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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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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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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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85Dietschi D Herzfeld D In vitro evaluation of marginal and internal adaptation of
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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
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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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Borgmeijer PJ Replacement risk of amalgam treatment modalities 15-year results
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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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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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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
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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51
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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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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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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
Internet Journal of Dental Science 2009 7 (2)
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53
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Microsc19893(1)161-74
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Adhes Dent 1999 1(3)191-209
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569ndash575
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Community Dent Oral Epidemiol 1980 Jun8(3)135-8
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54
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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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ClinOral Invest1997140-46
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Nanoleakage leakage within the hybrid layer Oper Dent 1995 20 18-25
55
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58
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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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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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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
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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
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
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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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
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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
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-
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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
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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
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
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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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107Franccedila FM Worschech CC Paulillo LA Martins LR Lovadino JR Fracture
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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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restorations The 10-year report J Adhes Dent 2001 3185-194
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
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
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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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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
technique on micro-tensile bond strength of resin composite in Class I cavities Dent
Mater 200723(5)533-8
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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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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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144Hudson JD Goldstein GR Georgescu M Enamel wear caused by three
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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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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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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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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
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200932(126)21-8
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Biology199843(8)629-632
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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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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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Edition of the Balkan Medical Days
Stomatological Section Abstract nr1091999128
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StomatologicăVol2199823-26
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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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Dentomaxillofac Radiol 2007 Oct36(7)377-81
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34
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59
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458
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dentin J Dent Res 2002 81 556-560
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
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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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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and replacement Chicago 1989Quintessence Publishing
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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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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
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Educ 200569(5)571ndash585
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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
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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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
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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
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
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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
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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
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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
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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
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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
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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
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118Gregoire GL Akon BA Millas A Interfacial micromorphological differences
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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
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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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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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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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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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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
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influence of simulated clinical handling on the flexural and compressive strength of
posterior composite restorative materials Dent Mater 199612116ndash120
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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
151Jacobsen T Soderhold KJ Some effects of water on dentin bonding Dent
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
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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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
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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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M Dentin shear strength effect of distance from the pulp Dent Mater 2002
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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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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analysis of amalgam restorations 15th
Edition of the Balkan Medical Days
Stomatological Section Abstract nr1091999128
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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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51
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52
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451
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1996751477-83
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59
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study on adhesive performance of functional monomers J Dent Res 2004 83 454-
458
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dentin J Dent Res 2002 81 556-560
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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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
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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
41
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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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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
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
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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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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
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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
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
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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
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
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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
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
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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
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)
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JADA 1972841349-1357
117Gordon JChristensen G Why switch to digital radiography J Am Dent
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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
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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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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
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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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
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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
151Jacobsen T Soderhold KJ Some effects of water on dentin bonding Dent
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
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
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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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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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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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Edition of the Balkan Medical Days
Stomatological Section Abstract nr1091999128
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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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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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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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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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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
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
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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
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
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
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42
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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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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-
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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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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
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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
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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
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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
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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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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
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
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systems in the prediction of occlusal caries in permanent molars in 6 and 11 year-old
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102Ferracane JL Developing a more complete understanding of stresses produced
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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109Fruits TJ Knapp JA Khajotia SS Microleakage in the proximal walls of
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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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118Gregoire GL Akon BA Millas A Interfacial micromorphological differences
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Prosthet Dent 2002 87633ndash641
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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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134Hilton TJ Cavity sealers liners and bases Current philosophies and indications
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138Hintze H Wenzel A Danielen B Behaviour of approximal carious lesions
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1995202ndash 6
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148Inoue S Van Meerbeek B Vargas M Lambrechts P Vanherle G Adhesion
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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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18(7)516-20
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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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art and future perspectives Quintessence Int 200233213-224
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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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studyDent Mater20011745-52
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Dent Res 1988 94 19-26
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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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PrimDentCare1999Apr659-62
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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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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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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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2003 24655-665
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longevity in a cohort of young US naval personnel JADA 2005136(2)171ndash178
56
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restorations with adhesive liners J Conserv Dent 201114(2)178-81
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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
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Am Dent Assoc 2007 Jun138(6)763-72
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Dentistry and Oral Epidemiology 1987 15 (2) 90-94
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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
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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
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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
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
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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Oper Dent 2008 Sep-Oct33(5)587-92
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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
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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
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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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36Bouillaguet S B Ciucchi T Jacoby JC Wataha DH Pashley Bonding
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37Bouschlicher MR Rueggeberg FA Effect of ramped light intensity on
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46Burke FJ Cheung SW Mjor IA Wilson NH-Reasons for the placement and
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47Burke FJ Wilson NH Cheung SW Mjoumlr IA Influence of patient factors on age
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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
the decision to replace existing amalgam restorations Quintessence Int 1999
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51Carvalho RM JC Pereira M Yoshiyama DH Pashley A review of
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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
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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
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1399
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63(12)1396-9
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shrinkage stress in polymer-based restoratives J Dent Res 199725435ndash440
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Prosthet Dent 198655446ndash7
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Dent200899131-40
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and replacement of restorations Prim Dent Care 20018(1)5-11
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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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1243
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Biology199843(8)629-632
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Edition of the Balkan Medical Days
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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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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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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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Restorative Materials In Class I And Class II Restorations An In-Vivo Study The
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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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amalgam restaorations JDentRes 1998 77 453-460
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54
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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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Int Dent J 199141(4)195-205
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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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of new adult patients diagnostic yield when combined with bitewing radiography and
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199242(3)139-44
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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
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
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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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interobserver agreement and comparison to histological hard-tissue sections Caries
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Prosthodont19892(3)217-223
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of new dental ceramics J Prosthet Dent 199574(2)145-150
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wall Oper Dent 2005 30(4)430-435
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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
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
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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44
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Operations Desert ShieldStorm Mil Med 1996161(10) 620ndash623
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26 717-727
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Sci 1998 106 1033-1042
