The Journal of the American Dental Association
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

J Am Dent Assoc, Vol 136, No 11, 1533-1540.
© 2005 American Dental Association
This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by POON, E. C.M.
Right arrow Articles by YIP, K. H.-K.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by POON, E. C.M.
Right arrow Articles by YIP, K. H.-K.
Related Collections
Right arrow Implants

RESEARCH

JADA Continuing Education

Clinical evaluation of packable and conventional hybrid posterior resin-based composites

Results at 3.5 years



ERIC C.M. POON, B.D.S., ROGER J. SMALES, M.D.S. (Hons), D.D.Sc. and KEVIN H.-K. YIP, B.D.S., M.Ed., M.Med.Sc., Ph.D.


   ABSTRACT
TOP
 ABSTRACT
SUBJECTS, MATERIALS AND METHODS
 RESULTS
 DISCUSSION
 CONCLUSIONS
 REFERENCES
 
Background. The authors evaluated clinical performances of a packable and a conventional hybrid resin-based composite used with a self-etch adhesive system.

Methods. Three dentists placed 105 posterior restorations in 65 adults. They placed a packable (SureFil, Dentsply DeTrey GmbH, Konstanz, Germany) and a conventional (SpectrumTPH, Dentsply DeTrey GmbH) resin-based composite using a self-etch resin adhesive system. The authors evaluated the restorations using Ryge modified criteria, photographs and die stone replicas.

Results. After 3.5 years, six large SureFil and two SpectrumTPH restorations had failed from bulk fracture and secondary caries, resulting in cumulative survival rates of 81.3 and 92.0 percent, respectively. Failed SureFil restorations generally were larger than the remaining intact restorations. Other ratings were satisfactory, with no significant differences between the two materials for any restoration parameter. Alfa ratings for both materials were approximately 80 percent or greater for marginal discoloration, anatomical form, surface texture and surface staining. Lower percentages of restorations were rated Alfa for color match, marginal integrity and gingival health. No postoperative sensitivity was reported. Net mean occlusal wear (± standard deviation) was 28.9 (± 32.9) micrometers for SureFil and 33.8 (± 29.6) µm for SpectrumTPH restorations; the difference was not statistically significant.

Conclusions. When used with a self-etch adhesive, the 3.5-year clinical performances of both composites were similar and satisfactory for the restoration of Class I and moderate-sized Class II cavities.

Clinical Implications. The two composites placed in this study have an increased risk of bulk fracture when placed in large intracoronal Class II molar preparations.

Key Words: Packable composite; conventional hybrid composite; clinical evaluation

Our study is a follow-up of our initial clinical findings reported at 12 months.1 These initial findings showed that the clinical performances of packable hybrid resin-based composite restorations and conventional hybrid resin-based composite restorations were satisfactory and not significantly different when they were placed with a simplified self-etch adhesive system. Although we stated the need for longer-term observations, there have been few published clinical studies of packable resin-based composites’ performance after one year.

The 3.5-year clinical performances of both resin-based composites were similar and satisfactory.

After two years, the clinical performances of three packable resin-based composites placed using different adhesive systems generally were considered satisfactory for the restoration of posterior teeth.2–6 Clinical successes ranged from 93 to 100 percent, and few unsatisfactory restoration characteristics or parameters were observed. Only one of these studies did not involve the use of a separate phosphoric acid etchant as part of the adhesive procedure.5

Our study tests the null hypothesis that, after 3.5 years, there are no significant differences between the clinical performances of a packable resin-based composite and a conventional resin-based composite placed using a simplified self-etch resin-based adhesive system.


   SUBJECTS, MATERIALS AND METHODS
TOP
 ABSTRACT
 SUBJECTS, MATERIALS AND METHODS
RESULTS
 DISCUSSION
 CONCLUSIONS
 REFERENCES
 
While we previously gave detailed descriptions about the subjects, materials and methods used in our study,1 following are summary details.

Subjects and operative procedures. We recruited 65 healthy adult subjects from among patients receiving care at The Prince Philip Dental Hospital, Hong Kong. Each subject signed an informed consent form before participating in the study. We required each subject to have no more than four vital posterior teeth with primary caries needing restoration. In addition, the teeth had to have opposing tooth contacts.

