title: The design and analysis of split-mouth studies: what statisticians and clinicians should know. Evaluation of packable and conventional hybrid resin composites in Class I restorations: three-year results of a randomized, double-blind and controlled clinical trial. Effect of acid etching time and technique on interfacial characteristics of the adhesive-dentin bond using differential staining. Performance of occlusin in butt-joint and bevel-edged preparations: five-year results. 4. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials Three-year clinical evaluation of a self-cured posterior composite resin. Clinical evaluation of packable composite resins in Class-II restorations Total-etch versus self-etch adhesive: effect on postoperative sensitivity. Clinical evaluation of the posterior composite Quixfil in class I and II cavities: 4-year follow-up of a randomized controlled trial. Composite resin restoration and postoperative sensitivity: clinical follow-up in an undergraduate program. Clinical evaluation of two "packable" posterior composite resins Clinical evaluation of two "packable" posterior composite resins: two-year results A prospective, randomized clinical trial of a two-step self-etching vs two-step etch-and-rinse adhesive and SEM margin analysis: four-year results. Evaluation of resin composite materials. Part II: in vivo investigations. Survival rates and reasons for failure of posterior composite restorations in multicentre clinical trial. Clinical performance of the posterior composite QuiXfil after 3, 6, and 18 months in Class 1 and 2 cavities. Class I occlusal composite resin restorations: in vivo post-operative sensitivity, wall adaptation, and microleakage. Short- and long-term clinical evaluation of post-operative sensitivity of a new resin-based restorative material and self-etching primer. The effect of adhesive and flowable composite on postoperative sensitivity: 2-week results. Effect of glass-ionomer cement lining on postoperative sensitivity in occlusal cavities restored with resin composite--a randomized clinical trial. A prospective randomized clinical trial of one bis-GMA-based and two ormocer-based composite restorative systems in class II cavities: Five-year results. 2-year clinical evaluation of Class I posterior composites. Clinical performance of a self-etching and a total-etch adhesive system - 2-year results. Clinical evaluation of nanofill and nanohybrid composite in Class I restorations: a 12-month randomized trial. Experimental and clinical evaluation of a self-etching and an etch-and-rinse adhesive system. Clinical evaluation of Solitaire-2 restorations placed in United Kingdom general dental practices: 1-year report. Self-etching adhesives and postoperative sensitivity. Postoperative sensitivity: a comparison of two bonding agents. 30-Month randomised clinical trial to evaluate the clinical performance of a nanofill and a nanohybrid composite. Clinical evaluation of Clearfil photoposterior: 3-year results. Clinical evaluation of two posterior composite resins: two-year results. Four-year clinical evaluation of Class II nano-hybrid resin composite restorations bonded with a one-step self-etch and a two-step etch-and-rinse adhesive.
abstract: The split-mouth design is a popular design in oral health research . In the most common split-mouth study , each of two treatments are r and omly assigned to either the right or left halves of the dentition . The attractiveness of the design is that it removes a lot of inter-individual variability from the estimates of the treatment effect . However , already about 20 years ago the pitfalls of the design have been reported in the oral health literature . Yet , many clinicians are not aware of the potential problems with the split-mouth design . Further , it is our experience that most statisticians are not even aware of the existence of this design . Since most of the critical remarks appeared in the oral health literature , we argue that it is necessary to introduce the split-mouth design to a statistical audience , so that both clinicians and statisticians clearly underst and the advantages , limitations , statistical considerations , and implication s of its use in clinical trials and advise them on its use in practice The clinical performance of packable and conventional hybrid resin composites in Class I restorations for a period of three years was compared using a r and omized controlled double-blind clinical trial with self-matching design . A total of 50 pairs of Class I restorations were placed in 32 adult patients by one dentist in a self-matching prospect i ve clinical trial . The paired teeth were divided into the TPH Spectrum/XenoIII ( TS ) restoration group and the Synergy Compact/One Coat ( SC ) restoration group according to a r and om number table . Application of the material s followed the manufacturer 's instructions . The restorations were evaluated by two independent evaluators using US Public Health Service (USPHS)-Ryge modified criteria . Statistical analysis was performed using the McNemar 's test with Yates ' continuity correction . After three years , 40 pairs of restorations were available for evaluation . Four TS and two SC restorations failed due to fracture . Only one TS-restored tooth showed postoperative sensitivity at baseline and the symptom disappeared one week later . Alpha ratings of TS vs SC restorations were as follows : 95 % vs 98 % for color match , 85 % vs 88 % for marginal integrity , 88 % vs 90 % for anatomical form , 85 % vs 83 % for marginal discoloration , 88 % vs 93 % for occlusal contact . For both material s , Alpha ratings were 88 % for surface texture . The three-year clinical performances of the two restorative material s were satisfactory and not significantly different for each of the parameters evaluated Dentin bonding using the total-etch method has been cl aim ed to be technique-sensitive . The aim of this study is to examine the effect of acid-etch variations on the dentin demineralization and interfacial structure of the adhesive-dentin bond using a differential staining technique . Single Bond adhesive with 35 % phosphoric acid gel was used . The occlusal one-third of the crown was removed from 60 extracted , unerupted human third molars . Smear layers were created by abrading the dentin with 600 grit SiC under water for 30 s. The prepared teeth were r and omly assigned to four groups according to etching time ( Group 1 , 10 s ; Group 2 , 15 s ; Group 3 , 30 s ; Group 4 , 60 s ) . In each group , the etching gel was : ( i ) applied and spread to the dentin surface and left to st and undisturbed ; ( ii ) applied and gently agitated during etching ; ( iii ) applied without using dispensing tips for the syringe and left for the same period as above . After rinsing , the etched dentin was then treated with the adhesive per manufacturers ' instructions . 