Roland W. Bryant

A clinical evaluation of posterior composite resin restorations: 8-year findings

OBJECTIVES From a continuing investigation of the clinical performance of three different types of composite resin, the findings of the clinical evaluation at 8 years are presented. METHODS One operator placed 330 restorations in Class I and Class II preparations in the posterior teeth of 72 patients. Every patient received at least one restoration of each type of material: a microfilled composite, a small particle hybrid, a relatively coarse particle hybrid, and an amalgam control. Restorations were evaluated using clinical criteria. RESULTS Forty six patients attended the 8-year recall. Twenty-five of the 213 restorations (13.7% of the composites and 5.8% of the amalgams) originally placed in these 46 patients had previously failed or been lost from the study or were assessed as requiring replacement at the 8-year recall. Bulk fracture and secondary caries at the margin were the most common forms of failure in the composite restorations. Other failures or losses were associated with a non-margin defect in the composite, caries not associated with the restoration, pulpal considerations, extraction for orthodontics and reasons unknown. One-hundred and ninety-three restorations (including five that required replacement) were available for clinical evaluation at 8 years and these included 17 Class II restorations. Significantly fewer restorations placed with the coarse particle hybrid exhibited evidence of marginal deterioration. CONCLUSION At 8 years, composite restorations in posterior teeth had failed at a rate two to three times that of amalgam restorations. The most common types of failure were bulk fracture and secondary caries at the margin.

Marginal fracture of amalgam restorations. A review.

— Factors considered to have an influence on the marginal fracture of amalgam restorations are discussed. Although the influence of cavity preparation, manipulative procedures and initial marginal adaptation on marginal fracture has been widely acknowledged, there has been much controversy over the relative roles of two intrinsic characteristics of amalgams, namely, resistance to corrosion and resistance to slow plastic deformation.

The finishing and early marginal fracture of clinical amalgam restorations

One operator placed 249 Tytin amalgam restorations in Class I and II preparations in the permanent teeth of 60 patients each of whom received a minimum of three restorations. At least one of these restorations was carved-only, at least one was immediately finished (at 8 or 10 min after trituration), and at least one restoration was polished (more than 24 h after placement). Restorations were principally assessed for marginal fracture at baseline and 1 year using the 11-unit scale for the evaluation of photographs developed by Mahler. Five factors were also assessed clinically at 1 year. Amalgam restorations, polished using finishing burs and rubber points at least 24 h after placement, exhibited more initial marginal fracture than carved-only or immediately finished restorations. At 1 year, the three techniques were comparable except for the superior surface texture of the polished restorations. The technique of immediate finishing of amalgam restorations has nothing to commend it in preference to existing techniques.

ABRASIVE WEAR OF DENTAL COMPOSITE RESINS

Abrasive wear is a major problem in the application of dental composite resins. In this study the friction and wear behaviours of two types of dental composites: one containing relatively coarse filler particles and some microfillers (Estilux) and another containing only microfiller particles (Durafill), have been investigated by using a scratch testing machine. Experimental results show that the coefficients of friction in both composites are essentially constant for applied loads up to 20 N. The wear resistance of Durafill is better than Estilux. Under the same testing conditions, the size, shape and distribution of the filler particles are more important variables than applied load and sliding speed in controlling the wear mechanism. It is shown that for Estilux, plastic ploughing by the diamond indenter is the predominant mechanism. For Durafill, however, the formation and propagation of tensile cracks on the worn surface is the main wear mechanism. The effects of two different indenters, diamond and enamel, on the basic wear mechanisms are also discussed.

Finishing of amalgam restorations: a three-year clinical study

Class I and Class II amalgam restorations were placed in the permanent teeth of 66 patients, each of whom received a minimum of three restorations. At least one of these restorations was carved-only, at least one was immediately finished (using a prophylaxis paste on rubber cups at low speed, 8 or 10 min after trituration), and at least one restoration was polished (using finishing burs and polishing points, more than 24 h after placement). The number of restorations available for assessment of marginal fracture using the 11-unit photographic scale developed by Mahler was 253 at baseline, 249 at 1-year and 2-year recalls and 228 at the 3-year recall. Although polished restorations exhibited greater initial (baseline) marginal fracture, at 1-year, 2-year and 3-year recalls the restorations were found to exhibit a similar amount of marginal fracture regardless of the finishing technique. The amount of perceived marginal fracture increased steadily after 1 year. The immediate finishing of amalgam restorations showed no long-term benefit over the other techniques and has little to commend it. The clinical finishing of amalgam restorations is discussed in the light of this and other research.