Two-year clinical evaluation of direct and indirect composite restorations in posterior teeth. Three-year clinical evaluation of direct and indirect composite restorations in posterior teeth. Clinical performance of bonded leucite-reinforced glass ceramic inlays and onlays after eight years. Computer-aided direct ceramic restorations: a 10-year prospective clinical study of Cerec CAD/CAM inlays and onlays. Clinical study of indirect composite resin inlays in posterior stress-bearing cavities placed by dental students: results after 4 years. Dentists' molar restoration choices and longevity: a web-based survey. One-year clinical evaluation of composite and ceramic inlays in posterior teeth. Leucite-reinforced glass ceramic inlays and onlays after 12 years. Four-year clinical evaluation of a self-adhesive luting agent for ceramic inlays Direct composite inlays versus conventional composite restorations: three-year clinical results Composite resin fillings and inlays. An 11-year evaluation Cervical microleakage in MOD restorations: in vitro comparison of indirect and direct composite. A preliminary prospective evaluation of all-ceramic crown-retained and inlay-retained fixed partial dentures. Clinical performance and marginal adaptation of class II direct and semidirect composite restorations over 3.5 years in vivo. Survival and reasons for failure of amalgam versus composite posterior restorations placed in a randomized clinical trial. Clinical evaluation of ceramic inlays compared to composite restorations. Direct resin composite restorations in vital versus root-filled posterior teeth: a controlled comparative long-term follow-up. A practice-based research network on the survival of ceramic inlay/onlay restorations. Marginal and internal fit of heat pressed versus CAD/CAM fabricated all-ceramic onlays after exposure to thermo-mechanical fatigue. Three-year clinical evaluation of a self-cured posterior composite resin. Fracture Rates and Lifetime Estimations of CAD/CAM All-ceramic Restorations A clinical and histological evaluation of conservative pulpal therapy in human teeth. Clinical evaluation of an all-ceramic restorative system: a 36-month clinical evaluation.
STATEMENT OF PROBLEM Few long-term clinical studies have reported data of modern posterior composites as direct and indirect restorations . PURPOSE This prospect i ve , long-term clinical trial ( 1 ) evaluated direct and indirect composite restorations for clinical acceptability as posterior restoratives in single or multisurface carious teeth and ( 2 ) provided a survey on the 2-year results . MATERIAL AND METHODS Nine dental students placed 88 composite restorations ( Tetric , blend-a-lux , Pertac-Hybrid Unifil ) , 43 direct composite restorations and 45 indirect inlays , under the supervision of an experienced dentist . The first clinical evaluation was performed 11 to 13 months after placement by 2 other experienced dentists , using modified USPHS criteria . A second follow-up of 60 restorations took place within 20 to 26 months after placement . RESULTS A total of 93 % of indirect and 90 % of direct composite restorations were assessed to be clinical ly excellent or acceptable . Two restorations ( 1 indirect composite inlay and 1 margin of a direct composite restoration )  failed during the second year because of fracture . Indirect inlays demonstrated a significantly better " anatomic form of the surface " than direct composite restorations . Premolars revealed a significantly better margin integrity and postoperative symptoms than molars . CONCLUSION Posterior composite restorations provided a satisfactory clinical performance over a 2-year period when placed by relatively inexperienced but supervised students STATEMENT OF THE PROBLEM Objective long-term clinical data are necessary to assess the performance of modern posterior composites as direct and indirect restorations . PURPOSE This prospect i ve , long-term clinical trial evaluated direct and indirect composite restorations for clinical acceptability as posterior restoratives in single or multisurface cavities and provided a survey on the 3-year results . MATERIAL AND METHODS Under the supervision of an experienced dentist , 9 dental students placed 88 composite restorations ( Tetric , blend-a-lux , Pertac-Hybrid Unifil ) , 43 direct composite restorations , and 45 indirect inlays .  