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POSTERIORES

Preparaciones e Incrustaciones en Resina

 journal of dentistry 38 (2010) 469–474 journal of dentistry 34 (2006) 427–435 d e n t a l m a t e r i a l s 2 8 ( 2 0 1 2 ) 87–101

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Durability of resin composite restorations in high C-factor A clinical evaluation of posterior composite restorations: Longevity of posterior composite restorations:
cavities: A 12-year follow-up Not only a matter of materials
17-year findings
Jan W.V. van Dijken * Flávio F. Demarco a,∗ , Marcos B. Corrêa a , Maximiliano S. Cenci a ,
Paulo Antônio da Rosa Rodolpho a, Maximiliano Sérgio Cenci b, Tiago Aurélio Donassollo c,
Institution of Odontology, Dental School Umeå, Umeå University, 901 87 Umeå, Sweden Rafael R. Moraes a , Niek J.M. Opdam b
Alessandro Dourado Loguércio d, Flávio Fernando Demarco c,*
a Graduate Program in Dentistry, School of Dentistry, Federal University of Pelotas, RS, Brazil
a
Private Practice, Caxias do Sul, RS, Brazil b Department of Restorative and Preventive Dentistry, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
article info abstract b
Graduate Program in Dentistry, Cariology Area, Faculty of Dentistry of Piracicaba, State University of Campinas, Piracicaba, SP, Brazil
c
Department of Operative Dentistry, Dental School, Federal University of Pelotas, Pelotas, RS, Brazil
Article history: Objective: Polymerization shrinkage and shrinkage stress has been considered as one of the d
Department of Operative Dentistry, Dental School, University of Oeste of Santa Catarina, Joaçaba, SC, Brazil a r t i c l e i n f o a b s t r a c t
Received 20 December 2009 main disadvantages of resin composite restorations. Cavities with high C-factors increase
Received in revised form the risk for interfacial failures. Several restorative techniques have been suggested to Article history: Resin composites have become the first choice for direct posterior restorations and are
21 February 2010 decrease the shrinkage stress. The purpose of this study was to evaluate the durability Received 5 August 2011
article info abstract increasingly popular among clinicians and patients. Meanwhile, a number of clinical reports
Accepted 22 February 2010 of techniques as oblique layering, indirect curing and/or a laminate with a poly-acid Received in revised form in the literature have discussed the durability of these restorations over long periods. In this
modified resin composite in direct Class I resin composite restorations in a 12-year fol- 12 September 2011 review, we have searched the dental literature looking for clinical trials investigating poste-
Article history: Objective: Since an increasing number of composite restorations in posterior teeth are
low-up. Accepted 13 September 2011 rior composite restorations over periods of at least 5 years of follow-up published between
Received 28 June 2005 placed as a routine, this study was conducted to evaluate long-term survival of these
Keywords: Methods: Each of 29 patients received one or two pair(s) rather extensive Class I restorations. 1996 and 2011. The search resulted in 34 selected studies. 90% of the clinical studies indicated
Received in revised form restorations placed in general practice.
Clinical The first restoration was a poly-acid modified resin composite/resin composite sandwich that annual failure rates between 1% and 3% can be achieved with Class I and II posterior
13 September 2005 Methods: Patients from a private dental office that received restorations in posterior teeth
C-factor restoration and the second a direct resin composite restoration. Both restorations, except for composite restorations depending on several factors such as tooth type and location, oper-
Accepted 20 September 2005 between 1987 and 1988 with P-50 (3M) or Herculite XR (Kerr) resin composites were selected Keywords:
Dental materials the laminate layer, were placed with oblique layering and two-step curing technique. 90 ator, and socioeconomic, demographic, and behavioral elements. The material properties
and invited to participate. Restorations were placed under rubber dam isolation. Dentine Clinical trials
Light curing restorations were evaluated annually with slightly modified USPHS criteria during 12 years. showed a minor effect on longevity. The main reasons for failure in the long term are sec-
walls were covered with glass ionomer cement, and composites were placed according to Failure
Resin composite Results: At 12 years, 38 pairs were evaluated. Two cases of slight post-operative sensitivity ondary caries, related to the individual caries risk, and fracture, related to the presence of
manufacturer’s instructions. Thirty-eight patients agreed to participate and signed an Long-term evaluations
were observed in one patient. A cumulative failure rate of 2.4% was observed for both the Keywords:
Sandwich Longevity a lining or the strength of the material used as well as patient factors such as bruxism.
Clinical trial informed consent prior to the evaluation. Two calibrated operators worked independently
Shrinkage stress resin composite and the laminate restorations. One laminate restoration showed non- Repair is a viable alternative to replacement, and it can increase significantly the lifetime of
in the evaluation, using modified USPHS criteria. Survival of restorations or subsets of Posterior restorations
acceptable color match, but was not replaced and one resin composite restoration showed a Composite
Resin composites restorations. As observed in the literature reviewed, a long survival rate for posterior com-