3 - 5 micro m thin sections of the adhesive/dentin ( a/d ) interface were cut with a microtome and stained with Goldner 's trichrome . Stained , thin sections from each prepared tooth were imaged with light microscopy . The depth and extent of dentin demineralization , and the a/d interdiffusion zone were clearly visible by this differential staining microtechnique . The thickness of the interdiffusion zone increased as a function of etching time . However , the etchant gel application methods have a significant influence on dentin demineralization . Although agitating acid gel facilitates the penetration and etching into dentin , it should not be recommended , especially for longer etching time . These results indicated that the etching technique has a large effect on the profile of both dentin demineralization and interfacial structure The five-year findings of a study to compare the performance of restorations of Occlusin ( ICI Dental , Macclesfield , UK ) in butt-joint and bevel-edged preparations are reported . Ninety-four ( 79 % ) of the restorations originally placed were review ed at five years , 20 restorations ( 17 % ) having failed during the study . Initial analysis of the overall results having failed to reveal any significant differences between the five-year performance of the two types of restorations , the results were combined and analyzed by Chi-square tests and step-wise logistic regression . Chi-square analysis indicated that of the independent variables investigated , size of restoration had the greatest effect on clinical performance . Step-wise logistic regression revealed that only four of the eight dependent variables investigated showed significant predictive relationships with the independent variables , the logistic equation for occlusal marginal adaptation being the most complex . The greatest amount of generalized occlusal surface wear tended to be seen in large-sized Class II restorations in molar teeth , with the main factor influencing wear being found to be the type of restoration ( Class I or Class II ) . It is concluded that the performance of  restorations of Occlusin  has not been found to differ significantly in butt-joint and bevel-edged preparations after five years in clinical service . Step-wise logistic regression has been found to be a useful tool in the analysis of data obtained during the clinical evaluation of a restorative material Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more 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 Abstract . This study investigated the clinical performance of two packable composite resins  in Class-II restorations . One hundred and four Class-II restorations were placed in 52 patients by five dentists ( four in dental practice s and one in a university clinic ) in a controlled prospect i ve multicentre clinical trial . Each patient received one Definite/Etch & Prime 3.0 ( D-EP ) and one Solitaire/Solid Bond ( S-SB ) restoration , which were examined clinical ly according to modified USPHS- criteria after 1 week ( baseline ) and after 1 year . Statistical analysis was performed using the Wilcoxon rank sum test and the error rates method . The significance level was set to 0.05 . At baseline both material s performed equally according to the evaluated criteria . After 1 year D-EP showed significantly worse marginal adaptation compared to S-SB . Both material s displayed significant deterioration for the criteria marginal adaptation , marginal discolouration , approximal contact , and fracture of restoration after 1 year compared to baseline . With a failure rate of 9.6 % after 1 year , D-EP did not fulfill ADA acceptance criteria for restorative material s. It is proposed that at least 1-year data of clinical testing should be available before a new material is broadly marketed BACKGROUND Self-etching adhesives are believed to prevent postoperative sensitivity when used under posterior resin-based composite restorations . The authors tested a twofold hypothesis : a self-etch , or SE , adhesive would result in less postoperative sensitivity than a total-etch , or TE , adhesive ; an SE adhesive would result in poorer enamel marginal integrity than a TE adhesive . METHODS Patients were selected on the basis of requiring Class I and II restorations in molars and premolars . The authors placed 30 restorations with the SE material ( Clearfil SE Bond , Kuraray America , New York ) and 36 restorations with Prime & Bond NT ( Dentsply Caulk , Milford , Del. ) , which uses 34 percent phosphoric acid to etch enamel and dentin simultaneously . Preparations were of st and ard design , with all margins in enamel without beveling . Upon rubber dam isolation , the authors conditioned the enamel and dentin walls with the self-etching primer ( for Clearfil SE Bond ) or etched with the proprietary 34 percent phosphoric acid ( for Prime & Bond NT ) , followed by application of the corresponding dentin adhesive . Teeth were restored with the proprietary hybrid resin-based composite indicated for posterior restorations : Clearfil AP-X for Clearfil SE Bond or Esthet-X Micro Matrix Restorative for Prime & Bond NT . The restored teeth were evaluated preoperatively and at two weeks , eight weeks and six months postoperatively for sensitivity to cold ( ice ) , air and masticatory forces , as well as for marginal discoloration . RESULTS Analysis of variance revealed no statistically significant