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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
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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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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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its possible influence on postoperative sensitivity Quintessence Int 198617103-11
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5 no21-7
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848
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class 2 composites Oper Dent 19981312-19
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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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Kompositefullungen Zahnartzlicher Welt 1999 108 270-273
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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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18(7)516-20
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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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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
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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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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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clinical results J Dent Res 199877 1020
196Mair LH Ten-year clinical assessment of three posterior resin composites and
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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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53
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569ndash575
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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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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
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199242(3)139-44
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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
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
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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
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
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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
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-
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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
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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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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
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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
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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
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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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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
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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
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
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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148Inoue S Van Meerbeek B Vargas M Lambrechts P Vanherle G Adhesion
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Activity EdApollonia Iasi2002
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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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composite restorations effected by increased flexibility J Dent Res 1990 691240ndash
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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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
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
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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
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amalgamelor dentare la pereţii cavităţilor RevMedicina
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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
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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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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
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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
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
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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
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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51
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PrimDentCare1999Apr659-62
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ScandJDRes 199210060-65
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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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864
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308
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In vivo evidence J Dent 2004 32611ndash621
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Dent Assoc 2003 69726ndash731
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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
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
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Oper Dent 2008 Sep-Oct33(5)587-92
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and replacement Chicago 1989Quintessence Publishing
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utilizing a filled and unfilled adhesive resin Dent Mater 200117268ndash276
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1451-56
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(6) 48-50
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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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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
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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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
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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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of reasons for the placement and replacement of restorations provided by vocational
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199930(4)234-42
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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
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
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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
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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
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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
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
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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
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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
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
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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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
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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
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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
the aged JPublic Health Dent1990 50(3) 164-171
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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
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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
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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
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
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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
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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ceramic and a ceromer used for making esthetic inlays Odontostomatol Trop
200932(126)21-8
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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
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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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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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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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influence of the amalgam alloy on the survival of amalgam restorations a secondary
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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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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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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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In vivo evidence J Dent 2004 32611ndash621
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451
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resin inlays Am J Dent 4(1)10-14 1991
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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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filling techniques for class V light-cured composite restorations J Dent Res
1996751477-83
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placement Impact of cavity depth and exposure time Oper Dent 2000 25113-120
59
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peripheral and central dentinal tissue a microtensile bond strength test The Journal of
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
Nakajima M Pashley DH Bonding of self-etch and total etch adhesives to carious
dentin J Dent Res 2002 81 556-560
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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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
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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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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
321
37Bouschlicher MR Rueggeberg FA Effect of ramped light intensity on
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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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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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42
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
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
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1399
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63(12)1396-9
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shrinkage stress in polymer-based restoratives J Dent Res 199725435ndash440
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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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30(3)163- 1681999
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1243
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Biology199843(8)629-632
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18(7)516-20
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Stomatological Section Abstract nr1091999128
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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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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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self-curing resin composite linings on microleakage in vitro Oper Dent 200227
569ndash575
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247Pontual AA de Melo D de Almeida S Boacutescolo F Haiter Neto FComparison
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caries Dentomaxillofac Radiol 2010 Oct39(7)431-6
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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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54
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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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Int Dent J 199141(4)195-205
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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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J Conserv Dent 201013(1)9-15
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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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404
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clinical evaluation of bonded amalgam restorations- Journal of Adhesive Dentistry
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231819-1829
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2003 24655-665
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York Springer-Verlag 1999
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200382 1169 (Abstract)
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longevity in a cohort of young US naval personnel JADA 2005136(2)171ndash178
56
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restorations with adhesive liners J Conserv Dent 201114(2)178-81
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direct posterior restorations JADA 2002 101387-1398
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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
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Am Dent Assoc 2007 Jun138(6)763-72
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Quintessence 2000253ndash76
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using different placement and curing techniques an in vitro study Am J Dent 2002
15244-247
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Dentistry and Oral Epidemiology 1987 15 (2) 90-94
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using second-generation CADCAM equipment J Esthet Dent 11(4)206-214 1999
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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
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10Direct Posterior Esthetic Restorations 2006 Quintessence Publishing Co
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
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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
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
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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
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
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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Class I cavities J Dent Res 200281 (Abstract)
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class 2 composites Oper Dent 19981312-19
47
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Activity EdApollonia Iasi2002
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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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composite restorations effected by increased flexibility J Dent Res 1990 691240ndash
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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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
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
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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
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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
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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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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
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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
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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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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PrimDentCare1999Apr659-62
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ScandJDRes 199210060-65
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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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864
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308
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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
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
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
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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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Rehabilitation (33) 2006690ndash697
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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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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
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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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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
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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-
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
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
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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
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
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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
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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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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
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
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102Ferracane JL Developing a more complete understanding of stresses produced
in dental composites during polymerization Dent Mater 2005 2136-42
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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
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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
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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
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
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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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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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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
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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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
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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
151Jacobsen T Soderhold KJ Some effects of water on dentin bonding Dent
Mater 1995 11(2)132-6
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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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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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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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18(7)516-20
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Dent 27(5)325-331 1999
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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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Edition of the Balkan Medical Days
Stomatological Section Abstract nr1091999128
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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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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
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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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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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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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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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34
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53
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54
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55
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56
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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
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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
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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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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
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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Behinderten Dtsch Zahnartzlicher 1999 54 96-102
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80De Munck J Van Meerbeek B Satoshi I Vargas M Yoshida Y Armstrong S
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Operations Desert ShieldStorm Mil Med 1996161(10) 620ndash623
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89Donly KJ Jensen ME Triolo PA clinical comparison of resin composite inlay
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30(3)163- 1681999
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its possible influence on postoperative sensitivity Quintessence Int 198617103-11
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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
