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Case Report
Straightforward replication of digital wax-up design into direct composite resin restorations in adolescents using a custom 3-dimensionally printed index
Ra’fat Ibrahim Farah, Sanaa Najeh Al-Haj Ali, Abdullah Alharbi, Bandar Alresheedi
Restor Dent Endod 2024;49(4):e36.   Published online October 10, 2024
DOI: https://doi.org/10.5395/rde.2024.49.e36
AbstractAbstract PDFPubReaderePub

This case report introduces a straightforward, noninvasive approach for the esthetic rehabilitation of malformed anterior teeth in adolescents using direct composite restorations. The universal composite resin restorations are applied within a transparent 3-dimensionally printed rigid-resin index, which is individually customized from a digital wax-up. Compared to other methods, this technique streamlines the restoration process, significantly reducing chairside time while enhancing the predictability, accuracy, and patient acceptance of the aesthetic outcome.

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Research Articles
Alkasite restorative material for endodontically treated teeth: a randomized controlled pilot study
Davi Ariel Nobuo Bepu, Renata Siqueira Scatolin, Natalia Saud Junqueira Franco, Luiza Pejon Sanchez, Aline Evangelista Souza-Gabriel, Silmara Aparecida Milori Corona
Restor Dent Endod 2024;49(3):e24.   Published online June 11, 2024
DOI: https://doi.org/10.5395/rde.2024.49.e24
AbstractAbstract PDFPubReaderePub
Objectives

This study aimed to evaluate the clinical performance of an alkasite restorative material in molars that had undergone root canal treatment.

Materials and Methods

The research was registered in Brazilian Registry of Clinical Trials. The randomized clinical trial involved 33 patients, each with at least 1 mandibular molar requiring restoration after receiving endodontic treatment. Patients were randomly assigned to receive either bulk-fill resin composite (Tetric N Ceram Bulk Fill, Ivoclar Vivadent) or the alkasite restorative material (Cention N, Ivoclar Vivadent). Upon completion of the restorations, 3 calibrated professionals utilized the United States Public Health Service criteria to assess various factors, including retention, secondary caries, marginal adaptation, restoration color, marginal pigmentation, and anatomical form. Evaluations were conducted at intervals of 7 days, 6 months, and 17 months. Additionally, the assessment encompassed the presence of radiolucent lines adjacent to the restoration, material deficiencies or excess, contact points, and caries recurrence. The data underwent analysis using the Friedman and Mann-Whitney tests (α = 0.05).

Results

After 17 months, the results revealed that the alkasite restorative material exhibited greater wear of anatomical shape compared to the bulk-fill resin composite (p = 0.0189). Furthermore, the alkasite restorative material significantly differed from the natural tooth color in most cases (p = 0.0000). However, no other criteria displayed significant differences between the materials or over time (p > 0.05).

Conclusions

The alkasite restorative material (Cention N) emerges as a viable option for restoring endodontically treated teeth, displaying clinically acceptable alterations after a 17-month evaluation period.

Trial Registration

Brazilian Registry of Clinical Trials (ReBEC) Identifier: RBR-97kx5jv

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Effects of surrounding and underlying shades on the color adjustment potential of a single-shade composite used in a thin layer
Mariana Silva Barros, Paula Fernanda Damasceno Silva, Márcia Luciana Carregosa Santana, Rafaella Mariana Fontes Bragança, André Luis Faria-e-Silva
Restor Dent Endod 2023;48(1):e7.   Published online December 29, 2022
DOI: https://doi.org/10.5395/rde.2023.48.e7
AbstractAbstract PDFPubReaderePub
Objectives

This study aimed to evaluate the surrounding and underlying shades’ effect on the color adjustment potential (CAP) of a single-shade composite used in a thin layer.

Materials and Methods

Cylinder specimens (1.0 mm thick) were built with the Vittra APS Unique composite, surrounded (dual specimens) or not (simple specimens) by a control composite (shade A1, A2, or A3). Simple specimens were also built only with the control composites. Each specimen’s color was measured against white and black backgrounds or the simple control specimens with a spectrophotometer (CIELAB system). The whiteness index for dentistry (WID) and translucency parameters (TP00) were calculated for simple specimens. Differences (ΔE00) in color between the simple/dual specimens and the controls were calculated. The CAP was calculated based on the ratios between data from simple and dual specimens.

