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Three-year randomised clinical trial to evaluate the clinical performance, quantitative and qualitative wear patterns of hybrid composite restorations.

Palaniappan S, Elsen L, Lijnen I, Peumans M, Van Meerbeek B, Lambrechts P - Clin Oral Investig (2009)

Bottom Line: The gypsum replicas at each recall were used for 3D laser scanning to quantify wear, and the epoxy resin replicas were observed under scanning electron microscope to study the qualitative wear patterns.Within the observation period, the nano-hybrid and micro-hybrid restorations evolved better in polishability with improved surface gloss retention than the conventional hybrid counterpart.Qualitatively, while the micro-filled and nano-hybrid composite restorations exhibited signs of fatigue similar to the conventional hybrid composite restorations at heavy occlusal contact area, their light occlusal contact areas showed less surface pitting after 3 years of clinical service.

View Article: PubMed Central - PubMed

Affiliation: Leuven BIOMAT Research Cluster, Department of Conservative Dentistry, School of Dentistry, Oral Pathology and Maxillo-Facial Surgery, Catholic University of Leuven, Kapucijnenvoer 7, 3000 Leuven, Belgium.

ABSTRACT
The aim of the study was to compare the clinical performance, quantitative and qualitative wear patterns of conventional hybrid (Tetric Ceram), micro-filled hybrid (Gradia Direct Posterior) and nano-hybrid (Tetric EvoCeram, TEC) posterior composite restorations in a 3-year randomised clinical trial. Sixteen Tetric Ceram, 17 TEC and 16 Gradia Direct Posterior restorations were placed in human molars and evaluated at baseline, 6, 12, 24 and 36 months of clinical service according to US Public Health Service criteria. The gypsum replicas at each recall were used for 3D laser scanning to quantify wear, and the epoxy resin replicas were observed under scanning electron microscope to study the qualitative wear patterns. After 3 years of clinical service, the three hybrid restorative materials performed clinically well in posterior cavities. Within the observation period, the nano-hybrid and micro-hybrid restorations evolved better in polishability with improved surface gloss retention than the conventional hybrid counterpart. The three hybrid composites showed enamel-like vertical wear and cavity-size dependant volume loss magnitude. Qualitatively, while the micro-filled and nano-hybrid composite restorations exhibited signs of fatigue similar to the conventional hybrid composite restorations at heavy occlusal contact area, their light occlusal contact areas showed less surface pitting after 3 years of clinical service.

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A representative conventional hybrid composite restoration. This figure includes a representative clinical picture (a), difference image (b) and SEM photomicrographs (c–l) of wear spots in a conventional hybrid composite restoration over the study period. a Clinical, occlusal view of a Tetric Ceram restoration in 26 with registered wear spots.  = light occlusal contact area;  = heavy OCA;  = contact-free occlusal area. b Difference image at 36 months is shown to enable a better differentiation of the wear spots. (c) Micro-morphological overview at 6 months under magnification (×15), higher magnification (×150) of heavy OCA at 12 (d), 24 (e) and 36 months (f); light OCA at 12 (g), 24 (h) and 36 months (i); CFOA at 12 (j), 24 (k) and 36 months (l)
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Fig5: A representative conventional hybrid composite restoration. This figure includes a representative clinical picture (a), difference image (b) and SEM photomicrographs (c–l) of wear spots in a conventional hybrid composite restoration over the study period. a Clinical, occlusal view of a Tetric Ceram restoration in 26 with registered wear spots. = light occlusal contact area; = heavy OCA; = contact-free occlusal area. b Difference image at 36 months is shown to enable a better differentiation of the wear spots. (c) Micro-morphological overview at 6 months under magnification (×15), higher magnification (×150) of heavy OCA at 12 (d), 24 (e) and 36 months (f); light OCA at 12 (g), 24 (h) and 36 months (i); CFOA at 12 (j), 24 (k) and 36 months (l)

Mentions: The SEM evaluation of the resin replica restorations demonstrated the occlusal surface alterations and the qualitative wear patterns. The qualitative wear patterns of one representative one conventional hybrid, one nano-hybrid and one micro-filled hybrid composite restoration is shown in Figs. 5, 6 and 7, respectively. Overall, three patterns of wear were evident: cyclic fatigue at heavy OCA (Fig. 5d–f for Tetric Ceram; Fig. 6d–f for TEC; Fig. 7d–f for Gradia Direct Posterior), pitting at light OCA (Fig. 5g–i for Tetric Ceram; Fig. 6g–i for TEC; Fig. 7g–i for Gradia Direct Posterior) and scratches/striations at CFOA (Fig. 5j–l for Tetric Ceram; Fig. 6j–l for TEC; Fig. 7j–l for Gradia Direct Posterior) along the food escape pathways. Compared to TEC and Gradia Direct Posterior, the majority of light OCAs of Tetric Ceram restorations exhibited less surface smoothness at baseline and 6 months (Fig. 5g). The surface irregularities of these restorations remained progressively pronounced until 36 months of clinical service (Fig. 5i). At high impact (heavy) occlusal contact areas shared by enamel and composite, approximately 55% of all restorations suffered from localised marginal fractures in less than two fourth of the marginal circumference (Figs. 5b, 6b and 7b) and fatigue crack growth at areas adjacent to the fractured margins at 12 months (Figs. 5d, 6d and 7d). At 24 months (Figs. 5e, 6e and 7e), while the margins were progressively degrading, the fatigue cracks propagated resulting in fatigue fracture at 36 months (Figs. 5f, 6f and 7f).Fig. 5


Three-year randomised clinical trial to evaluate the clinical performance, quantitative and qualitative wear patterns of hybrid composite restorations.

