Cavities of Teeth
Conditions
Brief summary
To compare a newly developed filling composite to a current filling composite system. Two restorations will be placed in each subject, one using system A and one using system B. The first system listed in the randomization pair will be placed on first tooth (#4-#13), and the second system on 2nd tooth (#4-#13). The same three researchers will be responsible for placement of all the restorations.
Detailed description
The aim of this (12-month; 36-month; 60-month) randomized controlled clinical trial is to evaluate and compare the esthetic outcomes and patient satisfaction of a simplified newly developed dental composite system (system A)for the esthetic region to a nanohybrid composite system (Filtek Supreme Ultra-system B) placed in class III, IV and V lesions. Even though dental composite systems have been used extensively for the anterior region, clinicians face challenges with shade selection and longevity of the material over the years. This new system has been developed to improve the esthetic outcomes and patient satisfaction by enhancing the blending capability of the material. Dental composite systems have been used for 50 years as state of art materials to restore the anterior region. Significant development has occurred regarding the composition and structure of dental composites, improving the longevity of these restorations; however, clinicians are faced with the challenge of selecting the most adequate shade and restorative technique to reproduce missing tooth structure. Depending on the size of the cavity preparation, a single layer of material or multiple layers might be needed to reproduce dentin and enamel. Different dental composite systems offer multiple body, dentin, and enamel shades. Therefore, clinicians are faced with the challenge of recreating nature using this material. Different devices, such as spectrophotometers have been introduced on the market for shade selection. However, one of the most important aspects when placing anterior composites is the esthetic outcome based on the patient's assessment. Therefore, this study will evaluate the esthetic outcomes of a simplified and a conventional dental composite system based on the provider's and patient's assessment.
Interventions
DIAGNOSTIC_TESTPulp vitality testing
each tooth will be tested to determine if the pulp of the tooth responds to cold
OTHERPhotos
Photos of teeth (Photos will be taken with a DSLR camera settings will be determined with optimal settings) and captured periodically throughout the study. Photographs will be made of the cavity preparation. Photographs will be made post-operatively
DRUGlocal and/or topical anesthetic
Local and/or topical anesthetic will be applied as necessary to the teeth or gingiva
DEVICErubber dam
The area will be isolated with rubber dam isolation
OTHERtooth surface cleaned
The tooth surface will be cleaned with flour of pumice on a prophy cup only, cavity preparation will be performed as usual for caries removal.
PROCEDUREenamel margins
Enamel margins will be beveled with a long flame diamond bur (8863.314.012 Komet) at 45 degrees to the external tooth surface to achieve the desired bevel length. Along with the use of the diamond bur, infinite invisible margins will be created by contouring and smoothing with a dark orange Sof-LexTM extra-thin contouring and polishing disc (3M).
PROCEDUREAdhesive Systems
Adhesive systems will be applied according to manufacturer's instructions and selective etching of the enamel will be performed. The dental composite will be incrementally placed using a two- layer or one-layer technique based on the cavity size and light-cured (detailed adhesive instruction sheet will be chairside for reference)
PROCEDUREcavity preparation
The technique to be used will be determined by the size of the final cavity preparation. For small preparations a one-layer technique will be used. No backing material is necessary for the Tokuyama system, Filtek Supreme Ultra will be determined by manufacturer's wheel. A two-layer technique will be used for a large cavity preparation. Large cavity preparation is defined as being 4mm in length or more and/or at least 2mm in depth.
OTHERShade selection using Easy Shade 5
A1 (shade determined by Easy Shade 5), ECM-001/Backing material, A1E/A2D (shade will be selected by shade wheel) A4 (shade determined by Easy shade5), ECM-001/Backing material, A3E/A6D (shade will be selected by shade wheel
PROCEDURELight Curing
A Valo Grand curing unit (Ultradent) with an exitant irradiance with no less than 500 and no greater than 1500 mW/cm2 as measured with MARC Light Collector will be used in standard mode to deliver the required radiant exposure J/cm2 for adhesive and dental composite increments.
