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Title Use Of Direct Composite Vs. Glass Ionomers On Gingival Margin
Clinical Question To get a high integrity gingival margin, is using glass ionomers superior to using direct composite?
Clinical Bottom Line Some of the studies showed no difference between direct composite and glass ionomers used for good seal on gingival margin. But there are also a couple of studies that show that use of flowable composite with bonding agent significantly reduces microleakage at the margins when compared to glass ionomers. (See Comments on the CAT below)
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 10204453Payne/1998Thirty caries and restoration-free human bicuspidsIn vitro Comparative Study
Key resultsIt appears that the use of a flowable composite resin (Tetric Flow) plus a bonding agent (Optibond) in the proximal box of a Class II restoration in permanent teeth will significantly reduce the microleakage at the cavosurface margin when compared with an injectable glass ionomer (Fuji II LC) with or without a bonding agent (Optibond).
#2) 17380801Kenyon/2007Human molarsIn vitro Comparative Study
Key resultsAll 20 specimens had at least one score of three (dye penetration involving less than half of the axial wall) or four. Statistical analysis (Wilcoxon paired-sample test) disclosed a significant decrease in the indirect composite microleakage scores for the two outer cuts (P = 0.006, P = 0.002). No significant differences in microleakage scores were found between materials for the inner cut surfaces of the specimens. Overall, the results of die penetration showed no statistical difference between Class II direct and indirect composite restorations for microleakage.
#3) 15002948Peumans/200328 patients and 52 lesionsUncontrolled, single group clinical trial
Key results100% retention rate was recorded after 2 years of clinical service. However, only 15% of the restorations showed a perfect marginal adaptation. All marginal defects were small, either located at the incisal or at the cervical margin. The percentage of small marginal defects was obviously higher at the incisal enamel margin than at the cervical dentin margin. At the 2-year recall, half of the restorations exhibited a superficial, localized discoloration at the restoration margin, however none of the restorations showed deep, generalized discoloration. Remaining criteria of clinical effectiveness were rated as excellent.
Evidence Search Search gingival margin, Search composite resin, Search glass ionomer
Comments on
The Evidence
Searches found are mostly comprehensive studies and in each study the groups were treated the same with an 80% completion rate. There were adequate follow-ups but the question of whether there was any recall bias is unanswered.
Applicability The increasing use of posterior composites in dental practice calls for increased attention to the need for mitigating the most common area of a leaking restoration, the gingival margin.
Specialty/Discipline (General Dentistry) (Restorative Dentistry)
Keywords gingival margine; compostie resin; glass ionomer
ID# 595
Date of submission: 03/26/2010spacer
E-mail shir@livemail.uthsca.edu
Author Solmaz Shir
Co-author(s) e-mail
Faculty mentor/Co-author Mark Littlestar, DDS
Faculty mentor/Co-author e-mail littlestarm@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
post a rationale
None available
Comments and Evidence-Based Updates on the CAT
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by London Ham (San Antonio, TX) on 04/16/2012
A PubMed search was conducted April 2012 and a more recent publication was found: PubMed: 19133948. This in vitro comparative study of eighteen dentine specimens reinforced the results found by the author: flowable composites with dentin bonding agents reduced micro-leakage at the margins when compared with glass ionomers.
by Donald G. Nield (San Antonio, TX) on 06/23/2011
Using flowable resins for the gingival margins of posterior composites improves marginal integrity.
by Albert Sanchez (San Antonio, TX) on 06/29/2011
In dealing with the most important area of Class II restorations, the gingival box,adaptation of the restoration to seal the margin is crucial. With the advent of low stress flowable composites, e.g. Heraeus Venus Bulk Fill and Dentsply Surefil SDR Flow, the self-adapting handling properties provide the ideal and coverage into all cavo-surfaces. Combining low shrinkage stress and ability to layer in 4 mm increments gives confidence of a sealed margin.

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