European Journal of Prosthodontics and Restorative Dentistry

Clinical Performance of Nanofilled and Microhybrid Direct Composite Restorations on Endodontically Treated Teeth


European Journal of Prosthodontics and Restorative Dentistry (2019) 27, 39–47

Clinical Trial
Resin composite
Aged Restorations
Endodontically Treated Tooth




This study evaluated the clinical performance of direct restorations made of nanofilled
and microhybrid resin composites in endodontically treated teeth. Twenty patients (11
males, 9 females; mean age: 34.2±10) that met the inclusion criteria received a total
of 48 restorations. After employing etch-and-rinse adhesive system, one dentist placed
all restorations using either a nanofilled (Filtek Ultimate) or microhybrid (Filtek Z250)
resin composite. The restorations were clinically reviewed at baseline, 6 months, and
up to 2 years using the modified United States Public Health Service (USPHS) criteria.
The changes were analyzed using the McNemar test and marginal homogeneity tests
(p<0.05). The mean observation period was 17.4 months. With respect to color match,
marginal adaptation, secondary caries, and surface texture, no significant differences
were found between the two restorative materials (p>0.05). Most restorations yielded
alpha or bravo scores with respect to the evaluation criteria. Five restorations failed due
to chipping up to 2 years (1 microhybrid at 6 m, and 3 at 2 years; 1 nanofilled at 2 y) and
were repaired. One complete replacement and one extraction due to endodontic complications were needed for 2 microhybrid resin group at 2 years.

Dr. Tugba Toz Akalın *
(DDS, PhD)

Dr. Funda Öztürk Bozkurt *
(DDS, PhD)

Dr. Aysun Kara Tuncer ^


(DDS, PhD)

Dr. Harika Gözükara Bağ †

Prof. Dr. Mutlu Özcan Δ

Address for Correspondence


Dr. Tugba Toz Akalın *


(DDS, Dr.Med.Dent, PhD)

Email: [email protected]



* Istanbul Medipol University, Department of
Restorative Dentistry, School of Dentistry,
Istanbul, Turkey

^ Bezmialem University, School Of Dentistry,
Department of Endodontics, Istanbul, Turkey
Inonu University, School of Medicine,
Department of Biostatistics, Malatya, Turkey

University of Zurich, Dental Materials Unit,
Center for Dental and Oral Medicine, Clinic for
Fixed and Removable Prosthodontics and Dental
Materials Science, Zurich, Switzerland




Clinical Performance
of Nanofilled and
Microhybrid Direct
Composite Restorations on
Endodontically Treated Teeth

Received: 02.01.2019
Accepted: 11.01.2019
doi: 10.1922/EJPRD_01638Akalin09

The selection of direct versus indirect restorations involves aesthetic, economic, mechanical, and anatomical considerations with respect to the restorative materials and the amount of remaining tooth structure.1 The process
of choosing the most suitable restoration for endodontically treated teeth is
important as such teeth are highly susceptible to fractures.2 Endodontically
treated teeth are weak due to loss of structure and as a consequence of restorative and endodontic procedures and/or caries.3 Helfer et al. reported
that endodontic treatment causes biological changes, rendering treated teeth
more susceptible to failure.4 However, other studies found no significant difference in moisture content and claimed that endodontic procedures do not
impair tooth strength.5,6 Current adhesive technologies enable restorations
without posts in many clinical situations that do not further weaken endodontically treated teeth.2
The loss of tooth vitality and structure after endodontic treatment has been
viewed as an issue for crown placement.7,8 Today, direct restorations are preferred as a basic treatment protocol for the replacement of lost tooth structure.

• • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • - Published by Dennis Barber Journals.


Copyright ©2019 by Dennis Barber Ltd. All rights reserved.


Dr. Tugba Toz Akalın, Dr. Funda Öztürk Bozkurt, Dr. Aysun Kara Tuncer, Dr. Harika Gözükara Bağ, Prof. Dr. Mutlu Özcan

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