Survival of Prosthodontic Restorations Luted with Resin-Based versus Composite-Based Cements: Retrospective Cohort Study

The purpose of this study was to evaluate clinical performance, survival, and complications of indirect composite inlays, onlays, and overlays on posterior teeth. Digital records of 282 patients treated between 2014 and 2018 were accessed and analyzed retrospectively. The included patients received 469 composite restorations luted with seven different resin-based types of cement, i.e., Filtek Ultimate Flow, Enamel Plus, Relyx Ultimate, Harvard Premium Flow, Relyx Unicem, Filtek Bulk Fill Flowable, and Filtek Ultimate. The restorations had been clinically and radiographically evaluated annually. The mechanical and clinical complications, e.g., debonding, fracture, and secondary caries, were evaluated and recorded. The examined restorations exhibited a high survival rate (84.9%), and failure was found in only 71 cases. Fracture was the most common cause (n = 36), followed by prosthetic work release (n = 19) and secondary caries (n = 16). There was a statistically significant difference between failure and cement material (Sig. < 0.001); the composite-based cements (87.2%) had a high survival rate compared to the resin-based cement (72.7%). Similarly, the cements with high viscosity (90.2%) had significantly higher survival rates than the low-viscosity cements (78.9%). Moreover, onlays showed higher longevity compared to overlays (Sig. = 0.007), and patients aged under 55 years showed less complications (Sig. = 0.036). Indirect composite restoration was a successful solution to tooth structure loss. The material of the cementation is an important part of the success. Higher survival rate was found in our study when the fixation materials with high viscosity were used, thus suggesting using these materials with indirect restorations. Composite-based cements had significantly higher survival rate than resin-based cements.

REABILITAÇÃO ESTÉTICA COM RESINA INDIRETA EM DENTES ANTERIORES: UM RELATO CLÍNICO

Introduction: The aesthetic rehabilitation of endodontically treated teeth depends on the degree of destruction of the crown, the tooth in question, the bone support, the type of prosthesis and the types of forces to which these teeth will be submitted. The indirect composite resins have improved physical and mechanical properties thanks to the incorporation of inorganic components and multifunctional monomers with a greater number of bonding points, making them capable of solving the problems in which ceramic restorations would be indicated. Objective: To present a clinical case report of an aesthetic rehabilitation of anterior teeth with indirect composite resin as a viable and less expensive treatment alternative. Case Report: Upon clinical examination, extensive and deficient restorations were observed in the upper anterior teeth. The proposed treatment plan aesthetic rehabilitation of dental elements with ceromeres. Conclusions: This treatment represented a viable and less expensive option that can be used both in situations of great dental destruction and in small dental absences, in substitution for ceramic restorations.

Flexural Strength of an Indirect Composite Modified with Single-Wall Carbon Nanotubes

Objectives The low resistance to fracture has limited the use of indirect composite resins for dental restorations, particularly in regions that are exposed to strong occlusal forces. To overcome this issue, different types of reinforcement for composites have been proposed, one of which is carbon nanotubes (CNTs). The aim of this study was to evaluate the flexural resistance of one commercial indirect composite resin (Sinfony, 3M/ESPE) after incorporation of single-wall carbon nanotubes (SWCNTs; Sigma–Aldrich, Inc., St. Louis, Missouri, United States) with or without the silanization form. Materials and Methods Specimens of composite resin were fabricated in a Teflon mold. The composite resin was prepared according to the manufacturer’s instructions (n = 10 for each group), with SWCNTs in three concentrations. Statistical Analysis The SWCNTs and SWCNT/SiO2-ATES specimens were evaluated by transmission electron microscopy, and a flexural test was conducted according to the ISO 4049/2009. Flexural strength data in MPa were submitted to one-way ANOVA following Tukey (p < 0.05). Results The SWCNTs did not improve the flexural strength of indirect composite resin when compared with the control, independent of the concentration added (p > 0.05). However, when SWCNTs and SWCNTs/SiO2-ATES were compared, the SWCNTs/SiO2-ATES showed higher values than the three concentrations of SWCNTs (p < 0.05). Conclusion The silanization process improves the SWCNTs strength proprieties, but the modification of chemical bonding between SWCNT and SWCNT/SiO2-ATES modified resins, in different concentrations, did not improve the composite resin flexural strength.

Endocrown - The Realm of Post-Free Endodontic Restorations

With increased dental awareness, there has been a growing trend in patients who are opting for teeth retention, so post-endodontic restorations play a significant role in dictating restoration longevity. However, till date restoration of root canal treated teeth is still controversial. Root canal treated teeth often suffer from extensive loss of tooth structure because of access cavity preparation, caries removal, replacement of restoration and trauma.1 Traditionally the restorative material of choice for an endodontically treated molar would be post and core followed by metal / ceramic crowns. However, studies have shown that these intra-canal posts may increase risk, of undermining the residual tooth structure, root perforation and catastrophic failures.2 With adhesive strategies, there has been a paradigm shift towards post-less restorations and utilisation of pulp chamber as an extension, thus integrating the crown and core as a single unit or monobloc. 2,3 This was the concept of the endocrown technique. 3 Bindle and Mormann first, delineated the use of porcelain adhesive endodontic crowns.4 Endocrowns are more practical, conservative, aesthetic, simple to fabricate, economical, less time consuming and allows favourable distribution of masticatory stresses. Most studies on endocrowns showed comparable or somewhat superior results to other conventional treatments for endodontically treated teeth (ETT). However, the available literature is based largely on the use of ceramic endocrowns. 2-4 It was observed that data pertaining to endocrown fabrication with other indirect restorative materials is still limited, and the choice is still unclear.Indirect composites show enhanced mechanical properties, creation of ideal contacts and contours, favourable wear, aesthetics and can serve as an economical alternative to ceramics.5 Hence, this paper attempts to present a case report of functional and aesthetic rehabilitation of an endodontically treated molar with an endocrown restoration utilising indirect composite (SR Adoro System).