Palaniappan S, Elsen L, Lijnen I, Peumans M, Van Meerbeek B, Lambrechts P - Clin Oral Investig (2009)

A representative conventional hybrid composite restoration. This figure includes a representative clinical picture (a), difference image (b) and SEM photomicrographs (c–l) of wear spots in a conventional hybrid composite restoration over the study period. a Clinical, occlusal view of a Tetric Ceram restoration in 26 with registered wear spots.  = light occlusal contact area;  = heavy OCA;  = contact-free occlusal area. b Difference image at 36 months is shown to enable a better differentiation of the wear spots. (c) Micro-morphological overview at 6 months under magnification (×15), higher magnification (×150) of heavy OCA at 12 (d), 24 (e) and 36 months (f); light OCA at 12 (g), 24 (h) and 36 months (i); CFOA at 12 (j), 24 (k) and 36 months (l)
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Related In: Results  -  Collection

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Fig5: A representative conventional hybrid composite restoration. This figure includes a representative clinical picture (a), difference image (b) and SEM photomicrographs (c–l) of wear spots in a conventional hybrid composite restoration over the study period. a Clinical, occlusal view of a Tetric Ceram restoration in 26 with registered wear spots. = light occlusal contact area; = heavy OCA; = contact-free occlusal area. b Difference image at 36 months is shown to enable a better differentiation of the wear spots. (c) Micro-morphological overview at 6 months under magnification (×15), higher magnification (×150) of heavy OCA at 12 (d), 24 (e) and 36 months (f); light OCA at 12 (g), 24 (h) and 36 months (i); CFOA at 12 (j), 24 (k) and 36 months (l)
Mentions: The SEM evaluation of the resin replica restorations demonstrated the occlusal surface alterations and the qualitative wear patterns. The qualitative wear patterns of one representative one conventional hybrid, one nano-hybrid and one micro-filled hybrid composite restoration is shown in Figs. 5, 6 and 7, respectively. Overall, three patterns of wear were evident: cyclic fatigue at heavy OCA (Fig. 5d–f for Tetric Ceram; Fig. 6d–f for TEC; Fig. 7d–f for Gradia Direct Posterior), pitting at light OCA (Fig. 5g–i for Tetric Ceram; Fig. 6g–i for TEC; Fig. 7g–i for Gradia Direct Posterior) and scratches/striations at CFOA (Fig. 5j–l for Tetric Ceram; Fig. 6j–l for TEC; Fig. 7j–l for Gradia Direct Posterior) along the food escape pathways. Compared to TEC and Gradia Direct Posterior, the majority of light OCAs of Tetric Ceram restorations exhibited less surface smoothness at baseline and 6 months (Fig. 5g). The surface irregularities of these restorations remained progressively pronounced until 36 months of clinical service (Fig. 5i). At high impact (heavy) occlusal contact areas shared by enamel and composite, approximately 55% of all restorations suffered from localised marginal fractures in less than two fourth of the marginal circumference (Figs. 5b, 6b and 7b) and fatigue crack growth at areas adjacent to the fractured margins at 12 months (Figs. 5d, 6d and 7d). At 24 months (Figs. 5e, 6e and 7e), while the margins were progressively degrading, the fatigue cracks propagated resulting in fatigue fracture at 36 months (Figs. 5f, 6f and 7f).Fig. 5

Bottom Line: The gypsum replicas at each recall were used for 3D laser scanning to quantify wear, and the epoxy resin replicas were observed under scanning electron microscope to study the qualitative wear patterns.Within the observation period, the nano-hybrid and micro-hybrid restorations evolved better in polishability with improved surface gloss retention than the conventional hybrid counterpart.Qualitatively, while the micro-filled and nano-hybrid composite restorations exhibited signs of fatigue similar to the conventional hybrid composite restorations at heavy occlusal contact area, their light occlusal contact areas showed less surface pitting after 3 years of clinical service.

View Article: PubMed Central - PubMed

Affiliation: Leuven BIOMAT Research Cluster, Department of Conservative Dentistry, School of Dentistry, Oral Pathology and Maxillo-Facial Surgery, Catholic University of Leuven, Kapucijnenvoer 7, 3000 Leuven, Belgium.

ABSTRACT
The aim of the study was to compare the clinical performance, quantitative and qualitative wear patterns of conventional hybrid (Tetric Ceram), micro-filled hybrid (Gradia Direct Posterior) and nano-hybrid (Tetric EvoCeram, TEC) posterior composite restorations in a 3-year randomised clinical trial. Sixteen Tetric Ceram, 17 TEC and 16 Gradia Direct Posterior restorations were placed in human molars and evaluated at baseline, 6, 12, 24 and 36 months of clinical service according to US Public Health Service criteria. The gypsum replicas at each recall were used for 3D laser scanning to quantify wear, and the epoxy resin replicas were observed under scanning electron microscope to study the qualitative wear patterns. After 3 years of clinical service, the three hybrid restorative materials performed clinically well in posterior cavities. Within the observation period, the nano-hybrid and micro-hybrid restorations evolved better in polishability with improved surface gloss retention than the conventional hybrid counterpart. The three hybrid composites showed enamel-like vertical wear and cavity-size dependant volume loss magnitude. Qualitatively, while the micro-filled and nano-hybrid composite restorations exhibited signs of fatigue similar to the conventional hybrid composite restorations at heavy occlusal contact area, their light occlusal contact areas showed less surface pitting after 3 years of clinical service.

Show MeSH
Related in: MedlinePlus