Two-year clinical performance of sonic-resin placement system in posterior restorations. A prospective, randomized, double-blind clinical trial of one nano-hybrid and one high-viscosity bulk-fill composite restorative systems in class II cavities: 12 months results A randomized controlled three year evaluation of "bulk-filled" posterior resin restorations based on stress decreasing resin technology. Bulk‐filled posterior resin restorations based on stress‐decreasing resin technology: a randomized, controlled 6‐year evaluation Randomized 3-year clinical evaluation of Class I and II posterior resin restorations placed with a bulk-fill resin composite and a one-step self-etching adhesive. Effectiveness of conventional treatment using bulk-fill composite resin versus Atraumatic Restorative Treatments in primary and permanent dentition: a pragmatic randomized clinical trial Influence of Adhesive Type and Placement Technique on Postoperative Sensitivity in Posterior Composite Restorations. Effect of posterior resin composite placement technique on the resin-dentin interface formed in vivo. The effect of a new-generation flowable composite resin on microleakage in Class V composite restorations as an intermediate layer Marginal adaptation of class II cavities restored with bulk-fill composites. Clinical evaluation of packable and conventional hybrid posterior resin-based composites: results at 3.5 years. Class I occlusal composite resin restorations: in vivo post-operative sensitivity, wall adaptation, and microleakage. Clinical study of indirect composite resin inlays in posterior stress-bearing cavities placed by dental students: results after 4 years. Three-year clinical evaluation of a self-cured posterior composite resin. Long-term clinical evaluation of fracture and pulp injury following glass-ionomer cement or composite resin applied as a base filling in teeth restored with amalgam. The clinical performance of a posterior composite resin restorative material, Heliomolar R.O.: 3-year report. A practice-based, randomized, controlled clinical trial of a new resin composite restorative: one-year results. Efficacy of conventional treatment with composite resin and atraumatic restorative treatment in posterior primary teeth: study protocol for a randomised controlled trial Saucer-shaped cavity preparations for posterior approximal resin composite restorations: observations up to 10 years. Three-year clinical evaluation of a silorane composite resin. Two-year clinical evaluation of ormocer, nanohybrid and nanofill composite restorative systems in posterior teeth. Bulk dentine replacement versus incrementally placed resin composite: A randomised controlled clinical trial. Endodontic complications after plastic restorations in general practice.
OBJECTIVE The objective of this split-mouth r and omized controlled study was to compare the 2-year clinical performance of two restorative techniques and material s for posterior permanent carious teeth . METHOD AND MATERIAL S After signing informed consent , 30 patients aged between 7 and 16 received two Class 1 restorations on cavities on permanent first or second molar teeth performed with one of two systems : incrementally placed conventional posterior composite resin ( Herculite Ultra , Kerr ) , and sonic-resin placement system ( SonicFill , Kerr ) with single-component self-etch adhesive system ( Kerr ) according to the manufacturers ' directions . Two blinded observers evaluated the restorations at three times ( baseline , and after 1 and 2 years ) according to the US Public Health Service modified criteria . Kruskal-Wallis test and Mann-Whitney U-test were used to compare the clinical performance of the restorative systems . RESULTS The restorative systems showed similar clinical performance at 2 years . At the end of 2 years in both groups , one restoration 's marginal staining Alpha ratings decreased . In the same period , two restorations in the conventional group and one in the SonicFill group received Bravo ratings for color match and surface roughness scorings . CONCLUSION The sonic-resin placement system demonstrated similar results to incrementally placed conventional composite resin in terms of clinical success . Considering the advantages of providing up to 5 mm in a single layer , and the adjustability of the viscosity , bulk-fill composite restorations seem to be a good alternative to posterior Class 1 composite restorations . CLINICAL RELEVANCE This study suggests that a new dental material for bulk-fill technology exhibits similar clinical success to incrementally placed composite resin Background : Recently , manufacturers