differences in postoperative sensitivity between the SE and TE material s at any recall time . Marginal discoloration was rated as " absent " for all restorations at six months . Only one tooth displayed sensitivity to occlusal forces at six months . CONCLUSION The SE adhesive did not differ from the TE adhesive in regard to sensitivity and marginal discoloration . CLINICAL IMPLICATION S Postoperative sensitivity may depend on the restorative technique rather than on the type of dentin adhesive used PURPOSE This longitudinal r and omized controlled clinical trial evaluated direct composite restorations for clinical acceptability as posterior restoratives in single- or multi-surface cavities and provides a survey of the 4-year results . MATERIAL S AND METHODS Three dentists placed 46 Quixfil ( Xeno III ) and 50 Tetric Ceram ( Syntac Classic ) composite restorations in stress-bearing Class I and II cavities in first or second molars ( 43 adult patients ) . Clinical evaluation was performed at baseline and after 4 years by 2 other dentists using modified USPHS criteria . At the last recall period , 37 Quixfil and 46 Tetric Ceram restorations  were assessed . RESULTS A total of 89.2 % of Quixfil and 97.8 % of Tetric Ceram posterior composites were assessed to be clinical ly excellent or acceptable with predominating alfa scores . Up to the 4-year recall , four Quixfil restorations failed because of bulk fracture , partial tooth fracture ( 2x ) and postoperative symptoms . One Tetric Ceram restoration was lost due to problems with tooth integrity . No significant differences between the two composites could be detected at 4 years for any of the evaluated clinical criteria ( p > 0.05 ) . The comparison of restoration performance with time within both groups yielded a significant increase in marginal discoloration and decrease in marginal integrity for both material s. After 4 years , small restorations exhibited significantly less marginal discoloration than large restorations . CONCLUSION Clinical assessment of stress-bearing Quixfil and Tetric Ceram posterior composite restorations showed good clinical results with predominantly alfa scores for both material OBJECTIVES To analyze the relationship between the cavity depth and liners with postoperative sensitivity of  resin composite restorations .  METHODS A clinical follow-up was conducted on 319 resin composite restorations made in the final year of an undergraduate program over a 3-year period . Along with the analyses of cavity type , cavity depth , type of pulpal protection and the material s used , the postoperative sensitivity was also examined on each restoration . RESULTS Thirty-nine percent of the restorations had no protective layer ( Group 1 ) . As the depth of the prepared cavities increased , the restorations received one of the three pulpal protection methods ; a calcium hydroxide base ( Group 2 ) , glass ionomer cement ( Group 3 ) , or protection with a calcium hydroxide base in combination with glass ionomer cement ( Group 4 ) . The incidence of postoperative sensitivity showed no significant difference among Groups 1 , 2 and 3 , but was significantly lower in Group 1 than in Group 4 . The restorations made in shallow and medium depth cavities demonstrated significantly less-postoperative sensitivity than those made in deep cavities . The newer generation dentine-bonding agents showed a significantly lower incidence of postoperative sensitivity than the early generation group . CONCLUSIONS Postoperative sensitivity in resin  composite restorations was not related to the absence of protective layers but increased with the depth of cavities restored with the resin composite . The type of dentine-bonding agents could also be responsible for postoperative sensitivity Abstract .The purpose of this study was to evaluate the clinical performance of two " packable " posterior composites : Prodigy Condensable ( P ) ( Kerr ) and Definite ( D ) ( Degussa ) .  Thirty-six patients participated in the study . A total of 78 restorations were made , 40 with D and 38 with  P.  Each patient received at least two restorations  , one of each studied material . The material s were h and led according to the manufacturer 's instructions . The restorations were finished and polished after 1 week . They were evaluated at baseline and after 1 year by two independent evaluators using the United States Public Health Service ( USPHS ) criteria . Colored slides were made of all the restorations . After 1 year , 35 patients and 76 restorations ( 39 with D and 37 with P ) were available for evaluation . All restorations received A criteria except the following ones , which received B criteria : color P ( one restoration ) and D ( one restoration ) , marginal staining P ( three restorations ) and D ( two restorations ) , surface staining P ( nine restorations ) and D ( three restorations ) , anatomic form P ( one restoration ) and D ( three restorations ) , and marginal adaptation P ( one restoration ) and D ( eight restorations ) . The obtained data were tabulated and statistically analyzed using the Fisher and McNemar tests . After 1 year , P showed a significant increase in superficial staining . For D , the marginal adaptation became significantly worse than baseline and P. The studied material s can be considered acceptable during this evaluation period . Further evaluations are necessary for a better clinical performance analysis The purpose of this study was to evaluate the clinical performance of two " packable " posterior composites : Prodigy Condensable/Optibond Solo — Kerr ( PC-OS ) and Definite/Etch & Prime — Degussa ( D-EP ) .  