Nakamura et al.

Asian Pac J Dent 2014; 14: 19-21

Eleven-year clinical performance of a premolar restoration madeof an indirect microfilled composite material: a case report
Mitsuo Nakamura, DDS, PhD,a,b Hideo Matsumura, DDS, PhD,b,c and Osamu Saiki,DDSdabc

Private Practice, Ichikawa, Department of Fixed Prosthodontics, Division of Advanced Dental
dTreatment, Dental Research Center, Nihon University School of Dentistry, and Nihon University
Graduate School of Dentistry, Tokyo, JapanThis report describes a clinical course of a premolar restoration made of a microfilled composite material. A
single restoration made of the Gradia indirect composite material was seated to mandibular second premolar of a57-year-old female patient. During the course of regular check-up, both second and adjacent first molar wereextracted. Although the premolar restoration is functioning for more than 11 years, loss of anatomic form at
the occlusal table is apparent. Care must be taken in application of a microfilled indirect composite material toposterior occlusal planes.
(Asian Pac J Dent 2014; 14: 19-21.)
Key Words: indirect restoration, microfilled composite, wear

Introduction
A growing number of indirect composite materials is being introduced in the fabrication of both anterior
and posterior restorations.

Gradia indirect material (GC Corp., Tokyo Japan) is a typical microfilled composite

material containing prepolymerized silica (less than 0.05 µm) composite and splintered glass (average, 1.0 µm).1
It is reported that a microfilled composite material shows a smoother surface after grinding, abrasion, oracid-attack compared to a macrofilled material.1-3

However, microfilled composite material is less resistant toocclusal contact wear than a macrofilled material.4

Although clinical performance of Gradia direct material has

been reported,
vivo.

5-7

only limited information is available on evaluation of Gradia indirect composite material inThis report describes the clinical course of a mandibular premolar restoration made with Gradia indirectcomposite material.

Clinical Report
A 57-year-old female patient presented with a chief complaint of masticatory disturbance associated withgingival recession and decay of her right mandibular second premolar.

The second premolar had undergone

treatment with a metallic restoration made of silver-palladium-copper-gold alloy, which was functioning for
more than 5 years.

The adjacent first molar was treated with a metallic restoration veneered with a hybrid

composite material. Further, a porcelain-fused-to-metal (PFM) restoration had been placed on the first premolar.
Examination revealed that the second premolar was not vital, and secondary dental caries along the cervicalmargin of the tooth was detected.

Several treatment options were proposed; 1) metallic restoration, 2)

composite restoration, 3) ceramic restoration, and 4) PFM restoration.
composite restoration.
obtained.

The patient chose the tooth-colored

The restorative procedure was then explained in detail and consent from the patient was

A summary of the restorative procedure for this case was previously reported.8

After the root canal treatment of the second premolar, an indirect core build-up structure was made with afiber-post (ParaPost Fiber White, Coltène/Whaledent AG, Altstätten, Switzerland) and a composite core material(Clearfil DC Core, Kuraray-Noritake Co., Ltd., Tokyo, Japan) (Fig. 2). The dowel-core structure was seated witha tri-n-butylborane initiated adhesive resin (Super-Bond C&B, Sun-Medical Co., Ltd., Moriyama, Japan).

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Asian Pac J Dent 2014; 14: 19-21

1

234Fig. 1.
Pre-operative view of the second premolar and adjacent teeth
Fig. 2.
Dowel core made with a fiber-post and a composite material
Fig. 3.
Fiber sheet placed on the abutment castFig. 4.
Composite restoration made with Gradia material
Fig. 5.
Worn composite restoration (11 y and 4 m after seating)and fractured first premolar (PFM restoration)
5

After the abutment preparation, an impression was made with a silicone elastomer, and a working cast wasprepared.

A piece of fiber sheet (FiberStick Net, Stick Tech Ltd., Turku, Finland) was placed surrounding theentire abutment (Fig. 3).
Tokyo, Japan).

The restoration was fabricated with an indirect composite material (Gradia, GC Corp.,

Prior to seating the restoration, the inner surface was treated with a silane primer (Porcelain

Liner M, Sun-Medical Co., Ltd.).
4).

The restoration was then seated with Super-Bond C&B adhesive resin (Fig.

The patient entered into a maintenance program.