have introduced bulk-fill composite resins that reportedly can be placed in increments of 4 mm or greater . Objective : The purpose of this article was to report the results of 12 months prospect i ve r and omized clinical trial that evaluated the clinical performance of one high-viscosity bulk-fill composite resin in Class II cavities of posterior teeth . Material s and Methods : Thirty-four participants had at least two Class II cavities included the study . Class II cavities restored with either a Tetric EvoCeram bulk-fi fill or universal nano-hybrid resin composite ( Tetric EvoCeram ) . A total of 74 restorations ( 37 with each material ) on 34 patients were placed according to the manufacturers ' instructions by one calibrated operator . Results : Seventy restorations were evaluated after 12 months evaluation period . No postoperative sensitivity , anatomic form , retention , and secondary caries were observed after 6 and 12 months . Regarding the items color match , marginal discoloration , and marginal adaptation , the statistical analysis did not detect any statistical significance between two material s ( P > 0.05 ) . Conclusion : After 12 months of clinical service , all restorations evaluated for both material s were classified as ideal , receiving predominantly Alfa scores for all parameters analyzed . Clinical Relevance : This study presents that high-viscosity bulk-fill resin composites ( RCs ) perform just as well as nano-hybrid RCs with the 2 mm RC layering technique , therefore could be alternative to conventional nano-hybrid RCs OBJECTIVE The objective of this r and omized controlled prospect i ve clinical trial was to evaluate the efficacy of a flowable resin composite ( SDR ) bulk fill technique in posterior restorations and to compare it intraindividually with a conventional 2 mm resin composite curing technique in a 3-year follow up . MATERIAL S AND METHODS Thirty-eight pairs Class II and 15 pairs Class I restorations were placed in 38 patients with a mean age of 55.3 years ( range 32 - 87 ) . Each patient received at r and om at least two , as similar as possible , Class II or Class I restorations of two restorative techniques . In all cavities a single step self-etch adhesive ( Xeno V ) was applied . In one of the cavities of each pair , a flowable resin composite ( SDR ) was placed , in bulk increments up to 4 mm as needed to fill the cavity 2 mm short of the occlusal cavosurface . The occlusal part was completed with a nano-hybrid resin composite ( Ceram X mono ) layer . In the second cavity , the hybrid resin composite was placed in 2 mm increments . The restorations were evaluated using slightly modified USPHS criteria at baseline and then yearly during 3 years . Caries risk and parafunctional habits of the participants were estimated . RESULTS After three years , 76 Class II and 28 Class I restorations could be observed . One molar resin composite-only tooth showed post-operative sensitivity during 3 weeks for temperature changes and occlusal forces . Two failed Class II molar restorations in the resin composite-only group were observed during the first year , one cusp fracture and one resin composite fracture . An annual failure rate of 1.3 % was found for the resin composite only restorations and of 0 % in the bulk-filled restorations ( n.s . ) . Ten participants were estimated as having high caries risk and eleven showed active bruxing habits . SIGNIFICANCE The 4 mm bulk-fill technique with the flowable resin composite SDR showed highly clinical effectiveness , which was comparable during the 3-year follow-up with the 2 mm resin composite layering technique This r and omized study evaluated a flowable resin composite bulk-fill technique in posterior restorations and compared it intraindividually with a conventional 2-mm resin composite layering technique over a 6-yr follow-up period . Thirty-eight pairs of Class II restorations and 15 pairs of Class I restorations were placed in 38 adults . In all cavities a single-step self-etch adhesive ( Xeno V ) was applied . In the first cavity of each pair , the flowable resin composite ( SDR ) was placed , in bulk increments of up to 4 mm . The occlusal part was completed with a layer of nanohybrid resin composite ( Ceram X mono ) . In the second cavity of each pair , the hybrid resin composite was placed in 2-mm increments . The restorations were evaluated using slightly modified US Public Health Service ( USPHS ) criteria at baseline and then annually for a time period of 6 yr . After 6 yr , 72 Class II restorations and 26 Class I restorations could be evaluated . Six failed Class II molar