Results

The Vittra APS Unique composite showed higher WID and TP00 values than the controls. The highest values of ΔE00 were observed among simple specimens. The color measurements of Vittra APS Unique (simple or dual) against the control specimens presented the lowest color differences. Only surrounding the single-shade composite with a shaded composite barely impacted the ΔE00. The highest CAP values were obtained using a shaded composite under simple or dual specimens.

Conclusions

The CAP of Vittra APS Unique was strongly affected by the underlying shade, while surrounding this composite with a shaded one barely affected its color adjustment.

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Errors in light-emitting diodes positioning when curing bulk fill and incremental composites: impact on properties after aging
Abdulrahman A. Balhaddad, Isadora M. Garcia, Haifa Maktabi, Maria Salem Ibrahim, Qoot Alkhubaizi, Howard Strassler, Fabrício M. Collares, Mary Anne S. Melo
Restor Dent Endod 2021;46(4):e51.   Published online September 24, 2021
DOI: https://doi.org/10.5395/rde.2021.46.e51
AbstractAbstract PDFPubReaderePub
Objectives

This study aimed to evaluate the effect of improper positioning single-peak and multi-peak lights on color change, microhardness of bottom and top, and surface topography of bulk fill and incremental composites after artificial aging for 1 year.

Materials and Methods

Bulk fill and incremental composites were cured using multi-peak and single-peak light-emitting diode (LED) following 4 clinical conditions: (1) optimal condition (no angulation or tip displacement), (2) tip-displacement (2 mm), (3) slight tip angulation (α = 20°) and (4) moderate tip angulation (α = 35°). After 1-year of water aging, the specimens were analyzed for color changes (ΔE), Vickers hardness, surface topography (Ra, Rt, and Rv), and scanning electron microscopy.

Results

For samples cured by single-peak LED, the improper positioning significantly increases the color change compared to the optimal position regardless of the type of composite (p < 0.001). For multi-peak LED, the type of resin composite and the curing condition displayed a significant effect on ΔE (p < 0.001). For both LEDs, the Vickers hardness and bottom/top ratio of Vickers hardness were affected by the type of composite and the curing condition (p < 0.01).

Conclusions

The bulk fill composite presented greater resistance to wear, higher color stability, and better microhardness than the incremental composite when subjected to improper curing. The multi-peak LED improves curing under improper conditions compared to single-peak LED. Prevention of errors when curing composites requires the attention of all personnel involved in the patient's care once the clinical relevance of the appropriate polymerization reflects on reliable long-term outcomes.

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  • 2 Web of Science
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Evaluation of the relation between the pulp stones and direct restorations using cone beam computed tomography in a Turkish subpopulation
Güzide Pelin Sezgin, Sema Sönmez Kaplan, Tuna Kaplan
Restor Dent Endod 2021;46(3):e34.   Published online June 8, 2021
DOI: https://doi.org/10.5395/rde.2021.46.e34
AbstractAbstract PDFPubReaderePub
Objectives

This study aimed to assess the presence of pulp stones through an examination of cone beam computed tomography images and correlate their prevalence with age, sex, dental arch and side, tooth type, and restoration type and depth.

Materials and Methods

Cone beam computed tomography images obtained from 673 patients and archival data on 11,494 teeth were evaluated. The associations of pulp stones with age, sex, dental arch and side, tooth type, and restoration type and depth were noted. All the measurements were subjected to a χ2 test and one sample χ2 test (p < 0.05).

Results

In the study group, 163 (24.2%) patients and 379 (3.3%) teeth had at least one pulp stone. The pulp stone frequency in those aged 30–39 years was significantly greater than in those aged 18–29 and ≥ 60 years, and the frequency was higher in females than in males (p < 0.05). The highest prevalence of pulp stones was found in maxillary dental arches and molar teeth (p < 0.05). Pulp stones were significantly more common in medium-depth restorations (p < 0.05).

