Juergen Manhart

Direct composite restorations in the posterior dentition have become an indispensable element of modern dentistry. The performance of these restoration, even in the masticatory load-bearing posterior region, has been conclusively proven in many clinical studies. This procedure is usually carreid out in an elaborate layering technique. This time-consuming procedure requires an economically sensible fee, corresponding to the effort involved. Aside from the possibilies that highly aesthetic composites offer in the application of polychromatic multiple-layer techniques, there is also a great market demand for the most simple and quick and therefore economical composite-based materials for posterior teeth. These products are offered in the category of bulk-fill composite.

Endodontic posts do not increase the strength of the remaining tooth structure in endodontically treated teeth. On the contrary, depending on the post design employed (tapered versus parallel-sided), the root can be weakened relative to the amount of tooth removed during preparation. In many cases, if there has been a high degree of damage to the clinical crown, conservative preparation for an anatomic tapered (biomimetic) post with the incorporation of a ferrule on solid tooth structure is necessary to protect the reaming root structure as well as for the long-term retention of the composite resin core and the definitive restoration. Adhesively luted endodontic posts reinforced with glass or quartz fiber lead to better homogeneous tension distribution when loaded than rigid metal or zirconium oxide ceramic posts. Fiber-reinforced posts also possess advantageous optical properties over metal or metal oxide post systems. The clinician should realize that there are admittedly substantial differences in the mechanical loading capacity of the different fiber-reinforced endodontic posts and should be aware of such differences in order to research and select a suitable post system for use.

This longitudinal randomized controlled clinical trial evaluated direct composite restorations for clinical acceptability as posterior restoratives in single- or multi-surface cavities and provides a survey of the 4-year results. Three dentists placed 46 Quixfil (Xeno III) and 50 Tetric Ceram (Syntac Classic) composite restorations in stress-bearing Class I and II cavities in first or second molars (43 adult patients). Clinical evaluation was performed at baseline and after 4 years by 2 other dentists using modified USPHS criteria. At the last recall period, 37 Quixfil and 46 Tetric Ceram restorations were assessed. A total of 89.2% of Quixfil and 97.8% of Tetric Ceram posterior composites were assessed to be clinically excellent or acceptable with predominating alfa scores. Up to the 4-year recall, four Quixfil restorations failed because of bulk fracture, partial tooth fracture (2x) and postoperative symptoms. One Tetric Ceram restoration was lost due to problems with tooth integrity. No significant differences between the two composites could be detected at 4 years for any of the evaluated clinical criteria (p > 0.05). The comparison of restoration performance with time within both groups yielded a significant increase in marginal discoloration and decrease in marginal integrity for both materials. After 4 years, small restorations exhibited significantly less marginal discoloration than large restorations. Clinical assessment of stress-bearing Quixfil and Tetric Ceram posterior composite restorations showed good clinical results with predominantly alfa scores for both materials.

This longitudinal randomized controlled clinical trial evaluated composite resin inlays for clinical acceptability in single- or multisurface preparations and provides a survey of the results up to 3 years. Twenty-one dental students placed 75 Artglass (Heraeus Kulzer) and 80 Charisma (Heraeus Kulzer) composite resin inlays in Class 1 and 2 preparations in posterior teeth (89 adults). Clinical evaluation was performed at baseline and up to 3 years by two other dentists using modified USPHS criteria. A total of 89.8% of Artglass and 84.1% of Charisma inlays were assessed as clinically excellent or acceptable with predominating Alfa scores. Up to the 3-year recall, five Artglass and 10 Charisma inlays failed mainly because of postoperative symptoms, bulk fracture, and loss of marginal integrity. No significant differences between composite resin materials could be detected at 3 years for all clinical criteria (P > .05). The comparison of restoration performance with time within both groups yielded a significant increase in marginal discoloration (P < .05) and deterioration of marginal and restoration integrity (P < .05) for both inlay systems. However, both changes were mainly effects of scoring shifts from Alfa to Bravo. No significant differences (P > .05) were recorded comparing premolars and molars. Small inlays showed significantly better outcome for some of the tested clinical parameters (P < .05). Clinical assessment of Artglass and Charisma composite resin inlays exhibited an annual failure rate of 3.4% and 5.3% that is within the range of published data. Indirect composite inlays are a competitive restorative procedure in stress-bearing preparations.