Thirty-six patients participated in this study . A total of 78 restorations ( 40 with D-EP  and 38 with  PC-OS ) were made . Each patient received at least two restorations ( one of each studied material ) . The material s were h and led according to the manufacturer 's instructions . The occlusal adjustments were made at the placement visit . The restorations were finished and polished after 1 week . They were evaluated at baseline , and after 1 year and 2 years by two independent evaluators using the USPHS criteria . Colored slides were made of all the restorations . After 2 years , 34 patients and 74 restorations ( 38 with D-EP and 36 with PC-OS ) were available for evaluation . A total of 50 % of PC-OS restorations received A criterion and 50 % received B criterion ( 2.8 % color , 11.1 % marginal staining , 27.8 % superficial staining , 2.8 % anatomic form and 5.6 % marginal adaptation ) . For D-EP , 60.5 % of restorations received A criterion and 39.5 % received B criterion ( 2.6 % color , 5.3 % marginal staining , 10.5 % superficial staining , 7.9 % anatomic form and 13.2 % marginal adaptation ) . The C criterion was observed only for marginal adaptation with D-EP ( 2 restorations—5.3 % ) . The obtained data were tabulated and statistically analyzed using the Fisher , Chi-square and McNemar tests . After 2 years , PC-OS showed a significant increase in superficial and marginal staining . For D-EP the marginal adaptation and superficial staining became significantly worse than baseline PURPOSE The aim of this blinded , r and omized , prospect i ve long-term study was to evaluate the clinical performance of the two-step self-etching adhesive AdheSE ( AS , Ivoclar Vivadent ) compared to the etch- and -rinse adhesive system Excite ( EX , Ivoclar Vivadent ) in combination with the hybrid resin composite Tetric Ceram HB ( Ivoclar Vivadent ) for Class I and II restorations . MATERIAL S AND METHODS In accordance with a split mouth design , 50 patients received 100 restorations in premolars and molars . The restorations were assigned at r and om to the self-etching ( AS ) or the etch- and -rinse ( EX ) group . Each restoration was scored according to the modified Ryge criteria at baseline and after 6 , 12 , 24 and 48 months . Epoxy resin replicas of 60 restorations were made at each observation period for an additional SEM analysis of the occlusal margins . RESULTS After 4 years , 60 of 100 restorations could be evaluated . The cumulative survival rate for group EX was 100 % and for group AS 96.7 % . One restoration in group AS had failed due to marginal gap formation . For the criterion marginal adaption in group AS , significantly more bravo ratings ( 30 % ) were observed after 4 years compared to group EX ( 6.7 % ) ( p < 0.05 ; Mann-Whitney U-test ) . The results of the SEM margin analysis revealed no significant differences between groups AS and EX ( Mann-Whitney U-test ; p > 0.05 ) . CONCLUSION Both adhesive systems performed satisfactorily over the four-year observation period . A significant deterioration over time was found for the criterion marginal adaption in AdheSE PURPOSE To clinical ly evaluate two different resin-based composites ( Solitaire I and Ariston pHc )  in order to determine the minimum clinical evaluation time needed to detect critical signs of failure . METHODS In a controlled prospect i ve clinical study , 99 cavities ( 30 Class I , 69 Class II ) in 31 patients were restored ( 50 Ariston pHc without enamel etching and rubber dam , 49 Solitaire I restorations with total etching and rubber dam )  and clinical ly investigated at baseline , after 6 , 12 , and 24 months . RESULTS After 2 years of clinical service , 49 restorations ( Ariston pHc : n = 38 , Solitaire : n = 11 ) had to be replaced . The majority of failures occurred after more than 1.5 years . The reasons for replacement were differently distributed in both groups ( Ariston pHc : 28 tooth fractures , 3 gap formations , 5 hypersensitivities , 1 bulk fracture , 1 marginal fracture . Solitaire : 5 gap formations , 1 hypersensitivity , 3 bulk fractures , 1 wear of the restorative material , 1 void in the restoration ) . Forty-four restorations were still in function after 2 years ( overall failure rate after 2 years : 14 % ; Ariston pHc : 17 % ; Solitaire : 7 % ; survival analysis algorithm according to Kaplan/Meier ) . Comparing the material s , no statistical differences were evident except for the criteria " integrity tooth " (= tooth fracture or cracks ) and " hypersensitivity " ( from the 12-month recall ; Mann-Whitney U-test ; P < 0.05 ) . In both cases of significant difference , Ariston pHc exhibited inferior results . After 2 years , only three teeth restored with Ariston pHc did not show considerably cracked enamel . The additional marginal analysis showed statistically significant differences for both material s regarding the criteria " perfect margin " ( decrease ) , " gap formation " ( increase ) , and " negative step formation " ( increase ; P < 0.05 ; Friedman 2-way ANOVA ) between the four recalls . Therefore , a 2-year in vivo evaluation should be recommended prior to marketing a dental restorative material n a multicentre clinical trial consisting of 12 centres , 232 amalgam and 932 composite Class I and Class II restorations were placed in 447 adult patients . At the 4-year review 76 per cent of patients with 71 per cent of the restorations were retrieved . In 8 centres after 4 years and 4 centres after 5 years a total of 12 amalgam  and 92 Occlusin restorations  had been replaced , having been considered to have failed . The reasons for failure were classified into three types : Type 1 , related to the restoration ( loss of material , recurrent caries and unacceptable marginal adaptation ) ; Type 2 , related to the restorative process ( pulpal involvement , primary caries , tooth fracture and unacceptable contact ) and Type 3 , caused by external factors . A greater proportion of the restorations of Occlusin were replaced than the restorations of amalgam . For the restorations of Occlusin the reasons for failure were : Type 1 , 59 per cent ; Type 2 , 32 per cent and Type 3 , 9 per cent . Loss of material and recurrent caries accounted for the failure of 35 and 13 restorations of Occlusin respectively . The main Type 2 reasons for failure of the restorations of Occlusin were pulpal involvement ( 16 restorations ) and primary caries ( 9 restorations ) . The overall 4-year survival of Occlusin restorations relative to Type 1 and to Type 1 + Type 2 reasons for failure was 96 per cent and 93 per cent respectively . The centre was found to have a significant influence on the survival rate