Clinical evaluation of the composite fillings with the inserts

Objective: Technique which reduce the polymerization shrinkage by decreasing the total quantity of resin to be cured and limit marginal microleakage is the use of composite inserts. The purpose of this clinical study was to assess the quality of composite fillings applied with the conventional or the inserting method. Methods: 295 composite fillings were made in class I and II defects in 117 patients. The defects were prepared applying protocols used for adhesive systems. Two microhybrid composite materials were used: Filtek Z250 (3MESPE) and Gradia (GC) with the conventional or the inserting method. In both methods the Single Bond adhesive (3MESPE) was applied strictly according to manufacturer's instruction. The fillings were assessed using the USPHS scale with modification according to van Dijken. Results: The percentage of clinically accepted fillings throughout the entire study period, irrespectively of materials used, class of defect or filling method, was 95,4% after 12 months and 94% after 24 months. Depending on the filling method – with or without inserts – the results were 97,66% and 90,97% respectively (p = 0,001). 17 failures were observed (6%). Neither total loss of fillings nor pulpitis in teeth with vital pulp were observed. The quality of fillings made with the inserts was significantly higher compared to the conventional one, irrespectively of materials used or class of defect. The post-treatment sensitivity was significantly lower when the fillings in class II defects were made with the Gradia and inserting method, compared to the conventional method (p = 0,035). The type of tooth, depth of defect or pulp vitality didn't influence the quality of assessed fillings. Conclusions: Based on the conducted clinical study with the observation period of 24 months it can be concluded that the quality of fillings made with the inserting method was superior to fillings made with the conventional method.