Eine klinisch-prospektive Studie zu Klasse-II-Kompositfüllungen in Bulk- versus Inkrementtechnik – Resultate nach neun Jahren

The objective of this prospective clinical trial was to evaluate the long-term clinical behavior of the sonically activated bulk-fill composite SonicFill in comparison to the conventional resin composite Herculite XRV Ultra after nine years of clinical service. Al-though SonicFill represents an exceptional pathway in the group of bulk-fill com-posites due to its ultrasound-activated application, only a few studies with an inves-tigation period longer of > 2 years are available so far. Follow-up examinations were carried out at baseline, after 12 months and after nine years using the FDI criteria according to Hickel et al. by an experienced examiner. In 2011 forty three patients (mean age 48.9 years) received 118 direct composite restorations in a split-mouth design (SF: n=64, HU: n=54). The restorations were placed by three experienced dentists in two private dental practices. OptibondFL was used in etch&rinse mode for all restorations. SonicFill was applied in a single increment of maximum 5mm and light cured for 40 s. With Herculite XRV Ultra, con-ventional layering was performed in 2mm increments having been light cured 40 s per layer. The statistical evaluation was carried out with SPSS using Mann-Whitney U and the Friedman tests. After nine years, 57 restorations (SF: n=32, HU: n=25) were examined in 23 patients, the recall rate was 48.3%. After 12 months three restorations in each group had to be replaced. Overall after nine years there were 8 failures in the SonicFill group and 5 in the Herculite group. Regarding failure rates, no significant difference between the two material groups could be determined (p=0.093). Both groups showed significant deterioration (p<0.05) regarding the following criteria: Surface gloss and pores, surface discoloration, marginal discoloration, color match and translucency, marginal fracture, marginal gap, marginal defect, and tooth integrity. In the Herculite group, there was also a significant deterioration in materi-al fractures and retention. Despite the deterioration, all restorations showed an overall good clinical performance. At baseline, compared to the SonicFill group, statistically significantly better values were found in the Herculite group with regard to color matching and translu-cency (p<0.05). In addition, Herculite XRV Ultra showed significantly better values in terms of tooth integrity than the SonicFill group in the 12-month recall. After nine years there were statistically significantly better values in the Herculite group for marginal quality (marginal discoloration, fracture, gap, defects) and in the SonicFill group for surface discoloration. Patient satisfaction was 100% throughout the clini-cal trial. Both the bulk-fill composite SonicFill and the incremental composite Herculite XRV Ultra showed a good clinical performance after nine years of clinical service. Con-cerning the failure rates, no significant difference was found between groups. Hercu-lite XRV Ultra showed significantly better results for marginal quality after nine years. Nevertheless, the long-term clinical behavior of both materials can be rated as good and comparable. Since only a few clinical long-term data for the assessment of bulk-fill composites, especially SonicFill, are available so far, further investigations of bulk-fill composite restorations should be followed up by long-term clinical trials in particular.