in both analyses OBJECTIVE This longitudinal r and omized controlled clinical trial evaluated direct composite restorations for clinical acceptability of posterior restoratives in single- or multisurface cavities and provided a preliminary survey of the 3- , 6- , and 18-month results . METHOD AND MATERIAL S Three clinicians placed 46 QuiXfil ( Xeno III ; Dentsply DeTrey ) and 50 Tetric Ceram ( Syntac Classic ; Vivadent ) composite restorations in stress-bearing Class 1 and 2 cavities in first or second molars ( 43 adult patients ) . Clinical evaluation was performed at baseline and after 3 , 6 , and 18 months by 2 other clinicians using modified US Public Health Service criteria . At the final recall period , 45 QuiXfil and 49 Tetric Ceram restorations were assessed . RESULTS A total of 97.8 % of QuiXfil and 100 % of Tetric Ceram posterior composites were assessed to be clinical ly excellent or acceptable with predominating Alpha scores . At the 18-month recall , 1 QuiXfil restoration had failed because of bulk fracture . No significant differences between either composite could be detected at 18 months for all evaluated clinical criteria ( P > .05 ) . Small QuiXfil restorations exhibited significantly less marginal discoloration ( P = .003 ) and better restoration integrity ( P = .008 ) than large restorations . The comparison of restoration performance with time within both groups yielded a significant increase in marginal discoloration for QuiXfil ( P = .011 ) and significant deterioration for anatomic form at the marginal step for Tetric Ceram ( P = .011 ) . However , both changes were only effects of scoring shifts from Alpha to Bravo . CONCLUSION Clinical assessment of stress-bearing QuiXfil and Tetric Ceram posterior composite restorations exhibited for both material s good clinical results with predominating Alpha scores 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 This study evaluated the post-operative sensitivity of posterior restorations restored with a resin-based restorative material and a self-etching primer .  Forty-six restorations , 28 Class I and 18 Class II were placed by two clinicians in 25 patients . After cavity preparations were completed under rubber dam isolation , they were restored using a self-etching primer ( Fluorobond , Shofu Inc , Kyoto , Japan ) and a resin-based restorative material ( Beautifil , Shofu Inc , Kyoto , Japan ) . Patients were contacted on days 2 and 7 post-operatively and question ed regarding the presence of sensitivity , the stimuli that created sensitivity , the length of time the sensitivity lasted and its intensity using a rating scale from slight to severe . If sensitivity was experienced on day 7 , patients were also contacted on days 14 , 30 and 90 to assess the degree of sensitivity . All patients were recalled after 6- , 12- and 24-months for further evaluation of any sensitivity experienced . Chi-Square and Fisher 's Exact Test were used for statistical analysis . At day 2 , six restorations were sensitive to cold with no statistical difference ( p > 0.05 ) from the restorations that were not sensitive . At day 7 , only two restorations were sensitive . No sensitivity was present after day 14 , which was also confirmed at the six-month recall . No correlation could be established among the duration of the sensitivity , the degree of pain and the causes that initiated sensitivity ( p > 0.05 ) . At one-year recall , one restoration was replaced due to post-operative sensitivity that started after the six-month recall . No sensitivity was noted at the 24-month recall . No correlation ( p > 0.05 ) was found between sensitive restorations and those with a normal response throughout the study . The study showed that Fluorobond self-etching primer and Beautifil resin-based restorative material , when placed in posterior restorations , do not result in long-term post-operative sensitivity OBJECTIVE To measure 2-week postoperative sensitivity in Class II composite restorations placed with a self-etching adhesive ( Clearfil SE Bond ) or a total-etch adhesive ( Prime&Bond NT ) with or without a flowable composite as cervical increment . METHOD AND MATERIAL S Upon approval by the University of Guarulhos Committee on Human Subjects , 100 restorations were inserted in 46 patients who required Class II restorations in their molars and premolars . Enamel and dentin walls were conditioned with a self-etching primer ( for Clearfil SE Bond ) or etched with 34 % phosphoric acid ( for Prime&Bond NT ) . A 1- to 2-mm-thick increment of a flowable composite ( Filtek Flow ) was used in the proximal box in 50 % of the restorations of each adhesive . Preparations were restored with a packable composite ( Surefil ) . The restorations were evaluated preoperatively and 2 weeks postoperatively for sensitivity to cold , air , and masticatory forces using a visual analog scale . Marginal integrity of the accessible margins was also evaluated . Statistical analysis used a mixed linear model with subject as a r and om effect . RESULTS Ninety-eight teeth from 44 subjects were observed at 2 weeks . The type of adhesive and use of flowable composite had no significant effects or interaction for any of the four outcomes of interest , ie , change from baseline to 2 weeks in sensitivity and response time for the cold or air stimulus . For the air stimulus , the overall average change from baseline was not significant for either sensitivity or response time . For the cold stimulus , the overall average change from baseline was significant for both sensitivity and response time . No case of sensitivity to masticatory forces was observed . CONCLUSION No differences in postoperative sensitivity were observed between a self-etch adhesive and a total-etch adhesive at 2 weeks . The use of flowable composite did not decrease postoperative sensitivity This study investigated the ability of a glass-ionomer cement ( GIC ) lining to reduce postoperative sensitivity in occlusal cavities restored with resin composite . In addition , the effects of a total-etch and self-etch adhesive on postoperative sensitivity were also compared . Patients who had moderate to