restorations , three in each group , were observed , result ing in a success rate of 93.9 % for all restorations and an annual failure rate ( AFR ) of 1.0 % for both groups . The AFR for Class II and Class I restorations in both groups was 1.4 % and 0 % , respectively . The main reason for failure was resin composite fracture PURPOSE To evaluate the 3-year clinical durability of the flowable bulk-fill resin composite SDR in Class I and Class II restorations . MATERIAL S AND METHODS Thirty-eight pairs of Class I and 62 pairs of Class II restorations were placed in 44 male and 42 female patients ( mean age 52.4 years ) . Each patient received at least two extended Class I or Class II restorations that were as similar as possible . In all cavities , a one-step self-etching adhesive ( XenoV+ ) was applied . One of the cavities of each pair was r and omly assigned to receive the flowable bulk-fill resin composite SDR in increments up to 4 mm as needed to fill the cavity 2 mm short of the occlusal cavosurface . The occlusal part was completed with an ormocer-based nanohybrid resin composite ( Ceram X mono+ ) . In the other cavity , only the resin composite CeramX mono+ was placed in 2 mm increments . The restorations were evaluated using slightly modified USPHS criteria at baseline and then annually for 3 years . Caries risk and bruxing habits of the participants were estimated . RESULTS No post-operative sensitivity was reported . At the 3-year follow-up , 196 restorations - 74 Class I and 122 Class II - were evaluated . Seven restorations failed ( 3.6 % ) , 4 SDR-CeramX mono+ and 3 CeramX mono+ only restorations , all of which were Class II . The main reason for failure was tooth fracture , followed by resin composite fracture . The annual failure rate ( AFR ) for all restorations ( Class I and II ) was 1.2 % for the bulkfilled restorations and 1.0 % for the resin composite-only restorations ( p > 0.05 ) . For the Class II restorations , the AFR was 2.2 % and 1.6 % , respectively . CONCLUSION The 4-mm bulk-fill technique showed good clinical effectiveness during the 3-year follow-up Background Clinical studies are being conducted in less strict conditions in order to establish an adequate scientific basis for decision making . The aim of this pragmatic r and omized clinical trial is to evaluate the effectiveness of single and multiple-surfaces restorations performed following the Atraumatic Restorative Treatment ( ART ) premises compared with Conventional Treatment ( CT ) using bulk fill composite restorations in primary and permanent teeth . Methods / design A total of 1,214 5-to-13 year-old children with at least one single or multiple-surface dentin caries lesion in primary or permanent molars will be selected in public schools of Barueri-SP , Brazil . The participants will be r and omly assigned into 2 groups : CT ( caries removal with bur and restoration performed with Scotchbond ™ Universal Adhesive system associated with Filtek Bulk Fill – 3 M/ESPE ) and ART ( Caries removal with h and instruments and restoration with high viscosity glass ionomer cement Ketac Molar Easy Mix – 3 M/ESPE ) . Ten untrained dentists will perform the treatment in in dental offices located at public schools . The restorations will be evaluated after 6 , 12 and 24 months by an independent trained and calibrated examiner . The restoration and tooth survival , the cost-effectiveness analysis between the two groups and the operators ’ preferences regarding the techniques will be also evaluated . Kaplan-Meier survival analysis and log-rank test will be applied for the restoration and tooth survival . All the average event rates in the two groups will be modelled and compared with a Cox proportional hazard shared frailty model since there is an operator-cluster effect . The significance level for all analyses will be 5 % . Discussion Our hypothesis is that despite similar expected effectiveness between ART using high viscosity GIC and conventional treatment using bulk fill composite resin when treating single or multiple-surface in posterior primary and permanent teeth , ART will present superior cost-effectiveness . The results of this trial will support decision-making by clinicians and policy makers . Trial registration NCT02568917 . Registered on May 10th 2015 PURPOSE This double blind , r and omized clinical trial compared the postoperative sensitivity of the placement technique ( incremental and bulk fill ) in posterior composite resin restorations bonded with two different adhesive strategies ( self-etch and etch- and -rinse ) . METHODS Posterior dental cavities of 72 participants ( n=236 ) , with