White Paper Bio-tribo corrosion study of Filtek™ Supreme Universal Restorative and Z100™ Restorative

in vitro and in vivo

Professor Paul Lambrechts and colleaguesKatholieke University of Leuven, Belgium

Five-year clinical data on Filtek Supreme Universal Restorative and Z100 Restorative

This study is of special interest because Filtek

Supreme restorative and Z100 restorative were

evaluated both qualitatively (USPHS criteria) and

quantitatively (3D laser-scanned images) for

clinical performance over a significant time period.

Fillings were placed in 37 molar teeth in 16 adult

patients. All restorations were placed under

rubber dam using Adper™ Single Bond (Adper™

Scotchbond™ 1) Dental Adhesive. Baseline data

were recorded and recalls were carried out

at six months and annually for five years. The

restorations were evaluated by two calibrated

examiners using modified USPHS criteria.

At baseline and at each recall, the study

restorations were photographed and

impressions were taken using individualized

custom trays for replica models. The replicas

were scanned three-dimensionally using laser

profilometry with an accuracy of 5 micrometers.

The resulting images were superimposed and

each recall image was digitally subtracted from

baseline using specially developed software.

Based on the blue articulation marks

photographed at baseline and each recall, the

wear facets could be identified on the different

images. The volume loss across the occlusal

surface of the restoration and the occlusal

enamel; the vertical height loss for each

study tooth and restoration surface; and the

differential wear relative to enamel, were

all measured.

The microwear features of the restorations were

also evaluated using SEM.

IntroductionProfessor Paul Lambrechts and coworkers have completed a five-year clinical study on

Filtek™ Supreme Universal Restorative and Z100™ Restorative. The study evaluated both the clinical

performance of Filtek Supreme and Z100 restoratives in Class I and II restorations, and compared the

bio-tribo wear rates of the restorations with that of enamel. Bio-tribo wear is a combination of corrosive

wear (erosion) and mechanical wear (attrition, abrasion, abfraction and fatigue).

2.

Results—Clinical evaluation

Table 1 shows the percent Alpha clinical

evaluation scores over the five-year time frame.

One restoration (Filtek™ Supreme Universal

Restorative) was lost to the study as the patient

decided to have a crown; otherwise, there was

100% recall throughout the study period.

No restorations fractured during the study,

however, some occasional minor chipping at

the marginal ridge area was seen for both

Filtek Supreme restorative and Z100 restorative.

There was no statistically significant difference

between Filtek Supreme restorative and Z100

restorative for anatomic form, secondary

caries, color match, margin adaptation, surface

staining, proximal contact or post-operative

sensitivity (p>0.05) throughout the study

duration. From baseline onwards, however,

Filtek Supreme restorative was statistically

significantly better than Z100 restorative for

polish retention (p<0.05).

Apart from the one request for a crown, no

restorations needed replacing during the study.

One restoration was repaired after endodontic

treatment, and one restoration had a chipping

defect repaired. Both these restorations were

kept in the study.

3.

White Paper Bio-tribo corrosion study of Filtek™ Supreme Universal Restorative and Z100™ Restorative

Table 1. Percent Alpha scores over time.

Baseline 1 year 2 years 3 years 5 years Filtek Filtek Filtek Filtek Filtek Supreme Z100 Supreme Z100 Supreme Z100 Supreme Z100 Supreme Z100

Anatomic form 100% 100% 94% 95% 94% 100% 100% 100% 94% 100%

Color match 83% 79% 83% 74% 78% 68% 76% 68% 82% 74%

Polish retention 56% 11% 56% 11% 72% 11% 82% 47% 88% 42%

Surface stain 94% 89% 100% 100% 89% 89% 88% 89% 88% 95%

Margin adaptation 94% 100% 78% 79% 50% 68% 53% 68% 71% 68%

Proximal contact 94% 89% 94% 89% 94% 89% 94% 89% 94% 89%

Secondary caries 100% 100% 100% 100% 100% 100% 100% 100% 94% 95%

Results -Material loss

The mean volume loss across the occlusal

surface of the restoration and the occlusal

enamel gave an indication of the overall wear

value or contact-free area bio-tribo corrosion

wear (Table 2). There was no statistically

significant difference in volume loss

between Filtek Supreme restorative and

Z100 restorative up to four years of the

study. At five years, Z100 restorative showed

a notably greater volume loss than Filtek

Supreme restorative, however there was no

statistically significant difference between

volume loss of Filtek Supreme restorative

and enamel at four and five years (p<0.05).