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Sci 1995 103322ndash326
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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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resistance of premolar teeth restored with different filling techniques J Contemp Dent
Pract 20056(3)62-9
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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
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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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848
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influence of simulated clinical handling on the flexural and compressive strength of
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148Inoue S Van Meerbeek B Vargas M Lambrechts P Vanherle G Adhesion
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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
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Kompositefullungen Zahnartzlicher Welt 1999 108 270-273
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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
201989117ndash121
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18(7)516-20
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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
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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
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posterior packable resin composites with and without flowable liners Oper Dent
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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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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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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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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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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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affecting cure at depths within light-activated resin composites Am J Dent
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of new adult patients diagnostic yield when combined with bitewing radiography and
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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-
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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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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
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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Statement on posterior resin-based composites JADA 1998 129(11)1627ndash1628
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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
40
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
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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
41
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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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Rehabilitation (33) 2006690ndash697
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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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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
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
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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
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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
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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
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
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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
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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
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
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)
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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
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
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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
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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of approximal and occlusal dental caries in a young adult population Community
Dent Oral Epidemiol 200533(3)212-8
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restoration-tooth interfacecomparing inlays and bulk
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
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influence of simulated clinical handling on the flexural and compressive strength of
posterior composite restorative materials Dent Mater 199612116ndash120
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Bucureşti 2001
148Inoue S Van Meerbeek B Vargas M Lambrechts P Vanherle G Adhesion
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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
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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
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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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
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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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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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analysis of amalgam restorations 15th
Edition of the Balkan Medical Days
Stomatological Section Abstract nr1091999128
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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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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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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
51
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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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53
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569ndash575
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54
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55
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56
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restorations with adhesive liners J Conserv Dent 201114(2)178-81
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OperDent 1991 16 17-20
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restorations JDent1991 19 272-277
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posterior crowns JDent 1997 25 225-227
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longevity of amalgam versus compomercomposite restorations in posterior primary
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Am Dent Assoc 2007 Jun138(6)763-72
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no1(2007)
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International 2005 36 41-48
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Quintessence 2000253ndash76
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Two-year results J Oral Rehabil 1990 17 257-268
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Dentistry and Oral Epidemiology 1987 15 (2) 90-94
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using second-generation CADCAM equipment J Esthet Dent 11(4)206-214 1999
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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
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10Direct Posterior Esthetic Restorations 2006 Quintessence Publishing Co
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
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dentin adhesive systems Dent Mater 2000 16(3)180-7
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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
RM Single-bottle adhesives behave as permeable membranes after polymerization I
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
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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
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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
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
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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45
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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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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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influence of simulated clinical handling on the flexural and compressive strength of
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148Inoue S Van Meerbeek B Vargas M Lambrechts P Vanherle G Adhesion
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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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restorative decisions made on the basis of simulated bitewing radiographs
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composite restorations effected by increased flexibility J Dent Res 1990 691240ndash
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
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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
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
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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
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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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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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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
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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affecting cure at depths within light-activated resin composites Am J Dent
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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-
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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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Am Dent Assoc 2007 Jun138(6)763-72
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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
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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
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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
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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
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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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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
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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5Alster D Feilzer AJ de Gee AJ Mol A Davidson CL The dependence of
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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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1999
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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
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
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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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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
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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
versus composite posterior restorations placed in a randomized clinical trial JADA
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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)
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
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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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41Browning WD Johnson WW Gregory PN- Clinical performances of
amalgam-bonded restorations A 42-months study- Journal of American Dental
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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
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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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42
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
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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
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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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
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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
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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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
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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
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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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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
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
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102Ferracane JL Developing a more complete understanding of stresses produced
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
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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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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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report Br Dent J 196511977-81
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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
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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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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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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
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148Inoue S Van Meerbeek B Vargas M Lambrechts P Vanherle G Adhesion
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151Jacobsen T Soderhold KJ Some effects of water on dentin bonding Dent
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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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1243
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Biology199843(8)629-632
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18(7)516-20
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Jan11(1)34-40
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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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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
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art and future perspectives Quintessence Int 200233213-224
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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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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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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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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
Caries Detection Methods Caries Res 2010 Sep 2344(5)465-471
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Adhes Dent 20079(5)469-75
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Mater 200723(1)2-8
234Ozer F Unlu N Sengun A Influence of dentinal regions on bond strengths of
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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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53
240Pashley DH Dentin a dynamic substrate--a reviewScanning
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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569ndash575
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54
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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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Int Dent J 199141(4)195-205
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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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J Conserv Dent 201013(1)9-15
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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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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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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
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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
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direct posterior restorations JADA 2002 101387-1398
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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
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Am Dent Assoc 2007 Jun138(6)763-72
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no1(2007)
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International 2005 36 41-48
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Quintessence 2000253ndash76
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using different placement and curing techniques an in vitro study Am J Dent 2002
15244-247
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Two-year results J Oral Rehabil 1990 17 257-268
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Dentistry and Oral Epidemiology 1987 15 (2) 90-94
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using second-generation CADCAM equipment J Esthet Dent 11(4)206-214 1999
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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
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10Direct Posterior Esthetic Restorations 2006 Quintessence Publishing Co
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
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dentin adhesive systems Dent Mater 2000 16(3)180-7
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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
RM Single-bottle adhesives behave as permeable membranes after polymerization I
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
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
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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Behinderten Dtsch Zahnartzlicher 1999 54 96-102
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shrinkage stress in polymer-based restoratives J Dent Res 199725435ndash440
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Prosthet Dent 198655446ndash7
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85Dietschi D Herzfeld D In vitro evaluation of marginal and internal adaptation of
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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
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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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composite restorations Oper Dent 200934(1)11-7
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dental resin composites Dent Mater 2005 211150-1157
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M Dentin shear strength effect of distance from the pulp Dent Mater 2002
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Edition of the Balkan Medical Days
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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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33
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19904011ndash7
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52
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34
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In vivo evidence J Dent 2004 32611ndash621
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451
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Radiology 27(1)3-11 1998
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Dent 200114177ndash185
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1996751477-83
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placement Impact of cavity depth and exposure time Oper Dent 2000 25113-120
59
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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
Nakajima M Pashley DH Bonding of self-etch and total etch adhesives to carious
dentin J Dent Res 2002 81 556-560
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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shear stress by hygroscopic expansion J Dent Res 1990 6936ndash39
45
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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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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)
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JADA 1972841349-1357
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Assoc 204 Vol 135 No 101437-1439
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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influence of simulated clinical handling on the flexural and compressive strength of
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148Inoue S Van Meerbeek B Vargas M Lambrechts P Vanherle G Adhesion
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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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restorative decisions made on the basis of simulated bitewing radiographs
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composite restorations effected by increased flexibility J Dent Res 1990 691240ndash
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
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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