a cavity depth of at least 3 mm , were r and omly divided into four groups . The restorations were bonded using either the etch- and -rinse Tetric N-Bond ( Ivoclar Vivadent ) or the self-etch Tetric N-Bond SE ( Ivoclar Vivadent ) . The composite resin Tetric N-Ceram Bulk Fill ( Ivoclar Vivadent ) was placed either incrementally or using the bulk-fill technique . Two experienced and calibrated examiners evaluated the restorations using World Dental Federation criteria after one week of clinical service . Spontaneous postoperative sensitivity was assessed using a 0 - 4 numerical rating scale and a 0 - 10 and 0 - 100 visual analog scale up to 48 h after the restorative procedure and after one week . RESULTS The risk ( p>0.49 ) and intensity of spontaneous postoperative sensitivity ( p>0.38 ) was not affected by the adhesive strategy or the filling technique . The overall risk of postoperative sensitivity was 20.3 % ( 95 % confidence interval 15.7 - 25.9 ) and typically occurred within 48 hours after the restorative procedure . CONCLUSIONS The overall risk of immediate postoperative sensitivity was 20.3 % and was not affected by either the adhesive strategy ( etch- and -rinse/self-etch ) or the filling technique ( incremental/ bulk ) OBJECTIVE The aim of this study was to evaluate the morphology of the resin-dentin interface formed in vivo with two posterior resin composite placement techniques ( incremental and bulk ) . METHOD AND MATERIAL S After approval from the patients , 12 Class II cavities with margins in enamel ( 2.5 x 2.5 x 4.5 mm ) were prepared in caries-free premolars scheduled to be extracted for orthodontic reasons ( n = 6 ) . The cavities were restored with Single Bond + Filtek P60 as a bulk condensable technique or Single Bond + Filtek Z250 as an oblique incremental technique . After 1 week , the teeth were extracted with minimal trauma to the restored area . After the teeth were sectioned , a polyvinyl siloxane impression was taken from the resin-dentin interface to control for artifacts created during preparation for scanning electron microscopy . The specimens were subsequently processed for and observed under a scanning electron microscope to assess gap formation . RESULTS The mean percentage of gap formation was 6.1 % for teeth restored with the incremental placement technique and 18.7 % for teeth restored with the bulk placement technique . The difference was statistically significant . CONCLUSION The incremental placement of posterior resin composites may still provide better seal than the new bulk condensable technique Aim : To evaluate the effect of application a new-generation bulk-fill flowable composite resin as an intermediate material between composite resin and dental substrates on micro-leakage in Class V composite restorations . Material s and Methods : A total of 144 Class V cavities were prepared in 72 human molars . Specimens were then r and omly distributed among three groups according to adhesive system applied ( Group 1 : Clearfil SE Bond ; Group 2 : Adper Easy One ; Group 3 : Adhesive 200 T ) , and each group was divided into three subgroups according to liner material used ( Group A : No liner-control group ; Group B : Aelite Flo LV , low viscosity microhybrid composite ; Group C : Smart dentin replacement ) . All cavities were restored using resin composite ( Aelite LS , low shrinkage posterior composite ) . Specimens were stained with 0.5 % basic fuchsin and evaluated dye penetration . Results : There was no significant difference in dye penetration was found between the control and the experimental groups . Conclusions : Micro-leakage is not affected by the application of either conventional or new-generation flowable composite resin as an intermediate material between composite resin and dental substrates OBJECTIVES To determine the marginal adaptation of bulk-fill composites in class II MO cavities . METHODS St and ardized class II MO cavities with bevelled enamel margins were prepared in 40 extracted human molars . The teeth were r and omly assigned to one of the five experimental groups ( n=8 ) . The teeth were restored with two horizontal increments of composite ( 4 mm and 2 mm thickness ) . The experimental groups were ( 1st/2nd increment ) : Gr . A - Venus Bulk-Fill/Venus Diamond ; Gr . B - Tetric EvoCeram BulkFill/Tetric EvoCeram ; Gr . C - Surefil SDR/Ceram-X ; Gr . D - SonicFill ; Gr . E - Ceram-X/Ceram-X ( control ) . After finishing procedures , impressions were made using a polyvinyl siloxane and epoxy resin replicas were obtained . Thermo-mechanical stressing was carried out 24h after the restorative procedure . All