Conclusions

Maxillary molar teeth, medium-depth restorations, individuals aged 30–39 years and females had a greater percentage of pulp stones.

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The polymerization efficiency of a bulk-fill composite based on matrix-modification technology
Tarek M. Elshazly, Christoph Bourauel, Moustafa N. Aboushelib, Dalia I. Sherief, Dalia I. El-Korashy
Restor Dent Endod 2020;45(3):e32.   Published online May 29, 2020
DOI: https://doi.org/10.5395/rde.2020.45.e32
AbstractAbstract PDFPubReaderePub
Objectives

To evaluate the polymerization efficiency of a matrix-modified bulk-fill composite, and compare it to a conventional composite which has a similar filler system. The degree of conversion (DC%) and monomer elution were measured over different storage periods. Additionally, fillers' content was examined.

Materials and Methods

Cylindrical specimens were prepared, in bulk and incrementally, from Filtek Bulk Fill (B) and Filtek Supreme XTE (S) composites using a Teflon mold, for each test (n = 6). Using attenuated total reflection method of Fourier transformation infrared spectroscopy, DC% was measured after 24 hours, 7 days, and 30 days. Using high-performance liquid chromatography, elution of hydroxyethyl methacrylate, triethylene glycol dimethacrylate, urethane dimethacrylate, and bisphenol-A glycidyl dimethacrylate was measured after 24 hours, 7 days and 30 days. Filler content was examined by scanning electron microscopy (SEM). Data were analyzed using 2-way mixed-model analysis of variance (α = 0.05).

Results

There was no significant difference in DC% over different storage periods between B-bulk and S-incremental. Higher monomer elution was detected significantly from S than B. The elution quantity and rate varied significantly over storage periods and between different monomers. SEM images showed differences in fillers' sizes and agglomeration between both materials.

Conclusions

Matrix-modified bulk-fill composites could be packed and cured in bulk with polymerization efficiency similar to conventional composites.

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Case Report
A CAD/CAM-based strategy for concurrent endodontic and restorative treatment
Patricia Maria Escobar, Anil Kishen, Fabiane Carneiro Lopes, Caroline Cristina Borges, Eugenio Gabriel Kegler, Manoel Damião Sousa-Neto
Restor Dent Endod 2019;44(3):e27.   Published online July 24, 2019
DOI: https://doi.org/10.5395/rde.2019.44.e27
AbstractAbstract PDFPubReaderePub

This case report describes a technique in which endodontic treatment and permanent indirect restoration were completed in the same clinical appointment with the aid of a computer-aided design/computer-aided manufacturing (CAD/CAM) system. Two patients were diagnosed with irreversible pulpitis of the mandibular first molar. After access preparation, root canals were located, irrigation was performed until bleeding ceased, and the coronal tooth structure was prepared for indirect restoration. Then, utilizing an interim 3-mm build-up of the endodontic access cavity, a hemi-arch digital scan was performed with an intraoral scanner. Subsequent to digital scanning, restoration design was performed simultaneously with the endodontic procedure. The root canals were shaped using the Race system under irrigation with 2.5% sodium hypochlorite followed by root canal filling. The pulp chamber was subsequently filled with a 3-mm-thick composite resin restoration mimicking the interim build-up previously utilized to facilitate block milling in the CAD/CAM system. Clinical try-in of the permanent onlay restoration was followed by acid etching, application of a 5th generation adhesive, and cementation of the indirect restoration. Once the restoration was cemented, rubber dam isolation was removed, followed by occlusal adjustment and polishing. After 2 years of follow-up, the restorations were esthetically and functionally satisfactory, without complications.

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Research Article
Influence of different universal adhesives on the repair performance of hybrid CAD-CAM materials
Gülbike Demirel, İsmail Hakkı Baltacıoğlu
Restor Dent Endod 2019;44(3):e23.   Published online May 20, 2019
DOI: https://doi.org/10.5395/rde.2019.44.e23
AbstractAbstract PDFPubReaderePub
Objectives

The aim of this study was to investigate the microshear bond strength (μSBS) of different universal adhesive systems applied to hybrid computer-aided design/computer-aided manufacturing (CAD-CAM) restorative materials repaired with a composite resin.