Clinical evaluation was performed at baseline and in yearly intervals after placement by 2 other experienced dentists , using modified USPHS criteria . A third follow-up of 60 restorations took place within 33 to 36 months after placement . RESULTS A total of 93 % of indirect and 87 % of direct restorations were assessed to be clinical ly excellent or acceptable . During the third year , 1 direct restoration in a molar failed because of margin opening . Indirect inlays exhibited a significantly better anatomic form of the surface than direct composite restorations . Premolars revealed a significantly better marginal integrity and anatomic form of the surface than molars . Restorations in molars exhibited a significantly higher failure rate compared with premolars . CONCLUSION Posterior composite restorations provided a satisfactory clinical performance over a 3-year period , even if placed by relatively inexperienced but supervised students OBJECTIVE Ceramic inlays and onlays are a tooth colored alternative to metallic restorations . Clinical long-term data are scarce though , especially about inlays and onlays having proximal margins in dentin . The present prospect i ve controlled clinical study evaluated the clinical performance of IPS Empress inlays and onlays with cuspal replacements and proximal margins below the cementoenamel junction over eight years . METHODS Ninety six ceramic restorations were placed in 34 patients by six dentists . The restorations were bonded with an enamel/dentin bonding system ( Syntac Classic ) and four different resin composite systems . The restorations were assessed after placement by two calibrated investigators using modified USPHS codes and criteria at the following time periods : baseline , 1,2,4,6 and 8 years . RESULTS Eight of the 96 restorations investigated had to be replaced ( failure rate 8 % ; Kaplan-Meier ) : Six inlays suffered cohesive bulk fractures , two teeth required endodontic treatment . After eight years of clinical service , significant deterioration ( Friedman 2-way ANOVA ; P < 0.05 ) was found for marginal adaptation of the remaining restorations . 98 % of the surviving restorations exhibited marginal deficiencies , independent of the luting composite . CONCLUSIONS IPS Empress inlays and onlays demonstrated to be successful even in large defects . Neither the absence of enamel margins , nor cuspal replacement significantly affected the quality of the restorations PURPOSE The objective of this follow-up study was to examine the performance of Cerec inlays and onlays in terms of clinical quality over a functional period of 10 years . MATERIAL S AND METHODS Of 200 Cerec inlays and onlays placed in a private practice between 1989 and early 1991 , 187 restorations were observed over a period of 10 years . The restorations were fabricated chairside using the Cerec-1 computer-aided design /manufacturing ( CAD/CAM ) method and Vita MK I feldspathic ceramic . An adhesive technique and luting composite resin were used for seating the restorations . After 10 years , the clinical performance of the restorations was evaluated using modified USPHS criteria . The results were used to classify success and failure . RESULTS According to Kaplan-Meier analysis , the success rate of Cerec inlays and onlays dropped to 90.4 % after 10 years . A total of 15 ( 8 % ) failures were found in 11 patients . Of these failures , 73 % were caused by either ceramic fractures ( 53 % ) or tooth fractures ( 20 % ) . The reasons for the remaining failures were caries ( 20 % ) and endodontic problems ( 7 % ) . The three-surface Cerec reconstructions were found to have the most failures . CONCLUSION The failure rate of 8 % and the drop of the survival probability rate to 90.4 % after 10 years of clinical service of Cerec-1 CAD/CAM restorations made of Vita MK I feldspathic ceramic appear to be acceptable in private practice . This is particularly true in light of the very high patient satisfaction OBJECTIVES This longitudinal r and omized controlled clinical trial evaluated the longevity of composite resin inlays in single- or multi-surface cavities up to 4 years . METHODS 21 dental students placed 75 Artglass and 80 Charisma composite resin inlays in class I and II cavities in posterior teeth ( 89 adult patients ) luted with dual-curing resin cements .  Clinical evaluation was performed up to 4 years using modified USPHS criteria . RESULTS 87.2 % of Artglass and 76.6 % of Charisma inlays were assessed to be clinical ly excellent or acceptable . Up to the 4-year recall 5 Artglass and 11 Charisma inlays failed mainly because of postoperative symptoms , bulk fracture , and loss of marginal integrity . No significant differences between both composite resin material s could be detected at 4 years for all clinical criteria ( Mann-Whitney U-test , p>0.05 ) . The comparison of restoration performance with time yielded a significant increase in marginal discolouration and postoperative symptoms ( p<0.05 ) , deterioration of surface texture quality , marginal and restoration integrity ( p<0.05 ) for both inlay systems . However , the changes were mainly effects of scoring shifts from alfa to bravo . Small inlays compared to large inlays and premolar restorations compared to molar