Three dentists (including K.H.-K.Y.) placed either a packable hybrid resin-based composite (SureFil, Dentsply DeTrey GmbH, Konstanz, Germany) or a conventional hybrid resin-based composite (SpectrumTPH, Dentsply DeTrey GmbH) in the teeth of each subject. None of the subjects received both materials. The dentists used Non-Rinse Conditioner (NRC) (Dentsply DeTrey GmbH) and Prime & Bond NT (PBNT) Dual Cure Adhesive (Dentsply DeTrey GmbH) with both restorative materials.

With few exceptions, the teeth were treated under local analgesia and isolated with a rubber dam. The dentists placed a light-cured glassionomer cement liner in deep cavities and used wedged metal matrices for Class II preparations. The dentists applied NRC and then PBNT adhesive to the preparations for 20 seconds each before gently removing excess liquid. Then they light-cured the PBNT for 10 seconds using a curing light. They incrementally added the resin-based composite materials, curing each 2- to 3-millimeter layer for 40 seconds, before using rotary finishing and polishing instruments, followed by polishing pastes to achieve a final luster.

Clinical evaluations. An independent assessor (E.C.M.P.) evaluated the restorations at the 3.5-year review. He directly evaluated restoration retention/fracture, recurrent caries, color match, marginal discoloration, marginal integrity, anatomical form/occlusal wear, surface texture and surface staining according to U.S. Public Health Service–Ryge modified criteria.7 These criteria are as follows:

– Alfa restorations are of satisfactory quality and meet all clinical standards with a range of excellence;
– Bravo restorations also are satisfactory, though not ideal, with a range of acceptability;
– Charlie restorations are not of acceptable quality and should be replaced or corrected for preventive reasons.

The assessor then evaluated the interproximal gingival bleeding adjacent to Class II restorations8 and postoperative tooth sensitivity as being either absent or present. He also procured clinical photographs and addition-cured silicone impressions for indirect evaluation of the restorations. He and a second independent assessor (R.J.S.) used the photographs to confirm any color mismatches and marginal or surface discolorations, as well as to measure the surface areas and proximal embrasure widths of the restorations by using an imaging analysis and software system. Die stone replicas were poured from the impressions, and the second independent assessor used them to confirm any marginal discrepancies and open interproximal contacts. He also used them to measure the surface wear of the restorations by using a standard semiquantitative ivorine tooth model. The cavosurface margin of the restoration showing the most severe wear or material loss determined the rating. The independent assessors also used die stone replicas of the cavity preparations to measure the approximate cavity depths from the deepest region of the pulpal floors to the cavosurface margins with a graduated metal probe.

Statistical analysis. One independent assessor (R.J.S.) analyzed the data using a statistical software package (Prism 2.01, GraphPad Software, San Diego). He used the Fisher exact test, Student t test, the nonparametric Mann-Whitney test and Kruskal-Wallis tests to determine clinical and dimensional differences between the two resin-based composites. He also calculated the cumulative survival rates for each resin-based composite.9 As a test of intraexaminer reliability, we redigitized 30 randomly selected color photographs and re-evaluated 30 randomly selected color photographs and 30 replicas. We used Cohen’s {kappa} statistic to compare the original and duplicate evaluations.10 For all tests, we set the probability level for statistical significance at {alpha} = .05.


   RESULTS
TOP
 ABSTRACT
 SUBJECTS, MATERIALS AND METHODS
 RESULTS
DISCUSSION
 CONCLUSIONS
 REFERENCES
 
Twelve subjects who were seen at baseline were not available at the one-year review, and 16 other subjects failed to attend the 3.5-year review. These people accounted for restoration dropouts of 50 percent for SureFil and 38 percent for SpectrumTPH over 3.5 years (Table 1Go). However, we found no significant difference between the two resin-based composites in the distribution of Class I and II premolar and molar restoration numbers at any period (Fisher exact tests, P = .20-.99). We also found no significant differences between the two resin-based composites or for each resin-based composite in the occlusal surface areas of the restorations (Table 2Go).


View this table:
[in this window]
[in a new window]
  		TABLE 1 NUMBER OF SUBJECTS WITH PLACED AND EVALUATED RESTORATIONS.

 

View this table:
[in this window]
[in a new window]
  		TABLE 2 OCCLUSAL SURFACE AREAS OF RESTORATIONS AT PLACEMENT.