specimens were su bmi tted to 240,000 occlusal loading and simultaneous 600 thermal cycles in water at 5 ° C and 50 ° C . After loading , a new set of epoxy resin replicas was obtained . Scanning electron microscopy was carried out at 200 × magnification . Results for the marginal adaptation were expressed as percentages of continuity relative to the exposed interface and analyzed by ANOVA and Duncan post hoc test ( p<0.05 ) . RESULTS In enamel , no significant differences were detected before and after thermo-mechanical loading between groups . In dentine , the worst results were observed in Gr . A CONCLUSION By applying simple layering techniques , bulk-fill material s do not allow better marginal adaptation than a st and ard composite . CLINICAL SIGNIFICANCE A new class of resin-base composite ( bulk-fill ) was recently launched on the market . The bulk-fill composites exhibited adequate marginal adaptation and similar to the results of the st and ard composite 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 ( Spectrum , 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 Spectrum restorations had failed from bulk fracture and secondary caries , result ing 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 material s for any restoration parameter . Alfa ratings for both material s 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 ( + /- st and ard deviation ) was 28.9 ( + /- 32.9 ) micrometers for SureFil and 33.8 ( + /- 29.6 ) microm for Spectrum 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 Implication s. The two composites placed in this study have an increased risk of bulk fracture when placed in large intracoronal Class II molar preparations PURPOSE To investigate the effect of restoration technique and adhesive system on the post-operative sensitivity and marginal adaptation of Class I occlusal composite resin restorations placed in vivo . MATERIAL S AND METHODS 48 Class I cavities were restored in vivo according to one of three protocol s : ( 1 ) Scotchbond Multi- Purpose /P50 placed in increments ; ( 2 ) Scotchbond Multi- Purpose /P50 placed in bulk , and ( 3 ) Clearfil Liner Bond 2/Clearfil Ray Posterior placed in bulk . Post-operative sensitivity and sensitivity on loading were recorded 5 - 7 weeks after placement of the restorations ; the teeth were cautiously extracted , immersed in a dye solution and sectioned . SEM observations were made from epoxy resin replicas . Microleakage and gap formation was assessed . RESULTS No differences among adhesive systems or restoration procedures were found for microleakage . Post-operative sensitivity was reported in 14 % of all teeth but was absent in the Clearfil Liner Bond 2 group . Sensitivity on loading was experienced by patients in 56 % of the restorations . Group 1 : nine teeth ; Group 2 : 15 teeth ; Group 3 : three teeth . Differences were statistically significant for all three groups . The SEM analysis showed that restorations placed in two layers showed less gaps than restorations placed in bulk 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 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 aim of this research was to analyse the long-term clinical behaviour of two dental material s applied as filling under  silver amalgam restorations  : glass-ionomer cement ( GIC ) and composite resin with adhesive system ( CR ) . In this study , 117 posterior teeth ( 29 premolars and 88 molars ) were selected with carious lesions which result ed in great loss of dentin and cusps with unsupported enamel . After caries removal , cavities were prepared and totally filled with GIC or with CR . In a following visit , new cavities were prepared , leaving the employed filling material as a base and support for the enamel , which were then restored with silver amalgam . Restorations were evaluated periodically after 6 months and up to 5 years . Both fracture and pulpal involvement rates were low . Although differences could be observed in the behaviour of the material s , statistical survival estimation showed that the performances of GIC and CR as filling material were similar . There was a significant association both between kind of tooth ( molar or premolar ) and long-term survival of the restorations ; and between degree of unsupported enamel and the same long-term survival . Our results confirmed that the technique in which GIC or CR are used as filling under  silver amalgam restorations is clinical ly acceptable A  posterior composite resin restorative material  was evaluated over a 3-year period by means of a controlled clinical trial . A total of 52 composite resin restorations and 52 amalgam