restorations showed significant better outcome for some of the tested clinical parameters for the Artglass inlays ( p<0.05 ) . For Charisma inlays no such influences were revealed . CONCLUSIONS Clinical assessment of Artglass and Charisma composite resin inlays exhibited an annual failure rate of 3.2 % and 5.9 % that is within the range of published data . Within the limitations of this study indirect composite inlays are a competitive restorative procedure in stress-bearing preparations STATEMENT OF PROBLEM The increasing trend toward esthetics has led to controversy as to the longevity of esthetic restorations and the wisdom of having traditional restorations replaced for esthetic reasons . With the assumption that the way dentists treat their own teeth may be a good indication of the accumulated wisdom of the profession , knowledge of dentists ' own restorative choices may provide guidance in selecting the most appropriate restorations . PURPOSE The purpose of this article was to determine restorative choices of dentists for personal molars and estimate restoration longevity . MATERIAL AND METHODS Information about dentists ' molars was obtained from a Web-based survey design ed to receive dentists ' demographic data and charting of 8 molar teeth with estimated longevity . Approximately 12,000 e-mails asking to access the website were sent to dentists ' addresses r and omly selected from a commercial data base . Nonrespondents received 1 reminder . The responses were statistically analyzed with a chi-square analysis ( alpha=.05 ) . RESULTS Seven hundred fifty-seven valid replies provided information for 6,034 teeth ( 22 % unrestored , 75 % restored , 2 % missing ) . Restorations reported included amalgam ( 36 % ) , gold inlay/onlay ( 13 % ) , complete veneer crown ( CVC ) ( 10 % ) , metal-ceramic crown ( MCC ) ( 8 % ) , and composite ( 7 % ) . Other esthetic options accounted for less than 3 % . Restorations with more than 20 years longevity included amalgam restorations ( 58 % ) , gold inlays/onlays ( 48 % ) and crowns ( 23 % ) . Fifty-six percent of esthetic restorations and 5 % of amalgams were placed in the last 5 years . The following restorations were placed in the last year ( n=186 ) : 38 % esthetic , 29 % crowns ( 18 % MCC ; 11 % CVC ) , and 17 % gold inlay/onlay or amalgam . Significant differences ( P<.001 ) were identified for dentist 's gender , year of graduation and practice location . CONCLUSIONS Most dentists have not replaced traditional metallic restorations with esthetic alternatives . Dentists still choose nonesthetic options for significant numbers of their own restorations STATEMENT OF PROBLEM There are only a few studies available that deal with the clinical behavior of composite and ceramic inlay systems as potential substitutes for amalgam restorations . PURPOSE This prospect i ve clinical trial evaluated composite and ceramic inlay systems for clinical acceptability as restorative material s in single or multisurface cavities of posterior teeth and provided 1-year results . MATERIAL AND METHODS Forty-seven composite inlays ( Tetric , Blend-a-lux , Pertac ) and 24 heat-pressed ceramic inlays ( IPS Empress )  were placed in 45 patients by 7 student operators under the supervision of an experienced dentist . The first clinical evaluation was performed 11 to 13 months after placement of the restorations and used modified United States Public Health Services criteria . RESULTS Satisfactory results over this period were found , as 100 % of ceramic inlays and 94 % of composite inlays were assessed to be clinical ly excellent and acceptable . Only 3 composite inlay restorations were scored delta ( unacceptable ) . Two inlays exhibited secondary caries and 1 demonstrated loss of pulp vitality . For the criteria " anatomic form of the surface " and " marginal integrity , " ceramic inlays were significantly better than composite inlays . CONCLUSION Posterior tooth-colored inlays provided acceptable and excellent clinical service , even if they are placed by relatively inexperienced student operators PURPOSE This controlled clinical trial aim ed to evaluate  IPS Empress inlays and onlays over 12 years . The null hypothesis was that different luting resins would have no influence on clinical outcome . MATERIAL S AND METHODS In the course of a prospect i ve clinical long-term trial , 96 ceramic inlays and onlays were placed in 34 patients using one adhesive ( Syntac ) and four different luting composites ( Tetric , Variolink Low , Variolink Ultra , Dual Cement ) . Recalls were carried out by two calibrated investigators using modified USPHS codes and criteria at baseline , 1 , 2 , 4 , 6 , 8 , and 12 years . RESULTS Fifteen of the 96 restorations had to be replaced ( failure rate 16 % ; Kaplan-Meier ) ; 12 of them suffered bulk fractures . After