 
Cohen’s {kappa} statistic ranged from 0.51 to 1.00, denoting moderate to very good agreements for the different parameters we evaluated.11

Restoration failures. We show the results of the restoration evaluations in Table 3Go. Three large SureFil restorations placed in deep Class II molar preparations fractured just before their baseline evaluations, resulting in a cumulative failure rate of 6.3 percent after one year. None of the SpectrumTPH restorations had failed by one year. Subsequently, three more Class II SureFil restorations failed, two from bulk fractures in a molar and a premolar, and one from recurrent marginal caries in a molar (Bravo ratings), resulting in a cumulative survival rate of 81.3 percent after 3.5 years. Two Class II SpectrumTPH restorations also failed—one from bulk fracture in a molar and one from recurrent marginal caries in a premolar (Bravo ratings)—resulting in a cumulative survival rate of 92.0 percent after 3.5 years. The dimensions of the failed SureFil restorations generally were larger than those of the remaining intact SureFil restorations (P ≤ .08, Table 4Go). Although there was no significant difference between the two resin-based composites for occlusal surface area (P = .30), there were significant differences for cavity depth (P = .001) and, consequently, cavity volume (P = .04). We were unable to show any statistically significant dimensional differences between the two resin-based composites for either failed (P ≥ .86) or intact (P ≥ .16) restorations.


View this table:
[in this window]
[in a new window]
  		TABLE 3 NUMBER OF RESTORATIONS EVALUATED FOR EACH CLINICAL PARAMETER AT EACH PERIOD.

 

View this table:
[in this window]
[in a new window]
  		TABLE 4 RESTORATION DIMENSIONS RELATED TO CLINICAL PERFORMANCE AT 3.5 YEARS.

 
Restoration parameter ratings. We recorded only Alfa and Bravo (satisfactory) ratings for the other restoration parameters (Table 3Go). Although the restorations still were satisfactory, there was a gradual and slight deterioration in the quality of the restorations over 3.5 years.

Color match. At baseline, the independent assessors gave Alfa ratings to 97 percent of the SureFil restorations and 92 percent of the SpectrumTPH restorations. At the 3.5-year review, the Alfa ratings had decreased to 70 percent for the SureFil restorations and 79 percent for the SpectrumTPH restorations. The restorations generally were lighter than the adjacent tooth structure (Figure 1Go).



View larger version (70K):
[in this window]
[in a new window]
  		Figure 1. The SureFil (Dentsply DeTrey GmbH, Konstanz, Germany) occlusal restoration in the second molar was rated Bravo (satisfactory, though not ideal, with a range of acceptability) for color match and surface staining and Alfa (satisfactory quality and meets all clinical standards with a range of excellence) for the other parameters at the 3.5-year review.

 
Marginal discoloration. None of the restorations exhibited marginal discoloration at baseline. At the 3.5-year review, 85 percent of the SureFil restorations and 83 percent of the SpectrumTPH restorations received Alfa ratings. The marginal discoloration was minor and confined to short sections of the affected restorations. We were able to detect discoloration more readily from the color photographs (Figure 2Go).



View larger version (80K):
[in this window]
[in a new window]
  		Figure 2. The SpectrumTPH (Dentsply DeTrey GmbH, Konstanz, Germany) occlusal restoration in the first molar was rated Bravo (satisfactory, though not ideal, with a range of acceptability) for marginal discoloration and Alfa (satisfactory quality and meets all clinical standards with a range of excellence) for the other parameters at the 3.5-year review.

 
Marginal integrity. All margins were intact at baseline. At the 3.5-year review, we recorded Alfa ratings of 59 percent for the SureFil restorations and 63 percent for the SpectrumTPH restorations. Small marginal defects resulted from deficiencies or the fracture of thin excesses of material. There was no significant difference between the Alfa and Bravo ratings for occlusal surface area of the restorations (t31 = .021, P = .98).

Anatomical form/occlusal wear. Our direct clinical examinations detected only minor wear changes at the 3.5-year review, with Alfa ratings of 89 percent for the SureFil restorations and 79 percent for the SpectrumTPH restorations. The net mean (± standard deviation [SD]) occlusal wear as measured from the die stone replicas was 28.9 (± 32.9) micrometers for the SureFil restorations and 33.8 (± 29.6) µm for the larger SpectrumTPH restorations; this difference was not statistically significant (t44 = .523, P = .60). This is equivalent to an annual wear rate of approximately 8 µm for SureFil restorations and 10 µm for SpectrumTPH restorations. We noted no open proximal contact gaps for Class II restorations from the die stone replicas during the evaluations, and there were no instances of food impaction when we asked the subjects about it.

