1 / 119

Update in direct restoratives

Update in direct restoratives. Caries incidence globally. Dental caries is still a major public health problem to most countries of the world Petersen, Baez, Kwan & Ogawa 2009 Future Use of Materials for Dental Restoration

neola
Download Presentation

Update in direct restoratives

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Update in direct restoratives

  2. Caries incidence globally • Dental caries is still a major public health problem to most countries of the world Petersen, Baez, Kwan & Ogawa 2009 Future Use of Materials for Dental Restoration Report of the meeting convened at WHO HQ, Geneva, Switzerland.

  3. “ Dentists spend approximately 70% of their time replacing restorations ” Minimal intervention dentistry: a review. FDI Commission Project. Tyas et al 2000

  4. DENTAL AMALGAM • bonded vs non bonded AR • longevity of AR • cavity size • operator experience • comparison with PCR • issue of mercury toxicity

  5. Bonded vs nonbonded AR • Longevity bonded AR > nonbonded AR ?

  6. Adhesively bonded versus non-bonded amalgam restorations for dental caries • randomized clinical trials • split mouth or paired tooth • Class I, II, or V restorations • with any adhesive • minimum follow up of 2 years Fedorowicz et al, Cochrane Database Syst Rev 2009 ; CD007517

  7. Adhesively bonded versus non-bonded amalgam restorations for dental caries • “ …no evidence to show a difference in amalgam restoration survival on the basis of whether the restoration was adhesively bonded or not.” Fedorowicz et al, Cochrane Database Syst Rev 2009 ; CD007517

  8. How long do direct restorations placed within the general dental services in England and Wales survive ? • 80 000 subjects, 503 965 restorations • 11-year duration • AR mainly for posterior load bearing CR for Class III and IV GIC for Class V Burke & Lucarotti 2009, 206:E2, discussion 26-7

  9. How long do direct restorations placed within the general dental services in England and Wales survive ? • small AR showed the best 10-year survival rates ( 58%) • large MOD AR showed poorer 10-year survival rates ( 43% ) • pin placement associated with reduced survival time • CR including incisal angle – reduced survival by 2 years • GIC – 10-yr survival rate of 38% Burke & Lucarotti 2009, 206:E2, discussion 26-7

  10. Longevity of restorations • AR – 16 years irregardless of restoration classification • CR – 6 years with Class 2 showing lowest longevity • High caries risk – reduced CR longevity compared to low or moderate caries Sunnegardh-Gronberg et al 2009

  11. Longevity of restorations • Operator experience dentists with 15 or more years of experience provided restorations with > longevity for both AR and CR Sunnegardh-Gronberg et al 2009

  12. 1997 Consensus Statement on Dental Amalgam • ‘ No controlled studies have been published demonstrating systemic adverse effects from amalgam restorations ” • ‘ .... the small amount of mercury released from amalgam restorations, especially during placement and removal, has not been shown to cause any …adverse health effects. ’ FDI World Dental Federation & WHO

  13. 1998 • Major review of the literature • “ based on available scientific information, amalgam continues to be a safe and effective restorative material “ • “ there currently appears to be no justification for discontinuing the use of dental amalgam ” ADA’s Council on Scientific Affairs

  14. 2004 • Expert panel reviewed literature from 1996 – 2003 • “ the current data are insufficient to support an association between mercury release from dental amalgam and various complaints that have been attributed to this restorative material. ”

  15. 2006 • 2 independent clinical trials • “ there were no statistically significant differences in adverse neuropsychological or renal effects observed over the 5-year period in children whose caries are restored using dental amalgam or composite materials …………….

  16. 2006 • ………. “ children ………..did not, on average, have statistically significant differences in neurobehavioral assessments in nerve conduction velocity when compared with children who received resin composite materials or amalgam ”

  17. 2006 • “ ……….amalgam should remain a viable dental restorative option for children ” Journal of the American Medical Association Environmental Health Perspectives

  18. Environmental concerns “ If environmental contamination by mercury containing waste from dental practices is not cut down to very low levels, then it is likely to be the main reason for government action against the use of amalgam in the future ” Eley 1997

  19. 2008 • “ …dental amalgams are effective and safe, both for patients and dental personnel and also noted that alternative materials are not without clinical limitations and toxicological hazards ” Scientific Committee of the European Commission

  20. 2009 • Literature review from 2004 – 2009 • “ the scientific evidence supports the position that amalgam is a valuable, viable and safe choice for dental patients ” ADA Council on Scientific Affairs

  21. 2009 • classified encapsulated dental amalgam as a class II medical device • “ …..the material is a safe and effective restorative option for patients ” FDA, US

  22. 2009 “ …dental amalgam remains a dental restorative material of choice, in the absence of an ideal alternative and lack of evidence of alternatives as a better practice. If dental amalgam were to be banned, a better and more long-lasting replacement would be needed than the materials available to date ….”