twelve years of clinical service , significantly more bulk fractures were found when light-curing composite was used for luting ( p < 0.05 ) . Fractures were noticed between 3 and 4 years of clinical service and later after 11 to 12 years ; aside from those times , no single fracture occurred . Secondary caries was not observed . CONCLUSION IPS Empress inlays and onlays exhibited satisfactory clinical outcomes over a 12-year clinical period . Restorations luted with dual-cured resin composites revealed significantly fewer bulk fractures Objectives The aim of this r and omized controlled clinical trial was to evaluate the 4-year clinical performance of a self-adhesive resin cement , RelyX Unicem ( 3 M ESPE ) , used for cementation of ceramic inlays . In addition , the influence of selectively acid-etching enamel prior to luting on the clinical performance of the restorations was assessed . Methods Sixty-two IPS Empress 2 inlays/onlays were placed in 31 patients by two experienced clinicians . The restorations were luted with RelyX Unicem with ( = experimental group : E ) or without ( = control group : NE ) prior enamel etching with phosphoric acid . At baseline , 6 months , and 1 , 2 , and 4 years after placement , the restorations were assessed by two calibrated investigators using modified USPHS criteria . Ten selected sample s of each group were investigated under SEM regarding morphological changes at the cement – inlay interface . Results The recall rate at 4 years was 97 % . Two restorations ( 1 E , 1 NE ) were lost , and one ( E ) had to be replaced due to inlay and tooth fracture result ing in a survival rate of 95 % . No significant differences between the experimental and control group were noticed regarding all criteria ( McNemar , p < 0.05 ) . An obvious deterioration in marginal integrity was observed after 4 years as only 5 % ( E = 7 % ; NE = 3 % ) of the restorations exhibited an excellent marginal adaptation . In 90 % of the restorations small , still clinical ly acceptable marginal deficiencies were observed . SEM of the luting gap showed an increased wear of the RelyX Unicem cement over the 4-year period . Conclusions The self-adhesive luting cement RelyX Unicem can be recommended for bonding of ceramic inlays/onlays . Additional selective enamel etching does not improve the clinical performance of the restorations within the 4-year period . Clinical relevance The self-adhesive resin composite RelyX Unicem showed acceptable clinical performance after 4 years of clinical service A clinical trial of direct composite inlays versus conventionally ( incrementally ) placed restorations made from the same material was started in January 1989 . Restorations were r and omly allocated to matched pairs of cavities . This study reports the 3-year performance of 71 of the 100 pairs of restorations placed over a 2-year period and followed-up every 6 months .  Clinical assessment s were made using USPHS criteria ( indirect measurements of occlusal wear were made using Ivoclar st and ard dies ) and annual bite wing radiographs . Direct inlays showed significantly less occlusal wear than conventional restorations , but the difference was small . The clinical performance of both types of restoration was similar and compared favourably with studies of other material s. No secondary decay was diagnosed . The direct inlays , however , took longer to place and did not reduce postoperative sensitivity or failure rate ( 8 % failure of inlays and 4 % of conventional composites over 3 years ) . Contouring of proximal and occlusal aspects was not facilitated with direct inlays but may be easier with indirect inlays on removable The purpose of this r and omized , clinical study was to evaluate the clinical performance of composite resin material s used for fillings and indirect inlays . Twenty-eight sets of five class II restorations ( two fillings , three inlays ) were placed in 88 premolars and 52 molars in 28 adults .  Brilliant Dentin and Estilux Posterior were used for both fillings and inlays , and SR-Isosit for inlays only . After 11 years , 27 sets of restorations ( 96 % ) were evaluated clinical ly using modified United States Public Health Service criteria . Replaced or repaired restorations were observed in 16 % of the fillings and 17 % of the inlays , and a further 5 % of the restorations were replaced for reasons not related to the restoration . The remaining 107 restorations exhibited optimal ratings in 30 % of the fillings and 12 % of the inlays ( P<0.05 ) and acceptable ratings in 70 % and 88 % , respectively . The reasons for failure were fracture of restoration ( four fillings , five inlays ) , secondary caries ( two fillings , four inlays ) , fracture of tooth ( two inlays ) , loss of proximal contact ( two fillings ) , and loss of restoration ( one inlay ) . Failures were seen more frequently in molar than premolar restorations ( P<0.05 ) , with no significant difference between fillings and inlays or between the five types of restoration ( P>0.05 ) This study compared microleakage between  indirect composite inlays and direct composite restorations . Forty-eight st and ard inlay MOD cavities , with cervical margins located either in enamel or dentin , were prepared in extracted human third molars . The specimens were r and omly divided into 3 groups ( n=16 ) . In the control group , the cavities were restored with the composite Filtek Z250 ( 3 M ESPE ) . For the experimental groups , indirect restorations were made with the Artglass ( Heraeus-Kulzer ) or Belleglass HP ( Kerr Laboratories ) systems and cemented with the dual curing cement RelyX ARC ( 3 M ESPE ) . The adhesive system Single Bond ( 3 M ESPE ) was applied on all groups . The specimens were su bmi tted to thermolcycling , coated with nail varnish , then immersed in 2 % basic fuchsine aqueous solution for 24 hours . The teeth were then sectioned and leakage scores were evaluated ( 40x ) , based on a st and ard ranking . Data were su bmi tted to statistical analysis ( Mann-Whitney and Kruskal-Wallis tests ) with a 95 % confidence level . No statistical difference was found between substrates ( p=0.595 ) , and the material s performed similarly in dentin ( p=0.482 ) . Direct restorations showed higher leakage than indirect restorations at the enamel margins ( p=0.004 ) . Within the limitations of this experimental design , overall leakage was similar between both substrates , while the indirect systems provided a better sealing than direct composites only in enamel PURPOSE The purpose of this preliminary prospect i ve study was to evaluate the clinical outcome of  crown-retained and inlay-retained fixed partial dentures ( FPDs )  made from a new lithium-disilicate glass-ceramic ( IPS e.max Press , Ivoclar Vivadent ) . MATERIAL S AND METHODS Eighty-one 3-unit FPDs were placed in 68 patients . The FPDs replaced teeth in the anterior ( 8 % ) and posterior region ( 92 % ) . All teeth were prepared according to a st and ardized protocol . The size of the proximal connector of the FPDs was 12 mm2 ( anterior ) or 16 mm2 ( posterior ) , respectively . Crown-retained FPDs were cemented either with glass ionomer ( n = 20 ) or resin composite ( n = 16 ) , while all inlay-retained FPDs ( n = 45 ) were cemented with resin composite . Initial follow-up was performed at 6 and 12 months and annually thereafter . RESULTS The mean observation periods were 48 months ( for crown-retained FPDs ) and 37 months ( for inlay-retained FPDs ) . None of the crown-retained FPDs  failed during the observation period , while 6 inlay-retained FPDs ( 13 % ) had to be replaced . Six cases failed because of debonding ( n = 3 ) or a combination of debonding and fracture ( n = 3 ) . During the observation period , 2 patients died and the status of another 5 patients is unknown . The 4-year survival rate according to Kaplan-Meier was 100 % for crown-retained FPDs and 89 % for inlay-retained FPDs . The differences between the groups were statistically significant . CONCLUSION Crown-retained 3-unit FPDs made from a new glass-ceramic have a significantly better outcome up to 5 years than inlay-retained 3-unit FPDs over the observation period OBJECTIVE The study evaluated the clinical performance and marginal adaptation of  direct and semi-direct class II composite restorations  in a split-mouth design over 3.5 years . DESIGN 44 upper posterior teeth in 11 adults with primary carious lesions were treated with 22  direct and 22  semi-direct restorations . Conventional cavities were prepared for both types of restorations . A fine fine hybrid composite ( APH ) and a multifunctional adhesive system ( Prisma universal bond 3 ) were used for all restorations . The incremental " 3-sited light curing " technique was applied to direct restorations . Semi-direct inlays were prefabricated on silicone casts and post-cured using light and heat .  Clinical performance was evaluated using modified USPHS parameters , while marginal adaptation was judged on replicas , using SEM and a st and ardized evaluation technique . RESULTS Clinical results after 3.5 years revealed a 100 % retention rate with no fractures , sensitivity or recurrent caries for both types of restorations . SEM-evaluation of the occlusal margins showed at the tooth-restoration interface relatively low rates of marginal openings over the observation period ( 4 - 8 % ) . Marginal restoration fractures ranged between 1 and 2 % , marginal tooth fractures between 3 and 9 % . Differences between the restorative techniques and after the different time observation periods were not statistically significant . Proportions of marginal