Surface texture and staining. At baseline, the independent assessors rated all restorations as Alfa, apart from one SpectrumTPH restoration. At the 3.5-year review, they rated 89 percent of the SureFil restorations and 100 percent of the SpectrumTPH restorations as Alfa for surface texture, while they rated 89 percent of the SureFil restorations and 96 percent of the SpectrumTPH restorations as Alfa for surface staining. They were able to detect discrete areas of surface roughness and slight staining more readily using color photographs (Figure 1Go). In two instances, the small surface defects appeared to have been caused by dental instruments during finishing and polishing.

Gingival bleeding. At baseline, the independent assessors rated all but two Class II SpectrumTPH restorations as being without adjacent gingival tissue bleeding after blunt probing. At the 3.5-year review, 69 percent of the SureFil Class II restorations and 71 percent of the SpectrumTPH Class II restorations were without adjacent gingival tissue bleeding. The mean (± SD) widths of the Class II cavity preparations at the occlusal embrasures were 3.3 (± 0.2) mm for the SureFil restorations and 3.5 (± 0.3) mm for the SpectrumTPH restorations; this difference was not statistically significant (t14 = .624, P = .54).

Postoperative sensitivity. At baseline, subjects reported mild transient tooth sensitivity for 7 percent of the teeth restored with SureFil and 3 percent of the teeth restored with SpectrumTPH. Subjects reported no sensitivity associated with the restored teeth at the 3.5-year review.

After 3.5 years, we found no statistically significant differences between the two resin-based composites for any of the clinical parameters evaluated (P ≥ .24). Therefore, the null hypothesis was not rejected.


   DISCUSSION
TOP
 ABSTRACT
 SUBJECTS, MATERIALS AND METHODS
 RESULTS
 DISCUSSION
CONCLUSIONS
 REFERENCES
 
Twenty-eight of the 61 subjects seen at baseline did not attend the 3.5-year review. In two of these subjects, three failed SureFil restorations had been replaced just before baseline. Several other subjects had moved or we were unable to contact them, several were unable to arrange a convenient appointment time, and concerns about increased unemployment in Hong Kong prevented some subjects from taking nonessential time away from their workplaces.

Restoration failures. Failures occurred only in Class II cavity preparations and usually resulted from the bulk fracture of large molar restorations placed in deep preparations (Table 3Go). This situation was especially significant for the SureFil restorations (Table 4Go). We also detected secondary caries at the gingival margin in one instance for each resin-based composite. These failures resulted in cumulative survival rates of 81.3 percent for the SureFil restorations and 92.0 percent for the SpectrumTPH restorations over 3.5 years. (If the three large SureFil Class II molar restorations that fractured just before baseline were not included in our calculation, then the cumulative survival rates for SureFil restorations would be 90 percent over 3.5 years).

One smaller three-year study of Class II pre-molar SpectrumTPH restorations, in which 36 percent phosphoric acid total-etch and Prime & Bond 2.1 (Dentsply DeTrey) were used as the adhesive system, reported a 100 percent survival rate.12

We observed one Class II premolar SpectrumTPH restoration with secondary caries in our study. Two two-year studies of Class I and II premolar and molar SureFil restorations, in which 34 percent phosphoric acid total-etch and Prime & Bond 2.1 were used as the adhesive system, reported survival rates of 100 percent2 and 96 percent.6

Restoration parameter ratings. Color match/surface texture and surface staining/gingival bleeding. The limited choice of shades (A, B, C) available for SureFil precluded accurate shade matching in several instances, with the restorations usually being too light. This problem was reported in 38 percent of SureFil restorations in a two-year study.6 In our study, the greater range of shades available for SpectrumTPH resulted in better shade matches. It was not possible, however, to distinguish clinically between the two resin-based composite materials from their shade matching and surface texture. The surface texture of all restorations was satisfactory, with discrete areas only of occasional surface roughness and staining evident for both resin-based composites. Other two-year studies of SureFil restorations also reported minimal surface roughness and slight staining that might have been related to smoking.2,6 For the Class II restorations, the proximal surface textures and areas (as reflected by their occlusal embrasure widths) probably were similar for both resin-based composites, as similar percentages of SureFil restorations and SpectrumTPH restorations were without adjacent gingival tissue bleeding after blunt probing (P = .99).