  23. 2009 “ …. while the harmful effects of mercury on health and the environment are recognized, the possible adverse effects of alternative materials require further research and monitoring. Providing the best care possible to meet patients’ needs should be of paramount importance. ”

  24. 2009 “… complete ban may not be realistic, practical and achievable. It may be prudent to consider ‘phasing down’ instead of ‘phasing out’ of dental amalgam at this stage ” Future use of materials for dental restoration Report of the meeting convened at WHO HQ, Geneva, Switzerland. 2009

  25. Ethical issues • correlate amalgams to adverse health symptoms/disease • removal of amalgams to provide placebo effect • removal of amalgams at patient’s request • amalgam - free practice

  26. Minimata Convention on Mercury Treaty • ........treaty to rein in the use and emission of health-hazardous mercury • amid pressure from dentist groups, the treaty also did not provide a cut-off date for the use of dental fillings using mercury amalgam, but did agree that the product should be phased down. UN Environmental Program ( UNEP) Geneva , 19th Jan 2013

  27. The World Alliance for Mercury-Free Dentistry called for phasing out dental amalgam by 2025 and by 2018 for baby teeth.

  28. “ majority of patients prefer a tooth – coloured material ( composite ), even when informed that the clinical longevity will be shorter than that of amalgam ” Espelid et al 2006

  29. DIRECT TOOTH COLOURED RESTORATIVE MATERIALS

  30. classical classical Glass Ionomer Cements Composite Resins GI – RESIN HYBRIDS RMGIC PM COMP RESIN

  31. GIC Resin Modified GIC Antonucci et al 1988, Mitra 1988 GIC + monomers + photoinitiators

  32. Issues - RMGIC • retention • margins • wear, loss of anatomic form • colour change • fluoride leaching

  33. RMGIC • Clinical evaluations of resin-modified glass-ionomer cements Sidhu, Dent Mater, 2010 , 26 (1) : 7-12 • Clinical performance of cervical restorations—A meta-analysis Heintze et al, Dent Mater, 2010, 26 ( ) : 993-1000

  34. Retention • retention rate range from 87.5% - 100% • 2-step SE > 3-step E & R > GIC > RMGIC > 2-step E & R > PMCR > 1-step SE

  35. anatomic form and wear • occurs in the mid- to long term

  36. secondary caries • No secondary caries was found in carious and non carious cavities for up to 5 years. Neo et al 1996 Abdalla et al 1997 van Dijken et al 1999 Folwaczmy et al 2001 Loguercio et al 2003

  37. Caries preventive effect of GIC and RMGIC • 4 out of 220 studies • RMGIC restorations remain as free of recurrent caries as did conventional GIC restorations Mickenautsch et al. Absence of carious lesions at margins of GIC and resin-modified GIC restorations. A systematic review . Eur J Prosthodont Rest Dent 2010:18:139-145

  38. colour stability initial colour may be acceptable but changes over time

  39. classical classical Glass Ionomer Cements Composite Resins GI – RESIN HYBRIDS RMGIC PM COMP RESIN

  40. Composite Resins Developments of CR • materials • bonding systems • light systems

  41. Material what’s new ?? • monomer /matrix • filler

  42. Monomers • traditionally bis-GMA ( Bowen 1960 ) + TEGDMA • UDMA ( Foster and Walker 1974 ) and modified UDMA

  43. NEW - monomers • reduce polymerization shrinkage/stress • SiloranesWeinmann et al 2005 • modified UDMA – increased molecular weight egKalore ( GC ), Venus ( Kulzer) N’Durance ( Septodent) • Ormocerseg Definite ( Degussa )Wolter et al 1994

  44. Microhybrid and nanohybrid CR • improved strength, handling & polishability Ritter 2005 Watanabe et al 2008 • reduced wear Yap et al 2004 Yesil et al 2008

  45. NEW – modify fillers Add • polymer nonofibers, glass fibres, fused silica fibres and titaniananoparticles • dicalcium/tetracalcium phosphate nanoparticles • antibacterial and remineralising agents eg fluoride, chlorhexidine, zinc oxide or quaternary ammmoniumpolyethyleneiminenanoparticles, MDPM monomer

  46. NEW • Nanocomposites • incorporate calcium fluoride nanoparticles into dental resins • high levels of calcium phosphate and fluoride release achievable at low filler particle levels due to high surface areas of nanoparticles • addition of nanoparticles do not affect mechanical properties of resin Xu et al 2010

  47. Bulk fill CR • high depth of cure (4-5 mm) • reduce incremental placement • less porosities • less time • use below the restoration (flowable) or as a restorative (sculptable) material

  48. Bulk Fill CR • Flowables • Surefil SDR Flow Dentsply • X-tra Base Voco • Venus Bulk Fill Heraeus Kulzer • FiltekBulk Fill 3M ESPE • Sculptables • Tetric N-Ceram Bulk Fill Ivoclar/Vivadent • X-tra Fil Voco • QuiXfil Dentsply • SonicFill Kerr

  49. How did we achieve the reduction in polymerization stress? ANSWER: • The kinetics of the radical polymerization is regulated • As the modulus development is slower less polymerization stress builds up. • Call it a chemical soft start polymerization if you like.

  50. Any (!) cap composite* SDR™ SDR™ Filling Technique Perfect Compatibility with metharylate-based bonding and capping composites * EsthetX HD, CeramX, Spectrum TPH 3, Filtek Supreme, Tetric EvoCeram, Artemis, Z100, Point4, Venus, Enamel HFO, Herculite, Premise, etc ... but not Filtek Silorane

More Related