alloy restorations were included in this trial , and were examined with regard to marginal integrity , surface texture , anatomical form and proximal contact with adjacent teeth . There were no significant differences in clinical performance between test and control material s , which both gave good service over the period of evaluation . Only five restorations ( one of amalgam and four of composite resin )  failed during the trial . Plastic replica dies were used to support the clinical examinations of the restorations , and such dies were found to be helpful This study evaluated the performance of a low-shrinking resin composite compared with an amalgam for restoration of Class I and II cavities of moderate size in posterior teeth in a general practice setting . Fifty-two pairs of test and control restorations were placed in 49 patients . Clinical evaluations and assessment s of replica models were carried out at baseline , six months and one year . Patients recorded their level of satisfaction with the restorations by means of  visual analog scales . Apart from one control restoration that failed due to a fractured cusp , all of the restorations review ed at six months and one year were intact with no unacceptable scores for any of the evaluation criteria . It was concluded that the resin composite evaluated , when used in conjunction with the recommended adhesive system , may be an appropriate alternative to amalgam in the restoration of posterior teeth over one year in clinical service Introduction Despite the widespread acceptance of conventional treatment using composite resin in primary teeth , there is limited evidence that this approach is the best option in paediatric clinics .  Atraumatic restorative treatment ( ART ) using high-viscosity glass ionomer cement has gradually become more popular because it performs well in clinical studies , is easy to h and le and is patient friendly . Therefore , the aim of this r and omised clinical trial study is to compare the restoration longevity of conventional treatment using composite resin with that of ART in posterior primary teeth . As secondary outcomes , cost-efficacy and patient self-reported discomfort will also be tested . Methods and analysis Children aged 3–6 years presenting with at least one occlusal and /or occlusal-proximal cavity will be r and omly assigned to one of two groups according to the dental treatment : ART ( experimental group ) or composite resin restoration ( control group ) . The dental treatment will be performed at a dental care trailer located in an educational complex in Barueri/SP , Brazil . The unit of r and omisation will be the child . A sample size of 240 teeth with occlusal cavities and 188 teeth with occlusal-proximal cavities has been calculated . The primary outcome will be restoration longevity , which will be clinical ly assessed after 6 , 12 , 18 and 24 months by two examiners . The duration of the dental treatment and the cost of all material s used will be considered when estimating the cost-efficacy of each treatment . Individual discomfort will be measured after each dental procedure using the Facial Scale of Wong-Baker . Ethics and dissemination This clinical trial was approved by the local ethics committee from the Faculty of Dentistry of the University of São Paulo ( registration no. 1.556.018 ) . Participants will be included after their legal guardians have signed an informed consent form containing detailed information about the research . Trial registration number www . clinical trials.gov , NCT02562456 ; Pre- results OBJECTIVE This clinical trial aim ed at study ing the long-term performance in routine clinical practice of  saucer-shaped Class II resin composite restorations .  METHOD AND MATERIAL S Fifty-one preparations were completed and filled with either of two light-cured posterior composites by seven dentists of the Public Dental Service . The restorations were evaluated annually , using the US Public Health Service criteria , bitewing radiographs , and dies based on replica impressions . At the final evaluation , the recall rate was 100 % . RESULTS After a mean of 7.2 + /- 1.3 years of service ( censored maximum of 9.6 years ) , 70 % of the restorations were acceptable for continued use . Caries and technical deficiencies were the main causes of failure . CONCLUSION The saucer configuration , by respecting and utilizing inherent properties of the resin composites , spares sound dentin and is preferable to the box preparation STATEMENT OF PROBLEM Composite resins are still outperformed by amalgams in the clinical practice with secondary caries and fractures