Marginal discoloration and marginal integrity. In our study, at the 3.5-year review, approximately 84 and 61 percent of all restorations received Alfa ratings for marginal discoloration and marginal integrity, respectively. Other two-year studies of SureFil restorations have reported Alfa ratings of 100 percent2 and 90 percent6 for marginal discoloration and 91 percent2 and 86 percent6 for marginal integrity. We were able to observe small discrete marginal discolorations and discrepancies more readily from the color photographs and replicas, respectively, than from the direct clinical examinations. In several instances, the occlusal discrepancies appeared to result from the fracture of thin flashes of resin-based composite material extended onto uninstrumented or unground enamel surfaces adjacent to the preparation margins. This also was reported in a related study, even though a 34 percent phosphoric acid etchant was used in it.6 However, the use of phosphoric acid etching13–16 and aggressive self-etch adhesives17 instead of NRC with PBNT might reduce the incidence of small marginal discrepancies in high-stress regions.

Though subjects reported several instances of mild transient sensitivity for the resin-based composite–restored teeth at the one-year review, no one reported any sensitivity at the 3.5-year review.

Anatomical form/occlusal wear. We observed only minor occlusal wear changes at the 3.5-year review, with Alfa ratings of 89 percent for the SureFil restorations and 79 percent for the SpectrumTPH restorations. A two-year study of SureFil restorations reported Alfa ratings of 96 percent for anatomical form.6 Another two-year study of SureFil restorations found a mean wear rate of 13.8 µm when using the same standard semiquantitative ivorine tooth model as we did in our study.2 However, the authors averaged six cavosurface margin scores for each restoration to determine the score for each restoration,18 rather than selecting, as we did, the cavosurface margin showing the most severe wear. With net mean (± SD) wear rates of 28.9 µm (± 32.9) for the SureFil restorations and 33.8 µm (± 29.6) for the SpectrumTPH restorations at the 3.5-year review, both resin-based composites appeared to meet the occlusal wear requirements of the ADA.9 However, the use of a semiquantitative ivorine tooth model will underestimate the actual amount of occlusal wear.19 Increased wear is to be expected for larger restorations, which probably is of more significance in our study than is the actual posterior resin-based composite restoration placed. The die stone replicas revealed no open Class II proximal restoration contacts for both resin-based composites, without any obviously superior results for the SureFil restorations.20,21

Postoperative sensitivity. Anecdotal evidence suggests that postoperative sensitivity can be reduced considerably in general dental practice by using self-etch adhesives.22 However, the evidence from controlled clinical trials for this reduction is equivocal when it is compared with that for the use of total-etch adhesives.23 Postoperative tooth sensitivity is attributed to many factors, and the correct application of the clinical technique chosen might be more relevant than the type of adhesive used.23 In our study, though subjects reported several instances of mild transient sensitivity for the resin-based composite–restored teeth at the one-year review, no one reported any sensitivity at the 3.5-year review.

Packable or high-density resin-based composites and self-etch adhesive systems are marketed as improving and simplifying the clinical use of resin-based materials as amalgam alloy substitutes for posterior restorations. However, advertising claims and the expectations of dentists for these resin-based materials have been exaggerated, and they would appear to offer few advantages when compared with correctly handled older conventional posterior resin-based composites and total-etch adhesive systems.5,20,21,23–33


   CONCLUSIONS
TOP
 ABSTRACT
 SUBJECTS, MATERIALS AND METHODS
 RESULTS
 DISCUSSION
 CONCLUSIONS
REFERENCES
 
The 3.5-year findings from our study showed that a packable hybrid resin-based composite, SureFil, and a conventional hybrid resin-based composite, SpectrumTPH, had satisfactory and similar clinical performances when used with a self-etch adhesive to restore Class I and moderate-sized Class II cavities. However, because of the increased risk of bulk fracture, the use of the two resin-based composites should be avoided in large intracoronal Class II molar cavity preparations.34


   FOOTNOTES
 

Dr. Poon is an honorary research assistant, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, PR China.


Dr. Smales is a visiting research fellow, Dental School, Faculty of Health Sciences, The University of Adelaide, Australia.