deep occlusal caries of at least one molar were recruited . Overall , 103 restorations were placed in 70 participants , with an average age of 22.8 + /- 3.8 years . Preoperatively , each tooth was evaluated for cold-stimulated tooth sensitivity using a visual analog scale . If present , tooth sensitivity induced by cold/hot drinks or occlusal function was also noted . Caries was stained with a caries detector dye , then removed using slow-speed burs and h and excavators . The cavity was restored with one of four r and omly allocated restorative procedures : 1 ) bonded with a two-step , total-etch adhesive ( Single Bond 2 ) ; 2 ) lined with a resin-modified GIC liner ( Fuji Lining LC ) , then bonded with total-etch adhesive ; 3 ) bonded with a two-step , self-etch adhesive ( Clearfil SE Bond ) and 4 ) lined with the GIC liner , then bonded with self-etch adhesive . The cavities were incrementally filled with a nanofilled hybrid resin composite . At recall , postoperative sensitivity was evaluated at one week and one month . Overall , postoperative sensitivity in daily function was rare . No significant difference in postoperative sensitivity , either in daily function or in response to a cold stimulus , was observed between the restorative procedures with or without the GIC liner , regardless of the adhesive used ( p > 0.05 ) . In addition , no difference in postoperative sensitivity was noted between use of the self-etch and total-etch adhesive OBJECTIVES Ormocer composites , consisting of a silicon-based polymer , have been developed recently as a tooth-colored restorative material . The purpose of this prospect i ve r and omized clinical trial was to evaluate the performance of two small-particle hybrid ormocer-based restorative systems ( AD , Admira/Admira Bond , VOCO ; DE , Definite/Etch & Prime 3.0 , Dentsply ) and one small-particle hybrid bis-GMA-based composite restorative system ( TC , Tetric-Ceram/Syntac , Ivoclar-Vivadent ) in class II cavities . METHODS From 128 occlusal-proximal restorations ( 44 AD , 43 DE and 41 TC ) placed in 32 adult patients , eventually 77 ( 22 AD , 29 DE and 26 TC ) remained available for evaluation after 5 years . Their clinical performance was scored according to the USPHS criteria and evaluation of bite-wing radiographs . RESULTS After 5 years , eight AD , six DE and seven TC restorations had failed ( p=0.10 , log-rank test ) . The main reason was fracture or marginal gap formation , while secondary caries accounted for four failures . In all restorations the quality of surface , margins and contact point decreased significantly compared to baseline . DE had a significant poorer color match ( p<0.01 ) . Statistical evaluation using the KW test showed that failures were concentrated on specific patients . CONCLUSIONS In a group of class II restorations , there was no significant difference in failures after 5 years between ormocer-based and bis-GMA-based restorative systems PURPOSE To clinical ly evaluate different br and s of resin composites in Class I restorations . MATERIAL S AND METHODS A total of 120 Class I cavities were prepared in permanent molars and restored with  four posterior resin composites : Clearfil Photo Posterior , Z100 , Herculite XR , and Heliomolar RO . The restorations were evaluated at baseline , 1 and 2 years using the USPHS criteria . RESULTS After 1 year , Z100 restorations were rated Alfa in all tested criteria . Clearfil PP , Herculite XR and Heliomolar RO showed slight changes in color match , anatomic form , and marginal adaptation . After 2 years , no significant difference was found in the evaluation of cavosurface discoloration for all tested material s. Z100 and Herculite XR were significantly more color stable than Clearfil PP and Heliomolar RO . The anatomic form evaluation showed Z100 with a significantly higher value than other groups . Heliomolar RO revealed the lowest percentage of marginal adaptation The purpose of this controlled prospect i ve clinical study was to compare the clinical performance of the self-etching adhesive system AdheSE and the established total-etch adhesive system Excite in classes I and II cavities for a period of 2 years . Fifty patients participated in this study . Each received two restorations , one with AdheSE , one with Excite by one calibrated , non-blinded operator . The resin composite used to restore the teeth was Tetric Ceram HB . One calibrated , blinded clinician re-evaluated the restorations at baseline , after 6 , 12 and 24 months after placement using the modified Ryge criteria . For this , vitality , post-operative sensitivity , visible marginal irregularity , marginal discolouration , secondary caries , surface texture , anatomic form and filling defect were considered . After 2 years , 67 restorations were review ed in 34 patients . None of the teeth showed signs of secondary caries . Two teeth , one of each group , had to receive endodontic treatment because of pulp inflammation . All other teeth remained vital . Slight marginal discolourations were observed in six AdheSE restorations and three Excite restorations . These restorations were scored as Beta . After 2 years , an overall clinical success rate , summing up all the Alpha and Beta scores , of 97 % was found , viewing both adhesive systems together . Statistic analysis using log-rank test showed no statistic differences in the overall survival rate between the two material s tested within the observation period . It can be concluded that both adhesive systems tested demonstrated very good clinical performance in the restoration of classes I and II cavities at the end of 2 years This r and omized trial evaluated the 12-month clinical performance of nanofill , a nanohybrid , and a microhybrid composite in restorations in occlusal cavities of posterior teeth . This study utilized 41 patients , each of whom had three molars affected by primary caries or the need to replace restorations . All restorations were performed in accordance with the manufacturer 's recommendations and evaluated in accordance with U.S. Public Health Service-modified criteria . Based on the results of the present study , the