being their most common failures . A material that suffers less polymerization shrinkage might improve the clinical performance of composite resins . PURPOSE To evaluate the clinical performance of a low-shrink silorane-based composite resin ( Filtek LS Low Shrink Posterior Restorative , 3 M ESPE , St. Paul , MN , USA ) in comparison with a methacrylate-based composite resin ( Tetric EvoCeram , Ivoclar Vivadent , Schaan , Principality of Liechtenstein ) over time . MATERIAL S AND METHODS C and i date s in need of Class II composite resin restorations participated in this r and omized controlled clinical trial . Those were 25 female and six male subjects with average age of 44.3 ± 12.7 years . Participants received 82 restorations , being 54 in premolars and 28 in molars . Procedures , which included the restoration of primary caries lesions or replacement of failing restorations , were done using modified preparations with no bevels or additional retention . Restorations were placed using Filtek LS ( and dedicated self-etch adhesive ) or Tetric EvoCeram ( with AdheSE , Ivoclar Vivadent ) , following manufacturers ' instructions . Incremental placement technique was applied and the restorations were immediately finished . Follow-up evaluations occurred at six , 12 , 24 , and 36 months and were done using the Fédération Dentaire Internationale criteria . Statistical analysis was performed using generalized estimating equations . RESULTS The recall rate at 36 months was 89 % . All interaction terms were not significant . CONCLUSIONS Filtek LS performs as well  as Tetric EvoCeram performs in the clinical setting at 36 months . CLINICAL SIGNIFICANCE The silorane-based composite resin Filtek LS and the conventional methacrylate-based composite resin Tetric EvoCeram performed similarly well in posterior restorations over at least 36 months of clinical service PURPOSE To evaluate and compare the 2-year clinical performance of an ormocer , a nanohybrid , and a nanofill resin composite with that of a microhybrid composite in restorations of small occlusal cavities made in posterior teeth . MATERIAL S AND METHODS Thirty-five patients , each with 4 occlusal restorations under occlusion , were enrolled in this study . A total of 140 restorations  was placed , 25 % for each material : an ormocer-based composite , Admira ; a nanohybrid resin composite , Tetric EvoCeram ; a nanofill resin composite , Filtek Supreme ; and a microhybrid resin composite , Tetric Ceram . Two operators placed all restorations according to the manufacturers ' instructions . One week after placement , the restorations were finished/polished and patients were advised to return for follow-up at 6 months , 1 year , and 2 years . All patients attended the 2-year visit where the clinical performance of all restorations was evaluated . Two independent examiners made all evaluations according to the USPHS modified Ryge criteria immediately after placement of restorations and at subsequent recall visits . The changes in the USPHS parameters during the 2-year period were analyzed with the Friedman test . Comparison of the baseline scores with those at the recall visits was made using the Wilcoxon signed rank test . The level of significance was set at p < 0.05 . RESULTS All material s showed only minor changes , and no differences were detected between their performance at baseline and after 2 years . Only one  ormocer and one  microhybrid composite restoration had failed after 2 years . No failure was detected in nanohybrid and nanofill composite restorations . Regarding the clinical performance , there were no statistically significant differences among the material s used ( p > 0.05 ) . CONCLUSION After 2 years , the ormocer , nanohybrid , and nanofill composites showed acceptable clinical performance similar to that of the microhybrid resin composite OBJECTIVE This r and omized controlled clinical trial compared two techniques and material s for restoring carious teeth-Bulk  dentine replacement versus incremental placement of a hybrid posterior resin composite material in terms of patient comfort ( post operative sensitivity and tenderness on biting ) . MATERIAL AND METHODS Seventy-two carious teeth were r and omized to one of two treatment groups : Group A-were restored with a bulk dentine replacement material or Group B-restored with incrementally placed hybrid composite . Patients were followed up by way of a structured phone call at day 2 and day 7 post-operatively . Patients reporting discomfort at day 7 were subsequently followed up on days 14 , and 30 . RESULTS All patients were followed up . At day 2 , 18/72 restored teeth had post-operative sensitivity ; this figure fell to 10/72 at day 7 . A Chi squared test revealed that at day 2 a greater level of sensitivity was reported by patients in Group A ( P=0.029 ) . However , at day 7 there was no statistically significant difference between the two groups in terms of sensitivity ( P=0.453 ) . 