigment volume shrinkage 2.3%, oblique when possible.
The 5 participants received also one
margins.
mity with normal
more Class II restoration with the cmf
effectiveness of the resin composite and showed the lowest contraction contact the clinic immediately if any discomfort filler: Ba glass, Ba-Al-B-Si glass, shrinkage stress after 30 min: Light cured 20–40 s per layer
instructed to
2.6 MPa
silanized, ø 0,7 m, max.
system in Class V non carious cervical stress of marketed resin composites adhesive. All teeth were in occlusion. 2,6 m, 74 wt%, 50 vol.%.
occur.
Clinical procedure
2.2.
lesions was reported recentlyin a 40,41 . During 2009, adult patients The majority of cavities had dentin Abbreviations: HEMA 2-hydroxyethyl-methacrylate, 4-MET 4-methacryloxyethyl trimetellitic acid, IBMA, isobornylmethacrylate, PENTA Phosphoric acid modified acrylate resin, TCB resin carboxylic
acid modified dimethacrylate, TEGDMA triethyleneglycol dimethacrylate, Bis GMA bisphenol A-glycidyl methacrylate, Bis EMA Bisphenol A ethoxylate dimethacrylate, UDMA urethane dimethacrylate;
5-year follow up , but no clinical attending the Public Dental Health bordered proximal cervical margins. CQ camphoroquinon.
43 of the old restorations and/or caries excavation
After removal
Statistical analysis
2.4.
according to the principles of adhesive dentistry, the opera-
study reported the durability in Class Service clinic at the Dental School CLINICAL PROCEDURE
tive field was carefully isolated with cotton rolls and suction
II restorations.The aim of the present Umeå, who at the yearly examination After removal of the old restorations
The characteristics of the restorations are described by
device. No bevel was placed. For all cavities a thin metallic
randomized controlled prospective did need two Class II restorations statistics using cumulative relative frequency 7,Vivadent; Demetron light meter, Kerr, restorations belonged to nor of the to the rules at the PDHS clinic at the
and/or caries excavation according
descriptive
matrix was used and carefully wedging was performed with
to the principles of adhesive dentistry,
study was to investigate the clinical were asked to participate in a clinical the scores. The experimental and control Orange, CA, USA). The low shrinkage earlier recall evaluation scores. Cohen- Dental School Umeå. Concomitant 947
distributions of
longevity of Class II restorations follow up. No patients were excluded the operative field was carefully with resin composite (els, Saremco) was kappa values performed dur-ing the treatment was given to the patients in
restorative techniques were compared intra-individually
wooden wedges (Kerr/Hawe Neos, Switzerland). No Ca(OH) 2
base or other base material was used. The cavities in each
performed with the TEGDMA/HEMA- because of caries risk, bruxing habits isolated with cotton rolls and suction applied in all cavities in layers of follow up were >86%. Bite-wing conformity with normal clinical routines
the non parametric Friedman two-way analysis of variance
individual pair were randomly distributed to the two test
test [47]
free resin composite system. The or not acceptable oral hygiene. device. No bevel was placed. For all maximally 2–3 mm with if possible, radiographs were takenat the yearly at the clinic. Patients wereinstructed
adhesives, before the operative procedure started, by throwing
3-step etch-and-rinse TEGDMA/ All patients were informed on the cavities a thin metallic matrix was used an oblique layering technique using recalls. The participants were asked to contact the clinic immediately if any
dice. In this way, an intraindividual comparison was possible
HEMA-free adhesive of the system background of the study and each and carefully wedging was performed selected resin composite instruments at their next visit and at all recalls if discomfort occur.
3.