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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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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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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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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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
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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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of teeth with long-term performing composite restorations J Oral Rehabil 2002
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affecting cure at depths within light-activated resin composites Am J Dent
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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-
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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
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Am Dent Assoc 2007 Jun138(6)763-72
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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
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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
transillumination Journal of Dental Research 1997 76 (4) 875-882
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
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323Van Meerbeek B Vargas S Inoue S Yoshida Y Peumans M Lambrechts P
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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
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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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
Lambrechts P Vanherle G Microtensile bond strengths of one- and two-step
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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
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848
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class 2 composites Oper Dent 19981312-19
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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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1243
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Biology199843(8)629-632
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18(7)516-20
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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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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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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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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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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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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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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
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
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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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404
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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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Quintessence 2000253ndash76
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57
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864
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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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systems J Dent 199523183ndash189
318Unterbrink GL Liebenberg WH Flowable resin composites as filled
adhesiveslsquo literature review and clinical recommendations Quintessence Int
199930249ndash257
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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
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323Van Meerbeek B Vargas S Inoue S Yoshida Y Peumans M Lambrechts P
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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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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
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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
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
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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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
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
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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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22Bader JD Shugars DA What do we know about how dentists make caries-
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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
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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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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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37Bouschlicher MR Rueggeberg FA Effect of ramped light intensity on
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38Braga RR Ferracane JL Hilton TJ Contraction stress of flowable composites
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42Brunthaler A Koumlnig F Lucas T Sperr W Schedle A Longevity of direct resin
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of reasons for the placement and replacement of restorations provided by vocational
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42
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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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
the decision to replace existing amalgam restorations Quintessence Int 1999
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51Carvalho RM JC Pereira M Yoshiyama DH Pashley A review of
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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
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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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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-
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Quintessence Int 1993 24583-591
43
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resin restorations 8-year findings J Dent 199826(4) 311ndash317
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1399
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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
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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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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
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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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of methacrylate dental resins Macromolecules 2003 366043-6053
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26 717-727
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Sci 1998 106 1033-1042
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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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30(3)163- 1681999
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5 no21-7
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1243
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Biology199843(8)629-632
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18(7)516-20
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Stomatological Section Abstract nr1091999128
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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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clinical results J Dent Res 199877 1020
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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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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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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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198732(7)519-23
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53
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Microsc19893(1)161-74
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569ndash575
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54
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ClinOral Invest1997140-46
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J Dent 199725(6)459-73
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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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56
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restorations JDent1991 19 272-277
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57
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of amalgam composite and glassndashionomer restorations J Dent Res 199069861ndash
864
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for stress in the periodontal tissue by orthodontic forcesAm J Orthod Dentofacial
Orthop921987499ndash505
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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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study of the influence of acidity of self-etching primers and smear layer thickness on
bonding to intact dentin J Adhes Dent 2000 283ndash98
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76(6)619-623 1996
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systems J Dent 199523183ndash189
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adhesiveslsquo literature review and clinical recommendations Quintessence Int
199930249ndash257
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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
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
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42
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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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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-
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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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1991469-72
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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
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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
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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
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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
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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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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
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
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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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restorations in adults Acta Odontol Scand 2004 6282-86
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14(3)149-57
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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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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
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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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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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of approximal and occlusal dental caries in a young adult population Community
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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148Inoue S Van Meerbeek B Vargas M Lambrechts P Vanherle G Adhesion
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151Jacobsen T Soderhold KJ Some effects of water on dentin bonding Dent
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48
154Jokstad A Mjor IA Analyses of long-term clinical behaviour of class II
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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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18(7)516-20
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Jan11(1)34-40
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Stomatological Section Abstract nr1091999128
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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
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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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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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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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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
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Dent Res 1988 94 19-26
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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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PrimDentCare1999Apr659-62
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Quintessence 198961-80
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ScandJDRes 199210060-65
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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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Am Dent Assoc 2010 141(3)319-29
52
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125749-751
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34
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Nanoleakage leakage within the hybrid layer Oper Dent 1995 20 18-25
55
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57
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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
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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
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adhesiveslsquo literature review and clinical recommendations Quintessence Int
199930249ndash257
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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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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
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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
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
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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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
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
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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-
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
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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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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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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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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
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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
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
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
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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
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
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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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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
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
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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
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
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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
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
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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
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
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120Gwinnett AJ Buonocore MG Adhesives and caries prevention a preliminary
report Br Dent J 196511977-81
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between enamel and adhesive Arch Oral Biol 1967121615-1620
122Gwinnett AJ Histologic changes in human enamel following treatment with
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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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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
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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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
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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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151Jacobsen T Soderhold KJ Some effects of water on dentin bonding Dent
Mater 1995 11(2)132-6
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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
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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
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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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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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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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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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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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depth as cavity predictors for approximal dentin caries lesions in primary teeth
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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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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relative diagnostic yields of clinical FOTI and radiographic examinations for the
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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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Quintessence Int 1998295ndash11
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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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Am Dent Assoc 2007 Jun138(6)763-72
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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
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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
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mica-based machinable glass ceramic for CADCAM restorations J Prosthet Dent
76(6)619-623 1996
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systems J Dent 199523183ndash189
318Unterbrink GL Liebenberg WH Flowable resin composites as filled
adhesiveslsquo literature review and clinical recommendations Quintessence Int
199930249ndash257
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approximal caries lesions utilizing wavelength-dependent fiber-optic
transillumination Journal of Dental Research 1997 76 (4) 875-882
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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
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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
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
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
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
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
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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-
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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
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
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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
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24Bader JD Shugars DA Bonito AJ Systematic reviews of selected dental caries
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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
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29Bedran-de-Castro AK Pereira PN Thompson JY Influence of load cycling
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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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NY Marcel Dekker Inc 1999
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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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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
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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
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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
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
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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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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
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
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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
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
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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
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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