chip fracture. Five restorations were replaced due to primary proximal caries. Survival rates restorations grouped on the basis of variables (material, tooth, cavity type and size) was
Survival posite restorations can be expected provided that patient, operator and materials factors
Conclusions: The high failure rate expected in the high C-factor Class I cavity, associated Failure causes determined using Kaplan–Meier survival curves.
are taken into account when the restorations are performed.
with polymerization shrinkage and shrinkage stress, were not observed. The techniques Posterior restorations Results: Ninety-eight failures were recorded among the 282 restorations providing a crude
© 2011 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.
used resulted in an excellent durability for the Class I resin composite restorations. estimate of 34.8% failures. The survival rate was not significant for material ( p = 0.92) but
# 2010 Elsevier Ltd. All rights reserved. was significant between tooth (lower premolars and lower molars, p < 0.0001), cavity type
( p < 0.001) and size ( p < 0.001). The majority of restorations exhibited A or B scores for the
evaluated criteria. The main failure cause was fracture of both composites. properties, resulting in reduced preparation size [5]; and rein-
Conclusions: The clinical performance of posterior resin composite restorations evaluated
1. Introduction forcement of the remaining dental structure [6]. A clinical
1. Introduction degree of conversion. In the pre-gel phase, the material is able was acceptable after 17-year evaluation. However, the probability of failure of resin com- study has shown that painful vital teeth with incomplete frac-
posite restorations in molars, Class II, and large restorations is higher. Direct restorations have been largely employed to restore pos- tures can be treated successfully by replacing the amalgam
to flow and stresses are relieved.2,3 Post-gel polymerization
# 2005 Elsevier Ltd. All rights reserved. terior teeth due to their low cost and less need for the removal fillings with bonded composite restorations [7]. On the other
Polymerization shrinkage of resin composites occurs during results in stresses in the tooth structures and tooth–material
of sound tooth substance when compared to indirect restora- hand, posterior composite restorations have been shown to
the change of distance of small monomer molecules into bonding interfaces.4–6 These shrinkage stresses may result in
polymer networks. The change to smaller intermolecular interfacial bond failures, microleakage, deformation of the tions, as well as to their acceptable clinical performance [1–4]. produce higher failure rates due to secondary caries [8,9].
distances between the polymer units, tightly linked by tooth cusps, post-operative sensitivity and in the long run in 1. Introduction In recent years, there has been an emphasis on relatively Despite the fact that both amalgam and composite resin However, although used in many practices around the world,
secondary caries.7–10 The configuration factor of the restora- are considered suitable materials for restoring Class I and amalgam is facing its demise, leaving resin composite as the
covalent bonds, compared to the larger distances between short-term studies to provide an early prediction of the long-
the free monomer molecules, loosely bounded by van der tion, ratio bonded to non-bonded surfaces in the cavity, has Class II cavities, some advantages can be related to com- most likely material for posterior restorations for widespread
Over the past decades, new developments in resin technology, term clinical performance of posterior composites. However,
Waals forces, result in a volumetric shrinkage of 2–4%.1 The posite restorations such as better esthetics; their adhesive use in the near future.
been reported to play an important role during the develop- patient demands for tooth-colored restorations and a need to long-term studies are needed to identify the modes of failure,3
magnitude of the shrinkage depends on the resin matrix ment of contraction stress.6 The amount of shrinkage stress find alternatives to amalgam were some reasons for the the possible reasons for these failures, and to compare the
formulation, amount of filler used in the resin composite and generated depends also on the visco-elastic behavior of the increased use of resin composite materials for posterior tooth expected life-span of posterior resin restorations. There is
restorations.1,2 limited information available on performance determinants ∗
Corresponding author at: Graduate Program in Dentistry, Federal University of Pelotas, Rua Gonçalves Chaves 457, 96015-560 Pelotas, RS,
* Fax: +46 90 135074. Brazil. Tel.: +55 53 3222 6690x135; fax: +55 53 3222 6690x135.
E-mail address: Jan.van.Dijken@odont.umu.se. E-mail addresses: flavio.demarco@pq.cnpq.br, ffdemarco@gmail.com (F.F. Demarco).
* Corresponding author. Present address: Departamento de Odontologia Restauradora, UFPel, rua Gonçalves Chaves, 457, 58 andar, CEP
0300-5712/$ – see front matter # 2010 Elsevier Ltd. All rights reserved. 0109-5641/$ – see front matter © 2011 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.
96015 560, Pelotas, RS, Brazil. Tel.: +55 53 32224439; fax: +55 53 32255581.
doi:10.1016/j.jdent.2010.02.007 doi:10.1016/j.dental.2011.09.003
E-mail address: fdemarco@ufpel.tche.br (F.F. Demarco).
0300-5712/$ – see front matter # 2005 Elsevier Ltd. All rights reserved.
doi:10.1016/j.jdent.2005.09.006
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¿Qué está
pasando?
¿Qué evaluar?
Criterios de Preparación
Remanentedental
Espesor y profundidad dentina interaxial
Presencia de techo de cámara pulpar
Integridad de las crestas marginales
Espesor amelodentinario de las cúspides