Dr. Yip is an associate professor in family dentistry and endodontics, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, PR China. Address reprint requests to Dr. Yip at Oral Diagnosis, The Prince Philip Dental Hospital, 34 Hospital Road, Hong Kong SAR, PR China, e-mail "hkyip{at}hkucc.hku.hk".


The authors gratefully acknowledge financial assistance from the Committee of Research and Conference Grants, The University of Hong Kong (grant 10202573). This clinical trial was conducted independently and was supported completely by university grants.


The authors gratefully acknowledge the clinical assistance of Dr. Frederick C.S. Chu, Dr. Belinda K.M. Poon and Dr. Fiona Y.C. Kong, and the technical assistance of Mr. Simon Lee and Mr. S.K. Mok. The provision of staff, clinical facilities and other support from Dr. Philip R.H. Newsome, line manager for Oral Diagnosis and Family Practice, also is much appreciated.


   REFERENCES
TOP
 ABSTRACT
 SUBJECTS, MATERIALS AND METHODS
 RESULTS
 DISCUSSION
 CONCLUSIONS
 REFERENCES
 

  1. Yip KH, Poon BK, Chu FC, Poon EC, Kong FY, Smales RJ. Clinical evaluation of packable and conventional hybrid resin-based composites for posterior restorations in permanent teeth: results at 12 months. JADA 2003;134:1581–9.[Abstract/Free Full Text]

  2. Perry RD, Kugel G. Two-year clinical evaluation of a high-density posterior restorative material. Compend Contin Educ Dent 2000; 21:1067–76.[Medline]

  3. Ernst CP, Buhtz C, Rissing C, Willershausen B. Clinical performance of resin composite restorations after 2 years. Compend Contin Educ Dent 2002;23:711–24.[Medline]

  4. Ernst CP, Canbek K, Aksogan K, Willershausen B. Two-year clinical performance of a packable posterior composite with and without a flowable composite liner. Clin Oral Investig 2003;7(3):129–34.[Medline]

  5. Lopes LG, Cefaly DF, Franco EB, Mondelli RF, Lauris JR, Navarro MF. Clinical evaluation of two ‘packable’ posterior composite resins: two-year results. Clin Oral Investig 2003;7(3):123–8.[Medline]

  6. Tükün LS, Tükün M, Özata F. Two-year clinical evaluation of a packable resin-based composite. JADA 2003;134:1205–12.[Abstract/Free Full Text]

  7. Ryge G. Clinical criteria. Int Dent J 1980;30:347–58.[Medline]

  8. Mühlemann HR, Son S. Gingival sulcus bleeding: a leading symptom in initial gingivitis. Helv Odontol Acta 1971;15(2):107–13.[Medline]

  9. American Dental Association Council on Scientific Affairs. ADA acceptance program guidelines: Resin-based composites for posterior restorations. Chicago: American Dental Association; 2001.

  10. Fleiss JL. Statistical methods for rates and proportions. 2nd ed. Somerset, N.J.: Wiley; 1981:212–36.

  11. Altman DG. Practical statistics for medical research. London: Chapman and Hall; 1991:404.

  12. Wucher M, Grobler SR, Senekal PJ. A 3-year clinical evaluation of a compomer, a composite and a compomer/composite (sandwich) in Class II restorations. Am J Dent 2002;15:274–8.[Medline]

  13. Ferrari M, Mannocci F, Kugel G, García-Godoy F. Standardized microscopic evaluation of the bonding mechanism of NRC/Prime & Bond NT. Am J Dent 1999;12(2):77–83.[Medline]

  14. Rosa BT, Perdigão J. Bond strengths of nonrinsing adhesives. Quintessence Int 2000;31:353–8.[Medline]

  15. Pashley DH, Tay FR. Aggressiveness of contemporary self-etching adhesives, Part II: etching effects on unground enamel. Dent Mater 2001;17:430–44.[Medline]

  16. Matos AB, Tate WH, Powers JM. Influence of enamel surface preparation on composite bond strength. Am J Dent 2003;(16 special number):37A–40A.

