Clinical Relevance Composite resin or ceramic inlays, onlays, and overlays can achieve high long-term survival and success rates. SUMMARY Objective: This study evaluated the long-term clinical performance and complications of composite resin or ceramic inlays, onlays, and overlays, as well as identified the factors that might influence the clinical outcome of the restorations. Method: A systematic literature search was conducted in the Pubmed, Embase, Cochrane Central Register of Controlled Trials, and Web of Science databases until April 30, 2019, without language restrictions. Randomized clinical trials, clinical retrospective, and prospective cohort studies with a mean follow-up period of five years were included. Two reviewers extracted the study data independently. Newcastle-Ottawa Scale was applied for quality assessment. Meta-analysis was performed by the random-effects model and fixed-effects model. Results: After removal of duplicates, 2818 studies were identified. Finally, 13 observational studies were included in the meta-analysis based on retrospective and prospective cohort studies. The cumulative survival rate and success rate of composite resin inlays, onlays, and overlays were 91% and 84% after five years of follow-up, respectively. The survival rates of ceramic inlays and onlays were 90% at 5 years, 89% at 8 years and 85% at 10 years, while the success rates of ceramic inlays and onlays were 88% at 5 years and 77% at 10 years. Secondary caries and endodontic complications were the predominant failures for composite resin inlays, onlays, and overlays, while restoration fractures and endodontic complications were the main failures for ceramic inlays and onlays. No direct association between parafuntional habits and bruxism and the fractures of restorations was found. Nonvital teeth and multiple-surface restorations tended to increase the risk of failure. Regarding other factors influencing the clinical outcome, no definite conclusion could be drawn due to inconsistent results. Conclusions: The long-term clinical outcomes have been demonstrated to achieve high survival and success rates based on 10-year data for ceramic inlays and onlays, as well as 5-year data for resin inlays, onlays, and overlays.
Clinical Relevance Dentin desensitizers and one-bottle self-etching adhesives can significantly reduce dentin hypersensitivity. Clinical desensitizing effectiveness depends on the individual dentin desensitizers/adhesives used. SUMMARY This in vivo study evaluated the desensitizing efficacy of two one-bottle self-etching adhesives, two dentin desensitizers and a placebo (water). Methods: Thirty-one volunteers with 55 hypersensitive teeth were recruited into this clinical investigation. The sensitive teeth were randomly assigned into five groups and treated with one of the following materials: iBond, Heraeus; Xeno V, Dentsply; Gluma desensitizer, Heraeus; Bifluorid 12, Voco; placebo (water). Mechanical and thermal stimuli were used to assess the tooth sensitivity response. Discomfort interval scale (DIS) scores of the sensitive teeth were recorded at three different investigation times (baseline, immediately and one month after treatment). Impressions were taken from the sensitive teeth at all three different investigation times, and replica models were made for the evaluation of the dentin surfaces by scanning electron microscopy. The Friedman test and the Mann Whitney U-test were used to analyze the data. Results: All dental materials significantly reduced the dentin hypersensitivity immediately ( p <0.05) and one month after treatment ( p <0.05), with the exception of Bifluorid 12 for mechanical tooth sensitivity. The placebo (water) only caused a short-term effect on the thermal dentin hypersensitivity ( p <0.05). Topical application of the dentin adhesives/desensitizers on sensitive dentinal areas resulted in occlusion of the patent tubules. Conclusions: The one-bottle self-etching adhesives and dentin desensitizers involved in the current clinical investigation could significantly relieve dentin hypersensitivity immediately and over the course of a month after treatment (except for Bifluorid 12 for tooth mechanical sensitivity). The placebo (water) had an immediate effect on thermal dentin hypersensitivity.
Clinical Relevance Salivary contamination before and after priming could significantly reduce the enamel bond strength of self-etching adhesives. Proper isolation should be performed before and during application of the adhesives and placement of the resin composite. Thorough water-spraying could significantly improve the μTBS of saliva-contaminated enamel. SUMMARY Objective: This study evaluated the effect of saliva contamination on the bovine enamel microtensile bond strengths (μTBS) of four self-etching adhesives. Materials and Methods: The labial enamel surfaces of extracted non-carious bovine incisors were serially wet ground. The enamel surfaces were not contaminated (Group A), contaminated with saliva before/after priming (Groups B/C) or they were water-sprayed after salivary contamination occurred before/after priming (Groups D/E). Four self-etching adhesives and the corresponding resin composites from the same manufacturer (Clearfil SE Bond + Clearfil AP-X, Kuraray Co; Xeno III + Ceram X, Densply; Frog + Ice, SDI; FL Bond II + Beautifil II, Shofu Inc) were applied onto the enamel surfaces. The μTBS tests were performed with a micro tester (BISCO, Inc). The enamel surface was analyzed with AFM (Atomic Force Microscopy) before/after salivary contamination occurred or after the saliva-contaminated enamel was water-sprayed. The data were analyzed using one-way ANOVA, factorial design ANOVA and post hoc Tukey's HSD multiple comparisons. Results: Salivary contamination significantly reduced the μTBS of all the adhesives in the current study ( p <0.001). Thorough water-spraying could significantly restore the μTBS of saliva-contaminated enamel to some degree ( p <0.05) or fully restore it for Clearfil SE Bond, but it could not remove some proteins adsorbed on the enamel surface. Conclusion: Hydrophilic self-etching adhesives are negatively influenced by salivary contamination. Thorough water-spraying could significantly improve the μTBS of the saliva-contaminated enamel. Proper isolation should be performed before and during application of the adhesives and during placement of the resin composite.
Clinical Relevance Depending on the application of the individual adhesives used, dentin adhesives seal dentin surfaces and reduce dentinal permeability. Dentin adhesives possessing a high sealing ability for dentin surfaces are suggested for the treatment of dentin hypersensitivity. SUMMARY Objectives: This in vitro study evaluated the sealing ability of dentin adhesives and a desensitizer. Methods: Standardized Class V cavities were prepared on the buccal and lingual surfaces of 55 freshly extracted human molars. The teeth were cut into two sections in a mesiodistal direction. All specimens were randomly divided into 11 groups (n=10). In each group, the cavities were treated with one of eight different dentin adhesives, a dentin desensitizer or a special combination of these, except for the control group. After all the cavities had been stained for 24 hours with 0.5% methlyene blue solution, the teeth were longitudinally cut into two sections through the center of the cavities. Dye penetration was recorded according to the stained areas. Epoxy resin replicas of two specimens per group were analyzed by SEM. Results: All dentin adhesives/desensitizer significantly reduced dentinal permeability ( p <0.05). The sealing ability of the different dentin adhesives/desensitizer was significantly different ( p <0.001). The degree of dye penetration corresponded well with the surface morphology of the dentin surfaces after the various treatments. Conclusions: None of the dentin adhesives/desensitizer could completely block fluid percolation through the dentinal tubules, but current dentin adhesives/desensitizers can significantly reduce dentin permeability.