Tanoue et al.

Int Chin J Dent 2006; 6: 105-109.

One-year clinical evaluation of anterior composite veneered
restorations made of the Solidex composite and silver-palladiumcopper-gold alloy
Naomi Tanoue, DDS, PhD,a Shuichi Mori, RDT,a Hidenori Sugawara, DDS, PhD,bHideo Matsumura, DDS, PhD,c,d and Hiroyasu Koizumi, DDS, PhDc,dab

Nagasaki University Hospital of Medicine and Dentistry, Nagasaki, Private Practice, Nagasaki,
dDepartment of Fixed Prosthodontics, Nihon University School of Dentistry, and Division of Advanced
Dental Treatment, Dental Research Center, Nihon University School of Dentistry, Tokyo, Japan

cPurpose: The purpose of the current study was to evaluate the clinical performance of composite veneered
restorations made of a light-activated composite material and silver-palladium-copper-gold alloy.
Materials and Methods: A total of 52 restorations veneered with the Solidex composite were clinicallyevaluated using modified USPHS criteria. Color match, veneer-metal interfacial staining, veneer surface texture,
wear, and recurrent dental caries were examined. The average observation period was 12 months.
Results: All restorations were judged as Alfa for all categories at baseline. After an observation period of 12months, the following cases were judged as Bravo; one for color match, two for veneer surface texture, and onefor wear. Veneer-metal interfacial staining and recurrent dental caries were not detected.
Conclusion: Within the limitation of the current study, it can be concluded that the Solidex indirect composite isclinically reliable material for use as an anterior veneering agent. (Int Chin J Dent 2006; 6: 105-109.)
Key Words: clinical evaluation, composite, restoration, veneer.

Introduction
The use of composite materials for veneered restorations has increased substantially, mainly due toimprovement in material properties. The Solidex material (Shofu Inc., Kyoto, Japan) is one of the highly loaded
composites applicable for indirect restorations with or without metal substructure.

In vitro evaluation

demonstrated that the Solidex composite demonstrated improved or equivalent properties as compared withother indirect composite materials.1-18 Indication of the Solidex composite was therefore extended from single
restorations to cast veneered fixed partial dentures (FPDs).
Although in-vitro property-test results have been extensively reported, limited information is available about
dental laboratory procedure and clinical results of restorations associated with the Solidex veneer.19 This study
reports on the clinical performance of composite veneered restorations made of the Solidex composite andsilver-palladium-copper-gold (Ag-Pd) alloy, after an average observation period of 12 months.

Materials and Methods
The Solidex composite was selected for clinical evaluation. The material consists of splintered glass (average3 µm), colloidal silica, prepolymerized silica composite, and urethane dimethacrylate (UDMA). The total filler
loading is 78%, and total inorganic filler loading is 53%.4,6
A total of 36 adult patients (20 females and 16 males), in whom full coverage facing restorations were planned,
were successively included. Fifty-two teeth (30 maxillary incisors, 10 maxillary canines, seven mandibularincisors, and five mandibular canines) were restored in the current study. The abutment was prepared according
to the conventional design for a composite veneered restoration with approximately 1.0-1.2 mm labial roundedshoulder preparation, lingual chamfer preparation, and 2.5-3.0 mm incisal edge reduction.
An impression was made with a silicone elastomeric material, poured with die stone and lab stone, and aworking cast was prepared. A composite veneered restoration or FPD was fabricated with the Solidex composite

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and Ag-Pd alloy according to the manufacturer’s specifications (Figs. 1-15). On the patient’s next visit, therestoration was tried-in, occlusion and articulation were adjusted, and the restoration was seated with a luting
agent. The patients entered a check-up program and oral examination was continued once or twice a year.

Fig. 1. Pre-operative view.

Fig. 2. Three anterior abutments.

Fig. 3. Try-in of a cast framework.

Fig. 4. Air-abrasion with alumina.

Fig. 5. Application of opaque resin.

Fig. 6. Staining of cervical areas.

Fig. 7. Dentin-colored material.

Fig. 8. Enamel-colored material.

Fig. 9. Translucency of incisal edges.

Fig. 10. Completed FPD.

Fig. 11. Lingual view.

Fig. 12. Seated FPD.

Fig. 13. Occlusal view.

Fig. 14. Labial view after 12 months.

Fig. 15. Occlusal view after 12 months.