Perawatan saluran akar pada gigi molar pertama kanan mandibula dengan pulpitis ireversibel simtomatikRoot canal treatment of mandibular right first molar with symptomatic irreversible pulpitis

Pendahuluan: Pulpitis ireversibel simtomatik ditandai dengan hipersensitivitas terhadap stimulus termal, yang menyebabkan nyeri spontan atau rasa sakit yang bertahan 30 detik atau lebih setelah stimulus dihilangkan, nyeri yang parah, persisten, dan sulit dilokalisir, dapat menjalar ke telinga, pelipis, mata atau leher. Kondisi pulpa yang terinflamasi tidak dapat kembali pulih dan perawatan saluran akar merupakan pilihan perawatan. Tujuan laporan kasus ini membahas mengenai perawatan saluran akar dengan pulpitis ireversibel simtomatik untuk menghentikan inflamasi pulpa dan mempertahan gigi. Laporan kasus: Pasien laki-laki berusia 35 tahun datang ke klinik dengan keluhan gigi belakang kanan bawah terasa sakit berdenyut sejak 1 minggu yang lalu. Gigi tersebut pernah dilakukan penambalan sementara 4 bulan sebelumnya dan tambalan tersebut patah serta nyeri spontan. Pemeriksaan radiologis gigi 46 menunjukkan gambaran radiolusen pada bagian mahkota hingga mencapai tanduk pulpa, terdapat 2 akar, dengan akar mesial dilaserasi ke arah distal dan akar distal lurus, serta saluran akar yang menghilang pada 2/3 dan 1/3 saluran akar distal dan mesial, tidak terdapat pelebaran membran periodontal, lamina dura normal dan tidak terdapat kelainan periapikal. Gigi 46 dilakukan anestesi lokal, dilanjutkan pembukaan akses dan ekstirpasi pulpa, kemudian preparasi saluran akar menggunakan nikel titanium rotary ProTaper Next® (Maillefer, Switzerland) dengan teknik crown down dan pengisian saluran akar. Restorasi follow up overlay komposit indirek pada gigi 46. Simpulan: Pulpitis ireversibel simtomatik pada gigi molar dengan akar dilaserasi terbukti dapat ditangani dengan perawatan saluran akar yang adekuat, ditandai dengan hilangnya keluhan pada pasien dalam kasus ini.Kata kunci: Pulpitis ireversibel simtomatik, perawatan saluran akar, teknik crown down. ABSTRACTIntroduction: Symptomatic irreversible pulpitis is characterised by hypersensitivity to the thermal stimuli, which causes spontaneous pain that lasts 30 seconds or more after the stimulus removed, severe, persistent and difficult to localise, can radiate to the ears, temples, eyes, or neck. The inflamed pulp does not recover; thus, root canal treatment is the treatment option. This case report was aimed to discuss the root canal treatment for symptomatic irreversible pulpitis to stop the pulp inflammation and preserve the teeth. Case report: A 35-year-old male patient came to the clinic with complaints of pulsating pain in the mandibular right molar since one week prior. The tooth had a temporary filling four months earlier, and the filling was fractured, and the pain was spontaneous. Radiological examination of tooth 46 showed radiolucent images on the crown until the pulp horn, there were found two roots, with mesial roots dilated distally and straight distal roots, and root canals that disappeared in the two-third and one-third of the distal and mesial root canals, no dilation of the periodontal membrane, normal lamina dura and no periapical abnormalities. Tooth 46 was subjected to local anaesthesia, followed by access opening and pulp extirpation, then the root canal preparation was performed using the ProTaper Next® rotary nickel-titanium (Maillefer, Switzerland) with the crown-down technique and root canal filling. Indirect composite overlay follow-up restoration was conducted of tooth 46. Conclusion: Symptomatic irreversible pulpitis in molars with dilacerated roots proved to be manageable with adequate root canal treatment, marked by the loss of the patients’ complaints.Keywords: Symptomatic irreversible pulpitis, root canal treatment, crown-down technique.

Investigation of Water Absorption and Color Change of Indirect Composite Resins

Purpose:Since conventional composite resins have some disadvantages such as polymerization shrinkage and secondarycaries formation, indirect restorations are preferred in cases where tooth tissue loss is high. The aim of this study is toexamine the water absorption and color change of indirect composite resins in different beverages.Materials & Methods:In the study, 40 specimens (10×2 mm) were arranged from each composite using three indirect(Signum Composite, Signum Ceramis and Gradia Plus) and one conventional (GrandioSO) composite resin. After thespecimens were polished, they were used for water absorption and color change test. The water absorption test wasperformed through keeping them in water for 7 days as specified in ISO 4049:2009. Samples were kept in coffee, tea anddistilled water for 7 days in order to examine color differences. The water absorption and color change values of thecomposite resins at the end of the 7th day were appraised using one-way analysis of variance (ANOVA) and Tukey’s test(p<0.05).Results:While there was no statistically considerable difference between the water absorption data of the indirect andtraditional composite resin materials we used in the study (p>0.05). When the color changes of resin-containingcomposites in water, coffee and tea were examined, traditional composite resin (GrandioSO) showed statistically lesscolor change than indirect composites in water, coffee and tea (p<0.05).Conclusion:Although indirect composite resins showed similar water absorption with conventional composite, theyshowed more color change than conventional composite. The highest color change in indirect composites was seen incoffee solution. Particle size of the indirect composites do not affect water absorption, but the decrease in particle size ofcomposites shows less color change.