8/72 and 6 /72 teeth had tenderness to biting at days 2 and 7 respectively . A Chi squared test revealed no statistically significant difference between the two groups in terms of tenderness on biting at any time period ( P=0.722 ) . Interestingly , Class I cavities were found to be more tender on biting than Class II cavities . At day 30 2/72 teeth exhibited sensitivity and none of the teeth exhibiting tenderness on biting . CONCLUSION At day 7 there was no significant difference between the two groups in terms of postoperative sensitivity and tenderness on biting AIM To test the hypothesis that dentine and pulp protection by conditioning- and -sealing is no less effective than using a conventional calcium hydroxide lining . METHODOLOGY A cohort of healthy adults requiring a new or replacement restoration in a posterior tooth was recruited in six general practice s. All procedures received local Ethics Committee approval . Exclusion criteria included signs and symptoms of pulp necrosis or inflammation , and patients unable to commit to a long-term trial . Cavity preparations were r and omized to receive a calcium hydroxide lining or conditioning- and -sealing with a smear-removing bonding system . Choice of bulk restorative material ( composite resin or amalgam ) was at the discretion of the dentist . The key outcome measure was evidence of pulpal breakdown identified at unscheduled ( emergency ) or scheduled recall examinations . Postoperative sensitivity was recorded on 100 mm VAS at 24 h , 4 days and 7 days . Pulp status was assessed at 6 , 12 , 24 and 36 month recall , and at any emergency recall appointment . The relationship between pre-treatment and treatment variables and pulp breakdown was assessed by logistic regression ( P = 0.05 ) . RESULTS A total of 602 teeth were recruited , with comparable numbers of cavities lined ( 288 , 47.8 % ) or conditioned and sealed ( 314 , 52.2 % ) . The majority ( 492 , 81.7 % ) were replacement restorations , and amalgam was the most common bulk restorative material ( 377 , 62.6 % ) . A total of 390 ( 64.8 % ) restored teeth were review ed at 6 months , 307 ( 51 % ) at 12 months , 363 ( 60.3 % ) at 24 months , and 279 ( 46.3 % ) at 36 months post-restoration . Sixteen cases of pulp breakdown were identified within 36 months of restoration placement , 11 presenting as emergencies and five detected at routine recall examination . Logistic regression showed that preoperative pain , cavity treatment by lining or conditioning- and -sealing and the use of rubber dam isolation had no association with pulp breakdown . Pulp breakdown was associated with deep or pulpally exposed cavities ( P < 0.001 , odds ratio 7.8 ) and with composite rather than amalgam restorations ( P = 0.001 , odds ratio 2.13 ) . Re-coding to identify teeth with pulp exposures revealed that pulpal exposure was the key determinant of adverse pulp outcomes ( P < 0.0001 , odds ratio 28.4 ) and that composite resin restorations were again more likely to be associated with pulp breakdown than amalgam ( P = 0.017 , odds ratio 3.92 ) . CONCLUSIONS Considered within the context of routine primary dental care : Dentists can be confident that pulps will be equally well protected from post-restorative breakdown up to 36 months by calcium hydroxide lining and conditioning- and -sealing with adhesive resins .  Residual dentine thickness appears to be a key determinant of pulp responses after restorative dental treatment . In deep and pulpally exposed cavities in posterior teeth , composites were associated with more pulpal breakdown than amalgams
Conclusions The present systematic review and meta- analysis indicate similar clinical performances of bulk-fill and conventional resin composites over a follow-up period of 12 to 72 months .
Clinical significance Based on the results of this study , the bulk-fill resin composites could be an alternative for direct restorations in posterior teeth .
Objectives The purpose of this systematic review was to compare the clinical performance of bulk-fill resin composites with conventional resin composites used for direct restorations of posterior teeth .
The research question was “ Do bulk-fill resin composites have a clinical performance comparable to conventional resin composites in posterior restorations ? ”