The restorations were evaluated immediately after seating (baseline) and after one year. On the basis of themodified United States Public Health Service (USPHS) criteria, the following characteristics of the restorations
were evaluated; color match, veneer-metal interfacial staining, veneer surface texture, wear, and recurrent dental
caries. The modified USPHS guidelines used in the current study are shown in Table 1.20-24 The clinical106

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Int Chin J Dent 2006; 6: 105-109.

protocol was approved by the Ethical Committee for Clinical Practice of the Nagasaki University Hospital of
Medicine and Dentistry (Approval No. 23) and the Medical Ethics Committee, Nihon University School ofDentistry (2003-22).
Table 1.

Modified USPHS criteria for direct clinical evaluations.

Category/Rating

Characteristics

Color matchA
The restoration appears to match the shade and translucency of adjacent tooth tissues.
BThe restoration does not match the shade and translucency of adjacent tooth tissues, but the mismatch is within thenormal range of tooth shades.
CThe restoration does not match the shade and translucency of adjacent tooth, and the mismatch is outside
the normal range of tooth shades and translucency.
Veneer-metal interfacial staining
ANo discoloration or incidence of microleakage.
B
Slight or superficial staining that can be polished away.
C
Deep penetration of staining that cannot be polished away.
Veneer surface texture
ASurface texture similar to polished enamel as determined by means of a sharp explorer.
BSurface texture gritty similar to a surface subject to a white stone or similar to a composite containing
supramicron sizes particles.
CSurface pitting is sufficiently coarse to inhibit the continuous movement of an explorer across the surface.
WearA
B
C

The restoration is a continuation of existing anatomic form or is slightly flattened.
A surface concavity is evident.
There is a loss of restorative substance such that a surface concavity is evident. Replacement is required.

Recurrent dental caries
A
The restoration is a continuation of existing anatomic form adjacent to the restoration.
CThere is visual evidence of dark deep discoloration adjacent to the restoration.
A, Alfa; B, Bravo; C, Charlie.

Results
Table 2 shows the clinical evaluation of the veneered restorations at baseline and after an average observation
period of 12 months. All restorations were judged as Alfa for all categories at the baseline evaluation. The
numbers of restorations judged as Bravo rating at the recall visit were; one for color match, two for veneer
surface texture, and one for wear. The remaining restorations were judged as Alfa for all categories. In thecurrent study, no restorations were judged as Charlie for any of the categories.
Table 2.

Clinical evaluation of composite-veneered restorations.

CategoryRating
Color match
Veneer-metal interfacial staining
Veneer surface texture
Wear
Recurrent dental caries

ABaseline
BC

After ave. 12 months
AB
C

5252
52
52
52

0000--

0000051
52
50
51
52

1021--

00000

A, Alfa; B, Bravo; C, Charlie. N=52.

Discussion
The one-year clinical evaluation of restorations made of the Solidex composite and Ag-Pd alloy demonstrated

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Int Chin J Dent 2006; 6: 105-109.

favorable results. Of the 52 restorations, only one exhibited change of color during the observation period.
Examination revealed that the staining composite material applied to the surface of the veneer has been
disappeared. This is probably caused by excessive tooth brushing for this restoration. This phenomenon is also
related to Bravo rating of veneer surface texture as well as wear of the veneering agent. The other case thatreceived Bravo rating in the category of veneer surface texture was micro-fracture of maxillary canine withdirect traumatic injury. Neither the laboratory procedure nor the material property was responsible for the Bravo
rating in this case. The incisal edge was modified with diamond cutting instrument and polished with a rotary
silicone instrument containing file diamond particles (Compo Master, Shofu Inc.).
As shown in the clinical results, restorations made of the Solidex composite demonstrated clinical success for
all cases after one year without Charlie rating. On the basis of the current evaluation, it can be concluded that
the Solidex composite is a clinically reliable material for use as an indirect veneering agent of anterior castrestorations.
Acknowledgments
This study was supported in part by Grants-in-Aid for Scientific Research B 18390525 (2006-2007) and C 17592030(2005-2007) from the Japan Society for the Promotion of Science (JSPS), a Grant from Dental Research Center, Nihon
University School of Dentistry, and by Sato Fund from Nihon University School of Dentistry.

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Reprint request to:
Dr. Naomi TanoueDepartment of Specialized Dentistry
Nagasaki University Hospital of Medicine and Dentistry
1-7-1, Sakamoto, Nagasaki 852-8501, Japan
Fax: +81-95-849-7689 E-mail: t-naomi@net.nagasaki-u.ac.jp
Received June 8, 2006. Accepted August 28, 2006.
Copyright ©2006 by the Editorial Council of the International Chinese Journal of Dentistry.

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