The vertical loss of enamel and composite

at the wear facets (marked with articulating

paper) was also measured (Table 3, next page).

4.

0.0

Table 2. Mean surface volume loss over time (mm3)

Baseline 6 months 12 months 24 months 36 months 48 months 60 months

Time

0.5

-0.5

-1

-1.5

-2.5

-2

-3

Z100 Filtek Supreme Enamel

Baseline

Case 1

5 Years 5 Years

Baseline

Case 2

5 Years

Baseline

Filtek™ Supreme Universal Restorative—5-Year Study Clinical Photos Case 3

Table 2: Mean surface volume loss over time (mm3)

Clinical photos courtesy of Professor Paul Lambrechts and colleagues

Case 4

5.

The vertical loss indicated the amount of

occlusal contact area wear. The largest amount

of vertical loss in the restorations occurred

between baseline and six months. This reflected

a “running-in” wear period for the composites

while the occlusion was readjusting after

restoration placement. There was no statistically

significant difference in the mean vertical loss

(occlusal contact area wear) between Filtek

Supreme restorative, Z100 restorative and

enamel at five years.

The SEM evaluation of surface microwear

showed a rougher surface for Z100 restorative

compared with Filtek Supreme restorative

(Fig. 1).

The researchers commented on the enamel-

like wear of both Filtek Supreme restorative

and Z100 restorative as being a very desirable

feature in a composite.

Fig. 1: Material specific microwear

Some micro-cracks visible.

Filtek Supreme Z100

Filtek Supre m e

Some micro -cracks visible

Z100

Some filler pluck-out & craters

Fig. 1 Material specific microwear

Filtek™ Supreme Universal Restorative

Some filler pluck-out and craters.

Filtek Supreme Z100

Filtek Supre m e

Some micro -cracks visible

Z100

Some filler pluck-out & craters

Fig. 1 Material specific microwear

Z100™ RestorativeZ100™ RestorativeZ100™ RestorativeZ100™ RestorativeZ100™ Restorative

Case 5

5 Years

Baseline

5 Years

Baseline

Case 6

5 Years

Baseline

Table 3. Mean vertical loss over time (micron)

Baseline 6 months 12 months 24 months 36 months 60 months

Time

0

-20

Z100 Filtek Supreme Enamel

-40

-60

-80

-100

-120Table 3: Mean vertical loss over time (micron)

Z100™ Restorative—5-Year Study Clinical Photos

White Paper Bio-tribo corrosion study of Filtek™ Supreme Universal Restorative and Z100™ Restorative

© 3M ESPE 2009. All rights reserved. 3M, ESPE, Adper, Filtek, Scotchbond and Z100 are trademarks of 3M or 3M ESPE AG. Used under license in Canada.

Conclusions

Filtek™ Supreme Universal Restorative and Z100™ Restorative both showed acceptable clinical

performance over five years in Class I and II restorations in molar teeth. Filtek Supreme restorative

had notably better surface polish retention than Z100 restorative—and Filtek Supreme restorative

showed better color stability and surface texture.

Wear rates measured quantitatively for Filtek Supreme restorative, Z100 restorative and enamel,

showed both composites to be equivalent to enamel for wear at the occlusal contact area at five

years. For generalized occlusal surface wear (mean volume loss) Filtek Supreme restorative

was not statistically different than enamel throughout the five years of the study.

According to these study results both Filtek Supreme restorative and Z100 restorative show

enamel-like wear over the long term.