material investigated demonstrated acceptable clinical performance after 12 months of clinical service . Long-term re-evaluations are necessary for a more detailed analysis of these composites PURPOSE To assess the one-step self-etching adhesive iBond Gluma inside ( 1-SE ) and the two-step etch- and rinse adhesive Gluma Comfort Bond ( 2-ER ) , both used in combination with the fine particle hybrid composite Venus , in a laboratory and in a prospect i ve clinical study . MATERIAL S AND METHODS In the in vitro study , tooth-composite interaction , microleakage , and adhesive failure of 8 Class V restorations per system were evaluated by light and scanning electron microscopy . In the in vivo study , 90 paired Class III/IV restorations were scored over 48 months ( modified USPHS criteria ) . Cumulative failure rates ( CFR ) were calculated . RESULTS In vitro , microleakage and adhesive failure at enamel margins were significantly increased with 1-SE in comparison with 2-ER . With 1-SE , micromechanical interlocking at enamel was reduced and pores within the adhesive layer arose . In vivo , after 48 months with 1-SE , decreased marginal integrity and an increased number of dark marginal color lines were observed . CONCLUSION Because the results of the 4-year clinical study showed lower esthetics and marginal integrity for the 1-SE adhesive , its use should be viewed critically , which is in line with the reduced enamel-adhesive-composite interaction found in vitro OBJECTIVE Packable composites are a comparatively recent addition to the dentist 's armamentarium , Solitaire-2 being an example of this type of material . This paper reports the performance of 100 restorations formed in Solitaire-2 in conjunction with the Gluma Solid Bond system and Gluma One Bond bonding systems , in Class I and II cavity restorations in permanent teeth , placed in the practice s of five members of the Product Research and Evaluation by Practitioners ( PREP ) Panel , a group of United Kingdom-based dental practitioners who are prepared to undertake research projects in their practice s. METHOD AND MATERIAL S Five members of the PREP Panel were each requested to place 20 Solitaire-2 restorations .  These restorations were review ed at 1 year by a trained and calibrated evaluator , and the PREP panel member who had placed the restorations . RESULTS A total of 88 restorations ( 33 Class I , 55 Class II ) in 49 patients ( mean age 43 years ) were review ed at 1 year . One Class II restoration ( a large mesio-occlusodistal restoration ) had been replaced at 10 months after a fracture was detected across the distal box . The remaining 87 ( 99 % ) of the restorations were intact with no secondary caries detected . CONCLUSION Ninety-nine percent of the Solitaire-2 restorations , placed in general dental practice conditions in conjunction with the Gluma Solid Bond system and Gluma One Bond bonding systems , were found to be performing satisfactorily at 1 year PURPOSE To test the hypothesis that the prevention of postoperative sensitivity in resin-based composite restorations is better achieved with a self-etching/self-priming ( SE/SP ) dentin bonding system without lining than with an early generation total-etch ( TE ) bonding system . METHODS Over a 4-year period , clinical follow-ups were conducted on patients who had received composite restorations .  The depth of each cavity was categorized as being shallow , medium or deep , and an evaluation was made regarding the need for pulpal protection for each restoration . Three different self-etching/self-priming ( SE/SP ) adhesive systems were compared to three different total-etch ( TE ) adhesive systems . The incidences of postoperative sensitivity ( IPS ) were examined by a st and ardized procedure 1 week after placement of the restoration . Patients ' ages varied between 16 - 83 years . RESULTS The  total number of restorations placed in vital teeth were 330 for 150 patients in the SE/SP group , and 126 for 70 patients in the TE group .  Incidences of IPS in the total number of restorations stratified for depth were 14 % in deep cavities , 6 % in medium depth cavities and 5 % in shallow cavities in the SE/SP group , and 35 % in deep cavities , 16 % in medium and 4 % in shallow cavities in the TE group . Fisher 's exact test showed the incidence of IPS was significantly higher in cases of deep ( P < 0.05 ) and medium ( P < 0.05 ) cavities . The test also revealed that in restorations placed with the SE/SP adhesive systems , the presence or absence of a protective liner or base made no significant difference in the IPS in medium and shallow cavities , while the use of such protective layers produced a significantly higher IPS ( 21 % ) , compared with no protection ( 0 % ) , in deep cavities ( P < 0.05 ) . The absence of protective liners or bases did not result in postoperative sensitivity in deep cavities , when the SE/SP dentin bonding systems were used Historically , postoperative pain associated with temperature was considered a thermal conduction problem . More recently , pulpal hydrodynamics has been used to explain this sensitivity . Relative to restorations placed with dentin bonding agents that require a separate etching step , agents that include an acidic primer are believed to result in a better seal of the dentinal tubules . This study compared pain associated with a st and ardized cold stimulus in two groups of restorations . One group was placed with a self-priming resin that required a separate etch step , the other with a self-etching , self-priming dentin bonding agent . This was a community-based , r and omized , double-blind clinical trial . Two hundred and nine restorations were placed for 76 participants . All teeth were asymptomatic at the start of the trial . Immediately following application of a st and ardized cold stimulus , participants rated the pain for each restored tooth using a Visual Analog Scale ( VAS ) . For each group of restorations , VAS scores at 13 weeks were compared to preoperative scores . In addition , the preoperative score was subtracted from the 13-week score , and the two groups of restorations were compared . For