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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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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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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
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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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
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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
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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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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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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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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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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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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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Borgmeijer PJ Replacement risk of amalgam treatment modalities 15-year results
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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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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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
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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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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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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
51
206Mejare I Malmgreen B Clinical and radiographic appearance of proximal
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Dent Res 1988 94 19-26
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relative diagnostic yields of clinical FOTI and radiographic examinations for the
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PrimDentCare1999Apr659-62
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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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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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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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of amalgam composite and glassndashionomer restorations J Dent Res 199069861ndash
864
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Orthop921987499ndash505
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308
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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
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76(6)619-623 1996
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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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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
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
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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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
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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-
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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polymerization contraction the influence of stress development versus stress
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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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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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1991469-72
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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
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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
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
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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
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
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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
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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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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
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
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systems in the prediction of occlusal caries in permanent molars in 6 and 11 year-old
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102Ferracane JL Developing a more complete understanding of stresses produced
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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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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118Gregoire GL Akon BA Millas A Interfacial micromorphological differences
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Prosthet Dent 2002 87633ndash641
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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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134Hilton TJ Cavity sealers liners and bases Current philosophies and indications
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1243
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Biology199843(8)629-632
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18(7)516-20
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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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art and future perspectives Quintessence Int 200233213-224
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clinical results J Dent Res 199877 1020
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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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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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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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of teeth with long-term performing composite restorations J Oral Rehabil 2002
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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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231819-1829
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56
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Quintessence 2000253ndash76
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57
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of amalgam composite and glassndashionomer restorations J Dent Res 199069861ndash
864
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Orthop921987499ndash505
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308
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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
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adhesiveslsquo literature review and clinical recommendations Quintessence Int
199930249ndash257
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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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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
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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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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Med 2008173(1)23ndash26
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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
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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
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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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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18(7)516-20
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Edition of the Balkan Medical Days
Stomatological Section Abstract nr1091999128
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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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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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Dent Mater 1989 5 392-398
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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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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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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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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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231819-1829
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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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56
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restorations with adhesive liners J Conserv Dent 201114(2)178-81
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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
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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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301Spreafico RC Gagliani M Composite resin restorations on posterior teeth In
Roulet JF Degrange M Adhesion The silent revolution in dentistry Chicago
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)
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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
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
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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
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
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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9
35Boschian PL S Guidotti R Pietrbissa M Gagliani- bdquoStress distribution in a
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48Calheiros FC Braga RR Kawano Y Ballester RY Relationship between
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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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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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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
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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
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73Davidson CL AJ Feilzer Polymerization shrinkage and polymerization
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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 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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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)
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
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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
97Feilzer AJ Dauvillier BS Effect of TEGDMABisGMA ratio on stress
development and viscoelastic properties of experimental twopaste composites J Dent
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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
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
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848
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148Inoue S Van Meerbeek B Vargas M Lambrechts P Vanherle G Adhesion
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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
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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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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
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
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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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Edition of the Balkan Medical Days
Stomatological Section Abstract nr1091999128
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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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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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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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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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53
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569ndash575
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54
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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
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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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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
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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
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Nanoleakage leakage within the hybrid layer Oper Dent 1995 20 18-25
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275Sarrett DC Clinical challenges and the relevance of materials testing for
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-
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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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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
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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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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
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
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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
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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
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316Thompson JY Bayne SC Heymann HO Mechanical properties of a new
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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
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321Van Meerbeek B De Munck J Yoshida Y Inoue S Vargas M Vijay P Van
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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
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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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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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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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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
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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Class I cavities J Dent Res 200281 (Abstract)
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1995202ndash 6
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influence of simulated clinical handling on the flexural and compressive strength of
posterior composite restorative materials Dent Mater 199612116ndash120
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48
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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
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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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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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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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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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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
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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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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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
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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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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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In vivo evidence J Dent 2004 32611ndash621
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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
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
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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
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
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
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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
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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30Behle C Flowable composite Proprieties and applications Pract Periodontics
Aesthetics Dent 1998 10347 350-351
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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
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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
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amalgam-bonded restorations A 42-months study- Journal of American Dental
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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
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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
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
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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
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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
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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
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)
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JADA 1972841349-1357
117Gordon JChristensen G Why switch to digital radiography J Am Dent
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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
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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
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
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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
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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of approximal and occlusal dental caries in a young adult population Community
Dent Oral Epidemiol 200533(3)212-8
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restoration-tooth interfacecomparing inlays and bulk
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
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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
151Jacobsen T Soderhold KJ Some effects of water on dentin bonding Dent
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
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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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
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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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M Dentin shear strength effect of distance from the pulp Dent Mater 2002
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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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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analysis of amalgam restorations 15th
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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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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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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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
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79369 (Abstract)
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51
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PrimDentCare1999Apr659-62
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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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864
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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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Lambrechts P Yoshida Y Inoue S Suzuki K Technique-sensitivity of
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58
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dynamics of the polymerization Biomaterials 1996 172313-2318
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451
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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
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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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
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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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-
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
66Cook WD Moopnar M Influence of chemical structure on the fracture
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-
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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
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
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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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1243
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Biology199843(8)629-632
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18(7)516-20
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Edition of the Balkan Medical Days
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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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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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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
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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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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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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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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
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edition 1996
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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Prosthodont19892(3)217-223
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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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299Soodabeh Kimyai Masomeh Mehdipour Siavash Savadi Oskoee Reasons
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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)
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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
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
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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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study of the influence of acidity of self-etching primers and smear layer thickness on
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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
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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154Jokstad A Mjor IA Analyses of long-term clinical behaviour of class II
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1243
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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
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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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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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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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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
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
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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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Influence of the Discomfort Reported by Children on the Performance of Approximal
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569ndash575
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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
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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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
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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
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29Bedran-de-Castro AK Pereira PN Thompson JY Influence of load cycling
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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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36Bouillaguet S B Ciucchi T Jacoby JC Wataha DH Pashley Bonding
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37Bouschlicher MR Rueggeberg FA Effect of ramped light intensity on
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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
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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
the decision to replace existing amalgam restorations Quintessence Int 1999
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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
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55Cehreli ZC Akca T Effect of dentinal tubule orientation on the microtensile
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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
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marginal leakage J Dent 2005 33(7) 603- 610
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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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Quintessence Int 1993 24583-591
43
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resin restorations 8-year findings J Dent 199826(4) 311ndash317
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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
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Prosthet Dent 198655446ndash7
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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
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Dent20104(3)270-9
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Lambrechts P Vanherle G Microtensile bond strengths of one- and two-step
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2006 22359-365
44
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Operations Desert ShieldStorm Mil Med 1996161(10) 620ndash623
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of methacrylate dental resins Macromolecules 2003 366043-6053
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26 717-727
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Sci 1998 106 1033-1042
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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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30(3)163- 1681999
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5 no21-7
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contraction in thin bonded resin layers J Dent Res 19896848ndash50
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1243
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Biology199843(8)629-632
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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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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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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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PrimDentCare1999Apr659-62
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Quintessence 198961-80
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ScandJDRes 199210060-65
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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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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
Caries Detection Methods Caries Res 2010 Sep 2344(5)465-471
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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
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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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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
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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569ndash575
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54
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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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J Dent 199725(6)459-73
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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
posterior composite restorations Dent Mater 200521(1) 9ndash12
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56
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57
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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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76(6)619-623 1996
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systems J Dent 199523183ndash189
318Unterbrink GL Liebenberg WH Flowable resin composites as filled
adhesiveslsquo literature review and clinical recommendations Quintessence Int
199930249ndash257
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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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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
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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
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
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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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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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
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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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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PrimDentCare1999Apr659-62
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ScandJDRes 199210060-65
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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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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
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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surfaces and its distribution by age and gender in university clinic patientsEur J
Dent20104(3)270-9
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Lambrechts P Vanherle G Microtensile bond strengths of one- and two-step
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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
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class II resin composite restorations after thermal and occlusal stressing Eur J Oral
Sci 1998 106 1033-1042
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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
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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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848
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class 2 composites Oper Dent 19981312-19
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Mater 1995 11(2)132-6
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technique J Am Dent Assoc 2000131375ndash383
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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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composite restorations effected by increased flexibility J Dent Res 1990 691240ndash
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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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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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
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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clinical results J Dent Res 199877 1020
196Mair LH Ten-year clinical assessment of three posterior resin composites and
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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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206Mejare I Malmgreen B Clinical and radiographic appearance of proximal
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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
227Neuhaus KW Ellwood R Lussi A Pitts N Traditional lesion detection aids
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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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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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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199242(3)139-44
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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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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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56
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Quintessence 2000253ndash76
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57
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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
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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
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199930249ndash257
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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
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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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a 4- MET-based self-etching adhesive J Dent Res 2000 79 249 (Abstract)
58
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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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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
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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
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
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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
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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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
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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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on the dental pulp J Oral Path 198211 439 ndash450
32Bernardo M Luis H Martin MD Survival and reasons for failure of amalgam
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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
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
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42
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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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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-
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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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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
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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
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
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
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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
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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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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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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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in dental composites during polymerization Dent Mater 2005 2136-42
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restorations in adults Acta Odontol Scand 2004 6282-86
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incremental methods in Class II composite resin restorations on gingival
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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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118Gregoire GL Akon BA Millas A Interfacial micromorphological differences
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Prosthet Dent 2002 87633ndash641
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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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134Hilton TJ Cavity sealers liners and bases Current philosophies and indications
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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
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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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148Inoue S Van Meerbeek B Vargas M Lambrechts P Vanherle G Adhesion
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151Jacobsen T Soderhold KJ Some effects of water on dentin bonding Dent
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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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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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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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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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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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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
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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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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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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
51
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Dent Res 1988 94 19-26
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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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PrimDentCare1999Apr659-62
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Quintessence 198961-80
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ScandJDRes 199210060-65
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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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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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Quintessence Int 1998295ndash11
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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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Nanoleakage leakage within the hybrid layer Oper Dent 1995 20 18-25
55
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57
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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
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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
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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
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approximal caries lesions utilizing wavelength-dependent fiber-optic
transillumination Journal of Dental Research 1997 76 (4) 875-882
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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
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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
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
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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Behinderten Dtsch Zahnartzlicher 1999 54 96-102
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shrinkage stress in polymer-based restoratives J Dent Res 199725435ndash440
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Prosthet Dent 198655446ndash7
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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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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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200126302ndash307
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influence of the amalgam alloy on the survival of amalgam restorations a secondary
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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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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
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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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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51
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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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53
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569ndash575
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Community Dent Oral Epidemiol 1980 Jun8(3)135-8
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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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295Smales RJ Webster DA Leppard PISurvival predictions of amalgam
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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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Dent Assoc 2003 69726ndash731
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study of the influence of acidity of self-etching primers and smear layer thickness on
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76(6)619-623 1996
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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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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
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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
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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
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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
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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
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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
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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of approximal and occlusal dental caries in a young adult population Community
Dent Oral Epidemiol 200533(3)212-8
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Activity EdApollonia Iasi2002
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48
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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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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
