Clinical Significance
When direct resin composites are used to replace amalgam restorations that have left staining on the dentin, concern
Hands OnAmalgam staining and composite adhesion
Section snippets
Background
As advances have been made in filler and polymer technologies and in adhesive resin materials for enamel and dentin, composites have become more predictable materials for use even in load-bearing situations. They are the preferred material for small restorations, large restorations, and stress-bearing direct posterior restorations in many cases. Should old amalgam fillings need to be replaced, often composite restorations can be used even for extensive cavity situations. However, the dentin
Methods
The 88 patients (mean age 51.6 years) required 118 extensive cusp-replacing DRCs in posterior teeth. These replaced existing amalgam restorations that had left stains on the underlying dentin from amalgam-related ion products (Fig 1). A three-step total-etch adhesive technology was used, with a hybrid composite chosen for the restoration. The restorations were evaluated at baseline and every 6 months thereafter, noting visible loss of anatomic contour, marginal discoloration, secondary caries,
Results
Observation lasted a minimum of 7 months and a maximum of 96 months, with a mean of 40.3 months. Mean treatment time was about 45 minutes. Four failures occurred, all in molar teeth. One resulted from fracture of the cusp, two from endodontic complications, and one from inadequate proximal contact. The cusp fracture failure required replacement of the restoration; endodontic therapy managed the two endodontic complications, with the endodontic access opening closed using composite; and a minor
Discussion
None of the failures were related to adhesion to dentin, so the amalgam ion staining appeared to have no effect on direct restoration adhesion. Three patients were treated using a rubber dam, but for extensive restorations it can be difficult to place the rubber dam and rubber dam clamp. Use of the rubber dam was not detrimental to the survival of the DRCs.
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Scholtanus JD, Özcan M: Clinical longevity of extensive direct composite restorations in amalgam replacement: Up to 3.5 years follow-up. J Dent 42:1404-1410, 2014
Reprints available from JD Scholtanus, Dept of Periodontology, Conservative Dentistry and Oral Hygiene, Ctr for Dentistry and Oral Hygiene, Univ Medical Ctr Groningen, The Univ of Groningen, Antonius Deusinglaan 1, 9713 AV, Groningen, The Netherlands; fax: +31 50 3632696; e-mail: [email protected]
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