62
U.M.F. “GR.T.POPA” IASI FACULTY OF DENTAL MEDICINE SYNTHESIS RESEARCHES REGARDING MORPHO-FUNCTIONAL RECONSTRUCTION IN PROXIMO-OCCLUSAL DENTAL CARIES Scientific coordinator Prof. dr. LACATUSU STEFAN PhD Student MEREUTA VASILE-DENISS 2012

UNIVERSITATEA DE MEDICINA SI FARMACIE “GR Doctorat/Rezumat... · universitatea de medicina si farmacie “gr.t.popa” iasi facultatea de medicina dentara rezumatul tezei de doctorat

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Page 1: UNIVERSITATEA DE MEDICINA SI FARMACIE “GR Doctorat/Rezumat... · universitatea de medicina si farmacie “gr.t.popa” iasi facultatea de medicina dentara rezumatul tezei de doctorat

UMF ldquoGRTPOPArdquo IASI

FACULTY OF DENTAL MEDICINE

SYNTHESIS

RESEARCHES REGARDING MORPHO-FUNCTIONAL

RECONSTRUCTION IN PROXIMO-OCCLUSAL

DENTAL CARIES

Scientific coordinator

Prof dr LACATUSU STEFAN

PhD Student

MEREUTA VASILE-DENISS

2012

Universitatea de Medicină şi Farmacie ldquoGrTPopardquo- Iaşi

Facultatea de Medicină Dentară

REZUMATUL

TEZEI DE DOCTORAT

Coordonator stiinţific

Prof dr LACATUSU STEFAN

Doctorand

MEREUTA VASILE-DENISS

2012

UNIVERSITATEA DE MEDICINA SI FARMACIE ldquoGRTPOPArdquo IASI

FACULTATEA DE MEDICINA DENTARA

REZUMATUL TEZEI DE DOCTORAT

CERCETARI PRIVIND POSIBILITATI DE REFACERE MORFOFUNCTIONALA IN PIERDERI DE SUBSTANTA

ODONTALE OCLUZO‐PROXIMALE

Coordonator stiințific Prof dr LĂCĂTUŞU ŞTEFAN

Doctorand MEREUȚĂ VASILE‐DENISS

2012

1

CONTENT

GENERAL PART

INTRODUCTION3

CHAPTI General aspects regarding proximo-occlusal carious dental

lesions5

CHAPTII Clasic and modern methods for diagnostic of noncavitary and

incipient proximal dental caries9

CHAPTIII General aspects regarding composition and properties of direct

proximal-occlusal restorations20

CHAPT IV Actual data regarding longevity of direct proximo-occlusal

restorations38

CHAPT V Studies regarding clinical performance of proximo-occlusal indirect

restorations versus direct restorations45

PERSONAL PART

CHAPTVI The aim of research theme General objectives Methodology48

CHAPTVII Study regarding clinical performance of proximo-occlusal

amalgam and composite resins restorations50

VII1Introduction50

VII2Aim of study50

VII3Materials and methods50

VII4Results and discussions52

VII5Conclusions82

CHAPTVIII Clinical performance of composite resins restorations related to

restorative technique 12-months longitudinal study83

VIII1Introductions83

VIII2Aim of study83

VIII3Materials and methods83

VIII4Results and discussions85

VIII5Conclusions111

CHAPTIX Study regarding marginal sealing status in composite resins limited

proximo-occlusal restorations performed using different techniques112

IX1Introduction112

IX2Aim of study115

IX3Materials and methods115

IX4Results and discussions118

IX5Conclusions124

2

CHAPTX Study regarding the effects of etching on enamel and dentine in

cervical area for proximal cavities localised at lateral dental group125

X1Introduction125

X2Aim of study125

X3Materials and methods126

X4Results and discussions126

X5Conclusions147

CHAPTXI FEA study regarding the biomechanical behaviour and fracture

resistance of proximo-occlusal amalgam and composite resins restorations148

XI1Introduction148

XI2Aim of study148

XI3Materials and metods149

XI4Results and discussions152

XI5Conclusions182

FINAL CONCLUSIONS182

PERSONAL CONTRIBUTION183

REFERENCES184

3

INTRODUCTION

Academic European of Operative Dentistry warned about the factors that

impose to the dentists the use of composite resins on large scale as materials for the

direct restorations at lateral dental group the mass-media rejection of amalgam the

patients desire for esthetic restorations even the request for biological principles to

minimise sacrifice of healthy dental tissues However amalgam must be used in

particular situations represented by extensive carious lesions high cariogenic risk and

bruxism

In this context any comparative study focused on both amalgam and

composite resins proximo-occlusal restorations presents a high practical importance

for dentists Besides numerous fillings replacements are based on improper decisions

regarding wear status of restorations than a real clinical failure Dentists must also

take in account the specific oral environment conditions especially for adhesive

materials that are laquosensitive technique raquo

The final decision and materialrestorative technique selection must be based

on a balance between resistance longevity and priceefficiency

4

CHAPTVI THE AIM OF STUDY GENERAL OBJECTIVES DATA

COLLECTION AND PROCESSING

VI1 The reason for theme choice

The reason for theme choice was determined by the fact that any comparative

study focused on both amalgam and composite resins proximo-occlusal restorations

presents a high practical importance for dentists Also it is a request to highlight

clinical and paraclinical aspects regarding factors that influence clinical performance

of direct composite resins restorations performed at the level of lateral dental group

The support offered by Discipline Cariology and Restorative Dentistry and Institute

Petru Poni allowed the performance of our researches

VI2Aim objectives methodology

The objectives of my researches were as follows

- Selection of literature data regarding histological morphopatological

etiopathogenic spects of dental caries posibilities of diagnostic for proximal

incipient dental caries using both clasic and modern diagnostic technology

properties and clinical behaviour of dental amalgam and composite resins and

other adhesive materials used in posterior restorations literature data

regarding longevity of proximo-occlusal direct restorations and literature data

regarding clinical performances of indirect restorations versus direct

restorations for lateral dental group

- Performing an epidemiological study based on clinical data (indices Ryge

modified USPHS) on posterior direct restorations

- The comparing research regarding clinical performance of posterior composite

resines restorations performed using different restorative techniques

- In vitro study focused on the assessment of the marginal sealing at the cervical

area of proximo-occlusal composite resins restorations

- In vitro study focused on the effects of etching at the cervical area for

proximo-occlusal composite resins restorations

- FEA (finite element analysis) study focused on the assessment of

biomechanical behaviour and resistance to fracture and deformation of

simulated proximo-occlusal restorations from amalgam and composite resins

To realise the proposed aims the working protocol was as follows

- clinical assessment of a study group with age 17-49 with class II dental caries

treated by one dentist using amalgam and composite resins

5

- clinical assessment of a study group with age 15-65 with class II dental caries

treated by one dentist using a selected composite resin and different restorative

techniques

- performing of data base for statistical processing

Database was collected between 2008-2011 in private practice and Faculty of

Dental Medicine UMF ―GrTPopa Iasi The paraclinical studies were performed in

collaboration with Institute Petru Poni Iasi

The patients were informed and gave their written consent to be included in

study groups Every patient was submitted to clinical examen and radiographic

examen The clinical examens consisted in assessment of Ryge indices (modified

USPHS) at baseline 6 months 12 months 18months and 24 months

The paraclinical tests consisted in

- in vitro tests on extracted teeth consisting in optical and atomic force

microscopy to assess the influence of different restorative techniques on the cervical

marginal sealing

- measurement of surface status (enamel dentine) after etching (different time

intervals) using AFM (Atomic Force Microscopy)

- statistical analysis in SPSS 13 for comparison of microleakage degree at

cervical level related to different restorative techniques

- FEA study performed using software COSMOSWorks 2010 for the

assessment of biomechanical behaviour of simulated posterior amalgam and

composite resins restorations

VI3 Data collecting and processing

The processing of reseraches data was performed using the follwing software

MS Office (graphs tables)

SPSS 16 (statistical tests)

The following statistical tests were used t Test test Kolmogorov-Smirnov test

Pearson test Wilcoxon The descriptive statistical analysis was performed using

Microsoft Excel and analitical statistical analysis was performed using SPSS 160

(SPSS Inc SUA)

6

CHAPTVII STUDY REGARDING CLINICAL PERFORMANCE OF

PROXIMO-OCCLUSAL AMALGAM AND COMPOSITE RESINS

RESTORATIONS

VII1 INTRODUCTION

The clinical performance of posterior direct restorations pn medium and long

term concerns dental practitioners that must correlate their therapeutical decisions

with material selection restorative technique external factors represented by oral

forces cariogenic risk patient parafunctions

VII2AIM OF STUDY

The aim of study consisted in assessment of clinical performance of amalgam

and composite resins proximal-occlusal restorations 4-years old

VII3 MATERIALS AND METHOD

The study group included 200 proximal-occlusal amalgam (n=100) and

composite resins (Herculite Kerr) (n=100) restorations 4-years old The study was

performed on 55 patients with age between 17-49 years examined in Dental Medicine

Faculty UMFGrTPopa Iaşi The assessment of fillings status was performed

using Ryge indices modified USPHS (US Public Health Service) (table 1) The

clinical peformance of restorations was also correlated with dental group (molars

bicusps) extension (medium extended) and cariogenic risk (medium high) The

following parameters were assessed

- color match

- marginal adaptation (integrity)

- marginal discoloration

- anatomical form (proximal)

- surface quality

The results presentation was performed using Microsoft Excel

VII4 RESULTS AND DISCUSSIONS

AB

C

S1

6

64

30

0

20

40

60

80

A

B

C

Fig VII1 Anatomical form (occlusal)-amalgam restorations (molars)

7

AB

C

S1

26

64

100

10

20

30

40

50

60

70

A

B

C

Fig VII2 Anatomical form (occlusal)-amalgam restorations (bicusps)

AB

C

S1

0

46

54

0

10

20

30

40

50

60

A

B

C

Fig VII3 Anatomical form (occlusal)-composite resins restorations (molars)

Fig VII4 Anatomical form (occlusal)-amalgam restorations (bicusps)

AB

C

S1

12

72

16

0

10

20

30

40

50

60

70

80

A

B

C

FigVII5 Anatomical form (proximal)-amalgam restorations (molars)

AB

C

S1

38

56

60

10

20

30

40

50

60

A

B

C

FigVII6 Anatomical form (proximal)-amalgam restorations (bicusps)

AB

C

S1

10

54

36

0

10

20

30

40

50

60

A

B

C

8

AB

C

S1

8

64

26

0

10

20

30

40

50

60

70

A

B

C

FigVII7 Anatomical form (proximal)-composite resins restorations (molars)

AB

C

S1

34

66

100

10

20

30

40

50

60

70

A

B

C

FigVII8 Anatomical form (proximal)-composite resins restorations (bicusps)

AB

C

S1

36

44

20

0

5

10

15

20

25

30

35

40

45

A

B

C

FigVII9 Marginal adaptation (proximal)- amalgam restorations(bicusps)

AB

C

S1

20

50

30

0

5

10

15

20

25

30

35

40

45

50

A

B

C

FigVII10 Marginal adaptation (proximal)-amalgam restorations (molars)

AB

C

S1

16

60

24

0

10

20

30

40

50

60

A

B

C

FigVII11 Marginal adaptation (proximal)-composite resins restorations (bicusps)

9

AB

C

S1

12

54

34

0

10

20

30

40

50

60

A

B

C

FigVII12 Marginal adaptation (proximal)-composite resins restorations (molars)

AB

C

S1

22

54

24

0

10

20

30

40

50

60

A

B

C

FigVII13 Surface quality-amalgam restorations (bicusps)

AB

C

S1

10

54

36

0

10

20

30

40

50

60

A

B

C

FigVII14 Surface quality-amalgam restorations (molars)

AB

C

S1

12

68

20

0

10

20

30

40

50

60

70

A

B

C

FigVII15 Surface quality-composite resins restorations (bicusps)

AB

C

S1

8

70

22

0

20

40

60

80

A

B

C

FigVII16 Surface quality-composite resins restorations (molars)

10

A

C

S1

98

20

20

40

60

80

100

A

C

FigVII17a-b Prevalence of marginal dental cariesamalgam restorations (moderate

CR)

A

C

S1

92

80

20

40

60

80

100

A

C

FigVII18 Prevalence of marginal dental cariesamalgam restorations (high CR)

A

C

S1

94

60

20

40

60

80

100

A

C

FigVII19 Prevalence of marginal dental cariescomposite resins restorations (CR

moderate)

A

C

S1

82

18

0

10

20

30

40

50

60

70

80

90

A

C

FigVII20 Prevalence of marginal dental cariescomposite resins restorations (high

CR)

11

The study data sustain the results obtained by most studies focused on

posterior amalgam restorations However Hickelampcol (2001) reviewed literature data

and proved that many results varies accordingly to different clinical factors (133)

Roulet JF(1997) warned about limits of cross-sectional studies related to composite

resins restorations because of the absence of data regarding restorative techniques

practitioner experience presence or absence of optimum isolation factors related by

patient (266)

VII5CONCLUSIONS

Amalgam proximo-occlusal restorations with minimum 6-years age present

excellent results for parameters anatomic form (occlusal) marginal

discoloration and marginal secondary dental caries good results for

parameters anatomic form (proximal) and marginal adaptation and poor results

for surface quality

Composite resins proximo-occlusal restorations (bicusps) with minimum 6-

years age present excellent results for parameters color match marginal

discoloration and marginal secondary dental caries and good results for

parameters anatomic form (occlusal proximal) marginal adaptation surface

quality

Composite resins proximo-occlusal restorations (molars) with minimum 6-

years age present good results for parameters color match marginal

discoloration marginal secondary dental caries marginal adaptation and poor

results for parameters anatomic form (occlusal) (54 indices Ryge C)

anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The restorations extended at external third of occlusal surface present highest

percents of indices C regarding anatomic form (occlusal) (54 indices Ryge

C) anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The exceeding of 6-years age will require careful monitorisation for early

interventions through polishing sealing reshaping and even replacement for

restorations with major defects

12

CHAPTVIII CLINICAL PERFORMANCE OF COMPOSITE RESINS

RESTORATIONS RELATED TO RESTORATIVE TECHNIQUE 12-

MONTHS LONGITUDINAL STUDY

VIII1 INTRODUCTION

The restorative technique has a major influence over clinical performance of

composite resins restorations in proximo-occlusal cavities In this context researches

focused on correlations between technique and clinical performance of direct

restorations improve the dentist decision regarding restorative technique choice

VIII2AIM OF STUDY

The aim of study was to determine the clinical performance of composite

resins proximo-occlusal restorations performed using different restorative techniques

VIII3MATERIALS AND METHOD

The group study included 37 patients with age 18-42 years with moderat

ecariogenic risk The total number of composite resins restorations (Herculite XRV

Kerr) was 60 divided in three study groups (n=20)

I Centripetal build-up

II Oblique layering

III Horisontal layering

The coronal restorations were assessed at an interval of 12 months using

indices Ryge modified USPHS

- indice ALFA (A)- IDEAL CLINIC

- indice BRAVO (B)- ACCEPTABLE CLINIC

- indice CHARLIE (C)- UNACCEPTABLE CLINIC

VIII4 RESULTS AND DISCUSSIONS

The statistical tests Kruskal-Wallis and Mann-Whitney were performed to

confirm or infirm research hypotesis (the direct restorations performed using different

restorative techniques present statistical significant differences regarding clinical

performance for the assessed parameters)

13

TableVIII1a-b Groups study (Kruskal-Wallis Test)

Ranks

20 2960

20 2560

20 3630

60

20 3050

20 2420

20 3680

60

20 2490

20 3140

20 3520

60

Restorative_techniques

Centripetal build-up

Oblique layering

Horizontal layering

Total

Centripetal build-up

Oblique layering

Horizontal layering

Total

Centripetal build-up

Oblique layering

Horizontal layering

Total

Marginal_adaptation

Marginal_discoloration

Anatomical_form

N Mean Rank

Test Statisticsab

4913 8031 4900

2 2 2

086 018 086

Chi-Square

df

Asymp Sig

Marginal_

adaptation

Marginal_

discoloration

Anatomical_

form

Kruskal Wallis Testa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between the three restorative

techniques for parameter marginal adaptation (p=0086)

There are no statistical significant differences between the three restorative

techniques for parameter marginal discoloration (p=0018)

There are no statistical significant differences between the three restorative

techniques for parameter anatomical form (proximal) (p=0086)

TableVIII2 Comparing results between restorations performed using three

techniques (marginal adaptation marginal discoloration anatomical form) Marginal adaptation Centripetal build-upOblique layering p=04 ns

Centripetal build-upHorizontal layering p=0191 ns

Oblique layering Horizontal layering p=0028 s

Marginal discoloration Centripetal build-upOblique layering p=0103 ns

Centripetal build-upHorizontal layering p=0195 ns

Oblique layering Horizontal layering p=0005 s

Anatomical form Centripetal build-upOblique layering p=0137 ns

Centripetal build-upHorizontal layering p=0029 s

Oblique layering Horizontal layering p=0433 ns

ns nesemnificativ

s semnificativ

p probabilitate

14

Tables VIII3a-b Mann-Whitney test Comparing analysis regarding marginal

discoloration between restorations performed using oblique layering technique and

centripetal build-up technique

Ranks

20 2180 43600

20 1920 38400

40

Restorative_techniques

Centripetal build-up

Oblique layering

Total

Marginal_adaptation

N Mean Rank Sum of Ranks

Test Statisticsb

174000

384000

-841

400

495a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

adaptation

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between centripetal build-up

and oblique layering techniques regarding parameter marginal adaptation (p=0400)

Tables VIII4a-b Mann-Whitney test Comparing analysis regarding marginal

adaptation between restorations performed using horisontal layering technique and

centripetal build-up technique

Ranks

20 1830 36600

20 2270 45400

40

Restorative_techniques

Centripetal build-up

Horizontal layering

Total

Marginal_adaptation

N Mean Rank Sum of Ranks

Test Statisticsb

156000

366000

-1307

191

242a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

adaptation

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between centripetal build-up

and horisontal layering techniques regarding parameter marginal adaptation

(p=0191)

15

TablesVIII5a-b Mann-Whitney test Comparing analysis regarding marginal

adaptation between restorations performed using oblique layering technique and

horisontal layering technique

Ranks

20 1690 33800

20 2410 48200

40

Restorative_techniques

Oblique layering

Horizontal layering

Total

Marginal_adaptation

N Mean Rank Sum of Ranks

Test Statisticsb

128000

338000

-2191

028

052a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

adaptation

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There is statistical significant differences between horisontal layering and

oblique layering techniques regarding parameter marginal adaptation (p=0028)

Tables VIII6a-b Mann-Whitney test Comparing analysis regarding marginal

discoloration between restorations performed using oblique layering technique and

centripetal build-up technique

There are no statistical significant differences between centripetal build-up

and oblique layering techniques regarding parameter marginal discoloration

(p=0103)

Ranks

20 2260 45200

20 1840 36800

40

Restorative_techniques

Centripetal build-up

Oblique layering

Total

Marginal_discoloration

N Mean Rank Sum of Ranks

Test Statisticsb

158000

368000

-1632

103

265a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

discoloration

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

16

Tables VIII7a-b Mann-Whitney test Comparing analysis regarding marginal

discoloration between restorations performed using centripetal build-up technique and

horisontal layering technique

Ranks

20 1840 36800

20 2260 45200

40

Restorative_techniques

Centripetal build-up

Horizontal layering

Total

Marginal_discoloration

N Mean Rank Sum of Ranks

Test Statisticsb

158000

368000

-1299

194

265a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

discoloration

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between centripetal build-up

and horisontal layering techniques regarding parameter marginal discoloration

(p=0103)

Tables VIII8a-b Mann-Whitney test Comparing analysis regarding marginal

discoloration between restorations performed using oblique layering technique and

horisontal layering technique

Ranks

20 1630 32600

20 2470 49400

40

Restorative_techniques

Oblique layering

Horizontal layering

Total

Marginal_discoloration

N Mean Rank Sum of Ranks

Test Statisticsb

116000

326000

-2822

005

023a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

discoloration

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There is statistical significant differences between horisontal layering and

oblique layering techniques regarding parameter marginal discoloration (p=0005)

17

TablesVIII9 a-b Mann-Whitney test Comparing analysis regarding anatomical

form between restorations performed using centripetal build-up technique and oblique

layering technique

Ranks

20 1830 36600

20 2270 45400

40

Restorative_techniques

Centripetal build-up

Oblique layering

Total

Anatomical_form

N Mean Rank Sum of Ranks

Test Statisticsb

156000

366000

-1486

137

242a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Anatomical_

form

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between centripetal build-up

and oblique layering techniques regarding parameter anatomical form (p=0137)

Tables VIII10a-b Mann-Whitney test Comparing analysis regarding anatomical

form between restorations performed using centripetal build-up technique and

horisontal layering technique

Ranks

20 1710 34200

20 2390 47800

40

Restorative_techniques

Centripetal build-up

Horizontal layering

Total

Anatomical_form

N Mean Rank Sum of Ranks

Test Statisticsb

132000

342000

-2184

029

068a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Anatomical_

form

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between centripetal build-up

and horisontal layering techniques regarding parameter anatomical form (p=0029)

18

Tables VIII11a-b Mann-Whitney test Comparing analysis regarding anatomical

form between restorations performed using oblique layering technique and horisontal

layering technique

Ranks

20 1920 38400

20 2180 43600

40

Restorative_techniques

Oblique layering

Horizontal layering

Total

Anatomical_form

N Mean Rank Sum of Ranks

Test Statisticsb

174000

384000

-784

433

495a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Anatomical_

form

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between horisontal layering and

oblique layering techniques regarding parameter anatomical form (p=0433)

Indices A for restorations performed using centripetal build-up technique were

as follows color match-80 marginal adaptation- 60 marginal discoloration-

70 anatomical form (proximal)- 80 surface quality- 60

Indices A for restorations performed using horisontal layering technique were

as follows color match-70 marginal adaptation- 40 marginal discoloration-

50 anatomical form (proximal)- 50 surface quality- 70

Indices A for restorations performed using oblique layering technique were as

follows color match-70 marginal adaptation- 80 marginal discoloration- 90

anatomical form (proximal)- 60 surface quality- 70

Indices B for restorations performed using centripetal build-up technique were

as follows color match-20 marginal adaptation- 30 marginal discoloration-

20 anatomical form (proximal)- 30 surface quality- 40

Indices B for restorations performed using horisontal layering technique were

as follows color match-30 marginal adaptation- 40 marginal discoloration-

30 anatomical form (proximal)- 30 surface quality- 30

Indices B for restorations performed using oblique layering technique were as

follows color match-30 marginal adaptation- 20 marginal discoloration- 10

anatomical form (proximal)- 40 surface quality- 30

19

Indices C for restorations performed using centripetal build-up technique were

as follows color match-0 marginal adaptation- 10 marginal discoloration- 0

anatomical form (proximal)- 0 surface quality- 0

Indices C for restorations performed using horisontal layering technique were

as follows color match-0 marginal adaptation- 20 marginal discoloration- 20

anatomical form (proximal)- 20 surface quality- 0

Indices C for restorations performed using oblique layering technique were as

follows color match-0 marginal adaptation- 0 marginal discoloration- 10

anatomical form (proximal)- 0 surface quality- 100

Discussions

For in vitro studies is difficult to reproduce the variables existent in oral cavity

like occlusal stress and pH and temperature changes (235) The clinical studies are

determinant in assessment of restorative techniques (300) The most researches

focuses on the influence of restorative technique on the reduction of lightcuring stress

(51 78 135)

VIII5 CONCLUSIONS

Oblique layering technique presents superior results regarding marginal

adaptation and marginal discoloration and is recommended for proximo-

occlusal dental caries close to enamel-cement jonction

Centripetal build-up presents good results regarding marginal adaptation and

anatomical form at proximal level (proximal surfaces and contact point)

Horisontal layering technique can be used for optimum results only in

proximal-occlusal cavities with moderate extension both in occlusal-cervical

and buccal-oral

20

CHAPTIX STUDY REGARDING MARGINAL SEALING STATUS IN

COMPOSITE RESINS LIMITED PROXIMO-OCCLUSAL RESTORATIONS

PERFORMED USING DIFFERENT TECHNIQUES

IX1INTRODUCTION

The contraction of composite resins can produce stress inside dental structure

The most contraction stress appears in the initial stages and development rate of stress

decreases gradually in time (5 98 160) The contraction stress of composite resins

can overpass adhesion strenght and can broke the link between dental tissues and

composite resin (73) When adhesion strenght is high stress can produce marginal

fracture or bulk fracture (74) These situations are associated with microleakage and

penetration of oral fluid and bacteria along dentinal walls endangering the pulpal

tissue or favourising secondary dental caries

IX2 AIM OF STUDY

The study aimed to assess the efficiency of marginal sealing along gingival

wall in limited proximal-occlusal restorations performed using three different

techniques

IX3MATERIALS AND METHOD

The study group included 30 teeth extracted for orthodontic and periodontal

reasons On every tooth two identical class II cavities (on mesial and distal surfaces)

were prepared with cylindrical burs under water cooling The gingival wall was

limited to enamel-cement jonction The cavity dimension were as follows 2 mm

buccal-oral 5mm depth Each tooth was introduced in a pattern of acrylat The

operator calibrated preparation technique on acrylat teeth in Simulation Laboratory of

UMF ―Gr T Popa Iaşi The 60 prepared cavities were randomly divided in three

study groups related to restorative technique The restoration were performed with

Filtek Z550 (3M ESPE) a nanohybrid composite resin The adhesive strategy

included etchamprinse in 2 steps and adhesive Adper Single Bond 2(3MESPE)

Group A (n=20) bulk restorative technique associated with lightcuring from

occlusal 40 seconds and from buccal and oral 20 seconds

Group B (n=20) oblique layering technique (first layer on buccal wall and

buccal frac12 of gingival wall was lightcured from buccal second layer on oral wall and

oral frac12 of gingival wall was lightcured from oral third oral as a triangle with point

oriented to gingival wall was lightcured from occlusal)

Group C (n=20) combined technique (bdquoflow layer on gingival and axial

walls lightcured under pressure only associated with solid composite resin layer)

The proximal surfaces were performed using Tofflemire and metallic matrices After

removal of matrices every restoration was lightcured for another 20 seconds Two

layers aof varnish were applied on composite resins restorations excepting cavity

margins and an area of 1 mm around them The samples were introduced in methylen

21

blue 10 for 48 hours After this stage samples were washed with water and teeth

were cut longitudinally with a diamonded disc

The die penetration was assessed with Zeiss (Iena Germany) X20 microscope

accordingly to four scores (0-3)

0 ndash no penetration

1 ndash die infiltration until external half of gingival wall

2 ndash die infiltration on all gingival wall

3 ndash die infiltration on gingival wall and axial wall

IX4RESULTS AND DISCUSSIONS

The result of die penetration are presented in table IX1

TableIX1 The results for die penetration

Grup 0 1 2 3

A (bulk) 0 0 3 17

B (layering) 0 4 5 11

C (combined) 12 5 2 1

In group A 17 sample had score 3 and 2 samples had score 2 In group B 11

sample had score 3 5 samples had score 2 and 4 sample had score 1 In group C with

best results 12 samples had score 0 5 samples had score 1 2 samples had score 2 1

sample had score 3

The recorded data were analysed using test Mann-Whitney The statistical

results are presented in tables IX2-IX4

Tables IX2a-b Mann-Whitney for comparisons of microleakage values between

bulk technique and incremental technique

Ranks

Restorative technique N Mean Rank Sum of Ranks

Scores

frequency

A ndash bulk technique 20 2420 24200

B ndash incremental

technique

20 1680 16800

Total 40

Test Statisticsb

scores

frequency

Mann-Whitney U 29000

Wilcoxon W 168000

Z -1970

Asymp Sig (2-tailed) 049

Exact Sig [2(1-tailed Sig)] 123a

a Not corrected for ties

b Grouping Variable restorative technique

22

Tables IX3a-b Mann-Whitney for comparisons of microleakage values between

bulk technique and mixed technique

Ranks

Restorative technique N Mean Rank Sum of Ranks

scores

frequency

A ndash bulk technique 20 3090 30900

C ndash mixed technique 20 1010 10100

Total 40

Test Statisticsb

scores

frequency

Mann-Whitney U 500

Wilcoxon W 101000

Z -4021

Asymp Sig (2-tailed) 000

Exact Sig [2(1-tailed Sig)] 000a

a Not corrected for ties

b Grouping Variable restorative technique

Tables IX4a-b Mann-Whitney test for comparisons of microleakage values

between incremental technique and mixed technique

Ranks

Restorative technique N Mean Rank Sum of Ranks

scores

frequency

B ndash incremental

technique

20 2990 29900

C ndash mixed technique 20 1210 12100

Total 40

Test Statisticsb

scores

frequency

Mann-Whitney U 5500

Wilcoxon W 121000

Z -3492

Asymp Sig (2-tailed) 000

Exact Sig [2(1-tailed Sig)] 000a

a Not corrected for ties

23

Test Statisticsb

scores

frequency

Mann-Whitney U 5500

Wilcoxon W 121000

Z -3492

Asymp Sig (2-tailed) 000

Exact Sig [2(1-tailed Sig)] 000a

a Not corrected for ties

b Grouping Variable tehnrestaurare

The results of microleakage degree were statistically significant when the

three restorative techniques were compared The results showed that best restorative

technique regarding marginal sealing in cervical area is combined technique followed

by oblique layering technique The use of layering techniques limits the development

of contraction forces between oposite walls event that favourises bulk stress voids

formation and fissure inside dental tissues The results of our study are similar with

other studies (114 293)

IX5 CONCLUSIONS

The values of die penetration at gingival wall were statistically different

between the three restorative techniques

We concluded that all restorative methods were associated with lightcuring

contraction and marginal microleakage

The combined technique was associated with lowest lightcuring contraction

and die penetration

The bulk technique was associated with highest lightcuring contraction and die

penetration

24

CHAPTX STUDY REGARDING THE EFFECTS OF ETCHING ON

ENAMEL AND DENTINE IN CERVICAL AREA FOR PROXIMAL

CAVITIES AT LATERAL DENTAL GROUP

X1 INTRODUCTION

The studies reported marginal defects and high microleakage at the level of

gingival margins localised in cervical area or close to enamel-cement jonction for

high percents of proximal-occlusal composite resins restorations (8485) The good

adhesion is requested to insure restoration longevity and to prevent marginal

microleakage and presence of secondary marginal dental caries The adhesion

strenght of different adhesive systems can vary accordingly to tissues areas (204 240)

and to variations in dentinal structures (234 330) Most studies focused on adhesive

systems performances used healthy dentine close to pulp room but in case of class II

restorations there are particular features that influences the adhesion at the level of

gingival margins

The surface topography is an important property that determines the

interaction manner between surfaces The surface roughness and surface energy can

increase or decrease the adhesion of composite resins to the hard dental tissues

X2 AIM OF STUDY

The aim of study was to compare surface roughness of enamel and dentine

after etching related to different distances related to enamel-dentinecement jonction

X3 MATERIALS AND METHODS

The study group included 20 molars extracted from orthodontics or

periodontal reasons with intact proximal surfaces The teeth were cut longitudinally in

sens buccal-oral with diamond discs under water cooling

A group study (10 teeth) included 10 samples obtained through transversal

cutting at distance of 2mm from enamel-dentinecement jonction and 10 samples

obtained through transversal cutting at distance of 15 mm from enamel-

dentinecement jonction Another study group (10 teeth) included 10 samples

obtained through transversal cutting at distance of 1mm from enamel-dentinecement

jonction and 10 samples obtained through transversal cutting at distance of 05 mm

from enamel-dentinecement jonction All these samples were divided in two halfes

through mesial-distal cutting The samples finishing was performed with abrasive

paper (100-4000) and final polishing was performed with a device Buehler model

Minimet with slices introduced in ultrasound bath for 4 minutes The second half of

each sample was etched for 15 seconds with ortophosphoric acid 37 for 15 seconds

Slices were washed with distilled water for 30 seconds after etching and dried

The samples were analysed with atomic force microscopy (AFM) regarding

surface roughness The results were expressed as relative variation of roughness

X4 RESULTS AND DISCUSSIONS

The aspect of etched enamel at 2 mm distance from ECJ can be seen in figure

X1 (section 10 microm) The surface roughness is higher comparing with sample before

etching

25

După gravajul cu acid ortofosforic 37

The aspect of etched enamel at 15 mm distance from ECJ can be seen in

figure X2 (section 10 microm) The surface roughness is higher comparing with sample

before etching but lower comparing with sample at 2 mm from ECJ

The aspect of etched enamel at 1 mm distance from ECJ can be seen in figure

X3 (section 10 microm) The surface roughness is higher comparing with sample before

etching but lower comparing with sample at 15mm and 2 mm from ECJ

The aspect of etched enamel at 15 mm distance from ECJ can be seen in

figure X4 (section 10 microm) The surface roughness is higher comparing with sample

before etching but lower comparing with sample at 1 mm 15 mm and 2 mm from

ECJ

FigX1 3D aspect of enamel at 2 mm from ECJ

after etching (10 microm)

FigX2 3D aspect of enamel at 15 mm from ECJ

after etching (10 microm)

FigX3 3D aspect of enamel at 1 mm from ECJ

after etching (10 microm)

FigX4 3D aspect of enamel at 05 mm from ECJ

after etching (10 microm)

26

The mean values of squared roughness for dentine and enamel before etching

are presented in tables X1 and X2

Table X1 Squared roughness values for dentine samples before and after etching

Before etching (nm) After etching (nm)

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

sample

1

335 282 283 259 1149 947 901 879

sample

2

352 284 274 266 1127 939 883 875

sample

3

357 273 278 263 1152 953 876 867

sample

4

323 269 264 258 1146 942 895 883

sample

5

348 298 271 268 1153 944 904 878

sample

6

339 274 278 273 1158 937 893 892

sample

7

352 283 269 266 1145 944 899 876

sample

8

349 292 272 274 1166 942 907 869

sample

9

357 284 275 265 1132 939 893 879

sample

10

348 281 277 262 1142 941 899 878

Table X2 Squared roughness values for enamel and dentine samples before and after

etching

Before etching (nm) After etching (nm)

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

sample 1 422 342 309 313 2255 1114 874 845

sample 2 418 338 324 304 2236 1102 882 839

sample 3 413 334 315 303 2239 1115 873 833

sample 4 416 336 322 308 2242 1116 868 842

sample 5 426 332 315 294 2218 1103 877 829

sample 6 412 332 317 306 2237 1099 874 847

sample 7 414 335 322 314 2252 1102 876 834

sample 8 416 325 318 313 2239 1106 875 838

sample 9 418 328 314 299 2246 1113 879 836

sample 10 413 334 316 305 2242 1104 873 839

The results for samples before etching prove a decreasing tendency for mean

values of squared roughness surface beginning with areas placed at distance of 2 mm

from ECJ (346 nm) followed by areas placed at distance of 15 mm from ECJ (282

nm) 1 mm from ECJ (274 nm) and 05 mm from ECJ (265 nm) After etching the

decreasing tendency maintained for dentine localised at 2 mm from ECJ to dentine

localised at 05 mm from ECJ The mean values of squared roughness after etching

were three times higher (tables X3)

27

Table X3 Squared roughness values for enamel and dentine samples before and

after etching

Dentine Enamel

Before etching

(nm)

After etching

(nm)

Before etching

(nm)

After etching

(nm)

2 mm ECJ 346 1147 416 2237

15 mm ECJ 282 942 333 1107

1 mm ECJ 274 895 317 875

05 mm ECJ 265 877 305 838

The descriptive statistics data for surface roughness of dentine before and after

etching are presented in tables X4 si X5

Table X4 Descriptive statistics for dentine samples before etching

Statistics

Dentine 2mm

before etching

Dentine 15mm

before etching

Dentine 1mm

before etching

Dentine 05mm

before etching

N Valid 10 10 10 10

Missing 0 0 0 0

Mean 346000 282000 274100 265400

Std Error of Mean 33830 27487 17026 16746

Std Deviation 106979 86923 53841 52957

Skewness -1214 354 -314 348

Std Error of Skewness 687 687 687 687

Kurtosis 1141 049 336 -539

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 3230 2690 2640 2580

Maximum 3570 2980 2830 2740

Table X5 Descriptive statistics for dentine samples after etching

Statistics

Dentine 2mm

after etching

Dentine 15mm

after etching

Dentine 1mm

after etching

Dentine 05mm

after etching

N Valid 10 10 10 10

Missing 0 0 0 0

1147000 942800 895000 877600

Std Error of Mean 36545 14591 29926 22020

Std Deviation 115566 46140 94634 69634

Skewness -267 1169 -951 535

Std Error of Skewness 687 687 687 687

Kurtosis 043 1776 564 1416

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 11270 9370 8760 8670

28

Statistics

Dentine 2mm

after etching

Dentine 15mm

after etching

Dentine 1mm

after etching

Dentine 05mm

after etching

N Valid 10 10 10 10

Missing 0 0 0 0

1147000 942800 895000 877600

Std Error of Mean 36545 14591 29926 22020

Std Deviation 115566 46140 94634 69634

Skewness -267 1169 -951 535

Std Error of Skewness 687 687 687 687

Kurtosis 043 1776 564 1416

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 11270 9370 8760 8670

Maximum 11660 9530 9070 8920

To choose the statistical test to compare roughness surface values was

performed a test Shapiro-Wilk If p is lower or equal with 0005 than hypothesis of

distribution normality is rejected (distribution deviates from normal form) In the table

X6 the distributions are normal The statistical test will be test t for pair samples

Table X6 Test Shapiro-Wilk for dentine samples

Tests of Normality

Kolmogorov-Smirnov

a Shapiro-Wilk

Statistic df Sig Statistic df Sig

Dentine 2mm before etching 274 10 032 877 10 122

Dentine 15mm after etching 209 10 200 952 10 689

Dentine 1mm before etching 134 10 200 983 10 980

Dentine 05mm before etching 155 10 200 949 10 661

Dentine 2mm after etching 133 10 200 977 10 946

Dentine 15mm after etching 197 10 200 916 10 329

Dentine 1mm after etching 216 10 200 925 10 401

Dentine 05 after etching 220 10 185 933 10 474

Enamel 2mm before etching 193 10 200 898 10 207

Enamel 15mm before etching 170 10 200 977 10 947

Enamel 1mm before etching 157 10 200 952 10 689

Enamel 05mm before etching 165 10 200 943 10 590

Enamel 2mm after etching 235 10 124 925 10 404

Enamel 15mm after etching 209 10 200 871 10 102

Enamel 1mm after etching 189 10 200 964 10 834

Enamel 05mm after etching 142 10 200 983 10 978

a Lilliefors Significance Correction

29

Tests of Normality

Kolmogorov-Smirnov

a Shapiro-Wilk

Statistic df Sig Statistic df Sig

Dentine 2mm before etching 274 10 032 877 10 122

Dentine 15mm after etching 209 10 200 952 10 689

Dentine 1mm before etching 134 10 200 983 10 980

Dentine 05mm before etching 155 10 200 949 10 661

Dentine 2mm after etching 133 10 200 977 10 946

Dentine 15mm after etching 197 10 200 916 10 329

Dentine 1mm after etching 216 10 200 925 10 401

Dentine 05 after etching 220 10 185 933 10 474

Enamel 2mm before etching 193 10 200 898 10 207

Enamel 15mm before etching 170 10 200 977 10 947

Enamel 1mm before etching 157 10 200 952 10 689

Enamel 05mm before etching 165 10 200 943 10 590

Enamel 2mm after etching 235 10 124 925 10 404

Enamel 15mm after etching 209 10 200 871 10 102

Enamel 1mm after etching 189 10 200 964 10 834

Enamel 05mm after etching 142 10 200 983 10 978

a Lilliefors Significance Correction

This is a lower bound of the true significance

The results of test t for pair dentine samples before and after etching are

presented in table X

Table X7 Test t for dentine before and after etching

Paired Samples Test

Paired Differences

t df

p (2-

tailed)

95 Confidence

Interval of the

Difference

Mean

Std

Dev

Std

Error

Mean Lower Upper

Pair

1

dentine2mmbeforeetching-

dentine2mmafteretching

-

8010000

174801 55277 -

8135045

-

7884955

-

144906

9 000

Pair

2

dentine15mmbeforeetching-

dentine15mmafteretching

-

6608000

102394 32380 -

6681248

-

6534752

-

204079

9 000

Pair

3

dentine1mmbeforeetching-

dentine1mmafteretching

-

6209000

117799 37251 -

6293269

-

6124731

-

166678

9 000

30

Paired Samples Test

Paired Differences

t df

p (2-

tailed)

95 Confidence

Interval of the

Difference

Mean

Std

Dev

Std

Error

Mean Lower Upper

Pair

1

dentine2mmbeforeetching-

dentine2mmafteretching

-

8010000

174801 55277 -

8135045

-

7884955

-

144906

9 000

Pair

2

dentine15mmbeforeetching-

dentine15mmafteretching

-

6608000

102394 32380 -

6681248

-

6534752

-

204079

9 000

Pair

3

dentine1mmbeforeetching-

dentine1mmafteretching

-

6209000

117799 37251 -

6293269

-

6124731

-

166678

9 000

Pair

4

dentine05mmbeforeetching-

dentine05mmafteretching

-

6122000

86384 27317 -

6183796

-

6060204

-

224109

9 000

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of dentine (

2mm 15 mm 1mm sau 05mm)

The descriptive statistics data for dentine surface roughness before and after

etching are presented in tables X8 and X9

Table X8 Descriptive statistics for enamel samples before etching

Statistics

Enamel 2mm

before etching

Enamel 15mm

before etching

Enamel 1mm

before etching

Enamel 05mm

before etching

N Valid 10 10 10 10

Missing 0 0 0 0

Mean 416800 333600 317200 305900

Std Error of Mean 13968 15217 14205 20355

Std Deviation 44171 48120 44920 64369

Skewness 1095 -156 -109 -411

Std Error of Skewness 687 687 687 687

Kurtosis 769 487 -118 -295

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 4120 3250 3090 2940

Maximum 4260 3420 3240 3140

31

Table X9 Descriptive statistics for enamel samples after etching

Statistics

Enamel 2mm

after etching

Enamel 15mm

after etching

Enamel 1mm

after etching

Enamel 05mm

after etching

N Valid 10 10 10 10

Missing 0 0 0 0

Mean 2237600 1107400 875100 838200

Std Error of Mean 31027 20232 11968 17436

Std Deviation 98116 63979 37845 55136

Skewness -850 267 042 040

Std Error of Skewness 687 687 687 687

Kurtosis 878 -1880 1082 -425

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 22180 10990 8680 8290

Maximum 22520 11160 8820 8470

To choose the statistical test to compare roughness surface values was

performed a test Shapiro-Wilk If p is lower or equal with 0005 than hypothesis of

distribution normality is rejected (distribution deviates from normal form) In the table

X10 the distributions are normal The statistical test will be test t for pair samples

Table X10 Test Shapiro-Wilk for enamel samples

Tests of Normality

Kolmogorov-Smirnova Shapiro-Wilk

Statistic df Sig Statistic df Sig

2mmenamel before etching 193 10 200 898 10 207

15mmenamel before etching 170 10 200 977 10 947

1mmenamel before etching 157 10 200 952 10 689

05mmenamel before etching 165 10 200 943 10 590

2mmenamel after etching 235 10 124 925 10 404

15mmenamel after etching 209 10 200 871 10 102

1mmenamel after etching 189 10 200 964 10 834

05mmenamel after etching 142 10 200 983 10 978

a Lilliefors Significance Correction

This is a lower bound of the true significance

The results of test t for pair enamel samples before and after etching are

presented in table X11

32

Table X11 Test t for enamel samples before and after etching

Paired Samples Test

Paired Differences

t df

p (2-

tailed)

95 Confidence

Interval of the

Difference

Mean

Std

Deviation

Std

Error

Mean Lower Upper

Pair

1

2mmenamel before

etching

2mmenamel after

etching

-18208 135220 42760 -

18304731

-

18111269

-

425815

9 000

Pair

2

15mmenamel before

etching

15mmenamel after

etching

-7738 73151 23132 -7790329 -7685671 -

334508

9 076

Pair

3

1mmenamel before

etching

1mmenamel after

etching

-5579 55468 17540 -5618679 -5539321 -

318065

9 065

Pair

4

05mmenamel before

etching

05mmenamel after

etching

-5323 60378 19093 -5366192 -5279808 -

278788

9 063

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel ( 2mm 15 mm 1mm sau

05mm) but the differences statistical significant are present only for enamel localised

at 2 mm from ECJ

X5CONCLUSIONS

The surfaces of enamel and dentine at cervical level record decreases of

roughness related to the decrease of distance to ECJ

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel but the differences

statistical significant are present only for enamel localised at 2 mm from ECJ

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of

dentine

33

CHAPTXI FEA STUDY REGARDING THE BIOMECHANICAL

BEHAVIOUR AND FRACTURE RESISTANCE OF PROXIMO-OCCLUSAL

AMALGAM AND COMPOSITE RESINS RESTORATIONS

XI1INTRODUCTION AIM OF STUDY

The individual variation of patients morphological and functional complexity

of tissues as well as difficult access limit the possibilities to investigate in clinical

studies the biomechanical behaviour of proximo-occlusal restorations In this context

simulation of the biomechanics for direct restorations represents an interesting

interdisciplinar domain in actual dentistry research

The study focused on two direction

- analysis of role of forces intensity on biomechanical behaviour related to

cavity dimension and material

- analysis of tension inside restoration structure related to forces intensity

XI2MATERIALS AND METHODS

The stages of finite element analysis study are as follows

object modelling (bicusps and proximo-occlusal restoration)

definition of parameters for materials and dental tissues

meshing

constraints and loading

types of contacts

equations system definition

results of simulation

The object 3D modelling was performed in Rhinoceros (figure XI1) The

definition of parameters was performed for Poisson constant Young modulus density

(table XI1) The selected materials were amalgam and composite resins The

analysed tissues were dentine and enamel The meshing constraints loading were

performed for forces of 200N 400N 600N 800 N The analysis was performed using

software COSMOSWorks 2010

34

Fig XI1 3D modellation of bicusp

Table XI1 Values of Young modulus Poisson constant compression resistance for

amalgam composite resin enamel (amalgam compozit smalţ)

Material Young modulus (GPa) Poisson constants

Compression

resistance

(Mpa)

Amalgam 55 033 483

Enamel 48 03 400

Composite

resin 220 022 345

Fig XI2 The forces and constraints application

The results are presented in values and culours red colours representing areas

with maximum values of tensions produced under influence of masticatory forces

The tensions produced in amalgam restoration are in a range from 0 to 22886

(force 800 N) The maximum von Misses tensions are associated with cervical area

of amalgam restorations This aspect proves that first modification in interface

restoration-cavity margins will appear at the level of gingival wall First marginal

35

defects and fissures in restoration bulk will appear at tensions over 1600Mpa

associated with forces of 800N for extended amalgam proximo-occlusal restorations

The tensions produced in composite resin restorations are in a range from 0 to

2285 (force 800 N) The maximum von Misses tensions are associated with cervical

area of composite resin restorationsThis aspect proves that first modification in

interface restoration-cavity margins will appear at the level of gingival wall First

marginal defects and fissures in restoration bulk will appear at tensions over 1716

Mpa associated with forces of 600N for moderate and extended composite resins

proximo-occlusal restorations

Fig XI3a-b ndash Simulated model of proximo-occlusal restoration

FigXI4a-b Dental amalgam restoration Cervical tension associated with 600 N

(c)800 N (d)

FigXI5a-b Composite resin restoration Cervical tension associated with 600 N

(c)800 N (d)

36

The deformation of amalgam can be produced only when is associated with

fissures in bulk of restorations while composite resins restorations present

deformation when are associated with a modification of volume and form because of

repeated action of medium forces on long term or high forces on short term (figures

XI4 XI5)

Fig XI4 Material deformation in area of maximum tension

000E + 00

500E -02

100E -01

150E -01

200E -01

250E -01

1 4 7 101316192225283134374043464952555861646770737679

Amalgam C ompoz it

Figura XI5 Deformarea funcție de material

The amalgam and composite resins were treated as homogenous isotropic and

liniar The advantage of this type of FEA study is that restorations parameters can be

modified any time is necessary both in arhitecture geometry and material indices

variability The results of this study sustain the conclusions of other FEA studies

focused on biomechanical behaviour of posterior restorations performed with

amalgam and composite resins(35 62 76 143)

37

XI4CONCLUSIONS

bull The amalgam in class II restorations has a low deformation tendency because

of uniform distribution of tension inside material

bull Composite resins class II restorations accumulate higher tensions comparing

with amalgam but deformation is avoided for a time because of the adhesion

forces performed between molecules under moderate oral forces In case of

high oral forces (600-800N) the risk of fracture in moderate class II

restorations is higher comparing with amalgam proximo-occlusal restorations

For extended class II restorations and forces of 600 N composite resins present

highest risk of fracture and deformation The von Misses tension at the

cervical interface restorationtooth can reach 1600Mpa

bull The amalgam in moderate class II restorations can resist to deformation even

for high intensity forces limited to 600N In extended class II restorations the

risk of deformation and fracture increases at values of 600N-800N of oral

forces The von Misses tension at the cervical interface restorationtooth can

reach 1700 Mpa

38

FINAL CONCLUSIONS

Amalgam proximo-occlusal restorations with minimum 6-years age present

excellent results for parameters anatomic form (occlusal) marginal

discoloration and marginal secondary dental caries good results for

parameters anatomic form (proximal) and marginal adaptation and poor results

for surface quality

Composite resins proximo-occlusal restorations (bicusps) with minimum 6-

years age present excellent results for parameters color match marginal

discoloration and marginal secondary dental caries and good results for

parameters anatomic form (occlusal proximal) marginal adaptation surface

quality

Composite resins proximo-occlusal restorations (molars) with minimum 6-

years age present good results for parameters color match marginal

discoloration marginal secondary dental caries marginal adaptation and poor

results for parameters anatomic form (occlusal) (54 indices Ryge C)

anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The restorations extended at external third of occlusal surface present highest

percents of indices C regarding anatomic form (occlusal) (54 indices Ryge

C) anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The exceeding of 6-years age will require careful monitorisation for early

interventions through polishing sealing reshaping and even replacement for

restorations with major defects

Oblique layering technique presents superior results regarding marginal

adaptation and marginal discoloration and is recommended for proximo-

occlusal dental caries close to enamel-cement jonction

Centripetal build-up presents good results regarding marginal adaptation and

anatomical form at proximal level (proximal surfaces and contact point)

Horisontal layering technique can be used for optimum results only in

proximal-occlusal cavities with moderate extension both in occlusal-cervical

and buccal-oral

The values of die penetration at gingival wall were statistically different

between the three restorative techniques

We concluded that all restorative methods were associated with lightcuring

contraction and marginal microleakage

The combined technique was associated with lowest lightcuring contraction

and die penetration

The bulk technique was associated with highest lightcuring contraction and die

penetration

39

The surfaces of enamel and dentine at cervical level record decreases of

roughness related to the decrease of distance to ECJ

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel but the differences

statistical significant are present only for enamel localised at 2 mm from ECJ

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of

dentine

bull The amalgam in class II restorations has a low deformation tendency because

of uniform distribution of tension inside material

bull Composite resins class II restorations accumulate higher tensions comparing

with amalgam but deformation is avoided for a time because of the adhesion

forces performed between molecules under moderate oral forces In case of

high oral forces (600-800N) the risk of fracture in moderate class II

restorations is higher comparing with amalgam proximo-occlusal restorations

For extended class II restorations and forces of 600 N composite resins present

highest risk of fracture and deformation The von Misses tension at the

cervical interface restorationtooth can reach 1600Mpa

bull The amalgam in moderate class II restorations can resist to deformation even

for high intensity forces limited to 600N In extended class II restorations the

risk of deformation and fracture increases at values of 600N-800N of oral

forces The von Misses tension at the cervical interface restorationtooth can

reach 1700 Mpa

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59Chen HY Manhart J Hickel R Kunzelmann KH Polymerization contraction

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Behinderten Dtsch Zahnartzlicher 1999 54 96-102

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Three Core Restorative Materials Supported with or without a Prefabricated Split-

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64Collins CJ Bryant RW Hodge KL A clinical evaluation of posterior composite

resin restorations 8-year findings J Dent 199826(4) 311ndash317

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71Dauvillier BS Aarnts MP Feilzer AJ Modeling of the viscoelastic behavior of

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bond strength and the polymerization contraction stress J Dent Res 1984

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shrinkage stress in polymer-based restoratives J Dent Res 199725435ndash440

74Davidson CL Resisting the curing contraction with adhesive composites J

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80De Munck J Van Meerbeek B Satoshi I Vargas M Yoshida Y Armstrong S

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82Deutsch WM Simecek JW Dental emergencies among Marines ashore in

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85Dietschi D Herzfeld D In vitro evaluation of marginal and internal adaptation of

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88Diefenderfer KE Rienhardt JW Shear bond strengths of ten adhesive

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89Donly KJ Jensen ME Triolo PA clinical comparison of resin composite inlay

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99Feilzer AJ De Gee AJ Davidson CL Setting stress in composite resin in relation

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108Francci C Loguercio AD Reis A Carrilho MR A novel filling technique for

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109Fruits TJ Knapp JA Khajotia SS Microleakage in the proximal walls of

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Effects of irradiation mode and filling technique on resindentin bond strength in

Class I cavities J Dent Res 200281 (Abstract)

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restorative decisions made on the basis of simulated bitewing radiographs

Community Dentistry and Oral Epidemiology 1994 22(2) 71-74

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1243

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Biology199843(8)629-632

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dental resin composites Dent Mater 2005 211150-1157

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marginal leakage around class II composite resin restorations in vitroQuint Int

201989117ndash121

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M Dentin shear strength effect of distance from the pulp Dent Mater 2002

18(7)516-20

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Materials Journal 2006 25(1)59-65

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Dent 27(5)325-331 1999

49

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Jan11(1)34-40

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JProsthet Dent 199369(4)425-430

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thermal behavior of dental composites Dent Mater 2008 24(8)1017ndash1024

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JDent 199826 627-632

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shrinkage and elasticity of flowable composites and filled adhesives Dent Mater

1999 15128-137

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Pendefunda 180Sorina Solomon Topoliceanu C Elements of dispersional

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Edition of the Balkan Medical Days

Stomatological Section Abstract nr1091999128

181Lăcătuşu St Andrian S Gianina Iovan- Consideraţii asupra adaptării

amalgamelor dentare la pereţii cavităţilor RevMedicina

StomatologicăVol2199823-26

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200126302ndash307

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restorative decisions microscopic and radiographic caries depth Community

Dentistry and Oral Epidemiology 1996 24 106-11

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Dent Mater 2002 18436-444

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constraint and filling technique in composite restorations Dent Mater 2004

20(3)236-43

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Polymerization shrinkage effects of boundary conditions and filling technique of

resin composite restorations J Dent 2004 32(6)459-70

50

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Quintessence Int 2004 35(2)156-61

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copolymerizations Macromolecules 1999 323913-3921

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clinical results J Dent Res 199877 1020

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two amalgams Quintessence Int 199829483ndash490

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Dentomaxillofac Radiol 2007 Oct36(7)377-81

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direct and indirect restorations icircn posterior teeth of the permanent

dentitionOperDent200429(5)481-508

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J Prosthet Dent 2000 Sep84(3)289-96

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Three-year clinical evaluation of composite and ceramic inlays Am J Dent 2001

Apr14(2)95-9

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hardness and depth of cure of light cured packable composite resins J Dent Res 2000

79369 (Abstract)

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caries-affected transparent dentin by citric acidAn atomic force microscopy

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deformation Dent Mater 200117241ndash246

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practitioners and dental caries JDent1990 18(3) 130-136

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(Cerana) Br Dent J 2006 Oct 21201(8)515-20

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PrimDentCare1999Apr659-62

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Quintessence 198961-80

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ScandJDRes 199210060-65

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33

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19904011ndash7

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Am Dent Assoc 2010 141(3)319-29

52

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125749-751

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34

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Monogr Oral Sci 20092142-51

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Quintessence Int 1998295ndash11

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569ndash575

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451

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458

346Yoshiyama M Tay FR Doi J Nishitani Y Yamada T Itou K Carvalho RM

Nakajima M Pashley DH Bonding of self-etch and total etch adhesives to carious

dentin J Dent Res 2002 81 556-560

  • COPERTA REZUMAT ENGLEZA (MEREUTA)pdf
  • REZUMAT ENGLEZA DR MEREUTA DENISSpdf
Page 2: UNIVERSITATEA DE MEDICINA SI FARMACIE “GR Doctorat/Rezumat... · universitatea de medicina si farmacie “gr.t.popa” iasi facultatea de medicina dentara rezumatul tezei de doctorat

Universitatea de Medicină şi Farmacie ldquoGrTPopardquo- Iaşi

Facultatea de Medicină Dentară

REZUMATUL

TEZEI DE DOCTORAT

Coordonator stiinţific

Prof dr LACATUSU STEFAN

Doctorand

MEREUTA VASILE-DENISS

2012

UNIVERSITATEA DE MEDICINA SI FARMACIE ldquoGRTPOPArdquo IASI

FACULTATEA DE MEDICINA DENTARA

REZUMATUL TEZEI DE DOCTORAT

CERCETARI PRIVIND POSIBILITATI DE REFACERE MORFOFUNCTIONALA IN PIERDERI DE SUBSTANTA

ODONTALE OCLUZO‐PROXIMALE

Coordonator stiințific Prof dr LĂCĂTUŞU ŞTEFAN

Doctorand MEREUȚĂ VASILE‐DENISS

2012

1

CONTENT

GENERAL PART

INTRODUCTION3

CHAPTI General aspects regarding proximo-occlusal carious dental

lesions5

CHAPTII Clasic and modern methods for diagnostic of noncavitary and

incipient proximal dental caries9

CHAPTIII General aspects regarding composition and properties of direct

proximal-occlusal restorations20

CHAPT IV Actual data regarding longevity of direct proximo-occlusal

restorations38

CHAPT V Studies regarding clinical performance of proximo-occlusal indirect

restorations versus direct restorations45

PERSONAL PART

CHAPTVI The aim of research theme General objectives Methodology48

CHAPTVII Study regarding clinical performance of proximo-occlusal

amalgam and composite resins restorations50

VII1Introduction50

VII2Aim of study50

VII3Materials and methods50

VII4Results and discussions52

VII5Conclusions82

CHAPTVIII Clinical performance of composite resins restorations related to

restorative technique 12-months longitudinal study83

VIII1Introductions83

VIII2Aim of study83

VIII3Materials and methods83

VIII4Results and discussions85

VIII5Conclusions111

CHAPTIX Study regarding marginal sealing status in composite resins limited

proximo-occlusal restorations performed using different techniques112

IX1Introduction112

IX2Aim of study115

IX3Materials and methods115

IX4Results and discussions118

IX5Conclusions124

2

CHAPTX Study regarding the effects of etching on enamel and dentine in

cervical area for proximal cavities localised at lateral dental group125

X1Introduction125

X2Aim of study125

X3Materials and methods126

X4Results and discussions126

X5Conclusions147

CHAPTXI FEA study regarding the biomechanical behaviour and fracture

resistance of proximo-occlusal amalgam and composite resins restorations148

XI1Introduction148

XI2Aim of study148

XI3Materials and metods149

XI4Results and discussions152

XI5Conclusions182

FINAL CONCLUSIONS182

PERSONAL CONTRIBUTION183

REFERENCES184

3

INTRODUCTION

Academic European of Operative Dentistry warned about the factors that

impose to the dentists the use of composite resins on large scale as materials for the

direct restorations at lateral dental group the mass-media rejection of amalgam the

patients desire for esthetic restorations even the request for biological principles to

minimise sacrifice of healthy dental tissues However amalgam must be used in

particular situations represented by extensive carious lesions high cariogenic risk and

bruxism

In this context any comparative study focused on both amalgam and

composite resins proximo-occlusal restorations presents a high practical importance

for dentists Besides numerous fillings replacements are based on improper decisions

regarding wear status of restorations than a real clinical failure Dentists must also

take in account the specific oral environment conditions especially for adhesive

materials that are laquosensitive technique raquo

The final decision and materialrestorative technique selection must be based

on a balance between resistance longevity and priceefficiency

4

CHAPTVI THE AIM OF STUDY GENERAL OBJECTIVES DATA

COLLECTION AND PROCESSING

VI1 The reason for theme choice

The reason for theme choice was determined by the fact that any comparative

study focused on both amalgam and composite resins proximo-occlusal restorations

presents a high practical importance for dentists Also it is a request to highlight

clinical and paraclinical aspects regarding factors that influence clinical performance

of direct composite resins restorations performed at the level of lateral dental group

The support offered by Discipline Cariology and Restorative Dentistry and Institute

Petru Poni allowed the performance of our researches

VI2Aim objectives methodology

The objectives of my researches were as follows

- Selection of literature data regarding histological morphopatological

etiopathogenic spects of dental caries posibilities of diagnostic for proximal

incipient dental caries using both clasic and modern diagnostic technology

properties and clinical behaviour of dental amalgam and composite resins and

other adhesive materials used in posterior restorations literature data

regarding longevity of proximo-occlusal direct restorations and literature data

regarding clinical performances of indirect restorations versus direct

restorations for lateral dental group

- Performing an epidemiological study based on clinical data (indices Ryge

modified USPHS) on posterior direct restorations

- The comparing research regarding clinical performance of posterior composite

resines restorations performed using different restorative techniques

- In vitro study focused on the assessment of the marginal sealing at the cervical

area of proximo-occlusal composite resins restorations

- In vitro study focused on the effects of etching at the cervical area for

proximo-occlusal composite resins restorations

- FEA (finite element analysis) study focused on the assessment of

biomechanical behaviour and resistance to fracture and deformation of

simulated proximo-occlusal restorations from amalgam and composite resins

To realise the proposed aims the working protocol was as follows

- clinical assessment of a study group with age 17-49 with class II dental caries

treated by one dentist using amalgam and composite resins

5

- clinical assessment of a study group with age 15-65 with class II dental caries

treated by one dentist using a selected composite resin and different restorative

techniques

- performing of data base for statistical processing

Database was collected between 2008-2011 in private practice and Faculty of

Dental Medicine UMF ―GrTPopa Iasi The paraclinical studies were performed in

collaboration with Institute Petru Poni Iasi

The patients were informed and gave their written consent to be included in

study groups Every patient was submitted to clinical examen and radiographic

examen The clinical examens consisted in assessment of Ryge indices (modified

USPHS) at baseline 6 months 12 months 18months and 24 months

The paraclinical tests consisted in

- in vitro tests on extracted teeth consisting in optical and atomic force

microscopy to assess the influence of different restorative techniques on the cervical

marginal sealing

- measurement of surface status (enamel dentine) after etching (different time

intervals) using AFM (Atomic Force Microscopy)

- statistical analysis in SPSS 13 for comparison of microleakage degree at

cervical level related to different restorative techniques

- FEA study performed using software COSMOSWorks 2010 for the

assessment of biomechanical behaviour of simulated posterior amalgam and

composite resins restorations

VI3 Data collecting and processing

The processing of reseraches data was performed using the follwing software

MS Office (graphs tables)

SPSS 16 (statistical tests)

The following statistical tests were used t Test test Kolmogorov-Smirnov test

Pearson test Wilcoxon The descriptive statistical analysis was performed using

Microsoft Excel and analitical statistical analysis was performed using SPSS 160

(SPSS Inc SUA)

6

CHAPTVII STUDY REGARDING CLINICAL PERFORMANCE OF

PROXIMO-OCCLUSAL AMALGAM AND COMPOSITE RESINS

RESTORATIONS

VII1 INTRODUCTION

The clinical performance of posterior direct restorations pn medium and long

term concerns dental practitioners that must correlate their therapeutical decisions

with material selection restorative technique external factors represented by oral

forces cariogenic risk patient parafunctions

VII2AIM OF STUDY

The aim of study consisted in assessment of clinical performance of amalgam

and composite resins proximal-occlusal restorations 4-years old

VII3 MATERIALS AND METHOD

The study group included 200 proximal-occlusal amalgam (n=100) and

composite resins (Herculite Kerr) (n=100) restorations 4-years old The study was

performed on 55 patients with age between 17-49 years examined in Dental Medicine

Faculty UMFGrTPopa Iaşi The assessment of fillings status was performed

using Ryge indices modified USPHS (US Public Health Service) (table 1) The

clinical peformance of restorations was also correlated with dental group (molars

bicusps) extension (medium extended) and cariogenic risk (medium high) The

following parameters were assessed

- color match

- marginal adaptation (integrity)

- marginal discoloration

- anatomical form (proximal)

- surface quality

The results presentation was performed using Microsoft Excel

VII4 RESULTS AND DISCUSSIONS

AB

C

S1

6

64

30

0

20

40

60

80

A

B

C

Fig VII1 Anatomical form (occlusal)-amalgam restorations (molars)

7

AB

C

S1

26

64

100

10

20

30

40

50

60

70

A

B

C

Fig VII2 Anatomical form (occlusal)-amalgam restorations (bicusps)

AB

C

S1

0

46

54

0

10

20

30

40

50

60

A

B

C

Fig VII3 Anatomical form (occlusal)-composite resins restorations (molars)

Fig VII4 Anatomical form (occlusal)-amalgam restorations (bicusps)

AB

C

S1

12

72

16

0

10

20

30

40

50

60

70

80

A

B

C

FigVII5 Anatomical form (proximal)-amalgam restorations (molars)

AB

C

S1

38

56

60

10

20

30

40

50

60

A

B

C

FigVII6 Anatomical form (proximal)-amalgam restorations (bicusps)

AB

C

S1

10

54

36

0

10

20

30

40

50

60

A

B

C

8

AB

C

S1

8

64

26

0

10

20

30

40

50

60

70

A

B

C

FigVII7 Anatomical form (proximal)-composite resins restorations (molars)

AB

C

S1

34

66

100

10

20

30

40

50

60

70

A

B

C

FigVII8 Anatomical form (proximal)-composite resins restorations (bicusps)

AB

C

S1

36

44

20

0

5

10

15

20

25

30

35

40

45

A

B

C

FigVII9 Marginal adaptation (proximal)- amalgam restorations(bicusps)

AB

C

S1

20

50

30

0

5

10

15

20

25

30

35

40

45

50

A

B

C

FigVII10 Marginal adaptation (proximal)-amalgam restorations (molars)

AB

C

S1

16

60

24

0

10

20

30

40

50

60

A

B

C

FigVII11 Marginal adaptation (proximal)-composite resins restorations (bicusps)

9

AB

C

S1

12

54

34

0

10

20

30

40

50

60

A

B

C

FigVII12 Marginal adaptation (proximal)-composite resins restorations (molars)

AB

C

S1

22

54

24

0

10

20

30

40

50

60

A

B

C

FigVII13 Surface quality-amalgam restorations (bicusps)

AB

C

S1

10

54

36

0

10

20

30

40

50

60

A

B

C

FigVII14 Surface quality-amalgam restorations (molars)

AB

C

S1

12

68

20

0

10

20

30

40

50

60

70

A

B

C

FigVII15 Surface quality-composite resins restorations (bicusps)

AB

C

S1

8

70

22

0

20

40

60

80

A

B

C

FigVII16 Surface quality-composite resins restorations (molars)

10

A

C

S1

98

20

20

40

60

80

100

A

C

FigVII17a-b Prevalence of marginal dental cariesamalgam restorations (moderate

CR)

A

C

S1

92

80

20

40

60

80

100

A

C

FigVII18 Prevalence of marginal dental cariesamalgam restorations (high CR)

A

C

S1

94

60

20

40

60

80

100

A

C

FigVII19 Prevalence of marginal dental cariescomposite resins restorations (CR

moderate)

A

C

S1

82

18

0

10

20

30

40

50

60

70

80

90

A

C

FigVII20 Prevalence of marginal dental cariescomposite resins restorations (high

CR)

11

The study data sustain the results obtained by most studies focused on

posterior amalgam restorations However Hickelampcol (2001) reviewed literature data

and proved that many results varies accordingly to different clinical factors (133)

Roulet JF(1997) warned about limits of cross-sectional studies related to composite

resins restorations because of the absence of data regarding restorative techniques

practitioner experience presence or absence of optimum isolation factors related by

patient (266)

VII5CONCLUSIONS

Amalgam proximo-occlusal restorations with minimum 6-years age present

excellent results for parameters anatomic form (occlusal) marginal

discoloration and marginal secondary dental caries good results for

parameters anatomic form (proximal) and marginal adaptation and poor results

for surface quality

Composite resins proximo-occlusal restorations (bicusps) with minimum 6-

years age present excellent results for parameters color match marginal

discoloration and marginal secondary dental caries and good results for

parameters anatomic form (occlusal proximal) marginal adaptation surface

quality

Composite resins proximo-occlusal restorations (molars) with minimum 6-

years age present good results for parameters color match marginal

discoloration marginal secondary dental caries marginal adaptation and poor

results for parameters anatomic form (occlusal) (54 indices Ryge C)

anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The restorations extended at external third of occlusal surface present highest

percents of indices C regarding anatomic form (occlusal) (54 indices Ryge

C) anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The exceeding of 6-years age will require careful monitorisation for early

interventions through polishing sealing reshaping and even replacement for

restorations with major defects

12

CHAPTVIII CLINICAL PERFORMANCE OF COMPOSITE RESINS

RESTORATIONS RELATED TO RESTORATIVE TECHNIQUE 12-

MONTHS LONGITUDINAL STUDY

VIII1 INTRODUCTION

The restorative technique has a major influence over clinical performance of

composite resins restorations in proximo-occlusal cavities In this context researches

focused on correlations between technique and clinical performance of direct

restorations improve the dentist decision regarding restorative technique choice

VIII2AIM OF STUDY

The aim of study was to determine the clinical performance of composite

resins proximo-occlusal restorations performed using different restorative techniques

VIII3MATERIALS AND METHOD

The group study included 37 patients with age 18-42 years with moderat

ecariogenic risk The total number of composite resins restorations (Herculite XRV

Kerr) was 60 divided in three study groups (n=20)

I Centripetal build-up

II Oblique layering

III Horisontal layering

The coronal restorations were assessed at an interval of 12 months using

indices Ryge modified USPHS

- indice ALFA (A)- IDEAL CLINIC

- indice BRAVO (B)- ACCEPTABLE CLINIC

- indice CHARLIE (C)- UNACCEPTABLE CLINIC

VIII4 RESULTS AND DISCUSSIONS

The statistical tests Kruskal-Wallis and Mann-Whitney were performed to

confirm or infirm research hypotesis (the direct restorations performed using different

restorative techniques present statistical significant differences regarding clinical

performance for the assessed parameters)

13

TableVIII1a-b Groups study (Kruskal-Wallis Test)

Ranks

20 2960

20 2560

20 3630

60

20 3050

20 2420

20 3680

60

20 2490

20 3140

20 3520

60

Restorative_techniques

Centripetal build-up

Oblique layering

Horizontal layering

Total

Centripetal build-up

Oblique layering

Horizontal layering

Total

Centripetal build-up

Oblique layering

Horizontal layering

Total

Marginal_adaptation

Marginal_discoloration

Anatomical_form

N Mean Rank

Test Statisticsab

4913 8031 4900

2 2 2

086 018 086

Chi-Square

df

Asymp Sig

Marginal_

adaptation

Marginal_

discoloration

Anatomical_

form

Kruskal Wallis Testa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between the three restorative

techniques for parameter marginal adaptation (p=0086)

There are no statistical significant differences between the three restorative

techniques for parameter marginal discoloration (p=0018)

There are no statistical significant differences between the three restorative

techniques for parameter anatomical form (proximal) (p=0086)

TableVIII2 Comparing results between restorations performed using three

techniques (marginal adaptation marginal discoloration anatomical form) Marginal adaptation Centripetal build-upOblique layering p=04 ns

Centripetal build-upHorizontal layering p=0191 ns

Oblique layering Horizontal layering p=0028 s

Marginal discoloration Centripetal build-upOblique layering p=0103 ns

Centripetal build-upHorizontal layering p=0195 ns

Oblique layering Horizontal layering p=0005 s

Anatomical form Centripetal build-upOblique layering p=0137 ns

Centripetal build-upHorizontal layering p=0029 s

Oblique layering Horizontal layering p=0433 ns

ns nesemnificativ

s semnificativ

p probabilitate

14

Tables VIII3a-b Mann-Whitney test Comparing analysis regarding marginal

discoloration between restorations performed using oblique layering technique and

centripetal build-up technique

Ranks

20 2180 43600

20 1920 38400

40

Restorative_techniques

Centripetal build-up

Oblique layering

Total

Marginal_adaptation

N Mean Rank Sum of Ranks

Test Statisticsb

174000

384000

-841

400

495a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

adaptation

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between centripetal build-up

and oblique layering techniques regarding parameter marginal adaptation (p=0400)

Tables VIII4a-b Mann-Whitney test Comparing analysis regarding marginal

adaptation between restorations performed using horisontal layering technique and

centripetal build-up technique

Ranks

20 1830 36600

20 2270 45400

40

Restorative_techniques

Centripetal build-up

Horizontal layering

Total

Marginal_adaptation

N Mean Rank Sum of Ranks

Test Statisticsb

156000

366000

-1307

191

242a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

adaptation

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between centripetal build-up

and horisontal layering techniques regarding parameter marginal adaptation

(p=0191)

15

TablesVIII5a-b Mann-Whitney test Comparing analysis regarding marginal

adaptation between restorations performed using oblique layering technique and

horisontal layering technique

Ranks

20 1690 33800

20 2410 48200

40

Restorative_techniques

Oblique layering

Horizontal layering

Total

Marginal_adaptation

N Mean Rank Sum of Ranks

Test Statisticsb

128000

338000

-2191

028

052a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

adaptation

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There is statistical significant differences between horisontal layering and

oblique layering techniques regarding parameter marginal adaptation (p=0028)

Tables VIII6a-b Mann-Whitney test Comparing analysis regarding marginal

discoloration between restorations performed using oblique layering technique and

centripetal build-up technique

There are no statistical significant differences between centripetal build-up

and oblique layering techniques regarding parameter marginal discoloration

(p=0103)

Ranks

20 2260 45200

20 1840 36800

40

Restorative_techniques

Centripetal build-up

Oblique layering

Total

Marginal_discoloration

N Mean Rank Sum of Ranks

Test Statisticsb

158000

368000

-1632

103

265a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

discoloration

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

16

Tables VIII7a-b Mann-Whitney test Comparing analysis regarding marginal

discoloration between restorations performed using centripetal build-up technique and

horisontal layering technique

Ranks

20 1840 36800

20 2260 45200

40

Restorative_techniques

Centripetal build-up

Horizontal layering

Total

Marginal_discoloration

N Mean Rank Sum of Ranks

Test Statisticsb

158000

368000

-1299

194

265a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

discoloration

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between centripetal build-up

and horisontal layering techniques regarding parameter marginal discoloration

(p=0103)

Tables VIII8a-b Mann-Whitney test Comparing analysis regarding marginal

discoloration between restorations performed using oblique layering technique and

horisontal layering technique

Ranks

20 1630 32600

20 2470 49400

40

Restorative_techniques

Oblique layering

Horizontal layering

Total

Marginal_discoloration

N Mean Rank Sum of Ranks

Test Statisticsb

116000

326000

-2822

005

023a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

discoloration

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There is statistical significant differences between horisontal layering and

oblique layering techniques regarding parameter marginal discoloration (p=0005)

17

TablesVIII9 a-b Mann-Whitney test Comparing analysis regarding anatomical

form between restorations performed using centripetal build-up technique and oblique

layering technique

Ranks

20 1830 36600

20 2270 45400

40

Restorative_techniques

Centripetal build-up

Oblique layering

Total

Anatomical_form

N Mean Rank Sum of Ranks

Test Statisticsb

156000

366000

-1486

137

242a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Anatomical_

form

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between centripetal build-up

and oblique layering techniques regarding parameter anatomical form (p=0137)

Tables VIII10a-b Mann-Whitney test Comparing analysis regarding anatomical

form between restorations performed using centripetal build-up technique and

horisontal layering technique

Ranks

20 1710 34200

20 2390 47800

40

Restorative_techniques

Centripetal build-up

Horizontal layering

Total

Anatomical_form

N Mean Rank Sum of Ranks

Test Statisticsb

132000

342000

-2184

029

068a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Anatomical_

form

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between centripetal build-up

and horisontal layering techniques regarding parameter anatomical form (p=0029)

18

Tables VIII11a-b Mann-Whitney test Comparing analysis regarding anatomical

form between restorations performed using oblique layering technique and horisontal

layering technique

Ranks

20 1920 38400

20 2180 43600

40

Restorative_techniques

Oblique layering

Horizontal layering

Total

Anatomical_form

N Mean Rank Sum of Ranks

Test Statisticsb

174000

384000

-784

433

495a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Anatomical_

form

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between horisontal layering and

oblique layering techniques regarding parameter anatomical form (p=0433)

Indices A for restorations performed using centripetal build-up technique were

as follows color match-80 marginal adaptation- 60 marginal discoloration-

70 anatomical form (proximal)- 80 surface quality- 60

Indices A for restorations performed using horisontal layering technique were

as follows color match-70 marginal adaptation- 40 marginal discoloration-

50 anatomical form (proximal)- 50 surface quality- 70

Indices A for restorations performed using oblique layering technique were as

follows color match-70 marginal adaptation- 80 marginal discoloration- 90

anatomical form (proximal)- 60 surface quality- 70

Indices B for restorations performed using centripetal build-up technique were

as follows color match-20 marginal adaptation- 30 marginal discoloration-

20 anatomical form (proximal)- 30 surface quality- 40

Indices B for restorations performed using horisontal layering technique were

as follows color match-30 marginal adaptation- 40 marginal discoloration-

30 anatomical form (proximal)- 30 surface quality- 30

Indices B for restorations performed using oblique layering technique were as

follows color match-30 marginal adaptation- 20 marginal discoloration- 10

anatomical form (proximal)- 40 surface quality- 30

19

Indices C for restorations performed using centripetal build-up technique were

as follows color match-0 marginal adaptation- 10 marginal discoloration- 0

anatomical form (proximal)- 0 surface quality- 0

Indices C for restorations performed using horisontal layering technique were

as follows color match-0 marginal adaptation- 20 marginal discoloration- 20

anatomical form (proximal)- 20 surface quality- 0

Indices C for restorations performed using oblique layering technique were as

follows color match-0 marginal adaptation- 0 marginal discoloration- 10

anatomical form (proximal)- 0 surface quality- 100

Discussions

For in vitro studies is difficult to reproduce the variables existent in oral cavity

like occlusal stress and pH and temperature changes (235) The clinical studies are

determinant in assessment of restorative techniques (300) The most researches

focuses on the influence of restorative technique on the reduction of lightcuring stress

(51 78 135)

VIII5 CONCLUSIONS

Oblique layering technique presents superior results regarding marginal

adaptation and marginal discoloration and is recommended for proximo-

occlusal dental caries close to enamel-cement jonction

Centripetal build-up presents good results regarding marginal adaptation and

anatomical form at proximal level (proximal surfaces and contact point)

Horisontal layering technique can be used for optimum results only in

proximal-occlusal cavities with moderate extension both in occlusal-cervical

and buccal-oral

20

CHAPTIX STUDY REGARDING MARGINAL SEALING STATUS IN

COMPOSITE RESINS LIMITED PROXIMO-OCCLUSAL RESTORATIONS

PERFORMED USING DIFFERENT TECHNIQUES

IX1INTRODUCTION

The contraction of composite resins can produce stress inside dental structure

The most contraction stress appears in the initial stages and development rate of stress

decreases gradually in time (5 98 160) The contraction stress of composite resins

can overpass adhesion strenght and can broke the link between dental tissues and

composite resin (73) When adhesion strenght is high stress can produce marginal

fracture or bulk fracture (74) These situations are associated with microleakage and

penetration of oral fluid and bacteria along dentinal walls endangering the pulpal

tissue or favourising secondary dental caries

IX2 AIM OF STUDY

The study aimed to assess the efficiency of marginal sealing along gingival

wall in limited proximal-occlusal restorations performed using three different

techniques

IX3MATERIALS AND METHOD

The study group included 30 teeth extracted for orthodontic and periodontal

reasons On every tooth two identical class II cavities (on mesial and distal surfaces)

were prepared with cylindrical burs under water cooling The gingival wall was

limited to enamel-cement jonction The cavity dimension were as follows 2 mm

buccal-oral 5mm depth Each tooth was introduced in a pattern of acrylat The

operator calibrated preparation technique on acrylat teeth in Simulation Laboratory of

UMF ―Gr T Popa Iaşi The 60 prepared cavities were randomly divided in three

study groups related to restorative technique The restoration were performed with

Filtek Z550 (3M ESPE) a nanohybrid composite resin The adhesive strategy

included etchamprinse in 2 steps and adhesive Adper Single Bond 2(3MESPE)

Group A (n=20) bulk restorative technique associated with lightcuring from

occlusal 40 seconds and from buccal and oral 20 seconds

Group B (n=20) oblique layering technique (first layer on buccal wall and

buccal frac12 of gingival wall was lightcured from buccal second layer on oral wall and

oral frac12 of gingival wall was lightcured from oral third oral as a triangle with point

oriented to gingival wall was lightcured from occlusal)

Group C (n=20) combined technique (bdquoflow layer on gingival and axial

walls lightcured under pressure only associated with solid composite resin layer)

The proximal surfaces were performed using Tofflemire and metallic matrices After

removal of matrices every restoration was lightcured for another 20 seconds Two

layers aof varnish were applied on composite resins restorations excepting cavity

margins and an area of 1 mm around them The samples were introduced in methylen

21

blue 10 for 48 hours After this stage samples were washed with water and teeth

were cut longitudinally with a diamonded disc

The die penetration was assessed with Zeiss (Iena Germany) X20 microscope

accordingly to four scores (0-3)

0 ndash no penetration

1 ndash die infiltration until external half of gingival wall

2 ndash die infiltration on all gingival wall

3 ndash die infiltration on gingival wall and axial wall

IX4RESULTS AND DISCUSSIONS

The result of die penetration are presented in table IX1

TableIX1 The results for die penetration

Grup 0 1 2 3

A (bulk) 0 0 3 17

B (layering) 0 4 5 11

C (combined) 12 5 2 1

In group A 17 sample had score 3 and 2 samples had score 2 In group B 11

sample had score 3 5 samples had score 2 and 4 sample had score 1 In group C with

best results 12 samples had score 0 5 samples had score 1 2 samples had score 2 1

sample had score 3

The recorded data were analysed using test Mann-Whitney The statistical

results are presented in tables IX2-IX4

Tables IX2a-b Mann-Whitney for comparisons of microleakage values between

bulk technique and incremental technique

Ranks

Restorative technique N Mean Rank Sum of Ranks

Scores

frequency

A ndash bulk technique 20 2420 24200

B ndash incremental

technique

20 1680 16800

Total 40

Test Statisticsb

scores

frequency

Mann-Whitney U 29000

Wilcoxon W 168000

Z -1970

Asymp Sig (2-tailed) 049

Exact Sig [2(1-tailed Sig)] 123a

a Not corrected for ties

b Grouping Variable restorative technique

22

Tables IX3a-b Mann-Whitney for comparisons of microleakage values between

bulk technique and mixed technique

Ranks

Restorative technique N Mean Rank Sum of Ranks

scores

frequency

A ndash bulk technique 20 3090 30900

C ndash mixed technique 20 1010 10100

Total 40

Test Statisticsb

scores

frequency

Mann-Whitney U 500

Wilcoxon W 101000

Z -4021

Asymp Sig (2-tailed) 000

Exact Sig [2(1-tailed Sig)] 000a

a Not corrected for ties

b Grouping Variable restorative technique

Tables IX4a-b Mann-Whitney test for comparisons of microleakage values

between incremental technique and mixed technique

Ranks

Restorative technique N Mean Rank Sum of Ranks

scores

frequency

B ndash incremental

technique

20 2990 29900

C ndash mixed technique 20 1210 12100

Total 40

Test Statisticsb

scores

frequency

Mann-Whitney U 5500

Wilcoxon W 121000

Z -3492

Asymp Sig (2-tailed) 000

Exact Sig [2(1-tailed Sig)] 000a

a Not corrected for ties

23

Test Statisticsb

scores

frequency

Mann-Whitney U 5500

Wilcoxon W 121000

Z -3492

Asymp Sig (2-tailed) 000

Exact Sig [2(1-tailed Sig)] 000a

a Not corrected for ties

b Grouping Variable tehnrestaurare

The results of microleakage degree were statistically significant when the

three restorative techniques were compared The results showed that best restorative

technique regarding marginal sealing in cervical area is combined technique followed

by oblique layering technique The use of layering techniques limits the development

of contraction forces between oposite walls event that favourises bulk stress voids

formation and fissure inside dental tissues The results of our study are similar with

other studies (114 293)

IX5 CONCLUSIONS

The values of die penetration at gingival wall were statistically different

between the three restorative techniques

We concluded that all restorative methods were associated with lightcuring

contraction and marginal microleakage

The combined technique was associated with lowest lightcuring contraction

and die penetration

The bulk technique was associated with highest lightcuring contraction and die

penetration

24

CHAPTX STUDY REGARDING THE EFFECTS OF ETCHING ON

ENAMEL AND DENTINE IN CERVICAL AREA FOR PROXIMAL

CAVITIES AT LATERAL DENTAL GROUP

X1 INTRODUCTION

The studies reported marginal defects and high microleakage at the level of

gingival margins localised in cervical area or close to enamel-cement jonction for

high percents of proximal-occlusal composite resins restorations (8485) The good

adhesion is requested to insure restoration longevity and to prevent marginal

microleakage and presence of secondary marginal dental caries The adhesion

strenght of different adhesive systems can vary accordingly to tissues areas (204 240)

and to variations in dentinal structures (234 330) Most studies focused on adhesive

systems performances used healthy dentine close to pulp room but in case of class II

restorations there are particular features that influences the adhesion at the level of

gingival margins

The surface topography is an important property that determines the

interaction manner between surfaces The surface roughness and surface energy can

increase or decrease the adhesion of composite resins to the hard dental tissues

X2 AIM OF STUDY

The aim of study was to compare surface roughness of enamel and dentine

after etching related to different distances related to enamel-dentinecement jonction

X3 MATERIALS AND METHODS

The study group included 20 molars extracted from orthodontics or

periodontal reasons with intact proximal surfaces The teeth were cut longitudinally in

sens buccal-oral with diamond discs under water cooling

A group study (10 teeth) included 10 samples obtained through transversal

cutting at distance of 2mm from enamel-dentinecement jonction and 10 samples

obtained through transversal cutting at distance of 15 mm from enamel-

dentinecement jonction Another study group (10 teeth) included 10 samples

obtained through transversal cutting at distance of 1mm from enamel-dentinecement

jonction and 10 samples obtained through transversal cutting at distance of 05 mm

from enamel-dentinecement jonction All these samples were divided in two halfes

through mesial-distal cutting The samples finishing was performed with abrasive

paper (100-4000) and final polishing was performed with a device Buehler model

Minimet with slices introduced in ultrasound bath for 4 minutes The second half of

each sample was etched for 15 seconds with ortophosphoric acid 37 for 15 seconds

Slices were washed with distilled water for 30 seconds after etching and dried

The samples were analysed with atomic force microscopy (AFM) regarding

surface roughness The results were expressed as relative variation of roughness

X4 RESULTS AND DISCUSSIONS

The aspect of etched enamel at 2 mm distance from ECJ can be seen in figure

X1 (section 10 microm) The surface roughness is higher comparing with sample before

etching

25

După gravajul cu acid ortofosforic 37

The aspect of etched enamel at 15 mm distance from ECJ can be seen in

figure X2 (section 10 microm) The surface roughness is higher comparing with sample

before etching but lower comparing with sample at 2 mm from ECJ

The aspect of etched enamel at 1 mm distance from ECJ can be seen in figure

X3 (section 10 microm) The surface roughness is higher comparing with sample before

etching but lower comparing with sample at 15mm and 2 mm from ECJ

The aspect of etched enamel at 15 mm distance from ECJ can be seen in

figure X4 (section 10 microm) The surface roughness is higher comparing with sample

before etching but lower comparing with sample at 1 mm 15 mm and 2 mm from

ECJ

FigX1 3D aspect of enamel at 2 mm from ECJ

after etching (10 microm)

FigX2 3D aspect of enamel at 15 mm from ECJ

after etching (10 microm)

FigX3 3D aspect of enamel at 1 mm from ECJ

after etching (10 microm)

FigX4 3D aspect of enamel at 05 mm from ECJ

after etching (10 microm)

26

The mean values of squared roughness for dentine and enamel before etching

are presented in tables X1 and X2

Table X1 Squared roughness values for dentine samples before and after etching

Before etching (nm) After etching (nm)

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

sample

1

335 282 283 259 1149 947 901 879

sample

2

352 284 274 266 1127 939 883 875

sample

3

357 273 278 263 1152 953 876 867

sample

4

323 269 264 258 1146 942 895 883

sample

5

348 298 271 268 1153 944 904 878

sample

6

339 274 278 273 1158 937 893 892

sample

7

352 283 269 266 1145 944 899 876

sample

8

349 292 272 274 1166 942 907 869

sample

9

357 284 275 265 1132 939 893 879

sample

10

348 281 277 262 1142 941 899 878

Table X2 Squared roughness values for enamel and dentine samples before and after

etching

Before etching (nm) After etching (nm)

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

sample 1 422 342 309 313 2255 1114 874 845

sample 2 418 338 324 304 2236 1102 882 839

sample 3 413 334 315 303 2239 1115 873 833

sample 4 416 336 322 308 2242 1116 868 842

sample 5 426 332 315 294 2218 1103 877 829

sample 6 412 332 317 306 2237 1099 874 847

sample 7 414 335 322 314 2252 1102 876 834

sample 8 416 325 318 313 2239 1106 875 838

sample 9 418 328 314 299 2246 1113 879 836

sample 10 413 334 316 305 2242 1104 873 839

The results for samples before etching prove a decreasing tendency for mean

values of squared roughness surface beginning with areas placed at distance of 2 mm

from ECJ (346 nm) followed by areas placed at distance of 15 mm from ECJ (282

nm) 1 mm from ECJ (274 nm) and 05 mm from ECJ (265 nm) After etching the

decreasing tendency maintained for dentine localised at 2 mm from ECJ to dentine

localised at 05 mm from ECJ The mean values of squared roughness after etching

were three times higher (tables X3)

27

Table X3 Squared roughness values for enamel and dentine samples before and

after etching

Dentine Enamel

Before etching

(nm)

After etching

(nm)

Before etching

(nm)

After etching

(nm)

2 mm ECJ 346 1147 416 2237

15 mm ECJ 282 942 333 1107

1 mm ECJ 274 895 317 875

05 mm ECJ 265 877 305 838

The descriptive statistics data for surface roughness of dentine before and after

etching are presented in tables X4 si X5

Table X4 Descriptive statistics for dentine samples before etching

Statistics

Dentine 2mm

before etching

Dentine 15mm

before etching

Dentine 1mm

before etching

Dentine 05mm

before etching

N Valid 10 10 10 10

Missing 0 0 0 0

Mean 346000 282000 274100 265400

Std Error of Mean 33830 27487 17026 16746

Std Deviation 106979 86923 53841 52957

Skewness -1214 354 -314 348

Std Error of Skewness 687 687 687 687

Kurtosis 1141 049 336 -539

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 3230 2690 2640 2580

Maximum 3570 2980 2830 2740

Table X5 Descriptive statistics for dentine samples after etching

Statistics

Dentine 2mm

after etching

Dentine 15mm

after etching

Dentine 1mm

after etching

Dentine 05mm

after etching

N Valid 10 10 10 10

Missing 0 0 0 0

1147000 942800 895000 877600

Std Error of Mean 36545 14591 29926 22020

Std Deviation 115566 46140 94634 69634

Skewness -267 1169 -951 535

Std Error of Skewness 687 687 687 687

Kurtosis 043 1776 564 1416

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 11270 9370 8760 8670

28

Statistics

Dentine 2mm

after etching

Dentine 15mm

after etching

Dentine 1mm

after etching

Dentine 05mm

after etching

N Valid 10 10 10 10

Missing 0 0 0 0

1147000 942800 895000 877600

Std Error of Mean 36545 14591 29926 22020

Std Deviation 115566 46140 94634 69634

Skewness -267 1169 -951 535

Std Error of Skewness 687 687 687 687

Kurtosis 043 1776 564 1416

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 11270 9370 8760 8670

Maximum 11660 9530 9070 8920

To choose the statistical test to compare roughness surface values was

performed a test Shapiro-Wilk If p is lower or equal with 0005 than hypothesis of

distribution normality is rejected (distribution deviates from normal form) In the table

X6 the distributions are normal The statistical test will be test t for pair samples

Table X6 Test Shapiro-Wilk for dentine samples

Tests of Normality

Kolmogorov-Smirnov

a Shapiro-Wilk

Statistic df Sig Statistic df Sig

Dentine 2mm before etching 274 10 032 877 10 122

Dentine 15mm after etching 209 10 200 952 10 689

Dentine 1mm before etching 134 10 200 983 10 980

Dentine 05mm before etching 155 10 200 949 10 661

Dentine 2mm after etching 133 10 200 977 10 946

Dentine 15mm after etching 197 10 200 916 10 329

Dentine 1mm after etching 216 10 200 925 10 401

Dentine 05 after etching 220 10 185 933 10 474

Enamel 2mm before etching 193 10 200 898 10 207

Enamel 15mm before etching 170 10 200 977 10 947

Enamel 1mm before etching 157 10 200 952 10 689

Enamel 05mm before etching 165 10 200 943 10 590

Enamel 2mm after etching 235 10 124 925 10 404

Enamel 15mm after etching 209 10 200 871 10 102

Enamel 1mm after etching 189 10 200 964 10 834

Enamel 05mm after etching 142 10 200 983 10 978

a Lilliefors Significance Correction

29

Tests of Normality

Kolmogorov-Smirnov

a Shapiro-Wilk

Statistic df Sig Statistic df Sig

Dentine 2mm before etching 274 10 032 877 10 122

Dentine 15mm after etching 209 10 200 952 10 689

Dentine 1mm before etching 134 10 200 983 10 980

Dentine 05mm before etching 155 10 200 949 10 661

Dentine 2mm after etching 133 10 200 977 10 946

Dentine 15mm after etching 197 10 200 916 10 329

Dentine 1mm after etching 216 10 200 925 10 401

Dentine 05 after etching 220 10 185 933 10 474

Enamel 2mm before etching 193 10 200 898 10 207

Enamel 15mm before etching 170 10 200 977 10 947

Enamel 1mm before etching 157 10 200 952 10 689

Enamel 05mm before etching 165 10 200 943 10 590

Enamel 2mm after etching 235 10 124 925 10 404

Enamel 15mm after etching 209 10 200 871 10 102

Enamel 1mm after etching 189 10 200 964 10 834

Enamel 05mm after etching 142 10 200 983 10 978

a Lilliefors Significance Correction

This is a lower bound of the true significance

The results of test t for pair dentine samples before and after etching are

presented in table X

Table X7 Test t for dentine before and after etching

Paired Samples Test

Paired Differences

t df

p (2-

tailed)

95 Confidence

Interval of the

Difference

Mean

Std

Dev

Std

Error

Mean Lower Upper

Pair

1

dentine2mmbeforeetching-

dentine2mmafteretching

-

8010000

174801 55277 -

8135045

-

7884955

-

144906

9 000

Pair

2

dentine15mmbeforeetching-

dentine15mmafteretching

-

6608000

102394 32380 -

6681248

-

6534752

-

204079

9 000

Pair

3

dentine1mmbeforeetching-

dentine1mmafteretching

-

6209000

117799 37251 -

6293269

-

6124731

-

166678

9 000

30

Paired Samples Test

Paired Differences

t df

p (2-

tailed)

95 Confidence

Interval of the

Difference

Mean

Std

Dev

Std

Error

Mean Lower Upper

Pair

1

dentine2mmbeforeetching-

dentine2mmafteretching

-

8010000

174801 55277 -

8135045

-

7884955

-

144906

9 000

Pair

2

dentine15mmbeforeetching-

dentine15mmafteretching

-

6608000

102394 32380 -

6681248

-

6534752

-

204079

9 000

Pair

3

dentine1mmbeforeetching-

dentine1mmafteretching

-

6209000

117799 37251 -

6293269

-

6124731

-

166678

9 000

Pair

4

dentine05mmbeforeetching-

dentine05mmafteretching

-

6122000

86384 27317 -

6183796

-

6060204

-

224109

9 000

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of dentine (

2mm 15 mm 1mm sau 05mm)

The descriptive statistics data for dentine surface roughness before and after

etching are presented in tables X8 and X9

Table X8 Descriptive statistics for enamel samples before etching

Statistics

Enamel 2mm

before etching

Enamel 15mm

before etching

Enamel 1mm

before etching

Enamel 05mm

before etching

N Valid 10 10 10 10

Missing 0 0 0 0

Mean 416800 333600 317200 305900

Std Error of Mean 13968 15217 14205 20355

Std Deviation 44171 48120 44920 64369

Skewness 1095 -156 -109 -411

Std Error of Skewness 687 687 687 687

Kurtosis 769 487 -118 -295

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 4120 3250 3090 2940

Maximum 4260 3420 3240 3140

31

Table X9 Descriptive statistics for enamel samples after etching

Statistics

Enamel 2mm

after etching

Enamel 15mm

after etching

Enamel 1mm

after etching

Enamel 05mm

after etching

N Valid 10 10 10 10

Missing 0 0 0 0

Mean 2237600 1107400 875100 838200

Std Error of Mean 31027 20232 11968 17436

Std Deviation 98116 63979 37845 55136

Skewness -850 267 042 040

Std Error of Skewness 687 687 687 687

Kurtosis 878 -1880 1082 -425

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 22180 10990 8680 8290

Maximum 22520 11160 8820 8470

To choose the statistical test to compare roughness surface values was

performed a test Shapiro-Wilk If p is lower or equal with 0005 than hypothesis of

distribution normality is rejected (distribution deviates from normal form) In the table

X10 the distributions are normal The statistical test will be test t for pair samples

Table X10 Test Shapiro-Wilk for enamel samples

Tests of Normality

Kolmogorov-Smirnova Shapiro-Wilk

Statistic df Sig Statistic df Sig

2mmenamel before etching 193 10 200 898 10 207

15mmenamel before etching 170 10 200 977 10 947

1mmenamel before etching 157 10 200 952 10 689

05mmenamel before etching 165 10 200 943 10 590

2mmenamel after etching 235 10 124 925 10 404

15mmenamel after etching 209 10 200 871 10 102

1mmenamel after etching 189 10 200 964 10 834

05mmenamel after etching 142 10 200 983 10 978

a Lilliefors Significance Correction

This is a lower bound of the true significance

The results of test t for pair enamel samples before and after etching are

presented in table X11

32

Table X11 Test t for enamel samples before and after etching

Paired Samples Test

Paired Differences

t df

p (2-

tailed)

95 Confidence

Interval of the

Difference

Mean

Std

Deviation

Std

Error

Mean Lower Upper

Pair

1

2mmenamel before

etching

2mmenamel after

etching

-18208 135220 42760 -

18304731

-

18111269

-

425815

9 000

Pair

2

15mmenamel before

etching

15mmenamel after

etching

-7738 73151 23132 -7790329 -7685671 -

334508

9 076

Pair

3

1mmenamel before

etching

1mmenamel after

etching

-5579 55468 17540 -5618679 -5539321 -

318065

9 065

Pair

4

05mmenamel before

etching

05mmenamel after

etching

-5323 60378 19093 -5366192 -5279808 -

278788

9 063

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel ( 2mm 15 mm 1mm sau

05mm) but the differences statistical significant are present only for enamel localised

at 2 mm from ECJ

X5CONCLUSIONS

The surfaces of enamel and dentine at cervical level record decreases of

roughness related to the decrease of distance to ECJ

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel but the differences

statistical significant are present only for enamel localised at 2 mm from ECJ

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of

dentine

33

CHAPTXI FEA STUDY REGARDING THE BIOMECHANICAL

BEHAVIOUR AND FRACTURE RESISTANCE OF PROXIMO-OCCLUSAL

AMALGAM AND COMPOSITE RESINS RESTORATIONS

XI1INTRODUCTION AIM OF STUDY

The individual variation of patients morphological and functional complexity

of tissues as well as difficult access limit the possibilities to investigate in clinical

studies the biomechanical behaviour of proximo-occlusal restorations In this context

simulation of the biomechanics for direct restorations represents an interesting

interdisciplinar domain in actual dentistry research

The study focused on two direction

- analysis of role of forces intensity on biomechanical behaviour related to

cavity dimension and material

- analysis of tension inside restoration structure related to forces intensity

XI2MATERIALS AND METHODS

The stages of finite element analysis study are as follows

object modelling (bicusps and proximo-occlusal restoration)

definition of parameters for materials and dental tissues

meshing

constraints and loading

types of contacts

equations system definition

results of simulation

The object 3D modelling was performed in Rhinoceros (figure XI1) The

definition of parameters was performed for Poisson constant Young modulus density

(table XI1) The selected materials were amalgam and composite resins The

analysed tissues were dentine and enamel The meshing constraints loading were

performed for forces of 200N 400N 600N 800 N The analysis was performed using

software COSMOSWorks 2010

34

Fig XI1 3D modellation of bicusp

Table XI1 Values of Young modulus Poisson constant compression resistance for

amalgam composite resin enamel (amalgam compozit smalţ)

Material Young modulus (GPa) Poisson constants

Compression

resistance

(Mpa)

Amalgam 55 033 483

Enamel 48 03 400

Composite

resin 220 022 345

Fig XI2 The forces and constraints application

The results are presented in values and culours red colours representing areas

with maximum values of tensions produced under influence of masticatory forces

The tensions produced in amalgam restoration are in a range from 0 to 22886

(force 800 N) The maximum von Misses tensions are associated with cervical area

of amalgam restorations This aspect proves that first modification in interface

restoration-cavity margins will appear at the level of gingival wall First marginal

35

defects and fissures in restoration bulk will appear at tensions over 1600Mpa

associated with forces of 800N for extended amalgam proximo-occlusal restorations

The tensions produced in composite resin restorations are in a range from 0 to

2285 (force 800 N) The maximum von Misses tensions are associated with cervical

area of composite resin restorationsThis aspect proves that first modification in

interface restoration-cavity margins will appear at the level of gingival wall First

marginal defects and fissures in restoration bulk will appear at tensions over 1716

Mpa associated with forces of 600N for moderate and extended composite resins

proximo-occlusal restorations

Fig XI3a-b ndash Simulated model of proximo-occlusal restoration

FigXI4a-b Dental amalgam restoration Cervical tension associated with 600 N

(c)800 N (d)

FigXI5a-b Composite resin restoration Cervical tension associated with 600 N

(c)800 N (d)

36

The deformation of amalgam can be produced only when is associated with

fissures in bulk of restorations while composite resins restorations present

deformation when are associated with a modification of volume and form because of

repeated action of medium forces on long term or high forces on short term (figures

XI4 XI5)

Fig XI4 Material deformation in area of maximum tension

000E + 00

500E -02

100E -01

150E -01

200E -01

250E -01

1 4 7 101316192225283134374043464952555861646770737679

Amalgam C ompoz it

Figura XI5 Deformarea funcție de material

The amalgam and composite resins were treated as homogenous isotropic and

liniar The advantage of this type of FEA study is that restorations parameters can be

modified any time is necessary both in arhitecture geometry and material indices

variability The results of this study sustain the conclusions of other FEA studies

focused on biomechanical behaviour of posterior restorations performed with

amalgam and composite resins(35 62 76 143)

37

XI4CONCLUSIONS

bull The amalgam in class II restorations has a low deformation tendency because

of uniform distribution of tension inside material

bull Composite resins class II restorations accumulate higher tensions comparing

with amalgam but deformation is avoided for a time because of the adhesion

forces performed between molecules under moderate oral forces In case of

high oral forces (600-800N) the risk of fracture in moderate class II

restorations is higher comparing with amalgam proximo-occlusal restorations

For extended class II restorations and forces of 600 N composite resins present

highest risk of fracture and deformation The von Misses tension at the

cervical interface restorationtooth can reach 1600Mpa

bull The amalgam in moderate class II restorations can resist to deformation even

for high intensity forces limited to 600N In extended class II restorations the

risk of deformation and fracture increases at values of 600N-800N of oral

forces The von Misses tension at the cervical interface restorationtooth can

reach 1700 Mpa

38

FINAL CONCLUSIONS

Amalgam proximo-occlusal restorations with minimum 6-years age present

excellent results for parameters anatomic form (occlusal) marginal

discoloration and marginal secondary dental caries good results for

parameters anatomic form (proximal) and marginal adaptation and poor results

for surface quality

Composite resins proximo-occlusal restorations (bicusps) with minimum 6-

years age present excellent results for parameters color match marginal

discoloration and marginal secondary dental caries and good results for

parameters anatomic form (occlusal proximal) marginal adaptation surface

quality

Composite resins proximo-occlusal restorations (molars) with minimum 6-

years age present good results for parameters color match marginal

discoloration marginal secondary dental caries marginal adaptation and poor

results for parameters anatomic form (occlusal) (54 indices Ryge C)

anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The restorations extended at external third of occlusal surface present highest

percents of indices C regarding anatomic form (occlusal) (54 indices Ryge

C) anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The exceeding of 6-years age will require careful monitorisation for early

interventions through polishing sealing reshaping and even replacement for

restorations with major defects

Oblique layering technique presents superior results regarding marginal

adaptation and marginal discoloration and is recommended for proximo-

occlusal dental caries close to enamel-cement jonction

Centripetal build-up presents good results regarding marginal adaptation and

anatomical form at proximal level (proximal surfaces and contact point)

Horisontal layering technique can be used for optimum results only in

proximal-occlusal cavities with moderate extension both in occlusal-cervical

and buccal-oral

The values of die penetration at gingival wall were statistically different

between the three restorative techniques

We concluded that all restorative methods were associated with lightcuring

contraction and marginal microleakage

The combined technique was associated with lowest lightcuring contraction

and die penetration

The bulk technique was associated with highest lightcuring contraction and die

penetration

39

The surfaces of enamel and dentine at cervical level record decreases of

roughness related to the decrease of distance to ECJ

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel but the differences

statistical significant are present only for enamel localised at 2 mm from ECJ

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of

dentine

bull The amalgam in class II restorations has a low deformation tendency because

of uniform distribution of tension inside material

bull Composite resins class II restorations accumulate higher tensions comparing

with amalgam but deformation is avoided for a time because of the adhesion

forces performed between molecules under moderate oral forces In case of

high oral forces (600-800N) the risk of fracture in moderate class II

restorations is higher comparing with amalgam proximo-occlusal restorations

For extended class II restorations and forces of 600 N composite resins present

highest risk of fracture and deformation The von Misses tension at the

cervical interface restorationtooth can reach 1600Mpa

bull The amalgam in moderate class II restorations can resist to deformation even

for high intensity forces limited to 600N In extended class II restorations the

risk of deformation and fracture increases at values of 600N-800N of oral

forces The von Misses tension at the cervical interface restorationtooth can

reach 1700 Mpa

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49Cardoso P Sadek F Microtensile bond strength on dentin using new adhesive

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51Carvalho RM JC Pereira M Yoshiyama DH Pashley A review of

polymerization contraction the influence of stress development versus stress

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posterior restorations 12-month results Eur J Dent 2010 Jan4(1)57-65

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59Chen HY Manhart J Hickel R Kunzelmann KH Polymerization contraction

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polymerization contraction stress of composites J Dent Res 2000 79812ndash817

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Behinderten Dtsch Zahnartzlicher 1999 54 96-102

62Cohen BI Pagnillo MK Deutsch ASMusikant BL Fracture Strength of

Three Core Restorative Materials Supported with or without a Prefabricated Split-

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in Class II composite resin restoration applied in bulk or in two increments

Quintessence Int 1993 24583-591

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64Collins CJ Bryant RW Hodge KL A clinical evaluation of posterior composite

resin restorations 8-year findings J Dent 199826(4) 311ndash317

65Condon JR Ferracane JL Assessing the effect of composite formulation on

polymerization stress J Am Dent Assoc2000 131497-503

66Cook WD Moopnar M Influence of chemical structure on the fracture

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68Crim GA Microleakage of three resin placement techniques Am J Dent

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70Dauvillier BS Aarnts MP Feilzer AJ Developments in shrinkage control of

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71Dauvillier BS Aarnts MP Feilzer AJ Modeling of the viscoelastic behavior of

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72Davidson CL Gee AJ Feilzer A The competition between the composite-dentin

bond strength and the polymerization contraction stress J Dent Res 1984

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73Davidson CL AJ Feilzer Polymerization shrinkage and polymerization

shrinkage stress in polymer-based restoratives J Dent Res 199725435ndash440

74Davidson CL Resisting the curing contraction with adhesive composites J

Prosthet Dent 198655446ndash7

75Davis RD Mayhew RB A clinical comparison of three anterior restorative resins

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Dent200899131-40

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79Demirci M Tuncer S Yuceokur AA Prevalence of caries on individual tooth

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Dent20104(3)270-9

80De Munck J Van Meerbeek B Satoshi I Vargas M Yoshida Y Armstrong S

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82Deutsch WM Simecek JW Dental emergencies among Marines ashore in

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85Dietschi D Herzfeld D In vitro evaluation of marginal and internal adaptation of

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86Dietschi D Marginal adaptation and seal of direct and indirect Class II composite

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20028195 (Abstract)

88Diefenderfer KE Rienhardt JW Shear bond strengths of ten adhesive

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89Donly KJ Jensen ME Triolo PA clinical comparison of resin composite inlay

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90Douglas WH Fields RP Fundingsland J A comparison between the

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91Eberhard J Hartman B Lenhard M Mayer T Kocher T Eickholz P Digital

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96Feilzer AJ AJ De Gee CL Davidson Increased wall-to-wall curing

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98Feilzer AJ de Gee AJ Davidson CL Relaxation of polymerization contraction

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99Feilzer AJ De Gee AJ Davidson CL Setting stress in composite resin in relation

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101Fennis YL Verdischbot EH vanrsquot Hof MA Performance of some diagnostic

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108Francci C Loguercio AD Reis A Carrilho MR A novel filling technique for

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109Fruits TJ Knapp JA Khajotia SS Microleakage in the proximal walls of

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Effects of irradiation mode and filling technique on resindentin bond strength in

Class I cavities J Dent Res 200281 (Abstract)

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117Gordon JChristensen G Why switch to digital radiography J Am Dent

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Dent Oral Epidemiol 200533(3)212-8

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1995202ndash 6

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Kompositefullungen Zahnartzlicher Welt 1999 108 270-273

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restorative decisions made on the basis of simulated bitewing radiographs

Community Dentistry and Oral Epidemiology 1994 22(2) 71-74

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1243

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Biology199843(8)629-632

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817-822

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composite restorations Oper Dent 200934(1)11-7

166Kleverlaan CJ Feilzer AJ Polymerization shrinkage and contraction stress of

dental resin composites Dent Mater 2005 211150-1157

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marginal leakage around class II composite resin restorations in vitroQuint Int

201989117ndash121

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M Dentin shear strength effect of distance from the pulp Dent Mater 2002

18(7)516-20

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thermal behavior of dental composites Dent Mater 2008 24(8)1017ndash1024

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JDent 199826 627-632

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shrinkage and elasticity of flowable composites and filled adhesives Dent Mater

1999 15128-137

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179Lăcătuşu St Luminiţa Costinescu Andrian S Gianina Iovan Valeria

Pendefunda 180Sorina Solomon Topoliceanu C Elements of dispersional

analysis of amalgam restorations 15th

Edition of the Balkan Medical Days

Stomatological Section Abstract nr1091999128

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amalgamelor dentare la pereţii cavităţilor RevMedicina

StomatologicăVol2199823-26

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200126302ndash307

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restorative decisions microscopic and radiographic caries depth Community

Dentistry and Oral Epidemiology 1996 24 106-11

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Dent Mater 2002 18436-444

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constraint and filling technique in composite restorations Dent Mater 2004

20(3)236-43

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Polymerization shrinkage effects of boundary conditions and filling technique of

resin composite restorations J Dent 2004 32(6)459-70

50

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Quintessence Int 2004 35(2)156-61

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art and future perspectives Quintessence Int 200233213-224

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temperature and comonomer composition on the polymerization behavior of

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and reactivity on the reaction kinetics of dimethacrylatedimethacrylate

copolymerizations Macromolecules 1999 323913-3921

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bonded composite restorations Dent Mater 1991 7(2) 107-13

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clinical results J Dent Res 199877 1020

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two amalgams Quintessence Int 199829483ndash490

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Dentomaxillofac Radiol 2007 Oct36(7)377-81

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direct and indirect restorations icircn posterior teeth of the permanent

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J Prosthet Dent 2000 Sep84(3)289-96

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Three-year clinical evaluation of composite and ceramic inlays Am J Dent 2001

Apr14(2)95-9

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hardness and depth of cure of light cured packable composite resins J Dent Res 2000

79369 (Abstract)

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caries-affected transparent dentin by citric acidAn atomic force microscopy

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relative diagnostic yields of clinical FOTI and radiographic examinations for the

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deformation Dent Mater 200117241ndash246

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practitioners and dental caries JDent1990 18(3) 130-136

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(Cerana) Br Dent J 2006 Oct 21201(8)515-20

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PrimDentCare1999Apr659-62

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Quintessence 198961-80

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ScandJDRes 199210060-65

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33

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19904011ndash7

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Kunststoff-FullungenDtschZahnartzlicher 1991 46 222-225

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Am Dent Assoc 2010 141(3)319-29

52

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Ciucchi B Russell CM Pashley DH Tensile bond strength and SEM evaluation of

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evolution of the longitudinal modulus during the photopolymerization of a bis-

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125749-751

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composites Oper Dent 23 1998282ndash289

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34

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Monogr Oral Sci 20092142-51

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Monogr Oral Sci 20092152-62

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Quintessence Int 1998295ndash11

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Influence of the Discomfort Reported by Children on the Performance of Approximal

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Restorative Materials In Class I And Class II Restorations An In-Vivo Study The

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569ndash575

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29(12)1131ndash1138

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Nanoleakage leakage within the hybrid layer Oper Dent 1995 20 18-25

55

275Sarrett DC Clinical challenges and the relevance of materials testing for

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451

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59

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458

346Yoshiyama M Tay FR Doi J Nishitani Y Yamada T Itou K Carvalho RM

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Page 3: UNIVERSITATEA DE MEDICINA SI FARMACIE “GR Doctorat/Rezumat... · universitatea de medicina si farmacie “gr.t.popa” iasi facultatea de medicina dentara rezumatul tezei de doctorat

UNIVERSITATEA DE MEDICINA SI FARMACIE ldquoGRTPOPArdquo IASI

FACULTATEA DE MEDICINA DENTARA

REZUMATUL TEZEI DE DOCTORAT

CERCETARI PRIVIND POSIBILITATI DE REFACERE MORFOFUNCTIONALA IN PIERDERI DE SUBSTANTA

ODONTALE OCLUZO‐PROXIMALE

Coordonator stiințific Prof dr LĂCĂTUŞU ŞTEFAN

Doctorand MEREUȚĂ VASILE‐DENISS

2012

1

CONTENT

GENERAL PART

INTRODUCTION3

CHAPTI General aspects regarding proximo-occlusal carious dental

lesions5

CHAPTII Clasic and modern methods for diagnostic of noncavitary and

incipient proximal dental caries9

CHAPTIII General aspects regarding composition and properties of direct

proximal-occlusal restorations20

CHAPT IV Actual data regarding longevity of direct proximo-occlusal

restorations38

CHAPT V Studies regarding clinical performance of proximo-occlusal indirect

restorations versus direct restorations45

PERSONAL PART

CHAPTVI The aim of research theme General objectives Methodology48

CHAPTVII Study regarding clinical performance of proximo-occlusal

amalgam and composite resins restorations50

VII1Introduction50

VII2Aim of study50

VII3Materials and methods50

VII4Results and discussions52

VII5Conclusions82

CHAPTVIII Clinical performance of composite resins restorations related to

restorative technique 12-months longitudinal study83

VIII1Introductions83

VIII2Aim of study83

VIII3Materials and methods83

VIII4Results and discussions85

VIII5Conclusions111

CHAPTIX Study regarding marginal sealing status in composite resins limited

proximo-occlusal restorations performed using different techniques112

IX1Introduction112

IX2Aim of study115

IX3Materials and methods115

IX4Results and discussions118

IX5Conclusions124

2

CHAPTX Study regarding the effects of etching on enamel and dentine in

cervical area for proximal cavities localised at lateral dental group125

X1Introduction125

X2Aim of study125

X3Materials and methods126

X4Results and discussions126

X5Conclusions147

CHAPTXI FEA study regarding the biomechanical behaviour and fracture

resistance of proximo-occlusal amalgam and composite resins restorations148

XI1Introduction148

XI2Aim of study148

XI3Materials and metods149

XI4Results and discussions152

XI5Conclusions182

FINAL CONCLUSIONS182

PERSONAL CONTRIBUTION183

REFERENCES184

3

INTRODUCTION

Academic European of Operative Dentistry warned about the factors that

impose to the dentists the use of composite resins on large scale as materials for the

direct restorations at lateral dental group the mass-media rejection of amalgam the

patients desire for esthetic restorations even the request for biological principles to

minimise sacrifice of healthy dental tissues However amalgam must be used in

particular situations represented by extensive carious lesions high cariogenic risk and

bruxism

In this context any comparative study focused on both amalgam and

composite resins proximo-occlusal restorations presents a high practical importance

for dentists Besides numerous fillings replacements are based on improper decisions

regarding wear status of restorations than a real clinical failure Dentists must also

take in account the specific oral environment conditions especially for adhesive

materials that are laquosensitive technique raquo

The final decision and materialrestorative technique selection must be based

on a balance between resistance longevity and priceefficiency

4

CHAPTVI THE AIM OF STUDY GENERAL OBJECTIVES DATA

COLLECTION AND PROCESSING

VI1 The reason for theme choice

The reason for theme choice was determined by the fact that any comparative

study focused on both amalgam and composite resins proximo-occlusal restorations

presents a high practical importance for dentists Also it is a request to highlight

clinical and paraclinical aspects regarding factors that influence clinical performance

of direct composite resins restorations performed at the level of lateral dental group

The support offered by Discipline Cariology and Restorative Dentistry and Institute

Petru Poni allowed the performance of our researches

VI2Aim objectives methodology

The objectives of my researches were as follows

- Selection of literature data regarding histological morphopatological

etiopathogenic spects of dental caries posibilities of diagnostic for proximal

incipient dental caries using both clasic and modern diagnostic technology

properties and clinical behaviour of dental amalgam and composite resins and

other adhesive materials used in posterior restorations literature data

regarding longevity of proximo-occlusal direct restorations and literature data

regarding clinical performances of indirect restorations versus direct

restorations for lateral dental group

- Performing an epidemiological study based on clinical data (indices Ryge

modified USPHS) on posterior direct restorations

- The comparing research regarding clinical performance of posterior composite

resines restorations performed using different restorative techniques

- In vitro study focused on the assessment of the marginal sealing at the cervical

area of proximo-occlusal composite resins restorations

- In vitro study focused on the effects of etching at the cervical area for

proximo-occlusal composite resins restorations

- FEA (finite element analysis) study focused on the assessment of

biomechanical behaviour and resistance to fracture and deformation of

simulated proximo-occlusal restorations from amalgam and composite resins

To realise the proposed aims the working protocol was as follows

- clinical assessment of a study group with age 17-49 with class II dental caries

treated by one dentist using amalgam and composite resins

5

- clinical assessment of a study group with age 15-65 with class II dental caries

treated by one dentist using a selected composite resin and different restorative

techniques

- performing of data base for statistical processing

Database was collected between 2008-2011 in private practice and Faculty of

Dental Medicine UMF ―GrTPopa Iasi The paraclinical studies were performed in

collaboration with Institute Petru Poni Iasi

The patients were informed and gave their written consent to be included in

study groups Every patient was submitted to clinical examen and radiographic

examen The clinical examens consisted in assessment of Ryge indices (modified

USPHS) at baseline 6 months 12 months 18months and 24 months

The paraclinical tests consisted in

- in vitro tests on extracted teeth consisting in optical and atomic force

microscopy to assess the influence of different restorative techniques on the cervical

marginal sealing

- measurement of surface status (enamel dentine) after etching (different time

intervals) using AFM (Atomic Force Microscopy)

- statistical analysis in SPSS 13 for comparison of microleakage degree at

cervical level related to different restorative techniques

- FEA study performed using software COSMOSWorks 2010 for the

assessment of biomechanical behaviour of simulated posterior amalgam and

composite resins restorations

VI3 Data collecting and processing

The processing of reseraches data was performed using the follwing software

MS Office (graphs tables)

SPSS 16 (statistical tests)

The following statistical tests were used t Test test Kolmogorov-Smirnov test

Pearson test Wilcoxon The descriptive statistical analysis was performed using

Microsoft Excel and analitical statistical analysis was performed using SPSS 160

(SPSS Inc SUA)

6

CHAPTVII STUDY REGARDING CLINICAL PERFORMANCE OF

PROXIMO-OCCLUSAL AMALGAM AND COMPOSITE RESINS

RESTORATIONS

VII1 INTRODUCTION

The clinical performance of posterior direct restorations pn medium and long

term concerns dental practitioners that must correlate their therapeutical decisions

with material selection restorative technique external factors represented by oral

forces cariogenic risk patient parafunctions

VII2AIM OF STUDY

The aim of study consisted in assessment of clinical performance of amalgam

and composite resins proximal-occlusal restorations 4-years old

VII3 MATERIALS AND METHOD

The study group included 200 proximal-occlusal amalgam (n=100) and

composite resins (Herculite Kerr) (n=100) restorations 4-years old The study was

performed on 55 patients with age between 17-49 years examined in Dental Medicine

Faculty UMFGrTPopa Iaşi The assessment of fillings status was performed

using Ryge indices modified USPHS (US Public Health Service) (table 1) The

clinical peformance of restorations was also correlated with dental group (molars

bicusps) extension (medium extended) and cariogenic risk (medium high) The

following parameters were assessed

- color match

- marginal adaptation (integrity)

- marginal discoloration

- anatomical form (proximal)

- surface quality

The results presentation was performed using Microsoft Excel

VII4 RESULTS AND DISCUSSIONS

AB

C

S1

6

64

30

0

20

40

60

80

A

B

C

Fig VII1 Anatomical form (occlusal)-amalgam restorations (molars)

7

AB

C

S1

26

64

100

10

20

30

40

50

60

70

A

B

C

Fig VII2 Anatomical form (occlusal)-amalgam restorations (bicusps)

AB

C

S1

0

46

54

0

10

20

30

40

50

60

A

B

C

Fig VII3 Anatomical form (occlusal)-composite resins restorations (molars)

Fig VII4 Anatomical form (occlusal)-amalgam restorations (bicusps)

AB

C

S1

12

72

16

0

10

20

30

40

50

60

70

80

A

B

C

FigVII5 Anatomical form (proximal)-amalgam restorations (molars)

AB

C

S1

38

56

60

10

20

30

40

50

60

A

B

C

FigVII6 Anatomical form (proximal)-amalgam restorations (bicusps)

AB

C

S1

10

54

36

0

10

20

30

40

50

60

A

B

C

8

AB

C

S1

8

64

26

0

10

20

30

40

50

60

70

A

B

C

FigVII7 Anatomical form (proximal)-composite resins restorations (molars)

AB

C

S1

34

66

100

10

20

30

40

50

60

70

A

B

C

FigVII8 Anatomical form (proximal)-composite resins restorations (bicusps)

AB

C

S1

36

44

20

0

5

10

15

20

25

30

35

40

45

A

B

C

FigVII9 Marginal adaptation (proximal)- amalgam restorations(bicusps)

AB

C

S1

20

50

30

0

5

10

15

20

25

30

35

40

45

50

A

B

C

FigVII10 Marginal adaptation (proximal)-amalgam restorations (molars)

AB

C

S1

16

60

24

0

10

20

30

40

50

60

A

B

C

FigVII11 Marginal adaptation (proximal)-composite resins restorations (bicusps)

9

AB

C

S1

12

54

34

0

10

20

30

40

50

60

A

B

C

FigVII12 Marginal adaptation (proximal)-composite resins restorations (molars)

AB

C

S1

22

54

24

0

10

20

30

40

50

60

A

B

C

FigVII13 Surface quality-amalgam restorations (bicusps)

AB

C

S1

10

54

36

0

10

20

30

40

50

60

A

B

C

FigVII14 Surface quality-amalgam restorations (molars)

AB

C

S1

12

68

20

0

10

20

30

40

50

60

70

A

B

C

FigVII15 Surface quality-composite resins restorations (bicusps)

AB

C

S1

8

70

22

0

20

40

60

80

A

B

C

FigVII16 Surface quality-composite resins restorations (molars)

10

A

C

S1

98

20

20

40

60

80

100

A

C

FigVII17a-b Prevalence of marginal dental cariesamalgam restorations (moderate

CR)

A

C

S1

92

80

20

40

60

80

100

A

C

FigVII18 Prevalence of marginal dental cariesamalgam restorations (high CR)

A

C

S1

94

60

20

40

60

80

100

A

C

FigVII19 Prevalence of marginal dental cariescomposite resins restorations (CR

moderate)

A

C

S1

82

18

0

10

20

30

40

50

60

70

80

90

A

C

FigVII20 Prevalence of marginal dental cariescomposite resins restorations (high

CR)

11

The study data sustain the results obtained by most studies focused on

posterior amalgam restorations However Hickelampcol (2001) reviewed literature data

and proved that many results varies accordingly to different clinical factors (133)

Roulet JF(1997) warned about limits of cross-sectional studies related to composite

resins restorations because of the absence of data regarding restorative techniques

practitioner experience presence or absence of optimum isolation factors related by

patient (266)

VII5CONCLUSIONS

Amalgam proximo-occlusal restorations with minimum 6-years age present

excellent results for parameters anatomic form (occlusal) marginal

discoloration and marginal secondary dental caries good results for

parameters anatomic form (proximal) and marginal adaptation and poor results

for surface quality

Composite resins proximo-occlusal restorations (bicusps) with minimum 6-

years age present excellent results for parameters color match marginal

discoloration and marginal secondary dental caries and good results for

parameters anatomic form (occlusal proximal) marginal adaptation surface

quality

Composite resins proximo-occlusal restorations (molars) with minimum 6-

years age present good results for parameters color match marginal

discoloration marginal secondary dental caries marginal adaptation and poor

results for parameters anatomic form (occlusal) (54 indices Ryge C)

anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The restorations extended at external third of occlusal surface present highest

percents of indices C regarding anatomic form (occlusal) (54 indices Ryge

C) anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The exceeding of 6-years age will require careful monitorisation for early

interventions through polishing sealing reshaping and even replacement for

restorations with major defects

12

CHAPTVIII CLINICAL PERFORMANCE OF COMPOSITE RESINS

RESTORATIONS RELATED TO RESTORATIVE TECHNIQUE 12-

MONTHS LONGITUDINAL STUDY

VIII1 INTRODUCTION

The restorative technique has a major influence over clinical performance of

composite resins restorations in proximo-occlusal cavities In this context researches

focused on correlations between technique and clinical performance of direct

restorations improve the dentist decision regarding restorative technique choice

VIII2AIM OF STUDY

The aim of study was to determine the clinical performance of composite

resins proximo-occlusal restorations performed using different restorative techniques

VIII3MATERIALS AND METHOD

The group study included 37 patients with age 18-42 years with moderat

ecariogenic risk The total number of composite resins restorations (Herculite XRV

Kerr) was 60 divided in three study groups (n=20)

I Centripetal build-up

II Oblique layering

III Horisontal layering

The coronal restorations were assessed at an interval of 12 months using

indices Ryge modified USPHS

- indice ALFA (A)- IDEAL CLINIC

- indice BRAVO (B)- ACCEPTABLE CLINIC

- indice CHARLIE (C)- UNACCEPTABLE CLINIC

VIII4 RESULTS AND DISCUSSIONS

The statistical tests Kruskal-Wallis and Mann-Whitney were performed to

confirm or infirm research hypotesis (the direct restorations performed using different

restorative techniques present statistical significant differences regarding clinical

performance for the assessed parameters)

13

TableVIII1a-b Groups study (Kruskal-Wallis Test)

Ranks

20 2960

20 2560

20 3630

60

20 3050

20 2420

20 3680

60

20 2490

20 3140

20 3520

60

Restorative_techniques

Centripetal build-up

Oblique layering

Horizontal layering

Total

Centripetal build-up

Oblique layering

Horizontal layering

Total

Centripetal build-up

Oblique layering

Horizontal layering

Total

Marginal_adaptation

Marginal_discoloration

Anatomical_form

N Mean Rank

Test Statisticsab

4913 8031 4900

2 2 2

086 018 086

Chi-Square

df

Asymp Sig

Marginal_

adaptation

Marginal_

discoloration

Anatomical_

form

Kruskal Wallis Testa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between the three restorative

techniques for parameter marginal adaptation (p=0086)

There are no statistical significant differences between the three restorative

techniques for parameter marginal discoloration (p=0018)

There are no statistical significant differences between the three restorative

techniques for parameter anatomical form (proximal) (p=0086)

TableVIII2 Comparing results between restorations performed using three

techniques (marginal adaptation marginal discoloration anatomical form) Marginal adaptation Centripetal build-upOblique layering p=04 ns

Centripetal build-upHorizontal layering p=0191 ns

Oblique layering Horizontal layering p=0028 s

Marginal discoloration Centripetal build-upOblique layering p=0103 ns

Centripetal build-upHorizontal layering p=0195 ns

Oblique layering Horizontal layering p=0005 s

Anatomical form Centripetal build-upOblique layering p=0137 ns

Centripetal build-upHorizontal layering p=0029 s

Oblique layering Horizontal layering p=0433 ns

ns nesemnificativ

s semnificativ

p probabilitate

14

Tables VIII3a-b Mann-Whitney test Comparing analysis regarding marginal

discoloration between restorations performed using oblique layering technique and

centripetal build-up technique

Ranks

20 2180 43600

20 1920 38400

40

Restorative_techniques

Centripetal build-up

Oblique layering

Total

Marginal_adaptation

N Mean Rank Sum of Ranks

Test Statisticsb

174000

384000

-841

400

495a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

adaptation

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between centripetal build-up

and oblique layering techniques regarding parameter marginal adaptation (p=0400)

Tables VIII4a-b Mann-Whitney test Comparing analysis regarding marginal

adaptation between restorations performed using horisontal layering technique and

centripetal build-up technique

Ranks

20 1830 36600

20 2270 45400

40

Restorative_techniques

Centripetal build-up

Horizontal layering

Total

Marginal_adaptation

N Mean Rank Sum of Ranks

Test Statisticsb

156000

366000

-1307

191

242a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

adaptation

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between centripetal build-up

and horisontal layering techniques regarding parameter marginal adaptation

(p=0191)

15

TablesVIII5a-b Mann-Whitney test Comparing analysis regarding marginal

adaptation between restorations performed using oblique layering technique and

horisontal layering technique

Ranks

20 1690 33800

20 2410 48200

40

Restorative_techniques

Oblique layering

Horizontal layering

Total

Marginal_adaptation

N Mean Rank Sum of Ranks

Test Statisticsb

128000

338000

-2191

028

052a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

adaptation

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There is statistical significant differences between horisontal layering and

oblique layering techniques regarding parameter marginal adaptation (p=0028)

Tables VIII6a-b Mann-Whitney test Comparing analysis regarding marginal

discoloration between restorations performed using oblique layering technique and

centripetal build-up technique

There are no statistical significant differences between centripetal build-up

and oblique layering techniques regarding parameter marginal discoloration

(p=0103)

Ranks

20 2260 45200

20 1840 36800

40

Restorative_techniques

Centripetal build-up

Oblique layering

Total

Marginal_discoloration

N Mean Rank Sum of Ranks

Test Statisticsb

158000

368000

-1632

103

265a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

discoloration

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

16

Tables VIII7a-b Mann-Whitney test Comparing analysis regarding marginal

discoloration between restorations performed using centripetal build-up technique and

horisontal layering technique

Ranks

20 1840 36800

20 2260 45200

40

Restorative_techniques

Centripetal build-up

Horizontal layering

Total

Marginal_discoloration

N Mean Rank Sum of Ranks

Test Statisticsb

158000

368000

-1299

194

265a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

discoloration

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between centripetal build-up

and horisontal layering techniques regarding parameter marginal discoloration

(p=0103)

Tables VIII8a-b Mann-Whitney test Comparing analysis regarding marginal

discoloration between restorations performed using oblique layering technique and

horisontal layering technique

Ranks

20 1630 32600

20 2470 49400

40

Restorative_techniques

Oblique layering

Horizontal layering

Total

Marginal_discoloration

N Mean Rank Sum of Ranks

Test Statisticsb

116000

326000

-2822

005

023a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

discoloration

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There is statistical significant differences between horisontal layering and

oblique layering techniques regarding parameter marginal discoloration (p=0005)

17

TablesVIII9 a-b Mann-Whitney test Comparing analysis regarding anatomical

form between restorations performed using centripetal build-up technique and oblique

layering technique

Ranks

20 1830 36600

20 2270 45400

40

Restorative_techniques

Centripetal build-up

Oblique layering

Total

Anatomical_form

N Mean Rank Sum of Ranks

Test Statisticsb

156000

366000

-1486

137

242a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Anatomical_

form

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between centripetal build-up

and oblique layering techniques regarding parameter anatomical form (p=0137)

Tables VIII10a-b Mann-Whitney test Comparing analysis regarding anatomical

form between restorations performed using centripetal build-up technique and

horisontal layering technique

Ranks

20 1710 34200

20 2390 47800

40

Restorative_techniques

Centripetal build-up

Horizontal layering

Total

Anatomical_form

N Mean Rank Sum of Ranks

Test Statisticsb

132000

342000

-2184

029

068a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Anatomical_

form

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between centripetal build-up

and horisontal layering techniques regarding parameter anatomical form (p=0029)

18

Tables VIII11a-b Mann-Whitney test Comparing analysis regarding anatomical

form between restorations performed using oblique layering technique and horisontal

layering technique

Ranks

20 1920 38400

20 2180 43600

40

Restorative_techniques

Oblique layering

Horizontal layering

Total

Anatomical_form

N Mean Rank Sum of Ranks

Test Statisticsb

174000

384000

-784

433

495a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Anatomical_

form

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between horisontal layering and

oblique layering techniques regarding parameter anatomical form (p=0433)

Indices A for restorations performed using centripetal build-up technique were

as follows color match-80 marginal adaptation- 60 marginal discoloration-

70 anatomical form (proximal)- 80 surface quality- 60

Indices A for restorations performed using horisontal layering technique were

as follows color match-70 marginal adaptation- 40 marginal discoloration-

50 anatomical form (proximal)- 50 surface quality- 70

Indices A for restorations performed using oblique layering technique were as

follows color match-70 marginal adaptation- 80 marginal discoloration- 90

anatomical form (proximal)- 60 surface quality- 70

Indices B for restorations performed using centripetal build-up technique were

as follows color match-20 marginal adaptation- 30 marginal discoloration-

20 anatomical form (proximal)- 30 surface quality- 40

Indices B for restorations performed using horisontal layering technique were

as follows color match-30 marginal adaptation- 40 marginal discoloration-

30 anatomical form (proximal)- 30 surface quality- 30

Indices B for restorations performed using oblique layering technique were as

follows color match-30 marginal adaptation- 20 marginal discoloration- 10

anatomical form (proximal)- 40 surface quality- 30

19

Indices C for restorations performed using centripetal build-up technique were

as follows color match-0 marginal adaptation- 10 marginal discoloration- 0

anatomical form (proximal)- 0 surface quality- 0

Indices C for restorations performed using horisontal layering technique were

as follows color match-0 marginal adaptation- 20 marginal discoloration- 20

anatomical form (proximal)- 20 surface quality- 0

Indices C for restorations performed using oblique layering technique were as

follows color match-0 marginal adaptation- 0 marginal discoloration- 10

anatomical form (proximal)- 0 surface quality- 100

Discussions

For in vitro studies is difficult to reproduce the variables existent in oral cavity

like occlusal stress and pH and temperature changes (235) The clinical studies are

determinant in assessment of restorative techniques (300) The most researches

focuses on the influence of restorative technique on the reduction of lightcuring stress

(51 78 135)

VIII5 CONCLUSIONS

Oblique layering technique presents superior results regarding marginal

adaptation and marginal discoloration and is recommended for proximo-

occlusal dental caries close to enamel-cement jonction

Centripetal build-up presents good results regarding marginal adaptation and

anatomical form at proximal level (proximal surfaces and contact point)

Horisontal layering technique can be used for optimum results only in

proximal-occlusal cavities with moderate extension both in occlusal-cervical

and buccal-oral

20

CHAPTIX STUDY REGARDING MARGINAL SEALING STATUS IN

COMPOSITE RESINS LIMITED PROXIMO-OCCLUSAL RESTORATIONS

PERFORMED USING DIFFERENT TECHNIQUES

IX1INTRODUCTION

The contraction of composite resins can produce stress inside dental structure

The most contraction stress appears in the initial stages and development rate of stress

decreases gradually in time (5 98 160) The contraction stress of composite resins

can overpass adhesion strenght and can broke the link between dental tissues and

composite resin (73) When adhesion strenght is high stress can produce marginal

fracture or bulk fracture (74) These situations are associated with microleakage and

penetration of oral fluid and bacteria along dentinal walls endangering the pulpal

tissue or favourising secondary dental caries

IX2 AIM OF STUDY

The study aimed to assess the efficiency of marginal sealing along gingival

wall in limited proximal-occlusal restorations performed using three different

techniques

IX3MATERIALS AND METHOD

The study group included 30 teeth extracted for orthodontic and periodontal

reasons On every tooth two identical class II cavities (on mesial and distal surfaces)

were prepared with cylindrical burs under water cooling The gingival wall was

limited to enamel-cement jonction The cavity dimension were as follows 2 mm

buccal-oral 5mm depth Each tooth was introduced in a pattern of acrylat The

operator calibrated preparation technique on acrylat teeth in Simulation Laboratory of

UMF ―Gr T Popa Iaşi The 60 prepared cavities were randomly divided in three

study groups related to restorative technique The restoration were performed with

Filtek Z550 (3M ESPE) a nanohybrid composite resin The adhesive strategy

included etchamprinse in 2 steps and adhesive Adper Single Bond 2(3MESPE)

Group A (n=20) bulk restorative technique associated with lightcuring from

occlusal 40 seconds and from buccal and oral 20 seconds

Group B (n=20) oblique layering technique (first layer on buccal wall and

buccal frac12 of gingival wall was lightcured from buccal second layer on oral wall and

oral frac12 of gingival wall was lightcured from oral third oral as a triangle with point

oriented to gingival wall was lightcured from occlusal)

Group C (n=20) combined technique (bdquoflow layer on gingival and axial

walls lightcured under pressure only associated with solid composite resin layer)

The proximal surfaces were performed using Tofflemire and metallic matrices After

removal of matrices every restoration was lightcured for another 20 seconds Two

layers aof varnish were applied on composite resins restorations excepting cavity

margins and an area of 1 mm around them The samples were introduced in methylen

21

blue 10 for 48 hours After this stage samples were washed with water and teeth

were cut longitudinally with a diamonded disc

The die penetration was assessed with Zeiss (Iena Germany) X20 microscope

accordingly to four scores (0-3)

0 ndash no penetration

1 ndash die infiltration until external half of gingival wall

2 ndash die infiltration on all gingival wall

3 ndash die infiltration on gingival wall and axial wall

IX4RESULTS AND DISCUSSIONS

The result of die penetration are presented in table IX1

TableIX1 The results for die penetration

Grup 0 1 2 3

A (bulk) 0 0 3 17

B (layering) 0 4 5 11

C (combined) 12 5 2 1

In group A 17 sample had score 3 and 2 samples had score 2 In group B 11

sample had score 3 5 samples had score 2 and 4 sample had score 1 In group C with

best results 12 samples had score 0 5 samples had score 1 2 samples had score 2 1

sample had score 3

The recorded data were analysed using test Mann-Whitney The statistical

results are presented in tables IX2-IX4

Tables IX2a-b Mann-Whitney for comparisons of microleakage values between

bulk technique and incremental technique

Ranks

Restorative technique N Mean Rank Sum of Ranks

Scores

frequency

A ndash bulk technique 20 2420 24200

B ndash incremental

technique

20 1680 16800

Total 40

Test Statisticsb

scores

frequency

Mann-Whitney U 29000

Wilcoxon W 168000

Z -1970

Asymp Sig (2-tailed) 049

Exact Sig [2(1-tailed Sig)] 123a

a Not corrected for ties

b Grouping Variable restorative technique

22

Tables IX3a-b Mann-Whitney for comparisons of microleakage values between

bulk technique and mixed technique

Ranks

Restorative technique N Mean Rank Sum of Ranks

scores

frequency

A ndash bulk technique 20 3090 30900

C ndash mixed technique 20 1010 10100

Total 40

Test Statisticsb

scores

frequency

Mann-Whitney U 500

Wilcoxon W 101000

Z -4021

Asymp Sig (2-tailed) 000

Exact Sig [2(1-tailed Sig)] 000a

a Not corrected for ties

b Grouping Variable restorative technique

Tables IX4a-b Mann-Whitney test for comparisons of microleakage values

between incremental technique and mixed technique

Ranks

Restorative technique N Mean Rank Sum of Ranks

scores

frequency

B ndash incremental

technique

20 2990 29900

C ndash mixed technique 20 1210 12100

Total 40

Test Statisticsb

scores

frequency

Mann-Whitney U 5500

Wilcoxon W 121000

Z -3492

Asymp Sig (2-tailed) 000

Exact Sig [2(1-tailed Sig)] 000a

a Not corrected for ties

23

Test Statisticsb

scores

frequency

Mann-Whitney U 5500

Wilcoxon W 121000

Z -3492

Asymp Sig (2-tailed) 000

Exact Sig [2(1-tailed Sig)] 000a

a Not corrected for ties

b Grouping Variable tehnrestaurare

The results of microleakage degree were statistically significant when the

three restorative techniques were compared The results showed that best restorative

technique regarding marginal sealing in cervical area is combined technique followed

by oblique layering technique The use of layering techniques limits the development

of contraction forces between oposite walls event that favourises bulk stress voids

formation and fissure inside dental tissues The results of our study are similar with

other studies (114 293)

IX5 CONCLUSIONS

The values of die penetration at gingival wall were statistically different

between the three restorative techniques

We concluded that all restorative methods were associated with lightcuring

contraction and marginal microleakage

The combined technique was associated with lowest lightcuring contraction

and die penetration

The bulk technique was associated with highest lightcuring contraction and die

penetration

24

CHAPTX STUDY REGARDING THE EFFECTS OF ETCHING ON

ENAMEL AND DENTINE IN CERVICAL AREA FOR PROXIMAL

CAVITIES AT LATERAL DENTAL GROUP

X1 INTRODUCTION

The studies reported marginal defects and high microleakage at the level of

gingival margins localised in cervical area or close to enamel-cement jonction for

high percents of proximal-occlusal composite resins restorations (8485) The good

adhesion is requested to insure restoration longevity and to prevent marginal

microleakage and presence of secondary marginal dental caries The adhesion

strenght of different adhesive systems can vary accordingly to tissues areas (204 240)

and to variations in dentinal structures (234 330) Most studies focused on adhesive

systems performances used healthy dentine close to pulp room but in case of class II

restorations there are particular features that influences the adhesion at the level of

gingival margins

The surface topography is an important property that determines the

interaction manner between surfaces The surface roughness and surface energy can

increase or decrease the adhesion of composite resins to the hard dental tissues

X2 AIM OF STUDY

The aim of study was to compare surface roughness of enamel and dentine

after etching related to different distances related to enamel-dentinecement jonction

X3 MATERIALS AND METHODS

The study group included 20 molars extracted from orthodontics or

periodontal reasons with intact proximal surfaces The teeth were cut longitudinally in

sens buccal-oral with diamond discs under water cooling

A group study (10 teeth) included 10 samples obtained through transversal

cutting at distance of 2mm from enamel-dentinecement jonction and 10 samples

obtained through transversal cutting at distance of 15 mm from enamel-

dentinecement jonction Another study group (10 teeth) included 10 samples

obtained through transversal cutting at distance of 1mm from enamel-dentinecement

jonction and 10 samples obtained through transversal cutting at distance of 05 mm

from enamel-dentinecement jonction All these samples were divided in two halfes

through mesial-distal cutting The samples finishing was performed with abrasive

paper (100-4000) and final polishing was performed with a device Buehler model

Minimet with slices introduced in ultrasound bath for 4 minutes The second half of

each sample was etched for 15 seconds with ortophosphoric acid 37 for 15 seconds

Slices were washed with distilled water for 30 seconds after etching and dried

The samples were analysed with atomic force microscopy (AFM) regarding

surface roughness The results were expressed as relative variation of roughness

X4 RESULTS AND DISCUSSIONS

The aspect of etched enamel at 2 mm distance from ECJ can be seen in figure

X1 (section 10 microm) The surface roughness is higher comparing with sample before

etching

25

După gravajul cu acid ortofosforic 37

The aspect of etched enamel at 15 mm distance from ECJ can be seen in

figure X2 (section 10 microm) The surface roughness is higher comparing with sample

before etching but lower comparing with sample at 2 mm from ECJ

The aspect of etched enamel at 1 mm distance from ECJ can be seen in figure

X3 (section 10 microm) The surface roughness is higher comparing with sample before

etching but lower comparing with sample at 15mm and 2 mm from ECJ

The aspect of etched enamel at 15 mm distance from ECJ can be seen in

figure X4 (section 10 microm) The surface roughness is higher comparing with sample

before etching but lower comparing with sample at 1 mm 15 mm and 2 mm from

ECJ

FigX1 3D aspect of enamel at 2 mm from ECJ

after etching (10 microm)

FigX2 3D aspect of enamel at 15 mm from ECJ

after etching (10 microm)

FigX3 3D aspect of enamel at 1 mm from ECJ

after etching (10 microm)

FigX4 3D aspect of enamel at 05 mm from ECJ

after etching (10 microm)

26

The mean values of squared roughness for dentine and enamel before etching

are presented in tables X1 and X2

Table X1 Squared roughness values for dentine samples before and after etching

Before etching (nm) After etching (nm)

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

sample

1

335 282 283 259 1149 947 901 879

sample

2

352 284 274 266 1127 939 883 875

sample

3

357 273 278 263 1152 953 876 867

sample

4

323 269 264 258 1146 942 895 883

sample

5

348 298 271 268 1153 944 904 878

sample

6

339 274 278 273 1158 937 893 892

sample

7

352 283 269 266 1145 944 899 876

sample

8

349 292 272 274 1166 942 907 869

sample

9

357 284 275 265 1132 939 893 879

sample

10

348 281 277 262 1142 941 899 878

Table X2 Squared roughness values for enamel and dentine samples before and after

etching

Before etching (nm) After etching (nm)

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

sample 1 422 342 309 313 2255 1114 874 845

sample 2 418 338 324 304 2236 1102 882 839

sample 3 413 334 315 303 2239 1115 873 833

sample 4 416 336 322 308 2242 1116 868 842

sample 5 426 332 315 294 2218 1103 877 829

sample 6 412 332 317 306 2237 1099 874 847

sample 7 414 335 322 314 2252 1102 876 834

sample 8 416 325 318 313 2239 1106 875 838

sample 9 418 328 314 299 2246 1113 879 836

sample 10 413 334 316 305 2242 1104 873 839

The results for samples before etching prove a decreasing tendency for mean

values of squared roughness surface beginning with areas placed at distance of 2 mm

from ECJ (346 nm) followed by areas placed at distance of 15 mm from ECJ (282

nm) 1 mm from ECJ (274 nm) and 05 mm from ECJ (265 nm) After etching the

decreasing tendency maintained for dentine localised at 2 mm from ECJ to dentine

localised at 05 mm from ECJ The mean values of squared roughness after etching

were three times higher (tables X3)

27

Table X3 Squared roughness values for enamel and dentine samples before and

after etching

Dentine Enamel

Before etching

(nm)

After etching

(nm)

Before etching

(nm)

After etching

(nm)

2 mm ECJ 346 1147 416 2237

15 mm ECJ 282 942 333 1107

1 mm ECJ 274 895 317 875

05 mm ECJ 265 877 305 838

The descriptive statistics data for surface roughness of dentine before and after

etching are presented in tables X4 si X5

Table X4 Descriptive statistics for dentine samples before etching

Statistics

Dentine 2mm

before etching

Dentine 15mm

before etching

Dentine 1mm

before etching

Dentine 05mm

before etching

N Valid 10 10 10 10

Missing 0 0 0 0

Mean 346000 282000 274100 265400

Std Error of Mean 33830 27487 17026 16746

Std Deviation 106979 86923 53841 52957

Skewness -1214 354 -314 348

Std Error of Skewness 687 687 687 687

Kurtosis 1141 049 336 -539

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 3230 2690 2640 2580

Maximum 3570 2980 2830 2740

Table X5 Descriptive statistics for dentine samples after etching

Statistics

Dentine 2mm

after etching

Dentine 15mm

after etching

Dentine 1mm

after etching

Dentine 05mm

after etching

N Valid 10 10 10 10

Missing 0 0 0 0

1147000 942800 895000 877600

Std Error of Mean 36545 14591 29926 22020

Std Deviation 115566 46140 94634 69634

Skewness -267 1169 -951 535

Std Error of Skewness 687 687 687 687

Kurtosis 043 1776 564 1416

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 11270 9370 8760 8670

28

Statistics

Dentine 2mm

after etching

Dentine 15mm

after etching

Dentine 1mm

after etching

Dentine 05mm

after etching

N Valid 10 10 10 10

Missing 0 0 0 0

1147000 942800 895000 877600

Std Error of Mean 36545 14591 29926 22020

Std Deviation 115566 46140 94634 69634

Skewness -267 1169 -951 535

Std Error of Skewness 687 687 687 687

Kurtosis 043 1776 564 1416

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 11270 9370 8760 8670

Maximum 11660 9530 9070 8920

To choose the statistical test to compare roughness surface values was

performed a test Shapiro-Wilk If p is lower or equal with 0005 than hypothesis of

distribution normality is rejected (distribution deviates from normal form) In the table

X6 the distributions are normal The statistical test will be test t for pair samples

Table X6 Test Shapiro-Wilk for dentine samples

Tests of Normality

Kolmogorov-Smirnov

a Shapiro-Wilk

Statistic df Sig Statistic df Sig

Dentine 2mm before etching 274 10 032 877 10 122

Dentine 15mm after etching 209 10 200 952 10 689

Dentine 1mm before etching 134 10 200 983 10 980

Dentine 05mm before etching 155 10 200 949 10 661

Dentine 2mm after etching 133 10 200 977 10 946

Dentine 15mm after etching 197 10 200 916 10 329

Dentine 1mm after etching 216 10 200 925 10 401

Dentine 05 after etching 220 10 185 933 10 474

Enamel 2mm before etching 193 10 200 898 10 207

Enamel 15mm before etching 170 10 200 977 10 947

Enamel 1mm before etching 157 10 200 952 10 689

Enamel 05mm before etching 165 10 200 943 10 590

Enamel 2mm after etching 235 10 124 925 10 404

Enamel 15mm after etching 209 10 200 871 10 102

Enamel 1mm after etching 189 10 200 964 10 834

Enamel 05mm after etching 142 10 200 983 10 978

a Lilliefors Significance Correction

29

Tests of Normality

Kolmogorov-Smirnov

a Shapiro-Wilk

Statistic df Sig Statistic df Sig

Dentine 2mm before etching 274 10 032 877 10 122

Dentine 15mm after etching 209 10 200 952 10 689

Dentine 1mm before etching 134 10 200 983 10 980

Dentine 05mm before etching 155 10 200 949 10 661

Dentine 2mm after etching 133 10 200 977 10 946

Dentine 15mm after etching 197 10 200 916 10 329

Dentine 1mm after etching 216 10 200 925 10 401

Dentine 05 after etching 220 10 185 933 10 474

Enamel 2mm before etching 193 10 200 898 10 207

Enamel 15mm before etching 170 10 200 977 10 947

Enamel 1mm before etching 157 10 200 952 10 689

Enamel 05mm before etching 165 10 200 943 10 590

Enamel 2mm after etching 235 10 124 925 10 404

Enamel 15mm after etching 209 10 200 871 10 102

Enamel 1mm after etching 189 10 200 964 10 834

Enamel 05mm after etching 142 10 200 983 10 978

a Lilliefors Significance Correction

This is a lower bound of the true significance

The results of test t for pair dentine samples before and after etching are

presented in table X

Table X7 Test t for dentine before and after etching

Paired Samples Test

Paired Differences

t df

p (2-

tailed)

95 Confidence

Interval of the

Difference

Mean

Std

Dev

Std

Error

Mean Lower Upper

Pair

1

dentine2mmbeforeetching-

dentine2mmafteretching

-

8010000

174801 55277 -

8135045

-

7884955

-

144906

9 000

Pair

2

dentine15mmbeforeetching-

dentine15mmafteretching

-

6608000

102394 32380 -

6681248

-

6534752

-

204079

9 000

Pair

3

dentine1mmbeforeetching-

dentine1mmafteretching

-

6209000

117799 37251 -

6293269

-

6124731

-

166678

9 000

30

Paired Samples Test

Paired Differences

t df

p (2-

tailed)

95 Confidence

Interval of the

Difference

Mean

Std

Dev

Std

Error

Mean Lower Upper

Pair

1

dentine2mmbeforeetching-

dentine2mmafteretching

-

8010000

174801 55277 -

8135045

-

7884955

-

144906

9 000

Pair

2

dentine15mmbeforeetching-

dentine15mmafteretching

-

6608000

102394 32380 -

6681248

-

6534752

-

204079

9 000

Pair

3

dentine1mmbeforeetching-

dentine1mmafteretching

-

6209000

117799 37251 -

6293269

-

6124731

-

166678

9 000

Pair

4

dentine05mmbeforeetching-

dentine05mmafteretching

-

6122000

86384 27317 -

6183796

-

6060204

-

224109

9 000

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of dentine (

2mm 15 mm 1mm sau 05mm)

The descriptive statistics data for dentine surface roughness before and after

etching are presented in tables X8 and X9

Table X8 Descriptive statistics for enamel samples before etching

Statistics

Enamel 2mm

before etching

Enamel 15mm

before etching

Enamel 1mm

before etching

Enamel 05mm

before etching

N Valid 10 10 10 10

Missing 0 0 0 0

Mean 416800 333600 317200 305900

Std Error of Mean 13968 15217 14205 20355

Std Deviation 44171 48120 44920 64369

Skewness 1095 -156 -109 -411

Std Error of Skewness 687 687 687 687

Kurtosis 769 487 -118 -295

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 4120 3250 3090 2940

Maximum 4260 3420 3240 3140

31

Table X9 Descriptive statistics for enamel samples after etching

Statistics

Enamel 2mm

after etching

Enamel 15mm

after etching

Enamel 1mm

after etching

Enamel 05mm

after etching

N Valid 10 10 10 10

Missing 0 0 0 0

Mean 2237600 1107400 875100 838200

Std Error of Mean 31027 20232 11968 17436

Std Deviation 98116 63979 37845 55136

Skewness -850 267 042 040

Std Error of Skewness 687 687 687 687

Kurtosis 878 -1880 1082 -425

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 22180 10990 8680 8290

Maximum 22520 11160 8820 8470

To choose the statistical test to compare roughness surface values was

performed a test Shapiro-Wilk If p is lower or equal with 0005 than hypothesis of

distribution normality is rejected (distribution deviates from normal form) In the table

X10 the distributions are normal The statistical test will be test t for pair samples

Table X10 Test Shapiro-Wilk for enamel samples

Tests of Normality

Kolmogorov-Smirnova Shapiro-Wilk

Statistic df Sig Statistic df Sig

2mmenamel before etching 193 10 200 898 10 207

15mmenamel before etching 170 10 200 977 10 947

1mmenamel before etching 157 10 200 952 10 689

05mmenamel before etching 165 10 200 943 10 590

2mmenamel after etching 235 10 124 925 10 404

15mmenamel after etching 209 10 200 871 10 102

1mmenamel after etching 189 10 200 964 10 834

05mmenamel after etching 142 10 200 983 10 978

a Lilliefors Significance Correction

This is a lower bound of the true significance

The results of test t for pair enamel samples before and after etching are

presented in table X11

32

Table X11 Test t for enamel samples before and after etching

Paired Samples Test

Paired Differences

t df

p (2-

tailed)

95 Confidence

Interval of the

Difference

Mean

Std

Deviation

Std

Error

Mean Lower Upper

Pair

1

2mmenamel before

etching

2mmenamel after

etching

-18208 135220 42760 -

18304731

-

18111269

-

425815

9 000

Pair

2

15mmenamel before

etching

15mmenamel after

etching

-7738 73151 23132 -7790329 -7685671 -

334508

9 076

Pair

3

1mmenamel before

etching

1mmenamel after

etching

-5579 55468 17540 -5618679 -5539321 -

318065

9 065

Pair

4

05mmenamel before

etching

05mmenamel after

etching

-5323 60378 19093 -5366192 -5279808 -

278788

9 063

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel ( 2mm 15 mm 1mm sau

05mm) but the differences statistical significant are present only for enamel localised

at 2 mm from ECJ

X5CONCLUSIONS

The surfaces of enamel and dentine at cervical level record decreases of

roughness related to the decrease of distance to ECJ

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel but the differences

statistical significant are present only for enamel localised at 2 mm from ECJ

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of

dentine

33

CHAPTXI FEA STUDY REGARDING THE BIOMECHANICAL

BEHAVIOUR AND FRACTURE RESISTANCE OF PROXIMO-OCCLUSAL

AMALGAM AND COMPOSITE RESINS RESTORATIONS

XI1INTRODUCTION AIM OF STUDY

The individual variation of patients morphological and functional complexity

of tissues as well as difficult access limit the possibilities to investigate in clinical

studies the biomechanical behaviour of proximo-occlusal restorations In this context

simulation of the biomechanics for direct restorations represents an interesting

interdisciplinar domain in actual dentistry research

The study focused on two direction

- analysis of role of forces intensity on biomechanical behaviour related to

cavity dimension and material

- analysis of tension inside restoration structure related to forces intensity

XI2MATERIALS AND METHODS

The stages of finite element analysis study are as follows

object modelling (bicusps and proximo-occlusal restoration)

definition of parameters for materials and dental tissues

meshing

constraints and loading

types of contacts

equations system definition

results of simulation

The object 3D modelling was performed in Rhinoceros (figure XI1) The

definition of parameters was performed for Poisson constant Young modulus density

(table XI1) The selected materials were amalgam and composite resins The

analysed tissues were dentine and enamel The meshing constraints loading were

performed for forces of 200N 400N 600N 800 N The analysis was performed using

software COSMOSWorks 2010

34

Fig XI1 3D modellation of bicusp

Table XI1 Values of Young modulus Poisson constant compression resistance for

amalgam composite resin enamel (amalgam compozit smalţ)

Material Young modulus (GPa) Poisson constants

Compression

resistance

(Mpa)

Amalgam 55 033 483

Enamel 48 03 400

Composite

resin 220 022 345

Fig XI2 The forces and constraints application

The results are presented in values and culours red colours representing areas

with maximum values of tensions produced under influence of masticatory forces

The tensions produced in amalgam restoration are in a range from 0 to 22886

(force 800 N) The maximum von Misses tensions are associated with cervical area

of amalgam restorations This aspect proves that first modification in interface

restoration-cavity margins will appear at the level of gingival wall First marginal

35

defects and fissures in restoration bulk will appear at tensions over 1600Mpa

associated with forces of 800N for extended amalgam proximo-occlusal restorations

The tensions produced in composite resin restorations are in a range from 0 to

2285 (force 800 N) The maximum von Misses tensions are associated with cervical

area of composite resin restorationsThis aspect proves that first modification in

interface restoration-cavity margins will appear at the level of gingival wall First

marginal defects and fissures in restoration bulk will appear at tensions over 1716

Mpa associated with forces of 600N for moderate and extended composite resins

proximo-occlusal restorations

Fig XI3a-b ndash Simulated model of proximo-occlusal restoration

FigXI4a-b Dental amalgam restoration Cervical tension associated with 600 N

(c)800 N (d)

FigXI5a-b Composite resin restoration Cervical tension associated with 600 N

(c)800 N (d)

36

The deformation of amalgam can be produced only when is associated with

fissures in bulk of restorations while composite resins restorations present

deformation when are associated with a modification of volume and form because of

repeated action of medium forces on long term or high forces on short term (figures

XI4 XI5)

Fig XI4 Material deformation in area of maximum tension

000E + 00

500E -02

100E -01

150E -01

200E -01

250E -01

1 4 7 101316192225283134374043464952555861646770737679

Amalgam C ompoz it

Figura XI5 Deformarea funcție de material

The amalgam and composite resins were treated as homogenous isotropic and

liniar The advantage of this type of FEA study is that restorations parameters can be

modified any time is necessary both in arhitecture geometry and material indices

variability The results of this study sustain the conclusions of other FEA studies

focused on biomechanical behaviour of posterior restorations performed with

amalgam and composite resins(35 62 76 143)

37

XI4CONCLUSIONS

bull The amalgam in class II restorations has a low deformation tendency because

of uniform distribution of tension inside material

bull Composite resins class II restorations accumulate higher tensions comparing

with amalgam but deformation is avoided for a time because of the adhesion

forces performed between molecules under moderate oral forces In case of

high oral forces (600-800N) the risk of fracture in moderate class II

restorations is higher comparing with amalgam proximo-occlusal restorations

For extended class II restorations and forces of 600 N composite resins present

highest risk of fracture and deformation The von Misses tension at the

cervical interface restorationtooth can reach 1600Mpa

bull The amalgam in moderate class II restorations can resist to deformation even

for high intensity forces limited to 600N In extended class II restorations the

risk of deformation and fracture increases at values of 600N-800N of oral

forces The von Misses tension at the cervical interface restorationtooth can

reach 1700 Mpa

38

FINAL CONCLUSIONS

Amalgam proximo-occlusal restorations with minimum 6-years age present

excellent results for parameters anatomic form (occlusal) marginal

discoloration and marginal secondary dental caries good results for

parameters anatomic form (proximal) and marginal adaptation and poor results

for surface quality

Composite resins proximo-occlusal restorations (bicusps) with minimum 6-

years age present excellent results for parameters color match marginal

discoloration and marginal secondary dental caries and good results for

parameters anatomic form (occlusal proximal) marginal adaptation surface

quality

Composite resins proximo-occlusal restorations (molars) with minimum 6-

years age present good results for parameters color match marginal

discoloration marginal secondary dental caries marginal adaptation and poor

results for parameters anatomic form (occlusal) (54 indices Ryge C)

anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The restorations extended at external third of occlusal surface present highest

percents of indices C regarding anatomic form (occlusal) (54 indices Ryge

C) anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The exceeding of 6-years age will require careful monitorisation for early

interventions through polishing sealing reshaping and even replacement for

restorations with major defects

Oblique layering technique presents superior results regarding marginal

adaptation and marginal discoloration and is recommended for proximo-

occlusal dental caries close to enamel-cement jonction

Centripetal build-up presents good results regarding marginal adaptation and

anatomical form at proximal level (proximal surfaces and contact point)

Horisontal layering technique can be used for optimum results only in

proximal-occlusal cavities with moderate extension both in occlusal-cervical

and buccal-oral

The values of die penetration at gingival wall were statistically different

between the three restorative techniques

We concluded that all restorative methods were associated with lightcuring

contraction and marginal microleakage

The combined technique was associated with lowest lightcuring contraction

and die penetration

The bulk technique was associated with highest lightcuring contraction and die

penetration

39

The surfaces of enamel and dentine at cervical level record decreases of

roughness related to the decrease of distance to ECJ

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel but the differences

statistical significant are present only for enamel localised at 2 mm from ECJ

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of

dentine

bull The amalgam in class II restorations has a low deformation tendency because

of uniform distribution of tension inside material

bull Composite resins class II restorations accumulate higher tensions comparing

with amalgam but deformation is avoided for a time because of the adhesion

forces performed between molecules under moderate oral forces In case of

high oral forces (600-800N) the risk of fracture in moderate class II

restorations is higher comparing with amalgam proximo-occlusal restorations

For extended class II restorations and forces of 600 N composite resins present

highest risk of fracture and deformation The von Misses tension at the

cervical interface restorationtooth can reach 1600Mpa

bull The amalgam in moderate class II restorations can resist to deformation even

for high intensity forces limited to 600N In extended class II restorations the

risk of deformation and fracture increases at values of 600N-800N of oral

forces The von Misses tension at the cervical interface restorationtooth can

reach 1700 Mpa

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2004 20939-946

49Cardoso P Sadek F Microtensile bond strength on dentin using new adhesive

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51Carvalho RM JC Pereira M Yoshiyama DH Pashley A review of

polymerization contraction the influence of stress development versus stress

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Study Orthodontic Tooth Movement J Dent Res 2005 84(5)428-433

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posterior restorations 12-month results Eur J Dent 2010 Jan4(1)57-65

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59Chen HY Manhart J Hickel R Kunzelmann KH Polymerization contraction

stress in light-cured packable composite resinsDent Mater 200117253-259

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polymerization contraction stress of composites J Dent Res 2000 79812ndash817

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Behinderten Dtsch Zahnartzlicher 1999 54 96-102

62Cohen BI Pagnillo MK Deutsch ASMusikant BL Fracture Strength of

Three Core Restorative Materials Supported with or without a Prefabricated Split-

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63Colli P Brannstrom M The marginal adaptation of four different bonding agents

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64Collins CJ Bryant RW Hodge KL A clinical evaluation of posterior composite

resin restorations 8-year findings J Dent 199826(4) 311ndash317

65Condon JR Ferracane JL Assessing the effect of composite formulation on

polymerization stress J Am Dent Assoc2000 131497-503

66Cook WD Moopnar M Influence of chemical structure on the fracture

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68Crim GA Microleakage of three resin placement techniques Am J Dent

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69Dauvillier B Aarnts M Feilzer A The competition between the composite-

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70Dauvillier BS Aarnts MP Feilzer AJ Developments in shrinkage control of

adhesive restoratives J Esthet Dent 2000 12291-299

71Dauvillier BS Aarnts MP Feilzer AJ Modeling of the viscoelastic behavior of

dental light-activated resin composites during curing Dent Mater 200319277ndash285

72Davidson CL Gee AJ Feilzer A The competition between the composite-dentin

bond strength and the polymerization contraction stress J Dent Res 1984

63(12)1396-9

73Davidson CL AJ Feilzer Polymerization shrinkage and polymerization

shrinkage stress in polymer-based restoratives J Dent Res 199725435ndash440

74Davidson CL Resisting the curing contraction with adhesive composites J

Prosthet Dent 198655446ndash7

75Davis RD Mayhew RB A clinical comparison of three anterior restorative resins

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Dent200899131-40

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79Demirci M Tuncer S Yuceokur AA Prevalence of caries on individual tooth

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80De Munck J Van Meerbeek B Satoshi I Vargas M Yoshida Y Armstrong S

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82Deutsch WM Simecek JW Dental emergencies among Marines ashore in

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85Dietschi D Herzfeld D In vitro evaluation of marginal and internal adaptation of

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86Dietschi D Marginal adaptation and seal of direct and indirect Class II composite

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88Diefenderfer KE Rienhardt JW Shear bond strengths of ten adhesive

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89Donly KJ Jensen ME Triolo PA clinical comparison of resin composite inlay

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91Eberhard J Hartman B Lenhard M Mayer T Kocher T Eickholz P Digital

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93Eick JD Welch FH Polymerization shrinkage of posterior composite resins and

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96Feilzer AJ AJ De Gee CL Davidson Increased wall-to-wall curing

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98Feilzer AJ de Gee AJ Davidson CL Relaxation of polymerization contraction

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99Feilzer AJ De Gee AJ Davidson CL Setting stress in composite resin in relation

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100Feilzer AJ Dooren LH de Gee AJ Davidson CL Influence of light intensity

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101Fennis YL Verdischbot EH vanrsquot Hof MA Performance of some diagnostic

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108Francci C Loguercio AD Reis A Carrilho MR A novel filling technique for

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113Gladys S Clinical and semiquantitative marginal analysis of four tooth-coloured

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Effects of irradiation mode and filling technique on resindentin bond strength in

Class I cavities J Dent Res 200281 (Abstract)

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117Gordon JChristensen G Why switch to digital radiography J Am Dent

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848

126Hashimoto M Tay FR Ito S Sano H Kaga M Pashley DH Permeability of

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138Hintze H Wenzel A Danielen B Behaviour of approximal carious lesions

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Dent Oral Epidemiol 200533(3)212-8

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154Jokstad A Mjor IA Analyses of long-term clinical behaviour of class II

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restorative decisions made on the basis of simulated bitewing radiographs

Community Dentistry and Oral Epidemiology 1994 22(2) 71-74

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1243

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Biology199843(8)629-632

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179Lăcătuşu St Luminiţa Costinescu Andrian S Gianina Iovan Valeria

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Edition of the Balkan Medical Days

Stomatological Section Abstract nr1091999128

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200126302ndash307

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Dentistry and Oral Epidemiology 1996 24 106-11

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20(3)236-43

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Polymerization shrinkage effects of boundary conditions and filling technique of

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50

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Quintessence Int 2004 35(2)156-61

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Dentomaxillofac Radiol 2007 Oct36(7)377-81

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Three-year clinical evaluation of composite and ceramic inlays Am J Dent 2001

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79369 (Abstract)

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Orthop921987499ndash505

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313Tay FR Frankenberger R Krejci I Bouillaguet S Pashley DH Carvalho

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199930249ndash257

319Vaarkamp J Ten Bosch J Verdonschot EH Quantitative diagnosis of small

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Oral Surg Oral Med Oral Pathol 198661(3)289-96

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451

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333Weaver WS Blank LW Pelleu GB Jr A visible light activated resin cured

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334Wendt SL Microleakage and cusp fracture resistance of heattreated composite

resin inlays Am J Dent 4(1)10-14 1991

335Wenzel A Hintze H Mikkelsen L Mouyen F Radiographic detection of

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1991 72 621-6

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Dentomaxillofac Radiol 1993 22 131-4

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enhance diagnosis in dental practice a review Int Dent J 1993 43 99-108

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Radiology 27(1)3-11 1998

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Dent 200114177ndash185

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cooper content amalgam restorations in a multiclinical trial JDent1996 24 203-210

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1996751477-83

343Yap AU Effectiveness of polymerization in composite restoratives claiming bulk

placement Impact of cavity depth and exposure time Oper Dent 2000 25113-120

59

344Yeşilyurt C Bulucu B Bond strength of total-etch dentin adhesive systems on

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Contemporary Dental Practice 7(2) 20061-13

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study on adhesive performance of functional monomers J Dent Res 2004 83 454-

458

346Yoshiyama M Tay FR Doi J Nishitani Y Yamada T Itou K Carvalho RM

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  • COPERTA REZUMAT ENGLEZA (MEREUTA)pdf
  • REZUMAT ENGLEZA DR MEREUTA DENISSpdf
Page 4: UNIVERSITATEA DE MEDICINA SI FARMACIE “GR Doctorat/Rezumat... · universitatea de medicina si farmacie “gr.t.popa” iasi facultatea de medicina dentara rezumatul tezei de doctorat

1

CONTENT

GENERAL PART

INTRODUCTION3

CHAPTI General aspects regarding proximo-occlusal carious dental

lesions5

CHAPTII Clasic and modern methods for diagnostic of noncavitary and

incipient proximal dental caries9

CHAPTIII General aspects regarding composition and properties of direct

proximal-occlusal restorations20

CHAPT IV Actual data regarding longevity of direct proximo-occlusal

restorations38

CHAPT V Studies regarding clinical performance of proximo-occlusal indirect

restorations versus direct restorations45

PERSONAL PART

CHAPTVI The aim of research theme General objectives Methodology48

CHAPTVII Study regarding clinical performance of proximo-occlusal

amalgam and composite resins restorations50

VII1Introduction50

VII2Aim of study50

VII3Materials and methods50

VII4Results and discussions52

VII5Conclusions82

CHAPTVIII Clinical performance of composite resins restorations related to

restorative technique 12-months longitudinal study83

VIII1Introductions83

VIII2Aim of study83

VIII3Materials and methods83

VIII4Results and discussions85

VIII5Conclusions111

CHAPTIX Study regarding marginal sealing status in composite resins limited

proximo-occlusal restorations performed using different techniques112

IX1Introduction112

IX2Aim of study115

IX3Materials and methods115

IX4Results and discussions118

IX5Conclusions124

2

CHAPTX Study regarding the effects of etching on enamel and dentine in

cervical area for proximal cavities localised at lateral dental group125

X1Introduction125

X2Aim of study125

X3Materials and methods126

X4Results and discussions126

X5Conclusions147

CHAPTXI FEA study regarding the biomechanical behaviour and fracture

resistance of proximo-occlusal amalgam and composite resins restorations148

XI1Introduction148

XI2Aim of study148

XI3Materials and metods149

XI4Results and discussions152

XI5Conclusions182

FINAL CONCLUSIONS182

PERSONAL CONTRIBUTION183

REFERENCES184

3

INTRODUCTION

Academic European of Operative Dentistry warned about the factors that

impose to the dentists the use of composite resins on large scale as materials for the

direct restorations at lateral dental group the mass-media rejection of amalgam the

patients desire for esthetic restorations even the request for biological principles to

minimise sacrifice of healthy dental tissues However amalgam must be used in

particular situations represented by extensive carious lesions high cariogenic risk and

bruxism

In this context any comparative study focused on both amalgam and

composite resins proximo-occlusal restorations presents a high practical importance

for dentists Besides numerous fillings replacements are based on improper decisions

regarding wear status of restorations than a real clinical failure Dentists must also

take in account the specific oral environment conditions especially for adhesive

materials that are laquosensitive technique raquo

The final decision and materialrestorative technique selection must be based

on a balance between resistance longevity and priceefficiency

4

CHAPTVI THE AIM OF STUDY GENERAL OBJECTIVES DATA

COLLECTION AND PROCESSING

VI1 The reason for theme choice

The reason for theme choice was determined by the fact that any comparative

study focused on both amalgam and composite resins proximo-occlusal restorations

presents a high practical importance for dentists Also it is a request to highlight

clinical and paraclinical aspects regarding factors that influence clinical performance

of direct composite resins restorations performed at the level of lateral dental group

The support offered by Discipline Cariology and Restorative Dentistry and Institute

Petru Poni allowed the performance of our researches

VI2Aim objectives methodology

The objectives of my researches were as follows

- Selection of literature data regarding histological morphopatological

etiopathogenic spects of dental caries posibilities of diagnostic for proximal

incipient dental caries using both clasic and modern diagnostic technology

properties and clinical behaviour of dental amalgam and composite resins and

other adhesive materials used in posterior restorations literature data

regarding longevity of proximo-occlusal direct restorations and literature data

regarding clinical performances of indirect restorations versus direct

restorations for lateral dental group

- Performing an epidemiological study based on clinical data (indices Ryge

modified USPHS) on posterior direct restorations

- The comparing research regarding clinical performance of posterior composite

resines restorations performed using different restorative techniques

- In vitro study focused on the assessment of the marginal sealing at the cervical

area of proximo-occlusal composite resins restorations

- In vitro study focused on the effects of etching at the cervical area for

proximo-occlusal composite resins restorations

- FEA (finite element analysis) study focused on the assessment of

biomechanical behaviour and resistance to fracture and deformation of

simulated proximo-occlusal restorations from amalgam and composite resins

To realise the proposed aims the working protocol was as follows

- clinical assessment of a study group with age 17-49 with class II dental caries

treated by one dentist using amalgam and composite resins

5

- clinical assessment of a study group with age 15-65 with class II dental caries

treated by one dentist using a selected composite resin and different restorative

techniques

- performing of data base for statistical processing

Database was collected between 2008-2011 in private practice and Faculty of

Dental Medicine UMF ―GrTPopa Iasi The paraclinical studies were performed in

collaboration with Institute Petru Poni Iasi

The patients were informed and gave their written consent to be included in

study groups Every patient was submitted to clinical examen and radiographic

examen The clinical examens consisted in assessment of Ryge indices (modified

USPHS) at baseline 6 months 12 months 18months and 24 months

The paraclinical tests consisted in

- in vitro tests on extracted teeth consisting in optical and atomic force

microscopy to assess the influence of different restorative techniques on the cervical

marginal sealing

- measurement of surface status (enamel dentine) after etching (different time

intervals) using AFM (Atomic Force Microscopy)

- statistical analysis in SPSS 13 for comparison of microleakage degree at

cervical level related to different restorative techniques

- FEA study performed using software COSMOSWorks 2010 for the

assessment of biomechanical behaviour of simulated posterior amalgam and

composite resins restorations

VI3 Data collecting and processing

The processing of reseraches data was performed using the follwing software

MS Office (graphs tables)

SPSS 16 (statistical tests)

The following statistical tests were used t Test test Kolmogorov-Smirnov test

Pearson test Wilcoxon The descriptive statistical analysis was performed using

Microsoft Excel and analitical statistical analysis was performed using SPSS 160

(SPSS Inc SUA)

6

CHAPTVII STUDY REGARDING CLINICAL PERFORMANCE OF

PROXIMO-OCCLUSAL AMALGAM AND COMPOSITE RESINS

RESTORATIONS

VII1 INTRODUCTION

The clinical performance of posterior direct restorations pn medium and long

term concerns dental practitioners that must correlate their therapeutical decisions

with material selection restorative technique external factors represented by oral

forces cariogenic risk patient parafunctions

VII2AIM OF STUDY

The aim of study consisted in assessment of clinical performance of amalgam

and composite resins proximal-occlusal restorations 4-years old

VII3 MATERIALS AND METHOD

The study group included 200 proximal-occlusal amalgam (n=100) and

composite resins (Herculite Kerr) (n=100) restorations 4-years old The study was

performed on 55 patients with age between 17-49 years examined in Dental Medicine

Faculty UMFGrTPopa Iaşi The assessment of fillings status was performed

using Ryge indices modified USPHS (US Public Health Service) (table 1) The

clinical peformance of restorations was also correlated with dental group (molars

bicusps) extension (medium extended) and cariogenic risk (medium high) The

following parameters were assessed

- color match

- marginal adaptation (integrity)

- marginal discoloration

- anatomical form (proximal)

- surface quality

The results presentation was performed using Microsoft Excel

VII4 RESULTS AND DISCUSSIONS

AB

C

S1

6

64

30

0

20

40

60

80

A

B

C

Fig VII1 Anatomical form (occlusal)-amalgam restorations (molars)

7

AB

C

S1

26

64

100

10

20

30

40

50

60

70

A

B

C

Fig VII2 Anatomical form (occlusal)-amalgam restorations (bicusps)

AB

C

S1

0

46

54

0

10

20

30

40

50

60

A

B

C

Fig VII3 Anatomical form (occlusal)-composite resins restorations (molars)

Fig VII4 Anatomical form (occlusal)-amalgam restorations (bicusps)

AB

C

S1

12

72

16

0

10

20

30

40

50

60

70

80

A

B

C

FigVII5 Anatomical form (proximal)-amalgam restorations (molars)

AB

C

S1

38

56

60

10

20

30

40

50

60

A

B

C

FigVII6 Anatomical form (proximal)-amalgam restorations (bicusps)

AB

C

S1

10

54

36

0

10

20

30

40

50

60

A

B

C

8

AB

C

S1

8

64

26

0

10

20

30

40

50

60

70

A

B

C

FigVII7 Anatomical form (proximal)-composite resins restorations (molars)

AB

C

S1

34

66

100

10

20

30

40

50

60

70

A

B

C

FigVII8 Anatomical form (proximal)-composite resins restorations (bicusps)

AB

C

S1

36

44

20

0

5

10

15

20

25

30

35

40

45

A

B

C

FigVII9 Marginal adaptation (proximal)- amalgam restorations(bicusps)

AB

C

S1

20

50

30

0

5

10

15

20

25

30

35

40

45

50

A

B

C

FigVII10 Marginal adaptation (proximal)-amalgam restorations (molars)

AB

C

S1

16

60

24

0

10

20

30

40

50

60

A

B

C

FigVII11 Marginal adaptation (proximal)-composite resins restorations (bicusps)

9

AB

C

S1

12

54

34

0

10

20

30

40

50

60

A

B

C

FigVII12 Marginal adaptation (proximal)-composite resins restorations (molars)

AB

C

S1

22

54

24

0

10

20

30

40

50

60

A

B

C

FigVII13 Surface quality-amalgam restorations (bicusps)

AB

C

S1

10

54

36

0

10

20

30

40

50

60

A

B

C

FigVII14 Surface quality-amalgam restorations (molars)

AB

C

S1

12

68

20

0

10

20

30

40

50

60

70

A

B

C

FigVII15 Surface quality-composite resins restorations (bicusps)

AB

C

S1

8

70

22

0

20

40

60

80

A

B

C

FigVII16 Surface quality-composite resins restorations (molars)

10

A

C

S1

98

20

20

40

60

80

100

A

C

FigVII17a-b Prevalence of marginal dental cariesamalgam restorations (moderate

CR)

A

C

S1

92

80

20

40

60

80

100

A

C

FigVII18 Prevalence of marginal dental cariesamalgam restorations (high CR)

A

C

S1

94

60

20

40

60

80

100

A

C

FigVII19 Prevalence of marginal dental cariescomposite resins restorations (CR

moderate)

A

C

S1

82

18

0

10

20

30

40

50

60

70

80

90

A

C

FigVII20 Prevalence of marginal dental cariescomposite resins restorations (high

CR)

11

The study data sustain the results obtained by most studies focused on

posterior amalgam restorations However Hickelampcol (2001) reviewed literature data

and proved that many results varies accordingly to different clinical factors (133)

Roulet JF(1997) warned about limits of cross-sectional studies related to composite

resins restorations because of the absence of data regarding restorative techniques

practitioner experience presence or absence of optimum isolation factors related by

patient (266)

VII5CONCLUSIONS

Amalgam proximo-occlusal restorations with minimum 6-years age present

excellent results for parameters anatomic form (occlusal) marginal

discoloration and marginal secondary dental caries good results for

parameters anatomic form (proximal) and marginal adaptation and poor results

for surface quality

Composite resins proximo-occlusal restorations (bicusps) with minimum 6-

years age present excellent results for parameters color match marginal

discoloration and marginal secondary dental caries and good results for

parameters anatomic form (occlusal proximal) marginal adaptation surface

quality

Composite resins proximo-occlusal restorations (molars) with minimum 6-

years age present good results for parameters color match marginal

discoloration marginal secondary dental caries marginal adaptation and poor

results for parameters anatomic form (occlusal) (54 indices Ryge C)

anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The restorations extended at external third of occlusal surface present highest

percents of indices C regarding anatomic form (occlusal) (54 indices Ryge

C) anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The exceeding of 6-years age will require careful monitorisation for early

interventions through polishing sealing reshaping and even replacement for

restorations with major defects

12

CHAPTVIII CLINICAL PERFORMANCE OF COMPOSITE RESINS

RESTORATIONS RELATED TO RESTORATIVE TECHNIQUE 12-

MONTHS LONGITUDINAL STUDY

VIII1 INTRODUCTION

The restorative technique has a major influence over clinical performance of

composite resins restorations in proximo-occlusal cavities In this context researches

focused on correlations between technique and clinical performance of direct

restorations improve the dentist decision regarding restorative technique choice

VIII2AIM OF STUDY

The aim of study was to determine the clinical performance of composite

resins proximo-occlusal restorations performed using different restorative techniques

VIII3MATERIALS AND METHOD

The group study included 37 patients with age 18-42 years with moderat

ecariogenic risk The total number of composite resins restorations (Herculite XRV

Kerr) was 60 divided in three study groups (n=20)

I Centripetal build-up

II Oblique layering

III Horisontal layering

The coronal restorations were assessed at an interval of 12 months using

indices Ryge modified USPHS

- indice ALFA (A)- IDEAL CLINIC

- indice BRAVO (B)- ACCEPTABLE CLINIC

- indice CHARLIE (C)- UNACCEPTABLE CLINIC

VIII4 RESULTS AND DISCUSSIONS

The statistical tests Kruskal-Wallis and Mann-Whitney were performed to

confirm or infirm research hypotesis (the direct restorations performed using different

restorative techniques present statistical significant differences regarding clinical

performance for the assessed parameters)

13

TableVIII1a-b Groups study (Kruskal-Wallis Test)

Ranks

20 2960

20 2560

20 3630

60

20 3050

20 2420

20 3680

60

20 2490

20 3140

20 3520

60

Restorative_techniques

Centripetal build-up

Oblique layering

Horizontal layering

Total

Centripetal build-up

Oblique layering

Horizontal layering

Total

Centripetal build-up

Oblique layering

Horizontal layering

Total

Marginal_adaptation

Marginal_discoloration

Anatomical_form

N Mean Rank

Test Statisticsab

4913 8031 4900

2 2 2

086 018 086

Chi-Square

df

Asymp Sig

Marginal_

adaptation

Marginal_

discoloration

Anatomical_

form

Kruskal Wallis Testa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between the three restorative

techniques for parameter marginal adaptation (p=0086)

There are no statistical significant differences between the three restorative

techniques for parameter marginal discoloration (p=0018)

There are no statistical significant differences between the three restorative

techniques for parameter anatomical form (proximal) (p=0086)

TableVIII2 Comparing results between restorations performed using three

techniques (marginal adaptation marginal discoloration anatomical form) Marginal adaptation Centripetal build-upOblique layering p=04 ns

Centripetal build-upHorizontal layering p=0191 ns

Oblique layering Horizontal layering p=0028 s

Marginal discoloration Centripetal build-upOblique layering p=0103 ns

Centripetal build-upHorizontal layering p=0195 ns

Oblique layering Horizontal layering p=0005 s

Anatomical form Centripetal build-upOblique layering p=0137 ns

Centripetal build-upHorizontal layering p=0029 s

Oblique layering Horizontal layering p=0433 ns

ns nesemnificativ

s semnificativ

p probabilitate

14

Tables VIII3a-b Mann-Whitney test Comparing analysis regarding marginal

discoloration between restorations performed using oblique layering technique and

centripetal build-up technique

Ranks

20 2180 43600

20 1920 38400

40

Restorative_techniques

Centripetal build-up

Oblique layering

Total

Marginal_adaptation

N Mean Rank Sum of Ranks

Test Statisticsb

174000

384000

-841

400

495a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

adaptation

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between centripetal build-up

and oblique layering techniques regarding parameter marginal adaptation (p=0400)

Tables VIII4a-b Mann-Whitney test Comparing analysis regarding marginal

adaptation between restorations performed using horisontal layering technique and

centripetal build-up technique

Ranks

20 1830 36600

20 2270 45400

40

Restorative_techniques

Centripetal build-up

Horizontal layering

Total

Marginal_adaptation

N Mean Rank Sum of Ranks

Test Statisticsb

156000

366000

-1307

191

242a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

adaptation

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between centripetal build-up

and horisontal layering techniques regarding parameter marginal adaptation

(p=0191)

15

TablesVIII5a-b Mann-Whitney test Comparing analysis regarding marginal

adaptation between restorations performed using oblique layering technique and

horisontal layering technique

Ranks

20 1690 33800

20 2410 48200

40

Restorative_techniques

Oblique layering

Horizontal layering

Total

Marginal_adaptation

N Mean Rank Sum of Ranks

Test Statisticsb

128000

338000

-2191

028

052a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

adaptation

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There is statistical significant differences between horisontal layering and

oblique layering techniques regarding parameter marginal adaptation (p=0028)

Tables VIII6a-b Mann-Whitney test Comparing analysis regarding marginal

discoloration between restorations performed using oblique layering technique and

centripetal build-up technique

There are no statistical significant differences between centripetal build-up

and oblique layering techniques regarding parameter marginal discoloration

(p=0103)

Ranks

20 2260 45200

20 1840 36800

40

Restorative_techniques

Centripetal build-up

Oblique layering

Total

Marginal_discoloration

N Mean Rank Sum of Ranks

Test Statisticsb

158000

368000

-1632

103

265a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

discoloration

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

16

Tables VIII7a-b Mann-Whitney test Comparing analysis regarding marginal

discoloration between restorations performed using centripetal build-up technique and

horisontal layering technique

Ranks

20 1840 36800

20 2260 45200

40

Restorative_techniques

Centripetal build-up

Horizontal layering

Total

Marginal_discoloration

N Mean Rank Sum of Ranks

Test Statisticsb

158000

368000

-1299

194

265a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

discoloration

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between centripetal build-up

and horisontal layering techniques regarding parameter marginal discoloration

(p=0103)

Tables VIII8a-b Mann-Whitney test Comparing analysis regarding marginal

discoloration between restorations performed using oblique layering technique and

horisontal layering technique

Ranks

20 1630 32600

20 2470 49400

40

Restorative_techniques

Oblique layering

Horizontal layering

Total

Marginal_discoloration

N Mean Rank Sum of Ranks

Test Statisticsb

116000

326000

-2822

005

023a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

discoloration

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There is statistical significant differences between horisontal layering and

oblique layering techniques regarding parameter marginal discoloration (p=0005)

17

TablesVIII9 a-b Mann-Whitney test Comparing analysis regarding anatomical

form between restorations performed using centripetal build-up technique and oblique

layering technique

Ranks

20 1830 36600

20 2270 45400

40

Restorative_techniques

Centripetal build-up

Oblique layering

Total

Anatomical_form

N Mean Rank Sum of Ranks

Test Statisticsb

156000

366000

-1486

137

242a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Anatomical_

form

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between centripetal build-up

and oblique layering techniques regarding parameter anatomical form (p=0137)

Tables VIII10a-b Mann-Whitney test Comparing analysis regarding anatomical

form between restorations performed using centripetal build-up technique and

horisontal layering technique

Ranks

20 1710 34200

20 2390 47800

40

Restorative_techniques

Centripetal build-up

Horizontal layering

Total

Anatomical_form

N Mean Rank Sum of Ranks

Test Statisticsb

132000

342000

-2184

029

068a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Anatomical_

form

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between centripetal build-up

and horisontal layering techniques regarding parameter anatomical form (p=0029)

18

Tables VIII11a-b Mann-Whitney test Comparing analysis regarding anatomical

form between restorations performed using oblique layering technique and horisontal

layering technique

Ranks

20 1920 38400

20 2180 43600

40

Restorative_techniques

Oblique layering

Horizontal layering

Total

Anatomical_form

N Mean Rank Sum of Ranks

Test Statisticsb

174000

384000

-784

433

495a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Anatomical_

form

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between horisontal layering and

oblique layering techniques regarding parameter anatomical form (p=0433)

Indices A for restorations performed using centripetal build-up technique were

as follows color match-80 marginal adaptation- 60 marginal discoloration-

70 anatomical form (proximal)- 80 surface quality- 60

Indices A for restorations performed using horisontal layering technique were

as follows color match-70 marginal adaptation- 40 marginal discoloration-

50 anatomical form (proximal)- 50 surface quality- 70

Indices A for restorations performed using oblique layering technique were as

follows color match-70 marginal adaptation- 80 marginal discoloration- 90

anatomical form (proximal)- 60 surface quality- 70

Indices B for restorations performed using centripetal build-up technique were

as follows color match-20 marginal adaptation- 30 marginal discoloration-

20 anatomical form (proximal)- 30 surface quality- 40

Indices B for restorations performed using horisontal layering technique were

as follows color match-30 marginal adaptation- 40 marginal discoloration-

30 anatomical form (proximal)- 30 surface quality- 30

Indices B for restorations performed using oblique layering technique were as

follows color match-30 marginal adaptation- 20 marginal discoloration- 10

anatomical form (proximal)- 40 surface quality- 30

19

Indices C for restorations performed using centripetal build-up technique were

as follows color match-0 marginal adaptation- 10 marginal discoloration- 0

anatomical form (proximal)- 0 surface quality- 0

Indices C for restorations performed using horisontal layering technique were

as follows color match-0 marginal adaptation- 20 marginal discoloration- 20

anatomical form (proximal)- 20 surface quality- 0

Indices C for restorations performed using oblique layering technique were as

follows color match-0 marginal adaptation- 0 marginal discoloration- 10

anatomical form (proximal)- 0 surface quality- 100

Discussions

For in vitro studies is difficult to reproduce the variables existent in oral cavity

like occlusal stress and pH and temperature changes (235) The clinical studies are

determinant in assessment of restorative techniques (300) The most researches

focuses on the influence of restorative technique on the reduction of lightcuring stress

(51 78 135)

VIII5 CONCLUSIONS

Oblique layering technique presents superior results regarding marginal

adaptation and marginal discoloration and is recommended for proximo-

occlusal dental caries close to enamel-cement jonction

Centripetal build-up presents good results regarding marginal adaptation and

anatomical form at proximal level (proximal surfaces and contact point)

Horisontal layering technique can be used for optimum results only in

proximal-occlusal cavities with moderate extension both in occlusal-cervical

and buccal-oral

20

CHAPTIX STUDY REGARDING MARGINAL SEALING STATUS IN

COMPOSITE RESINS LIMITED PROXIMO-OCCLUSAL RESTORATIONS

PERFORMED USING DIFFERENT TECHNIQUES

IX1INTRODUCTION

The contraction of composite resins can produce stress inside dental structure

The most contraction stress appears in the initial stages and development rate of stress

decreases gradually in time (5 98 160) The contraction stress of composite resins

can overpass adhesion strenght and can broke the link between dental tissues and

composite resin (73) When adhesion strenght is high stress can produce marginal

fracture or bulk fracture (74) These situations are associated with microleakage and

penetration of oral fluid and bacteria along dentinal walls endangering the pulpal

tissue or favourising secondary dental caries

IX2 AIM OF STUDY

The study aimed to assess the efficiency of marginal sealing along gingival

wall in limited proximal-occlusal restorations performed using three different

techniques

IX3MATERIALS AND METHOD

The study group included 30 teeth extracted for orthodontic and periodontal

reasons On every tooth two identical class II cavities (on mesial and distal surfaces)

were prepared with cylindrical burs under water cooling The gingival wall was

limited to enamel-cement jonction The cavity dimension were as follows 2 mm

buccal-oral 5mm depth Each tooth was introduced in a pattern of acrylat The

operator calibrated preparation technique on acrylat teeth in Simulation Laboratory of

UMF ―Gr T Popa Iaşi The 60 prepared cavities were randomly divided in three

study groups related to restorative technique The restoration were performed with

Filtek Z550 (3M ESPE) a nanohybrid composite resin The adhesive strategy

included etchamprinse in 2 steps and adhesive Adper Single Bond 2(3MESPE)

Group A (n=20) bulk restorative technique associated with lightcuring from

occlusal 40 seconds and from buccal and oral 20 seconds

Group B (n=20) oblique layering technique (first layer on buccal wall and

buccal frac12 of gingival wall was lightcured from buccal second layer on oral wall and

oral frac12 of gingival wall was lightcured from oral third oral as a triangle with point

oriented to gingival wall was lightcured from occlusal)

Group C (n=20) combined technique (bdquoflow layer on gingival and axial

walls lightcured under pressure only associated with solid composite resin layer)

The proximal surfaces were performed using Tofflemire and metallic matrices After

removal of matrices every restoration was lightcured for another 20 seconds Two

layers aof varnish were applied on composite resins restorations excepting cavity

margins and an area of 1 mm around them The samples were introduced in methylen

21

blue 10 for 48 hours After this stage samples were washed with water and teeth

were cut longitudinally with a diamonded disc

The die penetration was assessed with Zeiss (Iena Germany) X20 microscope

accordingly to four scores (0-3)

0 ndash no penetration

1 ndash die infiltration until external half of gingival wall

2 ndash die infiltration on all gingival wall

3 ndash die infiltration on gingival wall and axial wall

IX4RESULTS AND DISCUSSIONS

The result of die penetration are presented in table IX1

TableIX1 The results for die penetration

Grup 0 1 2 3

A (bulk) 0 0 3 17

B (layering) 0 4 5 11

C (combined) 12 5 2 1

In group A 17 sample had score 3 and 2 samples had score 2 In group B 11

sample had score 3 5 samples had score 2 and 4 sample had score 1 In group C with

best results 12 samples had score 0 5 samples had score 1 2 samples had score 2 1

sample had score 3

The recorded data were analysed using test Mann-Whitney The statistical

results are presented in tables IX2-IX4

Tables IX2a-b Mann-Whitney for comparisons of microleakage values between

bulk technique and incremental technique

Ranks

Restorative technique N Mean Rank Sum of Ranks

Scores

frequency

A ndash bulk technique 20 2420 24200

B ndash incremental

technique

20 1680 16800

Total 40

Test Statisticsb

scores

frequency

Mann-Whitney U 29000

Wilcoxon W 168000

Z -1970

Asymp Sig (2-tailed) 049

Exact Sig [2(1-tailed Sig)] 123a

a Not corrected for ties

b Grouping Variable restorative technique

22

Tables IX3a-b Mann-Whitney for comparisons of microleakage values between

bulk technique and mixed technique

Ranks

Restorative technique N Mean Rank Sum of Ranks

scores

frequency

A ndash bulk technique 20 3090 30900

C ndash mixed technique 20 1010 10100

Total 40

Test Statisticsb

scores

frequency

Mann-Whitney U 500

Wilcoxon W 101000

Z -4021

Asymp Sig (2-tailed) 000

Exact Sig [2(1-tailed Sig)] 000a

a Not corrected for ties

b Grouping Variable restorative technique

Tables IX4a-b Mann-Whitney test for comparisons of microleakage values

between incremental technique and mixed technique

Ranks

Restorative technique N Mean Rank Sum of Ranks

scores

frequency

B ndash incremental

technique

20 2990 29900

C ndash mixed technique 20 1210 12100

Total 40

Test Statisticsb

scores

frequency

Mann-Whitney U 5500

Wilcoxon W 121000

Z -3492

Asymp Sig (2-tailed) 000

Exact Sig [2(1-tailed Sig)] 000a

a Not corrected for ties

23

Test Statisticsb

scores

frequency

Mann-Whitney U 5500

Wilcoxon W 121000

Z -3492

Asymp Sig (2-tailed) 000

Exact Sig [2(1-tailed Sig)] 000a

a Not corrected for ties

b Grouping Variable tehnrestaurare

The results of microleakage degree were statistically significant when the

three restorative techniques were compared The results showed that best restorative

technique regarding marginal sealing in cervical area is combined technique followed

by oblique layering technique The use of layering techniques limits the development

of contraction forces between oposite walls event that favourises bulk stress voids

formation and fissure inside dental tissues The results of our study are similar with

other studies (114 293)

IX5 CONCLUSIONS

The values of die penetration at gingival wall were statistically different

between the three restorative techniques

We concluded that all restorative methods were associated with lightcuring

contraction and marginal microleakage

The combined technique was associated with lowest lightcuring contraction

and die penetration

The bulk technique was associated with highest lightcuring contraction and die

penetration

24

CHAPTX STUDY REGARDING THE EFFECTS OF ETCHING ON

ENAMEL AND DENTINE IN CERVICAL AREA FOR PROXIMAL

CAVITIES AT LATERAL DENTAL GROUP

X1 INTRODUCTION

The studies reported marginal defects and high microleakage at the level of

gingival margins localised in cervical area or close to enamel-cement jonction for

high percents of proximal-occlusal composite resins restorations (8485) The good

adhesion is requested to insure restoration longevity and to prevent marginal

microleakage and presence of secondary marginal dental caries The adhesion

strenght of different adhesive systems can vary accordingly to tissues areas (204 240)

and to variations in dentinal structures (234 330) Most studies focused on adhesive

systems performances used healthy dentine close to pulp room but in case of class II

restorations there are particular features that influences the adhesion at the level of

gingival margins

The surface topography is an important property that determines the

interaction manner between surfaces The surface roughness and surface energy can

increase or decrease the adhesion of composite resins to the hard dental tissues

X2 AIM OF STUDY

The aim of study was to compare surface roughness of enamel and dentine

after etching related to different distances related to enamel-dentinecement jonction

X3 MATERIALS AND METHODS

The study group included 20 molars extracted from orthodontics or

periodontal reasons with intact proximal surfaces The teeth were cut longitudinally in

sens buccal-oral with diamond discs under water cooling

A group study (10 teeth) included 10 samples obtained through transversal

cutting at distance of 2mm from enamel-dentinecement jonction and 10 samples

obtained through transversal cutting at distance of 15 mm from enamel-

dentinecement jonction Another study group (10 teeth) included 10 samples

obtained through transversal cutting at distance of 1mm from enamel-dentinecement

jonction and 10 samples obtained through transversal cutting at distance of 05 mm

from enamel-dentinecement jonction All these samples were divided in two halfes

through mesial-distal cutting The samples finishing was performed with abrasive

paper (100-4000) and final polishing was performed with a device Buehler model

Minimet with slices introduced in ultrasound bath for 4 minutes The second half of

each sample was etched for 15 seconds with ortophosphoric acid 37 for 15 seconds

Slices were washed with distilled water for 30 seconds after etching and dried

The samples were analysed with atomic force microscopy (AFM) regarding

surface roughness The results were expressed as relative variation of roughness

X4 RESULTS AND DISCUSSIONS

The aspect of etched enamel at 2 mm distance from ECJ can be seen in figure

X1 (section 10 microm) The surface roughness is higher comparing with sample before

etching

25

După gravajul cu acid ortofosforic 37

The aspect of etched enamel at 15 mm distance from ECJ can be seen in

figure X2 (section 10 microm) The surface roughness is higher comparing with sample

before etching but lower comparing with sample at 2 mm from ECJ

The aspect of etched enamel at 1 mm distance from ECJ can be seen in figure

X3 (section 10 microm) The surface roughness is higher comparing with sample before

etching but lower comparing with sample at 15mm and 2 mm from ECJ

The aspect of etched enamel at 15 mm distance from ECJ can be seen in

figure X4 (section 10 microm) The surface roughness is higher comparing with sample

before etching but lower comparing with sample at 1 mm 15 mm and 2 mm from

ECJ

FigX1 3D aspect of enamel at 2 mm from ECJ

after etching (10 microm)

FigX2 3D aspect of enamel at 15 mm from ECJ

after etching (10 microm)

FigX3 3D aspect of enamel at 1 mm from ECJ

after etching (10 microm)

FigX4 3D aspect of enamel at 05 mm from ECJ

after etching (10 microm)

26

The mean values of squared roughness for dentine and enamel before etching

are presented in tables X1 and X2

Table X1 Squared roughness values for dentine samples before and after etching

Before etching (nm) After etching (nm)

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

sample

1

335 282 283 259 1149 947 901 879

sample

2

352 284 274 266 1127 939 883 875

sample

3

357 273 278 263 1152 953 876 867

sample

4

323 269 264 258 1146 942 895 883

sample

5

348 298 271 268 1153 944 904 878

sample

6

339 274 278 273 1158 937 893 892

sample

7

352 283 269 266 1145 944 899 876

sample

8

349 292 272 274 1166 942 907 869

sample

9

357 284 275 265 1132 939 893 879

sample

10

348 281 277 262 1142 941 899 878

Table X2 Squared roughness values for enamel and dentine samples before and after

etching

Before etching (nm) After etching (nm)

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

sample 1 422 342 309 313 2255 1114 874 845

sample 2 418 338 324 304 2236 1102 882 839

sample 3 413 334 315 303 2239 1115 873 833

sample 4 416 336 322 308 2242 1116 868 842

sample 5 426 332 315 294 2218 1103 877 829

sample 6 412 332 317 306 2237 1099 874 847

sample 7 414 335 322 314 2252 1102 876 834

sample 8 416 325 318 313 2239 1106 875 838

sample 9 418 328 314 299 2246 1113 879 836

sample 10 413 334 316 305 2242 1104 873 839

The results for samples before etching prove a decreasing tendency for mean

values of squared roughness surface beginning with areas placed at distance of 2 mm

from ECJ (346 nm) followed by areas placed at distance of 15 mm from ECJ (282

nm) 1 mm from ECJ (274 nm) and 05 mm from ECJ (265 nm) After etching the

decreasing tendency maintained for dentine localised at 2 mm from ECJ to dentine

localised at 05 mm from ECJ The mean values of squared roughness after etching

were three times higher (tables X3)

27

Table X3 Squared roughness values for enamel and dentine samples before and

after etching

Dentine Enamel

Before etching

(nm)

After etching

(nm)

Before etching

(nm)

After etching

(nm)

2 mm ECJ 346 1147 416 2237

15 mm ECJ 282 942 333 1107

1 mm ECJ 274 895 317 875

05 mm ECJ 265 877 305 838

The descriptive statistics data for surface roughness of dentine before and after

etching are presented in tables X4 si X5

Table X4 Descriptive statistics for dentine samples before etching

Statistics

Dentine 2mm

before etching

Dentine 15mm

before etching

Dentine 1mm

before etching

Dentine 05mm

before etching

N Valid 10 10 10 10

Missing 0 0 0 0

Mean 346000 282000 274100 265400

Std Error of Mean 33830 27487 17026 16746

Std Deviation 106979 86923 53841 52957

Skewness -1214 354 -314 348

Std Error of Skewness 687 687 687 687

Kurtosis 1141 049 336 -539

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 3230 2690 2640 2580

Maximum 3570 2980 2830 2740

Table X5 Descriptive statistics for dentine samples after etching

Statistics

Dentine 2mm

after etching

Dentine 15mm

after etching

Dentine 1mm

after etching

Dentine 05mm

after etching

N Valid 10 10 10 10

Missing 0 0 0 0

1147000 942800 895000 877600

Std Error of Mean 36545 14591 29926 22020

Std Deviation 115566 46140 94634 69634

Skewness -267 1169 -951 535

Std Error of Skewness 687 687 687 687

Kurtosis 043 1776 564 1416

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 11270 9370 8760 8670

28

Statistics

Dentine 2mm

after etching

Dentine 15mm

after etching

Dentine 1mm

after etching

Dentine 05mm

after etching

N Valid 10 10 10 10

Missing 0 0 0 0

1147000 942800 895000 877600

Std Error of Mean 36545 14591 29926 22020

Std Deviation 115566 46140 94634 69634

Skewness -267 1169 -951 535

Std Error of Skewness 687 687 687 687

Kurtosis 043 1776 564 1416

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 11270 9370 8760 8670

Maximum 11660 9530 9070 8920

To choose the statistical test to compare roughness surface values was

performed a test Shapiro-Wilk If p is lower or equal with 0005 than hypothesis of

distribution normality is rejected (distribution deviates from normal form) In the table

X6 the distributions are normal The statistical test will be test t for pair samples

Table X6 Test Shapiro-Wilk for dentine samples

Tests of Normality

Kolmogorov-Smirnov

a Shapiro-Wilk

Statistic df Sig Statistic df Sig

Dentine 2mm before etching 274 10 032 877 10 122

Dentine 15mm after etching 209 10 200 952 10 689

Dentine 1mm before etching 134 10 200 983 10 980

Dentine 05mm before etching 155 10 200 949 10 661

Dentine 2mm after etching 133 10 200 977 10 946

Dentine 15mm after etching 197 10 200 916 10 329

Dentine 1mm after etching 216 10 200 925 10 401

Dentine 05 after etching 220 10 185 933 10 474

Enamel 2mm before etching 193 10 200 898 10 207

Enamel 15mm before etching 170 10 200 977 10 947

Enamel 1mm before etching 157 10 200 952 10 689

Enamel 05mm before etching 165 10 200 943 10 590

Enamel 2mm after etching 235 10 124 925 10 404

Enamel 15mm after etching 209 10 200 871 10 102

Enamel 1mm after etching 189 10 200 964 10 834

Enamel 05mm after etching 142 10 200 983 10 978

a Lilliefors Significance Correction

29

Tests of Normality

Kolmogorov-Smirnov

a Shapiro-Wilk

Statistic df Sig Statistic df Sig

Dentine 2mm before etching 274 10 032 877 10 122

Dentine 15mm after etching 209 10 200 952 10 689

Dentine 1mm before etching 134 10 200 983 10 980

Dentine 05mm before etching 155 10 200 949 10 661

Dentine 2mm after etching 133 10 200 977 10 946

Dentine 15mm after etching 197 10 200 916 10 329

Dentine 1mm after etching 216 10 200 925 10 401

Dentine 05 after etching 220 10 185 933 10 474

Enamel 2mm before etching 193 10 200 898 10 207

Enamel 15mm before etching 170 10 200 977 10 947

Enamel 1mm before etching 157 10 200 952 10 689

Enamel 05mm before etching 165 10 200 943 10 590

Enamel 2mm after etching 235 10 124 925 10 404

Enamel 15mm after etching 209 10 200 871 10 102

Enamel 1mm after etching 189 10 200 964 10 834

Enamel 05mm after etching 142 10 200 983 10 978

a Lilliefors Significance Correction

This is a lower bound of the true significance

The results of test t for pair dentine samples before and after etching are

presented in table X

Table X7 Test t for dentine before and after etching

Paired Samples Test

Paired Differences

t df

p (2-

tailed)

95 Confidence

Interval of the

Difference

Mean

Std

Dev

Std

Error

Mean Lower Upper

Pair

1

dentine2mmbeforeetching-

dentine2mmafteretching

-

8010000

174801 55277 -

8135045

-

7884955

-

144906

9 000

Pair

2

dentine15mmbeforeetching-

dentine15mmafteretching

-

6608000

102394 32380 -

6681248

-

6534752

-

204079

9 000

Pair

3

dentine1mmbeforeetching-

dentine1mmafteretching

-

6209000

117799 37251 -

6293269

-

6124731

-

166678

9 000

30

Paired Samples Test

Paired Differences

t df

p (2-

tailed)

95 Confidence

Interval of the

Difference

Mean

Std

Dev

Std

Error

Mean Lower Upper

Pair

1

dentine2mmbeforeetching-

dentine2mmafteretching

-

8010000

174801 55277 -

8135045

-

7884955

-

144906

9 000

Pair

2

dentine15mmbeforeetching-

dentine15mmafteretching

-

6608000

102394 32380 -

6681248

-

6534752

-

204079

9 000

Pair

3

dentine1mmbeforeetching-

dentine1mmafteretching

-

6209000

117799 37251 -

6293269

-

6124731

-

166678

9 000

Pair

4

dentine05mmbeforeetching-

dentine05mmafteretching

-

6122000

86384 27317 -

6183796

-

6060204

-

224109

9 000

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of dentine (

2mm 15 mm 1mm sau 05mm)

The descriptive statistics data for dentine surface roughness before and after

etching are presented in tables X8 and X9

Table X8 Descriptive statistics for enamel samples before etching

Statistics

Enamel 2mm

before etching

Enamel 15mm

before etching

Enamel 1mm

before etching

Enamel 05mm

before etching

N Valid 10 10 10 10

Missing 0 0 0 0

Mean 416800 333600 317200 305900

Std Error of Mean 13968 15217 14205 20355

Std Deviation 44171 48120 44920 64369

Skewness 1095 -156 -109 -411

Std Error of Skewness 687 687 687 687

Kurtosis 769 487 -118 -295

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 4120 3250 3090 2940

Maximum 4260 3420 3240 3140

31

Table X9 Descriptive statistics for enamel samples after etching

Statistics

Enamel 2mm

after etching

Enamel 15mm

after etching

Enamel 1mm

after etching

Enamel 05mm

after etching

N Valid 10 10 10 10

Missing 0 0 0 0

Mean 2237600 1107400 875100 838200

Std Error of Mean 31027 20232 11968 17436

Std Deviation 98116 63979 37845 55136

Skewness -850 267 042 040

Std Error of Skewness 687 687 687 687

Kurtosis 878 -1880 1082 -425

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 22180 10990 8680 8290

Maximum 22520 11160 8820 8470

To choose the statistical test to compare roughness surface values was

performed a test Shapiro-Wilk If p is lower or equal with 0005 than hypothesis of

distribution normality is rejected (distribution deviates from normal form) In the table

X10 the distributions are normal The statistical test will be test t for pair samples

Table X10 Test Shapiro-Wilk for enamel samples

Tests of Normality

Kolmogorov-Smirnova Shapiro-Wilk

Statistic df Sig Statistic df Sig

2mmenamel before etching 193 10 200 898 10 207

15mmenamel before etching 170 10 200 977 10 947

1mmenamel before etching 157 10 200 952 10 689

05mmenamel before etching 165 10 200 943 10 590

2mmenamel after etching 235 10 124 925 10 404

15mmenamel after etching 209 10 200 871 10 102

1mmenamel after etching 189 10 200 964 10 834

05mmenamel after etching 142 10 200 983 10 978

a Lilliefors Significance Correction

This is a lower bound of the true significance

The results of test t for pair enamel samples before and after etching are

presented in table X11

32

Table X11 Test t for enamel samples before and after etching

Paired Samples Test

Paired Differences

t df

p (2-

tailed)

95 Confidence

Interval of the

Difference

Mean

Std

Deviation

Std

Error

Mean Lower Upper

Pair

1

2mmenamel before

etching

2mmenamel after

etching

-18208 135220 42760 -

18304731

-

18111269

-

425815

9 000

Pair

2

15mmenamel before

etching

15mmenamel after

etching

-7738 73151 23132 -7790329 -7685671 -

334508

9 076

Pair

3

1mmenamel before

etching

1mmenamel after

etching

-5579 55468 17540 -5618679 -5539321 -

318065

9 065

Pair

4

05mmenamel before

etching

05mmenamel after

etching

-5323 60378 19093 -5366192 -5279808 -

278788

9 063

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel ( 2mm 15 mm 1mm sau

05mm) but the differences statistical significant are present only for enamel localised

at 2 mm from ECJ

X5CONCLUSIONS

The surfaces of enamel and dentine at cervical level record decreases of

roughness related to the decrease of distance to ECJ

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel but the differences

statistical significant are present only for enamel localised at 2 mm from ECJ

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of

dentine

33

CHAPTXI FEA STUDY REGARDING THE BIOMECHANICAL

BEHAVIOUR AND FRACTURE RESISTANCE OF PROXIMO-OCCLUSAL

AMALGAM AND COMPOSITE RESINS RESTORATIONS

XI1INTRODUCTION AIM OF STUDY

The individual variation of patients morphological and functional complexity

of tissues as well as difficult access limit the possibilities to investigate in clinical

studies the biomechanical behaviour of proximo-occlusal restorations In this context

simulation of the biomechanics for direct restorations represents an interesting

interdisciplinar domain in actual dentistry research

The study focused on two direction

- analysis of role of forces intensity on biomechanical behaviour related to

cavity dimension and material

- analysis of tension inside restoration structure related to forces intensity

XI2MATERIALS AND METHODS

The stages of finite element analysis study are as follows

object modelling (bicusps and proximo-occlusal restoration)

definition of parameters for materials and dental tissues

meshing

constraints and loading

types of contacts

equations system definition

results of simulation

The object 3D modelling was performed in Rhinoceros (figure XI1) The

definition of parameters was performed for Poisson constant Young modulus density

(table XI1) The selected materials were amalgam and composite resins The

analysed tissues were dentine and enamel The meshing constraints loading were

performed for forces of 200N 400N 600N 800 N The analysis was performed using

software COSMOSWorks 2010

34

Fig XI1 3D modellation of bicusp

Table XI1 Values of Young modulus Poisson constant compression resistance for

amalgam composite resin enamel (amalgam compozit smalţ)

Material Young modulus (GPa) Poisson constants

Compression

resistance

(Mpa)

Amalgam 55 033 483

Enamel 48 03 400

Composite

resin 220 022 345

Fig XI2 The forces and constraints application

The results are presented in values and culours red colours representing areas

with maximum values of tensions produced under influence of masticatory forces

The tensions produced in amalgam restoration are in a range from 0 to 22886

(force 800 N) The maximum von Misses tensions are associated with cervical area

of amalgam restorations This aspect proves that first modification in interface

restoration-cavity margins will appear at the level of gingival wall First marginal

35

defects and fissures in restoration bulk will appear at tensions over 1600Mpa

associated with forces of 800N for extended amalgam proximo-occlusal restorations

The tensions produced in composite resin restorations are in a range from 0 to

2285 (force 800 N) The maximum von Misses tensions are associated with cervical

area of composite resin restorationsThis aspect proves that first modification in

interface restoration-cavity margins will appear at the level of gingival wall First

marginal defects and fissures in restoration bulk will appear at tensions over 1716

Mpa associated with forces of 600N for moderate and extended composite resins

proximo-occlusal restorations

Fig XI3a-b ndash Simulated model of proximo-occlusal restoration

FigXI4a-b Dental amalgam restoration Cervical tension associated with 600 N

(c)800 N (d)

FigXI5a-b Composite resin restoration Cervical tension associated with 600 N

(c)800 N (d)

36

The deformation of amalgam can be produced only when is associated with

fissures in bulk of restorations while composite resins restorations present

deformation when are associated with a modification of volume and form because of

repeated action of medium forces on long term or high forces on short term (figures

XI4 XI5)

Fig XI4 Material deformation in area of maximum tension

000E + 00

500E -02

100E -01

150E -01

200E -01

250E -01

1 4 7 101316192225283134374043464952555861646770737679

Amalgam C ompoz it

Figura XI5 Deformarea funcție de material

The amalgam and composite resins were treated as homogenous isotropic and

liniar The advantage of this type of FEA study is that restorations parameters can be

modified any time is necessary both in arhitecture geometry and material indices

variability The results of this study sustain the conclusions of other FEA studies

focused on biomechanical behaviour of posterior restorations performed with

amalgam and composite resins(35 62 76 143)

37

XI4CONCLUSIONS

bull The amalgam in class II restorations has a low deformation tendency because

of uniform distribution of tension inside material

bull Composite resins class II restorations accumulate higher tensions comparing

with amalgam but deformation is avoided for a time because of the adhesion

forces performed between molecules under moderate oral forces In case of

high oral forces (600-800N) the risk of fracture in moderate class II

restorations is higher comparing with amalgam proximo-occlusal restorations

For extended class II restorations and forces of 600 N composite resins present

highest risk of fracture and deformation The von Misses tension at the

cervical interface restorationtooth can reach 1600Mpa

bull The amalgam in moderate class II restorations can resist to deformation even

for high intensity forces limited to 600N In extended class II restorations the

risk of deformation and fracture increases at values of 600N-800N of oral

forces The von Misses tension at the cervical interface restorationtooth can

reach 1700 Mpa

38

FINAL CONCLUSIONS

Amalgam proximo-occlusal restorations with minimum 6-years age present

excellent results for parameters anatomic form (occlusal) marginal

discoloration and marginal secondary dental caries good results for

parameters anatomic form (proximal) and marginal adaptation and poor results

for surface quality

Composite resins proximo-occlusal restorations (bicusps) with minimum 6-

years age present excellent results for parameters color match marginal

discoloration and marginal secondary dental caries and good results for

parameters anatomic form (occlusal proximal) marginal adaptation surface

quality

Composite resins proximo-occlusal restorations (molars) with minimum 6-

years age present good results for parameters color match marginal

discoloration marginal secondary dental caries marginal adaptation and poor

results for parameters anatomic form (occlusal) (54 indices Ryge C)

anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The restorations extended at external third of occlusal surface present highest

percents of indices C regarding anatomic form (occlusal) (54 indices Ryge

C) anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The exceeding of 6-years age will require careful monitorisation for early

interventions through polishing sealing reshaping and even replacement for

restorations with major defects

Oblique layering technique presents superior results regarding marginal

adaptation and marginal discoloration and is recommended for proximo-

occlusal dental caries close to enamel-cement jonction

Centripetal build-up presents good results regarding marginal adaptation and

anatomical form at proximal level (proximal surfaces and contact point)

Horisontal layering technique can be used for optimum results only in

proximal-occlusal cavities with moderate extension both in occlusal-cervical

and buccal-oral

The values of die penetration at gingival wall were statistically different

between the three restorative techniques

We concluded that all restorative methods were associated with lightcuring

contraction and marginal microleakage

The combined technique was associated with lowest lightcuring contraction

and die penetration

The bulk technique was associated with highest lightcuring contraction and die

penetration

39

The surfaces of enamel and dentine at cervical level record decreases of

roughness related to the decrease of distance to ECJ

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel but the differences

statistical significant are present only for enamel localised at 2 mm from ECJ

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of

dentine

bull The amalgam in class II restorations has a low deformation tendency because

of uniform distribution of tension inside material

bull Composite resins class II restorations accumulate higher tensions comparing

with amalgam but deformation is avoided for a time because of the adhesion

forces performed between molecules under moderate oral forces In case of

high oral forces (600-800N) the risk of fracture in moderate class II

restorations is higher comparing with amalgam proximo-occlusal restorations

For extended class II restorations and forces of 600 N composite resins present

highest risk of fracture and deformation The von Misses tension at the

cervical interface restorationtooth can reach 1600Mpa

bull The amalgam in moderate class II restorations can resist to deformation even

for high intensity forces limited to 600N In extended class II restorations the

risk of deformation and fracture increases at values of 600N-800N of oral

forces The von Misses tension at the cervical interface restorationtooth can

reach 1700 Mpa

REFERENCES

1ADA Council on Scientific Affairs ADA Council on Dental Benefit Programs

Statement on posterior resin-based composites JADA 1998 129(11)1627ndash1628

2Albers HF Tooth-colored restoratives 1st ed Santa Rosa CA Alto Books 1979

3Allander L Birkhed D Bratthall D Reasons for replacement of class II amalgam

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6Aggarwal V Logani A Jain V Shah N Effect of cyclic loading on marginal

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Oper Dent 2008 Sep-Oct33(5)587-92

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utilizing a filled and unfilled adhesive resin Dent Mater 200117268ndash276

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1451-56

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464-473

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Public Health Dent 1992 Winter52(2)102-10

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Dent 199158 36-39

28Bayne SC Dental biomaterials where are we and where are we going J Dent

Educ 200569(5)571ndash585

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191-194

30Behle C Flowable composite Proprieties and applications Pract Periodontics

Aesthetics Dent 1998 10347 350-351

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34Bonsor SJ Chadwick RGLongevity of conventional and bonded (sealed)

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9

35Boschian PL S Guidotti R Pietrbissa M Gagliani- bdquoStress distribution in a

post-restored tooth using the threedimensional finite element method Journal of Oral

Rehabilitation (33) 2006690ndash697

36Bouillaguet S B Ciucchi T Jacoby JC Wataha DH Pashley Bonding

characteristics to dentin walls of class II cavities in vitro Dent Mater 200117316ndash

321

37Bouschlicher MR Rueggeberg FA Effect of ramped light intensity on

polymerization force and conversion in a photoactivated composite J Esthet Dent

2000 12328-339

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and their efficacy as stress-relieving layers J Am Dent Assoc 2003134721ndash728

39Braga RR Ballester RY Ferracane JLFactors involved in the development of

polymerization shrinkage stress in resin-composites a systematic review Dent Mater

200521(10)962-70

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Timişoara1994

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amalgam-bonded restorations A 42-months study- Journal of American Dental

Association 2000nr131

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expansion on microleakage J Am Dent Assoc 1988116871ndash 874

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of reasons for the placement and replacement of restorations provided by vocational

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199930(4)234-42

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replacement of restorations in vocational training practicePrimary Dental Care

nr6(1) 1999

47Burke FJ Wilson NH Cheung SW Mjoumlr IA Influence of patient factors on age

of restorations at failure and reasons for their placement and replacement J Dent

200129(5)317-24

48Calheiros FC Braga RR Kawano Y Ballester RY Relationship between

contraction stress and degree of conversion in restorative composites Dent Mater

2004 20939-946

49Cardoso P Sadek F Microtensile bond strength on dentin using new adhesive

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the decision to replace existing amalgam restorations Quintessence Int 1999

Jun30(6)413-8

51Carvalho RM JC Pereira M Yoshiyama DH Pashley A review of

polymerization contraction the influence of stress development versus stress

reliefOper Dent19962117ndash24

52Castro VM Katz JO Hardman PK Glaros AG Spencer P Invitro comparison

of conventional film and direct digital imaging in the detection of approximal caries

Dentomaxillofac Radiol 2007 Mar36(3)138-42

53Cattaneo PM M Dalstra B Melsen- bdquoThe Finite Element Method a Tool to

Study Orthodontic Tooth Movement J Dent Res 2005 84(5)428-433

54Cattell MJ Clarke RL Lynch EJ The transverse strength reliability and

microstructural features of four dental ceramicspart 1 J Dent 25(5)399-407 1997

55Cehreli ZC Akca T Effect of dentinal tubule orientation on the microtensile

bond strength to primary dentin J Dent Child 2003 70(2) 139-144

56Celik C Arhun N Yamanel K Clinical evaluation of resin-based composites in

posterior restorations 12-month results Eur J Dent 2010 Jan4(1)57-65

57Cenci M Demarco F de Carvalho R Class II composite resin restorations with

two polymerization techniques Relationship between microtensile bond strength and

marginal leakage J Dent 2005 33(7) 603- 610

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Med 2008173(1)23ndash26

59Chen HY Manhart J Hickel R Kunzelmann KH Polymerization contraction

stress in light-cured packable composite resinsDent Mater 200117253-259

60Choi KK Condon JR Ferracane JL The effects of adhesive thickness on

polymerization contraction stress of composites J Dent Res 2000 79812ndash817

61Cichon P Kerschbaum T Verweildauer zahnartzlicher Restaurationen bei

Behinderten Dtsch Zahnartzlicher 1999 54 96-102

62Cohen BI Pagnillo MK Deutsch ASMusikant BL Fracture Strength of

Three Core Restorative Materials Supported with or without a Prefabricated Split-

Shank Post Journal of Prosthetic Dentistry1997 78 560ndash565

63Colli P Brannstrom M The marginal adaptation of four different bonding agents

in Class II composite resin restoration applied in bulk or in two increments

Quintessence Int 1993 24583-591

43

64Collins CJ Bryant RW Hodge KL A clinical evaluation of posterior composite

resin restorations 8-year findings J Dent 199826(4) 311ndash317

65Condon JR Ferracane JL Assessing the effect of composite formulation on

polymerization stress J Am Dent Assoc2000 131497-503

66Cook WD Moopnar M Influence of chemical structure on the fracture

behaviour of dimethacrylate composite resins Biomaterials 1990 11272-276

67Cortes DF Ellwood RP Ekstrand KR An in vitro comparison of a combined

FOTIvisual examination of occlusal caries with other caries diagnostic methods and

the effect of stain on their diagnostic performance Caries Res 2003 37 (1) 8-16

68Crim GA Microleakage of three resin placement techniques Am J Dent

1991469-72

69Dauvillier B Aarnts M Feilzer A The competition between the composite-

dentin strength and the polimerization contraction stress J Dent Res 1984 63 1396-

1399

70Dauvillier BS Aarnts MP Feilzer AJ Developments in shrinkage control of

adhesive restoratives J Esthet Dent 2000 12291-299

71Dauvillier BS Aarnts MP Feilzer AJ Modeling of the viscoelastic behavior of

dental light-activated resin composites during curing Dent Mater 200319277ndash285

72Davidson CL Gee AJ Feilzer A The competition between the composite-dentin

bond strength and the polymerization contraction stress J Dent Res 1984

63(12)1396-9

73Davidson CL AJ Feilzer Polymerization shrinkage and polymerization

shrinkage stress in polymer-based restoratives J Dent Res 199725435ndash440

74Davidson CL Resisting the curing contraction with adhesive composites J

Prosthet Dent 198655446ndash7

75Davis RD Mayhew RB A clinical comparison of three anterior restorative resins

at 3 years J Am Dent Assoc 1986112659-63

76Dejak B Mlotkowski A Three-dimensional finite element analysis of strength

and adhesion of composite resin versus ceramic inlays in molarsJ Prosthet

Dent200899131-40

77Deligeorgi V Mjor IA Wilson NH An overview of reasons for the placement

and replacement of restorations Prim Dent Care 20018(1)5-11

78Deliperi S Bardwell DN An alternative method to reduce polymerization

shrinkage in direct posterior composite restorations J Am Dent Assoc 2002

1331387ndash97

79Demirci M Tuncer S Yuceokur AA Prevalence of caries on individual tooth

surfaces and its distribution by age and gender in university clinic patientsEur J

Dent20104(3)270-9

80De Munck J Van Meerbeek B Satoshi I Vargas M Yoshida Y Armstrong S

Lambrechts P Vanherle G Microtensile bond strengths of one- and two-step

selfetch adhesives to bur-cut enamel and dentin Am J Dent 2003 16 414-420

81Dewaele M Truffier-Boutry D Devaux J Leloup G Volume contraction in

photocured dental resins the shrinkage-conversion relationship revisited Dent Mater

2006 22359-365

44

82Deutsch WM Simecek JW Dental emergencies among Marines ashore in

Operations Desert ShieldStorm Mil Med 1996161(10) 620ndash623

83Dickens SH Stansbury JW Choi KM Floyd CJ Photopolymerization kinetics

of methacrylate dental resins Macromolecules 2003 366043-6053

84Dietschi D De Siebenthal G Neveu-Rosenstand L Holz J Influence of the

restorative technique and new adhesives on the dentin marginal seal and adaptation of

resin composite Class II restorations An in vitro evaluation Quintessence Int 1995

26 717-727

85Dietschi D Herzfeld D In vitro evaluation of marginal and internal adaptation of

class II resin composite restorations after thermal and occlusal stressing Eur J Oral

Sci 1998 106 1033-1042

86Dietschi D Marginal adaptation and seal of direct and indirect Class II composite

resin restorations an in vitro evaluation Quintessence Int 26(2)127-138 1995

87Diefenderfer KE Simecek JW Ahlf RL Ragain JC Relationship between

caries status and dental emergencies among US naval personnel J Dent Res

20028195 (Abstract)

88Diefenderfer KE Rienhardt JW Shear bond strengths of ten adhesive

resinamalgam combinations Oper Dent 1997 22 50-56

89Donly KJ Jensen ME Triolo PA clinical comparison of resin composite inlay

and onlay posterior restorations and cast-gold restorations at 7 years Quintessence Int

30(3)163- 1681999

90Douglas WH Fields RP Fundingsland J A comparison between the

microleakage of direct and indirect composite restorative systems J Dent 17(4)184-

188 1989

91Eberhard J Hartman B Lenhard M Mayer T Kocher T Eickholz P Digital

subtraction radiography for monitoring dental demineralization An in vitro study

Caries Res 200034(3)219-24

92Edelstein BL Douglass CW Dispelling the myth that 50 percent of US

schoolchildren have never had a cavity Public Health Rep1995 110 (5) 522-530

93Eick JD Welch FH Polymerization shrinkage of posterior composite resins and

its possible influence on postoperative sensitivity Quintessence Int 198617103-11

94Elliott JE Lovell LG Bowman CN Primary cyclization in the polymerization of

bis GMA and TEGDMA a modeling approach to understanding the cure of dental

resins Dent Mater 2001 17221-229

95Ermis R Ulkam Aydin Examiner agreement in the replacement decisions of

class I amalgam restorations The Journal of contemporary dental practice 2004 Vol

5 no21-7

96Feilzer AJ AJ De Gee CL Davidson Increased wall-to-wall curing

contraction in thin bonded resin layers J Dent Res 19896848ndash50

97Feilzer AJ Dauvillier BS Effect of TEGDMABisGMA ratio on stress

development and viscoelastic properties of experimental twopaste composites J Dent

Res 2003 82824-828

98Feilzer AJ de Gee AJ Davidson CL Relaxation of polymerization contraction

shear stress by hygroscopic expansion J Dent Res 1990 6936ndash39

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99Feilzer AJ De Gee AJ Davidson CL Setting stress in composite resin in relation

to configuration of the restoration J Dent Res1987 661636-1639

100Feilzer AJ Dooren LH de Gee AJ Davidson CL Influence of light intensity

on polymerization shrinkage and integrity of restoration-cavity interface Eur J Oral

Sci 1995 103322ndash326

101Fennis YL Verdischbot EH vanrsquot Hof MA Performance of some diagnostic

systems in the prediction of occlusal caries in permanent molars in 6 and 11 year-old

children J Dent 1998 26(5) 403-40

102Ferracane JL Developing a more complete understanding of stresses produced

in dental composites during polymerization Dent Mater 2005 2136-42

103Ferrari M Influence of tissue characteristics at margins on leakage of Class II

indirect porcelain restorations Am JDent 1999 12(3)134-142

104Ferreira MC Vieira RS Marginal leakage in direct and indirect composite resin

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105Forss H Widstroumlm E Reasons for restorative therapy and the longevity of

restorations in adults Acta Odontol Scand 2004 6282-86

106Fradeani M Aquilano A Bassein L Longitudinal study of pressed glass-

ceramic inlays for four and a half years J Prosthet Dent 1997 78(4)346-353

107Franccedila FM Worschech CC Paulillo LA Martins LR Lovadino JR Fracture

resistance of premolar teeth restored with different filling techniques J Contemp Dent

Pract 20056(3)62-9

108Francci C Loguercio AD Reis A Carrilho MR A novel filling technique for

packable composite resin in Class II restorations J Esthet Restor Dent 2002

14(3)149-57

109Fruits TJ Knapp JA Khajotia SS Microleakage in the proximal walls of

direct and indirect posterior resin slot restorations Oper Dent 200631(6)719-27

110Gaengler P Hoyer I Montag R Clinical evaluation of posterior composite

restorations The 10-year report J Adhes Dent 2001 3185-194

111Garbuz DS Masri BA Estaile J Classification systems in orthopaedics J Am

Acad Orthop Surg 2002 10 290-297

112Ghavamnasiri M Moosavi H Tahvildarnejad N Effect of centripetal and

incremental methods in Class II composite resin restorations on gingival

microleakage J Contemp Dent Pract 20078(2)113-20

113Gladys S Clinical and semiquantitative marginal analysis of four tooth-coloured

inlay systems at 3 years J Dent 199523(6)329-338

114Giachetti L Scaminaci Russo D Bambi C Grandini R A review of

polymerization shrinkage stress current techniques for posterior direct resin

restorations J Contemp Dent Pract 20067(4)79-88

115Giannini M AJS Santos RM Carvalho LAMS Paulillo JR Lovadino

Effects of irradiation mode and filling technique on resindentin bond strength in

Class I cavities J Dent Res 200281 (Abstract)

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JADA 1972841349-1357

117Gordon JChristensen G Why switch to digital radiography J Am Dent

Assoc 204 Vol 135 No 101437-1439

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118Gregoire GL Akon BA Millas A Interfacial micromorphological differences

in hybrid layer formation between water- and solvent-based dentin bonding systems J

Prosthet Dent 2002 87633ndash641

119Gregory WA Physical properties and repair bond strength of direct and indirect

composite resins J Prosthet Dent 68(3)406-411 1992

120Gwinnett AJ Buonocore MG Adhesives and caries prevention a preliminary

report Br Dent J 196511977-81

121Gwinnett AJ Matsui A A study of enamel adhesives The physical relationship

between enamel and adhesive Arch Oral Biol 1967121615-1620

122Gwinnett AJ Histologic changes in human enamel following treatment with

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123Gwinnett AJ Moist versus dry dentin its effect on shear bond strength Am J

Dent 1992 5(3)127-9

124Haba Denisia Tehnici uzuale utilizate icircn radiologia dentară Edit Junimea

2007

125Hashimoto M Ito S Tay FR Svizero NR Sano H Kaga M Fluid movement

across the resin-dentin interface during and after bonding J Dent Res 2004 83843ndash

848

126Hashimoto M Tay FR Ito S Sano H Kaga M Pashley DH Permeability of

adhesive resin films J Biomed Mater Res 2005 74699ndash705

127Hawthorne WS Smales RJ Factors influencing long-term restoration survival

in three private dental practices in Adelaide Aust Dent J 19974259ndash63

128Helwig Klimek Attin Einfuumlhrung in Die ZahnErhaltung Urbanampfischer 2003

129He Z Shimada Y Tagami J The effects of cavity size and incremental

technique on micro-tensile bond strength of resin composite in Class I cavities Dent

Mater 200723(5)533-8

130He Z Shimada Y Sadr A Ikeda M Tagami J The effects of cavity size and

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131Hench LLBioceramicsfrom concept to clinicJ Amer Ceram Soc1991

74(7)1487-1570

132Heymann HO The clinical performance of CAD-CAM generated ceramic

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Fuzzi M Advances in Operative Dentistry ndash Challenges of the Future Chicago

Quintessence 2001

134Hilton TJ Cavity sealers liners and bases Current philosophies and indications

for use Oper Dent 199621134 ndash146

135Hilton TJ Schwartz RS Ferracane JL Microleakage of four Class II resin

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135- 144

136Hinoura K Setcos JK Philips RW Cavity design and placement technique for

class 2 composites Oper Dent 19981312-19

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19-23

138Hintze H Wenzel A Danielen B Behaviour of approximal carious lesions

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139Hintze H Wenzel A Influence of validation method on diagnostic accuracy of

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Dentomaxillofacial Radiol2002 31(1) 44-49

140Holtzman JM Berkey AB Mann J Predicting utilization of dental services by

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of approximal and occlusal dental caries in a young adult population Community

Dent Oral Epidemiol 200533(3)212-8

143Hubsch PF Middleton J Knox J A finite element analysis of the stress at the

restoration-tooth interfacecomparing inlays and bulk

fillingsBiomaterials2000211015ndash1019

144Hudson JD Goldstein GR Georgescu M Enamel wear caused by three

different restorative materials J Prosthet Dent 1995 74(6)647-654

145Hunter AR Treasure ET Hunter AJ Increases in cavity volume associated

with the removal of class 2 amalgam and composite restorations Oper Dent

1995202ndash 6

146Huysmans MC PG van der Varst EP Lautenschlager P Monaghan The

influence of simulated clinical handling on the flexural and compressive strength of

posterior composite restorative materials Dent Mater 199612116ndash120

147Iliescu A Gafar MCariologie şi Odontologie RestaurativăEditura Medicală

Bucureşti 2001

148Inoue S Van Meerbeek B Vargas M Lambrechts P Vanherle G Adhesion

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Prati C Grafiche Erredue 2000131-148

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dentin J Adhes Dent 2001 3 237-245

150Iovan Gianina Diagnosis and Management of Patients with High Caries

Activity EdApollonia Iasi2002

151Jacobsen T Soderhold KJ Some effects of water on dentin bonding Dent

Mater 1995 11(2)132-6

152Jackson RD Morgan M The new posterior resins and a simplified placement

technique J Am Dent Assoc 2000131375ndash383

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with flowable composite in the proximal box Am J Dent 200013235ndash238

48

154Jokstad A Mjor IA Analyses of long-term clinical behaviour of class II

amalgam restorations Acta OdontolScand 1991 49 47-63

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adhesives to dental hard tissues Clin Oral Investig 2002 6(3)155-60

157Kamann WK Gangler P Zur Funktionzeit von Amalgam

Kompositefullungen Zahnartzlicher Welt 1999 108 270-273

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of ground and intact enamel surfaces J Dent 199927523-530

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restorative decisions made on the basis of simulated bitewing radiographs

Community Dentistry and Oral Epidemiology 1994 22(2) 71-74

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composite restorations effected by increased flexibility J Dent Res 1990 691240ndash

1243

161Khairallah C Hokayem A Long-term clinical evaluation of 2 dental materials

used for the preparation of esthetic inlays Odontostomatol Trop 200932(127)5-13

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200932(126)21-8

163Kidd EAAssesment of dental carious lesionsArchof Oral

Biology199843(8)629-632

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proximal caries lesions at various levels in vitro Journal of Dentistry 2006 34(10)

817-822

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composite restorations Oper Dent 200934(1)11-7

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dental resin composites Dent Mater 2005 211150-1157

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marginal leakage around class II composite resin restorations in vitroQuint Int

201989117ndash121

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M Dentin shear strength effect of distance from the pulp Dent Mater 2002

18(7)516-20

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polimerisation Am J Dent 1998 11 17-22

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of Self-etching Adhesives to Caries-affected Dentin on the Gingival Wall Dental

Materials Journal 2006 25(1)59-65

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Dent 27(5)325-331 1999

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Jan11(1)34-40

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JProsthet Dent 199369(4)425-430

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thermal behavior of dental composites Dent Mater 2008 24(8)1017ndash1024

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JDent 199826 627-632

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shrinkage and elasticity of flowable composites and filled adhesives Dent Mater

1999 15128-137

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179Lăcătuşu St Luminiţa Costinescu Andrian S Gianina Iovan Valeria

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analysis of amalgam restorations 15th

Edition of the Balkan Medical Days

Stomatological Section Abstract nr1091999128

181Lăcătuşu St Andrian S Gianina Iovan- Consideraţii asupra adaptării

amalgamelor dentare la pereţii cavităţilor RevMedicina

StomatologicăVol2199823-26

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posterior packable resin composites with and without flowable liners Oper Dent

200126302ndash307

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and resin-based composite posterior restorations Quintessence Int 200738(6)511-4

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restorative decisions microscopic and radiographic caries depth Community

Dentistry and Oral Epidemiology 1996 24 106-11

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polymerization contraction stress for dental composites by two-step light-activation

Dent Mater 2002 18436-444

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constraint and filling technique in composite restorations Dent Mater 2004

20(3)236-43

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Polymerization shrinkage effects of boundary conditions and filling technique of

resin composite restorations J Dent 2004 32(6)459-70

50

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Quintessence Int 2004 35(2)156-61

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Dentomaxillofac Radiol 2007 Oct36(7)377-81

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J Prosthet Dent 2000 Sep84(3)289-96

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Three-year clinical evaluation of composite and ceramic inlays Am J Dent 2001

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79369 (Abstract)

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51

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52

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313Tay FR Frankenberger R Krejci I Bouillaguet S Pashley DH Carvalho

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317Unterbrink GL R Muessner Influence of light intensity on two restorative

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318Unterbrink GL Liebenberg WH Flowable resin composites as filled

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199930249ndash257

319Vaarkamp J Ten Bosch J Verdonschot EH Quantitative diagnosis of small

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Oral Surg Oral Med Oral Pathol 198661(3)289-96

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322Van Meerbeek B Van Landuyt K De Munck JHashimoto M Peumans M

Lambrechts P Yoshida Y Inoue S Suzuki K Technique-sensitivity of

contemporary adhesives Dent Mater J 2005 24(1) 1-13

323Van Meerbeek B Vargas S Inoue S Yoshida Y Peumans M Lambrechts P

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20016 119-144

324Van Meerbeek B Yoshida Y Inoue S Vargas M Abe Y Fukuda R Okazaki

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58

325Van Nieuwenhuysen JP DrsquoHoore W Carvalho J Qvist V Long-term

evaluation of extensive restorations in permanent teeth J Dent 200331(6)395ndash405

326Venhoven BA de Gee AJ Davidson CL Light initiation of dental resins

dynamics of the polymerization Biomaterials 1996 172313-2318

327Versluis A Douglas WH Cross M Sakaguchi RL Does an incremental filling

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329Waggoner W Ashton J Predictability of cavitation based upon radiographic

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330Watanabe LG Marshall GW Jr Marshall SJ Dentin shear strength effects of

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331Watts DC AS Marouf Optimal specimen geometry in bonded-disk

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451

332Watts DC Marouf AS Al-Hindi AM Photo-polymerization shrinkage-stress

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333Weaver WS Blank LW Pelleu GB Jr A visible light activated resin cured

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334Wendt SL Microleakage and cusp fracture resistance of heattreated composite

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1991 72 621-6

336Wenzel A Hintze H Perception of image quality in direct digital radiography

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Dentomaxillofac Radiol 1993 22 131-4

337Wenzel A Computer-aided image manipulation of intraoral radiographs to

enhance diagnosis in dental practice a review Int Dent J 1993 43 99-108

338Wenzel A Digital radiography and caries diagnosis Dento Maxillo Facial

Radiology 27(1)3-11 1998

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340Wibowo G Stockton L Microleakage of class II composite restorations Am J

Dent 200114177ndash185

341Wilson NHF Wastell DG Norman RD Five-year performance of high-

cooper content amalgam restorations in a multiclinical trial JDent1996 24 203-210

342Winkler MM Katona TR Paydar NH Finite element stress analysis of three

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1996751477-83

343Yap AU Effectiveness of polymerization in composite restoratives claiming bulk

placement Impact of cavity depth and exposure time Oper Dent 2000 25113-120

59

344Yeşilyurt C Bulucu B Bond strength of total-etch dentin adhesive systems on

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Contemporary Dental Practice 7(2) 20061-13

345Yoshida Y Van Meerbeek B Okazaki M Shintani H Suzuki K Comparative

study on adhesive performance of functional monomers J Dent Res 2004 83 454-

458

346Yoshiyama M Tay FR Doi J Nishitani Y Yamada T Itou K Carvalho RM

Nakajima M Pashley DH Bonding of self-etch and total etch adhesives to carious

dentin J Dent Res 2002 81 556-560

  • COPERTA REZUMAT ENGLEZA (MEREUTA)pdf
  • REZUMAT ENGLEZA DR MEREUTA DENISSpdf
Page 5: UNIVERSITATEA DE MEDICINA SI FARMACIE “GR Doctorat/Rezumat... · universitatea de medicina si farmacie “gr.t.popa” iasi facultatea de medicina dentara rezumatul tezei de doctorat

2

CHAPTX Study regarding the effects of etching on enamel and dentine in

cervical area for proximal cavities localised at lateral dental group125

X1Introduction125

X2Aim of study125

X3Materials and methods126

X4Results and discussions126

X5Conclusions147

CHAPTXI FEA study regarding the biomechanical behaviour and fracture

resistance of proximo-occlusal amalgam and composite resins restorations148

XI1Introduction148

XI2Aim of study148

XI3Materials and metods149

XI4Results and discussions152

XI5Conclusions182

FINAL CONCLUSIONS182

PERSONAL CONTRIBUTION183

REFERENCES184

3

INTRODUCTION

Academic European of Operative Dentistry warned about the factors that

impose to the dentists the use of composite resins on large scale as materials for the

direct restorations at lateral dental group the mass-media rejection of amalgam the

patients desire for esthetic restorations even the request for biological principles to

minimise sacrifice of healthy dental tissues However amalgam must be used in

particular situations represented by extensive carious lesions high cariogenic risk and

bruxism

In this context any comparative study focused on both amalgam and

composite resins proximo-occlusal restorations presents a high practical importance

for dentists Besides numerous fillings replacements are based on improper decisions

regarding wear status of restorations than a real clinical failure Dentists must also

take in account the specific oral environment conditions especially for adhesive

materials that are laquosensitive technique raquo

The final decision and materialrestorative technique selection must be based

on a balance between resistance longevity and priceefficiency

4

CHAPTVI THE AIM OF STUDY GENERAL OBJECTIVES DATA

COLLECTION AND PROCESSING

VI1 The reason for theme choice

The reason for theme choice was determined by the fact that any comparative

study focused on both amalgam and composite resins proximo-occlusal restorations

presents a high practical importance for dentists Also it is a request to highlight

clinical and paraclinical aspects regarding factors that influence clinical performance

of direct composite resins restorations performed at the level of lateral dental group

The support offered by Discipline Cariology and Restorative Dentistry and Institute

Petru Poni allowed the performance of our researches

VI2Aim objectives methodology

The objectives of my researches were as follows

- Selection of literature data regarding histological morphopatological

etiopathogenic spects of dental caries posibilities of diagnostic for proximal

incipient dental caries using both clasic and modern diagnostic technology

properties and clinical behaviour of dental amalgam and composite resins and

other adhesive materials used in posterior restorations literature data

regarding longevity of proximo-occlusal direct restorations and literature data

regarding clinical performances of indirect restorations versus direct

restorations for lateral dental group

- Performing an epidemiological study based on clinical data (indices Ryge

modified USPHS) on posterior direct restorations

- The comparing research regarding clinical performance of posterior composite

resines restorations performed using different restorative techniques

- In vitro study focused on the assessment of the marginal sealing at the cervical

area of proximo-occlusal composite resins restorations

- In vitro study focused on the effects of etching at the cervical area for

proximo-occlusal composite resins restorations

- FEA (finite element analysis) study focused on the assessment of

biomechanical behaviour and resistance to fracture and deformation of

simulated proximo-occlusal restorations from amalgam and composite resins

To realise the proposed aims the working protocol was as follows

- clinical assessment of a study group with age 17-49 with class II dental caries

treated by one dentist using amalgam and composite resins

5

- clinical assessment of a study group with age 15-65 with class II dental caries

treated by one dentist using a selected composite resin and different restorative

techniques

- performing of data base for statistical processing

Database was collected between 2008-2011 in private practice and Faculty of

Dental Medicine UMF ―GrTPopa Iasi The paraclinical studies were performed in

collaboration with Institute Petru Poni Iasi

The patients were informed and gave their written consent to be included in

study groups Every patient was submitted to clinical examen and radiographic

examen The clinical examens consisted in assessment of Ryge indices (modified

USPHS) at baseline 6 months 12 months 18months and 24 months

The paraclinical tests consisted in

- in vitro tests on extracted teeth consisting in optical and atomic force

microscopy to assess the influence of different restorative techniques on the cervical

marginal sealing

- measurement of surface status (enamel dentine) after etching (different time

intervals) using AFM (Atomic Force Microscopy)

- statistical analysis in SPSS 13 for comparison of microleakage degree at

cervical level related to different restorative techniques

- FEA study performed using software COSMOSWorks 2010 for the

assessment of biomechanical behaviour of simulated posterior amalgam and

composite resins restorations

VI3 Data collecting and processing

The processing of reseraches data was performed using the follwing software

MS Office (graphs tables)

SPSS 16 (statistical tests)

The following statistical tests were used t Test test Kolmogorov-Smirnov test

Pearson test Wilcoxon The descriptive statistical analysis was performed using

Microsoft Excel and analitical statistical analysis was performed using SPSS 160

(SPSS Inc SUA)

6

CHAPTVII STUDY REGARDING CLINICAL PERFORMANCE OF

PROXIMO-OCCLUSAL AMALGAM AND COMPOSITE RESINS

RESTORATIONS

VII1 INTRODUCTION

The clinical performance of posterior direct restorations pn medium and long

term concerns dental practitioners that must correlate their therapeutical decisions

with material selection restorative technique external factors represented by oral

forces cariogenic risk patient parafunctions

VII2AIM OF STUDY

The aim of study consisted in assessment of clinical performance of amalgam

and composite resins proximal-occlusal restorations 4-years old

VII3 MATERIALS AND METHOD

The study group included 200 proximal-occlusal amalgam (n=100) and

composite resins (Herculite Kerr) (n=100) restorations 4-years old The study was

performed on 55 patients with age between 17-49 years examined in Dental Medicine

Faculty UMFGrTPopa Iaşi The assessment of fillings status was performed

using Ryge indices modified USPHS (US Public Health Service) (table 1) The

clinical peformance of restorations was also correlated with dental group (molars

bicusps) extension (medium extended) and cariogenic risk (medium high) The

following parameters were assessed

- color match

- marginal adaptation (integrity)

- marginal discoloration

- anatomical form (proximal)

- surface quality

The results presentation was performed using Microsoft Excel

VII4 RESULTS AND DISCUSSIONS

AB

C

S1

6

64

30

0

20

40

60

80

A

B

C

Fig VII1 Anatomical form (occlusal)-amalgam restorations (molars)

7

AB

C

S1

26

64

100

10

20

30

40

50

60

70

A

B

C

Fig VII2 Anatomical form (occlusal)-amalgam restorations (bicusps)

AB

C

S1

0

46

54

0

10

20

30

40

50

60

A

B

C

Fig VII3 Anatomical form (occlusal)-composite resins restorations (molars)

Fig VII4 Anatomical form (occlusal)-amalgam restorations (bicusps)

AB

C

S1

12

72

16

0

10

20

30

40

50

60

70

80

A

B

C

FigVII5 Anatomical form (proximal)-amalgam restorations (molars)

AB

C

S1

38

56

60

10

20

30

40

50

60

A

B

C

FigVII6 Anatomical form (proximal)-amalgam restorations (bicusps)

AB

C

S1

10

54

36

0

10

20

30

40

50

60

A

B

C

8

AB

C

S1

8

64

26

0

10

20

30

40

50

60

70

A

B

C

FigVII7 Anatomical form (proximal)-composite resins restorations (molars)

AB

C

S1

34

66

100

10

20

30

40

50

60

70

A

B

C

FigVII8 Anatomical form (proximal)-composite resins restorations (bicusps)

AB

C

S1

36

44

20

0

5

10

15

20

25

30

35

40

45

A

B

C

FigVII9 Marginal adaptation (proximal)- amalgam restorations(bicusps)

AB

C

S1

20

50

30

0

5

10

15

20

25

30

35

40

45

50

A

B

C

FigVII10 Marginal adaptation (proximal)-amalgam restorations (molars)

AB

C

S1

16

60

24

0

10

20

30

40

50

60

A

B

C

FigVII11 Marginal adaptation (proximal)-composite resins restorations (bicusps)

9

AB

C

S1

12

54

34

0

10

20

30

40

50

60

A

B

C

FigVII12 Marginal adaptation (proximal)-composite resins restorations (molars)

AB

C

S1

22

54

24

0

10

20

30

40

50

60

A

B

C

FigVII13 Surface quality-amalgam restorations (bicusps)

AB

C

S1

10

54

36

0

10

20

30

40

50

60

A

B

C

FigVII14 Surface quality-amalgam restorations (molars)

AB

C

S1

12

68

20

0

10

20

30

40

50

60

70

A

B

C

FigVII15 Surface quality-composite resins restorations (bicusps)

AB

C

S1

8

70

22

0

20

40

60

80

A

B

C

FigVII16 Surface quality-composite resins restorations (molars)

10

A

C

S1

98

20

20

40

60

80

100

A

C

FigVII17a-b Prevalence of marginal dental cariesamalgam restorations (moderate

CR)

A

C

S1

92

80

20

40

60

80

100

A

C

FigVII18 Prevalence of marginal dental cariesamalgam restorations (high CR)

A

C

S1

94

60

20

40

60

80

100

A

C

FigVII19 Prevalence of marginal dental cariescomposite resins restorations (CR

moderate)

A

C

S1

82

18

0

10

20

30

40

50

60

70

80

90

A

C

FigVII20 Prevalence of marginal dental cariescomposite resins restorations (high

CR)

11

The study data sustain the results obtained by most studies focused on

posterior amalgam restorations However Hickelampcol (2001) reviewed literature data

and proved that many results varies accordingly to different clinical factors (133)

Roulet JF(1997) warned about limits of cross-sectional studies related to composite

resins restorations because of the absence of data regarding restorative techniques

practitioner experience presence or absence of optimum isolation factors related by

patient (266)

VII5CONCLUSIONS

Amalgam proximo-occlusal restorations with minimum 6-years age present

excellent results for parameters anatomic form (occlusal) marginal

discoloration and marginal secondary dental caries good results for

parameters anatomic form (proximal) and marginal adaptation and poor results

for surface quality

Composite resins proximo-occlusal restorations (bicusps) with minimum 6-

years age present excellent results for parameters color match marginal

discoloration and marginal secondary dental caries and good results for

parameters anatomic form (occlusal proximal) marginal adaptation surface

quality

Composite resins proximo-occlusal restorations (molars) with minimum 6-

years age present good results for parameters color match marginal

discoloration marginal secondary dental caries marginal adaptation and poor

results for parameters anatomic form (occlusal) (54 indices Ryge C)

anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The restorations extended at external third of occlusal surface present highest

percents of indices C regarding anatomic form (occlusal) (54 indices Ryge

C) anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The exceeding of 6-years age will require careful monitorisation for early

interventions through polishing sealing reshaping and even replacement for

restorations with major defects

12

CHAPTVIII CLINICAL PERFORMANCE OF COMPOSITE RESINS

RESTORATIONS RELATED TO RESTORATIVE TECHNIQUE 12-

MONTHS LONGITUDINAL STUDY

VIII1 INTRODUCTION

The restorative technique has a major influence over clinical performance of

composite resins restorations in proximo-occlusal cavities In this context researches

focused on correlations between technique and clinical performance of direct

restorations improve the dentist decision regarding restorative technique choice

VIII2AIM OF STUDY

The aim of study was to determine the clinical performance of composite

resins proximo-occlusal restorations performed using different restorative techniques

VIII3MATERIALS AND METHOD

The group study included 37 patients with age 18-42 years with moderat

ecariogenic risk The total number of composite resins restorations (Herculite XRV

Kerr) was 60 divided in three study groups (n=20)

I Centripetal build-up

II Oblique layering

III Horisontal layering

The coronal restorations were assessed at an interval of 12 months using

indices Ryge modified USPHS

- indice ALFA (A)- IDEAL CLINIC

- indice BRAVO (B)- ACCEPTABLE CLINIC

- indice CHARLIE (C)- UNACCEPTABLE CLINIC

VIII4 RESULTS AND DISCUSSIONS

The statistical tests Kruskal-Wallis and Mann-Whitney were performed to

confirm or infirm research hypotesis (the direct restorations performed using different

restorative techniques present statistical significant differences regarding clinical

performance for the assessed parameters)

13

TableVIII1a-b Groups study (Kruskal-Wallis Test)

Ranks

20 2960

20 2560

20 3630

60

20 3050

20 2420

20 3680

60

20 2490

20 3140

20 3520

60

Restorative_techniques

Centripetal build-up

Oblique layering

Horizontal layering

Total

Centripetal build-up

Oblique layering

Horizontal layering

Total

Centripetal build-up

Oblique layering

Horizontal layering

Total

Marginal_adaptation

Marginal_discoloration

Anatomical_form

N Mean Rank

Test Statisticsab

4913 8031 4900

2 2 2

086 018 086

Chi-Square

df

Asymp Sig

Marginal_

adaptation

Marginal_

discoloration

Anatomical_

form

Kruskal Wallis Testa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between the three restorative

techniques for parameter marginal adaptation (p=0086)

There are no statistical significant differences between the three restorative

techniques for parameter marginal discoloration (p=0018)

There are no statistical significant differences between the three restorative

techniques for parameter anatomical form (proximal) (p=0086)

TableVIII2 Comparing results between restorations performed using three

techniques (marginal adaptation marginal discoloration anatomical form) Marginal adaptation Centripetal build-upOblique layering p=04 ns

Centripetal build-upHorizontal layering p=0191 ns

Oblique layering Horizontal layering p=0028 s

Marginal discoloration Centripetal build-upOblique layering p=0103 ns

Centripetal build-upHorizontal layering p=0195 ns

Oblique layering Horizontal layering p=0005 s

Anatomical form Centripetal build-upOblique layering p=0137 ns

Centripetal build-upHorizontal layering p=0029 s

Oblique layering Horizontal layering p=0433 ns

ns nesemnificativ

s semnificativ

p probabilitate

14

Tables VIII3a-b Mann-Whitney test Comparing analysis regarding marginal

discoloration between restorations performed using oblique layering technique and

centripetal build-up technique

Ranks

20 2180 43600

20 1920 38400

40

Restorative_techniques

Centripetal build-up

Oblique layering

Total

Marginal_adaptation

N Mean Rank Sum of Ranks

Test Statisticsb

174000

384000

-841

400

495a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

adaptation

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between centripetal build-up

and oblique layering techniques regarding parameter marginal adaptation (p=0400)

Tables VIII4a-b Mann-Whitney test Comparing analysis regarding marginal

adaptation between restorations performed using horisontal layering technique and

centripetal build-up technique

Ranks

20 1830 36600

20 2270 45400

40

Restorative_techniques

Centripetal build-up

Horizontal layering

Total

Marginal_adaptation

N Mean Rank Sum of Ranks

Test Statisticsb

156000

366000

-1307

191

242a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

adaptation

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between centripetal build-up

and horisontal layering techniques regarding parameter marginal adaptation

(p=0191)

15

TablesVIII5a-b Mann-Whitney test Comparing analysis regarding marginal

adaptation between restorations performed using oblique layering technique and

horisontal layering technique

Ranks

20 1690 33800

20 2410 48200

40

Restorative_techniques

Oblique layering

Horizontal layering

Total

Marginal_adaptation

N Mean Rank Sum of Ranks

Test Statisticsb

128000

338000

-2191

028

052a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

adaptation

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There is statistical significant differences between horisontal layering and

oblique layering techniques regarding parameter marginal adaptation (p=0028)

Tables VIII6a-b Mann-Whitney test Comparing analysis regarding marginal

discoloration between restorations performed using oblique layering technique and

centripetal build-up technique

There are no statistical significant differences between centripetal build-up

and oblique layering techniques regarding parameter marginal discoloration

(p=0103)

Ranks

20 2260 45200

20 1840 36800

40

Restorative_techniques

Centripetal build-up

Oblique layering

Total

Marginal_discoloration

N Mean Rank Sum of Ranks

Test Statisticsb

158000

368000

-1632

103

265a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

discoloration

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

16

Tables VIII7a-b Mann-Whitney test Comparing analysis regarding marginal

discoloration between restorations performed using centripetal build-up technique and

horisontal layering technique

Ranks

20 1840 36800

20 2260 45200

40

Restorative_techniques

Centripetal build-up

Horizontal layering

Total

Marginal_discoloration

N Mean Rank Sum of Ranks

Test Statisticsb

158000

368000

-1299

194

265a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

discoloration

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between centripetal build-up

and horisontal layering techniques regarding parameter marginal discoloration

(p=0103)

Tables VIII8a-b Mann-Whitney test Comparing analysis regarding marginal

discoloration between restorations performed using oblique layering technique and

horisontal layering technique

Ranks

20 1630 32600

20 2470 49400

40

Restorative_techniques

Oblique layering

Horizontal layering

Total

Marginal_discoloration

N Mean Rank Sum of Ranks

Test Statisticsb

116000

326000

-2822

005

023a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

discoloration

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There is statistical significant differences between horisontal layering and

oblique layering techniques regarding parameter marginal discoloration (p=0005)

17

TablesVIII9 a-b Mann-Whitney test Comparing analysis regarding anatomical

form between restorations performed using centripetal build-up technique and oblique

layering technique

Ranks

20 1830 36600

20 2270 45400

40

Restorative_techniques

Centripetal build-up

Oblique layering

Total

Anatomical_form

N Mean Rank Sum of Ranks

Test Statisticsb

156000

366000

-1486

137

242a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Anatomical_

form

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between centripetal build-up

and oblique layering techniques regarding parameter anatomical form (p=0137)

Tables VIII10a-b Mann-Whitney test Comparing analysis regarding anatomical

form between restorations performed using centripetal build-up technique and

horisontal layering technique

Ranks

20 1710 34200

20 2390 47800

40

Restorative_techniques

Centripetal build-up

Horizontal layering

Total

Anatomical_form

N Mean Rank Sum of Ranks

Test Statisticsb

132000

342000

-2184

029

068a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Anatomical_

form

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between centripetal build-up

and horisontal layering techniques regarding parameter anatomical form (p=0029)

18

Tables VIII11a-b Mann-Whitney test Comparing analysis regarding anatomical

form between restorations performed using oblique layering technique and horisontal

layering technique

Ranks

20 1920 38400

20 2180 43600

40

Restorative_techniques

Oblique layering

Horizontal layering

Total

Anatomical_form

N Mean Rank Sum of Ranks

Test Statisticsb

174000

384000

-784

433

495a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Anatomical_

form

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between horisontal layering and

oblique layering techniques regarding parameter anatomical form (p=0433)

Indices A for restorations performed using centripetal build-up technique were

as follows color match-80 marginal adaptation- 60 marginal discoloration-

70 anatomical form (proximal)- 80 surface quality- 60

Indices A for restorations performed using horisontal layering technique were

as follows color match-70 marginal adaptation- 40 marginal discoloration-

50 anatomical form (proximal)- 50 surface quality- 70

Indices A for restorations performed using oblique layering technique were as

follows color match-70 marginal adaptation- 80 marginal discoloration- 90

anatomical form (proximal)- 60 surface quality- 70

Indices B for restorations performed using centripetal build-up technique were

as follows color match-20 marginal adaptation- 30 marginal discoloration-

20 anatomical form (proximal)- 30 surface quality- 40

Indices B for restorations performed using horisontal layering technique were

as follows color match-30 marginal adaptation- 40 marginal discoloration-

30 anatomical form (proximal)- 30 surface quality- 30

Indices B for restorations performed using oblique layering technique were as

follows color match-30 marginal adaptation- 20 marginal discoloration- 10

anatomical form (proximal)- 40 surface quality- 30

19

Indices C for restorations performed using centripetal build-up technique were

as follows color match-0 marginal adaptation- 10 marginal discoloration- 0

anatomical form (proximal)- 0 surface quality- 0

Indices C for restorations performed using horisontal layering technique were

as follows color match-0 marginal adaptation- 20 marginal discoloration- 20

anatomical form (proximal)- 20 surface quality- 0

Indices C for restorations performed using oblique layering technique were as

follows color match-0 marginal adaptation- 0 marginal discoloration- 10

anatomical form (proximal)- 0 surface quality- 100

Discussions

For in vitro studies is difficult to reproduce the variables existent in oral cavity

like occlusal stress and pH and temperature changes (235) The clinical studies are

determinant in assessment of restorative techniques (300) The most researches

focuses on the influence of restorative technique on the reduction of lightcuring stress

(51 78 135)

VIII5 CONCLUSIONS

Oblique layering technique presents superior results regarding marginal

adaptation and marginal discoloration and is recommended for proximo-

occlusal dental caries close to enamel-cement jonction

Centripetal build-up presents good results regarding marginal adaptation and

anatomical form at proximal level (proximal surfaces and contact point)

Horisontal layering technique can be used for optimum results only in

proximal-occlusal cavities with moderate extension both in occlusal-cervical

and buccal-oral

20

CHAPTIX STUDY REGARDING MARGINAL SEALING STATUS IN

COMPOSITE RESINS LIMITED PROXIMO-OCCLUSAL RESTORATIONS

PERFORMED USING DIFFERENT TECHNIQUES

IX1INTRODUCTION

The contraction of composite resins can produce stress inside dental structure

The most contraction stress appears in the initial stages and development rate of stress

decreases gradually in time (5 98 160) The contraction stress of composite resins

can overpass adhesion strenght and can broke the link between dental tissues and

composite resin (73) When adhesion strenght is high stress can produce marginal

fracture or bulk fracture (74) These situations are associated with microleakage and

penetration of oral fluid and bacteria along dentinal walls endangering the pulpal

tissue or favourising secondary dental caries

IX2 AIM OF STUDY

The study aimed to assess the efficiency of marginal sealing along gingival

wall in limited proximal-occlusal restorations performed using three different

techniques

IX3MATERIALS AND METHOD

The study group included 30 teeth extracted for orthodontic and periodontal

reasons On every tooth two identical class II cavities (on mesial and distal surfaces)

were prepared with cylindrical burs under water cooling The gingival wall was

limited to enamel-cement jonction The cavity dimension were as follows 2 mm

buccal-oral 5mm depth Each tooth was introduced in a pattern of acrylat The

operator calibrated preparation technique on acrylat teeth in Simulation Laboratory of

UMF ―Gr T Popa Iaşi The 60 prepared cavities were randomly divided in three

study groups related to restorative technique The restoration were performed with

Filtek Z550 (3M ESPE) a nanohybrid composite resin The adhesive strategy

included etchamprinse in 2 steps and adhesive Adper Single Bond 2(3MESPE)

Group A (n=20) bulk restorative technique associated with lightcuring from

occlusal 40 seconds and from buccal and oral 20 seconds

Group B (n=20) oblique layering technique (first layer on buccal wall and

buccal frac12 of gingival wall was lightcured from buccal second layer on oral wall and

oral frac12 of gingival wall was lightcured from oral third oral as a triangle with point

oriented to gingival wall was lightcured from occlusal)

Group C (n=20) combined technique (bdquoflow layer on gingival and axial

walls lightcured under pressure only associated with solid composite resin layer)

The proximal surfaces were performed using Tofflemire and metallic matrices After

removal of matrices every restoration was lightcured for another 20 seconds Two

layers aof varnish were applied on composite resins restorations excepting cavity

margins and an area of 1 mm around them The samples were introduced in methylen

21

blue 10 for 48 hours After this stage samples were washed with water and teeth

were cut longitudinally with a diamonded disc

The die penetration was assessed with Zeiss (Iena Germany) X20 microscope

accordingly to four scores (0-3)

0 ndash no penetration

1 ndash die infiltration until external half of gingival wall

2 ndash die infiltration on all gingival wall

3 ndash die infiltration on gingival wall and axial wall

IX4RESULTS AND DISCUSSIONS

The result of die penetration are presented in table IX1

TableIX1 The results for die penetration

Grup 0 1 2 3

A (bulk) 0 0 3 17

B (layering) 0 4 5 11

C (combined) 12 5 2 1

In group A 17 sample had score 3 and 2 samples had score 2 In group B 11

sample had score 3 5 samples had score 2 and 4 sample had score 1 In group C with

best results 12 samples had score 0 5 samples had score 1 2 samples had score 2 1

sample had score 3

The recorded data were analysed using test Mann-Whitney The statistical

results are presented in tables IX2-IX4

Tables IX2a-b Mann-Whitney for comparisons of microleakage values between

bulk technique and incremental technique

Ranks

Restorative technique N Mean Rank Sum of Ranks

Scores

frequency

A ndash bulk technique 20 2420 24200

B ndash incremental

technique

20 1680 16800

Total 40

Test Statisticsb

scores

frequency

Mann-Whitney U 29000

Wilcoxon W 168000

Z -1970

Asymp Sig (2-tailed) 049

Exact Sig [2(1-tailed Sig)] 123a

a Not corrected for ties

b Grouping Variable restorative technique

22

Tables IX3a-b Mann-Whitney for comparisons of microleakage values between

bulk technique and mixed technique

Ranks

Restorative technique N Mean Rank Sum of Ranks

scores

frequency

A ndash bulk technique 20 3090 30900

C ndash mixed technique 20 1010 10100

Total 40

Test Statisticsb

scores

frequency

Mann-Whitney U 500

Wilcoxon W 101000

Z -4021

Asymp Sig (2-tailed) 000

Exact Sig [2(1-tailed Sig)] 000a

a Not corrected for ties

b Grouping Variable restorative technique

Tables IX4a-b Mann-Whitney test for comparisons of microleakage values

between incremental technique and mixed technique

Ranks

Restorative technique N Mean Rank Sum of Ranks

scores

frequency

B ndash incremental

technique

20 2990 29900

C ndash mixed technique 20 1210 12100

Total 40

Test Statisticsb

scores

frequency

Mann-Whitney U 5500

Wilcoxon W 121000

Z -3492

Asymp Sig (2-tailed) 000

Exact Sig [2(1-tailed Sig)] 000a

a Not corrected for ties

23

Test Statisticsb

scores

frequency

Mann-Whitney U 5500

Wilcoxon W 121000

Z -3492

Asymp Sig (2-tailed) 000

Exact Sig [2(1-tailed Sig)] 000a

a Not corrected for ties

b Grouping Variable tehnrestaurare

The results of microleakage degree were statistically significant when the

three restorative techniques were compared The results showed that best restorative

technique regarding marginal sealing in cervical area is combined technique followed

by oblique layering technique The use of layering techniques limits the development

of contraction forces between oposite walls event that favourises bulk stress voids

formation and fissure inside dental tissues The results of our study are similar with

other studies (114 293)

IX5 CONCLUSIONS

The values of die penetration at gingival wall were statistically different

between the three restorative techniques

We concluded that all restorative methods were associated with lightcuring

contraction and marginal microleakage

The combined technique was associated with lowest lightcuring contraction

and die penetration

The bulk technique was associated with highest lightcuring contraction and die

penetration

24

CHAPTX STUDY REGARDING THE EFFECTS OF ETCHING ON

ENAMEL AND DENTINE IN CERVICAL AREA FOR PROXIMAL

CAVITIES AT LATERAL DENTAL GROUP

X1 INTRODUCTION

The studies reported marginal defects and high microleakage at the level of

gingival margins localised in cervical area or close to enamel-cement jonction for

high percents of proximal-occlusal composite resins restorations (8485) The good

adhesion is requested to insure restoration longevity and to prevent marginal

microleakage and presence of secondary marginal dental caries The adhesion

strenght of different adhesive systems can vary accordingly to tissues areas (204 240)

and to variations in dentinal structures (234 330) Most studies focused on adhesive

systems performances used healthy dentine close to pulp room but in case of class II

restorations there are particular features that influences the adhesion at the level of

gingival margins

The surface topography is an important property that determines the

interaction manner between surfaces The surface roughness and surface energy can

increase or decrease the adhesion of composite resins to the hard dental tissues

X2 AIM OF STUDY

The aim of study was to compare surface roughness of enamel and dentine

after etching related to different distances related to enamel-dentinecement jonction

X3 MATERIALS AND METHODS

The study group included 20 molars extracted from orthodontics or

periodontal reasons with intact proximal surfaces The teeth were cut longitudinally in

sens buccal-oral with diamond discs under water cooling

A group study (10 teeth) included 10 samples obtained through transversal

cutting at distance of 2mm from enamel-dentinecement jonction and 10 samples

obtained through transversal cutting at distance of 15 mm from enamel-

dentinecement jonction Another study group (10 teeth) included 10 samples

obtained through transversal cutting at distance of 1mm from enamel-dentinecement

jonction and 10 samples obtained through transversal cutting at distance of 05 mm

from enamel-dentinecement jonction All these samples were divided in two halfes

through mesial-distal cutting The samples finishing was performed with abrasive

paper (100-4000) and final polishing was performed with a device Buehler model

Minimet with slices introduced in ultrasound bath for 4 minutes The second half of

each sample was etched for 15 seconds with ortophosphoric acid 37 for 15 seconds

Slices were washed with distilled water for 30 seconds after etching and dried

The samples were analysed with atomic force microscopy (AFM) regarding

surface roughness The results were expressed as relative variation of roughness

X4 RESULTS AND DISCUSSIONS

The aspect of etched enamel at 2 mm distance from ECJ can be seen in figure

X1 (section 10 microm) The surface roughness is higher comparing with sample before

etching

25

După gravajul cu acid ortofosforic 37

The aspect of etched enamel at 15 mm distance from ECJ can be seen in

figure X2 (section 10 microm) The surface roughness is higher comparing with sample

before etching but lower comparing with sample at 2 mm from ECJ

The aspect of etched enamel at 1 mm distance from ECJ can be seen in figure

X3 (section 10 microm) The surface roughness is higher comparing with sample before

etching but lower comparing with sample at 15mm and 2 mm from ECJ

The aspect of etched enamel at 15 mm distance from ECJ can be seen in

figure X4 (section 10 microm) The surface roughness is higher comparing with sample

before etching but lower comparing with sample at 1 mm 15 mm and 2 mm from

ECJ

FigX1 3D aspect of enamel at 2 mm from ECJ

after etching (10 microm)

FigX2 3D aspect of enamel at 15 mm from ECJ

after etching (10 microm)

FigX3 3D aspect of enamel at 1 mm from ECJ

after etching (10 microm)

FigX4 3D aspect of enamel at 05 mm from ECJ

after etching (10 microm)

26

The mean values of squared roughness for dentine and enamel before etching

are presented in tables X1 and X2

Table X1 Squared roughness values for dentine samples before and after etching

Before etching (nm) After etching (nm)

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

sample

1

335 282 283 259 1149 947 901 879

sample

2

352 284 274 266 1127 939 883 875

sample

3

357 273 278 263 1152 953 876 867

sample

4

323 269 264 258 1146 942 895 883

sample

5

348 298 271 268 1153 944 904 878

sample

6

339 274 278 273 1158 937 893 892

sample

7

352 283 269 266 1145 944 899 876

sample

8

349 292 272 274 1166 942 907 869

sample

9

357 284 275 265 1132 939 893 879

sample

10

348 281 277 262 1142 941 899 878

Table X2 Squared roughness values for enamel and dentine samples before and after

etching

Before etching (nm) After etching (nm)

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

sample 1 422 342 309 313 2255 1114 874 845

sample 2 418 338 324 304 2236 1102 882 839

sample 3 413 334 315 303 2239 1115 873 833

sample 4 416 336 322 308 2242 1116 868 842

sample 5 426 332 315 294 2218 1103 877 829

sample 6 412 332 317 306 2237 1099 874 847

sample 7 414 335 322 314 2252 1102 876 834

sample 8 416 325 318 313 2239 1106 875 838

sample 9 418 328 314 299 2246 1113 879 836

sample 10 413 334 316 305 2242 1104 873 839

The results for samples before etching prove a decreasing tendency for mean

values of squared roughness surface beginning with areas placed at distance of 2 mm

from ECJ (346 nm) followed by areas placed at distance of 15 mm from ECJ (282

nm) 1 mm from ECJ (274 nm) and 05 mm from ECJ (265 nm) After etching the

decreasing tendency maintained for dentine localised at 2 mm from ECJ to dentine

localised at 05 mm from ECJ The mean values of squared roughness after etching

were three times higher (tables X3)

27

Table X3 Squared roughness values for enamel and dentine samples before and

after etching

Dentine Enamel

Before etching

(nm)

After etching

(nm)

Before etching

(nm)

After etching

(nm)

2 mm ECJ 346 1147 416 2237

15 mm ECJ 282 942 333 1107

1 mm ECJ 274 895 317 875

05 mm ECJ 265 877 305 838

The descriptive statistics data for surface roughness of dentine before and after

etching are presented in tables X4 si X5

Table X4 Descriptive statistics for dentine samples before etching

Statistics

Dentine 2mm

before etching

Dentine 15mm

before etching

Dentine 1mm

before etching

Dentine 05mm

before etching

N Valid 10 10 10 10

Missing 0 0 0 0

Mean 346000 282000 274100 265400

Std Error of Mean 33830 27487 17026 16746

Std Deviation 106979 86923 53841 52957

Skewness -1214 354 -314 348

Std Error of Skewness 687 687 687 687

Kurtosis 1141 049 336 -539

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 3230 2690 2640 2580

Maximum 3570 2980 2830 2740

Table X5 Descriptive statistics for dentine samples after etching

Statistics

Dentine 2mm

after etching

Dentine 15mm

after etching

Dentine 1mm

after etching

Dentine 05mm

after etching

N Valid 10 10 10 10

Missing 0 0 0 0

1147000 942800 895000 877600

Std Error of Mean 36545 14591 29926 22020

Std Deviation 115566 46140 94634 69634

Skewness -267 1169 -951 535

Std Error of Skewness 687 687 687 687

Kurtosis 043 1776 564 1416

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 11270 9370 8760 8670

28

Statistics

Dentine 2mm

after etching

Dentine 15mm

after etching

Dentine 1mm

after etching

Dentine 05mm

after etching

N Valid 10 10 10 10

Missing 0 0 0 0

1147000 942800 895000 877600

Std Error of Mean 36545 14591 29926 22020

Std Deviation 115566 46140 94634 69634

Skewness -267 1169 -951 535

Std Error of Skewness 687 687 687 687

Kurtosis 043 1776 564 1416

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 11270 9370 8760 8670

Maximum 11660 9530 9070 8920

To choose the statistical test to compare roughness surface values was

performed a test Shapiro-Wilk If p is lower or equal with 0005 than hypothesis of

distribution normality is rejected (distribution deviates from normal form) In the table

X6 the distributions are normal The statistical test will be test t for pair samples

Table X6 Test Shapiro-Wilk for dentine samples

Tests of Normality

Kolmogorov-Smirnov

a Shapiro-Wilk

Statistic df Sig Statistic df Sig

Dentine 2mm before etching 274 10 032 877 10 122

Dentine 15mm after etching 209 10 200 952 10 689

Dentine 1mm before etching 134 10 200 983 10 980

Dentine 05mm before etching 155 10 200 949 10 661

Dentine 2mm after etching 133 10 200 977 10 946

Dentine 15mm after etching 197 10 200 916 10 329

Dentine 1mm after etching 216 10 200 925 10 401

Dentine 05 after etching 220 10 185 933 10 474

Enamel 2mm before etching 193 10 200 898 10 207

Enamel 15mm before etching 170 10 200 977 10 947

Enamel 1mm before etching 157 10 200 952 10 689

Enamel 05mm before etching 165 10 200 943 10 590

Enamel 2mm after etching 235 10 124 925 10 404

Enamel 15mm after etching 209 10 200 871 10 102

Enamel 1mm after etching 189 10 200 964 10 834

Enamel 05mm after etching 142 10 200 983 10 978

a Lilliefors Significance Correction

29

Tests of Normality

Kolmogorov-Smirnov

a Shapiro-Wilk

Statistic df Sig Statistic df Sig

Dentine 2mm before etching 274 10 032 877 10 122

Dentine 15mm after etching 209 10 200 952 10 689

Dentine 1mm before etching 134 10 200 983 10 980

Dentine 05mm before etching 155 10 200 949 10 661

Dentine 2mm after etching 133 10 200 977 10 946

Dentine 15mm after etching 197 10 200 916 10 329

Dentine 1mm after etching 216 10 200 925 10 401

Dentine 05 after etching 220 10 185 933 10 474

Enamel 2mm before etching 193 10 200 898 10 207

Enamel 15mm before etching 170 10 200 977 10 947

Enamel 1mm before etching 157 10 200 952 10 689

Enamel 05mm before etching 165 10 200 943 10 590

Enamel 2mm after etching 235 10 124 925 10 404

Enamel 15mm after etching 209 10 200 871 10 102

Enamel 1mm after etching 189 10 200 964 10 834

Enamel 05mm after etching 142 10 200 983 10 978

a Lilliefors Significance Correction

This is a lower bound of the true significance

The results of test t for pair dentine samples before and after etching are

presented in table X

Table X7 Test t for dentine before and after etching

Paired Samples Test

Paired Differences

t df

p (2-

tailed)

95 Confidence

Interval of the

Difference

Mean

Std

Dev

Std

Error

Mean Lower Upper

Pair

1

dentine2mmbeforeetching-

dentine2mmafteretching

-

8010000

174801 55277 -

8135045

-

7884955

-

144906

9 000

Pair

2

dentine15mmbeforeetching-

dentine15mmafteretching

-

6608000

102394 32380 -

6681248

-

6534752

-

204079

9 000

Pair

3

dentine1mmbeforeetching-

dentine1mmafteretching

-

6209000

117799 37251 -

6293269

-

6124731

-

166678

9 000

30

Paired Samples Test

Paired Differences

t df

p (2-

tailed)

95 Confidence

Interval of the

Difference

Mean

Std

Dev

Std

Error

Mean Lower Upper

Pair

1

dentine2mmbeforeetching-

dentine2mmafteretching

-

8010000

174801 55277 -

8135045

-

7884955

-

144906

9 000

Pair

2

dentine15mmbeforeetching-

dentine15mmafteretching

-

6608000

102394 32380 -

6681248

-

6534752

-

204079

9 000

Pair

3

dentine1mmbeforeetching-

dentine1mmafteretching

-

6209000

117799 37251 -

6293269

-

6124731

-

166678

9 000

Pair

4

dentine05mmbeforeetching-

dentine05mmafteretching

-

6122000

86384 27317 -

6183796

-

6060204

-

224109

9 000

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of dentine (

2mm 15 mm 1mm sau 05mm)

The descriptive statistics data for dentine surface roughness before and after

etching are presented in tables X8 and X9

Table X8 Descriptive statistics for enamel samples before etching

Statistics

Enamel 2mm

before etching

Enamel 15mm

before etching

Enamel 1mm

before etching

Enamel 05mm

before etching

N Valid 10 10 10 10

Missing 0 0 0 0

Mean 416800 333600 317200 305900

Std Error of Mean 13968 15217 14205 20355

Std Deviation 44171 48120 44920 64369

Skewness 1095 -156 -109 -411

Std Error of Skewness 687 687 687 687

Kurtosis 769 487 -118 -295

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 4120 3250 3090 2940

Maximum 4260 3420 3240 3140

31

Table X9 Descriptive statistics for enamel samples after etching

Statistics

Enamel 2mm

after etching

Enamel 15mm

after etching

Enamel 1mm

after etching

Enamel 05mm

after etching

N Valid 10 10 10 10

Missing 0 0 0 0

Mean 2237600 1107400 875100 838200

Std Error of Mean 31027 20232 11968 17436

Std Deviation 98116 63979 37845 55136

Skewness -850 267 042 040

Std Error of Skewness 687 687 687 687

Kurtosis 878 -1880 1082 -425

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 22180 10990 8680 8290

Maximum 22520 11160 8820 8470

To choose the statistical test to compare roughness surface values was

performed a test Shapiro-Wilk If p is lower or equal with 0005 than hypothesis of

distribution normality is rejected (distribution deviates from normal form) In the table

X10 the distributions are normal The statistical test will be test t for pair samples

Table X10 Test Shapiro-Wilk for enamel samples

Tests of Normality

Kolmogorov-Smirnova Shapiro-Wilk

Statistic df Sig Statistic df Sig

2mmenamel before etching 193 10 200 898 10 207

15mmenamel before etching 170 10 200 977 10 947

1mmenamel before etching 157 10 200 952 10 689

05mmenamel before etching 165 10 200 943 10 590

2mmenamel after etching 235 10 124 925 10 404

15mmenamel after etching 209 10 200 871 10 102

1mmenamel after etching 189 10 200 964 10 834

05mmenamel after etching 142 10 200 983 10 978

a Lilliefors Significance Correction

This is a lower bound of the true significance

The results of test t for pair enamel samples before and after etching are

presented in table X11

32

Table X11 Test t for enamel samples before and after etching

Paired Samples Test

Paired Differences

t df

p (2-

tailed)

95 Confidence

Interval of the

Difference

Mean

Std

Deviation

Std

Error

Mean Lower Upper

Pair

1

2mmenamel before

etching

2mmenamel after

etching

-18208 135220 42760 -

18304731

-

18111269

-

425815

9 000

Pair

2

15mmenamel before

etching

15mmenamel after

etching

-7738 73151 23132 -7790329 -7685671 -

334508

9 076

Pair

3

1mmenamel before

etching

1mmenamel after

etching

-5579 55468 17540 -5618679 -5539321 -

318065

9 065

Pair

4

05mmenamel before

etching

05mmenamel after

etching

-5323 60378 19093 -5366192 -5279808 -

278788

9 063

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel ( 2mm 15 mm 1mm sau

05mm) but the differences statistical significant are present only for enamel localised

at 2 mm from ECJ

X5CONCLUSIONS

The surfaces of enamel and dentine at cervical level record decreases of

roughness related to the decrease of distance to ECJ

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel but the differences

statistical significant are present only for enamel localised at 2 mm from ECJ

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of

dentine

33

CHAPTXI FEA STUDY REGARDING THE BIOMECHANICAL

BEHAVIOUR AND FRACTURE RESISTANCE OF PROXIMO-OCCLUSAL

AMALGAM AND COMPOSITE RESINS RESTORATIONS

XI1INTRODUCTION AIM OF STUDY

The individual variation of patients morphological and functional complexity

of tissues as well as difficult access limit the possibilities to investigate in clinical

studies the biomechanical behaviour of proximo-occlusal restorations In this context

simulation of the biomechanics for direct restorations represents an interesting

interdisciplinar domain in actual dentistry research

The study focused on two direction

- analysis of role of forces intensity on biomechanical behaviour related to

cavity dimension and material

- analysis of tension inside restoration structure related to forces intensity

XI2MATERIALS AND METHODS

The stages of finite element analysis study are as follows

object modelling (bicusps and proximo-occlusal restoration)

definition of parameters for materials and dental tissues

meshing

constraints and loading

types of contacts

equations system definition

results of simulation

The object 3D modelling was performed in Rhinoceros (figure XI1) The

definition of parameters was performed for Poisson constant Young modulus density

(table XI1) The selected materials were amalgam and composite resins The

analysed tissues were dentine and enamel The meshing constraints loading were

performed for forces of 200N 400N 600N 800 N The analysis was performed using

software COSMOSWorks 2010

34

Fig XI1 3D modellation of bicusp

Table XI1 Values of Young modulus Poisson constant compression resistance for

amalgam composite resin enamel (amalgam compozit smalţ)

Material Young modulus (GPa) Poisson constants

Compression

resistance

(Mpa)

Amalgam 55 033 483

Enamel 48 03 400

Composite

resin 220 022 345

Fig XI2 The forces and constraints application

The results are presented in values and culours red colours representing areas

with maximum values of tensions produced under influence of masticatory forces

The tensions produced in amalgam restoration are in a range from 0 to 22886

(force 800 N) The maximum von Misses tensions are associated with cervical area

of amalgam restorations This aspect proves that first modification in interface

restoration-cavity margins will appear at the level of gingival wall First marginal

35

defects and fissures in restoration bulk will appear at tensions over 1600Mpa

associated with forces of 800N for extended amalgam proximo-occlusal restorations

The tensions produced in composite resin restorations are in a range from 0 to

2285 (force 800 N) The maximum von Misses tensions are associated with cervical

area of composite resin restorationsThis aspect proves that first modification in

interface restoration-cavity margins will appear at the level of gingival wall First

marginal defects and fissures in restoration bulk will appear at tensions over 1716

Mpa associated with forces of 600N for moderate and extended composite resins

proximo-occlusal restorations

Fig XI3a-b ndash Simulated model of proximo-occlusal restoration

FigXI4a-b Dental amalgam restoration Cervical tension associated with 600 N

(c)800 N (d)

FigXI5a-b Composite resin restoration Cervical tension associated with 600 N

(c)800 N (d)

36

The deformation of amalgam can be produced only when is associated with

fissures in bulk of restorations while composite resins restorations present

deformation when are associated with a modification of volume and form because of

repeated action of medium forces on long term or high forces on short term (figures

XI4 XI5)

Fig XI4 Material deformation in area of maximum tension

000E + 00

500E -02

100E -01

150E -01

200E -01

250E -01

1 4 7 101316192225283134374043464952555861646770737679

Amalgam C ompoz it

Figura XI5 Deformarea funcție de material

The amalgam and composite resins were treated as homogenous isotropic and

liniar The advantage of this type of FEA study is that restorations parameters can be

modified any time is necessary both in arhitecture geometry and material indices

variability The results of this study sustain the conclusions of other FEA studies

focused on biomechanical behaviour of posterior restorations performed with

amalgam and composite resins(35 62 76 143)

37

XI4CONCLUSIONS

bull The amalgam in class II restorations has a low deformation tendency because

of uniform distribution of tension inside material

bull Composite resins class II restorations accumulate higher tensions comparing

with amalgam but deformation is avoided for a time because of the adhesion

forces performed between molecules under moderate oral forces In case of

high oral forces (600-800N) the risk of fracture in moderate class II

restorations is higher comparing with amalgam proximo-occlusal restorations

For extended class II restorations and forces of 600 N composite resins present

highest risk of fracture and deformation The von Misses tension at the

cervical interface restorationtooth can reach 1600Mpa

bull The amalgam in moderate class II restorations can resist to deformation even

for high intensity forces limited to 600N In extended class II restorations the

risk of deformation and fracture increases at values of 600N-800N of oral

forces The von Misses tension at the cervical interface restorationtooth can

reach 1700 Mpa

38

FINAL CONCLUSIONS

Amalgam proximo-occlusal restorations with minimum 6-years age present

excellent results for parameters anatomic form (occlusal) marginal

discoloration and marginal secondary dental caries good results for

parameters anatomic form (proximal) and marginal adaptation and poor results

for surface quality

Composite resins proximo-occlusal restorations (bicusps) with minimum 6-

years age present excellent results for parameters color match marginal

discoloration and marginal secondary dental caries and good results for

parameters anatomic form (occlusal proximal) marginal adaptation surface

quality

Composite resins proximo-occlusal restorations (molars) with minimum 6-

years age present good results for parameters color match marginal

discoloration marginal secondary dental caries marginal adaptation and poor

results for parameters anatomic form (occlusal) (54 indices Ryge C)

anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The restorations extended at external third of occlusal surface present highest

percents of indices C regarding anatomic form (occlusal) (54 indices Ryge

C) anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The exceeding of 6-years age will require careful monitorisation for early

interventions through polishing sealing reshaping and even replacement for

restorations with major defects

Oblique layering technique presents superior results regarding marginal

adaptation and marginal discoloration and is recommended for proximo-

occlusal dental caries close to enamel-cement jonction

Centripetal build-up presents good results regarding marginal adaptation and

anatomical form at proximal level (proximal surfaces and contact point)

Horisontal layering technique can be used for optimum results only in

proximal-occlusal cavities with moderate extension both in occlusal-cervical

and buccal-oral

The values of die penetration at gingival wall were statistically different

between the three restorative techniques

We concluded that all restorative methods were associated with lightcuring

contraction and marginal microleakage

The combined technique was associated with lowest lightcuring contraction

and die penetration

The bulk technique was associated with highest lightcuring contraction and die

penetration

39

The surfaces of enamel and dentine at cervical level record decreases of

roughness related to the decrease of distance to ECJ

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel but the differences

statistical significant are present only for enamel localised at 2 mm from ECJ

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of

dentine

bull The amalgam in class II restorations has a low deformation tendency because

of uniform distribution of tension inside material

bull Composite resins class II restorations accumulate higher tensions comparing

with amalgam but deformation is avoided for a time because of the adhesion

forces performed between molecules under moderate oral forces In case of

high oral forces (600-800N) the risk of fracture in moderate class II

restorations is higher comparing with amalgam proximo-occlusal restorations

For extended class II restorations and forces of 600 N composite resins present

highest risk of fracture and deformation The von Misses tension at the

cervical interface restorationtooth can reach 1600Mpa

bull The amalgam in moderate class II restorations can resist to deformation even

for high intensity forces limited to 600N In extended class II restorations the

risk of deformation and fracture increases at values of 600N-800N of oral

forces The von Misses tension at the cervical interface restorationtooth can

reach 1700 Mpa

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1ADA Council on Scientific Affairs ADA Council on Dental Benefit Programs

Statement on posterior resin-based composites JADA 1998 129(11)1627ndash1628

2Albers HF Tooth-colored restoratives 1st ed Santa Rosa CA Alto Books 1979

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4Alomari QD Reinhardt JW Boyer DB Effect of liners on cusp deflection and

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5Alster D Feilzer AJ de Gee AJ Mol A Davidson CL The dependence of

shrinkage stress reduction on porosity concentration in thin resin layers J Dent Res

1992711619ndash1622

6Aggarwal V Logani A Jain V Shah N Effect of cyclic loading on marginal

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Oper Dent 2008 Sep-Oct33(5)587-92

7Andrian S Lăcătuşu St- Caria dentară- Protocoale şi tehnici- EdApolloniaIaşi

1999

8Andrian S- Restaurări fizionomice cu materiale plastice icircn cariologie-EdPanteon

Iaşi 2001

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9Andrian S Tratamentul Minim Invaziv al Cariei Dentare EditPrinceps Edit Iaşi

2002

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11Angmar-Mansson B ten Bosch JJ Advances in methods for diagnosting coronal

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12Angmar-Mansson B Al-Khateeb S Tranaeus S Monitoring the caries process

Optical methods for clinical diagnosis and quantification of enamel caries European

Journal of Oral Sciences 1996 104 480-485

13Angmar-Mansson B Al-Khateeb S Tranaeus S Caries diagnosis Journal of

Dental Education 1998 62 (10) 771-780

14Anusavice KJ- ldquoQuality evaluation of dental restorationscriteria for placement

and replacement Chicago 1989Quintessence Publishing

15Anusavice KJ Development and testing of ceramics for dental restorations In

Fischman G Clare A Hench J editors Bioceramics materials and applications

Westerville OH 1995

16Arhun N Celik C Yamanel KClinical evaluation of resin-based composites in

posterior restorations two-year results Oper Dent 201035(4)397-404

17Armstrong SR JC Keller DB Boyer The influence of water storage and C-

factor on the dentinndashresin composite microtensile bond strength and debond pathway

utilizing a filled and unfilled adhesive resin Dent Mater 200117268ndash276

18Armstrong S Boyer D Keller J Microtensile bond strength testing and failure

analysis of two dentin adhesives Dent Mater 1998 14(1)44-50

19Asmussen E Peutzfeldt A Influence of UEDMA BisGMA and TEGDMA on

selected mechanical properties of experimental resin composites Dent Mater1998

1451-56

20Asmussen E Clinical relevance of physical chemical and bonding properties of

composites resins Oper Dent 19851061-73

21Bader JD Brown JP Dilemmas in caries diagnosisJ Am Dent Assoc1993124

(6) 48-50

22Bader JD Shugars DA What do we know about how dentists make caries-

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464-473

26Bader JD Shugars DA Understanding dentistslsquo restorative treatment decisions J

Public Health Dent 1992 Winter52(2)102-10

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Dent 199158 36-39

28Bayne SC Dental biomaterials where are we and where are we going J Dent

Educ 200569(5)571ndash585

41

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191-194

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Aesthetics Dent 1998 10347 350-351

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NY Marcel Dekker Inc 1999

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9

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post-restored tooth using the threedimensional finite element method Journal of Oral

Rehabilitation (33) 2006690ndash697

36Bouillaguet S B Ciucchi T Jacoby JC Wataha DH Pashley Bonding

characteristics to dentin walls of class II cavities in vitro Dent Mater 200117316ndash

321

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2000 12328-339

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and their efficacy as stress-relieving layers J Am Dent Assoc 2003134721ndash728

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polymerization shrinkage stress in resin-composites a systematic review Dent Mater

200521(10)962-70

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Timişoara1994

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amalgam-bonded restorations A 42-months study- Journal of American Dental

Association 2000nr131

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of reasons for the placement and replacement of restorations provided by vocational

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199930(4)234-42

42

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replacement of restorations in vocational training practicePrimary Dental Care

nr6(1) 1999

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of restorations at failure and reasons for their placement and replacement J Dent

200129(5)317-24

48Calheiros FC Braga RR Kawano Y Ballester RY Relationship between

contraction stress and degree of conversion in restorative composites Dent Mater

2004 20939-946

49Cardoso P Sadek F Microtensile bond strength on dentin using new adhesive

systems with selfetching primers Braz J Oral Sci 2003 2(4) 156-159

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the decision to replace existing amalgam restorations Quintessence Int 1999

Jun30(6)413-8

51Carvalho RM JC Pereira M Yoshiyama DH Pashley A review of

polymerization contraction the influence of stress development versus stress

reliefOper Dent19962117ndash24

52Castro VM Katz JO Hardman PK Glaros AG Spencer P Invitro comparison

of conventional film and direct digital imaging in the detection of approximal caries

Dentomaxillofac Radiol 2007 Mar36(3)138-42

53Cattaneo PM M Dalstra B Melsen- bdquoThe Finite Element Method a Tool to

Study Orthodontic Tooth Movement J Dent Res 2005 84(5)428-433

54Cattell MJ Clarke RL Lynch EJ The transverse strength reliability and

microstructural features of four dental ceramicspart 1 J Dent 25(5)399-407 1997

55Cehreli ZC Akca T Effect of dentinal tubule orientation on the microtensile

bond strength to primary dentin J Dent Child 2003 70(2) 139-144

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posterior restorations 12-month results Eur J Dent 2010 Jan4(1)57-65

57Cenci M Demarco F de Carvalho R Class II composite resin restorations with

two polymerization techniques Relationship between microtensile bond strength and

marginal leakage J Dent 2005 33(7) 603- 610

58Chaffin J Moss D Review of current US Army dental emergency rates Mil

Med 2008173(1)23ndash26

59Chen HY Manhart J Hickel R Kunzelmann KH Polymerization contraction

stress in light-cured packable composite resinsDent Mater 200117253-259

60Choi KK Condon JR Ferracane JL The effects of adhesive thickness on

polymerization contraction stress of composites J Dent Res 2000 79812ndash817

61Cichon P Kerschbaum T Verweildauer zahnartzlicher Restaurationen bei

Behinderten Dtsch Zahnartzlicher 1999 54 96-102

62Cohen BI Pagnillo MK Deutsch ASMusikant BL Fracture Strength of

Three Core Restorative Materials Supported with or without a Prefabricated Split-

Shank Post Journal of Prosthetic Dentistry1997 78 560ndash565

63Colli P Brannstrom M The marginal adaptation of four different bonding agents

in Class II composite resin restoration applied in bulk or in two increments

Quintessence Int 1993 24583-591

43

64Collins CJ Bryant RW Hodge KL A clinical evaluation of posterior composite

resin restorations 8-year findings J Dent 199826(4) 311ndash317

65Condon JR Ferracane JL Assessing the effect of composite formulation on

polymerization stress J Am Dent Assoc2000 131497-503

66Cook WD Moopnar M Influence of chemical structure on the fracture

behaviour of dimethacrylate composite resins Biomaterials 1990 11272-276

67Cortes DF Ellwood RP Ekstrand KR An in vitro comparison of a combined

FOTIvisual examination of occlusal caries with other caries diagnostic methods and

the effect of stain on their diagnostic performance Caries Res 2003 37 (1) 8-16

68Crim GA Microleakage of three resin placement techniques Am J Dent

1991469-72

69Dauvillier B Aarnts M Feilzer A The competition between the composite-

dentin strength and the polimerization contraction stress J Dent Res 1984 63 1396-

1399

70Dauvillier BS Aarnts MP Feilzer AJ Developments in shrinkage control of

adhesive restoratives J Esthet Dent 2000 12291-299

71Dauvillier BS Aarnts MP Feilzer AJ Modeling of the viscoelastic behavior of

dental light-activated resin composites during curing Dent Mater 200319277ndash285

72Davidson CL Gee AJ Feilzer A The competition between the composite-dentin

bond strength and the polymerization contraction stress J Dent Res 1984

63(12)1396-9

73Davidson CL AJ Feilzer Polymerization shrinkage and polymerization

shrinkage stress in polymer-based restoratives J Dent Res 199725435ndash440

74Davidson CL Resisting the curing contraction with adhesive composites J

Prosthet Dent 198655446ndash7

75Davis RD Mayhew RB A clinical comparison of three anterior restorative resins

at 3 years J Am Dent Assoc 1986112659-63

76Dejak B Mlotkowski A Three-dimensional finite element analysis of strength

and adhesion of composite resin versus ceramic inlays in molarsJ Prosthet

Dent200899131-40

77Deligeorgi V Mjor IA Wilson NH An overview of reasons for the placement

and replacement of restorations Prim Dent Care 20018(1)5-11

78Deliperi S Bardwell DN An alternative method to reduce polymerization

shrinkage in direct posterior composite restorations J Am Dent Assoc 2002

1331387ndash97

79Demirci M Tuncer S Yuceokur AA Prevalence of caries on individual tooth

surfaces and its distribution by age and gender in university clinic patientsEur J

Dent20104(3)270-9

80De Munck J Van Meerbeek B Satoshi I Vargas M Yoshida Y Armstrong S

Lambrechts P Vanherle G Microtensile bond strengths of one- and two-step

selfetch adhesives to bur-cut enamel and dentin Am J Dent 2003 16 414-420

81Dewaele M Truffier-Boutry D Devaux J Leloup G Volume contraction in

photocured dental resins the shrinkage-conversion relationship revisited Dent Mater

2006 22359-365

44

82Deutsch WM Simecek JW Dental emergencies among Marines ashore in

Operations Desert ShieldStorm Mil Med 1996161(10) 620ndash623

83Dickens SH Stansbury JW Choi KM Floyd CJ Photopolymerization kinetics

of methacrylate dental resins Macromolecules 2003 366043-6053

84Dietschi D De Siebenthal G Neveu-Rosenstand L Holz J Influence of the

restorative technique and new adhesives on the dentin marginal seal and adaptation of

resin composite Class II restorations An in vitro evaluation Quintessence Int 1995

26 717-727

85Dietschi D Herzfeld D In vitro evaluation of marginal and internal adaptation of

class II resin composite restorations after thermal and occlusal stressing Eur J Oral

Sci 1998 106 1033-1042

86Dietschi D Marginal adaptation and seal of direct and indirect Class II composite

resin restorations an in vitro evaluation Quintessence Int 26(2)127-138 1995

87Diefenderfer KE Simecek JW Ahlf RL Ragain JC Relationship between

caries status and dental emergencies among US naval personnel J Dent Res

20028195 (Abstract)

88Diefenderfer KE Rienhardt JW Shear bond strengths of ten adhesive

resinamalgam combinations Oper Dent 1997 22 50-56

89Donly KJ Jensen ME Triolo PA clinical comparison of resin composite inlay

and onlay posterior restorations and cast-gold restorations at 7 years Quintessence Int

30(3)163- 1681999

90Douglas WH Fields RP Fundingsland J A comparison between the

microleakage of direct and indirect composite restorative systems J Dent 17(4)184-

188 1989

91Eberhard J Hartman B Lenhard M Mayer T Kocher T Eickholz P Digital

subtraction radiography for monitoring dental demineralization An in vitro study

Caries Res 200034(3)219-24

92Edelstein BL Douglass CW Dispelling the myth that 50 percent of US

schoolchildren have never had a cavity Public Health Rep1995 110 (5) 522-530

93Eick JD Welch FH Polymerization shrinkage of posterior composite resins and

its possible influence on postoperative sensitivity Quintessence Int 198617103-11

94Elliott JE Lovell LG Bowman CN Primary cyclization in the polymerization of

bis GMA and TEGDMA a modeling approach to understanding the cure of dental

resins Dent Mater 2001 17221-229

95Ermis R Ulkam Aydin Examiner agreement in the replacement decisions of

class I amalgam restorations The Journal of contemporary dental practice 2004 Vol

5 no21-7

96Feilzer AJ AJ De Gee CL Davidson Increased wall-to-wall curing

contraction in thin bonded resin layers J Dent Res 19896848ndash50

97Feilzer AJ Dauvillier BS Effect of TEGDMABisGMA ratio on stress

development and viscoelastic properties of experimental twopaste composites J Dent

Res 2003 82824-828

98Feilzer AJ de Gee AJ Davidson CL Relaxation of polymerization contraction

shear stress by hygroscopic expansion J Dent Res 1990 6936ndash39

45

99Feilzer AJ De Gee AJ Davidson CL Setting stress in composite resin in relation

to configuration of the restoration J Dent Res1987 661636-1639

100Feilzer AJ Dooren LH de Gee AJ Davidson CL Influence of light intensity

on polymerization shrinkage and integrity of restoration-cavity interface Eur J Oral

Sci 1995 103322ndash326

101Fennis YL Verdischbot EH vanrsquot Hof MA Performance of some diagnostic

systems in the prediction of occlusal caries in permanent molars in 6 and 11 year-old

children J Dent 1998 26(5) 403-40

102Ferracane JL Developing a more complete understanding of stresses produced

in dental composites during polymerization Dent Mater 2005 2136-42

103Ferrari M Influence of tissue characteristics at margins on leakage of Class II

indirect porcelain restorations Am JDent 1999 12(3)134-142

104Ferreira MC Vieira RS Marginal leakage in direct and indirect composite resin

restorations in primary teeth an in vitro study J Dent 200836(5)322-5

105Forss H Widstroumlm E Reasons for restorative therapy and the longevity of

restorations in adults Acta Odontol Scand 2004 6282-86

106Fradeani M Aquilano A Bassein L Longitudinal study of pressed glass-

ceramic inlays for four and a half years J Prosthet Dent 1997 78(4)346-353

107Franccedila FM Worschech CC Paulillo LA Martins LR Lovadino JR Fracture

resistance of premolar teeth restored with different filling techniques J Contemp Dent

Pract 20056(3)62-9

108Francci C Loguercio AD Reis A Carrilho MR A novel filling technique for

packable composite resin in Class II restorations J Esthet Restor Dent 2002

14(3)149-57

109Fruits TJ Knapp JA Khajotia SS Microleakage in the proximal walls of

direct and indirect posterior resin slot restorations Oper Dent 200631(6)719-27

110Gaengler P Hoyer I Montag R Clinical evaluation of posterior composite

restorations The 10-year report J Adhes Dent 2001 3185-194

111Garbuz DS Masri BA Estaile J Classification systems in orthopaedics J Am

Acad Orthop Surg 2002 10 290-297

112Ghavamnasiri M Moosavi H Tahvildarnejad N Effect of centripetal and

incremental methods in Class II composite resin restorations on gingival

microleakage J Contemp Dent Pract 20078(2)113-20

113Gladys S Clinical and semiquantitative marginal analysis of four tooth-coloured

inlay systems at 3 years J Dent 199523(6)329-338

114Giachetti L Scaminaci Russo D Bambi C Grandini R A review of

polymerization shrinkage stress current techniques for posterior direct resin

restorations J Contemp Dent Pract 20067(4)79-88

115Giannini M AJS Santos RM Carvalho LAMS Paulillo JR Lovadino

Effects of irradiation mode and filling technique on resindentin bond strength in

Class I cavities J Dent Res 200281 (Abstract)

116Going RE Microleakage around dental restorations A summarizing review

JADA 1972841349-1357

117Gordon JChristensen G Why switch to digital radiography J Am Dent

Assoc 204 Vol 135 No 101437-1439

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118Gregoire GL Akon BA Millas A Interfacial micromorphological differences

in hybrid layer formation between water- and solvent-based dentin bonding systems J

Prosthet Dent 2002 87633ndash641

119Gregory WA Physical properties and repair bond strength of direct and indirect

composite resins J Prosthet Dent 68(3)406-411 1992

120Gwinnett AJ Buonocore MG Adhesives and caries prevention a preliminary

report Br Dent J 196511977-81

121Gwinnett AJ Matsui A A study of enamel adhesives The physical relationship

between enamel and adhesive Arch Oral Biol 1967121615-1620

122Gwinnett AJ Histologic changes in human enamel following treatment with

acidic adhesive conditioning agents Arch Oral Biol 197116731-738

123Gwinnett AJ Moist versus dry dentin its effect on shear bond strength Am J

Dent 1992 5(3)127-9

124Haba Denisia Tehnici uzuale utilizate icircn radiologia dentară Edit Junimea

2007

125Hashimoto M Ito S Tay FR Svizero NR Sano H Kaga M Fluid movement

across the resin-dentin interface during and after bonding J Dent Res 2004 83843ndash

848

126Hashimoto M Tay FR Ito S Sano H Kaga M Pashley DH Permeability of

adhesive resin films J Biomed Mater Res 2005 74699ndash705

127Hawthorne WS Smales RJ Factors influencing long-term restoration survival

in three private dental practices in Adelaide Aust Dent J 19974259ndash63

128Helwig Klimek Attin Einfuumlhrung in Die ZahnErhaltung Urbanampfischer 2003

129He Z Shimada Y Tagami J The effects of cavity size and incremental

technique on micro-tensile bond strength of resin composite in Class I cavities Dent

Mater 200723(5)533-8

130He Z Shimada Y Sadr A Ikeda M Tagami J The effects of cavity size and

filling method on the bonding to Class I cavities J Adhes Dent 2008 Dec10(6)447-

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131Hench LLBioceramicsfrom concept to clinicJ Amer Ceram Soc1991

74(7)1487-1570

132Heymann HO The clinical performance of CAD-CAM generated ceramic

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133Hickel R Manhart J Longevity of restorations In Wilson NHF Roulet JF

Fuzzi M Advances in Operative Dentistry ndash Challenges of the Future Chicago

Quintessence 2001

134Hilton TJ Cavity sealers liners and bases Current philosophies and indications

for use Oper Dent 199621134 ndash146

135Hilton TJ Schwartz RS Ferracane JL Microleakage of four Class II resin

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135- 144

136Hinoura K Setcos JK Philips RW Cavity design and placement technique for

class 2 composites Oper Dent 19981312-19

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137Hintze H Wenzel A Clinically undetected dental caries assessed by bitewing

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19-23

138Hintze H Wenzel A Danielen B Behaviour of approximal carious lesions

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longitudinal study in young adults Caries Res 1999 33 415-22

139Hintze H Wenzel A Influence of validation method on diagnostic accuracy of

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Dentomaxillofacial Radiol2002 31(1) 44-49

140Holtzman JM Berkey AB Mann J Predicting utilization of dental services by

the aged JPublic Health Dent1990 50(3) 164-171

141Hofmann N Hunecke AInfluence of curing methods and matrix type on the

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31(1)97-105

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of approximal and occlusal dental caries in a young adult population Community

Dent Oral Epidemiol 200533(3)212-8

143Hubsch PF Middleton J Knox J A finite element analysis of the stress at the

restoration-tooth interfacecomparing inlays and bulk

fillingsBiomaterials2000211015ndash1019

144Hudson JD Goldstein GR Georgescu M Enamel wear caused by three

different restorative materials J Prosthet Dent 1995 74(6)647-654

145Hunter AR Treasure ET Hunter AJ Increases in cavity volume associated

with the removal of class 2 amalgam and composite restorations Oper Dent

1995202ndash 6

146Huysmans MC PG van der Varst EP Lautenschlager P Monaghan The

influence of simulated clinical handling on the flexural and compressive strength of

posterior composite restorative materials Dent Mater 199612116ndash120

147Iliescu A Gafar MCariologie şi Odontologie RestaurativăEditura Medicală

Bucureşti 2001

148Inoue S Van Meerbeek B Vargas M Lambrechts P Vanherle G Adhesion

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Prati C Grafiche Erredue 2000131-148

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dentin J Adhes Dent 2001 3 237-245

150Iovan Gianina Diagnosis and Management of Patients with High Caries

Activity EdApollonia Iasi2002

151Jacobsen T Soderhold KJ Some effects of water on dentin bonding Dent

Mater 1995 11(2)132-6

152Jackson RD Morgan M The new posterior resins and a simplified placement

technique J Am Dent Assoc 2000131375ndash383

153Jain P Belcher M Microleakage of class II resin-based composite restorations

with flowable composite in the proximal box Am J Dent 200013235ndash238

48

154Jokstad A Mjor IA Analyses of long-term clinical behaviour of class II

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adhesives to dental hard tissues Clin Oral Investig 2002 6(3)155-60

157Kamann WK Gangler P Zur Funktionzeit von Amalgam

Kompositefullungen Zahnartzlicher Welt 1999 108 270-273

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of ground and intact enamel surfaces J Dent 199927523-530

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restorative decisions made on the basis of simulated bitewing radiographs

Community Dentistry and Oral Epidemiology 1994 22(2) 71-74

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composite restorations effected by increased flexibility J Dent Res 1990 691240ndash

1243

161Khairallah C Hokayem A Long-term clinical evaluation of 2 dental materials

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200932(126)21-8

163Kidd EAAssesment of dental carious lesionsArchof Oral

Biology199843(8)629-632

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proximal caries lesions at various levels in vitro Journal of Dentistry 2006 34(10)

817-822

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composite restorations Oper Dent 200934(1)11-7

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dental resin composites Dent Mater 2005 211150-1157

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marginal leakage around class II composite resin restorations in vitroQuint Int

201989117ndash121

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M Dentin shear strength effect of distance from the pulp Dent Mater 2002

18(7)516-20

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polimerisation Am J Dent 1998 11 17-22

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Dent 27(5)325-331 1999

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Jan11(1)34-40

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JProsthet Dent 199369(4)425-430

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thermal behavior of dental composites Dent Mater 2008 24(8)1017ndash1024

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Borgmeijer PJ Replacement risk of amalgam treatment modalities 15-year results

JDent 199826 627-632

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shrinkage and elasticity of flowable composites and filled adhesives Dent Mater

1999 15128-137

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179Lăcătuşu St Luminiţa Costinescu Andrian S Gianina Iovan Valeria

Pendefunda 180Sorina Solomon Topoliceanu C Elements of dispersional

analysis of amalgam restorations 15th

Edition of the Balkan Medical Days

Stomatological Section Abstract nr1091999128

181Lăcătuşu St Andrian S Gianina Iovan- Consideraţii asupra adaptării

amalgamelor dentare la pereţii cavităţilor RevMedicina

StomatologicăVol2199823-26

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200126302ndash307

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restorative decisions microscopic and radiographic caries depth Community

Dentistry and Oral Epidemiology 1996 24 106-11

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polymerization contraction stress for dental composites by two-step light-activation

Dent Mater 2002 18436-444

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constraint and filling technique in composite restorations Dent Mater 2004

20(3)236-43

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Polymerization shrinkage effects of boundary conditions and filling technique of

resin composite restorations J Dent 2004 32(6)459-70

50

189Lopes GC Baratieri LN Monteiro S Jr Vieira LC Effect of posterior resin

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Quintessence Int 2004 35(2)156-61

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art and future perspectives Quintessence Int 200233213-224

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polymerization vs reduced light intensity J Adhes Dent 1 199931ndash39

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temperature and comonomer composition on the polymerization behavior of

dimethacrylate dental resins J Dent 1999 21879-883

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and reactivity on the reaction kinetics of dimethacrylatedimethacrylate

copolymerizations Macromolecules 1999 323913-3921

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bonded composite restorations Dent Mater 1991 7(2) 107-13

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clinical results J Dent Res 199877 1020

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two amalgams Quintessence Int 199829483ndash490

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depth as cavity predictors for approximal dentin caries lesions in primary teeth

Dentomaxillofac Radiol 2007 Oct36(7)377-81

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dentitionOperDent200429(5)481-508

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year clinical evaluation of direct and indirect composite restorations in posterior teeth

J Prosthet Dent 2000 Sep84(3)289-96

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Three-year clinical evaluation of composite and ceramic inlays Am J Dent 2001

Apr14(2)95-9

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hardness and depth of cure of light cured packable composite resins J Dent Res 2000

79369 (Abstract)

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caries-affected transparent dentin by citric acidAn atomic force microscopy

studyDent Mater20011745-52

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the diagnosis of proximal caries Scand J Dent Res 1985 93(2) 78-84

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Dent Res 1988 94 19-26

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33

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52

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34

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55

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of amalgam composite and glassndashionomer restorations J Dent Res 199069861ndash

864

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Orthop921987499ndash505

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312Tay FR Pashley DH Aggressiveness of contemporary self-etching systems

Part I Depth of penetration beyond dentin smear layers Dent Mater 2001 17(4) 296-

308

313Tay FR Frankenberger R Krejci I Bouillaguet S Pashley DH Carvalho

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In vivo evidence J Dent 2004 32611ndash621

314Tay FR Pashley DH Have dentin adhesives become too hydrophilic J Can

Dent Assoc 2003 69726ndash731

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76(6)619-623 1996

317Unterbrink GL R Muessner Influence of light intensity on two restorative

systems J Dent 199523183ndash189

318Unterbrink GL Liebenberg WH Flowable resin composites as filled

adhesiveslsquo literature review and clinical recommendations Quintessence Int

199930249ndash257

319Vaarkamp J Ten Bosch J Verdonschot EH Quantitative diagnosis of small

approximal caries lesions utilizing wavelength-dependent fiber-optic

transillumination Journal of Dental Research 1997 76 (4) 875-882

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Oral Surg Oral Med Oral Pathol 198661(3)289-96

321Van Meerbeek B De Munck J Yoshida Y Inoue S Vargas M Vijay P Van

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322Van Meerbeek B Van Landuyt K De Munck JHashimoto M Peumans M

Lambrechts P Yoshida Y Inoue S Suzuki K Technique-sensitivity of

contemporary adhesives Dent Mater J 2005 24(1) 1-13

323Van Meerbeek B Vargas S Inoue S Yoshida Y Peumans M Lambrechts P

Vanherle G Adhesives and cements to promote preservation dentistry Oper Dent

20016 119-144

324Van Meerbeek B Yoshida Y Inoue S Vargas M Abe Y Fukuda R Okazaki

M Lambrechts P Vanherle G Bonding mechanism micro-tensile bond strength of

a 4- MET-based self-etching adhesive J Dent Res 2000 79 249 (Abstract)

58

325Van Nieuwenhuysen JP DrsquoHoore W Carvalho J Qvist V Long-term

evaluation of extensive restorations in permanent teeth J Dent 200331(6)395ndash405

326Venhoven BA de Gee AJ Davidson CL Light initiation of dental resins

dynamics of the polymerization Biomaterials 1996 172313-2318

327Versluis A Douglas WH Cross M Sakaguchi RL Does an incremental filling

technique reduce polymerization shrinkage stresses J Dent Res 1996 75871ndash878

328Vries HC Ruiken HM Konig KG vanrsquot Hof MA Radiographic versus

clinical diagnosis of approximal carious lesions Caries Res1990 24 (5) 364-370

329Waggoner W Ashton J Predictability of cavitation based upon radiographic

appearance comparison of two film types Quintessence International 1989 20(1)

55-60

330Watanabe LG Marshall GW Jr Marshall SJ Dentin shear strength effects of

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331Watts DC AS Marouf Optimal specimen geometry in bonded-disk

shrinkage-strain measurements on light-cured biomaterials Dent Mater 200016447ndash

451

332Watts DC Marouf AS Al-Hindi AM Photo-polymerization shrinkage-stress

kinetics in resin-composites methods development Dent Mater 2003 191ndash11

333Weaver WS Blank LW Pelleu GB Jr A visible light activated resin cured

through tooth structure GenDent 198836236-7

334Wendt SL Microleakage and cusp fracture resistance of heattreated composite

resin inlays Am J Dent 4(1)10-14 1991

335Wenzel A Hintze H Mikkelsen L Mouyen F Radiographic detection of

occlusal caries in noncavitated teeth A comparison of conventional film radiographs

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1991 72 621-6

336Wenzel A Hintze H Perception of image quality in direct digital radiography

after application of various image treatment filters for detectability of dental diseases

Dentomaxillofac Radiol 1993 22 131-4

337Wenzel A Computer-aided image manipulation of intraoral radiographs to

enhance diagnosis in dental practice a review Int Dent J 1993 43 99-108

338Wenzel A Digital radiography and caries diagnosis Dento Maxillo Facial

Radiology 27(1)3-11 1998

339Wenzel A Haiter-Neto F Gotfredsen E Risk factors for a false positive test

outcome in diagnosis of caries in approximal surfaces impact of radiographic

modality and observer characteristics Caries Res 200741(3)170-6

340Wibowo G Stockton L Microleakage of class II composite restorations Am J

Dent 200114177ndash185

341Wilson NHF Wastell DG Norman RD Five-year performance of high-

cooper content amalgam restorations in a multiclinical trial JDent1996 24 203-210

342Winkler MM Katona TR Paydar NH Finite element stress analysis of three

filling techniques for class V light-cured composite restorations J Dent Res

1996751477-83

343Yap AU Effectiveness of polymerization in composite restoratives claiming bulk

placement Impact of cavity depth and exposure time Oper Dent 2000 25113-120

59

344Yeşilyurt C Bulucu B Bond strength of total-etch dentin adhesive systems on

peripheral and central dentinal tissue a microtensile bond strength test The Journal of

Contemporary Dental Practice 7(2) 20061-13

345Yoshida Y Van Meerbeek B Okazaki M Shintani H Suzuki K Comparative

study on adhesive performance of functional monomers J Dent Res 2004 83 454-

458

346Yoshiyama M Tay FR Doi J Nishitani Y Yamada T Itou K Carvalho RM

Nakajima M Pashley DH Bonding of self-etch and total etch adhesives to carious

dentin J Dent Res 2002 81 556-560

  • COPERTA REZUMAT ENGLEZA (MEREUTA)pdf
  • REZUMAT ENGLEZA DR MEREUTA DENISSpdf
Page 6: UNIVERSITATEA DE MEDICINA SI FARMACIE “GR Doctorat/Rezumat... · universitatea de medicina si farmacie “gr.t.popa” iasi facultatea de medicina dentara rezumatul tezei de doctorat

3

INTRODUCTION

Academic European of Operative Dentistry warned about the factors that

impose to the dentists the use of composite resins on large scale as materials for the

direct restorations at lateral dental group the mass-media rejection of amalgam the

patients desire for esthetic restorations even the request for biological principles to

minimise sacrifice of healthy dental tissues However amalgam must be used in

particular situations represented by extensive carious lesions high cariogenic risk and

bruxism

In this context any comparative study focused on both amalgam and

composite resins proximo-occlusal restorations presents a high practical importance

for dentists Besides numerous fillings replacements are based on improper decisions

regarding wear status of restorations than a real clinical failure Dentists must also

take in account the specific oral environment conditions especially for adhesive

materials that are laquosensitive technique raquo

The final decision and materialrestorative technique selection must be based

on a balance between resistance longevity and priceefficiency

4

CHAPTVI THE AIM OF STUDY GENERAL OBJECTIVES DATA

COLLECTION AND PROCESSING

VI1 The reason for theme choice

The reason for theme choice was determined by the fact that any comparative

study focused on both amalgam and composite resins proximo-occlusal restorations

presents a high practical importance for dentists Also it is a request to highlight

clinical and paraclinical aspects regarding factors that influence clinical performance

of direct composite resins restorations performed at the level of lateral dental group

The support offered by Discipline Cariology and Restorative Dentistry and Institute

Petru Poni allowed the performance of our researches

VI2Aim objectives methodology

The objectives of my researches were as follows

- Selection of literature data regarding histological morphopatological

etiopathogenic spects of dental caries posibilities of diagnostic for proximal

incipient dental caries using both clasic and modern diagnostic technology

properties and clinical behaviour of dental amalgam and composite resins and

other adhesive materials used in posterior restorations literature data

regarding longevity of proximo-occlusal direct restorations and literature data

regarding clinical performances of indirect restorations versus direct

restorations for lateral dental group

- Performing an epidemiological study based on clinical data (indices Ryge

modified USPHS) on posterior direct restorations

- The comparing research regarding clinical performance of posterior composite

resines restorations performed using different restorative techniques

- In vitro study focused on the assessment of the marginal sealing at the cervical

area of proximo-occlusal composite resins restorations

- In vitro study focused on the effects of etching at the cervical area for

proximo-occlusal composite resins restorations

- FEA (finite element analysis) study focused on the assessment of

biomechanical behaviour and resistance to fracture and deformation of

simulated proximo-occlusal restorations from amalgam and composite resins

To realise the proposed aims the working protocol was as follows

- clinical assessment of a study group with age 17-49 with class II dental caries

treated by one dentist using amalgam and composite resins

5

- clinical assessment of a study group with age 15-65 with class II dental caries

treated by one dentist using a selected composite resin and different restorative

techniques

- performing of data base for statistical processing

Database was collected between 2008-2011 in private practice and Faculty of

Dental Medicine UMF ―GrTPopa Iasi The paraclinical studies were performed in

collaboration with Institute Petru Poni Iasi

The patients were informed and gave their written consent to be included in

study groups Every patient was submitted to clinical examen and radiographic

examen The clinical examens consisted in assessment of Ryge indices (modified

USPHS) at baseline 6 months 12 months 18months and 24 months

The paraclinical tests consisted in

- in vitro tests on extracted teeth consisting in optical and atomic force

microscopy to assess the influence of different restorative techniques on the cervical

marginal sealing

- measurement of surface status (enamel dentine) after etching (different time

intervals) using AFM (Atomic Force Microscopy)

- statistical analysis in SPSS 13 for comparison of microleakage degree at

cervical level related to different restorative techniques

- FEA study performed using software COSMOSWorks 2010 for the

assessment of biomechanical behaviour of simulated posterior amalgam and

composite resins restorations

VI3 Data collecting and processing

The processing of reseraches data was performed using the follwing software

MS Office (graphs tables)

SPSS 16 (statistical tests)

The following statistical tests were used t Test test Kolmogorov-Smirnov test

Pearson test Wilcoxon The descriptive statistical analysis was performed using

Microsoft Excel and analitical statistical analysis was performed using SPSS 160

(SPSS Inc SUA)

6

CHAPTVII STUDY REGARDING CLINICAL PERFORMANCE OF

PROXIMO-OCCLUSAL AMALGAM AND COMPOSITE RESINS

RESTORATIONS

VII1 INTRODUCTION

The clinical performance of posterior direct restorations pn medium and long

term concerns dental practitioners that must correlate their therapeutical decisions

with material selection restorative technique external factors represented by oral

forces cariogenic risk patient parafunctions

VII2AIM OF STUDY

The aim of study consisted in assessment of clinical performance of amalgam

and composite resins proximal-occlusal restorations 4-years old

VII3 MATERIALS AND METHOD

The study group included 200 proximal-occlusal amalgam (n=100) and

composite resins (Herculite Kerr) (n=100) restorations 4-years old The study was

performed on 55 patients with age between 17-49 years examined in Dental Medicine

Faculty UMFGrTPopa Iaşi The assessment of fillings status was performed

using Ryge indices modified USPHS (US Public Health Service) (table 1) The

clinical peformance of restorations was also correlated with dental group (molars

bicusps) extension (medium extended) and cariogenic risk (medium high) The

following parameters were assessed

- color match

- marginal adaptation (integrity)

- marginal discoloration

- anatomical form (proximal)

- surface quality

The results presentation was performed using Microsoft Excel

VII4 RESULTS AND DISCUSSIONS

AB

C

S1

6

64

30

0

20

40

60

80

A

B

C

Fig VII1 Anatomical form (occlusal)-amalgam restorations (molars)

7

AB

C

S1

26

64

100

10

20

30

40

50

60

70

A

B

C

Fig VII2 Anatomical form (occlusal)-amalgam restorations (bicusps)

AB

C

S1

0

46

54

0

10

20

30

40

50

60

A

B

C

Fig VII3 Anatomical form (occlusal)-composite resins restorations (molars)

Fig VII4 Anatomical form (occlusal)-amalgam restorations (bicusps)

AB

C

S1

12

72

16

0

10

20

30

40

50

60

70

80

A

B

C

FigVII5 Anatomical form (proximal)-amalgam restorations (molars)

AB

C

S1

38

56

60

10

20

30

40

50

60

A

B

C

FigVII6 Anatomical form (proximal)-amalgam restorations (bicusps)

AB

C

S1

10

54

36

0

10

20

30

40

50

60

A

B

C

8

AB

C

S1

8

64

26

0

10

20

30

40

50

60

70

A

B

C

FigVII7 Anatomical form (proximal)-composite resins restorations (molars)

AB

C

S1

34

66

100

10

20

30

40

50

60

70

A

B

C

FigVII8 Anatomical form (proximal)-composite resins restorations (bicusps)

AB

C

S1

36

44

20

0

5

10

15

20

25

30

35

40

45

A

B

C

FigVII9 Marginal adaptation (proximal)- amalgam restorations(bicusps)

AB

C

S1

20

50

30

0

5

10

15

20

25

30

35

40

45

50

A

B

C

FigVII10 Marginal adaptation (proximal)-amalgam restorations (molars)

AB

C

S1

16

60

24

0

10

20

30

40

50

60

A

B

C

FigVII11 Marginal adaptation (proximal)-composite resins restorations (bicusps)

9

AB

C

S1

12

54

34

0

10

20

30

40

50

60

A

B

C

FigVII12 Marginal adaptation (proximal)-composite resins restorations (molars)

AB

C

S1

22

54

24

0

10

20

30

40

50

60

A

B

C

FigVII13 Surface quality-amalgam restorations (bicusps)

AB

C

S1

10

54

36

0

10

20

30

40

50

60

A

B

C

FigVII14 Surface quality-amalgam restorations (molars)

AB

C

S1

12

68

20

0

10

20

30

40

50

60

70

A

B

C

FigVII15 Surface quality-composite resins restorations (bicusps)

AB

C

S1

8

70

22

0

20

40

60

80

A

B

C

FigVII16 Surface quality-composite resins restorations (molars)

10

A

C

S1

98

20

20

40

60

80

100

A

C

FigVII17a-b Prevalence of marginal dental cariesamalgam restorations (moderate

CR)

A

C

S1

92

80

20

40

60

80

100

A

C

FigVII18 Prevalence of marginal dental cariesamalgam restorations (high CR)

A

C

S1

94

60

20

40

60

80

100

A

C

FigVII19 Prevalence of marginal dental cariescomposite resins restorations (CR

moderate)

A

C

S1

82

18

0

10

20

30

40

50

60

70

80

90

A

C

FigVII20 Prevalence of marginal dental cariescomposite resins restorations (high

CR)

11

The study data sustain the results obtained by most studies focused on

posterior amalgam restorations However Hickelampcol (2001) reviewed literature data

and proved that many results varies accordingly to different clinical factors (133)

Roulet JF(1997) warned about limits of cross-sectional studies related to composite

resins restorations because of the absence of data regarding restorative techniques

practitioner experience presence or absence of optimum isolation factors related by

patient (266)

VII5CONCLUSIONS

Amalgam proximo-occlusal restorations with minimum 6-years age present

excellent results for parameters anatomic form (occlusal) marginal

discoloration and marginal secondary dental caries good results for

parameters anatomic form (proximal) and marginal adaptation and poor results

for surface quality

Composite resins proximo-occlusal restorations (bicusps) with minimum 6-

years age present excellent results for parameters color match marginal

discoloration and marginal secondary dental caries and good results for

parameters anatomic form (occlusal proximal) marginal adaptation surface

quality

Composite resins proximo-occlusal restorations (molars) with minimum 6-

years age present good results for parameters color match marginal

discoloration marginal secondary dental caries marginal adaptation and poor

results for parameters anatomic form (occlusal) (54 indices Ryge C)

anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The restorations extended at external third of occlusal surface present highest

percents of indices C regarding anatomic form (occlusal) (54 indices Ryge

C) anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The exceeding of 6-years age will require careful monitorisation for early

interventions through polishing sealing reshaping and even replacement for

restorations with major defects

12

CHAPTVIII CLINICAL PERFORMANCE OF COMPOSITE RESINS

RESTORATIONS RELATED TO RESTORATIVE TECHNIQUE 12-

MONTHS LONGITUDINAL STUDY

VIII1 INTRODUCTION

The restorative technique has a major influence over clinical performance of

composite resins restorations in proximo-occlusal cavities In this context researches

focused on correlations between technique and clinical performance of direct

restorations improve the dentist decision regarding restorative technique choice

VIII2AIM OF STUDY

The aim of study was to determine the clinical performance of composite

resins proximo-occlusal restorations performed using different restorative techniques

VIII3MATERIALS AND METHOD

The group study included 37 patients with age 18-42 years with moderat

ecariogenic risk The total number of composite resins restorations (Herculite XRV

Kerr) was 60 divided in three study groups (n=20)

I Centripetal build-up

II Oblique layering

III Horisontal layering

The coronal restorations were assessed at an interval of 12 months using

indices Ryge modified USPHS

- indice ALFA (A)- IDEAL CLINIC

- indice BRAVO (B)- ACCEPTABLE CLINIC

- indice CHARLIE (C)- UNACCEPTABLE CLINIC

VIII4 RESULTS AND DISCUSSIONS

The statistical tests Kruskal-Wallis and Mann-Whitney were performed to

confirm or infirm research hypotesis (the direct restorations performed using different

restorative techniques present statistical significant differences regarding clinical

performance for the assessed parameters)

13

TableVIII1a-b Groups study (Kruskal-Wallis Test)

Ranks

20 2960

20 2560

20 3630

60

20 3050

20 2420

20 3680

60

20 2490

20 3140

20 3520

60

Restorative_techniques

Centripetal build-up

Oblique layering

Horizontal layering

Total

Centripetal build-up

Oblique layering

Horizontal layering

Total

Centripetal build-up

Oblique layering

Horizontal layering

Total

Marginal_adaptation

Marginal_discoloration

Anatomical_form

N Mean Rank

Test Statisticsab

4913 8031 4900

2 2 2

086 018 086

Chi-Square

df

Asymp Sig

Marginal_

adaptation

Marginal_

discoloration

Anatomical_

form

Kruskal Wallis Testa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between the three restorative

techniques for parameter marginal adaptation (p=0086)

There are no statistical significant differences between the three restorative

techniques for parameter marginal discoloration (p=0018)

There are no statistical significant differences between the three restorative

techniques for parameter anatomical form (proximal) (p=0086)

TableVIII2 Comparing results between restorations performed using three

techniques (marginal adaptation marginal discoloration anatomical form) Marginal adaptation Centripetal build-upOblique layering p=04 ns

Centripetal build-upHorizontal layering p=0191 ns

Oblique layering Horizontal layering p=0028 s

Marginal discoloration Centripetal build-upOblique layering p=0103 ns

Centripetal build-upHorizontal layering p=0195 ns

Oblique layering Horizontal layering p=0005 s

Anatomical form Centripetal build-upOblique layering p=0137 ns

Centripetal build-upHorizontal layering p=0029 s

Oblique layering Horizontal layering p=0433 ns

ns nesemnificativ

s semnificativ

p probabilitate

14

Tables VIII3a-b Mann-Whitney test Comparing analysis regarding marginal

discoloration between restorations performed using oblique layering technique and

centripetal build-up technique

Ranks

20 2180 43600

20 1920 38400

40

Restorative_techniques

Centripetal build-up

Oblique layering

Total

Marginal_adaptation

N Mean Rank Sum of Ranks

Test Statisticsb

174000

384000

-841

400

495a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

adaptation

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between centripetal build-up

and oblique layering techniques regarding parameter marginal adaptation (p=0400)

Tables VIII4a-b Mann-Whitney test Comparing analysis regarding marginal

adaptation between restorations performed using horisontal layering technique and

centripetal build-up technique

Ranks

20 1830 36600

20 2270 45400

40

Restorative_techniques

Centripetal build-up

Horizontal layering

Total

Marginal_adaptation

N Mean Rank Sum of Ranks

Test Statisticsb

156000

366000

-1307

191

242a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

adaptation

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between centripetal build-up

and horisontal layering techniques regarding parameter marginal adaptation

(p=0191)

15

TablesVIII5a-b Mann-Whitney test Comparing analysis regarding marginal

adaptation between restorations performed using oblique layering technique and

horisontal layering technique

Ranks

20 1690 33800

20 2410 48200

40

Restorative_techniques

Oblique layering

Horizontal layering

Total

Marginal_adaptation

N Mean Rank Sum of Ranks

Test Statisticsb

128000

338000

-2191

028

052a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

adaptation

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There is statistical significant differences between horisontal layering and

oblique layering techniques regarding parameter marginal adaptation (p=0028)

Tables VIII6a-b Mann-Whitney test Comparing analysis regarding marginal

discoloration between restorations performed using oblique layering technique and

centripetal build-up technique

There are no statistical significant differences between centripetal build-up

and oblique layering techniques regarding parameter marginal discoloration

(p=0103)

Ranks

20 2260 45200

20 1840 36800

40

Restorative_techniques

Centripetal build-up

Oblique layering

Total

Marginal_discoloration

N Mean Rank Sum of Ranks

Test Statisticsb

158000

368000

-1632

103

265a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

discoloration

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

16

Tables VIII7a-b Mann-Whitney test Comparing analysis regarding marginal

discoloration between restorations performed using centripetal build-up technique and

horisontal layering technique

Ranks

20 1840 36800

20 2260 45200

40

Restorative_techniques

Centripetal build-up

Horizontal layering

Total

Marginal_discoloration

N Mean Rank Sum of Ranks

Test Statisticsb

158000

368000

-1299

194

265a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

discoloration

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between centripetal build-up

and horisontal layering techniques regarding parameter marginal discoloration

(p=0103)

Tables VIII8a-b Mann-Whitney test Comparing analysis regarding marginal

discoloration between restorations performed using oblique layering technique and

horisontal layering technique

Ranks

20 1630 32600

20 2470 49400

40

Restorative_techniques

Oblique layering

Horizontal layering

Total

Marginal_discoloration

N Mean Rank Sum of Ranks

Test Statisticsb

116000

326000

-2822

005

023a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

discoloration

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There is statistical significant differences between horisontal layering and

oblique layering techniques regarding parameter marginal discoloration (p=0005)

17

TablesVIII9 a-b Mann-Whitney test Comparing analysis regarding anatomical

form between restorations performed using centripetal build-up technique and oblique

layering technique

Ranks

20 1830 36600

20 2270 45400

40

Restorative_techniques

Centripetal build-up

Oblique layering

Total

Anatomical_form

N Mean Rank Sum of Ranks

Test Statisticsb

156000

366000

-1486

137

242a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Anatomical_

form

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between centripetal build-up

and oblique layering techniques regarding parameter anatomical form (p=0137)

Tables VIII10a-b Mann-Whitney test Comparing analysis regarding anatomical

form between restorations performed using centripetal build-up technique and

horisontal layering technique

Ranks

20 1710 34200

20 2390 47800

40

Restorative_techniques

Centripetal build-up

Horizontal layering

Total

Anatomical_form

N Mean Rank Sum of Ranks

Test Statisticsb

132000

342000

-2184

029

068a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Anatomical_

form

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between centripetal build-up

and horisontal layering techniques regarding parameter anatomical form (p=0029)

18

Tables VIII11a-b Mann-Whitney test Comparing analysis regarding anatomical

form between restorations performed using oblique layering technique and horisontal

layering technique

Ranks

20 1920 38400

20 2180 43600

40

Restorative_techniques

Oblique layering

Horizontal layering

Total

Anatomical_form

N Mean Rank Sum of Ranks

Test Statisticsb

174000

384000

-784

433

495a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Anatomical_

form

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between horisontal layering and

oblique layering techniques regarding parameter anatomical form (p=0433)

Indices A for restorations performed using centripetal build-up technique were

as follows color match-80 marginal adaptation- 60 marginal discoloration-

70 anatomical form (proximal)- 80 surface quality- 60

Indices A for restorations performed using horisontal layering technique were

as follows color match-70 marginal adaptation- 40 marginal discoloration-

50 anatomical form (proximal)- 50 surface quality- 70

Indices A for restorations performed using oblique layering technique were as

follows color match-70 marginal adaptation- 80 marginal discoloration- 90

anatomical form (proximal)- 60 surface quality- 70

Indices B for restorations performed using centripetal build-up technique were

as follows color match-20 marginal adaptation- 30 marginal discoloration-

20 anatomical form (proximal)- 30 surface quality- 40

Indices B for restorations performed using horisontal layering technique were

as follows color match-30 marginal adaptation- 40 marginal discoloration-

30 anatomical form (proximal)- 30 surface quality- 30

Indices B for restorations performed using oblique layering technique were as

follows color match-30 marginal adaptation- 20 marginal discoloration- 10

anatomical form (proximal)- 40 surface quality- 30

19

Indices C for restorations performed using centripetal build-up technique were

as follows color match-0 marginal adaptation- 10 marginal discoloration- 0

anatomical form (proximal)- 0 surface quality- 0

Indices C for restorations performed using horisontal layering technique were

as follows color match-0 marginal adaptation- 20 marginal discoloration- 20

anatomical form (proximal)- 20 surface quality- 0

Indices C for restorations performed using oblique layering technique were as

follows color match-0 marginal adaptation- 0 marginal discoloration- 10

anatomical form (proximal)- 0 surface quality- 100

Discussions

For in vitro studies is difficult to reproduce the variables existent in oral cavity

like occlusal stress and pH and temperature changes (235) The clinical studies are

determinant in assessment of restorative techniques (300) The most researches

focuses on the influence of restorative technique on the reduction of lightcuring stress

(51 78 135)

VIII5 CONCLUSIONS

Oblique layering technique presents superior results regarding marginal

adaptation and marginal discoloration and is recommended for proximo-

occlusal dental caries close to enamel-cement jonction

Centripetal build-up presents good results regarding marginal adaptation and

anatomical form at proximal level (proximal surfaces and contact point)

Horisontal layering technique can be used for optimum results only in

proximal-occlusal cavities with moderate extension both in occlusal-cervical

and buccal-oral

20

CHAPTIX STUDY REGARDING MARGINAL SEALING STATUS IN

COMPOSITE RESINS LIMITED PROXIMO-OCCLUSAL RESTORATIONS

PERFORMED USING DIFFERENT TECHNIQUES

IX1INTRODUCTION

The contraction of composite resins can produce stress inside dental structure

The most contraction stress appears in the initial stages and development rate of stress

decreases gradually in time (5 98 160) The contraction stress of composite resins

can overpass adhesion strenght and can broke the link between dental tissues and

composite resin (73) When adhesion strenght is high stress can produce marginal

fracture or bulk fracture (74) These situations are associated with microleakage and

penetration of oral fluid and bacteria along dentinal walls endangering the pulpal

tissue or favourising secondary dental caries

IX2 AIM OF STUDY

The study aimed to assess the efficiency of marginal sealing along gingival

wall in limited proximal-occlusal restorations performed using three different

techniques

IX3MATERIALS AND METHOD

The study group included 30 teeth extracted for orthodontic and periodontal

reasons On every tooth two identical class II cavities (on mesial and distal surfaces)

were prepared with cylindrical burs under water cooling The gingival wall was

limited to enamel-cement jonction The cavity dimension were as follows 2 mm

buccal-oral 5mm depth Each tooth was introduced in a pattern of acrylat The

operator calibrated preparation technique on acrylat teeth in Simulation Laboratory of

UMF ―Gr T Popa Iaşi The 60 prepared cavities were randomly divided in three

study groups related to restorative technique The restoration were performed with

Filtek Z550 (3M ESPE) a nanohybrid composite resin The adhesive strategy

included etchamprinse in 2 steps and adhesive Adper Single Bond 2(3MESPE)

Group A (n=20) bulk restorative technique associated with lightcuring from

occlusal 40 seconds and from buccal and oral 20 seconds

Group B (n=20) oblique layering technique (first layer on buccal wall and

buccal frac12 of gingival wall was lightcured from buccal second layer on oral wall and

oral frac12 of gingival wall was lightcured from oral third oral as a triangle with point

oriented to gingival wall was lightcured from occlusal)

Group C (n=20) combined technique (bdquoflow layer on gingival and axial

walls lightcured under pressure only associated with solid composite resin layer)

The proximal surfaces were performed using Tofflemire and metallic matrices After

removal of matrices every restoration was lightcured for another 20 seconds Two

layers aof varnish were applied on composite resins restorations excepting cavity

margins and an area of 1 mm around them The samples were introduced in methylen

21

blue 10 for 48 hours After this stage samples were washed with water and teeth

were cut longitudinally with a diamonded disc

The die penetration was assessed with Zeiss (Iena Germany) X20 microscope

accordingly to four scores (0-3)

0 ndash no penetration

1 ndash die infiltration until external half of gingival wall

2 ndash die infiltration on all gingival wall

3 ndash die infiltration on gingival wall and axial wall

IX4RESULTS AND DISCUSSIONS

The result of die penetration are presented in table IX1

TableIX1 The results for die penetration

Grup 0 1 2 3

A (bulk) 0 0 3 17

B (layering) 0 4 5 11

C (combined) 12 5 2 1

In group A 17 sample had score 3 and 2 samples had score 2 In group B 11

sample had score 3 5 samples had score 2 and 4 sample had score 1 In group C with

best results 12 samples had score 0 5 samples had score 1 2 samples had score 2 1

sample had score 3

The recorded data were analysed using test Mann-Whitney The statistical

results are presented in tables IX2-IX4

Tables IX2a-b Mann-Whitney for comparisons of microleakage values between

bulk technique and incremental technique

Ranks

Restorative technique N Mean Rank Sum of Ranks

Scores

frequency

A ndash bulk technique 20 2420 24200

B ndash incremental

technique

20 1680 16800

Total 40

Test Statisticsb

scores

frequency

Mann-Whitney U 29000

Wilcoxon W 168000

Z -1970

Asymp Sig (2-tailed) 049

Exact Sig [2(1-tailed Sig)] 123a

a Not corrected for ties

b Grouping Variable restorative technique

22

Tables IX3a-b Mann-Whitney for comparisons of microleakage values between

bulk technique and mixed technique

Ranks

Restorative technique N Mean Rank Sum of Ranks

scores

frequency

A ndash bulk technique 20 3090 30900

C ndash mixed technique 20 1010 10100

Total 40

Test Statisticsb

scores

frequency

Mann-Whitney U 500

Wilcoxon W 101000

Z -4021

Asymp Sig (2-tailed) 000

Exact Sig [2(1-tailed Sig)] 000a

a Not corrected for ties

b Grouping Variable restorative technique

Tables IX4a-b Mann-Whitney test for comparisons of microleakage values

between incremental technique and mixed technique

Ranks

Restorative technique N Mean Rank Sum of Ranks

scores

frequency

B ndash incremental

technique

20 2990 29900

C ndash mixed technique 20 1210 12100

Total 40

Test Statisticsb

scores

frequency

Mann-Whitney U 5500

Wilcoxon W 121000

Z -3492

Asymp Sig (2-tailed) 000

Exact Sig [2(1-tailed Sig)] 000a

a Not corrected for ties

23

Test Statisticsb

scores

frequency

Mann-Whitney U 5500

Wilcoxon W 121000

Z -3492

Asymp Sig (2-tailed) 000

Exact Sig [2(1-tailed Sig)] 000a

a Not corrected for ties

b Grouping Variable tehnrestaurare

The results of microleakage degree were statistically significant when the

three restorative techniques were compared The results showed that best restorative

technique regarding marginal sealing in cervical area is combined technique followed

by oblique layering technique The use of layering techniques limits the development

of contraction forces between oposite walls event that favourises bulk stress voids

formation and fissure inside dental tissues The results of our study are similar with

other studies (114 293)

IX5 CONCLUSIONS

The values of die penetration at gingival wall were statistically different

between the three restorative techniques

We concluded that all restorative methods were associated with lightcuring

contraction and marginal microleakage

The combined technique was associated with lowest lightcuring contraction

and die penetration

The bulk technique was associated with highest lightcuring contraction and die

penetration

24

CHAPTX STUDY REGARDING THE EFFECTS OF ETCHING ON

ENAMEL AND DENTINE IN CERVICAL AREA FOR PROXIMAL

CAVITIES AT LATERAL DENTAL GROUP

X1 INTRODUCTION

The studies reported marginal defects and high microleakage at the level of

gingival margins localised in cervical area or close to enamel-cement jonction for

high percents of proximal-occlusal composite resins restorations (8485) The good

adhesion is requested to insure restoration longevity and to prevent marginal

microleakage and presence of secondary marginal dental caries The adhesion

strenght of different adhesive systems can vary accordingly to tissues areas (204 240)

and to variations in dentinal structures (234 330) Most studies focused on adhesive

systems performances used healthy dentine close to pulp room but in case of class II

restorations there are particular features that influences the adhesion at the level of

gingival margins

The surface topography is an important property that determines the

interaction manner between surfaces The surface roughness and surface energy can

increase or decrease the adhesion of composite resins to the hard dental tissues

X2 AIM OF STUDY

The aim of study was to compare surface roughness of enamel and dentine

after etching related to different distances related to enamel-dentinecement jonction

X3 MATERIALS AND METHODS

The study group included 20 molars extracted from orthodontics or

periodontal reasons with intact proximal surfaces The teeth were cut longitudinally in

sens buccal-oral with diamond discs under water cooling

A group study (10 teeth) included 10 samples obtained through transversal

cutting at distance of 2mm from enamel-dentinecement jonction and 10 samples

obtained through transversal cutting at distance of 15 mm from enamel-

dentinecement jonction Another study group (10 teeth) included 10 samples

obtained through transversal cutting at distance of 1mm from enamel-dentinecement

jonction and 10 samples obtained through transversal cutting at distance of 05 mm

from enamel-dentinecement jonction All these samples were divided in two halfes

through mesial-distal cutting The samples finishing was performed with abrasive

paper (100-4000) and final polishing was performed with a device Buehler model

Minimet with slices introduced in ultrasound bath for 4 minutes The second half of

each sample was etched for 15 seconds with ortophosphoric acid 37 for 15 seconds

Slices were washed with distilled water for 30 seconds after etching and dried

The samples were analysed with atomic force microscopy (AFM) regarding

surface roughness The results were expressed as relative variation of roughness

X4 RESULTS AND DISCUSSIONS

The aspect of etched enamel at 2 mm distance from ECJ can be seen in figure

X1 (section 10 microm) The surface roughness is higher comparing with sample before

etching

25

După gravajul cu acid ortofosforic 37

The aspect of etched enamel at 15 mm distance from ECJ can be seen in

figure X2 (section 10 microm) The surface roughness is higher comparing with sample

before etching but lower comparing with sample at 2 mm from ECJ

The aspect of etched enamel at 1 mm distance from ECJ can be seen in figure

X3 (section 10 microm) The surface roughness is higher comparing with sample before

etching but lower comparing with sample at 15mm and 2 mm from ECJ

The aspect of etched enamel at 15 mm distance from ECJ can be seen in

figure X4 (section 10 microm) The surface roughness is higher comparing with sample

before etching but lower comparing with sample at 1 mm 15 mm and 2 mm from

ECJ

FigX1 3D aspect of enamel at 2 mm from ECJ

after etching (10 microm)

FigX2 3D aspect of enamel at 15 mm from ECJ

after etching (10 microm)

FigX3 3D aspect of enamel at 1 mm from ECJ

after etching (10 microm)

FigX4 3D aspect of enamel at 05 mm from ECJ

after etching (10 microm)

26

The mean values of squared roughness for dentine and enamel before etching

are presented in tables X1 and X2

Table X1 Squared roughness values for dentine samples before and after etching

Before etching (nm) After etching (nm)

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

sample

1

335 282 283 259 1149 947 901 879

sample

2

352 284 274 266 1127 939 883 875

sample

3

357 273 278 263 1152 953 876 867

sample

4

323 269 264 258 1146 942 895 883

sample

5

348 298 271 268 1153 944 904 878

sample

6

339 274 278 273 1158 937 893 892

sample

7

352 283 269 266 1145 944 899 876

sample

8

349 292 272 274 1166 942 907 869

sample

9

357 284 275 265 1132 939 893 879

sample

10

348 281 277 262 1142 941 899 878

Table X2 Squared roughness values for enamel and dentine samples before and after

etching

Before etching (nm) After etching (nm)

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

sample 1 422 342 309 313 2255 1114 874 845

sample 2 418 338 324 304 2236 1102 882 839

sample 3 413 334 315 303 2239 1115 873 833

sample 4 416 336 322 308 2242 1116 868 842

sample 5 426 332 315 294 2218 1103 877 829

sample 6 412 332 317 306 2237 1099 874 847

sample 7 414 335 322 314 2252 1102 876 834

sample 8 416 325 318 313 2239 1106 875 838

sample 9 418 328 314 299 2246 1113 879 836

sample 10 413 334 316 305 2242 1104 873 839

The results for samples before etching prove a decreasing tendency for mean

values of squared roughness surface beginning with areas placed at distance of 2 mm

from ECJ (346 nm) followed by areas placed at distance of 15 mm from ECJ (282

nm) 1 mm from ECJ (274 nm) and 05 mm from ECJ (265 nm) After etching the

decreasing tendency maintained for dentine localised at 2 mm from ECJ to dentine

localised at 05 mm from ECJ The mean values of squared roughness after etching

were three times higher (tables X3)

27

Table X3 Squared roughness values for enamel and dentine samples before and

after etching

Dentine Enamel

Before etching

(nm)

After etching

(nm)

Before etching

(nm)

After etching

(nm)

2 mm ECJ 346 1147 416 2237

15 mm ECJ 282 942 333 1107

1 mm ECJ 274 895 317 875

05 mm ECJ 265 877 305 838

The descriptive statistics data for surface roughness of dentine before and after

etching are presented in tables X4 si X5

Table X4 Descriptive statistics for dentine samples before etching

Statistics

Dentine 2mm

before etching

Dentine 15mm

before etching

Dentine 1mm

before etching

Dentine 05mm

before etching

N Valid 10 10 10 10

Missing 0 0 0 0

Mean 346000 282000 274100 265400

Std Error of Mean 33830 27487 17026 16746

Std Deviation 106979 86923 53841 52957

Skewness -1214 354 -314 348

Std Error of Skewness 687 687 687 687

Kurtosis 1141 049 336 -539

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 3230 2690 2640 2580

Maximum 3570 2980 2830 2740

Table X5 Descriptive statistics for dentine samples after etching

Statistics

Dentine 2mm

after etching

Dentine 15mm

after etching

Dentine 1mm

after etching

Dentine 05mm

after etching

N Valid 10 10 10 10

Missing 0 0 0 0

1147000 942800 895000 877600

Std Error of Mean 36545 14591 29926 22020

Std Deviation 115566 46140 94634 69634

Skewness -267 1169 -951 535

Std Error of Skewness 687 687 687 687

Kurtosis 043 1776 564 1416

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 11270 9370 8760 8670

28

Statistics

Dentine 2mm

after etching

Dentine 15mm

after etching

Dentine 1mm

after etching

Dentine 05mm

after etching

N Valid 10 10 10 10

Missing 0 0 0 0

1147000 942800 895000 877600

Std Error of Mean 36545 14591 29926 22020

Std Deviation 115566 46140 94634 69634

Skewness -267 1169 -951 535

Std Error of Skewness 687 687 687 687

Kurtosis 043 1776 564 1416

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 11270 9370 8760 8670

Maximum 11660 9530 9070 8920

To choose the statistical test to compare roughness surface values was

performed a test Shapiro-Wilk If p is lower or equal with 0005 than hypothesis of

distribution normality is rejected (distribution deviates from normal form) In the table

X6 the distributions are normal The statistical test will be test t for pair samples

Table X6 Test Shapiro-Wilk for dentine samples

Tests of Normality

Kolmogorov-Smirnov

a Shapiro-Wilk

Statistic df Sig Statistic df Sig

Dentine 2mm before etching 274 10 032 877 10 122

Dentine 15mm after etching 209 10 200 952 10 689

Dentine 1mm before etching 134 10 200 983 10 980

Dentine 05mm before etching 155 10 200 949 10 661

Dentine 2mm after etching 133 10 200 977 10 946

Dentine 15mm after etching 197 10 200 916 10 329

Dentine 1mm after etching 216 10 200 925 10 401

Dentine 05 after etching 220 10 185 933 10 474

Enamel 2mm before etching 193 10 200 898 10 207

Enamel 15mm before etching 170 10 200 977 10 947

Enamel 1mm before etching 157 10 200 952 10 689

Enamel 05mm before etching 165 10 200 943 10 590

Enamel 2mm after etching 235 10 124 925 10 404

Enamel 15mm after etching 209 10 200 871 10 102

Enamel 1mm after etching 189 10 200 964 10 834

Enamel 05mm after etching 142 10 200 983 10 978

a Lilliefors Significance Correction

29

Tests of Normality

Kolmogorov-Smirnov

a Shapiro-Wilk

Statistic df Sig Statistic df Sig

Dentine 2mm before etching 274 10 032 877 10 122

Dentine 15mm after etching 209 10 200 952 10 689

Dentine 1mm before etching 134 10 200 983 10 980

Dentine 05mm before etching 155 10 200 949 10 661

Dentine 2mm after etching 133 10 200 977 10 946

Dentine 15mm after etching 197 10 200 916 10 329

Dentine 1mm after etching 216 10 200 925 10 401

Dentine 05 after etching 220 10 185 933 10 474

Enamel 2mm before etching 193 10 200 898 10 207

Enamel 15mm before etching 170 10 200 977 10 947

Enamel 1mm before etching 157 10 200 952 10 689

Enamel 05mm before etching 165 10 200 943 10 590

Enamel 2mm after etching 235 10 124 925 10 404

Enamel 15mm after etching 209 10 200 871 10 102

Enamel 1mm after etching 189 10 200 964 10 834

Enamel 05mm after etching 142 10 200 983 10 978

a Lilliefors Significance Correction

This is a lower bound of the true significance

The results of test t for pair dentine samples before and after etching are

presented in table X

Table X7 Test t for dentine before and after etching

Paired Samples Test

Paired Differences

t df

p (2-

tailed)

95 Confidence

Interval of the

Difference

Mean

Std

Dev

Std

Error

Mean Lower Upper

Pair

1

dentine2mmbeforeetching-

dentine2mmafteretching

-

8010000

174801 55277 -

8135045

-

7884955

-

144906

9 000

Pair

2

dentine15mmbeforeetching-

dentine15mmafteretching

-

6608000

102394 32380 -

6681248

-

6534752

-

204079

9 000

Pair

3

dentine1mmbeforeetching-

dentine1mmafteretching

-

6209000

117799 37251 -

6293269

-

6124731

-

166678

9 000

30

Paired Samples Test

Paired Differences

t df

p (2-

tailed)

95 Confidence

Interval of the

Difference

Mean

Std

Dev

Std

Error

Mean Lower Upper

Pair

1

dentine2mmbeforeetching-

dentine2mmafteretching

-

8010000

174801 55277 -

8135045

-

7884955

-

144906

9 000

Pair

2

dentine15mmbeforeetching-

dentine15mmafteretching

-

6608000

102394 32380 -

6681248

-

6534752

-

204079

9 000

Pair

3

dentine1mmbeforeetching-

dentine1mmafteretching

-

6209000

117799 37251 -

6293269

-

6124731

-

166678

9 000

Pair

4

dentine05mmbeforeetching-

dentine05mmafteretching

-

6122000

86384 27317 -

6183796

-

6060204

-

224109

9 000

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of dentine (

2mm 15 mm 1mm sau 05mm)

The descriptive statistics data for dentine surface roughness before and after

etching are presented in tables X8 and X9

Table X8 Descriptive statistics for enamel samples before etching

Statistics

Enamel 2mm

before etching

Enamel 15mm

before etching

Enamel 1mm

before etching

Enamel 05mm

before etching

N Valid 10 10 10 10

Missing 0 0 0 0

Mean 416800 333600 317200 305900

Std Error of Mean 13968 15217 14205 20355

Std Deviation 44171 48120 44920 64369

Skewness 1095 -156 -109 -411

Std Error of Skewness 687 687 687 687

Kurtosis 769 487 -118 -295

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 4120 3250 3090 2940

Maximum 4260 3420 3240 3140

31

Table X9 Descriptive statistics for enamel samples after etching

Statistics

Enamel 2mm

after etching

Enamel 15mm

after etching

Enamel 1mm

after etching

Enamel 05mm

after etching

N Valid 10 10 10 10

Missing 0 0 0 0

Mean 2237600 1107400 875100 838200

Std Error of Mean 31027 20232 11968 17436

Std Deviation 98116 63979 37845 55136

Skewness -850 267 042 040

Std Error of Skewness 687 687 687 687

Kurtosis 878 -1880 1082 -425

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 22180 10990 8680 8290

Maximum 22520 11160 8820 8470

To choose the statistical test to compare roughness surface values was

performed a test Shapiro-Wilk If p is lower or equal with 0005 than hypothesis of

distribution normality is rejected (distribution deviates from normal form) In the table

X10 the distributions are normal The statistical test will be test t for pair samples

Table X10 Test Shapiro-Wilk for enamel samples

Tests of Normality

Kolmogorov-Smirnova Shapiro-Wilk

Statistic df Sig Statistic df Sig

2mmenamel before etching 193 10 200 898 10 207

15mmenamel before etching 170 10 200 977 10 947

1mmenamel before etching 157 10 200 952 10 689

05mmenamel before etching 165 10 200 943 10 590

2mmenamel after etching 235 10 124 925 10 404

15mmenamel after etching 209 10 200 871 10 102

1mmenamel after etching 189 10 200 964 10 834

05mmenamel after etching 142 10 200 983 10 978

a Lilliefors Significance Correction

This is a lower bound of the true significance

The results of test t for pair enamel samples before and after etching are

presented in table X11

32

Table X11 Test t for enamel samples before and after etching

Paired Samples Test

Paired Differences

t df

p (2-

tailed)

95 Confidence

Interval of the

Difference

Mean

Std

Deviation

Std

Error

Mean Lower Upper

Pair

1

2mmenamel before

etching

2mmenamel after

etching

-18208 135220 42760 -

18304731

-

18111269

-

425815

9 000

Pair

2

15mmenamel before

etching

15mmenamel after

etching

-7738 73151 23132 -7790329 -7685671 -

334508

9 076

Pair

3

1mmenamel before

etching

1mmenamel after

etching

-5579 55468 17540 -5618679 -5539321 -

318065

9 065

Pair

4

05mmenamel before

etching

05mmenamel after

etching

-5323 60378 19093 -5366192 -5279808 -

278788

9 063

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel ( 2mm 15 mm 1mm sau

05mm) but the differences statistical significant are present only for enamel localised

at 2 mm from ECJ

X5CONCLUSIONS

The surfaces of enamel and dentine at cervical level record decreases of

roughness related to the decrease of distance to ECJ

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel but the differences

statistical significant are present only for enamel localised at 2 mm from ECJ

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of

dentine

33

CHAPTXI FEA STUDY REGARDING THE BIOMECHANICAL

BEHAVIOUR AND FRACTURE RESISTANCE OF PROXIMO-OCCLUSAL

AMALGAM AND COMPOSITE RESINS RESTORATIONS

XI1INTRODUCTION AIM OF STUDY

The individual variation of patients morphological and functional complexity

of tissues as well as difficult access limit the possibilities to investigate in clinical

studies the biomechanical behaviour of proximo-occlusal restorations In this context

simulation of the biomechanics for direct restorations represents an interesting

interdisciplinar domain in actual dentistry research

The study focused on two direction

- analysis of role of forces intensity on biomechanical behaviour related to

cavity dimension and material

- analysis of tension inside restoration structure related to forces intensity

XI2MATERIALS AND METHODS

The stages of finite element analysis study are as follows

object modelling (bicusps and proximo-occlusal restoration)

definition of parameters for materials and dental tissues

meshing

constraints and loading

types of contacts

equations system definition

results of simulation

The object 3D modelling was performed in Rhinoceros (figure XI1) The

definition of parameters was performed for Poisson constant Young modulus density

(table XI1) The selected materials were amalgam and composite resins The

analysed tissues were dentine and enamel The meshing constraints loading were

performed for forces of 200N 400N 600N 800 N The analysis was performed using

software COSMOSWorks 2010

34

Fig XI1 3D modellation of bicusp

Table XI1 Values of Young modulus Poisson constant compression resistance for

amalgam composite resin enamel (amalgam compozit smalţ)

Material Young modulus (GPa) Poisson constants

Compression

resistance

(Mpa)

Amalgam 55 033 483

Enamel 48 03 400

Composite

resin 220 022 345

Fig XI2 The forces and constraints application

The results are presented in values and culours red colours representing areas

with maximum values of tensions produced under influence of masticatory forces

The tensions produced in amalgam restoration are in a range from 0 to 22886

(force 800 N) The maximum von Misses tensions are associated with cervical area

of amalgam restorations This aspect proves that first modification in interface

restoration-cavity margins will appear at the level of gingival wall First marginal

35

defects and fissures in restoration bulk will appear at tensions over 1600Mpa

associated with forces of 800N for extended amalgam proximo-occlusal restorations

The tensions produced in composite resin restorations are in a range from 0 to

2285 (force 800 N) The maximum von Misses tensions are associated with cervical

area of composite resin restorationsThis aspect proves that first modification in

interface restoration-cavity margins will appear at the level of gingival wall First

marginal defects and fissures in restoration bulk will appear at tensions over 1716

Mpa associated with forces of 600N for moderate and extended composite resins

proximo-occlusal restorations

Fig XI3a-b ndash Simulated model of proximo-occlusal restoration

FigXI4a-b Dental amalgam restoration Cervical tension associated with 600 N

(c)800 N (d)

FigXI5a-b Composite resin restoration Cervical tension associated with 600 N

(c)800 N (d)

36

The deformation of amalgam can be produced only when is associated with

fissures in bulk of restorations while composite resins restorations present

deformation when are associated with a modification of volume and form because of

repeated action of medium forces on long term or high forces on short term (figures

XI4 XI5)

Fig XI4 Material deformation in area of maximum tension

000E + 00

500E -02

100E -01

150E -01

200E -01

250E -01

1 4 7 101316192225283134374043464952555861646770737679

Amalgam C ompoz it

Figura XI5 Deformarea funcție de material

The amalgam and composite resins were treated as homogenous isotropic and

liniar The advantage of this type of FEA study is that restorations parameters can be

modified any time is necessary both in arhitecture geometry and material indices

variability The results of this study sustain the conclusions of other FEA studies

focused on biomechanical behaviour of posterior restorations performed with

amalgam and composite resins(35 62 76 143)

37

XI4CONCLUSIONS

bull The amalgam in class II restorations has a low deformation tendency because

of uniform distribution of tension inside material

bull Composite resins class II restorations accumulate higher tensions comparing

with amalgam but deformation is avoided for a time because of the adhesion

forces performed between molecules under moderate oral forces In case of

high oral forces (600-800N) the risk of fracture in moderate class II

restorations is higher comparing with amalgam proximo-occlusal restorations

For extended class II restorations and forces of 600 N composite resins present

highest risk of fracture and deformation The von Misses tension at the

cervical interface restorationtooth can reach 1600Mpa

bull The amalgam in moderate class II restorations can resist to deformation even

for high intensity forces limited to 600N In extended class II restorations the

risk of deformation and fracture increases at values of 600N-800N of oral

forces The von Misses tension at the cervical interface restorationtooth can

reach 1700 Mpa

38

FINAL CONCLUSIONS

Amalgam proximo-occlusal restorations with minimum 6-years age present

excellent results for parameters anatomic form (occlusal) marginal

discoloration and marginal secondary dental caries good results for

parameters anatomic form (proximal) and marginal adaptation and poor results

for surface quality

Composite resins proximo-occlusal restorations (bicusps) with minimum 6-

years age present excellent results for parameters color match marginal

discoloration and marginal secondary dental caries and good results for

parameters anatomic form (occlusal proximal) marginal adaptation surface

quality

Composite resins proximo-occlusal restorations (molars) with minimum 6-

years age present good results for parameters color match marginal

discoloration marginal secondary dental caries marginal adaptation and poor

results for parameters anatomic form (occlusal) (54 indices Ryge C)

anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The restorations extended at external third of occlusal surface present highest

percents of indices C regarding anatomic form (occlusal) (54 indices Ryge

C) anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The exceeding of 6-years age will require careful monitorisation for early

interventions through polishing sealing reshaping and even replacement for

restorations with major defects

Oblique layering technique presents superior results regarding marginal

adaptation and marginal discoloration and is recommended for proximo-

occlusal dental caries close to enamel-cement jonction

Centripetal build-up presents good results regarding marginal adaptation and

anatomical form at proximal level (proximal surfaces and contact point)

Horisontal layering technique can be used for optimum results only in

proximal-occlusal cavities with moderate extension both in occlusal-cervical

and buccal-oral

The values of die penetration at gingival wall were statistically different

between the three restorative techniques

We concluded that all restorative methods were associated with lightcuring

contraction and marginal microleakage

The combined technique was associated with lowest lightcuring contraction

and die penetration

The bulk technique was associated with highest lightcuring contraction and die

penetration

39

The surfaces of enamel and dentine at cervical level record decreases of

roughness related to the decrease of distance to ECJ

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel but the differences

statistical significant are present only for enamel localised at 2 mm from ECJ

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of

dentine

bull The amalgam in class II restorations has a low deformation tendency because

of uniform distribution of tension inside material

bull Composite resins class II restorations accumulate higher tensions comparing

with amalgam but deformation is avoided for a time because of the adhesion

forces performed between molecules under moderate oral forces In case of

high oral forces (600-800N) the risk of fracture in moderate class II

restorations is higher comparing with amalgam proximo-occlusal restorations

For extended class II restorations and forces of 600 N composite resins present

highest risk of fracture and deformation The von Misses tension at the

cervical interface restorationtooth can reach 1600Mpa

bull The amalgam in moderate class II restorations can resist to deformation even

for high intensity forces limited to 600N In extended class II restorations the

risk of deformation and fracture increases at values of 600N-800N of oral

forces The von Misses tension at the cervical interface restorationtooth can

reach 1700 Mpa

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1ADA Council on Scientific Affairs ADA Council on Dental Benefit Programs

Statement on posterior resin-based composites JADA 1998 129(11)1627ndash1628

2Albers HF Tooth-colored restoratives 1st ed Santa Rosa CA Alto Books 1979

3Allander L Birkhed D Bratthall D Reasons for replacement of class II amalgam

restorations in private practice Swed Dent J 199014(4)179-84

4Alomari QD Reinhardt JW Boyer DB Effect of liners on cusp deflection and

gap formation in composite restorations Oper Dent 200126406- 11

5Alster D Feilzer AJ de Gee AJ Mol A Davidson CL The dependence of

shrinkage stress reduction on porosity concentration in thin resin layers J Dent Res

1992711619ndash1622

6Aggarwal V Logani A Jain V Shah N Effect of cyclic loading on marginal

adaptation and bond strength in direct vs indirect class II MO composite restorations

Oper Dent 2008 Sep-Oct33(5)587-92

7Andrian S Lăcătuşu St- Caria dentară- Protocoale şi tehnici- EdApolloniaIaşi

1999

8Andrian S- Restaurări fizionomice cu materiale plastice icircn cariologie-EdPanteon

Iaşi 2001

40

9Andrian S Tratamentul Minim Invaziv al Cariei Dentare EditPrinceps Edit Iaşi

2002

10Angmar-Mansson B ten Bosch JJ Optical methods for the detection and

quantification of caries Adv Dent Res 1987 1(1) 14-20

11Angmar-Mansson B ten Bosch JJ Advances in methods for diagnosting coronal

caries Adv Dent Res 1993 7(2) 70-79

12Angmar-Mansson B Al-Khateeb S Tranaeus S Monitoring the caries process

Optical methods for clinical diagnosis and quantification of enamel caries European

Journal of Oral Sciences 1996 104 480-485

13Angmar-Mansson B Al-Khateeb S Tranaeus S Caries diagnosis Journal of

Dental Education 1998 62 (10) 771-780

14Anusavice KJ- ldquoQuality evaluation of dental restorationscriteria for placement

and replacement Chicago 1989Quintessence Publishing

15Anusavice KJ Development and testing of ceramics for dental restorations In

Fischman G Clare A Hench J editors Bioceramics materials and applications

Westerville OH 1995

16Arhun N Celik C Yamanel KClinical evaluation of resin-based composites in

posterior restorations two-year results Oper Dent 201035(4)397-404

17Armstrong SR JC Keller DB Boyer The influence of water storage and C-

factor on the dentinndashresin composite microtensile bond strength and debond pathway

utilizing a filled and unfilled adhesive resin Dent Mater 200117268ndash276

18Armstrong S Boyer D Keller J Microtensile bond strength testing and failure

analysis of two dentin adhesives Dent Mater 1998 14(1)44-50

19Asmussen E Peutzfeldt A Influence of UEDMA BisGMA and TEGDMA on

selected mechanical properties of experimental resin composites Dent Mater1998

1451-56

20Asmussen E Clinical relevance of physical chemical and bonding properties of

composites resins Oper Dent 19851061-73

21Bader JD Brown JP Dilemmas in caries diagnosisJ Am Dent Assoc1993124

(6) 48-50

22Bader JD Shugars DA What do we know about how dentists make caries-

related treatment decisions Community Dent Oral Epidemiol 1997 25(1) 97-103

23Bader JD Shugars DA Bonito AJ A systematic review of the performance of

methods for identifying carious lesions JPublic Health Dent 2002 62 (4) 201-213

24Bader JD Shugars DA Bonito AJ Systematic reviews of selected dental caries

diagnostic and management methods J Dent Educ 2001 65 (10) 960-968

25Bader J Ismail A Survey of systematic reviews in dentistry JADA 2004 135

464-473

26Bader JD Shugars DA Understanding dentistslsquo restorative treatment decisions J

Public Health Dent 1992 Winter52(2)102-10

27Barkmeier WW Cooley RL Current status of adhesive resin systems J Am Coll

Dent 199158 36-39

28Bayne SC Dental biomaterials where are we and where are we going J Dent

Educ 200569(5)571ndash585

41

29Bedran-de-Castro AK Pereira PN Thompson JY Influence of load cycling

and tubule orientation on ultimate tensile strength of dentin J Adhes Dent 2004 6(3)

191-194

30Behle C Flowable composite Proprieties and applications Pract Periodontics

Aesthetics Dent 1998 10347 350-351

31Bergenholtz G Cox CF Bacterial leakage around dental restorations Its effects

on the dental pulp J Oral Path 198211 439 ndash450

32Bernardo M Luis H Martin MD Survival and reasons for failure of amalgam

versus composite posterior restorations placed in a randomized clinical trial JADA

2007138(6)775ndash783

33Black J Biological Performance of Materials Fundamentals of Biocompatibility

NY Marcel Dekker Inc 1999

34Bonsor SJ Chadwick RGLongevity of conventional and bonded (sealed)

amalgam restorations in a private general dental practice Br Dent J 2009206(2)88-

9

35Boschian PL S Guidotti R Pietrbissa M Gagliani- bdquoStress distribution in a

post-restored tooth using the threedimensional finite element method Journal of Oral

Rehabilitation (33) 2006690ndash697

36Bouillaguet S B Ciucchi T Jacoby JC Wataha DH Pashley Bonding

characteristics to dentin walls of class II cavities in vitro Dent Mater 200117316ndash

321

37Bouschlicher MR Rueggeberg FA Effect of ramped light intensity on

polymerization force and conversion in a photoactivated composite J Esthet Dent

2000 12328-339

38Braga RR Ferracane JL Hilton TJ Contraction stress of flowable composites

and their efficacy as stress-relieving layers J Am Dent Assoc 2003134721ndash728

39Braga RR Ballester RY Ferracane JLFactors involved in the development of

polymerization shrinkage stress in resin-composites a systematic review Dent Mater

200521(10)962-70

40Bratu D- Materiale dentare icircn cabinetul de stomatologie- Edit Helicon

Timişoara1994

41Browning WD Johnson WW Gregory PN- Clinical performances of

amalgam-bonded restorations A 42-months study- Journal of American Dental

Association 2000nr131

42Brunthaler A Koumlnig F Lucas T Sperr W Schedle A Longevity of direct resin

composite restorations in posterior teeth Clin Oral Investig 2003 763-70

43Bullard RH Leinfelder KR Russell CM Effect of coefficient of thermal

expansion on microleakage J Am Dent Assoc 1988116871ndash 874

44Buonocore MG Matsui A Gwinnett AJ Penetration of resin dental materials

into enamel surfaces with reference to bonding Arch Oral Biol 19681361-70

45Burke FJ Cheung SW Mjoumlr IA Wilson NH Restoration longevity and analysis

of reasons for the placement and replacement of restorations provided by vocational

dental practitioners and their trainers in the United Kingdom Quintessence Int

199930(4)234-42

42

46Burke FJ Cheung SW Mjor IA Wilson NH-Reasons for the placement and

replacement of restorations in vocational training practicePrimary Dental Care

nr6(1) 1999

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2004 20939-946

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Jun30(6)413-8

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polymerization contraction the influence of stress development versus stress

reliefOper Dent19962117ndash24

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of conventional film and direct digital imaging in the detection of approximal caries

Dentomaxillofac Radiol 2007 Mar36(3)138-42

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Study Orthodontic Tooth Movement J Dent Res 2005 84(5)428-433

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bond strength to primary dentin J Dent Child 2003 70(2) 139-144

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posterior restorations 12-month results Eur J Dent 2010 Jan4(1)57-65

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marginal leakage J Dent 2005 33(7) 603- 610

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Med 2008173(1)23ndash26

59Chen HY Manhart J Hickel R Kunzelmann KH Polymerization contraction

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polymerization contraction stress of composites J Dent Res 2000 79812ndash817

61Cichon P Kerschbaum T Verweildauer zahnartzlicher Restaurationen bei

Behinderten Dtsch Zahnartzlicher 1999 54 96-102

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Three Core Restorative Materials Supported with or without a Prefabricated Split-

Shank Post Journal of Prosthetic Dentistry1997 78 560ndash565

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in Class II composite resin restoration applied in bulk or in two increments

Quintessence Int 1993 24583-591

43

64Collins CJ Bryant RW Hodge KL A clinical evaluation of posterior composite

resin restorations 8-year findings J Dent 199826(4) 311ndash317

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polymerization stress J Am Dent Assoc2000 131497-503

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behaviour of dimethacrylate composite resins Biomaterials 1990 11272-276

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FOTIvisual examination of occlusal caries with other caries diagnostic methods and

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1991469-72

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1399

70Dauvillier BS Aarnts MP Feilzer AJ Developments in shrinkage control of

adhesive restoratives J Esthet Dent 2000 12291-299

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dental light-activated resin composites during curing Dent Mater 200319277ndash285

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bond strength and the polymerization contraction stress J Dent Res 1984

63(12)1396-9

73Davidson CL AJ Feilzer Polymerization shrinkage and polymerization

shrinkage stress in polymer-based restoratives J Dent Res 199725435ndash440

74Davidson CL Resisting the curing contraction with adhesive composites J

Prosthet Dent 198655446ndash7

75Davis RD Mayhew RB A clinical comparison of three anterior restorative resins

at 3 years J Am Dent Assoc 1986112659-63

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and adhesion of composite resin versus ceramic inlays in molarsJ Prosthet

Dent200899131-40

77Deligeorgi V Mjor IA Wilson NH An overview of reasons for the placement

and replacement of restorations Prim Dent Care 20018(1)5-11

78Deliperi S Bardwell DN An alternative method to reduce polymerization

shrinkage in direct posterior composite restorations J Am Dent Assoc 2002

1331387ndash97

79Demirci M Tuncer S Yuceokur AA Prevalence of caries on individual tooth

surfaces and its distribution by age and gender in university clinic patientsEur J

Dent20104(3)270-9

80De Munck J Van Meerbeek B Satoshi I Vargas M Yoshida Y Armstrong S

Lambrechts P Vanherle G Microtensile bond strengths of one- and two-step

selfetch adhesives to bur-cut enamel and dentin Am J Dent 2003 16 414-420

81Dewaele M Truffier-Boutry D Devaux J Leloup G Volume contraction in

photocured dental resins the shrinkage-conversion relationship revisited Dent Mater

2006 22359-365

44

82Deutsch WM Simecek JW Dental emergencies among Marines ashore in

Operations Desert ShieldStorm Mil Med 1996161(10) 620ndash623

83Dickens SH Stansbury JW Choi KM Floyd CJ Photopolymerization kinetics

of methacrylate dental resins Macromolecules 2003 366043-6053

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restorative technique and new adhesives on the dentin marginal seal and adaptation of

resin composite Class II restorations An in vitro evaluation Quintessence Int 1995

26 717-727

85Dietschi D Herzfeld D In vitro evaluation of marginal and internal adaptation of

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Sci 1998 106 1033-1042

86Dietschi D Marginal adaptation and seal of direct and indirect Class II composite

resin restorations an in vitro evaluation Quintessence Int 26(2)127-138 1995

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caries status and dental emergencies among US naval personnel J Dent Res

20028195 (Abstract)

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resinamalgam combinations Oper Dent 1997 22 50-56

89Donly KJ Jensen ME Triolo PA clinical comparison of resin composite inlay

and onlay posterior restorations and cast-gold restorations at 7 years Quintessence Int

30(3)163- 1681999

90Douglas WH Fields RP Fundingsland J A comparison between the

microleakage of direct and indirect composite restorative systems J Dent 17(4)184-

188 1989

91Eberhard J Hartman B Lenhard M Mayer T Kocher T Eickholz P Digital

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Caries Res 200034(3)219-24

92Edelstein BL Douglass CW Dispelling the myth that 50 percent of US

schoolchildren have never had a cavity Public Health Rep1995 110 (5) 522-530

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its possible influence on postoperative sensitivity Quintessence Int 198617103-11

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bis GMA and TEGDMA a modeling approach to understanding the cure of dental

resins Dent Mater 2001 17221-229

95Ermis R Ulkam Aydin Examiner agreement in the replacement decisions of

class I amalgam restorations The Journal of contemporary dental practice 2004 Vol

5 no21-7

96Feilzer AJ AJ De Gee CL Davidson Increased wall-to-wall curing

contraction in thin bonded resin layers J Dent Res 19896848ndash50

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development and viscoelastic properties of experimental twopaste composites J Dent

Res 2003 82824-828

98Feilzer AJ de Gee AJ Davidson CL Relaxation of polymerization contraction

shear stress by hygroscopic expansion J Dent Res 1990 6936ndash39

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99Feilzer AJ De Gee AJ Davidson CL Setting stress in composite resin in relation

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on polymerization shrinkage and integrity of restoration-cavity interface Eur J Oral

Sci 1995 103322ndash326

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systems in the prediction of occlusal caries in permanent molars in 6 and 11 year-old

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in dental composites during polymerization Dent Mater 2005 2136-42

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104Ferreira MC Vieira RS Marginal leakage in direct and indirect composite resin

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restorations in adults Acta Odontol Scand 2004 6282-86

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108Francci C Loguercio AD Reis A Carrilho MR A novel filling technique for

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14(3)149-57

109Fruits TJ Knapp JA Khajotia SS Microleakage in the proximal walls of

direct and indirect posterior resin slot restorations Oper Dent 200631(6)719-27

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restorations The 10-year report J Adhes Dent 2001 3185-194

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Acad Orthop Surg 2002 10 290-297

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incremental methods in Class II composite resin restorations on gingival

microleakage J Contemp Dent Pract 20078(2)113-20

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Effects of irradiation mode and filling technique on resindentin bond strength in

Class I cavities J Dent Res 200281 (Abstract)

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JADA 1972841349-1357

117Gordon JChristensen G Why switch to digital radiography J Am Dent

Assoc 204 Vol 135 No 101437-1439

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118Gregoire GL Akon BA Millas A Interfacial micromorphological differences

in hybrid layer formation between water- and solvent-based dentin bonding systems J

Prosthet Dent 2002 87633ndash641

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120Gwinnett AJ Buonocore MG Adhesives and caries prevention a preliminary

report Br Dent J 196511977-81

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124Haba Denisia Tehnici uzuale utilizate icircn radiologia dentară Edit Junimea

2007

125Hashimoto M Ito S Tay FR Svizero NR Sano H Kaga M Fluid movement

across the resin-dentin interface during and after bonding J Dent Res 2004 83843ndash

848

126Hashimoto M Tay FR Ito S Sano H Kaga M Pashley DH Permeability of

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in three private dental practices in Adelaide Aust Dent J 19974259ndash63

128Helwig Klimek Attin Einfuumlhrung in Die ZahnErhaltung Urbanampfischer 2003

129He Z Shimada Y Tagami J The effects of cavity size and incremental

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Mater 200723(5)533-8

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134Hilton TJ Cavity sealers liners and bases Current philosophies and indications

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class 2 composites Oper Dent 19981312-19

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138Hintze H Wenzel A Danielen B Behaviour of approximal carious lesions

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139Hintze H Wenzel A Influence of validation method on diagnostic accuracy of

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of approximal and occlusal dental caries in a young adult population Community

Dent Oral Epidemiol 200533(3)212-8

143Hubsch PF Middleton J Knox J A finite element analysis of the stress at the

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fillingsBiomaterials2000211015ndash1019

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145Hunter AR Treasure ET Hunter AJ Increases in cavity volume associated

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1995202ndash 6

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influence of simulated clinical handling on the flexural and compressive strength of

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Bucureşti 2001

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152Jackson RD Morgan M The new posterior resins and a simplified placement

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Kompositefullungen Zahnartzlicher Welt 1999 108 270-273

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Community Dentistry and Oral Epidemiology 1994 22(2) 71-74

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1243

161Khairallah C Hokayem A Long-term clinical evaluation of 2 dental materials

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Biology199843(8)629-632

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817-822

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dental resin composites Dent Mater 2005 211150-1157

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201989117ndash121

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18(7)516-20

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Dent 27(5)325-331 1999

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Jan11(1)34-40

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JProsthet Dent 199369(4)425-430

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JDent 199826 627-632

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1999 15128-137

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179Lăcătuşu St Luminiţa Costinescu Andrian S Gianina Iovan Valeria

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Edition of the Balkan Medical Days

Stomatological Section Abstract nr1091999128

181Lăcătuşu St Andrian S Gianina Iovan- Consideraţii asupra adaptării

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200126302ndash307

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Dentistry and Oral Epidemiology 1996 24 106-11

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polymerization contraction stress for dental composites by two-step light-activation

Dent Mater 2002 18436-444

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20(3)236-43

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Polymerization shrinkage effects of boundary conditions and filling technique of

resin composite restorations J Dent 2004 32(6)459-70

50

189Lopes GC Baratieri LN Monteiro S Jr Vieira LC Effect of posterior resin

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Quintessence Int 2004 35(2)156-61

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art and future perspectives Quintessence Int 200233213-224

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copolymerizations Macromolecules 1999 323913-3921

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clinical results J Dent Res 199877 1020

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two amalgams Quintessence Int 199829483ndash490

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Dentomaxillofac Radiol 2007 Oct36(7)377-81

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J Prosthet Dent 2000 Sep84(3)289-96

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Three-year clinical evaluation of composite and ceramic inlays Am J Dent 2001

Apr14(2)95-9

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79369 (Abstract)

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deformation Dent Mater 200117241ndash246

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practitioners and dental caries JDent1990 18(3) 130-136

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(Cerana) Br Dent J 2006 Oct 21201(8)515-20

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PrimDentCare1999Apr659-62

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Quintessence 198961-80

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ScandJDRes 199210060-65

215Mjor IA The reasons for replacement and the age of failed restorations in

general dental practice Acta OdontolScand19975558-63

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replacement and longevity of restorations in Florida J Am Coll Dent 199865(3)27ndash

33

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19904011ndash7

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Lake Buena Vista Fla Hanover Park Ill Quintessence 1989125-138

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Am Dent Assoc 2010 141(3)319-29

52

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Ciucchi B Russell CM Pashley DH Tensile bond strength and SEM evaluation of

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125749-751

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composites Oper Dent 23 1998282ndash289

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bond strength to dentin in resin composite restorations Dent Mater 200925(1)129-

34

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Monogr Oral Sci 20092142-51

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569ndash575

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55

275Sarrett DC Clinical challenges and the relevance of materials testing for

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286Sideridou I Tserki V Papanastasiou G Effect of chemical structure on degree

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287Sideridou I Tserki V Papanastasiou G Study of water sorption solubility and

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291Simecek JW Diefenderfer KE Ahlf RL Ragain JC Jr Dental sealant

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292Simi B Suprabha B Evaluation of microleakage in posterior nanocomposite

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OperDent 1991 16 17-20

295Smales RJ Webster DA Leppard PISurvival predictions of amalgam

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296Smales RJ Hawthorne WSLong-term survival of extensive amalgams and

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308Summit JB Robbins JW Hilton TJ Fundamentals in operative dentistry Cap

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57

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of amalgam composite and glassndashionomer restorations J Dent Res 199069861ndash

864

310Tanne K Mamoru S Burstone C Three-dimensional finite element analysis

for stress in the periodontal tissue by orthodontic forcesAm J Orthod Dentofacial

Orthop921987499ndash505

311Tanumiharja M Burrow MF Tyas MJ Microtensile bond strengths of seven

dentin adhesive systems Dent Mater 2000 16(3)180-7

312Tay FR Pashley DH Aggressiveness of contemporary self-etching systems

Part I Depth of penetration beyond dentin smear layers Dent Mater 2001 17(4) 296-

308

313Tay FR Frankenberger R Krejci I Bouillaguet S Pashley DH Carvalho

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In vivo evidence J Dent 2004 32611ndash621

314Tay FR Pashley DH Have dentin adhesives become too hydrophilic J Can

Dent Assoc 2003 69726ndash731

315Tay FR Sano H Carvalho R Pashley EL Pashley DH An ultrastructural

study of the influence of acidity of self-etching primers and smear layer thickness on

bonding to intact dentin J Adhes Dent 2000 283ndash98

316Thompson JY Bayne SC Heymann HO Mechanical properties of a new

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76(6)619-623 1996

317Unterbrink GL R Muessner Influence of light intensity on two restorative

systems J Dent 199523183ndash189

318Unterbrink GL Liebenberg WH Flowable resin composites as filled

adhesiveslsquo literature review and clinical recommendations Quintessence Int

199930249ndash257

319Vaarkamp J Ten Bosch J Verdonschot EH Quantitative diagnosis of small

approximal caries lesions utilizing wavelength-dependent fiber-optic

transillumination Journal of Dental Research 1997 76 (4) 875-882

320Valachovic RW Douglass CW Reiskin AB Chauncey HH McNeil BJ The

use of panoramic radiography in the evaluation of asymptomatic adult dental patients

Oral Surg Oral Med Oral Pathol 198661(3)289-96

321Van Meerbeek B De Munck J Yoshida Y Inoue S Vargas M Vijay P Van

Landuyt K Lambrechts P Vanherle G Adhesion to enamel and dentin Current

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322Van Meerbeek B Van Landuyt K De Munck JHashimoto M Peumans M

Lambrechts P Yoshida Y Inoue S Suzuki K Technique-sensitivity of

contemporary adhesives Dent Mater J 2005 24(1) 1-13

323Van Meerbeek B Vargas S Inoue S Yoshida Y Peumans M Lambrechts P

Vanherle G Adhesives and cements to promote preservation dentistry Oper Dent

20016 119-144

324Van Meerbeek B Yoshida Y Inoue S Vargas M Abe Y Fukuda R Okazaki

M Lambrechts P Vanherle G Bonding mechanism micro-tensile bond strength of

a 4- MET-based self-etching adhesive J Dent Res 2000 79 249 (Abstract)

58

325Van Nieuwenhuysen JP DrsquoHoore W Carvalho J Qvist V Long-term

evaluation of extensive restorations in permanent teeth J Dent 200331(6)395ndash405

326Venhoven BA de Gee AJ Davidson CL Light initiation of dental resins

dynamics of the polymerization Biomaterials 1996 172313-2318

327Versluis A Douglas WH Cross M Sakaguchi RL Does an incremental filling

technique reduce polymerization shrinkage stresses J Dent Res 1996 75871ndash878

328Vries HC Ruiken HM Konig KG vanrsquot Hof MA Radiographic versus

clinical diagnosis of approximal carious lesions Caries Res1990 24 (5) 364-370

329Waggoner W Ashton J Predictability of cavitation based upon radiographic

appearance comparison of two film types Quintessence International 1989 20(1)

55-60

330Watanabe LG Marshall GW Jr Marshall SJ Dentin shear strength effects of

tubule orientation and intra tooth location Dent Mater 1996 12 109-115

331Watts DC AS Marouf Optimal specimen geometry in bonded-disk

shrinkage-strain measurements on light-cured biomaterials Dent Mater 200016447ndash

451

332Watts DC Marouf AS Al-Hindi AM Photo-polymerization shrinkage-stress

kinetics in resin-composites methods development Dent Mater 2003 191ndash11

333Weaver WS Blank LW Pelleu GB Jr A visible light activated resin cured

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334Wendt SL Microleakage and cusp fracture resistance of heattreated composite

resin inlays Am J Dent 4(1)10-14 1991

335Wenzel A Hintze H Mikkelsen L Mouyen F Radiographic detection of

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1991 72 621-6

336Wenzel A Hintze H Perception of image quality in direct digital radiography

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Dentomaxillofac Radiol 1993 22 131-4

337Wenzel A Computer-aided image manipulation of intraoral radiographs to

enhance diagnosis in dental practice a review Int Dent J 1993 43 99-108

338Wenzel A Digital radiography and caries diagnosis Dento Maxillo Facial

Radiology 27(1)3-11 1998

339Wenzel A Haiter-Neto F Gotfredsen E Risk factors for a false positive test

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modality and observer characteristics Caries Res 200741(3)170-6

340Wibowo G Stockton L Microleakage of class II composite restorations Am J

Dent 200114177ndash185

341Wilson NHF Wastell DG Norman RD Five-year performance of high-

cooper content amalgam restorations in a multiclinical trial JDent1996 24 203-210

342Winkler MM Katona TR Paydar NH Finite element stress analysis of three

filling techniques for class V light-cured composite restorations J Dent Res

1996751477-83

343Yap AU Effectiveness of polymerization in composite restoratives claiming bulk

placement Impact of cavity depth and exposure time Oper Dent 2000 25113-120

59

344Yeşilyurt C Bulucu B Bond strength of total-etch dentin adhesive systems on

peripheral and central dentinal tissue a microtensile bond strength test The Journal of

Contemporary Dental Practice 7(2) 20061-13

345Yoshida Y Van Meerbeek B Okazaki M Shintani H Suzuki K Comparative

study on adhesive performance of functional monomers J Dent Res 2004 83 454-

458

346Yoshiyama M Tay FR Doi J Nishitani Y Yamada T Itou K Carvalho RM

Nakajima M Pashley DH Bonding of self-etch and total etch adhesives to carious

dentin J Dent Res 2002 81 556-560

  • COPERTA REZUMAT ENGLEZA (MEREUTA)pdf
  • REZUMAT ENGLEZA DR MEREUTA DENISSpdf
Page 7: UNIVERSITATEA DE MEDICINA SI FARMACIE “GR Doctorat/Rezumat... · universitatea de medicina si farmacie “gr.t.popa” iasi facultatea de medicina dentara rezumatul tezei de doctorat

4

CHAPTVI THE AIM OF STUDY GENERAL OBJECTIVES DATA

COLLECTION AND PROCESSING

VI1 The reason for theme choice

The reason for theme choice was determined by the fact that any comparative

study focused on both amalgam and composite resins proximo-occlusal restorations

presents a high practical importance for dentists Also it is a request to highlight

clinical and paraclinical aspects regarding factors that influence clinical performance

of direct composite resins restorations performed at the level of lateral dental group

The support offered by Discipline Cariology and Restorative Dentistry and Institute

Petru Poni allowed the performance of our researches

VI2Aim objectives methodology

The objectives of my researches were as follows

- Selection of literature data regarding histological morphopatological

etiopathogenic spects of dental caries posibilities of diagnostic for proximal

incipient dental caries using both clasic and modern diagnostic technology

properties and clinical behaviour of dental amalgam and composite resins and

other adhesive materials used in posterior restorations literature data

regarding longevity of proximo-occlusal direct restorations and literature data

regarding clinical performances of indirect restorations versus direct

restorations for lateral dental group

- Performing an epidemiological study based on clinical data (indices Ryge

modified USPHS) on posterior direct restorations

- The comparing research regarding clinical performance of posterior composite

resines restorations performed using different restorative techniques

- In vitro study focused on the assessment of the marginal sealing at the cervical

area of proximo-occlusal composite resins restorations

- In vitro study focused on the effects of etching at the cervical area for

proximo-occlusal composite resins restorations

- FEA (finite element analysis) study focused on the assessment of

biomechanical behaviour and resistance to fracture and deformation of

simulated proximo-occlusal restorations from amalgam and composite resins

To realise the proposed aims the working protocol was as follows

- clinical assessment of a study group with age 17-49 with class II dental caries

treated by one dentist using amalgam and composite resins

5

- clinical assessment of a study group with age 15-65 with class II dental caries

treated by one dentist using a selected composite resin and different restorative

techniques

- performing of data base for statistical processing

Database was collected between 2008-2011 in private practice and Faculty of

Dental Medicine UMF ―GrTPopa Iasi The paraclinical studies were performed in

collaboration with Institute Petru Poni Iasi

The patients were informed and gave their written consent to be included in

study groups Every patient was submitted to clinical examen and radiographic

examen The clinical examens consisted in assessment of Ryge indices (modified

USPHS) at baseline 6 months 12 months 18months and 24 months

The paraclinical tests consisted in

- in vitro tests on extracted teeth consisting in optical and atomic force

microscopy to assess the influence of different restorative techniques on the cervical

marginal sealing

- measurement of surface status (enamel dentine) after etching (different time

intervals) using AFM (Atomic Force Microscopy)

- statistical analysis in SPSS 13 for comparison of microleakage degree at

cervical level related to different restorative techniques

- FEA study performed using software COSMOSWorks 2010 for the

assessment of biomechanical behaviour of simulated posterior amalgam and

composite resins restorations

VI3 Data collecting and processing

The processing of reseraches data was performed using the follwing software

MS Office (graphs tables)

SPSS 16 (statistical tests)

The following statistical tests were used t Test test Kolmogorov-Smirnov test

Pearson test Wilcoxon The descriptive statistical analysis was performed using

Microsoft Excel and analitical statistical analysis was performed using SPSS 160

(SPSS Inc SUA)

6

CHAPTVII STUDY REGARDING CLINICAL PERFORMANCE OF

PROXIMO-OCCLUSAL AMALGAM AND COMPOSITE RESINS

RESTORATIONS

VII1 INTRODUCTION

The clinical performance of posterior direct restorations pn medium and long

term concerns dental practitioners that must correlate their therapeutical decisions

with material selection restorative technique external factors represented by oral

forces cariogenic risk patient parafunctions

VII2AIM OF STUDY

The aim of study consisted in assessment of clinical performance of amalgam

and composite resins proximal-occlusal restorations 4-years old

VII3 MATERIALS AND METHOD

The study group included 200 proximal-occlusal amalgam (n=100) and

composite resins (Herculite Kerr) (n=100) restorations 4-years old The study was

performed on 55 patients with age between 17-49 years examined in Dental Medicine

Faculty UMFGrTPopa Iaşi The assessment of fillings status was performed

using Ryge indices modified USPHS (US Public Health Service) (table 1) The

clinical peformance of restorations was also correlated with dental group (molars

bicusps) extension (medium extended) and cariogenic risk (medium high) The

following parameters were assessed

- color match

- marginal adaptation (integrity)

- marginal discoloration

- anatomical form (proximal)

- surface quality

The results presentation was performed using Microsoft Excel

VII4 RESULTS AND DISCUSSIONS

AB

C

S1

6

64

30

0

20

40

60

80

A

B

C

Fig VII1 Anatomical form (occlusal)-amalgam restorations (molars)

7

AB

C

S1

26

64

100

10

20

30

40

50

60

70

A

B

C

Fig VII2 Anatomical form (occlusal)-amalgam restorations (bicusps)

AB

C

S1

0

46

54

0

10

20

30

40

50

60

A

B

C

Fig VII3 Anatomical form (occlusal)-composite resins restorations (molars)

Fig VII4 Anatomical form (occlusal)-amalgam restorations (bicusps)

AB

C

S1

12

72

16

0

10

20

30

40

50

60

70

80

A

B

C

FigVII5 Anatomical form (proximal)-amalgam restorations (molars)

AB

C

S1

38

56

60

10

20

30

40

50

60

A

B

C

FigVII6 Anatomical form (proximal)-amalgam restorations (bicusps)

AB

C

S1

10

54

36

0

10

20

30

40

50

60

A

B

C

8

AB

C

S1

8

64

26

0

10

20

30

40

50

60

70

A

B

C

FigVII7 Anatomical form (proximal)-composite resins restorations (molars)

AB

C

S1

34

66

100

10

20

30

40

50

60

70

A

B

C

FigVII8 Anatomical form (proximal)-composite resins restorations (bicusps)

AB

C

S1

36

44

20

0

5

10

15

20

25

30

35

40

45

A

B

C

FigVII9 Marginal adaptation (proximal)- amalgam restorations(bicusps)

AB

C

S1

20

50

30

0

5

10

15

20

25

30

35

40

45

50

A

B

C

FigVII10 Marginal adaptation (proximal)-amalgam restorations (molars)

AB

C

S1

16

60

24

0

10

20

30

40

50

60

A

B

C

FigVII11 Marginal adaptation (proximal)-composite resins restorations (bicusps)

9

AB

C

S1

12

54

34

0

10

20

30

40

50

60

A

B

C

FigVII12 Marginal adaptation (proximal)-composite resins restorations (molars)

AB

C

S1

22

54

24

0

10

20

30

40

50

60

A

B

C

FigVII13 Surface quality-amalgam restorations (bicusps)

AB

C

S1

10

54

36

0

10

20

30

40

50

60

A

B

C

FigVII14 Surface quality-amalgam restorations (molars)

AB

C

S1

12

68

20

0

10

20

30

40

50

60

70

A

B

C

FigVII15 Surface quality-composite resins restorations (bicusps)

AB

C

S1

8

70

22

0

20

40

60

80

A

B

C

FigVII16 Surface quality-composite resins restorations (molars)

10

A

C

S1

98

20

20

40

60

80

100

A

C

FigVII17a-b Prevalence of marginal dental cariesamalgam restorations (moderate

CR)

A

C

S1

92

80

20

40

60

80

100

A

C

FigVII18 Prevalence of marginal dental cariesamalgam restorations (high CR)

A

C

S1

94

60

20

40

60

80

100

A

C

FigVII19 Prevalence of marginal dental cariescomposite resins restorations (CR

moderate)

A

C

S1

82

18

0

10

20

30

40

50

60

70

80

90

A

C

FigVII20 Prevalence of marginal dental cariescomposite resins restorations (high

CR)

11

The study data sustain the results obtained by most studies focused on

posterior amalgam restorations However Hickelampcol (2001) reviewed literature data

and proved that many results varies accordingly to different clinical factors (133)

Roulet JF(1997) warned about limits of cross-sectional studies related to composite

resins restorations because of the absence of data regarding restorative techniques

practitioner experience presence or absence of optimum isolation factors related by

patient (266)

VII5CONCLUSIONS

Amalgam proximo-occlusal restorations with minimum 6-years age present

excellent results for parameters anatomic form (occlusal) marginal

discoloration and marginal secondary dental caries good results for

parameters anatomic form (proximal) and marginal adaptation and poor results

for surface quality

Composite resins proximo-occlusal restorations (bicusps) with minimum 6-

years age present excellent results for parameters color match marginal

discoloration and marginal secondary dental caries and good results for

parameters anatomic form (occlusal proximal) marginal adaptation surface

quality

Composite resins proximo-occlusal restorations (molars) with minimum 6-

years age present good results for parameters color match marginal

discoloration marginal secondary dental caries marginal adaptation and poor

results for parameters anatomic form (occlusal) (54 indices Ryge C)

anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The restorations extended at external third of occlusal surface present highest

percents of indices C regarding anatomic form (occlusal) (54 indices Ryge

C) anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The exceeding of 6-years age will require careful monitorisation for early

interventions through polishing sealing reshaping and even replacement for

restorations with major defects

12

CHAPTVIII CLINICAL PERFORMANCE OF COMPOSITE RESINS

RESTORATIONS RELATED TO RESTORATIVE TECHNIQUE 12-

MONTHS LONGITUDINAL STUDY

VIII1 INTRODUCTION

The restorative technique has a major influence over clinical performance of

composite resins restorations in proximo-occlusal cavities In this context researches

focused on correlations between technique and clinical performance of direct

restorations improve the dentist decision regarding restorative technique choice

VIII2AIM OF STUDY

The aim of study was to determine the clinical performance of composite

resins proximo-occlusal restorations performed using different restorative techniques

VIII3MATERIALS AND METHOD

The group study included 37 patients with age 18-42 years with moderat

ecariogenic risk The total number of composite resins restorations (Herculite XRV

Kerr) was 60 divided in three study groups (n=20)

I Centripetal build-up

II Oblique layering

III Horisontal layering

The coronal restorations were assessed at an interval of 12 months using

indices Ryge modified USPHS

- indice ALFA (A)- IDEAL CLINIC

- indice BRAVO (B)- ACCEPTABLE CLINIC

- indice CHARLIE (C)- UNACCEPTABLE CLINIC

VIII4 RESULTS AND DISCUSSIONS

The statistical tests Kruskal-Wallis and Mann-Whitney were performed to

confirm or infirm research hypotesis (the direct restorations performed using different

restorative techniques present statistical significant differences regarding clinical

performance for the assessed parameters)

13

TableVIII1a-b Groups study (Kruskal-Wallis Test)

Ranks

20 2960

20 2560

20 3630

60

20 3050

20 2420

20 3680

60

20 2490

20 3140

20 3520

60

Restorative_techniques

Centripetal build-up

Oblique layering

Horizontal layering

Total

Centripetal build-up

Oblique layering

Horizontal layering

Total

Centripetal build-up

Oblique layering

Horizontal layering

Total

Marginal_adaptation

Marginal_discoloration

Anatomical_form

N Mean Rank

Test Statisticsab

4913 8031 4900

2 2 2

086 018 086

Chi-Square

df

Asymp Sig

Marginal_

adaptation

Marginal_

discoloration

Anatomical_

form

Kruskal Wallis Testa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between the three restorative

techniques for parameter marginal adaptation (p=0086)

There are no statistical significant differences between the three restorative

techniques for parameter marginal discoloration (p=0018)

There are no statistical significant differences between the three restorative

techniques for parameter anatomical form (proximal) (p=0086)

TableVIII2 Comparing results between restorations performed using three

techniques (marginal adaptation marginal discoloration anatomical form) Marginal adaptation Centripetal build-upOblique layering p=04 ns

Centripetal build-upHorizontal layering p=0191 ns

Oblique layering Horizontal layering p=0028 s

Marginal discoloration Centripetal build-upOblique layering p=0103 ns

Centripetal build-upHorizontal layering p=0195 ns

Oblique layering Horizontal layering p=0005 s

Anatomical form Centripetal build-upOblique layering p=0137 ns

Centripetal build-upHorizontal layering p=0029 s

Oblique layering Horizontal layering p=0433 ns

ns nesemnificativ

s semnificativ

p probabilitate

14

Tables VIII3a-b Mann-Whitney test Comparing analysis regarding marginal

discoloration between restorations performed using oblique layering technique and

centripetal build-up technique

Ranks

20 2180 43600

20 1920 38400

40

Restorative_techniques

Centripetal build-up

Oblique layering

Total

Marginal_adaptation

N Mean Rank Sum of Ranks

Test Statisticsb

174000

384000

-841

400

495a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

adaptation

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between centripetal build-up

and oblique layering techniques regarding parameter marginal adaptation (p=0400)

Tables VIII4a-b Mann-Whitney test Comparing analysis regarding marginal

adaptation between restorations performed using horisontal layering technique and

centripetal build-up technique

Ranks

20 1830 36600

20 2270 45400

40

Restorative_techniques

Centripetal build-up

Horizontal layering

Total

Marginal_adaptation

N Mean Rank Sum of Ranks

Test Statisticsb

156000

366000

-1307

191

242a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

adaptation

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between centripetal build-up

and horisontal layering techniques regarding parameter marginal adaptation

(p=0191)

15

TablesVIII5a-b Mann-Whitney test Comparing analysis regarding marginal

adaptation between restorations performed using oblique layering technique and

horisontal layering technique

Ranks

20 1690 33800

20 2410 48200

40

Restorative_techniques

Oblique layering

Horizontal layering

Total

Marginal_adaptation

N Mean Rank Sum of Ranks

Test Statisticsb

128000

338000

-2191

028

052a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

adaptation

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There is statistical significant differences between horisontal layering and

oblique layering techniques regarding parameter marginal adaptation (p=0028)

Tables VIII6a-b Mann-Whitney test Comparing analysis regarding marginal

discoloration between restorations performed using oblique layering technique and

centripetal build-up technique

There are no statistical significant differences between centripetal build-up

and oblique layering techniques regarding parameter marginal discoloration

(p=0103)

Ranks

20 2260 45200

20 1840 36800

40

Restorative_techniques

Centripetal build-up

Oblique layering

Total

Marginal_discoloration

N Mean Rank Sum of Ranks

Test Statisticsb

158000

368000

-1632

103

265a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

discoloration

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

16

Tables VIII7a-b Mann-Whitney test Comparing analysis regarding marginal

discoloration between restorations performed using centripetal build-up technique and

horisontal layering technique

Ranks

20 1840 36800

20 2260 45200

40

Restorative_techniques

Centripetal build-up

Horizontal layering

Total

Marginal_discoloration

N Mean Rank Sum of Ranks

Test Statisticsb

158000

368000

-1299

194

265a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

discoloration

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between centripetal build-up

and horisontal layering techniques regarding parameter marginal discoloration

(p=0103)

Tables VIII8a-b Mann-Whitney test Comparing analysis regarding marginal

discoloration between restorations performed using oblique layering technique and

horisontal layering technique

Ranks

20 1630 32600

20 2470 49400

40

Restorative_techniques

Oblique layering

Horizontal layering

Total

Marginal_discoloration

N Mean Rank Sum of Ranks

Test Statisticsb

116000

326000

-2822

005

023a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

discoloration

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There is statistical significant differences between horisontal layering and

oblique layering techniques regarding parameter marginal discoloration (p=0005)

17

TablesVIII9 a-b Mann-Whitney test Comparing analysis regarding anatomical

form between restorations performed using centripetal build-up technique and oblique

layering technique

Ranks

20 1830 36600

20 2270 45400

40

Restorative_techniques

Centripetal build-up

Oblique layering

Total

Anatomical_form

N Mean Rank Sum of Ranks

Test Statisticsb

156000

366000

-1486

137

242a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Anatomical_

form

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between centripetal build-up

and oblique layering techniques regarding parameter anatomical form (p=0137)

Tables VIII10a-b Mann-Whitney test Comparing analysis regarding anatomical

form between restorations performed using centripetal build-up technique and

horisontal layering technique

Ranks

20 1710 34200

20 2390 47800

40

Restorative_techniques

Centripetal build-up

Horizontal layering

Total

Anatomical_form

N Mean Rank Sum of Ranks

Test Statisticsb

132000

342000

-2184

029

068a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Anatomical_

form

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between centripetal build-up

and horisontal layering techniques regarding parameter anatomical form (p=0029)

18

Tables VIII11a-b Mann-Whitney test Comparing analysis regarding anatomical

form between restorations performed using oblique layering technique and horisontal

layering technique

Ranks

20 1920 38400

20 2180 43600

40

Restorative_techniques

Oblique layering

Horizontal layering

Total

Anatomical_form

N Mean Rank Sum of Ranks

Test Statisticsb

174000

384000

-784

433

495a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Anatomical_

form

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between horisontal layering and

oblique layering techniques regarding parameter anatomical form (p=0433)

Indices A for restorations performed using centripetal build-up technique were

as follows color match-80 marginal adaptation- 60 marginal discoloration-

70 anatomical form (proximal)- 80 surface quality- 60

Indices A for restorations performed using horisontal layering technique were

as follows color match-70 marginal adaptation- 40 marginal discoloration-

50 anatomical form (proximal)- 50 surface quality- 70

Indices A for restorations performed using oblique layering technique were as

follows color match-70 marginal adaptation- 80 marginal discoloration- 90

anatomical form (proximal)- 60 surface quality- 70

Indices B for restorations performed using centripetal build-up technique were

as follows color match-20 marginal adaptation- 30 marginal discoloration-

20 anatomical form (proximal)- 30 surface quality- 40

Indices B for restorations performed using horisontal layering technique were

as follows color match-30 marginal adaptation- 40 marginal discoloration-

30 anatomical form (proximal)- 30 surface quality- 30

Indices B for restorations performed using oblique layering technique were as

follows color match-30 marginal adaptation- 20 marginal discoloration- 10

anatomical form (proximal)- 40 surface quality- 30

19

Indices C for restorations performed using centripetal build-up technique were

as follows color match-0 marginal adaptation- 10 marginal discoloration- 0

anatomical form (proximal)- 0 surface quality- 0

Indices C for restorations performed using horisontal layering technique were

as follows color match-0 marginal adaptation- 20 marginal discoloration- 20

anatomical form (proximal)- 20 surface quality- 0

Indices C for restorations performed using oblique layering technique were as

follows color match-0 marginal adaptation- 0 marginal discoloration- 10

anatomical form (proximal)- 0 surface quality- 100

Discussions

For in vitro studies is difficult to reproduce the variables existent in oral cavity

like occlusal stress and pH and temperature changes (235) The clinical studies are

determinant in assessment of restorative techniques (300) The most researches

focuses on the influence of restorative technique on the reduction of lightcuring stress

(51 78 135)

VIII5 CONCLUSIONS

Oblique layering technique presents superior results regarding marginal

adaptation and marginal discoloration and is recommended for proximo-

occlusal dental caries close to enamel-cement jonction

Centripetal build-up presents good results regarding marginal adaptation and

anatomical form at proximal level (proximal surfaces and contact point)

Horisontal layering technique can be used for optimum results only in

proximal-occlusal cavities with moderate extension both in occlusal-cervical

and buccal-oral

20

CHAPTIX STUDY REGARDING MARGINAL SEALING STATUS IN

COMPOSITE RESINS LIMITED PROXIMO-OCCLUSAL RESTORATIONS

PERFORMED USING DIFFERENT TECHNIQUES

IX1INTRODUCTION

The contraction of composite resins can produce stress inside dental structure

The most contraction stress appears in the initial stages and development rate of stress

decreases gradually in time (5 98 160) The contraction stress of composite resins

can overpass adhesion strenght and can broke the link between dental tissues and

composite resin (73) When adhesion strenght is high stress can produce marginal

fracture or bulk fracture (74) These situations are associated with microleakage and

penetration of oral fluid and bacteria along dentinal walls endangering the pulpal

tissue or favourising secondary dental caries

IX2 AIM OF STUDY

The study aimed to assess the efficiency of marginal sealing along gingival

wall in limited proximal-occlusal restorations performed using three different

techniques

IX3MATERIALS AND METHOD

The study group included 30 teeth extracted for orthodontic and periodontal

reasons On every tooth two identical class II cavities (on mesial and distal surfaces)

were prepared with cylindrical burs under water cooling The gingival wall was

limited to enamel-cement jonction The cavity dimension were as follows 2 mm

buccal-oral 5mm depth Each tooth was introduced in a pattern of acrylat The

operator calibrated preparation technique on acrylat teeth in Simulation Laboratory of

UMF ―Gr T Popa Iaşi The 60 prepared cavities were randomly divided in three

study groups related to restorative technique The restoration were performed with

Filtek Z550 (3M ESPE) a nanohybrid composite resin The adhesive strategy

included etchamprinse in 2 steps and adhesive Adper Single Bond 2(3MESPE)

Group A (n=20) bulk restorative technique associated with lightcuring from

occlusal 40 seconds and from buccal and oral 20 seconds

Group B (n=20) oblique layering technique (first layer on buccal wall and

buccal frac12 of gingival wall was lightcured from buccal second layer on oral wall and

oral frac12 of gingival wall was lightcured from oral third oral as a triangle with point

oriented to gingival wall was lightcured from occlusal)

Group C (n=20) combined technique (bdquoflow layer on gingival and axial

walls lightcured under pressure only associated with solid composite resin layer)

The proximal surfaces were performed using Tofflemire and metallic matrices After

removal of matrices every restoration was lightcured for another 20 seconds Two

layers aof varnish were applied on composite resins restorations excepting cavity

margins and an area of 1 mm around them The samples were introduced in methylen

21

blue 10 for 48 hours After this stage samples were washed with water and teeth

were cut longitudinally with a diamonded disc

The die penetration was assessed with Zeiss (Iena Germany) X20 microscope

accordingly to four scores (0-3)

0 ndash no penetration

1 ndash die infiltration until external half of gingival wall

2 ndash die infiltration on all gingival wall

3 ndash die infiltration on gingival wall and axial wall

IX4RESULTS AND DISCUSSIONS

The result of die penetration are presented in table IX1

TableIX1 The results for die penetration

Grup 0 1 2 3

A (bulk) 0 0 3 17

B (layering) 0 4 5 11

C (combined) 12 5 2 1

In group A 17 sample had score 3 and 2 samples had score 2 In group B 11

sample had score 3 5 samples had score 2 and 4 sample had score 1 In group C with

best results 12 samples had score 0 5 samples had score 1 2 samples had score 2 1

sample had score 3

The recorded data were analysed using test Mann-Whitney The statistical

results are presented in tables IX2-IX4

Tables IX2a-b Mann-Whitney for comparisons of microleakage values between

bulk technique and incremental technique

Ranks

Restorative technique N Mean Rank Sum of Ranks

Scores

frequency

A ndash bulk technique 20 2420 24200

B ndash incremental

technique

20 1680 16800

Total 40

Test Statisticsb

scores

frequency

Mann-Whitney U 29000

Wilcoxon W 168000

Z -1970

Asymp Sig (2-tailed) 049

Exact Sig [2(1-tailed Sig)] 123a

a Not corrected for ties

b Grouping Variable restorative technique

22

Tables IX3a-b Mann-Whitney for comparisons of microleakage values between

bulk technique and mixed technique

Ranks

Restorative technique N Mean Rank Sum of Ranks

scores

frequency

A ndash bulk technique 20 3090 30900

C ndash mixed technique 20 1010 10100

Total 40

Test Statisticsb

scores

frequency

Mann-Whitney U 500

Wilcoxon W 101000

Z -4021

Asymp Sig (2-tailed) 000

Exact Sig [2(1-tailed Sig)] 000a

a Not corrected for ties

b Grouping Variable restorative technique

Tables IX4a-b Mann-Whitney test for comparisons of microleakage values

between incremental technique and mixed technique

Ranks

Restorative technique N Mean Rank Sum of Ranks

scores

frequency

B ndash incremental

technique

20 2990 29900

C ndash mixed technique 20 1210 12100

Total 40

Test Statisticsb

scores

frequency

Mann-Whitney U 5500

Wilcoxon W 121000

Z -3492

Asymp Sig (2-tailed) 000

Exact Sig [2(1-tailed Sig)] 000a

a Not corrected for ties

23

Test Statisticsb

scores

frequency

Mann-Whitney U 5500

Wilcoxon W 121000

Z -3492

Asymp Sig (2-tailed) 000

Exact Sig [2(1-tailed Sig)] 000a

a Not corrected for ties

b Grouping Variable tehnrestaurare

The results of microleakage degree were statistically significant when the

three restorative techniques were compared The results showed that best restorative

technique regarding marginal sealing in cervical area is combined technique followed

by oblique layering technique The use of layering techniques limits the development

of contraction forces between oposite walls event that favourises bulk stress voids

formation and fissure inside dental tissues The results of our study are similar with

other studies (114 293)

IX5 CONCLUSIONS

The values of die penetration at gingival wall were statistically different

between the three restorative techniques

We concluded that all restorative methods were associated with lightcuring

contraction and marginal microleakage

The combined technique was associated with lowest lightcuring contraction

and die penetration

The bulk technique was associated with highest lightcuring contraction and die

penetration

24

CHAPTX STUDY REGARDING THE EFFECTS OF ETCHING ON

ENAMEL AND DENTINE IN CERVICAL AREA FOR PROXIMAL

CAVITIES AT LATERAL DENTAL GROUP

X1 INTRODUCTION

The studies reported marginal defects and high microleakage at the level of

gingival margins localised in cervical area or close to enamel-cement jonction for

high percents of proximal-occlusal composite resins restorations (8485) The good

adhesion is requested to insure restoration longevity and to prevent marginal

microleakage and presence of secondary marginal dental caries The adhesion

strenght of different adhesive systems can vary accordingly to tissues areas (204 240)

and to variations in dentinal structures (234 330) Most studies focused on adhesive

systems performances used healthy dentine close to pulp room but in case of class II

restorations there are particular features that influences the adhesion at the level of

gingival margins

The surface topography is an important property that determines the

interaction manner between surfaces The surface roughness and surface energy can

increase or decrease the adhesion of composite resins to the hard dental tissues

X2 AIM OF STUDY

The aim of study was to compare surface roughness of enamel and dentine

after etching related to different distances related to enamel-dentinecement jonction

X3 MATERIALS AND METHODS

The study group included 20 molars extracted from orthodontics or

periodontal reasons with intact proximal surfaces The teeth were cut longitudinally in

sens buccal-oral with diamond discs under water cooling

A group study (10 teeth) included 10 samples obtained through transversal

cutting at distance of 2mm from enamel-dentinecement jonction and 10 samples

obtained through transversal cutting at distance of 15 mm from enamel-

dentinecement jonction Another study group (10 teeth) included 10 samples

obtained through transversal cutting at distance of 1mm from enamel-dentinecement

jonction and 10 samples obtained through transversal cutting at distance of 05 mm

from enamel-dentinecement jonction All these samples were divided in two halfes

through mesial-distal cutting The samples finishing was performed with abrasive

paper (100-4000) and final polishing was performed with a device Buehler model

Minimet with slices introduced in ultrasound bath for 4 minutes The second half of

each sample was etched for 15 seconds with ortophosphoric acid 37 for 15 seconds

Slices were washed with distilled water for 30 seconds after etching and dried

The samples were analysed with atomic force microscopy (AFM) regarding

surface roughness The results were expressed as relative variation of roughness

X4 RESULTS AND DISCUSSIONS

The aspect of etched enamel at 2 mm distance from ECJ can be seen in figure

X1 (section 10 microm) The surface roughness is higher comparing with sample before

etching

25

După gravajul cu acid ortofosforic 37

The aspect of etched enamel at 15 mm distance from ECJ can be seen in

figure X2 (section 10 microm) The surface roughness is higher comparing with sample

before etching but lower comparing with sample at 2 mm from ECJ

The aspect of etched enamel at 1 mm distance from ECJ can be seen in figure

X3 (section 10 microm) The surface roughness is higher comparing with sample before

etching but lower comparing with sample at 15mm and 2 mm from ECJ

The aspect of etched enamel at 15 mm distance from ECJ can be seen in

figure X4 (section 10 microm) The surface roughness is higher comparing with sample

before etching but lower comparing with sample at 1 mm 15 mm and 2 mm from

ECJ

FigX1 3D aspect of enamel at 2 mm from ECJ

after etching (10 microm)

FigX2 3D aspect of enamel at 15 mm from ECJ

after etching (10 microm)

FigX3 3D aspect of enamel at 1 mm from ECJ

after etching (10 microm)

FigX4 3D aspect of enamel at 05 mm from ECJ

after etching (10 microm)

26

The mean values of squared roughness for dentine and enamel before etching

are presented in tables X1 and X2

Table X1 Squared roughness values for dentine samples before and after etching

Before etching (nm) After etching (nm)

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

sample

1

335 282 283 259 1149 947 901 879

sample

2

352 284 274 266 1127 939 883 875

sample

3

357 273 278 263 1152 953 876 867

sample

4

323 269 264 258 1146 942 895 883

sample

5

348 298 271 268 1153 944 904 878

sample

6

339 274 278 273 1158 937 893 892

sample

7

352 283 269 266 1145 944 899 876

sample

8

349 292 272 274 1166 942 907 869

sample

9

357 284 275 265 1132 939 893 879

sample

10

348 281 277 262 1142 941 899 878

Table X2 Squared roughness values for enamel and dentine samples before and after

etching

Before etching (nm) After etching (nm)

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

sample 1 422 342 309 313 2255 1114 874 845

sample 2 418 338 324 304 2236 1102 882 839

sample 3 413 334 315 303 2239 1115 873 833

sample 4 416 336 322 308 2242 1116 868 842

sample 5 426 332 315 294 2218 1103 877 829

sample 6 412 332 317 306 2237 1099 874 847

sample 7 414 335 322 314 2252 1102 876 834

sample 8 416 325 318 313 2239 1106 875 838

sample 9 418 328 314 299 2246 1113 879 836

sample 10 413 334 316 305 2242 1104 873 839

The results for samples before etching prove a decreasing tendency for mean

values of squared roughness surface beginning with areas placed at distance of 2 mm

from ECJ (346 nm) followed by areas placed at distance of 15 mm from ECJ (282

nm) 1 mm from ECJ (274 nm) and 05 mm from ECJ (265 nm) After etching the

decreasing tendency maintained for dentine localised at 2 mm from ECJ to dentine

localised at 05 mm from ECJ The mean values of squared roughness after etching

were three times higher (tables X3)

27

Table X3 Squared roughness values for enamel and dentine samples before and

after etching

Dentine Enamel

Before etching

(nm)

After etching

(nm)

Before etching

(nm)

After etching

(nm)

2 mm ECJ 346 1147 416 2237

15 mm ECJ 282 942 333 1107

1 mm ECJ 274 895 317 875

05 mm ECJ 265 877 305 838

The descriptive statistics data for surface roughness of dentine before and after

etching are presented in tables X4 si X5

Table X4 Descriptive statistics for dentine samples before etching

Statistics

Dentine 2mm

before etching

Dentine 15mm

before etching

Dentine 1mm

before etching

Dentine 05mm

before etching

N Valid 10 10 10 10

Missing 0 0 0 0

Mean 346000 282000 274100 265400

Std Error of Mean 33830 27487 17026 16746

Std Deviation 106979 86923 53841 52957

Skewness -1214 354 -314 348

Std Error of Skewness 687 687 687 687

Kurtosis 1141 049 336 -539

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 3230 2690 2640 2580

Maximum 3570 2980 2830 2740

Table X5 Descriptive statistics for dentine samples after etching

Statistics

Dentine 2mm

after etching

Dentine 15mm

after etching

Dentine 1mm

after etching

Dentine 05mm

after etching

N Valid 10 10 10 10

Missing 0 0 0 0

1147000 942800 895000 877600

Std Error of Mean 36545 14591 29926 22020

Std Deviation 115566 46140 94634 69634

Skewness -267 1169 -951 535

Std Error of Skewness 687 687 687 687

Kurtosis 043 1776 564 1416

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 11270 9370 8760 8670

28

Statistics

Dentine 2mm

after etching

Dentine 15mm

after etching

Dentine 1mm

after etching

Dentine 05mm

after etching

N Valid 10 10 10 10

Missing 0 0 0 0

1147000 942800 895000 877600

Std Error of Mean 36545 14591 29926 22020

Std Deviation 115566 46140 94634 69634

Skewness -267 1169 -951 535

Std Error of Skewness 687 687 687 687

Kurtosis 043 1776 564 1416

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 11270 9370 8760 8670

Maximum 11660 9530 9070 8920

To choose the statistical test to compare roughness surface values was

performed a test Shapiro-Wilk If p is lower or equal with 0005 than hypothesis of

distribution normality is rejected (distribution deviates from normal form) In the table

X6 the distributions are normal The statistical test will be test t for pair samples

Table X6 Test Shapiro-Wilk for dentine samples

Tests of Normality

Kolmogorov-Smirnov

a Shapiro-Wilk

Statistic df Sig Statistic df Sig

Dentine 2mm before etching 274 10 032 877 10 122

Dentine 15mm after etching 209 10 200 952 10 689

Dentine 1mm before etching 134 10 200 983 10 980

Dentine 05mm before etching 155 10 200 949 10 661

Dentine 2mm after etching 133 10 200 977 10 946

Dentine 15mm after etching 197 10 200 916 10 329

Dentine 1mm after etching 216 10 200 925 10 401

Dentine 05 after etching 220 10 185 933 10 474

Enamel 2mm before etching 193 10 200 898 10 207

Enamel 15mm before etching 170 10 200 977 10 947

Enamel 1mm before etching 157 10 200 952 10 689

Enamel 05mm before etching 165 10 200 943 10 590

Enamel 2mm after etching 235 10 124 925 10 404

Enamel 15mm after etching 209 10 200 871 10 102

Enamel 1mm after etching 189 10 200 964 10 834

Enamel 05mm after etching 142 10 200 983 10 978

a Lilliefors Significance Correction

29

Tests of Normality

Kolmogorov-Smirnov

a Shapiro-Wilk

Statistic df Sig Statistic df Sig

Dentine 2mm before etching 274 10 032 877 10 122

Dentine 15mm after etching 209 10 200 952 10 689

Dentine 1mm before etching 134 10 200 983 10 980

Dentine 05mm before etching 155 10 200 949 10 661

Dentine 2mm after etching 133 10 200 977 10 946

Dentine 15mm after etching 197 10 200 916 10 329

Dentine 1mm after etching 216 10 200 925 10 401

Dentine 05 after etching 220 10 185 933 10 474

Enamel 2mm before etching 193 10 200 898 10 207

Enamel 15mm before etching 170 10 200 977 10 947

Enamel 1mm before etching 157 10 200 952 10 689

Enamel 05mm before etching 165 10 200 943 10 590

Enamel 2mm after etching 235 10 124 925 10 404

Enamel 15mm after etching 209 10 200 871 10 102

Enamel 1mm after etching 189 10 200 964 10 834

Enamel 05mm after etching 142 10 200 983 10 978

a Lilliefors Significance Correction

This is a lower bound of the true significance

The results of test t for pair dentine samples before and after etching are

presented in table X

Table X7 Test t for dentine before and after etching

Paired Samples Test

Paired Differences

t df

p (2-

tailed)

95 Confidence

Interval of the

Difference

Mean

Std

Dev

Std

Error

Mean Lower Upper

Pair

1

dentine2mmbeforeetching-

dentine2mmafteretching

-

8010000

174801 55277 -

8135045

-

7884955

-

144906

9 000

Pair

2

dentine15mmbeforeetching-

dentine15mmafteretching

-

6608000

102394 32380 -

6681248

-

6534752

-

204079

9 000

Pair

3

dentine1mmbeforeetching-

dentine1mmafteretching

-

6209000

117799 37251 -

6293269

-

6124731

-

166678

9 000

30

Paired Samples Test

Paired Differences

t df

p (2-

tailed)

95 Confidence

Interval of the

Difference

Mean

Std

Dev

Std

Error

Mean Lower Upper

Pair

1

dentine2mmbeforeetching-

dentine2mmafteretching

-

8010000

174801 55277 -

8135045

-

7884955

-

144906

9 000

Pair

2

dentine15mmbeforeetching-

dentine15mmafteretching

-

6608000

102394 32380 -

6681248

-

6534752

-

204079

9 000

Pair

3

dentine1mmbeforeetching-

dentine1mmafteretching

-

6209000

117799 37251 -

6293269

-

6124731

-

166678

9 000

Pair

4

dentine05mmbeforeetching-

dentine05mmafteretching

-

6122000

86384 27317 -

6183796

-

6060204

-

224109

9 000

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of dentine (

2mm 15 mm 1mm sau 05mm)

The descriptive statistics data for dentine surface roughness before and after

etching are presented in tables X8 and X9

Table X8 Descriptive statistics for enamel samples before etching

Statistics

Enamel 2mm

before etching

Enamel 15mm

before etching

Enamel 1mm

before etching

Enamel 05mm

before etching

N Valid 10 10 10 10

Missing 0 0 0 0

Mean 416800 333600 317200 305900

Std Error of Mean 13968 15217 14205 20355

Std Deviation 44171 48120 44920 64369

Skewness 1095 -156 -109 -411

Std Error of Skewness 687 687 687 687

Kurtosis 769 487 -118 -295

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 4120 3250 3090 2940

Maximum 4260 3420 3240 3140

31

Table X9 Descriptive statistics for enamel samples after etching

Statistics

Enamel 2mm

after etching

Enamel 15mm

after etching

Enamel 1mm

after etching

Enamel 05mm

after etching

N Valid 10 10 10 10

Missing 0 0 0 0

Mean 2237600 1107400 875100 838200

Std Error of Mean 31027 20232 11968 17436

Std Deviation 98116 63979 37845 55136

Skewness -850 267 042 040

Std Error of Skewness 687 687 687 687

Kurtosis 878 -1880 1082 -425

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 22180 10990 8680 8290

Maximum 22520 11160 8820 8470

To choose the statistical test to compare roughness surface values was

performed a test Shapiro-Wilk If p is lower or equal with 0005 than hypothesis of

distribution normality is rejected (distribution deviates from normal form) In the table

X10 the distributions are normal The statistical test will be test t for pair samples

Table X10 Test Shapiro-Wilk for enamel samples

Tests of Normality

Kolmogorov-Smirnova Shapiro-Wilk

Statistic df Sig Statistic df Sig

2mmenamel before etching 193 10 200 898 10 207

15mmenamel before etching 170 10 200 977 10 947

1mmenamel before etching 157 10 200 952 10 689

05mmenamel before etching 165 10 200 943 10 590

2mmenamel after etching 235 10 124 925 10 404

15mmenamel after etching 209 10 200 871 10 102

1mmenamel after etching 189 10 200 964 10 834

05mmenamel after etching 142 10 200 983 10 978

a Lilliefors Significance Correction

This is a lower bound of the true significance

The results of test t for pair enamel samples before and after etching are

presented in table X11

32

Table X11 Test t for enamel samples before and after etching

Paired Samples Test

Paired Differences

t df

p (2-

tailed)

95 Confidence

Interval of the

Difference

Mean

Std

Deviation

Std

Error

Mean Lower Upper

Pair

1

2mmenamel before

etching

2mmenamel after

etching

-18208 135220 42760 -

18304731

-

18111269

-

425815

9 000

Pair

2

15mmenamel before

etching

15mmenamel after

etching

-7738 73151 23132 -7790329 -7685671 -

334508

9 076

Pair

3

1mmenamel before

etching

1mmenamel after

etching

-5579 55468 17540 -5618679 -5539321 -

318065

9 065

Pair

4

05mmenamel before

etching

05mmenamel after

etching

-5323 60378 19093 -5366192 -5279808 -

278788

9 063

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel ( 2mm 15 mm 1mm sau

05mm) but the differences statistical significant are present only for enamel localised

at 2 mm from ECJ

X5CONCLUSIONS

The surfaces of enamel and dentine at cervical level record decreases of

roughness related to the decrease of distance to ECJ

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel but the differences

statistical significant are present only for enamel localised at 2 mm from ECJ

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of

dentine

33

CHAPTXI FEA STUDY REGARDING THE BIOMECHANICAL

BEHAVIOUR AND FRACTURE RESISTANCE OF PROXIMO-OCCLUSAL

AMALGAM AND COMPOSITE RESINS RESTORATIONS

XI1INTRODUCTION AIM OF STUDY

The individual variation of patients morphological and functional complexity

of tissues as well as difficult access limit the possibilities to investigate in clinical

studies the biomechanical behaviour of proximo-occlusal restorations In this context

simulation of the biomechanics for direct restorations represents an interesting

interdisciplinar domain in actual dentistry research

The study focused on two direction

- analysis of role of forces intensity on biomechanical behaviour related to

cavity dimension and material

- analysis of tension inside restoration structure related to forces intensity

XI2MATERIALS AND METHODS

The stages of finite element analysis study are as follows

object modelling (bicusps and proximo-occlusal restoration)

definition of parameters for materials and dental tissues

meshing

constraints and loading

types of contacts

equations system definition

results of simulation

The object 3D modelling was performed in Rhinoceros (figure XI1) The

definition of parameters was performed for Poisson constant Young modulus density

(table XI1) The selected materials were amalgam and composite resins The

analysed tissues were dentine and enamel The meshing constraints loading were

performed for forces of 200N 400N 600N 800 N The analysis was performed using

software COSMOSWorks 2010

34

Fig XI1 3D modellation of bicusp

Table XI1 Values of Young modulus Poisson constant compression resistance for

amalgam composite resin enamel (amalgam compozit smalţ)

Material Young modulus (GPa) Poisson constants

Compression

resistance

(Mpa)

Amalgam 55 033 483

Enamel 48 03 400

Composite

resin 220 022 345

Fig XI2 The forces and constraints application

The results are presented in values and culours red colours representing areas

with maximum values of tensions produced under influence of masticatory forces

The tensions produced in amalgam restoration are in a range from 0 to 22886

(force 800 N) The maximum von Misses tensions are associated with cervical area

of amalgam restorations This aspect proves that first modification in interface

restoration-cavity margins will appear at the level of gingival wall First marginal

35

defects and fissures in restoration bulk will appear at tensions over 1600Mpa

associated with forces of 800N for extended amalgam proximo-occlusal restorations

The tensions produced in composite resin restorations are in a range from 0 to

2285 (force 800 N) The maximum von Misses tensions are associated with cervical

area of composite resin restorationsThis aspect proves that first modification in

interface restoration-cavity margins will appear at the level of gingival wall First

marginal defects and fissures in restoration bulk will appear at tensions over 1716

Mpa associated with forces of 600N for moderate and extended composite resins

proximo-occlusal restorations

Fig XI3a-b ndash Simulated model of proximo-occlusal restoration

FigXI4a-b Dental amalgam restoration Cervical tension associated with 600 N

(c)800 N (d)

FigXI5a-b Composite resin restoration Cervical tension associated with 600 N

(c)800 N (d)

36

The deformation of amalgam can be produced only when is associated with

fissures in bulk of restorations while composite resins restorations present

deformation when are associated with a modification of volume and form because of

repeated action of medium forces on long term or high forces on short term (figures

XI4 XI5)

Fig XI4 Material deformation in area of maximum tension

000E + 00

500E -02

100E -01

150E -01

200E -01

250E -01

1 4 7 101316192225283134374043464952555861646770737679

Amalgam C ompoz it

Figura XI5 Deformarea funcție de material

The amalgam and composite resins were treated as homogenous isotropic and

liniar The advantage of this type of FEA study is that restorations parameters can be

modified any time is necessary both in arhitecture geometry and material indices

variability The results of this study sustain the conclusions of other FEA studies

focused on biomechanical behaviour of posterior restorations performed with

amalgam and composite resins(35 62 76 143)

37

XI4CONCLUSIONS

bull The amalgam in class II restorations has a low deformation tendency because

of uniform distribution of tension inside material

bull Composite resins class II restorations accumulate higher tensions comparing

with amalgam but deformation is avoided for a time because of the adhesion

forces performed between molecules under moderate oral forces In case of

high oral forces (600-800N) the risk of fracture in moderate class II

restorations is higher comparing with amalgam proximo-occlusal restorations

For extended class II restorations and forces of 600 N composite resins present

highest risk of fracture and deformation The von Misses tension at the

cervical interface restorationtooth can reach 1600Mpa

bull The amalgam in moderate class II restorations can resist to deformation even

for high intensity forces limited to 600N In extended class II restorations the

risk of deformation and fracture increases at values of 600N-800N of oral

forces The von Misses tension at the cervical interface restorationtooth can

reach 1700 Mpa

38

FINAL CONCLUSIONS

Amalgam proximo-occlusal restorations with minimum 6-years age present

excellent results for parameters anatomic form (occlusal) marginal

discoloration and marginal secondary dental caries good results for

parameters anatomic form (proximal) and marginal adaptation and poor results

for surface quality

Composite resins proximo-occlusal restorations (bicusps) with minimum 6-

years age present excellent results for parameters color match marginal

discoloration and marginal secondary dental caries and good results for

parameters anatomic form (occlusal proximal) marginal adaptation surface

quality

Composite resins proximo-occlusal restorations (molars) with minimum 6-

years age present good results for parameters color match marginal

discoloration marginal secondary dental caries marginal adaptation and poor

results for parameters anatomic form (occlusal) (54 indices Ryge C)

anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The restorations extended at external third of occlusal surface present highest

percents of indices C regarding anatomic form (occlusal) (54 indices Ryge

C) anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The exceeding of 6-years age will require careful monitorisation for early

interventions through polishing sealing reshaping and even replacement for

restorations with major defects

Oblique layering technique presents superior results regarding marginal

adaptation and marginal discoloration and is recommended for proximo-

occlusal dental caries close to enamel-cement jonction

Centripetal build-up presents good results regarding marginal adaptation and

anatomical form at proximal level (proximal surfaces and contact point)

Horisontal layering technique can be used for optimum results only in

proximal-occlusal cavities with moderate extension both in occlusal-cervical

and buccal-oral

The values of die penetration at gingival wall were statistically different

between the three restorative techniques

We concluded that all restorative methods were associated with lightcuring

contraction and marginal microleakage

The combined technique was associated with lowest lightcuring contraction

and die penetration

The bulk technique was associated with highest lightcuring contraction and die

penetration

39

The surfaces of enamel and dentine at cervical level record decreases of

roughness related to the decrease of distance to ECJ

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel but the differences

statistical significant are present only for enamel localised at 2 mm from ECJ

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of

dentine

bull The amalgam in class II restorations has a low deformation tendency because

of uniform distribution of tension inside material

bull Composite resins class II restorations accumulate higher tensions comparing

with amalgam but deformation is avoided for a time because of the adhesion

forces performed between molecules under moderate oral forces In case of

high oral forces (600-800N) the risk of fracture in moderate class II

restorations is higher comparing with amalgam proximo-occlusal restorations

For extended class II restorations and forces of 600 N composite resins present

highest risk of fracture and deformation The von Misses tension at the

cervical interface restorationtooth can reach 1600Mpa

bull The amalgam in moderate class II restorations can resist to deformation even

for high intensity forces limited to 600N In extended class II restorations the

risk of deformation and fracture increases at values of 600N-800N of oral

forces The von Misses tension at the cervical interface restorationtooth can

reach 1700 Mpa

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6Aggarwal V Logani A Jain V Shah N Effect of cyclic loading on marginal

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Oper Dent 2008 Sep-Oct33(5)587-92

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8Andrian S- Restaurări fizionomice cu materiale plastice icircn cariologie-EdPanteon

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9Andrian S Tratamentul Minim Invaziv al Cariei Dentare EditPrinceps Edit Iaşi

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13Angmar-Mansson B Al-Khateeb S Tranaeus S Caries diagnosis Journal of

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15Anusavice KJ Development and testing of ceramics for dental restorations In

Fischman G Clare A Hench J editors Bioceramics materials and applications

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16Arhun N Celik C Yamanel KClinical evaluation of resin-based composites in

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17Armstrong SR JC Keller DB Boyer The influence of water storage and C-

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utilizing a filled and unfilled adhesive resin Dent Mater 200117268ndash276

18Armstrong S Boyer D Keller J Microtensile bond strength testing and failure

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19Asmussen E Peutzfeldt A Influence of UEDMA BisGMA and TEGDMA on

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26Bader JD Shugars DA Understanding dentistslsquo restorative treatment decisions J

Public Health Dent 1992 Winter52(2)102-10

27Barkmeier WW Cooley RL Current status of adhesive resin systems J Am Coll

Dent 199158 36-39

28Bayne SC Dental biomaterials where are we and where are we going J Dent

Educ 200569(5)571ndash585

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29Bedran-de-Castro AK Pereira PN Thompson JY Influence of load cycling

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30Behle C Flowable composite Proprieties and applications Pract Periodontics

Aesthetics Dent 1998 10347 350-351

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33Black J Biological Performance of Materials Fundamentals of Biocompatibility

NY Marcel Dekker Inc 1999

34Bonsor SJ Chadwick RGLongevity of conventional and bonded (sealed)

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9

35Boschian PL S Guidotti R Pietrbissa M Gagliani- bdquoStress distribution in a

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Rehabilitation (33) 2006690ndash697

36Bouillaguet S B Ciucchi T Jacoby JC Wataha DH Pashley Bonding

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321

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38Braga RR Ferracane JL Hilton TJ Contraction stress of flowable composites

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39Braga RR Ballester RY Ferracane JLFactors involved in the development of

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40Bratu D- Materiale dentare icircn cabinetul de stomatologie- Edit Helicon

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Association 2000nr131

42Brunthaler A Koumlnig F Lucas T Sperr W Schedle A Longevity of direct resin

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43Bullard RH Leinfelder KR Russell CM Effect of coefficient of thermal

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44Buonocore MG Matsui A Gwinnett AJ Penetration of resin dental materials

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45Burke FJ Cheung SW Mjoumlr IA Wilson NH Restoration longevity and analysis

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46Burke FJ Cheung SW Mjor IA Wilson NH-Reasons for the placement and

replacement of restorations in vocational training practicePrimary Dental Care

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47Burke FJ Wilson NH Cheung SW Mjoumlr IA Influence of patient factors on age

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48Calheiros FC Braga RR Kawano Y Ballester RY Relationship between

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2004 20939-946

49Cardoso P Sadek F Microtensile bond strength on dentin using new adhesive

systems with selfetching primers Braz J Oral Sci 2003 2(4) 156-159

50Cardoso M Baratieri LN Ritter AV The effect of finishing and polishing on

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51Carvalho RM JC Pereira M Yoshiyama DH Pashley A review of

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reliefOper Dent19962117ndash24

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Dentomaxillofac Radiol 2007 Mar36(3)138-42

53Cattaneo PM M Dalstra B Melsen- bdquoThe Finite Element Method a Tool to

Study Orthodontic Tooth Movement J Dent Res 2005 84(5)428-433

54Cattell MJ Clarke RL Lynch EJ The transverse strength reliability and

microstructural features of four dental ceramicspart 1 J Dent 25(5)399-407 1997

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bond strength to primary dentin J Dent Child 2003 70(2) 139-144

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posterior restorations 12-month results Eur J Dent 2010 Jan4(1)57-65

57Cenci M Demarco F de Carvalho R Class II composite resin restorations with

two polymerization techniques Relationship between microtensile bond strength and

marginal leakage J Dent 2005 33(7) 603- 610

58Chaffin J Moss D Review of current US Army dental emergency rates Mil

Med 2008173(1)23ndash26

59Chen HY Manhart J Hickel R Kunzelmann KH Polymerization contraction

stress in light-cured packable composite resinsDent Mater 200117253-259

60Choi KK Condon JR Ferracane JL The effects of adhesive thickness on

polymerization contraction stress of composites J Dent Res 2000 79812ndash817

61Cichon P Kerschbaum T Verweildauer zahnartzlicher Restaurationen bei

Behinderten Dtsch Zahnartzlicher 1999 54 96-102

62Cohen BI Pagnillo MK Deutsch ASMusikant BL Fracture Strength of

Three Core Restorative Materials Supported with or without a Prefabricated Split-

Shank Post Journal of Prosthetic Dentistry1997 78 560ndash565

63Colli P Brannstrom M The marginal adaptation of four different bonding agents

in Class II composite resin restoration applied in bulk or in two increments

Quintessence Int 1993 24583-591

43

64Collins CJ Bryant RW Hodge KL A clinical evaluation of posterior composite

resin restorations 8-year findings J Dent 199826(4) 311ndash317

65Condon JR Ferracane JL Assessing the effect of composite formulation on

polymerization stress J Am Dent Assoc2000 131497-503

66Cook WD Moopnar M Influence of chemical structure on the fracture

behaviour of dimethacrylate composite resins Biomaterials 1990 11272-276

67Cortes DF Ellwood RP Ekstrand KR An in vitro comparison of a combined

FOTIvisual examination of occlusal caries with other caries diagnostic methods and

the effect of stain on their diagnostic performance Caries Res 2003 37 (1) 8-16

68Crim GA Microleakage of three resin placement techniques Am J Dent

1991469-72

69Dauvillier B Aarnts M Feilzer A The competition between the composite-

dentin strength and the polimerization contraction stress J Dent Res 1984 63 1396-

1399

70Dauvillier BS Aarnts MP Feilzer AJ Developments in shrinkage control of

adhesive restoratives J Esthet Dent 2000 12291-299

71Dauvillier BS Aarnts MP Feilzer AJ Modeling of the viscoelastic behavior of

dental light-activated resin composites during curing Dent Mater 200319277ndash285

72Davidson CL Gee AJ Feilzer A The competition between the composite-dentin

bond strength and the polymerization contraction stress J Dent Res 1984

63(12)1396-9

73Davidson CL AJ Feilzer Polymerization shrinkage and polymerization

shrinkage stress in polymer-based restoratives J Dent Res 199725435ndash440

74Davidson CL Resisting the curing contraction with adhesive composites J

Prosthet Dent 198655446ndash7

75Davis RD Mayhew RB A clinical comparison of three anterior restorative resins

at 3 years J Am Dent Assoc 1986112659-63

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Dent200899131-40

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1331387ndash97

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Dent20104(3)270-9

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2006 22359-365

44

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Operations Desert ShieldStorm Mil Med 1996161(10) 620ndash623

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26 717-727

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20028195 (Abstract)

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30(3)163- 1681999

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848

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1243

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Biology199843(8)629-632

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817-822

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18(7)516-20

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JDent 199826 627-632

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Edition of the Balkan Medical Days

Stomatological Section Abstract nr1091999128

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Dentistry and Oral Epidemiology 1996 24 106-11

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Dent Mater 2002 18436-444

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20(3)236-43

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Polymerization shrinkage effects of boundary conditions and filling technique of

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50

189Lopes GC Baratieri LN Monteiro S Jr Vieira LC Effect of posterior resin

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Dentomaxillofac Radiol 2007 Oct36(7)377-81

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J Prosthet Dent 2000 Sep84(3)289-96

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Three-year clinical evaluation of composite and ceramic inlays Am J Dent 2001

Apr14(2)95-9

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79369 (Abstract)

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PrimDentCare1999Apr659-62

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33

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52

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34

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Monogr Oral Sci 20092142-51

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53

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569ndash575

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Community Dent Oral Epidemiol 1980 Jun8(3)135-8

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54

256Radu TM A Uliuliuc Dana Apostolide S Andrian The effect of adhesive

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Soc Med Iaşi-2008 vol112 nr1supl1145-147

257Raskin A Michotte-Theall B Vreven J Wilson NH Clinical evaluation of a

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258Rasmusson CG Lundin SA Class II restorations in six different posterior

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259Rezwani-Kaminski T Kamann W Gaengler P Secondary caries susceptibility

of teeth with long-term performing composite restorations J Oral Rehabil 2002

29(12)1131ndash1138

260Roberson TM Heymann HO Swift EJ eds Sturdevantlsquos Art and Science of

Operative Dentistry 5th ed St Louis Mosby 2006293-7

261Robertello FJ Pink FE The effect of a training program on the reliability of

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J Appl Oral Sci 2010 Feb18(1)37-43

263Roulet JF Noack MJCriteria for substituting amalgam with composite resins

Int Dent J 199141(4)195-205

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265Roulet JF Longevity of ceramic inlays and amalgam- results up 6 years

ClinOral Invest1997140-46

266Roulet JFBenefits and disadvantages of tooth-coloured alternatives to amalgam

J Dent 199725(6)459-73

267Rueggeberg FA WF Caughman JW Curtis Jr HC Davis Factors

affecting cure at depths within light-activated resin composites Am J Dent

1993691ndash95

268Rueggeberg FA Ergle JW Mettenburg DJ Polymerization depths of

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269Rushton VE Horner K Worthington HV Screening panoramic radiography

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270Ruyter IE Types of resin-based inlay materials and their properties Int Dent J

199242(3)139-44

271Sajjan GS Mittal NEffect of different placement techniques on marginal

microleakage of deep class-II cavities restored with two composite resin formulations

J Conserv Dent 201013(1)9-15

272Sakaguchi RL MC Peters SR Nelson WH Douglas HW Poort Effects

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composites Dent Mater 200218197-202

274Sano H Takatsu T Ciucchi B Horner JA Matthews WG Pashley DH

Nanoleakage leakage within the hybrid layer Oper Dent 1995 20 18-25

55

275Sarrett DC Clinical challenges and the relevance of materials testing for

posterior composite restorations Dent Mater 200521(1) 9ndash12

276Sarrett DC Brooks CN Rose JT Clinical performance evaluation of a

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278Schirrmeister JF Huber K Hellwig E Hahn P Four-year evaluation of a resin

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279Schneiderman A Elbaum M Schultz T Keem S Greenebaum M Driller J

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281Shortall AC Marginal seal comparisons between resinbonded Class II porcelain

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wall Oper Dent 2005 30(4)430-435

284Sengun A Unlu N Ozer F Ozturk B Bond strength of five current adhesives

to caries-affected dentin J Oral Rehabil 2002 29 777-781

285Setcos JC Staninec M Wilson NH- A two-year randomized controlled

clinical evaluation of bonded amalgam restorations- Journal of Adhesive Dentistry

nr11999

286Sideridou I Tserki V Papanastasiou G Effect of chemical structure on degree

of conversion in light-cured dimethacrylate-based dental resins Biomaterials 2002

231819-1829

287Sideridou I Tserki V Papanastasiou G Study of water sorption solubility and

modulus of elasticity of light-cured dimethacrylate-based dental resins Biomaterials

2003 24655-665

288Sidi AD Naylor MN A comparison of bitewing radiography and interdental

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289SilverFH Christiansen DLBiomaterials Science and Biocompatibility New

York Springer-Verlag 1999

290Simecek JW Diefenderfer KE Ahlf RL Ragain JC Jr Longitudinal trends in

restorative treatment needs among a cohort of US naval personnel J Dent Res

200382 1169 (Abstract)

291Simecek JW Diefenderfer KE Ahlf RL Ragain JC Jr Dental sealant

longevity in a cohort of young US naval personnel JADA 2005136(2)171ndash178

56

292Simi B Suprabha B Evaluation of microleakage in posterior nanocomposite

restorations with adhesive liners J Conserv Dent 201114(2)178-81

293Simone D David N B An alternative to reduce polimeryzation shrinkage in

direct posterior restorations JADA 2002 101387-1398

294Smales RJ Longevity of cusp-covered amalgams survivals after 15 years

OperDent 1991 16 17-20

295Smales RJ Webster DA Leppard PISurvival predictions of amalgam

restorations JDent1991 19 272-277

296Smales RJ Hawthorne WSLong-term survival of extensive amalgams and

posterior crowns JDent 1997 25 225-227

297Soncini JA Maserejian NN Trachtenberg F Tavares M Hayes C The

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and permanent teeth findings From the New England Childrens Amalgam Trial J

Am Dent Assoc 2007 Jun138(6)763-72

298Sonoda H Banerjee A Sherriff M Tagami J Watson TF An in vitro

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affected dentine J Dent 2005 33(4)335-342

299Soodabeh Kimyai Masomeh Mehdipour Siavash Savadi Oskoee Reasons

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no1(2007)

300De Souza FB Guimaraes RP Vicente Silva CH A clinical evaluation of

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International 2005 36 41-48

301Spreafico RC Gagliani M Composite resin restorations on posterior teeth In

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Quintessence 2000253ndash76

302St Georges AJ Wilder AD Jr Perdigao J Microleakage of Class V composites

using different placement and curing techniques an in vitro study Am J Dent 2002

15244-247

303Stangel I Barolet RY Clinical evaluation of two posterior composite resins

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306Suh BI A study of the compatibility of adhesives with composites Proceeding

from the SCO Dental Products Inc Symposium 2003 24(8) 4-9 (Abstract)

307Summit JB Burgess JO Berry TG Six-year clinical evaluation of bonded and

pin-retained complex amalgam restorations Oper Dent 2004 29269-276

308Summit JB Robbins JW Hilton TJ Fundamentals in operative dentistry Cap

10Direct Posterior Esthetic Restorations 2006 Quintessence Publishing Co

57

309Svanberg M Mjor IA Orstavik D Mutans streptococci in plaque from margins

of amalgam composite and glassndashionomer restorations J Dent Res 199069861ndash

864

310Tanne K Mamoru S Burstone C Three-dimensional finite element analysis

for stress in the periodontal tissue by orthodontic forcesAm J Orthod Dentofacial

Orthop921987499ndash505

311Tanumiharja M Burrow MF Tyas MJ Microtensile bond strengths of seven

dentin adhesive systems Dent Mater 2000 16(3)180-7

312Tay FR Pashley DH Aggressiveness of contemporary self-etching systems

Part I Depth of penetration beyond dentin smear layers Dent Mater 2001 17(4) 296-

308

313Tay FR Frankenberger R Krejci I Bouillaguet S Pashley DH Carvalho

RM Single-bottle adhesives behave as permeable membranes after polymerization I

In vivo evidence J Dent 2004 32611ndash621

314Tay FR Pashley DH Have dentin adhesives become too hydrophilic J Can

Dent Assoc 2003 69726ndash731

315Tay FR Sano H Carvalho R Pashley EL Pashley DH An ultrastructural

study of the influence of acidity of self-etching primers and smear layer thickness on

bonding to intact dentin J Adhes Dent 2000 283ndash98

316Thompson JY Bayne SC Heymann HO Mechanical properties of a new

mica-based machinable glass ceramic for CADCAM restorations J Prosthet Dent

76(6)619-623 1996

317Unterbrink GL R Muessner Influence of light intensity on two restorative

systems J Dent 199523183ndash189

318Unterbrink GL Liebenberg WH Flowable resin composites as filled

adhesiveslsquo literature review and clinical recommendations Quintessence Int

199930249ndash257

319Vaarkamp J Ten Bosch J Verdonschot EH Quantitative diagnosis of small

approximal caries lesions utilizing wavelength-dependent fiber-optic

transillumination Journal of Dental Research 1997 76 (4) 875-882

320Valachovic RW Douglass CW Reiskin AB Chauncey HH McNeil BJ The

use of panoramic radiography in the evaluation of asymptomatic adult dental patients

Oral Surg Oral Med Oral Pathol 198661(3)289-96

321Van Meerbeek B De Munck J Yoshida Y Inoue S Vargas M Vijay P Van

Landuyt K Lambrechts P Vanherle G Adhesion to enamel and dentin Current

status and future challenges Oper Dent 2003 28 215-235

322Van Meerbeek B Van Landuyt K De Munck JHashimoto M Peumans M

Lambrechts P Yoshida Y Inoue S Suzuki K Technique-sensitivity of

contemporary adhesives Dent Mater J 2005 24(1) 1-13

323Van Meerbeek B Vargas S Inoue S Yoshida Y Peumans M Lambrechts P

Vanherle G Adhesives and cements to promote preservation dentistry Oper Dent

20016 119-144

324Van Meerbeek B Yoshida Y Inoue S Vargas M Abe Y Fukuda R Okazaki

M Lambrechts P Vanherle G Bonding mechanism micro-tensile bond strength of

a 4- MET-based self-etching adhesive J Dent Res 2000 79 249 (Abstract)

58

325Van Nieuwenhuysen JP DrsquoHoore W Carvalho J Qvist V Long-term

evaluation of extensive restorations in permanent teeth J Dent 200331(6)395ndash405

326Venhoven BA de Gee AJ Davidson CL Light initiation of dental resins

dynamics of the polymerization Biomaterials 1996 172313-2318

327Versluis A Douglas WH Cross M Sakaguchi RL Does an incremental filling

technique reduce polymerization shrinkage stresses J Dent Res 1996 75871ndash878

328Vries HC Ruiken HM Konig KG vanrsquot Hof MA Radiographic versus

clinical diagnosis of approximal carious lesions Caries Res1990 24 (5) 364-370

329Waggoner W Ashton J Predictability of cavitation based upon radiographic

appearance comparison of two film types Quintessence International 1989 20(1)

55-60

330Watanabe LG Marshall GW Jr Marshall SJ Dentin shear strength effects of

tubule orientation and intra tooth location Dent Mater 1996 12 109-115

331Watts DC AS Marouf Optimal specimen geometry in bonded-disk

shrinkage-strain measurements on light-cured biomaterials Dent Mater 200016447ndash

451

332Watts DC Marouf AS Al-Hindi AM Photo-polymerization shrinkage-stress

kinetics in resin-composites methods development Dent Mater 2003 191ndash11

333Weaver WS Blank LW Pelleu GB Jr A visible light activated resin cured

through tooth structure GenDent 198836236-7

334Wendt SL Microleakage and cusp fracture resistance of heattreated composite

resin inlays Am J Dent 4(1)10-14 1991

335Wenzel A Hintze H Mikkelsen L Mouyen F Radiographic detection of

occlusal caries in noncavitated teeth A comparison of conventional film radiographs

digitized film radiographs and RadioVisioGraphy-Oral Surg Oral Med Oral Pathol

1991 72 621-6

336Wenzel A Hintze H Perception of image quality in direct digital radiography

after application of various image treatment filters for detectability of dental diseases

Dentomaxillofac Radiol 1993 22 131-4

337Wenzel A Computer-aided image manipulation of intraoral radiographs to

enhance diagnosis in dental practice a review Int Dent J 1993 43 99-108

338Wenzel A Digital radiography and caries diagnosis Dento Maxillo Facial

Radiology 27(1)3-11 1998

339Wenzel A Haiter-Neto F Gotfredsen E Risk factors for a false positive test

outcome in diagnosis of caries in approximal surfaces impact of radiographic

modality and observer characteristics Caries Res 200741(3)170-6

340Wibowo G Stockton L Microleakage of class II composite restorations Am J

Dent 200114177ndash185

341Wilson NHF Wastell DG Norman RD Five-year performance of high-

cooper content amalgam restorations in a multiclinical trial JDent1996 24 203-210

342Winkler MM Katona TR Paydar NH Finite element stress analysis of three

filling techniques for class V light-cured composite restorations J Dent Res

1996751477-83

343Yap AU Effectiveness of polymerization in composite restoratives claiming bulk

placement Impact of cavity depth and exposure time Oper Dent 2000 25113-120

59

344Yeşilyurt C Bulucu B Bond strength of total-etch dentin adhesive systems on

peripheral and central dentinal tissue a microtensile bond strength test The Journal of

Contemporary Dental Practice 7(2) 20061-13

345Yoshida Y Van Meerbeek B Okazaki M Shintani H Suzuki K Comparative

study on adhesive performance of functional monomers J Dent Res 2004 83 454-

458

346Yoshiyama M Tay FR Doi J Nishitani Y Yamada T Itou K Carvalho RM

Nakajima M Pashley DH Bonding of self-etch and total etch adhesives to carious

dentin J Dent Res 2002 81 556-560

  • COPERTA REZUMAT ENGLEZA (MEREUTA)pdf
  • REZUMAT ENGLEZA DR MEREUTA DENISSpdf
Page 8: UNIVERSITATEA DE MEDICINA SI FARMACIE “GR Doctorat/Rezumat... · universitatea de medicina si farmacie “gr.t.popa” iasi facultatea de medicina dentara rezumatul tezei de doctorat

5

- clinical assessment of a study group with age 15-65 with class II dental caries

treated by one dentist using a selected composite resin and different restorative

techniques

- performing of data base for statistical processing

Database was collected between 2008-2011 in private practice and Faculty of

Dental Medicine UMF ―GrTPopa Iasi The paraclinical studies were performed in

collaboration with Institute Petru Poni Iasi

The patients were informed and gave their written consent to be included in

study groups Every patient was submitted to clinical examen and radiographic

examen The clinical examens consisted in assessment of Ryge indices (modified

USPHS) at baseline 6 months 12 months 18months and 24 months

The paraclinical tests consisted in

- in vitro tests on extracted teeth consisting in optical and atomic force

microscopy to assess the influence of different restorative techniques on the cervical

marginal sealing

- measurement of surface status (enamel dentine) after etching (different time

intervals) using AFM (Atomic Force Microscopy)

- statistical analysis in SPSS 13 for comparison of microleakage degree at

cervical level related to different restorative techniques

- FEA study performed using software COSMOSWorks 2010 for the

assessment of biomechanical behaviour of simulated posterior amalgam and

composite resins restorations

VI3 Data collecting and processing

The processing of reseraches data was performed using the follwing software

MS Office (graphs tables)

SPSS 16 (statistical tests)

The following statistical tests were used t Test test Kolmogorov-Smirnov test

Pearson test Wilcoxon The descriptive statistical analysis was performed using

Microsoft Excel and analitical statistical analysis was performed using SPSS 160

(SPSS Inc SUA)

6

CHAPTVII STUDY REGARDING CLINICAL PERFORMANCE OF

PROXIMO-OCCLUSAL AMALGAM AND COMPOSITE RESINS

RESTORATIONS

VII1 INTRODUCTION

The clinical performance of posterior direct restorations pn medium and long

term concerns dental practitioners that must correlate their therapeutical decisions

with material selection restorative technique external factors represented by oral

forces cariogenic risk patient parafunctions

VII2AIM OF STUDY

The aim of study consisted in assessment of clinical performance of amalgam

and composite resins proximal-occlusal restorations 4-years old

VII3 MATERIALS AND METHOD

The study group included 200 proximal-occlusal amalgam (n=100) and

composite resins (Herculite Kerr) (n=100) restorations 4-years old The study was

performed on 55 patients with age between 17-49 years examined in Dental Medicine

Faculty UMFGrTPopa Iaşi The assessment of fillings status was performed

using Ryge indices modified USPHS (US Public Health Service) (table 1) The

clinical peformance of restorations was also correlated with dental group (molars

bicusps) extension (medium extended) and cariogenic risk (medium high) The

following parameters were assessed

- color match

- marginal adaptation (integrity)

- marginal discoloration

- anatomical form (proximal)

- surface quality

The results presentation was performed using Microsoft Excel

VII4 RESULTS AND DISCUSSIONS

AB

C

S1

6

64

30

0

20

40

60

80

A

B

C

Fig VII1 Anatomical form (occlusal)-amalgam restorations (molars)

7

AB

C

S1

26

64

100

10

20

30

40

50

60

70

A

B

C

Fig VII2 Anatomical form (occlusal)-amalgam restorations (bicusps)

AB

C

S1

0

46

54

0

10

20

30

40

50

60

A

B

C

Fig VII3 Anatomical form (occlusal)-composite resins restorations (molars)

Fig VII4 Anatomical form (occlusal)-amalgam restorations (bicusps)

AB

C

S1

12

72

16

0

10

20

30

40

50

60

70

80

A

B

C

FigVII5 Anatomical form (proximal)-amalgam restorations (molars)

AB

C

S1

38

56

60

10

20

30

40

50

60

A

B

C

FigVII6 Anatomical form (proximal)-amalgam restorations (bicusps)

AB

C

S1

10

54

36

0

10

20

30

40

50

60

A

B

C

8

AB

C

S1

8

64

26

0

10

20

30

40

50

60

70

A

B

C

FigVII7 Anatomical form (proximal)-composite resins restorations (molars)

AB

C

S1

34

66

100

10

20

30

40

50

60

70

A

B

C

FigVII8 Anatomical form (proximal)-composite resins restorations (bicusps)

AB

C

S1

36

44

20

0

5

10

15

20

25

30

35

40

45

A

B

C

FigVII9 Marginal adaptation (proximal)- amalgam restorations(bicusps)

AB

C

S1

20

50

30

0

5

10

15

20

25

30

35

40

45

50

A

B

C

FigVII10 Marginal adaptation (proximal)-amalgam restorations (molars)

AB

C

S1

16

60

24

0

10

20

30

40

50

60

A

B

C

FigVII11 Marginal adaptation (proximal)-composite resins restorations (bicusps)

9

AB

C

S1

12

54

34

0

10

20

30

40

50

60

A

B

C

FigVII12 Marginal adaptation (proximal)-composite resins restorations (molars)

AB

C

S1

22

54

24

0

10

20

30

40

50

60

A

B

C

FigVII13 Surface quality-amalgam restorations (bicusps)

AB

C

S1

10

54

36

0

10

20

30

40

50

60

A

B

C

FigVII14 Surface quality-amalgam restorations (molars)

AB

C

S1

12

68

20

0

10

20

30

40

50

60

70

A

B

C

FigVII15 Surface quality-composite resins restorations (bicusps)

AB

C

S1

8

70

22

0

20

40

60

80

A

B

C

FigVII16 Surface quality-composite resins restorations (molars)

10

A

C

S1

98

20

20

40

60

80

100

A

C

FigVII17a-b Prevalence of marginal dental cariesamalgam restorations (moderate

CR)

A

C

S1

92

80

20

40

60

80

100

A

C

FigVII18 Prevalence of marginal dental cariesamalgam restorations (high CR)

A

C

S1

94

60

20

40

60

80

100

A

C

FigVII19 Prevalence of marginal dental cariescomposite resins restorations (CR

moderate)

A

C

S1

82

18

0

10

20

30

40

50

60

70

80

90

A

C

FigVII20 Prevalence of marginal dental cariescomposite resins restorations (high

CR)

11

The study data sustain the results obtained by most studies focused on

posterior amalgam restorations However Hickelampcol (2001) reviewed literature data

and proved that many results varies accordingly to different clinical factors (133)

Roulet JF(1997) warned about limits of cross-sectional studies related to composite

resins restorations because of the absence of data regarding restorative techniques

practitioner experience presence or absence of optimum isolation factors related by

patient (266)

VII5CONCLUSIONS

Amalgam proximo-occlusal restorations with minimum 6-years age present

excellent results for parameters anatomic form (occlusal) marginal

discoloration and marginal secondary dental caries good results for

parameters anatomic form (proximal) and marginal adaptation and poor results

for surface quality

Composite resins proximo-occlusal restorations (bicusps) with minimum 6-

years age present excellent results for parameters color match marginal

discoloration and marginal secondary dental caries and good results for

parameters anatomic form (occlusal proximal) marginal adaptation surface

quality

Composite resins proximo-occlusal restorations (molars) with minimum 6-

years age present good results for parameters color match marginal

discoloration marginal secondary dental caries marginal adaptation and poor

results for parameters anatomic form (occlusal) (54 indices Ryge C)

anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The restorations extended at external third of occlusal surface present highest

percents of indices C regarding anatomic form (occlusal) (54 indices Ryge

C) anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The exceeding of 6-years age will require careful monitorisation for early

interventions through polishing sealing reshaping and even replacement for

restorations with major defects

12

CHAPTVIII CLINICAL PERFORMANCE OF COMPOSITE RESINS

RESTORATIONS RELATED TO RESTORATIVE TECHNIQUE 12-

MONTHS LONGITUDINAL STUDY

VIII1 INTRODUCTION

The restorative technique has a major influence over clinical performance of

composite resins restorations in proximo-occlusal cavities In this context researches

focused on correlations between technique and clinical performance of direct

restorations improve the dentist decision regarding restorative technique choice

VIII2AIM OF STUDY

The aim of study was to determine the clinical performance of composite

resins proximo-occlusal restorations performed using different restorative techniques

VIII3MATERIALS AND METHOD

The group study included 37 patients with age 18-42 years with moderat

ecariogenic risk The total number of composite resins restorations (Herculite XRV

Kerr) was 60 divided in three study groups (n=20)

I Centripetal build-up

II Oblique layering

III Horisontal layering

The coronal restorations were assessed at an interval of 12 months using

indices Ryge modified USPHS

- indice ALFA (A)- IDEAL CLINIC

- indice BRAVO (B)- ACCEPTABLE CLINIC

- indice CHARLIE (C)- UNACCEPTABLE CLINIC

VIII4 RESULTS AND DISCUSSIONS

The statistical tests Kruskal-Wallis and Mann-Whitney were performed to

confirm or infirm research hypotesis (the direct restorations performed using different

restorative techniques present statistical significant differences regarding clinical

performance for the assessed parameters)

13

TableVIII1a-b Groups study (Kruskal-Wallis Test)

Ranks

20 2960

20 2560

20 3630

60

20 3050

20 2420

20 3680

60

20 2490

20 3140

20 3520

60

Restorative_techniques

Centripetal build-up

Oblique layering

Horizontal layering

Total

Centripetal build-up

Oblique layering

Horizontal layering

Total

Centripetal build-up

Oblique layering

Horizontal layering

Total

Marginal_adaptation

Marginal_discoloration

Anatomical_form

N Mean Rank

Test Statisticsab

4913 8031 4900

2 2 2

086 018 086

Chi-Square

df

Asymp Sig

Marginal_

adaptation

Marginal_

discoloration

Anatomical_

form

Kruskal Wallis Testa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between the three restorative

techniques for parameter marginal adaptation (p=0086)

There are no statistical significant differences between the three restorative

techniques for parameter marginal discoloration (p=0018)

There are no statistical significant differences between the three restorative

techniques for parameter anatomical form (proximal) (p=0086)

TableVIII2 Comparing results between restorations performed using three

techniques (marginal adaptation marginal discoloration anatomical form) Marginal adaptation Centripetal build-upOblique layering p=04 ns

Centripetal build-upHorizontal layering p=0191 ns

Oblique layering Horizontal layering p=0028 s

Marginal discoloration Centripetal build-upOblique layering p=0103 ns

Centripetal build-upHorizontal layering p=0195 ns

Oblique layering Horizontal layering p=0005 s

Anatomical form Centripetal build-upOblique layering p=0137 ns

Centripetal build-upHorizontal layering p=0029 s

Oblique layering Horizontal layering p=0433 ns

ns nesemnificativ

s semnificativ

p probabilitate

14

Tables VIII3a-b Mann-Whitney test Comparing analysis regarding marginal

discoloration between restorations performed using oblique layering technique and

centripetal build-up technique

Ranks

20 2180 43600

20 1920 38400

40

Restorative_techniques

Centripetal build-up

Oblique layering

Total

Marginal_adaptation

N Mean Rank Sum of Ranks

Test Statisticsb

174000

384000

-841

400

495a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

adaptation

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between centripetal build-up

and oblique layering techniques regarding parameter marginal adaptation (p=0400)

Tables VIII4a-b Mann-Whitney test Comparing analysis regarding marginal

adaptation between restorations performed using horisontal layering technique and

centripetal build-up technique

Ranks

20 1830 36600

20 2270 45400

40

Restorative_techniques

Centripetal build-up

Horizontal layering

Total

Marginal_adaptation

N Mean Rank Sum of Ranks

Test Statisticsb

156000

366000

-1307

191

242a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

adaptation

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between centripetal build-up

and horisontal layering techniques regarding parameter marginal adaptation

(p=0191)

15

TablesVIII5a-b Mann-Whitney test Comparing analysis regarding marginal

adaptation between restorations performed using oblique layering technique and

horisontal layering technique

Ranks

20 1690 33800

20 2410 48200

40

Restorative_techniques

Oblique layering

Horizontal layering

Total

Marginal_adaptation

N Mean Rank Sum of Ranks

Test Statisticsb

128000

338000

-2191

028

052a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

adaptation

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There is statistical significant differences between horisontal layering and

oblique layering techniques regarding parameter marginal adaptation (p=0028)

Tables VIII6a-b Mann-Whitney test Comparing analysis regarding marginal

discoloration between restorations performed using oblique layering technique and

centripetal build-up technique

There are no statistical significant differences between centripetal build-up

and oblique layering techniques regarding parameter marginal discoloration

(p=0103)

Ranks

20 2260 45200

20 1840 36800

40

Restorative_techniques

Centripetal build-up

Oblique layering

Total

Marginal_discoloration

N Mean Rank Sum of Ranks

Test Statisticsb

158000

368000

-1632

103

265a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

discoloration

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

16

Tables VIII7a-b Mann-Whitney test Comparing analysis regarding marginal

discoloration between restorations performed using centripetal build-up technique and

horisontal layering technique

Ranks

20 1840 36800

20 2260 45200

40

Restorative_techniques

Centripetal build-up

Horizontal layering

Total

Marginal_discoloration

N Mean Rank Sum of Ranks

Test Statisticsb

158000

368000

-1299

194

265a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

discoloration

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between centripetal build-up

and horisontal layering techniques regarding parameter marginal discoloration

(p=0103)

Tables VIII8a-b Mann-Whitney test Comparing analysis regarding marginal

discoloration between restorations performed using oblique layering technique and

horisontal layering technique

Ranks

20 1630 32600

20 2470 49400

40

Restorative_techniques

Oblique layering

Horizontal layering

Total

Marginal_discoloration

N Mean Rank Sum of Ranks

Test Statisticsb

116000

326000

-2822

005

023a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

discoloration

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There is statistical significant differences between horisontal layering and

oblique layering techniques regarding parameter marginal discoloration (p=0005)

17

TablesVIII9 a-b Mann-Whitney test Comparing analysis regarding anatomical

form between restorations performed using centripetal build-up technique and oblique

layering technique

Ranks

20 1830 36600

20 2270 45400

40

Restorative_techniques

Centripetal build-up

Oblique layering

Total

Anatomical_form

N Mean Rank Sum of Ranks

Test Statisticsb

156000

366000

-1486

137

242a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Anatomical_

form

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between centripetal build-up

and oblique layering techniques regarding parameter anatomical form (p=0137)

Tables VIII10a-b Mann-Whitney test Comparing analysis regarding anatomical

form between restorations performed using centripetal build-up technique and

horisontal layering technique

Ranks

20 1710 34200

20 2390 47800

40

Restorative_techniques

Centripetal build-up

Horizontal layering

Total

Anatomical_form

N Mean Rank Sum of Ranks

Test Statisticsb

132000

342000

-2184

029

068a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Anatomical_

form

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between centripetal build-up

and horisontal layering techniques regarding parameter anatomical form (p=0029)

18

Tables VIII11a-b Mann-Whitney test Comparing analysis regarding anatomical

form between restorations performed using oblique layering technique and horisontal

layering technique

Ranks

20 1920 38400

20 2180 43600

40

Restorative_techniques

Oblique layering

Horizontal layering

Total

Anatomical_form

N Mean Rank Sum of Ranks

Test Statisticsb

174000

384000

-784

433

495a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Anatomical_

form

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between horisontal layering and

oblique layering techniques regarding parameter anatomical form (p=0433)

Indices A for restorations performed using centripetal build-up technique were

as follows color match-80 marginal adaptation- 60 marginal discoloration-

70 anatomical form (proximal)- 80 surface quality- 60

Indices A for restorations performed using horisontal layering technique were

as follows color match-70 marginal adaptation- 40 marginal discoloration-

50 anatomical form (proximal)- 50 surface quality- 70

Indices A for restorations performed using oblique layering technique were as

follows color match-70 marginal adaptation- 80 marginal discoloration- 90

anatomical form (proximal)- 60 surface quality- 70

Indices B for restorations performed using centripetal build-up technique were

as follows color match-20 marginal adaptation- 30 marginal discoloration-

20 anatomical form (proximal)- 30 surface quality- 40

Indices B for restorations performed using horisontal layering technique were

as follows color match-30 marginal adaptation- 40 marginal discoloration-

30 anatomical form (proximal)- 30 surface quality- 30

Indices B for restorations performed using oblique layering technique were as

follows color match-30 marginal adaptation- 20 marginal discoloration- 10

anatomical form (proximal)- 40 surface quality- 30

19

Indices C for restorations performed using centripetal build-up technique were

as follows color match-0 marginal adaptation- 10 marginal discoloration- 0

anatomical form (proximal)- 0 surface quality- 0

Indices C for restorations performed using horisontal layering technique were

as follows color match-0 marginal adaptation- 20 marginal discoloration- 20

anatomical form (proximal)- 20 surface quality- 0

Indices C for restorations performed using oblique layering technique were as

follows color match-0 marginal adaptation- 0 marginal discoloration- 10

anatomical form (proximal)- 0 surface quality- 100

Discussions

For in vitro studies is difficult to reproduce the variables existent in oral cavity

like occlusal stress and pH and temperature changes (235) The clinical studies are

determinant in assessment of restorative techniques (300) The most researches

focuses on the influence of restorative technique on the reduction of lightcuring stress

(51 78 135)

VIII5 CONCLUSIONS

Oblique layering technique presents superior results regarding marginal

adaptation and marginal discoloration and is recommended for proximo-

occlusal dental caries close to enamel-cement jonction

Centripetal build-up presents good results regarding marginal adaptation and

anatomical form at proximal level (proximal surfaces and contact point)

Horisontal layering technique can be used for optimum results only in

proximal-occlusal cavities with moderate extension both in occlusal-cervical

and buccal-oral

20

CHAPTIX STUDY REGARDING MARGINAL SEALING STATUS IN

COMPOSITE RESINS LIMITED PROXIMO-OCCLUSAL RESTORATIONS

PERFORMED USING DIFFERENT TECHNIQUES

IX1INTRODUCTION

The contraction of composite resins can produce stress inside dental structure

The most contraction stress appears in the initial stages and development rate of stress

decreases gradually in time (5 98 160) The contraction stress of composite resins

can overpass adhesion strenght and can broke the link between dental tissues and

composite resin (73) When adhesion strenght is high stress can produce marginal

fracture or bulk fracture (74) These situations are associated with microleakage and

penetration of oral fluid and bacteria along dentinal walls endangering the pulpal

tissue or favourising secondary dental caries

IX2 AIM OF STUDY

The study aimed to assess the efficiency of marginal sealing along gingival

wall in limited proximal-occlusal restorations performed using three different

techniques

IX3MATERIALS AND METHOD

The study group included 30 teeth extracted for orthodontic and periodontal

reasons On every tooth two identical class II cavities (on mesial and distal surfaces)

were prepared with cylindrical burs under water cooling The gingival wall was

limited to enamel-cement jonction The cavity dimension were as follows 2 mm

buccal-oral 5mm depth Each tooth was introduced in a pattern of acrylat The

operator calibrated preparation technique on acrylat teeth in Simulation Laboratory of

UMF ―Gr T Popa Iaşi The 60 prepared cavities were randomly divided in three

study groups related to restorative technique The restoration were performed with

Filtek Z550 (3M ESPE) a nanohybrid composite resin The adhesive strategy

included etchamprinse in 2 steps and adhesive Adper Single Bond 2(3MESPE)

Group A (n=20) bulk restorative technique associated with lightcuring from

occlusal 40 seconds and from buccal and oral 20 seconds

Group B (n=20) oblique layering technique (first layer on buccal wall and

buccal frac12 of gingival wall was lightcured from buccal second layer on oral wall and

oral frac12 of gingival wall was lightcured from oral third oral as a triangle with point

oriented to gingival wall was lightcured from occlusal)

Group C (n=20) combined technique (bdquoflow layer on gingival and axial

walls lightcured under pressure only associated with solid composite resin layer)

The proximal surfaces were performed using Tofflemire and metallic matrices After

removal of matrices every restoration was lightcured for another 20 seconds Two

layers aof varnish were applied on composite resins restorations excepting cavity

margins and an area of 1 mm around them The samples were introduced in methylen

21

blue 10 for 48 hours After this stage samples were washed with water and teeth

were cut longitudinally with a diamonded disc

The die penetration was assessed with Zeiss (Iena Germany) X20 microscope

accordingly to four scores (0-3)

0 ndash no penetration

1 ndash die infiltration until external half of gingival wall

2 ndash die infiltration on all gingival wall

3 ndash die infiltration on gingival wall and axial wall

IX4RESULTS AND DISCUSSIONS

The result of die penetration are presented in table IX1

TableIX1 The results for die penetration

Grup 0 1 2 3

A (bulk) 0 0 3 17

B (layering) 0 4 5 11

C (combined) 12 5 2 1

In group A 17 sample had score 3 and 2 samples had score 2 In group B 11

sample had score 3 5 samples had score 2 and 4 sample had score 1 In group C with

best results 12 samples had score 0 5 samples had score 1 2 samples had score 2 1

sample had score 3

The recorded data were analysed using test Mann-Whitney The statistical

results are presented in tables IX2-IX4

Tables IX2a-b Mann-Whitney for comparisons of microleakage values between

bulk technique and incremental technique

Ranks

Restorative technique N Mean Rank Sum of Ranks

Scores

frequency

A ndash bulk technique 20 2420 24200

B ndash incremental

technique

20 1680 16800

Total 40

Test Statisticsb

scores

frequency

Mann-Whitney U 29000

Wilcoxon W 168000

Z -1970

Asymp Sig (2-tailed) 049

Exact Sig [2(1-tailed Sig)] 123a

a Not corrected for ties

b Grouping Variable restorative technique

22

Tables IX3a-b Mann-Whitney for comparisons of microleakage values between

bulk technique and mixed technique

Ranks

Restorative technique N Mean Rank Sum of Ranks

scores

frequency

A ndash bulk technique 20 3090 30900

C ndash mixed technique 20 1010 10100

Total 40

Test Statisticsb

scores

frequency

Mann-Whitney U 500

Wilcoxon W 101000

Z -4021

Asymp Sig (2-tailed) 000

Exact Sig [2(1-tailed Sig)] 000a

a Not corrected for ties

b Grouping Variable restorative technique

Tables IX4a-b Mann-Whitney test for comparisons of microleakage values

between incremental technique and mixed technique

Ranks

Restorative technique N Mean Rank Sum of Ranks

scores

frequency

B ndash incremental

technique

20 2990 29900

C ndash mixed technique 20 1210 12100

Total 40

Test Statisticsb

scores

frequency

Mann-Whitney U 5500

Wilcoxon W 121000

Z -3492

Asymp Sig (2-tailed) 000

Exact Sig [2(1-tailed Sig)] 000a

a Not corrected for ties

23

Test Statisticsb

scores

frequency

Mann-Whitney U 5500

Wilcoxon W 121000

Z -3492

Asymp Sig (2-tailed) 000

Exact Sig [2(1-tailed Sig)] 000a

a Not corrected for ties

b Grouping Variable tehnrestaurare

The results of microleakage degree were statistically significant when the

three restorative techniques were compared The results showed that best restorative

technique regarding marginal sealing in cervical area is combined technique followed

by oblique layering technique The use of layering techniques limits the development

of contraction forces between oposite walls event that favourises bulk stress voids

formation and fissure inside dental tissues The results of our study are similar with

other studies (114 293)

IX5 CONCLUSIONS

The values of die penetration at gingival wall were statistically different

between the three restorative techniques

We concluded that all restorative methods were associated with lightcuring

contraction and marginal microleakage

The combined technique was associated with lowest lightcuring contraction

and die penetration

The bulk technique was associated with highest lightcuring contraction and die

penetration

24

CHAPTX STUDY REGARDING THE EFFECTS OF ETCHING ON

ENAMEL AND DENTINE IN CERVICAL AREA FOR PROXIMAL

CAVITIES AT LATERAL DENTAL GROUP

X1 INTRODUCTION

The studies reported marginal defects and high microleakage at the level of

gingival margins localised in cervical area or close to enamel-cement jonction for

high percents of proximal-occlusal composite resins restorations (8485) The good

adhesion is requested to insure restoration longevity and to prevent marginal

microleakage and presence of secondary marginal dental caries The adhesion

strenght of different adhesive systems can vary accordingly to tissues areas (204 240)

and to variations in dentinal structures (234 330) Most studies focused on adhesive

systems performances used healthy dentine close to pulp room but in case of class II

restorations there are particular features that influences the adhesion at the level of

gingival margins

The surface topography is an important property that determines the

interaction manner between surfaces The surface roughness and surface energy can

increase or decrease the adhesion of composite resins to the hard dental tissues

X2 AIM OF STUDY

The aim of study was to compare surface roughness of enamel and dentine

after etching related to different distances related to enamel-dentinecement jonction

X3 MATERIALS AND METHODS

The study group included 20 molars extracted from orthodontics or

periodontal reasons with intact proximal surfaces The teeth were cut longitudinally in

sens buccal-oral with diamond discs under water cooling

A group study (10 teeth) included 10 samples obtained through transversal

cutting at distance of 2mm from enamel-dentinecement jonction and 10 samples

obtained through transversal cutting at distance of 15 mm from enamel-

dentinecement jonction Another study group (10 teeth) included 10 samples

obtained through transversal cutting at distance of 1mm from enamel-dentinecement

jonction and 10 samples obtained through transversal cutting at distance of 05 mm

from enamel-dentinecement jonction All these samples were divided in two halfes

through mesial-distal cutting The samples finishing was performed with abrasive

paper (100-4000) and final polishing was performed with a device Buehler model

Minimet with slices introduced in ultrasound bath for 4 minutes The second half of

each sample was etched for 15 seconds with ortophosphoric acid 37 for 15 seconds

Slices were washed with distilled water for 30 seconds after etching and dried

The samples were analysed with atomic force microscopy (AFM) regarding

surface roughness The results were expressed as relative variation of roughness

X4 RESULTS AND DISCUSSIONS

The aspect of etched enamel at 2 mm distance from ECJ can be seen in figure

X1 (section 10 microm) The surface roughness is higher comparing with sample before

etching

25

După gravajul cu acid ortofosforic 37

The aspect of etched enamel at 15 mm distance from ECJ can be seen in

figure X2 (section 10 microm) The surface roughness is higher comparing with sample

before etching but lower comparing with sample at 2 mm from ECJ

The aspect of etched enamel at 1 mm distance from ECJ can be seen in figure

X3 (section 10 microm) The surface roughness is higher comparing with sample before

etching but lower comparing with sample at 15mm and 2 mm from ECJ

The aspect of etched enamel at 15 mm distance from ECJ can be seen in

figure X4 (section 10 microm) The surface roughness is higher comparing with sample

before etching but lower comparing with sample at 1 mm 15 mm and 2 mm from

ECJ

FigX1 3D aspect of enamel at 2 mm from ECJ

after etching (10 microm)

FigX2 3D aspect of enamel at 15 mm from ECJ

after etching (10 microm)

FigX3 3D aspect of enamel at 1 mm from ECJ

after etching (10 microm)

FigX4 3D aspect of enamel at 05 mm from ECJ

after etching (10 microm)

26

The mean values of squared roughness for dentine and enamel before etching

are presented in tables X1 and X2

Table X1 Squared roughness values for dentine samples before and after etching

Before etching (nm) After etching (nm)

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

sample

1

335 282 283 259 1149 947 901 879

sample

2

352 284 274 266 1127 939 883 875

sample

3

357 273 278 263 1152 953 876 867

sample

4

323 269 264 258 1146 942 895 883

sample

5

348 298 271 268 1153 944 904 878

sample

6

339 274 278 273 1158 937 893 892

sample

7

352 283 269 266 1145 944 899 876

sample

8

349 292 272 274 1166 942 907 869

sample

9

357 284 275 265 1132 939 893 879

sample

10

348 281 277 262 1142 941 899 878

Table X2 Squared roughness values for enamel and dentine samples before and after

etching

Before etching (nm) After etching (nm)

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

sample 1 422 342 309 313 2255 1114 874 845

sample 2 418 338 324 304 2236 1102 882 839

sample 3 413 334 315 303 2239 1115 873 833

sample 4 416 336 322 308 2242 1116 868 842

sample 5 426 332 315 294 2218 1103 877 829

sample 6 412 332 317 306 2237 1099 874 847

sample 7 414 335 322 314 2252 1102 876 834

sample 8 416 325 318 313 2239 1106 875 838

sample 9 418 328 314 299 2246 1113 879 836

sample 10 413 334 316 305 2242 1104 873 839

The results for samples before etching prove a decreasing tendency for mean

values of squared roughness surface beginning with areas placed at distance of 2 mm

from ECJ (346 nm) followed by areas placed at distance of 15 mm from ECJ (282

nm) 1 mm from ECJ (274 nm) and 05 mm from ECJ (265 nm) After etching the

decreasing tendency maintained for dentine localised at 2 mm from ECJ to dentine

localised at 05 mm from ECJ The mean values of squared roughness after etching

were three times higher (tables X3)

27

Table X3 Squared roughness values for enamel and dentine samples before and

after etching

Dentine Enamel

Before etching

(nm)

After etching

(nm)

Before etching

(nm)

After etching

(nm)

2 mm ECJ 346 1147 416 2237

15 mm ECJ 282 942 333 1107

1 mm ECJ 274 895 317 875

05 mm ECJ 265 877 305 838

The descriptive statistics data for surface roughness of dentine before and after

etching are presented in tables X4 si X5

Table X4 Descriptive statistics for dentine samples before etching

Statistics

Dentine 2mm

before etching

Dentine 15mm

before etching

Dentine 1mm

before etching

Dentine 05mm

before etching

N Valid 10 10 10 10

Missing 0 0 0 0

Mean 346000 282000 274100 265400

Std Error of Mean 33830 27487 17026 16746

Std Deviation 106979 86923 53841 52957

Skewness -1214 354 -314 348

Std Error of Skewness 687 687 687 687

Kurtosis 1141 049 336 -539

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 3230 2690 2640 2580

Maximum 3570 2980 2830 2740

Table X5 Descriptive statistics for dentine samples after etching

Statistics

Dentine 2mm

after etching

Dentine 15mm

after etching

Dentine 1mm

after etching

Dentine 05mm

after etching

N Valid 10 10 10 10

Missing 0 0 0 0

1147000 942800 895000 877600

Std Error of Mean 36545 14591 29926 22020

Std Deviation 115566 46140 94634 69634

Skewness -267 1169 -951 535

Std Error of Skewness 687 687 687 687

Kurtosis 043 1776 564 1416

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 11270 9370 8760 8670

28

Statistics

Dentine 2mm

after etching

Dentine 15mm

after etching

Dentine 1mm

after etching

Dentine 05mm

after etching

N Valid 10 10 10 10

Missing 0 0 0 0

1147000 942800 895000 877600

Std Error of Mean 36545 14591 29926 22020

Std Deviation 115566 46140 94634 69634

Skewness -267 1169 -951 535

Std Error of Skewness 687 687 687 687

Kurtosis 043 1776 564 1416

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 11270 9370 8760 8670

Maximum 11660 9530 9070 8920

To choose the statistical test to compare roughness surface values was

performed a test Shapiro-Wilk If p is lower or equal with 0005 than hypothesis of

distribution normality is rejected (distribution deviates from normal form) In the table

X6 the distributions are normal The statistical test will be test t for pair samples

Table X6 Test Shapiro-Wilk for dentine samples

Tests of Normality

Kolmogorov-Smirnov

a Shapiro-Wilk

Statistic df Sig Statistic df Sig

Dentine 2mm before etching 274 10 032 877 10 122

Dentine 15mm after etching 209 10 200 952 10 689

Dentine 1mm before etching 134 10 200 983 10 980

Dentine 05mm before etching 155 10 200 949 10 661

Dentine 2mm after etching 133 10 200 977 10 946

Dentine 15mm after etching 197 10 200 916 10 329

Dentine 1mm after etching 216 10 200 925 10 401

Dentine 05 after etching 220 10 185 933 10 474

Enamel 2mm before etching 193 10 200 898 10 207

Enamel 15mm before etching 170 10 200 977 10 947

Enamel 1mm before etching 157 10 200 952 10 689

Enamel 05mm before etching 165 10 200 943 10 590

Enamel 2mm after etching 235 10 124 925 10 404

Enamel 15mm after etching 209 10 200 871 10 102

Enamel 1mm after etching 189 10 200 964 10 834

Enamel 05mm after etching 142 10 200 983 10 978

a Lilliefors Significance Correction

29

Tests of Normality

Kolmogorov-Smirnov

a Shapiro-Wilk

Statistic df Sig Statistic df Sig

Dentine 2mm before etching 274 10 032 877 10 122

Dentine 15mm after etching 209 10 200 952 10 689

Dentine 1mm before etching 134 10 200 983 10 980

Dentine 05mm before etching 155 10 200 949 10 661

Dentine 2mm after etching 133 10 200 977 10 946

Dentine 15mm after etching 197 10 200 916 10 329

Dentine 1mm after etching 216 10 200 925 10 401

Dentine 05 after etching 220 10 185 933 10 474

Enamel 2mm before etching 193 10 200 898 10 207

Enamel 15mm before etching 170 10 200 977 10 947

Enamel 1mm before etching 157 10 200 952 10 689

Enamel 05mm before etching 165 10 200 943 10 590

Enamel 2mm after etching 235 10 124 925 10 404

Enamel 15mm after etching 209 10 200 871 10 102

Enamel 1mm after etching 189 10 200 964 10 834

Enamel 05mm after etching 142 10 200 983 10 978

a Lilliefors Significance Correction

This is a lower bound of the true significance

The results of test t for pair dentine samples before and after etching are

presented in table X

Table X7 Test t for dentine before and after etching

Paired Samples Test

Paired Differences

t df

p (2-

tailed)

95 Confidence

Interval of the

Difference

Mean

Std

Dev

Std

Error

Mean Lower Upper

Pair

1

dentine2mmbeforeetching-

dentine2mmafteretching

-

8010000

174801 55277 -

8135045

-

7884955

-

144906

9 000

Pair

2

dentine15mmbeforeetching-

dentine15mmafteretching

-

6608000

102394 32380 -

6681248

-

6534752

-

204079

9 000

Pair

3

dentine1mmbeforeetching-

dentine1mmafteretching

-

6209000

117799 37251 -

6293269

-

6124731

-

166678

9 000

30

Paired Samples Test

Paired Differences

t df

p (2-

tailed)

95 Confidence

Interval of the

Difference

Mean

Std

Dev

Std

Error

Mean Lower Upper

Pair

1

dentine2mmbeforeetching-

dentine2mmafteretching

-

8010000

174801 55277 -

8135045

-

7884955

-

144906

9 000

Pair

2

dentine15mmbeforeetching-

dentine15mmafteretching

-

6608000

102394 32380 -

6681248

-

6534752

-

204079

9 000

Pair

3

dentine1mmbeforeetching-

dentine1mmafteretching

-

6209000

117799 37251 -

6293269

-

6124731

-

166678

9 000

Pair

4

dentine05mmbeforeetching-

dentine05mmafteretching

-

6122000

86384 27317 -

6183796

-

6060204

-

224109

9 000

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of dentine (

2mm 15 mm 1mm sau 05mm)

The descriptive statistics data for dentine surface roughness before and after

etching are presented in tables X8 and X9

Table X8 Descriptive statistics for enamel samples before etching

Statistics

Enamel 2mm

before etching

Enamel 15mm

before etching

Enamel 1mm

before etching

Enamel 05mm

before etching

N Valid 10 10 10 10

Missing 0 0 0 0

Mean 416800 333600 317200 305900

Std Error of Mean 13968 15217 14205 20355

Std Deviation 44171 48120 44920 64369

Skewness 1095 -156 -109 -411

Std Error of Skewness 687 687 687 687

Kurtosis 769 487 -118 -295

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 4120 3250 3090 2940

Maximum 4260 3420 3240 3140

31

Table X9 Descriptive statistics for enamel samples after etching

Statistics

Enamel 2mm

after etching

Enamel 15mm

after etching

Enamel 1mm

after etching

Enamel 05mm

after etching

N Valid 10 10 10 10

Missing 0 0 0 0

Mean 2237600 1107400 875100 838200

Std Error of Mean 31027 20232 11968 17436

Std Deviation 98116 63979 37845 55136

Skewness -850 267 042 040

Std Error of Skewness 687 687 687 687

Kurtosis 878 -1880 1082 -425

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 22180 10990 8680 8290

Maximum 22520 11160 8820 8470

To choose the statistical test to compare roughness surface values was

performed a test Shapiro-Wilk If p is lower or equal with 0005 than hypothesis of

distribution normality is rejected (distribution deviates from normal form) In the table

X10 the distributions are normal The statistical test will be test t for pair samples

Table X10 Test Shapiro-Wilk for enamel samples

Tests of Normality

Kolmogorov-Smirnova Shapiro-Wilk

Statistic df Sig Statistic df Sig

2mmenamel before etching 193 10 200 898 10 207

15mmenamel before etching 170 10 200 977 10 947

1mmenamel before etching 157 10 200 952 10 689

05mmenamel before etching 165 10 200 943 10 590

2mmenamel after etching 235 10 124 925 10 404

15mmenamel after etching 209 10 200 871 10 102

1mmenamel after etching 189 10 200 964 10 834

05mmenamel after etching 142 10 200 983 10 978

a Lilliefors Significance Correction

This is a lower bound of the true significance

The results of test t for pair enamel samples before and after etching are

presented in table X11

32

Table X11 Test t for enamel samples before and after etching

Paired Samples Test

Paired Differences

t df

p (2-

tailed)

95 Confidence

Interval of the

Difference

Mean

Std

Deviation

Std

Error

Mean Lower Upper

Pair

1

2mmenamel before

etching

2mmenamel after

etching

-18208 135220 42760 -

18304731

-

18111269

-

425815

9 000

Pair

2

15mmenamel before

etching

15mmenamel after

etching

-7738 73151 23132 -7790329 -7685671 -

334508

9 076

Pair

3

1mmenamel before

etching

1mmenamel after

etching

-5579 55468 17540 -5618679 -5539321 -

318065

9 065

Pair

4

05mmenamel before

etching

05mmenamel after

etching

-5323 60378 19093 -5366192 -5279808 -

278788

9 063

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel ( 2mm 15 mm 1mm sau

05mm) but the differences statistical significant are present only for enamel localised

at 2 mm from ECJ

X5CONCLUSIONS

The surfaces of enamel and dentine at cervical level record decreases of

roughness related to the decrease of distance to ECJ

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel but the differences

statistical significant are present only for enamel localised at 2 mm from ECJ

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of

dentine

33

CHAPTXI FEA STUDY REGARDING THE BIOMECHANICAL

BEHAVIOUR AND FRACTURE RESISTANCE OF PROXIMO-OCCLUSAL

AMALGAM AND COMPOSITE RESINS RESTORATIONS

XI1INTRODUCTION AIM OF STUDY

The individual variation of patients morphological and functional complexity

of tissues as well as difficult access limit the possibilities to investigate in clinical

studies the biomechanical behaviour of proximo-occlusal restorations In this context

simulation of the biomechanics for direct restorations represents an interesting

interdisciplinar domain in actual dentistry research

The study focused on two direction

- analysis of role of forces intensity on biomechanical behaviour related to

cavity dimension and material

- analysis of tension inside restoration structure related to forces intensity

XI2MATERIALS AND METHODS

The stages of finite element analysis study are as follows

object modelling (bicusps and proximo-occlusal restoration)

definition of parameters for materials and dental tissues

meshing

constraints and loading

types of contacts

equations system definition

results of simulation

The object 3D modelling was performed in Rhinoceros (figure XI1) The

definition of parameters was performed for Poisson constant Young modulus density

(table XI1) The selected materials were amalgam and composite resins The

analysed tissues were dentine and enamel The meshing constraints loading were

performed for forces of 200N 400N 600N 800 N The analysis was performed using

software COSMOSWorks 2010

34

Fig XI1 3D modellation of bicusp

Table XI1 Values of Young modulus Poisson constant compression resistance for

amalgam composite resin enamel (amalgam compozit smalţ)

Material Young modulus (GPa) Poisson constants

Compression

resistance

(Mpa)

Amalgam 55 033 483

Enamel 48 03 400

Composite

resin 220 022 345

Fig XI2 The forces and constraints application

The results are presented in values and culours red colours representing areas

with maximum values of tensions produced under influence of masticatory forces

The tensions produced in amalgam restoration are in a range from 0 to 22886

(force 800 N) The maximum von Misses tensions are associated with cervical area

of amalgam restorations This aspect proves that first modification in interface

restoration-cavity margins will appear at the level of gingival wall First marginal

35

defects and fissures in restoration bulk will appear at tensions over 1600Mpa

associated with forces of 800N for extended amalgam proximo-occlusal restorations

The tensions produced in composite resin restorations are in a range from 0 to

2285 (force 800 N) The maximum von Misses tensions are associated with cervical

area of composite resin restorationsThis aspect proves that first modification in

interface restoration-cavity margins will appear at the level of gingival wall First

marginal defects and fissures in restoration bulk will appear at tensions over 1716

Mpa associated with forces of 600N for moderate and extended composite resins

proximo-occlusal restorations

Fig XI3a-b ndash Simulated model of proximo-occlusal restoration

FigXI4a-b Dental amalgam restoration Cervical tension associated with 600 N

(c)800 N (d)

FigXI5a-b Composite resin restoration Cervical tension associated with 600 N

(c)800 N (d)

36

The deformation of amalgam can be produced only when is associated with

fissures in bulk of restorations while composite resins restorations present

deformation when are associated with a modification of volume and form because of

repeated action of medium forces on long term or high forces on short term (figures

XI4 XI5)

Fig XI4 Material deformation in area of maximum tension

000E + 00

500E -02

100E -01

150E -01

200E -01

250E -01

1 4 7 101316192225283134374043464952555861646770737679

Amalgam C ompoz it

Figura XI5 Deformarea funcție de material

The amalgam and composite resins were treated as homogenous isotropic and

liniar The advantage of this type of FEA study is that restorations parameters can be

modified any time is necessary both in arhitecture geometry and material indices

variability The results of this study sustain the conclusions of other FEA studies

focused on biomechanical behaviour of posterior restorations performed with

amalgam and composite resins(35 62 76 143)

37

XI4CONCLUSIONS

bull The amalgam in class II restorations has a low deformation tendency because

of uniform distribution of tension inside material

bull Composite resins class II restorations accumulate higher tensions comparing

with amalgam but deformation is avoided for a time because of the adhesion

forces performed between molecules under moderate oral forces In case of

high oral forces (600-800N) the risk of fracture in moderate class II

restorations is higher comparing with amalgam proximo-occlusal restorations

For extended class II restorations and forces of 600 N composite resins present

highest risk of fracture and deformation The von Misses tension at the

cervical interface restorationtooth can reach 1600Mpa

bull The amalgam in moderate class II restorations can resist to deformation even

for high intensity forces limited to 600N In extended class II restorations the

risk of deformation and fracture increases at values of 600N-800N of oral

forces The von Misses tension at the cervical interface restorationtooth can

reach 1700 Mpa

38

FINAL CONCLUSIONS

Amalgam proximo-occlusal restorations with minimum 6-years age present

excellent results for parameters anatomic form (occlusal) marginal

discoloration and marginal secondary dental caries good results for

parameters anatomic form (proximal) and marginal adaptation and poor results

for surface quality

Composite resins proximo-occlusal restorations (bicusps) with minimum 6-

years age present excellent results for parameters color match marginal

discoloration and marginal secondary dental caries and good results for

parameters anatomic form (occlusal proximal) marginal adaptation surface

quality

Composite resins proximo-occlusal restorations (molars) with minimum 6-

years age present good results for parameters color match marginal

discoloration marginal secondary dental caries marginal adaptation and poor

results for parameters anatomic form (occlusal) (54 indices Ryge C)

anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The restorations extended at external third of occlusal surface present highest

percents of indices C regarding anatomic form (occlusal) (54 indices Ryge

C) anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The exceeding of 6-years age will require careful monitorisation for early

interventions through polishing sealing reshaping and even replacement for

restorations with major defects

Oblique layering technique presents superior results regarding marginal

adaptation and marginal discoloration and is recommended for proximo-

occlusal dental caries close to enamel-cement jonction

Centripetal build-up presents good results regarding marginal adaptation and

anatomical form at proximal level (proximal surfaces and contact point)

Horisontal layering technique can be used for optimum results only in

proximal-occlusal cavities with moderate extension both in occlusal-cervical

and buccal-oral

The values of die penetration at gingival wall were statistically different

between the three restorative techniques

We concluded that all restorative methods were associated with lightcuring

contraction and marginal microleakage

The combined technique was associated with lowest lightcuring contraction

and die penetration

The bulk technique was associated with highest lightcuring contraction and die

penetration

39

The surfaces of enamel and dentine at cervical level record decreases of

roughness related to the decrease of distance to ECJ

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel but the differences

statistical significant are present only for enamel localised at 2 mm from ECJ

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of

dentine

bull The amalgam in class II restorations has a low deformation tendency because

of uniform distribution of tension inside material

bull Composite resins class II restorations accumulate higher tensions comparing

with amalgam but deformation is avoided for a time because of the adhesion

forces performed between molecules under moderate oral forces In case of

high oral forces (600-800N) the risk of fracture in moderate class II

restorations is higher comparing with amalgam proximo-occlusal restorations

For extended class II restorations and forces of 600 N composite resins present

highest risk of fracture and deformation The von Misses tension at the

cervical interface restorationtooth can reach 1600Mpa

bull The amalgam in moderate class II restorations can resist to deformation even

for high intensity forces limited to 600N In extended class II restorations the

risk of deformation and fracture increases at values of 600N-800N of oral

forces The von Misses tension at the cervical interface restorationtooth can

reach 1700 Mpa

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35Boschian PL S Guidotti R Pietrbissa M Gagliani- bdquoStress distribution in a

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49Cardoso P Sadek F Microtensile bond strength on dentin using new adhesive

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51Carvalho RM JC Pereira M Yoshiyama DH Pashley A review of

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Behinderten Dtsch Zahnartzlicher 1999 54 96-102

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Three Core Restorative Materials Supported with or without a Prefabricated Split-

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70Dauvillier BS Aarnts MP Feilzer AJ Developments in shrinkage control of

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71Dauvillier BS Aarnts MP Feilzer AJ Modeling of the viscoelastic behavior of

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72Davidson CL Gee AJ Feilzer A The competition between the composite-dentin

bond strength and the polymerization contraction stress J Dent Res 1984

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73Davidson CL AJ Feilzer Polymerization shrinkage and polymerization

shrinkage stress in polymer-based restoratives J Dent Res 199725435ndash440

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Prosthet Dent 198655446ndash7

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at 3 years J Am Dent Assoc 1986112659-63

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and adhesion of composite resin versus ceramic inlays in molarsJ Prosthet

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and replacement of restorations Prim Dent Care 20018(1)5-11

78Deliperi S Bardwell DN An alternative method to reduce polymerization

shrinkage in direct posterior composite restorations J Am Dent Assoc 2002

1331387ndash97

79Demirci M Tuncer S Yuceokur AA Prevalence of caries on individual tooth

surfaces and its distribution by age and gender in university clinic patientsEur J

Dent20104(3)270-9

80De Munck J Van Meerbeek B Satoshi I Vargas M Yoshida Y Armstrong S

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2006 22359-365

44

82Deutsch WM Simecek JW Dental emergencies among Marines ashore in

Operations Desert ShieldStorm Mil Med 1996161(10) 620ndash623

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of methacrylate dental resins Macromolecules 2003 366043-6053

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resin composite Class II restorations An in vitro evaluation Quintessence Int 1995

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85Dietschi D Herzfeld D In vitro evaluation of marginal and internal adaptation of

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86Dietschi D Marginal adaptation and seal of direct and indirect Class II composite

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caries status and dental emergencies among US naval personnel J Dent Res

20028195 (Abstract)

88Diefenderfer KE Rienhardt JW Shear bond strengths of ten adhesive

resinamalgam combinations Oper Dent 1997 22 50-56

89Donly KJ Jensen ME Triolo PA clinical comparison of resin composite inlay

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30(3)163- 1681999

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schoolchildren have never had a cavity Public Health Rep1995 110 (5) 522-530

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its possible influence on postoperative sensitivity Quintessence Int 198617103-11

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class I amalgam restorations The Journal of contemporary dental practice 2004 Vol

5 no21-7

96Feilzer AJ AJ De Gee CL Davidson Increased wall-to-wall curing

contraction in thin bonded resin layers J Dent Res 19896848ndash50

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98Feilzer AJ de Gee AJ Davidson CL Relaxation of polymerization contraction

shear stress by hygroscopic expansion J Dent Res 1990 6936ndash39

45

99Feilzer AJ De Gee AJ Davidson CL Setting stress in composite resin in relation

to configuration of the restoration J Dent Res1987 661636-1639

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on polymerization shrinkage and integrity of restoration-cavity interface Eur J Oral

Sci 1995 103322ndash326

101Fennis YL Verdischbot EH vanrsquot Hof MA Performance of some diagnostic

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indirect porcelain restorations Am JDent 1999 12(3)134-142

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restorations in primary teeth an in vitro study J Dent 200836(5)322-5

105Forss H Widstroumlm E Reasons for restorative therapy and the longevity of

restorations in adults Acta Odontol Scand 2004 6282-86

106Fradeani M Aquilano A Bassein L Longitudinal study of pressed glass-

ceramic inlays for four and a half years J Prosthet Dent 1997 78(4)346-353

107Franccedila FM Worschech CC Paulillo LA Martins LR Lovadino JR Fracture

resistance of premolar teeth restored with different filling techniques J Contemp Dent

Pract 20056(3)62-9

108Francci C Loguercio AD Reis A Carrilho MR A novel filling technique for

packable composite resin in Class II restorations J Esthet Restor Dent 2002

14(3)149-57

109Fruits TJ Knapp JA Khajotia SS Microleakage in the proximal walls of

direct and indirect posterior resin slot restorations Oper Dent 200631(6)719-27

110Gaengler P Hoyer I Montag R Clinical evaluation of posterior composite

restorations The 10-year report J Adhes Dent 2001 3185-194

111Garbuz DS Masri BA Estaile J Classification systems in orthopaedics J Am

Acad Orthop Surg 2002 10 290-297

112Ghavamnasiri M Moosavi H Tahvildarnejad N Effect of centripetal and

incremental methods in Class II composite resin restorations on gingival

microleakage J Contemp Dent Pract 20078(2)113-20

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848

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135- 144

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class 2 composites Oper Dent 19981312-19

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Dent Oral Epidemiol 200533(3)212-8

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1995202ndash 6

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influence of simulated clinical handling on the flexural and compressive strength of

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Bucureşti 2001

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Activity EdApollonia Iasi2002

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Mater 1995 11(2)132-6

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technique J Am Dent Assoc 2000131375ndash383

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with flowable composite in the proximal box Am J Dent 200013235ndash238

48

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Kompositefullungen Zahnartzlicher Welt 1999 108 270-273

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Community Dentistry and Oral Epidemiology 1994 22(2) 71-74

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composite restorations effected by increased flexibility J Dent Res 1990 691240ndash

1243

161Khairallah C Hokayem A Long-term clinical evaluation of 2 dental materials

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200932(126)21-8

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Biology199843(8)629-632

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817-822

165Kiremitci A Alpaslan T Gurgan SSix-year clinical evaluation of packable

composite restorations Oper Dent 200934(1)11-7

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dental resin composites Dent Mater 2005 211150-1157

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marginal leakage around class II composite resin restorations in vitroQuint Int

201989117ndash121

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18(7)516-20

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170Koyuturk A E Sengun A Ozer F Sener Y Gokalp A Shear Bond Strengths

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Materials Journal 2006 25(1)59-65

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Dent 27(5)325-331 1999

49

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Jan11(1)34-40

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JProsthet Dent 199369(4)425-430

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thermal behavior of dental composites Dent Mater 2008 24(8)1017ndash1024

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JDent 199826 627-632

176Labella R Lambrechts P Van Meerbeek B Vanherle G Polymerization

shrinkage and elasticity of flowable composites and filled adhesives Dent Mater

1999 15128-137

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179Lăcătuşu St Luminiţa Costinescu Andrian S Gianina Iovan Valeria

Pendefunda 180Sorina Solomon Topoliceanu C Elements of dispersional

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Edition of the Balkan Medical Days

Stomatological Section Abstract nr1091999128

181Lăcătuşu St Andrian S Gianina Iovan- Consideraţii asupra adaptării

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StomatologicăVol2199823-26

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200126302ndash307

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Dentistry and Oral Epidemiology 1996 24 106-11

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Dent Mater 2002 18436-444

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20(3)236-43

188Loguercio AD Reis A Schroeder M Balducci I Versluis A Ballester RY

Polymerization shrinkage effects of boundary conditions and filling technique of

resin composite restorations J Dent 2004 32(6)459-70

50

189Lopes GC Baratieri LN Monteiro S Jr Vieira LC Effect of posterior resin

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Quintessence Int 2004 35(2)156-61

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copolymerizations Macromolecules 1999 323913-3921

194Lutz F Krejci I Barbakow F Quality and durability of marginal adaptation in

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clinical results J Dent Res 199877 1020

196Mair LH Ten-year clinical assessment of three posterior resin composites and

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Dentomaxillofac Radiol 2007 Oct36(7)377-81

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J Prosthet Dent 2000 Sep84(3)289-96

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Three-year clinical evaluation of composite and ceramic inlays Am J Dent 2001

Apr14(2)95-9

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79369 (Abstract)

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PrimDentCare1999Apr659-62

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ScandJDRes 199210060-65

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33

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19904011ndash7

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52

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125749-751

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composites Oper Dent 23 1998282ndash289

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34

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Monogr Oral Sci 20092142-51

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569ndash575

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posterior composite 10-year report J Dent 199927(1) 13ndash19

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composite resins Five-year results Swed Dent J 1995 19 173-182

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of teeth with long-term performing composite restorations J Oral Rehabil 2002

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Operative Dentistry 5th ed St Louis Mosby 2006293-7

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examiners evaluating amalgam restorations Oper Dent 1997 Mar-Apr22(2)57-65

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J Appl Oral Sci 2010 Feb18(1)37-43

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Int Dent J 199141(4)195-205

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conditions on ceramiccomposite bond strength J Dent Res 1995 74(l)381-387

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ClinOral Invest1997140-46

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affecting cure at depths within light-activated resin composites Am J Dent

1993691ndash95

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contemporary light curing units using microhardness J Esthet Dent 200012340-9

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of new adult patients diagnostic yield when combined with bitewing radiography and

identification of selection criteria Br Dent J 2002 Mar 9192(5)275-9

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microleakage of deep class-II cavities restored with two composite resin formulations

J Conserv Dent 201013(1)9-15

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of polymerization contraction in composite restorations J Dent 1992 20178ndash182

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mechanical analysis of storage modulus development in lightactivated polymer matrix

composites Dent Mater 200218197-202

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Nanoleakage leakage within the hybrid layer Oper Dent 1995 20 18-25

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posterior composite restorations Dent Mater 200521(1) 9ndash12

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packable posterior composite in bulk-cured restorations JADA 2006 137(1)71ndash80

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edition 1996

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Assessment of dental caries with Digital Imaging Fiber-Optic Transillumination (DI-

FOTI)in vitro studyCaries Res 1997 31(2) 103-110

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caries diagnosis after data import from different digital radiography systems

interobserver agreement and comparison to histological hard-tissue sections Caries

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clinical evaluation of bonded amalgam restorations- Journal of Adhesive Dentistry

nr11999

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of conversion in light-cured dimethacrylate-based dental resins Biomaterials 2002

231819-1829

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modulus of elasticity of light-cured dimethacrylate-based dental resins Biomaterials

2003 24655-665

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York Springer-Verlag 1999

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293Simone D David N B An alternative to reduce polimeryzation shrinkage in

direct posterior restorations JADA 2002 101387-1398

294Smales RJ Longevity of cusp-covered amalgams survivals after 15 years

OperDent 1991 16 17-20

295Smales RJ Webster DA Leppard PISurvival predictions of amalgam

restorations JDent1991 19 272-277

296Smales RJ Hawthorne WSLong-term survival of extensive amalgams and

posterior crowns JDent 1997 25 225-227

297Soncini JA Maserejian NN Trachtenberg F Tavares M Hayes C The

longevity of amalgam versus compomercomposite restorations in posterior primary

and permanent teeth findings From the New England Childrens Amalgam Trial J

Am Dent Assoc 2007 Jun138(6)763-72

298Sonoda H Banerjee A Sherriff M Tagami J Watson TF An in vitro

investigation of microtensile bond strengths of two dentine adhesives to caries-

affected dentine J Dent 2005 33(4)335-342

299Soodabeh Kimyai Masomeh Mehdipour Siavash Savadi Oskoee Reasons

for retreatment of amalgam and composite restorations among the pacients referring

to Tabriz Faculty of dentistry J Dental Research Clinics Dental Prospects vol 1

no1(2007)

300De Souza FB Guimaraes RP Vicente Silva CH A clinical evaluation of

packable and microhybrid resin composite restorations one year report Quintessence

International 2005 36 41-48

301Spreafico RC Gagliani M Composite resin restorations on posterior teeth In

Roulet JF Degrange M Adhesion The silent revolution in dentistry Chicago

Quintessence 2000253ndash76

302St Georges AJ Wilder AD Jr Perdigao J Microleakage of Class V composites

using different placement and curing techniques an in vitro study Am J Dent 2002

15244-247

303Stangel I Barolet RY Clinical evaluation of two posterior composite resins

Two-year results J Oral Rehabil 1990 17 257-268

304Stephen KW Russell JI Creanor SL Comparison of fibre optic

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Dentistry and Oral Epidemiology 1987 15 (2) 90-94

305Sturdevant JR Bayne SC Heymann HO Margin gap size of ceramic inlays

using second-generation CADCAM equipment J Esthet Dent 11(4)206-214 1999

306Suh BI A study of the compatibility of adhesives with composites Proceeding

from the SCO Dental Products Inc Symposium 2003 24(8) 4-9 (Abstract)

307Summit JB Burgess JO Berry TG Six-year clinical evaluation of bonded and

pin-retained complex amalgam restorations Oper Dent 2004 29269-276

308Summit JB Robbins JW Hilton TJ Fundamentals in operative dentistry Cap

10Direct Posterior Esthetic Restorations 2006 Quintessence Publishing Co

57

309Svanberg M Mjor IA Orstavik D Mutans streptococci in plaque from margins

of amalgam composite and glassndashionomer restorations J Dent Res 199069861ndash

864

310Tanne K Mamoru S Burstone C Three-dimensional finite element analysis

for stress in the periodontal tissue by orthodontic forcesAm J Orthod Dentofacial

Orthop921987499ndash505

311Tanumiharja M Burrow MF Tyas MJ Microtensile bond strengths of seven

dentin adhesive systems Dent Mater 2000 16(3)180-7

312Tay FR Pashley DH Aggressiveness of contemporary self-etching systems

Part I Depth of penetration beyond dentin smear layers Dent Mater 2001 17(4) 296-

308

313Tay FR Frankenberger R Krejci I Bouillaguet S Pashley DH Carvalho

RM Single-bottle adhesives behave as permeable membranes after polymerization I

In vivo evidence J Dent 2004 32611ndash621

314Tay FR Pashley DH Have dentin adhesives become too hydrophilic J Can

Dent Assoc 2003 69726ndash731

315Tay FR Sano H Carvalho R Pashley EL Pashley DH An ultrastructural

study of the influence of acidity of self-etching primers and smear layer thickness on

bonding to intact dentin J Adhes Dent 2000 283ndash98

316Thompson JY Bayne SC Heymann HO Mechanical properties of a new

mica-based machinable glass ceramic for CADCAM restorations J Prosthet Dent

76(6)619-623 1996

317Unterbrink GL R Muessner Influence of light intensity on two restorative

systems J Dent 199523183ndash189

318Unterbrink GL Liebenberg WH Flowable resin composites as filled

adhesiveslsquo literature review and clinical recommendations Quintessence Int

199930249ndash257

319Vaarkamp J Ten Bosch J Verdonschot EH Quantitative diagnosis of small

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320Valachovic RW Douglass CW Reiskin AB Chauncey HH McNeil BJ The

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Oral Surg Oral Med Oral Pathol 198661(3)289-96

321Van Meerbeek B De Munck J Yoshida Y Inoue S Vargas M Vijay P Van

Landuyt K Lambrechts P Vanherle G Adhesion to enamel and dentin Current

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322Van Meerbeek B Van Landuyt K De Munck JHashimoto M Peumans M

Lambrechts P Yoshida Y Inoue S Suzuki K Technique-sensitivity of

contemporary adhesives Dent Mater J 2005 24(1) 1-13

323Van Meerbeek B Vargas S Inoue S Yoshida Y Peumans M Lambrechts P

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20016 119-144

324Van Meerbeek B Yoshida Y Inoue S Vargas M Abe Y Fukuda R Okazaki

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58

325Van Nieuwenhuysen JP DrsquoHoore W Carvalho J Qvist V Long-term

evaluation of extensive restorations in permanent teeth J Dent 200331(6)395ndash405

326Venhoven BA de Gee AJ Davidson CL Light initiation of dental resins

dynamics of the polymerization Biomaterials 1996 172313-2318

327Versluis A Douglas WH Cross M Sakaguchi RL Does an incremental filling

technique reduce polymerization shrinkage stresses J Dent Res 1996 75871ndash878

328Vries HC Ruiken HM Konig KG vanrsquot Hof MA Radiographic versus

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329Waggoner W Ashton J Predictability of cavitation based upon radiographic

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55-60

330Watanabe LG Marshall GW Jr Marshall SJ Dentin shear strength effects of

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331Watts DC AS Marouf Optimal specimen geometry in bonded-disk

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451

332Watts DC Marouf AS Al-Hindi AM Photo-polymerization shrinkage-stress

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333Weaver WS Blank LW Pelleu GB Jr A visible light activated resin cured

through tooth structure GenDent 198836236-7

334Wendt SL Microleakage and cusp fracture resistance of heattreated composite

resin inlays Am J Dent 4(1)10-14 1991

335Wenzel A Hintze H Mikkelsen L Mouyen F Radiographic detection of

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1991 72 621-6

336Wenzel A Hintze H Perception of image quality in direct digital radiography

after application of various image treatment filters for detectability of dental diseases

Dentomaxillofac Radiol 1993 22 131-4

337Wenzel A Computer-aided image manipulation of intraoral radiographs to

enhance diagnosis in dental practice a review Int Dent J 1993 43 99-108

338Wenzel A Digital radiography and caries diagnosis Dento Maxillo Facial

Radiology 27(1)3-11 1998

339Wenzel A Haiter-Neto F Gotfredsen E Risk factors for a false positive test

outcome in diagnosis of caries in approximal surfaces impact of radiographic

modality and observer characteristics Caries Res 200741(3)170-6

340Wibowo G Stockton L Microleakage of class II composite restorations Am J

Dent 200114177ndash185

341Wilson NHF Wastell DG Norman RD Five-year performance of high-

cooper content amalgam restorations in a multiclinical trial JDent1996 24 203-210

342Winkler MM Katona TR Paydar NH Finite element stress analysis of three

filling techniques for class V light-cured composite restorations J Dent Res

1996751477-83

343Yap AU Effectiveness of polymerization in composite restoratives claiming bulk

placement Impact of cavity depth and exposure time Oper Dent 2000 25113-120

59

344Yeşilyurt C Bulucu B Bond strength of total-etch dentin adhesive systems on

peripheral and central dentinal tissue a microtensile bond strength test The Journal of

Contemporary Dental Practice 7(2) 20061-13

345Yoshida Y Van Meerbeek B Okazaki M Shintani H Suzuki K Comparative

study on adhesive performance of functional monomers J Dent Res 2004 83 454-

458

346Yoshiyama M Tay FR Doi J Nishitani Y Yamada T Itou K Carvalho RM

Nakajima M Pashley DH Bonding of self-etch and total etch adhesives to carious

dentin J Dent Res 2002 81 556-560

  • COPERTA REZUMAT ENGLEZA (MEREUTA)pdf
  • REZUMAT ENGLEZA DR MEREUTA DENISSpdf
Page 9: UNIVERSITATEA DE MEDICINA SI FARMACIE “GR Doctorat/Rezumat... · universitatea de medicina si farmacie “gr.t.popa” iasi facultatea de medicina dentara rezumatul tezei de doctorat

6

CHAPTVII STUDY REGARDING CLINICAL PERFORMANCE OF

PROXIMO-OCCLUSAL AMALGAM AND COMPOSITE RESINS

RESTORATIONS

VII1 INTRODUCTION

The clinical performance of posterior direct restorations pn medium and long

term concerns dental practitioners that must correlate their therapeutical decisions

with material selection restorative technique external factors represented by oral

forces cariogenic risk patient parafunctions

VII2AIM OF STUDY

The aim of study consisted in assessment of clinical performance of amalgam

and composite resins proximal-occlusal restorations 4-years old

VII3 MATERIALS AND METHOD

The study group included 200 proximal-occlusal amalgam (n=100) and

composite resins (Herculite Kerr) (n=100) restorations 4-years old The study was

performed on 55 patients with age between 17-49 years examined in Dental Medicine

Faculty UMFGrTPopa Iaşi The assessment of fillings status was performed

using Ryge indices modified USPHS (US Public Health Service) (table 1) The

clinical peformance of restorations was also correlated with dental group (molars

bicusps) extension (medium extended) and cariogenic risk (medium high) The

following parameters were assessed

- color match

- marginal adaptation (integrity)

- marginal discoloration

- anatomical form (proximal)

- surface quality

The results presentation was performed using Microsoft Excel

VII4 RESULTS AND DISCUSSIONS

AB

C

S1

6

64

30

0

20

40

60

80

A

B

C

Fig VII1 Anatomical form (occlusal)-amalgam restorations (molars)

7

AB

C

S1

26

64

100

10

20

30

40

50

60

70

A

B

C

Fig VII2 Anatomical form (occlusal)-amalgam restorations (bicusps)

AB

C

S1

0

46

54

0

10

20

30

40

50

60

A

B

C

Fig VII3 Anatomical form (occlusal)-composite resins restorations (molars)

Fig VII4 Anatomical form (occlusal)-amalgam restorations (bicusps)

AB

C

S1

12

72

16

0

10

20

30

40

50

60

70

80

A

B

C

FigVII5 Anatomical form (proximal)-amalgam restorations (molars)

AB

C

S1

38

56

60

10

20

30

40

50

60

A

B

C

FigVII6 Anatomical form (proximal)-amalgam restorations (bicusps)

AB

C

S1

10

54

36

0

10

20

30

40

50

60

A

B

C

8

AB

C

S1

8

64

26

0

10

20

30

40

50

60

70

A

B

C

FigVII7 Anatomical form (proximal)-composite resins restorations (molars)

AB

C

S1

34

66

100

10

20

30

40

50

60

70

A

B

C

FigVII8 Anatomical form (proximal)-composite resins restorations (bicusps)

AB

C

S1

36

44

20

0

5

10

15

20

25

30

35

40

45

A

B

C

FigVII9 Marginal adaptation (proximal)- amalgam restorations(bicusps)

AB

C

S1

20

50

30

0

5

10

15

20

25

30

35

40

45

50

A

B

C

FigVII10 Marginal adaptation (proximal)-amalgam restorations (molars)

AB

C

S1

16

60

24

0

10

20

30

40

50

60

A

B

C

FigVII11 Marginal adaptation (proximal)-composite resins restorations (bicusps)

9

AB

C

S1

12

54

34

0

10

20

30

40

50

60

A

B

C

FigVII12 Marginal adaptation (proximal)-composite resins restorations (molars)

AB

C

S1

22

54

24

0

10

20

30

40

50

60

A

B

C

FigVII13 Surface quality-amalgam restorations (bicusps)

AB

C

S1

10

54

36

0

10

20

30

40

50

60

A

B

C

FigVII14 Surface quality-amalgam restorations (molars)

AB

C

S1

12

68

20

0

10

20

30

40

50

60

70

A

B

C

FigVII15 Surface quality-composite resins restorations (bicusps)

AB

C

S1

8

70

22

0

20

40

60

80

A

B

C

FigVII16 Surface quality-composite resins restorations (molars)

10

A

C

S1

98

20

20

40

60

80

100

A

C

FigVII17a-b Prevalence of marginal dental cariesamalgam restorations (moderate

CR)

A

C

S1

92

80

20

40

60

80

100

A

C

FigVII18 Prevalence of marginal dental cariesamalgam restorations (high CR)

A

C

S1

94

60

20

40

60

80

100

A

C

FigVII19 Prevalence of marginal dental cariescomposite resins restorations (CR

moderate)

A

C

S1

82

18

0

10

20

30

40

50

60

70

80

90

A

C

FigVII20 Prevalence of marginal dental cariescomposite resins restorations (high

CR)

11

The study data sustain the results obtained by most studies focused on

posterior amalgam restorations However Hickelampcol (2001) reviewed literature data

and proved that many results varies accordingly to different clinical factors (133)

Roulet JF(1997) warned about limits of cross-sectional studies related to composite

resins restorations because of the absence of data regarding restorative techniques

practitioner experience presence or absence of optimum isolation factors related by

patient (266)

VII5CONCLUSIONS

Amalgam proximo-occlusal restorations with minimum 6-years age present

excellent results for parameters anatomic form (occlusal) marginal

discoloration and marginal secondary dental caries good results for

parameters anatomic form (proximal) and marginal adaptation and poor results

for surface quality

Composite resins proximo-occlusal restorations (bicusps) with minimum 6-

years age present excellent results for parameters color match marginal

discoloration and marginal secondary dental caries and good results for

parameters anatomic form (occlusal proximal) marginal adaptation surface

quality

Composite resins proximo-occlusal restorations (molars) with minimum 6-

years age present good results for parameters color match marginal

discoloration marginal secondary dental caries marginal adaptation and poor

results for parameters anatomic form (occlusal) (54 indices Ryge C)

anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The restorations extended at external third of occlusal surface present highest

percents of indices C regarding anatomic form (occlusal) (54 indices Ryge

C) anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The exceeding of 6-years age will require careful monitorisation for early

interventions through polishing sealing reshaping and even replacement for

restorations with major defects

12

CHAPTVIII CLINICAL PERFORMANCE OF COMPOSITE RESINS

RESTORATIONS RELATED TO RESTORATIVE TECHNIQUE 12-

MONTHS LONGITUDINAL STUDY

VIII1 INTRODUCTION

The restorative technique has a major influence over clinical performance of

composite resins restorations in proximo-occlusal cavities In this context researches

focused on correlations between technique and clinical performance of direct

restorations improve the dentist decision regarding restorative technique choice

VIII2AIM OF STUDY

The aim of study was to determine the clinical performance of composite

resins proximo-occlusal restorations performed using different restorative techniques

VIII3MATERIALS AND METHOD

The group study included 37 patients with age 18-42 years with moderat

ecariogenic risk The total number of composite resins restorations (Herculite XRV

Kerr) was 60 divided in three study groups (n=20)

I Centripetal build-up

II Oblique layering

III Horisontal layering

The coronal restorations were assessed at an interval of 12 months using

indices Ryge modified USPHS

- indice ALFA (A)- IDEAL CLINIC

- indice BRAVO (B)- ACCEPTABLE CLINIC

- indice CHARLIE (C)- UNACCEPTABLE CLINIC

VIII4 RESULTS AND DISCUSSIONS

The statistical tests Kruskal-Wallis and Mann-Whitney were performed to

confirm or infirm research hypotesis (the direct restorations performed using different

restorative techniques present statistical significant differences regarding clinical

performance for the assessed parameters)

13

TableVIII1a-b Groups study (Kruskal-Wallis Test)

Ranks

20 2960

20 2560

20 3630

60

20 3050

20 2420

20 3680

60

20 2490

20 3140

20 3520

60

Restorative_techniques

Centripetal build-up

Oblique layering

Horizontal layering

Total

Centripetal build-up

Oblique layering

Horizontal layering

Total

Centripetal build-up

Oblique layering

Horizontal layering

Total

Marginal_adaptation

Marginal_discoloration

Anatomical_form

N Mean Rank

Test Statisticsab

4913 8031 4900

2 2 2

086 018 086

Chi-Square

df

Asymp Sig

Marginal_

adaptation

Marginal_

discoloration

Anatomical_

form

Kruskal Wallis Testa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between the three restorative

techniques for parameter marginal adaptation (p=0086)

There are no statistical significant differences between the three restorative

techniques for parameter marginal discoloration (p=0018)

There are no statistical significant differences between the three restorative

techniques for parameter anatomical form (proximal) (p=0086)

TableVIII2 Comparing results between restorations performed using three

techniques (marginal adaptation marginal discoloration anatomical form) Marginal adaptation Centripetal build-upOblique layering p=04 ns

Centripetal build-upHorizontal layering p=0191 ns

Oblique layering Horizontal layering p=0028 s

Marginal discoloration Centripetal build-upOblique layering p=0103 ns

Centripetal build-upHorizontal layering p=0195 ns

Oblique layering Horizontal layering p=0005 s

Anatomical form Centripetal build-upOblique layering p=0137 ns

Centripetal build-upHorizontal layering p=0029 s

Oblique layering Horizontal layering p=0433 ns

ns nesemnificativ

s semnificativ

p probabilitate

14

Tables VIII3a-b Mann-Whitney test Comparing analysis regarding marginal

discoloration between restorations performed using oblique layering technique and

centripetal build-up technique

Ranks

20 2180 43600

20 1920 38400

40

Restorative_techniques

Centripetal build-up

Oblique layering

Total

Marginal_adaptation

N Mean Rank Sum of Ranks

Test Statisticsb

174000

384000

-841

400

495a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

adaptation

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between centripetal build-up

and oblique layering techniques regarding parameter marginal adaptation (p=0400)

Tables VIII4a-b Mann-Whitney test Comparing analysis regarding marginal

adaptation between restorations performed using horisontal layering technique and

centripetal build-up technique

Ranks

20 1830 36600

20 2270 45400

40

Restorative_techniques

Centripetal build-up

Horizontal layering

Total

Marginal_adaptation

N Mean Rank Sum of Ranks

Test Statisticsb

156000

366000

-1307

191

242a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

adaptation

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between centripetal build-up

and horisontal layering techniques regarding parameter marginal adaptation

(p=0191)

15

TablesVIII5a-b Mann-Whitney test Comparing analysis regarding marginal

adaptation between restorations performed using oblique layering technique and

horisontal layering technique

Ranks

20 1690 33800

20 2410 48200

40

Restorative_techniques

Oblique layering

Horizontal layering

Total

Marginal_adaptation

N Mean Rank Sum of Ranks

Test Statisticsb

128000

338000

-2191

028

052a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

adaptation

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There is statistical significant differences between horisontal layering and

oblique layering techniques regarding parameter marginal adaptation (p=0028)

Tables VIII6a-b Mann-Whitney test Comparing analysis regarding marginal

discoloration between restorations performed using oblique layering technique and

centripetal build-up technique

There are no statistical significant differences between centripetal build-up

and oblique layering techniques regarding parameter marginal discoloration

(p=0103)

Ranks

20 2260 45200

20 1840 36800

40

Restorative_techniques

Centripetal build-up

Oblique layering

Total

Marginal_discoloration

N Mean Rank Sum of Ranks

Test Statisticsb

158000

368000

-1632

103

265a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

discoloration

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

16

Tables VIII7a-b Mann-Whitney test Comparing analysis regarding marginal

discoloration between restorations performed using centripetal build-up technique and

horisontal layering technique

Ranks

20 1840 36800

20 2260 45200

40

Restorative_techniques

Centripetal build-up

Horizontal layering

Total

Marginal_discoloration

N Mean Rank Sum of Ranks

Test Statisticsb

158000

368000

-1299

194

265a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

discoloration

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between centripetal build-up

and horisontal layering techniques regarding parameter marginal discoloration

(p=0103)

Tables VIII8a-b Mann-Whitney test Comparing analysis regarding marginal

discoloration between restorations performed using oblique layering technique and

horisontal layering technique

Ranks

20 1630 32600

20 2470 49400

40

Restorative_techniques

Oblique layering

Horizontal layering

Total

Marginal_discoloration

N Mean Rank Sum of Ranks

Test Statisticsb

116000

326000

-2822

005

023a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

discoloration

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There is statistical significant differences between horisontal layering and

oblique layering techniques regarding parameter marginal discoloration (p=0005)

17

TablesVIII9 a-b Mann-Whitney test Comparing analysis regarding anatomical

form between restorations performed using centripetal build-up technique and oblique

layering technique

Ranks

20 1830 36600

20 2270 45400

40

Restorative_techniques

Centripetal build-up

Oblique layering

Total

Anatomical_form

N Mean Rank Sum of Ranks

Test Statisticsb

156000

366000

-1486

137

242a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Anatomical_

form

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between centripetal build-up

and oblique layering techniques regarding parameter anatomical form (p=0137)

Tables VIII10a-b Mann-Whitney test Comparing analysis regarding anatomical

form between restorations performed using centripetal build-up technique and

horisontal layering technique

Ranks

20 1710 34200

20 2390 47800

40

Restorative_techniques

Centripetal build-up

Horizontal layering

Total

Anatomical_form

N Mean Rank Sum of Ranks

Test Statisticsb

132000

342000

-2184

029

068a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Anatomical_

form

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between centripetal build-up

and horisontal layering techniques regarding parameter anatomical form (p=0029)

18

Tables VIII11a-b Mann-Whitney test Comparing analysis regarding anatomical

form between restorations performed using oblique layering technique and horisontal

layering technique

Ranks

20 1920 38400

20 2180 43600

40

Restorative_techniques

Oblique layering

Horizontal layering

Total

Anatomical_form

N Mean Rank Sum of Ranks

Test Statisticsb

174000

384000

-784

433

495a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Anatomical_

form

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between horisontal layering and

oblique layering techniques regarding parameter anatomical form (p=0433)

Indices A for restorations performed using centripetal build-up technique were

as follows color match-80 marginal adaptation- 60 marginal discoloration-

70 anatomical form (proximal)- 80 surface quality- 60

Indices A for restorations performed using horisontal layering technique were

as follows color match-70 marginal adaptation- 40 marginal discoloration-

50 anatomical form (proximal)- 50 surface quality- 70

Indices A for restorations performed using oblique layering technique were as

follows color match-70 marginal adaptation- 80 marginal discoloration- 90

anatomical form (proximal)- 60 surface quality- 70

Indices B for restorations performed using centripetal build-up technique were

as follows color match-20 marginal adaptation- 30 marginal discoloration-

20 anatomical form (proximal)- 30 surface quality- 40

Indices B for restorations performed using horisontal layering technique were

as follows color match-30 marginal adaptation- 40 marginal discoloration-

30 anatomical form (proximal)- 30 surface quality- 30

Indices B for restorations performed using oblique layering technique were as

follows color match-30 marginal adaptation- 20 marginal discoloration- 10

anatomical form (proximal)- 40 surface quality- 30

19

Indices C for restorations performed using centripetal build-up technique were

as follows color match-0 marginal adaptation- 10 marginal discoloration- 0

anatomical form (proximal)- 0 surface quality- 0

Indices C for restorations performed using horisontal layering technique were

as follows color match-0 marginal adaptation- 20 marginal discoloration- 20

anatomical form (proximal)- 20 surface quality- 0

Indices C for restorations performed using oblique layering technique were as

follows color match-0 marginal adaptation- 0 marginal discoloration- 10

anatomical form (proximal)- 0 surface quality- 100

Discussions

For in vitro studies is difficult to reproduce the variables existent in oral cavity

like occlusal stress and pH and temperature changes (235) The clinical studies are

determinant in assessment of restorative techniques (300) The most researches

focuses on the influence of restorative technique on the reduction of lightcuring stress

(51 78 135)

VIII5 CONCLUSIONS

Oblique layering technique presents superior results regarding marginal

adaptation and marginal discoloration and is recommended for proximo-

occlusal dental caries close to enamel-cement jonction

Centripetal build-up presents good results regarding marginal adaptation and

anatomical form at proximal level (proximal surfaces and contact point)

Horisontal layering technique can be used for optimum results only in

proximal-occlusal cavities with moderate extension both in occlusal-cervical

and buccal-oral

20

CHAPTIX STUDY REGARDING MARGINAL SEALING STATUS IN

COMPOSITE RESINS LIMITED PROXIMO-OCCLUSAL RESTORATIONS

PERFORMED USING DIFFERENT TECHNIQUES

IX1INTRODUCTION

The contraction of composite resins can produce stress inside dental structure

The most contraction stress appears in the initial stages and development rate of stress

decreases gradually in time (5 98 160) The contraction stress of composite resins

can overpass adhesion strenght and can broke the link between dental tissues and

composite resin (73) When adhesion strenght is high stress can produce marginal

fracture or bulk fracture (74) These situations are associated with microleakage and

penetration of oral fluid and bacteria along dentinal walls endangering the pulpal

tissue or favourising secondary dental caries

IX2 AIM OF STUDY

The study aimed to assess the efficiency of marginal sealing along gingival

wall in limited proximal-occlusal restorations performed using three different

techniques

IX3MATERIALS AND METHOD

The study group included 30 teeth extracted for orthodontic and periodontal

reasons On every tooth two identical class II cavities (on mesial and distal surfaces)

were prepared with cylindrical burs under water cooling The gingival wall was

limited to enamel-cement jonction The cavity dimension were as follows 2 mm

buccal-oral 5mm depth Each tooth was introduced in a pattern of acrylat The

operator calibrated preparation technique on acrylat teeth in Simulation Laboratory of

UMF ―Gr T Popa Iaşi The 60 prepared cavities were randomly divided in three

study groups related to restorative technique The restoration were performed with

Filtek Z550 (3M ESPE) a nanohybrid composite resin The adhesive strategy

included etchamprinse in 2 steps and adhesive Adper Single Bond 2(3MESPE)

Group A (n=20) bulk restorative technique associated with lightcuring from

occlusal 40 seconds and from buccal and oral 20 seconds

Group B (n=20) oblique layering technique (first layer on buccal wall and

buccal frac12 of gingival wall was lightcured from buccal second layer on oral wall and

oral frac12 of gingival wall was lightcured from oral third oral as a triangle with point

oriented to gingival wall was lightcured from occlusal)

Group C (n=20) combined technique (bdquoflow layer on gingival and axial

walls lightcured under pressure only associated with solid composite resin layer)

The proximal surfaces were performed using Tofflemire and metallic matrices After

removal of matrices every restoration was lightcured for another 20 seconds Two

layers aof varnish were applied on composite resins restorations excepting cavity

margins and an area of 1 mm around them The samples were introduced in methylen

21

blue 10 for 48 hours After this stage samples were washed with water and teeth

were cut longitudinally with a diamonded disc

The die penetration was assessed with Zeiss (Iena Germany) X20 microscope

accordingly to four scores (0-3)

0 ndash no penetration

1 ndash die infiltration until external half of gingival wall

2 ndash die infiltration on all gingival wall

3 ndash die infiltration on gingival wall and axial wall

IX4RESULTS AND DISCUSSIONS

The result of die penetration are presented in table IX1

TableIX1 The results for die penetration

Grup 0 1 2 3

A (bulk) 0 0 3 17

B (layering) 0 4 5 11

C (combined) 12 5 2 1

In group A 17 sample had score 3 and 2 samples had score 2 In group B 11

sample had score 3 5 samples had score 2 and 4 sample had score 1 In group C with

best results 12 samples had score 0 5 samples had score 1 2 samples had score 2 1

sample had score 3

The recorded data were analysed using test Mann-Whitney The statistical

results are presented in tables IX2-IX4

Tables IX2a-b Mann-Whitney for comparisons of microleakage values between

bulk technique and incremental technique

Ranks

Restorative technique N Mean Rank Sum of Ranks

Scores

frequency

A ndash bulk technique 20 2420 24200

B ndash incremental

technique

20 1680 16800

Total 40

Test Statisticsb

scores

frequency

Mann-Whitney U 29000

Wilcoxon W 168000

Z -1970

Asymp Sig (2-tailed) 049

Exact Sig [2(1-tailed Sig)] 123a

a Not corrected for ties

b Grouping Variable restorative technique

22

Tables IX3a-b Mann-Whitney for comparisons of microleakage values between

bulk technique and mixed technique

Ranks

Restorative technique N Mean Rank Sum of Ranks

scores

frequency

A ndash bulk technique 20 3090 30900

C ndash mixed technique 20 1010 10100

Total 40

Test Statisticsb

scores

frequency

Mann-Whitney U 500

Wilcoxon W 101000

Z -4021

Asymp Sig (2-tailed) 000

Exact Sig [2(1-tailed Sig)] 000a

a Not corrected for ties

b Grouping Variable restorative technique

Tables IX4a-b Mann-Whitney test for comparisons of microleakage values

between incremental technique and mixed technique

Ranks

Restorative technique N Mean Rank Sum of Ranks

scores

frequency

B ndash incremental

technique

20 2990 29900

C ndash mixed technique 20 1210 12100

Total 40

Test Statisticsb

scores

frequency

Mann-Whitney U 5500

Wilcoxon W 121000

Z -3492

Asymp Sig (2-tailed) 000

Exact Sig [2(1-tailed Sig)] 000a

a Not corrected for ties

23

Test Statisticsb

scores

frequency

Mann-Whitney U 5500

Wilcoxon W 121000

Z -3492

Asymp Sig (2-tailed) 000

Exact Sig [2(1-tailed Sig)] 000a

a Not corrected for ties

b Grouping Variable tehnrestaurare

The results of microleakage degree were statistically significant when the

three restorative techniques were compared The results showed that best restorative

technique regarding marginal sealing in cervical area is combined technique followed

by oblique layering technique The use of layering techniques limits the development

of contraction forces between oposite walls event that favourises bulk stress voids

formation and fissure inside dental tissues The results of our study are similar with

other studies (114 293)

IX5 CONCLUSIONS

The values of die penetration at gingival wall were statistically different

between the three restorative techniques

We concluded that all restorative methods were associated with lightcuring

contraction and marginal microleakage

The combined technique was associated with lowest lightcuring contraction

and die penetration

The bulk technique was associated with highest lightcuring contraction and die

penetration

24

CHAPTX STUDY REGARDING THE EFFECTS OF ETCHING ON

ENAMEL AND DENTINE IN CERVICAL AREA FOR PROXIMAL

CAVITIES AT LATERAL DENTAL GROUP

X1 INTRODUCTION

The studies reported marginal defects and high microleakage at the level of

gingival margins localised in cervical area or close to enamel-cement jonction for

high percents of proximal-occlusal composite resins restorations (8485) The good

adhesion is requested to insure restoration longevity and to prevent marginal

microleakage and presence of secondary marginal dental caries The adhesion

strenght of different adhesive systems can vary accordingly to tissues areas (204 240)

and to variations in dentinal structures (234 330) Most studies focused on adhesive

systems performances used healthy dentine close to pulp room but in case of class II

restorations there are particular features that influences the adhesion at the level of

gingival margins

The surface topography is an important property that determines the

interaction manner between surfaces The surface roughness and surface energy can

increase or decrease the adhesion of composite resins to the hard dental tissues

X2 AIM OF STUDY

The aim of study was to compare surface roughness of enamel and dentine

after etching related to different distances related to enamel-dentinecement jonction

X3 MATERIALS AND METHODS

The study group included 20 molars extracted from orthodontics or

periodontal reasons with intact proximal surfaces The teeth were cut longitudinally in

sens buccal-oral with diamond discs under water cooling

A group study (10 teeth) included 10 samples obtained through transversal

cutting at distance of 2mm from enamel-dentinecement jonction and 10 samples

obtained through transversal cutting at distance of 15 mm from enamel-

dentinecement jonction Another study group (10 teeth) included 10 samples

obtained through transversal cutting at distance of 1mm from enamel-dentinecement

jonction and 10 samples obtained through transversal cutting at distance of 05 mm

from enamel-dentinecement jonction All these samples were divided in two halfes

through mesial-distal cutting The samples finishing was performed with abrasive

paper (100-4000) and final polishing was performed with a device Buehler model

Minimet with slices introduced in ultrasound bath for 4 minutes The second half of

each sample was etched for 15 seconds with ortophosphoric acid 37 for 15 seconds

Slices were washed with distilled water for 30 seconds after etching and dried

The samples were analysed with atomic force microscopy (AFM) regarding

surface roughness The results were expressed as relative variation of roughness

X4 RESULTS AND DISCUSSIONS

The aspect of etched enamel at 2 mm distance from ECJ can be seen in figure

X1 (section 10 microm) The surface roughness is higher comparing with sample before

etching

25

După gravajul cu acid ortofosforic 37

The aspect of etched enamel at 15 mm distance from ECJ can be seen in

figure X2 (section 10 microm) The surface roughness is higher comparing with sample

before etching but lower comparing with sample at 2 mm from ECJ

The aspect of etched enamel at 1 mm distance from ECJ can be seen in figure

X3 (section 10 microm) The surface roughness is higher comparing with sample before

etching but lower comparing with sample at 15mm and 2 mm from ECJ

The aspect of etched enamel at 15 mm distance from ECJ can be seen in

figure X4 (section 10 microm) The surface roughness is higher comparing with sample

before etching but lower comparing with sample at 1 mm 15 mm and 2 mm from

ECJ

FigX1 3D aspect of enamel at 2 mm from ECJ

after etching (10 microm)

FigX2 3D aspect of enamel at 15 mm from ECJ

after etching (10 microm)

FigX3 3D aspect of enamel at 1 mm from ECJ

after etching (10 microm)

FigX4 3D aspect of enamel at 05 mm from ECJ

after etching (10 microm)

26

The mean values of squared roughness for dentine and enamel before etching

are presented in tables X1 and X2

Table X1 Squared roughness values for dentine samples before and after etching

Before etching (nm) After etching (nm)

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

sample

1

335 282 283 259 1149 947 901 879

sample

2

352 284 274 266 1127 939 883 875

sample

3

357 273 278 263 1152 953 876 867

sample

4

323 269 264 258 1146 942 895 883

sample

5

348 298 271 268 1153 944 904 878

sample

6

339 274 278 273 1158 937 893 892

sample

7

352 283 269 266 1145 944 899 876

sample

8

349 292 272 274 1166 942 907 869

sample

9

357 284 275 265 1132 939 893 879

sample

10

348 281 277 262 1142 941 899 878

Table X2 Squared roughness values for enamel and dentine samples before and after

etching

Before etching (nm) After etching (nm)

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

sample 1 422 342 309 313 2255 1114 874 845

sample 2 418 338 324 304 2236 1102 882 839

sample 3 413 334 315 303 2239 1115 873 833

sample 4 416 336 322 308 2242 1116 868 842

sample 5 426 332 315 294 2218 1103 877 829

sample 6 412 332 317 306 2237 1099 874 847

sample 7 414 335 322 314 2252 1102 876 834

sample 8 416 325 318 313 2239 1106 875 838

sample 9 418 328 314 299 2246 1113 879 836

sample 10 413 334 316 305 2242 1104 873 839

The results for samples before etching prove a decreasing tendency for mean

values of squared roughness surface beginning with areas placed at distance of 2 mm

from ECJ (346 nm) followed by areas placed at distance of 15 mm from ECJ (282

nm) 1 mm from ECJ (274 nm) and 05 mm from ECJ (265 nm) After etching the

decreasing tendency maintained for dentine localised at 2 mm from ECJ to dentine

localised at 05 mm from ECJ The mean values of squared roughness after etching

were three times higher (tables X3)

27

Table X3 Squared roughness values for enamel and dentine samples before and

after etching

Dentine Enamel

Before etching

(nm)

After etching

(nm)

Before etching

(nm)

After etching

(nm)

2 mm ECJ 346 1147 416 2237

15 mm ECJ 282 942 333 1107

1 mm ECJ 274 895 317 875

05 mm ECJ 265 877 305 838

The descriptive statistics data for surface roughness of dentine before and after

etching are presented in tables X4 si X5

Table X4 Descriptive statistics for dentine samples before etching

Statistics

Dentine 2mm

before etching

Dentine 15mm

before etching

Dentine 1mm

before etching

Dentine 05mm

before etching

N Valid 10 10 10 10

Missing 0 0 0 0

Mean 346000 282000 274100 265400

Std Error of Mean 33830 27487 17026 16746

Std Deviation 106979 86923 53841 52957

Skewness -1214 354 -314 348

Std Error of Skewness 687 687 687 687

Kurtosis 1141 049 336 -539

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 3230 2690 2640 2580

Maximum 3570 2980 2830 2740

Table X5 Descriptive statistics for dentine samples after etching

Statistics

Dentine 2mm

after etching

Dentine 15mm

after etching

Dentine 1mm

after etching

Dentine 05mm

after etching

N Valid 10 10 10 10

Missing 0 0 0 0

1147000 942800 895000 877600

Std Error of Mean 36545 14591 29926 22020

Std Deviation 115566 46140 94634 69634

Skewness -267 1169 -951 535

Std Error of Skewness 687 687 687 687

Kurtosis 043 1776 564 1416

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 11270 9370 8760 8670

28

Statistics

Dentine 2mm

after etching

Dentine 15mm

after etching

Dentine 1mm

after etching

Dentine 05mm

after etching

N Valid 10 10 10 10

Missing 0 0 0 0

1147000 942800 895000 877600

Std Error of Mean 36545 14591 29926 22020

Std Deviation 115566 46140 94634 69634

Skewness -267 1169 -951 535

Std Error of Skewness 687 687 687 687

Kurtosis 043 1776 564 1416

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 11270 9370 8760 8670

Maximum 11660 9530 9070 8920

To choose the statistical test to compare roughness surface values was

performed a test Shapiro-Wilk If p is lower or equal with 0005 than hypothesis of

distribution normality is rejected (distribution deviates from normal form) In the table

X6 the distributions are normal The statistical test will be test t for pair samples

Table X6 Test Shapiro-Wilk for dentine samples

Tests of Normality

Kolmogorov-Smirnov

a Shapiro-Wilk

Statistic df Sig Statistic df Sig

Dentine 2mm before etching 274 10 032 877 10 122

Dentine 15mm after etching 209 10 200 952 10 689

Dentine 1mm before etching 134 10 200 983 10 980

Dentine 05mm before etching 155 10 200 949 10 661

Dentine 2mm after etching 133 10 200 977 10 946

Dentine 15mm after etching 197 10 200 916 10 329

Dentine 1mm after etching 216 10 200 925 10 401

Dentine 05 after etching 220 10 185 933 10 474

Enamel 2mm before etching 193 10 200 898 10 207

Enamel 15mm before etching 170 10 200 977 10 947

Enamel 1mm before etching 157 10 200 952 10 689

Enamel 05mm before etching 165 10 200 943 10 590

Enamel 2mm after etching 235 10 124 925 10 404

Enamel 15mm after etching 209 10 200 871 10 102

Enamel 1mm after etching 189 10 200 964 10 834

Enamel 05mm after etching 142 10 200 983 10 978

a Lilliefors Significance Correction

29

Tests of Normality

Kolmogorov-Smirnov

a Shapiro-Wilk

Statistic df Sig Statistic df Sig

Dentine 2mm before etching 274 10 032 877 10 122

Dentine 15mm after etching 209 10 200 952 10 689

Dentine 1mm before etching 134 10 200 983 10 980

Dentine 05mm before etching 155 10 200 949 10 661

Dentine 2mm after etching 133 10 200 977 10 946

Dentine 15mm after etching 197 10 200 916 10 329

Dentine 1mm after etching 216 10 200 925 10 401

Dentine 05 after etching 220 10 185 933 10 474

Enamel 2mm before etching 193 10 200 898 10 207

Enamel 15mm before etching 170 10 200 977 10 947

Enamel 1mm before etching 157 10 200 952 10 689

Enamel 05mm before etching 165 10 200 943 10 590

Enamel 2mm after etching 235 10 124 925 10 404

Enamel 15mm after etching 209 10 200 871 10 102

Enamel 1mm after etching 189 10 200 964 10 834

Enamel 05mm after etching 142 10 200 983 10 978

a Lilliefors Significance Correction

This is a lower bound of the true significance

The results of test t for pair dentine samples before and after etching are

presented in table X

Table X7 Test t for dentine before and after etching

Paired Samples Test

Paired Differences

t df

p (2-

tailed)

95 Confidence

Interval of the

Difference

Mean

Std

Dev

Std

Error

Mean Lower Upper

Pair

1

dentine2mmbeforeetching-

dentine2mmafteretching

-

8010000

174801 55277 -

8135045

-

7884955

-

144906

9 000

Pair

2

dentine15mmbeforeetching-

dentine15mmafteretching

-

6608000

102394 32380 -

6681248

-

6534752

-

204079

9 000

Pair

3

dentine1mmbeforeetching-

dentine1mmafteretching

-

6209000

117799 37251 -

6293269

-

6124731

-

166678

9 000

30

Paired Samples Test

Paired Differences

t df

p (2-

tailed)

95 Confidence

Interval of the

Difference

Mean

Std

Dev

Std

Error

Mean Lower Upper

Pair

1

dentine2mmbeforeetching-

dentine2mmafteretching

-

8010000

174801 55277 -

8135045

-

7884955

-

144906

9 000

Pair

2

dentine15mmbeforeetching-

dentine15mmafteretching

-

6608000

102394 32380 -

6681248

-

6534752

-

204079

9 000

Pair

3

dentine1mmbeforeetching-

dentine1mmafteretching

-

6209000

117799 37251 -

6293269

-

6124731

-

166678

9 000

Pair

4

dentine05mmbeforeetching-

dentine05mmafteretching

-

6122000

86384 27317 -

6183796

-

6060204

-

224109

9 000

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of dentine (

2mm 15 mm 1mm sau 05mm)

The descriptive statistics data for dentine surface roughness before and after

etching are presented in tables X8 and X9

Table X8 Descriptive statistics for enamel samples before etching

Statistics

Enamel 2mm

before etching

Enamel 15mm

before etching

Enamel 1mm

before etching

Enamel 05mm

before etching

N Valid 10 10 10 10

Missing 0 0 0 0

Mean 416800 333600 317200 305900

Std Error of Mean 13968 15217 14205 20355

Std Deviation 44171 48120 44920 64369

Skewness 1095 -156 -109 -411

Std Error of Skewness 687 687 687 687

Kurtosis 769 487 -118 -295

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 4120 3250 3090 2940

Maximum 4260 3420 3240 3140

31

Table X9 Descriptive statistics for enamel samples after etching

Statistics

Enamel 2mm

after etching

Enamel 15mm

after etching

Enamel 1mm

after etching

Enamel 05mm

after etching

N Valid 10 10 10 10

Missing 0 0 0 0

Mean 2237600 1107400 875100 838200

Std Error of Mean 31027 20232 11968 17436

Std Deviation 98116 63979 37845 55136

Skewness -850 267 042 040

Std Error of Skewness 687 687 687 687

Kurtosis 878 -1880 1082 -425

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 22180 10990 8680 8290

Maximum 22520 11160 8820 8470

To choose the statistical test to compare roughness surface values was

performed a test Shapiro-Wilk If p is lower or equal with 0005 than hypothesis of

distribution normality is rejected (distribution deviates from normal form) In the table

X10 the distributions are normal The statistical test will be test t for pair samples

Table X10 Test Shapiro-Wilk for enamel samples

Tests of Normality

Kolmogorov-Smirnova Shapiro-Wilk

Statistic df Sig Statistic df Sig

2mmenamel before etching 193 10 200 898 10 207

15mmenamel before etching 170 10 200 977 10 947

1mmenamel before etching 157 10 200 952 10 689

05mmenamel before etching 165 10 200 943 10 590

2mmenamel after etching 235 10 124 925 10 404

15mmenamel after etching 209 10 200 871 10 102

1mmenamel after etching 189 10 200 964 10 834

05mmenamel after etching 142 10 200 983 10 978

a Lilliefors Significance Correction

This is a lower bound of the true significance

The results of test t for pair enamel samples before and after etching are

presented in table X11

32

Table X11 Test t for enamel samples before and after etching

Paired Samples Test

Paired Differences

t df

p (2-

tailed)

95 Confidence

Interval of the

Difference

Mean

Std

Deviation

Std

Error

Mean Lower Upper

Pair

1

2mmenamel before

etching

2mmenamel after

etching

-18208 135220 42760 -

18304731

-

18111269

-

425815

9 000

Pair

2

15mmenamel before

etching

15mmenamel after

etching

-7738 73151 23132 -7790329 -7685671 -

334508

9 076

Pair

3

1mmenamel before

etching

1mmenamel after

etching

-5579 55468 17540 -5618679 -5539321 -

318065

9 065

Pair

4

05mmenamel before

etching

05mmenamel after

etching

-5323 60378 19093 -5366192 -5279808 -

278788

9 063

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel ( 2mm 15 mm 1mm sau

05mm) but the differences statistical significant are present only for enamel localised

at 2 mm from ECJ

X5CONCLUSIONS

The surfaces of enamel and dentine at cervical level record decreases of

roughness related to the decrease of distance to ECJ

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel but the differences

statistical significant are present only for enamel localised at 2 mm from ECJ

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of

dentine

33

CHAPTXI FEA STUDY REGARDING THE BIOMECHANICAL

BEHAVIOUR AND FRACTURE RESISTANCE OF PROXIMO-OCCLUSAL

AMALGAM AND COMPOSITE RESINS RESTORATIONS

XI1INTRODUCTION AIM OF STUDY

The individual variation of patients morphological and functional complexity

of tissues as well as difficult access limit the possibilities to investigate in clinical

studies the biomechanical behaviour of proximo-occlusal restorations In this context

simulation of the biomechanics for direct restorations represents an interesting

interdisciplinar domain in actual dentistry research

The study focused on two direction

- analysis of role of forces intensity on biomechanical behaviour related to

cavity dimension and material

- analysis of tension inside restoration structure related to forces intensity

XI2MATERIALS AND METHODS

The stages of finite element analysis study are as follows

object modelling (bicusps and proximo-occlusal restoration)

definition of parameters for materials and dental tissues

meshing

constraints and loading

types of contacts

equations system definition

results of simulation

The object 3D modelling was performed in Rhinoceros (figure XI1) The

definition of parameters was performed for Poisson constant Young modulus density

(table XI1) The selected materials were amalgam and composite resins The

analysed tissues were dentine and enamel The meshing constraints loading were

performed for forces of 200N 400N 600N 800 N The analysis was performed using

software COSMOSWorks 2010

34

Fig XI1 3D modellation of bicusp

Table XI1 Values of Young modulus Poisson constant compression resistance for

amalgam composite resin enamel (amalgam compozit smalţ)

Material Young modulus (GPa) Poisson constants

Compression

resistance

(Mpa)

Amalgam 55 033 483

Enamel 48 03 400

Composite

resin 220 022 345

Fig XI2 The forces and constraints application

The results are presented in values and culours red colours representing areas

with maximum values of tensions produced under influence of masticatory forces

The tensions produced in amalgam restoration are in a range from 0 to 22886

(force 800 N) The maximum von Misses tensions are associated with cervical area

of amalgam restorations This aspect proves that first modification in interface

restoration-cavity margins will appear at the level of gingival wall First marginal

35

defects and fissures in restoration bulk will appear at tensions over 1600Mpa

associated with forces of 800N for extended amalgam proximo-occlusal restorations

The tensions produced in composite resin restorations are in a range from 0 to

2285 (force 800 N) The maximum von Misses tensions are associated with cervical

area of composite resin restorationsThis aspect proves that first modification in

interface restoration-cavity margins will appear at the level of gingival wall First

marginal defects and fissures in restoration bulk will appear at tensions over 1716

Mpa associated with forces of 600N for moderate and extended composite resins

proximo-occlusal restorations

Fig XI3a-b ndash Simulated model of proximo-occlusal restoration

FigXI4a-b Dental amalgam restoration Cervical tension associated with 600 N

(c)800 N (d)

FigXI5a-b Composite resin restoration Cervical tension associated with 600 N

(c)800 N (d)

36

The deformation of amalgam can be produced only when is associated with

fissures in bulk of restorations while composite resins restorations present

deformation when are associated with a modification of volume and form because of

repeated action of medium forces on long term or high forces on short term (figures

XI4 XI5)

Fig XI4 Material deformation in area of maximum tension

000E + 00

500E -02

100E -01

150E -01

200E -01

250E -01

1 4 7 101316192225283134374043464952555861646770737679

Amalgam C ompoz it

Figura XI5 Deformarea funcție de material

The amalgam and composite resins were treated as homogenous isotropic and

liniar The advantage of this type of FEA study is that restorations parameters can be

modified any time is necessary both in arhitecture geometry and material indices

variability The results of this study sustain the conclusions of other FEA studies

focused on biomechanical behaviour of posterior restorations performed with

amalgam and composite resins(35 62 76 143)

37

XI4CONCLUSIONS

bull The amalgam in class II restorations has a low deformation tendency because

of uniform distribution of tension inside material

bull Composite resins class II restorations accumulate higher tensions comparing

with amalgam but deformation is avoided for a time because of the adhesion

forces performed between molecules under moderate oral forces In case of

high oral forces (600-800N) the risk of fracture in moderate class II

restorations is higher comparing with amalgam proximo-occlusal restorations

For extended class II restorations and forces of 600 N composite resins present

highest risk of fracture and deformation The von Misses tension at the

cervical interface restorationtooth can reach 1600Mpa

bull The amalgam in moderate class II restorations can resist to deformation even

for high intensity forces limited to 600N In extended class II restorations the

risk of deformation and fracture increases at values of 600N-800N of oral

forces The von Misses tension at the cervical interface restorationtooth can

reach 1700 Mpa

38

FINAL CONCLUSIONS

Amalgam proximo-occlusal restorations with minimum 6-years age present

excellent results for parameters anatomic form (occlusal) marginal

discoloration and marginal secondary dental caries good results for

parameters anatomic form (proximal) and marginal adaptation and poor results

for surface quality

Composite resins proximo-occlusal restorations (bicusps) with minimum 6-

years age present excellent results for parameters color match marginal

discoloration and marginal secondary dental caries and good results for

parameters anatomic form (occlusal proximal) marginal adaptation surface

quality

Composite resins proximo-occlusal restorations (molars) with minimum 6-

years age present good results for parameters color match marginal

discoloration marginal secondary dental caries marginal adaptation and poor

results for parameters anatomic form (occlusal) (54 indices Ryge C)

anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The restorations extended at external third of occlusal surface present highest

percents of indices C regarding anatomic form (occlusal) (54 indices Ryge

C) anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The exceeding of 6-years age will require careful monitorisation for early

interventions through polishing sealing reshaping and even replacement for

restorations with major defects

Oblique layering technique presents superior results regarding marginal

adaptation and marginal discoloration and is recommended for proximo-

occlusal dental caries close to enamel-cement jonction

Centripetal build-up presents good results regarding marginal adaptation and

anatomical form at proximal level (proximal surfaces and contact point)

Horisontal layering technique can be used for optimum results only in

proximal-occlusal cavities with moderate extension both in occlusal-cervical

and buccal-oral

The values of die penetration at gingival wall were statistically different

between the three restorative techniques

We concluded that all restorative methods were associated with lightcuring

contraction and marginal microleakage

The combined technique was associated with lowest lightcuring contraction

and die penetration

The bulk technique was associated with highest lightcuring contraction and die

penetration

39

The surfaces of enamel and dentine at cervical level record decreases of

roughness related to the decrease of distance to ECJ

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel but the differences

statistical significant are present only for enamel localised at 2 mm from ECJ

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of

dentine

bull The amalgam in class II restorations has a low deformation tendency because

of uniform distribution of tension inside material

bull Composite resins class II restorations accumulate higher tensions comparing

with amalgam but deformation is avoided for a time because of the adhesion

forces performed between molecules under moderate oral forces In case of

high oral forces (600-800N) the risk of fracture in moderate class II

restorations is higher comparing with amalgam proximo-occlusal restorations

For extended class II restorations and forces of 600 N composite resins present

highest risk of fracture and deformation The von Misses tension at the

cervical interface restorationtooth can reach 1600Mpa

bull The amalgam in moderate class II restorations can resist to deformation even

for high intensity forces limited to 600N In extended class II restorations the

risk of deformation and fracture increases at values of 600N-800N of oral

forces The von Misses tension at the cervical interface restorationtooth can

reach 1700 Mpa

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817-822

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dental resin composites Dent Mater 2005 211150-1157

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201989117ndash121

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18(7)516-20

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Materials Journal 2006 25(1)59-65

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Dent 27(5)325-331 1999

49

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Jan11(1)34-40

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JProsthet Dent 199369(4)425-430

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thermal behavior of dental composites Dent Mater 2008 24(8)1017ndash1024

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JDent 199826 627-632

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shrinkage and elasticity of flowable composites and filled adhesives Dent Mater

1999 15128-137

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Pendefunda 180Sorina Solomon Topoliceanu C Elements of dispersional

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Edition of the Balkan Medical Days

Stomatological Section Abstract nr1091999128

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StomatologicăVol2199823-26

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200126302ndash307

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Dentistry and Oral Epidemiology 1996 24 106-11

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Dent Mater 2002 18436-444

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20(3)236-43

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Polymerization shrinkage effects of boundary conditions and filling technique of

resin composite restorations J Dent 2004 32(6)459-70

50

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Quintessence Int 2004 35(2)156-61

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and reactivity on the reaction kinetics of dimethacrylatedimethacrylate

copolymerizations Macromolecules 1999 323913-3921

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clinical results J Dent Res 199877 1020

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two amalgams Quintessence Int 199829483ndash490

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Dentomaxillofac Radiol 2007 Oct36(7)377-81

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direct and indirect restorations icircn posterior teeth of the permanent

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composites for posterior restorations JADA Vol132 2001639-644

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J Prosthet Dent 2000 Sep84(3)289-96

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Three-year clinical evaluation of composite and ceramic inlays Am J Dent 2001

Apr14(2)95-9

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hardness and depth of cure of light cured packable composite resins J Dent Res 2000

79369 (Abstract)

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caries-affected transparent dentin by citric acidAn atomic force microscopy

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practitioners and dental caries JDent1990 18(3) 130-136

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(Cerana) Br Dent J 2006 Oct 21201(8)515-20

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PrimDentCare1999Apr659-62

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Quintessence 198961-80

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ScandJDRes 199210060-65

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33

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19904011ndash7

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Am Dent Assoc 2010 141(3)319-29

52

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125749-751

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34

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Monogr Oral Sci 20092142-51

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569ndash575

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Nanoleakage leakage within the hybrid layer Oper Dent 1995 20 18-25

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451

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338Wenzel A Digital radiography and caries diagnosis Dento Maxillo Facial

Radiology 27(1)3-11 1998

339Wenzel A Haiter-Neto F Gotfredsen E Risk factors for a false positive test

outcome in diagnosis of caries in approximal surfaces impact of radiographic

modality and observer characteristics Caries Res 200741(3)170-6

340Wibowo G Stockton L Microleakage of class II composite restorations Am J

Dent 200114177ndash185

341Wilson NHF Wastell DG Norman RD Five-year performance of high-

cooper content amalgam restorations in a multiclinical trial JDent1996 24 203-210

342Winkler MM Katona TR Paydar NH Finite element stress analysis of three

filling techniques for class V light-cured composite restorations J Dent Res

1996751477-83

343Yap AU Effectiveness of polymerization in composite restoratives claiming bulk

placement Impact of cavity depth and exposure time Oper Dent 2000 25113-120

59

344Yeşilyurt C Bulucu B Bond strength of total-etch dentin adhesive systems on

peripheral and central dentinal tissue a microtensile bond strength test The Journal of

Contemporary Dental Practice 7(2) 20061-13

345Yoshida Y Van Meerbeek B Okazaki M Shintani H Suzuki K Comparative

study on adhesive performance of functional monomers J Dent Res 2004 83 454-

458

346Yoshiyama M Tay FR Doi J Nishitani Y Yamada T Itou K Carvalho RM

Nakajima M Pashley DH Bonding of self-etch and total etch adhesives to carious

dentin J Dent Res 2002 81 556-560

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7

AB

C

S1

26

64

100

10

20

30

40

50

60

70

A

B

C

Fig VII2 Anatomical form (occlusal)-amalgam restorations (bicusps)

AB

C

S1

0

46

54

0

10

20

30

40

50

60

A

B

C

Fig VII3 Anatomical form (occlusal)-composite resins restorations (molars)

Fig VII4 Anatomical form (occlusal)-amalgam restorations (bicusps)

AB

C

S1

12

72

16

0

10

20

30

40

50

60

70

80

A

B

C

FigVII5 Anatomical form (proximal)-amalgam restorations (molars)

AB

C

S1

38

56

60

10

20

30

40

50

60

A

B

C

FigVII6 Anatomical form (proximal)-amalgam restorations (bicusps)

AB

C

S1

10

54

36

0

10

20

30

40

50

60

A

B

C

8

AB

C

S1

8

64

26

0

10

20

30

40

50

60

70

A

B

C

FigVII7 Anatomical form (proximal)-composite resins restorations (molars)

AB

C

S1

34

66

100

10

20

30

40

50

60

70

A

B

C

FigVII8 Anatomical form (proximal)-composite resins restorations (bicusps)

AB

C

S1

36

44

20

0

5

10

15

20

25

30

35

40

45

A

B

C

FigVII9 Marginal adaptation (proximal)- amalgam restorations(bicusps)

AB

C

S1

20

50

30

0

5

10

15

20

25

30

35

40

45

50

A

B

C

FigVII10 Marginal adaptation (proximal)-amalgam restorations (molars)

AB

C

S1

16

60

24

0

10

20

30

40

50

60

A

B

C

FigVII11 Marginal adaptation (proximal)-composite resins restorations (bicusps)

9

AB

C

S1

12

54

34

0

10

20

30

40

50

60

A

B

C

FigVII12 Marginal adaptation (proximal)-composite resins restorations (molars)

AB

C

S1

22

54

24

0

10

20

30

40

50

60

A

B

C

FigVII13 Surface quality-amalgam restorations (bicusps)

AB

C

S1

10

54

36

0

10

20

30

40

50

60

A

B

C

FigVII14 Surface quality-amalgam restorations (molars)

AB

C

S1

12

68

20

0

10

20

30

40

50

60

70

A

B

C

FigVII15 Surface quality-composite resins restorations (bicusps)

AB

C

S1

8

70

22

0

20

40

60

80

A

B

C

FigVII16 Surface quality-composite resins restorations (molars)

10

A

C

S1

98

20

20

40

60

80

100

A

C

FigVII17a-b Prevalence of marginal dental cariesamalgam restorations (moderate

CR)

A

C

S1

92

80

20

40

60

80

100

A

C

FigVII18 Prevalence of marginal dental cariesamalgam restorations (high CR)

A

C

S1

94

60

20

40

60

80

100

A

C

FigVII19 Prevalence of marginal dental cariescomposite resins restorations (CR

moderate)

A

C

S1

82

18

0

10

20

30

40

50

60

70

80

90

A

C

FigVII20 Prevalence of marginal dental cariescomposite resins restorations (high

CR)

11

The study data sustain the results obtained by most studies focused on

posterior amalgam restorations However Hickelampcol (2001) reviewed literature data

and proved that many results varies accordingly to different clinical factors (133)

Roulet JF(1997) warned about limits of cross-sectional studies related to composite

resins restorations because of the absence of data regarding restorative techniques

practitioner experience presence or absence of optimum isolation factors related by

patient (266)

VII5CONCLUSIONS

Amalgam proximo-occlusal restorations with minimum 6-years age present

excellent results for parameters anatomic form (occlusal) marginal

discoloration and marginal secondary dental caries good results for

parameters anatomic form (proximal) and marginal adaptation and poor results

for surface quality

Composite resins proximo-occlusal restorations (bicusps) with minimum 6-

years age present excellent results for parameters color match marginal

discoloration and marginal secondary dental caries and good results for

parameters anatomic form (occlusal proximal) marginal adaptation surface

quality

Composite resins proximo-occlusal restorations (molars) with minimum 6-

years age present good results for parameters color match marginal

discoloration marginal secondary dental caries marginal adaptation and poor

results for parameters anatomic form (occlusal) (54 indices Ryge C)

anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The restorations extended at external third of occlusal surface present highest

percents of indices C regarding anatomic form (occlusal) (54 indices Ryge

C) anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The exceeding of 6-years age will require careful monitorisation for early

interventions through polishing sealing reshaping and even replacement for

restorations with major defects

12

CHAPTVIII CLINICAL PERFORMANCE OF COMPOSITE RESINS

RESTORATIONS RELATED TO RESTORATIVE TECHNIQUE 12-

MONTHS LONGITUDINAL STUDY

VIII1 INTRODUCTION

The restorative technique has a major influence over clinical performance of

composite resins restorations in proximo-occlusal cavities In this context researches

focused on correlations between technique and clinical performance of direct

restorations improve the dentist decision regarding restorative technique choice

VIII2AIM OF STUDY

The aim of study was to determine the clinical performance of composite

resins proximo-occlusal restorations performed using different restorative techniques

VIII3MATERIALS AND METHOD

The group study included 37 patients with age 18-42 years with moderat

ecariogenic risk The total number of composite resins restorations (Herculite XRV

Kerr) was 60 divided in three study groups (n=20)

I Centripetal build-up

II Oblique layering

III Horisontal layering

The coronal restorations were assessed at an interval of 12 months using

indices Ryge modified USPHS

- indice ALFA (A)- IDEAL CLINIC

- indice BRAVO (B)- ACCEPTABLE CLINIC

- indice CHARLIE (C)- UNACCEPTABLE CLINIC

VIII4 RESULTS AND DISCUSSIONS

The statistical tests Kruskal-Wallis and Mann-Whitney were performed to

confirm or infirm research hypotesis (the direct restorations performed using different

restorative techniques present statistical significant differences regarding clinical

performance for the assessed parameters)

13

TableVIII1a-b Groups study (Kruskal-Wallis Test)

Ranks

20 2960

20 2560

20 3630

60

20 3050

20 2420

20 3680

60

20 2490

20 3140

20 3520

60

Restorative_techniques

Centripetal build-up

Oblique layering

Horizontal layering

Total

Centripetal build-up

Oblique layering

Horizontal layering

Total

Centripetal build-up

Oblique layering

Horizontal layering

Total

Marginal_adaptation

Marginal_discoloration

Anatomical_form

N Mean Rank

Test Statisticsab

4913 8031 4900

2 2 2

086 018 086

Chi-Square

df

Asymp Sig

Marginal_

adaptation

Marginal_

discoloration

Anatomical_

form

Kruskal Wallis Testa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between the three restorative

techniques for parameter marginal adaptation (p=0086)

There are no statistical significant differences between the three restorative

techniques for parameter marginal discoloration (p=0018)

There are no statistical significant differences between the three restorative

techniques for parameter anatomical form (proximal) (p=0086)

TableVIII2 Comparing results between restorations performed using three

techniques (marginal adaptation marginal discoloration anatomical form) Marginal adaptation Centripetal build-upOblique layering p=04 ns

Centripetal build-upHorizontal layering p=0191 ns

Oblique layering Horizontal layering p=0028 s

Marginal discoloration Centripetal build-upOblique layering p=0103 ns

Centripetal build-upHorizontal layering p=0195 ns

Oblique layering Horizontal layering p=0005 s

Anatomical form Centripetal build-upOblique layering p=0137 ns

Centripetal build-upHorizontal layering p=0029 s

Oblique layering Horizontal layering p=0433 ns

ns nesemnificativ

s semnificativ

p probabilitate

14

Tables VIII3a-b Mann-Whitney test Comparing analysis regarding marginal

discoloration between restorations performed using oblique layering technique and

centripetal build-up technique

Ranks

20 2180 43600

20 1920 38400

40

Restorative_techniques

Centripetal build-up

Oblique layering

Total

Marginal_adaptation

N Mean Rank Sum of Ranks

Test Statisticsb

174000

384000

-841

400

495a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

adaptation

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between centripetal build-up

and oblique layering techniques regarding parameter marginal adaptation (p=0400)

Tables VIII4a-b Mann-Whitney test Comparing analysis regarding marginal

adaptation between restorations performed using horisontal layering technique and

centripetal build-up technique

Ranks

20 1830 36600

20 2270 45400

40

Restorative_techniques

Centripetal build-up

Horizontal layering

Total

Marginal_adaptation

N Mean Rank Sum of Ranks

Test Statisticsb

156000

366000

-1307

191

242a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

adaptation

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between centripetal build-up

and horisontal layering techniques regarding parameter marginal adaptation

(p=0191)

15

TablesVIII5a-b Mann-Whitney test Comparing analysis regarding marginal

adaptation between restorations performed using oblique layering technique and

horisontal layering technique

Ranks

20 1690 33800

20 2410 48200

40

Restorative_techniques

Oblique layering

Horizontal layering

Total

Marginal_adaptation

N Mean Rank Sum of Ranks

Test Statisticsb

128000

338000

-2191

028

052a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

adaptation

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There is statistical significant differences between horisontal layering and

oblique layering techniques regarding parameter marginal adaptation (p=0028)

Tables VIII6a-b Mann-Whitney test Comparing analysis regarding marginal

discoloration between restorations performed using oblique layering technique and

centripetal build-up technique

There are no statistical significant differences between centripetal build-up

and oblique layering techniques regarding parameter marginal discoloration

(p=0103)

Ranks

20 2260 45200

20 1840 36800

40

Restorative_techniques

Centripetal build-up

Oblique layering

Total

Marginal_discoloration

N Mean Rank Sum of Ranks

Test Statisticsb

158000

368000

-1632

103

265a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

discoloration

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

16

Tables VIII7a-b Mann-Whitney test Comparing analysis regarding marginal

discoloration between restorations performed using centripetal build-up technique and

horisontal layering technique

Ranks

20 1840 36800

20 2260 45200

40

Restorative_techniques

Centripetal build-up

Horizontal layering

Total

Marginal_discoloration

N Mean Rank Sum of Ranks

Test Statisticsb

158000

368000

-1299

194

265a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

discoloration

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between centripetal build-up

and horisontal layering techniques regarding parameter marginal discoloration

(p=0103)

Tables VIII8a-b Mann-Whitney test Comparing analysis regarding marginal

discoloration between restorations performed using oblique layering technique and

horisontal layering technique

Ranks

20 1630 32600

20 2470 49400

40

Restorative_techniques

Oblique layering

Horizontal layering

Total

Marginal_discoloration

N Mean Rank Sum of Ranks

Test Statisticsb

116000

326000

-2822

005

023a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

discoloration

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There is statistical significant differences between horisontal layering and

oblique layering techniques regarding parameter marginal discoloration (p=0005)

17

TablesVIII9 a-b Mann-Whitney test Comparing analysis regarding anatomical

form between restorations performed using centripetal build-up technique and oblique

layering technique

Ranks

20 1830 36600

20 2270 45400

40

Restorative_techniques

Centripetal build-up

Oblique layering

Total

Anatomical_form

N Mean Rank Sum of Ranks

Test Statisticsb

156000

366000

-1486

137

242a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Anatomical_

form

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between centripetal build-up

and oblique layering techniques regarding parameter anatomical form (p=0137)

Tables VIII10a-b Mann-Whitney test Comparing analysis regarding anatomical

form between restorations performed using centripetal build-up technique and

horisontal layering technique

Ranks

20 1710 34200

20 2390 47800

40

Restorative_techniques

Centripetal build-up

Horizontal layering

Total

Anatomical_form

N Mean Rank Sum of Ranks

Test Statisticsb

132000

342000

-2184

029

068a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Anatomical_

form

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between centripetal build-up

and horisontal layering techniques regarding parameter anatomical form (p=0029)

18

Tables VIII11a-b Mann-Whitney test Comparing analysis regarding anatomical

form between restorations performed using oblique layering technique and horisontal

layering technique

Ranks

20 1920 38400

20 2180 43600

40

Restorative_techniques

Oblique layering

Horizontal layering

Total

Anatomical_form

N Mean Rank Sum of Ranks

Test Statisticsb

174000

384000

-784

433

495a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Anatomical_

form

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between horisontal layering and

oblique layering techniques regarding parameter anatomical form (p=0433)

Indices A for restorations performed using centripetal build-up technique were

as follows color match-80 marginal adaptation- 60 marginal discoloration-

70 anatomical form (proximal)- 80 surface quality- 60

Indices A for restorations performed using horisontal layering technique were

as follows color match-70 marginal adaptation- 40 marginal discoloration-

50 anatomical form (proximal)- 50 surface quality- 70

Indices A for restorations performed using oblique layering technique were as

follows color match-70 marginal adaptation- 80 marginal discoloration- 90

anatomical form (proximal)- 60 surface quality- 70

Indices B for restorations performed using centripetal build-up technique were

as follows color match-20 marginal adaptation- 30 marginal discoloration-

20 anatomical form (proximal)- 30 surface quality- 40

Indices B for restorations performed using horisontal layering technique were

as follows color match-30 marginal adaptation- 40 marginal discoloration-

30 anatomical form (proximal)- 30 surface quality- 30

Indices B for restorations performed using oblique layering technique were as

follows color match-30 marginal adaptation- 20 marginal discoloration- 10

anatomical form (proximal)- 40 surface quality- 30

19

Indices C for restorations performed using centripetal build-up technique were

as follows color match-0 marginal adaptation- 10 marginal discoloration- 0

anatomical form (proximal)- 0 surface quality- 0

Indices C for restorations performed using horisontal layering technique were

as follows color match-0 marginal adaptation- 20 marginal discoloration- 20

anatomical form (proximal)- 20 surface quality- 0

Indices C for restorations performed using oblique layering technique were as

follows color match-0 marginal adaptation- 0 marginal discoloration- 10

anatomical form (proximal)- 0 surface quality- 100

Discussions

For in vitro studies is difficult to reproduce the variables existent in oral cavity

like occlusal stress and pH and temperature changes (235) The clinical studies are

determinant in assessment of restorative techniques (300) The most researches

focuses on the influence of restorative technique on the reduction of lightcuring stress

(51 78 135)

VIII5 CONCLUSIONS

Oblique layering technique presents superior results regarding marginal

adaptation and marginal discoloration and is recommended for proximo-

occlusal dental caries close to enamel-cement jonction

Centripetal build-up presents good results regarding marginal adaptation and

anatomical form at proximal level (proximal surfaces and contact point)

Horisontal layering technique can be used for optimum results only in

proximal-occlusal cavities with moderate extension both in occlusal-cervical

and buccal-oral

20

CHAPTIX STUDY REGARDING MARGINAL SEALING STATUS IN

COMPOSITE RESINS LIMITED PROXIMO-OCCLUSAL RESTORATIONS

PERFORMED USING DIFFERENT TECHNIQUES

IX1INTRODUCTION

The contraction of composite resins can produce stress inside dental structure

The most contraction stress appears in the initial stages and development rate of stress

decreases gradually in time (5 98 160) The contraction stress of composite resins

can overpass adhesion strenght and can broke the link between dental tissues and

composite resin (73) When adhesion strenght is high stress can produce marginal

fracture or bulk fracture (74) These situations are associated with microleakage and

penetration of oral fluid and bacteria along dentinal walls endangering the pulpal

tissue or favourising secondary dental caries

IX2 AIM OF STUDY

The study aimed to assess the efficiency of marginal sealing along gingival

wall in limited proximal-occlusal restorations performed using three different

techniques

IX3MATERIALS AND METHOD

The study group included 30 teeth extracted for orthodontic and periodontal

reasons On every tooth two identical class II cavities (on mesial and distal surfaces)

were prepared with cylindrical burs under water cooling The gingival wall was

limited to enamel-cement jonction The cavity dimension were as follows 2 mm

buccal-oral 5mm depth Each tooth was introduced in a pattern of acrylat The

operator calibrated preparation technique on acrylat teeth in Simulation Laboratory of

UMF ―Gr T Popa Iaşi The 60 prepared cavities were randomly divided in three

study groups related to restorative technique The restoration were performed with

Filtek Z550 (3M ESPE) a nanohybrid composite resin The adhesive strategy

included etchamprinse in 2 steps and adhesive Adper Single Bond 2(3MESPE)

Group A (n=20) bulk restorative technique associated with lightcuring from

occlusal 40 seconds and from buccal and oral 20 seconds

Group B (n=20) oblique layering technique (first layer on buccal wall and

buccal frac12 of gingival wall was lightcured from buccal second layer on oral wall and

oral frac12 of gingival wall was lightcured from oral third oral as a triangle with point

oriented to gingival wall was lightcured from occlusal)

Group C (n=20) combined technique (bdquoflow layer on gingival and axial

walls lightcured under pressure only associated with solid composite resin layer)

The proximal surfaces were performed using Tofflemire and metallic matrices After

removal of matrices every restoration was lightcured for another 20 seconds Two

layers aof varnish were applied on composite resins restorations excepting cavity

margins and an area of 1 mm around them The samples were introduced in methylen

21

blue 10 for 48 hours After this stage samples were washed with water and teeth

were cut longitudinally with a diamonded disc

The die penetration was assessed with Zeiss (Iena Germany) X20 microscope

accordingly to four scores (0-3)

0 ndash no penetration

1 ndash die infiltration until external half of gingival wall

2 ndash die infiltration on all gingival wall

3 ndash die infiltration on gingival wall and axial wall

IX4RESULTS AND DISCUSSIONS

The result of die penetration are presented in table IX1

TableIX1 The results for die penetration

Grup 0 1 2 3

A (bulk) 0 0 3 17

B (layering) 0 4 5 11

C (combined) 12 5 2 1

In group A 17 sample had score 3 and 2 samples had score 2 In group B 11

sample had score 3 5 samples had score 2 and 4 sample had score 1 In group C with

best results 12 samples had score 0 5 samples had score 1 2 samples had score 2 1

sample had score 3

The recorded data were analysed using test Mann-Whitney The statistical

results are presented in tables IX2-IX4

Tables IX2a-b Mann-Whitney for comparisons of microleakage values between

bulk technique and incremental technique

Ranks

Restorative technique N Mean Rank Sum of Ranks

Scores

frequency

A ndash bulk technique 20 2420 24200

B ndash incremental

technique

20 1680 16800

Total 40

Test Statisticsb

scores

frequency

Mann-Whitney U 29000

Wilcoxon W 168000

Z -1970

Asymp Sig (2-tailed) 049

Exact Sig [2(1-tailed Sig)] 123a

a Not corrected for ties

b Grouping Variable restorative technique

22

Tables IX3a-b Mann-Whitney for comparisons of microleakage values between

bulk technique and mixed technique

Ranks

Restorative technique N Mean Rank Sum of Ranks

scores

frequency

A ndash bulk technique 20 3090 30900

C ndash mixed technique 20 1010 10100

Total 40

Test Statisticsb

scores

frequency

Mann-Whitney U 500

Wilcoxon W 101000

Z -4021

Asymp Sig (2-tailed) 000

Exact Sig [2(1-tailed Sig)] 000a

a Not corrected for ties

b Grouping Variable restorative technique

Tables IX4a-b Mann-Whitney test for comparisons of microleakage values

between incremental technique and mixed technique

Ranks

Restorative technique N Mean Rank Sum of Ranks

scores

frequency

B ndash incremental

technique

20 2990 29900

C ndash mixed technique 20 1210 12100

Total 40

Test Statisticsb

scores

frequency

Mann-Whitney U 5500

Wilcoxon W 121000

Z -3492

Asymp Sig (2-tailed) 000

Exact Sig [2(1-tailed Sig)] 000a

a Not corrected for ties

23

Test Statisticsb

scores

frequency

Mann-Whitney U 5500

Wilcoxon W 121000

Z -3492

Asymp Sig (2-tailed) 000

Exact Sig [2(1-tailed Sig)] 000a

a Not corrected for ties

b Grouping Variable tehnrestaurare

The results of microleakage degree were statistically significant when the

three restorative techniques were compared The results showed that best restorative

technique regarding marginal sealing in cervical area is combined technique followed

by oblique layering technique The use of layering techniques limits the development

of contraction forces between oposite walls event that favourises bulk stress voids

formation and fissure inside dental tissues The results of our study are similar with

other studies (114 293)

IX5 CONCLUSIONS

The values of die penetration at gingival wall were statistically different

between the three restorative techniques

We concluded that all restorative methods were associated with lightcuring

contraction and marginal microleakage

The combined technique was associated with lowest lightcuring contraction

and die penetration

The bulk technique was associated with highest lightcuring contraction and die

penetration

24

CHAPTX STUDY REGARDING THE EFFECTS OF ETCHING ON

ENAMEL AND DENTINE IN CERVICAL AREA FOR PROXIMAL

CAVITIES AT LATERAL DENTAL GROUP

X1 INTRODUCTION

The studies reported marginal defects and high microleakage at the level of

gingival margins localised in cervical area or close to enamel-cement jonction for

high percents of proximal-occlusal composite resins restorations (8485) The good

adhesion is requested to insure restoration longevity and to prevent marginal

microleakage and presence of secondary marginal dental caries The adhesion

strenght of different adhesive systems can vary accordingly to tissues areas (204 240)

and to variations in dentinal structures (234 330) Most studies focused on adhesive

systems performances used healthy dentine close to pulp room but in case of class II

restorations there are particular features that influences the adhesion at the level of

gingival margins

The surface topography is an important property that determines the

interaction manner between surfaces The surface roughness and surface energy can

increase or decrease the adhesion of composite resins to the hard dental tissues

X2 AIM OF STUDY

The aim of study was to compare surface roughness of enamel and dentine

after etching related to different distances related to enamel-dentinecement jonction

X3 MATERIALS AND METHODS

The study group included 20 molars extracted from orthodontics or

periodontal reasons with intact proximal surfaces The teeth were cut longitudinally in

sens buccal-oral with diamond discs under water cooling

A group study (10 teeth) included 10 samples obtained through transversal

cutting at distance of 2mm from enamel-dentinecement jonction and 10 samples

obtained through transversal cutting at distance of 15 mm from enamel-

dentinecement jonction Another study group (10 teeth) included 10 samples

obtained through transversal cutting at distance of 1mm from enamel-dentinecement

jonction and 10 samples obtained through transversal cutting at distance of 05 mm

from enamel-dentinecement jonction All these samples were divided in two halfes

through mesial-distal cutting The samples finishing was performed with abrasive

paper (100-4000) and final polishing was performed with a device Buehler model

Minimet with slices introduced in ultrasound bath for 4 minutes The second half of

each sample was etched for 15 seconds with ortophosphoric acid 37 for 15 seconds

Slices were washed with distilled water for 30 seconds after etching and dried

The samples were analysed with atomic force microscopy (AFM) regarding

surface roughness The results were expressed as relative variation of roughness

X4 RESULTS AND DISCUSSIONS

The aspect of etched enamel at 2 mm distance from ECJ can be seen in figure

X1 (section 10 microm) The surface roughness is higher comparing with sample before

etching

25

După gravajul cu acid ortofosforic 37

The aspect of etched enamel at 15 mm distance from ECJ can be seen in

figure X2 (section 10 microm) The surface roughness is higher comparing with sample

before etching but lower comparing with sample at 2 mm from ECJ

The aspect of etched enamel at 1 mm distance from ECJ can be seen in figure

X3 (section 10 microm) The surface roughness is higher comparing with sample before

etching but lower comparing with sample at 15mm and 2 mm from ECJ

The aspect of etched enamel at 15 mm distance from ECJ can be seen in

figure X4 (section 10 microm) The surface roughness is higher comparing with sample

before etching but lower comparing with sample at 1 mm 15 mm and 2 mm from

ECJ

FigX1 3D aspect of enamel at 2 mm from ECJ

after etching (10 microm)

FigX2 3D aspect of enamel at 15 mm from ECJ

after etching (10 microm)

FigX3 3D aspect of enamel at 1 mm from ECJ

after etching (10 microm)

FigX4 3D aspect of enamel at 05 mm from ECJ

after etching (10 microm)

26

The mean values of squared roughness for dentine and enamel before etching

are presented in tables X1 and X2

Table X1 Squared roughness values for dentine samples before and after etching

Before etching (nm) After etching (nm)

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

sample

1

335 282 283 259 1149 947 901 879

sample

2

352 284 274 266 1127 939 883 875

sample

3

357 273 278 263 1152 953 876 867

sample

4

323 269 264 258 1146 942 895 883

sample

5

348 298 271 268 1153 944 904 878

sample

6

339 274 278 273 1158 937 893 892

sample

7

352 283 269 266 1145 944 899 876

sample

8

349 292 272 274 1166 942 907 869

sample

9

357 284 275 265 1132 939 893 879

sample

10

348 281 277 262 1142 941 899 878

Table X2 Squared roughness values for enamel and dentine samples before and after

etching

Before etching (nm) After etching (nm)

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

sample 1 422 342 309 313 2255 1114 874 845

sample 2 418 338 324 304 2236 1102 882 839

sample 3 413 334 315 303 2239 1115 873 833

sample 4 416 336 322 308 2242 1116 868 842

sample 5 426 332 315 294 2218 1103 877 829

sample 6 412 332 317 306 2237 1099 874 847

sample 7 414 335 322 314 2252 1102 876 834

sample 8 416 325 318 313 2239 1106 875 838

sample 9 418 328 314 299 2246 1113 879 836

sample 10 413 334 316 305 2242 1104 873 839

The results for samples before etching prove a decreasing tendency for mean

values of squared roughness surface beginning with areas placed at distance of 2 mm

from ECJ (346 nm) followed by areas placed at distance of 15 mm from ECJ (282

nm) 1 mm from ECJ (274 nm) and 05 mm from ECJ (265 nm) After etching the

decreasing tendency maintained for dentine localised at 2 mm from ECJ to dentine

localised at 05 mm from ECJ The mean values of squared roughness after etching

were three times higher (tables X3)

27

Table X3 Squared roughness values for enamel and dentine samples before and

after etching

Dentine Enamel

Before etching

(nm)

After etching

(nm)

Before etching

(nm)

After etching

(nm)

2 mm ECJ 346 1147 416 2237

15 mm ECJ 282 942 333 1107

1 mm ECJ 274 895 317 875

05 mm ECJ 265 877 305 838

The descriptive statistics data for surface roughness of dentine before and after

etching are presented in tables X4 si X5

Table X4 Descriptive statistics for dentine samples before etching

Statistics

Dentine 2mm

before etching

Dentine 15mm

before etching

Dentine 1mm

before etching

Dentine 05mm

before etching

N Valid 10 10 10 10

Missing 0 0 0 0

Mean 346000 282000 274100 265400

Std Error of Mean 33830 27487 17026 16746

Std Deviation 106979 86923 53841 52957

Skewness -1214 354 -314 348

Std Error of Skewness 687 687 687 687

Kurtosis 1141 049 336 -539

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 3230 2690 2640 2580

Maximum 3570 2980 2830 2740

Table X5 Descriptive statistics for dentine samples after etching

Statistics

Dentine 2mm

after etching

Dentine 15mm

after etching

Dentine 1mm

after etching

Dentine 05mm

after etching

N Valid 10 10 10 10

Missing 0 0 0 0

1147000 942800 895000 877600

Std Error of Mean 36545 14591 29926 22020

Std Deviation 115566 46140 94634 69634

Skewness -267 1169 -951 535

Std Error of Skewness 687 687 687 687

Kurtosis 043 1776 564 1416

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 11270 9370 8760 8670

28

Statistics

Dentine 2mm

after etching

Dentine 15mm

after etching

Dentine 1mm

after etching

Dentine 05mm

after etching

N Valid 10 10 10 10

Missing 0 0 0 0

1147000 942800 895000 877600

Std Error of Mean 36545 14591 29926 22020

Std Deviation 115566 46140 94634 69634

Skewness -267 1169 -951 535

Std Error of Skewness 687 687 687 687

Kurtosis 043 1776 564 1416

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 11270 9370 8760 8670

Maximum 11660 9530 9070 8920

To choose the statistical test to compare roughness surface values was

performed a test Shapiro-Wilk If p is lower or equal with 0005 than hypothesis of

distribution normality is rejected (distribution deviates from normal form) In the table

X6 the distributions are normal The statistical test will be test t for pair samples

Table X6 Test Shapiro-Wilk for dentine samples

Tests of Normality

Kolmogorov-Smirnov

a Shapiro-Wilk

Statistic df Sig Statistic df Sig

Dentine 2mm before etching 274 10 032 877 10 122

Dentine 15mm after etching 209 10 200 952 10 689

Dentine 1mm before etching 134 10 200 983 10 980

Dentine 05mm before etching 155 10 200 949 10 661

Dentine 2mm after etching 133 10 200 977 10 946

Dentine 15mm after etching 197 10 200 916 10 329

Dentine 1mm after etching 216 10 200 925 10 401

Dentine 05 after etching 220 10 185 933 10 474

Enamel 2mm before etching 193 10 200 898 10 207

Enamel 15mm before etching 170 10 200 977 10 947

Enamel 1mm before etching 157 10 200 952 10 689

Enamel 05mm before etching 165 10 200 943 10 590

Enamel 2mm after etching 235 10 124 925 10 404

Enamel 15mm after etching 209 10 200 871 10 102

Enamel 1mm after etching 189 10 200 964 10 834

Enamel 05mm after etching 142 10 200 983 10 978

a Lilliefors Significance Correction

29

Tests of Normality

Kolmogorov-Smirnov

a Shapiro-Wilk

Statistic df Sig Statistic df Sig

Dentine 2mm before etching 274 10 032 877 10 122

Dentine 15mm after etching 209 10 200 952 10 689

Dentine 1mm before etching 134 10 200 983 10 980

Dentine 05mm before etching 155 10 200 949 10 661

Dentine 2mm after etching 133 10 200 977 10 946

Dentine 15mm after etching 197 10 200 916 10 329

Dentine 1mm after etching 216 10 200 925 10 401

Dentine 05 after etching 220 10 185 933 10 474

Enamel 2mm before etching 193 10 200 898 10 207

Enamel 15mm before etching 170 10 200 977 10 947

Enamel 1mm before etching 157 10 200 952 10 689

Enamel 05mm before etching 165 10 200 943 10 590

Enamel 2mm after etching 235 10 124 925 10 404

Enamel 15mm after etching 209 10 200 871 10 102

Enamel 1mm after etching 189 10 200 964 10 834

Enamel 05mm after etching 142 10 200 983 10 978

a Lilliefors Significance Correction

This is a lower bound of the true significance

The results of test t for pair dentine samples before and after etching are

presented in table X

Table X7 Test t for dentine before and after etching

Paired Samples Test

Paired Differences

t df

p (2-

tailed)

95 Confidence

Interval of the

Difference

Mean

Std

Dev

Std

Error

Mean Lower Upper

Pair

1

dentine2mmbeforeetching-

dentine2mmafteretching

-

8010000

174801 55277 -

8135045

-

7884955

-

144906

9 000

Pair

2

dentine15mmbeforeetching-

dentine15mmafteretching

-

6608000

102394 32380 -

6681248

-

6534752

-

204079

9 000

Pair

3

dentine1mmbeforeetching-

dentine1mmafteretching

-

6209000

117799 37251 -

6293269

-

6124731

-

166678

9 000

30

Paired Samples Test

Paired Differences

t df

p (2-

tailed)

95 Confidence

Interval of the

Difference

Mean

Std

Dev

Std

Error

Mean Lower Upper

Pair

1

dentine2mmbeforeetching-

dentine2mmafteretching

-

8010000

174801 55277 -

8135045

-

7884955

-

144906

9 000

Pair

2

dentine15mmbeforeetching-

dentine15mmafteretching

-

6608000

102394 32380 -

6681248

-

6534752

-

204079

9 000

Pair

3

dentine1mmbeforeetching-

dentine1mmafteretching

-

6209000

117799 37251 -

6293269

-

6124731

-

166678

9 000

Pair

4

dentine05mmbeforeetching-

dentine05mmafteretching

-

6122000

86384 27317 -

6183796

-

6060204

-

224109

9 000

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of dentine (

2mm 15 mm 1mm sau 05mm)

The descriptive statistics data for dentine surface roughness before and after

etching are presented in tables X8 and X9

Table X8 Descriptive statistics for enamel samples before etching

Statistics

Enamel 2mm

before etching

Enamel 15mm

before etching

Enamel 1mm

before etching

Enamel 05mm

before etching

N Valid 10 10 10 10

Missing 0 0 0 0

Mean 416800 333600 317200 305900

Std Error of Mean 13968 15217 14205 20355

Std Deviation 44171 48120 44920 64369

Skewness 1095 -156 -109 -411

Std Error of Skewness 687 687 687 687

Kurtosis 769 487 -118 -295

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 4120 3250 3090 2940

Maximum 4260 3420 3240 3140

31

Table X9 Descriptive statistics for enamel samples after etching

Statistics

Enamel 2mm

after etching

Enamel 15mm

after etching

Enamel 1mm

after etching

Enamel 05mm

after etching

N Valid 10 10 10 10

Missing 0 0 0 0

Mean 2237600 1107400 875100 838200

Std Error of Mean 31027 20232 11968 17436

Std Deviation 98116 63979 37845 55136

Skewness -850 267 042 040

Std Error of Skewness 687 687 687 687

Kurtosis 878 -1880 1082 -425

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 22180 10990 8680 8290

Maximum 22520 11160 8820 8470

To choose the statistical test to compare roughness surface values was

performed a test Shapiro-Wilk If p is lower or equal with 0005 than hypothesis of

distribution normality is rejected (distribution deviates from normal form) In the table

X10 the distributions are normal The statistical test will be test t for pair samples

Table X10 Test Shapiro-Wilk for enamel samples

Tests of Normality

Kolmogorov-Smirnova Shapiro-Wilk

Statistic df Sig Statistic df Sig

2mmenamel before etching 193 10 200 898 10 207

15mmenamel before etching 170 10 200 977 10 947

1mmenamel before etching 157 10 200 952 10 689

05mmenamel before etching 165 10 200 943 10 590

2mmenamel after etching 235 10 124 925 10 404

15mmenamel after etching 209 10 200 871 10 102

1mmenamel after etching 189 10 200 964 10 834

05mmenamel after etching 142 10 200 983 10 978

a Lilliefors Significance Correction

This is a lower bound of the true significance

The results of test t for pair enamel samples before and after etching are

presented in table X11

32

Table X11 Test t for enamel samples before and after etching

Paired Samples Test

Paired Differences

t df

p (2-

tailed)

95 Confidence

Interval of the

Difference

Mean

Std

Deviation

Std

Error

Mean Lower Upper

Pair

1

2mmenamel before

etching

2mmenamel after

etching

-18208 135220 42760 -

18304731

-

18111269

-

425815

9 000

Pair

2

15mmenamel before

etching

15mmenamel after

etching

-7738 73151 23132 -7790329 -7685671 -

334508

9 076

Pair

3

1mmenamel before

etching

1mmenamel after

etching

-5579 55468 17540 -5618679 -5539321 -

318065

9 065

Pair

4

05mmenamel before

etching

05mmenamel after

etching

-5323 60378 19093 -5366192 -5279808 -

278788

9 063

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel ( 2mm 15 mm 1mm sau

05mm) but the differences statistical significant are present only for enamel localised

at 2 mm from ECJ

X5CONCLUSIONS

The surfaces of enamel and dentine at cervical level record decreases of

roughness related to the decrease of distance to ECJ

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel but the differences

statistical significant are present only for enamel localised at 2 mm from ECJ

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of

dentine

33

CHAPTXI FEA STUDY REGARDING THE BIOMECHANICAL

BEHAVIOUR AND FRACTURE RESISTANCE OF PROXIMO-OCCLUSAL

AMALGAM AND COMPOSITE RESINS RESTORATIONS

XI1INTRODUCTION AIM OF STUDY

The individual variation of patients morphological and functional complexity

of tissues as well as difficult access limit the possibilities to investigate in clinical

studies the biomechanical behaviour of proximo-occlusal restorations In this context

simulation of the biomechanics for direct restorations represents an interesting

interdisciplinar domain in actual dentistry research

The study focused on two direction

- analysis of role of forces intensity on biomechanical behaviour related to

cavity dimension and material

- analysis of tension inside restoration structure related to forces intensity

XI2MATERIALS AND METHODS

The stages of finite element analysis study are as follows

object modelling (bicusps and proximo-occlusal restoration)

definition of parameters for materials and dental tissues

meshing

constraints and loading

types of contacts

equations system definition

results of simulation

The object 3D modelling was performed in Rhinoceros (figure XI1) The

definition of parameters was performed for Poisson constant Young modulus density

(table XI1) The selected materials were amalgam and composite resins The

analysed tissues were dentine and enamel The meshing constraints loading were

performed for forces of 200N 400N 600N 800 N The analysis was performed using

software COSMOSWorks 2010

34

Fig XI1 3D modellation of bicusp

Table XI1 Values of Young modulus Poisson constant compression resistance for

amalgam composite resin enamel (amalgam compozit smalţ)

Material Young modulus (GPa) Poisson constants

Compression

resistance

(Mpa)

Amalgam 55 033 483

Enamel 48 03 400

Composite

resin 220 022 345

Fig XI2 The forces and constraints application

The results are presented in values and culours red colours representing areas

with maximum values of tensions produced under influence of masticatory forces

The tensions produced in amalgam restoration are in a range from 0 to 22886

(force 800 N) The maximum von Misses tensions are associated with cervical area

of amalgam restorations This aspect proves that first modification in interface

restoration-cavity margins will appear at the level of gingival wall First marginal

35

defects and fissures in restoration bulk will appear at tensions over 1600Mpa

associated with forces of 800N for extended amalgam proximo-occlusal restorations

The tensions produced in composite resin restorations are in a range from 0 to

2285 (force 800 N) The maximum von Misses tensions are associated with cervical

area of composite resin restorationsThis aspect proves that first modification in

interface restoration-cavity margins will appear at the level of gingival wall First

marginal defects and fissures in restoration bulk will appear at tensions over 1716

Mpa associated with forces of 600N for moderate and extended composite resins

proximo-occlusal restorations

Fig XI3a-b ndash Simulated model of proximo-occlusal restoration

FigXI4a-b Dental amalgam restoration Cervical tension associated with 600 N

(c)800 N (d)

FigXI5a-b Composite resin restoration Cervical tension associated with 600 N

(c)800 N (d)

36

The deformation of amalgam can be produced only when is associated with

fissures in bulk of restorations while composite resins restorations present

deformation when are associated with a modification of volume and form because of

repeated action of medium forces on long term or high forces on short term (figures

XI4 XI5)

Fig XI4 Material deformation in area of maximum tension

000E + 00

500E -02

100E -01

150E -01

200E -01

250E -01

1 4 7 101316192225283134374043464952555861646770737679

Amalgam C ompoz it

Figura XI5 Deformarea funcție de material

The amalgam and composite resins were treated as homogenous isotropic and

liniar The advantage of this type of FEA study is that restorations parameters can be

modified any time is necessary both in arhitecture geometry and material indices

variability The results of this study sustain the conclusions of other FEA studies

focused on biomechanical behaviour of posterior restorations performed with

amalgam and composite resins(35 62 76 143)

37

XI4CONCLUSIONS

bull The amalgam in class II restorations has a low deformation tendency because

of uniform distribution of tension inside material

bull Composite resins class II restorations accumulate higher tensions comparing

with amalgam but deformation is avoided for a time because of the adhesion

forces performed between molecules under moderate oral forces In case of

high oral forces (600-800N) the risk of fracture in moderate class II

restorations is higher comparing with amalgam proximo-occlusal restorations

For extended class II restorations and forces of 600 N composite resins present

highest risk of fracture and deformation The von Misses tension at the

cervical interface restorationtooth can reach 1600Mpa

bull The amalgam in moderate class II restorations can resist to deformation even

for high intensity forces limited to 600N In extended class II restorations the

risk of deformation and fracture increases at values of 600N-800N of oral

forces The von Misses tension at the cervical interface restorationtooth can

reach 1700 Mpa

38

FINAL CONCLUSIONS

Amalgam proximo-occlusal restorations with minimum 6-years age present

excellent results for parameters anatomic form (occlusal) marginal

discoloration and marginal secondary dental caries good results for

parameters anatomic form (proximal) and marginal adaptation and poor results

for surface quality

Composite resins proximo-occlusal restorations (bicusps) with minimum 6-

years age present excellent results for parameters color match marginal

discoloration and marginal secondary dental caries and good results for

parameters anatomic form (occlusal proximal) marginal adaptation surface

quality

Composite resins proximo-occlusal restorations (molars) with minimum 6-

years age present good results for parameters color match marginal

discoloration marginal secondary dental caries marginal adaptation and poor

results for parameters anatomic form (occlusal) (54 indices Ryge C)

anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The restorations extended at external third of occlusal surface present highest

percents of indices C regarding anatomic form (occlusal) (54 indices Ryge

C) anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The exceeding of 6-years age will require careful monitorisation for early

interventions through polishing sealing reshaping and even replacement for

restorations with major defects

Oblique layering technique presents superior results regarding marginal

adaptation and marginal discoloration and is recommended for proximo-

occlusal dental caries close to enamel-cement jonction

Centripetal build-up presents good results regarding marginal adaptation and

anatomical form at proximal level (proximal surfaces and contact point)

Horisontal layering technique can be used for optimum results only in

proximal-occlusal cavities with moderate extension both in occlusal-cervical

and buccal-oral

The values of die penetration at gingival wall were statistically different

between the three restorative techniques

We concluded that all restorative methods were associated with lightcuring

contraction and marginal microleakage

The combined technique was associated with lowest lightcuring contraction

and die penetration

The bulk technique was associated with highest lightcuring contraction and die

penetration

39

The surfaces of enamel and dentine at cervical level record decreases of

roughness related to the decrease of distance to ECJ

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel but the differences

statistical significant are present only for enamel localised at 2 mm from ECJ

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of

dentine

bull The amalgam in class II restorations has a low deformation tendency because

of uniform distribution of tension inside material

bull Composite resins class II restorations accumulate higher tensions comparing

with amalgam but deformation is avoided for a time because of the adhesion

forces performed between molecules under moderate oral forces In case of

high oral forces (600-800N) the risk of fracture in moderate class II

restorations is higher comparing with amalgam proximo-occlusal restorations

For extended class II restorations and forces of 600 N composite resins present

highest risk of fracture and deformation The von Misses tension at the

cervical interface restorationtooth can reach 1600Mpa

bull The amalgam in moderate class II restorations can resist to deformation even

for high intensity forces limited to 600N In extended class II restorations the

risk of deformation and fracture increases at values of 600N-800N of oral

forces The von Misses tension at the cervical interface restorationtooth can

reach 1700 Mpa

REFERENCES

1ADA Council on Scientific Affairs ADA Council on Dental Benefit Programs

Statement on posterior resin-based composites JADA 1998 129(11)1627ndash1628

2Albers HF Tooth-colored restoratives 1st ed Santa Rosa CA Alto Books 1979

3Allander L Birkhed D Bratthall D Reasons for replacement of class II amalgam

restorations in private practice Swed Dent J 199014(4)179-84

4Alomari QD Reinhardt JW Boyer DB Effect of liners on cusp deflection and

gap formation in composite restorations Oper Dent 200126406- 11

5Alster D Feilzer AJ de Gee AJ Mol A Davidson CL The dependence of

shrinkage stress reduction on porosity concentration in thin resin layers J Dent Res

1992711619ndash1622

6Aggarwal V Logani A Jain V Shah N Effect of cyclic loading on marginal

adaptation and bond strength in direct vs indirect class II MO composite restorations

Oper Dent 2008 Sep-Oct33(5)587-92

7Andrian S Lăcătuşu St- Caria dentară- Protocoale şi tehnici- EdApolloniaIaşi

1999

8Andrian S- Restaurări fizionomice cu materiale plastice icircn cariologie-EdPanteon

Iaşi 2001

40

9Andrian S Tratamentul Minim Invaziv al Cariei Dentare EditPrinceps Edit Iaşi

2002

10Angmar-Mansson B ten Bosch JJ Optical methods for the detection and

quantification of caries Adv Dent Res 1987 1(1) 14-20

11Angmar-Mansson B ten Bosch JJ Advances in methods for diagnosting coronal

caries Adv Dent Res 1993 7(2) 70-79

12Angmar-Mansson B Al-Khateeb S Tranaeus S Monitoring the caries process

Optical methods for clinical diagnosis and quantification of enamel caries European

Journal of Oral Sciences 1996 104 480-485

13Angmar-Mansson B Al-Khateeb S Tranaeus S Caries diagnosis Journal of

Dental Education 1998 62 (10) 771-780

14Anusavice KJ- ldquoQuality evaluation of dental restorationscriteria for placement

and replacement Chicago 1989Quintessence Publishing

15Anusavice KJ Development and testing of ceramics for dental restorations In

Fischman G Clare A Hench J editors Bioceramics materials and applications

Westerville OH 1995

16Arhun N Celik C Yamanel KClinical evaluation of resin-based composites in

posterior restorations two-year results Oper Dent 201035(4)397-404

17Armstrong SR JC Keller DB Boyer The influence of water storage and C-

factor on the dentinndashresin composite microtensile bond strength and debond pathway

utilizing a filled and unfilled adhesive resin Dent Mater 200117268ndash276

18Armstrong S Boyer D Keller J Microtensile bond strength testing and failure

analysis of two dentin adhesives Dent Mater 1998 14(1)44-50

19Asmussen E Peutzfeldt A Influence of UEDMA BisGMA and TEGDMA on

selected mechanical properties of experimental resin composites Dent Mater1998

1451-56

20Asmussen E Clinical relevance of physical chemical and bonding properties of

composites resins Oper Dent 19851061-73

21Bader JD Brown JP Dilemmas in caries diagnosisJ Am Dent Assoc1993124

(6) 48-50

22Bader JD Shugars DA What do we know about how dentists make caries-

related treatment decisions Community Dent Oral Epidemiol 1997 25(1) 97-103

23Bader JD Shugars DA Bonito AJ A systematic review of the performance of

methods for identifying carious lesions JPublic Health Dent 2002 62 (4) 201-213

24Bader JD Shugars DA Bonito AJ Systematic reviews of selected dental caries

diagnostic and management methods J Dent Educ 2001 65 (10) 960-968

25Bader J Ismail A Survey of systematic reviews in dentistry JADA 2004 135

464-473

26Bader JD Shugars DA Understanding dentistslsquo restorative treatment decisions J

Public Health Dent 1992 Winter52(2)102-10

27Barkmeier WW Cooley RL Current status of adhesive resin systems J Am Coll

Dent 199158 36-39

28Bayne SC Dental biomaterials where are we and where are we going J Dent

Educ 200569(5)571ndash585

41

29Bedran-de-Castro AK Pereira PN Thompson JY Influence of load cycling

and tubule orientation on ultimate tensile strength of dentin J Adhes Dent 2004 6(3)

191-194

30Behle C Flowable composite Proprieties and applications Pract Periodontics

Aesthetics Dent 1998 10347 350-351

31Bergenholtz G Cox CF Bacterial leakage around dental restorations Its effects

on the dental pulp J Oral Path 198211 439 ndash450

32Bernardo M Luis H Martin MD Survival and reasons for failure of amalgam

versus composite posterior restorations placed in a randomized clinical trial JADA

2007138(6)775ndash783

33Black J Biological Performance of Materials Fundamentals of Biocompatibility

NY Marcel Dekker Inc 1999

34Bonsor SJ Chadwick RGLongevity of conventional and bonded (sealed)

amalgam restorations in a private general dental practice Br Dent J 2009206(2)88-

9

35Boschian PL S Guidotti R Pietrbissa M Gagliani- bdquoStress distribution in a

post-restored tooth using the threedimensional finite element method Journal of Oral

Rehabilitation (33) 2006690ndash697

36Bouillaguet S B Ciucchi T Jacoby JC Wataha DH Pashley Bonding

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321

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200521(10)962-70

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199930(4)234-42

42

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of restorations at failure and reasons for their placement and replacement J Dent

200129(5)317-24

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2004 20939-946

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Jun30(6)413-8

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Dentomaxillofac Radiol 2007 Mar36(3)138-42

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Study Orthodontic Tooth Movement J Dent Res 2005 84(5)428-433

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bond strength to primary dentin J Dent Child 2003 70(2) 139-144

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posterior restorations 12-month results Eur J Dent 2010 Jan4(1)57-65

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marginal leakage J Dent 2005 33(7) 603- 610

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Med 2008173(1)23ndash26

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stress in light-cured packable composite resinsDent Mater 200117253-259

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polymerization contraction stress of composites J Dent Res 2000 79812ndash817

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Behinderten Dtsch Zahnartzlicher 1999 54 96-102

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Three Core Restorative Materials Supported with or without a Prefabricated Split-

Shank Post Journal of Prosthetic Dentistry1997 78 560ndash565

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in Class II composite resin restoration applied in bulk or in two increments

Quintessence Int 1993 24583-591

43

64Collins CJ Bryant RW Hodge KL A clinical evaluation of posterior composite

resin restorations 8-year findings J Dent 199826(4) 311ndash317

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polymerization stress J Am Dent Assoc2000 131497-503

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behaviour of dimethacrylate composite resins Biomaterials 1990 11272-276

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FOTIvisual examination of occlusal caries with other caries diagnostic methods and

the effect of stain on their diagnostic performance Caries Res 2003 37 (1) 8-16

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1991469-72

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1399

70Dauvillier BS Aarnts MP Feilzer AJ Developments in shrinkage control of

adhesive restoratives J Esthet Dent 2000 12291-299

71Dauvillier BS Aarnts MP Feilzer AJ Modeling of the viscoelastic behavior of

dental light-activated resin composites during curing Dent Mater 200319277ndash285

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bond strength and the polymerization contraction stress J Dent Res 1984

63(12)1396-9

73Davidson CL AJ Feilzer Polymerization shrinkage and polymerization

shrinkage stress in polymer-based restoratives J Dent Res 199725435ndash440

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Prosthet Dent 198655446ndash7

75Davis RD Mayhew RB A clinical comparison of three anterior restorative resins

at 3 years J Am Dent Assoc 1986112659-63

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and adhesion of composite resin versus ceramic inlays in molarsJ Prosthet

Dent200899131-40

77Deligeorgi V Mjor IA Wilson NH An overview of reasons for the placement

and replacement of restorations Prim Dent Care 20018(1)5-11

78Deliperi S Bardwell DN An alternative method to reduce polymerization

shrinkage in direct posterior composite restorations J Am Dent Assoc 2002

1331387ndash97

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surfaces and its distribution by age and gender in university clinic patientsEur J

Dent20104(3)270-9

80De Munck J Van Meerbeek B Satoshi I Vargas M Yoshida Y Armstrong S

Lambrechts P Vanherle G Microtensile bond strengths of one- and two-step

selfetch adhesives to bur-cut enamel and dentin Am J Dent 2003 16 414-420

81Dewaele M Truffier-Boutry D Devaux J Leloup G Volume contraction in

photocured dental resins the shrinkage-conversion relationship revisited Dent Mater

2006 22359-365

44

82Deutsch WM Simecek JW Dental emergencies among Marines ashore in

Operations Desert ShieldStorm Mil Med 1996161(10) 620ndash623

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of methacrylate dental resins Macromolecules 2003 366043-6053

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restorative technique and new adhesives on the dentin marginal seal and adaptation of

resin composite Class II restorations An in vitro evaluation Quintessence Int 1995

26 717-727

85Dietschi D Herzfeld D In vitro evaluation of marginal and internal adaptation of

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Sci 1998 106 1033-1042

86Dietschi D Marginal adaptation and seal of direct and indirect Class II composite

resin restorations an in vitro evaluation Quintessence Int 26(2)127-138 1995

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caries status and dental emergencies among US naval personnel J Dent Res

20028195 (Abstract)

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resinamalgam combinations Oper Dent 1997 22 50-56

89Donly KJ Jensen ME Triolo PA clinical comparison of resin composite inlay

and onlay posterior restorations and cast-gold restorations at 7 years Quintessence Int

30(3)163- 1681999

90Douglas WH Fields RP Fundingsland J A comparison between the

microleakage of direct and indirect composite restorative systems J Dent 17(4)184-

188 1989

91Eberhard J Hartman B Lenhard M Mayer T Kocher T Eickholz P Digital

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Caries Res 200034(3)219-24

92Edelstein BL Douglass CW Dispelling the myth that 50 percent of US

schoolchildren have never had a cavity Public Health Rep1995 110 (5) 522-530

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its possible influence on postoperative sensitivity Quintessence Int 198617103-11

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bis GMA and TEGDMA a modeling approach to understanding the cure of dental

resins Dent Mater 2001 17221-229

95Ermis R Ulkam Aydin Examiner agreement in the replacement decisions of

class I amalgam restorations The Journal of contemporary dental practice 2004 Vol

5 no21-7

96Feilzer AJ AJ De Gee CL Davidson Increased wall-to-wall curing

contraction in thin bonded resin layers J Dent Res 19896848ndash50

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development and viscoelastic properties of experimental twopaste composites J Dent

Res 2003 82824-828

98Feilzer AJ de Gee AJ Davidson CL Relaxation of polymerization contraction

shear stress by hygroscopic expansion J Dent Res 1990 6936ndash39

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99Feilzer AJ De Gee AJ Davidson CL Setting stress in composite resin in relation

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on polymerization shrinkage and integrity of restoration-cavity interface Eur J Oral

Sci 1995 103322ndash326

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systems in the prediction of occlusal caries in permanent molars in 6 and 11 year-old

children J Dent 1998 26(5) 403-40

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in dental composites during polymerization Dent Mater 2005 2136-42

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104Ferreira MC Vieira RS Marginal leakage in direct and indirect composite resin

restorations in primary teeth an in vitro study J Dent 200836(5)322-5

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restorations in adults Acta Odontol Scand 2004 6282-86

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ceramic inlays for four and a half years J Prosthet Dent 1997 78(4)346-353

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108Francci C Loguercio AD Reis A Carrilho MR A novel filling technique for

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14(3)149-57

109Fruits TJ Knapp JA Khajotia SS Microleakage in the proximal walls of

direct and indirect posterior resin slot restorations Oper Dent 200631(6)719-27

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restorations The 10-year report J Adhes Dent 2001 3185-194

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Acad Orthop Surg 2002 10 290-297

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incremental methods in Class II composite resin restorations on gingival

microleakage J Contemp Dent Pract 20078(2)113-20

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Effects of irradiation mode and filling technique on resindentin bond strength in

Class I cavities J Dent Res 200281 (Abstract)

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JADA 1972841349-1357

117Gordon JChristensen G Why switch to digital radiography J Am Dent

Assoc 204 Vol 135 No 101437-1439

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118Gregoire GL Akon BA Millas A Interfacial micromorphological differences

in hybrid layer formation between water- and solvent-based dentin bonding systems J

Prosthet Dent 2002 87633ndash641

119Gregory WA Physical properties and repair bond strength of direct and indirect

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120Gwinnett AJ Buonocore MG Adhesives and caries prevention a preliminary

report Br Dent J 196511977-81

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124Haba Denisia Tehnici uzuale utilizate icircn radiologia dentară Edit Junimea

2007

125Hashimoto M Ito S Tay FR Svizero NR Sano H Kaga M Fluid movement

across the resin-dentin interface during and after bonding J Dent Res 2004 83843ndash

848

126Hashimoto M Tay FR Ito S Sano H Kaga M Pashley DH Permeability of

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127Hawthorne WS Smales RJ Factors influencing long-term restoration survival

in three private dental practices in Adelaide Aust Dent J 19974259ndash63

128Helwig Klimek Attin Einfuumlhrung in Die ZahnErhaltung Urbanampfischer 2003

129He Z Shimada Y Tagami J The effects of cavity size and incremental

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Mater 200723(5)533-8

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131Hench LLBioceramicsfrom concept to clinicJ Amer Ceram Soc1991

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Quintessence 2001

134Hilton TJ Cavity sealers liners and bases Current philosophies and indications

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135Hilton TJ Schwartz RS Ferracane JL Microleakage of four Class II resin

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135- 144

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class 2 composites Oper Dent 19981312-19

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19-23

138Hintze H Wenzel A Danielen B Behaviour of approximal carious lesions

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139Hintze H Wenzel A Influence of validation method on diagnostic accuracy of

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of approximal and occlusal dental caries in a young adult population Community

Dent Oral Epidemiol 200533(3)212-8

143Hubsch PF Middleton J Knox J A finite element analysis of the stress at the

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fillingsBiomaterials2000211015ndash1019

144Hudson JD Goldstein GR Georgescu M Enamel wear caused by three

different restorative materials J Prosthet Dent 1995 74(6)647-654

145Hunter AR Treasure ET Hunter AJ Increases in cavity volume associated

with the removal of class 2 amalgam and composite restorations Oper Dent

1995202ndash 6

146Huysmans MC PG van der Varst EP Lautenschlager P Monaghan The

influence of simulated clinical handling on the flexural and compressive strength of

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147Iliescu A Gafar MCariologie şi Odontologie RestaurativăEditura Medicală

Bucureşti 2001

148Inoue S Van Meerbeek B Vargas M Lambrechts P Vanherle G Adhesion

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150Iovan Gianina Diagnosis and Management of Patients with High Caries

Activity EdApollonia Iasi2002

151Jacobsen T Soderhold KJ Some effects of water on dentin bonding Dent

Mater 1995 11(2)132-6

152Jackson RD Morgan M The new posterior resins and a simplified placement

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48

154Jokstad A Mjor IA Analyses of long-term clinical behaviour of class II

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157Kamann WK Gangler P Zur Funktionzeit von Amalgam

Kompositefullungen Zahnartzlicher Welt 1999 108 270-273

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restorative decisions made on the basis of simulated bitewing radiographs

Community Dentistry and Oral Epidemiology 1994 22(2) 71-74

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1243

161Khairallah C Hokayem A Long-term clinical evaluation of 2 dental materials

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163Kidd EAAssesment of dental carious lesionsArchof Oral

Biology199843(8)629-632

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817-822

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dental resin composites Dent Mater 2005 211150-1157

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201989117ndash121

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18(7)516-20

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Dent 27(5)325-331 1999

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Jan11(1)34-40

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JProsthet Dent 199369(4)425-430

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JDent 199826 627-632

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1999 15128-137

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179Lăcătuşu St Luminiţa Costinescu Andrian S Gianina Iovan Valeria

Pendefunda 180Sorina Solomon Topoliceanu C Elements of dispersional

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Edition of the Balkan Medical Days

Stomatological Section Abstract nr1091999128

181Lăcătuşu St Andrian S Gianina Iovan- Consideraţii asupra adaptării

amalgamelor dentare la pereţii cavităţilor RevMedicina

StomatologicăVol2199823-26

182Leevailoj C Cochran MA Matis BA Moore BK Platt JA Microleakage of

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200126302ndash307

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restorative decisions microscopic and radiographic caries depth Community

Dentistry and Oral Epidemiology 1996 24 106-11

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polymerization contraction stress for dental composites by two-step light-activation

Dent Mater 2002 18436-444

187Loguercio AD Reis A Ballester RY Polymerization shrinkage effects of

constraint and filling technique in composite restorations Dent Mater 2004

20(3)236-43

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Polymerization shrinkage effects of boundary conditions and filling technique of

resin composite restorations J Dent 2004 32(6)459-70

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189Lopes GC Baratieri LN Monteiro S Jr Vieira LC Effect of posterior resin

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Quintessence Int 2004 35(2)156-61

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art and future perspectives Quintessence Int 200233213-224

191Loumlsche GM Marginal adaptation of class II composite fillings guided

polymerization vs reduced light intensity J Adhes Dent 1 199931ndash39

192Lovell LG Newman SM Bowman CN The effects of light intensity

temperature and comonomer composition on the polymerization behavior of

dimethacrylate dental resins J Dent 1999 21879-883

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and reactivity on the reaction kinetics of dimethacrylatedimethacrylate

copolymerizations Macromolecules 1999 323913-3921

194Lutz F Krejci I Barbakow F Quality and durability of marginal adaptation in

bonded composite restorations Dent Mater 1991 7(2) 107-13

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clinical results J Dent Res 199877 1020

196Mair LH Ten-year clinical assessment of three posterior resin composites and

two amalgams Quintessence Int 199829483ndash490

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depth as cavity predictors for approximal dentin caries lesions in primary teeth

Dentomaxillofac Radiol 2007 Oct36(7)377-81

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dentitionOperDent200429(5)481-508

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year clinical evaluation of direct and indirect composite restorations in posterior teeth

J Prosthet Dent 2000 Sep84(3)289-96

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Three-year clinical evaluation of composite and ceramic inlays Am J Dent 2001

Apr14(2)95-9

202Manhart J Chen HY Draegert U Kunzelmann KH Hickel R Vickers

hardness and depth of cure of light cured packable composite resins J Dent Res 2000

79369 (Abstract)

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structure and properties related to bonding J Dent 1997 25(6)441-58

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caries-affected transparent dentin by citric acidAn atomic force microscopy

studyDent Mater20011745-52

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the diagnosis of proximal caries Scand J Dent Res 1985 93(2) 78-84

51

206Mejare I Malmgreen B Clinical and radiographic appearance of proximal

carious lesions at the time of operative treatment in young permanent teeth Scand J

Dent Res 1988 94 19-26

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relative diagnostic yields of clinical FOTI and radiographic examinations for the

detection of approximal caries in youngsters Indian J Dent Res 200920(2)136-40

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restorative and luting materials attending to free and adhered surfaces volume and

deformation Dent Mater 200117241ndash246

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practitioners and dental caries JDent1990 18(3) 130-136

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(Cerana) Br Dent J 2006 Oct 21201(8)515-20

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PrimDentCare1999Apr659-62

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Quintessence 198961-80

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ScandJDRes 199210060-65

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general dental practice Acta OdontolScand19975558-63

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replacement and longevity of restorations in Florida J Am Coll Dent 199865(3)27ndash

33

217Mjoumlr IA Jokstad A Qvist V Longevity of posterior restorations Int Dent J

19904011ndash7

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Kunststoff-FullungenDtschZahnartzlicher 1991 46 222-225

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Am Dent Assoc 2010 141(3)319-29

52

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125749-751

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34

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54

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55

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56

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57

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864

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Part I Depth of penetration beyond dentin smear layers Dent Mater 2001 17(4) 296-

308

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In vivo evidence J Dent 2004 32611ndash621

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Dent Assoc 2003 69726ndash731

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199930249ndash257

319Vaarkamp J Ten Bosch J Verdonschot EH Quantitative diagnosis of small

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Oral Surg Oral Med Oral Pathol 198661(3)289-96

321Van Meerbeek B De Munck J Yoshida Y Inoue S Vargas M Vijay P Van

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Lambrechts P Yoshida Y Inoue S Suzuki K Technique-sensitivity of

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323Van Meerbeek B Vargas S Inoue S Yoshida Y Peumans M Lambrechts P

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20016 119-144

324Van Meerbeek B Yoshida Y Inoue S Vargas M Abe Y Fukuda R Okazaki

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a 4- MET-based self-etching adhesive J Dent Res 2000 79 249 (Abstract)

58

325Van Nieuwenhuysen JP DrsquoHoore W Carvalho J Qvist V Long-term

evaluation of extensive restorations in permanent teeth J Dent 200331(6)395ndash405

326Venhoven BA de Gee AJ Davidson CL Light initiation of dental resins

dynamics of the polymerization Biomaterials 1996 172313-2318

327Versluis A Douglas WH Cross M Sakaguchi RL Does an incremental filling

technique reduce polymerization shrinkage stresses J Dent Res 1996 75871ndash878

328Vries HC Ruiken HM Konig KG vanrsquot Hof MA Radiographic versus

clinical diagnosis of approximal carious lesions Caries Res1990 24 (5) 364-370

329Waggoner W Ashton J Predictability of cavitation based upon radiographic

appearance comparison of two film types Quintessence International 1989 20(1)

55-60

330Watanabe LG Marshall GW Jr Marshall SJ Dentin shear strength effects of

tubule orientation and intra tooth location Dent Mater 1996 12 109-115

331Watts DC AS Marouf Optimal specimen geometry in bonded-disk

shrinkage-strain measurements on light-cured biomaterials Dent Mater 200016447ndash

451

332Watts DC Marouf AS Al-Hindi AM Photo-polymerization shrinkage-stress

kinetics in resin-composites methods development Dent Mater 2003 191ndash11

333Weaver WS Blank LW Pelleu GB Jr A visible light activated resin cured

through tooth structure GenDent 198836236-7

334Wendt SL Microleakage and cusp fracture resistance of heattreated composite

resin inlays Am J Dent 4(1)10-14 1991

335Wenzel A Hintze H Mikkelsen L Mouyen F Radiographic detection of

occlusal caries in noncavitated teeth A comparison of conventional film radiographs

digitized film radiographs and RadioVisioGraphy-Oral Surg Oral Med Oral Pathol

1991 72 621-6

336Wenzel A Hintze H Perception of image quality in direct digital radiography

after application of various image treatment filters for detectability of dental diseases

Dentomaxillofac Radiol 1993 22 131-4

337Wenzel A Computer-aided image manipulation of intraoral radiographs to

enhance diagnosis in dental practice a review Int Dent J 1993 43 99-108

338Wenzel A Digital radiography and caries diagnosis Dento Maxillo Facial

Radiology 27(1)3-11 1998

339Wenzel A Haiter-Neto F Gotfredsen E Risk factors for a false positive test

outcome in diagnosis of caries in approximal surfaces impact of radiographic

modality and observer characteristics Caries Res 200741(3)170-6

340Wibowo G Stockton L Microleakage of class II composite restorations Am J

Dent 200114177ndash185

341Wilson NHF Wastell DG Norman RD Five-year performance of high-

cooper content amalgam restorations in a multiclinical trial JDent1996 24 203-210

342Winkler MM Katona TR Paydar NH Finite element stress analysis of three

filling techniques for class V light-cured composite restorations J Dent Res

1996751477-83

343Yap AU Effectiveness of polymerization in composite restoratives claiming bulk

placement Impact of cavity depth and exposure time Oper Dent 2000 25113-120

59

344Yeşilyurt C Bulucu B Bond strength of total-etch dentin adhesive systems on

peripheral and central dentinal tissue a microtensile bond strength test The Journal of

Contemporary Dental Practice 7(2) 20061-13

345Yoshida Y Van Meerbeek B Okazaki M Shintani H Suzuki K Comparative

study on adhesive performance of functional monomers J Dent Res 2004 83 454-

458

346Yoshiyama M Tay FR Doi J Nishitani Y Yamada T Itou K Carvalho RM

Nakajima M Pashley DH Bonding of self-etch and total etch adhesives to carious

dentin J Dent Res 2002 81 556-560

  • COPERTA REZUMAT ENGLEZA (MEREUTA)pdf
  • REZUMAT ENGLEZA DR MEREUTA DENISSpdf
Page 11: UNIVERSITATEA DE MEDICINA SI FARMACIE “GR Doctorat/Rezumat... · universitatea de medicina si farmacie “gr.t.popa” iasi facultatea de medicina dentara rezumatul tezei de doctorat

8

AB

C

S1

8

64

26

0

10

20

30

40

50

60

70

A

B

C

FigVII7 Anatomical form (proximal)-composite resins restorations (molars)

AB

C

S1

34

66

100

10

20

30

40

50

60

70

A

B

C

FigVII8 Anatomical form (proximal)-composite resins restorations (bicusps)

AB

C

S1

36

44

20

0

5

10

15

20

25

30

35

40

45

A

B

C

FigVII9 Marginal adaptation (proximal)- amalgam restorations(bicusps)

AB

C

S1

20

50

30

0

5

10

15

20

25

30

35

40

45

50

A

B

C

FigVII10 Marginal adaptation (proximal)-amalgam restorations (molars)

AB

C

S1

16

60

24

0

10

20

30

40

50

60

A

B

C

FigVII11 Marginal adaptation (proximal)-composite resins restorations (bicusps)

9

AB

C

S1

12

54

34

0

10

20

30

40

50

60

A

B

C

FigVII12 Marginal adaptation (proximal)-composite resins restorations (molars)

AB

C

S1

22

54

24

0

10

20

30

40

50

60

A

B

C

FigVII13 Surface quality-amalgam restorations (bicusps)

AB

C

S1

10

54

36

0

10

20

30

40

50

60

A

B

C

FigVII14 Surface quality-amalgam restorations (molars)

AB

C

S1

12

68

20

0

10

20

30

40

50

60

70

A

B

C

FigVII15 Surface quality-composite resins restorations (bicusps)

AB

C

S1

8

70

22

0

20

40

60

80

A

B

C

FigVII16 Surface quality-composite resins restorations (molars)

10

A

C

S1

98

20

20

40

60

80

100

A

C

FigVII17a-b Prevalence of marginal dental cariesamalgam restorations (moderate

CR)

A

C

S1

92

80

20

40

60

80

100

A

C

FigVII18 Prevalence of marginal dental cariesamalgam restorations (high CR)

A

C

S1

94

60

20

40

60

80

100

A

C

FigVII19 Prevalence of marginal dental cariescomposite resins restorations (CR

moderate)

A

C

S1

82

18

0

10

20

30

40

50

60

70

80

90

A

C

FigVII20 Prevalence of marginal dental cariescomposite resins restorations (high

CR)

11

The study data sustain the results obtained by most studies focused on

posterior amalgam restorations However Hickelampcol (2001) reviewed literature data

and proved that many results varies accordingly to different clinical factors (133)

Roulet JF(1997) warned about limits of cross-sectional studies related to composite

resins restorations because of the absence of data regarding restorative techniques

practitioner experience presence or absence of optimum isolation factors related by

patient (266)

VII5CONCLUSIONS

Amalgam proximo-occlusal restorations with minimum 6-years age present

excellent results for parameters anatomic form (occlusal) marginal

discoloration and marginal secondary dental caries good results for

parameters anatomic form (proximal) and marginal adaptation and poor results

for surface quality

Composite resins proximo-occlusal restorations (bicusps) with minimum 6-

years age present excellent results for parameters color match marginal

discoloration and marginal secondary dental caries and good results for

parameters anatomic form (occlusal proximal) marginal adaptation surface

quality

Composite resins proximo-occlusal restorations (molars) with minimum 6-

years age present good results for parameters color match marginal

discoloration marginal secondary dental caries marginal adaptation and poor

results for parameters anatomic form (occlusal) (54 indices Ryge C)

anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The restorations extended at external third of occlusal surface present highest

percents of indices C regarding anatomic form (occlusal) (54 indices Ryge

C) anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The exceeding of 6-years age will require careful monitorisation for early

interventions through polishing sealing reshaping and even replacement for

restorations with major defects

12

CHAPTVIII CLINICAL PERFORMANCE OF COMPOSITE RESINS

RESTORATIONS RELATED TO RESTORATIVE TECHNIQUE 12-

MONTHS LONGITUDINAL STUDY

VIII1 INTRODUCTION

The restorative technique has a major influence over clinical performance of

composite resins restorations in proximo-occlusal cavities In this context researches

focused on correlations between technique and clinical performance of direct

restorations improve the dentist decision regarding restorative technique choice

VIII2AIM OF STUDY

The aim of study was to determine the clinical performance of composite

resins proximo-occlusal restorations performed using different restorative techniques

VIII3MATERIALS AND METHOD

The group study included 37 patients with age 18-42 years with moderat

ecariogenic risk The total number of composite resins restorations (Herculite XRV

Kerr) was 60 divided in three study groups (n=20)

I Centripetal build-up

II Oblique layering

III Horisontal layering

The coronal restorations were assessed at an interval of 12 months using

indices Ryge modified USPHS

- indice ALFA (A)- IDEAL CLINIC

- indice BRAVO (B)- ACCEPTABLE CLINIC

- indice CHARLIE (C)- UNACCEPTABLE CLINIC

VIII4 RESULTS AND DISCUSSIONS

The statistical tests Kruskal-Wallis and Mann-Whitney were performed to

confirm or infirm research hypotesis (the direct restorations performed using different

restorative techniques present statistical significant differences regarding clinical

performance for the assessed parameters)

13

TableVIII1a-b Groups study (Kruskal-Wallis Test)

Ranks

20 2960

20 2560

20 3630

60

20 3050

20 2420

20 3680

60

20 2490

20 3140

20 3520

60

Restorative_techniques

Centripetal build-up

Oblique layering

Horizontal layering

Total

Centripetal build-up

Oblique layering

Horizontal layering

Total

Centripetal build-up

Oblique layering

Horizontal layering

Total

Marginal_adaptation

Marginal_discoloration

Anatomical_form

N Mean Rank

Test Statisticsab

4913 8031 4900

2 2 2

086 018 086

Chi-Square

df

Asymp Sig

Marginal_

adaptation

Marginal_

discoloration

Anatomical_

form

Kruskal Wallis Testa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between the three restorative

techniques for parameter marginal adaptation (p=0086)

There are no statistical significant differences between the three restorative

techniques for parameter marginal discoloration (p=0018)

There are no statistical significant differences between the three restorative

techniques for parameter anatomical form (proximal) (p=0086)

TableVIII2 Comparing results between restorations performed using three

techniques (marginal adaptation marginal discoloration anatomical form) Marginal adaptation Centripetal build-upOblique layering p=04 ns

Centripetal build-upHorizontal layering p=0191 ns

Oblique layering Horizontal layering p=0028 s

Marginal discoloration Centripetal build-upOblique layering p=0103 ns

Centripetal build-upHorizontal layering p=0195 ns

Oblique layering Horizontal layering p=0005 s

Anatomical form Centripetal build-upOblique layering p=0137 ns

Centripetal build-upHorizontal layering p=0029 s

Oblique layering Horizontal layering p=0433 ns

ns nesemnificativ

s semnificativ

p probabilitate

14

Tables VIII3a-b Mann-Whitney test Comparing analysis regarding marginal

discoloration between restorations performed using oblique layering technique and

centripetal build-up technique

Ranks

20 2180 43600

20 1920 38400

40

Restorative_techniques

Centripetal build-up

Oblique layering

Total

Marginal_adaptation

N Mean Rank Sum of Ranks

Test Statisticsb

174000

384000

-841

400

495a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

adaptation

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between centripetal build-up

and oblique layering techniques regarding parameter marginal adaptation (p=0400)

Tables VIII4a-b Mann-Whitney test Comparing analysis regarding marginal

adaptation between restorations performed using horisontal layering technique and

centripetal build-up technique

Ranks

20 1830 36600

20 2270 45400

40

Restorative_techniques

Centripetal build-up

Horizontal layering

Total

Marginal_adaptation

N Mean Rank Sum of Ranks

Test Statisticsb

156000

366000

-1307

191

242a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

adaptation

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between centripetal build-up

and horisontal layering techniques regarding parameter marginal adaptation

(p=0191)

15

TablesVIII5a-b Mann-Whitney test Comparing analysis regarding marginal

adaptation between restorations performed using oblique layering technique and

horisontal layering technique

Ranks

20 1690 33800

20 2410 48200

40

Restorative_techniques

Oblique layering

Horizontal layering

Total

Marginal_adaptation

N Mean Rank Sum of Ranks

Test Statisticsb

128000

338000

-2191

028

052a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

adaptation

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There is statistical significant differences between horisontal layering and

oblique layering techniques regarding parameter marginal adaptation (p=0028)

Tables VIII6a-b Mann-Whitney test Comparing analysis regarding marginal

discoloration between restorations performed using oblique layering technique and

centripetal build-up technique

There are no statistical significant differences between centripetal build-up

and oblique layering techniques regarding parameter marginal discoloration

(p=0103)

Ranks

20 2260 45200

20 1840 36800

40

Restorative_techniques

Centripetal build-up

Oblique layering

Total

Marginal_discoloration

N Mean Rank Sum of Ranks

Test Statisticsb

158000

368000

-1632

103

265a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

discoloration

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

16

Tables VIII7a-b Mann-Whitney test Comparing analysis regarding marginal

discoloration between restorations performed using centripetal build-up technique and

horisontal layering technique

Ranks

20 1840 36800

20 2260 45200

40

Restorative_techniques

Centripetal build-up

Horizontal layering

Total

Marginal_discoloration

N Mean Rank Sum of Ranks

Test Statisticsb

158000

368000

-1299

194

265a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

discoloration

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between centripetal build-up

and horisontal layering techniques regarding parameter marginal discoloration

(p=0103)

Tables VIII8a-b Mann-Whitney test Comparing analysis regarding marginal

discoloration between restorations performed using oblique layering technique and

horisontal layering technique

Ranks

20 1630 32600

20 2470 49400

40

Restorative_techniques

Oblique layering

Horizontal layering

Total

Marginal_discoloration

N Mean Rank Sum of Ranks

Test Statisticsb

116000

326000

-2822

005

023a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

discoloration

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There is statistical significant differences between horisontal layering and

oblique layering techniques regarding parameter marginal discoloration (p=0005)

17

TablesVIII9 a-b Mann-Whitney test Comparing analysis regarding anatomical

form between restorations performed using centripetal build-up technique and oblique

layering technique

Ranks

20 1830 36600

20 2270 45400

40

Restorative_techniques

Centripetal build-up

Oblique layering

Total

Anatomical_form

N Mean Rank Sum of Ranks

Test Statisticsb

156000

366000

-1486

137

242a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Anatomical_

form

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between centripetal build-up

and oblique layering techniques regarding parameter anatomical form (p=0137)

Tables VIII10a-b Mann-Whitney test Comparing analysis regarding anatomical

form between restorations performed using centripetal build-up technique and

horisontal layering technique

Ranks

20 1710 34200

20 2390 47800

40

Restorative_techniques

Centripetal build-up

Horizontal layering

Total

Anatomical_form

N Mean Rank Sum of Ranks

Test Statisticsb

132000

342000

-2184

029

068a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Anatomical_

form

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between centripetal build-up

and horisontal layering techniques regarding parameter anatomical form (p=0029)

18

Tables VIII11a-b Mann-Whitney test Comparing analysis regarding anatomical

form between restorations performed using oblique layering technique and horisontal

layering technique

Ranks

20 1920 38400

20 2180 43600

40

Restorative_techniques

Oblique layering

Horizontal layering

Total

Anatomical_form

N Mean Rank Sum of Ranks

Test Statisticsb

174000

384000

-784

433

495a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Anatomical_

form

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between horisontal layering and

oblique layering techniques regarding parameter anatomical form (p=0433)

Indices A for restorations performed using centripetal build-up technique were

as follows color match-80 marginal adaptation- 60 marginal discoloration-

70 anatomical form (proximal)- 80 surface quality- 60

Indices A for restorations performed using horisontal layering technique were

as follows color match-70 marginal adaptation- 40 marginal discoloration-

50 anatomical form (proximal)- 50 surface quality- 70

Indices A for restorations performed using oblique layering technique were as

follows color match-70 marginal adaptation- 80 marginal discoloration- 90

anatomical form (proximal)- 60 surface quality- 70

Indices B for restorations performed using centripetal build-up technique were

as follows color match-20 marginal adaptation- 30 marginal discoloration-

20 anatomical form (proximal)- 30 surface quality- 40

Indices B for restorations performed using horisontal layering technique were

as follows color match-30 marginal adaptation- 40 marginal discoloration-

30 anatomical form (proximal)- 30 surface quality- 30

Indices B for restorations performed using oblique layering technique were as

follows color match-30 marginal adaptation- 20 marginal discoloration- 10

anatomical form (proximal)- 40 surface quality- 30

19

Indices C for restorations performed using centripetal build-up technique were

as follows color match-0 marginal adaptation- 10 marginal discoloration- 0

anatomical form (proximal)- 0 surface quality- 0

Indices C for restorations performed using horisontal layering technique were

as follows color match-0 marginal adaptation- 20 marginal discoloration- 20

anatomical form (proximal)- 20 surface quality- 0

Indices C for restorations performed using oblique layering technique were as

follows color match-0 marginal adaptation- 0 marginal discoloration- 10

anatomical form (proximal)- 0 surface quality- 100

Discussions

For in vitro studies is difficult to reproduce the variables existent in oral cavity

like occlusal stress and pH and temperature changes (235) The clinical studies are

determinant in assessment of restorative techniques (300) The most researches

focuses on the influence of restorative technique on the reduction of lightcuring stress

(51 78 135)

VIII5 CONCLUSIONS

Oblique layering technique presents superior results regarding marginal

adaptation and marginal discoloration and is recommended for proximo-

occlusal dental caries close to enamel-cement jonction

Centripetal build-up presents good results regarding marginal adaptation and

anatomical form at proximal level (proximal surfaces and contact point)

Horisontal layering technique can be used for optimum results only in

proximal-occlusal cavities with moderate extension both in occlusal-cervical

and buccal-oral

20

CHAPTIX STUDY REGARDING MARGINAL SEALING STATUS IN

COMPOSITE RESINS LIMITED PROXIMO-OCCLUSAL RESTORATIONS

PERFORMED USING DIFFERENT TECHNIQUES

IX1INTRODUCTION

The contraction of composite resins can produce stress inside dental structure

The most contraction stress appears in the initial stages and development rate of stress

decreases gradually in time (5 98 160) The contraction stress of composite resins

can overpass adhesion strenght and can broke the link between dental tissues and

composite resin (73) When adhesion strenght is high stress can produce marginal

fracture or bulk fracture (74) These situations are associated with microleakage and

penetration of oral fluid and bacteria along dentinal walls endangering the pulpal

tissue or favourising secondary dental caries

IX2 AIM OF STUDY

The study aimed to assess the efficiency of marginal sealing along gingival

wall in limited proximal-occlusal restorations performed using three different

techniques

IX3MATERIALS AND METHOD

The study group included 30 teeth extracted for orthodontic and periodontal

reasons On every tooth two identical class II cavities (on mesial and distal surfaces)

were prepared with cylindrical burs under water cooling The gingival wall was

limited to enamel-cement jonction The cavity dimension were as follows 2 mm

buccal-oral 5mm depth Each tooth was introduced in a pattern of acrylat The

operator calibrated preparation technique on acrylat teeth in Simulation Laboratory of

UMF ―Gr T Popa Iaşi The 60 prepared cavities were randomly divided in three

study groups related to restorative technique The restoration were performed with

Filtek Z550 (3M ESPE) a nanohybrid composite resin The adhesive strategy

included etchamprinse in 2 steps and adhesive Adper Single Bond 2(3MESPE)

Group A (n=20) bulk restorative technique associated with lightcuring from

occlusal 40 seconds and from buccal and oral 20 seconds

Group B (n=20) oblique layering technique (first layer on buccal wall and

buccal frac12 of gingival wall was lightcured from buccal second layer on oral wall and

oral frac12 of gingival wall was lightcured from oral third oral as a triangle with point

oriented to gingival wall was lightcured from occlusal)

Group C (n=20) combined technique (bdquoflow layer on gingival and axial

walls lightcured under pressure only associated with solid composite resin layer)

The proximal surfaces were performed using Tofflemire and metallic matrices After

removal of matrices every restoration was lightcured for another 20 seconds Two

layers aof varnish were applied on composite resins restorations excepting cavity

margins and an area of 1 mm around them The samples were introduced in methylen

21

blue 10 for 48 hours After this stage samples were washed with water and teeth

were cut longitudinally with a diamonded disc

The die penetration was assessed with Zeiss (Iena Germany) X20 microscope

accordingly to four scores (0-3)

0 ndash no penetration

1 ndash die infiltration until external half of gingival wall

2 ndash die infiltration on all gingival wall

3 ndash die infiltration on gingival wall and axial wall

IX4RESULTS AND DISCUSSIONS

The result of die penetration are presented in table IX1

TableIX1 The results for die penetration

Grup 0 1 2 3

A (bulk) 0 0 3 17

B (layering) 0 4 5 11

C (combined) 12 5 2 1

In group A 17 sample had score 3 and 2 samples had score 2 In group B 11

sample had score 3 5 samples had score 2 and 4 sample had score 1 In group C with

best results 12 samples had score 0 5 samples had score 1 2 samples had score 2 1

sample had score 3

The recorded data were analysed using test Mann-Whitney The statistical

results are presented in tables IX2-IX4

Tables IX2a-b Mann-Whitney for comparisons of microleakage values between

bulk technique and incremental technique

Ranks

Restorative technique N Mean Rank Sum of Ranks

Scores

frequency

A ndash bulk technique 20 2420 24200

B ndash incremental

technique

20 1680 16800

Total 40

Test Statisticsb

scores

frequency

Mann-Whitney U 29000

Wilcoxon W 168000

Z -1970

Asymp Sig (2-tailed) 049

Exact Sig [2(1-tailed Sig)] 123a

a Not corrected for ties

b Grouping Variable restorative technique

22

Tables IX3a-b Mann-Whitney for comparisons of microleakage values between

bulk technique and mixed technique

Ranks

Restorative technique N Mean Rank Sum of Ranks

scores

frequency

A ndash bulk technique 20 3090 30900

C ndash mixed technique 20 1010 10100

Total 40

Test Statisticsb

scores

frequency

Mann-Whitney U 500

Wilcoxon W 101000

Z -4021

Asymp Sig (2-tailed) 000

Exact Sig [2(1-tailed Sig)] 000a

a Not corrected for ties

b Grouping Variable restorative technique

Tables IX4a-b Mann-Whitney test for comparisons of microleakage values

between incremental technique and mixed technique

Ranks

Restorative technique N Mean Rank Sum of Ranks

scores

frequency

B ndash incremental

technique

20 2990 29900

C ndash mixed technique 20 1210 12100

Total 40

Test Statisticsb

scores

frequency

Mann-Whitney U 5500

Wilcoxon W 121000

Z -3492

Asymp Sig (2-tailed) 000

Exact Sig [2(1-tailed Sig)] 000a

a Not corrected for ties

23

Test Statisticsb

scores

frequency

Mann-Whitney U 5500

Wilcoxon W 121000

Z -3492

Asymp Sig (2-tailed) 000

Exact Sig [2(1-tailed Sig)] 000a

a Not corrected for ties

b Grouping Variable tehnrestaurare

The results of microleakage degree were statistically significant when the

three restorative techniques were compared The results showed that best restorative

technique regarding marginal sealing in cervical area is combined technique followed

by oblique layering technique The use of layering techniques limits the development

of contraction forces between oposite walls event that favourises bulk stress voids

formation and fissure inside dental tissues The results of our study are similar with

other studies (114 293)

IX5 CONCLUSIONS

The values of die penetration at gingival wall were statistically different

between the three restorative techniques

We concluded that all restorative methods were associated with lightcuring

contraction and marginal microleakage

The combined technique was associated with lowest lightcuring contraction

and die penetration

The bulk technique was associated with highest lightcuring contraction and die

penetration

24

CHAPTX STUDY REGARDING THE EFFECTS OF ETCHING ON

ENAMEL AND DENTINE IN CERVICAL AREA FOR PROXIMAL

CAVITIES AT LATERAL DENTAL GROUP

X1 INTRODUCTION

The studies reported marginal defects and high microleakage at the level of

gingival margins localised in cervical area or close to enamel-cement jonction for

high percents of proximal-occlusal composite resins restorations (8485) The good

adhesion is requested to insure restoration longevity and to prevent marginal

microleakage and presence of secondary marginal dental caries The adhesion

strenght of different adhesive systems can vary accordingly to tissues areas (204 240)

and to variations in dentinal structures (234 330) Most studies focused on adhesive

systems performances used healthy dentine close to pulp room but in case of class II

restorations there are particular features that influences the adhesion at the level of

gingival margins

The surface topography is an important property that determines the

interaction manner between surfaces The surface roughness and surface energy can

increase or decrease the adhesion of composite resins to the hard dental tissues

X2 AIM OF STUDY

The aim of study was to compare surface roughness of enamel and dentine

after etching related to different distances related to enamel-dentinecement jonction

X3 MATERIALS AND METHODS

The study group included 20 molars extracted from orthodontics or

periodontal reasons with intact proximal surfaces The teeth were cut longitudinally in

sens buccal-oral with diamond discs under water cooling

A group study (10 teeth) included 10 samples obtained through transversal

cutting at distance of 2mm from enamel-dentinecement jonction and 10 samples

obtained through transversal cutting at distance of 15 mm from enamel-

dentinecement jonction Another study group (10 teeth) included 10 samples

obtained through transversal cutting at distance of 1mm from enamel-dentinecement

jonction and 10 samples obtained through transversal cutting at distance of 05 mm

from enamel-dentinecement jonction All these samples were divided in two halfes

through mesial-distal cutting The samples finishing was performed with abrasive

paper (100-4000) and final polishing was performed with a device Buehler model

Minimet with slices introduced in ultrasound bath for 4 minutes The second half of

each sample was etched for 15 seconds with ortophosphoric acid 37 for 15 seconds

Slices were washed with distilled water for 30 seconds after etching and dried

The samples were analysed with atomic force microscopy (AFM) regarding

surface roughness The results were expressed as relative variation of roughness

X4 RESULTS AND DISCUSSIONS

The aspect of etched enamel at 2 mm distance from ECJ can be seen in figure

X1 (section 10 microm) The surface roughness is higher comparing with sample before

etching

25

După gravajul cu acid ortofosforic 37

The aspect of etched enamel at 15 mm distance from ECJ can be seen in

figure X2 (section 10 microm) The surface roughness is higher comparing with sample

before etching but lower comparing with sample at 2 mm from ECJ

The aspect of etched enamel at 1 mm distance from ECJ can be seen in figure

X3 (section 10 microm) The surface roughness is higher comparing with sample before

etching but lower comparing with sample at 15mm and 2 mm from ECJ

The aspect of etched enamel at 15 mm distance from ECJ can be seen in

figure X4 (section 10 microm) The surface roughness is higher comparing with sample

before etching but lower comparing with sample at 1 mm 15 mm and 2 mm from

ECJ

FigX1 3D aspect of enamel at 2 mm from ECJ

after etching (10 microm)

FigX2 3D aspect of enamel at 15 mm from ECJ

after etching (10 microm)

FigX3 3D aspect of enamel at 1 mm from ECJ

after etching (10 microm)

FigX4 3D aspect of enamel at 05 mm from ECJ

after etching (10 microm)

26

The mean values of squared roughness for dentine and enamel before etching

are presented in tables X1 and X2

Table X1 Squared roughness values for dentine samples before and after etching

Before etching (nm) After etching (nm)

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

sample

1

335 282 283 259 1149 947 901 879

sample

2

352 284 274 266 1127 939 883 875

sample

3

357 273 278 263 1152 953 876 867

sample

4

323 269 264 258 1146 942 895 883

sample

5

348 298 271 268 1153 944 904 878

sample

6

339 274 278 273 1158 937 893 892

sample

7

352 283 269 266 1145 944 899 876

sample

8

349 292 272 274 1166 942 907 869

sample

9

357 284 275 265 1132 939 893 879

sample

10

348 281 277 262 1142 941 899 878

Table X2 Squared roughness values for enamel and dentine samples before and after

etching

Before etching (nm) After etching (nm)

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

sample 1 422 342 309 313 2255 1114 874 845

sample 2 418 338 324 304 2236 1102 882 839

sample 3 413 334 315 303 2239 1115 873 833

sample 4 416 336 322 308 2242 1116 868 842

sample 5 426 332 315 294 2218 1103 877 829

sample 6 412 332 317 306 2237 1099 874 847

sample 7 414 335 322 314 2252 1102 876 834

sample 8 416 325 318 313 2239 1106 875 838

sample 9 418 328 314 299 2246 1113 879 836

sample 10 413 334 316 305 2242 1104 873 839

The results for samples before etching prove a decreasing tendency for mean

values of squared roughness surface beginning with areas placed at distance of 2 mm

from ECJ (346 nm) followed by areas placed at distance of 15 mm from ECJ (282

nm) 1 mm from ECJ (274 nm) and 05 mm from ECJ (265 nm) After etching the

decreasing tendency maintained for dentine localised at 2 mm from ECJ to dentine

localised at 05 mm from ECJ The mean values of squared roughness after etching

were three times higher (tables X3)

27

Table X3 Squared roughness values for enamel and dentine samples before and

after etching

Dentine Enamel

Before etching

(nm)

After etching

(nm)

Before etching

(nm)

After etching

(nm)

2 mm ECJ 346 1147 416 2237

15 mm ECJ 282 942 333 1107

1 mm ECJ 274 895 317 875

05 mm ECJ 265 877 305 838

The descriptive statistics data for surface roughness of dentine before and after

etching are presented in tables X4 si X5

Table X4 Descriptive statistics for dentine samples before etching

Statistics

Dentine 2mm

before etching

Dentine 15mm

before etching

Dentine 1mm

before etching

Dentine 05mm

before etching

N Valid 10 10 10 10

Missing 0 0 0 0

Mean 346000 282000 274100 265400

Std Error of Mean 33830 27487 17026 16746

Std Deviation 106979 86923 53841 52957

Skewness -1214 354 -314 348

Std Error of Skewness 687 687 687 687

Kurtosis 1141 049 336 -539

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 3230 2690 2640 2580

Maximum 3570 2980 2830 2740

Table X5 Descriptive statistics for dentine samples after etching

Statistics

Dentine 2mm

after etching

Dentine 15mm

after etching

Dentine 1mm

after etching

Dentine 05mm

after etching

N Valid 10 10 10 10

Missing 0 0 0 0

1147000 942800 895000 877600

Std Error of Mean 36545 14591 29926 22020

Std Deviation 115566 46140 94634 69634

Skewness -267 1169 -951 535

Std Error of Skewness 687 687 687 687

Kurtosis 043 1776 564 1416

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 11270 9370 8760 8670

28

Statistics

Dentine 2mm

after etching

Dentine 15mm

after etching

Dentine 1mm

after etching

Dentine 05mm

after etching

N Valid 10 10 10 10

Missing 0 0 0 0

1147000 942800 895000 877600

Std Error of Mean 36545 14591 29926 22020

Std Deviation 115566 46140 94634 69634

Skewness -267 1169 -951 535

Std Error of Skewness 687 687 687 687

Kurtosis 043 1776 564 1416

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 11270 9370 8760 8670

Maximum 11660 9530 9070 8920

To choose the statistical test to compare roughness surface values was

performed a test Shapiro-Wilk If p is lower or equal with 0005 than hypothesis of

distribution normality is rejected (distribution deviates from normal form) In the table

X6 the distributions are normal The statistical test will be test t for pair samples

Table X6 Test Shapiro-Wilk for dentine samples

Tests of Normality

Kolmogorov-Smirnov

a Shapiro-Wilk

Statistic df Sig Statistic df Sig

Dentine 2mm before etching 274 10 032 877 10 122

Dentine 15mm after etching 209 10 200 952 10 689

Dentine 1mm before etching 134 10 200 983 10 980

Dentine 05mm before etching 155 10 200 949 10 661

Dentine 2mm after etching 133 10 200 977 10 946

Dentine 15mm after etching 197 10 200 916 10 329

Dentine 1mm after etching 216 10 200 925 10 401

Dentine 05 after etching 220 10 185 933 10 474

Enamel 2mm before etching 193 10 200 898 10 207

Enamel 15mm before etching 170 10 200 977 10 947

Enamel 1mm before etching 157 10 200 952 10 689

Enamel 05mm before etching 165 10 200 943 10 590

Enamel 2mm after etching 235 10 124 925 10 404

Enamel 15mm after etching 209 10 200 871 10 102

Enamel 1mm after etching 189 10 200 964 10 834

Enamel 05mm after etching 142 10 200 983 10 978

a Lilliefors Significance Correction

29

Tests of Normality

Kolmogorov-Smirnov

a Shapiro-Wilk

Statistic df Sig Statistic df Sig

Dentine 2mm before etching 274 10 032 877 10 122

Dentine 15mm after etching 209 10 200 952 10 689

Dentine 1mm before etching 134 10 200 983 10 980

Dentine 05mm before etching 155 10 200 949 10 661

Dentine 2mm after etching 133 10 200 977 10 946

Dentine 15mm after etching 197 10 200 916 10 329

Dentine 1mm after etching 216 10 200 925 10 401

Dentine 05 after etching 220 10 185 933 10 474

Enamel 2mm before etching 193 10 200 898 10 207

Enamel 15mm before etching 170 10 200 977 10 947

Enamel 1mm before etching 157 10 200 952 10 689

Enamel 05mm before etching 165 10 200 943 10 590

Enamel 2mm after etching 235 10 124 925 10 404

Enamel 15mm after etching 209 10 200 871 10 102

Enamel 1mm after etching 189 10 200 964 10 834

Enamel 05mm after etching 142 10 200 983 10 978

a Lilliefors Significance Correction

This is a lower bound of the true significance

The results of test t for pair dentine samples before and after etching are

presented in table X

Table X7 Test t for dentine before and after etching

Paired Samples Test

Paired Differences

t df

p (2-

tailed)

95 Confidence

Interval of the

Difference

Mean

Std

Dev

Std

Error

Mean Lower Upper

Pair

1

dentine2mmbeforeetching-

dentine2mmafteretching

-

8010000

174801 55277 -

8135045

-

7884955

-

144906

9 000

Pair

2

dentine15mmbeforeetching-

dentine15mmafteretching

-

6608000

102394 32380 -

6681248

-

6534752

-

204079

9 000

Pair

3

dentine1mmbeforeetching-

dentine1mmafteretching

-

6209000

117799 37251 -

6293269

-

6124731

-

166678

9 000

30

Paired Samples Test

Paired Differences

t df

p (2-

tailed)

95 Confidence

Interval of the

Difference

Mean

Std

Dev

Std

Error

Mean Lower Upper

Pair

1

dentine2mmbeforeetching-

dentine2mmafteretching

-

8010000

174801 55277 -

8135045

-

7884955

-

144906

9 000

Pair

2

dentine15mmbeforeetching-

dentine15mmafteretching

-

6608000

102394 32380 -

6681248

-

6534752

-

204079

9 000

Pair

3

dentine1mmbeforeetching-

dentine1mmafteretching

-

6209000

117799 37251 -

6293269

-

6124731

-

166678

9 000

Pair

4

dentine05mmbeforeetching-

dentine05mmafteretching

-

6122000

86384 27317 -

6183796

-

6060204

-

224109

9 000

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of dentine (

2mm 15 mm 1mm sau 05mm)

The descriptive statistics data for dentine surface roughness before and after

etching are presented in tables X8 and X9

Table X8 Descriptive statistics for enamel samples before etching

Statistics

Enamel 2mm

before etching

Enamel 15mm

before etching

Enamel 1mm

before etching

Enamel 05mm

before etching

N Valid 10 10 10 10

Missing 0 0 0 0

Mean 416800 333600 317200 305900

Std Error of Mean 13968 15217 14205 20355

Std Deviation 44171 48120 44920 64369

Skewness 1095 -156 -109 -411

Std Error of Skewness 687 687 687 687

Kurtosis 769 487 -118 -295

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 4120 3250 3090 2940

Maximum 4260 3420 3240 3140

31

Table X9 Descriptive statistics for enamel samples after etching

Statistics

Enamel 2mm

after etching

Enamel 15mm

after etching

Enamel 1mm

after etching

Enamel 05mm

after etching

N Valid 10 10 10 10

Missing 0 0 0 0

Mean 2237600 1107400 875100 838200

Std Error of Mean 31027 20232 11968 17436

Std Deviation 98116 63979 37845 55136

Skewness -850 267 042 040

Std Error of Skewness 687 687 687 687

Kurtosis 878 -1880 1082 -425

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 22180 10990 8680 8290

Maximum 22520 11160 8820 8470

To choose the statistical test to compare roughness surface values was

performed a test Shapiro-Wilk If p is lower or equal with 0005 than hypothesis of

distribution normality is rejected (distribution deviates from normal form) In the table

X10 the distributions are normal The statistical test will be test t for pair samples

Table X10 Test Shapiro-Wilk for enamel samples

Tests of Normality

Kolmogorov-Smirnova Shapiro-Wilk

Statistic df Sig Statistic df Sig

2mmenamel before etching 193 10 200 898 10 207

15mmenamel before etching 170 10 200 977 10 947

1mmenamel before etching 157 10 200 952 10 689

05mmenamel before etching 165 10 200 943 10 590

2mmenamel after etching 235 10 124 925 10 404

15mmenamel after etching 209 10 200 871 10 102

1mmenamel after etching 189 10 200 964 10 834

05mmenamel after etching 142 10 200 983 10 978

a Lilliefors Significance Correction

This is a lower bound of the true significance

The results of test t for pair enamel samples before and after etching are

presented in table X11

32

Table X11 Test t for enamel samples before and after etching

Paired Samples Test

Paired Differences

t df

p (2-

tailed)

95 Confidence

Interval of the

Difference

Mean

Std

Deviation

Std

Error

Mean Lower Upper

Pair

1

2mmenamel before

etching

2mmenamel after

etching

-18208 135220 42760 -

18304731

-

18111269

-

425815

9 000

Pair

2

15mmenamel before

etching

15mmenamel after

etching

-7738 73151 23132 -7790329 -7685671 -

334508

9 076

Pair

3

1mmenamel before

etching

1mmenamel after

etching

-5579 55468 17540 -5618679 -5539321 -

318065

9 065

Pair

4

05mmenamel before

etching

05mmenamel after

etching

-5323 60378 19093 -5366192 -5279808 -

278788

9 063

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel ( 2mm 15 mm 1mm sau

05mm) but the differences statistical significant are present only for enamel localised

at 2 mm from ECJ

X5CONCLUSIONS

The surfaces of enamel and dentine at cervical level record decreases of

roughness related to the decrease of distance to ECJ

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel but the differences

statistical significant are present only for enamel localised at 2 mm from ECJ

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of

dentine

33

CHAPTXI FEA STUDY REGARDING THE BIOMECHANICAL

BEHAVIOUR AND FRACTURE RESISTANCE OF PROXIMO-OCCLUSAL

AMALGAM AND COMPOSITE RESINS RESTORATIONS

XI1INTRODUCTION AIM OF STUDY

The individual variation of patients morphological and functional complexity

of tissues as well as difficult access limit the possibilities to investigate in clinical

studies the biomechanical behaviour of proximo-occlusal restorations In this context

simulation of the biomechanics for direct restorations represents an interesting

interdisciplinar domain in actual dentistry research

The study focused on two direction

- analysis of role of forces intensity on biomechanical behaviour related to

cavity dimension and material

- analysis of tension inside restoration structure related to forces intensity

XI2MATERIALS AND METHODS

The stages of finite element analysis study are as follows

object modelling (bicusps and proximo-occlusal restoration)

definition of parameters for materials and dental tissues

meshing

constraints and loading

types of contacts

equations system definition

results of simulation

The object 3D modelling was performed in Rhinoceros (figure XI1) The

definition of parameters was performed for Poisson constant Young modulus density

(table XI1) The selected materials were amalgam and composite resins The

analysed tissues were dentine and enamel The meshing constraints loading were

performed for forces of 200N 400N 600N 800 N The analysis was performed using

software COSMOSWorks 2010

34

Fig XI1 3D modellation of bicusp

Table XI1 Values of Young modulus Poisson constant compression resistance for

amalgam composite resin enamel (amalgam compozit smalţ)

Material Young modulus (GPa) Poisson constants

Compression

resistance

(Mpa)

Amalgam 55 033 483

Enamel 48 03 400

Composite

resin 220 022 345

Fig XI2 The forces and constraints application

The results are presented in values and culours red colours representing areas

with maximum values of tensions produced under influence of masticatory forces

The tensions produced in amalgam restoration are in a range from 0 to 22886

(force 800 N) The maximum von Misses tensions are associated with cervical area

of amalgam restorations This aspect proves that first modification in interface

restoration-cavity margins will appear at the level of gingival wall First marginal

35

defects and fissures in restoration bulk will appear at tensions over 1600Mpa

associated with forces of 800N for extended amalgam proximo-occlusal restorations

The tensions produced in composite resin restorations are in a range from 0 to

2285 (force 800 N) The maximum von Misses tensions are associated with cervical

area of composite resin restorationsThis aspect proves that first modification in

interface restoration-cavity margins will appear at the level of gingival wall First

marginal defects and fissures in restoration bulk will appear at tensions over 1716

Mpa associated with forces of 600N for moderate and extended composite resins

proximo-occlusal restorations

Fig XI3a-b ndash Simulated model of proximo-occlusal restoration

FigXI4a-b Dental amalgam restoration Cervical tension associated with 600 N

(c)800 N (d)

FigXI5a-b Composite resin restoration Cervical tension associated with 600 N

(c)800 N (d)

36

The deformation of amalgam can be produced only when is associated with

fissures in bulk of restorations while composite resins restorations present

deformation when are associated with a modification of volume and form because of

repeated action of medium forces on long term or high forces on short term (figures

XI4 XI5)

Fig XI4 Material deformation in area of maximum tension

000E + 00

500E -02

100E -01

150E -01

200E -01

250E -01

1 4 7 101316192225283134374043464952555861646770737679

Amalgam C ompoz it

Figura XI5 Deformarea funcție de material

The amalgam and composite resins were treated as homogenous isotropic and

liniar The advantage of this type of FEA study is that restorations parameters can be

modified any time is necessary both in arhitecture geometry and material indices

variability The results of this study sustain the conclusions of other FEA studies

focused on biomechanical behaviour of posterior restorations performed with

amalgam and composite resins(35 62 76 143)

37

XI4CONCLUSIONS

bull The amalgam in class II restorations has a low deformation tendency because

of uniform distribution of tension inside material

bull Composite resins class II restorations accumulate higher tensions comparing

with amalgam but deformation is avoided for a time because of the adhesion

forces performed between molecules under moderate oral forces In case of

high oral forces (600-800N) the risk of fracture in moderate class II

restorations is higher comparing with amalgam proximo-occlusal restorations

For extended class II restorations and forces of 600 N composite resins present

highest risk of fracture and deformation The von Misses tension at the

cervical interface restorationtooth can reach 1600Mpa

bull The amalgam in moderate class II restorations can resist to deformation even

for high intensity forces limited to 600N In extended class II restorations the

risk of deformation and fracture increases at values of 600N-800N of oral

forces The von Misses tension at the cervical interface restorationtooth can

reach 1700 Mpa

38

FINAL CONCLUSIONS

Amalgam proximo-occlusal restorations with minimum 6-years age present

excellent results for parameters anatomic form (occlusal) marginal

discoloration and marginal secondary dental caries good results for

parameters anatomic form (proximal) and marginal adaptation and poor results

for surface quality

Composite resins proximo-occlusal restorations (bicusps) with minimum 6-

years age present excellent results for parameters color match marginal

discoloration and marginal secondary dental caries and good results for

parameters anatomic form (occlusal proximal) marginal adaptation surface

quality

Composite resins proximo-occlusal restorations (molars) with minimum 6-

years age present good results for parameters color match marginal

discoloration marginal secondary dental caries marginal adaptation and poor

results for parameters anatomic form (occlusal) (54 indices Ryge C)

anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The restorations extended at external third of occlusal surface present highest

percents of indices C regarding anatomic form (occlusal) (54 indices Ryge

C) anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The exceeding of 6-years age will require careful monitorisation for early

interventions through polishing sealing reshaping and even replacement for

restorations with major defects

Oblique layering technique presents superior results regarding marginal

adaptation and marginal discoloration and is recommended for proximo-

occlusal dental caries close to enamel-cement jonction

Centripetal build-up presents good results regarding marginal adaptation and

anatomical form at proximal level (proximal surfaces and contact point)

Horisontal layering technique can be used for optimum results only in

proximal-occlusal cavities with moderate extension both in occlusal-cervical

and buccal-oral

The values of die penetration at gingival wall were statistically different

between the three restorative techniques

We concluded that all restorative methods were associated with lightcuring

contraction and marginal microleakage

The combined technique was associated with lowest lightcuring contraction

and die penetration

The bulk technique was associated with highest lightcuring contraction and die

penetration

39

The surfaces of enamel and dentine at cervical level record decreases of

roughness related to the decrease of distance to ECJ

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel but the differences

statistical significant are present only for enamel localised at 2 mm from ECJ

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of

dentine

bull The amalgam in class II restorations has a low deformation tendency because

of uniform distribution of tension inside material

bull Composite resins class II restorations accumulate higher tensions comparing

with amalgam but deformation is avoided for a time because of the adhesion

forces performed between molecules under moderate oral forces In case of

high oral forces (600-800N) the risk of fracture in moderate class II

restorations is higher comparing with amalgam proximo-occlusal restorations

For extended class II restorations and forces of 600 N composite resins present

highest risk of fracture and deformation The von Misses tension at the

cervical interface restorationtooth can reach 1600Mpa

bull The amalgam in moderate class II restorations can resist to deformation even

for high intensity forces limited to 600N In extended class II restorations the

risk of deformation and fracture increases at values of 600N-800N of oral

forces The von Misses tension at the cervical interface restorationtooth can

reach 1700 Mpa

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6Aggarwal V Logani A Jain V Shah N Effect of cyclic loading on marginal

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Oper Dent 2008 Sep-Oct33(5)587-92

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9Andrian S Tratamentul Minim Invaziv al Cariei Dentare EditPrinceps Edit Iaşi

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15Anusavice KJ Development and testing of ceramics for dental restorations In

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16Arhun N Celik C Yamanel KClinical evaluation of resin-based composites in

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17Armstrong SR JC Keller DB Boyer The influence of water storage and C-

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18Armstrong S Boyer D Keller J Microtensile bond strength testing and failure

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19Asmussen E Peutzfeldt A Influence of UEDMA BisGMA and TEGDMA on

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26Bader JD Shugars DA Understanding dentistslsquo restorative treatment decisions J

Public Health Dent 1992 Winter52(2)102-10

27Barkmeier WW Cooley RL Current status of adhesive resin systems J Am Coll

Dent 199158 36-39

28Bayne SC Dental biomaterials where are we and where are we going J Dent

Educ 200569(5)571ndash585

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29Bedran-de-Castro AK Pereira PN Thompson JY Influence of load cycling

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30Behle C Flowable composite Proprieties and applications Pract Periodontics

Aesthetics Dent 1998 10347 350-351

31Bergenholtz G Cox CF Bacterial leakage around dental restorations Its effects

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33Black J Biological Performance of Materials Fundamentals of Biocompatibility

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34Bonsor SJ Chadwick RGLongevity of conventional and bonded (sealed)

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9

35Boschian PL S Guidotti R Pietrbissa M Gagliani- bdquoStress distribution in a

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36Bouillaguet S B Ciucchi T Jacoby JC Wataha DH Pashley Bonding

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38Braga RR Ferracane JL Hilton TJ Contraction stress of flowable composites

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39Braga RR Ballester RY Ferracane JLFactors involved in the development of

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40Bratu D- Materiale dentare icircn cabinetul de stomatologie- Edit Helicon

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42Brunthaler A Koumlnig F Lucas T Sperr W Schedle A Longevity of direct resin

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43Bullard RH Leinfelder KR Russell CM Effect of coefficient of thermal

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44Buonocore MG Matsui A Gwinnett AJ Penetration of resin dental materials

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45Burke FJ Cheung SW Mjoumlr IA Wilson NH Restoration longevity and analysis

of reasons for the placement and replacement of restorations provided by vocational

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46Burke FJ Cheung SW Mjor IA Wilson NH-Reasons for the placement and

replacement of restorations in vocational training practicePrimary Dental Care

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47Burke FJ Wilson NH Cheung SW Mjoumlr IA Influence of patient factors on age

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48Calheiros FC Braga RR Kawano Y Ballester RY Relationship between

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2004 20939-946

49Cardoso P Sadek F Microtensile bond strength on dentin using new adhesive

systems with selfetching primers Braz J Oral Sci 2003 2(4) 156-159

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51Carvalho RM JC Pereira M Yoshiyama DH Pashley A review of

polymerization contraction the influence of stress development versus stress

reliefOper Dent19962117ndash24

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53Cattaneo PM M Dalstra B Melsen- bdquoThe Finite Element Method a Tool to

Study Orthodontic Tooth Movement J Dent Res 2005 84(5)428-433

54Cattell MJ Clarke RL Lynch EJ The transverse strength reliability and

microstructural features of four dental ceramicspart 1 J Dent 25(5)399-407 1997

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bond strength to primary dentin J Dent Child 2003 70(2) 139-144

56Celik C Arhun N Yamanel K Clinical evaluation of resin-based composites in

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57Cenci M Demarco F de Carvalho R Class II composite resin restorations with

two polymerization techniques Relationship between microtensile bond strength and

marginal leakage J Dent 2005 33(7) 603- 610

58Chaffin J Moss D Review of current US Army dental emergency rates Mil

Med 2008173(1)23ndash26

59Chen HY Manhart J Hickel R Kunzelmann KH Polymerization contraction

stress in light-cured packable composite resinsDent Mater 200117253-259

60Choi KK Condon JR Ferracane JL The effects of adhesive thickness on

polymerization contraction stress of composites J Dent Res 2000 79812ndash817

61Cichon P Kerschbaum T Verweildauer zahnartzlicher Restaurationen bei

Behinderten Dtsch Zahnartzlicher 1999 54 96-102

62Cohen BI Pagnillo MK Deutsch ASMusikant BL Fracture Strength of

Three Core Restorative Materials Supported with or without a Prefabricated Split-

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in Class II composite resin restoration applied in bulk or in two increments

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64Collins CJ Bryant RW Hodge KL A clinical evaluation of posterior composite

resin restorations 8-year findings J Dent 199826(4) 311ndash317

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polymerization stress J Am Dent Assoc2000 131497-503

66Cook WD Moopnar M Influence of chemical structure on the fracture

behaviour of dimethacrylate composite resins Biomaterials 1990 11272-276

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68Crim GA Microleakage of three resin placement techniques Am J Dent

1991469-72

69Dauvillier B Aarnts M Feilzer A The competition between the composite-

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1399

70Dauvillier BS Aarnts MP Feilzer AJ Developments in shrinkage control of

adhesive restoratives J Esthet Dent 2000 12291-299

71Dauvillier BS Aarnts MP Feilzer AJ Modeling of the viscoelastic behavior of

dental light-activated resin composites during curing Dent Mater 200319277ndash285

72Davidson CL Gee AJ Feilzer A The competition between the composite-dentin

bond strength and the polymerization contraction stress J Dent Res 1984

63(12)1396-9

73Davidson CL AJ Feilzer Polymerization shrinkage and polymerization

shrinkage stress in polymer-based restoratives J Dent Res 199725435ndash440

74Davidson CL Resisting the curing contraction with adhesive composites J

Prosthet Dent 198655446ndash7

75Davis RD Mayhew RB A clinical comparison of three anterior restorative resins

at 3 years J Am Dent Assoc 1986112659-63

76Dejak B Mlotkowski A Three-dimensional finite element analysis of strength

and adhesion of composite resin versus ceramic inlays in molarsJ Prosthet

Dent200899131-40

77Deligeorgi V Mjor IA Wilson NH An overview of reasons for the placement

and replacement of restorations Prim Dent Care 20018(1)5-11

78Deliperi S Bardwell DN An alternative method to reduce polymerization

shrinkage in direct posterior composite restorations J Am Dent Assoc 2002

1331387ndash97

79Demirci M Tuncer S Yuceokur AA Prevalence of caries on individual tooth

surfaces and its distribution by age and gender in university clinic patientsEur J

Dent20104(3)270-9

80De Munck J Van Meerbeek B Satoshi I Vargas M Yoshida Y Armstrong S

Lambrechts P Vanherle G Microtensile bond strengths of one- and two-step

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81Dewaele M Truffier-Boutry D Devaux J Leloup G Volume contraction in

photocured dental resins the shrinkage-conversion relationship revisited Dent Mater

2006 22359-365

44

82Deutsch WM Simecek JW Dental emergencies among Marines ashore in

Operations Desert ShieldStorm Mil Med 1996161(10) 620ndash623

83Dickens SH Stansbury JW Choi KM Floyd CJ Photopolymerization kinetics

of methacrylate dental resins Macromolecules 2003 366043-6053

84Dietschi D De Siebenthal G Neveu-Rosenstand L Holz J Influence of the

restorative technique and new adhesives on the dentin marginal seal and adaptation of

resin composite Class II restorations An in vitro evaluation Quintessence Int 1995

26 717-727

85Dietschi D Herzfeld D In vitro evaluation of marginal and internal adaptation of

class II resin composite restorations after thermal and occlusal stressing Eur J Oral

Sci 1998 106 1033-1042

86Dietschi D Marginal adaptation and seal of direct and indirect Class II composite

resin restorations an in vitro evaluation Quintessence Int 26(2)127-138 1995

87Diefenderfer KE Simecek JW Ahlf RL Ragain JC Relationship between

caries status and dental emergencies among US naval personnel J Dent Res

20028195 (Abstract)

88Diefenderfer KE Rienhardt JW Shear bond strengths of ten adhesive

resinamalgam combinations Oper Dent 1997 22 50-56

89Donly KJ Jensen ME Triolo PA clinical comparison of resin composite inlay

and onlay posterior restorations and cast-gold restorations at 7 years Quintessence Int

30(3)163- 1681999

90Douglas WH Fields RP Fundingsland J A comparison between the

microleakage of direct and indirect composite restorative systems J Dent 17(4)184-

188 1989

91Eberhard J Hartman B Lenhard M Mayer T Kocher T Eickholz P Digital

subtraction radiography for monitoring dental demineralization An in vitro study

Caries Res 200034(3)219-24

92Edelstein BL Douglass CW Dispelling the myth that 50 percent of US

schoolchildren have never had a cavity Public Health Rep1995 110 (5) 522-530

93Eick JD Welch FH Polymerization shrinkage of posterior composite resins and

its possible influence on postoperative sensitivity Quintessence Int 198617103-11

94Elliott JE Lovell LG Bowman CN Primary cyclization in the polymerization of

bis GMA and TEGDMA a modeling approach to understanding the cure of dental

resins Dent Mater 2001 17221-229

95Ermis R Ulkam Aydin Examiner agreement in the replacement decisions of

class I amalgam restorations The Journal of contemporary dental practice 2004 Vol

5 no21-7

96Feilzer AJ AJ De Gee CL Davidson Increased wall-to-wall curing

contraction in thin bonded resin layers J Dent Res 19896848ndash50

97Feilzer AJ Dauvillier BS Effect of TEGDMABisGMA ratio on stress

development and viscoelastic properties of experimental twopaste composites J Dent

Res 2003 82824-828

98Feilzer AJ de Gee AJ Davidson CL Relaxation of polymerization contraction

shear stress by hygroscopic expansion J Dent Res 1990 6936ndash39

45

99Feilzer AJ De Gee AJ Davidson CL Setting stress in composite resin in relation

to configuration of the restoration J Dent Res1987 661636-1639

100Feilzer AJ Dooren LH de Gee AJ Davidson CL Influence of light intensity

on polymerization shrinkage and integrity of restoration-cavity interface Eur J Oral

Sci 1995 103322ndash326

101Fennis YL Verdischbot EH vanrsquot Hof MA Performance of some diagnostic

systems in the prediction of occlusal caries in permanent molars in 6 and 11 year-old

children J Dent 1998 26(5) 403-40

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848

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135- 144

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Dent Oral Epidemiol 200533(3)212-8

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Bucureşti 2001

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Activity EdApollonia Iasi2002

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Mater 1995 11(2)132-6

152Jackson RD Morgan M The new posterior resins and a simplified placement

technique J Am Dent Assoc 2000131375ndash383

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with flowable composite in the proximal box Am J Dent 200013235ndash238

48

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Kompositefullungen Zahnartzlicher Welt 1999 108 270-273

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Community Dentistry and Oral Epidemiology 1994 22(2) 71-74

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composite restorations effected by increased flexibility J Dent Res 1990 691240ndash

1243

161Khairallah C Hokayem A Long-term clinical evaluation of 2 dental materials

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200932(126)21-8

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Biology199843(8)629-632

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817-822

165Kiremitci A Alpaslan T Gurgan SSix-year clinical evaluation of packable

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dental resin composites Dent Mater 2005 211150-1157

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marginal leakage around class II composite resin restorations in vitroQuint Int

201989117ndash121

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18(7)516-20

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Dent 27(5)325-331 1999

49

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Jan11(1)34-40

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JProsthet Dent 199369(4)425-430

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thermal behavior of dental composites Dent Mater 2008 24(8)1017ndash1024

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JDent 199826 627-632

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shrinkage and elasticity of flowable composites and filled adhesives Dent Mater

1999 15128-137

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179Lăcătuşu St Luminiţa Costinescu Andrian S Gianina Iovan Valeria

Pendefunda 180Sorina Solomon Topoliceanu C Elements of dispersional

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Edition of the Balkan Medical Days

Stomatological Section Abstract nr1091999128

181Lăcătuşu St Andrian S Gianina Iovan- Consideraţii asupra adaptării

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200126302ndash307

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Dentistry and Oral Epidemiology 1996 24 106-11

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Dent Mater 2002 18436-444

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20(3)236-43

188Loguercio AD Reis A Schroeder M Balducci I Versluis A Ballester RY

Polymerization shrinkage effects of boundary conditions and filling technique of

resin composite restorations J Dent 2004 32(6)459-70

50

189Lopes GC Baratieri LN Monteiro S Jr Vieira LC Effect of posterior resin

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Quintessence Int 2004 35(2)156-61

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193Lovell LG Stansbury JW Syrpes DC Bowman CN Effects of composition

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copolymerizations Macromolecules 1999 323913-3921

194Lutz F Krejci I Barbakow F Quality and durability of marginal adaptation in

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clinical results J Dent Res 199877 1020

196Mair LH Ten-year clinical assessment of three posterior resin composites and

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Dentomaxillofac Radiol 2007 Oct36(7)377-81

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J Prosthet Dent 2000 Sep84(3)289-96

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Three-year clinical evaluation of composite and ceramic inlays Am J Dent 2001

Apr14(2)95-9

202Manhart J Chen HY Draegert U Kunzelmann KH Hickel R Vickers

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79369 (Abstract)

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PrimDentCare1999Apr659-62

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33

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52

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125749-751

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34

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Monogr Oral Sci 20092142-51

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Influence of the Discomfort Reported by Children on the Performance of Approximal

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53

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569ndash575

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Community Dent Oral Epidemiol 1980 Jun8(3)135-8

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system on microleakage in cervical composite resin restorations Rev Med Chir

Soc Med Iaşi-2008 vol112 nr1supl1145-147

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posterior composite 10-year report J Dent 199927(1) 13ndash19

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composite resins Five-year results Swed Dent J 1995 19 173-182

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of teeth with long-term performing composite restorations J Oral Rehabil 2002

29(12)1131ndash1138

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Operative Dentistry 5th ed St Louis Mosby 2006293-7

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examiners evaluating amalgam restorations Oper Dent 1997 Mar-Apr22(2)57-65

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J Appl Oral Sci 2010 Feb18(1)37-43

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Int Dent J 199141(4)195-205

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conditions on ceramiccomposite bond strength J Dent Res 1995 74(l)381-387

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ClinOral Invest1997140-46

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J Dent 199725(6)459-73

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affecting cure at depths within light-activated resin composites Am J Dent

1993691ndash95

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contemporary light curing units using microhardness J Esthet Dent 200012340-9

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of new adult patients diagnostic yield when combined with bitewing radiography and

identification of selection criteria Br Dent J 2002 Mar 9192(5)275-9

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microleakage of deep class-II cavities restored with two composite resin formulations

J Conserv Dent 201013(1)9-15

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of polymerization contraction in composite restorations J Dent 1992 20178ndash182

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mechanical analysis of storage modulus development in lightactivated polymer matrix

composites Dent Mater 200218197-202

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Nanoleakage leakage within the hybrid layer Oper Dent 1995 20 18-25

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posterior composite restorations Dent Mater 200521(1) 9ndash12

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packable posterior composite in bulk-cured restorations JADA 2006 137(1)71ndash80

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edition 1996

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404

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Assessment of dental caries with Digital Imaging Fiber-Optic Transillumination (DI-

FOTI)in vitro studyCaries Res 1997 31(2) 103-110

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interobserver agreement and comparison to histological hard-tissue sections Caries

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282Seghi RR Denry 1L Rosenstiel SF Relative fracture toughness and hardness

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283Sengun A Koyuturk AE Sener Y Ozer F Effect of desensitizers on the bond

strength of a self-etching adhesive system to caries affected dentin on the gingival

wall Oper Dent 2005 30(4)430-435

284Sengun A Unlu N Ozer F Ozturk B Bond strength of five current adhesives

to caries-affected dentin J Oral Rehabil 2002 29 777-781

285Setcos JC Staninec M Wilson NH- A two-year randomized controlled

clinical evaluation of bonded amalgam restorations- Journal of Adhesive Dentistry

nr11999

286Sideridou I Tserki V Papanastasiou G Effect of chemical structure on degree

of conversion in light-cured dimethacrylate-based dental resins Biomaterials 2002

231819-1829

287Sideridou I Tserki V Papanastasiou G Study of water sorption solubility and

modulus of elasticity of light-cured dimethacrylate-based dental resins Biomaterials

2003 24655-665

288Sidi AD Naylor MN A comparison of bitewing radiography and interdental

transillumination as adjuncts to the clinical identification of approximal caries in

posterior teeth Br Dent J 1988 164 (1) 15-18

289SilverFH Christiansen DLBiomaterials Science and Biocompatibility New

York Springer-Verlag 1999

290Simecek JW Diefenderfer KE Ahlf RL Ragain JC Jr Longitudinal trends in

restorative treatment needs among a cohort of US naval personnel J Dent Res

200382 1169 (Abstract)

291Simecek JW Diefenderfer KE Ahlf RL Ragain JC Jr Dental sealant

longevity in a cohort of young US naval personnel JADA 2005136(2)171ndash178

56

292Simi B Suprabha B Evaluation of microleakage in posterior nanocomposite

restorations with adhesive liners J Conserv Dent 201114(2)178-81

293Simone D David N B An alternative to reduce polimeryzation shrinkage in

direct posterior restorations JADA 2002 101387-1398

294Smales RJ Longevity of cusp-covered amalgams survivals after 15 years

OperDent 1991 16 17-20

295Smales RJ Webster DA Leppard PISurvival predictions of amalgam

restorations JDent1991 19 272-277

296Smales RJ Hawthorne WSLong-term survival of extensive amalgams and

posterior crowns JDent 1997 25 225-227

297Soncini JA Maserejian NN Trachtenberg F Tavares M Hayes C The

longevity of amalgam versus compomercomposite restorations in posterior primary

and permanent teeth findings From the New England Childrens Amalgam Trial J

Am Dent Assoc 2007 Jun138(6)763-72

298Sonoda H Banerjee A Sherriff M Tagami J Watson TF An in vitro

investigation of microtensile bond strengths of two dentine adhesives to caries-

affected dentine J Dent 2005 33(4)335-342

299Soodabeh Kimyai Masomeh Mehdipour Siavash Savadi Oskoee Reasons

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to Tabriz Faculty of dentistry J Dental Research Clinics Dental Prospects vol 1

no1(2007)

300De Souza FB Guimaraes RP Vicente Silva CH A clinical evaluation of

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International 2005 36 41-48

301Spreafico RC Gagliani M Composite resin restorations on posterior teeth In

Roulet JF Degrange M Adhesion The silent revolution in dentistry Chicago

Quintessence 2000253ndash76

302St Georges AJ Wilder AD Jr Perdigao J Microleakage of Class V composites

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15244-247

303Stangel I Barolet RY Clinical evaluation of two posterior composite resins

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306Suh BI A study of the compatibility of adhesives with composites Proceeding

from the SCO Dental Products Inc Symposium 2003 24(8) 4-9 (Abstract)

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pin-retained complex amalgam restorations Oper Dent 2004 29269-276

308Summit JB Robbins JW Hilton TJ Fundamentals in operative dentistry Cap

10Direct Posterior Esthetic Restorations 2006 Quintessence Publishing Co

57

309Svanberg M Mjor IA Orstavik D Mutans streptococci in plaque from margins

of amalgam composite and glassndashionomer restorations J Dent Res 199069861ndash

864

310Tanne K Mamoru S Burstone C Three-dimensional finite element analysis

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Orthop921987499ndash505

311Tanumiharja M Burrow MF Tyas MJ Microtensile bond strengths of seven

dentin adhesive systems Dent Mater 2000 16(3)180-7

312Tay FR Pashley DH Aggressiveness of contemporary self-etching systems

Part I Depth of penetration beyond dentin smear layers Dent Mater 2001 17(4) 296-

308

313Tay FR Frankenberger R Krejci I Bouillaguet S Pashley DH Carvalho

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In vivo evidence J Dent 2004 32611ndash621

314Tay FR Pashley DH Have dentin adhesives become too hydrophilic J Can

Dent Assoc 2003 69726ndash731

315Tay FR Sano H Carvalho R Pashley EL Pashley DH An ultrastructural

study of the influence of acidity of self-etching primers and smear layer thickness on

bonding to intact dentin J Adhes Dent 2000 283ndash98

316Thompson JY Bayne SC Heymann HO Mechanical properties of a new

mica-based machinable glass ceramic for CADCAM restorations J Prosthet Dent

76(6)619-623 1996

317Unterbrink GL R Muessner Influence of light intensity on two restorative

systems J Dent 199523183ndash189

318Unterbrink GL Liebenberg WH Flowable resin composites as filled

adhesiveslsquo literature review and clinical recommendations Quintessence Int

199930249ndash257

319Vaarkamp J Ten Bosch J Verdonschot EH Quantitative diagnosis of small

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320Valachovic RW Douglass CW Reiskin AB Chauncey HH McNeil BJ The

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Oral Surg Oral Med Oral Pathol 198661(3)289-96

321Van Meerbeek B De Munck J Yoshida Y Inoue S Vargas M Vijay P Van

Landuyt K Lambrechts P Vanherle G Adhesion to enamel and dentin Current

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322Van Meerbeek B Van Landuyt K De Munck JHashimoto M Peumans M

Lambrechts P Yoshida Y Inoue S Suzuki K Technique-sensitivity of

contemporary adhesives Dent Mater J 2005 24(1) 1-13

323Van Meerbeek B Vargas S Inoue S Yoshida Y Peumans M Lambrechts P

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20016 119-144

324Van Meerbeek B Yoshida Y Inoue S Vargas M Abe Y Fukuda R Okazaki

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58

325Van Nieuwenhuysen JP DrsquoHoore W Carvalho J Qvist V Long-term

evaluation of extensive restorations in permanent teeth J Dent 200331(6)395ndash405

326Venhoven BA de Gee AJ Davidson CL Light initiation of dental resins

dynamics of the polymerization Biomaterials 1996 172313-2318

327Versluis A Douglas WH Cross M Sakaguchi RL Does an incremental filling

technique reduce polymerization shrinkage stresses J Dent Res 1996 75871ndash878

328Vries HC Ruiken HM Konig KG vanrsquot Hof MA Radiographic versus

clinical diagnosis of approximal carious lesions Caries Res1990 24 (5) 364-370

329Waggoner W Ashton J Predictability of cavitation based upon radiographic

appearance comparison of two film types Quintessence International 1989 20(1)

55-60

330Watanabe LG Marshall GW Jr Marshall SJ Dentin shear strength effects of

tubule orientation and intra tooth location Dent Mater 1996 12 109-115

331Watts DC AS Marouf Optimal specimen geometry in bonded-disk

shrinkage-strain measurements on light-cured biomaterials Dent Mater 200016447ndash

451

332Watts DC Marouf AS Al-Hindi AM Photo-polymerization shrinkage-stress

kinetics in resin-composites methods development Dent Mater 2003 191ndash11

333Weaver WS Blank LW Pelleu GB Jr A visible light activated resin cured

through tooth structure GenDent 198836236-7

334Wendt SL Microleakage and cusp fracture resistance of heattreated composite

resin inlays Am J Dent 4(1)10-14 1991

335Wenzel A Hintze H Mikkelsen L Mouyen F Radiographic detection of

occlusal caries in noncavitated teeth A comparison of conventional film radiographs

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1991 72 621-6

336Wenzel A Hintze H Perception of image quality in direct digital radiography

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Dentomaxillofac Radiol 1993 22 131-4

337Wenzel A Computer-aided image manipulation of intraoral radiographs to

enhance diagnosis in dental practice a review Int Dent J 1993 43 99-108

338Wenzel A Digital radiography and caries diagnosis Dento Maxillo Facial

Radiology 27(1)3-11 1998

339Wenzel A Haiter-Neto F Gotfredsen E Risk factors for a false positive test

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modality and observer characteristics Caries Res 200741(3)170-6

340Wibowo G Stockton L Microleakage of class II composite restorations Am J

Dent 200114177ndash185

341Wilson NHF Wastell DG Norman RD Five-year performance of high-

cooper content amalgam restorations in a multiclinical trial JDent1996 24 203-210

342Winkler MM Katona TR Paydar NH Finite element stress analysis of three

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1996751477-83

343Yap AU Effectiveness of polymerization in composite restoratives claiming bulk

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59

344Yeşilyurt C Bulucu B Bond strength of total-etch dentin adhesive systems on

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Contemporary Dental Practice 7(2) 20061-13

345Yoshida Y Van Meerbeek B Okazaki M Shintani H Suzuki K Comparative

study on adhesive performance of functional monomers J Dent Res 2004 83 454-

458

346Yoshiyama M Tay FR Doi J Nishitani Y Yamada T Itou K Carvalho RM

Nakajima M Pashley DH Bonding of self-etch and total etch adhesives to carious

dentin J Dent Res 2002 81 556-560

  • COPERTA REZUMAT ENGLEZA (MEREUTA)pdf
  • REZUMAT ENGLEZA DR MEREUTA DENISSpdf
Page 12: UNIVERSITATEA DE MEDICINA SI FARMACIE “GR Doctorat/Rezumat... · universitatea de medicina si farmacie “gr.t.popa” iasi facultatea de medicina dentara rezumatul tezei de doctorat

9

AB

C

S1

12

54

34

0

10

20

30

40

50

60

A

B

C

FigVII12 Marginal adaptation (proximal)-composite resins restorations (molars)

AB

C

S1

22

54

24

0

10

20

30

40

50

60

A

B

C

FigVII13 Surface quality-amalgam restorations (bicusps)

AB

C

S1

10

54

36

0

10

20

30

40

50

60

A

B

C

FigVII14 Surface quality-amalgam restorations (molars)

AB

C

S1

12

68

20

0

10

20

30

40

50

60

70

A

B

C

FigVII15 Surface quality-composite resins restorations (bicusps)

AB

C

S1

8

70

22

0

20

40

60

80

A

B

C

FigVII16 Surface quality-composite resins restorations (molars)

10

A

C

S1

98

20

20

40

60

80

100

A

C

FigVII17a-b Prevalence of marginal dental cariesamalgam restorations (moderate

CR)

A

C

S1

92

80

20

40

60

80

100

A

C

FigVII18 Prevalence of marginal dental cariesamalgam restorations (high CR)

A

C

S1

94

60

20

40

60

80

100

A

C

FigVII19 Prevalence of marginal dental cariescomposite resins restorations (CR

moderate)

A

C

S1

82

18

0

10

20

30

40

50

60

70

80

90

A

C

FigVII20 Prevalence of marginal dental cariescomposite resins restorations (high

CR)

11

The study data sustain the results obtained by most studies focused on

posterior amalgam restorations However Hickelampcol (2001) reviewed literature data

and proved that many results varies accordingly to different clinical factors (133)

Roulet JF(1997) warned about limits of cross-sectional studies related to composite

resins restorations because of the absence of data regarding restorative techniques

practitioner experience presence or absence of optimum isolation factors related by

patient (266)

VII5CONCLUSIONS

Amalgam proximo-occlusal restorations with minimum 6-years age present

excellent results for parameters anatomic form (occlusal) marginal

discoloration and marginal secondary dental caries good results for

parameters anatomic form (proximal) and marginal adaptation and poor results

for surface quality

Composite resins proximo-occlusal restorations (bicusps) with minimum 6-

years age present excellent results for parameters color match marginal

discoloration and marginal secondary dental caries and good results for

parameters anatomic form (occlusal proximal) marginal adaptation surface

quality

Composite resins proximo-occlusal restorations (molars) with minimum 6-

years age present good results for parameters color match marginal

discoloration marginal secondary dental caries marginal adaptation and poor

results for parameters anatomic form (occlusal) (54 indices Ryge C)

anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The restorations extended at external third of occlusal surface present highest

percents of indices C regarding anatomic form (occlusal) (54 indices Ryge

C) anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The exceeding of 6-years age will require careful monitorisation for early

interventions through polishing sealing reshaping and even replacement for

restorations with major defects

12

CHAPTVIII CLINICAL PERFORMANCE OF COMPOSITE RESINS

RESTORATIONS RELATED TO RESTORATIVE TECHNIQUE 12-

MONTHS LONGITUDINAL STUDY

VIII1 INTRODUCTION

The restorative technique has a major influence over clinical performance of

composite resins restorations in proximo-occlusal cavities In this context researches

focused on correlations between technique and clinical performance of direct

restorations improve the dentist decision regarding restorative technique choice

VIII2AIM OF STUDY

The aim of study was to determine the clinical performance of composite

resins proximo-occlusal restorations performed using different restorative techniques

VIII3MATERIALS AND METHOD

The group study included 37 patients with age 18-42 years with moderat

ecariogenic risk The total number of composite resins restorations (Herculite XRV

Kerr) was 60 divided in three study groups (n=20)

I Centripetal build-up

II Oblique layering

III Horisontal layering

The coronal restorations were assessed at an interval of 12 months using

indices Ryge modified USPHS

- indice ALFA (A)- IDEAL CLINIC

- indice BRAVO (B)- ACCEPTABLE CLINIC

- indice CHARLIE (C)- UNACCEPTABLE CLINIC

VIII4 RESULTS AND DISCUSSIONS

The statistical tests Kruskal-Wallis and Mann-Whitney were performed to

confirm or infirm research hypotesis (the direct restorations performed using different

restorative techniques present statistical significant differences regarding clinical

performance for the assessed parameters)

13

TableVIII1a-b Groups study (Kruskal-Wallis Test)

Ranks

20 2960

20 2560

20 3630

60

20 3050

20 2420

20 3680

60

20 2490

20 3140

20 3520

60

Restorative_techniques

Centripetal build-up

Oblique layering

Horizontal layering

Total

Centripetal build-up

Oblique layering

Horizontal layering

Total

Centripetal build-up

Oblique layering

Horizontal layering

Total

Marginal_adaptation

Marginal_discoloration

Anatomical_form

N Mean Rank

Test Statisticsab

4913 8031 4900

2 2 2

086 018 086

Chi-Square

df

Asymp Sig

Marginal_

adaptation

Marginal_

discoloration

Anatomical_

form

Kruskal Wallis Testa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between the three restorative

techniques for parameter marginal adaptation (p=0086)

There are no statistical significant differences between the three restorative

techniques for parameter marginal discoloration (p=0018)

There are no statistical significant differences between the three restorative

techniques for parameter anatomical form (proximal) (p=0086)

TableVIII2 Comparing results between restorations performed using three

techniques (marginal adaptation marginal discoloration anatomical form) Marginal adaptation Centripetal build-upOblique layering p=04 ns

Centripetal build-upHorizontal layering p=0191 ns

Oblique layering Horizontal layering p=0028 s

Marginal discoloration Centripetal build-upOblique layering p=0103 ns

Centripetal build-upHorizontal layering p=0195 ns

Oblique layering Horizontal layering p=0005 s

Anatomical form Centripetal build-upOblique layering p=0137 ns

Centripetal build-upHorizontal layering p=0029 s

Oblique layering Horizontal layering p=0433 ns

ns nesemnificativ

s semnificativ

p probabilitate

14

Tables VIII3a-b Mann-Whitney test Comparing analysis regarding marginal

discoloration between restorations performed using oblique layering technique and

centripetal build-up technique

Ranks

20 2180 43600

20 1920 38400

40

Restorative_techniques

Centripetal build-up

Oblique layering

Total

Marginal_adaptation

N Mean Rank Sum of Ranks

Test Statisticsb

174000

384000

-841

400

495a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

adaptation

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between centripetal build-up

and oblique layering techniques regarding parameter marginal adaptation (p=0400)

Tables VIII4a-b Mann-Whitney test Comparing analysis regarding marginal

adaptation between restorations performed using horisontal layering technique and

centripetal build-up technique

Ranks

20 1830 36600

20 2270 45400

40

Restorative_techniques

Centripetal build-up

Horizontal layering

Total

Marginal_adaptation

N Mean Rank Sum of Ranks

Test Statisticsb

156000

366000

-1307

191

242a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

adaptation

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between centripetal build-up

and horisontal layering techniques regarding parameter marginal adaptation

(p=0191)

15

TablesVIII5a-b Mann-Whitney test Comparing analysis regarding marginal

adaptation between restorations performed using oblique layering technique and

horisontal layering technique

Ranks

20 1690 33800

20 2410 48200

40

Restorative_techniques

Oblique layering

Horizontal layering

Total

Marginal_adaptation

N Mean Rank Sum of Ranks

Test Statisticsb

128000

338000

-2191

028

052a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

adaptation

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There is statistical significant differences between horisontal layering and

oblique layering techniques regarding parameter marginal adaptation (p=0028)

Tables VIII6a-b Mann-Whitney test Comparing analysis regarding marginal

discoloration between restorations performed using oblique layering technique and

centripetal build-up technique

There are no statistical significant differences between centripetal build-up

and oblique layering techniques regarding parameter marginal discoloration

(p=0103)

Ranks

20 2260 45200

20 1840 36800

40

Restorative_techniques

Centripetal build-up

Oblique layering

Total

Marginal_discoloration

N Mean Rank Sum of Ranks

Test Statisticsb

158000

368000

-1632

103

265a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

discoloration

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

16

Tables VIII7a-b Mann-Whitney test Comparing analysis regarding marginal

discoloration between restorations performed using centripetal build-up technique and

horisontal layering technique

Ranks

20 1840 36800

20 2260 45200

40

Restorative_techniques

Centripetal build-up

Horizontal layering

Total

Marginal_discoloration

N Mean Rank Sum of Ranks

Test Statisticsb

158000

368000

-1299

194

265a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

discoloration

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between centripetal build-up

and horisontal layering techniques regarding parameter marginal discoloration

(p=0103)

Tables VIII8a-b Mann-Whitney test Comparing analysis regarding marginal

discoloration between restorations performed using oblique layering technique and

horisontal layering technique

Ranks

20 1630 32600

20 2470 49400

40

Restorative_techniques

Oblique layering

Horizontal layering

Total

Marginal_discoloration

N Mean Rank Sum of Ranks

Test Statisticsb

116000

326000

-2822

005

023a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

discoloration

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There is statistical significant differences between horisontal layering and

oblique layering techniques regarding parameter marginal discoloration (p=0005)

17

TablesVIII9 a-b Mann-Whitney test Comparing analysis regarding anatomical

form between restorations performed using centripetal build-up technique and oblique

layering technique

Ranks

20 1830 36600

20 2270 45400

40

Restorative_techniques

Centripetal build-up

Oblique layering

Total

Anatomical_form

N Mean Rank Sum of Ranks

Test Statisticsb

156000

366000

-1486

137

242a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Anatomical_

form

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between centripetal build-up

and oblique layering techniques regarding parameter anatomical form (p=0137)

Tables VIII10a-b Mann-Whitney test Comparing analysis regarding anatomical

form between restorations performed using centripetal build-up technique and

horisontal layering technique

Ranks

20 1710 34200

20 2390 47800

40

Restorative_techniques

Centripetal build-up

Horizontal layering

Total

Anatomical_form

N Mean Rank Sum of Ranks

Test Statisticsb

132000

342000

-2184

029

068a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Anatomical_

form

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between centripetal build-up

and horisontal layering techniques regarding parameter anatomical form (p=0029)

18

Tables VIII11a-b Mann-Whitney test Comparing analysis regarding anatomical

form between restorations performed using oblique layering technique and horisontal

layering technique

Ranks

20 1920 38400

20 2180 43600

40

Restorative_techniques

Oblique layering

Horizontal layering

Total

Anatomical_form

N Mean Rank Sum of Ranks

Test Statisticsb

174000

384000

-784

433

495a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Anatomical_

form

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between horisontal layering and

oblique layering techniques regarding parameter anatomical form (p=0433)

Indices A for restorations performed using centripetal build-up technique were

as follows color match-80 marginal adaptation- 60 marginal discoloration-

70 anatomical form (proximal)- 80 surface quality- 60

Indices A for restorations performed using horisontal layering technique were

as follows color match-70 marginal adaptation- 40 marginal discoloration-

50 anatomical form (proximal)- 50 surface quality- 70

Indices A for restorations performed using oblique layering technique were as

follows color match-70 marginal adaptation- 80 marginal discoloration- 90

anatomical form (proximal)- 60 surface quality- 70

Indices B for restorations performed using centripetal build-up technique were

as follows color match-20 marginal adaptation- 30 marginal discoloration-

20 anatomical form (proximal)- 30 surface quality- 40

Indices B for restorations performed using horisontal layering technique were

as follows color match-30 marginal adaptation- 40 marginal discoloration-

30 anatomical form (proximal)- 30 surface quality- 30

Indices B for restorations performed using oblique layering technique were as

follows color match-30 marginal adaptation- 20 marginal discoloration- 10

anatomical form (proximal)- 40 surface quality- 30

19

Indices C for restorations performed using centripetal build-up technique were

as follows color match-0 marginal adaptation- 10 marginal discoloration- 0

anatomical form (proximal)- 0 surface quality- 0

Indices C for restorations performed using horisontal layering technique were

as follows color match-0 marginal adaptation- 20 marginal discoloration- 20

anatomical form (proximal)- 20 surface quality- 0

Indices C for restorations performed using oblique layering technique were as

follows color match-0 marginal adaptation- 0 marginal discoloration- 10

anatomical form (proximal)- 0 surface quality- 100

Discussions

For in vitro studies is difficult to reproduce the variables existent in oral cavity

like occlusal stress and pH and temperature changes (235) The clinical studies are

determinant in assessment of restorative techniques (300) The most researches

focuses on the influence of restorative technique on the reduction of lightcuring stress

(51 78 135)

VIII5 CONCLUSIONS

Oblique layering technique presents superior results regarding marginal

adaptation and marginal discoloration and is recommended for proximo-

occlusal dental caries close to enamel-cement jonction

Centripetal build-up presents good results regarding marginal adaptation and

anatomical form at proximal level (proximal surfaces and contact point)

Horisontal layering technique can be used for optimum results only in

proximal-occlusal cavities with moderate extension both in occlusal-cervical

and buccal-oral

20

CHAPTIX STUDY REGARDING MARGINAL SEALING STATUS IN

COMPOSITE RESINS LIMITED PROXIMO-OCCLUSAL RESTORATIONS

PERFORMED USING DIFFERENT TECHNIQUES

IX1INTRODUCTION

The contraction of composite resins can produce stress inside dental structure

The most contraction stress appears in the initial stages and development rate of stress

decreases gradually in time (5 98 160) The contraction stress of composite resins

can overpass adhesion strenght and can broke the link between dental tissues and

composite resin (73) When adhesion strenght is high stress can produce marginal

fracture or bulk fracture (74) These situations are associated with microleakage and

penetration of oral fluid and bacteria along dentinal walls endangering the pulpal

tissue or favourising secondary dental caries

IX2 AIM OF STUDY

The study aimed to assess the efficiency of marginal sealing along gingival

wall in limited proximal-occlusal restorations performed using three different

techniques

IX3MATERIALS AND METHOD

The study group included 30 teeth extracted for orthodontic and periodontal

reasons On every tooth two identical class II cavities (on mesial and distal surfaces)

were prepared with cylindrical burs under water cooling The gingival wall was

limited to enamel-cement jonction The cavity dimension were as follows 2 mm

buccal-oral 5mm depth Each tooth was introduced in a pattern of acrylat The

operator calibrated preparation technique on acrylat teeth in Simulation Laboratory of

UMF ―Gr T Popa Iaşi The 60 prepared cavities were randomly divided in three

study groups related to restorative technique The restoration were performed with

Filtek Z550 (3M ESPE) a nanohybrid composite resin The adhesive strategy

included etchamprinse in 2 steps and adhesive Adper Single Bond 2(3MESPE)

Group A (n=20) bulk restorative technique associated with lightcuring from

occlusal 40 seconds and from buccal and oral 20 seconds

Group B (n=20) oblique layering technique (first layer on buccal wall and

buccal frac12 of gingival wall was lightcured from buccal second layer on oral wall and

oral frac12 of gingival wall was lightcured from oral third oral as a triangle with point

oriented to gingival wall was lightcured from occlusal)

Group C (n=20) combined technique (bdquoflow layer on gingival and axial

walls lightcured under pressure only associated with solid composite resin layer)

The proximal surfaces were performed using Tofflemire and metallic matrices After

removal of matrices every restoration was lightcured for another 20 seconds Two

layers aof varnish were applied on composite resins restorations excepting cavity

margins and an area of 1 mm around them The samples were introduced in methylen

21

blue 10 for 48 hours After this stage samples were washed with water and teeth

were cut longitudinally with a diamonded disc

The die penetration was assessed with Zeiss (Iena Germany) X20 microscope

accordingly to four scores (0-3)

0 ndash no penetration

1 ndash die infiltration until external half of gingival wall

2 ndash die infiltration on all gingival wall

3 ndash die infiltration on gingival wall and axial wall

IX4RESULTS AND DISCUSSIONS

The result of die penetration are presented in table IX1

TableIX1 The results for die penetration

Grup 0 1 2 3

A (bulk) 0 0 3 17

B (layering) 0 4 5 11

C (combined) 12 5 2 1

In group A 17 sample had score 3 and 2 samples had score 2 In group B 11

sample had score 3 5 samples had score 2 and 4 sample had score 1 In group C with

best results 12 samples had score 0 5 samples had score 1 2 samples had score 2 1

sample had score 3

The recorded data were analysed using test Mann-Whitney The statistical

results are presented in tables IX2-IX4

Tables IX2a-b Mann-Whitney for comparisons of microleakage values between

bulk technique and incremental technique

Ranks

Restorative technique N Mean Rank Sum of Ranks

Scores

frequency

A ndash bulk technique 20 2420 24200

B ndash incremental

technique

20 1680 16800

Total 40

Test Statisticsb

scores

frequency

Mann-Whitney U 29000

Wilcoxon W 168000

Z -1970

Asymp Sig (2-tailed) 049

Exact Sig [2(1-tailed Sig)] 123a

a Not corrected for ties

b Grouping Variable restorative technique

22

Tables IX3a-b Mann-Whitney for comparisons of microleakage values between

bulk technique and mixed technique

Ranks

Restorative technique N Mean Rank Sum of Ranks

scores

frequency

A ndash bulk technique 20 3090 30900

C ndash mixed technique 20 1010 10100

Total 40

Test Statisticsb

scores

frequency

Mann-Whitney U 500

Wilcoxon W 101000

Z -4021

Asymp Sig (2-tailed) 000

Exact Sig [2(1-tailed Sig)] 000a

a Not corrected for ties

b Grouping Variable restorative technique

Tables IX4a-b Mann-Whitney test for comparisons of microleakage values

between incremental technique and mixed technique

Ranks

Restorative technique N Mean Rank Sum of Ranks

scores

frequency

B ndash incremental

technique

20 2990 29900

C ndash mixed technique 20 1210 12100

Total 40

Test Statisticsb

scores

frequency

Mann-Whitney U 5500

Wilcoxon W 121000

Z -3492

Asymp Sig (2-tailed) 000

Exact Sig [2(1-tailed Sig)] 000a

a Not corrected for ties

23

Test Statisticsb

scores

frequency

Mann-Whitney U 5500

Wilcoxon W 121000

Z -3492

Asymp Sig (2-tailed) 000

Exact Sig [2(1-tailed Sig)] 000a

a Not corrected for ties

b Grouping Variable tehnrestaurare

The results of microleakage degree were statistically significant when the

three restorative techniques were compared The results showed that best restorative

technique regarding marginal sealing in cervical area is combined technique followed

by oblique layering technique The use of layering techniques limits the development

of contraction forces between oposite walls event that favourises bulk stress voids

formation and fissure inside dental tissues The results of our study are similar with

other studies (114 293)

IX5 CONCLUSIONS

The values of die penetration at gingival wall were statistically different

between the three restorative techniques

We concluded that all restorative methods were associated with lightcuring

contraction and marginal microleakage

The combined technique was associated with lowest lightcuring contraction

and die penetration

The bulk technique was associated with highest lightcuring contraction and die

penetration

24

CHAPTX STUDY REGARDING THE EFFECTS OF ETCHING ON

ENAMEL AND DENTINE IN CERVICAL AREA FOR PROXIMAL

CAVITIES AT LATERAL DENTAL GROUP

X1 INTRODUCTION

The studies reported marginal defects and high microleakage at the level of

gingival margins localised in cervical area or close to enamel-cement jonction for

high percents of proximal-occlusal composite resins restorations (8485) The good

adhesion is requested to insure restoration longevity and to prevent marginal

microleakage and presence of secondary marginal dental caries The adhesion

strenght of different adhesive systems can vary accordingly to tissues areas (204 240)

and to variations in dentinal structures (234 330) Most studies focused on adhesive

systems performances used healthy dentine close to pulp room but in case of class II

restorations there are particular features that influences the adhesion at the level of

gingival margins

The surface topography is an important property that determines the

interaction manner between surfaces The surface roughness and surface energy can

increase or decrease the adhesion of composite resins to the hard dental tissues

X2 AIM OF STUDY

The aim of study was to compare surface roughness of enamel and dentine

after etching related to different distances related to enamel-dentinecement jonction

X3 MATERIALS AND METHODS

The study group included 20 molars extracted from orthodontics or

periodontal reasons with intact proximal surfaces The teeth were cut longitudinally in

sens buccal-oral with diamond discs under water cooling

A group study (10 teeth) included 10 samples obtained through transversal

cutting at distance of 2mm from enamel-dentinecement jonction and 10 samples

obtained through transversal cutting at distance of 15 mm from enamel-

dentinecement jonction Another study group (10 teeth) included 10 samples

obtained through transversal cutting at distance of 1mm from enamel-dentinecement

jonction and 10 samples obtained through transversal cutting at distance of 05 mm

from enamel-dentinecement jonction All these samples were divided in two halfes

through mesial-distal cutting The samples finishing was performed with abrasive

paper (100-4000) and final polishing was performed with a device Buehler model

Minimet with slices introduced in ultrasound bath for 4 minutes The second half of

each sample was etched for 15 seconds with ortophosphoric acid 37 for 15 seconds

Slices were washed with distilled water for 30 seconds after etching and dried

The samples were analysed with atomic force microscopy (AFM) regarding

surface roughness The results were expressed as relative variation of roughness

X4 RESULTS AND DISCUSSIONS

The aspect of etched enamel at 2 mm distance from ECJ can be seen in figure

X1 (section 10 microm) The surface roughness is higher comparing with sample before

etching

25

După gravajul cu acid ortofosforic 37

The aspect of etched enamel at 15 mm distance from ECJ can be seen in

figure X2 (section 10 microm) The surface roughness is higher comparing with sample

before etching but lower comparing with sample at 2 mm from ECJ

The aspect of etched enamel at 1 mm distance from ECJ can be seen in figure

X3 (section 10 microm) The surface roughness is higher comparing with sample before

etching but lower comparing with sample at 15mm and 2 mm from ECJ

The aspect of etched enamel at 15 mm distance from ECJ can be seen in

figure X4 (section 10 microm) The surface roughness is higher comparing with sample

before etching but lower comparing with sample at 1 mm 15 mm and 2 mm from

ECJ

FigX1 3D aspect of enamel at 2 mm from ECJ

after etching (10 microm)

FigX2 3D aspect of enamel at 15 mm from ECJ

after etching (10 microm)

FigX3 3D aspect of enamel at 1 mm from ECJ

after etching (10 microm)

FigX4 3D aspect of enamel at 05 mm from ECJ

after etching (10 microm)

26

The mean values of squared roughness for dentine and enamel before etching

are presented in tables X1 and X2

Table X1 Squared roughness values for dentine samples before and after etching

Before etching (nm) After etching (nm)

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

sample

1

335 282 283 259 1149 947 901 879

sample

2

352 284 274 266 1127 939 883 875

sample

3

357 273 278 263 1152 953 876 867

sample

4

323 269 264 258 1146 942 895 883

sample

5

348 298 271 268 1153 944 904 878

sample

6

339 274 278 273 1158 937 893 892

sample

7

352 283 269 266 1145 944 899 876

sample

8

349 292 272 274 1166 942 907 869

sample

9

357 284 275 265 1132 939 893 879

sample

10

348 281 277 262 1142 941 899 878

Table X2 Squared roughness values for enamel and dentine samples before and after

etching

Before etching (nm) After etching (nm)

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

sample 1 422 342 309 313 2255 1114 874 845

sample 2 418 338 324 304 2236 1102 882 839

sample 3 413 334 315 303 2239 1115 873 833

sample 4 416 336 322 308 2242 1116 868 842

sample 5 426 332 315 294 2218 1103 877 829

sample 6 412 332 317 306 2237 1099 874 847

sample 7 414 335 322 314 2252 1102 876 834

sample 8 416 325 318 313 2239 1106 875 838

sample 9 418 328 314 299 2246 1113 879 836

sample 10 413 334 316 305 2242 1104 873 839

The results for samples before etching prove a decreasing tendency for mean

values of squared roughness surface beginning with areas placed at distance of 2 mm

from ECJ (346 nm) followed by areas placed at distance of 15 mm from ECJ (282

nm) 1 mm from ECJ (274 nm) and 05 mm from ECJ (265 nm) After etching the

decreasing tendency maintained for dentine localised at 2 mm from ECJ to dentine

localised at 05 mm from ECJ The mean values of squared roughness after etching

were three times higher (tables X3)

27

Table X3 Squared roughness values for enamel and dentine samples before and

after etching

Dentine Enamel

Before etching

(nm)

After etching

(nm)

Before etching

(nm)

After etching

(nm)

2 mm ECJ 346 1147 416 2237

15 mm ECJ 282 942 333 1107

1 mm ECJ 274 895 317 875

05 mm ECJ 265 877 305 838

The descriptive statistics data for surface roughness of dentine before and after

etching are presented in tables X4 si X5

Table X4 Descriptive statistics for dentine samples before etching

Statistics

Dentine 2mm

before etching

Dentine 15mm

before etching

Dentine 1mm

before etching

Dentine 05mm

before etching

N Valid 10 10 10 10

Missing 0 0 0 0

Mean 346000 282000 274100 265400

Std Error of Mean 33830 27487 17026 16746

Std Deviation 106979 86923 53841 52957

Skewness -1214 354 -314 348

Std Error of Skewness 687 687 687 687

Kurtosis 1141 049 336 -539

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 3230 2690 2640 2580

Maximum 3570 2980 2830 2740

Table X5 Descriptive statistics for dentine samples after etching

Statistics

Dentine 2mm

after etching

Dentine 15mm

after etching

Dentine 1mm

after etching

Dentine 05mm

after etching

N Valid 10 10 10 10

Missing 0 0 0 0

1147000 942800 895000 877600

Std Error of Mean 36545 14591 29926 22020

Std Deviation 115566 46140 94634 69634

Skewness -267 1169 -951 535

Std Error of Skewness 687 687 687 687

Kurtosis 043 1776 564 1416

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 11270 9370 8760 8670

28

Statistics

Dentine 2mm

after etching

Dentine 15mm

after etching

Dentine 1mm

after etching

Dentine 05mm

after etching

N Valid 10 10 10 10

Missing 0 0 0 0

1147000 942800 895000 877600

Std Error of Mean 36545 14591 29926 22020

Std Deviation 115566 46140 94634 69634

Skewness -267 1169 -951 535

Std Error of Skewness 687 687 687 687

Kurtosis 043 1776 564 1416

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 11270 9370 8760 8670

Maximum 11660 9530 9070 8920

To choose the statistical test to compare roughness surface values was

performed a test Shapiro-Wilk If p is lower or equal with 0005 than hypothesis of

distribution normality is rejected (distribution deviates from normal form) In the table

X6 the distributions are normal The statistical test will be test t for pair samples

Table X6 Test Shapiro-Wilk for dentine samples

Tests of Normality

Kolmogorov-Smirnov

a Shapiro-Wilk

Statistic df Sig Statistic df Sig

Dentine 2mm before etching 274 10 032 877 10 122

Dentine 15mm after etching 209 10 200 952 10 689

Dentine 1mm before etching 134 10 200 983 10 980

Dentine 05mm before etching 155 10 200 949 10 661

Dentine 2mm after etching 133 10 200 977 10 946

Dentine 15mm after etching 197 10 200 916 10 329

Dentine 1mm after etching 216 10 200 925 10 401

Dentine 05 after etching 220 10 185 933 10 474

Enamel 2mm before etching 193 10 200 898 10 207

Enamel 15mm before etching 170 10 200 977 10 947

Enamel 1mm before etching 157 10 200 952 10 689

Enamel 05mm before etching 165 10 200 943 10 590

Enamel 2mm after etching 235 10 124 925 10 404

Enamel 15mm after etching 209 10 200 871 10 102

Enamel 1mm after etching 189 10 200 964 10 834

Enamel 05mm after etching 142 10 200 983 10 978

a Lilliefors Significance Correction

29

Tests of Normality

Kolmogorov-Smirnov

a Shapiro-Wilk

Statistic df Sig Statistic df Sig

Dentine 2mm before etching 274 10 032 877 10 122

Dentine 15mm after etching 209 10 200 952 10 689

Dentine 1mm before etching 134 10 200 983 10 980

Dentine 05mm before etching 155 10 200 949 10 661

Dentine 2mm after etching 133 10 200 977 10 946

Dentine 15mm after etching 197 10 200 916 10 329

Dentine 1mm after etching 216 10 200 925 10 401

Dentine 05 after etching 220 10 185 933 10 474

Enamel 2mm before etching 193 10 200 898 10 207

Enamel 15mm before etching 170 10 200 977 10 947

Enamel 1mm before etching 157 10 200 952 10 689

Enamel 05mm before etching 165 10 200 943 10 590

Enamel 2mm after etching 235 10 124 925 10 404

Enamel 15mm after etching 209 10 200 871 10 102

Enamel 1mm after etching 189 10 200 964 10 834

Enamel 05mm after etching 142 10 200 983 10 978

a Lilliefors Significance Correction

This is a lower bound of the true significance

The results of test t for pair dentine samples before and after etching are

presented in table X

Table X7 Test t for dentine before and after etching

Paired Samples Test

Paired Differences

t df

p (2-

tailed)

95 Confidence

Interval of the

Difference

Mean

Std

Dev

Std

Error

Mean Lower Upper

Pair

1

dentine2mmbeforeetching-

dentine2mmafteretching

-

8010000

174801 55277 -

8135045

-

7884955

-

144906

9 000

Pair

2

dentine15mmbeforeetching-

dentine15mmafteretching

-

6608000

102394 32380 -

6681248

-

6534752

-

204079

9 000

Pair

3

dentine1mmbeforeetching-

dentine1mmafteretching

-

6209000

117799 37251 -

6293269

-

6124731

-

166678

9 000

30

Paired Samples Test

Paired Differences

t df

p (2-

tailed)

95 Confidence

Interval of the

Difference

Mean

Std

Dev

Std

Error

Mean Lower Upper

Pair

1

dentine2mmbeforeetching-

dentine2mmafteretching

-

8010000

174801 55277 -

8135045

-

7884955

-

144906

9 000

Pair

2

dentine15mmbeforeetching-

dentine15mmafteretching

-

6608000

102394 32380 -

6681248

-

6534752

-

204079

9 000

Pair

3

dentine1mmbeforeetching-

dentine1mmafteretching

-

6209000

117799 37251 -

6293269

-

6124731

-

166678

9 000

Pair

4

dentine05mmbeforeetching-

dentine05mmafteretching

-

6122000

86384 27317 -

6183796

-

6060204

-

224109

9 000

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of dentine (

2mm 15 mm 1mm sau 05mm)

The descriptive statistics data for dentine surface roughness before and after

etching are presented in tables X8 and X9

Table X8 Descriptive statistics for enamel samples before etching

Statistics

Enamel 2mm

before etching

Enamel 15mm

before etching

Enamel 1mm

before etching

Enamel 05mm

before etching

N Valid 10 10 10 10

Missing 0 0 0 0

Mean 416800 333600 317200 305900

Std Error of Mean 13968 15217 14205 20355

Std Deviation 44171 48120 44920 64369

Skewness 1095 -156 -109 -411

Std Error of Skewness 687 687 687 687

Kurtosis 769 487 -118 -295

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 4120 3250 3090 2940

Maximum 4260 3420 3240 3140

31

Table X9 Descriptive statistics for enamel samples after etching

Statistics

Enamel 2mm

after etching

Enamel 15mm

after etching

Enamel 1mm

after etching

Enamel 05mm

after etching

N Valid 10 10 10 10

Missing 0 0 0 0

Mean 2237600 1107400 875100 838200

Std Error of Mean 31027 20232 11968 17436

Std Deviation 98116 63979 37845 55136

Skewness -850 267 042 040

Std Error of Skewness 687 687 687 687

Kurtosis 878 -1880 1082 -425

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 22180 10990 8680 8290

Maximum 22520 11160 8820 8470

To choose the statistical test to compare roughness surface values was

performed a test Shapiro-Wilk If p is lower or equal with 0005 than hypothesis of

distribution normality is rejected (distribution deviates from normal form) In the table

X10 the distributions are normal The statistical test will be test t for pair samples

Table X10 Test Shapiro-Wilk for enamel samples

Tests of Normality

Kolmogorov-Smirnova Shapiro-Wilk

Statistic df Sig Statistic df Sig

2mmenamel before etching 193 10 200 898 10 207

15mmenamel before etching 170 10 200 977 10 947

1mmenamel before etching 157 10 200 952 10 689

05mmenamel before etching 165 10 200 943 10 590

2mmenamel after etching 235 10 124 925 10 404

15mmenamel after etching 209 10 200 871 10 102

1mmenamel after etching 189 10 200 964 10 834

05mmenamel after etching 142 10 200 983 10 978

a Lilliefors Significance Correction

This is a lower bound of the true significance

The results of test t for pair enamel samples before and after etching are

presented in table X11

32

Table X11 Test t for enamel samples before and after etching

Paired Samples Test

Paired Differences

t df

p (2-

tailed)

95 Confidence

Interval of the

Difference

Mean

Std

Deviation

Std

Error

Mean Lower Upper

Pair

1

2mmenamel before

etching

2mmenamel after

etching

-18208 135220 42760 -

18304731

-

18111269

-

425815

9 000

Pair

2

15mmenamel before

etching

15mmenamel after

etching

-7738 73151 23132 -7790329 -7685671 -

334508

9 076

Pair

3

1mmenamel before

etching

1mmenamel after

etching

-5579 55468 17540 -5618679 -5539321 -

318065

9 065

Pair

4

05mmenamel before

etching

05mmenamel after

etching

-5323 60378 19093 -5366192 -5279808 -

278788

9 063

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel ( 2mm 15 mm 1mm sau

05mm) but the differences statistical significant are present only for enamel localised

at 2 mm from ECJ

X5CONCLUSIONS

The surfaces of enamel and dentine at cervical level record decreases of

roughness related to the decrease of distance to ECJ

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel but the differences

statistical significant are present only for enamel localised at 2 mm from ECJ

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of

dentine

33

CHAPTXI FEA STUDY REGARDING THE BIOMECHANICAL

BEHAVIOUR AND FRACTURE RESISTANCE OF PROXIMO-OCCLUSAL

AMALGAM AND COMPOSITE RESINS RESTORATIONS

XI1INTRODUCTION AIM OF STUDY

The individual variation of patients morphological and functional complexity

of tissues as well as difficult access limit the possibilities to investigate in clinical

studies the biomechanical behaviour of proximo-occlusal restorations In this context

simulation of the biomechanics for direct restorations represents an interesting

interdisciplinar domain in actual dentistry research

The study focused on two direction

- analysis of role of forces intensity on biomechanical behaviour related to

cavity dimension and material

- analysis of tension inside restoration structure related to forces intensity

XI2MATERIALS AND METHODS

The stages of finite element analysis study are as follows

object modelling (bicusps and proximo-occlusal restoration)

definition of parameters for materials and dental tissues

meshing

constraints and loading

types of contacts

equations system definition

results of simulation

The object 3D modelling was performed in Rhinoceros (figure XI1) The

definition of parameters was performed for Poisson constant Young modulus density

(table XI1) The selected materials were amalgam and composite resins The

analysed tissues were dentine and enamel The meshing constraints loading were

performed for forces of 200N 400N 600N 800 N The analysis was performed using

software COSMOSWorks 2010

34

Fig XI1 3D modellation of bicusp

Table XI1 Values of Young modulus Poisson constant compression resistance for

amalgam composite resin enamel (amalgam compozit smalţ)

Material Young modulus (GPa) Poisson constants

Compression

resistance

(Mpa)

Amalgam 55 033 483

Enamel 48 03 400

Composite

resin 220 022 345

Fig XI2 The forces and constraints application

The results are presented in values and culours red colours representing areas

with maximum values of tensions produced under influence of masticatory forces

The tensions produced in amalgam restoration are in a range from 0 to 22886

(force 800 N) The maximum von Misses tensions are associated with cervical area

of amalgam restorations This aspect proves that first modification in interface

restoration-cavity margins will appear at the level of gingival wall First marginal

35

defects and fissures in restoration bulk will appear at tensions over 1600Mpa

associated with forces of 800N for extended amalgam proximo-occlusal restorations

The tensions produced in composite resin restorations are in a range from 0 to

2285 (force 800 N) The maximum von Misses tensions are associated with cervical

area of composite resin restorationsThis aspect proves that first modification in

interface restoration-cavity margins will appear at the level of gingival wall First

marginal defects and fissures in restoration bulk will appear at tensions over 1716

Mpa associated with forces of 600N for moderate and extended composite resins

proximo-occlusal restorations

Fig XI3a-b ndash Simulated model of proximo-occlusal restoration

FigXI4a-b Dental amalgam restoration Cervical tension associated with 600 N

(c)800 N (d)

FigXI5a-b Composite resin restoration Cervical tension associated with 600 N

(c)800 N (d)

36

The deformation of amalgam can be produced only when is associated with

fissures in bulk of restorations while composite resins restorations present

deformation when are associated with a modification of volume and form because of

repeated action of medium forces on long term or high forces on short term (figures

XI4 XI5)

Fig XI4 Material deformation in area of maximum tension

000E + 00

500E -02

100E -01

150E -01

200E -01

250E -01

1 4 7 101316192225283134374043464952555861646770737679

Amalgam C ompoz it

Figura XI5 Deformarea funcție de material

The amalgam and composite resins were treated as homogenous isotropic and

liniar The advantage of this type of FEA study is that restorations parameters can be

modified any time is necessary both in arhitecture geometry and material indices

variability The results of this study sustain the conclusions of other FEA studies

focused on biomechanical behaviour of posterior restorations performed with

amalgam and composite resins(35 62 76 143)

37

XI4CONCLUSIONS

bull The amalgam in class II restorations has a low deformation tendency because

of uniform distribution of tension inside material

bull Composite resins class II restorations accumulate higher tensions comparing

with amalgam but deformation is avoided for a time because of the adhesion

forces performed between molecules under moderate oral forces In case of

high oral forces (600-800N) the risk of fracture in moderate class II

restorations is higher comparing with amalgam proximo-occlusal restorations

For extended class II restorations and forces of 600 N composite resins present

highest risk of fracture and deformation The von Misses tension at the

cervical interface restorationtooth can reach 1600Mpa

bull The amalgam in moderate class II restorations can resist to deformation even

for high intensity forces limited to 600N In extended class II restorations the

risk of deformation and fracture increases at values of 600N-800N of oral

forces The von Misses tension at the cervical interface restorationtooth can

reach 1700 Mpa

38

FINAL CONCLUSIONS

Amalgam proximo-occlusal restorations with minimum 6-years age present

excellent results for parameters anatomic form (occlusal) marginal

discoloration and marginal secondary dental caries good results for

parameters anatomic form (proximal) and marginal adaptation and poor results

for surface quality

Composite resins proximo-occlusal restorations (bicusps) with minimum 6-

years age present excellent results for parameters color match marginal

discoloration and marginal secondary dental caries and good results for

parameters anatomic form (occlusal proximal) marginal adaptation surface

quality

Composite resins proximo-occlusal restorations (molars) with minimum 6-

years age present good results for parameters color match marginal

discoloration marginal secondary dental caries marginal adaptation and poor

results for parameters anatomic form (occlusal) (54 indices Ryge C)

anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The restorations extended at external third of occlusal surface present highest

percents of indices C regarding anatomic form (occlusal) (54 indices Ryge

C) anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The exceeding of 6-years age will require careful monitorisation for early

interventions through polishing sealing reshaping and even replacement for

restorations with major defects

Oblique layering technique presents superior results regarding marginal

adaptation and marginal discoloration and is recommended for proximo-

occlusal dental caries close to enamel-cement jonction

Centripetal build-up presents good results regarding marginal adaptation and

anatomical form at proximal level (proximal surfaces and contact point)

Horisontal layering technique can be used for optimum results only in

proximal-occlusal cavities with moderate extension both in occlusal-cervical

and buccal-oral

The values of die penetration at gingival wall were statistically different

between the three restorative techniques

We concluded that all restorative methods were associated with lightcuring

contraction and marginal microleakage

The combined technique was associated with lowest lightcuring contraction

and die penetration

The bulk technique was associated with highest lightcuring contraction and die

penetration

39

The surfaces of enamel and dentine at cervical level record decreases of

roughness related to the decrease of distance to ECJ

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel but the differences

statistical significant are present only for enamel localised at 2 mm from ECJ

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of

dentine

bull The amalgam in class II restorations has a low deformation tendency because

of uniform distribution of tension inside material

bull Composite resins class II restorations accumulate higher tensions comparing

with amalgam but deformation is avoided for a time because of the adhesion

forces performed between molecules under moderate oral forces In case of

high oral forces (600-800N) the risk of fracture in moderate class II

restorations is higher comparing with amalgam proximo-occlusal restorations

For extended class II restorations and forces of 600 N composite resins present

highest risk of fracture and deformation The von Misses tension at the

cervical interface restorationtooth can reach 1600Mpa

bull The amalgam in moderate class II restorations can resist to deformation even

for high intensity forces limited to 600N In extended class II restorations the

risk of deformation and fracture increases at values of 600N-800N of oral

forces The von Misses tension at the cervical interface restorationtooth can

reach 1700 Mpa

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2004 20939-946

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51Carvalho RM JC Pereira M Yoshiyama DH Pashley A review of

polymerization contraction the influence of stress development versus stress

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posterior restorations 12-month results Eur J Dent 2010 Jan4(1)57-65

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59Chen HY Manhart J Hickel R Kunzelmann KH Polymerization contraction

stress in light-cured packable composite resinsDent Mater 200117253-259

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polymerization contraction stress of composites J Dent Res 2000 79812ndash817

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Behinderten Dtsch Zahnartzlicher 1999 54 96-102

62Cohen BI Pagnillo MK Deutsch ASMusikant BL Fracture Strength of

Three Core Restorative Materials Supported with or without a Prefabricated Split-

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64Collins CJ Bryant RW Hodge KL A clinical evaluation of posterior composite

resin restorations 8-year findings J Dent 199826(4) 311ndash317

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polymerization stress J Am Dent Assoc2000 131497-503

66Cook WD Moopnar M Influence of chemical structure on the fracture

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68Crim GA Microleakage of three resin placement techniques Am J Dent

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70Dauvillier BS Aarnts MP Feilzer AJ Developments in shrinkage control of

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71Dauvillier BS Aarnts MP Feilzer AJ Modeling of the viscoelastic behavior of

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72Davidson CL Gee AJ Feilzer A The competition between the composite-dentin

bond strength and the polymerization contraction stress J Dent Res 1984

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73Davidson CL AJ Feilzer Polymerization shrinkage and polymerization

shrinkage stress in polymer-based restoratives J Dent Res 199725435ndash440

74Davidson CL Resisting the curing contraction with adhesive composites J

Prosthet Dent 198655446ndash7

75Davis RD Mayhew RB A clinical comparison of three anterior restorative resins

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Dent200899131-40

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80De Munck J Van Meerbeek B Satoshi I Vargas M Yoshida Y Armstrong S

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82Deutsch WM Simecek JW Dental emergencies among Marines ashore in

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85Dietschi D Herzfeld D In vitro evaluation of marginal and internal adaptation of

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86Dietschi D Marginal adaptation and seal of direct and indirect Class II composite

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88Diefenderfer KE Rienhardt JW Shear bond strengths of ten adhesive

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89Donly KJ Jensen ME Triolo PA clinical comparison of resin composite inlay

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96Feilzer AJ AJ De Gee CL Davidson Increased wall-to-wall curing

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98Feilzer AJ de Gee AJ Davidson CL Relaxation of polymerization contraction

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99Feilzer AJ De Gee AJ Davidson CL Setting stress in composite resin in relation

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100Feilzer AJ Dooren LH de Gee AJ Davidson CL Influence of light intensity

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101Fennis YL Verdischbot EH vanrsquot Hof MA Performance of some diagnostic

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108Francci C Loguercio AD Reis A Carrilho MR A novel filling technique for

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109Fruits TJ Knapp JA Khajotia SS Microleakage in the proximal walls of

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113Gladys S Clinical and semiquantitative marginal analysis of four tooth-coloured

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Effects of irradiation mode and filling technique on resindentin bond strength in

Class I cavities J Dent Res 200281 (Abstract)

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117Gordon JChristensen G Why switch to digital radiography J Am Dent

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126Hashimoto M Tay FR Ito S Sano H Kaga M Pashley DH Permeability of

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restorative decisions made on the basis of simulated bitewing radiographs

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1243

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Biology199843(8)629-632

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179Lăcătuşu St Luminiţa Costinescu Andrian S Gianina Iovan Valeria

Pendefunda 180Sorina Solomon Topoliceanu C Elements of dispersional

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Edition of the Balkan Medical Days

Stomatological Section Abstract nr1091999128

181Lăcătuşu St Andrian S Gianina Iovan- Consideraţii asupra adaptării

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200126302ndash307

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Dentistry and Oral Epidemiology 1996 24 106-11

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Dent Mater 2002 18436-444

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20(3)236-43

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Polymerization shrinkage effects of boundary conditions and filling technique of

resin composite restorations J Dent 2004 32(6)459-70

50

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Quintessence Int 2004 35(2)156-61

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copolymerizations Macromolecules 1999 323913-3921

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bonded composite restorations Dent Mater 1991 7(2) 107-13

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clinical results J Dent Res 199877 1020

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Dentomaxillofac Radiol 2007 Oct36(7)377-81

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J Prosthet Dent 2000 Sep84(3)289-96

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Three-year clinical evaluation of composite and ceramic inlays Am J Dent 2001

Apr14(2)95-9

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hardness and depth of cure of light cured packable composite resins J Dent Res 2000

79369 (Abstract)

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(Cerana) Br Dent J 2006 Oct 21201(8)515-20

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PrimDentCare1999Apr659-62

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Quintessence 198961-80

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ScandJDRes 199210060-65

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33

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19904011ndash7

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Am Dent Assoc 2010 141(3)319-29

52

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125749-751

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34

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569ndash575

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308

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58

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327Versluis A Douglas WH Cross M Sakaguchi RL Does an incremental filling

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451

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Radiology 27(1)3-11 1998

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1996751477-83

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59

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Contemporary Dental Practice 7(2) 20061-13

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458

346Yoshiyama M Tay FR Doi J Nishitani Y Yamada T Itou K Carvalho RM

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  • COPERTA REZUMAT ENGLEZA (MEREUTA)pdf
  • REZUMAT ENGLEZA DR MEREUTA DENISSpdf
Page 13: UNIVERSITATEA DE MEDICINA SI FARMACIE “GR Doctorat/Rezumat... · universitatea de medicina si farmacie “gr.t.popa” iasi facultatea de medicina dentara rezumatul tezei de doctorat

10

A

C

S1

98

20

20

40

60

80

100

A

C

FigVII17a-b Prevalence of marginal dental cariesamalgam restorations (moderate

CR)

A

C

S1

92

80

20

40

60

80

100

A

C

FigVII18 Prevalence of marginal dental cariesamalgam restorations (high CR)

A

C

S1

94

60

20

40

60

80

100

A

C

FigVII19 Prevalence of marginal dental cariescomposite resins restorations (CR

moderate)

A

C

S1

82

18

0

10

20

30

40

50

60

70

80

90

A

C

FigVII20 Prevalence of marginal dental cariescomposite resins restorations (high

CR)

11

The study data sustain the results obtained by most studies focused on

posterior amalgam restorations However Hickelampcol (2001) reviewed literature data

and proved that many results varies accordingly to different clinical factors (133)

Roulet JF(1997) warned about limits of cross-sectional studies related to composite

resins restorations because of the absence of data regarding restorative techniques

practitioner experience presence or absence of optimum isolation factors related by

patient (266)

VII5CONCLUSIONS

Amalgam proximo-occlusal restorations with minimum 6-years age present

excellent results for parameters anatomic form (occlusal) marginal

discoloration and marginal secondary dental caries good results for

parameters anatomic form (proximal) and marginal adaptation and poor results

for surface quality

Composite resins proximo-occlusal restorations (bicusps) with minimum 6-

years age present excellent results for parameters color match marginal

discoloration and marginal secondary dental caries and good results for

parameters anatomic form (occlusal proximal) marginal adaptation surface

quality

Composite resins proximo-occlusal restorations (molars) with minimum 6-

years age present good results for parameters color match marginal

discoloration marginal secondary dental caries marginal adaptation and poor

results for parameters anatomic form (occlusal) (54 indices Ryge C)

anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The restorations extended at external third of occlusal surface present highest

percents of indices C regarding anatomic form (occlusal) (54 indices Ryge

C) anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The exceeding of 6-years age will require careful monitorisation for early

interventions through polishing sealing reshaping and even replacement for

restorations with major defects

12

CHAPTVIII CLINICAL PERFORMANCE OF COMPOSITE RESINS

RESTORATIONS RELATED TO RESTORATIVE TECHNIQUE 12-

MONTHS LONGITUDINAL STUDY

VIII1 INTRODUCTION

The restorative technique has a major influence over clinical performance of

composite resins restorations in proximo-occlusal cavities In this context researches

focused on correlations between technique and clinical performance of direct

restorations improve the dentist decision regarding restorative technique choice

VIII2AIM OF STUDY

The aim of study was to determine the clinical performance of composite

resins proximo-occlusal restorations performed using different restorative techniques

VIII3MATERIALS AND METHOD

The group study included 37 patients with age 18-42 years with moderat

ecariogenic risk The total number of composite resins restorations (Herculite XRV

Kerr) was 60 divided in three study groups (n=20)

I Centripetal build-up

II Oblique layering

III Horisontal layering

The coronal restorations were assessed at an interval of 12 months using

indices Ryge modified USPHS

- indice ALFA (A)- IDEAL CLINIC

- indice BRAVO (B)- ACCEPTABLE CLINIC

- indice CHARLIE (C)- UNACCEPTABLE CLINIC

VIII4 RESULTS AND DISCUSSIONS

The statistical tests Kruskal-Wallis and Mann-Whitney were performed to

confirm or infirm research hypotesis (the direct restorations performed using different

restorative techniques present statistical significant differences regarding clinical

performance for the assessed parameters)

13

TableVIII1a-b Groups study (Kruskal-Wallis Test)

Ranks

20 2960

20 2560

20 3630

60

20 3050

20 2420

20 3680

60

20 2490

20 3140

20 3520

60

Restorative_techniques

Centripetal build-up

Oblique layering

Horizontal layering

Total

Centripetal build-up

Oblique layering

Horizontal layering

Total

Centripetal build-up

Oblique layering

Horizontal layering

Total

Marginal_adaptation

Marginal_discoloration

Anatomical_form

N Mean Rank

Test Statisticsab

4913 8031 4900

2 2 2

086 018 086

Chi-Square

df

Asymp Sig

Marginal_

adaptation

Marginal_

discoloration

Anatomical_

form

Kruskal Wallis Testa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between the three restorative

techniques for parameter marginal adaptation (p=0086)

There are no statistical significant differences between the three restorative

techniques for parameter marginal discoloration (p=0018)

There are no statistical significant differences between the three restorative

techniques for parameter anatomical form (proximal) (p=0086)

TableVIII2 Comparing results between restorations performed using three

techniques (marginal adaptation marginal discoloration anatomical form) Marginal adaptation Centripetal build-upOblique layering p=04 ns

Centripetal build-upHorizontal layering p=0191 ns

Oblique layering Horizontal layering p=0028 s

Marginal discoloration Centripetal build-upOblique layering p=0103 ns

Centripetal build-upHorizontal layering p=0195 ns

Oblique layering Horizontal layering p=0005 s

Anatomical form Centripetal build-upOblique layering p=0137 ns

Centripetal build-upHorizontal layering p=0029 s

Oblique layering Horizontal layering p=0433 ns

ns nesemnificativ

s semnificativ

p probabilitate

14

Tables VIII3a-b Mann-Whitney test Comparing analysis regarding marginal

discoloration between restorations performed using oblique layering technique and

centripetal build-up technique

Ranks

20 2180 43600

20 1920 38400

40

Restorative_techniques

Centripetal build-up

Oblique layering

Total

Marginal_adaptation

N Mean Rank Sum of Ranks

Test Statisticsb

174000

384000

-841

400

495a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

adaptation

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between centripetal build-up

and oblique layering techniques regarding parameter marginal adaptation (p=0400)

Tables VIII4a-b Mann-Whitney test Comparing analysis regarding marginal

adaptation between restorations performed using horisontal layering technique and

centripetal build-up technique

Ranks

20 1830 36600

20 2270 45400

40

Restorative_techniques

Centripetal build-up

Horizontal layering

Total

Marginal_adaptation

N Mean Rank Sum of Ranks

Test Statisticsb

156000

366000

-1307

191

242a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

adaptation

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between centripetal build-up

and horisontal layering techniques regarding parameter marginal adaptation

(p=0191)

15

TablesVIII5a-b Mann-Whitney test Comparing analysis regarding marginal

adaptation between restorations performed using oblique layering technique and

horisontal layering technique

Ranks

20 1690 33800

20 2410 48200

40

Restorative_techniques

Oblique layering

Horizontal layering

Total

Marginal_adaptation

N Mean Rank Sum of Ranks

Test Statisticsb

128000

338000

-2191

028

052a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

adaptation

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There is statistical significant differences between horisontal layering and

oblique layering techniques regarding parameter marginal adaptation (p=0028)

Tables VIII6a-b Mann-Whitney test Comparing analysis regarding marginal

discoloration between restorations performed using oblique layering technique and

centripetal build-up technique

There are no statistical significant differences between centripetal build-up

and oblique layering techniques regarding parameter marginal discoloration

(p=0103)

Ranks

20 2260 45200

20 1840 36800

40

Restorative_techniques

Centripetal build-up

Oblique layering

Total

Marginal_discoloration

N Mean Rank Sum of Ranks

Test Statisticsb

158000

368000

-1632

103

265a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

discoloration

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

16

Tables VIII7a-b Mann-Whitney test Comparing analysis regarding marginal

discoloration between restorations performed using centripetal build-up technique and

horisontal layering technique

Ranks

20 1840 36800

20 2260 45200

40

Restorative_techniques

Centripetal build-up

Horizontal layering

Total

Marginal_discoloration

N Mean Rank Sum of Ranks

Test Statisticsb

158000

368000

-1299

194

265a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

discoloration

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between centripetal build-up

and horisontal layering techniques regarding parameter marginal discoloration

(p=0103)

Tables VIII8a-b Mann-Whitney test Comparing analysis regarding marginal

discoloration between restorations performed using oblique layering technique and

horisontal layering technique

Ranks

20 1630 32600

20 2470 49400

40

Restorative_techniques

Oblique layering

Horizontal layering

Total

Marginal_discoloration

N Mean Rank Sum of Ranks

Test Statisticsb

116000

326000

-2822

005

023a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

discoloration

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There is statistical significant differences between horisontal layering and

oblique layering techniques regarding parameter marginal discoloration (p=0005)

17

TablesVIII9 a-b Mann-Whitney test Comparing analysis regarding anatomical

form between restorations performed using centripetal build-up technique and oblique

layering technique

Ranks

20 1830 36600

20 2270 45400

40

Restorative_techniques

Centripetal build-up

Oblique layering

Total

Anatomical_form

N Mean Rank Sum of Ranks

Test Statisticsb

156000

366000

-1486

137

242a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Anatomical_

form

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between centripetal build-up

and oblique layering techniques regarding parameter anatomical form (p=0137)

Tables VIII10a-b Mann-Whitney test Comparing analysis regarding anatomical

form between restorations performed using centripetal build-up technique and

horisontal layering technique

Ranks

20 1710 34200

20 2390 47800

40

Restorative_techniques

Centripetal build-up

Horizontal layering

Total

Anatomical_form

N Mean Rank Sum of Ranks

Test Statisticsb

132000

342000

-2184

029

068a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Anatomical_

form

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between centripetal build-up

and horisontal layering techniques regarding parameter anatomical form (p=0029)

18

Tables VIII11a-b Mann-Whitney test Comparing analysis regarding anatomical

form between restorations performed using oblique layering technique and horisontal

layering technique

Ranks

20 1920 38400

20 2180 43600

40

Restorative_techniques

Oblique layering

Horizontal layering

Total

Anatomical_form

N Mean Rank Sum of Ranks

Test Statisticsb

174000

384000

-784

433

495a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Anatomical_

form

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between horisontal layering and

oblique layering techniques regarding parameter anatomical form (p=0433)

Indices A for restorations performed using centripetal build-up technique were

as follows color match-80 marginal adaptation- 60 marginal discoloration-

70 anatomical form (proximal)- 80 surface quality- 60

Indices A for restorations performed using horisontal layering technique were

as follows color match-70 marginal adaptation- 40 marginal discoloration-

50 anatomical form (proximal)- 50 surface quality- 70

Indices A for restorations performed using oblique layering technique were as

follows color match-70 marginal adaptation- 80 marginal discoloration- 90

anatomical form (proximal)- 60 surface quality- 70

Indices B for restorations performed using centripetal build-up technique were

as follows color match-20 marginal adaptation- 30 marginal discoloration-

20 anatomical form (proximal)- 30 surface quality- 40

Indices B for restorations performed using horisontal layering technique were

as follows color match-30 marginal adaptation- 40 marginal discoloration-

30 anatomical form (proximal)- 30 surface quality- 30

Indices B for restorations performed using oblique layering technique were as

follows color match-30 marginal adaptation- 20 marginal discoloration- 10

anatomical form (proximal)- 40 surface quality- 30

19

Indices C for restorations performed using centripetal build-up technique were

as follows color match-0 marginal adaptation- 10 marginal discoloration- 0

anatomical form (proximal)- 0 surface quality- 0

Indices C for restorations performed using horisontal layering technique were

as follows color match-0 marginal adaptation- 20 marginal discoloration- 20

anatomical form (proximal)- 20 surface quality- 0

Indices C for restorations performed using oblique layering technique were as

follows color match-0 marginal adaptation- 0 marginal discoloration- 10

anatomical form (proximal)- 0 surface quality- 100

Discussions

For in vitro studies is difficult to reproduce the variables existent in oral cavity

like occlusal stress and pH and temperature changes (235) The clinical studies are

determinant in assessment of restorative techniques (300) The most researches

focuses on the influence of restorative technique on the reduction of lightcuring stress

(51 78 135)

VIII5 CONCLUSIONS

Oblique layering technique presents superior results regarding marginal

adaptation and marginal discoloration and is recommended for proximo-

occlusal dental caries close to enamel-cement jonction

Centripetal build-up presents good results regarding marginal adaptation and

anatomical form at proximal level (proximal surfaces and contact point)

Horisontal layering technique can be used for optimum results only in

proximal-occlusal cavities with moderate extension both in occlusal-cervical

and buccal-oral

20

CHAPTIX STUDY REGARDING MARGINAL SEALING STATUS IN

COMPOSITE RESINS LIMITED PROXIMO-OCCLUSAL RESTORATIONS

PERFORMED USING DIFFERENT TECHNIQUES

IX1INTRODUCTION

The contraction of composite resins can produce stress inside dental structure

The most contraction stress appears in the initial stages and development rate of stress

decreases gradually in time (5 98 160) The contraction stress of composite resins

can overpass adhesion strenght and can broke the link between dental tissues and

composite resin (73) When adhesion strenght is high stress can produce marginal

fracture or bulk fracture (74) These situations are associated with microleakage and

penetration of oral fluid and bacteria along dentinal walls endangering the pulpal

tissue or favourising secondary dental caries

IX2 AIM OF STUDY

The study aimed to assess the efficiency of marginal sealing along gingival

wall in limited proximal-occlusal restorations performed using three different

techniques

IX3MATERIALS AND METHOD

The study group included 30 teeth extracted for orthodontic and periodontal

reasons On every tooth two identical class II cavities (on mesial and distal surfaces)

were prepared with cylindrical burs under water cooling The gingival wall was

limited to enamel-cement jonction The cavity dimension were as follows 2 mm

buccal-oral 5mm depth Each tooth was introduced in a pattern of acrylat The

operator calibrated preparation technique on acrylat teeth in Simulation Laboratory of

UMF ―Gr T Popa Iaşi The 60 prepared cavities were randomly divided in three

study groups related to restorative technique The restoration were performed with

Filtek Z550 (3M ESPE) a nanohybrid composite resin The adhesive strategy

included etchamprinse in 2 steps and adhesive Adper Single Bond 2(3MESPE)

Group A (n=20) bulk restorative technique associated with lightcuring from

occlusal 40 seconds and from buccal and oral 20 seconds

Group B (n=20) oblique layering technique (first layer on buccal wall and

buccal frac12 of gingival wall was lightcured from buccal second layer on oral wall and

oral frac12 of gingival wall was lightcured from oral third oral as a triangle with point

oriented to gingival wall was lightcured from occlusal)

Group C (n=20) combined technique (bdquoflow layer on gingival and axial

walls lightcured under pressure only associated with solid composite resin layer)

The proximal surfaces were performed using Tofflemire and metallic matrices After

removal of matrices every restoration was lightcured for another 20 seconds Two

layers aof varnish were applied on composite resins restorations excepting cavity

margins and an area of 1 mm around them The samples were introduced in methylen

21

blue 10 for 48 hours After this stage samples were washed with water and teeth

were cut longitudinally with a diamonded disc

The die penetration was assessed with Zeiss (Iena Germany) X20 microscope

accordingly to four scores (0-3)

0 ndash no penetration

1 ndash die infiltration until external half of gingival wall

2 ndash die infiltration on all gingival wall

3 ndash die infiltration on gingival wall and axial wall

IX4RESULTS AND DISCUSSIONS

The result of die penetration are presented in table IX1

TableIX1 The results for die penetration

Grup 0 1 2 3

A (bulk) 0 0 3 17

B (layering) 0 4 5 11

C (combined) 12 5 2 1

In group A 17 sample had score 3 and 2 samples had score 2 In group B 11

sample had score 3 5 samples had score 2 and 4 sample had score 1 In group C with

best results 12 samples had score 0 5 samples had score 1 2 samples had score 2 1

sample had score 3

The recorded data were analysed using test Mann-Whitney The statistical

results are presented in tables IX2-IX4

Tables IX2a-b Mann-Whitney for comparisons of microleakage values between

bulk technique and incremental technique

Ranks

Restorative technique N Mean Rank Sum of Ranks

Scores

frequency

A ndash bulk technique 20 2420 24200

B ndash incremental

technique

20 1680 16800

Total 40

Test Statisticsb

scores

frequency

Mann-Whitney U 29000

Wilcoxon W 168000

Z -1970

Asymp Sig (2-tailed) 049

Exact Sig [2(1-tailed Sig)] 123a

a Not corrected for ties

b Grouping Variable restorative technique

22

Tables IX3a-b Mann-Whitney for comparisons of microleakage values between

bulk technique and mixed technique

Ranks

Restorative technique N Mean Rank Sum of Ranks

scores

frequency

A ndash bulk technique 20 3090 30900

C ndash mixed technique 20 1010 10100

Total 40

Test Statisticsb

scores

frequency

Mann-Whitney U 500

Wilcoxon W 101000

Z -4021

Asymp Sig (2-tailed) 000

Exact Sig [2(1-tailed Sig)] 000a

a Not corrected for ties

b Grouping Variable restorative technique

Tables IX4a-b Mann-Whitney test for comparisons of microleakage values

between incremental technique and mixed technique

Ranks

Restorative technique N Mean Rank Sum of Ranks

scores

frequency

B ndash incremental

technique

20 2990 29900

C ndash mixed technique 20 1210 12100

Total 40

Test Statisticsb

scores

frequency

Mann-Whitney U 5500

Wilcoxon W 121000

Z -3492

Asymp Sig (2-tailed) 000

Exact Sig [2(1-tailed Sig)] 000a

a Not corrected for ties

23

Test Statisticsb

scores

frequency

Mann-Whitney U 5500

Wilcoxon W 121000

Z -3492

Asymp Sig (2-tailed) 000

Exact Sig [2(1-tailed Sig)] 000a

a Not corrected for ties

b Grouping Variable tehnrestaurare

The results of microleakage degree were statistically significant when the

three restorative techniques were compared The results showed that best restorative

technique regarding marginal sealing in cervical area is combined technique followed

by oblique layering technique The use of layering techniques limits the development

of contraction forces between oposite walls event that favourises bulk stress voids

formation and fissure inside dental tissues The results of our study are similar with

other studies (114 293)

IX5 CONCLUSIONS

The values of die penetration at gingival wall were statistically different

between the three restorative techniques

We concluded that all restorative methods were associated with lightcuring

contraction and marginal microleakage

The combined technique was associated with lowest lightcuring contraction

and die penetration

The bulk technique was associated with highest lightcuring contraction and die

penetration

24

CHAPTX STUDY REGARDING THE EFFECTS OF ETCHING ON

ENAMEL AND DENTINE IN CERVICAL AREA FOR PROXIMAL

CAVITIES AT LATERAL DENTAL GROUP

X1 INTRODUCTION

The studies reported marginal defects and high microleakage at the level of

gingival margins localised in cervical area or close to enamel-cement jonction for

high percents of proximal-occlusal composite resins restorations (8485) The good

adhesion is requested to insure restoration longevity and to prevent marginal

microleakage and presence of secondary marginal dental caries The adhesion

strenght of different adhesive systems can vary accordingly to tissues areas (204 240)

and to variations in dentinal structures (234 330) Most studies focused on adhesive

systems performances used healthy dentine close to pulp room but in case of class II

restorations there are particular features that influences the adhesion at the level of

gingival margins

The surface topography is an important property that determines the

interaction manner between surfaces The surface roughness and surface energy can

increase or decrease the adhesion of composite resins to the hard dental tissues

X2 AIM OF STUDY

The aim of study was to compare surface roughness of enamel and dentine

after etching related to different distances related to enamel-dentinecement jonction

X3 MATERIALS AND METHODS

The study group included 20 molars extracted from orthodontics or

periodontal reasons with intact proximal surfaces The teeth were cut longitudinally in

sens buccal-oral with diamond discs under water cooling

A group study (10 teeth) included 10 samples obtained through transversal

cutting at distance of 2mm from enamel-dentinecement jonction and 10 samples

obtained through transversal cutting at distance of 15 mm from enamel-

dentinecement jonction Another study group (10 teeth) included 10 samples

obtained through transversal cutting at distance of 1mm from enamel-dentinecement

jonction and 10 samples obtained through transversal cutting at distance of 05 mm

from enamel-dentinecement jonction All these samples were divided in two halfes

through mesial-distal cutting The samples finishing was performed with abrasive

paper (100-4000) and final polishing was performed with a device Buehler model

Minimet with slices introduced in ultrasound bath for 4 minutes The second half of

each sample was etched for 15 seconds with ortophosphoric acid 37 for 15 seconds

Slices were washed with distilled water for 30 seconds after etching and dried

The samples were analysed with atomic force microscopy (AFM) regarding

surface roughness The results were expressed as relative variation of roughness

X4 RESULTS AND DISCUSSIONS

The aspect of etched enamel at 2 mm distance from ECJ can be seen in figure

X1 (section 10 microm) The surface roughness is higher comparing with sample before

etching

25

După gravajul cu acid ortofosforic 37

The aspect of etched enamel at 15 mm distance from ECJ can be seen in

figure X2 (section 10 microm) The surface roughness is higher comparing with sample

before etching but lower comparing with sample at 2 mm from ECJ

The aspect of etched enamel at 1 mm distance from ECJ can be seen in figure

X3 (section 10 microm) The surface roughness is higher comparing with sample before

etching but lower comparing with sample at 15mm and 2 mm from ECJ

The aspect of etched enamel at 15 mm distance from ECJ can be seen in

figure X4 (section 10 microm) The surface roughness is higher comparing with sample

before etching but lower comparing with sample at 1 mm 15 mm and 2 mm from

ECJ

FigX1 3D aspect of enamel at 2 mm from ECJ

after etching (10 microm)

FigX2 3D aspect of enamel at 15 mm from ECJ

after etching (10 microm)

FigX3 3D aspect of enamel at 1 mm from ECJ

after etching (10 microm)

FigX4 3D aspect of enamel at 05 mm from ECJ

after etching (10 microm)

26

The mean values of squared roughness for dentine and enamel before etching

are presented in tables X1 and X2

Table X1 Squared roughness values for dentine samples before and after etching

Before etching (nm) After etching (nm)

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

sample

1

335 282 283 259 1149 947 901 879

sample

2

352 284 274 266 1127 939 883 875

sample

3

357 273 278 263 1152 953 876 867

sample

4

323 269 264 258 1146 942 895 883

sample

5

348 298 271 268 1153 944 904 878

sample

6

339 274 278 273 1158 937 893 892

sample

7

352 283 269 266 1145 944 899 876

sample

8

349 292 272 274 1166 942 907 869

sample

9

357 284 275 265 1132 939 893 879

sample

10

348 281 277 262 1142 941 899 878

Table X2 Squared roughness values for enamel and dentine samples before and after

etching

Before etching (nm) After etching (nm)

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

sample 1 422 342 309 313 2255 1114 874 845

sample 2 418 338 324 304 2236 1102 882 839

sample 3 413 334 315 303 2239 1115 873 833

sample 4 416 336 322 308 2242 1116 868 842

sample 5 426 332 315 294 2218 1103 877 829

sample 6 412 332 317 306 2237 1099 874 847

sample 7 414 335 322 314 2252 1102 876 834

sample 8 416 325 318 313 2239 1106 875 838

sample 9 418 328 314 299 2246 1113 879 836

sample 10 413 334 316 305 2242 1104 873 839

The results for samples before etching prove a decreasing tendency for mean

values of squared roughness surface beginning with areas placed at distance of 2 mm

from ECJ (346 nm) followed by areas placed at distance of 15 mm from ECJ (282

nm) 1 mm from ECJ (274 nm) and 05 mm from ECJ (265 nm) After etching the

decreasing tendency maintained for dentine localised at 2 mm from ECJ to dentine

localised at 05 mm from ECJ The mean values of squared roughness after etching

were three times higher (tables X3)

27

Table X3 Squared roughness values for enamel and dentine samples before and

after etching

Dentine Enamel

Before etching

(nm)

After etching

(nm)

Before etching

(nm)

After etching

(nm)

2 mm ECJ 346 1147 416 2237

15 mm ECJ 282 942 333 1107

1 mm ECJ 274 895 317 875

05 mm ECJ 265 877 305 838

The descriptive statistics data for surface roughness of dentine before and after

etching are presented in tables X4 si X5

Table X4 Descriptive statistics for dentine samples before etching

Statistics

Dentine 2mm

before etching

Dentine 15mm

before etching

Dentine 1mm

before etching

Dentine 05mm

before etching

N Valid 10 10 10 10

Missing 0 0 0 0

Mean 346000 282000 274100 265400

Std Error of Mean 33830 27487 17026 16746

Std Deviation 106979 86923 53841 52957

Skewness -1214 354 -314 348

Std Error of Skewness 687 687 687 687

Kurtosis 1141 049 336 -539

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 3230 2690 2640 2580

Maximum 3570 2980 2830 2740

Table X5 Descriptive statistics for dentine samples after etching

Statistics

Dentine 2mm

after etching

Dentine 15mm

after etching

Dentine 1mm

after etching

Dentine 05mm

after etching

N Valid 10 10 10 10

Missing 0 0 0 0

1147000 942800 895000 877600

Std Error of Mean 36545 14591 29926 22020

Std Deviation 115566 46140 94634 69634

Skewness -267 1169 -951 535

Std Error of Skewness 687 687 687 687

Kurtosis 043 1776 564 1416

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 11270 9370 8760 8670

28

Statistics

Dentine 2mm

after etching

Dentine 15mm

after etching

Dentine 1mm

after etching

Dentine 05mm

after etching

N Valid 10 10 10 10

Missing 0 0 0 0

1147000 942800 895000 877600

Std Error of Mean 36545 14591 29926 22020

Std Deviation 115566 46140 94634 69634

Skewness -267 1169 -951 535

Std Error of Skewness 687 687 687 687

Kurtosis 043 1776 564 1416

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 11270 9370 8760 8670

Maximum 11660 9530 9070 8920

To choose the statistical test to compare roughness surface values was

performed a test Shapiro-Wilk If p is lower or equal with 0005 than hypothesis of

distribution normality is rejected (distribution deviates from normal form) In the table

X6 the distributions are normal The statistical test will be test t for pair samples

Table X6 Test Shapiro-Wilk for dentine samples

Tests of Normality

Kolmogorov-Smirnov

a Shapiro-Wilk

Statistic df Sig Statistic df Sig

Dentine 2mm before etching 274 10 032 877 10 122

Dentine 15mm after etching 209 10 200 952 10 689

Dentine 1mm before etching 134 10 200 983 10 980

Dentine 05mm before etching 155 10 200 949 10 661

Dentine 2mm after etching 133 10 200 977 10 946

Dentine 15mm after etching 197 10 200 916 10 329

Dentine 1mm after etching 216 10 200 925 10 401

Dentine 05 after etching 220 10 185 933 10 474

Enamel 2mm before etching 193 10 200 898 10 207

Enamel 15mm before etching 170 10 200 977 10 947

Enamel 1mm before etching 157 10 200 952 10 689

Enamel 05mm before etching 165 10 200 943 10 590

Enamel 2mm after etching 235 10 124 925 10 404

Enamel 15mm after etching 209 10 200 871 10 102

Enamel 1mm after etching 189 10 200 964 10 834

Enamel 05mm after etching 142 10 200 983 10 978

a Lilliefors Significance Correction

29

Tests of Normality

Kolmogorov-Smirnov

a Shapiro-Wilk

Statistic df Sig Statistic df Sig

Dentine 2mm before etching 274 10 032 877 10 122

Dentine 15mm after etching 209 10 200 952 10 689

Dentine 1mm before etching 134 10 200 983 10 980

Dentine 05mm before etching 155 10 200 949 10 661

Dentine 2mm after etching 133 10 200 977 10 946

Dentine 15mm after etching 197 10 200 916 10 329

Dentine 1mm after etching 216 10 200 925 10 401

Dentine 05 after etching 220 10 185 933 10 474

Enamel 2mm before etching 193 10 200 898 10 207

Enamel 15mm before etching 170 10 200 977 10 947

Enamel 1mm before etching 157 10 200 952 10 689

Enamel 05mm before etching 165 10 200 943 10 590

Enamel 2mm after etching 235 10 124 925 10 404

Enamel 15mm after etching 209 10 200 871 10 102

Enamel 1mm after etching 189 10 200 964 10 834

Enamel 05mm after etching 142 10 200 983 10 978

a Lilliefors Significance Correction

This is a lower bound of the true significance

The results of test t for pair dentine samples before and after etching are

presented in table X

Table X7 Test t for dentine before and after etching

Paired Samples Test

Paired Differences

t df

p (2-

tailed)

95 Confidence

Interval of the

Difference

Mean

Std

Dev

Std

Error

Mean Lower Upper

Pair

1

dentine2mmbeforeetching-

dentine2mmafteretching

-

8010000

174801 55277 -

8135045

-

7884955

-

144906

9 000

Pair

2

dentine15mmbeforeetching-

dentine15mmafteretching

-

6608000

102394 32380 -

6681248

-

6534752

-

204079

9 000

Pair

3

dentine1mmbeforeetching-

dentine1mmafteretching

-

6209000

117799 37251 -

6293269

-

6124731

-

166678

9 000

30

Paired Samples Test

Paired Differences

t df

p (2-

tailed)

95 Confidence

Interval of the

Difference

Mean

Std

Dev

Std

Error

Mean Lower Upper

Pair

1

dentine2mmbeforeetching-

dentine2mmafteretching

-

8010000

174801 55277 -

8135045

-

7884955

-

144906

9 000

Pair

2

dentine15mmbeforeetching-

dentine15mmafteretching

-

6608000

102394 32380 -

6681248

-

6534752

-

204079

9 000

Pair

3

dentine1mmbeforeetching-

dentine1mmafteretching

-

6209000

117799 37251 -

6293269

-

6124731

-

166678

9 000

Pair

4

dentine05mmbeforeetching-

dentine05mmafteretching

-

6122000

86384 27317 -

6183796

-

6060204

-

224109

9 000

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of dentine (

2mm 15 mm 1mm sau 05mm)

The descriptive statistics data for dentine surface roughness before and after

etching are presented in tables X8 and X9

Table X8 Descriptive statistics for enamel samples before etching

Statistics

Enamel 2mm

before etching

Enamel 15mm

before etching

Enamel 1mm

before etching

Enamel 05mm

before etching

N Valid 10 10 10 10

Missing 0 0 0 0

Mean 416800 333600 317200 305900

Std Error of Mean 13968 15217 14205 20355

Std Deviation 44171 48120 44920 64369

Skewness 1095 -156 -109 -411

Std Error of Skewness 687 687 687 687

Kurtosis 769 487 -118 -295

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 4120 3250 3090 2940

Maximum 4260 3420 3240 3140

31

Table X9 Descriptive statistics for enamel samples after etching

Statistics

Enamel 2mm

after etching

Enamel 15mm

after etching

Enamel 1mm

after etching

Enamel 05mm

after etching

N Valid 10 10 10 10

Missing 0 0 0 0

Mean 2237600 1107400 875100 838200

Std Error of Mean 31027 20232 11968 17436

Std Deviation 98116 63979 37845 55136

Skewness -850 267 042 040

Std Error of Skewness 687 687 687 687

Kurtosis 878 -1880 1082 -425

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 22180 10990 8680 8290

Maximum 22520 11160 8820 8470

To choose the statistical test to compare roughness surface values was

performed a test Shapiro-Wilk If p is lower or equal with 0005 than hypothesis of

distribution normality is rejected (distribution deviates from normal form) In the table

X10 the distributions are normal The statistical test will be test t for pair samples

Table X10 Test Shapiro-Wilk for enamel samples

Tests of Normality

Kolmogorov-Smirnova Shapiro-Wilk

Statistic df Sig Statistic df Sig

2mmenamel before etching 193 10 200 898 10 207

15mmenamel before etching 170 10 200 977 10 947

1mmenamel before etching 157 10 200 952 10 689

05mmenamel before etching 165 10 200 943 10 590

2mmenamel after etching 235 10 124 925 10 404

15mmenamel after etching 209 10 200 871 10 102

1mmenamel after etching 189 10 200 964 10 834

05mmenamel after etching 142 10 200 983 10 978

a Lilliefors Significance Correction

This is a lower bound of the true significance

The results of test t for pair enamel samples before and after etching are

presented in table X11

32

Table X11 Test t for enamel samples before and after etching

Paired Samples Test

Paired Differences

t df

p (2-

tailed)

95 Confidence

Interval of the

Difference

Mean

Std

Deviation

Std

Error

Mean Lower Upper

Pair

1

2mmenamel before

etching

2mmenamel after

etching

-18208 135220 42760 -

18304731

-

18111269

-

425815

9 000

Pair

2

15mmenamel before

etching

15mmenamel after

etching

-7738 73151 23132 -7790329 -7685671 -

334508

9 076

Pair

3

1mmenamel before

etching

1mmenamel after

etching

-5579 55468 17540 -5618679 -5539321 -

318065

9 065

Pair

4

05mmenamel before

etching

05mmenamel after

etching

-5323 60378 19093 -5366192 -5279808 -

278788

9 063

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel ( 2mm 15 mm 1mm sau

05mm) but the differences statistical significant are present only for enamel localised

at 2 mm from ECJ

X5CONCLUSIONS

The surfaces of enamel and dentine at cervical level record decreases of

roughness related to the decrease of distance to ECJ

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel but the differences

statistical significant are present only for enamel localised at 2 mm from ECJ

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of

dentine

33

CHAPTXI FEA STUDY REGARDING THE BIOMECHANICAL

BEHAVIOUR AND FRACTURE RESISTANCE OF PROXIMO-OCCLUSAL

AMALGAM AND COMPOSITE RESINS RESTORATIONS

XI1INTRODUCTION AIM OF STUDY

The individual variation of patients morphological and functional complexity

of tissues as well as difficult access limit the possibilities to investigate in clinical

studies the biomechanical behaviour of proximo-occlusal restorations In this context

simulation of the biomechanics for direct restorations represents an interesting

interdisciplinar domain in actual dentistry research

The study focused on two direction

- analysis of role of forces intensity on biomechanical behaviour related to

cavity dimension and material

- analysis of tension inside restoration structure related to forces intensity

XI2MATERIALS AND METHODS

The stages of finite element analysis study are as follows

object modelling (bicusps and proximo-occlusal restoration)

definition of parameters for materials and dental tissues

meshing

constraints and loading

types of contacts

equations system definition

results of simulation

The object 3D modelling was performed in Rhinoceros (figure XI1) The

definition of parameters was performed for Poisson constant Young modulus density

(table XI1) The selected materials were amalgam and composite resins The

analysed tissues were dentine and enamel The meshing constraints loading were

performed for forces of 200N 400N 600N 800 N The analysis was performed using

software COSMOSWorks 2010

34

Fig XI1 3D modellation of bicusp

Table XI1 Values of Young modulus Poisson constant compression resistance for

amalgam composite resin enamel (amalgam compozit smalţ)

Material Young modulus (GPa) Poisson constants

Compression

resistance

(Mpa)

Amalgam 55 033 483

Enamel 48 03 400

Composite

resin 220 022 345

Fig XI2 The forces and constraints application

The results are presented in values and culours red colours representing areas

with maximum values of tensions produced under influence of masticatory forces

The tensions produced in amalgam restoration are in a range from 0 to 22886

(force 800 N) The maximum von Misses tensions are associated with cervical area

of amalgam restorations This aspect proves that first modification in interface

restoration-cavity margins will appear at the level of gingival wall First marginal

35

defects and fissures in restoration bulk will appear at tensions over 1600Mpa

associated with forces of 800N for extended amalgam proximo-occlusal restorations

The tensions produced in composite resin restorations are in a range from 0 to

2285 (force 800 N) The maximum von Misses tensions are associated with cervical

area of composite resin restorationsThis aspect proves that first modification in

interface restoration-cavity margins will appear at the level of gingival wall First

marginal defects and fissures in restoration bulk will appear at tensions over 1716

Mpa associated with forces of 600N for moderate and extended composite resins

proximo-occlusal restorations

Fig XI3a-b ndash Simulated model of proximo-occlusal restoration

FigXI4a-b Dental amalgam restoration Cervical tension associated with 600 N

(c)800 N (d)

FigXI5a-b Composite resin restoration Cervical tension associated with 600 N

(c)800 N (d)

36

The deformation of amalgam can be produced only when is associated with

fissures in bulk of restorations while composite resins restorations present

deformation when are associated with a modification of volume and form because of

repeated action of medium forces on long term or high forces on short term (figures

XI4 XI5)

Fig XI4 Material deformation in area of maximum tension

000E + 00

500E -02

100E -01

150E -01

200E -01

250E -01

1 4 7 101316192225283134374043464952555861646770737679

Amalgam C ompoz it

Figura XI5 Deformarea funcție de material

The amalgam and composite resins were treated as homogenous isotropic and

liniar The advantage of this type of FEA study is that restorations parameters can be

modified any time is necessary both in arhitecture geometry and material indices

variability The results of this study sustain the conclusions of other FEA studies

focused on biomechanical behaviour of posterior restorations performed with

amalgam and composite resins(35 62 76 143)

37

XI4CONCLUSIONS

bull The amalgam in class II restorations has a low deformation tendency because

of uniform distribution of tension inside material

bull Composite resins class II restorations accumulate higher tensions comparing

with amalgam but deformation is avoided for a time because of the adhesion

forces performed between molecules under moderate oral forces In case of

high oral forces (600-800N) the risk of fracture in moderate class II

restorations is higher comparing with amalgam proximo-occlusal restorations

For extended class II restorations and forces of 600 N composite resins present

highest risk of fracture and deformation The von Misses tension at the

cervical interface restorationtooth can reach 1600Mpa

bull The amalgam in moderate class II restorations can resist to deformation even

for high intensity forces limited to 600N In extended class II restorations the

risk of deformation and fracture increases at values of 600N-800N of oral

forces The von Misses tension at the cervical interface restorationtooth can

reach 1700 Mpa

38

FINAL CONCLUSIONS

Amalgam proximo-occlusal restorations with minimum 6-years age present

excellent results for parameters anatomic form (occlusal) marginal

discoloration and marginal secondary dental caries good results for

parameters anatomic form (proximal) and marginal adaptation and poor results

for surface quality

Composite resins proximo-occlusal restorations (bicusps) with minimum 6-

years age present excellent results for parameters color match marginal

discoloration and marginal secondary dental caries and good results for

parameters anatomic form (occlusal proximal) marginal adaptation surface

quality

Composite resins proximo-occlusal restorations (molars) with minimum 6-

years age present good results for parameters color match marginal

discoloration marginal secondary dental caries marginal adaptation and poor

results for parameters anatomic form (occlusal) (54 indices Ryge C)

anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The restorations extended at external third of occlusal surface present highest

percents of indices C regarding anatomic form (occlusal) (54 indices Ryge

C) anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The exceeding of 6-years age will require careful monitorisation for early

interventions through polishing sealing reshaping and even replacement for

restorations with major defects

Oblique layering technique presents superior results regarding marginal

adaptation and marginal discoloration and is recommended for proximo-

occlusal dental caries close to enamel-cement jonction

Centripetal build-up presents good results regarding marginal adaptation and

anatomical form at proximal level (proximal surfaces and contact point)

Horisontal layering technique can be used for optimum results only in

proximal-occlusal cavities with moderate extension both in occlusal-cervical

and buccal-oral

The values of die penetration at gingival wall were statistically different

between the three restorative techniques

We concluded that all restorative methods were associated with lightcuring

contraction and marginal microleakage

The combined technique was associated with lowest lightcuring contraction

and die penetration

The bulk technique was associated with highest lightcuring contraction and die

penetration

39

The surfaces of enamel and dentine at cervical level record decreases of

roughness related to the decrease of distance to ECJ

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel but the differences

statistical significant are present only for enamel localised at 2 mm from ECJ

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of

dentine

bull The amalgam in class II restorations has a low deformation tendency because

of uniform distribution of tension inside material

bull Composite resins class II restorations accumulate higher tensions comparing

with amalgam but deformation is avoided for a time because of the adhesion

forces performed between molecules under moderate oral forces In case of

high oral forces (600-800N) the risk of fracture in moderate class II

restorations is higher comparing with amalgam proximo-occlusal restorations

For extended class II restorations and forces of 600 N composite resins present

highest risk of fracture and deformation The von Misses tension at the

cervical interface restorationtooth can reach 1600Mpa

bull The amalgam in moderate class II restorations can resist to deformation even

for high intensity forces limited to 600N In extended class II restorations the

risk of deformation and fracture increases at values of 600N-800N of oral

forces The von Misses tension at the cervical interface restorationtooth can

reach 1700 Mpa

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6Aggarwal V Logani A Jain V Shah N Effect of cyclic loading on marginal

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Oper Dent 2008 Sep-Oct33(5)587-92

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8Andrian S- Restaurări fizionomice cu materiale plastice icircn cariologie-EdPanteon

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9Andrian S Tratamentul Minim Invaziv al Cariei Dentare EditPrinceps Edit Iaşi

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13Angmar-Mansson B Al-Khateeb S Tranaeus S Caries diagnosis Journal of

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14Anusavice KJ- ldquoQuality evaluation of dental restorationscriteria for placement

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15Anusavice KJ Development and testing of ceramics for dental restorations In

Fischman G Clare A Hench J editors Bioceramics materials and applications

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16Arhun N Celik C Yamanel KClinical evaluation of resin-based composites in

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17Armstrong SR JC Keller DB Boyer The influence of water storage and C-

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utilizing a filled and unfilled adhesive resin Dent Mater 200117268ndash276

18Armstrong S Boyer D Keller J Microtensile bond strength testing and failure

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19Asmussen E Peutzfeldt A Influence of UEDMA BisGMA and TEGDMA on

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26Bader JD Shugars DA Understanding dentistslsquo restorative treatment decisions J

Public Health Dent 1992 Winter52(2)102-10

27Barkmeier WW Cooley RL Current status of adhesive resin systems J Am Coll

Dent 199158 36-39

28Bayne SC Dental biomaterials where are we and where are we going J Dent

Educ 200569(5)571ndash585

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29Bedran-de-Castro AK Pereira PN Thompson JY Influence of load cycling

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30Behle C Flowable composite Proprieties and applications Pract Periodontics

Aesthetics Dent 1998 10347 350-351

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33Black J Biological Performance of Materials Fundamentals of Biocompatibility

NY Marcel Dekker Inc 1999

34Bonsor SJ Chadwick RGLongevity of conventional and bonded (sealed)

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9

35Boschian PL S Guidotti R Pietrbissa M Gagliani- bdquoStress distribution in a

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Rehabilitation (33) 2006690ndash697

36Bouillaguet S B Ciucchi T Jacoby JC Wataha DH Pashley Bonding

characteristics to dentin walls of class II cavities in vitro Dent Mater 200117316ndash

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2000 12328-339

38Braga RR Ferracane JL Hilton TJ Contraction stress of flowable composites

and their efficacy as stress-relieving layers J Am Dent Assoc 2003134721ndash728

39Braga RR Ballester RY Ferracane JLFactors involved in the development of

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40Bratu D- Materiale dentare icircn cabinetul de stomatologie- Edit Helicon

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Association 2000nr131

42Brunthaler A Koumlnig F Lucas T Sperr W Schedle A Longevity of direct resin

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43Bullard RH Leinfelder KR Russell CM Effect of coefficient of thermal

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44Buonocore MG Matsui A Gwinnett AJ Penetration of resin dental materials

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45Burke FJ Cheung SW Mjoumlr IA Wilson NH Restoration longevity and analysis

of reasons for the placement and replacement of restorations provided by vocational

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46Burke FJ Cheung SW Mjor IA Wilson NH-Reasons for the placement and

replacement of restorations in vocational training practicePrimary Dental Care

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47Burke FJ Wilson NH Cheung SW Mjoumlr IA Influence of patient factors on age

of restorations at failure and reasons for their placement and replacement J Dent

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48Calheiros FC Braga RR Kawano Y Ballester RY Relationship between

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2004 20939-946

49Cardoso P Sadek F Microtensile bond strength on dentin using new adhesive

systems with selfetching primers Braz J Oral Sci 2003 2(4) 156-159

50Cardoso M Baratieri LN Ritter AV The effect of finishing and polishing on

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51Carvalho RM JC Pereira M Yoshiyama DH Pashley A review of

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reliefOper Dent19962117ndash24

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Dentomaxillofac Radiol 2007 Mar36(3)138-42

53Cattaneo PM M Dalstra B Melsen- bdquoThe Finite Element Method a Tool to

Study Orthodontic Tooth Movement J Dent Res 2005 84(5)428-433

54Cattell MJ Clarke RL Lynch EJ The transverse strength reliability and

microstructural features of four dental ceramicspart 1 J Dent 25(5)399-407 1997

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bond strength to primary dentin J Dent Child 2003 70(2) 139-144

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posterior restorations 12-month results Eur J Dent 2010 Jan4(1)57-65

57Cenci M Demarco F de Carvalho R Class II composite resin restorations with

two polymerization techniques Relationship between microtensile bond strength and

marginal leakage J Dent 2005 33(7) 603- 610

58Chaffin J Moss D Review of current US Army dental emergency rates Mil

Med 2008173(1)23ndash26

59Chen HY Manhart J Hickel R Kunzelmann KH Polymerization contraction

stress in light-cured packable composite resinsDent Mater 200117253-259

60Choi KK Condon JR Ferracane JL The effects of adhesive thickness on

polymerization contraction stress of composites J Dent Res 2000 79812ndash817

61Cichon P Kerschbaum T Verweildauer zahnartzlicher Restaurationen bei

Behinderten Dtsch Zahnartzlicher 1999 54 96-102

62Cohen BI Pagnillo MK Deutsch ASMusikant BL Fracture Strength of

Three Core Restorative Materials Supported with or without a Prefabricated Split-

Shank Post Journal of Prosthetic Dentistry1997 78 560ndash565

63Colli P Brannstrom M The marginal adaptation of four different bonding agents

in Class II composite resin restoration applied in bulk or in two increments

Quintessence Int 1993 24583-591

43

64Collins CJ Bryant RW Hodge KL A clinical evaluation of posterior composite

resin restorations 8-year findings J Dent 199826(4) 311ndash317

65Condon JR Ferracane JL Assessing the effect of composite formulation on

polymerization stress J Am Dent Assoc2000 131497-503

66Cook WD Moopnar M Influence of chemical structure on the fracture

behaviour of dimethacrylate composite resins Biomaterials 1990 11272-276

67Cortes DF Ellwood RP Ekstrand KR An in vitro comparison of a combined

FOTIvisual examination of occlusal caries with other caries diagnostic methods and

the effect of stain on their diagnostic performance Caries Res 2003 37 (1) 8-16

68Crim GA Microleakage of three resin placement techniques Am J Dent

1991469-72

69Dauvillier B Aarnts M Feilzer A The competition between the composite-

dentin strength and the polimerization contraction stress J Dent Res 1984 63 1396-

1399

70Dauvillier BS Aarnts MP Feilzer AJ Developments in shrinkage control of

adhesive restoratives J Esthet Dent 2000 12291-299

71Dauvillier BS Aarnts MP Feilzer AJ Modeling of the viscoelastic behavior of

dental light-activated resin composites during curing Dent Mater 200319277ndash285

72Davidson CL Gee AJ Feilzer A The competition between the composite-dentin

bond strength and the polymerization contraction stress J Dent Res 1984

63(12)1396-9

73Davidson CL AJ Feilzer Polymerization shrinkage and polymerization

shrinkage stress in polymer-based restoratives J Dent Res 199725435ndash440

74Davidson CL Resisting the curing contraction with adhesive composites J

Prosthet Dent 198655446ndash7

75Davis RD Mayhew RB A clinical comparison of three anterior restorative resins

at 3 years J Am Dent Assoc 1986112659-63

76Dejak B Mlotkowski A Three-dimensional finite element analysis of strength

and adhesion of composite resin versus ceramic inlays in molarsJ Prosthet

Dent200899131-40

77Deligeorgi V Mjor IA Wilson NH An overview of reasons for the placement

and replacement of restorations Prim Dent Care 20018(1)5-11

78Deliperi S Bardwell DN An alternative method to reduce polymerization

shrinkage in direct posterior composite restorations J Am Dent Assoc 2002

1331387ndash97

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Dent20104(3)270-9

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2006 22359-365

44

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848

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1243

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Biology199843(8)629-632

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817-822

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18(7)516-20

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Jan11(1)34-40

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JDent 199826 627-632

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1999 15128-137

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Edition of the Balkan Medical Days

Stomatological Section Abstract nr1091999128

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Dentistry and Oral Epidemiology 1996 24 106-11

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Dent Mater 2002 18436-444

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20(3)236-43

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Polymerization shrinkage effects of boundary conditions and filling technique of

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50

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Quintessence Int 2004 35(2)156-61

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Dentomaxillofac Radiol 2007 Oct36(7)377-81

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J Prosthet Dent 2000 Sep84(3)289-96

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Three-year clinical evaluation of composite and ceramic inlays Am J Dent 2001

Apr14(2)95-9

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79369 (Abstract)

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PrimDentCare1999Apr659-62

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33

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52

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125749-751

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34

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Monogr Oral Sci 20092142-51

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53

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569ndash575

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Community Dent Oral Epidemiol 1980 Jun8(3)135-8

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volumetric polymerization shrinkage and bulk modulus of dental composites and an

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placement techniques on marginal microleakage of deep class-II cavities restored with

two composite resin formulations J Conserv Dent 2010 13(1) 9ndash15

54

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system on microleakage in cervical composite resin restorations Rev Med Chir

Soc Med Iaşi-2008 vol112 nr1supl1145-147

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posterior composite 10-year report J Dent 199927(1) 13ndash19

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259Rezwani-Kaminski T Kamann W Gaengler P Secondary caries susceptibility

of teeth with long-term performing composite restorations J Oral Rehabil 2002

29(12)1131ndash1138

260Roberson TM Heymann HO Swift EJ eds Sturdevantlsquos Art and Science of

Operative Dentistry 5th ed St Louis Mosby 2006293-7

261Robertello FJ Pink FE The effect of a training program on the reliability of

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262Rodrigues JSA Pin LF Machado G Della Bona A Demarco FF Influence

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J Appl Oral Sci 2010 Feb18(1)37-43

263Roulet JF Noack MJCriteria for substituting amalgam with composite resins

Int Dent J 199141(4)195-205

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265Roulet JF Longevity of ceramic inlays and amalgam- results up 6 years

ClinOral Invest1997140-46

266Roulet JFBenefits and disadvantages of tooth-coloured alternatives to amalgam

J Dent 199725(6)459-73

267Rueggeberg FA WF Caughman JW Curtis Jr HC Davis Factors

affecting cure at depths within light-activated resin composites Am J Dent

1993691ndash95

268Rueggeberg FA Ergle JW Mettenburg DJ Polymerization depths of

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269Rushton VE Horner K Worthington HV Screening panoramic radiography

of new adult patients diagnostic yield when combined with bitewing radiography and

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270Ruyter IE Types of resin-based inlay materials and their properties Int Dent J

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271Sajjan GS Mittal NEffect of different placement techniques on marginal

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J Conserv Dent 201013(1)9-15

272Sakaguchi RL MC Peters SR Nelson WH Douglas HW Poort Effects

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273Sakaguchi RL Shah NC Lim BS Ferracane JL Borgersen SE Dynamic

mechanical analysis of storage modulus development in lightactivated polymer matrix

composites Dent Mater 200218197-202

274Sano H Takatsu T Ciucchi B Horner JA Matthews WG Pashley DH

Nanoleakage leakage within the hybrid layer Oper Dent 1995 20 18-25

55

275Sarrett DC Clinical challenges and the relevance of materials testing for

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276Sarrett DC Brooks CN Rose JT Clinical performance evaluation of a

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278Schirrmeister JF Huber K Hellwig E Hahn P Four-year evaluation of a resin

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404

279Schneiderman A Elbaum M Schultz T Keem S Greenebaum M Driller J

Assessment of dental caries with Digital Imaging Fiber-Optic Transillumination (DI-

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280Schulte AG Wittchen A Stachniss V Jacquet W Bottenberg P Approximal

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281Shortall AC Marginal seal comparisons between resinbonded Class II porcelain

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Prosthodont19892(3)217-223

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284Sengun A Unlu N Ozer F Ozturk B Bond strength of five current adhesives

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285Setcos JC Staninec M Wilson NH- A two-year randomized controlled

clinical evaluation of bonded amalgam restorations- Journal of Adhesive Dentistry

nr11999

286Sideridou I Tserki V Papanastasiou G Effect of chemical structure on degree

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231819-1829

287Sideridou I Tserki V Papanastasiou G Study of water sorption solubility and

modulus of elasticity of light-cured dimethacrylate-based dental resins Biomaterials

2003 24655-665

288Sidi AD Naylor MN A comparison of bitewing radiography and interdental

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289SilverFH Christiansen DLBiomaterials Science and Biocompatibility New

York Springer-Verlag 1999

290Simecek JW Diefenderfer KE Ahlf RL Ragain JC Jr Longitudinal trends in

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200382 1169 (Abstract)

291Simecek JW Diefenderfer KE Ahlf RL Ragain JC Jr Dental sealant

longevity in a cohort of young US naval personnel JADA 2005136(2)171ndash178

56

292Simi B Suprabha B Evaluation of microleakage in posterior nanocomposite

restorations with adhesive liners J Conserv Dent 201114(2)178-81

293Simone D David N B An alternative to reduce polimeryzation shrinkage in

direct posterior restorations JADA 2002 101387-1398

294Smales RJ Longevity of cusp-covered amalgams survivals after 15 years

OperDent 1991 16 17-20

295Smales RJ Webster DA Leppard PISurvival predictions of amalgam

restorations JDent1991 19 272-277

296Smales RJ Hawthorne WSLong-term survival of extensive amalgams and

posterior crowns JDent 1997 25 225-227

297Soncini JA Maserejian NN Trachtenberg F Tavares M Hayes C The

longevity of amalgam versus compomercomposite restorations in posterior primary

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Am Dent Assoc 2007 Jun138(6)763-72

298Sonoda H Banerjee A Sherriff M Tagami J Watson TF An in vitro

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affected dentine J Dent 2005 33(4)335-342

299Soodabeh Kimyai Masomeh Mehdipour Siavash Savadi Oskoee Reasons

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no1(2007)

300De Souza FB Guimaraes RP Vicente Silva CH A clinical evaluation of

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International 2005 36 41-48

301Spreafico RC Gagliani M Composite resin restorations on posterior teeth In

Roulet JF Degrange M Adhesion The silent revolution in dentistry Chicago

Quintessence 2000253ndash76

302St Georges AJ Wilder AD Jr Perdigao J Microleakage of Class V composites

using different placement and curing techniques an in vitro study Am J Dent 2002

15244-247

303Stangel I Barolet RY Clinical evaluation of two posterior composite resins

Two-year results J Oral Rehabil 1990 17 257-268

304Stephen KW Russell JI Creanor SL Comparison of fibre optic

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Dentistry and Oral Epidemiology 1987 15 (2) 90-94

305Sturdevant JR Bayne SC Heymann HO Margin gap size of ceramic inlays

using second-generation CADCAM equipment J Esthet Dent 11(4)206-214 1999

306Suh BI A study of the compatibility of adhesives with composites Proceeding

from the SCO Dental Products Inc Symposium 2003 24(8) 4-9 (Abstract)

307Summit JB Burgess JO Berry TG Six-year clinical evaluation of bonded and

pin-retained complex amalgam restorations Oper Dent 2004 29269-276

308Summit JB Robbins JW Hilton TJ Fundamentals in operative dentistry Cap

10Direct Posterior Esthetic Restorations 2006 Quintessence Publishing Co

57

309Svanberg M Mjor IA Orstavik D Mutans streptococci in plaque from margins

of amalgam composite and glassndashionomer restorations J Dent Res 199069861ndash

864

310Tanne K Mamoru S Burstone C Three-dimensional finite element analysis

for stress in the periodontal tissue by orthodontic forcesAm J Orthod Dentofacial

Orthop921987499ndash505

311Tanumiharja M Burrow MF Tyas MJ Microtensile bond strengths of seven

dentin adhesive systems Dent Mater 2000 16(3)180-7

312Tay FR Pashley DH Aggressiveness of contemporary self-etching systems

Part I Depth of penetration beyond dentin smear layers Dent Mater 2001 17(4) 296-

308

313Tay FR Frankenberger R Krejci I Bouillaguet S Pashley DH Carvalho

RM Single-bottle adhesives behave as permeable membranes after polymerization I

In vivo evidence J Dent 2004 32611ndash621

314Tay FR Pashley DH Have dentin adhesives become too hydrophilic J Can

Dent Assoc 2003 69726ndash731

315Tay FR Sano H Carvalho R Pashley EL Pashley DH An ultrastructural

study of the influence of acidity of self-etching primers and smear layer thickness on

bonding to intact dentin J Adhes Dent 2000 283ndash98

316Thompson JY Bayne SC Heymann HO Mechanical properties of a new

mica-based machinable glass ceramic for CADCAM restorations J Prosthet Dent

76(6)619-623 1996

317Unterbrink GL R Muessner Influence of light intensity on two restorative

systems J Dent 199523183ndash189

318Unterbrink GL Liebenberg WH Flowable resin composites as filled

adhesiveslsquo literature review and clinical recommendations Quintessence Int

199930249ndash257

319Vaarkamp J Ten Bosch J Verdonschot EH Quantitative diagnosis of small

approximal caries lesions utilizing wavelength-dependent fiber-optic

transillumination Journal of Dental Research 1997 76 (4) 875-882

320Valachovic RW Douglass CW Reiskin AB Chauncey HH McNeil BJ The

use of panoramic radiography in the evaluation of asymptomatic adult dental patients

Oral Surg Oral Med Oral Pathol 198661(3)289-96

321Van Meerbeek B De Munck J Yoshida Y Inoue S Vargas M Vijay P Van

Landuyt K Lambrechts P Vanherle G Adhesion to enamel and dentin Current

status and future challenges Oper Dent 2003 28 215-235

322Van Meerbeek B Van Landuyt K De Munck JHashimoto M Peumans M

Lambrechts P Yoshida Y Inoue S Suzuki K Technique-sensitivity of

contemporary adhesives Dent Mater J 2005 24(1) 1-13

323Van Meerbeek B Vargas S Inoue S Yoshida Y Peumans M Lambrechts P

Vanherle G Adhesives and cements to promote preservation dentistry Oper Dent

20016 119-144

324Van Meerbeek B Yoshida Y Inoue S Vargas M Abe Y Fukuda R Okazaki

M Lambrechts P Vanherle G Bonding mechanism micro-tensile bond strength of

a 4- MET-based self-etching adhesive J Dent Res 2000 79 249 (Abstract)

58

325Van Nieuwenhuysen JP DrsquoHoore W Carvalho J Qvist V Long-term

evaluation of extensive restorations in permanent teeth J Dent 200331(6)395ndash405

326Venhoven BA de Gee AJ Davidson CL Light initiation of dental resins

dynamics of the polymerization Biomaterials 1996 172313-2318

327Versluis A Douglas WH Cross M Sakaguchi RL Does an incremental filling

technique reduce polymerization shrinkage stresses J Dent Res 1996 75871ndash878

328Vries HC Ruiken HM Konig KG vanrsquot Hof MA Radiographic versus

clinical diagnosis of approximal carious lesions Caries Res1990 24 (5) 364-370

329Waggoner W Ashton J Predictability of cavitation based upon radiographic

appearance comparison of two film types Quintessence International 1989 20(1)

55-60

330Watanabe LG Marshall GW Jr Marshall SJ Dentin shear strength effects of

tubule orientation and intra tooth location Dent Mater 1996 12 109-115

331Watts DC AS Marouf Optimal specimen geometry in bonded-disk

shrinkage-strain measurements on light-cured biomaterials Dent Mater 200016447ndash

451

332Watts DC Marouf AS Al-Hindi AM Photo-polymerization shrinkage-stress

kinetics in resin-composites methods development Dent Mater 2003 191ndash11

333Weaver WS Blank LW Pelleu GB Jr A visible light activated resin cured

through tooth structure GenDent 198836236-7

334Wendt SL Microleakage and cusp fracture resistance of heattreated composite

resin inlays Am J Dent 4(1)10-14 1991

335Wenzel A Hintze H Mikkelsen L Mouyen F Radiographic detection of

occlusal caries in noncavitated teeth A comparison of conventional film radiographs

digitized film radiographs and RadioVisioGraphy-Oral Surg Oral Med Oral Pathol

1991 72 621-6

336Wenzel A Hintze H Perception of image quality in direct digital radiography

after application of various image treatment filters for detectability of dental diseases

Dentomaxillofac Radiol 1993 22 131-4

337Wenzel A Computer-aided image manipulation of intraoral radiographs to

enhance diagnosis in dental practice a review Int Dent J 1993 43 99-108

338Wenzel A Digital radiography and caries diagnosis Dento Maxillo Facial

Radiology 27(1)3-11 1998

339Wenzel A Haiter-Neto F Gotfredsen E Risk factors for a false positive test

outcome in diagnosis of caries in approximal surfaces impact of radiographic

modality and observer characteristics Caries Res 200741(3)170-6

340Wibowo G Stockton L Microleakage of class II composite restorations Am J

Dent 200114177ndash185

341Wilson NHF Wastell DG Norman RD Five-year performance of high-

cooper content amalgam restorations in a multiclinical trial JDent1996 24 203-210

342Winkler MM Katona TR Paydar NH Finite element stress analysis of three

filling techniques for class V light-cured composite restorations J Dent Res

1996751477-83

343Yap AU Effectiveness of polymerization in composite restoratives claiming bulk

placement Impact of cavity depth and exposure time Oper Dent 2000 25113-120

59

344Yeşilyurt C Bulucu B Bond strength of total-etch dentin adhesive systems on

peripheral and central dentinal tissue a microtensile bond strength test The Journal of

Contemporary Dental Practice 7(2) 20061-13

345Yoshida Y Van Meerbeek B Okazaki M Shintani H Suzuki K Comparative

study on adhesive performance of functional monomers J Dent Res 2004 83 454-

458

346Yoshiyama M Tay FR Doi J Nishitani Y Yamada T Itou K Carvalho RM

Nakajima M Pashley DH Bonding of self-etch and total etch adhesives to carious

dentin J Dent Res 2002 81 556-560

  • COPERTA REZUMAT ENGLEZA (MEREUTA)pdf
  • REZUMAT ENGLEZA DR MEREUTA DENISSpdf
Page 14: UNIVERSITATEA DE MEDICINA SI FARMACIE “GR Doctorat/Rezumat... · universitatea de medicina si farmacie “gr.t.popa” iasi facultatea de medicina dentara rezumatul tezei de doctorat

11

The study data sustain the results obtained by most studies focused on

posterior amalgam restorations However Hickelampcol (2001) reviewed literature data

and proved that many results varies accordingly to different clinical factors (133)

Roulet JF(1997) warned about limits of cross-sectional studies related to composite

resins restorations because of the absence of data regarding restorative techniques

practitioner experience presence or absence of optimum isolation factors related by

patient (266)

VII5CONCLUSIONS

Amalgam proximo-occlusal restorations with minimum 6-years age present

excellent results for parameters anatomic form (occlusal) marginal

discoloration and marginal secondary dental caries good results for

parameters anatomic form (proximal) and marginal adaptation and poor results

for surface quality

Composite resins proximo-occlusal restorations (bicusps) with minimum 6-

years age present excellent results for parameters color match marginal

discoloration and marginal secondary dental caries and good results for

parameters anatomic form (occlusal proximal) marginal adaptation surface

quality

Composite resins proximo-occlusal restorations (molars) with minimum 6-

years age present good results for parameters color match marginal

discoloration marginal secondary dental caries marginal adaptation and poor

results for parameters anatomic form (occlusal) (54 indices Ryge C)

anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The restorations extended at external third of occlusal surface present highest

percents of indices C regarding anatomic form (occlusal) (54 indices Ryge

C) anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The exceeding of 6-years age will require careful monitorisation for early

interventions through polishing sealing reshaping and even replacement for

restorations with major defects

12

CHAPTVIII CLINICAL PERFORMANCE OF COMPOSITE RESINS

RESTORATIONS RELATED TO RESTORATIVE TECHNIQUE 12-

MONTHS LONGITUDINAL STUDY

VIII1 INTRODUCTION

The restorative technique has a major influence over clinical performance of

composite resins restorations in proximo-occlusal cavities In this context researches

focused on correlations between technique and clinical performance of direct

restorations improve the dentist decision regarding restorative technique choice

VIII2AIM OF STUDY

The aim of study was to determine the clinical performance of composite

resins proximo-occlusal restorations performed using different restorative techniques

VIII3MATERIALS AND METHOD

The group study included 37 patients with age 18-42 years with moderat

ecariogenic risk The total number of composite resins restorations (Herculite XRV

Kerr) was 60 divided in three study groups (n=20)

I Centripetal build-up

II Oblique layering

III Horisontal layering

The coronal restorations were assessed at an interval of 12 months using

indices Ryge modified USPHS

- indice ALFA (A)- IDEAL CLINIC

- indice BRAVO (B)- ACCEPTABLE CLINIC

- indice CHARLIE (C)- UNACCEPTABLE CLINIC

VIII4 RESULTS AND DISCUSSIONS

The statistical tests Kruskal-Wallis and Mann-Whitney were performed to

confirm or infirm research hypotesis (the direct restorations performed using different

restorative techniques present statistical significant differences regarding clinical

performance for the assessed parameters)

13

TableVIII1a-b Groups study (Kruskal-Wallis Test)

Ranks

20 2960

20 2560

20 3630

60

20 3050

20 2420

20 3680

60

20 2490

20 3140

20 3520

60

Restorative_techniques

Centripetal build-up

Oblique layering

Horizontal layering

Total

Centripetal build-up

Oblique layering

Horizontal layering

Total

Centripetal build-up

Oblique layering

Horizontal layering

Total

Marginal_adaptation

Marginal_discoloration

Anatomical_form

N Mean Rank

Test Statisticsab

4913 8031 4900

2 2 2

086 018 086

Chi-Square

df

Asymp Sig

Marginal_

adaptation

Marginal_

discoloration

Anatomical_

form

Kruskal Wallis Testa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between the three restorative

techniques for parameter marginal adaptation (p=0086)

There are no statistical significant differences between the three restorative

techniques for parameter marginal discoloration (p=0018)

There are no statistical significant differences between the three restorative

techniques for parameter anatomical form (proximal) (p=0086)

TableVIII2 Comparing results between restorations performed using three

techniques (marginal adaptation marginal discoloration anatomical form) Marginal adaptation Centripetal build-upOblique layering p=04 ns

Centripetal build-upHorizontal layering p=0191 ns

Oblique layering Horizontal layering p=0028 s

Marginal discoloration Centripetal build-upOblique layering p=0103 ns

Centripetal build-upHorizontal layering p=0195 ns

Oblique layering Horizontal layering p=0005 s

Anatomical form Centripetal build-upOblique layering p=0137 ns

Centripetal build-upHorizontal layering p=0029 s

Oblique layering Horizontal layering p=0433 ns

ns nesemnificativ

s semnificativ

p probabilitate

14

Tables VIII3a-b Mann-Whitney test Comparing analysis regarding marginal

discoloration between restorations performed using oblique layering technique and

centripetal build-up technique

Ranks

20 2180 43600

20 1920 38400

40

Restorative_techniques

Centripetal build-up

Oblique layering

Total

Marginal_adaptation

N Mean Rank Sum of Ranks

Test Statisticsb

174000

384000

-841

400

495a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

adaptation

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between centripetal build-up

and oblique layering techniques regarding parameter marginal adaptation (p=0400)

Tables VIII4a-b Mann-Whitney test Comparing analysis regarding marginal

adaptation between restorations performed using horisontal layering technique and

centripetal build-up technique

Ranks

20 1830 36600

20 2270 45400

40

Restorative_techniques

Centripetal build-up

Horizontal layering

Total

Marginal_adaptation

N Mean Rank Sum of Ranks

Test Statisticsb

156000

366000

-1307

191

242a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

adaptation

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between centripetal build-up

and horisontal layering techniques regarding parameter marginal adaptation

(p=0191)

15

TablesVIII5a-b Mann-Whitney test Comparing analysis regarding marginal

adaptation between restorations performed using oblique layering technique and

horisontal layering technique

Ranks

20 1690 33800

20 2410 48200

40

Restorative_techniques

Oblique layering

Horizontal layering

Total

Marginal_adaptation

N Mean Rank Sum of Ranks

Test Statisticsb

128000

338000

-2191

028

052a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

adaptation

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There is statistical significant differences between horisontal layering and

oblique layering techniques regarding parameter marginal adaptation (p=0028)

Tables VIII6a-b Mann-Whitney test Comparing analysis regarding marginal

discoloration between restorations performed using oblique layering technique and

centripetal build-up technique

There are no statistical significant differences between centripetal build-up

and oblique layering techniques regarding parameter marginal discoloration

(p=0103)

Ranks

20 2260 45200

20 1840 36800

40

Restorative_techniques

Centripetal build-up

Oblique layering

Total

Marginal_discoloration

N Mean Rank Sum of Ranks

Test Statisticsb

158000

368000

-1632

103

265a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

discoloration

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

16

Tables VIII7a-b Mann-Whitney test Comparing analysis regarding marginal

discoloration between restorations performed using centripetal build-up technique and

horisontal layering technique

Ranks

20 1840 36800

20 2260 45200

40

Restorative_techniques

Centripetal build-up

Horizontal layering

Total

Marginal_discoloration

N Mean Rank Sum of Ranks

Test Statisticsb

158000

368000

-1299

194

265a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

discoloration

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between centripetal build-up

and horisontal layering techniques regarding parameter marginal discoloration

(p=0103)

Tables VIII8a-b Mann-Whitney test Comparing analysis regarding marginal

discoloration between restorations performed using oblique layering technique and

horisontal layering technique

Ranks

20 1630 32600

20 2470 49400

40

Restorative_techniques

Oblique layering

Horizontal layering

Total

Marginal_discoloration

N Mean Rank Sum of Ranks

Test Statisticsb

116000

326000

-2822

005

023a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

discoloration

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There is statistical significant differences between horisontal layering and

oblique layering techniques regarding parameter marginal discoloration (p=0005)

17

TablesVIII9 a-b Mann-Whitney test Comparing analysis regarding anatomical

form between restorations performed using centripetal build-up technique and oblique

layering technique

Ranks

20 1830 36600

20 2270 45400

40

Restorative_techniques

Centripetal build-up

Oblique layering

Total

Anatomical_form

N Mean Rank Sum of Ranks

Test Statisticsb

156000

366000

-1486

137

242a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Anatomical_

form

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between centripetal build-up

and oblique layering techniques regarding parameter anatomical form (p=0137)

Tables VIII10a-b Mann-Whitney test Comparing analysis regarding anatomical

form between restorations performed using centripetal build-up technique and

horisontal layering technique

Ranks

20 1710 34200

20 2390 47800

40

Restorative_techniques

Centripetal build-up

Horizontal layering

Total

Anatomical_form

N Mean Rank Sum of Ranks

Test Statisticsb

132000

342000

-2184

029

068a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Anatomical_

form

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between centripetal build-up

and horisontal layering techniques regarding parameter anatomical form (p=0029)

18

Tables VIII11a-b Mann-Whitney test Comparing analysis regarding anatomical

form between restorations performed using oblique layering technique and horisontal

layering technique

Ranks

20 1920 38400

20 2180 43600

40

Restorative_techniques

Oblique layering

Horizontal layering

Total

Anatomical_form

N Mean Rank Sum of Ranks

Test Statisticsb

174000

384000

-784

433

495a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Anatomical_

form

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between horisontal layering and

oblique layering techniques regarding parameter anatomical form (p=0433)

Indices A for restorations performed using centripetal build-up technique were

as follows color match-80 marginal adaptation- 60 marginal discoloration-

70 anatomical form (proximal)- 80 surface quality- 60

Indices A for restorations performed using horisontal layering technique were

as follows color match-70 marginal adaptation- 40 marginal discoloration-

50 anatomical form (proximal)- 50 surface quality- 70

Indices A for restorations performed using oblique layering technique were as

follows color match-70 marginal adaptation- 80 marginal discoloration- 90

anatomical form (proximal)- 60 surface quality- 70

Indices B for restorations performed using centripetal build-up technique were

as follows color match-20 marginal adaptation- 30 marginal discoloration-

20 anatomical form (proximal)- 30 surface quality- 40

Indices B for restorations performed using horisontal layering technique were

as follows color match-30 marginal adaptation- 40 marginal discoloration-

30 anatomical form (proximal)- 30 surface quality- 30

Indices B for restorations performed using oblique layering technique were as

follows color match-30 marginal adaptation- 20 marginal discoloration- 10

anatomical form (proximal)- 40 surface quality- 30

19

Indices C for restorations performed using centripetal build-up technique were

as follows color match-0 marginal adaptation- 10 marginal discoloration- 0

anatomical form (proximal)- 0 surface quality- 0

Indices C for restorations performed using horisontal layering technique were

as follows color match-0 marginal adaptation- 20 marginal discoloration- 20

anatomical form (proximal)- 20 surface quality- 0

Indices C for restorations performed using oblique layering technique were as

follows color match-0 marginal adaptation- 0 marginal discoloration- 10

anatomical form (proximal)- 0 surface quality- 100

Discussions

For in vitro studies is difficult to reproduce the variables existent in oral cavity

like occlusal stress and pH and temperature changes (235) The clinical studies are

determinant in assessment of restorative techniques (300) The most researches

focuses on the influence of restorative technique on the reduction of lightcuring stress

(51 78 135)

VIII5 CONCLUSIONS

Oblique layering technique presents superior results regarding marginal

adaptation and marginal discoloration and is recommended for proximo-

occlusal dental caries close to enamel-cement jonction

Centripetal build-up presents good results regarding marginal adaptation and

anatomical form at proximal level (proximal surfaces and contact point)

Horisontal layering technique can be used for optimum results only in

proximal-occlusal cavities with moderate extension both in occlusal-cervical

and buccal-oral

20

CHAPTIX STUDY REGARDING MARGINAL SEALING STATUS IN

COMPOSITE RESINS LIMITED PROXIMO-OCCLUSAL RESTORATIONS

PERFORMED USING DIFFERENT TECHNIQUES

IX1INTRODUCTION

The contraction of composite resins can produce stress inside dental structure

The most contraction stress appears in the initial stages and development rate of stress

decreases gradually in time (5 98 160) The contraction stress of composite resins

can overpass adhesion strenght and can broke the link between dental tissues and

composite resin (73) When adhesion strenght is high stress can produce marginal

fracture or bulk fracture (74) These situations are associated with microleakage and

penetration of oral fluid and bacteria along dentinal walls endangering the pulpal

tissue or favourising secondary dental caries

IX2 AIM OF STUDY

The study aimed to assess the efficiency of marginal sealing along gingival

wall in limited proximal-occlusal restorations performed using three different

techniques

IX3MATERIALS AND METHOD

The study group included 30 teeth extracted for orthodontic and periodontal

reasons On every tooth two identical class II cavities (on mesial and distal surfaces)

were prepared with cylindrical burs under water cooling The gingival wall was

limited to enamel-cement jonction The cavity dimension were as follows 2 mm

buccal-oral 5mm depth Each tooth was introduced in a pattern of acrylat The

operator calibrated preparation technique on acrylat teeth in Simulation Laboratory of

UMF ―Gr T Popa Iaşi The 60 prepared cavities were randomly divided in three

study groups related to restorative technique The restoration were performed with

Filtek Z550 (3M ESPE) a nanohybrid composite resin The adhesive strategy

included etchamprinse in 2 steps and adhesive Adper Single Bond 2(3MESPE)

Group A (n=20) bulk restorative technique associated with lightcuring from

occlusal 40 seconds and from buccal and oral 20 seconds

Group B (n=20) oblique layering technique (first layer on buccal wall and

buccal frac12 of gingival wall was lightcured from buccal second layer on oral wall and

oral frac12 of gingival wall was lightcured from oral third oral as a triangle with point

oriented to gingival wall was lightcured from occlusal)

Group C (n=20) combined technique (bdquoflow layer on gingival and axial

walls lightcured under pressure only associated with solid composite resin layer)

The proximal surfaces were performed using Tofflemire and metallic matrices After

removal of matrices every restoration was lightcured for another 20 seconds Two

layers aof varnish were applied on composite resins restorations excepting cavity

margins and an area of 1 mm around them The samples were introduced in methylen

21

blue 10 for 48 hours After this stage samples were washed with water and teeth

were cut longitudinally with a diamonded disc

The die penetration was assessed with Zeiss (Iena Germany) X20 microscope

accordingly to four scores (0-3)

0 ndash no penetration

1 ndash die infiltration until external half of gingival wall

2 ndash die infiltration on all gingival wall

3 ndash die infiltration on gingival wall and axial wall

IX4RESULTS AND DISCUSSIONS

The result of die penetration are presented in table IX1

TableIX1 The results for die penetration

Grup 0 1 2 3

A (bulk) 0 0 3 17

B (layering) 0 4 5 11

C (combined) 12 5 2 1

In group A 17 sample had score 3 and 2 samples had score 2 In group B 11

sample had score 3 5 samples had score 2 and 4 sample had score 1 In group C with

best results 12 samples had score 0 5 samples had score 1 2 samples had score 2 1

sample had score 3

The recorded data were analysed using test Mann-Whitney The statistical

results are presented in tables IX2-IX4

Tables IX2a-b Mann-Whitney for comparisons of microleakage values between

bulk technique and incremental technique

Ranks

Restorative technique N Mean Rank Sum of Ranks

Scores

frequency

A ndash bulk technique 20 2420 24200

B ndash incremental

technique

20 1680 16800

Total 40

Test Statisticsb

scores

frequency

Mann-Whitney U 29000

Wilcoxon W 168000

Z -1970

Asymp Sig (2-tailed) 049

Exact Sig [2(1-tailed Sig)] 123a

a Not corrected for ties

b Grouping Variable restorative technique

22

Tables IX3a-b Mann-Whitney for comparisons of microleakage values between

bulk technique and mixed technique

Ranks

Restorative technique N Mean Rank Sum of Ranks

scores

frequency

A ndash bulk technique 20 3090 30900

C ndash mixed technique 20 1010 10100

Total 40

Test Statisticsb

scores

frequency

Mann-Whitney U 500

Wilcoxon W 101000

Z -4021

Asymp Sig (2-tailed) 000

Exact Sig [2(1-tailed Sig)] 000a

a Not corrected for ties

b Grouping Variable restorative technique

Tables IX4a-b Mann-Whitney test for comparisons of microleakage values

between incremental technique and mixed technique

Ranks

Restorative technique N Mean Rank Sum of Ranks

scores

frequency

B ndash incremental

technique

20 2990 29900

C ndash mixed technique 20 1210 12100

Total 40

Test Statisticsb

scores

frequency

Mann-Whitney U 5500

Wilcoxon W 121000

Z -3492

Asymp Sig (2-tailed) 000

Exact Sig [2(1-tailed Sig)] 000a

a Not corrected for ties

23

Test Statisticsb

scores

frequency

Mann-Whitney U 5500

Wilcoxon W 121000

Z -3492

Asymp Sig (2-tailed) 000

Exact Sig [2(1-tailed Sig)] 000a

a Not corrected for ties

b Grouping Variable tehnrestaurare

The results of microleakage degree were statistically significant when the

three restorative techniques were compared The results showed that best restorative

technique regarding marginal sealing in cervical area is combined technique followed

by oblique layering technique The use of layering techniques limits the development

of contraction forces between oposite walls event that favourises bulk stress voids

formation and fissure inside dental tissues The results of our study are similar with

other studies (114 293)

IX5 CONCLUSIONS

The values of die penetration at gingival wall were statistically different

between the three restorative techniques

We concluded that all restorative methods were associated with lightcuring

contraction and marginal microleakage

The combined technique was associated with lowest lightcuring contraction

and die penetration

The bulk technique was associated with highest lightcuring contraction and die

penetration

24

CHAPTX STUDY REGARDING THE EFFECTS OF ETCHING ON

ENAMEL AND DENTINE IN CERVICAL AREA FOR PROXIMAL

CAVITIES AT LATERAL DENTAL GROUP

X1 INTRODUCTION

The studies reported marginal defects and high microleakage at the level of

gingival margins localised in cervical area or close to enamel-cement jonction for

high percents of proximal-occlusal composite resins restorations (8485) The good

adhesion is requested to insure restoration longevity and to prevent marginal

microleakage and presence of secondary marginal dental caries The adhesion

strenght of different adhesive systems can vary accordingly to tissues areas (204 240)

and to variations in dentinal structures (234 330) Most studies focused on adhesive

systems performances used healthy dentine close to pulp room but in case of class II

restorations there are particular features that influences the adhesion at the level of

gingival margins

The surface topography is an important property that determines the

interaction manner between surfaces The surface roughness and surface energy can

increase or decrease the adhesion of composite resins to the hard dental tissues

X2 AIM OF STUDY

The aim of study was to compare surface roughness of enamel and dentine

after etching related to different distances related to enamel-dentinecement jonction

X3 MATERIALS AND METHODS

The study group included 20 molars extracted from orthodontics or

periodontal reasons with intact proximal surfaces The teeth were cut longitudinally in

sens buccal-oral with diamond discs under water cooling

A group study (10 teeth) included 10 samples obtained through transversal

cutting at distance of 2mm from enamel-dentinecement jonction and 10 samples

obtained through transversal cutting at distance of 15 mm from enamel-

dentinecement jonction Another study group (10 teeth) included 10 samples

obtained through transversal cutting at distance of 1mm from enamel-dentinecement

jonction and 10 samples obtained through transversal cutting at distance of 05 mm

from enamel-dentinecement jonction All these samples were divided in two halfes

through mesial-distal cutting The samples finishing was performed with abrasive

paper (100-4000) and final polishing was performed with a device Buehler model

Minimet with slices introduced in ultrasound bath for 4 minutes The second half of

each sample was etched for 15 seconds with ortophosphoric acid 37 for 15 seconds

Slices were washed with distilled water for 30 seconds after etching and dried

The samples were analysed with atomic force microscopy (AFM) regarding

surface roughness The results were expressed as relative variation of roughness

X4 RESULTS AND DISCUSSIONS

The aspect of etched enamel at 2 mm distance from ECJ can be seen in figure

X1 (section 10 microm) The surface roughness is higher comparing with sample before

etching

25

După gravajul cu acid ortofosforic 37

The aspect of etched enamel at 15 mm distance from ECJ can be seen in

figure X2 (section 10 microm) The surface roughness is higher comparing with sample

before etching but lower comparing with sample at 2 mm from ECJ

The aspect of etched enamel at 1 mm distance from ECJ can be seen in figure

X3 (section 10 microm) The surface roughness is higher comparing with sample before

etching but lower comparing with sample at 15mm and 2 mm from ECJ

The aspect of etched enamel at 15 mm distance from ECJ can be seen in

figure X4 (section 10 microm) The surface roughness is higher comparing with sample

before etching but lower comparing with sample at 1 mm 15 mm and 2 mm from

ECJ

FigX1 3D aspect of enamel at 2 mm from ECJ

after etching (10 microm)

FigX2 3D aspect of enamel at 15 mm from ECJ

after etching (10 microm)

FigX3 3D aspect of enamel at 1 mm from ECJ

after etching (10 microm)

FigX4 3D aspect of enamel at 05 mm from ECJ

after etching (10 microm)

26

The mean values of squared roughness for dentine and enamel before etching

are presented in tables X1 and X2

Table X1 Squared roughness values for dentine samples before and after etching

Before etching (nm) After etching (nm)

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

sample

1

335 282 283 259 1149 947 901 879

sample

2

352 284 274 266 1127 939 883 875

sample

3

357 273 278 263 1152 953 876 867

sample

4

323 269 264 258 1146 942 895 883

sample

5

348 298 271 268 1153 944 904 878

sample

6

339 274 278 273 1158 937 893 892

sample

7

352 283 269 266 1145 944 899 876

sample

8

349 292 272 274 1166 942 907 869

sample

9

357 284 275 265 1132 939 893 879

sample

10

348 281 277 262 1142 941 899 878

Table X2 Squared roughness values for enamel and dentine samples before and after

etching

Before etching (nm) After etching (nm)

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

sample 1 422 342 309 313 2255 1114 874 845

sample 2 418 338 324 304 2236 1102 882 839

sample 3 413 334 315 303 2239 1115 873 833

sample 4 416 336 322 308 2242 1116 868 842

sample 5 426 332 315 294 2218 1103 877 829

sample 6 412 332 317 306 2237 1099 874 847

sample 7 414 335 322 314 2252 1102 876 834

sample 8 416 325 318 313 2239 1106 875 838

sample 9 418 328 314 299 2246 1113 879 836

sample 10 413 334 316 305 2242 1104 873 839

The results for samples before etching prove a decreasing tendency for mean

values of squared roughness surface beginning with areas placed at distance of 2 mm

from ECJ (346 nm) followed by areas placed at distance of 15 mm from ECJ (282

nm) 1 mm from ECJ (274 nm) and 05 mm from ECJ (265 nm) After etching the

decreasing tendency maintained for dentine localised at 2 mm from ECJ to dentine

localised at 05 mm from ECJ The mean values of squared roughness after etching

were three times higher (tables X3)

27

Table X3 Squared roughness values for enamel and dentine samples before and

after etching

Dentine Enamel

Before etching

(nm)

After etching

(nm)

Before etching

(nm)

After etching

(nm)

2 mm ECJ 346 1147 416 2237

15 mm ECJ 282 942 333 1107

1 mm ECJ 274 895 317 875

05 mm ECJ 265 877 305 838

The descriptive statistics data for surface roughness of dentine before and after

etching are presented in tables X4 si X5

Table X4 Descriptive statistics for dentine samples before etching

Statistics

Dentine 2mm

before etching

Dentine 15mm

before etching

Dentine 1mm

before etching

Dentine 05mm

before etching

N Valid 10 10 10 10

Missing 0 0 0 0

Mean 346000 282000 274100 265400

Std Error of Mean 33830 27487 17026 16746

Std Deviation 106979 86923 53841 52957

Skewness -1214 354 -314 348

Std Error of Skewness 687 687 687 687

Kurtosis 1141 049 336 -539

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 3230 2690 2640 2580

Maximum 3570 2980 2830 2740

Table X5 Descriptive statistics for dentine samples after etching

Statistics

Dentine 2mm

after etching

Dentine 15mm

after etching

Dentine 1mm

after etching

Dentine 05mm

after etching

N Valid 10 10 10 10

Missing 0 0 0 0

1147000 942800 895000 877600

Std Error of Mean 36545 14591 29926 22020

Std Deviation 115566 46140 94634 69634

Skewness -267 1169 -951 535

Std Error of Skewness 687 687 687 687

Kurtosis 043 1776 564 1416

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 11270 9370 8760 8670

28

Statistics

Dentine 2mm

after etching

Dentine 15mm

after etching

Dentine 1mm

after etching

Dentine 05mm

after etching

N Valid 10 10 10 10

Missing 0 0 0 0

1147000 942800 895000 877600

Std Error of Mean 36545 14591 29926 22020

Std Deviation 115566 46140 94634 69634

Skewness -267 1169 -951 535

Std Error of Skewness 687 687 687 687

Kurtosis 043 1776 564 1416

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 11270 9370 8760 8670

Maximum 11660 9530 9070 8920

To choose the statistical test to compare roughness surface values was

performed a test Shapiro-Wilk If p is lower or equal with 0005 than hypothesis of

distribution normality is rejected (distribution deviates from normal form) In the table

X6 the distributions are normal The statistical test will be test t for pair samples

Table X6 Test Shapiro-Wilk for dentine samples

Tests of Normality

Kolmogorov-Smirnov

a Shapiro-Wilk

Statistic df Sig Statistic df Sig

Dentine 2mm before etching 274 10 032 877 10 122

Dentine 15mm after etching 209 10 200 952 10 689

Dentine 1mm before etching 134 10 200 983 10 980

Dentine 05mm before etching 155 10 200 949 10 661

Dentine 2mm after etching 133 10 200 977 10 946

Dentine 15mm after etching 197 10 200 916 10 329

Dentine 1mm after etching 216 10 200 925 10 401

Dentine 05 after etching 220 10 185 933 10 474

Enamel 2mm before etching 193 10 200 898 10 207

Enamel 15mm before etching 170 10 200 977 10 947

Enamel 1mm before etching 157 10 200 952 10 689

Enamel 05mm before etching 165 10 200 943 10 590

Enamel 2mm after etching 235 10 124 925 10 404

Enamel 15mm after etching 209 10 200 871 10 102

Enamel 1mm after etching 189 10 200 964 10 834

Enamel 05mm after etching 142 10 200 983 10 978

a Lilliefors Significance Correction

29

Tests of Normality

Kolmogorov-Smirnov

a Shapiro-Wilk

Statistic df Sig Statistic df Sig

Dentine 2mm before etching 274 10 032 877 10 122

Dentine 15mm after etching 209 10 200 952 10 689

Dentine 1mm before etching 134 10 200 983 10 980

Dentine 05mm before etching 155 10 200 949 10 661

Dentine 2mm after etching 133 10 200 977 10 946

Dentine 15mm after etching 197 10 200 916 10 329

Dentine 1mm after etching 216 10 200 925 10 401

Dentine 05 after etching 220 10 185 933 10 474

Enamel 2mm before etching 193 10 200 898 10 207

Enamel 15mm before etching 170 10 200 977 10 947

Enamel 1mm before etching 157 10 200 952 10 689

Enamel 05mm before etching 165 10 200 943 10 590

Enamel 2mm after etching 235 10 124 925 10 404

Enamel 15mm after etching 209 10 200 871 10 102

Enamel 1mm after etching 189 10 200 964 10 834

Enamel 05mm after etching 142 10 200 983 10 978

a Lilliefors Significance Correction

This is a lower bound of the true significance

The results of test t for pair dentine samples before and after etching are

presented in table X

Table X7 Test t for dentine before and after etching

Paired Samples Test

Paired Differences

t df

p (2-

tailed)

95 Confidence

Interval of the

Difference

Mean

Std

Dev

Std

Error

Mean Lower Upper

Pair

1

dentine2mmbeforeetching-

dentine2mmafteretching

-

8010000

174801 55277 -

8135045

-

7884955

-

144906

9 000

Pair

2

dentine15mmbeforeetching-

dentine15mmafteretching

-

6608000

102394 32380 -

6681248

-

6534752

-

204079

9 000

Pair

3

dentine1mmbeforeetching-

dentine1mmafteretching

-

6209000

117799 37251 -

6293269

-

6124731

-

166678

9 000

30

Paired Samples Test

Paired Differences

t df

p (2-

tailed)

95 Confidence

Interval of the

Difference

Mean

Std

Dev

Std

Error

Mean Lower Upper

Pair

1

dentine2mmbeforeetching-

dentine2mmafteretching

-

8010000

174801 55277 -

8135045

-

7884955

-

144906

9 000

Pair

2

dentine15mmbeforeetching-

dentine15mmafteretching

-

6608000

102394 32380 -

6681248

-

6534752

-

204079

9 000

Pair

3

dentine1mmbeforeetching-

dentine1mmafteretching

-

6209000

117799 37251 -

6293269

-

6124731

-

166678

9 000

Pair

4

dentine05mmbeforeetching-

dentine05mmafteretching

-

6122000

86384 27317 -

6183796

-

6060204

-

224109

9 000

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of dentine (

2mm 15 mm 1mm sau 05mm)

The descriptive statistics data for dentine surface roughness before and after

etching are presented in tables X8 and X9

Table X8 Descriptive statistics for enamel samples before etching

Statistics

Enamel 2mm

before etching

Enamel 15mm

before etching

Enamel 1mm

before etching

Enamel 05mm

before etching

N Valid 10 10 10 10

Missing 0 0 0 0

Mean 416800 333600 317200 305900

Std Error of Mean 13968 15217 14205 20355

Std Deviation 44171 48120 44920 64369

Skewness 1095 -156 -109 -411

Std Error of Skewness 687 687 687 687

Kurtosis 769 487 -118 -295

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 4120 3250 3090 2940

Maximum 4260 3420 3240 3140

31

Table X9 Descriptive statistics for enamel samples after etching

Statistics

Enamel 2mm

after etching

Enamel 15mm

after etching

Enamel 1mm

after etching

Enamel 05mm

after etching

N Valid 10 10 10 10

Missing 0 0 0 0

Mean 2237600 1107400 875100 838200

Std Error of Mean 31027 20232 11968 17436

Std Deviation 98116 63979 37845 55136

Skewness -850 267 042 040

Std Error of Skewness 687 687 687 687

Kurtosis 878 -1880 1082 -425

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 22180 10990 8680 8290

Maximum 22520 11160 8820 8470

To choose the statistical test to compare roughness surface values was

performed a test Shapiro-Wilk If p is lower or equal with 0005 than hypothesis of

distribution normality is rejected (distribution deviates from normal form) In the table

X10 the distributions are normal The statistical test will be test t for pair samples

Table X10 Test Shapiro-Wilk for enamel samples

Tests of Normality

Kolmogorov-Smirnova Shapiro-Wilk

Statistic df Sig Statistic df Sig

2mmenamel before etching 193 10 200 898 10 207

15mmenamel before etching 170 10 200 977 10 947

1mmenamel before etching 157 10 200 952 10 689

05mmenamel before etching 165 10 200 943 10 590

2mmenamel after etching 235 10 124 925 10 404

15mmenamel after etching 209 10 200 871 10 102

1mmenamel after etching 189 10 200 964 10 834

05mmenamel after etching 142 10 200 983 10 978

a Lilliefors Significance Correction

This is a lower bound of the true significance

The results of test t for pair enamel samples before and after etching are

presented in table X11

32

Table X11 Test t for enamel samples before and after etching

Paired Samples Test

Paired Differences

t df

p (2-

tailed)

95 Confidence

Interval of the

Difference

Mean

Std

Deviation

Std

Error

Mean Lower Upper

Pair

1

2mmenamel before

etching

2mmenamel after

etching

-18208 135220 42760 -

18304731

-

18111269

-

425815

9 000

Pair

2

15mmenamel before

etching

15mmenamel after

etching

-7738 73151 23132 -7790329 -7685671 -

334508

9 076

Pair

3

1mmenamel before

etching

1mmenamel after

etching

-5579 55468 17540 -5618679 -5539321 -

318065

9 065

Pair

4

05mmenamel before

etching

05mmenamel after

etching

-5323 60378 19093 -5366192 -5279808 -

278788

9 063

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel ( 2mm 15 mm 1mm sau

05mm) but the differences statistical significant are present only for enamel localised

at 2 mm from ECJ

X5CONCLUSIONS

The surfaces of enamel and dentine at cervical level record decreases of

roughness related to the decrease of distance to ECJ

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel but the differences

statistical significant are present only for enamel localised at 2 mm from ECJ

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of

dentine

33

CHAPTXI FEA STUDY REGARDING THE BIOMECHANICAL

BEHAVIOUR AND FRACTURE RESISTANCE OF PROXIMO-OCCLUSAL

AMALGAM AND COMPOSITE RESINS RESTORATIONS

XI1INTRODUCTION AIM OF STUDY

The individual variation of patients morphological and functional complexity

of tissues as well as difficult access limit the possibilities to investigate in clinical

studies the biomechanical behaviour of proximo-occlusal restorations In this context

simulation of the biomechanics for direct restorations represents an interesting

interdisciplinar domain in actual dentistry research

The study focused on two direction

- analysis of role of forces intensity on biomechanical behaviour related to

cavity dimension and material

- analysis of tension inside restoration structure related to forces intensity

XI2MATERIALS AND METHODS

The stages of finite element analysis study are as follows

object modelling (bicusps and proximo-occlusal restoration)

definition of parameters for materials and dental tissues

meshing

constraints and loading

types of contacts

equations system definition

results of simulation

The object 3D modelling was performed in Rhinoceros (figure XI1) The

definition of parameters was performed for Poisson constant Young modulus density

(table XI1) The selected materials were amalgam and composite resins The

analysed tissues were dentine and enamel The meshing constraints loading were

performed for forces of 200N 400N 600N 800 N The analysis was performed using

software COSMOSWorks 2010

34

Fig XI1 3D modellation of bicusp

Table XI1 Values of Young modulus Poisson constant compression resistance for

amalgam composite resin enamel (amalgam compozit smalţ)

Material Young modulus (GPa) Poisson constants

Compression

resistance

(Mpa)

Amalgam 55 033 483

Enamel 48 03 400

Composite

resin 220 022 345

Fig XI2 The forces and constraints application

The results are presented in values and culours red colours representing areas

with maximum values of tensions produced under influence of masticatory forces

The tensions produced in amalgam restoration are in a range from 0 to 22886

(force 800 N) The maximum von Misses tensions are associated with cervical area

of amalgam restorations This aspect proves that first modification in interface

restoration-cavity margins will appear at the level of gingival wall First marginal

35

defects and fissures in restoration bulk will appear at tensions over 1600Mpa

associated with forces of 800N for extended amalgam proximo-occlusal restorations

The tensions produced in composite resin restorations are in a range from 0 to

2285 (force 800 N) The maximum von Misses tensions are associated with cervical

area of composite resin restorationsThis aspect proves that first modification in

interface restoration-cavity margins will appear at the level of gingival wall First

marginal defects and fissures in restoration bulk will appear at tensions over 1716

Mpa associated with forces of 600N for moderate and extended composite resins

proximo-occlusal restorations

Fig XI3a-b ndash Simulated model of proximo-occlusal restoration

FigXI4a-b Dental amalgam restoration Cervical tension associated with 600 N

(c)800 N (d)

FigXI5a-b Composite resin restoration Cervical tension associated with 600 N

(c)800 N (d)

36

The deformation of amalgam can be produced only when is associated with

fissures in bulk of restorations while composite resins restorations present

deformation when are associated with a modification of volume and form because of

repeated action of medium forces on long term or high forces on short term (figures

XI4 XI5)

Fig XI4 Material deformation in area of maximum tension

000E + 00

500E -02

100E -01

150E -01

200E -01

250E -01

1 4 7 101316192225283134374043464952555861646770737679

Amalgam C ompoz it

Figura XI5 Deformarea funcție de material

The amalgam and composite resins were treated as homogenous isotropic and

liniar The advantage of this type of FEA study is that restorations parameters can be

modified any time is necessary both in arhitecture geometry and material indices

variability The results of this study sustain the conclusions of other FEA studies

focused on biomechanical behaviour of posterior restorations performed with

amalgam and composite resins(35 62 76 143)

37

XI4CONCLUSIONS

bull The amalgam in class II restorations has a low deformation tendency because

of uniform distribution of tension inside material

bull Composite resins class II restorations accumulate higher tensions comparing

with amalgam but deformation is avoided for a time because of the adhesion

forces performed between molecules under moderate oral forces In case of

high oral forces (600-800N) the risk of fracture in moderate class II

restorations is higher comparing with amalgam proximo-occlusal restorations

For extended class II restorations and forces of 600 N composite resins present

highest risk of fracture and deformation The von Misses tension at the

cervical interface restorationtooth can reach 1600Mpa

bull The amalgam in moderate class II restorations can resist to deformation even

for high intensity forces limited to 600N In extended class II restorations the

risk of deformation and fracture increases at values of 600N-800N of oral

forces The von Misses tension at the cervical interface restorationtooth can

reach 1700 Mpa

38

FINAL CONCLUSIONS

Amalgam proximo-occlusal restorations with minimum 6-years age present

excellent results for parameters anatomic form (occlusal) marginal

discoloration and marginal secondary dental caries good results for

parameters anatomic form (proximal) and marginal adaptation and poor results

for surface quality

Composite resins proximo-occlusal restorations (bicusps) with minimum 6-

years age present excellent results for parameters color match marginal

discoloration and marginal secondary dental caries and good results for

parameters anatomic form (occlusal proximal) marginal adaptation surface

quality

Composite resins proximo-occlusal restorations (molars) with minimum 6-

years age present good results for parameters color match marginal

discoloration marginal secondary dental caries marginal adaptation and poor

results for parameters anatomic form (occlusal) (54 indices Ryge C)

anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The restorations extended at external third of occlusal surface present highest

percents of indices C regarding anatomic form (occlusal) (54 indices Ryge

C) anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The exceeding of 6-years age will require careful monitorisation for early

interventions through polishing sealing reshaping and even replacement for

restorations with major defects

Oblique layering technique presents superior results regarding marginal

adaptation and marginal discoloration and is recommended for proximo-

occlusal dental caries close to enamel-cement jonction

Centripetal build-up presents good results regarding marginal adaptation and

anatomical form at proximal level (proximal surfaces and contact point)

Horisontal layering technique can be used for optimum results only in

proximal-occlusal cavities with moderate extension both in occlusal-cervical

and buccal-oral

The values of die penetration at gingival wall were statistically different

between the three restorative techniques

We concluded that all restorative methods were associated with lightcuring

contraction and marginal microleakage

The combined technique was associated with lowest lightcuring contraction

and die penetration

The bulk technique was associated with highest lightcuring contraction and die

penetration

39

The surfaces of enamel and dentine at cervical level record decreases of

roughness related to the decrease of distance to ECJ

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel but the differences

statistical significant are present only for enamel localised at 2 mm from ECJ

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of

dentine

bull The amalgam in class II restorations has a low deformation tendency because

of uniform distribution of tension inside material

bull Composite resins class II restorations accumulate higher tensions comparing

with amalgam but deformation is avoided for a time because of the adhesion

forces performed between molecules under moderate oral forces In case of

high oral forces (600-800N) the risk of fracture in moderate class II

restorations is higher comparing with amalgam proximo-occlusal restorations

For extended class II restorations and forces of 600 N composite resins present

highest risk of fracture and deformation The von Misses tension at the

cervical interface restorationtooth can reach 1600Mpa

bull The amalgam in moderate class II restorations can resist to deformation even

for high intensity forces limited to 600N In extended class II restorations the

risk of deformation and fracture increases at values of 600N-800N of oral

forces The von Misses tension at the cervical interface restorationtooth can

reach 1700 Mpa

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Biology199843(8)629-632

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201989117ndash121

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18(7)516-20

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Materials Journal 2006 25(1)59-65

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Dent 27(5)325-331 1999

49

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Jan11(1)34-40

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JProsthet Dent 199369(4)425-430

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thermal behavior of dental composites Dent Mater 2008 24(8)1017ndash1024

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JDent 199826 627-632

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shrinkage and elasticity of flowable composites and filled adhesives Dent Mater

1999 15128-137

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Pendefunda 180Sorina Solomon Topoliceanu C Elements of dispersional

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Edition of the Balkan Medical Days

Stomatological Section Abstract nr1091999128

181Lăcătuşu St Andrian S Gianina Iovan- Consideraţii asupra adaptării

amalgamelor dentare la pereţii cavităţilor RevMedicina

StomatologicăVol2199823-26

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200126302ndash307

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restorative decisions microscopic and radiographic caries depth Community

Dentistry and Oral Epidemiology 1996 24 106-11

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polymerization contraction stress for dental composites by two-step light-activation

Dent Mater 2002 18436-444

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constraint and filling technique in composite restorations Dent Mater 2004

20(3)236-43

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Polymerization shrinkage effects of boundary conditions and filling technique of

resin composite restorations J Dent 2004 32(6)459-70

50

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Quintessence Int 2004 35(2)156-61

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art and future perspectives Quintessence Int 200233213-224

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and reactivity on the reaction kinetics of dimethacrylatedimethacrylate

copolymerizations Macromolecules 1999 323913-3921

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bonded composite restorations Dent Mater 1991 7(2) 107-13

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clinical results J Dent Res 199877 1020

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two amalgams Quintessence Int 199829483ndash490

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depth as cavity predictors for approximal dentin caries lesions in primary teeth

Dentomaxillofac Radiol 2007 Oct36(7)377-81

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direct and indirect restorations icircn posterior teeth of the permanent

dentitionOperDent200429(5)481-508

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composites for posterior restorations JADA Vol132 2001639-644

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J Prosthet Dent 2000 Sep84(3)289-96

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Three-year clinical evaluation of composite and ceramic inlays Am J Dent 2001

Apr14(2)95-9

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hardness and depth of cure of light cured packable composite resins J Dent Res 2000

79369 (Abstract)

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caries-affected transparent dentin by citric acidAn atomic force microscopy

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51

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deformation Dent Mater 200117241ndash246

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practitioners and dental caries JDent1990 18(3) 130-136

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(Cerana) Br Dent J 2006 Oct 21201(8)515-20

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PrimDentCare1999Apr659-62

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Quintessence 198961-80

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ScandJDRes 199210060-65

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33

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19904011ndash7

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Am Dent Assoc 2010 141(3)319-29

52

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125749-751

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34

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Monogr Oral Sci 20092142-51

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Monogr Oral Sci 20092152-62

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Quintessence Int 1998295ndash11

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569ndash575

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Nanoleakage leakage within the hybrid layer Oper Dent 1995 20 18-25

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451

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343Yap AU Effectiveness of polymerization in composite restoratives claiming bulk

placement Impact of cavity depth and exposure time Oper Dent 2000 25113-120

59

344Yeşilyurt C Bulucu B Bond strength of total-etch dentin adhesive systems on

peripheral and central dentinal tissue a microtensile bond strength test The Journal of

Contemporary Dental Practice 7(2) 20061-13

345Yoshida Y Van Meerbeek B Okazaki M Shintani H Suzuki K Comparative

study on adhesive performance of functional monomers J Dent Res 2004 83 454-

458

346Yoshiyama M Tay FR Doi J Nishitani Y Yamada T Itou K Carvalho RM

Nakajima M Pashley DH Bonding of self-etch and total etch adhesives to carious

dentin J Dent Res 2002 81 556-560

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12

CHAPTVIII CLINICAL PERFORMANCE OF COMPOSITE RESINS

RESTORATIONS RELATED TO RESTORATIVE TECHNIQUE 12-

MONTHS LONGITUDINAL STUDY

VIII1 INTRODUCTION

The restorative technique has a major influence over clinical performance of

composite resins restorations in proximo-occlusal cavities In this context researches

focused on correlations between technique and clinical performance of direct

restorations improve the dentist decision regarding restorative technique choice

VIII2AIM OF STUDY

The aim of study was to determine the clinical performance of composite

resins proximo-occlusal restorations performed using different restorative techniques

VIII3MATERIALS AND METHOD

The group study included 37 patients with age 18-42 years with moderat

ecariogenic risk The total number of composite resins restorations (Herculite XRV

Kerr) was 60 divided in three study groups (n=20)

I Centripetal build-up

II Oblique layering

III Horisontal layering

The coronal restorations were assessed at an interval of 12 months using

indices Ryge modified USPHS

- indice ALFA (A)- IDEAL CLINIC

- indice BRAVO (B)- ACCEPTABLE CLINIC

- indice CHARLIE (C)- UNACCEPTABLE CLINIC

VIII4 RESULTS AND DISCUSSIONS

The statistical tests Kruskal-Wallis and Mann-Whitney were performed to

confirm or infirm research hypotesis (the direct restorations performed using different

restorative techniques present statistical significant differences regarding clinical

performance for the assessed parameters)

13

TableVIII1a-b Groups study (Kruskal-Wallis Test)

Ranks

20 2960

20 2560

20 3630

60

20 3050

20 2420

20 3680

60

20 2490

20 3140

20 3520

60

Restorative_techniques

Centripetal build-up

Oblique layering

Horizontal layering

Total

Centripetal build-up

Oblique layering

Horizontal layering

Total

Centripetal build-up

Oblique layering

Horizontal layering

Total

Marginal_adaptation

Marginal_discoloration

Anatomical_form

N Mean Rank

Test Statisticsab

4913 8031 4900

2 2 2

086 018 086

Chi-Square

df

Asymp Sig

Marginal_

adaptation

Marginal_

discoloration

Anatomical_

form

Kruskal Wallis Testa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between the three restorative

techniques for parameter marginal adaptation (p=0086)

There are no statistical significant differences between the three restorative

techniques for parameter marginal discoloration (p=0018)

There are no statistical significant differences between the three restorative

techniques for parameter anatomical form (proximal) (p=0086)

TableVIII2 Comparing results between restorations performed using three

techniques (marginal adaptation marginal discoloration anatomical form) Marginal adaptation Centripetal build-upOblique layering p=04 ns

Centripetal build-upHorizontal layering p=0191 ns

Oblique layering Horizontal layering p=0028 s

Marginal discoloration Centripetal build-upOblique layering p=0103 ns

Centripetal build-upHorizontal layering p=0195 ns

Oblique layering Horizontal layering p=0005 s

Anatomical form Centripetal build-upOblique layering p=0137 ns

Centripetal build-upHorizontal layering p=0029 s

Oblique layering Horizontal layering p=0433 ns

ns nesemnificativ

s semnificativ

p probabilitate

14

Tables VIII3a-b Mann-Whitney test Comparing analysis regarding marginal

discoloration between restorations performed using oblique layering technique and

centripetal build-up technique

Ranks

20 2180 43600

20 1920 38400

40

Restorative_techniques

Centripetal build-up

Oblique layering

Total

Marginal_adaptation

N Mean Rank Sum of Ranks

Test Statisticsb

174000

384000

-841

400

495a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

adaptation

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between centripetal build-up

and oblique layering techniques regarding parameter marginal adaptation (p=0400)

Tables VIII4a-b Mann-Whitney test Comparing analysis regarding marginal

adaptation between restorations performed using horisontal layering technique and

centripetal build-up technique

Ranks

20 1830 36600

20 2270 45400

40

Restorative_techniques

Centripetal build-up

Horizontal layering

Total

Marginal_adaptation

N Mean Rank Sum of Ranks

Test Statisticsb

156000

366000

-1307

191

242a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

adaptation

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between centripetal build-up

and horisontal layering techniques regarding parameter marginal adaptation

(p=0191)

15

TablesVIII5a-b Mann-Whitney test Comparing analysis regarding marginal

adaptation between restorations performed using oblique layering technique and

horisontal layering technique

Ranks

20 1690 33800

20 2410 48200

40

Restorative_techniques

Oblique layering

Horizontal layering

Total

Marginal_adaptation

N Mean Rank Sum of Ranks

Test Statisticsb

128000

338000

-2191

028

052a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

adaptation

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There is statistical significant differences between horisontal layering and

oblique layering techniques regarding parameter marginal adaptation (p=0028)

Tables VIII6a-b Mann-Whitney test Comparing analysis regarding marginal

discoloration between restorations performed using oblique layering technique and

centripetal build-up technique

There are no statistical significant differences between centripetal build-up

and oblique layering techniques regarding parameter marginal discoloration

(p=0103)

Ranks

20 2260 45200

20 1840 36800

40

Restorative_techniques

Centripetal build-up

Oblique layering

Total

Marginal_discoloration

N Mean Rank Sum of Ranks

Test Statisticsb

158000

368000

-1632

103

265a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

discoloration

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

16

Tables VIII7a-b Mann-Whitney test Comparing analysis regarding marginal

discoloration between restorations performed using centripetal build-up technique and

horisontal layering technique

Ranks

20 1840 36800

20 2260 45200

40

Restorative_techniques

Centripetal build-up

Horizontal layering

Total

Marginal_discoloration

N Mean Rank Sum of Ranks

Test Statisticsb

158000

368000

-1299

194

265a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

discoloration

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between centripetal build-up

and horisontal layering techniques regarding parameter marginal discoloration

(p=0103)

Tables VIII8a-b Mann-Whitney test Comparing analysis regarding marginal

discoloration between restorations performed using oblique layering technique and

horisontal layering technique

Ranks

20 1630 32600

20 2470 49400

40

Restorative_techniques

Oblique layering

Horizontal layering

Total

Marginal_discoloration

N Mean Rank Sum of Ranks

Test Statisticsb

116000

326000

-2822

005

023a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

discoloration

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There is statistical significant differences between horisontal layering and

oblique layering techniques regarding parameter marginal discoloration (p=0005)

17

TablesVIII9 a-b Mann-Whitney test Comparing analysis regarding anatomical

form between restorations performed using centripetal build-up technique and oblique

layering technique

Ranks

20 1830 36600

20 2270 45400

40

Restorative_techniques

Centripetal build-up

Oblique layering

Total

Anatomical_form

N Mean Rank Sum of Ranks

Test Statisticsb

156000

366000

-1486

137

242a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Anatomical_

form

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between centripetal build-up

and oblique layering techniques regarding parameter anatomical form (p=0137)

Tables VIII10a-b Mann-Whitney test Comparing analysis regarding anatomical

form between restorations performed using centripetal build-up technique and

horisontal layering technique

Ranks

20 1710 34200

20 2390 47800

40

Restorative_techniques

Centripetal build-up

Horizontal layering

Total

Anatomical_form

N Mean Rank Sum of Ranks

Test Statisticsb

132000

342000

-2184

029

068a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Anatomical_

form

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between centripetal build-up

and horisontal layering techniques regarding parameter anatomical form (p=0029)

18

Tables VIII11a-b Mann-Whitney test Comparing analysis regarding anatomical

form between restorations performed using oblique layering technique and horisontal

layering technique

Ranks

20 1920 38400

20 2180 43600

40

Restorative_techniques

Oblique layering

Horizontal layering

Total

Anatomical_form

N Mean Rank Sum of Ranks

Test Statisticsb

174000

384000

-784

433

495a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Anatomical_

form

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between horisontal layering and

oblique layering techniques regarding parameter anatomical form (p=0433)

Indices A for restorations performed using centripetal build-up technique were

as follows color match-80 marginal adaptation- 60 marginal discoloration-

70 anatomical form (proximal)- 80 surface quality- 60

Indices A for restorations performed using horisontal layering technique were

as follows color match-70 marginal adaptation- 40 marginal discoloration-

50 anatomical form (proximal)- 50 surface quality- 70

Indices A for restorations performed using oblique layering technique were as

follows color match-70 marginal adaptation- 80 marginal discoloration- 90

anatomical form (proximal)- 60 surface quality- 70

Indices B for restorations performed using centripetal build-up technique were

as follows color match-20 marginal adaptation- 30 marginal discoloration-

20 anatomical form (proximal)- 30 surface quality- 40

Indices B for restorations performed using horisontal layering technique were

as follows color match-30 marginal adaptation- 40 marginal discoloration-

30 anatomical form (proximal)- 30 surface quality- 30

Indices B for restorations performed using oblique layering technique were as

follows color match-30 marginal adaptation- 20 marginal discoloration- 10

anatomical form (proximal)- 40 surface quality- 30

19

Indices C for restorations performed using centripetal build-up technique were

as follows color match-0 marginal adaptation- 10 marginal discoloration- 0

anatomical form (proximal)- 0 surface quality- 0

Indices C for restorations performed using horisontal layering technique were

as follows color match-0 marginal adaptation- 20 marginal discoloration- 20

anatomical form (proximal)- 20 surface quality- 0

Indices C for restorations performed using oblique layering technique were as

follows color match-0 marginal adaptation- 0 marginal discoloration- 10

anatomical form (proximal)- 0 surface quality- 100

Discussions

For in vitro studies is difficult to reproduce the variables existent in oral cavity

like occlusal stress and pH and temperature changes (235) The clinical studies are

determinant in assessment of restorative techniques (300) The most researches

focuses on the influence of restorative technique on the reduction of lightcuring stress

(51 78 135)

VIII5 CONCLUSIONS

Oblique layering technique presents superior results regarding marginal

adaptation and marginal discoloration and is recommended for proximo-

occlusal dental caries close to enamel-cement jonction

Centripetal build-up presents good results regarding marginal adaptation and

anatomical form at proximal level (proximal surfaces and contact point)

Horisontal layering technique can be used for optimum results only in

proximal-occlusal cavities with moderate extension both in occlusal-cervical

and buccal-oral

20

CHAPTIX STUDY REGARDING MARGINAL SEALING STATUS IN

COMPOSITE RESINS LIMITED PROXIMO-OCCLUSAL RESTORATIONS

PERFORMED USING DIFFERENT TECHNIQUES

IX1INTRODUCTION

The contraction of composite resins can produce stress inside dental structure

The most contraction stress appears in the initial stages and development rate of stress

decreases gradually in time (5 98 160) The contraction stress of composite resins

can overpass adhesion strenght and can broke the link between dental tissues and

composite resin (73) When adhesion strenght is high stress can produce marginal

fracture or bulk fracture (74) These situations are associated with microleakage and

penetration of oral fluid and bacteria along dentinal walls endangering the pulpal

tissue or favourising secondary dental caries

IX2 AIM OF STUDY

The study aimed to assess the efficiency of marginal sealing along gingival

wall in limited proximal-occlusal restorations performed using three different

techniques

IX3MATERIALS AND METHOD

The study group included 30 teeth extracted for orthodontic and periodontal

reasons On every tooth two identical class II cavities (on mesial and distal surfaces)

were prepared with cylindrical burs under water cooling The gingival wall was

limited to enamel-cement jonction The cavity dimension were as follows 2 mm

buccal-oral 5mm depth Each tooth was introduced in a pattern of acrylat The

operator calibrated preparation technique on acrylat teeth in Simulation Laboratory of

UMF ―Gr T Popa Iaşi The 60 prepared cavities were randomly divided in three

study groups related to restorative technique The restoration were performed with

Filtek Z550 (3M ESPE) a nanohybrid composite resin The adhesive strategy

included etchamprinse in 2 steps and adhesive Adper Single Bond 2(3MESPE)

Group A (n=20) bulk restorative technique associated with lightcuring from

occlusal 40 seconds and from buccal and oral 20 seconds

Group B (n=20) oblique layering technique (first layer on buccal wall and

buccal frac12 of gingival wall was lightcured from buccal second layer on oral wall and

oral frac12 of gingival wall was lightcured from oral third oral as a triangle with point

oriented to gingival wall was lightcured from occlusal)

Group C (n=20) combined technique (bdquoflow layer on gingival and axial

walls lightcured under pressure only associated with solid composite resin layer)

The proximal surfaces were performed using Tofflemire and metallic matrices After

removal of matrices every restoration was lightcured for another 20 seconds Two

layers aof varnish were applied on composite resins restorations excepting cavity

margins and an area of 1 mm around them The samples were introduced in methylen

21

blue 10 for 48 hours After this stage samples were washed with water and teeth

were cut longitudinally with a diamonded disc

The die penetration was assessed with Zeiss (Iena Germany) X20 microscope

accordingly to four scores (0-3)

0 ndash no penetration

1 ndash die infiltration until external half of gingival wall

2 ndash die infiltration on all gingival wall

3 ndash die infiltration on gingival wall and axial wall

IX4RESULTS AND DISCUSSIONS

The result of die penetration are presented in table IX1

TableIX1 The results for die penetration

Grup 0 1 2 3

A (bulk) 0 0 3 17

B (layering) 0 4 5 11

C (combined) 12 5 2 1

In group A 17 sample had score 3 and 2 samples had score 2 In group B 11

sample had score 3 5 samples had score 2 and 4 sample had score 1 In group C with

best results 12 samples had score 0 5 samples had score 1 2 samples had score 2 1

sample had score 3

The recorded data were analysed using test Mann-Whitney The statistical

results are presented in tables IX2-IX4

Tables IX2a-b Mann-Whitney for comparisons of microleakage values between

bulk technique and incremental technique

Ranks

Restorative technique N Mean Rank Sum of Ranks

Scores

frequency

A ndash bulk technique 20 2420 24200

B ndash incremental

technique

20 1680 16800

Total 40

Test Statisticsb

scores

frequency

Mann-Whitney U 29000

Wilcoxon W 168000

Z -1970

Asymp Sig (2-tailed) 049

Exact Sig [2(1-tailed Sig)] 123a

a Not corrected for ties

b Grouping Variable restorative technique

22

Tables IX3a-b Mann-Whitney for comparisons of microleakage values between

bulk technique and mixed technique

Ranks

Restorative technique N Mean Rank Sum of Ranks

scores

frequency

A ndash bulk technique 20 3090 30900

C ndash mixed technique 20 1010 10100

Total 40

Test Statisticsb

scores

frequency

Mann-Whitney U 500

Wilcoxon W 101000

Z -4021

Asymp Sig (2-tailed) 000

Exact Sig [2(1-tailed Sig)] 000a

a Not corrected for ties

b Grouping Variable restorative technique

Tables IX4a-b Mann-Whitney test for comparisons of microleakage values

between incremental technique and mixed technique

Ranks

Restorative technique N Mean Rank Sum of Ranks

scores

frequency

B ndash incremental

technique

20 2990 29900

C ndash mixed technique 20 1210 12100

Total 40

Test Statisticsb

scores

frequency

Mann-Whitney U 5500

Wilcoxon W 121000

Z -3492

Asymp Sig (2-tailed) 000

Exact Sig [2(1-tailed Sig)] 000a

a Not corrected for ties

23

Test Statisticsb

scores

frequency

Mann-Whitney U 5500

Wilcoxon W 121000

Z -3492

Asymp Sig (2-tailed) 000

Exact Sig [2(1-tailed Sig)] 000a

a Not corrected for ties

b Grouping Variable tehnrestaurare

The results of microleakage degree were statistically significant when the

three restorative techniques were compared The results showed that best restorative

technique regarding marginal sealing in cervical area is combined technique followed

by oblique layering technique The use of layering techniques limits the development

of contraction forces between oposite walls event that favourises bulk stress voids

formation and fissure inside dental tissues The results of our study are similar with

other studies (114 293)

IX5 CONCLUSIONS

The values of die penetration at gingival wall were statistically different

between the three restorative techniques

We concluded that all restorative methods were associated with lightcuring

contraction and marginal microleakage

The combined technique was associated with lowest lightcuring contraction

and die penetration

The bulk technique was associated with highest lightcuring contraction and die

penetration

24

CHAPTX STUDY REGARDING THE EFFECTS OF ETCHING ON

ENAMEL AND DENTINE IN CERVICAL AREA FOR PROXIMAL

CAVITIES AT LATERAL DENTAL GROUP

X1 INTRODUCTION

The studies reported marginal defects and high microleakage at the level of

gingival margins localised in cervical area or close to enamel-cement jonction for

high percents of proximal-occlusal composite resins restorations (8485) The good

adhesion is requested to insure restoration longevity and to prevent marginal

microleakage and presence of secondary marginal dental caries The adhesion

strenght of different adhesive systems can vary accordingly to tissues areas (204 240)

and to variations in dentinal structures (234 330) Most studies focused on adhesive

systems performances used healthy dentine close to pulp room but in case of class II

restorations there are particular features that influences the adhesion at the level of

gingival margins

The surface topography is an important property that determines the

interaction manner between surfaces The surface roughness and surface energy can

increase or decrease the adhesion of composite resins to the hard dental tissues

X2 AIM OF STUDY

The aim of study was to compare surface roughness of enamel and dentine

after etching related to different distances related to enamel-dentinecement jonction

X3 MATERIALS AND METHODS

The study group included 20 molars extracted from orthodontics or

periodontal reasons with intact proximal surfaces The teeth were cut longitudinally in

sens buccal-oral with diamond discs under water cooling

A group study (10 teeth) included 10 samples obtained through transversal

cutting at distance of 2mm from enamel-dentinecement jonction and 10 samples

obtained through transversal cutting at distance of 15 mm from enamel-

dentinecement jonction Another study group (10 teeth) included 10 samples

obtained through transversal cutting at distance of 1mm from enamel-dentinecement

jonction and 10 samples obtained through transversal cutting at distance of 05 mm

from enamel-dentinecement jonction All these samples were divided in two halfes

through mesial-distal cutting The samples finishing was performed with abrasive

paper (100-4000) and final polishing was performed with a device Buehler model

Minimet with slices introduced in ultrasound bath for 4 minutes The second half of

each sample was etched for 15 seconds with ortophosphoric acid 37 for 15 seconds

Slices were washed with distilled water for 30 seconds after etching and dried

The samples were analysed with atomic force microscopy (AFM) regarding

surface roughness The results were expressed as relative variation of roughness

X4 RESULTS AND DISCUSSIONS

The aspect of etched enamel at 2 mm distance from ECJ can be seen in figure

X1 (section 10 microm) The surface roughness is higher comparing with sample before

etching

25

După gravajul cu acid ortofosforic 37

The aspect of etched enamel at 15 mm distance from ECJ can be seen in

figure X2 (section 10 microm) The surface roughness is higher comparing with sample

before etching but lower comparing with sample at 2 mm from ECJ

The aspect of etched enamel at 1 mm distance from ECJ can be seen in figure

X3 (section 10 microm) The surface roughness is higher comparing with sample before

etching but lower comparing with sample at 15mm and 2 mm from ECJ

The aspect of etched enamel at 15 mm distance from ECJ can be seen in

figure X4 (section 10 microm) The surface roughness is higher comparing with sample

before etching but lower comparing with sample at 1 mm 15 mm and 2 mm from

ECJ

FigX1 3D aspect of enamel at 2 mm from ECJ

after etching (10 microm)

FigX2 3D aspect of enamel at 15 mm from ECJ

after etching (10 microm)

FigX3 3D aspect of enamel at 1 mm from ECJ

after etching (10 microm)

FigX4 3D aspect of enamel at 05 mm from ECJ

after etching (10 microm)

26

The mean values of squared roughness for dentine and enamel before etching

are presented in tables X1 and X2

Table X1 Squared roughness values for dentine samples before and after etching

Before etching (nm) After etching (nm)

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

sample

1

335 282 283 259 1149 947 901 879

sample

2

352 284 274 266 1127 939 883 875

sample

3

357 273 278 263 1152 953 876 867

sample

4

323 269 264 258 1146 942 895 883

sample

5

348 298 271 268 1153 944 904 878

sample

6

339 274 278 273 1158 937 893 892

sample

7

352 283 269 266 1145 944 899 876

sample

8

349 292 272 274 1166 942 907 869

sample

9

357 284 275 265 1132 939 893 879

sample

10

348 281 277 262 1142 941 899 878

Table X2 Squared roughness values for enamel and dentine samples before and after

etching

Before etching (nm) After etching (nm)

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

sample 1 422 342 309 313 2255 1114 874 845

sample 2 418 338 324 304 2236 1102 882 839

sample 3 413 334 315 303 2239 1115 873 833

sample 4 416 336 322 308 2242 1116 868 842

sample 5 426 332 315 294 2218 1103 877 829

sample 6 412 332 317 306 2237 1099 874 847

sample 7 414 335 322 314 2252 1102 876 834

sample 8 416 325 318 313 2239 1106 875 838

sample 9 418 328 314 299 2246 1113 879 836

sample 10 413 334 316 305 2242 1104 873 839

The results for samples before etching prove a decreasing tendency for mean

values of squared roughness surface beginning with areas placed at distance of 2 mm

from ECJ (346 nm) followed by areas placed at distance of 15 mm from ECJ (282

nm) 1 mm from ECJ (274 nm) and 05 mm from ECJ (265 nm) After etching the

decreasing tendency maintained for dentine localised at 2 mm from ECJ to dentine

localised at 05 mm from ECJ The mean values of squared roughness after etching

were three times higher (tables X3)

27

Table X3 Squared roughness values for enamel and dentine samples before and

after etching

Dentine Enamel

Before etching

(nm)

After etching

(nm)

Before etching

(nm)

After etching

(nm)

2 mm ECJ 346 1147 416 2237

15 mm ECJ 282 942 333 1107

1 mm ECJ 274 895 317 875

05 mm ECJ 265 877 305 838

The descriptive statistics data for surface roughness of dentine before and after

etching are presented in tables X4 si X5

Table X4 Descriptive statistics for dentine samples before etching

Statistics

Dentine 2mm

before etching

Dentine 15mm

before etching

Dentine 1mm

before etching

Dentine 05mm

before etching

N Valid 10 10 10 10

Missing 0 0 0 0

Mean 346000 282000 274100 265400

Std Error of Mean 33830 27487 17026 16746

Std Deviation 106979 86923 53841 52957

Skewness -1214 354 -314 348

Std Error of Skewness 687 687 687 687

Kurtosis 1141 049 336 -539

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 3230 2690 2640 2580

Maximum 3570 2980 2830 2740

Table X5 Descriptive statistics for dentine samples after etching

Statistics

Dentine 2mm

after etching

Dentine 15mm

after etching

Dentine 1mm

after etching

Dentine 05mm

after etching

N Valid 10 10 10 10

Missing 0 0 0 0

1147000 942800 895000 877600

Std Error of Mean 36545 14591 29926 22020

Std Deviation 115566 46140 94634 69634

Skewness -267 1169 -951 535

Std Error of Skewness 687 687 687 687

Kurtosis 043 1776 564 1416

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 11270 9370 8760 8670

28

Statistics

Dentine 2mm

after etching

Dentine 15mm

after etching

Dentine 1mm

after etching

Dentine 05mm

after etching

N Valid 10 10 10 10

Missing 0 0 0 0

1147000 942800 895000 877600

Std Error of Mean 36545 14591 29926 22020

Std Deviation 115566 46140 94634 69634

Skewness -267 1169 -951 535

Std Error of Skewness 687 687 687 687

Kurtosis 043 1776 564 1416

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 11270 9370 8760 8670

Maximum 11660 9530 9070 8920

To choose the statistical test to compare roughness surface values was

performed a test Shapiro-Wilk If p is lower or equal with 0005 than hypothesis of

distribution normality is rejected (distribution deviates from normal form) In the table

X6 the distributions are normal The statistical test will be test t for pair samples

Table X6 Test Shapiro-Wilk for dentine samples

Tests of Normality

Kolmogorov-Smirnov

a Shapiro-Wilk

Statistic df Sig Statistic df Sig

Dentine 2mm before etching 274 10 032 877 10 122

Dentine 15mm after etching 209 10 200 952 10 689

Dentine 1mm before etching 134 10 200 983 10 980

Dentine 05mm before etching 155 10 200 949 10 661

Dentine 2mm after etching 133 10 200 977 10 946

Dentine 15mm after etching 197 10 200 916 10 329

Dentine 1mm after etching 216 10 200 925 10 401

Dentine 05 after etching 220 10 185 933 10 474

Enamel 2mm before etching 193 10 200 898 10 207

Enamel 15mm before etching 170 10 200 977 10 947

Enamel 1mm before etching 157 10 200 952 10 689

Enamel 05mm before etching 165 10 200 943 10 590

Enamel 2mm after etching 235 10 124 925 10 404

Enamel 15mm after etching 209 10 200 871 10 102

Enamel 1mm after etching 189 10 200 964 10 834

Enamel 05mm after etching 142 10 200 983 10 978

a Lilliefors Significance Correction

29

Tests of Normality

Kolmogorov-Smirnov

a Shapiro-Wilk

Statistic df Sig Statistic df Sig

Dentine 2mm before etching 274 10 032 877 10 122

Dentine 15mm after etching 209 10 200 952 10 689

Dentine 1mm before etching 134 10 200 983 10 980

Dentine 05mm before etching 155 10 200 949 10 661

Dentine 2mm after etching 133 10 200 977 10 946

Dentine 15mm after etching 197 10 200 916 10 329

Dentine 1mm after etching 216 10 200 925 10 401

Dentine 05 after etching 220 10 185 933 10 474

Enamel 2mm before etching 193 10 200 898 10 207

Enamel 15mm before etching 170 10 200 977 10 947

Enamel 1mm before etching 157 10 200 952 10 689

Enamel 05mm before etching 165 10 200 943 10 590

Enamel 2mm after etching 235 10 124 925 10 404

Enamel 15mm after etching 209 10 200 871 10 102

Enamel 1mm after etching 189 10 200 964 10 834

Enamel 05mm after etching 142 10 200 983 10 978

a Lilliefors Significance Correction

This is a lower bound of the true significance

The results of test t for pair dentine samples before and after etching are

presented in table X

Table X7 Test t for dentine before and after etching

Paired Samples Test

Paired Differences

t df

p (2-

tailed)

95 Confidence

Interval of the

Difference

Mean

Std

Dev

Std

Error

Mean Lower Upper

Pair

1

dentine2mmbeforeetching-

dentine2mmafteretching

-

8010000

174801 55277 -

8135045

-

7884955

-

144906

9 000

Pair

2

dentine15mmbeforeetching-

dentine15mmafteretching

-

6608000

102394 32380 -

6681248

-

6534752

-

204079

9 000

Pair

3

dentine1mmbeforeetching-

dentine1mmafteretching

-

6209000

117799 37251 -

6293269

-

6124731

-

166678

9 000

30

Paired Samples Test

Paired Differences

t df

p (2-

tailed)

95 Confidence

Interval of the

Difference

Mean

Std

Dev

Std

Error

Mean Lower Upper

Pair

1

dentine2mmbeforeetching-

dentine2mmafteretching

-

8010000

174801 55277 -

8135045

-

7884955

-

144906

9 000

Pair

2

dentine15mmbeforeetching-

dentine15mmafteretching

-

6608000

102394 32380 -

6681248

-

6534752

-

204079

9 000

Pair

3

dentine1mmbeforeetching-

dentine1mmafteretching

-

6209000

117799 37251 -

6293269

-

6124731

-

166678

9 000

Pair

4

dentine05mmbeforeetching-

dentine05mmafteretching

-

6122000

86384 27317 -

6183796

-

6060204

-

224109

9 000

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of dentine (

2mm 15 mm 1mm sau 05mm)

The descriptive statistics data for dentine surface roughness before and after

etching are presented in tables X8 and X9

Table X8 Descriptive statistics for enamel samples before etching

Statistics

Enamel 2mm

before etching

Enamel 15mm

before etching

Enamel 1mm

before etching

Enamel 05mm

before etching

N Valid 10 10 10 10

Missing 0 0 0 0

Mean 416800 333600 317200 305900

Std Error of Mean 13968 15217 14205 20355

Std Deviation 44171 48120 44920 64369

Skewness 1095 -156 -109 -411

Std Error of Skewness 687 687 687 687

Kurtosis 769 487 -118 -295

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 4120 3250 3090 2940

Maximum 4260 3420 3240 3140

31

Table X9 Descriptive statistics for enamel samples after etching

Statistics

Enamel 2mm

after etching

Enamel 15mm

after etching

Enamel 1mm

after etching

Enamel 05mm

after etching

N Valid 10 10 10 10

Missing 0 0 0 0

Mean 2237600 1107400 875100 838200

Std Error of Mean 31027 20232 11968 17436

Std Deviation 98116 63979 37845 55136

Skewness -850 267 042 040

Std Error of Skewness 687 687 687 687

Kurtosis 878 -1880 1082 -425

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 22180 10990 8680 8290

Maximum 22520 11160 8820 8470

To choose the statistical test to compare roughness surface values was

performed a test Shapiro-Wilk If p is lower or equal with 0005 than hypothesis of

distribution normality is rejected (distribution deviates from normal form) In the table

X10 the distributions are normal The statistical test will be test t for pair samples

Table X10 Test Shapiro-Wilk for enamel samples

Tests of Normality

Kolmogorov-Smirnova Shapiro-Wilk

Statistic df Sig Statistic df Sig

2mmenamel before etching 193 10 200 898 10 207

15mmenamel before etching 170 10 200 977 10 947

1mmenamel before etching 157 10 200 952 10 689

05mmenamel before etching 165 10 200 943 10 590

2mmenamel after etching 235 10 124 925 10 404

15mmenamel after etching 209 10 200 871 10 102

1mmenamel after etching 189 10 200 964 10 834

05mmenamel after etching 142 10 200 983 10 978

a Lilliefors Significance Correction

This is a lower bound of the true significance

The results of test t for pair enamel samples before and after etching are

presented in table X11

32

Table X11 Test t for enamel samples before and after etching

Paired Samples Test

Paired Differences

t df

p (2-

tailed)

95 Confidence

Interval of the

Difference

Mean

Std

Deviation

Std

Error

Mean Lower Upper

Pair

1

2mmenamel before

etching

2mmenamel after

etching

-18208 135220 42760 -

18304731

-

18111269

-

425815

9 000

Pair

2

15mmenamel before

etching

15mmenamel after

etching

-7738 73151 23132 -7790329 -7685671 -

334508

9 076

Pair

3

1mmenamel before

etching

1mmenamel after

etching

-5579 55468 17540 -5618679 -5539321 -

318065

9 065

Pair

4

05mmenamel before

etching

05mmenamel after

etching

-5323 60378 19093 -5366192 -5279808 -

278788

9 063

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel ( 2mm 15 mm 1mm sau

05mm) but the differences statistical significant are present only for enamel localised

at 2 mm from ECJ

X5CONCLUSIONS

The surfaces of enamel and dentine at cervical level record decreases of

roughness related to the decrease of distance to ECJ

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel but the differences

statistical significant are present only for enamel localised at 2 mm from ECJ

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of

dentine

33

CHAPTXI FEA STUDY REGARDING THE BIOMECHANICAL

BEHAVIOUR AND FRACTURE RESISTANCE OF PROXIMO-OCCLUSAL

AMALGAM AND COMPOSITE RESINS RESTORATIONS

XI1INTRODUCTION AIM OF STUDY

The individual variation of patients morphological and functional complexity

of tissues as well as difficult access limit the possibilities to investigate in clinical

studies the biomechanical behaviour of proximo-occlusal restorations In this context

simulation of the biomechanics for direct restorations represents an interesting

interdisciplinar domain in actual dentistry research

The study focused on two direction

- analysis of role of forces intensity on biomechanical behaviour related to

cavity dimension and material

- analysis of tension inside restoration structure related to forces intensity

XI2MATERIALS AND METHODS

The stages of finite element analysis study are as follows

object modelling (bicusps and proximo-occlusal restoration)

definition of parameters for materials and dental tissues

meshing

constraints and loading

types of contacts

equations system definition

results of simulation

The object 3D modelling was performed in Rhinoceros (figure XI1) The

definition of parameters was performed for Poisson constant Young modulus density

(table XI1) The selected materials were amalgam and composite resins The

analysed tissues were dentine and enamel The meshing constraints loading were

performed for forces of 200N 400N 600N 800 N The analysis was performed using

software COSMOSWorks 2010

34

Fig XI1 3D modellation of bicusp

Table XI1 Values of Young modulus Poisson constant compression resistance for

amalgam composite resin enamel (amalgam compozit smalţ)

Material Young modulus (GPa) Poisson constants

Compression

resistance

(Mpa)

Amalgam 55 033 483

Enamel 48 03 400

Composite

resin 220 022 345

Fig XI2 The forces and constraints application

The results are presented in values and culours red colours representing areas

with maximum values of tensions produced under influence of masticatory forces

The tensions produced in amalgam restoration are in a range from 0 to 22886

(force 800 N) The maximum von Misses tensions are associated with cervical area

of amalgam restorations This aspect proves that first modification in interface

restoration-cavity margins will appear at the level of gingival wall First marginal

35

defects and fissures in restoration bulk will appear at tensions over 1600Mpa

associated with forces of 800N for extended amalgam proximo-occlusal restorations

The tensions produced in composite resin restorations are in a range from 0 to

2285 (force 800 N) The maximum von Misses tensions are associated with cervical

area of composite resin restorationsThis aspect proves that first modification in

interface restoration-cavity margins will appear at the level of gingival wall First

marginal defects and fissures in restoration bulk will appear at tensions over 1716

Mpa associated with forces of 600N for moderate and extended composite resins

proximo-occlusal restorations

Fig XI3a-b ndash Simulated model of proximo-occlusal restoration

FigXI4a-b Dental amalgam restoration Cervical tension associated with 600 N

(c)800 N (d)

FigXI5a-b Composite resin restoration Cervical tension associated with 600 N

(c)800 N (d)

36

The deformation of amalgam can be produced only when is associated with

fissures in bulk of restorations while composite resins restorations present

deformation when are associated with a modification of volume and form because of

repeated action of medium forces on long term or high forces on short term (figures

XI4 XI5)

Fig XI4 Material deformation in area of maximum tension

000E + 00

500E -02

100E -01

150E -01

200E -01

250E -01

1 4 7 101316192225283134374043464952555861646770737679

Amalgam C ompoz it

Figura XI5 Deformarea funcție de material

The amalgam and composite resins were treated as homogenous isotropic and

liniar The advantage of this type of FEA study is that restorations parameters can be

modified any time is necessary both in arhitecture geometry and material indices

variability The results of this study sustain the conclusions of other FEA studies

focused on biomechanical behaviour of posterior restorations performed with

amalgam and composite resins(35 62 76 143)

37

XI4CONCLUSIONS

bull The amalgam in class II restorations has a low deformation tendency because

of uniform distribution of tension inside material

bull Composite resins class II restorations accumulate higher tensions comparing

with amalgam but deformation is avoided for a time because of the adhesion

forces performed between molecules under moderate oral forces In case of

high oral forces (600-800N) the risk of fracture in moderate class II

restorations is higher comparing with amalgam proximo-occlusal restorations

For extended class II restorations and forces of 600 N composite resins present

highest risk of fracture and deformation The von Misses tension at the

cervical interface restorationtooth can reach 1600Mpa

bull The amalgam in moderate class II restorations can resist to deformation even

for high intensity forces limited to 600N In extended class II restorations the

risk of deformation and fracture increases at values of 600N-800N of oral

forces The von Misses tension at the cervical interface restorationtooth can

reach 1700 Mpa

38

FINAL CONCLUSIONS

Amalgam proximo-occlusal restorations with minimum 6-years age present

excellent results for parameters anatomic form (occlusal) marginal

discoloration and marginal secondary dental caries good results for

parameters anatomic form (proximal) and marginal adaptation and poor results

for surface quality

Composite resins proximo-occlusal restorations (bicusps) with minimum 6-

years age present excellent results for parameters color match marginal

discoloration and marginal secondary dental caries and good results for

parameters anatomic form (occlusal proximal) marginal adaptation surface

quality

Composite resins proximo-occlusal restorations (molars) with minimum 6-

years age present good results for parameters color match marginal

discoloration marginal secondary dental caries marginal adaptation and poor

results for parameters anatomic form (occlusal) (54 indices Ryge C)

anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The restorations extended at external third of occlusal surface present highest

percents of indices C regarding anatomic form (occlusal) (54 indices Ryge

C) anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The exceeding of 6-years age will require careful monitorisation for early

interventions through polishing sealing reshaping and even replacement for

restorations with major defects

Oblique layering technique presents superior results regarding marginal

adaptation and marginal discoloration and is recommended for proximo-

occlusal dental caries close to enamel-cement jonction

Centripetal build-up presents good results regarding marginal adaptation and

anatomical form at proximal level (proximal surfaces and contact point)

Horisontal layering technique can be used for optimum results only in

proximal-occlusal cavities with moderate extension both in occlusal-cervical

and buccal-oral

The values of die penetration at gingival wall were statistically different

between the three restorative techniques

We concluded that all restorative methods were associated with lightcuring

contraction and marginal microleakage

The combined technique was associated with lowest lightcuring contraction

and die penetration

The bulk technique was associated with highest lightcuring contraction and die

penetration

39

The surfaces of enamel and dentine at cervical level record decreases of

roughness related to the decrease of distance to ECJ

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel but the differences

statistical significant are present only for enamel localised at 2 mm from ECJ

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of

dentine

bull The amalgam in class II restorations has a low deformation tendency because

of uniform distribution of tension inside material

bull Composite resins class II restorations accumulate higher tensions comparing

with amalgam but deformation is avoided for a time because of the adhesion

forces performed between molecules under moderate oral forces In case of

high oral forces (600-800N) the risk of fracture in moderate class II

restorations is higher comparing with amalgam proximo-occlusal restorations

For extended class II restorations and forces of 600 N composite resins present

highest risk of fracture and deformation The von Misses tension at the

cervical interface restorationtooth can reach 1600Mpa

bull The amalgam in moderate class II restorations can resist to deformation even

for high intensity forces limited to 600N In extended class II restorations the

risk of deformation and fracture increases at values of 600N-800N of oral

forces The von Misses tension at the cervical interface restorationtooth can

reach 1700 Mpa

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6Aggarwal V Logani A Jain V Shah N Effect of cyclic loading on marginal

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Oper Dent 2008 Sep-Oct33(5)587-92

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15Anusavice KJ Development and testing of ceramics for dental restorations In

Fischman G Clare A Hench J editors Bioceramics materials and applications

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16Arhun N Celik C Yamanel KClinical evaluation of resin-based composites in

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17Armstrong SR JC Keller DB Boyer The influence of water storage and C-

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18Armstrong S Boyer D Keller J Microtensile bond strength testing and failure

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19Asmussen E Peutzfeldt A Influence of UEDMA BisGMA and TEGDMA on

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Public Health Dent 1992 Winter52(2)102-10

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Dent 199158 36-39

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Educ 200569(5)571ndash585

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30Behle C Flowable composite Proprieties and applications Pract Periodontics

Aesthetics Dent 1998 10347 350-351

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NY Marcel Dekker Inc 1999

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9

35Boschian PL S Guidotti R Pietrbissa M Gagliani- bdquoStress distribution in a

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42Brunthaler A Koumlnig F Lucas T Sperr W Schedle A Longevity of direct resin

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46Burke FJ Cheung SW Mjor IA Wilson NH-Reasons for the placement and

replacement of restorations in vocational training practicePrimary Dental Care

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2004 20939-946

49Cardoso P Sadek F Microtensile bond strength on dentin using new adhesive

systems with selfetching primers Braz J Oral Sci 2003 2(4) 156-159

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53Cattaneo PM M Dalstra B Melsen- bdquoThe Finite Element Method a Tool to

Study Orthodontic Tooth Movement J Dent Res 2005 84(5)428-433

54Cattell MJ Clarke RL Lynch EJ The transverse strength reliability and

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marginal leakage J Dent 2005 33(7) 603- 610

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Med 2008173(1)23ndash26

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stress in light-cured packable composite resinsDent Mater 200117253-259

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polymerization contraction stress of composites J Dent Res 2000 79812ndash817

61Cichon P Kerschbaum T Verweildauer zahnartzlicher Restaurationen bei

Behinderten Dtsch Zahnartzlicher 1999 54 96-102

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Three Core Restorative Materials Supported with or without a Prefabricated Split-

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in Class II composite resin restoration applied in bulk or in two increments

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resin restorations 8-year findings J Dent 199826(4) 311ndash317

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polymerization stress J Am Dent Assoc2000 131497-503

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1991469-72

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70Dauvillier BS Aarnts MP Feilzer AJ Developments in shrinkage control of

adhesive restoratives J Esthet Dent 2000 12291-299

71Dauvillier BS Aarnts MP Feilzer AJ Modeling of the viscoelastic behavior of

dental light-activated resin composites during curing Dent Mater 200319277ndash285

72Davidson CL Gee AJ Feilzer A The competition between the composite-dentin

bond strength and the polymerization contraction stress J Dent Res 1984

63(12)1396-9

73Davidson CL AJ Feilzer Polymerization shrinkage and polymerization

shrinkage stress in polymer-based restoratives J Dent Res 199725435ndash440

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Prosthet Dent 198655446ndash7

75Davis RD Mayhew RB A clinical comparison of three anterior restorative resins

at 3 years J Am Dent Assoc 1986112659-63

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and adhesion of composite resin versus ceramic inlays in molarsJ Prosthet

Dent200899131-40

77Deligeorgi V Mjor IA Wilson NH An overview of reasons for the placement

and replacement of restorations Prim Dent Care 20018(1)5-11

78Deliperi S Bardwell DN An alternative method to reduce polymerization

shrinkage in direct posterior composite restorations J Am Dent Assoc 2002

1331387ndash97

79Demirci M Tuncer S Yuceokur AA Prevalence of caries on individual tooth

surfaces and its distribution by age and gender in university clinic patientsEur J

Dent20104(3)270-9

80De Munck J Van Meerbeek B Satoshi I Vargas M Yoshida Y Armstrong S

Lambrechts P Vanherle G Microtensile bond strengths of one- and two-step

selfetch adhesives to bur-cut enamel and dentin Am J Dent 2003 16 414-420

81Dewaele M Truffier-Boutry D Devaux J Leloup G Volume contraction in

photocured dental resins the shrinkage-conversion relationship revisited Dent Mater

2006 22359-365

44

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848

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135- 144

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class 2 composites Oper Dent 19981312-19

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Dent Oral Epidemiol 200533(3)212-8

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Bucureşti 2001

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Activity EdApollonia Iasi2002

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Mater 1995 11(2)132-6

152Jackson RD Morgan M The new posterior resins and a simplified placement

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48

154Jokstad A Mjor IA Analyses of long-term clinical behaviour of class II

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1243

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Biology199843(8)629-632

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817-822

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201989117ndash121

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18(7)516-20

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Jan11(1)34-40

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JProsthet Dent 199369(4)425-430

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JDent 199826 627-632

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1999 15128-137

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Pendefunda 180Sorina Solomon Topoliceanu C Elements of dispersional

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Edition of the Balkan Medical Days

Stomatological Section Abstract nr1091999128

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Dentistry and Oral Epidemiology 1996 24 106-11

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Dent Mater 2002 18436-444

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20(3)236-43

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Polymerization shrinkage effects of boundary conditions and filling technique of

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50

189Lopes GC Baratieri LN Monteiro S Jr Vieira LC Effect of posterior resin

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Dentomaxillofac Radiol 2007 Oct36(7)377-81

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J Prosthet Dent 2000 Sep84(3)289-96

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Three-year clinical evaluation of composite and ceramic inlays Am J Dent 2001

Apr14(2)95-9

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79369 (Abstract)

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PrimDentCare1999Apr659-62

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33

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52

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125749-751

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34

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Monogr Oral Sci 20092142-51

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53

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569ndash575

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Community Dent Oral Epidemiol 1999 Oct27(5)331-7

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Community Dent Oral Epidemiol 1980 Jun8(3)135-8

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volumetric polymerization shrinkage and bulk modulus of dental composites and an

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placement techniques on marginal microleakage of deep class-II cavities restored with

two composite resin formulations J Conserv Dent 2010 13(1) 9ndash15

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system on microleakage in cervical composite resin restorations Rev Med Chir

Soc Med Iaşi-2008 vol112 nr1supl1145-147

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posterior composite 10-year report J Dent 199927(1) 13ndash19

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composite resins Five-year results Swed Dent J 1995 19 173-182

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of teeth with long-term performing composite restorations J Oral Rehabil 2002

29(12)1131ndash1138

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Operative Dentistry 5th ed St Louis Mosby 2006293-7

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examiners evaluating amalgam restorations Oper Dent 1997 Mar-Apr22(2)57-65

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J Appl Oral Sci 2010 Feb18(1)37-43

263Roulet JF Noack MJCriteria for substituting amalgam with composite resins

Int Dent J 199141(4)195-205

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265Roulet JF Longevity of ceramic inlays and amalgam- results up 6 years

ClinOral Invest1997140-46

266Roulet JFBenefits and disadvantages of tooth-coloured alternatives to amalgam

J Dent 199725(6)459-73

267Rueggeberg FA WF Caughman JW Curtis Jr HC Davis Factors

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1993691ndash95

268Rueggeberg FA Ergle JW Mettenburg DJ Polymerization depths of

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269Rushton VE Horner K Worthington HV Screening panoramic radiography

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270Ruyter IE Types of resin-based inlay materials and their properties Int Dent J

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271Sajjan GS Mittal NEffect of different placement techniques on marginal

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J Conserv Dent 201013(1)9-15

272Sakaguchi RL MC Peters SR Nelson WH Douglas HW Poort Effects

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274Sano H Takatsu T Ciucchi B Horner JA Matthews WG Pashley DH

Nanoleakage leakage within the hybrid layer Oper Dent 1995 20 18-25

55

275Sarrett DC Clinical challenges and the relevance of materials testing for

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276Sarrett DC Brooks CN Rose JT Clinical performance evaluation of a

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287Sideridou I Tserki V Papanastasiou G Study of water sorption solubility and

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289SilverFH Christiansen DLBiomaterials Science and Biocompatibility New

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290Simecek JW Diefenderfer KE Ahlf RL Ragain JC Jr Longitudinal trends in

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291Simecek JW Diefenderfer KE Ahlf RL Ragain JC Jr Dental sealant

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56

292Simi B Suprabha B Evaluation of microleakage in posterior nanocomposite

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295Smales RJ Webster DA Leppard PISurvival predictions of amalgam

restorations JDent1991 19 272-277

296Smales RJ Hawthorne WSLong-term survival of extensive amalgams and

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297Soncini JA Maserejian NN Trachtenberg F Tavares M Hayes C The

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Am Dent Assoc 2007 Jun138(6)763-72

298Sonoda H Banerjee A Sherriff M Tagami J Watson TF An in vitro

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299Soodabeh Kimyai Masomeh Mehdipour Siavash Savadi Oskoee Reasons

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Quintessence 2000253ndash76

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308Summit JB Robbins JW Hilton TJ Fundamentals in operative dentistry Cap

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57

309Svanberg M Mjor IA Orstavik D Mutans streptococci in plaque from margins

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864

310Tanne K Mamoru S Burstone C Three-dimensional finite element analysis

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Orthop921987499ndash505

311Tanumiharja M Burrow MF Tyas MJ Microtensile bond strengths of seven

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312Tay FR Pashley DH Aggressiveness of contemporary self-etching systems

Part I Depth of penetration beyond dentin smear layers Dent Mater 2001 17(4) 296-

308

313Tay FR Frankenberger R Krejci I Bouillaguet S Pashley DH Carvalho

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In vivo evidence J Dent 2004 32611ndash621

314Tay FR Pashley DH Have dentin adhesives become too hydrophilic J Can

Dent Assoc 2003 69726ndash731

315Tay FR Sano H Carvalho R Pashley EL Pashley DH An ultrastructural

study of the influence of acidity of self-etching primers and smear layer thickness on

bonding to intact dentin J Adhes Dent 2000 283ndash98

316Thompson JY Bayne SC Heymann HO Mechanical properties of a new

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76(6)619-623 1996

317Unterbrink GL R Muessner Influence of light intensity on two restorative

systems J Dent 199523183ndash189

318Unterbrink GL Liebenberg WH Flowable resin composites as filled

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199930249ndash257

319Vaarkamp J Ten Bosch J Verdonschot EH Quantitative diagnosis of small

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Oral Surg Oral Med Oral Pathol 198661(3)289-96

321Van Meerbeek B De Munck J Yoshida Y Inoue S Vargas M Vijay P Van

Landuyt K Lambrechts P Vanherle G Adhesion to enamel and dentin Current

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322Van Meerbeek B Van Landuyt K De Munck JHashimoto M Peumans M

Lambrechts P Yoshida Y Inoue S Suzuki K Technique-sensitivity of

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323Van Meerbeek B Vargas S Inoue S Yoshida Y Peumans M Lambrechts P

Vanherle G Adhesives and cements to promote preservation dentistry Oper Dent

20016 119-144

324Van Meerbeek B Yoshida Y Inoue S Vargas M Abe Y Fukuda R Okazaki

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58

325Van Nieuwenhuysen JP DrsquoHoore W Carvalho J Qvist V Long-term

evaluation of extensive restorations in permanent teeth J Dent 200331(6)395ndash405

326Venhoven BA de Gee AJ Davidson CL Light initiation of dental resins

dynamics of the polymerization Biomaterials 1996 172313-2318

327Versluis A Douglas WH Cross M Sakaguchi RL Does an incremental filling

technique reduce polymerization shrinkage stresses J Dent Res 1996 75871ndash878

328Vries HC Ruiken HM Konig KG vanrsquot Hof MA Radiographic versus

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329Waggoner W Ashton J Predictability of cavitation based upon radiographic

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55-60

330Watanabe LG Marshall GW Jr Marshall SJ Dentin shear strength effects of

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331Watts DC AS Marouf Optimal specimen geometry in bonded-disk

shrinkage-strain measurements on light-cured biomaterials Dent Mater 200016447ndash

451

332Watts DC Marouf AS Al-Hindi AM Photo-polymerization shrinkage-stress

kinetics in resin-composites methods development Dent Mater 2003 191ndash11

333Weaver WS Blank LW Pelleu GB Jr A visible light activated resin cured

through tooth structure GenDent 198836236-7

334Wendt SL Microleakage and cusp fracture resistance of heattreated composite

resin inlays Am J Dent 4(1)10-14 1991

335Wenzel A Hintze H Mikkelsen L Mouyen F Radiographic detection of

occlusal caries in noncavitated teeth A comparison of conventional film radiographs

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1991 72 621-6

336Wenzel A Hintze H Perception of image quality in direct digital radiography

after application of various image treatment filters for detectability of dental diseases

Dentomaxillofac Radiol 1993 22 131-4

337Wenzel A Computer-aided image manipulation of intraoral radiographs to

enhance diagnosis in dental practice a review Int Dent J 1993 43 99-108

338Wenzel A Digital radiography and caries diagnosis Dento Maxillo Facial

Radiology 27(1)3-11 1998

339Wenzel A Haiter-Neto F Gotfredsen E Risk factors for a false positive test

outcome in diagnosis of caries in approximal surfaces impact of radiographic

modality and observer characteristics Caries Res 200741(3)170-6

340Wibowo G Stockton L Microleakage of class II composite restorations Am J

Dent 200114177ndash185

341Wilson NHF Wastell DG Norman RD Five-year performance of high-

cooper content amalgam restorations in a multiclinical trial JDent1996 24 203-210

342Winkler MM Katona TR Paydar NH Finite element stress analysis of three

filling techniques for class V light-cured composite restorations J Dent Res

1996751477-83

343Yap AU Effectiveness of polymerization in composite restoratives claiming bulk

placement Impact of cavity depth and exposure time Oper Dent 2000 25113-120

59

344Yeşilyurt C Bulucu B Bond strength of total-etch dentin adhesive systems on

peripheral and central dentinal tissue a microtensile bond strength test The Journal of

Contemporary Dental Practice 7(2) 20061-13

345Yoshida Y Van Meerbeek B Okazaki M Shintani H Suzuki K Comparative

study on adhesive performance of functional monomers J Dent Res 2004 83 454-

458

346Yoshiyama M Tay FR Doi J Nishitani Y Yamada T Itou K Carvalho RM

Nakajima M Pashley DH Bonding of self-etch and total etch adhesives to carious

dentin J Dent Res 2002 81 556-560

  • COPERTA REZUMAT ENGLEZA (MEREUTA)pdf
  • REZUMAT ENGLEZA DR MEREUTA DENISSpdf
Page 16: UNIVERSITATEA DE MEDICINA SI FARMACIE “GR Doctorat/Rezumat... · universitatea de medicina si farmacie “gr.t.popa” iasi facultatea de medicina dentara rezumatul tezei de doctorat

13

TableVIII1a-b Groups study (Kruskal-Wallis Test)

Ranks

20 2960

20 2560

20 3630

60

20 3050

20 2420

20 3680

60

20 2490

20 3140

20 3520

60

Restorative_techniques

Centripetal build-up

Oblique layering

Horizontal layering

Total

Centripetal build-up

Oblique layering

Horizontal layering

Total

Centripetal build-up

Oblique layering

Horizontal layering

Total

Marginal_adaptation

Marginal_discoloration

Anatomical_form

N Mean Rank

Test Statisticsab

4913 8031 4900

2 2 2

086 018 086

Chi-Square

df

Asymp Sig

Marginal_

adaptation

Marginal_

discoloration

Anatomical_

form

Kruskal Wallis Testa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between the three restorative

techniques for parameter marginal adaptation (p=0086)

There are no statistical significant differences between the three restorative

techniques for parameter marginal discoloration (p=0018)

There are no statistical significant differences between the three restorative

techniques for parameter anatomical form (proximal) (p=0086)

TableVIII2 Comparing results between restorations performed using three

techniques (marginal adaptation marginal discoloration anatomical form) Marginal adaptation Centripetal build-upOblique layering p=04 ns

Centripetal build-upHorizontal layering p=0191 ns

Oblique layering Horizontal layering p=0028 s

Marginal discoloration Centripetal build-upOblique layering p=0103 ns

Centripetal build-upHorizontal layering p=0195 ns

Oblique layering Horizontal layering p=0005 s

Anatomical form Centripetal build-upOblique layering p=0137 ns

Centripetal build-upHorizontal layering p=0029 s

Oblique layering Horizontal layering p=0433 ns

ns nesemnificativ

s semnificativ

p probabilitate

14

Tables VIII3a-b Mann-Whitney test Comparing analysis regarding marginal

discoloration between restorations performed using oblique layering technique and

centripetal build-up technique

Ranks

20 2180 43600

20 1920 38400

40

Restorative_techniques

Centripetal build-up

Oblique layering

Total

Marginal_adaptation

N Mean Rank Sum of Ranks

Test Statisticsb

174000

384000

-841

400

495a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

adaptation

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between centripetal build-up

and oblique layering techniques regarding parameter marginal adaptation (p=0400)

Tables VIII4a-b Mann-Whitney test Comparing analysis regarding marginal

adaptation between restorations performed using horisontal layering technique and

centripetal build-up technique

Ranks

20 1830 36600

20 2270 45400

40

Restorative_techniques

Centripetal build-up

Horizontal layering

Total

Marginal_adaptation

N Mean Rank Sum of Ranks

Test Statisticsb

156000

366000

-1307

191

242a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

adaptation

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between centripetal build-up

and horisontal layering techniques regarding parameter marginal adaptation

(p=0191)

15

TablesVIII5a-b Mann-Whitney test Comparing analysis regarding marginal

adaptation between restorations performed using oblique layering technique and

horisontal layering technique

Ranks

20 1690 33800

20 2410 48200

40

Restorative_techniques

Oblique layering

Horizontal layering

Total

Marginal_adaptation

N Mean Rank Sum of Ranks

Test Statisticsb

128000

338000

-2191

028

052a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

adaptation

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There is statistical significant differences between horisontal layering and

oblique layering techniques regarding parameter marginal adaptation (p=0028)

Tables VIII6a-b Mann-Whitney test Comparing analysis regarding marginal

discoloration between restorations performed using oblique layering technique and

centripetal build-up technique

There are no statistical significant differences between centripetal build-up

and oblique layering techniques regarding parameter marginal discoloration

(p=0103)

Ranks

20 2260 45200

20 1840 36800

40

Restorative_techniques

Centripetal build-up

Oblique layering

Total

Marginal_discoloration

N Mean Rank Sum of Ranks

Test Statisticsb

158000

368000

-1632

103

265a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

discoloration

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

16

Tables VIII7a-b Mann-Whitney test Comparing analysis regarding marginal

discoloration between restorations performed using centripetal build-up technique and

horisontal layering technique

Ranks

20 1840 36800

20 2260 45200

40

Restorative_techniques

Centripetal build-up

Horizontal layering

Total

Marginal_discoloration

N Mean Rank Sum of Ranks

Test Statisticsb

158000

368000

-1299

194

265a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

discoloration

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between centripetal build-up

and horisontal layering techniques regarding parameter marginal discoloration

(p=0103)

Tables VIII8a-b Mann-Whitney test Comparing analysis regarding marginal

discoloration between restorations performed using oblique layering technique and

horisontal layering technique

Ranks

20 1630 32600

20 2470 49400

40

Restorative_techniques

Oblique layering

Horizontal layering

Total

Marginal_discoloration

N Mean Rank Sum of Ranks

Test Statisticsb

116000

326000

-2822

005

023a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

discoloration

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There is statistical significant differences between horisontal layering and

oblique layering techniques regarding parameter marginal discoloration (p=0005)

17

TablesVIII9 a-b Mann-Whitney test Comparing analysis regarding anatomical

form between restorations performed using centripetal build-up technique and oblique

layering technique

Ranks

20 1830 36600

20 2270 45400

40

Restorative_techniques

Centripetal build-up

Oblique layering

Total

Anatomical_form

N Mean Rank Sum of Ranks

Test Statisticsb

156000

366000

-1486

137

242a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Anatomical_

form

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between centripetal build-up

and oblique layering techniques regarding parameter anatomical form (p=0137)

Tables VIII10a-b Mann-Whitney test Comparing analysis regarding anatomical

form between restorations performed using centripetal build-up technique and

horisontal layering technique

Ranks

20 1710 34200

20 2390 47800

40

Restorative_techniques

Centripetal build-up

Horizontal layering

Total

Anatomical_form

N Mean Rank Sum of Ranks

Test Statisticsb

132000

342000

-2184

029

068a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Anatomical_

form

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between centripetal build-up

and horisontal layering techniques regarding parameter anatomical form (p=0029)

18

Tables VIII11a-b Mann-Whitney test Comparing analysis regarding anatomical

form between restorations performed using oblique layering technique and horisontal

layering technique

Ranks

20 1920 38400

20 2180 43600

40

Restorative_techniques

Oblique layering

Horizontal layering

Total

Anatomical_form

N Mean Rank Sum of Ranks

Test Statisticsb

174000

384000

-784

433

495a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Anatomical_

form

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between horisontal layering and

oblique layering techniques regarding parameter anatomical form (p=0433)

Indices A for restorations performed using centripetal build-up technique were

as follows color match-80 marginal adaptation- 60 marginal discoloration-

70 anatomical form (proximal)- 80 surface quality- 60

Indices A for restorations performed using horisontal layering technique were

as follows color match-70 marginal adaptation- 40 marginal discoloration-

50 anatomical form (proximal)- 50 surface quality- 70

Indices A for restorations performed using oblique layering technique were as

follows color match-70 marginal adaptation- 80 marginal discoloration- 90

anatomical form (proximal)- 60 surface quality- 70

Indices B for restorations performed using centripetal build-up technique were

as follows color match-20 marginal adaptation- 30 marginal discoloration-

20 anatomical form (proximal)- 30 surface quality- 40

Indices B for restorations performed using horisontal layering technique were

as follows color match-30 marginal adaptation- 40 marginal discoloration-

30 anatomical form (proximal)- 30 surface quality- 30

Indices B for restorations performed using oblique layering technique were as

follows color match-30 marginal adaptation- 20 marginal discoloration- 10

anatomical form (proximal)- 40 surface quality- 30

19

Indices C for restorations performed using centripetal build-up technique were

as follows color match-0 marginal adaptation- 10 marginal discoloration- 0

anatomical form (proximal)- 0 surface quality- 0

Indices C for restorations performed using horisontal layering technique were

as follows color match-0 marginal adaptation- 20 marginal discoloration- 20

anatomical form (proximal)- 20 surface quality- 0

Indices C for restorations performed using oblique layering technique were as

follows color match-0 marginal adaptation- 0 marginal discoloration- 10

anatomical form (proximal)- 0 surface quality- 100

Discussions

For in vitro studies is difficult to reproduce the variables existent in oral cavity

like occlusal stress and pH and temperature changes (235) The clinical studies are

determinant in assessment of restorative techniques (300) The most researches

focuses on the influence of restorative technique on the reduction of lightcuring stress

(51 78 135)

VIII5 CONCLUSIONS

Oblique layering technique presents superior results regarding marginal

adaptation and marginal discoloration and is recommended for proximo-

occlusal dental caries close to enamel-cement jonction

Centripetal build-up presents good results regarding marginal adaptation and

anatomical form at proximal level (proximal surfaces and contact point)

Horisontal layering technique can be used for optimum results only in

proximal-occlusal cavities with moderate extension both in occlusal-cervical

and buccal-oral

20

CHAPTIX STUDY REGARDING MARGINAL SEALING STATUS IN

COMPOSITE RESINS LIMITED PROXIMO-OCCLUSAL RESTORATIONS

PERFORMED USING DIFFERENT TECHNIQUES

IX1INTRODUCTION

The contraction of composite resins can produce stress inside dental structure

The most contraction stress appears in the initial stages and development rate of stress

decreases gradually in time (5 98 160) The contraction stress of composite resins

can overpass adhesion strenght and can broke the link between dental tissues and

composite resin (73) When adhesion strenght is high stress can produce marginal

fracture or bulk fracture (74) These situations are associated with microleakage and

penetration of oral fluid and bacteria along dentinal walls endangering the pulpal

tissue or favourising secondary dental caries

IX2 AIM OF STUDY

The study aimed to assess the efficiency of marginal sealing along gingival

wall in limited proximal-occlusal restorations performed using three different

techniques

IX3MATERIALS AND METHOD

The study group included 30 teeth extracted for orthodontic and periodontal

reasons On every tooth two identical class II cavities (on mesial and distal surfaces)

were prepared with cylindrical burs under water cooling The gingival wall was

limited to enamel-cement jonction The cavity dimension were as follows 2 mm

buccal-oral 5mm depth Each tooth was introduced in a pattern of acrylat The

operator calibrated preparation technique on acrylat teeth in Simulation Laboratory of

UMF ―Gr T Popa Iaşi The 60 prepared cavities were randomly divided in three

study groups related to restorative technique The restoration were performed with

Filtek Z550 (3M ESPE) a nanohybrid composite resin The adhesive strategy

included etchamprinse in 2 steps and adhesive Adper Single Bond 2(3MESPE)

Group A (n=20) bulk restorative technique associated with lightcuring from

occlusal 40 seconds and from buccal and oral 20 seconds

Group B (n=20) oblique layering technique (first layer on buccal wall and

buccal frac12 of gingival wall was lightcured from buccal second layer on oral wall and

oral frac12 of gingival wall was lightcured from oral third oral as a triangle with point

oriented to gingival wall was lightcured from occlusal)

Group C (n=20) combined technique (bdquoflow layer on gingival and axial

walls lightcured under pressure only associated with solid composite resin layer)

The proximal surfaces were performed using Tofflemire and metallic matrices After

removal of matrices every restoration was lightcured for another 20 seconds Two

layers aof varnish were applied on composite resins restorations excepting cavity

margins and an area of 1 mm around them The samples were introduced in methylen

21

blue 10 for 48 hours After this stage samples were washed with water and teeth

were cut longitudinally with a diamonded disc

The die penetration was assessed with Zeiss (Iena Germany) X20 microscope

accordingly to four scores (0-3)

0 ndash no penetration

1 ndash die infiltration until external half of gingival wall

2 ndash die infiltration on all gingival wall

3 ndash die infiltration on gingival wall and axial wall

IX4RESULTS AND DISCUSSIONS

The result of die penetration are presented in table IX1

TableIX1 The results for die penetration

Grup 0 1 2 3

A (bulk) 0 0 3 17

B (layering) 0 4 5 11

C (combined) 12 5 2 1

In group A 17 sample had score 3 and 2 samples had score 2 In group B 11

sample had score 3 5 samples had score 2 and 4 sample had score 1 In group C with

best results 12 samples had score 0 5 samples had score 1 2 samples had score 2 1

sample had score 3

The recorded data were analysed using test Mann-Whitney The statistical

results are presented in tables IX2-IX4

Tables IX2a-b Mann-Whitney for comparisons of microleakage values between

bulk technique and incremental technique

Ranks

Restorative technique N Mean Rank Sum of Ranks

Scores

frequency

A ndash bulk technique 20 2420 24200

B ndash incremental

technique

20 1680 16800

Total 40

Test Statisticsb

scores

frequency

Mann-Whitney U 29000

Wilcoxon W 168000

Z -1970

Asymp Sig (2-tailed) 049

Exact Sig [2(1-tailed Sig)] 123a

a Not corrected for ties

b Grouping Variable restorative technique

22

Tables IX3a-b Mann-Whitney for comparisons of microleakage values between

bulk technique and mixed technique

Ranks

Restorative technique N Mean Rank Sum of Ranks

scores

frequency

A ndash bulk technique 20 3090 30900

C ndash mixed technique 20 1010 10100

Total 40

Test Statisticsb

scores

frequency

Mann-Whitney U 500

Wilcoxon W 101000

Z -4021

Asymp Sig (2-tailed) 000

Exact Sig [2(1-tailed Sig)] 000a

a Not corrected for ties

b Grouping Variable restorative technique

Tables IX4a-b Mann-Whitney test for comparisons of microleakage values

between incremental technique and mixed technique

Ranks

Restorative technique N Mean Rank Sum of Ranks

scores

frequency

B ndash incremental

technique

20 2990 29900

C ndash mixed technique 20 1210 12100

Total 40

Test Statisticsb

scores

frequency

Mann-Whitney U 5500

Wilcoxon W 121000

Z -3492

Asymp Sig (2-tailed) 000

Exact Sig [2(1-tailed Sig)] 000a

a Not corrected for ties

23

Test Statisticsb

scores

frequency

Mann-Whitney U 5500

Wilcoxon W 121000

Z -3492

Asymp Sig (2-tailed) 000

Exact Sig [2(1-tailed Sig)] 000a

a Not corrected for ties

b Grouping Variable tehnrestaurare

The results of microleakage degree were statistically significant when the

three restorative techniques were compared The results showed that best restorative

technique regarding marginal sealing in cervical area is combined technique followed

by oblique layering technique The use of layering techniques limits the development

of contraction forces between oposite walls event that favourises bulk stress voids

formation and fissure inside dental tissues The results of our study are similar with

other studies (114 293)

IX5 CONCLUSIONS

The values of die penetration at gingival wall were statistically different

between the three restorative techniques

We concluded that all restorative methods were associated with lightcuring

contraction and marginal microleakage

The combined technique was associated with lowest lightcuring contraction

and die penetration

The bulk technique was associated with highest lightcuring contraction and die

penetration

24

CHAPTX STUDY REGARDING THE EFFECTS OF ETCHING ON

ENAMEL AND DENTINE IN CERVICAL AREA FOR PROXIMAL

CAVITIES AT LATERAL DENTAL GROUP

X1 INTRODUCTION

The studies reported marginal defects and high microleakage at the level of

gingival margins localised in cervical area or close to enamel-cement jonction for

high percents of proximal-occlusal composite resins restorations (8485) The good

adhesion is requested to insure restoration longevity and to prevent marginal

microleakage and presence of secondary marginal dental caries The adhesion

strenght of different adhesive systems can vary accordingly to tissues areas (204 240)

and to variations in dentinal structures (234 330) Most studies focused on adhesive

systems performances used healthy dentine close to pulp room but in case of class II

restorations there are particular features that influences the adhesion at the level of

gingival margins

The surface topography is an important property that determines the

interaction manner between surfaces The surface roughness and surface energy can

increase or decrease the adhesion of composite resins to the hard dental tissues

X2 AIM OF STUDY

The aim of study was to compare surface roughness of enamel and dentine

after etching related to different distances related to enamel-dentinecement jonction

X3 MATERIALS AND METHODS

The study group included 20 molars extracted from orthodontics or

periodontal reasons with intact proximal surfaces The teeth were cut longitudinally in

sens buccal-oral with diamond discs under water cooling

A group study (10 teeth) included 10 samples obtained through transversal

cutting at distance of 2mm from enamel-dentinecement jonction and 10 samples

obtained through transversal cutting at distance of 15 mm from enamel-

dentinecement jonction Another study group (10 teeth) included 10 samples

obtained through transversal cutting at distance of 1mm from enamel-dentinecement

jonction and 10 samples obtained through transversal cutting at distance of 05 mm

from enamel-dentinecement jonction All these samples were divided in two halfes

through mesial-distal cutting The samples finishing was performed with abrasive

paper (100-4000) and final polishing was performed with a device Buehler model

Minimet with slices introduced in ultrasound bath for 4 minutes The second half of

each sample was etched for 15 seconds with ortophosphoric acid 37 for 15 seconds

Slices were washed with distilled water for 30 seconds after etching and dried

The samples were analysed with atomic force microscopy (AFM) regarding

surface roughness The results were expressed as relative variation of roughness

X4 RESULTS AND DISCUSSIONS

The aspect of etched enamel at 2 mm distance from ECJ can be seen in figure

X1 (section 10 microm) The surface roughness is higher comparing with sample before

etching

25

După gravajul cu acid ortofosforic 37

The aspect of etched enamel at 15 mm distance from ECJ can be seen in

figure X2 (section 10 microm) The surface roughness is higher comparing with sample

before etching but lower comparing with sample at 2 mm from ECJ

The aspect of etched enamel at 1 mm distance from ECJ can be seen in figure

X3 (section 10 microm) The surface roughness is higher comparing with sample before

etching but lower comparing with sample at 15mm and 2 mm from ECJ

The aspect of etched enamel at 15 mm distance from ECJ can be seen in

figure X4 (section 10 microm) The surface roughness is higher comparing with sample

before etching but lower comparing with sample at 1 mm 15 mm and 2 mm from

ECJ

FigX1 3D aspect of enamel at 2 mm from ECJ

after etching (10 microm)

FigX2 3D aspect of enamel at 15 mm from ECJ

after etching (10 microm)

FigX3 3D aspect of enamel at 1 mm from ECJ

after etching (10 microm)

FigX4 3D aspect of enamel at 05 mm from ECJ

after etching (10 microm)

26

The mean values of squared roughness for dentine and enamel before etching

are presented in tables X1 and X2

Table X1 Squared roughness values for dentine samples before and after etching

Before etching (nm) After etching (nm)

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

sample

1

335 282 283 259 1149 947 901 879

sample

2

352 284 274 266 1127 939 883 875

sample

3

357 273 278 263 1152 953 876 867

sample

4

323 269 264 258 1146 942 895 883

sample

5

348 298 271 268 1153 944 904 878

sample

6

339 274 278 273 1158 937 893 892

sample

7

352 283 269 266 1145 944 899 876

sample

8

349 292 272 274 1166 942 907 869

sample

9

357 284 275 265 1132 939 893 879

sample

10

348 281 277 262 1142 941 899 878

Table X2 Squared roughness values for enamel and dentine samples before and after

etching

Before etching (nm) After etching (nm)

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

sample 1 422 342 309 313 2255 1114 874 845

sample 2 418 338 324 304 2236 1102 882 839

sample 3 413 334 315 303 2239 1115 873 833

sample 4 416 336 322 308 2242 1116 868 842

sample 5 426 332 315 294 2218 1103 877 829

sample 6 412 332 317 306 2237 1099 874 847

sample 7 414 335 322 314 2252 1102 876 834

sample 8 416 325 318 313 2239 1106 875 838

sample 9 418 328 314 299 2246 1113 879 836

sample 10 413 334 316 305 2242 1104 873 839

The results for samples before etching prove a decreasing tendency for mean

values of squared roughness surface beginning with areas placed at distance of 2 mm

from ECJ (346 nm) followed by areas placed at distance of 15 mm from ECJ (282

nm) 1 mm from ECJ (274 nm) and 05 mm from ECJ (265 nm) After etching the

decreasing tendency maintained for dentine localised at 2 mm from ECJ to dentine

localised at 05 mm from ECJ The mean values of squared roughness after etching

were three times higher (tables X3)

27

Table X3 Squared roughness values for enamel and dentine samples before and

after etching

Dentine Enamel

Before etching

(nm)

After etching

(nm)

Before etching

(nm)

After etching

(nm)

2 mm ECJ 346 1147 416 2237

15 mm ECJ 282 942 333 1107

1 mm ECJ 274 895 317 875

05 mm ECJ 265 877 305 838

The descriptive statistics data for surface roughness of dentine before and after

etching are presented in tables X4 si X5

Table X4 Descriptive statistics for dentine samples before etching

Statistics

Dentine 2mm

before etching

Dentine 15mm

before etching

Dentine 1mm

before etching

Dentine 05mm

before etching

N Valid 10 10 10 10

Missing 0 0 0 0

Mean 346000 282000 274100 265400

Std Error of Mean 33830 27487 17026 16746

Std Deviation 106979 86923 53841 52957

Skewness -1214 354 -314 348

Std Error of Skewness 687 687 687 687

Kurtosis 1141 049 336 -539

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 3230 2690 2640 2580

Maximum 3570 2980 2830 2740

Table X5 Descriptive statistics for dentine samples after etching

Statistics

Dentine 2mm

after etching

Dentine 15mm

after etching

Dentine 1mm

after etching

Dentine 05mm

after etching

N Valid 10 10 10 10

Missing 0 0 0 0

1147000 942800 895000 877600

Std Error of Mean 36545 14591 29926 22020

Std Deviation 115566 46140 94634 69634

Skewness -267 1169 -951 535

Std Error of Skewness 687 687 687 687

Kurtosis 043 1776 564 1416

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 11270 9370 8760 8670

28

Statistics

Dentine 2mm

after etching

Dentine 15mm

after etching

Dentine 1mm

after etching

Dentine 05mm

after etching

N Valid 10 10 10 10

Missing 0 0 0 0

1147000 942800 895000 877600

Std Error of Mean 36545 14591 29926 22020

Std Deviation 115566 46140 94634 69634

Skewness -267 1169 -951 535

Std Error of Skewness 687 687 687 687

Kurtosis 043 1776 564 1416

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 11270 9370 8760 8670

Maximum 11660 9530 9070 8920

To choose the statistical test to compare roughness surface values was

performed a test Shapiro-Wilk If p is lower or equal with 0005 than hypothesis of

distribution normality is rejected (distribution deviates from normal form) In the table

X6 the distributions are normal The statistical test will be test t for pair samples

Table X6 Test Shapiro-Wilk for dentine samples

Tests of Normality

Kolmogorov-Smirnov

a Shapiro-Wilk

Statistic df Sig Statistic df Sig

Dentine 2mm before etching 274 10 032 877 10 122

Dentine 15mm after etching 209 10 200 952 10 689

Dentine 1mm before etching 134 10 200 983 10 980

Dentine 05mm before etching 155 10 200 949 10 661

Dentine 2mm after etching 133 10 200 977 10 946

Dentine 15mm after etching 197 10 200 916 10 329

Dentine 1mm after etching 216 10 200 925 10 401

Dentine 05 after etching 220 10 185 933 10 474

Enamel 2mm before etching 193 10 200 898 10 207

Enamel 15mm before etching 170 10 200 977 10 947

Enamel 1mm before etching 157 10 200 952 10 689

Enamel 05mm before etching 165 10 200 943 10 590

Enamel 2mm after etching 235 10 124 925 10 404

Enamel 15mm after etching 209 10 200 871 10 102

Enamel 1mm after etching 189 10 200 964 10 834

Enamel 05mm after etching 142 10 200 983 10 978

a Lilliefors Significance Correction

29

Tests of Normality

Kolmogorov-Smirnov

a Shapiro-Wilk

Statistic df Sig Statistic df Sig

Dentine 2mm before etching 274 10 032 877 10 122

Dentine 15mm after etching 209 10 200 952 10 689

Dentine 1mm before etching 134 10 200 983 10 980

Dentine 05mm before etching 155 10 200 949 10 661

Dentine 2mm after etching 133 10 200 977 10 946

Dentine 15mm after etching 197 10 200 916 10 329

Dentine 1mm after etching 216 10 200 925 10 401

Dentine 05 after etching 220 10 185 933 10 474

Enamel 2mm before etching 193 10 200 898 10 207

Enamel 15mm before etching 170 10 200 977 10 947

Enamel 1mm before etching 157 10 200 952 10 689

Enamel 05mm before etching 165 10 200 943 10 590

Enamel 2mm after etching 235 10 124 925 10 404

Enamel 15mm after etching 209 10 200 871 10 102

Enamel 1mm after etching 189 10 200 964 10 834

Enamel 05mm after etching 142 10 200 983 10 978

a Lilliefors Significance Correction

This is a lower bound of the true significance

The results of test t for pair dentine samples before and after etching are

presented in table X

Table X7 Test t for dentine before and after etching

Paired Samples Test

Paired Differences

t df

p (2-

tailed)

95 Confidence

Interval of the

Difference

Mean

Std

Dev

Std

Error

Mean Lower Upper

Pair

1

dentine2mmbeforeetching-

dentine2mmafteretching

-

8010000

174801 55277 -

8135045

-

7884955

-

144906

9 000

Pair

2

dentine15mmbeforeetching-

dentine15mmafteretching

-

6608000

102394 32380 -

6681248

-

6534752

-

204079

9 000

Pair

3

dentine1mmbeforeetching-

dentine1mmafteretching

-

6209000

117799 37251 -

6293269

-

6124731

-

166678

9 000

30

Paired Samples Test

Paired Differences

t df

p (2-

tailed)

95 Confidence

Interval of the

Difference

Mean

Std

Dev

Std

Error

Mean Lower Upper

Pair

1

dentine2mmbeforeetching-

dentine2mmafteretching

-

8010000

174801 55277 -

8135045

-

7884955

-

144906

9 000

Pair

2

dentine15mmbeforeetching-

dentine15mmafteretching

-

6608000

102394 32380 -

6681248

-

6534752

-

204079

9 000

Pair

3

dentine1mmbeforeetching-

dentine1mmafteretching

-

6209000

117799 37251 -

6293269

-

6124731

-

166678

9 000

Pair

4

dentine05mmbeforeetching-

dentine05mmafteretching

-

6122000

86384 27317 -

6183796

-

6060204

-

224109

9 000

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of dentine (

2mm 15 mm 1mm sau 05mm)

The descriptive statistics data for dentine surface roughness before and after

etching are presented in tables X8 and X9

Table X8 Descriptive statistics for enamel samples before etching

Statistics

Enamel 2mm

before etching

Enamel 15mm

before etching

Enamel 1mm

before etching

Enamel 05mm

before etching

N Valid 10 10 10 10

Missing 0 0 0 0

Mean 416800 333600 317200 305900

Std Error of Mean 13968 15217 14205 20355

Std Deviation 44171 48120 44920 64369

Skewness 1095 -156 -109 -411

Std Error of Skewness 687 687 687 687

Kurtosis 769 487 -118 -295

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 4120 3250 3090 2940

Maximum 4260 3420 3240 3140

31

Table X9 Descriptive statistics for enamel samples after etching

Statistics

Enamel 2mm

after etching

Enamel 15mm

after etching

Enamel 1mm

after etching

Enamel 05mm

after etching

N Valid 10 10 10 10

Missing 0 0 0 0

Mean 2237600 1107400 875100 838200

Std Error of Mean 31027 20232 11968 17436

Std Deviation 98116 63979 37845 55136

Skewness -850 267 042 040

Std Error of Skewness 687 687 687 687

Kurtosis 878 -1880 1082 -425

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 22180 10990 8680 8290

Maximum 22520 11160 8820 8470

To choose the statistical test to compare roughness surface values was

performed a test Shapiro-Wilk If p is lower or equal with 0005 than hypothesis of

distribution normality is rejected (distribution deviates from normal form) In the table

X10 the distributions are normal The statistical test will be test t for pair samples

Table X10 Test Shapiro-Wilk for enamel samples

Tests of Normality

Kolmogorov-Smirnova Shapiro-Wilk

Statistic df Sig Statistic df Sig

2mmenamel before etching 193 10 200 898 10 207

15mmenamel before etching 170 10 200 977 10 947

1mmenamel before etching 157 10 200 952 10 689

05mmenamel before etching 165 10 200 943 10 590

2mmenamel after etching 235 10 124 925 10 404

15mmenamel after etching 209 10 200 871 10 102

1mmenamel after etching 189 10 200 964 10 834

05mmenamel after etching 142 10 200 983 10 978

a Lilliefors Significance Correction

This is a lower bound of the true significance

The results of test t for pair enamel samples before and after etching are

presented in table X11

32

Table X11 Test t for enamel samples before and after etching

Paired Samples Test

Paired Differences

t df

p (2-

tailed)

95 Confidence

Interval of the

Difference

Mean

Std

Deviation

Std

Error

Mean Lower Upper

Pair

1

2mmenamel before

etching

2mmenamel after

etching

-18208 135220 42760 -

18304731

-

18111269

-

425815

9 000

Pair

2

15mmenamel before

etching

15mmenamel after

etching

-7738 73151 23132 -7790329 -7685671 -

334508

9 076

Pair

3

1mmenamel before

etching

1mmenamel after

etching

-5579 55468 17540 -5618679 -5539321 -

318065

9 065

Pair

4

05mmenamel before

etching

05mmenamel after

etching

-5323 60378 19093 -5366192 -5279808 -

278788

9 063

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel ( 2mm 15 mm 1mm sau

05mm) but the differences statistical significant are present only for enamel localised

at 2 mm from ECJ

X5CONCLUSIONS

The surfaces of enamel and dentine at cervical level record decreases of

roughness related to the decrease of distance to ECJ

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel but the differences

statistical significant are present only for enamel localised at 2 mm from ECJ

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of

dentine

33

CHAPTXI FEA STUDY REGARDING THE BIOMECHANICAL

BEHAVIOUR AND FRACTURE RESISTANCE OF PROXIMO-OCCLUSAL

AMALGAM AND COMPOSITE RESINS RESTORATIONS

XI1INTRODUCTION AIM OF STUDY

The individual variation of patients morphological and functional complexity

of tissues as well as difficult access limit the possibilities to investigate in clinical

studies the biomechanical behaviour of proximo-occlusal restorations In this context

simulation of the biomechanics for direct restorations represents an interesting

interdisciplinar domain in actual dentistry research

The study focused on two direction

- analysis of role of forces intensity on biomechanical behaviour related to

cavity dimension and material

- analysis of tension inside restoration structure related to forces intensity

XI2MATERIALS AND METHODS

The stages of finite element analysis study are as follows

object modelling (bicusps and proximo-occlusal restoration)

definition of parameters for materials and dental tissues

meshing

constraints and loading

types of contacts

equations system definition

results of simulation

The object 3D modelling was performed in Rhinoceros (figure XI1) The

definition of parameters was performed for Poisson constant Young modulus density

(table XI1) The selected materials were amalgam and composite resins The

analysed tissues were dentine and enamel The meshing constraints loading were

performed for forces of 200N 400N 600N 800 N The analysis was performed using

software COSMOSWorks 2010

34

Fig XI1 3D modellation of bicusp

Table XI1 Values of Young modulus Poisson constant compression resistance for

amalgam composite resin enamel (amalgam compozit smalţ)

Material Young modulus (GPa) Poisson constants

Compression

resistance

(Mpa)

Amalgam 55 033 483

Enamel 48 03 400

Composite

resin 220 022 345

Fig XI2 The forces and constraints application

The results are presented in values and culours red colours representing areas

with maximum values of tensions produced under influence of masticatory forces

The tensions produced in amalgam restoration are in a range from 0 to 22886

(force 800 N) The maximum von Misses tensions are associated with cervical area

of amalgam restorations This aspect proves that first modification in interface

restoration-cavity margins will appear at the level of gingival wall First marginal

35

defects and fissures in restoration bulk will appear at tensions over 1600Mpa

associated with forces of 800N for extended amalgam proximo-occlusal restorations

The tensions produced in composite resin restorations are in a range from 0 to

2285 (force 800 N) The maximum von Misses tensions are associated with cervical

area of composite resin restorationsThis aspect proves that first modification in

interface restoration-cavity margins will appear at the level of gingival wall First

marginal defects and fissures in restoration bulk will appear at tensions over 1716

Mpa associated with forces of 600N for moderate and extended composite resins

proximo-occlusal restorations

Fig XI3a-b ndash Simulated model of proximo-occlusal restoration

FigXI4a-b Dental amalgam restoration Cervical tension associated with 600 N

(c)800 N (d)

FigXI5a-b Composite resin restoration Cervical tension associated with 600 N

(c)800 N (d)

36

The deformation of amalgam can be produced only when is associated with

fissures in bulk of restorations while composite resins restorations present

deformation when are associated with a modification of volume and form because of

repeated action of medium forces on long term or high forces on short term (figures

XI4 XI5)

Fig XI4 Material deformation in area of maximum tension

000E + 00

500E -02

100E -01

150E -01

200E -01

250E -01

1 4 7 101316192225283134374043464952555861646770737679

Amalgam C ompoz it

Figura XI5 Deformarea funcție de material

The amalgam and composite resins were treated as homogenous isotropic and

liniar The advantage of this type of FEA study is that restorations parameters can be

modified any time is necessary both in arhitecture geometry and material indices

variability The results of this study sustain the conclusions of other FEA studies

focused on biomechanical behaviour of posterior restorations performed with

amalgam and composite resins(35 62 76 143)

37

XI4CONCLUSIONS

bull The amalgam in class II restorations has a low deformation tendency because

of uniform distribution of tension inside material

bull Composite resins class II restorations accumulate higher tensions comparing

with amalgam but deformation is avoided for a time because of the adhesion

forces performed between molecules under moderate oral forces In case of

high oral forces (600-800N) the risk of fracture in moderate class II

restorations is higher comparing with amalgam proximo-occlusal restorations

For extended class II restorations and forces of 600 N composite resins present

highest risk of fracture and deformation The von Misses tension at the

cervical interface restorationtooth can reach 1600Mpa

bull The amalgam in moderate class II restorations can resist to deformation even

for high intensity forces limited to 600N In extended class II restorations the

risk of deformation and fracture increases at values of 600N-800N of oral

forces The von Misses tension at the cervical interface restorationtooth can

reach 1700 Mpa

38

FINAL CONCLUSIONS

Amalgam proximo-occlusal restorations with minimum 6-years age present

excellent results for parameters anatomic form (occlusal) marginal

discoloration and marginal secondary dental caries good results for

parameters anatomic form (proximal) and marginal adaptation and poor results

for surface quality

Composite resins proximo-occlusal restorations (bicusps) with minimum 6-

years age present excellent results for parameters color match marginal

discoloration and marginal secondary dental caries and good results for

parameters anatomic form (occlusal proximal) marginal adaptation surface

quality

Composite resins proximo-occlusal restorations (molars) with minimum 6-

years age present good results for parameters color match marginal

discoloration marginal secondary dental caries marginal adaptation and poor

results for parameters anatomic form (occlusal) (54 indices Ryge C)

anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The restorations extended at external third of occlusal surface present highest

percents of indices C regarding anatomic form (occlusal) (54 indices Ryge

C) anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The exceeding of 6-years age will require careful monitorisation for early

interventions through polishing sealing reshaping and even replacement for

restorations with major defects

Oblique layering technique presents superior results regarding marginal

adaptation and marginal discoloration and is recommended for proximo-

occlusal dental caries close to enamel-cement jonction

Centripetal build-up presents good results regarding marginal adaptation and

anatomical form at proximal level (proximal surfaces and contact point)

Horisontal layering technique can be used for optimum results only in

proximal-occlusal cavities with moderate extension both in occlusal-cervical

and buccal-oral

The values of die penetration at gingival wall were statistically different

between the three restorative techniques

We concluded that all restorative methods were associated with lightcuring

contraction and marginal microleakage

The combined technique was associated with lowest lightcuring contraction

and die penetration

The bulk technique was associated with highest lightcuring contraction and die

penetration

39

The surfaces of enamel and dentine at cervical level record decreases of

roughness related to the decrease of distance to ECJ

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel but the differences

statistical significant are present only for enamel localised at 2 mm from ECJ

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of

dentine

bull The amalgam in class II restorations has a low deformation tendency because

of uniform distribution of tension inside material

bull Composite resins class II restorations accumulate higher tensions comparing

with amalgam but deformation is avoided for a time because of the adhesion

forces performed between molecules under moderate oral forces In case of

high oral forces (600-800N) the risk of fracture in moderate class II

restorations is higher comparing with amalgam proximo-occlusal restorations

For extended class II restorations and forces of 600 N composite resins present

highest risk of fracture and deformation The von Misses tension at the

cervical interface restorationtooth can reach 1600Mpa

bull The amalgam in moderate class II restorations can resist to deformation even

for high intensity forces limited to 600N In extended class II restorations the

risk of deformation and fracture increases at values of 600N-800N of oral

forces The von Misses tension at the cervical interface restorationtooth can

reach 1700 Mpa

REFERENCES

1ADA Council on Scientific Affairs ADA Council on Dental Benefit Programs

Statement on posterior resin-based composites JADA 1998 129(11)1627ndash1628

2Albers HF Tooth-colored restoratives 1st ed Santa Rosa CA Alto Books 1979

3Allander L Birkhed D Bratthall D Reasons for replacement of class II amalgam

restorations in private practice Swed Dent J 199014(4)179-84

4Alomari QD Reinhardt JW Boyer DB Effect of liners on cusp deflection and

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5Alster D Feilzer AJ de Gee AJ Mol A Davidson CL The dependence of

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1992711619ndash1622

6Aggarwal V Logani A Jain V Shah N Effect of cyclic loading on marginal

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Oper Dent 2008 Sep-Oct33(5)587-92

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8Andrian S- Restaurări fizionomice cu materiale plastice icircn cariologie-EdPanteon

Iaşi 2001

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posterior restorations two-year results Oper Dent 201035(4)397-404

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utilizing a filled and unfilled adhesive resin Dent Mater 200117268ndash276

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analysis of two dentin adhesives Dent Mater 1998 14(1)44-50

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selected mechanical properties of experimental resin composites Dent Mater1998

1451-56

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composites resins Oper Dent 19851061-73

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464-473

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Public Health Dent 1992 Winter52(2)102-10

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Dent 199158 36-39

28Bayne SC Dental biomaterials where are we and where are we going J Dent

Educ 200569(5)571ndash585

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191-194

30Behle C Flowable composite Proprieties and applications Pract Periodontics

Aesthetics Dent 1998 10347 350-351

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2007138(6)775ndash783

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NY Marcel Dekker Inc 1999

34Bonsor SJ Chadwick RGLongevity of conventional and bonded (sealed)

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9

35Boschian PL S Guidotti R Pietrbissa M Gagliani- bdquoStress distribution in a

post-restored tooth using the threedimensional finite element method Journal of Oral

Rehabilitation (33) 2006690ndash697

36Bouillaguet S B Ciucchi T Jacoby JC Wataha DH Pashley Bonding

characteristics to dentin walls of class II cavities in vitro Dent Mater 200117316ndash

321

37Bouschlicher MR Rueggeberg FA Effect of ramped light intensity on

polymerization force and conversion in a photoactivated composite J Esthet Dent

2000 12328-339

38Braga RR Ferracane JL Hilton TJ Contraction stress of flowable composites

and their efficacy as stress-relieving layers J Am Dent Assoc 2003134721ndash728

39Braga RR Ballester RY Ferracane JLFactors involved in the development of

polymerization shrinkage stress in resin-composites a systematic review Dent Mater

200521(10)962-70

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Timişoara1994

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amalgam-bonded restorations A 42-months study- Journal of American Dental

Association 2000nr131

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expansion on microleakage J Am Dent Assoc 1988116871ndash 874

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into enamel surfaces with reference to bonding Arch Oral Biol 19681361-70

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of reasons for the placement and replacement of restorations provided by vocational

dental practitioners and their trainers in the United Kingdom Quintessence Int

199930(4)234-42

42

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replacement of restorations in vocational training practicePrimary Dental Care

nr6(1) 1999

47Burke FJ Wilson NH Cheung SW Mjoumlr IA Influence of patient factors on age

of restorations at failure and reasons for their placement and replacement J Dent

200129(5)317-24

48Calheiros FC Braga RR Kawano Y Ballester RY Relationship between

contraction stress and degree of conversion in restorative composites Dent Mater

2004 20939-946

49Cardoso P Sadek F Microtensile bond strength on dentin using new adhesive

systems with selfetching primers Braz J Oral Sci 2003 2(4) 156-159

50Cardoso M Baratieri LN Ritter AV The effect of finishing and polishing on

the decision to replace existing amalgam restorations Quintessence Int 1999

Jun30(6)413-8

51Carvalho RM JC Pereira M Yoshiyama DH Pashley A review of

polymerization contraction the influence of stress development versus stress

reliefOper Dent19962117ndash24

52Castro VM Katz JO Hardman PK Glaros AG Spencer P Invitro comparison

of conventional film and direct digital imaging in the detection of approximal caries

Dentomaxillofac Radiol 2007 Mar36(3)138-42

53Cattaneo PM M Dalstra B Melsen- bdquoThe Finite Element Method a Tool to

Study Orthodontic Tooth Movement J Dent Res 2005 84(5)428-433

54Cattell MJ Clarke RL Lynch EJ The transverse strength reliability and

microstructural features of four dental ceramicspart 1 J Dent 25(5)399-407 1997

55Cehreli ZC Akca T Effect of dentinal tubule orientation on the microtensile

bond strength to primary dentin J Dent Child 2003 70(2) 139-144

56Celik C Arhun N Yamanel K Clinical evaluation of resin-based composites in

posterior restorations 12-month results Eur J Dent 2010 Jan4(1)57-65

57Cenci M Demarco F de Carvalho R Class II composite resin restorations with

two polymerization techniques Relationship between microtensile bond strength and

marginal leakage J Dent 2005 33(7) 603- 610

58Chaffin J Moss D Review of current US Army dental emergency rates Mil

Med 2008173(1)23ndash26

59Chen HY Manhart J Hickel R Kunzelmann KH Polymerization contraction

stress in light-cured packable composite resinsDent Mater 200117253-259

60Choi KK Condon JR Ferracane JL The effects of adhesive thickness on

polymerization contraction stress of composites J Dent Res 2000 79812ndash817

61Cichon P Kerschbaum T Verweildauer zahnartzlicher Restaurationen bei

Behinderten Dtsch Zahnartzlicher 1999 54 96-102

62Cohen BI Pagnillo MK Deutsch ASMusikant BL Fracture Strength of

Three Core Restorative Materials Supported with or without a Prefabricated Split-

Shank Post Journal of Prosthetic Dentistry1997 78 560ndash565

63Colli P Brannstrom M The marginal adaptation of four different bonding agents

in Class II composite resin restoration applied in bulk or in two increments

Quintessence Int 1993 24583-591

43

64Collins CJ Bryant RW Hodge KL A clinical evaluation of posterior composite

resin restorations 8-year findings J Dent 199826(4) 311ndash317

65Condon JR Ferracane JL Assessing the effect of composite formulation on

polymerization stress J Am Dent Assoc2000 131497-503

66Cook WD Moopnar M Influence of chemical structure on the fracture

behaviour of dimethacrylate composite resins Biomaterials 1990 11272-276

67Cortes DF Ellwood RP Ekstrand KR An in vitro comparison of a combined

FOTIvisual examination of occlusal caries with other caries diagnostic methods and

the effect of stain on their diagnostic performance Caries Res 2003 37 (1) 8-16

68Crim GA Microleakage of three resin placement techniques Am J Dent

1991469-72

69Dauvillier B Aarnts M Feilzer A The competition between the composite-

dentin strength and the polimerization contraction stress J Dent Res 1984 63 1396-

1399

70Dauvillier BS Aarnts MP Feilzer AJ Developments in shrinkage control of

adhesive restoratives J Esthet Dent 2000 12291-299

71Dauvillier BS Aarnts MP Feilzer AJ Modeling of the viscoelastic behavior of

dental light-activated resin composites during curing Dent Mater 200319277ndash285

72Davidson CL Gee AJ Feilzer A The competition between the composite-dentin

bond strength and the polymerization contraction stress J Dent Res 1984

63(12)1396-9

73Davidson CL AJ Feilzer Polymerization shrinkage and polymerization

shrinkage stress in polymer-based restoratives J Dent Res 199725435ndash440

74Davidson CL Resisting the curing contraction with adhesive composites J

Prosthet Dent 198655446ndash7

75Davis RD Mayhew RB A clinical comparison of three anterior restorative resins

at 3 years J Am Dent Assoc 1986112659-63

76Dejak B Mlotkowski A Three-dimensional finite element analysis of strength

and adhesion of composite resin versus ceramic inlays in molarsJ Prosthet

Dent200899131-40

77Deligeorgi V Mjor IA Wilson NH An overview of reasons for the placement

and replacement of restorations Prim Dent Care 20018(1)5-11

78Deliperi S Bardwell DN An alternative method to reduce polymerization

shrinkage in direct posterior composite restorations J Am Dent Assoc 2002

1331387ndash97

79Demirci M Tuncer S Yuceokur AA Prevalence of caries on individual tooth

surfaces and its distribution by age and gender in university clinic patientsEur J

Dent20104(3)270-9

80De Munck J Van Meerbeek B Satoshi I Vargas M Yoshida Y Armstrong S

Lambrechts P Vanherle G Microtensile bond strengths of one- and two-step

selfetch adhesives to bur-cut enamel and dentin Am J Dent 2003 16 414-420

81Dewaele M Truffier-Boutry D Devaux J Leloup G Volume contraction in

photocured dental resins the shrinkage-conversion relationship revisited Dent Mater

2006 22359-365

44

82Deutsch WM Simecek JW Dental emergencies among Marines ashore in

Operations Desert ShieldStorm Mil Med 1996161(10) 620ndash623

83Dickens SH Stansbury JW Choi KM Floyd CJ Photopolymerization kinetics

of methacrylate dental resins Macromolecules 2003 366043-6053

84Dietschi D De Siebenthal G Neveu-Rosenstand L Holz J Influence of the

restorative technique and new adhesives on the dentin marginal seal and adaptation of

resin composite Class II restorations An in vitro evaluation Quintessence Int 1995

26 717-727

85Dietschi D Herzfeld D In vitro evaluation of marginal and internal adaptation of

class II resin composite restorations after thermal and occlusal stressing Eur J Oral

Sci 1998 106 1033-1042

86Dietschi D Marginal adaptation and seal of direct and indirect Class II composite

resin restorations an in vitro evaluation Quintessence Int 26(2)127-138 1995

87Diefenderfer KE Simecek JW Ahlf RL Ragain JC Relationship between

caries status and dental emergencies among US naval personnel J Dent Res

20028195 (Abstract)

88Diefenderfer KE Rienhardt JW Shear bond strengths of ten adhesive

resinamalgam combinations Oper Dent 1997 22 50-56

89Donly KJ Jensen ME Triolo PA clinical comparison of resin composite inlay

and onlay posterior restorations and cast-gold restorations at 7 years Quintessence Int

30(3)163- 1681999

90Douglas WH Fields RP Fundingsland J A comparison between the

microleakage of direct and indirect composite restorative systems J Dent 17(4)184-

188 1989

91Eberhard J Hartman B Lenhard M Mayer T Kocher T Eickholz P Digital

subtraction radiography for monitoring dental demineralization An in vitro study

Caries Res 200034(3)219-24

92Edelstein BL Douglass CW Dispelling the myth that 50 percent of US

schoolchildren have never had a cavity Public Health Rep1995 110 (5) 522-530

93Eick JD Welch FH Polymerization shrinkage of posterior composite resins and

its possible influence on postoperative sensitivity Quintessence Int 198617103-11

94Elliott JE Lovell LG Bowman CN Primary cyclization in the polymerization of

bis GMA and TEGDMA a modeling approach to understanding the cure of dental

resins Dent Mater 2001 17221-229

95Ermis R Ulkam Aydin Examiner agreement in the replacement decisions of

class I amalgam restorations The Journal of contemporary dental practice 2004 Vol

5 no21-7

96Feilzer AJ AJ De Gee CL Davidson Increased wall-to-wall curing

contraction in thin bonded resin layers J Dent Res 19896848ndash50

97Feilzer AJ Dauvillier BS Effect of TEGDMABisGMA ratio on stress

development and viscoelastic properties of experimental twopaste composites J Dent

Res 2003 82824-828

98Feilzer AJ de Gee AJ Davidson CL Relaxation of polymerization contraction

shear stress by hygroscopic expansion J Dent Res 1990 6936ndash39

45

99Feilzer AJ De Gee AJ Davidson CL Setting stress in composite resin in relation

to configuration of the restoration J Dent Res1987 661636-1639

100Feilzer AJ Dooren LH de Gee AJ Davidson CL Influence of light intensity

on polymerization shrinkage and integrity of restoration-cavity interface Eur J Oral

Sci 1995 103322ndash326

101Fennis YL Verdischbot EH vanrsquot Hof MA Performance of some diagnostic

systems in the prediction of occlusal caries in permanent molars in 6 and 11 year-old

children J Dent 1998 26(5) 403-40

102Ferracane JL Developing a more complete understanding of stresses produced

in dental composites during polymerization Dent Mater 2005 2136-42

103Ferrari M Influence of tissue characteristics at margins on leakage of Class II

indirect porcelain restorations Am JDent 1999 12(3)134-142

104Ferreira MC Vieira RS Marginal leakage in direct and indirect composite resin

restorations in primary teeth an in vitro study J Dent 200836(5)322-5

105Forss H Widstroumlm E Reasons for restorative therapy and the longevity of

restorations in adults Acta Odontol Scand 2004 6282-86

106Fradeani M Aquilano A Bassein L Longitudinal study of pressed glass-

ceramic inlays for four and a half years J Prosthet Dent 1997 78(4)346-353

107Franccedila FM Worschech CC Paulillo LA Martins LR Lovadino JR Fracture

resistance of premolar teeth restored with different filling techniques J Contemp Dent

Pract 20056(3)62-9

108Francci C Loguercio AD Reis A Carrilho MR A novel filling technique for

packable composite resin in Class II restorations J Esthet Restor Dent 2002

14(3)149-57

109Fruits TJ Knapp JA Khajotia SS Microleakage in the proximal walls of

direct and indirect posterior resin slot restorations Oper Dent 200631(6)719-27

110Gaengler P Hoyer I Montag R Clinical evaluation of posterior composite

restorations The 10-year report J Adhes Dent 2001 3185-194

111Garbuz DS Masri BA Estaile J Classification systems in orthopaedics J Am

Acad Orthop Surg 2002 10 290-297

112Ghavamnasiri M Moosavi H Tahvildarnejad N Effect of centripetal and

incremental methods in Class II composite resin restorations on gingival

microleakage J Contemp Dent Pract 20078(2)113-20

113Gladys S Clinical and semiquantitative marginal analysis of four tooth-coloured

inlay systems at 3 years J Dent 199523(6)329-338

114Giachetti L Scaminaci Russo D Bambi C Grandini R A review of

polymerization shrinkage stress current techniques for posterior direct resin

restorations J Contemp Dent Pract 20067(4)79-88

115Giannini M AJS Santos RM Carvalho LAMS Paulillo JR Lovadino

Effects of irradiation mode and filling technique on resindentin bond strength in

Class I cavities J Dent Res 200281 (Abstract)

116Going RE Microleakage around dental restorations A summarizing review

JADA 1972841349-1357

117Gordon JChristensen G Why switch to digital radiography J Am Dent

Assoc 204 Vol 135 No 101437-1439

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118Gregoire GL Akon BA Millas A Interfacial micromorphological differences

in hybrid layer formation between water- and solvent-based dentin bonding systems J

Prosthet Dent 2002 87633ndash641

119Gregory WA Physical properties and repair bond strength of direct and indirect

composite resins J Prosthet Dent 68(3)406-411 1992

120Gwinnett AJ Buonocore MG Adhesives and caries prevention a preliminary

report Br Dent J 196511977-81

121Gwinnett AJ Matsui A A study of enamel adhesives The physical relationship

between enamel and adhesive Arch Oral Biol 1967121615-1620

122Gwinnett AJ Histologic changes in human enamel following treatment with

acidic adhesive conditioning agents Arch Oral Biol 197116731-738

123Gwinnett AJ Moist versus dry dentin its effect on shear bond strength Am J

Dent 1992 5(3)127-9

124Haba Denisia Tehnici uzuale utilizate icircn radiologia dentară Edit Junimea

2007

125Hashimoto M Ito S Tay FR Svizero NR Sano H Kaga M Fluid movement

across the resin-dentin interface during and after bonding J Dent Res 2004 83843ndash

848

126Hashimoto M Tay FR Ito S Sano H Kaga M Pashley DH Permeability of

adhesive resin films J Biomed Mater Res 2005 74699ndash705

127Hawthorne WS Smales RJ Factors influencing long-term restoration survival

in three private dental practices in Adelaide Aust Dent J 19974259ndash63

128Helwig Klimek Attin Einfuumlhrung in Die ZahnErhaltung Urbanampfischer 2003

129He Z Shimada Y Tagami J The effects of cavity size and incremental

technique on micro-tensile bond strength of resin composite in Class I cavities Dent

Mater 200723(5)533-8

130He Z Shimada Y Sadr A Ikeda M Tagami J The effects of cavity size and

filling method on the bonding to Class I cavities J Adhes Dent 2008 Dec10(6)447-

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131Hench LLBioceramicsfrom concept to clinicJ Amer Ceram Soc1991

74(7)1487-1570

132Heymann HO The clinical performance of CAD-CAM generated ceramic

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Fuzzi M Advances in Operative Dentistry ndash Challenges of the Future Chicago

Quintessence 2001

134Hilton TJ Cavity sealers liners and bases Current philosophies and indications

for use Oper Dent 199621134 ndash146

135Hilton TJ Schwartz RS Ferracane JL Microleakage of four Class II resin

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135- 144

136Hinoura K Setcos JK Philips RW Cavity design and placement technique for

class 2 composites Oper Dent 19981312-19

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137Hintze H Wenzel A Clinically undetected dental caries assessed by bitewing

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19-23

138Hintze H Wenzel A Danielen B Behaviour of approximal carious lesions

assessed by clinical examination after tooth separation and radiography A 2+-years

longitudinal study in young adults Caries Res 1999 33 415-22

139Hintze H Wenzel A Influence of validation method on diagnostic accuracy of

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Dentomaxillofacial Radiol2002 31(1) 44-49

140Holtzman JM Berkey AB Mann J Predicting utilization of dental services by

the aged JPublic Health Dent1990 50(3) 164-171

141Hofmann N Hunecke AInfluence of curing methods and matrix type on the

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31(1)97-105

142Hopcraft MS Morgan MVComparison of radiographic and clinical diagnosis

of approximal and occlusal dental caries in a young adult population Community

Dent Oral Epidemiol 200533(3)212-8

143Hubsch PF Middleton J Knox J A finite element analysis of the stress at the

restoration-tooth interfacecomparing inlays and bulk

fillingsBiomaterials2000211015ndash1019

144Hudson JD Goldstein GR Georgescu M Enamel wear caused by three

different restorative materials J Prosthet Dent 1995 74(6)647-654

145Hunter AR Treasure ET Hunter AJ Increases in cavity volume associated

with the removal of class 2 amalgam and composite restorations Oper Dent

1995202ndash 6

146Huysmans MC PG van der Varst EP Lautenschlager P Monaghan The

influence of simulated clinical handling on the flexural and compressive strength of

posterior composite restorative materials Dent Mater 199612116ndash120

147Iliescu A Gafar MCariologie şi Odontologie RestaurativăEditura Medicală

Bucureşti 2001

148Inoue S Van Meerbeek B Vargas M Lambrechts P Vanherle G Adhesion

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Prati C Grafiche Erredue 2000131-148

149Inoue S Vargas MA Abe Y Yoshida Y LambrechtsP Vanherle G Sano H

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dentin J Adhes Dent 2001 3 237-245

150Iovan Gianina Diagnosis and Management of Patients with High Caries

Activity EdApollonia Iasi2002

151Jacobsen T Soderhold KJ Some effects of water on dentin bonding Dent

Mater 1995 11(2)132-6

152Jackson RD Morgan M The new posterior resins and a simplified placement

technique J Am Dent Assoc 2000131375ndash383

153Jain P Belcher M Microleakage of class II resin-based composite restorations

with flowable composite in the proximal box Am J Dent 200013235ndash238

48

154Jokstad A Mjor IA Analyses of long-term clinical behaviour of class II

amalgam restorations Acta OdontolScand 1991 49 47-63

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adhesives to dental hard tissues Clin Oral Investig 2002 6(3)155-60

157Kamann WK Gangler P Zur Funktionzeit von Amalgam

Kompositefullungen Zahnartzlicher Welt 1999 108 270-273

158Kanemura N Sano H Tagami J Tensile bond strength to and SEM evaluation

of ground and intact enamel surfaces J Dent 199927523-530

159Kay EJ Nutall M Relationship between dentistlsquos treatment attitudes and

restorative decisions made on the basis of simulated bitewing radiographs

Community Dentistry and Oral Epidemiology 1994 22(2) 71-74

160Kemp-Scholte CM Davidson CL Complete marginal seal of Class V resin

composite restorations effected by increased flexibility J Dent Res 1990 691240ndash

1243

161Khairallah C Hokayem A Long-term clinical evaluation of 2 dental materials

used for the preparation of esthetic inlays Odontostomatol Trop 200932(127)5-13

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200932(126)21-8

163Kidd EAAssesment of dental carious lesionsArchof Oral

Biology199843(8)629-632

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proximal caries lesions at various levels in vitro Journal of Dentistry 2006 34(10)

817-822

165Kiremitci A Alpaslan T Gurgan SSix-year clinical evaluation of packable

composite restorations Oper Dent 200934(1)11-7

166Kleverlaan CJ Feilzer AJ Polymerization shrinkage and contraction stress of

dental resin composites Dent Mater 2005 211150-1157

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marginal leakage around class II composite resin restorations in vitroQuint Int

201989117ndash121

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M Dentin shear strength effect of distance from the pulp Dent Mater 2002

18(7)516-20

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polimerisation Am J Dent 1998 11 17-22

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of Self-etching Adhesives to Caries-affected Dentin on the Gingival Wall Dental

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Dent 27(5)325-331 1999

49

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Jan11(1)34-40

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JProsthet Dent 199369(4)425-430

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thermal behavior of dental composites Dent Mater 2008 24(8)1017ndash1024

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Borgmeijer PJ Replacement risk of amalgam treatment modalities 15-year results

JDent 199826 627-632

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shrinkage and elasticity of flowable composites and filled adhesives Dent Mater

1999 15128-137

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179Lăcătuşu St Luminiţa Costinescu Andrian S Gianina Iovan Valeria

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analysis of amalgam restorations 15th

Edition of the Balkan Medical Days

Stomatological Section Abstract nr1091999128

181Lăcătuşu St Andrian S Gianina Iovan- Consideraţii asupra adaptării

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StomatologicăVol2199823-26

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posterior packable resin composites with and without flowable liners Oper Dent

200126302ndash307

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and resin-based composite posterior restorations Quintessence Int 200738(6)511-4

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restorative decisions microscopic and radiographic caries depth Community

Dentistry and Oral Epidemiology 1996 24 106-11

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polymerization contraction stress for dental composites by two-step light-activation

Dent Mater 2002 18436-444

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constraint and filling technique in composite restorations Dent Mater 2004

20(3)236-43

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Polymerization shrinkage effects of boundary conditions and filling technique of

resin composite restorations J Dent 2004 32(6)459-70

50

189Lopes GC Baratieri LN Monteiro S Jr Vieira LC Effect of posterior resin

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Quintessence Int 2004 35(2)156-61

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Dentomaxillofac Radiol 2007 Oct36(7)377-81

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J Prosthet Dent 2000 Sep84(3)289-96

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Three-year clinical evaluation of composite and ceramic inlays Am J Dent 2001

Apr14(2)95-9

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79369 (Abstract)

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51

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33

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19904011ndash7

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Am Dent Assoc 2010 141(3)319-29

52

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125749-751

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34

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569ndash575

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54

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55

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of amalgam composite and glassndashionomer restorations J Dent Res 199069861ndash

864

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Orthop921987499ndash505

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Part I Depth of penetration beyond dentin smear layers Dent Mater 2001 17(4) 296-

308

313Tay FR Frankenberger R Krejci I Bouillaguet S Pashley DH Carvalho

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In vivo evidence J Dent 2004 32611ndash621

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Dent Assoc 2003 69726ndash731

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study of the influence of acidity of self-etching primers and smear layer thickness on

bonding to intact dentin J Adhes Dent 2000 283ndash98

316Thompson JY Bayne SC Heymann HO Mechanical properties of a new

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76(6)619-623 1996

317Unterbrink GL R Muessner Influence of light intensity on two restorative

systems J Dent 199523183ndash189

318Unterbrink GL Liebenberg WH Flowable resin composites as filled

adhesiveslsquo literature review and clinical recommendations Quintessence Int

199930249ndash257

319Vaarkamp J Ten Bosch J Verdonschot EH Quantitative diagnosis of small

approximal caries lesions utilizing wavelength-dependent fiber-optic

transillumination Journal of Dental Research 1997 76 (4) 875-882

320Valachovic RW Douglass CW Reiskin AB Chauncey HH McNeil BJ The

use of panoramic radiography in the evaluation of asymptomatic adult dental patients

Oral Surg Oral Med Oral Pathol 198661(3)289-96

321Van Meerbeek B De Munck J Yoshida Y Inoue S Vargas M Vijay P Van

Landuyt K Lambrechts P Vanherle G Adhesion to enamel and dentin Current

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322Van Meerbeek B Van Landuyt K De Munck JHashimoto M Peumans M

Lambrechts P Yoshida Y Inoue S Suzuki K Technique-sensitivity of

contemporary adhesives Dent Mater J 2005 24(1) 1-13

323Van Meerbeek B Vargas S Inoue S Yoshida Y Peumans M Lambrechts P

Vanherle G Adhesives and cements to promote preservation dentistry Oper Dent

20016 119-144

324Van Meerbeek B Yoshida Y Inoue S Vargas M Abe Y Fukuda R Okazaki

M Lambrechts P Vanherle G Bonding mechanism micro-tensile bond strength of

a 4- MET-based self-etching adhesive J Dent Res 2000 79 249 (Abstract)

58

325Van Nieuwenhuysen JP DrsquoHoore W Carvalho J Qvist V Long-term

evaluation of extensive restorations in permanent teeth J Dent 200331(6)395ndash405

326Venhoven BA de Gee AJ Davidson CL Light initiation of dental resins

dynamics of the polymerization Biomaterials 1996 172313-2318

327Versluis A Douglas WH Cross M Sakaguchi RL Does an incremental filling

technique reduce polymerization shrinkage stresses J Dent Res 1996 75871ndash878

328Vries HC Ruiken HM Konig KG vanrsquot Hof MA Radiographic versus

clinical diagnosis of approximal carious lesions Caries Res1990 24 (5) 364-370

329Waggoner W Ashton J Predictability of cavitation based upon radiographic

appearance comparison of two film types Quintessence International 1989 20(1)

55-60

330Watanabe LG Marshall GW Jr Marshall SJ Dentin shear strength effects of

tubule orientation and intra tooth location Dent Mater 1996 12 109-115

331Watts DC AS Marouf Optimal specimen geometry in bonded-disk

shrinkage-strain measurements on light-cured biomaterials Dent Mater 200016447ndash

451

332Watts DC Marouf AS Al-Hindi AM Photo-polymerization shrinkage-stress

kinetics in resin-composites methods development Dent Mater 2003 191ndash11

333Weaver WS Blank LW Pelleu GB Jr A visible light activated resin cured

through tooth structure GenDent 198836236-7

334Wendt SL Microleakage and cusp fracture resistance of heattreated composite

resin inlays Am J Dent 4(1)10-14 1991

335Wenzel A Hintze H Mikkelsen L Mouyen F Radiographic detection of

occlusal caries in noncavitated teeth A comparison of conventional film radiographs

digitized film radiographs and RadioVisioGraphy-Oral Surg Oral Med Oral Pathol

1991 72 621-6

336Wenzel A Hintze H Perception of image quality in direct digital radiography

after application of various image treatment filters for detectability of dental diseases

Dentomaxillofac Radiol 1993 22 131-4

337Wenzel A Computer-aided image manipulation of intraoral radiographs to

enhance diagnosis in dental practice a review Int Dent J 1993 43 99-108

338Wenzel A Digital radiography and caries diagnosis Dento Maxillo Facial

Radiology 27(1)3-11 1998

339Wenzel A Haiter-Neto F Gotfredsen E Risk factors for a false positive test

outcome in diagnosis of caries in approximal surfaces impact of radiographic

modality and observer characteristics Caries Res 200741(3)170-6

340Wibowo G Stockton L Microleakage of class II composite restorations Am J

Dent 200114177ndash185

341Wilson NHF Wastell DG Norman RD Five-year performance of high-

cooper content amalgam restorations in a multiclinical trial JDent1996 24 203-210

342Winkler MM Katona TR Paydar NH Finite element stress analysis of three

filling techniques for class V light-cured composite restorations J Dent Res

1996751477-83

343Yap AU Effectiveness of polymerization in composite restoratives claiming bulk

placement Impact of cavity depth and exposure time Oper Dent 2000 25113-120

59

344Yeşilyurt C Bulucu B Bond strength of total-etch dentin adhesive systems on

peripheral and central dentinal tissue a microtensile bond strength test The Journal of

Contemporary Dental Practice 7(2) 20061-13

345Yoshida Y Van Meerbeek B Okazaki M Shintani H Suzuki K Comparative

study on adhesive performance of functional monomers J Dent Res 2004 83 454-

458

346Yoshiyama M Tay FR Doi J Nishitani Y Yamada T Itou K Carvalho RM

Nakajima M Pashley DH Bonding of self-etch and total etch adhesives to carious

dentin J Dent Res 2002 81 556-560

  • COPERTA REZUMAT ENGLEZA (MEREUTA)pdf
  • REZUMAT ENGLEZA DR MEREUTA DENISSpdf
Page 17: UNIVERSITATEA DE MEDICINA SI FARMACIE “GR Doctorat/Rezumat... · universitatea de medicina si farmacie “gr.t.popa” iasi facultatea de medicina dentara rezumatul tezei de doctorat

14

Tables VIII3a-b Mann-Whitney test Comparing analysis regarding marginal

discoloration between restorations performed using oblique layering technique and

centripetal build-up technique

Ranks

20 2180 43600

20 1920 38400

40

Restorative_techniques

Centripetal build-up

Oblique layering

Total

Marginal_adaptation

N Mean Rank Sum of Ranks

Test Statisticsb

174000

384000

-841

400

495a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

adaptation

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between centripetal build-up

and oblique layering techniques regarding parameter marginal adaptation (p=0400)

Tables VIII4a-b Mann-Whitney test Comparing analysis regarding marginal

adaptation between restorations performed using horisontal layering technique and

centripetal build-up technique

Ranks

20 1830 36600

20 2270 45400

40

Restorative_techniques

Centripetal build-up

Horizontal layering

Total

Marginal_adaptation

N Mean Rank Sum of Ranks

Test Statisticsb

156000

366000

-1307

191

242a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

adaptation

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between centripetal build-up

and horisontal layering techniques regarding parameter marginal adaptation

(p=0191)

15

TablesVIII5a-b Mann-Whitney test Comparing analysis regarding marginal

adaptation between restorations performed using oblique layering technique and

horisontal layering technique

Ranks

20 1690 33800

20 2410 48200

40

Restorative_techniques

Oblique layering

Horizontal layering

Total

Marginal_adaptation

N Mean Rank Sum of Ranks

Test Statisticsb

128000

338000

-2191

028

052a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

adaptation

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There is statistical significant differences between horisontal layering and

oblique layering techniques regarding parameter marginal adaptation (p=0028)

Tables VIII6a-b Mann-Whitney test Comparing analysis regarding marginal

discoloration between restorations performed using oblique layering technique and

centripetal build-up technique

There are no statistical significant differences between centripetal build-up

and oblique layering techniques regarding parameter marginal discoloration

(p=0103)

Ranks

20 2260 45200

20 1840 36800

40

Restorative_techniques

Centripetal build-up

Oblique layering

Total

Marginal_discoloration

N Mean Rank Sum of Ranks

Test Statisticsb

158000

368000

-1632

103

265a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

discoloration

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

16

Tables VIII7a-b Mann-Whitney test Comparing analysis regarding marginal

discoloration between restorations performed using centripetal build-up technique and

horisontal layering technique

Ranks

20 1840 36800

20 2260 45200

40

Restorative_techniques

Centripetal build-up

Horizontal layering

Total

Marginal_discoloration

N Mean Rank Sum of Ranks

Test Statisticsb

158000

368000

-1299

194

265a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

discoloration

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between centripetal build-up

and horisontal layering techniques regarding parameter marginal discoloration

(p=0103)

Tables VIII8a-b Mann-Whitney test Comparing analysis regarding marginal

discoloration between restorations performed using oblique layering technique and

horisontal layering technique

Ranks

20 1630 32600

20 2470 49400

40

Restorative_techniques

Oblique layering

Horizontal layering

Total

Marginal_discoloration

N Mean Rank Sum of Ranks

Test Statisticsb

116000

326000

-2822

005

023a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

discoloration

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There is statistical significant differences between horisontal layering and

oblique layering techniques regarding parameter marginal discoloration (p=0005)

17

TablesVIII9 a-b Mann-Whitney test Comparing analysis regarding anatomical

form between restorations performed using centripetal build-up technique and oblique

layering technique

Ranks

20 1830 36600

20 2270 45400

40

Restorative_techniques

Centripetal build-up

Oblique layering

Total

Anatomical_form

N Mean Rank Sum of Ranks

Test Statisticsb

156000

366000

-1486

137

242a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Anatomical_

form

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between centripetal build-up

and oblique layering techniques regarding parameter anatomical form (p=0137)

Tables VIII10a-b Mann-Whitney test Comparing analysis regarding anatomical

form between restorations performed using centripetal build-up technique and

horisontal layering technique

Ranks

20 1710 34200

20 2390 47800

40

Restorative_techniques

Centripetal build-up

Horizontal layering

Total

Anatomical_form

N Mean Rank Sum of Ranks

Test Statisticsb

132000

342000

-2184

029

068a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Anatomical_

form

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between centripetal build-up

and horisontal layering techniques regarding parameter anatomical form (p=0029)

18

Tables VIII11a-b Mann-Whitney test Comparing analysis regarding anatomical

form between restorations performed using oblique layering technique and horisontal

layering technique

Ranks

20 1920 38400

20 2180 43600

40

Restorative_techniques

Oblique layering

Horizontal layering

Total

Anatomical_form

N Mean Rank Sum of Ranks

Test Statisticsb

174000

384000

-784

433

495a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Anatomical_

form

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between horisontal layering and

oblique layering techniques regarding parameter anatomical form (p=0433)

Indices A for restorations performed using centripetal build-up technique were

as follows color match-80 marginal adaptation- 60 marginal discoloration-

70 anatomical form (proximal)- 80 surface quality- 60

Indices A for restorations performed using horisontal layering technique were

as follows color match-70 marginal adaptation- 40 marginal discoloration-

50 anatomical form (proximal)- 50 surface quality- 70

Indices A for restorations performed using oblique layering technique were as

follows color match-70 marginal adaptation- 80 marginal discoloration- 90

anatomical form (proximal)- 60 surface quality- 70

Indices B for restorations performed using centripetal build-up technique were

as follows color match-20 marginal adaptation- 30 marginal discoloration-

20 anatomical form (proximal)- 30 surface quality- 40

Indices B for restorations performed using horisontal layering technique were

as follows color match-30 marginal adaptation- 40 marginal discoloration-

30 anatomical form (proximal)- 30 surface quality- 30

Indices B for restorations performed using oblique layering technique were as

follows color match-30 marginal adaptation- 20 marginal discoloration- 10

anatomical form (proximal)- 40 surface quality- 30

19

Indices C for restorations performed using centripetal build-up technique were

as follows color match-0 marginal adaptation- 10 marginal discoloration- 0

anatomical form (proximal)- 0 surface quality- 0

Indices C for restorations performed using horisontal layering technique were

as follows color match-0 marginal adaptation- 20 marginal discoloration- 20

anatomical form (proximal)- 20 surface quality- 0

Indices C for restorations performed using oblique layering technique were as

follows color match-0 marginal adaptation- 0 marginal discoloration- 10

anatomical form (proximal)- 0 surface quality- 100

Discussions

For in vitro studies is difficult to reproduce the variables existent in oral cavity

like occlusal stress and pH and temperature changes (235) The clinical studies are

determinant in assessment of restorative techniques (300) The most researches

focuses on the influence of restorative technique on the reduction of lightcuring stress

(51 78 135)

VIII5 CONCLUSIONS

Oblique layering technique presents superior results regarding marginal

adaptation and marginal discoloration and is recommended for proximo-

occlusal dental caries close to enamel-cement jonction

Centripetal build-up presents good results regarding marginal adaptation and

anatomical form at proximal level (proximal surfaces and contact point)

Horisontal layering technique can be used for optimum results only in

proximal-occlusal cavities with moderate extension both in occlusal-cervical

and buccal-oral

20

CHAPTIX STUDY REGARDING MARGINAL SEALING STATUS IN

COMPOSITE RESINS LIMITED PROXIMO-OCCLUSAL RESTORATIONS

PERFORMED USING DIFFERENT TECHNIQUES

IX1INTRODUCTION

The contraction of composite resins can produce stress inside dental structure

The most contraction stress appears in the initial stages and development rate of stress

decreases gradually in time (5 98 160) The contraction stress of composite resins

can overpass adhesion strenght and can broke the link between dental tissues and

composite resin (73) When adhesion strenght is high stress can produce marginal

fracture or bulk fracture (74) These situations are associated with microleakage and

penetration of oral fluid and bacteria along dentinal walls endangering the pulpal

tissue or favourising secondary dental caries

IX2 AIM OF STUDY

The study aimed to assess the efficiency of marginal sealing along gingival

wall in limited proximal-occlusal restorations performed using three different

techniques

IX3MATERIALS AND METHOD

The study group included 30 teeth extracted for orthodontic and periodontal

reasons On every tooth two identical class II cavities (on mesial and distal surfaces)

were prepared with cylindrical burs under water cooling The gingival wall was

limited to enamel-cement jonction The cavity dimension were as follows 2 mm

buccal-oral 5mm depth Each tooth was introduced in a pattern of acrylat The

operator calibrated preparation technique on acrylat teeth in Simulation Laboratory of

UMF ―Gr T Popa Iaşi The 60 prepared cavities were randomly divided in three

study groups related to restorative technique The restoration were performed with

Filtek Z550 (3M ESPE) a nanohybrid composite resin The adhesive strategy

included etchamprinse in 2 steps and adhesive Adper Single Bond 2(3MESPE)

Group A (n=20) bulk restorative technique associated with lightcuring from

occlusal 40 seconds and from buccal and oral 20 seconds

Group B (n=20) oblique layering technique (first layer on buccal wall and

buccal frac12 of gingival wall was lightcured from buccal second layer on oral wall and

oral frac12 of gingival wall was lightcured from oral third oral as a triangle with point

oriented to gingival wall was lightcured from occlusal)

Group C (n=20) combined technique (bdquoflow layer on gingival and axial

walls lightcured under pressure only associated with solid composite resin layer)

The proximal surfaces were performed using Tofflemire and metallic matrices After

removal of matrices every restoration was lightcured for another 20 seconds Two

layers aof varnish were applied on composite resins restorations excepting cavity

margins and an area of 1 mm around them The samples were introduced in methylen

21

blue 10 for 48 hours After this stage samples were washed with water and teeth

were cut longitudinally with a diamonded disc

The die penetration was assessed with Zeiss (Iena Germany) X20 microscope

accordingly to four scores (0-3)

0 ndash no penetration

1 ndash die infiltration until external half of gingival wall

2 ndash die infiltration on all gingival wall

3 ndash die infiltration on gingival wall and axial wall

IX4RESULTS AND DISCUSSIONS

The result of die penetration are presented in table IX1

TableIX1 The results for die penetration

Grup 0 1 2 3

A (bulk) 0 0 3 17

B (layering) 0 4 5 11

C (combined) 12 5 2 1

In group A 17 sample had score 3 and 2 samples had score 2 In group B 11

sample had score 3 5 samples had score 2 and 4 sample had score 1 In group C with

best results 12 samples had score 0 5 samples had score 1 2 samples had score 2 1

sample had score 3

The recorded data were analysed using test Mann-Whitney The statistical

results are presented in tables IX2-IX4

Tables IX2a-b Mann-Whitney for comparisons of microleakage values between

bulk technique and incremental technique

Ranks

Restorative technique N Mean Rank Sum of Ranks

Scores

frequency

A ndash bulk technique 20 2420 24200

B ndash incremental

technique

20 1680 16800

Total 40

Test Statisticsb

scores

frequency

Mann-Whitney U 29000

Wilcoxon W 168000

Z -1970

Asymp Sig (2-tailed) 049

Exact Sig [2(1-tailed Sig)] 123a

a Not corrected for ties

b Grouping Variable restorative technique

22

Tables IX3a-b Mann-Whitney for comparisons of microleakage values between

bulk technique and mixed technique

Ranks

Restorative technique N Mean Rank Sum of Ranks

scores

frequency

A ndash bulk technique 20 3090 30900

C ndash mixed technique 20 1010 10100

Total 40

Test Statisticsb

scores

frequency

Mann-Whitney U 500

Wilcoxon W 101000

Z -4021

Asymp Sig (2-tailed) 000

Exact Sig [2(1-tailed Sig)] 000a

a Not corrected for ties

b Grouping Variable restorative technique

Tables IX4a-b Mann-Whitney test for comparisons of microleakage values

between incremental technique and mixed technique

Ranks

Restorative technique N Mean Rank Sum of Ranks

scores

frequency

B ndash incremental

technique

20 2990 29900

C ndash mixed technique 20 1210 12100

Total 40

Test Statisticsb

scores

frequency

Mann-Whitney U 5500

Wilcoxon W 121000

Z -3492

Asymp Sig (2-tailed) 000

Exact Sig [2(1-tailed Sig)] 000a

a Not corrected for ties

23

Test Statisticsb

scores

frequency

Mann-Whitney U 5500

Wilcoxon W 121000

Z -3492

Asymp Sig (2-tailed) 000

Exact Sig [2(1-tailed Sig)] 000a

a Not corrected for ties

b Grouping Variable tehnrestaurare

The results of microleakage degree were statistically significant when the

three restorative techniques were compared The results showed that best restorative

technique regarding marginal sealing in cervical area is combined technique followed

by oblique layering technique The use of layering techniques limits the development

of contraction forces between oposite walls event that favourises bulk stress voids

formation and fissure inside dental tissues The results of our study are similar with

other studies (114 293)

IX5 CONCLUSIONS

The values of die penetration at gingival wall were statistically different

between the three restorative techniques

We concluded that all restorative methods were associated with lightcuring

contraction and marginal microleakage

The combined technique was associated with lowest lightcuring contraction

and die penetration

The bulk technique was associated with highest lightcuring contraction and die

penetration

24

CHAPTX STUDY REGARDING THE EFFECTS OF ETCHING ON

ENAMEL AND DENTINE IN CERVICAL AREA FOR PROXIMAL

CAVITIES AT LATERAL DENTAL GROUP

X1 INTRODUCTION

The studies reported marginal defects and high microleakage at the level of

gingival margins localised in cervical area or close to enamel-cement jonction for

high percents of proximal-occlusal composite resins restorations (8485) The good

adhesion is requested to insure restoration longevity and to prevent marginal

microleakage and presence of secondary marginal dental caries The adhesion

strenght of different adhesive systems can vary accordingly to tissues areas (204 240)

and to variations in dentinal structures (234 330) Most studies focused on adhesive

systems performances used healthy dentine close to pulp room but in case of class II

restorations there are particular features that influences the adhesion at the level of

gingival margins

The surface topography is an important property that determines the

interaction manner between surfaces The surface roughness and surface energy can

increase or decrease the adhesion of composite resins to the hard dental tissues

X2 AIM OF STUDY

The aim of study was to compare surface roughness of enamel and dentine

after etching related to different distances related to enamel-dentinecement jonction

X3 MATERIALS AND METHODS

The study group included 20 molars extracted from orthodontics or

periodontal reasons with intact proximal surfaces The teeth were cut longitudinally in

sens buccal-oral with diamond discs under water cooling

A group study (10 teeth) included 10 samples obtained through transversal

cutting at distance of 2mm from enamel-dentinecement jonction and 10 samples

obtained through transversal cutting at distance of 15 mm from enamel-

dentinecement jonction Another study group (10 teeth) included 10 samples

obtained through transversal cutting at distance of 1mm from enamel-dentinecement

jonction and 10 samples obtained through transversal cutting at distance of 05 mm

from enamel-dentinecement jonction All these samples were divided in two halfes

through mesial-distal cutting The samples finishing was performed with abrasive

paper (100-4000) and final polishing was performed with a device Buehler model

Minimet with slices introduced in ultrasound bath for 4 minutes The second half of

each sample was etched for 15 seconds with ortophosphoric acid 37 for 15 seconds

Slices were washed with distilled water for 30 seconds after etching and dried

The samples were analysed with atomic force microscopy (AFM) regarding

surface roughness The results were expressed as relative variation of roughness

X4 RESULTS AND DISCUSSIONS

The aspect of etched enamel at 2 mm distance from ECJ can be seen in figure

X1 (section 10 microm) The surface roughness is higher comparing with sample before

etching

25

După gravajul cu acid ortofosforic 37

The aspect of etched enamel at 15 mm distance from ECJ can be seen in

figure X2 (section 10 microm) The surface roughness is higher comparing with sample

before etching but lower comparing with sample at 2 mm from ECJ

The aspect of etched enamel at 1 mm distance from ECJ can be seen in figure

X3 (section 10 microm) The surface roughness is higher comparing with sample before

etching but lower comparing with sample at 15mm and 2 mm from ECJ

The aspect of etched enamel at 15 mm distance from ECJ can be seen in

figure X4 (section 10 microm) The surface roughness is higher comparing with sample

before etching but lower comparing with sample at 1 mm 15 mm and 2 mm from

ECJ

FigX1 3D aspect of enamel at 2 mm from ECJ

after etching (10 microm)

FigX2 3D aspect of enamel at 15 mm from ECJ

after etching (10 microm)

FigX3 3D aspect of enamel at 1 mm from ECJ

after etching (10 microm)

FigX4 3D aspect of enamel at 05 mm from ECJ

after etching (10 microm)

26

The mean values of squared roughness for dentine and enamel before etching

are presented in tables X1 and X2

Table X1 Squared roughness values for dentine samples before and after etching

Before etching (nm) After etching (nm)

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

sample

1

335 282 283 259 1149 947 901 879

sample

2

352 284 274 266 1127 939 883 875

sample

3

357 273 278 263 1152 953 876 867

sample

4

323 269 264 258 1146 942 895 883

sample

5

348 298 271 268 1153 944 904 878

sample

6

339 274 278 273 1158 937 893 892

sample

7

352 283 269 266 1145 944 899 876

sample

8

349 292 272 274 1166 942 907 869

sample

9

357 284 275 265 1132 939 893 879

sample

10

348 281 277 262 1142 941 899 878

Table X2 Squared roughness values for enamel and dentine samples before and after

etching

Before etching (nm) After etching (nm)

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

sample 1 422 342 309 313 2255 1114 874 845

sample 2 418 338 324 304 2236 1102 882 839

sample 3 413 334 315 303 2239 1115 873 833

sample 4 416 336 322 308 2242 1116 868 842

sample 5 426 332 315 294 2218 1103 877 829

sample 6 412 332 317 306 2237 1099 874 847

sample 7 414 335 322 314 2252 1102 876 834

sample 8 416 325 318 313 2239 1106 875 838

sample 9 418 328 314 299 2246 1113 879 836

sample 10 413 334 316 305 2242 1104 873 839

The results for samples before etching prove a decreasing tendency for mean

values of squared roughness surface beginning with areas placed at distance of 2 mm

from ECJ (346 nm) followed by areas placed at distance of 15 mm from ECJ (282

nm) 1 mm from ECJ (274 nm) and 05 mm from ECJ (265 nm) After etching the

decreasing tendency maintained for dentine localised at 2 mm from ECJ to dentine

localised at 05 mm from ECJ The mean values of squared roughness after etching

were three times higher (tables X3)

27

Table X3 Squared roughness values for enamel and dentine samples before and

after etching

Dentine Enamel

Before etching

(nm)

After etching

(nm)

Before etching

(nm)

After etching

(nm)

2 mm ECJ 346 1147 416 2237

15 mm ECJ 282 942 333 1107

1 mm ECJ 274 895 317 875

05 mm ECJ 265 877 305 838

The descriptive statistics data for surface roughness of dentine before and after

etching are presented in tables X4 si X5

Table X4 Descriptive statistics for dentine samples before etching

Statistics

Dentine 2mm

before etching

Dentine 15mm

before etching

Dentine 1mm

before etching

Dentine 05mm

before etching

N Valid 10 10 10 10

Missing 0 0 0 0

Mean 346000 282000 274100 265400

Std Error of Mean 33830 27487 17026 16746

Std Deviation 106979 86923 53841 52957

Skewness -1214 354 -314 348

Std Error of Skewness 687 687 687 687

Kurtosis 1141 049 336 -539

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 3230 2690 2640 2580

Maximum 3570 2980 2830 2740

Table X5 Descriptive statistics for dentine samples after etching

Statistics

Dentine 2mm

after etching

Dentine 15mm

after etching

Dentine 1mm

after etching

Dentine 05mm

after etching

N Valid 10 10 10 10

Missing 0 0 0 0

1147000 942800 895000 877600

Std Error of Mean 36545 14591 29926 22020

Std Deviation 115566 46140 94634 69634

Skewness -267 1169 -951 535

Std Error of Skewness 687 687 687 687

Kurtosis 043 1776 564 1416

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 11270 9370 8760 8670

28

Statistics

Dentine 2mm

after etching

Dentine 15mm

after etching

Dentine 1mm

after etching

Dentine 05mm

after etching

N Valid 10 10 10 10

Missing 0 0 0 0

1147000 942800 895000 877600

Std Error of Mean 36545 14591 29926 22020

Std Deviation 115566 46140 94634 69634

Skewness -267 1169 -951 535

Std Error of Skewness 687 687 687 687

Kurtosis 043 1776 564 1416

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 11270 9370 8760 8670

Maximum 11660 9530 9070 8920

To choose the statistical test to compare roughness surface values was

performed a test Shapiro-Wilk If p is lower or equal with 0005 than hypothesis of

distribution normality is rejected (distribution deviates from normal form) In the table

X6 the distributions are normal The statistical test will be test t for pair samples

Table X6 Test Shapiro-Wilk for dentine samples

Tests of Normality

Kolmogorov-Smirnov

a Shapiro-Wilk

Statistic df Sig Statistic df Sig

Dentine 2mm before etching 274 10 032 877 10 122

Dentine 15mm after etching 209 10 200 952 10 689

Dentine 1mm before etching 134 10 200 983 10 980

Dentine 05mm before etching 155 10 200 949 10 661

Dentine 2mm after etching 133 10 200 977 10 946

Dentine 15mm after etching 197 10 200 916 10 329

Dentine 1mm after etching 216 10 200 925 10 401

Dentine 05 after etching 220 10 185 933 10 474

Enamel 2mm before etching 193 10 200 898 10 207

Enamel 15mm before etching 170 10 200 977 10 947

Enamel 1mm before etching 157 10 200 952 10 689

Enamel 05mm before etching 165 10 200 943 10 590

Enamel 2mm after etching 235 10 124 925 10 404

Enamel 15mm after etching 209 10 200 871 10 102

Enamel 1mm after etching 189 10 200 964 10 834

Enamel 05mm after etching 142 10 200 983 10 978

a Lilliefors Significance Correction

29

Tests of Normality

Kolmogorov-Smirnov

a Shapiro-Wilk

Statistic df Sig Statistic df Sig

Dentine 2mm before etching 274 10 032 877 10 122

Dentine 15mm after etching 209 10 200 952 10 689

Dentine 1mm before etching 134 10 200 983 10 980

Dentine 05mm before etching 155 10 200 949 10 661

Dentine 2mm after etching 133 10 200 977 10 946

Dentine 15mm after etching 197 10 200 916 10 329

Dentine 1mm after etching 216 10 200 925 10 401

Dentine 05 after etching 220 10 185 933 10 474

Enamel 2mm before etching 193 10 200 898 10 207

Enamel 15mm before etching 170 10 200 977 10 947

Enamel 1mm before etching 157 10 200 952 10 689

Enamel 05mm before etching 165 10 200 943 10 590

Enamel 2mm after etching 235 10 124 925 10 404

Enamel 15mm after etching 209 10 200 871 10 102

Enamel 1mm after etching 189 10 200 964 10 834

Enamel 05mm after etching 142 10 200 983 10 978

a Lilliefors Significance Correction

This is a lower bound of the true significance

The results of test t for pair dentine samples before and after etching are

presented in table X

Table X7 Test t for dentine before and after etching

Paired Samples Test

Paired Differences

t df

p (2-

tailed)

95 Confidence

Interval of the

Difference

Mean

Std

Dev

Std

Error

Mean Lower Upper

Pair

1

dentine2mmbeforeetching-

dentine2mmafteretching

-

8010000

174801 55277 -

8135045

-

7884955

-

144906

9 000

Pair

2

dentine15mmbeforeetching-

dentine15mmafteretching

-

6608000

102394 32380 -

6681248

-

6534752

-

204079

9 000

Pair

3

dentine1mmbeforeetching-

dentine1mmafteretching

-

6209000

117799 37251 -

6293269

-

6124731

-

166678

9 000

30

Paired Samples Test

Paired Differences

t df

p (2-

tailed)

95 Confidence

Interval of the

Difference

Mean

Std

Dev

Std

Error

Mean Lower Upper

Pair

1

dentine2mmbeforeetching-

dentine2mmafteretching

-

8010000

174801 55277 -

8135045

-

7884955

-

144906

9 000

Pair

2

dentine15mmbeforeetching-

dentine15mmafteretching

-

6608000

102394 32380 -

6681248

-

6534752

-

204079

9 000

Pair

3

dentine1mmbeforeetching-

dentine1mmafteretching

-

6209000

117799 37251 -

6293269

-

6124731

-

166678

9 000

Pair

4

dentine05mmbeforeetching-

dentine05mmafteretching

-

6122000

86384 27317 -

6183796

-

6060204

-

224109

9 000

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of dentine (

2mm 15 mm 1mm sau 05mm)

The descriptive statistics data for dentine surface roughness before and after

etching are presented in tables X8 and X9

Table X8 Descriptive statistics for enamel samples before etching

Statistics

Enamel 2mm

before etching

Enamel 15mm

before etching

Enamel 1mm

before etching

Enamel 05mm

before etching

N Valid 10 10 10 10

Missing 0 0 0 0

Mean 416800 333600 317200 305900

Std Error of Mean 13968 15217 14205 20355

Std Deviation 44171 48120 44920 64369

Skewness 1095 -156 -109 -411

Std Error of Skewness 687 687 687 687

Kurtosis 769 487 -118 -295

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 4120 3250 3090 2940

Maximum 4260 3420 3240 3140

31

Table X9 Descriptive statistics for enamel samples after etching

Statistics

Enamel 2mm

after etching

Enamel 15mm

after etching

Enamel 1mm

after etching

Enamel 05mm

after etching

N Valid 10 10 10 10

Missing 0 0 0 0

Mean 2237600 1107400 875100 838200

Std Error of Mean 31027 20232 11968 17436

Std Deviation 98116 63979 37845 55136

Skewness -850 267 042 040

Std Error of Skewness 687 687 687 687

Kurtosis 878 -1880 1082 -425

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 22180 10990 8680 8290

Maximum 22520 11160 8820 8470

To choose the statistical test to compare roughness surface values was

performed a test Shapiro-Wilk If p is lower or equal with 0005 than hypothesis of

distribution normality is rejected (distribution deviates from normal form) In the table

X10 the distributions are normal The statistical test will be test t for pair samples

Table X10 Test Shapiro-Wilk for enamel samples

Tests of Normality

Kolmogorov-Smirnova Shapiro-Wilk

Statistic df Sig Statistic df Sig

2mmenamel before etching 193 10 200 898 10 207

15mmenamel before etching 170 10 200 977 10 947

1mmenamel before etching 157 10 200 952 10 689

05mmenamel before etching 165 10 200 943 10 590

2mmenamel after etching 235 10 124 925 10 404

15mmenamel after etching 209 10 200 871 10 102

1mmenamel after etching 189 10 200 964 10 834

05mmenamel after etching 142 10 200 983 10 978

a Lilliefors Significance Correction

This is a lower bound of the true significance

The results of test t for pair enamel samples before and after etching are

presented in table X11

32

Table X11 Test t for enamel samples before and after etching

Paired Samples Test

Paired Differences

t df

p (2-

tailed)

95 Confidence

Interval of the

Difference

Mean

Std

Deviation

Std

Error

Mean Lower Upper

Pair

1

2mmenamel before

etching

2mmenamel after

etching

-18208 135220 42760 -

18304731

-

18111269

-

425815

9 000

Pair

2

15mmenamel before

etching

15mmenamel after

etching

-7738 73151 23132 -7790329 -7685671 -

334508

9 076

Pair

3

1mmenamel before

etching

1mmenamel after

etching

-5579 55468 17540 -5618679 -5539321 -

318065

9 065

Pair

4

05mmenamel before

etching

05mmenamel after

etching

-5323 60378 19093 -5366192 -5279808 -

278788

9 063

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel ( 2mm 15 mm 1mm sau

05mm) but the differences statistical significant are present only for enamel localised

at 2 mm from ECJ

X5CONCLUSIONS

The surfaces of enamel and dentine at cervical level record decreases of

roughness related to the decrease of distance to ECJ

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel but the differences

statistical significant are present only for enamel localised at 2 mm from ECJ

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of

dentine

33

CHAPTXI FEA STUDY REGARDING THE BIOMECHANICAL

BEHAVIOUR AND FRACTURE RESISTANCE OF PROXIMO-OCCLUSAL

AMALGAM AND COMPOSITE RESINS RESTORATIONS

XI1INTRODUCTION AIM OF STUDY

The individual variation of patients morphological and functional complexity

of tissues as well as difficult access limit the possibilities to investigate in clinical

studies the biomechanical behaviour of proximo-occlusal restorations In this context

simulation of the biomechanics for direct restorations represents an interesting

interdisciplinar domain in actual dentistry research

The study focused on two direction

- analysis of role of forces intensity on biomechanical behaviour related to

cavity dimension and material

- analysis of tension inside restoration structure related to forces intensity

XI2MATERIALS AND METHODS

The stages of finite element analysis study are as follows

object modelling (bicusps and proximo-occlusal restoration)

definition of parameters for materials and dental tissues

meshing

constraints and loading

types of contacts

equations system definition

results of simulation

The object 3D modelling was performed in Rhinoceros (figure XI1) The

definition of parameters was performed for Poisson constant Young modulus density

(table XI1) The selected materials were amalgam and composite resins The

analysed tissues were dentine and enamel The meshing constraints loading were

performed for forces of 200N 400N 600N 800 N The analysis was performed using

software COSMOSWorks 2010

34

Fig XI1 3D modellation of bicusp

Table XI1 Values of Young modulus Poisson constant compression resistance for

amalgam composite resin enamel (amalgam compozit smalţ)

Material Young modulus (GPa) Poisson constants

Compression

resistance

(Mpa)

Amalgam 55 033 483

Enamel 48 03 400

Composite

resin 220 022 345

Fig XI2 The forces and constraints application

The results are presented in values and culours red colours representing areas

with maximum values of tensions produced under influence of masticatory forces

The tensions produced in amalgam restoration are in a range from 0 to 22886

(force 800 N) The maximum von Misses tensions are associated with cervical area

of amalgam restorations This aspect proves that first modification in interface

restoration-cavity margins will appear at the level of gingival wall First marginal

35

defects and fissures in restoration bulk will appear at tensions over 1600Mpa

associated with forces of 800N for extended amalgam proximo-occlusal restorations

The tensions produced in composite resin restorations are in a range from 0 to

2285 (force 800 N) The maximum von Misses tensions are associated with cervical

area of composite resin restorationsThis aspect proves that first modification in

interface restoration-cavity margins will appear at the level of gingival wall First

marginal defects and fissures in restoration bulk will appear at tensions over 1716

Mpa associated with forces of 600N for moderate and extended composite resins

proximo-occlusal restorations

Fig XI3a-b ndash Simulated model of proximo-occlusal restoration

FigXI4a-b Dental amalgam restoration Cervical tension associated with 600 N

(c)800 N (d)

FigXI5a-b Composite resin restoration Cervical tension associated with 600 N

(c)800 N (d)

36

The deformation of amalgam can be produced only when is associated with

fissures in bulk of restorations while composite resins restorations present

deformation when are associated with a modification of volume and form because of

repeated action of medium forces on long term or high forces on short term (figures

XI4 XI5)

Fig XI4 Material deformation in area of maximum tension

000E + 00

500E -02

100E -01

150E -01

200E -01

250E -01

1 4 7 101316192225283134374043464952555861646770737679

Amalgam C ompoz it

Figura XI5 Deformarea funcție de material

The amalgam and composite resins were treated as homogenous isotropic and

liniar The advantage of this type of FEA study is that restorations parameters can be

modified any time is necessary both in arhitecture geometry and material indices

variability The results of this study sustain the conclusions of other FEA studies

focused on biomechanical behaviour of posterior restorations performed with

amalgam and composite resins(35 62 76 143)

37

XI4CONCLUSIONS

bull The amalgam in class II restorations has a low deformation tendency because

of uniform distribution of tension inside material

bull Composite resins class II restorations accumulate higher tensions comparing

with amalgam but deformation is avoided for a time because of the adhesion

forces performed between molecules under moderate oral forces In case of

high oral forces (600-800N) the risk of fracture in moderate class II

restorations is higher comparing with amalgam proximo-occlusal restorations

For extended class II restorations and forces of 600 N composite resins present

highest risk of fracture and deformation The von Misses tension at the

cervical interface restorationtooth can reach 1600Mpa

bull The amalgam in moderate class II restorations can resist to deformation even

for high intensity forces limited to 600N In extended class II restorations the

risk of deformation and fracture increases at values of 600N-800N of oral

forces The von Misses tension at the cervical interface restorationtooth can

reach 1700 Mpa

38

FINAL CONCLUSIONS

Amalgam proximo-occlusal restorations with minimum 6-years age present

excellent results for parameters anatomic form (occlusal) marginal

discoloration and marginal secondary dental caries good results for

parameters anatomic form (proximal) and marginal adaptation and poor results

for surface quality

Composite resins proximo-occlusal restorations (bicusps) with minimum 6-

years age present excellent results for parameters color match marginal

discoloration and marginal secondary dental caries and good results for

parameters anatomic form (occlusal proximal) marginal adaptation surface

quality

Composite resins proximo-occlusal restorations (molars) with minimum 6-

years age present good results for parameters color match marginal

discoloration marginal secondary dental caries marginal adaptation and poor

results for parameters anatomic form (occlusal) (54 indices Ryge C)

anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The restorations extended at external third of occlusal surface present highest

percents of indices C regarding anatomic form (occlusal) (54 indices Ryge

C) anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The exceeding of 6-years age will require careful monitorisation for early

interventions through polishing sealing reshaping and even replacement for

restorations with major defects

Oblique layering technique presents superior results regarding marginal

adaptation and marginal discoloration and is recommended for proximo-

occlusal dental caries close to enamel-cement jonction

Centripetal build-up presents good results regarding marginal adaptation and

anatomical form at proximal level (proximal surfaces and contact point)

Horisontal layering technique can be used for optimum results only in

proximal-occlusal cavities with moderate extension both in occlusal-cervical

and buccal-oral

The values of die penetration at gingival wall were statistically different

between the three restorative techniques

We concluded that all restorative methods were associated with lightcuring

contraction and marginal microleakage

The combined technique was associated with lowest lightcuring contraction

and die penetration

The bulk technique was associated with highest lightcuring contraction and die

penetration

39

The surfaces of enamel and dentine at cervical level record decreases of

roughness related to the decrease of distance to ECJ

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel but the differences

statistical significant are present only for enamel localised at 2 mm from ECJ

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of

dentine

bull The amalgam in class II restorations has a low deformation tendency because

of uniform distribution of tension inside material

bull Composite resins class II restorations accumulate higher tensions comparing

with amalgam but deformation is avoided for a time because of the adhesion

forces performed between molecules under moderate oral forces In case of

high oral forces (600-800N) the risk of fracture in moderate class II

restorations is higher comparing with amalgam proximo-occlusal restorations

For extended class II restorations and forces of 600 N composite resins present

highest risk of fracture and deformation The von Misses tension at the

cervical interface restorationtooth can reach 1600Mpa

bull The amalgam in moderate class II restorations can resist to deformation even

for high intensity forces limited to 600N In extended class II restorations the

risk of deformation and fracture increases at values of 600N-800N of oral

forces The von Misses tension at the cervical interface restorationtooth can

reach 1700 Mpa

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2004 20939-946

49Cardoso P Sadek F Microtensile bond strength on dentin using new adhesive

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Three Core Restorative Materials Supported with or without a Prefabricated Split-

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Prosthet Dent 198655446ndash7

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shrinkage in direct posterior composite restorations J Am Dent Assoc 2002

1331387ndash97

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80De Munck J Van Meerbeek B Satoshi I Vargas M Yoshida Y Armstrong S

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82Deutsch WM Simecek JW Dental emergencies among Marines ashore in

Operations Desert ShieldStorm Mil Med 1996161(10) 620ndash623

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of methacrylate dental resins Macromolecules 2003 366043-6053

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caries status and dental emergencies among US naval personnel J Dent Res

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and onlay posterior restorations and cast-gold restorations at 7 years Quintessence Int

30(3)163- 1681999

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its possible influence on postoperative sensitivity Quintessence Int 198617103-11

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96Feilzer AJ AJ De Gee CL Davidson Increased wall-to-wall curing

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shear stress by hygroscopic expansion J Dent Res 1990 6936ndash39

45

99Feilzer AJ De Gee AJ Davidson CL Setting stress in composite resin in relation

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ceramic inlays for four and a half years J Prosthet Dent 1997 78(4)346-353

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resistance of premolar teeth restored with different filling techniques J Contemp Dent

Pract 20056(3)62-9

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14(3)149-57

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Acad Orthop Surg 2002 10 290-297

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incremental methods in Class II composite resin restorations on gingival

microleakage J Contemp Dent Pract 20078(2)113-20

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inlay systems at 3 years J Dent 199523(6)329-338

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polymerization shrinkage stress current techniques for posterior direct resin

restorations J Contemp Dent Pract 20067(4)79-88

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Effects of irradiation mode and filling technique on resindentin bond strength in

Class I cavities J Dent Res 200281 (Abstract)

116Going RE Microleakage around dental restorations A summarizing review

JADA 1972841349-1357

117Gordon JChristensen G Why switch to digital radiography J Am Dent

Assoc 204 Vol 135 No 101437-1439

46

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Prosthet Dent 2002 87633ndash641

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124Haba Denisia Tehnici uzuale utilizate icircn radiologia dentară Edit Junimea

2007

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across the resin-dentin interface during and after bonding J Dent Res 2004 83843ndash

848

126Hashimoto M Tay FR Ito S Sano H Kaga M Pashley DH Permeability of

adhesive resin films J Biomed Mater Res 2005 74699ndash705

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in three private dental practices in Adelaide Aust Dent J 19974259ndash63

128Helwig Klimek Attin Einfuumlhrung in Die ZahnErhaltung Urbanampfischer 2003

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technique on micro-tensile bond strength of resin composite in Class I cavities Dent

Mater 200723(5)533-8

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135- 144

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class 2 composites Oper Dent 19981312-19

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19-23

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Dent Oral Epidemiol 200533(3)212-8

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1995202ndash 6

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Bucureşti 2001

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Prati C Grafiche Erredue 2000131-148

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Activity EdApollonia Iasi2002

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Mater 1995 11(2)132-6

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technique J Am Dent Assoc 2000131375ndash383

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48

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Kompositefullungen Zahnartzlicher Welt 1999 108 270-273

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1243

161Khairallah C Hokayem A Long-term clinical evaluation of 2 dental materials

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Biology199843(8)629-632

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817-822

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dental resin composites Dent Mater 2005 211150-1157

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marginal leakage around class II composite resin restorations in vitroQuint Int

201989117ndash121

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18(7)516-20

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Dent 27(5)325-331 1999

49

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Jan11(1)34-40

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JProsthet Dent 199369(4)425-430

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thermal behavior of dental composites Dent Mater 2008 24(8)1017ndash1024

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JDent 199826 627-632

176Labella R Lambrechts P Van Meerbeek B Vanherle G Polymerization

shrinkage and elasticity of flowable composites and filled adhesives Dent Mater

1999 15128-137

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179Lăcătuşu St Luminiţa Costinescu Andrian S Gianina Iovan Valeria

Pendefunda 180Sorina Solomon Topoliceanu C Elements of dispersional

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Edition of the Balkan Medical Days

Stomatological Section Abstract nr1091999128

181Lăcătuşu St Andrian S Gianina Iovan- Consideraţii asupra adaptării

amalgamelor dentare la pereţii cavităţilor RevMedicina

StomatologicăVol2199823-26

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200126302ndash307

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Dentistry and Oral Epidemiology 1996 24 106-11

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Dent Mater 2002 18436-444

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20(3)236-43

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Polymerization shrinkage effects of boundary conditions and filling technique of

resin composite restorations J Dent 2004 32(6)459-70

50

189Lopes GC Baratieri LN Monteiro S Jr Vieira LC Effect of posterior resin

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Quintessence Int 2004 35(2)156-61

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191Loumlsche GM Marginal adaptation of class II composite fillings guided

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copolymerizations Macromolecules 1999 323913-3921

194Lutz F Krejci I Barbakow F Quality and durability of marginal adaptation in

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clinical results J Dent Res 199877 1020

196Mair LH Ten-year clinical assessment of three posterior resin composites and

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Dentomaxillofac Radiol 2007 Oct36(7)377-81

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J Prosthet Dent 2000 Sep84(3)289-96

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Three-year clinical evaluation of composite and ceramic inlays Am J Dent 2001

Apr14(2)95-9

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79369 (Abstract)

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PrimDentCare1999Apr659-62

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33

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52

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125749-751

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34

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Monogr Oral Sci 20092142-51

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of teeth with long-term performing composite restorations J Oral Rehabil 2002

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Operative Dentistry 5th ed St Louis Mosby 2006293-7

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ClinOral Invest1997140-46

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affecting cure at depths within light-activated resin composites Am J Dent

1993691ndash95

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of new adult patients diagnostic yield when combined with bitewing radiography and

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microleakage of deep class-II cavities restored with two composite resin formulations

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of polymerization contraction in composite restorations J Dent 1992 20178ndash182

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composites Dent Mater 200218197-202

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Nanoleakage leakage within the hybrid layer Oper Dent 1995 20 18-25

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posterior composite restorations Dent Mater 200521(1) 9ndash12

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packable posterior composite in bulk-cured restorations JADA 2006 137(1)71ndash80

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edition 1996

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Assessment of dental caries with Digital Imaging Fiber-Optic Transillumination (DI-

FOTI)in vitro studyCaries Res 1997 31(2) 103-110

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interobserver agreement and comparison to histological hard-tissue sections Caries

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of conversion in light-cured dimethacrylate-based dental resins Biomaterials 2002

231819-1829

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modulus of elasticity of light-cured dimethacrylate-based dental resins Biomaterials

2003 24655-665

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York Springer-Verlag 1999

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Am Dent Assoc 2007 Jun138(6)763-72

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from the SCO Dental Products Inc Symposium 2003 24(8) 4-9 (Abstract)

307Summit JB Burgess JO Berry TG Six-year clinical evaluation of bonded and

pin-retained complex amalgam restorations Oper Dent 2004 29269-276

308Summit JB Robbins JW Hilton TJ Fundamentals in operative dentistry Cap

10Direct Posterior Esthetic Restorations 2006 Quintessence Publishing Co

57

309Svanberg M Mjor IA Orstavik D Mutans streptococci in plaque from margins

of amalgam composite and glassndashionomer restorations J Dent Res 199069861ndash

864

310Tanne K Mamoru S Burstone C Three-dimensional finite element analysis

for stress in the periodontal tissue by orthodontic forcesAm J Orthod Dentofacial

Orthop921987499ndash505

311Tanumiharja M Burrow MF Tyas MJ Microtensile bond strengths of seven

dentin adhesive systems Dent Mater 2000 16(3)180-7

312Tay FR Pashley DH Aggressiveness of contemporary self-etching systems

Part I Depth of penetration beyond dentin smear layers Dent Mater 2001 17(4) 296-

308

313Tay FR Frankenberger R Krejci I Bouillaguet S Pashley DH Carvalho

RM Single-bottle adhesives behave as permeable membranes after polymerization I

In vivo evidence J Dent 2004 32611ndash621

314Tay FR Pashley DH Have dentin adhesives become too hydrophilic J Can

Dent Assoc 2003 69726ndash731

315Tay FR Sano H Carvalho R Pashley EL Pashley DH An ultrastructural

study of the influence of acidity of self-etching primers and smear layer thickness on

bonding to intact dentin J Adhes Dent 2000 283ndash98

316Thompson JY Bayne SC Heymann HO Mechanical properties of a new

mica-based machinable glass ceramic for CADCAM restorations J Prosthet Dent

76(6)619-623 1996

317Unterbrink GL R Muessner Influence of light intensity on two restorative

systems J Dent 199523183ndash189

318Unterbrink GL Liebenberg WH Flowable resin composites as filled

adhesiveslsquo literature review and clinical recommendations Quintessence Int

199930249ndash257

319Vaarkamp J Ten Bosch J Verdonschot EH Quantitative diagnosis of small

approximal caries lesions utilizing wavelength-dependent fiber-optic

transillumination Journal of Dental Research 1997 76 (4) 875-882

320Valachovic RW Douglass CW Reiskin AB Chauncey HH McNeil BJ The

use of panoramic radiography in the evaluation of asymptomatic adult dental patients

Oral Surg Oral Med Oral Pathol 198661(3)289-96

321Van Meerbeek B De Munck J Yoshida Y Inoue S Vargas M Vijay P Van

Landuyt K Lambrechts P Vanherle G Adhesion to enamel and dentin Current

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322Van Meerbeek B Van Landuyt K De Munck JHashimoto M Peumans M

Lambrechts P Yoshida Y Inoue S Suzuki K Technique-sensitivity of

contemporary adhesives Dent Mater J 2005 24(1) 1-13

323Van Meerbeek B Vargas S Inoue S Yoshida Y Peumans M Lambrechts P

Vanherle G Adhesives and cements to promote preservation dentistry Oper Dent

20016 119-144

324Van Meerbeek B Yoshida Y Inoue S Vargas M Abe Y Fukuda R Okazaki

M Lambrechts P Vanherle G Bonding mechanism micro-tensile bond strength of

a 4- MET-based self-etching adhesive J Dent Res 2000 79 249 (Abstract)

58

325Van Nieuwenhuysen JP DrsquoHoore W Carvalho J Qvist V Long-term

evaluation of extensive restorations in permanent teeth J Dent 200331(6)395ndash405

326Venhoven BA de Gee AJ Davidson CL Light initiation of dental resins

dynamics of the polymerization Biomaterials 1996 172313-2318

327Versluis A Douglas WH Cross M Sakaguchi RL Does an incremental filling

technique reduce polymerization shrinkage stresses J Dent Res 1996 75871ndash878

328Vries HC Ruiken HM Konig KG vanrsquot Hof MA Radiographic versus

clinical diagnosis of approximal carious lesions Caries Res1990 24 (5) 364-370

329Waggoner W Ashton J Predictability of cavitation based upon radiographic

appearance comparison of two film types Quintessence International 1989 20(1)

55-60

330Watanabe LG Marshall GW Jr Marshall SJ Dentin shear strength effects of

tubule orientation and intra tooth location Dent Mater 1996 12 109-115

331Watts DC AS Marouf Optimal specimen geometry in bonded-disk

shrinkage-strain measurements on light-cured biomaterials Dent Mater 200016447ndash

451

332Watts DC Marouf AS Al-Hindi AM Photo-polymerization shrinkage-stress

kinetics in resin-composites methods development Dent Mater 2003 191ndash11

333Weaver WS Blank LW Pelleu GB Jr A visible light activated resin cured

through tooth structure GenDent 198836236-7

334Wendt SL Microleakage and cusp fracture resistance of heattreated composite

resin inlays Am J Dent 4(1)10-14 1991

335Wenzel A Hintze H Mikkelsen L Mouyen F Radiographic detection of

occlusal caries in noncavitated teeth A comparison of conventional film radiographs

digitized film radiographs and RadioVisioGraphy-Oral Surg Oral Med Oral Pathol

1991 72 621-6

336Wenzel A Hintze H Perception of image quality in direct digital radiography

after application of various image treatment filters for detectability of dental diseases

Dentomaxillofac Radiol 1993 22 131-4

337Wenzel A Computer-aided image manipulation of intraoral radiographs to

enhance diagnosis in dental practice a review Int Dent J 1993 43 99-108

338Wenzel A Digital radiography and caries diagnosis Dento Maxillo Facial

Radiology 27(1)3-11 1998

339Wenzel A Haiter-Neto F Gotfredsen E Risk factors for a false positive test

outcome in diagnosis of caries in approximal surfaces impact of radiographic

modality and observer characteristics Caries Res 200741(3)170-6

340Wibowo G Stockton L Microleakage of class II composite restorations Am J

Dent 200114177ndash185

341Wilson NHF Wastell DG Norman RD Five-year performance of high-

cooper content amalgam restorations in a multiclinical trial JDent1996 24 203-210

342Winkler MM Katona TR Paydar NH Finite element stress analysis of three

filling techniques for class V light-cured composite restorations J Dent Res

1996751477-83

343Yap AU Effectiveness of polymerization in composite restoratives claiming bulk

placement Impact of cavity depth and exposure time Oper Dent 2000 25113-120

59

344Yeşilyurt C Bulucu B Bond strength of total-etch dentin adhesive systems on

peripheral and central dentinal tissue a microtensile bond strength test The Journal of

Contemporary Dental Practice 7(2) 20061-13

345Yoshida Y Van Meerbeek B Okazaki M Shintani H Suzuki K Comparative

study on adhesive performance of functional monomers J Dent Res 2004 83 454-

458

346Yoshiyama M Tay FR Doi J Nishitani Y Yamada T Itou K Carvalho RM

Nakajima M Pashley DH Bonding of self-etch and total etch adhesives to carious

dentin J Dent Res 2002 81 556-560

  • COPERTA REZUMAT ENGLEZA (MEREUTA)pdf
  • REZUMAT ENGLEZA DR MEREUTA DENISSpdf
Page 18: UNIVERSITATEA DE MEDICINA SI FARMACIE “GR Doctorat/Rezumat... · universitatea de medicina si farmacie “gr.t.popa” iasi facultatea de medicina dentara rezumatul tezei de doctorat

15

TablesVIII5a-b Mann-Whitney test Comparing analysis regarding marginal

adaptation between restorations performed using oblique layering technique and

horisontal layering technique

Ranks

20 1690 33800

20 2410 48200

40

Restorative_techniques

Oblique layering

Horizontal layering

Total

Marginal_adaptation

N Mean Rank Sum of Ranks

Test Statisticsb

128000

338000

-2191

028

052a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

adaptation

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There is statistical significant differences between horisontal layering and

oblique layering techniques regarding parameter marginal adaptation (p=0028)

Tables VIII6a-b Mann-Whitney test Comparing analysis regarding marginal

discoloration between restorations performed using oblique layering technique and

centripetal build-up technique

There are no statistical significant differences between centripetal build-up

and oblique layering techniques regarding parameter marginal discoloration

(p=0103)

Ranks

20 2260 45200

20 1840 36800

40

Restorative_techniques

Centripetal build-up

Oblique layering

Total

Marginal_discoloration

N Mean Rank Sum of Ranks

Test Statisticsb

158000

368000

-1632

103

265a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

discoloration

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

16

Tables VIII7a-b Mann-Whitney test Comparing analysis regarding marginal

discoloration between restorations performed using centripetal build-up technique and

horisontal layering technique

Ranks

20 1840 36800

20 2260 45200

40

Restorative_techniques

Centripetal build-up

Horizontal layering

Total

Marginal_discoloration

N Mean Rank Sum of Ranks

Test Statisticsb

158000

368000

-1299

194

265a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

discoloration

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between centripetal build-up

and horisontal layering techniques regarding parameter marginal discoloration

(p=0103)

Tables VIII8a-b Mann-Whitney test Comparing analysis regarding marginal

discoloration between restorations performed using oblique layering technique and

horisontal layering technique

Ranks

20 1630 32600

20 2470 49400

40

Restorative_techniques

Oblique layering

Horizontal layering

Total

Marginal_discoloration

N Mean Rank Sum of Ranks

Test Statisticsb

116000

326000

-2822

005

023a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

discoloration

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There is statistical significant differences between horisontal layering and

oblique layering techniques regarding parameter marginal discoloration (p=0005)

17

TablesVIII9 a-b Mann-Whitney test Comparing analysis regarding anatomical

form between restorations performed using centripetal build-up technique and oblique

layering technique

Ranks

20 1830 36600

20 2270 45400

40

Restorative_techniques

Centripetal build-up

Oblique layering

Total

Anatomical_form

N Mean Rank Sum of Ranks

Test Statisticsb

156000

366000

-1486

137

242a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Anatomical_

form

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between centripetal build-up

and oblique layering techniques regarding parameter anatomical form (p=0137)

Tables VIII10a-b Mann-Whitney test Comparing analysis regarding anatomical

form between restorations performed using centripetal build-up technique and

horisontal layering technique

Ranks

20 1710 34200

20 2390 47800

40

Restorative_techniques

Centripetal build-up

Horizontal layering

Total

Anatomical_form

N Mean Rank Sum of Ranks

Test Statisticsb

132000

342000

-2184

029

068a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Anatomical_

form

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between centripetal build-up

and horisontal layering techniques regarding parameter anatomical form (p=0029)

18

Tables VIII11a-b Mann-Whitney test Comparing analysis regarding anatomical

form between restorations performed using oblique layering technique and horisontal

layering technique

Ranks

20 1920 38400

20 2180 43600

40

Restorative_techniques

Oblique layering

Horizontal layering

Total

Anatomical_form

N Mean Rank Sum of Ranks

Test Statisticsb

174000

384000

-784

433

495a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Anatomical_

form

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between horisontal layering and

oblique layering techniques regarding parameter anatomical form (p=0433)

Indices A for restorations performed using centripetal build-up technique were

as follows color match-80 marginal adaptation- 60 marginal discoloration-

70 anatomical form (proximal)- 80 surface quality- 60

Indices A for restorations performed using horisontal layering technique were

as follows color match-70 marginal adaptation- 40 marginal discoloration-

50 anatomical form (proximal)- 50 surface quality- 70

Indices A for restorations performed using oblique layering technique were as

follows color match-70 marginal adaptation- 80 marginal discoloration- 90

anatomical form (proximal)- 60 surface quality- 70

Indices B for restorations performed using centripetal build-up technique were

as follows color match-20 marginal adaptation- 30 marginal discoloration-

20 anatomical form (proximal)- 30 surface quality- 40

Indices B for restorations performed using horisontal layering technique were

as follows color match-30 marginal adaptation- 40 marginal discoloration-

30 anatomical form (proximal)- 30 surface quality- 30

Indices B for restorations performed using oblique layering technique were as

follows color match-30 marginal adaptation- 20 marginal discoloration- 10

anatomical form (proximal)- 40 surface quality- 30

19

Indices C for restorations performed using centripetal build-up technique were

as follows color match-0 marginal adaptation- 10 marginal discoloration- 0

anatomical form (proximal)- 0 surface quality- 0

Indices C for restorations performed using horisontal layering technique were

as follows color match-0 marginal adaptation- 20 marginal discoloration- 20

anatomical form (proximal)- 20 surface quality- 0

Indices C for restorations performed using oblique layering technique were as

follows color match-0 marginal adaptation- 0 marginal discoloration- 10

anatomical form (proximal)- 0 surface quality- 100

Discussions

For in vitro studies is difficult to reproduce the variables existent in oral cavity

like occlusal stress and pH and temperature changes (235) The clinical studies are

determinant in assessment of restorative techniques (300) The most researches

focuses on the influence of restorative technique on the reduction of lightcuring stress

(51 78 135)

VIII5 CONCLUSIONS

Oblique layering technique presents superior results regarding marginal

adaptation and marginal discoloration and is recommended for proximo-

occlusal dental caries close to enamel-cement jonction

Centripetal build-up presents good results regarding marginal adaptation and

anatomical form at proximal level (proximal surfaces and contact point)

Horisontal layering technique can be used for optimum results only in

proximal-occlusal cavities with moderate extension both in occlusal-cervical

and buccal-oral

20

CHAPTIX STUDY REGARDING MARGINAL SEALING STATUS IN

COMPOSITE RESINS LIMITED PROXIMO-OCCLUSAL RESTORATIONS

PERFORMED USING DIFFERENT TECHNIQUES

IX1INTRODUCTION

The contraction of composite resins can produce stress inside dental structure

The most contraction stress appears in the initial stages and development rate of stress

decreases gradually in time (5 98 160) The contraction stress of composite resins

can overpass adhesion strenght and can broke the link between dental tissues and

composite resin (73) When adhesion strenght is high stress can produce marginal

fracture or bulk fracture (74) These situations are associated with microleakage and

penetration of oral fluid and bacteria along dentinal walls endangering the pulpal

tissue or favourising secondary dental caries

IX2 AIM OF STUDY

The study aimed to assess the efficiency of marginal sealing along gingival

wall in limited proximal-occlusal restorations performed using three different

techniques

IX3MATERIALS AND METHOD

The study group included 30 teeth extracted for orthodontic and periodontal

reasons On every tooth two identical class II cavities (on mesial and distal surfaces)

were prepared with cylindrical burs under water cooling The gingival wall was

limited to enamel-cement jonction The cavity dimension were as follows 2 mm

buccal-oral 5mm depth Each tooth was introduced in a pattern of acrylat The

operator calibrated preparation technique on acrylat teeth in Simulation Laboratory of

UMF ―Gr T Popa Iaşi The 60 prepared cavities were randomly divided in three

study groups related to restorative technique The restoration were performed with

Filtek Z550 (3M ESPE) a nanohybrid composite resin The adhesive strategy

included etchamprinse in 2 steps and adhesive Adper Single Bond 2(3MESPE)

Group A (n=20) bulk restorative technique associated with lightcuring from

occlusal 40 seconds and from buccal and oral 20 seconds

Group B (n=20) oblique layering technique (first layer on buccal wall and

buccal frac12 of gingival wall was lightcured from buccal second layer on oral wall and

oral frac12 of gingival wall was lightcured from oral third oral as a triangle with point

oriented to gingival wall was lightcured from occlusal)

Group C (n=20) combined technique (bdquoflow layer on gingival and axial

walls lightcured under pressure only associated with solid composite resin layer)

The proximal surfaces were performed using Tofflemire and metallic matrices After

removal of matrices every restoration was lightcured for another 20 seconds Two

layers aof varnish were applied on composite resins restorations excepting cavity

margins and an area of 1 mm around them The samples were introduced in methylen

21

blue 10 for 48 hours After this stage samples were washed with water and teeth

were cut longitudinally with a diamonded disc

The die penetration was assessed with Zeiss (Iena Germany) X20 microscope

accordingly to four scores (0-3)

0 ndash no penetration

1 ndash die infiltration until external half of gingival wall

2 ndash die infiltration on all gingival wall

3 ndash die infiltration on gingival wall and axial wall

IX4RESULTS AND DISCUSSIONS

The result of die penetration are presented in table IX1

TableIX1 The results for die penetration

Grup 0 1 2 3

A (bulk) 0 0 3 17

B (layering) 0 4 5 11

C (combined) 12 5 2 1

In group A 17 sample had score 3 and 2 samples had score 2 In group B 11

sample had score 3 5 samples had score 2 and 4 sample had score 1 In group C with

best results 12 samples had score 0 5 samples had score 1 2 samples had score 2 1

sample had score 3

The recorded data were analysed using test Mann-Whitney The statistical

results are presented in tables IX2-IX4

Tables IX2a-b Mann-Whitney for comparisons of microleakage values between

bulk technique and incremental technique

Ranks

Restorative technique N Mean Rank Sum of Ranks

Scores

frequency

A ndash bulk technique 20 2420 24200

B ndash incremental

technique

20 1680 16800

Total 40

Test Statisticsb

scores

frequency

Mann-Whitney U 29000

Wilcoxon W 168000

Z -1970

Asymp Sig (2-tailed) 049

Exact Sig [2(1-tailed Sig)] 123a

a Not corrected for ties

b Grouping Variable restorative technique

22

Tables IX3a-b Mann-Whitney for comparisons of microleakage values between

bulk technique and mixed technique

Ranks

Restorative technique N Mean Rank Sum of Ranks

scores

frequency

A ndash bulk technique 20 3090 30900

C ndash mixed technique 20 1010 10100

Total 40

Test Statisticsb

scores

frequency

Mann-Whitney U 500

Wilcoxon W 101000

Z -4021

Asymp Sig (2-tailed) 000

Exact Sig [2(1-tailed Sig)] 000a

a Not corrected for ties

b Grouping Variable restorative technique

Tables IX4a-b Mann-Whitney test for comparisons of microleakage values

between incremental technique and mixed technique

Ranks

Restorative technique N Mean Rank Sum of Ranks

scores

frequency

B ndash incremental

technique

20 2990 29900

C ndash mixed technique 20 1210 12100

Total 40

Test Statisticsb

scores

frequency

Mann-Whitney U 5500

Wilcoxon W 121000

Z -3492

Asymp Sig (2-tailed) 000

Exact Sig [2(1-tailed Sig)] 000a

a Not corrected for ties

23

Test Statisticsb

scores

frequency

Mann-Whitney U 5500

Wilcoxon W 121000

Z -3492

Asymp Sig (2-tailed) 000

Exact Sig [2(1-tailed Sig)] 000a

a Not corrected for ties

b Grouping Variable tehnrestaurare

The results of microleakage degree were statistically significant when the

three restorative techniques were compared The results showed that best restorative

technique regarding marginal sealing in cervical area is combined technique followed

by oblique layering technique The use of layering techniques limits the development

of contraction forces between oposite walls event that favourises bulk stress voids

formation and fissure inside dental tissues The results of our study are similar with

other studies (114 293)

IX5 CONCLUSIONS

The values of die penetration at gingival wall were statistically different

between the three restorative techniques

We concluded that all restorative methods were associated with lightcuring

contraction and marginal microleakage

The combined technique was associated with lowest lightcuring contraction

and die penetration

The bulk technique was associated with highest lightcuring contraction and die

penetration

24

CHAPTX STUDY REGARDING THE EFFECTS OF ETCHING ON

ENAMEL AND DENTINE IN CERVICAL AREA FOR PROXIMAL

CAVITIES AT LATERAL DENTAL GROUP

X1 INTRODUCTION

The studies reported marginal defects and high microleakage at the level of

gingival margins localised in cervical area or close to enamel-cement jonction for

high percents of proximal-occlusal composite resins restorations (8485) The good

adhesion is requested to insure restoration longevity and to prevent marginal

microleakage and presence of secondary marginal dental caries The adhesion

strenght of different adhesive systems can vary accordingly to tissues areas (204 240)

and to variations in dentinal structures (234 330) Most studies focused on adhesive

systems performances used healthy dentine close to pulp room but in case of class II

restorations there are particular features that influences the adhesion at the level of

gingival margins

The surface topography is an important property that determines the

interaction manner between surfaces The surface roughness and surface energy can

increase or decrease the adhesion of composite resins to the hard dental tissues

X2 AIM OF STUDY

The aim of study was to compare surface roughness of enamel and dentine

after etching related to different distances related to enamel-dentinecement jonction

X3 MATERIALS AND METHODS

The study group included 20 molars extracted from orthodontics or

periodontal reasons with intact proximal surfaces The teeth were cut longitudinally in

sens buccal-oral with diamond discs under water cooling

A group study (10 teeth) included 10 samples obtained through transversal

cutting at distance of 2mm from enamel-dentinecement jonction and 10 samples

obtained through transversal cutting at distance of 15 mm from enamel-

dentinecement jonction Another study group (10 teeth) included 10 samples

obtained through transversal cutting at distance of 1mm from enamel-dentinecement

jonction and 10 samples obtained through transversal cutting at distance of 05 mm

from enamel-dentinecement jonction All these samples were divided in two halfes

through mesial-distal cutting The samples finishing was performed with abrasive

paper (100-4000) and final polishing was performed with a device Buehler model

Minimet with slices introduced in ultrasound bath for 4 minutes The second half of

each sample was etched for 15 seconds with ortophosphoric acid 37 for 15 seconds

Slices were washed with distilled water for 30 seconds after etching and dried

The samples were analysed with atomic force microscopy (AFM) regarding

surface roughness The results were expressed as relative variation of roughness

X4 RESULTS AND DISCUSSIONS

The aspect of etched enamel at 2 mm distance from ECJ can be seen in figure

X1 (section 10 microm) The surface roughness is higher comparing with sample before

etching

25

După gravajul cu acid ortofosforic 37

The aspect of etched enamel at 15 mm distance from ECJ can be seen in

figure X2 (section 10 microm) The surface roughness is higher comparing with sample

before etching but lower comparing with sample at 2 mm from ECJ

The aspect of etched enamel at 1 mm distance from ECJ can be seen in figure

X3 (section 10 microm) The surface roughness is higher comparing with sample before

etching but lower comparing with sample at 15mm and 2 mm from ECJ

The aspect of etched enamel at 15 mm distance from ECJ can be seen in

figure X4 (section 10 microm) The surface roughness is higher comparing with sample

before etching but lower comparing with sample at 1 mm 15 mm and 2 mm from

ECJ

FigX1 3D aspect of enamel at 2 mm from ECJ

after etching (10 microm)

FigX2 3D aspect of enamel at 15 mm from ECJ

after etching (10 microm)

FigX3 3D aspect of enamel at 1 mm from ECJ

after etching (10 microm)

FigX4 3D aspect of enamel at 05 mm from ECJ

after etching (10 microm)

26

The mean values of squared roughness for dentine and enamel before etching

are presented in tables X1 and X2

Table X1 Squared roughness values for dentine samples before and after etching

Before etching (nm) After etching (nm)

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

sample

1

335 282 283 259 1149 947 901 879

sample

2

352 284 274 266 1127 939 883 875

sample

3

357 273 278 263 1152 953 876 867

sample

4

323 269 264 258 1146 942 895 883

sample

5

348 298 271 268 1153 944 904 878

sample

6

339 274 278 273 1158 937 893 892

sample

7

352 283 269 266 1145 944 899 876

sample

8

349 292 272 274 1166 942 907 869

sample

9

357 284 275 265 1132 939 893 879

sample

10

348 281 277 262 1142 941 899 878

Table X2 Squared roughness values for enamel and dentine samples before and after

etching

Before etching (nm) After etching (nm)

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

sample 1 422 342 309 313 2255 1114 874 845

sample 2 418 338 324 304 2236 1102 882 839

sample 3 413 334 315 303 2239 1115 873 833

sample 4 416 336 322 308 2242 1116 868 842

sample 5 426 332 315 294 2218 1103 877 829

sample 6 412 332 317 306 2237 1099 874 847

sample 7 414 335 322 314 2252 1102 876 834

sample 8 416 325 318 313 2239 1106 875 838

sample 9 418 328 314 299 2246 1113 879 836

sample 10 413 334 316 305 2242 1104 873 839

The results for samples before etching prove a decreasing tendency for mean

values of squared roughness surface beginning with areas placed at distance of 2 mm

from ECJ (346 nm) followed by areas placed at distance of 15 mm from ECJ (282

nm) 1 mm from ECJ (274 nm) and 05 mm from ECJ (265 nm) After etching the

decreasing tendency maintained for dentine localised at 2 mm from ECJ to dentine

localised at 05 mm from ECJ The mean values of squared roughness after etching

were three times higher (tables X3)

27

Table X3 Squared roughness values for enamel and dentine samples before and

after etching

Dentine Enamel

Before etching

(nm)

After etching

(nm)

Before etching

(nm)

After etching

(nm)

2 mm ECJ 346 1147 416 2237

15 mm ECJ 282 942 333 1107

1 mm ECJ 274 895 317 875

05 mm ECJ 265 877 305 838

The descriptive statistics data for surface roughness of dentine before and after

etching are presented in tables X4 si X5

Table X4 Descriptive statistics for dentine samples before etching

Statistics

Dentine 2mm

before etching

Dentine 15mm

before etching

Dentine 1mm

before etching

Dentine 05mm

before etching

N Valid 10 10 10 10

Missing 0 0 0 0

Mean 346000 282000 274100 265400

Std Error of Mean 33830 27487 17026 16746

Std Deviation 106979 86923 53841 52957

Skewness -1214 354 -314 348

Std Error of Skewness 687 687 687 687

Kurtosis 1141 049 336 -539

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 3230 2690 2640 2580

Maximum 3570 2980 2830 2740

Table X5 Descriptive statistics for dentine samples after etching

Statistics

Dentine 2mm

after etching

Dentine 15mm

after etching

Dentine 1mm

after etching

Dentine 05mm

after etching

N Valid 10 10 10 10

Missing 0 0 0 0

1147000 942800 895000 877600

Std Error of Mean 36545 14591 29926 22020

Std Deviation 115566 46140 94634 69634

Skewness -267 1169 -951 535

Std Error of Skewness 687 687 687 687

Kurtosis 043 1776 564 1416

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 11270 9370 8760 8670

28

Statistics

Dentine 2mm

after etching

Dentine 15mm

after etching

Dentine 1mm

after etching

Dentine 05mm

after etching

N Valid 10 10 10 10

Missing 0 0 0 0

1147000 942800 895000 877600

Std Error of Mean 36545 14591 29926 22020

Std Deviation 115566 46140 94634 69634

Skewness -267 1169 -951 535

Std Error of Skewness 687 687 687 687

Kurtosis 043 1776 564 1416

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 11270 9370 8760 8670

Maximum 11660 9530 9070 8920

To choose the statistical test to compare roughness surface values was

performed a test Shapiro-Wilk If p is lower or equal with 0005 than hypothesis of

distribution normality is rejected (distribution deviates from normal form) In the table

X6 the distributions are normal The statistical test will be test t for pair samples

Table X6 Test Shapiro-Wilk for dentine samples

Tests of Normality

Kolmogorov-Smirnov

a Shapiro-Wilk

Statistic df Sig Statistic df Sig

Dentine 2mm before etching 274 10 032 877 10 122

Dentine 15mm after etching 209 10 200 952 10 689

Dentine 1mm before etching 134 10 200 983 10 980

Dentine 05mm before etching 155 10 200 949 10 661

Dentine 2mm after etching 133 10 200 977 10 946

Dentine 15mm after etching 197 10 200 916 10 329

Dentine 1mm after etching 216 10 200 925 10 401

Dentine 05 after etching 220 10 185 933 10 474

Enamel 2mm before etching 193 10 200 898 10 207

Enamel 15mm before etching 170 10 200 977 10 947

Enamel 1mm before etching 157 10 200 952 10 689

Enamel 05mm before etching 165 10 200 943 10 590

Enamel 2mm after etching 235 10 124 925 10 404

Enamel 15mm after etching 209 10 200 871 10 102

Enamel 1mm after etching 189 10 200 964 10 834

Enamel 05mm after etching 142 10 200 983 10 978

a Lilliefors Significance Correction

29

Tests of Normality

Kolmogorov-Smirnov

a Shapiro-Wilk

Statistic df Sig Statistic df Sig

Dentine 2mm before etching 274 10 032 877 10 122

Dentine 15mm after etching 209 10 200 952 10 689

Dentine 1mm before etching 134 10 200 983 10 980

Dentine 05mm before etching 155 10 200 949 10 661

Dentine 2mm after etching 133 10 200 977 10 946

Dentine 15mm after etching 197 10 200 916 10 329

Dentine 1mm after etching 216 10 200 925 10 401

Dentine 05 after etching 220 10 185 933 10 474

Enamel 2mm before etching 193 10 200 898 10 207

Enamel 15mm before etching 170 10 200 977 10 947

Enamel 1mm before etching 157 10 200 952 10 689

Enamel 05mm before etching 165 10 200 943 10 590

Enamel 2mm after etching 235 10 124 925 10 404

Enamel 15mm after etching 209 10 200 871 10 102

Enamel 1mm after etching 189 10 200 964 10 834

Enamel 05mm after etching 142 10 200 983 10 978

a Lilliefors Significance Correction

This is a lower bound of the true significance

The results of test t for pair dentine samples before and after etching are

presented in table X

Table X7 Test t for dentine before and after etching

Paired Samples Test

Paired Differences

t df

p (2-

tailed)

95 Confidence

Interval of the

Difference

Mean

Std

Dev

Std

Error

Mean Lower Upper

Pair

1

dentine2mmbeforeetching-

dentine2mmafteretching

-

8010000

174801 55277 -

8135045

-

7884955

-

144906

9 000

Pair

2

dentine15mmbeforeetching-

dentine15mmafteretching

-

6608000

102394 32380 -

6681248

-

6534752

-

204079

9 000

Pair

3

dentine1mmbeforeetching-

dentine1mmafteretching

-

6209000

117799 37251 -

6293269

-

6124731

-

166678

9 000

30

Paired Samples Test

Paired Differences

t df

p (2-

tailed)

95 Confidence

Interval of the

Difference

Mean

Std

Dev

Std

Error

Mean Lower Upper

Pair

1

dentine2mmbeforeetching-

dentine2mmafteretching

-

8010000

174801 55277 -

8135045

-

7884955

-

144906

9 000

Pair

2

dentine15mmbeforeetching-

dentine15mmafteretching

-

6608000

102394 32380 -

6681248

-

6534752

-

204079

9 000

Pair

3

dentine1mmbeforeetching-

dentine1mmafteretching

-

6209000

117799 37251 -

6293269

-

6124731

-

166678

9 000

Pair

4

dentine05mmbeforeetching-

dentine05mmafteretching

-

6122000

86384 27317 -

6183796

-

6060204

-

224109

9 000

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of dentine (

2mm 15 mm 1mm sau 05mm)

The descriptive statistics data for dentine surface roughness before and after

etching are presented in tables X8 and X9

Table X8 Descriptive statistics for enamel samples before etching

Statistics

Enamel 2mm

before etching

Enamel 15mm

before etching

Enamel 1mm

before etching

Enamel 05mm

before etching

N Valid 10 10 10 10

Missing 0 0 0 0

Mean 416800 333600 317200 305900

Std Error of Mean 13968 15217 14205 20355

Std Deviation 44171 48120 44920 64369

Skewness 1095 -156 -109 -411

Std Error of Skewness 687 687 687 687

Kurtosis 769 487 -118 -295

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 4120 3250 3090 2940

Maximum 4260 3420 3240 3140

31

Table X9 Descriptive statistics for enamel samples after etching

Statistics

Enamel 2mm

after etching

Enamel 15mm

after etching

Enamel 1mm

after etching

Enamel 05mm

after etching

N Valid 10 10 10 10

Missing 0 0 0 0

Mean 2237600 1107400 875100 838200

Std Error of Mean 31027 20232 11968 17436

Std Deviation 98116 63979 37845 55136

Skewness -850 267 042 040

Std Error of Skewness 687 687 687 687

Kurtosis 878 -1880 1082 -425

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 22180 10990 8680 8290

Maximum 22520 11160 8820 8470

To choose the statistical test to compare roughness surface values was

performed a test Shapiro-Wilk If p is lower or equal with 0005 than hypothesis of

distribution normality is rejected (distribution deviates from normal form) In the table

X10 the distributions are normal The statistical test will be test t for pair samples

Table X10 Test Shapiro-Wilk for enamel samples

Tests of Normality

Kolmogorov-Smirnova Shapiro-Wilk

Statistic df Sig Statistic df Sig

2mmenamel before etching 193 10 200 898 10 207

15mmenamel before etching 170 10 200 977 10 947

1mmenamel before etching 157 10 200 952 10 689

05mmenamel before etching 165 10 200 943 10 590

2mmenamel after etching 235 10 124 925 10 404

15mmenamel after etching 209 10 200 871 10 102

1mmenamel after etching 189 10 200 964 10 834

05mmenamel after etching 142 10 200 983 10 978

a Lilliefors Significance Correction

This is a lower bound of the true significance

The results of test t for pair enamel samples before and after etching are

presented in table X11

32

Table X11 Test t for enamel samples before and after etching

Paired Samples Test

Paired Differences

t df

p (2-

tailed)

95 Confidence

Interval of the

Difference

Mean

Std

Deviation

Std

Error

Mean Lower Upper

Pair

1

2mmenamel before

etching

2mmenamel after

etching

-18208 135220 42760 -

18304731

-

18111269

-

425815

9 000

Pair

2

15mmenamel before

etching

15mmenamel after

etching

-7738 73151 23132 -7790329 -7685671 -

334508

9 076

Pair

3

1mmenamel before

etching

1mmenamel after

etching

-5579 55468 17540 -5618679 -5539321 -

318065

9 065

Pair

4

05mmenamel before

etching

05mmenamel after

etching

-5323 60378 19093 -5366192 -5279808 -

278788

9 063

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel ( 2mm 15 mm 1mm sau

05mm) but the differences statistical significant are present only for enamel localised

at 2 mm from ECJ

X5CONCLUSIONS

The surfaces of enamel and dentine at cervical level record decreases of

roughness related to the decrease of distance to ECJ

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel but the differences

statistical significant are present only for enamel localised at 2 mm from ECJ

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of

dentine

33

CHAPTXI FEA STUDY REGARDING THE BIOMECHANICAL

BEHAVIOUR AND FRACTURE RESISTANCE OF PROXIMO-OCCLUSAL

AMALGAM AND COMPOSITE RESINS RESTORATIONS

XI1INTRODUCTION AIM OF STUDY

The individual variation of patients morphological and functional complexity

of tissues as well as difficult access limit the possibilities to investigate in clinical

studies the biomechanical behaviour of proximo-occlusal restorations In this context

simulation of the biomechanics for direct restorations represents an interesting

interdisciplinar domain in actual dentistry research

The study focused on two direction

- analysis of role of forces intensity on biomechanical behaviour related to

cavity dimension and material

- analysis of tension inside restoration structure related to forces intensity

XI2MATERIALS AND METHODS

The stages of finite element analysis study are as follows

object modelling (bicusps and proximo-occlusal restoration)

definition of parameters for materials and dental tissues

meshing

constraints and loading

types of contacts

equations system definition

results of simulation

The object 3D modelling was performed in Rhinoceros (figure XI1) The

definition of parameters was performed for Poisson constant Young modulus density

(table XI1) The selected materials were amalgam and composite resins The

analysed tissues were dentine and enamel The meshing constraints loading were

performed for forces of 200N 400N 600N 800 N The analysis was performed using

software COSMOSWorks 2010

34

Fig XI1 3D modellation of bicusp

Table XI1 Values of Young modulus Poisson constant compression resistance for

amalgam composite resin enamel (amalgam compozit smalţ)

Material Young modulus (GPa) Poisson constants

Compression

resistance

(Mpa)

Amalgam 55 033 483

Enamel 48 03 400

Composite

resin 220 022 345

Fig XI2 The forces and constraints application

The results are presented in values and culours red colours representing areas

with maximum values of tensions produced under influence of masticatory forces

The tensions produced in amalgam restoration are in a range from 0 to 22886

(force 800 N) The maximum von Misses tensions are associated with cervical area

of amalgam restorations This aspect proves that first modification in interface

restoration-cavity margins will appear at the level of gingival wall First marginal

35

defects and fissures in restoration bulk will appear at tensions over 1600Mpa

associated with forces of 800N for extended amalgam proximo-occlusal restorations

The tensions produced in composite resin restorations are in a range from 0 to

2285 (force 800 N) The maximum von Misses tensions are associated with cervical

area of composite resin restorationsThis aspect proves that first modification in

interface restoration-cavity margins will appear at the level of gingival wall First

marginal defects and fissures in restoration bulk will appear at tensions over 1716

Mpa associated with forces of 600N for moderate and extended composite resins

proximo-occlusal restorations

Fig XI3a-b ndash Simulated model of proximo-occlusal restoration

FigXI4a-b Dental amalgam restoration Cervical tension associated with 600 N

(c)800 N (d)

FigXI5a-b Composite resin restoration Cervical tension associated with 600 N

(c)800 N (d)

36

The deformation of amalgam can be produced only when is associated with

fissures in bulk of restorations while composite resins restorations present

deformation when are associated with a modification of volume and form because of

repeated action of medium forces on long term or high forces on short term (figures

XI4 XI5)

Fig XI4 Material deformation in area of maximum tension

000E + 00

500E -02

100E -01

150E -01

200E -01

250E -01

1 4 7 101316192225283134374043464952555861646770737679

Amalgam C ompoz it

Figura XI5 Deformarea funcție de material

The amalgam and composite resins were treated as homogenous isotropic and

liniar The advantage of this type of FEA study is that restorations parameters can be

modified any time is necessary both in arhitecture geometry and material indices

variability The results of this study sustain the conclusions of other FEA studies

focused on biomechanical behaviour of posterior restorations performed with

amalgam and composite resins(35 62 76 143)

37

XI4CONCLUSIONS

bull The amalgam in class II restorations has a low deformation tendency because

of uniform distribution of tension inside material

bull Composite resins class II restorations accumulate higher tensions comparing

with amalgam but deformation is avoided for a time because of the adhesion

forces performed between molecules under moderate oral forces In case of

high oral forces (600-800N) the risk of fracture in moderate class II

restorations is higher comparing with amalgam proximo-occlusal restorations

For extended class II restorations and forces of 600 N composite resins present

highest risk of fracture and deformation The von Misses tension at the

cervical interface restorationtooth can reach 1600Mpa

bull The amalgam in moderate class II restorations can resist to deformation even

for high intensity forces limited to 600N In extended class II restorations the

risk of deformation and fracture increases at values of 600N-800N of oral

forces The von Misses tension at the cervical interface restorationtooth can

reach 1700 Mpa

38

FINAL CONCLUSIONS

Amalgam proximo-occlusal restorations with minimum 6-years age present

excellent results for parameters anatomic form (occlusal) marginal

discoloration and marginal secondary dental caries good results for

parameters anatomic form (proximal) and marginal adaptation and poor results

for surface quality

Composite resins proximo-occlusal restorations (bicusps) with minimum 6-

years age present excellent results for parameters color match marginal

discoloration and marginal secondary dental caries and good results for

parameters anatomic form (occlusal proximal) marginal adaptation surface

quality

Composite resins proximo-occlusal restorations (molars) with minimum 6-

years age present good results for parameters color match marginal

discoloration marginal secondary dental caries marginal adaptation and poor

results for parameters anatomic form (occlusal) (54 indices Ryge C)

anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The restorations extended at external third of occlusal surface present highest

percents of indices C regarding anatomic form (occlusal) (54 indices Ryge

C) anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The exceeding of 6-years age will require careful monitorisation for early

interventions through polishing sealing reshaping and even replacement for

restorations with major defects

Oblique layering technique presents superior results regarding marginal

adaptation and marginal discoloration and is recommended for proximo-

occlusal dental caries close to enamel-cement jonction

Centripetal build-up presents good results regarding marginal adaptation and

anatomical form at proximal level (proximal surfaces and contact point)

Horisontal layering technique can be used for optimum results only in

proximal-occlusal cavities with moderate extension both in occlusal-cervical

and buccal-oral

The values of die penetration at gingival wall were statistically different

between the three restorative techniques

We concluded that all restorative methods were associated with lightcuring

contraction and marginal microleakage

The combined technique was associated with lowest lightcuring contraction

and die penetration

The bulk technique was associated with highest lightcuring contraction and die

penetration

39

The surfaces of enamel and dentine at cervical level record decreases of

roughness related to the decrease of distance to ECJ

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel but the differences

statistical significant are present only for enamel localised at 2 mm from ECJ

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of

dentine

bull The amalgam in class II restorations has a low deformation tendency because

of uniform distribution of tension inside material

bull Composite resins class II restorations accumulate higher tensions comparing

with amalgam but deformation is avoided for a time because of the adhesion

forces performed between molecules under moderate oral forces In case of

high oral forces (600-800N) the risk of fracture in moderate class II

restorations is higher comparing with amalgam proximo-occlusal restorations

For extended class II restorations and forces of 600 N composite resins present

highest risk of fracture and deformation The von Misses tension at the

cervical interface restorationtooth can reach 1600Mpa

bull The amalgam in moderate class II restorations can resist to deformation even

for high intensity forces limited to 600N In extended class II restorations the

risk of deformation and fracture increases at values of 600N-800N of oral

forces The von Misses tension at the cervical interface restorationtooth can

reach 1700 Mpa

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Statement on posterior resin-based composites JADA 1998 129(11)1627ndash1628

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6Aggarwal V Logani A Jain V Shah N Effect of cyclic loading on marginal

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Oper Dent 2008 Sep-Oct33(5)587-92

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15Anusavice KJ Development and testing of ceramics for dental restorations In

Fischman G Clare A Hench J editors Bioceramics materials and applications

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16Arhun N Celik C Yamanel KClinical evaluation of resin-based composites in

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17Armstrong SR JC Keller DB Boyer The influence of water storage and C-

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18Armstrong S Boyer D Keller J Microtensile bond strength testing and failure

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19Asmussen E Peutzfeldt A Influence of UEDMA BisGMA and TEGDMA on

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26Bader JD Shugars DA Understanding dentistslsquo restorative treatment decisions J

Public Health Dent 1992 Winter52(2)102-10

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Dent 199158 36-39

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Educ 200569(5)571ndash585

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30Behle C Flowable composite Proprieties and applications Pract Periodontics

Aesthetics Dent 1998 10347 350-351

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33Black J Biological Performance of Materials Fundamentals of Biocompatibility

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9

35Boschian PL S Guidotti R Pietrbissa M Gagliani- bdquoStress distribution in a

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36Bouillaguet S B Ciucchi T Jacoby JC Wataha DH Pashley Bonding

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39Braga RR Ballester RY Ferracane JLFactors involved in the development of

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42Brunthaler A Koumlnig F Lucas T Sperr W Schedle A Longevity of direct resin

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45Burke FJ Cheung SW Mjoumlr IA Wilson NH Restoration longevity and analysis

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46Burke FJ Cheung SW Mjor IA Wilson NH-Reasons for the placement and

replacement of restorations in vocational training practicePrimary Dental Care

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2004 20939-946

49Cardoso P Sadek F Microtensile bond strength on dentin using new adhesive

systems with selfetching primers Braz J Oral Sci 2003 2(4) 156-159

50Cardoso M Baratieri LN Ritter AV The effect of finishing and polishing on

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51Carvalho RM JC Pereira M Yoshiyama DH Pashley A review of

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53Cattaneo PM M Dalstra B Melsen- bdquoThe Finite Element Method a Tool to

Study Orthodontic Tooth Movement J Dent Res 2005 84(5)428-433

54Cattell MJ Clarke RL Lynch EJ The transverse strength reliability and

microstructural features of four dental ceramicspart 1 J Dent 25(5)399-407 1997

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57Cenci M Demarco F de Carvalho R Class II composite resin restorations with

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marginal leakage J Dent 2005 33(7) 603- 610

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Med 2008173(1)23ndash26

59Chen HY Manhart J Hickel R Kunzelmann KH Polymerization contraction

stress in light-cured packable composite resinsDent Mater 200117253-259

60Choi KK Condon JR Ferracane JL The effects of adhesive thickness on

polymerization contraction stress of composites J Dent Res 2000 79812ndash817

61Cichon P Kerschbaum T Verweildauer zahnartzlicher Restaurationen bei

Behinderten Dtsch Zahnartzlicher 1999 54 96-102

62Cohen BI Pagnillo MK Deutsch ASMusikant BL Fracture Strength of

Three Core Restorative Materials Supported with or without a Prefabricated Split-

Shank Post Journal of Prosthetic Dentistry1997 78 560ndash565

63Colli P Brannstrom M The marginal adaptation of four different bonding agents

in Class II composite resin restoration applied in bulk or in two increments

Quintessence Int 1993 24583-591

43

64Collins CJ Bryant RW Hodge KL A clinical evaluation of posterior composite

resin restorations 8-year findings J Dent 199826(4) 311ndash317

65Condon JR Ferracane JL Assessing the effect of composite formulation on

polymerization stress J Am Dent Assoc2000 131497-503

66Cook WD Moopnar M Influence of chemical structure on the fracture

behaviour of dimethacrylate composite resins Biomaterials 1990 11272-276

67Cortes DF Ellwood RP Ekstrand KR An in vitro comparison of a combined

FOTIvisual examination of occlusal caries with other caries diagnostic methods and

the effect of stain on their diagnostic performance Caries Res 2003 37 (1) 8-16

68Crim GA Microleakage of three resin placement techniques Am J Dent

1991469-72

69Dauvillier B Aarnts M Feilzer A The competition between the composite-

dentin strength and the polimerization contraction stress J Dent Res 1984 63 1396-

1399

70Dauvillier BS Aarnts MP Feilzer AJ Developments in shrinkage control of

adhesive restoratives J Esthet Dent 2000 12291-299

71Dauvillier BS Aarnts MP Feilzer AJ Modeling of the viscoelastic behavior of

dental light-activated resin composites during curing Dent Mater 200319277ndash285

72Davidson CL Gee AJ Feilzer A The competition between the composite-dentin

bond strength and the polymerization contraction stress J Dent Res 1984

63(12)1396-9

73Davidson CL AJ Feilzer Polymerization shrinkage and polymerization

shrinkage stress in polymer-based restoratives J Dent Res 199725435ndash440

74Davidson CL Resisting the curing contraction with adhesive composites J

Prosthet Dent 198655446ndash7

75Davis RD Mayhew RB A clinical comparison of three anterior restorative resins

at 3 years J Am Dent Assoc 1986112659-63

76Dejak B Mlotkowski A Three-dimensional finite element analysis of strength

and adhesion of composite resin versus ceramic inlays in molarsJ Prosthet

Dent200899131-40

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1331387ndash97

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Dent20104(3)270-9

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2006 22359-365

44

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848

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1243

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Biology199843(8)629-632

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817-822

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201989117ndash121

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18(7)516-20

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Jan11(1)34-40

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JDent 199826 627-632

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1999 15128-137

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Pendefunda 180Sorina Solomon Topoliceanu C Elements of dispersional

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Edition of the Balkan Medical Days

Stomatological Section Abstract nr1091999128

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Dentistry and Oral Epidemiology 1996 24 106-11

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Dent Mater 2002 18436-444

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20(3)236-43

188Loguercio AD Reis A Schroeder M Balducci I Versluis A Ballester RY

Polymerization shrinkage effects of boundary conditions and filling technique of

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50

189Lopes GC Baratieri LN Monteiro S Jr Vieira LC Effect of posterior resin

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Quintessence Int 2004 35(2)156-61

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196Mair LH Ten-year clinical assessment of three posterior resin composites and

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Dentomaxillofac Radiol 2007 Oct36(7)377-81

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J Prosthet Dent 2000 Sep84(3)289-96

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Three-year clinical evaluation of composite and ceramic inlays Am J Dent 2001

Apr14(2)95-9

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79369 (Abstract)

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deformation Dent Mater 200117241ndash246

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PrimDentCare1999Apr659-62

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Quintessence 198961-80

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ScandJDRes 199210060-65

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33

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19904011ndash7

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Am Dent Assoc 2010 141(3)319-29

52

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125749-751

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composites Oper Dent 23 1998282ndash289

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bond strength to dentin in resin composite restorations Dent Mater 200925(1)129-

34

227Neuhaus KW Ellwood R Lussi A Pitts N Traditional lesion detection aids

Monogr Oral Sci 20092142-51

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Influence of the Discomfort Reported by Children on the Performance of Approximal

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Restorative Materials In Class I And Class II Restorations An In-Vivo Study The

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Regional variability in the permeability of human dentine Arch Oral Biol

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53

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self-curing resin composite linings on microleakage in vitro Oper Dent 200227

569ndash575

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Community Dent Oral Epidemiol 1999 Oct27(5)331-7

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(2) 93-98

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Community Dent Oral Epidemiol 1980 Jun8(3)135-8

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Dent Mater 1989 5 392-398

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volumetric polymerization shrinkage and bulk modulus of dental composites and an

unfilled resin Am J Dent 200013176ndash180

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placement techniques on marginal microleakage of deep class-II cavities restored with

two composite resin formulations J Conserv Dent 2010 13(1) 9ndash15

54

256Radu TM A Uliuliuc Dana Apostolide S Andrian The effect of adhesive

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Soc Med Iaşi-2008 vol112 nr1supl1145-147

257Raskin A Michotte-Theall B Vreven J Wilson NH Clinical evaluation of a

posterior composite 10-year report J Dent 199927(1) 13ndash19

258Rasmusson CG Lundin SA Class II restorations in six different posterior

composite resins Five-year results Swed Dent J 1995 19 173-182

259Rezwani-Kaminski T Kamann W Gaengler P Secondary caries susceptibility

of teeth with long-term performing composite restorations J Oral Rehabil 2002

29(12)1131ndash1138

260Roberson TM Heymann HO Swift EJ eds Sturdevantlsquos Art and Science of

Operative Dentistry 5th ed St Louis Mosby 2006293-7

261Robertello FJ Pink FE The effect of a training program on the reliability of

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262Rodrigues JSA Pin LF Machado G Della Bona A Demarco FF Influence

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J Appl Oral Sci 2010 Feb18(1)37-43

263Roulet JF Noack MJCriteria for substituting amalgam with composite resins

Int Dent J 199141(4)195-205

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265Roulet JF Longevity of ceramic inlays and amalgam- results up 6 years

ClinOral Invest1997140-46

266Roulet JFBenefits and disadvantages of tooth-coloured alternatives to amalgam

J Dent 199725(6)459-73

267Rueggeberg FA WF Caughman JW Curtis Jr HC Davis Factors

affecting cure at depths within light-activated resin composites Am J Dent

1993691ndash95

268Rueggeberg FA Ergle JW Mettenburg DJ Polymerization depths of

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269Rushton VE Horner K Worthington HV Screening panoramic radiography

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270Ruyter IE Types of resin-based inlay materials and their properties Int Dent J

199242(3)139-44

271Sajjan GS Mittal NEffect of different placement techniques on marginal

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J Conserv Dent 201013(1)9-15

272Sakaguchi RL MC Peters SR Nelson WH Douglas HW Poort Effects

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273Sakaguchi RL Shah NC Lim BS Ferracane JL Borgersen SE Dynamic

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composites Dent Mater 200218197-202

274Sano H Takatsu T Ciucchi B Horner JA Matthews WG Pashley DH

Nanoleakage leakage within the hybrid layer Oper Dent 1995 20 18-25

55

275Sarrett DC Clinical challenges and the relevance of materials testing for

posterior composite restorations Dent Mater 200521(1) 9ndash12

276Sarrett DC Brooks CN Rose JT Clinical performance evaluation of a

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277Shackelford JF Introduction to Materials Science for Engineers fourth

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278Schirrmeister JF Huber K Hellwig E Hahn P Four-year evaluation of a resin

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404

279Schneiderman A Elbaum M Schultz T Keem S Greenebaum M Driller J

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280Schulte AG Wittchen A Stachniss V Jacquet W Bottenberg P Approximal

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281Shortall AC Marginal seal comparisons between resinbonded Class II porcelain

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Prosthodont19892(3)217-223

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284Sengun A Unlu N Ozer F Ozturk B Bond strength of five current adhesives

to caries-affected dentin J Oral Rehabil 2002 29 777-781

285Setcos JC Staninec M Wilson NH- A two-year randomized controlled

clinical evaluation of bonded amalgam restorations- Journal of Adhesive Dentistry

nr11999

286Sideridou I Tserki V Papanastasiou G Effect of chemical structure on degree

of conversion in light-cured dimethacrylate-based dental resins Biomaterials 2002

231819-1829

287Sideridou I Tserki V Papanastasiou G Study of water sorption solubility and

modulus of elasticity of light-cured dimethacrylate-based dental resins Biomaterials

2003 24655-665

288Sidi AD Naylor MN A comparison of bitewing radiography and interdental

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289SilverFH Christiansen DLBiomaterials Science and Biocompatibility New

York Springer-Verlag 1999

290Simecek JW Diefenderfer KE Ahlf RL Ragain JC Jr Longitudinal trends in

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200382 1169 (Abstract)

291Simecek JW Diefenderfer KE Ahlf RL Ragain JC Jr Dental sealant

longevity in a cohort of young US naval personnel JADA 2005136(2)171ndash178

56

292Simi B Suprabha B Evaluation of microleakage in posterior nanocomposite

restorations with adhesive liners J Conserv Dent 201114(2)178-81

293Simone D David N B An alternative to reduce polimeryzation shrinkage in

direct posterior restorations JADA 2002 101387-1398

294Smales RJ Longevity of cusp-covered amalgams survivals after 15 years

OperDent 1991 16 17-20

295Smales RJ Webster DA Leppard PISurvival predictions of amalgam

restorations JDent1991 19 272-277

296Smales RJ Hawthorne WSLong-term survival of extensive amalgams and

posterior crowns JDent 1997 25 225-227

297Soncini JA Maserejian NN Trachtenberg F Tavares M Hayes C The

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Am Dent Assoc 2007 Jun138(6)763-72

298Sonoda H Banerjee A Sherriff M Tagami J Watson TF An in vitro

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299Soodabeh Kimyai Masomeh Mehdipour Siavash Savadi Oskoee Reasons

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300De Souza FB Guimaraes RP Vicente Silva CH A clinical evaluation of

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International 2005 36 41-48

301Spreafico RC Gagliani M Composite resin restorations on posterior teeth In

Roulet JF Degrange M Adhesion The silent revolution in dentistry Chicago

Quintessence 2000253ndash76

302St Georges AJ Wilder AD Jr Perdigao J Microleakage of Class V composites

using different placement and curing techniques an in vitro study Am J Dent 2002

15244-247

303Stangel I Barolet RY Clinical evaluation of two posterior composite resins

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Dentistry and Oral Epidemiology 1987 15 (2) 90-94

305Sturdevant JR Bayne SC Heymann HO Margin gap size of ceramic inlays

using second-generation CADCAM equipment J Esthet Dent 11(4)206-214 1999

306Suh BI A study of the compatibility of adhesives with composites Proceeding

from the SCO Dental Products Inc Symposium 2003 24(8) 4-9 (Abstract)

307Summit JB Burgess JO Berry TG Six-year clinical evaluation of bonded and

pin-retained complex amalgam restorations Oper Dent 2004 29269-276

308Summit JB Robbins JW Hilton TJ Fundamentals in operative dentistry Cap

10Direct Posterior Esthetic Restorations 2006 Quintessence Publishing Co

57

309Svanberg M Mjor IA Orstavik D Mutans streptococci in plaque from margins

of amalgam composite and glassndashionomer restorations J Dent Res 199069861ndash

864

310Tanne K Mamoru S Burstone C Three-dimensional finite element analysis

for stress in the periodontal tissue by orthodontic forcesAm J Orthod Dentofacial

Orthop921987499ndash505

311Tanumiharja M Burrow MF Tyas MJ Microtensile bond strengths of seven

dentin adhesive systems Dent Mater 2000 16(3)180-7

312Tay FR Pashley DH Aggressiveness of contemporary self-etching systems

Part I Depth of penetration beyond dentin smear layers Dent Mater 2001 17(4) 296-

308

313Tay FR Frankenberger R Krejci I Bouillaguet S Pashley DH Carvalho

RM Single-bottle adhesives behave as permeable membranes after polymerization I

In vivo evidence J Dent 2004 32611ndash621

314Tay FR Pashley DH Have dentin adhesives become too hydrophilic J Can

Dent Assoc 2003 69726ndash731

315Tay FR Sano H Carvalho R Pashley EL Pashley DH An ultrastructural

study of the influence of acidity of self-etching primers and smear layer thickness on

bonding to intact dentin J Adhes Dent 2000 283ndash98

316Thompson JY Bayne SC Heymann HO Mechanical properties of a new

mica-based machinable glass ceramic for CADCAM restorations J Prosthet Dent

76(6)619-623 1996

317Unterbrink GL R Muessner Influence of light intensity on two restorative

systems J Dent 199523183ndash189

318Unterbrink GL Liebenberg WH Flowable resin composites as filled

adhesiveslsquo literature review and clinical recommendations Quintessence Int

199930249ndash257

319Vaarkamp J Ten Bosch J Verdonschot EH Quantitative diagnosis of small

approximal caries lesions utilizing wavelength-dependent fiber-optic

transillumination Journal of Dental Research 1997 76 (4) 875-882

320Valachovic RW Douglass CW Reiskin AB Chauncey HH McNeil BJ The

use of panoramic radiography in the evaluation of asymptomatic adult dental patients

Oral Surg Oral Med Oral Pathol 198661(3)289-96

321Van Meerbeek B De Munck J Yoshida Y Inoue S Vargas M Vijay P Van

Landuyt K Lambrechts P Vanherle G Adhesion to enamel and dentin Current

status and future challenges Oper Dent 2003 28 215-235

322Van Meerbeek B Van Landuyt K De Munck JHashimoto M Peumans M

Lambrechts P Yoshida Y Inoue S Suzuki K Technique-sensitivity of

contemporary adhesives Dent Mater J 2005 24(1) 1-13

323Van Meerbeek B Vargas S Inoue S Yoshida Y Peumans M Lambrechts P

Vanherle G Adhesives and cements to promote preservation dentistry Oper Dent

20016 119-144

324Van Meerbeek B Yoshida Y Inoue S Vargas M Abe Y Fukuda R Okazaki

M Lambrechts P Vanherle G Bonding mechanism micro-tensile bond strength of

a 4- MET-based self-etching adhesive J Dent Res 2000 79 249 (Abstract)

58

325Van Nieuwenhuysen JP DrsquoHoore W Carvalho J Qvist V Long-term

evaluation of extensive restorations in permanent teeth J Dent 200331(6)395ndash405

326Venhoven BA de Gee AJ Davidson CL Light initiation of dental resins

dynamics of the polymerization Biomaterials 1996 172313-2318

327Versluis A Douglas WH Cross M Sakaguchi RL Does an incremental filling

technique reduce polymerization shrinkage stresses J Dent Res 1996 75871ndash878

328Vries HC Ruiken HM Konig KG vanrsquot Hof MA Radiographic versus

clinical diagnosis of approximal carious lesions Caries Res1990 24 (5) 364-370

329Waggoner W Ashton J Predictability of cavitation based upon radiographic

appearance comparison of two film types Quintessence International 1989 20(1)

55-60

330Watanabe LG Marshall GW Jr Marshall SJ Dentin shear strength effects of

tubule orientation and intra tooth location Dent Mater 1996 12 109-115

331Watts DC AS Marouf Optimal specimen geometry in bonded-disk

shrinkage-strain measurements on light-cured biomaterials Dent Mater 200016447ndash

451

332Watts DC Marouf AS Al-Hindi AM Photo-polymerization shrinkage-stress

kinetics in resin-composites methods development Dent Mater 2003 191ndash11

333Weaver WS Blank LW Pelleu GB Jr A visible light activated resin cured

through tooth structure GenDent 198836236-7

334Wendt SL Microleakage and cusp fracture resistance of heattreated composite

resin inlays Am J Dent 4(1)10-14 1991

335Wenzel A Hintze H Mikkelsen L Mouyen F Radiographic detection of

occlusal caries in noncavitated teeth A comparison of conventional film radiographs

digitized film radiographs and RadioVisioGraphy-Oral Surg Oral Med Oral Pathol

1991 72 621-6

336Wenzel A Hintze H Perception of image quality in direct digital radiography

after application of various image treatment filters for detectability of dental diseases

Dentomaxillofac Radiol 1993 22 131-4

337Wenzel A Computer-aided image manipulation of intraoral radiographs to

enhance diagnosis in dental practice a review Int Dent J 1993 43 99-108

338Wenzel A Digital radiography and caries diagnosis Dento Maxillo Facial

Radiology 27(1)3-11 1998

339Wenzel A Haiter-Neto F Gotfredsen E Risk factors for a false positive test

outcome in diagnosis of caries in approximal surfaces impact of radiographic

modality and observer characteristics Caries Res 200741(3)170-6

340Wibowo G Stockton L Microleakage of class II composite restorations Am J

Dent 200114177ndash185

341Wilson NHF Wastell DG Norman RD Five-year performance of high-

cooper content amalgam restorations in a multiclinical trial JDent1996 24 203-210

342Winkler MM Katona TR Paydar NH Finite element stress analysis of three

filling techniques for class V light-cured composite restorations J Dent Res

1996751477-83

343Yap AU Effectiveness of polymerization in composite restoratives claiming bulk

placement Impact of cavity depth and exposure time Oper Dent 2000 25113-120

59

344Yeşilyurt C Bulucu B Bond strength of total-etch dentin adhesive systems on

peripheral and central dentinal tissue a microtensile bond strength test The Journal of

Contemporary Dental Practice 7(2) 20061-13

345Yoshida Y Van Meerbeek B Okazaki M Shintani H Suzuki K Comparative

study on adhesive performance of functional monomers J Dent Res 2004 83 454-

458

346Yoshiyama M Tay FR Doi J Nishitani Y Yamada T Itou K Carvalho RM

Nakajima M Pashley DH Bonding of self-etch and total etch adhesives to carious

dentin J Dent Res 2002 81 556-560

  • COPERTA REZUMAT ENGLEZA (MEREUTA)pdf
  • REZUMAT ENGLEZA DR MEREUTA DENISSpdf
Page 19: UNIVERSITATEA DE MEDICINA SI FARMACIE “GR Doctorat/Rezumat... · universitatea de medicina si farmacie “gr.t.popa” iasi facultatea de medicina dentara rezumatul tezei de doctorat

16

Tables VIII7a-b Mann-Whitney test Comparing analysis regarding marginal

discoloration between restorations performed using centripetal build-up technique and

horisontal layering technique

Ranks

20 1840 36800

20 2260 45200

40

Restorative_techniques

Centripetal build-up

Horizontal layering

Total

Marginal_discoloration

N Mean Rank Sum of Ranks

Test Statisticsb

158000

368000

-1299

194

265a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

discoloration

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between centripetal build-up

and horisontal layering techniques regarding parameter marginal discoloration

(p=0103)

Tables VIII8a-b Mann-Whitney test Comparing analysis regarding marginal

discoloration between restorations performed using oblique layering technique and

horisontal layering technique

Ranks

20 1630 32600

20 2470 49400

40

Restorative_techniques

Oblique layering

Horizontal layering

Total

Marginal_discoloration

N Mean Rank Sum of Ranks

Test Statisticsb

116000

326000

-2822

005

023a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Marginal_

discoloration

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There is statistical significant differences between horisontal layering and

oblique layering techniques regarding parameter marginal discoloration (p=0005)

17

TablesVIII9 a-b Mann-Whitney test Comparing analysis regarding anatomical

form between restorations performed using centripetal build-up technique and oblique

layering technique

Ranks

20 1830 36600

20 2270 45400

40

Restorative_techniques

Centripetal build-up

Oblique layering

Total

Anatomical_form

N Mean Rank Sum of Ranks

Test Statisticsb

156000

366000

-1486

137

242a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Anatomical_

form

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between centripetal build-up

and oblique layering techniques regarding parameter anatomical form (p=0137)

Tables VIII10a-b Mann-Whitney test Comparing analysis regarding anatomical

form between restorations performed using centripetal build-up technique and

horisontal layering technique

Ranks

20 1710 34200

20 2390 47800

40

Restorative_techniques

Centripetal build-up

Horizontal layering

Total

Anatomical_form

N Mean Rank Sum of Ranks

Test Statisticsb

132000

342000

-2184

029

068a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Anatomical_

form

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between centripetal build-up

and horisontal layering techniques regarding parameter anatomical form (p=0029)

18

Tables VIII11a-b Mann-Whitney test Comparing analysis regarding anatomical

form between restorations performed using oblique layering technique and horisontal

layering technique

Ranks

20 1920 38400

20 2180 43600

40

Restorative_techniques

Oblique layering

Horizontal layering

Total

Anatomical_form

N Mean Rank Sum of Ranks

Test Statisticsb

174000

384000

-784

433

495a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Anatomical_

form

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between horisontal layering and

oblique layering techniques regarding parameter anatomical form (p=0433)

Indices A for restorations performed using centripetal build-up technique were

as follows color match-80 marginal adaptation- 60 marginal discoloration-

70 anatomical form (proximal)- 80 surface quality- 60

Indices A for restorations performed using horisontal layering technique were

as follows color match-70 marginal adaptation- 40 marginal discoloration-

50 anatomical form (proximal)- 50 surface quality- 70

Indices A for restorations performed using oblique layering technique were as

follows color match-70 marginal adaptation- 80 marginal discoloration- 90

anatomical form (proximal)- 60 surface quality- 70

Indices B for restorations performed using centripetal build-up technique were

as follows color match-20 marginal adaptation- 30 marginal discoloration-

20 anatomical form (proximal)- 30 surface quality- 40

Indices B for restorations performed using horisontal layering technique were

as follows color match-30 marginal adaptation- 40 marginal discoloration-

30 anatomical form (proximal)- 30 surface quality- 30

Indices B for restorations performed using oblique layering technique were as

follows color match-30 marginal adaptation- 20 marginal discoloration- 10

anatomical form (proximal)- 40 surface quality- 30

19

Indices C for restorations performed using centripetal build-up technique were

as follows color match-0 marginal adaptation- 10 marginal discoloration- 0

anatomical form (proximal)- 0 surface quality- 0

Indices C for restorations performed using horisontal layering technique were

as follows color match-0 marginal adaptation- 20 marginal discoloration- 20

anatomical form (proximal)- 20 surface quality- 0

Indices C for restorations performed using oblique layering technique were as

follows color match-0 marginal adaptation- 0 marginal discoloration- 10

anatomical form (proximal)- 0 surface quality- 100

Discussions

For in vitro studies is difficult to reproduce the variables existent in oral cavity

like occlusal stress and pH and temperature changes (235) The clinical studies are

determinant in assessment of restorative techniques (300) The most researches

focuses on the influence of restorative technique on the reduction of lightcuring stress

(51 78 135)

VIII5 CONCLUSIONS

Oblique layering technique presents superior results regarding marginal

adaptation and marginal discoloration and is recommended for proximo-

occlusal dental caries close to enamel-cement jonction

Centripetal build-up presents good results regarding marginal adaptation and

anatomical form at proximal level (proximal surfaces and contact point)

Horisontal layering technique can be used for optimum results only in

proximal-occlusal cavities with moderate extension both in occlusal-cervical

and buccal-oral

20

CHAPTIX STUDY REGARDING MARGINAL SEALING STATUS IN

COMPOSITE RESINS LIMITED PROXIMO-OCCLUSAL RESTORATIONS

PERFORMED USING DIFFERENT TECHNIQUES

IX1INTRODUCTION

The contraction of composite resins can produce stress inside dental structure

The most contraction stress appears in the initial stages and development rate of stress

decreases gradually in time (5 98 160) The contraction stress of composite resins

can overpass adhesion strenght and can broke the link between dental tissues and

composite resin (73) When adhesion strenght is high stress can produce marginal

fracture or bulk fracture (74) These situations are associated with microleakage and

penetration of oral fluid and bacteria along dentinal walls endangering the pulpal

tissue or favourising secondary dental caries

IX2 AIM OF STUDY

The study aimed to assess the efficiency of marginal sealing along gingival

wall in limited proximal-occlusal restorations performed using three different

techniques

IX3MATERIALS AND METHOD

The study group included 30 teeth extracted for orthodontic and periodontal

reasons On every tooth two identical class II cavities (on mesial and distal surfaces)

were prepared with cylindrical burs under water cooling The gingival wall was

limited to enamel-cement jonction The cavity dimension were as follows 2 mm

buccal-oral 5mm depth Each tooth was introduced in a pattern of acrylat The

operator calibrated preparation technique on acrylat teeth in Simulation Laboratory of

UMF ―Gr T Popa Iaşi The 60 prepared cavities were randomly divided in three

study groups related to restorative technique The restoration were performed with

Filtek Z550 (3M ESPE) a nanohybrid composite resin The adhesive strategy

included etchamprinse in 2 steps and adhesive Adper Single Bond 2(3MESPE)

Group A (n=20) bulk restorative technique associated with lightcuring from

occlusal 40 seconds and from buccal and oral 20 seconds

Group B (n=20) oblique layering technique (first layer on buccal wall and

buccal frac12 of gingival wall was lightcured from buccal second layer on oral wall and

oral frac12 of gingival wall was lightcured from oral third oral as a triangle with point

oriented to gingival wall was lightcured from occlusal)

Group C (n=20) combined technique (bdquoflow layer on gingival and axial

walls lightcured under pressure only associated with solid composite resin layer)

The proximal surfaces were performed using Tofflemire and metallic matrices After

removal of matrices every restoration was lightcured for another 20 seconds Two

layers aof varnish were applied on composite resins restorations excepting cavity

margins and an area of 1 mm around them The samples were introduced in methylen

21

blue 10 for 48 hours After this stage samples were washed with water and teeth

were cut longitudinally with a diamonded disc

The die penetration was assessed with Zeiss (Iena Germany) X20 microscope

accordingly to four scores (0-3)

0 ndash no penetration

1 ndash die infiltration until external half of gingival wall

2 ndash die infiltration on all gingival wall

3 ndash die infiltration on gingival wall and axial wall

IX4RESULTS AND DISCUSSIONS

The result of die penetration are presented in table IX1

TableIX1 The results for die penetration

Grup 0 1 2 3

A (bulk) 0 0 3 17

B (layering) 0 4 5 11

C (combined) 12 5 2 1

In group A 17 sample had score 3 and 2 samples had score 2 In group B 11

sample had score 3 5 samples had score 2 and 4 sample had score 1 In group C with

best results 12 samples had score 0 5 samples had score 1 2 samples had score 2 1

sample had score 3

The recorded data were analysed using test Mann-Whitney The statistical

results are presented in tables IX2-IX4

Tables IX2a-b Mann-Whitney for comparisons of microleakage values between

bulk technique and incremental technique

Ranks

Restorative technique N Mean Rank Sum of Ranks

Scores

frequency

A ndash bulk technique 20 2420 24200

B ndash incremental

technique

20 1680 16800

Total 40

Test Statisticsb

scores

frequency

Mann-Whitney U 29000

Wilcoxon W 168000

Z -1970

Asymp Sig (2-tailed) 049

Exact Sig [2(1-tailed Sig)] 123a

a Not corrected for ties

b Grouping Variable restorative technique

22

Tables IX3a-b Mann-Whitney for comparisons of microleakage values between

bulk technique and mixed technique

Ranks

Restorative technique N Mean Rank Sum of Ranks

scores

frequency

A ndash bulk technique 20 3090 30900

C ndash mixed technique 20 1010 10100

Total 40

Test Statisticsb

scores

frequency

Mann-Whitney U 500

Wilcoxon W 101000

Z -4021

Asymp Sig (2-tailed) 000

Exact Sig [2(1-tailed Sig)] 000a

a Not corrected for ties

b Grouping Variable restorative technique

Tables IX4a-b Mann-Whitney test for comparisons of microleakage values

between incremental technique and mixed technique

Ranks

Restorative technique N Mean Rank Sum of Ranks

scores

frequency

B ndash incremental

technique

20 2990 29900

C ndash mixed technique 20 1210 12100

Total 40

Test Statisticsb

scores

frequency

Mann-Whitney U 5500

Wilcoxon W 121000

Z -3492

Asymp Sig (2-tailed) 000

Exact Sig [2(1-tailed Sig)] 000a

a Not corrected for ties

23

Test Statisticsb

scores

frequency

Mann-Whitney U 5500

Wilcoxon W 121000

Z -3492

Asymp Sig (2-tailed) 000

Exact Sig [2(1-tailed Sig)] 000a

a Not corrected for ties

b Grouping Variable tehnrestaurare

The results of microleakage degree were statistically significant when the

three restorative techniques were compared The results showed that best restorative

technique regarding marginal sealing in cervical area is combined technique followed

by oblique layering technique The use of layering techniques limits the development

of contraction forces between oposite walls event that favourises bulk stress voids

formation and fissure inside dental tissues The results of our study are similar with

other studies (114 293)

IX5 CONCLUSIONS

The values of die penetration at gingival wall were statistically different

between the three restorative techniques

We concluded that all restorative methods were associated with lightcuring

contraction and marginal microleakage

The combined technique was associated with lowest lightcuring contraction

and die penetration

The bulk technique was associated with highest lightcuring contraction and die

penetration

24

CHAPTX STUDY REGARDING THE EFFECTS OF ETCHING ON

ENAMEL AND DENTINE IN CERVICAL AREA FOR PROXIMAL

CAVITIES AT LATERAL DENTAL GROUP

X1 INTRODUCTION

The studies reported marginal defects and high microleakage at the level of

gingival margins localised in cervical area or close to enamel-cement jonction for

high percents of proximal-occlusal composite resins restorations (8485) The good

adhesion is requested to insure restoration longevity and to prevent marginal

microleakage and presence of secondary marginal dental caries The adhesion

strenght of different adhesive systems can vary accordingly to tissues areas (204 240)

and to variations in dentinal structures (234 330) Most studies focused on adhesive

systems performances used healthy dentine close to pulp room but in case of class II

restorations there are particular features that influences the adhesion at the level of

gingival margins

The surface topography is an important property that determines the

interaction manner between surfaces The surface roughness and surface energy can

increase or decrease the adhesion of composite resins to the hard dental tissues

X2 AIM OF STUDY

The aim of study was to compare surface roughness of enamel and dentine

after etching related to different distances related to enamel-dentinecement jonction

X3 MATERIALS AND METHODS

The study group included 20 molars extracted from orthodontics or

periodontal reasons with intact proximal surfaces The teeth were cut longitudinally in

sens buccal-oral with diamond discs under water cooling

A group study (10 teeth) included 10 samples obtained through transversal

cutting at distance of 2mm from enamel-dentinecement jonction and 10 samples

obtained through transversal cutting at distance of 15 mm from enamel-

dentinecement jonction Another study group (10 teeth) included 10 samples

obtained through transversal cutting at distance of 1mm from enamel-dentinecement

jonction and 10 samples obtained through transversal cutting at distance of 05 mm

from enamel-dentinecement jonction All these samples were divided in two halfes

through mesial-distal cutting The samples finishing was performed with abrasive

paper (100-4000) and final polishing was performed with a device Buehler model

Minimet with slices introduced in ultrasound bath for 4 minutes The second half of

each sample was etched for 15 seconds with ortophosphoric acid 37 for 15 seconds

Slices were washed with distilled water for 30 seconds after etching and dried

The samples were analysed with atomic force microscopy (AFM) regarding

surface roughness The results were expressed as relative variation of roughness

X4 RESULTS AND DISCUSSIONS

The aspect of etched enamel at 2 mm distance from ECJ can be seen in figure

X1 (section 10 microm) The surface roughness is higher comparing with sample before

etching

25

După gravajul cu acid ortofosforic 37

The aspect of etched enamel at 15 mm distance from ECJ can be seen in

figure X2 (section 10 microm) The surface roughness is higher comparing with sample

before etching but lower comparing with sample at 2 mm from ECJ

The aspect of etched enamel at 1 mm distance from ECJ can be seen in figure

X3 (section 10 microm) The surface roughness is higher comparing with sample before

etching but lower comparing with sample at 15mm and 2 mm from ECJ

The aspect of etched enamel at 15 mm distance from ECJ can be seen in

figure X4 (section 10 microm) The surface roughness is higher comparing with sample

before etching but lower comparing with sample at 1 mm 15 mm and 2 mm from

ECJ

FigX1 3D aspect of enamel at 2 mm from ECJ

after etching (10 microm)

FigX2 3D aspect of enamel at 15 mm from ECJ

after etching (10 microm)

FigX3 3D aspect of enamel at 1 mm from ECJ

after etching (10 microm)

FigX4 3D aspect of enamel at 05 mm from ECJ

after etching (10 microm)

26

The mean values of squared roughness for dentine and enamel before etching

are presented in tables X1 and X2

Table X1 Squared roughness values for dentine samples before and after etching

Before etching (nm) After etching (nm)

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

sample

1

335 282 283 259 1149 947 901 879

sample

2

352 284 274 266 1127 939 883 875

sample

3

357 273 278 263 1152 953 876 867

sample

4

323 269 264 258 1146 942 895 883

sample

5

348 298 271 268 1153 944 904 878

sample

6

339 274 278 273 1158 937 893 892

sample

7

352 283 269 266 1145 944 899 876

sample

8

349 292 272 274 1166 942 907 869

sample

9

357 284 275 265 1132 939 893 879

sample

10

348 281 277 262 1142 941 899 878

Table X2 Squared roughness values for enamel and dentine samples before and after

etching

Before etching (nm) After etching (nm)

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

sample 1 422 342 309 313 2255 1114 874 845

sample 2 418 338 324 304 2236 1102 882 839

sample 3 413 334 315 303 2239 1115 873 833

sample 4 416 336 322 308 2242 1116 868 842

sample 5 426 332 315 294 2218 1103 877 829

sample 6 412 332 317 306 2237 1099 874 847

sample 7 414 335 322 314 2252 1102 876 834

sample 8 416 325 318 313 2239 1106 875 838

sample 9 418 328 314 299 2246 1113 879 836

sample 10 413 334 316 305 2242 1104 873 839

The results for samples before etching prove a decreasing tendency for mean

values of squared roughness surface beginning with areas placed at distance of 2 mm

from ECJ (346 nm) followed by areas placed at distance of 15 mm from ECJ (282

nm) 1 mm from ECJ (274 nm) and 05 mm from ECJ (265 nm) After etching the

decreasing tendency maintained for dentine localised at 2 mm from ECJ to dentine

localised at 05 mm from ECJ The mean values of squared roughness after etching

were three times higher (tables X3)

27

Table X3 Squared roughness values for enamel and dentine samples before and

after etching

Dentine Enamel

Before etching

(nm)

After etching

(nm)

Before etching

(nm)

After etching

(nm)

2 mm ECJ 346 1147 416 2237

15 mm ECJ 282 942 333 1107

1 mm ECJ 274 895 317 875

05 mm ECJ 265 877 305 838

The descriptive statistics data for surface roughness of dentine before and after

etching are presented in tables X4 si X5

Table X4 Descriptive statistics for dentine samples before etching

Statistics

Dentine 2mm

before etching

Dentine 15mm

before etching

Dentine 1mm

before etching

Dentine 05mm

before etching

N Valid 10 10 10 10

Missing 0 0 0 0

Mean 346000 282000 274100 265400

Std Error of Mean 33830 27487 17026 16746

Std Deviation 106979 86923 53841 52957

Skewness -1214 354 -314 348

Std Error of Skewness 687 687 687 687

Kurtosis 1141 049 336 -539

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 3230 2690 2640 2580

Maximum 3570 2980 2830 2740

Table X5 Descriptive statistics for dentine samples after etching

Statistics

Dentine 2mm

after etching

Dentine 15mm

after etching

Dentine 1mm

after etching

Dentine 05mm

after etching

N Valid 10 10 10 10

Missing 0 0 0 0

1147000 942800 895000 877600

Std Error of Mean 36545 14591 29926 22020

Std Deviation 115566 46140 94634 69634

Skewness -267 1169 -951 535

Std Error of Skewness 687 687 687 687

Kurtosis 043 1776 564 1416

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 11270 9370 8760 8670

28

Statistics

Dentine 2mm

after etching

Dentine 15mm

after etching

Dentine 1mm

after etching

Dentine 05mm

after etching

N Valid 10 10 10 10

Missing 0 0 0 0

1147000 942800 895000 877600

Std Error of Mean 36545 14591 29926 22020

Std Deviation 115566 46140 94634 69634

Skewness -267 1169 -951 535

Std Error of Skewness 687 687 687 687

Kurtosis 043 1776 564 1416

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 11270 9370 8760 8670

Maximum 11660 9530 9070 8920

To choose the statistical test to compare roughness surface values was

performed a test Shapiro-Wilk If p is lower or equal with 0005 than hypothesis of

distribution normality is rejected (distribution deviates from normal form) In the table

X6 the distributions are normal The statistical test will be test t for pair samples

Table X6 Test Shapiro-Wilk for dentine samples

Tests of Normality

Kolmogorov-Smirnov

a Shapiro-Wilk

Statistic df Sig Statistic df Sig

Dentine 2mm before etching 274 10 032 877 10 122

Dentine 15mm after etching 209 10 200 952 10 689

Dentine 1mm before etching 134 10 200 983 10 980

Dentine 05mm before etching 155 10 200 949 10 661

Dentine 2mm after etching 133 10 200 977 10 946

Dentine 15mm after etching 197 10 200 916 10 329

Dentine 1mm after etching 216 10 200 925 10 401

Dentine 05 after etching 220 10 185 933 10 474

Enamel 2mm before etching 193 10 200 898 10 207

Enamel 15mm before etching 170 10 200 977 10 947

Enamel 1mm before etching 157 10 200 952 10 689

Enamel 05mm before etching 165 10 200 943 10 590

Enamel 2mm after etching 235 10 124 925 10 404

Enamel 15mm after etching 209 10 200 871 10 102

Enamel 1mm after etching 189 10 200 964 10 834

Enamel 05mm after etching 142 10 200 983 10 978

a Lilliefors Significance Correction

29

Tests of Normality

Kolmogorov-Smirnov

a Shapiro-Wilk

Statistic df Sig Statistic df Sig

Dentine 2mm before etching 274 10 032 877 10 122

Dentine 15mm after etching 209 10 200 952 10 689

Dentine 1mm before etching 134 10 200 983 10 980

Dentine 05mm before etching 155 10 200 949 10 661

Dentine 2mm after etching 133 10 200 977 10 946

Dentine 15mm after etching 197 10 200 916 10 329

Dentine 1mm after etching 216 10 200 925 10 401

Dentine 05 after etching 220 10 185 933 10 474

Enamel 2mm before etching 193 10 200 898 10 207

Enamel 15mm before etching 170 10 200 977 10 947

Enamel 1mm before etching 157 10 200 952 10 689

Enamel 05mm before etching 165 10 200 943 10 590

Enamel 2mm after etching 235 10 124 925 10 404

Enamel 15mm after etching 209 10 200 871 10 102

Enamel 1mm after etching 189 10 200 964 10 834

Enamel 05mm after etching 142 10 200 983 10 978

a Lilliefors Significance Correction

This is a lower bound of the true significance

The results of test t for pair dentine samples before and after etching are

presented in table X

Table X7 Test t for dentine before and after etching

Paired Samples Test

Paired Differences

t df

p (2-

tailed)

95 Confidence

Interval of the

Difference

Mean

Std

Dev

Std

Error

Mean Lower Upper

Pair

1

dentine2mmbeforeetching-

dentine2mmafteretching

-

8010000

174801 55277 -

8135045

-

7884955

-

144906

9 000

Pair

2

dentine15mmbeforeetching-

dentine15mmafteretching

-

6608000

102394 32380 -

6681248

-

6534752

-

204079

9 000

Pair

3

dentine1mmbeforeetching-

dentine1mmafteretching

-

6209000

117799 37251 -

6293269

-

6124731

-

166678

9 000

30

Paired Samples Test

Paired Differences

t df

p (2-

tailed)

95 Confidence

Interval of the

Difference

Mean

Std

Dev

Std

Error

Mean Lower Upper

Pair

1

dentine2mmbeforeetching-

dentine2mmafteretching

-

8010000

174801 55277 -

8135045

-

7884955

-

144906

9 000

Pair

2

dentine15mmbeforeetching-

dentine15mmafteretching

-

6608000

102394 32380 -

6681248

-

6534752

-

204079

9 000

Pair

3

dentine1mmbeforeetching-

dentine1mmafteretching

-

6209000

117799 37251 -

6293269

-

6124731

-

166678

9 000

Pair

4

dentine05mmbeforeetching-

dentine05mmafteretching

-

6122000

86384 27317 -

6183796

-

6060204

-

224109

9 000

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of dentine (

2mm 15 mm 1mm sau 05mm)

The descriptive statistics data for dentine surface roughness before and after

etching are presented in tables X8 and X9

Table X8 Descriptive statistics for enamel samples before etching

Statistics

Enamel 2mm

before etching

Enamel 15mm

before etching

Enamel 1mm

before etching

Enamel 05mm

before etching

N Valid 10 10 10 10

Missing 0 0 0 0

Mean 416800 333600 317200 305900

Std Error of Mean 13968 15217 14205 20355

Std Deviation 44171 48120 44920 64369

Skewness 1095 -156 -109 -411

Std Error of Skewness 687 687 687 687

Kurtosis 769 487 -118 -295

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 4120 3250 3090 2940

Maximum 4260 3420 3240 3140

31

Table X9 Descriptive statistics for enamel samples after etching

Statistics

Enamel 2mm

after etching

Enamel 15mm

after etching

Enamel 1mm

after etching

Enamel 05mm

after etching

N Valid 10 10 10 10

Missing 0 0 0 0

Mean 2237600 1107400 875100 838200

Std Error of Mean 31027 20232 11968 17436

Std Deviation 98116 63979 37845 55136

Skewness -850 267 042 040

Std Error of Skewness 687 687 687 687

Kurtosis 878 -1880 1082 -425

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 22180 10990 8680 8290

Maximum 22520 11160 8820 8470

To choose the statistical test to compare roughness surface values was

performed a test Shapiro-Wilk If p is lower or equal with 0005 than hypothesis of

distribution normality is rejected (distribution deviates from normal form) In the table

X10 the distributions are normal The statistical test will be test t for pair samples

Table X10 Test Shapiro-Wilk for enamel samples

Tests of Normality

Kolmogorov-Smirnova Shapiro-Wilk

Statistic df Sig Statistic df Sig

2mmenamel before etching 193 10 200 898 10 207

15mmenamel before etching 170 10 200 977 10 947

1mmenamel before etching 157 10 200 952 10 689

05mmenamel before etching 165 10 200 943 10 590

2mmenamel after etching 235 10 124 925 10 404

15mmenamel after etching 209 10 200 871 10 102

1mmenamel after etching 189 10 200 964 10 834

05mmenamel after etching 142 10 200 983 10 978

a Lilliefors Significance Correction

This is a lower bound of the true significance

The results of test t for pair enamel samples before and after etching are

presented in table X11

32

Table X11 Test t for enamel samples before and after etching

Paired Samples Test

Paired Differences

t df

p (2-

tailed)

95 Confidence

Interval of the

Difference

Mean

Std

Deviation

Std

Error

Mean Lower Upper

Pair

1

2mmenamel before

etching

2mmenamel after

etching

-18208 135220 42760 -

18304731

-

18111269

-

425815

9 000

Pair

2

15mmenamel before

etching

15mmenamel after

etching

-7738 73151 23132 -7790329 -7685671 -

334508

9 076

Pair

3

1mmenamel before

etching

1mmenamel after

etching

-5579 55468 17540 -5618679 -5539321 -

318065

9 065

Pair

4

05mmenamel before

etching

05mmenamel after

etching

-5323 60378 19093 -5366192 -5279808 -

278788

9 063

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel ( 2mm 15 mm 1mm sau

05mm) but the differences statistical significant are present only for enamel localised

at 2 mm from ECJ

X5CONCLUSIONS

The surfaces of enamel and dentine at cervical level record decreases of

roughness related to the decrease of distance to ECJ

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel but the differences

statistical significant are present only for enamel localised at 2 mm from ECJ

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of

dentine

33

CHAPTXI FEA STUDY REGARDING THE BIOMECHANICAL

BEHAVIOUR AND FRACTURE RESISTANCE OF PROXIMO-OCCLUSAL

AMALGAM AND COMPOSITE RESINS RESTORATIONS

XI1INTRODUCTION AIM OF STUDY

The individual variation of patients morphological and functional complexity

of tissues as well as difficult access limit the possibilities to investigate in clinical

studies the biomechanical behaviour of proximo-occlusal restorations In this context

simulation of the biomechanics for direct restorations represents an interesting

interdisciplinar domain in actual dentistry research

The study focused on two direction

- analysis of role of forces intensity on biomechanical behaviour related to

cavity dimension and material

- analysis of tension inside restoration structure related to forces intensity

XI2MATERIALS AND METHODS

The stages of finite element analysis study are as follows

object modelling (bicusps and proximo-occlusal restoration)

definition of parameters for materials and dental tissues

meshing

constraints and loading

types of contacts

equations system definition

results of simulation

The object 3D modelling was performed in Rhinoceros (figure XI1) The

definition of parameters was performed for Poisson constant Young modulus density

(table XI1) The selected materials were amalgam and composite resins The

analysed tissues were dentine and enamel The meshing constraints loading were

performed for forces of 200N 400N 600N 800 N The analysis was performed using

software COSMOSWorks 2010

34

Fig XI1 3D modellation of bicusp

Table XI1 Values of Young modulus Poisson constant compression resistance for

amalgam composite resin enamel (amalgam compozit smalţ)

Material Young modulus (GPa) Poisson constants

Compression

resistance

(Mpa)

Amalgam 55 033 483

Enamel 48 03 400

Composite

resin 220 022 345

Fig XI2 The forces and constraints application

The results are presented in values and culours red colours representing areas

with maximum values of tensions produced under influence of masticatory forces

The tensions produced in amalgam restoration are in a range from 0 to 22886

(force 800 N) The maximum von Misses tensions are associated with cervical area

of amalgam restorations This aspect proves that first modification in interface

restoration-cavity margins will appear at the level of gingival wall First marginal

35

defects and fissures in restoration bulk will appear at tensions over 1600Mpa

associated with forces of 800N for extended amalgam proximo-occlusal restorations

The tensions produced in composite resin restorations are in a range from 0 to

2285 (force 800 N) The maximum von Misses tensions are associated with cervical

area of composite resin restorationsThis aspect proves that first modification in

interface restoration-cavity margins will appear at the level of gingival wall First

marginal defects and fissures in restoration bulk will appear at tensions over 1716

Mpa associated with forces of 600N for moderate and extended composite resins

proximo-occlusal restorations

Fig XI3a-b ndash Simulated model of proximo-occlusal restoration

FigXI4a-b Dental amalgam restoration Cervical tension associated with 600 N

(c)800 N (d)

FigXI5a-b Composite resin restoration Cervical tension associated with 600 N

(c)800 N (d)

36

The deformation of amalgam can be produced only when is associated with

fissures in bulk of restorations while composite resins restorations present

deformation when are associated with a modification of volume and form because of

repeated action of medium forces on long term or high forces on short term (figures

XI4 XI5)

Fig XI4 Material deformation in area of maximum tension

000E + 00

500E -02

100E -01

150E -01

200E -01

250E -01

1 4 7 101316192225283134374043464952555861646770737679

Amalgam C ompoz it

Figura XI5 Deformarea funcție de material

The amalgam and composite resins were treated as homogenous isotropic and

liniar The advantage of this type of FEA study is that restorations parameters can be

modified any time is necessary both in arhitecture geometry and material indices

variability The results of this study sustain the conclusions of other FEA studies

focused on biomechanical behaviour of posterior restorations performed with

amalgam and composite resins(35 62 76 143)

37

XI4CONCLUSIONS

bull The amalgam in class II restorations has a low deformation tendency because

of uniform distribution of tension inside material

bull Composite resins class II restorations accumulate higher tensions comparing

with amalgam but deformation is avoided for a time because of the adhesion

forces performed between molecules under moderate oral forces In case of

high oral forces (600-800N) the risk of fracture in moderate class II

restorations is higher comparing with amalgam proximo-occlusal restorations

For extended class II restorations and forces of 600 N composite resins present

highest risk of fracture and deformation The von Misses tension at the

cervical interface restorationtooth can reach 1600Mpa

bull The amalgam in moderate class II restorations can resist to deformation even

for high intensity forces limited to 600N In extended class II restorations the

risk of deformation and fracture increases at values of 600N-800N of oral

forces The von Misses tension at the cervical interface restorationtooth can

reach 1700 Mpa

38

FINAL CONCLUSIONS

Amalgam proximo-occlusal restorations with minimum 6-years age present

excellent results for parameters anatomic form (occlusal) marginal

discoloration and marginal secondary dental caries good results for

parameters anatomic form (proximal) and marginal adaptation and poor results

for surface quality

Composite resins proximo-occlusal restorations (bicusps) with minimum 6-

years age present excellent results for parameters color match marginal

discoloration and marginal secondary dental caries and good results for

parameters anatomic form (occlusal proximal) marginal adaptation surface

quality

Composite resins proximo-occlusal restorations (molars) with minimum 6-

years age present good results for parameters color match marginal

discoloration marginal secondary dental caries marginal adaptation and poor

results for parameters anatomic form (occlusal) (54 indices Ryge C)

anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The restorations extended at external third of occlusal surface present highest

percents of indices C regarding anatomic form (occlusal) (54 indices Ryge

C) anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The exceeding of 6-years age will require careful monitorisation for early

interventions through polishing sealing reshaping and even replacement for

restorations with major defects

Oblique layering technique presents superior results regarding marginal

adaptation and marginal discoloration and is recommended for proximo-

occlusal dental caries close to enamel-cement jonction

Centripetal build-up presents good results regarding marginal adaptation and

anatomical form at proximal level (proximal surfaces and contact point)

Horisontal layering technique can be used for optimum results only in

proximal-occlusal cavities with moderate extension both in occlusal-cervical

and buccal-oral

The values of die penetration at gingival wall were statistically different

between the three restorative techniques

We concluded that all restorative methods were associated with lightcuring

contraction and marginal microleakage

The combined technique was associated with lowest lightcuring contraction

and die penetration

The bulk technique was associated with highest lightcuring contraction and die

penetration

39

The surfaces of enamel and dentine at cervical level record decreases of

roughness related to the decrease of distance to ECJ

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel but the differences

statistical significant are present only for enamel localised at 2 mm from ECJ

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of

dentine

bull The amalgam in class II restorations has a low deformation tendency because

of uniform distribution of tension inside material

bull Composite resins class II restorations accumulate higher tensions comparing

with amalgam but deformation is avoided for a time because of the adhesion

forces performed between molecules under moderate oral forces In case of

high oral forces (600-800N) the risk of fracture in moderate class II

restorations is higher comparing with amalgam proximo-occlusal restorations

For extended class II restorations and forces of 600 N composite resins present

highest risk of fracture and deformation The von Misses tension at the

cervical interface restorationtooth can reach 1600Mpa

bull The amalgam in moderate class II restorations can resist to deformation even

for high intensity forces limited to 600N In extended class II restorations the

risk of deformation and fracture increases at values of 600N-800N of oral

forces The von Misses tension at the cervical interface restorationtooth can

reach 1700 Mpa

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1ADA Council on Scientific Affairs ADA Council on Dental Benefit Programs

Statement on posterior resin-based composites JADA 1998 129(11)1627ndash1628

2Albers HF Tooth-colored restoratives 1st ed Santa Rosa CA Alto Books 1979

3Allander L Birkhed D Bratthall D Reasons for replacement of class II amalgam

restorations in private practice Swed Dent J 199014(4)179-84

4Alomari QD Reinhardt JW Boyer DB Effect of liners on cusp deflection and

gap formation in composite restorations Oper Dent 200126406- 11

5Alster D Feilzer AJ de Gee AJ Mol A Davidson CL The dependence of

shrinkage stress reduction on porosity concentration in thin resin layers J Dent Res

1992711619ndash1622

6Aggarwal V Logani A Jain V Shah N Effect of cyclic loading on marginal

adaptation and bond strength in direct vs indirect class II MO composite restorations

Oper Dent 2008 Sep-Oct33(5)587-92

7Andrian S Lăcătuşu St- Caria dentară- Protocoale şi tehnici- EdApolloniaIaşi

1999

8Andrian S- Restaurări fizionomice cu materiale plastice icircn cariologie-EdPanteon

Iaşi 2001

40

9Andrian S Tratamentul Minim Invaziv al Cariei Dentare EditPrinceps Edit Iaşi

2002

10Angmar-Mansson B ten Bosch JJ Optical methods for the detection and

quantification of caries Adv Dent Res 1987 1(1) 14-20

11Angmar-Mansson B ten Bosch JJ Advances in methods for diagnosting coronal

caries Adv Dent Res 1993 7(2) 70-79

12Angmar-Mansson B Al-Khateeb S Tranaeus S Monitoring the caries process

Optical methods for clinical diagnosis and quantification of enamel caries European

Journal of Oral Sciences 1996 104 480-485

13Angmar-Mansson B Al-Khateeb S Tranaeus S Caries diagnosis Journal of

Dental Education 1998 62 (10) 771-780

14Anusavice KJ- ldquoQuality evaluation of dental restorationscriteria for placement

and replacement Chicago 1989Quintessence Publishing

15Anusavice KJ Development and testing of ceramics for dental restorations In

Fischman G Clare A Hench J editors Bioceramics materials and applications

Westerville OH 1995

16Arhun N Celik C Yamanel KClinical evaluation of resin-based composites in

posterior restorations two-year results Oper Dent 201035(4)397-404

17Armstrong SR JC Keller DB Boyer The influence of water storage and C-

factor on the dentinndashresin composite microtensile bond strength and debond pathway

utilizing a filled and unfilled adhesive resin Dent Mater 200117268ndash276

18Armstrong S Boyer D Keller J Microtensile bond strength testing and failure

analysis of two dentin adhesives Dent Mater 1998 14(1)44-50

19Asmussen E Peutzfeldt A Influence of UEDMA BisGMA and TEGDMA on

selected mechanical properties of experimental resin composites Dent Mater1998

1451-56

20Asmussen E Clinical relevance of physical chemical and bonding properties of

composites resins Oper Dent 19851061-73

21Bader JD Brown JP Dilemmas in caries diagnosisJ Am Dent Assoc1993124

(6) 48-50

22Bader JD Shugars DA What do we know about how dentists make caries-

related treatment decisions Community Dent Oral Epidemiol 1997 25(1) 97-103

23Bader JD Shugars DA Bonito AJ A systematic review of the performance of

methods for identifying carious lesions JPublic Health Dent 2002 62 (4) 201-213

24Bader JD Shugars DA Bonito AJ Systematic reviews of selected dental caries

diagnostic and management methods J Dent Educ 2001 65 (10) 960-968

25Bader J Ismail A Survey of systematic reviews in dentistry JADA 2004 135

464-473

26Bader JD Shugars DA Understanding dentistslsquo restorative treatment decisions J

Public Health Dent 1992 Winter52(2)102-10

27Barkmeier WW Cooley RL Current status of adhesive resin systems J Am Coll

Dent 199158 36-39

28Bayne SC Dental biomaterials where are we and where are we going J Dent

Educ 200569(5)571ndash585

41

29Bedran-de-Castro AK Pereira PN Thompson JY Influence of load cycling

and tubule orientation on ultimate tensile strength of dentin J Adhes Dent 2004 6(3)

191-194

30Behle C Flowable composite Proprieties and applications Pract Periodontics

Aesthetics Dent 1998 10347 350-351

31Bergenholtz G Cox CF Bacterial leakage around dental restorations Its effects

on the dental pulp J Oral Path 198211 439 ndash450

32Bernardo M Luis H Martin MD Survival and reasons for failure of amalgam

versus composite posterior restorations placed in a randomized clinical trial JADA

2007138(6)775ndash783

33Black J Biological Performance of Materials Fundamentals of Biocompatibility

NY Marcel Dekker Inc 1999

34Bonsor SJ Chadwick RGLongevity of conventional and bonded (sealed)

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9

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Rehabilitation (33) 2006690ndash697

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321

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polymerization shrinkage stress in resin-composites a systematic review Dent Mater

200521(10)962-70

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Timişoara1994

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of reasons for the placement and replacement of restorations provided by vocational

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199930(4)234-42

42

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nr6(1) 1999

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of restorations at failure and reasons for their placement and replacement J Dent

200129(5)317-24

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contraction stress and degree of conversion in restorative composites Dent Mater

2004 20939-946

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the decision to replace existing amalgam restorations Quintessence Int 1999

Jun30(6)413-8

51Carvalho RM JC Pereira M Yoshiyama DH Pashley A review of

polymerization contraction the influence of stress development versus stress

reliefOper Dent19962117ndash24

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of conventional film and direct digital imaging in the detection of approximal caries

Dentomaxillofac Radiol 2007 Mar36(3)138-42

53Cattaneo PM M Dalstra B Melsen- bdquoThe Finite Element Method a Tool to

Study Orthodontic Tooth Movement J Dent Res 2005 84(5)428-433

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microstructural features of four dental ceramicspart 1 J Dent 25(5)399-407 1997

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bond strength to primary dentin J Dent Child 2003 70(2) 139-144

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posterior restorations 12-month results Eur J Dent 2010 Jan4(1)57-65

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two polymerization techniques Relationship between microtensile bond strength and

marginal leakage J Dent 2005 33(7) 603- 610

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Med 2008173(1)23ndash26

59Chen HY Manhart J Hickel R Kunzelmann KH Polymerization contraction

stress in light-cured packable composite resinsDent Mater 200117253-259

60Choi KK Condon JR Ferracane JL The effects of adhesive thickness on

polymerization contraction stress of composites J Dent Res 2000 79812ndash817

61Cichon P Kerschbaum T Verweildauer zahnartzlicher Restaurationen bei

Behinderten Dtsch Zahnartzlicher 1999 54 96-102

62Cohen BI Pagnillo MK Deutsch ASMusikant BL Fracture Strength of

Three Core Restorative Materials Supported with or without a Prefabricated Split-

Shank Post Journal of Prosthetic Dentistry1997 78 560ndash565

63Colli P Brannstrom M The marginal adaptation of four different bonding agents

in Class II composite resin restoration applied in bulk or in two increments

Quintessence Int 1993 24583-591

43

64Collins CJ Bryant RW Hodge KL A clinical evaluation of posterior composite

resin restorations 8-year findings J Dent 199826(4) 311ndash317

65Condon JR Ferracane JL Assessing the effect of composite formulation on

polymerization stress J Am Dent Assoc2000 131497-503

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behaviour of dimethacrylate composite resins Biomaterials 1990 11272-276

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FOTIvisual examination of occlusal caries with other caries diagnostic methods and

the effect of stain on their diagnostic performance Caries Res 2003 37 (1) 8-16

68Crim GA Microleakage of three resin placement techniques Am J Dent

1991469-72

69Dauvillier B Aarnts M Feilzer A The competition between the composite-

dentin strength and the polimerization contraction stress J Dent Res 1984 63 1396-

1399

70Dauvillier BS Aarnts MP Feilzer AJ Developments in shrinkage control of

adhesive restoratives J Esthet Dent 2000 12291-299

71Dauvillier BS Aarnts MP Feilzer AJ Modeling of the viscoelastic behavior of

dental light-activated resin composites during curing Dent Mater 200319277ndash285

72Davidson CL Gee AJ Feilzer A The competition between the composite-dentin

bond strength and the polymerization contraction stress J Dent Res 1984

63(12)1396-9

73Davidson CL AJ Feilzer Polymerization shrinkage and polymerization

shrinkage stress in polymer-based restoratives J Dent Res 199725435ndash440

74Davidson CL Resisting the curing contraction with adhesive composites J

Prosthet Dent 198655446ndash7

75Davis RD Mayhew RB A clinical comparison of three anterior restorative resins

at 3 years J Am Dent Assoc 1986112659-63

76Dejak B Mlotkowski A Three-dimensional finite element analysis of strength

and adhesion of composite resin versus ceramic inlays in molarsJ Prosthet

Dent200899131-40

77Deligeorgi V Mjor IA Wilson NH An overview of reasons for the placement

and replacement of restorations Prim Dent Care 20018(1)5-11

78Deliperi S Bardwell DN An alternative method to reduce polymerization

shrinkage in direct posterior composite restorations J Am Dent Assoc 2002

1331387ndash97

79Demirci M Tuncer S Yuceokur AA Prevalence of caries on individual tooth

surfaces and its distribution by age and gender in university clinic patientsEur J

Dent20104(3)270-9

80De Munck J Van Meerbeek B Satoshi I Vargas M Yoshida Y Armstrong S

Lambrechts P Vanherle G Microtensile bond strengths of one- and two-step

selfetch adhesives to bur-cut enamel and dentin Am J Dent 2003 16 414-420

81Dewaele M Truffier-Boutry D Devaux J Leloup G Volume contraction in

photocured dental resins the shrinkage-conversion relationship revisited Dent Mater

2006 22359-365

44

82Deutsch WM Simecek JW Dental emergencies among Marines ashore in

Operations Desert ShieldStorm Mil Med 1996161(10) 620ndash623

83Dickens SH Stansbury JW Choi KM Floyd CJ Photopolymerization kinetics

of methacrylate dental resins Macromolecules 2003 366043-6053

84Dietschi D De Siebenthal G Neveu-Rosenstand L Holz J Influence of the

restorative technique and new adhesives on the dentin marginal seal and adaptation of

resin composite Class II restorations An in vitro evaluation Quintessence Int 1995

26 717-727

85Dietschi D Herzfeld D In vitro evaluation of marginal and internal adaptation of

class II resin composite restorations after thermal and occlusal stressing Eur J Oral

Sci 1998 106 1033-1042

86Dietschi D Marginal adaptation and seal of direct and indirect Class II composite

resin restorations an in vitro evaluation Quintessence Int 26(2)127-138 1995

87Diefenderfer KE Simecek JW Ahlf RL Ragain JC Relationship between

caries status and dental emergencies among US naval personnel J Dent Res

20028195 (Abstract)

88Diefenderfer KE Rienhardt JW Shear bond strengths of ten adhesive

resinamalgam combinations Oper Dent 1997 22 50-56

89Donly KJ Jensen ME Triolo PA clinical comparison of resin composite inlay

and onlay posterior restorations and cast-gold restorations at 7 years Quintessence Int

30(3)163- 1681999

90Douglas WH Fields RP Fundingsland J A comparison between the

microleakage of direct and indirect composite restorative systems J Dent 17(4)184-

188 1989

91Eberhard J Hartman B Lenhard M Mayer T Kocher T Eickholz P Digital

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Caries Res 200034(3)219-24

92Edelstein BL Douglass CW Dispelling the myth that 50 percent of US

schoolchildren have never had a cavity Public Health Rep1995 110 (5) 522-530

93Eick JD Welch FH Polymerization shrinkage of posterior composite resins and

its possible influence on postoperative sensitivity Quintessence Int 198617103-11

94Elliott JE Lovell LG Bowman CN Primary cyclization in the polymerization of

bis GMA and TEGDMA a modeling approach to understanding the cure of dental

resins Dent Mater 2001 17221-229

95Ermis R Ulkam Aydin Examiner agreement in the replacement decisions of

class I amalgam restorations The Journal of contemporary dental practice 2004 Vol

5 no21-7

96Feilzer AJ AJ De Gee CL Davidson Increased wall-to-wall curing

contraction in thin bonded resin layers J Dent Res 19896848ndash50

97Feilzer AJ Dauvillier BS Effect of TEGDMABisGMA ratio on stress

development and viscoelastic properties of experimental twopaste composites J Dent

Res 2003 82824-828

98Feilzer AJ de Gee AJ Davidson CL Relaxation of polymerization contraction

shear stress by hygroscopic expansion J Dent Res 1990 6936ndash39

45

99Feilzer AJ De Gee AJ Davidson CL Setting stress in composite resin in relation

to configuration of the restoration J Dent Res1987 661636-1639

100Feilzer AJ Dooren LH de Gee AJ Davidson CL Influence of light intensity

on polymerization shrinkage and integrity of restoration-cavity interface Eur J Oral

Sci 1995 103322ndash326

101Fennis YL Verdischbot EH vanrsquot Hof MA Performance of some diagnostic

systems in the prediction of occlusal caries in permanent molars in 6 and 11 year-old

children J Dent 1998 26(5) 403-40

102Ferracane JL Developing a more complete understanding of stresses produced

in dental composites during polymerization Dent Mater 2005 2136-42

103Ferrari M Influence of tissue characteristics at margins on leakage of Class II

indirect porcelain restorations Am JDent 1999 12(3)134-142

104Ferreira MC Vieira RS Marginal leakage in direct and indirect composite resin

restorations in primary teeth an in vitro study J Dent 200836(5)322-5

105Forss H Widstroumlm E Reasons for restorative therapy and the longevity of

restorations in adults Acta Odontol Scand 2004 6282-86

106Fradeani M Aquilano A Bassein L Longitudinal study of pressed glass-

ceramic inlays for four and a half years J Prosthet Dent 1997 78(4)346-353

107Franccedila FM Worschech CC Paulillo LA Martins LR Lovadino JR Fracture

resistance of premolar teeth restored with different filling techniques J Contemp Dent

Pract 20056(3)62-9

108Francci C Loguercio AD Reis A Carrilho MR A novel filling technique for

packable composite resin in Class II restorations J Esthet Restor Dent 2002

14(3)149-57

109Fruits TJ Knapp JA Khajotia SS Microleakage in the proximal walls of

direct and indirect posterior resin slot restorations Oper Dent 200631(6)719-27

110Gaengler P Hoyer I Montag R Clinical evaluation of posterior composite

restorations The 10-year report J Adhes Dent 2001 3185-194

111Garbuz DS Masri BA Estaile J Classification systems in orthopaedics J Am

Acad Orthop Surg 2002 10 290-297

112Ghavamnasiri M Moosavi H Tahvildarnejad N Effect of centripetal and

incremental methods in Class II composite resin restorations on gingival

microleakage J Contemp Dent Pract 20078(2)113-20

113Gladys S Clinical and semiquantitative marginal analysis of four tooth-coloured

inlay systems at 3 years J Dent 199523(6)329-338

114Giachetti L Scaminaci Russo D Bambi C Grandini R A review of

polymerization shrinkage stress current techniques for posterior direct resin

restorations J Contemp Dent Pract 20067(4)79-88

115Giannini M AJS Santos RM Carvalho LAMS Paulillo JR Lovadino

Effects of irradiation mode and filling technique on resindentin bond strength in

Class I cavities J Dent Res 200281 (Abstract)

116Going RE Microleakage around dental restorations A summarizing review

JADA 1972841349-1357

117Gordon JChristensen G Why switch to digital radiography J Am Dent

Assoc 204 Vol 135 No 101437-1439

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118Gregoire GL Akon BA Millas A Interfacial micromorphological differences

in hybrid layer formation between water- and solvent-based dentin bonding systems J

Prosthet Dent 2002 87633ndash641

119Gregory WA Physical properties and repair bond strength of direct and indirect

composite resins J Prosthet Dent 68(3)406-411 1992

120Gwinnett AJ Buonocore MG Adhesives and caries prevention a preliminary

report Br Dent J 196511977-81

121Gwinnett AJ Matsui A A study of enamel adhesives The physical relationship

between enamel and adhesive Arch Oral Biol 1967121615-1620

122Gwinnett AJ Histologic changes in human enamel following treatment with

acidic adhesive conditioning agents Arch Oral Biol 197116731-738

123Gwinnett AJ Moist versus dry dentin its effect on shear bond strength Am J

Dent 1992 5(3)127-9

124Haba Denisia Tehnici uzuale utilizate icircn radiologia dentară Edit Junimea

2007

125Hashimoto M Ito S Tay FR Svizero NR Sano H Kaga M Fluid movement

across the resin-dentin interface during and after bonding J Dent Res 2004 83843ndash

848

126Hashimoto M Tay FR Ito S Sano H Kaga M Pashley DH Permeability of

adhesive resin films J Biomed Mater Res 2005 74699ndash705

127Hawthorne WS Smales RJ Factors influencing long-term restoration survival

in three private dental practices in Adelaide Aust Dent J 19974259ndash63

128Helwig Klimek Attin Einfuumlhrung in Die ZahnErhaltung Urbanampfischer 2003

129He Z Shimada Y Tagami J The effects of cavity size and incremental

technique on micro-tensile bond strength of resin composite in Class I cavities Dent

Mater 200723(5)533-8

130He Z Shimada Y Sadr A Ikeda M Tagami J The effects of cavity size and

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131Hench LLBioceramicsfrom concept to clinicJ Amer Ceram Soc1991

74(7)1487-1570

132Heymann HO The clinical performance of CAD-CAM generated ceramic

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133Hickel R Manhart J Longevity of restorations In Wilson NHF Roulet JF

Fuzzi M Advances in Operative Dentistry ndash Challenges of the Future Chicago

Quintessence 2001

134Hilton TJ Cavity sealers liners and bases Current philosophies and indications

for use Oper Dent 199621134 ndash146

135Hilton TJ Schwartz RS Ferracane JL Microleakage of four Class II resin

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135- 144

136Hinoura K Setcos JK Philips RW Cavity design and placement technique for

class 2 composites Oper Dent 19981312-19

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137Hintze H Wenzel A Clinically undetected dental caries assessed by bitewing

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19-23

138Hintze H Wenzel A Danielen B Behaviour of approximal carious lesions

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longitudinal study in young adults Caries Res 1999 33 415-22

139Hintze H Wenzel A Influence of validation method on diagnostic accuracy of

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Dentomaxillofacial Radiol2002 31(1) 44-49

140Holtzman JM Berkey AB Mann J Predicting utilization of dental services by

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141Hofmann N Hunecke AInfluence of curing methods and matrix type on the

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31(1)97-105

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of approximal and occlusal dental caries in a young adult population Community

Dent Oral Epidemiol 200533(3)212-8

143Hubsch PF Middleton J Knox J A finite element analysis of the stress at the

restoration-tooth interfacecomparing inlays and bulk

fillingsBiomaterials2000211015ndash1019

144Hudson JD Goldstein GR Georgescu M Enamel wear caused by three

different restorative materials J Prosthet Dent 1995 74(6)647-654

145Hunter AR Treasure ET Hunter AJ Increases in cavity volume associated

with the removal of class 2 amalgam and composite restorations Oper Dent

1995202ndash 6

146Huysmans MC PG van der Varst EP Lautenschlager P Monaghan The

influence of simulated clinical handling on the flexural and compressive strength of

posterior composite restorative materials Dent Mater 199612116ndash120

147Iliescu A Gafar MCariologie şi Odontologie RestaurativăEditura Medicală

Bucureşti 2001

148Inoue S Van Meerbeek B Vargas M Lambrechts P Vanherle G Adhesion

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Prati C Grafiche Erredue 2000131-148

149Inoue S Vargas MA Abe Y Yoshida Y LambrechtsP Vanherle G Sano H

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dentin J Adhes Dent 2001 3 237-245

150Iovan Gianina Diagnosis and Management of Patients with High Caries

Activity EdApollonia Iasi2002

151Jacobsen T Soderhold KJ Some effects of water on dentin bonding Dent

Mater 1995 11(2)132-6

152Jackson RD Morgan M The new posterior resins and a simplified placement

technique J Am Dent Assoc 2000131375ndash383

153Jain P Belcher M Microleakage of class II resin-based composite restorations

with flowable composite in the proximal box Am J Dent 200013235ndash238

48

154Jokstad A Mjor IA Analyses of long-term clinical behaviour of class II

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155Jokstad A Mjor IA Qvist V The age of restorations in situ Acta Odontol

Scand 1994 52 234-248

156Kaaden C Powers JM Friedl KH Schmalz G Bond strength of self-etching

adhesives to dental hard tissues Clin Oral Investig 2002 6(3)155-60

157Kamann WK Gangler P Zur Funktionzeit von Amalgam

Kompositefullungen Zahnartzlicher Welt 1999 108 270-273

158Kanemura N Sano H Tagami J Tensile bond strength to and SEM evaluation

of ground and intact enamel surfaces J Dent 199927523-530

159Kay EJ Nutall M Relationship between dentistlsquos treatment attitudes and

restorative decisions made on the basis of simulated bitewing radiographs

Community Dentistry and Oral Epidemiology 1994 22(2) 71-74

160Kemp-Scholte CM Davidson CL Complete marginal seal of Class V resin

composite restorations effected by increased flexibility J Dent Res 1990 691240ndash

1243

161Khairallah C Hokayem A Long-term clinical evaluation of 2 dental materials

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200932(126)21-8

163Kidd EAAssesment of dental carious lesionsArchof Oral

Biology199843(8)629-632

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proximal caries lesions at various levels in vitro Journal of Dentistry 2006 34(10)

817-822

165Kiremitci A Alpaslan T Gurgan SSix-year clinical evaluation of packable

composite restorations Oper Dent 200934(1)11-7

166Kleverlaan CJ Feilzer AJ Polymerization shrinkage and contraction stress of

dental resin composites Dent Mater 2005 211150-1157

167Koenigsberg SA Fuks R GrajowerThe effect of three filling techniques on

marginal leakage around class II composite resin restorations in vitroQuint Int

201989117ndash121

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M Dentin shear strength effect of distance from the pulp Dent Mater 2002

18(7)516-20

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of Self-etching Adhesives to Caries-affected Dentin on the Gingival Wall Dental

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Dent 27(5)325-331 1999

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Jan11(1)34-40

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JProsthet Dent 199369(4)425-430

174Koplin C Jaeger R Hahn P Kinetic model for the coupled volumetric and

thermal behavior of dental composites Dent Mater 2008 24(8)1017ndash1024

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Borgmeijer PJ Replacement risk of amalgam treatment modalities 15-year results

JDent 199826 627-632

176Labella R Lambrechts P Van Meerbeek B Vanherle G Polymerization

shrinkage and elasticity of flowable composites and filled adhesives Dent Mater

1999 15128-137

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179Lăcătuşu St Luminiţa Costinescu Andrian S Gianina Iovan Valeria

Pendefunda 180Sorina Solomon Topoliceanu C Elements of dispersional

analysis of amalgam restorations 15th

Edition of the Balkan Medical Days

Stomatological Section Abstract nr1091999128

181Lăcătuşu St Andrian S Gianina Iovan- Consideraţii asupra adaptării

amalgamelor dentare la pereţii cavităţilor RevMedicina

StomatologicăVol2199823-26

182Leevailoj C Cochran MA Matis BA Moore BK Platt JA Microleakage of

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200126302ndash307

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restorative decisions microscopic and radiographic caries depth Community

Dentistry and Oral Epidemiology 1996 24 106-11

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polymerization contraction stress for dental composites by two-step light-activation

Dent Mater 2002 18436-444

187Loguercio AD Reis A Ballester RY Polymerization shrinkage effects of

constraint and filling technique in composite restorations Dent Mater 2004

20(3)236-43

188Loguercio AD Reis A Schroeder M Balducci I Versluis A Ballester RY

Polymerization shrinkage effects of boundary conditions and filling technique of

resin composite restorations J Dent 2004 32(6)459-70

50

189Lopes GC Baratieri LN Monteiro S Jr Vieira LC Effect of posterior resin

composite placement technique on the resin-dentin interface formed in vivo

Quintessence Int 2004 35(2)156-61

190Lopes GC Baratieri LN de Andrada MA Dental adhesion present state of the

art and future perspectives Quintessence Int 200233213-224

191Loumlsche GM Marginal adaptation of class II composite fillings guided

polymerization vs reduced light intensity J Adhes Dent 1 199931ndash39

192Lovell LG Newman SM Bowman CN The effects of light intensity

temperature and comonomer composition on the polymerization behavior of

dimethacrylate dental resins J Dent 1999 21879-883

193Lovell LG Stansbury JW Syrpes DC Bowman CN Effects of composition

and reactivity on the reaction kinetics of dimethacrylatedimethacrylate

copolymerizations Macromolecules 1999 323913-3921

194Lutz F Krejci I Barbakow F Quality and durability of marginal adaptation in

bonded composite restorations Dent Mater 1991 7(2) 107-13

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clinical results J Dent Res 199877 1020

196Mair LH Ten-year clinical assessment of three posterior resin composites and

two amalgams Quintessence Int 199829483ndash490

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depth as cavity predictors for approximal dentin caries lesions in primary teeth

Dentomaxillofac Radiol 2007 Oct36(7)377-81

198Manhart J Chen H Hamm G Hickel R Review of the clinical survival of

direct and indirect restorations icircn posterior teeth of the permanent

dentitionOperDent200429(5)481-508

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year clinical evaluation of direct and indirect composite restorations in posterior teeth

J Prosthet Dent 2000 Sep84(3)289-96

201Manhart J Chen HY Neuerer P Scheibenbogen-Fuchsbrunner A Hickel R

Three-year clinical evaluation of composite and ceramic inlays Am J Dent 2001

Apr14(2)95-9

202Manhart J Chen HY Draegert U Kunzelmann KH Hickel R Vickers

hardness and depth of cure of light cured packable composite resins J Dent Res 2000

79369 (Abstract)

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structure and properties related to bonding J Dent 1997 25(6)441-58

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caries-affected transparent dentin by citric acidAn atomic force microscopy

studyDent Mater20011745-52

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the diagnosis of proximal caries Scand J Dent Res 1985 93(2) 78-84

51

206Mejare I Malmgreen B Clinical and radiographic appearance of proximal

carious lesions at the time of operative treatment in young permanent teeth Scand J

Dent Res 1988 94 19-26

207Mendonccedila JS Neto RG Santiago SL Lauris JR Navarro MF de Carvalho

RM Direct resin composite restorations versus indirect composite inlays one-year

results J Contemp Dent Pract 2010 May 111(3)025-32

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relative diagnostic yields of clinical FOTI and radiographic examinations for the

detection of approximal caries in youngsters Indian J Dent Res 200920(2)136-40

209Miguel A JC La Macorra A predictive formula of the contraction stress in

restorative and luting materials attending to free and adhered surfaces volume and

deformation Dent Mater 200117241ndash246

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practitioners and dental caries JDent1990 18(3) 130-136

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(Cerana) Br Dent J 2006 Oct 21201(8)515-20

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PrimDentCare1999Apr659-62

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Quintessence 198961-80

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ScandJDRes 199210060-65

215Mjor IA The reasons for replacement and the age of failed restorations in

general dental practice Acta OdontolScand19975558-63

216Mjoumlr IA Moorhead JE Selection of restorative materials reasons for

replacement and longevity of restorations in Florida J Am Coll Dent 199865(3)27ndash

33

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19904011ndash7

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Am Dent Assoc 2010 141(3)319-29

52

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125749-751

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34

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Monogr Oral Sci 20092142-51

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569ndash575

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54

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55

275Sarrett DC Clinical challenges and the relevance of materials testing for

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296Smales RJ Hawthorne WSLong-term survival of extensive amalgams and

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of amalgam composite and glassndashionomer restorations J Dent Res 199069861ndash

864

310Tanne K Mamoru S Burstone C Three-dimensional finite element analysis

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Orthop921987499ndash505

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Part I Depth of penetration beyond dentin smear layers Dent Mater 2001 17(4) 296-

308

313Tay FR Frankenberger R Krejci I Bouillaguet S Pashley DH Carvalho

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In vivo evidence J Dent 2004 32611ndash621

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Dent Assoc 2003 69726ndash731

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study of the influence of acidity of self-etching primers and smear layer thickness on

bonding to intact dentin J Adhes Dent 2000 283ndash98

316Thompson JY Bayne SC Heymann HO Mechanical properties of a new

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76(6)619-623 1996

317Unterbrink GL R Muessner Influence of light intensity on two restorative

systems J Dent 199523183ndash189

318Unterbrink GL Liebenberg WH Flowable resin composites as filled

adhesiveslsquo literature review and clinical recommendations Quintessence Int

199930249ndash257

319Vaarkamp J Ten Bosch J Verdonschot EH Quantitative diagnosis of small

approximal caries lesions utilizing wavelength-dependent fiber-optic

transillumination Journal of Dental Research 1997 76 (4) 875-882

320Valachovic RW Douglass CW Reiskin AB Chauncey HH McNeil BJ The

use of panoramic radiography in the evaluation of asymptomatic adult dental patients

Oral Surg Oral Med Oral Pathol 198661(3)289-96

321Van Meerbeek B De Munck J Yoshida Y Inoue S Vargas M Vijay P Van

Landuyt K Lambrechts P Vanherle G Adhesion to enamel and dentin Current

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322Van Meerbeek B Van Landuyt K De Munck JHashimoto M Peumans M

Lambrechts P Yoshida Y Inoue S Suzuki K Technique-sensitivity of

contemporary adhesives Dent Mater J 2005 24(1) 1-13

323Van Meerbeek B Vargas S Inoue S Yoshida Y Peumans M Lambrechts P

Vanherle G Adhesives and cements to promote preservation dentistry Oper Dent

20016 119-144

324Van Meerbeek B Yoshida Y Inoue S Vargas M Abe Y Fukuda R Okazaki

M Lambrechts P Vanherle G Bonding mechanism micro-tensile bond strength of

a 4- MET-based self-etching adhesive J Dent Res 2000 79 249 (Abstract)

58

325Van Nieuwenhuysen JP DrsquoHoore W Carvalho J Qvist V Long-term

evaluation of extensive restorations in permanent teeth J Dent 200331(6)395ndash405

326Venhoven BA de Gee AJ Davidson CL Light initiation of dental resins

dynamics of the polymerization Biomaterials 1996 172313-2318

327Versluis A Douglas WH Cross M Sakaguchi RL Does an incremental filling

technique reduce polymerization shrinkage stresses J Dent Res 1996 75871ndash878

328Vries HC Ruiken HM Konig KG vanrsquot Hof MA Radiographic versus

clinical diagnosis of approximal carious lesions Caries Res1990 24 (5) 364-370

329Waggoner W Ashton J Predictability of cavitation based upon radiographic

appearance comparison of two film types Quintessence International 1989 20(1)

55-60

330Watanabe LG Marshall GW Jr Marshall SJ Dentin shear strength effects of

tubule orientation and intra tooth location Dent Mater 1996 12 109-115

331Watts DC AS Marouf Optimal specimen geometry in bonded-disk

shrinkage-strain measurements on light-cured biomaterials Dent Mater 200016447ndash

451

332Watts DC Marouf AS Al-Hindi AM Photo-polymerization shrinkage-stress

kinetics in resin-composites methods development Dent Mater 2003 191ndash11

333Weaver WS Blank LW Pelleu GB Jr A visible light activated resin cured

through tooth structure GenDent 198836236-7

334Wendt SL Microleakage and cusp fracture resistance of heattreated composite

resin inlays Am J Dent 4(1)10-14 1991

335Wenzel A Hintze H Mikkelsen L Mouyen F Radiographic detection of

occlusal caries in noncavitated teeth A comparison of conventional film radiographs

digitized film radiographs and RadioVisioGraphy-Oral Surg Oral Med Oral Pathol

1991 72 621-6

336Wenzel A Hintze H Perception of image quality in direct digital radiography

after application of various image treatment filters for detectability of dental diseases

Dentomaxillofac Radiol 1993 22 131-4

337Wenzel A Computer-aided image manipulation of intraoral radiographs to

enhance diagnosis in dental practice a review Int Dent J 1993 43 99-108

338Wenzel A Digital radiography and caries diagnosis Dento Maxillo Facial

Radiology 27(1)3-11 1998

339Wenzel A Haiter-Neto F Gotfredsen E Risk factors for a false positive test

outcome in diagnosis of caries in approximal surfaces impact of radiographic

modality and observer characteristics Caries Res 200741(3)170-6

340Wibowo G Stockton L Microleakage of class II composite restorations Am J

Dent 200114177ndash185

341Wilson NHF Wastell DG Norman RD Five-year performance of high-

cooper content amalgam restorations in a multiclinical trial JDent1996 24 203-210

342Winkler MM Katona TR Paydar NH Finite element stress analysis of three

filling techniques for class V light-cured composite restorations J Dent Res

1996751477-83

343Yap AU Effectiveness of polymerization in composite restoratives claiming bulk

placement Impact of cavity depth and exposure time Oper Dent 2000 25113-120

59

344Yeşilyurt C Bulucu B Bond strength of total-etch dentin adhesive systems on

peripheral and central dentinal tissue a microtensile bond strength test The Journal of

Contemporary Dental Practice 7(2) 20061-13

345Yoshida Y Van Meerbeek B Okazaki M Shintani H Suzuki K Comparative

study on adhesive performance of functional monomers J Dent Res 2004 83 454-

458

346Yoshiyama M Tay FR Doi J Nishitani Y Yamada T Itou K Carvalho RM

Nakajima M Pashley DH Bonding of self-etch and total etch adhesives to carious

dentin J Dent Res 2002 81 556-560

  • COPERTA REZUMAT ENGLEZA (MEREUTA)pdf
  • REZUMAT ENGLEZA DR MEREUTA DENISSpdf
Page 20: UNIVERSITATEA DE MEDICINA SI FARMACIE “GR Doctorat/Rezumat... · universitatea de medicina si farmacie “gr.t.popa” iasi facultatea de medicina dentara rezumatul tezei de doctorat

17

TablesVIII9 a-b Mann-Whitney test Comparing analysis regarding anatomical

form between restorations performed using centripetal build-up technique and oblique

layering technique

Ranks

20 1830 36600

20 2270 45400

40

Restorative_techniques

Centripetal build-up

Oblique layering

Total

Anatomical_form

N Mean Rank Sum of Ranks

Test Statisticsb

156000

366000

-1486

137

242a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Anatomical_

form

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between centripetal build-up

and oblique layering techniques regarding parameter anatomical form (p=0137)

Tables VIII10a-b Mann-Whitney test Comparing analysis regarding anatomical

form between restorations performed using centripetal build-up technique and

horisontal layering technique

Ranks

20 1710 34200

20 2390 47800

40

Restorative_techniques

Centripetal build-up

Horizontal layering

Total

Anatomical_form

N Mean Rank Sum of Ranks

Test Statisticsb

132000

342000

-2184

029

068a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Anatomical_

form

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between centripetal build-up

and horisontal layering techniques regarding parameter anatomical form (p=0029)

18

Tables VIII11a-b Mann-Whitney test Comparing analysis regarding anatomical

form between restorations performed using oblique layering technique and horisontal

layering technique

Ranks

20 1920 38400

20 2180 43600

40

Restorative_techniques

Oblique layering

Horizontal layering

Total

Anatomical_form

N Mean Rank Sum of Ranks

Test Statisticsb

174000

384000

-784

433

495a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Anatomical_

form

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between horisontal layering and

oblique layering techniques regarding parameter anatomical form (p=0433)

Indices A for restorations performed using centripetal build-up technique were

as follows color match-80 marginal adaptation- 60 marginal discoloration-

70 anatomical form (proximal)- 80 surface quality- 60

Indices A for restorations performed using horisontal layering technique were

as follows color match-70 marginal adaptation- 40 marginal discoloration-

50 anatomical form (proximal)- 50 surface quality- 70

Indices A for restorations performed using oblique layering technique were as

follows color match-70 marginal adaptation- 80 marginal discoloration- 90

anatomical form (proximal)- 60 surface quality- 70

Indices B for restorations performed using centripetal build-up technique were

as follows color match-20 marginal adaptation- 30 marginal discoloration-

20 anatomical form (proximal)- 30 surface quality- 40

Indices B for restorations performed using horisontal layering technique were

as follows color match-30 marginal adaptation- 40 marginal discoloration-

30 anatomical form (proximal)- 30 surface quality- 30

Indices B for restorations performed using oblique layering technique were as

follows color match-30 marginal adaptation- 20 marginal discoloration- 10

anatomical form (proximal)- 40 surface quality- 30

19

Indices C for restorations performed using centripetal build-up technique were

as follows color match-0 marginal adaptation- 10 marginal discoloration- 0

anatomical form (proximal)- 0 surface quality- 0

Indices C for restorations performed using horisontal layering technique were

as follows color match-0 marginal adaptation- 20 marginal discoloration- 20

anatomical form (proximal)- 20 surface quality- 0

Indices C for restorations performed using oblique layering technique were as

follows color match-0 marginal adaptation- 0 marginal discoloration- 10

anatomical form (proximal)- 0 surface quality- 100

Discussions

For in vitro studies is difficult to reproduce the variables existent in oral cavity

like occlusal stress and pH and temperature changes (235) The clinical studies are

determinant in assessment of restorative techniques (300) The most researches

focuses on the influence of restorative technique on the reduction of lightcuring stress

(51 78 135)

VIII5 CONCLUSIONS

Oblique layering technique presents superior results regarding marginal

adaptation and marginal discoloration and is recommended for proximo-

occlusal dental caries close to enamel-cement jonction

Centripetal build-up presents good results regarding marginal adaptation and

anatomical form at proximal level (proximal surfaces and contact point)

Horisontal layering technique can be used for optimum results only in

proximal-occlusal cavities with moderate extension both in occlusal-cervical

and buccal-oral

20

CHAPTIX STUDY REGARDING MARGINAL SEALING STATUS IN

COMPOSITE RESINS LIMITED PROXIMO-OCCLUSAL RESTORATIONS

PERFORMED USING DIFFERENT TECHNIQUES

IX1INTRODUCTION

The contraction of composite resins can produce stress inside dental structure

The most contraction stress appears in the initial stages and development rate of stress

decreases gradually in time (5 98 160) The contraction stress of composite resins

can overpass adhesion strenght and can broke the link between dental tissues and

composite resin (73) When adhesion strenght is high stress can produce marginal

fracture or bulk fracture (74) These situations are associated with microleakage and

penetration of oral fluid and bacteria along dentinal walls endangering the pulpal

tissue or favourising secondary dental caries

IX2 AIM OF STUDY

The study aimed to assess the efficiency of marginal sealing along gingival

wall in limited proximal-occlusal restorations performed using three different

techniques

IX3MATERIALS AND METHOD

The study group included 30 teeth extracted for orthodontic and periodontal

reasons On every tooth two identical class II cavities (on mesial and distal surfaces)

were prepared with cylindrical burs under water cooling The gingival wall was

limited to enamel-cement jonction The cavity dimension were as follows 2 mm

buccal-oral 5mm depth Each tooth was introduced in a pattern of acrylat The

operator calibrated preparation technique on acrylat teeth in Simulation Laboratory of

UMF ―Gr T Popa Iaşi The 60 prepared cavities were randomly divided in three

study groups related to restorative technique The restoration were performed with

Filtek Z550 (3M ESPE) a nanohybrid composite resin The adhesive strategy

included etchamprinse in 2 steps and adhesive Adper Single Bond 2(3MESPE)

Group A (n=20) bulk restorative technique associated with lightcuring from

occlusal 40 seconds and from buccal and oral 20 seconds

Group B (n=20) oblique layering technique (first layer on buccal wall and

buccal frac12 of gingival wall was lightcured from buccal second layer on oral wall and

oral frac12 of gingival wall was lightcured from oral third oral as a triangle with point

oriented to gingival wall was lightcured from occlusal)

Group C (n=20) combined technique (bdquoflow layer on gingival and axial

walls lightcured under pressure only associated with solid composite resin layer)

The proximal surfaces were performed using Tofflemire and metallic matrices After

removal of matrices every restoration was lightcured for another 20 seconds Two

layers aof varnish were applied on composite resins restorations excepting cavity

margins and an area of 1 mm around them The samples were introduced in methylen

21

blue 10 for 48 hours After this stage samples were washed with water and teeth

were cut longitudinally with a diamonded disc

The die penetration was assessed with Zeiss (Iena Germany) X20 microscope

accordingly to four scores (0-3)

0 ndash no penetration

1 ndash die infiltration until external half of gingival wall

2 ndash die infiltration on all gingival wall

3 ndash die infiltration on gingival wall and axial wall

IX4RESULTS AND DISCUSSIONS

The result of die penetration are presented in table IX1

TableIX1 The results for die penetration

Grup 0 1 2 3

A (bulk) 0 0 3 17

B (layering) 0 4 5 11

C (combined) 12 5 2 1

In group A 17 sample had score 3 and 2 samples had score 2 In group B 11

sample had score 3 5 samples had score 2 and 4 sample had score 1 In group C with

best results 12 samples had score 0 5 samples had score 1 2 samples had score 2 1

sample had score 3

The recorded data were analysed using test Mann-Whitney The statistical

results are presented in tables IX2-IX4

Tables IX2a-b Mann-Whitney for comparisons of microleakage values between

bulk technique and incremental technique

Ranks

Restorative technique N Mean Rank Sum of Ranks

Scores

frequency

A ndash bulk technique 20 2420 24200

B ndash incremental

technique

20 1680 16800

Total 40

Test Statisticsb

scores

frequency

Mann-Whitney U 29000

Wilcoxon W 168000

Z -1970

Asymp Sig (2-tailed) 049

Exact Sig [2(1-tailed Sig)] 123a

a Not corrected for ties

b Grouping Variable restorative technique

22

Tables IX3a-b Mann-Whitney for comparisons of microleakage values between

bulk technique and mixed technique

Ranks

Restorative technique N Mean Rank Sum of Ranks

scores

frequency

A ndash bulk technique 20 3090 30900

C ndash mixed technique 20 1010 10100

Total 40

Test Statisticsb

scores

frequency

Mann-Whitney U 500

Wilcoxon W 101000

Z -4021

Asymp Sig (2-tailed) 000

Exact Sig [2(1-tailed Sig)] 000a

a Not corrected for ties

b Grouping Variable restorative technique

Tables IX4a-b Mann-Whitney test for comparisons of microleakage values

between incremental technique and mixed technique

Ranks

Restorative technique N Mean Rank Sum of Ranks

scores

frequency

B ndash incremental

technique

20 2990 29900

C ndash mixed technique 20 1210 12100

Total 40

Test Statisticsb

scores

frequency

Mann-Whitney U 5500

Wilcoxon W 121000

Z -3492

Asymp Sig (2-tailed) 000

Exact Sig [2(1-tailed Sig)] 000a

a Not corrected for ties

23

Test Statisticsb

scores

frequency

Mann-Whitney U 5500

Wilcoxon W 121000

Z -3492

Asymp Sig (2-tailed) 000

Exact Sig [2(1-tailed Sig)] 000a

a Not corrected for ties

b Grouping Variable tehnrestaurare

The results of microleakage degree were statistically significant when the

three restorative techniques were compared The results showed that best restorative

technique regarding marginal sealing in cervical area is combined technique followed

by oblique layering technique The use of layering techniques limits the development

of contraction forces between oposite walls event that favourises bulk stress voids

formation and fissure inside dental tissues The results of our study are similar with

other studies (114 293)

IX5 CONCLUSIONS

The values of die penetration at gingival wall were statistically different

between the three restorative techniques

We concluded that all restorative methods were associated with lightcuring

contraction and marginal microleakage

The combined technique was associated with lowest lightcuring contraction

and die penetration

The bulk technique was associated with highest lightcuring contraction and die

penetration

24

CHAPTX STUDY REGARDING THE EFFECTS OF ETCHING ON

ENAMEL AND DENTINE IN CERVICAL AREA FOR PROXIMAL

CAVITIES AT LATERAL DENTAL GROUP

X1 INTRODUCTION

The studies reported marginal defects and high microleakage at the level of

gingival margins localised in cervical area or close to enamel-cement jonction for

high percents of proximal-occlusal composite resins restorations (8485) The good

adhesion is requested to insure restoration longevity and to prevent marginal

microleakage and presence of secondary marginal dental caries The adhesion

strenght of different adhesive systems can vary accordingly to tissues areas (204 240)

and to variations in dentinal structures (234 330) Most studies focused on adhesive

systems performances used healthy dentine close to pulp room but in case of class II

restorations there are particular features that influences the adhesion at the level of

gingival margins

The surface topography is an important property that determines the

interaction manner between surfaces The surface roughness and surface energy can

increase or decrease the adhesion of composite resins to the hard dental tissues

X2 AIM OF STUDY

The aim of study was to compare surface roughness of enamel and dentine

after etching related to different distances related to enamel-dentinecement jonction

X3 MATERIALS AND METHODS

The study group included 20 molars extracted from orthodontics or

periodontal reasons with intact proximal surfaces The teeth were cut longitudinally in

sens buccal-oral with diamond discs under water cooling

A group study (10 teeth) included 10 samples obtained through transversal

cutting at distance of 2mm from enamel-dentinecement jonction and 10 samples

obtained through transversal cutting at distance of 15 mm from enamel-

dentinecement jonction Another study group (10 teeth) included 10 samples

obtained through transversal cutting at distance of 1mm from enamel-dentinecement

jonction and 10 samples obtained through transversal cutting at distance of 05 mm

from enamel-dentinecement jonction All these samples were divided in two halfes

through mesial-distal cutting The samples finishing was performed with abrasive

paper (100-4000) and final polishing was performed with a device Buehler model

Minimet with slices introduced in ultrasound bath for 4 minutes The second half of

each sample was etched for 15 seconds with ortophosphoric acid 37 for 15 seconds

Slices were washed with distilled water for 30 seconds after etching and dried

The samples were analysed with atomic force microscopy (AFM) regarding

surface roughness The results were expressed as relative variation of roughness

X4 RESULTS AND DISCUSSIONS

The aspect of etched enamel at 2 mm distance from ECJ can be seen in figure

X1 (section 10 microm) The surface roughness is higher comparing with sample before

etching

25

După gravajul cu acid ortofosforic 37

The aspect of etched enamel at 15 mm distance from ECJ can be seen in

figure X2 (section 10 microm) The surface roughness is higher comparing with sample

before etching but lower comparing with sample at 2 mm from ECJ

The aspect of etched enamel at 1 mm distance from ECJ can be seen in figure

X3 (section 10 microm) The surface roughness is higher comparing with sample before

etching but lower comparing with sample at 15mm and 2 mm from ECJ

The aspect of etched enamel at 15 mm distance from ECJ can be seen in

figure X4 (section 10 microm) The surface roughness is higher comparing with sample

before etching but lower comparing with sample at 1 mm 15 mm and 2 mm from

ECJ

FigX1 3D aspect of enamel at 2 mm from ECJ

after etching (10 microm)

FigX2 3D aspect of enamel at 15 mm from ECJ

after etching (10 microm)

FigX3 3D aspect of enamel at 1 mm from ECJ

after etching (10 microm)

FigX4 3D aspect of enamel at 05 mm from ECJ

after etching (10 microm)

26

The mean values of squared roughness for dentine and enamel before etching

are presented in tables X1 and X2

Table X1 Squared roughness values for dentine samples before and after etching

Before etching (nm) After etching (nm)

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

sample

1

335 282 283 259 1149 947 901 879

sample

2

352 284 274 266 1127 939 883 875

sample

3

357 273 278 263 1152 953 876 867

sample

4

323 269 264 258 1146 942 895 883

sample

5

348 298 271 268 1153 944 904 878

sample

6

339 274 278 273 1158 937 893 892

sample

7

352 283 269 266 1145 944 899 876

sample

8

349 292 272 274 1166 942 907 869

sample

9

357 284 275 265 1132 939 893 879

sample

10

348 281 277 262 1142 941 899 878

Table X2 Squared roughness values for enamel and dentine samples before and after

etching

Before etching (nm) After etching (nm)

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

sample 1 422 342 309 313 2255 1114 874 845

sample 2 418 338 324 304 2236 1102 882 839

sample 3 413 334 315 303 2239 1115 873 833

sample 4 416 336 322 308 2242 1116 868 842

sample 5 426 332 315 294 2218 1103 877 829

sample 6 412 332 317 306 2237 1099 874 847

sample 7 414 335 322 314 2252 1102 876 834

sample 8 416 325 318 313 2239 1106 875 838

sample 9 418 328 314 299 2246 1113 879 836

sample 10 413 334 316 305 2242 1104 873 839

The results for samples before etching prove a decreasing tendency for mean

values of squared roughness surface beginning with areas placed at distance of 2 mm

from ECJ (346 nm) followed by areas placed at distance of 15 mm from ECJ (282

nm) 1 mm from ECJ (274 nm) and 05 mm from ECJ (265 nm) After etching the

decreasing tendency maintained for dentine localised at 2 mm from ECJ to dentine

localised at 05 mm from ECJ The mean values of squared roughness after etching

were three times higher (tables X3)

27

Table X3 Squared roughness values for enamel and dentine samples before and

after etching

Dentine Enamel

Before etching

(nm)

After etching

(nm)

Before etching

(nm)

After etching

(nm)

2 mm ECJ 346 1147 416 2237

15 mm ECJ 282 942 333 1107

1 mm ECJ 274 895 317 875

05 mm ECJ 265 877 305 838

The descriptive statistics data for surface roughness of dentine before and after

etching are presented in tables X4 si X5

Table X4 Descriptive statistics for dentine samples before etching

Statistics

Dentine 2mm

before etching

Dentine 15mm

before etching

Dentine 1mm

before etching

Dentine 05mm

before etching

N Valid 10 10 10 10

Missing 0 0 0 0

Mean 346000 282000 274100 265400

Std Error of Mean 33830 27487 17026 16746

Std Deviation 106979 86923 53841 52957

Skewness -1214 354 -314 348

Std Error of Skewness 687 687 687 687

Kurtosis 1141 049 336 -539

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 3230 2690 2640 2580

Maximum 3570 2980 2830 2740

Table X5 Descriptive statistics for dentine samples after etching

Statistics

Dentine 2mm

after etching

Dentine 15mm

after etching

Dentine 1mm

after etching

Dentine 05mm

after etching

N Valid 10 10 10 10

Missing 0 0 0 0

1147000 942800 895000 877600

Std Error of Mean 36545 14591 29926 22020

Std Deviation 115566 46140 94634 69634

Skewness -267 1169 -951 535

Std Error of Skewness 687 687 687 687

Kurtosis 043 1776 564 1416

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 11270 9370 8760 8670

28

Statistics

Dentine 2mm

after etching

Dentine 15mm

after etching

Dentine 1mm

after etching

Dentine 05mm

after etching

N Valid 10 10 10 10

Missing 0 0 0 0

1147000 942800 895000 877600

Std Error of Mean 36545 14591 29926 22020

Std Deviation 115566 46140 94634 69634

Skewness -267 1169 -951 535

Std Error of Skewness 687 687 687 687

Kurtosis 043 1776 564 1416

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 11270 9370 8760 8670

Maximum 11660 9530 9070 8920

To choose the statistical test to compare roughness surface values was

performed a test Shapiro-Wilk If p is lower or equal with 0005 than hypothesis of

distribution normality is rejected (distribution deviates from normal form) In the table

X6 the distributions are normal The statistical test will be test t for pair samples

Table X6 Test Shapiro-Wilk for dentine samples

Tests of Normality

Kolmogorov-Smirnov

a Shapiro-Wilk

Statistic df Sig Statistic df Sig

Dentine 2mm before etching 274 10 032 877 10 122

Dentine 15mm after etching 209 10 200 952 10 689

Dentine 1mm before etching 134 10 200 983 10 980

Dentine 05mm before etching 155 10 200 949 10 661

Dentine 2mm after etching 133 10 200 977 10 946

Dentine 15mm after etching 197 10 200 916 10 329

Dentine 1mm after etching 216 10 200 925 10 401

Dentine 05 after etching 220 10 185 933 10 474

Enamel 2mm before etching 193 10 200 898 10 207

Enamel 15mm before etching 170 10 200 977 10 947

Enamel 1mm before etching 157 10 200 952 10 689

Enamel 05mm before etching 165 10 200 943 10 590

Enamel 2mm after etching 235 10 124 925 10 404

Enamel 15mm after etching 209 10 200 871 10 102

Enamel 1mm after etching 189 10 200 964 10 834

Enamel 05mm after etching 142 10 200 983 10 978

a Lilliefors Significance Correction

29

Tests of Normality

Kolmogorov-Smirnov

a Shapiro-Wilk

Statistic df Sig Statistic df Sig

Dentine 2mm before etching 274 10 032 877 10 122

Dentine 15mm after etching 209 10 200 952 10 689

Dentine 1mm before etching 134 10 200 983 10 980

Dentine 05mm before etching 155 10 200 949 10 661

Dentine 2mm after etching 133 10 200 977 10 946

Dentine 15mm after etching 197 10 200 916 10 329

Dentine 1mm after etching 216 10 200 925 10 401

Dentine 05 after etching 220 10 185 933 10 474

Enamel 2mm before etching 193 10 200 898 10 207

Enamel 15mm before etching 170 10 200 977 10 947

Enamel 1mm before etching 157 10 200 952 10 689

Enamel 05mm before etching 165 10 200 943 10 590

Enamel 2mm after etching 235 10 124 925 10 404

Enamel 15mm after etching 209 10 200 871 10 102

Enamel 1mm after etching 189 10 200 964 10 834

Enamel 05mm after etching 142 10 200 983 10 978

a Lilliefors Significance Correction

This is a lower bound of the true significance

The results of test t for pair dentine samples before and after etching are

presented in table X

Table X7 Test t for dentine before and after etching

Paired Samples Test

Paired Differences

t df

p (2-

tailed)

95 Confidence

Interval of the

Difference

Mean

Std

Dev

Std

Error

Mean Lower Upper

Pair

1

dentine2mmbeforeetching-

dentine2mmafteretching

-

8010000

174801 55277 -

8135045

-

7884955

-

144906

9 000

Pair

2

dentine15mmbeforeetching-

dentine15mmafteretching

-

6608000

102394 32380 -

6681248

-

6534752

-

204079

9 000

Pair

3

dentine1mmbeforeetching-

dentine1mmafteretching

-

6209000

117799 37251 -

6293269

-

6124731

-

166678

9 000

30

Paired Samples Test

Paired Differences

t df

p (2-

tailed)

95 Confidence

Interval of the

Difference

Mean

Std

Dev

Std

Error

Mean Lower Upper

Pair

1

dentine2mmbeforeetching-

dentine2mmafteretching

-

8010000

174801 55277 -

8135045

-

7884955

-

144906

9 000

Pair

2

dentine15mmbeforeetching-

dentine15mmafteretching

-

6608000

102394 32380 -

6681248

-

6534752

-

204079

9 000

Pair

3

dentine1mmbeforeetching-

dentine1mmafteretching

-

6209000

117799 37251 -

6293269

-

6124731

-

166678

9 000

Pair

4

dentine05mmbeforeetching-

dentine05mmafteretching

-

6122000

86384 27317 -

6183796

-

6060204

-

224109

9 000

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of dentine (

2mm 15 mm 1mm sau 05mm)

The descriptive statistics data for dentine surface roughness before and after

etching are presented in tables X8 and X9

Table X8 Descriptive statistics for enamel samples before etching

Statistics

Enamel 2mm

before etching

Enamel 15mm

before etching

Enamel 1mm

before etching

Enamel 05mm

before etching

N Valid 10 10 10 10

Missing 0 0 0 0

Mean 416800 333600 317200 305900

Std Error of Mean 13968 15217 14205 20355

Std Deviation 44171 48120 44920 64369

Skewness 1095 -156 -109 -411

Std Error of Skewness 687 687 687 687

Kurtosis 769 487 -118 -295

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 4120 3250 3090 2940

Maximum 4260 3420 3240 3140

31

Table X9 Descriptive statistics for enamel samples after etching

Statistics

Enamel 2mm

after etching

Enamel 15mm

after etching

Enamel 1mm

after etching

Enamel 05mm

after etching

N Valid 10 10 10 10

Missing 0 0 0 0

Mean 2237600 1107400 875100 838200

Std Error of Mean 31027 20232 11968 17436

Std Deviation 98116 63979 37845 55136

Skewness -850 267 042 040

Std Error of Skewness 687 687 687 687

Kurtosis 878 -1880 1082 -425

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 22180 10990 8680 8290

Maximum 22520 11160 8820 8470

To choose the statistical test to compare roughness surface values was

performed a test Shapiro-Wilk If p is lower or equal with 0005 than hypothesis of

distribution normality is rejected (distribution deviates from normal form) In the table

X10 the distributions are normal The statistical test will be test t for pair samples

Table X10 Test Shapiro-Wilk for enamel samples

Tests of Normality

Kolmogorov-Smirnova Shapiro-Wilk

Statistic df Sig Statistic df Sig

2mmenamel before etching 193 10 200 898 10 207

15mmenamel before etching 170 10 200 977 10 947

1mmenamel before etching 157 10 200 952 10 689

05mmenamel before etching 165 10 200 943 10 590

2mmenamel after etching 235 10 124 925 10 404

15mmenamel after etching 209 10 200 871 10 102

1mmenamel after etching 189 10 200 964 10 834

05mmenamel after etching 142 10 200 983 10 978

a Lilliefors Significance Correction

This is a lower bound of the true significance

The results of test t for pair enamel samples before and after etching are

presented in table X11

32

Table X11 Test t for enamel samples before and after etching

Paired Samples Test

Paired Differences

t df

p (2-

tailed)

95 Confidence

Interval of the

Difference

Mean

Std

Deviation

Std

Error

Mean Lower Upper

Pair

1

2mmenamel before

etching

2mmenamel after

etching

-18208 135220 42760 -

18304731

-

18111269

-

425815

9 000

Pair

2

15mmenamel before

etching

15mmenamel after

etching

-7738 73151 23132 -7790329 -7685671 -

334508

9 076

Pair

3

1mmenamel before

etching

1mmenamel after

etching

-5579 55468 17540 -5618679 -5539321 -

318065

9 065

Pair

4

05mmenamel before

etching

05mmenamel after

etching

-5323 60378 19093 -5366192 -5279808 -

278788

9 063

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel ( 2mm 15 mm 1mm sau

05mm) but the differences statistical significant are present only for enamel localised

at 2 mm from ECJ

X5CONCLUSIONS

The surfaces of enamel and dentine at cervical level record decreases of

roughness related to the decrease of distance to ECJ

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel but the differences

statistical significant are present only for enamel localised at 2 mm from ECJ

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of

dentine

33

CHAPTXI FEA STUDY REGARDING THE BIOMECHANICAL

BEHAVIOUR AND FRACTURE RESISTANCE OF PROXIMO-OCCLUSAL

AMALGAM AND COMPOSITE RESINS RESTORATIONS

XI1INTRODUCTION AIM OF STUDY

The individual variation of patients morphological and functional complexity

of tissues as well as difficult access limit the possibilities to investigate in clinical

studies the biomechanical behaviour of proximo-occlusal restorations In this context

simulation of the biomechanics for direct restorations represents an interesting

interdisciplinar domain in actual dentistry research

The study focused on two direction

- analysis of role of forces intensity on biomechanical behaviour related to

cavity dimension and material

- analysis of tension inside restoration structure related to forces intensity

XI2MATERIALS AND METHODS

The stages of finite element analysis study are as follows

object modelling (bicusps and proximo-occlusal restoration)

definition of parameters for materials and dental tissues

meshing

constraints and loading

types of contacts

equations system definition

results of simulation

The object 3D modelling was performed in Rhinoceros (figure XI1) The

definition of parameters was performed for Poisson constant Young modulus density

(table XI1) The selected materials were amalgam and composite resins The

analysed tissues were dentine and enamel The meshing constraints loading were

performed for forces of 200N 400N 600N 800 N The analysis was performed using

software COSMOSWorks 2010

34

Fig XI1 3D modellation of bicusp

Table XI1 Values of Young modulus Poisson constant compression resistance for

amalgam composite resin enamel (amalgam compozit smalţ)

Material Young modulus (GPa) Poisson constants

Compression

resistance

(Mpa)

Amalgam 55 033 483

Enamel 48 03 400

Composite

resin 220 022 345

Fig XI2 The forces and constraints application

The results are presented in values and culours red colours representing areas

with maximum values of tensions produced under influence of masticatory forces

The tensions produced in amalgam restoration are in a range from 0 to 22886

(force 800 N) The maximum von Misses tensions are associated with cervical area

of amalgam restorations This aspect proves that first modification in interface

restoration-cavity margins will appear at the level of gingival wall First marginal

35

defects and fissures in restoration bulk will appear at tensions over 1600Mpa

associated with forces of 800N for extended amalgam proximo-occlusal restorations

The tensions produced in composite resin restorations are in a range from 0 to

2285 (force 800 N) The maximum von Misses tensions are associated with cervical

area of composite resin restorationsThis aspect proves that first modification in

interface restoration-cavity margins will appear at the level of gingival wall First

marginal defects and fissures in restoration bulk will appear at tensions over 1716

Mpa associated with forces of 600N for moderate and extended composite resins

proximo-occlusal restorations

Fig XI3a-b ndash Simulated model of proximo-occlusal restoration

FigXI4a-b Dental amalgam restoration Cervical tension associated with 600 N

(c)800 N (d)

FigXI5a-b Composite resin restoration Cervical tension associated with 600 N

(c)800 N (d)

36

The deformation of amalgam can be produced only when is associated with

fissures in bulk of restorations while composite resins restorations present

deformation when are associated with a modification of volume and form because of

repeated action of medium forces on long term or high forces on short term (figures

XI4 XI5)

Fig XI4 Material deformation in area of maximum tension

000E + 00

500E -02

100E -01

150E -01

200E -01

250E -01

1 4 7 101316192225283134374043464952555861646770737679

Amalgam C ompoz it

Figura XI5 Deformarea funcție de material

The amalgam and composite resins were treated as homogenous isotropic and

liniar The advantage of this type of FEA study is that restorations parameters can be

modified any time is necessary both in arhitecture geometry and material indices

variability The results of this study sustain the conclusions of other FEA studies

focused on biomechanical behaviour of posterior restorations performed with

amalgam and composite resins(35 62 76 143)

37

XI4CONCLUSIONS

bull The amalgam in class II restorations has a low deformation tendency because

of uniform distribution of tension inside material

bull Composite resins class II restorations accumulate higher tensions comparing

with amalgam but deformation is avoided for a time because of the adhesion

forces performed between molecules under moderate oral forces In case of

high oral forces (600-800N) the risk of fracture in moderate class II

restorations is higher comparing with amalgam proximo-occlusal restorations

For extended class II restorations and forces of 600 N composite resins present

highest risk of fracture and deformation The von Misses tension at the

cervical interface restorationtooth can reach 1600Mpa

bull The amalgam in moderate class II restorations can resist to deformation even

for high intensity forces limited to 600N In extended class II restorations the

risk of deformation and fracture increases at values of 600N-800N of oral

forces The von Misses tension at the cervical interface restorationtooth can

reach 1700 Mpa

38

FINAL CONCLUSIONS

Amalgam proximo-occlusal restorations with minimum 6-years age present

excellent results for parameters anatomic form (occlusal) marginal

discoloration and marginal secondary dental caries good results for

parameters anatomic form (proximal) and marginal adaptation and poor results

for surface quality

Composite resins proximo-occlusal restorations (bicusps) with minimum 6-

years age present excellent results for parameters color match marginal

discoloration and marginal secondary dental caries and good results for

parameters anatomic form (occlusal proximal) marginal adaptation surface

quality

Composite resins proximo-occlusal restorations (molars) with minimum 6-

years age present good results for parameters color match marginal

discoloration marginal secondary dental caries marginal adaptation and poor

results for parameters anatomic form (occlusal) (54 indices Ryge C)

anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The restorations extended at external third of occlusal surface present highest

percents of indices C regarding anatomic form (occlusal) (54 indices Ryge

C) anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The exceeding of 6-years age will require careful monitorisation for early

interventions through polishing sealing reshaping and even replacement for

restorations with major defects

Oblique layering technique presents superior results regarding marginal

adaptation and marginal discoloration and is recommended for proximo-

occlusal dental caries close to enamel-cement jonction

Centripetal build-up presents good results regarding marginal adaptation and

anatomical form at proximal level (proximal surfaces and contact point)

Horisontal layering technique can be used for optimum results only in

proximal-occlusal cavities with moderate extension both in occlusal-cervical

and buccal-oral

The values of die penetration at gingival wall were statistically different

between the three restorative techniques

We concluded that all restorative methods were associated with lightcuring

contraction and marginal microleakage

The combined technique was associated with lowest lightcuring contraction

and die penetration

The bulk technique was associated with highest lightcuring contraction and die

penetration

39

The surfaces of enamel and dentine at cervical level record decreases of

roughness related to the decrease of distance to ECJ

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel but the differences

statistical significant are present only for enamel localised at 2 mm from ECJ

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of

dentine

bull The amalgam in class II restorations has a low deformation tendency because

of uniform distribution of tension inside material

bull Composite resins class II restorations accumulate higher tensions comparing

with amalgam but deformation is avoided for a time because of the adhesion

forces performed between molecules under moderate oral forces In case of

high oral forces (600-800N) the risk of fracture in moderate class II

restorations is higher comparing with amalgam proximo-occlusal restorations

For extended class II restorations and forces of 600 N composite resins present

highest risk of fracture and deformation The von Misses tension at the

cervical interface restorationtooth can reach 1600Mpa

bull The amalgam in moderate class II restorations can resist to deformation even

for high intensity forces limited to 600N In extended class II restorations the

risk of deformation and fracture increases at values of 600N-800N of oral

forces The von Misses tension at the cervical interface restorationtooth can

reach 1700 Mpa

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1ADA Council on Scientific Affairs ADA Council on Dental Benefit Programs

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Oper Dent 2008 Sep-Oct33(5)587-92

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utilizing a filled and unfilled adhesive resin Dent Mater 200117268ndash276

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1451-56

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diagnostic and management methods J Dent Educ 2001 65 (10) 960-968

25Bader J Ismail A Survey of systematic reviews in dentistry JADA 2004 135

464-473

26Bader JD Shugars DA Understanding dentistslsquo restorative treatment decisions J

Public Health Dent 1992 Winter52(2)102-10

27Barkmeier WW Cooley RL Current status of adhesive resin systems J Am Coll

Dent 199158 36-39

28Bayne SC Dental biomaterials where are we and where are we going J Dent

Educ 200569(5)571ndash585

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29Bedran-de-Castro AK Pereira PN Thompson JY Influence of load cycling

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30Behle C Flowable composite Proprieties and applications Pract Periodontics

Aesthetics Dent 1998 10347 350-351

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33Black J Biological Performance of Materials Fundamentals of Biocompatibility

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34Bonsor SJ Chadwick RGLongevity of conventional and bonded (sealed)

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9

35Boschian PL S Guidotti R Pietrbissa M Gagliani- bdquoStress distribution in a

post-restored tooth using the threedimensional finite element method Journal of Oral

Rehabilitation (33) 2006690ndash697

36Bouillaguet S B Ciucchi T Jacoby JC Wataha DH Pashley Bonding

characteristics to dentin walls of class II cavities in vitro Dent Mater 200117316ndash

321

37Bouschlicher MR Rueggeberg FA Effect of ramped light intensity on

polymerization force and conversion in a photoactivated composite J Esthet Dent

2000 12328-339

38Braga RR Ferracane JL Hilton TJ Contraction stress of flowable composites

and their efficacy as stress-relieving layers J Am Dent Assoc 2003134721ndash728

39Braga RR Ballester RY Ferracane JLFactors involved in the development of

polymerization shrinkage stress in resin-composites a systematic review Dent Mater

200521(10)962-70

40Bratu D- Materiale dentare icircn cabinetul de stomatologie- Edit Helicon

Timişoara1994

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amalgam-bonded restorations A 42-months study- Journal of American Dental

Association 2000nr131

42Brunthaler A Koumlnig F Lucas T Sperr W Schedle A Longevity of direct resin

composite restorations in posterior teeth Clin Oral Investig 2003 763-70

43Bullard RH Leinfelder KR Russell CM Effect of coefficient of thermal

expansion on microleakage J Am Dent Assoc 1988116871ndash 874

44Buonocore MG Matsui A Gwinnett AJ Penetration of resin dental materials

into enamel surfaces with reference to bonding Arch Oral Biol 19681361-70

45Burke FJ Cheung SW Mjoumlr IA Wilson NH Restoration longevity and analysis

of reasons for the placement and replacement of restorations provided by vocational

dental practitioners and their trainers in the United Kingdom Quintessence Int

199930(4)234-42

42

46Burke FJ Cheung SW Mjor IA Wilson NH-Reasons for the placement and

replacement of restorations in vocational training practicePrimary Dental Care

nr6(1) 1999

47Burke FJ Wilson NH Cheung SW Mjoumlr IA Influence of patient factors on age

of restorations at failure and reasons for their placement and replacement J Dent

200129(5)317-24

48Calheiros FC Braga RR Kawano Y Ballester RY Relationship between

contraction stress and degree of conversion in restorative composites Dent Mater

2004 20939-946

49Cardoso P Sadek F Microtensile bond strength on dentin using new adhesive

systems with selfetching primers Braz J Oral Sci 2003 2(4) 156-159

50Cardoso M Baratieri LN Ritter AV The effect of finishing and polishing on

the decision to replace existing amalgam restorations Quintessence Int 1999

Jun30(6)413-8

51Carvalho RM JC Pereira M Yoshiyama DH Pashley A review of

polymerization contraction the influence of stress development versus stress

reliefOper Dent19962117ndash24

52Castro VM Katz JO Hardman PK Glaros AG Spencer P Invitro comparison

of conventional film and direct digital imaging in the detection of approximal caries

Dentomaxillofac Radiol 2007 Mar36(3)138-42

53Cattaneo PM M Dalstra B Melsen- bdquoThe Finite Element Method a Tool to

Study Orthodontic Tooth Movement J Dent Res 2005 84(5)428-433

54Cattell MJ Clarke RL Lynch EJ The transverse strength reliability and

microstructural features of four dental ceramicspart 1 J Dent 25(5)399-407 1997

55Cehreli ZC Akca T Effect of dentinal tubule orientation on the microtensile

bond strength to primary dentin J Dent Child 2003 70(2) 139-144

56Celik C Arhun N Yamanel K Clinical evaluation of resin-based composites in

posterior restorations 12-month results Eur J Dent 2010 Jan4(1)57-65

57Cenci M Demarco F de Carvalho R Class II composite resin restorations with

two polymerization techniques Relationship between microtensile bond strength and

marginal leakage J Dent 2005 33(7) 603- 610

58Chaffin J Moss D Review of current US Army dental emergency rates Mil

Med 2008173(1)23ndash26

59Chen HY Manhart J Hickel R Kunzelmann KH Polymerization contraction

stress in light-cured packable composite resinsDent Mater 200117253-259

60Choi KK Condon JR Ferracane JL The effects of adhesive thickness on

polymerization contraction stress of composites J Dent Res 2000 79812ndash817

61Cichon P Kerschbaum T Verweildauer zahnartzlicher Restaurationen bei

Behinderten Dtsch Zahnartzlicher 1999 54 96-102

62Cohen BI Pagnillo MK Deutsch ASMusikant BL Fracture Strength of

Three Core Restorative Materials Supported with or without a Prefabricated Split-

Shank Post Journal of Prosthetic Dentistry1997 78 560ndash565

63Colli P Brannstrom M The marginal adaptation of four different bonding agents

in Class II composite resin restoration applied in bulk or in two increments

Quintessence Int 1993 24583-591

43

64Collins CJ Bryant RW Hodge KL A clinical evaluation of posterior composite

resin restorations 8-year findings J Dent 199826(4) 311ndash317

65Condon JR Ferracane JL Assessing the effect of composite formulation on

polymerization stress J Am Dent Assoc2000 131497-503

66Cook WD Moopnar M Influence of chemical structure on the fracture

behaviour of dimethacrylate composite resins Biomaterials 1990 11272-276

67Cortes DF Ellwood RP Ekstrand KR An in vitro comparison of a combined

FOTIvisual examination of occlusal caries with other caries diagnostic methods and

the effect of stain on their diagnostic performance Caries Res 2003 37 (1) 8-16

68Crim GA Microleakage of three resin placement techniques Am J Dent

1991469-72

69Dauvillier B Aarnts M Feilzer A The competition between the composite-

dentin strength and the polimerization contraction stress J Dent Res 1984 63 1396-

1399

70Dauvillier BS Aarnts MP Feilzer AJ Developments in shrinkage control of

adhesive restoratives J Esthet Dent 2000 12291-299

71Dauvillier BS Aarnts MP Feilzer AJ Modeling of the viscoelastic behavior of

dental light-activated resin composites during curing Dent Mater 200319277ndash285

72Davidson CL Gee AJ Feilzer A The competition between the composite-dentin

bond strength and the polymerization contraction stress J Dent Res 1984

63(12)1396-9

73Davidson CL AJ Feilzer Polymerization shrinkage and polymerization

shrinkage stress in polymer-based restoratives J Dent Res 199725435ndash440

74Davidson CL Resisting the curing contraction with adhesive composites J

Prosthet Dent 198655446ndash7

75Davis RD Mayhew RB A clinical comparison of three anterior restorative resins

at 3 years J Am Dent Assoc 1986112659-63

76Dejak B Mlotkowski A Three-dimensional finite element analysis of strength

and adhesion of composite resin versus ceramic inlays in molarsJ Prosthet

Dent200899131-40

77Deligeorgi V Mjor IA Wilson NH An overview of reasons for the placement

and replacement of restorations Prim Dent Care 20018(1)5-11

78Deliperi S Bardwell DN An alternative method to reduce polymerization

shrinkage in direct posterior composite restorations J Am Dent Assoc 2002

1331387ndash97

79Demirci M Tuncer S Yuceokur AA Prevalence of caries on individual tooth

surfaces and its distribution by age and gender in university clinic patientsEur J

Dent20104(3)270-9

80De Munck J Van Meerbeek B Satoshi I Vargas M Yoshida Y Armstrong S

Lambrechts P Vanherle G Microtensile bond strengths of one- and two-step

selfetch adhesives to bur-cut enamel and dentin Am J Dent 2003 16 414-420

81Dewaele M Truffier-Boutry D Devaux J Leloup G Volume contraction in

photocured dental resins the shrinkage-conversion relationship revisited Dent Mater

2006 22359-365

44

82Deutsch WM Simecek JW Dental emergencies among Marines ashore in

Operations Desert ShieldStorm Mil Med 1996161(10) 620ndash623

83Dickens SH Stansbury JW Choi KM Floyd CJ Photopolymerization kinetics

of methacrylate dental resins Macromolecules 2003 366043-6053

84Dietschi D De Siebenthal G Neveu-Rosenstand L Holz J Influence of the

restorative technique and new adhesives on the dentin marginal seal and adaptation of

resin composite Class II restorations An in vitro evaluation Quintessence Int 1995

26 717-727

85Dietschi D Herzfeld D In vitro evaluation of marginal and internal adaptation of

class II resin composite restorations after thermal and occlusal stressing Eur J Oral

Sci 1998 106 1033-1042

86Dietschi D Marginal adaptation and seal of direct and indirect Class II composite

resin restorations an in vitro evaluation Quintessence Int 26(2)127-138 1995

87Diefenderfer KE Simecek JW Ahlf RL Ragain JC Relationship between

caries status and dental emergencies among US naval personnel J Dent Res

20028195 (Abstract)

88Diefenderfer KE Rienhardt JW Shear bond strengths of ten adhesive

resinamalgam combinations Oper Dent 1997 22 50-56

89Donly KJ Jensen ME Triolo PA clinical comparison of resin composite inlay

and onlay posterior restorations and cast-gold restorations at 7 years Quintessence Int

30(3)163- 1681999

90Douglas WH Fields RP Fundingsland J A comparison between the

microleakage of direct and indirect composite restorative systems J Dent 17(4)184-

188 1989

91Eberhard J Hartman B Lenhard M Mayer T Kocher T Eickholz P Digital

subtraction radiography for monitoring dental demineralization An in vitro study

Caries Res 200034(3)219-24

92Edelstein BL Douglass CW Dispelling the myth that 50 percent of US

schoolchildren have never had a cavity Public Health Rep1995 110 (5) 522-530

93Eick JD Welch FH Polymerization shrinkage of posterior composite resins and

its possible influence on postoperative sensitivity Quintessence Int 198617103-11

94Elliott JE Lovell LG Bowman CN Primary cyclization in the polymerization of

bis GMA and TEGDMA a modeling approach to understanding the cure of dental

resins Dent Mater 2001 17221-229

95Ermis R Ulkam Aydin Examiner agreement in the replacement decisions of

class I amalgam restorations The Journal of contemporary dental practice 2004 Vol

5 no21-7

96Feilzer AJ AJ De Gee CL Davidson Increased wall-to-wall curing

contraction in thin bonded resin layers J Dent Res 19896848ndash50

97Feilzer AJ Dauvillier BS Effect of TEGDMABisGMA ratio on stress

development and viscoelastic properties of experimental twopaste composites J Dent

Res 2003 82824-828

98Feilzer AJ de Gee AJ Davidson CL Relaxation of polymerization contraction

shear stress by hygroscopic expansion J Dent Res 1990 6936ndash39

45

99Feilzer AJ De Gee AJ Davidson CL Setting stress in composite resin in relation

to configuration of the restoration J Dent Res1987 661636-1639

100Feilzer AJ Dooren LH de Gee AJ Davidson CL Influence of light intensity

on polymerization shrinkage and integrity of restoration-cavity interface Eur J Oral

Sci 1995 103322ndash326

101Fennis YL Verdischbot EH vanrsquot Hof MA Performance of some diagnostic

systems in the prediction of occlusal caries in permanent molars in 6 and 11 year-old

children J Dent 1998 26(5) 403-40

102Ferracane JL Developing a more complete understanding of stresses produced

in dental composites during polymerization Dent Mater 2005 2136-42

103Ferrari M Influence of tissue characteristics at margins on leakage of Class II

indirect porcelain restorations Am JDent 1999 12(3)134-142

104Ferreira MC Vieira RS Marginal leakage in direct and indirect composite resin

restorations in primary teeth an in vitro study J Dent 200836(5)322-5

105Forss H Widstroumlm E Reasons for restorative therapy and the longevity of

restorations in adults Acta Odontol Scand 2004 6282-86

106Fradeani M Aquilano A Bassein L Longitudinal study of pressed glass-

ceramic inlays for four and a half years J Prosthet Dent 1997 78(4)346-353

107Franccedila FM Worschech CC Paulillo LA Martins LR Lovadino JR Fracture

resistance of premolar teeth restored with different filling techniques J Contemp Dent

Pract 20056(3)62-9

108Francci C Loguercio AD Reis A Carrilho MR A novel filling technique for

packable composite resin in Class II restorations J Esthet Restor Dent 2002

14(3)149-57

109Fruits TJ Knapp JA Khajotia SS Microleakage in the proximal walls of

direct and indirect posterior resin slot restorations Oper Dent 200631(6)719-27

110Gaengler P Hoyer I Montag R Clinical evaluation of posterior composite

restorations The 10-year report J Adhes Dent 2001 3185-194

111Garbuz DS Masri BA Estaile J Classification systems in orthopaedics J Am

Acad Orthop Surg 2002 10 290-297

112Ghavamnasiri M Moosavi H Tahvildarnejad N Effect of centripetal and

incremental methods in Class II composite resin restorations on gingival

microleakage J Contemp Dent Pract 20078(2)113-20

113Gladys S Clinical and semiquantitative marginal analysis of four tooth-coloured

inlay systems at 3 years J Dent 199523(6)329-338

114Giachetti L Scaminaci Russo D Bambi C Grandini R A review of

polymerization shrinkage stress current techniques for posterior direct resin

restorations J Contemp Dent Pract 20067(4)79-88

115Giannini M AJS Santos RM Carvalho LAMS Paulillo JR Lovadino

Effects of irradiation mode and filling technique on resindentin bond strength in

Class I cavities J Dent Res 200281 (Abstract)

116Going RE Microleakage around dental restorations A summarizing review

JADA 1972841349-1357

117Gordon JChristensen G Why switch to digital radiography J Am Dent

Assoc 204 Vol 135 No 101437-1439

46

118Gregoire GL Akon BA Millas A Interfacial micromorphological differences

in hybrid layer formation between water- and solvent-based dentin bonding systems J

Prosthet Dent 2002 87633ndash641

119Gregory WA Physical properties and repair bond strength of direct and indirect

composite resins J Prosthet Dent 68(3)406-411 1992

120Gwinnett AJ Buonocore MG Adhesives and caries prevention a preliminary

report Br Dent J 196511977-81

121Gwinnett AJ Matsui A A study of enamel adhesives The physical relationship

between enamel and adhesive Arch Oral Biol 1967121615-1620

122Gwinnett AJ Histologic changes in human enamel following treatment with

acidic adhesive conditioning agents Arch Oral Biol 197116731-738

123Gwinnett AJ Moist versus dry dentin its effect on shear bond strength Am J

Dent 1992 5(3)127-9

124Haba Denisia Tehnici uzuale utilizate icircn radiologia dentară Edit Junimea

2007

125Hashimoto M Ito S Tay FR Svizero NR Sano H Kaga M Fluid movement

across the resin-dentin interface during and after bonding J Dent Res 2004 83843ndash

848

126Hashimoto M Tay FR Ito S Sano H Kaga M Pashley DH Permeability of

adhesive resin films J Biomed Mater Res 2005 74699ndash705

127Hawthorne WS Smales RJ Factors influencing long-term restoration survival

in three private dental practices in Adelaide Aust Dent J 19974259ndash63

128Helwig Klimek Attin Einfuumlhrung in Die ZahnErhaltung Urbanampfischer 2003

129He Z Shimada Y Tagami J The effects of cavity size and incremental

technique on micro-tensile bond strength of resin composite in Class I cavities Dent

Mater 200723(5)533-8

130He Z Shimada Y Sadr A Ikeda M Tagami J The effects of cavity size and

filling method on the bonding to Class I cavities J Adhes Dent 2008 Dec10(6)447-

53

131Hench LLBioceramicsfrom concept to clinicJ Amer Ceram Soc1991

74(7)1487-1570

132Heymann HO The clinical performance of CAD-CAM generated ceramic

inlays a four-year study J Am Dent Assoc1996 127(8)1171-1181

133Hickel R Manhart J Longevity of restorations In Wilson NHF Roulet JF

Fuzzi M Advances in Operative Dentistry ndash Challenges of the Future Chicago

Quintessence 2001

134Hilton TJ Cavity sealers liners and bases Current philosophies and indications

for use Oper Dent 199621134 ndash146

135Hilton TJ Schwartz RS Ferracane JL Microleakage of four Class II resin

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135- 144

136Hinoura K Setcos JK Philips RW Cavity design and placement technique for

class 2 composites Oper Dent 19981312-19

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137Hintze H Wenzel A Clinically undetected dental caries assessed by bitewing

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19-23

138Hintze H Wenzel A Danielen B Behaviour of approximal carious lesions

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longitudinal study in young adults Caries Res 1999 33 415-22

139Hintze H Wenzel A Influence of validation method on diagnostic accuracy of

dental caries A comparison of six digital and two conventional radiographic systems

Dentomaxillofacial Radiol2002 31(1) 44-49

140Holtzman JM Berkey AB Mann J Predicting utilization of dental services by

the aged JPublic Health Dent1990 50(3) 164-171

141Hofmann N Hunecke AInfluence of curing methods and matrix type on the

marginal seal of class II resin-based composite restorations in vitro Oper Dent 2006

31(1)97-105

142Hopcraft MS Morgan MVComparison of radiographic and clinical diagnosis

of approximal and occlusal dental caries in a young adult population Community

Dent Oral Epidemiol 200533(3)212-8

143Hubsch PF Middleton J Knox J A finite element analysis of the stress at the

restoration-tooth interfacecomparing inlays and bulk

fillingsBiomaterials2000211015ndash1019

144Hudson JD Goldstein GR Georgescu M Enamel wear caused by three

different restorative materials J Prosthet Dent 1995 74(6)647-654

145Hunter AR Treasure ET Hunter AJ Increases in cavity volume associated

with the removal of class 2 amalgam and composite restorations Oper Dent

1995202ndash 6

146Huysmans MC PG van der Varst EP Lautenschlager P Monaghan The

influence of simulated clinical handling on the flexural and compressive strength of

posterior composite restorative materials Dent Mater 199612116ndash120

147Iliescu A Gafar MCariologie şi Odontologie RestaurativăEditura Medicală

Bucureşti 2001

148Inoue S Van Meerbeek B Vargas M Lambrechts P Vanherle G Adhesion

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Prati C Grafiche Erredue 2000131-148

149Inoue S Vargas MA Abe Y Yoshida Y LambrechtsP Vanherle G Sano H

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dentin J Adhes Dent 2001 3 237-245

150Iovan Gianina Diagnosis and Management of Patients with High Caries

Activity EdApollonia Iasi2002

151Jacobsen T Soderhold KJ Some effects of water on dentin bonding Dent

Mater 1995 11(2)132-6

152Jackson RD Morgan M The new posterior resins and a simplified placement

technique J Am Dent Assoc 2000131375ndash383

153Jain P Belcher M Microleakage of class II resin-based composite restorations

with flowable composite in the proximal box Am J Dent 200013235ndash238

48

154Jokstad A Mjor IA Analyses of long-term clinical behaviour of class II

amalgam restorations Acta OdontolScand 1991 49 47-63

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Scand 1994 52 234-248

156Kaaden C Powers JM Friedl KH Schmalz G Bond strength of self-etching

adhesives to dental hard tissues Clin Oral Investig 2002 6(3)155-60

157Kamann WK Gangler P Zur Funktionzeit von Amalgam

Kompositefullungen Zahnartzlicher Welt 1999 108 270-273

158Kanemura N Sano H Tagami J Tensile bond strength to and SEM evaluation

of ground and intact enamel surfaces J Dent 199927523-530

159Kay EJ Nutall M Relationship between dentistlsquos treatment attitudes and

restorative decisions made on the basis of simulated bitewing radiographs

Community Dentistry and Oral Epidemiology 1994 22(2) 71-74

160Kemp-Scholte CM Davidson CL Complete marginal seal of Class V resin

composite restorations effected by increased flexibility J Dent Res 1990 691240ndash

1243

161Khairallah C Hokayem A Long-term clinical evaluation of 2 dental materials

used for the preparation of esthetic inlays Odontostomatol Trop 200932(127)5-13

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200932(126)21-8

163Kidd EAAssesment of dental carious lesionsArchof Oral

Biology199843(8)629-632

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proximal caries lesions at various levels in vitro Journal of Dentistry 2006 34(10)

817-822

165Kiremitci A Alpaslan T Gurgan SSix-year clinical evaluation of packable

composite restorations Oper Dent 200934(1)11-7

166Kleverlaan CJ Feilzer AJ Polymerization shrinkage and contraction stress of

dental resin composites Dent Mater 2005 211150-1157

167Koenigsberg SA Fuks R GrajowerThe effect of three filling techniques on

marginal leakage around class II composite resin restorations in vitroQuint Int

201989117ndash121

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M Dentin shear strength effect of distance from the pulp Dent Mater 2002

18(7)516-20

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light-cured resin composite on shrinkage viscosity adhesion and degree of

polimerisation Am J Dent 1998 11 17-22

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Dent 27(5)325-331 1999

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Jan11(1)34-40

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JProsthet Dent 199369(4)425-430

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thermal behavior of dental composites Dent Mater 2008 24(8)1017ndash1024

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Borgmeijer PJ Replacement risk of amalgam treatment modalities 15-year results

JDent 199826 627-632

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shrinkage and elasticity of flowable composites and filled adhesives Dent Mater

1999 15128-137

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178Lăcătuşu St- Caria dentară explozivă- EdCronica Iaşi 1996

179Lăcătuşu St Luminiţa Costinescu Andrian S Gianina Iovan Valeria

Pendefunda 180Sorina Solomon Topoliceanu C Elements of dispersional

analysis of amalgam restorations 15th

Edition of the Balkan Medical Days

Stomatological Section Abstract nr1091999128

181Lăcătuşu St Andrian S Gianina Iovan- Consideraţii asupra adaptării

amalgamelor dentare la pereţii cavităţilor RevMedicina

StomatologicăVol2199823-26

182Leevailoj C Cochran MA Matis BA Moore BK Platt JA Microleakage of

posterior packable resin composites with and without flowable liners Oper Dent

200126302ndash307

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influence of the amalgam alloy on the survival of amalgam restorations a secondary

analysis of multiple controlled clinical trials JDentRes 1997 76 1787-1798

184Levin L Coval M Geiger SBCross-sectional radiographic survey of amalgam

and resin-based composite posterior restorations Quintessence Int 200738(6)511-4

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Dentistry and Oral Epidemiology 1996 24 106-11

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20(3)236-43

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Polymerization shrinkage effects of boundary conditions and filling technique of

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50

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79369 (Abstract)

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33

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19904011ndash7

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52

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34

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54

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55

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systems J Dent 199523183ndash189

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199930249ndash257

319Vaarkamp J Ten Bosch J Verdonschot EH Quantitative diagnosis of small

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Lambrechts P Yoshida Y Inoue S Suzuki K Technique-sensitivity of

contemporary adhesives Dent Mater J 2005 24(1) 1-13

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58

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55-60

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331Watts DC AS Marouf Optimal specimen geometry in bonded-disk

shrinkage-strain measurements on light-cured biomaterials Dent Mater 200016447ndash

451

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kinetics in resin-composites methods development Dent Mater 2003 191ndash11

333Weaver WS Blank LW Pelleu GB Jr A visible light activated resin cured

through tooth structure GenDent 198836236-7

334Wendt SL Microleakage and cusp fracture resistance of heattreated composite

resin inlays Am J Dent 4(1)10-14 1991

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1991 72 621-6

336Wenzel A Hintze H Perception of image quality in direct digital radiography

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Dentomaxillofac Radiol 1993 22 131-4

337Wenzel A Computer-aided image manipulation of intraoral radiographs to

enhance diagnosis in dental practice a review Int Dent J 1993 43 99-108

338Wenzel A Digital radiography and caries diagnosis Dento Maxillo Facial

Radiology 27(1)3-11 1998

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modality and observer characteristics Caries Res 200741(3)170-6

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Dent 200114177ndash185

341Wilson NHF Wastell DG Norman RD Five-year performance of high-

cooper content amalgam restorations in a multiclinical trial JDent1996 24 203-210

342Winkler MM Katona TR Paydar NH Finite element stress analysis of three

filling techniques for class V light-cured composite restorations J Dent Res

1996751477-83

343Yap AU Effectiveness of polymerization in composite restoratives claiming bulk

placement Impact of cavity depth and exposure time Oper Dent 2000 25113-120

59

344Yeşilyurt C Bulucu B Bond strength of total-etch dentin adhesive systems on

peripheral and central dentinal tissue a microtensile bond strength test The Journal of

Contemporary Dental Practice 7(2) 20061-13

345Yoshida Y Van Meerbeek B Okazaki M Shintani H Suzuki K Comparative

study on adhesive performance of functional monomers J Dent Res 2004 83 454-

458

346Yoshiyama M Tay FR Doi J Nishitani Y Yamada T Itou K Carvalho RM

Nakajima M Pashley DH Bonding of self-etch and total etch adhesives to carious

dentin J Dent Res 2002 81 556-560

  • COPERTA REZUMAT ENGLEZA (MEREUTA)pdf
  • REZUMAT ENGLEZA DR MEREUTA DENISSpdf
Page 21: UNIVERSITATEA DE MEDICINA SI FARMACIE “GR Doctorat/Rezumat... · universitatea de medicina si farmacie “gr.t.popa” iasi facultatea de medicina dentara rezumatul tezei de doctorat

18

Tables VIII11a-b Mann-Whitney test Comparing analysis regarding anatomical

form between restorations performed using oblique layering technique and horisontal

layering technique

Ranks

20 1920 38400

20 2180 43600

40

Restorative_techniques

Oblique layering

Horizontal layering

Total

Anatomical_form

N Mean Rank Sum of Ranks

Test Statisticsb

174000

384000

-784

433

495a

Mann-Whitney U

Wilcoxon W

Z

Asymp Sig (2-tailed)

Exact Sig [2(1-tailed

Sig)]

Anatomical_

form

Not corrected for tiesa

Grouping Variable Restorative_techniquesb

There are no statistical significant differences between horisontal layering and

oblique layering techniques regarding parameter anatomical form (p=0433)

Indices A for restorations performed using centripetal build-up technique were

as follows color match-80 marginal adaptation- 60 marginal discoloration-

70 anatomical form (proximal)- 80 surface quality- 60

Indices A for restorations performed using horisontal layering technique were

as follows color match-70 marginal adaptation- 40 marginal discoloration-

50 anatomical form (proximal)- 50 surface quality- 70

Indices A for restorations performed using oblique layering technique were as

follows color match-70 marginal adaptation- 80 marginal discoloration- 90

anatomical form (proximal)- 60 surface quality- 70

Indices B for restorations performed using centripetal build-up technique were

as follows color match-20 marginal adaptation- 30 marginal discoloration-

20 anatomical form (proximal)- 30 surface quality- 40

Indices B for restorations performed using horisontal layering technique were

as follows color match-30 marginal adaptation- 40 marginal discoloration-

30 anatomical form (proximal)- 30 surface quality- 30

Indices B for restorations performed using oblique layering technique were as

follows color match-30 marginal adaptation- 20 marginal discoloration- 10

anatomical form (proximal)- 40 surface quality- 30

19

Indices C for restorations performed using centripetal build-up technique were

as follows color match-0 marginal adaptation- 10 marginal discoloration- 0

anatomical form (proximal)- 0 surface quality- 0

Indices C for restorations performed using horisontal layering technique were

as follows color match-0 marginal adaptation- 20 marginal discoloration- 20

anatomical form (proximal)- 20 surface quality- 0

Indices C for restorations performed using oblique layering technique were as

follows color match-0 marginal adaptation- 0 marginal discoloration- 10

anatomical form (proximal)- 0 surface quality- 100

Discussions

For in vitro studies is difficult to reproduce the variables existent in oral cavity

like occlusal stress and pH and temperature changes (235) The clinical studies are

determinant in assessment of restorative techniques (300) The most researches

focuses on the influence of restorative technique on the reduction of lightcuring stress

(51 78 135)

VIII5 CONCLUSIONS

Oblique layering technique presents superior results regarding marginal

adaptation and marginal discoloration and is recommended for proximo-

occlusal dental caries close to enamel-cement jonction

Centripetal build-up presents good results regarding marginal adaptation and

anatomical form at proximal level (proximal surfaces and contact point)

Horisontal layering technique can be used for optimum results only in

proximal-occlusal cavities with moderate extension both in occlusal-cervical

and buccal-oral

20

CHAPTIX STUDY REGARDING MARGINAL SEALING STATUS IN

COMPOSITE RESINS LIMITED PROXIMO-OCCLUSAL RESTORATIONS

PERFORMED USING DIFFERENT TECHNIQUES

IX1INTRODUCTION

The contraction of composite resins can produce stress inside dental structure

The most contraction stress appears in the initial stages and development rate of stress

decreases gradually in time (5 98 160) The contraction stress of composite resins

can overpass adhesion strenght and can broke the link between dental tissues and

composite resin (73) When adhesion strenght is high stress can produce marginal

fracture or bulk fracture (74) These situations are associated with microleakage and

penetration of oral fluid and bacteria along dentinal walls endangering the pulpal

tissue or favourising secondary dental caries

IX2 AIM OF STUDY

The study aimed to assess the efficiency of marginal sealing along gingival

wall in limited proximal-occlusal restorations performed using three different

techniques

IX3MATERIALS AND METHOD

The study group included 30 teeth extracted for orthodontic and periodontal

reasons On every tooth two identical class II cavities (on mesial and distal surfaces)

were prepared with cylindrical burs under water cooling The gingival wall was

limited to enamel-cement jonction The cavity dimension were as follows 2 mm

buccal-oral 5mm depth Each tooth was introduced in a pattern of acrylat The

operator calibrated preparation technique on acrylat teeth in Simulation Laboratory of

UMF ―Gr T Popa Iaşi The 60 prepared cavities were randomly divided in three

study groups related to restorative technique The restoration were performed with

Filtek Z550 (3M ESPE) a nanohybrid composite resin The adhesive strategy

included etchamprinse in 2 steps and adhesive Adper Single Bond 2(3MESPE)

Group A (n=20) bulk restorative technique associated with lightcuring from

occlusal 40 seconds and from buccal and oral 20 seconds

Group B (n=20) oblique layering technique (first layer on buccal wall and

buccal frac12 of gingival wall was lightcured from buccal second layer on oral wall and

oral frac12 of gingival wall was lightcured from oral third oral as a triangle with point

oriented to gingival wall was lightcured from occlusal)

Group C (n=20) combined technique (bdquoflow layer on gingival and axial

walls lightcured under pressure only associated with solid composite resin layer)

The proximal surfaces were performed using Tofflemire and metallic matrices After

removal of matrices every restoration was lightcured for another 20 seconds Two

layers aof varnish were applied on composite resins restorations excepting cavity

margins and an area of 1 mm around them The samples were introduced in methylen

21

blue 10 for 48 hours After this stage samples were washed with water and teeth

were cut longitudinally with a diamonded disc

The die penetration was assessed with Zeiss (Iena Germany) X20 microscope

accordingly to four scores (0-3)

0 ndash no penetration

1 ndash die infiltration until external half of gingival wall

2 ndash die infiltration on all gingival wall

3 ndash die infiltration on gingival wall and axial wall

IX4RESULTS AND DISCUSSIONS

The result of die penetration are presented in table IX1

TableIX1 The results for die penetration

Grup 0 1 2 3

A (bulk) 0 0 3 17

B (layering) 0 4 5 11

C (combined) 12 5 2 1

In group A 17 sample had score 3 and 2 samples had score 2 In group B 11

sample had score 3 5 samples had score 2 and 4 sample had score 1 In group C with

best results 12 samples had score 0 5 samples had score 1 2 samples had score 2 1

sample had score 3

The recorded data were analysed using test Mann-Whitney The statistical

results are presented in tables IX2-IX4

Tables IX2a-b Mann-Whitney for comparisons of microleakage values between

bulk technique and incremental technique

Ranks

Restorative technique N Mean Rank Sum of Ranks

Scores

frequency

A ndash bulk technique 20 2420 24200

B ndash incremental

technique

20 1680 16800

Total 40

Test Statisticsb

scores

frequency

Mann-Whitney U 29000

Wilcoxon W 168000

Z -1970

Asymp Sig (2-tailed) 049

Exact Sig [2(1-tailed Sig)] 123a

a Not corrected for ties

b Grouping Variable restorative technique

22

Tables IX3a-b Mann-Whitney for comparisons of microleakage values between

bulk technique and mixed technique

Ranks

Restorative technique N Mean Rank Sum of Ranks

scores

frequency

A ndash bulk technique 20 3090 30900

C ndash mixed technique 20 1010 10100

Total 40

Test Statisticsb

scores

frequency

Mann-Whitney U 500

Wilcoxon W 101000

Z -4021

Asymp Sig (2-tailed) 000

Exact Sig [2(1-tailed Sig)] 000a

a Not corrected for ties

b Grouping Variable restorative technique

Tables IX4a-b Mann-Whitney test for comparisons of microleakage values

between incremental technique and mixed technique

Ranks

Restorative technique N Mean Rank Sum of Ranks

scores

frequency

B ndash incremental

technique

20 2990 29900

C ndash mixed technique 20 1210 12100

Total 40

Test Statisticsb

scores

frequency

Mann-Whitney U 5500

Wilcoxon W 121000

Z -3492

Asymp Sig (2-tailed) 000

Exact Sig [2(1-tailed Sig)] 000a

a Not corrected for ties

23

Test Statisticsb

scores

frequency

Mann-Whitney U 5500

Wilcoxon W 121000

Z -3492

Asymp Sig (2-tailed) 000

Exact Sig [2(1-tailed Sig)] 000a

a Not corrected for ties

b Grouping Variable tehnrestaurare

The results of microleakage degree were statistically significant when the

three restorative techniques were compared The results showed that best restorative

technique regarding marginal sealing in cervical area is combined technique followed

by oblique layering technique The use of layering techniques limits the development

of contraction forces between oposite walls event that favourises bulk stress voids

formation and fissure inside dental tissues The results of our study are similar with

other studies (114 293)

IX5 CONCLUSIONS

The values of die penetration at gingival wall were statistically different

between the three restorative techniques

We concluded that all restorative methods were associated with lightcuring

contraction and marginal microleakage

The combined technique was associated with lowest lightcuring contraction

and die penetration

The bulk technique was associated with highest lightcuring contraction and die

penetration

24

CHAPTX STUDY REGARDING THE EFFECTS OF ETCHING ON

ENAMEL AND DENTINE IN CERVICAL AREA FOR PROXIMAL

CAVITIES AT LATERAL DENTAL GROUP

X1 INTRODUCTION

The studies reported marginal defects and high microleakage at the level of

gingival margins localised in cervical area or close to enamel-cement jonction for

high percents of proximal-occlusal composite resins restorations (8485) The good

adhesion is requested to insure restoration longevity and to prevent marginal

microleakage and presence of secondary marginal dental caries The adhesion

strenght of different adhesive systems can vary accordingly to tissues areas (204 240)

and to variations in dentinal structures (234 330) Most studies focused on adhesive

systems performances used healthy dentine close to pulp room but in case of class II

restorations there are particular features that influences the adhesion at the level of

gingival margins

The surface topography is an important property that determines the

interaction manner between surfaces The surface roughness and surface energy can

increase or decrease the adhesion of composite resins to the hard dental tissues

X2 AIM OF STUDY

The aim of study was to compare surface roughness of enamel and dentine

after etching related to different distances related to enamel-dentinecement jonction

X3 MATERIALS AND METHODS

The study group included 20 molars extracted from orthodontics or

periodontal reasons with intact proximal surfaces The teeth were cut longitudinally in

sens buccal-oral with diamond discs under water cooling

A group study (10 teeth) included 10 samples obtained through transversal

cutting at distance of 2mm from enamel-dentinecement jonction and 10 samples

obtained through transversal cutting at distance of 15 mm from enamel-

dentinecement jonction Another study group (10 teeth) included 10 samples

obtained through transversal cutting at distance of 1mm from enamel-dentinecement

jonction and 10 samples obtained through transversal cutting at distance of 05 mm

from enamel-dentinecement jonction All these samples were divided in two halfes

through mesial-distal cutting The samples finishing was performed with abrasive

paper (100-4000) and final polishing was performed with a device Buehler model

Minimet with slices introduced in ultrasound bath for 4 minutes The second half of

each sample was etched for 15 seconds with ortophosphoric acid 37 for 15 seconds

Slices were washed with distilled water for 30 seconds after etching and dried

The samples were analysed with atomic force microscopy (AFM) regarding

surface roughness The results were expressed as relative variation of roughness

X4 RESULTS AND DISCUSSIONS

The aspect of etched enamel at 2 mm distance from ECJ can be seen in figure

X1 (section 10 microm) The surface roughness is higher comparing with sample before

etching

25

După gravajul cu acid ortofosforic 37

The aspect of etched enamel at 15 mm distance from ECJ can be seen in

figure X2 (section 10 microm) The surface roughness is higher comparing with sample

before etching but lower comparing with sample at 2 mm from ECJ

The aspect of etched enamel at 1 mm distance from ECJ can be seen in figure

X3 (section 10 microm) The surface roughness is higher comparing with sample before

etching but lower comparing with sample at 15mm and 2 mm from ECJ

The aspect of etched enamel at 15 mm distance from ECJ can be seen in

figure X4 (section 10 microm) The surface roughness is higher comparing with sample

before etching but lower comparing with sample at 1 mm 15 mm and 2 mm from

ECJ

FigX1 3D aspect of enamel at 2 mm from ECJ

after etching (10 microm)

FigX2 3D aspect of enamel at 15 mm from ECJ

after etching (10 microm)

FigX3 3D aspect of enamel at 1 mm from ECJ

after etching (10 microm)

FigX4 3D aspect of enamel at 05 mm from ECJ

after etching (10 microm)

26

The mean values of squared roughness for dentine and enamel before etching

are presented in tables X1 and X2

Table X1 Squared roughness values for dentine samples before and after etching

Before etching (nm) After etching (nm)

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

sample

1

335 282 283 259 1149 947 901 879

sample

2

352 284 274 266 1127 939 883 875

sample

3

357 273 278 263 1152 953 876 867

sample

4

323 269 264 258 1146 942 895 883

sample

5

348 298 271 268 1153 944 904 878

sample

6

339 274 278 273 1158 937 893 892

sample

7

352 283 269 266 1145 944 899 876

sample

8

349 292 272 274 1166 942 907 869

sample

9

357 284 275 265 1132 939 893 879

sample

10

348 281 277 262 1142 941 899 878

Table X2 Squared roughness values for enamel and dentine samples before and after

etching

Before etching (nm) After etching (nm)

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

sample 1 422 342 309 313 2255 1114 874 845

sample 2 418 338 324 304 2236 1102 882 839

sample 3 413 334 315 303 2239 1115 873 833

sample 4 416 336 322 308 2242 1116 868 842

sample 5 426 332 315 294 2218 1103 877 829

sample 6 412 332 317 306 2237 1099 874 847

sample 7 414 335 322 314 2252 1102 876 834

sample 8 416 325 318 313 2239 1106 875 838

sample 9 418 328 314 299 2246 1113 879 836

sample 10 413 334 316 305 2242 1104 873 839

The results for samples before etching prove a decreasing tendency for mean

values of squared roughness surface beginning with areas placed at distance of 2 mm

from ECJ (346 nm) followed by areas placed at distance of 15 mm from ECJ (282

nm) 1 mm from ECJ (274 nm) and 05 mm from ECJ (265 nm) After etching the

decreasing tendency maintained for dentine localised at 2 mm from ECJ to dentine

localised at 05 mm from ECJ The mean values of squared roughness after etching

were three times higher (tables X3)

27

Table X3 Squared roughness values for enamel and dentine samples before and

after etching

Dentine Enamel

Before etching

(nm)

After etching

(nm)

Before etching

(nm)

After etching

(nm)

2 mm ECJ 346 1147 416 2237

15 mm ECJ 282 942 333 1107

1 mm ECJ 274 895 317 875

05 mm ECJ 265 877 305 838

The descriptive statistics data for surface roughness of dentine before and after

etching are presented in tables X4 si X5

Table X4 Descriptive statistics for dentine samples before etching

Statistics

Dentine 2mm

before etching

Dentine 15mm

before etching

Dentine 1mm

before etching

Dentine 05mm

before etching

N Valid 10 10 10 10

Missing 0 0 0 0

Mean 346000 282000 274100 265400

Std Error of Mean 33830 27487 17026 16746

Std Deviation 106979 86923 53841 52957

Skewness -1214 354 -314 348

Std Error of Skewness 687 687 687 687

Kurtosis 1141 049 336 -539

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 3230 2690 2640 2580

Maximum 3570 2980 2830 2740

Table X5 Descriptive statistics for dentine samples after etching

Statistics

Dentine 2mm

after etching

Dentine 15mm

after etching

Dentine 1mm

after etching

Dentine 05mm

after etching

N Valid 10 10 10 10

Missing 0 0 0 0

1147000 942800 895000 877600

Std Error of Mean 36545 14591 29926 22020

Std Deviation 115566 46140 94634 69634

Skewness -267 1169 -951 535

Std Error of Skewness 687 687 687 687

Kurtosis 043 1776 564 1416

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 11270 9370 8760 8670

28

Statistics

Dentine 2mm

after etching

Dentine 15mm

after etching

Dentine 1mm

after etching

Dentine 05mm

after etching

N Valid 10 10 10 10

Missing 0 0 0 0

1147000 942800 895000 877600

Std Error of Mean 36545 14591 29926 22020

Std Deviation 115566 46140 94634 69634

Skewness -267 1169 -951 535

Std Error of Skewness 687 687 687 687

Kurtosis 043 1776 564 1416

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 11270 9370 8760 8670

Maximum 11660 9530 9070 8920

To choose the statistical test to compare roughness surface values was

performed a test Shapiro-Wilk If p is lower or equal with 0005 than hypothesis of

distribution normality is rejected (distribution deviates from normal form) In the table

X6 the distributions are normal The statistical test will be test t for pair samples

Table X6 Test Shapiro-Wilk for dentine samples

Tests of Normality

Kolmogorov-Smirnov

a Shapiro-Wilk

Statistic df Sig Statistic df Sig

Dentine 2mm before etching 274 10 032 877 10 122

Dentine 15mm after etching 209 10 200 952 10 689

Dentine 1mm before etching 134 10 200 983 10 980

Dentine 05mm before etching 155 10 200 949 10 661

Dentine 2mm after etching 133 10 200 977 10 946

Dentine 15mm after etching 197 10 200 916 10 329

Dentine 1mm after etching 216 10 200 925 10 401

Dentine 05 after etching 220 10 185 933 10 474

Enamel 2mm before etching 193 10 200 898 10 207

Enamel 15mm before etching 170 10 200 977 10 947

Enamel 1mm before etching 157 10 200 952 10 689

Enamel 05mm before etching 165 10 200 943 10 590

Enamel 2mm after etching 235 10 124 925 10 404

Enamel 15mm after etching 209 10 200 871 10 102

Enamel 1mm after etching 189 10 200 964 10 834

Enamel 05mm after etching 142 10 200 983 10 978

a Lilliefors Significance Correction

29

Tests of Normality

Kolmogorov-Smirnov

a Shapiro-Wilk

Statistic df Sig Statistic df Sig

Dentine 2mm before etching 274 10 032 877 10 122

Dentine 15mm after etching 209 10 200 952 10 689

Dentine 1mm before etching 134 10 200 983 10 980

Dentine 05mm before etching 155 10 200 949 10 661

Dentine 2mm after etching 133 10 200 977 10 946

Dentine 15mm after etching 197 10 200 916 10 329

Dentine 1mm after etching 216 10 200 925 10 401

Dentine 05 after etching 220 10 185 933 10 474

Enamel 2mm before etching 193 10 200 898 10 207

Enamel 15mm before etching 170 10 200 977 10 947

Enamel 1mm before etching 157 10 200 952 10 689

Enamel 05mm before etching 165 10 200 943 10 590

Enamel 2mm after etching 235 10 124 925 10 404

Enamel 15mm after etching 209 10 200 871 10 102

Enamel 1mm after etching 189 10 200 964 10 834

Enamel 05mm after etching 142 10 200 983 10 978

a Lilliefors Significance Correction

This is a lower bound of the true significance

The results of test t for pair dentine samples before and after etching are

presented in table X

Table X7 Test t for dentine before and after etching

Paired Samples Test

Paired Differences

t df

p (2-

tailed)

95 Confidence

Interval of the

Difference

Mean

Std

Dev

Std

Error

Mean Lower Upper

Pair

1

dentine2mmbeforeetching-

dentine2mmafteretching

-

8010000

174801 55277 -

8135045

-

7884955

-

144906

9 000

Pair

2

dentine15mmbeforeetching-

dentine15mmafteretching

-

6608000

102394 32380 -

6681248

-

6534752

-

204079

9 000

Pair

3

dentine1mmbeforeetching-

dentine1mmafteretching

-

6209000

117799 37251 -

6293269

-

6124731

-

166678

9 000

30

Paired Samples Test

Paired Differences

t df

p (2-

tailed)

95 Confidence

Interval of the

Difference

Mean

Std

Dev

Std

Error

Mean Lower Upper

Pair

1

dentine2mmbeforeetching-

dentine2mmafteretching

-

8010000

174801 55277 -

8135045

-

7884955

-

144906

9 000

Pair

2

dentine15mmbeforeetching-

dentine15mmafteretching

-

6608000

102394 32380 -

6681248

-

6534752

-

204079

9 000

Pair

3

dentine1mmbeforeetching-

dentine1mmafteretching

-

6209000

117799 37251 -

6293269

-

6124731

-

166678

9 000

Pair

4

dentine05mmbeforeetching-

dentine05mmafteretching

-

6122000

86384 27317 -

6183796

-

6060204

-

224109

9 000

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of dentine (

2mm 15 mm 1mm sau 05mm)

The descriptive statistics data for dentine surface roughness before and after

etching are presented in tables X8 and X9

Table X8 Descriptive statistics for enamel samples before etching

Statistics

Enamel 2mm

before etching

Enamel 15mm

before etching

Enamel 1mm

before etching

Enamel 05mm

before etching

N Valid 10 10 10 10

Missing 0 0 0 0

Mean 416800 333600 317200 305900

Std Error of Mean 13968 15217 14205 20355

Std Deviation 44171 48120 44920 64369

Skewness 1095 -156 -109 -411

Std Error of Skewness 687 687 687 687

Kurtosis 769 487 -118 -295

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 4120 3250 3090 2940

Maximum 4260 3420 3240 3140

31

Table X9 Descriptive statistics for enamel samples after etching

Statistics

Enamel 2mm

after etching

Enamel 15mm

after etching

Enamel 1mm

after etching

Enamel 05mm

after etching

N Valid 10 10 10 10

Missing 0 0 0 0

Mean 2237600 1107400 875100 838200

Std Error of Mean 31027 20232 11968 17436

Std Deviation 98116 63979 37845 55136

Skewness -850 267 042 040

Std Error of Skewness 687 687 687 687

Kurtosis 878 -1880 1082 -425

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 22180 10990 8680 8290

Maximum 22520 11160 8820 8470

To choose the statistical test to compare roughness surface values was

performed a test Shapiro-Wilk If p is lower or equal with 0005 than hypothesis of

distribution normality is rejected (distribution deviates from normal form) In the table

X10 the distributions are normal The statistical test will be test t for pair samples

Table X10 Test Shapiro-Wilk for enamel samples

Tests of Normality

Kolmogorov-Smirnova Shapiro-Wilk

Statistic df Sig Statistic df Sig

2mmenamel before etching 193 10 200 898 10 207

15mmenamel before etching 170 10 200 977 10 947

1mmenamel before etching 157 10 200 952 10 689

05mmenamel before etching 165 10 200 943 10 590

2mmenamel after etching 235 10 124 925 10 404

15mmenamel after etching 209 10 200 871 10 102

1mmenamel after etching 189 10 200 964 10 834

05mmenamel after etching 142 10 200 983 10 978

a Lilliefors Significance Correction

This is a lower bound of the true significance

The results of test t for pair enamel samples before and after etching are

presented in table X11

32

Table X11 Test t for enamel samples before and after etching

Paired Samples Test

Paired Differences

t df

p (2-

tailed)

95 Confidence

Interval of the

Difference

Mean

Std

Deviation

Std

Error

Mean Lower Upper

Pair

1

2mmenamel before

etching

2mmenamel after

etching

-18208 135220 42760 -

18304731

-

18111269

-

425815

9 000

Pair

2

15mmenamel before

etching

15mmenamel after

etching

-7738 73151 23132 -7790329 -7685671 -

334508

9 076

Pair

3

1mmenamel before

etching

1mmenamel after

etching

-5579 55468 17540 -5618679 -5539321 -

318065

9 065

Pair

4

05mmenamel before

etching

05mmenamel after

etching

-5323 60378 19093 -5366192 -5279808 -

278788

9 063

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel ( 2mm 15 mm 1mm sau

05mm) but the differences statistical significant are present only for enamel localised

at 2 mm from ECJ

X5CONCLUSIONS

The surfaces of enamel and dentine at cervical level record decreases of

roughness related to the decrease of distance to ECJ

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel but the differences

statistical significant are present only for enamel localised at 2 mm from ECJ

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of

dentine

33

CHAPTXI FEA STUDY REGARDING THE BIOMECHANICAL

BEHAVIOUR AND FRACTURE RESISTANCE OF PROXIMO-OCCLUSAL

AMALGAM AND COMPOSITE RESINS RESTORATIONS

XI1INTRODUCTION AIM OF STUDY

The individual variation of patients morphological and functional complexity

of tissues as well as difficult access limit the possibilities to investigate in clinical

studies the biomechanical behaviour of proximo-occlusal restorations In this context

simulation of the biomechanics for direct restorations represents an interesting

interdisciplinar domain in actual dentistry research

The study focused on two direction

- analysis of role of forces intensity on biomechanical behaviour related to

cavity dimension and material

- analysis of tension inside restoration structure related to forces intensity

XI2MATERIALS AND METHODS

The stages of finite element analysis study are as follows

object modelling (bicusps and proximo-occlusal restoration)

definition of parameters for materials and dental tissues

meshing

constraints and loading

types of contacts

equations system definition

results of simulation

The object 3D modelling was performed in Rhinoceros (figure XI1) The

definition of parameters was performed for Poisson constant Young modulus density

(table XI1) The selected materials were amalgam and composite resins The

analysed tissues were dentine and enamel The meshing constraints loading were

performed for forces of 200N 400N 600N 800 N The analysis was performed using

software COSMOSWorks 2010

34

Fig XI1 3D modellation of bicusp

Table XI1 Values of Young modulus Poisson constant compression resistance for

amalgam composite resin enamel (amalgam compozit smalţ)

Material Young modulus (GPa) Poisson constants

Compression

resistance

(Mpa)

Amalgam 55 033 483

Enamel 48 03 400

Composite

resin 220 022 345

Fig XI2 The forces and constraints application

The results are presented in values and culours red colours representing areas

with maximum values of tensions produced under influence of masticatory forces

The tensions produced in amalgam restoration are in a range from 0 to 22886

(force 800 N) The maximum von Misses tensions are associated with cervical area

of amalgam restorations This aspect proves that first modification in interface

restoration-cavity margins will appear at the level of gingival wall First marginal

35

defects and fissures in restoration bulk will appear at tensions over 1600Mpa

associated with forces of 800N for extended amalgam proximo-occlusal restorations

The tensions produced in composite resin restorations are in a range from 0 to

2285 (force 800 N) The maximum von Misses tensions are associated with cervical

area of composite resin restorationsThis aspect proves that first modification in

interface restoration-cavity margins will appear at the level of gingival wall First

marginal defects and fissures in restoration bulk will appear at tensions over 1716

Mpa associated with forces of 600N for moderate and extended composite resins

proximo-occlusal restorations

Fig XI3a-b ndash Simulated model of proximo-occlusal restoration

FigXI4a-b Dental amalgam restoration Cervical tension associated with 600 N

(c)800 N (d)

FigXI5a-b Composite resin restoration Cervical tension associated with 600 N

(c)800 N (d)

36

The deformation of amalgam can be produced only when is associated with

fissures in bulk of restorations while composite resins restorations present

deformation when are associated with a modification of volume and form because of

repeated action of medium forces on long term or high forces on short term (figures

XI4 XI5)

Fig XI4 Material deformation in area of maximum tension

000E + 00

500E -02

100E -01

150E -01

200E -01

250E -01

1 4 7 101316192225283134374043464952555861646770737679

Amalgam C ompoz it

Figura XI5 Deformarea funcție de material

The amalgam and composite resins were treated as homogenous isotropic and

liniar The advantage of this type of FEA study is that restorations parameters can be

modified any time is necessary both in arhitecture geometry and material indices

variability The results of this study sustain the conclusions of other FEA studies

focused on biomechanical behaviour of posterior restorations performed with

amalgam and composite resins(35 62 76 143)

37

XI4CONCLUSIONS

bull The amalgam in class II restorations has a low deformation tendency because

of uniform distribution of tension inside material

bull Composite resins class II restorations accumulate higher tensions comparing

with amalgam but deformation is avoided for a time because of the adhesion

forces performed between molecules under moderate oral forces In case of

high oral forces (600-800N) the risk of fracture in moderate class II

restorations is higher comparing with amalgam proximo-occlusal restorations

For extended class II restorations and forces of 600 N composite resins present

highest risk of fracture and deformation The von Misses tension at the

cervical interface restorationtooth can reach 1600Mpa

bull The amalgam in moderate class II restorations can resist to deformation even

for high intensity forces limited to 600N In extended class II restorations the

risk of deformation and fracture increases at values of 600N-800N of oral

forces The von Misses tension at the cervical interface restorationtooth can

reach 1700 Mpa

38

FINAL CONCLUSIONS

Amalgam proximo-occlusal restorations with minimum 6-years age present

excellent results for parameters anatomic form (occlusal) marginal

discoloration and marginal secondary dental caries good results for

parameters anatomic form (proximal) and marginal adaptation and poor results

for surface quality

Composite resins proximo-occlusal restorations (bicusps) with minimum 6-

years age present excellent results for parameters color match marginal

discoloration and marginal secondary dental caries and good results for

parameters anatomic form (occlusal proximal) marginal adaptation surface

quality

Composite resins proximo-occlusal restorations (molars) with minimum 6-

years age present good results for parameters color match marginal

discoloration marginal secondary dental caries marginal adaptation and poor

results for parameters anatomic form (occlusal) (54 indices Ryge C)

anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The restorations extended at external third of occlusal surface present highest

percents of indices C regarding anatomic form (occlusal) (54 indices Ryge

C) anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The exceeding of 6-years age will require careful monitorisation for early

interventions through polishing sealing reshaping and even replacement for

restorations with major defects

Oblique layering technique presents superior results regarding marginal

adaptation and marginal discoloration and is recommended for proximo-

occlusal dental caries close to enamel-cement jonction

Centripetal build-up presents good results regarding marginal adaptation and

anatomical form at proximal level (proximal surfaces and contact point)

Horisontal layering technique can be used for optimum results only in

proximal-occlusal cavities with moderate extension both in occlusal-cervical

and buccal-oral

The values of die penetration at gingival wall were statistically different

between the three restorative techniques

We concluded that all restorative methods were associated with lightcuring

contraction and marginal microleakage

The combined technique was associated with lowest lightcuring contraction

and die penetration

The bulk technique was associated with highest lightcuring contraction and die

penetration

39

The surfaces of enamel and dentine at cervical level record decreases of

roughness related to the decrease of distance to ECJ

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel but the differences

statistical significant are present only for enamel localised at 2 mm from ECJ

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of

dentine

bull The amalgam in class II restorations has a low deformation tendency because

of uniform distribution of tension inside material

bull Composite resins class II restorations accumulate higher tensions comparing

with amalgam but deformation is avoided for a time because of the adhesion

forces performed between molecules under moderate oral forces In case of

high oral forces (600-800N) the risk of fracture in moderate class II

restorations is higher comparing with amalgam proximo-occlusal restorations

For extended class II restorations and forces of 600 N composite resins present

highest risk of fracture and deformation The von Misses tension at the

cervical interface restorationtooth can reach 1600Mpa

bull The amalgam in moderate class II restorations can resist to deformation even

for high intensity forces limited to 600N In extended class II restorations the

risk of deformation and fracture increases at values of 600N-800N of oral

forces The von Misses tension at the cervical interface restorationtooth can

reach 1700 Mpa

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1243

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Biology199843(8)629-632

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817-822

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dental resin composites Dent Mater 2005 211150-1157

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201989117ndash121

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18(7)516-20

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Materials Journal 2006 25(1)59-65

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Dent 27(5)325-331 1999

49

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Jan11(1)34-40

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JProsthet Dent 199369(4)425-430

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thermal behavior of dental composites Dent Mater 2008 24(8)1017ndash1024

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JDent 199826 627-632

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shrinkage and elasticity of flowable composites and filled adhesives Dent Mater

1999 15128-137

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Pendefunda 180Sorina Solomon Topoliceanu C Elements of dispersional

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Edition of the Balkan Medical Days

Stomatological Section Abstract nr1091999128

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StomatologicăVol2199823-26

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200126302ndash307

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Dentistry and Oral Epidemiology 1996 24 106-11

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Dent Mater 2002 18436-444

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constraint and filling technique in composite restorations Dent Mater 2004

20(3)236-43

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Polymerization shrinkage effects of boundary conditions and filling technique of

resin composite restorations J Dent 2004 32(6)459-70

50

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Quintessence Int 2004 35(2)156-61

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art and future perspectives Quintessence Int 200233213-224

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and reactivity on the reaction kinetics of dimethacrylatedimethacrylate

copolymerizations Macromolecules 1999 323913-3921

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bonded composite restorations Dent Mater 1991 7(2) 107-13

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clinical results J Dent Res 199877 1020

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two amalgams Quintessence Int 199829483ndash490

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depth as cavity predictors for approximal dentin caries lesions in primary teeth

Dentomaxillofac Radiol 2007 Oct36(7)377-81

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direct and indirect restorations icircn posterior teeth of the permanent

dentitionOperDent200429(5)481-508

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composites for posterior restorations JADA Vol132 2001639-644

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J Prosthet Dent 2000 Sep84(3)289-96

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Three-year clinical evaluation of composite and ceramic inlays Am J Dent 2001

Apr14(2)95-9

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hardness and depth of cure of light cured packable composite resins J Dent Res 2000

79369 (Abstract)

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caries-affected transparent dentin by citric acidAn atomic force microscopy

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deformation Dent Mater 200117241ndash246

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practitioners and dental caries JDent1990 18(3) 130-136

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(Cerana) Br Dent J 2006 Oct 21201(8)515-20

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PrimDentCare1999Apr659-62

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Quintessence 198961-80

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ScandJDRes 199210060-65

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33

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19904011ndash7

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Am Dent Assoc 2010 141(3)319-29

52

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125749-751

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34

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Monogr Oral Sci 20092142-51

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569ndash575

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451

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Radiology 27(1)3-11 1998

339Wenzel A Haiter-Neto F Gotfredsen E Risk factors for a false positive test

outcome in diagnosis of caries in approximal surfaces impact of radiographic

modality and observer characteristics Caries Res 200741(3)170-6

340Wibowo G Stockton L Microleakage of class II composite restorations Am J

Dent 200114177ndash185

341Wilson NHF Wastell DG Norman RD Five-year performance of high-

cooper content amalgam restorations in a multiclinical trial JDent1996 24 203-210

342Winkler MM Katona TR Paydar NH Finite element stress analysis of three

filling techniques for class V light-cured composite restorations J Dent Res

1996751477-83

343Yap AU Effectiveness of polymerization in composite restoratives claiming bulk

placement Impact of cavity depth and exposure time Oper Dent 2000 25113-120

59

344Yeşilyurt C Bulucu B Bond strength of total-etch dentin adhesive systems on

peripheral and central dentinal tissue a microtensile bond strength test The Journal of

Contemporary Dental Practice 7(2) 20061-13

345Yoshida Y Van Meerbeek B Okazaki M Shintani H Suzuki K Comparative

study on adhesive performance of functional monomers J Dent Res 2004 83 454-

458

346Yoshiyama M Tay FR Doi J Nishitani Y Yamada T Itou K Carvalho RM

Nakajima M Pashley DH Bonding of self-etch and total etch adhesives to carious

dentin J Dent Res 2002 81 556-560

  • COPERTA REZUMAT ENGLEZA (MEREUTA)pdf
  • REZUMAT ENGLEZA DR MEREUTA DENISSpdf
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19

Indices C for restorations performed using centripetal build-up technique were

as follows color match-0 marginal adaptation- 10 marginal discoloration- 0

anatomical form (proximal)- 0 surface quality- 0

Indices C for restorations performed using horisontal layering technique were

as follows color match-0 marginal adaptation- 20 marginal discoloration- 20

anatomical form (proximal)- 20 surface quality- 0

Indices C for restorations performed using oblique layering technique were as

follows color match-0 marginal adaptation- 0 marginal discoloration- 10

anatomical form (proximal)- 0 surface quality- 100

Discussions

For in vitro studies is difficult to reproduce the variables existent in oral cavity

like occlusal stress and pH and temperature changes (235) The clinical studies are

determinant in assessment of restorative techniques (300) The most researches

focuses on the influence of restorative technique on the reduction of lightcuring stress

(51 78 135)

VIII5 CONCLUSIONS

Oblique layering technique presents superior results regarding marginal

adaptation and marginal discoloration and is recommended for proximo-

occlusal dental caries close to enamel-cement jonction

Centripetal build-up presents good results regarding marginal adaptation and

anatomical form at proximal level (proximal surfaces and contact point)

Horisontal layering technique can be used for optimum results only in

proximal-occlusal cavities with moderate extension both in occlusal-cervical

and buccal-oral

20

CHAPTIX STUDY REGARDING MARGINAL SEALING STATUS IN

COMPOSITE RESINS LIMITED PROXIMO-OCCLUSAL RESTORATIONS

PERFORMED USING DIFFERENT TECHNIQUES

IX1INTRODUCTION

The contraction of composite resins can produce stress inside dental structure

The most contraction stress appears in the initial stages and development rate of stress

decreases gradually in time (5 98 160) The contraction stress of composite resins

can overpass adhesion strenght and can broke the link between dental tissues and

composite resin (73) When adhesion strenght is high stress can produce marginal

fracture or bulk fracture (74) These situations are associated with microleakage and

penetration of oral fluid and bacteria along dentinal walls endangering the pulpal

tissue or favourising secondary dental caries

IX2 AIM OF STUDY

The study aimed to assess the efficiency of marginal sealing along gingival

wall in limited proximal-occlusal restorations performed using three different

techniques

IX3MATERIALS AND METHOD

The study group included 30 teeth extracted for orthodontic and periodontal

reasons On every tooth two identical class II cavities (on mesial and distal surfaces)

were prepared with cylindrical burs under water cooling The gingival wall was

limited to enamel-cement jonction The cavity dimension were as follows 2 mm

buccal-oral 5mm depth Each tooth was introduced in a pattern of acrylat The

operator calibrated preparation technique on acrylat teeth in Simulation Laboratory of

UMF ―Gr T Popa Iaşi The 60 prepared cavities were randomly divided in three

study groups related to restorative technique The restoration were performed with

Filtek Z550 (3M ESPE) a nanohybrid composite resin The adhesive strategy

included etchamprinse in 2 steps and adhesive Adper Single Bond 2(3MESPE)

Group A (n=20) bulk restorative technique associated with lightcuring from

occlusal 40 seconds and from buccal and oral 20 seconds

Group B (n=20) oblique layering technique (first layer on buccal wall and

buccal frac12 of gingival wall was lightcured from buccal second layer on oral wall and

oral frac12 of gingival wall was lightcured from oral third oral as a triangle with point

oriented to gingival wall was lightcured from occlusal)

Group C (n=20) combined technique (bdquoflow layer on gingival and axial

walls lightcured under pressure only associated with solid composite resin layer)

The proximal surfaces were performed using Tofflemire and metallic matrices After

removal of matrices every restoration was lightcured for another 20 seconds Two

layers aof varnish were applied on composite resins restorations excepting cavity

margins and an area of 1 mm around them The samples were introduced in methylen

21

blue 10 for 48 hours After this stage samples were washed with water and teeth

were cut longitudinally with a diamonded disc

The die penetration was assessed with Zeiss (Iena Germany) X20 microscope

accordingly to four scores (0-3)

0 ndash no penetration

1 ndash die infiltration until external half of gingival wall

2 ndash die infiltration on all gingival wall

3 ndash die infiltration on gingival wall and axial wall

IX4RESULTS AND DISCUSSIONS

The result of die penetration are presented in table IX1

TableIX1 The results for die penetration

Grup 0 1 2 3

A (bulk) 0 0 3 17

B (layering) 0 4 5 11

C (combined) 12 5 2 1

In group A 17 sample had score 3 and 2 samples had score 2 In group B 11

sample had score 3 5 samples had score 2 and 4 sample had score 1 In group C with

best results 12 samples had score 0 5 samples had score 1 2 samples had score 2 1

sample had score 3

The recorded data were analysed using test Mann-Whitney The statistical

results are presented in tables IX2-IX4

Tables IX2a-b Mann-Whitney for comparisons of microleakage values between

bulk technique and incremental technique

Ranks

Restorative technique N Mean Rank Sum of Ranks

Scores

frequency

A ndash bulk technique 20 2420 24200

B ndash incremental

technique

20 1680 16800

Total 40

Test Statisticsb

scores

frequency

Mann-Whitney U 29000

Wilcoxon W 168000

Z -1970

Asymp Sig (2-tailed) 049

Exact Sig [2(1-tailed Sig)] 123a

a Not corrected for ties

b Grouping Variable restorative technique

22

Tables IX3a-b Mann-Whitney for comparisons of microleakage values between

bulk technique and mixed technique

Ranks

Restorative technique N Mean Rank Sum of Ranks

scores

frequency

A ndash bulk technique 20 3090 30900

C ndash mixed technique 20 1010 10100

Total 40

Test Statisticsb

scores

frequency

Mann-Whitney U 500

Wilcoxon W 101000

Z -4021

Asymp Sig (2-tailed) 000

Exact Sig [2(1-tailed Sig)] 000a

a Not corrected for ties

b Grouping Variable restorative technique

Tables IX4a-b Mann-Whitney test for comparisons of microleakage values

between incremental technique and mixed technique

Ranks

Restorative technique N Mean Rank Sum of Ranks

scores

frequency

B ndash incremental

technique

20 2990 29900

C ndash mixed technique 20 1210 12100

Total 40

Test Statisticsb

scores

frequency

Mann-Whitney U 5500

Wilcoxon W 121000

Z -3492

Asymp Sig (2-tailed) 000

Exact Sig [2(1-tailed Sig)] 000a

a Not corrected for ties

23

Test Statisticsb

scores

frequency

Mann-Whitney U 5500

Wilcoxon W 121000

Z -3492

Asymp Sig (2-tailed) 000

Exact Sig [2(1-tailed Sig)] 000a

a Not corrected for ties

b Grouping Variable tehnrestaurare

The results of microleakage degree were statistically significant when the

three restorative techniques were compared The results showed that best restorative

technique regarding marginal sealing in cervical area is combined technique followed

by oblique layering technique The use of layering techniques limits the development

of contraction forces between oposite walls event that favourises bulk stress voids

formation and fissure inside dental tissues The results of our study are similar with

other studies (114 293)

IX5 CONCLUSIONS

The values of die penetration at gingival wall were statistically different

between the three restorative techniques

We concluded that all restorative methods were associated with lightcuring

contraction and marginal microleakage

The combined technique was associated with lowest lightcuring contraction

and die penetration

The bulk technique was associated with highest lightcuring contraction and die

penetration

24

CHAPTX STUDY REGARDING THE EFFECTS OF ETCHING ON

ENAMEL AND DENTINE IN CERVICAL AREA FOR PROXIMAL

CAVITIES AT LATERAL DENTAL GROUP

X1 INTRODUCTION

The studies reported marginal defects and high microleakage at the level of

gingival margins localised in cervical area or close to enamel-cement jonction for

high percents of proximal-occlusal composite resins restorations (8485) The good

adhesion is requested to insure restoration longevity and to prevent marginal

microleakage and presence of secondary marginal dental caries The adhesion

strenght of different adhesive systems can vary accordingly to tissues areas (204 240)

and to variations in dentinal structures (234 330) Most studies focused on adhesive

systems performances used healthy dentine close to pulp room but in case of class II

restorations there are particular features that influences the adhesion at the level of

gingival margins

The surface topography is an important property that determines the

interaction manner between surfaces The surface roughness and surface energy can

increase or decrease the adhesion of composite resins to the hard dental tissues

X2 AIM OF STUDY

The aim of study was to compare surface roughness of enamel and dentine

after etching related to different distances related to enamel-dentinecement jonction

X3 MATERIALS AND METHODS

The study group included 20 molars extracted from orthodontics or

periodontal reasons with intact proximal surfaces The teeth were cut longitudinally in

sens buccal-oral with diamond discs under water cooling

A group study (10 teeth) included 10 samples obtained through transversal

cutting at distance of 2mm from enamel-dentinecement jonction and 10 samples

obtained through transversal cutting at distance of 15 mm from enamel-

dentinecement jonction Another study group (10 teeth) included 10 samples

obtained through transversal cutting at distance of 1mm from enamel-dentinecement

jonction and 10 samples obtained through transversal cutting at distance of 05 mm

from enamel-dentinecement jonction All these samples were divided in two halfes

through mesial-distal cutting The samples finishing was performed with abrasive

paper (100-4000) and final polishing was performed with a device Buehler model

Minimet with slices introduced in ultrasound bath for 4 minutes The second half of

each sample was etched for 15 seconds with ortophosphoric acid 37 for 15 seconds

Slices were washed with distilled water for 30 seconds after etching and dried

The samples were analysed with atomic force microscopy (AFM) regarding

surface roughness The results were expressed as relative variation of roughness

X4 RESULTS AND DISCUSSIONS

The aspect of etched enamel at 2 mm distance from ECJ can be seen in figure

X1 (section 10 microm) The surface roughness is higher comparing with sample before

etching

25

După gravajul cu acid ortofosforic 37

The aspect of etched enamel at 15 mm distance from ECJ can be seen in

figure X2 (section 10 microm) The surface roughness is higher comparing with sample

before etching but lower comparing with sample at 2 mm from ECJ

The aspect of etched enamel at 1 mm distance from ECJ can be seen in figure

X3 (section 10 microm) The surface roughness is higher comparing with sample before

etching but lower comparing with sample at 15mm and 2 mm from ECJ

The aspect of etched enamel at 15 mm distance from ECJ can be seen in

figure X4 (section 10 microm) The surface roughness is higher comparing with sample

before etching but lower comparing with sample at 1 mm 15 mm and 2 mm from

ECJ

FigX1 3D aspect of enamel at 2 mm from ECJ

after etching (10 microm)

FigX2 3D aspect of enamel at 15 mm from ECJ

after etching (10 microm)

FigX3 3D aspect of enamel at 1 mm from ECJ

after etching (10 microm)

FigX4 3D aspect of enamel at 05 mm from ECJ

after etching (10 microm)

26

The mean values of squared roughness for dentine and enamel before etching

are presented in tables X1 and X2

Table X1 Squared roughness values for dentine samples before and after etching

Before etching (nm) After etching (nm)

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

sample

1

335 282 283 259 1149 947 901 879

sample

2

352 284 274 266 1127 939 883 875

sample

3

357 273 278 263 1152 953 876 867

sample

4

323 269 264 258 1146 942 895 883

sample

5

348 298 271 268 1153 944 904 878

sample

6

339 274 278 273 1158 937 893 892

sample

7

352 283 269 266 1145 944 899 876

sample

8

349 292 272 274 1166 942 907 869

sample

9

357 284 275 265 1132 939 893 879

sample

10

348 281 277 262 1142 941 899 878

Table X2 Squared roughness values for enamel and dentine samples before and after

etching

Before etching (nm) After etching (nm)

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

sample 1 422 342 309 313 2255 1114 874 845

sample 2 418 338 324 304 2236 1102 882 839

sample 3 413 334 315 303 2239 1115 873 833

sample 4 416 336 322 308 2242 1116 868 842

sample 5 426 332 315 294 2218 1103 877 829

sample 6 412 332 317 306 2237 1099 874 847

sample 7 414 335 322 314 2252 1102 876 834

sample 8 416 325 318 313 2239 1106 875 838

sample 9 418 328 314 299 2246 1113 879 836

sample 10 413 334 316 305 2242 1104 873 839

The results for samples before etching prove a decreasing tendency for mean

values of squared roughness surface beginning with areas placed at distance of 2 mm

from ECJ (346 nm) followed by areas placed at distance of 15 mm from ECJ (282

nm) 1 mm from ECJ (274 nm) and 05 mm from ECJ (265 nm) After etching the

decreasing tendency maintained for dentine localised at 2 mm from ECJ to dentine

localised at 05 mm from ECJ The mean values of squared roughness after etching

were three times higher (tables X3)

27

Table X3 Squared roughness values for enamel and dentine samples before and

after etching

Dentine Enamel

Before etching

(nm)

After etching

(nm)

Before etching

(nm)

After etching

(nm)

2 mm ECJ 346 1147 416 2237

15 mm ECJ 282 942 333 1107

1 mm ECJ 274 895 317 875

05 mm ECJ 265 877 305 838

The descriptive statistics data for surface roughness of dentine before and after

etching are presented in tables X4 si X5

Table X4 Descriptive statistics for dentine samples before etching

Statistics

Dentine 2mm

before etching

Dentine 15mm

before etching

Dentine 1mm

before etching

Dentine 05mm

before etching

N Valid 10 10 10 10

Missing 0 0 0 0

Mean 346000 282000 274100 265400

Std Error of Mean 33830 27487 17026 16746

Std Deviation 106979 86923 53841 52957

Skewness -1214 354 -314 348

Std Error of Skewness 687 687 687 687

Kurtosis 1141 049 336 -539

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 3230 2690 2640 2580

Maximum 3570 2980 2830 2740

Table X5 Descriptive statistics for dentine samples after etching

Statistics

Dentine 2mm

after etching

Dentine 15mm

after etching

Dentine 1mm

after etching

Dentine 05mm

after etching

N Valid 10 10 10 10

Missing 0 0 0 0

1147000 942800 895000 877600

Std Error of Mean 36545 14591 29926 22020

Std Deviation 115566 46140 94634 69634

Skewness -267 1169 -951 535

Std Error of Skewness 687 687 687 687

Kurtosis 043 1776 564 1416

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 11270 9370 8760 8670

28

Statistics

Dentine 2mm

after etching

Dentine 15mm

after etching

Dentine 1mm

after etching

Dentine 05mm

after etching

N Valid 10 10 10 10

Missing 0 0 0 0

1147000 942800 895000 877600

Std Error of Mean 36545 14591 29926 22020

Std Deviation 115566 46140 94634 69634

Skewness -267 1169 -951 535

Std Error of Skewness 687 687 687 687

Kurtosis 043 1776 564 1416

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 11270 9370 8760 8670

Maximum 11660 9530 9070 8920

To choose the statistical test to compare roughness surface values was

performed a test Shapiro-Wilk If p is lower or equal with 0005 than hypothesis of

distribution normality is rejected (distribution deviates from normal form) In the table

X6 the distributions are normal The statistical test will be test t for pair samples

Table X6 Test Shapiro-Wilk for dentine samples

Tests of Normality

Kolmogorov-Smirnov

a Shapiro-Wilk

Statistic df Sig Statistic df Sig

Dentine 2mm before etching 274 10 032 877 10 122

Dentine 15mm after etching 209 10 200 952 10 689

Dentine 1mm before etching 134 10 200 983 10 980

Dentine 05mm before etching 155 10 200 949 10 661

Dentine 2mm after etching 133 10 200 977 10 946

Dentine 15mm after etching 197 10 200 916 10 329

Dentine 1mm after etching 216 10 200 925 10 401

Dentine 05 after etching 220 10 185 933 10 474

Enamel 2mm before etching 193 10 200 898 10 207

Enamel 15mm before etching 170 10 200 977 10 947

Enamel 1mm before etching 157 10 200 952 10 689

Enamel 05mm before etching 165 10 200 943 10 590

Enamel 2mm after etching 235 10 124 925 10 404

Enamel 15mm after etching 209 10 200 871 10 102

Enamel 1mm after etching 189 10 200 964 10 834

Enamel 05mm after etching 142 10 200 983 10 978

a Lilliefors Significance Correction

29

Tests of Normality

Kolmogorov-Smirnov

a Shapiro-Wilk

Statistic df Sig Statistic df Sig

Dentine 2mm before etching 274 10 032 877 10 122

Dentine 15mm after etching 209 10 200 952 10 689

Dentine 1mm before etching 134 10 200 983 10 980

Dentine 05mm before etching 155 10 200 949 10 661

Dentine 2mm after etching 133 10 200 977 10 946

Dentine 15mm after etching 197 10 200 916 10 329

Dentine 1mm after etching 216 10 200 925 10 401

Dentine 05 after etching 220 10 185 933 10 474

Enamel 2mm before etching 193 10 200 898 10 207

Enamel 15mm before etching 170 10 200 977 10 947

Enamel 1mm before etching 157 10 200 952 10 689

Enamel 05mm before etching 165 10 200 943 10 590

Enamel 2mm after etching 235 10 124 925 10 404

Enamel 15mm after etching 209 10 200 871 10 102

Enamel 1mm after etching 189 10 200 964 10 834

Enamel 05mm after etching 142 10 200 983 10 978

a Lilliefors Significance Correction

This is a lower bound of the true significance

The results of test t for pair dentine samples before and after etching are

presented in table X

Table X7 Test t for dentine before and after etching

Paired Samples Test

Paired Differences

t df

p (2-

tailed)

95 Confidence

Interval of the

Difference

Mean

Std

Dev

Std

Error

Mean Lower Upper

Pair

1

dentine2mmbeforeetching-

dentine2mmafteretching

-

8010000

174801 55277 -

8135045

-

7884955

-

144906

9 000

Pair

2

dentine15mmbeforeetching-

dentine15mmafteretching

-

6608000

102394 32380 -

6681248

-

6534752

-

204079

9 000

Pair

3

dentine1mmbeforeetching-

dentine1mmafteretching

-

6209000

117799 37251 -

6293269

-

6124731

-

166678

9 000

30

Paired Samples Test

Paired Differences

t df

p (2-

tailed)

95 Confidence

Interval of the

Difference

Mean

Std

Dev

Std

Error

Mean Lower Upper

Pair

1

dentine2mmbeforeetching-

dentine2mmafteretching

-

8010000

174801 55277 -

8135045

-

7884955

-

144906

9 000

Pair

2

dentine15mmbeforeetching-

dentine15mmafteretching

-

6608000

102394 32380 -

6681248

-

6534752

-

204079

9 000

Pair

3

dentine1mmbeforeetching-

dentine1mmafteretching

-

6209000

117799 37251 -

6293269

-

6124731

-

166678

9 000

Pair

4

dentine05mmbeforeetching-

dentine05mmafteretching

-

6122000

86384 27317 -

6183796

-

6060204

-

224109

9 000

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of dentine (

2mm 15 mm 1mm sau 05mm)

The descriptive statistics data for dentine surface roughness before and after

etching are presented in tables X8 and X9

Table X8 Descriptive statistics for enamel samples before etching

Statistics

Enamel 2mm

before etching

Enamel 15mm

before etching

Enamel 1mm

before etching

Enamel 05mm

before etching

N Valid 10 10 10 10

Missing 0 0 0 0

Mean 416800 333600 317200 305900

Std Error of Mean 13968 15217 14205 20355

Std Deviation 44171 48120 44920 64369

Skewness 1095 -156 -109 -411

Std Error of Skewness 687 687 687 687

Kurtosis 769 487 -118 -295

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 4120 3250 3090 2940

Maximum 4260 3420 3240 3140

31

Table X9 Descriptive statistics for enamel samples after etching

Statistics

Enamel 2mm

after etching

Enamel 15mm

after etching

Enamel 1mm

after etching

Enamel 05mm

after etching

N Valid 10 10 10 10

Missing 0 0 0 0

Mean 2237600 1107400 875100 838200

Std Error of Mean 31027 20232 11968 17436

Std Deviation 98116 63979 37845 55136

Skewness -850 267 042 040

Std Error of Skewness 687 687 687 687

Kurtosis 878 -1880 1082 -425

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 22180 10990 8680 8290

Maximum 22520 11160 8820 8470

To choose the statistical test to compare roughness surface values was

performed a test Shapiro-Wilk If p is lower or equal with 0005 than hypothesis of

distribution normality is rejected (distribution deviates from normal form) In the table

X10 the distributions are normal The statistical test will be test t for pair samples

Table X10 Test Shapiro-Wilk for enamel samples

Tests of Normality

Kolmogorov-Smirnova Shapiro-Wilk

Statistic df Sig Statistic df Sig

2mmenamel before etching 193 10 200 898 10 207

15mmenamel before etching 170 10 200 977 10 947

1mmenamel before etching 157 10 200 952 10 689

05mmenamel before etching 165 10 200 943 10 590

2mmenamel after etching 235 10 124 925 10 404

15mmenamel after etching 209 10 200 871 10 102

1mmenamel after etching 189 10 200 964 10 834

05mmenamel after etching 142 10 200 983 10 978

a Lilliefors Significance Correction

This is a lower bound of the true significance

The results of test t for pair enamel samples before and after etching are

presented in table X11

32

Table X11 Test t for enamel samples before and after etching

Paired Samples Test

Paired Differences

t df

p (2-

tailed)

95 Confidence

Interval of the

Difference

Mean

Std

Deviation

Std

Error

Mean Lower Upper

Pair

1

2mmenamel before

etching

2mmenamel after

etching

-18208 135220 42760 -

18304731

-

18111269

-

425815

9 000

Pair

2

15mmenamel before

etching

15mmenamel after

etching

-7738 73151 23132 -7790329 -7685671 -

334508

9 076

Pair

3

1mmenamel before

etching

1mmenamel after

etching

-5579 55468 17540 -5618679 -5539321 -

318065

9 065

Pair

4

05mmenamel before

etching

05mmenamel after

etching

-5323 60378 19093 -5366192 -5279808 -

278788

9 063

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel ( 2mm 15 mm 1mm sau

05mm) but the differences statistical significant are present only for enamel localised

at 2 mm from ECJ

X5CONCLUSIONS

The surfaces of enamel and dentine at cervical level record decreases of

roughness related to the decrease of distance to ECJ

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel but the differences

statistical significant are present only for enamel localised at 2 mm from ECJ

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of

dentine

33

CHAPTXI FEA STUDY REGARDING THE BIOMECHANICAL

BEHAVIOUR AND FRACTURE RESISTANCE OF PROXIMO-OCCLUSAL

AMALGAM AND COMPOSITE RESINS RESTORATIONS

XI1INTRODUCTION AIM OF STUDY

The individual variation of patients morphological and functional complexity

of tissues as well as difficult access limit the possibilities to investigate in clinical

studies the biomechanical behaviour of proximo-occlusal restorations In this context

simulation of the biomechanics for direct restorations represents an interesting

interdisciplinar domain in actual dentistry research

The study focused on two direction

- analysis of role of forces intensity on biomechanical behaviour related to

cavity dimension and material

- analysis of tension inside restoration structure related to forces intensity

XI2MATERIALS AND METHODS

The stages of finite element analysis study are as follows

object modelling (bicusps and proximo-occlusal restoration)

definition of parameters for materials and dental tissues

meshing

constraints and loading

types of contacts

equations system definition

results of simulation

The object 3D modelling was performed in Rhinoceros (figure XI1) The

definition of parameters was performed for Poisson constant Young modulus density

(table XI1) The selected materials were amalgam and composite resins The

analysed tissues were dentine and enamel The meshing constraints loading were

performed for forces of 200N 400N 600N 800 N The analysis was performed using

software COSMOSWorks 2010

34

Fig XI1 3D modellation of bicusp

Table XI1 Values of Young modulus Poisson constant compression resistance for

amalgam composite resin enamel (amalgam compozit smalţ)

Material Young modulus (GPa) Poisson constants

Compression

resistance

(Mpa)

Amalgam 55 033 483

Enamel 48 03 400

Composite

resin 220 022 345

Fig XI2 The forces and constraints application

The results are presented in values and culours red colours representing areas

with maximum values of tensions produced under influence of masticatory forces

The tensions produced in amalgam restoration are in a range from 0 to 22886

(force 800 N) The maximum von Misses tensions are associated with cervical area

of amalgam restorations This aspect proves that first modification in interface

restoration-cavity margins will appear at the level of gingival wall First marginal

35

defects and fissures in restoration bulk will appear at tensions over 1600Mpa

associated with forces of 800N for extended amalgam proximo-occlusal restorations

The tensions produced in composite resin restorations are in a range from 0 to

2285 (force 800 N) The maximum von Misses tensions are associated with cervical

area of composite resin restorationsThis aspect proves that first modification in

interface restoration-cavity margins will appear at the level of gingival wall First

marginal defects and fissures in restoration bulk will appear at tensions over 1716

Mpa associated with forces of 600N for moderate and extended composite resins

proximo-occlusal restorations

Fig XI3a-b ndash Simulated model of proximo-occlusal restoration

FigXI4a-b Dental amalgam restoration Cervical tension associated with 600 N

(c)800 N (d)

FigXI5a-b Composite resin restoration Cervical tension associated with 600 N

(c)800 N (d)

36

The deformation of amalgam can be produced only when is associated with

fissures in bulk of restorations while composite resins restorations present

deformation when are associated with a modification of volume and form because of

repeated action of medium forces on long term or high forces on short term (figures

XI4 XI5)

Fig XI4 Material deformation in area of maximum tension

000E + 00

500E -02

100E -01

150E -01

200E -01

250E -01

1 4 7 101316192225283134374043464952555861646770737679

Amalgam C ompoz it

Figura XI5 Deformarea funcție de material

The amalgam and composite resins were treated as homogenous isotropic and

liniar The advantage of this type of FEA study is that restorations parameters can be

modified any time is necessary both in arhitecture geometry and material indices

variability The results of this study sustain the conclusions of other FEA studies

focused on biomechanical behaviour of posterior restorations performed with

amalgam and composite resins(35 62 76 143)

37

XI4CONCLUSIONS

bull The amalgam in class II restorations has a low deformation tendency because

of uniform distribution of tension inside material

bull Composite resins class II restorations accumulate higher tensions comparing

with amalgam but deformation is avoided for a time because of the adhesion

forces performed between molecules under moderate oral forces In case of

high oral forces (600-800N) the risk of fracture in moderate class II

restorations is higher comparing with amalgam proximo-occlusal restorations

For extended class II restorations and forces of 600 N composite resins present

highest risk of fracture and deformation The von Misses tension at the

cervical interface restorationtooth can reach 1600Mpa

bull The amalgam in moderate class II restorations can resist to deformation even

for high intensity forces limited to 600N In extended class II restorations the

risk of deformation and fracture increases at values of 600N-800N of oral

forces The von Misses tension at the cervical interface restorationtooth can

reach 1700 Mpa

38

FINAL CONCLUSIONS

Amalgam proximo-occlusal restorations with minimum 6-years age present

excellent results for parameters anatomic form (occlusal) marginal

discoloration and marginal secondary dental caries good results for

parameters anatomic form (proximal) and marginal adaptation and poor results

for surface quality

Composite resins proximo-occlusal restorations (bicusps) with minimum 6-

years age present excellent results for parameters color match marginal

discoloration and marginal secondary dental caries and good results for

parameters anatomic form (occlusal proximal) marginal adaptation surface

quality

Composite resins proximo-occlusal restorations (molars) with minimum 6-

years age present good results for parameters color match marginal

discoloration marginal secondary dental caries marginal adaptation and poor

results for parameters anatomic form (occlusal) (54 indices Ryge C)

anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The restorations extended at external third of occlusal surface present highest

percents of indices C regarding anatomic form (occlusal) (54 indices Ryge

C) anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The exceeding of 6-years age will require careful monitorisation for early

interventions through polishing sealing reshaping and even replacement for

restorations with major defects

Oblique layering technique presents superior results regarding marginal

adaptation and marginal discoloration and is recommended for proximo-

occlusal dental caries close to enamel-cement jonction

Centripetal build-up presents good results regarding marginal adaptation and

anatomical form at proximal level (proximal surfaces and contact point)

Horisontal layering technique can be used for optimum results only in

proximal-occlusal cavities with moderate extension both in occlusal-cervical

and buccal-oral

The values of die penetration at gingival wall were statistically different

between the three restorative techniques

We concluded that all restorative methods were associated with lightcuring

contraction and marginal microleakage

The combined technique was associated with lowest lightcuring contraction

and die penetration

The bulk technique was associated with highest lightcuring contraction and die

penetration

39

The surfaces of enamel and dentine at cervical level record decreases of

roughness related to the decrease of distance to ECJ

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel but the differences

statistical significant are present only for enamel localised at 2 mm from ECJ

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of

dentine

bull The amalgam in class II restorations has a low deformation tendency because

of uniform distribution of tension inside material

bull Composite resins class II restorations accumulate higher tensions comparing

with amalgam but deformation is avoided for a time because of the adhesion

forces performed between molecules under moderate oral forces In case of

high oral forces (600-800N) the risk of fracture in moderate class II

restorations is higher comparing with amalgam proximo-occlusal restorations

For extended class II restorations and forces of 600 N composite resins present

highest risk of fracture and deformation The von Misses tension at the

cervical interface restorationtooth can reach 1600Mpa

bull The amalgam in moderate class II restorations can resist to deformation even

for high intensity forces limited to 600N In extended class II restorations the

risk of deformation and fracture increases at values of 600N-800N of oral

forces The von Misses tension at the cervical interface restorationtooth can

reach 1700 Mpa

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shrinkage stress in polymer-based restoratives J Dent Res 199725435ndash440

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99Feilzer AJ De Gee AJ Davidson CL Setting stress in composite resin in relation

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Effects of irradiation mode and filling technique on resindentin bond strength in

Class I cavities J Dent Res 200281 (Abstract)

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148Inoue S Van Meerbeek B Vargas M Lambrechts P Vanherle G Adhesion

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149Inoue S Vargas MA Abe Y Yoshida Y LambrechtsP Vanherle G Sano H

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dentin J Adhes Dent 2001 3 237-245

150Iovan Gianina Diagnosis and Management of Patients with High Caries

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Mater 1995 11(2)132-6

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technique J Am Dent Assoc 2000131375ndash383

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with flowable composite in the proximal box Am J Dent 200013235ndash238

48

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Kompositefullungen Zahnartzlicher Welt 1999 108 270-273

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Community Dentistry and Oral Epidemiology 1994 22(2) 71-74

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1243

161Khairallah C Hokayem A Long-term clinical evaluation of 2 dental materials

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Biology199843(8)629-632

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817-822

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166Kleverlaan CJ Feilzer AJ Polymerization shrinkage and contraction stress of

dental resin composites Dent Mater 2005 211150-1157

167Koenigsberg SA Fuks R GrajowerThe effect of three filling techniques on

marginal leakage around class II composite resin restorations in vitroQuint Int

201989117ndash121

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18(7)516-20

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Dent 27(5)325-331 1999

49

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Jan11(1)34-40

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JProsthet Dent 199369(4)425-430

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thermal behavior of dental composites Dent Mater 2008 24(8)1017ndash1024

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JDent 199826 627-632

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shrinkage and elasticity of flowable composites and filled adhesives Dent Mater

1999 15128-137

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Pendefunda 180Sorina Solomon Topoliceanu C Elements of dispersional

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Edition of the Balkan Medical Days

Stomatological Section Abstract nr1091999128

181Lăcătuşu St Andrian S Gianina Iovan- Consideraţii asupra adaptării

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StomatologicăVol2199823-26

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200126302ndash307

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Dentistry and Oral Epidemiology 1996 24 106-11

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Dent Mater 2002 18436-444

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20(3)236-43

188Loguercio AD Reis A Schroeder M Balducci I Versluis A Ballester RY

Polymerization shrinkage effects of boundary conditions and filling technique of

resin composite restorations J Dent 2004 32(6)459-70

50

189Lopes GC Baratieri LN Monteiro S Jr Vieira LC Effect of posterior resin

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Quintessence Int 2004 35(2)156-61

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art and future perspectives Quintessence Int 200233213-224

191Loumlsche GM Marginal adaptation of class II composite fillings guided

polymerization vs reduced light intensity J Adhes Dent 1 199931ndash39

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and reactivity on the reaction kinetics of dimethacrylatedimethacrylate

copolymerizations Macromolecules 1999 323913-3921

194Lutz F Krejci I Barbakow F Quality and durability of marginal adaptation in

bonded composite restorations Dent Mater 1991 7(2) 107-13

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clinical results J Dent Res 199877 1020

196Mair LH Ten-year clinical assessment of three posterior resin composites and

two amalgams Quintessence Int 199829483ndash490

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depth as cavity predictors for approximal dentin caries lesions in primary teeth

Dentomaxillofac Radiol 2007 Oct36(7)377-81

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direct and indirect restorations icircn posterior teeth of the permanent

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composites for posterior restorations JADA Vol132 2001639-644

200Manhart J Neuerer P Scheibenbogen-Fuchsbrunner A Hickel R Three-

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J Prosthet Dent 2000 Sep84(3)289-96

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Three-year clinical evaluation of composite and ceramic inlays Am J Dent 2001

Apr14(2)95-9

202Manhart J Chen HY Draegert U Kunzelmann KH Hickel R Vickers

hardness and depth of cure of light cured packable composite resins J Dent Res 2000

79369 (Abstract)

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caries-affected transparent dentin by citric acidAn atomic force microscopy

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51

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207Mendonccedila JS Neto RG Santiago SL Lauris JR Navarro MF de Carvalho

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relative diagnostic yields of clinical FOTI and radiographic examinations for the

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209Miguel A JC La Macorra A predictive formula of the contraction stress in

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deformation Dent Mater 200117241ndash246

210Mileman PA van der Weele IT Accuracy in radiographic diagnosis Dutch

practitioners and dental caries JDent1990 18(3) 130-136

211Millar BJ Robinson PB Eight year results with direct ceramic restorations

(Cerana) Br Dent J 2006 Oct 21201(8)515-20

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PrimDentCare1999Apr659-62

213Mjor IA Amalgam and composite resin restorations longevity and reasons for

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Quintessence 198961-80

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ScandJDRes 199210060-65

215Mjor IA The reasons for replacement and the age of failed restorations in

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33

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19904011ndash7

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Am Dent Assoc 2010 141(3)319-29

52

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125749-751

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composites Oper Dent 23 1998282ndash289

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34

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Monogr Oral Sci 20092142-51

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Monogr Oral Sci 20092152-62

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Quintessence Int 1998295ndash11

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Influence of the Discomfort Reported by Children on the Performance of Approximal

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Restorative Materials In Class I And Class II Restorations An In-Vivo Study The

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569ndash575

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of teeth with long-term performing composite restorations J Oral Rehabil 2002

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ClinOral Invest1997140-46

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Nanoleakage leakage within the hybrid layer Oper Dent 1995 20 18-25

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In vivo evidence J Dent 2004 32611ndash621

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Lambrechts P Yoshida Y Inoue S Suzuki K Technique-sensitivity of

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clinical diagnosis of approximal carious lesions Caries Res1990 24 (5) 364-370

329Waggoner W Ashton J Predictability of cavitation based upon radiographic

appearance comparison of two film types Quintessence International 1989 20(1)

55-60

330Watanabe LG Marshall GW Jr Marshall SJ Dentin shear strength effects of

tubule orientation and intra tooth location Dent Mater 1996 12 109-115

331Watts DC AS Marouf Optimal specimen geometry in bonded-disk

shrinkage-strain measurements on light-cured biomaterials Dent Mater 200016447ndash

451

332Watts DC Marouf AS Al-Hindi AM Photo-polymerization shrinkage-stress

kinetics in resin-composites methods development Dent Mater 2003 191ndash11

333Weaver WS Blank LW Pelleu GB Jr A visible light activated resin cured

through tooth structure GenDent 198836236-7

334Wendt SL Microleakage and cusp fracture resistance of heattreated composite

resin inlays Am J Dent 4(1)10-14 1991

335Wenzel A Hintze H Mikkelsen L Mouyen F Radiographic detection of

occlusal caries in noncavitated teeth A comparison of conventional film radiographs

digitized film radiographs and RadioVisioGraphy-Oral Surg Oral Med Oral Pathol

1991 72 621-6

336Wenzel A Hintze H Perception of image quality in direct digital radiography

after application of various image treatment filters for detectability of dental diseases

Dentomaxillofac Radiol 1993 22 131-4

337Wenzel A Computer-aided image manipulation of intraoral radiographs to

enhance diagnosis in dental practice a review Int Dent J 1993 43 99-108

338Wenzel A Digital radiography and caries diagnosis Dento Maxillo Facial

Radiology 27(1)3-11 1998

339Wenzel A Haiter-Neto F Gotfredsen E Risk factors for a false positive test

outcome in diagnosis of caries in approximal surfaces impact of radiographic

modality and observer characteristics Caries Res 200741(3)170-6

340Wibowo G Stockton L Microleakage of class II composite restorations Am J

Dent 200114177ndash185

341Wilson NHF Wastell DG Norman RD Five-year performance of high-

cooper content amalgam restorations in a multiclinical trial JDent1996 24 203-210

342Winkler MM Katona TR Paydar NH Finite element stress analysis of three

filling techniques for class V light-cured composite restorations J Dent Res

1996751477-83

343Yap AU Effectiveness of polymerization in composite restoratives claiming bulk

placement Impact of cavity depth and exposure time Oper Dent 2000 25113-120

59

344Yeşilyurt C Bulucu B Bond strength of total-etch dentin adhesive systems on

peripheral and central dentinal tissue a microtensile bond strength test The Journal of

Contemporary Dental Practice 7(2) 20061-13

345Yoshida Y Van Meerbeek B Okazaki M Shintani H Suzuki K Comparative

study on adhesive performance of functional monomers J Dent Res 2004 83 454-

458

346Yoshiyama M Tay FR Doi J Nishitani Y Yamada T Itou K Carvalho RM

Nakajima M Pashley DH Bonding of self-etch and total etch adhesives to carious

dentin J Dent Res 2002 81 556-560

  • COPERTA REZUMAT ENGLEZA (MEREUTA)pdf
  • REZUMAT ENGLEZA DR MEREUTA DENISSpdf
Page 23: UNIVERSITATEA DE MEDICINA SI FARMACIE “GR Doctorat/Rezumat... · universitatea de medicina si farmacie “gr.t.popa” iasi facultatea de medicina dentara rezumatul tezei de doctorat

20

CHAPTIX STUDY REGARDING MARGINAL SEALING STATUS IN

COMPOSITE RESINS LIMITED PROXIMO-OCCLUSAL RESTORATIONS

PERFORMED USING DIFFERENT TECHNIQUES

IX1INTRODUCTION

The contraction of composite resins can produce stress inside dental structure

The most contraction stress appears in the initial stages and development rate of stress

decreases gradually in time (5 98 160) The contraction stress of composite resins

can overpass adhesion strenght and can broke the link between dental tissues and

composite resin (73) When adhesion strenght is high stress can produce marginal

fracture or bulk fracture (74) These situations are associated with microleakage and

penetration of oral fluid and bacteria along dentinal walls endangering the pulpal

tissue or favourising secondary dental caries

IX2 AIM OF STUDY

The study aimed to assess the efficiency of marginal sealing along gingival

wall in limited proximal-occlusal restorations performed using three different

techniques

IX3MATERIALS AND METHOD

The study group included 30 teeth extracted for orthodontic and periodontal

reasons On every tooth two identical class II cavities (on mesial and distal surfaces)

were prepared with cylindrical burs under water cooling The gingival wall was

limited to enamel-cement jonction The cavity dimension were as follows 2 mm

buccal-oral 5mm depth Each tooth was introduced in a pattern of acrylat The

operator calibrated preparation technique on acrylat teeth in Simulation Laboratory of

UMF ―Gr T Popa Iaşi The 60 prepared cavities were randomly divided in three

study groups related to restorative technique The restoration were performed with

Filtek Z550 (3M ESPE) a nanohybrid composite resin The adhesive strategy

included etchamprinse in 2 steps and adhesive Adper Single Bond 2(3MESPE)

Group A (n=20) bulk restorative technique associated with lightcuring from

occlusal 40 seconds and from buccal and oral 20 seconds

Group B (n=20) oblique layering technique (first layer on buccal wall and

buccal frac12 of gingival wall was lightcured from buccal second layer on oral wall and

oral frac12 of gingival wall was lightcured from oral third oral as a triangle with point

oriented to gingival wall was lightcured from occlusal)

Group C (n=20) combined technique (bdquoflow layer on gingival and axial

walls lightcured under pressure only associated with solid composite resin layer)

The proximal surfaces were performed using Tofflemire and metallic matrices After

removal of matrices every restoration was lightcured for another 20 seconds Two

layers aof varnish were applied on composite resins restorations excepting cavity

margins and an area of 1 mm around them The samples were introduced in methylen

21

blue 10 for 48 hours After this stage samples were washed with water and teeth

were cut longitudinally with a diamonded disc

The die penetration was assessed with Zeiss (Iena Germany) X20 microscope

accordingly to four scores (0-3)

0 ndash no penetration

1 ndash die infiltration until external half of gingival wall

2 ndash die infiltration on all gingival wall

3 ndash die infiltration on gingival wall and axial wall

IX4RESULTS AND DISCUSSIONS

The result of die penetration are presented in table IX1

TableIX1 The results for die penetration

Grup 0 1 2 3

A (bulk) 0 0 3 17

B (layering) 0 4 5 11

C (combined) 12 5 2 1

In group A 17 sample had score 3 and 2 samples had score 2 In group B 11

sample had score 3 5 samples had score 2 and 4 sample had score 1 In group C with

best results 12 samples had score 0 5 samples had score 1 2 samples had score 2 1

sample had score 3

The recorded data were analysed using test Mann-Whitney The statistical

results are presented in tables IX2-IX4

Tables IX2a-b Mann-Whitney for comparisons of microleakage values between

bulk technique and incremental technique

Ranks

Restorative technique N Mean Rank Sum of Ranks

Scores

frequency

A ndash bulk technique 20 2420 24200

B ndash incremental

technique

20 1680 16800

Total 40

Test Statisticsb

scores

frequency

Mann-Whitney U 29000

Wilcoxon W 168000

Z -1970

Asymp Sig (2-tailed) 049

Exact Sig [2(1-tailed Sig)] 123a

a Not corrected for ties

b Grouping Variable restorative technique

22

Tables IX3a-b Mann-Whitney for comparisons of microleakage values between

bulk technique and mixed technique

Ranks

Restorative technique N Mean Rank Sum of Ranks

scores

frequency

A ndash bulk technique 20 3090 30900

C ndash mixed technique 20 1010 10100

Total 40

Test Statisticsb

scores

frequency

Mann-Whitney U 500

Wilcoxon W 101000

Z -4021

Asymp Sig (2-tailed) 000

Exact Sig [2(1-tailed Sig)] 000a

a Not corrected for ties

b Grouping Variable restorative technique

Tables IX4a-b Mann-Whitney test for comparisons of microleakage values

between incremental technique and mixed technique

Ranks

Restorative technique N Mean Rank Sum of Ranks

scores

frequency

B ndash incremental

technique

20 2990 29900

C ndash mixed technique 20 1210 12100

Total 40

Test Statisticsb

scores

frequency

Mann-Whitney U 5500

Wilcoxon W 121000

Z -3492

Asymp Sig (2-tailed) 000

Exact Sig [2(1-tailed Sig)] 000a

a Not corrected for ties

23

Test Statisticsb

scores

frequency

Mann-Whitney U 5500

Wilcoxon W 121000

Z -3492

Asymp Sig (2-tailed) 000

Exact Sig [2(1-tailed Sig)] 000a

a Not corrected for ties

b Grouping Variable tehnrestaurare

The results of microleakage degree were statistically significant when the

three restorative techniques were compared The results showed that best restorative

technique regarding marginal sealing in cervical area is combined technique followed

by oblique layering technique The use of layering techniques limits the development

of contraction forces between oposite walls event that favourises bulk stress voids

formation and fissure inside dental tissues The results of our study are similar with

other studies (114 293)

IX5 CONCLUSIONS

The values of die penetration at gingival wall were statistically different

between the three restorative techniques

We concluded that all restorative methods were associated with lightcuring

contraction and marginal microleakage

The combined technique was associated with lowest lightcuring contraction

and die penetration

The bulk technique was associated with highest lightcuring contraction and die

penetration

24

CHAPTX STUDY REGARDING THE EFFECTS OF ETCHING ON

ENAMEL AND DENTINE IN CERVICAL AREA FOR PROXIMAL

CAVITIES AT LATERAL DENTAL GROUP

X1 INTRODUCTION

The studies reported marginal defects and high microleakage at the level of

gingival margins localised in cervical area or close to enamel-cement jonction for

high percents of proximal-occlusal composite resins restorations (8485) The good

adhesion is requested to insure restoration longevity and to prevent marginal

microleakage and presence of secondary marginal dental caries The adhesion

strenght of different adhesive systems can vary accordingly to tissues areas (204 240)

and to variations in dentinal structures (234 330) Most studies focused on adhesive

systems performances used healthy dentine close to pulp room but in case of class II

restorations there are particular features that influences the adhesion at the level of

gingival margins

The surface topography is an important property that determines the

interaction manner between surfaces The surface roughness and surface energy can

increase or decrease the adhesion of composite resins to the hard dental tissues

X2 AIM OF STUDY

The aim of study was to compare surface roughness of enamel and dentine

after etching related to different distances related to enamel-dentinecement jonction

X3 MATERIALS AND METHODS

The study group included 20 molars extracted from orthodontics or

periodontal reasons with intact proximal surfaces The teeth were cut longitudinally in

sens buccal-oral with diamond discs under water cooling

A group study (10 teeth) included 10 samples obtained through transversal

cutting at distance of 2mm from enamel-dentinecement jonction and 10 samples

obtained through transversal cutting at distance of 15 mm from enamel-

dentinecement jonction Another study group (10 teeth) included 10 samples

obtained through transversal cutting at distance of 1mm from enamel-dentinecement

jonction and 10 samples obtained through transversal cutting at distance of 05 mm

from enamel-dentinecement jonction All these samples were divided in two halfes

through mesial-distal cutting The samples finishing was performed with abrasive

paper (100-4000) and final polishing was performed with a device Buehler model

Minimet with slices introduced in ultrasound bath for 4 minutes The second half of

each sample was etched for 15 seconds with ortophosphoric acid 37 for 15 seconds

Slices were washed with distilled water for 30 seconds after etching and dried

The samples were analysed with atomic force microscopy (AFM) regarding

surface roughness The results were expressed as relative variation of roughness

X4 RESULTS AND DISCUSSIONS

The aspect of etched enamel at 2 mm distance from ECJ can be seen in figure

X1 (section 10 microm) The surface roughness is higher comparing with sample before

etching

25

După gravajul cu acid ortofosforic 37

The aspect of etched enamel at 15 mm distance from ECJ can be seen in

figure X2 (section 10 microm) The surface roughness is higher comparing with sample

before etching but lower comparing with sample at 2 mm from ECJ

The aspect of etched enamel at 1 mm distance from ECJ can be seen in figure

X3 (section 10 microm) The surface roughness is higher comparing with sample before

etching but lower comparing with sample at 15mm and 2 mm from ECJ

The aspect of etched enamel at 15 mm distance from ECJ can be seen in

figure X4 (section 10 microm) The surface roughness is higher comparing with sample

before etching but lower comparing with sample at 1 mm 15 mm and 2 mm from

ECJ

FigX1 3D aspect of enamel at 2 mm from ECJ

after etching (10 microm)

FigX2 3D aspect of enamel at 15 mm from ECJ

after etching (10 microm)

FigX3 3D aspect of enamel at 1 mm from ECJ

after etching (10 microm)

FigX4 3D aspect of enamel at 05 mm from ECJ

after etching (10 microm)

26

The mean values of squared roughness for dentine and enamel before etching

are presented in tables X1 and X2

Table X1 Squared roughness values for dentine samples before and after etching

Before etching (nm) After etching (nm)

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

sample

1

335 282 283 259 1149 947 901 879

sample

2

352 284 274 266 1127 939 883 875

sample

3

357 273 278 263 1152 953 876 867

sample

4

323 269 264 258 1146 942 895 883

sample

5

348 298 271 268 1153 944 904 878

sample

6

339 274 278 273 1158 937 893 892

sample

7

352 283 269 266 1145 944 899 876

sample

8

349 292 272 274 1166 942 907 869

sample

9

357 284 275 265 1132 939 893 879

sample

10

348 281 277 262 1142 941 899 878

Table X2 Squared roughness values for enamel and dentine samples before and after

etching

Before etching (nm) After etching (nm)

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

sample 1 422 342 309 313 2255 1114 874 845

sample 2 418 338 324 304 2236 1102 882 839

sample 3 413 334 315 303 2239 1115 873 833

sample 4 416 336 322 308 2242 1116 868 842

sample 5 426 332 315 294 2218 1103 877 829

sample 6 412 332 317 306 2237 1099 874 847

sample 7 414 335 322 314 2252 1102 876 834

sample 8 416 325 318 313 2239 1106 875 838

sample 9 418 328 314 299 2246 1113 879 836

sample 10 413 334 316 305 2242 1104 873 839

The results for samples before etching prove a decreasing tendency for mean

values of squared roughness surface beginning with areas placed at distance of 2 mm

from ECJ (346 nm) followed by areas placed at distance of 15 mm from ECJ (282

nm) 1 mm from ECJ (274 nm) and 05 mm from ECJ (265 nm) After etching the

decreasing tendency maintained for dentine localised at 2 mm from ECJ to dentine

localised at 05 mm from ECJ The mean values of squared roughness after etching

were three times higher (tables X3)

27

Table X3 Squared roughness values for enamel and dentine samples before and

after etching

Dentine Enamel

Before etching

(nm)

After etching

(nm)

Before etching

(nm)

After etching

(nm)

2 mm ECJ 346 1147 416 2237

15 mm ECJ 282 942 333 1107

1 mm ECJ 274 895 317 875

05 mm ECJ 265 877 305 838

The descriptive statistics data for surface roughness of dentine before and after

etching are presented in tables X4 si X5

Table X4 Descriptive statistics for dentine samples before etching

Statistics

Dentine 2mm

before etching

Dentine 15mm

before etching

Dentine 1mm

before etching

Dentine 05mm

before etching

N Valid 10 10 10 10

Missing 0 0 0 0

Mean 346000 282000 274100 265400

Std Error of Mean 33830 27487 17026 16746

Std Deviation 106979 86923 53841 52957

Skewness -1214 354 -314 348

Std Error of Skewness 687 687 687 687

Kurtosis 1141 049 336 -539

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 3230 2690 2640 2580

Maximum 3570 2980 2830 2740

Table X5 Descriptive statistics for dentine samples after etching

Statistics

Dentine 2mm

after etching

Dentine 15mm

after etching

Dentine 1mm

after etching

Dentine 05mm

after etching

N Valid 10 10 10 10

Missing 0 0 0 0

1147000 942800 895000 877600

Std Error of Mean 36545 14591 29926 22020

Std Deviation 115566 46140 94634 69634

Skewness -267 1169 -951 535

Std Error of Skewness 687 687 687 687

Kurtosis 043 1776 564 1416

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 11270 9370 8760 8670

28

Statistics

Dentine 2mm

after etching

Dentine 15mm

after etching

Dentine 1mm

after etching

Dentine 05mm

after etching

N Valid 10 10 10 10

Missing 0 0 0 0

1147000 942800 895000 877600

Std Error of Mean 36545 14591 29926 22020

Std Deviation 115566 46140 94634 69634

Skewness -267 1169 -951 535

Std Error of Skewness 687 687 687 687

Kurtosis 043 1776 564 1416

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 11270 9370 8760 8670

Maximum 11660 9530 9070 8920

To choose the statistical test to compare roughness surface values was

performed a test Shapiro-Wilk If p is lower or equal with 0005 than hypothesis of

distribution normality is rejected (distribution deviates from normal form) In the table

X6 the distributions are normal The statistical test will be test t for pair samples

Table X6 Test Shapiro-Wilk for dentine samples

Tests of Normality

Kolmogorov-Smirnov

a Shapiro-Wilk

Statistic df Sig Statistic df Sig

Dentine 2mm before etching 274 10 032 877 10 122

Dentine 15mm after etching 209 10 200 952 10 689

Dentine 1mm before etching 134 10 200 983 10 980

Dentine 05mm before etching 155 10 200 949 10 661

Dentine 2mm after etching 133 10 200 977 10 946

Dentine 15mm after etching 197 10 200 916 10 329

Dentine 1mm after etching 216 10 200 925 10 401

Dentine 05 after etching 220 10 185 933 10 474

Enamel 2mm before etching 193 10 200 898 10 207

Enamel 15mm before etching 170 10 200 977 10 947

Enamel 1mm before etching 157 10 200 952 10 689

Enamel 05mm before etching 165 10 200 943 10 590

Enamel 2mm after etching 235 10 124 925 10 404

Enamel 15mm after etching 209 10 200 871 10 102

Enamel 1mm after etching 189 10 200 964 10 834

Enamel 05mm after etching 142 10 200 983 10 978

a Lilliefors Significance Correction

29

Tests of Normality

Kolmogorov-Smirnov

a Shapiro-Wilk

Statistic df Sig Statistic df Sig

Dentine 2mm before etching 274 10 032 877 10 122

Dentine 15mm after etching 209 10 200 952 10 689

Dentine 1mm before etching 134 10 200 983 10 980

Dentine 05mm before etching 155 10 200 949 10 661

Dentine 2mm after etching 133 10 200 977 10 946

Dentine 15mm after etching 197 10 200 916 10 329

Dentine 1mm after etching 216 10 200 925 10 401

Dentine 05 after etching 220 10 185 933 10 474

Enamel 2mm before etching 193 10 200 898 10 207

Enamel 15mm before etching 170 10 200 977 10 947

Enamel 1mm before etching 157 10 200 952 10 689

Enamel 05mm before etching 165 10 200 943 10 590

Enamel 2mm after etching 235 10 124 925 10 404

Enamel 15mm after etching 209 10 200 871 10 102

Enamel 1mm after etching 189 10 200 964 10 834

Enamel 05mm after etching 142 10 200 983 10 978

a Lilliefors Significance Correction

This is a lower bound of the true significance

The results of test t for pair dentine samples before and after etching are

presented in table X

Table X7 Test t for dentine before and after etching

Paired Samples Test

Paired Differences

t df

p (2-

tailed)

95 Confidence

Interval of the

Difference

Mean

Std

Dev

Std

Error

Mean Lower Upper

Pair

1

dentine2mmbeforeetching-

dentine2mmafteretching

-

8010000

174801 55277 -

8135045

-

7884955

-

144906

9 000

Pair

2

dentine15mmbeforeetching-

dentine15mmafteretching

-

6608000

102394 32380 -

6681248

-

6534752

-

204079

9 000

Pair

3

dentine1mmbeforeetching-

dentine1mmafteretching

-

6209000

117799 37251 -

6293269

-

6124731

-

166678

9 000

30

Paired Samples Test

Paired Differences

t df

p (2-

tailed)

95 Confidence

Interval of the

Difference

Mean

Std

Dev

Std

Error

Mean Lower Upper

Pair

1

dentine2mmbeforeetching-

dentine2mmafteretching

-

8010000

174801 55277 -

8135045

-

7884955

-

144906

9 000

Pair

2

dentine15mmbeforeetching-

dentine15mmafteretching

-

6608000

102394 32380 -

6681248

-

6534752

-

204079

9 000

Pair

3

dentine1mmbeforeetching-

dentine1mmafteretching

-

6209000

117799 37251 -

6293269

-

6124731

-

166678

9 000

Pair

4

dentine05mmbeforeetching-

dentine05mmafteretching

-

6122000

86384 27317 -

6183796

-

6060204

-

224109

9 000

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of dentine (

2mm 15 mm 1mm sau 05mm)

The descriptive statistics data for dentine surface roughness before and after

etching are presented in tables X8 and X9

Table X8 Descriptive statistics for enamel samples before etching

Statistics

Enamel 2mm

before etching

Enamel 15mm

before etching

Enamel 1mm

before etching

Enamel 05mm

before etching

N Valid 10 10 10 10

Missing 0 0 0 0

Mean 416800 333600 317200 305900

Std Error of Mean 13968 15217 14205 20355

Std Deviation 44171 48120 44920 64369

Skewness 1095 -156 -109 -411

Std Error of Skewness 687 687 687 687

Kurtosis 769 487 -118 -295

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 4120 3250 3090 2940

Maximum 4260 3420 3240 3140

31

Table X9 Descriptive statistics for enamel samples after etching

Statistics

Enamel 2mm

after etching

Enamel 15mm

after etching

Enamel 1mm

after etching

Enamel 05mm

after etching

N Valid 10 10 10 10

Missing 0 0 0 0

Mean 2237600 1107400 875100 838200

Std Error of Mean 31027 20232 11968 17436

Std Deviation 98116 63979 37845 55136

Skewness -850 267 042 040

Std Error of Skewness 687 687 687 687

Kurtosis 878 -1880 1082 -425

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 22180 10990 8680 8290

Maximum 22520 11160 8820 8470

To choose the statistical test to compare roughness surface values was

performed a test Shapiro-Wilk If p is lower or equal with 0005 than hypothesis of

distribution normality is rejected (distribution deviates from normal form) In the table

X10 the distributions are normal The statistical test will be test t for pair samples

Table X10 Test Shapiro-Wilk for enamel samples

Tests of Normality

Kolmogorov-Smirnova Shapiro-Wilk

Statistic df Sig Statistic df Sig

2mmenamel before etching 193 10 200 898 10 207

15mmenamel before etching 170 10 200 977 10 947

1mmenamel before etching 157 10 200 952 10 689

05mmenamel before etching 165 10 200 943 10 590

2mmenamel after etching 235 10 124 925 10 404

15mmenamel after etching 209 10 200 871 10 102

1mmenamel after etching 189 10 200 964 10 834

05mmenamel after etching 142 10 200 983 10 978

a Lilliefors Significance Correction

This is a lower bound of the true significance

The results of test t for pair enamel samples before and after etching are

presented in table X11

32

Table X11 Test t for enamel samples before and after etching

Paired Samples Test

Paired Differences

t df

p (2-

tailed)

95 Confidence

Interval of the

Difference

Mean

Std

Deviation

Std

Error

Mean Lower Upper

Pair

1

2mmenamel before

etching

2mmenamel after

etching

-18208 135220 42760 -

18304731

-

18111269

-

425815

9 000

Pair

2

15mmenamel before

etching

15mmenamel after

etching

-7738 73151 23132 -7790329 -7685671 -

334508

9 076

Pair

3

1mmenamel before

etching

1mmenamel after

etching

-5579 55468 17540 -5618679 -5539321 -

318065

9 065

Pair

4

05mmenamel before

etching

05mmenamel after

etching

-5323 60378 19093 -5366192 -5279808 -

278788

9 063

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel ( 2mm 15 mm 1mm sau

05mm) but the differences statistical significant are present only for enamel localised

at 2 mm from ECJ

X5CONCLUSIONS

The surfaces of enamel and dentine at cervical level record decreases of

roughness related to the decrease of distance to ECJ

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel but the differences

statistical significant are present only for enamel localised at 2 mm from ECJ

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of

dentine

33

CHAPTXI FEA STUDY REGARDING THE BIOMECHANICAL

BEHAVIOUR AND FRACTURE RESISTANCE OF PROXIMO-OCCLUSAL

AMALGAM AND COMPOSITE RESINS RESTORATIONS

XI1INTRODUCTION AIM OF STUDY

The individual variation of patients morphological and functional complexity

of tissues as well as difficult access limit the possibilities to investigate in clinical

studies the biomechanical behaviour of proximo-occlusal restorations In this context

simulation of the biomechanics for direct restorations represents an interesting

interdisciplinar domain in actual dentistry research

The study focused on two direction

- analysis of role of forces intensity on biomechanical behaviour related to

cavity dimension and material

- analysis of tension inside restoration structure related to forces intensity

XI2MATERIALS AND METHODS

The stages of finite element analysis study are as follows

object modelling (bicusps and proximo-occlusal restoration)

definition of parameters for materials and dental tissues

meshing

constraints and loading

types of contacts

equations system definition

results of simulation

The object 3D modelling was performed in Rhinoceros (figure XI1) The

definition of parameters was performed for Poisson constant Young modulus density

(table XI1) The selected materials were amalgam and composite resins The

analysed tissues were dentine and enamel The meshing constraints loading were

performed for forces of 200N 400N 600N 800 N The analysis was performed using

software COSMOSWorks 2010

34

Fig XI1 3D modellation of bicusp

Table XI1 Values of Young modulus Poisson constant compression resistance for

amalgam composite resin enamel (amalgam compozit smalţ)

Material Young modulus (GPa) Poisson constants

Compression

resistance

(Mpa)

Amalgam 55 033 483

Enamel 48 03 400

Composite

resin 220 022 345

Fig XI2 The forces and constraints application

The results are presented in values and culours red colours representing areas

with maximum values of tensions produced under influence of masticatory forces

The tensions produced in amalgam restoration are in a range from 0 to 22886

(force 800 N) The maximum von Misses tensions are associated with cervical area

of amalgam restorations This aspect proves that first modification in interface

restoration-cavity margins will appear at the level of gingival wall First marginal

35

defects and fissures in restoration bulk will appear at tensions over 1600Mpa

associated with forces of 800N for extended amalgam proximo-occlusal restorations

The tensions produced in composite resin restorations are in a range from 0 to

2285 (force 800 N) The maximum von Misses tensions are associated with cervical

area of composite resin restorationsThis aspect proves that first modification in

interface restoration-cavity margins will appear at the level of gingival wall First

marginal defects and fissures in restoration bulk will appear at tensions over 1716

Mpa associated with forces of 600N for moderate and extended composite resins

proximo-occlusal restorations

Fig XI3a-b ndash Simulated model of proximo-occlusal restoration

FigXI4a-b Dental amalgam restoration Cervical tension associated with 600 N

(c)800 N (d)

FigXI5a-b Composite resin restoration Cervical tension associated with 600 N

(c)800 N (d)

36

The deformation of amalgam can be produced only when is associated with

fissures in bulk of restorations while composite resins restorations present

deformation when are associated with a modification of volume and form because of

repeated action of medium forces on long term or high forces on short term (figures

XI4 XI5)

Fig XI4 Material deformation in area of maximum tension

000E + 00

500E -02

100E -01

150E -01

200E -01

250E -01

1 4 7 101316192225283134374043464952555861646770737679

Amalgam C ompoz it

Figura XI5 Deformarea funcție de material

The amalgam and composite resins were treated as homogenous isotropic and

liniar The advantage of this type of FEA study is that restorations parameters can be

modified any time is necessary both in arhitecture geometry and material indices

variability The results of this study sustain the conclusions of other FEA studies

focused on biomechanical behaviour of posterior restorations performed with

amalgam and composite resins(35 62 76 143)

37

XI4CONCLUSIONS

bull The amalgam in class II restorations has a low deformation tendency because

of uniform distribution of tension inside material

bull Composite resins class II restorations accumulate higher tensions comparing

with amalgam but deformation is avoided for a time because of the adhesion

forces performed between molecules under moderate oral forces In case of

high oral forces (600-800N) the risk of fracture in moderate class II

restorations is higher comparing with amalgam proximo-occlusal restorations

For extended class II restorations and forces of 600 N composite resins present

highest risk of fracture and deformation The von Misses tension at the

cervical interface restorationtooth can reach 1600Mpa

bull The amalgam in moderate class II restorations can resist to deformation even

for high intensity forces limited to 600N In extended class II restorations the

risk of deformation and fracture increases at values of 600N-800N of oral

forces The von Misses tension at the cervical interface restorationtooth can

reach 1700 Mpa

38

FINAL CONCLUSIONS

Amalgam proximo-occlusal restorations with minimum 6-years age present

excellent results for parameters anatomic form (occlusal) marginal

discoloration and marginal secondary dental caries good results for

parameters anatomic form (proximal) and marginal adaptation and poor results

for surface quality

Composite resins proximo-occlusal restorations (bicusps) with minimum 6-

years age present excellent results for parameters color match marginal

discoloration and marginal secondary dental caries and good results for

parameters anatomic form (occlusal proximal) marginal adaptation surface

quality

Composite resins proximo-occlusal restorations (molars) with minimum 6-

years age present good results for parameters color match marginal

discoloration marginal secondary dental caries marginal adaptation and poor

results for parameters anatomic form (occlusal) (54 indices Ryge C)

anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The restorations extended at external third of occlusal surface present highest

percents of indices C regarding anatomic form (occlusal) (54 indices Ryge

C) anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The exceeding of 6-years age will require careful monitorisation for early

interventions through polishing sealing reshaping and even replacement for

restorations with major defects

Oblique layering technique presents superior results regarding marginal

adaptation and marginal discoloration and is recommended for proximo-

occlusal dental caries close to enamel-cement jonction

Centripetal build-up presents good results regarding marginal adaptation and

anatomical form at proximal level (proximal surfaces and contact point)

Horisontal layering technique can be used for optimum results only in

proximal-occlusal cavities with moderate extension both in occlusal-cervical

and buccal-oral

The values of die penetration at gingival wall were statistically different

between the three restorative techniques

We concluded that all restorative methods were associated with lightcuring

contraction and marginal microleakage

The combined technique was associated with lowest lightcuring contraction

and die penetration

The bulk technique was associated with highest lightcuring contraction and die

penetration

39

The surfaces of enamel and dentine at cervical level record decreases of

roughness related to the decrease of distance to ECJ

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel but the differences

statistical significant are present only for enamel localised at 2 mm from ECJ

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of

dentine

bull The amalgam in class II restorations has a low deformation tendency because

of uniform distribution of tension inside material

bull Composite resins class II restorations accumulate higher tensions comparing

with amalgam but deformation is avoided for a time because of the adhesion

forces performed between molecules under moderate oral forces In case of

high oral forces (600-800N) the risk of fracture in moderate class II

restorations is higher comparing with amalgam proximo-occlusal restorations

For extended class II restorations and forces of 600 N composite resins present

highest risk of fracture and deformation The von Misses tension at the

cervical interface restorationtooth can reach 1600Mpa

bull The amalgam in moderate class II restorations can resist to deformation even

for high intensity forces limited to 600N In extended class II restorations the

risk of deformation and fracture increases at values of 600N-800N of oral

forces The von Misses tension at the cervical interface restorationtooth can

reach 1700 Mpa

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Mater 1995 11(2)132-6

152Jackson RD Morgan M The new posterior resins and a simplified placement

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48

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Kompositefullungen Zahnartzlicher Welt 1999 108 270-273

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Community Dentistry and Oral Epidemiology 1994 22(2) 71-74

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1243

161Khairallah C Hokayem A Long-term clinical evaluation of 2 dental materials

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Biology199843(8)629-632

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817-822

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166Kleverlaan CJ Feilzer AJ Polymerization shrinkage and contraction stress of

dental resin composites Dent Mater 2005 211150-1157

167Koenigsberg SA Fuks R GrajowerThe effect of three filling techniques on

marginal leakage around class II composite resin restorations in vitroQuint Int

201989117ndash121

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18(7)516-20

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Dent 27(5)325-331 1999

49

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Jan11(1)34-40

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JProsthet Dent 199369(4)425-430

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thermal behavior of dental composites Dent Mater 2008 24(8)1017ndash1024

175Kreulen CM Tobi H Gruythuysen RJM van Amerongen WE

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JDent 199826 627-632

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shrinkage and elasticity of flowable composites and filled adhesives Dent Mater

1999 15128-137

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178Lăcătuşu St- Caria dentară explozivă- EdCronica Iaşi 1996

179Lăcătuşu St Luminiţa Costinescu Andrian S Gianina Iovan Valeria

Pendefunda 180Sorina Solomon Topoliceanu C Elements of dispersional

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Edition of the Balkan Medical Days

Stomatological Section Abstract nr1091999128

181Lăcătuşu St Andrian S Gianina Iovan- Consideraţii asupra adaptării

amalgamelor dentare la pereţii cavităţilor RevMedicina

StomatologicăVol2199823-26

182Leevailoj C Cochran MA Matis BA Moore BK Platt JA Microleakage of

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200126302ndash307

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Dentistry and Oral Epidemiology 1996 24 106-11

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Dent Mater 2002 18436-444

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constraint and filling technique in composite restorations Dent Mater 2004

20(3)236-43

188Loguercio AD Reis A Schroeder M Balducci I Versluis A Ballester RY

Polymerization shrinkage effects of boundary conditions and filling technique of

resin composite restorations J Dent 2004 32(6)459-70

50

189Lopes GC Baratieri LN Monteiro S Jr Vieira LC Effect of posterior resin

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Quintessence Int 2004 35(2)156-61

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art and future perspectives Quintessence Int 200233213-224

191Loumlsche GM Marginal adaptation of class II composite fillings guided

polymerization vs reduced light intensity J Adhes Dent 1 199931ndash39

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and reactivity on the reaction kinetics of dimethacrylatedimethacrylate

copolymerizations Macromolecules 1999 323913-3921

194Lutz F Krejci I Barbakow F Quality and durability of marginal adaptation in

bonded composite restorations Dent Mater 1991 7(2) 107-13

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clinical results J Dent Res 199877 1020

196Mair LH Ten-year clinical assessment of three posterior resin composites and

two amalgams Quintessence Int 199829483ndash490

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depth as cavity predictors for approximal dentin caries lesions in primary teeth

Dentomaxillofac Radiol 2007 Oct36(7)377-81

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direct and indirect restorations icircn posterior teeth of the permanent

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composites for posterior restorations JADA Vol132 2001639-644

200Manhart J Neuerer P Scheibenbogen-Fuchsbrunner A Hickel R Three-

year clinical evaluation of direct and indirect composite restorations in posterior teeth

J Prosthet Dent 2000 Sep84(3)289-96

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Three-year clinical evaluation of composite and ceramic inlays Am J Dent 2001

Apr14(2)95-9

202Manhart J Chen HY Draegert U Kunzelmann KH Hickel R Vickers

hardness and depth of cure of light cured packable composite resins J Dent Res 2000

79369 (Abstract)

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caries-affected transparent dentin by citric acidAn atomic force microscopy

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51

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209Miguel A JC La Macorra A predictive formula of the contraction stress in

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deformation Dent Mater 200117241ndash246

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practitioners and dental caries JDent1990 18(3) 130-136

211Millar BJ Robinson PB Eight year results with direct ceramic restorations

(Cerana) Br Dent J 2006 Oct 21201(8)515-20

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PrimDentCare1999Apr659-62

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Quintessence 198961-80

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ScandJDRes 199210060-65

215Mjor IA The reasons for replacement and the age of failed restorations in

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33

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19904011ndash7

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Am Dent Assoc 2010 141(3)319-29

52

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125749-751

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composites Oper Dent 23 1998282ndash289

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34

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Monogr Oral Sci 20092142-51

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Monogr Oral Sci 20092152-62

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Quintessence Int 1998295ndash11

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Influence of the Discomfort Reported by Children on the Performance of Approximal

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569ndash575

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Nanoleakage leakage within the hybrid layer Oper Dent 1995 20 18-25

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In vivo evidence J Dent 2004 32611ndash621

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Oral Surg Oral Med Oral Pathol 198661(3)289-96

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327Versluis A Douglas WH Cross M Sakaguchi RL Does an incremental filling

technique reduce polymerization shrinkage stresses J Dent Res 1996 75871ndash878

328Vries HC Ruiken HM Konig KG vanrsquot Hof MA Radiographic versus

clinical diagnosis of approximal carious lesions Caries Res1990 24 (5) 364-370

329Waggoner W Ashton J Predictability of cavitation based upon radiographic

appearance comparison of two film types Quintessence International 1989 20(1)

55-60

330Watanabe LG Marshall GW Jr Marshall SJ Dentin shear strength effects of

tubule orientation and intra tooth location Dent Mater 1996 12 109-115

331Watts DC AS Marouf Optimal specimen geometry in bonded-disk

shrinkage-strain measurements on light-cured biomaterials Dent Mater 200016447ndash

451

332Watts DC Marouf AS Al-Hindi AM Photo-polymerization shrinkage-stress

kinetics in resin-composites methods development Dent Mater 2003 191ndash11

333Weaver WS Blank LW Pelleu GB Jr A visible light activated resin cured

through tooth structure GenDent 198836236-7

334Wendt SL Microleakage and cusp fracture resistance of heattreated composite

resin inlays Am J Dent 4(1)10-14 1991

335Wenzel A Hintze H Mikkelsen L Mouyen F Radiographic detection of

occlusal caries in noncavitated teeth A comparison of conventional film radiographs

digitized film radiographs and RadioVisioGraphy-Oral Surg Oral Med Oral Pathol

1991 72 621-6

336Wenzel A Hintze H Perception of image quality in direct digital radiography

after application of various image treatment filters for detectability of dental diseases

Dentomaxillofac Radiol 1993 22 131-4

337Wenzel A Computer-aided image manipulation of intraoral radiographs to

enhance diagnosis in dental practice a review Int Dent J 1993 43 99-108

338Wenzel A Digital radiography and caries diagnosis Dento Maxillo Facial

Radiology 27(1)3-11 1998

339Wenzel A Haiter-Neto F Gotfredsen E Risk factors for a false positive test

outcome in diagnosis of caries in approximal surfaces impact of radiographic

modality and observer characteristics Caries Res 200741(3)170-6

340Wibowo G Stockton L Microleakage of class II composite restorations Am J

Dent 200114177ndash185

341Wilson NHF Wastell DG Norman RD Five-year performance of high-

cooper content amalgam restorations in a multiclinical trial JDent1996 24 203-210

342Winkler MM Katona TR Paydar NH Finite element stress analysis of three

filling techniques for class V light-cured composite restorations J Dent Res

1996751477-83

343Yap AU Effectiveness of polymerization in composite restoratives claiming bulk

placement Impact of cavity depth and exposure time Oper Dent 2000 25113-120

59

344Yeşilyurt C Bulucu B Bond strength of total-etch dentin adhesive systems on

peripheral and central dentinal tissue a microtensile bond strength test The Journal of

Contemporary Dental Practice 7(2) 20061-13

345Yoshida Y Van Meerbeek B Okazaki M Shintani H Suzuki K Comparative

study on adhesive performance of functional monomers J Dent Res 2004 83 454-

458

346Yoshiyama M Tay FR Doi J Nishitani Y Yamada T Itou K Carvalho RM

Nakajima M Pashley DH Bonding of self-etch and total etch adhesives to carious

dentin J Dent Res 2002 81 556-560

  • COPERTA REZUMAT ENGLEZA (MEREUTA)pdf
  • REZUMAT ENGLEZA DR MEREUTA DENISSpdf
Page 24: UNIVERSITATEA DE MEDICINA SI FARMACIE “GR Doctorat/Rezumat... · universitatea de medicina si farmacie “gr.t.popa” iasi facultatea de medicina dentara rezumatul tezei de doctorat

21

blue 10 for 48 hours After this stage samples were washed with water and teeth

were cut longitudinally with a diamonded disc

The die penetration was assessed with Zeiss (Iena Germany) X20 microscope

accordingly to four scores (0-3)

0 ndash no penetration

1 ndash die infiltration until external half of gingival wall

2 ndash die infiltration on all gingival wall

3 ndash die infiltration on gingival wall and axial wall

IX4RESULTS AND DISCUSSIONS

The result of die penetration are presented in table IX1

TableIX1 The results for die penetration

Grup 0 1 2 3

A (bulk) 0 0 3 17

B (layering) 0 4 5 11

C (combined) 12 5 2 1

In group A 17 sample had score 3 and 2 samples had score 2 In group B 11

sample had score 3 5 samples had score 2 and 4 sample had score 1 In group C with

best results 12 samples had score 0 5 samples had score 1 2 samples had score 2 1

sample had score 3

The recorded data were analysed using test Mann-Whitney The statistical

results are presented in tables IX2-IX4

Tables IX2a-b Mann-Whitney for comparisons of microleakage values between

bulk technique and incremental technique

Ranks

Restorative technique N Mean Rank Sum of Ranks

Scores

frequency

A ndash bulk technique 20 2420 24200

B ndash incremental

technique

20 1680 16800

Total 40

Test Statisticsb

scores

frequency

Mann-Whitney U 29000

Wilcoxon W 168000

Z -1970

Asymp Sig (2-tailed) 049

Exact Sig [2(1-tailed Sig)] 123a

a Not corrected for ties

b Grouping Variable restorative technique

22

Tables IX3a-b Mann-Whitney for comparisons of microleakage values between

bulk technique and mixed technique

Ranks

Restorative technique N Mean Rank Sum of Ranks

scores

frequency

A ndash bulk technique 20 3090 30900

C ndash mixed technique 20 1010 10100

Total 40

Test Statisticsb

scores

frequency

Mann-Whitney U 500

Wilcoxon W 101000

Z -4021

Asymp Sig (2-tailed) 000

Exact Sig [2(1-tailed Sig)] 000a

a Not corrected for ties

b Grouping Variable restorative technique

Tables IX4a-b Mann-Whitney test for comparisons of microleakage values

between incremental technique and mixed technique

Ranks

Restorative technique N Mean Rank Sum of Ranks

scores

frequency

B ndash incremental

technique

20 2990 29900

C ndash mixed technique 20 1210 12100

Total 40

Test Statisticsb

scores

frequency

Mann-Whitney U 5500

Wilcoxon W 121000

Z -3492

Asymp Sig (2-tailed) 000

Exact Sig [2(1-tailed Sig)] 000a

a Not corrected for ties

23

Test Statisticsb

scores

frequency

Mann-Whitney U 5500

Wilcoxon W 121000

Z -3492

Asymp Sig (2-tailed) 000

Exact Sig [2(1-tailed Sig)] 000a

a Not corrected for ties

b Grouping Variable tehnrestaurare

The results of microleakage degree were statistically significant when the

three restorative techniques were compared The results showed that best restorative

technique regarding marginal sealing in cervical area is combined technique followed

by oblique layering technique The use of layering techniques limits the development

of contraction forces between oposite walls event that favourises bulk stress voids

formation and fissure inside dental tissues The results of our study are similar with

other studies (114 293)

IX5 CONCLUSIONS

The values of die penetration at gingival wall were statistically different

between the three restorative techniques

We concluded that all restorative methods were associated with lightcuring

contraction and marginal microleakage

The combined technique was associated with lowest lightcuring contraction

and die penetration

The bulk technique was associated with highest lightcuring contraction and die

penetration

24

CHAPTX STUDY REGARDING THE EFFECTS OF ETCHING ON

ENAMEL AND DENTINE IN CERVICAL AREA FOR PROXIMAL

CAVITIES AT LATERAL DENTAL GROUP

X1 INTRODUCTION

The studies reported marginal defects and high microleakage at the level of

gingival margins localised in cervical area or close to enamel-cement jonction for

high percents of proximal-occlusal composite resins restorations (8485) The good

adhesion is requested to insure restoration longevity and to prevent marginal

microleakage and presence of secondary marginal dental caries The adhesion

strenght of different adhesive systems can vary accordingly to tissues areas (204 240)

and to variations in dentinal structures (234 330) Most studies focused on adhesive

systems performances used healthy dentine close to pulp room but in case of class II

restorations there are particular features that influences the adhesion at the level of

gingival margins

The surface topography is an important property that determines the

interaction manner between surfaces The surface roughness and surface energy can

increase or decrease the adhesion of composite resins to the hard dental tissues

X2 AIM OF STUDY

The aim of study was to compare surface roughness of enamel and dentine

after etching related to different distances related to enamel-dentinecement jonction

X3 MATERIALS AND METHODS

The study group included 20 molars extracted from orthodontics or

periodontal reasons with intact proximal surfaces The teeth were cut longitudinally in

sens buccal-oral with diamond discs under water cooling

A group study (10 teeth) included 10 samples obtained through transversal

cutting at distance of 2mm from enamel-dentinecement jonction and 10 samples

obtained through transversal cutting at distance of 15 mm from enamel-

dentinecement jonction Another study group (10 teeth) included 10 samples

obtained through transversal cutting at distance of 1mm from enamel-dentinecement

jonction and 10 samples obtained through transversal cutting at distance of 05 mm

from enamel-dentinecement jonction All these samples were divided in two halfes

through mesial-distal cutting The samples finishing was performed with abrasive

paper (100-4000) and final polishing was performed with a device Buehler model

Minimet with slices introduced in ultrasound bath for 4 minutes The second half of

each sample was etched for 15 seconds with ortophosphoric acid 37 for 15 seconds

Slices were washed with distilled water for 30 seconds after etching and dried

The samples were analysed with atomic force microscopy (AFM) regarding

surface roughness The results were expressed as relative variation of roughness

X4 RESULTS AND DISCUSSIONS

The aspect of etched enamel at 2 mm distance from ECJ can be seen in figure

X1 (section 10 microm) The surface roughness is higher comparing with sample before

etching

25

După gravajul cu acid ortofosforic 37

The aspect of etched enamel at 15 mm distance from ECJ can be seen in

figure X2 (section 10 microm) The surface roughness is higher comparing with sample

before etching but lower comparing with sample at 2 mm from ECJ

The aspect of etched enamel at 1 mm distance from ECJ can be seen in figure

X3 (section 10 microm) The surface roughness is higher comparing with sample before

etching but lower comparing with sample at 15mm and 2 mm from ECJ

The aspect of etched enamel at 15 mm distance from ECJ can be seen in

figure X4 (section 10 microm) The surface roughness is higher comparing with sample

before etching but lower comparing with sample at 1 mm 15 mm and 2 mm from

ECJ

FigX1 3D aspect of enamel at 2 mm from ECJ

after etching (10 microm)

FigX2 3D aspect of enamel at 15 mm from ECJ

after etching (10 microm)

FigX3 3D aspect of enamel at 1 mm from ECJ

after etching (10 microm)

FigX4 3D aspect of enamel at 05 mm from ECJ

after etching (10 microm)

26

The mean values of squared roughness for dentine and enamel before etching

are presented in tables X1 and X2

Table X1 Squared roughness values for dentine samples before and after etching

Before etching (nm) After etching (nm)

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

sample

1

335 282 283 259 1149 947 901 879

sample

2

352 284 274 266 1127 939 883 875

sample

3

357 273 278 263 1152 953 876 867

sample

4

323 269 264 258 1146 942 895 883

sample

5

348 298 271 268 1153 944 904 878

sample

6

339 274 278 273 1158 937 893 892

sample

7

352 283 269 266 1145 944 899 876

sample

8

349 292 272 274 1166 942 907 869

sample

9

357 284 275 265 1132 939 893 879

sample

10

348 281 277 262 1142 941 899 878

Table X2 Squared roughness values for enamel and dentine samples before and after

etching

Before etching (nm) After etching (nm)

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

sample 1 422 342 309 313 2255 1114 874 845

sample 2 418 338 324 304 2236 1102 882 839

sample 3 413 334 315 303 2239 1115 873 833

sample 4 416 336 322 308 2242 1116 868 842

sample 5 426 332 315 294 2218 1103 877 829

sample 6 412 332 317 306 2237 1099 874 847

sample 7 414 335 322 314 2252 1102 876 834

sample 8 416 325 318 313 2239 1106 875 838

sample 9 418 328 314 299 2246 1113 879 836

sample 10 413 334 316 305 2242 1104 873 839

The results for samples before etching prove a decreasing tendency for mean

values of squared roughness surface beginning with areas placed at distance of 2 mm

from ECJ (346 nm) followed by areas placed at distance of 15 mm from ECJ (282

nm) 1 mm from ECJ (274 nm) and 05 mm from ECJ (265 nm) After etching the

decreasing tendency maintained for dentine localised at 2 mm from ECJ to dentine

localised at 05 mm from ECJ The mean values of squared roughness after etching

were three times higher (tables X3)

27

Table X3 Squared roughness values for enamel and dentine samples before and

after etching

Dentine Enamel

Before etching

(nm)

After etching

(nm)

Before etching

(nm)

After etching

(nm)

2 mm ECJ 346 1147 416 2237

15 mm ECJ 282 942 333 1107

1 mm ECJ 274 895 317 875

05 mm ECJ 265 877 305 838

The descriptive statistics data for surface roughness of dentine before and after

etching are presented in tables X4 si X5

Table X4 Descriptive statistics for dentine samples before etching

Statistics

Dentine 2mm

before etching

Dentine 15mm

before etching

Dentine 1mm

before etching

Dentine 05mm

before etching

N Valid 10 10 10 10

Missing 0 0 0 0

Mean 346000 282000 274100 265400

Std Error of Mean 33830 27487 17026 16746

Std Deviation 106979 86923 53841 52957

Skewness -1214 354 -314 348

Std Error of Skewness 687 687 687 687

Kurtosis 1141 049 336 -539

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 3230 2690 2640 2580

Maximum 3570 2980 2830 2740

Table X5 Descriptive statistics for dentine samples after etching

Statistics

Dentine 2mm

after etching

Dentine 15mm

after etching

Dentine 1mm

after etching

Dentine 05mm

after etching

N Valid 10 10 10 10

Missing 0 0 0 0

1147000 942800 895000 877600

Std Error of Mean 36545 14591 29926 22020

Std Deviation 115566 46140 94634 69634

Skewness -267 1169 -951 535

Std Error of Skewness 687 687 687 687

Kurtosis 043 1776 564 1416

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 11270 9370 8760 8670

28

Statistics

Dentine 2mm

after etching

Dentine 15mm

after etching

Dentine 1mm

after etching

Dentine 05mm

after etching

N Valid 10 10 10 10

Missing 0 0 0 0

1147000 942800 895000 877600

Std Error of Mean 36545 14591 29926 22020

Std Deviation 115566 46140 94634 69634

Skewness -267 1169 -951 535

Std Error of Skewness 687 687 687 687

Kurtosis 043 1776 564 1416

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 11270 9370 8760 8670

Maximum 11660 9530 9070 8920

To choose the statistical test to compare roughness surface values was

performed a test Shapiro-Wilk If p is lower or equal with 0005 than hypothesis of

distribution normality is rejected (distribution deviates from normal form) In the table

X6 the distributions are normal The statistical test will be test t for pair samples

Table X6 Test Shapiro-Wilk for dentine samples

Tests of Normality

Kolmogorov-Smirnov

a Shapiro-Wilk

Statistic df Sig Statistic df Sig

Dentine 2mm before etching 274 10 032 877 10 122

Dentine 15mm after etching 209 10 200 952 10 689

Dentine 1mm before etching 134 10 200 983 10 980

Dentine 05mm before etching 155 10 200 949 10 661

Dentine 2mm after etching 133 10 200 977 10 946

Dentine 15mm after etching 197 10 200 916 10 329

Dentine 1mm after etching 216 10 200 925 10 401

Dentine 05 after etching 220 10 185 933 10 474

Enamel 2mm before etching 193 10 200 898 10 207

Enamel 15mm before etching 170 10 200 977 10 947

Enamel 1mm before etching 157 10 200 952 10 689

Enamel 05mm before etching 165 10 200 943 10 590

Enamel 2mm after etching 235 10 124 925 10 404

Enamel 15mm after etching 209 10 200 871 10 102

Enamel 1mm after etching 189 10 200 964 10 834

Enamel 05mm after etching 142 10 200 983 10 978

a Lilliefors Significance Correction

29

Tests of Normality

Kolmogorov-Smirnov

a Shapiro-Wilk

Statistic df Sig Statistic df Sig

Dentine 2mm before etching 274 10 032 877 10 122

Dentine 15mm after etching 209 10 200 952 10 689

Dentine 1mm before etching 134 10 200 983 10 980

Dentine 05mm before etching 155 10 200 949 10 661

Dentine 2mm after etching 133 10 200 977 10 946

Dentine 15mm after etching 197 10 200 916 10 329

Dentine 1mm after etching 216 10 200 925 10 401

Dentine 05 after etching 220 10 185 933 10 474

Enamel 2mm before etching 193 10 200 898 10 207

Enamel 15mm before etching 170 10 200 977 10 947

Enamel 1mm before etching 157 10 200 952 10 689

Enamel 05mm before etching 165 10 200 943 10 590

Enamel 2mm after etching 235 10 124 925 10 404

Enamel 15mm after etching 209 10 200 871 10 102

Enamel 1mm after etching 189 10 200 964 10 834

Enamel 05mm after etching 142 10 200 983 10 978

a Lilliefors Significance Correction

This is a lower bound of the true significance

The results of test t for pair dentine samples before and after etching are

presented in table X

Table X7 Test t for dentine before and after etching

Paired Samples Test

Paired Differences

t df

p (2-

tailed)

95 Confidence

Interval of the

Difference

Mean

Std

Dev

Std

Error

Mean Lower Upper

Pair

1

dentine2mmbeforeetching-

dentine2mmafteretching

-

8010000

174801 55277 -

8135045

-

7884955

-

144906

9 000

Pair

2

dentine15mmbeforeetching-

dentine15mmafteretching

-

6608000

102394 32380 -

6681248

-

6534752

-

204079

9 000

Pair

3

dentine1mmbeforeetching-

dentine1mmafteretching

-

6209000

117799 37251 -

6293269

-

6124731

-

166678

9 000

30

Paired Samples Test

Paired Differences

t df

p (2-

tailed)

95 Confidence

Interval of the

Difference

Mean

Std

Dev

Std

Error

Mean Lower Upper

Pair

1

dentine2mmbeforeetching-

dentine2mmafteretching

-

8010000

174801 55277 -

8135045

-

7884955

-

144906

9 000

Pair

2

dentine15mmbeforeetching-

dentine15mmafteretching

-

6608000

102394 32380 -

6681248

-

6534752

-

204079

9 000

Pair

3

dentine1mmbeforeetching-

dentine1mmafteretching

-

6209000

117799 37251 -

6293269

-

6124731

-

166678

9 000

Pair

4

dentine05mmbeforeetching-

dentine05mmafteretching

-

6122000

86384 27317 -

6183796

-

6060204

-

224109

9 000

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of dentine (

2mm 15 mm 1mm sau 05mm)

The descriptive statistics data for dentine surface roughness before and after

etching are presented in tables X8 and X9

Table X8 Descriptive statistics for enamel samples before etching

Statistics

Enamel 2mm

before etching

Enamel 15mm

before etching

Enamel 1mm

before etching

Enamel 05mm

before etching

N Valid 10 10 10 10

Missing 0 0 0 0

Mean 416800 333600 317200 305900

Std Error of Mean 13968 15217 14205 20355

Std Deviation 44171 48120 44920 64369

Skewness 1095 -156 -109 -411

Std Error of Skewness 687 687 687 687

Kurtosis 769 487 -118 -295

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 4120 3250 3090 2940

Maximum 4260 3420 3240 3140

31

Table X9 Descriptive statistics for enamel samples after etching

Statistics

Enamel 2mm

after etching

Enamel 15mm

after etching

Enamel 1mm

after etching

Enamel 05mm

after etching

N Valid 10 10 10 10

Missing 0 0 0 0

Mean 2237600 1107400 875100 838200

Std Error of Mean 31027 20232 11968 17436

Std Deviation 98116 63979 37845 55136

Skewness -850 267 042 040

Std Error of Skewness 687 687 687 687

Kurtosis 878 -1880 1082 -425

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 22180 10990 8680 8290

Maximum 22520 11160 8820 8470

To choose the statistical test to compare roughness surface values was

performed a test Shapiro-Wilk If p is lower or equal with 0005 than hypothesis of

distribution normality is rejected (distribution deviates from normal form) In the table

X10 the distributions are normal The statistical test will be test t for pair samples

Table X10 Test Shapiro-Wilk for enamel samples

Tests of Normality

Kolmogorov-Smirnova Shapiro-Wilk

Statistic df Sig Statistic df Sig

2mmenamel before etching 193 10 200 898 10 207

15mmenamel before etching 170 10 200 977 10 947

1mmenamel before etching 157 10 200 952 10 689

05mmenamel before etching 165 10 200 943 10 590

2mmenamel after etching 235 10 124 925 10 404

15mmenamel after etching 209 10 200 871 10 102

1mmenamel after etching 189 10 200 964 10 834

05mmenamel after etching 142 10 200 983 10 978

a Lilliefors Significance Correction

This is a lower bound of the true significance

The results of test t for pair enamel samples before and after etching are

presented in table X11

32

Table X11 Test t for enamel samples before and after etching

Paired Samples Test

Paired Differences

t df

p (2-

tailed)

95 Confidence

Interval of the

Difference

Mean

Std

Deviation

Std

Error

Mean Lower Upper

Pair

1

2mmenamel before

etching

2mmenamel after

etching

-18208 135220 42760 -

18304731

-

18111269

-

425815

9 000

Pair

2

15mmenamel before

etching

15mmenamel after

etching

-7738 73151 23132 -7790329 -7685671 -

334508

9 076

Pair

3

1mmenamel before

etching

1mmenamel after

etching

-5579 55468 17540 -5618679 -5539321 -

318065

9 065

Pair

4

05mmenamel before

etching

05mmenamel after

etching

-5323 60378 19093 -5366192 -5279808 -

278788

9 063

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel ( 2mm 15 mm 1mm sau

05mm) but the differences statistical significant are present only for enamel localised

at 2 mm from ECJ

X5CONCLUSIONS

The surfaces of enamel and dentine at cervical level record decreases of

roughness related to the decrease of distance to ECJ

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel but the differences

statistical significant are present only for enamel localised at 2 mm from ECJ

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of

dentine

33

CHAPTXI FEA STUDY REGARDING THE BIOMECHANICAL

BEHAVIOUR AND FRACTURE RESISTANCE OF PROXIMO-OCCLUSAL

AMALGAM AND COMPOSITE RESINS RESTORATIONS

XI1INTRODUCTION AIM OF STUDY

The individual variation of patients morphological and functional complexity

of tissues as well as difficult access limit the possibilities to investigate in clinical

studies the biomechanical behaviour of proximo-occlusal restorations In this context

simulation of the biomechanics for direct restorations represents an interesting

interdisciplinar domain in actual dentistry research

The study focused on two direction

- analysis of role of forces intensity on biomechanical behaviour related to

cavity dimension and material

- analysis of tension inside restoration structure related to forces intensity

XI2MATERIALS AND METHODS

The stages of finite element analysis study are as follows

object modelling (bicusps and proximo-occlusal restoration)

definition of parameters for materials and dental tissues

meshing

constraints and loading

types of contacts

equations system definition

results of simulation

The object 3D modelling was performed in Rhinoceros (figure XI1) The

definition of parameters was performed for Poisson constant Young modulus density

(table XI1) The selected materials were amalgam and composite resins The

analysed tissues were dentine and enamel The meshing constraints loading were

performed for forces of 200N 400N 600N 800 N The analysis was performed using

software COSMOSWorks 2010

34

Fig XI1 3D modellation of bicusp

Table XI1 Values of Young modulus Poisson constant compression resistance for

amalgam composite resin enamel (amalgam compozit smalţ)

Material Young modulus (GPa) Poisson constants

Compression

resistance

(Mpa)

Amalgam 55 033 483

Enamel 48 03 400

Composite

resin 220 022 345

Fig XI2 The forces and constraints application

The results are presented in values and culours red colours representing areas

with maximum values of tensions produced under influence of masticatory forces

The tensions produced in amalgam restoration are in a range from 0 to 22886

(force 800 N) The maximum von Misses tensions are associated with cervical area

of amalgam restorations This aspect proves that first modification in interface

restoration-cavity margins will appear at the level of gingival wall First marginal

35

defects and fissures in restoration bulk will appear at tensions over 1600Mpa

associated with forces of 800N for extended amalgam proximo-occlusal restorations

The tensions produced in composite resin restorations are in a range from 0 to

2285 (force 800 N) The maximum von Misses tensions are associated with cervical

area of composite resin restorationsThis aspect proves that first modification in

interface restoration-cavity margins will appear at the level of gingival wall First

marginal defects and fissures in restoration bulk will appear at tensions over 1716

Mpa associated with forces of 600N for moderate and extended composite resins

proximo-occlusal restorations

Fig XI3a-b ndash Simulated model of proximo-occlusal restoration

FigXI4a-b Dental amalgam restoration Cervical tension associated with 600 N

(c)800 N (d)

FigXI5a-b Composite resin restoration Cervical tension associated with 600 N

(c)800 N (d)

36

The deformation of amalgam can be produced only when is associated with

fissures in bulk of restorations while composite resins restorations present

deformation when are associated with a modification of volume and form because of

repeated action of medium forces on long term or high forces on short term (figures

XI4 XI5)

Fig XI4 Material deformation in area of maximum tension

000E + 00

500E -02

100E -01

150E -01

200E -01

250E -01

1 4 7 101316192225283134374043464952555861646770737679

Amalgam C ompoz it

Figura XI5 Deformarea funcție de material

The amalgam and composite resins were treated as homogenous isotropic and

liniar The advantage of this type of FEA study is that restorations parameters can be

modified any time is necessary both in arhitecture geometry and material indices

variability The results of this study sustain the conclusions of other FEA studies

focused on biomechanical behaviour of posterior restorations performed with

amalgam and composite resins(35 62 76 143)

37

XI4CONCLUSIONS

bull The amalgam in class II restorations has a low deformation tendency because

of uniform distribution of tension inside material

bull Composite resins class II restorations accumulate higher tensions comparing

with amalgam but deformation is avoided for a time because of the adhesion

forces performed between molecules under moderate oral forces In case of

high oral forces (600-800N) the risk of fracture in moderate class II

restorations is higher comparing with amalgam proximo-occlusal restorations

For extended class II restorations and forces of 600 N composite resins present

highest risk of fracture and deformation The von Misses tension at the

cervical interface restorationtooth can reach 1600Mpa

bull The amalgam in moderate class II restorations can resist to deformation even

for high intensity forces limited to 600N In extended class II restorations the

risk of deformation and fracture increases at values of 600N-800N of oral

forces The von Misses tension at the cervical interface restorationtooth can

reach 1700 Mpa

38

FINAL CONCLUSIONS

Amalgam proximo-occlusal restorations with minimum 6-years age present

excellent results for parameters anatomic form (occlusal) marginal

discoloration and marginal secondary dental caries good results for

parameters anatomic form (proximal) and marginal adaptation and poor results

for surface quality

Composite resins proximo-occlusal restorations (bicusps) with minimum 6-

years age present excellent results for parameters color match marginal

discoloration and marginal secondary dental caries and good results for

parameters anatomic form (occlusal proximal) marginal adaptation surface

quality

Composite resins proximo-occlusal restorations (molars) with minimum 6-

years age present good results for parameters color match marginal

discoloration marginal secondary dental caries marginal adaptation and poor

results for parameters anatomic form (occlusal) (54 indices Ryge C)

anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The restorations extended at external third of occlusal surface present highest

percents of indices C regarding anatomic form (occlusal) (54 indices Ryge

C) anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The exceeding of 6-years age will require careful monitorisation for early

interventions through polishing sealing reshaping and even replacement for

restorations with major defects

Oblique layering technique presents superior results regarding marginal

adaptation and marginal discoloration and is recommended for proximo-

occlusal dental caries close to enamel-cement jonction

Centripetal build-up presents good results regarding marginal adaptation and

anatomical form at proximal level (proximal surfaces and contact point)

Horisontal layering technique can be used for optimum results only in

proximal-occlusal cavities with moderate extension both in occlusal-cervical

and buccal-oral

The values of die penetration at gingival wall were statistically different

between the three restorative techniques

We concluded that all restorative methods were associated with lightcuring

contraction and marginal microleakage

The combined technique was associated with lowest lightcuring contraction

and die penetration

The bulk technique was associated with highest lightcuring contraction and die

penetration

39

The surfaces of enamel and dentine at cervical level record decreases of

roughness related to the decrease of distance to ECJ

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel but the differences

statistical significant are present only for enamel localised at 2 mm from ECJ

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of

dentine

bull The amalgam in class II restorations has a low deformation tendency because

of uniform distribution of tension inside material

bull Composite resins class II restorations accumulate higher tensions comparing

with amalgam but deformation is avoided for a time because of the adhesion

forces performed between molecules under moderate oral forces In case of

high oral forces (600-800N) the risk of fracture in moderate class II

restorations is higher comparing with amalgam proximo-occlusal restorations

For extended class II restorations and forces of 600 N composite resins present

highest risk of fracture and deformation The von Misses tension at the

cervical interface restorationtooth can reach 1600Mpa

bull The amalgam in moderate class II restorations can resist to deformation even

for high intensity forces limited to 600N In extended class II restorations the

risk of deformation and fracture increases at values of 600N-800N of oral

forces The von Misses tension at the cervical interface restorationtooth can

reach 1700 Mpa

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1243

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201989117ndash121

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18(7)516-20

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Materials Journal 2006 25(1)59-65

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Dent 27(5)325-331 1999

49

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Jan11(1)34-40

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JProsthet Dent 199369(4)425-430

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thermal behavior of dental composites Dent Mater 2008 24(8)1017ndash1024

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JDent 199826 627-632

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shrinkage and elasticity of flowable composites and filled adhesives Dent Mater

1999 15128-137

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Pendefunda 180Sorina Solomon Topoliceanu C Elements of dispersional

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Edition of the Balkan Medical Days

Stomatological Section Abstract nr1091999128

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amalgamelor dentare la pereţii cavităţilor RevMedicina

StomatologicăVol2199823-26

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200126302ndash307

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restorative decisions microscopic and radiographic caries depth Community

Dentistry and Oral Epidemiology 1996 24 106-11

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polymerization contraction stress for dental composites by two-step light-activation

Dent Mater 2002 18436-444

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constraint and filling technique in composite restorations Dent Mater 2004

20(3)236-43

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Polymerization shrinkage effects of boundary conditions and filling technique of

resin composite restorations J Dent 2004 32(6)459-70

50

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Quintessence Int 2004 35(2)156-61

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art and future perspectives Quintessence Int 200233213-224

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and reactivity on the reaction kinetics of dimethacrylatedimethacrylate

copolymerizations Macromolecules 1999 323913-3921

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bonded composite restorations Dent Mater 1991 7(2) 107-13

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clinical results J Dent Res 199877 1020

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two amalgams Quintessence Int 199829483ndash490

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depth as cavity predictors for approximal dentin caries lesions in primary teeth

Dentomaxillofac Radiol 2007 Oct36(7)377-81

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direct and indirect restorations icircn posterior teeth of the permanent

dentitionOperDent200429(5)481-508

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composites for posterior restorations JADA Vol132 2001639-644

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J Prosthet Dent 2000 Sep84(3)289-96

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Three-year clinical evaluation of composite and ceramic inlays Am J Dent 2001

Apr14(2)95-9

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hardness and depth of cure of light cured packable composite resins J Dent Res 2000

79369 (Abstract)

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caries-affected transparent dentin by citric acidAn atomic force microscopy

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practitioners and dental caries JDent1990 18(3) 130-136

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(Cerana) Br Dent J 2006 Oct 21201(8)515-20

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PrimDentCare1999Apr659-62

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Quintessence 198961-80

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ScandJDRes 199210060-65

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33

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19904011ndash7

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Am Dent Assoc 2010 141(3)319-29

52

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125749-751

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34

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Monogr Oral Sci 20092142-51

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569ndash575

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Nanoleakage leakage within the hybrid layer Oper Dent 1995 20 18-25

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451

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341Wilson NHF Wastell DG Norman RD Five-year performance of high-

cooper content amalgam restorations in a multiclinical trial JDent1996 24 203-210

342Winkler MM Katona TR Paydar NH Finite element stress analysis of three

filling techniques for class V light-cured composite restorations J Dent Res

1996751477-83

343Yap AU Effectiveness of polymerization in composite restoratives claiming bulk

placement Impact of cavity depth and exposure time Oper Dent 2000 25113-120

59

344Yeşilyurt C Bulucu B Bond strength of total-etch dentin adhesive systems on

peripheral and central dentinal tissue a microtensile bond strength test The Journal of

Contemporary Dental Practice 7(2) 20061-13

345Yoshida Y Van Meerbeek B Okazaki M Shintani H Suzuki K Comparative

study on adhesive performance of functional monomers J Dent Res 2004 83 454-

458

346Yoshiyama M Tay FR Doi J Nishitani Y Yamada T Itou K Carvalho RM

Nakajima M Pashley DH Bonding of self-etch and total etch adhesives to carious

dentin J Dent Res 2002 81 556-560

  • COPERTA REZUMAT ENGLEZA (MEREUTA)pdf
  • REZUMAT ENGLEZA DR MEREUTA DENISSpdf
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22

Tables IX3a-b Mann-Whitney for comparisons of microleakage values between

bulk technique and mixed technique

Ranks

Restorative technique N Mean Rank Sum of Ranks

scores

frequency

A ndash bulk technique 20 3090 30900

C ndash mixed technique 20 1010 10100

Total 40

Test Statisticsb

scores

frequency

Mann-Whitney U 500

Wilcoxon W 101000

Z -4021

Asymp Sig (2-tailed) 000

Exact Sig [2(1-tailed Sig)] 000a

a Not corrected for ties

b Grouping Variable restorative technique

Tables IX4a-b Mann-Whitney test for comparisons of microleakage values

between incremental technique and mixed technique

Ranks

Restorative technique N Mean Rank Sum of Ranks

scores

frequency

B ndash incremental

technique

20 2990 29900

C ndash mixed technique 20 1210 12100

Total 40

Test Statisticsb

scores

frequency

Mann-Whitney U 5500

Wilcoxon W 121000

Z -3492

Asymp Sig (2-tailed) 000

Exact Sig [2(1-tailed Sig)] 000a

a Not corrected for ties

23

Test Statisticsb

scores

frequency

Mann-Whitney U 5500

Wilcoxon W 121000

Z -3492

Asymp Sig (2-tailed) 000

Exact Sig [2(1-tailed Sig)] 000a

a Not corrected for ties

b Grouping Variable tehnrestaurare

The results of microleakage degree were statistically significant when the

three restorative techniques were compared The results showed that best restorative

technique regarding marginal sealing in cervical area is combined technique followed

by oblique layering technique The use of layering techniques limits the development

of contraction forces between oposite walls event that favourises bulk stress voids

formation and fissure inside dental tissues The results of our study are similar with

other studies (114 293)

IX5 CONCLUSIONS

The values of die penetration at gingival wall were statistically different

between the three restorative techniques

We concluded that all restorative methods were associated with lightcuring

contraction and marginal microleakage

The combined technique was associated with lowest lightcuring contraction

and die penetration

The bulk technique was associated with highest lightcuring contraction and die

penetration

24

CHAPTX STUDY REGARDING THE EFFECTS OF ETCHING ON

ENAMEL AND DENTINE IN CERVICAL AREA FOR PROXIMAL

CAVITIES AT LATERAL DENTAL GROUP

X1 INTRODUCTION

The studies reported marginal defects and high microleakage at the level of

gingival margins localised in cervical area or close to enamel-cement jonction for

high percents of proximal-occlusal composite resins restorations (8485) The good

adhesion is requested to insure restoration longevity and to prevent marginal

microleakage and presence of secondary marginal dental caries The adhesion

strenght of different adhesive systems can vary accordingly to tissues areas (204 240)

and to variations in dentinal structures (234 330) Most studies focused on adhesive

systems performances used healthy dentine close to pulp room but in case of class II

restorations there are particular features that influences the adhesion at the level of

gingival margins

The surface topography is an important property that determines the

interaction manner between surfaces The surface roughness and surface energy can

increase or decrease the adhesion of composite resins to the hard dental tissues

X2 AIM OF STUDY

The aim of study was to compare surface roughness of enamel and dentine

after etching related to different distances related to enamel-dentinecement jonction

X3 MATERIALS AND METHODS

The study group included 20 molars extracted from orthodontics or

periodontal reasons with intact proximal surfaces The teeth were cut longitudinally in

sens buccal-oral with diamond discs under water cooling

A group study (10 teeth) included 10 samples obtained through transversal

cutting at distance of 2mm from enamel-dentinecement jonction and 10 samples

obtained through transversal cutting at distance of 15 mm from enamel-

dentinecement jonction Another study group (10 teeth) included 10 samples

obtained through transversal cutting at distance of 1mm from enamel-dentinecement

jonction and 10 samples obtained through transversal cutting at distance of 05 mm

from enamel-dentinecement jonction All these samples were divided in two halfes

through mesial-distal cutting The samples finishing was performed with abrasive

paper (100-4000) and final polishing was performed with a device Buehler model

Minimet with slices introduced in ultrasound bath for 4 minutes The second half of

each sample was etched for 15 seconds with ortophosphoric acid 37 for 15 seconds

Slices were washed with distilled water for 30 seconds after etching and dried

The samples were analysed with atomic force microscopy (AFM) regarding

surface roughness The results were expressed as relative variation of roughness

X4 RESULTS AND DISCUSSIONS

The aspect of etched enamel at 2 mm distance from ECJ can be seen in figure

X1 (section 10 microm) The surface roughness is higher comparing with sample before

etching

25

După gravajul cu acid ortofosforic 37

The aspect of etched enamel at 15 mm distance from ECJ can be seen in

figure X2 (section 10 microm) The surface roughness is higher comparing with sample

before etching but lower comparing with sample at 2 mm from ECJ

The aspect of etched enamel at 1 mm distance from ECJ can be seen in figure

X3 (section 10 microm) The surface roughness is higher comparing with sample before

etching but lower comparing with sample at 15mm and 2 mm from ECJ

The aspect of etched enamel at 15 mm distance from ECJ can be seen in

figure X4 (section 10 microm) The surface roughness is higher comparing with sample

before etching but lower comparing with sample at 1 mm 15 mm and 2 mm from

ECJ

FigX1 3D aspect of enamel at 2 mm from ECJ

after etching (10 microm)

FigX2 3D aspect of enamel at 15 mm from ECJ

after etching (10 microm)

FigX3 3D aspect of enamel at 1 mm from ECJ

after etching (10 microm)

FigX4 3D aspect of enamel at 05 mm from ECJ

after etching (10 microm)

26

The mean values of squared roughness for dentine and enamel before etching

are presented in tables X1 and X2

Table X1 Squared roughness values for dentine samples before and after etching

Before etching (nm) After etching (nm)

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

sample

1

335 282 283 259 1149 947 901 879

sample

2

352 284 274 266 1127 939 883 875

sample

3

357 273 278 263 1152 953 876 867

sample

4

323 269 264 258 1146 942 895 883

sample

5

348 298 271 268 1153 944 904 878

sample

6

339 274 278 273 1158 937 893 892

sample

7

352 283 269 266 1145 944 899 876

sample

8

349 292 272 274 1166 942 907 869

sample

9

357 284 275 265 1132 939 893 879

sample

10

348 281 277 262 1142 941 899 878

Table X2 Squared roughness values for enamel and dentine samples before and after

etching

Before etching (nm) After etching (nm)

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

sample 1 422 342 309 313 2255 1114 874 845

sample 2 418 338 324 304 2236 1102 882 839

sample 3 413 334 315 303 2239 1115 873 833

sample 4 416 336 322 308 2242 1116 868 842

sample 5 426 332 315 294 2218 1103 877 829

sample 6 412 332 317 306 2237 1099 874 847

sample 7 414 335 322 314 2252 1102 876 834

sample 8 416 325 318 313 2239 1106 875 838

sample 9 418 328 314 299 2246 1113 879 836

sample 10 413 334 316 305 2242 1104 873 839

The results for samples before etching prove a decreasing tendency for mean

values of squared roughness surface beginning with areas placed at distance of 2 mm

from ECJ (346 nm) followed by areas placed at distance of 15 mm from ECJ (282

nm) 1 mm from ECJ (274 nm) and 05 mm from ECJ (265 nm) After etching the

decreasing tendency maintained for dentine localised at 2 mm from ECJ to dentine

localised at 05 mm from ECJ The mean values of squared roughness after etching

were three times higher (tables X3)

27

Table X3 Squared roughness values for enamel and dentine samples before and

after etching

Dentine Enamel

Before etching

(nm)

After etching

(nm)

Before etching

(nm)

After etching

(nm)

2 mm ECJ 346 1147 416 2237

15 mm ECJ 282 942 333 1107

1 mm ECJ 274 895 317 875

05 mm ECJ 265 877 305 838

The descriptive statistics data for surface roughness of dentine before and after

etching are presented in tables X4 si X5

Table X4 Descriptive statistics for dentine samples before etching

Statistics

Dentine 2mm

before etching

Dentine 15mm

before etching

Dentine 1mm

before etching

Dentine 05mm

before etching

N Valid 10 10 10 10

Missing 0 0 0 0

Mean 346000 282000 274100 265400

Std Error of Mean 33830 27487 17026 16746

Std Deviation 106979 86923 53841 52957

Skewness -1214 354 -314 348

Std Error of Skewness 687 687 687 687

Kurtosis 1141 049 336 -539

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 3230 2690 2640 2580

Maximum 3570 2980 2830 2740

Table X5 Descriptive statistics for dentine samples after etching

Statistics

Dentine 2mm

after etching

Dentine 15mm

after etching

Dentine 1mm

after etching

Dentine 05mm

after etching

N Valid 10 10 10 10

Missing 0 0 0 0

1147000 942800 895000 877600

Std Error of Mean 36545 14591 29926 22020

Std Deviation 115566 46140 94634 69634

Skewness -267 1169 -951 535

Std Error of Skewness 687 687 687 687

Kurtosis 043 1776 564 1416

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 11270 9370 8760 8670

28

Statistics

Dentine 2mm

after etching

Dentine 15mm

after etching

Dentine 1mm

after etching

Dentine 05mm

after etching

N Valid 10 10 10 10

Missing 0 0 0 0

1147000 942800 895000 877600

Std Error of Mean 36545 14591 29926 22020

Std Deviation 115566 46140 94634 69634

Skewness -267 1169 -951 535

Std Error of Skewness 687 687 687 687

Kurtosis 043 1776 564 1416

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 11270 9370 8760 8670

Maximum 11660 9530 9070 8920

To choose the statistical test to compare roughness surface values was

performed a test Shapiro-Wilk If p is lower or equal with 0005 than hypothesis of

distribution normality is rejected (distribution deviates from normal form) In the table

X6 the distributions are normal The statistical test will be test t for pair samples

Table X6 Test Shapiro-Wilk for dentine samples

Tests of Normality

Kolmogorov-Smirnov

a Shapiro-Wilk

Statistic df Sig Statistic df Sig

Dentine 2mm before etching 274 10 032 877 10 122

Dentine 15mm after etching 209 10 200 952 10 689

Dentine 1mm before etching 134 10 200 983 10 980

Dentine 05mm before etching 155 10 200 949 10 661

Dentine 2mm after etching 133 10 200 977 10 946

Dentine 15mm after etching 197 10 200 916 10 329

Dentine 1mm after etching 216 10 200 925 10 401

Dentine 05 after etching 220 10 185 933 10 474

Enamel 2mm before etching 193 10 200 898 10 207

Enamel 15mm before etching 170 10 200 977 10 947

Enamel 1mm before etching 157 10 200 952 10 689

Enamel 05mm before etching 165 10 200 943 10 590

Enamel 2mm after etching 235 10 124 925 10 404

Enamel 15mm after etching 209 10 200 871 10 102

Enamel 1mm after etching 189 10 200 964 10 834

Enamel 05mm after etching 142 10 200 983 10 978

a Lilliefors Significance Correction

29

Tests of Normality

Kolmogorov-Smirnov

a Shapiro-Wilk

Statistic df Sig Statistic df Sig

Dentine 2mm before etching 274 10 032 877 10 122

Dentine 15mm after etching 209 10 200 952 10 689

Dentine 1mm before etching 134 10 200 983 10 980

Dentine 05mm before etching 155 10 200 949 10 661

Dentine 2mm after etching 133 10 200 977 10 946

Dentine 15mm after etching 197 10 200 916 10 329

Dentine 1mm after etching 216 10 200 925 10 401

Dentine 05 after etching 220 10 185 933 10 474

Enamel 2mm before etching 193 10 200 898 10 207

Enamel 15mm before etching 170 10 200 977 10 947

Enamel 1mm before etching 157 10 200 952 10 689

Enamel 05mm before etching 165 10 200 943 10 590

Enamel 2mm after etching 235 10 124 925 10 404

Enamel 15mm after etching 209 10 200 871 10 102

Enamel 1mm after etching 189 10 200 964 10 834

Enamel 05mm after etching 142 10 200 983 10 978

a Lilliefors Significance Correction

This is a lower bound of the true significance

The results of test t for pair dentine samples before and after etching are

presented in table X

Table X7 Test t for dentine before and after etching

Paired Samples Test

Paired Differences

t df

p (2-

tailed)

95 Confidence

Interval of the

Difference

Mean

Std

Dev

Std

Error

Mean Lower Upper

Pair

1

dentine2mmbeforeetching-

dentine2mmafteretching

-

8010000

174801 55277 -

8135045

-

7884955

-

144906

9 000

Pair

2

dentine15mmbeforeetching-

dentine15mmafteretching

-

6608000

102394 32380 -

6681248

-

6534752

-

204079

9 000

Pair

3

dentine1mmbeforeetching-

dentine1mmafteretching

-

6209000

117799 37251 -

6293269

-

6124731

-

166678

9 000

30

Paired Samples Test

Paired Differences

t df

p (2-

tailed)

95 Confidence

Interval of the

Difference

Mean

Std

Dev

Std

Error

Mean Lower Upper

Pair

1

dentine2mmbeforeetching-

dentine2mmafteretching

-

8010000

174801 55277 -

8135045

-

7884955

-

144906

9 000

Pair

2

dentine15mmbeforeetching-

dentine15mmafteretching

-

6608000

102394 32380 -

6681248

-

6534752

-

204079

9 000

Pair

3

dentine1mmbeforeetching-

dentine1mmafteretching

-

6209000

117799 37251 -

6293269

-

6124731

-

166678

9 000

Pair

4

dentine05mmbeforeetching-

dentine05mmafteretching

-

6122000

86384 27317 -

6183796

-

6060204

-

224109

9 000

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of dentine (

2mm 15 mm 1mm sau 05mm)

The descriptive statistics data for dentine surface roughness before and after

etching are presented in tables X8 and X9

Table X8 Descriptive statistics for enamel samples before etching

Statistics

Enamel 2mm

before etching

Enamel 15mm

before etching

Enamel 1mm

before etching

Enamel 05mm

before etching

N Valid 10 10 10 10

Missing 0 0 0 0

Mean 416800 333600 317200 305900

Std Error of Mean 13968 15217 14205 20355

Std Deviation 44171 48120 44920 64369

Skewness 1095 -156 -109 -411

Std Error of Skewness 687 687 687 687

Kurtosis 769 487 -118 -295

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 4120 3250 3090 2940

Maximum 4260 3420 3240 3140

31

Table X9 Descriptive statistics for enamel samples after etching

Statistics

Enamel 2mm

after etching

Enamel 15mm

after etching

Enamel 1mm

after etching

Enamel 05mm

after etching

N Valid 10 10 10 10

Missing 0 0 0 0

Mean 2237600 1107400 875100 838200

Std Error of Mean 31027 20232 11968 17436

Std Deviation 98116 63979 37845 55136

Skewness -850 267 042 040

Std Error of Skewness 687 687 687 687

Kurtosis 878 -1880 1082 -425

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 22180 10990 8680 8290

Maximum 22520 11160 8820 8470

To choose the statistical test to compare roughness surface values was

performed a test Shapiro-Wilk If p is lower or equal with 0005 than hypothesis of

distribution normality is rejected (distribution deviates from normal form) In the table

X10 the distributions are normal The statistical test will be test t for pair samples

Table X10 Test Shapiro-Wilk for enamel samples

Tests of Normality

Kolmogorov-Smirnova Shapiro-Wilk

Statistic df Sig Statistic df Sig

2mmenamel before etching 193 10 200 898 10 207

15mmenamel before etching 170 10 200 977 10 947

1mmenamel before etching 157 10 200 952 10 689

05mmenamel before etching 165 10 200 943 10 590

2mmenamel after etching 235 10 124 925 10 404

15mmenamel after etching 209 10 200 871 10 102

1mmenamel after etching 189 10 200 964 10 834

05mmenamel after etching 142 10 200 983 10 978

a Lilliefors Significance Correction

This is a lower bound of the true significance

The results of test t for pair enamel samples before and after etching are

presented in table X11

32

Table X11 Test t for enamel samples before and after etching

Paired Samples Test

Paired Differences

t df

p (2-

tailed)

95 Confidence

Interval of the

Difference

Mean

Std

Deviation

Std

Error

Mean Lower Upper

Pair

1

2mmenamel before

etching

2mmenamel after

etching

-18208 135220 42760 -

18304731

-

18111269

-

425815

9 000

Pair

2

15mmenamel before

etching

15mmenamel after

etching

-7738 73151 23132 -7790329 -7685671 -

334508

9 076

Pair

3

1mmenamel before

etching

1mmenamel after

etching

-5579 55468 17540 -5618679 -5539321 -

318065

9 065

Pair

4

05mmenamel before

etching

05mmenamel after

etching

-5323 60378 19093 -5366192 -5279808 -

278788

9 063

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel ( 2mm 15 mm 1mm sau

05mm) but the differences statistical significant are present only for enamel localised

at 2 mm from ECJ

X5CONCLUSIONS

The surfaces of enamel and dentine at cervical level record decreases of

roughness related to the decrease of distance to ECJ

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel but the differences

statistical significant are present only for enamel localised at 2 mm from ECJ

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of

dentine

33

CHAPTXI FEA STUDY REGARDING THE BIOMECHANICAL

BEHAVIOUR AND FRACTURE RESISTANCE OF PROXIMO-OCCLUSAL

AMALGAM AND COMPOSITE RESINS RESTORATIONS

XI1INTRODUCTION AIM OF STUDY

The individual variation of patients morphological and functional complexity

of tissues as well as difficult access limit the possibilities to investigate in clinical

studies the biomechanical behaviour of proximo-occlusal restorations In this context

simulation of the biomechanics for direct restorations represents an interesting

interdisciplinar domain in actual dentistry research

The study focused on two direction

- analysis of role of forces intensity on biomechanical behaviour related to

cavity dimension and material

- analysis of tension inside restoration structure related to forces intensity

XI2MATERIALS AND METHODS

The stages of finite element analysis study are as follows

object modelling (bicusps and proximo-occlusal restoration)

definition of parameters for materials and dental tissues

meshing

constraints and loading

types of contacts

equations system definition

results of simulation

The object 3D modelling was performed in Rhinoceros (figure XI1) The

definition of parameters was performed for Poisson constant Young modulus density

(table XI1) The selected materials were amalgam and composite resins The

analysed tissues were dentine and enamel The meshing constraints loading were

performed for forces of 200N 400N 600N 800 N The analysis was performed using

software COSMOSWorks 2010

34

Fig XI1 3D modellation of bicusp

Table XI1 Values of Young modulus Poisson constant compression resistance for

amalgam composite resin enamel (amalgam compozit smalţ)

Material Young modulus (GPa) Poisson constants

Compression

resistance

(Mpa)

Amalgam 55 033 483

Enamel 48 03 400

Composite

resin 220 022 345

Fig XI2 The forces and constraints application

The results are presented in values and culours red colours representing areas

with maximum values of tensions produced under influence of masticatory forces

The tensions produced in amalgam restoration are in a range from 0 to 22886

(force 800 N) The maximum von Misses tensions are associated with cervical area

of amalgam restorations This aspect proves that first modification in interface

restoration-cavity margins will appear at the level of gingival wall First marginal

35

defects and fissures in restoration bulk will appear at tensions over 1600Mpa

associated with forces of 800N for extended amalgam proximo-occlusal restorations

The tensions produced in composite resin restorations are in a range from 0 to

2285 (force 800 N) The maximum von Misses tensions are associated with cervical

area of composite resin restorationsThis aspect proves that first modification in

interface restoration-cavity margins will appear at the level of gingival wall First

marginal defects and fissures in restoration bulk will appear at tensions over 1716

Mpa associated with forces of 600N for moderate and extended composite resins

proximo-occlusal restorations

Fig XI3a-b ndash Simulated model of proximo-occlusal restoration

FigXI4a-b Dental amalgam restoration Cervical tension associated with 600 N

(c)800 N (d)

FigXI5a-b Composite resin restoration Cervical tension associated with 600 N

(c)800 N (d)

36

The deformation of amalgam can be produced only when is associated with

fissures in bulk of restorations while composite resins restorations present

deformation when are associated with a modification of volume and form because of

repeated action of medium forces on long term or high forces on short term (figures

XI4 XI5)

Fig XI4 Material deformation in area of maximum tension

000E + 00

500E -02

100E -01

150E -01

200E -01

250E -01

1 4 7 101316192225283134374043464952555861646770737679

Amalgam C ompoz it

Figura XI5 Deformarea funcție de material

The amalgam and composite resins were treated as homogenous isotropic and

liniar The advantage of this type of FEA study is that restorations parameters can be

modified any time is necessary both in arhitecture geometry and material indices

variability The results of this study sustain the conclusions of other FEA studies

focused on biomechanical behaviour of posterior restorations performed with

amalgam and composite resins(35 62 76 143)

37

XI4CONCLUSIONS

bull The amalgam in class II restorations has a low deformation tendency because

of uniform distribution of tension inside material

bull Composite resins class II restorations accumulate higher tensions comparing

with amalgam but deformation is avoided for a time because of the adhesion

forces performed between molecules under moderate oral forces In case of

high oral forces (600-800N) the risk of fracture in moderate class II

restorations is higher comparing with amalgam proximo-occlusal restorations

For extended class II restorations and forces of 600 N composite resins present

highest risk of fracture and deformation The von Misses tension at the

cervical interface restorationtooth can reach 1600Mpa

bull The amalgam in moderate class II restorations can resist to deformation even

for high intensity forces limited to 600N In extended class II restorations the

risk of deformation and fracture increases at values of 600N-800N of oral

forces The von Misses tension at the cervical interface restorationtooth can

reach 1700 Mpa

38

FINAL CONCLUSIONS

Amalgam proximo-occlusal restorations with minimum 6-years age present

excellent results for parameters anatomic form (occlusal) marginal

discoloration and marginal secondary dental caries good results for

parameters anatomic form (proximal) and marginal adaptation and poor results

for surface quality

Composite resins proximo-occlusal restorations (bicusps) with minimum 6-

years age present excellent results for parameters color match marginal

discoloration and marginal secondary dental caries and good results for

parameters anatomic form (occlusal proximal) marginal adaptation surface

quality

Composite resins proximo-occlusal restorations (molars) with minimum 6-

years age present good results for parameters color match marginal

discoloration marginal secondary dental caries marginal adaptation and poor

results for parameters anatomic form (occlusal) (54 indices Ryge C)

anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The restorations extended at external third of occlusal surface present highest

percents of indices C regarding anatomic form (occlusal) (54 indices Ryge

C) anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The exceeding of 6-years age will require careful monitorisation for early

interventions through polishing sealing reshaping and even replacement for

restorations with major defects

Oblique layering technique presents superior results regarding marginal

adaptation and marginal discoloration and is recommended for proximo-

occlusal dental caries close to enamel-cement jonction

Centripetal build-up presents good results regarding marginal adaptation and

anatomical form at proximal level (proximal surfaces and contact point)

Horisontal layering technique can be used for optimum results only in

proximal-occlusal cavities with moderate extension both in occlusal-cervical

and buccal-oral

The values of die penetration at gingival wall were statistically different

between the three restorative techniques

We concluded that all restorative methods were associated with lightcuring

contraction and marginal microleakage

The combined technique was associated with lowest lightcuring contraction

and die penetration

The bulk technique was associated with highest lightcuring contraction and die

penetration

39

The surfaces of enamel and dentine at cervical level record decreases of

roughness related to the decrease of distance to ECJ

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel but the differences

statistical significant are present only for enamel localised at 2 mm from ECJ

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of

dentine

bull The amalgam in class II restorations has a low deformation tendency because

of uniform distribution of tension inside material

bull Composite resins class II restorations accumulate higher tensions comparing

with amalgam but deformation is avoided for a time because of the adhesion

forces performed between molecules under moderate oral forces In case of

high oral forces (600-800N) the risk of fracture in moderate class II

restorations is higher comparing with amalgam proximo-occlusal restorations

For extended class II restorations and forces of 600 N composite resins present

highest risk of fracture and deformation The von Misses tension at the

cervical interface restorationtooth can reach 1600Mpa

bull The amalgam in moderate class II restorations can resist to deformation even

for high intensity forces limited to 600N In extended class II restorations the

risk of deformation and fracture increases at values of 600N-800N of oral

forces The von Misses tension at the cervical interface restorationtooth can

reach 1700 Mpa

REFERENCES

1ADA Council on Scientific Affairs ADA Council on Dental Benefit Programs

Statement on posterior resin-based composites JADA 1998 129(11)1627ndash1628

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utilizing a filled and unfilled adhesive resin Dent Mater 200117268ndash276

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1451-56

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464-473

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Public Health Dent 1992 Winter52(2)102-10

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Dent 199158 36-39

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Educ 200569(5)571ndash585

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191-194

30Behle C Flowable composite Proprieties and applications Pract Periodontics

Aesthetics Dent 1998 10347 350-351

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35Boschian PL S Guidotti R Pietrbissa M Gagliani- bdquoStress distribution in a

post-restored tooth using the threedimensional finite element method Journal of Oral

Rehabilitation (33) 2006690ndash697

36Bouillaguet S B Ciucchi T Jacoby JC Wataha DH Pashley Bonding

characteristics to dentin walls of class II cavities in vitro Dent Mater 200117316ndash

321

37Bouschlicher MR Rueggeberg FA Effect of ramped light intensity on

polymerization force and conversion in a photoactivated composite J Esthet Dent

2000 12328-339

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and their efficacy as stress-relieving layers J Am Dent Assoc 2003134721ndash728

39Braga RR Ballester RY Ferracane JLFactors involved in the development of

polymerization shrinkage stress in resin-composites a systematic review Dent Mater

200521(10)962-70

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Timişoara1994

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amalgam-bonded restorations A 42-months study- Journal of American Dental

Association 2000nr131

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of reasons for the placement and replacement of restorations provided by vocational

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199930(4)234-42

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replacement of restorations in vocational training practicePrimary Dental Care

nr6(1) 1999

47Burke FJ Wilson NH Cheung SW Mjoumlr IA Influence of patient factors on age

of restorations at failure and reasons for their placement and replacement J Dent

200129(5)317-24

48Calheiros FC Braga RR Kawano Y Ballester RY Relationship between

contraction stress and degree of conversion in restorative composites Dent Mater

2004 20939-946

49Cardoso P Sadek F Microtensile bond strength on dentin using new adhesive

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the decision to replace existing amalgam restorations Quintessence Int 1999

Jun30(6)413-8

51Carvalho RM JC Pereira M Yoshiyama DH Pashley A review of

polymerization contraction the influence of stress development versus stress

reliefOper Dent19962117ndash24

52Castro VM Katz JO Hardman PK Glaros AG Spencer P Invitro comparison

of conventional film and direct digital imaging in the detection of approximal caries

Dentomaxillofac Radiol 2007 Mar36(3)138-42

53Cattaneo PM M Dalstra B Melsen- bdquoThe Finite Element Method a Tool to

Study Orthodontic Tooth Movement J Dent Res 2005 84(5)428-433

54Cattell MJ Clarke RL Lynch EJ The transverse strength reliability and

microstructural features of four dental ceramicspart 1 J Dent 25(5)399-407 1997

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bond strength to primary dentin J Dent Child 2003 70(2) 139-144

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posterior restorations 12-month results Eur J Dent 2010 Jan4(1)57-65

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two polymerization techniques Relationship between microtensile bond strength and

marginal leakage J Dent 2005 33(7) 603- 610

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Med 2008173(1)23ndash26

59Chen HY Manhart J Hickel R Kunzelmann KH Polymerization contraction

stress in light-cured packable composite resinsDent Mater 200117253-259

60Choi KK Condon JR Ferracane JL The effects of adhesive thickness on

polymerization contraction stress of composites J Dent Res 2000 79812ndash817

61Cichon P Kerschbaum T Verweildauer zahnartzlicher Restaurationen bei

Behinderten Dtsch Zahnartzlicher 1999 54 96-102

62Cohen BI Pagnillo MK Deutsch ASMusikant BL Fracture Strength of

Three Core Restorative Materials Supported with or without a Prefabricated Split-

Shank Post Journal of Prosthetic Dentistry1997 78 560ndash565

63Colli P Brannstrom M The marginal adaptation of four different bonding agents

in Class II composite resin restoration applied in bulk or in two increments

Quintessence Int 1993 24583-591

43

64Collins CJ Bryant RW Hodge KL A clinical evaluation of posterior composite

resin restorations 8-year findings J Dent 199826(4) 311ndash317

65Condon JR Ferracane JL Assessing the effect of composite formulation on

polymerization stress J Am Dent Assoc2000 131497-503

66Cook WD Moopnar M Influence of chemical structure on the fracture

behaviour of dimethacrylate composite resins Biomaterials 1990 11272-276

67Cortes DF Ellwood RP Ekstrand KR An in vitro comparison of a combined

FOTIvisual examination of occlusal caries with other caries diagnostic methods and

the effect of stain on their diagnostic performance Caries Res 2003 37 (1) 8-16

68Crim GA Microleakage of three resin placement techniques Am J Dent

1991469-72

69Dauvillier B Aarnts M Feilzer A The competition between the composite-

dentin strength and the polimerization contraction stress J Dent Res 1984 63 1396-

1399

70Dauvillier BS Aarnts MP Feilzer AJ Developments in shrinkage control of

adhesive restoratives J Esthet Dent 2000 12291-299

71Dauvillier BS Aarnts MP Feilzer AJ Modeling of the viscoelastic behavior of

dental light-activated resin composites during curing Dent Mater 200319277ndash285

72Davidson CL Gee AJ Feilzer A The competition between the composite-dentin

bond strength and the polymerization contraction stress J Dent Res 1984

63(12)1396-9

73Davidson CL AJ Feilzer Polymerization shrinkage and polymerization

shrinkage stress in polymer-based restoratives J Dent Res 199725435ndash440

74Davidson CL Resisting the curing contraction with adhesive composites J

Prosthet Dent 198655446ndash7

75Davis RD Mayhew RB A clinical comparison of three anterior restorative resins

at 3 years J Am Dent Assoc 1986112659-63

76Dejak B Mlotkowski A Three-dimensional finite element analysis of strength

and adhesion of composite resin versus ceramic inlays in molarsJ Prosthet

Dent200899131-40

77Deligeorgi V Mjor IA Wilson NH An overview of reasons for the placement

and replacement of restorations Prim Dent Care 20018(1)5-11

78Deliperi S Bardwell DN An alternative method to reduce polymerization

shrinkage in direct posterior composite restorations J Am Dent Assoc 2002

1331387ndash97

79Demirci M Tuncer S Yuceokur AA Prevalence of caries on individual tooth

surfaces and its distribution by age and gender in university clinic patientsEur J

Dent20104(3)270-9

80De Munck J Van Meerbeek B Satoshi I Vargas M Yoshida Y Armstrong S

Lambrechts P Vanherle G Microtensile bond strengths of one- and two-step

selfetch adhesives to bur-cut enamel and dentin Am J Dent 2003 16 414-420

81Dewaele M Truffier-Boutry D Devaux J Leloup G Volume contraction in

photocured dental resins the shrinkage-conversion relationship revisited Dent Mater

2006 22359-365

44

82Deutsch WM Simecek JW Dental emergencies among Marines ashore in

Operations Desert ShieldStorm Mil Med 1996161(10) 620ndash623

83Dickens SH Stansbury JW Choi KM Floyd CJ Photopolymerization kinetics

of methacrylate dental resins Macromolecules 2003 366043-6053

84Dietschi D De Siebenthal G Neveu-Rosenstand L Holz J Influence of the

restorative technique and new adhesives on the dentin marginal seal and adaptation of

resin composite Class II restorations An in vitro evaluation Quintessence Int 1995

26 717-727

85Dietschi D Herzfeld D In vitro evaluation of marginal and internal adaptation of

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Sci 1998 106 1033-1042

86Dietschi D Marginal adaptation and seal of direct and indirect Class II composite

resin restorations an in vitro evaluation Quintessence Int 26(2)127-138 1995

87Diefenderfer KE Simecek JW Ahlf RL Ragain JC Relationship between

caries status and dental emergencies among US naval personnel J Dent Res

20028195 (Abstract)

88Diefenderfer KE Rienhardt JW Shear bond strengths of ten adhesive

resinamalgam combinations Oper Dent 1997 22 50-56

89Donly KJ Jensen ME Triolo PA clinical comparison of resin composite inlay

and onlay posterior restorations and cast-gold restorations at 7 years Quintessence Int

30(3)163- 1681999

90Douglas WH Fields RP Fundingsland J A comparison between the

microleakage of direct and indirect composite restorative systems J Dent 17(4)184-

188 1989

91Eberhard J Hartman B Lenhard M Mayer T Kocher T Eickholz P Digital

subtraction radiography for monitoring dental demineralization An in vitro study

Caries Res 200034(3)219-24

92Edelstein BL Douglass CW Dispelling the myth that 50 percent of US

schoolchildren have never had a cavity Public Health Rep1995 110 (5) 522-530

93Eick JD Welch FH Polymerization shrinkage of posterior composite resins and

its possible influence on postoperative sensitivity Quintessence Int 198617103-11

94Elliott JE Lovell LG Bowman CN Primary cyclization in the polymerization of

bis GMA and TEGDMA a modeling approach to understanding the cure of dental

resins Dent Mater 2001 17221-229

95Ermis R Ulkam Aydin Examiner agreement in the replacement decisions of

class I amalgam restorations The Journal of contemporary dental practice 2004 Vol

5 no21-7

96Feilzer AJ AJ De Gee CL Davidson Increased wall-to-wall curing

contraction in thin bonded resin layers J Dent Res 19896848ndash50

97Feilzer AJ Dauvillier BS Effect of TEGDMABisGMA ratio on stress

development and viscoelastic properties of experimental twopaste composites J Dent

Res 2003 82824-828

98Feilzer AJ de Gee AJ Davidson CL Relaxation of polymerization contraction

shear stress by hygroscopic expansion J Dent Res 1990 6936ndash39

45

99Feilzer AJ De Gee AJ Davidson CL Setting stress in composite resin in relation

to configuration of the restoration J Dent Res1987 661636-1639

100Feilzer AJ Dooren LH de Gee AJ Davidson CL Influence of light intensity

on polymerization shrinkage and integrity of restoration-cavity interface Eur J Oral

Sci 1995 103322ndash326

101Fennis YL Verdischbot EH vanrsquot Hof MA Performance of some diagnostic

systems in the prediction of occlusal caries in permanent molars in 6 and 11 year-old

children J Dent 1998 26(5) 403-40

102Ferracane JL Developing a more complete understanding of stresses produced

in dental composites during polymerization Dent Mater 2005 2136-42

103Ferrari M Influence of tissue characteristics at margins on leakage of Class II

indirect porcelain restorations Am JDent 1999 12(3)134-142

104Ferreira MC Vieira RS Marginal leakage in direct and indirect composite resin

restorations in primary teeth an in vitro study J Dent 200836(5)322-5

105Forss H Widstroumlm E Reasons for restorative therapy and the longevity of

restorations in adults Acta Odontol Scand 2004 6282-86

106Fradeani M Aquilano A Bassein L Longitudinal study of pressed glass-

ceramic inlays for four and a half years J Prosthet Dent 1997 78(4)346-353

107Franccedila FM Worschech CC Paulillo LA Martins LR Lovadino JR Fracture

resistance of premolar teeth restored with different filling techniques J Contemp Dent

Pract 20056(3)62-9

108Francci C Loguercio AD Reis A Carrilho MR A novel filling technique for

packable composite resin in Class II restorations J Esthet Restor Dent 2002

14(3)149-57

109Fruits TJ Knapp JA Khajotia SS Microleakage in the proximal walls of

direct and indirect posterior resin slot restorations Oper Dent 200631(6)719-27

110Gaengler P Hoyer I Montag R Clinical evaluation of posterior composite

restorations The 10-year report J Adhes Dent 2001 3185-194

111Garbuz DS Masri BA Estaile J Classification systems in orthopaedics J Am

Acad Orthop Surg 2002 10 290-297

112Ghavamnasiri M Moosavi H Tahvildarnejad N Effect of centripetal and

incremental methods in Class II composite resin restorations on gingival

microleakage J Contemp Dent Pract 20078(2)113-20

113Gladys S Clinical and semiquantitative marginal analysis of four tooth-coloured

inlay systems at 3 years J Dent 199523(6)329-338

114Giachetti L Scaminaci Russo D Bambi C Grandini R A review of

polymerization shrinkage stress current techniques for posterior direct resin

restorations J Contemp Dent Pract 20067(4)79-88

115Giannini M AJS Santos RM Carvalho LAMS Paulillo JR Lovadino

Effects of irradiation mode and filling technique on resindentin bond strength in

Class I cavities J Dent Res 200281 (Abstract)

116Going RE Microleakage around dental restorations A summarizing review

JADA 1972841349-1357

117Gordon JChristensen G Why switch to digital radiography J Am Dent

Assoc 204 Vol 135 No 101437-1439

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118Gregoire GL Akon BA Millas A Interfacial micromorphological differences

in hybrid layer formation between water- and solvent-based dentin bonding systems J

Prosthet Dent 2002 87633ndash641

119Gregory WA Physical properties and repair bond strength of direct and indirect

composite resins J Prosthet Dent 68(3)406-411 1992

120Gwinnett AJ Buonocore MG Adhesives and caries prevention a preliminary

report Br Dent J 196511977-81

121Gwinnett AJ Matsui A A study of enamel adhesives The physical relationship

between enamel and adhesive Arch Oral Biol 1967121615-1620

122Gwinnett AJ Histologic changes in human enamel following treatment with

acidic adhesive conditioning agents Arch Oral Biol 197116731-738

123Gwinnett AJ Moist versus dry dentin its effect on shear bond strength Am J

Dent 1992 5(3)127-9

124Haba Denisia Tehnici uzuale utilizate icircn radiologia dentară Edit Junimea

2007

125Hashimoto M Ito S Tay FR Svizero NR Sano H Kaga M Fluid movement

across the resin-dentin interface during and after bonding J Dent Res 2004 83843ndash

848

126Hashimoto M Tay FR Ito S Sano H Kaga M Pashley DH Permeability of

adhesive resin films J Biomed Mater Res 2005 74699ndash705

127Hawthorne WS Smales RJ Factors influencing long-term restoration survival

in three private dental practices in Adelaide Aust Dent J 19974259ndash63

128Helwig Klimek Attin Einfuumlhrung in Die ZahnErhaltung Urbanampfischer 2003

129He Z Shimada Y Tagami J The effects of cavity size and incremental

technique on micro-tensile bond strength of resin composite in Class I cavities Dent

Mater 200723(5)533-8

130He Z Shimada Y Sadr A Ikeda M Tagami J The effects of cavity size and

filling method on the bonding to Class I cavities J Adhes Dent 2008 Dec10(6)447-

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131Hench LLBioceramicsfrom concept to clinicJ Amer Ceram Soc1991

74(7)1487-1570

132Heymann HO The clinical performance of CAD-CAM generated ceramic

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Fuzzi M Advances in Operative Dentistry ndash Challenges of the Future Chicago

Quintessence 2001

134Hilton TJ Cavity sealers liners and bases Current philosophies and indications

for use Oper Dent 199621134 ndash146

135Hilton TJ Schwartz RS Ferracane JL Microleakage of four Class II resin

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135- 144

136Hinoura K Setcos JK Philips RW Cavity design and placement technique for

class 2 composites Oper Dent 19981312-19

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19-23

138Hintze H Wenzel A Danielen B Behaviour of approximal carious lesions

assessed by clinical examination after tooth separation and radiography A 2+-years

longitudinal study in young adults Caries Res 1999 33 415-22

139Hintze H Wenzel A Influence of validation method on diagnostic accuracy of

dental caries A comparison of six digital and two conventional radiographic systems

Dentomaxillofacial Radiol2002 31(1) 44-49

140Holtzman JM Berkey AB Mann J Predicting utilization of dental services by

the aged JPublic Health Dent1990 50(3) 164-171

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marginal seal of class II resin-based composite restorations in vitro Oper Dent 2006

31(1)97-105

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of approximal and occlusal dental caries in a young adult population Community

Dent Oral Epidemiol 200533(3)212-8

143Hubsch PF Middleton J Knox J A finite element analysis of the stress at the

restoration-tooth interfacecomparing inlays and bulk

fillingsBiomaterials2000211015ndash1019

144Hudson JD Goldstein GR Georgescu M Enamel wear caused by three

different restorative materials J Prosthet Dent 1995 74(6)647-654

145Hunter AR Treasure ET Hunter AJ Increases in cavity volume associated

with the removal of class 2 amalgam and composite restorations Oper Dent

1995202ndash 6

146Huysmans MC PG van der Varst EP Lautenschlager P Monaghan The

influence of simulated clinical handling on the flexural and compressive strength of

posterior composite restorative materials Dent Mater 199612116ndash120

147Iliescu A Gafar MCariologie şi Odontologie RestaurativăEditura Medicală

Bucureşti 2001

148Inoue S Van Meerbeek B Vargas M Lambrechts P Vanherle G Adhesion

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Prati C Grafiche Erredue 2000131-148

149Inoue S Vargas MA Abe Y Yoshida Y LambrechtsP Vanherle G Sano H

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dentin J Adhes Dent 2001 3 237-245

150Iovan Gianina Diagnosis and Management of Patients with High Caries

Activity EdApollonia Iasi2002

151Jacobsen T Soderhold KJ Some effects of water on dentin bonding Dent

Mater 1995 11(2)132-6

152Jackson RD Morgan M The new posterior resins and a simplified placement

technique J Am Dent Assoc 2000131375ndash383

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with flowable composite in the proximal box Am J Dent 200013235ndash238

48

154Jokstad A Mjor IA Analyses of long-term clinical behaviour of class II

amalgam restorations Acta OdontolScand 1991 49 47-63

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Scand 1994 52 234-248

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adhesives to dental hard tissues Clin Oral Investig 2002 6(3)155-60

157Kamann WK Gangler P Zur Funktionzeit von Amalgam

Kompositefullungen Zahnartzlicher Welt 1999 108 270-273

158Kanemura N Sano H Tagami J Tensile bond strength to and SEM evaluation

of ground and intact enamel surfaces J Dent 199927523-530

159Kay EJ Nutall M Relationship between dentistlsquos treatment attitudes and

restorative decisions made on the basis of simulated bitewing radiographs

Community Dentistry and Oral Epidemiology 1994 22(2) 71-74

160Kemp-Scholte CM Davidson CL Complete marginal seal of Class V resin

composite restorations effected by increased flexibility J Dent Res 1990 691240ndash

1243

161Khairallah C Hokayem A Long-term clinical evaluation of 2 dental materials

used for the preparation of esthetic inlays Odontostomatol Trop 200932(127)5-13

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200932(126)21-8

163Kidd EAAssesment of dental carious lesionsArchof Oral

Biology199843(8)629-632

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proximal caries lesions at various levels in vitro Journal of Dentistry 2006 34(10)

817-822

165Kiremitci A Alpaslan T Gurgan SSix-year clinical evaluation of packable

composite restorations Oper Dent 200934(1)11-7

166Kleverlaan CJ Feilzer AJ Polymerization shrinkage and contraction stress of

dental resin composites Dent Mater 2005 211150-1157

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marginal leakage around class II composite resin restorations in vitroQuint Int

201989117ndash121

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M Dentin shear strength effect of distance from the pulp Dent Mater 2002

18(7)516-20

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light-cured resin composite on shrinkage viscosity adhesion and degree of

polimerisation Am J Dent 1998 11 17-22

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of Self-etching Adhesives to Caries-affected Dentin on the Gingival Wall Dental

Materials Journal 2006 25(1)59-65

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Dent 27(5)325-331 1999

49

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Jan11(1)34-40

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JProsthet Dent 199369(4)425-430

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thermal behavior of dental composites Dent Mater 2008 24(8)1017ndash1024

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Borgmeijer PJ Replacement risk of amalgam treatment modalities 15-year results

JDent 199826 627-632

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shrinkage and elasticity of flowable composites and filled adhesives Dent Mater

1999 15128-137

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179Lăcătuşu St Luminiţa Costinescu Andrian S Gianina Iovan Valeria

Pendefunda 180Sorina Solomon Topoliceanu C Elements of dispersional

analysis of amalgam restorations 15th

Edition of the Balkan Medical Days

Stomatological Section Abstract nr1091999128

181Lăcătuşu St Andrian S Gianina Iovan- Consideraţii asupra adaptării

amalgamelor dentare la pereţii cavităţilor RevMedicina

StomatologicăVol2199823-26

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posterior packable resin composites with and without flowable liners Oper Dent

200126302ndash307

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influence of the amalgam alloy on the survival of amalgam restorations a secondary

analysis of multiple controlled clinical trials JDentRes 1997 76 1787-1798

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and resin-based composite posterior restorations Quintessence Int 200738(6)511-4

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restorative decisions microscopic and radiographic caries depth Community

Dentistry and Oral Epidemiology 1996 24 106-11

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polymerization contraction stress for dental composites by two-step light-activation

Dent Mater 2002 18436-444

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constraint and filling technique in composite restorations Dent Mater 2004

20(3)236-43

188Loguercio AD Reis A Schroeder M Balducci I Versluis A Ballester RY

Polymerization shrinkage effects of boundary conditions and filling technique of

resin composite restorations J Dent 2004 32(6)459-70

50

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Quintessence Int 2004 35(2)156-61

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clinical results J Dent Res 199877 1020

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Dentomaxillofac Radiol 2007 Oct36(7)377-81

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J Prosthet Dent 2000 Sep84(3)289-96

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Three-year clinical evaluation of composite and ceramic inlays Am J Dent 2001

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79369 (Abstract)

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33

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Am Dent Assoc 2010 141(3)319-29

52

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125749-751

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34

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Orthop921987499ndash505

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Part I Depth of penetration beyond dentin smear layers Dent Mater 2001 17(4) 296-

308

313Tay FR Frankenberger R Krejci I Bouillaguet S Pashley DH Carvalho

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In vivo evidence J Dent 2004 32611ndash621

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76(6)619-623 1996

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systems J Dent 199523183ndash189

318Unterbrink GL Liebenberg WH Flowable resin composites as filled

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199930249ndash257

319Vaarkamp J Ten Bosch J Verdonschot EH Quantitative diagnosis of small

approximal caries lesions utilizing wavelength-dependent fiber-optic

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use of panoramic radiography in the evaluation of asymptomatic adult dental patients

Oral Surg Oral Med Oral Pathol 198661(3)289-96

321Van Meerbeek B De Munck J Yoshida Y Inoue S Vargas M Vijay P Van

Landuyt K Lambrechts P Vanherle G Adhesion to enamel and dentin Current

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322Van Meerbeek B Van Landuyt K De Munck JHashimoto M Peumans M

Lambrechts P Yoshida Y Inoue S Suzuki K Technique-sensitivity of

contemporary adhesives Dent Mater J 2005 24(1) 1-13

323Van Meerbeek B Vargas S Inoue S Yoshida Y Peumans M Lambrechts P

Vanherle G Adhesives and cements to promote preservation dentistry Oper Dent

20016 119-144

324Van Meerbeek B Yoshida Y Inoue S Vargas M Abe Y Fukuda R Okazaki

M Lambrechts P Vanherle G Bonding mechanism micro-tensile bond strength of

a 4- MET-based self-etching adhesive J Dent Res 2000 79 249 (Abstract)

58

325Van Nieuwenhuysen JP DrsquoHoore W Carvalho J Qvist V Long-term

evaluation of extensive restorations in permanent teeth J Dent 200331(6)395ndash405

326Venhoven BA de Gee AJ Davidson CL Light initiation of dental resins

dynamics of the polymerization Biomaterials 1996 172313-2318

327Versluis A Douglas WH Cross M Sakaguchi RL Does an incremental filling

technique reduce polymerization shrinkage stresses J Dent Res 1996 75871ndash878

328Vries HC Ruiken HM Konig KG vanrsquot Hof MA Radiographic versus

clinical diagnosis of approximal carious lesions Caries Res1990 24 (5) 364-370

329Waggoner W Ashton J Predictability of cavitation based upon radiographic

appearance comparison of two film types Quintessence International 1989 20(1)

55-60

330Watanabe LG Marshall GW Jr Marshall SJ Dentin shear strength effects of

tubule orientation and intra tooth location Dent Mater 1996 12 109-115

331Watts DC AS Marouf Optimal specimen geometry in bonded-disk

shrinkage-strain measurements on light-cured biomaterials Dent Mater 200016447ndash

451

332Watts DC Marouf AS Al-Hindi AM Photo-polymerization shrinkage-stress

kinetics in resin-composites methods development Dent Mater 2003 191ndash11

333Weaver WS Blank LW Pelleu GB Jr A visible light activated resin cured

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334Wendt SL Microleakage and cusp fracture resistance of heattreated composite

resin inlays Am J Dent 4(1)10-14 1991

335Wenzel A Hintze H Mikkelsen L Mouyen F Radiographic detection of

occlusal caries in noncavitated teeth A comparison of conventional film radiographs

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1991 72 621-6

336Wenzel A Hintze H Perception of image quality in direct digital radiography

after application of various image treatment filters for detectability of dental diseases

Dentomaxillofac Radiol 1993 22 131-4

337Wenzel A Computer-aided image manipulation of intraoral radiographs to

enhance diagnosis in dental practice a review Int Dent J 1993 43 99-108

338Wenzel A Digital radiography and caries diagnosis Dento Maxillo Facial

Radiology 27(1)3-11 1998

339Wenzel A Haiter-Neto F Gotfredsen E Risk factors for a false positive test

outcome in diagnosis of caries in approximal surfaces impact of radiographic

modality and observer characteristics Caries Res 200741(3)170-6

340Wibowo G Stockton L Microleakage of class II composite restorations Am J

Dent 200114177ndash185

341Wilson NHF Wastell DG Norman RD Five-year performance of high-

cooper content amalgam restorations in a multiclinical trial JDent1996 24 203-210

342Winkler MM Katona TR Paydar NH Finite element stress analysis of three

filling techniques for class V light-cured composite restorations J Dent Res

1996751477-83

343Yap AU Effectiveness of polymerization in composite restoratives claiming bulk

placement Impact of cavity depth and exposure time Oper Dent 2000 25113-120

59

344Yeşilyurt C Bulucu B Bond strength of total-etch dentin adhesive systems on

peripheral and central dentinal tissue a microtensile bond strength test The Journal of

Contemporary Dental Practice 7(2) 20061-13

345Yoshida Y Van Meerbeek B Okazaki M Shintani H Suzuki K Comparative

study on adhesive performance of functional monomers J Dent Res 2004 83 454-

458

346Yoshiyama M Tay FR Doi J Nishitani Y Yamada T Itou K Carvalho RM

Nakajima M Pashley DH Bonding of self-etch and total etch adhesives to carious

dentin J Dent Res 2002 81 556-560

  • COPERTA REZUMAT ENGLEZA (MEREUTA)pdf
  • REZUMAT ENGLEZA DR MEREUTA DENISSpdf
Page 26: UNIVERSITATEA DE MEDICINA SI FARMACIE “GR Doctorat/Rezumat... · universitatea de medicina si farmacie “gr.t.popa” iasi facultatea de medicina dentara rezumatul tezei de doctorat

23

Test Statisticsb

scores

frequency

Mann-Whitney U 5500

Wilcoxon W 121000

Z -3492

Asymp Sig (2-tailed) 000

Exact Sig [2(1-tailed Sig)] 000a

a Not corrected for ties

b Grouping Variable tehnrestaurare

The results of microleakage degree were statistically significant when the

three restorative techniques were compared The results showed that best restorative

technique regarding marginal sealing in cervical area is combined technique followed

by oblique layering technique The use of layering techniques limits the development

of contraction forces between oposite walls event that favourises bulk stress voids

formation and fissure inside dental tissues The results of our study are similar with

other studies (114 293)

IX5 CONCLUSIONS

The values of die penetration at gingival wall were statistically different

between the three restorative techniques

We concluded that all restorative methods were associated with lightcuring

contraction and marginal microleakage

The combined technique was associated with lowest lightcuring contraction

and die penetration

The bulk technique was associated with highest lightcuring contraction and die

penetration

24

CHAPTX STUDY REGARDING THE EFFECTS OF ETCHING ON

ENAMEL AND DENTINE IN CERVICAL AREA FOR PROXIMAL

CAVITIES AT LATERAL DENTAL GROUP

X1 INTRODUCTION

The studies reported marginal defects and high microleakage at the level of

gingival margins localised in cervical area or close to enamel-cement jonction for

high percents of proximal-occlusal composite resins restorations (8485) The good

adhesion is requested to insure restoration longevity and to prevent marginal

microleakage and presence of secondary marginal dental caries The adhesion

strenght of different adhesive systems can vary accordingly to tissues areas (204 240)

and to variations in dentinal structures (234 330) Most studies focused on adhesive

systems performances used healthy dentine close to pulp room but in case of class II

restorations there are particular features that influences the adhesion at the level of

gingival margins

The surface topography is an important property that determines the

interaction manner between surfaces The surface roughness and surface energy can

increase or decrease the adhesion of composite resins to the hard dental tissues

X2 AIM OF STUDY

The aim of study was to compare surface roughness of enamel and dentine

after etching related to different distances related to enamel-dentinecement jonction

X3 MATERIALS AND METHODS

The study group included 20 molars extracted from orthodontics or

periodontal reasons with intact proximal surfaces The teeth were cut longitudinally in

sens buccal-oral with diamond discs under water cooling

A group study (10 teeth) included 10 samples obtained through transversal

cutting at distance of 2mm from enamel-dentinecement jonction and 10 samples

obtained through transversal cutting at distance of 15 mm from enamel-

dentinecement jonction Another study group (10 teeth) included 10 samples

obtained through transversal cutting at distance of 1mm from enamel-dentinecement

jonction and 10 samples obtained through transversal cutting at distance of 05 mm

from enamel-dentinecement jonction All these samples were divided in two halfes

through mesial-distal cutting The samples finishing was performed with abrasive

paper (100-4000) and final polishing was performed with a device Buehler model

Minimet with slices introduced in ultrasound bath for 4 minutes The second half of

each sample was etched for 15 seconds with ortophosphoric acid 37 for 15 seconds

Slices were washed with distilled water for 30 seconds after etching and dried

The samples were analysed with atomic force microscopy (AFM) regarding

surface roughness The results were expressed as relative variation of roughness

X4 RESULTS AND DISCUSSIONS

The aspect of etched enamel at 2 mm distance from ECJ can be seen in figure

X1 (section 10 microm) The surface roughness is higher comparing with sample before

etching

25

După gravajul cu acid ortofosforic 37

The aspect of etched enamel at 15 mm distance from ECJ can be seen in

figure X2 (section 10 microm) The surface roughness is higher comparing with sample

before etching but lower comparing with sample at 2 mm from ECJ

The aspect of etched enamel at 1 mm distance from ECJ can be seen in figure

X3 (section 10 microm) The surface roughness is higher comparing with sample before

etching but lower comparing with sample at 15mm and 2 mm from ECJ

The aspect of etched enamel at 15 mm distance from ECJ can be seen in

figure X4 (section 10 microm) The surface roughness is higher comparing with sample

before etching but lower comparing with sample at 1 mm 15 mm and 2 mm from

ECJ

FigX1 3D aspect of enamel at 2 mm from ECJ

after etching (10 microm)

FigX2 3D aspect of enamel at 15 mm from ECJ

after etching (10 microm)

FigX3 3D aspect of enamel at 1 mm from ECJ

after etching (10 microm)

FigX4 3D aspect of enamel at 05 mm from ECJ

after etching (10 microm)

26

The mean values of squared roughness for dentine and enamel before etching

are presented in tables X1 and X2

Table X1 Squared roughness values for dentine samples before and after etching

Before etching (nm) After etching (nm)

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

sample

1

335 282 283 259 1149 947 901 879

sample

2

352 284 274 266 1127 939 883 875

sample

3

357 273 278 263 1152 953 876 867

sample

4

323 269 264 258 1146 942 895 883

sample

5

348 298 271 268 1153 944 904 878

sample

6

339 274 278 273 1158 937 893 892

sample

7

352 283 269 266 1145 944 899 876

sample

8

349 292 272 274 1166 942 907 869

sample

9

357 284 275 265 1132 939 893 879

sample

10

348 281 277 262 1142 941 899 878

Table X2 Squared roughness values for enamel and dentine samples before and after

etching

Before etching (nm) After etching (nm)

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

sample 1 422 342 309 313 2255 1114 874 845

sample 2 418 338 324 304 2236 1102 882 839

sample 3 413 334 315 303 2239 1115 873 833

sample 4 416 336 322 308 2242 1116 868 842

sample 5 426 332 315 294 2218 1103 877 829

sample 6 412 332 317 306 2237 1099 874 847

sample 7 414 335 322 314 2252 1102 876 834

sample 8 416 325 318 313 2239 1106 875 838

sample 9 418 328 314 299 2246 1113 879 836

sample 10 413 334 316 305 2242 1104 873 839

The results for samples before etching prove a decreasing tendency for mean

values of squared roughness surface beginning with areas placed at distance of 2 mm

from ECJ (346 nm) followed by areas placed at distance of 15 mm from ECJ (282

nm) 1 mm from ECJ (274 nm) and 05 mm from ECJ (265 nm) After etching the

decreasing tendency maintained for dentine localised at 2 mm from ECJ to dentine

localised at 05 mm from ECJ The mean values of squared roughness after etching

were three times higher (tables X3)

27

Table X3 Squared roughness values for enamel and dentine samples before and

after etching

Dentine Enamel

Before etching

(nm)

After etching

(nm)

Before etching

(nm)

After etching

(nm)

2 mm ECJ 346 1147 416 2237

15 mm ECJ 282 942 333 1107

1 mm ECJ 274 895 317 875

05 mm ECJ 265 877 305 838

The descriptive statistics data for surface roughness of dentine before and after

etching are presented in tables X4 si X5

Table X4 Descriptive statistics for dentine samples before etching

Statistics

Dentine 2mm

before etching

Dentine 15mm

before etching

Dentine 1mm

before etching

Dentine 05mm

before etching

N Valid 10 10 10 10

Missing 0 0 0 0

Mean 346000 282000 274100 265400

Std Error of Mean 33830 27487 17026 16746

Std Deviation 106979 86923 53841 52957

Skewness -1214 354 -314 348

Std Error of Skewness 687 687 687 687

Kurtosis 1141 049 336 -539

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 3230 2690 2640 2580

Maximum 3570 2980 2830 2740

Table X5 Descriptive statistics for dentine samples after etching

Statistics

Dentine 2mm

after etching

Dentine 15mm

after etching

Dentine 1mm

after etching

Dentine 05mm

after etching

N Valid 10 10 10 10

Missing 0 0 0 0

1147000 942800 895000 877600

Std Error of Mean 36545 14591 29926 22020

Std Deviation 115566 46140 94634 69634

Skewness -267 1169 -951 535

Std Error of Skewness 687 687 687 687

Kurtosis 043 1776 564 1416

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 11270 9370 8760 8670

28

Statistics

Dentine 2mm

after etching

Dentine 15mm

after etching

Dentine 1mm

after etching

Dentine 05mm

after etching

N Valid 10 10 10 10

Missing 0 0 0 0

1147000 942800 895000 877600

Std Error of Mean 36545 14591 29926 22020

Std Deviation 115566 46140 94634 69634

Skewness -267 1169 -951 535

Std Error of Skewness 687 687 687 687

Kurtosis 043 1776 564 1416

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 11270 9370 8760 8670

Maximum 11660 9530 9070 8920

To choose the statistical test to compare roughness surface values was

performed a test Shapiro-Wilk If p is lower or equal with 0005 than hypothesis of

distribution normality is rejected (distribution deviates from normal form) In the table

X6 the distributions are normal The statistical test will be test t for pair samples

Table X6 Test Shapiro-Wilk for dentine samples

Tests of Normality

Kolmogorov-Smirnov

a Shapiro-Wilk

Statistic df Sig Statistic df Sig

Dentine 2mm before etching 274 10 032 877 10 122

Dentine 15mm after etching 209 10 200 952 10 689

Dentine 1mm before etching 134 10 200 983 10 980

Dentine 05mm before etching 155 10 200 949 10 661

Dentine 2mm after etching 133 10 200 977 10 946

Dentine 15mm after etching 197 10 200 916 10 329

Dentine 1mm after etching 216 10 200 925 10 401

Dentine 05 after etching 220 10 185 933 10 474

Enamel 2mm before etching 193 10 200 898 10 207

Enamel 15mm before etching 170 10 200 977 10 947

Enamel 1mm before etching 157 10 200 952 10 689

Enamel 05mm before etching 165 10 200 943 10 590

Enamel 2mm after etching 235 10 124 925 10 404

Enamel 15mm after etching 209 10 200 871 10 102

Enamel 1mm after etching 189 10 200 964 10 834

Enamel 05mm after etching 142 10 200 983 10 978

a Lilliefors Significance Correction

29

Tests of Normality

Kolmogorov-Smirnov

a Shapiro-Wilk

Statistic df Sig Statistic df Sig

Dentine 2mm before etching 274 10 032 877 10 122

Dentine 15mm after etching 209 10 200 952 10 689

Dentine 1mm before etching 134 10 200 983 10 980

Dentine 05mm before etching 155 10 200 949 10 661

Dentine 2mm after etching 133 10 200 977 10 946

Dentine 15mm after etching 197 10 200 916 10 329

Dentine 1mm after etching 216 10 200 925 10 401

Dentine 05 after etching 220 10 185 933 10 474

Enamel 2mm before etching 193 10 200 898 10 207

Enamel 15mm before etching 170 10 200 977 10 947

Enamel 1mm before etching 157 10 200 952 10 689

Enamel 05mm before etching 165 10 200 943 10 590

Enamel 2mm after etching 235 10 124 925 10 404

Enamel 15mm after etching 209 10 200 871 10 102

Enamel 1mm after etching 189 10 200 964 10 834

Enamel 05mm after etching 142 10 200 983 10 978

a Lilliefors Significance Correction

This is a lower bound of the true significance

The results of test t for pair dentine samples before and after etching are

presented in table X

Table X7 Test t for dentine before and after etching

Paired Samples Test

Paired Differences

t df

p (2-

tailed)

95 Confidence

Interval of the

Difference

Mean

Std

Dev

Std

Error

Mean Lower Upper

Pair

1

dentine2mmbeforeetching-

dentine2mmafteretching

-

8010000

174801 55277 -

8135045

-

7884955

-

144906

9 000

Pair

2

dentine15mmbeforeetching-

dentine15mmafteretching

-

6608000

102394 32380 -

6681248

-

6534752

-

204079

9 000

Pair

3

dentine1mmbeforeetching-

dentine1mmafteretching

-

6209000

117799 37251 -

6293269

-

6124731

-

166678

9 000

30

Paired Samples Test

Paired Differences

t df

p (2-

tailed)

95 Confidence

Interval of the

Difference

Mean

Std

Dev

Std

Error

Mean Lower Upper

Pair

1

dentine2mmbeforeetching-

dentine2mmafteretching

-

8010000

174801 55277 -

8135045

-

7884955

-

144906

9 000

Pair

2

dentine15mmbeforeetching-

dentine15mmafteretching

-

6608000

102394 32380 -

6681248

-

6534752

-

204079

9 000

Pair

3

dentine1mmbeforeetching-

dentine1mmafteretching

-

6209000

117799 37251 -

6293269

-

6124731

-

166678

9 000

Pair

4

dentine05mmbeforeetching-

dentine05mmafteretching

-

6122000

86384 27317 -

6183796

-

6060204

-

224109

9 000

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of dentine (

2mm 15 mm 1mm sau 05mm)

The descriptive statistics data for dentine surface roughness before and after

etching are presented in tables X8 and X9

Table X8 Descriptive statistics for enamel samples before etching

Statistics

Enamel 2mm

before etching

Enamel 15mm

before etching

Enamel 1mm

before etching

Enamel 05mm

before etching

N Valid 10 10 10 10

Missing 0 0 0 0

Mean 416800 333600 317200 305900

Std Error of Mean 13968 15217 14205 20355

Std Deviation 44171 48120 44920 64369

Skewness 1095 -156 -109 -411

Std Error of Skewness 687 687 687 687

Kurtosis 769 487 -118 -295

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 4120 3250 3090 2940

Maximum 4260 3420 3240 3140

31

Table X9 Descriptive statistics for enamel samples after etching

Statistics

Enamel 2mm

after etching

Enamel 15mm

after etching

Enamel 1mm

after etching

Enamel 05mm

after etching

N Valid 10 10 10 10

Missing 0 0 0 0

Mean 2237600 1107400 875100 838200

Std Error of Mean 31027 20232 11968 17436

Std Deviation 98116 63979 37845 55136

Skewness -850 267 042 040

Std Error of Skewness 687 687 687 687

Kurtosis 878 -1880 1082 -425

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 22180 10990 8680 8290

Maximum 22520 11160 8820 8470

To choose the statistical test to compare roughness surface values was

performed a test Shapiro-Wilk If p is lower or equal with 0005 than hypothesis of

distribution normality is rejected (distribution deviates from normal form) In the table

X10 the distributions are normal The statistical test will be test t for pair samples

Table X10 Test Shapiro-Wilk for enamel samples

Tests of Normality

Kolmogorov-Smirnova Shapiro-Wilk

Statistic df Sig Statistic df Sig

2mmenamel before etching 193 10 200 898 10 207

15mmenamel before etching 170 10 200 977 10 947

1mmenamel before etching 157 10 200 952 10 689

05mmenamel before etching 165 10 200 943 10 590

2mmenamel after etching 235 10 124 925 10 404

15mmenamel after etching 209 10 200 871 10 102

1mmenamel after etching 189 10 200 964 10 834

05mmenamel after etching 142 10 200 983 10 978

a Lilliefors Significance Correction

This is a lower bound of the true significance

The results of test t for pair enamel samples before and after etching are

presented in table X11

32

Table X11 Test t for enamel samples before and after etching

Paired Samples Test

Paired Differences

t df

p (2-

tailed)

95 Confidence

Interval of the

Difference

Mean

Std

Deviation

Std

Error

Mean Lower Upper

Pair

1

2mmenamel before

etching

2mmenamel after

etching

-18208 135220 42760 -

18304731

-

18111269

-

425815

9 000

Pair

2

15mmenamel before

etching

15mmenamel after

etching

-7738 73151 23132 -7790329 -7685671 -

334508

9 076

Pair

3

1mmenamel before

etching

1mmenamel after

etching

-5579 55468 17540 -5618679 -5539321 -

318065

9 065

Pair

4

05mmenamel before

etching

05mmenamel after

etching

-5323 60378 19093 -5366192 -5279808 -

278788

9 063

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel ( 2mm 15 mm 1mm sau

05mm) but the differences statistical significant are present only for enamel localised

at 2 mm from ECJ

X5CONCLUSIONS

The surfaces of enamel and dentine at cervical level record decreases of

roughness related to the decrease of distance to ECJ

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel but the differences

statistical significant are present only for enamel localised at 2 mm from ECJ

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of

dentine

33

CHAPTXI FEA STUDY REGARDING THE BIOMECHANICAL

BEHAVIOUR AND FRACTURE RESISTANCE OF PROXIMO-OCCLUSAL

AMALGAM AND COMPOSITE RESINS RESTORATIONS

XI1INTRODUCTION AIM OF STUDY

The individual variation of patients morphological and functional complexity

of tissues as well as difficult access limit the possibilities to investigate in clinical

studies the biomechanical behaviour of proximo-occlusal restorations In this context

simulation of the biomechanics for direct restorations represents an interesting

interdisciplinar domain in actual dentistry research

The study focused on two direction

- analysis of role of forces intensity on biomechanical behaviour related to

cavity dimension and material

- analysis of tension inside restoration structure related to forces intensity

XI2MATERIALS AND METHODS

The stages of finite element analysis study are as follows

object modelling (bicusps and proximo-occlusal restoration)

definition of parameters for materials and dental tissues

meshing

constraints and loading

types of contacts

equations system definition

results of simulation

The object 3D modelling was performed in Rhinoceros (figure XI1) The

definition of parameters was performed for Poisson constant Young modulus density

(table XI1) The selected materials were amalgam and composite resins The

analysed tissues were dentine and enamel The meshing constraints loading were

performed for forces of 200N 400N 600N 800 N The analysis was performed using

software COSMOSWorks 2010

34

Fig XI1 3D modellation of bicusp

Table XI1 Values of Young modulus Poisson constant compression resistance for

amalgam composite resin enamel (amalgam compozit smalţ)

Material Young modulus (GPa) Poisson constants

Compression

resistance

(Mpa)

Amalgam 55 033 483

Enamel 48 03 400

Composite

resin 220 022 345

Fig XI2 The forces and constraints application

The results are presented in values and culours red colours representing areas

with maximum values of tensions produced under influence of masticatory forces

The tensions produced in amalgam restoration are in a range from 0 to 22886

(force 800 N) The maximum von Misses tensions are associated with cervical area

of amalgam restorations This aspect proves that first modification in interface

restoration-cavity margins will appear at the level of gingival wall First marginal

35

defects and fissures in restoration bulk will appear at tensions over 1600Mpa

associated with forces of 800N for extended amalgam proximo-occlusal restorations

The tensions produced in composite resin restorations are in a range from 0 to

2285 (force 800 N) The maximum von Misses tensions are associated with cervical

area of composite resin restorationsThis aspect proves that first modification in

interface restoration-cavity margins will appear at the level of gingival wall First

marginal defects and fissures in restoration bulk will appear at tensions over 1716

Mpa associated with forces of 600N for moderate and extended composite resins

proximo-occlusal restorations

Fig XI3a-b ndash Simulated model of proximo-occlusal restoration

FigXI4a-b Dental amalgam restoration Cervical tension associated with 600 N

(c)800 N (d)

FigXI5a-b Composite resin restoration Cervical tension associated with 600 N

(c)800 N (d)

36

The deformation of amalgam can be produced only when is associated with

fissures in bulk of restorations while composite resins restorations present

deformation when are associated with a modification of volume and form because of

repeated action of medium forces on long term or high forces on short term (figures

XI4 XI5)

Fig XI4 Material deformation in area of maximum tension

000E + 00

500E -02

100E -01

150E -01

200E -01

250E -01

1 4 7 101316192225283134374043464952555861646770737679

Amalgam C ompoz it

Figura XI5 Deformarea funcție de material

The amalgam and composite resins were treated as homogenous isotropic and

liniar The advantage of this type of FEA study is that restorations parameters can be

modified any time is necessary both in arhitecture geometry and material indices

variability The results of this study sustain the conclusions of other FEA studies

focused on biomechanical behaviour of posterior restorations performed with

amalgam and composite resins(35 62 76 143)

37

XI4CONCLUSIONS

bull The amalgam in class II restorations has a low deformation tendency because

of uniform distribution of tension inside material

bull Composite resins class II restorations accumulate higher tensions comparing

with amalgam but deformation is avoided for a time because of the adhesion

forces performed between molecules under moderate oral forces In case of

high oral forces (600-800N) the risk of fracture in moderate class II

restorations is higher comparing with amalgam proximo-occlusal restorations

For extended class II restorations and forces of 600 N composite resins present

highest risk of fracture and deformation The von Misses tension at the

cervical interface restorationtooth can reach 1600Mpa

bull The amalgam in moderate class II restorations can resist to deformation even

for high intensity forces limited to 600N In extended class II restorations the

risk of deformation and fracture increases at values of 600N-800N of oral

forces The von Misses tension at the cervical interface restorationtooth can

reach 1700 Mpa

38

FINAL CONCLUSIONS

Amalgam proximo-occlusal restorations with minimum 6-years age present

excellent results for parameters anatomic form (occlusal) marginal

discoloration and marginal secondary dental caries good results for

parameters anatomic form (proximal) and marginal adaptation and poor results

for surface quality

Composite resins proximo-occlusal restorations (bicusps) with minimum 6-

years age present excellent results for parameters color match marginal

discoloration and marginal secondary dental caries and good results for

parameters anatomic form (occlusal proximal) marginal adaptation surface

quality

Composite resins proximo-occlusal restorations (molars) with minimum 6-

years age present good results for parameters color match marginal

discoloration marginal secondary dental caries marginal adaptation and poor

results for parameters anatomic form (occlusal) (54 indices Ryge C)

anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The restorations extended at external third of occlusal surface present highest

percents of indices C regarding anatomic form (occlusal) (54 indices Ryge

C) anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The exceeding of 6-years age will require careful monitorisation for early

interventions through polishing sealing reshaping and even replacement for

restorations with major defects

Oblique layering technique presents superior results regarding marginal

adaptation and marginal discoloration and is recommended for proximo-

occlusal dental caries close to enamel-cement jonction

Centripetal build-up presents good results regarding marginal adaptation and

anatomical form at proximal level (proximal surfaces and contact point)

Horisontal layering technique can be used for optimum results only in

proximal-occlusal cavities with moderate extension both in occlusal-cervical

and buccal-oral

The values of die penetration at gingival wall were statistically different

between the three restorative techniques

We concluded that all restorative methods were associated with lightcuring

contraction and marginal microleakage

The combined technique was associated with lowest lightcuring contraction

and die penetration

The bulk technique was associated with highest lightcuring contraction and die

penetration

39

The surfaces of enamel and dentine at cervical level record decreases of

roughness related to the decrease of distance to ECJ

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel but the differences

statistical significant are present only for enamel localised at 2 mm from ECJ

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of

dentine

bull The amalgam in class II restorations has a low deformation tendency because

of uniform distribution of tension inside material

bull Composite resins class II restorations accumulate higher tensions comparing

with amalgam but deformation is avoided for a time because of the adhesion

forces performed between molecules under moderate oral forces In case of

high oral forces (600-800N) the risk of fracture in moderate class II

restorations is higher comparing with amalgam proximo-occlusal restorations

For extended class II restorations and forces of 600 N composite resins present

highest risk of fracture and deformation The von Misses tension at the

cervical interface restorationtooth can reach 1600Mpa

bull The amalgam in moderate class II restorations can resist to deformation even

for high intensity forces limited to 600N In extended class II restorations the

risk of deformation and fracture increases at values of 600N-800N of oral

forces The von Misses tension at the cervical interface restorationtooth can

reach 1700 Mpa

REFERENCES

1ADA Council on Scientific Affairs ADA Council on Dental Benefit Programs

Statement on posterior resin-based composites JADA 1998 129(11)1627ndash1628

2Albers HF Tooth-colored restoratives 1st ed Santa Rosa CA Alto Books 1979

3Allander L Birkhed D Bratthall D Reasons for replacement of class II amalgam

restorations in private practice Swed Dent J 199014(4)179-84

4Alomari QD Reinhardt JW Boyer DB Effect of liners on cusp deflection and

gap formation in composite restorations Oper Dent 200126406- 11

5Alster D Feilzer AJ de Gee AJ Mol A Davidson CL The dependence of

shrinkage stress reduction on porosity concentration in thin resin layers J Dent Res

1992711619ndash1622

6Aggarwal V Logani A Jain V Shah N Effect of cyclic loading on marginal

adaptation and bond strength in direct vs indirect class II MO composite restorations

Oper Dent 2008 Sep-Oct33(5)587-92

7Andrian S Lăcătuşu St- Caria dentară- Protocoale şi tehnici- EdApolloniaIaşi

1999

8Andrian S- Restaurări fizionomice cu materiale plastice icircn cariologie-EdPanteon

Iaşi 2001

40

9Andrian S Tratamentul Minim Invaziv al Cariei Dentare EditPrinceps Edit Iaşi

2002

10Angmar-Mansson B ten Bosch JJ Optical methods for the detection and

quantification of caries Adv Dent Res 1987 1(1) 14-20

11Angmar-Mansson B ten Bosch JJ Advances in methods for diagnosting coronal

caries Adv Dent Res 1993 7(2) 70-79

12Angmar-Mansson B Al-Khateeb S Tranaeus S Monitoring the caries process

Optical methods for clinical diagnosis and quantification of enamel caries European

Journal of Oral Sciences 1996 104 480-485

13Angmar-Mansson B Al-Khateeb S Tranaeus S Caries diagnosis Journal of

Dental Education 1998 62 (10) 771-780

14Anusavice KJ- ldquoQuality evaluation of dental restorationscriteria for placement

and replacement Chicago 1989Quintessence Publishing

15Anusavice KJ Development and testing of ceramics for dental restorations In

Fischman G Clare A Hench J editors Bioceramics materials and applications

Westerville OH 1995

16Arhun N Celik C Yamanel KClinical evaluation of resin-based composites in

posterior restorations two-year results Oper Dent 201035(4)397-404

17Armstrong SR JC Keller DB Boyer The influence of water storage and C-

factor on the dentinndashresin composite microtensile bond strength and debond pathway

utilizing a filled and unfilled adhesive resin Dent Mater 200117268ndash276

18Armstrong S Boyer D Keller J Microtensile bond strength testing and failure

analysis of two dentin adhesives Dent Mater 1998 14(1)44-50

19Asmussen E Peutzfeldt A Influence of UEDMA BisGMA and TEGDMA on

selected mechanical properties of experimental resin composites Dent Mater1998

1451-56

20Asmussen E Clinical relevance of physical chemical and bonding properties of

composites resins Oper Dent 19851061-73

21Bader JD Brown JP Dilemmas in caries diagnosisJ Am Dent Assoc1993124

(6) 48-50

22Bader JD Shugars DA What do we know about how dentists make caries-

related treatment decisions Community Dent Oral Epidemiol 1997 25(1) 97-103

23Bader JD Shugars DA Bonito AJ A systematic review of the performance of

methods for identifying carious lesions JPublic Health Dent 2002 62 (4) 201-213

24Bader JD Shugars DA Bonito AJ Systematic reviews of selected dental caries

diagnostic and management methods J Dent Educ 2001 65 (10) 960-968

25Bader J Ismail A Survey of systematic reviews in dentistry JADA 2004 135

464-473

26Bader JD Shugars DA Understanding dentistslsquo restorative treatment decisions J

Public Health Dent 1992 Winter52(2)102-10

27Barkmeier WW Cooley RL Current status of adhesive resin systems J Am Coll

Dent 199158 36-39

28Bayne SC Dental biomaterials where are we and where are we going J Dent

Educ 200569(5)571ndash585

41

29Bedran-de-Castro AK Pereira PN Thompson JY Influence of load cycling

and tubule orientation on ultimate tensile strength of dentin J Adhes Dent 2004 6(3)

191-194

30Behle C Flowable composite Proprieties and applications Pract Periodontics

Aesthetics Dent 1998 10347 350-351

31Bergenholtz G Cox CF Bacterial leakage around dental restorations Its effects

on the dental pulp J Oral Path 198211 439 ndash450

32Bernardo M Luis H Martin MD Survival and reasons for failure of amalgam

versus composite posterior restorations placed in a randomized clinical trial JADA

2007138(6)775ndash783

33Black J Biological Performance of Materials Fundamentals of Biocompatibility

NY Marcel Dekker Inc 1999

34Bonsor SJ Chadwick RGLongevity of conventional and bonded (sealed)

amalgam restorations in a private general dental practice Br Dent J 2009206(2)88-

9

35Boschian PL S Guidotti R Pietrbissa M Gagliani- bdquoStress distribution in a

post-restored tooth using the threedimensional finite element method Journal of Oral

Rehabilitation (33) 2006690ndash697

36Bouillaguet S B Ciucchi T Jacoby JC Wataha DH Pashley Bonding

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321

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200521(10)962-70

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199930(4)234-42

42

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of restorations at failure and reasons for their placement and replacement J Dent

200129(5)317-24

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2004 20939-946

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Jun30(6)413-8

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Dentomaxillofac Radiol 2007 Mar36(3)138-42

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Study Orthodontic Tooth Movement J Dent Res 2005 84(5)428-433

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bond strength to primary dentin J Dent Child 2003 70(2) 139-144

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posterior restorations 12-month results Eur J Dent 2010 Jan4(1)57-65

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marginal leakage J Dent 2005 33(7) 603- 610

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Med 2008173(1)23ndash26

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stress in light-cured packable composite resinsDent Mater 200117253-259

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polymerization contraction stress of composites J Dent Res 2000 79812ndash817

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Behinderten Dtsch Zahnartzlicher 1999 54 96-102

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Three Core Restorative Materials Supported with or without a Prefabricated Split-

Shank Post Journal of Prosthetic Dentistry1997 78 560ndash565

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in Class II composite resin restoration applied in bulk or in two increments

Quintessence Int 1993 24583-591

43

64Collins CJ Bryant RW Hodge KL A clinical evaluation of posterior composite

resin restorations 8-year findings J Dent 199826(4) 311ndash317

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polymerization stress J Am Dent Assoc2000 131497-503

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behaviour of dimethacrylate composite resins Biomaterials 1990 11272-276

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FOTIvisual examination of occlusal caries with other caries diagnostic methods and

the effect of stain on their diagnostic performance Caries Res 2003 37 (1) 8-16

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1991469-72

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1399

70Dauvillier BS Aarnts MP Feilzer AJ Developments in shrinkage control of

adhesive restoratives J Esthet Dent 2000 12291-299

71Dauvillier BS Aarnts MP Feilzer AJ Modeling of the viscoelastic behavior of

dental light-activated resin composites during curing Dent Mater 200319277ndash285

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bond strength and the polymerization contraction stress J Dent Res 1984

63(12)1396-9

73Davidson CL AJ Feilzer Polymerization shrinkage and polymerization

shrinkage stress in polymer-based restoratives J Dent Res 199725435ndash440

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Prosthet Dent 198655446ndash7

75Davis RD Mayhew RB A clinical comparison of three anterior restorative resins

at 3 years J Am Dent Assoc 1986112659-63

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and adhesion of composite resin versus ceramic inlays in molarsJ Prosthet

Dent200899131-40

77Deligeorgi V Mjor IA Wilson NH An overview of reasons for the placement

and replacement of restorations Prim Dent Care 20018(1)5-11

78Deliperi S Bardwell DN An alternative method to reduce polymerization

shrinkage in direct posterior composite restorations J Am Dent Assoc 2002

1331387ndash97

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surfaces and its distribution by age and gender in university clinic patientsEur J

Dent20104(3)270-9

80De Munck J Van Meerbeek B Satoshi I Vargas M Yoshida Y Armstrong S

Lambrechts P Vanherle G Microtensile bond strengths of one- and two-step

selfetch adhesives to bur-cut enamel and dentin Am J Dent 2003 16 414-420

81Dewaele M Truffier-Boutry D Devaux J Leloup G Volume contraction in

photocured dental resins the shrinkage-conversion relationship revisited Dent Mater

2006 22359-365

44

82Deutsch WM Simecek JW Dental emergencies among Marines ashore in

Operations Desert ShieldStorm Mil Med 1996161(10) 620ndash623

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of methacrylate dental resins Macromolecules 2003 366043-6053

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restorative technique and new adhesives on the dentin marginal seal and adaptation of

resin composite Class II restorations An in vitro evaluation Quintessence Int 1995

26 717-727

85Dietschi D Herzfeld D In vitro evaluation of marginal and internal adaptation of

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Sci 1998 106 1033-1042

86Dietschi D Marginal adaptation and seal of direct and indirect Class II composite

resin restorations an in vitro evaluation Quintessence Int 26(2)127-138 1995

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caries status and dental emergencies among US naval personnel J Dent Res

20028195 (Abstract)

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resinamalgam combinations Oper Dent 1997 22 50-56

89Donly KJ Jensen ME Triolo PA clinical comparison of resin composite inlay

and onlay posterior restorations and cast-gold restorations at 7 years Quintessence Int

30(3)163- 1681999

90Douglas WH Fields RP Fundingsland J A comparison between the

microleakage of direct and indirect composite restorative systems J Dent 17(4)184-

188 1989

91Eberhard J Hartman B Lenhard M Mayer T Kocher T Eickholz P Digital

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Caries Res 200034(3)219-24

92Edelstein BL Douglass CW Dispelling the myth that 50 percent of US

schoolchildren have never had a cavity Public Health Rep1995 110 (5) 522-530

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its possible influence on postoperative sensitivity Quintessence Int 198617103-11

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bis GMA and TEGDMA a modeling approach to understanding the cure of dental

resins Dent Mater 2001 17221-229

95Ermis R Ulkam Aydin Examiner agreement in the replacement decisions of

class I amalgam restorations The Journal of contemporary dental practice 2004 Vol

5 no21-7

96Feilzer AJ AJ De Gee CL Davidson Increased wall-to-wall curing

contraction in thin bonded resin layers J Dent Res 19896848ndash50

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development and viscoelastic properties of experimental twopaste composites J Dent

Res 2003 82824-828

98Feilzer AJ de Gee AJ Davidson CL Relaxation of polymerization contraction

shear stress by hygroscopic expansion J Dent Res 1990 6936ndash39

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99Feilzer AJ De Gee AJ Davidson CL Setting stress in composite resin in relation

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on polymerization shrinkage and integrity of restoration-cavity interface Eur J Oral

Sci 1995 103322ndash326

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systems in the prediction of occlusal caries in permanent molars in 6 and 11 year-old

children J Dent 1998 26(5) 403-40

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in dental composites during polymerization Dent Mater 2005 2136-42

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104Ferreira MC Vieira RS Marginal leakage in direct and indirect composite resin

restorations in primary teeth an in vitro study J Dent 200836(5)322-5

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restorations in adults Acta Odontol Scand 2004 6282-86

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ceramic inlays for four and a half years J Prosthet Dent 1997 78(4)346-353

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108Francci C Loguercio AD Reis A Carrilho MR A novel filling technique for

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14(3)149-57

109Fruits TJ Knapp JA Khajotia SS Microleakage in the proximal walls of

direct and indirect posterior resin slot restorations Oper Dent 200631(6)719-27

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restorations The 10-year report J Adhes Dent 2001 3185-194

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Acad Orthop Surg 2002 10 290-297

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incremental methods in Class II composite resin restorations on gingival

microleakage J Contemp Dent Pract 20078(2)113-20

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Effects of irradiation mode and filling technique on resindentin bond strength in

Class I cavities J Dent Res 200281 (Abstract)

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JADA 1972841349-1357

117Gordon JChristensen G Why switch to digital radiography J Am Dent

Assoc 204 Vol 135 No 101437-1439

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118Gregoire GL Akon BA Millas A Interfacial micromorphological differences

in hybrid layer formation between water- and solvent-based dentin bonding systems J

Prosthet Dent 2002 87633ndash641

119Gregory WA Physical properties and repair bond strength of direct and indirect

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120Gwinnett AJ Buonocore MG Adhesives and caries prevention a preliminary

report Br Dent J 196511977-81

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124Haba Denisia Tehnici uzuale utilizate icircn radiologia dentară Edit Junimea

2007

125Hashimoto M Ito S Tay FR Svizero NR Sano H Kaga M Fluid movement

across the resin-dentin interface during and after bonding J Dent Res 2004 83843ndash

848

126Hashimoto M Tay FR Ito S Sano H Kaga M Pashley DH Permeability of

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127Hawthorne WS Smales RJ Factors influencing long-term restoration survival

in three private dental practices in Adelaide Aust Dent J 19974259ndash63

128Helwig Klimek Attin Einfuumlhrung in Die ZahnErhaltung Urbanampfischer 2003

129He Z Shimada Y Tagami J The effects of cavity size and incremental

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Mater 200723(5)533-8

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131Hench LLBioceramicsfrom concept to clinicJ Amer Ceram Soc1991

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Quintessence 2001

134Hilton TJ Cavity sealers liners and bases Current philosophies and indications

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135Hilton TJ Schwartz RS Ferracane JL Microleakage of four Class II resin

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135- 144

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class 2 composites Oper Dent 19981312-19

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19-23

138Hintze H Wenzel A Danielen B Behaviour of approximal carious lesions

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139Hintze H Wenzel A Influence of validation method on diagnostic accuracy of

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of approximal and occlusal dental caries in a young adult population Community

Dent Oral Epidemiol 200533(3)212-8

143Hubsch PF Middleton J Knox J A finite element analysis of the stress at the

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fillingsBiomaterials2000211015ndash1019

144Hudson JD Goldstein GR Georgescu M Enamel wear caused by three

different restorative materials J Prosthet Dent 1995 74(6)647-654

145Hunter AR Treasure ET Hunter AJ Increases in cavity volume associated

with the removal of class 2 amalgam and composite restorations Oper Dent

1995202ndash 6

146Huysmans MC PG van der Varst EP Lautenschlager P Monaghan The

influence of simulated clinical handling on the flexural and compressive strength of

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147Iliescu A Gafar MCariologie şi Odontologie RestaurativăEditura Medicală

Bucureşti 2001

148Inoue S Van Meerbeek B Vargas M Lambrechts P Vanherle G Adhesion

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150Iovan Gianina Diagnosis and Management of Patients with High Caries

Activity EdApollonia Iasi2002

151Jacobsen T Soderhold KJ Some effects of water on dentin bonding Dent

Mater 1995 11(2)132-6

152Jackson RD Morgan M The new posterior resins and a simplified placement

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48

154Jokstad A Mjor IA Analyses of long-term clinical behaviour of class II

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157Kamann WK Gangler P Zur Funktionzeit von Amalgam

Kompositefullungen Zahnartzlicher Welt 1999 108 270-273

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restorative decisions made on the basis of simulated bitewing radiographs

Community Dentistry and Oral Epidemiology 1994 22(2) 71-74

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1243

161Khairallah C Hokayem A Long-term clinical evaluation of 2 dental materials

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163Kidd EAAssesment of dental carious lesionsArchof Oral

Biology199843(8)629-632

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817-822

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dental resin composites Dent Mater 2005 211150-1157

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201989117ndash121

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18(7)516-20

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Dent 27(5)325-331 1999

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Jan11(1)34-40

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JProsthet Dent 199369(4)425-430

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JDent 199826 627-632

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1999 15128-137

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179Lăcătuşu St Luminiţa Costinescu Andrian S Gianina Iovan Valeria

Pendefunda 180Sorina Solomon Topoliceanu C Elements of dispersional

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Edition of the Balkan Medical Days

Stomatological Section Abstract nr1091999128

181Lăcătuşu St Andrian S Gianina Iovan- Consideraţii asupra adaptării

amalgamelor dentare la pereţii cavităţilor RevMedicina

StomatologicăVol2199823-26

182Leevailoj C Cochran MA Matis BA Moore BK Platt JA Microleakage of

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200126302ndash307

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restorative decisions microscopic and radiographic caries depth Community

Dentistry and Oral Epidemiology 1996 24 106-11

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polymerization contraction stress for dental composites by two-step light-activation

Dent Mater 2002 18436-444

187Loguercio AD Reis A Ballester RY Polymerization shrinkage effects of

constraint and filling technique in composite restorations Dent Mater 2004

20(3)236-43

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Polymerization shrinkage effects of boundary conditions and filling technique of

resin composite restorations J Dent 2004 32(6)459-70

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189Lopes GC Baratieri LN Monteiro S Jr Vieira LC Effect of posterior resin

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Quintessence Int 2004 35(2)156-61

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art and future perspectives Quintessence Int 200233213-224

191Loumlsche GM Marginal adaptation of class II composite fillings guided

polymerization vs reduced light intensity J Adhes Dent 1 199931ndash39

192Lovell LG Newman SM Bowman CN The effects of light intensity

temperature and comonomer composition on the polymerization behavior of

dimethacrylate dental resins J Dent 1999 21879-883

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and reactivity on the reaction kinetics of dimethacrylatedimethacrylate

copolymerizations Macromolecules 1999 323913-3921

194Lutz F Krejci I Barbakow F Quality and durability of marginal adaptation in

bonded composite restorations Dent Mater 1991 7(2) 107-13

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clinical results J Dent Res 199877 1020

196Mair LH Ten-year clinical assessment of three posterior resin composites and

two amalgams Quintessence Int 199829483ndash490

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depth as cavity predictors for approximal dentin caries lesions in primary teeth

Dentomaxillofac Radiol 2007 Oct36(7)377-81

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dentitionOperDent200429(5)481-508

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year clinical evaluation of direct and indirect composite restorations in posterior teeth

J Prosthet Dent 2000 Sep84(3)289-96

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Three-year clinical evaluation of composite and ceramic inlays Am J Dent 2001

Apr14(2)95-9

202Manhart J Chen HY Draegert U Kunzelmann KH Hickel R Vickers

hardness and depth of cure of light cured packable composite resins J Dent Res 2000

79369 (Abstract)

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structure and properties related to bonding J Dent 1997 25(6)441-58

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caries-affected transparent dentin by citric acidAn atomic force microscopy

studyDent Mater20011745-52

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the diagnosis of proximal caries Scand J Dent Res 1985 93(2) 78-84

51

206Mejare I Malmgreen B Clinical and radiographic appearance of proximal

carious lesions at the time of operative treatment in young permanent teeth Scand J

Dent Res 1988 94 19-26

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relative diagnostic yields of clinical FOTI and radiographic examinations for the

detection of approximal caries in youngsters Indian J Dent Res 200920(2)136-40

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restorative and luting materials attending to free and adhered surfaces volume and

deformation Dent Mater 200117241ndash246

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practitioners and dental caries JDent1990 18(3) 130-136

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(Cerana) Br Dent J 2006 Oct 21201(8)515-20

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PrimDentCare1999Apr659-62

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Quintessence 198961-80

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ScandJDRes 199210060-65

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general dental practice Acta OdontolScand19975558-63

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replacement and longevity of restorations in Florida J Am Coll Dent 199865(3)27ndash

33

217Mjoumlr IA Jokstad A Qvist V Longevity of posterior restorations Int Dent J

19904011ndash7

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Kunststoff-FullungenDtschZahnartzlicher 1991 46 222-225

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Am Dent Assoc 2010 141(3)319-29

52

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125749-751

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34

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Influence of the Discomfort Reported by Children on the Performance of Approximal

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53

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54

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55

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56

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296Smales RJ Hawthorne WSLong-term survival of extensive amalgams and

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57

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864

310Tanne K Mamoru S Burstone C Three-dimensional finite element analysis

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Orthop921987499ndash505

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Part I Depth of penetration beyond dentin smear layers Dent Mater 2001 17(4) 296-

308

313Tay FR Frankenberger R Krejci I Bouillaguet S Pashley DH Carvalho

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In vivo evidence J Dent 2004 32611ndash621

314Tay FR Pashley DH Have dentin adhesives become too hydrophilic J Can

Dent Assoc 2003 69726ndash731

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316Thompson JY Bayne SC Heymann HO Mechanical properties of a new

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76(6)619-623 1996

317Unterbrink GL R Muessner Influence of light intensity on two restorative

systems J Dent 199523183ndash189

318Unterbrink GL Liebenberg WH Flowable resin composites as filled

adhesiveslsquo literature review and clinical recommendations Quintessence Int

199930249ndash257

319Vaarkamp J Ten Bosch J Verdonschot EH Quantitative diagnosis of small

approximal caries lesions utilizing wavelength-dependent fiber-optic

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320Valachovic RW Douglass CW Reiskin AB Chauncey HH McNeil BJ The

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Oral Surg Oral Med Oral Pathol 198661(3)289-96

321Van Meerbeek B De Munck J Yoshida Y Inoue S Vargas M Vijay P Van

Landuyt K Lambrechts P Vanherle G Adhesion to enamel and dentin Current

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322Van Meerbeek B Van Landuyt K De Munck JHashimoto M Peumans M

Lambrechts P Yoshida Y Inoue S Suzuki K Technique-sensitivity of

contemporary adhesives Dent Mater J 2005 24(1) 1-13

323Van Meerbeek B Vargas S Inoue S Yoshida Y Peumans M Lambrechts P

Vanherle G Adhesives and cements to promote preservation dentistry Oper Dent

20016 119-144

324Van Meerbeek B Yoshida Y Inoue S Vargas M Abe Y Fukuda R Okazaki

M Lambrechts P Vanherle G Bonding mechanism micro-tensile bond strength of

a 4- MET-based self-etching adhesive J Dent Res 2000 79 249 (Abstract)

58

325Van Nieuwenhuysen JP DrsquoHoore W Carvalho J Qvist V Long-term

evaluation of extensive restorations in permanent teeth J Dent 200331(6)395ndash405

326Venhoven BA de Gee AJ Davidson CL Light initiation of dental resins

dynamics of the polymerization Biomaterials 1996 172313-2318

327Versluis A Douglas WH Cross M Sakaguchi RL Does an incremental filling

technique reduce polymerization shrinkage stresses J Dent Res 1996 75871ndash878

328Vries HC Ruiken HM Konig KG vanrsquot Hof MA Radiographic versus

clinical diagnosis of approximal carious lesions Caries Res1990 24 (5) 364-370

329Waggoner W Ashton J Predictability of cavitation based upon radiographic

appearance comparison of two film types Quintessence International 1989 20(1)

55-60

330Watanabe LG Marshall GW Jr Marshall SJ Dentin shear strength effects of

tubule orientation and intra tooth location Dent Mater 1996 12 109-115

331Watts DC AS Marouf Optimal specimen geometry in bonded-disk

shrinkage-strain measurements on light-cured biomaterials Dent Mater 200016447ndash

451

332Watts DC Marouf AS Al-Hindi AM Photo-polymerization shrinkage-stress

kinetics in resin-composites methods development Dent Mater 2003 191ndash11

333Weaver WS Blank LW Pelleu GB Jr A visible light activated resin cured

through tooth structure GenDent 198836236-7

334Wendt SL Microleakage and cusp fracture resistance of heattreated composite

resin inlays Am J Dent 4(1)10-14 1991

335Wenzel A Hintze H Mikkelsen L Mouyen F Radiographic detection of

occlusal caries in noncavitated teeth A comparison of conventional film radiographs

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1991 72 621-6

336Wenzel A Hintze H Perception of image quality in direct digital radiography

after application of various image treatment filters for detectability of dental diseases

Dentomaxillofac Radiol 1993 22 131-4

337Wenzel A Computer-aided image manipulation of intraoral radiographs to

enhance diagnosis in dental practice a review Int Dent J 1993 43 99-108

338Wenzel A Digital radiography and caries diagnosis Dento Maxillo Facial

Radiology 27(1)3-11 1998

339Wenzel A Haiter-Neto F Gotfredsen E Risk factors for a false positive test

outcome in diagnosis of caries in approximal surfaces impact of radiographic

modality and observer characteristics Caries Res 200741(3)170-6

340Wibowo G Stockton L Microleakage of class II composite restorations Am J

Dent 200114177ndash185

341Wilson NHF Wastell DG Norman RD Five-year performance of high-

cooper content amalgam restorations in a multiclinical trial JDent1996 24 203-210

342Winkler MM Katona TR Paydar NH Finite element stress analysis of three

filling techniques for class V light-cured composite restorations J Dent Res

1996751477-83

343Yap AU Effectiveness of polymerization in composite restoratives claiming bulk

placement Impact of cavity depth and exposure time Oper Dent 2000 25113-120

59

344Yeşilyurt C Bulucu B Bond strength of total-etch dentin adhesive systems on

peripheral and central dentinal tissue a microtensile bond strength test The Journal of

Contemporary Dental Practice 7(2) 20061-13

345Yoshida Y Van Meerbeek B Okazaki M Shintani H Suzuki K Comparative

study on adhesive performance of functional monomers J Dent Res 2004 83 454-

458

346Yoshiyama M Tay FR Doi J Nishitani Y Yamada T Itou K Carvalho RM

Nakajima M Pashley DH Bonding of self-etch and total etch adhesives to carious

dentin J Dent Res 2002 81 556-560

  • COPERTA REZUMAT ENGLEZA (MEREUTA)pdf
  • REZUMAT ENGLEZA DR MEREUTA DENISSpdf
Page 27: UNIVERSITATEA DE MEDICINA SI FARMACIE “GR Doctorat/Rezumat... · universitatea de medicina si farmacie “gr.t.popa” iasi facultatea de medicina dentara rezumatul tezei de doctorat

24

CHAPTX STUDY REGARDING THE EFFECTS OF ETCHING ON

ENAMEL AND DENTINE IN CERVICAL AREA FOR PROXIMAL

CAVITIES AT LATERAL DENTAL GROUP

X1 INTRODUCTION

The studies reported marginal defects and high microleakage at the level of

gingival margins localised in cervical area or close to enamel-cement jonction for

high percents of proximal-occlusal composite resins restorations (8485) The good

adhesion is requested to insure restoration longevity and to prevent marginal

microleakage and presence of secondary marginal dental caries The adhesion

strenght of different adhesive systems can vary accordingly to tissues areas (204 240)

and to variations in dentinal structures (234 330) Most studies focused on adhesive

systems performances used healthy dentine close to pulp room but in case of class II

restorations there are particular features that influences the adhesion at the level of

gingival margins

The surface topography is an important property that determines the

interaction manner between surfaces The surface roughness and surface energy can

increase or decrease the adhesion of composite resins to the hard dental tissues

X2 AIM OF STUDY

The aim of study was to compare surface roughness of enamel and dentine

after etching related to different distances related to enamel-dentinecement jonction

X3 MATERIALS AND METHODS

The study group included 20 molars extracted from orthodontics or

periodontal reasons with intact proximal surfaces The teeth were cut longitudinally in

sens buccal-oral with diamond discs under water cooling

A group study (10 teeth) included 10 samples obtained through transversal

cutting at distance of 2mm from enamel-dentinecement jonction and 10 samples

obtained through transversal cutting at distance of 15 mm from enamel-

dentinecement jonction Another study group (10 teeth) included 10 samples

obtained through transversal cutting at distance of 1mm from enamel-dentinecement

jonction and 10 samples obtained through transversal cutting at distance of 05 mm

from enamel-dentinecement jonction All these samples were divided in two halfes

through mesial-distal cutting The samples finishing was performed with abrasive

paper (100-4000) and final polishing was performed with a device Buehler model

Minimet with slices introduced in ultrasound bath for 4 minutes The second half of

each sample was etched for 15 seconds with ortophosphoric acid 37 for 15 seconds

Slices were washed with distilled water for 30 seconds after etching and dried

The samples were analysed with atomic force microscopy (AFM) regarding

surface roughness The results were expressed as relative variation of roughness

X4 RESULTS AND DISCUSSIONS

The aspect of etched enamel at 2 mm distance from ECJ can be seen in figure

X1 (section 10 microm) The surface roughness is higher comparing with sample before

etching

25

După gravajul cu acid ortofosforic 37

The aspect of etched enamel at 15 mm distance from ECJ can be seen in

figure X2 (section 10 microm) The surface roughness is higher comparing with sample

before etching but lower comparing with sample at 2 mm from ECJ

The aspect of etched enamel at 1 mm distance from ECJ can be seen in figure

X3 (section 10 microm) The surface roughness is higher comparing with sample before

etching but lower comparing with sample at 15mm and 2 mm from ECJ

The aspect of etched enamel at 15 mm distance from ECJ can be seen in

figure X4 (section 10 microm) The surface roughness is higher comparing with sample

before etching but lower comparing with sample at 1 mm 15 mm and 2 mm from

ECJ

FigX1 3D aspect of enamel at 2 mm from ECJ

after etching (10 microm)

FigX2 3D aspect of enamel at 15 mm from ECJ

after etching (10 microm)

FigX3 3D aspect of enamel at 1 mm from ECJ

after etching (10 microm)

FigX4 3D aspect of enamel at 05 mm from ECJ

after etching (10 microm)

26

The mean values of squared roughness for dentine and enamel before etching

are presented in tables X1 and X2

Table X1 Squared roughness values for dentine samples before and after etching

Before etching (nm) After etching (nm)

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

sample

1

335 282 283 259 1149 947 901 879

sample

2

352 284 274 266 1127 939 883 875

sample

3

357 273 278 263 1152 953 876 867

sample

4

323 269 264 258 1146 942 895 883

sample

5

348 298 271 268 1153 944 904 878

sample

6

339 274 278 273 1158 937 893 892

sample

7

352 283 269 266 1145 944 899 876

sample

8

349 292 272 274 1166 942 907 869

sample

9

357 284 275 265 1132 939 893 879

sample

10

348 281 277 262 1142 941 899 878

Table X2 Squared roughness values for enamel and dentine samples before and after

etching

Before etching (nm) After etching (nm)

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

sample 1 422 342 309 313 2255 1114 874 845

sample 2 418 338 324 304 2236 1102 882 839

sample 3 413 334 315 303 2239 1115 873 833

sample 4 416 336 322 308 2242 1116 868 842

sample 5 426 332 315 294 2218 1103 877 829

sample 6 412 332 317 306 2237 1099 874 847

sample 7 414 335 322 314 2252 1102 876 834

sample 8 416 325 318 313 2239 1106 875 838

sample 9 418 328 314 299 2246 1113 879 836

sample 10 413 334 316 305 2242 1104 873 839

The results for samples before etching prove a decreasing tendency for mean

values of squared roughness surface beginning with areas placed at distance of 2 mm

from ECJ (346 nm) followed by areas placed at distance of 15 mm from ECJ (282

nm) 1 mm from ECJ (274 nm) and 05 mm from ECJ (265 nm) After etching the

decreasing tendency maintained for dentine localised at 2 mm from ECJ to dentine

localised at 05 mm from ECJ The mean values of squared roughness after etching

were three times higher (tables X3)

27

Table X3 Squared roughness values for enamel and dentine samples before and

after etching

Dentine Enamel

Before etching

(nm)

After etching

(nm)

Before etching

(nm)

After etching

(nm)

2 mm ECJ 346 1147 416 2237

15 mm ECJ 282 942 333 1107

1 mm ECJ 274 895 317 875

05 mm ECJ 265 877 305 838

The descriptive statistics data for surface roughness of dentine before and after

etching are presented in tables X4 si X5

Table X4 Descriptive statistics for dentine samples before etching

Statistics

Dentine 2mm

before etching

Dentine 15mm

before etching

Dentine 1mm

before etching

Dentine 05mm

before etching

N Valid 10 10 10 10

Missing 0 0 0 0

Mean 346000 282000 274100 265400

Std Error of Mean 33830 27487 17026 16746

Std Deviation 106979 86923 53841 52957

Skewness -1214 354 -314 348

Std Error of Skewness 687 687 687 687

Kurtosis 1141 049 336 -539

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 3230 2690 2640 2580

Maximum 3570 2980 2830 2740

Table X5 Descriptive statistics for dentine samples after etching

Statistics

Dentine 2mm

after etching

Dentine 15mm

after etching

Dentine 1mm

after etching

Dentine 05mm

after etching

N Valid 10 10 10 10

Missing 0 0 0 0

1147000 942800 895000 877600

Std Error of Mean 36545 14591 29926 22020

Std Deviation 115566 46140 94634 69634

Skewness -267 1169 -951 535

Std Error of Skewness 687 687 687 687

Kurtosis 043 1776 564 1416

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 11270 9370 8760 8670

28

Statistics

Dentine 2mm

after etching

Dentine 15mm

after etching

Dentine 1mm

after etching

Dentine 05mm

after etching

N Valid 10 10 10 10

Missing 0 0 0 0

1147000 942800 895000 877600

Std Error of Mean 36545 14591 29926 22020

Std Deviation 115566 46140 94634 69634

Skewness -267 1169 -951 535

Std Error of Skewness 687 687 687 687

Kurtosis 043 1776 564 1416

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 11270 9370 8760 8670

Maximum 11660 9530 9070 8920

To choose the statistical test to compare roughness surface values was

performed a test Shapiro-Wilk If p is lower or equal with 0005 than hypothesis of

distribution normality is rejected (distribution deviates from normal form) In the table

X6 the distributions are normal The statistical test will be test t for pair samples

Table X6 Test Shapiro-Wilk for dentine samples

Tests of Normality

Kolmogorov-Smirnov

a Shapiro-Wilk

Statistic df Sig Statistic df Sig

Dentine 2mm before etching 274 10 032 877 10 122

Dentine 15mm after etching 209 10 200 952 10 689

Dentine 1mm before etching 134 10 200 983 10 980

Dentine 05mm before etching 155 10 200 949 10 661

Dentine 2mm after etching 133 10 200 977 10 946

Dentine 15mm after etching 197 10 200 916 10 329

Dentine 1mm after etching 216 10 200 925 10 401

Dentine 05 after etching 220 10 185 933 10 474

Enamel 2mm before etching 193 10 200 898 10 207

Enamel 15mm before etching 170 10 200 977 10 947

Enamel 1mm before etching 157 10 200 952 10 689

Enamel 05mm before etching 165 10 200 943 10 590

Enamel 2mm after etching 235 10 124 925 10 404

Enamel 15mm after etching 209 10 200 871 10 102

Enamel 1mm after etching 189 10 200 964 10 834

Enamel 05mm after etching 142 10 200 983 10 978

a Lilliefors Significance Correction

29

Tests of Normality

Kolmogorov-Smirnov

a Shapiro-Wilk

Statistic df Sig Statistic df Sig

Dentine 2mm before etching 274 10 032 877 10 122

Dentine 15mm after etching 209 10 200 952 10 689

Dentine 1mm before etching 134 10 200 983 10 980

Dentine 05mm before etching 155 10 200 949 10 661

Dentine 2mm after etching 133 10 200 977 10 946

Dentine 15mm after etching 197 10 200 916 10 329

Dentine 1mm after etching 216 10 200 925 10 401

Dentine 05 after etching 220 10 185 933 10 474

Enamel 2mm before etching 193 10 200 898 10 207

Enamel 15mm before etching 170 10 200 977 10 947

Enamel 1mm before etching 157 10 200 952 10 689

Enamel 05mm before etching 165 10 200 943 10 590

Enamel 2mm after etching 235 10 124 925 10 404

Enamel 15mm after etching 209 10 200 871 10 102

Enamel 1mm after etching 189 10 200 964 10 834

Enamel 05mm after etching 142 10 200 983 10 978

a Lilliefors Significance Correction

This is a lower bound of the true significance

The results of test t for pair dentine samples before and after etching are

presented in table X

Table X7 Test t for dentine before and after etching

Paired Samples Test

Paired Differences

t df

p (2-

tailed)

95 Confidence

Interval of the

Difference

Mean

Std

Dev

Std

Error

Mean Lower Upper

Pair

1

dentine2mmbeforeetching-

dentine2mmafteretching

-

8010000

174801 55277 -

8135045

-

7884955

-

144906

9 000

Pair

2

dentine15mmbeforeetching-

dentine15mmafteretching

-

6608000

102394 32380 -

6681248

-

6534752

-

204079

9 000

Pair

3

dentine1mmbeforeetching-

dentine1mmafteretching

-

6209000

117799 37251 -

6293269

-

6124731

-

166678

9 000

30

Paired Samples Test

Paired Differences

t df

p (2-

tailed)

95 Confidence

Interval of the

Difference

Mean

Std

Dev

Std

Error

Mean Lower Upper

Pair

1

dentine2mmbeforeetching-

dentine2mmafteretching

-

8010000

174801 55277 -

8135045

-

7884955

-

144906

9 000

Pair

2

dentine15mmbeforeetching-

dentine15mmafteretching

-

6608000

102394 32380 -

6681248

-

6534752

-

204079

9 000

Pair

3

dentine1mmbeforeetching-

dentine1mmafteretching

-

6209000

117799 37251 -

6293269

-

6124731

-

166678

9 000

Pair

4

dentine05mmbeforeetching-

dentine05mmafteretching

-

6122000

86384 27317 -

6183796

-

6060204

-

224109

9 000

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of dentine (

2mm 15 mm 1mm sau 05mm)

The descriptive statistics data for dentine surface roughness before and after

etching are presented in tables X8 and X9

Table X8 Descriptive statistics for enamel samples before etching

Statistics

Enamel 2mm

before etching

Enamel 15mm

before etching

Enamel 1mm

before etching

Enamel 05mm

before etching

N Valid 10 10 10 10

Missing 0 0 0 0

Mean 416800 333600 317200 305900

Std Error of Mean 13968 15217 14205 20355

Std Deviation 44171 48120 44920 64369

Skewness 1095 -156 -109 -411

Std Error of Skewness 687 687 687 687

Kurtosis 769 487 -118 -295

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 4120 3250 3090 2940

Maximum 4260 3420 3240 3140

31

Table X9 Descriptive statistics for enamel samples after etching

Statistics

Enamel 2mm

after etching

Enamel 15mm

after etching

Enamel 1mm

after etching

Enamel 05mm

after etching

N Valid 10 10 10 10

Missing 0 0 0 0

Mean 2237600 1107400 875100 838200

Std Error of Mean 31027 20232 11968 17436

Std Deviation 98116 63979 37845 55136

Skewness -850 267 042 040

Std Error of Skewness 687 687 687 687

Kurtosis 878 -1880 1082 -425

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 22180 10990 8680 8290

Maximum 22520 11160 8820 8470

To choose the statistical test to compare roughness surface values was

performed a test Shapiro-Wilk If p is lower or equal with 0005 than hypothesis of

distribution normality is rejected (distribution deviates from normal form) In the table

X10 the distributions are normal The statistical test will be test t for pair samples

Table X10 Test Shapiro-Wilk for enamel samples

Tests of Normality

Kolmogorov-Smirnova Shapiro-Wilk

Statistic df Sig Statistic df Sig

2mmenamel before etching 193 10 200 898 10 207

15mmenamel before etching 170 10 200 977 10 947

1mmenamel before etching 157 10 200 952 10 689

05mmenamel before etching 165 10 200 943 10 590

2mmenamel after etching 235 10 124 925 10 404

15mmenamel after etching 209 10 200 871 10 102

1mmenamel after etching 189 10 200 964 10 834

05mmenamel after etching 142 10 200 983 10 978

a Lilliefors Significance Correction

This is a lower bound of the true significance

The results of test t for pair enamel samples before and after etching are

presented in table X11

32

Table X11 Test t for enamel samples before and after etching

Paired Samples Test

Paired Differences

t df

p (2-

tailed)

95 Confidence

Interval of the

Difference

Mean

Std

Deviation

Std

Error

Mean Lower Upper

Pair

1

2mmenamel before

etching

2mmenamel after

etching

-18208 135220 42760 -

18304731

-

18111269

-

425815

9 000

Pair

2

15mmenamel before

etching

15mmenamel after

etching

-7738 73151 23132 -7790329 -7685671 -

334508

9 076

Pair

3

1mmenamel before

etching

1mmenamel after

etching

-5579 55468 17540 -5618679 -5539321 -

318065

9 065

Pair

4

05mmenamel before

etching

05mmenamel after

etching

-5323 60378 19093 -5366192 -5279808 -

278788

9 063

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel ( 2mm 15 mm 1mm sau

05mm) but the differences statistical significant are present only for enamel localised

at 2 mm from ECJ

X5CONCLUSIONS

The surfaces of enamel and dentine at cervical level record decreases of

roughness related to the decrease of distance to ECJ

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel but the differences

statistical significant are present only for enamel localised at 2 mm from ECJ

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of

dentine

33

CHAPTXI FEA STUDY REGARDING THE BIOMECHANICAL

BEHAVIOUR AND FRACTURE RESISTANCE OF PROXIMO-OCCLUSAL

AMALGAM AND COMPOSITE RESINS RESTORATIONS

XI1INTRODUCTION AIM OF STUDY

The individual variation of patients morphological and functional complexity

of tissues as well as difficult access limit the possibilities to investigate in clinical

studies the biomechanical behaviour of proximo-occlusal restorations In this context

simulation of the biomechanics for direct restorations represents an interesting

interdisciplinar domain in actual dentistry research

The study focused on two direction

- analysis of role of forces intensity on biomechanical behaviour related to

cavity dimension and material

- analysis of tension inside restoration structure related to forces intensity

XI2MATERIALS AND METHODS

The stages of finite element analysis study are as follows

object modelling (bicusps and proximo-occlusal restoration)

definition of parameters for materials and dental tissues

meshing

constraints and loading

types of contacts

equations system definition

results of simulation

The object 3D modelling was performed in Rhinoceros (figure XI1) The

definition of parameters was performed for Poisson constant Young modulus density

(table XI1) The selected materials were amalgam and composite resins The

analysed tissues were dentine and enamel The meshing constraints loading were

performed for forces of 200N 400N 600N 800 N The analysis was performed using

software COSMOSWorks 2010

34

Fig XI1 3D modellation of bicusp

Table XI1 Values of Young modulus Poisson constant compression resistance for

amalgam composite resin enamel (amalgam compozit smalţ)

Material Young modulus (GPa) Poisson constants

Compression

resistance

(Mpa)

Amalgam 55 033 483

Enamel 48 03 400

Composite

resin 220 022 345

Fig XI2 The forces and constraints application

The results are presented in values and culours red colours representing areas

with maximum values of tensions produced under influence of masticatory forces

The tensions produced in amalgam restoration are in a range from 0 to 22886

(force 800 N) The maximum von Misses tensions are associated with cervical area

of amalgam restorations This aspect proves that first modification in interface

restoration-cavity margins will appear at the level of gingival wall First marginal

35

defects and fissures in restoration bulk will appear at tensions over 1600Mpa

associated with forces of 800N for extended amalgam proximo-occlusal restorations

The tensions produced in composite resin restorations are in a range from 0 to

2285 (force 800 N) The maximum von Misses tensions are associated with cervical

area of composite resin restorationsThis aspect proves that first modification in

interface restoration-cavity margins will appear at the level of gingival wall First

marginal defects and fissures in restoration bulk will appear at tensions over 1716

Mpa associated with forces of 600N for moderate and extended composite resins

proximo-occlusal restorations

Fig XI3a-b ndash Simulated model of proximo-occlusal restoration

FigXI4a-b Dental amalgam restoration Cervical tension associated with 600 N

(c)800 N (d)

FigXI5a-b Composite resin restoration Cervical tension associated with 600 N

(c)800 N (d)

36

The deformation of amalgam can be produced only when is associated with

fissures in bulk of restorations while composite resins restorations present

deformation when are associated with a modification of volume and form because of

repeated action of medium forces on long term or high forces on short term (figures

XI4 XI5)

Fig XI4 Material deformation in area of maximum tension

000E + 00

500E -02

100E -01

150E -01

200E -01

250E -01

1 4 7 101316192225283134374043464952555861646770737679

Amalgam C ompoz it

Figura XI5 Deformarea funcție de material

The amalgam and composite resins were treated as homogenous isotropic and

liniar The advantage of this type of FEA study is that restorations parameters can be

modified any time is necessary both in arhitecture geometry and material indices

variability The results of this study sustain the conclusions of other FEA studies

focused on biomechanical behaviour of posterior restorations performed with

amalgam and composite resins(35 62 76 143)

37

XI4CONCLUSIONS

bull The amalgam in class II restorations has a low deformation tendency because

of uniform distribution of tension inside material

bull Composite resins class II restorations accumulate higher tensions comparing

with amalgam but deformation is avoided for a time because of the adhesion

forces performed between molecules under moderate oral forces In case of

high oral forces (600-800N) the risk of fracture in moderate class II

restorations is higher comparing with amalgam proximo-occlusal restorations

For extended class II restorations and forces of 600 N composite resins present

highest risk of fracture and deformation The von Misses tension at the

cervical interface restorationtooth can reach 1600Mpa

bull The amalgam in moderate class II restorations can resist to deformation even

for high intensity forces limited to 600N In extended class II restorations the

risk of deformation and fracture increases at values of 600N-800N of oral

forces The von Misses tension at the cervical interface restorationtooth can

reach 1700 Mpa

38

FINAL CONCLUSIONS

Amalgam proximo-occlusal restorations with minimum 6-years age present

excellent results for parameters anatomic form (occlusal) marginal

discoloration and marginal secondary dental caries good results for

parameters anatomic form (proximal) and marginal adaptation and poor results

for surface quality

Composite resins proximo-occlusal restorations (bicusps) with minimum 6-

years age present excellent results for parameters color match marginal

discoloration and marginal secondary dental caries and good results for

parameters anatomic form (occlusal proximal) marginal adaptation surface

quality

Composite resins proximo-occlusal restorations (molars) with minimum 6-

years age present good results for parameters color match marginal

discoloration marginal secondary dental caries marginal adaptation and poor

results for parameters anatomic form (occlusal) (54 indices Ryge C)

anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The restorations extended at external third of occlusal surface present highest

percents of indices C regarding anatomic form (occlusal) (54 indices Ryge

C) anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The exceeding of 6-years age will require careful monitorisation for early

interventions through polishing sealing reshaping and even replacement for

restorations with major defects

Oblique layering technique presents superior results regarding marginal

adaptation and marginal discoloration and is recommended for proximo-

occlusal dental caries close to enamel-cement jonction

Centripetal build-up presents good results regarding marginal adaptation and

anatomical form at proximal level (proximal surfaces and contact point)

Horisontal layering technique can be used for optimum results only in

proximal-occlusal cavities with moderate extension both in occlusal-cervical

and buccal-oral

The values of die penetration at gingival wall were statistically different

between the three restorative techniques

We concluded that all restorative methods were associated with lightcuring

contraction and marginal microleakage

The combined technique was associated with lowest lightcuring contraction

and die penetration

The bulk technique was associated with highest lightcuring contraction and die

penetration

39

The surfaces of enamel and dentine at cervical level record decreases of

roughness related to the decrease of distance to ECJ

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel but the differences

statistical significant are present only for enamel localised at 2 mm from ECJ

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of

dentine

bull The amalgam in class II restorations has a low deformation tendency because

of uniform distribution of tension inside material

bull Composite resins class II restorations accumulate higher tensions comparing

with amalgam but deformation is avoided for a time because of the adhesion

forces performed between molecules under moderate oral forces In case of

high oral forces (600-800N) the risk of fracture in moderate class II

restorations is higher comparing with amalgam proximo-occlusal restorations

For extended class II restorations and forces of 600 N composite resins present

highest risk of fracture and deformation The von Misses tension at the

cervical interface restorationtooth can reach 1600Mpa

bull The amalgam in moderate class II restorations can resist to deformation even

for high intensity forces limited to 600N In extended class II restorations the

risk of deformation and fracture increases at values of 600N-800N of oral

forces The von Misses tension at the cervical interface restorationtooth can

reach 1700 Mpa

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Statement on posterior resin-based composites JADA 1998 129(11)1627ndash1628

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6Aggarwal V Logani A Jain V Shah N Effect of cyclic loading on marginal

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Oper Dent 2008 Sep-Oct33(5)587-92

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8Andrian S- Restaurări fizionomice cu materiale plastice icircn cariologie-EdPanteon

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9Andrian S Tratamentul Minim Invaziv al Cariei Dentare EditPrinceps Edit Iaşi

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13Angmar-Mansson B Al-Khateeb S Tranaeus S Caries diagnosis Journal of

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15Anusavice KJ Development and testing of ceramics for dental restorations In

Fischman G Clare A Hench J editors Bioceramics materials and applications

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16Arhun N Celik C Yamanel KClinical evaluation of resin-based composites in

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17Armstrong SR JC Keller DB Boyer The influence of water storage and C-

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utilizing a filled and unfilled adhesive resin Dent Mater 200117268ndash276

18Armstrong S Boyer D Keller J Microtensile bond strength testing and failure

analysis of two dentin adhesives Dent Mater 1998 14(1)44-50

19Asmussen E Peutzfeldt A Influence of UEDMA BisGMA and TEGDMA on

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26Bader JD Shugars DA Understanding dentistslsquo restorative treatment decisions J

Public Health Dent 1992 Winter52(2)102-10

27Barkmeier WW Cooley RL Current status of adhesive resin systems J Am Coll

Dent 199158 36-39

28Bayne SC Dental biomaterials where are we and where are we going J Dent

Educ 200569(5)571ndash585

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29Bedran-de-Castro AK Pereira PN Thompson JY Influence of load cycling

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30Behle C Flowable composite Proprieties and applications Pract Periodontics

Aesthetics Dent 1998 10347 350-351

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33Black J Biological Performance of Materials Fundamentals of Biocompatibility

NY Marcel Dekker Inc 1999

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9

35Boschian PL S Guidotti R Pietrbissa M Gagliani- bdquoStress distribution in a

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Rehabilitation (33) 2006690ndash697

36Bouillaguet S B Ciucchi T Jacoby JC Wataha DH Pashley Bonding

characteristics to dentin walls of class II cavities in vitro Dent Mater 200117316ndash

321

37Bouschlicher MR Rueggeberg FA Effect of ramped light intensity on

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2000 12328-339

38Braga RR Ferracane JL Hilton TJ Contraction stress of flowable composites

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39Braga RR Ballester RY Ferracane JLFactors involved in the development of

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40Bratu D- Materiale dentare icircn cabinetul de stomatologie- Edit Helicon

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Association 2000nr131

42Brunthaler A Koumlnig F Lucas T Sperr W Schedle A Longevity of direct resin

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43Bullard RH Leinfelder KR Russell CM Effect of coefficient of thermal

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44Buonocore MG Matsui A Gwinnett AJ Penetration of resin dental materials

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45Burke FJ Cheung SW Mjoumlr IA Wilson NH Restoration longevity and analysis

of reasons for the placement and replacement of restorations provided by vocational

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46Burke FJ Cheung SW Mjor IA Wilson NH-Reasons for the placement and

replacement of restorations in vocational training practicePrimary Dental Care

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47Burke FJ Wilson NH Cheung SW Mjoumlr IA Influence of patient factors on age

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48Calheiros FC Braga RR Kawano Y Ballester RY Relationship between

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2004 20939-946

49Cardoso P Sadek F Microtensile bond strength on dentin using new adhesive

systems with selfetching primers Braz J Oral Sci 2003 2(4) 156-159

50Cardoso M Baratieri LN Ritter AV The effect of finishing and polishing on

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51Carvalho RM JC Pereira M Yoshiyama DH Pashley A review of

polymerization contraction the influence of stress development versus stress

reliefOper Dent19962117ndash24

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Dentomaxillofac Radiol 2007 Mar36(3)138-42

53Cattaneo PM M Dalstra B Melsen- bdquoThe Finite Element Method a Tool to

Study Orthodontic Tooth Movement J Dent Res 2005 84(5)428-433

54Cattell MJ Clarke RL Lynch EJ The transverse strength reliability and

microstructural features of four dental ceramicspart 1 J Dent 25(5)399-407 1997

55Cehreli ZC Akca T Effect of dentinal tubule orientation on the microtensile

bond strength to primary dentin J Dent Child 2003 70(2) 139-144

56Celik C Arhun N Yamanel K Clinical evaluation of resin-based composites in

posterior restorations 12-month results Eur J Dent 2010 Jan4(1)57-65

57Cenci M Demarco F de Carvalho R Class II composite resin restorations with

two polymerization techniques Relationship between microtensile bond strength and

marginal leakage J Dent 2005 33(7) 603- 610

58Chaffin J Moss D Review of current US Army dental emergency rates Mil

Med 2008173(1)23ndash26

59Chen HY Manhart J Hickel R Kunzelmann KH Polymerization contraction

stress in light-cured packable composite resinsDent Mater 200117253-259

60Choi KK Condon JR Ferracane JL The effects of adhesive thickness on

polymerization contraction stress of composites J Dent Res 2000 79812ndash817

61Cichon P Kerschbaum T Verweildauer zahnartzlicher Restaurationen bei

Behinderten Dtsch Zahnartzlicher 1999 54 96-102

62Cohen BI Pagnillo MK Deutsch ASMusikant BL Fracture Strength of

Three Core Restorative Materials Supported with or without a Prefabricated Split-

Shank Post Journal of Prosthetic Dentistry1997 78 560ndash565

63Colli P Brannstrom M The marginal adaptation of four different bonding agents

in Class II composite resin restoration applied in bulk or in two increments

Quintessence Int 1993 24583-591

43

64Collins CJ Bryant RW Hodge KL A clinical evaluation of posterior composite

resin restorations 8-year findings J Dent 199826(4) 311ndash317

65Condon JR Ferracane JL Assessing the effect of composite formulation on

polymerization stress J Am Dent Assoc2000 131497-503

66Cook WD Moopnar M Influence of chemical structure on the fracture

behaviour of dimethacrylate composite resins Biomaterials 1990 11272-276

67Cortes DF Ellwood RP Ekstrand KR An in vitro comparison of a combined

FOTIvisual examination of occlusal caries with other caries diagnostic methods and

the effect of stain on their diagnostic performance Caries Res 2003 37 (1) 8-16

68Crim GA Microleakage of three resin placement techniques Am J Dent

1991469-72

69Dauvillier B Aarnts M Feilzer A The competition between the composite-

dentin strength and the polimerization contraction stress J Dent Res 1984 63 1396-

1399

70Dauvillier BS Aarnts MP Feilzer AJ Developments in shrinkage control of

adhesive restoratives J Esthet Dent 2000 12291-299

71Dauvillier BS Aarnts MP Feilzer AJ Modeling of the viscoelastic behavior of

dental light-activated resin composites during curing Dent Mater 200319277ndash285

72Davidson CL Gee AJ Feilzer A The competition between the composite-dentin

bond strength and the polymerization contraction stress J Dent Res 1984

63(12)1396-9

73Davidson CL AJ Feilzer Polymerization shrinkage and polymerization

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Prosthet Dent 198655446ndash7

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Dent200899131-40

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1331387ndash97

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Dent20104(3)270-9

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2006 22359-365

44

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Operations Desert ShieldStorm Mil Med 1996161(10) 620ndash623

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26 717-727

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20028195 (Abstract)

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30(3)163- 1681999

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848

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1243

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Biology199843(8)629-632

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817-822

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18(7)516-20

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Jan11(1)34-40

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JDent 199826 627-632

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Edition of the Balkan Medical Days

Stomatological Section Abstract nr1091999128

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Dentistry and Oral Epidemiology 1996 24 106-11

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Dent Mater 2002 18436-444

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20(3)236-43

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Polymerization shrinkage effects of boundary conditions and filling technique of

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50

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Dentomaxillofac Radiol 2007 Oct36(7)377-81

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J Prosthet Dent 2000 Sep84(3)289-96

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Three-year clinical evaluation of composite and ceramic inlays Am J Dent 2001

Apr14(2)95-9

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79369 (Abstract)

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PrimDentCare1999Apr659-62

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Quintessence 198961-80

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ScandJDRes 199210060-65

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33

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Am Dent Assoc 2010 141(3)319-29

52

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125749-751

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composites Oper Dent 23 1998282ndash289

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34

227Neuhaus KW Ellwood R Lussi A Pitts N Traditional lesion detection aids

Monogr Oral Sci 20092142-51

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Monogr Oral Sci 20092152-62

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Influence of the Discomfort Reported by Children on the Performance of Approximal

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Restorative Materials In Class I And Class II Restorations An In-Vivo Study The

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Regional variability in the permeability of human dentine Arch Oral Biol

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53

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Adhes Dent 1999 1(3)191-209

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569ndash575

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Community Dent Oral Epidemiol 1999 Oct27(5)331-7

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Community Dent Oral Epidemiol 1980 Jun8(3)135-8

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254Price RB Rizkalla AS Hall GC Effect of stepped light exposure on the

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255Radhika M Girija S 1 Kumaraswamy B Neetu M Effect of different

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54

256Radu TM A Uliuliuc Dana Apostolide S Andrian The effect of adhesive

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258Rasmusson CG Lundin SA Class II restorations in six different posterior

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of teeth with long-term performing composite restorations J Oral Rehabil 2002

29(12)1131ndash1138

260Roberson TM Heymann HO Swift EJ eds Sturdevantlsquos Art and Science of

Operative Dentistry 5th ed St Louis Mosby 2006293-7

261Robertello FJ Pink FE The effect of a training program on the reliability of

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J Appl Oral Sci 2010 Feb18(1)37-43

263Roulet JF Noack MJCriteria for substituting amalgam with composite resins

Int Dent J 199141(4)195-205

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ClinOral Invest1997140-46

266Roulet JFBenefits and disadvantages of tooth-coloured alternatives to amalgam

J Dent 199725(6)459-73

267Rueggeberg FA WF Caughman JW Curtis Jr HC Davis Factors

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1993691ndash95

268Rueggeberg FA Ergle JW Mettenburg DJ Polymerization depths of

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269Rushton VE Horner K Worthington HV Screening panoramic radiography

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270Ruyter IE Types of resin-based inlay materials and their properties Int Dent J

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271Sajjan GS Mittal NEffect of different placement techniques on marginal

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J Conserv Dent 201013(1)9-15

272Sakaguchi RL MC Peters SR Nelson WH Douglas HW Poort Effects

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composites Dent Mater 200218197-202

274Sano H Takatsu T Ciucchi B Horner JA Matthews WG Pashley DH

Nanoleakage leakage within the hybrid layer Oper Dent 1995 20 18-25

55

275Sarrett DC Clinical challenges and the relevance of materials testing for

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276Sarrett DC Brooks CN Rose JT Clinical performance evaluation of a

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278Schirrmeister JF Huber K Hellwig E Hahn P Four-year evaluation of a resin

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279Schneiderman A Elbaum M Schultz T Keem S Greenebaum M Driller J

Assessment of dental caries with Digital Imaging Fiber-Optic Transillumination (DI-

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286Sideridou I Tserki V Papanastasiou G Effect of chemical structure on degree

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231819-1829

287Sideridou I Tserki V Papanastasiou G Study of water sorption solubility and

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289SilverFH Christiansen DLBiomaterials Science and Biocompatibility New

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290Simecek JW Diefenderfer KE Ahlf RL Ragain JC Jr Longitudinal trends in

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200382 1169 (Abstract)

291Simecek JW Diefenderfer KE Ahlf RL Ragain JC Jr Dental sealant

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56

292Simi B Suprabha B Evaluation of microleakage in posterior nanocomposite

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294Smales RJ Longevity of cusp-covered amalgams survivals after 15 years

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295Smales RJ Webster DA Leppard PISurvival predictions of amalgam

restorations JDent1991 19 272-277

296Smales RJ Hawthorne WSLong-term survival of extensive amalgams and

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297Soncini JA Maserejian NN Trachtenberg F Tavares M Hayes C The

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298Sonoda H Banerjee A Sherriff M Tagami J Watson TF An in vitro

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299Soodabeh Kimyai Masomeh Mehdipour Siavash Savadi Oskoee Reasons

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300De Souza FB Guimaraes RP Vicente Silva CH A clinical evaluation of

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301Spreafico RC Gagliani M Composite resin restorations on posterior teeth In

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Quintessence 2000253ndash76

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303Stangel I Barolet RY Clinical evaluation of two posterior composite resins

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from the SCO Dental Products Inc Symposium 2003 24(8) 4-9 (Abstract)

307Summit JB Burgess JO Berry TG Six-year clinical evaluation of bonded and

pin-retained complex amalgam restorations Oper Dent 2004 29269-276

308Summit JB Robbins JW Hilton TJ Fundamentals in operative dentistry Cap

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57

309Svanberg M Mjor IA Orstavik D Mutans streptococci in plaque from margins

of amalgam composite and glassndashionomer restorations J Dent Res 199069861ndash

864

310Tanne K Mamoru S Burstone C Three-dimensional finite element analysis

for stress in the periodontal tissue by orthodontic forcesAm J Orthod Dentofacial

Orthop921987499ndash505

311Tanumiharja M Burrow MF Tyas MJ Microtensile bond strengths of seven

dentin adhesive systems Dent Mater 2000 16(3)180-7

312Tay FR Pashley DH Aggressiveness of contemporary self-etching systems

Part I Depth of penetration beyond dentin smear layers Dent Mater 2001 17(4) 296-

308

313Tay FR Frankenberger R Krejci I Bouillaguet S Pashley DH Carvalho

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In vivo evidence J Dent 2004 32611ndash621

314Tay FR Pashley DH Have dentin adhesives become too hydrophilic J Can

Dent Assoc 2003 69726ndash731

315Tay FR Sano H Carvalho R Pashley EL Pashley DH An ultrastructural

study of the influence of acidity of self-etching primers and smear layer thickness on

bonding to intact dentin J Adhes Dent 2000 283ndash98

316Thompson JY Bayne SC Heymann HO Mechanical properties of a new

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76(6)619-623 1996

317Unterbrink GL R Muessner Influence of light intensity on two restorative

systems J Dent 199523183ndash189

318Unterbrink GL Liebenberg WH Flowable resin composites as filled

adhesiveslsquo literature review and clinical recommendations Quintessence Int

199930249ndash257

319Vaarkamp J Ten Bosch J Verdonschot EH Quantitative diagnosis of small

approximal caries lesions utilizing wavelength-dependent fiber-optic

transillumination Journal of Dental Research 1997 76 (4) 875-882

320Valachovic RW Douglass CW Reiskin AB Chauncey HH McNeil BJ The

use of panoramic radiography in the evaluation of asymptomatic adult dental patients

Oral Surg Oral Med Oral Pathol 198661(3)289-96

321Van Meerbeek B De Munck J Yoshida Y Inoue S Vargas M Vijay P Van

Landuyt K Lambrechts P Vanherle G Adhesion to enamel and dentin Current

status and future challenges Oper Dent 2003 28 215-235

322Van Meerbeek B Van Landuyt K De Munck JHashimoto M Peumans M

Lambrechts P Yoshida Y Inoue S Suzuki K Technique-sensitivity of

contemporary adhesives Dent Mater J 2005 24(1) 1-13

323Van Meerbeek B Vargas S Inoue S Yoshida Y Peumans M Lambrechts P

Vanherle G Adhesives and cements to promote preservation dentistry Oper Dent

20016 119-144

324Van Meerbeek B Yoshida Y Inoue S Vargas M Abe Y Fukuda R Okazaki

M Lambrechts P Vanherle G Bonding mechanism micro-tensile bond strength of

a 4- MET-based self-etching adhesive J Dent Res 2000 79 249 (Abstract)

58

325Van Nieuwenhuysen JP DrsquoHoore W Carvalho J Qvist V Long-term

evaluation of extensive restorations in permanent teeth J Dent 200331(6)395ndash405

326Venhoven BA de Gee AJ Davidson CL Light initiation of dental resins

dynamics of the polymerization Biomaterials 1996 172313-2318

327Versluis A Douglas WH Cross M Sakaguchi RL Does an incremental filling

technique reduce polymerization shrinkage stresses J Dent Res 1996 75871ndash878

328Vries HC Ruiken HM Konig KG vanrsquot Hof MA Radiographic versus

clinical diagnosis of approximal carious lesions Caries Res1990 24 (5) 364-370

329Waggoner W Ashton J Predictability of cavitation based upon radiographic

appearance comparison of two film types Quintessence International 1989 20(1)

55-60

330Watanabe LG Marshall GW Jr Marshall SJ Dentin shear strength effects of

tubule orientation and intra tooth location Dent Mater 1996 12 109-115

331Watts DC AS Marouf Optimal specimen geometry in bonded-disk

shrinkage-strain measurements on light-cured biomaterials Dent Mater 200016447ndash

451

332Watts DC Marouf AS Al-Hindi AM Photo-polymerization shrinkage-stress

kinetics in resin-composites methods development Dent Mater 2003 191ndash11

333Weaver WS Blank LW Pelleu GB Jr A visible light activated resin cured

through tooth structure GenDent 198836236-7

334Wendt SL Microleakage and cusp fracture resistance of heattreated composite

resin inlays Am J Dent 4(1)10-14 1991

335Wenzel A Hintze H Mikkelsen L Mouyen F Radiographic detection of

occlusal caries in noncavitated teeth A comparison of conventional film radiographs

digitized film radiographs and RadioVisioGraphy-Oral Surg Oral Med Oral Pathol

1991 72 621-6

336Wenzel A Hintze H Perception of image quality in direct digital radiography

after application of various image treatment filters for detectability of dental diseases

Dentomaxillofac Radiol 1993 22 131-4

337Wenzel A Computer-aided image manipulation of intraoral radiographs to

enhance diagnosis in dental practice a review Int Dent J 1993 43 99-108

338Wenzel A Digital radiography and caries diagnosis Dento Maxillo Facial

Radiology 27(1)3-11 1998

339Wenzel A Haiter-Neto F Gotfredsen E Risk factors for a false positive test

outcome in diagnosis of caries in approximal surfaces impact of radiographic

modality and observer characteristics Caries Res 200741(3)170-6

340Wibowo G Stockton L Microleakage of class II composite restorations Am J

Dent 200114177ndash185

341Wilson NHF Wastell DG Norman RD Five-year performance of high-

cooper content amalgam restorations in a multiclinical trial JDent1996 24 203-210

342Winkler MM Katona TR Paydar NH Finite element stress analysis of three

filling techniques for class V light-cured composite restorations J Dent Res

1996751477-83

343Yap AU Effectiveness of polymerization in composite restoratives claiming bulk

placement Impact of cavity depth and exposure time Oper Dent 2000 25113-120

59

344Yeşilyurt C Bulucu B Bond strength of total-etch dentin adhesive systems on

peripheral and central dentinal tissue a microtensile bond strength test The Journal of

Contemporary Dental Practice 7(2) 20061-13

345Yoshida Y Van Meerbeek B Okazaki M Shintani H Suzuki K Comparative

study on adhesive performance of functional monomers J Dent Res 2004 83 454-

458

346Yoshiyama M Tay FR Doi J Nishitani Y Yamada T Itou K Carvalho RM

Nakajima M Pashley DH Bonding of self-etch and total etch adhesives to carious

dentin J Dent Res 2002 81 556-560

  • COPERTA REZUMAT ENGLEZA (MEREUTA)pdf
  • REZUMAT ENGLEZA DR MEREUTA DENISSpdf
Page 28: UNIVERSITATEA DE MEDICINA SI FARMACIE “GR Doctorat/Rezumat... · universitatea de medicina si farmacie “gr.t.popa” iasi facultatea de medicina dentara rezumatul tezei de doctorat

25

După gravajul cu acid ortofosforic 37

The aspect of etched enamel at 15 mm distance from ECJ can be seen in

figure X2 (section 10 microm) The surface roughness is higher comparing with sample

before etching but lower comparing with sample at 2 mm from ECJ

The aspect of etched enamel at 1 mm distance from ECJ can be seen in figure

X3 (section 10 microm) The surface roughness is higher comparing with sample before

etching but lower comparing with sample at 15mm and 2 mm from ECJ

The aspect of etched enamel at 15 mm distance from ECJ can be seen in

figure X4 (section 10 microm) The surface roughness is higher comparing with sample

before etching but lower comparing with sample at 1 mm 15 mm and 2 mm from

ECJ

FigX1 3D aspect of enamel at 2 mm from ECJ

after etching (10 microm)

FigX2 3D aspect of enamel at 15 mm from ECJ

after etching (10 microm)

FigX3 3D aspect of enamel at 1 mm from ECJ

after etching (10 microm)

FigX4 3D aspect of enamel at 05 mm from ECJ

after etching (10 microm)

26

The mean values of squared roughness for dentine and enamel before etching

are presented in tables X1 and X2

Table X1 Squared roughness values for dentine samples before and after etching

Before etching (nm) After etching (nm)

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

sample

1

335 282 283 259 1149 947 901 879

sample

2

352 284 274 266 1127 939 883 875

sample

3

357 273 278 263 1152 953 876 867

sample

4

323 269 264 258 1146 942 895 883

sample

5

348 298 271 268 1153 944 904 878

sample

6

339 274 278 273 1158 937 893 892

sample

7

352 283 269 266 1145 944 899 876

sample

8

349 292 272 274 1166 942 907 869

sample

9

357 284 275 265 1132 939 893 879

sample

10

348 281 277 262 1142 941 899 878

Table X2 Squared roughness values for enamel and dentine samples before and after

etching

Before etching (nm) After etching (nm)

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

sample 1 422 342 309 313 2255 1114 874 845

sample 2 418 338 324 304 2236 1102 882 839

sample 3 413 334 315 303 2239 1115 873 833

sample 4 416 336 322 308 2242 1116 868 842

sample 5 426 332 315 294 2218 1103 877 829

sample 6 412 332 317 306 2237 1099 874 847

sample 7 414 335 322 314 2252 1102 876 834

sample 8 416 325 318 313 2239 1106 875 838

sample 9 418 328 314 299 2246 1113 879 836

sample 10 413 334 316 305 2242 1104 873 839

The results for samples before etching prove a decreasing tendency for mean

values of squared roughness surface beginning with areas placed at distance of 2 mm

from ECJ (346 nm) followed by areas placed at distance of 15 mm from ECJ (282

nm) 1 mm from ECJ (274 nm) and 05 mm from ECJ (265 nm) After etching the

decreasing tendency maintained for dentine localised at 2 mm from ECJ to dentine

localised at 05 mm from ECJ The mean values of squared roughness after etching

were three times higher (tables X3)

27

Table X3 Squared roughness values for enamel and dentine samples before and

after etching

Dentine Enamel

Before etching

(nm)

After etching

(nm)

Before etching

(nm)

After etching

(nm)

2 mm ECJ 346 1147 416 2237

15 mm ECJ 282 942 333 1107

1 mm ECJ 274 895 317 875

05 mm ECJ 265 877 305 838

The descriptive statistics data for surface roughness of dentine before and after

etching are presented in tables X4 si X5

Table X4 Descriptive statistics for dentine samples before etching

Statistics

Dentine 2mm

before etching

Dentine 15mm

before etching

Dentine 1mm

before etching

Dentine 05mm

before etching

N Valid 10 10 10 10

Missing 0 0 0 0

Mean 346000 282000 274100 265400

Std Error of Mean 33830 27487 17026 16746

Std Deviation 106979 86923 53841 52957

Skewness -1214 354 -314 348

Std Error of Skewness 687 687 687 687

Kurtosis 1141 049 336 -539

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 3230 2690 2640 2580

Maximum 3570 2980 2830 2740

Table X5 Descriptive statistics for dentine samples after etching

Statistics

Dentine 2mm

after etching

Dentine 15mm

after etching

Dentine 1mm

after etching

Dentine 05mm

after etching

N Valid 10 10 10 10

Missing 0 0 0 0

1147000 942800 895000 877600

Std Error of Mean 36545 14591 29926 22020

Std Deviation 115566 46140 94634 69634

Skewness -267 1169 -951 535

Std Error of Skewness 687 687 687 687

Kurtosis 043 1776 564 1416

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 11270 9370 8760 8670

28

Statistics

Dentine 2mm

after etching

Dentine 15mm

after etching

Dentine 1mm

after etching

Dentine 05mm

after etching

N Valid 10 10 10 10

Missing 0 0 0 0

1147000 942800 895000 877600

Std Error of Mean 36545 14591 29926 22020

Std Deviation 115566 46140 94634 69634

Skewness -267 1169 -951 535

Std Error of Skewness 687 687 687 687

Kurtosis 043 1776 564 1416

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 11270 9370 8760 8670

Maximum 11660 9530 9070 8920

To choose the statistical test to compare roughness surface values was

performed a test Shapiro-Wilk If p is lower or equal with 0005 than hypothesis of

distribution normality is rejected (distribution deviates from normal form) In the table

X6 the distributions are normal The statistical test will be test t for pair samples

Table X6 Test Shapiro-Wilk for dentine samples

Tests of Normality

Kolmogorov-Smirnov

a Shapiro-Wilk

Statistic df Sig Statistic df Sig

Dentine 2mm before etching 274 10 032 877 10 122

Dentine 15mm after etching 209 10 200 952 10 689

Dentine 1mm before etching 134 10 200 983 10 980

Dentine 05mm before etching 155 10 200 949 10 661

Dentine 2mm after etching 133 10 200 977 10 946

Dentine 15mm after etching 197 10 200 916 10 329

Dentine 1mm after etching 216 10 200 925 10 401

Dentine 05 after etching 220 10 185 933 10 474

Enamel 2mm before etching 193 10 200 898 10 207

Enamel 15mm before etching 170 10 200 977 10 947

Enamel 1mm before etching 157 10 200 952 10 689

Enamel 05mm before etching 165 10 200 943 10 590

Enamel 2mm after etching 235 10 124 925 10 404

Enamel 15mm after etching 209 10 200 871 10 102

Enamel 1mm after etching 189 10 200 964 10 834

Enamel 05mm after etching 142 10 200 983 10 978

a Lilliefors Significance Correction

29

Tests of Normality

Kolmogorov-Smirnov

a Shapiro-Wilk

Statistic df Sig Statistic df Sig

Dentine 2mm before etching 274 10 032 877 10 122

Dentine 15mm after etching 209 10 200 952 10 689

Dentine 1mm before etching 134 10 200 983 10 980

Dentine 05mm before etching 155 10 200 949 10 661

Dentine 2mm after etching 133 10 200 977 10 946

Dentine 15mm after etching 197 10 200 916 10 329

Dentine 1mm after etching 216 10 200 925 10 401

Dentine 05 after etching 220 10 185 933 10 474

Enamel 2mm before etching 193 10 200 898 10 207

Enamel 15mm before etching 170 10 200 977 10 947

Enamel 1mm before etching 157 10 200 952 10 689

Enamel 05mm before etching 165 10 200 943 10 590

Enamel 2mm after etching 235 10 124 925 10 404

Enamel 15mm after etching 209 10 200 871 10 102

Enamel 1mm after etching 189 10 200 964 10 834

Enamel 05mm after etching 142 10 200 983 10 978

a Lilliefors Significance Correction

This is a lower bound of the true significance

The results of test t for pair dentine samples before and after etching are

presented in table X

Table X7 Test t for dentine before and after etching

Paired Samples Test

Paired Differences

t df

p (2-

tailed)

95 Confidence

Interval of the

Difference

Mean

Std

Dev

Std

Error

Mean Lower Upper

Pair

1

dentine2mmbeforeetching-

dentine2mmafteretching

-

8010000

174801 55277 -

8135045

-

7884955

-

144906

9 000

Pair

2

dentine15mmbeforeetching-

dentine15mmafteretching

-

6608000

102394 32380 -

6681248

-

6534752

-

204079

9 000

Pair

3

dentine1mmbeforeetching-

dentine1mmafteretching

-

6209000

117799 37251 -

6293269

-

6124731

-

166678

9 000

30

Paired Samples Test

Paired Differences

t df

p (2-

tailed)

95 Confidence

Interval of the

Difference

Mean

Std

Dev

Std

Error

Mean Lower Upper

Pair

1

dentine2mmbeforeetching-

dentine2mmafteretching

-

8010000

174801 55277 -

8135045

-

7884955

-

144906

9 000

Pair

2

dentine15mmbeforeetching-

dentine15mmafteretching

-

6608000

102394 32380 -

6681248

-

6534752

-

204079

9 000

Pair

3

dentine1mmbeforeetching-

dentine1mmafteretching

-

6209000

117799 37251 -

6293269

-

6124731

-

166678

9 000

Pair

4

dentine05mmbeforeetching-

dentine05mmafteretching

-

6122000

86384 27317 -

6183796

-

6060204

-

224109

9 000

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of dentine (

2mm 15 mm 1mm sau 05mm)

The descriptive statistics data for dentine surface roughness before and after

etching are presented in tables X8 and X9

Table X8 Descriptive statistics for enamel samples before etching

Statistics

Enamel 2mm

before etching

Enamel 15mm

before etching

Enamel 1mm

before etching

Enamel 05mm

before etching

N Valid 10 10 10 10

Missing 0 0 0 0

Mean 416800 333600 317200 305900

Std Error of Mean 13968 15217 14205 20355

Std Deviation 44171 48120 44920 64369

Skewness 1095 -156 -109 -411

Std Error of Skewness 687 687 687 687

Kurtosis 769 487 -118 -295

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 4120 3250 3090 2940

Maximum 4260 3420 3240 3140

31

Table X9 Descriptive statistics for enamel samples after etching

Statistics

Enamel 2mm

after etching

Enamel 15mm

after etching

Enamel 1mm

after etching

Enamel 05mm

after etching

N Valid 10 10 10 10

Missing 0 0 0 0

Mean 2237600 1107400 875100 838200

Std Error of Mean 31027 20232 11968 17436

Std Deviation 98116 63979 37845 55136

Skewness -850 267 042 040

Std Error of Skewness 687 687 687 687

Kurtosis 878 -1880 1082 -425

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 22180 10990 8680 8290

Maximum 22520 11160 8820 8470

To choose the statistical test to compare roughness surface values was

performed a test Shapiro-Wilk If p is lower or equal with 0005 than hypothesis of

distribution normality is rejected (distribution deviates from normal form) In the table

X10 the distributions are normal The statistical test will be test t for pair samples

Table X10 Test Shapiro-Wilk for enamel samples

Tests of Normality

Kolmogorov-Smirnova Shapiro-Wilk

Statistic df Sig Statistic df Sig

2mmenamel before etching 193 10 200 898 10 207

15mmenamel before etching 170 10 200 977 10 947

1mmenamel before etching 157 10 200 952 10 689

05mmenamel before etching 165 10 200 943 10 590

2mmenamel after etching 235 10 124 925 10 404

15mmenamel after etching 209 10 200 871 10 102

1mmenamel after etching 189 10 200 964 10 834

05mmenamel after etching 142 10 200 983 10 978

a Lilliefors Significance Correction

This is a lower bound of the true significance

The results of test t for pair enamel samples before and after etching are

presented in table X11

32

Table X11 Test t for enamel samples before and after etching

Paired Samples Test

Paired Differences

t df

p (2-

tailed)

95 Confidence

Interval of the

Difference

Mean

Std

Deviation

Std

Error

Mean Lower Upper

Pair

1

2mmenamel before

etching

2mmenamel after

etching

-18208 135220 42760 -

18304731

-

18111269

-

425815

9 000

Pair

2

15mmenamel before

etching

15mmenamel after

etching

-7738 73151 23132 -7790329 -7685671 -

334508

9 076

Pair

3

1mmenamel before

etching

1mmenamel after

etching

-5579 55468 17540 -5618679 -5539321 -

318065

9 065

Pair

4

05mmenamel before

etching

05mmenamel after

etching

-5323 60378 19093 -5366192 -5279808 -

278788

9 063

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel ( 2mm 15 mm 1mm sau

05mm) but the differences statistical significant are present only for enamel localised

at 2 mm from ECJ

X5CONCLUSIONS

The surfaces of enamel and dentine at cervical level record decreases of

roughness related to the decrease of distance to ECJ

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel but the differences

statistical significant are present only for enamel localised at 2 mm from ECJ

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of

dentine

33

CHAPTXI FEA STUDY REGARDING THE BIOMECHANICAL

BEHAVIOUR AND FRACTURE RESISTANCE OF PROXIMO-OCCLUSAL

AMALGAM AND COMPOSITE RESINS RESTORATIONS

XI1INTRODUCTION AIM OF STUDY

The individual variation of patients morphological and functional complexity

of tissues as well as difficult access limit the possibilities to investigate in clinical

studies the biomechanical behaviour of proximo-occlusal restorations In this context

simulation of the biomechanics for direct restorations represents an interesting

interdisciplinar domain in actual dentistry research

The study focused on two direction

- analysis of role of forces intensity on biomechanical behaviour related to

cavity dimension and material

- analysis of tension inside restoration structure related to forces intensity

XI2MATERIALS AND METHODS

The stages of finite element analysis study are as follows

object modelling (bicusps and proximo-occlusal restoration)

definition of parameters for materials and dental tissues

meshing

constraints and loading

types of contacts

equations system definition

results of simulation

The object 3D modelling was performed in Rhinoceros (figure XI1) The

definition of parameters was performed for Poisson constant Young modulus density

(table XI1) The selected materials were amalgam and composite resins The

analysed tissues were dentine and enamel The meshing constraints loading were

performed for forces of 200N 400N 600N 800 N The analysis was performed using

software COSMOSWorks 2010

34

Fig XI1 3D modellation of bicusp

Table XI1 Values of Young modulus Poisson constant compression resistance for

amalgam composite resin enamel (amalgam compozit smalţ)

Material Young modulus (GPa) Poisson constants

Compression

resistance

(Mpa)

Amalgam 55 033 483

Enamel 48 03 400

Composite

resin 220 022 345

Fig XI2 The forces and constraints application

The results are presented in values and culours red colours representing areas

with maximum values of tensions produced under influence of masticatory forces

The tensions produced in amalgam restoration are in a range from 0 to 22886

(force 800 N) The maximum von Misses tensions are associated with cervical area

of amalgam restorations This aspect proves that first modification in interface

restoration-cavity margins will appear at the level of gingival wall First marginal

35

defects and fissures in restoration bulk will appear at tensions over 1600Mpa

associated with forces of 800N for extended amalgam proximo-occlusal restorations

The tensions produced in composite resin restorations are in a range from 0 to

2285 (force 800 N) The maximum von Misses tensions are associated with cervical

area of composite resin restorationsThis aspect proves that first modification in

interface restoration-cavity margins will appear at the level of gingival wall First

marginal defects and fissures in restoration bulk will appear at tensions over 1716

Mpa associated with forces of 600N for moderate and extended composite resins

proximo-occlusal restorations

Fig XI3a-b ndash Simulated model of proximo-occlusal restoration

FigXI4a-b Dental amalgam restoration Cervical tension associated with 600 N

(c)800 N (d)

FigXI5a-b Composite resin restoration Cervical tension associated with 600 N

(c)800 N (d)

36

The deformation of amalgam can be produced only when is associated with

fissures in bulk of restorations while composite resins restorations present

deformation when are associated with a modification of volume and form because of

repeated action of medium forces on long term or high forces on short term (figures

XI4 XI5)

Fig XI4 Material deformation in area of maximum tension

000E + 00

500E -02

100E -01

150E -01

200E -01

250E -01

1 4 7 101316192225283134374043464952555861646770737679

Amalgam C ompoz it

Figura XI5 Deformarea funcție de material

The amalgam and composite resins were treated as homogenous isotropic and

liniar The advantage of this type of FEA study is that restorations parameters can be

modified any time is necessary both in arhitecture geometry and material indices

variability The results of this study sustain the conclusions of other FEA studies

focused on biomechanical behaviour of posterior restorations performed with

amalgam and composite resins(35 62 76 143)

37

XI4CONCLUSIONS

bull The amalgam in class II restorations has a low deformation tendency because

of uniform distribution of tension inside material

bull Composite resins class II restorations accumulate higher tensions comparing

with amalgam but deformation is avoided for a time because of the adhesion

forces performed between molecules under moderate oral forces In case of

high oral forces (600-800N) the risk of fracture in moderate class II

restorations is higher comparing with amalgam proximo-occlusal restorations

For extended class II restorations and forces of 600 N composite resins present

highest risk of fracture and deformation The von Misses tension at the

cervical interface restorationtooth can reach 1600Mpa

bull The amalgam in moderate class II restorations can resist to deformation even

for high intensity forces limited to 600N In extended class II restorations the

risk of deformation and fracture increases at values of 600N-800N of oral

forces The von Misses tension at the cervical interface restorationtooth can

reach 1700 Mpa

38

FINAL CONCLUSIONS

Amalgam proximo-occlusal restorations with minimum 6-years age present

excellent results for parameters anatomic form (occlusal) marginal

discoloration and marginal secondary dental caries good results for

parameters anatomic form (proximal) and marginal adaptation and poor results

for surface quality

Composite resins proximo-occlusal restorations (bicusps) with minimum 6-

years age present excellent results for parameters color match marginal

discoloration and marginal secondary dental caries and good results for

parameters anatomic form (occlusal proximal) marginal adaptation surface

quality

Composite resins proximo-occlusal restorations (molars) with minimum 6-

years age present good results for parameters color match marginal

discoloration marginal secondary dental caries marginal adaptation and poor

results for parameters anatomic form (occlusal) (54 indices Ryge C)

anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The restorations extended at external third of occlusal surface present highest

percents of indices C regarding anatomic form (occlusal) (54 indices Ryge

C) anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The exceeding of 6-years age will require careful monitorisation for early

interventions through polishing sealing reshaping and even replacement for

restorations with major defects

Oblique layering technique presents superior results regarding marginal

adaptation and marginal discoloration and is recommended for proximo-

occlusal dental caries close to enamel-cement jonction

Centripetal build-up presents good results regarding marginal adaptation and

anatomical form at proximal level (proximal surfaces and contact point)

Horisontal layering technique can be used for optimum results only in

proximal-occlusal cavities with moderate extension both in occlusal-cervical

and buccal-oral

The values of die penetration at gingival wall were statistically different

between the three restorative techniques

We concluded that all restorative methods were associated with lightcuring

contraction and marginal microleakage

The combined technique was associated with lowest lightcuring contraction

and die penetration

The bulk technique was associated with highest lightcuring contraction and die

penetration

39

The surfaces of enamel and dentine at cervical level record decreases of

roughness related to the decrease of distance to ECJ

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel but the differences

statistical significant are present only for enamel localised at 2 mm from ECJ

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of

dentine

bull The amalgam in class II restorations has a low deformation tendency because

of uniform distribution of tension inside material

bull Composite resins class II restorations accumulate higher tensions comparing

with amalgam but deformation is avoided for a time because of the adhesion

forces performed between molecules under moderate oral forces In case of

high oral forces (600-800N) the risk of fracture in moderate class II

restorations is higher comparing with amalgam proximo-occlusal restorations

For extended class II restorations and forces of 600 N composite resins present

highest risk of fracture and deformation The von Misses tension at the

cervical interface restorationtooth can reach 1600Mpa

bull The amalgam in moderate class II restorations can resist to deformation even

for high intensity forces limited to 600N In extended class II restorations the

risk of deformation and fracture increases at values of 600N-800N of oral

forces The von Misses tension at the cervical interface restorationtooth can

reach 1700 Mpa

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Pract 20056(3)62-9

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incremental methods in Class II composite resin restorations on gingival

microleakage J Contemp Dent Pract 20078(2)113-20

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polymerization shrinkage stress current techniques for posterior direct resin

restorations J Contemp Dent Pract 20067(4)79-88

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Effects of irradiation mode and filling technique on resindentin bond strength in

Class I cavities J Dent Res 200281 (Abstract)

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JADA 1972841349-1357

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46

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2007

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848

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135- 144

136Hinoura K Setcos JK Philips RW Cavity design and placement technique for

class 2 composites Oper Dent 19981312-19

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19-23

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Dent Oral Epidemiol 200533(3)212-8

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1995202ndash 6

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influence of simulated clinical handling on the flexural and compressive strength of

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Bucureşti 2001

148Inoue S Van Meerbeek B Vargas M Lambrechts P Vanherle G Adhesion

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Prati C Grafiche Erredue 2000131-148

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Activity EdApollonia Iasi2002

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Mater 1995 11(2)132-6

152Jackson RD Morgan M The new posterior resins and a simplified placement

technique J Am Dent Assoc 2000131375ndash383

153Jain P Belcher M Microleakage of class II resin-based composite restorations

with flowable composite in the proximal box Am J Dent 200013235ndash238

48

154Jokstad A Mjor IA Analyses of long-term clinical behaviour of class II

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Kompositefullungen Zahnartzlicher Welt 1999 108 270-273

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restorative decisions made on the basis of simulated bitewing radiographs

Community Dentistry and Oral Epidemiology 1994 22(2) 71-74

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composite restorations effected by increased flexibility J Dent Res 1990 691240ndash

1243

161Khairallah C Hokayem A Long-term clinical evaluation of 2 dental materials

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200932(126)21-8

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Biology199843(8)629-632

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817-822

165Kiremitci A Alpaslan T Gurgan SSix-year clinical evaluation of packable

composite restorations Oper Dent 200934(1)11-7

166Kleverlaan CJ Feilzer AJ Polymerization shrinkage and contraction stress of

dental resin composites Dent Mater 2005 211150-1157

167Koenigsberg SA Fuks R GrajowerThe effect of three filling techniques on

marginal leakage around class II composite resin restorations in vitroQuint Int

201989117ndash121

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18(7)516-20

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170Koyuturk A E Sengun A Ozer F Sener Y Gokalp A Shear Bond Strengths

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Materials Journal 2006 25(1)59-65

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Dent 27(5)325-331 1999

49

172Krejci I Lieber CM Lutz FTime required to remove totally bonded tooth-

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Jan11(1)34-40

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JProsthet Dent 199369(4)425-430

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thermal behavior of dental composites Dent Mater 2008 24(8)1017ndash1024

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Borgmeijer PJ Replacement risk of amalgam treatment modalities 15-year results

JDent 199826 627-632

176Labella R Lambrechts P Van Meerbeek B Vanherle G Polymerization

shrinkage and elasticity of flowable composites and filled adhesives Dent Mater

1999 15128-137

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178Lăcătuşu St- Caria dentară explozivă- EdCronica Iaşi 1996

179Lăcătuşu St Luminiţa Costinescu Andrian S Gianina Iovan Valeria

Pendefunda 180Sorina Solomon Topoliceanu C Elements of dispersional

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Edition of the Balkan Medical Days

Stomatological Section Abstract nr1091999128

181Lăcătuşu St Andrian S Gianina Iovan- Consideraţii asupra adaptării

amalgamelor dentare la pereţii cavităţilor RevMedicina

StomatologicăVol2199823-26

182Leevailoj C Cochran MA Matis BA Moore BK Platt JA Microleakage of

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200126302ndash307

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Dentistry and Oral Epidemiology 1996 24 106-11

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Dent Mater 2002 18436-444

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20(3)236-43

188Loguercio AD Reis A Schroeder M Balducci I Versluis A Ballester RY

Polymerization shrinkage effects of boundary conditions and filling technique of

resin composite restorations J Dent 2004 32(6)459-70

50

189Lopes GC Baratieri LN Monteiro S Jr Vieira LC Effect of posterior resin

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Quintessence Int 2004 35(2)156-61

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art and future perspectives Quintessence Int 200233213-224

191Loumlsche GM Marginal adaptation of class II composite fillings guided

polymerization vs reduced light intensity J Adhes Dent 1 199931ndash39

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193Lovell LG Stansbury JW Syrpes DC Bowman CN Effects of composition

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copolymerizations Macromolecules 1999 323913-3921

194Lutz F Krejci I Barbakow F Quality and durability of marginal adaptation in

bonded composite restorations Dent Mater 1991 7(2) 107-13

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clinical results J Dent Res 199877 1020

196Mair LH Ten-year clinical assessment of three posterior resin composites and

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Dentomaxillofac Radiol 2007 Oct36(7)377-81

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J Prosthet Dent 2000 Sep84(3)289-96

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Three-year clinical evaluation of composite and ceramic inlays Am J Dent 2001

Apr14(2)95-9

202Manhart J Chen HY Draegert U Kunzelmann KH Hickel R Vickers

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79369 (Abstract)

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PrimDentCare1999Apr659-62

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ScandJDRes 199210060-65

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33

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Am Dent Assoc 2010 141(3)319-29

52

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125749-751

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34

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Monogr Oral Sci 20092142-51

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569ndash575

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Community Dent Oral Epidemiol 1980 Jun8(3)135-8

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posterior composite 10-year report J Dent 199927(1) 13ndash19

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of teeth with long-term performing composite restorations J Oral Rehabil 2002

29(12)1131ndash1138

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Operative Dentistry 5th ed St Louis Mosby 2006293-7

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examiners evaluating amalgam restorations Oper Dent 1997 Mar-Apr22(2)57-65

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conditions on ceramiccomposite bond strength J Dent Res 1995 74(l)381-387

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ClinOral Invest1997140-46

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affecting cure at depths within light-activated resin composites Am J Dent

1993691ndash95

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contemporary light curing units using microhardness J Esthet Dent 200012340-9

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of new adult patients diagnostic yield when combined with bitewing radiography and

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microleakage of deep class-II cavities restored with two composite resin formulations

J Conserv Dent 201013(1)9-15

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of polymerization contraction in composite restorations J Dent 1992 20178ndash182

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mechanical analysis of storage modulus development in lightactivated polymer matrix

composites Dent Mater 200218197-202

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Nanoleakage leakage within the hybrid layer Oper Dent 1995 20 18-25

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posterior composite restorations Dent Mater 200521(1) 9ndash12

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packable posterior composite in bulk-cured restorations JADA 2006 137(1)71ndash80

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edition 1996

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Assessment of dental caries with Digital Imaging Fiber-Optic Transillumination (DI-

FOTI)in vitro studyCaries Res 1997 31(2) 103-110

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caries diagnosis after data import from different digital radiography systems

interobserver agreement and comparison to histological hard-tissue sections Caries

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clinical evaluation of bonded amalgam restorations- Journal of Adhesive Dentistry

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of conversion in light-cured dimethacrylate-based dental resins Biomaterials 2002

231819-1829

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modulus of elasticity of light-cured dimethacrylate-based dental resins Biomaterials

2003 24655-665

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York Springer-Verlag 1999

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restorations JDent1991 19 272-277

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Am Dent Assoc 2007 Jun138(6)763-72

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Quintessence 2000253ndash76

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Two-year results J Oral Rehabil 1990 17 257-268

304Stephen KW Russell JI Creanor SL Comparison of fibre optic

transillumination with clinical and radiographic caries diagnosis Community

Dentistry and Oral Epidemiology 1987 15 (2) 90-94

305Sturdevant JR Bayne SC Heymann HO Margin gap size of ceramic inlays

using second-generation CADCAM equipment J Esthet Dent 11(4)206-214 1999

306Suh BI A study of the compatibility of adhesives with composites Proceeding

from the SCO Dental Products Inc Symposium 2003 24(8) 4-9 (Abstract)

307Summit JB Burgess JO Berry TG Six-year clinical evaluation of bonded and

pin-retained complex amalgam restorations Oper Dent 2004 29269-276

308Summit JB Robbins JW Hilton TJ Fundamentals in operative dentistry Cap

10Direct Posterior Esthetic Restorations 2006 Quintessence Publishing Co

57

309Svanberg M Mjor IA Orstavik D Mutans streptococci in plaque from margins

of amalgam composite and glassndashionomer restorations J Dent Res 199069861ndash

864

310Tanne K Mamoru S Burstone C Three-dimensional finite element analysis

for stress in the periodontal tissue by orthodontic forcesAm J Orthod Dentofacial

Orthop921987499ndash505

311Tanumiharja M Burrow MF Tyas MJ Microtensile bond strengths of seven

dentin adhesive systems Dent Mater 2000 16(3)180-7

312Tay FR Pashley DH Aggressiveness of contemporary self-etching systems

Part I Depth of penetration beyond dentin smear layers Dent Mater 2001 17(4) 296-

308

313Tay FR Frankenberger R Krejci I Bouillaguet S Pashley DH Carvalho

RM Single-bottle adhesives behave as permeable membranes after polymerization I

In vivo evidence J Dent 2004 32611ndash621

314Tay FR Pashley DH Have dentin adhesives become too hydrophilic J Can

Dent Assoc 2003 69726ndash731

315Tay FR Sano H Carvalho R Pashley EL Pashley DH An ultrastructural

study of the influence of acidity of self-etching primers and smear layer thickness on

bonding to intact dentin J Adhes Dent 2000 283ndash98

316Thompson JY Bayne SC Heymann HO Mechanical properties of a new

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76(6)619-623 1996

317Unterbrink GL R Muessner Influence of light intensity on two restorative

systems J Dent 199523183ndash189

318Unterbrink GL Liebenberg WH Flowable resin composites as filled

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199930249ndash257

319Vaarkamp J Ten Bosch J Verdonschot EH Quantitative diagnosis of small

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320Valachovic RW Douglass CW Reiskin AB Chauncey HH McNeil BJ The

use of panoramic radiography in the evaluation of asymptomatic adult dental patients

Oral Surg Oral Med Oral Pathol 198661(3)289-96

321Van Meerbeek B De Munck J Yoshida Y Inoue S Vargas M Vijay P Van

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322Van Meerbeek B Van Landuyt K De Munck JHashimoto M Peumans M

Lambrechts P Yoshida Y Inoue S Suzuki K Technique-sensitivity of

contemporary adhesives Dent Mater J 2005 24(1) 1-13

323Van Meerbeek B Vargas S Inoue S Yoshida Y Peumans M Lambrechts P

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20016 119-144

324Van Meerbeek B Yoshida Y Inoue S Vargas M Abe Y Fukuda R Okazaki

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58

325Van Nieuwenhuysen JP DrsquoHoore W Carvalho J Qvist V Long-term

evaluation of extensive restorations in permanent teeth J Dent 200331(6)395ndash405

326Venhoven BA de Gee AJ Davidson CL Light initiation of dental resins

dynamics of the polymerization Biomaterials 1996 172313-2318

327Versluis A Douglas WH Cross M Sakaguchi RL Does an incremental filling

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328Vries HC Ruiken HM Konig KG vanrsquot Hof MA Radiographic versus

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329Waggoner W Ashton J Predictability of cavitation based upon radiographic

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330Watanabe LG Marshall GW Jr Marshall SJ Dentin shear strength effects of

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331Watts DC AS Marouf Optimal specimen geometry in bonded-disk

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451

332Watts DC Marouf AS Al-Hindi AM Photo-polymerization shrinkage-stress

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333Weaver WS Blank LW Pelleu GB Jr A visible light activated resin cured

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334Wendt SL Microleakage and cusp fracture resistance of heattreated composite

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335Wenzel A Hintze H Mikkelsen L Mouyen F Radiographic detection of

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336Wenzel A Hintze H Perception of image quality in direct digital radiography

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337Wenzel A Computer-aided image manipulation of intraoral radiographs to

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338Wenzel A Digital radiography and caries diagnosis Dento Maxillo Facial

Radiology 27(1)3-11 1998

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341Wilson NHF Wastell DG Norman RD Five-year performance of high-

cooper content amalgam restorations in a multiclinical trial JDent1996 24 203-210

342Winkler MM Katona TR Paydar NH Finite element stress analysis of three

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1996751477-83

343Yap AU Effectiveness of polymerization in composite restoratives claiming bulk

placement Impact of cavity depth and exposure time Oper Dent 2000 25113-120

59

344Yeşilyurt C Bulucu B Bond strength of total-etch dentin adhesive systems on

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Contemporary Dental Practice 7(2) 20061-13

345Yoshida Y Van Meerbeek B Okazaki M Shintani H Suzuki K Comparative

study on adhesive performance of functional monomers J Dent Res 2004 83 454-

458

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Nakajima M Pashley DH Bonding of self-etch and total etch adhesives to carious

dentin J Dent Res 2002 81 556-560

  • COPERTA REZUMAT ENGLEZA (MEREUTA)pdf
  • REZUMAT ENGLEZA DR MEREUTA DENISSpdf
Page 29: UNIVERSITATEA DE MEDICINA SI FARMACIE “GR Doctorat/Rezumat... · universitatea de medicina si farmacie “gr.t.popa” iasi facultatea de medicina dentara rezumatul tezei de doctorat

26

The mean values of squared roughness for dentine and enamel before etching

are presented in tables X1 and X2

Table X1 Squared roughness values for dentine samples before and after etching

Before etching (nm) After etching (nm)

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

sample

1

335 282 283 259 1149 947 901 879

sample

2

352 284 274 266 1127 939 883 875

sample

3

357 273 278 263 1152 953 876 867

sample

4

323 269 264 258 1146 942 895 883

sample

5

348 298 271 268 1153 944 904 878

sample

6

339 274 278 273 1158 937 893 892

sample

7

352 283 269 266 1145 944 899 876

sample

8

349 292 272 274 1166 942 907 869

sample

9

357 284 275 265 1132 939 893 879

sample

10

348 281 277 262 1142 941 899 878

Table X2 Squared roughness values for enamel and dentine samples before and after

etching

Before etching (nm) After etching (nm)

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

2mm

ECJ

15mm

ECJ

1mm

ECJ

05mm

ECJ

sample 1 422 342 309 313 2255 1114 874 845

sample 2 418 338 324 304 2236 1102 882 839

sample 3 413 334 315 303 2239 1115 873 833

sample 4 416 336 322 308 2242 1116 868 842

sample 5 426 332 315 294 2218 1103 877 829

sample 6 412 332 317 306 2237 1099 874 847

sample 7 414 335 322 314 2252 1102 876 834

sample 8 416 325 318 313 2239 1106 875 838

sample 9 418 328 314 299 2246 1113 879 836

sample 10 413 334 316 305 2242 1104 873 839

The results for samples before etching prove a decreasing tendency for mean

values of squared roughness surface beginning with areas placed at distance of 2 mm

from ECJ (346 nm) followed by areas placed at distance of 15 mm from ECJ (282

nm) 1 mm from ECJ (274 nm) and 05 mm from ECJ (265 nm) After etching the

decreasing tendency maintained for dentine localised at 2 mm from ECJ to dentine

localised at 05 mm from ECJ The mean values of squared roughness after etching

were three times higher (tables X3)

27

Table X3 Squared roughness values for enamel and dentine samples before and

after etching

Dentine Enamel

Before etching

(nm)

After etching

(nm)

Before etching

(nm)

After etching

(nm)

2 mm ECJ 346 1147 416 2237

15 mm ECJ 282 942 333 1107

1 mm ECJ 274 895 317 875

05 mm ECJ 265 877 305 838

The descriptive statistics data for surface roughness of dentine before and after

etching are presented in tables X4 si X5

Table X4 Descriptive statistics for dentine samples before etching

Statistics

Dentine 2mm

before etching

Dentine 15mm

before etching

Dentine 1mm

before etching

Dentine 05mm

before etching

N Valid 10 10 10 10

Missing 0 0 0 0

Mean 346000 282000 274100 265400

Std Error of Mean 33830 27487 17026 16746

Std Deviation 106979 86923 53841 52957

Skewness -1214 354 -314 348

Std Error of Skewness 687 687 687 687

Kurtosis 1141 049 336 -539

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 3230 2690 2640 2580

Maximum 3570 2980 2830 2740

Table X5 Descriptive statistics for dentine samples after etching

Statistics

Dentine 2mm

after etching

Dentine 15mm

after etching

Dentine 1mm

after etching

Dentine 05mm

after etching

N Valid 10 10 10 10

Missing 0 0 0 0

1147000 942800 895000 877600

Std Error of Mean 36545 14591 29926 22020

Std Deviation 115566 46140 94634 69634

Skewness -267 1169 -951 535

Std Error of Skewness 687 687 687 687

Kurtosis 043 1776 564 1416

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 11270 9370 8760 8670

28

Statistics

Dentine 2mm

after etching

Dentine 15mm

after etching

Dentine 1mm

after etching

Dentine 05mm

after etching

N Valid 10 10 10 10

Missing 0 0 0 0

1147000 942800 895000 877600

Std Error of Mean 36545 14591 29926 22020

Std Deviation 115566 46140 94634 69634

Skewness -267 1169 -951 535

Std Error of Skewness 687 687 687 687

Kurtosis 043 1776 564 1416

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 11270 9370 8760 8670

Maximum 11660 9530 9070 8920

To choose the statistical test to compare roughness surface values was

performed a test Shapiro-Wilk If p is lower or equal with 0005 than hypothesis of

distribution normality is rejected (distribution deviates from normal form) In the table

X6 the distributions are normal The statistical test will be test t for pair samples

Table X6 Test Shapiro-Wilk for dentine samples

Tests of Normality

Kolmogorov-Smirnov

a Shapiro-Wilk

Statistic df Sig Statistic df Sig

Dentine 2mm before etching 274 10 032 877 10 122

Dentine 15mm after etching 209 10 200 952 10 689

Dentine 1mm before etching 134 10 200 983 10 980

Dentine 05mm before etching 155 10 200 949 10 661

Dentine 2mm after etching 133 10 200 977 10 946

Dentine 15mm after etching 197 10 200 916 10 329

Dentine 1mm after etching 216 10 200 925 10 401

Dentine 05 after etching 220 10 185 933 10 474

Enamel 2mm before etching 193 10 200 898 10 207

Enamel 15mm before etching 170 10 200 977 10 947

Enamel 1mm before etching 157 10 200 952 10 689

Enamel 05mm before etching 165 10 200 943 10 590

Enamel 2mm after etching 235 10 124 925 10 404

Enamel 15mm after etching 209 10 200 871 10 102

Enamel 1mm after etching 189 10 200 964 10 834

Enamel 05mm after etching 142 10 200 983 10 978

a Lilliefors Significance Correction

29

Tests of Normality

Kolmogorov-Smirnov

a Shapiro-Wilk

Statistic df Sig Statistic df Sig

Dentine 2mm before etching 274 10 032 877 10 122

Dentine 15mm after etching 209 10 200 952 10 689

Dentine 1mm before etching 134 10 200 983 10 980

Dentine 05mm before etching 155 10 200 949 10 661

Dentine 2mm after etching 133 10 200 977 10 946

Dentine 15mm after etching 197 10 200 916 10 329

Dentine 1mm after etching 216 10 200 925 10 401

Dentine 05 after etching 220 10 185 933 10 474

Enamel 2mm before etching 193 10 200 898 10 207

Enamel 15mm before etching 170 10 200 977 10 947

Enamel 1mm before etching 157 10 200 952 10 689

Enamel 05mm before etching 165 10 200 943 10 590

Enamel 2mm after etching 235 10 124 925 10 404

Enamel 15mm after etching 209 10 200 871 10 102

Enamel 1mm after etching 189 10 200 964 10 834

Enamel 05mm after etching 142 10 200 983 10 978

a Lilliefors Significance Correction

This is a lower bound of the true significance

The results of test t for pair dentine samples before and after etching are

presented in table X

Table X7 Test t for dentine before and after etching

Paired Samples Test

Paired Differences

t df

p (2-

tailed)

95 Confidence

Interval of the

Difference

Mean

Std

Dev

Std

Error

Mean Lower Upper

Pair

1

dentine2mmbeforeetching-

dentine2mmafteretching

-

8010000

174801 55277 -

8135045

-

7884955

-

144906

9 000

Pair

2

dentine15mmbeforeetching-

dentine15mmafteretching

-

6608000

102394 32380 -

6681248

-

6534752

-

204079

9 000

Pair

3

dentine1mmbeforeetching-

dentine1mmafteretching

-

6209000

117799 37251 -

6293269

-

6124731

-

166678

9 000

30

Paired Samples Test

Paired Differences

t df

p (2-

tailed)

95 Confidence

Interval of the

Difference

Mean

Std

Dev

Std

Error

Mean Lower Upper

Pair

1

dentine2mmbeforeetching-

dentine2mmafteretching

-

8010000

174801 55277 -

8135045

-

7884955

-

144906

9 000

Pair

2

dentine15mmbeforeetching-

dentine15mmafteretching

-

6608000

102394 32380 -

6681248

-

6534752

-

204079

9 000

Pair

3

dentine1mmbeforeetching-

dentine1mmafteretching

-

6209000

117799 37251 -

6293269

-

6124731

-

166678

9 000

Pair

4

dentine05mmbeforeetching-

dentine05mmafteretching

-

6122000

86384 27317 -

6183796

-

6060204

-

224109

9 000

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of dentine (

2mm 15 mm 1mm sau 05mm)

The descriptive statistics data for dentine surface roughness before and after

etching are presented in tables X8 and X9

Table X8 Descriptive statistics for enamel samples before etching

Statistics

Enamel 2mm

before etching

Enamel 15mm

before etching

Enamel 1mm

before etching

Enamel 05mm

before etching

N Valid 10 10 10 10

Missing 0 0 0 0

Mean 416800 333600 317200 305900

Std Error of Mean 13968 15217 14205 20355

Std Deviation 44171 48120 44920 64369

Skewness 1095 -156 -109 -411

Std Error of Skewness 687 687 687 687

Kurtosis 769 487 -118 -295

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 4120 3250 3090 2940

Maximum 4260 3420 3240 3140

31

Table X9 Descriptive statistics for enamel samples after etching

Statistics

Enamel 2mm

after etching

Enamel 15mm

after etching

Enamel 1mm

after etching

Enamel 05mm

after etching

N Valid 10 10 10 10

Missing 0 0 0 0

Mean 2237600 1107400 875100 838200

Std Error of Mean 31027 20232 11968 17436

Std Deviation 98116 63979 37845 55136

Skewness -850 267 042 040

Std Error of Skewness 687 687 687 687

Kurtosis 878 -1880 1082 -425

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 22180 10990 8680 8290

Maximum 22520 11160 8820 8470

To choose the statistical test to compare roughness surface values was

performed a test Shapiro-Wilk If p is lower or equal with 0005 than hypothesis of

distribution normality is rejected (distribution deviates from normal form) In the table

X10 the distributions are normal The statistical test will be test t for pair samples

Table X10 Test Shapiro-Wilk for enamel samples

Tests of Normality

Kolmogorov-Smirnova Shapiro-Wilk

Statistic df Sig Statistic df Sig

2mmenamel before etching 193 10 200 898 10 207

15mmenamel before etching 170 10 200 977 10 947

1mmenamel before etching 157 10 200 952 10 689

05mmenamel before etching 165 10 200 943 10 590

2mmenamel after etching 235 10 124 925 10 404

15mmenamel after etching 209 10 200 871 10 102

1mmenamel after etching 189 10 200 964 10 834

05mmenamel after etching 142 10 200 983 10 978

a Lilliefors Significance Correction

This is a lower bound of the true significance

The results of test t for pair enamel samples before and after etching are

presented in table X11

32

Table X11 Test t for enamel samples before and after etching

Paired Samples Test

Paired Differences

t df

p (2-

tailed)

95 Confidence

Interval of the

Difference

Mean

Std

Deviation

Std

Error

Mean Lower Upper

Pair

1

2mmenamel before

etching

2mmenamel after

etching

-18208 135220 42760 -

18304731

-

18111269

-

425815

9 000

Pair

2

15mmenamel before

etching

15mmenamel after

etching

-7738 73151 23132 -7790329 -7685671 -

334508

9 076

Pair

3

1mmenamel before

etching

1mmenamel after

etching

-5579 55468 17540 -5618679 -5539321 -

318065

9 065

Pair

4

05mmenamel before

etching

05mmenamel after

etching

-5323 60378 19093 -5366192 -5279808 -

278788

9 063

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel ( 2mm 15 mm 1mm sau

05mm) but the differences statistical significant are present only for enamel localised

at 2 mm from ECJ

X5CONCLUSIONS

The surfaces of enamel and dentine at cervical level record decreases of

roughness related to the decrease of distance to ECJ

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel but the differences

statistical significant are present only for enamel localised at 2 mm from ECJ

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of

dentine

33

CHAPTXI FEA STUDY REGARDING THE BIOMECHANICAL

BEHAVIOUR AND FRACTURE RESISTANCE OF PROXIMO-OCCLUSAL

AMALGAM AND COMPOSITE RESINS RESTORATIONS

XI1INTRODUCTION AIM OF STUDY

The individual variation of patients morphological and functional complexity

of tissues as well as difficult access limit the possibilities to investigate in clinical

studies the biomechanical behaviour of proximo-occlusal restorations In this context

simulation of the biomechanics for direct restorations represents an interesting

interdisciplinar domain in actual dentistry research

The study focused on two direction

- analysis of role of forces intensity on biomechanical behaviour related to

cavity dimension and material

- analysis of tension inside restoration structure related to forces intensity

XI2MATERIALS AND METHODS

The stages of finite element analysis study are as follows

object modelling (bicusps and proximo-occlusal restoration)

definition of parameters for materials and dental tissues

meshing

constraints and loading

types of contacts

equations system definition

results of simulation

The object 3D modelling was performed in Rhinoceros (figure XI1) The

definition of parameters was performed for Poisson constant Young modulus density

(table XI1) The selected materials were amalgam and composite resins The

analysed tissues were dentine and enamel The meshing constraints loading were

performed for forces of 200N 400N 600N 800 N The analysis was performed using

software COSMOSWorks 2010

34

Fig XI1 3D modellation of bicusp

Table XI1 Values of Young modulus Poisson constant compression resistance for

amalgam composite resin enamel (amalgam compozit smalţ)

Material Young modulus (GPa) Poisson constants

Compression

resistance

(Mpa)

Amalgam 55 033 483

Enamel 48 03 400

Composite

resin 220 022 345

Fig XI2 The forces and constraints application

The results are presented in values and culours red colours representing areas

with maximum values of tensions produced under influence of masticatory forces

The tensions produced in amalgam restoration are in a range from 0 to 22886

(force 800 N) The maximum von Misses tensions are associated with cervical area

of amalgam restorations This aspect proves that first modification in interface

restoration-cavity margins will appear at the level of gingival wall First marginal

35

defects and fissures in restoration bulk will appear at tensions over 1600Mpa

associated with forces of 800N for extended amalgam proximo-occlusal restorations

The tensions produced in composite resin restorations are in a range from 0 to

2285 (force 800 N) The maximum von Misses tensions are associated with cervical

area of composite resin restorationsThis aspect proves that first modification in

interface restoration-cavity margins will appear at the level of gingival wall First

marginal defects and fissures in restoration bulk will appear at tensions over 1716

Mpa associated with forces of 600N for moderate and extended composite resins

proximo-occlusal restorations

Fig XI3a-b ndash Simulated model of proximo-occlusal restoration

FigXI4a-b Dental amalgam restoration Cervical tension associated with 600 N

(c)800 N (d)

FigXI5a-b Composite resin restoration Cervical tension associated with 600 N

(c)800 N (d)

36

The deformation of amalgam can be produced only when is associated with

fissures in bulk of restorations while composite resins restorations present

deformation when are associated with a modification of volume and form because of

repeated action of medium forces on long term or high forces on short term (figures

XI4 XI5)

Fig XI4 Material deformation in area of maximum tension

000E + 00

500E -02

100E -01

150E -01

200E -01

250E -01

1 4 7 101316192225283134374043464952555861646770737679

Amalgam C ompoz it

Figura XI5 Deformarea funcție de material

The amalgam and composite resins were treated as homogenous isotropic and

liniar The advantage of this type of FEA study is that restorations parameters can be

modified any time is necessary both in arhitecture geometry and material indices

variability The results of this study sustain the conclusions of other FEA studies

focused on biomechanical behaviour of posterior restorations performed with

amalgam and composite resins(35 62 76 143)

37

XI4CONCLUSIONS

bull The amalgam in class II restorations has a low deformation tendency because

of uniform distribution of tension inside material

bull Composite resins class II restorations accumulate higher tensions comparing

with amalgam but deformation is avoided for a time because of the adhesion

forces performed between molecules under moderate oral forces In case of

high oral forces (600-800N) the risk of fracture in moderate class II

restorations is higher comparing with amalgam proximo-occlusal restorations

For extended class II restorations and forces of 600 N composite resins present

highest risk of fracture and deformation The von Misses tension at the

cervical interface restorationtooth can reach 1600Mpa

bull The amalgam in moderate class II restorations can resist to deformation even

for high intensity forces limited to 600N In extended class II restorations the

risk of deformation and fracture increases at values of 600N-800N of oral

forces The von Misses tension at the cervical interface restorationtooth can

reach 1700 Mpa

38

FINAL CONCLUSIONS

Amalgam proximo-occlusal restorations with minimum 6-years age present

excellent results for parameters anatomic form (occlusal) marginal

discoloration and marginal secondary dental caries good results for

parameters anatomic form (proximal) and marginal adaptation and poor results

for surface quality

Composite resins proximo-occlusal restorations (bicusps) with minimum 6-

years age present excellent results for parameters color match marginal

discoloration and marginal secondary dental caries and good results for

parameters anatomic form (occlusal proximal) marginal adaptation surface

quality

Composite resins proximo-occlusal restorations (molars) with minimum 6-

years age present good results for parameters color match marginal

discoloration marginal secondary dental caries marginal adaptation and poor

results for parameters anatomic form (occlusal) (54 indices Ryge C)

anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The restorations extended at external third of occlusal surface present highest

percents of indices C regarding anatomic form (occlusal) (54 indices Ryge

C) anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The exceeding of 6-years age will require careful monitorisation for early

interventions through polishing sealing reshaping and even replacement for

restorations with major defects

Oblique layering technique presents superior results regarding marginal

adaptation and marginal discoloration and is recommended for proximo-

occlusal dental caries close to enamel-cement jonction

Centripetal build-up presents good results regarding marginal adaptation and

anatomical form at proximal level (proximal surfaces and contact point)

Horisontal layering technique can be used for optimum results only in

proximal-occlusal cavities with moderate extension both in occlusal-cervical

and buccal-oral

The values of die penetration at gingival wall were statistically different

between the three restorative techniques

We concluded that all restorative methods were associated with lightcuring

contraction and marginal microleakage

The combined technique was associated with lowest lightcuring contraction

and die penetration

The bulk technique was associated with highest lightcuring contraction and die

penetration

39

The surfaces of enamel and dentine at cervical level record decreases of

roughness related to the decrease of distance to ECJ

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel but the differences

statistical significant are present only for enamel localised at 2 mm from ECJ

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of

dentine

bull The amalgam in class II restorations has a low deformation tendency because

of uniform distribution of tension inside material

bull Composite resins class II restorations accumulate higher tensions comparing

with amalgam but deformation is avoided for a time because of the adhesion

forces performed between molecules under moderate oral forces In case of

high oral forces (600-800N) the risk of fracture in moderate class II

restorations is higher comparing with amalgam proximo-occlusal restorations

For extended class II restorations and forces of 600 N composite resins present

highest risk of fracture and deformation The von Misses tension at the

cervical interface restorationtooth can reach 1600Mpa

bull The amalgam in moderate class II restorations can resist to deformation even

for high intensity forces limited to 600N In extended class II restorations the

risk of deformation and fracture increases at values of 600N-800N of oral

forces The von Misses tension at the cervical interface restorationtooth can

reach 1700 Mpa

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464-473

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28Bayne SC Dental biomaterials where are we and where are we going J Dent

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30Behle C Flowable composite Proprieties and applications Pract Periodontics

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35Boschian PL S Guidotti R Pietrbissa M Gagliani- bdquoStress distribution in a

post-restored tooth using the threedimensional finite element method Journal of Oral

Rehabilitation (33) 2006690ndash697

36Bouillaguet S B Ciucchi T Jacoby JC Wataha DH Pashley Bonding

characteristics to dentin walls of class II cavities in vitro Dent Mater 200117316ndash

321

37Bouschlicher MR Rueggeberg FA Effect of ramped light intensity on

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2000 12328-339

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and their efficacy as stress-relieving layers J Am Dent Assoc 2003134721ndash728

39Braga RR Ballester RY Ferracane JLFactors involved in the development of

polymerization shrinkage stress in resin-composites a systematic review Dent Mater

200521(10)962-70

40Bratu D- Materiale dentare icircn cabinetul de stomatologie- Edit Helicon

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42Brunthaler A Koumlnig F Lucas T Sperr W Schedle A Longevity of direct resin

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43Bullard RH Leinfelder KR Russell CM Effect of coefficient of thermal

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45Burke FJ Cheung SW Mjoumlr IA Wilson NH Restoration longevity and analysis

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replacement of restorations in vocational training practicePrimary Dental Care

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47Burke FJ Wilson NH Cheung SW Mjoumlr IA Influence of patient factors on age

of restorations at failure and reasons for their placement and replacement J Dent

200129(5)317-24

48Calheiros FC Braga RR Kawano Y Ballester RY Relationship between

contraction stress and degree of conversion in restorative composites Dent Mater

2004 20939-946

49Cardoso P Sadek F Microtensile bond strength on dentin using new adhesive

systems with selfetching primers Braz J Oral Sci 2003 2(4) 156-159

50Cardoso M Baratieri LN Ritter AV The effect of finishing and polishing on

the decision to replace existing amalgam restorations Quintessence Int 1999

Jun30(6)413-8

51Carvalho RM JC Pereira M Yoshiyama DH Pashley A review of

polymerization contraction the influence of stress development versus stress

reliefOper Dent19962117ndash24

52Castro VM Katz JO Hardman PK Glaros AG Spencer P Invitro comparison

of conventional film and direct digital imaging in the detection of approximal caries

Dentomaxillofac Radiol 2007 Mar36(3)138-42

53Cattaneo PM M Dalstra B Melsen- bdquoThe Finite Element Method a Tool to

Study Orthodontic Tooth Movement J Dent Res 2005 84(5)428-433

54Cattell MJ Clarke RL Lynch EJ The transverse strength reliability and

microstructural features of four dental ceramicspart 1 J Dent 25(5)399-407 1997

55Cehreli ZC Akca T Effect of dentinal tubule orientation on the microtensile

bond strength to primary dentin J Dent Child 2003 70(2) 139-144

56Celik C Arhun N Yamanel K Clinical evaluation of resin-based composites in

posterior restorations 12-month results Eur J Dent 2010 Jan4(1)57-65

57Cenci M Demarco F de Carvalho R Class II composite resin restorations with

two polymerization techniques Relationship between microtensile bond strength and

marginal leakage J Dent 2005 33(7) 603- 610

58Chaffin J Moss D Review of current US Army dental emergency rates Mil

Med 2008173(1)23ndash26

59Chen HY Manhart J Hickel R Kunzelmann KH Polymerization contraction

stress in light-cured packable composite resinsDent Mater 200117253-259

60Choi KK Condon JR Ferracane JL The effects of adhesive thickness on

polymerization contraction stress of composites J Dent Res 2000 79812ndash817

61Cichon P Kerschbaum T Verweildauer zahnartzlicher Restaurationen bei

Behinderten Dtsch Zahnartzlicher 1999 54 96-102

62Cohen BI Pagnillo MK Deutsch ASMusikant BL Fracture Strength of

Three Core Restorative Materials Supported with or without a Prefabricated Split-

Shank Post Journal of Prosthetic Dentistry1997 78 560ndash565

63Colli P Brannstrom M The marginal adaptation of four different bonding agents

in Class II composite resin restoration applied in bulk or in two increments

Quintessence Int 1993 24583-591

43

64Collins CJ Bryant RW Hodge KL A clinical evaluation of posterior composite

resin restorations 8-year findings J Dent 199826(4) 311ndash317

65Condon JR Ferracane JL Assessing the effect of composite formulation on

polymerization stress J Am Dent Assoc2000 131497-503

66Cook WD Moopnar M Influence of chemical structure on the fracture

behaviour of dimethacrylate composite resins Biomaterials 1990 11272-276

67Cortes DF Ellwood RP Ekstrand KR An in vitro comparison of a combined

FOTIvisual examination of occlusal caries with other caries diagnostic methods and

the effect of stain on their diagnostic performance Caries Res 2003 37 (1) 8-16

68Crim GA Microleakage of three resin placement techniques Am J Dent

1991469-72

69Dauvillier B Aarnts M Feilzer A The competition between the composite-

dentin strength and the polimerization contraction stress J Dent Res 1984 63 1396-

1399

70Dauvillier BS Aarnts MP Feilzer AJ Developments in shrinkage control of

adhesive restoratives J Esthet Dent 2000 12291-299

71Dauvillier BS Aarnts MP Feilzer AJ Modeling of the viscoelastic behavior of

dental light-activated resin composites during curing Dent Mater 200319277ndash285

72Davidson CL Gee AJ Feilzer A The competition between the composite-dentin

bond strength and the polymerization contraction stress J Dent Res 1984

63(12)1396-9

73Davidson CL AJ Feilzer Polymerization shrinkage and polymerization

shrinkage stress in polymer-based restoratives J Dent Res 199725435ndash440

74Davidson CL Resisting the curing contraction with adhesive composites J

Prosthet Dent 198655446ndash7

75Davis RD Mayhew RB A clinical comparison of three anterior restorative resins

at 3 years J Am Dent Assoc 1986112659-63

76Dejak B Mlotkowski A Three-dimensional finite element analysis of strength

and adhesion of composite resin versus ceramic inlays in molarsJ Prosthet

Dent200899131-40

77Deligeorgi V Mjor IA Wilson NH An overview of reasons for the placement

and replacement of restorations Prim Dent Care 20018(1)5-11

78Deliperi S Bardwell DN An alternative method to reduce polymerization

shrinkage in direct posterior composite restorations J Am Dent Assoc 2002

1331387ndash97

79Demirci M Tuncer S Yuceokur AA Prevalence of caries on individual tooth

surfaces and its distribution by age and gender in university clinic patientsEur J

Dent20104(3)270-9

80De Munck J Van Meerbeek B Satoshi I Vargas M Yoshida Y Armstrong S

Lambrechts P Vanherle G Microtensile bond strengths of one- and two-step

selfetch adhesives to bur-cut enamel and dentin Am J Dent 2003 16 414-420

81Dewaele M Truffier-Boutry D Devaux J Leloup G Volume contraction in

photocured dental resins the shrinkage-conversion relationship revisited Dent Mater

2006 22359-365

44

82Deutsch WM Simecek JW Dental emergencies among Marines ashore in

Operations Desert ShieldStorm Mil Med 1996161(10) 620ndash623

83Dickens SH Stansbury JW Choi KM Floyd CJ Photopolymerization kinetics

of methacrylate dental resins Macromolecules 2003 366043-6053

84Dietschi D De Siebenthal G Neveu-Rosenstand L Holz J Influence of the

restorative technique and new adhesives on the dentin marginal seal and adaptation of

resin composite Class II restorations An in vitro evaluation Quintessence Int 1995

26 717-727

85Dietschi D Herzfeld D In vitro evaluation of marginal and internal adaptation of

class II resin composite restorations after thermal and occlusal stressing Eur J Oral

Sci 1998 106 1033-1042

86Dietschi D Marginal adaptation and seal of direct and indirect Class II composite

resin restorations an in vitro evaluation Quintessence Int 26(2)127-138 1995

87Diefenderfer KE Simecek JW Ahlf RL Ragain JC Relationship between

caries status and dental emergencies among US naval personnel J Dent Res

20028195 (Abstract)

88Diefenderfer KE Rienhardt JW Shear bond strengths of ten adhesive

resinamalgam combinations Oper Dent 1997 22 50-56

89Donly KJ Jensen ME Triolo PA clinical comparison of resin composite inlay

and onlay posterior restorations and cast-gold restorations at 7 years Quintessence Int

30(3)163- 1681999

90Douglas WH Fields RP Fundingsland J A comparison between the

microleakage of direct and indirect composite restorative systems J Dent 17(4)184-

188 1989

91Eberhard J Hartman B Lenhard M Mayer T Kocher T Eickholz P Digital

subtraction radiography for monitoring dental demineralization An in vitro study

Caries Res 200034(3)219-24

92Edelstein BL Douglass CW Dispelling the myth that 50 percent of US

schoolchildren have never had a cavity Public Health Rep1995 110 (5) 522-530

93Eick JD Welch FH Polymerization shrinkage of posterior composite resins and

its possible influence on postoperative sensitivity Quintessence Int 198617103-11

94Elliott JE Lovell LG Bowman CN Primary cyclization in the polymerization of

bis GMA and TEGDMA a modeling approach to understanding the cure of dental

resins Dent Mater 2001 17221-229

95Ermis R Ulkam Aydin Examiner agreement in the replacement decisions of

class I amalgam restorations The Journal of contemporary dental practice 2004 Vol

5 no21-7

96Feilzer AJ AJ De Gee CL Davidson Increased wall-to-wall curing

contraction in thin bonded resin layers J Dent Res 19896848ndash50

97Feilzer AJ Dauvillier BS Effect of TEGDMABisGMA ratio on stress

development and viscoelastic properties of experimental twopaste composites J Dent

Res 2003 82824-828

98Feilzer AJ de Gee AJ Davidson CL Relaxation of polymerization contraction

shear stress by hygroscopic expansion J Dent Res 1990 6936ndash39

45

99Feilzer AJ De Gee AJ Davidson CL Setting stress in composite resin in relation

to configuration of the restoration J Dent Res1987 661636-1639

100Feilzer AJ Dooren LH de Gee AJ Davidson CL Influence of light intensity

on polymerization shrinkage and integrity of restoration-cavity interface Eur J Oral

Sci 1995 103322ndash326

101Fennis YL Verdischbot EH vanrsquot Hof MA Performance of some diagnostic

systems in the prediction of occlusal caries in permanent molars in 6 and 11 year-old

children J Dent 1998 26(5) 403-40

102Ferracane JL Developing a more complete understanding of stresses produced

in dental composites during polymerization Dent Mater 2005 2136-42

103Ferrari M Influence of tissue characteristics at margins on leakage of Class II

indirect porcelain restorations Am JDent 1999 12(3)134-142

104Ferreira MC Vieira RS Marginal leakage in direct and indirect composite resin

restorations in primary teeth an in vitro study J Dent 200836(5)322-5

105Forss H Widstroumlm E Reasons for restorative therapy and the longevity of

restorations in adults Acta Odontol Scand 2004 6282-86

106Fradeani M Aquilano A Bassein L Longitudinal study of pressed glass-

ceramic inlays for four and a half years J Prosthet Dent 1997 78(4)346-353

107Franccedila FM Worschech CC Paulillo LA Martins LR Lovadino JR Fracture

resistance of premolar teeth restored with different filling techniques J Contemp Dent

Pract 20056(3)62-9

108Francci C Loguercio AD Reis A Carrilho MR A novel filling technique for

packable composite resin in Class II restorations J Esthet Restor Dent 2002

14(3)149-57

109Fruits TJ Knapp JA Khajotia SS Microleakage in the proximal walls of

direct and indirect posterior resin slot restorations Oper Dent 200631(6)719-27

110Gaengler P Hoyer I Montag R Clinical evaluation of posterior composite

restorations The 10-year report J Adhes Dent 2001 3185-194

111Garbuz DS Masri BA Estaile J Classification systems in orthopaedics J Am

Acad Orthop Surg 2002 10 290-297

112Ghavamnasiri M Moosavi H Tahvildarnejad N Effect of centripetal and

incremental methods in Class II composite resin restorations on gingival

microleakage J Contemp Dent Pract 20078(2)113-20

113Gladys S Clinical and semiquantitative marginal analysis of four tooth-coloured

inlay systems at 3 years J Dent 199523(6)329-338

114Giachetti L Scaminaci Russo D Bambi C Grandini R A review of

polymerization shrinkage stress current techniques for posterior direct resin

restorations J Contemp Dent Pract 20067(4)79-88

115Giannini M AJS Santos RM Carvalho LAMS Paulillo JR Lovadino

Effects of irradiation mode and filling technique on resindentin bond strength in

Class I cavities J Dent Res 200281 (Abstract)

116Going RE Microleakage around dental restorations A summarizing review

JADA 1972841349-1357

117Gordon JChristensen G Why switch to digital radiography J Am Dent

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118Gregoire GL Akon BA Millas A Interfacial micromorphological differences

in hybrid layer formation between water- and solvent-based dentin bonding systems J

Prosthet Dent 2002 87633ndash641

119Gregory WA Physical properties and repair bond strength of direct and indirect

composite resins J Prosthet Dent 68(3)406-411 1992

120Gwinnett AJ Buonocore MG Adhesives and caries prevention a preliminary

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121Gwinnett AJ Matsui A A study of enamel adhesives The physical relationship

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122Gwinnett AJ Histologic changes in human enamel following treatment with

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124Haba Denisia Tehnici uzuale utilizate icircn radiologia dentară Edit Junimea

2007

125Hashimoto M Ito S Tay FR Svizero NR Sano H Kaga M Fluid movement

across the resin-dentin interface during and after bonding J Dent Res 2004 83843ndash

848

126Hashimoto M Tay FR Ito S Sano H Kaga M Pashley DH Permeability of

adhesive resin films J Biomed Mater Res 2005 74699ndash705

127Hawthorne WS Smales RJ Factors influencing long-term restoration survival

in three private dental practices in Adelaide Aust Dent J 19974259ndash63

128Helwig Klimek Attin Einfuumlhrung in Die ZahnErhaltung Urbanampfischer 2003

129He Z Shimada Y Tagami J The effects of cavity size and incremental

technique on micro-tensile bond strength of resin composite in Class I cavities Dent

Mater 200723(5)533-8

130He Z Shimada Y Sadr A Ikeda M Tagami J The effects of cavity size and

filling method on the bonding to Class I cavities J Adhes Dent 2008 Dec10(6)447-

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131Hench LLBioceramicsfrom concept to clinicJ Amer Ceram Soc1991

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132Heymann HO The clinical performance of CAD-CAM generated ceramic

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Quintessence 2001

134Hilton TJ Cavity sealers liners and bases Current philosophies and indications

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135Hilton TJ Schwartz RS Ferracane JL Microleakage of four Class II resin

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19-23

138Hintze H Wenzel A Danielen B Behaviour of approximal carious lesions

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longitudinal study in young adults Caries Res 1999 33 415-22

139Hintze H Wenzel A Influence of validation method on diagnostic accuracy of

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Dentomaxillofacial Radiol2002 31(1) 44-49

140Holtzman JM Berkey AB Mann J Predicting utilization of dental services by

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of approximal and occlusal dental caries in a young adult population Community

Dent Oral Epidemiol 200533(3)212-8

143Hubsch PF Middleton J Knox J A finite element analysis of the stress at the

restoration-tooth interfacecomparing inlays and bulk

fillingsBiomaterials2000211015ndash1019

144Hudson JD Goldstein GR Georgescu M Enamel wear caused by three

different restorative materials J Prosthet Dent 1995 74(6)647-654

145Hunter AR Treasure ET Hunter AJ Increases in cavity volume associated

with the removal of class 2 amalgam and composite restorations Oper Dent

1995202ndash 6

146Huysmans MC PG van der Varst EP Lautenschlager P Monaghan The

influence of simulated clinical handling on the flexural and compressive strength of

posterior composite restorative materials Dent Mater 199612116ndash120

147Iliescu A Gafar MCariologie şi Odontologie RestaurativăEditura Medicală

Bucureşti 2001

148Inoue S Van Meerbeek B Vargas M Lambrechts P Vanherle G Adhesion

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Prati C Grafiche Erredue 2000131-148

149Inoue S Vargas MA Abe Y Yoshida Y LambrechtsP Vanherle G Sano H

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dentin J Adhes Dent 2001 3 237-245

150Iovan Gianina Diagnosis and Management of Patients with High Caries

Activity EdApollonia Iasi2002

151Jacobsen T Soderhold KJ Some effects of water on dentin bonding Dent

Mater 1995 11(2)132-6

152Jackson RD Morgan M The new posterior resins and a simplified placement

technique J Am Dent Assoc 2000131375ndash383

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with flowable composite in the proximal box Am J Dent 200013235ndash238

48

154Jokstad A Mjor IA Analyses of long-term clinical behaviour of class II

amalgam restorations Acta OdontolScand 1991 49 47-63

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Scand 1994 52 234-248

156Kaaden C Powers JM Friedl KH Schmalz G Bond strength of self-etching

adhesives to dental hard tissues Clin Oral Investig 2002 6(3)155-60

157Kamann WK Gangler P Zur Funktionzeit von Amalgam

Kompositefullungen Zahnartzlicher Welt 1999 108 270-273

158Kanemura N Sano H Tagami J Tensile bond strength to and SEM evaluation

of ground and intact enamel surfaces J Dent 199927523-530

159Kay EJ Nutall M Relationship between dentistlsquos treatment attitudes and

restorative decisions made on the basis of simulated bitewing radiographs

Community Dentistry and Oral Epidemiology 1994 22(2) 71-74

160Kemp-Scholte CM Davidson CL Complete marginal seal of Class V resin

composite restorations effected by increased flexibility J Dent Res 1990 691240ndash

1243

161Khairallah C Hokayem A Long-term clinical evaluation of 2 dental materials

used for the preparation of esthetic inlays Odontostomatol Trop 200932(127)5-13

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200932(126)21-8

163Kidd EAAssesment of dental carious lesionsArchof Oral

Biology199843(8)629-632

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proximal caries lesions at various levels in vitro Journal of Dentistry 2006 34(10)

817-822

165Kiremitci A Alpaslan T Gurgan SSix-year clinical evaluation of packable

composite restorations Oper Dent 200934(1)11-7

166Kleverlaan CJ Feilzer AJ Polymerization shrinkage and contraction stress of

dental resin composites Dent Mater 2005 211150-1157

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marginal leakage around class II composite resin restorations in vitroQuint Int

201989117ndash121

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M Dentin shear strength effect of distance from the pulp Dent Mater 2002

18(7)516-20

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polimerisation Am J Dent 1998 11 17-22

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Jan11(1)34-40

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JProsthet Dent 199369(4)425-430

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thermal behavior of dental composites Dent Mater 2008 24(8)1017ndash1024

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JDent 199826 627-632

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1999 15128-137

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179Lăcătuşu St Luminiţa Costinescu Andrian S Gianina Iovan Valeria

Pendefunda 180Sorina Solomon Topoliceanu C Elements of dispersional

analysis of amalgam restorations 15th

Edition of the Balkan Medical Days

Stomatological Section Abstract nr1091999128

181Lăcătuşu St Andrian S Gianina Iovan- Consideraţii asupra adaptării

amalgamelor dentare la pereţii cavităţilor RevMedicina

StomatologicăVol2199823-26

182Leevailoj C Cochran MA Matis BA Moore BK Platt JA Microleakage of

posterior packable resin composites with and without flowable liners Oper Dent

200126302ndash307

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influence of the amalgam alloy on the survival of amalgam restorations a secondary

analysis of multiple controlled clinical trials JDentRes 1997 76 1787-1798

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Dentistry and Oral Epidemiology 1996 24 106-11

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Dent Mater 2002 18436-444

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20(3)236-43

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Polymerization shrinkage effects of boundary conditions and filling technique of

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50

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Quintessence Int 2004 35(2)156-61

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copolymerizations Macromolecules 1999 323913-3921

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bonded composite restorations Dent Mater 1991 7(2) 107-13

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clinical results J Dent Res 199877 1020

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Dentomaxillofac Radiol 2007 Oct36(7)377-81

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J Prosthet Dent 2000 Sep84(3)289-96

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Three-year clinical evaluation of composite and ceramic inlays Am J Dent 2001

Apr14(2)95-9

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hardness and depth of cure of light cured packable composite resins J Dent Res 2000

79369 (Abstract)

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51

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PrimDentCare1999Apr659-62

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ScandJDRes 199210060-65

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33

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19904011ndash7

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Am Dent Assoc 2010 141(3)319-29

52

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125749-751

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34

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53

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54

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55

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308

313Tay FR Frankenberger R Krejci I Bouillaguet S Pashley DH Carvalho

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In vivo evidence J Dent 2004 32611ndash621

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systems J Dent 199523183ndash189

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199930249ndash257

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Oral Surg Oral Med Oral Pathol 198661(3)289-96

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Lambrechts P Yoshida Y Inoue S Suzuki K Technique-sensitivity of

contemporary adhesives Dent Mater J 2005 24(1) 1-13

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58

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326Venhoven BA de Gee AJ Davidson CL Light initiation of dental resins

dynamics of the polymerization Biomaterials 1996 172313-2318

327Versluis A Douglas WH Cross M Sakaguchi RL Does an incremental filling

technique reduce polymerization shrinkage stresses J Dent Res 1996 75871ndash878

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451

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kinetics in resin-composites methods development Dent Mater 2003 191ndash11

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334Wendt SL Microleakage and cusp fracture resistance of heattreated composite

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1991 72 621-6

336Wenzel A Hintze H Perception of image quality in direct digital radiography

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Dentomaxillofac Radiol 1993 22 131-4

337Wenzel A Computer-aided image manipulation of intraoral radiographs to

enhance diagnosis in dental practice a review Int Dent J 1993 43 99-108

338Wenzel A Digital radiography and caries diagnosis Dento Maxillo Facial

Radiology 27(1)3-11 1998

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modality and observer characteristics Caries Res 200741(3)170-6

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Dent 200114177ndash185

341Wilson NHF Wastell DG Norman RD Five-year performance of high-

cooper content amalgam restorations in a multiclinical trial JDent1996 24 203-210

342Winkler MM Katona TR Paydar NH Finite element stress analysis of three

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1996751477-83

343Yap AU Effectiveness of polymerization in composite restoratives claiming bulk

placement Impact of cavity depth and exposure time Oper Dent 2000 25113-120

59

344Yeşilyurt C Bulucu B Bond strength of total-etch dentin adhesive systems on

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Contemporary Dental Practice 7(2) 20061-13

345Yoshida Y Van Meerbeek B Okazaki M Shintani H Suzuki K Comparative

study on adhesive performance of functional monomers J Dent Res 2004 83 454-

458

346Yoshiyama M Tay FR Doi J Nishitani Y Yamada T Itou K Carvalho RM

Nakajima M Pashley DH Bonding of self-etch and total etch adhesives to carious

dentin J Dent Res 2002 81 556-560

  • COPERTA REZUMAT ENGLEZA (MEREUTA)pdf
  • REZUMAT ENGLEZA DR MEREUTA DENISSpdf
Page 30: UNIVERSITATEA DE MEDICINA SI FARMACIE “GR Doctorat/Rezumat... · universitatea de medicina si farmacie “gr.t.popa” iasi facultatea de medicina dentara rezumatul tezei de doctorat

27

Table X3 Squared roughness values for enamel and dentine samples before and

after etching

Dentine Enamel

Before etching

(nm)

After etching

(nm)

Before etching

(nm)

After etching

(nm)

2 mm ECJ 346 1147 416 2237

15 mm ECJ 282 942 333 1107

1 mm ECJ 274 895 317 875

05 mm ECJ 265 877 305 838

The descriptive statistics data for surface roughness of dentine before and after

etching are presented in tables X4 si X5

Table X4 Descriptive statistics for dentine samples before etching

Statistics

Dentine 2mm

before etching

Dentine 15mm

before etching

Dentine 1mm

before etching

Dentine 05mm

before etching

N Valid 10 10 10 10

Missing 0 0 0 0

Mean 346000 282000 274100 265400

Std Error of Mean 33830 27487 17026 16746

Std Deviation 106979 86923 53841 52957

Skewness -1214 354 -314 348

Std Error of Skewness 687 687 687 687

Kurtosis 1141 049 336 -539

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 3230 2690 2640 2580

Maximum 3570 2980 2830 2740

Table X5 Descriptive statistics for dentine samples after etching

Statistics

Dentine 2mm

after etching

Dentine 15mm

after etching

Dentine 1mm

after etching

Dentine 05mm

after etching

N Valid 10 10 10 10

Missing 0 0 0 0

1147000 942800 895000 877600

Std Error of Mean 36545 14591 29926 22020

Std Deviation 115566 46140 94634 69634

Skewness -267 1169 -951 535

Std Error of Skewness 687 687 687 687

Kurtosis 043 1776 564 1416

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 11270 9370 8760 8670

28

Statistics

Dentine 2mm

after etching

Dentine 15mm

after etching

Dentine 1mm

after etching

Dentine 05mm

after etching

N Valid 10 10 10 10

Missing 0 0 0 0

1147000 942800 895000 877600

Std Error of Mean 36545 14591 29926 22020

Std Deviation 115566 46140 94634 69634

Skewness -267 1169 -951 535

Std Error of Skewness 687 687 687 687

Kurtosis 043 1776 564 1416

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 11270 9370 8760 8670

Maximum 11660 9530 9070 8920

To choose the statistical test to compare roughness surface values was

performed a test Shapiro-Wilk If p is lower or equal with 0005 than hypothesis of

distribution normality is rejected (distribution deviates from normal form) In the table

X6 the distributions are normal The statistical test will be test t for pair samples

Table X6 Test Shapiro-Wilk for dentine samples

Tests of Normality

Kolmogorov-Smirnov

a Shapiro-Wilk

Statistic df Sig Statistic df Sig

Dentine 2mm before etching 274 10 032 877 10 122

Dentine 15mm after etching 209 10 200 952 10 689

Dentine 1mm before etching 134 10 200 983 10 980

Dentine 05mm before etching 155 10 200 949 10 661

Dentine 2mm after etching 133 10 200 977 10 946

Dentine 15mm after etching 197 10 200 916 10 329

Dentine 1mm after etching 216 10 200 925 10 401

Dentine 05 after etching 220 10 185 933 10 474

Enamel 2mm before etching 193 10 200 898 10 207

Enamel 15mm before etching 170 10 200 977 10 947

Enamel 1mm before etching 157 10 200 952 10 689

Enamel 05mm before etching 165 10 200 943 10 590

Enamel 2mm after etching 235 10 124 925 10 404

Enamel 15mm after etching 209 10 200 871 10 102

Enamel 1mm after etching 189 10 200 964 10 834

Enamel 05mm after etching 142 10 200 983 10 978

a Lilliefors Significance Correction

29

Tests of Normality

Kolmogorov-Smirnov

a Shapiro-Wilk

Statistic df Sig Statistic df Sig

Dentine 2mm before etching 274 10 032 877 10 122

Dentine 15mm after etching 209 10 200 952 10 689

Dentine 1mm before etching 134 10 200 983 10 980

Dentine 05mm before etching 155 10 200 949 10 661

Dentine 2mm after etching 133 10 200 977 10 946

Dentine 15mm after etching 197 10 200 916 10 329

Dentine 1mm after etching 216 10 200 925 10 401

Dentine 05 after etching 220 10 185 933 10 474

Enamel 2mm before etching 193 10 200 898 10 207

Enamel 15mm before etching 170 10 200 977 10 947

Enamel 1mm before etching 157 10 200 952 10 689

Enamel 05mm before etching 165 10 200 943 10 590

Enamel 2mm after etching 235 10 124 925 10 404

Enamel 15mm after etching 209 10 200 871 10 102

Enamel 1mm after etching 189 10 200 964 10 834

Enamel 05mm after etching 142 10 200 983 10 978

a Lilliefors Significance Correction

This is a lower bound of the true significance

The results of test t for pair dentine samples before and after etching are

presented in table X

Table X7 Test t for dentine before and after etching

Paired Samples Test

Paired Differences

t df

p (2-

tailed)

95 Confidence

Interval of the

Difference

Mean

Std

Dev

Std

Error

Mean Lower Upper

Pair

1

dentine2mmbeforeetching-

dentine2mmafteretching

-

8010000

174801 55277 -

8135045

-

7884955

-

144906

9 000

Pair

2

dentine15mmbeforeetching-

dentine15mmafteretching

-

6608000

102394 32380 -

6681248

-

6534752

-

204079

9 000

Pair

3

dentine1mmbeforeetching-

dentine1mmafteretching

-

6209000

117799 37251 -

6293269

-

6124731

-

166678

9 000

30

Paired Samples Test

Paired Differences

t df

p (2-

tailed)

95 Confidence

Interval of the

Difference

Mean

Std

Dev

Std

Error

Mean Lower Upper

Pair

1

dentine2mmbeforeetching-

dentine2mmafteretching

-

8010000

174801 55277 -

8135045

-

7884955

-

144906

9 000

Pair

2

dentine15mmbeforeetching-

dentine15mmafteretching

-

6608000

102394 32380 -

6681248

-

6534752

-

204079

9 000

Pair

3

dentine1mmbeforeetching-

dentine1mmafteretching

-

6209000

117799 37251 -

6293269

-

6124731

-

166678

9 000

Pair

4

dentine05mmbeforeetching-

dentine05mmafteretching

-

6122000

86384 27317 -

6183796

-

6060204

-

224109

9 000

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of dentine (

2mm 15 mm 1mm sau 05mm)

