Behaviour of general dental practitioners in Germany regarding posterior restorations with flowable composites

Because the recommendation to use flowables for posterior restorations is still a matter of debate, the objective of this study was to determine in a nationwide survey in Germany how frequently, for what indications, and for what reasons, German dentists use flowable composites in posterior teeth. In addition, the acceptance of a simplified filling technique for posterior restorations using a low stress flowable composite was evaluated. Completed questionnaires from all over Germany were returned by 1,449 dentists resulting in a response rate of 48.5%; 78.6% of whom regularly used flowable composites for posterior restorations. The most frequent indications were cavity lining (80.1%) and small Class I fillings (74.2%). Flowables were less frequently used for small Class II fillings (22.7%) or other indications (13.6%). Most frequent reasons given for the use of flowables in posterior teeth were the prevention of voids (71.7%) and superior adaptation to cavity walls (72.9%), whereas saving time was considered less important (13.8%). Based on the subjective opinion of the dentists the simplified filling technique seemed to deliver advantages compared to the methods used to date particularly with regard to good cavity adaptation and ease of use. In conclusion, resin composites are the standard material type used for posterior restorations by general dental practitioners in Germany and most dentists use flowable composites as liners.

Relevance of in vitro tests of adhesive and composite dental materials, a review in 3 parts. Part 1: Approval requirements and standardized testing of composite materials according to ISO specifications

The first part of this three-part review on the relevance of laboratory testing of composites and adhesives deals with approval requirements for composite materials. We compare the in vivo and in vitro literature data and discuss the relevance of in vitro analyses. The standardized ISO protocols are presented, with a focus on the evaluation of physical parameters. These tests all have a standardized protocol that describes the entire test set-up. The tests analyse flexural strength, depth of cure, susceptibility to ambient light, color stability, water sorption and solubility, and radiopacity. Some tests have a clinical correlation. A high flexural strength, for instance, decreases the risk of fractures of the marginal ridge in posterior restorations and incisal edge build-ups of restored anterior teeth. Other tests do not have a clinical correlation or the threshold values are too low, which results in an approval of materials that show inferior clinical properties (e.g., radiopacity). It is advantageous to know the test set-ups and the ideal threshold values to correctly interpret the material data. Overall, however, laboratory assessment alone cannot ensure the clinical success of a product.

Depth of cure of resin composites: is the ISO 4049 method suitable for bulk fill materials?

To evaluate if depth of cure D(ISO) determined by the ISO 4049 method is accurately reflected with bulk fill materials when compared to depth of cure D(new) determined by Vickers microhardness profiles.

Effect of zirconia surface treatments on the shear strength of zirconia/veneering ceramic composites

Aim of the investigation was to assess the effect of different surface treatments on the bond strength of veneering ceramics to zirconia. In a shear test, the influences of polishing, sandblasting, and silica-coating of the zirconia surface on bonding were assessed with five different veneering ceramics. In addition the effect of liner application was examined. With one veneering ceramic, the impact of regeneration firing of zirconia was also evaluated. Statistical analysis was performed with one-way ANOVA and post hoc Scheffé's test. Failure in every case occurred in the veneering ceramic adjacent to the interface with a thin layer of ceramic remaining on the zirconia surface, indicating that bond strength was higher than the cohesive strength of the veneering ceramic. Shear strength ranged from 23.5 +/- 3.4 MPa to 33.0 +/- 6.8 MPa without explicit correlation to the respective surface treatment. Regeneration firing significantly decreased the shear strength of both polished and sandblasted surfaces. Findings of this study revealed that bonding between veneering ceramics and zirconia might be based on chemical bonds. On this note, sandblasting was not a necessary surface pretreatment to enhance bond strength and that regeneration firing was not recommended.

Ultra-high-resolution dual-source CT for forensic dental visualization-discrimination of ceramic and composite fillings

Dental identification is the most valuable method to identify human remains in single cases with major postmortem alterations as well as in mass casualties because of its practicability and demanding reliability. Computed tomography (CT) has been investigated as a supportive tool for forensic identification and has proven to be valuable. It can also scan the dentition of a deceased within minutes. In the present study, we investigated currently used restorative materials using ultra-high-resolution dual-source CT and the extended CT scale for the purpose of a color-encoded, in scale, and artifact-free visualization in 3D volume rendering. In 122 human molars, 220 cavities with 2-, 3-, 4- and 5-mm diameter were prepared. With presently used filling materials (different composites, temporary filling materials, ceramic, and liner), these cavities were restored in six teeth for each material and cavity size (exception amalgam n = 1). The teeth were CT scanned and images reconstructed using an extended CT scale. Filling materials were analyzed in terms of resulting Hounsfield units (HU) and filling size representation within the images. Varying restorative materials showed distinctively differing radiopacities allowing for CT-data-based discrimination. Particularly, ceramic and composite fillings could be differentiated. The HU values were used to generate an updated volume-rendering preset for postmortem extended CT scale data of the dentition to easily visualize the position of restorations, the shape (in scale), and the material used which is color encoded in 3D. The results provide the scientific background for the application of 3D volume rendering to visualize the human dentition for forensic identification purposes.

Influence of increment thickness on microhardness and dentin bond strength of bulk fill resin composites

OBJECTIVES To investigate the influence of increment thickness on Vickers microhardness (HV) and shear bond strength (SBS) to dentin of a conventional and four bulk fill resin composites. METHODS HV and SBS were determined on specimens of the conventional resin composite Filtek Supreme XTE (XTE) and the bulk fill resin composites SDR (SDR), Filtek Bulk Fill (FBF), x-tra fil (XFIL), and Tetric EvoCeram Bulk Fill (TEBF) after 24h storage. HV was measured either as profiles at depths up to 6mm or at the bottom of 2mm/4mm/6mm thick resin composite specimens. SBS of 2mm/4mm/6mm thick resin composite increments was measured to dentin surfaces of extracted human molars treated with the adhesive system OptiBond FL, and the failure mode was stereomicroscopically determined at 40× magnification. HV profiles and failure modes were descriptively analysed whereas HV at the bottom of resin composite specimens and SBS were statistically analysed with nonparametric ANOVA followed by Wilcoxon rank sum tests (α=0.05). RESULTS HV profiles (medians at 2mm/4mm/6mm): XTE 105.6/88.8/38.3, SDR 34.0/35.5/36.9, FBF 36.4/38.7/37.1, XFIL 103.4/103.9/101.9, TEBF 63.5/59.7/51.9. HV at the bottom of resin composite specimens (medians at 2mm/4mm/6mm): XTE (p<0.0001) 105.5>85.5>31.1, SDR (p=0.10) 25.8=21.9=26.0, FBF (p=0.16) 26.6=25.3=28.9, XFIL (p=0.18) 110.5=107.2=101.9, TEBF (p<0.0001) 63.0>54.9>48.2. SBS (MPa, medians at 2mm/4mm/6mm): XTE (p<0.0001) 23.9>18.9=16.7, SDR (p=0.26) 24.6=22.7=23.4, FBF (p=0.11) 21.4=20.3=22.0, x-tra fil (p=0.55) 27.0=24.0=23.6, TEBF (p=0.11) 21.0=20.7=19.0. The predominant SBS failure mode was cohesive failure in dentin. SIGNIFICANCE At increasing increment thickness, HV and SBS decreased for the conventional resin composite but generally remained constant for the bulk fill resin composites.