fractures and openings at the restoration-luting composite interface were less than 10 % after 3.5 years . CONCLUSION The results indicated no significant differences for direct and semi-direct fine hybrid composite restorations  in medium size cavities in posterior teeth with respect to clinical performance and marginal adaptation over 3.5 years BACKGROUND Failure of dental restorations is a major concern in dental practice . Replacement of failed restorations constitutes the majority of operative work . Clinicians should be aware of the longevity of , and likely reasons for the failure of , direct posterior restorations . In a long-term , r and omized clinical trial , the authors compared the longevity of  amalgam and composite .  SUBJECTS , METHODS AND MATERIAL S : The authors r and omly assigned one-half of the 472 subjects , whose age ranged from 8 through 12 years , to receive amalgam restorations in posterior teeth and the other one-half to receive resin-based composite restorations .  Study dentists saw subjects annually to conduct follow-up oral examinations and take bitewing radiographs . Restorations needing replacement were failures . The dentists recorded differential reasons for restoration failure . RESULTS Subjects received a total of 1,748 restorations at baseline , which the authors followed for up to seven years . Overall , 10.1 percent of the baseline restorations failed . The survival rate of the amalgam restorations was 94.4 percent ; that of composite restorations was 85.5 percent . Annual failure rates ranged from 0.16 to 2.83 percent for amalgam restorations and from 0.94 to 9.43 percent for composite restorations .  Secondary caries was the main reason for failure in both material s. Risk of secondary caries was 3.5 times greater in the composite group . CONCLUSION Amalgam restorations performed better than did composite restorations . The difference in performance was accentuated in large restorations and in those with more than three surfaces involved . CLINICAL IMPLICATION S Use of amalgam appears to be preferable to use of composites in multisurface restorations of large posterior teeth if longevity is the primary criterion in material selection This study compared the clinical performance of  indirectly manufactured ceramic Evopress inlays with those of directly placed , fine particle hybrid Filtek Z250 composite restorations in posterior teeth . From January 2000 to October 2003 , 109 patients received 264 Evopress ( Wegold ) ceramic inlays and 68 patients received 145 Filtek Z250 ( 3 M ESPE ) composite restorations in a dental office . Two-hundred and fifty ceramic inlays ( 95 % ) and 135 composite restorations ( 93 % ) were re-examined up to 57 months after placement . Modified USPHS criteria were used for the study . The worst finding of all the assessment s was the overall assessment of individual restorations . On the basis of these criteria , 220 ( 88 % ) Evopress ceramic inlays were assessed as Alpha at the time of clinical re-examination , 26 ( 10 % ) were judged Beta and four ceramic inlays ( 2 % ) were rated Delta in the re-examination interval and thus categorized as failures . At the time of re-examination , 91 of the 135 composite restorations ( 67 % ) were judged Alpha , 36 restorations ( 26 % ) were rated Beta and three restorations ( 2 % ) were judged Charlie . Five restorations ( 4 % ) were categorized as failures ( Delta ) . In two cases , there were marginal gap formations ; there were also two cases of secondary caries after 28 and 35 months , as well as a fracture after 13 months . According to Kaplan and Meier , the survival rate after 57 months was 94 % for ceramic inlays and 93 % for composite restorations . The log rank test showed no significant differences in the survival curves . The current study showed that indirectly manufactured Evopress ceramic inlays performed better than direct Filtek Z250 composite restorations in marginal adaptation , color match and anatomic form . However , with regard to survival probability , there was no significant difference This study compared direct composite restorations on vital versus endodontically-treated posterior teeth , six to eight years after placement . All clinical procedures were performed using st and ardized material s and protocol s. The patients were identified with the aid of a computerized billing system followed by a chart search . With each patient , the prime investigator matched a r and omly chosen endodontically-treated tooth ( test tooth ) with a vital counterpart ( control tooth ) with a direct composite restoration . Of the 84 patients who fulfilled the inclusion criteria , 44 were available for recall . Two calibrated observers , blinded to the tooth vitality status , evaluated the fillings by applying the modified USPHS criteria . The outcome was dichotomized to revision indicated/recommended vs revision not indicated . Odds Ratios ( OR ) and corresponding 95 % Confidence Intervals ( 95 % CI ) were calculated . Residual confounding was corrected using a multivariable regression analysis with the remaining known confounders filling size , tooth type and age of the fillings in months as independent variables . The crude association between the presence/absence of root canal treatment and the need for revision ( OR , 95 % CI ) was 2.12 ( 1.02 - 4.38 ; p = 0.04 ) . Correcting for all potential confounders in the multivariable analysis changed this association marginally to an OR of 1.98 ( 0.90 - 4.38 ; p = 0.09 ) OBJECTIVE To evaluate prospect ively the longevity of  ceramic inlay/onlay restorations  placed in a web-based practice -based research network and to investigate risk factors associated with restoration failures . MATERIAL S AND METHODS Data were collected by a practice -based research network called Ceramic Success Analysis ( CSA ) . 5791 inlay/onlay ceramic restorations were placed in 5523 patients by 167 dentists between 1994 and 2014 in their dental practice s. For each restoration specific information related to the tooth , procedures and material s used were recorded . Annual failure rates ( AFRs ) were calculated and variables associated with failure were assessed by a multivariate Cox-regression analysis with shared frailty . RESULTS The mean observation time was 3 years ( maximum 15 years ) of clinical service , and AFRs at 3 and 10 years follow up were calculated as 1.0 % and 1.6 % . Restorations with cervical outline in dentin showed a 78 % higher risk for failure compared to restorations with margins in enamel . The presence of a liner or base of glass-ionomer cement result ed in a risk for failure twice as large as that of restorations without liner or base material . Restorations performed with simplified adhesive systems ( 2-step etch- and -rinse and 1-step self-etch ) presented a risk of failure 142 % higher than restorations performed with adhesives with bonding resin as a separate step ( 3-step etch- and -rinse and 2-step self-etch ) . 220 failures were recorded and the most predominant reason for failure was fracture of the restoration or tooth ( 44.5 % ) . CONCLUSIONS Ceramic inlay/onlay restorations made from several glass ceramic material s and applied by a large number of dentists showed a good survival . Deep cervical cavity outline , presence of a glass ionomer lining cement , and use of simplified adhesive systems were risk factors for survival OBJECTIVES The aim of the study was to evaluate the marginal and internal fit of heat-pressed and CAD/CAM fabricated all-ceramic onlays before and after luting as well as after thermo-mechanical fatigue . MATERIAL S AND METHODS Seventy-two caries-free , extracted human m and ibular molars were r and omly divided into three groups ( n=24/group ) . All teeth received an onlay preparation with a mesio-occlusal-distal inlay cavity and an occlusal reduction of all cusps . Teeth were restored with heat-pressed IPS-e.max-Press * ( IP , * Ivoclar-Vivadent ) and Vita-PM9 ( VP , Vita-Zahnfabrik ) as well as CAD/CAM fabricated IPS-e.max-CAD * ( IC , Cerec 3D/InLab/Sirona ) all-ceramic material s. After cementation with a dual-polymerising resin cement ( VariolinkII * ) , all restorations were subjected to mouth-motion fatigue ( 98 N , 1.2 million cycles ; 5 ° C/55 ° C ) . Marginal fit discrepancies were examined on epoxy replicas before and after luting as well as after fatigue at 200 × magnification . Internal fit was evaluated by multiple sectioning technique . For the statistical analysis , a linear model was fitted with accounting for repeated measurements . RESULTS Adhesive cementation of onlays result ed in significantly increased marginal gap values in all groups , whereas thermo-mechanical fatigue had no effect . Marginal gap values of all test groups were equal after fatigue exposure . Internal discrepancies of CAD/CAM fabricated restorations were significantly higher than both press manufactured onlays . CONCLUSIONS Mean marginal gap values of the investigated onlays before and after luting as well as after fatigue were within the clinical ly acceptable range . Marginal fit was not affected by the investigated heat-press versus CAD/CAM fabrication technique . Press fabrication result ed in a superior internal fit of onlays as compared to the CAD/CAM technique . CLINICAL RELEVANCE Clinical requirements of 100 μm for marginal fit were fulfilled by the heat-press as well as by the CAD/CAM fabricated all-ceramic onlays . Superior internal fit was observed with the heat-press manufacturing method . The impact of present findings on the clinical long-term behaviour of differently fabricated all-ceramic onlays