Linn J, Messer HH. Effect of restorative procedures on th strength of endodontically treated molars. J Endod 1994;20:479-85
Espesor y profundidad dentina interaxial
Presencia de techo de cámara pulpar
Integridad de los rebordes marginales
Espesor amelodentinario de las cúspides
Espesor y profundidad dentina interaxial
Presencia de techo de cámara pulpar
Integridad de los rebordes marginales
Espesor amelodentinario de las cúspides
Espesor amelodentinario remanente dental
La magnitud de la deformación cuspidea es
estrechamente dependiente de la profundidad y
el espesor de la base del remanente cuspídeo

Vitales remanente
No Vitales 3 mm
mínimo 2mm

Becciani R, Castellucci A. La biomecánica del dente trattado endodonticamente. Implicazioni cliniche. Dental Cadmos 2002
Dietschi D, Spreafico R. Adhesive metal-free restorations current concepts for esthetic treatment of posterior teeth. Berlin: Quintessence, 1997
Espesor y profundidad dentina interaxial
Presencia de techo de cámara pulpar
Integridad de los rebordes margínales
Espesor amelodentinario de las cúspides
 Techo de cámara pulpar
“Si no se asocia con la perdida de
una o ambas crestas marginales no
es un factor relevante en validez
biomecanica del diente”

Becciani R, Castelucci A. La biomecanicca del dentre trattato endodonticamente. Implicazioni cliniche. Dental Cadmos2002;1:15-32
 Sector de Pertenencia
Concavidades cervicales en premolares superiores mas
susceptibles a fracturas MD.

Inclinación lingual coronas en molares inferiores mayor riesgo

cúspides linguales.

Premolares inferiores son los dientes con menor riesgo de

fractura.

Gher ME, Dunlap RM, Anderson MH et al. Clinical survey of fractured teeth. J Am Dent Ass 1987;114:147-7
 Tipo de oclusión
En ausencia de guía anterior o canina, como en los
casos de mordida abierta anterior, o la presencia de
hábitos parafuncionales, no es recomendable
cubrimientos parciales.

Dietschi D, Spreafico R. Adhesive Metal-Free restorations: current concepts for esthetic treatment of posterior teeth. Berlin: Quintessence, 1997:61
Paso a paso de la preparación
hasta la impresión
1. Análisis oclusal previo
2. Determinar el color del diente
3. Aislamiento absoluto
4. Remoción caries - restauraciones
5. Calibrar cúspides
1. Grosor Cuspides

Calibrar cada
cúspide en su
base
 1. Grosor Cuspides

débil
demasiado
e
sistent
d re
Pare
1. Grosor Cuspides
6. Reducción oclusal
Solo si es necesaria
6. Reducción oclusal
Usar una fresa
de diamante
calibrada a 2
mm
6. Reducción oclusal

Mínimo 2 mm.

Mínimo 2 mm.
 Selladodentinal
Dentina recién expuesta es el sustrato ideal para adhesión
Disminuye el riesgo de contaminación bacteriana
Elimina sensibilidad postoperatoria
7. Sellado dentinal - Build up
7. Sellado dentinal - Build up
Gentilmente cedido por Andres Roman
 Un reborde Dos rebordes Dos rebordes Dos rebordes
ausente ausentes ausentes ausentes
Grosor de Grosor de Grosor de
paredes mayor paredes mayor paredes menor Grosor de
a 3mm en la a 2 mm en la a 2mm en la paredes menor
base base base a 3mm en la
base
Ausencia de Presencia de Poca cantidad Ausencia de
dentina dentina de dentina dentina
interaxial interaxial interaxial interaxial
Piso gingival Piso gingival
Piso gingival alto Piso gingival alto bajo bajo

Alta Alta
Baja Baja
probabilidad de probabilidad de
probabilidad de probabilidad de
Deflexión Deflexión
Deflexión Deflexión
cuspidea cuspidea
cuspidea cuspidea
Gentilmente cedido por Andres Roman
Tips al preparar
 Build-up
Build-up. Build-up Build-up
Bajar cúspides 2mm
Preparación Preparación Bajar cúspides 2mm
Bisel
expulsiva SIN expulsiva SIN Bisel
Contrabisel
cobertura/bisel/ cobertura/bisel/ Levantamiento de
Levantamiento de
contrabisel contrabisel margen gingival
margen gingival

Gentilmente cedido por Andres Roman

Istmo
Oclusal

Profundidad
 Pared
Gingival
1.5 mm
Casosclínicos
 Adhesión
Material
Resina convencional Polimerización
Directas Pulido
Resina bulk fill
Control

Manual
Indirectas Resina
Fresada

Cerámica Analoga
Sellado dentinal
Fresada
Impresión
Cementación
Control