Clinical evaluation of class II restorations using direct fiber-reinforced composite

Objectives: evaluating the clinical performance of class II fiber-reinforced direct composite restorations on devital teeth. Materials and methods: Thirty (30) patients 18 years or older were included in this clinical trial restoring 35 molar teeth. Inclusion criteria: two to four surface restorations, replacement of composite and amalgam fillings associated with periapical lesions, virgin teeth with decay reaching the pulp; only teeth having root canal fillings terminating 0-2 mm from the radiographic apex and having homogeneous root fillings were included. Teeth with residual cavity walls less than 1 mm or with complete loss of the clinical crown were excluded. Teeth were restored using a combination of Ultra etch 35% phosphoric acid, PQ1 adhesive system and Vit-l-escence microhybrid composite resin (Ultradent, South Jordan, UT). The enamel peripheral skeleton of the restoration was built-up first; a resin impregnated polyethylene ribbon fiber piece (Ribbond Triaxial, Seattle WA) was covered with B1 Perma-Flo flowable composite (Ultradent), placed into a prepared canal, folded and light cured (Deliperi et al, 2005); then, dentin and enamel occlusal surface stratification was completed. Results: All 35 restorations were evaluated at 6 month intervals during the 1 year period using a modified USPHS criteria by two independent evaluators pre-calibrated at 85% reliability. No failure was reported and alpha scores were recorded for all parameters. Before starting the treatment, 26 out of 35 teeth (74%) had apical periodontitis as diagnosed radiographically. At the one year recall, no sign of periapical lesion were detected and X-Rays reported neither periodontal ligament widening or periapical radiolucency. Conclusion: direct fiber reinforced composite resins demonstrated excellent clinical performance after 1 year.