Results
of the adhesive systems.
was compared with a HEMA-free participant provided informed consent with wooden wedges (Kerr/Hawe (Hu Friedy). Every increment was light they had experienced symptoms in STATISTICAL ANALYSIS
After rinsing of the cavities with water, application of the
1-step self-etch adhesive. The null to participate in the study. The study Neos, Switzerland). No Ca(OH)2base cured for 20–40 s. After checking the the region of the experimental teeth The characteristics of the restorations
respective adhesive was performed according to the manu-
Three molar teeth (1 cmf, 3 ASE) showed post-operative sen-
hypothesis tested was that the design followed the requirements or other base material was used. occlusion/articulation and contouring The caries risk of each participant are described by descriptive statistics
facturer’s instructions (Table 2). Curing was performed with
sitivity during the first 3 weeks for temperature changes and
adhesives showed similar clinical outlined in the CONSORT 2010 The cavities in each individual pair with finishing diamond burrs, the final and their parafunctional habits using cumulative relative frequency
a well controlled light curing unit for at least 10 s (Astralis 7,
occlusal forces. Two male patients with 2 pair of restorations
performance when used with the statement. All participants were were randomly distributed to the two polishing was performed with the activity at baseline and during distributions of the scores. The
Vivadent; Demetron light meter, Kerr, Orange, CA, USA). The
(2P, 2M) could not be evaluated during the whole 6 year follow
1-step self-etch adhesive. informed on the background of the test adhesives, before the operative Shofu polishing system (brownie). the follow ups was estimated by experimental and control restorative
low shrinkage resin composite (els, Saremco) was applied in
up due to death of both participants during the third and fifth
all cavities in layers of maximally 2–3 mm with if possible,
year, respectively, of the follow up. After 6 years, 135 restora-
Materials and methods study, which was approved by the procedure started, by throwing EVALUATION treatingclinician by means of clinical techniques were compared intra-
ethics committee of the University of
individually with the non parametric
and socio-demographic information
dice. In this way, an intra individual
The restorations were blindly
an oblique layering technique using selected resin compos-
tions were evaluated.
EXPERIMENTAL DESIGN Umeå (Dnr 07-152M).Reasons for comparison was possible of the the 6 evaluated and scored by using routinely available at the annual Friedman two-way analysis of variance
ite instruments (Hu Friedy). Every increment was light cured
Twenty-one Class II molar restorations failed during
47
for 20–40 s. After checking
The study was a randomized the occlusion/articulation and con- years (15.6%), adhesive systems. After rinsing of the slightly modified US Public Health clinical examinations, e.g. incipient test .
placement of the resin composite 8 cmf/els (11.4%) and 13 ASE/els (20.0%). This
touring with finishing diamond
controlled prospective trial. In an burrs, the final polishing was resulted in cavities with water, application of the Service criteria at base-line (after caries lesions, former caries history,
restorations were carious lesions, annual failure rates (AFR) of 1.9% and 3.3%, for cmf
performed with the Shofu polishing system (brownie).
intra-individual comparison each fracture of old fillings or replacements respective adhesive was performed performance of the restorations) and frequency, dietary habits, oral hygiene, Results
and AES respectivelly and a significant difference in overall
participant received one pair of due to aesthetic or other reasons. No according to the manufacturer’s then yearlyduring the 6 year follow up medications, salivary properties and Three molar teeth (1 cmf, 3 ASE)
durability between the two adhesives (p < 0.001).
2.3.
similar sized Class II resin composite Class I cavities were included because failure frequencies, years of failure and (Table 3) . During the evaluations, symptoms related to bruxing activity showed post-operative sen-
instructions (Table 2). Curing was
Evaluation
44
The cumulative
performed with a well controlled light
reasons for failure
restorations. The two restorations in of the relative good durability of these are shown in Table 4. The scores at baseline, the evaluators had neither knowledge 45,46 . All patients were informed about sitivity during the first 3 weeks for
3 and 6 years for the evaluated restorations are given as rel-
each pair were performed with the restorations. Operative procedures curing unit for at least 10 s (Astralis of which studythe evaluated RC the follow up evaluations according temperature changes and occlusal
The restorations were blindly evaluated and scored by using
slightly modified US Public Health Service criteria at base- ative cumulative frequencies in Table 5. The main reason for
line (after performance of the restorations) and then yearly failure was resin composite fracture (9), followed by a combi-
during the 6 year follow up (Table 3) [44]. During the evalua- nation of resin fracture/secondary caries (4) and cusp fracture
tions, the evaluators had neither knowledge of which study (4). Eleven of the failures were observed in male and ten in
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