PROCEDUREContoured and polished
The restoration will be contoured and polished with - Long flame diamond bur (8863.314.012 Komet), Sof-Lex Medium (orange) Contouring and Polishing Discs (3M), Green Jiffy cup pre-polisher (Ultradent Products, Inc.), Blue and grey silicone points composite polisher gloss plus finisher (Kerr Hawe)
OTHERConsent
The consent form will be signed, copy will be provided to the patient
OTHERHealth Questionnaire
The health questionnaire will be completed at initial visit and updated at each follow-up visit
RADIATIONxray
When necessary a radiograph (xray) will be obtained
OTHERRelease of medical information signed
The release of medical information form will be signed
OTHEROral Exam
An Oral Exam will be completed
OTHERTeeth Assessment
The teeth assessment by subject will be completed using the Visual Analog Scale (VAS) and Verbal Rating Scale (VRS) at the follow-up visits 1 month after restoration, 1 year, 2 years and 3 years post restoration.
OTHERClinical Assessment
A clinical assessment will be completed by the evaluators
DEVICETokuyama Universal Bond
Tokuyama Universal Bond (TUB) single component self-etching 1-step adhesive system with Tokyuama supra-nanofilled dental composite (ECM) (Tokuyama Dental Corp., Japan)
DEVICEScotchBond
Scotch Bond Universal one-step adhesive system with Filtek Supreme Ultra™, nanofilled dental composite (3M)
Sponsors
Tokuyama Dental Corporation
Erica Teixeira
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
TRIPLE (Subject, Investigator, Outcomes Assessor)
Masking description
The statistician will prepare a randomization list of A-B and B-A pairs to be applied sequentially as subjects receive restorations. The first system listed in the randomization pair will be placed on first tooth (#4-#13), and the second system on 2nd tooth (#4-#13). The random sequence will be individually placed in opaque, consecutively numbered and sealed envelopes, which should be opened by the operator immediately before the intervention.
Intervention model description
Simple randomization will be used for assignment of the treatment groups. Randomization: Two restorations will be placed in each subject, one using system A and one using system B.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* Sensible tooth -responds to cold or electric pulp testing (done at screening) * Patient 18years of age or old * Current radiograph available (done at screening as needed) * A pair of the same type of restorations needed in the anterior esthetic/facial region (tooth #4-#13).
Exclusion criteria
* Fewer than 20 teeth * Advanced untreated periodontal disease or recent periodontal surgery * Rampant uncontrolled caries activity * Bruxism or clenching and visible wear facets on the occlusal surface * Undergoing or in need of TMJ therapy * Known allergy to methacrylate-based materials or product ingredients * History of poor dental visit attendance * Not available for recall for at least 3 years * Fractured or visibly cracked tooth * Poor oral hygiene * Sensitive tooth or currently using desensitizing treatments, pastes or medicaments * Pregnant * Abutment teeth for prostheses * Teeth considered for restoration are non-vital, have had root canal therapy or been pulp capped * Teeth or supporting structures with any symptomatic pathology or extensive caries lesion * Individual supervised by PI or supervised by member of research team * Individual subordinate to the PI or subordinate to any member of the research team * Student or trainee under the direction of the PI or under the direction of a member of the research team
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Patient satisfaction of the restoration appearance (esthetics) VAS | 3 years and 5 years | Patient satisfaction-VAS (Visual Analog Scale of 0-10 with 0 poor and 10 excellent result) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Patient satisfaction of the restoration appearance (esthetics) VRS | 3 years and 5 years | Patient satisfaction- VRS (Verbal Rating Scale - very satisfied to not at all satisfied) |
| Percent success of the restoration according to the esthetic appearance | baseline, 1 year, 3 years, 5 years | Esthetic outcomes using the World Dental Federation instrument (FDI criteria- 5-likert scale criteria 1-best to 5 worst score) measured by the clinician's evaluators |
| Percent success of the restoration according to biological aspects | baseline, 1 year, 3 years, 5 years | using the World Dental Federation instrument (FDI criteria- 5-likert scale criteria 1-best to 5 worst score) by the clinician's evaluator |
| Percent success of the restoration according to functional aspects | baseline, 1 year, 3 years, 5 years | using the World Dental Federation instrument (FDI criteria- 5-likert scale criteria 1-best to 5 worst score) by the clinician's evaluator |
Countries
United States
Outcome results
None listed