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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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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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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
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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
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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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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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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34
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864
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In vivo evidence J Dent 2004 32611ndash621
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approximal caries lesions utilizing wavelength-dependent fiber-optic
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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
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
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resin inlays Am J Dent 4(1)10-14 1991
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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
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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
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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
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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Three Core Restorative Materials Supported with or without a Prefabricated Split-
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69Dauvillier B Aarnts M Feilzer A The competition between the composite-
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Prosthet Dent 198655446ndash7
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80De Munck J Van Meerbeek B Satoshi I Vargas M Yoshida Y Armstrong S
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85Dietschi D Herzfeld D In vitro evaluation of marginal and internal adaptation of
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89Donly KJ Jensen ME Triolo PA clinical comparison of resin composite inlay
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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
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
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ceramic inlays for four and a half years J Prosthet Dent 1997 78(4)346-353
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Pract 20056(3)62-9
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packable composite resin in Class II restorations J Esthet Restor Dent 2002
14(3)149-57
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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
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
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Effects of irradiation mode and filling technique on resindentin bond strength in
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848
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148Inoue S Van Meerbeek B Vargas M Lambrechts P Vanherle G Adhesion
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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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restorative decisions made on the basis of simulated bitewing radiographs
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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
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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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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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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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
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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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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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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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79369 (Abstract)
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51
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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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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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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
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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-
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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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restorative treatment needs among a cohort of US naval personnel J Dent Res
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direct posterior restorations JADA 2002 101387-1398
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restorations JDent1991 19 272-277
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posterior crowns JDent 1997 25 225-227
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no1(2007)
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Quintessence 2000253ndash76
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15244-247
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308Summit JB Robbins JW Hilton TJ Fundamentals in operative dentistry Cap
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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
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
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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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Dent Assoc 2003 69726ndash731
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systems J Dent 199523183ndash189
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199930249ndash257
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Lambrechts P Yoshida Y Inoue S Suzuki K Technique-sensitivity of
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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
technique reduce polymerization shrinkage stresses J Dent Res 1996 75871ndash878
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55-60
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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
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
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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
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peripheral and central dentinal tissue a microtensile bond strength test The Journal of
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
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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
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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88Diefenderfer KE Rienhardt JW Shear bond strengths of ten adhesive
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848
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class 2 composites Oper Dent 19981312-19
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148Inoue S Van Meerbeek B Vargas M Lambrechts P Vanherle G Adhesion
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Mater 1995 11(2)132-6
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Kompositefullungen Zahnartzlicher Welt 1999 108 270-273
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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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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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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
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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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clinical results J Dent Res 199877 1020
196Mair LH Ten-year clinical assessment of three posterior resin composites and
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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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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
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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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199242(3)139-44
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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
55
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posterior composite restorations Dent Mater 200521(1) 9ndash12
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231819-1829
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56
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restorations JDent1991 19 272-277
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Quintessence 2000253ndash76
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57
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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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199930249ndash257
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20016 119-144
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58
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dynamics of the polymerization Biomaterials 1996 172313-2318
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55-60
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451
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Dent 200114177ndash185
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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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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
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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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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848
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1243
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Biology199843(8)629-632
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18(7)516-20
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Jan11(1)34-40
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Edition of the Balkan Medical Days
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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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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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53
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569ndash575
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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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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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58
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451
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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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dentin J Dent Res 2002 81 556-560
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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63(12)1396-9
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Prosthet Dent 198655446ndash7
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Dent200899131-40
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and replacement of restorations Prim Dent Care 20018(1)5-11
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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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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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18(7)516-20
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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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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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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
227Neuhaus KW Ellwood R Lussi A Pitts N Traditional lesion detection aids
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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1999 15(1)46-53
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Adhes Dent 1999 1(3)191-209
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569ndash575
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55
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864
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Dent 200114177ndash185
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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
peripheral and central dentinal tissue a microtensile bond strength test The Journal of
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
Nakajima M Pashley DH Bonding of self-etch and total etch adhesives to carious
dentin J Dent Res 2002 81 556-560
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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1399
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63(12)1396-9
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shrinkage stress in polymer-based restoratives J Dent Res 199725435ndash440
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Prosthet Dent 198655446ndash7
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Dent200899131-40
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and replacement of restorations Prim Dent Care 20018(1)5-11
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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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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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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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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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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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Restorative Materials In Class I And Class II Restorations An In-Vivo Study The
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53
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1999 15(1)46-53
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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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54
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29(12)1131ndash1138
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Operative Dentistry 5th ed St Louis Mosby 2006293-7
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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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of new adult patients diagnostic yield when combined with bitewing radiography and
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199242(3)139-44
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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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mechanical analysis of storage modulus development in lightactivated polymer matrix
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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
posterior composite restorations Dent Mater 200521(1) 9ndash12
276Sarrett DC Brooks CN Rose JT Clinical performance evaluation of a
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286Sideridou I Tserki V Papanastasiou G Effect of chemical structure on degree
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231819-1829
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2003 24655-665
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York Springer-Verlag 1999
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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
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direct posterior restorations JADA 2002 101387-1398
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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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Am Dent Assoc 2007 Jun138(6)763-72
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Quintessence 2000253ndash76
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pin-retained complex amalgam restorations Oper Dent 2004 29269-276
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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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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
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76(6)619-623 1996
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systems J Dent 199523183ndash189
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adhesiveslsquo literature review and clinical recommendations Quintessence Int
199930249ndash257
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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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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
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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
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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
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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
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
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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
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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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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30Behle C Flowable composite Proprieties and applications Pract Periodontics
Aesthetics Dent 1998 10347 350-351
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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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42Brunthaler A Koumlnig F Lucas T Sperr W Schedle A Longevity of direct resin
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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
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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
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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Operations Desert ShieldStorm Mil Med 1996161(10) 620ndash623
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26 717-727
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1243
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Biology199843(8)629-632
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18(7)516-20
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Jan11(1)34-40
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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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clinical results J Dent Res 199877 1020
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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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52
222Nakajima M Sano H Burrow MF Tagami J Yoshiyama M Ebisu S
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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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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
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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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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ClinOral Invest1997140-46
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J Dent 199725(6)459-73
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1993691ndash95
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Nanoleakage leakage within the hybrid layer Oper Dent 1995 20 18-25
55
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In vivo evidence J Dent 2004 32611ndash621
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458
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utilizing a filled and unfilled adhesive resin Dent Mater 200117268ndash276
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1451-56
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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
41
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Aesthetics Dent 1998 10347 350-351
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9
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characteristics to dentin walls of class II cavities in vitro Dent Mater 200117316ndash
321
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200521(10)962-70
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Timişoara1994
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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
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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
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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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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
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848
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148Inoue S Van Meerbeek B Vargas M Lambrechts P Vanherle G Adhesion
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Mater 1995 11(2)132-6
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48
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Kompositefullungen Zahnartzlicher Welt 1999 108 270-273
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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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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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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
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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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clinical results J Dent Res 199877 1020
196Mair LH Ten-year clinical assessment of three posterior resin composites and
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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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53
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569ndash575