Materials and Methods

Four types of CAD-CAM hybrid block materials—Lava Ultimate (LA), Vita Enamic (VE), CeraSmart (CS), and Shofu Block HC (SH)—were used in this study, in combination with the following four adhesive protocols: 1) control: porcelain primer + total etch adhesive (CO), 2) Single Bond Universal (SB), 3) All Bond Universal (AB), and 4) Clearfil Universal Bond (CU). The μSBS of the composite resin (Clearfil Majesty Esthetic) was measured and the data were analyzed using two-way analysis of variance and the Tukey test, with the level of significance set at p < 0.05.

Results

The CAD-CAM block type and block-adhesive combination had significant effects on the bond strength values (p < 0.05). Significant differences were found between the following pairs of groups: VE/CO and VE/AB, CS/CO and CS/AB, VE/CU and CS/CU, and VE/AB and CS/AB (p < 0.05).

Conclusions

The μSBS values were affected by hybrid block type. All tested universal adhesive treatments can be used as an alternative to the control treatment for repair, except the AB system on VE blocks (the VE/AB group). The μSBS values showed variation across different adhesive treatments on different hybrid CAD-CAM block types.

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Case Report
Management of large class II lesions in molars: how to restore and when to perform surgical crown lengthening?
Ana Belén Dablanca-Blanco, Juan Blanco-Carrión, Benjamín Martín-Biedma, Purificación Varela-Patiño, Alba Bello-Castro, Pablo Castelo-Baz
Restor Dent Endod 2017;42(3):240-252.   Published online August 3, 2017
DOI: https://doi.org/10.5395/rde.2017.42.3.240
AbstractAbstract PDFPubReaderePub

The restoration of endodontic tooth is always a challenge for the clinician, not only due to excessive loss of tooth structure but also invasion of the biological width due to large decayed lesions. In this paper, the 7 most common clinical scenarios in molars with class II lesions ever deeper were examined. This includes both the type of restoration (direct or indirect) and the management of the cavity margin, such as the need for deep margin elevation (DME) or crown lengthening. It is necessary to have the DME when the healthy tooth remnant is in the sulcus or at the epithelium level. For caries that reaches the connective tissue or the bone crest, crown lengthening is required. Endocrowns are a good treatment option in the endodontically treated tooth when the loss of structure is advanced.

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Research Article
Retentive strength of different intracanal posts in restorations of anterior primary teeth: an in vitro study
Mahtab Memarpour, Fereshteh Shafiei, Maryam Abbaszadeh
Restor Dent Endod 2013;38(4):215-221.   Published online November 12, 2013
DOI: https://doi.org/10.5395/rde.2013.38.4.215
AbstractAbstract PDFPubReaderePub
Objectives

To determine the retentive strength and failure mode of undercut composite post, glass fiber post and polyethylene fiber post luted with flowable composite resin and resin-cement.

Materials and Methods

Coronal parts of 120 primary canine teeth were sectioned and specimens were treated endodontically. The teeth were randomly divided into 6 groups (n = 20). Prepared root canals received intracanal retainers with a short composite post, undercut composite post, glass fiber post luted with flowable resin or resin-cement, and polyethylene fiber post luted with flowable resin or resin-cement. After crown reconstruction, samples were tested for retentive strength and failure mode. Statistical analysis was done with one-way ANOVA and Tukey tests (p < 0.05).

Results

There were statistically significant differences between groups (p = 0.001). Mean bond strength in the undercut group was significantly greater than in the short composite post (p = 0.030), and the glass fiber post (p = 0.001) and the polyethylene fiber post group luted with resin-cement (p = 0.008). However, the differences between the undercut group and the groups with flowable composite as the luting agent were not significant (p = 0.068, p = 0.557). Adhesive failure was more frequent in the fiber post groups.

Conclusions

Although the composite post with undercutting showed the greatest resistance to dislodgement, fiber posts cemented with flowable composite resin provided acceptable results in terms of retentive strength and fracture mode.

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