The descriptive statistics data for dentine surface roughness before and after

etching are presented in tables X8 and X9

Table X8 Descriptive statistics for enamel samples before etching

Statistics

Enamel 2mm

before etching

Enamel 15mm

before etching

Enamel 1mm

before etching

Enamel 05mm

before etching

N Valid 10 10 10 10

Missing 0 0 0 0

Mean 416800 333600 317200 305900

Std Error of Mean 13968 15217 14205 20355

Std Deviation 44171 48120 44920 64369

Skewness 1095 -156 -109 -411

Std Error of Skewness 687 687 687 687

Kurtosis 769 487 -118 -295

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 4120 3250 3090 2940

Maximum 4260 3420 3240 3140

31

Table X9 Descriptive statistics for enamel samples after etching

Statistics

Enamel 2mm

after etching

Enamel 15mm

after etching

Enamel 1mm

after etching

Enamel 05mm

after etching

N Valid 10 10 10 10

Missing 0 0 0 0

Mean 2237600 1107400 875100 838200

Std Error of Mean 31027 20232 11968 17436

Std Deviation 98116 63979 37845 55136

Skewness -850 267 042 040

Std Error of Skewness 687 687 687 687

Kurtosis 878 -1880 1082 -425

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 22180 10990 8680 8290

Maximum 22520 11160 8820 8470

To choose the statistical test to compare roughness surface values was

performed a test Shapiro-Wilk If p is lower or equal with 0005 than hypothesis of

distribution normality is rejected (distribution deviates from normal form) In the table

X10 the distributions are normal The statistical test will be test t for pair samples

Table X10 Test Shapiro-Wilk for enamel samples

Tests of Normality

Kolmogorov-Smirnova Shapiro-Wilk

Statistic df Sig Statistic df Sig

2mmenamel before etching 193 10 200 898 10 207

15mmenamel before etching 170 10 200 977 10 947

1mmenamel before etching 157 10 200 952 10 689

05mmenamel before etching 165 10 200 943 10 590

2mmenamel after etching 235 10 124 925 10 404

15mmenamel after etching 209 10 200 871 10 102

1mmenamel after etching 189 10 200 964 10 834

05mmenamel after etching 142 10 200 983 10 978

a Lilliefors Significance Correction

This is a lower bound of the true significance

The results of test t for pair enamel samples before and after etching are

presented in table X11

32

Table X11 Test t for enamel samples before and after etching

Paired Samples Test

Paired Differences

t df

p (2-

tailed)

95 Confidence

Interval of the

Difference

Mean

Std

Deviation

Std

Error

Mean Lower Upper

Pair

1

2mmenamel before

etching

2mmenamel after

etching

-18208 135220 42760 -

18304731

-

18111269

-

425815

9 000

Pair

2

15mmenamel before

etching

15mmenamel after

etching

-7738 73151 23132 -7790329 -7685671 -

334508

9 076

Pair

3

1mmenamel before

etching

1mmenamel after

etching

-5579 55468 17540 -5618679 -5539321 -

318065

9 065

Pair

4

05mmenamel before

etching

05mmenamel after

etching

-5323 60378 19093 -5366192 -5279808 -

278788

9 063

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel ( 2mm 15 mm 1mm sau

05mm) but the differences statistical significant are present only for enamel localised

at 2 mm from ECJ

X5CONCLUSIONS

The surfaces of enamel and dentine at cervical level record decreases of

roughness related to the decrease of distance to ECJ

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel but the differences

statistical significant are present only for enamel localised at 2 mm from ECJ

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of

dentine

33

CHAPTXI FEA STUDY REGARDING THE BIOMECHANICAL

BEHAVIOUR AND FRACTURE RESISTANCE OF PROXIMO-OCCLUSAL

AMALGAM AND COMPOSITE RESINS RESTORATIONS

XI1INTRODUCTION AIM OF STUDY

The individual variation of patients morphological and functional complexity

of tissues as well as difficult access limit the possibilities to investigate in clinical

studies the biomechanical behaviour of proximo-occlusal restorations In this context

simulation of the biomechanics for direct restorations represents an interesting

interdisciplinar domain in actual dentistry research

The study focused on two direction

- analysis of role of forces intensity on biomechanical behaviour related to

cavity dimension and material

- analysis of tension inside restoration structure related to forces intensity

XI2MATERIALS AND METHODS

The stages of finite element analysis study are as follows

object modelling (bicusps and proximo-occlusal restoration)

definition of parameters for materials and dental tissues

meshing

constraints and loading

types of contacts

equations system definition

results of simulation

The object 3D modelling was performed in Rhinoceros (figure XI1) The

definition of parameters was performed for Poisson constant Young modulus density

(table XI1) The selected materials were amalgam and composite resins The

analysed tissues were dentine and enamel The meshing constraints loading were

performed for forces of 200N 400N 600N 800 N The analysis was performed using

software COSMOSWorks 2010

34

Fig XI1 3D modellation of bicusp

Table XI1 Values of Young modulus Poisson constant compression resistance for

amalgam composite resin enamel (amalgam compozit smalţ)

Material Young modulus (GPa) Poisson constants

Compression

resistance

(Mpa)

Amalgam 55 033 483

Enamel 48 03 400

Composite

resin 220 022 345

Fig XI2 The forces and constraints application

The results are presented in values and culours red colours representing areas

with maximum values of tensions produced under influence of masticatory forces

The tensions produced in amalgam restoration are in a range from 0 to 22886

(force 800 N) The maximum von Misses tensions are associated with cervical area

of amalgam restorations This aspect proves that first modification in interface

restoration-cavity margins will appear at the level of gingival wall First marginal

35

defects and fissures in restoration bulk will appear at tensions over 1600Mpa

associated with forces of 800N for extended amalgam proximo-occlusal restorations

The tensions produced in composite resin restorations are in a range from 0 to

2285 (force 800 N) The maximum von Misses tensions are associated with cervical

area of composite resin restorationsThis aspect proves that first modification in

interface restoration-cavity margins will appear at the level of gingival wall First

marginal defects and fissures in restoration bulk will appear at tensions over 1716

Mpa associated with forces of 600N for moderate and extended composite resins

proximo-occlusal restorations

Fig XI3a-b ndash Simulated model of proximo-occlusal restoration

FigXI4a-b Dental amalgam restoration Cervical tension associated with 600 N

(c)800 N (d)

FigXI5a-b Composite resin restoration Cervical tension associated with 600 N

(c)800 N (d)

36

The deformation of amalgam can be produced only when is associated with

fissures in bulk of restorations while composite resins restorations present

deformation when are associated with a modification of volume and form because of

repeated action of medium forces on long term or high forces on short term (figures

XI4 XI5)

Fig XI4 Material deformation in area of maximum tension

000E + 00

500E -02

100E -01

150E -01

200E -01

250E -01

1 4 7 101316192225283134374043464952555861646770737679

Amalgam C ompoz it

Figura XI5 Deformarea funcție de material

The amalgam and composite resins were treated as homogenous isotropic and

liniar The advantage of this type of FEA study is that restorations parameters can be

modified any time is necessary both in arhitecture geometry and material indices

variability The results of this study sustain the conclusions of other FEA studies

focused on biomechanical behaviour of posterior restorations performed with

amalgam and composite resins(35 62 76 143)

37

XI4CONCLUSIONS

bull The amalgam in class II restorations has a low deformation tendency because

of uniform distribution of tension inside material

bull Composite resins class II restorations accumulate higher tensions comparing

with amalgam but deformation is avoided for a time because of the adhesion

forces performed between molecules under moderate oral forces In case of

high oral forces (600-800N) the risk of fracture in moderate class II

restorations is higher comparing with amalgam proximo-occlusal restorations

For extended class II restorations and forces of 600 N composite resins present

highest risk of fracture and deformation The von Misses tension at the

cervical interface restorationtooth can reach 1600Mpa

bull The amalgam in moderate class II restorations can resist to deformation even

for high intensity forces limited to 600N In extended class II restorations the

risk of deformation and fracture increases at values of 600N-800N of oral

forces The von Misses tension at the cervical interface restorationtooth can

reach 1700 Mpa

38

FINAL CONCLUSIONS

Amalgam proximo-occlusal restorations with minimum 6-years age present

excellent results for parameters anatomic form (occlusal) marginal

discoloration and marginal secondary dental caries good results for

parameters anatomic form (proximal) and marginal adaptation and poor results

for surface quality

Composite resins proximo-occlusal restorations (bicusps) with minimum 6-

years age present excellent results for parameters color match marginal

discoloration and marginal secondary dental caries and good results for

parameters anatomic form (occlusal proximal) marginal adaptation surface

quality

Composite resins proximo-occlusal restorations (molars) with minimum 6-

years age present good results for parameters color match marginal

discoloration marginal secondary dental caries marginal adaptation and poor

results for parameters anatomic form (occlusal) (54 indices Ryge C)

anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The restorations extended at external third of occlusal surface present highest

percents of indices C regarding anatomic form (occlusal) (54 indices Ryge

C) anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The exceeding of 6-years age will require careful monitorisation for early

interventions through polishing sealing reshaping and even replacement for

restorations with major defects

Oblique layering technique presents superior results regarding marginal

adaptation and marginal discoloration and is recommended for proximo-

occlusal dental caries close to enamel-cement jonction

Centripetal build-up presents good results regarding marginal adaptation and

anatomical form at proximal level (proximal surfaces and contact point)

Horisontal layering technique can be used for optimum results only in

proximal-occlusal cavities with moderate extension both in occlusal-cervical

and buccal-oral

The values of die penetration at gingival wall were statistically different

between the three restorative techniques

We concluded that all restorative methods were associated with lightcuring

contraction and marginal microleakage

The combined technique was associated with lowest lightcuring contraction

and die penetration

The bulk technique was associated with highest lightcuring contraction and die

penetration

39

The surfaces of enamel and dentine at cervical level record decreases of

roughness related to the decrease of distance to ECJ

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel but the differences

statistical significant are present only for enamel localised at 2 mm from ECJ

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of

dentine

bull The amalgam in class II restorations has a low deformation tendency because

of uniform distribution of tension inside material

bull Composite resins class II restorations accumulate higher tensions comparing

with amalgam but deformation is avoided for a time because of the adhesion

forces performed between molecules under moderate oral forces In case of

high oral forces (600-800N) the risk of fracture in moderate class II

restorations is higher comparing with amalgam proximo-occlusal restorations

For extended class II restorations and forces of 600 N composite resins present

highest risk of fracture and deformation The von Misses tension at the

cervical interface restorationtooth can reach 1600Mpa

bull The amalgam in moderate class II restorations can resist to deformation even

for high intensity forces limited to 600N In extended class II restorations the

risk of deformation and fracture increases at values of 600N-800N of oral

forces The von Misses tension at the cervical interface restorationtooth can

reach 1700 Mpa

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Statement on posterior resin-based composites JADA 1998 129(11)1627ndash1628

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6Aggarwal V Logani A Jain V Shah N Effect of cyclic loading on marginal

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Oper Dent 2008 Sep-Oct33(5)587-92

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8Andrian S- Restaurări fizionomice cu materiale plastice icircn cariologie-EdPanteon

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9Andrian S Tratamentul Minim Invaziv al Cariei Dentare EditPrinceps Edit Iaşi

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13Angmar-Mansson B Al-Khateeb S Tranaeus S Caries diagnosis Journal of

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15Anusavice KJ Development and testing of ceramics for dental restorations In

Fischman G Clare A Hench J editors Bioceramics materials and applications

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16Arhun N Celik C Yamanel KClinical evaluation of resin-based composites in

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17Armstrong SR JC Keller DB Boyer The influence of water storage and C-

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utilizing a filled and unfilled adhesive resin Dent Mater 200117268ndash276

18Armstrong S Boyer D Keller J Microtensile bond strength testing and failure

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19Asmussen E Peutzfeldt A Influence of UEDMA BisGMA and TEGDMA on

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26Bader JD Shugars DA Understanding dentistslsquo restorative treatment decisions J

Public Health Dent 1992 Winter52(2)102-10

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Dent 199158 36-39

28Bayne SC Dental biomaterials where are we and where are we going J Dent

Educ 200569(5)571ndash585

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29Bedran-de-Castro AK Pereira PN Thompson JY Influence of load cycling

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30Behle C Flowable composite Proprieties and applications Pract Periodontics

Aesthetics Dent 1998 10347 350-351

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33Black J Biological Performance of Materials Fundamentals of Biocompatibility

NY Marcel Dekker Inc 1999

34Bonsor SJ Chadwick RGLongevity of conventional and bonded (sealed)

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9

35Boschian PL S Guidotti R Pietrbissa M Gagliani- bdquoStress distribution in a

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Rehabilitation (33) 2006690ndash697

36Bouillaguet S B Ciucchi T Jacoby JC Wataha DH Pashley Bonding

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38Braga RR Ferracane JL Hilton TJ Contraction stress of flowable composites

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39Braga RR Ballester RY Ferracane JLFactors involved in the development of

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40Bratu D- Materiale dentare icircn cabinetul de stomatologie- Edit Helicon

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42Brunthaler A Koumlnig F Lucas T Sperr W Schedle A Longevity of direct resin

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43Bullard RH Leinfelder KR Russell CM Effect of coefficient of thermal

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45Burke FJ Cheung SW Mjoumlr IA Wilson NH Restoration longevity and analysis

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46Burke FJ Cheung SW Mjor IA Wilson NH-Reasons for the placement and

replacement of restorations in vocational training practicePrimary Dental Care

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47Burke FJ Wilson NH Cheung SW Mjoumlr IA Influence of patient factors on age

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48Calheiros FC Braga RR Kawano Y Ballester RY Relationship between

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2004 20939-946

49Cardoso P Sadek F Microtensile bond strength on dentin using new adhesive

systems with selfetching primers Braz J Oral Sci 2003 2(4) 156-159

50Cardoso M Baratieri LN Ritter AV The effect of finishing and polishing on

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51Carvalho RM JC Pereira M Yoshiyama DH Pashley A review of

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reliefOper Dent19962117ndash24

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Dentomaxillofac Radiol 2007 Mar36(3)138-42

53Cattaneo PM M Dalstra B Melsen- bdquoThe Finite Element Method a Tool to

Study Orthodontic Tooth Movement J Dent Res 2005 84(5)428-433

54Cattell MJ Clarke RL Lynch EJ The transverse strength reliability and

microstructural features of four dental ceramicspart 1 J Dent 25(5)399-407 1997

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bond strength to primary dentin J Dent Child 2003 70(2) 139-144

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posterior restorations 12-month results Eur J Dent 2010 Jan4(1)57-65

57Cenci M Demarco F de Carvalho R Class II composite resin restorations with

two polymerization techniques Relationship between microtensile bond strength and

marginal leakage J Dent 2005 33(7) 603- 610

58Chaffin J Moss D Review of current US Army dental emergency rates Mil

Med 2008173(1)23ndash26

59Chen HY Manhart J Hickel R Kunzelmann KH Polymerization contraction

stress in light-cured packable composite resinsDent Mater 200117253-259

60Choi KK Condon JR Ferracane JL The effects of adhesive thickness on

polymerization contraction stress of composites J Dent Res 2000 79812ndash817

61Cichon P Kerschbaum T Verweildauer zahnartzlicher Restaurationen bei

Behinderten Dtsch Zahnartzlicher 1999 54 96-102

62Cohen BI Pagnillo MK Deutsch ASMusikant BL Fracture Strength of

Three Core Restorative Materials Supported with or without a Prefabricated Split-

Shank Post Journal of Prosthetic Dentistry1997 78 560ndash565

63Colli P Brannstrom M The marginal adaptation of four different bonding agents

in Class II composite resin restoration applied in bulk or in two increments

Quintessence Int 1993 24583-591

43

64Collins CJ Bryant RW Hodge KL A clinical evaluation of posterior composite

resin restorations 8-year findings J Dent 199826(4) 311ndash317

65Condon JR Ferracane JL Assessing the effect of composite formulation on

polymerization stress J Am Dent Assoc2000 131497-503

66Cook WD Moopnar M Influence of chemical structure on the fracture

behaviour of dimethacrylate composite resins Biomaterials 1990 11272-276

67Cortes DF Ellwood RP Ekstrand KR An in vitro comparison of a combined

FOTIvisual examination of occlusal caries with other caries diagnostic methods and

the effect of stain on their diagnostic performance Caries Res 2003 37 (1) 8-16

68Crim GA Microleakage of three resin placement techniques Am J Dent

1991469-72

69Dauvillier B Aarnts M Feilzer A The competition between the composite-

dentin strength and the polimerization contraction stress J Dent Res 1984 63 1396-

1399

70Dauvillier BS Aarnts MP Feilzer AJ Developments in shrinkage control of

adhesive restoratives J Esthet Dent 2000 12291-299

71Dauvillier BS Aarnts MP Feilzer AJ Modeling of the viscoelastic behavior of

dental light-activated resin composites during curing Dent Mater 200319277ndash285

72Davidson CL Gee AJ Feilzer A The competition between the composite-dentin

bond strength and the polymerization contraction stress J Dent Res 1984

63(12)1396-9

73Davidson CL AJ Feilzer Polymerization shrinkage and polymerization

shrinkage stress in polymer-based restoratives J Dent Res 199725435ndash440

74Davidson CL Resisting the curing contraction with adhesive composites J

Prosthet Dent 198655446ndash7

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Dent200899131-40

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1331387ndash97

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Dent20104(3)270-9

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2006 22359-365

44

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20028195 (Abstract)

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848

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1243

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Biology199843(8)629-632

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817-822

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18(7)516-20

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Jan11(1)34-40

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JDent 199826 627-632

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1999 15128-137

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Edition of the Balkan Medical Days

Stomatological Section Abstract nr1091999128

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Dentistry and Oral Epidemiology 1996 24 106-11

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Dent Mater 2002 18436-444

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20(3)236-43

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Polymerization shrinkage effects of boundary conditions and filling technique of

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50

189Lopes GC Baratieri LN Monteiro S Jr Vieira LC Effect of posterior resin

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Dentomaxillofac Radiol 2007 Oct36(7)377-81

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J Prosthet Dent 2000 Sep84(3)289-96

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Three-year clinical evaluation of composite and ceramic inlays Am J Dent 2001

Apr14(2)95-9

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79369 (Abstract)

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PrimDentCare1999Apr659-62

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33

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52

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34

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Monogr Oral Sci 20092142-51

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Restorative Materials In Class I And Class II Restorations An In-Vivo Study The

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53

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569ndash575

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Community Dent Oral Epidemiol 1980 Jun8(3)135-8

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volumetric polymerization shrinkage and bulk modulus of dental composites and an

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255Radhika M Girija S 1 Kumaraswamy B Neetu M Effect of different

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two composite resin formulations J Conserv Dent 2010 13(1) 9ndash15

54

256Radu TM A Uliuliuc Dana Apostolide S Andrian The effect of adhesive

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Soc Med Iaşi-2008 vol112 nr1supl1145-147

257Raskin A Michotte-Theall B Vreven J Wilson NH Clinical evaluation of a

posterior composite 10-year report J Dent 199927(1) 13ndash19

258Rasmusson CG Lundin SA Class II restorations in six different posterior

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259Rezwani-Kaminski T Kamann W Gaengler P Secondary caries susceptibility

of teeth with long-term performing composite restorations J Oral Rehabil 2002

29(12)1131ndash1138

260Roberson TM Heymann HO Swift EJ eds Sturdevantlsquos Art and Science of

Operative Dentistry 5th ed St Louis Mosby 2006293-7

261Robertello FJ Pink FE The effect of a training program on the reliability of

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262Rodrigues JSA Pin LF Machado G Della Bona A Demarco FF Influence

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J Appl Oral Sci 2010 Feb18(1)37-43

263Roulet JF Noack MJCriteria for substituting amalgam with composite resins

Int Dent J 199141(4)195-205

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ClinOral Invest1997140-46

266Roulet JFBenefits and disadvantages of tooth-coloured alternatives to amalgam

J Dent 199725(6)459-73

267Rueggeberg FA WF Caughman JW Curtis Jr HC Davis Factors

affecting cure at depths within light-activated resin composites Am J Dent

1993691ndash95

268Rueggeberg FA Ergle JW Mettenburg DJ Polymerization depths of

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269Rushton VE Horner K Worthington HV Screening panoramic radiography

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270Ruyter IE Types of resin-based inlay materials and their properties Int Dent J

199242(3)139-44

271Sajjan GS Mittal NEffect of different placement techniques on marginal

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J Conserv Dent 201013(1)9-15

272Sakaguchi RL MC Peters SR Nelson WH Douglas HW Poort Effects

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273Sakaguchi RL Shah NC Lim BS Ferracane JL Borgersen SE Dynamic

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composites Dent Mater 200218197-202

274Sano H Takatsu T Ciucchi B Horner JA Matthews WG Pashley DH

Nanoleakage leakage within the hybrid layer Oper Dent 1995 20 18-25

55

275Sarrett DC Clinical challenges and the relevance of materials testing for

posterior composite restorations Dent Mater 200521(1) 9ndash12

276Sarrett DC Brooks CN Rose JT Clinical performance evaluation of a

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278Schirrmeister JF Huber K Hellwig E Hahn P Four-year evaluation of a resin

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404

279Schneiderman A Elbaum M Schultz T Keem S Greenebaum M Driller J

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284Sengun A Unlu N Ozer F Ozturk B Bond strength of five current adhesives

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286Sideridou I Tserki V Papanastasiou G Effect of chemical structure on degree

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231819-1829

287Sideridou I Tserki V Papanastasiou G Study of water sorption solubility and

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289SilverFH Christiansen DLBiomaterials Science and Biocompatibility New

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290Simecek JW Diefenderfer KE Ahlf RL Ragain JC Jr Longitudinal trends in

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200382 1169 (Abstract)

291Simecek JW Diefenderfer KE Ahlf RL Ragain JC Jr Dental sealant

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56

292Simi B Suprabha B Evaluation of microleakage in posterior nanocomposite

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295Smales RJ Webster DA Leppard PISurvival predictions of amalgam

restorations JDent1991 19 272-277

296Smales RJ Hawthorne WSLong-term survival of extensive amalgams and

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298Sonoda H Banerjee A Sherriff M Tagami J Watson TF An in vitro

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Quintessence 2000253ndash76

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308Summit JB Robbins JW Hilton TJ Fundamentals in operative dentistry Cap

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57

309Svanberg M Mjor IA Orstavik D Mutans streptococci in plaque from margins

of amalgam composite and glassndashionomer restorations J Dent Res 199069861ndash

864

310Tanne K Mamoru S Burstone C Three-dimensional finite element analysis

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Orthop921987499ndash505

311Tanumiharja M Burrow MF Tyas MJ Microtensile bond strengths of seven

dentin adhesive systems Dent Mater 2000 16(3)180-7

312Tay FR Pashley DH Aggressiveness of contemporary self-etching systems

Part I Depth of penetration beyond dentin smear layers Dent Mater 2001 17(4) 296-

308

313Tay FR Frankenberger R Krejci I Bouillaguet S Pashley DH Carvalho

RM Single-bottle adhesives behave as permeable membranes after polymerization I

In vivo evidence J Dent 2004 32611ndash621

314Tay FR Pashley DH Have dentin adhesives become too hydrophilic J Can

Dent Assoc 2003 69726ndash731

315Tay FR Sano H Carvalho R Pashley EL Pashley DH An ultrastructural

study of the influence of acidity of self-etching primers and smear layer thickness on

bonding to intact dentin J Adhes Dent 2000 283ndash98

316Thompson JY Bayne SC Heymann HO Mechanical properties of a new

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76(6)619-623 1996

317Unterbrink GL R Muessner Influence of light intensity on two restorative

systems J Dent 199523183ndash189

318Unterbrink GL Liebenberg WH Flowable resin composites as filled

adhesiveslsquo literature review and clinical recommendations Quintessence Int

199930249ndash257

319Vaarkamp J Ten Bosch J Verdonschot EH Quantitative diagnosis of small

approximal caries lesions utilizing wavelength-dependent fiber-optic

transillumination Journal of Dental Research 1997 76 (4) 875-882

320Valachovic RW Douglass CW Reiskin AB Chauncey HH McNeil BJ The

use of panoramic radiography in the evaluation of asymptomatic adult dental patients

Oral Surg Oral Med Oral Pathol 198661(3)289-96

321Van Meerbeek B De Munck J Yoshida Y Inoue S Vargas M Vijay P Van

Landuyt K Lambrechts P Vanherle G Adhesion to enamel and dentin Current

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322Van Meerbeek B Van Landuyt K De Munck JHashimoto M Peumans M

Lambrechts P Yoshida Y Inoue S Suzuki K Technique-sensitivity of

contemporary adhesives Dent Mater J 2005 24(1) 1-13

323Van Meerbeek B Vargas S Inoue S Yoshida Y Peumans M Lambrechts P

Vanherle G Adhesives and cements to promote preservation dentistry Oper Dent

20016 119-144

324Van Meerbeek B Yoshida Y Inoue S Vargas M Abe Y Fukuda R Okazaki

M Lambrechts P Vanherle G Bonding mechanism micro-tensile bond strength of

a 4- MET-based self-etching adhesive J Dent Res 2000 79 249 (Abstract)

58

325Van Nieuwenhuysen JP DrsquoHoore W Carvalho J Qvist V Long-term

evaluation of extensive restorations in permanent teeth J Dent 200331(6)395ndash405

326Venhoven BA de Gee AJ Davidson CL Light initiation of dental resins

dynamics of the polymerization Biomaterials 1996 172313-2318

327Versluis A Douglas WH Cross M Sakaguchi RL Does an incremental filling

technique reduce polymerization shrinkage stresses J Dent Res 1996 75871ndash878

328Vries HC Ruiken HM Konig KG vanrsquot Hof MA Radiographic versus

clinical diagnosis of approximal carious lesions Caries Res1990 24 (5) 364-370

329Waggoner W Ashton J Predictability of cavitation based upon radiographic

appearance comparison of two film types Quintessence International 1989 20(1)

55-60

330Watanabe LG Marshall GW Jr Marshall SJ Dentin shear strength effects of

tubule orientation and intra tooth location Dent Mater 1996 12 109-115

331Watts DC AS Marouf Optimal specimen geometry in bonded-disk

shrinkage-strain measurements on light-cured biomaterials Dent Mater 200016447ndash

451

332Watts DC Marouf AS Al-Hindi AM Photo-polymerization shrinkage-stress

kinetics in resin-composites methods development Dent Mater 2003 191ndash11

333Weaver WS Blank LW Pelleu GB Jr A visible light activated resin cured

through tooth structure GenDent 198836236-7

334Wendt SL Microleakage and cusp fracture resistance of heattreated composite

resin inlays Am J Dent 4(1)10-14 1991

335Wenzel A Hintze H Mikkelsen L Mouyen F Radiographic detection of

occlusal caries in noncavitated teeth A comparison of conventional film radiographs

digitized film radiographs and RadioVisioGraphy-Oral Surg Oral Med Oral Pathol

1991 72 621-6

336Wenzel A Hintze H Perception of image quality in direct digital radiography

after application of various image treatment filters for detectability of dental diseases

Dentomaxillofac Radiol 1993 22 131-4

337Wenzel A Computer-aided image manipulation of intraoral radiographs to

enhance diagnosis in dental practice a review Int Dent J 1993 43 99-108

338Wenzel A Digital radiography and caries diagnosis Dento Maxillo Facial

Radiology 27(1)3-11 1998

339Wenzel A Haiter-Neto F Gotfredsen E Risk factors for a false positive test

outcome in diagnosis of caries in approximal surfaces impact of radiographic

modality and observer characteristics Caries Res 200741(3)170-6

340Wibowo G Stockton L Microleakage of class II composite restorations Am J

Dent 200114177ndash185

341Wilson NHF Wastell DG Norman RD Five-year performance of high-

cooper content amalgam restorations in a multiclinical trial JDent1996 24 203-210

342Winkler MM Katona TR Paydar NH Finite element stress analysis of three

filling techniques for class V light-cured composite restorations J Dent Res

1996751477-83

343Yap AU Effectiveness of polymerization in composite restoratives claiming bulk

placement Impact of cavity depth and exposure time Oper Dent 2000 25113-120

59

344Yeşilyurt C Bulucu B Bond strength of total-etch dentin adhesive systems on

peripheral and central dentinal tissue a microtensile bond strength test The Journal of

Contemporary Dental Practice 7(2) 20061-13

345Yoshida Y Van Meerbeek B Okazaki M Shintani H Suzuki K Comparative

study on adhesive performance of functional monomers J Dent Res 2004 83 454-

458

346Yoshiyama M Tay FR Doi J Nishitani Y Yamada T Itou K Carvalho RM

Nakajima M Pashley DH Bonding of self-etch and total etch adhesives to carious

dentin J Dent Res 2002 81 556-560

  • COPERTA REZUMAT ENGLEZA (MEREUTA)pdf
  • REZUMAT ENGLEZA DR MEREUTA DENISSpdf
Page 31: UNIVERSITATEA DE MEDICINA SI FARMACIE “GR Doctorat/Rezumat... · universitatea de medicina si farmacie “gr.t.popa” iasi facultatea de medicina dentara rezumatul tezei de doctorat

28

Statistics

Dentine 2mm

after etching

Dentine 15mm

after etching

Dentine 1mm

after etching

Dentine 05mm

after etching

N Valid 10 10 10 10

Missing 0 0 0 0

1147000 942800 895000 877600

Std Error of Mean 36545 14591 29926 22020

Std Deviation 115566 46140 94634 69634

Skewness -267 1169 -951 535

Std Error of Skewness 687 687 687 687

Kurtosis 043 1776 564 1416

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 11270 9370 8760 8670

Maximum 11660 9530 9070 8920

To choose the statistical test to compare roughness surface values was

performed a test Shapiro-Wilk If p is lower or equal with 0005 than hypothesis of

distribution normality is rejected (distribution deviates from normal form) In the table

X6 the distributions are normal The statistical test will be test t for pair samples

Table X6 Test Shapiro-Wilk for dentine samples

Tests of Normality

Kolmogorov-Smirnov

a Shapiro-Wilk

Statistic df Sig Statistic df Sig

Dentine 2mm before etching 274 10 032 877 10 122

Dentine 15mm after etching 209 10 200 952 10 689

Dentine 1mm before etching 134 10 200 983 10 980

Dentine 05mm before etching 155 10 200 949 10 661

Dentine 2mm after etching 133 10 200 977 10 946

Dentine 15mm after etching 197 10 200 916 10 329

Dentine 1mm after etching 216 10 200 925 10 401

Dentine 05 after etching 220 10 185 933 10 474

Enamel 2mm before etching 193 10 200 898 10 207

Enamel 15mm before etching 170 10 200 977 10 947

Enamel 1mm before etching 157 10 200 952 10 689

Enamel 05mm before etching 165 10 200 943 10 590

Enamel 2mm after etching 235 10 124 925 10 404

Enamel 15mm after etching 209 10 200 871 10 102

Enamel 1mm after etching 189 10 200 964 10 834

Enamel 05mm after etching 142 10 200 983 10 978

a Lilliefors Significance Correction

29

Tests of Normality

Kolmogorov-Smirnov

a Shapiro-Wilk

Statistic df Sig Statistic df Sig

Dentine 2mm before etching 274 10 032 877 10 122

Dentine 15mm after etching 209 10 200 952 10 689

Dentine 1mm before etching 134 10 200 983 10 980

Dentine 05mm before etching 155 10 200 949 10 661

Dentine 2mm after etching 133 10 200 977 10 946

Dentine 15mm after etching 197 10 200 916 10 329

Dentine 1mm after etching 216 10 200 925 10 401

Dentine 05 after etching 220 10 185 933 10 474

Enamel 2mm before etching 193 10 200 898 10 207

Enamel 15mm before etching 170 10 200 977 10 947

Enamel 1mm before etching 157 10 200 952 10 689

Enamel 05mm before etching 165 10 200 943 10 590

Enamel 2mm after etching 235 10 124 925 10 404

Enamel 15mm after etching 209 10 200 871 10 102

Enamel 1mm after etching 189 10 200 964 10 834

Enamel 05mm after etching 142 10 200 983 10 978

a Lilliefors Significance Correction

This is a lower bound of the true significance

The results of test t for pair dentine samples before and after etching are

presented in table X

Table X7 Test t for dentine before and after etching

Paired Samples Test

Paired Differences

t df

p (2-

tailed)

95 Confidence

Interval of the

Difference

Mean

Std

Dev

Std

Error

Mean Lower Upper

Pair

1

dentine2mmbeforeetching-

dentine2mmafteretching

-

8010000

174801 55277 -

8135045

-

7884955

-

144906

9 000

Pair

2

dentine15mmbeforeetching-

dentine15mmafteretching

-

6608000

102394 32380 -

6681248

-

6534752

-

204079

9 000

Pair

3

dentine1mmbeforeetching-

dentine1mmafteretching

-

6209000

117799 37251 -

6293269

-

6124731

-

166678

9 000

30

Paired Samples Test

Paired Differences

t df

p (2-

tailed)

95 Confidence

Interval of the

Difference

Mean

Std

Dev

Std

Error

Mean Lower Upper

Pair

1

dentine2mmbeforeetching-

dentine2mmafteretching

-

8010000

174801 55277 -

8135045

-

7884955

-

144906

9 000

Pair

2

dentine15mmbeforeetching-

dentine15mmafteretching

-

6608000

102394 32380 -

6681248

-

6534752

-

204079

9 000

Pair

3

dentine1mmbeforeetching-

dentine1mmafteretching

-

6209000

117799 37251 -

6293269

-

6124731

-

166678

9 000

Pair

4

dentine05mmbeforeetching-

dentine05mmafteretching

-

6122000

86384 27317 -

6183796

-

6060204

-

224109

9 000

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of dentine (

2mm 15 mm 1mm sau 05mm)

The descriptive statistics data for dentine surface roughness before and after

etching are presented in tables X8 and X9

Table X8 Descriptive statistics for enamel samples before etching

Statistics

Enamel 2mm

before etching

Enamel 15mm

before etching

Enamel 1mm

before etching

Enamel 05mm

before etching

N Valid 10 10 10 10

Missing 0 0 0 0

Mean 416800 333600 317200 305900

Std Error of Mean 13968 15217 14205 20355

Std Deviation 44171 48120 44920 64369

Skewness 1095 -156 -109 -411

Std Error of Skewness 687 687 687 687

Kurtosis 769 487 -118 -295

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 4120 3250 3090 2940

Maximum 4260 3420 3240 3140

31

Table X9 Descriptive statistics for enamel samples after etching

Statistics

Enamel 2mm

after etching

Enamel 15mm

after etching

Enamel 1mm

after etching

Enamel 05mm

after etching

N Valid 10 10 10 10

Missing 0 0 0 0

Mean 2237600 1107400 875100 838200

Std Error of Mean 31027 20232 11968 17436

Std Deviation 98116 63979 37845 55136

Skewness -850 267 042 040

Std Error of Skewness 687 687 687 687

Kurtosis 878 -1880 1082 -425

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 22180 10990 8680 8290

Maximum 22520 11160 8820 8470

To choose the statistical test to compare roughness surface values was

performed a test Shapiro-Wilk If p is lower or equal with 0005 than hypothesis of

distribution normality is rejected (distribution deviates from normal form) In the table

X10 the distributions are normal The statistical test will be test t for pair samples

Table X10 Test Shapiro-Wilk for enamel samples

Tests of Normality

Kolmogorov-Smirnova Shapiro-Wilk

Statistic df Sig Statistic df Sig

2mmenamel before etching 193 10 200 898 10 207

15mmenamel before etching 170 10 200 977 10 947

1mmenamel before etching 157 10 200 952 10 689

05mmenamel before etching 165 10 200 943 10 590

2mmenamel after etching 235 10 124 925 10 404

15mmenamel after etching 209 10 200 871 10 102

1mmenamel after etching 189 10 200 964 10 834

05mmenamel after etching 142 10 200 983 10 978

a Lilliefors Significance Correction

This is a lower bound of the true significance

The results of test t for pair enamel samples before and after etching are

presented in table X11

32

Table X11 Test t for enamel samples before and after etching

Paired Samples Test

Paired Differences

t df

p (2-

tailed)

95 Confidence

Interval of the

Difference

Mean

Std

Deviation

Std

Error

Mean Lower Upper

Pair

1

2mmenamel before

etching

2mmenamel after

etching

-18208 135220 42760 -

18304731

-

18111269

-

425815

9 000

Pair

2

15mmenamel before

etching

15mmenamel after

etching

-7738 73151 23132 -7790329 -7685671 -

334508

9 076

Pair

3

1mmenamel before

etching

1mmenamel after

etching

-5579 55468 17540 -5618679 -5539321 -

318065

9 065

Pair

4

05mmenamel before

etching

05mmenamel after

etching

-5323 60378 19093 -5366192 -5279808 -

278788

9 063

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel ( 2mm 15 mm 1mm sau

05mm) but the differences statistical significant are present only for enamel localised

at 2 mm from ECJ

X5CONCLUSIONS

The surfaces of enamel and dentine at cervical level record decreases of

roughness related to the decrease of distance to ECJ

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel but the differences

statistical significant are present only for enamel localised at 2 mm from ECJ

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of

dentine

33

CHAPTXI FEA STUDY REGARDING THE BIOMECHANICAL

BEHAVIOUR AND FRACTURE RESISTANCE OF PROXIMO-OCCLUSAL

AMALGAM AND COMPOSITE RESINS RESTORATIONS

XI1INTRODUCTION AIM OF STUDY

The individual variation of patients morphological and functional complexity

of tissues as well as difficult access limit the possibilities to investigate in clinical

studies the biomechanical behaviour of proximo-occlusal restorations In this context

simulation of the biomechanics for direct restorations represents an interesting

interdisciplinar domain in actual dentistry research

The study focused on two direction

- analysis of role of forces intensity on biomechanical behaviour related to

cavity dimension and material

- analysis of tension inside restoration structure related to forces intensity

XI2MATERIALS AND METHODS

The stages of finite element analysis study are as follows

object modelling (bicusps and proximo-occlusal restoration)

definition of parameters for materials and dental tissues

meshing

constraints and loading

types of contacts

equations system definition

results of simulation

The object 3D modelling was performed in Rhinoceros (figure XI1) The

definition of parameters was performed for Poisson constant Young modulus density

(table XI1) The selected materials were amalgam and composite resins The

analysed tissues were dentine and enamel The meshing constraints loading were

performed for forces of 200N 400N 600N 800 N The analysis was performed using

software COSMOSWorks 2010

34

Fig XI1 3D modellation of bicusp

Table XI1 Values of Young modulus Poisson constant compression resistance for

amalgam composite resin enamel (amalgam compozit smalţ)

Material Young modulus (GPa) Poisson constants

Compression

resistance

(Mpa)

Amalgam 55 033 483

Enamel 48 03 400

Composite

resin 220 022 345

Fig XI2 The forces and constraints application

The results are presented in values and culours red colours representing areas

with maximum values of tensions produced under influence of masticatory forces

The tensions produced in amalgam restoration are in a range from 0 to 22886

(force 800 N) The maximum von Misses tensions are associated with cervical area

of amalgam restorations This aspect proves that first modification in interface

restoration-cavity margins will appear at the level of gingival wall First marginal

35

defects and fissures in restoration bulk will appear at tensions over 1600Mpa

associated with forces of 800N for extended amalgam proximo-occlusal restorations

The tensions produced in composite resin restorations are in a range from 0 to

2285 (force 800 N) The maximum von Misses tensions are associated with cervical

area of composite resin restorationsThis aspect proves that first modification in

interface restoration-cavity margins will appear at the level of gingival wall First

marginal defects and fissures in restoration bulk will appear at tensions over 1716

Mpa associated with forces of 600N for moderate and extended composite resins

proximo-occlusal restorations

Fig XI3a-b ndash Simulated model of proximo-occlusal restoration

FigXI4a-b Dental amalgam restoration Cervical tension associated with 600 N

(c)800 N (d)

FigXI5a-b Composite resin restoration Cervical tension associated with 600 N

(c)800 N (d)

36

The deformation of amalgam can be produced only when is associated with

fissures in bulk of restorations while composite resins restorations present

deformation when are associated with a modification of volume and form because of

repeated action of medium forces on long term or high forces on short term (figures

XI4 XI5)

Fig XI4 Material deformation in area of maximum tension

000E + 00

500E -02

100E -01

150E -01

200E -01

250E -01

1 4 7 101316192225283134374043464952555861646770737679

Amalgam C ompoz it

Figura XI5 Deformarea funcție de material

The amalgam and composite resins were treated as homogenous isotropic and

liniar The advantage of this type of FEA study is that restorations parameters can be

modified any time is necessary both in arhitecture geometry and material indices

variability The results of this study sustain the conclusions of other FEA studies

focused on biomechanical behaviour of posterior restorations performed with

amalgam and composite resins(35 62 76 143)

37

XI4CONCLUSIONS

bull The amalgam in class II restorations has a low deformation tendency because

of uniform distribution of tension inside material

bull Composite resins class II restorations accumulate higher tensions comparing

with amalgam but deformation is avoided for a time because of the adhesion

forces performed between molecules under moderate oral forces In case of

high oral forces (600-800N) the risk of fracture in moderate class II

restorations is higher comparing with amalgam proximo-occlusal restorations

For extended class II restorations and forces of 600 N composite resins present

highest risk of fracture and deformation The von Misses tension at the

cervical interface restorationtooth can reach 1600Mpa

bull The amalgam in moderate class II restorations can resist to deformation even

for high intensity forces limited to 600N In extended class II restorations the

risk of deformation and fracture increases at values of 600N-800N of oral

forces The von Misses tension at the cervical interface restorationtooth can

reach 1700 Mpa

38

FINAL CONCLUSIONS

Amalgam proximo-occlusal restorations with minimum 6-years age present

excellent results for parameters anatomic form (occlusal) marginal

discoloration and marginal secondary dental caries good results for

parameters anatomic form (proximal) and marginal adaptation and poor results

for surface quality

Composite resins proximo-occlusal restorations (bicusps) with minimum 6-

years age present excellent results for parameters color match marginal

discoloration and marginal secondary dental caries and good results for

parameters anatomic form (occlusal proximal) marginal adaptation surface

quality

Composite resins proximo-occlusal restorations (molars) with minimum 6-

years age present good results for parameters color match marginal

discoloration marginal secondary dental caries marginal adaptation and poor

results for parameters anatomic form (occlusal) (54 indices Ryge C)

anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The restorations extended at external third of occlusal surface present highest

percents of indices C regarding anatomic form (occlusal) (54 indices Ryge

C) anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The exceeding of 6-years age will require careful monitorisation for early

interventions through polishing sealing reshaping and even replacement for

restorations with major defects

Oblique layering technique presents superior results regarding marginal

adaptation and marginal discoloration and is recommended for proximo-

occlusal dental caries close to enamel-cement jonction

Centripetal build-up presents good results regarding marginal adaptation and

anatomical form at proximal level (proximal surfaces and contact point)

Horisontal layering technique can be used for optimum results only in

proximal-occlusal cavities with moderate extension both in occlusal-cervical

and buccal-oral

The values of die penetration at gingival wall were statistically different

between the three restorative techniques

We concluded that all restorative methods were associated with lightcuring

contraction and marginal microleakage

The combined technique was associated with lowest lightcuring contraction

and die penetration

The bulk technique was associated with highest lightcuring contraction and die

penetration

39

The surfaces of enamel and dentine at cervical level record decreases of

roughness related to the decrease of distance to ECJ

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel but the differences

statistical significant are present only for enamel localised at 2 mm from ECJ

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of

dentine

bull The amalgam in class II restorations has a low deformation tendency because

of uniform distribution of tension inside material

bull Composite resins class II restorations accumulate higher tensions comparing

with amalgam but deformation is avoided for a time because of the adhesion

forces performed between molecules under moderate oral forces In case of

high oral forces (600-800N) the risk of fracture in moderate class II

restorations is higher comparing with amalgam proximo-occlusal restorations

For extended class II restorations and forces of 600 N composite resins present

highest risk of fracture and deformation The von Misses tension at the

cervical interface restorationtooth can reach 1600Mpa

bull The amalgam in moderate class II restorations can resist to deformation even

for high intensity forces limited to 600N In extended class II restorations the

risk of deformation and fracture increases at values of 600N-800N of oral

forces The von Misses tension at the cervical interface restorationtooth can

reach 1700 Mpa

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Biology199843(8)629-632

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817-822

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dental resin composites Dent Mater 2005 211150-1157

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201989117ndash121

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18(7)516-20

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Materials Journal 2006 25(1)59-65

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Dent 27(5)325-331 1999

49

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Jan11(1)34-40

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JProsthet Dent 199369(4)425-430

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thermal behavior of dental composites Dent Mater 2008 24(8)1017ndash1024

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JDent 199826 627-632

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shrinkage and elasticity of flowable composites and filled adhesives Dent Mater

1999 15128-137

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Pendefunda 180Sorina Solomon Topoliceanu C Elements of dispersional

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Edition of the Balkan Medical Days

Stomatological Section Abstract nr1091999128

181Lăcătuşu St Andrian S Gianina Iovan- Consideraţii asupra adaptării

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200126302ndash307

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Dentistry and Oral Epidemiology 1996 24 106-11

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Dent Mater 2002 18436-444

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20(3)236-43

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Polymerization shrinkage effects of boundary conditions and filling technique of

resin composite restorations J Dent 2004 32(6)459-70

50

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Quintessence Int 2004 35(2)156-61

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copolymerizations Macromolecules 1999 323913-3921

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clinical results J Dent Res 199877 1020

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Dentomaxillofac Radiol 2007 Oct36(7)377-81

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direct and indirect restorations icircn posterior teeth of the permanent

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J Prosthet Dent 2000 Sep84(3)289-96

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Three-year clinical evaluation of composite and ceramic inlays Am J Dent 2001

Apr14(2)95-9

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hardness and depth of cure of light cured packable composite resins J Dent Res 2000

79369 (Abstract)

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caries-affected transparent dentin by citric acidAn atomic force microscopy

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practitioners and dental caries JDent1990 18(3) 130-136

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(Cerana) Br Dent J 2006 Oct 21201(8)515-20

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PrimDentCare1999Apr659-62

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Quintessence 198961-80

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ScandJDRes 199210060-65

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33

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19904011ndash7

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Am Dent Assoc 2010 141(3)319-29

52

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125749-751

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34

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Monogr Oral Sci 20092142-51

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569ndash575

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Nanoleakage leakage within the hybrid layer Oper Dent 1995 20 18-25

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451

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336Wenzel A Hintze H Perception of image quality in direct digital radiography

after application of various image treatment filters for detectability of dental diseases

Dentomaxillofac Radiol 1993 22 131-4

337Wenzel A Computer-aided image manipulation of intraoral radiographs to

enhance diagnosis in dental practice a review Int Dent J 1993 43 99-108

338Wenzel A Digital radiography and caries diagnosis Dento Maxillo Facial

Radiology 27(1)3-11 1998

339Wenzel A Haiter-Neto F Gotfredsen E Risk factors for a false positive test

outcome in diagnosis of caries in approximal surfaces impact of radiographic

modality and observer characteristics Caries Res 200741(3)170-6

340Wibowo G Stockton L Microleakage of class II composite restorations Am J

Dent 200114177ndash185

341Wilson NHF Wastell DG Norman RD Five-year performance of high-

cooper content amalgam restorations in a multiclinical trial JDent1996 24 203-210

342Winkler MM Katona TR Paydar NH Finite element stress analysis of three

filling techniques for class V light-cured composite restorations J Dent Res

1996751477-83

343Yap AU Effectiveness of polymerization in composite restoratives claiming bulk

placement Impact of cavity depth and exposure time Oper Dent 2000 25113-120

59

344Yeşilyurt C Bulucu B Bond strength of total-etch dentin adhesive systems on

peripheral and central dentinal tissue a microtensile bond strength test The Journal of

Contemporary Dental Practice 7(2) 20061-13

345Yoshida Y Van Meerbeek B Okazaki M Shintani H Suzuki K Comparative

study on adhesive performance of functional monomers J Dent Res 2004 83 454-

458

346Yoshiyama M Tay FR Doi J Nishitani Y Yamada T Itou K Carvalho RM

Nakajima M Pashley DH Bonding of self-etch and total etch adhesives to carious

dentin J Dent Res 2002 81 556-560

  • COPERTA REZUMAT ENGLEZA (MEREUTA)pdf
  • REZUMAT ENGLEZA DR MEREUTA DENISSpdf
Page 32: UNIVERSITATEA DE MEDICINA SI FARMACIE “GR Doctorat/Rezumat... · universitatea de medicina si farmacie “gr.t.popa” iasi facultatea de medicina dentara rezumatul tezei de doctorat

29

Tests of Normality

Kolmogorov-Smirnov

a Shapiro-Wilk

Statistic df Sig Statistic df Sig

Dentine 2mm before etching 274 10 032 877 10 122

Dentine 15mm after etching 209 10 200 952 10 689

Dentine 1mm before etching 134 10 200 983 10 980

Dentine 05mm before etching 155 10 200 949 10 661

Dentine 2mm after etching 133 10 200 977 10 946

Dentine 15mm after etching 197 10 200 916 10 329

Dentine 1mm after etching 216 10 200 925 10 401

Dentine 05 after etching 220 10 185 933 10 474

Enamel 2mm before etching 193 10 200 898 10 207

Enamel 15mm before etching 170 10 200 977 10 947

Enamel 1mm before etching 157 10 200 952 10 689

Enamel 05mm before etching 165 10 200 943 10 590

Enamel 2mm after etching 235 10 124 925 10 404

Enamel 15mm after etching 209 10 200 871 10 102

Enamel 1mm after etching 189 10 200 964 10 834

Enamel 05mm after etching 142 10 200 983 10 978

a Lilliefors Significance Correction

This is a lower bound of the true significance

The results of test t for pair dentine samples before and after etching are

presented in table X

Table X7 Test t for dentine before and after etching

Paired Samples Test

Paired Differences

t df

p (2-

tailed)

95 Confidence

Interval of the

Difference

Mean

Std

Dev

Std

Error

Mean Lower Upper

Pair

1

dentine2mmbeforeetching-

dentine2mmafteretching

-

8010000

174801 55277 -

8135045

-

7884955

-

144906

9 000

Pair

2

dentine15mmbeforeetching-

dentine15mmafteretching

-

6608000

102394 32380 -

6681248

-

6534752

-

204079

9 000

Pair

3

dentine1mmbeforeetching-

dentine1mmafteretching

-

6209000

117799 37251 -

6293269

-

6124731

-

166678

9 000

30

Paired Samples Test

Paired Differences

t df

p (2-

tailed)

95 Confidence

Interval of the

Difference

Mean

Std

Dev

Std

Error

Mean Lower Upper

Pair

1

dentine2mmbeforeetching-

dentine2mmafteretching

-

8010000

174801 55277 -

8135045

-

7884955

-

144906

9 000

Pair

2

dentine15mmbeforeetching-

dentine15mmafteretching

-

6608000

102394 32380 -

6681248

-

6534752

-

204079

9 000

Pair

3

dentine1mmbeforeetching-

dentine1mmafteretching

-

6209000

117799 37251 -

6293269

-

6124731

-

166678

9 000

Pair

4

dentine05mmbeforeetching-

dentine05mmafteretching

-

6122000

86384 27317 -

6183796

-

6060204

-

224109

9 000

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of dentine (

2mm 15 mm 1mm sau 05mm)

The descriptive statistics data for dentine surface roughness before and after

etching are presented in tables X8 and X9

Table X8 Descriptive statistics for enamel samples before etching

Statistics

Enamel 2mm

before etching

Enamel 15mm

before etching

Enamel 1mm

before etching

Enamel 05mm

before etching

N Valid 10 10 10 10

Missing 0 0 0 0

Mean 416800 333600 317200 305900

Std Error of Mean 13968 15217 14205 20355

Std Deviation 44171 48120 44920 64369

Skewness 1095 -156 -109 -411

Std Error of Skewness 687 687 687 687

Kurtosis 769 487 -118 -295

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 4120 3250 3090 2940

Maximum 4260 3420 3240 3140

31

Table X9 Descriptive statistics for enamel samples after etching

Statistics

Enamel 2mm

after etching

Enamel 15mm

after etching

Enamel 1mm

after etching

Enamel 05mm

after etching

N Valid 10 10 10 10

Missing 0 0 0 0

Mean 2237600 1107400 875100 838200

Std Error of Mean 31027 20232 11968 17436

Std Deviation 98116 63979 37845 55136

Skewness -850 267 042 040

Std Error of Skewness 687 687 687 687

Kurtosis 878 -1880 1082 -425

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 22180 10990 8680 8290

Maximum 22520 11160 8820 8470

To choose the statistical test to compare roughness surface values was

performed a test Shapiro-Wilk If p is lower or equal with 0005 than hypothesis of

distribution normality is rejected (distribution deviates from normal form) In the table

X10 the distributions are normal The statistical test will be test t for pair samples

Table X10 Test Shapiro-Wilk for enamel samples

Tests of Normality

Kolmogorov-Smirnova Shapiro-Wilk

Statistic df Sig Statistic df Sig

2mmenamel before etching 193 10 200 898 10 207

15mmenamel before etching 170 10 200 977 10 947

1mmenamel before etching 157 10 200 952 10 689

05mmenamel before etching 165 10 200 943 10 590

2mmenamel after etching 235 10 124 925 10 404

15mmenamel after etching 209 10 200 871 10 102

1mmenamel after etching 189 10 200 964 10 834

05mmenamel after etching 142 10 200 983 10 978

a Lilliefors Significance Correction

This is a lower bound of the true significance

The results of test t for pair enamel samples before and after etching are

presented in table X11

32

Table X11 Test t for enamel samples before and after etching

Paired Samples Test

Paired Differences

t df

p (2-

tailed)

95 Confidence

Interval of the

Difference

Mean

Std

Deviation

Std

Error

Mean Lower Upper

Pair

1

2mmenamel before

etching

2mmenamel after

etching

-18208 135220 42760 -

18304731

-

18111269

-

425815

9 000

Pair

2

15mmenamel before

etching

15mmenamel after

etching

-7738 73151 23132 -7790329 -7685671 -

334508

9 076

Pair

3

1mmenamel before

etching

1mmenamel after

etching

-5579 55468 17540 -5618679 -5539321 -

318065

9 065

Pair

4

05mmenamel before

etching

05mmenamel after

etching

-5323 60378 19093 -5366192 -5279808 -

278788

9 063

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel ( 2mm 15 mm 1mm sau

05mm) but the differences statistical significant are present only for enamel localised

at 2 mm from ECJ

X5CONCLUSIONS

The surfaces of enamel and dentine at cervical level record decreases of

roughness related to the decrease of distance to ECJ

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel but the differences

statistical significant are present only for enamel localised at 2 mm from ECJ

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of

dentine

33

CHAPTXI FEA STUDY REGARDING THE BIOMECHANICAL

BEHAVIOUR AND FRACTURE RESISTANCE OF PROXIMO-OCCLUSAL

AMALGAM AND COMPOSITE RESINS RESTORATIONS

XI1INTRODUCTION AIM OF STUDY

The individual variation of patients morphological and functional complexity

of tissues as well as difficult access limit the possibilities to investigate in clinical

studies the biomechanical behaviour of proximo-occlusal restorations In this context

simulation of the biomechanics for direct restorations represents an interesting

interdisciplinar domain in actual dentistry research

The study focused on two direction

- analysis of role of forces intensity on biomechanical behaviour related to

cavity dimension and material

- analysis of tension inside restoration structure related to forces intensity

XI2MATERIALS AND METHODS

The stages of finite element analysis study are as follows

object modelling (bicusps and proximo-occlusal restoration)

definition of parameters for materials and dental tissues

meshing

constraints and loading

types of contacts

equations system definition

results of simulation

The object 3D modelling was performed in Rhinoceros (figure XI1) The

definition of parameters was performed for Poisson constant Young modulus density

(table XI1) The selected materials were amalgam and composite resins The

analysed tissues were dentine and enamel The meshing constraints loading were

performed for forces of 200N 400N 600N 800 N The analysis was performed using

software COSMOSWorks 2010

34

Fig XI1 3D modellation of bicusp

Table XI1 Values of Young modulus Poisson constant compression resistance for

amalgam composite resin enamel (amalgam compozit smalţ)

Material Young modulus (GPa) Poisson constants

Compression

resistance

(Mpa)

Amalgam 55 033 483

Enamel 48 03 400

Composite

resin 220 022 345

Fig XI2 The forces and constraints application

The results are presented in values and culours red colours representing areas

with maximum values of tensions produced under influence of masticatory forces

The tensions produced in amalgam restoration are in a range from 0 to 22886

(force 800 N) The maximum von Misses tensions are associated with cervical area

of amalgam restorations This aspect proves that first modification in interface

restoration-cavity margins will appear at the level of gingival wall First marginal

35

defects and fissures in restoration bulk will appear at tensions over 1600Mpa

associated with forces of 800N for extended amalgam proximo-occlusal restorations

The tensions produced in composite resin restorations are in a range from 0 to

2285 (force 800 N) The maximum von Misses tensions are associated with cervical

area of composite resin restorationsThis aspect proves that first modification in

interface restoration-cavity margins will appear at the level of gingival wall First

marginal defects and fissures in restoration bulk will appear at tensions over 1716

Mpa associated with forces of 600N for moderate and extended composite resins

proximo-occlusal restorations

Fig XI3a-b ndash Simulated model of proximo-occlusal restoration

FigXI4a-b Dental amalgam restoration Cervical tension associated with 600 N

(c)800 N (d)

FigXI5a-b Composite resin restoration Cervical tension associated with 600 N

(c)800 N (d)

36

The deformation of amalgam can be produced only when is associated with

fissures in bulk of restorations while composite resins restorations present

deformation when are associated with a modification of volume and form because of

repeated action of medium forces on long term or high forces on short term (figures

XI4 XI5)

Fig XI4 Material deformation in area of maximum tension

000E + 00

500E -02

100E -01

150E -01

200E -01

250E -01

1 4 7 101316192225283134374043464952555861646770737679

Amalgam C ompoz it

Figura XI5 Deformarea funcție de material

The amalgam and composite resins were treated as homogenous isotropic and

liniar The advantage of this type of FEA study is that restorations parameters can be

modified any time is necessary both in arhitecture geometry and material indices

variability The results of this study sustain the conclusions of other FEA studies

focused on biomechanical behaviour of posterior restorations performed with

amalgam and composite resins(35 62 76 143)

37

XI4CONCLUSIONS

bull The amalgam in class II restorations has a low deformation tendency because

of uniform distribution of tension inside material

bull Composite resins class II restorations accumulate higher tensions comparing

with amalgam but deformation is avoided for a time because of the adhesion

forces performed between molecules under moderate oral forces In case of

high oral forces (600-800N) the risk of fracture in moderate class II

restorations is higher comparing with amalgam proximo-occlusal restorations

For extended class II restorations and forces of 600 N composite resins present

highest risk of fracture and deformation The von Misses tension at the

cervical interface restorationtooth can reach 1600Mpa

bull The amalgam in moderate class II restorations can resist to deformation even

for high intensity forces limited to 600N In extended class II restorations the

risk of deformation and fracture increases at values of 600N-800N of oral

forces The von Misses tension at the cervical interface restorationtooth can

reach 1700 Mpa

38

FINAL CONCLUSIONS

Amalgam proximo-occlusal restorations with minimum 6-years age present

excellent results for parameters anatomic form (occlusal) marginal

discoloration and marginal secondary dental caries good results for

parameters anatomic form (proximal) and marginal adaptation and poor results

for surface quality

Composite resins proximo-occlusal restorations (bicusps) with minimum 6-

years age present excellent results for parameters color match marginal

discoloration and marginal secondary dental caries and good results for

parameters anatomic form (occlusal proximal) marginal adaptation surface

quality

Composite resins proximo-occlusal restorations (molars) with minimum 6-

years age present good results for parameters color match marginal

discoloration marginal secondary dental caries marginal adaptation and poor

results for parameters anatomic form (occlusal) (54 indices Ryge C)

anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The restorations extended at external third of occlusal surface present highest

percents of indices C regarding anatomic form (occlusal) (54 indices Ryge

C) anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The exceeding of 6-years age will require careful monitorisation for early

interventions through polishing sealing reshaping and even replacement for

restorations with major defects

Oblique layering technique presents superior results regarding marginal

adaptation and marginal discoloration and is recommended for proximo-

occlusal dental caries close to enamel-cement jonction

Centripetal build-up presents good results regarding marginal adaptation and

anatomical form at proximal level (proximal surfaces and contact point)

Horisontal layering technique can be used for optimum results only in

proximal-occlusal cavities with moderate extension both in occlusal-cervical

and buccal-oral

The values of die penetration at gingival wall were statistically different

between the three restorative techniques

We concluded that all restorative methods were associated with lightcuring

contraction and marginal microleakage

The combined technique was associated with lowest lightcuring contraction

and die penetration

The bulk technique was associated with highest lightcuring contraction and die

penetration

39

The surfaces of enamel and dentine at cervical level record decreases of

roughness related to the decrease of distance to ECJ

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel but the differences

statistical significant are present only for enamel localised at 2 mm from ECJ

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of

dentine

bull The amalgam in class II restorations has a low deformation tendency because

of uniform distribution of tension inside material

bull Composite resins class II restorations accumulate higher tensions comparing

with amalgam but deformation is avoided for a time because of the adhesion

forces performed between molecules under moderate oral forces In case of

high oral forces (600-800N) the risk of fracture in moderate class II

restorations is higher comparing with amalgam proximo-occlusal restorations

For extended class II restorations and forces of 600 N composite resins present

highest risk of fracture and deformation The von Misses tension at the

cervical interface restorationtooth can reach 1600Mpa

bull The amalgam in moderate class II restorations can resist to deformation even

for high intensity forces limited to 600N In extended class II restorations the

risk of deformation and fracture increases at values of 600N-800N of oral

forces The von Misses tension at the cervical interface restorationtooth can

reach 1700 Mpa

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Statement on posterior resin-based composites JADA 1998 129(11)1627ndash1628

2Albers HF Tooth-colored restoratives 1st ed Santa Rosa CA Alto Books 1979

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4Alomari QD Reinhardt JW Boyer DB Effect of liners on cusp deflection and

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6Aggarwal V Logani A Jain V Shah N Effect of cyclic loading on marginal

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Oper Dent 2008 Sep-Oct33(5)587-92

7Andrian S Lăcătuşu St- Caria dentară- Protocoale şi tehnici- EdApolloniaIaşi

1999

8Andrian S- Restaurări fizionomice cu materiale plastice icircn cariologie-EdPanteon

Iaşi 2001

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9Andrian S Tratamentul Minim Invaziv al Cariei Dentare EditPrinceps Edit Iaşi

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13Angmar-Mansson B Al-Khateeb S Tranaeus S Caries diagnosis Journal of

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14Anusavice KJ- ldquoQuality evaluation of dental restorationscriteria for placement

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15Anusavice KJ Development and testing of ceramics for dental restorations In

Fischman G Clare A Hench J editors Bioceramics materials and applications

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16Arhun N Celik C Yamanel KClinical evaluation of resin-based composites in

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17Armstrong SR JC Keller DB Boyer The influence of water storage and C-

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utilizing a filled and unfilled adhesive resin Dent Mater 200117268ndash276

18Armstrong S Boyer D Keller J Microtensile bond strength testing and failure

analysis of two dentin adhesives Dent Mater 1998 14(1)44-50

19Asmussen E Peutzfeldt A Influence of UEDMA BisGMA and TEGDMA on

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1451-56

20Asmussen E Clinical relevance of physical chemical and bonding properties of

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22Bader JD Shugars DA What do we know about how dentists make caries-

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464-473

26Bader JD Shugars DA Understanding dentistslsquo restorative treatment decisions J

Public Health Dent 1992 Winter52(2)102-10

27Barkmeier WW Cooley RL Current status of adhesive resin systems J Am Coll

Dent 199158 36-39

28Bayne SC Dental biomaterials where are we and where are we going J Dent

Educ 200569(5)571ndash585

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29Bedran-de-Castro AK Pereira PN Thompson JY Influence of load cycling

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30Behle C Flowable composite Proprieties and applications Pract Periodontics

Aesthetics Dent 1998 10347 350-351

31Bergenholtz G Cox CF Bacterial leakage around dental restorations Its effects

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32Bernardo M Luis H Martin MD Survival and reasons for failure of amalgam

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33Black J Biological Performance of Materials Fundamentals of Biocompatibility

NY Marcel Dekker Inc 1999

34Bonsor SJ Chadwick RGLongevity of conventional and bonded (sealed)

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9

35Boschian PL S Guidotti R Pietrbissa M Gagliani- bdquoStress distribution in a

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Rehabilitation (33) 2006690ndash697

36Bouillaguet S B Ciucchi T Jacoby JC Wataha DH Pashley Bonding

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321

37Bouschlicher MR Rueggeberg FA Effect of ramped light intensity on

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2000 12328-339

38Braga RR Ferracane JL Hilton TJ Contraction stress of flowable composites

and their efficacy as stress-relieving layers J Am Dent Assoc 2003134721ndash728

39Braga RR Ballester RY Ferracane JLFactors involved in the development of

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200521(10)962-70

40Bratu D- Materiale dentare icircn cabinetul de stomatologie- Edit Helicon

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41Browning WD Johnson WW Gregory PN- Clinical performances of

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Association 2000nr131

42Brunthaler A Koumlnig F Lucas T Sperr W Schedle A Longevity of direct resin

composite restorations in posterior teeth Clin Oral Investig 2003 763-70

43Bullard RH Leinfelder KR Russell CM Effect of coefficient of thermal

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44Buonocore MG Matsui A Gwinnett AJ Penetration of resin dental materials

into enamel surfaces with reference to bonding Arch Oral Biol 19681361-70

45Burke FJ Cheung SW Mjoumlr IA Wilson NH Restoration longevity and analysis

of reasons for the placement and replacement of restorations provided by vocational

dental practitioners and their trainers in the United Kingdom Quintessence Int

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46Burke FJ Cheung SW Mjor IA Wilson NH-Reasons for the placement and

replacement of restorations in vocational training practicePrimary Dental Care

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47Burke FJ Wilson NH Cheung SW Mjoumlr IA Influence of patient factors on age

of restorations at failure and reasons for their placement and replacement J Dent

200129(5)317-24

48Calheiros FC Braga RR Kawano Y Ballester RY Relationship between

contraction stress and degree of conversion in restorative composites Dent Mater

2004 20939-946

49Cardoso P Sadek F Microtensile bond strength on dentin using new adhesive

systems with selfetching primers Braz J Oral Sci 2003 2(4) 156-159

50Cardoso M Baratieri LN Ritter AV The effect of finishing and polishing on

the decision to replace existing amalgam restorations Quintessence Int 1999

Jun30(6)413-8

51Carvalho RM JC Pereira M Yoshiyama DH Pashley A review of

polymerization contraction the influence of stress development versus stress

reliefOper Dent19962117ndash24

52Castro VM Katz JO Hardman PK Glaros AG Spencer P Invitro comparison

of conventional film and direct digital imaging in the detection of approximal caries

Dentomaxillofac Radiol 2007 Mar36(3)138-42

53Cattaneo PM M Dalstra B Melsen- bdquoThe Finite Element Method a Tool to

Study Orthodontic Tooth Movement J Dent Res 2005 84(5)428-433

54Cattell MJ Clarke RL Lynch EJ The transverse strength reliability and

microstructural features of four dental ceramicspart 1 J Dent 25(5)399-407 1997

55Cehreli ZC Akca T Effect of dentinal tubule orientation on the microtensile

bond strength to primary dentin J Dent Child 2003 70(2) 139-144

56Celik C Arhun N Yamanel K Clinical evaluation of resin-based composites in

posterior restorations 12-month results Eur J Dent 2010 Jan4(1)57-65

57Cenci M Demarco F de Carvalho R Class II composite resin restorations with

two polymerization techniques Relationship between microtensile bond strength and

marginal leakage J Dent 2005 33(7) 603- 610

58Chaffin J Moss D Review of current US Army dental emergency rates Mil

Med 2008173(1)23ndash26

59Chen HY Manhart J Hickel R Kunzelmann KH Polymerization contraction

stress in light-cured packable composite resinsDent Mater 200117253-259

60Choi KK Condon JR Ferracane JL The effects of adhesive thickness on

polymerization contraction stress of composites J Dent Res 2000 79812ndash817

61Cichon P Kerschbaum T Verweildauer zahnartzlicher Restaurationen bei

Behinderten Dtsch Zahnartzlicher 1999 54 96-102

62Cohen BI Pagnillo MK Deutsch ASMusikant BL Fracture Strength of

Three Core Restorative Materials Supported with or without a Prefabricated Split-

Shank Post Journal of Prosthetic Dentistry1997 78 560ndash565

63Colli P Brannstrom M The marginal adaptation of four different bonding agents

in Class II composite resin restoration applied in bulk or in two increments

Quintessence Int 1993 24583-591

43

64Collins CJ Bryant RW Hodge KL A clinical evaluation of posterior composite

resin restorations 8-year findings J Dent 199826(4) 311ndash317

65Condon JR Ferracane JL Assessing the effect of composite formulation on

polymerization stress J Am Dent Assoc2000 131497-503

66Cook WD Moopnar M Influence of chemical structure on the fracture

behaviour of dimethacrylate composite resins Biomaterials 1990 11272-276

67Cortes DF Ellwood RP Ekstrand KR An in vitro comparison of a combined

FOTIvisual examination of occlusal caries with other caries diagnostic methods and

the effect of stain on their diagnostic performance Caries Res 2003 37 (1) 8-16

68Crim GA Microleakage of three resin placement techniques Am J Dent

1991469-72

69Dauvillier B Aarnts M Feilzer A The competition between the composite-

dentin strength and the polimerization contraction stress J Dent Res 1984 63 1396-

1399

70Dauvillier BS Aarnts MP Feilzer AJ Developments in shrinkage control of

adhesive restoratives J Esthet Dent 2000 12291-299

71Dauvillier BS Aarnts MP Feilzer AJ Modeling of the viscoelastic behavior of

dental light-activated resin composites during curing Dent Mater 200319277ndash285

72Davidson CL Gee AJ Feilzer A The competition between the composite-dentin

bond strength and the polymerization contraction stress J Dent Res 1984

63(12)1396-9

73Davidson CL AJ Feilzer Polymerization shrinkage and polymerization

shrinkage stress in polymer-based restoratives J Dent Res 199725435ndash440

74Davidson CL Resisting the curing contraction with adhesive composites J

Prosthet Dent 198655446ndash7

75Davis RD Mayhew RB A clinical comparison of three anterior restorative resins

at 3 years J Am Dent Assoc 1986112659-63

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Dent200899131-40

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1331387ndash97

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Dent20104(3)270-9

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2006 22359-365

44

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Operations Desert ShieldStorm Mil Med 1996161(10) 620ndash623

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26 717-727

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20028195 (Abstract)

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30(3)163- 1681999

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848

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1243

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Biology199843(8)629-632

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817-822

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18(7)516-20

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JDent 199826 627-632

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Edition of the Balkan Medical Days

Stomatological Section Abstract nr1091999128

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Dentistry and Oral Epidemiology 1996 24 106-11

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Dent Mater 2002 18436-444

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20(3)236-43

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Polymerization shrinkage effects of boundary conditions and filling technique of

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50

189Lopes GC Baratieri LN Monteiro S Jr Vieira LC Effect of posterior resin

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Dentomaxillofac Radiol 2007 Oct36(7)377-81

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J Prosthet Dent 2000 Sep84(3)289-96

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Three-year clinical evaluation of composite and ceramic inlays Am J Dent 2001

Apr14(2)95-9

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79369 (Abstract)

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PrimDentCare1999Apr659-62

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33

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52

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34

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Monogr Oral Sci 20092142-51

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53

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569ndash575

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Community Dent Oral Epidemiol 1980 Jun8(3)135-8

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two composite resin formulations J Conserv Dent 2010 13(1) 9ndash15

54

256Radu TM A Uliuliuc Dana Apostolide S Andrian The effect of adhesive

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Soc Med Iaşi-2008 vol112 nr1supl1145-147

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posterior composite 10-year report J Dent 199927(1) 13ndash19

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of teeth with long-term performing composite restorations J Oral Rehabil 2002

29(12)1131ndash1138

260Roberson TM Heymann HO Swift EJ eds Sturdevantlsquos Art and Science of

Operative Dentistry 5th ed St Louis Mosby 2006293-7

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Int Dent J 199141(4)195-205

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ClinOral Invest1997140-46

266Roulet JFBenefits and disadvantages of tooth-coloured alternatives to amalgam

J Dent 199725(6)459-73

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1993691ndash95

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269Rushton VE Horner K Worthington HV Screening panoramic radiography

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271Sajjan GS Mittal NEffect of different placement techniques on marginal

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J Conserv Dent 201013(1)9-15

272Sakaguchi RL MC Peters SR Nelson WH Douglas HW Poort Effects

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composites Dent Mater 200218197-202

274Sano H Takatsu T Ciucchi B Horner JA Matthews WG Pashley DH

Nanoleakage leakage within the hybrid layer Oper Dent 1995 20 18-25

55

275Sarrett DC Clinical challenges and the relevance of materials testing for

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276Sarrett DC Brooks CN Rose JT Clinical performance evaluation of a

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404

279Schneiderman A Elbaum M Schultz T Keem S Greenebaum M Driller J

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286Sideridou I Tserki V Papanastasiou G Effect of chemical structure on degree

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287Sideridou I Tserki V Papanastasiou G Study of water sorption solubility and

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291Simecek JW Diefenderfer KE Ahlf RL Ragain JC Jr Dental sealant

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56

292Simi B Suprabha B Evaluation of microleakage in posterior nanocomposite

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295Smales RJ Webster DA Leppard PISurvival predictions of amalgam

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296Smales RJ Hawthorne WSLong-term survival of extensive amalgams and

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297Soncini JA Maserejian NN Trachtenberg F Tavares M Hayes C The

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301Spreafico RC Gagliani M Composite resin restorations on posterior teeth In

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Quintessence 2000253ndash76

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303Stangel I Barolet RY Clinical evaluation of two posterior composite resins

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from the SCO Dental Products Inc Symposium 2003 24(8) 4-9 (Abstract)

307Summit JB Burgess JO Berry TG Six-year clinical evaluation of bonded and

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308Summit JB Robbins JW Hilton TJ Fundamentals in operative dentistry Cap

10Direct Posterior Esthetic Restorations 2006 Quintessence Publishing Co

57

309Svanberg M Mjor IA Orstavik D Mutans streptococci in plaque from margins

of amalgam composite and glassndashionomer restorations J Dent Res 199069861ndash

864

310Tanne K Mamoru S Burstone C Three-dimensional finite element analysis

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Orthop921987499ndash505

311Tanumiharja M Burrow MF Tyas MJ Microtensile bond strengths of seven

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312Tay FR Pashley DH Aggressiveness of contemporary self-etching systems

Part I Depth of penetration beyond dentin smear layers Dent Mater 2001 17(4) 296-

308

313Tay FR Frankenberger R Krejci I Bouillaguet S Pashley DH Carvalho

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In vivo evidence J Dent 2004 32611ndash621

314Tay FR Pashley DH Have dentin adhesives become too hydrophilic J Can

Dent Assoc 2003 69726ndash731

315Tay FR Sano H Carvalho R Pashley EL Pashley DH An ultrastructural

study of the influence of acidity of self-etching primers and smear layer thickness on

bonding to intact dentin J Adhes Dent 2000 283ndash98

316Thompson JY Bayne SC Heymann HO Mechanical properties of a new

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76(6)619-623 1996

317Unterbrink GL R Muessner Influence of light intensity on two restorative

systems J Dent 199523183ndash189

318Unterbrink GL Liebenberg WH Flowable resin composites as filled

adhesiveslsquo literature review and clinical recommendations Quintessence Int

199930249ndash257

319Vaarkamp J Ten Bosch J Verdonschot EH Quantitative diagnosis of small

approximal caries lesions utilizing wavelength-dependent fiber-optic

transillumination Journal of Dental Research 1997 76 (4) 875-882

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Oral Surg Oral Med Oral Pathol 198661(3)289-96

321Van Meerbeek B De Munck J Yoshida Y Inoue S Vargas M Vijay P Van

Landuyt K Lambrechts P Vanherle G Adhesion to enamel and dentin Current

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322Van Meerbeek B Van Landuyt K De Munck JHashimoto M Peumans M

Lambrechts P Yoshida Y Inoue S Suzuki K Technique-sensitivity of

contemporary adhesives Dent Mater J 2005 24(1) 1-13

323Van Meerbeek B Vargas S Inoue S Yoshida Y Peumans M Lambrechts P

Vanherle G Adhesives and cements to promote preservation dentistry Oper Dent

20016 119-144

324Van Meerbeek B Yoshida Y Inoue S Vargas M Abe Y Fukuda R Okazaki

M Lambrechts P Vanherle G Bonding mechanism micro-tensile bond strength of

a 4- MET-based self-etching adhesive J Dent Res 2000 79 249 (Abstract)

58

325Van Nieuwenhuysen JP DrsquoHoore W Carvalho J Qvist V Long-term

evaluation of extensive restorations in permanent teeth J Dent 200331(6)395ndash405

326Venhoven BA de Gee AJ Davidson CL Light initiation of dental resins

dynamics of the polymerization Biomaterials 1996 172313-2318

327Versluis A Douglas WH Cross M Sakaguchi RL Does an incremental filling

technique reduce polymerization shrinkage stresses J Dent Res 1996 75871ndash878

328Vries HC Ruiken HM Konig KG vanrsquot Hof MA Radiographic versus

clinical diagnosis of approximal carious lesions Caries Res1990 24 (5) 364-370

329Waggoner W Ashton J Predictability of cavitation based upon radiographic

appearance comparison of two film types Quintessence International 1989 20(1)

55-60

330Watanabe LG Marshall GW Jr Marshall SJ Dentin shear strength effects of

tubule orientation and intra tooth location Dent Mater 1996 12 109-115

331Watts DC AS Marouf Optimal specimen geometry in bonded-disk

shrinkage-strain measurements on light-cured biomaterials Dent Mater 200016447ndash

451

332Watts DC Marouf AS Al-Hindi AM Photo-polymerization shrinkage-stress

kinetics in resin-composites methods development Dent Mater 2003 191ndash11

333Weaver WS Blank LW Pelleu GB Jr A visible light activated resin cured

through tooth structure GenDent 198836236-7

334Wendt SL Microleakage and cusp fracture resistance of heattreated composite

resin inlays Am J Dent 4(1)10-14 1991

335Wenzel A Hintze H Mikkelsen L Mouyen F Radiographic detection of

occlusal caries in noncavitated teeth A comparison of conventional film radiographs

digitized film radiographs and RadioVisioGraphy-Oral Surg Oral Med Oral Pathol

1991 72 621-6

336Wenzel A Hintze H Perception of image quality in direct digital radiography

after application of various image treatment filters for detectability of dental diseases

Dentomaxillofac Radiol 1993 22 131-4

337Wenzel A Computer-aided image manipulation of intraoral radiographs to

enhance diagnosis in dental practice a review Int Dent J 1993 43 99-108

338Wenzel A Digital radiography and caries diagnosis Dento Maxillo Facial

Radiology 27(1)3-11 1998

339Wenzel A Haiter-Neto F Gotfredsen E Risk factors for a false positive test

outcome in diagnosis of caries in approximal surfaces impact of radiographic

modality and observer characteristics Caries Res 200741(3)170-6

340Wibowo G Stockton L Microleakage of class II composite restorations Am J

Dent 200114177ndash185

341Wilson NHF Wastell DG Norman RD Five-year performance of high-

cooper content amalgam restorations in a multiclinical trial JDent1996 24 203-210

342Winkler MM Katona TR Paydar NH Finite element stress analysis of three

filling techniques for class V light-cured composite restorations J Dent Res

1996751477-83

343Yap AU Effectiveness of polymerization in composite restoratives claiming bulk

placement Impact of cavity depth and exposure time Oper Dent 2000 25113-120

59

344Yeşilyurt C Bulucu B Bond strength of total-etch dentin adhesive systems on

peripheral and central dentinal tissue a microtensile bond strength test The Journal of

Contemporary Dental Practice 7(2) 20061-13

345Yoshida Y Van Meerbeek B Okazaki M Shintani H Suzuki K Comparative

study on adhesive performance of functional monomers J Dent Res 2004 83 454-

458

346Yoshiyama M Tay FR Doi J Nishitani Y Yamada T Itou K Carvalho RM

Nakajima M Pashley DH Bonding of self-etch and total etch adhesives to carious

dentin J Dent Res 2002 81 556-560

  • COPERTA REZUMAT ENGLEZA (MEREUTA)pdf
  • REZUMAT ENGLEZA DR MEREUTA DENISSpdf
Page 33: UNIVERSITATEA DE MEDICINA SI FARMACIE “GR Doctorat/Rezumat... · universitatea de medicina si farmacie “gr.t.popa” iasi facultatea de medicina dentara rezumatul tezei de doctorat

30

Paired Samples Test

Paired Differences

t df

p (2-

tailed)

95 Confidence

Interval of the

Difference

Mean

Std

Dev

Std

Error

Mean Lower Upper

Pair

1

dentine2mmbeforeetching-

dentine2mmafteretching

-

8010000

174801 55277 -

8135045

-

7884955

-

144906

9 000

Pair

2

dentine15mmbeforeetching-

dentine15mmafteretching

-

6608000

102394 32380 -

6681248

-

6534752

-

204079

9 000

Pair

3

dentine1mmbeforeetching-

dentine1mmafteretching

-

6209000

117799 37251 -

6293269

-

6124731

-

166678

9 000

Pair

4

dentine05mmbeforeetching-

dentine05mmafteretching

-

6122000

86384 27317 -

6183796

-

6060204

-

224109

9 000

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of dentine (

2mm 15 mm 1mm sau 05mm)

The descriptive statistics data for dentine surface roughness before and after

etching are presented in tables X8 and X9

Table X8 Descriptive statistics for enamel samples before etching

Statistics

Enamel 2mm

before etching

Enamel 15mm

before etching

Enamel 1mm

before etching

Enamel 05mm

before etching

N Valid 10 10 10 10

Missing 0 0 0 0

Mean 416800 333600 317200 305900

Std Error of Mean 13968 15217 14205 20355

Std Deviation 44171 48120 44920 64369

Skewness 1095 -156 -109 -411

Std Error of Skewness 687 687 687 687

Kurtosis 769 487 -118 -295

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 4120 3250 3090 2940

Maximum 4260 3420 3240 3140

31

Table X9 Descriptive statistics for enamel samples after etching

Statistics

Enamel 2mm

after etching

Enamel 15mm

after etching

Enamel 1mm

after etching

Enamel 05mm

after etching

N Valid 10 10 10 10

Missing 0 0 0 0

Mean 2237600 1107400 875100 838200

Std Error of Mean 31027 20232 11968 17436

Std Deviation 98116 63979 37845 55136

Skewness -850 267 042 040

Std Error of Skewness 687 687 687 687

Kurtosis 878 -1880 1082 -425

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 22180 10990 8680 8290

Maximum 22520 11160 8820 8470

To choose the statistical test to compare roughness surface values was

performed a test Shapiro-Wilk If p is lower or equal with 0005 than hypothesis of

distribution normality is rejected (distribution deviates from normal form) In the table

X10 the distributions are normal The statistical test will be test t for pair samples

Table X10 Test Shapiro-Wilk for enamel samples

Tests of Normality

Kolmogorov-Smirnova Shapiro-Wilk

Statistic df Sig Statistic df Sig

2mmenamel before etching 193 10 200 898 10 207

15mmenamel before etching 170 10 200 977 10 947

1mmenamel before etching 157 10 200 952 10 689

05mmenamel before etching 165 10 200 943 10 590

2mmenamel after etching 235 10 124 925 10 404

15mmenamel after etching 209 10 200 871 10 102

1mmenamel after etching 189 10 200 964 10 834

05mmenamel after etching 142 10 200 983 10 978

a Lilliefors Significance Correction

This is a lower bound of the true significance

The results of test t for pair enamel samples before and after etching are

presented in table X11

32

Table X11 Test t for enamel samples before and after etching

Paired Samples Test

Paired Differences

t df

p (2-

tailed)

95 Confidence

Interval of the

Difference

Mean

Std

Deviation

Std

Error

Mean Lower Upper

Pair

1

2mmenamel before

etching

2mmenamel after

etching

-18208 135220 42760 -

18304731

-

18111269

-

425815

9 000

Pair

2

15mmenamel before

etching

15mmenamel after

etching

-7738 73151 23132 -7790329 -7685671 -

334508

9 076

Pair

3

1mmenamel before

etching

1mmenamel after

etching

-5579 55468 17540 -5618679 -5539321 -

318065

9 065

Pair

4

05mmenamel before

etching

05mmenamel after

etching

-5323 60378 19093 -5366192 -5279808 -

278788

9 063

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel ( 2mm 15 mm 1mm sau

05mm) but the differences statistical significant are present only for enamel localised

at 2 mm from ECJ

X5CONCLUSIONS

The surfaces of enamel and dentine at cervical level record decreases of

roughness related to the decrease of distance to ECJ

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel but the differences

statistical significant are present only for enamel localised at 2 mm from ECJ

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of

dentine

33

CHAPTXI FEA STUDY REGARDING THE BIOMECHANICAL

BEHAVIOUR AND FRACTURE RESISTANCE OF PROXIMO-OCCLUSAL

AMALGAM AND COMPOSITE RESINS RESTORATIONS

XI1INTRODUCTION AIM OF STUDY

The individual variation of patients morphological and functional complexity

of tissues as well as difficult access limit the possibilities to investigate in clinical

studies the biomechanical behaviour of proximo-occlusal restorations In this context

simulation of the biomechanics for direct restorations represents an interesting

interdisciplinar domain in actual dentistry research

The study focused on two direction

- analysis of role of forces intensity on biomechanical behaviour related to

cavity dimension and material

- analysis of tension inside restoration structure related to forces intensity

XI2MATERIALS AND METHODS

The stages of finite element analysis study are as follows

object modelling (bicusps and proximo-occlusal restoration)

definition of parameters for materials and dental tissues

meshing

constraints and loading

types of contacts

equations system definition

results of simulation

The object 3D modelling was performed in Rhinoceros (figure XI1) The

definition of parameters was performed for Poisson constant Young modulus density

(table XI1) The selected materials were amalgam and composite resins The

analysed tissues were dentine and enamel The meshing constraints loading were

performed for forces of 200N 400N 600N 800 N The analysis was performed using

software COSMOSWorks 2010

34

Fig XI1 3D modellation of bicusp

Table XI1 Values of Young modulus Poisson constant compression resistance for

amalgam composite resin enamel (amalgam compozit smalţ)

Material Young modulus (GPa) Poisson constants

Compression

resistance

(Mpa)

Amalgam 55 033 483

Enamel 48 03 400

Composite

resin 220 022 345

Fig XI2 The forces and constraints application

The results are presented in values and culours red colours representing areas

with maximum values of tensions produced under influence of masticatory forces

The tensions produced in amalgam restoration are in a range from 0 to 22886

(force 800 N) The maximum von Misses tensions are associated with cervical area

of amalgam restorations This aspect proves that first modification in interface

restoration-cavity margins will appear at the level of gingival wall First marginal

35

defects and fissures in restoration bulk will appear at tensions over 1600Mpa

associated with forces of 800N for extended amalgam proximo-occlusal restorations

The tensions produced in composite resin restorations are in a range from 0 to

2285 (force 800 N) The maximum von Misses tensions are associated with cervical

area of composite resin restorationsThis aspect proves that first modification in

interface restoration-cavity margins will appear at the level of gingival wall First

marginal defects and fissures in restoration bulk will appear at tensions over 1716

Mpa associated with forces of 600N for moderate and extended composite resins

proximo-occlusal restorations

Fig XI3a-b ndash Simulated model of proximo-occlusal restoration

FigXI4a-b Dental amalgam restoration Cervical tension associated with 600 N

(c)800 N (d)

FigXI5a-b Composite resin restoration Cervical tension associated with 600 N

(c)800 N (d)

36

The deformation of amalgam can be produced only when is associated with

fissures in bulk of restorations while composite resins restorations present

deformation when are associated with a modification of volume and form because of

repeated action of medium forces on long term or high forces on short term (figures

XI4 XI5)

Fig XI4 Material deformation in area of maximum tension

000E + 00

500E -02

100E -01

150E -01

200E -01

250E -01

1 4 7 101316192225283134374043464952555861646770737679

Amalgam C ompoz it

Figura XI5 Deformarea funcție de material

The amalgam and composite resins were treated as homogenous isotropic and

liniar The advantage of this type of FEA study is that restorations parameters can be

modified any time is necessary both in arhitecture geometry and material indices

variability The results of this study sustain the conclusions of other FEA studies

focused on biomechanical behaviour of posterior restorations performed with

amalgam and composite resins(35 62 76 143)

37

XI4CONCLUSIONS

bull The amalgam in class II restorations has a low deformation tendency because

of uniform distribution of tension inside material

bull Composite resins class II restorations accumulate higher tensions comparing

with amalgam but deformation is avoided for a time because of the adhesion

forces performed between molecules under moderate oral forces In case of

high oral forces (600-800N) the risk of fracture in moderate class II

restorations is higher comparing with amalgam proximo-occlusal restorations

For extended class II restorations and forces of 600 N composite resins present

highest risk of fracture and deformation The von Misses tension at the

cervical interface restorationtooth can reach 1600Mpa

bull The amalgam in moderate class II restorations can resist to deformation even

for high intensity forces limited to 600N In extended class II restorations the

risk of deformation and fracture increases at values of 600N-800N of oral

forces The von Misses tension at the cervical interface restorationtooth can

reach 1700 Mpa

38

FINAL CONCLUSIONS

Amalgam proximo-occlusal restorations with minimum 6-years age present

excellent results for parameters anatomic form (occlusal) marginal

discoloration and marginal secondary dental caries good results for

parameters anatomic form (proximal) and marginal adaptation and poor results

for surface quality

Composite resins proximo-occlusal restorations (bicusps) with minimum 6-

years age present excellent results for parameters color match marginal

discoloration and marginal secondary dental caries and good results for

parameters anatomic form (occlusal proximal) marginal adaptation surface

quality

Composite resins proximo-occlusal restorations (molars) with minimum 6-

years age present good results for parameters color match marginal

discoloration marginal secondary dental caries marginal adaptation and poor

results for parameters anatomic form (occlusal) (54 indices Ryge C)

anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The restorations extended at external third of occlusal surface present highest

percents of indices C regarding anatomic form (occlusal) (54 indices Ryge

C) anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The exceeding of 6-years age will require careful monitorisation for early

interventions through polishing sealing reshaping and even replacement for

restorations with major defects

Oblique layering technique presents superior results regarding marginal

adaptation and marginal discoloration and is recommended for proximo-

occlusal dental caries close to enamel-cement jonction

Centripetal build-up presents good results regarding marginal adaptation and

anatomical form at proximal level (proximal surfaces and contact point)

Horisontal layering technique can be used for optimum results only in

proximal-occlusal cavities with moderate extension both in occlusal-cervical

and buccal-oral

The values of die penetration at gingival wall were statistically different

between the three restorative techniques

We concluded that all restorative methods were associated with lightcuring

contraction and marginal microleakage

The combined technique was associated with lowest lightcuring contraction

and die penetration

The bulk technique was associated with highest lightcuring contraction and die

penetration

39

The surfaces of enamel and dentine at cervical level record decreases of

roughness related to the decrease of distance to ECJ

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel but the differences

statistical significant are present only for enamel localised at 2 mm from ECJ

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of

dentine

bull The amalgam in class II restorations has a low deformation tendency because

of uniform distribution of tension inside material

bull Composite resins class II restorations accumulate higher tensions comparing

with amalgam but deformation is avoided for a time because of the adhesion

forces performed between molecules under moderate oral forces In case of

high oral forces (600-800N) the risk of fracture in moderate class II

restorations is higher comparing with amalgam proximo-occlusal restorations

For extended class II restorations and forces of 600 N composite resins present

highest risk of fracture and deformation The von Misses tension at the

cervical interface restorationtooth can reach 1600Mpa

bull The amalgam in moderate class II restorations can resist to deformation even

for high intensity forces limited to 600N In extended class II restorations the

risk of deformation and fracture increases at values of 600N-800N of oral

forces The von Misses tension at the cervical interface restorationtooth can

reach 1700 Mpa

REFERENCES

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48Calheiros FC Braga RR Kawano Y Ballester RY Relationship between

contraction stress and degree of conversion in restorative composites Dent Mater

2004 20939-946

49Cardoso P Sadek F Microtensile bond strength on dentin using new adhesive

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the decision to replace existing amalgam restorations Quintessence Int 1999

Jun30(6)413-8

51Carvalho RM JC Pereira M Yoshiyama DH Pashley A review of

polymerization contraction the influence of stress development versus stress

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Dentomaxillofac Radiol 2007 Mar36(3)138-42

53Cattaneo PM M Dalstra B Melsen- bdquoThe Finite Element Method a Tool to

Study Orthodontic Tooth Movement J Dent Res 2005 84(5)428-433

54Cattell MJ Clarke RL Lynch EJ The transverse strength reliability and

microstructural features of four dental ceramicspart 1 J Dent 25(5)399-407 1997

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bond strength to primary dentin J Dent Child 2003 70(2) 139-144

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posterior restorations 12-month results Eur J Dent 2010 Jan4(1)57-65

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two polymerization techniques Relationship between microtensile bond strength and

marginal leakage J Dent 2005 33(7) 603- 610

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Med 2008173(1)23ndash26

59Chen HY Manhart J Hickel R Kunzelmann KH Polymerization contraction

stress in light-cured packable composite resinsDent Mater 200117253-259

60Choi KK Condon JR Ferracane JL The effects of adhesive thickness on

polymerization contraction stress of composites J Dent Res 2000 79812ndash817

61Cichon P Kerschbaum T Verweildauer zahnartzlicher Restaurationen bei

Behinderten Dtsch Zahnartzlicher 1999 54 96-102

62Cohen BI Pagnillo MK Deutsch ASMusikant BL Fracture Strength of

Three Core Restorative Materials Supported with or without a Prefabricated Split-

Shank Post Journal of Prosthetic Dentistry1997 78 560ndash565

63Colli P Brannstrom M The marginal adaptation of four different bonding agents

in Class II composite resin restoration applied in bulk or in two increments

Quintessence Int 1993 24583-591

43

64Collins CJ Bryant RW Hodge KL A clinical evaluation of posterior composite

resin restorations 8-year findings J Dent 199826(4) 311ndash317

65Condon JR Ferracane JL Assessing the effect of composite formulation on

polymerization stress J Am Dent Assoc2000 131497-503

66Cook WD Moopnar M Influence of chemical structure on the fracture

behaviour of dimethacrylate composite resins Biomaterials 1990 11272-276

67Cortes DF Ellwood RP Ekstrand KR An in vitro comparison of a combined

FOTIvisual examination of occlusal caries with other caries diagnostic methods and

the effect of stain on their diagnostic performance Caries Res 2003 37 (1) 8-16

68Crim GA Microleakage of three resin placement techniques Am J Dent

1991469-72

69Dauvillier B Aarnts M Feilzer A The competition between the composite-

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1399

70Dauvillier BS Aarnts MP Feilzer AJ Developments in shrinkage control of

adhesive restoratives J Esthet Dent 2000 12291-299

71Dauvillier BS Aarnts MP Feilzer AJ Modeling of the viscoelastic behavior of

dental light-activated resin composites during curing Dent Mater 200319277ndash285

72Davidson CL Gee AJ Feilzer A The competition between the composite-dentin

bond strength and the polymerization contraction stress J Dent Res 1984

63(12)1396-9

73Davidson CL AJ Feilzer Polymerization shrinkage and polymerization

shrinkage stress in polymer-based restoratives J Dent Res 199725435ndash440

74Davidson CL Resisting the curing contraction with adhesive composites J

Prosthet Dent 198655446ndash7

75Davis RD Mayhew RB A clinical comparison of three anterior restorative resins

at 3 years J Am Dent Assoc 1986112659-63

76Dejak B Mlotkowski A Three-dimensional finite element analysis of strength

and adhesion of composite resin versus ceramic inlays in molarsJ Prosthet

Dent200899131-40

77Deligeorgi V Mjor IA Wilson NH An overview of reasons for the placement

and replacement of restorations Prim Dent Care 20018(1)5-11

78Deliperi S Bardwell DN An alternative method to reduce polymerization

shrinkage in direct posterior composite restorations J Am Dent Assoc 2002

1331387ndash97

79Demirci M Tuncer S Yuceokur AA Prevalence of caries on individual tooth

surfaces and its distribution by age and gender in university clinic patientsEur J

Dent20104(3)270-9

80De Munck J Van Meerbeek B Satoshi I Vargas M Yoshida Y Armstrong S

Lambrechts P Vanherle G Microtensile bond strengths of one- and two-step

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81Dewaele M Truffier-Boutry D Devaux J Leloup G Volume contraction in

photocured dental resins the shrinkage-conversion relationship revisited Dent Mater

2006 22359-365

44

82Deutsch WM Simecek JW Dental emergencies among Marines ashore in

Operations Desert ShieldStorm Mil Med 1996161(10) 620ndash623

83Dickens SH Stansbury JW Choi KM Floyd CJ Photopolymerization kinetics

of methacrylate dental resins Macromolecules 2003 366043-6053

84Dietschi D De Siebenthal G Neveu-Rosenstand L Holz J Influence of the

restorative technique and new adhesives on the dentin marginal seal and adaptation of

resin composite Class II restorations An in vitro evaluation Quintessence Int 1995

26 717-727

85Dietschi D Herzfeld D In vitro evaluation of marginal and internal adaptation of

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Sci 1998 106 1033-1042

86Dietschi D Marginal adaptation and seal of direct and indirect Class II composite

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87Diefenderfer KE Simecek JW Ahlf RL Ragain JC Relationship between

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20028195 (Abstract)

88Diefenderfer KE Rienhardt JW Shear bond strengths of ten adhesive

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89Donly KJ Jensen ME Triolo PA clinical comparison of resin composite inlay

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30(3)163- 1681999

90Douglas WH Fields RP Fundingsland J A comparison between the

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91Eberhard J Hartman B Lenhard M Mayer T Kocher T Eickholz P Digital

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Caries Res 200034(3)219-24

92Edelstein BL Douglass CW Dispelling the myth that 50 percent of US

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94Elliott JE Lovell LG Bowman CN Primary cyclization in the polymerization of

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96Feilzer AJ AJ De Gee CL Davidson Increased wall-to-wall curing

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98Feilzer AJ de Gee AJ Davidson CL Relaxation of polymerization contraction

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45

99Feilzer AJ De Gee AJ Davidson CL Setting stress in composite resin in relation

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100Feilzer AJ Dooren LH de Gee AJ Davidson CL Influence of light intensity

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Sci 1995 103322ndash326

101Fennis YL Verdischbot EH vanrsquot Hof MA Performance of some diagnostic

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102Ferracane JL Developing a more complete understanding of stresses produced

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104Ferreira MC Vieira RS Marginal leakage in direct and indirect composite resin

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105Forss H Widstroumlm E Reasons for restorative therapy and the longevity of

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106Fradeani M Aquilano A Bassein L Longitudinal study of pressed glass-

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108Francci C Loguercio AD Reis A Carrilho MR A novel filling technique for

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109Fruits TJ Knapp JA Khajotia SS Microleakage in the proximal walls of

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111Garbuz DS Masri BA Estaile J Classification systems in orthopaedics J Am

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112Ghavamnasiri M Moosavi H Tahvildarnejad N Effect of centripetal and

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113Gladys S Clinical and semiquantitative marginal analysis of four tooth-coloured

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115Giannini M AJS Santos RM Carvalho LAMS Paulillo JR Lovadino

Effects of irradiation mode and filling technique on resindentin bond strength in

Class I cavities J Dent Res 200281 (Abstract)

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117Gordon JChristensen G Why switch to digital radiography J Am Dent

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124Haba Denisia Tehnici uzuale utilizate icircn radiologia dentară Edit Junimea

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848

126Hashimoto M Tay FR Ito S Sano H Kaga M Pashley DH Permeability of

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127Hawthorne WS Smales RJ Factors influencing long-term restoration survival

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138Hintze H Wenzel A Danielen B Behaviour of approximal carious lesions

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Dent Oral Epidemiol 200533(3)212-8

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1995202ndash 6

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influence of simulated clinical handling on the flexural and compressive strength of

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Bucureşti 2001

148Inoue S Van Meerbeek B Vargas M Lambrechts P Vanherle G Adhesion

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48

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157Kamann WK Gangler P Zur Funktionzeit von Amalgam

Kompositefullungen Zahnartzlicher Welt 1999 108 270-273

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restorative decisions made on the basis of simulated bitewing radiographs

Community Dentistry and Oral Epidemiology 1994 22(2) 71-74

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composite restorations effected by increased flexibility J Dent Res 1990 691240ndash

1243

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200932(126)21-8

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Biology199843(8)629-632

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817-822

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composite restorations Oper Dent 200934(1)11-7

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dental resin composites Dent Mater 2005 211150-1157

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marginal leakage around class II composite resin restorations in vitroQuint Int

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18(7)516-20

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Jan11(1)34-40

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thermal behavior of dental composites Dent Mater 2008 24(8)1017ndash1024

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Edition of the Balkan Medical Days

Stomatological Section Abstract nr1091999128

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200126302ndash307

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Dentistry and Oral Epidemiology 1996 24 106-11

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polymerization contraction stress for dental composites by two-step light-activation

Dent Mater 2002 18436-444

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constraint and filling technique in composite restorations Dent Mater 2004

20(3)236-43

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Polymerization shrinkage effects of boundary conditions and filling technique of

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50

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79369 (Abstract)

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51

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33

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52

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34

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54

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451

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enhance diagnosis in dental practice a review Int Dent J 1993 43 99-108

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Radiology 27(1)3-11 1998

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Dent 200114177ndash185

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cooper content amalgam restorations in a multiclinical trial JDent1996 24 203-210

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1996751477-83

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placement Impact of cavity depth and exposure time Oper Dent 2000 25113-120

59

344Yeşilyurt C Bulucu B Bond strength of total-etch dentin adhesive systems on

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Contemporary Dental Practice 7(2) 20061-13

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study on adhesive performance of functional monomers J Dent Res 2004 83 454-

458

346Yoshiyama M Tay FR Doi J Nishitani Y Yamada T Itou K Carvalho RM

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  • COPERTA REZUMAT ENGLEZA (MEREUTA)pdf
  • REZUMAT ENGLEZA DR MEREUTA DENISSpdf
Page 34: UNIVERSITATEA DE MEDICINA SI FARMACIE “GR Doctorat/Rezumat... · universitatea de medicina si farmacie “gr.t.popa” iasi facultatea de medicina dentara rezumatul tezei de doctorat

31

Table X9 Descriptive statistics for enamel samples after etching

Statistics

Enamel 2mm

after etching

Enamel 15mm

after etching

Enamel 1mm

after etching

Enamel 05mm

after etching

N Valid 10 10 10 10

Missing 0 0 0 0

Mean 2237600 1107400 875100 838200

Std Error of Mean 31027 20232 11968 17436

Std Deviation 98116 63979 37845 55136

Skewness -850 267 042 040

Std Error of Skewness 687 687 687 687

Kurtosis 878 -1880 1082 -425

Std Error of Kurtosis 1334 1334 1334 1334

Minimum 22180 10990 8680 8290

Maximum 22520 11160 8820 8470

To choose the statistical test to compare roughness surface values was

performed a test Shapiro-Wilk If p is lower or equal with 0005 than hypothesis of

distribution normality is rejected (distribution deviates from normal form) In the table

X10 the distributions are normal The statistical test will be test t for pair samples

Table X10 Test Shapiro-Wilk for enamel samples

Tests of Normality

Kolmogorov-Smirnova Shapiro-Wilk

Statistic df Sig Statistic df Sig

2mmenamel before etching 193 10 200 898 10 207

15mmenamel before etching 170 10 200 977 10 947

1mmenamel before etching 157 10 200 952 10 689

05mmenamel before etching 165 10 200 943 10 590

2mmenamel after etching 235 10 124 925 10 404

15mmenamel after etching 209 10 200 871 10 102

1mmenamel after etching 189 10 200 964 10 834

05mmenamel after etching 142 10 200 983 10 978

a Lilliefors Significance Correction

This is a lower bound of the true significance

The results of test t for pair enamel samples before and after etching are

presented in table X11

32

Table X11 Test t for enamel samples before and after etching

Paired Samples Test

Paired Differences

t df

p (2-

tailed)

95 Confidence

Interval of the

Difference

Mean

Std

Deviation

Std

Error

Mean Lower Upper

Pair

1

2mmenamel before

etching

2mmenamel after

etching

-18208 135220 42760 -

18304731

-

18111269

-

425815

9 000

Pair

2

15mmenamel before

etching

15mmenamel after

etching

-7738 73151 23132 -7790329 -7685671 -

334508

9 076

Pair

3

1mmenamel before

etching

1mmenamel after

etching

-5579 55468 17540 -5618679 -5539321 -

318065

9 065

Pair

4

05mmenamel before

etching

05mmenamel after

etching

-5323 60378 19093 -5366192 -5279808 -

278788

9 063

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel ( 2mm 15 mm 1mm sau

05mm) but the differences statistical significant are present only for enamel localised

at 2 mm from ECJ

X5CONCLUSIONS

The surfaces of enamel and dentine at cervical level record decreases of

roughness related to the decrease of distance to ECJ

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel but the differences

statistical significant are present only for enamel localised at 2 mm from ECJ

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of

dentine

33

CHAPTXI FEA STUDY REGARDING THE BIOMECHANICAL

BEHAVIOUR AND FRACTURE RESISTANCE OF PROXIMO-OCCLUSAL

AMALGAM AND COMPOSITE RESINS RESTORATIONS

XI1INTRODUCTION AIM OF STUDY

The individual variation of patients morphological and functional complexity

of tissues as well as difficult access limit the possibilities to investigate in clinical

studies the biomechanical behaviour of proximo-occlusal restorations In this context

simulation of the biomechanics for direct restorations represents an interesting

interdisciplinar domain in actual dentistry research

The study focused on two direction

- analysis of role of forces intensity on biomechanical behaviour related to

cavity dimension and material

- analysis of tension inside restoration structure related to forces intensity

XI2MATERIALS AND METHODS

The stages of finite element analysis study are as follows

object modelling (bicusps and proximo-occlusal restoration)

definition of parameters for materials and dental tissues

meshing

constraints and loading

types of contacts

equations system definition

results of simulation

The object 3D modelling was performed in Rhinoceros (figure XI1) The

definition of parameters was performed for Poisson constant Young modulus density

(table XI1) The selected materials were amalgam and composite resins The

analysed tissues were dentine and enamel The meshing constraints loading were

performed for forces of 200N 400N 600N 800 N The analysis was performed using

software COSMOSWorks 2010

34

Fig XI1 3D modellation of bicusp

Table XI1 Values of Young modulus Poisson constant compression resistance for

amalgam composite resin enamel (amalgam compozit smalţ)

Material Young modulus (GPa) Poisson constants

Compression

resistance

(Mpa)

Amalgam 55 033 483

Enamel 48 03 400

Composite

resin 220 022 345

Fig XI2 The forces and constraints application

The results are presented in values and culours red colours representing areas

with maximum values of tensions produced under influence of masticatory forces

The tensions produced in amalgam restoration are in a range from 0 to 22886

(force 800 N) The maximum von Misses tensions are associated with cervical area

of amalgam restorations This aspect proves that first modification in interface

restoration-cavity margins will appear at the level of gingival wall First marginal

35

defects and fissures in restoration bulk will appear at tensions over 1600Mpa

associated with forces of 800N for extended amalgam proximo-occlusal restorations

The tensions produced in composite resin restorations are in a range from 0 to

2285 (force 800 N) The maximum von Misses tensions are associated with cervical

area of composite resin restorationsThis aspect proves that first modification in

interface restoration-cavity margins will appear at the level of gingival wall First

marginal defects and fissures in restoration bulk will appear at tensions over 1716

Mpa associated with forces of 600N for moderate and extended composite resins

proximo-occlusal restorations

Fig XI3a-b ndash Simulated model of proximo-occlusal restoration

FigXI4a-b Dental amalgam restoration Cervical tension associated with 600 N

(c)800 N (d)

FigXI5a-b Composite resin restoration Cervical tension associated with 600 N

(c)800 N (d)

36

The deformation of amalgam can be produced only when is associated with

fissures in bulk of restorations while composite resins restorations present

deformation when are associated with a modification of volume and form because of

repeated action of medium forces on long term or high forces on short term (figures

XI4 XI5)

Fig XI4 Material deformation in area of maximum tension

000E + 00

500E -02

100E -01

150E -01

200E -01

250E -01

1 4 7 101316192225283134374043464952555861646770737679

Amalgam C ompoz it

Figura XI5 Deformarea funcție de material

The amalgam and composite resins were treated as homogenous isotropic and

liniar The advantage of this type of FEA study is that restorations parameters can be

modified any time is necessary both in arhitecture geometry and material indices

variability The results of this study sustain the conclusions of other FEA studies

focused on biomechanical behaviour of posterior restorations performed with

amalgam and composite resins(35 62 76 143)

37

XI4CONCLUSIONS

bull The amalgam in class II restorations has a low deformation tendency because

of uniform distribution of tension inside material

bull Composite resins class II restorations accumulate higher tensions comparing

with amalgam but deformation is avoided for a time because of the adhesion

forces performed between molecules under moderate oral forces In case of

high oral forces (600-800N) the risk of fracture in moderate class II

restorations is higher comparing with amalgam proximo-occlusal restorations

For extended class II restorations and forces of 600 N composite resins present

highest risk of fracture and deformation The von Misses tension at the

cervical interface restorationtooth can reach 1600Mpa

bull The amalgam in moderate class II restorations can resist to deformation even

for high intensity forces limited to 600N In extended class II restorations the

risk of deformation and fracture increases at values of 600N-800N of oral

forces The von Misses tension at the cervical interface restorationtooth can

reach 1700 Mpa

38

FINAL CONCLUSIONS

Amalgam proximo-occlusal restorations with minimum 6-years age present

excellent results for parameters anatomic form (occlusal) marginal

discoloration and marginal secondary dental caries good results for

parameters anatomic form (proximal) and marginal adaptation and poor results

for surface quality

Composite resins proximo-occlusal restorations (bicusps) with minimum 6-

years age present excellent results for parameters color match marginal

discoloration and marginal secondary dental caries and good results for

parameters anatomic form (occlusal proximal) marginal adaptation surface

quality

Composite resins proximo-occlusal restorations (molars) with minimum 6-

years age present good results for parameters color match marginal

discoloration marginal secondary dental caries marginal adaptation and poor

results for parameters anatomic form (occlusal) (54 indices Ryge C)

anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The restorations extended at external third of occlusal surface present highest

percents of indices C regarding anatomic form (occlusal) (54 indices Ryge

C) anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The exceeding of 6-years age will require careful monitorisation for early

interventions through polishing sealing reshaping and even replacement for

restorations with major defects

Oblique layering technique presents superior results regarding marginal

adaptation and marginal discoloration and is recommended for proximo-

occlusal dental caries close to enamel-cement jonction

Centripetal build-up presents good results regarding marginal adaptation and

anatomical form at proximal level (proximal surfaces and contact point)

Horisontal layering technique can be used for optimum results only in

proximal-occlusal cavities with moderate extension both in occlusal-cervical

and buccal-oral

The values of die penetration at gingival wall were statistically different

between the three restorative techniques

We concluded that all restorative methods were associated with lightcuring

contraction and marginal microleakage

The combined technique was associated with lowest lightcuring contraction

and die penetration

The bulk technique was associated with highest lightcuring contraction and die

penetration

39

The surfaces of enamel and dentine at cervical level record decreases of

roughness related to the decrease of distance to ECJ

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel but the differences

statistical significant are present only for enamel localised at 2 mm from ECJ

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of

dentine

bull The amalgam in class II restorations has a low deformation tendency because

of uniform distribution of tension inside material

bull Composite resins class II restorations accumulate higher tensions comparing

with amalgam but deformation is avoided for a time because of the adhesion

forces performed between molecules under moderate oral forces In case of

high oral forces (600-800N) the risk of fracture in moderate class II

restorations is higher comparing with amalgam proximo-occlusal restorations

For extended class II restorations and forces of 600 N composite resins present

highest risk of fracture and deformation The von Misses tension at the

cervical interface restorationtooth can reach 1600Mpa

bull The amalgam in moderate class II restorations can resist to deformation even

for high intensity forces limited to 600N In extended class II restorations the

risk of deformation and fracture increases at values of 600N-800N of oral

forces The von Misses tension at the cervical interface restorationtooth can

reach 1700 Mpa

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82Deutsch WM Simecek JW Dental emergencies among Marines ashore in

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99Feilzer AJ De Gee AJ Davidson CL Setting stress in composite resin in relation

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ceramic inlays for four and a half years J Prosthet Dent 1997 78(4)346-353

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restorations J Contemp Dent Pract 20067(4)79-88

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Effects of irradiation mode and filling technique on resindentin bond strength in

Class I cavities J Dent Res 200281 (Abstract)

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JADA 1972841349-1357

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2007

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848

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technique on micro-tensile bond strength of resin composite in Class I cavities Dent

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135- 144

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class 2 composites Oper Dent 19981312-19

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Dent Oral Epidemiol 200533(3)212-8

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1995202ndash 6

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Prati C Grafiche Erredue 2000131-148

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Activity EdApollonia Iasi2002

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Mater 1995 11(2)132-6

152Jackson RD Morgan M The new posterior resins and a simplified placement

technique J Am Dent Assoc 2000131375ndash383

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48

154Jokstad A Mjor IA Analyses of long-term clinical behaviour of class II

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Kompositefullungen Zahnartzlicher Welt 1999 108 270-273

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Community Dentistry and Oral Epidemiology 1994 22(2) 71-74

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1243

161Khairallah C Hokayem A Long-term clinical evaluation of 2 dental materials

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Biology199843(8)629-632

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817-822

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dental resin composites Dent Mater 2005 211150-1157

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marginal leakage around class II composite resin restorations in vitroQuint Int

201989117ndash121

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18(7)516-20

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Dent 27(5)325-331 1999

49

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Jan11(1)34-40

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JProsthet Dent 199369(4)425-430

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thermal behavior of dental composites Dent Mater 2008 24(8)1017ndash1024

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JDent 199826 627-632

176Labella R Lambrechts P Van Meerbeek B Vanherle G Polymerization

shrinkage and elasticity of flowable composites and filled adhesives Dent Mater

1999 15128-137

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Pendefunda 180Sorina Solomon Topoliceanu C Elements of dispersional

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Edition of the Balkan Medical Days

Stomatological Section Abstract nr1091999128

181Lăcătuşu St Andrian S Gianina Iovan- Consideraţii asupra adaptării

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StomatologicăVol2199823-26

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200126302ndash307

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Dentistry and Oral Epidemiology 1996 24 106-11

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Dent Mater 2002 18436-444

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20(3)236-43

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Polymerization shrinkage effects of boundary conditions and filling technique of

resin composite restorations J Dent 2004 32(6)459-70

50

189Lopes GC Baratieri LN Monteiro S Jr Vieira LC Effect of posterior resin

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Quintessence Int 2004 35(2)156-61

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art and future perspectives Quintessence Int 200233213-224

191Loumlsche GM Marginal adaptation of class II composite fillings guided

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copolymerizations Macromolecules 1999 323913-3921

194Lutz F Krejci I Barbakow F Quality and durability of marginal adaptation in

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clinical results J Dent Res 199877 1020

196Mair LH Ten-year clinical assessment of three posterior resin composites and

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Dentomaxillofac Radiol 2007 Oct36(7)377-81

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J Prosthet Dent 2000 Sep84(3)289-96

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Three-year clinical evaluation of composite and ceramic inlays Am J Dent 2001

Apr14(2)95-9

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79369 (Abstract)

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PrimDentCare1999Apr659-62

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33

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Am Dent Assoc 2010 141(3)319-29

52

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125749-751

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composites Oper Dent 23 1998282ndash289

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34

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Monogr Oral Sci 20092142-51

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of teeth with long-term performing composite restorations J Oral Rehabil 2002

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Operative Dentistry 5th ed St Louis Mosby 2006293-7

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ClinOral Invest1997140-46

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affecting cure at depths within light-activated resin composites Am J Dent

1993691ndash95

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microleakage of deep class-II cavities restored with two composite resin formulations

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of polymerization contraction in composite restorations J Dent 1992 20178ndash182

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Nanoleakage leakage within the hybrid layer Oper Dent 1995 20 18-25

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posterior composite restorations Dent Mater 200521(1) 9ndash12

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packable posterior composite in bulk-cured restorations JADA 2006 137(1)71ndash80

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Assessment of dental caries with Digital Imaging Fiber-Optic Transillumination (DI-

FOTI)in vitro studyCaries Res 1997 31(2) 103-110

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interobserver agreement and comparison to histological hard-tissue sections Caries

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of conversion in light-cured dimethacrylate-based dental resins Biomaterials 2002

231819-1829

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modulus of elasticity of light-cured dimethacrylate-based dental resins Biomaterials

2003 24655-665

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York Springer-Verlag 1999

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Am Dent Assoc 2007 Jun138(6)763-72

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Quintessence 2000253ndash76

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from the SCO Dental Products Inc Symposium 2003 24(8) 4-9 (Abstract)

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57

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of amalgam composite and glassndashionomer restorations J Dent Res 199069861ndash

864

310Tanne K Mamoru S Burstone C Three-dimensional finite element analysis

for stress in the periodontal tissue by orthodontic forcesAm J Orthod Dentofacial

Orthop921987499ndash505

311Tanumiharja M Burrow MF Tyas MJ Microtensile bond strengths of seven

dentin adhesive systems Dent Mater 2000 16(3)180-7

312Tay FR Pashley DH Aggressiveness of contemporary self-etching systems

Part I Depth of penetration beyond dentin smear layers Dent Mater 2001 17(4) 296-

308

313Tay FR Frankenberger R Krejci I Bouillaguet S Pashley DH Carvalho

RM Single-bottle adhesives behave as permeable membranes after polymerization I

In vivo evidence J Dent 2004 32611ndash621

314Tay FR Pashley DH Have dentin adhesives become too hydrophilic J Can

Dent Assoc 2003 69726ndash731

315Tay FR Sano H Carvalho R Pashley EL Pashley DH An ultrastructural

study of the influence of acidity of self-etching primers and smear layer thickness on

bonding to intact dentin J Adhes Dent 2000 283ndash98

316Thompson JY Bayne SC Heymann HO Mechanical properties of a new

mica-based machinable glass ceramic for CADCAM restorations J Prosthet Dent

76(6)619-623 1996

317Unterbrink GL R Muessner Influence of light intensity on two restorative

systems J Dent 199523183ndash189

318Unterbrink GL Liebenberg WH Flowable resin composites as filled

adhesiveslsquo literature review and clinical recommendations Quintessence Int

199930249ndash257

319Vaarkamp J Ten Bosch J Verdonschot EH Quantitative diagnosis of small

approximal caries lesions utilizing wavelength-dependent fiber-optic

transillumination Journal of Dental Research 1997 76 (4) 875-882

320Valachovic RW Douglass CW Reiskin AB Chauncey HH McNeil BJ The

use of panoramic radiography in the evaluation of asymptomatic adult dental patients

Oral Surg Oral Med Oral Pathol 198661(3)289-96

321Van Meerbeek B De Munck J Yoshida Y Inoue S Vargas M Vijay P Van

Landuyt K Lambrechts P Vanherle G Adhesion to enamel and dentin Current

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322Van Meerbeek B Van Landuyt K De Munck JHashimoto M Peumans M

Lambrechts P Yoshida Y Inoue S Suzuki K Technique-sensitivity of

contemporary adhesives Dent Mater J 2005 24(1) 1-13

323Van Meerbeek B Vargas S Inoue S Yoshida Y Peumans M Lambrechts P

Vanherle G Adhesives and cements to promote preservation dentistry Oper Dent

20016 119-144

324Van Meerbeek B Yoshida Y Inoue S Vargas M Abe Y Fukuda R Okazaki

M Lambrechts P Vanherle G Bonding mechanism micro-tensile bond strength of

a 4- MET-based self-etching adhesive J Dent Res 2000 79 249 (Abstract)

58

325Van Nieuwenhuysen JP DrsquoHoore W Carvalho J Qvist V Long-term

evaluation of extensive restorations in permanent teeth J Dent 200331(6)395ndash405

326Venhoven BA de Gee AJ Davidson CL Light initiation of dental resins

dynamics of the polymerization Biomaterials 1996 172313-2318

327Versluis A Douglas WH Cross M Sakaguchi RL Does an incremental filling

technique reduce polymerization shrinkage stresses J Dent Res 1996 75871ndash878

328Vries HC Ruiken HM Konig KG vanrsquot Hof MA Radiographic versus

clinical diagnosis of approximal carious lesions Caries Res1990 24 (5) 364-370

329Waggoner W Ashton J Predictability of cavitation based upon radiographic

appearance comparison of two film types Quintessence International 1989 20(1)

55-60

330Watanabe LG Marshall GW Jr Marshall SJ Dentin shear strength effects of

tubule orientation and intra tooth location Dent Mater 1996 12 109-115

331Watts DC AS Marouf Optimal specimen geometry in bonded-disk

shrinkage-strain measurements on light-cured biomaterials Dent Mater 200016447ndash

451

332Watts DC Marouf AS Al-Hindi AM Photo-polymerization shrinkage-stress

kinetics in resin-composites methods development Dent Mater 2003 191ndash11

333Weaver WS Blank LW Pelleu GB Jr A visible light activated resin cured

through tooth structure GenDent 198836236-7

334Wendt SL Microleakage and cusp fracture resistance of heattreated composite

resin inlays Am J Dent 4(1)10-14 1991

335Wenzel A Hintze H Mikkelsen L Mouyen F Radiographic detection of

occlusal caries in noncavitated teeth A comparison of conventional film radiographs

digitized film radiographs and RadioVisioGraphy-Oral Surg Oral Med Oral Pathol

1991 72 621-6

336Wenzel A Hintze H Perception of image quality in direct digital radiography

after application of various image treatment filters for detectability of dental diseases

Dentomaxillofac Radiol 1993 22 131-4

337Wenzel A Computer-aided image manipulation of intraoral radiographs to

enhance diagnosis in dental practice a review Int Dent J 1993 43 99-108

338Wenzel A Digital radiography and caries diagnosis Dento Maxillo Facial

Radiology 27(1)3-11 1998

339Wenzel A Haiter-Neto F Gotfredsen E Risk factors for a false positive test

outcome in diagnosis of caries in approximal surfaces impact of radiographic

modality and observer characteristics Caries Res 200741(3)170-6

340Wibowo G Stockton L Microleakage of class II composite restorations Am J

Dent 200114177ndash185

341Wilson NHF Wastell DG Norman RD Five-year performance of high-

cooper content amalgam restorations in a multiclinical trial JDent1996 24 203-210

342Winkler MM Katona TR Paydar NH Finite element stress analysis of three

filling techniques for class V light-cured composite restorations J Dent Res

1996751477-83

343Yap AU Effectiveness of polymerization in composite restoratives claiming bulk

placement Impact of cavity depth and exposure time Oper Dent 2000 25113-120

59

344Yeşilyurt C Bulucu B Bond strength of total-etch dentin adhesive systems on

peripheral and central dentinal tissue a microtensile bond strength test The Journal of

Contemporary Dental Practice 7(2) 20061-13

345Yoshida Y Van Meerbeek B Okazaki M Shintani H Suzuki K Comparative

study on adhesive performance of functional monomers J Dent Res 2004 83 454-

458

346Yoshiyama M Tay FR Doi J Nishitani Y Yamada T Itou K Carvalho RM

Nakajima M Pashley DH Bonding of self-etch and total etch adhesives to carious

dentin J Dent Res 2002 81 556-560

  • COPERTA REZUMAT ENGLEZA (MEREUTA)pdf
  • REZUMAT ENGLEZA DR MEREUTA DENISSpdf
Page 35: UNIVERSITATEA DE MEDICINA SI FARMACIE “GR Doctorat/Rezumat... · universitatea de medicina si farmacie “gr.t.popa” iasi facultatea de medicina dentara rezumatul tezei de doctorat

32

Table X11 Test t for enamel samples before and after etching

Paired Samples Test

Paired Differences

t df

p (2-

tailed)

95 Confidence

Interval of the

Difference

Mean

Std

Deviation

Std

Error

Mean Lower Upper

Pair

1

2mmenamel before

etching

2mmenamel after

etching

-18208 135220 42760 -

18304731

-

18111269

-

425815

9 000

Pair

2

15mmenamel before

etching

15mmenamel after

etching

-7738 73151 23132 -7790329 -7685671 -

334508

9 076

Pair

3

1mmenamel before

etching

1mmenamel after

etching

-5579 55468 17540 -5618679 -5539321 -

318065

9 065

Pair

4

05mmenamel before

etching

05mmenamel after

etching

-5323 60378 19093 -5366192 -5279808 -

278788

9 063

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel ( 2mm 15 mm 1mm sau

05mm) but the differences statistical significant are present only for enamel localised

at 2 mm from ECJ

X5CONCLUSIONS

The surfaces of enamel and dentine at cervical level record decreases of

roughness related to the decrease of distance to ECJ

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel but the differences

statistical significant are present only for enamel localised at 2 mm from ECJ

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of

dentine

33

CHAPTXI FEA STUDY REGARDING THE BIOMECHANICAL

BEHAVIOUR AND FRACTURE RESISTANCE OF PROXIMO-OCCLUSAL

AMALGAM AND COMPOSITE RESINS RESTORATIONS

XI1INTRODUCTION AIM OF STUDY

The individual variation of patients morphological and functional complexity

of tissues as well as difficult access limit the possibilities to investigate in clinical

studies the biomechanical behaviour of proximo-occlusal restorations In this context

simulation of the biomechanics for direct restorations represents an interesting

interdisciplinar domain in actual dentistry research

The study focused on two direction

- analysis of role of forces intensity on biomechanical behaviour related to

cavity dimension and material

- analysis of tension inside restoration structure related to forces intensity

XI2MATERIALS AND METHODS

The stages of finite element analysis study are as follows

object modelling (bicusps and proximo-occlusal restoration)

definition of parameters for materials and dental tissues

meshing

constraints and loading

types of contacts

equations system definition

results of simulation

The object 3D modelling was performed in Rhinoceros (figure XI1) The

definition of parameters was performed for Poisson constant Young modulus density

(table XI1) The selected materials were amalgam and composite resins The

analysed tissues were dentine and enamel The meshing constraints loading were

performed for forces of 200N 400N 600N 800 N The analysis was performed using

software COSMOSWorks 2010

34

Fig XI1 3D modellation of bicusp

Table XI1 Values of Young modulus Poisson constant compression resistance for

amalgam composite resin enamel (amalgam compozit smalţ)

Material Young modulus (GPa) Poisson constants

Compression

resistance

(Mpa)

Amalgam 55 033 483

Enamel 48 03 400

Composite

resin 220 022 345

Fig XI2 The forces and constraints application

The results are presented in values and culours red colours representing areas

with maximum values of tensions produced under influence of masticatory forces

The tensions produced in amalgam restoration are in a range from 0 to 22886

(force 800 N) The maximum von Misses tensions are associated with cervical area

of amalgam restorations This aspect proves that first modification in interface

restoration-cavity margins will appear at the level of gingival wall First marginal

35

defects and fissures in restoration bulk will appear at tensions over 1600Mpa

associated with forces of 800N for extended amalgam proximo-occlusal restorations

The tensions produced in composite resin restorations are in a range from 0 to

2285 (force 800 N) The maximum von Misses tensions are associated with cervical

area of composite resin restorationsThis aspect proves that first modification in

interface restoration-cavity margins will appear at the level of gingival wall First

marginal defects and fissures in restoration bulk will appear at tensions over 1716

Mpa associated with forces of 600N for moderate and extended composite resins

proximo-occlusal restorations

Fig XI3a-b ndash Simulated model of proximo-occlusal restoration

FigXI4a-b Dental amalgam restoration Cervical tension associated with 600 N

(c)800 N (d)

FigXI5a-b Composite resin restoration Cervical tension associated with 600 N

(c)800 N (d)

36

The deformation of amalgam can be produced only when is associated with

fissures in bulk of restorations while composite resins restorations present

deformation when are associated with a modification of volume and form because of

repeated action of medium forces on long term or high forces on short term (figures

XI4 XI5)

Fig XI4 Material deformation in area of maximum tension

000E + 00

500E -02

100E -01

150E -01

200E -01

250E -01

1 4 7 101316192225283134374043464952555861646770737679

Amalgam C ompoz it

Figura XI5 Deformarea funcție de material

The amalgam and composite resins were treated as homogenous isotropic and

liniar The advantage of this type of FEA study is that restorations parameters can be

modified any time is necessary both in arhitecture geometry and material indices

variability The results of this study sustain the conclusions of other FEA studies

focused on biomechanical behaviour of posterior restorations performed with

amalgam and composite resins(35 62 76 143)

37

XI4CONCLUSIONS

bull The amalgam in class II restorations has a low deformation tendency because

of uniform distribution of tension inside material

bull Composite resins class II restorations accumulate higher tensions comparing

with amalgam but deformation is avoided for a time because of the adhesion

forces performed between molecules under moderate oral forces In case of

high oral forces (600-800N) the risk of fracture in moderate class II

restorations is higher comparing with amalgam proximo-occlusal restorations

For extended class II restorations and forces of 600 N composite resins present

highest risk of fracture and deformation The von Misses tension at the

cervical interface restorationtooth can reach 1600Mpa

bull The amalgam in moderate class II restorations can resist to deformation even

for high intensity forces limited to 600N In extended class II restorations the

risk of deformation and fracture increases at values of 600N-800N of oral

forces The von Misses tension at the cervical interface restorationtooth can

reach 1700 Mpa

38

FINAL CONCLUSIONS

Amalgam proximo-occlusal restorations with minimum 6-years age present

excellent results for parameters anatomic form (occlusal) marginal

discoloration and marginal secondary dental caries good results for

parameters anatomic form (proximal) and marginal adaptation and poor results

for surface quality

Composite resins proximo-occlusal restorations (bicusps) with minimum 6-

years age present excellent results for parameters color match marginal

discoloration and marginal secondary dental caries and good results for

parameters anatomic form (occlusal proximal) marginal adaptation surface

quality

Composite resins proximo-occlusal restorations (molars) with minimum 6-

years age present good results for parameters color match marginal

discoloration marginal secondary dental caries marginal adaptation and poor

results for parameters anatomic form (occlusal) (54 indices Ryge C)

anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The restorations extended at external third of occlusal surface present highest

percents of indices C regarding anatomic form (occlusal) (54 indices Ryge

C) anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The exceeding of 6-years age will require careful monitorisation for early

interventions through polishing sealing reshaping and even replacement for

restorations with major defects

Oblique layering technique presents superior results regarding marginal

adaptation and marginal discoloration and is recommended for proximo-

occlusal dental caries close to enamel-cement jonction

Centripetal build-up presents good results regarding marginal adaptation and

anatomical form at proximal level (proximal surfaces and contact point)

Horisontal layering technique can be used for optimum results only in

proximal-occlusal cavities with moderate extension both in occlusal-cervical

and buccal-oral

The values of die penetration at gingival wall were statistically different

between the three restorative techniques

We concluded that all restorative methods were associated with lightcuring

contraction and marginal microleakage

The combined technique was associated with lowest lightcuring contraction

and die penetration

The bulk technique was associated with highest lightcuring contraction and die

penetration

39

The surfaces of enamel and dentine at cervical level record decreases of

roughness related to the decrease of distance to ECJ

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel but the differences

statistical significant are present only for enamel localised at 2 mm from ECJ

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of

dentine

bull The amalgam in class II restorations has a low deformation tendency because

of uniform distribution of tension inside material

bull Composite resins class II restorations accumulate higher tensions comparing

with amalgam but deformation is avoided for a time because of the adhesion

forces performed between molecules under moderate oral forces In case of

high oral forces (600-800N) the risk of fracture in moderate class II

restorations is higher comparing with amalgam proximo-occlusal restorations

For extended class II restorations and forces of 600 N composite resins present

highest risk of fracture and deformation The von Misses tension at the

cervical interface restorationtooth can reach 1600Mpa

bull The amalgam in moderate class II restorations can resist to deformation even

for high intensity forces limited to 600N In extended class II restorations the

risk of deformation and fracture increases at values of 600N-800N of oral

forces The von Misses tension at the cervical interface restorationtooth can

reach 1700 Mpa

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35Boschian PL S Guidotti R Pietrbissa M Gagliani- bdquoStress distribution in a

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42Brunthaler A Koumlnig F Lucas T Sperr W Schedle A Longevity of direct resin

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46Burke FJ Cheung SW Mjor IA Wilson NH-Reasons for the placement and

replacement of restorations in vocational training practicePrimary Dental Care

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2004 20939-946

49Cardoso P Sadek F Microtensile bond strength on dentin using new adhesive

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51Carvalho RM JC Pereira M Yoshiyama DH Pashley A review of

polymerization contraction the influence of stress development versus stress

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Study Orthodontic Tooth Movement J Dent Res 2005 84(5)428-433

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stress in light-cured packable composite resinsDent Mater 200117253-259

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Behinderten Dtsch Zahnartzlicher 1999 54 96-102

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Three Core Restorative Materials Supported with or without a Prefabricated Split-

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in Class II composite resin restoration applied in bulk or in two increments

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1991469-72

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70Dauvillier BS Aarnts MP Feilzer AJ Developments in shrinkage control of

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71Dauvillier BS Aarnts MP Feilzer AJ Modeling of the viscoelastic behavior of

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bond strength and the polymerization contraction stress J Dent Res 1984

63(12)1396-9

73Davidson CL AJ Feilzer Polymerization shrinkage and polymerization

shrinkage stress in polymer-based restoratives J Dent Res 199725435ndash440

74Davidson CL Resisting the curing contraction with adhesive composites J

Prosthet Dent 198655446ndash7

75Davis RD Mayhew RB A clinical comparison of three anterior restorative resins

at 3 years J Am Dent Assoc 1986112659-63

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and adhesion of composite resin versus ceramic inlays in molarsJ Prosthet

Dent200899131-40

77Deligeorgi V Mjor IA Wilson NH An overview of reasons for the placement

and replacement of restorations Prim Dent Care 20018(1)5-11

78Deliperi S Bardwell DN An alternative method to reduce polymerization

shrinkage in direct posterior composite restorations J Am Dent Assoc 2002

1331387ndash97

79Demirci M Tuncer S Yuceokur AA Prevalence of caries on individual tooth

surfaces and its distribution by age and gender in university clinic patientsEur J

Dent20104(3)270-9

80De Munck J Van Meerbeek B Satoshi I Vargas M Yoshida Y Armstrong S

Lambrechts P Vanherle G Microtensile bond strengths of one- and two-step

selfetch adhesives to bur-cut enamel and dentin Am J Dent 2003 16 414-420

81Dewaele M Truffier-Boutry D Devaux J Leloup G Volume contraction in

photocured dental resins the shrinkage-conversion relationship revisited Dent Mater

2006 22359-365

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82Deutsch WM Simecek JW Dental emergencies among Marines ashore in

Operations Desert ShieldStorm Mil Med 1996161(10) 620ndash623

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848

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135- 144

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class 2 composites Oper Dent 19981312-19

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Bucureşti 2001

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Activity EdApollonia Iasi2002

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Mater 1995 11(2)132-6

152Jackson RD Morgan M The new posterior resins and a simplified placement

technique J Am Dent Assoc 2000131375ndash383

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1243

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Biology199843(8)629-632

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817-822

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201989117ndash121

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18(7)516-20

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Jan11(1)34-40

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JProsthet Dent 199369(4)425-430

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JDent 199826 627-632

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1999 15128-137

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Pendefunda 180Sorina Solomon Topoliceanu C Elements of dispersional

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Edition of the Balkan Medical Days

Stomatological Section Abstract nr1091999128

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Dentistry and Oral Epidemiology 1996 24 106-11

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Dent Mater 2002 18436-444

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20(3)236-43

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Polymerization shrinkage effects of boundary conditions and filling technique of

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50

189Lopes GC Baratieri LN Monteiro S Jr Vieira LC Effect of posterior resin

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Quintessence Int 2004 35(2)156-61

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Dentomaxillofac Radiol 2007 Oct36(7)377-81

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J Prosthet Dent 2000 Sep84(3)289-96

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Three-year clinical evaluation of composite and ceramic inlays Am J Dent 2001

Apr14(2)95-9

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79369 (Abstract)

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PrimDentCare1999Apr659-62

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33

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52

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125749-751

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34

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Monogr Oral Sci 20092142-51

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53

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569ndash575

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Community Dent Oral Epidemiol 1980 Jun8(3)135-8

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volumetric polymerization shrinkage and bulk modulus of dental composites and an

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two composite resin formulations J Conserv Dent 2010 13(1) 9ndash15

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system on microleakage in cervical composite resin restorations Rev Med Chir

Soc Med Iaşi-2008 vol112 nr1supl1145-147

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posterior composite 10-year report J Dent 199927(1) 13ndash19

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composite resins Five-year results Swed Dent J 1995 19 173-182

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of teeth with long-term performing composite restorations J Oral Rehabil 2002

29(12)1131ndash1138

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Operative Dentistry 5th ed St Louis Mosby 2006293-7

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examiners evaluating amalgam restorations Oper Dent 1997 Mar-Apr22(2)57-65

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J Appl Oral Sci 2010 Feb18(1)37-43

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Nanoleakage leakage within the hybrid layer Oper Dent 1995 20 18-25

55

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56

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restorations JDent1991 19 272-277

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Quintessence 2000253ndash76

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15244-247

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from the SCO Dental Products Inc Symposium 2003 24(8) 4-9 (Abstract)

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pin-retained complex amalgam restorations Oper Dent 2004 29269-276

308Summit JB Robbins JW Hilton TJ Fundamentals in operative dentistry Cap

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57

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of amalgam composite and glassndashionomer restorations J Dent Res 199069861ndash

864

310Tanne K Mamoru S Burstone C Three-dimensional finite element analysis

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Orthop921987499ndash505

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dentin adhesive systems Dent Mater 2000 16(3)180-7

312Tay FR Pashley DH Aggressiveness of contemporary self-etching systems

Part I Depth of penetration beyond dentin smear layers Dent Mater 2001 17(4) 296-

308

313Tay FR Frankenberger R Krejci I Bouillaguet S Pashley DH Carvalho

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In vivo evidence J Dent 2004 32611ndash621

314Tay FR Pashley DH Have dentin adhesives become too hydrophilic J Can

Dent Assoc 2003 69726ndash731

315Tay FR Sano H Carvalho R Pashley EL Pashley DH An ultrastructural

study of the influence of acidity of self-etching primers and smear layer thickness on

bonding to intact dentin J Adhes Dent 2000 283ndash98

316Thompson JY Bayne SC Heymann HO Mechanical properties of a new

mica-based machinable glass ceramic for CADCAM restorations J Prosthet Dent

76(6)619-623 1996

317Unterbrink GL R Muessner Influence of light intensity on two restorative

systems J Dent 199523183ndash189

318Unterbrink GL Liebenberg WH Flowable resin composites as filled

adhesiveslsquo literature review and clinical recommendations Quintessence Int

199930249ndash257

319Vaarkamp J Ten Bosch J Verdonschot EH Quantitative diagnosis of small

approximal caries lesions utilizing wavelength-dependent fiber-optic

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Oral Surg Oral Med Oral Pathol 198661(3)289-96

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Landuyt K Lambrechts P Vanherle G Adhesion to enamel and dentin Current

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Lambrechts P Yoshida Y Inoue S Suzuki K Technique-sensitivity of

contemporary adhesives Dent Mater J 2005 24(1) 1-13

323Van Meerbeek B Vargas S Inoue S Yoshida Y Peumans M Lambrechts P

Vanherle G Adhesives and cements to promote preservation dentistry Oper Dent

20016 119-144

324Van Meerbeek B Yoshida Y Inoue S Vargas M Abe Y Fukuda R Okazaki

M Lambrechts P Vanherle G Bonding mechanism micro-tensile bond strength of

a 4- MET-based self-etching adhesive J Dent Res 2000 79 249 (Abstract)

58

325Van Nieuwenhuysen JP DrsquoHoore W Carvalho J Qvist V Long-term

evaluation of extensive restorations in permanent teeth J Dent 200331(6)395ndash405

326Venhoven BA de Gee AJ Davidson CL Light initiation of dental resins

dynamics of the polymerization Biomaterials 1996 172313-2318

327Versluis A Douglas WH Cross M Sakaguchi RL Does an incremental filling

technique reduce polymerization shrinkage stresses J Dent Res 1996 75871ndash878

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clinical diagnosis of approximal carious lesions Caries Res1990 24 (5) 364-370

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appearance comparison of two film types Quintessence International 1989 20(1)

55-60

330Watanabe LG Marshall GW Jr Marshall SJ Dentin shear strength effects of

tubule orientation and intra tooth location Dent Mater 1996 12 109-115

331Watts DC AS Marouf Optimal specimen geometry in bonded-disk

shrinkage-strain measurements on light-cured biomaterials Dent Mater 200016447ndash

451

332Watts DC Marouf AS Al-Hindi AM Photo-polymerization shrinkage-stress

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333Weaver WS Blank LW Pelleu GB Jr A visible light activated resin cured

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334Wendt SL Microleakage and cusp fracture resistance of heattreated composite

resin inlays Am J Dent 4(1)10-14 1991

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1991 72 621-6

336Wenzel A Hintze H Perception of image quality in direct digital radiography

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Dentomaxillofac Radiol 1993 22 131-4

337Wenzel A Computer-aided image manipulation of intraoral radiographs to

enhance diagnosis in dental practice a review Int Dent J 1993 43 99-108

338Wenzel A Digital radiography and caries diagnosis Dento Maxillo Facial

Radiology 27(1)3-11 1998

339Wenzel A Haiter-Neto F Gotfredsen E Risk factors for a false positive test

outcome in diagnosis of caries in approximal surfaces impact of radiographic

modality and observer characteristics Caries Res 200741(3)170-6

340Wibowo G Stockton L Microleakage of class II composite restorations Am J

Dent 200114177ndash185

341Wilson NHF Wastell DG Norman RD Five-year performance of high-

cooper content amalgam restorations in a multiclinical trial JDent1996 24 203-210

342Winkler MM Katona TR Paydar NH Finite element stress analysis of three

filling techniques for class V light-cured composite restorations J Dent Res

1996751477-83

343Yap AU Effectiveness of polymerization in composite restoratives claiming bulk

placement Impact of cavity depth and exposure time Oper Dent 2000 25113-120

59

344Yeşilyurt C Bulucu B Bond strength of total-etch dentin adhesive systems on

peripheral and central dentinal tissue a microtensile bond strength test The Journal of

Contemporary Dental Practice 7(2) 20061-13

345Yoshida Y Van Meerbeek B Okazaki M Shintani H Suzuki K Comparative

study on adhesive performance of functional monomers J Dent Res 2004 83 454-

458

346Yoshiyama M Tay FR Doi J Nishitani Y Yamada T Itou K Carvalho RM

Nakajima M Pashley DH Bonding of self-etch and total etch adhesives to carious

dentin J Dent Res 2002 81 556-560

  • COPERTA REZUMAT ENGLEZA (MEREUTA)pdf
  • REZUMAT ENGLEZA DR MEREUTA DENISSpdf
Page 36: UNIVERSITATEA DE MEDICINA SI FARMACIE “GR Doctorat/Rezumat... · universitatea de medicina si farmacie “gr.t.popa” iasi facultatea de medicina dentara rezumatul tezei de doctorat

33

CHAPTXI FEA STUDY REGARDING THE BIOMECHANICAL

BEHAVIOUR AND FRACTURE RESISTANCE OF PROXIMO-OCCLUSAL

AMALGAM AND COMPOSITE RESINS RESTORATIONS

XI1INTRODUCTION AIM OF STUDY

The individual variation of patients morphological and functional complexity

of tissues as well as difficult access limit the possibilities to investigate in clinical

studies the biomechanical behaviour of proximo-occlusal restorations In this context

simulation of the biomechanics for direct restorations represents an interesting

interdisciplinar domain in actual dentistry research

The study focused on two direction

- analysis of role of forces intensity on biomechanical behaviour related to

cavity dimension and material

- analysis of tension inside restoration structure related to forces intensity

XI2MATERIALS AND METHODS

The stages of finite element analysis study are as follows

object modelling (bicusps and proximo-occlusal restoration)

definition of parameters for materials and dental tissues

meshing

constraints and loading

types of contacts

equations system definition

results of simulation

The object 3D modelling was performed in Rhinoceros (figure XI1) The

definition of parameters was performed for Poisson constant Young modulus density

(table XI1) The selected materials were amalgam and composite resins The

analysed tissues were dentine and enamel The meshing constraints loading were

performed for forces of 200N 400N 600N 800 N The analysis was performed using

software COSMOSWorks 2010

34

Fig XI1 3D modellation of bicusp

Table XI1 Values of Young modulus Poisson constant compression resistance for

amalgam composite resin enamel (amalgam compozit smalţ)

Material Young modulus (GPa) Poisson constants

Compression

resistance

(Mpa)

Amalgam 55 033 483

Enamel 48 03 400

Composite

resin 220 022 345

Fig XI2 The forces and constraints application

The results are presented in values and culours red colours representing areas

with maximum values of tensions produced under influence of masticatory forces

The tensions produced in amalgam restoration are in a range from 0 to 22886

(force 800 N) The maximum von Misses tensions are associated with cervical area

of amalgam restorations This aspect proves that first modification in interface

restoration-cavity margins will appear at the level of gingival wall First marginal

35

defects and fissures in restoration bulk will appear at tensions over 1600Mpa

associated with forces of 800N for extended amalgam proximo-occlusal restorations

The tensions produced in composite resin restorations are in a range from 0 to

2285 (force 800 N) The maximum von Misses tensions are associated with cervical

area of composite resin restorationsThis aspect proves that first modification in

interface restoration-cavity margins will appear at the level of gingival wall First

marginal defects and fissures in restoration bulk will appear at tensions over 1716

Mpa associated with forces of 600N for moderate and extended composite resins

proximo-occlusal restorations

Fig XI3a-b ndash Simulated model of proximo-occlusal restoration

FigXI4a-b Dental amalgam restoration Cervical tension associated with 600 N

(c)800 N (d)

FigXI5a-b Composite resin restoration Cervical tension associated with 600 N

(c)800 N (d)

36

The deformation of amalgam can be produced only when is associated with

fissures in bulk of restorations while composite resins restorations present

deformation when are associated with a modification of volume and form because of

repeated action of medium forces on long term or high forces on short term (figures

XI4 XI5)

Fig XI4 Material deformation in area of maximum tension

000E + 00

500E -02

100E -01

150E -01

200E -01

250E -01

1 4 7 101316192225283134374043464952555861646770737679

Amalgam C ompoz it

Figura XI5 Deformarea funcție de material

The amalgam and composite resins were treated as homogenous isotropic and

liniar The advantage of this type of FEA study is that restorations parameters can be

modified any time is necessary both in arhitecture geometry and material indices

variability The results of this study sustain the conclusions of other FEA studies

focused on biomechanical behaviour of posterior restorations performed with

amalgam and composite resins(35 62 76 143)

37

XI4CONCLUSIONS

bull The amalgam in class II restorations has a low deformation tendency because

of uniform distribution of tension inside material

bull Composite resins class II restorations accumulate higher tensions comparing

with amalgam but deformation is avoided for a time because of the adhesion

forces performed between molecules under moderate oral forces In case of

high oral forces (600-800N) the risk of fracture in moderate class II

restorations is higher comparing with amalgam proximo-occlusal restorations

For extended class II restorations and forces of 600 N composite resins present

highest risk of fracture and deformation The von Misses tension at the

cervical interface restorationtooth can reach 1600Mpa

bull The amalgam in moderate class II restorations can resist to deformation even

for high intensity forces limited to 600N In extended class II restorations the

risk of deformation and fracture increases at values of 600N-800N of oral

forces The von Misses tension at the cervical interface restorationtooth can

reach 1700 Mpa

38

FINAL CONCLUSIONS

Amalgam proximo-occlusal restorations with minimum 6-years age present

excellent results for parameters anatomic form (occlusal) marginal

discoloration and marginal secondary dental caries good results for

parameters anatomic form (proximal) and marginal adaptation and poor results

for surface quality

Composite resins proximo-occlusal restorations (bicusps) with minimum 6-

years age present excellent results for parameters color match marginal

discoloration and marginal secondary dental caries and good results for

parameters anatomic form (occlusal proximal) marginal adaptation surface

quality

Composite resins proximo-occlusal restorations (molars) with minimum 6-

years age present good results for parameters color match marginal

discoloration marginal secondary dental caries marginal adaptation and poor

results for parameters anatomic form (occlusal) (54 indices Ryge C)

anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The restorations extended at external third of occlusal surface present highest

percents of indices C regarding anatomic form (occlusal) (54 indices Ryge

C) anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The exceeding of 6-years age will require careful monitorisation for early

interventions through polishing sealing reshaping and even replacement for

restorations with major defects

Oblique layering technique presents superior results regarding marginal

adaptation and marginal discoloration and is recommended for proximo-

occlusal dental caries close to enamel-cement jonction

Centripetal build-up presents good results regarding marginal adaptation and

anatomical form at proximal level (proximal surfaces and contact point)

Horisontal layering technique can be used for optimum results only in

proximal-occlusal cavities with moderate extension both in occlusal-cervical

and buccal-oral

The values of die penetration at gingival wall were statistically different

between the three restorative techniques

We concluded that all restorative methods were associated with lightcuring

contraction and marginal microleakage

The combined technique was associated with lowest lightcuring contraction

and die penetration

The bulk technique was associated with highest lightcuring contraction and die

penetration

39

The surfaces of enamel and dentine at cervical level record decreases of

roughness related to the decrease of distance to ECJ

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel but the differences

statistical significant are present only for enamel localised at 2 mm from ECJ

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of

dentine

bull The amalgam in class II restorations has a low deformation tendency because

of uniform distribution of tension inside material

bull Composite resins class II restorations accumulate higher tensions comparing

with amalgam but deformation is avoided for a time because of the adhesion

forces performed between molecules under moderate oral forces In case of

high oral forces (600-800N) the risk of fracture in moderate class II

restorations is higher comparing with amalgam proximo-occlusal restorations

For extended class II restorations and forces of 600 N composite resins present

highest risk of fracture and deformation The von Misses tension at the

cervical interface restorationtooth can reach 1600Mpa

bull The amalgam in moderate class II restorations can resist to deformation even

for high intensity forces limited to 600N In extended class II restorations the

risk of deformation and fracture increases at values of 600N-800N of oral

forces The von Misses tension at the cervical interface restorationtooth can

reach 1700 Mpa

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34Bonsor SJ Chadwick RGLongevity of conventional and bonded (sealed)

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35Boschian PL S Guidotti R Pietrbissa M Gagliani- bdquoStress distribution in a

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36Bouillaguet S B Ciucchi T Jacoby JC Wataha DH Pashley Bonding

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321

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38Braga RR Ferracane JL Hilton TJ Contraction stress of flowable composites

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39Braga RR Ballester RY Ferracane JLFactors involved in the development of

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40Bratu D- Materiale dentare icircn cabinetul de stomatologie- Edit Helicon

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41Browning WD Johnson WW Gregory PN- Clinical performances of

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42Brunthaler A Koumlnig F Lucas T Sperr W Schedle A Longevity of direct resin

composite restorations in posterior teeth Clin Oral Investig 2003 763-70

43Bullard RH Leinfelder KR Russell CM Effect of coefficient of thermal

expansion on microleakage J Am Dent Assoc 1988116871ndash 874

44Buonocore MG Matsui A Gwinnett AJ Penetration of resin dental materials

into enamel surfaces with reference to bonding Arch Oral Biol 19681361-70

45Burke FJ Cheung SW Mjoumlr IA Wilson NH Restoration longevity and analysis

of reasons for the placement and replacement of restorations provided by vocational

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46Burke FJ Cheung SW Mjor IA Wilson NH-Reasons for the placement and

replacement of restorations in vocational training practicePrimary Dental Care

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contraction stress and degree of conversion in restorative composites Dent Mater

2004 20939-946

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Jun30(6)413-8

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polymerization contraction the influence of stress development versus stress

reliefOper Dent19962117ndash24

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of conventional film and direct digital imaging in the detection of approximal caries

Dentomaxillofac Radiol 2007 Mar36(3)138-42

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Study Orthodontic Tooth Movement J Dent Res 2005 84(5)428-433

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marginal leakage J Dent 2005 33(7) 603- 610

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Med 2008173(1)23ndash26

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polymerization contraction stress of composites J Dent Res 2000 79812ndash817

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Behinderten Dtsch Zahnartzlicher 1999 54 96-102

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Three Core Restorative Materials Supported with or without a Prefabricated Split-

Shank Post Journal of Prosthetic Dentistry1997 78 560ndash565

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in Class II composite resin restoration applied in bulk or in two increments

Quintessence Int 1993 24583-591

43

64Collins CJ Bryant RW Hodge KL A clinical evaluation of posterior composite

resin restorations 8-year findings J Dent 199826(4) 311ndash317

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polymerization stress J Am Dent Assoc2000 131497-503

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behaviour of dimethacrylate composite resins Biomaterials 1990 11272-276

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FOTIvisual examination of occlusal caries with other caries diagnostic methods and

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1991469-72

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1399

70Dauvillier BS Aarnts MP Feilzer AJ Developments in shrinkage control of

adhesive restoratives J Esthet Dent 2000 12291-299

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dental light-activated resin composites during curing Dent Mater 200319277ndash285

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bond strength and the polymerization contraction stress J Dent Res 1984

63(12)1396-9

73Davidson CL AJ Feilzer Polymerization shrinkage and polymerization

shrinkage stress in polymer-based restoratives J Dent Res 199725435ndash440

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Prosthet Dent 198655446ndash7

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at 3 years J Am Dent Assoc 1986112659-63

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and adhesion of composite resin versus ceramic inlays in molarsJ Prosthet

Dent200899131-40

77Deligeorgi V Mjor IA Wilson NH An overview of reasons for the placement

and replacement of restorations Prim Dent Care 20018(1)5-11

78Deliperi S Bardwell DN An alternative method to reduce polymerization

shrinkage in direct posterior composite restorations J Am Dent Assoc 2002

1331387ndash97

79Demirci M Tuncer S Yuceokur AA Prevalence of caries on individual tooth

surfaces and its distribution by age and gender in university clinic patientsEur J

Dent20104(3)270-9

80De Munck J Van Meerbeek B Satoshi I Vargas M Yoshida Y Armstrong S

Lambrechts P Vanherle G Microtensile bond strengths of one- and two-step

selfetch adhesives to bur-cut enamel and dentin Am J Dent 2003 16 414-420

81Dewaele M Truffier-Boutry D Devaux J Leloup G Volume contraction in

photocured dental resins the shrinkage-conversion relationship revisited Dent Mater

2006 22359-365

44

82Deutsch WM Simecek JW Dental emergencies among Marines ashore in

Operations Desert ShieldStorm Mil Med 1996161(10) 620ndash623

83Dickens SH Stansbury JW Choi KM Floyd CJ Photopolymerization kinetics

of methacrylate dental resins Macromolecules 2003 366043-6053

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restorative technique and new adhesives on the dentin marginal seal and adaptation of

resin composite Class II restorations An in vitro evaluation Quintessence Int 1995

26 717-727

85Dietschi D Herzfeld D In vitro evaluation of marginal and internal adaptation of

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Sci 1998 106 1033-1042

86Dietschi D Marginal adaptation and seal of direct and indirect Class II composite

resin restorations an in vitro evaluation Quintessence Int 26(2)127-138 1995

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caries status and dental emergencies among US naval personnel J Dent Res

20028195 (Abstract)

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resinamalgam combinations Oper Dent 1997 22 50-56

89Donly KJ Jensen ME Triolo PA clinical comparison of resin composite inlay

and onlay posterior restorations and cast-gold restorations at 7 years Quintessence Int

30(3)163- 1681999

90Douglas WH Fields RP Fundingsland J A comparison between the

microleakage of direct and indirect composite restorative systems J Dent 17(4)184-

188 1989

91Eberhard J Hartman B Lenhard M Mayer T Kocher T Eickholz P Digital

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Caries Res 200034(3)219-24

92Edelstein BL Douglass CW Dispelling the myth that 50 percent of US

schoolchildren have never had a cavity Public Health Rep1995 110 (5) 522-530

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its possible influence on postoperative sensitivity Quintessence Int 198617103-11

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bis GMA and TEGDMA a modeling approach to understanding the cure of dental

resins Dent Mater 2001 17221-229

95Ermis R Ulkam Aydin Examiner agreement in the replacement decisions of

class I amalgam restorations The Journal of contemporary dental practice 2004 Vol

5 no21-7

96Feilzer AJ AJ De Gee CL Davidson Increased wall-to-wall curing

contraction in thin bonded resin layers J Dent Res 19896848ndash50

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development and viscoelastic properties of experimental twopaste composites J Dent

Res 2003 82824-828

98Feilzer AJ de Gee AJ Davidson CL Relaxation of polymerization contraction

shear stress by hygroscopic expansion J Dent Res 1990 6936ndash39

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99Feilzer AJ De Gee AJ Davidson CL Setting stress in composite resin in relation

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on polymerization shrinkage and integrity of restoration-cavity interface Eur J Oral

Sci 1995 103322ndash326

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systems in the prediction of occlusal caries in permanent molars in 6 and 11 year-old

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in dental composites during polymerization Dent Mater 2005 2136-42

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104Ferreira MC Vieira RS Marginal leakage in direct and indirect composite resin

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restorations in adults Acta Odontol Scand 2004 6282-86

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108Francci C Loguercio AD Reis A Carrilho MR A novel filling technique for

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14(3)149-57

109Fruits TJ Knapp JA Khajotia SS Microleakage in the proximal walls of

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restorations The 10-year report J Adhes Dent 2001 3185-194

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Acad Orthop Surg 2002 10 290-297

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incremental methods in Class II composite resin restorations on gingival

microleakage J Contemp Dent Pract 20078(2)113-20

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Effects of irradiation mode and filling technique on resindentin bond strength in

Class I cavities J Dent Res 200281 (Abstract)

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JADA 1972841349-1357

117Gordon JChristensen G Why switch to digital radiography J Am Dent

Assoc 204 Vol 135 No 101437-1439

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118Gregoire GL Akon BA Millas A Interfacial micromorphological differences

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Prosthet Dent 2002 87633ndash641

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report Br Dent J 196511977-81

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124Haba Denisia Tehnici uzuale utilizate icircn radiologia dentară Edit Junimea

2007

125Hashimoto M Ito S Tay FR Svizero NR Sano H Kaga M Fluid movement

across the resin-dentin interface during and after bonding J Dent Res 2004 83843ndash

848

126Hashimoto M Tay FR Ito S Sano H Kaga M Pashley DH Permeability of

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129He Z Shimada Y Tagami J The effects of cavity size and incremental

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134Hilton TJ Cavity sealers liners and bases Current philosophies and indications

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135- 144

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class 2 composites Oper Dent 19981312-19

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138Hintze H Wenzel A Danielen B Behaviour of approximal carious lesions

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139Hintze H Wenzel A Influence of validation method on diagnostic accuracy of

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of approximal and occlusal dental caries in a young adult population Community

Dent Oral Epidemiol 200533(3)212-8

143Hubsch PF Middleton J Knox J A finite element analysis of the stress at the

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fillingsBiomaterials2000211015ndash1019

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1995202ndash 6

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influence of simulated clinical handling on the flexural and compressive strength of

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Bucureşti 2001

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152Jackson RD Morgan M The new posterior resins and a simplified placement

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154Jokstad A Mjor IA Analyses of long-term clinical behaviour of class II

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Kompositefullungen Zahnartzlicher Welt 1999 108 270-273

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Community Dentistry and Oral Epidemiology 1994 22(2) 71-74

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1243

161Khairallah C Hokayem A Long-term clinical evaluation of 2 dental materials

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Biology199843(8)629-632

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817-822

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dental resin composites Dent Mater 2005 211150-1157

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201989117ndash121

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18(7)516-20

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Dent 27(5)325-331 1999

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Jan11(1)34-40

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JDent 199826 627-632

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1999 15128-137

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179Lăcătuşu St Luminiţa Costinescu Andrian S Gianina Iovan Valeria

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Edition of the Balkan Medical Days

Stomatological Section Abstract nr1091999128

181Lăcătuşu St Andrian S Gianina Iovan- Consideraţii asupra adaptării

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200126302ndash307

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Dentistry and Oral Epidemiology 1996 24 106-11

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polymerization contraction stress for dental composites by two-step light-activation

Dent Mater 2002 18436-444

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20(3)236-43

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Polymerization shrinkage effects of boundary conditions and filling technique of

resin composite restorations J Dent 2004 32(6)459-70

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189Lopes GC Baratieri LN Monteiro S Jr Vieira LC Effect of posterior resin

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Quintessence Int 2004 35(2)156-61

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art and future perspectives Quintessence Int 200233213-224

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copolymerizations Macromolecules 1999 323913-3921

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clinical results J Dent Res 199877 1020

196Mair LH Ten-year clinical assessment of three posterior resin composites and

two amalgams Quintessence Int 199829483ndash490

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Dentomaxillofac Radiol 2007 Oct36(7)377-81

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J Prosthet Dent 2000 Sep84(3)289-96

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Three-year clinical evaluation of composite and ceramic inlays Am J Dent 2001

Apr14(2)95-9

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79369 (Abstract)

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deformation Dent Mater 200117241ndash246

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practitioners and dental caries JDent1990 18(3) 130-136

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(Cerana) Br Dent J 2006 Oct 21201(8)515-20

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PrimDentCare1999Apr659-62

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Quintessence 198961-80

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ScandJDRes 199210060-65

215Mjor IA The reasons for replacement and the age of failed restorations in

general dental practice Acta OdontolScand19975558-63

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replacement and longevity of restorations in Florida J Am Coll Dent 199865(3)27ndash

33

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19904011ndash7

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Lake Buena Vista Fla Hanover Park Ill Quintessence 1989125-138

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Am Dent Assoc 2010 141(3)319-29

52

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Ciucchi B Russell CM Pashley DH Tensile bond strength and SEM evaluation of

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125749-751

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bond strength to dentin in resin composite restorations Dent Mater 200925(1)129-

34

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Monogr Oral Sci 20092142-51

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Monogr Oral Sci 20092152-62

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Quintessence Int 1998295ndash11

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Influence of the Discomfort Reported by Children on the Performance of Approximal

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Internet Journal of Dental Science 2009 7 (2)

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53

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569ndash575

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54

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Nanoleakage leakage within the hybrid layer Oper Dent 1995 20 18-25

55

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56

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57

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864

310Tanne K Mamoru S Burstone C Three-dimensional finite element analysis

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Orthop921987499ndash505

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312Tay FR Pashley DH Aggressiveness of contemporary self-etching systems

Part I Depth of penetration beyond dentin smear layers Dent Mater 2001 17(4) 296-

308

313Tay FR Frankenberger R Krejci I Bouillaguet S Pashley DH Carvalho

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In vivo evidence J Dent 2004 32611ndash621

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Dent Assoc 2003 69726ndash731

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76(6)619-623 1996

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systems J Dent 199523183ndash189

318Unterbrink GL Liebenberg WH Flowable resin composites as filled

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199930249ndash257

319Vaarkamp J Ten Bosch J Verdonschot EH Quantitative diagnosis of small

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Oral Surg Oral Med Oral Pathol 198661(3)289-96

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322Van Meerbeek B Van Landuyt K De Munck JHashimoto M Peumans M

Lambrechts P Yoshida Y Inoue S Suzuki K Technique-sensitivity of

contemporary adhesives Dent Mater J 2005 24(1) 1-13

323Van Meerbeek B Vargas S Inoue S Yoshida Y Peumans M Lambrechts P

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20016 119-144

324Van Meerbeek B Yoshida Y Inoue S Vargas M Abe Y Fukuda R Okazaki

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58

325Van Nieuwenhuysen JP DrsquoHoore W Carvalho J Qvist V Long-term

evaluation of extensive restorations in permanent teeth J Dent 200331(6)395ndash405

326Venhoven BA de Gee AJ Davidson CL Light initiation of dental resins

dynamics of the polymerization Biomaterials 1996 172313-2318

327Versluis A Douglas WH Cross M Sakaguchi RL Does an incremental filling

technique reduce polymerization shrinkage stresses J Dent Res 1996 75871ndash878

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329Waggoner W Ashton J Predictability of cavitation based upon radiographic

appearance comparison of two film types Quintessence International 1989 20(1)

55-60

330Watanabe LG Marshall GW Jr Marshall SJ Dentin shear strength effects of

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331Watts DC AS Marouf Optimal specimen geometry in bonded-disk

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451

332Watts DC Marouf AS Al-Hindi AM Photo-polymerization shrinkage-stress

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333Weaver WS Blank LW Pelleu GB Jr A visible light activated resin cured

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334Wendt SL Microleakage and cusp fracture resistance of heattreated composite

resin inlays Am J Dent 4(1)10-14 1991

335Wenzel A Hintze H Mikkelsen L Mouyen F Radiographic detection of

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1991 72 621-6

336Wenzel A Hintze H Perception of image quality in direct digital radiography

after application of various image treatment filters for detectability of dental diseases

Dentomaxillofac Radiol 1993 22 131-4

337Wenzel A Computer-aided image manipulation of intraoral radiographs to

enhance diagnosis in dental practice a review Int Dent J 1993 43 99-108

338Wenzel A Digital radiography and caries diagnosis Dento Maxillo Facial

Radiology 27(1)3-11 1998

339Wenzel A Haiter-Neto F Gotfredsen E Risk factors for a false positive test

outcome in diagnosis of caries in approximal surfaces impact of radiographic

modality and observer characteristics Caries Res 200741(3)170-6

340Wibowo G Stockton L Microleakage of class II composite restorations Am J

Dent 200114177ndash185

341Wilson NHF Wastell DG Norman RD Five-year performance of high-

cooper content amalgam restorations in a multiclinical trial JDent1996 24 203-210

342Winkler MM Katona TR Paydar NH Finite element stress analysis of three

filling techniques for class V light-cured composite restorations J Dent Res

1996751477-83

343Yap AU Effectiveness of polymerization in composite restoratives claiming bulk

placement Impact of cavity depth and exposure time Oper Dent 2000 25113-120

59

344Yeşilyurt C Bulucu B Bond strength of total-etch dentin adhesive systems on

peripheral and central dentinal tissue a microtensile bond strength test The Journal of

Contemporary Dental Practice 7(2) 20061-13

345Yoshida Y Van Meerbeek B Okazaki M Shintani H Suzuki K Comparative

study on adhesive performance of functional monomers J Dent Res 2004 83 454-

458

346Yoshiyama M Tay FR Doi J Nishitani Y Yamada T Itou K Carvalho RM

Nakajima M Pashley DH Bonding of self-etch and total etch adhesives to carious

dentin J Dent Res 2002 81 556-560

  • COPERTA REZUMAT ENGLEZA (MEREUTA)pdf
  • REZUMAT ENGLEZA DR MEREUTA DENISSpdf
Page 37: UNIVERSITATEA DE MEDICINA SI FARMACIE “GR Doctorat/Rezumat... · universitatea de medicina si farmacie “gr.t.popa” iasi facultatea de medicina dentara rezumatul tezei de doctorat

34

Fig XI1 3D modellation of bicusp

Table XI1 Values of Young modulus Poisson constant compression resistance for

amalgam composite resin enamel (amalgam compozit smalţ)

Material Young modulus (GPa) Poisson constants

Compression

resistance

(Mpa)

Amalgam 55 033 483

Enamel 48 03 400

Composite

resin 220 022 345

Fig XI2 The forces and constraints application

The results are presented in values and culours red colours representing areas

with maximum values of tensions produced under influence of masticatory forces

The tensions produced in amalgam restoration are in a range from 0 to 22886

(force 800 N) The maximum von Misses tensions are associated with cervical area

of amalgam restorations This aspect proves that first modification in interface

restoration-cavity margins will appear at the level of gingival wall First marginal

35

defects and fissures in restoration bulk will appear at tensions over 1600Mpa

associated with forces of 800N for extended amalgam proximo-occlusal restorations

The tensions produced in composite resin restorations are in a range from 0 to

2285 (force 800 N) The maximum von Misses tensions are associated with cervical

area of composite resin restorationsThis aspect proves that first modification in

interface restoration-cavity margins will appear at the level of gingival wall First

marginal defects and fissures in restoration bulk will appear at tensions over 1716

Mpa associated with forces of 600N for moderate and extended composite resins

proximo-occlusal restorations

Fig XI3a-b ndash Simulated model of proximo-occlusal restoration

FigXI4a-b Dental amalgam restoration Cervical tension associated with 600 N

(c)800 N (d)

FigXI5a-b Composite resin restoration Cervical tension associated with 600 N

(c)800 N (d)

36

The deformation of amalgam can be produced only when is associated with

fissures in bulk of restorations while composite resins restorations present

deformation when are associated with a modification of volume and form because of

repeated action of medium forces on long term or high forces on short term (figures

XI4 XI5)

Fig XI4 Material deformation in area of maximum tension

000E + 00

500E -02

100E -01

150E -01

200E -01

250E -01

1 4 7 101316192225283134374043464952555861646770737679

Amalgam C ompoz it

Figura XI5 Deformarea funcție de material

The amalgam and composite resins were treated as homogenous isotropic and

liniar The advantage of this type of FEA study is that restorations parameters can be

modified any time is necessary both in arhitecture geometry and material indices

variability The results of this study sustain the conclusions of other FEA studies

focused on biomechanical behaviour of posterior restorations performed with

amalgam and composite resins(35 62 76 143)

37

XI4CONCLUSIONS

bull The amalgam in class II restorations has a low deformation tendency because

of uniform distribution of tension inside material

bull Composite resins class II restorations accumulate higher tensions comparing

with amalgam but deformation is avoided for a time because of the adhesion

forces performed between molecules under moderate oral forces In case of

high oral forces (600-800N) the risk of fracture in moderate class II

restorations is higher comparing with amalgam proximo-occlusal restorations

For extended class II restorations and forces of 600 N composite resins present

highest risk of fracture and deformation The von Misses tension at the

cervical interface restorationtooth can reach 1600Mpa

bull The amalgam in moderate class II restorations can resist to deformation even

for high intensity forces limited to 600N In extended class II restorations the

risk of deformation and fracture increases at values of 600N-800N of oral

forces The von Misses tension at the cervical interface restorationtooth can

reach 1700 Mpa

38

FINAL CONCLUSIONS

Amalgam proximo-occlusal restorations with minimum 6-years age present

excellent results for parameters anatomic form (occlusal) marginal

discoloration and marginal secondary dental caries good results for

parameters anatomic form (proximal) and marginal adaptation and poor results

for surface quality

Composite resins proximo-occlusal restorations (bicusps) with minimum 6-

years age present excellent results for parameters color match marginal

discoloration and marginal secondary dental caries and good results for

parameters anatomic form (occlusal proximal) marginal adaptation surface

quality

Composite resins proximo-occlusal restorations (molars) with minimum 6-

years age present good results for parameters color match marginal

discoloration marginal secondary dental caries marginal adaptation and poor

results for parameters anatomic form (occlusal) (54 indices Ryge C)

anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The restorations extended at external third of occlusal surface present highest

percents of indices C regarding anatomic form (occlusal) (54 indices Ryge

C) anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The exceeding of 6-years age will require careful monitorisation for early

interventions through polishing sealing reshaping and even replacement for

restorations with major defects

Oblique layering technique presents superior results regarding marginal

adaptation and marginal discoloration and is recommended for proximo-

occlusal dental caries close to enamel-cement jonction

Centripetal build-up presents good results regarding marginal adaptation and

anatomical form at proximal level (proximal surfaces and contact point)

Horisontal layering technique can be used for optimum results only in

proximal-occlusal cavities with moderate extension both in occlusal-cervical

and buccal-oral

The values of die penetration at gingival wall were statistically different

between the three restorative techniques

We concluded that all restorative methods were associated with lightcuring

contraction and marginal microleakage

The combined technique was associated with lowest lightcuring contraction

and die penetration

The bulk technique was associated with highest lightcuring contraction and die

penetration

39

The surfaces of enamel and dentine at cervical level record decreases of

roughness related to the decrease of distance to ECJ

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel but the differences

statistical significant are present only for enamel localised at 2 mm from ECJ

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of

dentine

bull The amalgam in class II restorations has a low deformation tendency because

of uniform distribution of tension inside material

bull Composite resins class II restorations accumulate higher tensions comparing

with amalgam but deformation is avoided for a time because of the adhesion

forces performed between molecules under moderate oral forces In case of

high oral forces (600-800N) the risk of fracture in moderate class II

restorations is higher comparing with amalgam proximo-occlusal restorations

For extended class II restorations and forces of 600 N composite resins present

highest risk of fracture and deformation The von Misses tension at the

cervical interface restorationtooth can reach 1600Mpa

bull The amalgam in moderate class II restorations can resist to deformation even

for high intensity forces limited to 600N In extended class II restorations the

risk of deformation and fracture increases at values of 600N-800N of oral

forces The von Misses tension at the cervical interface restorationtooth can

reach 1700 Mpa

REFERENCES

1ADA Council on Scientific Affairs ADA Council on Dental Benefit Programs

Statement on posterior resin-based composites JADA 1998 129(11)1627ndash1628

2Albers HF Tooth-colored restoratives 1st ed Santa Rosa CA Alto Books 1979

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6Aggarwal V Logani A Jain V Shah N Effect of cyclic loading on marginal

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7Andrian S Lăcătuşu St- Caria dentară- Protocoale şi tehnici- EdApolloniaIaşi

1999

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Iaşi 2001

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9Andrian S Tratamentul Minim Invaziv al Cariei Dentare EditPrinceps Edit Iaşi

2002

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Optical methods for clinical diagnosis and quantification of enamel caries European

Journal of Oral Sciences 1996 104 480-485

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Fischman G Clare A Hench J editors Bioceramics materials and applications

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posterior restorations two-year results Oper Dent 201035(4)397-404

17Armstrong SR JC Keller DB Boyer The influence of water storage and C-

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utilizing a filled and unfilled adhesive resin Dent Mater 200117268ndash276

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1451-56

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464-473

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Public Health Dent 1992 Winter52(2)102-10

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Dent 199158 36-39

28Bayne SC Dental biomaterials where are we and where are we going J Dent

Educ 200569(5)571ndash585

41

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191-194

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Aesthetics Dent 1998 10347 350-351

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NY Marcel Dekker Inc 1999

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9

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post-restored tooth using the threedimensional finite element method Journal of Oral

Rehabilitation (33) 2006690ndash697

36Bouillaguet S B Ciucchi T Jacoby JC Wataha DH Pashley Bonding

characteristics to dentin walls of class II cavities in vitro Dent Mater 200117316ndash

321

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and their efficacy as stress-relieving layers J Am Dent Assoc 2003134721ndash728

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polymerization shrinkage stress in resin-composites a systematic review Dent Mater

200521(10)962-70

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Timişoara1994

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amalgam-bonded restorations A 42-months study- Journal of American Dental

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of reasons for the placement and replacement of restorations provided by vocational

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199930(4)234-42

42

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replacement of restorations in vocational training practicePrimary Dental Care

nr6(1) 1999

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of restorations at failure and reasons for their placement and replacement J Dent

200129(5)317-24

48Calheiros FC Braga RR Kawano Y Ballester RY Relationship between

contraction stress and degree of conversion in restorative composites Dent Mater

2004 20939-946

49Cardoso P Sadek F Microtensile bond strength on dentin using new adhesive

systems with selfetching primers Braz J Oral Sci 2003 2(4) 156-159

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the decision to replace existing amalgam restorations Quintessence Int 1999

Jun30(6)413-8

51Carvalho RM JC Pereira M Yoshiyama DH Pashley A review of

polymerization contraction the influence of stress development versus stress

reliefOper Dent19962117ndash24

52Castro VM Katz JO Hardman PK Glaros AG Spencer P Invitro comparison

of conventional film and direct digital imaging in the detection of approximal caries

Dentomaxillofac Radiol 2007 Mar36(3)138-42

53Cattaneo PM M Dalstra B Melsen- bdquoThe Finite Element Method a Tool to

Study Orthodontic Tooth Movement J Dent Res 2005 84(5)428-433

54Cattell MJ Clarke RL Lynch EJ The transverse strength reliability and

microstructural features of four dental ceramicspart 1 J Dent 25(5)399-407 1997

55Cehreli ZC Akca T Effect of dentinal tubule orientation on the microtensile

bond strength to primary dentin J Dent Child 2003 70(2) 139-144

56Celik C Arhun N Yamanel K Clinical evaluation of resin-based composites in

posterior restorations 12-month results Eur J Dent 2010 Jan4(1)57-65

57Cenci M Demarco F de Carvalho R Class II composite resin restorations with

two polymerization techniques Relationship between microtensile bond strength and

marginal leakage J Dent 2005 33(7) 603- 610

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Med 2008173(1)23ndash26

59Chen HY Manhart J Hickel R Kunzelmann KH Polymerization contraction

stress in light-cured packable composite resinsDent Mater 200117253-259

60Choi KK Condon JR Ferracane JL The effects of adhesive thickness on

polymerization contraction stress of composites J Dent Res 2000 79812ndash817

61Cichon P Kerschbaum T Verweildauer zahnartzlicher Restaurationen bei

Behinderten Dtsch Zahnartzlicher 1999 54 96-102

62Cohen BI Pagnillo MK Deutsch ASMusikant BL Fracture Strength of

Three Core Restorative Materials Supported with or without a Prefabricated Split-

Shank Post Journal of Prosthetic Dentistry1997 78 560ndash565

63Colli P Brannstrom M The marginal adaptation of four different bonding agents

in Class II composite resin restoration applied in bulk or in two increments

Quintessence Int 1993 24583-591

43

64Collins CJ Bryant RW Hodge KL A clinical evaluation of posterior composite

resin restorations 8-year findings J Dent 199826(4) 311ndash317

65Condon JR Ferracane JL Assessing the effect of composite formulation on

polymerization stress J Am Dent Assoc2000 131497-503

66Cook WD Moopnar M Influence of chemical structure on the fracture

behaviour of dimethacrylate composite resins Biomaterials 1990 11272-276

67Cortes DF Ellwood RP Ekstrand KR An in vitro comparison of a combined

FOTIvisual examination of occlusal caries with other caries diagnostic methods and

the effect of stain on their diagnostic performance Caries Res 2003 37 (1) 8-16

68Crim GA Microleakage of three resin placement techniques Am J Dent

1991469-72

69Dauvillier B Aarnts M Feilzer A The competition between the composite-

dentin strength and the polimerization contraction stress J Dent Res 1984 63 1396-

1399

70Dauvillier BS Aarnts MP Feilzer AJ Developments in shrinkage control of

adhesive restoratives J Esthet Dent 2000 12291-299

71Dauvillier BS Aarnts MP Feilzer AJ Modeling of the viscoelastic behavior of

dental light-activated resin composites during curing Dent Mater 200319277ndash285

72Davidson CL Gee AJ Feilzer A The competition between the composite-dentin

bond strength and the polymerization contraction stress J Dent Res 1984

63(12)1396-9

73Davidson CL AJ Feilzer Polymerization shrinkage and polymerization

shrinkage stress in polymer-based restoratives J Dent Res 199725435ndash440

74Davidson CL Resisting the curing contraction with adhesive composites J

Prosthet Dent 198655446ndash7

75Davis RD Mayhew RB A clinical comparison of three anterior restorative resins

at 3 years J Am Dent Assoc 1986112659-63

76Dejak B Mlotkowski A Three-dimensional finite element analysis of strength

and adhesion of composite resin versus ceramic inlays in molarsJ Prosthet

Dent200899131-40

77Deligeorgi V Mjor IA Wilson NH An overview of reasons for the placement

and replacement of restorations Prim Dent Care 20018(1)5-11

78Deliperi S Bardwell DN An alternative method to reduce polymerization

shrinkage in direct posterior composite restorations J Am Dent Assoc 2002

1331387ndash97

79Demirci M Tuncer S Yuceokur AA Prevalence of caries on individual tooth

surfaces and its distribution by age and gender in university clinic patientsEur J

Dent20104(3)270-9

80De Munck J Van Meerbeek B Satoshi I Vargas M Yoshida Y Armstrong S

Lambrechts P Vanherle G Microtensile bond strengths of one- and two-step

selfetch adhesives to bur-cut enamel and dentin Am J Dent 2003 16 414-420

81Dewaele M Truffier-Boutry D Devaux J Leloup G Volume contraction in

photocured dental resins the shrinkage-conversion relationship revisited Dent Mater

2006 22359-365

44

82Deutsch WM Simecek JW Dental emergencies among Marines ashore in

Operations Desert ShieldStorm Mil Med 1996161(10) 620ndash623

83Dickens SH Stansbury JW Choi KM Floyd CJ Photopolymerization kinetics

of methacrylate dental resins Macromolecules 2003 366043-6053

84Dietschi D De Siebenthal G Neveu-Rosenstand L Holz J Influence of the

restorative technique and new adhesives on the dentin marginal seal and adaptation of

resin composite Class II restorations An in vitro evaluation Quintessence Int 1995

26 717-727

85Dietschi D Herzfeld D In vitro evaluation of marginal and internal adaptation of

class II resin composite restorations after thermal and occlusal stressing Eur J Oral

Sci 1998 106 1033-1042

86Dietschi D Marginal adaptation and seal of direct and indirect Class II composite

resin restorations an in vitro evaluation Quintessence Int 26(2)127-138 1995

87Diefenderfer KE Simecek JW Ahlf RL Ragain JC Relationship between

caries status and dental emergencies among US naval personnel J Dent Res

20028195 (Abstract)

88Diefenderfer KE Rienhardt JW Shear bond strengths of ten adhesive

resinamalgam combinations Oper Dent 1997 22 50-56

89Donly KJ Jensen ME Triolo PA clinical comparison of resin composite inlay

and onlay posterior restorations and cast-gold restorations at 7 years Quintessence Int

30(3)163- 1681999

90Douglas WH Fields RP Fundingsland J A comparison between the

microleakage of direct and indirect composite restorative systems J Dent 17(4)184-

188 1989

91Eberhard J Hartman B Lenhard M Mayer T Kocher T Eickholz P Digital

subtraction radiography for monitoring dental demineralization An in vitro study

Caries Res 200034(3)219-24

92Edelstein BL Douglass CW Dispelling the myth that 50 percent of US

schoolchildren have never had a cavity Public Health Rep1995 110 (5) 522-530

93Eick JD Welch FH Polymerization shrinkage of posterior composite resins and

its possible influence on postoperative sensitivity Quintessence Int 198617103-11

94Elliott JE Lovell LG Bowman CN Primary cyclization in the polymerization of

bis GMA and TEGDMA a modeling approach to understanding the cure of dental

resins Dent Mater 2001 17221-229

95Ermis R Ulkam Aydin Examiner agreement in the replacement decisions of

class I amalgam restorations The Journal of contemporary dental practice 2004 Vol

5 no21-7

96Feilzer AJ AJ De Gee CL Davidson Increased wall-to-wall curing

contraction in thin bonded resin layers J Dent Res 19896848ndash50

97Feilzer AJ Dauvillier BS Effect of TEGDMABisGMA ratio on stress

development and viscoelastic properties of experimental twopaste composites J Dent

Res 2003 82824-828

98Feilzer AJ de Gee AJ Davidson CL Relaxation of polymerization contraction

shear stress by hygroscopic expansion J Dent Res 1990 6936ndash39

45

99Feilzer AJ De Gee AJ Davidson CL Setting stress in composite resin in relation

to configuration of the restoration J Dent Res1987 661636-1639

100Feilzer AJ Dooren LH de Gee AJ Davidson CL Influence of light intensity

on polymerization shrinkage and integrity of restoration-cavity interface Eur J Oral

Sci 1995 103322ndash326

101Fennis YL Verdischbot EH vanrsquot Hof MA Performance of some diagnostic

systems in the prediction of occlusal caries in permanent molars in 6 and 11 year-old

children J Dent 1998 26(5) 403-40

102Ferracane JL Developing a more complete understanding of stresses produced

in dental composites during polymerization Dent Mater 2005 2136-42

103Ferrari M Influence of tissue characteristics at margins on leakage of Class II

indirect porcelain restorations Am JDent 1999 12(3)134-142

104Ferreira MC Vieira RS Marginal leakage in direct and indirect composite resin

restorations in primary teeth an in vitro study J Dent 200836(5)322-5

105Forss H Widstroumlm E Reasons for restorative therapy and the longevity of

restorations in adults Acta Odontol Scand 2004 6282-86

106Fradeani M Aquilano A Bassein L Longitudinal study of pressed glass-

ceramic inlays for four and a half years J Prosthet Dent 1997 78(4)346-353

107Franccedila FM Worschech CC Paulillo LA Martins LR Lovadino JR Fracture

resistance of premolar teeth restored with different filling techniques J Contemp Dent

Pract 20056(3)62-9

108Francci C Loguercio AD Reis A Carrilho MR A novel filling technique for

packable composite resin in Class II restorations J Esthet Restor Dent 2002

14(3)149-57

109Fruits TJ Knapp JA Khajotia SS Microleakage in the proximal walls of

direct and indirect posterior resin slot restorations Oper Dent 200631(6)719-27

110Gaengler P Hoyer I Montag R Clinical evaluation of posterior composite

restorations The 10-year report J Adhes Dent 2001 3185-194

111Garbuz DS Masri BA Estaile J Classification systems in orthopaedics J Am

Acad Orthop Surg 2002 10 290-297

112Ghavamnasiri M Moosavi H Tahvildarnejad N Effect of centripetal and

incremental methods in Class II composite resin restorations on gingival

microleakage J Contemp Dent Pract 20078(2)113-20

113Gladys S Clinical and semiquantitative marginal analysis of four tooth-coloured

inlay systems at 3 years J Dent 199523(6)329-338

114Giachetti L Scaminaci Russo D Bambi C Grandini R A review of

polymerization shrinkage stress current techniques for posterior direct resin

restorations J Contemp Dent Pract 20067(4)79-88

115Giannini M AJS Santos RM Carvalho LAMS Paulillo JR Lovadino

Effects of irradiation mode and filling technique on resindentin bond strength in

Class I cavities J Dent Res 200281 (Abstract)

116Going RE Microleakage around dental restorations A summarizing review

JADA 1972841349-1357

117Gordon JChristensen G Why switch to digital radiography J Am Dent

Assoc 204 Vol 135 No 101437-1439

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118Gregoire GL Akon BA Millas A Interfacial micromorphological differences

in hybrid layer formation between water- and solvent-based dentin bonding systems J

Prosthet Dent 2002 87633ndash641

119Gregory WA Physical properties and repair bond strength of direct and indirect

composite resins J Prosthet Dent 68(3)406-411 1992

120Gwinnett AJ Buonocore MG Adhesives and caries prevention a preliminary

report Br Dent J 196511977-81

121Gwinnett AJ Matsui A A study of enamel adhesives The physical relationship

between enamel and adhesive Arch Oral Biol 1967121615-1620

122Gwinnett AJ Histologic changes in human enamel following treatment with

acidic adhesive conditioning agents Arch Oral Biol 197116731-738

123Gwinnett AJ Moist versus dry dentin its effect on shear bond strength Am J

Dent 1992 5(3)127-9

124Haba Denisia Tehnici uzuale utilizate icircn radiologia dentară Edit Junimea

2007

125Hashimoto M Ito S Tay FR Svizero NR Sano H Kaga M Fluid movement

across the resin-dentin interface during and after bonding J Dent Res 2004 83843ndash

848

126Hashimoto M Tay FR Ito S Sano H Kaga M Pashley DH Permeability of

adhesive resin films J Biomed Mater Res 2005 74699ndash705

127Hawthorne WS Smales RJ Factors influencing long-term restoration survival

in three private dental practices in Adelaide Aust Dent J 19974259ndash63

128Helwig Klimek Attin Einfuumlhrung in Die ZahnErhaltung Urbanampfischer 2003

129He Z Shimada Y Tagami J The effects of cavity size and incremental

technique on micro-tensile bond strength of resin composite in Class I cavities Dent

Mater 200723(5)533-8

130He Z Shimada Y Sadr A Ikeda M Tagami J The effects of cavity size and

filling method on the bonding to Class I cavities J Adhes Dent 2008 Dec10(6)447-

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131Hench LLBioceramicsfrom concept to clinicJ Amer Ceram Soc1991

74(7)1487-1570

132Heymann HO The clinical performance of CAD-CAM generated ceramic

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133Hickel R Manhart J Longevity of restorations In Wilson NHF Roulet JF

Fuzzi M Advances in Operative Dentistry ndash Challenges of the Future Chicago

Quintessence 2001

134Hilton TJ Cavity sealers liners and bases Current philosophies and indications

for use Oper Dent 199621134 ndash146

135Hilton TJ Schwartz RS Ferracane JL Microleakage of four Class II resin

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135- 144

136Hinoura K Setcos JK Philips RW Cavity design and placement technique for

class 2 composites Oper Dent 19981312-19

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137Hintze H Wenzel A Clinically undetected dental caries assessed by bitewing

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19-23

138Hintze H Wenzel A Danielen B Behaviour of approximal carious lesions

assessed by clinical examination after tooth separation and radiography A 2+-years

longitudinal study in young adults Caries Res 1999 33 415-22

139Hintze H Wenzel A Influence of validation method on diagnostic accuracy of

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Dentomaxillofacial Radiol2002 31(1) 44-49

140Holtzman JM Berkey AB Mann J Predicting utilization of dental services by

the aged JPublic Health Dent1990 50(3) 164-171

141Hofmann N Hunecke AInfluence of curing methods and matrix type on the

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31(1)97-105

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of approximal and occlusal dental caries in a young adult population Community

Dent Oral Epidemiol 200533(3)212-8

143Hubsch PF Middleton J Knox J A finite element analysis of the stress at the

restoration-tooth interfacecomparing inlays and bulk

fillingsBiomaterials2000211015ndash1019

144Hudson JD Goldstein GR Georgescu M Enamel wear caused by three

different restorative materials J Prosthet Dent 1995 74(6)647-654

145Hunter AR Treasure ET Hunter AJ Increases in cavity volume associated

with the removal of class 2 amalgam and composite restorations Oper Dent

1995202ndash 6

146Huysmans MC PG van der Varst EP Lautenschlager P Monaghan The

influence of simulated clinical handling on the flexural and compressive strength of

posterior composite restorative materials Dent Mater 199612116ndash120

147Iliescu A Gafar MCariologie şi Odontologie RestaurativăEditura Medicală

Bucureşti 2001

148Inoue S Van Meerbeek B Vargas M Lambrechts P Vanherle G Adhesion

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Prati C Grafiche Erredue 2000131-148

149Inoue S Vargas MA Abe Y Yoshida Y LambrechtsP Vanherle G Sano H

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dentin J Adhes Dent 2001 3 237-245

150Iovan Gianina Diagnosis and Management of Patients with High Caries

Activity EdApollonia Iasi2002

151Jacobsen T Soderhold KJ Some effects of water on dentin bonding Dent

Mater 1995 11(2)132-6

152Jackson RD Morgan M The new posterior resins and a simplified placement

technique J Am Dent Assoc 2000131375ndash383

153Jain P Belcher M Microleakage of class II resin-based composite restorations

with flowable composite in the proximal box Am J Dent 200013235ndash238

48

154Jokstad A Mjor IA Analyses of long-term clinical behaviour of class II

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adhesives to dental hard tissues Clin Oral Investig 2002 6(3)155-60

157Kamann WK Gangler P Zur Funktionzeit von Amalgam

Kompositefullungen Zahnartzlicher Welt 1999 108 270-273

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of ground and intact enamel surfaces J Dent 199927523-530

159Kay EJ Nutall M Relationship between dentistlsquos treatment attitudes and

restorative decisions made on the basis of simulated bitewing radiographs

Community Dentistry and Oral Epidemiology 1994 22(2) 71-74

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composite restorations effected by increased flexibility J Dent Res 1990 691240ndash

1243

161Khairallah C Hokayem A Long-term clinical evaluation of 2 dental materials

used for the preparation of esthetic inlays Odontostomatol Trop 200932(127)5-13

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200932(126)21-8

163Kidd EAAssesment of dental carious lesionsArchof Oral

Biology199843(8)629-632

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proximal caries lesions at various levels in vitro Journal of Dentistry 2006 34(10)

817-822

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composite restorations Oper Dent 200934(1)11-7

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dental resin composites Dent Mater 2005 211150-1157

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marginal leakage around class II composite resin restorations in vitroQuint Int

201989117ndash121

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M Dentin shear strength effect of distance from the pulp Dent Mater 2002

18(7)516-20

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polimerisation Am J Dent 1998 11 17-22

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Dent 27(5)325-331 1999

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Jan11(1)34-40

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JProsthet Dent 199369(4)425-430

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thermal behavior of dental composites Dent Mater 2008 24(8)1017ndash1024

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Borgmeijer PJ Replacement risk of amalgam treatment modalities 15-year results

JDent 199826 627-632

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shrinkage and elasticity of flowable composites and filled adhesives Dent Mater

1999 15128-137

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179Lăcătuşu St Luminiţa Costinescu Andrian S Gianina Iovan Valeria

Pendefunda 180Sorina Solomon Topoliceanu C Elements of dispersional

analysis of amalgam restorations 15th

Edition of the Balkan Medical Days

Stomatological Section Abstract nr1091999128

181Lăcătuşu St Andrian S Gianina Iovan- Consideraţii asupra adaptării

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StomatologicăVol2199823-26

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posterior packable resin composites with and without flowable liners Oper Dent

200126302ndash307

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restorative decisions microscopic and radiographic caries depth Community

Dentistry and Oral Epidemiology 1996 24 106-11

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polymerization contraction stress for dental composites by two-step light-activation

Dent Mater 2002 18436-444

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constraint and filling technique in composite restorations Dent Mater 2004

20(3)236-43

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Polymerization shrinkage effects of boundary conditions and filling technique of

resin composite restorations J Dent 2004 32(6)459-70

50

189Lopes GC Baratieri LN Monteiro S Jr Vieira LC Effect of posterior resin

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Quintessence Int 2004 35(2)156-61

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art and future perspectives Quintessence Int 200233213-224

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polymerization vs reduced light intensity J Adhes Dent 1 199931ndash39

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temperature and comonomer composition on the polymerization behavior of

dimethacrylate dental resins J Dent 1999 21879-883

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and reactivity on the reaction kinetics of dimethacrylatedimethacrylate

copolymerizations Macromolecules 1999 323913-3921

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bonded composite restorations Dent Mater 1991 7(2) 107-13

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clinical results J Dent Res 199877 1020

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two amalgams Quintessence Int 199829483ndash490

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depth as cavity predictors for approximal dentin caries lesions in primary teeth

Dentomaxillofac Radiol 2007 Oct36(7)377-81

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direct and indirect restorations icircn posterior teeth of the permanent

dentitionOperDent200429(5)481-508

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year clinical evaluation of direct and indirect composite restorations in posterior teeth

J Prosthet Dent 2000 Sep84(3)289-96

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Three-year clinical evaluation of composite and ceramic inlays Am J Dent 2001

Apr14(2)95-9

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79369 (Abstract)

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(Cerana) Br Dent J 2006 Oct 21201(8)515-20

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PrimDentCare1999Apr659-62

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33

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52

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34

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55

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308

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systems J Dent 199523183ndash189

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199930249ndash257

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Oral Surg Oral Med Oral Pathol 198661(3)289-96

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Lambrechts P Yoshida Y Inoue S Suzuki K Technique-sensitivity of

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58

325Van Nieuwenhuysen JP DrsquoHoore W Carvalho J Qvist V Long-term

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326Venhoven BA de Gee AJ Davidson CL Light initiation of dental resins

dynamics of the polymerization Biomaterials 1996 172313-2318

327Versluis A Douglas WH Cross M Sakaguchi RL Does an incremental filling

technique reduce polymerization shrinkage stresses J Dent Res 1996 75871ndash878

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330Watanabe LG Marshall GW Jr Marshall SJ Dentin shear strength effects of

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451

332Watts DC Marouf AS Al-Hindi AM Photo-polymerization shrinkage-stress

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333Weaver WS Blank LW Pelleu GB Jr A visible light activated resin cured

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334Wendt SL Microleakage and cusp fracture resistance of heattreated composite

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1991 72 621-6

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Dentomaxillofac Radiol 1993 22 131-4

337Wenzel A Computer-aided image manipulation of intraoral radiographs to

enhance diagnosis in dental practice a review Int Dent J 1993 43 99-108

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Radiology 27(1)3-11 1998

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Dent 200114177ndash185

341Wilson NHF Wastell DG Norman RD Five-year performance of high-

cooper content amalgam restorations in a multiclinical trial JDent1996 24 203-210

342Winkler MM Katona TR Paydar NH Finite element stress analysis of three

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1996751477-83

343Yap AU Effectiveness of polymerization in composite restoratives claiming bulk

placement Impact of cavity depth and exposure time Oper Dent 2000 25113-120

59

344Yeşilyurt C Bulucu B Bond strength of total-etch dentin adhesive systems on

peripheral and central dentinal tissue a microtensile bond strength test The Journal of

Contemporary Dental Practice 7(2) 20061-13

345Yoshida Y Van Meerbeek B Okazaki M Shintani H Suzuki K Comparative

study on adhesive performance of functional monomers J Dent Res 2004 83 454-

458

346Yoshiyama M Tay FR Doi J Nishitani Y Yamada T Itou K Carvalho RM

Nakajima M Pashley DH Bonding of self-etch and total etch adhesives to carious

dentin J Dent Res 2002 81 556-560

  • COPERTA REZUMAT ENGLEZA (MEREUTA)pdf
  • REZUMAT ENGLEZA DR MEREUTA DENISSpdf
Page 38: UNIVERSITATEA DE MEDICINA SI FARMACIE “GR Doctorat/Rezumat... · universitatea de medicina si farmacie “gr.t.popa” iasi facultatea de medicina dentara rezumatul tezei de doctorat

35

defects and fissures in restoration bulk will appear at tensions over 1600Mpa

associated with forces of 800N for extended amalgam proximo-occlusal restorations

The tensions produced in composite resin restorations are in a range from 0 to

2285 (force 800 N) The maximum von Misses tensions are associated with cervical

area of composite resin restorationsThis aspect proves that first modification in

interface restoration-cavity margins will appear at the level of gingival wall First

marginal defects and fissures in restoration bulk will appear at tensions over 1716

Mpa associated with forces of 600N for moderate and extended composite resins

proximo-occlusal restorations

Fig XI3a-b ndash Simulated model of proximo-occlusal restoration

FigXI4a-b Dental amalgam restoration Cervical tension associated with 600 N

(c)800 N (d)

FigXI5a-b Composite resin restoration Cervical tension associated with 600 N

(c)800 N (d)

36

The deformation of amalgam can be produced only when is associated with

fissures in bulk of restorations while composite resins restorations present

deformation when are associated with a modification of volume and form because of

repeated action of medium forces on long term or high forces on short term (figures

XI4 XI5)

Fig XI4 Material deformation in area of maximum tension

000E + 00

500E -02

100E -01

150E -01

200E -01

250E -01

1 4 7 101316192225283134374043464952555861646770737679

Amalgam C ompoz it

Figura XI5 Deformarea funcție de material

The amalgam and composite resins were treated as homogenous isotropic and

liniar The advantage of this type of FEA study is that restorations parameters can be

modified any time is necessary both in arhitecture geometry and material indices

variability The results of this study sustain the conclusions of other FEA studies

focused on biomechanical behaviour of posterior restorations performed with

amalgam and composite resins(35 62 76 143)

37

XI4CONCLUSIONS

bull The amalgam in class II restorations has a low deformation tendency because

of uniform distribution of tension inside material

bull Composite resins class II restorations accumulate higher tensions comparing

with amalgam but deformation is avoided for a time because of the adhesion

forces performed between molecules under moderate oral forces In case of

high oral forces (600-800N) the risk of fracture in moderate class II

restorations is higher comparing with amalgam proximo-occlusal restorations

For extended class II restorations and forces of 600 N composite resins present

highest risk of fracture and deformation The von Misses tension at the

cervical interface restorationtooth can reach 1600Mpa

bull The amalgam in moderate class II restorations can resist to deformation even

for high intensity forces limited to 600N In extended class II restorations the

risk of deformation and fracture increases at values of 600N-800N of oral

forces The von Misses tension at the cervical interface restorationtooth can

reach 1700 Mpa

38

FINAL CONCLUSIONS

Amalgam proximo-occlusal restorations with minimum 6-years age present

excellent results for parameters anatomic form (occlusal) marginal

discoloration and marginal secondary dental caries good results for

parameters anatomic form (proximal) and marginal adaptation and poor results

for surface quality

Composite resins proximo-occlusal restorations (bicusps) with minimum 6-

years age present excellent results for parameters color match marginal

discoloration and marginal secondary dental caries and good results for

parameters anatomic form (occlusal proximal) marginal adaptation surface

quality

Composite resins proximo-occlusal restorations (molars) with minimum 6-

years age present good results for parameters color match marginal

discoloration marginal secondary dental caries marginal adaptation and poor

results for parameters anatomic form (occlusal) (54 indices Ryge C)

anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The restorations extended at external third of occlusal surface present highest

percents of indices C regarding anatomic form (occlusal) (54 indices Ryge

C) anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The exceeding of 6-years age will require careful monitorisation for early

interventions through polishing sealing reshaping and even replacement for

restorations with major defects

Oblique layering technique presents superior results regarding marginal

adaptation and marginal discoloration and is recommended for proximo-

occlusal dental caries close to enamel-cement jonction

Centripetal build-up presents good results regarding marginal adaptation and

anatomical form at proximal level (proximal surfaces and contact point)

Horisontal layering technique can be used for optimum results only in

proximal-occlusal cavities with moderate extension both in occlusal-cervical

and buccal-oral

The values of die penetration at gingival wall were statistically different

between the three restorative techniques

We concluded that all restorative methods were associated with lightcuring

contraction and marginal microleakage

The combined technique was associated with lowest lightcuring contraction

and die penetration

The bulk technique was associated with highest lightcuring contraction and die

penetration

39

The surfaces of enamel and dentine at cervical level record decreases of

roughness related to the decrease of distance to ECJ

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel but the differences

statistical significant are present only for enamel localised at 2 mm from ECJ

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of

dentine

bull The amalgam in class II restorations has a low deformation tendency because

of uniform distribution of tension inside material

bull Composite resins class II restorations accumulate higher tensions comparing

with amalgam but deformation is avoided for a time because of the adhesion

forces performed between molecules under moderate oral forces In case of

high oral forces (600-800N) the risk of fracture in moderate class II

restorations is higher comparing with amalgam proximo-occlusal restorations

For extended class II restorations and forces of 600 N composite resins present

highest risk of fracture and deformation The von Misses tension at the

cervical interface restorationtooth can reach 1600Mpa

bull The amalgam in moderate class II restorations can resist to deformation even

for high intensity forces limited to 600N In extended class II restorations the

risk of deformation and fracture increases at values of 600N-800N of oral

forces The von Misses tension at the cervical interface restorationtooth can

reach 1700 Mpa

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35Boschian PL S Guidotti R Pietrbissa M Gagliani- bdquoStress distribution in a

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36Bouillaguet S B Ciucchi T Jacoby JC Wataha DH Pashley Bonding

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200521(10)962-70

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replacement of restorations in vocational training practicePrimary Dental Care

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of restorations at failure and reasons for their placement and replacement J Dent

200129(5)317-24

48Calheiros FC Braga RR Kawano Y Ballester RY Relationship between

contraction stress and degree of conversion in restorative composites Dent Mater

2004 20939-946

49Cardoso P Sadek F Microtensile bond strength on dentin using new adhesive

systems with selfetching primers Braz J Oral Sci 2003 2(4) 156-159

50Cardoso M Baratieri LN Ritter AV The effect of finishing and polishing on

the decision to replace existing amalgam restorations Quintessence Int 1999

Jun30(6)413-8

51Carvalho RM JC Pereira M Yoshiyama DH Pashley A review of

polymerization contraction the influence of stress development versus stress

reliefOper Dent19962117ndash24

52Castro VM Katz JO Hardman PK Glaros AG Spencer P Invitro comparison

of conventional film and direct digital imaging in the detection of approximal caries

Dentomaxillofac Radiol 2007 Mar36(3)138-42

53Cattaneo PM M Dalstra B Melsen- bdquoThe Finite Element Method a Tool to

Study Orthodontic Tooth Movement J Dent Res 2005 84(5)428-433

54Cattell MJ Clarke RL Lynch EJ The transverse strength reliability and

microstructural features of four dental ceramicspart 1 J Dent 25(5)399-407 1997

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bond strength to primary dentin J Dent Child 2003 70(2) 139-144

56Celik C Arhun N Yamanel K Clinical evaluation of resin-based composites in

posterior restorations 12-month results Eur J Dent 2010 Jan4(1)57-65

57Cenci M Demarco F de Carvalho R Class II composite resin restorations with

two polymerization techniques Relationship between microtensile bond strength and

marginal leakage J Dent 2005 33(7) 603- 610

58Chaffin J Moss D Review of current US Army dental emergency rates Mil

Med 2008173(1)23ndash26

59Chen HY Manhart J Hickel R Kunzelmann KH Polymerization contraction

stress in light-cured packable composite resinsDent Mater 200117253-259

60Choi KK Condon JR Ferracane JL The effects of adhesive thickness on

polymerization contraction stress of composites J Dent Res 2000 79812ndash817

61Cichon P Kerschbaum T Verweildauer zahnartzlicher Restaurationen bei

Behinderten Dtsch Zahnartzlicher 1999 54 96-102

62Cohen BI Pagnillo MK Deutsch ASMusikant BL Fracture Strength of

Three Core Restorative Materials Supported with or without a Prefabricated Split-

Shank Post Journal of Prosthetic Dentistry1997 78 560ndash565

63Colli P Brannstrom M The marginal adaptation of four different bonding agents

in Class II composite resin restoration applied in bulk or in two increments

Quintessence Int 1993 24583-591

43

64Collins CJ Bryant RW Hodge KL A clinical evaluation of posterior composite

resin restorations 8-year findings J Dent 199826(4) 311ndash317

65Condon JR Ferracane JL Assessing the effect of composite formulation on

polymerization stress J Am Dent Assoc2000 131497-503

66Cook WD Moopnar M Influence of chemical structure on the fracture

behaviour of dimethacrylate composite resins Biomaterials 1990 11272-276

67Cortes DF Ellwood RP Ekstrand KR An in vitro comparison of a combined

FOTIvisual examination of occlusal caries with other caries diagnostic methods and

the effect of stain on their diagnostic performance Caries Res 2003 37 (1) 8-16

68Crim GA Microleakage of three resin placement techniques Am J Dent

1991469-72

69Dauvillier B Aarnts M Feilzer A The competition between the composite-

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1399

70Dauvillier BS Aarnts MP Feilzer AJ Developments in shrinkage control of

adhesive restoratives J Esthet Dent 2000 12291-299

71Dauvillier BS Aarnts MP Feilzer AJ Modeling of the viscoelastic behavior of

dental light-activated resin composites during curing Dent Mater 200319277ndash285

72Davidson CL Gee AJ Feilzer A The competition between the composite-dentin

bond strength and the polymerization contraction stress J Dent Res 1984

63(12)1396-9

73Davidson CL AJ Feilzer Polymerization shrinkage and polymerization

shrinkage stress in polymer-based restoratives J Dent Res 199725435ndash440

74Davidson CL Resisting the curing contraction with adhesive composites J

Prosthet Dent 198655446ndash7

75Davis RD Mayhew RB A clinical comparison of three anterior restorative resins

at 3 years J Am Dent Assoc 1986112659-63

76Dejak B Mlotkowski A Three-dimensional finite element analysis of strength

and adhesion of composite resin versus ceramic inlays in molarsJ Prosthet

Dent200899131-40

77Deligeorgi V Mjor IA Wilson NH An overview of reasons for the placement

and replacement of restorations Prim Dent Care 20018(1)5-11

78Deliperi S Bardwell DN An alternative method to reduce polymerization

shrinkage in direct posterior composite restorations J Am Dent Assoc 2002

1331387ndash97

79Demirci M Tuncer S Yuceokur AA Prevalence of caries on individual tooth

surfaces and its distribution by age and gender in university clinic patientsEur J

Dent20104(3)270-9

80De Munck J Van Meerbeek B Satoshi I Vargas M Yoshida Y Armstrong S

Lambrechts P Vanherle G Microtensile bond strengths of one- and two-step

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81Dewaele M Truffier-Boutry D Devaux J Leloup G Volume contraction in

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2006 22359-365

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82Deutsch WM Simecek JW Dental emergencies among Marines ashore in

Operations Desert ShieldStorm Mil Med 1996161(10) 620ndash623

83Dickens SH Stansbury JW Choi KM Floyd CJ Photopolymerization kinetics

of methacrylate dental resins Macromolecules 2003 366043-6053

84Dietschi D De Siebenthal G Neveu-Rosenstand L Holz J Influence of the

restorative technique and new adhesives on the dentin marginal seal and adaptation of

resin composite Class II restorations An in vitro evaluation Quintessence Int 1995

26 717-727

85Dietschi D Herzfeld D In vitro evaluation of marginal and internal adaptation of

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Sci 1998 106 1033-1042

86Dietschi D Marginal adaptation and seal of direct and indirect Class II composite

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87Diefenderfer KE Simecek JW Ahlf RL Ragain JC Relationship between

caries status and dental emergencies among US naval personnel J Dent Res

20028195 (Abstract)

88Diefenderfer KE Rienhardt JW Shear bond strengths of ten adhesive

resinamalgam combinations Oper Dent 1997 22 50-56

89Donly KJ Jensen ME Triolo PA clinical comparison of resin composite inlay

and onlay posterior restorations and cast-gold restorations at 7 years Quintessence Int

30(3)163- 1681999

90Douglas WH Fields RP Fundingsland J A comparison between the

microleakage of direct and indirect composite restorative systems J Dent 17(4)184-

188 1989

91Eberhard J Hartman B Lenhard M Mayer T Kocher T Eickholz P Digital

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92Edelstein BL Douglass CW Dispelling the myth that 50 percent of US

schoolchildren have never had a cavity Public Health Rep1995 110 (5) 522-530

93Eick JD Welch FH Polymerization shrinkage of posterior composite resins and

its possible influence on postoperative sensitivity Quintessence Int 198617103-11

94Elliott JE Lovell LG Bowman CN Primary cyclization in the polymerization of

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resins Dent Mater 2001 17221-229

95Ermis R Ulkam Aydin Examiner agreement in the replacement decisions of

class I amalgam restorations The Journal of contemporary dental practice 2004 Vol

5 no21-7

96Feilzer AJ AJ De Gee CL Davidson Increased wall-to-wall curing

contraction in thin bonded resin layers J Dent Res 19896848ndash50

97Feilzer AJ Dauvillier BS Effect of TEGDMABisGMA ratio on stress

development and viscoelastic properties of experimental twopaste composites J Dent

Res 2003 82824-828

98Feilzer AJ de Gee AJ Davidson CL Relaxation of polymerization contraction

shear stress by hygroscopic expansion J Dent Res 1990 6936ndash39

45

99Feilzer AJ De Gee AJ Davidson CL Setting stress in composite resin in relation

to configuration of the restoration J Dent Res1987 661636-1639

100Feilzer AJ Dooren LH de Gee AJ Davidson CL Influence of light intensity

on polymerization shrinkage and integrity of restoration-cavity interface Eur J Oral

Sci 1995 103322ndash326

101Fennis YL Verdischbot EH vanrsquot Hof MA Performance of some diagnostic

systems in the prediction of occlusal caries in permanent molars in 6 and 11 year-old

children J Dent 1998 26(5) 403-40

102Ferracane JL Developing a more complete understanding of stresses produced

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103Ferrari M Influence of tissue characteristics at margins on leakage of Class II

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104Ferreira MC Vieira RS Marginal leakage in direct and indirect composite resin

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105Forss H Widstroumlm E Reasons for restorative therapy and the longevity of

restorations in adults Acta Odontol Scand 2004 6282-86

106Fradeani M Aquilano A Bassein L Longitudinal study of pressed glass-

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107Franccedila FM Worschech CC Paulillo LA Martins LR Lovadino JR Fracture

resistance of premolar teeth restored with different filling techniques J Contemp Dent

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108Francci C Loguercio AD Reis A Carrilho MR A novel filling technique for

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14(3)149-57

109Fruits TJ Knapp JA Khajotia SS Microleakage in the proximal walls of

direct and indirect posterior resin slot restorations Oper Dent 200631(6)719-27

110Gaengler P Hoyer I Montag R Clinical evaluation of posterior composite

restorations The 10-year report J Adhes Dent 2001 3185-194

111Garbuz DS Masri BA Estaile J Classification systems in orthopaedics J Am

Acad Orthop Surg 2002 10 290-297

112Ghavamnasiri M Moosavi H Tahvildarnejad N Effect of centripetal and

incremental methods in Class II composite resin restorations on gingival

microleakage J Contemp Dent Pract 20078(2)113-20

113Gladys S Clinical and semiquantitative marginal analysis of four tooth-coloured

inlay systems at 3 years J Dent 199523(6)329-338

114Giachetti L Scaminaci Russo D Bambi C Grandini R A review of

polymerization shrinkage stress current techniques for posterior direct resin

restorations J Contemp Dent Pract 20067(4)79-88

115Giannini M AJS Santos RM Carvalho LAMS Paulillo JR Lovadino

Effects of irradiation mode and filling technique on resindentin bond strength in

Class I cavities J Dent Res 200281 (Abstract)

116Going RE Microleakage around dental restorations A summarizing review

JADA 1972841349-1357

117Gordon JChristensen G Why switch to digital radiography J Am Dent

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118Gregoire GL Akon BA Millas A Interfacial micromorphological differences

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Prosthet Dent 2002 87633ndash641

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124Haba Denisia Tehnici uzuale utilizate icircn radiologia dentară Edit Junimea

2007

125Hashimoto M Ito S Tay FR Svizero NR Sano H Kaga M Fluid movement

across the resin-dentin interface during and after bonding J Dent Res 2004 83843ndash

848

126Hashimoto M Tay FR Ito S Sano H Kaga M Pashley DH Permeability of

adhesive resin films J Biomed Mater Res 2005 74699ndash705

127Hawthorne WS Smales RJ Factors influencing long-term restoration survival

in three private dental practices in Adelaide Aust Dent J 19974259ndash63

128Helwig Klimek Attin Einfuumlhrung in Die ZahnErhaltung Urbanampfischer 2003

129He Z Shimada Y Tagami J The effects of cavity size and incremental

technique on micro-tensile bond strength of resin composite in Class I cavities Dent

Mater 200723(5)533-8

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131Hench LLBioceramicsfrom concept to clinicJ Amer Ceram Soc1991

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135Hilton TJ Schwartz RS Ferracane JL Microleakage of four Class II resin

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138Hintze H Wenzel A Danielen B Behaviour of approximal carious lesions

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139Hintze H Wenzel A Influence of validation method on diagnostic accuracy of

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of approximal and occlusal dental caries in a young adult population Community

Dent Oral Epidemiol 200533(3)212-8

143Hubsch PF Middleton J Knox J A finite element analysis of the stress at the

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fillingsBiomaterials2000211015ndash1019

144Hudson JD Goldstein GR Georgescu M Enamel wear caused by three

different restorative materials J Prosthet Dent 1995 74(6)647-654

145Hunter AR Treasure ET Hunter AJ Increases in cavity volume associated

with the removal of class 2 amalgam and composite restorations Oper Dent

1995202ndash 6

146Huysmans MC PG van der Varst EP Lautenschlager P Monaghan The

influence of simulated clinical handling on the flexural and compressive strength of

posterior composite restorative materials Dent Mater 199612116ndash120

147Iliescu A Gafar MCariologie şi Odontologie RestaurativăEditura Medicală

Bucureşti 2001

148Inoue S Van Meerbeek B Vargas M Lambrechts P Vanherle G Adhesion

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Prati C Grafiche Erredue 2000131-148

149Inoue S Vargas MA Abe Y Yoshida Y LambrechtsP Vanherle G Sano H

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150Iovan Gianina Diagnosis and Management of Patients with High Caries

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151Jacobsen T Soderhold KJ Some effects of water on dentin bonding Dent

Mater 1995 11(2)132-6

152Jackson RD Morgan M The new posterior resins and a simplified placement

technique J Am Dent Assoc 2000131375ndash383

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154Jokstad A Mjor IA Analyses of long-term clinical behaviour of class II

amalgam restorations Acta OdontolScand 1991 49 47-63

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adhesives to dental hard tissues Clin Oral Investig 2002 6(3)155-60

157Kamann WK Gangler P Zur Funktionzeit von Amalgam

Kompositefullungen Zahnartzlicher Welt 1999 108 270-273

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159Kay EJ Nutall M Relationship between dentistlsquos treatment attitudes and

restorative decisions made on the basis of simulated bitewing radiographs

Community Dentistry and Oral Epidemiology 1994 22(2) 71-74

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composite restorations effected by increased flexibility J Dent Res 1990 691240ndash

1243

161Khairallah C Hokayem A Long-term clinical evaluation of 2 dental materials

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200932(126)21-8

163Kidd EAAssesment of dental carious lesionsArchof Oral

Biology199843(8)629-632

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proximal caries lesions at various levels in vitro Journal of Dentistry 2006 34(10)

817-822

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composite restorations Oper Dent 200934(1)11-7

166Kleverlaan CJ Feilzer AJ Polymerization shrinkage and contraction stress of

dental resin composites Dent Mater 2005 211150-1157

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marginal leakage around class II composite resin restorations in vitroQuint Int

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M Dentin shear strength effect of distance from the pulp Dent Mater 2002

18(7)516-20

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polimerisation Am J Dent 1998 11 17-22

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thermal behavior of dental composites Dent Mater 2008 24(8)1017ndash1024

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179Lăcătuşu St Luminiţa Costinescu Andrian S Gianina Iovan Valeria

Pendefunda 180Sorina Solomon Topoliceanu C Elements of dispersional

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Edition of the Balkan Medical Days

Stomatological Section Abstract nr1091999128

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200126302ndash307

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Dentistry and Oral Epidemiology 1996 24 106-11

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20(3)236-43

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Polymerization shrinkage effects of boundary conditions and filling technique of

resin composite restorations J Dent 2004 32(6)459-70

50

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Quintessence Int 2004 35(2)156-61

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copolymerizations Macromolecules 1999 323913-3921

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clinical results J Dent Res 199877 1020

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Dentomaxillofac Radiol 2007 Oct36(7)377-81

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J Prosthet Dent 2000 Sep84(3)289-96

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Three-year clinical evaluation of composite and ceramic inlays Am J Dent 2001

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79369 (Abstract)

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(Cerana) Br Dent J 2006 Oct 21201(8)515-20

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PrimDentCare1999Apr659-62

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ScandJDRes 199210060-65

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33

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19904011ndash7

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52

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34

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54

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Part I Depth of penetration beyond dentin smear layers Dent Mater 2001 17(4) 296-

308

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In vivo evidence J Dent 2004 32611ndash621

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76(6)619-623 1996

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199930249ndash257

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Lambrechts P Yoshida Y Inoue S Suzuki K Technique-sensitivity of

contemporary adhesives Dent Mater J 2005 24(1) 1-13

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58

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dynamics of the polymerization Biomaterials 1996 172313-2318

327Versluis A Douglas WH Cross M Sakaguchi RL Does an incremental filling

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55-60

330Watanabe LG Marshall GW Jr Marshall SJ Dentin shear strength effects of

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331Watts DC AS Marouf Optimal specimen geometry in bonded-disk

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451

332Watts DC Marouf AS Al-Hindi AM Photo-polymerization shrinkage-stress

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333Weaver WS Blank LW Pelleu GB Jr A visible light activated resin cured

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334Wendt SL Microleakage and cusp fracture resistance of heattreated composite

resin inlays Am J Dent 4(1)10-14 1991

335Wenzel A Hintze H Mikkelsen L Mouyen F Radiographic detection of

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1991 72 621-6

336Wenzel A Hintze H Perception of image quality in direct digital radiography

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Dentomaxillofac Radiol 1993 22 131-4

337Wenzel A Computer-aided image manipulation of intraoral radiographs to

enhance diagnosis in dental practice a review Int Dent J 1993 43 99-108

338Wenzel A Digital radiography and caries diagnosis Dento Maxillo Facial

Radiology 27(1)3-11 1998

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Dent 200114177ndash185

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cooper content amalgam restorations in a multiclinical trial JDent1996 24 203-210

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filling techniques for class V light-cured composite restorations J Dent Res

1996751477-83

343Yap AU Effectiveness of polymerization in composite restoratives claiming bulk

placement Impact of cavity depth and exposure time Oper Dent 2000 25113-120

59

344Yeşilyurt C Bulucu B Bond strength of total-etch dentin adhesive systems on

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Contemporary Dental Practice 7(2) 20061-13

345Yoshida Y Van Meerbeek B Okazaki M Shintani H Suzuki K Comparative

study on adhesive performance of functional monomers J Dent Res 2004 83 454-

458

346Yoshiyama M Tay FR Doi J Nishitani Y Yamada T Itou K Carvalho RM

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dentin J Dent Res 2002 81 556-560

  • COPERTA REZUMAT ENGLEZA (MEREUTA)pdf
  • REZUMAT ENGLEZA DR MEREUTA DENISSpdf
Page 39: UNIVERSITATEA DE MEDICINA SI FARMACIE “GR Doctorat/Rezumat... · universitatea de medicina si farmacie “gr.t.popa” iasi facultatea de medicina dentara rezumatul tezei de doctorat

36

The deformation of amalgam can be produced only when is associated with

fissures in bulk of restorations while composite resins restorations present

deformation when are associated with a modification of volume and form because of

repeated action of medium forces on long term or high forces on short term (figures

XI4 XI5)

Fig XI4 Material deformation in area of maximum tension

000E + 00

500E -02

100E -01

150E -01

200E -01

250E -01

1 4 7 101316192225283134374043464952555861646770737679

Amalgam C ompoz it

Figura XI5 Deformarea funcție de material

The amalgam and composite resins were treated as homogenous isotropic and

liniar The advantage of this type of FEA study is that restorations parameters can be

modified any time is necessary both in arhitecture geometry and material indices

variability The results of this study sustain the conclusions of other FEA studies

focused on biomechanical behaviour of posterior restorations performed with

amalgam and composite resins(35 62 76 143)

37

XI4CONCLUSIONS

bull The amalgam in class II restorations has a low deformation tendency because

of uniform distribution of tension inside material

bull Composite resins class II restorations accumulate higher tensions comparing

with amalgam but deformation is avoided for a time because of the adhesion

forces performed between molecules under moderate oral forces In case of

high oral forces (600-800N) the risk of fracture in moderate class II

restorations is higher comparing with amalgam proximo-occlusal restorations

For extended class II restorations and forces of 600 N composite resins present

highest risk of fracture and deformation The von Misses tension at the

cervical interface restorationtooth can reach 1600Mpa

bull The amalgam in moderate class II restorations can resist to deformation even

for high intensity forces limited to 600N In extended class II restorations the

risk of deformation and fracture increases at values of 600N-800N of oral

forces The von Misses tension at the cervical interface restorationtooth can

reach 1700 Mpa

38

FINAL CONCLUSIONS

Amalgam proximo-occlusal restorations with minimum 6-years age present

excellent results for parameters anatomic form (occlusal) marginal

discoloration and marginal secondary dental caries good results for

parameters anatomic form (proximal) and marginal adaptation and poor results

for surface quality

Composite resins proximo-occlusal restorations (bicusps) with minimum 6-

years age present excellent results for parameters color match marginal

discoloration and marginal secondary dental caries and good results for

parameters anatomic form (occlusal proximal) marginal adaptation surface

quality

Composite resins proximo-occlusal restorations (molars) with minimum 6-

years age present good results for parameters color match marginal

discoloration marginal secondary dental caries marginal adaptation and poor

results for parameters anatomic form (occlusal) (54 indices Ryge C)

anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The restorations extended at external third of occlusal surface present highest

percents of indices C regarding anatomic form (occlusal) (54 indices Ryge

C) anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The exceeding of 6-years age will require careful monitorisation for early

interventions through polishing sealing reshaping and even replacement for

restorations with major defects

Oblique layering technique presents superior results regarding marginal

adaptation and marginal discoloration and is recommended for proximo-

occlusal dental caries close to enamel-cement jonction

Centripetal build-up presents good results regarding marginal adaptation and

anatomical form at proximal level (proximal surfaces and contact point)

Horisontal layering technique can be used for optimum results only in

proximal-occlusal cavities with moderate extension both in occlusal-cervical

and buccal-oral

The values of die penetration at gingival wall were statistically different

between the three restorative techniques

We concluded that all restorative methods were associated with lightcuring

contraction and marginal microleakage

The combined technique was associated with lowest lightcuring contraction

and die penetration

The bulk technique was associated with highest lightcuring contraction and die

penetration

39

The surfaces of enamel and dentine at cervical level record decreases of

roughness related to the decrease of distance to ECJ

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel but the differences

statistical significant are present only for enamel localised at 2 mm from ECJ

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of

dentine

bull The amalgam in class II restorations has a low deformation tendency because

of uniform distribution of tension inside material

bull Composite resins class II restorations accumulate higher tensions comparing

with amalgam but deformation is avoided for a time because of the adhesion

forces performed between molecules under moderate oral forces In case of

high oral forces (600-800N) the risk of fracture in moderate class II

restorations is higher comparing with amalgam proximo-occlusal restorations

For extended class II restorations and forces of 600 N composite resins present

highest risk of fracture and deformation The von Misses tension at the

cervical interface restorationtooth can reach 1600Mpa

bull The amalgam in moderate class II restorations can resist to deformation even

for high intensity forces limited to 600N In extended class II restorations the

risk of deformation and fracture increases at values of 600N-800N of oral

forces The von Misses tension at the cervical interface restorationtooth can

reach 1700 Mpa

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817-822

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dental resin composites Dent Mater 2005 211150-1157

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201989117ndash121

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18(7)516-20

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Materials Journal 2006 25(1)59-65

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Dent 27(5)325-331 1999

49

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Jan11(1)34-40

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JProsthet Dent 199369(4)425-430

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thermal behavior of dental composites Dent Mater 2008 24(8)1017ndash1024

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JDent 199826 627-632

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shrinkage and elasticity of flowable composites and filled adhesives Dent Mater

1999 15128-137

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Pendefunda 180Sorina Solomon Topoliceanu C Elements of dispersional

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Edition of the Balkan Medical Days

Stomatological Section Abstract nr1091999128

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StomatologicăVol2199823-26

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200126302ndash307

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Dentistry and Oral Epidemiology 1996 24 106-11

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Dent Mater 2002 18436-444

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20(3)236-43

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Polymerization shrinkage effects of boundary conditions and filling technique of

resin composite restorations J Dent 2004 32(6)459-70

50

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Quintessence Int 2004 35(2)156-61

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and reactivity on the reaction kinetics of dimethacrylatedimethacrylate

copolymerizations Macromolecules 1999 323913-3921

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clinical results J Dent Res 199877 1020

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two amalgams Quintessence Int 199829483ndash490

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Dentomaxillofac Radiol 2007 Oct36(7)377-81

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direct and indirect restorations icircn posterior teeth of the permanent

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composites for posterior restorations JADA Vol132 2001639-644

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J Prosthet Dent 2000 Sep84(3)289-96

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Three-year clinical evaluation of composite and ceramic inlays Am J Dent 2001

Apr14(2)95-9

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hardness and depth of cure of light cured packable composite resins J Dent Res 2000

79369 (Abstract)

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caries-affected transparent dentin by citric acidAn atomic force microscopy

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practitioners and dental caries JDent1990 18(3) 130-136

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(Cerana) Br Dent J 2006 Oct 21201(8)515-20

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PrimDentCare1999Apr659-62

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Quintessence 198961-80

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ScandJDRes 199210060-65

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33

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19904011ndash7

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Am Dent Assoc 2010 141(3)319-29

52

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125749-751

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34

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Monogr Oral Sci 20092142-51

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569ndash575

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Nanoleakage leakage within the hybrid layer Oper Dent 1995 20 18-25

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451

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338Wenzel A Digital radiography and caries diagnosis Dento Maxillo Facial

Radiology 27(1)3-11 1998

339Wenzel A Haiter-Neto F Gotfredsen E Risk factors for a false positive test

outcome in diagnosis of caries in approximal surfaces impact of radiographic

modality and observer characteristics Caries Res 200741(3)170-6

340Wibowo G Stockton L Microleakage of class II composite restorations Am J

Dent 200114177ndash185

341Wilson NHF Wastell DG Norman RD Five-year performance of high-

cooper content amalgam restorations in a multiclinical trial JDent1996 24 203-210

342Winkler MM Katona TR Paydar NH Finite element stress analysis of three

filling techniques for class V light-cured composite restorations J Dent Res

1996751477-83

343Yap AU Effectiveness of polymerization in composite restoratives claiming bulk

placement Impact of cavity depth and exposure time Oper Dent 2000 25113-120

59

344Yeşilyurt C Bulucu B Bond strength of total-etch dentin adhesive systems on

peripheral and central dentinal tissue a microtensile bond strength test The Journal of

Contemporary Dental Practice 7(2) 20061-13

345Yoshida Y Van Meerbeek B Okazaki M Shintani H Suzuki K Comparative

study on adhesive performance of functional monomers J Dent Res 2004 83 454-

458

346Yoshiyama M Tay FR Doi J Nishitani Y Yamada T Itou K Carvalho RM

Nakajima M Pashley DH Bonding of self-etch and total etch adhesives to carious

dentin J Dent Res 2002 81 556-560

  • COPERTA REZUMAT ENGLEZA (MEREUTA)pdf
  • REZUMAT ENGLEZA DR MEREUTA DENISSpdf
Page 40: UNIVERSITATEA DE MEDICINA SI FARMACIE “GR Doctorat/Rezumat... · universitatea de medicina si farmacie “gr.t.popa” iasi facultatea de medicina dentara rezumatul tezei de doctorat

37

XI4CONCLUSIONS

bull The amalgam in class II restorations has a low deformation tendency because

of uniform distribution of tension inside material

bull Composite resins class II restorations accumulate higher tensions comparing

with amalgam but deformation is avoided for a time because of the adhesion

forces performed between molecules under moderate oral forces In case of

high oral forces (600-800N) the risk of fracture in moderate class II

restorations is higher comparing with amalgam proximo-occlusal restorations

For extended class II restorations and forces of 600 N composite resins present

highest risk of fracture and deformation The von Misses tension at the

cervical interface restorationtooth can reach 1600Mpa

bull The amalgam in moderate class II restorations can resist to deformation even

for high intensity forces limited to 600N In extended class II restorations the

risk of deformation and fracture increases at values of 600N-800N of oral

forces The von Misses tension at the cervical interface restorationtooth can

reach 1700 Mpa

38

FINAL CONCLUSIONS

Amalgam proximo-occlusal restorations with minimum 6-years age present

excellent results for parameters anatomic form (occlusal) marginal

discoloration and marginal secondary dental caries good results for

parameters anatomic form (proximal) and marginal adaptation and poor results

for surface quality

Composite resins proximo-occlusal restorations (bicusps) with minimum 6-

years age present excellent results for parameters color match marginal

discoloration and marginal secondary dental caries and good results for

parameters anatomic form (occlusal proximal) marginal adaptation surface

quality

Composite resins proximo-occlusal restorations (molars) with minimum 6-

years age present good results for parameters color match marginal

discoloration marginal secondary dental caries marginal adaptation and poor

results for parameters anatomic form (occlusal) (54 indices Ryge C)

anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The restorations extended at external third of occlusal surface present highest

percents of indices C regarding anatomic form (occlusal) (54 indices Ryge

C) anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The exceeding of 6-years age will require careful monitorisation for early

interventions through polishing sealing reshaping and even replacement for

restorations with major defects

Oblique layering technique presents superior results regarding marginal

adaptation and marginal discoloration and is recommended for proximo-

occlusal dental caries close to enamel-cement jonction

Centripetal build-up presents good results regarding marginal adaptation and

anatomical form at proximal level (proximal surfaces and contact point)

Horisontal layering technique can be used for optimum results only in

proximal-occlusal cavities with moderate extension both in occlusal-cervical

and buccal-oral

The values of die penetration at gingival wall were statistically different

between the three restorative techniques

We concluded that all restorative methods were associated with lightcuring

contraction and marginal microleakage

The combined technique was associated with lowest lightcuring contraction

and die penetration

The bulk technique was associated with highest lightcuring contraction and die

penetration

39

The surfaces of enamel and dentine at cervical level record decreases of

roughness related to the decrease of distance to ECJ

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel but the differences

statistical significant are present only for enamel localised at 2 mm from ECJ

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of

dentine

bull The amalgam in class II restorations has a low deformation tendency because

of uniform distribution of tension inside material

bull Composite resins class II restorations accumulate higher tensions comparing

with amalgam but deformation is avoided for a time because of the adhesion

forces performed between molecules under moderate oral forces In case of

high oral forces (600-800N) the risk of fracture in moderate class II

restorations is higher comparing with amalgam proximo-occlusal restorations

For extended class II restorations and forces of 600 N composite resins present

highest risk of fracture and deformation The von Misses tension at the

cervical interface restorationtooth can reach 1600Mpa

bull The amalgam in moderate class II restorations can resist to deformation even

for high intensity forces limited to 600N In extended class II restorations the

risk of deformation and fracture increases at values of 600N-800N of oral

forces The von Misses tension at the cervical interface restorationtooth can

reach 1700 Mpa

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Activity EdApollonia Iasi2002

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Mater 1995 11(2)132-6

152Jackson RD Morgan M The new posterior resins and a simplified placement

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with flowable composite in the proximal box Am J Dent 200013235ndash238

48

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Kompositefullungen Zahnartzlicher Welt 1999 108 270-273

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Community Dentistry and Oral Epidemiology 1994 22(2) 71-74

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composite restorations effected by increased flexibility J Dent Res 1990 691240ndash

1243

161Khairallah C Hokayem A Long-term clinical evaluation of 2 dental materials

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200932(126)21-8

163Kidd EAAssesment of dental carious lesionsArchof Oral

Biology199843(8)629-632

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817-822

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166Kleverlaan CJ Feilzer AJ Polymerization shrinkage and contraction stress of

dental resin composites Dent Mater 2005 211150-1157

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marginal leakage around class II composite resin restorations in vitroQuint Int

201989117ndash121

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18(7)516-20

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Materials Journal 2006 25(1)59-65

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Dent 27(5)325-331 1999

49

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Jan11(1)34-40

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JProsthet Dent 199369(4)425-430

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thermal behavior of dental composites Dent Mater 2008 24(8)1017ndash1024

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JDent 199826 627-632

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shrinkage and elasticity of flowable composites and filled adhesives Dent Mater

1999 15128-137

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Pendefunda 180Sorina Solomon Topoliceanu C Elements of dispersional

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Edition of the Balkan Medical Days

Stomatological Section Abstract nr1091999128

181Lăcătuşu St Andrian S Gianina Iovan- Consideraţii asupra adaptării

amalgamelor dentare la pereţii cavităţilor RevMedicina

StomatologicăVol2199823-26

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200126302ndash307

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Dentistry and Oral Epidemiology 1996 24 106-11

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polymerization contraction stress for dental composites by two-step light-activation

Dent Mater 2002 18436-444

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constraint and filling technique in composite restorations Dent Mater 2004

20(3)236-43

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Polymerization shrinkage effects of boundary conditions and filling technique of

resin composite restorations J Dent 2004 32(6)459-70

50

189Lopes GC Baratieri LN Monteiro S Jr Vieira LC Effect of posterior resin

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Quintessence Int 2004 35(2)156-61

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art and future perspectives Quintessence Int 200233213-224

191Loumlsche GM Marginal adaptation of class II composite fillings guided

polymerization vs reduced light intensity J Adhes Dent 1 199931ndash39

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and reactivity on the reaction kinetics of dimethacrylatedimethacrylate

copolymerizations Macromolecules 1999 323913-3921

194Lutz F Krejci I Barbakow F Quality and durability of marginal adaptation in

bonded composite restorations Dent Mater 1991 7(2) 107-13

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clinical results J Dent Res 199877 1020

196Mair LH Ten-year clinical assessment of three posterior resin composites and

two amalgams Quintessence Int 199829483ndash490

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depth as cavity predictors for approximal dentin caries lesions in primary teeth

Dentomaxillofac Radiol 2007 Oct36(7)377-81

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direct and indirect restorations icircn posterior teeth of the permanent

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200Manhart J Neuerer P Scheibenbogen-Fuchsbrunner A Hickel R Three-

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J Prosthet Dent 2000 Sep84(3)289-96

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Three-year clinical evaluation of composite and ceramic inlays Am J Dent 2001

Apr14(2)95-9

202Manhart J Chen HY Draegert U Kunzelmann KH Hickel R Vickers

hardness and depth of cure of light cured packable composite resins J Dent Res 2000

79369 (Abstract)

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caries-affected transparent dentin by citric acidAn atomic force microscopy

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51

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Dent Res 1988 94 19-26

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209Miguel A JC La Macorra A predictive formula of the contraction stress in

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deformation Dent Mater 200117241ndash246

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practitioners and dental caries JDent1990 18(3) 130-136

211Millar BJ Robinson PB Eight year results with direct ceramic restorations

(Cerana) Br Dent J 2006 Oct 21201(8)515-20

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PrimDentCare1999Apr659-62

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Quintessence 198961-80

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ScandJDRes 199210060-65

215Mjor IA The reasons for replacement and the age of failed restorations in

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33

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19904011ndash7

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Am Dent Assoc 2010 141(3)319-29

52

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125749-751

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composites Oper Dent 23 1998282ndash289

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34

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Monogr Oral Sci 20092142-51

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Monogr Oral Sci 20092152-62

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Quintessence Int 1998295ndash11

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569ndash575

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Nanoleakage leakage within the hybrid layer Oper Dent 1995 20 18-25

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In vivo evidence J Dent 2004 32611ndash621

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Oral Surg Oral Med Oral Pathol 198661(3)289-96

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327Versluis A Douglas WH Cross M Sakaguchi RL Does an incremental filling

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55-60

330Watanabe LG Marshall GW Jr Marshall SJ Dentin shear strength effects of

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shrinkage-strain measurements on light-cured biomaterials Dent Mater 200016447ndash

451

332Watts DC Marouf AS Al-Hindi AM Photo-polymerization shrinkage-stress

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333Weaver WS Blank LW Pelleu GB Jr A visible light activated resin cured

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1991 72 621-6

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Dentomaxillofac Radiol 1993 22 131-4

337Wenzel A Computer-aided image manipulation of intraoral radiographs to

enhance diagnosis in dental practice a review Int Dent J 1993 43 99-108

338Wenzel A Digital radiography and caries diagnosis Dento Maxillo Facial

Radiology 27(1)3-11 1998

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modality and observer characteristics Caries Res 200741(3)170-6

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Dent 200114177ndash185

341Wilson NHF Wastell DG Norman RD Five-year performance of high-

cooper content amalgam restorations in a multiclinical trial JDent1996 24 203-210

342Winkler MM Katona TR Paydar NH Finite element stress analysis of three

filling techniques for class V light-cured composite restorations J Dent Res

1996751477-83

343Yap AU Effectiveness of polymerization in composite restoratives claiming bulk

placement Impact of cavity depth and exposure time Oper Dent 2000 25113-120

59

344Yeşilyurt C Bulucu B Bond strength of total-etch dentin adhesive systems on

peripheral and central dentinal tissue a microtensile bond strength test The Journal of

Contemporary Dental Practice 7(2) 20061-13

345Yoshida Y Van Meerbeek B Okazaki M Shintani H Suzuki K Comparative

study on adhesive performance of functional monomers J Dent Res 2004 83 454-

458

346Yoshiyama M Tay FR Doi J Nishitani Y Yamada T Itou K Carvalho RM

Nakajima M Pashley DH Bonding of self-etch and total etch adhesives to carious

dentin J Dent Res 2002 81 556-560

  • COPERTA REZUMAT ENGLEZA (MEREUTA)pdf
  • REZUMAT ENGLEZA DR MEREUTA DENISSpdf
Page 41: UNIVERSITATEA DE MEDICINA SI FARMACIE “GR Doctorat/Rezumat... · universitatea de medicina si farmacie “gr.t.popa” iasi facultatea de medicina dentara rezumatul tezei de doctorat

38

FINAL CONCLUSIONS

Amalgam proximo-occlusal restorations with minimum 6-years age present

excellent results for parameters anatomic form (occlusal) marginal

discoloration and marginal secondary dental caries good results for

parameters anatomic form (proximal) and marginal adaptation and poor results

for surface quality

Composite resins proximo-occlusal restorations (bicusps) with minimum 6-

years age present excellent results for parameters color match marginal

discoloration and marginal secondary dental caries and good results for

parameters anatomic form (occlusal proximal) marginal adaptation surface

quality

Composite resins proximo-occlusal restorations (molars) with minimum 6-

years age present good results for parameters color match marginal

discoloration marginal secondary dental caries marginal adaptation and poor

results for parameters anatomic form (occlusal) (54 indices Ryge C)

anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The restorations extended at external third of occlusal surface present highest

percents of indices C regarding anatomic form (occlusal) (54 indices Ryge

C) anatomic form (proximal) (34 indices Ryge C) and surface quality (36

indices Ryge C)

The exceeding of 6-years age will require careful monitorisation for early

interventions through polishing sealing reshaping and even replacement for

restorations with major defects

Oblique layering technique presents superior results regarding marginal

adaptation and marginal discoloration and is recommended for proximo-

occlusal dental caries close to enamel-cement jonction

Centripetal build-up presents good results regarding marginal adaptation and

anatomical form at proximal level (proximal surfaces and contact point)

Horisontal layering technique can be used for optimum results only in

proximal-occlusal cavities with moderate extension both in occlusal-cervical

and buccal-oral

The values of die penetration at gingival wall were statistically different

between the three restorative techniques

We concluded that all restorative methods were associated with lightcuring

contraction and marginal microleakage

The combined technique was associated with lowest lightcuring contraction

and die penetration

The bulk technique was associated with highest lightcuring contraction and die

penetration

39

The surfaces of enamel and dentine at cervical level record decreases of

roughness related to the decrease of distance to ECJ

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel but the differences

statistical significant are present only for enamel localised at 2 mm from ECJ

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of

dentine

bull The amalgam in class II restorations has a low deformation tendency because

of uniform distribution of tension inside material

bull Composite resins class II restorations accumulate higher tensions comparing

with amalgam but deformation is avoided for a time because of the adhesion

forces performed between molecules under moderate oral forces In case of

high oral forces (600-800N) the risk of fracture in moderate class II

restorations is higher comparing with amalgam proximo-occlusal restorations

For extended class II restorations and forces of 600 N composite resins present

highest risk of fracture and deformation The von Misses tension at the

cervical interface restorationtooth can reach 1600Mpa

bull The amalgam in moderate class II restorations can resist to deformation even

for high intensity forces limited to 600N In extended class II restorations the

risk of deformation and fracture increases at values of 600N-800N of oral

forces The von Misses tension at the cervical interface restorationtooth can

reach 1700 Mpa

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64Collins CJ Bryant RW Hodge KL A clinical evaluation of posterior composite

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71Dauvillier BS Aarnts MP Feilzer AJ Modeling of the viscoelastic behavior of

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80De Munck J Van Meerbeek B Satoshi I Vargas M Yoshida Y Armstrong S

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82Deutsch WM Simecek JW Dental emergencies among Marines ashore in

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89Donly KJ Jensen ME Triolo PA clinical comparison of resin composite inlay

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Effects of irradiation mode and filling technique on resindentin bond strength in

Class I cavities J Dent Res 200281 (Abstract)

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48

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Kompositefullungen Zahnartzlicher Welt 1999 108 270-273

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Community Dentistry and Oral Epidemiology 1994 22(2) 71-74

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1243

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Biology199843(8)629-632

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817-822

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dental resin composites Dent Mater 2005 211150-1157

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201989117ndash121

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18(7)516-20

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Dent 27(5)325-331 1999

49

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Jan11(1)34-40

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JProsthet Dent 199369(4)425-430

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thermal behavior of dental composites Dent Mater 2008 24(8)1017ndash1024

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JDent 199826 627-632

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shrinkage and elasticity of flowable composites and filled adhesives Dent Mater

1999 15128-137

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Pendefunda 180Sorina Solomon Topoliceanu C Elements of dispersional

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Edition of the Balkan Medical Days

Stomatological Section Abstract nr1091999128

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StomatologicăVol2199823-26

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200126302ndash307

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Dentistry and Oral Epidemiology 1996 24 106-11

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Dent Mater 2002 18436-444

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20(3)236-43

188Loguercio AD Reis A Schroeder M Balducci I Versluis A Ballester RY

Polymerization shrinkage effects of boundary conditions and filling technique of

resin composite restorations J Dent 2004 32(6)459-70

50

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Quintessence Int 2004 35(2)156-61

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191Loumlsche GM Marginal adaptation of class II composite fillings guided

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copolymerizations Macromolecules 1999 323913-3921

194Lutz F Krejci I Barbakow F Quality and durability of marginal adaptation in

bonded composite restorations Dent Mater 1991 7(2) 107-13

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clinical results J Dent Res 199877 1020

196Mair LH Ten-year clinical assessment of three posterior resin composites and

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depth as cavity predictors for approximal dentin caries lesions in primary teeth

Dentomaxillofac Radiol 2007 Oct36(7)377-81

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direct and indirect restorations icircn posterior teeth of the permanent

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200Manhart J Neuerer P Scheibenbogen-Fuchsbrunner A Hickel R Three-

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J Prosthet Dent 2000 Sep84(3)289-96

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Three-year clinical evaluation of composite and ceramic inlays Am J Dent 2001

Apr14(2)95-9

202Manhart J Chen HY Draegert U Kunzelmann KH Hickel R Vickers

hardness and depth of cure of light cured packable composite resins J Dent Res 2000

79369 (Abstract)

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caries-affected transparent dentin by citric acidAn atomic force microscopy

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51

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209Miguel A JC La Macorra A predictive formula of the contraction stress in

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deformation Dent Mater 200117241ndash246

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practitioners and dental caries JDent1990 18(3) 130-136

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PrimDentCare1999Apr659-62

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Quintessence 198961-80

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ScandJDRes 199210060-65

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33

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19904011ndash7

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Am Dent Assoc 2010 141(3)319-29

52

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125749-751

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composites Oper Dent 23 1998282ndash289

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34

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Monogr Oral Sci 20092142-51

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569ndash575

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Nanoleakage leakage within the hybrid layer Oper Dent 1995 20 18-25

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864

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308

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In vivo evidence J Dent 2004 32611ndash621

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76(6)619-623 1996

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Landuyt K Lambrechts P Vanherle G Adhesion to enamel and dentin Current

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322Van Meerbeek B Van Landuyt K De Munck JHashimoto M Peumans M

Lambrechts P Yoshida Y Inoue S Suzuki K Technique-sensitivity of

contemporary adhesives Dent Mater J 2005 24(1) 1-13

323Van Meerbeek B Vargas S Inoue S Yoshida Y Peumans M Lambrechts P

Vanherle G Adhesives and cements to promote preservation dentistry Oper Dent

20016 119-144

324Van Meerbeek B Yoshida Y Inoue S Vargas M Abe Y Fukuda R Okazaki

M Lambrechts P Vanherle G Bonding mechanism micro-tensile bond strength of

a 4- MET-based self-etching adhesive J Dent Res 2000 79 249 (Abstract)

58

325Van Nieuwenhuysen JP DrsquoHoore W Carvalho J Qvist V Long-term

evaluation of extensive restorations in permanent teeth J Dent 200331(6)395ndash405

326Venhoven BA de Gee AJ Davidson CL Light initiation of dental resins

dynamics of the polymerization Biomaterials 1996 172313-2318

327Versluis A Douglas WH Cross M Sakaguchi RL Does an incremental filling

technique reduce polymerization shrinkage stresses J Dent Res 1996 75871ndash878

328Vries HC Ruiken HM Konig KG vanrsquot Hof MA Radiographic versus

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329Waggoner W Ashton J Predictability of cavitation based upon radiographic

appearance comparison of two film types Quintessence International 1989 20(1)

55-60

330Watanabe LG Marshall GW Jr Marshall SJ Dentin shear strength effects of

tubule orientation and intra tooth location Dent Mater 1996 12 109-115

331Watts DC AS Marouf Optimal specimen geometry in bonded-disk

shrinkage-strain measurements on light-cured biomaterials Dent Mater 200016447ndash

451

332Watts DC Marouf AS Al-Hindi AM Photo-polymerization shrinkage-stress

kinetics in resin-composites methods development Dent Mater 2003 191ndash11

333Weaver WS Blank LW Pelleu GB Jr A visible light activated resin cured

through tooth structure GenDent 198836236-7

334Wendt SL Microleakage and cusp fracture resistance of heattreated composite

resin inlays Am J Dent 4(1)10-14 1991

335Wenzel A Hintze H Mikkelsen L Mouyen F Radiographic detection of

occlusal caries in noncavitated teeth A comparison of conventional film radiographs

digitized film radiographs and RadioVisioGraphy-Oral Surg Oral Med Oral Pathol

1991 72 621-6

336Wenzel A Hintze H Perception of image quality in direct digital radiography

after application of various image treatment filters for detectability of dental diseases

Dentomaxillofac Radiol 1993 22 131-4

337Wenzel A Computer-aided image manipulation of intraoral radiographs to

enhance diagnosis in dental practice a review Int Dent J 1993 43 99-108

338Wenzel A Digital radiography and caries diagnosis Dento Maxillo Facial

Radiology 27(1)3-11 1998

339Wenzel A Haiter-Neto F Gotfredsen E Risk factors for a false positive test

outcome in diagnosis of caries in approximal surfaces impact of radiographic

modality and observer characteristics Caries Res 200741(3)170-6

340Wibowo G Stockton L Microleakage of class II composite restorations Am J

Dent 200114177ndash185

341Wilson NHF Wastell DG Norman RD Five-year performance of high-

cooper content amalgam restorations in a multiclinical trial JDent1996 24 203-210

342Winkler MM Katona TR Paydar NH Finite element stress analysis of three

filling techniques for class V light-cured composite restorations J Dent Res

1996751477-83

343Yap AU Effectiveness of polymerization in composite restoratives claiming bulk

placement Impact of cavity depth and exposure time Oper Dent 2000 25113-120

59

344Yeşilyurt C Bulucu B Bond strength of total-etch dentin adhesive systems on

peripheral and central dentinal tissue a microtensile bond strength test The Journal of

Contemporary Dental Practice 7(2) 20061-13

345Yoshida Y Van Meerbeek B Okazaki M Shintani H Suzuki K Comparative

study on adhesive performance of functional monomers J Dent Res 2004 83 454-

458

346Yoshiyama M Tay FR Doi J Nishitani Y Yamada T Itou K Carvalho RM

Nakajima M Pashley DH Bonding of self-etch and total etch adhesives to carious

dentin J Dent Res 2002 81 556-560

  • COPERTA REZUMAT ENGLEZA (MEREUTA)pdf
  • REZUMAT ENGLEZA DR MEREUTA DENISSpdf
Page 42: UNIVERSITATEA DE MEDICINA SI FARMACIE “GR Doctorat/Rezumat... · universitatea de medicina si farmacie “gr.t.popa” iasi facultatea de medicina dentara rezumatul tezei de doctorat

39

The surfaces of enamel and dentine at cervical level record decreases of

roughness related to the decrease of distance to ECJ

The results show that the enamel etching is associated with an increase of

surface roughness no matter the distance to ECJ of enamel but the differences

statistical significant are present only for enamel localised at 2 mm from ECJ

The results show that the dentine etching is associated with a statistical

significant increase of surface roughness no matter the distance to ECJ of

dentine

bull The amalgam in class II restorations has a low deformation tendency because

of uniform distribution of tension inside material

bull Composite resins class II restorations accumulate higher tensions comparing

with amalgam but deformation is avoided for a time because of the adhesion

forces performed between molecules under moderate oral forces In case of

high oral forces (600-800N) the risk of fracture in moderate class II

restorations is higher comparing with amalgam proximo-occlusal restorations

For extended class II restorations and forces of 600 N composite resins present

highest risk of fracture and deformation The von Misses tension at the

cervical interface restorationtooth can reach 1600Mpa

bull The amalgam in moderate class II restorations can resist to deformation even

for high intensity forces limited to 600N In extended class II restorations the

risk of deformation and fracture increases at values of 600N-800N of oral

forces The von Misses tension at the cervical interface restorationtooth can

reach 1700 Mpa

REFERENCES

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utilizing a filled and unfilled adhesive resin Dent Mater 200117268ndash276

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26Bader JD Shugars DA Understanding dentistslsquo restorative treatment decisions J

Public Health Dent 1992 Winter52(2)102-10

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Dent 199158 36-39

28Bayne SC Dental biomaterials where are we and where are we going J Dent

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29Bedran-de-Castro AK Pereira PN Thompson JY Influence of load cycling

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30Behle C Flowable composite Proprieties and applications Pract Periodontics

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35Boschian PL S Guidotti R Pietrbissa M Gagliani- bdquoStress distribution in a

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36Bouillaguet S B Ciucchi T Jacoby JC Wataha DH Pashley Bonding

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321

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45Burke FJ Cheung SW Mjoumlr IA Wilson NH Restoration longevity and analysis

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46Burke FJ Cheung SW Mjor IA Wilson NH-Reasons for the placement and

replacement of restorations in vocational training practicePrimary Dental Care

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47Burke FJ Wilson NH Cheung SW Mjoumlr IA Influence of patient factors on age

of restorations at failure and reasons for their placement and replacement J Dent

200129(5)317-24

48Calheiros FC Braga RR Kawano Y Ballester RY Relationship between

contraction stress and degree of conversion in restorative composites Dent Mater

2004 20939-946

49Cardoso P Sadek F Microtensile bond strength on dentin using new adhesive

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50Cardoso M Baratieri LN Ritter AV The effect of finishing and polishing on

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51Carvalho RM JC Pereira M Yoshiyama DH Pashley A review of

polymerization contraction the influence of stress development versus stress

reliefOper Dent19962117ndash24

52Castro VM Katz JO Hardman PK Glaros AG Spencer P Invitro comparison

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Dentomaxillofac Radiol 2007 Mar36(3)138-42

53Cattaneo PM M Dalstra B Melsen- bdquoThe Finite Element Method a Tool to

Study Orthodontic Tooth Movement J Dent Res 2005 84(5)428-433

54Cattell MJ Clarke RL Lynch EJ The transverse strength reliability and

microstructural features of four dental ceramicspart 1 J Dent 25(5)399-407 1997

55Cehreli ZC Akca T Effect of dentinal tubule orientation on the microtensile

bond strength to primary dentin J Dent Child 2003 70(2) 139-144

56Celik C Arhun N Yamanel K Clinical evaluation of resin-based composites in

posterior restorations 12-month results Eur J Dent 2010 Jan4(1)57-65

57Cenci M Demarco F de Carvalho R Class II composite resin restorations with

two polymerization techniques Relationship between microtensile bond strength and

marginal leakage J Dent 2005 33(7) 603- 610

58Chaffin J Moss D Review of current US Army dental emergency rates Mil

Med 2008173(1)23ndash26

59Chen HY Manhart J Hickel R Kunzelmann KH Polymerization contraction

stress in light-cured packable composite resinsDent Mater 200117253-259

60Choi KK Condon JR Ferracane JL The effects of adhesive thickness on

polymerization contraction stress of composites J Dent Res 2000 79812ndash817

61Cichon P Kerschbaum T Verweildauer zahnartzlicher Restaurationen bei

Behinderten Dtsch Zahnartzlicher 1999 54 96-102

62Cohen BI Pagnillo MK Deutsch ASMusikant BL Fracture Strength of

Three Core Restorative Materials Supported with or without a Prefabricated Split-

Shank Post Journal of Prosthetic Dentistry1997 78 560ndash565

63Colli P Brannstrom M The marginal adaptation of four different bonding agents

in Class II composite resin restoration applied in bulk or in two increments

Quintessence Int 1993 24583-591

43

64Collins CJ Bryant RW Hodge KL A clinical evaluation of posterior composite

resin restorations 8-year findings J Dent 199826(4) 311ndash317

65Condon JR Ferracane JL Assessing the effect of composite formulation on

polymerization stress J Am Dent Assoc2000 131497-503

66Cook WD Moopnar M Influence of chemical structure on the fracture

behaviour of dimethacrylate composite resins Biomaterials 1990 11272-276

67Cortes DF Ellwood RP Ekstrand KR An in vitro comparison of a combined

FOTIvisual examination of occlusal caries with other caries diagnostic methods and

the effect of stain on their diagnostic performance Caries Res 2003 37 (1) 8-16

68Crim GA Microleakage of three resin placement techniques Am J Dent

1991469-72

69Dauvillier B Aarnts M Feilzer A The competition between the composite-

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1399

70Dauvillier BS Aarnts MP Feilzer AJ Developments in shrinkage control of

adhesive restoratives J Esthet Dent 2000 12291-299

71Dauvillier BS Aarnts MP Feilzer AJ Modeling of the viscoelastic behavior of

dental light-activated resin composites during curing Dent Mater 200319277ndash285

72Davidson CL Gee AJ Feilzer A The competition between the composite-dentin

bond strength and the polymerization contraction stress J Dent Res 1984

63(12)1396-9

73Davidson CL AJ Feilzer Polymerization shrinkage and polymerization

shrinkage stress in polymer-based restoratives J Dent Res 199725435ndash440

74Davidson CL Resisting the curing contraction with adhesive composites J

Prosthet Dent 198655446ndash7

75Davis RD Mayhew RB A clinical comparison of three anterior restorative resins

at 3 years J Am Dent Assoc 1986112659-63

76Dejak B Mlotkowski A Three-dimensional finite element analysis of strength

and adhesion of composite resin versus ceramic inlays in molarsJ Prosthet

Dent200899131-40

77Deligeorgi V Mjor IA Wilson NH An overview of reasons for the placement

and replacement of restorations Prim Dent Care 20018(1)5-11

78Deliperi S Bardwell DN An alternative method to reduce polymerization

shrinkage in direct posterior composite restorations J Am Dent Assoc 2002

1331387ndash97

79Demirci M Tuncer S Yuceokur AA Prevalence of caries on individual tooth

surfaces and its distribution by age and gender in university clinic patientsEur J

Dent20104(3)270-9

80De Munck J Van Meerbeek B Satoshi I Vargas M Yoshida Y Armstrong S

Lambrechts P Vanherle G Microtensile bond strengths of one- and two-step

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81Dewaele M Truffier-Boutry D Devaux J Leloup G Volume contraction in

photocured dental resins the shrinkage-conversion relationship revisited Dent Mater

2006 22359-365

44

82Deutsch WM Simecek JW Dental emergencies among Marines ashore in

Operations Desert ShieldStorm Mil Med 1996161(10) 620ndash623

83Dickens SH Stansbury JW Choi KM Floyd CJ Photopolymerization kinetics

of methacrylate dental resins Macromolecules 2003 366043-6053

84Dietschi D De Siebenthal G Neveu-Rosenstand L Holz J Influence of the

restorative technique and new adhesives on the dentin marginal seal and adaptation of

resin composite Class II restorations An in vitro evaluation Quintessence Int 1995

26 717-727

85Dietschi D Herzfeld D In vitro evaluation of marginal and internal adaptation of

class II resin composite restorations after thermal and occlusal stressing Eur J Oral

Sci 1998 106 1033-1042

86Dietschi D Marginal adaptation and seal of direct and indirect Class II composite

resin restorations an in vitro evaluation Quintessence Int 26(2)127-138 1995

87Diefenderfer KE Simecek JW Ahlf RL Ragain JC Relationship between

caries status and dental emergencies among US naval personnel J Dent Res

20028195 (Abstract)

88Diefenderfer KE Rienhardt JW Shear bond strengths of ten adhesive

resinamalgam combinations Oper Dent 1997 22 50-56

89Donly KJ Jensen ME Triolo PA clinical comparison of resin composite inlay

and onlay posterior restorations and cast-gold restorations at 7 years Quintessence Int

30(3)163- 1681999

90Douglas WH Fields RP Fundingsland J A comparison between the

microleakage of direct and indirect composite restorative systems J Dent 17(4)184-

188 1989

91Eberhard J Hartman B Lenhard M Mayer T Kocher T Eickholz P Digital

subtraction radiography for monitoring dental demineralization An in vitro study

Caries Res 200034(3)219-24

92Edelstein BL Douglass CW Dispelling the myth that 50 percent of US

schoolchildren have never had a cavity Public Health Rep1995 110 (5) 522-530

93Eick JD Welch FH Polymerization shrinkage of posterior composite resins and

its possible influence on postoperative sensitivity Quintessence Int 198617103-11

94Elliott JE Lovell LG Bowman CN Primary cyclization in the polymerization of

bis GMA and TEGDMA a modeling approach to understanding the cure of dental

resins Dent Mater 2001 17221-229

95Ermis R Ulkam Aydin Examiner agreement in the replacement decisions of

class I amalgam restorations The Journal of contemporary dental practice 2004 Vol

5 no21-7

96Feilzer AJ AJ De Gee CL Davidson Increased wall-to-wall curing

contraction in thin bonded resin layers J Dent Res 19896848ndash50

97Feilzer AJ Dauvillier BS Effect of TEGDMABisGMA ratio on stress

development and viscoelastic properties of experimental twopaste composites J Dent