During the check-up period, the first and second molars

were extracted after five and 11 years respectively, following the seating of the composite premolar restoration
due to chronic marginal periodontitis.

Unfortunately, the patient suffered from systemic disease, and it wasdifficult for her to maintain regular visits to the clinic especially in the 6 years after the first molar was extracted.
Figure 5 shows the occlusal view of the restoration 11 years and four months after seating.

Although therestoration is still functioning, severe abrasion is detected and posterior occlusion is collapsing.

A fracture canalso be detected along the distal marginal ridge of the ceramic veneer of the first premolar.

Replacement of thepremolar restorations and fabrication of a removable partial denture was recommended to the patient.

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Asian Pac J Dent 2014; 14: 19-21

Discussion
One of the problems associated with indirect composite material is lack of wear resistance.
characteristic has been apparent especially for microfilled composite material.
as a microfilled indirect composite material.
macrofilled material.

Gradia composite is categorized

A microfilled composite material shows smoother surface than aThis feature is derived from both the particle size of the inorganic filler and thedifference in wear resistance between inorganic filler and matrix polymer.
exhibited severe wear in vivo over 11 years.
smooth.

ThisAs shown in Fig. 5, Gradia material

However, the worn surface of the Gradia restoration appears to be

These findings correlate with the results of in vitro studies.1-4

Figure 5 also shows marginal fracture of sintered porcelain material adjacent to the Gradia restoration.
Porcelain material is brittle and resistant to contact wear.

The authors consider that composite material was

gradually worn, whereas porcelain material fractured suddenly due to the collapse of occlusal contact of molar
dentition.

Shiono et al.9 reported on the clinical performance of restorations made of a highly filled indirectcomposite material.

The material included more than 90% of micro and macro inorganic filler.

Although therestorations made with the highly filled composite material showed loss of gloss in many cases, the restorations
did not exhibit apparent wear or fracture at the occlusal contact areas.
Considering the change of the surface texture of composite materials in vivo, great care must be taken in
fabrication of molar restorations with microfilled composite material.

Moreover, application of microfilled

composite material is recommended for use as anterior small restorations, especially in facial areas due to its
surface smoothness.
Acknowledgments
This clinical report is supported in part by Grant-in-Aid for Scientific Research C 24592934 (2012-2014) from the Japan
Society for the Promotion of Science (JSPS).

References
1. Soeno K, Matsumura H, Atsuta M, Kawasaki K. Influence of acidulated phosphate fluoride agent and effectiveness ofsubsequent polishing on composite material surfaces. Oper Dent 2002; 27: 305-10.
2. Ohara N, Koizumi H, Matsumoto Y, Nakayama D, Ogino T, Matsumura H. Surface roughness and gloss of indirectcomposites etched with acidulated phosphate fluoride solution. Acta Odontol Scand 2009; 67: 313-20.
3. Jain V, Platt JA, Moore K, Spohr AM, Borges GA. Color stability, gloss, and surface roughness of indirect composite resins. JOral Sci 2013; 55: 9-15.
4. Jain V, Platt JA, Moore BK, Borges GA. In vitro wear of new indirect resin composites. Oper Dent 2009; 34: 423-8.
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for endodontically treated teeth. Int J Prosthodont 2005; 18: 399-404.
6. Burrow MF, Tyas MJ. Comparison of two all-in-one adhesives bonded to non-carious cervical lesions--results at 3 years. Clin
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7. Palaniappan S, Elsen L, Lijnen I, Peumans M, Van Meerbeek B, Lambrechts P. Nanohybrid and microfilled hybrid versus
conventional hybrid composite restorations: 5-year clinical wear performance. Clin Oral Investig 2012; 16: 181-90.
8. Nakamura N. Esthetic recovery of molars. In the Quintessence Year Book 2003, Quintessence Publishing, Tokyo, 222-3,
2003, ISBN 4-87417-790-5.
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Correspondence to:Dr. Mitsuo Nakamura
Department of Fixed Prosthodontics, Nihon University School of Dentistry
1-8-13 Kanda-Surugadai, Chiyoda-ku, Tokyo 101-8310, Japan
Fax: +81-3-3219-8351 E-mail: ndent@sea.plala.or.jp
Copyright ©2014 by the Asian Pacific Journal of Dentistry.

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Accepted July 20, 2014.
Online ISSN 2185-3487, Print ISSN 2185-3479