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  • 1.
    Albertsson, Katarina Wikén
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    van Dijken, Jan W V
    Umeå University, Faculty of Medicine, Department of Odontology.
    Awareness of toothbrushing and dentifrice habits in regularly dental care receiving adults2010In: Swedish Dental Journal, ISSN 0347-9994, Vol. 34, no 2, p. 71-78Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to investigate toothbrushing and dentifrice habits in a Swedish adult population with relatively high caries frequency, which received regularly dental care and to evaluate the awareness of their toothbrush technique. Sixty adult participants with high caries frequency, 29 woman and 31 men, answered a self-reporting questionnaire with 42 questions concerning their oral care, brushing technique and -habits.The responses were related to their clinical behaviour observed during a customary toothbrushing session. Fifty-three participants fulfilled both the questionnaire and the clinical observation. Half of these used toothpaste containing 1450-1500 ppm fluoride but only one of all participants was aware of the fluoride concentration used. The majority used a manual toothbrush and 95% brushed their teeth twice a day using 0.9 g toothpaste. A wide range of brushing methods and habits was observed. Sixty percent did not brush systematically. Spitting of toothpaste-saliva during brushing was performed by 60% and after brushing by 15%.The observed brushing times were significantly higher than the self reported. The observed brushing times were <1 min: 3.4%, 1-2 min: 36.7% and >2 min: 47.0%. There was a significant correlation between observed brushing time and caries activity. Rinsing with water after brushing was performed once (32%) or twice (44%) during the observations. Only 9% rinsed with toothpaste slurry after brushing. It can be concluded that the awareness of the individual toothbrushing, post-brushing behaviour and the use of fluoride toothpaste was non-optimal in the adult participants. Oral health promotion by optimalized use of fluoride toothpaste and improved post-brushing behaviour should be recommended.

  • 2.
    Andersson-Wenckert, Ingrid
    et al.
    Umeå University, Faculty of Medicine, Odontology, Pediatric Dentistry.
    van Dijken, Jan
    Umeå University, Faculty of Medicine, Odontology, Dental Hygiene.
    Kieri, C
    Durability of extensive Class II open-sandwich restorations with a resin-modified glass ionomer cement after 6 years.2004In: American Journal of Dentistry, ISSN 0894-8275, Vol. 17, no 1, p. 43-50Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To evaluate the durability of a modified open-sandwich restoration utilizing a resin-modified glass ionomer cement (RMGIC) in large cavities. METHODS: 268, mostly extensive, Class II Vitremer/Z100 restorations were placed in 151 patients. 47% of the restorations were placed in patients considered as caries-risk patients. Six experimental groups, differing from each other in thickness of RMGIC layer and preconditioning, were evaluated at baseline and annually during 6-7 years according to modified USPHS criteria. RESULTS: After 6 years, 220 restorations were evaluated. 42 failures (19%) were observed. The most frequent reasons for failure were material fracture (n = 11), tooth fractures (n = 9) and secondary caries (n = 10). Non-acceptable proximal dissolution of the RMGIC was seen in six restorations. Significantly more failures, but similar dissolution of the RMGIC, were recorded in high caries risk patients. No differences were seen between the experimental groups or between restorations with thick or thin RMGIC layer. 160 restorations were also evaluated at 7 years. Another 13 failures were observed, eight with non-acceptable dissolution, three secondary caries and two fractures. It can be concluded that the modified open sandwich restoration showed an acceptable durability for the extensive restorations evaluated. An accelerating dissolution of the RMGIC was observed at the end of the study.

  • 3. Astvaldsdottir, Alfheidur
    et al.
    Dagerhamn, Jessica
    van Dijken, Jan W. V.
    Umeå University, Faculty of Medicine, Department of Odontology, Dental Hygiene.
    Naimi-Akbar, Aron
    Sandborgh-Englund, Gunilla
    Tranaeus, Sofia
    Nilsson, Mikael
    Longevity of posterior resin composite restorations in adults: A systematic review2015In: Journal of Dentistry, ISSN 0300-5712, E-ISSN 1879-176X, Vol. 43, no 8, p. 934-954Article, review/survey (Refereed)
    Abstract [en]

    Objective: To conduct a systematic review of the literature on the longevity of posterior resin composite restorations in adults. Material and methods: A systematic literature search was conducted according to predetermined criteria for inclusion and exclusion. The studies selected were prospective clinical trials with a minimum follow-up time of 4 years, 40 restorations per experimental group and an annual attrition rate of less than 5%. Initially, abstracts and full-text articles were assessed independently and the assessment was subsequently agreed on by five reviewers. The methodological quality of the studies was assessed according to the Swedish Council on Health Technology Assessment (SBU) standard checklist for determining the extent to which studies meet basic quality criteria. Results: In all, the literature search identified 4275 abstracts and 93 articles were read in fulltext. There were eighteen studies which met the criteria for inclusion, eight of which were included in the analysis. There were 80 failures of restorations with a total follow-up time at risk for failure of 62,030 months. The overall incidence rate for all causes of failure was 1.55 lost restorations per 100 restoration years. The most common biological reason for failure (a total of 31 restorations) was secondary caries, with or without fracture of the restoration. The quality of the evidence was low. Conclusions: In an efficacy setting, the overall survival proportion of posterior resin composite restorations is high. The major reasons for failure are secondary caries and restoration fracture which supports the importance of adequate follow-up time. Clinical significance: The overall survival proportion of posterior composite restorations was high, but the results cannot be extrapolated to an effectiveness setting. The importance of adequate follow-up time is supported by the finding that secondary caries often occurred after 3 years or later.

  • 4.
    Berglund, Anders
    et al.
    Umeå University, Faculty of Medicine, Odontology, Dental Technology/Dental Materials Science.
    Hulterström, Anna Karin
    Umeå University, Faculty of Medicine, Odontology, Dental Technology/Dental Materials Science.
    Gruffman, Ewa
    Umeå University, Faculty of Medicine, Odontology, Dental Materials Science.
    van Dijken, Jan
    Umeå University, Faculty of Medicine, Odontology, Dental Hygiene.
    Dimensional change of a calcium aluminate cement for posterior restorations in aqueous and dry media.2006In: Dental Materials, ISSN 0109-5641, E-ISSN 1879-0097, Vol. 22, no 5, p. 470-476Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: A calcium aluminate cement has recently been developed, with claims of being an alternative to dental amalgam and resin composites in posterior cavities. However, its' mechanical properties are not well evaluated and the aim of the study was therefore, to evaluate its' dimensional stability over time. METHODS: The dimensional changes of the cement, Doxadent, and two composite resins, Esthet-X and InTen-S, were tested during 360 d. The specimens were stored at 37+/-1 degrees C either in 100% air humidity (dry) or immersed in distilled water (wet), except for the first 24h when all specimens were stored at 100% air humidity and 37+/-1 degrees C. RESULTS: During the first 24h, Doxadent decreased in volume with 0.04%, while InTen-S and Esthet-X decreased with 1.60 and 1.75%, respectively. From d 1-360, the dry Doxadent specimens increased in volume with 2.0% and in weight with 5.5%, while the corresponding increase for the wet specimens were 4.1 and 6.3%, respectively. The volume of both composites increased 0.8% or less in dry and wet conditions, while the increase in weight for InTen-S was 1.2% for the wet specimens and 0.6% for the dry. The corresponding figures for Esthet-X were 0.7 and 0.2%. SIGNIFICANCE: Doxadent was less dimensionally stable than the composites tested. Doxadent increased 2 times more in volume immersed in water than in 100% air humidity, while the increase in weight was almost similar. The clinical implications of the results found in the present study are uncertain. A material that continues to absorb water during prolonged periods and continues to react is questionable for clinical use.

  • 5. Dalton Bittencourt, DD
    et al.
    Ezecelevski, IG
    Reis, A
    van Dijken, Jan
    Umeå University, Faculty of Medicine, Odontology, Dental Hygiene.
    Loguercio, AD
    An 18-months' evaluation of self-etch and etch & rinse adhesive in non-carious cervical lesions.2005In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 63, no 3, p. 173-178Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE. In this intra-individual comparison (an 18-months' randomized, controlled prospective study), we evaluated the clinical performance of one self-etch and one "etch & rinse" adhesive in non-carious cervical lesions. METHODS. Twenty-five patients with at least two pairs of similar-sized non-carious cervical lesions participated. Seventy-eight restorations were placed; 39 with etch & rinse (Single-Bond) and 39 with self-etch (Adper Prompt). Both adhesives were combined with the microfilled resin composite Filtek-A110. The restorations were evaluated at baseline, 6, 12, and 18 months according to slightly modified USPHS criteria. Statistical differences between the adhesives was tested with McNemar's test and clinical degradation over time for each material with the Fisher exact test (a=0.05). RESULTS. Thirty pairs were evaluated at 12 and 18 months. Two self-etch restorations were lost after 18 months. Nine Adper Prompt and four Single-Bond restorations scored bravo for marginal adaptation at 18 months (p<0.05). Nine Adper Prompt and three Single-Bond restorations scored bravo for marginal discoloration (p<0.05). CONCLUSIONS. Both adhesive systems showed acceptable clinical retention rates according to the ADA full acceptance criteria for enamel-bonding systems in class V non-carious lesions. The self-etch adhesive showed a faster progressive marginal degradation.

  • 6. de Gee, Anton J
    et al.
    Kleverlaan, Cees J
    van Dijken, Jan
    Umeå University, Faculty of Medicine, Odontology, Dental Hygiene.
    Dentala kompositer: betydelsen av polymerisationskrympning och genererade spänningar2007In: Tandläkartidningen, ISSN 0039-6982, Vol. 99, no 3, p. 40-44Article in journal (Refereed)
    Abstract [en]

    During the curing shrinkage of adhesively bonded resin composites tensile stresses develop, which are exerted back onto the cavity walls. the extent of the stress determines whether part of the tooth structure will fracture. Unfortunately, shrinkage stress values are not available for the general practitioner. Recommendations are therefore made for the use of low shrinkage and/or low shrinkage stress resin ccomposites for different cavity types. In the current study, thirty resin composites were evaluated for shrinkage and shrinkage stress. The majorityof the composites compplied with the hypothesis that a low shrinkage is accompanied with a high shrinkage stress and visa-versa. Some composite materials showed both a low shrinkage and a low shrinkage stress and are thus proposed to give the least problems with respect to marginal seal and enamel fracture.

  • 7.
    Dijken, Jan W. V. van
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology, Dental Hygiene. Umeå University, Faculty of Medicine, Department of Odontology.
    Sunnegårdh-Grönberg, Karin
    Umeå University, Faculty of Medicine, Department of Odontology, Cariology. Umeå University, Faculty of Medicine, Department of Odontology.
    A two-year clinical evaluation of a new calcium aluminate cement in Class II cavities2003In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 61, no 4, p. 235-40Article in journal (Refereed)
    Abstract [en]

    A calcium aluminate cement (Doxa Certex, Uppsala, Sweden) has recently been developed intended for use as direct restorative filling material for posterior restorations. The material is inorganic and non-metallic and the main components are CaO, Al2O3, SiO2, and water. The aim of this study was to evaluate intra-individually the experimental calcium aluminate cement (CAC) and a resin composite (RC) in Class II restorations. Each of 57 participants received at least one pair of restorations of the same size, one CAC and one RC (Tetric Ceram). Sixty-one pairs were performed. The restorations were evaluated clinically, according to slightly modified USPHS criteria, at baseline, after 6 months, 1, and 2 years. One-hundred-and-twenty restorations were evaluated at 2 years. Postoperative sensitivity was reported for 5 restorations (2 RC, 3 CAC). Significantly better clinical durability was shown for RC. Five non-acceptable CAC restorations (8.2%) were observed at 6 months, 10 CAC (16.7%) and 2 RC (3.3%) at 12 months, and 11 CAC (18.3%) at 24 months. This resulted in a cumulative failure frequency of 43.3% for the CAC material and 3.3% for the RC material. Main reasons for failure for the CAC were partial material fracture (7), cusp fracture (5), and proximal chip fracture (6). The CAC showed a non-acceptable clinical failure rate for Class II restorations, probably caused by its difficult handling and low mechanical properties.

  • 8.
    Dijken, Jan W.V. van
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Ardlin, Berit
    Umeå University, Faculty of Medicine, Department of Odontology.
    Tillberg, Anders
    Umeå University, Faculty of Medicine, Department of Odontology.
    Wahlin, Ylwa Britt
    Umeå University, Faculty of Medicine, Department of Odontology.
    Berglund, Anders
    Umeå University, Faculty of Medicine, Department of Odontology.
    Sunnegårdh-Grönberg, Karin
    Umeå University, Faculty of Medicine, Department of Odontology.
    Lindberg, Anders
    Umeå University, Faculty of Medicine, Department of Odontology.
    Molin, Margareta
    Umeå University, Faculty of Medicine, Department of Odontology.
    Sjögren, Göran
    Umeå University, Faculty of Medicine, Department of Odontology.
    Hulterström, Anna Karin
    Umeå University, Faculty of Medicine, Department of Odontology.
    Samarbete breddar forskning: Oral Biomaterialgruppen, Umeå2008In: Tandläkartidningen, Vol. 100, no 5, p. 74-79Article in journal (Other (popular science, discussion, etc.))
    Abstract [sv]

    Vid institutionen för odontologi vid Umeå Universitet finns en lång tradition av biomaterialforskning. För drygt två år sedan samlades större delen av den forskningen i ett vetenskapligt nätverk. Här beskrivs ett axplock av det breda forskningsarbetet.

  • 9. Fagundes, Ticiane Cestari
    et al.
    Barata, Terezinha Jesus Esteves
    Carvalho, Carlos A R
    Franco, Eduardo B
    van Dijken, Jan W V
    Umeå University, Faculty of Medicine, Odontology.
    Navarro, Maria Fidela Lima
    Clinical evaluation of two packable posterior composites: a five-year follow-up2009In: The Journal of the American Dental Association (1939), ISSN 0002-8177, E-ISSN 1943-4723, Vol. 140, no 4, p. 447-54Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Research has suggested that packable resin-based composites inserted with a placement technique similar to amalgam condensation can reduce the sensitivity associated with posterior restorations. The authors evaluated the clinical performance, including associated sensitivity, of two packable composites in a randomized five-year clinical trial. METHODS: A single operator randomly placed two restorations in each of 33 patients: one restoration consisting of Alert (Jeneric/Pentron, Wallingford, Conn.) and the other consisting of SureFil (Dentsply/Caulk, Milford, Del.). There were 30 Class I and 36 Class II restorations. Two independent evaluators evaluated the restorations by using modified U.S. Public Health Service criteria. The authors analyzed data by means of the Fisher, chi(2) and McNemar tests at P < .05. RESULTS: Of 60 restorations evaluated at five years, two Class II restorations (one SureFil, one Alert) failed. All other restorations received the highest score possible for sensitivity and vitality. The only difference between the composites at the five-year recall was the significantly better surface texture of SureFil. The authors observed significantly different scores between the baseline and at five years for marginal discoloration (Alert and SureFil), surface texture (Alert and SureFil) and color (SureFil). CONCLUSIONS: Both packable resin-based composites showed excellent durability during the five-year follow-up. CLINICAL IMPLICATIONS: The investigated resin-based composites are suitable for posterior restorations.

  • 10. Franz, Alexander
    et al.
    Konradsson, Katarina
    Umeå University, Faculty of Medicine, Odontology.
    König, Franz
    Van Dijken, Jan
    Schedle, Andreas
    Cytotoxicity of a calcium aluminate cement in comparison with other dental cements and resin-based materials.2006In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 64, no 1, p. 1-8Article in journal (Refereed)
  • 11.
    Johansson, Elisabeth
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology, Dental Hygiene.
    Anderson-Weckert, Ingrid
    Umeå University, Faculty of Medicine, Department of Odontology, Dental Hygiene.
    Hagenbjörk-Gustavsson, Annika
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    van Dijken, Jan
    Umeå University, Faculty of Medicine, Department of Odontology, Dental Hygiene.
    Ozone air levels adjacent to a dental ozone gas delivery system2007In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 65, no 6, p. 324-330Article in journal (Refereed)
    Abstract [en]

    Objective. Ozone (O(3)) has been suggested as an anti-microbial treatment in dentistry, with an ozone gas delivery system introduced for the treatment of fissure and root caries. The aim of this study was to investigate the sealing capacity of the novel delivery system and its re-suction capacity during accidental displacement of the cup at different stages of ozone delivery. Material and methods. Ozone leakage was studied in vitro after application on a flat metal surface and on buccal and occlusal tooth surfaces. An ozone analyzer was used to measure ozone gas concentrations adjacent to the delivering cups when adapted to the target surfaces during and after 10-20 s application cycles. The measured levels were compared with the background concentrations in the room. Measurements were performed 1) after complete ozone application cycles, 2) within the cycle before the start of the suction period, and 3) after displacements of the cup during the cycles. Results. Ozone air values varied between 8 and 166 microg.m(-3) for the flat metal surface and between 0 and 108 microg.m(-3) for the tooth surfaces. Ozone leakage levels were 7.6 microg.m(-3) for the flat and 7.4 microg.m(-3) and 5.6 microg.m(-3) for the buccal and occlusal surfaces, respectively, and 5.2 microg.m(-3) and 9.8 microg.m(-3) for the premolar and molar surfaces, respectively. Cycles with displacement showed significantly higher leakage levels than continuous complete cycles (p=0.03). Conclusions. Ozone application cycles with displacements showed significantly higher leakage levels than continuous complete cycles. The largest ozone delivery cups showed the highest leakage values. A change in background levels was seen with similar change in adjacent ozone levels. The overall measured ozone leakage values were low after normally functioning delivery cycles and after repeated displacements. The delivery system can be considered safe.

  • 12.
    Johansson, Elisabeth
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology, Dental Hygiene.
    Claesson, Rolf
    Umeå University, Faculty of Medicine, Department of Odontology, Oral Microbiology.
    van Dijken, J W V
    Umeå University, Faculty of Medicine, Department of Odontology, Dental Hygiene.
    Antibacterial effect of ozone on cariogenic bacterial species.2009In: Journal of Dentistry, ISSN 0300-5712, E-ISSN 1879-176X, Vol. 37, no 6, p. 449-453Article in journal (Refereed)
    Abstract [en]

    Objective: The aim was to evaluate the antibacterial effect of ozone on cariogenic bacterial species with and without the presence of saliva and a possible effect on the salivary proteins.

    Methods: Suspensions of Actinomyces naeslundii (ACTCC 12104T), Lactobacilli casei (N CTC 151) and Streptococcus mutans (NCTC 10449), in salt buffer or in saliva, were exposed to ozone gas delivered by the ozone generator Healozone™ 2130C. Aliquots of the suspensions were taken after 10, 30 and 60s ozone exposures and cultivated on agar plates. Initial number of bacteria per ml was 8.0×107 (SD 2.2×107) (A. naeslundii), 1.0×108 (SD 3.1×106) (L. casei) and 1.0×108 (SD 7.0×105) (S. mutans), respectively. The proteins were separated by SDS electrophoresis and visualized by silver staining.

    Results: In salt buffer 92%, 73% and 64% of the initial numbers of A. naeslundiiS. mutans and L. casei, respectively, were killed already after 10s ozone exposure, while approximately 99.9% of the bacteria were dead after a 60s exposure. After 10 and 30s, but not after 60s exposure to ozone, S. mutans and L. casei were less efficiently killed in saliva compared to the salt buffer. Various saliva proteins were degraded by ozone after a 60s exposure.

    Conclusions:The cariogenic species S. mutansL. casei and A. naeslundii were almost eliminated following 60s of ozone treatment. This killing was reduced in the presence of saliva although increasing the ozone application time to 60s overcame these reductants in saliva. Detection of altered salivary proteins indicates that saliva components constitute additional targets for ozone.

  • 13.
    Johansson, Elisabeth
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology, Dental Hygiene.
    van Dijken, Jan W V
    Umeå University, Faculty of Medicine, Department of Odontology, Dental Hygiene.
    Karlsson, Lena
    Division of Cariology, Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Andersson-Wenckert, Ingrid
    Umeå University, Faculty of Medicine, Department of Odontology.
    Treatment effect of ozone and fluoride varnish application on occlusal caries in primary molars: a 12-month study2014In: Clinical Oral Investigations, ISSN 1432-6981, E-ISSN 1436-3771, Vol. 18, no 7, p. 1835-1843Article in journal (Refereed)
    Abstract [en]

    AIM: The aim of this study is to evaluate the effect of ozone and fluoride varnish on occlusal caries in primary molars in a split-mouth study.

    MATERIALS AND METHODS: Caries risk was estimated by treating Public Dental Health Service dentists. Children with occlusal caries with Ekstrand index scores ≤3 (VI ≤3) were included. Selection of caries lesions was discontinued for ethical reasons due to non-acceptable clinical results during the follow-up. In the continued evaluation pairs of teeth with non-cavitated caries lesions, Ekstrand score ≤2a (VI ≤2) were selected. Fifty pairs of carious primary molars were included, 18 boys and 15 girls (mean 4.7 years, range 3-8). At baseline, the lesions were assessed by visual inspection (VI) and laser-induced fluorescence (LF), in each pair to treatment with 40 s ozone (HealOzone(TM), 2,100 ppm) or fluoride varnish Duraphat®. The treatments and evaluations were repeated at 3, 6 9 months and evaluations only at 12 months.

    RESULTS: Medium-high caries risk was observed in VI ≤3 children and low-medium risk in VI ≤2a children. In the 15 pairs VI ≤3 lesions, 8 treated with ozone and 9 with fluoride progressed to failure. In the 35 pairs VI ≤2a lesions, one lesion failed. Median baseline LF values in the VI ≤3 group were 76 and 69, for ozone and fluoride lesions, respectively, and 21 and 19 in the VI ≤2a group. At 12 months, LF values in the VI ≤2a group were 15 and 18. No improvement or difference in LF values was found over time between the caries lesions treated with ozone or fluoride.

    CONCLUSIONS: Neither ozone nor fluoride varnish treatments stopped the progression of caries in cavitated lesions. In low and medium caries risk children, non-cavitated lesions following both treatments showed slight or no progression. The use of ozone or fluoride varnish treatments in this regime as caries preventive method, added to the daily use of fluoridated toothpaste, to arrest caries progression in primary molars must therefore be questioned.

  • 14.
    Konradsson, Katarina
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology, Dental Hygiene.
    Claesson, Rolf
    Umeå University, Faculty of Medicine, Department of Odontology, Oral Microbiology.
    van Dijken, Jan
    Umeå University, Faculty of Medicine, Department of Odontology, Dental Hygiene.
    Dental biofilm, gingivitis and interleukin-1 adjacent to approximal sites of a bonded ceramic.2007In: Journal of Clinical Periodontology, ISSN 0303-6979, E-ISSN 1600-051X, Vol. 34, no 12, p. 1062-1067Article in journal (Refereed)
    Abstract [en]

    Aim: The aim of this study was to investigate in vivo the influence of aged, resin-bonded, ceramic restorations on approximal dental biofilm formation and gingival inflammatory response, associated with and without customary oral hygiene. Material and Methods: In a cross-sectional and in a 10-day experimental gingivitis study, Quigley-Hein plaque index, gingival index (GI), crevicular fluid and its levels of interleukin (IL)-1alpha, -1beta and receptor antagonist were measured at appoximal surfaces of leucite-reinforced bonded ceramic coverages, resin composite restorations and enamel and compared intra-individually in 17 participants. Results: No differences were found between the ceramic, composite and enamel regarding plaque index, GI, levels of IL-1alpha, -1beta and the receptor antagonist. Throughout, higher crevicular fluid amounts were observed at ceramic sites compared with the enamel (p<0.05). In the experimental gingivitis, plaque index, GI, crevicular fluid and its IL-1alpha levels increased significantly. Conclusion: The need for optimal oral hygiene and professional preventive oral health care does not seem to be reduced with regard to approximal surfaces of aged, resin-bonded, leucite-reinforced ceramic restorations in comparison with those of a hybrid, resin composite and enamel.

  • 15.
    Konradsson, Katarina
    et al.
    Umeå University, Faculty of Medicine, Odontology, Dental Hygiene.
    Claesson, Rolf
    Umeå University, Faculty of Medicine, Odontology, Oral Microbiology.
    van Dijken, Jan
    Umeå University, Faculty of Medicine, Odontology, Dental Hygiene.
    Mutans streptococci and lactobacilli in plaque on a leucite-reinforced dental ceramic and on a calcium aluminate cement.2006In: Clinical Oral Investigations, ISSN 1432-6981, E-ISSN 1436-3771, Vol. 10, no 3, p. 175-180Article in journal (Refereed)
    Abstract [en]

    In this in vivo study, the proportions of mutans streptococci and lactobacilli in plaque were examined (1) on proximal surfaces of bonded, leucite-reinforced ceramic crowns and (2) on class V restorations of calcium aluminate cement (CAC). The examined proportions were intraindividually compared with those of resin composite and enamel. Mutans streptococci and lactobacilli in samples from plaque that was accumulated for 10 days on the following surfaces were determined by cultivation on blood agar plates and species-selective plates: (1) proximal leucite-reinforced ceramic crown, class II composite and enamel (n=11); and (2) class V restoration of CAC and composite, and enamel (n=17). Mutans streptococci and lactobacilli in the samples were distributed in three groups: 0, >0-1, and >1% of total bacteria. The surfaces with detected mutans streptococci were similarly distributed between the materials and enamel. The highest proportion of mutans streptococci and lactobacilli were observed on ceramic followed by composite and enamel. A higher proportion of lactobacilli, but not of mutans streptococci, was detected on enamel compared to CAC and composite. However, no significant differences were found between the surfaces. Conclusively, the materials investigated did not show different relative proportions of mutans streptococci and lactobacilli in plaque, compared to enamel.

  • 16.
    Konradsson, Katarina
    et al.
    Umeå University, Faculty of Medicine, Odontology, Dental Hygiene.
    van Dijken, Jan
    Umeå University, Faculty of Medicine, Odontology, Dental Hygiene.
    Effect of a novel ceramic filling material on plaque formation and marginal gingiva.2002In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 60, no 6, p. 370-374Article in journal (Refereed)
    Abstract [en]

    The aim of this clinical investigation was to evaluate a novel ceramic (CF) filling material (DoxaDent) compared to resin composite (RC) and enamel in regard to plaque formation and gingival inflammation. The CF material is inorganic, non-metallic, and contains calcium aluminate, silicate, and water. To make intra-individual comparisons possible, each participant had at least one set of three test surfaces: two Class V restorations with subgingival cervical margins (one of the novel CF material and one of a hybrid RC) and one non-filled enamel surface (E). The amounts of plaque, gingival crevicular fluid, and clinical signs of gingival inflammation were intra-individually compared in 20 sets of the three test surfaces. In a cross-sectional study (CSS), the effect of oral hygiene on plaque formation and gingivitis around the surfaces was evaluated. In a following 10-day experimental gingivitis study (EGS), plaque formation and the induction of gingivitis during refrain from oral hygiene was compared. In the CSS, no significant differences were found between the surfaces in terms of amount of plaque and degree of gingival inflammation. At the end of the EGS the restorative materials showed a significantly higher amount of plaque (CF versus E, P = 0.014; RC versus E, P = 0.034), but no significant differences were found in degree of gingival inflammation. In condusion, the ceramic filling material was comparable to RC regarding plaque formation and gingival inflammation with customary oral hygiene. With neglected oral hygiene, significantly less plaque growth and a non-significant tendency toward lower amounts of gingival crevicular fluid were observed on enamel surfaces.

  • 17.
    Konradsson, Katarina
    et al.
    Umeå University, Faculty of Medicine, Odontology.
    van Dijken, Jan
    Umeå University.
    Interleukin-1 levels in gingival crevicular fluid adjacent to restorations of calcium aluminate cement and resin composite.2005In: Journal of Clinical Periodontology, ISSN 0303-6979, E-ISSN 1600-051X, Vol. 32, no 5, p. 462-466Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: The aim of this clinical study was to intra-individually compare Class V restorations of a calcium aluminate cement (CAC), resin composite and enamel with respect to the adjacent levels of interleukin (IL)-1alpha, IL-1beta and IL-1 receptor antagonist (IL-1ra) in gingival crevicular fluid (GCF). The hypothesis was that there are higher IL-1 levels adjacent to resin composite, compared with CAC and enamel. MATERIALS AND METHODS: In 15 subjects, at least one set of two Class V restorations with subgingival margins, one CAC and one universal hybrid resin composite, and one control surface of enamel were included. In a cross-sectional study and on days 0, 3 and 7 of an experimental gingivitis study, GCFs were collected with Periopaper for 30 s. The GCF concentrations of IL-1alpha, IL-1beta and IL-1ra were quantified with enzyme linked immunosorbent assays. RESULTS: Neither the cross-sectional study nor the experimental gingivitis study showed any significant differences in the levels of IL-1alpha, IL-1beta and IL-1ra between CAC, resin composite and enamel sites (p>0.05). In the cross-sectional study, low IL-1 concentrations were observed. The IL-1 levels increased significantly during the experimental gingivitis. CONCLUSION: Regardless of CAC or resin composite, the restorations per se did not affect the GCF levels of IL-1 and IL-1ra, neither at healthy gingiva, nor at initiation of plaque-related gingival inflammation.

  • 18.
    Lindberg, A
    et al.
    Umeå University, Faculty of Medicine, Odontology, Dental Hygiene.
    Peutzfeldt, A
    Umeå University, Faculty of Medicine, Odontology, Dental Hygiene.
    van Dijken, Jan
    Umeå University, Faculty of Medicine, Odontology, Dental Hygiene.
    Curing depths of a universal hybrid and a flowable resin composite cured with quartz tungsten halogen and light-emitting diode units.2004In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 62, no 2, p. 97-101Article in journal (Refereed)
    Abstract [en]

    This in vitro study evaluated curing depths of a universal hybrid resin composite with two viscosities (Tetric Ceram and Tetric Flow) after curing with 6 different quartz tungsten halogen and light-emitting diode curing units. Irradiance (light intensity) of the curing units varied between 200 and 700 mW/cm2. The curing units were used for standard, soft-start, or pulse curing. Curing times were 20 and 40 s for standard curing, 3 + 10 s and 3 + 30 s for pulse curing, and 40 s for soft-start. Resin composite specimens, 5 in each group, with a diameter of 4 mm and a height of 6 mm, were made in brass molds and cured from one side at a distance of 6 mm. After 2 weeks, the specimens were ground longitudinally half through the specimen. Curing depth was then determined by measurement of Wallace hardness for each half millimeter starting at 0.5 mm from the top surface. For all curing units and for both resin composites an increased curing time led to statistically significantly higher depth of cure (P < 0.0005). Tetric Flow showed a statistically significantly higher depth of cure than Tetric Ceram (P < 0.0005). All curing units cured more than 2.0 mm of both composites from a distance of 6 mm at 20 s curing time. The value for 40 s was 3.0 mm. The composite closer to the surface than the depth of cure value was equally well cured with all curing units investigated. There was a significant linear correlation between the determined irradiance of the curing units and the depths of cure obtained (20s: r = 0.89, P < 0.025; 40 s: r = 0.91, P < 0.01).

  • 19. Lindberg, A
    et al.
    Peutzfeldt, A
    van Dijken, Jan
    Umeå University.
    Effect of power density of curing unit, exposure duration, and light guide distance on composite depth of cure.2005In: Clinical Oral Investigations, Vol. 9, no 2, p. 71-6Article in journal (Refereed)
    Abstract [en]

    This in vitro study compared the depth of cure obtained with six quartz tungsten halogen and light-emitting diode curing units at different exposure times and light tip-resin composite distances. Resin composite specimens (Tetric Ceram, A3; diameter 4 mm, height 6 mm) were exposed from 0-, 3-, and 6-mm distance. The curing units (200-700 mW/cm2) were used for standard (20 and 40 s), pulse-delay mode (initial exposure of 3 s at 200 mW/cm2, followed by a resting period of 3 min and a final exposure of 10 or 30 s at 600 mW/cm2), or soft-start curing (40 s; exponential ramping). Curing depth was determined by measurement of Wallace hardness for each half millimeter starting at 0.5 mm from the top surface. For each specimen, a mean H(W) value was calculated from the H(W) values determined at the depths of 2.0 mm and less (0.5, 1.0, 1.5, and 2.0 mm, respectively). The depth of cure for each specimen was found by determining the greatest depth before an H(W) value exceeding the minimal H(W) value by 25% occurred. For all curing units, an increase in exposure time led to significantly higher depth of cure. Increasing the light tip-resin composite distance significantly reduced the depth of cure. With a light tip-resin composite distance of 6 mm, median values of depth of cure varied between 2.0 and 3.5 mm following a 20-s (or 3+10 s) exposure and between 3.0 and 4.5 mm following a 40-s (or 3+30 s) exposure. The composite situated above the depth of cure value cured equally well with all curing units. At both exposure times, Luxomax resulted in the significantly lowest depth of cure, and Astralis 7 yielded significantly higher depth. At both exposure times, a significant linear correlation was found between the determined power densities of the curing units and the pooled depth of cure values obtained. It seems that for the resin composite tested, the recommended exposure time of 40 s per 2-mm increment may be reduced to 20 s, or that increments may be increased from 2 to 3.5 mm. It may be that the absolute values of depth of cure found are material specific, but we believe that the relationships found between curing units, between exposure times, and between light guide distances are universal.

  • 20.
    Lindberg, Anders
    et al.
    Umeå University, Faculty of Medicine, Odontology, Dental Hygiene.
    Emami, N
    van Dijken, Jan
    Umeå University, Faculty of Medicine, Odontology, Dental Hygiene.
    A Fourier transform Raman spectroscopy analysis of the degree of conversion of a universal hybrid resin composite cured with light-emitting diode curing units.2005In: Swedish Dental Journal, ISSN 0347-9994, Vol. 29, no 3, p. 105-112Article in journal (Refereed)
    Abstract [en]

    The degree of conversion (DC), of a universal hybrid resin composite cured with LED curing units with low and high power densities and a 510 mW/cm2 quartz tungsten halogen unit, was investigated with Fourier Transform Raman spectroscopy. Three curing depths (0, 2, 4mm) and 0 and 7 mm light guide tip - resin composite (LT - RC) distances were tested. The DC of the LED units varied between 52.3% - 59.8% at the top surface and 46.4% - 57.0% at 4 mm depth. The DC of specimen cured with a 0 mm LT- RC distance at 4 mm depth varied between 50.8% - 57.0% and with 7 mm distance between 46.4% - 55.4%. The low power density LED unit showed a significantly lower DC for both distances at all depth levels compared to the other curing units (p < 0.05). Significant differences between the other curing units were only found at the 4 mm depth level cured from 7 mm distance (p < 0.05). The reduction in DC by increasing LT- RC distance was less than 10% for all curing units. It can be concluded that the improved LED curing units could cure the studied resin composite to the same DC as the control unit.

  • 21.
    Lindberg, Anders
    et al.
    Umeå University, Faculty of Medicine, Odontology, Dental Hygiene.
    van Dijken, Jan
    Umeå University, Faculty of Medicine, Odontology, Dental Hygiene.
    Hörstedt, Per
    Umeå University, Faculty of Medicine, Medical Biosciences, Pathology.
    In vivo interfacial adaptation of class II resin composite restorations with and without a flowable resin composite liner.2005In: Clinical Oral Investigations, ISSN 1432-6981, E-ISSN 1436-3771, Vol. 9, no 2, p. 77-83Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to evaluate in vivo the interfacial adaptation of class II resin composite restorations with and without a flowable liner. In 24 premolars scheduled to be extracted after 1 month, 48 box-shaped, enamel-bordered class II cavities were prepared and restored with a flowable liner (FRC, Tetric Flow/Tetric Ceram/Syntac Single-Component) or without (TRC), cured with three different curing modes: soft start and 500- or 700-mW/cm2 continuous irradiation. Interfacial adaptation was evaluated by quantitative scanning electron microscopic analysis using replica method. Gap-free adaptation in the cervical enamel (CE) was observed for FRC and TRC in 96.2 and 90.2%, for the dentin (D) in 63.6 and 64.9%, and for occlusal enamel (OE) in 99.7 and 99.5%, respectively. The difference between the two restorations was not statistically significant (ns). Significant better adaptation was observed for OE than CE and D (p<0.01), and for CE than D (p<0.01). Gap-free adaptation with the soft-start and 500- and 700-mW/cm2 continuous-curing modes was observed for CE: 88.7%, 92.7%, 97.9% (ns); OE: 99.8%, 98.7%, 100% (ns); and D: 64.0%, 63.9%, and 64.6% (ns), respectively. It can be concluded that neither the use of flowable resin composite liner nor the curing mode used influenced the interfacial adaptation.

  • 22.
    Lindberg, Anders
    et al.
    Umeå University, Faculty of Medicine, Odontology, Dental Hygiene.
    van Dijken, Jan
    Umeå University, Faculty of Medicine, Odontology, Dental Hygiene.
    Lindberg, M
    3-year evaluation of a new open sandwich technique in Class II cavities.2003In: American Journal of Dentistry, ISSN 0894-8275, Vol. 16, no 1, p. 33-36Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To evaluate the durability of a new open sandwich restoration with, as shown in a previous scanning electron microscope study, improved interfacial adaptation. A polyacid-modified resin-based composite (PMRC; compomer) was placed as an intermediate layer and covered with resin composite (RC). A direct RC restoration was used as control. MATERIALS AND METHODS: Of 57 patients, each received at least one pair of Class II restorations, one PMRC/RC open sandwich and one RC control. In total, 75 pairs of Class II restorations, 68 premolars and 82 molars, all in occlusion, were placed by two dentists. Most of the cavities were surrounded by enamel. The restorations were evaluated at baseline, 6, 12, 24 and 36 months by a slightly modified USPHS criteria. RESULTS: Five of 148 restorations evaluated during 3 years were rated as unacceptable. Two, one in each group, because of endodontic treatment and one RC restoration was replaced because of tooth fracture. Secondary caries was observed contiguous to one restoration in each group at the 36-month recall. Except for the two patients with pulpitis, none of the others reported postoperative sensitivity. No significant differences were seen between the restoration techniques. For marginal adaptation a significant change occurred between baseline and 6 months in both groups. For marginal discoloration, a significant change was observed at 6 months in the sandwich group and at 36 months in the RC group. Color match of the resin composite material changed significantly in both groups at 36 months. It was concluded that both techniques showed good durability during the 3-year follow up.

  • 23.
    Lindberg, Anders
    et al.
    Umeå University, Faculty of Medicine, Odontology.
    van Dijken, Jan
    Umeå University, Faculty of Medicine, Odontology, Dental Hygiene.
    Lindberg, Marianne
    Nine-year evaluation of a polyacid-modified resin composite/resin composite open sandwich technique in Class II cavities2007In: Journal of Dentistry, ISSN 0300-5712, E-ISSN 1879-176X, Vol. 35, no 2, p. 124-129Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: The aim of this study was to evaluate in an intraindividual comparison the durability of a polyacid-modified resin composite/resin composite open sandwich restoration in a 9 years follow-up. A polyacid-modified resin composite (PMRC; compomer, Dyract) was placed as an intermediate layer and covered with resin composite (RC, Prisma TPH). A direct RC restoration was used as control. METHODS: Each of 57 patients, received at least one pair of Class II restorations, one open sandwich and one resin composite control. In total 75 pairs of Class II restorations, 68 premolars and 82 molars, all in occlusion, were placed by two dentists. Most of the cavities were surrounded by enamel. The restorations were evaluated at baseline, 6, 12, 24, 36 months and 9 years by slightly modified USPHS criteria. Survival of restorations grouped on the two different techniques was determined using Kaplan-Meier survival curves. RESULTS: After 9 years, 14 of 135 evaluated restorations were estimated as unacceptable, 6 in the sandwich group and 8 in the control group. Over all annual failure rate during the 9-year period was 1.1%. The survival rate was not significant different between the two techniques (p=0.604). Reasons of failure were: secondary caries (8), fracture of tooth (1), fracture of restoration (2), endodontic treatment (3). CONCLUSIONS: Both restorative techniques showed good durability during the 9-year period. No clinical advantage was observed for the sandwich technique.

  • 24. Opdam, N J M
    et al.
    van de Sande, F H
    Bronkhorst, E
    Cenci, M S
    Bottenberg, P
    Pallesen, U
    Gaengler, P
    Lindberg, A
    Umeå University, Faculty of Medicine, Department of Odontology.
    Huysmans, M C D N J M
    van Dijken, Jan
    Umeå University, Faculty of Medicine, Department of Odontology.
    Longevity of posterior composite restorations: a systematic review and meta-analysis2014In: Journal of Dental Research, ISSN 0022-0345, E-ISSN 1544-0591, Vol. 93, no 10, p. 943-949Article in journal (Refereed)
    Abstract [en]

    The aim of this meta-analysis, based on individual participant data from several studies, was to investigate the influence of patient-, materials-, and tooth-related variables on the survival of posterior resin composite restorations. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a search resulting in 12 longitudinal studies of direct posterior resin composite restorations with at least 5 years' follow-up. Original datasets were still available, including placement/failure/censoring of restorations, restored surfaces, materials used, reasons for clinical failure, and caries-risk status. A database including all restorations was constructed, and a multivariate Cox regression method was used to analyze variables of interest [patient (age; gender; caries-risk status), jaw (upper; lower), number of restored surfaces, resin composite and adhesive materials, and use of glass-ionomer cement as base/liner (present or absent)]. The hazard ratios with respective 95% confidence intervals were determined, and annual failure rates were calculated for subgroups. Of all restorations, 2,816 (2,585 Class II and 231 Class I) were included in the analysis, of which 569 failed during the observation period. Main reasons for failure were caries and fracture. The regression analyses showed a significantly higher risk of failure for restorations in high-caries-risk individuals and those with a higher number of restored surfaces.

  • 25. Pallasen, Ulla
    et al.
    van Dijken, Jan
    Umeå University, Faculty of Medicine, Department of Odontology.
    Halken, Jette
    Hallonsten, Anna-Lena
    Höigaard, Ruth
    Longevity of posterior resin composite restorations in permanent teeth in Public Dental Health Service: A prospective 8 years follow up2013In: Journal of Dentistry, ISSN 0300-5712, E-ISSN 1879-176X, Vol. 41, no 4, p. 297-306Article in journal (Refereed)
    Abstract [en]

    Objectives: To investigate in a prospective follow up the longevity of posterior resin composites (RC) placed in permanent teeth of children and adolescents attending Public Dental Health Service.

    Methods: All posterior RC placed, in the PDHS clinics in the cities of Copenhagen and Frederiksberg in Denmark between November 1998 and December 2002, in permanent teeth of children and adolescents up to 18 years, were evaluated in an up to 8 years follow up. The endpoint of each restoration was defined, when repair or replacement was performed. Survival analyses were performed between subgroups with Kaplan–Meier analysis. The individual contribution of different cofactors to predict the outcome was performed with Cox regression analysis.

    Results: Totally 2881 children with a mean age of 13.7 years (5–18) received 4355 RC restorations placed by 115 dentists. Eighty percent were placed in molars and 49% were Class I. Two percent of restorations with base material and 1% of the restorations without base material showed postoperative sensitivity (n.s.). Replacements were made in 406 and repairs in 125 restorations. Kaplan–Meier analysis showed a cumulative survival at 8 years of 84.3%, resulting in an annual failure rate of 2%. Lower patient age, more than one restoration per patient, placement of a base material and placement of RC: in molars, in cavities with high number of surfaces, in lower jaw teeth, showed all significant higher failure rates. Five variables had significant importance for the end point, replacement/repair of the resin composite restorations: age of patient, age of operator, jaw, tooth type and cavity size.

    Significance: Posterior RC restorations placed in children and adolescents in Public Dental Health clinics showed an acceptable durability with annual failure rates comparable with those of randomized controlled RC studies in adults.

  • 26. Pallesen, Ulla
    et al.
    van Dijken, Jan
    Umeå University, Faculty of Medicine, Department of Odontology.
    Noninvasiv behandling af slid og erosion2011In: Odontologi, ISSN 0105-0141, p. 115-136Article in journal (Refereed)
    Abstract [da]

    Slid og erosion af taender synes i dag at vaere et voksende problem for mange patienter. I de fleste tilfaelde kan tandlaegens tidlige diagnostik fore till, att forebyggende tiltag ivaerkdaettes i tide, så fortsatte skader ophorer, eller progressionen begraenes. Desvaerre er det ikke altid muligt, og hvis skaderne blivertilstraekkeligt store, vil omfattande restaurerende behandling i nogle tilfaelde vaere nodvendig for at fjerne symptomer, bevare pulpas vitalitet og for at genoprette tyggefunktion og aestetik. Hvor probelemet tidligere oftest var til stede hos aeldre mennesker, så forekommer det i dag også hos unge, hvor taendeerne har en lang funktionsperiode foran sig. Nyere behandlinger med binding af plast till emalje og dentin har i dag gjort det muligt i nogle at tilgodese biologi, funktion og aestetik på en mere konservativ måde end tidligere, hvor det ekstremt slide tandsaet ofte blev restaureret med fuldkroner på alle taender. Hvis behandlingen udfores med direkte plast, kan det også betyde, at omkostningerne bliver mindre, så flere får mulighed for at få udfort en nodvendig rekonstruktion af tndsaettet. I det folgende vil forskellige faktorer i forbindelse med tandslid og erosion blive belyst, indikation for restaurerende behandling vil blive diskuteret, og eksempler på behandling efternononvasive principper vil blive gennemgået.

  • 27. Pallesen, Ulla
    et al.
    van Dijken, Jan
    Umeå University, Faculty of Medicine, Department of Odontology.
    Operativ cariesbehandling med fokus på posteriore plastfyldninger2013In: Tandlægebladet, ISSN 0039-9353, Vol. 117, no 4, p. 314-320Article, review/survey (Refereed)
    Abstract [da]

    Operative treatment of caries with focus on resin restorationsin posterior teethFor environmental reasons, composite resin must be the firstchoice of material for restoration of posterior teeth. For dentalhealth reasons, it is therefore interesting to know, whether longevityof resin restorations can compete with longevity of amalgamrestorations.The question is whether the advantages of resin restorations,such as better aesthetics, and better adhesive qualities, leadingto reduced cavity preparation and reinforcement of tooth structure,can compensate shortcomings of the material. Importantshortcomings are the missing caries preventive effect, the insufficientfracture resistance, and the technique sensitivity.Long term clinical studies have led to new knowledge about theseissues, which are highlighted in the present article. Reasonsfor replacement of resin restorations are discussed, and factorsinfluencing longevity are examined, including type of tooth andcavity sizes, various patient related factors, skills of the operator,and the operator’s indications for replacement of restorations, aswell as some general factors.Finally, facts about the various materials’ influence on longevity ofthe resin restorations are highlighted, including the importance ofresin type, resin viscosity, bonding agents, and isolating agents.

  • 28. Pallesen, Ulla
    et al.
    van Dijken, Jan
    Umeå University, Faculty of Medicine, Odontology, Dental Hygiene.
    Restoration of traumatized teeth with resin composites2007In: Textbook and color atlas of traumatic injuries to the teeth, Blackwell munkgaard , 2007, p. 716-728Chapter in book (Refereed)
    Abstract [en]

    The primary choice for initial restoratioon of a crown-fractured front tooth has for long time been resin composite material. The restoration can in most cases be performed immediately after injury if there is no sign of periodontal injury and the tooth responds to a sensibility test. The method´s adhesive charater is conservative to toothstructure and with minimal risk of pulpal complication. In addition it offers an esthetic solution to the patient immediately after an injury, which may bring a little joy in a sad situation. The resin composite build-up is often changed or repaired couple of times, before the tooth is resored with a porcelain or porcelain fused to metal crown, at a time when the pulp is out of danger for more invasive preparation. In some cases an endodontictretment is still necessary. After crown therapy a gingival inflammation may occer due to the usual sub-gingival preparations. Afer some years in situ, the crowns may present an esthetic problem due to exposure of un-esthetic crown-margins. The invasive permanent crown restorations are thefore often not sucessful on a longterm scale. On other hand a conservativedirect restoration of an extensively fractured incisor crown with composite may be an exceedingly demanding procedure, involing esthetic acceptability, function and biological aspects and require significant skills, which may influence durability. When are we ready to consider the non-invasive resin composite crown build-up as a permanent restoration? Has its durability improved? Do today´s materials and techniques result in a better prognosis? Where are the problems? In this chapter these matters will be discussed with focus on factors in clinical procedures, which can influence the longevity of the restoration.

  • 29. Pallesen, Ulla
    et al.
    van Dijken, Jan W V
    Umeå University, Faculty of Medicine, Department of Odontology.
    A randomized controlled 27 years follow up of three resin composites in Class II restorations2015In: Journal of Dentistry, ISSN 0300-5712, E-ISSN 1879-176X, Vol. 43, no 12, p. 1547-1558Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To evaluate the durability of three conventional resin composites in Class II restorations during 27 years.

    METHODS: Thirty participants, 25 female and 5 male (mean age 38.2 yrs, range 25-63), received at least three (one set) as similar as possible Class II restorations of moderate size. The three cavities were chosen at random to be restored with a chemical-cured (Clearfil Posterior) and two visible light-cured resin composites (Adaptic II, Occlusin). A chemical-cured enamel bonding agent (Clearfil New Bond) was applied after Ca(OH)2 covering of dentin and enamel etch. Marginal sealing of the restorations was performed after finishing. One operator placed 99 restorations (33 sets). Evaluation was performed with slightly modified USPHS criteria at baseline, 2, 3, 10 and 27 years.

    RESULTS: Postoperative sensitivity was observed in 5 patients. Three participants with 11 restorations (11%) could not be evaluated at the 27 year recall. Thirty-seven restorations failed (13 AII, 10CP and 14 O). The overall success rate after 27 years was 56.5% (AII 55.2%, CP 63.0%, O 51.7%; p=0.70), with an annual failure rate of 1.6%. The main reason for failure was secondary caries (54.1%), followed by occlusal wear (21.6%) and material fracture (18.9%). Non-acceptable color match was seen in 24 (28.3%) of the restorations (AII 2, CP 16, O 6). Cox regression-analysis showed significant influence of the covariates tooth type, caries risk, and bruxing activity of the participants.

    CONCLUSIONS: Class II restorations of the three conventional resin composites showed an acceptable success rate during the 27 year evaluation.

  • 30. Pallesen, Ulla
    et al.
    van Dijken, Jan W V
    Umeå University, Faculty of Medicine, Department of Odontology.
    A randomized controlled 30 years follow up of three conventional resin composites in Class II restorations2015In: Dental Materials, ISSN 0109-5641, E-ISSN 1879-0097, Vol. 31, no 10, p. 1232-1244Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The aim of this 30 year randomized controlled study was to evaluate, by intraindividual comparisons, the durability of three conventional resin composites in Class II restorations.

    METHODS: Each of 30 participants, 21 female and 9 male (mean age 30 years, range 20-43), received at least three (one set) as similar as possible Class II restorations of moderate size. After cavity preparation, the three cavities were chosen at random to be restored with two chemical-cured (P10, Miradapt) and one light-cured resin composite (P30). A chemical-cured enamel bonding agent was applied after etching of the enamel. The chemical-cured resin composites were placed in bulk and the light-cured in increments. One operator placed 99 restorations (33 sets). The restorations were evaluated with slightly modified USPHS criteria at baseline, 2, 3, 5, 10, 15, 20 and 30 years. Statistical analyses were performed by the Kaplan-Meier, log-rank test and Cox regression analyses.

    RESULTS: After 30 years, 5 participants with 15 restorations (15%) could not be evaluated during the whole evaluation. Seven participants were considered as caries risk and eight participants as having active parafunctional habits. Postoperative sensitivity was observed in 24 teeth. In total 28 restorations, 9 P10, 12 P30 and 7 Miradapt restorations failed during the 30 years. The main reasons for failure were secondary caries (39.2%) and material fracture (35.7%). Sixty-four percent of the secondary caries lesions were found in high caries risk participants and 70% of the material fractures occurred in participants with active parafunctional habits. The overall success rate at 30 years was 63%, with an annual failure rate of 1.1%. 68-81% of the restorations showed non-acceptable color match. No statistical significant difference in survival rate was found between the three resin composites (p=0.45). The variables tooth type, cavity size, age, and gender of the participants did not significantly affect the probability of failure.

    SIGNIFICANCE: The three conventional resin composites showed good clinical performance during the 30 year evaluation. The chemical cured resin composites showed better performance than the light-cured composite.

  • 31. Pallesen, Ulla
    et al.
    van Dijken, Jan W. V.
    Umeå University, Faculty of Medicine, Department of Odontology, Dental Hygiene.
    Halken, Jette
    Hallonsten, Anna-Lena
    Hoigaard, Ruth
    Longevity of posterior composite restorations in permanent teeth in Public Dental Health Service: A prospective 8 years follow up (vol 41, pg 297, 2013)2013In: Journal of Dentistry, ISSN 0300-5712, E-ISSN 1879-176X, Vol. 41, no 11, p. 1132-1133Article in journal (Refereed)
  • 32. Pallesen, Ulla
    et al.
    van Dijken, Jan WV
    Umeå University, Faculty of Medicine, Department of Odontology.
    Halken, Jette
    Hallonsten, Anna-Lena
    Höigaard, Ruth
    A prospective 8-year follow-up of posterior resin composite restorations in permanent teeth of children and adolescents in Public Dental Health Service: reasons for replacement2014In: Clinical Oral Investigations, ISSN 1432-6981, E-ISSN 1436-3771, Vol. 18, no 3, p. 819-827Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: The aim of the study was to investigate reasons for replacement and repair of posterior resin composite (RC) restorations placed in permanent teeth of children and adolescents attending Public Dental Health Service in Denmark.

    MATERIAL AND METHOD: All posterior RC placed consecutively by 115 dentists over a period of 4 years were evaluated at baseline and up to 8 years later. The endpoint of each restoration was defined when repair or replacement was performed. The influence of patient, dentist and material factors on reasons for repair or replacement was investigated.

    RESULTS: A total of 4,355 restorations were placed. Replacements comprised 406 and repairs 125 restorations. The cumulative survival rate at 8 years was 84 %. Failed restorations were most frequently seen due to secondary caries (57 %), post-operative sensitivity (POS) (10 %) and RC fracture (6 %). POS was observed in 1.5 % of the evaluations and reported more often in girls and from teeth restored with a base material. Older dentists showed lower proportion of replaced restorations due to secondary caries than younger dentists.

    CONCLUSION: Posterior RC restorations in children and adolescents performed in general practice showed a good durability with annual failure rates of 2 %. The main reason for failure was secondary caries followed by post-operative sensitivity and resin composite fracture. A high proportion of replaced/repaired RC restorations were caused by primary caries in a non-filled surface.

    CLINICAL RELEVANCE: Secondary caries was the main reason for failure of RC in children and young adults. More teeth with post-operative sensitivity and a shorter longevity of restorations were observed when a base material was used.

  • 33.
    Persson, Anitha
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology, Dental Hygiene.
    Claesson, Rolf
    Umeå University, Faculty of Medicine, Department of Odontology, Oral Microbiology.
    van Dijken, Jan
    Umeå University, Faculty of Medicine, Department of Odontology, Dental Hygiene.
    Levels of mutans streptococci and lactobacilli in plaque on aged restorations of an ion-releasing and a universal hybrid composite resin2005In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 63, no 1, p. 21-25Article in journal (Refereed)
    Abstract [en]

    The purpose of this in vivo study was to evaluate the cariogenic microflora of plaque on aged restorations of a hydroxyl, fluoride, and calcium ion-releasing composite resin (IRCR) (Ariston pHc), and to compare it intra-individually with a universal hybrid composite resin and enamel. Each of 19 subjects received one proximal restoration of the IRCR, one proximal universal hybrid composite resin restoration (CR) and each subject had one non-filled proximal enamel control surface to make intra-individual comparisons possible. To avoid peak ion releases from the materials, aged restorations were studied. Plaque was collected from 57 surfaces using sterile applicator tips. Samples were cultured to determine the numbers of mutans streptococci, lactobacilli, and total microorganisms. The relative numbers for mutans streptococci (% of total bacteria) were: IRCR 0.59%, CR 0.40%, enamel 0.22%. Two outliers were found in the IRCR group. Excluding these outliers resulted in a relative number of 0.33%. Lactobacilli were detected in the plaque from only 9 surfaces and at very low relative proportions for all three surfaces: 0.01%. The enamel surfaces showed the lowest relative numbers of mutans streptococci and lactobacilli, but the differences were not significant. It can be concluded that the ion release of the IRCR did not influence the growth of cariogenic microorganisms in dental plaque.

  • 34.
    Persson, Anitha
    et al.
    Umeå University, Faculty of Medicine, Odontology, Dental Hygiene.
    Lingström, P
    Bäcklund, T
    Umeå University, Faculty of Medicine, Radiation Sciences.
    van Dijken, Jan
    Umeå University, Faculty of Medicine, Odontology, Dental Hygiene.
    Evaluation of a skin reference electrode used for intraoral pH measurements in combination with a microtouch electrode2004In: Clinical Oral Investigations, ISSN 1432-6981, E-ISSN 1436-3771, Vol. 8, no 3, p. 172-175Article in journal (Refereed)
    Abstract [en]

    The aim of this in vivo study was to evaluate a skin reference electrode used with the microtouch method for measurements of intraoral pH. Registrations of plaque pH were made in ten healthy subjects before and up to 30 min after a mouth rinse with 10% sucrose. A microtouch electrode (Beetrode) was used in combination with two different half-cell reference electrodes: a skin silver-silver chloride plate or a glass capillary reference electrode. The skin electrode was placed on the subject's forearm in combination with a conductive gel. The glass capillary electrode, together with one of the test subject's fingers, was placed in a beaker with a 3 M KCl solution. High agreement between the two reference systems resulted in almost identical plaque-pH curves (r=0.97). The mean differences between the two systems at the different time points varied between -0.15 and +0.01 pH units, with an overall mean pH difference of 0.03 pH units. It can be concluded that the use of the skin reference electrode may very well replace the traditional reference electrode used in combination with a microtouch electrode for intraoral use.

  • 35.
    Persson, Anitha
    et al.
    Umeå University, Faculty of Medicine, Odontology, Dental Hygiene.
    Lingström, P
    van Dijken, Jan
    Umeå University, Faculty of Medicine, Odontology, Dental Hygiene.
    Effect of a hydroxyl ion-releasing composite resin on plaque acidogenicity2005In: Caries Research, ISSN 0008-6568, E-ISSN 1421-976X, Vol. 39, no 3, p. 201-206Article in journal (Refereed)
    Abstract [en]

    The aim of this in vivo study was to evaluate the neutralizing capacity, registered as change of plaque acidogenicity, on aged proximal restorations of an ion-releasing composite resin (IRCR), which releases hydroxyl, calcium, and fluoride ions at low pH. Twenty patients, with a mean age of 63 years (range 43-85), participated. All had one aged proximal IRCR restoration (mean age 15 months) and one nonrestored enamel surface to make an intraindividual comparison possible. The neutralizing effect of the IRCR was evaluated by measuring plaque pH, using the microtouch method, after a mouthrinse with 10% sucrose. The plaque pH measurements were repeated 1.5 years later on the IRCR (mean age 34 months), the enamel surfaces and a universal hybrid composite resin (CR). At both 15 and 34 months, the plaque on the IRCR surfaces showed the least acidogenic potential for the whole 60-min time interval. The largest differences between the IRCR, CR and enamel were found during the first 15 min. At 15 months, the total areas under the plaque pH curve (AUC(5.7) and AUC(6.2)) differed significantly between the IRCR and enamel surfaces for the time periods 0-5 min and 5-15 min. At 34 months, significant differences were found between IRCR and CR at the 0- to 5-min time period. It can be concluded that IRCR restorations countered the plaque pH fall and maintained it at levels where less enamel and dentin demineralization can occur. Copyright (c) 2005 S. Karger AG, Basel.

  • 36.
    Persson, Anitha
    et al.
    Umeå University, Faculty of Medicine, Odontology, Dental Hygiene.
    Lingström, Peter
    Bergdahl, Maud
    Claesson, Rolf
    Umeå University, Faculty of Medicine, Odontology.
    van Dijken, Jan
    Umeå University, Faculty of Medicine, Odontology, Dental Hygiene.
    Buffering effect of a prophylactic gel on dental plaque in institutionalised elderly2007In: Gerodontology, ISSN 0734-0664, E-ISSN 1741-2358, Vol. 24, no 2, p. 98-104Article in journal (Refereed)
    Abstract [en]

    Objectives: The effect of multiple daily applications of a prophylactic gel, with buffering substances, on plaque acidogenicity in elderly institutionalised individuals was evaluated. Background: Many elderly suffer from reduced salivary flow, poor oral hygiene and increased levels of cariogenic bacteria and are considered to be at an increased risk for coronal and root caries. Reinforcing the buffering capacity of dental plaque by the addition of substances such as bicarbonate and phosphates may decrease their caries activity. Materials and methods: Fourteen elderly, with subjective dry mouth, were treated for 16-day-periods at random with: (i) Profylin fluoride gel with buffering components; (ii) Profylin fluoride gel without buffering components and (iii) rinsing with water. Applications were made four times a day and each period was followed by a 2-week wash-out period. The plaque pH was registered after a carbohydrate challenge and the following were recorded before and after each test period: stimulated salivary secretion rate, buffer capacity, number Colony Farming Units (CFU) mutans streptococci, lactobacilli and a sample of Candida albicans on oral mucosa. Results: Eleven participants (mean age 76.6 years) fulfilled the study. Changes in plaque pH measurements, when calculated as area under the curve (AUC(6.2) and AUC(5.7)) values (pH x min), before and after each of the three treatments, showed no significant differences. A tendency to a higher plaque acidogenicity and amount of cariogenic microorganisms was found after the gel treatments. C. albicans was found in low levels. Conclusion: Frequent applications of the gel did not result in an improved neutralising effect in the elderly. This may be caused by a combination of several factors, such as the level of oral dryness of the individuals and low solubility, release and retention of the gel substances in plaque. Instead, an increased plaque acidogenicity was noted.

  • 37.
    Persson, Anitha
    et al.
    Umeå University, Faculty of Medicine, Odontology, Dental Hygiene.
    Lingström, Peter
    Bergdahl, Maud
    van Dijken, Jan
    Umeå University, Faculty of Medicine, Odontology, Dental Hygiene.
    Buffering effect of a prophylactic gel on dental plaque.2006In: Clinical Oral Investigations, ISSN 1432-6981, E-ISSN 1436-3771, Vol. 10, no 4, p. 289-295Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to evaluate the effect of a new prophylactic gel on plaque pH and plaque fluoride concentration. Twelve participants with normal (n=6, >/=0.7 ml/min) and low (n=6, <0.7 ml/min) stimulated whole salivary secretion rate were included. After 3 days of plaque accumulation, at random the participants were (1) treated with Profylin fluoride gel with buffering components (active gel), (2) treated with Profylin fluoride gel without buffering components (placebo gel), (3) asked to rinse with water, and (4) given no treatment. All test series were followed by rinsing with a nutrition solution; after which registration of plaque pH was performed during 60 min. There were two drop outs with low salivary secretion rate in the water session. The overall least pronounced pH fall was found after the use of the prophylactic gel. Significant differences between the prophylactic gel and the placebo gel were found for the participants with normal secretion rate. Fluoride plaque concentrations evaluated in 12 individuals after (1) application of the active gel, (2) rinsing with 0.2% NaF, and (3) rinsing with water showed significantly higher values after rinsing with the NaF solution. It can be concluded that application of the active gel, particularly in subjects with normal salivary secretion rate, in general, buffered plaque pH to higher levels. Factors like concentration of buffering agent and solubility of the gel need to be further evaluated to improve the effect.

  • 38. Samuelsson, Roy
    et al.
    van dijken, Jan
    Umeå University, Faculty of Medicine, Department of Odontology.
    Microinvasive tooth preparation for bonded ceramic restorations2013In: The American Journal of Esthetic Dentistry, ISSN 2162-2841, Vol. 3, no 2, p. 112-123Article in journal (Refereed)
    Abstract [en]

    Bonded ceramics and especially porcelain veneers have long been regarded as a less invasive method of fixed prosthodontic treatment. The guidelines for tooth preparation associated with traditional full crowns are long established; unfortunately, there are no such preparation guidelines regarding bonded ceramics, and a number of different approaches have been described in the literature. It may seem that deviating from a full-crown preparation will automatically lead to a more minimally invasive treatment. However, when scrutinizing the photographs and procedures described in the literature, significant tooth reduction can often be seen even if the stated goals were to remove as little tooth substance as possible and confine the preparation to enamel. Thus, this paper discusses minimally invasive approaches to tooth preparation when using bonded ceramic restorations.

  • 39.
    Sjögren, Göran
    et al.
    Umeå University, Faculty of Medicine, Odontology, Dental Materials Science.
    Molin, Margareta
    Umeå University, Faculty of Medicine, Odontology, Dental Materials Science.
    van Dijken, Jan
    Umeå University, Faculty of Medicine, Odontology, Dental Materials Science.
    A 10-year prospective evaluation of CAD/CAM-manufactured (Cerec) ceramic inlays cemented with a chemically cured or dual-cured resin composite2004In: International Journal of Prosthodontics, ISSN 0893-2174, E-ISSN 1139-9791, Vol. 17, no 2, p. 241-246Article in journal (Refereed)
    Abstract [en]

    PURPOSE: The present follow-up study was carried out to evaluate the performance of Class II Cerec inlays after 10 years of clinical service. MATERIALS AND METHODS: Sixty-six Class II CAD/CAM ceramic inlays were placed in 27 patients. Each patient received at least one inlay luted with a dual-cured resin composite and one inlay luted with a chemically cured resin composite. At the 10-year recall, 25 (93%) patients with 61 (92%) inlays were available for evaluation using a slight modification of the USPHS criteria. RESULTS: Fifty-four (89%) of the 61 inlays reevaluated still functioned well at the 10-year recall. During the follow-up period, seven (11%) of the inlays required replacement because of: four inlay fractures, one cusp fracture, endodontic problems in one case, and postoperative symptoms in one case. All the replaced inlays had been luted with the dual-cured resin composite. The fractured inlays were all placed in molars. The estimated survival rate after 10 years was 89%, 77% for the dual-cured resin composite-luted inlays and 100% for the chemically cured resin composite-luted ones. The difference was statistically significant. CONCLUSION: Patient satisfaction with and acceptance of the Cerec inlays were high, and the performance after 10 years of clinical service was acceptable, especially regarding the inlays luted with the chemically cured resin composite. The properties of the luting agents seem to affect the longevity of the type of ceramic inlays evaluated.

  • 40.
    Stefanski, Sebastian
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    van Dijken, Jan W V
    Umeå University, Faculty of Medicine, Department of Odontology.
    Clinical performance of a nanofilled resin composite with and without an intermediary layer of flowable composite: a 2-year evaluation2012In: Clinical Oral Investigations, ISSN 1432-6981, E-ISSN 1436-3771, Vol. 16, no 1, p. 147-153Article in journal (Refereed)
    Abstract [en]

    The objective of this prospective clinical follow-up was to evaluate the 2-year clinical performance of a nanofilled resin composite in class II restorations. The restorations were made with and without intermediary layer of a nanofilled flowable resin composite studied in an intraindividual comparison. Each participant received at least two, as similar as possible, class II restorations of the nanofilled resin composite. One restoration of each pair (54) was chosen at random to be restored with an intermediary layer with flowable nanofilled resin composite. The other was restored without. The restorations were evaluated with slightly modified US Public Health Services criteria at baseline, 1, and 2 years. Ninety-two restorations, 46 pairs, were evaluated at 2 years. A prediction of the caries risk showed that 22 of the evaluated 48 patients were considered as high-risk patients. Two failures were observed, one in each group, resulting in a 2.2% failure rate. No statistical difference was seen between the restorations restored with and without layer of flowable resin composite. The nanofilled resin composite showed very good surface characteristics and color match, which did not change significantly during the follow-up period. The nanofilled resin composite showed a good clinical performance with a 2.2% failure rate after 2 years. No differences were observed between the restorations with and without the nanofilled flowable resin intermediary layer.

  • 41.
    Sunnegårdh-Grönberg, Karin
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Dijken, Jan W. V. van
    Umeå University, Faculty of Medicine, Department of Odontology.
    Surface roughness of a novel "ceramic restorative cement" after treatment with different polishing techniques in vitro2003In: Clinical Oral Investigations, ISSN 1432-6981, E-ISSN 1436-3771, Vol. 7, no 1, p. 27-31Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to determine the surface roughness of a novel calcium aluminate cement (CAC) intended for posterior restorations after treatment with different polishing devices in vitro. Forty-eight CAC specimens were polished with diamond burs at 15,550 rpm or 27,000 rpm, Sof-Lex discs, Jiffy points, Shofu silicone points, and Aaba universal polisher. Amalgam specimens were polished with Shofu silicone points and used as reference. Roughness was measured using a profilometer. The smoothest CAC surface was observed after use of the fine Sof-Lex disc (roughness average [Ra] 0.26 mm). Diamond burs at higher speed, points, and polisher gave rather similar results (Ra 0.58–0.72 mm). An increase in surface roughness could be seen from using diamond burs at lower speed (Ra 2.3 mm). Extra fine Shofu points and Sof-Lex discs as a final step reincreased surface roughness. Polished amalgam showed the smoothest surface in the study (Ra 0.17). It can be concluded that the smoothest CAC surfaces were obtained with the fine Sof-Lex discs. Different polishing points and diamond burs at higher speed, which are suitable polishing devices for posterior restorations, also gave relatively smooth surfaces.

  • 42.
    Sunnegårdh-Grönberg, Karin
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Dijken, Jan W. V. van
    Umeå University, Faculty of Medicine, Department of Odontology.
    Funegård, Ulrika
    Umeå University, Faculty of Medicine, Department of Odontology.
    Lindberg, Anders
    Umeå University, Faculty of Medicine, Department of Odontology.
    Nilsson, Mats
    Futurum, County Hospital Ryhov, 551 85 Jönköping, Sweden.
    Selection of dental materials and longevity of replaced restorations in Public Dental Health clinics in northern Sweden.2009In: Journal of Dentistry, ISSN 0300-5712, E-ISSN 1879-176X, no 37, p. 673-678Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To investigate the selection of direct restorative materials and longevity of replaced restorations in relation to operator and patients characteristics. METHODS: A cross-sectional study of treatment in practice, recording all new placements and replacements of direct restorations was performed during 2 weeks comprising all dentists within the Public Dental Health clinics in the county council of Västerbotten. RESULTS: A total of 2834 data collection sheets, one for each placed restoration, were received with a dropout of 10%. Restorations analyzed in the study were placed in permanent teeth in patients older than 15 years. First restorations placed due to primary caries were 671 and replacements 1536. Class II was the most frequently treated cavity followed by class I. The median longevity of replaced restorations was for amalgam, resin based composite and glass ionomer 16, 6 and 11 years, respectively. High caries risk patients showed shorter longevity for resin based composite restorations than low or moderate risk patients. Secondary caries as reason for failure for class II resin based composite restorations occurred significantly later than loss or fracture. Significantly longer longevity was observed for replaced restorations executed by more experienced dentists. CONCLUSIONS: The use of amalgam was negligible and the material was predominantly replaced by resin based composites in first and replaced restorations. Class II was the most frequent placed and replaced restorations. Caries risk and experience of operator influenced longevity of replacements.

  • 43.
    Sunnegårdh-Grönberg, Karin
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology, Cariology. Umeå University, Faculty of Medicine, Department of Odontology.
    Dijken, Jan W. V. van
    Umeå University, Faculty of Medicine, Department of Odontology, Dental Hygiene. Umeå University, Faculty of Medicine, Department of Odontology.
    Lindberg, A
    Hörstedt, Per
    Umeå University, Faculty of Medicine, Department of Medical Biosciences.
    Interfacial adaptation of a calcium aluminate cement used in class II cavities, in vivo2004In: Clinical Oral Investigations, ISSN 1432-6981, E-ISSN 1436-3771, Vol. 8, no 2, p. 75-80Article in journal (Refereed)
    Abstract [en]

    The aim of this in vivo study was to evaluate the interfacial marginal adaptation of a calcium aluminate cement, Doxadent (DD), and to compare it intra-individually with a resin composite, Tetric Ceram/Syntac Single-Component (TC/SS), in Class II cavities. Sixteen Class II box-shaped, enamel-bordered cavities were prepared in eight premolars scheduled to be extracted after 1 month's service for orthodontic reasons. The interfacial marginal adaptation (internal surfaces) of the restorations was evaluated by a quantitative scanning electron microscope analysis using a replica method. DD showed a statistically significant, lower degree of gap-free adaptation to enamel compared with TC/SS: 84% vs. 93%. To dentin, DD showed a significantly better adaptation than TC/SS: 72% vs. 49%. A high frequency of enamel fractures perpendicular to the margins was observed for the DD restorations, which may be explained by an expansion of the calcium-aluminate cement. It can be concluded that DD showed a better adaptation to dentin while TC/SS showed a better adaptation to enamel. The dimensional changes of DD have to be investigated before clinical use can be recommended.

  • 44.
    Sunnegårdh-Grönberg, Karin
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology, Dental Hygiene. Umeå University, Faculty of Medicine, Department of Odontology.
    Peutzfeldt, Anne
    Department of Dental Materials, School of Dentistry, University of Copenhagen, Denmark.
    Dijken, Jan W. V. van
    Umeå University, Faculty of Medicine, Department of Odontology.
    Flexural strength and modulus of a novel ceramic restorative cement intended for posterior restorations as determined by a three-point bending test2003In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 61, no 2, p. 87-92Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to compare a new restorative cement intended for posterior restorations, Doxadent, with other types of tooth-colored materials as regards flexural strength and flexural modulus. The new restorative material consists mainly of calcium aluminate. Four hybrid resin composites, one polyacid-modified resin composite, one resin-modified glass ionomer cement, one conventional glass ionomer cement, one zinc phosphate cement, and an experimental version as well as the marketed version of Doxadent were investigated. Flexural strength and flexural modulus were tested according to ISO standard 4049 and determined after 1 d, 1 week, and 2 weeks. Together with the zinc phosphate cement, Doxadent had the lowest flexural strengths (13-22 MPa). The strongest materials were the resin composites and the polyacid-modified resin composite (83-136 MPa). The highest flexural modulus was found for Doxadent (17-19 GPa). The flexural strength of Doxadent decreased significantly from 1 week to 2 weeks, while flexural modulus remained unchanged. The other materials reacted in different ways to prolonged water storage. It can be concluded that the restorative cement Doxadent had significantly lower flexural strength and significantly higher flexural modulus than today's materials used for direct posterior restorations.

  • 45.
    Sunnegårdh-Grönberg, Karin
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Peutzfeldt, Anne
    Department of Dental materials, School of Dentistry, University of Copenhagen, Denmark.
    Dijken, Jan W. V. van
    Umeå University, Faculty of Medicine, Department of Odontology.
    Hardness and in vitro wear of a novel ceramic restorative cement2002In: European Journal of Oral Sciences, ISSN 0909-8836, E-ISSN 1600-0722, Vol. 110, no 2, p. 175-178Article in journal (Refereed)
    Abstract [en]

    The aim of the present work was to compare a new ceramic restorative cement for posterior restorations, DoxaDent, with other types of tooth-colored materials for direct use as regards hardness and in vitro wear. Four hybrid resin composites, one polyacid-modified resin composite, one resin-modified glass ionomer cement, one conventional glass ionomer cement, one zinc phosphate cement, an experimental version as well as the marketed version of the ceramic restorative cement, were investigated. Hardness of the materials was tested with the Wallace indentation tester and wear was tested with the ACTA wear machine. All tests were carried out on 2-wk-old specimens. DoxaDent was as hard as the zinc phosphate cement and the hardest resin composite. The ceramic restorative cement wore significantly more than the resin composites, the same as the zinc phosphate cement, and less than the glass ionomer cements. No correlation between hardness and wear was found. It can be concluded that the ceramic restorative cement is a rather hard material but with a relatively low wear resistance.

  • 46.
    van Dijken, Jan
    Umeå University, Faculty of Medicine, Odontology, Dental Hygiene.
    A 6-year clinical evaluation of Class I poly-acid modified resin composite/resin composite laminate restorations cured with a two-step curing technique.2003In: Dental Materials, ISSN 0109-5641, E-ISSN 1879-0097, Vol. 19, no 5, p. 423-428Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Polymerization shrinkage is still one of the main disadvantages of resin composite restorations (RC). Especially in cavities with a high C-factor, debonding can occur. A laminate restoration including a base with a more elastic behavior might result in a better adaptation. The purpose of this study was to evaluate the durability of a combination of two techniques suggested to counter the stress formation in direct RC restorations in cavities with the highest C-factor. METHODS: Each of the 29 patients received one or two pair(s) of Class I restorations. The first restoration was a poly-acid modified resin composite/resin composite (PMRC/RC) sandwich restoration and the second a direct RC restoration. Both restorations, except for the PMRC layer, were placed with oblique layering and two-step curing technique. Ninety restorations, 23 premolar and 67 molars, were evaluated annually with slightly modified USPHS criteria during 6 years. RESULTS: At 6 years, 41 pairs were evaluated. A cumulative failure rate of 2.4% was observed for both the RC and the laminate restorations. One laminate restoration showed non-acceptable color match, but was not replaced and one RC restoration showed non-acceptable marginal adaptation. Two cases of slight postoperative sensitivity were observed in one patient. Three restorations were partially replaced due to primary proximal caries. SIGNIFICANCE: A high durability for and no differences, were observed between both restorative techniques in Class I cavities.

  • 47.
    van Dijken, Jan
    Umeå University, Faculty of Medicine, Odontology, Dental Hygiene.
    Durability of three simplified adhesive systems in Class V non-carious cervical dentin lesions.2004In: American Journal of Dentistry, ISSN 0894-8275, Vol. 17, no 1, p. 27-82Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To investigate the durability of three simplified systems in Class V non-carious abrasion/erosion lesions. METHODS: 144 non-carious cervical dentin lesions were restored either with Clearfil Liner Bond 2, a 2-step self-etching primer (n = 46), One Coat Bond, a one bottle total-etch system applied with one coat (n = 46), or Prompt-L-Pop, a 1-step self-etching primer ("all-in-one") (n = 52), in 90 individuals. Ninety-eight of the lesions showed sclerotic dentin and 46 were non-sclerotic. Sixty-one were slightly roughened with a diamond bur before conditioning. The restorations were evaluated every 6 months during a 2-year period with slightly modified USPHS criteria. RESULTS: All except three restorations were evaluated over 2 years. The cumulative loss rates for Clearfil Liner Bond 2, One Coat Bond and Prompt-L-Pop were at 6 months: 4.3, 2.2 and 3.9%, at 18 months: 4.3, 10.9 and 15.4% and at 24 months: 8.7, 13.0 and 21.2%, respectively. The cumulative loss rates of the materials in sclerotic lesions (15.7%) versus non-sclerotic lesions (14.0%) were not significanty different. Restorations placed with a diamond bur-roughened lesions showed a loss rate of 14.5%, while for the non-roughened lesions the frequency was 14.8%.

  • 48.
    van Dijken, Jan
    Umeå University, Faculty of Medicine, Odontology, Dental Hygiene.
    Resin-modified glass ionomer cement and self-cured resin composite luted ceramic inlays. A 5-year clinical evaluation.2003In: Dental Materials, ISSN 0109-5641, E-ISSN 1879-0097, Vol. 19, no 7, p. 670-674Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: This study evaluated IPS Empress ceramic inlays luted with two chemical-cured luting agents, a resin-modified glass ionomer cement (Fuji Plus (F)) and a resin composite (RC) (Panavia 21 (P)). METHODS: Seventy-nine ceramic inlays were placed in Class II cavities in 29 patients. At least two inlays were placed in each patient to compare the luting techniques intra-individually. In each patient half of the inlays were luted with F and the other half with P. The inlays were evaluated clinically, according to modified USPHS criteria (van Dijken, 1986), at baseline, after 6 months, and yearly during 5 years. RESULTS: At 5 years, 71 inlays were evaluated. Two small partial fractures were observed at 3 years (1P, 1F). One inlay showed recurrent root caries at 4 years (P). Four inlays, two in each group showed non-acceptable color match (2P, 2F). Small defects were observed in 4 inlays (2P, 2F). A slight ditching of the cement margins was observed in both luting groups but did not seem to increase during the second half of the evaluation. No significant difference in durability was observed between the two luting agents. SIGNIFICANCE: IPS Empress inlays luted with the chemical-cured RC and the resin-modified glass ionomer cement functioned satisfactory during the 5 years follow-up.

  • 49.
    van Dijken, Jan
    Umeå University, Faculty of Medicine, Odontology, Dental Hygiene.
    Retention of a resin-modified glass ionomer adhesive in non-carious cervical lesions. A 6-year follow-up.2005In: Journal of Dentistry, ISSN 0300-5712, E-ISSN 1879-176X, Vol. 33, no 7, p. 541-547Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: The purpose of this study was to evaluate the clinical retention of a new resin-modified glass ionomer cement based adhesive combined with a hybrid resin composite or a poly-acid modified resin composite in non-carious cervical lesions during a 6-year period. METHODS: The resin-modified glass ionomer adhesive (Fuji Bond LC), was placed in 73 cervical lesions, 36 with a universal hybrid resin composite (Tetric Ceram) and 37 with a poly-acid modified resin composite (Hytac). Fifty-one in lesions with sclerotic dentin and 22 in non-sclerotic ones. Of the sclerotic lesions 38 were slightly roughened with a diamond bur before conditioning. The restorations were evaluated with slightly modified USPHS criteria every six months during a 6-year period. RESULTS: All except six restorations were evaluated during the 6 years. Twelve (17.9%) were lost, four Tetric Ceram (11.8%) and eight Hytac (24.2%) (p<0.05). Four were found in non-sclerotic lesions (20.0%) and eight in sclerotic lesions (17.0%). The differences between the sclerotic and non-sclerotic and the roughened and non-roughened lesions were not significant. CONCLUSIONS: The resin-modified glass adhesive showed a superior clinical retention combined with the resin composite material, with an annual failure rate of 2%.

  • 50.
    van Dijken, Jan
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Hasselrot, Lars
    A prospective 15-year evaluation of extensive dentin-enamel-bonded pressed ceramic coverages2010In: Dental Materials, ISSN 0109-5641, E-ISSN 1879-0097, Vol. 26, no 9, p. 929-939Article in journal (Refereed)
    Abstract [en]

    The popularity of tooth-colored posterior restorations has increased during the last years because of a growing demand for esthetics and concern about the biocompatibility of amalgam [1]. Applying the adhesive bonding concept, several dental ceramic systems have been used during the last decades for veneer, inlay and onlay restorations [2]. Most ceramic materials can be bonded to the underlying conditioned tooth surface after etching with hydrofluoric acid or ammonium bifluorid, mediated by use of an enamel/dentin bonding system and a resin composite luting material. Acid etching increase surface roughness and wetting of enamel, dentin and ceramic surfaces, which promote mechanical interlocking of resin bonding systems.

     

    Bulk fracture and loss of restoration have been reported as the main reasons of failure in short-term evaluations of inlays and onlays [3]. Leucite-reinforced glass–ceramic inlays showed improved clinical durability compared to fired ceramics [3], [4] and [5]. The advantage of bonded ceramics can be expected in the extremely non-retentive coverage situation [6], [7], [8] and [9]. Traditional crown preparation techniques will in these cases occasionally result in extensive preparation and/or endodontic treatment in combination with a post and core placement in order to obtain retention. The minimal preparation for the bonded ceramic is less traumatic for the tooth, and pulp vitality can be preserved [9]. There are few preparation design standards for the ideal dentin–enamel-bonded crowns, and Burke [10] showed in vitro no differences between varying degrees of tooth preparation to enhance protection to fracture. The durability of the bonded ceramic will depend on the strength of the bond between tooth, luting system and ceramic and on the inherent strength of the ceramic. The use of chemically cured resin composite cements have been suggested to obtain optimal conversion and decreased stress formation during polymerization [5] and [11].

    Few studies report the longevity of dentin–enamel-bonded all-ceramic crowns also defined as “partial or full coverage restorations in which an all-ceramic is bonded to the underlying dentin and any available enamel using a resin luting material” [1], [9], [12], [13] and [14]. In a systematic review assessing the 5-year survival rates of single crowns, densily sintered aluminum crowns and reinforced glass–ceramic crowns (Empress) showed survival rates comparable to those seen for porcelain-fused-to-metal (PFM) crowns [15]. The short-term results of the extensive adhesively luted coverages are promising but clinical long-term data are not available [9]. The aim of this study was to investigate the long-term durability of these extensive dentin–enamel-bonded posterior ceramic coverages. In addition the effect of luting cement, bonding system and preparation type was studied. The hypothesis tested was that there was (1) no difference in durability for the ceramic coverage placed with different luting agents and different bonding agents, and (2) no difference in durability between vital and endodontic treated teeth.

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