Res 2003 82824-828

98Feilzer AJ de Gee AJ Davidson CL Relaxation of polymerization contraction

shear stress by hygroscopic expansion J Dent Res 1990 6936ndash39

45

99Feilzer AJ De Gee AJ Davidson CL Setting stress in composite resin in relation

to configuration of the restoration J Dent Res1987 661636-1639

100Feilzer AJ Dooren LH de Gee AJ Davidson CL Influence of light intensity

on polymerization shrinkage and integrity of restoration-cavity interface Eur J Oral

Sci 1995 103322ndash326

101Fennis YL Verdischbot EH vanrsquot Hof MA Performance of some diagnostic

systems in the prediction of occlusal caries in permanent molars in 6 and 11 year-old

children J Dent 1998 26(5) 403-40

102Ferracane JL Developing a more complete understanding of stresses produced

in dental composites during polymerization Dent Mater 2005 2136-42

103Ferrari M Influence of tissue characteristics at margins on leakage of Class II

indirect porcelain restorations Am JDent 1999 12(3)134-142

104Ferreira MC Vieira RS Marginal leakage in direct and indirect composite resin

restorations in primary teeth an in vitro study J Dent 200836(5)322-5

105Forss H Widstroumlm E Reasons for restorative therapy and the longevity of

restorations in adults Acta Odontol Scand 2004 6282-86

106Fradeani M Aquilano A Bassein L Longitudinal study of pressed glass-

ceramic inlays for four and a half years J Prosthet Dent 1997 78(4)346-353

107Franccedila FM Worschech CC Paulillo LA Martins LR Lovadino JR Fracture

resistance of premolar teeth restored with different filling techniques J Contemp Dent

Pract 20056(3)62-9

108Francci C Loguercio AD Reis A Carrilho MR A novel filling technique for

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14(3)149-57

109Fruits TJ Knapp JA Khajotia SS Microleakage in the proximal walls of

direct and indirect posterior resin slot restorations Oper Dent 200631(6)719-27

110Gaengler P Hoyer I Montag R Clinical evaluation of posterior composite

restorations The 10-year report J Adhes Dent 2001 3185-194

111Garbuz DS Masri BA Estaile J Classification systems in orthopaedics J Am

Acad Orthop Surg 2002 10 290-297

112Ghavamnasiri M Moosavi H Tahvildarnejad N Effect of centripetal and

incremental methods in Class II composite resin restorations on gingival

microleakage J Contemp Dent Pract 20078(2)113-20

113Gladys S Clinical and semiquantitative marginal analysis of four tooth-coloured

inlay systems at 3 years J Dent 199523(6)329-338

114Giachetti L Scaminaci Russo D Bambi C Grandini R A review of

polymerization shrinkage stress current techniques for posterior direct resin

restorations J Contemp Dent Pract 20067(4)79-88

115Giannini M AJS Santos RM Carvalho LAMS Paulillo JR Lovadino

Effects of irradiation mode and filling technique on resindentin bond strength in

Class I cavities J Dent Res 200281 (Abstract)

116Going RE Microleakage around dental restorations A summarizing review

JADA 1972841349-1357

117Gordon JChristensen G Why switch to digital radiography J Am Dent

Assoc 204 Vol 135 No 101437-1439

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118Gregoire GL Akon BA Millas A Interfacial micromorphological differences

in hybrid layer formation between water- and solvent-based dentin bonding systems J

Prosthet Dent 2002 87633ndash641

119Gregory WA Physical properties and repair bond strength of direct and indirect

composite resins J Prosthet Dent 68(3)406-411 1992

120Gwinnett AJ Buonocore MG Adhesives and caries prevention a preliminary

report Br Dent J 196511977-81

121Gwinnett AJ Matsui A A study of enamel adhesives The physical relationship

between enamel and adhesive Arch Oral Biol 1967121615-1620

122Gwinnett AJ Histologic changes in human enamel following treatment with

acidic adhesive conditioning agents Arch Oral Biol 197116731-738

123Gwinnett AJ Moist versus dry dentin its effect on shear bond strength Am J

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124Haba Denisia Tehnici uzuale utilizate icircn radiologia dentară Edit Junimea

2007

125Hashimoto M Ito S Tay FR Svizero NR Sano H Kaga M Fluid movement

across the resin-dentin interface during and after bonding J Dent Res 2004 83843ndash

848

126Hashimoto M Tay FR Ito S Sano H Kaga M Pashley DH Permeability of

adhesive resin films J Biomed Mater Res 2005 74699ndash705

127Hawthorne WS Smales RJ Factors influencing long-term restoration survival

in three private dental practices in Adelaide Aust Dent J 19974259ndash63

128Helwig Klimek Attin Einfuumlhrung in Die ZahnErhaltung Urbanampfischer 2003

129He Z Shimada Y Tagami J The effects of cavity size and incremental

technique on micro-tensile bond strength of resin composite in Class I cavities Dent

Mater 200723(5)533-8

130He Z Shimada Y Sadr A Ikeda M Tagami J The effects of cavity size and

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53

131Hench LLBioceramicsfrom concept to clinicJ Amer Ceram Soc1991

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132Heymann HO The clinical performance of CAD-CAM generated ceramic

inlays a four-year study J Am Dent Assoc1996 127(8)1171-1181

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Quintessence 2001

134Hilton TJ Cavity sealers liners and bases Current philosophies and indications

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135Hilton TJ Schwartz RS Ferracane JL Microleakage of four Class II resin

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135- 144

136Hinoura K Setcos JK Philips RW Cavity design and placement technique for

class 2 composites Oper Dent 19981312-19

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137Hintze H Wenzel A Clinically undetected dental caries assessed by bitewing

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19-23

138Hintze H Wenzel A Danielen B Behaviour of approximal carious lesions

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longitudinal study in young adults Caries Res 1999 33 415-22

139Hintze H Wenzel A Influence of validation method on diagnostic accuracy of

dental caries A comparison of six digital and two conventional radiographic systems

Dentomaxillofacial Radiol2002 31(1) 44-49

140Holtzman JM Berkey AB Mann J Predicting utilization of dental services by

the aged JPublic Health Dent1990 50(3) 164-171

141Hofmann N Hunecke AInfluence of curing methods and matrix type on the

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31(1)97-105

142Hopcraft MS Morgan MVComparison of radiographic and clinical diagnosis

of approximal and occlusal dental caries in a young adult population Community

Dent Oral Epidemiol 200533(3)212-8

143Hubsch PF Middleton J Knox J A finite element analysis of the stress at the

restoration-tooth interfacecomparing inlays and bulk

fillingsBiomaterials2000211015ndash1019

144Hudson JD Goldstein GR Georgescu M Enamel wear caused by three

different restorative materials J Prosthet Dent 1995 74(6)647-654

145Hunter AR Treasure ET Hunter AJ Increases in cavity volume associated

with the removal of class 2 amalgam and composite restorations Oper Dent

1995202ndash 6

146Huysmans MC PG van der Varst EP Lautenschlager P Monaghan The

influence of simulated clinical handling on the flexural and compressive strength of

posterior composite restorative materials Dent Mater 199612116ndash120

147Iliescu A Gafar MCariologie şi Odontologie RestaurativăEditura Medicală

Bucureşti 2001

148Inoue S Van Meerbeek B Vargas M Lambrechts P Vanherle G Adhesion

mechanism of self-etching adhesives In Advanced adhesive dentistry proceedings

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Prati C Grafiche Erredue 2000131-148

149Inoue S Vargas MA Abe Y Yoshida Y LambrechtsP Vanherle G Sano H

Van Meerbeek B Microtensile bond strength of eleven contemporary adhesives to

dentin J Adhes Dent 2001 3 237-245

150Iovan Gianina Diagnosis and Management of Patients with High Caries

Activity EdApollonia Iasi2002

151Jacobsen T Soderhold KJ Some effects of water on dentin bonding Dent

Mater 1995 11(2)132-6

152Jackson RD Morgan M The new posterior resins and a simplified placement

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48

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Kompositefullungen Zahnartzlicher Welt 1999 108 270-273

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Community Dentistry and Oral Epidemiology 1994 22(2) 71-74

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1243

161Khairallah C Hokayem A Long-term clinical evaluation of 2 dental materials

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163Kidd EAAssesment of dental carious lesionsArchof Oral

Biology199843(8)629-632

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817-822

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166Kleverlaan CJ Feilzer AJ Polymerization shrinkage and contraction stress of

dental resin composites Dent Mater 2005 211150-1157

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marginal leakage around class II composite resin restorations in vitroQuint Int

201989117ndash121

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18(7)516-20

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Materials Journal 2006 25(1)59-65

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Dent 27(5)325-331 1999

49

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Jan11(1)34-40

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JProsthet Dent 199369(4)425-430

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thermal behavior of dental composites Dent Mater 2008 24(8)1017ndash1024

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JDent 199826 627-632

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shrinkage and elasticity of flowable composites and filled adhesives Dent Mater

1999 15128-137

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179Lăcătuşu St Luminiţa Costinescu Andrian S Gianina Iovan Valeria

Pendefunda 180Sorina Solomon Topoliceanu C Elements of dispersional

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Edition of the Balkan Medical Days

Stomatological Section Abstract nr1091999128

181Lăcătuşu St Andrian S Gianina Iovan- Consideraţii asupra adaptării

amalgamelor dentare la pereţii cavităţilor RevMedicina

StomatologicăVol2199823-26

182Leevailoj C Cochran MA Matis BA Moore BK Platt JA Microleakage of

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200126302ndash307

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Dentistry and Oral Epidemiology 1996 24 106-11

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Dent Mater 2002 18436-444

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20(3)236-43

188Loguercio AD Reis A Schroeder M Balducci I Versluis A Ballester RY

Polymerization shrinkage effects of boundary conditions and filling technique of

resin composite restorations J Dent 2004 32(6)459-70

50

189Lopes GC Baratieri LN Monteiro S Jr Vieira LC Effect of posterior resin

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Quintessence Int 2004 35(2)156-61

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art and future perspectives Quintessence Int 200233213-224

191Loumlsche GM Marginal adaptation of class II composite fillings guided

polymerization vs reduced light intensity J Adhes Dent 1 199931ndash39

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copolymerizations Macromolecules 1999 323913-3921

194Lutz F Krejci I Barbakow F Quality and durability of marginal adaptation in

bonded composite restorations Dent Mater 1991 7(2) 107-13

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clinical results J Dent Res 199877 1020

196Mair LH Ten-year clinical assessment of three posterior resin composites and

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Dentomaxillofac Radiol 2007 Oct36(7)377-81

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direct and indirect restorations icircn posterior teeth of the permanent

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200Manhart J Neuerer P Scheibenbogen-Fuchsbrunner A Hickel R Three-

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J Prosthet Dent 2000 Sep84(3)289-96

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Three-year clinical evaluation of composite and ceramic inlays Am J Dent 2001

Apr14(2)95-9

202Manhart J Chen HY Draegert U Kunzelmann KH Hickel R Vickers

hardness and depth of cure of light cured packable composite resins J Dent Res 2000

79369 (Abstract)

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caries-affected transparent dentin by citric acidAn atomic force microscopy

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51

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209Miguel A JC La Macorra A predictive formula of the contraction stress in

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deformation Dent Mater 200117241ndash246

210Mileman PA van der Weele IT Accuracy in radiographic diagnosis Dutch

practitioners and dental caries JDent1990 18(3) 130-136

211Millar BJ Robinson PB Eight year results with direct ceramic restorations

(Cerana) Br Dent J 2006 Oct 21201(8)515-20

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PrimDentCare1999Apr659-62

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Quintessence 198961-80

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ScandJDRes 199210060-65

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33

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19904011ndash7

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Am Dent Assoc 2010 141(3)319-29

52

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125749-751

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composites Oper Dent 23 1998282ndash289

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34

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Monogr Oral Sci 20092142-51

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Monogr Oral Sci 20092152-62

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Quintessence Int 1998295ndash11

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569ndash575

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Nanoleakage leakage within the hybrid layer Oper Dent 1995 20 18-25

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In vivo evidence J Dent 2004 32611ndash621

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Oral Surg Oral Med Oral Pathol 198661(3)289-96

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55-60

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shrinkage-strain measurements on light-cured biomaterials Dent Mater 200016447ndash

451

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Dentomaxillofac Radiol 1993 22 131-4

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59

344Yeşilyurt C Bulucu B Bond strength of total-etch dentin adhesive systems on

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458

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  • COPERTA REZUMAT ENGLEZA (MEREUTA)pdf
  • REZUMAT ENGLEZA DR MEREUTA DENISSpdf
Page 43: UNIVERSITATEA DE MEDICINA SI FARMACIE “GR Doctorat/Rezumat... · universitatea de medicina si farmacie “gr.t.popa” iasi facultatea de medicina dentara rezumatul tezei de doctorat

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utilizing a filled and unfilled adhesive resin Dent Mater 200117268ndash276

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selected mechanical properties of experimental resin composites Dent Mater1998

1451-56

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464-473

26Bader JD Shugars DA Understanding dentistslsquo restorative treatment decisions J

Public Health Dent 1992 Winter52(2)102-10

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Dent 199158 36-39

28Bayne SC Dental biomaterials where are we and where are we going J Dent

Educ 200569(5)571ndash585

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191-194

30Behle C Flowable composite Proprieties and applications Pract Periodontics

Aesthetics Dent 1998 10347 350-351

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33Black J Biological Performance of Materials Fundamentals of Biocompatibility

NY Marcel Dekker Inc 1999

34Bonsor SJ Chadwick RGLongevity of conventional and bonded (sealed)

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9

35Boschian PL S Guidotti R Pietrbissa M Gagliani- bdquoStress distribution in a

post-restored tooth using the threedimensional finite element method Journal of Oral

Rehabilitation (33) 2006690ndash697

36Bouillaguet S B Ciucchi T Jacoby JC Wataha DH Pashley Bonding

characteristics to dentin walls of class II cavities in vitro Dent Mater 200117316ndash

321

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2000 12328-339

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and their efficacy as stress-relieving layers J Am Dent Assoc 2003134721ndash728

39Braga RR Ballester RY Ferracane JLFactors involved in the development of

polymerization shrinkage stress in resin-composites a systematic review Dent Mater

200521(10)962-70

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Timişoara1994

41Browning WD Johnson WW Gregory PN- Clinical performances of

amalgam-bonded restorations A 42-months study- Journal of American Dental

Association 2000nr131

42Brunthaler A Koumlnig F Lucas T Sperr W Schedle A Longevity of direct resin

composite restorations in posterior teeth Clin Oral Investig 2003 763-70

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expansion on microleakage J Am Dent Assoc 1988116871ndash 874

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into enamel surfaces with reference to bonding Arch Oral Biol 19681361-70

45Burke FJ Cheung SW Mjoumlr IA Wilson NH Restoration longevity and analysis

of reasons for the placement and replacement of restorations provided by vocational

dental practitioners and their trainers in the United Kingdom Quintessence Int

199930(4)234-42

42

46Burke FJ Cheung SW Mjor IA Wilson NH-Reasons for the placement and

replacement of restorations in vocational training practicePrimary Dental Care

nr6(1) 1999

47Burke FJ Wilson NH Cheung SW Mjoumlr IA Influence of patient factors on age

of restorations at failure and reasons for their placement and replacement J Dent

200129(5)317-24

48Calheiros FC Braga RR Kawano Y Ballester RY Relationship between

contraction stress and degree of conversion in restorative composites Dent Mater

2004 20939-946

49Cardoso P Sadek F Microtensile bond strength on dentin using new adhesive

systems with selfetching primers Braz J Oral Sci 2003 2(4) 156-159

50Cardoso M Baratieri LN Ritter AV The effect of finishing and polishing on

the decision to replace existing amalgam restorations Quintessence Int 1999

Jun30(6)413-8

51Carvalho RM JC Pereira M Yoshiyama DH Pashley A review of

polymerization contraction the influence of stress development versus stress

reliefOper Dent19962117ndash24

52Castro VM Katz JO Hardman PK Glaros AG Spencer P Invitro comparison

of conventional film and direct digital imaging in the detection of approximal caries

Dentomaxillofac Radiol 2007 Mar36(3)138-42

53Cattaneo PM M Dalstra B Melsen- bdquoThe Finite Element Method a Tool to

Study Orthodontic Tooth Movement J Dent Res 2005 84(5)428-433

54Cattell MJ Clarke RL Lynch EJ The transverse strength reliability and

microstructural features of four dental ceramicspart 1 J Dent 25(5)399-407 1997

55Cehreli ZC Akca T Effect of dentinal tubule orientation on the microtensile

bond strength to primary dentin J Dent Child 2003 70(2) 139-144

56Celik C Arhun N Yamanel K Clinical evaluation of resin-based composites in

posterior restorations 12-month results Eur J Dent 2010 Jan4(1)57-65

57Cenci M Demarco F de Carvalho R Class II composite resin restorations with

two polymerization techniques Relationship between microtensile bond strength and

marginal leakage J Dent 2005 33(7) 603- 610

58Chaffin J Moss D Review of current US Army dental emergency rates Mil

Med 2008173(1)23ndash26

59Chen HY Manhart J Hickel R Kunzelmann KH Polymerization contraction

stress in light-cured packable composite resinsDent Mater 200117253-259

60Choi KK Condon JR Ferracane JL The effects of adhesive thickness on

polymerization contraction stress of composites J Dent Res 2000 79812ndash817

61Cichon P Kerschbaum T Verweildauer zahnartzlicher Restaurationen bei

Behinderten Dtsch Zahnartzlicher 1999 54 96-102

62Cohen BI Pagnillo MK Deutsch ASMusikant BL Fracture Strength of

Three Core Restorative Materials Supported with or without a Prefabricated Split-

Shank Post Journal of Prosthetic Dentistry1997 78 560ndash565

63Colli P Brannstrom M The marginal adaptation of four different bonding agents

in Class II composite resin restoration applied in bulk or in two increments

Quintessence Int 1993 24583-591

43

64Collins CJ Bryant RW Hodge KL A clinical evaluation of posterior composite

resin restorations 8-year findings J Dent 199826(4) 311ndash317

65Condon JR Ferracane JL Assessing the effect of composite formulation on

polymerization stress J Am Dent Assoc2000 131497-503

66Cook WD Moopnar M Influence of chemical structure on the fracture

behaviour of dimethacrylate composite resins Biomaterials 1990 11272-276

67Cortes DF Ellwood RP Ekstrand KR An in vitro comparison of a combined

FOTIvisual examination of occlusal caries with other caries diagnostic methods and

the effect of stain on their diagnostic performance Caries Res 2003 37 (1) 8-16

68Crim GA Microleakage of three resin placement techniques Am J Dent

1991469-72

69Dauvillier B Aarnts M Feilzer A The competition between the composite-

dentin strength and the polimerization contraction stress J Dent Res 1984 63 1396-

1399

70Dauvillier BS Aarnts MP Feilzer AJ Developments in shrinkage control of

adhesive restoratives J Esthet Dent 2000 12291-299

71Dauvillier BS Aarnts MP Feilzer AJ Modeling of the viscoelastic behavior of

dental light-activated resin composites during curing Dent Mater 200319277ndash285

72Davidson CL Gee AJ Feilzer A The competition between the composite-dentin

bond strength and the polymerization contraction stress J Dent Res 1984

63(12)1396-9

73Davidson CL AJ Feilzer Polymerization shrinkage and polymerization

shrinkage stress in polymer-based restoratives J Dent Res 199725435ndash440

74Davidson CL Resisting the curing contraction with adhesive composites J

Prosthet Dent 198655446ndash7

75Davis RD Mayhew RB A clinical comparison of three anterior restorative resins

at 3 years J Am Dent Assoc 1986112659-63

76Dejak B Mlotkowski A Three-dimensional finite element analysis of strength

and adhesion of composite resin versus ceramic inlays in molarsJ Prosthet

Dent200899131-40

77Deligeorgi V Mjor IA Wilson NH An overview of reasons for the placement

and replacement of restorations Prim Dent Care 20018(1)5-11

78Deliperi S Bardwell DN An alternative method to reduce polymerization

shrinkage in direct posterior composite restorations J Am Dent Assoc 2002

1331387ndash97

79Demirci M Tuncer S Yuceokur AA Prevalence of caries on individual tooth

surfaces and its distribution by age and gender in university clinic patientsEur J

Dent20104(3)270-9

80De Munck J Van Meerbeek B Satoshi I Vargas M Yoshida Y Armstrong S

Lambrechts P Vanherle G Microtensile bond strengths of one- and two-step

selfetch adhesives to bur-cut enamel and dentin Am J Dent 2003 16 414-420

81Dewaele M Truffier-Boutry D Devaux J Leloup G Volume contraction in

photocured dental resins the shrinkage-conversion relationship revisited Dent Mater

2006 22359-365

44

82Deutsch WM Simecek JW Dental emergencies among Marines ashore in

Operations Desert ShieldStorm Mil Med 1996161(10) 620ndash623

83Dickens SH Stansbury JW Choi KM Floyd CJ Photopolymerization kinetics

of methacrylate dental resins Macromolecules 2003 366043-6053

84Dietschi D De Siebenthal G Neveu-Rosenstand L Holz J Influence of the

restorative technique and new adhesives on the dentin marginal seal and adaptation of

resin composite Class II restorations An in vitro evaluation Quintessence Int 1995

26 717-727

85Dietschi D Herzfeld D In vitro evaluation of marginal and internal adaptation of

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Sci 1998 106 1033-1042

86Dietschi D Marginal adaptation and seal of direct and indirect Class II composite

resin restorations an in vitro evaluation Quintessence Int 26(2)127-138 1995

87Diefenderfer KE Simecek JW Ahlf RL Ragain JC Relationship between

caries status and dental emergencies among US naval personnel J Dent Res

20028195 (Abstract)

88Diefenderfer KE Rienhardt JW Shear bond strengths of ten adhesive

resinamalgam combinations Oper Dent 1997 22 50-56

89Donly KJ Jensen ME Triolo PA clinical comparison of resin composite inlay

and onlay posterior restorations and cast-gold restorations at 7 years Quintessence Int

30(3)163- 1681999

90Douglas WH Fields RP Fundingsland J A comparison between the

microleakage of direct and indirect composite restorative systems J Dent 17(4)184-

188 1989

91Eberhard J Hartman B Lenhard M Mayer T Kocher T Eickholz P Digital

subtraction radiography for monitoring dental demineralization An in vitro study

Caries Res 200034(3)219-24

92Edelstein BL Douglass CW Dispelling the myth that 50 percent of US

schoolchildren have never had a cavity Public Health Rep1995 110 (5) 522-530

93Eick JD Welch FH Polymerization shrinkage of posterior composite resins and

its possible influence on postoperative sensitivity Quintessence Int 198617103-11

94Elliott JE Lovell LG Bowman CN Primary cyclization in the polymerization of

bis GMA and TEGDMA a modeling approach to understanding the cure of dental

resins Dent Mater 2001 17221-229

95Ermis R Ulkam Aydin Examiner agreement in the replacement decisions of

class I amalgam restorations The Journal of contemporary dental practice 2004 Vol

5 no21-7

96Feilzer AJ AJ De Gee CL Davidson Increased wall-to-wall curing

contraction in thin bonded resin layers J Dent Res 19896848ndash50

97Feilzer AJ Dauvillier BS Effect of TEGDMABisGMA ratio on stress

development and viscoelastic properties of experimental twopaste composites J Dent

Res 2003 82824-828

98Feilzer AJ de Gee AJ Davidson CL Relaxation of polymerization contraction

shear stress by hygroscopic expansion J Dent Res 1990 6936ndash39

45

99Feilzer AJ De Gee AJ Davidson CL Setting stress in composite resin in relation

to configuration of the restoration J Dent Res1987 661636-1639

100Feilzer AJ Dooren LH de Gee AJ Davidson CL Influence of light intensity

on polymerization shrinkage and integrity of restoration-cavity interface Eur J Oral

Sci 1995 103322ndash326

101Fennis YL Verdischbot EH vanrsquot Hof MA Performance of some diagnostic

systems in the prediction of occlusal caries in permanent molars in 6 and 11 year-old

children J Dent 1998 26(5) 403-40

102Ferracane JL Developing a more complete understanding of stresses produced

in dental composites during polymerization Dent Mater 2005 2136-42

103Ferrari M Influence of tissue characteristics at margins on leakage of Class II

indirect porcelain restorations Am JDent 1999 12(3)134-142

104Ferreira MC Vieira RS Marginal leakage in direct and indirect composite resin

restorations in primary teeth an in vitro study J Dent 200836(5)322-5

105Forss H Widstroumlm E Reasons for restorative therapy and the longevity of

restorations in adults Acta Odontol Scand 2004 6282-86

106Fradeani M Aquilano A Bassein L Longitudinal study of pressed glass-

ceramic inlays for four and a half years J Prosthet Dent 1997 78(4)346-353

107Franccedila FM Worschech CC Paulillo LA Martins LR Lovadino JR Fracture

resistance of premolar teeth restored with different filling techniques J Contemp Dent

Pract 20056(3)62-9

108Francci C Loguercio AD Reis A Carrilho MR A novel filling technique for

packable composite resin in Class II restorations J Esthet Restor Dent 2002

14(3)149-57

109Fruits TJ Knapp JA Khajotia SS Microleakage in the proximal walls of

direct and indirect posterior resin slot restorations Oper Dent 200631(6)719-27

110Gaengler P Hoyer I Montag R Clinical evaluation of posterior composite

restorations The 10-year report J Adhes Dent 2001 3185-194

111Garbuz DS Masri BA Estaile J Classification systems in orthopaedics J Am

Acad Orthop Surg 2002 10 290-297

112Ghavamnasiri M Moosavi H Tahvildarnejad N Effect of centripetal and

incremental methods in Class II composite resin restorations on gingival

microleakage J Contemp Dent Pract 20078(2)113-20

113Gladys S Clinical and semiquantitative marginal analysis of four tooth-coloured

inlay systems at 3 years J Dent 199523(6)329-338

114Giachetti L Scaminaci Russo D Bambi C Grandini R A review of

polymerization shrinkage stress current techniques for posterior direct resin

restorations J Contemp Dent Pract 20067(4)79-88

115Giannini M AJS Santos RM Carvalho LAMS Paulillo JR Lovadino

Effects of irradiation mode and filling technique on resindentin bond strength in

Class I cavities J Dent Res 200281 (Abstract)

116Going RE Microleakage around dental restorations A summarizing review

JADA 1972841349-1357

117Gordon JChristensen G Why switch to digital radiography J Am Dent

Assoc 204 Vol 135 No 101437-1439

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118Gregoire GL Akon BA Millas A Interfacial micromorphological differences

in hybrid layer formation between water- and solvent-based dentin bonding systems J

Prosthet Dent 2002 87633ndash641

119Gregory WA Physical properties and repair bond strength of direct and indirect

composite resins J Prosthet Dent 68(3)406-411 1992

120Gwinnett AJ Buonocore MG Adhesives and caries prevention a preliminary

report Br Dent J 196511977-81

121Gwinnett AJ Matsui A A study of enamel adhesives The physical relationship

between enamel and adhesive Arch Oral Biol 1967121615-1620

122Gwinnett AJ Histologic changes in human enamel following treatment with

acidic adhesive conditioning agents Arch Oral Biol 197116731-738

123Gwinnett AJ Moist versus dry dentin its effect on shear bond strength Am J

Dent 1992 5(3)127-9

124Haba Denisia Tehnici uzuale utilizate icircn radiologia dentară Edit Junimea

2007

125Hashimoto M Ito S Tay FR Svizero NR Sano H Kaga M Fluid movement

across the resin-dentin interface during and after bonding J Dent Res 2004 83843ndash

848

126Hashimoto M Tay FR Ito S Sano H Kaga M Pashley DH Permeability of

adhesive resin films J Biomed Mater Res 2005 74699ndash705

127Hawthorne WS Smales RJ Factors influencing long-term restoration survival

in three private dental practices in Adelaide Aust Dent J 19974259ndash63

128Helwig Klimek Attin Einfuumlhrung in Die ZahnErhaltung Urbanampfischer 2003

129He Z Shimada Y Tagami J The effects of cavity size and incremental

technique on micro-tensile bond strength of resin composite in Class I cavities Dent

Mater 200723(5)533-8

130He Z Shimada Y Sadr A Ikeda M Tagami J The effects of cavity size and

filling method on the bonding to Class I cavities J Adhes Dent 2008 Dec10(6)447-

53

131Hench LLBioceramicsfrom concept to clinicJ Amer Ceram Soc1991

74(7)1487-1570

132Heymann HO The clinical performance of CAD-CAM generated ceramic

inlays a four-year study J Am Dent Assoc1996 127(8)1171-1181

133Hickel R Manhart J Longevity of restorations In Wilson NHF Roulet JF

Fuzzi M Advances in Operative Dentistry ndash Challenges of the Future Chicago

Quintessence 2001

134Hilton TJ Cavity sealers liners and bases Current philosophies and indications

for use Oper Dent 199621134 ndash146

135Hilton TJ Schwartz RS Ferracane JL Microleakage of four Class II resin

composite insertion techniques at intraoral temperature Quintessence Int 1997 28

135- 144

136Hinoura K Setcos JK Philips RW Cavity design and placement technique for

class 2 composites Oper Dent 19981312-19

47

137Hintze H Wenzel A Clinically undetected dental caries assessed by bitewing

screening in children with little caries experienceDentomaxillofac Radiol 1994 23

19-23

138Hintze H Wenzel A Danielen B Behaviour of approximal carious lesions

assessed by clinical examination after tooth separation and radiography A 2+-years

longitudinal study in young adults Caries Res 1999 33 415-22

139Hintze H Wenzel A Influence of validation method on diagnostic accuracy of

dental caries A comparison of six digital and two conventional radiographic systems

Dentomaxillofacial Radiol2002 31(1) 44-49

140Holtzman JM Berkey AB Mann J Predicting utilization of dental services by

the aged JPublic Health Dent1990 50(3) 164-171

141Hofmann N Hunecke AInfluence of curing methods and matrix type on the

marginal seal of class II resin-based composite restorations in vitro Oper Dent 2006

31(1)97-105

142Hopcraft MS Morgan MVComparison of radiographic and clinical diagnosis

of approximal and occlusal dental caries in a young adult population Community

Dent Oral Epidemiol 200533(3)212-8

143Hubsch PF Middleton J Knox J A finite element analysis of the stress at the

restoration-tooth interfacecomparing inlays and bulk

fillingsBiomaterials2000211015ndash1019

144Hudson JD Goldstein GR Georgescu M Enamel wear caused by three

different restorative materials J Prosthet Dent 1995 74(6)647-654

145Hunter AR Treasure ET Hunter AJ Increases in cavity volume associated

with the removal of class 2 amalgam and composite restorations Oper Dent

1995202ndash 6

146Huysmans MC PG van der Varst EP Lautenschlager P Monaghan The

influence of simulated clinical handling on the flexural and compressive strength of

posterior composite restorative materials Dent Mater 199612116ndash120

147Iliescu A Gafar MCariologie şi Odontologie RestaurativăEditura Medicală

Bucureşti 2001

148Inoue S Van Meerbeek B Vargas M Lambrechts P Vanherle G Adhesion

mechanism of self-etching adhesives In Advanced adhesive dentistry proceedings

book of the Granada 3rd International Kuraray Symposium Tagami J Toledano M

Prati C Grafiche Erredue 2000131-148

149Inoue S Vargas MA Abe Y Yoshida Y LambrechtsP Vanherle G Sano H

Van Meerbeek B Microtensile bond strength of eleven contemporary adhesives to

dentin J Adhes Dent 2001 3 237-245

150Iovan Gianina Diagnosis and Management of Patients with High Caries

Activity EdApollonia Iasi2002

151Jacobsen T Soderhold KJ Some effects of water on dentin bonding Dent

Mater 1995 11(2)132-6

152Jackson RD Morgan M The new posterior resins and a simplified placement

technique J Am Dent Assoc 2000131375ndash383

153Jain P Belcher M Microleakage of class II resin-based composite restorations

with flowable composite in the proximal box Am J Dent 200013235ndash238

48

154Jokstad A Mjor IA Analyses of long-term clinical behaviour of class II

amalgam restorations Acta OdontolScand 1991 49 47-63

155Jokstad A Mjor IA Qvist V The age of restorations in situ Acta Odontol

Scand 1994 52 234-248

156Kaaden C Powers JM Friedl KH Schmalz G Bond strength of self-etching

adhesives to dental hard tissues Clin Oral Investig 2002 6(3)155-60

157Kamann WK Gangler P Zur Funktionzeit von Amalgam

Kompositefullungen Zahnartzlicher Welt 1999 108 270-273

158Kanemura N Sano H Tagami J Tensile bond strength to and SEM evaluation

of ground and intact enamel surfaces J Dent 199927523-530

159Kay EJ Nutall M Relationship between dentistlsquos treatment attitudes and

restorative decisions made on the basis of simulated bitewing radiographs

Community Dentistry and Oral Epidemiology 1994 22(2) 71-74

160Kemp-Scholte CM Davidson CL Complete marginal seal of Class V resin

composite restorations effected by increased flexibility J Dent Res 1990 691240ndash

1243

161Khairallah C Hokayem A Long-term clinical evaluation of 2 dental materials

used for the preparation of esthetic inlays Odontostomatol Trop 200932(127)5-13

162Khairallah C Sabbagh J Hokayem A Clinical study comparing at 5 years a

ceramic and a ceromer used for making esthetic inlays Odontostomatol Trop

200932(126)21-8

163Kidd EAAssesment of dental carious lesionsArchof Oral

Biology199843(8)629-632

164Kielbassa A Paris S Lussi A Meyer-Lueckel H Evaluation of cavitations in

proximal caries lesions at various levels in vitro Journal of Dentistry 2006 34(10)

817-822

165Kiremitci A Alpaslan T Gurgan SSix-year clinical evaluation of packable

composite restorations Oper Dent 200934(1)11-7

166Kleverlaan CJ Feilzer AJ Polymerization shrinkage and contraction stress of

dental resin composites Dent Mater 2005 211150-1157

167Koenigsberg SA Fuks R GrajowerThe effect of three filling techniques on

marginal leakage around class II composite resin restorations in vitroQuint Int

201989117ndash121

168Konishi N Watanabe LG Hilton JF Marshall GW Marshall SJ Staninec

M Dentin shear strength effect of distance from the pulp Dent Mater 2002

18(7)516-20

169Koran P Kurschner R Effect of sequential versus continous irradiation of a

light-cured resin composite on shrinkage viscosity adhesion and degree of

polimerisation Am J Dent 1998 11 17-22

170Koyuturk A E Sengun A Ozer F Sener Y Gokalp A Shear Bond Strengths

of Self-etching Adhesives to Caries-affected Dentin on the Gingival Wall Dental

Materials Journal 2006 25(1)59-65

171Kramer N IPS Empress inlays and onlays after four years-a clinical study J

Dent 27(5)325-331 1999

49

172Krejci I Lieber CM Lutz FTime required to remove totally bonded tooth-

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Jan11(1)34-40

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JProsthet Dent 199369(4)425-430

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thermal behavior of dental composites Dent Mater 2008 24(8)1017ndash1024

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JDent 199826 627-632

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shrinkage and elasticity of flowable composites and filled adhesives Dent Mater

1999 15128-137

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Pendefunda 180Sorina Solomon Topoliceanu C Elements of dispersional

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Edition of the Balkan Medical Days

Stomatological Section Abstract nr1091999128

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amalgamelor dentare la pereţii cavităţilor RevMedicina

StomatologicăVol2199823-26

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200126302ndash307

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Dentistry and Oral Epidemiology 1996 24 106-11

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Dent Mater 2002 18436-444

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20(3)236-43

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Polymerization shrinkage effects of boundary conditions and filling technique of

resin composite restorations J Dent 2004 32(6)459-70

50

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Quintessence Int 2004 35(2)156-61

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copolymerizations Macromolecules 1999 323913-3921

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clinical results J Dent Res 199877 1020

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Dentomaxillofac Radiol 2007 Oct36(7)377-81

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J Prosthet Dent 2000 Sep84(3)289-96

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Three-year clinical evaluation of composite and ceramic inlays Am J Dent 2001

Apr14(2)95-9

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hardness and depth of cure of light cured packable composite resins J Dent Res 2000

79369 (Abstract)

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PrimDentCare1999Apr659-62

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ScandJDRes 199210060-65

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33

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19904011ndash7

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Am Dent Assoc 2010 141(3)319-29

52

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125749-751

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34

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Monogr Oral Sci 20092142-51

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451

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458

346Yoshiyama M Tay FR Doi J Nishitani Y Yamada T Itou K Carvalho RM

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Page 44: UNIVERSITATEA DE MEDICINA SI FARMACIE “GR Doctorat/Rezumat... · universitatea de medicina si farmacie “gr.t.popa” iasi facultatea de medicina dentara rezumatul tezei de doctorat

41

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191-194

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Aesthetics Dent 1998 10347 350-351

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9

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Rehabilitation (33) 2006690ndash697

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321

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polymerization shrinkage stress in resin-composites a systematic review Dent Mater

200521(10)962-70

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Timişoara1994

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199930(4)234-42

42

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of restorations at failure and reasons for their placement and replacement J Dent

200129(5)317-24

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contraction stress and degree of conversion in restorative composites Dent Mater

2004 20939-946

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Jun30(6)413-8

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polymerization contraction the influence of stress development versus stress

reliefOper Dent19962117ndash24

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of conventional film and direct digital imaging in the detection of approximal caries

Dentomaxillofac Radiol 2007 Mar36(3)138-42

53Cattaneo PM M Dalstra B Melsen- bdquoThe Finite Element Method a Tool to

Study Orthodontic Tooth Movement J Dent Res 2005 84(5)428-433

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microstructural features of four dental ceramicspart 1 J Dent 25(5)399-407 1997

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bond strength to primary dentin J Dent Child 2003 70(2) 139-144

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posterior restorations 12-month results Eur J Dent 2010 Jan4(1)57-65

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two polymerization techniques Relationship between microtensile bond strength and

marginal leakage J Dent 2005 33(7) 603- 610

58Chaffin J Moss D Review of current US Army dental emergency rates Mil

Med 2008173(1)23ndash26

59Chen HY Manhart J Hickel R Kunzelmann KH Polymerization contraction

stress in light-cured packable composite resinsDent Mater 200117253-259

60Choi KK Condon JR Ferracane JL The effects of adhesive thickness on

polymerization contraction stress of composites J Dent Res 2000 79812ndash817

61Cichon P Kerschbaum T Verweildauer zahnartzlicher Restaurationen bei

Behinderten Dtsch Zahnartzlicher 1999 54 96-102

62Cohen BI Pagnillo MK Deutsch ASMusikant BL Fracture Strength of

Three Core Restorative Materials Supported with or without a Prefabricated Split-

Shank Post Journal of Prosthetic Dentistry1997 78 560ndash565

63Colli P Brannstrom M The marginal adaptation of four different bonding agents

in Class II composite resin restoration applied in bulk or in two increments

Quintessence Int 1993 24583-591

43

64Collins CJ Bryant RW Hodge KL A clinical evaluation of posterior composite

resin restorations 8-year findings J Dent 199826(4) 311ndash317

65Condon JR Ferracane JL Assessing the effect of composite formulation on

polymerization stress J Am Dent Assoc2000 131497-503

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behaviour of dimethacrylate composite resins Biomaterials 1990 11272-276

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FOTIvisual examination of occlusal caries with other caries diagnostic methods and

the effect of stain on their diagnostic performance Caries Res 2003 37 (1) 8-16

68Crim GA Microleakage of three resin placement techniques Am J Dent

1991469-72

69Dauvillier B Aarnts M Feilzer A The competition between the composite-

dentin strength and the polimerization contraction stress J Dent Res 1984 63 1396-

1399

70Dauvillier BS Aarnts MP Feilzer AJ Developments in shrinkage control of

adhesive restoratives J Esthet Dent 2000 12291-299

71Dauvillier BS Aarnts MP Feilzer AJ Modeling of the viscoelastic behavior of

dental light-activated resin composites during curing Dent Mater 200319277ndash285

72Davidson CL Gee AJ Feilzer A The competition between the composite-dentin

bond strength and the polymerization contraction stress J Dent Res 1984

63(12)1396-9

73Davidson CL AJ Feilzer Polymerization shrinkage and polymerization

shrinkage stress in polymer-based restoratives J Dent Res 199725435ndash440

74Davidson CL Resisting the curing contraction with adhesive composites J

Prosthet Dent 198655446ndash7

75Davis RD Mayhew RB A clinical comparison of three anterior restorative resins

at 3 years J Am Dent Assoc 1986112659-63

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and adhesion of composite resin versus ceramic inlays in molarsJ Prosthet

Dent200899131-40

77Deligeorgi V Mjor IA Wilson NH An overview of reasons for the placement

and replacement of restorations Prim Dent Care 20018(1)5-11

78Deliperi S Bardwell DN An alternative method to reduce polymerization

shrinkage in direct posterior composite restorations J Am Dent Assoc 2002

1331387ndash97

79Demirci M Tuncer S Yuceokur AA Prevalence of caries on individual tooth

surfaces and its distribution by age and gender in university clinic patientsEur J

Dent20104(3)270-9

80De Munck J Van Meerbeek B Satoshi I Vargas M Yoshida Y Armstrong S

Lambrechts P Vanherle G Microtensile bond strengths of one- and two-step

selfetch adhesives to bur-cut enamel and dentin Am J Dent 2003 16 414-420

81Dewaele M Truffier-Boutry D Devaux J Leloup G Volume contraction in

photocured dental resins the shrinkage-conversion relationship revisited Dent Mater

2006 22359-365

44

82Deutsch WM Simecek JW Dental emergencies among Marines ashore in

Operations Desert ShieldStorm Mil Med 1996161(10) 620ndash623

83Dickens SH Stansbury JW Choi KM Floyd CJ Photopolymerization kinetics

of methacrylate dental resins Macromolecules 2003 366043-6053

84Dietschi D De Siebenthal G Neveu-Rosenstand L Holz J Influence of the

restorative technique and new adhesives on the dentin marginal seal and adaptation of

resin composite Class II restorations An in vitro evaluation Quintessence Int 1995

26 717-727

85Dietschi D Herzfeld D In vitro evaluation of marginal and internal adaptation of

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Sci 1998 106 1033-1042

86Dietschi D Marginal adaptation and seal of direct and indirect Class II composite

resin restorations an in vitro evaluation Quintessence Int 26(2)127-138 1995

87Diefenderfer KE Simecek JW Ahlf RL Ragain JC Relationship between

caries status and dental emergencies among US naval personnel J Dent Res

20028195 (Abstract)

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resinamalgam combinations Oper Dent 1997 22 50-56

89Donly KJ Jensen ME Triolo PA clinical comparison of resin composite inlay

and onlay posterior restorations and cast-gold restorations at 7 years Quintessence Int

30(3)163- 1681999

90Douglas WH Fields RP Fundingsland J A comparison between the

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188 1989

91Eberhard J Hartman B Lenhard M Mayer T Kocher T Eickholz P Digital

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Caries Res 200034(3)219-24

92Edelstein BL Douglass CW Dispelling the myth that 50 percent of US

schoolchildren have never had a cavity Public Health Rep1995 110 (5) 522-530

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its possible influence on postoperative sensitivity Quintessence Int 198617103-11

94Elliott JE Lovell LG Bowman CN Primary cyclization in the polymerization of

bis GMA and TEGDMA a modeling approach to understanding the cure of dental

resins Dent Mater 2001 17221-229

95Ermis R Ulkam Aydin Examiner agreement in the replacement decisions of

class I amalgam restorations The Journal of contemporary dental practice 2004 Vol

5 no21-7

96Feilzer AJ AJ De Gee CL Davidson Increased wall-to-wall curing

contraction in thin bonded resin layers J Dent Res 19896848ndash50

97Feilzer AJ Dauvillier BS Effect of TEGDMABisGMA ratio on stress

development and viscoelastic properties of experimental twopaste composites J Dent

Res 2003 82824-828

98Feilzer AJ de Gee AJ Davidson CL Relaxation of polymerization contraction

shear stress by hygroscopic expansion J Dent Res 1990 6936ndash39

45

99Feilzer AJ De Gee AJ Davidson CL Setting stress in composite resin in relation

to configuration of the restoration J Dent Res1987 661636-1639

100Feilzer AJ Dooren LH de Gee AJ Davidson CL Influence of light intensity

on polymerization shrinkage and integrity of restoration-cavity interface Eur J Oral

Sci 1995 103322ndash326

101Fennis YL Verdischbot EH vanrsquot Hof MA Performance of some diagnostic

systems in the prediction of occlusal caries in permanent molars in 6 and 11 year-old

children J Dent 1998 26(5) 403-40

102Ferracane JL Developing a more complete understanding of stresses produced

in dental composites during polymerization Dent Mater 2005 2136-42

103Ferrari M Influence of tissue characteristics at margins on leakage of Class II

indirect porcelain restorations Am JDent 1999 12(3)134-142

104Ferreira MC Vieira RS Marginal leakage in direct and indirect composite resin

restorations in primary teeth an in vitro study J Dent 200836(5)322-5

105Forss H Widstroumlm E Reasons for restorative therapy and the longevity of

restorations in adults Acta Odontol Scand 2004 6282-86

106Fradeani M Aquilano A Bassein L Longitudinal study of pressed glass-

ceramic inlays for four and a half years J Prosthet Dent 1997 78(4)346-353

107Franccedila FM Worschech CC Paulillo LA Martins LR Lovadino JR Fracture

resistance of premolar teeth restored with different filling techniques J Contemp Dent

Pract 20056(3)62-9

108Francci C Loguercio AD Reis A Carrilho MR A novel filling technique for

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14(3)149-57

109Fruits TJ Knapp JA Khajotia SS Microleakage in the proximal walls of

direct and indirect posterior resin slot restorations Oper Dent 200631(6)719-27

110Gaengler P Hoyer I Montag R Clinical evaluation of posterior composite

restorations The 10-year report J Adhes Dent 2001 3185-194

111Garbuz DS Masri BA Estaile J Classification systems in orthopaedics J Am

Acad Orthop Surg 2002 10 290-297

112Ghavamnasiri M Moosavi H Tahvildarnejad N Effect of centripetal and

incremental methods in Class II composite resin restorations on gingival

microleakage J Contemp Dent Pract 20078(2)113-20

113Gladys S Clinical and semiquantitative marginal analysis of four tooth-coloured

inlay systems at 3 years J Dent 199523(6)329-338

114Giachetti L Scaminaci Russo D Bambi C Grandini R A review of

polymerization shrinkage stress current techniques for posterior direct resin

restorations J Contemp Dent Pract 20067(4)79-88

115Giannini M AJS Santos RM Carvalho LAMS Paulillo JR Lovadino

Effects of irradiation mode and filling technique on resindentin bond strength in

Class I cavities J Dent Res 200281 (Abstract)

116Going RE Microleakage around dental restorations A summarizing review

JADA 1972841349-1357

117Gordon JChristensen G Why switch to digital radiography J Am Dent

Assoc 204 Vol 135 No 101437-1439

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118Gregoire GL Akon BA Millas A Interfacial micromorphological differences

in hybrid layer formation between water- and solvent-based dentin bonding systems J

Prosthet Dent 2002 87633ndash641

119Gregory WA Physical properties and repair bond strength of direct and indirect

composite resins J Prosthet Dent 68(3)406-411 1992

120Gwinnett AJ Buonocore MG Adhesives and caries prevention a preliminary

report Br Dent J 196511977-81

121Gwinnett AJ Matsui A A study of enamel adhesives The physical relationship

between enamel and adhesive Arch Oral Biol 1967121615-1620

122Gwinnett AJ Histologic changes in human enamel following treatment with

acidic adhesive conditioning agents Arch Oral Biol 197116731-738

123Gwinnett AJ Moist versus dry dentin its effect on shear bond strength Am J

Dent 1992 5(3)127-9

124Haba Denisia Tehnici uzuale utilizate icircn radiologia dentară Edit Junimea

2007

125Hashimoto M Ito S Tay FR Svizero NR Sano H Kaga M Fluid movement

across the resin-dentin interface during and after bonding J Dent Res 2004 83843ndash

848

126Hashimoto M Tay FR Ito S Sano H Kaga M Pashley DH Permeability of

adhesive resin films J Biomed Mater Res 2005 74699ndash705

127Hawthorne WS Smales RJ Factors influencing long-term restoration survival

in three private dental practices in Adelaide Aust Dent J 19974259ndash63

128Helwig Klimek Attin Einfuumlhrung in Die ZahnErhaltung Urbanampfischer 2003

129He Z Shimada Y Tagami J The effects of cavity size and incremental

technique on micro-tensile bond strength of resin composite in Class I cavities Dent

Mater 200723(5)533-8

130He Z Shimada Y Sadr A Ikeda M Tagami J The effects of cavity size and

filling method on the bonding to Class I cavities J Adhes Dent 2008 Dec10(6)447-

53

131Hench LLBioceramicsfrom concept to clinicJ Amer Ceram Soc1991

74(7)1487-1570

132Heymann HO The clinical performance of CAD-CAM generated ceramic

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133Hickel R Manhart J Longevity of restorations In Wilson NHF Roulet JF

Fuzzi M Advances in Operative Dentistry ndash Challenges of the Future Chicago

Quintessence 2001

134Hilton TJ Cavity sealers liners and bases Current philosophies and indications

for use Oper Dent 199621134 ndash146

135Hilton TJ Schwartz RS Ferracane JL Microleakage of four Class II resin

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135- 144

136Hinoura K Setcos JK Philips RW Cavity design and placement technique for

class 2 composites Oper Dent 19981312-19

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137Hintze H Wenzel A Clinically undetected dental caries assessed by bitewing

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19-23

138Hintze H Wenzel A Danielen B Behaviour of approximal carious lesions

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longitudinal study in young adults Caries Res 1999 33 415-22

139Hintze H Wenzel A Influence of validation method on diagnostic accuracy of

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Dentomaxillofacial Radiol2002 31(1) 44-49

140Holtzman JM Berkey AB Mann J Predicting utilization of dental services by

the aged JPublic Health Dent1990 50(3) 164-171

141Hofmann N Hunecke AInfluence of curing methods and matrix type on the

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31(1)97-105

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of approximal and occlusal dental caries in a young adult population Community

Dent Oral Epidemiol 200533(3)212-8

143Hubsch PF Middleton J Knox J A finite element analysis of the stress at the

restoration-tooth interfacecomparing inlays and bulk

fillingsBiomaterials2000211015ndash1019

144Hudson JD Goldstein GR Georgescu M Enamel wear caused by three

different restorative materials J Prosthet Dent 1995 74(6)647-654

145Hunter AR Treasure ET Hunter AJ Increases in cavity volume associated

with the removal of class 2 amalgam and composite restorations Oper Dent

1995202ndash 6

146Huysmans MC PG van der Varst EP Lautenschlager P Monaghan The

influence of simulated clinical handling on the flexural and compressive strength of

posterior composite restorative materials Dent Mater 199612116ndash120

147Iliescu A Gafar MCariologie şi Odontologie RestaurativăEditura Medicală

Bucureşti 2001

148Inoue S Van Meerbeek B Vargas M Lambrechts P Vanherle G Adhesion

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Prati C Grafiche Erredue 2000131-148

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dentin J Adhes Dent 2001 3 237-245

150Iovan Gianina Diagnosis and Management of Patients with High Caries

Activity EdApollonia Iasi2002

151Jacobsen T Soderhold KJ Some effects of water on dentin bonding Dent

Mater 1995 11(2)132-6

152Jackson RD Morgan M The new posterior resins and a simplified placement

technique J Am Dent Assoc 2000131375ndash383

153Jain P Belcher M Microleakage of class II resin-based composite restorations

with flowable composite in the proximal box Am J Dent 200013235ndash238

48

154Jokstad A Mjor IA Analyses of long-term clinical behaviour of class II

amalgam restorations Acta OdontolScand 1991 49 47-63

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Scand 1994 52 234-248

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adhesives to dental hard tissues Clin Oral Investig 2002 6(3)155-60

157Kamann WK Gangler P Zur Funktionzeit von Amalgam

Kompositefullungen Zahnartzlicher Welt 1999 108 270-273

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of ground and intact enamel surfaces J Dent 199927523-530

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restorative decisions made on the basis of simulated bitewing radiographs

Community Dentistry and Oral Epidemiology 1994 22(2) 71-74

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composite restorations effected by increased flexibility J Dent Res 1990 691240ndash

1243

161Khairallah C Hokayem A Long-term clinical evaluation of 2 dental materials

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200932(126)21-8

163Kidd EAAssesment of dental carious lesionsArchof Oral

Biology199843(8)629-632

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proximal caries lesions at various levels in vitro Journal of Dentistry 2006 34(10)

817-822

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composite restorations Oper Dent 200934(1)11-7

166Kleverlaan CJ Feilzer AJ Polymerization shrinkage and contraction stress of

dental resin composites Dent Mater 2005 211150-1157

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marginal leakage around class II composite resin restorations in vitroQuint Int

201989117ndash121

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M Dentin shear strength effect of distance from the pulp Dent Mater 2002

18(7)516-20

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polimerisation Am J Dent 1998 11 17-22

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of Self-etching Adhesives to Caries-affected Dentin on the Gingival Wall Dental

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Dent 27(5)325-331 1999

49

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Jan11(1)34-40

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JProsthet Dent 199369(4)425-430

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thermal behavior of dental composites Dent Mater 2008 24(8)1017ndash1024

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Borgmeijer PJ Replacement risk of amalgam treatment modalities 15-year results

JDent 199826 627-632

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shrinkage and elasticity of flowable composites and filled adhesives Dent Mater

1999 15128-137

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179Lăcătuşu St Luminiţa Costinescu Andrian S Gianina Iovan Valeria

Pendefunda 180Sorina Solomon Topoliceanu C Elements of dispersional

analysis of amalgam restorations 15th

Edition of the Balkan Medical Days

Stomatological Section Abstract nr1091999128

181Lăcătuşu St Andrian S Gianina Iovan- Consideraţii asupra adaptării

amalgamelor dentare la pereţii cavităţilor RevMedicina

StomatologicăVol2199823-26

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posterior packable resin composites with and without flowable liners Oper Dent

200126302ndash307

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restorative decisions microscopic and radiographic caries depth Community

Dentistry and Oral Epidemiology 1996 24 106-11

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polymerization contraction stress for dental composites by two-step light-activation

Dent Mater 2002 18436-444

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constraint and filling technique in composite restorations Dent Mater 2004

20(3)236-43

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Polymerization shrinkage effects of boundary conditions and filling technique of

resin composite restorations J Dent 2004 32(6)459-70

50

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Quintessence Int 2004 35(2)156-61

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art and future perspectives Quintessence Int 200233213-224

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polymerization vs reduced light intensity J Adhes Dent 1 199931ndash39

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temperature and comonomer composition on the polymerization behavior of

dimethacrylate dental resins J Dent 1999 21879-883

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and reactivity on the reaction kinetics of dimethacrylatedimethacrylate

copolymerizations Macromolecules 1999 323913-3921

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bonded composite restorations Dent Mater 1991 7(2) 107-13

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clinical results J Dent Res 199877 1020

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two amalgams Quintessence Int 199829483ndash490

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depth as cavity predictors for approximal dentin caries lesions in primary teeth

Dentomaxillofac Radiol 2007 Oct36(7)377-81

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dentitionOperDent200429(5)481-508

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J Prosthet Dent 2000 Sep84(3)289-96

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Three-year clinical evaluation of composite and ceramic inlays Am J Dent 2001

Apr14(2)95-9

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hardness and depth of cure of light cured packable composite resins J Dent Res 2000

79369 (Abstract)

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caries-affected transparent dentin by citric acidAn atomic force microscopy

studyDent Mater20011745-52

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the diagnosis of proximal caries Scand J Dent Res 1985 93(2) 78-84

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206Mejare I Malmgreen B Clinical and radiographic appearance of proximal

carious lesions at the time of operative treatment in young permanent teeth Scand J

Dent Res 1988 94 19-26

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RM Direct resin composite restorations versus indirect composite inlays one-year

results J Contemp Dent Pract 2010 May 111(3)025-32

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relative diagnostic yields of clinical FOTI and radiographic examinations for the

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(Cerana) Br Dent J 2006 Oct 21201(8)515-20

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33

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19904011ndash7

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Am Dent Assoc 2010 141(3)319-29

52

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125749-751

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34

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Monogr Oral Sci 20092142-51

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Monogr Oral Sci 20092152-62

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Influence of the Discomfort Reported by Children on the Performance of Approximal

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569ndash575

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Nanoleakage leakage within the hybrid layer Oper Dent 1995 20 18-25

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451

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458

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  • COPERTA REZUMAT ENGLEZA (MEREUTA)pdf
  • REZUMAT ENGLEZA DR MEREUTA DENISSpdf
Page 45: UNIVERSITATEA DE MEDICINA SI FARMACIE “GR Doctorat/Rezumat... · universitatea de medicina si farmacie “gr.t.popa” iasi facultatea de medicina dentara rezumatul tezei de doctorat

42

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2004 20939-946

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microstructural features of four dental ceramicspart 1 J Dent 25(5)399-407 1997

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marginal leakage J Dent 2005 33(7) 603- 610

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Med 2008173(1)23ndash26

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polymerization contraction stress of composites J Dent Res 2000 79812ndash817

61Cichon P Kerschbaum T Verweildauer zahnartzlicher Restaurationen bei

Behinderten Dtsch Zahnartzlicher 1999 54 96-102

62Cohen BI Pagnillo MK Deutsch ASMusikant BL Fracture Strength of

Three Core Restorative Materials Supported with or without a Prefabricated Split-

Shank Post Journal of Prosthetic Dentistry1997 78 560ndash565

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in Class II composite resin restoration applied in bulk or in two increments

Quintessence Int 1993 24583-591

43

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resin restorations 8-year findings J Dent 199826(4) 311ndash317

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polymerization stress J Am Dent Assoc2000 131497-503

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behaviour of dimethacrylate composite resins Biomaterials 1990 11272-276

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1399

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dental light-activated resin composites during curing Dent Mater 200319277ndash285

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bond strength and the polymerization contraction stress J Dent Res 1984

63(12)1396-9

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shrinkage stress in polymer-based restoratives J Dent Res 199725435ndash440

74Davidson CL Resisting the curing contraction with adhesive composites J

Prosthet Dent 198655446ndash7

75Davis RD Mayhew RB A clinical comparison of three anterior restorative resins

at 3 years J Am Dent Assoc 1986112659-63

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and adhesion of composite resin versus ceramic inlays in molarsJ Prosthet

Dent200899131-40

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and replacement of restorations Prim Dent Care 20018(1)5-11

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shrinkage in direct posterior composite restorations J Am Dent Assoc 2002

1331387ndash97

79Demirci M Tuncer S Yuceokur AA Prevalence of caries on individual tooth

surfaces and its distribution by age and gender in university clinic patientsEur J

Dent20104(3)270-9

80De Munck J Van Meerbeek B Satoshi I Vargas M Yoshida Y Armstrong S

Lambrechts P Vanherle G Microtensile bond strengths of one- and two-step

selfetch adhesives to bur-cut enamel and dentin Am J Dent 2003 16 414-420

81Dewaele M Truffier-Boutry D Devaux J Leloup G Volume contraction in

photocured dental resins the shrinkage-conversion relationship revisited Dent Mater

2006 22359-365

44

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848

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135- 144

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class 2 composites Oper Dent 19981312-19

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Dent Oral Epidemiol 200533(3)212-8

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Bucureşti 2001

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Activity EdApollonia Iasi2002

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Mater 1995 11(2)132-6

152Jackson RD Morgan M The new posterior resins and a simplified placement

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48

154Jokstad A Mjor IA Analyses of long-term clinical behaviour of class II

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1243

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Biology199843(8)629-632

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817-822

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201989117ndash121

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18(7)516-20

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Jan11(1)34-40

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JProsthet Dent 199369(4)425-430

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JDent 199826 627-632

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1999 15128-137

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Pendefunda 180Sorina Solomon Topoliceanu C Elements of dispersional

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Edition of the Balkan Medical Days

Stomatological Section Abstract nr1091999128

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Dentistry and Oral Epidemiology 1996 24 106-11

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Dent Mater 2002 18436-444

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20(3)236-43

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Polymerization shrinkage effects of boundary conditions and filling technique of

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50

189Lopes GC Baratieri LN Monteiro S Jr Vieira LC Effect of posterior resin

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Dentomaxillofac Radiol 2007 Oct36(7)377-81

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J Prosthet Dent 2000 Sep84(3)289-96

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Three-year clinical evaluation of composite and ceramic inlays Am J Dent 2001

Apr14(2)95-9

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79369 (Abstract)

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PrimDentCare1999Apr659-62

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33

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52

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125749-751

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34

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Monogr Oral Sci 20092142-51

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53

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569ndash575

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Community Dent Oral Epidemiol 1999 Oct27(5)331-7

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Community Dent Oral Epidemiol 1980 Jun8(3)135-8

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volumetric polymerization shrinkage and bulk modulus of dental composites and an

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placement techniques on marginal microleakage of deep class-II cavities restored with

two composite resin formulations J Conserv Dent 2010 13(1) 9ndash15

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system on microleakage in cervical composite resin restorations Rev Med Chir

Soc Med Iaşi-2008 vol112 nr1supl1145-147

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posterior composite 10-year report J Dent 199927(1) 13ndash19

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composite resins Five-year results Swed Dent J 1995 19 173-182

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of teeth with long-term performing composite restorations J Oral Rehabil 2002

29(12)1131ndash1138

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Operative Dentistry 5th ed St Louis Mosby 2006293-7

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59

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dentin J Dent Res 2002 81 556-560

  • COPERTA REZUMAT ENGLEZA (MEREUTA)pdf
  • REZUMAT ENGLEZA DR MEREUTA DENISSpdf
Page 46: UNIVERSITATEA DE MEDICINA SI FARMACIE “GR Doctorat/Rezumat... · universitatea de medicina si farmacie “gr.t.popa” iasi facultatea de medicina dentara rezumatul tezei de doctorat

43

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1399

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Prosthet Dent 198655446ndash7

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1331387ndash97

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Dent20104(3)270-9

80De Munck J Van Meerbeek B Satoshi I Vargas M Yoshida Y Armstrong S

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photocured dental resins the shrinkage-conversion relationship revisited Dent Mater

2006 22359-365

44

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Operations Desert ShieldStorm Mil Med 1996161(10) 620ndash623

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26 717-727

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30(3)163- 1681999

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Caries Res 200034(3)219-24

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schoolchildren have never had a cavity Public Health Rep1995 110 (5) 522-530

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resins Dent Mater 2001 17221-229

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96Feilzer AJ AJ De Gee CL Davidson Increased wall-to-wall curing

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98Feilzer AJ de Gee AJ Davidson CL Relaxation of polymerization contraction

shear stress by hygroscopic expansion J Dent Res 1990 6936ndash39

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99Feilzer AJ De Gee AJ Davidson CL Setting stress in composite resin in relation

to configuration of the restoration J Dent Res1987 661636-1639

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on polymerization shrinkage and integrity of restoration-cavity interface Eur J Oral

Sci 1995 103322ndash326

101Fennis YL Verdischbot EH vanrsquot Hof MA Performance of some diagnostic

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children J Dent 1998 26(5) 403-40

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restorations in adults Acta Odontol Scand 2004 6282-86

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108Francci C Loguercio AD Reis A Carrilho MR A novel filling technique for

packable composite resin in Class II restorations J Esthet Restor Dent 2002

14(3)149-57

109Fruits TJ Knapp JA Khajotia SS Microleakage in the proximal walls of

direct and indirect posterior resin slot restorations Oper Dent 200631(6)719-27

110Gaengler P Hoyer I Montag R Clinical evaluation of posterior composite

restorations The 10-year report J Adhes Dent 2001 3185-194

111Garbuz DS Masri BA Estaile J Classification systems in orthopaedics J Am

Acad Orthop Surg 2002 10 290-297

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incremental methods in Class II composite resin restorations on gingival

microleakage J Contemp Dent Pract 20078(2)113-20

113Gladys S Clinical and semiquantitative marginal analysis of four tooth-coloured

inlay systems at 3 years J Dent 199523(6)329-338

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polymerization shrinkage stress current techniques for posterior direct resin

restorations J Contemp Dent Pract 20067(4)79-88

115Giannini M AJS Santos RM Carvalho LAMS Paulillo JR Lovadino

Effects of irradiation mode and filling technique on resindentin bond strength in

Class I cavities J Dent Res 200281 (Abstract)

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JADA 1972841349-1357

117Gordon JChristensen G Why switch to digital radiography J Am Dent

Assoc 204 Vol 135 No 101437-1439

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118Gregoire GL Akon BA Millas A Interfacial micromorphological differences

in hybrid layer formation between water- and solvent-based dentin bonding systems J

Prosthet Dent 2002 87633ndash641

119Gregory WA Physical properties and repair bond strength of direct and indirect

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report Br Dent J 196511977-81

121Gwinnett AJ Matsui A A study of enamel adhesives The physical relationship

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122Gwinnett AJ Histologic changes in human enamel following treatment with

acidic adhesive conditioning agents Arch Oral Biol 197116731-738

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Dent 1992 5(3)127-9

124Haba Denisia Tehnici uzuale utilizate icircn radiologia dentară Edit Junimea

2007

125Hashimoto M Ito S Tay FR Svizero NR Sano H Kaga M Fluid movement

across the resin-dentin interface during and after bonding J Dent Res 2004 83843ndash

848

126Hashimoto M Tay FR Ito S Sano H Kaga M Pashley DH Permeability of

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in three private dental practices in Adelaide Aust Dent J 19974259ndash63

128Helwig Klimek Attin Einfuumlhrung in Die ZahnErhaltung Urbanampfischer 2003

129He Z Shimada Y Tagami J The effects of cavity size and incremental

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131Hench LLBioceramicsfrom concept to clinicJ Amer Ceram Soc1991

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132Heymann HO The clinical performance of CAD-CAM generated ceramic

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Quintessence 2001

134Hilton TJ Cavity sealers liners and bases Current philosophies and indications

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135- 144

136Hinoura K Setcos JK Philips RW Cavity design and placement technique for

class 2 composites Oper Dent 19981312-19

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137Hintze H Wenzel A Clinically undetected dental caries assessed by bitewing

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19-23

138Hintze H Wenzel A Danielen B Behaviour of approximal carious lesions

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Dentomaxillofacial Radiol2002 31(1) 44-49

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of approximal and occlusal dental caries in a young adult population Community

Dent Oral Epidemiol 200533(3)212-8

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fillingsBiomaterials2000211015ndash1019

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different restorative materials J Prosthet Dent 1995 74(6)647-654

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with the removal of class 2 amalgam and composite restorations Oper Dent

1995202ndash 6

146Huysmans MC PG van der Varst EP Lautenschlager P Monaghan The

influence of simulated clinical handling on the flexural and compressive strength of

posterior composite restorative materials Dent Mater 199612116ndash120

147Iliescu A Gafar MCariologie şi Odontologie RestaurativăEditura Medicală

Bucureşti 2001

148Inoue S Van Meerbeek B Vargas M Lambrechts P Vanherle G Adhesion

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Prati C Grafiche Erredue 2000131-148

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dentin J Adhes Dent 2001 3 237-245

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Activity EdApollonia Iasi2002

151Jacobsen T Soderhold KJ Some effects of water on dentin bonding Dent

Mater 1995 11(2)132-6

152Jackson RD Morgan M The new posterior resins and a simplified placement

technique J Am Dent Assoc 2000131375ndash383

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with flowable composite in the proximal box Am J Dent 200013235ndash238

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154Jokstad A Mjor IA Analyses of long-term clinical behaviour of class II

amalgam restorations Acta OdontolScand 1991 49 47-63

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Kompositefullungen Zahnartzlicher Welt 1999 108 270-273

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Community Dentistry and Oral Epidemiology 1994 22(2) 71-74

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1243

161Khairallah C Hokayem A Long-term clinical evaluation of 2 dental materials

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163Kidd EAAssesment of dental carious lesionsArchof Oral

Biology199843(8)629-632

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817-822

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166Kleverlaan CJ Feilzer AJ Polymerization shrinkage and contraction stress of

dental resin composites Dent Mater 2005 211150-1157

167Koenigsberg SA Fuks R GrajowerThe effect of three filling techniques on

marginal leakage around class II composite resin restorations in vitroQuint Int

201989117ndash121

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18(7)516-20

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Materials Journal 2006 25(1)59-65

171Kramer N IPS Empress inlays and onlays after four years-a clinical study J

Dent 27(5)325-331 1999

49

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Jan11(1)34-40

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JProsthet Dent 199369(4)425-430

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thermal behavior of dental composites Dent Mater 2008 24(8)1017ndash1024

175Kreulen CM Tobi H Gruythuysen RJM van Amerongen WE

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JDent 199826 627-632

176Labella R Lambrechts P Van Meerbeek B Vanherle G Polymerization

shrinkage and elasticity of flowable composites and filled adhesives Dent Mater

1999 15128-137

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178Lăcătuşu St- Caria dentară explozivă- EdCronica Iaşi 1996

179Lăcătuşu St Luminiţa Costinescu Andrian S Gianina Iovan Valeria

Pendefunda 180Sorina Solomon Topoliceanu C Elements of dispersional

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Edition of the Balkan Medical Days

Stomatological Section Abstract nr1091999128

181Lăcătuşu St Andrian S Gianina Iovan- Consideraţii asupra adaptării

amalgamelor dentare la pereţii cavităţilor RevMedicina

StomatologicăVol2199823-26

182Leevailoj C Cochran MA Matis BA Moore BK Platt JA Microleakage of

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200126302ndash307

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Dentistry and Oral Epidemiology 1996 24 106-11

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Dent Mater 2002 18436-444

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constraint and filling technique in composite restorations Dent Mater 2004

20(3)236-43

188Loguercio AD Reis A Schroeder M Balducci I Versluis A Ballester RY

Polymerization shrinkage effects of boundary conditions and filling technique of

resin composite restorations J Dent 2004 32(6)459-70

50

189Lopes GC Baratieri LN Monteiro S Jr Vieira LC Effect of posterior resin

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Quintessence Int 2004 35(2)156-61

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art and future perspectives Quintessence Int 200233213-224

191Loumlsche GM Marginal adaptation of class II composite fillings guided

polymerization vs reduced light intensity J Adhes Dent 1 199931ndash39

192Lovell LG Newman SM Bowman CN The effects of light intensity

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and reactivity on the reaction kinetics of dimethacrylatedimethacrylate

copolymerizations Macromolecules 1999 323913-3921

194Lutz F Krejci I Barbakow F Quality and durability of marginal adaptation in

bonded composite restorations Dent Mater 1991 7(2) 107-13

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clinical results J Dent Res 199877 1020

196Mair LH Ten-year clinical assessment of three posterior resin composites and

two amalgams Quintessence Int 199829483ndash490

197Mariath AA Casagrande L de Araujo FB Grey levels and radiolucent lesion

depth as cavity predictors for approximal dentin caries lesions in primary teeth

Dentomaxillofac Radiol 2007 Oct36(7)377-81

198Manhart J Chen H Hamm G Hickel R Review of the clinical survival of

direct and indirect restorations icircn posterior teeth of the permanent

dentitionOperDent200429(5)481-508

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composites for posterior restorations JADA Vol132 2001639-644

200Manhart J Neuerer P Scheibenbogen-Fuchsbrunner A Hickel R Three-

year clinical evaluation of direct and indirect composite restorations in posterior teeth

J Prosthet Dent 2000 Sep84(3)289-96

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Three-year clinical evaluation of composite and ceramic inlays Am J Dent 2001

Apr14(2)95-9

202Manhart J Chen HY Draegert U Kunzelmann KH Hickel R Vickers

hardness and depth of cure of light cured packable composite resins J Dent Res 2000

79369 (Abstract)

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caries-affected transparent dentin by citric acidAn atomic force microscopy

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51

206Mejare I Malmgreen B Clinical and radiographic appearance of proximal

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Dent Res 1988 94 19-26

207Mendonccedila JS Neto RG Santiago SL Lauris JR Navarro MF de Carvalho

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relative diagnostic yields of clinical FOTI and radiographic examinations for the

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209Miguel A JC La Macorra A predictive formula of the contraction stress in

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deformation Dent Mater 200117241ndash246

210Mileman PA van der Weele IT Accuracy in radiographic diagnosis Dutch

practitioners and dental caries JDent1990 18(3) 130-136

211Millar BJ Robinson PB Eight year results with direct ceramic restorations

(Cerana) Br Dent J 2006 Oct 21201(8)515-20

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PrimDentCare1999Apr659-62

213Mjor IA Amalgam and composite resin restorations longevity and reasons for

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Quintessence 198961-80

214Mjor IA Long term cost of restorative therapy using different materials

ScandJDRes 199210060-65

215Mjor IA The reasons for replacement and the age of failed restorations in

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33

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19904011ndash7

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Am Dent Assoc 2010 141(3)319-29

52

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Ciucchi B Russell CM Pashley DH Tensile bond strength and SEM evaluation of

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evolution of the longitudinal modulus during the photopolymerization of a bis-

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125749-751

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composites Oper Dent 23 1998282ndash289

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34

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Monogr Oral Sci 20092142-51

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Monogr Oral Sci 20092152-62

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Quintessence Int 1998295ndash11

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Influence of the Discomfort Reported by Children on the Performance of Approximal

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Restorative Materials In Class I And Class II Restorations An In-Vivo Study The

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569ndash575

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Nanoleakage leakage within the hybrid layer Oper Dent 1995 20 18-25

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In vivo evidence J Dent 2004 32611ndash621

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shrinkage-strain measurements on light-cured biomaterials Dent Mater 200016447ndash

451

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59

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Contemporary Dental Practice 7(2) 20061-13

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458

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  • COPERTA REZUMAT ENGLEZA (MEREUTA)pdf
  • REZUMAT ENGLEZA DR MEREUTA DENISSpdf
Page 47: UNIVERSITATEA DE MEDICINA SI FARMACIE “GR Doctorat/Rezumat... · universitatea de medicina si farmacie “gr.t.popa” iasi facultatea de medicina dentara rezumatul tezei de doctorat

44

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1243

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Biology199843(8)629-632

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Edition of the Balkan Medical Days

Stomatological Section Abstract nr1091999128

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Dentistry and Oral Epidemiology 1996 24 106-11

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Dent Mater 2002 18436-444

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20(3)236-43

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Polymerization shrinkage effects of boundary conditions and filling technique of

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50

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Dentomaxillofac Radiol 2007 Oct36(7)377-81

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J Prosthet Dent 2000 Sep84(3)289-96

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Three-year clinical evaluation of composite and ceramic inlays Am J Dent 2001

Apr14(2)95-9

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79369 (Abstract)

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(Cerana) Br Dent J 2006 Oct 21201(8)515-20

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PrimDentCare1999Apr659-62

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Quintessence 198961-80

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33

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19904011ndash7

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Kunststoff-FullungenDtschZahnartzlicher 1991 46 222-225

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Am Dent Assoc 2010 141(3)319-29

52

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Ciucchi B Russell CM Pashley DH Tensile bond strength and SEM evaluation of

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125749-751

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34

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Monogr Oral Sci 20092142-51

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Monogr Oral Sci 20092152-62

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Restorative Materials In Class I And Class II Restorations An In-Vivo Study The

Internet Journal of Dental Science 2009 7 (2)

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53

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199523(3)137-43

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1999 15(1)46-53

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Adhes Dent 1999 1(3)191-209

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self-curing resin composite linings on microleakage in vitro Oper Dent 200227

569ndash575

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Amalgam und Kunststoff-FullungenDtschZahnartzlicher 1991 46 222-225

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Nanoleakage leakage within the hybrid layer Oper Dent 1995 20 18-25

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  • COPERTA REZUMAT ENGLEZA (MEREUTA)pdf
  • REZUMAT ENGLEZA DR MEREUTA DENISSpdf
Page 48: UNIVERSITATEA DE MEDICINA SI FARMACIE “GR Doctorat/Rezumat... · universitatea de medicina si farmacie “gr.t.popa” iasi facultatea de medicina dentara rezumatul tezei de doctorat

45

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Class I cavities J Dent Res 200281 (Abstract)

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across the resin-dentin interface during and after bonding J Dent Res 2004 83843ndash

848

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130He Z Shimada Y Sadr A Ikeda M Tagami J The effects of cavity size and

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134Hilton TJ Cavity sealers liners and bases Current philosophies and indications

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135- 144

136Hinoura K Setcos JK Philips RW Cavity design and placement technique for

class 2 composites Oper Dent 19981312-19

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138Hintze H Wenzel A Danielen B Behaviour of approximal carious lesions

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of approximal and occlusal dental caries in a young adult population Community

Dent Oral Epidemiol 200533(3)212-8

143Hubsch PF Middleton J Knox J A finite element analysis of the stress at the

restoration-tooth interfacecomparing inlays and bulk

fillingsBiomaterials2000211015ndash1019

144Hudson JD Goldstein GR Georgescu M Enamel wear caused by three

different restorative materials J Prosthet Dent 1995 74(6)647-654

145Hunter AR Treasure ET Hunter AJ Increases in cavity volume associated

with the removal of class 2 amalgam and composite restorations Oper Dent

1995202ndash 6

146Huysmans MC PG van der Varst EP Lautenschlager P Monaghan The

influence of simulated clinical handling on the flexural and compressive strength of

posterior composite restorative materials Dent Mater 199612116ndash120

147Iliescu A Gafar MCariologie şi Odontologie RestaurativăEditura Medicală

Bucureşti 2001

148Inoue S Van Meerbeek B Vargas M Lambrechts P Vanherle G Adhesion

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Prati C Grafiche Erredue 2000131-148

149Inoue S Vargas MA Abe Y Yoshida Y LambrechtsP Vanherle G Sano H

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dentin J Adhes Dent 2001 3 237-245

150Iovan Gianina Diagnosis and Management of Patients with High Caries

Activity EdApollonia Iasi2002

151Jacobsen T Soderhold KJ Some effects of water on dentin bonding Dent

Mater 1995 11(2)132-6

152Jackson RD Morgan M The new posterior resins and a simplified placement

technique J Am Dent Assoc 2000131375ndash383

153Jain P Belcher M Microleakage of class II resin-based composite restorations

with flowable composite in the proximal box Am J Dent 200013235ndash238

48

154Jokstad A Mjor IA Analyses of long-term clinical behaviour of class II

amalgam restorations Acta OdontolScand 1991 49 47-63

155Jokstad A Mjor IA Qvist V The age of restorations in situ Acta Odontol

Scand 1994 52 234-248

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157Kamann WK Gangler P Zur Funktionzeit von Amalgam

Kompositefullungen Zahnartzlicher Welt 1999 108 270-273

158Kanemura N Sano H Tagami J Tensile bond strength to and SEM evaluation

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159Kay EJ Nutall M Relationship between dentistlsquos treatment attitudes and

restorative decisions made on the basis of simulated bitewing radiographs

Community Dentistry and Oral Epidemiology 1994 22(2) 71-74

160Kemp-Scholte CM Davidson CL Complete marginal seal of Class V resin

composite restorations effected by increased flexibility J Dent Res 1990 691240ndash

1243

161Khairallah C Hokayem A Long-term clinical evaluation of 2 dental materials

used for the preparation of esthetic inlays Odontostomatol Trop 200932(127)5-13

162Khairallah C Sabbagh J Hokayem A Clinical study comparing at 5 years a

ceramic and a ceromer used for making esthetic inlays Odontostomatol Trop

200932(126)21-8

163Kidd EAAssesment of dental carious lesionsArchof Oral

Biology199843(8)629-632

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proximal caries lesions at various levels in vitro Journal of Dentistry 2006 34(10)

817-822

165Kiremitci A Alpaslan T Gurgan SSix-year clinical evaluation of packable

composite restorations Oper Dent 200934(1)11-7

166Kleverlaan CJ Feilzer AJ Polymerization shrinkage and contraction stress of

dental resin composites Dent Mater 2005 211150-1157

167Koenigsberg SA Fuks R GrajowerThe effect of three filling techniques on

marginal leakage around class II composite resin restorations in vitroQuint Int

201989117ndash121

168Konishi N Watanabe LG Hilton JF Marshall GW Marshall SJ Staninec

M Dentin shear strength effect of distance from the pulp Dent Mater 2002

18(7)516-20

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polimerisation Am J Dent 1998 11 17-22

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of Self-etching Adhesives to Caries-affected Dentin on the Gingival Wall Dental

Materials Journal 2006 25(1)59-65

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Dent 27(5)325-331 1999

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Jan11(1)34-40

173Krejci I Wear of ceramic inlays their enamel antagonists and luting cements

JProsthet Dent 199369(4)425-430

174Koplin C Jaeger R Hahn P Kinetic model for the coupled volumetric and

thermal behavior of dental composites Dent Mater 2008 24(8)1017ndash1024

175Kreulen CM Tobi H Gruythuysen RJM van Amerongen WE

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JDent 199826 627-632

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shrinkage and elasticity of flowable composites and filled adhesives Dent Mater

1999 15128-137

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Pendefunda 180Sorina Solomon Topoliceanu C Elements of dispersional

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Edition of the Balkan Medical Days

Stomatological Section Abstract nr1091999128

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amalgamelor dentare la pereţii cavităţilor RevMedicina

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200126302ndash307

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Dentistry and Oral Epidemiology 1996 24 106-11

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Dent Mater 2002 18436-444

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20(3)236-43

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Polymerization shrinkage effects of boundary conditions and filling technique of

resin composite restorations J Dent 2004 32(6)459-70

50

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Quintessence Int 2004 35(2)156-61

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copolymerizations Macromolecules 1999 323913-3921

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bonded composite restorations Dent Mater 1991 7(2) 107-13

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clinical results J Dent Res 199877 1020

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Dentomaxillofac Radiol 2007 Oct36(7)377-81

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J Prosthet Dent 2000 Sep84(3)289-96

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Three-year clinical evaluation of composite and ceramic inlays Am J Dent 2001

Apr14(2)95-9

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hardness and depth of cure of light cured packable composite resins J Dent Res 2000

79369 (Abstract)

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deformation Dent Mater 200117241ndash246

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(Cerana) Br Dent J 2006 Oct 21201(8)515-20

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PrimDentCare1999Apr659-62

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Quintessence 198961-80

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ScandJDRes 199210060-65

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33

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19904011ndash7

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Am Dent Assoc 2010 141(3)319-29

52

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125749-751

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34

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Monogr Oral Sci 20092142-51

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451

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458

346Yoshiyama M Tay FR Doi J Nishitani Y Yamada T Itou K Carvalho RM

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Page 49: UNIVERSITATEA DE MEDICINA SI FARMACIE “GR Doctorat/Rezumat... · universitatea de medicina si farmacie “gr.t.popa” iasi facultatea de medicina dentara rezumatul tezei de doctorat

46

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848

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135- 144

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class 2 composites Oper Dent 19981312-19

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Dent Oral Epidemiol 200533(3)212-8

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1995202ndash 6

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influence of simulated clinical handling on the flexural and compressive strength of

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Bucureşti 2001

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Prati C Grafiche Erredue 2000131-148

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Activity EdApollonia Iasi2002

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Mater 1995 11(2)132-6

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technique J Am Dent Assoc 2000131375ndash383

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with flowable composite in the proximal box Am J Dent 200013235ndash238

48

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Kompositefullungen Zahnartzlicher Welt 1999 108 270-273

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Community Dentistry and Oral Epidemiology 1994 22(2) 71-74

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composite restorations effected by increased flexibility J Dent Res 1990 691240ndash

1243

161Khairallah C Hokayem A Long-term clinical evaluation of 2 dental materials

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200932(126)21-8

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Biology199843(8)629-632

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817-822

165Kiremitci A Alpaslan T Gurgan SSix-year clinical evaluation of packable

composite restorations Oper Dent 200934(1)11-7

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dental resin composites Dent Mater 2005 211150-1157

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marginal leakage around class II composite resin restorations in vitroQuint Int

201989117ndash121

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18(7)516-20

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Materials Journal 2006 25(1)59-65

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Dent 27(5)325-331 1999

49

172Krejci I Lieber CM Lutz FTime required to remove totally bonded tooth-

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Jan11(1)34-40

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JProsthet Dent 199369(4)425-430

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thermal behavior of dental composites Dent Mater 2008 24(8)1017ndash1024

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Borgmeijer PJ Replacement risk of amalgam treatment modalities 15-year results

JDent 199826 627-632

176Labella R Lambrechts P Van Meerbeek B Vanherle G Polymerization

shrinkage and elasticity of flowable composites and filled adhesives Dent Mater

1999 15128-137

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178Lăcătuşu St- Caria dentară explozivă- EdCronica Iaşi 1996

179Lăcătuşu St Luminiţa Costinescu Andrian S Gianina Iovan Valeria

Pendefunda 180Sorina Solomon Topoliceanu C Elements of dispersional

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Edition of the Balkan Medical Days

Stomatological Section Abstract nr1091999128

181Lăcătuşu St Andrian S Gianina Iovan- Consideraţii asupra adaptării

amalgamelor dentare la pereţii cavităţilor RevMedicina

StomatologicăVol2199823-26

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200126302ndash307

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Dentistry and Oral Epidemiology 1996 24 106-11

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Dent Mater 2002 18436-444

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20(3)236-43

188Loguercio AD Reis A Schroeder M Balducci I Versluis A Ballester RY

Polymerization shrinkage effects of boundary conditions and filling technique of

resin composite restorations J Dent 2004 32(6)459-70

50

189Lopes GC Baratieri LN Monteiro S Jr Vieira LC Effect of posterior resin

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Quintessence Int 2004 35(2)156-61

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191Loumlsche GM Marginal adaptation of class II composite fillings guided

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copolymerizations Macromolecules 1999 323913-3921

194Lutz F Krejci I Barbakow F Quality and durability of marginal adaptation in

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clinical results J Dent Res 199877 1020

196Mair LH Ten-year clinical assessment of three posterior resin composites and

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Dentomaxillofac Radiol 2007 Oct36(7)377-81

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J Prosthet Dent 2000 Sep84(3)289-96

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Three-year clinical evaluation of composite and ceramic inlays Am J Dent 2001

Apr14(2)95-9

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79369 (Abstract)

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PrimDentCare1999Apr659-62

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33

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52

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125749-751

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34

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Monogr Oral Sci 20092142-51

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569ndash575

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Community Dent Oral Epidemiol 1980 Jun8(3)135-8

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posterior composite 10-year report J Dent 199927(1) 13ndash19

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of teeth with long-term performing composite restorations J Oral Rehabil 2002

29(12)1131ndash1138

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Operative Dentistry 5th ed St Louis Mosby 2006293-7

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examiners evaluating amalgam restorations Oper Dent 1997 Mar-Apr22(2)57-65

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Int Dent J 199141(4)195-205

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conditions on ceramiccomposite bond strength J Dent Res 1995 74(l)381-387

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ClinOral Invest1997140-46

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J Dent 199725(6)459-73

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affecting cure at depths within light-activated resin composites Am J Dent

1993691ndash95

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contemporary light curing units using microhardness J Esthet Dent 200012340-9

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of new adult patients diagnostic yield when combined with bitewing radiography and

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microleakage of deep class-II cavities restored with two composite resin formulations

J Conserv Dent 201013(1)9-15

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of polymerization contraction in composite restorations J Dent 1992 20178ndash182

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mechanical analysis of storage modulus development in lightactivated polymer matrix

composites Dent Mater 200218197-202

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Nanoleakage leakage within the hybrid layer Oper Dent 1995 20 18-25

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posterior composite restorations Dent Mater 200521(1) 9ndash12

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packable posterior composite in bulk-cured restorations JADA 2006 137(1)71ndash80

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edition 1996

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404

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Assessment of dental caries with Digital Imaging Fiber-Optic Transillumination (DI-

FOTI)in vitro studyCaries Res 1997 31(2) 103-110

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caries diagnosis after data import from different digital radiography systems

interobserver agreement and comparison to histological hard-tissue sections Caries

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Prosthodont19892(3)217-223

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clinical evaluation of bonded amalgam restorations- Journal of Adhesive Dentistry

nr11999

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of conversion in light-cured dimethacrylate-based dental resins Biomaterials 2002

231819-1829

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modulus of elasticity of light-cured dimethacrylate-based dental resins Biomaterials

2003 24655-665

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York Springer-Verlag 1999

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restorations with adhesive liners J Conserv Dent 201114(2)178-81

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Am Dent Assoc 2007 Jun138(6)763-72

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57

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308

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In vivo evidence J Dent 2004 32611ndash621

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59

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458

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dentin J Dent Res 2002 81 556-560

  • COPERTA REZUMAT ENGLEZA (MEREUTA)pdf
  • REZUMAT ENGLEZA DR MEREUTA DENISSpdf
Page 50: UNIVERSITATEA DE MEDICINA SI FARMACIE “GR Doctorat/Rezumat... · universitatea de medicina si farmacie “gr.t.popa” iasi facultatea de medicina dentara rezumatul tezei de doctorat

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of approximal and occlusal dental caries in a young adult population Community

Dent Oral Epidemiol 200533(3)212-8

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with the removal of class 2 amalgam and composite restorations Oper Dent

1995202ndash 6

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influence of simulated clinical handling on the flexural and compressive strength of

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147Iliescu A Gafar MCariologie şi Odontologie RestaurativăEditura Medicală

Bucureşti 2001

148Inoue S Van Meerbeek B Vargas M Lambrechts P Vanherle G Adhesion

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Prati C Grafiche Erredue 2000131-148

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dentin J Adhes Dent 2001 3 237-245

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Activity EdApollonia Iasi2002

151Jacobsen T Soderhold KJ Some effects of water on dentin bonding Dent

Mater 1995 11(2)132-6

152Jackson RD Morgan M The new posterior resins and a simplified placement

technique J Am Dent Assoc 2000131375ndash383

153Jain P Belcher M Microleakage of class II resin-based composite restorations

with flowable composite in the proximal box Am J Dent 200013235ndash238

48

154Jokstad A Mjor IA Analyses of long-term clinical behaviour of class II

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Scand 1994 52 234-248

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Kompositefullungen Zahnartzlicher Welt 1999 108 270-273

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restorative decisions made on the basis of simulated bitewing radiographs

Community Dentistry and Oral Epidemiology 1994 22(2) 71-74

160Kemp-Scholte CM Davidson CL Complete marginal seal of Class V resin

composite restorations effected by increased flexibility J Dent Res 1990 691240ndash

1243

161Khairallah C Hokayem A Long-term clinical evaluation of 2 dental materials

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200932(126)21-8

163Kidd EAAssesment of dental carious lesionsArchof Oral

Biology199843(8)629-632

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proximal caries lesions at various levels in vitro Journal of Dentistry 2006 34(10)

817-822

165Kiremitci A Alpaslan T Gurgan SSix-year clinical evaluation of packable

composite restorations Oper Dent 200934(1)11-7

166Kleverlaan CJ Feilzer AJ Polymerization shrinkage and contraction stress of

dental resin composites Dent Mater 2005 211150-1157

167Koenigsberg SA Fuks R GrajowerThe effect of three filling techniques on

marginal leakage around class II composite resin restorations in vitroQuint Int

201989117ndash121

168Konishi N Watanabe LG Hilton JF Marshall GW Marshall SJ Staninec

M Dentin shear strength effect of distance from the pulp Dent Mater 2002

18(7)516-20

169Koran P Kurschner R Effect of sequential versus continous irradiation of a

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170Koyuturk A E Sengun A Ozer F Sener Y Gokalp A Shear Bond Strengths

of Self-etching Adhesives to Caries-affected Dentin on the Gingival Wall Dental

Materials Journal 2006 25(1)59-65

171Kramer N IPS Empress inlays and onlays after four years-a clinical study J

Dent 27(5)325-331 1999

49

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colored posterior restorations and related tooth substance loss Dent Mater 1995

Jan11(1)34-40

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JProsthet Dent 199369(4)425-430

174Koplin C Jaeger R Hahn P Kinetic model for the coupled volumetric and

thermal behavior of dental composites Dent Mater 2008 24(8)1017ndash1024

175Kreulen CM Tobi H Gruythuysen RJM van Amerongen WE

Borgmeijer PJ Replacement risk of amalgam treatment modalities 15-year results

JDent 199826 627-632

176Labella R Lambrechts P Van Meerbeek B Vanherle G Polymerization

shrinkage and elasticity of flowable composites and filled adhesives Dent Mater

1999 15128-137

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178Lăcătuşu St- Caria dentară explozivă- EdCronica Iaşi 1996

179Lăcătuşu St Luminiţa Costinescu Andrian S Gianina Iovan Valeria

Pendefunda 180Sorina Solomon Topoliceanu C Elements of dispersional

analysis of amalgam restorations 15th

Edition of the Balkan Medical Days

Stomatological Section Abstract nr1091999128

181Lăcătuşu St Andrian S Gianina Iovan- Consideraţii asupra adaptării

amalgamelor dentare la pereţii cavităţilor RevMedicina

StomatologicăVol2199823-26

182Leevailoj C Cochran MA Matis BA Moore BK Platt JA Microleakage of

posterior packable resin composites with and without flowable liners Oper Dent

200126302ndash307

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influence of the amalgam alloy on the survival of amalgam restorations a secondary

analysis of multiple controlled clinical trials JDentRes 1997 76 1787-1798

184Levin L Coval M Geiger SBCross-sectional radiographic survey of amalgam

and resin-based composite posterior restorations Quintessence Int 200738(6)511-4

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restorative decisions microscopic and radiographic caries depth Community

Dentistry and Oral Epidemiology 1996 24 106-11

186Lim BS Ferracane JL Sakaguchi RL Condon JR Reduction of

polymerization contraction stress for dental composites by two-step light-activation

Dent Mater 2002 18436-444

187Loguercio AD Reis A Ballester RY Polymerization shrinkage effects of

constraint and filling technique in composite restorations Dent Mater 2004

20(3)236-43

188Loguercio AD Reis A Schroeder M Balducci I Versluis A Ballester RY

Polymerization shrinkage effects of boundary conditions and filling technique of

resin composite restorations J Dent 2004 32(6)459-70

50

189Lopes GC Baratieri LN Monteiro S Jr Vieira LC Effect of posterior resin

composite placement technique on the resin-dentin interface formed in vivo

Quintessence Int 2004 35(2)156-61

190Lopes GC Baratieri LN de Andrada MA Dental adhesion present state of the

art and future perspectives Quintessence Int 200233213-224

191Loumlsche GM Marginal adaptation of class II composite fillings guided

polymerization vs reduced light intensity J Adhes Dent 1 199931ndash39

192Lovell LG Newman SM Bowman CN The effects of light intensity

temperature and comonomer composition on the polymerization behavior of

dimethacrylate dental resins J Dent 1999 21879-883

193Lovell LG Stansbury JW Syrpes DC Bowman CN Effects of composition

and reactivity on the reaction kinetics of dimethacrylatedimethacrylate

copolymerizations Macromolecules 1999 323913-3921

194Lutz F Krejci I Barbakow F Quality and durability of marginal adaptation in

bonded composite restorations Dent Mater 1991 7(2) 107-13

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clinical results J Dent Res 199877 1020

196Mair LH Ten-year clinical assessment of three posterior resin composites and

two amalgams Quintessence Int 199829483ndash490

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depth as cavity predictors for approximal dentin caries lesions in primary teeth

Dentomaxillofac Radiol 2007 Oct36(7)377-81

198Manhart J Chen H Hamm G Hickel R Review of the clinical survival of

direct and indirect restorations icircn posterior teeth of the permanent

dentitionOperDent200429(5)481-508

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200Manhart J Neuerer P Scheibenbogen-Fuchsbrunner A Hickel R Three-

year clinical evaluation of direct and indirect composite restorations in posterior teeth

J Prosthet Dent 2000 Sep84(3)289-96

201Manhart J Chen HY Neuerer P Scheibenbogen-Fuchsbrunner A Hickel R

Three-year clinical evaluation of composite and ceramic inlays Am J Dent 2001

Apr14(2)95-9

202Manhart J Chen HY Draegert U Kunzelmann KH Hickel R Vickers

hardness and depth of cure of light cured packable composite resins J Dent Res 2000

79369 (Abstract)

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the diagnosis of proximal caries Scand J Dent Res 1985 93(2) 78-84

51

206Mejare I Malmgreen B Clinical and radiographic appearance of proximal

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relative diagnostic yields of clinical FOTI and radiographic examinations for the

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deformation Dent Mater 200117241ndash246

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practitioners and dental caries JDent1990 18(3) 130-136

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(Cerana) Br Dent J 2006 Oct 21201(8)515-20

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PrimDentCare1999Apr659-62

213Mjor IA Amalgam and composite resin restorations longevity and reasons for

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Quintessence 198961-80

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ScandJDRes 199210060-65

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33

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19904011ndash7

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Kunststoff-FullungenDtschZahnartzlicher 1991 46 222-225

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Am Dent Assoc 2010 141(3)319-29

52

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Ciucchi B Russell CM Pashley DH Tensile bond strength and SEM evaluation of

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evolution of the longitudinal modulus during the photopolymerization of a bis-

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125749-751

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in vitro study of the effect of restorative technique on marginal leakage in posterior

composites Oper Dent 23 1998282ndash289

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bond strength to dentin in resin composite restorations Dent Mater 200925(1)129-

34

227Neuhaus KW Ellwood R Lussi A Pitts N Traditional lesion detection aids

Monogr Oral Sci 20092142-51

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Monogr Oral Sci 20092152-62

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Quintessence Int 1998295ndash11

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Influence of the Discomfort Reported by Children on the Performance of Approximal

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Adhes Dent 20079(5)469-75

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different adhesive systems J Oral Rehabil 2003 30 659-663

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Restorative Materials In Class I And Class II Restorations An In-Vivo Study The

Internet Journal of Dental Science 2009 7 (2)

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Regional variability in the permeability of human dentine Arch Oral Biol

198732(7)519-23

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Part II Etching effects on unground enamel Dent Mater 2001 17 430-444

53

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Microsc19893(1)161-74

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1999 15(1)46-53

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Adhes Dent 1999 1(3)191-209

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self-curing resin composite linings on microleakage in vitro Oper Dent 200227

569ndash575

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Amalgam und Kunststoff-FullungenDtschZahnartzlicher 1991 46 222-225

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Community Dent Oral Epidemiol 1999 Oct27(5)331-7

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(2) 93-98

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Community Dent Oral Epidemiol 1980 Jun8(3)135-8

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Dent Mater 1989 5 392-398

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volumetric polymerization shrinkage and bulk modulus of dental composites and an

unfilled resin Am J Dent 200013176ndash180

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placement techniques on marginal microleakage of deep class-II cavities restored with

two composite resin formulations J Conserv Dent 2010 13(1) 9ndash15

54

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system on microleakage in cervical composite resin restorations Rev Med Chir

Soc Med Iaşi-2008 vol112 nr1supl1145-147

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posterior composite 10-year report J Dent 199927(1) 13ndash19

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composite resins Five-year results Swed Dent J 1995 19 173-182

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of teeth with long-term performing composite restorations J Oral Rehabil 2002

29(12)1131ndash1138

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Nanoleakage leakage within the hybrid layer Oper Dent 1995 20 18-25

55

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308

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In vivo evidence J Dent 2004 32611ndash621

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M Lambrechts P Vanherle G Bonding mechanism micro-tensile bond strength of

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327Versluis A Douglas WH Cross M Sakaguchi RL Does an incremental filling

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451

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336Wenzel A Hintze H Perception of image quality in direct digital radiography

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Radiology 27(1)3-11 1998

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458

346Yoshiyama M Tay FR Doi J Nishitani Y Yamada T Itou K Carvalho RM

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dentin J Dent Res 2002 81 556-560

  • COPERTA REZUMAT ENGLEZA (MEREUTA)pdf
  • REZUMAT ENGLEZA DR MEREUTA DENISSpdf
Page 51: UNIVERSITATEA DE MEDICINA SI FARMACIE “GR Doctorat/Rezumat... · universitatea de medicina si farmacie “gr.t.popa” iasi facultatea de medicina dentara rezumatul tezei de doctorat

48

154Jokstad A Mjor IA Analyses of long-term clinical behaviour of class II

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159Kay EJ Nutall M Relationship between dentistlsquos treatment attitudes and

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Community Dentistry and Oral Epidemiology 1994 22(2) 71-74

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1243

161Khairallah C Hokayem A Long-term clinical evaluation of 2 dental materials

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Biology199843(8)629-632

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proximal caries lesions at various levels in vitro Journal of Dentistry 2006 34(10)

817-822

165Kiremitci A Alpaslan T Gurgan SSix-year clinical evaluation of packable

composite restorations Oper Dent 200934(1)11-7

166Kleverlaan CJ Feilzer AJ Polymerization shrinkage and contraction stress of

dental resin composites Dent Mater 2005 211150-1157

167Koenigsberg SA Fuks R GrajowerThe effect of three filling techniques on

marginal leakage around class II composite resin restorations in vitroQuint Int

201989117ndash121

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M Dentin shear strength effect of distance from the pulp Dent Mater 2002

18(7)516-20

169Koran P Kurschner R Effect of sequential versus continous irradiation of a

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of Self-etching Adhesives to Caries-affected Dentin on the Gingival Wall Dental

Materials Journal 2006 25(1)59-65

171Kramer N IPS Empress inlays and onlays after four years-a clinical study J

Dent 27(5)325-331 1999

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Jan11(1)34-40

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JProsthet Dent 199369(4)425-430

174Koplin C Jaeger R Hahn P Kinetic model for the coupled volumetric and

thermal behavior of dental composites Dent Mater 2008 24(8)1017ndash1024

175Kreulen CM Tobi H Gruythuysen RJM van Amerongen WE

Borgmeijer PJ Replacement risk of amalgam treatment modalities 15-year results

JDent 199826 627-632

176Labella R Lambrechts P Van Meerbeek B Vanherle G Polymerization

shrinkage and elasticity of flowable composites and filled adhesives Dent Mater

1999 15128-137

177Lăcătuşu St- Caria dentară-problemele mineralizării- EdJunimea Iaşi 1998

178Lăcătuşu St- Caria dentară explozivă- EdCronica Iaşi 1996

179Lăcătuşu St Luminiţa Costinescu Andrian S Gianina Iovan Valeria

Pendefunda 180Sorina Solomon Topoliceanu C Elements of dispersional

analysis of amalgam restorations 15th

Edition of the Balkan Medical Days

Stomatological Section Abstract nr1091999128

181Lăcătuşu St Andrian S Gianina Iovan- Consideraţii asupra adaptării

amalgamelor dentare la pereţii cavităţilor RevMedicina

StomatologicăVol2199823-26

182Leevailoj C Cochran MA Matis BA Moore BK Platt JA Microleakage of

posterior packable resin composites with and without flowable liners Oper Dent

200126302ndash307

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influence of the amalgam alloy on the survival of amalgam restorations a secondary

analysis of multiple controlled clinical trials JDentRes 1997 76 1787-1798

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restorative decisions microscopic and radiographic caries depth Community

Dentistry and Oral Epidemiology 1996 24 106-11

186Lim BS Ferracane JL Sakaguchi RL Condon JR Reduction of

polymerization contraction stress for dental composites by two-step light-activation

Dent Mater 2002 18436-444

187Loguercio AD Reis A Ballester RY Polymerization shrinkage effects of

constraint and filling technique in composite restorations Dent Mater 2004

20(3)236-43

188Loguercio AD Reis A Schroeder M Balducci I Versluis A Ballester RY

Polymerization shrinkage effects of boundary conditions and filling technique of

resin composite restorations J Dent 2004 32(6)459-70

50

189Lopes GC Baratieri LN Monteiro S Jr Vieira LC Effect of posterior resin

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Quintessence Int 2004 35(2)156-61

190Lopes GC Baratieri LN de Andrada MA Dental adhesion present state of the

art and future perspectives Quintessence Int 200233213-224

191Loumlsche GM Marginal adaptation of class II composite fillings guided

polymerization vs reduced light intensity J Adhes Dent 1 199931ndash39

192Lovell LG Newman SM Bowman CN The effects of light intensity

temperature and comonomer composition on the polymerization behavior of

dimethacrylate dental resins J Dent 1999 21879-883

193Lovell LG Stansbury JW Syrpes DC Bowman CN Effects of composition

and reactivity on the reaction kinetics of dimethacrylatedimethacrylate

copolymerizations Macromolecules 1999 323913-3921

194Lutz F Krejci I Barbakow F Quality and durability of marginal adaptation in

bonded composite restorations Dent Mater 1991 7(2) 107-13

195Mach Z Ruzickova T Staninec M Bonded amalgam restaorations three year

clinical results J Dent Res 199877 1020

196Mair LH Ten-year clinical assessment of three posterior resin composites and

two amalgams Quintessence Int 199829483ndash490

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depth as cavity predictors for approximal dentin caries lesions in primary teeth

Dentomaxillofac Radiol 2007 Oct36(7)377-81

198Manhart J Chen H Hamm G Hickel R Review of the clinical survival of

direct and indirect restorations icircn posterior teeth of the permanent

dentitionOperDent200429(5)481-508

199Manhart J Hong YC R Hickel The suitability of packable resin-based

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200Manhart J Neuerer P Scheibenbogen-Fuchsbrunner A Hickel R Three-

year clinical evaluation of direct and indirect composite restorations in posterior teeth

J Prosthet Dent 2000 Sep84(3)289-96

201Manhart J Chen HY Neuerer P Scheibenbogen-Fuchsbrunner A Hickel R

Three-year clinical evaluation of composite and ceramic inlays Am J Dent 2001

Apr14(2)95-9

202Manhart J Chen HY Draegert U Kunzelmann KH Hickel R Vickers

hardness and depth of cure of light cured packable composite resins J Dent Res 2000

79369 (Abstract)

203Marshall GW Jr Marshall SJ Kinney JH Balooch M The dentin substrate

structure and properties related to bonding J Dent 1997 25(6)441-58

204Marshall GW Jr Chang YJ Gansky SA Marshall SJ Demineralization of

caries-affected transparent dentin by citric acidAn atomic force microscopy

studyDent Mater20011745-52

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the diagnosis of proximal caries Scand J Dent Res 1985 93(2) 78-84

51

206Mejare I Malmgreen B Clinical and radiographic appearance of proximal

carious lesions at the time of operative treatment in young permanent teeth Scand J

Dent Res 1988 94 19-26

207Mendonccedila JS Neto RG Santiago SL Lauris JR Navarro MF de Carvalho

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relative diagnostic yields of clinical FOTI and radiographic examinations for the

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209Miguel A JC La Macorra A predictive formula of the contraction stress in

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deformation Dent Mater 200117241ndash246

210Mileman PA van der Weele IT Accuracy in radiographic diagnosis Dutch

practitioners and dental caries JDent1990 18(3) 130-136

211Millar BJ Robinson PB Eight year results with direct ceramic restorations

(Cerana) Br Dent J 2006 Oct 21201(8)515-20

212Millar BJ Cerana-a direct ceramic inlay technique

PrimDentCare1999Apr659-62

213Mjor IA Amalgam and composite resin restorations longevity and reasons for

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Quintessence 198961-80

214Mjor IA Long term cost of restorative therapy using different materials

ScandJDRes 199210060-65

215Mjor IA The reasons for replacement and the age of failed restorations in

general dental practice Acta OdontolScand19975558-63

216Mjoumlr IA Moorhead JE Selection of restorative materials reasons for

replacement and longevity of restorations in Florida J Am Coll Dent 199865(3)27ndash

33

217Mjoumlr IA Jokstad A Qvist V Longevity of posterior restorations Int Dent J

19904011ndash7

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Kunststoff-FullungenDtschZahnartzlicher 1991 46 222-225

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Lake Buena Vista Fla Hanover Park Ill Quintessence 1989125-138

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Am Dent Assoc 2010 141(3)319-29

52

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Ciucchi B Russell CM Pashley DH Tensile bond strength and SEM evaluation of

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single-bottle dentin adhesives to caries- affected dentin Oper Dent 2000 25 2-10

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evolution of the longitudinal modulus during the photopolymerization of a bis-

GMATEGDMA resin by pulsed photoacoustic technique J Phys IV France 2005

125749-751

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composites Oper Dent 23 1998282ndash289

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bond strength to dentin in resin composite restorations Dent Mater 200925(1)129-

34

227Neuhaus KW Ellwood R Lussi A Pitts N Traditional lesion detection aids

Monogr Oral Sci 20092142-51

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Monogr Oral Sci 20092152-62

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Quintessence Int 1998295ndash11

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Influence of the Discomfort Reported by Children on the Performance of Approximal

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Adhes Dent 20079(5)469-75

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clinical study on longevity of posterior composite and amalgam restorations Dent

Mater 200723(1)2-8

234Ozer F Unlu N Sengun A Influence of dentinal regions on bond strengths of

different adhesive systems J Oral Rehabil 2003 30 659-663

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Restorative Materials In Class I And Class II Restorations An In-Vivo Study The

Internet Journal of Dental Science 2009 7 (2)

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Regional variability in the permeability of human dentine Arch Oral Biol

198732(7)519-23

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report for the American Journal of Dentistry Am J Dent 1991 4(1)5-9

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Part II Etching effects on unground enamel Dent Mater 2001 17 430-444

53

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Microsc19893(1)161-74

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569ndash575

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Nanoleakage leakage within the hybrid layer Oper Dent 1995 20 18-25

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451

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344Yeşilyurt C Bulucu B Bond strength of total-etch dentin adhesive systems on

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458

346Yoshiyama M Tay FR Doi J Nishitani Y Yamada T Itou K Carvalho RM

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dentin J Dent Res 2002 81 556-560

  • COPERTA REZUMAT ENGLEZA (MEREUTA)pdf
  • REZUMAT ENGLEZA DR MEREUTA DENISSpdf
Page 52: UNIVERSITATEA DE MEDICINA SI FARMACIE “GR Doctorat/Rezumat... · universitatea de medicina si farmacie “gr.t.popa” iasi facultatea de medicina dentara rezumatul tezei de doctorat

49

172Krejci I Lieber CM Lutz FTime required to remove totally bonded tooth-

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Jan11(1)34-40

173Krejci I Wear of ceramic inlays their enamel antagonists and luting cements

JProsthet Dent 199369(4)425-430

174Koplin C Jaeger R Hahn P Kinetic model for the coupled volumetric and

thermal behavior of dental composites Dent Mater 2008 24(8)1017ndash1024

175Kreulen CM Tobi H Gruythuysen RJM van Amerongen WE

Borgmeijer PJ Replacement risk of amalgam treatment modalities 15-year results

JDent 199826 627-632

176Labella R Lambrechts P Van Meerbeek B Vanherle G Polymerization

shrinkage and elasticity of flowable composites and filled adhesives Dent Mater

1999 15128-137

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178Lăcătuşu St- Caria dentară explozivă- EdCronica Iaşi 1996

179Lăcătuşu St Luminiţa Costinescu Andrian S Gianina Iovan Valeria

Pendefunda 180Sorina Solomon Topoliceanu C Elements of dispersional

analysis of amalgam restorations 15th

Edition of the Balkan Medical Days

Stomatological Section Abstract nr1091999128

181Lăcătuşu St Andrian S Gianina Iovan- Consideraţii asupra adaptării

amalgamelor dentare la pereţii cavităţilor RevMedicina

StomatologicăVol2199823-26

182Leevailoj C Cochran MA Matis BA Moore BK Platt JA Microleakage of

posterior packable resin composites with and without flowable liners Oper Dent

200126302ndash307

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influence of the amalgam alloy on the survival of amalgam restorations a secondary

analysis of multiple controlled clinical trials JDentRes 1997 76 1787-1798

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restorative decisions microscopic and radiographic caries depth Community

Dentistry and Oral Epidemiology 1996 24 106-11

186Lim BS Ferracane JL Sakaguchi RL Condon JR Reduction of

polymerization contraction stress for dental composites by two-step light-activation

Dent Mater 2002 18436-444

187Loguercio AD Reis A Ballester RY Polymerization shrinkage effects of

constraint and filling technique in composite restorations Dent Mater 2004

20(3)236-43

188Loguercio AD Reis A Schroeder M Balducci I Versluis A Ballester RY

Polymerization shrinkage effects of boundary conditions and filling technique of

resin composite restorations J Dent 2004 32(6)459-70

50

189Lopes GC Baratieri LN Monteiro S Jr Vieira LC Effect of posterior resin

composite placement technique on the resin-dentin interface formed in vivo

Quintessence Int 2004 35(2)156-61

190Lopes GC Baratieri LN de Andrada MA Dental adhesion present state of the

art and future perspectives Quintessence Int 200233213-224

191Loumlsche GM Marginal adaptation of class II composite fillings guided

polymerization vs reduced light intensity J Adhes Dent 1 199931ndash39

192Lovell LG Newman SM Bowman CN The effects of light intensity

temperature and comonomer composition on the polymerization behavior of

dimethacrylate dental resins J Dent 1999 21879-883

193Lovell LG Stansbury JW Syrpes DC Bowman CN Effects of composition

and reactivity on the reaction kinetics of dimethacrylatedimethacrylate

copolymerizations Macromolecules 1999 323913-3921

194Lutz F Krejci I Barbakow F Quality and durability of marginal adaptation in

bonded composite restorations Dent Mater 1991 7(2) 107-13

195Mach Z Ruzickova T Staninec M Bonded amalgam restaorations three year

clinical results J Dent Res 199877 1020

196Mair LH Ten-year clinical assessment of three posterior resin composites and

two amalgams Quintessence Int 199829483ndash490

197Mariath AA Casagrande L de Araujo FB Grey levels and radiolucent lesion

depth as cavity predictors for approximal dentin caries lesions in primary teeth

Dentomaxillofac Radiol 2007 Oct36(7)377-81

198Manhart J Chen H Hamm G Hickel R Review of the clinical survival of

direct and indirect restorations icircn posterior teeth of the permanent

dentitionOperDent200429(5)481-508

199Manhart J Hong YC R Hickel The suitability of packable resin-based

composites for posterior restorations JADA Vol132 2001639-644

200Manhart J Neuerer P Scheibenbogen-Fuchsbrunner A Hickel R Three-

year clinical evaluation of direct and indirect composite restorations in posterior teeth

J Prosthet Dent 2000 Sep84(3)289-96

201Manhart J Chen HY Neuerer P Scheibenbogen-Fuchsbrunner A Hickel R

Three-year clinical evaluation of composite and ceramic inlays Am J Dent 2001

Apr14(2)95-9

202Manhart J Chen HY Draegert U Kunzelmann KH Hickel R Vickers

hardness and depth of cure of light cured packable composite resins J Dent Res 2000

79369 (Abstract)

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204Marshall GW Jr Chang YJ Gansky SA Marshall SJ Demineralization of

caries-affected transparent dentin by citric acidAn atomic force microscopy

studyDent Mater20011745-52

205Mejare I Grondahl H Carlstedt K Accuracy at radiography and probing for

the diagnosis of proximal caries Scand J Dent Res 1985 93(2) 78-84

51

206Mejare I Malmgreen B Clinical and radiographic appearance of proximal

carious lesions at the time of operative treatment in young permanent teeth Scand J

Dent Res 1988 94 19-26

207Mendonccedila JS Neto RG Santiago SL Lauris JR Navarro MF de Carvalho

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208Mialhe FL Pereira AC Meneghim Mde C Ambrosano GM Pardi V The

relative diagnostic yields of clinical FOTI and radiographic examinations for the

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209Miguel A JC La Macorra A predictive formula of the contraction stress in

restorative and luting materials attending to free and adhered surfaces volume and

deformation Dent Mater 200117241ndash246

210Mileman PA van der Weele IT Accuracy in radiographic diagnosis Dutch

practitioners and dental caries JDent1990 18(3) 130-136

211Millar BJ Robinson PB Eight year results with direct ceramic restorations

(Cerana) Br Dent J 2006 Oct 21201(8)515-20

212Millar BJ Cerana-a direct ceramic inlay technique

PrimDentCare1999Apr659-62

213Mjor IA Amalgam and composite resin restorations longevity and reasons for

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Quintessence 198961-80

214Mjor IA Long term cost of restorative therapy using different materials

ScandJDRes 199210060-65

215Mjor IA The reasons for replacement and the age of failed restorations in

general dental practice Acta OdontolScand19975558-63

216Mjoumlr IA Moorhead JE Selection of restorative materials reasons for

replacement and longevity of restorations in Florida J Am Coll Dent 199865(3)27ndash

33

217Mjoumlr IA Jokstad A Qvist V Longevity of posterior restorations Int Dent J

19904011ndash7

218Meyer G Marienhagen B Motsch A Eine Langzeitstudie an Amalgam und

Kunststoff-FullungenDtschZahnartzlicher 1991 46 222-225

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interface using adhesive systems with three different solvents bonded to dry and moist

dentinmdashan in vitro study Quintessence Int 2005 36511ndash521

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criteria for placement and replacement Proceedings of the International Symposium

on Criteria for Placement and Replacement of Dental Restorations Oct 19ndash21 1987

Lake Buena Vista Fla Hanover Park Ill Quintessence 1989125-138

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packable and nanostructured resin-based composites placed with two techniques J

Am Dent Assoc 2010 141(3)319-29

52

222Nakajima M Sano H Burrow MF Tagami J Yoshiyama M Ebisu S

Ciucchi B Russell CM Pashley DH Tensile bond strength and SEM evaluation of

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single-bottle dentin adhesives to caries- affected dentin Oper Dent 2000 25 2-10

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evolution of the longitudinal modulus during the photopolymerization of a bis-

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125749-751

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in vitro study of the effect of restorative technique on marginal leakage in posterior

composites Oper Dent 23 1998282ndash289

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bond strength to dentin in resin composite restorations Dent Mater 200925(1)129-

34

227Neuhaus KW Ellwood R Lussi A Pitts N Traditional lesion detection aids

Monogr Oral Sci 20092142-51

228Neuhaus KW Longbottom C Ellwood R Lussi ANovel lesion detection aids

Monogr Oral Sci 20092152-62

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posterior approximal resin composite restorations Observations up to 10 years

Quintessence Int 1998295ndash11

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Influence of the Discomfort Reported by Children on the Performance of Approximal

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reasons for failure of sandwich and total-etch posterior composite resin restorations J

Adhes Dent 20079(5)469-75

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clinical study on longevity of posterior composite and amalgam restorations Dent

Mater 200723(1)2-8

234Ozer F Unlu N Sengun A Influence of dentinal regions on bond strengths of

different adhesive systems J Oral Rehabil 2003 30 659-663

235Pardal D Hegde M Clinical Evaluation Of Different Posterior Composite

Restorative Materials In Class I And Class II Restorations An In-Vivo Study The

Internet Journal of Dental Science 2009 7 (2)

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Regional variability in the permeability of human dentine Arch Oral Biol

198732(7)519-23

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239Pashley DH Tay FR Aggressiveness of contemporary self-etching adhesives

Part II Etching effects on unground enamel Dent Mater 2001 17 430-444

53

240Pashley DH Dentin a dynamic substrate--a reviewScanning

Microsc19893(1)161-74

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199523(3)137-43

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1999 15(1)46-53

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Adhes Dent 1999 1(3)191-209

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self-curing resin composite linings on microleakage in vitro Oper Dent 200227

569ndash575

245Pieper K Meyer G Marienhagen B Motsch A Eine Langzeitstudie an

Amalgam und Kunststoff-FullungenDtschZahnartzlicher 1991 46 222-225

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caries Dentomaxillofac Radiol 2010 Oct39(7)431-6

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2005136(11)1533-40

249Poorterman JH Aartman IH Kalsbeek H Underestimation of the prevalence

of approximal caries and inadequate restorations in a clinical epidemiological study

Community Dent Oral Epidemiol 1999 Oct27(5)331-7

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radiographic judgement of occlusal caries in adolescents Eur J Oral Sci 2000 108

(2) 93-98

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interexaminer reliability of radiographic diagnosis of approximal carious lesions

Community Dent Oral Epidemiol 1980 Jun8(3)135-8

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275Sarrett DC Clinical challenges and the relevance of materials testing for

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451

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1991 72 621-6

336Wenzel A Hintze H Perception of image quality in direct digital radiography

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Dentomaxillofac Radiol 1993 22 131-4

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Radiology 27(1)3-11 1998

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Dent 200114177ndash185

341Wilson NHF Wastell DG Norman RD Five-year performance of high-

cooper content amalgam restorations in a multiclinical trial JDent1996 24 203-210

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1996751477-83

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59

344Yeşilyurt C Bulucu B Bond strength of total-etch dentin adhesive systems on

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Contemporary Dental Practice 7(2) 20061-13

345Yoshida Y Van Meerbeek B Okazaki M Shintani H Suzuki K Comparative

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458

346Yoshiyama M Tay FR Doi J Nishitani Y Yamada T Itou K Carvalho RM

Nakajima M Pashley DH Bonding of self-etch and total etch adhesives to carious

dentin J Dent Res 2002 81 556-560

  • COPERTA REZUMAT ENGLEZA (MEREUTA)pdf
  • REZUMAT ENGLEZA DR MEREUTA DENISSpdf
Page 53: UNIVERSITATEA DE MEDICINA SI FARMACIE “GR Doctorat/Rezumat... · universitatea de medicina si farmacie “gr.t.popa” iasi facultatea de medicina dentara rezumatul tezei de doctorat

50

189Lopes GC Baratieri LN Monteiro S Jr Vieira LC Effect of posterior resin

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Quintessence Int 2004 35(2)156-61

190Lopes GC Baratieri LN de Andrada MA Dental adhesion present state of the

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191Loumlsche GM Marginal adaptation of class II composite fillings guided

polymerization vs reduced light intensity J Adhes Dent 1 199931ndash39

192Lovell LG Newman SM Bowman CN The effects of light intensity

temperature and comonomer composition on the polymerization behavior of

dimethacrylate dental resins J Dent 1999 21879-883

193Lovell LG Stansbury JW Syrpes DC Bowman CN Effects of composition

and reactivity on the reaction kinetics of dimethacrylatedimethacrylate

copolymerizations Macromolecules 1999 323913-3921

194Lutz F Krejci I Barbakow F Quality and durability of marginal adaptation in

bonded composite restorations Dent Mater 1991 7(2) 107-13

195Mach Z Ruzickova T Staninec M Bonded amalgam restaorations three year

clinical results J Dent Res 199877 1020

196Mair LH Ten-year clinical assessment of three posterior resin composites and

two amalgams Quintessence Int 199829483ndash490

197Mariath AA Casagrande L de Araujo FB Grey levels and radiolucent lesion

depth as cavity predictors for approximal dentin caries lesions in primary teeth

Dentomaxillofac Radiol 2007 Oct36(7)377-81

198Manhart J Chen H Hamm G Hickel R Review of the clinical survival of

direct and indirect restorations icircn posterior teeth of the permanent

dentitionOperDent200429(5)481-508

199Manhart J Hong YC R Hickel The suitability of packable resin-based

composites for posterior restorations JADA Vol132 2001639-644

200Manhart J Neuerer P Scheibenbogen-Fuchsbrunner A Hickel R Three-

year clinical evaluation of direct and indirect composite restorations in posterior teeth

J Prosthet Dent 2000 Sep84(3)289-96

201Manhart J Chen HY Neuerer P Scheibenbogen-Fuchsbrunner A Hickel R

Three-year clinical evaluation of composite and ceramic inlays Am J Dent 2001

Apr14(2)95-9

202Manhart J Chen HY Draegert U Kunzelmann KH Hickel R Vickers

hardness and depth of cure of light cured packable composite resins J Dent Res 2000

79369 (Abstract)

203Marshall GW Jr Marshall SJ Kinney JH Balooch M The dentin substrate

structure and properties related to bonding J Dent 1997 25(6)441-58

204Marshall GW Jr Chang YJ Gansky SA Marshall SJ Demineralization of

caries-affected transparent dentin by citric acidAn atomic force microscopy

studyDent Mater20011745-52

205Mejare I Grondahl H Carlstedt K Accuracy at radiography and probing for

the diagnosis of proximal caries Scand J Dent Res 1985 93(2) 78-84

51

206Mejare I Malmgreen B Clinical and radiographic appearance of proximal

carious lesions at the time of operative treatment in young permanent teeth Scand J

Dent Res 1988 94 19-26

207Mendonccedila JS Neto RG Santiago SL Lauris JR Navarro MF de Carvalho

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results J Contemp Dent Pract 2010 May 111(3)025-32

208Mialhe FL Pereira AC Meneghim Mde C Ambrosano GM Pardi V The

relative diagnostic yields of clinical FOTI and radiographic examinations for the

detection of approximal caries in youngsters Indian J Dent Res 200920(2)136-40

209Miguel A JC La Macorra A predictive formula of the contraction stress in

restorative and luting materials attending to free and adhered surfaces volume and

deformation Dent Mater 200117241ndash246

210Mileman PA van der Weele IT Accuracy in radiographic diagnosis Dutch

practitioners and dental caries JDent1990 18(3) 130-136

211Millar BJ Robinson PB Eight year results with direct ceramic restorations

(Cerana) Br Dent J 2006 Oct 21201(8)515-20

212Millar BJ Cerana-a direct ceramic inlay technique

PrimDentCare1999Apr659-62

213Mjor IA Amalgam and composite resin restorations longevity and reasons for

replacement In Anusavice K Quality evaluation of dental restorations Chicago

Quintessence 198961-80

214Mjor IA Long term cost of restorative therapy using different materials

ScandJDRes 199210060-65

215Mjor IA The reasons for replacement and the age of failed restorations in

general dental practice Acta OdontolScand19975558-63

216Mjoumlr IA Moorhead JE Selection of restorative materials reasons for

replacement and longevity of restorations in Florida J Am Coll Dent 199865(3)27ndash

33

217Mjoumlr IA Jokstad A Qvist V Longevity of posterior restorations Int Dent J

19904011ndash7

218Meyer G Marienhagen B Motsch A Eine Langzeitstudie an Amalgam und

Kunststoff-FullungenDtschZahnartzlicher 1991 46 222-225

219Mohan B Kandaswamy D A confocal microscopic evaluation of resin-dentin

interface using adhesive systems with three different solvents bonded to dry and moist

dentinmdashan in vitro study Quintessence Int 2005 36511ndash521

220Moffa JP Comparative performance of amalgam and composite resin

restorations and criteria for their use In Quality evaluation of dental restorations

criteria for placement and replacement Proceedings of the International Symposium

on Criteria for Placement and Replacement of Dental Restorations Oct 19ndash21 1987

Lake Buena Vista Fla Hanover Park Ill Quintessence 1989125-138

221Monteiro PM Manso MC Gavinha S Melo P Two-year clinical evaluation of

packable and nanostructured resin-based composites placed with two techniques J

Am Dent Assoc 2010 141(3)319-29

52

222Nakajima M Sano H Burrow MF Tagami J Yoshiyama M Ebisu S

Ciucchi B Russell CM Pashley DH Tensile bond strength and SEM evaluation of

caries-affected dentin using dentin adhesives J Dent Res 1995 74 1679-1688

223Nakajima M Sano H Urabe I Tagami J Pashley DH Bond strengths of

single-bottle dentin adhesives to caries- affected dentin Oper Dent 2000 25 2-10

224Navarrete M Rivera-Torres F Vera-Graziano R Villagraacuten-Muniz M The

evolution of the longitudinal modulus during the photopolymerization of a bis-

GMATEGDMA resin by pulsed photoacoustic technique J Phys IV France 2005

125749-751

225Neiva IF MA De Andrada LN Baratieri S Monteiro JrAV Ritter An

in vitro study of the effect of restorative technique on marginal leakage in posterior

composites Oper Dent 23 1998282ndash289

226Niu Y Ma X Fan M Zhu S Effects of layering techniques on the micro-tensile

bond strength to dentin in resin composite restorations Dent Mater 200925(1)129-

34

227Neuhaus KW Ellwood R Lussi A Pitts N Traditional lesion detection aids

Monogr Oral Sci 20092142-51

228Neuhaus KW Longbottom C Ellwood R Lussi ANovel lesion detection aids

Monogr Oral Sci 20092152-62

229Nordbo H Leirskar J von der Fehr FR Saucer-shaped cavity preparations for

posterior approximal resin composite restorations Observations up to 10 years

Quintessence Int 1998295ndash11

230Novaes TF Matos R Raggio DP Imparato JC Braga MM Mendes FM

Influence of the Discomfort Reported by Children on the Performance of Approximal

Caries Detection Methods Caries Res 2010 Sep 2344(5)465-471

231Opdam NJ Bronkhorst EM Roeters JM Loomans BA Longevity and

reasons for failure of sandwich and total-etch posterior composite resin restorations J

Adhes Dent 20079(5)469-75

232Opdam NJ Bronkhorst EM Roeters JM Loomans BA A retrospective

clinical study on longevity of posterior composite and amalgam restorations Dent

Mater 200723(1)2-8

234Ozer F Unlu N Sengun A Influence of dentinal regions on bond strengths of

different adhesive systems J Oral Rehabil 2003 30 659-663

235Pardal D Hegde M Clinical Evaluation Of Different Posterior Composite

Restorative Materials In Class I And Class II Restorations An In-Vivo Study The

Internet Journal of Dental Science 2009 7 (2)

236Pashley DH Andringa HJ Derkson GD Derkson ME Kalathoor SR

Regional variability in the permeability of human dentine Arch Oral Biol

198732(7)519-23

237Pashley DH Pashley EL Carvalho RM Tay FR The effects of dentin

permeability on restorative dentistry Dent Clin North Am 2002 46(2)211-45

238Pashley DH Pashley EL Dentin permeability and restorative dentistry a status

report for the American Journal of Dentistry Am J Dent 1991 4(1)5-9

239Pashley DH Tay FR Aggressiveness of contemporary self-etching adhesives

Part II Etching effects on unground enamel Dent Mater 2001 17 430-444

53

240Pashley DH Dentin a dynamic substrate--a reviewScanning

Microsc19893(1)161-74

241Paterson FM Paterson RC Watts A Blinkhorn AS Initial stages in the

development of valid criteria for the replacement of amalgam restaorations J Dent

199523(3)137-43

242Pereira PN Okuda M Sano H Yoshikawa T Burrow MF Tagami J Effect

of intrinsic wetness and regional difference on dentin bond strength Dent Mater

1999 15(1)46-53

243Perdigao J Lopes M Dentin bonding questions for the new millennium J

Adhes Dent 1999 1(3)191-209

244Peutzfeldt A Asmussen E Composite restorations influence of flowable and

self-curing resin composite linings on microleakage in vitro Oper Dent 200227

569ndash575

245Pieper K Meyer G Marienhagen B Motsch A Eine Langzeitstudie an

Amalgam und Kunststoff-FullungenDtschZahnartzlicher 1991 46 222-225

246Plasmans PJM Creugers NHJ Mulder J Long-term survival of extensive

amalgam restaorations JDentRes 1998 77 453-460

247Pontual AA de Melo D de Almeida S Boacutescolo F Haiter Neto FComparison

of digital systems and conventional dental film for the detection of approximal enamel

caries Dentomaxillofac Radiol 2010 Oct39(7)431-6

248Poon EC Smales RJ Yip KHClinical evaluation of packable and conventional

hybrid posterior resin-based composites results at 35 years JADA

2005136(11)1533-40

249Poorterman JH Aartman IH Kalsbeek H Underestimation of the prevalence

of approximal caries and inadequate restorations in a clinical epidemiological study

Community Dent Oral Epidemiol 1999 Oct27(5)331-7

250Poorterman JH Weerheijm KL Groen HJ Kalsbeek H Clinical and

radiographic judgement of occlusal caries in adolescents Eur J Oral Sci 2000 108

(2) 93-98

251Poulsen S Bille J Rugg-Gunn AJ Evaluation of a calibration trial to increase

interexaminer reliability of radiographic diagnosis of approximal carious lesions

Community Dent Oral Epidemiol 1980 Jun8(3)135-8

252Prati C Pashley DH Dentin wetness permeability and thickness and bond

strength of adhesive resins Am J Dent 1992 5 33-38

253Prati C Early marginal microleakage in class II resin composite restorations

Dent Mater 1989 5 392-398

254Price RB Rizkalla AS Hall GC Effect of stepped light exposure on the

volumetric polymerization shrinkage and bulk modulus of dental composites and an

unfilled resin Am J Dent 200013176ndash180

255Radhika M Girija S 1 Kumaraswamy B Neetu M Effect of different

placement techniques on marginal microleakage of deep class-II cavities restored with

two composite resin formulations J Conserv Dent 2010 13(1) 9ndash15

54

256Radu TM A Uliuliuc Dana Apostolide S Andrian The effect of adhesive

system on microleakage in cervical composite resin restorations Rev Med Chir

Soc Med Iaşi-2008 vol112 nr1supl1145-147

257Raskin A Michotte-Theall B Vreven J Wilson NH Clinical evaluation of a

posterior composite 10-year report J Dent 199927(1) 13ndash19

258Rasmusson CG Lundin SA Class II restorations in six different posterior

composite resins Five-year results Swed Dent J 1995 19 173-182

259Rezwani-Kaminski T Kamann W Gaengler P Secondary caries susceptibility

of teeth with long-term performing composite restorations J Oral Rehabil 2002

29(12)1131ndash1138

260Roberson TM Heymann HO Swift EJ eds Sturdevantlsquos Art and Science of

Operative Dentistry 5th ed St Louis Mosby 2006293-7

261Robertello FJ Pink FE The effect of a training program on the reliability of

examiners evaluating amalgam restorations Oper Dent 1997 Mar-Apr22(2)57-65

262Rodrigues JSA Pin LF Machado G Della Bona A Demarco FF Influence

of different restorative techniques on marginal seal of class II composite restorations

J Appl Oral Sci 2010 Feb18(1)37-43

263Roulet JF Noack MJCriteria for substituting amalgam with composite resins

Int Dent J 199141(4)195-205

264Roulet J-F Soderholm KJM Longmate J Effects of treatment and storage

conditions on ceramiccomposite bond strength J Dent Res 1995 74(l)381-387

265Roulet JF Longevity of ceramic inlays and amalgam- results up 6 years

ClinOral Invest1997140-46

266Roulet JFBenefits and disadvantages of tooth-coloured alternatives to amalgam

J Dent 199725(6)459-73

267Rueggeberg FA WF Caughman JW Curtis Jr HC Davis Factors

affecting cure at depths within light-activated resin composites Am J Dent

1993691ndash95

268Rueggeberg FA Ergle JW Mettenburg DJ Polymerization depths of

contemporary light curing units using microhardness J Esthet Dent 200012340-9

269Rushton VE Horner K Worthington HV Screening panoramic radiography

of new adult patients diagnostic yield when combined with bitewing radiography and

identification of selection criteria Br Dent J 2002 Mar 9192(5)275-9

270Ruyter IE Types of resin-based inlay materials and their properties Int Dent J

199242(3)139-44

271Sajjan GS Mittal NEffect of different placement techniques on marginal

microleakage of deep class-II cavities restored with two composite resin formulations

J Conserv Dent 201013(1)9-15

272Sakaguchi RL MC Peters SR Nelson WH Douglas HW Poort Effects

of polymerization contraction in composite restorations J Dent 1992 20178ndash182

273Sakaguchi RL Shah NC Lim BS Ferracane JL Borgersen SE Dynamic

mechanical analysis of storage modulus development in lightactivated polymer matrix

composites Dent Mater 200218197-202

274Sano H Takatsu T Ciucchi B Horner JA Matthews WG Pashley DH

Nanoleakage leakage within the hybrid layer Oper Dent 1995 20 18-25

55

275Sarrett DC Clinical challenges and the relevance of materials testing for

posterior composite restorations Dent Mater 200521(1) 9ndash12

276Sarrett DC Brooks CN Rose JT Clinical performance evaluation of a

packable posterior composite in bulk-cured restorations JADA 2006 137(1)71ndash80

277Shackelford JF Introduction to Materials Science for Engineers fourth

edition 1996

278Schirrmeister JF Huber K Hellwig E Hahn P Four-year evaluation of a resin

composite including nanofillers in posterior cavities J Adhes Dent 200911(5)399-

404

279Schneiderman A Elbaum M Schultz T Keem S Greenebaum M Driller J

Assessment of dental caries with Digital Imaging Fiber-Optic Transillumination (DI-

FOTI)in vitro studyCaries Res 1997 31(2) 103-110

280Schulte AG Wittchen A Stachniss V Jacquet W Bottenberg P Approximal

caries diagnosis after data import from different digital radiography systems

interobserver agreement and comparison to histological hard-tissue sections Caries

Res 200842(1)57-61

281Shortall AC Marginal seal comparisons between resinbonded Class II porcelain

inlays posterior composite restorationsand direct composite resin inlays Int J

Prosthodont19892(3)217-223

282Seghi RR Denry 1L Rosenstiel SF Relative fracture toughness and hardness

of new dental ceramics J Prosthet Dent 199574(2)145-150

283Sengun A Koyuturk AE Sener Y Ozer F Effect of desensitizers on the bond

strength of a self-etching adhesive system to caries affected dentin on the gingival

wall Oper Dent 2005 30(4)430-435

284Sengun A Unlu N Ozer F Ozturk B Bond strength of five current adhesives

to caries-affected dentin J Oral Rehabil 2002 29 777-781

285Setcos JC Staninec M Wilson NH- A two-year randomized controlled

clinical evaluation of bonded amalgam restorations- Journal of Adhesive Dentistry

nr11999

286Sideridou I Tserki V Papanastasiou G Effect of chemical structure on degree

of conversion in light-cured dimethacrylate-based dental resins Biomaterials 2002

231819-1829

287Sideridou I Tserki V Papanastasiou G Study of water sorption solubility and

modulus of elasticity of light-cured dimethacrylate-based dental resins Biomaterials

2003 24655-665

288Sidi AD Naylor MN A comparison of bitewing radiography and interdental

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posterior teeth Br Dent J 1988 164 (1) 15-18

289SilverFH Christiansen DLBiomaterials Science and Biocompatibility New

York Springer-Verlag 1999

290Simecek JW Diefenderfer KE Ahlf RL Ragain JC Jr Longitudinal trends in

restorative treatment needs among a cohort of US naval personnel J Dent Res

200382 1169 (Abstract)

291Simecek JW Diefenderfer KE Ahlf RL Ragain JC Jr Dental sealant

longevity in a cohort of young US naval personnel JADA 2005136(2)171ndash178

56

292Simi B Suprabha B Evaluation of microleakage in posterior nanocomposite

restorations with adhesive liners J Conserv Dent 201114(2)178-81

293Simone D David N B An alternative to reduce polimeryzation shrinkage in

direct posterior restorations JADA 2002 101387-1398

294Smales RJ Longevity of cusp-covered amalgams survivals after 15 years

OperDent 1991 16 17-20

295Smales RJ Webster DA Leppard PISurvival predictions of amalgam

restorations JDent1991 19 272-277

296Smales RJ Hawthorne WSLong-term survival of extensive amalgams and

posterior crowns JDent 1997 25 225-227

297Soncini JA Maserejian NN Trachtenberg F Tavares M Hayes C The

longevity of amalgam versus compomercomposite restorations in posterior primary

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Am Dent Assoc 2007 Jun138(6)763-72

298Sonoda H Banerjee A Sherriff M Tagami J Watson TF An in vitro

investigation of microtensile bond strengths of two dentine adhesives to caries-

affected dentine J Dent 2005 33(4)335-342

299Soodabeh Kimyai Masomeh Mehdipour Siavash Savadi Oskoee Reasons

for retreatment of amalgam and composite restorations among the pacients referring

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no1(2007)

300De Souza FB Guimaraes RP Vicente Silva CH A clinical evaluation of

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International 2005 36 41-48

301Spreafico RC Gagliani M Composite resin restorations on posterior teeth In

Roulet JF Degrange M Adhesion The silent revolution in dentistry Chicago

Quintessence 2000253ndash76

302St Georges AJ Wilder AD Jr Perdigao J Microleakage of Class V composites

using different placement and curing techniques an in vitro study Am J Dent 2002

15244-247

303Stangel I Barolet RY Clinical evaluation of two posterior composite resins

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304Stephen KW Russell JI Creanor SL Comparison of fibre optic

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Dentistry and Oral Epidemiology 1987 15 (2) 90-94

305Sturdevant JR Bayne SC Heymann HO Margin gap size of ceramic inlays

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306Suh BI A study of the compatibility of adhesives with composites Proceeding

from the SCO Dental Products Inc Symposium 2003 24(8) 4-9 (Abstract)

307Summit JB Burgess JO Berry TG Six-year clinical evaluation of bonded and

pin-retained complex amalgam restorations Oper Dent 2004 29269-276

308Summit JB Robbins JW Hilton TJ Fundamentals in operative dentistry Cap

10Direct Posterior Esthetic Restorations 2006 Quintessence Publishing Co

57

309Svanberg M Mjor IA Orstavik D Mutans streptococci in plaque from margins

of amalgam composite and glassndashionomer restorations J Dent Res 199069861ndash

864

310Tanne K Mamoru S Burstone C Three-dimensional finite element analysis

for stress in the periodontal tissue by orthodontic forcesAm J Orthod Dentofacial

Orthop921987499ndash505

311Tanumiharja M Burrow MF Tyas MJ Microtensile bond strengths of seven

dentin adhesive systems Dent Mater 2000 16(3)180-7

312Tay FR Pashley DH Aggressiveness of contemporary self-etching systems

Part I Depth of penetration beyond dentin smear layers Dent Mater 2001 17(4) 296-

308

313Tay FR Frankenberger R Krejci I Bouillaguet S Pashley DH Carvalho

RM Single-bottle adhesives behave as permeable membranes after polymerization I

In vivo evidence J Dent 2004 32611ndash621

314Tay FR Pashley DH Have dentin adhesives become too hydrophilic J Can

Dent Assoc 2003 69726ndash731

315Tay FR Sano H Carvalho R Pashley EL Pashley DH An ultrastructural

study of the influence of acidity of self-etching primers and smear layer thickness on

bonding to intact dentin J Adhes Dent 2000 283ndash98

316Thompson JY Bayne SC Heymann HO Mechanical properties of a new

mica-based machinable glass ceramic for CADCAM restorations J Prosthet Dent

76(6)619-623 1996

317Unterbrink GL R Muessner Influence of light intensity on two restorative

systems J Dent 199523183ndash189

318Unterbrink GL Liebenberg WH Flowable resin composites as filled

adhesiveslsquo literature review and clinical recommendations Quintessence Int

199930249ndash257

319Vaarkamp J Ten Bosch J Verdonschot EH Quantitative diagnosis of small

approximal caries lesions utilizing wavelength-dependent fiber-optic

transillumination Journal of Dental Research 1997 76 (4) 875-882

320Valachovic RW Douglass CW Reiskin AB Chauncey HH McNeil BJ The

use of panoramic radiography in the evaluation of asymptomatic adult dental patients

Oral Surg Oral Med Oral Pathol 198661(3)289-96

321Van Meerbeek B De Munck J Yoshida Y Inoue S Vargas M Vijay P Van

Landuyt K Lambrechts P Vanherle G Adhesion to enamel and dentin Current

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322Van Meerbeek B Van Landuyt K De Munck JHashimoto M Peumans M

Lambrechts P Yoshida Y Inoue S Suzuki K Technique-sensitivity of

contemporary adhesives Dent Mater J 2005 24(1) 1-13

323Van Meerbeek B Vargas S Inoue S Yoshida Y Peumans M Lambrechts P

Vanherle G Adhesives and cements to promote preservation dentistry Oper Dent

20016 119-144

324Van Meerbeek B Yoshida Y Inoue S Vargas M Abe Y Fukuda R Okazaki

M Lambrechts P Vanherle G Bonding mechanism micro-tensile bond strength of

a 4- MET-based self-etching adhesive J Dent Res 2000 79 249 (Abstract)

58

325Van Nieuwenhuysen JP DrsquoHoore W Carvalho J Qvist V Long-term

evaluation of extensive restorations in permanent teeth J Dent 200331(6)395ndash405

326Venhoven BA de Gee AJ Davidson CL Light initiation of dental resins

dynamics of the polymerization Biomaterials 1996 172313-2318

327Versluis A Douglas WH Cross M Sakaguchi RL Does an incremental filling

technique reduce polymerization shrinkage stresses J Dent Res 1996 75871ndash878

328Vries HC Ruiken HM Konig KG vanrsquot Hof MA Radiographic versus

clinical diagnosis of approximal carious lesions Caries Res1990 24 (5) 364-370

329Waggoner W Ashton J Predictability of cavitation based upon radiographic

appearance comparison of two film types Quintessence International 1989 20(1)

55-60

330Watanabe LG Marshall GW Jr Marshall SJ Dentin shear strength effects of

tubule orientation and intra tooth location Dent Mater 1996 12 109-115

331Watts DC AS Marouf Optimal specimen geometry in bonded-disk

shrinkage-strain measurements on light-cured biomaterials Dent Mater 200016447ndash

451

332Watts DC Marouf AS Al-Hindi AM Photo-polymerization shrinkage-stress

kinetics in resin-composites methods development Dent Mater 2003 191ndash11

333Weaver WS Blank LW Pelleu GB Jr A visible light activated resin cured

through tooth structure GenDent 198836236-7

334Wendt SL Microleakage and cusp fracture resistance of heattreated composite

resin inlays Am J Dent 4(1)10-14 1991

335Wenzel A Hintze H Mikkelsen L Mouyen F Radiographic detection of

occlusal caries in noncavitated teeth A comparison of conventional film radiographs

digitized film radiographs and RadioVisioGraphy-Oral Surg Oral Med Oral Pathol

1991 72 621-6

336Wenzel A Hintze H Perception of image quality in direct digital radiography

after application of various image treatment filters for detectability of dental diseases

Dentomaxillofac Radiol 1993 22 131-4

337Wenzel A Computer-aided image manipulation of intraoral radiographs to

enhance diagnosis in dental practice a review Int Dent J 1993 43 99-108

338Wenzel A Digital radiography and caries diagnosis Dento Maxillo Facial

Radiology 27(1)3-11 1998

339Wenzel A Haiter-Neto F Gotfredsen E Risk factors for a false positive test

outcome in diagnosis of caries in approximal surfaces impact of radiographic

modality and observer characteristics Caries Res 200741(3)170-6

340Wibowo G Stockton L Microleakage of class II composite restorations Am J

Dent 200114177ndash185

341Wilson NHF Wastell DG Norman RD Five-year performance of high-

cooper content amalgam restorations in a multiclinical trial JDent1996 24 203-210

342Winkler MM Katona TR Paydar NH Finite element stress analysis of three

filling techniques for class V light-cured composite restorations J Dent Res

1996751477-83

343Yap AU Effectiveness of polymerization in composite restoratives claiming bulk

placement Impact of cavity depth and exposure time Oper Dent 2000 25113-120

59

344Yeşilyurt C Bulucu B Bond strength of total-etch dentin adhesive systems on

peripheral and central dentinal tissue a microtensile bond strength test The Journal of

Contemporary Dental Practice 7(2) 20061-13

345Yoshida Y Van Meerbeek B Okazaki M Shintani H Suzuki K Comparative

study on adhesive performance of functional monomers J Dent Res 2004 83 454-

458

346Yoshiyama M Tay FR Doi J Nishitani Y Yamada T Itou K Carvalho RM

Nakajima M Pashley DH Bonding of self-etch and total etch adhesives to carious

dentin J Dent Res 2002 81 556-560

  • COPERTA REZUMAT ENGLEZA (MEREUTA)pdf
  • REZUMAT ENGLEZA DR MEREUTA DENISSpdf
Page 54: UNIVERSITATEA DE MEDICINA SI FARMACIE “GR Doctorat/Rezumat... · universitatea de medicina si farmacie “gr.t.popa” iasi facultatea de medicina dentara rezumatul tezei de doctorat

51

206Mejare I Malmgreen B Clinical and radiographic appearance of proximal

carious lesions at the time of operative treatment in young permanent teeth Scand J

Dent Res 1988 94 19-26

207Mendonccedila JS Neto RG Santiago SL Lauris JR Navarro MF de Carvalho

RM Direct resin composite restorations versus indirect composite inlays one-year

results J Contemp Dent Pract 2010 May 111(3)025-32

208Mialhe FL Pereira AC Meneghim Mde C Ambrosano GM Pardi V The

relative diagnostic yields of clinical FOTI and radiographic examinations for the

detection of approximal caries in youngsters Indian J Dent Res 200920(2)136-40

209Miguel A JC La Macorra A predictive formula of the contraction stress in

restorative and luting materials attending to free and adhered surfaces volume and

deformation Dent Mater 200117241ndash246

210Mileman PA van der Weele IT Accuracy in radiographic diagnosis Dutch

practitioners and dental caries JDent1990 18(3) 130-136

211Millar BJ Robinson PB Eight year results with direct ceramic restorations

(Cerana) Br Dent J 2006 Oct 21201(8)515-20

212Millar BJ Cerana-a direct ceramic inlay technique

PrimDentCare1999Apr659-62

213Mjor IA Amalgam and composite resin restorations longevity and reasons for

replacement In Anusavice K Quality evaluation of dental restorations Chicago

Quintessence 198961-80

214Mjor IA Long term cost of restorative therapy using different materials

ScandJDRes 199210060-65

215Mjor IA The reasons for replacement and the age of failed restorations in

general dental practice Acta OdontolScand19975558-63

216Mjoumlr IA Moorhead JE Selection of restorative materials reasons for

replacement and longevity of restorations in Florida J Am Coll Dent 199865(3)27ndash

33

217Mjoumlr IA Jokstad A Qvist V Longevity of posterior restorations Int Dent J

19904011ndash7

218Meyer G Marienhagen B Motsch A Eine Langzeitstudie an Amalgam und

Kunststoff-FullungenDtschZahnartzlicher 1991 46 222-225

219Mohan B Kandaswamy D A confocal microscopic evaluation of resin-dentin

interface using adhesive systems with three different solvents bonded to dry and moist

dentinmdashan in vitro study Quintessence Int 2005 36511ndash521

220Moffa JP Comparative performance of amalgam and composite resin

restorations and criteria for their use In Quality evaluation of dental restorations

criteria for placement and replacement Proceedings of the International Symposium

on Criteria for Placement and Replacement of Dental Restorations Oct 19ndash21 1987

Lake Buena Vista Fla Hanover Park Ill Quintessence 1989125-138

221Monteiro PM Manso MC Gavinha S Melo P Two-year clinical evaluation of

packable and nanostructured resin-based composites placed with two techniques J

Am Dent Assoc 2010 141(3)319-29

52

222Nakajima M Sano H Burrow MF Tagami J Yoshiyama M Ebisu S

Ciucchi B Russell CM Pashley DH Tensile bond strength and SEM evaluation of

caries-affected dentin using dentin adhesives J Dent Res 1995 74 1679-1688

223Nakajima M Sano H Urabe I Tagami J Pashley DH Bond strengths of

single-bottle dentin adhesives to caries- affected dentin Oper Dent 2000 25 2-10

224Navarrete M Rivera-Torres F Vera-Graziano R Villagraacuten-Muniz M The

evolution of the longitudinal modulus during the photopolymerization of a bis-

GMATEGDMA resin by pulsed photoacoustic technique J Phys IV France 2005

125749-751

225Neiva IF MA De Andrada LN Baratieri S Monteiro JrAV Ritter An

in vitro study of the effect of restorative technique on marginal leakage in posterior

composites Oper Dent 23 1998282ndash289

226Niu Y Ma X Fan M Zhu S Effects of layering techniques on the micro-tensile

bond strength to dentin in resin composite restorations Dent Mater 200925(1)129-

34

227Neuhaus KW Ellwood R Lussi A Pitts N Traditional lesion detection aids

Monogr Oral Sci 20092142-51

228Neuhaus KW Longbottom C Ellwood R Lussi ANovel lesion detection aids

Monogr Oral Sci 20092152-62

229Nordbo H Leirskar J von der Fehr FR Saucer-shaped cavity preparations for

posterior approximal resin composite restorations Observations up to 10 years

Quintessence Int 1998295ndash11

230Novaes TF Matos R Raggio DP Imparato JC Braga MM Mendes FM

Influence of the Discomfort Reported by Children on the Performance of Approximal

Caries Detection Methods Caries Res 2010 Sep 2344(5)465-471

231Opdam NJ Bronkhorst EM Roeters JM Loomans BA Longevity and

reasons for failure of sandwich and total-etch posterior composite resin restorations J

Adhes Dent 20079(5)469-75

232Opdam NJ Bronkhorst EM Roeters JM Loomans BA A retrospective

clinical study on longevity of posterior composite and amalgam restorations Dent

Mater 200723(1)2-8

234Ozer F Unlu N Sengun A Influence of dentinal regions on bond strengths of

different adhesive systems J Oral Rehabil 2003 30 659-663

235Pardal D Hegde M Clinical Evaluation Of Different Posterior Composite

Restorative Materials In Class I And Class II Restorations An In-Vivo Study The

Internet Journal of Dental Science 2009 7 (2)

236Pashley DH Andringa HJ Derkson GD Derkson ME Kalathoor SR

Regional variability in the permeability of human dentine Arch Oral Biol

198732(7)519-23

237Pashley DH Pashley EL Carvalho RM Tay FR The effects of dentin

permeability on restorative dentistry Dent Clin North Am 2002 46(2)211-45

238Pashley DH Pashley EL Dentin permeability and restorative dentistry a status

report for the American Journal of Dentistry Am J Dent 1991 4(1)5-9

239Pashley DH Tay FR Aggressiveness of contemporary self-etching adhesives

Part II Etching effects on unground enamel Dent Mater 2001 17 430-444

53

240Pashley DH Dentin a dynamic substrate--a reviewScanning

Microsc19893(1)161-74

241Paterson FM Paterson RC Watts A Blinkhorn AS Initial stages in the

development of valid criteria for the replacement of amalgam restaorations J Dent

199523(3)137-43

242Pereira PN Okuda M Sano H Yoshikawa T Burrow MF Tagami J Effect

of intrinsic wetness and regional difference on dentin bond strength Dent Mater

1999 15(1)46-53

243Perdigao J Lopes M Dentin bonding questions for the new millennium J

Adhes Dent 1999 1(3)191-209

244Peutzfeldt A Asmussen E Composite restorations influence of flowable and

self-curing resin composite linings on microleakage in vitro Oper Dent 200227

569ndash575

245Pieper K Meyer G Marienhagen B Motsch A Eine Langzeitstudie an

Amalgam und Kunststoff-FullungenDtschZahnartzlicher 1991 46 222-225

246Plasmans PJM Creugers NHJ Mulder J Long-term survival of extensive

amalgam restaorations JDentRes 1998 77 453-460

247Pontual AA de Melo D de Almeida S Boacutescolo F Haiter Neto FComparison

of digital systems and conventional dental film for the detection of approximal enamel

caries Dentomaxillofac Radiol 2010 Oct39(7)431-6

248Poon EC Smales RJ Yip KHClinical evaluation of packable and conventional

hybrid posterior resin-based composites results at 35 years JADA

2005136(11)1533-40

249Poorterman JH Aartman IH Kalsbeek H Underestimation of the prevalence

of approximal caries and inadequate restorations in a clinical epidemiological study

Community Dent Oral Epidemiol 1999 Oct27(5)331-7

250Poorterman JH Weerheijm KL Groen HJ Kalsbeek H Clinical and

radiographic judgement of occlusal caries in adolescents Eur J Oral Sci 2000 108

(2) 93-98

251Poulsen S Bille J Rugg-Gunn AJ Evaluation of a calibration trial to increase

interexaminer reliability of radiographic diagnosis of approximal carious lesions

Community Dent Oral Epidemiol 1980 Jun8(3)135-8

252Prati C Pashley DH Dentin wetness permeability and thickness and bond

strength of adhesive resins Am J Dent 1992 5 33-38

253Prati C Early marginal microleakage in class II resin composite restorations

Dent Mater 1989 5 392-398

254Price RB Rizkalla AS Hall GC Effect of stepped light exposure on the

volumetric polymerization shrinkage and bulk modulus of dental composites and an

unfilled resin Am J Dent 200013176ndash180

255Radhika M Girija S 1 Kumaraswamy B Neetu M Effect of different

placement techniques on marginal microleakage of deep class-II cavities restored with

two composite resin formulations J Conserv Dent 2010 13(1) 9ndash15

54

256Radu TM A Uliuliuc Dana Apostolide S Andrian The effect of adhesive

system on microleakage in cervical composite resin restorations Rev Med Chir

Soc Med Iaşi-2008 vol112 nr1supl1145-147

257Raskin A Michotte-Theall B Vreven J Wilson NH Clinical evaluation of a

posterior composite 10-year report J Dent 199927(1) 13ndash19

258Rasmusson CG Lundin SA Class II restorations in six different posterior

composite resins Five-year results Swed Dent J 1995 19 173-182

259Rezwani-Kaminski T Kamann W Gaengler P Secondary caries susceptibility

of teeth with long-term performing composite restorations J Oral Rehabil 2002

29(12)1131ndash1138

260Roberson TM Heymann HO Swift EJ eds Sturdevantlsquos Art and Science of

Operative Dentistry 5th ed St Louis Mosby 2006293-7

261Robertello FJ Pink FE The effect of a training program on the reliability of

examiners evaluating amalgam restorations Oper Dent 1997 Mar-Apr22(2)57-65

262Rodrigues JSA Pin LF Machado G Della Bona A Demarco FF Influence

of different restorative techniques on marginal seal of class II composite restorations

J Appl Oral Sci 2010 Feb18(1)37-43

263Roulet JF Noack MJCriteria for substituting amalgam with composite resins

Int Dent J 199141(4)195-205

264Roulet J-F Soderholm KJM Longmate J Effects of treatment and storage

conditions on ceramiccomposite bond strength J Dent Res 1995 74(l)381-387

265Roulet JF Longevity of ceramic inlays and amalgam- results up 6 years

ClinOral Invest1997140-46

266Roulet JFBenefits and disadvantages of tooth-coloured alternatives to amalgam

J Dent 199725(6)459-73

267Rueggeberg FA WF Caughman JW Curtis Jr HC Davis Factors

affecting cure at depths within light-activated resin composites Am J Dent

1993691ndash95

268Rueggeberg FA Ergle JW Mettenburg DJ Polymerization depths of

contemporary light curing units using microhardness J Esthet Dent 200012340-9

269Rushton VE Horner K Worthington HV Screening panoramic radiography

of new adult patients diagnostic yield when combined with bitewing radiography and

identification of selection criteria Br Dent J 2002 Mar 9192(5)275-9

270Ruyter IE Types of resin-based inlay materials and their properties Int Dent J

199242(3)139-44

271Sajjan GS Mittal NEffect of different placement techniques on marginal

microleakage of deep class-II cavities restored with two composite resin formulations

J Conserv Dent 201013(1)9-15

272Sakaguchi RL MC Peters SR Nelson WH Douglas HW Poort Effects

of polymerization contraction in composite restorations J Dent 1992 20178ndash182

273Sakaguchi RL Shah NC Lim BS Ferracane JL Borgersen SE Dynamic

mechanical analysis of storage modulus development in lightactivated polymer matrix

composites Dent Mater 200218197-202

274Sano H Takatsu T Ciucchi B Horner JA Matthews WG Pashley DH

Nanoleakage leakage within the hybrid layer Oper Dent 1995 20 18-25

55

275Sarrett DC Clinical challenges and the relevance of materials testing for

posterior composite restorations Dent Mater 200521(1) 9ndash12

276Sarrett DC Brooks CN Rose JT Clinical performance evaluation of a

packable posterior composite in bulk-cured restorations JADA 2006 137(1)71ndash80

277Shackelford JF Introduction to Materials Science for Engineers fourth

edition 1996

278Schirrmeister JF Huber K Hellwig E Hahn P Four-year evaluation of a resin

composite including nanofillers in posterior cavities J Adhes Dent 200911(5)399-

404

279Schneiderman A Elbaum M Schultz T Keem S Greenebaum M Driller J

Assessment of dental caries with Digital Imaging Fiber-Optic Transillumination (DI-

FOTI)in vitro studyCaries Res 1997 31(2) 103-110

280Schulte AG Wittchen A Stachniss V Jacquet W Bottenberg P Approximal

caries diagnosis after data import from different digital radiography systems

interobserver agreement and comparison to histological hard-tissue sections Caries

Res 200842(1)57-61

281Shortall AC Marginal seal comparisons between resinbonded Class II porcelain

inlays posterior composite restorationsand direct composite resin inlays Int J

Prosthodont19892(3)217-223

282Seghi RR Denry 1L Rosenstiel SF Relative fracture toughness and hardness

of new dental ceramics J Prosthet Dent 199574(2)145-150

283Sengun A Koyuturk AE Sener Y Ozer F Effect of desensitizers on the bond

strength of a self-etching adhesive system to caries affected dentin on the gingival

wall Oper Dent 2005 30(4)430-435

284Sengun A Unlu N Ozer F Ozturk B Bond strength of five current adhesives

to caries-affected dentin J Oral Rehabil 2002 29 777-781

285Setcos JC Staninec M Wilson NH- A two-year randomized controlled

clinical evaluation of bonded amalgam restorations- Journal of Adhesive Dentistry

nr11999

286Sideridou I Tserki V Papanastasiou G Effect of chemical structure on degree

of conversion in light-cured dimethacrylate-based dental resins Biomaterials 2002

231819-1829

287Sideridou I Tserki V Papanastasiou G Study of water sorption solubility and

modulus of elasticity of light-cured dimethacrylate-based dental resins Biomaterials

2003 24655-665

288Sidi AD Naylor MN A comparison of bitewing radiography and interdental

transillumination as adjuncts to the clinical identification of approximal caries in

posterior teeth Br Dent J 1988 164 (1) 15-18

289SilverFH Christiansen DLBiomaterials Science and Biocompatibility New

York Springer-Verlag 1999

290Simecek JW Diefenderfer KE Ahlf RL Ragain JC Jr Longitudinal trends in

restorative treatment needs among a cohort of US naval personnel J Dent Res

200382 1169 (Abstract)

291Simecek JW Diefenderfer KE Ahlf RL Ragain JC Jr Dental sealant

longevity in a cohort of young US naval personnel JADA 2005136(2)171ndash178

56

292Simi B Suprabha B Evaluation of microleakage in posterior nanocomposite

restorations with adhesive liners J Conserv Dent 201114(2)178-81

293Simone D David N B An alternative to reduce polimeryzation shrinkage in

direct posterior restorations JADA 2002 101387-1398

294Smales RJ Longevity of cusp-covered amalgams survivals after 15 years

OperDent 1991 16 17-20

295Smales RJ Webster DA Leppard PISurvival predictions of amalgam

restorations JDent1991 19 272-277

296Smales RJ Hawthorne WSLong-term survival of extensive amalgams and

posterior crowns JDent 1997 25 225-227

297Soncini JA Maserejian NN Trachtenberg F Tavares M Hayes C The

longevity of amalgam versus compomercomposite restorations in posterior primary

and permanent teeth findings From the New England Childrens Amalgam Trial J

Am Dent Assoc 2007 Jun138(6)763-72

298Sonoda H Banerjee A Sherriff M Tagami J Watson TF An in vitro

investigation of microtensile bond strengths of two dentine adhesives to caries-

affected dentine J Dent 2005 33(4)335-342

299Soodabeh Kimyai Masomeh Mehdipour Siavash Savadi Oskoee Reasons

for retreatment of amalgam and composite restorations among the pacients referring

to Tabriz Faculty of dentistry J Dental Research Clinics Dental Prospects vol 1

no1(2007)

300De Souza FB Guimaraes RP Vicente Silva CH A clinical evaluation of

packable and microhybrid resin composite restorations one year report Quintessence

International 2005 36 41-48

301Spreafico RC Gagliani M Composite resin restorations on posterior teeth In

Roulet JF Degrange M Adhesion The silent revolution in dentistry Chicago

Quintessence 2000253ndash76

302St Georges AJ Wilder AD Jr Perdigao J Microleakage of Class V composites

using different placement and curing techniques an in vitro study Am J Dent 2002

15244-247

303Stangel I Barolet RY Clinical evaluation of two posterior composite resins

Two-year results J Oral Rehabil 1990 17 257-268

304Stephen KW Russell JI Creanor SL Comparison of fibre optic

transillumination with clinical and radiographic caries diagnosis Community

Dentistry and Oral Epidemiology 1987 15 (2) 90-94

305Sturdevant JR Bayne SC Heymann HO Margin gap size of ceramic inlays

using second-generation CADCAM equipment J Esthet Dent 11(4)206-214 1999

306Suh BI A study of the compatibility of adhesives with composites Proceeding

from the SCO Dental Products Inc Symposium 2003 24(8) 4-9 (Abstract)

307Summit JB Burgess JO Berry TG Six-year clinical evaluation of bonded and

pin-retained complex amalgam restorations Oper Dent 2004 29269-276

308Summit JB Robbins JW Hilton TJ Fundamentals in operative dentistry Cap

10Direct Posterior Esthetic Restorations 2006 Quintessence Publishing Co

57

309Svanberg M Mjor IA Orstavik D Mutans streptococci in plaque from margins

of amalgam composite and glassndashionomer restorations J Dent Res 199069861ndash

864

310Tanne K Mamoru S Burstone C Three-dimensional finite element analysis

for stress in the periodontal tissue by orthodontic forcesAm J Orthod Dentofacial

Orthop921987499ndash505

311Tanumiharja M Burrow MF Tyas MJ Microtensile bond strengths of seven

dentin adhesive systems Dent Mater 2000 16(3)180-7

312Tay FR Pashley DH Aggressiveness of contemporary self-etching systems

Part I Depth of penetration beyond dentin smear layers Dent Mater 2001 17(4) 296-

308

313Tay FR Frankenberger R Krejci I Bouillaguet S Pashley DH Carvalho

RM Single-bottle adhesives behave as permeable membranes after polymerization I

In vivo evidence J Dent 2004 32611ndash621

314Tay FR Pashley DH Have dentin adhesives become too hydrophilic J Can

Dent Assoc 2003 69726ndash731

315Tay FR Sano H Carvalho R Pashley EL Pashley DH An ultrastructural

study of the influence of acidity of self-etching primers and smear layer thickness on

bonding to intact dentin J Adhes Dent 2000 283ndash98

316Thompson JY Bayne SC Heymann HO Mechanical properties of a new

mica-based machinable glass ceramic for CADCAM restorations J Prosthet Dent

76(6)619-623 1996

317Unterbrink GL R Muessner Influence of light intensity on two restorative

systems J Dent 199523183ndash189

318Unterbrink GL Liebenberg WH Flowable resin composites as filled

adhesiveslsquo literature review and clinical recommendations Quintessence Int

199930249ndash257

319Vaarkamp J Ten Bosch J Verdonschot EH Quantitative diagnosis of small

approximal caries lesions utilizing wavelength-dependent fiber-optic

transillumination Journal of Dental Research 1997 76 (4) 875-882

320Valachovic RW Douglass CW Reiskin AB Chauncey HH McNeil BJ The

use of panoramic radiography in the evaluation of asymptomatic adult dental patients

Oral Surg Oral Med Oral Pathol 198661(3)289-96

321Van Meerbeek B De Munck J Yoshida Y Inoue S Vargas M Vijay P Van

Landuyt K Lambrechts P Vanherle G Adhesion to enamel and dentin Current

status and future challenges Oper Dent 2003 28 215-235

322Van Meerbeek B Van Landuyt K De Munck JHashimoto M Peumans M

Lambrechts P Yoshida Y Inoue S Suzuki K Technique-sensitivity of

contemporary adhesives Dent Mater J 2005 24(1) 1-13

323Van Meerbeek B Vargas S Inoue S Yoshida Y Peumans M Lambrechts P

Vanherle G Adhesives and cements to promote preservation dentistry Oper Dent

20016 119-144

324Van Meerbeek B Yoshida Y Inoue S Vargas M Abe Y Fukuda R Okazaki

M Lambrechts P Vanherle G Bonding mechanism micro-tensile bond strength of

a 4- MET-based self-etching adhesive J Dent Res 2000 79 249 (Abstract)

58

325Van Nieuwenhuysen JP DrsquoHoore W Carvalho J Qvist V Long-term

evaluation of extensive restorations in permanent teeth J Dent 200331(6)395ndash405

326Venhoven BA de Gee AJ Davidson CL Light initiation of dental resins

dynamics of the polymerization Biomaterials 1996 172313-2318

327Versluis A Douglas WH Cross M Sakaguchi RL Does an incremental filling

technique reduce polymerization shrinkage stresses J Dent Res 1996 75871ndash878

328Vries HC Ruiken HM Konig KG vanrsquot Hof MA Radiographic versus

clinical diagnosis of approximal carious lesions Caries Res1990 24 (5) 364-370

329Waggoner W Ashton J Predictability of cavitation based upon radiographic

appearance comparison of two film types Quintessence International 1989 20(1)

55-60

330Watanabe LG Marshall GW Jr Marshall SJ Dentin shear strength effects of

tubule orientation and intra tooth location Dent Mater 1996 12 109-115

331Watts DC AS Marouf Optimal specimen geometry in bonded-disk

shrinkage-strain measurements on light-cured biomaterials Dent Mater 200016447ndash

451

332Watts DC Marouf AS Al-Hindi AM Photo-polymerization shrinkage-stress

kinetics in resin-composites methods development Dent Mater 2003 191ndash11

333Weaver WS Blank LW Pelleu GB Jr A visible light activated resin cured

through tooth structure GenDent 198836236-7

334Wendt SL Microleakage and cusp fracture resistance of heattreated composite

resin inlays Am J Dent 4(1)10-14 1991

335Wenzel A Hintze H Mikkelsen L Mouyen F Radiographic detection of

occlusal caries in noncavitated teeth A comparison of conventional film radiographs

digitized film radiographs and RadioVisioGraphy-Oral Surg Oral Med Oral Pathol

1991 72 621-6

336Wenzel A Hintze H Perception of image quality in direct digital radiography

after application of various image treatment filters for detectability of dental diseases

Dentomaxillofac Radiol 1993 22 131-4

337Wenzel A Computer-aided image manipulation of intraoral radiographs to

enhance diagnosis in dental practice a review Int Dent J 1993 43 99-108

338Wenzel A Digital radiography and caries diagnosis Dento Maxillo Facial

Radiology 27(1)3-11 1998

339Wenzel A Haiter-Neto F Gotfredsen E Risk factors for a false positive test

outcome in diagnosis of caries in approximal surfaces impact of radiographic

modality and observer characteristics Caries Res 200741(3)170-6

340Wibowo G Stockton L Microleakage of class II composite restorations Am J

Dent 200114177ndash185

341Wilson NHF Wastell DG Norman RD Five-year performance of high-

cooper content amalgam restorations in a multiclinical trial JDent1996 24 203-210

342Winkler MM Katona TR Paydar NH Finite element stress analysis of three

filling techniques for class V light-cured composite restorations J Dent Res

1996751477-83

343Yap AU Effectiveness of polymerization in composite restoratives claiming bulk

placement Impact of cavity depth and exposure time Oper Dent 2000 25113-120

59

344Yeşilyurt C Bulucu B Bond strength of total-etch dentin adhesive systems on

peripheral and central dentinal tissue a microtensile bond strength test The Journal of

Contemporary Dental Practice 7(2) 20061-13

345Yoshida Y Van Meerbeek B Okazaki M Shintani H Suzuki K Comparative

study on adhesive performance of functional monomers J Dent Res 2004 83 454-

458

346Yoshiyama M Tay FR Doi J Nishitani Y Yamada T Itou K Carvalho RM

Nakajima M Pashley DH Bonding of self-etch and total etch adhesives to carious

dentin J Dent Res 2002 81 556-560

  • COPERTA REZUMAT ENGLEZA (MEREUTA)pdf
  • REZUMAT ENGLEZA DR MEREUTA DENISSpdf
Page 55: UNIVERSITATEA DE MEDICINA SI FARMACIE “GR Doctorat/Rezumat... · universitatea de medicina si farmacie “gr.t.popa” iasi facultatea de medicina dentara rezumatul tezei de doctorat

52

222Nakajima M Sano H Burrow MF Tagami J Yoshiyama M Ebisu S

Ciucchi B Russell CM Pashley DH Tensile bond strength and SEM evaluation of

caries-affected dentin using dentin adhesives J Dent Res 1995 74 1679-1688

223Nakajima M Sano H Urabe I Tagami J Pashley DH Bond strengths of

single-bottle dentin adhesives to caries- affected dentin Oper Dent 2000 25 2-10

224Navarrete M Rivera-Torres F Vera-Graziano R Villagraacuten-Muniz M The

evolution of the longitudinal modulus during the photopolymerization of a bis-

GMATEGDMA resin by pulsed photoacoustic technique J Phys IV France 2005

125749-751

225Neiva IF MA De Andrada LN Baratieri S Monteiro JrAV Ritter An

in vitro study of the effect of restorative technique on marginal leakage in posterior

composites Oper Dent 23 1998282ndash289

226Niu Y Ma X Fan M Zhu S Effects of layering techniques on the micro-tensile

bond strength to dentin in resin composite restorations Dent Mater 200925(1)129-

34

227Neuhaus KW Ellwood R Lussi A Pitts N Traditional lesion detection aids

Monogr Oral Sci 20092142-51

228Neuhaus KW Longbottom C Ellwood R Lussi ANovel lesion detection aids

Monogr Oral Sci 20092152-62

229Nordbo H Leirskar J von der Fehr FR Saucer-shaped cavity preparations for

posterior approximal resin composite restorations Observations up to 10 years

Quintessence Int 1998295ndash11

230Novaes TF Matos R Raggio DP Imparato JC Braga MM Mendes FM

Influence of the Discomfort Reported by Children on the Performance of Approximal

Caries Detection Methods Caries Res 2010 Sep 2344(5)465-471

231Opdam NJ Bronkhorst EM Roeters JM Loomans BA Longevity and

reasons for failure of sandwich and total-etch posterior composite resin restorations J

Adhes Dent 20079(5)469-75

232Opdam NJ Bronkhorst EM Roeters JM Loomans BA A retrospective

clinical study on longevity of posterior composite and amalgam restorations Dent

Mater 200723(1)2-8

234Ozer F Unlu N Sengun A Influence of dentinal regions on bond strengths of

different adhesive systems J Oral Rehabil 2003 30 659-663

235Pardal D Hegde M Clinical Evaluation Of Different Posterior Composite

Restorative Materials In Class I And Class II Restorations An In-Vivo Study The

Internet Journal of Dental Science 2009 7 (2)

236Pashley DH Andringa HJ Derkson GD Derkson ME Kalathoor SR

Regional variability in the permeability of human dentine Arch Oral Biol

198732(7)519-23

237Pashley DH Pashley EL Carvalho RM Tay FR The effects of dentin

permeability on restorative dentistry Dent Clin North Am 2002 46(2)211-45

238Pashley DH Pashley EL Dentin permeability and restorative dentistry a status

report for the American Journal of Dentistry Am J Dent 1991 4(1)5-9

239Pashley DH Tay FR Aggressiveness of contemporary self-etching adhesives

Part II Etching effects on unground enamel Dent Mater 2001 17 430-444

53

240Pashley DH Dentin a dynamic substrate--a reviewScanning

Microsc19893(1)161-74

241Paterson FM Paterson RC Watts A Blinkhorn AS Initial stages in the

development of valid criteria for the replacement of amalgam restaorations J Dent

199523(3)137-43

242Pereira PN Okuda M Sano H Yoshikawa T Burrow MF Tagami J Effect

of intrinsic wetness and regional difference on dentin bond strength Dent Mater

1999 15(1)46-53

243Perdigao J Lopes M Dentin bonding questions for the new millennium J

Adhes Dent 1999 1(3)191-209

244Peutzfeldt A Asmussen E Composite restorations influence of flowable and

self-curing resin composite linings on microleakage in vitro Oper Dent 200227

569ndash575

245Pieper K Meyer G Marienhagen B Motsch A Eine Langzeitstudie an

Amalgam und Kunststoff-FullungenDtschZahnartzlicher 1991 46 222-225

246Plasmans PJM Creugers NHJ Mulder J Long-term survival of extensive

amalgam restaorations JDentRes 1998 77 453-460

247Pontual AA de Melo D de Almeida S Boacutescolo F Haiter Neto FComparison

of digital systems and conventional dental film for the detection of approximal enamel

caries Dentomaxillofac Radiol 2010 Oct39(7)431-6

248Poon EC Smales RJ Yip KHClinical evaluation of packable and conventional

hybrid posterior resin-based composites results at 35 years JADA

2005136(11)1533-40

249Poorterman JH Aartman IH Kalsbeek H Underestimation of the prevalence

of approximal caries and inadequate restorations in a clinical epidemiological study

Community Dent Oral Epidemiol 1999 Oct27(5)331-7

250Poorterman JH Weerheijm KL Groen HJ Kalsbeek H Clinical and

radiographic judgement of occlusal caries in adolescents Eur J Oral Sci 2000 108

(2) 93-98

251Poulsen S Bille J Rugg-Gunn AJ Evaluation of a calibration trial to increase

interexaminer reliability of radiographic diagnosis of approximal carious lesions

Community Dent Oral Epidemiol 1980 Jun8(3)135-8

252Prati C Pashley DH Dentin wetness permeability and thickness and bond

strength of adhesive resins Am J Dent 1992 5 33-38

253Prati C Early marginal microleakage in class II resin composite restorations

Dent Mater 1989 5 392-398

254Price RB Rizkalla AS Hall GC Effect of stepped light exposure on the

volumetric polymerization shrinkage and bulk modulus of dental composites and an

unfilled resin Am J Dent 200013176ndash180

255Radhika M Girija S 1 Kumaraswamy B Neetu M Effect of different

placement techniques on marginal microleakage of deep class-II cavities restored with

two composite resin formulations J Conserv Dent 2010 13(1) 9ndash15

54

256Radu TM A Uliuliuc Dana Apostolide S Andrian The effect of adhesive

system on microleakage in cervical composite resin restorations Rev Med Chir

Soc Med Iaşi-2008 vol112 nr1supl1145-147

257Raskin A Michotte-Theall B Vreven J Wilson NH Clinical evaluation of a

posterior composite 10-year report J Dent 199927(1) 13ndash19

258Rasmusson CG Lundin SA Class II restorations in six different posterior

composite resins Five-year results Swed Dent J 1995 19 173-182

259Rezwani-Kaminski T Kamann W Gaengler P Secondary caries susceptibility

of teeth with long-term performing composite restorations J Oral Rehabil 2002

29(12)1131ndash1138

260Roberson TM Heymann HO Swift EJ eds Sturdevantlsquos Art and Science of

Operative Dentistry 5th ed St Louis Mosby 2006293-7

261Robertello FJ Pink FE The effect of a training program on the reliability of

examiners evaluating amalgam restorations Oper Dent 1997 Mar-Apr22(2)57-65

262Rodrigues JSA Pin LF Machado G Della Bona A Demarco FF Influence

of different restorative techniques on marginal seal of class II composite restorations

J Appl Oral Sci 2010 Feb18(1)37-43

263Roulet JF Noack MJCriteria for substituting amalgam with composite resins

Int Dent J 199141(4)195-205

264Roulet J-F Soderholm KJM Longmate J Effects of treatment and storage

conditions on ceramiccomposite bond strength J Dent Res 1995 74(l)381-387

265Roulet JF Longevity of ceramic inlays and amalgam- results up 6 years

ClinOral Invest1997140-46

266Roulet JFBenefits and disadvantages of tooth-coloured alternatives to amalgam

J Dent 199725(6)459-73

267Rueggeberg FA WF Caughman JW Curtis Jr HC Davis Factors

affecting cure at depths within light-activated resin composites Am J Dent

1993691ndash95

268Rueggeberg FA Ergle JW Mettenburg DJ Polymerization depths of

contemporary light curing units using microhardness J Esthet Dent 200012340-9

269Rushton VE Horner K Worthington HV Screening panoramic radiography

of new adult patients diagnostic yield when combined with bitewing radiography and

identification of selection criteria Br Dent J 2002 Mar 9192(5)275-9

270Ruyter IE Types of resin-based inlay materials and their properties Int Dent J

199242(3)139-44

271Sajjan GS Mittal NEffect of different placement techniques on marginal

microleakage of deep class-II cavities restored with two composite resin formulations

J Conserv Dent 201013(1)9-15

272Sakaguchi RL MC Peters SR Nelson WH Douglas HW Poort Effects

of polymerization contraction in composite restorations J Dent 1992 20178ndash182

273Sakaguchi RL Shah NC Lim BS Ferracane JL Borgersen SE Dynamic

mechanical analysis of storage modulus development in lightactivated polymer matrix

composites Dent Mater 200218197-202

274Sano H Takatsu T Ciucchi B Horner JA Matthews WG Pashley DH

Nanoleakage leakage within the hybrid layer Oper Dent 1995 20 18-25

55

275Sarrett DC Clinical challenges and the relevance of materials testing for

posterior composite restorations Dent Mater 200521(1) 9ndash12

276Sarrett DC Brooks CN Rose JT Clinical performance evaluation of a

packable posterior composite in bulk-cured restorations JADA 2006 137(1)71ndash80

277Shackelford JF Introduction to Materials Science for Engineers fourth

edition 1996

278Schirrmeister JF Huber K Hellwig E Hahn P Four-year evaluation of a resin

composite including nanofillers in posterior cavities J Adhes Dent 200911(5)399-

404

279Schneiderman A Elbaum M Schultz T Keem S Greenebaum M Driller J

Assessment of dental caries with Digital Imaging Fiber-Optic Transillumination (DI-

FOTI)in vitro studyCaries Res 1997 31(2) 103-110

280Schulte AG Wittchen A Stachniss V Jacquet W Bottenberg P Approximal

caries diagnosis after data import from different digital radiography systems

interobserver agreement and comparison to histological hard-tissue sections Caries

Res 200842(1)57-61

281Shortall AC Marginal seal comparisons between resinbonded Class II porcelain

inlays posterior composite restorationsand direct composite resin inlays Int J

Prosthodont19892(3)217-223

282Seghi RR Denry 1L Rosenstiel SF Relative fracture toughness and hardness

of new dental ceramics J Prosthet Dent 199574(2)145-150

283Sengun A Koyuturk AE Sener Y Ozer F Effect of desensitizers on the bond

strength of a self-etching adhesive system to caries affected dentin on the gingival

wall Oper Dent 2005 30(4)430-435

284Sengun A Unlu N Ozer F Ozturk B Bond strength of five current adhesives

to caries-affected dentin J Oral Rehabil 2002 29 777-781

285Setcos JC Staninec M Wilson NH- A two-year randomized controlled

clinical evaluation of bonded amalgam restorations- Journal of Adhesive Dentistry

nr11999

286Sideridou I Tserki V Papanastasiou G Effect of chemical structure on degree

of conversion in light-cured dimethacrylate-based dental resins Biomaterials 2002

231819-1829

287Sideridou I Tserki V Papanastasiou G Study of water sorption solubility and

modulus of elasticity of light-cured dimethacrylate-based dental resins Biomaterials

2003 24655-665

288Sidi AD Naylor MN A comparison of bitewing radiography and interdental

transillumination as adjuncts to the clinical identification of approximal caries in

posterior teeth Br Dent J 1988 164 (1) 15-18

289SilverFH Christiansen DLBiomaterials Science and Biocompatibility New

York Springer-Verlag 1999

290Simecek JW Diefenderfer KE Ahlf RL Ragain JC Jr Longitudinal trends in

restorative treatment needs among a cohort of US naval personnel J Dent Res

200382 1169 (Abstract)

291Simecek JW Diefenderfer KE Ahlf RL Ragain JC Jr Dental sealant

longevity in a cohort of young US naval personnel JADA 2005136(2)171ndash178

56

292Simi B Suprabha B Evaluation of microleakage in posterior nanocomposite

restorations with adhesive liners J Conserv Dent 201114(2)178-81

293Simone D David N B An alternative to reduce polimeryzation shrinkage in

direct posterior restorations JADA 2002 101387-1398

294Smales RJ Longevity of cusp-covered amalgams survivals after 15 years

OperDent 1991 16 17-20

295Smales RJ Webster DA Leppard PISurvival predictions of amalgam

restorations JDent1991 19 272-277

296Smales RJ Hawthorne WSLong-term survival of extensive amalgams and

posterior crowns JDent 1997 25 225-227

297Soncini JA Maserejian NN Trachtenberg F Tavares M Hayes C The

longevity of amalgam versus compomercomposite restorations in posterior primary

and permanent teeth findings From the New England Childrens Amalgam Trial J

Am Dent Assoc 2007 Jun138(6)763-72

298Sonoda H Banerjee A Sherriff M Tagami J Watson TF An in vitro

investigation of microtensile bond strengths of two dentine adhesives to caries-

affected dentine J Dent 2005 33(4)335-342

299Soodabeh Kimyai Masomeh Mehdipour Siavash Savadi Oskoee Reasons

for retreatment of amalgam and composite restorations among the pacients referring

to Tabriz Faculty of dentistry J Dental Research Clinics Dental Prospects vol 1

no1(2007)

300De Souza FB Guimaraes RP Vicente Silva CH A clinical evaluation of

packable and microhybrid resin composite restorations one year report Quintessence

International 2005 36 41-48

301Spreafico RC Gagliani M Composite resin restorations on posterior teeth In

Roulet JF Degrange M Adhesion The silent revolution in dentistry Chicago

Quintessence 2000253ndash76

302St Georges AJ Wilder AD Jr Perdigao J Microleakage of Class V composites

using different placement and curing techniques an in vitro study Am J Dent 2002

15244-247

303Stangel I Barolet RY Clinical evaluation of two posterior composite resins

Two-year results J Oral Rehabil 1990 17 257-268

304Stephen KW Russell JI Creanor SL Comparison of fibre optic

transillumination with clinical and radiographic caries diagnosis Community

Dentistry and Oral Epidemiology 1987 15 (2) 90-94

305Sturdevant JR Bayne SC Heymann HO Margin gap size of ceramic inlays

using second-generation CADCAM equipment J Esthet Dent 11(4)206-214 1999

306Suh BI A study of the compatibility of adhesives with composites Proceeding

from the SCO Dental Products Inc Symposium 2003 24(8) 4-9 (Abstract)

307Summit JB Burgess JO Berry TG Six-year clinical evaluation of bonded and

pin-retained complex amalgam restorations Oper Dent 2004 29269-276

308Summit JB Robbins JW Hilton TJ Fundamentals in operative dentistry Cap

10Direct Posterior Esthetic Restorations 2006 Quintessence Publishing Co

57

309Svanberg M Mjor IA Orstavik D Mutans streptococci in plaque from margins

of amalgam composite and glassndashionomer restorations J Dent Res 199069861ndash

864

310Tanne K Mamoru S Burstone C Three-dimensional finite element analysis

for stress in the periodontal tissue by orthodontic forcesAm J Orthod Dentofacial

Orthop921987499ndash505

311Tanumiharja M Burrow MF Tyas MJ Microtensile bond strengths of seven

dentin adhesive systems Dent Mater 2000 16(3)180-7

312Tay FR Pashley DH Aggressiveness of contemporary self-etching systems

Part I Depth of penetration beyond dentin smear layers Dent Mater 2001 17(4) 296-

308

313Tay FR Frankenberger R Krejci I Bouillaguet S Pashley DH Carvalho

RM Single-bottle adhesives behave as permeable membranes after polymerization I

In vivo evidence J Dent 2004 32611ndash621

314Tay FR Pashley DH Have dentin adhesives become too hydrophilic J Can

Dent Assoc 2003 69726ndash731

315Tay FR Sano H Carvalho R Pashley EL Pashley DH An ultrastructural

study of the influence of acidity of self-etching primers and smear layer thickness on

bonding to intact dentin J Adhes Dent 2000 283ndash98

316Thompson JY Bayne SC Heymann HO Mechanical properties of a new

mica-based machinable glass ceramic for CADCAM restorations J Prosthet Dent

76(6)619-623 1996

317Unterbrink GL R Muessner Influence of light intensity on two restorative

systems J Dent 199523183ndash189

318Unterbrink GL Liebenberg WH Flowable resin composites as filled

adhesiveslsquo literature review and clinical recommendations Quintessence Int

199930249ndash257

319Vaarkamp J Ten Bosch J Verdonschot EH Quantitative diagnosis of small

approximal caries lesions utilizing wavelength-dependent fiber-optic

transillumination Journal of Dental Research 1997 76 (4) 875-882

320Valachovic RW Douglass CW Reiskin AB Chauncey HH McNeil BJ The

use of panoramic radiography in the evaluation of asymptomatic adult dental patients

Oral Surg Oral Med Oral Pathol 198661(3)289-96

321Van Meerbeek B De Munck J Yoshida Y Inoue S Vargas M Vijay P Van

Landuyt K Lambrechts P Vanherle G Adhesion to enamel and dentin Current

status and future challenges Oper Dent 2003 28 215-235

322Van Meerbeek B Van Landuyt K De Munck JHashimoto M Peumans M

Lambrechts P Yoshida Y Inoue S Suzuki K Technique-sensitivity of

contemporary adhesives Dent Mater J 2005 24(1) 1-13

323Van Meerbeek B Vargas S Inoue S Yoshida Y Peumans M Lambrechts P

Vanherle G Adhesives and cements to promote preservation dentistry Oper Dent

20016 119-144

324Van Meerbeek B Yoshida Y Inoue S Vargas M Abe Y Fukuda R Okazaki

M Lambrechts P Vanherle G Bonding mechanism micro-tensile bond strength of

a 4- MET-based self-etching adhesive J Dent Res 2000 79 249 (Abstract)

58

325Van Nieuwenhuysen JP DrsquoHoore W Carvalho J Qvist V Long-term

evaluation of extensive restorations in permanent teeth J Dent 200331(6)395ndash405

326Venhoven BA de Gee AJ Davidson CL Light initiation of dental resins

dynamics of the polymerization Biomaterials 1996 172313-2318

327Versluis A Douglas WH Cross M Sakaguchi RL Does an incremental filling

technique reduce polymerization shrinkage stresses J Dent Res 1996 75871ndash878

328Vries HC Ruiken HM Konig KG vanrsquot Hof MA Radiographic versus

clinical diagnosis of approximal carious lesions Caries Res1990 24 (5) 364-370

329Waggoner W Ashton J Predictability of cavitation based upon radiographic

appearance comparison of two film types Quintessence International 1989 20(1)

55-60

330Watanabe LG Marshall GW Jr Marshall SJ Dentin shear strength effects of

tubule orientation and intra tooth location Dent Mater 1996 12 109-115

331Watts DC AS Marouf Optimal specimen geometry in bonded-disk

shrinkage-strain measurements on light-cured biomaterials Dent Mater 200016447ndash

451

332Watts DC Marouf AS Al-Hindi AM Photo-polymerization shrinkage-stress

kinetics in resin-composites methods development Dent Mater 2003 191ndash11

333Weaver WS Blank LW Pelleu GB Jr A visible light activated resin cured

through tooth structure GenDent 198836236-7

334Wendt SL Microleakage and cusp fracture resistance of heattreated composite

resin inlays Am J Dent 4(1)10-14 1991

335Wenzel A Hintze H Mikkelsen L Mouyen F Radiographic detection of

occlusal caries in noncavitated teeth A comparison of conventional film radiographs

digitized film radiographs and RadioVisioGraphy-Oral Surg Oral Med Oral Pathol

1991 72 621-6

336Wenzel A Hintze H Perception of image quality in direct digital radiography

after application of various image treatment filters for detectability of dental diseases

Dentomaxillofac Radiol 1993 22 131-4

337Wenzel A Computer-aided image manipulation of intraoral radiographs to

enhance diagnosis in dental practice a review Int Dent J 1993 43 99-108

338Wenzel A Digital radiography and caries diagnosis Dento Maxillo Facial

Radiology 27(1)3-11 1998

339Wenzel A Haiter-Neto F Gotfredsen E Risk factors for a false positive test

outcome in diagnosis of caries in approximal surfaces impact of radiographic

modality and observer characteristics Caries Res 200741(3)170-6

340Wibowo G Stockton L Microleakage of class II composite restorations Am J

Dent 200114177ndash185

341Wilson NHF Wastell DG Norman RD Five-year performance of high-

cooper content amalgam restorations in a multiclinical trial JDent1996 24 203-210

342Winkler MM Katona TR Paydar NH Finite element stress analysis of three

filling techniques for class V light-cured composite restorations J Dent Res

1996751477-83

343Yap AU Effectiveness of polymerization in composite restoratives claiming bulk

placement Impact of cavity depth and exposure time Oper Dent 2000 25113-120

59

344Yeşilyurt C Bulucu B Bond strength of total-etch dentin adhesive systems on

peripheral and central dentinal tissue a microtensile bond strength test The Journal of

Contemporary Dental Practice 7(2) 20061-13

345Yoshida Y Van Meerbeek B Okazaki M Shintani H Suzuki K Comparative

study on adhesive performance of functional monomers J Dent Res 2004 83 454-

458

346Yoshiyama M Tay FR Doi J Nishitani Y Yamada T Itou K Carvalho RM

Nakajima M Pashley DH Bonding of self-etch and total etch adhesives to carious

dentin J Dent Res 2002 81 556-560

  • COPERTA REZUMAT ENGLEZA (MEREUTA)pdf
  • REZUMAT ENGLEZA DR MEREUTA DENISSpdf
Page 56: UNIVERSITATEA DE MEDICINA SI FARMACIE “GR Doctorat/Rezumat... · universitatea de medicina si farmacie “gr.t.popa” iasi facultatea de medicina dentara rezumatul tezei de doctorat

53

240Pashley DH Dentin a dynamic substrate--a reviewScanning

Microsc19893(1)161-74

241Paterson FM Paterson RC Watts A Blinkhorn AS Initial stages in the

development of valid criteria for the replacement of amalgam restaorations J Dent

199523(3)137-43

242Pereira PN Okuda M Sano H Yoshikawa T Burrow MF Tagami J Effect

of intrinsic wetness and regional difference on dentin bond strength Dent Mater

1999 15(1)46-53

243Perdigao J Lopes M Dentin bonding questions for the new millennium J

Adhes Dent 1999 1(3)191-209

244Peutzfeldt A Asmussen E Composite restorations influence of flowable and

self-curing resin composite linings on microleakage in vitro Oper Dent 200227

569ndash575

245Pieper K Meyer G Marienhagen B Motsch A Eine Langzeitstudie an

Amalgam und Kunststoff-FullungenDtschZahnartzlicher 1991 46 222-225

246Plasmans PJM Creugers NHJ Mulder J Long-term survival of extensive

amalgam restaorations JDentRes 1998 77 453-460

247Pontual AA de Melo D de Almeida S Boacutescolo F Haiter Neto FComparison

of digital systems and conventional dental film for the detection of approximal enamel

caries Dentomaxillofac Radiol 2010 Oct39(7)431-6

248Poon EC Smales RJ Yip KHClinical evaluation of packable and conventional

hybrid posterior resin-based composites results at 35 years JADA

2005136(11)1533-40

249Poorterman JH Aartman IH Kalsbeek H Underestimation of the prevalence

of approximal caries and inadequate restorations in a clinical epidemiological study

Community Dent Oral Epidemiol 1999 Oct27(5)331-7

250Poorterman JH Weerheijm KL Groen HJ Kalsbeek H Clinical and

radiographic judgement of occlusal caries in adolescents Eur J Oral Sci 2000 108

(2) 93-98

251Poulsen S Bille J Rugg-Gunn AJ Evaluation of a calibration trial to increase

interexaminer reliability of radiographic diagnosis of approximal carious lesions

Community Dent Oral Epidemiol 1980 Jun8(3)135-8

252Prati C Pashley DH Dentin wetness permeability and thickness and bond

strength of adhesive resins Am J Dent 1992 5 33-38

253Prati C Early marginal microleakage in class II resin composite restorations

Dent Mater 1989 5 392-398

254Price RB Rizkalla AS Hall GC Effect of stepped light exposure on the

volumetric polymerization shrinkage and bulk modulus of dental composites and an

unfilled resin Am J Dent 200013176ndash180

255Radhika M Girija S 1 Kumaraswamy B Neetu M Effect of different

placement techniques on marginal microleakage of deep class-II cavities restored with

two composite resin formulations J Conserv Dent 2010 13(1) 9ndash15

54

256Radu TM A Uliuliuc Dana Apostolide S Andrian The effect of adhesive

system on microleakage in cervical composite resin restorations Rev Med Chir

Soc Med Iaşi-2008 vol112 nr1supl1145-147

257Raskin A Michotte-Theall B Vreven J Wilson NH Clinical evaluation of a

posterior composite 10-year report J Dent 199927(1) 13ndash19

258Rasmusson CG Lundin SA Class II restorations in six different posterior

composite resins Five-year results Swed Dent J 1995 19 173-182

259Rezwani-Kaminski T Kamann W Gaengler P Secondary caries susceptibility

of teeth with long-term performing composite restorations J Oral Rehabil 2002

29(12)1131ndash1138

260Roberson TM Heymann HO Swift EJ eds Sturdevantlsquos Art and Science of

Operative Dentistry 5th ed St Louis Mosby 2006293-7

261Robertello FJ Pink FE The effect of a training program on the reliability of

examiners evaluating amalgam restorations Oper Dent 1997 Mar-Apr22(2)57-65

262Rodrigues JSA Pin LF Machado G Della Bona A Demarco FF Influence

of different restorative techniques on marginal seal of class II composite restorations

J Appl Oral Sci 2010 Feb18(1)37-43

263Roulet JF Noack MJCriteria for substituting amalgam with composite resins

Int Dent J 199141(4)195-205

264Roulet J-F Soderholm KJM Longmate J Effects of treatment and storage

conditions on ceramiccomposite bond strength J Dent Res 1995 74(l)381-387

265Roulet JF Longevity of ceramic inlays and amalgam- results up 6 years

ClinOral Invest1997140-46

266Roulet JFBenefits and disadvantages of tooth-coloured alternatives to amalgam

J Dent 199725(6)459-73

267Rueggeberg FA WF Caughman JW Curtis Jr HC Davis Factors

affecting cure at depths within light-activated resin composites Am J Dent

1993691ndash95

268Rueggeberg FA Ergle JW Mettenburg DJ Polymerization depths of

contemporary light curing units using microhardness J Esthet Dent 200012340-9

269Rushton VE Horner K Worthington HV Screening panoramic radiography

of new adult patients diagnostic yield when combined with bitewing radiography and

identification of selection criteria Br Dent J 2002 Mar 9192(5)275-9

270Ruyter IE Types of resin-based inlay materials and their properties Int Dent J

199242(3)139-44

271Sajjan GS Mittal NEffect of different placement techniques on marginal

microleakage of deep class-II cavities restored with two composite resin formulations

J Conserv Dent 201013(1)9-15

272Sakaguchi RL MC Peters SR Nelson WH Douglas HW Poort Effects

of polymerization contraction in composite restorations J Dent 1992 20178ndash182

273Sakaguchi RL Shah NC Lim BS Ferracane JL Borgersen SE Dynamic

mechanical analysis of storage modulus development in lightactivated polymer matrix

composites Dent Mater 200218197-202

274Sano H Takatsu T Ciucchi B Horner JA Matthews WG Pashley DH

Nanoleakage leakage within the hybrid layer Oper Dent 1995 20 18-25

55

275Sarrett DC Clinical challenges and the relevance of materials testing for

posterior composite restorations Dent Mater 200521(1) 9ndash12

276Sarrett DC Brooks CN Rose JT Clinical performance evaluation of a

packable posterior composite in bulk-cured restorations JADA 2006 137(1)71ndash80

277Shackelford JF Introduction to Materials Science for Engineers fourth

edition 1996

278Schirrmeister JF Huber K Hellwig E Hahn P Four-year evaluation of a resin

composite including nanofillers in posterior cavities J Adhes Dent 200911(5)399-

404

279Schneiderman A Elbaum M Schultz T Keem S Greenebaum M Driller J

Assessment of dental caries with Digital Imaging Fiber-Optic Transillumination (DI-

FOTI)in vitro studyCaries Res 1997 31(2) 103-110

280Schulte AG Wittchen A Stachniss V Jacquet W Bottenberg P Approximal

caries diagnosis after data import from different digital radiography systems

interobserver agreement and comparison to histological hard-tissue sections Caries

Res 200842(1)57-61

281Shortall AC Marginal seal comparisons between resinbonded Class II porcelain

inlays posterior composite restorationsand direct composite resin inlays Int J

Prosthodont19892(3)217-223

282Seghi RR Denry 1L Rosenstiel SF Relative fracture toughness and hardness

of new dental ceramics J Prosthet Dent 199574(2)145-150

283Sengun A Koyuturk AE Sener Y Ozer F Effect of desensitizers on the bond

strength of a self-etching adhesive system to caries affected dentin on the gingival

wall Oper Dent 2005 30(4)430-435

284Sengun A Unlu N Ozer F Ozturk B Bond strength of five current adhesives

to caries-affected dentin J Oral Rehabil 2002 29 777-781

285Setcos JC Staninec M Wilson NH- A two-year randomized controlled

clinical evaluation of bonded amalgam restorations- Journal of Adhesive Dentistry

nr11999

286Sideridou I Tserki V Papanastasiou G Effect of chemical structure on degree

of conversion in light-cured dimethacrylate-based dental resins Biomaterials 2002

231819-1829

287Sideridou I Tserki V Papanastasiou G Study of water sorption solubility and

modulus of elasticity of light-cured dimethacrylate-based dental resins Biomaterials

2003 24655-665

288Sidi AD Naylor MN A comparison of bitewing radiography and interdental

transillumination as adjuncts to the clinical identification of approximal caries in

posterior teeth Br Dent J 1988 164 (1) 15-18

289SilverFH Christiansen DLBiomaterials Science and Biocompatibility New

York Springer-Verlag 1999

290Simecek JW Diefenderfer KE Ahlf RL Ragain JC Jr Longitudinal trends in

restorative treatment needs among a cohort of US naval personnel J Dent Res

200382 1169 (Abstract)

291Simecek JW Diefenderfer KE Ahlf RL Ragain JC Jr Dental sealant

longevity in a cohort of young US naval personnel JADA 2005136(2)171ndash178

56

292Simi B Suprabha B Evaluation of microleakage in posterior nanocomposite

restorations with adhesive liners J Conserv Dent 201114(2)178-81

293Simone D David N B An alternative to reduce polimeryzation shrinkage in

direct posterior restorations JADA 2002 101387-1398

294Smales RJ Longevity of cusp-covered amalgams survivals after 15 years

OperDent 1991 16 17-20

295Smales RJ Webster DA Leppard PISurvival predictions of amalgam

restorations JDent1991 19 272-277

296Smales RJ Hawthorne WSLong-term survival of extensive amalgams and

posterior crowns JDent 1997 25 225-227

297Soncini JA Maserejian NN Trachtenberg F Tavares M Hayes C The

longevity of amalgam versus compomercomposite restorations in posterior primary

and permanent teeth findings From the New England Childrens Amalgam Trial J

Am Dent Assoc 2007 Jun138(6)763-72

298Sonoda H Banerjee A Sherriff M Tagami J Watson TF An in vitro

investigation of microtensile bond strengths of two dentine adhesives to caries-

affected dentine J Dent 2005 33(4)335-342

299Soodabeh Kimyai Masomeh Mehdipour Siavash Savadi Oskoee Reasons

for retreatment of amalgam and composite restorations among the pacients referring

to Tabriz Faculty of dentistry J Dental Research Clinics Dental Prospects vol 1

no1(2007)

300De Souza FB Guimaraes RP Vicente Silva CH A clinical evaluation of

packable and microhybrid resin composite restorations one year report Quintessence

International 2005 36 41-48

301Spreafico RC Gagliani M Composite resin restorations on posterior teeth In

Roulet JF Degrange M Adhesion The silent revolution in dentistry Chicago

Quintessence 2000253ndash76

302St Georges AJ Wilder AD Jr Perdigao J Microleakage of Class V composites

using different placement and curing techniques an in vitro study Am J Dent 2002

15244-247

303Stangel I Barolet RY Clinical evaluation of two posterior composite resins

Two-year results J Oral Rehabil 1990 17 257-268

304Stephen KW Russell JI Creanor SL Comparison of fibre optic

transillumination with clinical and radiographic caries diagnosis Community

Dentistry and Oral Epidemiology 1987 15 (2) 90-94

305Sturdevant JR Bayne SC Heymann HO Margin gap size of ceramic inlays

using second-generation CADCAM equipment J Esthet Dent 11(4)206-214 1999

306Suh BI A study of the compatibility of adhesives with composites Proceeding

from the SCO Dental Products Inc Symposium 2003 24(8) 4-9 (Abstract)

307Summit JB Burgess JO Berry TG Six-year clinical evaluation of bonded and

pin-retained complex amalgam restorations Oper Dent 2004 29269-276

308Summit JB Robbins JW Hilton TJ Fundamentals in operative dentistry Cap

10Direct Posterior Esthetic Restorations 2006 Quintessence Publishing Co

57

309Svanberg M Mjor IA Orstavik D Mutans streptococci in plaque from margins

of amalgam composite and glassndashionomer restorations J Dent Res 199069861ndash

864

310Tanne K Mamoru S Burstone C Three-dimensional finite element analysis

for stress in the periodontal tissue by orthodontic forcesAm J Orthod Dentofacial

Orthop921987499ndash505

311Tanumiharja M Burrow MF Tyas MJ Microtensile bond strengths of seven

dentin adhesive systems Dent Mater 2000 16(3)180-7

312Tay FR Pashley DH Aggressiveness of contemporary self-etching systems

Part I Depth of penetration beyond dentin smear layers Dent Mater 2001 17(4) 296-

308

313Tay FR Frankenberger R Krejci I Bouillaguet S Pashley DH Carvalho

RM Single-bottle adhesives behave as permeable membranes after polymerization I

In vivo evidence J Dent 2004 32611ndash621

314Tay FR Pashley DH Have dentin adhesives become too hydrophilic J Can

Dent Assoc 2003 69726ndash731

315Tay FR Sano H Carvalho R Pashley EL Pashley DH An ultrastructural

study of the influence of acidity of self-etching primers and smear layer thickness on

bonding to intact dentin J Adhes Dent 2000 283ndash98

316Thompson JY Bayne SC Heymann HO Mechanical properties of a new

mica-based machinable glass ceramic for CADCAM restorations J Prosthet Dent

76(6)619-623 1996

317Unterbrink GL R Muessner Influence of light intensity on two restorative

systems J Dent 199523183ndash189

318Unterbrink GL Liebenberg WH Flowable resin composites as filled

adhesiveslsquo literature review and clinical recommendations Quintessence Int

199930249ndash257

319Vaarkamp J Ten Bosch J Verdonschot EH Quantitative diagnosis of small

approximal caries lesions utilizing wavelength-dependent fiber-optic

transillumination Journal of Dental Research 1997 76 (4) 875-882

320Valachovic RW Douglass CW Reiskin AB Chauncey HH McNeil BJ The

use of panoramic radiography in the evaluation of asymptomatic adult dental patients

Oral Surg Oral Med Oral Pathol 198661(3)289-96

321Van Meerbeek B De Munck J Yoshida Y Inoue S Vargas M Vijay P Van

Landuyt K Lambrechts P Vanherle G Adhesion to enamel and dentin Current

status and future challenges Oper Dent 2003 28 215-235

322Van Meerbeek B Van Landuyt K De Munck JHashimoto M Peumans M

Lambrechts P Yoshida Y Inoue S Suzuki K Technique-sensitivity of

contemporary adhesives Dent Mater J 2005 24(1) 1-13

323Van Meerbeek B Vargas S Inoue S Yoshida Y Peumans M Lambrechts P

Vanherle G Adhesives and cements to promote preservation dentistry Oper Dent

20016 119-144

324Van Meerbeek B Yoshida Y Inoue S Vargas M Abe Y Fukuda R Okazaki

M Lambrechts P Vanherle G Bonding mechanism micro-tensile bond strength of

a 4- MET-based self-etching adhesive J Dent Res 2000 79 249 (Abstract)

58

325Van Nieuwenhuysen JP DrsquoHoore W Carvalho J Qvist V Long-term

evaluation of extensive restorations in permanent teeth J Dent 200331(6)395ndash405

326Venhoven BA de Gee AJ Davidson CL Light initiation of dental resins

dynamics of the polymerization Biomaterials 1996 172313-2318

327Versluis A Douglas WH Cross M Sakaguchi RL Does an incremental filling

technique reduce polymerization shrinkage stresses J Dent Res 1996 75871ndash878

328Vries HC Ruiken HM Konig KG vanrsquot Hof MA Radiographic versus

clinical diagnosis of approximal carious lesions Caries Res1990 24 (5) 364-370

329Waggoner W Ashton J Predictability of cavitation based upon radiographic

appearance comparison of two film types Quintessence International 1989 20(1)

55-60

330Watanabe LG Marshall GW Jr Marshall SJ Dentin shear strength effects of

tubule orientation and intra tooth location Dent Mater 1996 12 109-115

331Watts DC AS Marouf Optimal specimen geometry in bonded-disk

shrinkage-strain measurements on light-cured biomaterials Dent Mater 200016447ndash

451

332Watts DC Marouf AS Al-Hindi AM Photo-polymerization shrinkage-stress

kinetics in resin-composites methods development Dent Mater 2003 191ndash11

333Weaver WS Blank LW Pelleu GB Jr A visible light activated resin cured

through tooth structure GenDent 198836236-7

334Wendt SL Microleakage and cusp fracture resistance of heattreated composite

resin inlays Am J Dent 4(1)10-14 1991

335Wenzel A Hintze H Mikkelsen L Mouyen F Radiographic detection of

occlusal caries in noncavitated teeth A comparison of conventional film radiographs

digitized film radiographs and RadioVisioGraphy-Oral Surg Oral Med Oral Pathol

1991 72 621-6

336Wenzel A Hintze H Perception of image quality in direct digital radiography

after application of various image treatment filters for detectability of dental diseases

Dentomaxillofac Radiol 1993 22 131-4

337Wenzel A Computer-aided image manipulation of intraoral radiographs to

enhance diagnosis in dental practice a review Int Dent J 1993 43 99-108

338Wenzel A Digital radiography and caries diagnosis Dento Maxillo Facial

Radiology 27(1)3-11 1998

339Wenzel A Haiter-Neto F Gotfredsen E Risk factors for a false positive test

outcome in diagnosis of caries in approximal surfaces impact of radiographic

modality and observer characteristics Caries Res 200741(3)170-6

340Wibowo G Stockton L Microleakage of class II composite restorations Am J

Dent 200114177ndash185

341Wilson NHF Wastell DG Norman RD Five-year performance of high-

cooper content amalgam restorations in a multiclinical trial JDent1996 24 203-210

342Winkler MM Katona TR Paydar NH Finite element stress analysis of three

filling techniques for class V light-cured composite restorations J Dent Res

1996751477-83

343Yap AU Effectiveness of polymerization in composite restoratives claiming bulk

placement Impact of cavity depth and exposure time Oper Dent 2000 25113-120

59

344Yeşilyurt C Bulucu B Bond strength of total-etch dentin adhesive systems on

peripheral and central dentinal tissue a microtensile bond strength test The Journal of

Contemporary Dental Practice 7(2) 20061-13

345Yoshida Y Van Meerbeek B Okazaki M Shintani H Suzuki K Comparative

study on adhesive performance of functional monomers J Dent Res 2004 83 454-

458

346Yoshiyama M Tay FR Doi J Nishitani Y Yamada T Itou K Carvalho RM

Nakajima M Pashley DH Bonding of self-etch and total etch adhesives to carious

dentin J Dent Res 2002 81 556-560

  • COPERTA REZUMAT ENGLEZA (MEREUTA)pdf
  • REZUMAT ENGLEZA DR MEREUTA DENISSpdf
Page 57: UNIVERSITATEA DE MEDICINA SI FARMACIE “GR Doctorat/Rezumat... · universitatea de medicina si farmacie “gr.t.popa” iasi facultatea de medicina dentara rezumatul tezei de doctorat

54

256Radu TM A Uliuliuc Dana Apostolide S Andrian The effect of adhesive

system on microleakage in cervical composite resin restorations Rev Med Chir

Soc Med Iaşi-2008 vol112 nr1supl1145-147

257Raskin A Michotte-Theall B Vreven J Wilson NH Clinical evaluation of a

posterior composite 10-year report J Dent 199927(1) 13ndash19

258Rasmusson CG Lundin SA Class II restorations in six different posterior

composite resins Five-year results Swed Dent J 1995 19 173-182

259Rezwani-Kaminski T Kamann W Gaengler P Secondary caries susceptibility

of teeth with long-term performing composite restorations J Oral Rehabil 2002

29(12)1131ndash1138

260Roberson TM Heymann HO Swift EJ eds Sturdevantlsquos Art and Science of

Operative Dentistry 5th ed St Louis Mosby 2006293-7

261Robertello FJ Pink FE The effect of a training program on the reliability of

examiners evaluating amalgam restorations Oper Dent 1997 Mar-Apr22(2)57-65

262Rodrigues JSA Pin LF Machado G Della Bona A Demarco FF Influence

of different restorative techniques on marginal seal of class II composite restorations

J Appl Oral Sci 2010 Feb18(1)37-43

263Roulet JF Noack MJCriteria for substituting amalgam with composite resins

Int Dent J 199141(4)195-205

264Roulet J-F Soderholm KJM Longmate J Effects of treatment and storage

conditions on ceramiccomposite bond strength J Dent Res 1995 74(l)381-387

265Roulet JF Longevity of ceramic inlays and amalgam- results up 6 years

ClinOral Invest1997140-46

266Roulet JFBenefits and disadvantages of tooth-coloured alternatives to amalgam

J Dent 199725(6)459-73

267Rueggeberg FA WF Caughman JW Curtis Jr HC Davis Factors

affecting cure at depths within light-activated resin composites Am J Dent

1993691ndash95

268Rueggeberg FA Ergle JW Mettenburg DJ Polymerization depths of

contemporary light curing units using microhardness J Esthet Dent 200012340-9

269Rushton VE Horner K Worthington HV Screening panoramic radiography

of new adult patients diagnostic yield when combined with bitewing radiography and

identification of selection criteria Br Dent J 2002 Mar 9192(5)275-9

270Ruyter IE Types of resin-based inlay materials and their properties Int Dent J

199242(3)139-44

271Sajjan GS Mittal NEffect of different placement techniques on marginal

microleakage of deep class-II cavities restored with two composite resin formulations

J Conserv Dent 201013(1)9-15

272Sakaguchi RL MC Peters SR Nelson WH Douglas HW Poort Effects

of polymerization contraction in composite restorations J Dent 1992 20178ndash182

273Sakaguchi RL Shah NC Lim BS Ferracane JL Borgersen SE Dynamic

mechanical analysis of storage modulus development in lightactivated polymer matrix

composites Dent Mater 200218197-202

274Sano H Takatsu T Ciucchi B Horner JA Matthews WG Pashley DH

Nanoleakage leakage within the hybrid layer Oper Dent 1995 20 18-25

55

275Sarrett DC Clinical challenges and the relevance of materials testing for

posterior composite restorations Dent Mater 200521(1) 9ndash12

276Sarrett DC Brooks CN Rose JT Clinical performance evaluation of a

packable posterior composite in bulk-cured restorations JADA 2006 137(1)71ndash80

277Shackelford JF Introduction to Materials Science for Engineers fourth

edition 1996

278Schirrmeister JF Huber K Hellwig E Hahn P Four-year evaluation of a resin

composite including nanofillers in posterior cavities J Adhes Dent 200911(5)399-

404

279Schneiderman A Elbaum M Schultz T Keem S Greenebaum M Driller J

Assessment of dental caries with Digital Imaging Fiber-Optic Transillumination (DI-

FOTI)in vitro studyCaries Res 1997 31(2) 103-110

280Schulte AG Wittchen A Stachniss V Jacquet W Bottenberg P Approximal

caries diagnosis after data import from different digital radiography systems

interobserver agreement and comparison to histological hard-tissue sections Caries

Res 200842(1)57-61

281Shortall AC Marginal seal comparisons between resinbonded Class II porcelain

inlays posterior composite restorationsand direct composite resin inlays Int J

Prosthodont19892(3)217-223

282Seghi RR Denry 1L Rosenstiel SF Relative fracture toughness and hardness

of new dental ceramics J Prosthet Dent 199574(2)145-150

283Sengun A Koyuturk AE Sener Y Ozer F Effect of desensitizers on the bond

strength of a self-etching adhesive system to caries affected dentin on the gingival

wall Oper Dent 2005 30(4)430-435

284Sengun A Unlu N Ozer F Ozturk B Bond strength of five current adhesives

to caries-affected dentin J Oral Rehabil 2002 29 777-781

285Setcos JC Staninec M Wilson NH- A two-year randomized controlled

clinical evaluation of bonded amalgam restorations- Journal of Adhesive Dentistry

nr11999

286Sideridou I Tserki V Papanastasiou G Effect of chemical structure on degree

of conversion in light-cured dimethacrylate-based dental resins Biomaterials 2002

231819-1829

287Sideridou I Tserki V Papanastasiou G Study of water sorption solubility and

modulus of elasticity of light-cured dimethacrylate-based dental resins Biomaterials

2003 24655-665

288Sidi AD Naylor MN A comparison of bitewing radiography and interdental

transillumination as adjuncts to the clinical identification of approximal caries in

posterior teeth Br Dent J 1988 164 (1) 15-18

289SilverFH Christiansen DLBiomaterials Science and Biocompatibility New

York Springer-Verlag 1999

290Simecek JW Diefenderfer KE Ahlf RL Ragain JC Jr Longitudinal trends in

restorative treatment needs among a cohort of US naval personnel J Dent Res

200382 1169 (Abstract)

291Simecek JW Diefenderfer KE Ahlf RL Ragain JC Jr Dental sealant

longevity in a cohort of young US naval personnel JADA 2005136(2)171ndash178

56

292Simi B Suprabha B Evaluation of microleakage in posterior nanocomposite

restorations with adhesive liners J Conserv Dent 201114(2)178-81

293Simone D David N B An alternative to reduce polimeryzation shrinkage in

direct posterior restorations JADA 2002 101387-1398

294Smales RJ Longevity of cusp-covered amalgams survivals after 15 years

OperDent 1991 16 17-20

295Smales RJ Webster DA Leppard PISurvival predictions of amalgam

restorations JDent1991 19 272-277

296Smales RJ Hawthorne WSLong-term survival of extensive amalgams and

posterior crowns JDent 1997 25 225-227

297Soncini JA Maserejian NN Trachtenberg F Tavares M Hayes C The

longevity of amalgam versus compomercomposite restorations in posterior primary

and permanent teeth findings From the New England Childrens Amalgam Trial J

Am Dent Assoc 2007 Jun138(6)763-72

298Sonoda H Banerjee A Sherriff M Tagami J Watson TF An in vitro

investigation of microtensile bond strengths of two dentine adhesives to caries-

affected dentine J Dent 2005 33(4)335-342

299Soodabeh Kimyai Masomeh Mehdipour Siavash Savadi Oskoee Reasons

for retreatment of amalgam and composite restorations among the pacients referring

to Tabriz Faculty of dentistry J Dental Research Clinics Dental Prospects vol 1

no1(2007)

300De Souza FB Guimaraes RP Vicente Silva CH A clinical evaluation of

packable and microhybrid resin composite restorations one year report Quintessence

International 2005 36 41-48

301Spreafico RC Gagliani M Composite resin restorations on posterior teeth In

Roulet JF Degrange M Adhesion The silent revolution in dentistry Chicago

Quintessence 2000253ndash76

302St Georges AJ Wilder AD Jr Perdigao J Microleakage of Class V composites

using different placement and curing techniques an in vitro study Am J Dent 2002

15244-247

303Stangel I Barolet RY Clinical evaluation of two posterior composite resins

Two-year results J Oral Rehabil 1990 17 257-268

304Stephen KW Russell JI Creanor SL Comparison of fibre optic

transillumination with clinical and radiographic caries diagnosis Community

Dentistry and Oral Epidemiology 1987 15 (2) 90-94

305Sturdevant JR Bayne SC Heymann HO Margin gap size of ceramic inlays

using second-generation CADCAM equipment J Esthet Dent 11(4)206-214 1999

306Suh BI A study of the compatibility of adhesives with composites Proceeding

from the SCO Dental Products Inc Symposium 2003 24(8) 4-9 (Abstract)

307Summit JB Burgess JO Berry TG Six-year clinical evaluation of bonded and

pin-retained complex amalgam restorations Oper Dent 2004 29269-276

308Summit JB Robbins JW Hilton TJ Fundamentals in operative dentistry Cap

10Direct Posterior Esthetic Restorations 2006 Quintessence Publishing Co

57

309Svanberg M Mjor IA Orstavik D Mutans streptococci in plaque from margins

of amalgam composite and glassndashionomer restorations J Dent Res 199069861ndash

864

310Tanne K Mamoru S Burstone C Three-dimensional finite element analysis

for stress in the periodontal tissue by orthodontic forcesAm J Orthod Dentofacial

Orthop921987499ndash505

311Tanumiharja M Burrow MF Tyas MJ Microtensile bond strengths of seven

dentin adhesive systems Dent Mater 2000 16(3)180-7

312Tay FR Pashley DH Aggressiveness of contemporary self-etching systems

Part I Depth of penetration beyond dentin smear layers Dent Mater 2001 17(4) 296-

308

313Tay FR Frankenberger R Krejci I Bouillaguet S Pashley DH Carvalho

RM Single-bottle adhesives behave as permeable membranes after polymerization I

In vivo evidence J Dent 2004 32611ndash621

314Tay FR Pashley DH Have dentin adhesives become too hydrophilic J Can

Dent Assoc 2003 69726ndash731

315Tay FR Sano H Carvalho R Pashley EL Pashley DH An ultrastructural

study of the influence of acidity of self-etching primers and smear layer thickness on

bonding to intact dentin J Adhes Dent 2000 283ndash98

316Thompson JY Bayne SC Heymann HO Mechanical properties of a new

mica-based machinable glass ceramic for CADCAM restorations J Prosthet Dent

76(6)619-623 1996

317Unterbrink GL R Muessner Influence of light intensity on two restorative

systems J Dent 199523183ndash189

318Unterbrink GL Liebenberg WH Flowable resin composites as filled

adhesiveslsquo literature review and clinical recommendations Quintessence Int

199930249ndash257

319Vaarkamp J Ten Bosch J Verdonschot EH Quantitative diagnosis of small

approximal caries lesions utilizing wavelength-dependent fiber-optic

transillumination Journal of Dental Research 1997 76 (4) 875-882

320Valachovic RW Douglass CW Reiskin AB Chauncey HH McNeil BJ The

use of panoramic radiography in the evaluation of asymptomatic adult dental patients

Oral Surg Oral Med Oral Pathol 198661(3)289-96

321Van Meerbeek B De Munck J Yoshida Y Inoue S Vargas M Vijay P Van

Landuyt K Lambrechts P Vanherle G Adhesion to enamel and dentin Current

status and future challenges Oper Dent 2003 28 215-235

322Van Meerbeek B Van Landuyt K De Munck JHashimoto M Peumans M

Lambrechts P Yoshida Y Inoue S Suzuki K Technique-sensitivity of

contemporary adhesives Dent Mater J 2005 24(1) 1-13

323Van Meerbeek B Vargas S Inoue S Yoshida Y Peumans M Lambrechts P

Vanherle G Adhesives and cements to promote preservation dentistry Oper Dent

20016 119-144

324Van Meerbeek B Yoshida Y Inoue S Vargas M Abe Y Fukuda R Okazaki

M Lambrechts P Vanherle G Bonding mechanism micro-tensile bond strength of

a 4- MET-based self-etching adhesive J Dent Res 2000 79 249 (Abstract)

58

325Van Nieuwenhuysen JP DrsquoHoore W Carvalho J Qvist V Long-term

evaluation of extensive restorations in permanent teeth J Dent 200331(6)395ndash405

326Venhoven BA de Gee AJ Davidson CL Light initiation of dental resins

dynamics of the polymerization Biomaterials 1996 172313-2318

327Versluis A Douglas WH Cross M Sakaguchi RL Does an incremental filling

technique reduce polymerization shrinkage stresses J Dent Res 1996 75871ndash878

328Vries HC Ruiken HM Konig KG vanrsquot Hof MA Radiographic versus

clinical diagnosis of approximal carious lesions Caries Res1990 24 (5) 364-370

329Waggoner W Ashton J Predictability of cavitation based upon radiographic

appearance comparison of two film types Quintessence International 1989 20(1)

55-60

330Watanabe LG Marshall GW Jr Marshall SJ Dentin shear strength effects of

tubule orientation and intra tooth location Dent Mater 1996 12 109-115

331Watts DC AS Marouf Optimal specimen geometry in bonded-disk

shrinkage-strain measurements on light-cured biomaterials Dent Mater 200016447ndash

451

332Watts DC Marouf AS Al-Hindi AM Photo-polymerization shrinkage-stress

kinetics in resin-composites methods development Dent Mater 2003 191ndash11

333Weaver WS Blank LW Pelleu GB Jr A visible light activated resin cured

through tooth structure GenDent 198836236-7

334Wendt SL Microleakage and cusp fracture resistance of heattreated composite

resin inlays Am J Dent 4(1)10-14 1991

335Wenzel A Hintze H Mikkelsen L Mouyen F Radiographic detection of

occlusal caries in noncavitated teeth A comparison of conventional film radiographs

digitized film radiographs and RadioVisioGraphy-Oral Surg Oral Med Oral Pathol

1991 72 621-6

336Wenzel A Hintze H Perception of image quality in direct digital radiography

after application of various image treatment filters for detectability of dental diseases

Dentomaxillofac Radiol 1993 22 131-4

337Wenzel A Computer-aided image manipulation of intraoral radiographs to

enhance diagnosis in dental practice a review Int Dent J 1993 43 99-108

338Wenzel A Digital radiography and caries diagnosis Dento Maxillo Facial

Radiology 27(1)3-11 1998

339Wenzel A Haiter-Neto F Gotfredsen E Risk factors for a false positive test

outcome in diagnosis of caries in approximal surfaces impact of radiographic

modality and observer characteristics Caries Res 200741(3)170-6

340Wibowo G Stockton L Microleakage of class II composite restorations Am J

Dent 200114177ndash185

341Wilson NHF Wastell DG Norman RD Five-year performance of high-

cooper content amalgam restorations in a multiclinical trial JDent1996 24 203-210

342Winkler MM Katona TR Paydar NH Finite element stress analysis of three

filling techniques for class V light-cured composite restorations J Dent Res

1996751477-83

343Yap AU Effectiveness of polymerization in composite restoratives claiming bulk

placement Impact of cavity depth and exposure time Oper Dent 2000 25113-120

59

344Yeşilyurt C Bulucu B Bond strength of total-etch dentin adhesive systems on

peripheral and central dentinal tissue a microtensile bond strength test The Journal of

Contemporary Dental Practice 7(2) 20061-13

345Yoshida Y Van Meerbeek B Okazaki M Shintani H Suzuki K Comparative

study on adhesive performance of functional monomers J Dent Res 2004 83 454-

458

346Yoshiyama M Tay FR Doi J Nishitani Y Yamada T Itou K Carvalho RM

Nakajima M Pashley DH Bonding of self-etch and total etch adhesives to carious

dentin J Dent Res 2002 81 556-560

  • COPERTA REZUMAT ENGLEZA (MEREUTA)pdf
  • REZUMAT ENGLEZA DR MEREUTA DENISSpdf
Page 58: UNIVERSITATEA DE MEDICINA SI FARMACIE “GR Doctorat/Rezumat... · universitatea de medicina si farmacie “gr.t.popa” iasi facultatea de medicina dentara rezumatul tezei de doctorat

55

275Sarrett DC Clinical challenges and the relevance of materials testing for

posterior composite restorations Dent Mater 200521(1) 9ndash12

276Sarrett DC Brooks CN Rose JT Clinical performance evaluation of a

packable posterior composite in bulk-cured restorations JADA 2006 137(1)71ndash80

277Shackelford JF Introduction to Materials Science for Engineers fourth

edition 1996

278Schirrmeister JF Huber K Hellwig E Hahn P Four-year evaluation of a resin

composite including nanofillers in posterior cavities J Adhes Dent 200911(5)399-

404

279Schneiderman A Elbaum M Schultz T Keem S Greenebaum M Driller J

Assessment of dental caries with Digital Imaging Fiber-Optic Transillumination (DI-

FOTI)in vitro studyCaries Res 1997 31(2) 103-110

280Schulte AG Wittchen A Stachniss V Jacquet W Bottenberg P Approximal

caries diagnosis after data import from different digital radiography systems

interobserver agreement and comparison to histological hard-tissue sections Caries

Res 200842(1)57-61

281Shortall AC Marginal seal comparisons between resinbonded Class II porcelain

inlays posterior composite restorationsand direct composite resin inlays Int J

Prosthodont19892(3)217-223

282Seghi RR Denry 1L Rosenstiel SF Relative fracture toughness and hardness

of new dental ceramics J Prosthet Dent 199574(2)145-150

283Sengun A Koyuturk AE Sener Y Ozer F Effect of desensitizers on the bond

strength of a self-etching adhesive system to caries affected dentin on the gingival

wall Oper Dent 2005 30(4)430-435

284Sengun A Unlu N Ozer F Ozturk B Bond strength of five current adhesives

to caries-affected dentin J Oral Rehabil 2002 29 777-781

285Setcos JC Staninec M Wilson NH- A two-year randomized controlled

clinical evaluation of bonded amalgam restorations- Journal of Adhesive Dentistry

nr11999

286Sideridou I Tserki V Papanastasiou G Effect of chemical structure on degree

of conversion in light-cured dimethacrylate-based dental resins Biomaterials 2002

231819-1829

287Sideridou I Tserki V Papanastasiou G Study of water sorption solubility and

modulus of elasticity of light-cured dimethacrylate-based dental resins Biomaterials

2003 24655-665

288Sidi AD Naylor MN A comparison of bitewing radiography and interdental

transillumination as adjuncts to the clinical identification of approximal caries in

posterior teeth Br Dent J 1988 164 (1) 15-18

289SilverFH Christiansen DLBiomaterials Science and Biocompatibility New

York Springer-Verlag 1999

290Simecek JW Diefenderfer KE Ahlf RL Ragain JC Jr Longitudinal trends in

restorative treatment needs among a cohort of US naval personnel J Dent Res

200382 1169 (Abstract)

291Simecek JW Diefenderfer KE Ahlf RL Ragain JC Jr Dental sealant

longevity in a cohort of young US naval personnel JADA 2005136(2)171ndash178

56

292Simi B Suprabha B Evaluation of microleakage in posterior nanocomposite

restorations with adhesive liners J Conserv Dent 201114(2)178-81

293Simone D David N B An alternative to reduce polimeryzation shrinkage in

direct posterior restorations JADA 2002 101387-1398

294Smales RJ Longevity of cusp-covered amalgams survivals after 15 years

OperDent 1991 16 17-20

295Smales RJ Webster DA Leppard PISurvival predictions of amalgam

restorations JDent1991 19 272-277

296Smales RJ Hawthorne WSLong-term survival of extensive amalgams and

posterior crowns JDent 1997 25 225-227

297Soncini JA Maserejian NN Trachtenberg F Tavares M Hayes C The

longevity of amalgam versus compomercomposite restorations in posterior primary

and permanent teeth findings From the New England Childrens Amalgam Trial J

Am Dent Assoc 2007 Jun138(6)763-72

298Sonoda H Banerjee A Sherriff M Tagami J Watson TF An in vitro

investigation of microtensile bond strengths of two dentine adhesives to caries-

affected dentine J Dent 2005 33(4)335-342

299Soodabeh Kimyai Masomeh Mehdipour Siavash Savadi Oskoee Reasons

for retreatment of amalgam and composite restorations among the pacients referring

to Tabriz Faculty of dentistry J Dental Research Clinics Dental Prospects vol 1

no1(2007)

300De Souza FB Guimaraes RP Vicente Silva CH A clinical evaluation of

packable and microhybrid resin composite restorations one year report Quintessence

International 2005 36 41-48

301Spreafico RC Gagliani M Composite resin restorations on posterior teeth In

Roulet JF Degrange M Adhesion The silent revolution in dentistry Chicago

Quintessence 2000253ndash76

302St Georges AJ Wilder AD Jr Perdigao J Microleakage of Class V composites

using different placement and curing techniques an in vitro study Am J Dent 2002

15244-247

303Stangel I Barolet RY Clinical evaluation of two posterior composite resins

Two-year results J Oral Rehabil 1990 17 257-268

304Stephen KW Russell JI Creanor SL Comparison of fibre optic

transillumination with clinical and radiographic caries diagnosis Community

Dentistry and Oral Epidemiology 1987 15 (2) 90-94

305Sturdevant JR Bayne SC Heymann HO Margin gap size of ceramic inlays

using second-generation CADCAM equipment J Esthet Dent 11(4)206-214 1999

306Suh BI A study of the compatibility of adhesives with composites Proceeding

from the SCO Dental Products Inc Symposium 2003 24(8) 4-9 (Abstract)

307Summit JB Burgess JO Berry TG Six-year clinical evaluation of bonded and

pin-retained complex amalgam restorations Oper Dent 2004 29269-276

308Summit JB Robbins JW Hilton TJ Fundamentals in operative dentistry Cap

10Direct Posterior Esthetic Restorations 2006 Quintessence Publishing Co

57

309Svanberg M Mjor IA Orstavik D Mutans streptococci in plaque from margins

of amalgam composite and glassndashionomer restorations J Dent Res 199069861ndash

864

310Tanne K Mamoru S Burstone C Three-dimensional finite element analysis

for stress in the periodontal tissue by orthodontic forcesAm J Orthod Dentofacial

Orthop921987499ndash505

311Tanumiharja M Burrow MF Tyas MJ Microtensile bond strengths of seven

dentin adhesive systems Dent Mater 2000 16(3)180-7

312Tay FR Pashley DH Aggressiveness of contemporary self-etching systems

Part I Depth of penetration beyond dentin smear layers Dent Mater 2001 17(4) 296-

308

313Tay FR Frankenberger R Krejci I Bouillaguet S Pashley DH Carvalho

RM Single-bottle adhesives behave as permeable membranes after polymerization I

In vivo evidence J Dent 2004 32611ndash621

314Tay FR Pashley DH Have dentin adhesives become too hydrophilic J Can

Dent Assoc 2003 69726ndash731

315Tay FR Sano H Carvalho R Pashley EL Pashley DH An ultrastructural

study of the influence of acidity of self-etching primers and smear layer thickness on

bonding to intact dentin J Adhes Dent 2000 283ndash98

316Thompson JY Bayne SC Heymann HO Mechanical properties of a new

mica-based machinable glass ceramic for CADCAM restorations J Prosthet Dent

76(6)619-623 1996

317Unterbrink GL R Muessner Influence of light intensity on two restorative

systems J Dent 199523183ndash189

318Unterbrink GL Liebenberg WH Flowable resin composites as filled

adhesiveslsquo literature review and clinical recommendations Quintessence Int

199930249ndash257

319Vaarkamp J Ten Bosch J Verdonschot EH Quantitative diagnosis of small

approximal caries lesions utilizing wavelength-dependent fiber-optic

transillumination Journal of Dental Research 1997 76 (4) 875-882

320Valachovic RW Douglass CW Reiskin AB Chauncey HH McNeil BJ The

use of panoramic radiography in the evaluation of asymptomatic adult dental patients

Oral Surg Oral Med Oral Pathol 198661(3)289-96

321Van Meerbeek B De Munck J Yoshida Y Inoue S Vargas M Vijay P Van

Landuyt K Lambrechts P Vanherle G Adhesion to enamel and dentin Current

status and future challenges Oper Dent 2003 28 215-235

322Van Meerbeek B Van Landuyt K De Munck JHashimoto M Peumans M

Lambrechts P Yoshida Y Inoue S Suzuki K Technique-sensitivity of

contemporary adhesives Dent Mater J 2005 24(1) 1-13

323Van Meerbeek B Vargas S Inoue S Yoshida Y Peumans M Lambrechts P

Vanherle G Adhesives and cements to promote preservation dentistry Oper Dent

20016 119-144

324Van Meerbeek B Yoshida Y Inoue S Vargas M Abe Y Fukuda R Okazaki

M Lambrechts P Vanherle G Bonding mechanism micro-tensile bond strength of

a 4- MET-based self-etching adhesive J Dent Res 2000 79 249 (Abstract)

58

325Van Nieuwenhuysen JP DrsquoHoore W Carvalho J Qvist V Long-term

evaluation of extensive restorations in permanent teeth J Dent 200331(6)395ndash405

326Venhoven BA de Gee AJ Davidson CL Light initiation of dental resins

dynamics of the polymerization Biomaterials 1996 172313-2318

327Versluis A Douglas WH Cross M Sakaguchi RL Does an incremental filling

technique reduce polymerization shrinkage stresses J Dent Res 1996 75871ndash878

328Vries HC Ruiken HM Konig KG vanrsquot Hof MA Radiographic versus

clinical diagnosis of approximal carious lesions Caries Res1990 24 (5) 364-370

329Waggoner W Ashton J Predictability of cavitation based upon radiographic

appearance comparison of two film types Quintessence International 1989 20(1)

55-60

330Watanabe LG Marshall GW Jr Marshall SJ Dentin shear strength effects of

tubule orientation and intra tooth location Dent Mater 1996 12 109-115

331Watts DC AS Marouf Optimal specimen geometry in bonded-disk

shrinkage-strain measurements on light-cured biomaterials Dent Mater 200016447ndash

451

332Watts DC Marouf AS Al-Hindi AM Photo-polymerization shrinkage-stress

kinetics in resin-composites methods development Dent Mater 2003 191ndash11

333Weaver WS Blank LW Pelleu GB Jr A visible light activated resin cured

through tooth structure GenDent 198836236-7

334Wendt SL Microleakage and cusp fracture resistance of heattreated composite

resin inlays Am J Dent 4(1)10-14 1991

335Wenzel A Hintze H Mikkelsen L Mouyen F Radiographic detection of

occlusal caries in noncavitated teeth A comparison of conventional film radiographs

digitized film radiographs and RadioVisioGraphy-Oral Surg Oral Med Oral Pathol

1991 72 621-6

336Wenzel A Hintze H Perception of image quality in direct digital radiography

after application of various image treatment filters for detectability of dental diseases

Dentomaxillofac Radiol 1993 22 131-4

337Wenzel A Computer-aided image manipulation of intraoral radiographs to

enhance diagnosis in dental practice a review Int Dent J 1993 43 99-108

338Wenzel A Digital radiography and caries diagnosis Dento Maxillo Facial

Radiology 27(1)3-11 1998

339Wenzel A Haiter-Neto F Gotfredsen E Risk factors for a false positive test

outcome in diagnosis of caries in approximal surfaces impact of radiographic

modality and observer characteristics Caries Res 200741(3)170-6

340Wibowo G Stockton L Microleakage of class II composite restorations Am J

Dent 200114177ndash185

341Wilson NHF Wastell DG Norman RD Five-year performance of high-

cooper content amalgam restorations in a multiclinical trial JDent1996 24 203-210

342Winkler MM Katona TR Paydar NH Finite element stress analysis of three

filling techniques for class V light-cured composite restorations J Dent Res

1996751477-83

343Yap AU Effectiveness of polymerization in composite restoratives claiming bulk

placement Impact of cavity depth and exposure time Oper Dent 2000 25113-120

59

344Yeşilyurt C Bulucu B Bond strength of total-etch dentin adhesive systems on

peripheral and central dentinal tissue a microtensile bond strength test The Journal of

Contemporary Dental Practice 7(2) 20061-13

345Yoshida Y Van Meerbeek B Okazaki M Shintani H Suzuki K Comparative

study on adhesive performance of functional monomers J Dent Res 2004 83 454-

458

346Yoshiyama M Tay FR Doi J Nishitani Y Yamada T Itou K Carvalho RM

Nakajima M Pashley DH Bonding of self-etch and total etch adhesives to carious

dentin J Dent Res 2002 81 556-560

  • COPERTA REZUMAT ENGLEZA (MEREUTA)pdf
  • REZUMAT ENGLEZA DR MEREUTA DENISSpdf
Page 59: UNIVERSITATEA DE MEDICINA SI FARMACIE “GR Doctorat/Rezumat... · universitatea de medicina si farmacie “gr.t.popa” iasi facultatea de medicina dentara rezumatul tezei de doctorat

56

292Simi B Suprabha B Evaluation of microleakage in posterior nanocomposite

restorations with adhesive liners J Conserv Dent 201114(2)178-81

293Simone D David N B An alternative to reduce polimeryzation shrinkage in

direct posterior restorations JADA 2002 101387-1398

294Smales RJ Longevity of cusp-covered amalgams survivals after 15 years

OperDent 1991 16 17-20

295Smales RJ Webster DA Leppard PISurvival predictions of amalgam

restorations JDent1991 19 272-277

296Smales RJ Hawthorne WSLong-term survival of extensive amalgams and

posterior crowns JDent 1997 25 225-227

297Soncini JA Maserejian NN Trachtenberg F Tavares M Hayes C The

longevity of amalgam versus compomercomposite restorations in posterior primary

and permanent teeth findings From the New England Childrens Amalgam Trial J

Am Dent Assoc 2007 Jun138(6)763-72

298Sonoda H Banerjee A Sherriff M Tagami J Watson TF An in vitro

investigation of microtensile bond strengths of two dentine adhesives to caries-

affected dentine J Dent 2005 33(4)335-342

299Soodabeh Kimyai Masomeh Mehdipour Siavash Savadi Oskoee Reasons

for retreatment of amalgam and composite restorations among the pacients referring

to Tabriz Faculty of dentistry J Dental Research Clinics Dental Prospects vol 1

no1(2007)

300De Souza FB Guimaraes RP Vicente Silva CH A clinical evaluation of

packable and microhybrid resin composite restorations one year report Quintessence

International 2005 36 41-48

301Spreafico RC Gagliani M Composite resin restorations on posterior teeth In

Roulet JF Degrange M Adhesion The silent revolution in dentistry Chicago

Quintessence 2000253ndash76

302St Georges AJ Wilder AD Jr Perdigao J Microleakage of Class V composites

using different placement and curing techniques an in vitro study Am J Dent 2002

15244-247

303Stangel I Barolet RY Clinical evaluation of two posterior composite resins

Two-year results J Oral Rehabil 1990 17 257-268

304Stephen KW Russell JI Creanor SL Comparison of fibre optic

transillumination with clinical and radiographic caries diagnosis Community

Dentistry and Oral Epidemiology 1987 15 (2) 90-94

305Sturdevant JR Bayne SC Heymann HO Margin gap size of ceramic inlays

using second-generation CADCAM equipment J Esthet Dent 11(4)206-214 1999

306Suh BI A study of the compatibility of adhesives with composites Proceeding

from the SCO Dental Products Inc Symposium 2003 24(8) 4-9 (Abstract)

307Summit JB Burgess JO Berry TG Six-year clinical evaluation of bonded and

pin-retained complex amalgam restorations Oper Dent 2004 29269-276

308Summit JB Robbins JW Hilton TJ Fundamentals in operative dentistry Cap

10Direct Posterior Esthetic Restorations 2006 Quintessence Publishing Co

57

309Svanberg M Mjor IA Orstavik D Mutans streptococci in plaque from margins

of amalgam composite and glassndashionomer restorations J Dent Res 199069861ndash

864

310Tanne K Mamoru S Burstone C Three-dimensional finite element analysis

for stress in the periodontal tissue by orthodontic forcesAm J Orthod Dentofacial

Orthop921987499ndash505

311Tanumiharja M Burrow MF Tyas MJ Microtensile bond strengths of seven

dentin adhesive systems Dent Mater 2000 16(3)180-7

312Tay FR Pashley DH Aggressiveness of contemporary self-etching systems

Part I Depth of penetration beyond dentin smear layers Dent Mater 2001 17(4) 296-

308

313Tay FR Frankenberger R Krejci I Bouillaguet S Pashley DH Carvalho

RM Single-bottle adhesives behave as permeable membranes after polymerization I

In vivo evidence J Dent 2004 32611ndash621

314Tay FR Pashley DH Have dentin adhesives become too hydrophilic J Can

Dent Assoc 2003 69726ndash731

315Tay FR Sano H Carvalho R Pashley EL Pashley DH An ultrastructural

study of the influence of acidity of self-etching primers and smear layer thickness on

bonding to intact dentin J Adhes Dent 2000 283ndash98

316Thompson JY Bayne SC Heymann HO Mechanical properties of a new

mica-based machinable glass ceramic for CADCAM restorations J Prosthet Dent

76(6)619-623 1996

317Unterbrink GL R Muessner Influence of light intensity on two restorative

systems J Dent 199523183ndash189

318Unterbrink GL Liebenberg WH Flowable resin composites as filled

adhesiveslsquo literature review and clinical recommendations Quintessence Int

199930249ndash257

319Vaarkamp J Ten Bosch J Verdonschot EH Quantitative diagnosis of small

approximal caries lesions utilizing wavelength-dependent fiber-optic

transillumination Journal of Dental Research 1997 76 (4) 875-882

320Valachovic RW Douglass CW Reiskin AB Chauncey HH McNeil BJ The

use of panoramic radiography in the evaluation of asymptomatic adult dental patients

Oral Surg Oral Med Oral Pathol 198661(3)289-96

321Van Meerbeek B De Munck J Yoshida Y Inoue S Vargas M Vijay P Van

Landuyt K Lambrechts P Vanherle G Adhesion to enamel and dentin Current

status and future challenges Oper Dent 2003 28 215-235

322Van Meerbeek B Van Landuyt K De Munck JHashimoto M Peumans M

Lambrechts P Yoshida Y Inoue S Suzuki K Technique-sensitivity of

contemporary adhesives Dent Mater J 2005 24(1) 1-13

323Van Meerbeek B Vargas S Inoue S Yoshida Y Peumans M Lambrechts P

Vanherle G Adhesives and cements to promote preservation dentistry Oper Dent

20016 119-144

324Van Meerbeek B Yoshida Y Inoue S Vargas M Abe Y Fukuda R Okazaki

M Lambrechts P Vanherle G Bonding mechanism micro-tensile bond strength of

a 4- MET-based self-etching adhesive J Dent Res 2000 79 249 (Abstract)

58

325Van Nieuwenhuysen JP DrsquoHoore W Carvalho J Qvist V Long-term

evaluation of extensive restorations in permanent teeth J Dent 200331(6)395ndash405

326Venhoven BA de Gee AJ Davidson CL Light initiation of dental resins

dynamics of the polymerization Biomaterials 1996 172313-2318

327Versluis A Douglas WH Cross M Sakaguchi RL Does an incremental filling

technique reduce polymerization shrinkage stresses J Dent Res 1996 75871ndash878

328Vries HC Ruiken HM Konig KG vanrsquot Hof MA Radiographic versus

clinical diagnosis of approximal carious lesions Caries Res1990 24 (5) 364-370

329Waggoner W Ashton J Predictability of cavitation based upon radiographic

appearance comparison of two film types Quintessence International 1989 20(1)

55-60

330Watanabe LG Marshall GW Jr Marshall SJ Dentin shear strength effects of

tubule orientation and intra tooth location Dent Mater 1996 12 109-115

331Watts DC AS Marouf Optimal specimen geometry in bonded-disk

shrinkage-strain measurements on light-cured biomaterials Dent Mater 200016447ndash

451

332Watts DC Marouf AS Al-Hindi AM Photo-polymerization shrinkage-stress

kinetics in resin-composites methods development Dent Mater 2003 191ndash11

333Weaver WS Blank LW Pelleu GB Jr A visible light activated resin cured

through tooth structure GenDent 198836236-7

334Wendt SL Microleakage and cusp fracture resistance of heattreated composite

resin inlays Am J Dent 4(1)10-14 1991

335Wenzel A Hintze H Mikkelsen L Mouyen F Radiographic detection of

occlusal caries in noncavitated teeth A comparison of conventional film radiographs

digitized film radiographs and RadioVisioGraphy-Oral Surg Oral Med Oral Pathol

1991 72 621-6

336Wenzel A Hintze H Perception of image quality in direct digital radiography

after application of various image treatment filters for detectability of dental diseases

Dentomaxillofac Radiol 1993 22 131-4

337Wenzel A Computer-aided image manipulation of intraoral radiographs to

enhance diagnosis in dental practice a review Int Dent J 1993 43 99-108

338Wenzel A Digital radiography and caries diagnosis Dento Maxillo Facial

Radiology 27(1)3-11 1998

339Wenzel A Haiter-Neto F Gotfredsen E Risk factors for a false positive test

outcome in diagnosis of caries in approximal surfaces impact of radiographic

modality and observer characteristics Caries Res 200741(3)170-6

340Wibowo G Stockton L Microleakage of class II composite restorations Am J

Dent 200114177ndash185

341Wilson NHF Wastell DG Norman RD Five-year performance of high-

cooper content amalgam restorations in a multiclinical trial JDent1996 24 203-210

342Winkler MM Katona TR Paydar NH Finite element stress analysis of three

filling techniques for class V light-cured composite restorations J Dent Res

1996751477-83

343Yap AU Effectiveness of polymerization in composite restoratives claiming bulk

placement Impact of cavity depth and exposure time Oper Dent 2000 25113-120

59

344Yeşilyurt C Bulucu B Bond strength of total-etch dentin adhesive systems on

peripheral and central dentinal tissue a microtensile bond strength test The Journal of

Contemporary Dental Practice 7(2) 20061-13

345Yoshida Y Van Meerbeek B Okazaki M Shintani H Suzuki K Comparative

study on adhesive performance of functional monomers J Dent Res 2004 83 454-

458

346Yoshiyama M Tay FR Doi J Nishitani Y Yamada T Itou K Carvalho RM

Nakajima M Pashley DH Bonding of self-etch and total etch adhesives to carious

dentin J Dent Res 2002 81 556-560

  • COPERTA REZUMAT ENGLEZA (MEREUTA)pdf
  • REZUMAT ENGLEZA DR MEREUTA DENISSpdf
Page 60: UNIVERSITATEA DE MEDICINA SI FARMACIE “GR Doctorat/Rezumat... · universitatea de medicina si farmacie “gr.t.popa” iasi facultatea de medicina dentara rezumatul tezei de doctorat

57

309Svanberg M Mjor IA Orstavik D Mutans streptococci in plaque from margins

of amalgam composite and glassndashionomer restorations J Dent Res 199069861ndash

864

310Tanne K Mamoru S Burstone C Three-dimensional finite element analysis

for stress in the periodontal tissue by orthodontic forcesAm J Orthod Dentofacial

Orthop921987499ndash505

311Tanumiharja M Burrow MF Tyas MJ Microtensile bond strengths of seven

dentin adhesive systems Dent Mater 2000 16(3)180-7

312Tay FR Pashley DH Aggressiveness of contemporary self-etching systems

Part I Depth of penetration beyond dentin smear layers Dent Mater 2001 17(4) 296-

308

313Tay FR Frankenberger R Krejci I Bouillaguet S Pashley DH Carvalho

RM Single-bottle adhesives behave as permeable membranes after polymerization I

In vivo evidence J Dent 2004 32611ndash621

314Tay FR Pashley DH Have dentin adhesives become too hydrophilic J Can

Dent Assoc 2003 69726ndash731

315Tay FR Sano H Carvalho R Pashley EL Pashley DH An ultrastructural

study of the influence of acidity of self-etching primers and smear layer thickness on

bonding to intact dentin J Adhes Dent 2000 283ndash98

316Thompson JY Bayne SC Heymann HO Mechanical properties of a new

mica-based machinable glass ceramic for CADCAM restorations J Prosthet Dent

76(6)619-623 1996

317Unterbrink GL R Muessner Influence of light intensity on two restorative

systems J Dent 199523183ndash189

318Unterbrink GL Liebenberg WH Flowable resin composites as filled

adhesiveslsquo literature review and clinical recommendations Quintessence Int

199930249ndash257

319Vaarkamp J Ten Bosch J Verdonschot EH Quantitative diagnosis of small

approximal caries lesions utilizing wavelength-dependent fiber-optic

transillumination Journal of Dental Research 1997 76 (4) 875-882

320Valachovic RW Douglass CW Reiskin AB Chauncey HH McNeil BJ The

use of panoramic radiography in the evaluation of asymptomatic adult dental patients

Oral Surg Oral Med Oral Pathol 198661(3)289-96

321Van Meerbeek B De Munck J Yoshida Y Inoue S Vargas M Vijay P Van

Landuyt K Lambrechts P Vanherle G Adhesion to enamel and dentin Current

status and future challenges Oper Dent 2003 28 215-235

322Van Meerbeek B Van Landuyt K De Munck JHashimoto M Peumans M

Lambrechts P Yoshida Y Inoue S Suzuki K Technique-sensitivity of

contemporary adhesives Dent Mater J 2005 24(1) 1-13

323Van Meerbeek B Vargas S Inoue S Yoshida Y Peumans M Lambrechts P

Vanherle G Adhesives and cements to promote preservation dentistry Oper Dent

20016 119-144

324Van Meerbeek B Yoshida Y Inoue S Vargas M Abe Y Fukuda R Okazaki

M Lambrechts P Vanherle G Bonding mechanism micro-tensile bond strength of

a 4- MET-based self-etching adhesive J Dent Res 2000 79 249 (Abstract)

58

325Van Nieuwenhuysen JP DrsquoHoore W Carvalho J Qvist V Long-term

evaluation of extensive restorations in permanent teeth J Dent 200331(6)395ndash405

326Venhoven BA de Gee AJ Davidson CL Light initiation of dental resins

dynamics of the polymerization Biomaterials 1996 172313-2318

327Versluis A Douglas WH Cross M Sakaguchi RL Does an incremental filling

technique reduce polymerization shrinkage stresses J Dent Res 1996 75871ndash878

328Vries HC Ruiken HM Konig KG vanrsquot Hof MA Radiographic versus

clinical diagnosis of approximal carious lesions Caries Res1990 24 (5) 364-370

329Waggoner W Ashton J Predictability of cavitation based upon radiographic

appearance comparison of two film types Quintessence International 1989 20(1)

55-60

330Watanabe LG Marshall GW Jr Marshall SJ Dentin shear strength effects of

tubule orientation and intra tooth location Dent Mater 1996 12 109-115

331Watts DC AS Marouf Optimal specimen geometry in bonded-disk

shrinkage-strain measurements on light-cured biomaterials Dent Mater 200016447ndash

451

332Watts DC Marouf AS Al-Hindi AM Photo-polymerization shrinkage-stress

kinetics in resin-composites methods development Dent Mater 2003 191ndash11

333Weaver WS Blank LW Pelleu GB Jr A visible light activated resin cured

through tooth structure GenDent 198836236-7

334Wendt SL Microleakage and cusp fracture resistance of heattreated composite

resin inlays Am J Dent 4(1)10-14 1991

335Wenzel A Hintze H Mikkelsen L Mouyen F Radiographic detection of

occlusal caries in noncavitated teeth A comparison of conventional film radiographs

digitized film radiographs and RadioVisioGraphy-Oral Surg Oral Med Oral Pathol

1991 72 621-6

336Wenzel A Hintze H Perception of image quality in direct digital radiography

after application of various image treatment filters for detectability of dental diseases

Dentomaxillofac Radiol 1993 22 131-4

337Wenzel A Computer-aided image manipulation of intraoral radiographs to

enhance diagnosis in dental practice a review Int Dent J 1993 43 99-108

338Wenzel A Digital radiography and caries diagnosis Dento Maxillo Facial

Radiology 27(1)3-11 1998

339Wenzel A Haiter-Neto F Gotfredsen E Risk factors for a false positive test

outcome in diagnosis of caries in approximal surfaces impact of radiographic

modality and observer characteristics Caries Res 200741(3)170-6

340Wibowo G Stockton L Microleakage of class II composite restorations Am J

Dent 200114177ndash185

341Wilson NHF Wastell DG Norman RD Five-year performance of high-

cooper content amalgam restorations in a multiclinical trial JDent1996 24 203-210

342Winkler MM Katona TR Paydar NH Finite element stress analysis of three

filling techniques for class V light-cured composite restorations J Dent Res

1996751477-83

343Yap AU Effectiveness of polymerization in composite restoratives claiming bulk

placement Impact of cavity depth and exposure time Oper Dent 2000 25113-120

59

344Yeşilyurt C Bulucu B Bond strength of total-etch dentin adhesive systems on

peripheral and central dentinal tissue a microtensile bond strength test The Journal of

Contemporary Dental Practice 7(2) 20061-13

345Yoshida Y Van Meerbeek B Okazaki M Shintani H Suzuki K Comparative

study on adhesive performance of functional monomers J Dent Res 2004 83 454-

458

346Yoshiyama M Tay FR Doi J Nishitani Y Yamada T Itou K Carvalho RM

Nakajima M Pashley DH Bonding of self-etch and total etch adhesives to carious

dentin J Dent Res 2002 81 556-560

  • COPERTA REZUMAT ENGLEZA (MEREUTA)pdf
  • REZUMAT ENGLEZA DR MEREUTA DENISSpdf
Page 61: UNIVERSITATEA DE MEDICINA SI FARMACIE “GR Doctorat/Rezumat... · universitatea de medicina si farmacie “gr.t.popa” iasi facultatea de medicina dentara rezumatul tezei de doctorat

58

325Van Nieuwenhuysen JP DrsquoHoore W Carvalho J Qvist V Long-term

evaluation of extensive restorations in permanent teeth J Dent 200331(6)395ndash405

326Venhoven BA de Gee AJ Davidson CL Light initiation of dental resins

dynamics of the polymerization Biomaterials 1996 172313-2318

327Versluis A Douglas WH Cross M Sakaguchi RL Does an incremental filling

technique reduce polymerization shrinkage stresses J Dent Res 1996 75871ndash878

328Vries HC Ruiken HM Konig KG vanrsquot Hof MA Radiographic versus

clinical diagnosis of approximal carious lesions Caries Res1990 24 (5) 364-370

329Waggoner W Ashton J Predictability of cavitation based upon radiographic

appearance comparison of two film types Quintessence International 1989 20(1)

55-60

330Watanabe LG Marshall GW Jr Marshall SJ Dentin shear strength effects of

tubule orientation and intra tooth location Dent Mater 1996 12 109-115

331Watts DC AS Marouf Optimal specimen geometry in bonded-disk

shrinkage-strain measurements on light-cured biomaterials Dent Mater 200016447ndash

451

332Watts DC Marouf AS Al-Hindi AM Photo-polymerization shrinkage-stress

kinetics in resin-composites methods development Dent Mater 2003 191ndash11

333Weaver WS Blank LW Pelleu GB Jr A visible light activated resin cured

through tooth structure GenDent 198836236-7

334Wendt SL Microleakage and cusp fracture resistance of heattreated composite

resin inlays Am J Dent 4(1)10-14 1991

335Wenzel A Hintze H Mikkelsen L Mouyen F Radiographic detection of

occlusal caries in noncavitated teeth A comparison of conventional film radiographs

digitized film radiographs and RadioVisioGraphy-Oral Surg Oral Med Oral Pathol

1991 72 621-6

336Wenzel A Hintze H Perception of image quality in direct digital radiography

after application of various image treatment filters for detectability of dental diseases

Dentomaxillofac Radiol 1993 22 131-4

337Wenzel A Computer-aided image manipulation of intraoral radiographs to

enhance diagnosis in dental practice a review Int Dent J 1993 43 99-108

338Wenzel A Digital radiography and caries diagnosis Dento Maxillo Facial

Radiology 27(1)3-11 1998

339Wenzel A Haiter-Neto F Gotfredsen E Risk factors for a false positive test

outcome in diagnosis of caries in approximal surfaces impact of radiographic

modality and observer characteristics Caries Res 200741(3)170-6

340Wibowo G Stockton L Microleakage of class II composite restorations Am J

Dent 200114177ndash185

341Wilson NHF Wastell DG Norman RD Five-year performance of high-

cooper content amalgam restorations in a multiclinical trial JDent1996 24 203-210

342Winkler MM Katona TR Paydar NH Finite element stress analysis of three

filling techniques for class V light-cured composite restorations J Dent Res

1996751477-83

343Yap AU Effectiveness of polymerization in composite restoratives claiming bulk

placement Impact of cavity depth and exposure time Oper Dent 2000 25113-120

59

344Yeşilyurt C Bulucu B Bond strength of total-etch dentin adhesive systems on

peripheral and central dentinal tissue a microtensile bond strength test The Journal of

Contemporary Dental Practice 7(2) 20061-13

345Yoshida Y Van Meerbeek B Okazaki M Shintani H Suzuki K Comparative

study on adhesive performance of functional monomers J Dent Res 2004 83 454-

458

346Yoshiyama M Tay FR Doi J Nishitani Y Yamada T Itou K Carvalho RM

Nakajima M Pashley DH Bonding of self-etch and total etch adhesives to carious

dentin J Dent Res 2002 81 556-560

  • COPERTA REZUMAT ENGLEZA (MEREUTA)pdf
  • REZUMAT ENGLEZA DR MEREUTA DENISSpdf
Page 62: UNIVERSITATEA DE MEDICINA SI FARMACIE “GR Doctorat/Rezumat... · universitatea de medicina si farmacie “gr.t.popa” iasi facultatea de medicina dentara rezumatul tezei de doctorat

59

344Yeşilyurt C Bulucu B Bond strength of total-etch dentin adhesive systems on

peripheral and central dentinal tissue a microtensile bond strength test The Journal of

Contemporary Dental Practice 7(2) 20061-13

345Yoshida Y Van Meerbeek B Okazaki M Shintani H Suzuki K Comparative

study on adhesive performance of functional monomers J Dent Res 2004 83 454-

458

346Yoshiyama M Tay FR Doi J Nishitani Y Yamada T Itou K Carvalho RM

Nakajima M Pashley DH Bonding of self-etch and total etch adhesives to carious

dentin J Dent Res 2002 81 556-560

  • COPERTA REZUMAT ENGLEZA (MEREUTA)pdf
  • REZUMAT ENGLEZA DR MEREUTA DENISSpdf