both groups of restorations , the median scores were significantly reduced at 13 weeks . This decrease in the VAS score reflects a reduction in sensitivity below that which existed preoperatively . There was no significant difference between the two groups of restorations in terms of change in sensitivity at 13 weeks OBJECTIVE To evaluate the clinical performance of a nanofill and a nanohybrid composite in restorations in occlusal cavities of posterior teeth in a r and omised trial over 30 months . METHODS Forty-one adolescents participated in the study . The teeth were restored with a nanofill ( Filtek Z350 , 3 M ESPE ) , a nanohybrid ( Esthet-X , Dentsply ) ; Filtek Z250 ( 3 M ESPE ) was used as a control . After 30 months , the restorations were evaluated in accordance with the US Public Health Service ( USPHS ) modified criteria . The McNemar and Friedman tests were used for statistical analysis , at a level of significance of 5 % . RESULTS There were significant differences in the roughness of Filtek Z250 ( p=0.008 ) and Filtek Z350 ( p<0.001 ) when the four time periods ( baseline , 6 months , 12 months and 30 months ) were compared . There were significant differences in the marginal adaptation of Filtek Z250 ( p=0.001 ) , Filtek Z350 ( p<0.001 ) and Esthet-X ( p=0.011 ) . Except for one of each composite restoration , all the modifications ranged from Alpha to Bravo . There were significant differences in the surface roughness ( p=0.005 ) when the three composites were compared after 30 months . CONCLUSIONS The material s investigated showed acceptable clinical performance after 30 months . Long-term re-evaluations are necessary for a more detailed analysis of these composites ( CEP : # 1252 ) The purpose of this study was to evaluate a new resin composite/bonding restorative system in clinical trials involving human subjects . Sixty restorations were inserted in Class I and Class II preparations in premolars and molars . The enamel margins of the preparations were etched for 60 seconds with 37 % phosphoric acid gel . The dentinal surfaces of cavity preparations were etched for 40 seconds with 37 % phosphoric acid in glycerine ( K-etchant gel ) and bonding agent ( Clearfil Photo Bond ) applied . A resin composite ( Clearfil Photoposterior ) was placed in three increments with a 20 second light cure of each increment and a 60 second light cure of the final increment . All the restorations were evaluated using the USPHS system and M-L indirect scale . At 36 month recalls , compared to baseline , surface texture for essentially all the restorations was rated Bravo , while all other characteristics were rated Alpha . Secondary caries was reported for one restoration during the third year of clinical use . Wear showed an adjusted mean value of 14.6 microns at 36 months or 4.9 microns per year . No cases of clinical post-operative sensitivity to hot , cold , percussion and foods were reported during the length of the study . Clearfil Photoposterior resin composite system has exhibited remarkable wear resistance and no post-operative sensitivity throughout the length of the study Two composite resins were evaluated for clinical acceptability as restorative material s in Class I and II cavities over a 2-year-period . In addition , dispersed phase alloy was evaluated for comparison . All restorations were assessed for anatomical form , marginal integrity and marginal leakage using modified United States Public Health Service ( USPHS ) criteria . At the 2-year recall , 96 % of the composites and 100 % of the amalgams were rated ' alpha ' or ' bravo ' , using the parameters of assessment defined in this study . However , a significant number of shifts from the baseline , within the level of acceptability , had occurred . The two composites showed the greatest number of shifts for anatomical form and marginal leakage , while there were no differences between the composites and the amalgam for shifts in marginal integrity . Although a very high level of acceptability was determined for all of the material s , the frequency of rating change within categories for the composites was a cause of concern with regard to their long-term clinical use OBJECTIVE The objective of this prospect i ve clinical trial was to evaluate the 4-year clinical performance of an ormocer-based nano-hybrid resin composite ( Ceram X ; Dentsply/DeTrey ) in Class II restorations placed with a one-step self-etch ( Xeno III ; Dentsply/DeTrey ) and two-step etch- and -rinse adhesive ( Ivoclar Vivadent ) . METHODS Seventy-eight participants received at r and om at least two , as similar as possible , Class II restorations of the nano-hybrid resin composite bonded with either a single step self-etch adhesive or a control 2-step etch- and -rinse adhesive . The 165 restorations were evaluated using slightly modified USPHS criteria at baseline and then yearly during 4 years . RESULTS 162 restorations were evaluated at 4 years . Postoperative sensitivity was observed in 6 patients ( 3 Xeno III , 3 Exite ) between 1 and 3 weeks . Eleven failed restorations ( 6.8 % ) were observed during the follow up . Seven in the one-step self-etch adhesive group ( 7.7 % ) and four in the 2-step etch- and -rinse group ( 5.6 % ) . This result ed in non-significant different annual failure rates of 1.9 % and 1.4 % , respectively . Fracture of restoration was the main reason for failure . CONCLUSION The ormocer-based nano-hybrid resin composite showed a good clinical performance in Class II cavities during the 4 year evaluation . No significant difference was seen in overall clinical effectiveness between the two adhesives
target: No overall effect was revealed in the meta-analyses , meaning that no influence of the  ER or SE strategy on POS .
  SIGNIFICANCE The type of adhesive strategy ( ER or SE ) for posterior resin composite restorations does not influence the risk and intensity of POS .
background: OBJECTIVES A systematic review and meta- analysis were performed on the risk and intensity of postoperative sensitivity ( POS ) in posterior resin composite restorations bonded with self-etch ( SE ) and etch- and -rinse ( ER ) adhesives .