warrants further investigation A study was conducted to determine whether the wear resistance of a posterior composite could be improved by maximizing filler particle-to-particle contacts . This was expected to reduce stress concentrations on the resin matrix and thus reduce occlusal wear . A self-curing quartz-filled composite with this design , P-10 , was used to restore 90 Class I and II cavity preparations in adult teeth . Restorations were recalled after baseline at six months , one year , two years , and three years to measure wear by direct and indirect evaluation methods . There was no apparent advantage for this material compared with other previously evaluated posterior composites . The average cumulative wear for P-10 after three years was 145 microns . In addition , the restorations were evaluated for color-matching , interfacial staining , secondary caries , marginal adaptation , surface texture , and postoperative sensitivity . This material was not significantly different in those ways from other posterior composite products except in terms of more rapid color change , because it is self-cured The gathering of clinical data on fractures of dental restorations through prospect i ve clinical trials is a labor- and time-consuming enterprise . Here , we propose an unconventional approach for collecting large data sets , from which clinical information on indirect restorations can be retrospectively analyzed . The authors accessed the data base of an industry-scale machining center in Germany and obtained information on 34,911 computer-aided design (CAD)/computer-aided manufacturing ( CAM ) all-ceramic posterior restorations . The fractures of bridges , crowns , onlays , and inlays fabricated from different all-ceramic systems over a period of 3.5 y were reported by dentists and entered in the data base . Survival analyses and estimations of future life revealed differences in performance among  ZrO2-based restorations  and lithium disilicate and leucite-reinforced glass-ceramics Three intermediary base material s , a zinc oxide-eugenol ( Cavitec ) and two calcium hydroxide liners ( Life and Dycal ) , were selected at r and om for use as a base beneath  amalgam or composite restorations on humans following complete caries removal .  Life and Dycal , selected at r and om , were also used as direct and indirect pulp capping agents as clinical ly indicated . Clinical evaluations of signs and symptoms were made before treatment and at one-week , six-month , and one-year intervals following treatment . Histological evaluations were performed on three complete caries removal teeth and 18 direct pulp capping teeth six months following treatment . No significant differences in clinical symptomatology result ed between the material s in the complete caries removal group or the indirect and direct pulp capping groups PURPOSE To clinical ly evaluate an all-ceramic restorative system ( Finesse All-Ceramic ) when used in conjunction with an ultra-low fusing porcelain ( Finesse ) using bonded esthetic resin cements ( Enforce & Calibra ) . METHODS This report describes the 3-year results of a prospect i ve , consecutive case clinical evaluation for Finesse All-Ceramic .  Forty posterior and anterior crowns , 20 all ceramic inlays and onlays , and 26 veneers were placed in 43 patients at the initiation of this study .  St and ard ceramic preparations were performed followed by conventional polyvinylsiloxane ( Aquasil ) impression techniques using cord retraction . The bonded resin cement was used to place the restorations following manufacturer 's instructions . RESULTS A majority of restorations ( 95 - 100 % ) were evaluated to be optimal at baseline ( B ) , 1 month , 12 , 24 and 36 months using a modified Ryge criteria for the following categories : color match , marginal adaptation , porcelain staining , secondary caries , postoperative sensitivity , and retention . Assessment of color match at 36 months result ed in 97 % of all crowns and 100 % of all veneers and onlays being rated alfa for shade match to Vita Lumin shade guide . The overall 3-year success rate at the 3-year recall ( inlay/onlays , crowns , and veneers ) was 98.57 % , with the success rate for crowns and veneers at this time period being 100 %
The difference of the two techniques did not reach statistical significance in order to recommend one technique over the other .
CLINICAL SIGNIFICANCE Resin composite material s , placed directly or indirectly , exhibit a promising long-term clinical performance when rehabilitation of posterior teeth is needed .
OBJECTIVE To evaluate the long-term clinical performance of direct versus indirect composite inlays/onlays  in posterior teeth .
Although many years in clinical practice , the selection of the best treatment protocol still remains subjective .