  17. Tay FR, Pashley DH, King NM, et al. Aggressiveness of self-etch adhesives on unground enamel. Oper Dent 2004;29:309–16.[Medline]

  18. Perry R, Kugel G, Leinfelder K. One-year clinical evaluation of SureFil packable composite. Compend Contin Educ Dent 1999;20: 544–53.[Medline]

  19. Perry R, Kugel G, Kunzelmann KH, Flessa HP, Estafan D. Composite restoration wear analysis: conventional methods vs. three-dimensional laser digitizer. JADA 2000;131:1472–7.[Abstract/Free Full Text]

  20. Peumans M, Van Meerbeek B, Asscherickx K, et al. Do condensable composites help to achieve better proximal contacts? Dent Mater 2001;17:533–41.[Medline]

  21. Klein F, Keller ÁK, Staehle HJ, Dörfer CE. Proximal contact formation with different restorative materials and techniques. Am J Dent 2002;15:232–5.[Medline]

  22. Christensen GJ. Preventing postoperative tooth sensitivity in Class I, II and V restorations. JADA 2002;133:229–31.[Free Full Text]

  23. Perdigão J, Geraldeli S, Hodges JS. Total-etch versus self-etch adhesive: effect on postoperative sensitivity. JADA 2003;134:1621–9.[Abstract/Free Full Text]

  24. Ferracane JL, Choi KK, Condon JR. In vitro wear of packable dental composites. Compend Contin Educ Dent 1999;25(supplement):S60–6.

  25. Brackett WW, Covey DA. Resistance to condensation of ‘condensable’ resin composites as evaluated by a mechanical test. Oper Dent 2000;25:424–6.[Medline]

  26. Manhart J, Kunzelmann KH, Chen HY, Hickel R. Mechanical properties and wear behaviour of light-cured packable composite resins. Dent Mater 2000;16(1):33–40.[Medline]

  27. Roeder LB, Tate WH, Powers JM. Effect of finishing and polishing procedures on the surface roughness of packable composites. Oper Dent 2000;25:534–43.[Medline]

  28. Aw TC, Nicholls JI. Polymerization shrinkage of densely-filled resin composites. Oper Dent 2001;26:498–504.[Medline]

  29. Ernst CP, Martin M, Stuff S, Willershausen B. Clinical performance of a packable resin composite for posterior teeth after three years. Clin Oral Investig 2001;5(3):148–55.[Medline]

  30. Oberlander H, Hiller KA, Thonemann B, Schmalz G. Clinical evaluation of packable composite resins in Class-II restorations. Clin Oral Investig 2001;5(2):102–7.[Medline]

  31. Burgess JO, Walker R, Davidson JM. Posterior resin-based composite: review of the literature. Pediatr Dent 2002;24:465–79.[Medline]

  32. Fabianelli A, Goracci C, Ferrari M. Sealing ability of packable resin composites in Class II restorations. J Adhes Dent 2003;5:217–23.[Medline]

  33. Tay FR, Pashley DH. Have dentin adhesives become too hydrophilic? J Can Dent Assoc 2003;69:726–31.[Medline]

  34. Statement on posterior resin-based composites. ADA Council on Scientific Affairs; ADA Council on Dental Benefit Programs. JADA 1998;129:1627–8.[Free Full Text]




This article has been cited by other articles:


Home page
 Journal of the American Dental AssociationHome page
T. C. Fagundes, T. J. E. Barata, C. A.R. Carvalho, E. B. Franco, J. W.V. van Dijken, and M. F. L. Navarro
Clinical Evaluation of Two Packable Posterior Composites: A Five-Year Follow-up
J Am Dent Assoc, April 1, 2009; 140(4): 447 - 454.
[Abstract] [Full Text] [PDF]

Home page
 JDRHome page
J.L. Drummond
Degradation, Fatigue, and Failure of Resin Dental Composite Materials
Journal of Dental Research, August 1, 2008; 87(8): 710 - 719.
[Abstract] [Full Text] [PDF]

Home page
 Journal of the American Dental AssociationHome page
N. K. Ersin, U. Candan, A. Aykut, O. Oncag, C. Eronat, and T. Kose
A clinical evaluation of resin-based composite and glass ionomer cement restorations placed in primary teeth using the ART approach: Results at 24 months.
J Am Dent Assoc, November 1, 2006; 137(11): 1529 - 1536.
[Abstract] [Full Text] [PDF]

This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by POON, E. C.M.
Right arrow Articles by YIP, K. H.-K.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by POON, E. C.M.
Right arrow Articles by YIP, K. H.-K.
Related Collections
Right arrow Implants

HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS