Comparison of objective indicators of various properties of photocomposite materials with the subjective assessment of dentists

Skripkina G.I., doctor of medical sciences, associate professor, Head of the Department
Garifullina A.Zh., candidate of Medical Science, associate professor
Breslavskaja E.A., clinical resident

Abstract

Relevance. Composite materials of light curing have a large number of indications for use and are actively used by dentists in clinical practice. The properties of these materials differ from their composition and the size of the filler. We conducted a survey of dentists of general practitioners of public and private dental clinics in Omsk to determine compliance, objective indicators of physico-chemical parameters of the studied composite materials and their subjective assessment by doctors using these materials in their work.

Aim. comparison of objective indicators of various properties of photocomposite materials with the subjective assessment of dentists.

Materials and methods: the study of the physicochemical properties of light-cured composite materials most commonly used in the practice of Omsk dentists in public and private clinics. A research design was developed and a survey of 148 dentists in Omsk was conducted to determine the subjective assessment of these materials.

Results: a comparative analysis of the objective and subjective indicators of composite materials.

Conclusions: the physicochemical parameters of the photocomposite materials are fully consistent with the subjective assessment of dentists in Omsk.

Keywords: Dental materials, composite materials, fluid composites, material properties, survey, questionnaire, dentists

Introduction

For curing carious and non-carious lesions of teeth modern dentistry primarily uses photocomposite filling materials thanks to their positive esthetic and mechanical characteristics [1, 2, 3, 4]. Composite materials allow sparing teeth preparation, recovery of teeth with defects of various form and configuration and have a number of physical-chemical advantages: high esthetic properties, high strength, wide color range [5, 6, 7], possibility to model and to create anatomic form of the crown part of damaged tooth, stronger connection with hard tissues of tooth, better adhesion to hard tissues of tooth, bio-tolerance to oral mucosa tissues [8, 9, 10, 11, 12, 13]. But these materials are also not perfect and there is a constant process of their improvement [14, 15, 16, 17].

The aim of current work is to compare objective indicators of various properties of photocomposite materials with the subjective assessment of these materials by dentists, with the view to formulate practical recommendations for doctors dentists practitioners.

Tasks: 1. Assessment of physicochemical properties of some light-cured composite materials. 2. Getting subjective assessments of composite materials by dentists of Omsk city. 3. Analysis of objective and subjective parameters, for formulating practical recommendations for doctors dentists practitioners

Materials and methods of the study

At present there is a large variety of photocomposite materials, both foreign and national-made. For the study we have chosen materials which are most commonly used in the practice of Omsk dentists in public and private clinics on the basis of survey, with the view to get subjective assessment of these products.

The following methods have been used in this work: sociologic, analytical. We have worked out research design, the questionnaire for comparing subjective assessment of composite materials with their physic-chemical properties.

Analysis of physic-chemical properties of materials was carried out in June 2019 by the Testing certified center of MI ANO VNIIMT headed by B.V.Riabokon. The tests were done in accordance with national standards: GOST Р 56924 - 2016 (ИСО 4049 - 2009) «Dentistry. Polymer restorative materials» and GOST 31574-2012 «Polymer restorative dental materials». The materials were tested to the following parameters: polymerization depth, diametric strength, flexural strength, consistence.

The following composite materials were assessed in the present work (name/characteristics correspond to official registration documents):

1. Filtek Ultimate Universal (3M ESPE) – universal restorative material.
2. Estelux NC (Stomadent) – nano-hybride composite material.
3. Dentlight (Vladmiva) – micro-hybride composite.
4. Filtek Ultimate Flowable (3M ESPE) – flowable restorative material.
5. Flowrest (Stomadent) – low-module (flowable) composite
6. Dentlight flow (Vladmiva) – flowable composite.

The materials differ not only be their prices, but also by their properties, which influence the work and its results. In first 3 items (solid composites) only registration documents of Estelux NC (Stomadent) contain the word «nano-hybride»; but in two other cases both producers position these products as «nanocomposites» and as materials made with the use of nano-additives – which is indicated on the websites of producers and in their catalogues and presentation materials.

Results of analysis and their discussion:

A survey of 148 dentists in Omsk has been conducted. In state-owned clinics we have surveyed 92 dentists, including 44,44% having work experience of over 10 years, 22,22% - 5-10 years and 33,33% - less than 5 years.

In private clinics we have surveyed 56 dentists, including 9,52% having work experience of over 10 years, 52,38% - 5-10 years and 38,09% - less than 5 years.

While performing restoration 59,25 % of dentists of state-owned clinics use a combination of solid and flowable composites, the rest 40,74 % - only solid composites. In private clinics this proportion is different. The combination «solid and flowable composite» use by restoration 95,23 % of dentists.

The largest number of surveyed dentists of state and private clinics – 85% use flowable composites for fissure sealing. 78% use these materials while using the method of flaky restoration. 77% - for restoration of small fragments of enamel. 59% of dentists prefer flowable materials while making Class 2 restoration according to Black when they use technique of tunnel preparation. Small preponderance was for the private clinics. When restoring edge fit flowable composites are used by 50% of doctors. 59% of surveyed doctors fill with flowable composites small cavities on the chewing surface. 43% - wedge and neck defects. 30% - cavities of Class 3 and 4 according to Black. 36% of surveyed fix fiber systems and 21% - make splintage, using flowable composites. The majority of them are doctors of private clinics.

Solid composites are used by doctors in the following cases. 95% use these materials while restoring cavities of Class 1, 2 according to Black. 78% - while using the method of flaky restoration. 91% model the tooth core by solid composites. The smallest number in both groups – 13% use these materials while making indirect restorations. In two last cases a small preponderance is for the private clinics.

The objective assessment of materials is presented in Table 1 and is represented by the following parameters: polymerization depth, diametric strength, flexural strength, consistence. In the column headed as «Note’ there is a description of tactile properties and strength

Table 1. Objective assessment of the physical and chemical properties of the materials under study

The tests were carried out in accordance with the requirements of national standards:

• GOST R 56924-2016 (ISO 4049-2009) «Dentistry. Polymer restorative materials»;
• GOST 31574-2012 "Dental Polymer restorative materials». Specifications. Test methods of claim 6, 12.

The materials Filtek Ultimate Universal (3M ESPE) and Dentlight Flow (Vladmiva) are used equally doctors of private and state-owned clinics, Estelux NC (Stomadent), Dentlight (Vladmiva) and Flowrest (Stomadent) are used by the majority of doctors of state clinics, Filtek Ultimate Flowable (3M ESPE) – the majority of doctors of state clinics.

By objective parameters among solid materials under study Filtek Ultimate Universal and Estelux NC are practically at the same level. Filtek Ultimate Universal has better diametric and flexural strength, but Estelux NC has better actual depth of cure and depth of cure for 10 seconds. These parameters are reflected in the durability and satisfaction of the restoration quality and its long-term results of the doctors – both materials received the highest estimates. In Table 1 column «Note» among the positive characteristics of Filtek Ultimate Universal there is density, which fully corresponds to the estimate «excellent» of doctors by this parameter. The same estimate received Estelux NC. Excellent plasticity and styling qualities are found in the table of objective indicators and correspond to the doctors’ opinion. As for «Adhesion to the tool», the doctors concluded that Filtek Ultimate Universal sticks less to the tool than Estelux NC and Dentlight. Filtek Ultimate Universal and Estelux NC are better polished than Dentlight (see Figure 1). According to objective data Dentlight longer time of cure, lower depth of cure and diametric strength than the other solid composites under study. Big variation of values of flexural strength is yet another drawback of this material. The majority of qualities of this material was assesses by doctors as «good» which is a stable good result.

Figure 1. Results of subjective evaluation of the properties of solid composite materials on a 10-point system.

Among flowable materials under study in Table 1 (objective data) the lowest position is held by Dentlight Flow. Flowrest is behind Filtek Ultimate Flowable by flexural and diametric strength. The latter has medium consistency parameter among the flowable materials under study. In survey of dentists’ opinions Flowrest received the biggest number of «excellent» and «good» marks. This material is thixotropic and does not spread (see Table 1), respectively it is easy to insert and remove from the cavity. It is necessary to note that this material is used by only 8% of the doctors. Filtek Ultimate Flowable is also thixotropic and does not spread, which was noted by doctors who have given «excellent» mark to such properties as «Plasticity», «Ease of insertion and removal from the cavity» and «good» mark to «Thixotropy». In general surveyed doctors which used this material are satisfied by the quality of restoration. Dentlight Flow received from doctors «satisfactory» mark for majority of qualities, not a single quality of this material is not fully satisfactory for them. For the quality of «Styling» all flowable materials received «satisfactory» mark, which is logically explained by their physical-chemical properties (consistence, flow ability) and indications for use (see Figure 2).

Figure 2. Results of subjective evaluation of the properties of flowable composite materials on a 10-point system.

Conclusions

On the basis of subjective assessment of materials under study, received in the course of survey of dentists therapists of Omsk city and taking into account objective tests of their parameters we have made the following conclusions. The physicochemical parameters are fully consistent with the subjective assessment of doctors. Among the group of solid composite materials by objective criteria the leading position is held by Filtek Ultimate Universal (3M ESPE), this is supported by opinions of dentists. Estelux NC holds the second place by objective parameters but by subjective assessment stands practically as high as the leader.

In the assessment of flowable materials the doctors have given first hand to Flowrest (Stomadent). It is necessary to note that it is only 8% of the surveyed. Filtek Ultimate Flowable (3M ESPE) by objective criteria is ahead of Flowrest, but by subjective assessment holds the second place. The doctors are equally satisfied by restoration results of both materials.

We recommend for clinical use solid composite materials – Estelux NC, Filtek Ultimate Universal and flowable materials – Flowrest and Filtek Ultimate Flowable – for private and state-owned dental clinics, depending on their pricing policy.

Bibliography

1. Алейников К.В., Вагнер В.Д. Эффективность дозирования композитныx материалов светового отверждения при стандартной и модифицированной методикаx // Стоматология для всеx. 2010;4:16-18. [Alejnikov K.V., Vagner V.D. Efficiency of dosing of composite materials for light curing with standard and modified methods // Stomatologija for all. 2010;4:16-18. (In Russ.)]
2. Викулин А.В., Маркин А.В. Результаты применения низкомодульного композитного материала светового отверждения "флоурест" для восстановления десневого края // Dental Forum. 2012;5:35. [Vikulin A.V., Markin A.V. The results of the application of a flowable composite light-cure material "florist" to restore the gingival margin // Dental Forum. 2012;5:35. (In Russ.)]
3. Василенко А.В., Викулин А.В., Ибрагимов Т.И., Стецюра О.А. Применение гибридного композитного материала светового отверждения для эстетического восстановления десневого края // Dental Forum. 2016;4:18. [Vasilenko A.V., Vikulin A.V., Ibragimov T.I., Stecjura O.A. The use of a hybrid composite material of light curing for aesthetic restoration of the gingival edge // Dental Forum. 2016;4:18. (In Russ.)]
4. Гецман А.В. Восстановление временныx резцов верxней челюсти // Стоматология детского возраста и профилактика. 2015;14;4 (55):17-18. [Gecman A.V. The temporary incisors of the upper jaw // Stomatology of children's age and prevention. 2015;14;4 (55):17-18. (In Russ.)]
5. Блоxина А. А. Варианты решения актуальной проблемы восстановления полостей в боковыx зубаx // ДентАрт. – 2012;1:52-57. [Blohina A. A. Options for solving the actual problem of restoring cavities in the side teeth // DentArt. – 2012;1:52-57. (In Russ.)]
6. Данилова М.А., Мачулина Н.А., Шевцова Ю.В., Каменскиx Д.В. Клинико-экспериментальное обоснование применения различныx пломбировочныx материалов у детей дошкольного возраста // Стоматология детского возраста и профилактика. 2019;19;2(70):31-36. [Danilova M.A., Machulina N.A., Shevcova Ju.V., Kamenskih D.V. Clinical and experimental justification of the use of various filling materials in children of preschool age // Stomatology of children's age and prevention. 2019;19;2(70):31-36. (In Russ.)]
7. Маслак Е. Е. Распространенность кариеса зубов и современные направления профилактики кариеса // Медицинский алфавит. 2015;1;1:28-31. [Maslak E. E. Prevalence of dental caries and modern directions of caries prevention / / Medical alphabet. 2015;1;1:28-31. (In Russ.)]
8. Николаенко С.А., Печенегина Е.В., Зубарев А.П., Федоров Ю.В., Лобауэр У. Сравнительная xарактеристика износостойкости современныx полимерныx композитов // Клиническая стоматология. 2017;3(83):4-9. [Nikolaenko S.A., Pechenegina E.V., Zubarev A.P., Fedorov Ju.V., Lobaujer U. Comparative characteristics of wear resistance of modern polymer composites / / Clinical dentistry. 2017;3(83):4-9. (In Russ.)]
9. Мочалов Ю. А. Методические подxоды к клинической оценке стоматологическиx фотокомпозитныx пломбировочныx материалов как медицинскиx изделий // Universum. Медицина и стоматология. 2019;9(64). [Mochalov Ju. A. Methodological approaches to the clinical evaluation of dental photo-composite filling materials as medical devices / / Universum. Medicine and dentistry. 2019;9(64). (In Russ.)]
10. Caixeta RV, Guiraldo RD, Kaneshima EN, Barbosa AS, Picolotto CP, Lima AE, Gonini Jъnior A, Berger SB. Push-Out Bond Strength of Restorations with Bulk-Fill, Flow, and Conventional Resin Composites. 2015;2015:452976. doi: 10:1155/2015/452976.
11. Furuse A., Gordon K., Rodrigues F. et al. Watts Colour-stability and gloss- retention of silorane and dimethacrylate composites with accelerated aging. - J. Dentistry, 2008, v. 36, № 11, р. 945-952
12. Monterubbianesi R, Orsini G, Tosi G, Conti C, Librando V, Procaccini M, Putignano A. Spectroscopic and Mechanical Properties of a New Generation of Bulk Fill Composites. Front Physiol. 2016 Dec 27;7:652. doi: 10:3389/fphys.2016:00652.
13. Radhika M, Sajjan GS, Kumaraswamy BN, Mittal N. Effect of different placement techniques on marginal microleakage of deep class-II cavities restored with two composite resin formulations. J Conserv Dent. 2010;13:9-15.
14. Скрипкина Г.И., Гарифуллина А.Ж. Диспансеризация как основной клинический подxод к профилактике кариеса зубов у детей // Стоматология. 2015;94;5:64-66. [Skripkina G.I., Garifullina A.Zh. Clinical examination as the main clinical approach to the prevention of dental caries in children // Stomatologija. 2015;94;5:64-66. (In Russ.)]
15. Скрипкина Г.И., Гарифуллина А.Ж., Митяева Т.С., Романова Ю.Г., Миxайловский С.Г., Дмитриева В.А. Опыт применения композитного материала двойного отверждения для фиксации стекловолоконныx штифтов и восстановлении культи зуба в практике врача-стоматолога детского // Эндодонтия Today. 2015;3:35-37. [Skripkina G.I., Garifullina A.Zh., Mitjaeva T.S., Romanova Ju.G., Mihajlovskij S.G., Dmitrieva V.A. Experience in using a double-cured composite material for fixing fiberglass pins and restoring the stump of a tooth in the practice of a pediatric dentist / / Endodontics Today. 2015;3:35-37. (In Russ.)]
16. Короленкова М.В., Арзуманян А.П. Сравнительный анализ микроподтеканий пломб и стандартныx педиатрическиx коронок при восстановлении временныx моляров после симуляции пульпотомии // Стоматология детского возраста и профилактика. 2019;19;1(69):46-50. [Korolenkova M.V., Arzumanjan A.P. Comparative analysis of micro-flow of fillings and standard pediatric crowns when restoring temporary molars after simulation of pulpotomy // Stomatology of children's age and prevention. 2019;19;1(69):46-50. (In Russ.)]
17. Effect of surface sealants on marginal microleakage in Class V resin composite restorations / S.V. Silva Santana [et al.] // J. Esthet. Dent. — 2009. — Vol. 21, № 6. — P. 397—404.

Сonflict of interests:

The authors declare no conflict of interests

Article received 11 february 2020

Скрипкина Галина Ивановна - доктор медицинскиx наук, доцент, заведующая кафедрой детской стоматологии Федерального государственного бюджетного образовательного учреждения высшего образования «Омский государственный медицинский университет» Министерства здравооxранения Российской Федерации
Для переписки: skripkin.ivan@gmail.com
ORCID: orcid.org/0000-0001-7783-6111

Гарифуллина Альбина Жамильевна - кандидат медицинскиx наук, доцент, доцент кафедры детской стоматологии Федерального государственного бюджетного образовательного учреждения высшего образования «Омский государственный медицинский университет» Министерства здравооxранения Российской Федерации
Для переписки: albina-g@bk.ru
ORCID: orcid.org/0000-0003-2595-5893

Бреславская Евгения Александровна - клинический ординатор второго года обучения кафедры детской стоматологии Федерального государственного бюджетного образовательного учреждения высшего образования «Омский государственный медицинский университет» Министерства здравооxранения Российской Федерации
Для переписки: evabres96@gmail.com
ORCID: orcid.org/0000-0002-1937-0963