Department of Restorative Dentistry, Faculty of Dentistry, Dental School, University of Chile, Sergio Livingstone Pohlhammer, Olivos 943, Independencia, Santiago, Chile.
Faculty of Dentistry, Universidad de Los Andes, Avenida Monseñor Álvaro del Portillo 12455, Las Condes, Santiago, Chile.
Clin Oral Investig. 2022 Oct;26(10):6087-6095. doi: 10.1007/s00784-022-04557-z. Epub 2022 May 24.
Our goal was to evaluate the clinical behavior of resin-based composite (RBC) restorations with sealed marginal defects using nano-filled flowable RBCs (FRS) compared with resin-based sealant (RBS); this work used marginal adaptation, marginal staining, and secondary caries according to the World Dental Federation (FDI) criteria.
This was a prospective, randomized, double-blind, controlled trial. Fifty-four patients who met the inclusion criteria (older than 18 years old; with high cariogenic risk determined by Cariogram software; and restorations with marginal defects, 3 and 4 according to FDI criteria) were randomly divided into three groups. There were three defective RBC restorations per patient and were repaired (n = 162). The groups were RBS-marginal sealing using a resin-based sealant (Clinpro Sealant, 3 M ESPE, MN, USA) plus adhesive (Single Bond Universal, 3 M ESPE, MN, USA); FRS-sealing using flowable resin (Filtek Flow Z350XT, 3 M ESPE, MN, USA) plus adhesive (Single Bond Universal, 3 M ESPE, MN, USA); and control-no repair treatment. All procedures were performed under complete isolation. Evaluations were evaluated at 1-week post treatment (baseline) as well as at 18 and 36 months after treatment regarding marginal adaptation, marginal staining, and secondary caries according to FDI criteria. The data were analyzed using the Wilcoxon test (α = 0.05) to compare the differences in each treatment group at different evaluation times.
Marginal adaptation of micro-repaired RBC restorations were seen in patients with a high risk of caries using flowable resin composite or resin-based sealants. There were differences (P < 0.001) when baseline was compared at 18 and 36 months. Marginal staining showed differences when baseline was compared to 18 months (P < 0.001) and 36 months (P = 0.001) for both treatments. Secondary caries parameters for RBS treatment showed differences when baseline was compared to 36 months (P = 0.025) and when 18 months was compared to 36 months (P = 0.046).
Micro-repair of RBC restorations resulted in clinical deterioration of marginal adaptation and marginal staining. Nano-filled flowable resin composites were sealed on defective restorations; 3 and 4 FDI marginal defects have better clinical performance to prevent secondary caries than resin-based sealants after 36 months.
Micro-repair with RBS does not seem to be an effective treatment to prevent secondary caries.
我们的目标是使用纳米填充流动型复合树脂（FRS）与树脂基密封剂（RBS）比较，评估密封有边缘缺陷的树脂基复合材料（RBC）修复体的临床行为；本研究根据世界牙科联盟（FDI）标准，使用边缘适应性、边缘染色和继发龋来评估。
这是一项前瞻性、随机、双盲、对照临床试验。符合纳入标准（年龄大于 18 岁；用 Cariogram 软件确定有高致龋风险；有边缘缺陷的修复体，FDI 标准的 3 和 4 级）的 54 名患者被随机分为三组。每位患者有三个缺陷 RBC 修复体，并进行修复（n=162）。三组分别为：使用树脂基密封剂（Clinpro Sealant，3M ESPE，MN，USA）加粘合剂（Single Bond Universal，3M ESPE，MN，USA）密封 RBC 边缘；使用流动型树脂（Filtek Flow Z350XT，3M ESPE，MN，USA）加粘合剂（Single Bond Universal，3M ESPE，MN，USA）密封 RBC 边缘；对照组不做修复处理。所有程序均在完全隔离下进行。在治疗后 1 周（基线）以及治疗后 18 个月和 36 个月时，根据 FDI 标准评估边缘适应性、边缘染色和继发龋。采用 Wilcoxon 检验（α=0.05）分析数据，比较不同治疗组在不同时间的差异。
在高龋风险的患者中，使用流动型复合树脂或树脂基密封剂对 RBC 微修复体的边缘适应性进行了观察。在 18 个月和 36 个月时与基线相比有差异（P<0.001）。在基线与 18 个月（P<0.001）和 36 个月（P=0.001）时，边缘染色的治疗均有差异。RBS 治疗的继发龋参数在与 36 个月时（P=0.025）和 18 个月与 36 个月时（P=0.046）相比有差异。
RBC 修复体的微修复导致边缘适应性和边缘染色的临床恶化。纳米填充流动型树脂复合材料对有缺陷的修复体进行密封；在 36 个月后，与树脂基密封剂相比，3 和 4 FDI 边缘缺陷具有更好的临床性能，可预防继发龋。
RBS 的微修复似乎不是预防继发龋的有效治疗方法。