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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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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
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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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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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56
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57
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In vivo evidence J Dent 2004 32611ndash621
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458
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200521(10)962-70
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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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polymerization contraction the influence of stress development versus stress
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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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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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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
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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
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
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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
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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
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
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
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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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Activity EdApollonia Iasi2002
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48
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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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200126302ndash307
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influence of the amalgam alloy on the survival of amalgam restorations a secondary
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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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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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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
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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
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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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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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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34
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864
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In vivo evidence J Dent 2004 32611ndash621
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451
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458
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2004 20939-946
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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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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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1399
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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
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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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Dent200899131-40
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shrinkage in direct posterior composite restorations J Am Dent Assoc 2002
1331387ndash97
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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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2006 22359-365
44
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Operations Desert ShieldStorm Mil Med 1996161(10) 620ndash623
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restorative technique and new adhesives on the dentin marginal seal and adaptation of
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26 717-727
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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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848
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48
154Jokstad A Mjor IA Analyses of long-term clinical behaviour of class II
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Community Dentistry and Oral Epidemiology 1994 22(2) 71-74
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1243
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JDent 199826 627-632
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Stomatological Section Abstract nr1091999128
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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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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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art and future perspectives Quintessence Int 200233213-224
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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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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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J Prosthet Dent 2000 Sep84(3)289-96
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79369 (Abstract)
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ScandJDRes 199210060-65
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34
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2006 22359-365
44
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Operations Desert ShieldStorm Mil Med 1996161(10) 620ndash623
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caries status and dental emergencies among US naval personnel J Dent Res
20028195 (Abstract)
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30(3)163- 1681999
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848
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Mater 1995 11(2)132-6
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Kompositefullungen Zahnartzlicher Welt 1999 108 270-273
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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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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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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
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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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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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clinical results J Dent Res 199877 1020
196Mair LH Ten-year clinical assessment of three posterior resin composites and
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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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53
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569ndash575
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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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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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199242(3)139-44
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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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In vivo evidence J Dent 2004 32611ndash621
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458
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dentin J Dent Res 2002 81 556-560
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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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848
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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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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
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Bucureşti 2001
148Inoue S Van Meerbeek B Vargas M Lambrechts P Vanherle G Adhesion
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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
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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
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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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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ceramic and a ceromer used for making esthetic inlays Odontostomatol Trop
200932(126)21-8
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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
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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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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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analysis of amalgam restorations 15th
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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influence of the amalgam alloy on the survival of amalgam restorations a secondary
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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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Dentomaxillofac Radiol 2007 Oct36(7)377-81
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79369 (Abstract)
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52
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34
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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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848
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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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restorative decisions made on the basis of simulated bitewing radiographs
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composite restorations effected by increased flexibility J Dent Res 1990 691240ndash
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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18(7)516-20
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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
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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
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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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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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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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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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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
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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
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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
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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-
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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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864
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308
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In vivo evidence J Dent 2004 32611ndash621
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451
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458
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848
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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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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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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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Bucureşti 2001
148Inoue S Van Meerbeek B Vargas M Lambrechts P Vanherle G Adhesion
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Mater 1995 11(2)132-6
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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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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
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
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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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
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
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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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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
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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
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
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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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temperature and comonomer composition on the polymerization behavior of
dimethacrylate dental resins J Dent 1999 21879-883
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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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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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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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Dent Res 1988 94 19-26
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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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PrimDentCare1999Apr659-62
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Quintessence 198961-80
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ScandJDRes 199210060-65
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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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Kunststoff-FullungenDtschZahnartzlicher 1991 46 222-225
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Am Dent Assoc 2010 141(3)319-29
52
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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
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Monogr Oral Sci 20092142-51
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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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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
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53
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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
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54
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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
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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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48
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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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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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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
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amalgamelor dentare la pereţii cavităţilor RevMedicina
StomatologicăVol2199823-26
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200126302ndash307
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influence of the amalgam alloy on the survival of amalgam restorations a secondary
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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
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
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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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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
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
dentitionOperDent200429(5)481-508
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composites for posterior restorations JADA Vol132 2001639-644
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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
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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
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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33
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Am Dent Assoc 2010 141(3)319-29
52
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34
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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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48
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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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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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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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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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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
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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
composite placement technique on the resin-dentin interface formed in vivo
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
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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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79369 (Abstract)
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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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451
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458
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JDent 199826 627-632
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1999 15128-137
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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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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
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
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
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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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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
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Dentomaxillofac Radiol 2007 Oct36(7)377-81
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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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79369 (Abstract)
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51
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ScandJDRes 199210060-65
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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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In vivo evidence J Dent 2004 32611ndash621
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dynamics of the polymerization Biomaterials 1996 172313-2318
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shrinkage-strain measurements on light-cured biomaterials Dent Mater 200016447ndash
451
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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
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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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
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)
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
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
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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-
FOTI)in vitro studyCaries Res 1997 31(2) 103-110
280Schulte AG Wittchen A Stachniss V Jacquet W Bottenberg P Approximal
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interobserver agreement and comparison to histological hard-tissue sections Caries
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281Shortall AC Marginal seal comparisons between resinbonded Class II porcelain
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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
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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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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
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56
292Simi B Suprabha B Evaluation of microleakage in posterior nanocomposite
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293Simone D David N B An alternative to reduce polimeryzation shrinkage in
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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
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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
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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
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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
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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
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
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
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
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
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
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
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
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
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